Grady Health System,,,,,,,,,,,,,,,,,,,,,,,,
No Cash Disounts ,,,,,,,,,,,,,,,,,,,,,,,,
Procedure,Code Type,Code,NDC,Procedure Description,Charge, Payor Rate Min,PayorRate Max ,Aetna/Coventry Exp Reimbursement,Anthem Exp Reimbursement,Ambetter  Exp Reimbursement ,Amerigroup Exp Reiembursement,BCBS HMO/POS Exp Reimbursement,BCBS PPO Exp Reimbursement,Caresource Exp Reimbursement,Cigna Exp Reimbursement,Eon Health Exp Reimbursement,Humana Exp Reimbursement,Kaiser Exp Reimbursement,Multiplan Exp Reimbursement,NaphCare/USP Exp Reimbursement,Peachstate Exp Reimbursement,Tricare/Veteran's Choice Exp Reimbursement,Wellcare Medicaid Exp Reimbursement,Wellcare Medicare Exp Reimbusrement 
MS003,MS-DRG V38 (FY2021),MS003,,"ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES","$914,459.44","$136,503.65","$573,019.79","$413,995.33",,"$144,385.53","$144,385.53","$450,985.30","$450,985.30","$194,687.78","$382,149.53","$136,503.65","$413,995.33","$504,437.36","$573,019.79","$182,532.67","$185,417.02","$167,931.68","$136,503.65","$194,687.78"
MS004,MS-DRG V38 (FY2021),MS004,,"TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES","$636,206.74",$0.00,"$500,611.30","$410,855.25",,"$96,873.63","$96,873.63",$0.00,$0.00,"$36,289.36","$379,251.00","$112,641.38","$410,855.25","$500,611.30",$0.00,"$134,386.24","$32,473.86","$147,233.83","$107,277.50","$34,561.30"
MS011,MS-DRG V38 (FY2021),MS011,,"TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC","$339,454.04",$0.00,"$53,518.70",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$47,587.29",$0.00,$0.00,$0.00,$0.00,$0.00,"$53,518.70","$45,321.23",$0.00
MS012,MS-DRG V38 (FY2021),MS012,,"TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC","$550,694.70",$0.00,"$131,299.98",$0.00,,$0.00,$0.00,$0.00,$0.00,"$131,299.98",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$112,717.74","$124,172.81",$0.00,"$40,861.37"
MS013,MS-DRG V38 (FY2021),MS013,,"TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC","$297,166.67",$0.00,"$28,929.99",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$28,929.99",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$28,929.99",$0.00
MS020,MS-DRG V38 (FY2021),MS020,,INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC,"$582,619.91",$0.00,"$461,392.05","$376,724.33",,"$138,618.42","$138,618.42","$395,862.19","$395,862.19",$0.00,"$349,539.44","$87,750.60","$378,667.73","$461,392.05",$0.00,"$121,357.54",$0.00,"$101,514.63","$83,572.00",$0.00
MS021,MS-DRG V38 (FY2021),MS021,,INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC,"$583,001.67",$0.00,"$583,001.67","$473,012.79",,"$63,868.06","$63,868.06","$208,069.92","$208,069.92",$0.00,"$441,667.93",$0.00,"$478,473.59","$583,001.67",$0.00,"$152,156.12",$0.00,"$91,625.03",$0.00,$0.00
MS022,MS-DRG V38 (FY2021),MS022,,INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC,"$234,328.10",$0.00,"$95,010.54",$0.00,,$0.00,$0.00,$0.00,$0.00,"$40,476.72",$0.00,"$95,010.54",$0.00,$0.00,$0.00,$0.00,"$38,549.28",$0.00,"$90,486.22","$40,476.72"
MS023,MS-DRG V38 (FY2021),MS023,,CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR,"$196,525.14","$47,251.92","$139,066.20","$105,398.91",,"$47,251.92","$47,251.92","$139,066.20","$139,066.20","$55,770.42","$97,291.30","$52,188.44","$105,398.91","$128,424.52","$123,922.26","$56,307.53","$53,114.71","$59,017.16","$49,703.28","$55,770.42"
MS024,MS-DRG V38 (FY2021),MS024,,CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC,"$130,486.04",$0.00,"$86,190.36","$65,614.02",,"$33,436.68","$33,436.68","$12,087.95","$12,278.79",$0.00,"$60,566.78","$41,250.33","$33,522.62","$79,948.14","$86,190.36","$40,262.62",$0.00,"$45,945.91","$39,286.03",$0.00
MS025,MS-DRG V38 (FY2021),MS025,,CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC,"$267,381.34",$0.00,"$202,785.63","$142,062.50",,"$43,989.27","$43,989.27","$202,785.63","$202,785.63",$0.00,"$141,483.39","$43,833.50","$153,273.67","$186,758.08","$99,788.97","$44,051.81",$0.00,"$49,032.85","$41,746.19",$0.00
MS026,MS-DRG V38 (FY2021),MS026,,CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC,"$193,601.20",$0.00,"$38,018.73",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$38,018.73",$0.00,$0.00
MS027,MS-DRG V38 (FY2021),MS027,,CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC,"$232,805.15",$0.00,"$232,805.15","$186,530.70",,"$50,036.05","$50,036.05","$6,278.59","$6,691.99",$0.00,"$176,367.53","$30,181.04","$191,064.82","$232,805.15","$82,819.30","$36,977.13",$0.00,"$32,717.89","$28,743.85",$0.00
MS028,MS-DRG V38 (FY2021),MS028,,SPINAL PROCEDURES WITH MCC,"$347,500.96",$0.00,"$171,853.56","$129,721.09",,"$48,170.38","$48,170.38","$118,180.23","$118,180.23",$0.00,"$130,192.10","$52,005.99","$141,041.44","$171,853.56",$0.00,"$56,039.87",$0.00,"$58,799.12","$49,529.51",$0.00
MS029,MS-DRG V38 (FY2021),MS029,,SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS,"$235,720.44",$0.00,"$229,583.19",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$35,718.41",$0.00,$0.00,"$229,583.19",$0.00,$0.00,"$39,335.16","$34,017.53",$0.00
MS030,MS-DRG V38 (FY2021),MS030,,SPINAL PROCEDURES WITHOUT CC/MCC,"$272,147.33",$0.00,"$29,329.56",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$29,329.56",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$27,932.91",$0.00
MS031,MS-DRG V38 (FY2021),MS031,,VENTRICULAR SHUNT PROCEDURES WITH MCC,"$137,706.89",$0.00,"$59,024.65",$0.00,,$0.00,$0.00,$0.00,$0.00,"$27,366.98",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$22,834.72","$59,024.65",$0.00,"$23,976.45"
MS032,MS-DRG V38 (FY2021),MS032,,VENTRICULAR SHUNT PROCEDURES WITH CC,"$70,263.73",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS033,MS-DRG V38 (FY2021),MS033,,VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC,"$165,469.13",$0.00,"$12,635.25",$0.00,,$0.00,$0.00,$0.00,$0.00,"$12,635.25",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$12,033.57",$0.00,$0.00,"$12,635.25"
MS034,MS-DRG V38 (FY2021),MS034,,CAROTID ARTERY STENT PROCEDURES WITH MCC,"$188,053.13",$0.00,"$43,799.77",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$43,799.77",$0.00,$0.00
MS035,MS-DRG V38 (FY2021),MS035,,CAROTID ARTERY STENT PROCEDURES WITH CC,"$139,030.64",$0.00,"$58,140.79",$0.00,,$0.00,$0.00,"$58,140.79","$58,140.79",$0.00,$0.00,"$29,535.25",$0.00,$0.00,$0.00,$0.00,$0.00,"$31,946.16","$28,128.81",$0.00
MS036,MS-DRG V38 (FY2021),MS036,,CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC,"$108,107.37",$0.00,"$11,686.15",$0.00,,$0.00,$0.00,"$11,686.15","$11,686.15",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS037,MS-DRG V38 (FY2021),MS037,,EXTRACRANIAL PROCEDURES WITH MCC,"$165,872.04",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS038,MS-DRG V38 (FY2021),MS038,,EXTRACRANIAL PROCEDURES WITH CC,"$149,444.40",$0.00,"$26,825.78",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$26,825.78",$0.00,$0.00
MS039,MS-DRG V38 (FY2021),MS039,,EXTRACRANIAL PROCEDURES WITHOUT CC/MCC,"$67,509.02",$0.00,"$53,458.66","$6,097.75",,"$9,445.21","$9,445.21",$0.00,$0.00,$0.00,"$15,555.38",$0.00,"$43,873.91","$53,458.66",$0.00,"$11,340.50",$0.00,"$22,384.03",$0.00,$0.00
MS040,MS-DRG V38 (FY2021),MS040,,"PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC","$191,287.99",$0.00,"$120,959.00","$96,599.08",,"$33,882.07","$33,882.07",$0.00,$0.00,"$28,186.61","$91,635.60","$40,730.30","$99,271.90","$120,959.00",$0.00,"$39,499.78","$26,844.41","$45,324.46","$38,790.76","$28,186.61"
MS041,MS-DRG V38 (FY2021),MS041,,"PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR","$107,464.72",$0.00,"$72,242.00","$10,458.90",,"$18,982.35","$18,982.35",$0.00,$0.00,"$27,464.00","$32,608.13","$30,008.81","$6,724.57","$72,242.00",$0.00,"$23,772.63","$26,156.21","$32,512.09","$28,579.82","$27,464.00"
MS042,MS-DRG V38 (FY2021),MS042,,"PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC","$125,934.52",$0.00,"$125,934.52",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$125,934.52",$0.00,$0.00,$0.00,$0.00,$0.00
MS052,MS-DRG V38 (FY2021),MS052,,SPINAL DISORDERS AND INJURIES WITH CC/MCC,"$167,513.45",$0.00,"$167,513.45","$69,148.53",,"$14,114.26","$14,114.26","$167,513.45","$167,513.45",$0.00,"$63,079.81","$24,934.09","$68,336.46","$83,265.35",$0.00,"$16,328.58",$0.00,"$26,447.68","$23,746.75",$0.00
MS053,MS-DRG V38 (FY2021),MS053,,SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC,"$51,551.25",$0.00,"$12,615.31",$0.00,,$0.00,$0.00,"$12,615.31","$12,615.31",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS054,MS-DRG V38 (FY2021),MS054,,NERVOUS SYSTEM NEOPLASMS WITH MCC,"$69,785.83",$0.00,"$32,180.45","$19,352.55",,"$11,646.29","$11,646.29","$2,686.98","$3,100.38","$16,209.33","$18,426.38","$22,960.49","$15,497.86","$32,180.45",$0.00,"$13,433.57","$16,209.33","$24,089.19","$21,867.13","$16,209.33"
MS055,MS-DRG V38 (FY2021),MS055,,NERVOUS SYSTEM NEOPLASMS WITHOUT MCC,"$36,800.05",$0.00,"$20,540.66",$0.00,,$0.00,$0.00,$0.00,$0.00,"$12,918.59",$0.00,"$20,540.66",$0.00,$0.00,$0.00,$0.00,"$12,303.42",$0.00,"$19,562.53","$12,918.59"
MS056,MS-DRG V38 (FY2021),MS056,,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC,"$61,925.61",$0.00,"$51,366.19",$0.00,,$0.00,$0.00,"$50,952.79","$51,366.19","$4,348.77",$0.00,"$28,784.91",$0.00,$0.00,$0.00,$0.00,"$3,891.53","$31,049.49","$27,414.20","$4,141.69"
MS057,MS-DRG V38 (FY2021),MS057,,DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC,"$41,960.94",$0.00,"$20,335.16","$11,753.32",,"$9,014.09","$9,014.09",$0.00,$0.00,$0.00,"$16,648.50","$20,335.16","$9,564.24","$17,411.42",$0.00,"$12,137.42",$0.00,"$18,349.35","$19,366.82",$0.00
MS058,MS-DRG V38 (FY2021),MS058,,MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC,"$63,152.87",$0.00,"$35,850.39","$7,413.00",,"$14,581.07","$14,581.07","$8,998.30","$9,189.14",$0.00,"$30,877.13",$0.00,"$8,006.13","$27,593.07",$0.00,"$19,594.52",$0.00,"$35,850.39",$0.00,$0.00
MS059,MS-DRG V38 (FY2021),MS059,,MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC,"$56,177.75",$0.00,"$33,948.36","$22,239.00",,"$9,184.58","$9,184.58","$5,373.96","$6,200.76",$0.00,"$18,994.38","$21,254.77","$16,079.42","$33,948.36",$0.00,"$10,931.50",$0.00,"$22,050.83","$20,242.64",$0.00
MS060,MS-DRG V38 (FY2021),MS060,,MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC,"$53,943.97",$0.00,"$10,125.78",$0.00,,$0.00,$0.00,"$10,125.78","$10,125.78",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS061,MS-DRG V38 (FY2021),MS061,,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC","$215,011.32",$0.00,"$215,011.32","$172,150.80",,"$46,621.97","$46,621.97",$0.00,$0.00,$0.00,"$162,887.36","$32,892.67","$176,461.31","$215,011.32",$0.00,"$32,518.99",$0.00,"$35,958.33","$31,326.35",$0.00
MS062,MS-DRG V38 (FY2021),MS062,,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC","$93,269.56",$0.00,"$73,869.50","$10,294.20",,"$16,561.69","$16,561.69","$15,389.95","$15,580.79",$0.00,"$27,654.00","$27,546.62","$15,607.97","$73,869.50",$0.00,"$20,160.87",$0.00,"$29,569.72","$26,234.88",$0.00
MS063,MS-DRG V38 (FY2021),MS063,,"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC","$63,603.89",$0.00,"$50,374.27","$16,777.32",,"$13,476.07","$13,476.07",$0.00,$0.00,$0.00,"$23,111.00",$0.00,"$18,358.07","$50,374.27",$0.00,"$16,848.86",$0.00,"$26,871.51",$0.00,$0.00
MS064,MS-DRG V38 (FY2021),MS064,,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC,"$105,704.25",$0.00,"$64,405.47","$27,463.97",,"$15,513.81","$15,513.81","$29,622.92","$32,103.32","$55,740.19","$25,778.50","$26,614.49","$27,643.93","$64,405.47",$0.00,"$18,793.56","$44,500.15","$28,455.79","$25,347.13","$25,793.36"
MS065,MS-DRG V38 (FY2021),MS065,,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS,"$63,356.11",$0.00,"$60,123.35","$30,114.20",,"$9,499.65","$9,499.65","$8,998.30","$9,189.14",$0.00,"$14,130.88","$20,825.64","$15,153.44","$60,123.35","$54,112.55","$10,301.98",$0.00,"$21,537.99","$19,833.94",$0.00
MS066,MS-DRG V38 (FY2021),MS066,,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC,"$50,628.05",$0.00,"$30,837.84","$7,603.42",,"$6,721.07","$6,721.07",$0.00,$0.00,$0.00,"$13,858.75","$18,702.38","$8,810.14","$30,837.84",$0.00,"$7,187.44",$0.00,"$19,000.67","$17,811.79",$0.00
MS067,MS-DRG V38 (FY2021),MS067,,NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC,"$28,316.17",$0.00,"$25,105.11",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$25,105.11",$0.00,$0.00
MS068,MS-DRG V38 (FY2021),MS068,,NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC,"$43,177.97",$0.00,"$20,522.91",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$19,976.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$20,522.91","$19,024.95",$0.00
MS069,MS-DRG V38 (FY2021),MS069,,TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC,"$47,895.12",$0.00,"$19,517.62",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$19,134.97",$0.00,$0.00,$0.00,$0.00,$0.00,"$19,517.62","$18,223.78",$0.00
MS070,MS-DRG V38 (FY2021),MS070,,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH MCC,"$105,870.94",$0.00,"$32,577.11",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$25,234.77",$0.00,$0.00,$0.00,$0.00,$0.00,"$32,577.11","$28,582.72",$0.00
MS071,MS-DRG V38 (FY2021),MS071,,NONSPECIFIC CEREBROVASCULAR DISORDERS WITH CC,"$54,742.86",$0.00,"$35,678.57",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$20,600.14",$0.00,$0.00,"$35,678.57",$0.00,$0.00,"$21,268.52","$19,619.18",$0.00
MS072,MS-DRG V38 (FY2021),MS072,,NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT CC/MCC,"$49,721.87",$0.00,"$18,849.31",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$18,849.31",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$17,951.72",$0.00
MS073,MS-DRG V38 (FY2021),MS073,,CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC,"$38,488.01",$0.00,"$24,705.77",$0.00,,$0.00,$0.00,"$18,808.86","$21,702.66",$0.00,$0.00,"$23,476.45",$0.00,$0.00,$0.00,$0.00,$0.00,"$24,705.77","$22,358.52",$0.00
MS074,MS-DRG V38 (FY2021),MS074,,CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC,"$36,882.23",$0.00,"$36,882.23","$22,239.00",,"$7,896.59","$7,896.59","$5,373.96","$6,200.76","$9,019.34","$13,586.38","$20,555.00","$14,569.53","$36,882.23",$0.00,"$9,905.01","$8,589.85","$21,214.59","$19,576.19","$9,019.34"
MS077,MS-DRG V38 (FY2021),MS077,,HYPERTENSIVE ENCEPHALOPATHY WITH MCC,"$55,799.48",$0.00,"$25,742.09",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$24,343.64",$0.00,$0.00,$0.00,$0.00,$0.00,"$25,742.09","$23,184.42",$0.00
MS078,MS-DRG V38 (FY2021),MS078,,HYPERTENSIVE ENCEPHALOPATHY WITH CC,"$54,922.62",$0.00,"$20,376.67",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$20,376.67",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$19,406.35",$0.00
MS080,MS-DRG V38 (FY2021),MS080,,NONTRAUMATIC STUPOR AND COMA WITH MCC,"$104,177.04",$0.00,"$29,003.98",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$29,003.98",$0.00,$0.00
MS081,MS-DRG V38 (FY2021),MS081,,NONTRAUMATIC STUPOR AND COMA WITHOUT MCC,"$60,660.46",$0.00,"$20,324.45",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$20,324.45",$0.00,$0.00
MS082,MS-DRG V38 (FY2021),MS082,,TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC,"$113,961.07",$0.00,"$73,345.89","$20,548.50",,"$17,085.63","$17,085.63","$32,838.37","$32,838.37",$0.00,"$30,962.25","$29,190.82","$60,195.49","$73,345.89",$0.00,"$22,572.74",$0.00,"$31,534.56","$27,800.78",$0.00
MS083,MS-DRG V38 (FY2021),MS083,,TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC,"$72,409.57",$0.00,"$83,592.12","$65,296.22",,"$11,068.80","$11,068.80","$23,591.33","$23,591.33",$0.00,"$63,327.35","$22,759.59","$68,604.63","$83,592.12",$0.00,"$13,138.85",$0.00,"$23,849.11","$21,675.80",$0.00
MS084,MS-DRG V38 (FY2021),MS084,,TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC,"$90,193.56",$0.00,"$90,193.56","$71,022.52",,"$7,668.99","$7,668.99","$18,103.32","$18,103.32",$0.00,"$68,328.43","$18,985.24","$74,022.47","$90,193.56",$0.00,"$8,994.81",$0.00,"$20,473.08","$18,985.24",$0.00
MS085,MS-DRG V38 (FY2021),MS085,,TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC,"$189,335.99",$0.00,"$189,335.99","$144,070.99",,"$36,753.55","$36,753.55","$102,971.71","$102,971.71","$7,054.97","$143,436.35","$29,149.82","$155,389.38","$189,335.99",$0.00,"$23,840.21","$6,719.03","$39,231.69","$27,761.73","$7,054.97"
MS086,MS-DRG V38 (FY2021),MS086,,TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC,"$156,793.36",$0.00,"$156,793.36","$8,908.52",,"$9,979.86","$9,979.86",$0.00,$0.00,$0.00,"$10,531.72","$22,261.41","$21,878.17","$26,657.70","$156,793.36","$12,408.08",$0.00,"$23,253.77","$21,201.34",$0.00
MS087,MS-DRG V38 (FY2021),MS087,,TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC,"$47,063.05",$0.00,"$54,184.31","$26,334.62",,"$6,658.59","$6,658.59",$0.00,$0.00,"$6,369.44","$11,539.00","$19,537.48","$44,469.44","$54,184.31",$0.00,"$8,412.39","$6,066.14","$19,998.62","$18,607.12","$6,369.44"
MS088,MS-DRG V38 (FY2021),MS088,,CONCUSSION WITH MCC,"$30,525.96",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS089,MS-DRG V38 (FY2021),MS089,,CONCUSSION WITH CC,"$57,874.13",$0.00,"$12,615.31",$0.00,,$0.00,$0.00,"$12,615.31","$12,615.31",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS090,MS-DRG V38 (FY2021),MS090,,CONCUSSION WITHOUT CC/MCC,"$60,183.19",$0.00,"$19,599.65",$0.00,,$0.00,$0.00,"$12,615.31","$12,615.31",$0.00,$0.00,"$19,599.65",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$18,666.33",$0.00
MS091,MS-DRG V38 (FY2021),MS091,,OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC,"$63,998.86",$0.00,"$25,926.64",$0.00,,$0.00,$0.00,"$6,750.52","$6,750.52",$0.00,$0.00,"$24,498.09",$0.00,$0.00,$0.00,$0.00,$0.00,"$25,926.64","$23,331.51",$0.00
MS092,MS-DRG V38 (FY2021),MS092,,OTHER DISORDERS OF NERVOUS SYSTEM WITH CC,"$60,857.94",$0.00,"$60,857.94","$3,911.25",,"$8,023.34","$8,023.34",$0.00,$0.00,$0.00,"$13,283.88","$20,404.67","$3,652.60","$60,857.94",$0.00,"$9,684.47",$0.00,"$21,034.94","$19,433.02",$0.00
MS093,MS-DRG V38 (FY2021),MS093,,OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC,"$29,679.55",$0.00,"$21,343.61","$8,833.50",,"$6,054.32","$6,054.32","$17,402.15","$17,402.15",$0.00,"$10,466.50","$19,004.44","$4,008.53","$21,343.61",$0.00,"$7,630.49",$0.00,"$19,361.64","$18,099.47",$0.00
MS095,MS-DRG V38 (FY2021),MS095,,BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC,"$169,019.44",$0.00,"$2,114.21",$0.00,,$0.00,$0.00,"$2,114.21","$2,114.21",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS097,MS-DRG V38 (FY2021),MS097,,NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC,"$139,074.53",$0.00,"$46,143.44",$0.00,,$0.00,$0.00,"$19,067.63","$20,403.25",$0.00,$0.00,"$38,239.38",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$46,143.44",$0.00
MS098,MS-DRG V38 (FY2021),MS098,,NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC,"$153,058.81",$0.00,"$27,162.57",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$27,162.57",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$25,869.11",$0.00
MS099,MS-DRG V38 (FY2021),MS099,,NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC,"$17,809.68",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS100,MS-DRG V38 (FY2021),MS100,,SEIZURES WITH MCC,"$102,448.60",$0.00,"$127,077.03","$93,899.27",,"$17,698.61","$17,698.61","$98,169.13","$98,264.55",$0.00,"$96,270.47","$26,241.38","$104,293.01","$127,077.03",$0.00,"$18,246.24",$0.00,"$28,009.92","$24,991.79",$0.00
MS101,MS-DRG V38 (FY2021),MS101,,SEIZURES WITHOUT MCC,"$42,510.28","$3,828.93","$30,456.31","$5,421.27",,"$6,754.10","$6,754.10","$10,125.78","$10,125.78","$7,280.31","$12,139.88","$19,836.12","$3,828.93","$30,456.31","$28,419.72","$8,850.46","$6,933.64","$20,355.50","$18,891.54","$7,280.31"
MS102,MS-DRG V38 (FY2021),MS102,,HEADACHES WITH MCC,"$62,695.41",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS103,MS-DRG V38 (FY2021),MS103,,HEADACHES WITHOUT MCC,"$28,099.76",$0.00,"$19,674.42",$0.00,,$0.00,$0.00,$0.00,$0.00,"$6,704.13",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,384.88","$19,674.42",$0.00,"$6,704.13"
MS113,MS-DRG V38 (FY2021),MS113,,ORBITAL PROCEDURES WITH CC/MCC,"$276,386.52",$0.00,"$276,386.52","$178,969.26",,"$48,711.01","$48,711.01",$0.00,$0.00,$0.00,"$176,625.91","$28,372.83","$191,344.73","$233,146.18","$276,386.52","$36,547.34",$0.00,"$30,557.04","$27,021.74",$0.00
MS114,MS-DRG V38 (FY2021),MS114,,ORBITAL PROCEDURES WITHOUT CC/MCC,"$85,129.34",$0.00,"$22,869.95",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$21,940.21",$0.00,$0.00,$0.00,$0.00,$0.00,"$22,869.95","$20,895.44",$0.00
MS115,MS-DRG V38 (FY2021),MS115,,EXTRAOCULAR PROCEDURES EXCEPT ORBIT,"$127,763.81",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS116,MS-DRG V38 (FY2021),MS116,,INTRAOCULAR PROCEDURES WITH CC/MCC,"$73,177.83",$0.00,"$30,595.31",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$26,725.21",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$30,595.31",$0.00
MS117,MS-DRG V38 (FY2021),MS117,,INTRAOCULAR PROCEDURES WITHOUT CC/MCC,"$76,776.84",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS121,MS-DRG V38 (FY2021),MS121,,ACUTE MAJOR EYE INFECTIONS WITH CC/MCC,"$14,957.61",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS123,MS-DRG V38 (FY2021),MS123,,NEUROLOGICAL EYE DISORDERS,"$31,611.75",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS124,MS-DRG V38 (FY2021),MS124,,OTHER DISORDERS OF THE EYE WITH MCC,"$65,266.14",$0.00,"$24,491.81","$3,771.72",,"$10,203.89","$10,203.89",$0.00,$0.00,$0.00,"$19,104.25",$0.00,"$3,939.75","$21,706.29",$0.00,"$13,927.76",$0.00,"$24,491.81",$0.00,$0.00
MS125,MS-DRG V38 (FY2021),MS125,,OTHER DISORDERS OF THE EYE WITHOUT MCC,"$27,226.03",$0.00,"$19,591.92",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$19,197.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$19,591.92","$18,282.99",$0.00
MS137,MS-DRG V38 (FY2021),MS137,,MOUTH PROCEDURES WITH CC/MCC,"$78,189.63",$0.00,"$22,914.03",$0.00,,$0.00,$0.00,$0.00,$0.00,"$8,799.70",$0.00,"$22,914.03",$0.00,$0.00,$0.00,$0.00,"$8,380.67",$0.00,"$21,822.89","$8,799.70"
MS138,MS-DRG V38 (FY2021),MS138,,MOUTH PROCEDURES WITHOUT CC/MCC,"$75,844.99",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS139,MS-DRG V38 (FY2021),MS139,,SALIVARY GLAND PROCEDURES,"$196,269.49",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS146,MS-DRG V38 (FY2021),MS146,,"EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC","$27,695.41",$0.00,"$28,926.04",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$26,982.15",$0.00,$0.00,$0.00,$0.00,$0.00,"$28,926.04","$25,697.29",$0.00
MS147,MS-DRG V38 (FY2021),MS147,,"EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC","$81,929.39",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS149,MS-DRG V38 (FY2021),MS149,,DYSEQUILIBRIUM,"$25,264.18",$0.00,"$19,110.92",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$18,794.64",$0.00,$0.00,$0.00,$0.00,$0.00,"$19,110.92","$17,899.66",$0.00
MS150,MS-DRG V38 (FY2021),MS150,,EPISTAXIS WITH MCC,"$35,349.85",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS152,MS-DRG V38 (FY2021),MS152,,OTITIS MEDIA AND URI WITH MCC,"$25,427.40",$0.00,"$20,902.85",$0.00,,$0.00,$0.00,"$12,373.56","$12,564.40",$0.00,$0.00,"$20,902.85",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$19,907.48",$0.00
MS153,MS-DRG V38 (FY2021),MS153,,OTITIS MEDIA AND URI WITHOUT MCC,"$23,236.56",$0.00,"$18,914.10","$8,009.00",,"$6,144.47","$6,144.47",$0.00,$0.00,$0.00,"$9,713.00",$0.00,"$10,415.87","$16,796.75",$0.00,"$7,081.17",$0.00,"$18,914.10",$0.00,$0.00
MS154,MS-DRG V38 (FY2021),MS154,,"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH MCC","$78,575.98",$0.00,"$13,877.82",$0.00,,$0.00,$0.00,"$13,877.82","$13,877.82",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS155,MS-DRG V38 (FY2021),MS155,,"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC","$33,592.57",$0.00,"$20,504.12",$0.00,,$0.00,$0.00,"$9,814.28","$10,227.68","$6,474.98",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,166.65","$20,504.12",$0.00,"$6,474.98"
MS156,MS-DRG V38 (FY2021),MS156,,"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC","$11,775.59",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS157,MS-DRG V38 (FY2021),MS157,,DENTAL AND ORAL DISEASES WITH MCC,"$127,681.78",$0.00,"$92,183.95",$0.00,,$0.00,$0.00,"$90,943.75","$92,183.95",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$25,908.70",$0.00,$0.00
MS158,MS-DRG V38 (FY2021),MS158,,DENTAL AND ORAL DISEASES WITH CC,"$48,944.63",$0.00,"$20,222.38",$0.00,,$0.00,$0.00,$0.00,$0.00,"$8,794.95",$0.00,"$19,724.72",$0.00,$0.00,$0.00,$0.00,"$8,376.14","$20,222.38","$18,785.45","$8,794.95"
MS159,MS-DRG V38 (FY2021),MS159,,DENTAL AND ORAL DISEASES WITHOUT CC/MCC,"$38,358.00",$0.00,"$49,192.35","$7,739.80",,"$5,297.42","$5,297.42","$9,814.28","$10,227.68",$0.00,"$9,252.38","$18,401.02","$7,632.24","$49,192.35",$0.00,"$6,745.36",$0.00,"$18,640.54","$17,524.78",$0.00
MS163,MS-DRG V38 (FY2021),MS163,,MAJOR CHEST PROCEDURES WITH MCC,"$267,286.98",$0.00,"$296,439.13","$231,748.76",,"$77,251.30","$77,251.30",$0.00,$0.00,$0.00,"$224,575.09",$0.00,"$243,289.68","$296,439.13",$0.00,"$60,731.26",$0.00,"$52,946.21",$0.00,$0.00
MS164,MS-DRG V38 (FY2021),MS164,,MAJOR CHEST PROCEDURES WITH CC,"$232,898.57",$0.00,"$222,897.67","$182,933.69",,"$48,318.24","$48,318.24",$0.00,$0.00,$0.00,"$168,861.87","$31,102.90","$182,933.69","$222,897.67",$0.00,"$34,322.38",$0.00,"$33,819.53","$29,621.81",$0.00
MS165,MS-DRG V38 (FY2021),MS165,,MAJOR CHEST PROCEDURES WITHOUT CC/MCC,"$130,810.27",$0.00,"$28,246.73",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$26,439.54",$0.00,$0.00,$0.00,$0.00,$0.00,"$28,246.73","$25,180.51",$0.00
MS166,MS-DRG V38 (FY2021),MS166,,OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC,"$301,767.57",$0.00,"$55,255.73","$11,119.50",,"$32,677.10","$32,677.10",$0.00,$0.00,$0.00,"$51,297.13","$39,297.27","$16,179.17","$55,255.73",$0.00,"$37,397.68",$0.00,"$43,611.96","$47,571.93",$0.00
MS167,MS-DRG V38 (FY2021),MS167,,OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC,"$124,448.13",$0.00,"$70,722.18","$11,119.50",,"$17,689.01","$17,689.01","$69,481.98","$70,722.18","$18,341.98","$26,323.00","$26,885.12","$16,604.60","$32,510.42",$0.00,"$19,190.53","$17,468.56","$28,779.21","$25,604.88","$18,341.98"
MS168,MS-DRG V38 (FY2021),MS168,,OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,"$110,031.99",$0.00,"$22,868.93",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$22,868.93",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$21,779.93",$0.00
MS175,MS-DRG V38 (FY2021),MS175,,PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE,"$101,945.47",$0.00,"$101,945.47","$16,388.79",,"$13,630.48","$13,630.48","$101,023.25","$101,945.47",$0.00,"$19,860.50","$23,432.41","$16,704.06","$38,070.00",$0.00,"$14,479.10",$0.00,"$24,940.97","$22,316.58",$0.00
MS176,MS-DRG V38 (FY2021),MS176,,PULMONARY EMBOLISM WITHOUT MCC,"$35,673.73",$0.00,"$18,666.99",$0.00,,$0.00,$0.00,"$2,811.52","$2,906.94","$8,645.42",$0.00,"$18,666.99",$0.00,$0.00,$0.00,$0.00,"$7,736.43","$18,474.68","$18,666.99","$8,233.74"
MS177,MS-DRG V38 (FY2021),MS177,,RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC,"$42,498.23","$2,527.77","$35,112.81","$8,077.76",,"$17,398.03","$17,398.03","$10,747.92","$12,401.52","$2,824.77","$26,004.00","$26,726.58","$8,082.82","$21,757.37","$11,693.56","$18,957.97","$2,527.77","$35,112.81","$30,597.17","$2,690.25"
MS178,MS-DRG V38 (FY2021),MS178,,RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC,"$36,896.13","$3,578.23","$31,014.33","$11,379.31",,"$12,414.80","$12,414.80","$5,373.96","$6,200.76","$3,998.66","$17,095.38","$22,298.99","$10,783.80","$31,014.33","$27,319.11","$12,463.21","$3,578.23","$27,587.02","$24,618.39","$3,808.24"
MS179,MS-DRG V38 (FY2021),MS179,,RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC,"$27,548.37",$0.00,"$27,548.37","$18,808.67",,"$8,651.71","$8,651.71",$0.00,$0.00,$0.00,"$11,908.88","$19,721.29","$12,770.64","$27,548.37","$11,997.43","$8,682.05",$0.00,"$23,205.61","$21,137.62",$0.00
MS180,MS-DRG V38 (FY2021),MS180,,RESPIRATORY NEOPLASMS WITH MCC,"$63,974.95",$0.00,"$27,231.65",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$25,590.12",$0.00,$0.00,$0.00,$0.00,$0.00,"$27,231.65","$24,371.54",$0.00
MS181,MS-DRG V38 (FY2021),MS181,,RESPIRATORY NEOPLASMS WITH CC,"$36,031.82",$0.00,"$22,553.09",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$21,675.08",$0.00,$0.00,$0.00,$0.00,$0.00,"$22,553.09","$20,642.93",$0.00
MS182,MS-DRG V38 (FY2021),MS182,,RESPIRATORY NEOPLASMS WITHOUT CC/MCC,"$48,989.48",$0.00,"$19,562.08",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$19,562.08",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$18,630.55",$0.00
MS183,MS-DRG V38 (FY2021),MS183,,MAJOR CHEST TRAUMA WITH MCC,"$58,281.78",$0.00,"$24,116.10",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$24,116.10",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$22,967.71",$0.00
MS184,MS-DRG V38 (FY2021),MS184,,MAJOR CHEST TRAUMA WITH CC,"$70,021.94",$0.00,"$64,519.81","$16,501.29",,"$8,826.65","$8,826.65","$18,103.32","$18,103.32",$0.00,"$14,000.25","$20,760.71","$52,951.87","$64,519.81",$0.00,"$10,206.75",$0.00,"$21,460.41","$19,772.10",$0.00
MS185,MS-DRG V38 (FY2021),MS185,,MAJOR CHEST TRAUMA WITHOUT CC/MCC,"$44,282.53",$0.00,"$19,139.50",$0.00,,$0.00,$0.00,"$18,103.32","$18,103.32",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$19,139.50",$0.00,$0.00
MS186,MS-DRG V38 (FY2021),MS186,,PLEURAL EFFUSION WITH MCC,"$236,210.70",$0.00,"$31,067.06",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$31,067.06",$0.00,$0.00
MS187,MS-DRG V38 (FY2021),MS187,,PLEURAL EFFUSION WITH CC,"$12,763.23",$0.00,"$20,826.98",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$20,826.98",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$19,835.22",$0.00
MS188,MS-DRG V38 (FY2021),MS188,,PLEURAL EFFUSION WITHOUT CC/MCC,"$30,559.47",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS189,MS-DRG V38 (FY2021),MS189,,PULMONARY EDEMA AND RESPIRATORY FAILURE,"$32,816.55",$0.00,"$36,477.30","$18,276.90",,"$10,832.27","$10,832.27","$2,811.52","$2,906.94",$0.00,"$16,715.88","$22,110.38","$15,587.39","$36,477.30","$26,164.57","$12,186.54",$0.00,"$23,073.29","$21,057.50",$0.00
MS190,MS-DRG V38 (FY2021),MS190,,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC,"$29,547.04",$0.00,"$22,487.76",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$21,620.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$22,487.76","$20,590.86",$0.00
MS191,MS-DRG V38 (FY2021),MS191,,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC,"$24,766.79",$0.00,"$20,436.33",$0.00,,$0.00,$0.00,"$2,686.98","$3,100.38",$0.00,$0.00,"$19,903.76",$0.00,$0.00,$0.00,$0.00,$0.00,"$20,436.33","$18,955.96",$0.00
MS192,MS-DRG V38 (FY2021),MS192,,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC,"$22,599.02",$0.00,"$18,936.98",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$18,649.09",$0.00,$0.00,$0.00,$0.00,$0.00,"$18,936.98","$17,761.04",$0.00
MS193,MS-DRG V38 (FY2021),MS193,,SIMPLE PNEUMONIA AND PLEURISY WITH MCC,"$41,774.36","$2,686.98","$43,491.25","$5,147.10",,"$12,934.28","$12,934.28","$2,686.98","$3,100.38","$12,776.92","$18,335.63","$22,915.39","$3,781.24","$33,085.28","$43,491.25","$13,367.42","$12,168.50","$24,035.30","$21,824.18","$12,776.92"
MS194,MS-DRG V38 (FY2021),MS194,,SIMPLE PNEUMONIA AND PLEURISY WITH CC,"$27,402.20",$0.00,"$20,557.21","$7,773.52",,"$8,647.25","$8,647.25","$13,434.90","$15,501.90","$3,239.94","$12,218.25","$19,875.06","$6,896.00","$20,557.21",$0.00,"$8,907.60","$2,899.29","$20,402.05","$18,928.63","$3,085.65"
MS195,MS-DRG V38 (FY2021),MS195,,SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC,"$20,747.29",$0.00,"$18,715.67",$0.00,,$0.00,$0.00,$0.00,$0.00,"$3,270.32",$0.00,"$18,463.89",$0.00,$0.00,$0.00,$0.00,"$2,926.47","$18,715.67","$17,584.66","$3,114.59"
MS196,MS-DRG V38 (FY2021),MS196,,INTERSTITIAL LUNG DISEASE WITH MCC,"$94,220.64",$0.00,"$50,112.69","$25,945.50",,"$14,847.95","$14,847.95",$0.00,$0.00,$0.00,"$23,036.75","$25,251.85","$24,703.77","$50,112.69",$0.00,"$16,794.73",$0.00,"$26,827.41","$24,049.38",$0.00
MS197,MS-DRG V38 (FY2021),MS197,,INTERSTITIAL LUNG DISEASE WITH CC,"$19,710.08",$0.00,"$21,487.37",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$21,487.37",$0.00,$0.00
MS198,MS-DRG V38 (FY2021),MS198,,INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC,"$53,864.01",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS199,MS-DRG V38 (FY2021),MS199,,PNEUMOTHORAX WITH MCC,"$72,549.81",$0.00,"$71,834.87","$24,352.04",,"$16,374.25","$16,374.25","$15,188.24","$16,428.44","$14,397.09","$24,668.88",$0.00,"$19,741.79","$71,834.87",$0.00,"$17,984.61","$13,711.52","$27,796.78",$0.00,"$14,397.09"
MS200,MS-DRG V38 (FY2021),MS200,,PNEUMOTHORAX WITH CC,"$55,166.69","$6,062.24","$41,863.22","$12,860.44",,"$9,000.71","$9,000.71","$6,062.24","$6,475.64","$7,589.69","$14,878.88","$21,197.39","$7,597.89","$33,230.54","$41,863.22","$10,847.31","$6,902.85","$21,982.26","$20,187.99","$7,247.99"
MS201,MS-DRG V38 (FY2021),MS201,,PNEUMOTHORAX WITHOUT CC/MCC,"$60,656.77",$0.00,"$18,709.23",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$18,709.23",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$17,818.31",$0.00
MS202,MS-DRG V38 (FY2021),MS202,,BRONCHITIS AND ASTHMA WITH CC/MCC,"$23,543.04",$0.00,"$20,887.13",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$20,280.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$20,887.13","$19,315.22",$0.00
MS203,MS-DRG V38 (FY2021),MS203,,BRONCHITIS AND ASTHMA WITHOUT CC/MCC,"$18,811.21",$0.00,"$18,811.21",$0.00,,$0.00,$0.00,"$13,808.52","$14,921.58",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$18,811.21",$0.00,$0.00
MS204,MS-DRG V38 (FY2021),MS204,,RESPIRATORY SIGNS AND SYMPTOMS,"$21,967.37",$0.00,"$19,780.56",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$19,354.99",$0.00,$0.00,$0.00,$0.00,$0.00,"$19,780.56","$18,433.32",$0.00
MS205,MS-DRG V38 (FY2021),MS205,,OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC,"$59,946.32",$0.00,"$46,642.66","$16,622.71",,"$12,495.13","$12,495.13","$8,060.94","$9,301.14",$0.00,"$22,470.25","$24,970.31","$12,908.72","$46,642.66",$0.00,"$16,381.71",$0.00,"$26,490.96","$23,781.25",$0.00
MS206,MS-DRG V38 (FY2021),MS206,,OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC,"$42,692.11",$0.00,"$34,911.74","$3,951.50",,"$7,088.81","$7,088.81",$0.00,$0.00,$0.00,"$11,996.88","$19,765.04","$4,150.00","$34,911.74",$0.00,"$8,746.21",$0.00,"$20,270.57","$18,823.85",$0.00
MS207,MS-DRG V38 (FY2021),MS207,,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS,"$391,535.95",$0.00,"$391,535.95","$287,200.17",,"$93,399.65","$93,399.65","$391,440.53","$391,535.95",$0.00,"$265,173.58","$50,474.52","$287,271.37","$350,029.12",$0.00,"$78,281.84",$0.00,"$59,984.89","$50,474.52",$0.00
MS208,MS-DRG V38 (FY2021),MS208,,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS,"$143,637.93",$0.00,"$33,431.63","$5,315.01",,"$20,501.51","$20,501.51",$0.00,$0.00,$0.00,"$28,140.35","$30,778.29","$5,386.48","$22,287.15",$0.00,"$24,901.37",$0.00,"$33,431.63","$29,312.66",$0.00
MS215,MS-DRG V38 (FY2021),MS215,,OTHER HEART ASSIST SYSTEM IMPLANT,"$426,802.21",$0.00,"$426,802.21","$348,369.98",,"$149,083.31","$149,083.31",$0.00,$0.00,$0.00,"$323,335.01","$101,862.99","$350,279.60","$426,802.21",$0.00,"$129,174.20",$0.00,"$118,379.20","$97,012.37",$0.00
MS216,MS-DRG V38 (FY2021),MS216,,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC,"$576,491.39",$0.00,"$95,156.23",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$95,156.23",$0.00,$0.00
MS219,MS-DRG V38 (FY2021),MS219,,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC,"$367,804.52",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS220,MS-DRG V38 (FY2021),MS220,,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC,"$398,617.10",$0.00,"$314,960.76","$255,107.13",,"$83,053.39","$83,053.39",$0.00,$0.00,$0.00,"$238,606.64",$0.00,"$258,490.53","$314,960.76",$0.00,"$67,066.33",$0.00,"$56,475.77",$0.00,$0.00
MS222,MS-DRG V38 (FY2021),MS222,,"CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITH AMI, HF OR SHOCK WITH MCC","$205,128.61",$0.00,"$168,498.51",$0.00,,$0.00,$0.00,"$168,085.11","$168,498.51",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$81,291.22",$0.00,$0.00
MS224,MS-DRG V38 (FY2021),MS224,,"CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITHOUT AMI, HF OR SHOCK WITH MCC","$503,791.35",$0.00,"$66,349.55",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$66,349.55",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$63,190.05",$0.00
MS225,MS-DRG V38 (FY2021),MS225,,"CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITHOUT AMI, HF OR SHOCK WITHOUT MCC","$291,760.53",$0.00,"$59,276.04",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$49,909.59",$0.00,$0.00,$0.00,$0.00,$0.00,"$59,276.04","$49,909.59",$0.00
MS226,MS-DRG V38 (FY2021),MS226,,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATHETERIZATION WITH MCC,"$359,696.11",$0.00,"$59,504.66",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$59,504.66",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$56,671.10",$0.00
MS227,MS-DRG V38 (FY2021),MS227,,CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC,"$240,062.25",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS228,MS-DRG V38 (FY2021),MS228,,OTHER CARDIOTHORACIC PROCEDURES WITH MCC,"$254,951.76",$0.00,"$66,076.66",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$66,076.66",$0.00,$0.00,$0.00,$0.00,$0.00,"$64,482.16","$66,076.66",$0.00
MS233,MS-DRG V38 (FY2021),MS233,,CORONARY BYPASS WITH CARDIAC CATHETERIZATION WITH MCC,"$401,991.67",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS234,MS-DRG V38 (FY2021),MS234,,CORONARY BYPASS WITH CARDIAC CATHETERIZATION WITHOUT MCC,"$414,195.60",$0.00,"$55,662.39",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$55,662.39",$0.00,$0.00
MS235,MS-DRG V38 (FY2021),MS235,,CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC,"$390,480.96",$0.00,"$82,191.24",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$46,536.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$82,191.24","$44,320.66",$0.00
MS236,MS-DRG V38 (FY2021),MS236,,CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC,"$413,337.80",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS239,MS-DRG V38 (FY2021),MS239,,AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC,"$520,828.58",$0.00,"$520,828.58","$425,960.23",,"$42,477.55","$42,477.55",$0.00,$0.00,$0.00,"$394,567.12","$45,984.42","$427,447.72","$520,828.58",$0.00,"$126,573.84",$0.00,"$51,280.25","$43,794.69",$0.00
MS240,MS-DRG V38 (FY2021),MS240,,AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC,"$126,678.36",$0.00,"$35,684.78",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$32,140.33",$0.00,$0.00,$0.00,$0.00,$0.00,"$35,684.78","$32,140.33",$0.00
MS241,MS-DRG V38 (FY2021),MS241,,AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC,"$110,238.42",$0.00,"$25,528.14",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$25,528.14",$0.00,$0.00
MS242,MS-DRG V38 (FY2021),MS242,,PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC,"$104,330.72",$0.00,"$43,451.88",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$43,451.88",$0.00,$0.00
MS243,MS-DRG V38 (FY2021),MS243,,PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC,"$345,056.94",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS244,MS-DRG V38 (FY2021),MS244,,PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC,"$68,287.60",$0.00,"$30,094.00",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$27,985.36",$0.00,$0.00,$0.00,$0.00,$0.00,"$30,094.00","$26,652.72",$0.00
MS245,MS-DRG V38 (FY2021),MS245,,AICD GENERATOR PROCEDURES,"$130,970.26",$0.00,"$49,391.39",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$49,391.39",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$47,039.42",$0.00
MS246,MS-DRG V38 (FY2021),MS246,,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITH MCC OR 4+ ARTERIES OR STENTS,"$117,759.90",$0.00,"$81,055.22","$11,556.88",,"$28,890.80","$28,890.80",$0.00,$0.00,$0.00,"$61,405.47","$35,484.73","$17,653.94","$81,055.22",$0.00,"$31,805.11",$0.00,"$39,055.90","$33,794.98",$0.00
MS247,MS-DRG V38 (FY2021),MS247,,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITHOUT MCC,"$96,041.09",$0.00,"$74,539.79","$17,057.68",,"$18,374.51","$18,374.51","$5,277.93","$5,277.93",$0.00,"$27,977.13","$27,707.22","$30,001.65","$74,539.79","$58,858.96","$20,396.45",$0.00,"$29,761.63","$26,387.83",$0.00
MS249,MS-DRG V38 (FY2021),MS249,,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH NON-DRUG-ELUTING STENT WITHOUT MCC,"$62,163.32",$0.00,"$26,900.15",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$26,900.15",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$25,619.19",$0.00
MS250,MS-DRG V38 (FY2021),MS250,,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT CORONARY ARTERY STENT WITH MCC,"$197,512.09",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS251,MS-DRG V38 (FY2021),MS251,,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT CORONARY ARTERY STENT WITHOUT MCC,"$66,056.50",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS252,MS-DRG V38 (FY2021),MS252,,OTHER VASCULAR PROCEDURES WITH MCC,"$135,537.36",$0.00,"$100,414.90",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$36,220.00",$0.00,$0.00,"$100,414.90",$0.00,$0.00,"$39,934.57","$34,495.24",$0.00
MS253,MS-DRG V38 (FY2021),MS253,,OTHER VASCULAR PROCEDURES WITH CC,"$127,085.65",$0.00,"$34,432.01",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$31,615.43",$0.00,$0.00,$0.00,$0.00,$0.00,"$34,432.01","$30,109.93",$0.00
MS254,MS-DRG V38 (FY2021),MS254,,OTHER VASCULAR PROCEDURES WITHOUT CC/MCC,"$138,838.07",$0.00,"$26,240.69",$0.00,,$0.00,$0.00,$0.00,$0.00,"$17,984.48",$0.00,"$26,240.69",$0.00,$0.00,$0.00,$0.00,"$17,128.08",$0.00,"$24,991.13","$17,984.48"
MS255,MS-DRG V38 (FY2021),MS255,,UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC,"$99,723.78",$0.00,"$31,909.30",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$31,909.30",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$30,389.81",$0.00
MS256,MS-DRG V38 (FY2021),MS256,,UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC,"$58,773.98",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS258,MS-DRG V38 (FY2021),MS258,,CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC,"$216,020.52",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS260,MS-DRG V38 (FY2021),MS260,,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC,"$137,514.66",$0.00,"$43,357.97",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$43,357.97",$0.00,$0.00
MS262,MS-DRG V38 (FY2021),MS262,,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC,"$55,028.69",$0.00,"$10,687.26",$0.00,,$0.00,$0.00,"$10,273.86","$10,687.26",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS264,MS-DRG V38 (FY2021),MS264,,OTHER CIRCULATORY SYSTEM O.R. PROCEDURES,"$130,321.70",$0.00,"$39,670.80",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$35,999.28",$0.00,$0.00,$0.00,$0.00,$0.00,"$39,670.80","$34,285.03",$0.00
MS265,MS-DRG V38 (FY2021),MS265,,AICD LEAD PROCEDURES,"$272,946.60",$0.00,"$35,132.77",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$35,132.77",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$33,459.78",$0.00
MS269,MS-DRG V38 (FY2021),MS269,,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC,"$156,820.43",$0.00,"$42,958.09",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$42,958.09",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$40,912.47",$0.00
MS270,MS-DRG V38 (FY2021),MS270,,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC,"$237,495.42",$0.00,"$196,008.66","$152,937.46",,"$148,491.41","$148,491.41","$117,429.85","$118,256.65",$0.00,"$148,491.41","$48,724.42","$160,865.70","$196,008.66",$0.00,"$51,226.20",$0.00,"$54,877.59","$46,404.21",$0.00
MS271,MS-DRG V38 (FY2021),MS271,,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC,"$231,957.31",$0.00,"$161,466.25",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$38,048.73",$0.00,$0.00,"$161,466.25",$0.00,$0.00,"$42,119.94","$36,236.89",$0.00
MS272,MS-DRG V38 (FY2021),MS272,,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC,"$143,872.00",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS273,MS-DRG V38 (FY2021),MS273,,PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC,"$181,260.80",$0.00,"$91,804.70","$75,237.00",,"$50,225.02","$50,225.02",$0.00,$0.00,$0.00,"$69,549.02","$39,157.85","$44,119.66","$91,804.70",$0.00,"$37,193.18",$0.00,"$43,445.35","$37,293.19",$0.00
MS274,MS-DRG V38 (FY2021),MS274,,PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC,"$94,097.07",$0.00,"$35,395.88",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$35,395.88",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$33,710.36",$0.00
MS280,MS-DRG V38 (FY2021),MS280,,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC","$52,451.22",$0.00,"$32,089.26","$15,033.65",,"$15,431.69","$15,431.69","$16,869.12","$17,441.64",$0.00,"$22,424.88","$24,947.74","$17,813.05","$20,968.38",$0.00,"$16,348.64",$0.00,"$32,089.26","$23,759.75",$0.00
MS281,MS-DRG V38 (FY2021),MS281,,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC","$42,726.66",$0.00,"$42,566.21","$30,729.00",,"$9,146.20","$9,146.20","$19,680.64","$20,348.58",$0.00,"$13,319.63","$20,422.44","$13,390.76","$42,566.21",$0.00,"$9,710.54",$0.00,"$21,056.17","$19,449.94",$0.00
MS282,MS-DRG V38 (FY2021),MS282,,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC","$24,406.47",$0.00,"$19,171.35",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$18,845.21",$0.00,$0.00,$0.00,$0.00,$0.00,"$19,171.35","$17,947.82",$0.00
MS283,MS-DRG V38 (FY2021),MS283,,"ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC","$46,496.48",$0.00,"$96,797.90","$78,861.99",,"$14,953.28","$14,953.28",$0.00,$0.00,$0.00,"$73,331.75","$28,357.09","$11,537.64","$96,797.90",$0.00,"$18,040.74",$0.00,"$27,842.50","$27,006.75",$0.00
MS286,MS-DRG V38 (FY2021),MS286,,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC","$86,452.85",$0.00,"$31,090.31",$0.00,,$0.00,$0.00,"$16,121.88","$18,602.28",$0.00,$0.00,"$28,819.07",$0.00,$0.00,$0.00,$0.00,$0.00,"$31,090.31","$27,446.73",$0.00
MS287,MS-DRG V38 (FY2021),MS287,,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC","$69,653.49",$0.00,"$29,646.46","$14,579.01",,"$10,077.15","$10,077.15","$11,246.08","$11,627.76",$0.00,"$15,842.75","$21,676.42","$5,663.06","$29,646.46",$0.00,"$11,550.01",$0.00,"$22,554.71","$20,644.21",$0.00
MS288,MS-DRG V38 (FY2021),MS288,,ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC,"$97,204.39",$0.00,"$34,846.87",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$34,846.87",$0.00,$0.00
MS291,MS-DRG V38 (FY2021),MS291,,HEART FAILURE AND SHOCK WITH MCC,"$45,823.74",$0.00,"$59,590.83","$51,443.70",,"$13,475.17","$13,475.17","$10,976.02","$10,976.02","$13,148.68","$18,504.75","$21,904.23","$19,843.82","$59,590.83",$0.00,"$13,490.72","$12,522.56","$24,135.73","$21,904.23","$13,148.68"
MS292,MS-DRG V38 (FY2021),MS292,,HEART FAILURE AND SHOCK WITH CC,"$29,976.17",$0.00,"$25,542.17","$14,378.70",,"$8,768.64","$8,768.64","$15,816.70","$15,816.70",$0.00,"$12,450.63","$19,990.54","$3,423.49","$22,244.34","$25,542.17","$9,077.01",$0.00,"$20,540.04","$19,038.61",$0.00
MS293,MS-DRG V38 (FY2021),MS293,,HEART FAILURE AND SHOCK WITHOUT CC/MCC,"$22,224.07",$0.00,"$19,670.90",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$18,280.74",$0.00,$0.00,"$19,670.90",$0.00,$0.00,"$18,496.80","$17,410.23",$0.00
MS294,MS-DRG V38 (FY2021),MS294,,DEEP VEIN THROMBOPHLEBITIS WITH CC/MCC,"$47,909.23",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS296,MS-DRG V38 (FY2021),MS296,,"CARDIAC ARREST, UNEXPLAINED WITH MCC","$108,581.50",$0.00,"$55,644.87",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$24,534.30",$0.00,$0.00,"$55,644.87",$0.00,$0.00,$0.00,"$23,366.00",$0.00
MS299,MS-DRG V38 (FY2021),MS299,,PERIPHERAL VASCULAR DISORDERS WITH MCC,"$25,951.46",$0.00,"$24,984.23",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$23,709.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$24,984.23","$22,580.44",$0.00
MS300,MS-DRG V38 (FY2021),MS300,,PERIPHERAL VASCULAR DISORDERS WITH CC,"$27,694.75",$0.00,"$21,537.17",$0.00,,$0.00,$0.00,"$2,686.98","$3,100.38","$9,821.82",$0.00,"$20,824.93",$0.00,$0.00,$0.00,$0.00,"$9,354.11","$21,537.17","$19,833.27","$9,821.82"
MS301,MS-DRG V38 (FY2021),MS301,,PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC,"$16,174.84",$0.00,"$18,762.52",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$18,762.52",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$17,869.07",$0.00
MS302,MS-DRG V38 (FY2021),MS302,,ATHEROSCLEROSIS WITH MCC,"$23,496.28",$0.00,"$22,147.21",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$22,147.21",$0.00,$0.00
MS303,MS-DRG V38 (FY2021),MS303,,ATHEROSCLEROSIS WITHOUT MCC,"$22,915.89",$0.00,"$18,663.40",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$18,420.15",$0.00,$0.00,$0.00,$0.00,$0.00,"$18,663.40","$17,543.00",$0.00
MS304,MS-DRG V38 (FY2021),MS304,,HYPERTENSION WITH MCC,"$33,821.34",$0.00,"$22,059.01",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$21,261.62",$0.00,$0.00,$0.00,$0.00,$0.00,"$22,059.01","$20,249.16",$0.00
MS305,MS-DRG V38 (FY2021),MS305,,HYPERTENSION WITHOUT MCC,"$21,234.75",$0.00,"$19,723.81","$5,147.10",,"$5,598.22","$5,598.22","$8,060.94","$9,301.14",$0.00,"$10,058.13","$12,322.90","$3,994.80","$19,723.81",$0.00,"$7,332.77",$0.00,"$19,119.10","$12,322.90",$0.00
MS306,MS-DRG V38 (FY2021),MS306,,CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC,"$71,082.00",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS307,MS-DRG V38 (FY2021),MS307,,CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC,"$15,089.90",$0.00,"$20,349.78",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$20,349.78",$0.00,$0.00
MS308,MS-DRG V38 (FY2021),MS308,,CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC,"$54,292.93",$0.00,"$22,844.63","$3,728.28",,"$10,806.38","$10,806.38","$5,623.04","$5,813.88",$0.00,"$20,330.88","$21,919.03","$3,891.70","$14,418.05",$0.00,"$11,905.86",$0.00,"$22,844.63","$20,875.27",$0.00
MS309,MS-DRG V38 (FY2021),MS309,,CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC,"$30,990.07",$0.00,"$19,321.62",$0.00,,$0.00,$0.00,"$5,373.96","$6,200.76",$0.00,$0.00,"$18,970.96",$0.00,$0.00,$0.00,$0.00,$0.00,"$19,321.62","$18,067.58",$0.00
MS310,MS-DRG V38 (FY2021),MS310,,CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC,"$25,908.37",$0.00,"$22,828.20","$3,919.29",,"$4,902.90","$4,902.90",$0.00,$0.00,"$3,409.57","$7,690.38","$17,624.69","$3,748.58","$22,828.20",$0.00,"$5,606.59","$3,051.09","$17,712.81","$16,785.42","$3,247.21"
MS311,MS-DRG V38 (FY2021),MS311,,ANGINA PECTORIS,"$10,272.26",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS312,MS-DRG V38 (FY2021),MS312,,SYNCOPE AND COLLAPSE,"$36,440.00",$0.00,"$21,765.49",$0.00,,$0.00,$0.00,"$6,787.90","$6,787.90","$7,256.54",$0.00,"$19,383.03",$0.00,$0.00,"$21,765.49",$0.00,"$6,911.00","$19,814.06","$18,460.03","$7,256.54"
MS313,MS-DRG V38 (FY2021),MS313,,CHEST PAIN,"$30,679.71",$0.00,"$18,986.78",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$18,707.26",$0.00,$0.00,$0.00,$0.00,$0.00,"$18,986.78","$17,816.56",$0.00
MS314,MS-DRG V38 (FY2021),MS314,,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC,"$49,490.72",$0.00,"$90,518.61","$73,551.33",,"$17,132.94","$17,132.94","$2,686.98","$3,100.38",$0.00,"$68,574.70","$27,671.68","$27,623.06","$90,518.61",$0.00,"$20,344.32",$0.00,"$29,719.16","$26,353.98",$0.00
MS315,MS-DRG V38 (FY2021),MS315,,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC,"$28,825.40",$0.00,"$21,070.06",$0.00,,$0.00,$0.00,$0.00,$0.00,"$10,816.43",$0.00,"$20,434.06",$0.00,$0.00,$0.00,$0.00,"$9,679.17","$21,070.06","$19,461.01","$10,301.36"
MS316,MS-DRG V38 (FY2021),MS316,,OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC,"$56,774.44",$0.00,"$56,774.44","$19,392.50",,"$5,542.88","$5,542.88",$0.00,$0.00,$0.00,"$10,205.25",$0.00,"$10,943.74","$56,774.44",$0.00,"$7,440.03",$0.00,"$19,206.47",$0.00,$0.00
MS326,MS-DRG V38 (FY2021),MS326,,"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC","$208,735.55",$0.00,"$152,532.58","$125,184.57",,"$48,062.38","$48,062.38",$0.00,$0.00,$0.00,"$115,554.98","$49,819.86","$125,184.57","$152,532.58",$0.00,"$52,833.10",$0.00,"$74,365.49","$47,447.49",$0.00
MS327,MS-DRG V38 (FY2021),MS327,,"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC","$197,512.11",$0.00,"$34,156.81",$0.00,,$0.00,$0.00,"$2,811.52","$2,906.94",$0.00,$0.00,"$31,385.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$34,156.81","$29,890.60",$0.00
MS328,MS-DRG V38 (FY2021),MS328,,"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC","$118,279.34",$0.00,"$94,605.75",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$94,605.75",$0.00,$0.00,$0.00,$0.00,$0.00
MS329,MS-DRG V38 (FY2021),MS329,,MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC,"$241,729.00",$0.00,"$145,226.91","$109,237.85",,"$45,321.29","$45,321.29","$18,747.83","$19,988.03","$46,359.35","$110,020.39","$47,337.16","$119,188.76","$145,226.91",$0.00,"$49,191.26","$44,151.78","$53,219.79","$45,083.01","$46,359.35"
MS330,MS-DRG V38 (FY2021),MS330,,MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,"$176,914.64",$0.00,"$132,529.93","$108,450.47",,"$22,752.58","$22,752.58","$107,244.69","$107,244.69",$0.00,"$100,401.45","$31,070.11","$108,768.24","$132,529.93",$0.00,"$25,329.40",$0.00,"$33,780.33","$29,590.58",$0.00
MS331,MS-DRG V38 (FY2021),MS331,,MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC,"$129,001.57",$0.00,"$148,688.87","$121,669.64",,"$24,220.60","$24,220.60","$5,373.96","$6,200.76","$16,029.62","$112,643.08","$25,346.16","$122,030.00","$148,688.87",$0.00,"$16,933.05","$15,266.31","$26,940.12","$24,139.20","$16,029.62"
MS332,MS-DRG V38 (FY2021),MS332,,RECTAL RESECTION WITH MCC,"$767,080.03",$0.00,"$90,845.74",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$90,845.74",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$86,519.75",$0.00
MS333,MS-DRG V38 (FY2021),MS333,,RECTAL RESECTION WITH CC,"$522,727.26",$0.00,"$56,104.18",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$56,104.18",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$53,432.55",$0.00
MS335,MS-DRG V38 (FY2021),MS335,,PERITONEAL ADHESIOLYSIS WITH MCC,"$140,105.60",$0.00,"$110,895.56","$90,563.14",,"$38,274.42","$38,274.42",$0.00,$0.00,$0.00,"$84,011.79",$0.00,"$91,012.77","$110,895.56",$0.00,"$40,549.32",$0.00,"$46,179.48",$0.00,$0.00
MS336,MS-DRG V38 (FY2021),MS336,,PERITONEAL ADHESIOLYSIS WITH CC,"$185,168.03",$0.00,"$72,874.87",$0.00,,$0.00,$0.00,"$71,221.27","$72,874.87",$0.00,$0.00,"$29,289.24",$0.00,$0.00,$0.00,$0.00,$0.00,"$31,652.16","$27,894.51",$0.00
MS337,MS-DRG V38 (FY2021),MS337,,PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC,"$144,037.69",$0.00,"$43,588.46",$0.00,,$0.00,$0.00,"$41,934.86","$43,588.46",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS339,MS-DRG V38 (FY2021),MS339,,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAGNOSIS WITH CC,"$102,218.40",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS340,MS-DRG V38 (FY2021),MS340,,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,"$86,826.87",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS341,MS-DRG V38 (FY2021),MS341,,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAGNOSIS WITH MCC,"$102,562.74",$0.00,"$36,751.27",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$31,284.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$36,751.27",$0.00
MS342,MS-DRG V38 (FY2021),MS342,,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAGNOSIS WITH CC,"$81,962.16",$0.00,"$60,127.78","$4,152.92",,"$11,703.42","$11,703.42","$2,686.98","$3,100.38",$0.00,"$22,141.63",$0.00,"$5,521.83","$60,127.78",$0.00,"$16,142.14",$0.00,"$26,295.79",$0.00,$0.00
MS343,MS-DRG V38 (FY2021),MS343,,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,"$82,661.45",$0.00,"$70,753.35","$3,706.50",,"$8,393.76","$8,393.76","$9,441.14","$10,267.94",$0.00,"$15,834.50",$0.00,"$7,075.14","$70,753.35","$58,511.81","$11,543.98",$0.00,"$22,549.80",$0.00,$0.00
MS344,MS-DRG V38 (FY2021),MS344,,MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC,"$55,793.21",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS345,MS-DRG V38 (FY2021),MS345,,MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,"$65,888.78",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS346,MS-DRG V38 (FY2021),MS346,,MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC,"$222,424.62",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS347,MS-DRG V38 (FY2021),MS347,,ANAL AND STOMAL PROCEDURES WITH MCC,"$78,960.96",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS348,MS-DRG V38 (FY2021),MS348,,ANAL AND STOMAL PROCEDURES WITH CC,"$95,049.72",$0.00,"$24,654.33",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$23,433.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$24,654.33","$22,317.52",$0.00
MS349,MS-DRG V38 (FY2021),MS349,,ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC,"$57,204.72",$0.00,"$40,375.68","$3,888.30",,"$8,102.78","$8,102.78","$5,373.96","$6,200.76",$0.00,"$13,487.38",$0.00,"$6,026.40","$40,375.68",$0.00,"$9,832.84",$0.00,"$21,155.80",$0.00,$0.00
MS350,MS-DRG V38 (FY2021),MS350,,INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC,"$258,225.83",$0.00,"$30,472.16",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$30,472.16",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$29,021.10",$0.00
MS351,MS-DRG V38 (FY2021),MS351,,INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC,"$111,340.31",$0.00,"$114,048.28","$93,450.84",,"$13,594.50","$13,594.50",$0.00,$0.00,$0.00,"$86,400.20",$0.00,"$93,600.21","$114,048.28",$0.00,"$14,618.44",$0.00,"$25,054.47",$0.00,$0.00
MS352,MS-DRG V38 (FY2021),MS352,,INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC,"$95,272.46",$0.00,"$21,938.97",$0.00,,$0.00,$0.00,"$4,400.68","$4,814.08",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$21,938.97",$0.00,$0.00
MS353,MS-DRG V38 (FY2021),MS353,,HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC,"$183,813.62",$0.00,"$77,604.07","$8,983.50",,"$25,953.35","$25,953.35",$0.00,$0.00,$0.00,"$40,794.88","$34,077.63","$5,681.42","$77,604.07",$0.00,"$29,741.12",$0.00,"$37,374.40","$32,454.89",$0.00
MS354,MS-DRG V38 (FY2021),MS354,,HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC,"$121,827.34",$0.00,"$27,208.78",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$27,208.78",$0.00,$0.00
MS355,MS-DRG V38 (FY2021),MS355,,HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC,"$116,886.76",$0.00,"$40,274.04",$0.00,,$0.00,$0.00,"$39,447.24","$40,274.04",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS356,MS-DRG V38 (FY2021),MS356,,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC,"$159,442.84",$0.00,"$68,067.76",$0.00,,$0.00,$0.00,"$65,587.36","$68,067.76",$0.00,$0.00,"$39,681.10",$0.00,$0.00,$0.00,$0.00,$0.00,"$46,441.63","$39,681.10",$0.00
MS357,MS-DRG V38 (FY2021),MS357,,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC,"$144,309.55",$0.00,"$27,791.66",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$27,791.66",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$27,791.66",$0.00
MS358,MS-DRG V38 (FY2021),MS358,,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,"$83,754.95",$0.00,"$66,333.91","$3,991.51",,"$12,261.28","$12,261.28",$0.00,$0.00,$0.00,"$18,859.50",$0.00,"$5,778.35","$66,333.91",$0.00,"$13,749.33",$0.00,"$24,346.43",$0.00,$0.00
MS368,MS-DRG V38 (FY2021),MS368,,MAJOR ESOPHAGEAL DISORDERS WITH MCC,"$83,947.71",$0.00,"$28,691.00","$4,237.92",,"$16,638.45","$16,638.45",$0.00,$0.00,$0.00,"$26,174.50",$0.00,"$4,678.10","$21,077.61",$0.00,"$19,082.27",$0.00,"$28,691.00",$0.00,$0.00
MS369,MS-DRG V38 (FY2021),MS369,,MAJOR ESOPHAGEAL DISORDERS WITH CC,"$21,827.08",$0.00,"$21,827.08","$7,439.66",,"$9,553.21","$9,553.21",$0.00,$0.00,$0.00,"$14,617.63",$0.00,"$8,473.19","$17,181.21",$0.00,"$10,656.83",$0.00,"$21,827.08",$0.00,$0.00
MS370,MS-DRG V38 (FY2021),MS370,,MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC,"$66,442.55",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS371,MS-DRG V38 (FY2021),MS371,,MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC,"$96,081.86",$0.00,"$27,236.55",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$25,594.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$27,236.55","$24,375.45",$0.00
MS372,MS-DRG V38 (FY2021),MS372,,MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC,"$34,977.32",$0.00,"$21,495.52",$0.00,,$0.00,$0.00,"$16,122.38","$18,602.78",$0.00,$0.00,"$20,790.09",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,495.52","$19,800.09",$0.00
MS373,MS-DRG V38 (FY2021),MS373,,MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC,"$35,998.65",$0.00,"$18,871.86",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$18,871.86",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$17,973.20",$0.00
MS374,MS-DRG V38 (FY2021),MS374,,DIGESTIVE MALIGNANCY WITH MCC,"$103,204.32",$0.00,"$103,204.32",$0.00,,$0.00,$0.00,"$10,502.56","$10,502.56",$0.00,$0.00,"$27,453.01",$0.00,$0.00,"$103,204.32",$0.00,$0.00,"$25,228.00","$26,145.72",$0.00
MS375,MS-DRG V38 (FY2021),MS375,,DIGESTIVE MALIGNANCY WITH CC,"$35,163.84",$0.00,"$23,004.69",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$22,052.97",$0.00,$0.00,$0.00,$0.00,$0.00,"$23,004.69","$21,002.83",$0.00
MS376,MS-DRG V38 (FY2021),MS376,,DIGESTIVE MALIGNANCY WITHOUT CC/MCC,"$48,503.62",$0.00,"$20,645.23",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$20,645.23",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$19,662.12",$0.00
MS377,MS-DRG V38 (FY2021),MS377,,GASTROINTESTINAL HEMORRHAGE WITH MCC,"$70,936.56",$0.00,"$56,749.25",$0.00,,$0.00,$0.00,"$9,562.04","$9,657.46",$0.00,$0.00,"$25,897.63",$0.00,$0.00,"$56,749.25",$0.00,$0.00,"$27,599.14","$24,664.41",$0.00
MS378,MS-DRG V38 (FY2021),MS378,,GASTROINTESTINAL HEMORRHAGE WITH CC,"$46,107.77",$0.00,"$34,384.78","$15,645.00",,"$8,944.47","$8,944.47","$11,560.74","$12,482.96","$9,378.74","$13,586.38","$19,576.19","$14,569.53","$34,384.78",$0.00,"$9,905.01","$8,932.14","$21,214.59","$19,576.19","$9,378.74"
MS379,MS-DRG V38 (FY2021),MS379,,GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC,"$31,751.94",$0.00,"$18,418.41",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$18,215.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$18,418.41","$17,347.75",$0.00
MS380,MS-DRG V38 (FY2021),MS380,,COMPLICATED PEPTIC ULCER WITH MCC,"$194,237.98",$0.00,"$194,237.98","$149,487.14",,"$37,964.87","$37,964.87",$0.00,$0.00,$0.00,"$147,149.99",$0.00,"$159,412.49","$194,237.98",$0.00,"$24,569.41",$0.00,"$28,560.33",$0.00,$0.00
MS381,MS-DRG V38 (FY2021),MS381,,COMPLICATED PEPTIC ULCER WITH CC,"$39,414.09",$0.00,"$21,938.15",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$21,160.49",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,938.15","$20,152.85",$0.00
MS382,MS-DRG V38 (FY2021),MS382,,COMPLICATED PEPTIC ULCER WITHOUT CC/MCC,"$29,454.03",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS383,MS-DRG V38 (FY2021),MS383,,UNCOMPLICATED PEPTIC ULCER WITH MCC,"$23,976.51",$0.00,"$23,976.51",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$23,976.51",$0.00,$0.00
MS384,MS-DRG V38 (FY2021),MS384,,UNCOMPLICATED PEPTIC ULCER WITHOUT MCC,"$28,646.45",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS385,MS-DRG V38 (FY2021),MS385,,INFLAMMATORY BOWEL DISEASE WITH MCC,"$30,332.97",$0.00,"$24,806.99",$0.00,,$0.00,$0.00,"$5,373.96","$6,200.76",$0.00,$0.00,"$24,806.99",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$23,625.70",$0.00
MS386,MS-DRG V38 (FY2021),MS386,,INFLAMMATORY BOWEL DISEASE WITH CC,"$42,038.36",$0.00,"$21,190.92",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$20,535.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,190.92","$19,557.33",$0.00
MS387,MS-DRG V38 (FY2021),MS387,,INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC,"$10,077.40",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS388,MS-DRG V38 (FY2021),MS388,,GASTROINTESTINAL OBSTRUCTION WITH MCC,"$41,076.48",$0.00,"$25,599.99",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$24,224.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$25,599.99","$23,071.18",$0.00
MS389,MS-DRG V38 (FY2021),MS389,,GASTROINTESTINAL OBSTRUCTION WITH CC,"$48,051.18",$0.00,"$31,553.56",$0.00,,$0.00,$0.00,"$28,246.36","$31,553.56",$0.00,$0.00,"$19,540.89",$0.00,$0.00,$0.00,$0.00,$0.00,"$20,002.70","$18,610.37",$0.00
MS390,MS-DRG V38 (FY2021),MS390,,GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC,"$27,965.09",$0.00,"$17,763.43",$0.00,,$0.00,$0.00,$0.00,$0.00,"$5,593.59",$0.00,"$17,763.43",$0.00,$0.00,$0.00,$0.00,"$5,327.23",$0.00,"$16,917.55","$5,593.59"
MS391,MS-DRG V38 (FY2021),MS391,,"ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC","$32,257.92",$0.00,"$23,230.90","$7,617.21",,"$10,689.45","$10,689.45","$2,686.98","$3,100.38",$0.00,"$16,981.25","$22,242.27","$7,432.68","$17,525.21",$0.00,"$12,380.02",$0.00,"$23,230.90","$21,183.11",$0.00
MS392,MS-DRG V38 (FY2021),MS392,,"ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC","$41,242.74","$2,686.98","$41,242.74","$26,798.81",,"$6,594.33","$6,594.33","$2,686.98","$3,100.38","$4,472.47","$10,470.63","$19,006.49","$11,228.32","$41,242.74","$23,420.75","$7,633.51","$4,002.23","$19,364.08","$18,101.42","$4,259.49"
MS393,MS-DRG V38 (FY2021),MS393,,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC,"$40,255.87",$0.00,"$26,411.73",$0.00,,$0.00,$0.00,"$18,875.00","$19,701.80",$0.00,$0.00,"$24,904.01",$0.00,$0.00,$0.00,$0.00,$0.00,"$26,411.73","$23,718.10",$0.00
MS394,MS-DRG V38 (FY2021),MS394,,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC,"$32,593.15",$0.00,"$21,956.06","$7,774.20",,"$8,433.03","$8,433.03",$0.00,$0.00,"$5,859.66","$12,898.88","$20,213.34","$7,280.15","$21,956.06",$0.00,"$9,403.81","$5,243.56","$20,806.29","$19,250.80","$5,580.62"
MS395,MS-DRG V38 (FY2021),MS395,,OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC,"$23,721.88",$0.00,"$18,489.46","$7,413.00",,"$5,334.34","$5,334.34","$2,686.98","$3,100.38","$4,987.03","$8,998.00",$0.00,"$7,147.50","$12,116.27",$0.00,"$6,559.90","$4,462.69","$18,489.46",$0.00,"$4,749.55"
MS405,MS-DRG V38 (FY2021),MS405,,"PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC","$145,298.26",$0.00,"$50,890.72",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$50,890.72",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$48,467.35",$0.00
MS406,MS-DRG V38 (FY2021),MS406,,"PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC","$225,697.89",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS407,MS-DRG V38 (FY2021),MS407,,"PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC","$318,263.69",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS410,MS-DRG V38 (FY2021),MS410,,BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC,"$253,939.10",$0.00,"$201,119.77","$165,060.41",,"$38,872.71","$38,872.71",$0.00,$0.00,$0.00,"$152,363.46",$0.00,"$165,060.42","$201,119.77",$0.00,"$26,144.96",$0.00,"$26,701.64",$0.00,$0.00
MS414,MS-DRG V38 (FY2021),MS414,,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC,"$133,963.84",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS415,MS-DRG V38 (FY2021),MS415,,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC,"$105,615.66",$0.00,"$120,290.03","$98,196.28",,"$18,089.78","$18,089.78",$0.00,$0.00,$0.00,"$91,128.81",$0.00,"$98,722.88","$120,290.03",$0.00,"$20,566.86",$0.00,"$29,900.46",$0.00,$0.00
MS416,MS-DRG V38 (FY2021),MS416,,CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC,"$251,266.77",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS417,MS-DRG V38 (FY2021),MS417,,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC,"$166,765.88",$0.00,"$146,623.60","$119,984.61",,"$26,260.53","$26,260.53",$0.00,$0.00,$0.00,"$111,078.49","$30,276.71","$120,335.03","$146,623.60",$0.00,"$24,165.59",$0.00,"$32,832.21","$28,834.96",$0.00
MS418,MS-DRG V38 (FY2021),MS418,,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC,"$127,391.14",$0.00,"$25,207.41",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$25,207.41",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$24,007.06",$0.00
MS419,MS-DRG V38 (FY2021),MS419,,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC,"$112,851.30",$0.00,"$104,723.37","$85,947.21",,"$10,992.93","$10,992.93",$0.00,$0.00,"$11,300.32","$79,335.88","$22,732.94","$85,947.21","$104,723.37","$67,774.35","$13,099.76","$10,762.21","$23,817.26","$21,650.42","$11,300.32"
MS420,MS-DRG V38 (FY2021),MS420,,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC,"$131,891.46",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS423,MS-DRG V38 (FY2021),MS423,,OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC,"$177,734.14",$0.00,"$381,197.38",$0.00,,$0.00,$0.00,"$379,130.38","$381,197.38",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS432,MS-DRG V38 (FY2021),MS432,,CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC,"$45,372.01",$0.00,"$28,036.05","$15,014.69",,"$12,693.53","$12,693.53",$0.00,$0.00,$0.00,"$25,071.75","$26,263.25","$17,070.50","$27,475.36",$0.00,"$18,278.31",$0.00,"$28,036.05","$25,012.62",$0.00
MS433,MS-DRG V38 (FY2021),MS433,,CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC,"$34,482.10",$0.00,"$29,212.66","$15,030.56",,"$8,187.57","$8,187.57",$0.00,$0.00,$0.00,"$14,190.00","$20,855.02","$14,492.23","$29,212.66",$0.00,"$10,345.09",$0.00,"$21,573.12","$19,861.92",$0.00
MS434,MS-DRG V38 (FY2021),MS434,,CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC,"$24,253.79",$0.00,"$18,175.50",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$18,175.50",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$17,310.00",$0.00
MS435,MS-DRG V38 (FY2021),MS435,,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC,"$135,004.73",$0.00,"$27,004.64",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$25,400.15",$0.00,$0.00,$0.00,$0.00,$0.00,"$27,004.64","$24,190.62",$0.00
MS436,MS-DRG V38 (FY2021),MS436,,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC,"$33,015.06",$0.00,"$21,514.22",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$21,514.22",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$20,489.83",$0.00
MS437,MS-DRG V38 (FY2021),MS437,,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CC/MCC,"$43,538.47",$0.00,"$19,475.99",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$19,475.99",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$19,475.99",$0.00
MS438,MS-DRG V38 (FY2021),MS438,,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC,"$43,344.92",$0.00,"$26,524.44",$0.00,,$0.00,$0.00,"$10,747.92","$12,401.52",$0.00,$0.00,"$24,998.33",$0.00,$0.00,$0.00,$0.00,$0.00,"$26,524.44","$23,807.93",$0.00
MS439,MS-DRG V38 (FY2021),MS439,,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC,"$32,570.94",$0.00,"$20,063.94","$3,934.11",,"$8,096.53","$8,096.53",$0.00,$0.00,"$8,543.93","$11,649.00","$19,592.13","$3,287.36","$18,691.33",$0.00,"$8,492.59","$8,137.08","$20,063.94","$18,659.17","$8,543.93"
MS440,MS-DRG V38 (FY2021),MS440,,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC,"$25,885.20",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS441,MS-DRG V38 (FY2021),MS441,,"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC","$49,968.07",$0.00,"$26,532.44",$0.00,,$0.00,$0.00,"$10,747.92","$12,401.52",$0.00,$0.00,"$26,532.44",$0.00,$0.00,$0.00,$0.00,$0.00,"$19,575.49","$26,532.44",$0.00
MS442,MS-DRG V38 (FY2021),MS442,,"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC","$39,441.95",$0.00,"$35,767.17",$0.00,,$0.00,$0.00,"$35,767.17","$35,767.17",$0.00,$0.00,"$20,181.21",$0.00,$0.00,$0.00,$0.00,$0.00,"$20,767.89","$19,220.20",$0.00
MS443,MS-DRG V38 (FY2021),MS443,,"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC","$38,187.18",$0.00,"$38,930.80","$26,654.58",,"$5,812.44","$5,812.44",$0.00,$0.00,"$6,477.83","$9,354.13",$0.00,"$10,031.02","$38,930.80",$0.00,"$6,819.53","$6,169.37","$18,700.96",$0.00,"$6,477.83"
MS444,MS-DRG V38 (FY2021),MS444,,DISORDERS OF THE BILIARY TRACT WITH MCC,"$58,031.91",$0.00,"$24,914.95",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$24,914.95",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$23,728.52",$0.00
MS445,MS-DRG V38 (FY2021),MS445,,DISORDERS OF THE BILIARY TRACT WITH CC,"$56,381.40",$0.00,"$21,920.18",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$21,145.45",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,920.18","$20,138.52",$0.00
MS446,MS-DRG V38 (FY2021),MS446,,DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC,"$20,696.92",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS453,MS-DRG V38 (FY2021),MS453,,COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH MCC,"$508,429.90",$0.00,"$215,352.80",$0.00,,$0.00,$0.00,"$215,352.80","$215,352.80",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS454,MS-DRG V38 (FY2021),MS454,,COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH CC,"$295,473.87",$0.00,"$77,117.24",$0.00,,$0.00,$0.00,$0.00,$0.00,"$77,117.24",$0.00,"$55,659.30",$0.00,$0.00,$0.00,$0.00,"$63,264.79","$63,164.90","$53,008.86","$50,919.68"
MS455,MS-DRG V38 (FY2021),MS455,,COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITHOUT CC/MCC,"$296,923.30",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS457,MS-DRG V38 (FY2021),MS457,,"SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH CC","$293,611.36",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS459,MS-DRG V38 (FY2021),MS459,,SPINAL FUSION EXCEPT CERVICAL WITH MCC,"$349,219.02",$0.00,"$211,271.76","$168,686.68",,"$59,522.12","$59,522.12",$0.00,$0.00,$0.00,"$160,054.37","$60,627.44","$173,392.23","$211,271.76",$0.00,"$68,686.54",$0.00,"$69,101.93","$57,740.42",$0.00
MS460,MS-DRG V38 (FY2021),MS460,,SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC,"$293,626.38",$0.00,"$169,581.78",$0.00,,$0.00,$0.00,"$169,581.78","$169,581.78",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS463,MS-DRG V38 (FY2021),MS463,,WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC,"$491,326.85",$0.00,"$407,660.93","$320,951.59",,"$47,614.31","$47,614.31",$0.00,$0.00,$0.00,"$308,834.05","$55,832.33","$334,570.22","$407,660.93",$0.00,"$94,279.70",$0.00,"$55,837.96","$53,173.65",$0.00
MS464,MS-DRG V38 (FY2021),MS464,,WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC,"$265,763.31",$0.00,"$146,335.63","$119,606.40",,"$28,112.95","$28,112.95",$0.00,$0.00,"$28,628.74","$110,860.33",$0.00,"$120,098.69","$146,335.63",$0.00,"$29,598.76","$27,265.48","$37,258.44",$0.00,"$28,628.74"
MS465,MS-DRG V38 (FY2021),MS465,,WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,"$90,004.25",$0.00,"$77,963.23","$24,001.19",,"$17,372.15","$17,372.15",$0.00,$0.00,"$13,952.11","$26,334.00",$0.00,"$28,239.62","$77,963.23",$0.00,"$19,198.54","$13,287.73","$28,785.73",$0.00,"$13,952.11"
MS466,MS-DRG V38 (FY2021),MS466,,REVISION OF HIP OR KNEE REPLACEMENT WITH MCC,"$483,391.00",$0.00,"$54,786.94",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$54,786.94",$0.00,$0.00
MS467,MS-DRG V38 (FY2021),MS467,,REVISION OF HIP OR KNEE REPLACEMENT WITH CC,"$212,438.67",$0.00,"$41,826.76",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$37,803.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$41,826.76","$36,003.24",$0.00
MS468,MS-DRG V38 (FY2021),MS468,,REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC,"$185,691.73",$0.00,"$36,110.24",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$36,110.24",$0.00,$0.00
MS469,MS-DRG V38 (FY2021),MS469,,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT,"$250,207.22",$0.00,"$165,554.86",$0.00,,$0.00,$0.00,"$163,074.46","$165,554.86",$0.00,$0.00,"$35,259.88",$0.00,$0.00,$0.00,$0.00,$0.00,"$38,787.20","$33,580.84",$0.00
MS470,MS-DRG V38 (FY2021),MS470,,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC,"$143,646.61",$0.00,"$29,220.19",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$27,254.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$29,220.19","$25,956.32",$0.00
MS471,MS-DRG V38 (FY2021),MS471,,CERVICAL SPINAL FUSION WITH MCC,"$489,126.05",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS472,MS-DRG V38 (FY2021),MS472,,CERVICAL SPINAL FUSION WITH CC,"$166,587.77",$0.00,"$160,311.29","$126,832.61",,"$31,742.12","$31,742.12","$90,267.65","$90,267.65",$0.00,"$121,447.94","$34,587.43","$131,568.61","$160,311.29",$0.00,"$30,488.93",$0.00,"$37,983.62","$32,940.41",$0.00
MS473,MS-DRG V38 (FY2021),MS473,,CERVICAL SPINAL FUSION WITHOUT CC/MCC,"$190,835.60",$0.00,"$73,815.33",$0.00,,$0.00,$0.00,"$73,815.33","$73,815.33",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS474,MS-DRG V38 (FY2021),MS474,,AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC,"$319,512.04",$0.00,"$86,905.25",$0.00,,$0.00,$0.00,"$86,905.25","$86,905.25",$0.00,$0.00,"$40,282.68",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$38,364.46",$0.00
MS475,MS-DRG V38 (FY2021),MS475,,AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC,"$326,501.77",$0.00,"$326,501.77","$263,694.41",,"$75,662.96","$75,662.96",$0.00,$0.00,$0.00,"$247,349.82","$28,160.30","$267,962.31","$326,501.77",$0.00,"$64,048.46",$0.00,"$30,303.06","$26,819.33",$0.00
MS476,MS-DRG V38 (FY2021),MS476,,AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,"$78,987.82",$0.00,"$9,120.12",$0.00,,$0.00,$0.00,$0.00,$0.00,"$9,120.12",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$8,685.83",$0.00,$0.00,"$9,120.12"
MS477,MS-DRG V38 (FY2021),MS477,,BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,"$89,104.22",$0.00,"$39,729.61",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$39,729.61",$0.00,$0.00
MS478,MS-DRG V38 (FY2021),MS478,,BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC,"$149,390.67",$0.00,"$121,691.89",$0.00,,$0.00,$0.00,"$120,451.69","$121,691.89","$21,403.57",$0.00,"$29,637.06",$0.00,$0.00,$0.00,$0.00,"$20,384.36","$32,067.82","$28,225.77","$21,403.57"
MS479,MS-DRG V38 (FY2021),MS479,,BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC,"$90,529.51",$0.00,"$71,699.35","$15,577.18",,"$15,452.22","$15,452.22",$0.00,$0.00,$0.00,"$24,503.88",$0.00,"$18,769.33","$71,699.35",$0.00,"$17,864.32",$0.00,"$27,698.78",$0.00,$0.00
MS480,MS-DRG V38 (FY2021),MS480,,HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC,"$230,321.76",$0.00,"$143,684.76","$116,454.02",,"$27,354.62","$27,354.62","$78,713.33","$79,540.13",$0.00,"$108,852.10","$34,430.27","$117,923.11","$143,684.76",$0.00,"$30,258.36",$0.00,"$37,795.79","$32,790.73",$0.00
MS481,MS-DRG V38 (FY2021),MS481,,HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC,"$153,360.18","$13,045.68","$91,568.13","$13,045.68",,"$17,651.52","$17,651.52","$50,746.67","$51,986.87","$20,409.50","$28,707.25","$28,070.09","$19,240.38","$68,283.40","$91,568.13","$20,928.74","$16,097.59","$30,195.26","$26,733.42","$16,920.75"
MS482,MS-DRG V38 (FY2021),MS482,,HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC,"$131,354.06",$0.00,"$82,947.32","$13,343.09",,"$14,498.06","$14,498.06",$0.00,$0.00,"$15,767.20","$62,356.82","$25,046.15","$20,216.62","$82,311.01","$82,947.32","$16,492.99","$15,016.39","$26,581.60","$23,853.48","$15,767.20"
MS483,MS-DRG V38 (FY2021),MS483,,MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES,"$130,235.38",$0.00,"$32,680.33",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$30,149.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$32,680.33","$28,713.91",$0.00
MS486,MS-DRG V38 (FY2021),MS486,,KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC,"$127,868.41",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS487,MS-DRG V38 (FY2021),MS487,,KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC,"$57,259.89",$0.00,"$24,785.80",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$24,785.80",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$23,605.52",$0.00
MS488,MS-DRG V38 (FY2021),MS488,,KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC,"$263,384.75","$11,740.43","$263,384.75","$131,612.13",,"$29,195.89","$29,195.89","$11,740.43","$12,567.23","$14,369.52","$125,430.67","$27,259.61","$135,883.23","$165,568.51","$263,384.75","$19,739.85","$13,685.26","$29,226.72","$25,961.53","$14,369.52"
MS489,MS-DRG V38 (FY2021),MS489,,KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC,"$243,443.87",$0.00,"$242,647.77","$91,044.36",,"$15,985.05","$15,985.05","$2,686.98","$3,100.38",$0.00,"$93,585.19","$22,406.27","$101,383.95","$123,532.45","$242,647.77","$12,620.61",$0.00,"$23,426.88","$21,339.30",$0.00
MS492,MS-DRG V38 (FY2021),MS492,,"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH MCC","$225,520.35",$0.00,"$167,518.79","$137,521.97",,"$36,956.69","$36,956.69","$75,969.03","$76,795.83",$0.00,"$126,908.17","$37,346.90","$137,483.85","$167,518.79","$97,394.98","$42,010.85",$0.00,"$41,281.24","$35,568.48",$0.00
MS493,MS-DRG V38 (FY2021),MS493,,"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC","$145,371.74","$4,787.73","$108,921.50","$89,271.80",,"$18,167.43","$18,167.43","$4,787.73","$5,201.13","$13,089.73","$82,516.28","$28,127.50","$89,392.64","$108,921.50","$67,758.80","$23,075.96","$12,466.42","$31,944.52","$28,127.50","$13,089.73"
MS494,MS-DRG V38 (FY2021),MS494,,"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITHOUT CC/MCC","$110,624.34","$5,989.40","$95,441.38","$5,989.40",,"$13,742.95","$13,742.95","$37,586.24","$39,653.24","$13,089.73","$24,906.75","$26,181.24","$8,346.59","$77,751.89","$95,441.38","$18,158.03","$12,466.42","$27,938.05","$24,934.51","$13,089.73"
MS495,MS-DRG V38 (FY2021),MS495,,LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC,"$173,304.14",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS496,MS-DRG V38 (FY2021),MS496,,LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC,"$130,367.45",$0.00,"$29,808.99",$0.00,,$0.00,$0.00,"$21,164.34","$23,644.74","$13,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$13,025.13","$29,808.99",$0.00,"$13,676.38"
MS497,MS-DRG V38 (FY2021),MS497,,LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC,"$39,695.77",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS498,MS-DRG V38 (FY2021),MS498,,LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CC/MCC,"$146,260.94",$0.00,"$146,260.94","$116,373.01",,"$25,167.60","$25,167.60",$0.00,$0.00,$0.00,"$110,803.75","$30,532.28","$120,037.39","$146,260.94",$0.00,"$24,540.49",$0.00,"$33,137.63","$29,078.36",$0.00
MS499,MS-DRG V38 (FY2021),MS499,,LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CC/MCC,"$74,371.51",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS500,MS-DRG V38 (FY2021),MS500,,SOFT TISSUE PROCEDURES WITH MCC,"$251,242.13",$0.00,"$80,884.60","$80,884.60",,"$80,884.60","$80,884.60","$49,944.68","$50,771.48",$0.00,"$80,884.60",$0.00,"$80,884.60","$80,884.60",$0.00,"$80,884.60",$0.00,"$37,768.84",$0.00,$0.00
MS501,MS-DRG V38 (FY2021),MS501,,SOFT TISSUE PROCEDURES WITH CC,"$85,788.80",$0.00,"$116,069.81","$85,052.56",,"$14,990.77","$14,990.77","$20,127.55","$21,463.17",$0.00,"$87,931.67","$25,269.62","$95,259.31","$116,069.81","$62,879.13","$16,820.79",$0.00,"$26,848.64","$24,066.30",$0.00
MS502,MS-DRG V38 (FY2021),MS502,,SOFT TISSUE PROCEDURES WITHOUT CC/MCC,"$164,767.02",$0.00,"$164,767.02","$131,254.80",,"$27,071.50","$27,071.50","$10,747.92","$12,401.52",$0.00,"$124,823.50","$22,827.91","$135,225.45","$164,767.02",$0.00,"$14,731.48",$0.00,"$23,930.76","$21,740.87",$0.00
MS503,MS-DRG V38 (FY2021),MS503,,FOOT PROCEDURES WITH MCC,"$159,040.72",$0.00,"$187,255.41","$114,463.21",,"$187,255.41","$187,255.41",$0.00,$0.00,$0.00,"$187,255.41","$32,367.16","$187,255.41","$148,306.29",$0.00,"$187,255.41",$0.00,"$35,330.35","$30,825.87",$0.00
MS504,MS-DRG V38 (FY2021),MS504,,FOOT PROCEDURES WITH CC,"$71,195.33",$0.00,"$115,745.60","$91,749.18",,"$14,635.25","$14,635.25",$0.00,$0.00,$0.00,"$87,686.05",$0.00,"$94,993.22","$115,745.60",$0.00,"$17,407.21",$0.00,"$27,326.39",$0.00,$0.00
MS505,MS-DRG V38 (FY2021),MS505,,FOOT PROCEDURES WITHOUT CC/MCC,"$133,223.81",$0.00,"$133,223.81","$105,985.08",,"$18,476.51","$18,476.51",$954.94,$954.94,$0.00,"$100,927.12",$0.00,"$109,337.71","$133,223.81",$0.00,"$16,855.87",$0.00,"$26,878.91",$0.00,$0.00
MS506,MS-DRG V38 (FY2021),MS506,,MAJOR THUMB OR JOINT PROCEDURES,"$55,238.14",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS508,MS-DRG V38 (FY2021),MS508,,MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITHOUT CC/MCC,"$131,740.67",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS510,MS-DRG V38 (FY2021),MS510,,"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH MCC","$226,326.20",$0.00,"$179,649.18","$142,410.43",,"$35,064.54","$35,064.54","$70,509.31","$71,336.11",$0.00,"$136,097.86",$0.00,"$147,439.34","$179,649.18",$0.00,"$27,947.77",$0.00,"$35,913.41",$0.00,$0.00
MS511,MS-DRG V38 (FY2021),MS511,,"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH CC","$145,778.06",$0.00,"$101,547.55","$79,601.21",,"$14,735.49","$14,735.49","$25,351.72","$26,178.52","$14,912.43","$76,929.96","$26,678.75","$83,340.79","$101,547.55",$0.00,"$18,887.80","$14,202.32","$28,532.58","$25,408.33","$14,912.43"
MS512,MS-DRG V38 (FY2021),MS512,,"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC","$114,994.21",$0.00,"$69,039.85","$3,900.00",,"$11,570.42","$11,570.42","$5,373.96","$6,200.76","$9,824.67","$20,814.75",$0.00,"$8,928.39","$69,039.85","$47,895.51","$15,174.79","$9,356.83","$25,507.72",$0.00,"$9,824.67"
MS513,MS-DRG V38 (FY2021),MS513,,"HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC","$78,102.12",$0.00,"$95,133.80","$7,740.51",,"$12,908.39","$12,908.39","$39,948.95","$41,602.55",$0.00,"$21,685.13",$0.00,"$8,775.22","$34,223.36","$95,133.80","$15,809.32",$0.00,"$26,024.64",$0.00,$0.00
MS514,MS-DRG V38 (FY2021),MS514,,"HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC","$61,562.59",$0.00,"$38,957.44","$3,850.82",,"$8,029.59","$8,029.59",$0.00,$0.00,$0.00,"$14,668.50","$21,109.64","$5,825.91","$38,957.44",$0.00,"$10,693.93",$0.00,"$21,857.31","$20,104.47",$0.00
MS515,MS-DRG V38 (FY2021),MS515,,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC,"$234,040.17",$0.00,"$209,366.89","$167,884.58",,"$28,772.09","$28,772.09",$0.00,$0.00,$0.00,"$158,611.27","$35,356.23","$171,828.87","$209,366.89",$0.00,"$31,616.65",$0.00,"$38,902.35","$33,672.60",$0.00
MS516,MS-DRG V38 (FY2021),MS516,,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC,"$192,718.78",$0.00,"$192,718.78","$3,970.52",,"$18,238.84","$18,238.84",$0.00,$0.00,$0.00,"$26,662.63","$27,053.91","$6,215.66","$41,578.09","$192,718.78","$19,438.14",$0.00,"$28,980.91","$25,765.63",$0.00
MS517,MS-DRG V38 (FY2021),MS517,,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CC/MCC,"$194,960.94",$0.00,"$194,960.94","$94,035.85",,"$17,213.24","$17,213.24",$0.00,$0.00,$0.00,"$93,200.66",$0.00,"$100,967.39","$123,024.86","$194,960.94","$14,187.39",$0.00,"$24,703.31",$0.00,$0.00
MS518,MS-DRG V38 (FY2021),MS518,,BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR,"$254,394.10",$0.00,"$35,329.63",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$35,329.63",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$35,329.63",$0.00
MS519,MS-DRG V38 (FY2021),MS519,,BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC,"$185,066.54",$0.00,"$146,572.73","$116,871.74",,"$23,586.33","$23,586.33",$0.00,$0.00,$0.00,"$111,039.92",$0.00,"$120,293.25","$146,572.73","$101,333.30","$19,133.38",$0.00,"$28,732.65",$0.00,$0.00
MS520,MS-DRG V38 (FY2021),MS520,,BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC,"$111,654.81",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS533,MS-DRG V38 (FY2021),MS533,,FRACTURES OF FEMUR WITH MCC,"$17,831.69",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS534,MS-DRG V38 (FY2021),MS534,,FRACTURES OF FEMUR WITHOUT MCC,"$44,159.95",$0.00,"$19,117.88",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$19,117.88",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$18,207.50",$0.00
MS535,MS-DRG V38 (FY2021),MS535,,FRACTURES OF HIP AND PELVIS WITH MCC,"$56,240.74",$0.00,"$55,410.08","$20,909.40",,"$11,076.83","$11,076.83",$0.00,$0.00,$0.00,"$16,872.63","$22,188.27","$45,475.45","$55,410.08",$0.00,"$12,300.82",$0.00,"$23,166.38","$21,131.69",$0.00
MS536,MS-DRG V38 (FY2021),MS536,,FRACTURES OF HIP AND PELVIS WITHOUT MCC,"$53,189.17",$0.00,"$51,105.97","$22,523.60",,"$6,427.42","$6,427.42","$18,103.32","$18,103.32",$0.00,"$10,429.38","$18,985.98","$41,943.03","$51,105.97",$0.00,"$7,603.43",$0.00,"$19,339.59","$18,081.89",$0.00
MS539,MS-DRG V38 (FY2021),MS539,,OSTEOMYELITIS WITH MCC,"$24,264.69",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS540,MS-DRG V38 (FY2021),MS540,,OSTEOMYELITIS WITH CC,"$51,504.62",$0.00,"$23,761.72",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$22,686.47",$0.00,$0.00,$0.00,$0.00,$0.00,"$23,761.72","$21,606.16",$0.00
MS541,MS-DRG V38 (FY2021),MS541,,OSTEOMYELITIS WITHOUT CC/MCC,"$16,467.66",$0.00,"$20,549.86","$7,413.00",,"$8,227.74","$8,227.74",$0.00,$0.00,$0.00,"$12,467.13",$0.00,"$6,521.61","$13,050.54",$0.00,"$9,089.03",$0.00,"$20,549.86",$0.00,$0.00
MS542,MS-DRG V38 (FY2021),MS542,,PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC,"$79,838.91",$0.00,"$28,047.49",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$28,047.49",$0.00,$0.00
MS543,MS-DRG V38 (FY2021),MS543,,PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC,"$55,321.02",$0.00,"$21,021.07",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$21,021.07",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$20,020.07",$0.00
MS544,MS-DRG V38 (FY2021),MS544,,PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC,"$41,415.80",$0.00,"$19,338.77",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$19,338.77",$0.00,$0.00
MS545,MS-DRG V38 (FY2021),MS545,,CONNECTIVE TISSUE DISORDERS WITH MCC,"$102,672.95",$0.00,"$33,790.14",$0.00,,$0.00,$0.00,$0.00,$0.00,"$21,592.78",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$20,564.56","$33,790.14",$0.00,"$21,592.78"
MS546,MS-DRG V38 (FY2021),MS546,,CONNECTIVE TISSUE DISORDERS WITH CC,"$50,791.42",$0.00,"$39,074.00","$29,652.00",,"$10,452.92","$10,452.92",$0.00,$0.00,"$11,302.22","$16,546.75",$0.00,"$17,744.13","$39,074.00","$23,690.09","$12,063.24","$10,764.02","$22,972.84",$0.00,"$11,302.22"
MS547,MS-DRG V38 (FY2021),MS547,,CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,"$21,109.46",$0.00,"$21,983.21","$3,706.50",,"$7,127.20","$7,127.20",$0.00,$0.00,$0.00,"$11,138.88","$19,338.61","$3,981.64","$21,983.21",$0.00,"$8,120.69",$0.00,"$19,760.97","$18,417.72",$0.00
MS548,MS-DRG V38 (FY2021),MS548,,SEPTIC ARTHRITIS WITH MCC,"$367,692.60",$0.00,"$33,605.39",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$33,605.39",$0.00,$0.00
MS549,MS-DRG V38 (FY2021),MS549,,SEPTIC ARTHRITIS WITH CC,"$7,854.00",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS550,MS-DRG V38 (FY2021),MS550,,SEPTIC ARTHRITIS WITHOUT CC/MCC,"$12,624.11",$0.00,"$20,201.14","$4,050.80",,"$7,488.69","$7,488.69",$0.00,$0.00,$0.00,"$11,880.00",$0.00,"$3,746.96","$9,998.30",$0.00,"$8,661.00",$0.00,"$20,201.14",$0.00,$0.00
MS551,MS-DRG V38 (FY2021),MS551,,MEDICAL BACK PROBLEMS WITH MCC,"$74,275.74",$0.00,"$26,125.09",$0.00,,$0.00,$0.00,$0.00,$0.00,"$10,545.38",$0.00,"$24,664.14",$0.00,$0.00,"$25,317.60",$0.00,"$10,043.22","$26,125.09","$23,489.66","$10,545.38"
MS552,MS-DRG V38 (FY2021),MS552,,MEDICAL BACK PROBLEMS WITHOUT MCC,"$59,297.86","$3,841.70","$46,583.09","$9,546.30",,"$7,763.60","$7,763.60","$15,188.24","$16,428.44","$8,574.36","$12,538.63","$20,034.27","$3,841.70","$46,583.09","$46,274.32","$9,141.16","$8,166.06","$41,185.53","$19,080.26","$8,574.36"
MS553,MS-DRG V38 (FY2021),MS553,,BONE DISEASES AND ARTHROPATHIES WITH MCC,"$36,166.50",$0.00,"$28,077.22",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$22,587.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$28,077.22","$21,511.79",$0.00
MS554,MS-DRG V38 (FY2021),MS554,,BONE DISEASES AND ARTHROPATHIES WITHOUT MCC,"$35,579.19",$0.00,"$19,573.95",$0.00,,$0.00,$0.00,$0.00,$0.00,"$7,576.01",$0.00,"$19,182.11",$0.00,$0.00,$0.00,$0.00,"$7,215.26","$19,573.95","$18,268.68","$7,576.01"
MS555,MS-DRG V38 (FY2021),MS555,,SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,"$25,282.80",$0.00,"$25,282.80",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$22,791.03",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$25,282.80",$0.00
MS556,MS-DRG V38 (FY2021),MS556,,SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC,"$42,341.00",$0.00,"$19,611.52",$0.00,,$0.00,$0.00,"$2,686.98","$3,100.38",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$19,611.52",$0.00,$0.00
MS557,MS-DRG V38 (FY2021),MS557,,"TENDONITIS, MYOSITIS AND BURSITIS WITH MCC","$170,818.99",$0.00,"$25,053.66","$10,448.71",,"$12,736.12","$12,736.12",$0.00,$0.00,"$9,431.03","$20,050.25",$0.00,"$7,288.53","$23,483.23",$0.00,"$14,617.44","$8,981.94","$25,053.66",$0.00,"$9,431.03"
MS558,MS-DRG V38 (FY2021),MS558,,"TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC","$21,774.06",$0.00,"$20,179.91","$7,413.00",,"$7,606.51","$7,606.51",$0.00,$0.00,"$7,410.57","$11,844.25","$19,689.18","$6,684.92","$14,709.82",$0.00,"$8,634.93","$7,057.69","$20,179.91","$18,751.60","$7,410.57"
MS559,MS-DRG V38 (FY2021),MS559,,"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC","$45,213.85",$0.00,"$26,115.65",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$26,115.65",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$24,872.05",$0.00
MS560,MS-DRG V38 (FY2021),MS560,,"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC","$15,066.84",$0.00,"$9,664.00",$0.00,,$0.00,$0.00,"$9,250.60","$9,664.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS561,MS-DRG V38 (FY2021),MS561,,"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC","$8,782.18",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS562,MS-DRG V38 (FY2021),MS562,,"FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC","$49,245.47",$0.00,"$29,572.12","$9,066.71",,"$12,233.61","$12,233.61","$9,814.28","$10,227.68",$0.00,"$18,522.63","$23,008.32","$24,270.04","$29,572.12",$0.00,"$13,503.74",$0.00,"$24,146.36","$21,912.69",$0.00
MS563,MS-DRG V38 (FY2021),MS563,,"FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC","$38,944.33","$2,686.98","$30,007.85","$8,967.92",,"$6,922.80","$6,922.80","$2,686.98","$3,100.38","$8,143.64","$11,742.50","$19,638.62","$24,627.66","$30,007.85","$29,566.02","$8,560.76","$7,755.86","$20,119.49","$18,703.45","$8,143.64"
MS564,MS-DRG V38 (FY2021),MS564,,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC,"$55,285.72",$0.00,"$25,493.02",$0.00,,$0.00,$0.00,$0.00,$0.00,"$10,783.08",$0.00,"$24,135.23",$0.00,$0.00,$0.00,$0.00,"$10,269.60","$25,493.02","$22,985.93","$10,783.08"
MS565,MS-DRG V38 (FY2021),MS565,,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC,"$65,982.38",$0.00,"$58,773.78","$9,233.75",,"$8,388.40","$8,388.40","$22,118.54","$23,835.84","$10,783.08","$13,481.88",$0.00,"$42,888.55","$52,258.04","$58,773.78","$9,828.83","$10,269.60","$21,152.55",$0.00,"$10,783.08"
MS566,MS-DRG V38 (FY2021),MS566,,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC,"$29,921.18",$0.00,"$19,333.07",$0.00,,$0.00,$0.00,"$12,501.26","$13,328.06",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$19,333.07",$0.00,$0.00
MS570,MS-DRG V38 (FY2021),MS570,,SKIN DEBRIDEMENT WITH MCC,"$360,933.98",$0.00,"$37,352.79",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$29,679.42",$0.00,$0.00,$0.00,$0.00,$0.00,"$37,352.79","$29,679.42",$0.00
MS571,MS-DRG V38 (FY2021),MS571,,SKIN DEBRIDEMENT WITH CC,"$106,191.09",$0.00,"$92,480.47","$72,862.51",,"$13,088.69","$13,088.69","$80,227.85","$82,294.85",$0.00,"$70,060.96","$25,230.67","$7,827.96","$92,480.47",$0.00,"$16,763.65",$0.00,"$26,802.10","$24,029.21",$0.00
MS572,MS-DRG V38 (FY2021),MS572,,SKIN DEBRIDEMENT WITHOUT CC/MCC,"$187,600.31",$0.00,"$187,600.31",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$187,600.31",$0.00,$0.00,$0.00,$0.00,$0.00
MS575,MS-DRG V38 (FY2021),MS575,,SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC,"$133,262.82",$0.00,"$106,610.25",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$106,610.25",$0.00,$0.00,$0.00,$0.00,$0.00
MS576,MS-DRG V38 (FY2021),MS576,,SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC,"$176,052.37",$0.00,"$52,745.32",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$52,745.32",$0.00,$0.00
MS577,MS-DRG V38 (FY2021),MS577,,SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC,"$213,560.92",$0.00,"$210,439.66","$162,300.32",,"$42,716.04","$42,716.04",$0.00,$0.00,"$21,616.55","$159,423.97","$30,310.19","$172,709.30","$210,439.66",$0.00,"$30,411.56","$20,587.20","$32,872.23","$28,866.85","$21,616.55"
MS578,MS-DRG V38 (FY2021),MS578,,SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC,"$112,564.89",$0.00,"$89,151.39","$73,098.67",,"$11,748.05","$11,748.05","$41,042.07","$41,042.07",$0.00,"$67,538.93",$0.00,"$6,314.74","$89,151.39",$0.00,"$16,313.56",$0.00,"$26,435.44",$0.00,$0.00
MS579,MS-DRG V38 (FY2021),MS579,,"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC","$150,391.94",$0.00,"$37,531.20",$0.00,,$0.00,$0.00,"$13,787.57","$15,441.17",$0.00,$0.00,"$34,208.84",$0.00,$0.00,$0.00,$0.00,$0.00,"$37,531.20","$32,579.85",$0.00
MS580,MS-DRG V38 (FY2021),MS580,,"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC","$97,065.04",$0.00,"$96,657.78","$69,069.43",,"$14,037.50","$14,037.50","$65,020.71","$65,020.71","$17,313.20","$73,225.58","$24,796.03","$13,426.57","$96,657.78",$0.00,"$16,126.10","$13,096.07","$26,282.71","$23,615.27","$13,137.34"
MS581,MS-DRG V38 (FY2021),MS581,,"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC","$289,721.02",$0.00,"$289,721.02","$237,713.18",,"$62,203.92","$62,203.92",$0.00,$0.00,"$9,351.17","$219,485.64","$22,377.58","$237,776.11","$289,721.02",$0.00,"$51,492.35","$8,905.88","$23,392.60","$21,311.98","$9,351.17"
MS582,MS-DRG V38 (FY2021),MS582,,MASTECTOMY FOR MALIGNANCY WITH CC/MCC,"$108,486.63",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS583,MS-DRG V38 (FY2021),MS583,,MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC,"$133,531.92",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS584,MS-DRG V38 (FY2021),MS584,,"BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC","$83,463.29",$0.00,"$16,271.13",$0.00,,$0.00,$0.00,$0.00,$0.00,"$16,271.13",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$15,496.32",$0.00,$0.00,"$16,271.13"
MS585,MS-DRG V38 (FY2021),MS585,,"BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC","$94,934.52",$0.00,"$77,375.13",$0.00,,$0.00,$0.00,$0.00,$0.00,"$77,375.13",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$66,928.30",$0.00,$0.00,"$15,175.67"
MS592,MS-DRG V38 (FY2021),MS592,,SKIN ULCERS WITH MCC,"$29,392.08",$0.00,"$21,094.03",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$21,094.03",$0.00,$0.00
MS593,MS-DRG V38 (FY2021),MS593,,SKIN ULCERS WITH CC,"$14,429.36",$0.00,"$22,518.78",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$21,646.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$22,518.78","$20,615.57",$0.00
MS595,MS-DRG V38 (FY2021),MS595,,MAJOR SKIN DISORDERS WITH MCC,"$79,451.71",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS596,MS-DRG V38 (FY2021),MS596,,MAJOR SKIN DISORDERS WITHOUT MCC,"$123,653.36",$0.00,"$123,653.36",$0.00,,$0.00,$0.00,"$123,653.36","$123,653.36",$0.00,$0.00,"$20,459.36",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,100.29","$19,485.10",$0.00
MS597,MS-DRG V38 (FY2021),MS597,,MALIGNANT BREAST DISORDERS WITH MCC,"$45,690.59",$0.00,"$26,970.32",$0.00,,$0.00,$0.00,$0.00,$0.00,"$11,679.69",$0.00,"$25,371.44",$0.00,$0.00,$0.00,$0.00,"$11,123.52","$26,970.32","$24,163.28","$11,679.69"
MS598,MS-DRG V38 (FY2021),MS598,,MALIGNANT BREAST DISORDERS WITH CC,"$47,939.53",$0.00,"$35,696.67","$11,119.50",,"$10,028.06","$10,028.06",$0.00,$0.00,$0.00,"$14,968.25","$21,241.80","$10,944.14","$35,696.67",$0.00,"$10,912.47",$0.00,"$22,035.33","$20,230.29",$0.00
MS600,MS-DRG V38 (FY2021),MS600,,NON-MALIGNANT BREAST DISORDERS WITH CC/MCC,"$17,031.86",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS602,MS-DRG V38 (FY2021),MS602,,CELLULITIS WITH MCC,"$31,558.70",$0.00,"$24,821.74",$0.00,,$0.00,$0.00,"$5,623.04","$5,813.88",$0.00,$0.00,"$23,573.49",$0.00,$0.00,"$18,754.05",$0.00,$0.00,"$24,821.74","$22,450.94",$0.00
MS603,MS-DRG V38 (FY2021),MS603,,CELLULITIS WITHOUT MCC,"$25,058.75",$0.00,"$20,033.73","$7,705.48",,"$7,539.56","$7,539.56","$8,060.94","$9,301.14","$8,400.36","$11,598.13","$19,566.86","$6,546.00","$17,835.13",$0.00,"$8,455.50","$8,000.35","$20,033.73","$18,635.10","$8,400.36"
MS604,MS-DRG V38 (FY2021),MS604,,"TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC","$101,032.73",$0.00,"$101,032.73","$82,862.67",,"$11,267.84","$11,267.84",$0.00,$0.00,$0.00,"$76,539.94","$23,810.62","$82,918.27","$101,032.73",$0.00,"$14,680.60",$0.00,"$25,105.11","$22,676.78",$0.00
MS605,MS-DRG V38 (FY2021),MS605,,"TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC","$51,893.10",$0.00,"$33,846.48","$9,021.51",,"$6,840.68","$6,840.68","$12,615.31","$12,615.31","$6,631.86","$12,040.88","$19,786.89","$27,778.04","$33,846.48",$0.00,"$8,778.29","$6,316.06","$20,354.44","$18,844.66","$6,631.86"
MS606,MS-DRG V38 (FY2021),MS606,,MINOR SKIN DISORDERS WITH MCC,"$47,650.33",$0.00,"$25,358.28",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$25,358.28",$0.00,$0.00
MS607,MS-DRG V38 (FY2021),MS607,,MINOR SKIN DISORDERS WITHOUT MCC,"$23,686.40",$0.00,"$19,891.64","$7,413.00",,"$6,512.21","$6,512.21",$0.00,$0.00,$0.00,"$11,358.88","$19,447.95","$6,767.14","$9,573.60",$0.00,"$8,281.08",$0.00,"$19,891.64","$18,521.86",$0.00
MS614,MS-DRG V38 (FY2021),MS614,,ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC,"$212,122.84",$0.00,"$167,928.51","$137,733.48",,"$32,363.06","$32,363.06",$0.00,$0.00,$0.00,"$127,218.57","$30,431.14","$137,820.12","$167,928.51",$0.00,"$24,392.14",$0.00,"$33,016.77","$28,982.04",$0.00
MS616,MS-DRG V38 (FY2021),MS616,,"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC","$93,561.19",$0.00,"$45,817.70",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$41,143.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$45,817.70","$39,183.85",$0.00
MS617,MS-DRG V38 (FY2021),MS617,,"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC","$86,986.67",$0.00,"$78,850.16","$25,945.50",,"$17,812.19","$17,812.19",$0.00,$0.00,$0.00,"$28,205.38","$27,820.65","$30,246.42","$78,850.16",$0.00,"$20,562.86",$0.00,"$29,897.18","$26,495.86",$0.00
MS623,MS-DRG V38 (FY2021),MS623,,"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC","$103,125.77",$0.00,"$37,368.58",$0.00,,$0.00,$0.00,"$32,821.18","$37,368.58",$0.00,$0.00,"$25,933.22",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$24,698.30",$0.00
MS626,MS-DRG V38 (FY2021),MS626,,"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC","$118,910.60",$0.00,"$6,200.76",$0.00,,$0.00,$0.00,"$5,373.96","$6,200.76",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS627,MS-DRG V38 (FY2021),MS627,,"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC","$116,934.25",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS628,MS-DRG V38 (FY2021),MS628,,"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH MCC","$276,605.25",$0.00,"$39,014.36",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$39,014.36",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$37,156.53",$0.00
MS629,MS-DRG V38 (FY2021),MS629,,"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC","$111,380.25",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS630,MS-DRG V38 (FY2021),MS630,,"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITHOUT CC/MCC","$133,228.18",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS637,MS-DRG V38 (FY2021),MS637,,DIABETES WITH MCC,"$49,572.97",$0.00,"$40,133.70","$23,679.60",,"$12,446.04","$12,446.04","$12,812.76","$13,226.16","$12,842.52","$19,053.38","$23,272.11","$20,432.15","$40,133.70",$0.00,"$13,890.67","$12,230.98","$24,461.58","$22,163.91","$12,842.52"
MS638,MS-DRG V38 (FY2021),MS638,,DIABETES WITH CC,"$26,255.33",$0.00,"$22,063.63","$3,911.25",,"$7,373.55","$7,373.55","$10,747.92","$12,401.52","$3,201.70","$12,156.38","$19,844.30","$3,621.13","$22,063.63",$0.00,"$8,862.48","$2,865.07","$20,365.28","$18,899.33","$3,049.24"
MS639,MS-DRG V38 (FY2021),MS639,,DIABETES WITHOUT CC/MCC,"$31,516.95",$0.00,"$31,516.95","$7,647.08",,"$5,416.13","$5,416.13","$8,310.02","$8,914.26","$5,219.92","$8,431.50","$17,993.04","$7,233.31","$31,516.95",$0.00,"$6,146.90","$4,971.35","$18,153.00","$17,136.23","$5,219.92"
MS640,MS-DRG V38 (FY2021),MS640,,"MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC","$79,244.98",$0.00,"$79,244.98","$41,477.14",,"$9,857.58","$9,857.58",$0.00,$0.00,"$9,221.86","$60,034.09","$22,100.13","$17,903.38","$79,244.98",$0.00,"$12,171.50","$8,782.73","$23,061.04","$21,047.74","$9,221.86"
MS641,MS-DRG V38 (FY2021),MS641,,"MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC","$120,359.68",$0.00,"$120,359.68","$98,637.65",,"$6,293.53","$6,293.53","$8,424.16","$8,424.16","$7,062.58","$91,181.59","$17,809.69","$98,780.05","$120,359.68",$0.00,"$7,584.39","$6,726.27","$19,324.07","$16,961.90","$7,062.58"
MS642,MS-DRG V38 (FY2021),MS642,,INBORN AND OTHER DISORDERS OF METABOLISM,"$30,798.13",$0.00,"$6,200.76",$0.00,,$0.00,$0.00,"$5,373.96","$6,200.76",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS643,MS-DRG V38 (FY2021),MS643,,ENDOCRINE DISORDERS WITH MCC,"$41,672.78",$0.00,"$82,100.01","$64,232.27",,"$14,691.75","$14,691.75","$2,686.98","$3,100.38",$0.00,"$62,196.98","$24,910.85","$22,826.66","$82,100.01",$0.00,"$16,294.50",$0.00,"$26,419.91","$23,724.62",$0.00
MS644,MS-DRG V38 (FY2021),MS644,,ENDOCRINE DISORDERS WITH CC,"$29,810.42",$0.00,"$21,541.26",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$20,828.37",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,541.26","$19,836.54",$0.00
MS645,MS-DRG V38 (FY2021),MS645,,ENDOCRINE DISORDERS WITHOUT CC/MCC,"$43,072.30",$0.00,"$19,394.31",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$19,031.78",$0.00,$0.00,$0.00,$0.00,$0.00,"$19,394.31","$18,125.50",$0.00
MS653,MS-DRG V38 (FY2021),MS653,,MAJOR BLADDER PROCEDURES WITH MCC,"$339,583.17",$0.00,"$58,358.97",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$58,358.97",$0.00,$0.00
MS654,MS-DRG V38 (FY2021),MS654,,MAJOR BLADDER PROCEDURES WITH CC,"$404,315.96",$0.00,"$398,005.53",$0.00,,$0.00,$0.00,$0.00,$0.00,"$398,005.53",$0.00,"$33,020.46",$0.00,$0.00,$0.00,$0.00,"$398,005.53","$38,871.58","$31,448.06","$398,005.53"
MS655,MS-DRG V38 (FY2021),MS655,,MAJOR BLADDER PROCEDURES WITHOUT CC/MCC,"$208,530.97",$0.00,"$75,740.26",$0.00,,$0.00,$0.00,"$74,500.06","$75,740.26",$0.00,$0.00,"$27,896.52",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$26,568.11",$0.00
MS656,MS-DRG V38 (FY2021),MS656,,KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC,"$437,450.34",$0.00,"$253,891.46",$0.00,,$0.00,$0.00,"$252,651.26","$253,891.46",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS657,MS-DRG V38 (FY2021),MS657,,KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC,"$193,583.67",$0.00,"$173,329.09",$0.00,,$0.00,$0.00,"$172,088.89","$173,329.09",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS658,MS-DRG V38 (FY2021),MS658,,KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC,"$161,097.01",$0.00,"$58,312.85",$0.00,,$0.00,$0.00,"$58,312.85","$58,312.85",$0.00,$0.00,"$24,530.88",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$23,362.74",$0.00
MS659,MS-DRG V38 (FY2021),MS659,,KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC,"$113,356.36",$0.00,"$35,029.80",$0.00,,$0.00,$0.00,$0.00,$0.00,"$9,090.65",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$8,657.76","$35,029.80",$0.00,"$9,090.65"
MS660,MS-DRG V38 (FY2021),MS660,,KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC,"$89,171.20",$0.00,"$75,856.50",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$23,511.30",$0.00,$0.00,$0.00,$0.00,$0.00,"$75,856.50","$22,391.71",$0.00
MS661,MS-DRG V38 (FY2021),MS661,,KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC,"$160,446.31",$0.00,"$160,446.31","$131,407.21",,"$26,493.57","$26,493.57","$8,060.94","$9,301.14",$0.00,"$121,550.23",$0.00,"$131,679.42","$160,446.31",$0.00,"$12,993.46",$0.00,"$44,096.27",$0.00,$0.00
MS663,MS-DRG V38 (FY2021),MS663,,MINOR BLADDER PROCEDURES WITH CC,"$166,916.19",$0.00,"$132,197.62","$108,254.09",,"$19,135.49","$19,135.49",$0.00,$0.00,$0.00,"$100,149.71",$0.00,"$108,495.52","$132,197.62",$0.00,"$15,271.03",$0.00,"$25,586.10",$0.00,$0.00
MS664,MS-DRG V38 (FY2021),MS664,,MINOR BLADDER PROCEDURES WITHOUT CC/MCC,"$101,749.97",$0.00,"$12,130.79",$0.00,,$0.00,$0.00,"$11,717.39","$12,130.79",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS667,MS-DRG V38 (FY2021),MS667,,PROSTATECTOMY WITHOUT CC/MCC,"$65,479.60",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS668,MS-DRG V38 (FY2021),MS668,,TRANSURETHRAL PROCEDURES WITH MCC,"$139,065.49",$0.00,"$35,915.88",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$35,915.88",$0.00,$0.00
MS669,MS-DRG V38 (FY2021),MS669,,TRANSURETHRAL PROCEDURES WITH CC,"$121,595.99",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS670,MS-DRG V38 (FY2021),MS670,,TRANSURETHRAL PROCEDURES WITHOUT CC/MCC,"$5,820.40",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS671,MS-DRG V38 (FY2021),MS671,,URETHRAL PROCEDURES WITH CC/MCC,"$187,953.06",$0.00,"$156,574.35","$128,247.86",,"$26,304.88","$26,304.88",$0.00,$0.00,$0.00,"$118,616.94","$26,291.95","$128,501.69","$156,574.35",$0.00,"$18,320.42",$0.00,"$28,070.35","$25,039.95",$0.00
MS672,MS-DRG V38 (FY2021),MS672,,URETHRAL PROCEDURES WITHOUT CC/MCC,"$163,388.33",$0.00,"$136,550.05","$112,067.60",,"$18,072.13","$18,072.13",$0.00,$0.00,$0.00,"$103,447.01",$0.00,"$112,067.60","$136,550.05",$0.00,"$10,357.11",$0.00,"$21,582.93",$0.00,$0.00
MS673,MS-DRG V38 (FY2021),MS673,,OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC,"$122,574.68",$0.00,"$42,337.17",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$36,410.02",$0.00,$0.00,$0.00,$0.00,$0.00,"$42,337.17","$36,410.02",$0.00
MS674,MS-DRG V38 (FY2021),MS674,,OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC,"$98,884.32",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS675,MS-DRG V38 (FY2021),MS675,,OTHER KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CC/MCC,"$121,040.24",$0.00,"$26,473.00",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$26,473.00",$0.00,$0.00
MS682,MS-DRG V38 (FY2021),MS682,,RENAL FAILURE WITH MCC,"$45,920.23",$0.00,"$26,628.42","$22,338.00",,"$13,561.75","$13,561.75","$12,937.30","$13,032.72","$15,998.23","$20,322.50","$23,902.86","$21,793.11","$26,628.42",$0.00,"$14,815.93","$11,998.26","$25,215.35","$22,764.63","$12,616.02"
MS683,MS-DRG V38 (FY2021),MS683,,RENAL FAILURE WITH CC,"$24,383.79",$0.00,"$31,160.10","$11,182.19",,"$8,490.15","$8,490.15","$3,375.26","$3,375.26",$0.00,"$12,337.88","$19,934.50","$10,177.45","$31,160.10",$0.00,"$8,994.81",$0.00,"$20,236.40","$18,985.24",$0.00
MS684,MS-DRG V38 (FY2021),MS684,,RENAL FAILURE WITHOUT CC/MCC,"$11,874.33",$0.00,"$18,170.14","$3,706.50",,"$5,431.31","$5,431.31",$0.00,$0.00,$0.00,"$8,460.38",$0.00,"$3,360.22","$8,379.35",$0.00,"$6,167.96",$0.00,"$18,170.14",$0.00,$0.00
MS686,MS-DRG V38 (FY2021),MS686,,KIDNEY AND URINARY TRACT NEOPLASMS WITH MCC,"$53,047.00",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS687,MS-DRG V38 (FY2021),MS687,,KIDNEY AND URINARY TRACT NEOPLASMS WITH CC,"$22,139.59",$0.00,"$21,741.34",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$21,741.34",$0.00,$0.00
MS689,MS-DRG V38 (FY2021),MS689,,KIDNEY AND URINARY TRACT INFECTIONS WITH MCC,"$30,594.07",$0.00,"$22,280.33",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$21,446.82",$0.00,$0.00,$0.00,$0.00,$0.00,"$22,280.33","$20,425.54",$0.00
MS690,MS-DRG V38 (FY2021),MS690,,KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC,"$38,475.04",$0.00,"$38,475.04","$7,413.00",,"$6,956.71","$6,956.71",$0.00,$0.00,$0.00,"$10,873.50","$19,206.72","$6,663.05","$38,475.04",$0.00,"$7,927.21",$0.00,"$17,599.41","$18,292.11",$0.00
MS693,MS-DRG V38 (FY2021),MS693,,URINARY STONES WITH MCC,"$36,340.29",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS694,MS-DRG V38 (FY2021),MS694,,URINARY STONES WITHOUT MCC,"$30,408.22",$0.00,"$22,027.43","$3,994.29",,"$6,122.16","$6,122.16",$0.00,$0.00,$0.00,"$14,180.50","$18,862.29","$8,086.81","$22,027.43",$0.00,"$7,422.00",$0.00,"$19,191.77","$17,964.09",$0.00
MS695,MS-DRG V38 (FY2021),MS695,,KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC,"$28,871.29",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS696,MS-DRG V38 (FY2021),MS696,,KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC,"$9,539.42",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS698,MS-DRG V38 (FY2021),MS698,,OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC,"$38,241.11",$0.00,"$26,363.55",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$24,863.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$26,363.55","$23,679.70",$0.00
MS699,MS-DRG V38 (FY2021),MS699,,OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC,"$27,723.93",$0.00,"$21,922.34","$12,014.60",,"$9,077.47","$9,077.47",$0.00,$0.00,"$4,436.27","$14,199.63","$20,859.81","$10,876.54","$19,704.17",$0.00,"$10,352.10","$3,969.84","$21,922.34","$19,866.49","$4,225.02"
MS700,MS-DRG V38 (FY2021),MS700,,OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CC/MCC,"$35,130.91",$0.00,"$35,130.91","$15,652.50",,"$6,346.19","$6,346.19",$0.00,$0.00,$0.00,"$10,198.38","$18,871.19","$7,542.32","$35,130.91",$0.00,"$7,435.02",$0.00,"$19,202.40","$17,972.56",$0.00
MS707,MS-DRG V38 (FY2021),MS707,,MAJOR MALE PELVIC PROCEDURES WITH CC/MCC,"$176,286.27",$0.00,"$26,581.02",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$26,581.02",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$25,315.26",$0.00
MS708,MS-DRG V38 (FY2021),MS708,,MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC,"$158,688.94",$0.00,"$25,003.02",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$23,725.19",$0.00,$0.00,$0.00,$0.00,$0.00,"$25,003.02","$22,595.42",$0.00
MS709,MS-DRG V38 (FY2021),MS709,,PENIS PROCEDURES WITH CC/MCC,"$154,592.73",$0.00,"$43,219.19",$0.00,,$0.00,$0.00,"$41,565.59","$43,219.19",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$32,790.56",$0.00,$0.00
MS710,MS-DRG V38 (FY2021),MS710,,PENIS PROCEDURES WITHOUT CC/MCC,"$120,205.88",$0.00,"$120,205.88",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$120,205.88",$0.00,$0.00,$0.00,$0.00,$0.00
MS711,MS-DRG V38 (FY2021),MS711,,TESTES PROCEDURES WITH CC/MCC,"$116,547.40",$0.00,"$85,899.31","$60,410.25",,"$20,124.84","$20,124.84",$0.00,$0.00,$0.00,"$65,075.23",$0.00,"$4,158.09","$85,899.31",$0.00,"$21,484.09",$0.00,"$30,647.69",$0.00,$0.00
MS713,MS-DRG V38 (FY2021),MS713,,TRANSURETHRAL PROSTATECTOMY WITH CC/MCC,"$101,621.77",$0.00,"$25,084.68",$0.00,,$0.00,$0.00,$0.00,$0.00,"$12,822.56",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$12,211.96","$25,084.68",$0.00,"$12,822.56"
MS714,MS-DRG V38 (FY2021),MS714,,TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC,"$94,694.62",$0.00,"$20,620.89",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$20,620.89",$0.00,$0.00
MS715,MS-DRG V38 (FY2021),MS715,,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CC/MCC,"$187,611.62",$0.00,"$148,588.40","$121,358.48",,"$25,363.14","$25,363.14",$0.00,$0.00,$0.00,"$112,566.97",$0.00,"$121,947.55","$148,588.40",$0.00,"$21,416.93",$0.00,"$30,592.97",$0.00,$0.00
MS717,MS-DRG V38 (FY2021),MS717,,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITH CC/MCC,"$157,074.61",$0.00,"$326,740.55",$0.00,,$0.00,$0.00,"$24,896.03","$26,963.03",$0.00,$0.00,"$23,674.83",$0.00,$0.00,"$326,740.55",$0.00,$0.00,$0.00,"$23,674.83",$0.00
MS718,MS-DRG V38 (FY2021),MS718,,OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITHOUT CC/MCC,"$22,148.36",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS722,MS-DRG V38 (FY2021),MS722,,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH MCC","$54,088.40",$0.00,"$26,136.81",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$26,136.81",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$24,892.20",$0.00
MS723,MS-DRG V38 (FY2021),MS723,,"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH CC","$66,385.19",$0.00,"$22,188.86",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$21,370.28",$0.00,$0.00,$0.00,$0.00,$0.00,"$22,188.86","$20,352.65",$0.00
MS725,MS-DRG V38 (FY2021),MS725,,BENIGN PROSTATIC HYPERTROPHY WITH MCC,"$106,692.19",$0.00,"$23,861.50",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$22,381.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$23,861.50","$21,315.89",$0.00
MS727,MS-DRG V38 (FY2021),MS727,,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC,"$40,626.78",$0.00,"$23,556.40",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$23,556.40",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$22,434.67",$0.00
MS728,MS-DRG V38 (FY2021),MS728,,INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC,"$23,335.23",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS729,MS-DRG V38 (FY2021),MS729,,OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CC/MCC,"$34,366.70",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS737,MS-DRG V38 (FY2021),MS737,,UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC,"$147,024.07",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS738,MS-DRG V38 (FY2021),MS738,,UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC,"$158,686.23",$0.00,"$23,225.63",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$23,225.63",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$22,119.65",$0.00
MS739,MS-DRG V38 (FY2021),MS739,,UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC,"$296,855.03",$0.00,"$76,002.23",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$39,391.56",$0.00,$0.00,$0.00,$0.00,$0.00,"$76,002.23","$37,515.77",$0.00
MS740,MS-DRG V38 (FY2021),MS740,,UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC,"$135,704.06",$0.00,"$27,721.64",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$27,721.64",$0.00,$0.00
MS741,MS-DRG V38 (FY2021),MS741,,UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC,"$184,068.62",$0.00,"$156,113.16","$128,057.13",,"$24,716.30","$24,716.30",$0.00,$0.00,$0.00,"$118,267.54",$0.00,"$128,123.16","$156,113.16",$0.00,"$13,327.31",$0.00,"$24,002.64",$0.00,$0.00
MS742,MS-DRG V38 (FY2021),MS742,,UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC,"$158,819.74",$0.00,"$144,571.35","$118,514.53",,"$22,674.12","$22,674.12","$99,078.57","$100,318.77",$0.00,"$109,523.76","$25,364.14","$118,650.74","$144,571.35","$135,777.03","$16,936.07",$0.00,"$26,942.56","$24,156.36",$0.00
MS743,MS-DRG V38 (FY2021),MS743,,UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC,"$143,180.92",$0.00,"$94,504.91","$77,560.87",,"$8,884.67","$8,884.67","$38,115.55","$38,942.35","$9,034.34","$71,594.65",$0.00,"$16,934.63","$94,504.91",$0.00,"$11,512.92","$8,031.14","$22,524.51",$0.00,"$8,432.69"
MS744,MS-DRG V38 (FY2021),MS744,,"D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC","$73,587.84",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS745,MS-DRG V38 (FY2021),MS745,,"D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC","$26,631.76",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS746,MS-DRG V38 (FY2021),MS746,,"VAGINA, CERVIX AND VULVA PROCEDURES WITH CC/MCC","$105,879.71",$0.00,"$75,281.45",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$24,948.45",$0.00,$0.00,"$75,281.45",$0.00,$0.00,$0.00,"$23,760.43",$0.00
MS748,MS-DRG V38 (FY2021),MS748,,FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,"$129,642.77",$0.00,"$101,307.70","$83,143.95",,"$9,679.95","$9,679.95",$0.00,$0.00,$0.00,"$76,748.26",$0.00,"$83,143.95","$101,307.70",$0.00,"$13,249.13",$0.00,"$23,938.94",$0.00,$0.00
MS749,MS-DRG V38 (FY2021),MS749,,OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH CC/MCC,"$135,024.00",$0.00,"$31,516.36",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$31,516.36",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$30,015.58",$0.00
MS754,MS-DRG V38 (FY2021),MS754,,"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH MCC","$195,394.27",$0.00,"$27,533.80",$0.00,,$0.00,$0.00,$0.00,$0.00,"$12,213.09",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$11,631.52","$27,533.80",$0.00,"$12,213.09"
MS755,MS-DRG V38 (FY2021),MS755,,"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH CC","$36,654.21",$0.00,"$20,798.98",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$20,798.98",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$19,808.55",$0.00
MS757,MS-DRG V38 (FY2021),MS757,,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH MCC","$32,789.28",$0.00,"$29,643.01",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$23,508.57",$0.00,$0.00,$0.00,$0.00,$0.00,"$29,643.01","$22,389.11",$0.00
MS758,MS-DRG V38 (FY2021),MS758,,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH CC","$59,230.39",$0.00,"$20,399.89",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$20,399.89",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$19,428.47",$0.00
MS759,MS-DRG V38 (FY2021),MS759,,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC","$29,906.90",$0.00,"$5,834.14",$0.00,,$0.00,$0.00,$0.00,$0.00,"$5,834.14",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,556.33",$0.00,$0.00,"$5,834.14"
MS760,MS-DRG V38 (FY2021),MS760,,MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC,"$34,815.78",$0.00,"$3,100.38",$0.00,,$0.00,$0.00,"$2,686.98","$3,100.38",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS761,MS-DRG V38 (FY2021),MS761,,MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC,"$13,285.58",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS768,MS-DRG V38 (FY2021),MS768,,VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C,"$24,918.58",$0.00,"$21,373.04","$10,495.80",,"$5,570.00","$5,570.00",$0.00,$0.00,"$6,092.76","$13,853.13",$0.00,"$14,855.59","$20,902.18",$0.00,"$10,099.48","$5,802.63","$21,373.04",$0.00,"$6,092.76"
MS769,MS-DRG V38 (FY2021),MS769,,POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES,"$77,957.63",$0.00,"$12,361.42",$0.00,,$0.00,$0.00,"$10,125.78","$10,125.78","$12,361.42",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$11,772.78",$0.00,$0.00,"$12,361.42"
MS770,MS-DRG V38 (FY2021),MS770,,"ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY","$24,066.01",$0.00,"$6,160.27",$0.00,,$0.00,$0.00,$0.00,$0.00,"$6,160.27",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,866.92",$0.00,$0.00,"$6,160.27"
MS776,MS-DRG V38 (FY2021),MS776,,POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES,"$18,942.70",$0.00,"$18,942.70","$3,706.50",,"$3,843.48","$3,843.48","$5,373.96","$6,200.76","$6,166.92","$3,843.48",$0.00,"$3,376.61","$3,044.04","$13,481.20","$3,843.48","$5,873.26","$18,942.70",$0.00,"$6,166.92"
MS779,MS-DRG V38 (FY2021),MS779,,ABORTION WITHOUT D&C,"$6,858.48",$0.00,"$23,300.47","$11,631.48",,"$5,702.65","$5,702.65","$4,686.44","$4,686.44","$1,598.25","$15,699.75",$0.00,"$16,835.84","$23,300.47",$0.00,"$11,445.75","$1,430.21","$22,469.79",$0.00,"$1,522.14"
MS783,MS-DRG V38 (FY2021),MS783,,CESAREAN SECTION WITH STERILIZATION WITH MCC,"$62,314.45",$0.00,"$9,542.28",$0.00,,$0.00,$0.00,$0.00,$0.00,"$9,542.28",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$9,087.89",$0.00,$0.00,"$9,542.28"
MS784,MS-DRG V38 (FY2021),MS784,,CESAREAN SECTION WITH STERILIZATION WITH CC,"$46,895.99",$0.00,"$37,137.03","$13,268.37",,"$14,371.50","$14,371.50","$6,748.70","$6,748.70","$9,542.28","$14,371.50",$0.00,"$7,705.74","$37,137.03","$12,460.97","$10,477.40","$9,087.89","$21,680.91",$0.00,"$9,542.28"
MS785,MS-DRG V38 (FY2021),MS785,,CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC,"$39,721.93",$0.00,"$9,542.28",$0.00,,$0.00,$0.00,"$6,748.70","$6,748.70","$9,542.28",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$9,087.89",$0.00,$0.00,"$9,542.28"
MS786,MS-DRG V38 (FY2021),MS786,,CESAREAN SECTION WITHOUT STERILIZATION WITH MCC,"$51,801.26",$0.00,"$51,796.52","$15,654.45",,"$23,574.38","$23,574.38","$6,748.70","$6,748.70","$9,542.28","$23,574.38",$0.00,"$24,076.48","$51,796.52","$27,565.16","$17,186.67","$9,087.89","$27,146.72",$0.00,"$9,542.28"
MS787,MS-DRG V38 (FY2021),MS787,,CESAREAN SECTION WITHOUT STERILIZATION WITH CC,"$49,236.94",$0.00,"$38,858.99","$12,539.10",,"$9,750.51","$9,750.51","$8,614.80","$8,614.80","$9,542.28","$14,375.63","$20,947.28","$7,707.95","$38,858.99",$0.00,"$10,480.42","$9,087.89","$21,683.37","$19,949.79","$9,542.28"
MS788,MS-DRG V38 (FY2021),MS788,,CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC,"$47,640.54",$0.00,"$37,750.88","$13,783.82",,"$10,458.44","$10,458.44",$0.00,$0.00,"$7,775.68","$12,460.25",$0.00,"$13,361.92","$37,750.88",$0.00,"$9,084.02","$7,405.42","$20,545.77",$0.00,"$7,775.68"
MS789,MS-DRG V38 (FY2021),MS789,,"NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY","$53,673.91",$0.00,"$23,015.92",$0.00,,$0.00,$0.00,"$3,375.26","$3,375.26","$23,015.92",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$20,596.05",$0.00,$0.00,$219.20
MS790,MS-DRG V38 (FY2021),MS790,,"EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE","$103,576.27",$0.00,"$345,528.12","$283,258.07",,"$102,715.00","$102,715.00","$64,129.94","$64,129.94","$25,214.25","$261,763.73",$0.00,"$283,577.38","$345,528.12",$0.00,"$76,626.93","$24,017.10","$58,657.03",$0.00,"$25,214.25"
MS791,MS-DRG V38 (FY2021),MS791,,PREMATURITY WITH MAJOR PROBLEMS,"$82,258.14",$0.00,"$131,833.16","$11,254.49",,"$5,186.00","$5,186.00",$0.00,$0.00,"$22,302.88","$19,759.75",$0.00,"$16,878.92","$15,649.71","$131,833.16","$19,759.75","$21,244.37","$44,228.51",$0.00,"$22,302.88"
MS792,MS-DRG V38 (FY2021),MS792,,PREMATURITY WITHOUT MAJOR PROBLEMS,"$31,899.59",$0.00,"$31,899.59","$3,345.30",,"$2,012.00","$2,012.00","$1,783.96","$1,783.96","$3,643.33","$5,340.18",$0.00,"$5,340.18","$4,229.42",$0.00,"$5,340.18","$3,473.37","$31,899.59",$0.00,"$3,643.33"
MS793,MS-DRG V38 (FY2021),MS793,,FULL TERM NEONATE WITH MAJOR PROBLEMS,"$12,069.27",$0.00,"$45,073.74","$3,345.30",,"$2,012.00","$2,012.00","$1,873.16","$1,873.16","$22,302.88","$4,386.25",$0.00,"$4,386.25","$3,473.91","$19,810.22","$4,386.25","$21,244.37","$45,073.74",$0.00,"$22,302.88"
MS794,MS-DRG V38 (FY2021),MS794,,NEONATE WITH OTHER SIGNIFICANT PROBLEMS,"$24,446.07",$0.00,"$24,446.07","$3,345.30",,"$2,012.00","$2,012.00","$1,873.16","$1,873.16","$2,765.74","$5,394.25",$0.00,"$5,394.25","$4,272.25",$0.00,"$5,394.25","$2,637.56","$24,446.07",$0.00,"$2,765.74"
MS795,MS-DRG V38 (FY2021),MS795,,NORMAL NEWBORN,"$14,674.90",$0.00,"$14,674.90","$3,414.60",,"$1,012.00","$1,012.00","$2,809.74","$2,809.74","$2,149.62","$2,575.38",$0.00,"$1,781.77","$3,743.93","$2,259.28","$1,877.55","$2,050.78","$14,674.90",$0.00,"$2,149.62"
MS796,MS-DRG V38 (FY2021),MS796,,VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC,"$42,660.61",$0.00,"$8,366.13",$0.00,,$0.00,$0.00,$0.00,$0.00,"$8,366.13",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$7,967.75",$0.00,$0.00,"$8,366.13"
MS797,MS-DRG V38 (FY2021),MS797,,VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC,"$41,198.85",$0.00,"$8,366.13",$0.00,,$0.00,$0.00,$0.00,$0.00,"$8,366.13",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$7,967.75",$0.00,$0.00,"$8,366.13"
MS798,MS-DRG V38 (FY2021),MS798,,VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC,"$38,722.84",$0.00,"$8,366.13",$0.00,,$0.00,$0.00,$0.00,$0.00,"$8,366.13",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$7,967.75",$0.00,$0.00,"$8,366.13"
MS799,MS-DRG V38 (FY2021),MS799,,SPLENECTOMY WITH MCC,"$151,364.89",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS803,MS-DRG V38 (FY2021),MS803,,OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC,"$140,848.34",$0.00,"$27,694.69",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$27,694.69",$0.00,$0.00
MS805,MS-DRG V38 (FY2021),MS805,,VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC,"$25,233.70",$0.00,"$25,233.70","$8,366.28",,"$7,241.19","$7,241.19","$8,418.64","$8,418.64","$6,961.79","$14,309.63",$0.00,"$7,672.56","$14,281.34",$0.00,"$10,432.30","$6,630.28","$25,233.70",$0.00,"$6,961.79"
MS806,MS-DRG V38 (FY2021),MS806,,VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC,"$20,189.99","$4,686.44","$21,350.23","$7,161.00",,"$6,397.98","$6,397.98","$4,686.44","$4,686.44","$6,092.76","$9,751.50","$18,649.09","$7,746.04","$13,604.81","$21,350.23","$7,109.24","$5,802.63","$18,936.98","$17,761.04","$6,092.76"
MS807,MS-DRG V38 (FY2021),MS807,,VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC,"$18,047.20",$0.00,"$18,264.05","$8,386.19",,"$9,714.52","$9,714.52","$4,686.44","$4,686.44","$6,092.76","$8,618.50",$0.00,"$8,401.97","$11,615.99","$17,521.13","$6,283.23","$5,802.63","$18,264.05",$0.00,"$6,092.76"
MS808,MS-DRG V38 (FY2021),MS808,,MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC,"$45,737.63",$0.00,"$30,536.62",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$30,536.62",$0.00,$0.00
MS809,MS-DRG V38 (FY2021),MS809,,MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC,"$51,680.88",$0.00,"$22,111.75",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$22,111.75",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$21,058.81",$0.00
MS810,MS-DRG V38 (FY2021),MS810,,MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CC/MCC,"$25,311.67",$0.00,"$20,194.88",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$20,194.88",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$19,233.22",$0.00
MS811,MS-DRG V38 (FY2021),MS811,,RED BLOOD CELL DISORDERS WITH MCC,"$78,735.41",$0.00,"$78,735.41","$61,435.82",,"$11,450.82","$11,450.82","$13,434.90","$15,501.90","$30,963.95","$18,429.13","$22,961.85","$19,762.72","$78,735.41",$0.00,"$13,435.57","$30,963.95","$24,090.82","$21,868.43","$30,963.95"
MS812,MS-DRG V38 (FY2021),MS812,,RED BLOOD CELL DISORDERS WITHOUT MCC,"$25,670.36",$0.00,"$20,255.87","$3,706.50",,"$7,285.18","$7,285.18","$2,686.98","$2,686.98","$8,071.38","$11,972.13","$19,752.74","$3,776.02","$13,151.79",$0.00,"$8,728.17","$7,687.04","$20,255.87","$18,812.13","$8,071.38"
MS813,MS-DRG V38 (FY2021),MS813,,COAGULATION DISORDERS,"$87,448.69",$0.00,"$87,448.69","$71,371.72",,"$14,757.80","$14,757.80",$0.00,$0.00,$0.00,"$66,249.02",$0.00,"$23,373.77","$87,448.69",$0.00,"$15,890.52",$0.00,"$52,183.21",$0.00,$0.00
MS814,MS-DRG V38 (FY2021),MS814,,RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC,"$33,623.63",$0.00,"$27,429.29",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$25,755.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$27,429.29","$24,529.05",$0.00
MS815,MS-DRG V38 (FY2021),MS815,,RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC,"$12,736.15",$0.00,"$21,416.31",$0.00,,$0.00,$0.00,"$16,564.80","$16,978.20",$0.00,$0.00,"$20,723.81",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,416.31","$19,736.96",$0.00
MS816,MS-DRG V38 (FY2021),MS816,,RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC,"$27,666.93",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS817,MS-DRG V38 (FY2021),MS817,,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC,"$174,168.93",$0.00,"$78,339.09","$23,165.68",,"$35,061.75","$35,061.75",$0.00,$0.00,"$15,615.48","$34,597.75",$0.00,"$32,736.50","$78,339.09",$0.00,"$25,223.16","$11,253.79","$33,693.78",$0.00,"$7,558.26"
MS818,MS-DRG V38 (FY2021),MS818,,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC,"$76,595.14",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS819,MS-DRG V38 (FY2021),MS819,,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC,"$81,283.87",$0.00,"$7,495.20",$0.00,,$0.00,$0.00,$0.00,$0.00,"$7,495.20",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$7,138.29",$0.00,$0.00,"$7,495.20"
MS821,MS-DRG V38 (FY2021),MS821,,LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC,"$137,152.32",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS823,MS-DRG V38 (FY2021),MS823,,LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC,"$161,090.53",$0.00,"$65,586.69",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$65,586.69",$0.00,$0.00
MS827,MS-DRG V38 (FY2021),MS827,,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC,"$364,083.79",$0.00,"$32,906.05",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$32,906.05",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$32,906.05",$0.00
MS829,MS-DRG V38 (FY2021),MS829,,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC,"$81,675.14",$0.00,"$38,787.20",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$38,787.20",$0.00,$0.00
MS830,MS-DRG V38 (FY2021),MS830,,MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC,"$178,519.03",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS831,MS-DRG V38 (FY2021),MS831,,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC,"$21,952.85",$0.00,"$21,952.85","$11,262.47",,"$16,926.53","$16,926.53",$0.00,$0.00,"$7,495.20","$14,829.38",$0.00,"$9,939.05","$19,151.15",$0.00,"$10,811.22","$7,138.29","$21,952.85",$0.00,"$7,495.20"
MS832,MS-DRG V38 (FY2021),MS832,,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC,"$14,349.99",$0.00,"$18,988.42","$3,981.51",,"$9,854.06","$9,854.06","$5,373.96","$6,200.76","$7,495.20","$13,838.13","$18,692.12","$2,930.57","$10,159.89",$0.00,"$7,172.39","$7,138.29","$18,988.42","$17,802.02","$7,495.20"
MS833,MS-DRG V38 (FY2021),MS833,,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC,"$11,239.61",$0.00,"$7,048.80","$7,048.80",,"$7,048.80","$7,048.80","$2,686.98","$3,100.38","$6,092.76","$7,048.80",$0.00,"$7,048.80","$7,048.80","$6,068.80","$7,048.80","$5,802.63","$7,048.80",$0.00,"$6,092.76"
MS834,MS-DRG V38 (FY2021),MS834,,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH MCC,"$309,893.14",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS835,MS-DRG V38 (FY2021),MS835,,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH CC,"$309,512.69",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS836,MS-DRG V38 (FY2021),MS836,,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITHOUT CC/MCC,"$17,798.27",$0.00,"$23,905.45",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$23,905.45",$0.00,$0.00
MS837,MS-DRG V38 (FY2021),MS837,,CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC,"$62,068.97",$0.00,"$62,068.97",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$62,068.97",$0.00,$0.00
MS838,MS-DRG V38 (FY2021),MS838,,CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT,"$29,889.57",$0.00,"$31,012.72",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$31,012.72",$0.00,$0.00
MS839,MS-DRG V38 (FY2021),MS839,,CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC,"$24,053.73",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS840,MS-DRG V38 (FY2021),MS840,,LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC,"$89,797.14",$0.00,"$34,299.15",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$34,299.15",$0.00,$0.00,$0.00,$0.00,$0.00,"$28,807.13","$34,299.15",$0.00
MS841,MS-DRG V38 (FY2021),MS841,,LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC,"$45,586.68",$0.00,"$19,565.68",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$19,565.68",$0.00,$0.00
MS842,MS-DRG V38 (FY2021),MS842,,LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC,"$26,361.82",$0.00,"$21,645.35",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$21,645.35",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$20,614.66",$0.00
MS843,MS-DRG V38 (FY2021),MS843,,OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC,"$84,392.23",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS844,MS-DRG V38 (FY2021),MS844,,OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC,"$45,369.94",$0.00,"$22,057.74",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$22,057.74",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$21,007.37",$0.00
MS846,MS-DRG V38 (FY2021),MS846,,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC,"$39,620.81",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS847,MS-DRG V38 (FY2021),MS847,,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC,"$45,264.16",$0.00,"$45,264.16","$19,556.25",,"$10,326.18","$10,326.18",$0.00,$0.00,$0.00,"$18,093.63",$0.00,"$19,402.95","$45,264.16","$34,827.46","$13,190.98",$0.00,"$23,891.56",$0.00,$0.00
MS848,MS-DRG V38 (FY2021),MS848,,CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC,"$28,998.68",$0.00,"$22,966.96","$11,119.50",,"$7,545.81","$7,545.81",$0.00,$0.00,$0.00,"$13,494.25",$0.00,"$12,768.30","$22,966.96",$0.00,"$9,837.86",$0.00,"$21,159.88",$0.00,$0.00
MS853,MS-DRG V38 (FY2021),MS853,,INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC,"$890,931.60",$0.00,"$890,931.60","$460,972.74",,"$153,553.63","$153,553.63","$890,931.60","$890,931.60",$0.00,"$428,083.19","$48,645.14","$463,756.79","$565,069.81","$228,902.42","$140,496.05",$0.00,"$54,782.85","$46,328.70",$0.00
MS854,MS-DRG V38 (FY2021),MS854,,INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC,"$107,718.03",$0.00,"$28,571.70",$0.00,,$0.00,$0.00,$766.50,$766.50,$0.00,$0.00,"$28,571.70",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$27,211.14",$0.00
MS856,MS-DRG V38 (FY2021),MS856,,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC,"$342,694.67",$0.00,"$49,287.63",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$49,287.63",$0.00,$0.00
MS857,MS-DRG V38 (FY2021),MS857,,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC,"$409,840.86",$0.00,"$409,840.86","$333,075.20",,"$18,297.75","$18,297.75",$0.00,$0.00,$0.00,"$310,485.49","$27,697.65","$336,359.28","$409,840.86",$0.00,"$88,518.80",$0.00,"$53,140.71","$26,378.71",$0.00
MS858,MS-DRG V38 (FY2021),MS858,,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC,"$206,438.96",$0.00,"$206,438.96",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$206,438.96",$0.00,$0.00,$0.00,$0.00,$0.00
MS862,MS-DRG V38 (FY2021),MS862,,POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC,"$38,391.08",$0.00,"$28,258.17",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$28,258.17",$0.00,$0.00
MS863,MS-DRG V38 (FY2021),MS863,,POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC,"$40,021.22",$0.00,"$20,554.34",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$20,554.34",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$19,575.56",$0.00
MS864,MS-DRG V38 (FY2021),MS864,,FEVER AND INFLAMMATORY CONDITIONS,"$20,175.01",$0.00,"$47,628.02",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$47,628.02",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$29,690.76",$0.00
MS865,MS-DRG V38 (FY2021),MS865,,VIRAL ILLNESS WITH MCC,"$14,008.97",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS866,MS-DRG V38 (FY2021),MS866,,VIRAL ILLNESS WITHOUT MCC,"$26,124.06",$0.00,"$26,124.06","$11,119.50",,"$6,627.35","$6,627.35",$0.00,$0.00,$0.00,"$11,257.13",$0.00,"$10,651.53","$26,124.06",$0.00,"$8,206.90",$0.00,"$19,831.20",$0.00,$0.00
MS867,MS-DRG V38 (FY2021),MS867,,OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC,"$15,095.10",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS868,MS-DRG V38 (FY2021),MS868,,OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC,"$69,508.29",$0.00,"$69,508.29","$44,478.00",,"$9,726.37","$9,726.37",$0.00,$0.00,$0.00,"$15,083.75",$0.00,"$16,175.27","$69,508.29",$0.00,"$10,996.66",$0.00,"$22,103.93",$0.00,$0.00
MS869,MS-DRG V38 (FY2021),MS869,,OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC,"$14,690.86",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS870,MS-DRG V38 (FY2021),MS870,,SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS,"$437,462.32",$0.00,"$437,462.32","$355,514.01",,"$119,822.46","$119,822.46","$329,494.18","$329,589.60",$0.00,"$331,410.85","$57,021.26","$359,028.42","$437,462.32",$0.00,"$105,276.97",$0.00,"$64,792.48","$71,505.46",$0.00
MS871,MS-DRG V38 (FY2021),MS871,,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC,"$84,768.76","$7,088.64","$69,468.99","$33,107.31",,"$16,130.58","$16,130.58","$7,088.64","$7,088.64","$17,608.91","$25,661.63","$26,556.42","$27,518.59","$69,468.99","$47,721.33","$18,708.37","$16,770.40","$28,386.40","$30,367.39","$17,608.91"
MS872,MS-DRG V38 (FY2021),MS872,,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC,"$45,041.46",$0.00,"$25,653.18","$7,665.47",,"$9,397.01","$9,397.01",$0.00,$0.00,"$7,781.16","$14,290.38","$20,904.90","$7,127.66","$25,653.18",$0.00,"$10,418.26","$6,963.04","$21,632.73","$19,909.43","$7,410.63"
MS876,MS-DRG V38 (FY2021),MS876,,O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS,"$135,195.61",$0.00,"$46,127.21",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$46,127.21",$0.00,$0.00
MS880,MS-DRG V38 (FY2021),MS880,,ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION,"$28,727.53","$5,603.41","$50,316.83","$7,955.52",,"$5,983.81","$5,983.81","$6,750.52","$6,750.52","$5,883.58","$11,782.38","$50,316.83","$7,019.44","$50,065.60","$33,004.93","$8,589.83","$5,603.41","$20,143.15","$49,378.27","$5,883.58"
MS881,MS-DRG V38 (FY2021),MS881,,DEPRESSIVE NEUROSES,"$19,401.50",$0.00,"$19,401.50",$0.00,,$0.00,$0.00,$0.00,$0.00,"$5,075.40",$0.00,"$19,401.50",$0.00,$0.00,"$5,860.95",$0.00,"$4,833.71",$0.00,"$18,477.62","$5,075.40"
MS882,MS-DRG V38 (FY2021),MS882,,NEUROSES EXCEPT DEPRESSIVE,"$37,787.89",$0.00,"$12,620.55",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$12,620.55",$0.00,$0.00
MS883,MS-DRG V38 (FY2021),MS883,,DISORDERS OF PERSONALITY AND IMPULSE CONTROL,"$20,732.26",$0.00,"$22,936.59",$0.00,,$0.00,$0.00,"$5,619.48","$5,619.48","$7,497.10",$0.00,"$22,936.59",$0.00,$0.00,$0.00,$0.00,"$7,140.10","$7,183.84","$21,844.37","$7,497.10"
MS884,MS-DRG V38 (FY2021),MS884,,ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY,"$44,664.95",$0.00,"$24,888.70",$0.00,,$0.00,$0.00,"$2,686.98","$3,100.38",$0.00,$0.00,"$23,629.52",$0.00,$0.00,$0.00,$0.00,$0.00,"$24,888.70","$22,504.30",$0.00
MS885,MS-DRG V38 (FY2021),MS885,,PSYCHOSES,"$22,555.24","$4,682.90","$16,711.75","$10,035.90",,"$9,119.42","$9,119.42","$4,682.90","$4,682.90","$6,867.66","$16,711.75","$9,222.35","$12,800.77","$14,261.38","$11,383.39","$9,000.00","$6,540.64","$4,851.36","$8,783.19","$6,867.66"
MS886,MS-DRG V38 (FY2021),MS886,,BEHAVIORAL AND DEVELOPMENTAL DISORDERS,"$16,492.72",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS887,MS-DRG V38 (FY2021),MS887,,OTHER MENTAL DISORDER DIAGNOSES,"$57,514.90",$0.00,"$57,514.90","$19,254.53",,"$8,326.81","$8,326.81",$0.00,$0.00,$0.00,"$14,961.38",$0.00,"$16,044.03","$57,514.90",$0.00,"$10,907.45",$0.00,"$22,031.26",$0.00,$0.00
MS894,MS-DRG V38 (FY2021),MS894,,"ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA","$18,043.08",$0.00,"$17,768.90",$0.00,,$0.00,$0.00,$0.00,$0.00,"$13,291.30",$0.00,"$17,768.90",$0.00,$0.00,$0.00,$0.00,"$12,658.39",$0.00,"$16,922.76","$13,291.30"
MS896,MS-DRG V38 (FY2021),MS896,,"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC","$57,435.46",$0.00,"$40,932.53","$15,913.15",,"$13,606.38","$13,606.38","$3,375.26","$3,375.26",$0.00,"$23,645.88","$25,554.59","$15,138.49","$40,932.53",$0.00,"$17,238.80",$0.00,"$27,189.19","$24,337.70",$0.00
MS897,MS-DRG V38 (FY2021),MS897,,"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC","$41,618.80","$4,824.19","$41,618.80","$24,105.67",,"$41,618.80","$41,618.80","$5,623.04","$5,813.88","$6,821.08","$41,618.80","$19,418.55","$41,618.80","$32,962.09","$14,261.88","$41,618.80","$6,496.27","$4,824.19","$18,493.86","$6,821.08"
MS901,MS-DRG V38 (FY2021),MS901,,WOUND DEBRIDEMENTS FOR INJURIES WITH MCC,"$95,589.07",$0.00,"$137,327.80",$0.00,,$0.00,$0.00,"$137,327.80","$137,327.80",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS902,MS-DRG V38 (FY2021),MS902,,WOUND DEBRIDEMENTS FOR INJURIES WITH CC,"$69,538.00",$0.00,"$29,207.95",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$27,243.90",$0.00,$0.00,$0.00,$0.00,$0.00,"$29,207.95","$25,946.57",$0.00
MS903,MS-DRG V38 (FY2021),MS903,,WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC,"$342,304.46",$0.00,"$342,304.46","$279,915.50",,"$77,005.60","$77,005.60",$0.00,$0.00,$0.00,"$259,321.57",$0.00,"$280,931.70","$342,304.46",$0.00,"$66,795.60",$0.00,"$40,627.42",$0.00,$0.00
MS904,MS-DRG V38 (FY2021),MS904,,SKIN GRAFTS FOR INJURIES WITH CC/MCC,"$127,205.10",$0.00,"$136,934.37","$109,656.53",,"$30,023.48","$30,023.48","$132,961.05","$132,961.05","$25,040.40","$103,738.17",$0.00,"$112,383.02","$136,934.37",$0.00,"$35,459.97","$23,848.01","$42,033.36",$0.00,"$25,040.40"
MS905,MS-DRG V38 (FY2021),MS905,,SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC,"$55,613.82",$0.00,"$57,852.44",$0.00,,$0.00,$0.00,"$57,852.44","$57,852.44",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS906,MS-DRG V38 (FY2021),MS906,,HAND PROCEDURES FOR INJURIES,"$156,068.25",$0.00,"$156,068.25","$126,830.06",,"$24,684.42","$24,684.42","$102,200.59","$102,200.59",$0.00,"$118,233.52",$0.00,"$128,086.32","$156,068.25",$0.00,"$17,451.31",$0.00,"$27,362.32",$0.00,$0.00
MS907,MS-DRG V38 (FY2021),MS907,,OTHER O.R. PROCEDURES FOR INJURIES WITH MCC,"$388,246.60",$0.00,"$388,246.60","$195,377.40",,"$60,162.97","$60,162.97","$71,015.93","$71,015.93","$41,365.72","$189,941.91",$0.00,"$205,770.40","$250,723.31",$0.00,"$45,461.07","$39,395.94","$388,246.60",$0.00,"$41,365.72"
MS908,MS-DRG V38 (FY2021),MS908,,OTHER O.R. PROCEDURES FOR INJURIES WITH CC,"$182,669.21",$0.00,"$182,669.21","$87,374.68",,"$17,472.12","$17,472.12",$0.00,$0.00,"$16,654.30","$89,996.30","$27,901.30","$97,496.00","$118,795.12","$182,669.21","$20,681.15","$15,861.25","$29,993.55","$26,572.67","$16,654.30"
MS909,MS-DRG V38 (FY2021),MS909,,OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC,"$85,790.96",$0.00,"$58,188.52","$9,096.46",,"$11,207.15","$11,207.15",$0.00,$0.00,"$16,654.30","$18,132.13","$22,814.25","$47,755.73","$58,188.52",$0.00,"$13,219.05","$15,861.25","$23,914.43","$21,727.86","$16,654.30"
MS913,MS-DRG V38 (FY2021),MS913,,TRAUMATIC INJURY WITH MCC,"$49,677.46",$0.00,"$25,201.47",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$25,201.47",$0.00,$0.00
MS914,MS-DRG V38 (FY2021),MS914,,TRAUMATIC INJURY WITHOUT MCC,"$53,110.42",$0.00,"$42,063.45","$34,521.77",,"$6,256.04","$6,256.04",$0.00,$0.00,$0.00,"$11,848.38",$0.00,"$34,521.77","$42,063.45",$0.00,"$8,637.95",$0.00,"$20,182.36",$0.00,$0.00
MS915,MS-DRG V38 (FY2021),MS915,,ALLERGIC REACTIONS WITH MCC,"$137,187.38",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS916,MS-DRG V38 (FY2021),MS916,,ALLERGIC REACTIONS WITHOUT MCC,"$12,783.43",$0.00,"$18,988.45",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$18,129.72",$0.00,$0.00,$0.00,$0.00,$0.00,"$18,316.33","$18,988.45",$0.00
MS917,MS-DRG V38 (FY2021),MS917,,POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC,"$37,138.99",$0.00,"$51,372.18","$15,715.11",,"$12,541.54","$12,541.54","$9,562.04","$9,657.46","$11,999.16","$20,119.00","$23,801.74","$17,979.07","$51,372.18",$0.00,"$14,667.56","$11,427.78","$25,094.49","$22,668.32","$11,999.16"
MS918,MS-DRG V38 (FY2021),MS918,,POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC,"$20,804.36","$2,488.34","$19,547.84","$3,706.50",,"$2,488.34","$2,488.34","$5,623.04","$5,813.88","$6,256.30","$10,780.00","$19,160.25","$3,729.06","$12,112.06","$13,648.19","$6,834.23","$5,958.38","$19,547.84","$18,247.86","$6,256.30"
MS919,MS-DRG V38 (FY2021),MS919,,COMPLICATIONS OF TREATMENT WITH MCC,"$69,950.28",$0.00,"$69,950.28","$26,105.70",,"$14,950.60","$14,950.60",$0.00,$0.00,$0.00,"$25,097.88","$26,276.23","$26,914.05","$69,950.28",$0.00,"$18,297.37",$0.00,"$28,051.57","$25,024.98",$0.00
MS920,MS-DRG V38 (FY2021),MS920,,COMPLICATIONS OF TREATMENT WITH CC,"$41,998.17",$0.00,"$28,277.30","$15,662.42",,"$8,791.84","$8,791.84","$6,750.52","$6,750.52",$0.00,"$13,853.13","$20,687.60","$14,855.59","$28,277.30",$0.00,"$10,099.48",$0.00,"$21,373.04","$19,702.48",$0.00
MS921,MS-DRG V38 (FY2021),MS921,,COMPLICATIONS OF TREATMENT WITHOUT CC/MCC,"$18,521.98",$0.00,"$18,521.98",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$18,521.98",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$17,639.98",$0.00
MS922,MS-DRG V38 (FY2021),MS922,,"OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC","$76,457.28",$0.00,"$61,719.57","$10,797.35",,"$13,346.64","$13,346.64",$0.00,$0.00,"$1,492.22","$22,049.50",$0.00,"$3,753.19","$61,719.57",$0.00,"$16,074.98","$1,335.32","$26,241.08",$0.00,"$1,421.16"
MS923,MS-DRG V38 (FY2021),MS923,,"OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC","$26,415.60",$0.00,"$2,906.94",$0.00,,$0.00,$0.00,"$2,811.52","$2,906.94",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS927,MS-DRG V38 (FY2021),MS927,,EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT,"$666,744.44",$0.00,"$366,645.98","$300,908.95",,"$138,794.21","$138,794.21",$0.00,$0.00,"$128,927.26","$277,762.11",$0.00,"$300,908.95","$366,645.98",$0.00,"$199,919.71","$122,787.92","$176,013.20",$0.00,"$128,927.26"
MS928,MS-DRG V38 (FY2021),MS928,,FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC,"$195,914.18",$0.00,"$126,523.70","$103,838.89",,"$48,038.28","$48,038.28","$98,182.96","$98,182.96","$21,266.66","$95,851.28","$56,136.99","$103,838.89","$126,523.70",$0.00,"$62,099.56","$20,253.97","$63,735.75","$53,463.80","$21,266.66"
MS929,MS-DRG V38 (FY2021),MS929,,FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC,"$109,114.80","$9,685.54","$80,164.64","$52,200.82",,"$48,038.28","$48,038.28","$80,164.64","$80,164.64","$10,169.81","$48,185.37","$33,904.08","$52,200.82","$63,604.70","$60,897.37","$62,099.56","$9,685.54","$63,735.75","$32,289.60","$10,169.81"
MS933,MS-DRG V38 (FY2021),MS933,,EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT,"$337,015.37",$0.00,"$35,261.93",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$35,261.93",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$33,582.79",$0.00
MS934,MS-DRG V38 (FY2021),MS934,,FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY,"$24,737.13",$0.00,"$27,924.99","$13,568.33",,"$14,056.24","$14,056.24","$5,099.09","$5,099.09","$2,480.91","$12,524.62","$26,170.31","$4,043.26","$16,532.51",$0.00,"$18,141.99","$2,220.06","$27,924.99","$24,924.10","$2,362.77"
MS935,MS-DRG V38 (FY2021),MS935,,NON-EXTENSIVE BURNS,"$18,751.19","$2,410.65","$28,925.37","$15,169.68",,"$13,136.00","$13,136.00","$8,993.40","$8,993.40","$2,693.89","$23,337.97","$27,007.44","$15,169.68","$18,483.67","$7,817.30","$19,369.96","$2,410.65","$28,925.37","$25,721.37","$2,565.61"
MS940,MS-DRG V38 (FY2021),MS940,,O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC,"$132,291.35",$0.00,"$27,930.95",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$27,930.95",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$27,930.95",$0.00
MS941,MS-DRG V38 (FY2021),MS941,,O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC,"$123,413.02",$0.00,"$26,996.52",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$26,996.52",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$25,710.97",$0.00
MS947,MS-DRG V38 (FY2021),MS947,,SIGNS AND SYMPTOMS WITH MCC,"$34,753.59",$0.00,"$22,923.01",$0.00,,$0.00,$0.00,$0.00,$0.00,"$14,525.45",$0.00,"$21,984.63",$0.00,$0.00,$0.00,$0.00,"$13,833.77","$22,923.01","$20,937.74","$14,525.45"
MS948,MS-DRG V38 (FY2021),MS948,,SIGNS AND SYMPTOMS WITHOUT MCC,"$32,911.45",$0.00,"$31,248.40","$3,909.58",,"$2,448.05","$2,448.05","$2,686.98","$3,100.38",$0.00,"$10,719.50","$19,130.18","$3,483.39","$31,248.40","$17,149.01","$6,011.26",$0.00,"$19,511.90","$18,219.22",$0.00
MS950,MS-DRG V38 (FY2021),MS950,,AFTERCARE WITHOUT CC/MCC,"$21,227.52",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS951,MS-DRG V38 (FY2021),MS951,,OTHER FACTORS INFLUENCING HEALTH STATUS,"$20,033.73",$0.00,"$20,033.73",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$20,033.73",$0.00,$0.00
MS955,MS-DRG V38 (FY2021),MS955,,CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,"$360,607.51","$49,740.42","$440,243.88","$361,311.26",,"$49,740.42","$49,740.42","$155,516.11","$155,516.11","$56,532.01","$333,518.09","$74,415.79","$361,311.27","$440,243.88","$303,884.19","$105,609.45","$53,840.04","$62,801.51","$70,872.18","$56,532.01"
MS956,MS-DRG V38 (FY2021),MS956,,"LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA","$312,754.79","$38,679.47","$278,577.75","$174,522.63",,"$49,032.90","$49,032.90","$57,043.76","$57,043.76","$103,932.75","$161,097.81","$40,613.44","$174,522.63","$212,649.13","$278,577.75","$39,328.35","$84,114.71","$45,184.81","$38,679.47","$53,545.64"
MS957,MS-DRG V38 (FY2021),MS957,,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC,"$661,644.95","$61,099.30","$661,644.95","$260,299.36",,"$61,099.30","$61,099.30","$190,235.48","$190,235.48","$80,537.94","$256,957.20","$65,286.01","$278,370.30","$339,183.51","$661,644.95","$78,684.59","$76,702.83","$74,669.01","$62,177.15","$80,537.94"
MS958,MS-DRG V38 (FY2021),MS958,,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC,"$269,852.82","$31,603.87","$179,708.38","$120,370.81",,"$34,455.10","$34,455.10","$132,225.45","$132,225.45","$33,184.05","$120,574.69","$42,442.17","$130,622.58","$159,158.58","$179,708.38","$42,010.85","$31,603.87","$47,370.16","$40,421.11","$33,184.05"
MS959,MS-DRG V38 (FY2021),MS959,,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC,"$171,148.47",$0.00,"$121,673.30","$100,458.68",,"$22,713.31","$22,713.31",$0.00,$0.00,"$20,439.46","$92,176.73",$0.00,"$99,858.13","$121,673.30",$0.00,"$28,073.07","$19,466.16","$36,015.52",$0.00,"$20,439.46"
MS963,MS-DRG V38 (FY2021),MS963,,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC,"$180,094.36","$24,162.84","$113,231.89","$30,309.79",,"$24,162.84","$24,162.84","$69,300.83","$69,300.83","$30,904.01","$37,470.13","$32,425.24","$64,598.93","$78,711.32","$113,231.89","$27,317.23","$29,432.41","$35,399.75","$30,881.18","$30,904.01"
MS964,MS-DRG V38 (FY2021),MS964,,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC,"$77,259.41",$0.00,"$62,293.64","$12,715.70",,"$13,182.41","$13,182.41","$36,292.83","$36,292.83","$4,534.88","$20,535.63",$0.00,"$51,124.83","$62,293.64","$33,880.61","$14,971.29","$4,058.08","$25,341.92",$0.00,"$4,318.93"
MS965,MS-DRG V38 (FY2021),MS965,,OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC,"$52,366.58",$0.00,"$46,222.92","$8,853.60",,"$8,406.25","$8,406.25",$0.00,$0.00,"$8,595.28","$12,610.13",$0.00,"$37,935.50","$46,222.92",$0.00,"$9,193.30","$8,185.98","$20,634.78",$0.00,"$8,595.28"
MS969,MS-DRG V38 (FY2021),MS969,,HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC,"$887,778.99",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS970,MS-DRG V38 (FY2021),MS970,,HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC,"$138,163.30",$0.00,"$36,966.90",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$36,966.90",$0.00,$0.00
MS974,MS-DRG V38 (FY2021),MS974,,HIV WITH MAJOR RELATED CONDITION WITH MCC,"$108,685.66",$0.00,"$64,425.98","$15,927.32",,"$23,964.69","$23,964.69","$58,478.37","$59,718.57",$0.00,"$36,766.13","$27,554.25","$13,595.40","$64,425.98",$0.00,"$26,803.98",$0.00,"$44,204.35","$27,554.25",$0.00
MS975,MS-DRG V38 (FY2021),MS975,,HIV WITH MAJOR RELATED CONDITION WITH CC,"$45,147.32",$0.00,"$25,529.20",$0.00,,$0.00,$0.00,"$21,105.77","$21,105.77",$0.00,$0.00,"$22,973.48",$0.00,$0.00,$0.00,$0.00,$0.00,"$24,104.72","$25,529.20",$0.00
MS976,MS-DRG V38 (FY2021),MS976,,HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC,"$24,325.42",$0.00,"$23,764.33",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$23,764.33",$0.00,$0.00
MS977,MS-DRG V38 (FY2021),MS977,,HIV WITH OR WITHOUT OTHER RELATED CONDITION,"$31,936.67",$0.00,"$23,765.79",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$23,765.79",$0.00,$0.00
MS981,MS-DRG V38 (FY2021),MS981,,EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC,"$265,737.73",$0.00,"$47,748.94",$0.00,,$0.00,$0.00,"$6,750.52","$6,750.52",$0.00,$0.00,"$44,568.12",$0.00,$0.00,$0.00,$0.00,$0.00,"$47,748.94","$42,445.83",$0.00
MS982,MS-DRG V38 (FY2021),MS982,,EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC,"$113,885.53",$0.00,"$33,055.16",$0.00,,$0.00,$0.00,$0.00,$0.00,"$21,856.15",$0.00,"$30,463.26",$0.00,$0.00,$0.00,$0.00,"$20,815.40","$33,055.16","$29,012.63","$21,856.15"
MS983,MS-DRG V38 (FY2021),MS983,,EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,"$151,230.13",$0.00,"$84,648.54","$7,643.73",,"$16,101.12","$16,101.12","$39,894.90","$40,721.70",$0.00,"$64,127.69",$0.00,"$7,786.79","$84,648.54",$0.00,"$16,410.80",$0.00,"$26,514.63",$0.00,$0.00
MS987,MS-DRG V38 (FY2021),MS987,,NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC,"$273,920.69",$0.00,"$129,871.79",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$62,005.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$129,871.79","$59,052.55",$0.00
MS988,MS-DRG V38 (FY2021),MS988,,NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC,"$81,715.39",$0.00,"$101,160.63","$82,827.45",,"$15,747.67","$15,747.67",$0.00,$0.00,$0.00,"$76,636.84","$24,328.59","$83,023.25","$101,160.63",$0.00,"$17,224.76",$0.00,"$27,177.75","$24,328.59",$0.00
MS989,MS-DRG V38 (FY2021),MS989,,NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,"$81,698.56",$0.00,$0.00,$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS998,MS-DRG V38 (FY2021),MS998,,PRINCIPAL DIAGNOSIS INVALID AS DISCHARGE DIAGNOSIS,"$19,922.78",$0.00,"$6,092.76",$0.00,,$0.00,$0.00,$0.00,$0.00,"$6,092.76",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,802.63",$0.00,$0.00,"$6,092.76"
MS999,MS-DRG V38 (FY2021),MS999,,UNGROUPABLE,"$360,607.51",$0.00,"$62,801.51",$0.00,,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$62,801.51",$0.00,$0.00
812,EAP,CPT® 00812,,ANESTHESIA LOWER INTST ENDOSCOPIC PX SCR COLSC,$625.00,$0.00,$625.00,$339.38,$446.06,$0.00,$107.68,$446.06,$446.06,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$0.00,$0.00
813,EAP,CPT® 00813,,ANESTHESIA COMBINED UPPER&LOWER GI ENDOSCOPIC PX,$625.00,$0.00,$625.00,$339.38,$446.06,$0.00,$107.68,$446.06,$446.06,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$0.00,$0.00
11721,EAP,CPT®11721,,"PR DEBRIDEMENT OF NAILS, 6 OR MORE",$73.67,,,,,,,,,,,,,,,,,,,
16020,EAP,CPT®16020,,PR DRESS/DEBRID SMALL BURN NO ANES,$161.00,,,,,,,,,,,,,,,,,,,
17250,EAP,CPT® 17250,,CHEM CAUTERY GRANULATN TISSUE,$305.00,$0.00,$305.00,$305.00,$0.00,$167.55,$52.55,$0.00,$0.00,$53.40,$305.00,$175.24,$305.00,$241.56,$244.00,$243.48,$37.05,$38.57,$48.56,$166.90
19120,EAP,CPT®19120,,PR REMOVAL OF BREAST LESION,"$1,298.00",,,,,,,,,,,,,,,,,,,
20526,EAP,CPT® 20526,,INJECT CARPAL TUNNEL,$284.00,$0.00,$284.00,$284.00,$0.00,$251.01,$48.93,$0.00,$0.00,$49.73,$284.00,$262.54,$284.00,$224.93,$227.20,$284.00,$44.45,$59.49,$45.21,$250.04
20550,EAP,CPT® 20550,,INJECT TENDON SHEATH/LIGAMENT,$197.00,$31.36,$262.54,$197.00,$197.00,$251.01,$33.94,$197.00,$197.00,$34.49,$197.00,$262.54,$197.00,$156.02,$157.60,$197.00,$70.34,$40.75,$31.36,$250.04
20551,EAP,CPT® 20551,,INJECT TENDON ORIGIN/INSERT,$202.00,$0.00,$262.54,$202.00,$0.00,$251.01,$0.00,$0.00,$0.00,$35.37,$202.00,$262.54,$202.00,$159.98,$161.60,$202.00,$0.00,$41.47,$32.16,$250.04
20552,EAP,CPT® 20552,,"INJECT TRIGGER POINT, 1 OR 2",$201.00,$0.00,$262.54,$201.00,$0.00,$251.01,$34.63,$0.00,$0.00,$35.19,$201.00,$262.54,$201.00,$159.19,$160.80,$201.00,$66.56,$40.02,$32.00,$250.04
20553,EAP,CPT® 20553,,"INJECT TRIGGER POINTS, > 3",$230.00,$0.00,$262.54,$230.00,$0.00,$251.01,$39.63,$0.00,$0.00,$40.27,$230.00,$262.54,$230.00,$182.16,$184.00,$230.00,$66.56,$45.07,$36.62,$250.04
20600,EAP,CPT® 20600,,ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US,$182.00,$28.97,$262.54,$182.00,$182.00,$251.01,$31.36,$182.00,$182.00,$31.87,$182.00,$262.54,$182.00,$144.14,$145.60,$182.00,$54.79,$37.50,$28.97,$250.04
20604,EAP,CPT® 20604,,ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT,$274.00,$0.00,$274.00,$274.00,$0.00,$251.01,$47.21,$0.00,$0.00,$47.98,$274.00,$262.54,$274.00,$217.01,$219.20,$274.00,$69.40,$47.60,$43.62,$250.04
20606,EAP,CPT® 20606,,ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US,$303.00,$0.00,$626.89,$303.00,$0.00,$599.36,$52.21,$0.00,$0.00,$53.05,$303.00,$626.89,$303.00,$239.98,$242.40,$303.00,$76.82,$54.81,$48.24,$597.04
20610,EAP,CPT®20610,,PR ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US,$135.33,,,,,,,,,,,,,,,,,,,
20610,EAP,CPT® 20610,,ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US,$223.00,$35.50,$262.54,$223.00,$223.00,$251.01,$38.42,$223.00,$223.00,$39.05,$223.00,$262.54,$223.00,$176.62,$178.40,$223.00,$70.76,$47.59,$35.50,$250.04
20611,EAP,CPT® 20611,,ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US,$338.00,$0.00,$338.00,$338.00,$0.00,$251.01,$58.24,$0.00,$0.00,$59.18,$338.00,$262.54,$338.00,$267.70,$270.40,$338.00,$88.61,$62.38,$53.81,$250.04
28470,EAP,CPT® 28470,,CLOSED RX METATARSAL FX,$790.00,$0.00,$790.00,$790.00,$0.00,$206.78,$136.11,$0.00,$0.00,$138.32,$790.00,$216.27,$790.00,$625.68,$632.00,$300.48,$214.80,$210.83,$125.77,$205.98
28510,EAP,CPT® 28510,,CLOSED RX TOE FX,$438.00,$0.00,$346.90,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$346.90,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
29826,EAP,CPT®29826,,PR SHOULDER SCOPE BONE SHAVING,$546.00,,,,,,,,,,,,,,,,,,,
29881,EAP,CPT®29881,,PR ARTHRS KNE SURG W/MENISCECTOMY MED/LAT W/SHVG,"$1,687.00",,,,,,,,,,,,,,,,,,,
31720,EAP,CPT®31720,,"PR CATHETER ASPIRATN,NASOTRACH",$172.00,,,,,,,,,,,,,,,,,,,
36415,EAP,CPT® 36415,,"PHLEB, VENIPUNCTURE",$11.00,$1.51,$11.00,$5.97,$3.00,$3.00,$1.51,$3.00,$3.00,$1.93,$11.00,$3.15,$5.50,$8.71,$8.80,$4.35,$1.72,$3.00,$1.75,$3.00
36556,EAP,CPT®36556,,PR INSERT NON-TUNNEL CV CATH,$252.33,,,,,,,,,,,,,,,,,,,
42820,EAP,CPT®42820,,"REMOVE TONSILS/ADENOIDS,<12 Y/O",$893.00,,,,,,,,,,,,,,,,,,,
43235,EAP,CPT®43235,,PR ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC,$383.00,,,,,,,,,,,,,,,,,,,
43239,EAP,CPT®43239,,PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE,$432.00,,,,,,,,,,,,,,,,,,,
43239,EAP,CPT® 43239,,EGD TRANSORAL BIOPSY SINGLE/MULTIPLE,"$1,341.00",$143.86,"$1,341.00","$1,341.00","$1,341.00",$753.62,$231.05,"$1,341.00","$1,341.00",$234.80,"$1,341.00",$788.23,"$1,341.00","$1,062.07","$1,072.80","$1,095.14",$236.04,$143.86,$213.49,$750.70
45330,EAP,CPT® 45330,,SIGMOIDOSCOPY FLX DX W/COLLJ SPEC BR/WA IF PFRMD,$628.00,$0.00,$766.13,$628.00,$628.00,$732.48,$0.00,$628.00,$628.00,$109.96,$628.00,$766.13,$628.00,$497.38,$502.40,$628.00,$0.00,$58.04,$99.98,$729.64
45378,EAP,CPT®45378,,PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD,$579.00,,,,,,,,,,,,,,,,,,,
45378,EAP,CPT® 45378,,COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD,"$1,188.00",$189.13,"$1,188.00","$1,188.00","$1,188.00",$732.48,$204.69,"$1,188.00","$1,188.00",$208.01,"$1,188.00",$766.13,"$1,188.00",$940.90,$950.40,"$1,064.43",$325.51,$192.90,$189.13,$729.64
45380,EAP,CPT®45380,,PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE,$626.00,,,,,,,,,,,,,,,,,,,
45380,EAP,CPT® 45380,,COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE,"$1,530.00",$208.77,"$1,530.00","$1,530.00","$1,482.64",$962.95,$263.61,"$1,482.64","$1,482.64",$267.89,"$1,530.00","$1,007.17","$1,530.00","$1,211.76","$1,224.00","$1,399.33",$353.17,$208.77,$243.58,$959.21
45385,EAP,CPT®45385,,PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ,$795.00,,,,,,,,,,,,,,,,,,,
45385,EAP,CPT® 45385,,COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ,"$1,598.00",$254.40,"$1,598.00","$1,598.00","$1,482.64",$962.95,$275.33,"$1,482.64","$1,482.64",$279.80,"$1,598.00","$1,007.17","$1,598.00","$1,265.62","$1,278.40","$1,399.33",$450.95,$265.02,$254.40,$959.21
45391,EAP,CPT®45391,,PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX,$804.00,,,,,,,,,,,,,,,,,,,
47562,EAP,CPT®47562,,"PR LAP,CHOLECYSTECTOMY","$1,960.00",,,,,,,,,,,,,,,,,,,
49505,EAP,CPT®49505,,"PR REPAIR ING HERNIA,5+Y/O,REDUCIBL","$1,550.00",,,,,,,,,,,,,,,,,,,
55700,EAP,CPT®55700,,"PR BIOPSY OF PROSTATE,NEEDLE/PUNCH",$408.00,,,,,,,,,,,,,,,,,,,
55866,EAP,CPT®55866,,"PR LAP,PROSTATECTOMY,RADICAL,W/NERVE SPARE,INCL ROBOTIC","$4,510.00",,,,,,,,,,,,,,,,,,,
56605,EAP,CPT® 56605,,"BIOPSY VULVA/PERINEUM,ONE LESN",$328.00,$52.22,$640.34,$328.00,$328.00,$612.22,$56.51,$328.00,$328.00,$57.43,$328.00,$640.34,$328.00,$259.78,$262.40,$328.00,$84.36,$63.10,$52.22,$609.84
57454,EAP,CPT® 57454,,"COLPOSC,CERVIX W/ADJ VAG,W/BX & CURRETAG",$594.00,$94.56,$594.00,$594.00,$594.00,$259.59,$102.34,$594.00,$594.00,$104.00,$594.00,$271.52,$594.00,$470.45,$475.20,$377.23,$99.94,$140.25,$94.56,$258.59
57455,EAP,CPT® 57455,,"COLPOSCOPY,CERVIX W/ADJ VAGINA,W/BX",$560.00,$89.15,$560.00,$560.00,$560.00,$259.59,$96.49,$560.00,$560.00,$98.05,$560.00,$271.52,$560.00,$443.52,$448.00,$377.23,$145.54,$115.02,$89.15,$258.59
57456,EAP,CPT® 57456,,"COLPOSCOPY,CERVIX W/ADJ VAGINA, CURETTAG",$526.00,$83.74,$526.00,$526.00,$526.00,$259.59,$90.63,$526.00,$526.00,$92.10,$526.00,$271.52,$526.00,$416.59,$420.80,$377.23,$137.69,$106.36,$83.74,$258.59
57500,EAP,CPT® 57500,,BIOPSY/EXCIS CERVICAL LESN,$518.00,$71.26,$640.34,$518.00,$518.00,$612.22,$89.25,$518.00,$518.00,$90.70,$518.00,$640.34,$518.00,$410.26,$414.40,$518.00,$71.26,$78.23,$82.47,$609.84
58100,EAP,CPT® 58100,,BIOPSY OF UTERUS LINING,$353.00,$56.20,$353.00,$353.00,$353.00,$159.23,$60.82,$353.00,$353.00,$61.81,$353.00,$166.54,$353.00,$279.58,$282.40,$231.38,$59.72,$67.07,$56.20,$158.61
58110,EAP,CPT® 58110,,ENDOMET BIOPSY DONE W/COLPOSCOPY,$184.00,$0.00,$184.00,$184.00,$0.00,$0.00,$43.25,$0.00,$0.00,$32.22,$184.00,$0.00,$92.00,$145.73,$147.20,$0.00,$50.14,$42.91,$29.29,$0.00
58300,EAP,CPT® 58300,,INSERT INTRAUTERINE DEVICE,$265.00,$0.00,$265.00,$265.00,$0.00,$47.17,$45.66,$0.00,$0.00,$46.40,$265.00,$0.00,$265.00,$209.88,$212.00,$159.00,$69.90,$0.00,$42.19,$0.00
58301,EAP,CPT® 58301,,REMOVE INTRAUTERINE DEVICE,$367.00,$0.00,$367.00,$367.00,$0.00,$259.59,$63.23,$0.00,$0.00,$64.26,$367.00,$271.52,$367.00,$290.66,$293.60,$367.00,$81.66,$70.31,$58.43,$258.59
59025,EAP,CPT®59025,,PR FETAL NON-STRESS TEST,$91.00,,,,,,,,,,,,,,,,,,,
59400,EAP,CPT®59400,,"PR FULL ROUT OBSTE CARE,VAGINAL DELIV","$6,654.00",,,,,,,,,,,,,,,,,,,
59409,EAP,CPT®59409,,"PR OBSTETRICAL CARE,VAG DELIV ONLY","$2,545.00",,,,,,,,,,,,,,,,,,,
59510,EAP,CPT®59510,,"PR FULL ROUT OBSTE CARE,CESAREAN DELIV","$7,379.00",,,,,,,,,,,,,,,,,,,
59610,EAP,CPT®59610,,"PR ROUT OB CARE,VAG DELIV,PREV C-SEC","$7,001.00",,,,,,,,,,,,,,,,,,,
62322,EAP,CPT®62322,,PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN,$205.33,,,,,,,,,,,,,,,,,,,
62323,EAP,CPT®62323,,PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN,$309.00,,,,,,,,,,,,,,,,,,,
64450,EAP,CPT® 64450,,INJECTION AA&/STRD OTHER PERIPHERAL NERVE/BRANCH,$275.00,$43.78,$626.89,$275.00,$275.00,$599.36,$47.38,$275.00,$275.00,$48.15,$275.00,$626.89,$275.00,$217.80,$220.00,$275.00,$85.27,$44.35,$43.78,$597.04
64483,EAP,CPT®64483,,"PR INJECT ANES/STEROID FORAMEN LUMBAR/SACRAL W IMG GUIDE ,1 LEVEL",$347.00,,,,,,,,,,,,,,,,,,,
66821,EAP,CPT®66821,,"PR DISCISSION,2ND CATARACT,LASER",$953.00,,,,,,,,,,,,,,,,,,,
66984,EAP,CPT®66984,,PR XCAPSL CTRC RMVL INSJ IO LENS PROSTH W/O ECP,"$1,579.00",,,,,,,,,,,,,,,,,,,
67028,EAP,CPT®67028,,PR INJECT INTRAVITREAL PHARMCOLOGIC,$302.00,,,,,,,,,,,,,,,,,,,
69210,EAP,CPT® 69210,,REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT,$172.00,$0.00,$172.00,$172.00,$0.00,$0.00,$29.63,$0.00,$0.00,$30.12,$172.00,$55.17,$172.00,$136.22,$137.60,$76.65,$47.34,$0.00,$0.00,$0.00
70355,EAP,CPT®70355,,PR ORTHOPANTOGRAM,$32.00,,,,,,,,,,,,,,,,,,,
70360,EAP,CPT® 70360,,X-RAY NECK SOFT TISSUE,$76.00,$12.10,$80.04,$55.02,$43.33,$76.53,$13.09,$43.33,$43.33,$13.31,$76.00,$80.04,$18.24,$60.19,$60.80,$76.00,$24.86,$21.61,$12.10,$76.23
70450,EAP,CPT®70450,,"PR CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL",$131.00,,,,,,,,,,,,,,,,,,,
70450,EAP,CPT® 70450,,"CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL",$257.00,$40.22,$257.00,$257.00,$257.00,$107.47,$44.28,$257.00,$257.00,$45.00,$257.00,$112.41,$257.00,$203.54,$205.60,$156.18,$40.22,$73.47,$40.91,$107.06
70486,EAP,CPT®70486,,"PR CT SCAN,MAXILLOFACIAL AREA,W/O CONTRAST",$132.00,,,,,,,,,,,,,,,,,,,
70492,EAP,CPT® 70492,,CT NECK TISSUE COMBO,$577.00,$0.00,$577.00,$577.00,$577.00,$193.45,$0.00,$577.00,$577.00,$101.03,$577.00,$202.33,$577.00,$456.98,$461.60,$281.11,$0.00,$164.96,$91.86,$192.70
70496,EAP,CPT®70496,,"PR CT ANGIO,HEAD COMBO,INCL IMAGE PROCESS",$268.00,,,,,,,,,,,,,,,,,,,
70498,EAP,CPT®70498,,"PR CT ANGIO,NECK COMBO,INCL IMAGE PROCESS",$268.00,,,,,,,,,,,,,,,,,,,
70551,EAP,CPT®70551,,PR MRI BRAIN,$228.00,,,,,,,,,,,,,,,,,,,
70553,EAP,CPT®70553,,PR MRI BRAIN COMBO,$352.00,,,,,,,,,,,,,,,,,,,
71045,EAP,CPT®71045,,CHG RADIOLOGIC EXAM CHEST SINGLE VIEW,$28.00,,,,,,,,,,,,,,,,,,,
71046,EAP,CPT®71046,,CHG RADIOLOGIC EXAM CHEST 2 VIEWS,$34.00,,,,,,,,,,,,,,,,,,,
71046,EAP,CPT® 71046,,RADIOLOGIC EXAM CHEST 2 VIEWS,$77.00,$12.26,$80.04,$59.99,$47.17,$76.53,$13.27,$47.17,$47.17,$13.48,$77.00,$80.04,$18.48,$60.98,$61.60,$77.00,$29.30,$21.97,$12.26,$76.23
71111,EAP,CPT® 71111,,"X-RAY RIBS, CHEST 4+ VW",$124.00,$19.74,$124.00,$94.69,$85.48,$107.47,$21.36,$85.48,$85.48,$21.71,$124.00,$112.41,$29.76,$98.21,$99.20,$124.00,$50.44,$35.30,$19.74,$107.06
71250,EAP,CPT®71250,,"PR CT SCAN,THORAX,W/O CONTRAST",$177.00,,,,,,,,,,,,,,,,,,,
71250,EAP,CPT® 71250,,"CT SCAN,THORAX,W/O CONTRAST",$354.00,$55.40,$354.00,$354.00,$354.00,$107.47,$60.99,$354.00,$354.00,$61.98,$354.00,$112.41,$84.96,$280.37,$283.20,$156.18,$55.40,$101.21,$56.36,$107.06
71260,EAP,CPT®71260,,PR CAT SCAN OF CHEST CONTRAST,$192.00,,,,,,,,,,,,,,,,,,,
71260,EAP,CPT® 71260,,CAT SCAN OF CHEST CONTRAST,$473.00,$74.02,$473.00,$473.00,$473.00,$193.45,$81.50,$473.00,$473.00,$82.82,$473.00,$202.33,$113.52,$374.62,$378.40,$281.11,$74.02,$135.06,$75.30,$192.70
71275,EAP,CPT®71275,,"PR CT ANGIO, CHEST (NON-CORON), COMBO, INCL IMG PROC",$279.00,,,,,,,,,,,,,,,,,,,
71275,EAP,CPT® 71275,,"CT ANGIO, CHEST, COMBO, INCL IMAGE PROC",$637.00,$99.69,$637.00,$637.00,$637.00,$193.45,$442.66,$637.00,$637.00,$111.53,$637.00,$202.33,$152.88,$504.50,$509.60,$281.11,$99.69,$214.30,$101.41,$192.70
72040,EAP,CPT®72040,,CHG RADEX SPINE CERVICAL 2 OR 3 VIEWS,$35.00,,,,,,,,,,,,,,,,,,,
72040,EAP,CPT® 72040,,RADEX SPINE CERVICAL 2 OR 3 VIEWS,$95.00,$15.12,$95.00,$64.75,$60.47,$76.53,$16.37,$60.47,$60.47,$16.63,$95.00,$80.04,$22.80,$75.24,$76.00,$95.00,$34.09,$27.01,$15.12,$76.23
72050,EAP,CPT® 72050,,RADEX SPINE CERVICAL 4 OR 5 VIEWS,$130.00,$0.00,$130.00,$89.13,$86.36,$107.47,$0.00,$86.36,$86.36,$22.76,$130.00,$112.41,$31.20,$102.96,$104.00,$130.00,$0.00,$37.10,$20.70,$107.06
72052,EAP,CPT® 72052,,RADEX SPINE CERVICAL 6 OR MORE VIEWS,$156.00,$24.84,$156.00,$110.01,$110.79,$107.47,$26.88,$110.79,$110.79,$27.31,$156.00,$112.41,$37.44,$123.55,$124.80,$156.00,$61.14,$44.66,$24.84,$107.06
72070,EAP,CPT®72070,,CHG X-RAY THORACIC SPINE 2 VW,$31.00,,,,,,,,,,,,,,,,,,,
72070,EAP,CPT® 72070,,X-RAY THORACIC SPINE 2 VW,$76.00,$12.10,$112.41,$66.85,$53.49,$107.47,$13.09,$53.49,$53.49,$13.31,$76.00,$112.41,$18.24,$60.19,$60.80,$76.00,$35.88,$21.61,$12.10,$107.06
72080,EAP,CPT® 72080,,X-RAY THOR-LUMB SP 2 VW,$82.00,$13.05,$82.00,$59.87,$56.99,$76.53,$14.13,$56.99,$56.99,$14.36,$82.00,$80.04,$19.68,$64.94,$65.60,$82.00,$36.61,$23.41,$13.05,$76.23
72100,EAP,CPT®72100,,CHG X-RAY LUMBAR SPINE 2/3 VW,$35.00,,,,,,,,,,,,,,,,,,,
72100,EAP,CPT® 72100,,X-RAY LUMBAR SPINE 2/3 VW,$95.00,$15.12,$112.41,$68.92,$64.85,$107.47,$16.37,$64.85,$64.85,$16.63,$95.00,$112.41,$22.80,$75.24,$76.00,$95.00,$36.61,$27.01,$15.12,$107.06
72110,EAP,CPT®72110,,CHG X-RAY LUMBAR SPINE 4 VW,$40.00,,,,,,,,,,,,,,,,,,,
72110,EAP,CPT® 72110,,X-RAY LUMBAR SPINE 4 VW,$125.00,$19.90,$125.00,$96.08,$90.72,$107.47,$21.54,$90.72,$90.72,$21.89,$125.00,$112.41,$30.00,$99.00,$100.00,$125.00,$50.44,$35.66,$19.90,$107.06
72125,EAP,CPT®72125,,"PR CT SCAN,CERVICAL SPINE,W/O CONTRAST",$154.00,,,,,,,,,,,,,,,,,,,
72131,EAP,CPT® 72131,,"CT SCAN,LUMBAR SPINE,W/O CONTRAST",$371.00,$58.06,$371.00,$371.00,$371.00,$107.47,$63.92,$371.00,$371.00,$64.96,$371.00,$112.41,$371.00,$293.83,$296.80,$156.18,$58.06,$105.89,$59.06,$107.06
72141,EAP,CPT®72141,,"PR MRI, CERV SPINE",$228.00,,,,,,,,,,,,,,,,,,,
72148,EAP,CPT®72148,,"PR MRI, LUMBAR SPINE",$228.00,,,,,,,,,,,,,,,,,,,
72170,EAP,CPT®72170,,CHG X-RAY PELVIS 1/2 VW,$27.00,,,,,,,,,,,,,,,,,,,
72190,EAP,CPT®72190,,CHG X-RAY PELVIS 3+ VW,$39.00,,,,,,,,,,,,,,,,,,,
72193,EAP,CPT®72193,,PR CT SCAN OF PELVIS CONTRAST,$177.00,,,,,,,,,,,,,,,,,,,
72220,EAP,CPT® 72220,,X-RAY SACRUM/COCCYX 2+ VW,$79.00,$12.58,$80.04,$55.02,$49.14,$76.53,$13.61,$49.14,$49.14,$13.83,$79.00,$80.04,$18.96,$62.57,$63.20,$79.00,$30.55,$22.69,$12.58,$76.23
73000,EAP,CPT® 73000,,X-RAY CLAVICLE,$81.00,$12.90,$81.00,$54.31,$45.08,$76.53,$13.96,$45.08,$45.08,$14.18,$81.00,$80.04,$19.44,$64.15,$64.80,$81.00,$27.72,$23.05,$12.90,$76.23
73030,EAP,CPT®73030,,CHG X-RAY SHOULDER 2+ VW,$29.00,,,,,,,,,,,,,,,,,,,
73030,EAP,CPT® 73030,,X-RAY SHOULDER 2+ VW,$83.00,$13.21,$83.00,$57.09,$48.26,$76.53,$22.88,$48.26,$48.26,$14.53,$83.00,$80.04,$19.92,$65.74,$66.40,$83.00,$30.90,$23.77,$13.21,$76.23
73060,EAP,CPT®73060,,CHG X-RAY HUMERUS,$26.00,,,,,,,,,,,,,,,,,,,
73060,EAP,CPT® 73060,,X-RAY HUMERUS,$81.00,$12.90,$81.00,$57.09,$48.26,$76.53,$13.96,$48.26,$48.26,$14.18,$81.00,$80.04,$19.44,$64.15,$64.80,$81.00,$30.55,$23.05,$12.90,$76.23
73070,EAP,CPT®73070,,CHG X-RAY ELBOW 2 VW,$26.00,,,,,,,,,,,,,,,,,,,
73070,EAP,CPT® 73070,,X-RAY ELBOW 2 VW,$71.00,$11.30,$80.04,$53.63,$45.08,$76.53,$12.23,$45.08,$45.08,$12.43,$71.00,$80.04,$17.04,$56.23,$56.80,$71.00,$27.38,$20.17,$11.30,$76.23
73080,EAP,CPT® 73080,,X-RAY ELBOW 3+ VW,$78.00,$12.42,$80.04,$61.29,$60.47,$76.53,$13.44,$60.47,$60.47,$13.66,$78.00,$80.04,$18.72,$61.78,$62.40,$78.00,$30.55,$22.33,$12.42,$76.23
73090,EAP,CPT®73090,,CHG X-RAY FOREARM 2 VW,$26.00,,,,,,,,,,,,,,,,,,,
73090,EAP,CPT® 73090,,X-RAY FOREARM 2 VW,$72.00,$11.46,$80.04,$50.84,$45.08,$76.53,$12.41,$45.08,$45.08,$12.61,$72.00,$80.04,$17.28,$57.02,$57.60,$72.00,$27.72,$20.53,$11.46,$76.23
73100,EAP,CPT® 73100,,X-RAY WRIST 2 VW,$86.00,$13.69,$86.00,$57.09,$46.81,$76.53,$14.82,$46.81,$46.81,$15.06,$86.00,$80.04,$20.64,$68.11,$68.80,$86.00,$27.37,$24.49,$13.69,$76.23
73110,EAP,CPT®73110,,CHG X-RAY WRIST 3+ VW,$27.00,,,,,,,,,,,,,,,,,,,
73110,EAP,CPT® 73110,,X-RAY WRIST 3+ VW,$106.00,$16.88,$106.00,$69.63,$59.03,$76.53,$18.26,$59.03,$59.03,$18.56,$106.00,$80.04,$25.44,$83.95,$84.80,$106.00,$28.79,$30.25,$16.88,$76.23
73120,EAP,CPT® 73120,,X-RAY HAND 2 VW,$77.00,$12.26,$112.41,$51.53,$44.19,$107.47,$13.27,$44.19,$44.19,$13.48,$77.00,$112.41,$18.48,$60.98,$61.60,$77.00,$27.37,$21.97,$12.26,$107.06
73130,EAP,CPT®73130,,CHG X-RAY HAND 3+ VW,$27.00,,,,,,,,,,,,,,,,,,,
73130,EAP,CPT® 73130,,X-RAY HAND 3+ VW,$92.00,$14.65,$92.00,$60.58,$52.06,$76.53,$21.03,$52.06,$52.06,$16.11,$92.00,$80.04,$22.08,$72.86,$73.60,$92.00,$28.79,$26.29,$14.65,$76.23
73501,EAP,CPT®73501,,CHG RADEX HIP UNILATERAL WITH PELVIS 1 VIEW,$29.00,,,,,,,,,,,,,,,,,,,
73502,EAP,CPT®73502,,CHG RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS,$35.00,,,,,,,,,,,,,,,,,,,
73502,EAP,CPT® 73502,,RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS,$120.00,$19.10,$120.00,$81.46,$72.12,$76.53,$20.68,$72.12,$72.12,$21.01,$120.00,$80.04,$28.80,$95.04,$96.00,$111.21,$39.45,$34.22,$19.10,$76.23
73521,EAP,CPT® 73521,,RADEX HIPS BILATERAL WITH PELVIS 2 VIEWS,$101.00,$16.08,$112.41,$77.98,$67.83,$107.47,$17.40,$67.83,$67.83,$17.68,$101.00,$112.41,$24.24,$79.99,$80.80,$101.00,$37.75,$28.81,$16.08,$107.06
73522,EAP,CPT® 73522,,RADEX HIPS BILATERAL WITH PELVIS 3-4 VIEWS,$131.00,$20.86,$131.00,$96.08,$80.69,$107.47,$22.57,$80.69,$80.69,$22.94,$131.00,$112.41,$31.44,$103.75,$104.80,$131.00,$46.58,$37.46,$20.86,$107.06
73552,EAP,CPT®73552,,CHG RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS,$28.00,,,,,,,,,,,,,,,,,,,
73552,EAP,CPT® 73552,,RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS,$89.00,$14.17,$89.00,$64.07,$54.94,$76.53,$15.33,$54.94,$54.94,$15.58,$89.00,$80.04,$21.36,$70.49,$71.20,$89.00,$30.93,$25.57,$14.17,$76.23
73560,EAP,CPT®73560,,CHG X-RAY KNEE 1 OR 2 VIEW,$26.00,,,,,,,,,,,,,,,,,,,
73560,EAP,CPT® 73560,,X-RAY KNEE 1 OR 2 VIEW,$88.00,$15.16,$132.00,$60.58,$45.95,$76.53,$15.16,$45.95,$45.95,$23.11,$132.00,$80.04,$31.68,$69.70,$105.60,$111.21,$28.43,$25.21,$21.01,$76.23
73562,EAP,CPT® 73562,,X-RAY KNEE 3 VIEW,$105.00,$16.72,$105.00,$70.32,$57.87,$76.53,$18.09,$57.87,$57.87,$18.38,$105.00,$80.04,$25.20,$83.16,$84.00,$105.00,$31.26,$29.89,$16.72,$76.23
73564,EAP,CPT® 73564,,X-RAY KNEE 4+ VIEW,$115.00,$18.31,$115.00,$77.98,$66.59,$107.47,$19.81,$66.59,$66.59,$20.14,$115.00,$112.41,$27.60,$91.08,$92.00,$115.00,$34.81,$32.78,$18.31,$107.06
73590,EAP,CPT®73590,,"CHG X-RAY TIB + FIB, 2VW",$25.00,,,,,,,,,,,,,,,,,,,
73590,EAP,CPT® 73590,,"X-RAY TIB + FIB, 2VW",$79.00,$12.58,$80.04,$56.41,$43.33,$76.53,$13.61,$43.33,$43.33,$13.83,$79.00,$80.04,$18.96,$62.57,$63.20,$79.00,$28.43,$22.69,$12.58,$76.23
73600,EAP,CPT®73600,,CHG X-RAY ANKLE 2 VW,$26.00,,,,,,,,,,,,,,,,,,,
73600,EAP,CPT® 73600,,X-RAY ANKLE 2 VW,$82.00,$13.05,$82.00,$58.48,$44.19,$76.53,$14.13,$44.19,$44.19,$14.36,$82.00,$80.04,$19.68,$64.94,$65.60,$82.00,$27.37,$23.41,$13.05,$76.23
73610,EAP,CPT®73610,,CHG X-RAY ANKLE 3+ VW,$27.00,,,,,,,,,,,,,,,,,,,
73610,EAP,CPT® 73610,,X-RAY ANKLE 3+ VW,$92.00,$14.65,$92.00,$61.97,$52.06,$76.53,$15.85,$52.06,$52.06,$16.11,$92.00,$80.04,$22.08,$72.86,$73.60,$92.00,$28.79,$26.29,$14.65,$76.23
73620,EAP,CPT®73620,,CHG X-RAY FOOT 2 VW,$24.00,,,,,,,,,,,,,,,,,,,
73620,EAP,CPT® 73620,,X-RAY FOOT 2 VW,$71.00,$11.30,$80.04,$50.84,$42.45,$76.53,$12.23,$42.45,$42.45,$12.43,$71.00,$80.04,$17.04,$56.23,$56.80,$71.00,$27.37,$20.17,$11.30,$76.23
73630,EAP,CPT®73630,,CHG X-RAY FOOT 3+ VW,$26.00,,,,,,,,,,,,,,,,,,,
73630,EAP,CPT® 73630,,X-RAY FOOT 3+ VW,$86.00,$13.69,$86.00,$57.09,$51.19,$76.53,$14.82,$51.19,$51.19,$15.06,$86.00,$80.04,$20.64,$68.11,$68.80,$86.00,$28.79,$24.49,$13.69,$76.23
73660,EAP,CPT® 73660,,X-RAY TOE(S),$76.00,$12.10,$80.04,$55.02,$48.57,$76.53,$13.09,$48.57,$48.57,$13.31,$76.00,$80.04,$18.24,$60.19,$60.80,$76.00,$23.09,$21.61,$12.10,$76.23
73700,EAP,CPT® 73700,,"CT SCAN,LOWER EXTREMITY,W/O CONTRAST",$371.00,$58.06,$371.00,$371.00,$371.00,$107.47,$63.92,$371.00,$371.00,$64.96,$371.00,$112.41,$371.00,$293.83,$296.80,$156.18,$58.06,$105.89,$59.06,$107.06
73721,EAP,CPT®73721,,"PR MRI LOWER EXTREM JT, W/O CONTRAST",$208.00,,,,,,,,,,,,,,,,,,,
74018,EAP,CPT®74018,,CHG RADIOLOGIC EXAM ABDOMEN 1 VIEW,$28.00,,,,,,,,,,,,,,,,,,,
74022,EAP,CPT®74022,,CHG RADIOLOGIC EXAM COMPLETE ACUTE ABDOMEN SERIES,$49.00,,,,,,,,,,,,,,,,,,,
74022,EAP,CPT® 74022,,RADIOLOGIC EXAM COMPLETE ACUTE ABDOMEN SERIES,$115.00,$0.00,$115.00,$87.73,$76.04,$107.47,$19.81,$76.04,$76.04,$20.14,$115.00,$112.41,$27.60,$91.08,$92.00,$115.00,$44.36,$32.78,$0.00,$107.06
74150,EAP,CPT® 74150,,"CT SCAN,ABDOMEN,W/O CONTRAST",$316.00,$49.45,$316.00,$316.00,$316.00,$107.47,$54.45,$316.00,$316.00,$55.33,$316.00,$112.41,$316.00,$250.27,$252.80,$156.18,$49.45,$90.40,$50.31,$107.06
74160,EAP,CPT® 74160,,CT SCAN OF ABDOMEN CONTRAST,$637.00,$99.69,$637.00,$637.00,$637.00,$193.45,$109.75,$637.00,$637.00,$111.53,$637.00,$202.33,$637.00,$504.50,$509.60,$281.11,$99.69,$185.49,$101.41,$192.70
74170,EAP,CPT® 74170,,CT SCAN OF ABDOMEN COMBO,$637.00,$99.69,$637.00,$637.00,$637.00,$193.45,$408.96,$637.00,$637.00,$111.53,$637.00,$202.33,$637.00,$504.50,$509.60,$281.11,$99.69,$211.06,$101.41,$192.70
74174,EAP,CPT®74174,,PR CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMGES,$335.00,,,,,,,,,,,,,,,,,,,
74174,EAP,CPT® 74174,,CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMGES,"$1,046.00",$163.70,"$1,046.00","$1,046.00",$755.50,$370.02,$180.22,$755.50,$755.50,$183.15,"$1,046.00",$387.01,$251.04,$828.43,$836.80,$537.70,$163.70,$298.94,$166.52,$368.58
74176,EAP,CPT®74176,,"CHG CT SCAN,ABDOMENT AND PELVIS,W/O CONTRAST",$267.00,,,,,,,,,,,,,,,,,,,
74176,EAP,CPT® 74176,,"CT SCAN,ABDOMENT AND PELVIS,W/O CONTRAST",$398.00,$0.00,$398.00,$398.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$398.00,$0.00,$95.52,$315.22,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
74177,EAP,CPT®74177,,"CHG CT SCAN,ABDOMENT AND PELVIS,W CONTRAST",$280.00,,,,,,,,,,,,,,,,,,,
74177,EAP,CPT® 74177,,"CT SCAN,ABDOMENT AND PELVIS,W CONTRAST",$835.00,$0.00,$835.00,$835.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$835.00,$0.00,$200.40,$661.32,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
74183,EAP,CPT®74183,,"PR MRI, ABDOMEN, COMBO",$335.00,,,,,,,,,,,,,,,,,,,
76536,EAP,CPT®76536,,"US, HEAD/NECK TISSUES,REAL TIME",$87.00,,,,,,,,,,,,,,,,,,,
76536,EAP,CPT® 76536,,"US,HEAD/NECK TISSUES,B-SCAN/REAL TIME",$311.00,$49.51,$311.00,$230.46,$196.88,$107.47,$53.58,$196.88,$196.88,$54.45,$311.00,$112.41,$74.64,$246.31,$248.80,$156.18,$82.37,$88.96,$49.51,$107.06
76642,EAP,CPT®76642,,CHG US BREAST UNI REAL TIME WITH IMAGE LIMITED,$104.00,,,,,,,,,,,,,,,,,,,
76700,EAP,CPT®76700,,"PR US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",$126.00,,,,,,,,,,,,,,,,,,,
76700,EAP,CPT® 76700,,"US,ABDOM,B-SCAN &/OR REAL TIME,COMPLETE",$291.00,$46.33,$291.00,$242.27,$227.84,$107.47,$50.14,$227.84,$227.84,$50.95,$291.00,$112.41,$69.84,$230.47,$232.80,$156.18,$115.39,$83.20,$46.33,$107.06
76705,EAP,CPT®76705,,"PR US, ABDOMEN LIMITED",$138.33,,,,,,,,,,,,,,,,,,,
76705,EAP,CPT® 76705,,SONO ABDOMEN LIMITED,$219.00,$34.86,$219.00,$181.01,$175.05,$107.47,$37.73,$175.05,$175.05,$38.35,$219.00,$112.41,$52.56,$173.45,$175.20,$156.18,$83.78,$62.67,$34.86,$107.06
76706,EAP,CPT® 76706,,US ABDOMINAL AORTA REAL TIME SCREEN STUDY AAA,$306.00,$48.72,$306.00,$185.20,$160.30,$107.47,$52.72,$160.30,$160.30,$53.58,$306.00,$112.41,$73.44,$242.35,$244.80,$156.18,$90.50,$87.52,$48.72,$107.06
76770,EAP,CPT®76770,,"PR US,RETROPERIT,REAL TIME,COMPLETE",$172.00,,,,,,,,,,,,,,,,,,,
76770,EAP,CPT® 76770,,"US,RETROPERIT, B-SCAN/REAL TIME,COMPLETE",$271.00,$43.14,$271.00,$224.19,$222.59,$107.47,$46.69,$222.59,$222.59,$47.45,$271.00,$112.41,$65.04,$214.63,$216.80,$156.18,$112.23,$77.44,$43.14,$107.06
76775,EAP,CPT® 76775,,SONO ABD RETROPERITNL LTD,$106.00,$16.88,$194.25,$106.00,$194.25,$107.47,$18.26,$194.25,$194.25,$18.56,$106.00,$112.41,$25.44,$83.95,$84.80,$106.00,$83.43,$30.25,$16.88,$107.06
76805,EAP,CPT®76805,,"CHG US, OB >/= 14 WKS, SNGL FETUS",$222.00,,,,,,,,,,,,,,,,,,,
76815,EAP,CPT®76815,,"CHG US,PREGNANT UTERUS,LIMITED, 1/> FETUSES",$100.00,,,,,,,,,,,,,,,,,,,
76816,EAP,CPT®76816,,"CHG US,PREGNANT UTERUS,F/U,TRANSABD APP",$130.00,,,,,,,,,,,,,,,,,,,
76817,EAP,CPT®76817,,"CHG US,PREGNANT UTERUS,TRANSVAGINAL",$158.33,,,,,,,,,,,,,,,,,,,
76819,EAP,CPT®76819,,"CHG FETAL BIOPHYS PROF,W/O NST",$118.00,,,,,,,,,,,,,,,,,,,
76820,EAP,CPT®76820,,CHG DOPPLER FETAL UMBILICAL ARTERY,$77.00,,,,,,,,,,,,,,,,,,,
76830,EAP,CPT®76830,,"CHG ECHOGRAPHY,TRANSVAGINAL",$106.00,,,,,,,,,,,,,,,,,,,
76830,EAP,CPT® 76830,,"ECHOGRAPHY,TRANSVAGINAL",$314.00,$49.99,$314.00,$242.30,$203.54,$107.47,$61.14,$203.54,$203.54,$54.98,$314.00,$112.41,$75.36,$248.69,$251.20,$156.18,$92.96,$89.68,$49.99,$107.06
76856,EAP,CPT®76856,,"PR US,PELVIC (NONOBSTETRIC),REAL TIME,COMPLETE",$105.00,,,,,,,,,,,,,,,,,,,
76856,EAP,CPT® 76856,,"ECHO,PELVIC (NONOBSTETRIC)",$267.00,$42.51,$267.00,$218.61,$204.41,$107.47,$61.14,$204.41,$204.41,$46.75,$267.00,$112.41,$64.08,$211.46,$213.60,$156.18,$92.96,$76.36,$42.51,$107.06
76870,EAP,CPT® 76870,,"ECHO,SCROTUM & CONTENTS",$260.00,$41.39,$260.00,$135.07,$207.04,$107.47,$44.80,$207.04,$207.04,$45.52,$260.00,$112.41,$62.40,$205.92,$208.00,$156.18,$90.49,$74.20,$41.39,$107.06
76882,EAP,CPT® 76882,,"US,EXTREMITY,NONVASCULAR,REAL-TIME IMAGE,LIMITED",$116.00,$0.00,$116.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$116.00,$0.00,$27.84,$91.87,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
76937,EAP,CPT®76937,,"CHG US GUIDE, VASCULAR ACCESS",$61.00,,,,,,,,,,,,,,,,,,,
76942,EAP,CPT® 76942,,SONO GUIDE NEEDLE BIOPSY,$91.00,$0.00,$360.62,$91.00,$360.62,$0.00,$61.14,$360.62,$360.62,$15.93,$91.00,$0.00,$21.84,$72.07,$72.80,$0.00,$92.25,$25.93,$14.49,$0.00
77063,EAP,CPT® 77063,,SCREENING DIGITAL BREAST TOMOSYNTHESIS BI,$88.00,$14.01,$88.00,$88.00,$61.68,$15.66,$15.16,$61.68,$61.68,$15.41,$88.00,$26.75,$21.12,$69.70,$70.40,$25.21,$53.24,$25.21,$14.01,$25.21
77063,EAP,CPT®77063,,CHG SCREENING DIGITAL BREAST TOMOSYNTHESIS BI,$92.00,,,,,,,,,,,,,,,,,,,
77065,EAP,CPT®77065,,CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI,$126.00,,,,,,,,,,,,,,,,,,,
77066,EAP,CPT®77066,,CHG DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI,$154.00,,,,,,,,,,,,,,,,,,,
77067,EAP,CPT®77067,,CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD,$118.00,,,,,,,,,,,,,,,,,,,
77067,EAP,CPT® 77067,,SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD,$349.00,$55.56,$349.00,$268.04,$240.02,$62.12,$60.13,$240.02,$240.02,$61.11,$349.00,$106.31,$83.76,$276.41,$279.20,$99.77,$132.75,$99.77,$55.56,$99.77
77080,EAP,CPT® 77080,,"DEXA,BONE DENSITY,AXIAL SKELETON",$105.00,$16.72,$146.62,$80.76,$146.62,$107.47,$103.40,$146.62,$146.62,$18.38,$105.00,$112.41,$25.20,$83.16,$84.00,$105.00,$108.31,$29.89,$16.72,$107.06
77081,EAP,CPT® 77081,,"DEXA,BONE DENSITY,APPENDICULR SKELTN",$78.00,$0.00,$80.04,$55.02,$0.00,$0.00,$13.44,$46.36,$46.36,$13.66,$78.00,$80.04,$18.72,$61.78,$62.40,$78.00,$38.50,$0.00,$0.00,$0.00
78815,EAP,CPT®78815,,PET IMAGING CT ATTENUATION SKULL BASE MID-THIGH,$365.00,,,,,,,,,,,,,,,,,,,
80053,EAP,CPT®80053,,"COMP, METABOLIC PANEL",$46.00,,,,,,,,,,,,,,,,,,,
80061,EAP,CPT®80061,,"CHEM 3, LIPID PANEL",$59.00,,,,,,,,,,,,,,,,,,,
80164,EAP,CPT®80164,,CHG DRUG SCREEN QUANT DIPROPYLACETIC ACID TOTAL,$50.00,,,,,,,,,,,,,,,,,,,
80185,EAP,CPT®80185,,ASSAY OF PHENYTOIN TOTAL,$58.00,,,,,,,,,,,,,,,,,,,
80202,EAP,CPT®80202,,ASSAY OF VANCOMYCIN,$50.00,,,,,,,,,,,,,,,,,,,
81000,EAP,CPT®81000,,URINALYSIS NONAUTO W/ SCOPE,$14.00,,,,,,,,,,,,,,,,,,,
81001,EAP,CPT® 81001,,URINALYSIS WITH MICROSCOPY,$11.00,$1.77,$11.00,$5.65,$4.63,$4.31,$1.77,$4.63,$4.63,$4.68,$11.00,$3.33,$8.86,$8.71,$8.80,$4.60,$4.99,$3.17,$3.49,$3.17
81002,EAP,CPT®81002,,CHG URINALYSIS NONAUTO W/O SCOPE,$11.00,,,,,,,,,,,,,,,,,,,
81003,EAP,CPT® 81003,,URINALYSIS,$8.00,$1.25,$8.00,$4.01,$3.28,$3.06,$1.25,$3.28,$3.28,$3.33,$8.00,$2.36,$6.28,$6.34,$6.40,$3.26,$3.55,$2.25,$2.48,$2.25
81003,EAP,CPT®81003,,URINALYSIS AUTO W/O SCOPE,$10.00,,,,,,,,,,,,,,,,,,,
81025,EAP,CPT®81025,,URINE PREGNANCY TEST,$28.00,,,,,,,,,,,,,,,,,,,
81025,EAP,CPT® 81025,,PREGNANCY TEST-URINE,$30.00,$4.33,$30.00,$11.26,$9.24,$8.61,$4.33,$9.24,$9.24,$9.36,$30.00,$9.04,$17.68,$23.76,$24.00,$12.48,$9.97,$8.61,$6.98,$8.61
81050,EAP,CPT®81050,,URINALYSIS VOLUME MEASURE,$13.00,,,,,,,,,,,,,,,,,,,
82010,EAP,CPT®82010,,ACETONE ASSAY,$36.00,,,,,,,,,,,,,,,,,,,
82043,EAP,CPT®82043,,MICROALBUMIN QUANTITATIVE,$25.00,,,,,,,,,,,,,,,,,,,
82140,EAP,CPT®82140,,ASSAY OF AMMONIA,$43.00,,,,,,,,,,,,,,,,,,,
82274,EAP,CPT® 82274,,"BLOOD,OCCULT,FECAL HGB,FECES,1-3 SIMULT",$56.00,$8.89,$56.00,$28.36,$23.22,$16.45,$8.89,$23.22,$23.22,$25.48,$56.00,$16.72,$44.44,$44.35,$44.80,$23.08,$27.15,$15.92,$19.01,$15.92
82306,EAP,CPT®82306,,VITAMIN D 25 HYDROXY,$130.00,,,,,,,,,,,,,,,,,,,
82330,EAP,CPT®82330,,ASSAY OF IONIZED CALCIUM,$60.00,,,,,,,,,,,,,,,,,,,
82378,EAP,CPT®82378,,CARCINOEMBRYINIC ANTIGEN,$83.00,,,,,,,,,,,,,,,,,,,
82436,EAP,CPT®82436,,ASSAY OF URINE CHLORIDE,$22.00,,,,,,,,,,,,,,,,,,,
82533,EAP,CPT®82533,,TOTAL CORTISOL,$71.00,,,,,,,,,,,,,,,,,,,
82550,EAP,CPT®82550,,ASSAY OF CK (CPK),$29.00,,,,,,,,,,,,,,,,,,,
82553,EAP,CPT®82553,,CREATINE MB FRACTION,$51.00,,,,,,,,,,,,,,,,,,,
82565,EAP,CPT®82565,,ASSAY OF CREATININE,$22.00,,,,,,,,,,,,,,,,,,,
82570,EAP,CPT®82570,,ASSAY OF URINE CREATININE,$23.00,,,,,,,,,,,,,,,,,,,
82607,EAP,CPT®82607,,VITAMIN B12,$66.00,,,,,,,,,,,,,,,,,,,
82728,EAP,CPT®82728,,ASSAY OF FERRITIN,$60.00,,,,,,,,,,,,,,,,,,,
82746,EAP,CPT®82746,,ASSAY OF FOLIC ACID SERUM,$64.00,,,,,,,,,,,,,,,,,,,
82800,EAP,CPT®82800,,BLOOD PH,$37.00,,,,,,,,,,,,,,,,,,,
82803,EAP,CPT®82803,,BLOOD GASES ANY COMBINATION,$85.00,,,,,,,,,,,,,,,,,,,
82805,EAP,CPT®82805,,BLOOD GASES W/O2 SATURATION,$124.00,,,,,,,,,,,,,,,,,,,
82947,EAP,CPT®82947,,ASSAY GLUCOSE BLOOD QUANT,$17.00,,,,,,,,,,,,,,,,,,,
82950,EAP,CPT®82950,,GLUCOSE TEST,$21.00,,,,,,,,,,,,,,,,,,,
82977,EAP,CPT®82977,,ASSAY OF GGT,$32.00,,,,,,,,,,,,,,,,,,,
83010,EAP,CPT®83010,,ASSAY OF HAPTOGLOBIN QUANT,$16.00,,,,,,,,,,,,,,,,,,,
83020,EAP,CPT®83020,,HEMOGLOBIN ELECTROPHORESIS,$54.67,,,,,,,,,,,,,,,,,,,
83036,EAP,CPT® 83036,,HGB GLYCOSYLATED A1C,$34.00,$5.44,$34.00,$17.31,$14.17,$13.21,$5.44,$14.17,$14.17,$14.33,$34.00,$10.20,$27.12,$26.93,$27.20,$14.08,$15.27,$9.71,$10.69,$9.71
83036,EAP,CPT®83036,,GLYCOSYLATED HEMOGLOBIN TEST,$43.00,,,,,,,,,,,,,,,,,,,
83540,EAP,CPT®83540,,ASSAY OF IRON,$28.00,,,,,,,,,,,,,,,,,,,
83605,EAP,CPT®83605,,ASSAY OF LACTIC ACID,$47.00,,,,,,,,,,,,,,,,,,,
83615,EAP,CPT®83615,,LACTATE (LD) (LDH) ENZYME,$26.00,,,,,,,,,,,,,,,,,,,
83655,EAP,CPT®83655,,ASSAY OF LEAD,$53.00,,,,,,,,,,,,,,,,,,,
83690,EAP,CPT®83690,,ASSAY OF LIPASE,$30.00,,,,,,,,,,,,,,,,,,,
83735,EAP,CPT®83735,,ASSAY OF MAGNESIUM,$29.00,,,,,,,,,,,,,,,,,,,
83880,EAP,CPT®83880,,ASSAY OF NATRIURETIC PEPTIDE,$149.00,,,,,,,,,,,,,,,,,,,
83883,EAP,CPT®83883,,ASSAY NEPHELOMETRY NOT SPEC,$60.00,,,,,,,,,,,,,,,,,,,
83930,EAP,CPT®83930,,ASSAY OF BLOOD OSMOLALITY,$29.00,,,,,,,,,,,,,,,,,,,
83935,EAP,CPT®83935,,ASSAY OF URINE OSMOLALITY,$30.00,,,,,,,,,,,,,,,,,,,
83970,EAP,CPT®83970,,ASSAY OF PARATHORMONE,$181.00,,,,,,,,,,,,,,,,,,,
84100,EAP,CPT®84100,,ASSAY OF PHOSPORUS,$21.00,,,,,,,,,,,,,,,,,,,
84132,EAP,CPT®84132,,ASSAY OF SERUM POTASSIUM,$20.00,,,,,,,,,,,,,,,,,,,
84133,EAP,CPT®84133,,ASSAY OF URINE POTASSIUM,$19.00,,,,,,,,,,,,,,,,,,,
84134,EAP,CPT®84134,,ASSAY OF PREALBUMIN,$64.00,,,,,,,,,,,,,,,,,,,
84146,EAP,CPT®84146,,ASSAY OF PROLACTIN,$85.00,,,,,,,,,,,,,,,,,,,
84153,EAP,CPT®84153,,ASSAY OF PSA TOTAL,$81.00,,,,,,,,,,,,,,,,,,,
84165,EAP,CPT®84165,,PROTEIN ELECTROPHORESIS SERUM,$57.00,,,,,,,,,,,,,,,,,,,
84295,EAP,CPT®84295,,ASSAY OF SERUM SODIUM,$21.00,,,,,,,,,,,,,,,,,,,
84300,EAP,CPT®84300,,ASSAY OF URINE SODIUM,$15.00,,,,,,,,,,,,,,,,,,,
84403,EAP,CPT®84403,,ASSAY OF TOTAL TESTOSTERONE,$113.00,,,,,,,,,,,,,,,,,,,
84439,EAP,CPT®84439,,ASSAY OF FREE THYROXINE,$40.00,,,,,,,,,,,,,,,,,,,
84443,EAP,CPT®84443,,ASSAY THYROID STIM HORMONE,$74.00,,,,,,,,,,,,,,,,,,,
84478,EAP,CPT®84478,,ASSAY OF TRIGLYCERIDES,$25.00,,,,,,,,,,,,,,,,,,,
84480,EAP,CPT®84480,,ASSAY OF TRIIODOTHYRONINE (T3),$56.00,,,,,,,,,,,,,,,,,,,
84540,EAP,CPT®84540,,ASSAY OF URINE/UREA-N,$21.00,,,,,,,,,,,,,,,,,,,
84550,EAP,CPT®84550,,ASSAY OF BLOOD/URIC ACID,$20.00,,,,,,,,,,,,,,,,,,,
84702,EAP,CPT®84702,,"HCG,QUANTITATIVE(QUEST)",$28.00,,,,,,,,,,,,,,,,,,,
85007,EAP,CPT®85007,,BL SMEAR W/ DIFF WBC COUNT,$15.00,,,,,,,,,,,,,,,,,,,
85008,EAP,CPT®85008,,BL SMEAR W/O DIFF WBC COUNT,$15.00,,,,,,,,,,,,,,,,,,,
85018,EAP,CPT® 85018,,"HEMOGLOBIN, MICRO(METER)",$8.00,$1.32,$8.00,$4.22,$3.46,$3.23,$1.32,$3.46,$3.46,$3.50,$8.00,$2.49,$6.62,$6.34,$6.40,$3.44,$3.73,$2.37,$2.61,$2.37
85018,EAP,CPT®85018,,HEMOGLOBIN,$10.00,,,,,,,,,,,,,,,,,,,
85025,EAP,CPT® 85025,,"CBC, PLAT & DIFF",$27.00,$4.34,$27.00,$13.86,$9.59,$7.20,$4.34,$9.59,$9.59,$11.48,$27.00,$8.16,$21.72,$21.38,$21.60,$11.27,$12.23,$7.77,$8.56,$7.77
85025,EAP,CPT®85025,,COMPLETE CBC W/ AUTO DIFF WBC,$34.00,,,,,,,,,,,,,,,,,,,
85027,EAP,CPT® 85027,,CBC & PLAT,$23.00,$3.61,$23.00,$11.54,$9.45,$7.73,$3.61,$9.45,$9.45,$9.57,$23.00,$6.79,$18.08,$18.22,$18.40,$9.38,$10.19,$6.47,$7.13,$6.47
85027,EAP,CPT®85027,,COMPLETE CBC AUTOMATED,$28.00,,,,,,,,,,,,,,,,,,,
85379,EAP,CPT®85379,,FIBRIN DEGRADATION QUANT,$45.00,,,,,,,,,,,,,,,,,,,
85520,EAP,CPT®85520,,HEPARIN ASSAY,$57.00,,,,,,,,,,,,,,,,,,,
85610,EAP,CPT® 85610,,PT(PROTHROMBIN TIME),$15.00,$0.00,$15.00,$7.00,$5.74,$0.00,$2.20,$5.74,$5.74,$5.81,$15.00,$4.50,$10.98,$11.88,$12.00,$6.22,$6.19,$4.29,$0.00,$0.00
85610,EAP,CPT®85610,,PROTHROMBIN TIME,$17.00,,,,,,,,,,,,,,,,,,,
85670,EAP,CPT®85670,,THROMBIN TIME PLASMA,$25.00,,,,,,,,,,,,,,,,,,,
85730,EAP,CPT®85730,,THROMBOPLASTIN TIME PARTIAL,$26.00,,,,,,,,,,,,,,,,,,,
86359,EAP,CPT®86359,,T CELLS TOTAL COUNT,$103.00,,,,,,,,,,,,,,,,,,,
86360,EAP,CPT®86360,,LYMPHOCYTES SUBSET,$206.00,,,,,,,,,,,,,,,,,,,
86431,EAP,CPT®86431,,RHEUMATOID FACTOR QUANT,$25.00,,,,,,,,,,,,,,,,,,,
86580,EAP,CPT®86580,,CHG TB INTRADERMAL TEST,$28.00,,,,,,,,,,,,,,,,,,,
86592,EAP,CPT®86592,,SYPHILIS TEST NON-TREP QUAL,$19.00,,,,,,,,,,,,,,,,,,,
86593,EAP,CPT®86593,,SYPHILIS TEST NON-TREP QUANT,$19.00,,,,,,,,,,,,,,,,,,,
86703,EAP,CPT®86703,,HIV 1 & 2 ONE RESULT ANTIBODY,$60.00,,,,,,,,,,,,,,,,,,,
86762,EAP,CPT®86762,,RUBELLA ANTIBODY,$51.00,,,,,,,,,,,,,,,,,,,
86787,EAP,CPT®86787,,VARICELLA-ZOSTER ANTIBODY,$56.00,,,,,,,,,,,,,,,,,,,
86790,EAP,CPT®86790,,VIRUS ANTIBODY NOS,$56.00,,,,,,,,,,,,,,,,,,,
87015,EAP,CPT®87015,,SPECIMEN INFECT AGENT CONCNTJ,$29.00,,,,,,,,,,,,,,,,,,,
87040,EAP,CPT®87040,,BLOOD CULTURE FOR BACTERIA,$45.00,,,,,,,,,,,,,,,,,,,
87070,EAP,CPT® 87070,,Culture Other Specimen Aerobic,$30.00,$0.00,$30.00,$15.37,$12.57,$0.00,$4.82,$12.57,$12.57,$12.73,$30.00,$9.05,$24.06,$23.76,$24.00,$12.50,$13.56,$8.62,$0.00,$0.00
87075,EAP,CPT®87075,,CULTURE BACTERIA EXCEPT BLOOD,$41.00,,,,,,,,,,,,,,,,,,,
87081,EAP,CPT®87081,,CULTURE SCREEN ONLY,$29.00,,,,,,,,,,,,,,,,,,,
87086,EAP,CPT®87086,,URINE CULTURE/COLONY COUNT,$35.00,,,,,,,,,,,,,,,,,,,
87102,EAP,CPT®87102,,FUNGUS ISOLATION CULTURE,$37.00,,,,,,,,,,,,,,,,,,,
87116,EAP,CPT®87116,,MYCOBACTERIA CULTURE,$32.00,,,,,,,,,,,,,,,,,,,
87176,EAP,CPT®87176,,TISSUE HOMOGENIZATION CULTURE,$26.00,,,,,,,,,,,,,,,,,,,
87186,EAP,CPT®87186,,MICROBE SUSCEPTIBLE MIC,$38.00,,,,,,,,,,,,,,,,,,,
87205,EAP,CPT®87205,,SMEAR GRAM STAIN,$10.00,,,,,,,,,,,,,,,,,,,
87206,EAP,CPT®87206,,SMEAR FLOURESCENT/ACID STAIN,$24.00,,,,,,,,,,,,,,,,,,,
87210,EAP,CPT®87210,,SMEAR WET MOUNT SALINE/INK,$19.00,,,,,,,,,,,,,,,,,,,
87210,EAP,CPT® 87210,,"O & P DIRECT, SMEAR",$20.00,$2.93,$20.00,$7.62,$6.23,$5.60,$2.93,$6.23,$6.23,$6.30,$20.00,$6.11,$11.92,$15.84,$16.00,$8.44,$6.71,$5.82,$4.70,$5.82
87389,EAP,CPT®87389,,CHG IAAD IA HIV-1 AG W/HIV-1 & HIV-2 ANTBDY SINGLE,$102.00,,,,,,,,,,,,,,,,,,,
87430,EAP,CPT® 87430,,IAAD IA STREPTOCOCCUS GROUP A,$59.00,$8.46,$59.00,$21.36,$17.52,$16.32,$8.46,$17.52,$17.52,$17.71,$59.00,$17.65,$33.52,$46.73,$47.20,$24.37,$18.87,$16.81,$13.21,$16.81
88104,EAP,CPT®88104,,"CHG CYTOPATH FLUIDS,SMEAR,INTERP",$88.00,,,,,,,,,,,,,,,,,,,
88112,EAP,CPT®88112,,"CHG CYTOPATH, CELL ENHANCE TECH",$87.00,,,,,,,,,,,,,,,,,,,
88142,EAP,CPT®88142,,CYTOPATH C/V THIN LAYER,$89.00,,,,,,,,,,,,,,,,,,,
88161,EAP,CPT®88161,,CYTOPATH FNA MISC,$79.00,,,,,,,,,,,,,,,,,,,
89050,EAP,CPT®89050,,BODY FLUID CELL COUNT,$21.00,,,,,,,,,,,,,,,,,,,
90460,EAP,CPT® 90460,,IM ADM THRU 18YR ANY RTE 1ST/ONLY COMPT VAC/TOX,$21.93,$0.00,$21.93,$11.91,$15.65,$3.90,$8.61,$15.65,$15.65,$3.84,$21.93,$21.90,$10.97,$17.37,$17.54,$14.42,$7.83,$14.42,$0.00,$14.42
90461,EAP,CPT® 90461,,IM ADM THRU 18YR ANY RTE ADDL VAC/TOX COMPT,$21.93,$0.00,$21.93,$11.91,$15.65,$3.90,$0.00,$15.65,$15.65,$3.84,$21.93,$13.61,$10.97,$17.37,$17.54,$12.98,$0.00,$12.98,$0.00,$12.98
90471,EAP,CPT®90471,,"PR IMMUNIZ ADMIN,1 SINGLE/COMB VAC/TOXOID",$43.00,,,,,,,,,,,,,,,,,,,
90471,EAP,CPT® 90471,,"IMMUNIZ ADMIN,1 SINGLE/COMB VAC/TOXOID",$50.00,$7.83,$50.00,$27.15,$35.69,$36.54,$8.61,$35.69,$35.69,$8.75,$50.00,$38.22,$25.00,$39.60,$40.00,$50.00,$7.83,$14.42,$7.96,$36.40
90472,EAP,CPT®90472,,"PR IMMUNIZ,ADMIN,EACH ADDL",$39.00,,,,,,,,,,,,,,,,,,,
90472,EAP,CPT® 90472,,"IMMUNIZ,ADMIN,EACH ADDL",$45.00,$0.00,$45.00,$24.44,$32.12,$0.00,$7.75,$32.12,$32.12,$7.88,$45.00,$0.00,$22.50,$35.64,$36.00,$0.00,$7.04,$12.98,$7.16,$0.00
90620,EAP,CPT® 90620,,MENB RECOMBINANT PROT W/OUT MEMBR VESIC VACC IM,$30.00,$0.00,$200.63,$13.50,$21.41,$5.34,$5.17,$21.41,$21.41,$200.63,$30.00,$0.00,$15.00,$23.76,$24.00,$18.00,$200.63,$0.00,$191.04,$0.00
90621,EAP,CPT® 90621,,MENB RECOMBINANT LIPOPROTEIN VACCINE IM,$30.00,$0.00,$163.94,$13.50,$21.41,$5.34,$5.17,$21.41,$21.41,$163.94,$30.00,$0.00,$15.00,$23.76,$24.00,$18.00,$163.94,$0.00,$156.09,$0.00
90632,EAP,CPT® 90632,,HEPA VACCINE ADULT IM,$30.00,$0.00,$70.39,$13.50,$21.41,$0.00,$56.67,$21.41,$21.41,$70.39,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$70.39,$0.00,$67.03,$0.00
90633,EAP,CPT® 90633,,HEPA VACCINE PED/ADOL-2 DOSE,$30.00,$0.00,$30.00,$13.50,$21.41,$0.00,$9.40,$21.41,$21.41,$5.25,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$4.70,$0.00,$4.78,$0.00
90636,EAP,CPT® 90636,,HEPA/HEPB VACCINE ADULT IM,$30.00,$0.00,$122.20,$13.50,$21.41,$0.00,$107.88,$21.41,$21.41,$122.20,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$122.20,$0.00,$116.36,$0.00
90647,EAP,CPT® 90647,,"HIB VACCINE, PRP-OMP, IM",$30.00,$0.00,$30.00,$13.50,$21.41,$0.00,$5.17,$21.41,$21.41,$5.25,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$4.70,$0.00,$4.78,$0.00
90648,EAP,CPT® 90648,,"HIB VACCINE, PRP-T, IM",$30.00,$0.00,$30.00,$13.50,$21.41,$0.00,$5.17,$21.41,$21.41,$5.25,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$4.70,$0.00,$4.78,$0.00
90651,EAP,CPT® 90651,,HUMAN PAPILLOMA VIRUS NONAVALENT HPV 3 DOSE IM,$30.00,$0.00,$267.82,$13.50,$21.41,$5.34,$5.17,$21.41,$21.41,$267.82,$30.00,$0.00,$15.00,$23.76,$24.00,$18.00,$267.82,$0.00,$255.01,$0.00
90670,EAP,CPT® 90670,,PNEUMOCOCCAL CONJ VACCINE 13 VALENT IM,$30.00,$4.38,$252.18,$13.50,$21.41,$7.80,$5.17,$21.41,$21.41,$252.18,$30.00,$4.38,$15.00,$23.76,$24.00,$4.38,$252.18,$7.80,$240.12,$7.80
90674,EAP,CPT® 90674,,CCIIV4 VACCINE PRESERVATIVE FREE 0.5 ML IM USE,$30.00,$4.38,$33.05,$13.50,$21.41,$7.80,$5.17,$21.41,$21.41,$33.05,$30.00,$4.38,$15.00,$23.76,$24.00,$4.38,$33.05,$7.80,$31.47,$7.80
90680,EAP,CPT® 90680,,"ROTOVIRUS VACCINE, ORAL",$30.00,$0.00,$30.00,$13.50,$21.41,$0.00,$5.17,$21.41,$21.41,$5.25,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$4.70,$0.00,$4.78,$0.00
90681,EAP,CPT® 90681,,"ROTOVIRUS VACCINE, HUMAN ATTENUATED, 2 DOSE, ORAL",$30.00,$0.00,$30.00,$13.50,$21.41,$5.34,$5.17,$21.41,$21.41,$5.25,$30.00,$0.00,$15.00,$23.76,$24.00,$18.00,$4.70,$0.00,$4.78,$0.00
90685,EAP,CPT® 90685,,IIV4 VACC PRSRV FREE 0.25 ML DOS FOR IM USE,$30.00,$0.00,$23.76,$0.00,$0.00,$0.00,$5.17,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$23.76,$0.00,$0.00,$4.70,$0.00,$0.00,$0.00
90686,EAP,CPT® 90686,,IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE,$25.00,$3.65,$25.00,$11.25,$17.84,$6.50,$4.31,$17.84,$17.84,$22.36,$25.00,$3.65,$12.50,$19.80,$20.00,$3.65,$22.36,$6.50,$21.29,$6.50
90696,EAP,CPT® 90696,,"DTAP-IPV, IM, AGE 4-6 YEAR",$30.00,$0.00,$30.00,$13.50,$21.41,$0.00,$5.17,$21.41,$21.41,$5.25,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$4.70,$0.00,$4.78,$0.00
90698,EAP,CPT® 90698,,"DTAP-HIB-IP VACCINE, IM",$30.00,$0.00,$30.00,$13.50,$21.41,$0.00,$5.17,$21.41,$21.41,$5.25,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$4.70,$0.00,$4.78,$0.00
90700,EAP,CPT® 90700,,"DTAP IMMUNIZATION, IM",$30.00,$0.00,$30.00,$13.50,$21.41,$0.00,$5.17,$21.41,$21.41,$5.25,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$4.70,$0.00,$4.78,$0.00
90707,EAP,CPT® 90707,,"MMR VIRUS IMMUNIZATION, SUBCUT",$30.00,$0.00,$92.45,$13.50,$21.41,$0.00,$11.75,$21.41,$21.41,$92.45,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$92.45,$0.00,$88.03,$0.00
90710,EAP,CPT® 90710,,"COMBINED VACCINE,MMR+VARICELLA,SQ",$30.00,$0.00,$30.00,$13.50,$21.41,$0.00,$5.17,$21.41,$21.41,$5.25,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$4.70,$0.00,$4.78,$0.00
90713,EAP,CPT® 90713,,"POLIOMYELITIS IMMUNIZATN,INACTV,SQ",$30.00,$0.00,$30.00,$0.00,$21.41,$0.00,$0.00,$21.41,$21.41,$0.00,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$0.00,$0.00,$0.00,$0.00
90715,EAP,CPT® 90715,,TDAP VACCINE >7 IM,$30.00,$0.00,$39.53,$13.50,$21.41,$0.00,$5.17,$21.41,$21.41,$39.53,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$39.53,$0.00,$37.64,$0.00
90716,EAP,CPT® 90716,,"CHICKEN POX VACCINE,LIVE,SUBCUT",$30.00,$0.00,$159.48,$13.50,$21.41,$5.34,$9.40,$21.41,$21.41,$159.48,$30.00,$0.00,$15.00,$23.76,$24.00,$18.00,$159.48,$0.00,$151.85,$0.00
90723,EAP,CPT® 90723,,DTAP-HEPB-IPV VACCINE INTRAMUSCULAR,$30.00,$0.00,$30.00,$13.50,$21.41,$5.34,$5.17,$21.41,$21.41,$5.25,$30.00,$0.00,$15.00,$23.76,$24.00,$18.00,$4.70,$0.00,$4.78,$0.00
90732,EAP,CPT® 90732,,PPSV23 VACCINE 2 YRS OR OLDER FOR SUBQ/IM USE,$30.00,$4.38,$134.20,$13.50,$21.41,$7.80,$9.40,$21.41,$21.41,$134.20,$30.00,$4.38,$15.00,$23.76,$24.00,$4.38,$134.20,$7.80,$127.78,$7.80
90734,EAP,CPT® 90734,,MENACWYD/MENACWY-CRM CONJ VACC GRPS ACWY IM USE,$30.00,$0.00,$143.71,$13.50,$21.41,$5.34,$9.40,$21.41,$21.41,$143.71,$30.00,$0.00,$15.00,$23.76,$24.00,$18.00,$143.71,$0.00,$136.84,$0.00
90744,EAP,CPT® 90744,,"HEP B VACCINE,PED/ADOL,IM",$30.00,$0.00,$30.00,$13.50,$21.41,$7.80,$5.17,$21.41,$21.41,$5.25,$30.00,$0.00,$15.00,$23.76,$24.00,$18.00,$4.70,$7.80,$0.00,$7.80
90746,EAP,CPT® 90746,,HEPATITIS B VACCINE ADULT 3 DOSE IM,$227.00,$0.00,$227.00,$102.15,$162.01,$59.02,$70.16,$162.01,$162.01,$78.80,$227.00,$0.00,$113.50,$179.78,$181.60,$136.20,$78.80,$59.02,$75.03,$59.02
90791,EAP,CPT® 90791,,PSYCHIATRIC DIAGNOSTIC EVALUATION,$509.00,$0.00,$403.13,$0.00,$0.00,$0.00,$140.01,$363.27,$363.27,$89.12,$0.00,$131.75,$0.00,$403.13,$0.00,$183.04,$143.47,$0.00,$0.00,$0.00
90792,EAP,CPT®90792,,PR PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES,$406.00,,,,,,,,,,,,,,,,,,,
90832,EAP,CPT®90832,,PR PSYCHOTHERAPY W/PATIENT 30 MINUTES,$181.33,,,,,,,,,,,,,,,,,,,
90832,EAP,CPT® 90832,,PSYCHOTHERAPY W/PATIENT 30 MINUTES,$249.00,$39.64,$249.00,$135.21,$177.71,$125.96,$62.31,$177.71,$177.71,$43.60,$249.00,$131.75,$124.50,$197.21,$199.20,$183.04,$59.54,$63.85,$39.64,$125.47
90834,EAP,CPT®90834,,PR PSYCHOTHERAPY W/PATIENT 45 MINUTES,$241.67,,,,,,,,,,,,,,,,,,,
90837,EAP,CPT®90837,,PR PSYCHOTHERAPY W/PATIENT 60 MINUTES,$361.33,,,,,,,,,,,,,,,,,,,
90837,EAP,CPT® 90837,,PSYCHOTHERAPY W/PATIENT 60 MINUTES,$495.00,$78.80,$495.00,$268.79,$353.28,$125.96,$144.55,$353.28,$353.28,$86.67,$495.00,$131.75,$247.50,$392.04,$396.00,$183.04,$124.37,$127.35,$78.80,$125.47
90846,EAP,CPT®90846,,PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS,$308.00,,,,,,,,,,,,,,,,,,,
90847,EAP,CPT®90847,,PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS,$303.33,,,,,,,,,,,,,,,,,,,
90853,EAP,CPT®90853,,PR GROUP PSYCHOTHERAPY,$72.33,,,,,,,,,,,,,,,,,,,
91111,EAP,CPT® 91111,,GASTROINTESTINAL TRACT IMAGING ESOPHAGUS W/I&R,"$2,932.00",$0.00,"$2,932.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,932.00",$0.00,$0.00,"$2,322.14",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
92012,EAP,CPT®92012,,"PR EYE EXAM ESTABLISHED PT, INTERMED",$151.00,,,,,,,,,,,,,,,,,,,
92014,EAP,CPT®92014,,"PR EYE EXAM, EST PATIENT,COMPREHESV",$229.00,,,,,,,,,,,,,,,,,,,
92083,EAP,CPT®92083,,"PR VISUAL FIELD EXAM,EXTENDED",$111.00,,,,,,,,,,,,,,,,,,,
92133,EAP,CPT®92133,,PR COMPUTERIZED OPHTHALMIC IMAGING OPTIC NERVE,$77.00,,,,,,,,,,,,,,,,,,,
92134,EAP,CPT®92134,,PR COMPUTERIZED OPHTHALMIC IMAGING RETINA,$87.00,,,,,,,,,,,,,,,,,,,
92250,EAP,CPT®92250,,PR FUNDAL PHOTOGRAPHY,$82.33,,,,,,,,,,,,,,,,,,,
92250,EAP,CPT® 92250,,FUNDAL PHOTOGRAPHY,$160.00,$23.77,$160.00,$86.88,$114.19,$104.55,$27.57,$114.19,$114.19,$28.01,$160.00,$109.35,$80.00,$126.72,$128.00,$151.93,$59.03,$23.77,$25.47,$104.14
92507,EAP,CPT®92507,,PR SPEECH/HEARING THERAPY,$243.00,,,,,,,,,,,,,,,,,,,
92551,EAP,CPT® 92551,,"PURE TONE HEARING TEST, AIR",$44.00,$0.00,$44.00,$23.89,$31.40,$7.83,$7.58,$31.40,$31.40,$7.70,$44.00,$0.00,$22.00,$34.85,$35.20,$26.40,$9.01,$0.00,$7.00,$0.00
92552,EAP,CPT® 92552,,"PURE TONE AUDIOMETRY, AIR",$112.00,$17.48,$112.00,$60.82,$79.93,$104.55,$19.30,$79.93,$79.93,$19.61,$112.00,$109.35,$56.00,$88.70,$89.60,$112.00,$17.48,$32.05,$17.83,$104.14
92567,EAP,CPT®92567,,PR TYMPANOMETRY,$32.67,,,,,,,,,,,,,,,,,,,
92586,EAP,CPT®92586,,"PR AUDITORY EVOKED POTENTIAL, LIMITED",$290.00,,,,,,,,,,,,,,,,,,,
92610,EAP,CPT®92610,,"PR EVAL,ORAL & PHARYNGEAL SWALLOW FUNCTION",$224.00,,,,,,,,,,,,,,,,,,,
93000,EAP,CPT® 93000,,"ELECTROCARDIOGRAM, COMPLETE",$61.00,$0.00,$61.00,$32.44,$43.54,$10.86,$10.51,$43.54,$43.54,$10.68,$61.00,$18.17,$30.50,$48.31,$48.80,$17.30,$28.07,$17.30,$0.00,$17.30
93005,EAP,CPT®93005,,"PR ELECTROCARDIOGRAM, TRACING",$25.67,,,,,,,,,,,,,,,,,,,
93015,EAP,CPT® 93015,,CV STRS TST XERS&/OR RX CONT ECG W/SI&R,$252.00,$0.00,$252.00,$145.99,$179.85,$44.86,$43.42,$179.85,$179.85,$44.12,$252.00,$76.29,$126.00,$199.58,$201.60,$72.09,$110.83,$72.09,$0.00,$72.09
93017,EAP,CPT®93017,,"PR CARDIAC STRESS TST,TRACING ONLY",$98.67,,,,,,,,,,,,,,,,,,,
93306,EAP,CPT®93306,,"PR ECHO HEART XTHORACIC,COMPLETE W DOPPLER",$213.33,,,,,,,,,,,,,,,,,,,
93306,EAP,CPT® 93306,,"ECHO HEART XTHORACIC,COMPLETE W DOPPLER",$739.00,$117.65,$739.00,$435.94,$527.42,$461.79,$195.39,$527.42,$527.42,$129.39,$739.00,$483.00,$369.50,$585.29,$591.20,$671.06,$254.50,$136.14,$117.65,$460.00
93308,EAP,CPT®93308,,"PR ECHO HEART XTHORACIC,LIMITED",$137.67,,,,,,,,,,,,,,,,,,,
93452,EAP,CPT®93452,,PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I,$741.00,,,,,,,,,,,,,,,,,,,
93880,EAP,CPT® 93880,,"DUPLEX SCAN EXTRACRANIAL,BILAT",$711.00,$113.19,$711.00,$387.33,$520.86,$223.46,$122.50,$520.86,$520.86,$124.49,$711.00,$233.72,$355.50,$563.11,$568.80,$324.73,$179.50,$162.44,$113.19,$222.60
93926,EAP,CPT® 93926,,DUPLEX LO EXTREM ART UNILAT/LTD,$479.00,$76.26,$479.00,$258.92,$424.07,$107.47,$82.53,$424.07,$424.07,$83.87,$479.00,$112.41,$239.50,$379.37,$383.20,$156.18,$120.13,$127.86,$76.26,$107.06
93970,EAP,CPT®93970,,"PR DUPLEX EXTREM VENOUS,BILAT",$237.33,,,,,,,,,,,,,,,,,,,
93970,EAP,CPT® 93970,,"DUPLEX EXTREM VENOUS,BILAT",$695.00,$110.64,$695.00,$377.18,$523.58,$223.46,$119.75,$523.58,$523.58,$121.69,$695.00,$233.72,$347.50,$550.44,$556.00,$324.73,$199.35,$163.16,$110.64,$222.60
93971,EAP,CPT®93971,,"PR DUPLEX EXTREM VENOUS,UNI OR LTD",$148.67,,,,,,,,,,,,,,,,,,,
93971,EAP,CPT® 93971,,"DUPLEX EXTREM VENOUS,UNI OR LTD",$434.00,$69.09,$434.00,$229.82,$346.68,$107.47,$113.40,$346.68,$346.68,$75.99,$434.00,$112.41,$217.00,$343.73,$347.20,$156.18,$132.53,$101.21,$69.09,$107.06
94060,EAP,CPT®94060,,PR EVAL OF BRONCHOSPASM,$38.33,,,,,,,,,,,,,,,,,,,
94640,EAP,CPT® 94640,,"INHAL RX, AIRWAY OBST/DX SPUTUM INDUCT",$63.00,$10.03,$184.50,$34.21,$44.96,$176.40,$10.85,$44.96,$44.96,$11.03,$63.00,$184.50,$31.50,$49.90,$50.40,$63.00,$19.30,$18.01,$10.03,$175.71
94660,EAP,CPT®94660,,"PR POS AIRWAY PRESSURE, CPAP",$118.00,,,,,,,,,,,,,,,,,,,
94681,EAP,CPT®94681,,"PR EXHALED AIR ANALYSIS: O2, CO2",$31.00,,,,,,,,,,,,,,,,,,,
94726,EAP,CPT®94726,,PR PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY RESIST,$72.00,,,,,,,,,,,,,,,,,,,
94729,EAP,CPT®94729,,PR DIFFUSING CAPACITY,$67.00,,,,,,,,,,,,,,,,,,,
95810,EAP,CPT®95810,,PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND,$353.67,,,,,,,,,,,,,,,,,,,
96161,EAP,CPT® 96161,,CAREGIVER HLTH RISK ASSMT SCORE DOC STND INSTRM,$9.00,$0.00,$27.40,$4.89,$6.42,$26.20,$1.55,$6.42,$6.42,$1.58,$9.00,$27.40,$4.50,$7.13,$7.20,$9.00,$1.41,$2.52,$0.00,$26.10
96361,EAP,CPT® 96361,,"IV INFUSION, HYDRATION, EA ADD HOUR",$48.00,$7.64,$48.00,$26.06,$34.26,$36.54,$8.27,$34.26,$34.26,$8.40,$48.00,$38.22,$24.00,$38.02,$38.40,$48.00,$15.67,$13.69,$7.64,$36.40
96372,EAP,CPT® 96372,,"INJECTION,THERAP/PROPH/DIAGNOST, IM OR SUBCUT",$50.00,$7.96,$60.65,$27.15,$35.69,$57.98,$8.61,$35.69,$35.69,$8.75,$50.00,$60.65,$25.00,$39.60,$40.00,$50.00,$20.00,$14.42,$7.96,$57.76
97022,EAP,CPT®97022,,PR WHIRLPOOL THERAPY,$55.00,,,,,,,,,,,,,,,,,,,
97035,EAP,CPT®97035,,PR ULTRASOUND THERAPY,$44.00,,,,,,,,,,,,,,,,,,,
97110,EAP,CPT®97110,,PR THERAPEUTIC EXERCISES,$94.00,,,,,,,,,,,,,,,,,,,
97112,EAP,CPT®97112,,"PR NEUROMUSC REEDUCAT,1+ AREAS, EA 15 MIN",$108.00,,,,,,,,,,,,,,,,,,,
97116,EAP,CPT®97116,,PR GAIT TRAINING THERAPY,$88.67,,,,,,,,,,,,,,,,,,,
97161,EAP,CPT®97161,,PR PHYSICAL THERAPY EVALUATION LOW COMPLEX 20 MINS,$263.00,,,,,,,,,,,,,,,,,,,
97162,EAP,CPT®97162,,PR PHYSICAL THERAPY EVALUATION MOD COMPLEX 30 MINS,$263.00,,,,,,,,,,,,,,,,,,,
97165,EAP,CPT®97165,,PR OCCUPATIONAL THERAPY EVAL LOW COMPLEX 30 MINS,$279.00,,,,,,,,,,,,,,,,,,,
97166,EAP,CPT®97166,,PR OCCUPATIONAL THERAPY EVAL MOD COMPLEX 45 MINS,$278.00,,,,,,,,,,,,,,,,,,,
97530,EAP,CPT®97530,,PR THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN,$121.00,,,,,,,,,,,,,,,,,,,
97535,EAP,CPT®97535,,PR SELF-CARE/HOME MGMT TRAINING EACH 15 MINUTES,$105.00,,,,,,,,,,,,,,,,,,,
97542,EAP,CPT®97542,,"PR WHEELCHAIR MNGEMENT TRAINING, EA 15 MIN",$102.00,,,,,,,,,,,,,,,,,,,
97597,EAP,CPT®97597,,PR DEBRIDEMENT OPEN WOUND 20 SQ CM<,$114.00,,,,,,,,,,,,,,,,,,,
97760,EAP,CPT®97760,,"PR ORTHOTIC MGMT AND TRAINING, EACH 15 MIN",$151.00,,,,,,,,,,,,,,,,,,,
97763,EAP,CPT®97763,,PR ORTHOTICS/PROSTH MGMT &/TRAINJ SBSQ ENCTR 15 MIN,$162.00,,,,,,,,,,,,,,,,,,,
97802,EAP,CPT® 97802,,"MED NUTR THER, 1ST, INDIV, EA 15 MIN",$134.00,$20.97,$134.00,$72.76,$95.64,$23.85,$23.09,$95.64,$95.64,$23.46,$134.00,$29.55,$67.00,$106.13,$107.20,$34.61,$20.97,$34.61,$21.33,$34.61
97803,EAP,CPT® 97803,,"MED NUTR THER, SUBSQ, INDIV, EA 15 MIN",$116.00,$18.15,$116.00,$62.99,$82.79,$20.65,$19.99,$82.79,$82.79,$20.31,$116.00,$25.06,$58.00,$91.87,$92.80,$29.21,$18.15,$29.21,$18.47,$29.21
98966,EAP,CPT® 98966,,NONPHYSICIAN TELEPHONE ASSESSMENT 5-10 MIN,$161.00,$0.00,$161.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$161.00,$0.00,$80.50,$127.51,$128.80,$0.00,$0.00,$0.00,$0.00,$0.00
98967,EAP,CPT® 98967,,NONPHYSICIAN TELEPHONE ASSESSMENT 11-20 MIN,$266.00,$0.00,$266.00,$144.44,$0.00,$47.35,$45.83,$0.00,$0.00,$0.00,$266.00,$0.00,$133.00,$210.67,$212.80,$159.60,$41.63,$0.00,$0.00,$0.00
98968,EAP,CPT® 98968,,NONPHYSICIAN TELEPHONE ASSESSMENT 21-30 MIN,$386.00,$0.00,$386.00,$209.60,$0.00,$68.71,$66.51,$0.00,$0.00,$67.59,$386.00,$0.00,$193.00,$305.71,$308.80,$231.60,$60.41,$0.00,$0.00,$0.00
99024,EAP,CPT® 99024,,POST-OP FOLLOW-UP VISIT,$0.01,$0.00,$0.01,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.01,$0.00,$0.00,$0.01,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
99173,EAP,CPT® 99173,,"VISUAL SCREENING TEST, BILAT",$11.00,$0.00,$11.00,$5.97,$7.85,$1.96,$1.90,$7.85,$7.85,$1.93,$11.00,$0.00,$5.50,$8.71,$8.80,$6.60,$1.72,$0.00,$0.00,$0.00
99201,EAP,CPT® 99201,,OFFICE OUTPATIENT NEW 10 MINUTES,$329.00,$0.00,$329.00,$0.00,$299.34,$58.56,$67.13,$299.34,$299.34,$57.61,$329.00,$28.83,$164.50,$260.57,$263.20,$27.04,$108.52,$27.04,$99.16,$27.04
99202,EAP,CPT®99202,,PR OFFICE OUTPATIENT NEW 20 MINUTES,$146.67,,,,,,,,,,,,,,,,,,,
99202,EAP,CPT® 99202,,OFFICE OUTPATIENT NEW 20 MINUTES,$378.00,$0.00,$378.00,$0.00,$299.34,$67.28,$67.13,$299.34,$299.34,$66.18,$378.00,$54.20,$189.00,$299.38,$302.40,$51.57,$108.52,$51.57,$99.16,$51.57
99203,EAP,CPT®99203,,PR OFFICE OUTPATIENT NEW 30 MINUTES,$219.67,,,,,,,,,,,,,,,,,,,
99203,EAP,CPT® 99203,,OFFICE OUTPATIENT NEW 30 MINUTES,$442.00,$0.00,$442.00,$0.00,$299.34,$78.68,$67.13,$299.34,$299.34,$77.39,$442.00,$82.35,$221.00,$350.06,$353.60,$77.17,$108.52,$77.17,$99.16,$77.17
99204,EAP,CPT®99204,,PR OFFICE OUTPATIENT NEW 45 MINUTES,$374.00,,,,,,,,,,,,,,,,,,,
99204,EAP,CPT® 99204,,OFFICE OUTPATIENT NEW 45 MINUTES,$569.00,$0.00,$569.00,$0.00,$299.34,$101.28,$67.13,$299.34,$299.34,$99.63,$569.00,$138.78,$284.50,$450.65,$455.20,$131.98,$108.52,$131.98,$99.16,$131.98
99205,EAP,CPT®99205,,PR OFFICE OUTPATIENT NEW 60 MINUTES,$489.67,,,,,,,,,,,,,,,,,,,
99205,EAP,CPT® 99205,,OFFICE OUTPATIENT NEW 60 MINUTES,$686.00,$0.00,$686.00,$0.00,$299.34,$122.11,$67.13,$299.34,$299.34,$120.11,$686.00,$181.26,$343.00,$543.31,$548.80,$172.37,$108.52,$172.37,$99.16,$172.37
99211,EAP,CPT®99211,,PR OFFICE OUTPATIENT VISIT 5 MINUTES,$27.00,,,,,,,,,,,,,,,,,,,
99211,EAP,CPT® 99211,,OFFICE OUTPATIENT VISIT 5 MINUTES,$290.00,$0.00,$299.34,$0.00,$299.34,$51.62,$67.13,$299.34,$299.34,$50.78,$290.00,$9.84,$145.00,$229.68,$232.00,$9.38,$108.52,$9.38,$99.16,$9.38
99212,EAP,CPT®99212,,PR OFFICE OUTPATIENT VISIT 10 MINUTES,$76.00,,,,,,,,,,,,,,,,,,,
99212,EAP,CPT® 99212,,OFFICE OUTPATIENT VISIT 10 MINUTES,$313.00,$0.00,$313.00,$0.00,$299.34,$55.71,$67.13,$299.34,$299.34,$54.80,$313.00,$27.29,$156.50,$247.90,$250.40,$26.32,$108.52,$26.32,$99.16,$26.32
99213,EAP,CPT®99213,,PR OFFICE OUTPATIENT VISIT 15 MINUTES,$149.67,,,,,,,,,,,,,,,,,,,
99213,EAP,CPT® 99213,,OFFICE OUTPATIENT VISIT 15 MINUTES,$399.00,$0.00,$399.00,$0.00,$299.34,$71.02,$67.13,$299.34,$299.34,$69.86,$399.00,$54.93,$199.50,$316.01,$319.20,$52.29,$108.52,$52.29,$99.16,$52.29
99214,EAP,CPT®99214,,PR OFFICE OUTPATIENT VISIT 25 MINUTES,$229.00,,,,,,,,,,,,,,,,,,,
99214,EAP,CPT® 99214,,OFFICE OUTPATIENT VISIT 25 MINUTES,$491.00,$0.00,$491.00,$0.00,$299.34,$87.40,$67.13,$299.34,$299.34,$85.97,$491.00,$84.06,$245.50,$388.87,$392.80,$80.42,$108.52,$80.42,$99.16,$80.42
99215,EAP,CPT®99215,,PR OFFICE OUTPATIENT VISIT 40 MINUTES,$322.33,,,,,,,,,,,,,,,,,,,
99215,EAP,CPT® 99215,,OFFICE OUTPATIENT VISIT 40 MINUTES,$541.00,$0.00,$541.00,$0.00,$299.34,$96.30,$67.13,$299.34,$299.34,$94.72,$541.00,$118.93,$270.50,$428.47,$432.80,$113.60,$108.52,$113.60,$99.16,$113.60
99243,EAP,CPT®99243,,PR OFFICE CONSULTATION NEW/ESTAB PATIENT 40 MIN,$277.33,,,,,,,,,,,,,,,,,,,
99243,EAP,CPT® 99243,,OFFICE CONSULTATION NEW/ESTAB PATIENT 40 MIN,$436.00,$0.00,$436.00,$0.00,$299.34,$77.61,$67.13,$299.34,$299.34,$76.34,$436.00,$0.00,$218.00,$345.31,$348.80,$261.60,$112.44,$0.00,$0.00,$0.00
99244,EAP,CPT®99244,,PR OFFICE CONSULTATION NEW/ESTAB PATIENT 60 MIN,$445.33,,,,,,,,,,,,,,,,,,,
99244,EAP,CPT® 99244,,OFFICE CONSULTATION NEW/ESTAB PATIENT 60 MIN,$652.00,$0.00,$652.00,$0.00,$299.34,$116.06,$67.13,$299.34,$299.34,$114.16,$652.00,$0.00,$326.00,$516.38,$521.60,$391.20,$155.65,$0.00,$0.00,$0.00
99381,EAP,CPT® 99381,,"PREVENTIVE VISIT,NEW,INFANT < 1 YR",$395.00,$0.00,$395.00,$0.00,$299.34,$70.31,$67.13,$299.34,$299.34,$69.16,$395.00,$0.00,$197.50,$312.84,$316.00,$237.00,$61.82,$0.00,$0.00,$0.00
99382,EAP,CPT® 99382,,"PREVENTIVE VISIT,NEW,AGE 1-4",$413.00,$0.00,$413.00,$0.00,$299.34,$73.51,$67.13,$299.34,$299.34,$72.31,$413.00,$0.00,$206.50,$327.10,$330.40,$247.80,$64.63,$0.00,$0.00,$0.00
99383,EAP,CPT® 99383,,"PREVENTIVE VISIT,NEW,AGE5-11",$429.00,$0.00,$429.00,$0.00,$299.34,$76.36,$67.13,$299.34,$299.34,$75.11,$429.00,$0.00,$214.50,$339.77,$343.20,$257.40,$67.14,$0.00,$0.00,$0.00
99384,EAP,CPT® 99384,,"PREVENTIVE VISIT,NEW,12-17",$485.00,$0.00,$485.00,$0.00,$299.34,$86.33,$67.13,$299.34,$299.34,$84.92,$485.00,$0.00,$242.50,$384.12,$388.00,$291.00,$75.90,$0.00,$0.00,$0.00
99385,EAP,CPT®99385,,"PR PREVENTIVE VISIT,NEW,18-39",$284.33,,,,,,,,,,,,,,,,,,,
99385,EAP,CPT® 99385,,"PREVENTIVE VISIT,NEW,18-39",$469.00,$0.00,$469.00,$0.00,$299.34,$83.48,$67.13,$299.34,$299.34,$82.12,$469.00,$0.00,$234.50,$371.45,$375.20,$281.40,$84.34,$0.00,$0.00,$0.00
99386,EAP,CPT®99386,,"PR PREVENTIVE VISIT,NEW,40-64",$345.33,,,,,,,,,,,,,,,,,,,
99386,EAP,CPT® 99386,,"PREVENTIVE VISIT,NEW,40-64",$545.00,$0.00,$545.00,$0.00,$299.34,$97.01,$67.13,$299.34,$299.34,$95.43,$545.00,$0.00,$272.50,$431.64,$436.00,$327.00,$84.34,$0.00,$0.00,$0.00
99387,EAP,CPT® 99387,,"PREVENTIVE VISIT,NEW,65 & OVER",$591.00,$0.00,$591.00,$0.00,$299.34,$0.00,$0.00,$299.34,$299.34,$0.00,$591.00,$0.00,$295.50,$468.07,$472.80,$0.00,$0.00,$0.00,$0.00,$0.00
99391,EAP,CPT® 99391,,"PREVENTIVE VISIT,EST, INFANT < 1 YR",$354.00,$0.00,$354.00,$0.00,$299.34,$63.01,$67.13,$299.34,$299.34,$61.98,$354.00,$0.00,$177.00,$280.37,$283.20,$212.40,$55.40,$0.00,$0.00,$0.00
99392,EAP,CPT® 99392,,"PREVENTIVE VISIT,EST,AGE 1-4",$378.00,$0.00,$378.00,$0.00,$299.34,$67.28,$67.13,$299.34,$299.34,$66.18,$378.00,$0.00,$189.00,$299.38,$302.40,$226.80,$59.16,$0.00,$0.00,$0.00
99393,EAP,CPT® 99393,,"PREVENTIVE VISIT,EST,AGE5-11",$377.00,$0.00,$377.00,$0.00,$299.34,$67.11,$67.13,$299.34,$299.34,$66.01,$377.00,$0.00,$188.50,$298.58,$301.60,$226.20,$59.00,$0.00,$0.00,$0.00
99394,EAP,CPT® 99394,,"PREVENTIVE VISIT,EST,12-17",$414.00,$0.00,$414.00,$0.00,$299.34,$73.69,$67.13,$299.34,$299.34,$72.49,$414.00,$0.00,$207.00,$327.89,$331.20,$248.40,$64.79,$0.00,$0.00,$0.00
99395,EAP,CPT® 99395,,"PREVENTIVE VISIT,EST,18-39",$423.00,$0.00,$423.00,$0.00,$299.34,$75.29,$67.13,$299.34,$299.34,$74.06,$423.00,$0.00,$211.50,$335.02,$338.40,$253.80,$84.34,$0.00,$0.00,$0.00
99396,EAP,CPT® 99396,,"PREVENTIVE VISIT,EST,40-64",$450.00,$0.00,$450.00,$0.00,$299.34,$80.10,$67.13,$299.34,$299.34,$78.79,$450.00,$0.00,$225.00,$356.40,$360.00,$270.00,$84.34,$0.00,$0.00,$0.00
99406,EAP,CPT® 99406,,TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES,$54.00,$0.00,$299.34,$0.00,$299.34,$0.00,$0.00,$299.34,$299.34,$9.45,$54.00,$0.00,$27.00,$42.77,$43.20,$0.00,$0.00,$0.00,$0.00,$0.00
99441,EAP,CPT® 99441,,PHYS/QHP TELEPHONE EVALUATION 5-10 MIN,$161.00,$0.00,$161.00,$87.42,$0.00,$28.66,$27.74,$0.00,$0.00,$28.19,$161.00,$0.00,$80.50,$127.51,$128.80,$96.60,$25.20,$0.00,$0.00,$0.00
99442,EAP,CPT® 99442,,PHYS/QHP TELEPHONE EVALUATION 11-20 MIN,$266.00,$0.00,$266.00,$144.44,$0.00,$47.35,$45.83,$0.00,$0.00,$46.57,$266.00,$0.00,$133.00,$210.67,$212.80,$159.60,$41.63,$0.00,$0.00,$0.00
99443,EAP,CPT® 99443,,PHYS/QHP TELEPHONE EVALUATION 21-30 MIN,$386.00,$0.00,$386.00,$209.60,$0.00,$68.71,$66.51,$0.00,$0.00,$67.59,$386.00,$0.00,$193.00,$305.71,$308.80,$231.60,$60.41,$0.00,$0.00,$0.00
99495,EAP,CPT® 99495,,TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISCHRGE,$656.00,$0.00,$656.00,$0.00,$299.34,$111.17,$67.13,$299.34,$299.34,$114.86,$656.00,$116.27,$328.00,$519.55,$524.80,$161.54,$102.66,$125.50,$104.44,$110.73
99496,EAP,CPT® 99496,,TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCHARGE,$867.00,$0.00,$867.00,$0.00,$299.34,$0.00,$67.13,$299.34,$299.34,$151.80,$867.00,$116.27,$433.50,$686.66,$693.60,$161.54,$135.69,$165.53,$0.00,$0.00
10932085,EAP,HCPCS C1729,,Catheter Urethral 8fr Foley 2 Way Latex Dover Silicone,$107.00,$0.00,$107.00,$58.10,$76.37,$0.00,$18.44,$76.37,$76.37,$18.73,$107.00,$0.00,$53.50,$84.74,$85.60,$0.00,$16.75,$0.00,$17.03,$0.00
10933190,EAP,HCPCS C1729,,Catheter Urethral 18fr Foley 2 Way Medium Olive Coude Tip 1,$26.00,$0.00,$26.00,$14.12,$18.56,$0.00,$4.48,$18.56,$18.56,$4.55,$26.00,$0.00,$13.00,$20.59,$20.80,$0.00,$4.07,$0.00,$4.14,$0.00
10945160,EAP,HCPCS C1751,,Catheter Umb 3.5fr 15in .15ml Clr Strl Lf Arg 1 Lum Ll Hub,$34.00,$0.00,$34.00,$18.46,$24.27,$0.00,$5.86,$24.27,$24.27,$5.95,$34.00,$0.00,$17.00,$26.93,$27.20,$0.00,$5.32,$0.00,$5.41,$0.00
10945178,EAP,HCPCS C1751,,Cap Tube 13mm Blu Eztpr Dbl Flng Sl Thb Tab Pe,$34.00,$0.00,$34.00,$18.46,$24.27,$0.00,$5.86,$24.27,$24.27,$5.95,$34.00,$0.00,$17.00,$26.93,$27.20,$0.00,$5.32,$0.00,$5.41,$0.00
10945194,EAP,HCPCS C1729,,System Drn 35cm 700ml Blu Strl Lf Be2 Mntr Trndcr Atch Vntrc,"$1,307.00",$0.00,"$1,307.00",$709.70,$932.81,$0.00,$225.19,$932.81,$932.81,$228.85,"$1,307.00",$0.00,$653.50,"$1,035.14","$1,045.60",$0.00,$204.55,$0.00,$208.07,$0.00
10961170,EAP,HCPCS C1751,,Kit Arterial Line .018in 20ga 22ga 1.75in Catheter Radiopq,$57.00,$0.00,$57.00,$30.95,$40.68,$0.00,$9.82,$40.68,$40.68,$9.98,$57.00,$0.00,$28.50,$45.14,$45.60,$0.00,$8.92,$0.00,$9.07,$0.00
11100001,EAP,Custom 11100001,,HB MED-SUR-GY/PVT,"$2,871.00",$0.00,"$2,696.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,696.00",$0.00,$0.00,"$2,135.23",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
11100003,EAP,Custom 11100003,,Tele Private Med Surg,"$3,172.00",$0.00,"$2,978.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,978.00",$0.00,$0.00,"$2,358.58",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
11100021,EAP,Custom 11100021,,HB  PVT GYN,"$2,871.00",$0.00,"$2,696.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,696.00",$0.00,$0.00,"$2,135.23",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
11100023,EAP,Custom 11100023,,Tele Private  Gyn,"$3,172.00",$0.00,"$2,978.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,978.00",$0.00,$0.00,"$2,358.58",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
11100501,EAP,Custom 11100501,,Trauma Private Med Surg,"$3,191.00",$0.00,"$2,996.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,996.00",$0.00,$0.00,"$2,372.83",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
11100503,EAP,Custom 11100503,,Trauma Tele Private Med Surg,"$3,491.00",$0.00,"$3,278.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,278.00",$0.00,$0.00,"$2,596.18",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
11100521,EAP,Custom 11100521,,Trauma Private  Gyn,"$3,191.00",$0.00,"$2,996.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,996.00",$0.00,$0.00,"$2,372.83",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
11100523,EAP,Custom 11100523,,Trauma Tele Private  Gyn,"$3,491.00",$0.00,"$3,278.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,278.00",$0.00,$0.00,"$2,596.18",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
11200001,EAP,Custom 11200001,,Private Ob,"$3,022.00",$0.00,"$2,838.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,838.00",$0.00,$0.00,"$2,247.70",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
11200002,EAP,Custom 11200002,,Tele Private Ob,"$3,317.00",$0.00,"$3,115.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,115.00",$0.00,$0.00,"$2,467.08",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
11200501,EAP,Custom 11200501,,Trauma Private Ob,"$3,342.00",$0.00,"$3,138.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,138.00",$0.00,$0.00,"$2,485.30",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
11200502,EAP,Custom 11200502,,Trauma Tele Private Ob,"$3,637.00",$0.00,"$3,415.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,415.00",$0.00,$0.00,"$2,704.68",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
11400002,EAP,Custom 11400002,,Private Psy,"$2,664.00",$0.00,"$2,501.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,501.00",$0.00,$0.00,"$1,980.79",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
11400502,EAP,Custom 11400502,,Trauma Private Psy,"$2,983.00",$0.00,"$2,801.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,801.00",$0.00,$0.00,"$2,218.39",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
11500001,EAP,Custom 11500001,,Inpatient Hospice,"$2,878.00",$0.00,"$2,702.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,702.00",$0.00,$0.00,"$2,139.98",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
11500501,EAP,Custom 11500501,,TRAUMA INPATIENT HOSPICE,"$2,982.00",$0.00,"$2,800.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,800.00",$0.00,$0.00,"$2,217.60",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
12100001,EAP,Custom 12100001,,Semiprivate Medsurg,"$2,034.00",$0.00,"$1,910.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,910.00",$0.00,$0.00,"$1,512.72",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
12100003,EAP,Custom 12100003,,Tele Semiprivate,"$2,394.00",$0.00,"$2,248.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,248.00",$0.00,$0.00,"$1,780.42",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
12100021,EAP,Custom 12100021,,Semiprivate Gyn,"$2,034.00",$0.00,"$1,910.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,910.00",$0.00,$0.00,"$1,512.72",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
12100023,EAP,Custom 12100023,,Tele Semiprivate Gyn,"$2,394.00",$0.00,"$2,248.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,248.00",$0.00,$0.00,"$1,780.42",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
12100501,EAP,Custom 12100501,,Trauma Semiprivate Medsurg,"$2,354.00",$0.00,"$2,210.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,210.00",$0.00,$0.00,"$1,750.32",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
12100503,EAP,Custom 12100503,,Trauma Tele Semiprivate,"$2,714.00",$0.00,"$2,548.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,548.00",$0.00,$0.00,"$2,018.02",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
12100521,EAP,Custom 12100521,,Trauma Semiprivate Gyn,"$2,354.00",$0.00,"$2,210.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,210.00",$0.00,$0.00,"$1,750.32",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
12100523,EAP,Custom 12100523,,Trauma Tele Semiprivate Gyn,"$2,714.00",$0.00,"$2,548.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,548.00",$0.00,$0.00,"$2,018.02",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
12200001,EAP,Custom 12200001,,Semiprivate Ob,"$2,215.00",$0.00,"$2,080.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,080.00",$0.00,$0.00,"$1,647.36",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
12200002,EAP,Custom 12200002,,Tele Semiprivate Ob,"$2,245.00",$0.00,"$2,108.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,108.00",$0.00,$0.00,"$1,669.54",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
12200501,EAP,Custom 12200501,,Trauma Semiprivate Ob,"$2,535.00",$0.00,"$2,380.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,380.00",$0.00,$0.00,"$1,884.96",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
12200502,EAP,Custom 12200502,,Trauma Tele Semiprivate Ob,"$2,565.00",$0.00,"$2,408.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,408.00",$0.00,$0.00,"$1,907.14",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
12400002,EAP,Custom 12400002,,Semiprivate Psych,"$2,465.00",$0.00,"$2,315.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,315.00",$0.00,$0.00,"$1,833.48",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
12400502,EAP,Custom 12400502,,Trauma Semiprivate Psych,"$2,785.00",$0.00,"$2,615.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,615.00",$0.00,$0.00,"$2,071.08",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
16400001,EAP,Custom 16400001,,Tele.isolation,"$3,275.00",$0.00,"$3,075.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,075.00",$0.00,$0.00,"$2,435.40",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
16400002,EAP,Custom 16400002,,Isolation Med Surg,"$3,157.00",$0.00,"$2,964.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,964.00",$0.00,$0.00,"$2,347.49",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
16400004,EAP,Custom 16400004,,Isolation Med Surg,"$3,157.00",$0.00,"$2,964.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,964.00",$0.00,$0.00,"$2,347.49",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
16400005,EAP,Custom 16400005,,Isolation Ob,"$3,346.00",$0.00,"$3,142.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,142.00",$0.00,$0.00,"$2,488.46",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
16400006,EAP,Custom 16400006,,Tele.isolation Ob,"$3,362.00",$0.00,"$3,157.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,157.00",$0.00,$0.00,"$2,500.34",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
16400007,EAP,Custom 16400007,,Isolation High-risk Scu,"$3,712.00",$0.00,"$3,485.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,485.00",$0.00,$0.00,"$2,760.12",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
16400022,EAP,Custom 16400022,,Isolation  Gyn,"$3,157.00",$0.00,"$2,964.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,964.00",$0.00,$0.00,"$2,347.49",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
16400501,EAP,Custom 16400501,,Trauma Tele.isolation,"$3,594.00",$0.00,"$3,375.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,375.00",$0.00,$0.00,"$2,673.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
16400502,EAP,Custom 16400502,,Trauma Isolation Med Surg,"$3,476.00",$0.00,"$3,264.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,264.00",$0.00,$0.00,"$2,585.09",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
16400504,EAP,Custom 16400504,,Trauma Isolation Med Surg,"$3,476.00",$0.00,"$3,264.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,264.00",$0.00,$0.00,"$2,585.09",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
16400505,EAP,Custom 16400505,,Trauma Isolation Ob,"$3,666.00",$0.00,"$3,442.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,442.00",$0.00,$0.00,"$2,726.06",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
16400506,EAP,,,Trauma Tele.isolation Ob,"$3,682.00",$0.00,"$3,457.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,457.00",$0.00,$0.00,"$2,737.94",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
16400507,EAP,Custom 16400507,,Trauma Isolation High-risk Scu,"$4,031.00",$0.00,"$3,785.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,785.00",$0.00,$0.00,"$2,997.72",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
16400522,EAP,Custom 16400522,,Trauma Isolation  Gyn,"$3,476.00",$0.00,"$3,264.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,264.00",$0.00,$0.00,"$2,585.09",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
17000001,EAP,Custom 17000001,,General Nursery,$797.00,$0.00,$748.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$748.00,$0.00,$0.00,$592.42,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
17100001,EAP,Custom 17100001,,NURSERY/LEVEL I,"$1,250.00",$0.00,"$1,026.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,026.00",$0.00,$0.00,$812.59,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
17100002,EAP,Custom 17100002,,Nursery Level I,"$1,250.00",$0.00,"$1,026.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,026.00",$0.00,$0.00,$812.59,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
17200002,EAP,Custom 17200002,,Nursery Level Ii,"$3,247.00",$0.00,"$3,049.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,049.00",$0.00,$0.00,"$2,414.81",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
17300001,EAP,Custom 17300001,,Nursery Level Iii,"$5,408.00",$0.00,"$5,078.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,078.00",$0.00,$0.00,"$4,021.78",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
17400001,EAP,Custom 17400001,,Nursery/level Iv,"$6,307.00",$0.00,"$5,922.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,922.00",$0.00,$0.00,"$4,690.22",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
18000010,EAP,Custom 18000010,,Leave Of Absence,$0.01,$0.00,$0.01,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.01,$0.00,$0.00,$0.01,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
19818887,EAP,HCPCS A6197,,Dressing Wound Square 6x6in 2 Layer Absorbent Nonwoven Soft,$56.00,$0.00,$56.00,$0.00,$39.97,$0.00,$0.00,$39.97,$39.97,$0.00,$56.00,$0.00,$28.00,$44.35,$44.80,$0.00,$0.00,$0.00,$0.00,$0.00
19979858,EAP,HCPCS C1729,,Kit Pressure Monitr Transducer Tipped Catheter Drill Bit,"$2,403.00",$0.00,"$2,403.00","$1,304.83","$1,715.02",$0.00,$414.02,"$1,715.02","$1,715.02",$420.75,"$2,403.00",$0.00,"$1,201.50","$1,903.18","$1,922.40",$0.00,$376.07,$0.00,$382.56,$0.00
19988898,EAP,Custom 19988898,,Catheter Pressure 3.5mm 5mm 82cm 2cm Sensor Tip External,$58.00,$0.00,$58.00,$0.00,$41.39,$0.00,$0.00,$41.39,$41.39,$0.00,$58.00,$0.00,$29.00,$45.94,$46.40,$0.00,$0.00,$0.00,$0.00,$0.00
19993849,EAP,HCPCS C1751,,Kit Arterial Line .018in 20ga 22ga 1.75in Catheter Radiopq,$29.00,$0.00,$29.00,$15.75,$20.70,$0.00,$5.00,$20.70,$20.70,$5.08,$29.00,$0.00,$14.50,$22.97,$23.20,$0.00,$4.54,$0.00,$4.62,$0.00
19993898,EAP,HCPCS C1729,,Tray Catheterization 16fr Foley Antireflux Evident Seal,$26.00,$0.00,$26.00,$14.12,$18.56,$0.00,$4.48,$18.56,$18.56,$4.55,$26.00,$0.00,$13.00,$20.59,$20.80,$0.00,$4.07,$0.00,$4.14,$0.00
19994800,EAP,Custom 19994800,,Kit Crntmy 25ga 5/8in Strl Rzr Ndl Drp,"$2,065.00",$0.00,"$2,065.00",$0.00,"$1,473.79",$0.00,$0.00,"$1,473.79","$1,473.79",$0.00,"$2,065.00",$0.00,"$1,032.50","$1,635.48","$1,652.00",$0.00,$0.00,$0.00,$0.00,$0.00
20000001,EAP,Custom 20000001,,Intensive Care Icu Ob,"$6,105.00",$0.00,"$5,732.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,732.00",$0.00,$0.00,"$4,539.74",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
20000501,EAP,Custom 20000501,,Trauma Intensive Care Icu Ob,"$6,455.00",$0.00,"$6,032.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,032.00",$0.00,$0.00,"$4,777.34",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
20100001,EAP,Custom 20100001,,Intensive Care Icu Surgical,"$6,105.00",$0.00,"$5,732.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,732.00",$0.00,$0.00,"$4,539.74",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
20100501,EAP,Custom 20100501,,Trauma Intensive Care Icu Surgical,"$6,455.00",$0.00,"$6,032.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,032.00",$0.00,$0.00,"$4,777.34",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
20200001,EAP,Custom 20200001,,Intensive Care Icu Medical,"$6,105.00",$0.00,"$5,732.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,732.00",$0.00,$0.00,"$4,539.74",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
20200501,EAP,Custom 20200501,,Trauma Intensive Care Icu Medical,"$6,455.00",$0.00,"$6,032.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,032.00",$0.00,$0.00,"$4,777.34",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
20600001,EAP,Custom 20600001,,Intermediate Care,"$3,762.00",$0.00,"$3,513.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,513.00",$0.00,$0.00,"$2,782.30",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
20600002,EAP,Custom 20600002,,Intermediate Care Burn,"$8,700.00",$0.00,"$8,145.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$8,145.00",$0.00,$0.00,"$6,450.84",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
20600005,EAP,Custom 20600005,,Intermediate Care,"$3,762.00",$0.00,"$3,513.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,513.00",$0.00,$0.00,"$2,782.30",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
20600501,EAP,Custom 20600501,,Trauma Intermediate Care,"$4,421.00",$0.00,"$3,813.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,813.00",$0.00,$0.00,"$3,019.90",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
20600502,EAP,Custom 20600502,,Trauma Intermediate Care Burn,"$8,995.00",$0.00,"$8,445.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$8,445.00",$0.00,$0.00,"$6,688.44",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
20700001,EAP,Custom 20700001,,Intensive Care Icu Burn,"$9,500.00",$0.00,"$8,884.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$8,884.00",$0.00,$0.00,"$7,036.13",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
20700501,EAP,Custom 20700501,,Trauma Intensive Care Icu Burn,"$9,785.00",$0.00,"$9,184.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$9,184.00",$0.00,$0.00,"$7,273.73",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
21000001,EAP,Custom 21000001,,Intensive Care Icu Medical,"$6,105.00",$0.00,"$5,732.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,732.00",$0.00,$0.00,"$4,539.74",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
21400005,EAP,,,Intermediate Coronary Care Unit,"$4,500.00",$0.00,"$4,190.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,190.00",$0.00,$0.00,"$3,318.48",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
21400505,EAP,Custom 21400505,,Trauma Intermediate Coronary Care Unit,"$4,900.00",$0.00,"$4,490.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,490.00",$0.00,$0.00,"$3,556.08",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
21900001,EAP,Custom 21900001,,Intermediate Care,"$3,513.00",$0.00,"$3,513.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,513.00",$0.00,$0.00,"$2,782.30",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
25000134,EAP,Custom 25000134,,Rocephin 250mg,$15.00,$0.00,$15.00,$0.00,$10.71,$0.00,$0.00,$10.71,$10.71,$0.00,$15.00,$0.00,$7.50,$11.88,$12.00,$0.00,$0.00,$0.00,$0.00,$0.00
25000141,EAP,Custom 25000141,,Toradol 30 Mg,$37.00,$0.00,$37.00,$0.00,$26.41,$0.00,$0.00,$26.41,$26.41,$0.00,$37.00,$0.00,$18.50,$29.30,$29.60,$0.00,$0.00,$0.00,$0.00,$0.00
25000153,EAP,Custom 25000153,,"Rocephin 250mg, Im",$59.00,$0.00,$59.00,$0.00,$42.11,$0.00,$0.00,$42.11,$42.11,$0.00,$59.00,$0.00,$29.50,$46.73,$47.20,$0.00,$0.00,$0.00,$0.00,$0.00
25000157,EAP,Custom 25000157,,Depoprovera 150mg,$180.00,$0.00,$180.00,$0.00,$128.47,$0.00,$0.00,$128.47,$128.47,$0.00,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$0.00,$0.00,$0.00,$0.00
25000169,EAP,Custom 25000169,,Vit B 12 100mcg,$46.00,$0.00,$46.00,$0.00,$32.83,$0.00,$0.00,$32.83,$32.83,$0.00,$46.00,$0.00,$23.00,$36.43,$36.80,$0.00,$0.00,$0.00,$0.00,$0.00
25000182,EAP,Custom 25000182,,Rocephin Injection,$59.00,$0.00,$59.00,$0.00,$42.11,$0.00,$0.00,$42.11,$42.11,$0.00,$59.00,$0.00,$29.50,$46.73,$47.20,$0.00,$0.00,$0.00,$0.00,$0.00
25000187,EAP,Custom 25000187,,Rocephin 250mg,$34.00,$0.00,$34.00,$0.00,$24.27,$0.00,$0.00,$24.27,$24.27,$0.00,$34.00,$0.00,$17.00,$26.93,$27.20,$0.00,$0.00,$0.00,$0.00,$0.00
25000189,EAP,Custom 25000189,,Bicillin Injection,$44.00,$0.00,$44.00,$0.00,$31.40,$0.00,$0.00,$31.40,$31.40,$0.00,$44.00,$0.00,$22.00,$34.85,$35.20,$0.00,$0.00,$0.00,$0.00,$0.00
25000224,EAP,Custom 25000224,,Rocephin 250mg (cef,$59.00,$0.00,$59.00,$0.00,$42.11,$0.00,$0.00,$42.11,$42.11,$0.00,$59.00,$0.00,$29.50,$46.73,$47.20,$0.00,$0.00,$0.00,$0.00,$0.00
25000226,EAP,Custom 25000226,,Depo Provera Inject,$171.00,$0.00,$171.00,$0.00,$122.04,$0.00,$0.00,$122.04,$122.04,$0.00,$171.00,$0.00,$85.50,$135.43,$136.80,$0.00,$0.00,$0.00,$0.00,$0.00
25000227,EAP,Custom 25000227,,Oral Contraceptives,$13.00,$0.00,$13.00,$0.00,$9.28,$0.00,$0.00,$9.28,$9.28,$0.00,$13.00,$0.00,$6.50,$10.30,$10.40,$0.00,$0.00,$0.00,$0.00,$0.00
25000229,EAP,Custom 25000229,,Plan B,$39.00,$0.00,$39.00,$0.00,$27.83,$0.00,$0.00,$27.83,$27.83,$0.00,$39.00,$0.00,$19.50,$30.89,$31.20,$0.00,$0.00,$0.00,$0.00,$0.00
25000230,EAP,Custom 25000230,,Evra Transdermal Pa,$20.00,$0.00,$20.00,$0.00,$14.27,$0.00,$0.00,$14.27,$14.27,$0.00,$20.00,$0.00,$10.00,$15.84,$16.00,$0.00,$0.00,$0.00,$0.00,$0.00
25000327,EAP,Custom 25000327,,Oral Contraceptives,$11.00,$0.00,$11.00,$0.00,$7.85,$0.00,$0.00,$7.85,$7.85,$0.00,$11.00,$0.00,$5.50,$8.71,$8.80,$0.00,$0.00,$0.00,$0.00,$0.00
25000908,EAP,Custom 25000908,,Evra Trandermal Pat,$17.00,$0.00,$17.00,$0.00,$12.13,$0.00,$0.00,$12.13,$12.13,$0.00,$17.00,$0.00,$8.50,$13.46,$13.60,$0.00,$0.00,$0.00,$0.00,$0.00
25000960,EAP,Custom 25000960,,Hetastarch (hespan),$435.00,$0.00,$435.00,$0.00,$310.46,$0.00,$0.00,$310.46,$310.46,$0.00,$435.00,$0.00,$217.50,$344.52,$348.00,$0.00,$0.00,$0.00,$0.00,$0.00
25000961,EAP,Custom 25000961,,Hetastarch,$435.00,$0.00,$435.00,$0.00,$310.46,$0.00,$0.00,$310.46,$310.46,$0.00,$435.00,$0.00,$217.50,$344.52,$348.00,$0.00,$0.00,$0.00,$0.00,$0.00
25000966,EAP,Custom 25000966,,"Rocephin 250mg, 1gm",$59.00,$0.00,$59.00,$0.00,$42.11,$0.00,$0.00,$42.11,$42.11,$0.00,$59.00,$0.00,$29.50,$46.73,$47.20,$0.00,$0.00,$0.00,$0.00,$0.00
25000990,EAP,Custom 25000990,,Nitric Oxide (per Hr),$789.00,$0.00,$789.00,$0.00,$563.11,$0.00,$0.00,$563.11,$563.11,$0.00,$789.00,$0.00,$394.50,$624.89,$631.20,$0.00,$0.00,$0.00,$0.00,$0.00
25002130,EAP,Custom 25002130,,Zithromax,$24.00,$0.00,$24.00,$0.00,$17.13,$0.00,$0.00,$17.13,$17.13,$0.00,$24.00,$0.00,$12.00,$19.01,$19.20,$0.00,$0.00,$0.00,$0.00,$0.00
25500016,EAP,HCPCS Q9965,,Locm 150-199mg/ml I,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$4.28,$4.28,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
25500039,EAP,HCPCS Q9965,,Locm 150-199mg/ml I,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$4.28,$4.28,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
25800010,EAP,Custom 25800010,,Solutions Sodium Ch,$49.00,$0.00,$49.00,$0.00,$34.97,$0.00,$0.00,$34.97,$34.97,$0.00,$49.00,$0.00,$24.50,$38.81,$39.20,$0.00,$0.00,$0.00,$0.00,$0.00
25800013,EAP,Custom 25800013,,Solution Iv D 5% In,$49.00,$0.00,$49.00,$0.00,$34.97,$0.00,$0.00,$34.97,$34.97,$0.00,$49.00,$0.00,$24.50,$38.81,$39.20,$0.00,$0.00,$0.00,$0.00,$0.00
25800016,EAP,Custom 25800016,,Solution Iv Lactate,$49.00,$0.00,$49.00,$0.00,$34.97,$0.00,$0.00,$34.97,$34.97,$0.00,$49.00,$0.00,$24.50,$38.81,$39.20,$0.00,$0.00,$0.00,$0.00,$0.00
25800017,EAP,Custom 25800017,,Solution Iv Nacl 0.,$49.00,$0.00,$49.00,$0.00,$34.97,$0.00,$0.00,$34.97,$34.97,$0.00,$49.00,$0.00,$24.50,$38.81,$39.20,$0.00,$0.00,$0.00,$0.00,$0.00
25800018,EAP,Custom 25800018,,Solution Iv Nacl 0.,$49.00,$0.00,$49.00,$0.00,$34.97,$0.00,$0.00,$34.97,$34.97,$0.00,$49.00,$0.00,$24.50,$38.81,$39.20,$0.00,$0.00,$0.00,$0.00,$0.00
25800019,EAP,Custom 25800019,,Solution Iv Nacl 0.,$49.00,$0.00,$49.00,$0.00,$34.97,$0.00,$0.00,$34.97,$34.97,$0.00,$49.00,$0.00,$24.50,$38.81,$39.20,$0.00,$0.00,$0.00,$0.00,$0.00
25800020,EAP,Custom 25800020,,Solution Iv Nacl 0.,$49.00,$0.00,$49.00,$0.00,$34.97,$0.00,$0.00,$34.97,$34.97,$0.00,$49.00,$0.00,$24.50,$38.81,$39.20,$0.00,$0.00,$0.00,$0.00,$0.00
25800031,EAP,Custom 25800031,,Solution Iv D 5% In,$49.00,$0.00,$49.00,$0.00,$34.97,$0.00,$0.00,$34.97,$34.97,$0.00,$49.00,$0.00,$24.50,$38.81,$39.20,$0.00,$0.00,$0.00,$0.00,$0.00
25800033,EAP,Custom 25800033,,Solution Iv Lactate,$49.00,$0.00,$49.00,$0.00,$34.97,$0.00,$0.00,$34.97,$34.97,$0.00,$49.00,$0.00,$24.50,$38.81,$39.20,$0.00,$0.00,$0.00,$0.00,$0.00
25800034,EAP,Custom 25800034,,Solution Iv Nacl 0.,$49.00,$0.00,$49.00,$0.00,$34.97,$0.00,$0.00,$34.97,$34.97,$0.00,$49.00,$0.00,$24.50,$38.81,$39.20,$0.00,$0.00,$0.00,$0.00,$0.00
25800037,EAP,Custom 25800037,,Solution Iv Nacl 0.,$49.00,$0.00,$49.00,$0.00,$34.97,$0.00,$0.00,$34.97,$34.97,$0.00,$49.00,$0.00,$24.50,$38.81,$39.20,$0.00,$0.00,$0.00,$0.00,$0.00
25800038,EAP,Custom 25800038,,Solution Iv Nacl 0.,$49.00,$0.00,$49.00,$0.00,$34.97,$0.00,$0.00,$34.97,$34.97,$0.00,$49.00,$0.00,$24.50,$38.81,$39.20,$0.00,$0.00,$0.00,$0.00,$0.00
25800039,EAP,Custom 25800039,,Solution Iv Nacl 0.,$49.00,$0.00,$49.00,$0.00,$34.97,$0.00,$0.00,$34.97,$34.97,$0.00,$49.00,$0.00,$24.50,$38.81,$39.20,$0.00,$0.00,$0.00,$0.00,$0.00
25800060,EAP,Custom 25800060,,Iv Fluids,$61.00,$0.00,$61.00,$0.00,$43.54,$0.00,$0.00,$43.54,$43.54,$0.00,$61.00,$0.00,$30.50,$48.31,$48.80,$0.00,$0.00,$0.00,$0.00,$0.00
25800061,EAP,Custom 25800061,,Iv Fluids,$61.00,$0.00,$61.00,$0.00,$43.54,$0.00,$0.00,$43.54,$43.54,$0.00,$61.00,$0.00,$30.50,$48.31,$48.80,$0.00,$0.00,$0.00,$0.00,$0.00
25800062,EAP,Custom 25800062,,I.v. Fluids 500ml,$64.00,$0.00,$64.00,$0.00,$45.68,$0.00,$0.00,$45.68,$45.68,$0.00,$64.00,$0.00,$32.00,$50.69,$51.20,$0.00,$0.00,$0.00,$0.00,$0.00
25800063,EAP,Custom 25800063,,I.v. Fluid 100ml,$64.00,$0.00,$64.00,$0.00,$45.68,$0.00,$0.00,$45.68,$45.68,$0.00,$64.00,$0.00,$32.00,$50.69,$51.20,$0.00,$0.00,$0.00,$0.00,$0.00
25800080,EAP,Custom 25800080,,Iv Fluids 1000ml,$64.00,$0.00,$64.00,$0.00,$45.68,$0.00,$0.00,$45.68,$45.68,$0.00,$64.00,$0.00,$32.00,$50.69,$51.20,$0.00,$0.00,$0.00,$0.00,$0.00
25800095,EAP,Custom 25800095,,Solution Iv Water For Irr,$49.00,$0.00,$49.00,$0.00,$34.97,$0.00,$0.00,$34.97,$34.97,$0.00,$49.00,$0.00,$24.50,$38.81,$39.20,$0.00,$0.00,$0.00,$0.00,$0.00
25800260,EAP,Custom 25800260,,Iv Fluid 500ml,$64.00,$0.00,$64.00,$0.00,$45.68,$0.00,$0.00,$45.68,$45.68,$0.00,$64.00,$0.00,$32.00,$50.69,$51.20,$0.00,$0.00,$0.00,$0.00,$0.00
25800262,EAP,Custom 25800262,,Solutions  Advantage Glou,$49.00,$0.00,$49.00,$0.00,$34.97,$0.00,$0.00,$34.97,$34.97,$0.00,$49.00,$0.00,$24.50,$38.81,$39.20,$0.00,$0.00,$0.00,$0.00,$0.00
25800263,EAP,Custom 25800263,,Solution Irrigation Water 150,$49.00,$0.00,$49.00,$0.00,$34.97,$0.00,$0.00,$34.97,$34.97,$0.00,$49.00,$0.00,$24.50,$38.81,$39.20,$0.00,$0.00,$0.00,$0.00,$0.00
25800264,EAP,Custom 25800264,,Solutions Iv Water For Inject,$49.00,$0.00,$49.00,$0.00,$34.97,$0.00,$0.00,$34.97,$34.97,$0.00,$49.00,$0.00,$24.50,$38.81,$39.20,$0.00,$0.00,$0.00,$0.00,$0.00
25800265,EAP,Custom 25800265,,Solutions Sodium Chloride,$37.00,$0.00,$37.00,$0.00,$26.41,$0.00,$0.00,$26.41,$26.41,$0.00,$37.00,$0.00,$18.50,$29.30,$29.60,$0.00,$0.00,$0.00,$0.00,$0.00
25800267,EAP,Custom 25800267,,"Iv Fluids, 100cc",$34.00,$0.00,$34.00,$0.00,$24.27,$0.00,$0.00,$24.27,$24.27,$0.00,$34.00,$0.00,$17.00,$26.93,$27.20,$0.00,$0.00,$0.00,$0.00,$0.00
25800268,EAP,Custom 25800268,,"Iv Fluids, 500cc",$64.00,$0.00,$64.00,$0.00,$45.68,$0.00,$0.00,$45.68,$45.68,$0.00,$64.00,$0.00,$32.00,$50.69,$51.20,$0.00,$0.00,$0.00,$0.00,$0.00
25800269,EAP,Custom 25800269,,"Iv Fluids, 1000cc",$64.00,$0.00,$64.00,$0.00,$45.68,$0.00,$0.00,$45.68,$45.68,$0.00,$64.00,$0.00,$32.00,$50.69,$51.20,$0.00,$0.00,$0.00,$0.00,$0.00
25800274,EAP,Custom 25800274,,Solution Iv Nacl 0.9% Gla,$49.00,$0.00,$49.00,$0.00,$34.97,$0.00,$0.00,$34.97,$34.97,$0.00,$49.00,$0.00,$24.50,$38.81,$39.20,$0.00,$0.00,$0.00,$0.00,$0.00
25800277,EAP,Custom 25800277,,Solution Iv Nacl 0.9% 50m,$49.00,$0.00,$49.00,$0.00,$34.97,$0.00,$0.00,$34.97,$34.97,$0.00,$49.00,$0.00,$24.50,$38.81,$39.20,$0.00,$0.00,$0.00,$0.00,$0.00
25800278,EAP,Custom 25800278,,"Iv Fluids, 50cc",$34.00,$0.00,$34.00,$0.00,$24.27,$0.00,$0.00,$24.27,$24.27,$0.00,$34.00,$0.00,$17.00,$26.93,$27.20,$0.00,$0.00,$0.00,$0.00,$0.00
25800401,EAP,Custom 25800401,,I.v. Fluids,$64.00,$0.00,$64.00,$0.00,$45.68,$0.00,$0.00,$45.68,$45.68,$0.00,$64.00,$0.00,$32.00,$50.69,$51.20,$0.00,$0.00,$0.00,$0.00,$0.00
25800402,EAP,Custom 25800402,,I.v. Fluids 1000cc,$64.00,$0.00,$64.00,$0.00,$45.68,$0.00,$0.00,$45.68,$45.68,$0.00,$64.00,$0.00,$32.00,$50.69,$51.20,$0.00,$0.00,$0.00,$0.00,$0.00
25800403,EAP,Custom 25800403,,I.v. Fluids 500ml,$64.00,$0.00,$64.00,$0.00,$45.68,$0.00,$0.00,$45.68,$45.68,$0.00,$64.00,$0.00,$32.00,$50.69,$51.20,$0.00,$0.00,$0.00,$0.00,$0.00
25800404,EAP,Custom 25800404,,Iv Fluid 1000cc,$64.00,$0.00,$64.00,$0.00,$45.68,$0.00,$0.00,$45.68,$45.68,$0.00,$64.00,$0.00,$32.00,$50.69,$51.20,$0.00,$0.00,$0.00,$0.00,$0.00
25800405,EAP,Custom 25800405,,"Iv Fluid, # Bags",$61.00,$0.00,$61.00,$0.00,$43.54,$0.00,$0.00,$43.54,$43.54,$0.00,$61.00,$0.00,$30.50,$48.31,$48.80,$0.00,$0.00,$0.00,$0.00,$0.00
25800406,EAP,Custom 25800406,,"Iv Fluid, #bags",$61.00,$0.00,$61.00,$0.00,$43.54,$0.00,$0.00,$43.54,$43.54,$0.00,$61.00,$0.00,$30.50,$48.31,$48.80,$0.00,$0.00,$0.00,$0.00,$0.00
25800407,EAP,Custom 25800407,,Iv Fluids 1000ml,$64.00,$0.00,$64.00,$0.00,$45.68,$0.00,$0.00,$45.68,$45.68,$0.00,$64.00,$0.00,$32.00,$50.69,$51.20,$0.00,$0.00,$0.00,$0.00,$0.00
25800408,EAP,Custom 25800408,,Iv Fluids 500cc,$64.00,$0.00,$64.00,$0.00,$45.68,$0.00,$0.00,$45.68,$45.68,$0.00,$64.00,$0.00,$32.00,$50.69,$51.20,$0.00,$0.00,$0.00,$0.00,$0.00
25800409,EAP,Custom 25800409,,Iv Fluids 50cc,$34.00,$0.00,$34.00,$0.00,$24.27,$0.00,$0.00,$24.27,$24.27,$0.00,$34.00,$0.00,$17.00,$26.93,$27.20,$0.00,$0.00,$0.00,$0.00,$0.00
25800410,EAP,Custom 25800410,,Iv Fluids-500ml,$64.00,$0.00,$64.00,$0.00,$45.68,$0.00,$0.00,$45.68,$45.68,$0.00,$64.00,$0.00,$32.00,$50.69,$51.20,$0.00,$0.00,$0.00,$0.00,$0.00
25800411,EAP,Custom 25800411,,Solution Intravenous Viaflex Latex Free Plasma-lyte A,$29.00,$0.00,$29.00,$0.00,$20.70,$0.00,$0.00,$20.70,$20.70,$0.00,$29.00,$0.00,$14.50,$22.97,$23.20,$0.00,$0.00,$0.00,$0.00,$0.00
25800412,EAP,Custom 25800412,,Solution Irr 0.9% Na Chlor Urmtc 3l Strl Lf,$27.00,$0.00,$27.00,$0.00,$19.27,$0.00,$0.00,$19.27,$19.27,$0.00,$27.00,$0.00,$13.50,$21.38,$21.60,$0.00,$0.00,$0.00,$0.00,$0.00
25900227,EAP,Custom 25900227,,Oral Contraceptives,$12.00,$0.00,$12.00,$0.00,$8.56,$0.00,$0.00,$8.56,$8.56,$0.00,$12.00,$0.00,$6.00,$9.50,$9.60,$0.00,$0.00,$0.00,$0.00,$0.00
25900255,EAP,Custom 25900255,,Insulin 5 Units,$4.00,$0.00,$4.00,$0.00,$2.85,$0.00,$0.00,$2.85,$2.85,$0.00,$4.00,$0.00,$2.00,$3.17,$3.20,$0.00,$0.00,$0.00,$0.00,$0.00
26000001,EAP,CPT® 96360,,Iv Hydra Initial (31 Min To 1 Hr),$969.00,$34.59,$881.00,$478.38,$628.77,$176.19,$151.79,$628.77,$628.77,$154.26,$881.00,$184.28,$440.50,$697.75,$704.80,$256.03,$53.93,$34.59,$140.26,$175.50
26000003,EAP,CPT® 96361,,Iv Hydra Add'l (31 Min To 1 Hr),$326.00,$13.69,$296.00,$160.73,$211.26,$36.54,$51.00,$211.26,$211.26,$51.83,$296.00,$38.22,$148.00,$234.43,$236.80,$53.10,$15.67,$13.69,$47.12,$36.40
26000005,EAP,CPT® 96365,,"Iv Infus Ther,prophylax,dx Initial (16 Min To 1 Hr)","$1,690.00",$65.68,"$1,538.00",$835.13,"$1,097.67",$176.19,$264.99,"$1,097.67","$1,097.67",$269.29,"$1,538.00",$184.28,$769.00,"$1,218.10","$1,230.40",$256.03,$65.68,$72.05,$244.85,$175.50
26000006,EAP,CPT® 96366,,"Iv Infus Ther,prophylax,dx Add'l (31 Min To 1 Hr)",$326.00,$20.85,$296.00,$160.73,$211.26,$36.54,$51.00,$211.26,$211.26,$51.83,$296.00,$38.22,$148.00,$234.43,$236.80,$53.10,$20.85,$21.98,$47.12,$36.40
26000007,EAP,CPT® 96367,,"Iv Infus Ther,prophylax,dx Add'l New Med (31 Min To 1 Hr)",$492.00,$31.35,$447.00,$242.72,$319.02,$57.98,$77.02,$319.02,$319.02,$78.27,$447.00,$60.65,$223.50,$354.02,$357.60,$84.26,$32.97,$31.35,$71.16,$57.76
26000008,EAP,CPT® 96368,,"Iv Infus Ther,prophylax,dx Add'l Concur (31 Min To 1 Hr)",$593.00,$0.00,$490.00,$266.07,$349.71,$0.00,$84.42,$349.71,$349.71,$85.80,$490.00,$0.00,$245.00,$388.08,$392.00,$0.00,$19.47,$21.26,$78.01,$0.00
26000111,EAP,CPT® 96374,,"Iv Push - Ther,prophylax,dx 1st Med",$593.00,$39.99,$490.00,$266.07,$349.71,$176.19,$84.42,$349.71,$349.71,$85.80,$490.00,$184.28,$245.00,$388.08,$392.00,$256.03,$52.02,$39.99,$78.01,$175.50
26000112,EAP,CPT® 96375,,"Iv Push - Ther,prophylax,dx Add'l Med",$492.00,$16.57,$447.00,$242.72,$319.02,$36.54,$77.02,$319.02,$319.02,$78.27,$447.00,$38.22,$223.50,$354.02,$357.60,$53.10,$22.60,$16.57,$71.16,$36.40
26000113,EAP,CPT® 96376,,"Iv Push - Ther,prophylax,dx Ea Push Same Med",$328.00,$0.00,$298.00,$161.81,$212.68,$0.00,$51.34,$212.68,$212.68,$52.18,$298.00,$0.00,$149.00,$236.02,$238.40,$0.00,$46.64,$0.00,$47.44,$0.00
26000114,EAP,CPT® 96523,,Picc/portacath Line Flush,$265.00,$27.46,$241.00,$63.09,$172.00,$52.75,$28.83,$172.00,$172.00,$42.20,$241.00,$55.17,$120.50,$190.87,$192.80,$76.65,$27.46,$28.10,$38.37,$52.54
27000010,EAP,Custom 27000010,,Tube Salem Sump 48 Lengt,$16.00,$0.00,$16.00,$0.00,$11.42,$0.00,$0.00,$11.42,$11.42,$0.00,$16.00,$0.00,$8.00,$12.67,$12.80,$0.00,$0.00,$0.00,$0.00,$0.00
27000011,EAP,Custom 27000011,,Tube Salem Silicone Size,$16.00,$0.00,$16.00,$0.00,$11.42,$0.00,$0.00,$11.42,$11.42,$0.00,$16.00,$0.00,$8.00,$12.67,$12.80,$0.00,$0.00,$0.00,$0.00,$0.00
27000012,EAP,Custom 27000012,,Tubes Salem Sump 48 Leng,$16.00,$0.00,$16.00,$0.00,$11.42,$0.00,$0.00,$11.42,$11.42,$0.00,$16.00,$0.00,$8.00,$12.67,$12.80,$0.00,$0.00,$0.00,$0.00,$0.00
27000015,EAP,Custom 27000015,,Scapel Surg W/handle Atta,$142.00,$0.00,$142.00,$0.00,$101.35,$0.00,$0.00,$101.35,$101.35,$0.00,$142.00,$0.00,$71.00,$112.46,$113.60,$0.00,$0.00,$0.00,$0.00,$0.00
27000016,EAP,Custom 27000016,,Scaple Surg W/handle Atta,$152.00,$0.00,$152.00,$0.00,$108.48,$0.00,$0.00,$108.48,$108.48,$0.00,$152.00,$0.00,$76.00,$120.38,$121.60,$0.00,$0.00,$0.00,$0.00,$0.00
27000019,EAP,Custom 27000019,,Kit L.f. Trach Care,$511.00,$0.00,$511.00,$0.00,$364.70,$0.00,$0.00,$364.70,$364.70,$0.00,$511.00,$0.00,$255.50,$404.71,$408.80,$0.00,$0.00,$0.00,$0.00,$0.00
27000024,EAP,Custom 27000024,,Bag 1000ml Pump Set,$39.00,$0.00,$39.00,$0.00,$27.83,$0.00,$0.00,$27.83,$27.83,$0.00,$39.00,$0.00,$19.50,$30.89,$31.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000026,EAP,Custom 27000026,,Kit Triple Lumen Catheter,$587.00,$0.00,$587.00,$0.00,$418.94,$0.00,$0.00,$418.94,$418.94,$0.00,$587.00,$0.00,$293.50,$464.90,$469.60,$0.00,$0.00,$0.00,$0.00,$0.00
27000027,EAP,Custom 27000027,,Filter Set 0.22 Micron,$20.00,$0.00,$20.00,$0.00,$14.27,$0.00,$0.00,$14.27,$14.27,$0.00,$20.00,$0.00,$10.00,$15.84,$16.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000029,EAP,Custom 27000029,,Set T-port Small Bore Ext,$14.00,$0.00,$14.00,$0.00,$9.99,$0.00,$0.00,$9.99,$9.99,$0.00,$14.00,$0.00,$7.00,$11.09,$11.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000031,EAP,Custom 27000031,,Tray Douch Disposable,$69.00,$0.00,$69.00,$0.00,$49.25,$0.00,$0.00,$49.25,$49.25,$0.00,$69.00,$0.00,$34.50,$54.65,$55.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000033,EAP,Custom 27000033,,Tray Foley Preconnected 1,$59.00,$0.00,$59.00,$0.00,$42.11,$0.00,$0.00,$42.11,$42.11,$0.00,$59.00,$0.00,$29.50,$46.73,$47.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000034,EAP,Custom 27000034,,Tray Foley Perconnected 1,$59.00,$0.00,$59.00,$0.00,$42.11,$0.00,$0.00,$42.11,$42.11,$0.00,$59.00,$0.00,$29.50,$46.73,$47.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000035,EAP,Custom 27000035,,Tray Thoracentesis Dispos,$235.00,$0.00,$235.00,$0.00,$167.72,$0.00,$0.00,$167.72,$167.72,$0.00,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000036,EAP,Custom 27000036,,Central Line Dressing Tray With Biopatch,$47.00,$0.00,$47.00,$0.00,$33.54,$0.00,$0.00,$33.54,$33.54,$0.00,$47.00,$0.00,$23.50,$37.22,$37.60,$0.00,$0.00,$0.00,$0.00,$0.00
27000045,EAP,Custom 27000045,,Sleeve Knee Regular Dvt,$388.00,$0.00,$388.00,$0.00,$276.92,$0.00,$0.00,$276.92,$276.92,$0.00,$388.00,$0.00,$194.00,$307.30,$310.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000046,EAP,Custom 27000046,,Sleeve Knee X-large Dvt,$469.00,$0.00,$469.00,$0.00,$334.73,$0.00,$0.00,$334.73,$334.73,$0.00,$469.00,$0.00,$234.50,$371.45,$375.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000047,EAP,Custom 27000047,,Sleeve Thigh Regular Dvt,$553.00,$0.00,$553.00,$0.00,$394.68,$0.00,$0.00,$394.68,$394.68,$0.00,$553.00,$0.00,$276.50,$437.98,$442.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000048,EAP,Custom 27000048,,Sleeve Thigh X-large Dvt,$663.00,$0.00,$663.00,$0.00,$473.18,$0.00,$0.00,$473.18,$473.18,$0.00,$663.00,$0.00,$331.50,$525.10,$530.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000066,EAP,Custom 27000066,,"Tray,instrumen 13-1/2x9/34x5/8",$391.00,$0.00,$391.00,$0.00,$279.06,$0.00,$0.00,$279.06,$279.06,$0.00,$391.00,$0.00,$195.50,$309.67,$312.80,$0.00,$0.00,$0.00,$0.00,$0.00
27000076,EAP,HCPCS C1729,,Catheter Coude Size 14fr,$44.00,$0.00,$44.00,$23.89,$31.40,$0.00,$7.58,$31.40,$31.40,$7.70,$44.00,$0.00,$22.00,$34.85,$35.20,$0.00,$6.89,$0.00,$7.00,$0.00
27000078,EAP,Custom 27000078,,Tubes Salem Sump 48 Leng,$16.00,$0.00,$16.00,$0.00,$11.42,$0.00,$0.00,$11.42,$11.42,$0.00,$16.00,$0.00,$8.00,$12.67,$12.80,$0.00,$0.00,$0.00,$0.00,$0.00
27000079,EAP,Custom 27000079,,Kit Tracheotomy Care Ster,$30.00,$0.00,$30.00,$0.00,$21.41,$0.00,$0.00,$21.41,$21.41,$0.00,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000081,EAP,Custom 27000081,,Scapel Surg W/ Handle Attached,$132.00,$0.00,$132.00,$0.00,$94.21,$0.00,$0.00,$94.21,$94.21,$0.00,$132.00,$0.00,$66.00,$104.54,$105.60,$0.00,$0.00,$0.00,$0.00,$0.00
27000087,EAP,Custom 27000087,,Kit Thoracotomy,$203.00,$0.00,$203.00,$0.00,$144.88,$0.00,$0.00,$144.88,$144.88,$0.00,$203.00,$0.00,$101.50,$160.78,$162.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000093,EAP,Custom 27000093,,Bag 1000ml Pump Set,$28.00,$0.00,$28.00,$0.00,$19.98,$0.00,$0.00,$19.98,$19.98,$0.00,$28.00,$0.00,$14.00,$22.18,$22.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000094,EAP,Custom 27000094,,Chest Unit Drainage Pleur,$455.00,$0.00,$455.00,$0.00,$324.73,$0.00,$0.00,$324.73,$324.73,$0.00,$455.00,$0.00,$227.50,$360.36,$364.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000097,EAP,Custom 27000097,,Kit Triple Lumen Catheter,$299.00,$0.00,$299.00,$0.00,$213.40,$0.00,$0.00,$213.40,$213.40,$0.00,$299.00,$0.00,$149.50,$236.81,$239.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000098,EAP,Custom 27000098,,Vest Econo Cotton Small,$94.00,$0.00,$94.00,$0.00,$67.09,$0.00,$0.00,$67.09,$67.09,$0.00,$94.00,$0.00,$47.00,$74.45,$75.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000101,EAP,Custom 27000101,,Vest Econo Cotton X-large,$109.00,$0.00,$109.00,$0.00,$77.79,$0.00,$0.00,$77.79,$77.79,$0.00,$109.00,$0.00,$54.50,$86.33,$87.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000103,EAP,Custom 27000103,,Filter Set 0.22 Micron,$19.00,$0.00,$19.00,$0.00,$13.56,$0.00,$0.00,$13.56,$13.56,$0.00,$19.00,$0.00,$9.50,$15.05,$15.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000107,EAP,Custom 27000107,,Tray Foley Perconnected 1,$52.00,$0.00,$52.00,$0.00,$37.11,$0.00,$0.00,$37.11,$37.11,$0.00,$52.00,$0.00,$26.00,$41.18,$41.60,$0.00,$0.00,$0.00,$0.00,$0.00
27000109,EAP,Custom 27000109,,Tray Thoracentesis Dispos,$235.00,$0.00,$235.00,$0.00,$167.72,$0.00,$0.00,$167.72,$167.72,$0.00,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000119,EAP,Custom 27000119,,3ml Posiflush Saline Syringe,$10.00,$0.00,$10.00,$0.00,$7.14,$0.00,$0.00,$7.14,$7.14,$0.00,$10.00,$0.00,$5.00,$7.92,$8.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000125,EAP,Custom 27000125,,Sleeve Thigh Regular Dvt,$469.00,$0.00,$469.00,$0.00,$334.73,$0.00,$0.00,$334.73,$334.73,$0.00,$469.00,$0.00,$234.50,$371.45,$375.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000127,EAP,Custom 27000127,,"Tray,catheter Instrument Dulmn",$718.00,$0.00,$718.00,$0.00,$512.44,$0.00,$0.00,$512.44,$512.44,$0.00,$718.00,$0.00,$359.00,$568.66,$574.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000150,EAP,Custom 27000150,,Catheter Urethral Two-eye,$10.00,$0.00,$10.00,$0.00,$7.14,$0.00,$0.00,$7.14,$7.14,$0.00,$10.00,$0.00,$5.00,$7.92,$8.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000151,EAP,HCPCS C1729,,Catheter Coude Size 14fr,$109.00,$0.00,$109.00,$59.19,$77.79,$0.00,$18.78,$77.79,$77.79,$19.09,$109.00,$0.00,$54.50,$86.33,$87.20,$0.00,$17.06,$0.00,$17.35,$0.00
27000152,EAP,HCPCS C1729,,Catheter Coude 30cc 24fr,$87.00,$0.00,$87.00,$47.24,$62.09,$0.00,$14.99,$62.09,$62.09,$15.23,$87.00,$0.00,$43.50,$68.90,$69.60,$0.00,$13.62,$0.00,$13.85,$0.00
27000153,EAP,Custom 27000153,,Tube Salem Silicone Size,$38.00,$0.00,$38.00,$0.00,$27.12,$0.00,$0.00,$27.12,$27.12,$0.00,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000154,EAP,Custom 27000154,,Tubes Salem Sump 48 Leng,$38.00,$0.00,$38.00,$0.00,$27.12,$0.00,$0.00,$27.12,$27.12,$0.00,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000155,EAP,Custom 27000155,,Kit Tracheotomy Care Ster,$65.00,$0.00,$65.00,$0.00,$46.39,$0.00,$0.00,$46.39,$46.39,$0.00,$65.00,$0.00,$32.50,$51.48,$52.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000168,EAP,Custom 27000168,,Bag 1000ml Pump Set,$39.00,$0.00,$39.00,$0.00,$27.83,$0.00,$0.00,$27.83,$27.83,$0.00,$39.00,$0.00,$19.50,$30.89,$31.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000169,EAP,Custom 27000169,,Chest Unit Drainage Pleur,$455.00,$0.00,$455.00,$0.00,$324.73,$0.00,$0.00,$324.73,$324.73,$0.00,$455.00,$0.00,$227.50,$360.36,$364.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000173,EAP,Custom 27000173,,Tube Feeding Ng 8fr 36in Entr,$65.00,$0.00,$65.00,$0.00,$46.39,$0.00,$0.00,$46.39,$46.39,$0.00,$65.00,$0.00,$32.50,$51.48,$52.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000174,EAP,Custom 27000174,,Kit Triple Lumen Catheter,$299.00,$0.00,$299.00,$0.00,$213.40,$0.00,$0.00,$213.40,$213.40,$0.00,$299.00,$0.00,$149.50,$236.81,$239.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000179,EAP,Custom 27000179,,Filter Set 0.22 Micron,$19.00,$0.00,$19.00,$0.00,$13.56,$0.00,$0.00,$13.56,$13.56,$0.00,$19.00,$0.00,$9.50,$15.05,$15.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000181,EAP,Custom 27000181,,Tray Foley Preconnected 1,$59.00,$0.00,$59.00,$0.00,$42.11,$0.00,$0.00,$42.11,$42.11,$0.00,$59.00,$0.00,$29.50,$46.73,$47.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000182,EAP,Custom 27000182,,Tray Foley Perconnected 1,$59.00,$0.00,$59.00,$0.00,$42.11,$0.00,$0.00,$42.11,$42.11,$0.00,$59.00,$0.00,$29.50,$46.73,$47.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000184,EAP,Custom 27000184,,Tray Thoracentesis Dispos,$235.00,$0.00,$235.00,$0.00,$167.72,$0.00,$0.00,$167.72,$167.72,$0.00,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000191,EAP,Custom 27000191,,"Suture,silk, 0",$15.00,$0.00,$15.00,$0.00,$10.71,$0.00,$0.00,$10.71,$10.71,$0.00,$15.00,$0.00,$7.50,$11.88,$12.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000197,EAP,Custom 27000197,,Sleeve Knee Regular Dvt,$388.00,$0.00,$388.00,$0.00,$276.92,$0.00,$0.00,$276.92,$276.92,$0.00,$388.00,$0.00,$194.00,$307.30,$310.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000198,EAP,Custom 27000198,,Sleeve Knee X-large Dvt,$469.00,$0.00,$469.00,$0.00,$334.73,$0.00,$0.00,$334.73,$334.73,$0.00,$469.00,$0.00,$234.50,$371.45,$375.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000199,EAP,Custom 27000199,,Sleeve Thigh Regular Dvt,$553.00,$0.00,$553.00,$0.00,$394.68,$0.00,$0.00,$394.68,$394.68,$0.00,$553.00,$0.00,$276.50,$437.98,$442.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000200,EAP,Custom 27000200,,Sleeve Thigh X-large Dvt,$663.00,$0.00,$663.00,$0.00,$473.18,$0.00,$0.00,$473.18,$473.18,$0.00,$663.00,$0.00,$331.50,$525.10,$530.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000222,EAP,Custom 27000222,,Catheter Urethral 14fr,$10.00,$0.00,$10.00,$0.00,$7.14,$0.00,$0.00,$7.14,$7.14,$0.00,$10.00,$0.00,$5.00,$7.92,$8.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000223,EAP,Custom 27000223,,Catheter Urethral Two-eye,$10.00,$0.00,$10.00,$0.00,$7.14,$0.00,$0.00,$7.14,$7.14,$0.00,$10.00,$0.00,$5.00,$7.92,$8.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000224,EAP,Custom 27000224,,Tube Salem Sump 48 Lengt,$38.00,$0.00,$38.00,$0.00,$27.12,$0.00,$0.00,$27.12,$27.12,$0.00,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000225,EAP,Custom 27000225,,Tubes Salem Sump 48 Leng,$38.00,$0.00,$38.00,$0.00,$27.12,$0.00,$0.00,$27.12,$27.12,$0.00,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000226,EAP,Custom 27000226,,Kit Tracheotomy Care Ster,$65.00,$0.00,$65.00,$0.00,$46.39,$0.00,$0.00,$46.39,$46.39,$0.00,$65.00,$0.00,$32.50,$51.48,$52.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000228,EAP,Custom 27000228,,Scapel Surg W/handle Atta,$142.00,$0.00,$142.00,$0.00,$101.35,$0.00,$0.00,$101.35,$101.35,$0.00,$142.00,$0.00,$71.00,$112.46,$113.60,$0.00,$0.00,$0.00,$0.00,$0.00
27000232,EAP,Custom 27000232,,Cream Baza 5oz,$56.00,$0.00,$56.00,$0.00,$39.97,$0.00,$0.00,$39.97,$39.97,$0.00,$56.00,$0.00,$28.00,$44.35,$44.80,$0.00,$0.00,$0.00,$0.00,$0.00
27000240,EAP,Custom 27000240,,Bag 1000ml Pump Set,$39.00,$0.00,$39.00,$0.00,$27.83,$0.00,$0.00,$27.83,$27.83,$0.00,$39.00,$0.00,$19.50,$30.89,$31.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000241,EAP,Custom 27000241,,Needle Port-cath 20ga X 1,$36.00,$0.00,$36.00,$0.00,$25.69,$0.00,$0.00,$25.69,$25.69,$0.00,$36.00,$0.00,$18.00,$28.51,$28.80,$0.00,$0.00,$0.00,$0.00,$0.00
27000242,EAP,Custom 27000242,,Chest Unit Drainage Pleur,$455.00,$0.00,$455.00,$0.00,$324.73,$0.00,$0.00,$324.73,$324.73,$0.00,$455.00,$0.00,$227.50,$360.36,$364.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000245,EAP,Custom 27000245,,Kit Triple Lumen Catheter,$420.00,$0.00,$420.00,$0.00,$299.75,$0.00,$0.00,$299.75,$299.75,$0.00,$420.00,$0.00,$210.00,$332.64,$336.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000250,EAP,Custom 27000250,,Tray Foley Preconnected W,$19.00,$0.00,$19.00,$0.00,$13.56,$0.00,$0.00,$13.56,$13.56,$0.00,$19.00,$0.00,$9.50,$15.05,$15.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000251,EAP,Custom 27000251,,Tray Foley Preconnected 1,$59.00,$0.00,$59.00,$0.00,$42.11,$0.00,$0.00,$42.11,$42.11,$0.00,$59.00,$0.00,$29.50,$46.73,$47.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000252,EAP,Custom 27000252,,Tray Foley Perconnected 1,$59.00,$0.00,$59.00,$0.00,$42.11,$0.00,$0.00,$42.11,$42.11,$0.00,$59.00,$0.00,$29.50,$46.73,$47.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000253,EAP,Custom 27000253,,Tray Thoracentesis/parace,$67.00,$0.00,$67.00,$0.00,$47.82,$0.00,$0.00,$47.82,$47.82,$0.00,$67.00,$0.00,$33.50,$53.06,$53.60,$0.00,$0.00,$0.00,$0.00,$0.00
27000254,EAP,Custom 27000254,,Central Line Dressing Tray With Biopatch,$47.00,$0.00,$47.00,$0.00,$33.54,$0.00,$0.00,$33.54,$33.54,$0.00,$47.00,$0.00,$23.50,$37.22,$37.60,$0.00,$0.00,$0.00,$0.00,$0.00
27000259,EAP,Custom 27000259,,"Suture, Silk, 0",$15.00,$0.00,$15.00,$0.00,$10.71,$0.00,$0.00,$10.71,$10.71,$0.00,$15.00,$0.00,$7.50,$11.88,$12.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000265,EAP,Custom 27000265,,Sleeve Knee Regular Dvt,$388.00,$0.00,$388.00,$0.00,$276.92,$0.00,$0.00,$276.92,$276.92,$0.00,$388.00,$0.00,$194.00,$307.30,$310.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000266,EAP,Custom 27000266,,Sleeve Knee X-large Dvt,$469.00,$0.00,$469.00,$0.00,$334.73,$0.00,$0.00,$334.73,$334.73,$0.00,$469.00,$0.00,$234.50,$371.45,$375.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000267,EAP,Custom 27000267,,Sleeve Thigh Regular Dvt,$553.00,$0.00,$553.00,$0.00,$394.68,$0.00,$0.00,$394.68,$394.68,$0.00,$553.00,$0.00,$276.50,$437.98,$442.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000268,EAP,Custom 27000268,,Sleeve Thigh X-large Dvt,$284.00,$0.00,$284.00,$0.00,$202.69,$0.00,$0.00,$202.69,$202.69,$0.00,$284.00,$0.00,$142.00,$224.93,$227.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000293,EAP,Custom 27000293,,Catheter Urethral Two-eye,$10.00,$0.00,$10.00,$0.00,$7.14,$0.00,$0.00,$7.14,$7.14,$0.00,$10.00,$0.00,$5.00,$7.92,$8.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000294,EAP,HCPCS C1729,,Catheter Coude Size 14fr,$109.00,$0.00,$109.00,$59.19,$77.79,$0.00,$18.78,$77.79,$77.79,$19.09,$109.00,$0.00,$54.50,$86.33,$87.20,$0.00,$17.06,$0.00,$17.35,$0.00
27000295,EAP,HCPCS C1729,,Catheter Coude 30cc 24fr,$87.00,$0.00,$87.00,$47.24,$62.09,$0.00,$14.99,$62.09,$62.09,$15.23,$87.00,$0.00,$43.50,$68.90,$69.60,$0.00,$13.62,$0.00,$13.85,$0.00
27000296,EAP,Custom 27000296,,Tube Salem Silicone Size,$38.00,$0.00,$38.00,$0.00,$27.12,$0.00,$0.00,$27.12,$27.12,$0.00,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000297,EAP,Custom 27000297,,Tubes Salem Sump 48 Leng,$38.00,$0.00,$38.00,$0.00,$27.12,$0.00,$0.00,$27.12,$27.12,$0.00,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000298,EAP,Custom 27000298,,Kit Tracheotomy Care Ster,$61.00,$0.00,$61.00,$0.00,$43.54,$0.00,$0.00,$43.54,$43.54,$0.00,$61.00,$0.00,$30.50,$48.31,$48.80,$0.00,$0.00,$0.00,$0.00,$0.00
27000300,EAP,Custom 27000300,,Scapel Surg W/handle Atta,$142.00,$0.00,$142.00,$0.00,$101.35,$0.00,$0.00,$101.35,$101.35,$0.00,$142.00,$0.00,$71.00,$112.46,$113.60,$0.00,$0.00,$0.00,$0.00,$0.00
27000314,EAP,Custom 27000314,,Bag 1000ml Pump Set,$39.00,$0.00,$39.00,$0.00,$27.83,$0.00,$0.00,$27.83,$27.83,$0.00,$39.00,$0.00,$19.50,$30.89,$31.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000315,EAP,Custom 27000315,,Chest Unit Drainage Pleur,$455.00,$0.00,$455.00,$0.00,$324.73,$0.00,$0.00,$324.73,$324.73,$0.00,$455.00,$0.00,$227.50,$360.36,$364.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000318,EAP,Custom 27000318,,Tube Feeding Ng 8fr 36in Entr,$65.00,$0.00,$65.00,$0.00,$46.39,$0.00,$0.00,$46.39,$46.39,$0.00,$65.00,$0.00,$32.50,$51.48,$52.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000319,EAP,Custom 27000319,,Kit Triple Lumen Catheter,$697.00,$0.00,$697.00,$0.00,$497.45,$0.00,$0.00,$497.45,$497.45,$0.00,$697.00,$0.00,$348.50,$552.02,$557.60,$0.00,$0.00,$0.00,$0.00,$0.00
27000323,EAP,Custom 27000323,,Vest Econo Cotton X-large,$102.00,$0.00,$102.00,$0.00,$72.80,$0.00,$0.00,$72.80,$72.80,$0.00,$102.00,$0.00,$51.00,$80.78,$81.60,$0.00,$0.00,$0.00,$0.00,$0.00
27000324,EAP,Custom 27000324,,Filter Set 0.22 Micron,$19.00,$0.00,$19.00,$0.00,$13.56,$0.00,$0.00,$13.56,$13.56,$0.00,$19.00,$0.00,$9.50,$15.05,$15.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000326,EAP,Custom 27000326,,Tray Foley Preconnected 1,$59.00,$0.00,$59.00,$0.00,$42.11,$0.00,$0.00,$42.11,$42.11,$0.00,$59.00,$0.00,$29.50,$46.73,$47.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000327,EAP,Custom 27000327,,Tray Foley Perconnected 1,$59.00,$0.00,$59.00,$0.00,$42.11,$0.00,$0.00,$42.11,$42.11,$0.00,$59.00,$0.00,$29.50,$46.73,$47.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000330,EAP,Custom 27000330,,Central Line Dressing Tray With Biopatch,$47.00,$0.00,$47.00,$0.00,$33.54,$0.00,$0.00,$33.54,$33.54,$0.00,$47.00,$0.00,$23.50,$37.22,$37.60,$0.00,$0.00,$0.00,$0.00,$0.00
27000335,EAP,Custom 27000335,,"Suture, Silk, 0",$15.00,$0.00,$15.00,$0.00,$10.71,$0.00,$0.00,$10.71,$10.71,$0.00,$15.00,$0.00,$7.50,$11.88,$12.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000341,EAP,Custom 27000341,,Sleeve Knee Regular Dvt,$388.00,$0.00,$388.00,$0.00,$276.92,$0.00,$0.00,$276.92,$276.92,$0.00,$388.00,$0.00,$194.00,$307.30,$310.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000342,EAP,Custom 27000342,,Sleeve Knee X-large Dvt,$469.00,$0.00,$469.00,$0.00,$334.73,$0.00,$0.00,$334.73,$334.73,$0.00,$469.00,$0.00,$234.50,$371.45,$375.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000343,EAP,Custom 27000343,,Sleeve Thigh Regular Dvt,$553.00,$0.00,$553.00,$0.00,$394.68,$0.00,$0.00,$394.68,$394.68,$0.00,$553.00,$0.00,$276.50,$437.98,$442.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000344,EAP,Custom 27000344,,Sleeve Thigh X-large Dvt,$284.00,$0.00,$284.00,$0.00,$202.69,$0.00,$0.00,$202.69,$202.69,$0.00,$284.00,$0.00,$142.00,$224.93,$227.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000345,EAP,Custom 27000345,,Tubes Extension Plain Pla,$16.00,$0.00,$16.00,$0.00,$11.42,$0.00,$0.00,$11.42,$11.42,$0.00,$16.00,$0.00,$8.00,$12.67,$12.80,$0.00,$0.00,$0.00,$0.00,$0.00
27000358,EAP,Custom 27000358,,Catheter  Thoracic 16f,$40.00,$0.00,$40.00,$0.00,$28.55,$0.00,$0.00,$28.55,$28.55,$0.00,$40.00,$0.00,$20.00,$31.68,$32.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000359,EAP,Custom 27000359,,Catheter  Thoracic 20fr,$40.00,$0.00,$40.00,$0.00,$28.55,$0.00,$0.00,$28.55,$28.55,$0.00,$40.00,$0.00,$20.00,$31.68,$32.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000360,EAP,Custom 27000360,,Catheter Thoracic 36fr,$43.00,$0.00,$43.00,$0.00,$30.69,$0.00,$0.00,$30.69,$30.69,$0.00,$43.00,$0.00,$21.50,$34.06,$34.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000361,EAP,Custom 27000361,,Catheter Ventricular 20cm,$735.00,$0.00,$735.00,$0.00,$524.57,$0.00,$0.00,$524.57,$524.57,$0.00,$735.00,$0.00,$367.50,$582.12,$588.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000362,EAP,Custom 27000362,,Catheter Edm 11 Becker,"$1,339.00",$0.00,"$1,339.00",$0.00,$955.64,$0.00,$0.00,$955.64,$955.64,$0.00,"$1,339.00",$0.00,$669.50,"$1,060.49","$1,071.20",$0.00,$0.00,$0.00,$0.00,$0.00
27000363,EAP,Custom 27000363,,Tube Feeding Plastic 8fr,$10.00,$0.00,$10.00,$0.00,$7.14,$0.00,$0.00,$7.14,$7.14,$0.00,$10.00,$0.00,$5.00,$7.92,$8.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000364,EAP,Custom 27000364,,Artery Arterial Catheriza,$42.00,$0.00,$42.00,$0.00,$29.98,$0.00,$0.00,$29.98,$29.98,$0.00,$42.00,$0.00,$21.00,$33.26,$33.60,$0.00,$0.00,$0.00,$0.00,$0.00
27000365,EAP,Custom 27000365,,Artery Radial Catherizati,$69.00,$0.00,$69.00,$0.00,$49.25,$0.00,$0.00,$49.25,$49.25,$0.00,$69.00,$0.00,$34.50,$54.65,$55.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000366,EAP,Custom 27000366,,Tube Salem Sump 48 Lengt,$38.00,$0.00,$38.00,$0.00,$27.12,$0.00,$0.00,$27.12,$27.12,$0.00,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000367,EAP,Custom 27000367,,Tube Salem Silicone Size,$38.00,$0.00,$38.00,$0.00,$27.12,$0.00,$0.00,$27.12,$27.12,$0.00,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000368,EAP,Custom 27000368,,Tubes Salem Sump 48 Leng,$16.00,$0.00,$16.00,$0.00,$11.42,$0.00,$0.00,$11.42,$11.42,$0.00,$16.00,$0.00,$8.00,$12.67,$12.80,$0.00,$0.00,$0.00,$0.00,$0.00
27000369,EAP,Custom 27000369,,Kit Tracheotomy Care Ster,$61.00,$0.00,$61.00,$0.00,$43.54,$0.00,$0.00,$43.54,$43.54,$0.00,$61.00,$0.00,$30.50,$48.31,$48.80,$0.00,$0.00,$0.00,$0.00,$0.00
27000371,EAP,Custom 27000371,,Bag Drainage Becker,$197.00,$0.00,$197.00,$0.00,$140.60,$0.00,$0.00,$140.60,$140.60,$0.00,$197.00,$0.00,$98.50,$156.02,$157.60,$0.00,$0.00,$0.00,$0.00,$0.00
27000372,EAP,Custom 27000372,,Tray Catheter Insrtn Dulm,$377.00,$0.00,$377.00,$0.00,$269.06,$0.00,$0.00,$269.06,$269.06,$0.00,$377.00,$0.00,$188.50,$298.58,$301.60,$0.00,$0.00,$0.00,$0.00,$0.00
27000373,EAP,Custom 27000373,,Scapel Surg W/handle Atta,$142.00,$0.00,$142.00,$0.00,$101.35,$0.00,$0.00,$101.35,$101.35,$0.00,$142.00,$0.00,$71.00,$112.46,$113.60,$0.00,$0.00,$0.00,$0.00,$0.00
27000374,EAP,Custom 27000374,,Scaple Surg W/handle Atta,$152.00,$0.00,$152.00,$0.00,$108.48,$0.00,$0.00,$108.48,$108.48,$0.00,$152.00,$0.00,$76.00,$120.38,$121.60,$0.00,$0.00,$0.00,$0.00,$0.00
27000376,EAP,Custom 27000376,,Set Blood Administration,$34.00,$0.00,$34.00,$0.00,$24.27,$0.00,$0.00,$24.27,$24.27,$0.00,$34.00,$0.00,$17.00,$26.93,$27.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000378,EAP,Custom 27000378,,Cream Baza 5oz,$26.00,$0.00,$26.00,$0.00,$18.56,$0.00,$0.00,$18.56,$18.56,$0.00,$26.00,$0.00,$13.00,$20.59,$20.80,$0.00,$0.00,$0.00,$0.00,$0.00
27000386,EAP,Custom 27000386,,Pouch Fecal Incontinence,$21.00,$0.00,$21.00,$0.00,$14.99,$0.00,$0.00,$14.99,$14.99,$0.00,$21.00,$0.00,$10.50,$16.63,$16.80,$0.00,$0.00,$0.00,$0.00,$0.00
27000387,EAP,Custom 27000387,,Kit Pressure Monitoring T,$177.00,$0.00,$177.00,$0.00,$126.32,$0.00,$0.00,$126.32,$126.32,$0.00,$177.00,$0.00,$88.50,$140.18,$141.60,$0.00,$0.00,$0.00,$0.00,$0.00
27000388,EAP,Custom 27000388,,Transducer  Disp For Icp,$36.00,$0.00,$36.00,$0.00,$25.69,$0.00,$0.00,$25.69,$25.69,$0.00,$36.00,$0.00,$18.00,$28.51,$28.80,$0.00,$0.00,$0.00,$0.00,$0.00
27000389,EAP,Custom 27000389,,Bridge Kit Bifurated Resp,$131.00,$0.00,$131.00,$0.00,$93.49,$0.00,$0.00,$93.49,$93.49,$0.00,$131.00,$0.00,$65.50,$103.75,$104.80,$0.00,$0.00,$0.00,$0.00,$0.00
27000390,EAP,Custom 27000390,,Kit Transducer Monitoring,$339.00,$0.00,$339.00,$0.00,$241.94,$0.00,$0.00,$241.94,$241.94,$0.00,$339.00,$0.00,$169.50,$268.49,$271.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000392,EAP,Custom 27000392,,Kit  Pressure Monitoring,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$178.43,$178.43,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000394,EAP,Custom 27000394,,Bag 1000ml Pump Set,$34.00,$0.00,$34.00,$0.00,$24.27,$0.00,$0.00,$24.27,$24.27,$0.00,$34.00,$0.00,$17.00,$26.93,$27.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000395,EAP,Custom 27000395,,Kit Pecutaneous Introduce,$101.00,$0.00,$101.00,$0.00,$72.08,$0.00,$0.00,$72.08,$72.08,$0.00,$101.00,$0.00,$50.50,$79.99,$80.80,$0.00,$0.00,$0.00,$0.00,$0.00
27000396,EAP,Custom 27000396,,Chest Unit Drainage Pleur,$455.00,$0.00,$455.00,$0.00,$324.73,$0.00,$0.00,$324.73,$324.73,$0.00,$455.00,$0.00,$227.50,$360.36,$364.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000403,EAP,Custom 27000403,,Tube Feeding Ng 8fr 36in Entr,$61.00,$0.00,$61.00,$0.00,$43.54,$0.00,$0.00,$43.54,$43.54,$0.00,$61.00,$0.00,$30.50,$48.31,$48.80,$0.00,$0.00,$0.00,$0.00,$0.00
27000404,EAP,Custom 27000404,,Kit Triple Lumen Catheter,$299.00,$0.00,$299.00,$0.00,$213.40,$0.00,$0.00,$213.40,$213.40,$0.00,$299.00,$0.00,$149.50,$236.81,$239.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000405,EAP,Custom 27000405,,Catheter Swan Ganz,$674.00,$0.00,$674.00,$0.00,$481.03,$0.00,$0.00,$481.03,$481.03,$0.00,$674.00,$0.00,$337.00,$533.81,$539.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000406,EAP,Custom 27000406,,Delivery System Closed In,$65.00,$0.00,$65.00,$0.00,$46.39,$0.00,$0.00,$46.39,$46.39,$0.00,$65.00,$0.00,$32.50,$51.48,$52.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000407,EAP,Custom 27000407,,Probe V-pacing,"$1,403.00",$0.00,"$1,403.00",$0.00,"$1,001.32",$0.00,$0.00,"$1,001.32","$1,001.32",$0.00,"$1,403.00",$0.00,$701.50,"$1,111.18","$1,122.40",$0.00,$0.00,$0.00,$0.00,$0.00
27000410,EAP,Custom 27000410,,Filter Set 0.22 Micron,$19.00,$0.00,$19.00,$0.00,$13.56,$0.00,$0.00,$13.56,$13.56,$0.00,$19.00,$0.00,$9.50,$15.05,$15.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000412,EAP,Custom 27000412,,Kit Ventriculostomy,"$1,652.00",$0.00,"$1,652.00",$0.00,"$1,179.03",$0.00,$0.00,"$1,179.03","$1,179.03",$0.00,"$1,652.00",$0.00,$826.00,"$1,308.38","$1,321.60",$0.00,$0.00,$0.00,$0.00,$0.00
27000414,EAP,Custom 27000414,,"Suture, Silk, 0",$15.00,$0.00,$15.00,$0.00,$10.71,$0.00,$0.00,$10.71,$10.71,$0.00,$15.00,$0.00,$7.50,$11.88,$12.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000454,EAP,Custom 27000454,,Catheter  Thoracic 28fr,$40.00,$0.00,$40.00,$0.00,$28.55,$0.00,$0.00,$28.55,$28.55,$0.00,$40.00,$0.00,$20.00,$31.68,$32.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000455,EAP,Custom 27000455,,Catheter Thoracic 32fr,$40.00,$0.00,$40.00,$0.00,$28.55,$0.00,$0.00,$28.55,$28.55,$0.00,$40.00,$0.00,$20.00,$31.68,$32.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000456,EAP,Custom 27000456,,Catheter Thoracic 36fr,$40.00,$0.00,$40.00,$0.00,$28.55,$0.00,$0.00,$28.55,$28.55,$0.00,$40.00,$0.00,$20.00,$31.68,$32.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000457,EAP,Custom 27000457,,Catheter Urethral 14fr,$10.00,$0.00,$10.00,$0.00,$7.14,$0.00,$0.00,$7.14,$7.14,$0.00,$10.00,$0.00,$5.00,$7.92,$8.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000458,EAP,Custom 27000458,,Catheter Urethral Two-eye,$10.00,$0.00,$10.00,$0.00,$7.14,$0.00,$0.00,$7.14,$7.14,$0.00,$10.00,$0.00,$5.00,$7.92,$8.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000459,EAP,Custom 27000459,,Tube Salem Sump 48 Lengt,$36.00,$0.00,$36.00,$0.00,$25.69,$0.00,$0.00,$25.69,$25.69,$0.00,$36.00,$0.00,$18.00,$28.51,$28.80,$0.00,$0.00,$0.00,$0.00,$0.00
27000460,EAP,Custom 27000460,,Tube Salem Silicone Size,$28.00,$0.00,$28.00,$0.00,$19.98,$0.00,$0.00,$19.98,$19.98,$0.00,$28.00,$0.00,$14.00,$22.18,$22.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000461,EAP,Custom 27000461,,Tubes Salem Sump 48 Leng,$38.00,$0.00,$38.00,$0.00,$27.12,$0.00,$0.00,$27.12,$27.12,$0.00,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000462,EAP,Custom 27000462,,Kit Tracheotomy Care Ster,$61.00,$0.00,$61.00,$0.00,$43.54,$0.00,$0.00,$43.54,$43.54,$0.00,$61.00,$0.00,$30.50,$48.31,$48.80,$0.00,$0.00,$0.00,$0.00,$0.00
27000464,EAP,Custom 27000464,,Scaple Surg W/handle Atta,$152.00,$0.00,$152.00,$0.00,$108.48,$0.00,$0.00,$108.48,$108.48,$0.00,$152.00,$0.00,$76.00,$120.38,$121.60,$0.00,$0.00,$0.00,$0.00,$0.00
27000474,EAP,Custom 27000474,,Bag 1000ml Pump Set,$39.00,$0.00,$39.00,$0.00,$27.83,$0.00,$0.00,$27.83,$27.83,$0.00,$39.00,$0.00,$19.50,$30.89,$31.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000475,EAP,Custom 27000475,,Needle Port-cath 20ga X 1,$34.00,$0.00,$34.00,$0.00,$24.27,$0.00,$0.00,$24.27,$24.27,$0.00,$34.00,$0.00,$17.00,$26.93,$27.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000476,EAP,Custom 27000476,,Chest Unit Drainage Pleur,$195.00,$0.00,$195.00,$0.00,$139.17,$0.00,$0.00,$139.17,$139.17,$0.00,$195.00,$0.00,$97.50,$154.44,$156.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000481,EAP,Custom 27000481,,Tube Feeding Ng 8fr 36in Entr,$30.00,$0.00,$30.00,$0.00,$21.41,$0.00,$0.00,$21.41,$21.41,$0.00,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000482,EAP,Custom 27000482,,Kit Triple Lumen Catheter,$299.00,$0.00,$299.00,$0.00,$213.40,$0.00,$0.00,$213.40,$213.40,$0.00,$299.00,$0.00,$149.50,$236.81,$239.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000483,EAP,Custom 27000483,,Filter Set 0.22 Micron,$19.00,$0.00,$19.00,$0.00,$13.56,$0.00,$0.00,$13.56,$13.56,$0.00,$19.00,$0.00,$9.50,$15.05,$15.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000484,EAP,Custom 27000484,,Tray Catheter Urethral 14,$17.00,$0.00,$17.00,$0.00,$12.13,$0.00,$0.00,$12.13,$12.13,$0.00,$17.00,$0.00,$8.50,$13.46,$13.60,$0.00,$0.00,$0.00,$0.00,$0.00
27000487,EAP,Custom 27000487,,Tray Foley Preconnected 1,$59.00,$0.00,$59.00,$0.00,$42.11,$0.00,$0.00,$42.11,$42.11,$0.00,$59.00,$0.00,$29.50,$46.73,$47.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000488,EAP,Custom 27000488,,Tray Foley Perconnected 1,$59.00,$0.00,$59.00,$0.00,$42.11,$0.00,$0.00,$42.11,$42.11,$0.00,$59.00,$0.00,$29.50,$46.73,$47.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000489,EAP,Custom 27000489,,Tray Thoracentesis Dispos,$235.00,$0.00,$235.00,$0.00,$167.72,$0.00,$0.00,$167.72,$167.72,$0.00,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000491,EAP,Custom 27000491,,Central Line Dressing Tray With Biopatch,$47.00,$0.00,$47.00,$0.00,$33.54,$0.00,$0.00,$33.54,$33.54,$0.00,$47.00,$0.00,$23.50,$37.22,$37.60,$0.00,$0.00,$0.00,$0.00,$0.00
27000495,EAP,Custom 27000495,,"Suture, Silk, 0",$15.00,$0.00,$15.00,$0.00,$10.71,$0.00,$0.00,$10.71,$10.71,$0.00,$15.00,$0.00,$7.50,$11.88,$12.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000501,EAP,Custom 27000501,,Sleeve Knee Regular Dvt,$388.00,$0.00,$388.00,$0.00,$276.92,$0.00,$0.00,$276.92,$276.92,$0.00,$388.00,$0.00,$194.00,$307.30,$310.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000502,EAP,Custom 27000502,,Sleeve Knee X-large Dvt,$469.00,$0.00,$469.00,$0.00,$334.73,$0.00,$0.00,$334.73,$334.73,$0.00,$469.00,$0.00,$234.50,$371.45,$375.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000503,EAP,Custom 27000503,,Sleeve Thigh Regular Dvt,$228.00,$0.00,$228.00,$0.00,$162.72,$0.00,$0.00,$162.72,$162.72,$0.00,$228.00,$0.00,$114.00,$180.58,$182.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000504,EAP,Custom 27000504,,Sleeve Thigh X-large Dvt,$616.00,$0.00,$616.00,$0.00,$439.64,$0.00,$0.00,$439.64,$439.64,$0.00,$616.00,$0.00,$308.00,$487.87,$492.80,$0.00,$0.00,$0.00,$0.00,$0.00
27000530,EAP,Custom 27000530,,Catheter  Thoracic 28fr,$43.00,$0.00,$43.00,$0.00,$30.69,$0.00,$0.00,$30.69,$30.69,$0.00,$43.00,$0.00,$21.50,$34.06,$34.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000531,EAP,Custom 27000531,,Catheter Thoracic 32fr,$43.00,$0.00,$43.00,$0.00,$30.69,$0.00,$0.00,$30.69,$30.69,$0.00,$43.00,$0.00,$21.50,$34.06,$34.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000532,EAP,Custom 27000532,,Catheter Thoracic 36fr,$43.00,$0.00,$43.00,$0.00,$30.69,$0.00,$0.00,$30.69,$30.69,$0.00,$43.00,$0.00,$21.50,$34.06,$34.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000533,EAP,Custom 27000533,,Tube Salem Sump 48 Lengt,$38.00,$0.00,$38.00,$0.00,$27.12,$0.00,$0.00,$27.12,$27.12,$0.00,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000534,EAP,Custom 27000534,,Tubes Salem Sump 48 Leng,$16.00,$0.00,$16.00,$0.00,$11.42,$0.00,$0.00,$11.42,$11.42,$0.00,$16.00,$0.00,$8.00,$12.67,$12.80,$0.00,$0.00,$0.00,$0.00,$0.00
27000535,EAP,Custom 27000535,,Kit Tracheotomy Care Ster,$65.00,$0.00,$65.00,$0.00,$46.39,$0.00,$0.00,$46.39,$46.39,$0.00,$65.00,$0.00,$32.50,$51.48,$52.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000538,EAP,Custom 27000538,,Scapel Surg W/ Handle Atta,$142.00,$0.00,$142.00,$0.00,$101.35,$0.00,$0.00,$101.35,$101.35,$0.00,$142.00,$0.00,$71.00,$112.46,$113.60,$0.00,$0.00,$0.00,$0.00,$0.00
27000543,EAP,Custom 27000543,,Kit Thoracotomy,$36.00,$0.00,$36.00,$0.00,$25.69,$0.00,$0.00,$25.69,$25.69,$0.00,$36.00,$0.00,$18.00,$28.51,$28.80,$0.00,$0.00,$0.00,$0.00,$0.00
27000549,EAP,Custom 27000549,,Bag 1000ml Pump Set,$39.00,$0.00,$39.00,$0.00,$27.83,$0.00,$0.00,$27.83,$27.83,$0.00,$39.00,$0.00,$19.50,$30.89,$31.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000551,EAP,Custom 27000551,,Chest Unit Drainage Pleur,$69.00,$0.00,$69.00,$0.00,$49.25,$0.00,$0.00,$49.25,$49.25,$0.00,$69.00,$0.00,$34.50,$54.65,$55.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000556,EAP,Custom 27000556,,Tube Feeding Ng 8fr 36in Entr,$30.00,$0.00,$30.00,$0.00,$21.41,$0.00,$0.00,$21.41,$21.41,$0.00,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000557,EAP,Custom 27000557,,Kit Triple Lumen Catheter,$299.00,$0.00,$299.00,$0.00,$213.40,$0.00,$0.00,$213.40,$213.40,$0.00,$299.00,$0.00,$149.50,$236.81,$239.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000558,EAP,Custom 27000558,,Filter Set 0.22 Micron,$19.00,$0.00,$19.00,$0.00,$13.56,$0.00,$0.00,$13.56,$13.56,$0.00,$19.00,$0.00,$9.50,$15.05,$15.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000559,EAP,Custom 27000559,,Tray Catheter Urethral 14,$17.00,$0.00,$17.00,$0.00,$12.13,$0.00,$0.00,$12.13,$12.13,$0.00,$17.00,$0.00,$8.50,$13.46,$13.60,$0.00,$0.00,$0.00,$0.00,$0.00
27000560,EAP,Custom 27000560,,Tray Douch Disposable,$69.00,$0.00,$69.00,$0.00,$49.25,$0.00,$0.00,$49.25,$49.25,$0.00,$69.00,$0.00,$34.50,$54.65,$55.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000562,EAP,Custom 27000562,,Tray Foley Preconnected 1,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$15.70,$15.70,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
27000563,EAP,Custom 27000563,,Tray Foley Perconnected 1,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$15.70,$15.70,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
27000564,EAP,Custom 27000564,,Tray Thoracentesis Dispos,$261.00,$0.00,$261.00,$0.00,$186.28,$0.00,$0.00,$186.28,$186.28,$0.00,$261.00,$0.00,$130.50,$206.71,$208.80,$0.00,$0.00,$0.00,$0.00,$0.00
27000570,EAP,Custom 27000570,,"Suture, Silk, 0",$15.00,$0.00,$15.00,$0.00,$10.71,$0.00,$0.00,$10.71,$10.71,$0.00,$15.00,$0.00,$7.50,$11.88,$12.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000577,EAP,Custom 27000577,,Sleeve Knee Regular Dvt,$388.00,$0.00,$388.00,$0.00,$276.92,$0.00,$0.00,$276.92,$276.92,$0.00,$388.00,$0.00,$194.00,$307.30,$310.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000578,EAP,Custom 27000578,,Sleeve Knee X-large Dvt,$469.00,$0.00,$469.00,$0.00,$334.73,$0.00,$0.00,$334.73,$334.73,$0.00,$469.00,$0.00,$234.50,$371.45,$375.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000579,EAP,Custom 27000579,,Sleeve Thigh Regular Dvt,$238.00,$0.00,$238.00,$0.00,$169.86,$0.00,$0.00,$169.86,$169.86,$0.00,$238.00,$0.00,$119.00,$188.50,$190.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000580,EAP,Custom 27000580,,Sleeve Thigh X-large Dvt,$616.00,$0.00,$616.00,$0.00,$439.64,$0.00,$0.00,$439.64,$439.64,$0.00,$616.00,$0.00,$308.00,$487.87,$492.80,$0.00,$0.00,$0.00,$0.00,$0.00
27000604,EAP,Custom 27000604,,Catheter  Thoracic 28fr,$40.00,$0.00,$40.00,$0.00,$28.55,$0.00,$0.00,$28.55,$28.55,$0.00,$40.00,$0.00,$20.00,$31.68,$32.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000605,EAP,Custom 27000605,,Catheter Thoracic 32fr,$18.00,$0.00,$18.00,$0.00,$12.85,$0.00,$0.00,$12.85,$12.85,$0.00,$18.00,$0.00,$9.00,$14.26,$14.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000606,EAP,Custom 27000606,,Catheter Thoracic 36fr,$18.00,$0.00,$18.00,$0.00,$12.85,$0.00,$0.00,$12.85,$12.85,$0.00,$18.00,$0.00,$9.00,$14.26,$14.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000607,EAP,Custom 27000607,,Tube Salem Sump 48 Lengt,$38.00,$0.00,$38.00,$0.00,$27.12,$0.00,$0.00,$27.12,$27.12,$0.00,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000608,EAP,Custom 27000608,,Tubes Salem Sump 48 Leng,$38.00,$0.00,$38.00,$0.00,$27.12,$0.00,$0.00,$27.12,$27.12,$0.00,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000612,EAP,Custom 27000612,,Scapel Surg W/handle Atta,$142.00,$0.00,$142.00,$0.00,$101.35,$0.00,$0.00,$101.35,$101.35,$0.00,$142.00,$0.00,$71.00,$112.46,$113.60,$0.00,$0.00,$0.00,$0.00,$0.00
27000613,EAP,Custom 27000613,,Scaple Surg W/handle Atta,$152.00,$0.00,$152.00,$0.00,$108.48,$0.00,$0.00,$108.48,$108.48,$0.00,$152.00,$0.00,$76.00,$120.38,$121.60,$0.00,$0.00,$0.00,$0.00,$0.00
27000618,EAP,Custom 27000618,,Kit Thoracotomy,$93.00,$0.00,$93.00,$0.00,$66.37,$0.00,$0.00,$66.37,$66.37,$0.00,$93.00,$0.00,$46.50,$73.66,$74.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000624,EAP,Custom 27000624,,Bag 1000ml Pump Set,$39.00,$0.00,$39.00,$0.00,$27.83,$0.00,$0.00,$27.83,$27.83,$0.00,$39.00,$0.00,$19.50,$30.89,$31.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000625,EAP,Custom 27000625,,Chest Unit Drainage Pleur,$332.00,$0.00,$332.00,$0.00,$236.95,$0.00,$0.00,$236.95,$236.95,$0.00,$332.00,$0.00,$166.00,$262.94,$265.60,$0.00,$0.00,$0.00,$0.00,$0.00
27000630,EAP,Custom 27000630,,Dressing X-large,$697.00,$0.00,$697.00,$0.00,$497.45,$0.00,$0.00,$497.45,$497.45,$0.00,$697.00,$0.00,$348.50,$552.02,$557.60,$0.00,$0.00,$0.00,$0.00,$0.00
27000632,EAP,Custom 27000632,,Tube Feeding Ng 8fr 36in Entr,$30.00,$0.00,$30.00,$0.00,$21.41,$0.00,$0.00,$21.41,$21.41,$0.00,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000633,EAP,Custom 27000633,,Kit Triple Lumen Catheter,$299.00,$0.00,$299.00,$0.00,$213.40,$0.00,$0.00,$213.40,$213.40,$0.00,$299.00,$0.00,$149.50,$236.81,$239.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000637,EAP,Custom 27000637,,Tray Catheter Urethral 14,$17.00,$0.00,$17.00,$0.00,$12.13,$0.00,$0.00,$12.13,$12.13,$0.00,$17.00,$0.00,$8.50,$13.46,$13.60,$0.00,$0.00,$0.00,$0.00,$0.00
27000638,EAP,Custom 27000638,,Tray Douch Disposable,$69.00,$0.00,$69.00,$0.00,$49.25,$0.00,$0.00,$49.25,$49.25,$0.00,$69.00,$0.00,$34.50,$54.65,$55.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000640,EAP,Custom 27000640,,Tray Foley Preconnected 1,$59.00,$0.00,$59.00,$0.00,$42.11,$0.00,$0.00,$42.11,$42.11,$0.00,$59.00,$0.00,$29.50,$46.73,$47.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000641,EAP,Custom 27000641,,Tray Foley Perconnected 1,$59.00,$0.00,$59.00,$0.00,$42.11,$0.00,$0.00,$42.11,$42.11,$0.00,$59.00,$0.00,$29.50,$46.73,$47.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000642,EAP,Custom 27000642,,Tray Thoracentesis Dispos,$235.00,$0.00,$235.00,$0.00,$167.72,$0.00,$0.00,$167.72,$167.72,$0.00,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000648,EAP,Custom 27000648,,"Suture, Silk, 0",$15.00,$0.00,$15.00,$0.00,$10.71,$0.00,$0.00,$10.71,$10.71,$0.00,$15.00,$0.00,$7.50,$11.88,$12.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000653,EAP,Custom 27000653,,Sleeve Knee Regular Dvt,$388.00,$0.00,$388.00,$0.00,$276.92,$0.00,$0.00,$276.92,$276.92,$0.00,$388.00,$0.00,$194.00,$307.30,$310.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000654,EAP,Custom 27000654,,Sleeve Knee X-large Dvt,$469.00,$0.00,$469.00,$0.00,$334.73,$0.00,$0.00,$334.73,$334.73,$0.00,$469.00,$0.00,$234.50,$371.45,$375.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000655,EAP,Custom 27000655,,Sleeve Thigh Regular Dvt,$553.00,$0.00,$553.00,$0.00,$394.68,$0.00,$0.00,$394.68,$394.68,$0.00,$553.00,$0.00,$276.50,$437.98,$442.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000656,EAP,Custom 27000656,,Sleeve Thigh X-large Dvt,$663.00,$0.00,$663.00,$0.00,$473.18,$0.00,$0.00,$473.18,$473.18,$0.00,$663.00,$0.00,$331.50,$525.10,$530.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000666,EAP,Custom 27000666,,Tube Salem Sump 48 Lengt,$38.00,$0.00,$38.00,$0.00,$27.12,$0.00,$0.00,$27.12,$27.12,$0.00,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000667,EAP,Custom 27000667,,Scapel Surg W/handle Atta,$142.00,$0.00,$142.00,$0.00,$101.35,$0.00,$0.00,$101.35,$101.35,$0.00,$142.00,$0.00,$71.00,$112.46,$113.60,$0.00,$0.00,$0.00,$0.00,$0.00
27000679,EAP,Custom 27000679,,Kit Triple Lumen Catheter,$646.00,$0.00,$646.00,$0.00,$461.05,$0.00,$0.00,$461.05,$461.05,$0.00,$646.00,$0.00,$323.00,$511.63,$516.80,$0.00,$0.00,$0.00,$0.00,$0.00
27000680,EAP,Custom 27000680,,Filter Set 0.22 Micron,$7.00,$0.00,$7.00,$0.00,$5.00,$0.00,$0.00,$5.00,$5.00,$0.00,$7.00,$0.00,$3.50,$5.54,$5.60,$0.00,$0.00,$0.00,$0.00,$0.00
27000683,EAP,Custom 27000683,,Tray Catheter Urethral 14,$17.00,$0.00,$17.00,$0.00,$12.13,$0.00,$0.00,$12.13,$12.13,$0.00,$17.00,$0.00,$8.50,$13.46,$13.60,$0.00,$0.00,$0.00,$0.00,$0.00
27000686,EAP,Custom 27000686,,Tray Foley Preconnected 1,$59.00,$0.00,$59.00,$0.00,$42.11,$0.00,$0.00,$42.11,$42.11,$0.00,$59.00,$0.00,$29.50,$46.73,$47.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000687,EAP,Custom 27000687,,Tray Foley Perconnected 1,$59.00,$0.00,$59.00,$0.00,$42.11,$0.00,$0.00,$42.11,$42.11,$0.00,$59.00,$0.00,$29.50,$46.73,$47.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000689,EAP,Custom 27000689,,Tray Thoracentesis Dispos,$216.00,$0.00,$216.00,$0.00,$154.16,$0.00,$0.00,$154.16,$154.16,$0.00,$216.00,$0.00,$108.00,$171.07,$172.80,$0.00,$0.00,$0.00,$0.00,$0.00
27000691,EAP,Custom 27000691,,Bag Drainage Ureteral,$92.00,$0.00,$92.00,$0.00,$65.66,$0.00,$0.00,$65.66,$65.66,$0.00,$92.00,$0.00,$46.00,$72.86,$73.60,$0.00,$0.00,$0.00,$0.00,$0.00
27000696,EAP,Custom 27000696,,"Suture, Silk, 0",$15.00,$0.00,$15.00,$0.00,$10.71,$0.00,$0.00,$10.71,$10.71,$0.00,$15.00,$0.00,$7.50,$11.88,$12.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000697,EAP,Custom 27000697,,10ml Posiflush Saline Syringe,$10.00,$0.00,$10.00,$0.00,$7.14,$0.00,$0.00,$7.14,$7.14,$0.00,$10.00,$0.00,$5.00,$7.92,$8.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000701,EAP,Custom 27000701,,Sleeve Knee Regular Dvt,$378.00,$0.00,$378.00,$0.00,$269.78,$0.00,$0.00,$269.78,$269.78,$0.00,$378.00,$0.00,$189.00,$299.38,$302.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000702,EAP,Custom 27000702,,Sleeve Knee X-large Dvt,$469.00,$0.00,$469.00,$0.00,$334.73,$0.00,$0.00,$334.73,$334.73,$0.00,$469.00,$0.00,$234.50,$371.45,$375.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000703,EAP,Custom 27000703,,Sleeve Thigh Regular Dvt,$553.00,$0.00,$553.00,$0.00,$394.68,$0.00,$0.00,$394.68,$394.68,$0.00,$553.00,$0.00,$276.50,$437.98,$442.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000704,EAP,Custom 27000704,,Sleeve Thigh X-large Dvt,$284.00,$0.00,$284.00,$0.00,$202.69,$0.00,$0.00,$202.69,$202.69,$0.00,$284.00,$0.00,$142.00,$224.93,$227.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000705,EAP,Custom 27000705,,Sucrose Analgesia,$15.00,$0.00,$15.00,$0.00,$10.71,$0.00,$0.00,$10.71,$10.71,$0.00,$15.00,$0.00,$7.50,$11.88,$12.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000709,EAP,Custom 27000709,,Tray Circumcision,$47.00,$0.00,$47.00,$0.00,$33.54,$0.00,$0.00,$33.54,$33.54,$0.00,$47.00,$0.00,$23.50,$37.22,$37.60,$0.00,$0.00,$0.00,$0.00,$0.00
27000710,EAP,Custom 27000710,,Needle Spinal 22g 25/bx,$3.00,$0.00,$3.00,$0.00,$2.14,$0.00,$0.00,$2.14,$2.14,$0.00,$3.00,$0.00,$1.50,$2.38,$2.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000712,EAP,Custom 27000712,,Tubes Capillary Hepariniz,$160.00,$0.00,$160.00,$0.00,$114.19,$0.00,$0.00,$114.19,$114.19,$0.00,$160.00,$0.00,$80.00,$126.72,$128.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000714,EAP,Custom 27000714,,Tube Feeding Plastic 8fr,$3.00,$0.00,$3.00,$0.00,$2.14,$0.00,$0.00,$2.14,$2.14,$0.00,$3.00,$0.00,$1.50,$2.38,$2.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000715,EAP,Custom 27000715,,Scapel Surg W/handle Atta,$142.00,$0.00,$142.00,$0.00,$101.35,$0.00,$0.00,$101.35,$101.35,$0.00,$142.00,$0.00,$71.00,$112.46,$113.60,$0.00,$0.00,$0.00,$0.00,$0.00
27000721,EAP,Custom 27000721,,Tray Catheter Urethral 14,$17.00,$0.00,$17.00,$0.00,$12.13,$0.00,$0.00,$12.13,$12.13,$0.00,$17.00,$0.00,$8.50,$13.46,$13.60,$0.00,$0.00,$0.00,$0.00,$0.00
27000723,EAP,Custom 27000723,,Tray Foley Preconnected 1,$59.00,$0.00,$59.00,$0.00,$42.11,$0.00,$0.00,$42.11,$42.11,$0.00,$59.00,$0.00,$29.50,$46.73,$47.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000724,EAP,Custom 27000724,,Tray Foley Perconnected 1,$59.00,$0.00,$59.00,$0.00,$42.11,$0.00,$0.00,$42.11,$42.11,$0.00,$59.00,$0.00,$29.50,$46.73,$47.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000725,EAP,HCPCS C1751,,Catheter  Iv 26g 120/cs,$28.00,$0.00,$28.00,$15.20,$19.98,$0.00,$4.82,$19.98,$19.98,$4.90,$28.00,$0.00,$14.00,$22.18,$22.40,$0.00,$4.38,$0.00,$4.46,$0.00
27000726,EAP,Custom 27000726,,Sleeve Knee Regular Dvt,$166.00,$0.00,$166.00,$0.00,$118.47,$0.00,$0.00,$118.47,$118.47,$0.00,$166.00,$0.00,$83.00,$131.47,$132.80,$0.00,$0.00,$0.00,$0.00,$0.00
27000727,EAP,Custom 27000727,,Sleeve Knee X-large Dvt,$201.00,$0.00,$201.00,$0.00,$143.45,$0.00,$0.00,$143.45,$143.45,$0.00,$201.00,$0.00,$100.50,$159.19,$160.80,$0.00,$0.00,$0.00,$0.00,$0.00
27000728,EAP,Custom 27000728,,Sleeve Thigh X-large Dvt,$284.00,$0.00,$284.00,$0.00,$202.69,$0.00,$0.00,$202.69,$202.69,$0.00,$284.00,$0.00,$142.00,$224.93,$227.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000741,EAP,Custom 27000741,,Catheter  Thoracic 28fr,$40.00,$0.00,$40.00,$0.00,$28.55,$0.00,$0.00,$28.55,$28.55,$0.00,$40.00,$0.00,$20.00,$31.68,$32.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000742,EAP,Custom 27000742,,Catheter Thoracic 32fr,$40.00,$0.00,$40.00,$0.00,$28.55,$0.00,$0.00,$28.55,$28.55,$0.00,$40.00,$0.00,$20.00,$31.68,$32.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000743,EAP,Custom 27000743,,Catheter Thoracic 36fr,$18.00,$0.00,$18.00,$0.00,$12.85,$0.00,$0.00,$12.85,$12.85,$0.00,$18.00,$0.00,$9.00,$14.26,$14.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000744,EAP,Custom 27000744,,Tube Salem Sump 48 Lengt,$38.00,$0.00,$38.00,$0.00,$27.12,$0.00,$0.00,$27.12,$27.12,$0.00,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000745,EAP,Custom 27000745,,Tubes Salem Sump 48 Leng,$38.00,$0.00,$38.00,$0.00,$27.12,$0.00,$0.00,$27.12,$27.12,$0.00,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000748,EAP,Custom 27000748,,Scapel Surg W/handle Att,$142.00,$0.00,$142.00,$0.00,$101.35,$0.00,$0.00,$101.35,$101.35,$0.00,$142.00,$0.00,$71.00,$112.46,$113.60,$0.00,$0.00,$0.00,$0.00,$0.00
27000760,EAP,Custom 27000760,,Bag 1000ml Pump Set,$39.00,$0.00,$39.00,$0.00,$27.83,$0.00,$0.00,$27.83,$27.83,$0.00,$39.00,$0.00,$19.50,$30.89,$31.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000762,EAP,Custom 27000762,,Chest Unit Drainage Pleur,$420.00,$0.00,$420.00,$0.00,$299.75,$0.00,$0.00,$299.75,$299.75,$0.00,$420.00,$0.00,$210.00,$332.64,$336.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000765,EAP,Custom 27000765,,Tube Feeding Ng 8fr 36in Entr,$65.00,$0.00,$65.00,$0.00,$46.39,$0.00,$0.00,$46.39,$46.39,$0.00,$65.00,$0.00,$32.50,$51.48,$52.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000766,EAP,Custom 27000766,,Kit Triple Lumen Catheter,$299.00,$0.00,$299.00,$0.00,$213.40,$0.00,$0.00,$213.40,$213.40,$0.00,$299.00,$0.00,$149.50,$236.81,$239.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000770,EAP,Custom 27000770,,Filter Set 0.22 Micron,$7.00,$0.00,$7.00,$0.00,$5.00,$0.00,$0.00,$5.00,$5.00,$0.00,$7.00,$0.00,$3.50,$5.54,$5.60,$0.00,$0.00,$0.00,$0.00,$0.00
27000771,EAP,Custom 27000771,,Tray Catheter Urethral 14,$17.00,$0.00,$17.00,$0.00,$12.13,$0.00,$0.00,$12.13,$12.13,$0.00,$17.00,$0.00,$8.50,$13.46,$13.60,$0.00,$0.00,$0.00,$0.00,$0.00
27000772,EAP,Custom 27000772,,Tray Douch Disposable,$69.00,$0.00,$69.00,$0.00,$49.25,$0.00,$0.00,$49.25,$49.25,$0.00,$69.00,$0.00,$34.50,$54.65,$55.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000773,EAP,Custom 27000773,,Tray Foley Preconnected 1,$59.00,$0.00,$59.00,$0.00,$42.11,$0.00,$0.00,$42.11,$42.11,$0.00,$59.00,$0.00,$29.50,$46.73,$47.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000774,EAP,Custom 27000774,,Tray Foley Perconnected 1,$59.00,$0.00,$59.00,$0.00,$42.11,$0.00,$0.00,$42.11,$42.11,$0.00,$59.00,$0.00,$29.50,$46.73,$47.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000775,EAP,Custom 27000775,,Tray Thoracentesis Dispos,$235.00,$0.00,$235.00,$0.00,$167.72,$0.00,$0.00,$167.72,$167.72,$0.00,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000776,EAP,Custom 27000776,,Central Line Dressing Tray With Biopatch,$47.00,$0.00,$47.00,$0.00,$33.54,$0.00,$0.00,$33.54,$33.54,$0.00,$47.00,$0.00,$23.50,$37.22,$37.60,$0.00,$0.00,$0.00,$0.00,$0.00
27000781,EAP,Custom 27000781,,"Suture, Silk, 0",$15.00,$0.00,$15.00,$0.00,$10.71,$0.00,$0.00,$10.71,$10.71,$0.00,$15.00,$0.00,$7.50,$11.88,$12.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000784,EAP,Custom 27000784,,3ml Posiflush Saline Syringe,$40.00,$0.00,$40.00,$0.00,$28.55,$0.00,$0.00,$28.55,$28.55,$0.00,$40.00,$0.00,$20.00,$31.68,$32.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000787,EAP,Custom 27000787,,Sleeve Knee Regular Dvt,$388.00,$0.00,$388.00,$0.00,$276.92,$0.00,$0.00,$276.92,$276.92,$0.00,$388.00,$0.00,$194.00,$307.30,$310.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000788,EAP,Custom 27000788,,Sleeve Knee X-ray Dvt,$469.00,$0.00,$469.00,$0.00,$334.73,$0.00,$0.00,$334.73,$334.73,$0.00,$469.00,$0.00,$234.50,$371.45,$375.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000789,EAP,Custom 27000789,,Sleeve Thigh Regular Dvt,$553.00,$0.00,$553.00,$0.00,$394.68,$0.00,$0.00,$394.68,$394.68,$0.00,$553.00,$0.00,$276.50,$437.98,$442.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000790,EAP,Custom 27000790,,Sleeve Thigh X-large Dvt,$284.00,$0.00,$284.00,$0.00,$202.69,$0.00,$0.00,$202.69,$202.69,$0.00,$284.00,$0.00,$142.00,$224.93,$227.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000791,EAP,Custom 27000791,,First Step Select Overlay,$131.00,$0.00,$131.00,$0.00,$93.49,$0.00,$0.00,$93.49,$93.49,$0.00,$131.00,$0.00,$65.50,$103.75,$104.80,$0.00,$0.00,$0.00,$0.00,$0.00
27000792,EAP,Custom 27000792,,Telemetry Med Supplies,$150.00,$0.00,$150.00,$0.00,$107.06,$0.00,$0.00,$107.06,$107.06,$0.00,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000793,EAP,Custom 27000793,,Med/surg Isolation Supplies,$281.00,$0.00,$281.00,$0.00,$200.55,$0.00,$0.00,$200.55,$200.55,$0.00,$281.00,$0.00,$140.50,$222.55,$224.80,$0.00,$0.00,$0.00,$0.00,$0.00
27000803,EAP,Custom 27000803,,Dialysis Filter,$699.00,$0.00,$699.00,$0.00,$498.88,$0.00,$0.00,$498.88,$498.88,$0.00,$699.00,$0.00,$349.50,$553.61,$559.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000810,EAP,Custom 27000810,,Needle Spinal 18ga,$16.00,$0.00,$16.00,$0.00,$11.42,$0.00,$0.00,$11.42,$11.42,$0.00,$16.00,$0.00,$8.00,$12.67,$12.80,$0.00,$0.00,$0.00,$0.00,$0.00
27000811,EAP,Custom 27000811,,Needle Spinal Sterile 20g,$10.00,$0.00,$10.00,$0.00,$7.14,$0.00,$0.00,$7.14,$7.14,$0.00,$10.00,$0.00,$5.00,$7.92,$8.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000815,EAP,Custom 27000815,,Catheter  Thoracic 28fr,$43.00,$0.00,$43.00,$0.00,$30.69,$0.00,$0.00,$30.69,$30.69,$0.00,$43.00,$0.00,$21.50,$34.06,$34.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000816,EAP,Custom 27000816,,Catheter Thoracic 32fr,$43.00,$0.00,$43.00,$0.00,$30.69,$0.00,$0.00,$30.69,$30.69,$0.00,$43.00,$0.00,$21.50,$34.06,$34.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000817,EAP,Custom 27000817,,Catheter Thoracic 36fr,$43.00,$0.00,$43.00,$0.00,$30.69,$0.00,$0.00,$30.69,$30.69,$0.00,$43.00,$0.00,$21.50,$34.06,$34.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000818,EAP,HCPCS C1729,,Catheter Foley 30cc 28fr,$39.00,$0.00,$39.00,$21.18,$27.83,$0.00,$6.72,$27.83,$27.83,$6.83,$39.00,$0.00,$19.50,$30.89,$31.20,$0.00,$6.10,$0.00,$6.21,$0.00
27000819,EAP,Custom 27000819,,Artery Arterial Catheriza,$109.00,$0.00,$109.00,$0.00,$77.79,$0.00,$0.00,$77.79,$77.79,$0.00,$109.00,$0.00,$54.50,$86.33,$87.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000820,EAP,Custom 27000820,,Artery Radial Catherizati,$69.00,$0.00,$69.00,$0.00,$49.25,$0.00,$0.00,$49.25,$49.25,$0.00,$69.00,$0.00,$34.50,$54.65,$55.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000821,EAP,Custom 27000821,,Tube Salem Silicone Size,$38.00,$0.00,$38.00,$0.00,$27.12,$0.00,$0.00,$27.12,$27.12,$0.00,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000822,EAP,Custom 27000822,,Tubes Salem Sump 48 Leng,$38.00,$0.00,$38.00,$0.00,$27.12,$0.00,$0.00,$27.12,$27.12,$0.00,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000826,EAP,Custom 27000826,,Tray Catheter Insrtn Dulm,$434.00,$0.00,$434.00,$0.00,$309.75,$0.00,$0.00,$309.75,$309.75,$0.00,$434.00,$0.00,$217.00,$343.73,$347.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000828,EAP,Custom 27000828,,Catheter Peritoneal Adult,$210.00,$0.00,$210.00,$0.00,$149.88,$0.00,$0.00,$149.88,$149.88,$0.00,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000829,EAP,Custom 27000829,,Triconnector With Valve,$39.00,$0.00,$39.00,$0.00,$27.83,$0.00,$0.00,$27.83,$27.83,$0.00,$39.00,$0.00,$19.50,$30.89,$31.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000830,EAP,Custom 27000830,,Set Blood Administration,$34.00,$0.00,$34.00,$0.00,$24.27,$0.00,$0.00,$24.27,$24.27,$0.00,$34.00,$0.00,$17.00,$26.93,$27.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000834,EAP,Custom 27000834,,Kit L.f. Trach Care,$237.00,$0.00,$237.00,$0.00,$169.15,$0.00,$0.00,$169.15,$169.15,$0.00,$237.00,$0.00,$118.50,$187.70,$189.60,$0.00,$0.00,$0.00,$0.00,$0.00
27000836,EAP,Custom 27000836,,Kit Thoracotomy,$217.00,$0.00,$217.00,$0.00,$154.87,$0.00,$0.00,$154.87,$154.87,$0.00,$217.00,$0.00,$108.50,$171.86,$173.60,$0.00,$0.00,$0.00,$0.00,$0.00
27000841,EAP,Custom 27000841,,Pouch Fecal Incontinence,$52.00,$0.00,$52.00,$0.00,$37.11,$0.00,$0.00,$37.11,$37.11,$0.00,$52.00,$0.00,$26.00,$41.18,$41.60,$0.00,$0.00,$0.00,$0.00,$0.00
27000842,EAP,Custom 27000842,,Kit Pressure Monitoring T,$177.00,$0.00,$177.00,$0.00,$126.32,$0.00,$0.00,$126.32,$126.32,$0.00,$177.00,$0.00,$88.50,$140.18,$141.60,$0.00,$0.00,$0.00,$0.00,$0.00
27000843,EAP,Custom 27000843,,Kit Transducer Monitoring,$339.00,$0.00,$339.00,$0.00,$241.94,$0.00,$0.00,$241.94,$241.94,$0.00,$339.00,$0.00,$169.50,$268.49,$271.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000844,EAP,Custom 27000844,,Kit  Pressure Monitoring,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$178.43,$178.43,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000846,EAP,Custom 27000846,,Bag 1000ml Pump Set,$39.00,$0.00,$39.00,$0.00,$27.83,$0.00,$0.00,$27.83,$27.83,$0.00,$39.00,$0.00,$19.50,$30.89,$31.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000847,EAP,Custom 27000847,,Kit Pecutaneous Introduce,$298.00,$0.00,$298.00,$0.00,$212.68,$0.00,$0.00,$212.68,$212.68,$0.00,$298.00,$0.00,$149.00,$236.02,$238.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000848,EAP,Custom 27000848,,Chest Unit Drainage Pleur,$420.00,$0.00,$420.00,$0.00,$299.75,$0.00,$0.00,$299.75,$299.75,$0.00,$420.00,$0.00,$210.00,$332.64,$336.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000849,EAP,Custom 27000849,,Chest Unit Dry Suction Sy,$316.00,$0.00,$316.00,$0.00,$225.53,$0.00,$0.00,$225.53,$225.53,$0.00,$316.00,$0.00,$158.00,$250.27,$252.80,$0.00,$0.00,$0.00,$0.00,$0.00
27000854,EAP,Custom 27000854,,Trac Dressing Xl,$70.00,$0.00,$70.00,$0.00,$49.96,$0.00,$0.00,$49.96,$49.96,$0.00,$70.00,$0.00,$35.00,$55.44,$56.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000857,EAP,Custom 27000857,,Tube Feeding Ng 8fr 36in Entr,$65.00,$0.00,$65.00,$0.00,$46.39,$0.00,$0.00,$46.39,$46.39,$0.00,$65.00,$0.00,$32.50,$51.48,$52.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000858,EAP,Custom 27000858,,Kit Triple Lumen Catheter,$697.00,$0.00,$697.00,$0.00,$497.45,$0.00,$0.00,$497.45,$497.45,$0.00,$697.00,$0.00,$348.50,$552.02,$557.60,$0.00,$0.00,$0.00,$0.00,$0.00
27000859,EAP,Custom 27000859,,Catheter Swan Ganz,$726.00,$0.00,$726.00,$0.00,$518.15,$0.00,$0.00,$518.15,$518.15,$0.00,$726.00,$0.00,$363.00,$574.99,$580.80,$0.00,$0.00,$0.00,$0.00,$0.00
27000860,EAP,Custom 27000860,,Delivery System Closed In,$152.00,$0.00,$152.00,$0.00,$108.48,$0.00,$0.00,$108.48,$108.48,$0.00,$152.00,$0.00,$76.00,$120.38,$121.60,$0.00,$0.00,$0.00,$0.00,$0.00
27000866,EAP,Custom 27000866,,Tray Foley Perconnected 1,$59.00,$0.00,$59.00,$0.00,$42.11,$0.00,$0.00,$42.11,$42.11,$0.00,$59.00,$0.00,$29.50,$46.73,$47.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000868,EAP,Custom 27000868,,Tray Urine Meter 18fr,$94.00,$0.00,$94.00,$0.00,$67.09,$0.00,$0.00,$67.09,$67.09,$0.00,$94.00,$0.00,$47.00,$74.45,$75.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000869,EAP,Custom 27000869,,Kit Ventriculostomy,$763.00,$0.00,$763.00,$0.00,$544.55,$0.00,$0.00,$544.55,$544.55,$0.00,$763.00,$0.00,$381.50,$604.30,$610.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000870,EAP,Custom 27000870,,Tray Thoracentesis Dispos,$101.00,$0.00,$101.00,$0.00,$72.08,$0.00,$0.00,$72.08,$72.08,$0.00,$101.00,$0.00,$50.50,$79.99,$80.80,$0.00,$0.00,$0.00,$0.00,$0.00
27000872,EAP,Custom 27000872,,Central Line Dressing Tray With Biopatch,$47.00,$0.00,$47.00,$0.00,$33.54,$0.00,$0.00,$33.54,$33.54,$0.00,$47.00,$0.00,$23.50,$37.22,$37.60,$0.00,$0.00,$0.00,$0.00,$0.00
27000880,EAP,Custom 27000880,,Femoral Arterial Line Kit,$178.00,$0.00,$178.00,$0.00,$127.04,$0.00,$0.00,$127.04,$127.04,$0.00,$178.00,$0.00,$89.00,$140.98,$142.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000881,EAP,Custom 27000881,,Sleeve Knee Regular Dvt,$388.00,$0.00,$388.00,$0.00,$276.92,$0.00,$0.00,$276.92,$276.92,$0.00,$388.00,$0.00,$194.00,$307.30,$310.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000882,EAP,Custom 27000882,,Sleeve Knee X-large Dvt,$469.00,$0.00,$469.00,$0.00,$334.73,$0.00,$0.00,$334.73,$334.73,$0.00,$469.00,$0.00,$234.50,$371.45,$375.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000883,EAP,Custom 27000883,,Sleeve Thigh Regular Dvt,$553.00,$0.00,$553.00,$0.00,$394.68,$0.00,$0.00,$394.68,$394.68,$0.00,$553.00,$0.00,$276.50,$437.98,$442.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000884,EAP,Custom 27000884,,Sleeve Thigh X-large Dvt,$284.00,$0.00,$284.00,$0.00,$202.69,$0.00,$0.00,$202.69,$202.69,$0.00,$284.00,$0.00,$142.00,$224.93,$227.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000886,EAP,Custom 27000886,,Med/surg Isolation Supplies,$281.00,$0.00,$281.00,$0.00,$200.55,$0.00,$0.00,$200.55,$200.55,$0.00,$281.00,$0.00,$140.50,$222.55,$224.80,$0.00,$0.00,$0.00,$0.00,$0.00
27000887,EAP,Custom 27000887,,Med/pri Supplies,$64.00,$0.00,$64.00,$0.00,$45.68,$0.00,$0.00,$45.68,$45.68,$0.00,$64.00,$0.00,$32.00,$50.69,$51.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000888,EAP,Custom 27000888,,Med/surg Semi-supplies,$64.00,$0.00,$64.00,$0.00,$45.68,$0.00,$0.00,$45.68,$45.68,$0.00,$64.00,$0.00,$32.00,$50.69,$51.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000902,EAP,Custom 27000902,,Catheter  Thoracic 28fr,$43.00,$0.00,$43.00,$0.00,$30.69,$0.00,$0.00,$30.69,$30.69,$0.00,$43.00,$0.00,$21.50,$34.06,$34.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000903,EAP,Custom 27000903,,Catheter Thoracic 32fr,$40.00,$0.00,$40.00,$0.00,$28.55,$0.00,$0.00,$28.55,$28.55,$0.00,$40.00,$0.00,$20.00,$31.68,$32.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000904,EAP,Custom 27000904,,Catheter Thoracic 36fr,$43.00,$0.00,$43.00,$0.00,$30.69,$0.00,$0.00,$30.69,$30.69,$0.00,$43.00,$0.00,$21.50,$34.06,$34.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000905,EAP,HCPCS C1729,,Catheter Foley 16fr,$18.00,$0.00,$18.00,$9.77,$12.85,$0.00,$3.10,$12.85,$12.85,$3.15,$18.00,$0.00,$9.00,$14.26,$14.40,$0.00,$2.82,$0.00,$2.87,$0.00
27000906,EAP,HCPCS C1729,,Catheter Coude Size 14fr,$109.00,$0.00,$109.00,$59.19,$77.79,$0.00,$18.78,$77.79,$77.79,$19.09,$109.00,$0.00,$54.50,$86.33,$87.20,$0.00,$17.06,$0.00,$17.35,$0.00
27000907,EAP,HCPCS C1729,,Catheter Coude Size 16fr,$109.00,$0.00,$109.00,$59.19,$77.79,$0.00,$18.78,$77.79,$77.79,$19.09,$109.00,$0.00,$54.50,$86.33,$87.20,$0.00,$17.06,$0.00,$17.35,$0.00
27000908,EAP,Custom 27000908,,Artery Arterial Catheriza,$109.00,$0.00,$109.00,$0.00,$77.79,$0.00,$0.00,$77.79,$77.79,$0.00,$109.00,$0.00,$54.50,$86.33,$87.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000909,EAP,Custom 27000909,,Artery Radial Catherizati,$69.00,$0.00,$69.00,$0.00,$49.25,$0.00,$0.00,$49.25,$49.25,$0.00,$69.00,$0.00,$34.50,$54.65,$55.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000910,EAP,Custom 27000910,,Tube Salem Sump 48 Lengt,$38.00,$0.00,$38.00,$0.00,$27.12,$0.00,$0.00,$27.12,$27.12,$0.00,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000911,EAP,Custom 27000911,,Tube Salem Silicone Size,$38.00,$0.00,$38.00,$0.00,$27.12,$0.00,$0.00,$27.12,$27.12,$0.00,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000912,EAP,Custom 27000912,,Tubes Salem Sump 48 Leng,$16.00,$0.00,$16.00,$0.00,$11.42,$0.00,$0.00,$11.42,$11.42,$0.00,$16.00,$0.00,$8.00,$12.67,$12.80,$0.00,$0.00,$0.00,$0.00,$0.00
27000915,EAP,Custom 27000915,,Tray Catheter Insrtn Dulm,$937.00,$0.00,$937.00,$0.00,$668.74,$0.00,$0.00,$668.74,$668.74,$0.00,$937.00,$0.00,$468.50,$742.10,$749.60,$0.00,$0.00,$0.00,$0.00,$0.00
27000916,EAP,Custom 27000916,,Scaple Surg W/handle Atta,$142.00,$0.00,$142.00,$0.00,$101.35,$0.00,$0.00,$101.35,$101.35,$0.00,$142.00,$0.00,$71.00,$112.46,$113.60,$0.00,$0.00,$0.00,$0.00,$0.00
27000918,EAP,Custom 27000918,,Triconnector With Valve,$39.00,$0.00,$39.00,$0.00,$27.83,$0.00,$0.00,$27.83,$27.83,$0.00,$39.00,$0.00,$19.50,$30.89,$31.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000922,EAP,Custom 27000922,,Pouch Active Life Squib Drain,$17.00,$0.00,$17.00,$0.00,$12.13,$0.00,$0.00,$12.13,$12.13,$0.00,$17.00,$0.00,$8.50,$13.46,$13.60,$0.00,$0.00,$0.00,$0.00,$0.00
27000926,EAP,Custom 27000926,,Kit Thoracotomy,$210.00,$0.00,$210.00,$0.00,$149.88,$0.00,$0.00,$149.88,$149.88,$0.00,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000931,EAP,Custom 27000931,,Pouch Fecal Incontinence,$52.00,$0.00,$52.00,$0.00,$37.11,$0.00,$0.00,$37.11,$37.11,$0.00,$52.00,$0.00,$26.00,$41.18,$41.60,$0.00,$0.00,$0.00,$0.00,$0.00
27000932,EAP,Custom 27000932,,Kit Pressure Monitoring T,$177.00,$0.00,$177.00,$0.00,$126.32,$0.00,$0.00,$126.32,$126.32,$0.00,$177.00,$0.00,$88.50,$140.18,$141.60,$0.00,$0.00,$0.00,$0.00,$0.00
27000933,EAP,Custom 27000933,,Kit  Pressure Monitoring,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$178.43,$178.43,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000934,EAP,Custom 27000934,,Bag 1000ml Pump Set,$39.00,$0.00,$39.00,$0.00,$27.83,$0.00,$0.00,$27.83,$27.83,$0.00,$39.00,$0.00,$19.50,$30.89,$31.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000935,EAP,Custom 27000935,,Needle Port-cath 20ga X 1,$16.00,$0.00,$16.00,$0.00,$11.42,$0.00,$0.00,$11.42,$11.42,$0.00,$16.00,$0.00,$8.00,$12.67,$12.80,$0.00,$0.00,$0.00,$0.00,$0.00
27000936,EAP,Custom 27000936,,Chest Unit Drainage Pleur,$455.00,$0.00,$455.00,$0.00,$324.73,$0.00,$0.00,$324.73,$324.73,$0.00,$455.00,$0.00,$227.50,$360.36,$364.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000941,EAP,Custom 27000941,,Dressing X-large,$321.00,$0.00,$321.00,$0.00,$229.10,$0.00,$0.00,$229.10,$229.10,$0.00,$321.00,$0.00,$160.50,$254.23,$256.80,$0.00,$0.00,$0.00,$0.00,$0.00
27000942,EAP,Custom 27000942,,Trac Dressing Xl,$157.00,$0.00,$157.00,$0.00,$112.05,$0.00,$0.00,$112.05,$112.05,$0.00,$157.00,$0.00,$78.50,$124.34,$125.60,$0.00,$0.00,$0.00,$0.00,$0.00
27000945,EAP,Custom 27000945,,Tube Feeding Ng 8fr 36in Entri,$65.00,$0.00,$65.00,$0.00,$46.39,$0.00,$0.00,$46.39,$46.39,$0.00,$65.00,$0.00,$32.50,$51.48,$52.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000946,EAP,Custom 27000946,,Kit Triple Lumen Catheter,$697.00,$0.00,$697.00,$0.00,$497.45,$0.00,$0.00,$497.45,$497.45,$0.00,$697.00,$0.00,$348.50,$552.02,$557.60,$0.00,$0.00,$0.00,$0.00,$0.00
27000949,EAP,Custom 27000949,,Filter Set 0.22 Micron,$20.00,$0.00,$20.00,$0.00,$14.27,$0.00,$0.00,$14.27,$14.27,$0.00,$20.00,$0.00,$10.00,$15.84,$16.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000951,EAP,Custom 27000951,,Tray Foley Preconnected 1,$59.00,$0.00,$59.00,$0.00,$42.11,$0.00,$0.00,$42.11,$42.11,$0.00,$59.00,$0.00,$29.50,$46.73,$47.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000952,EAP,Custom 27000952,,Tray Foley Perconnected 1,$59.00,$0.00,$59.00,$0.00,$42.11,$0.00,$0.00,$42.11,$42.11,$0.00,$59.00,$0.00,$29.50,$46.73,$47.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000953,EAP,Custom 27000953,,Tray Thoracentesis Dispos,$235.00,$0.00,$235.00,$0.00,$167.72,$0.00,$0.00,$167.72,$167.72,$0.00,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000955,EAP,Custom 27000955,,Central Line Dressing Tray With Biopatch,$47.00,$0.00,$47.00,$0.00,$33.54,$0.00,$0.00,$33.54,$33.54,$0.00,$47.00,$0.00,$23.50,$37.22,$37.60,$0.00,$0.00,$0.00,$0.00,$0.00
27000962,EAP,Custom 27000962,,Sleeve Knee Regular Dvt,$370.00,$0.00,$370.00,$0.00,$264.07,$0.00,$0.00,$264.07,$264.07,$0.00,$370.00,$0.00,$185.00,$293.04,$296.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000963,EAP,Custom 27000963,,Sleeve Knee X-large Dvt,$450.00,$0.00,$450.00,$0.00,$321.17,$0.00,$0.00,$321.17,$321.17,$0.00,$450.00,$0.00,$225.00,$356.40,$360.00,$0.00,$0.00,$0.00,$0.00,$0.00
27000964,EAP,Custom 27000964,,Sleeve Thigh Regular Dvt,$529.00,$0.00,$529.00,$0.00,$377.55,$0.00,$0.00,$377.55,$377.55,$0.00,$529.00,$0.00,$264.50,$418.97,$423.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000965,EAP,Custom 27000965,,Sleeve Thigh X-large Dvt,$488.00,$0.00,$488.00,$0.00,$348.29,$0.00,$0.00,$348.29,$348.29,$0.00,$488.00,$0.00,$244.00,$386.50,$390.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000968,EAP,Custom 27000968,,Dialysis Fluid Bag,$166.00,$0.00,$166.00,$0.00,$118.47,$0.00,$0.00,$118.47,$118.47,$0.00,$166.00,$0.00,$83.00,$131.47,$132.80,$0.00,$0.00,$0.00,$0.00,$0.00
27000969,EAP,Custom 27000969,,Dialysis Filter,$699.00,$0.00,$699.00,$0.00,$498.88,$0.00,$0.00,$498.88,$498.88,$0.00,$699.00,$0.00,$349.50,$553.61,$559.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000975,EAP,Custom 27000975,,Ioban 2 Drape Incise Smal,$43.00,$0.00,$43.00,$0.00,$30.69,$0.00,$0.00,$30.69,$30.69,$0.00,$43.00,$0.00,$21.50,$34.06,$34.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000977,EAP,Custom 27000977,,Ioban 2 Drape Incise Larg,$462.00,$0.00,$462.00,$0.00,$329.73,$0.00,$0.00,$329.73,$329.73,$0.00,$462.00,$0.00,$231.00,$365.90,$369.60,$0.00,$0.00,$0.00,$0.00,$0.00
27000978,EAP,Custom 27000978,,Needle Spinal 18ga,$16.00,$0.00,$16.00,$0.00,$11.42,$0.00,$0.00,$11.42,$11.42,$0.00,$16.00,$0.00,$8.00,$12.67,$12.80,$0.00,$0.00,$0.00,$0.00,$0.00
27000982,EAP,Custom 27000982,,Catheter Thoracic 32fr,$43.00,$0.00,$43.00,$0.00,$30.69,$0.00,$0.00,$30.69,$30.69,$0.00,$43.00,$0.00,$21.50,$34.06,$34.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000983,EAP,Custom 27000983,,Catheter Thoracic 36fr,$43.00,$0.00,$43.00,$0.00,$30.69,$0.00,$0.00,$30.69,$30.69,$0.00,$43.00,$0.00,$21.50,$34.06,$34.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000984,EAP,Custom 27000984,,Catheter Urethral Two-eye,$7.00,$0.00,$7.00,$0.00,$5.00,$0.00,$0.00,$5.00,$5.00,$0.00,$7.00,$0.00,$3.50,$5.54,$5.60,$0.00,$0.00,$0.00,$0.00,$0.00
27000985,EAP,HCPCS C1729,,Catheter Foley 5cc 14fr,$19.00,$0.00,$19.00,$10.32,$13.56,$0.00,$3.27,$13.56,$13.56,$3.33,$19.00,$0.00,$9.50,$15.05,$15.20,$0.00,$2.97,$0.00,$3.02,$0.00
27000986,EAP,HCPCS C1729,,Catheter Foley 16fr,$18.00,$0.00,$18.00,$9.77,$12.85,$0.00,$3.10,$12.85,$12.85,$3.15,$18.00,$0.00,$9.00,$14.26,$14.40,$0.00,$2.82,$0.00,$2.87,$0.00
27000987,EAP,HCPCS C1729,,Catheter Foley 5cc 18fr,$19.00,$0.00,$19.00,$10.32,$13.56,$0.00,$3.27,$13.56,$13.56,$3.33,$19.00,$0.00,$9.50,$15.05,$15.20,$0.00,$2.97,$0.00,$3.02,$0.00
27000988,EAP,HCPCS C1729,,Catheter Foley 3-way 30cc,$37.00,$0.00,$37.00,$20.09,$26.41,$0.00,$6.37,$26.41,$26.41,$6.48,$37.00,$0.00,$18.50,$29.30,$29.60,$0.00,$5.79,$0.00,$5.89,$0.00
27000989,EAP,Custom 27000989,,Catheter Ventricular 20cm,$313.00,$0.00,$313.00,$0.00,$223.39,$0.00,$0.00,$223.39,$223.39,$0.00,$313.00,$0.00,$156.50,$247.90,$250.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000990,EAP,Custom 27000990,,Catheter Edm Ii Becker,$617.00,$0.00,$617.00,$0.00,$440.35,$0.00,$0.00,$440.35,$440.35,$0.00,$617.00,$0.00,$308.50,$488.66,$493.60,$0.00,$0.00,$0.00,$0.00,$0.00
27000991,EAP,Custom 27000991,,Artery Arterial Catheriza,$109.00,$0.00,$109.00,$0.00,$77.79,$0.00,$0.00,$77.79,$77.79,$0.00,$109.00,$0.00,$54.50,$86.33,$87.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000992,EAP,Custom 27000992,,Artery Radial Catherizati,$69.00,$0.00,$69.00,$0.00,$49.25,$0.00,$0.00,$49.25,$49.25,$0.00,$69.00,$0.00,$34.50,$54.65,$55.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000993,EAP,Custom 27000993,,Tube Salem Sump 48 Lengt,$38.00,$0.00,$38.00,$0.00,$27.12,$0.00,$0.00,$27.12,$27.12,$0.00,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000994,EAP,Custom 27000994,,Tube Salem Silicone Size,$38.00,$0.00,$38.00,$0.00,$27.12,$0.00,$0.00,$27.12,$27.12,$0.00,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000995,EAP,Custom 27000995,,Tubes Salem Sump 48 Leng,$38.00,$0.00,$38.00,$0.00,$27.12,$0.00,$0.00,$27.12,$27.12,$0.00,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
27000996,EAP,Custom 27000996,,Kit Percuatane Trache 7fr,"$1,219.00",$0.00,"$1,219.00",$0.00,$870.00,$0.00,$0.00,$870.00,$870.00,$0.00,"$1,219.00",$0.00,$609.50,$965.45,$975.20,$0.00,$0.00,$0.00,$0.00,$0.00
27000997,EAP,Custom 27000997,,Kit Percuatane Trache 8fr,"$1,424.00",$0.00,"$1,424.00",$0.00,"$1,016.31",$0.00,$0.00,"$1,016.31","$1,016.31",$0.00,"$1,424.00",$0.00,$712.00,"$1,127.81","$1,139.20",$0.00,$0.00,$0.00,$0.00,$0.00
27000998,EAP,Custom 27000998,,Kit Tracheotomy Care Ster,$65.00,$0.00,$65.00,$0.00,$46.39,$0.00,$0.00,$46.39,$46.39,$0.00,$65.00,$0.00,$32.50,$51.48,$52.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001001,EAP,Custom 27001001,,Bag Drainage Becker,$213.00,$0.00,$213.00,$0.00,$152.02,$0.00,$0.00,$152.02,$152.02,$0.00,$213.00,$0.00,$106.50,$168.70,$170.40,$0.00,$0.00,$0.00,$0.00,$0.00
27001002,EAP,Custom 27001002,,Tray Catheter Insrtn Dulm,$937.00,$0.00,$937.00,$0.00,$668.74,$0.00,$0.00,$668.74,$668.74,$0.00,$937.00,$0.00,$468.50,$742.10,$749.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001006,EAP,Custom 27001006,,Scapel Surg W/handle Atta,$142.00,$0.00,$142.00,$0.00,$101.35,$0.00,$0.00,$101.35,$101.35,$0.00,$142.00,$0.00,$71.00,$112.46,$113.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001007,EAP,Custom 27001007,,Scaple Surg W/handle Atta,$152.00,$0.00,$152.00,$0.00,$108.48,$0.00,$0.00,$108.48,$108.48,$0.00,$152.00,$0.00,$76.00,$120.38,$121.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001009,EAP,Custom 27001009,,Triconnector With Valve,$38.00,$0.00,$38.00,$0.00,$27.12,$0.00,$0.00,$27.12,$27.12,$0.00,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
27001012,EAP,Custom 27001012,,Cream Baza 5oz,$63.00,$0.00,$63.00,$0.00,$44.96,$0.00,$0.00,$44.96,$44.96,$0.00,$63.00,$0.00,$31.50,$49.90,$50.40,$0.00,$0.00,$0.00,$0.00,$0.00
27001016,EAP,Custom 27001016,,Valve Anti-reflux Salem S,$49.00,$0.00,$49.00,$0.00,$34.97,$0.00,$0.00,$34.97,$34.97,$0.00,$49.00,$0.00,$24.50,$38.81,$39.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001017,EAP,Custom 27001017,,Kit L.f. Trach Care,$237.00,$0.00,$237.00,$0.00,$169.15,$0.00,$0.00,$169.15,$169.15,$0.00,$237.00,$0.00,$118.50,$187.70,$189.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001019,EAP,Custom 27001019,,Kit Thoracotomy,$217.00,$0.00,$217.00,$0.00,$154.87,$0.00,$0.00,$154.87,$154.87,$0.00,$217.00,$0.00,$108.50,$171.86,$173.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001025,EAP,Custom 27001025,,Pouch Fecal Incontinence,$52.00,$0.00,$52.00,$0.00,$37.11,$0.00,$0.00,$37.11,$37.11,$0.00,$52.00,$0.00,$26.00,$41.18,$41.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001026,EAP,Custom 27001026,,Kit Pressure Monitoring T,$177.00,$0.00,$177.00,$0.00,$126.32,$0.00,$0.00,$126.32,$126.32,$0.00,$177.00,$0.00,$88.50,$140.18,$141.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001027,EAP,Custom 27001027,,Transducer  Disp For Icp,$79.00,$0.00,$79.00,$0.00,$56.38,$0.00,$0.00,$56.38,$56.38,$0.00,$79.00,$0.00,$39.50,$62.57,$63.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001028,EAP,Custom 27001028,,Kit Transducer Monitoring,$339.00,$0.00,$339.00,$0.00,$241.94,$0.00,$0.00,$241.94,$241.94,$0.00,$339.00,$0.00,$169.50,$268.49,$271.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001029,EAP,Custom 27001029,,Kit  Pressure Monitoring,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$178.43,$178.43,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001031,EAP,Custom 27001031,,Bag 1000ml Pump Set,$39.00,$0.00,$39.00,$0.00,$27.83,$0.00,$0.00,$27.83,$27.83,$0.00,$39.00,$0.00,$19.50,$30.89,$31.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001032,EAP,Custom 27001032,,Kit Pecutaneous Introduce,$298.00,$0.00,$298.00,$0.00,$212.68,$0.00,$0.00,$212.68,$212.68,$0.00,$298.00,$0.00,$149.00,$236.02,$238.40,$0.00,$0.00,$0.00,$0.00,$0.00
27001033,EAP,Custom 27001033,,Chest Unit Drainage Pleur,$455.00,$0.00,$455.00,$0.00,$324.73,$0.00,$0.00,$324.73,$324.73,$0.00,$455.00,$0.00,$227.50,$360.36,$364.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001034,EAP,Custom 27001034,,Chest Unit Dry Suction Sy,$333.00,$0.00,$333.00,$0.00,$237.66,$0.00,$0.00,$237.66,$237.66,$0.00,$333.00,$0.00,$166.50,$263.74,$266.40,$0.00,$0.00,$0.00,$0.00,$0.00
27001035,EAP,Custom 27001035,,Bag  Auto-transfusion Ple,$245.00,$0.00,$245.00,$0.00,$174.86,$0.00,$0.00,$174.86,$174.86,$0.00,$245.00,$0.00,$122.50,$194.04,$196.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001040,EAP,Custom 27001040,,Dressing X-large,$682.00,$0.00,$682.00,$0.00,$486.74,$0.00,$0.00,$486.74,$486.74,$0.00,$682.00,$0.00,$341.00,$540.14,$545.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001041,EAP,Custom 27001041,,Trac Dressing Xl,$170.00,$0.00,$170.00,$0.00,$121.33,$0.00,$0.00,$121.33,$121.33,$0.00,$170.00,$0.00,$85.00,$134.64,$136.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001044,EAP,Custom 27001044,,Tube Feeding Ng 8fr 36in Entr,$65.00,$0.00,$65.00,$0.00,$46.39,$0.00,$0.00,$46.39,$46.39,$0.00,$65.00,$0.00,$32.50,$51.48,$52.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001045,EAP,Custom 27001045,,Kit Triple Lumen Catheter,$697.00,$0.00,$697.00,$0.00,$497.45,$0.00,$0.00,$497.45,$497.45,$0.00,$697.00,$0.00,$348.50,$552.02,$557.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001046,EAP,Custom 27001046,,Wire Guide Dual Purpose,$362.00,$0.00,$362.00,$0.00,$258.36,$0.00,$0.00,$258.36,$258.36,$0.00,$362.00,$0.00,$181.00,$286.70,$289.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001047,EAP,Custom 27001047,,Kit Monitoring Intracrani,$426.00,$0.00,$426.00,$0.00,$304.04,$0.00,$0.00,$304.04,$304.04,$0.00,$426.00,$0.00,$213.00,$337.39,$340.80,$0.00,$0.00,$0.00,$0.00,$0.00
27001048,EAP,Custom 27001048,,Cath  Trauma Ventricular,$438.00,$0.00,$438.00,$0.00,$312.60,$0.00,$0.00,$312.60,$312.60,$0.00,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$0.00,$0.00,$0.00,$0.00
27001049,EAP,Custom 27001049,,Catheter Swan Ganz,$309.00,$0.00,$309.00,$0.00,$220.53,$0.00,$0.00,$220.53,$220.53,$0.00,$309.00,$0.00,$154.50,$244.73,$247.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001050,EAP,Custom 27001050,,Delivery System Closed In,$152.00,$0.00,$152.00,$0.00,$108.48,$0.00,$0.00,$108.48,$108.48,$0.00,$152.00,$0.00,$76.00,$120.38,$121.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001051,EAP,Custom 27001051,,Probe V-pacing,"$1,277.00",$0.00,"$1,277.00",$0.00,$911.39,$0.00,$0.00,$911.39,$911.39,$0.00,"$1,277.00",$0.00,$638.50,"$1,011.38","$1,021.60",$0.00,$0.00,$0.00,$0.00,$0.00
27001055,EAP,Custom 27001055,,Filter Set 0.22 Micron,$20.00,$0.00,$20.00,$0.00,$14.27,$0.00,$0.00,$14.27,$14.27,$0.00,$20.00,$0.00,$10.00,$15.84,$16.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001057,EAP,Custom 27001057,,Tray Foley Preconnected 1,$52.00,$0.00,$52.00,$0.00,$37.11,$0.00,$0.00,$37.11,$37.11,$0.00,$52.00,$0.00,$26.00,$41.18,$41.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001058,EAP,Custom 27001058,,Tray Foley Perconnected 1,$59.00,$0.00,$59.00,$0.00,$42.11,$0.00,$0.00,$42.11,$42.11,$0.00,$59.00,$0.00,$29.50,$46.73,$47.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001060,EAP,Custom 27001060,,Tray Urine Meter 18fr,$94.00,$0.00,$94.00,$0.00,$67.09,$0.00,$0.00,$67.09,$67.09,$0.00,$94.00,$0.00,$47.00,$74.45,$75.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001061,EAP,Custom 27001061,,Kit Ventriculostomy,"$1,782.00",$0.00,"$1,782.00",$0.00,"$1,271.81",$0.00,$0.00,"$1,271.81","$1,271.81",$0.00,"$1,782.00",$0.00,$891.00,"$1,411.34","$1,425.60",$0.00,$0.00,$0.00,$0.00,$0.00
27001062,EAP,Custom 27001062,,Tray Thoracentesis Dispos,$101.00,$0.00,$101.00,$0.00,$72.08,$0.00,$0.00,$72.08,$72.08,$0.00,$101.00,$0.00,$50.50,$79.99,$80.80,$0.00,$0.00,$0.00,$0.00,$0.00
27001063,EAP,Custom 27001063,,Central Line Dressing Tray With Biopatch,$47.00,$0.00,$47.00,$0.00,$33.54,$0.00,$0.00,$33.54,$33.54,$0.00,$47.00,$0.00,$23.50,$37.22,$37.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001064,EAP,Custom 27001064,,Bag Drainage Ureteral,$39.00,$0.00,$39.00,$0.00,$27.83,$0.00,$0.00,$27.83,$27.83,$0.00,$39.00,$0.00,$19.50,$30.89,$31.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001078,EAP,Custom 27001078,,Femoral Arterial Line Kit,$172.00,$0.00,$172.00,$0.00,$122.76,$0.00,$0.00,$122.76,$122.76,$0.00,$172.00,$0.00,$86.00,$136.22,$137.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001079,EAP,Custom 27001079,,Kit Percutane Trache 9fr,"$3,007.00",$0.00,"$3,007.00",$0.00,"$2,146.10",$0.00,$0.00,"$2,146.10","$2,146.10",$0.00,"$3,007.00",$0.00,"$1,503.50","$2,381.54","$2,405.60",$0.00,$0.00,$0.00,$0.00,$0.00
27001081,EAP,Custom 27001081,,Cath Cco Swan Ganz 8fr,"$2,182.00",$0.00,"$2,182.00",$0.00,"$1,557.29",$0.00,$0.00,"$1,557.29","$1,557.29",$0.00,"$2,182.00",$0.00,"$1,091.00","$1,728.14","$1,745.60",$0.00,$0.00,$0.00,$0.00,$0.00
27001082,EAP,Custom 27001082,,Sleeve Knee Regular Dvt,$388.00,$0.00,$388.00,$0.00,$276.92,$0.00,$0.00,$276.92,$276.92,$0.00,$388.00,$0.00,$194.00,$307.30,$310.40,$0.00,$0.00,$0.00,$0.00,$0.00
27001083,EAP,Custom 27001083,,Sleeve Knee X-large Dvt,$469.00,$0.00,$469.00,$0.00,$334.73,$0.00,$0.00,$334.73,$334.73,$0.00,$469.00,$0.00,$234.50,$371.45,$375.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001084,EAP,Custom 27001084,,Sleeve Thigh Regular Dvt,$553.00,$0.00,$553.00,$0.00,$394.68,$0.00,$0.00,$394.68,$394.68,$0.00,$553.00,$0.00,$276.50,$437.98,$442.40,$0.00,$0.00,$0.00,$0.00,$0.00
27001085,EAP,Custom 27001085,,Sleeve Thigh X-large Dvt,$284.00,$0.00,$284.00,$0.00,$202.69,$0.00,$0.00,$202.69,$202.69,$0.00,$284.00,$0.00,$142.00,$224.93,$227.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001086,EAP,Custom 27001086,,First Step Select Overlay,$60.00,$0.00,$60.00,$0.00,$42.82,$0.00,$0.00,$42.82,$42.82,$0.00,$60.00,$0.00,$30.00,$47.52,$48.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001096,EAP,Custom 27001096,,Dialysis Filter,$300.00,$0.00,$300.00,$0.00,$214.11,$0.00,$0.00,$214.11,$214.11,$0.00,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001101,EAP,Custom 27001101,,Needle Spinal 22ga X 3-1/,$10.00,$0.00,$10.00,$0.00,$7.14,$0.00,$0.00,$7.14,$7.14,$0.00,$10.00,$0.00,$5.00,$7.92,$8.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001106,EAP,Custom 27001106,,Catheter  Thoracic 28fr,$18.00,$0.00,$18.00,$0.00,$12.85,$0.00,$0.00,$12.85,$12.85,$0.00,$18.00,$0.00,$9.00,$14.26,$14.40,$0.00,$0.00,$0.00,$0.00,$0.00
27001107,EAP,Custom 27001107,,Catheter Thoracic 32fr,$43.00,$0.00,$43.00,$0.00,$30.69,$0.00,$0.00,$30.69,$30.69,$0.00,$43.00,$0.00,$21.50,$34.06,$34.40,$0.00,$0.00,$0.00,$0.00,$0.00
27001108,EAP,Custom 27001108,,Catheter Thoracic 36fr,$43.00,$0.00,$43.00,$0.00,$30.69,$0.00,$0.00,$30.69,$30.69,$0.00,$43.00,$0.00,$21.50,$34.06,$34.40,$0.00,$0.00,$0.00,$0.00,$0.00
27001109,EAP,HCPCS C1729,,Catheter Foley 5cc 14fr,$19.00,$0.00,$19.00,$10.32,$13.56,$0.00,$3.27,$13.56,$13.56,$3.33,$19.00,$0.00,$9.50,$15.05,$15.20,$0.00,$2.97,$0.00,$3.02,$0.00
27001110,EAP,HCPCS C1729,,Catheter Foley 16fr,$18.00,$0.00,$18.00,$9.77,$12.85,$0.00,$3.10,$12.85,$12.85,$3.15,$18.00,$0.00,$9.00,$14.26,$14.40,$0.00,$2.82,$0.00,$2.87,$0.00
27001111,EAP,HCPCS C1729,,Catheter Foley 5cc 18fr,$19.00,$0.00,$19.00,$10.32,$13.56,$0.00,$3.27,$13.56,$13.56,$3.33,$19.00,$0.00,$9.50,$15.05,$15.20,$0.00,$2.97,$0.00,$3.02,$0.00
27001112,EAP,HCPCS C1729,,Catheter Foley 30cc 28fr,$39.00,$0.00,$39.00,$21.18,$27.83,$0.00,$6.72,$27.83,$27.83,$6.83,$39.00,$0.00,$19.50,$30.89,$31.20,$0.00,$6.10,$0.00,$6.21,$0.00
27001113,EAP,Custom 27001113,,Catheter Ventricular 20cm,$735.00,$0.00,$735.00,$0.00,$524.57,$0.00,$0.00,$524.57,$524.57,$0.00,$735.00,$0.00,$367.50,$582.12,$588.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001114,EAP,Custom 27001114,,Catheter Edm Ii Becker,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,"$1,027.73","$1,027.73",$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
27001115,EAP,Custom 27001115,,Tube  Feeding Ng  8fr 43in En,$65.00,$0.00,$65.00,$0.00,$46.39,$0.00,$0.00,$46.39,$46.39,$0.00,$65.00,$0.00,$32.50,$51.48,$52.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001116,EAP,Custom 27001116,,Artery Arterial Catheriza,$109.00,$0.00,$109.00,$0.00,$77.79,$0.00,$0.00,$77.79,$77.79,$0.00,$109.00,$0.00,$54.50,$86.33,$87.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001117,EAP,Custom 27001117,,Artery Radial Catherizati,$69.00,$0.00,$69.00,$0.00,$49.25,$0.00,$0.00,$49.25,$49.25,$0.00,$69.00,$0.00,$34.50,$54.65,$55.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001118,EAP,Custom 27001118,,Tube Salem Sump 48 Lengt,$38.00,$0.00,$38.00,$0.00,$27.12,$0.00,$0.00,$27.12,$27.12,$0.00,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
27001119,EAP,Custom 27001119,,Tube Salem Silicone Size,$38.00,$0.00,$38.00,$0.00,$27.12,$0.00,$0.00,$27.12,$27.12,$0.00,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
27001120,EAP,Custom 27001120,,Tubes Salem Sump 48 Leng,$38.00,$0.00,$38.00,$0.00,$27.12,$0.00,$0.00,$27.12,$27.12,$0.00,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
27001124,EAP,Custom 27001124,,Bag Drainage Becker,$213.00,$0.00,$213.00,$0.00,$152.02,$0.00,$0.00,$152.02,$152.02,$0.00,$213.00,$0.00,$106.50,$168.70,$170.40,$0.00,$0.00,$0.00,$0.00,$0.00
27001125,EAP,Custom 27001125,,Blades Surgical #10 W/o H,$10.00,$0.00,$10.00,$0.00,$7.14,$0.00,$0.00,$7.14,$7.14,$0.00,$10.00,$0.00,$5.00,$7.92,$8.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001126,EAP,Custom 27001126,,Scapel Surg W/handle Atta,$142.00,$0.00,$142.00,$0.00,$101.35,$0.00,$0.00,$101.35,$101.35,$0.00,$142.00,$0.00,$71.00,$112.46,$113.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001127,EAP,Custom 27001127,,Triconnector With Valve,$39.00,$0.00,$39.00,$0.00,$27.83,$0.00,$0.00,$27.83,$27.83,$0.00,$39.00,$0.00,$19.50,$30.89,$31.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001129,EAP,Custom 27001129,,Set Blood Administration,$36.00,$0.00,$36.00,$0.00,$25.69,$0.00,$0.00,$25.69,$25.69,$0.00,$36.00,$0.00,$18.00,$28.51,$28.80,$0.00,$0.00,$0.00,$0.00,$0.00
27001135,EAP,Custom 27001135,,Valve Anti-reflux Salem S,$49.00,$0.00,$49.00,$0.00,$34.97,$0.00,$0.00,$34.97,$34.97,$0.00,$49.00,$0.00,$24.50,$38.81,$39.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001137,EAP,Custom 27001137,,Kit Thoracotomy,$217.00,$0.00,$217.00,$0.00,$154.87,$0.00,$0.00,$154.87,$154.87,$0.00,$217.00,$0.00,$108.50,$171.86,$173.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001142,EAP,Custom 27001142,,Pouch Fecal Incontinence,$52.00,$0.00,$52.00,$0.00,$37.11,$0.00,$0.00,$37.11,$37.11,$0.00,$52.00,$0.00,$26.00,$41.18,$41.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001143,EAP,Custom 27001143,,Kit Pressure Monitoring T,$177.00,$0.00,$177.00,$0.00,$126.32,$0.00,$0.00,$126.32,$126.32,$0.00,$177.00,$0.00,$88.50,$140.18,$141.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001144,EAP,Custom 27001144,,Transducer  Disp For Icp,$79.00,$0.00,$79.00,$0.00,$56.38,$0.00,$0.00,$56.38,$56.38,$0.00,$79.00,$0.00,$39.50,$62.57,$63.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001145,EAP,Custom 27001145,,Bridge Kit Bifurated Resp,$120.00,$0.00,$120.00,$0.00,$85.64,$0.00,$0.00,$85.64,$85.64,$0.00,$120.00,$0.00,$60.00,$95.04,$96.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001146,EAP,Custom 27001146,,Kit Transducer Monitoring,$339.00,$0.00,$339.00,$0.00,$241.94,$0.00,$0.00,$241.94,$241.94,$0.00,$339.00,$0.00,$169.50,$268.49,$271.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001147,EAP,Custom 27001147,,Kit  Pressure Monitoring,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$178.43,$178.43,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001149,EAP,Custom 27001149,,Bag 1000ml Pump Set,$39.00,$0.00,$39.00,$0.00,$27.83,$0.00,$0.00,$27.83,$27.83,$0.00,$39.00,$0.00,$19.50,$30.89,$31.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001150,EAP,Custom 27001150,,Kit Pecutaneous Introduce,$276.00,$0.00,$276.00,$0.00,$196.98,$0.00,$0.00,$196.98,$196.98,$0.00,$276.00,$0.00,$138.00,$218.59,$220.80,$0.00,$0.00,$0.00,$0.00,$0.00
27001151,EAP,Custom 27001151,,Chest Unit Drainage Pleur,$401.00,$0.00,$401.00,$0.00,$286.19,$0.00,$0.00,$286.19,$286.19,$0.00,$401.00,$0.00,$200.50,$317.59,$320.80,$0.00,$0.00,$0.00,$0.00,$0.00
27001152,EAP,Custom 27001152,,Chest Unit Dry Suction Sy,$316.00,$0.00,$316.00,$0.00,$225.53,$0.00,$0.00,$225.53,$225.53,$0.00,$316.00,$0.00,$158.00,$250.27,$252.80,$0.00,$0.00,$0.00,$0.00,$0.00
27001157,EAP,Custom 27001157,,Dressing X-large,$697.00,$0.00,$697.00,$0.00,$497.45,$0.00,$0.00,$497.45,$497.45,$0.00,$697.00,$0.00,$348.50,$552.02,$557.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001158,EAP,Custom 27001158,,Trac Dressing Xl,$157.00,$0.00,$157.00,$0.00,$112.05,$0.00,$0.00,$112.05,$112.05,$0.00,$157.00,$0.00,$78.50,$124.34,$125.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001161,EAP,Custom 27001161,,Tube Feeding Ng 8fr 36in Entr,$65.00,$0.00,$65.00,$0.00,$46.39,$0.00,$0.00,$46.39,$46.39,$0.00,$65.00,$0.00,$32.50,$51.48,$52.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001162,EAP,Custom 27001162,,Kit Triple Lumen Catheter,$344.00,$0.00,$344.00,$0.00,$245.51,$0.00,$0.00,$245.51,$245.51,$0.00,$344.00,$0.00,$172.00,$272.45,$275.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001163,EAP,Custom 27001163,,Wire Guide Dual Purpose,$392.00,$0.00,$392.00,$0.00,$279.77,$0.00,$0.00,$279.77,$279.77,$0.00,$392.00,$0.00,$196.00,$310.46,$313.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001164,EAP,Custom 27001164,,Kit Monitoring Intracrani,$460.00,$0.00,$460.00,$0.00,$328.30,$0.00,$0.00,$328.30,$328.30,$0.00,$460.00,$0.00,$230.00,$364.32,$368.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001165,EAP,Custom 27001165,,Cath  Trauma Ventricular,"$1,014.00",$0.00,"$1,014.00",$0.00,$723.69,$0.00,$0.00,$723.69,$723.69,$0.00,"$1,014.00",$0.00,$507.00,$803.09,$811.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001166,EAP,Custom 27001166,,Catheter Swan Ganz,$309.00,$0.00,$309.00,$0.00,$220.53,$0.00,$0.00,$220.53,$220.53,$0.00,$309.00,$0.00,$154.50,$244.73,$247.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001167,EAP,Custom 27001167,,Delivery System Closed In,$65.00,$0.00,$65.00,$0.00,$46.39,$0.00,$0.00,$46.39,$46.39,$0.00,$65.00,$0.00,$32.50,$51.48,$52.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001173,EAP,Custom 27001173,,Filter Set 0.22 Micron,$20.00,$0.00,$20.00,$0.00,$14.27,$0.00,$0.00,$14.27,$14.27,$0.00,$20.00,$0.00,$10.00,$15.84,$16.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001174,EAP,Custom 27001174,,Tray Catheter Urethral 14,$17.00,$0.00,$17.00,$0.00,$12.13,$0.00,$0.00,$12.13,$12.13,$0.00,$17.00,$0.00,$8.50,$13.46,$13.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001176,EAP,Custom 27001176,,Kit Ventriculostomy,"$1,782.00",$0.00,"$1,782.00",$0.00,"$1,271.81",$0.00,$0.00,"$1,271.81","$1,271.81",$0.00,"$1,782.00",$0.00,$891.00,"$1,411.34","$1,425.60",$0.00,$0.00,$0.00,$0.00,$0.00
27001178,EAP,Custom 27001178,,Central Line Dressing Tray With Biopatch,$47.00,$0.00,$47.00,$0.00,$33.54,$0.00,$0.00,$33.54,$33.54,$0.00,$47.00,$0.00,$23.50,$37.22,$37.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001179,EAP,Custom 27001179,,Kit Lumbar Drainage Edm,$788.00,$0.00,$788.00,$0.00,$562.40,$0.00,$0.00,$562.40,$562.40,$0.00,$788.00,$0.00,$394.00,$624.10,$630.40,$0.00,$0.00,$0.00,$0.00,$0.00
27001190,EAP,Custom 27001190,,Sleeve Knee Regular Dvt,$388.00,$0.00,$388.00,$0.00,$276.92,$0.00,$0.00,$276.92,$276.92,$0.00,$388.00,$0.00,$194.00,$307.30,$310.40,$0.00,$0.00,$0.00,$0.00,$0.00
27001191,EAP,Custom 27001191,,Sleeve Knee X-large Dvt,$469.00,$0.00,$469.00,$0.00,$334.73,$0.00,$0.00,$334.73,$334.73,$0.00,$469.00,$0.00,$234.50,$371.45,$375.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001192,EAP,Custom 27001192,,Sleeve Thigh Regular Dvt,$553.00,$0.00,$553.00,$0.00,$394.68,$0.00,$0.00,$394.68,$394.68,$0.00,$553.00,$0.00,$276.50,$437.98,$442.40,$0.00,$0.00,$0.00,$0.00,$0.00
27001193,EAP,Custom 27001193,,Sleeve Thigh X-large Dvt,$663.00,$0.00,$663.00,$0.00,$473.18,$0.00,$0.00,$473.18,$473.18,$0.00,$663.00,$0.00,$331.50,$525.10,$530.40,$0.00,$0.00,$0.00,$0.00,$0.00
27001194,EAP,Custom 27001194,,First Step Select Overlay,$131.00,$0.00,$131.00,$0.00,$93.49,$0.00,$0.00,$93.49,$93.49,$0.00,$131.00,$0.00,$65.50,$103.75,$104.80,$0.00,$0.00,$0.00,$0.00,$0.00
27001205,EAP,Custom 27001205,,Dialysis Filter,$651.00,$0.00,$651.00,$0.00,$464.62,$0.00,$0.00,$464.62,$464.62,$0.00,$651.00,$0.00,$325.50,$515.59,$520.80,$0.00,$0.00,$0.00,$0.00,$0.00
27001206,EAP,Custom 27001206,,Tubes Extension Plain Pla,$15.00,$0.00,$15.00,$0.00,$10.71,$0.00,$0.00,$10.71,$10.71,$0.00,$15.00,$0.00,$7.50,$11.88,$12.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001218,EAP,Custom 27001218,,Catheter Thoracic 16f,$40.00,$0.00,$40.00,$0.00,$28.55,$0.00,$0.00,$28.55,$28.55,$0.00,$40.00,$0.00,$20.00,$31.68,$32.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001219,EAP,Custom 27001219,,Catheter Thoracic 20fr,$40.00,$0.00,$40.00,$0.00,$28.55,$0.00,$0.00,$28.55,$28.55,$0.00,$40.00,$0.00,$20.00,$31.68,$32.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001220,EAP,Custom 27001220,,Catheter Thoracic 24fr,$18.00,$0.00,$18.00,$0.00,$12.85,$0.00,$0.00,$12.85,$12.85,$0.00,$18.00,$0.00,$9.00,$14.26,$14.40,$0.00,$0.00,$0.00,$0.00,$0.00
27001221,EAP,Custom 27001221,,Catheter Thoracic 28fr,$18.00,$0.00,$18.00,$0.00,$12.85,$0.00,$0.00,$12.85,$12.85,$0.00,$18.00,$0.00,$9.00,$14.26,$14.40,$0.00,$0.00,$0.00,$0.00,$0.00
27001222,EAP,Custom 27001222,,Catheter Thoracic 32fr,$18.00,$0.00,$18.00,$0.00,$12.85,$0.00,$0.00,$12.85,$12.85,$0.00,$18.00,$0.00,$9.00,$14.26,$14.40,$0.00,$0.00,$0.00,$0.00,$0.00
27001223,EAP,Custom 27001223,,Catheter Urethral 8fr,$31.00,$0.00,$31.00,$0.00,$22.12,$0.00,$0.00,$22.12,$22.12,$0.00,$31.00,$0.00,$15.50,$24.55,$24.80,$0.00,$0.00,$0.00,$0.00,$0.00
27001224,EAP,Custom 27001224,,Entriflex,$30.00,$0.00,$30.00,$0.00,$21.41,$0.00,$0.00,$21.41,$21.41,$0.00,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001225,EAP,Custom 27001225,,Tube  Feeding Nasogastric,$10.00,$0.00,$10.00,$0.00,$7.14,$0.00,$0.00,$7.14,$7.14,$0.00,$10.00,$0.00,$5.00,$7.92,$8.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001226,EAP,Custom 27001226,,Artery Arterial Catheriza,$109.00,$0.00,$109.00,$0.00,$77.79,$0.00,$0.00,$77.79,$77.79,$0.00,$109.00,$0.00,$54.50,$86.33,$87.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001227,EAP,Custom 27001227,,Artery Radial Catherizati,$69.00,$0.00,$69.00,$0.00,$49.25,$0.00,$0.00,$49.25,$49.25,$0.00,$69.00,$0.00,$34.50,$54.65,$55.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001228,EAP,Custom 27001228,,Tube Salem Sump 48 Lengt,$38.00,$0.00,$38.00,$0.00,$27.12,$0.00,$0.00,$27.12,$27.12,$0.00,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
27001229,EAP,Custom 27001229,,Tubes Salem Sump 48 Leng,$38.00,$0.00,$38.00,$0.00,$27.12,$0.00,$0.00,$27.12,$27.12,$0.00,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
27001231,EAP,Custom 27001231,,Set Urinary Drain W/conta,$21.00,$0.00,$21.00,$0.00,$14.99,$0.00,$0.00,$14.99,$14.99,$0.00,$21.00,$0.00,$10.50,$16.63,$16.80,$0.00,$0.00,$0.00,$0.00,$0.00
27001232,EAP,Custom 27001232,,Tray Catheter Insrtn Dulm,$434.00,$0.00,$434.00,$0.00,$309.75,$0.00,$0.00,$309.75,$309.75,$0.00,$434.00,$0.00,$217.00,$343.73,$347.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001234,EAP,Custom 27001234,,Scapel Surg W/handle Atta,$142.00,$0.00,$142.00,$0.00,$101.35,$0.00,$0.00,$101.35,$101.35,$0.00,$142.00,$0.00,$71.00,$112.46,$113.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001235,EAP,Custom 27001235,,Stapler Skin Disposable 3,$38.00,$0.00,$38.00,$0.00,$27.12,$0.00,$0.00,$27.12,$27.12,$0.00,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
27001236,EAP,Custom 27001236,,Triconnector With Valve,$39.00,$0.00,$39.00,$0.00,$27.83,$0.00,$0.00,$27.83,$27.83,$0.00,$39.00,$0.00,$19.50,$30.89,$31.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001240,EAP,Custom 27001240,,Aquacel Ag 4x4,$92.00,$0.00,$92.00,$0.00,$65.66,$0.00,$0.00,$65.66,$65.66,$0.00,$92.00,$0.00,$46.00,$72.86,$73.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001243,EAP,Custom 27001243,,Electrodes Operative,$289.00,$0.00,$289.00,$0.00,$206.26,$0.00,$0.00,$206.26,$206.26,$0.00,$289.00,$0.00,$144.50,$228.89,$231.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001249,EAP,Custom 27001249,,Kit Pressure Monitoring T,$177.00,$0.00,$177.00,$0.00,$126.32,$0.00,$0.00,$126.32,$126.32,$0.00,$177.00,$0.00,$88.50,$140.18,$141.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001250,EAP,Custom 27001250,,Kit Transducer Monitoring,$339.00,$0.00,$339.00,$0.00,$241.94,$0.00,$0.00,$241.94,$241.94,$0.00,$339.00,$0.00,$169.50,$268.49,$271.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001252,EAP,Custom 27001252,,Kit  Pressure Monitoring,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$178.43,$178.43,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001254,EAP,Custom 27001254,,Bag 1000ml Pump Set,$28.00,$0.00,$28.00,$0.00,$19.98,$0.00,$0.00,$19.98,$19.98,$0.00,$28.00,$0.00,$14.00,$22.18,$22.40,$0.00,$0.00,$0.00,$0.00,$0.00
27001255,EAP,Custom 27001255,,Kit Pecutaneous Introduce,$276.00,$0.00,$276.00,$0.00,$196.98,$0.00,$0.00,$196.98,$196.98,$0.00,$276.00,$0.00,$138.00,$218.59,$220.80,$0.00,$0.00,$0.00,$0.00,$0.00
27001256,EAP,Custom 27001256,,Chest Unit Drainage Pleur,$195.00,$0.00,$195.00,$0.00,$139.17,$0.00,$0.00,$139.17,$139.17,$0.00,$195.00,$0.00,$97.50,$154.44,$156.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001257,EAP,Custom 27001257,,Bag Pressure  500cc,$82.00,$0.00,$82.00,$0.00,$58.52,$0.00,$0.00,$58.52,$58.52,$0.00,$82.00,$0.00,$41.00,$64.94,$65.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001258,EAP,Custom 27001258,,Bag Pressure 1000cc,$36.00,$0.00,$36.00,$0.00,$25.69,$0.00,$0.00,$25.69,$25.69,$0.00,$36.00,$0.00,$18.00,$28.51,$28.80,$0.00,$0.00,$0.00,$0.00,$0.00
27001260,EAP,Custom 27001260,,Tube Feeding Ng 8fr 36in Entri,$65.00,$0.00,$65.00,$0.00,$46.39,$0.00,$0.00,$46.39,$46.39,$0.00,$65.00,$0.00,$32.50,$51.48,$52.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001261,EAP,Custom 27001261,,Multi Lumen Cvc W/o Silver Su,$751.00,$0.00,$751.00,$0.00,$535.99,$0.00,$0.00,$535.99,$535.99,$0.00,$751.00,$0.00,$375.50,$594.79,$600.80,$0.00,$0.00,$0.00,$0.00,$0.00
27001262,EAP,Custom 27001262,,Kit Triple Lumen Catheter,$697.00,$0.00,$697.00,$0.00,$497.45,$0.00,$0.00,$497.45,$497.45,$0.00,$697.00,$0.00,$348.50,$552.02,$557.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001263,EAP,Custom 27001263,,Catheter Swan Ganz,$726.00,$0.00,$726.00,$0.00,$518.15,$0.00,$0.00,$518.15,$518.15,$0.00,$726.00,$0.00,$363.00,$574.99,$580.80,$0.00,$0.00,$0.00,$0.00,$0.00
27001264,EAP,Custom 27001264,,Delivery System Closed In,$141.00,$0.00,$141.00,$0.00,$100.63,$0.00,$0.00,$100.63,$100.63,$0.00,$141.00,$0.00,$70.50,$111.67,$112.80,$0.00,$0.00,$0.00,$0.00,$0.00
27001265,EAP,Custom 27001265,,Set T-port Small Bore Ext,$14.00,$0.00,$14.00,$0.00,$9.99,$0.00,$0.00,$9.99,$9.99,$0.00,$14.00,$0.00,$7.00,$11.09,$11.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001268,EAP,Custom 27001268,,Tray Catheter Urethral 14,$17.00,$0.00,$17.00,$0.00,$12.13,$0.00,$0.00,$12.13,$12.13,$0.00,$17.00,$0.00,$8.50,$13.46,$13.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001270,EAP,Custom 27001270,,Tray Foley Preconnected 1,$59.00,$0.00,$59.00,$0.00,$42.11,$0.00,$0.00,$42.11,$42.11,$0.00,$59.00,$0.00,$29.50,$46.73,$47.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001271,EAP,Custom 27001271,,Tray Foley Perconnected 1,$59.00,$0.00,$59.00,$0.00,$42.11,$0.00,$0.00,$42.11,$42.11,$0.00,$59.00,$0.00,$29.50,$46.73,$47.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001272,EAP,Custom 27001272,,Tray Thoracentesis Dispos,$207.00,$0.00,$207.00,$0.00,$147.74,$0.00,$0.00,$147.74,$147.74,$0.00,$207.00,$0.00,$103.50,$163.94,$165.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001273,EAP,Custom 27001273,,Sponges Laparotomy 6522,$119.00,$0.00,$119.00,$0.00,$84.93,$0.00,$0.00,$84.93,$84.93,$0.00,$119.00,$0.00,$59.50,$94.25,$95.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001274,EAP,Custom 27001274,,Bovie Pencil Valleylab,$34.00,$0.00,$34.00,$0.00,$24.27,$0.00,$0.00,$24.27,$24.27,$0.00,$34.00,$0.00,$17.00,$26.93,$27.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001283,EAP,Custom 27001283,,Dressing Acticoat 16x16,$678.00,$0.00,$678.00,$0.00,$483.89,$0.00,$0.00,$483.89,$483.89,$0.00,$678.00,$0.00,$339.00,$536.98,$542.40,$0.00,$0.00,$0.00,$0.00,$0.00
27001284,EAP,Custom 27001284,,Kit Vascular Conform,$108.00,$0.00,$108.00,$0.00,$77.08,$0.00,$0.00,$77.08,$77.08,$0.00,$108.00,$0.00,$54.00,$85.54,$86.40,$0.00,$0.00,$0.00,$0.00,$0.00
27001285,EAP,Custom 27001285,,Sleeve Knee Regular Dvt,$388.00,$0.00,$388.00,$0.00,$276.92,$0.00,$0.00,$276.92,$276.92,$0.00,$388.00,$0.00,$194.00,$307.30,$310.40,$0.00,$0.00,$0.00,$0.00,$0.00
27001286,EAP,Custom 27001286,,Sleeve Knee X-large Dvt,$469.00,$0.00,$469.00,$0.00,$334.73,$0.00,$0.00,$334.73,$334.73,$0.00,$469.00,$0.00,$234.50,$371.45,$375.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001287,EAP,Custom 27001287,,Sleeve Thigh Regular Dvt,$553.00,$0.00,$553.00,$0.00,$394.68,$0.00,$0.00,$394.68,$394.68,$0.00,$553.00,$0.00,$276.50,$437.98,$442.40,$0.00,$0.00,$0.00,$0.00,$0.00
27001288,EAP,Custom 27001288,,Sleeve Thigh X-large Dvt,$284.00,$0.00,$284.00,$0.00,$202.69,$0.00,$0.00,$202.69,$202.69,$0.00,$284.00,$0.00,$142.00,$224.93,$227.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001289,EAP,Custom 27001289,,1st First Select Overlay,$131.00,$0.00,$131.00,$0.00,$93.49,$0.00,$0.00,$93.49,$93.49,$0.00,$131.00,$0.00,$65.50,$103.75,$104.80,$0.00,$0.00,$0.00,$0.00,$0.00
27001298,EAP,Custom 27001298,,Therapy For Cvvh/cvvhd 4,$166.00,$0.00,$166.00,$0.00,$118.47,$0.00,$0.00,$118.47,$118.47,$0.00,$166.00,$0.00,$83.00,$131.47,$132.80,$0.00,$0.00,$0.00,$0.00,$0.00
27001299,EAP,Custom 27001299,,Dialysis Filter,$699.00,$0.00,$699.00,$0.00,$498.88,$0.00,$0.00,$498.88,$498.88,$0.00,$699.00,$0.00,$349.50,$553.61,$559.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001312,EAP,Custom 27001312,,Catheter  Thoracic 20fr,$40.00,$0.00,$40.00,$0.00,$28.55,$0.00,$0.00,$28.55,$28.55,$0.00,$40.00,$0.00,$20.00,$31.68,$32.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001313,EAP,Custom 27001313,,Catheter Thoracic 32fr,$43.00,$0.00,$43.00,$0.00,$30.69,$0.00,$0.00,$30.69,$30.69,$0.00,$43.00,$0.00,$21.50,$34.06,$34.40,$0.00,$0.00,$0.00,$0.00,$0.00
27001314,EAP,Custom 27001314,,Catheter Thoracic 36fr,$43.00,$0.00,$43.00,$0.00,$30.69,$0.00,$0.00,$30.69,$30.69,$0.00,$43.00,$0.00,$21.50,$34.06,$34.40,$0.00,$0.00,$0.00,$0.00,$0.00
27001315,EAP,HCPCS C1729,,Catheter Foley 5cc 14fr,$19.00,$0.00,$19.00,$10.32,$13.56,$0.00,$3.27,$13.56,$13.56,$3.33,$19.00,$0.00,$9.50,$15.05,$15.20,$0.00,$2.97,$0.00,$3.02,$0.00
27001316,EAP,HCPCS C1729,,Catheter Foley 16fr,$18.00,$0.00,$18.00,$9.77,$12.85,$0.00,$3.10,$12.85,$12.85,$3.15,$18.00,$0.00,$9.00,$14.26,$14.40,$0.00,$2.82,$0.00,$2.87,$0.00
27001317,EAP,HCPCS C1729,,Catheter Foley 5cc 18fr,$19.00,$0.00,$19.00,$10.32,$13.56,$0.00,$3.27,$13.56,$13.56,$3.33,$19.00,$0.00,$9.50,$15.05,$15.20,$0.00,$2.97,$0.00,$3.02,$0.00
27001318,EAP,Custom 27001318,,Catheter Ventricular 20cm,$683.00,$0.00,$683.00,$0.00,$487.46,$0.00,$0.00,$487.46,$487.46,$0.00,$683.00,$0.00,$341.50,$540.94,$546.40,$0.00,$0.00,$0.00,$0.00,$0.00
27001319,EAP,Custom 27001319,,Catheter Edm Ii Becker,"$1,339.00",$0.00,"$1,339.00",$0.00,$955.64,$0.00,$0.00,$955.64,$955.64,$0.00,"$1,339.00",$0.00,$669.50,"$1,060.49","$1,071.20",$0.00,$0.00,$0.00,$0.00,$0.00
27001320,EAP,Custom 27001320,,Artery Arterial Catheriza,$47.00,$0.00,$47.00,$0.00,$33.54,$0.00,$0.00,$33.54,$33.54,$0.00,$47.00,$0.00,$23.50,$37.22,$37.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001321,EAP,Custom 27001321,,Artery Radial Catherizati,$69.00,$0.00,$69.00,$0.00,$49.25,$0.00,$0.00,$49.25,$49.25,$0.00,$69.00,$0.00,$34.50,$54.65,$55.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001322,EAP,Custom 27001322,,Tube Salem Sump 48 Lengt,$38.00,$0.00,$38.00,$0.00,$27.12,$0.00,$0.00,$27.12,$27.12,$0.00,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
27001323,EAP,Custom 27001323,,Tube Salem Silicone Size,$38.00,$0.00,$38.00,$0.00,$27.12,$0.00,$0.00,$27.12,$27.12,$0.00,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
27001324,EAP,Custom 27001324,,Tubes Salem Sump 48 Leng,$38.00,$0.00,$38.00,$0.00,$27.12,$0.00,$0.00,$27.12,$27.12,$0.00,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
27001328,EAP,Custom 27001328,,Bag Drainage Becker,$202.00,$0.00,$202.00,$0.00,$144.17,$0.00,$0.00,$144.17,$144.17,$0.00,$202.00,$0.00,$101.00,$159.98,$161.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001329,EAP,Custom 27001329,,Tray Catheter Insrtn Dulm,$937.00,$0.00,$937.00,$0.00,$668.74,$0.00,$0.00,$668.74,$668.74,$0.00,$937.00,$0.00,$468.50,$742.10,$749.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001330,EAP,Custom 27001330,,Scapel Surg W/handle Atta,$142.00,$0.00,$142.00,$0.00,$101.35,$0.00,$0.00,$101.35,$101.35,$0.00,$142.00,$0.00,$71.00,$112.46,$113.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001331,EAP,Custom 27001331,,Triconnector With Valve,$17.00,$0.00,$17.00,$0.00,$12.13,$0.00,$0.00,$12.13,$12.13,$0.00,$17.00,$0.00,$8.50,$13.46,$13.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001337,EAP,Custom 27001337,,Cable Patient 12 Pin #r53,$300.00,$0.00,$300.00,$0.00,$214.11,$0.00,$0.00,$214.11,$214.11,$0.00,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001341,EAP,Custom 27001341,,Kit Thoracotomy,$217.00,$0.00,$217.00,$0.00,$154.87,$0.00,$0.00,$154.87,$154.87,$0.00,$217.00,$0.00,$108.50,$171.86,$173.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001347,EAP,Custom 27001347,,Pouch Fecal Incontinence,$52.00,$0.00,$52.00,$0.00,$37.11,$0.00,$0.00,$37.11,$37.11,$0.00,$52.00,$0.00,$26.00,$41.18,$41.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001348,EAP,Custom 27001348,,Kit Pressure Monitoring T,$177.00,$0.00,$177.00,$0.00,$126.32,$0.00,$0.00,$126.32,$126.32,$0.00,$177.00,$0.00,$88.50,$140.18,$141.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001349,EAP,Custom 27001349,,Transducer  Disp For Icp,$36.00,$0.00,$36.00,$0.00,$25.69,$0.00,$0.00,$25.69,$25.69,$0.00,$36.00,$0.00,$18.00,$28.51,$28.80,$0.00,$0.00,$0.00,$0.00,$0.00
27001350,EAP,Custom 27001350,,Bridge Kit Bifurated Resp,$120.00,$0.00,$120.00,$0.00,$85.64,$0.00,$0.00,$85.64,$85.64,$0.00,$120.00,$0.00,$60.00,$95.04,$96.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001351,EAP,Custom 27001351,,Kit Transducer Monitoring,$324.00,$0.00,$324.00,$0.00,$231.24,$0.00,$0.00,$231.24,$231.24,$0.00,$324.00,$0.00,$162.00,$256.61,$259.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001352,EAP,Custom 27001352,,Kit  Pressure Monitoring,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$178.43,$178.43,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001354,EAP,Custom 27001354,,Bag Feeding Gavage 500ml,$28.00,$0.00,$28.00,$0.00,$19.98,$0.00,$0.00,$19.98,$19.98,$0.00,$28.00,$0.00,$14.00,$22.18,$22.40,$0.00,$0.00,$0.00,$0.00,$0.00
27001355,EAP,Custom 27001355,,Bag 1000ml Pump Set,$39.00,$0.00,$39.00,$0.00,$27.83,$0.00,$0.00,$27.83,$27.83,$0.00,$39.00,$0.00,$19.50,$30.89,$31.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001356,EAP,Custom 27001356,,Kit Pecutaneous Introduce,$129.00,$0.00,$129.00,$0.00,$92.07,$0.00,$0.00,$92.07,$92.07,$0.00,$129.00,$0.00,$64.50,$102.17,$103.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001357,EAP,Custom 27001357,,Chest Unit Drainage Pleur,$455.00,$0.00,$455.00,$0.00,$324.73,$0.00,$0.00,$324.73,$324.73,$0.00,$455.00,$0.00,$227.50,$360.36,$364.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001358,EAP,Custom 27001358,,Chest Imot Dry Suction Sy,$316.00,$0.00,$316.00,$0.00,$225.53,$0.00,$0.00,$225.53,$225.53,$0.00,$316.00,$0.00,$158.00,$250.27,$252.80,$0.00,$0.00,$0.00,$0.00,$0.00
27001363,EAP,Custom 27001363,,Trac Dressing Xl,$157.00,$0.00,$157.00,$0.00,$112.05,$0.00,$0.00,$112.05,$112.05,$0.00,$157.00,$0.00,$78.50,$124.34,$125.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001366,EAP,Custom 27001366,,Tube Feeding Ng 8fr 36in Entr,$65.00,$0.00,$65.00,$0.00,$46.39,$0.00,$0.00,$46.39,$46.39,$0.00,$65.00,$0.00,$32.50,$51.48,$52.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001367,EAP,Custom 27001367,,Kit Triple Lumen Catheter,$697.00,$0.00,$697.00,$0.00,$497.45,$0.00,$0.00,$497.45,$497.45,$0.00,$697.00,$0.00,$348.50,$552.02,$557.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001369,EAP,Custom 27001369,,Kit Monitoring Intracrani,$460.00,$0.00,$460.00,$0.00,$328.30,$0.00,$0.00,$328.30,$328.30,$0.00,$460.00,$0.00,$230.00,$364.32,$368.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001370,EAP,Custom 27001370,,Catheter Swan Ganz,$674.00,$0.00,$674.00,$0.00,$481.03,$0.00,$0.00,$481.03,$481.03,$0.00,$674.00,$0.00,$337.00,$533.81,$539.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001371,EAP,Custom 27001371,,Delivery System Closed In,$152.00,$0.00,$152.00,$0.00,$108.48,$0.00,$0.00,$108.48,$108.48,$0.00,$152.00,$0.00,$76.00,$120.38,$121.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001372,EAP,Custom 27001372,,Probe V-pacing,"$1,403.00",$0.00,"$1,403.00",$0.00,"$1,001.32",$0.00,$0.00,"$1,001.32","$1,001.32",$0.00,"$1,403.00",$0.00,$701.50,"$1,111.18","$1,122.40",$0.00,$0.00,$0.00,$0.00,$0.00
27001374,EAP,Custom 27001374,,Filter Set 0.22 Micron,$20.00,$0.00,$20.00,$0.00,$14.27,$0.00,$0.00,$14.27,$14.27,$0.00,$20.00,$0.00,$10.00,$15.84,$16.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001376,EAP,Custom 27001376,,Tray Foley Perconnected 1,$59.00,$0.00,$59.00,$0.00,$42.11,$0.00,$0.00,$42.11,$42.11,$0.00,$59.00,$0.00,$29.50,$46.73,$47.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001377,EAP,Custom 27001377,,Kit Ventriculostomy,"$1,782.00",$0.00,"$1,782.00",$0.00,"$1,271.81",$0.00,$0.00,"$1,271.81","$1,271.81",$0.00,"$1,782.00",$0.00,$891.00,"$1,411.34","$1,425.60",$0.00,$0.00,$0.00,$0.00,$0.00
27001379,EAP,Custom 27001379,,Tray Pericardiocentesis,"$1,235.00",$0.00,"$1,235.00",$0.00,$881.42,$0.00,$0.00,$881.42,$881.42,$0.00,"$1,235.00",$0.00,$617.50,$978.12,$988.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001380,EAP,Custom 27001380,,Central Line Dressing Tray With Biopatch,$47.00,$0.00,$47.00,$0.00,$33.54,$0.00,$0.00,$33.54,$33.54,$0.00,$47.00,$0.00,$23.50,$37.22,$37.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001391,EAP,Custom 27001391,,.014 Nitrex Guidewire,"$2,554.00",$0.00,"$2,554.00",$0.00,"$1,822.79",$0.00,$0.00,"$1,822.79","$1,822.79",$0.00,"$2,554.00",$0.00,"$1,277.00","$2,022.77","$2,043.20",$0.00,$0.00,$0.00,$0.00,$0.00
27001392,EAP,Custom 27001392,,Sleeve Knee Regular Dvt,$388.00,$0.00,$388.00,$0.00,$276.92,$0.00,$0.00,$276.92,$276.92,$0.00,$388.00,$0.00,$194.00,$307.30,$310.40,$0.00,$0.00,$0.00,$0.00,$0.00
27001393,EAP,Custom 27001393,,Sleeve Knee X-large Dvt,$469.00,$0.00,$469.00,$0.00,$334.73,$0.00,$0.00,$334.73,$334.73,$0.00,$469.00,$0.00,$234.50,$371.45,$375.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001394,EAP,Custom 27001394,,Sleeve Thigh Regular Dvt,$553.00,$0.00,$553.00,$0.00,$394.68,$0.00,$0.00,$394.68,$394.68,$0.00,$553.00,$0.00,$276.50,$437.98,$442.40,$0.00,$0.00,$0.00,$0.00,$0.00
27001395,EAP,Custom 27001395,,Sleeve Thigh X-large Dvt,$616.00,$0.00,$616.00,$0.00,$439.64,$0.00,$0.00,$439.64,$439.64,$0.00,$616.00,$0.00,$308.00,$487.87,$492.80,$0.00,$0.00,$0.00,$0.00,$0.00
27001399,EAP,Custom 27001399,,Tray Circumcision,$65.00,$0.00,$65.00,$0.00,$46.39,$0.00,$0.00,$46.39,$46.39,$0.00,$65.00,$0.00,$32.50,$51.48,$52.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001400,EAP,Custom 27001400,,Needle Neo-natal Lumbar P,$21.00,$0.00,$21.00,$0.00,$14.99,$0.00,$0.00,$14.99,$14.99,$0.00,$21.00,$0.00,$10.50,$16.63,$16.80,$0.00,$0.00,$0.00,$0.00,$0.00
27001401,EAP,Custom 27001401,,Tubes Capillary Hepariniz,$150.00,$0.00,$150.00,$0.00,$107.06,$0.00,$0.00,$107.06,$107.06,$0.00,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001403,EAP,Custom 27001403,,Tube Feeding Plastic 8fr,$10.00,$0.00,$10.00,$0.00,$7.14,$0.00,$0.00,$7.14,$7.14,$0.00,$10.00,$0.00,$5.00,$7.92,$8.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001408,EAP,Custom 27001408,,Bag Feeding Gavage 500ml,$14.00,$0.00,$14.00,$0.00,$9.99,$0.00,$0.00,$9.99,$9.99,$0.00,$14.00,$0.00,$7.00,$11.09,$11.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001409,EAP,Custom 27001409,,Set Breast Pump Complete,$71.00,$0.00,$71.00,$0.00,$50.67,$0.00,$0.00,$50.67,$50.67,$0.00,$71.00,$0.00,$35.50,$56.23,$56.80,$0.00,$0.00,$0.00,$0.00,$0.00
27001410,EAP,Custom 27001410,,Cassettes Imed #9260 20/c,$16.00,$0.00,$16.00,$0.00,$11.42,$0.00,$0.00,$11.42,$11.42,$0.00,$16.00,$0.00,$8.00,$12.67,$12.80,$0.00,$0.00,$0.00,$0.00,$0.00
27001411,EAP,Custom 27001411,,Catheter Quick Iv 22ga,$7.00,$0.00,$7.00,$0.00,$5.00,$0.00,$0.00,$5.00,$5.00,$0.00,$7.00,$0.00,$3.50,$5.54,$5.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001412,EAP,Custom 27001412,,Filter Set 0.22 Micron,$15.00,$0.00,$15.00,$0.00,$10.71,$0.00,$0.00,$10.71,$10.71,$0.00,$15.00,$0.00,$7.50,$11.88,$12.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001413,EAP,Custom 27001413,,Set T-port Small Bore Ext,$14.00,$0.00,$14.00,$0.00,$9.99,$0.00,$0.00,$9.99,$9.99,$0.00,$14.00,$0.00,$7.00,$11.09,$11.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001415,EAP,Custom 27001415,,Tube Sump Gastric 50/cs,$19.00,$0.00,$19.00,$0.00,$13.56,$0.00,$0.00,$13.56,$13.56,$0.00,$19.00,$0.00,$9.50,$15.05,$15.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001418,EAP,Custom 27001418,,Precision Introd.26g(1.9f),$149.00,$0.00,$149.00,$0.00,$106.34,$0.00,$0.00,$106.34,$106.34,$0.00,$149.00,$0.00,$74.50,$118.01,$119.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001419,EAP,Custom 27001419,,26g Catheter(1.9f 1st Picc Bd),$260.00,$0.00,$260.00,$0.00,$185.56,$0.00,$0.00,$185.56,$185.56,$0.00,$260.00,$0.00,$130.00,$205.92,$208.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001420,EAP,Custom 27001420,,Picc Tray (bd Procedure Tray),$219.00,$0.00,$219.00,$0.00,$156.30,$0.00,$0.00,$156.30,$156.30,$0.00,$219.00,$0.00,$109.50,$173.45,$175.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001421,EAP,Custom 27001421,,Precision Introducer 22g(2.8f),$183.00,$0.00,$183.00,$0.00,$130.61,$0.00,$0.00,$130.61,$130.61,$0.00,$183.00,$0.00,$91.50,$144.94,$146.40,$0.00,$0.00,$0.00,$0.00,$0.00
27001422,EAP,Custom 27001422,,22g Catheter(2.8f 1st Picc Bd),$343.00,$0.00,$343.00,$0.00,$244.80,$0.00,$0.00,$244.80,$244.80,$0.00,$343.00,$0.00,$171.50,$271.66,$274.40,$0.00,$0.00,$0.00,$0.00,$0.00
27001423,EAP,Custom 27001423,,Argyle Picc 1.9frx39cm Dual Lu,$423.00,$0.00,$423.00,$0.00,$301.90,$0.00,$0.00,$301.90,$301.90,$0.00,$423.00,$0.00,$211.50,$335.02,$338.40,$0.00,$0.00,$0.00,$0.00,$0.00
27001424,EAP,Custom 27001424,,20g(3fr)bdl Cath Picc Dual Lum,$154.00,$0.00,$154.00,$0.00,$109.91,$0.00,$0.00,$109.91,$109.91,$0.00,$154.00,$0.00,$77.00,$121.97,$123.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001428,EAP,Custom 27001428,,Tray Circumcision,$30.00,$0.00,$30.00,$0.00,$21.41,$0.00,$0.00,$21.41,$21.41,$0.00,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001429,EAP,Custom 27001429,,Needle Neo-natal Lumbar P,$21.00,$0.00,$21.00,$0.00,$14.99,$0.00,$0.00,$14.99,$14.99,$0.00,$21.00,$0.00,$10.50,$16.63,$16.80,$0.00,$0.00,$0.00,$0.00,$0.00
27001430,EAP,Custom 27001430,,Needle Spinal 22g 25/bx,$10.00,$0.00,$10.00,$0.00,$7.14,$0.00,$0.00,$7.14,$7.14,$0.00,$10.00,$0.00,$5.00,$7.92,$8.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001431,EAP,Custom 27001431,,Tubes Capillary Hepariniz,$150.00,$0.00,$150.00,$0.00,$107.06,$0.00,$0.00,$107.06,$107.06,$0.00,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001432,EAP,Custom 27001432,,Tube Nasogastric Feeding,$91.00,$0.00,$91.00,$0.00,$64.95,$0.00,$0.00,$64.95,$64.95,$0.00,$91.00,$0.00,$45.50,$72.07,$72.80,$0.00,$0.00,$0.00,$0.00,$0.00
27001435,EAP,Custom 27001435,,Catheter Urethral 8fr,$15.00,$0.00,$15.00,$0.00,$10.71,$0.00,$0.00,$10.71,$10.71,$0.00,$15.00,$0.00,$7.50,$11.88,$12.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001436,EAP,Custom 27001436,,Catheter Umbilical 15 3-,$49.00,$0.00,$49.00,$0.00,$34.97,$0.00,$0.00,$34.97,$34.97,$0.00,$49.00,$0.00,$24.50,$38.81,$39.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001437,EAP,Custom 27001437,,Catheter Umbilical 15 5f,$63.00,$0.00,$63.00,$0.00,$44.96,$0.00,$0.00,$44.96,$44.96,$0.00,$63.00,$0.00,$31.50,$49.90,$50.40,$0.00,$0.00,$0.00,$0.00,$0.00
27001438,EAP,Custom 27001438,,Tube Feeding Plastic 8fr,$10.00,$0.00,$10.00,$0.00,$7.14,$0.00,$0.00,$7.14,$7.14,$0.00,$10.00,$0.00,$5.00,$7.92,$8.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001441,EAP,Custom 27001441,,Scapel Surg W/handle Atta,$142.00,$0.00,$142.00,$0.00,$101.35,$0.00,$0.00,$101.35,$101.35,$0.00,$142.00,$0.00,$71.00,$112.46,$113.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001443,EAP,Custom 27001443,,Pouch Little Ones  Cut To,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$4.28,$4.28,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
27001446,EAP,Custom 27001446,,Transducer With Interg 43,$37.00,$0.00,$37.00,$0.00,$26.41,$0.00,$0.00,$26.41,$26.41,$0.00,$37.00,$0.00,$18.50,$29.30,$29.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001447,EAP,Custom 27001447,,Bag 1000ml Pump Set,$39.00,$0.00,$39.00,$0.00,$27.83,$0.00,$0.00,$27.83,$27.83,$0.00,$39.00,$0.00,$19.50,$30.89,$31.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001448,EAP,Custom 27001448,,Catheter  Thoracic Trocar,$134.00,$0.00,$134.00,$0.00,$95.64,$0.00,$0.00,$95.64,$95.64,$0.00,$134.00,$0.00,$67.00,$106.13,$107.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001449,EAP,Custom 27001449,,Catheter Thoracic Trocar 10 F,$177.00,$0.00,$177.00,$0.00,$126.32,$0.00,$0.00,$126.32,$126.32,$0.00,$177.00,$0.00,$88.50,$140.18,$141.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001450,EAP,Custom 27001450,,Chest Unit  Drainage Pleur,$161.00,$0.00,$161.00,$0.00,$114.91,$0.00,$0.00,$114.91,$114.91,$0.00,$161.00,$0.00,$80.50,$127.51,$128.80,$0.00,$0.00,$0.00,$0.00,$0.00
27001451,EAP,Custom 27001451,,Cassettes Imed #9260 20/c,$38.00,$0.00,$38.00,$0.00,$27.12,$0.00,$0.00,$27.12,$27.12,$0.00,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
27001452,EAP,Custom 27001452,,Catheter Quick Iv 22gax1-,$3.00,$0.00,$3.00,$0.00,$2.14,$0.00,$0.00,$2.14,$2.14,$0.00,$3.00,$0.00,$1.50,$2.38,$2.40,$0.00,$0.00,$0.00,$0.00,$0.00
27001453,EAP,Custom 27001453,,Catheter Introducer Steri,$3.00,$0.00,$3.00,$0.00,$2.14,$0.00,$0.00,$2.14,$2.14,$0.00,$3.00,$0.00,$1.50,$2.38,$2.40,$0.00,$0.00,$0.00,$0.00,$0.00
27001454,EAP,Custom 27001454,,Filter Set 0.22 Micron,$20.00,$0.00,$20.00,$0.00,$14.27,$0.00,$0.00,$14.27,$14.27,$0.00,$20.00,$0.00,$10.00,$15.84,$16.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001455,EAP,Custom 27001455,,Set T-port Small Bore Ext,$14.00,$0.00,$14.00,$0.00,$9.99,$0.00,$0.00,$9.99,$9.99,$0.00,$14.00,$0.00,$7.00,$11.09,$11.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001456,EAP,Custom 27001456,,Tray Transfusion Sterile,$597.00,$0.00,$597.00,$0.00,$426.08,$0.00,$0.00,$426.08,$426.08,$0.00,$597.00,$0.00,$298.50,$472.82,$477.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001458,EAP,Custom 27001458,,Tube Sump Gastric 50/cs,$44.00,$0.00,$44.00,$0.00,$31.40,$0.00,$0.00,$31.40,$31.40,$0.00,$44.00,$0.00,$22.00,$34.85,$35.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001459,EAP,HCPCS C1751,,Catheter  Iv 26g 120/cs,$28.00,$0.00,$28.00,$15.20,$19.98,$0.00,$4.82,$19.98,$19.98,$4.90,$28.00,$0.00,$14.00,$22.18,$22.40,$0.00,$4.38,$0.00,$4.46,$0.00
27001466,EAP,Custom 27001466,,Catheter Suction 5fr Ster,$10.00,$0.00,$10.00,$0.00,$7.14,$0.00,$0.00,$7.14,$7.14,$0.00,$10.00,$0.00,$5.00,$7.92,$8.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001468,EAP,Custom 27001468,,Catheter  Suction Plastic 14,$3.00,$0.00,$3.00,$0.00,$2.14,$0.00,$0.00,$2.14,$2.14,$0.00,$3.00,$0.00,$1.50,$2.38,$2.40,$0.00,$0.00,$0.00,$0.00,$0.00
27001469,EAP,Custom 27001469,,Catheter Urethral Two-eye,$10.00,$0.00,$10.00,$0.00,$7.14,$0.00,$0.00,$7.14,$7.14,$0.00,$10.00,$0.00,$5.00,$7.92,$8.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001471,EAP,Custom 27001471,,Set Urinary Drain W/conta,$20.00,$0.00,$20.00,$0.00,$14.27,$0.00,$0.00,$14.27,$14.27,$0.00,$20.00,$0.00,$10.00,$15.84,$16.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001473,EAP,Custom 27001473,,Scaple Surg W/handle Atta,$142.00,$0.00,$142.00,$0.00,$101.35,$0.00,$0.00,$101.35,$101.35,$0.00,$142.00,$0.00,$71.00,$112.46,$113.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001475,EAP,Custom 27001475,,Stapler Skin Disposable 3,$87.00,$0.00,$87.00,$0.00,$62.09,$0.00,$0.00,$62.09,$62.09,$0.00,$87.00,$0.00,$43.50,$68.90,$69.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001486,EAP,Custom 27001486,,Speculum Pediatric,$10.00,$0.00,$10.00,$0.00,$7.14,$0.00,$0.00,$7.14,$7.14,$0.00,$10.00,$0.00,$5.00,$7.92,$8.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001487,EAP,Custom 27001487,,Bag Hyperinflation,$85.00,$0.00,$85.00,$0.00,$60.66,$0.00,$0.00,$60.66,$60.66,$0.00,$85.00,$0.00,$42.50,$67.32,$68.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001490,EAP,Custom 27001490,,Tray Catheter Urethral 14,$17.00,$0.00,$17.00,$0.00,$12.13,$0.00,$0.00,$12.13,$12.13,$0.00,$17.00,$0.00,$8.50,$13.46,$13.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001492,EAP,Custom 27001492,,Tray Foley Preconnected 1,$51.00,$0.00,$51.00,$0.00,$36.40,$0.00,$0.00,$36.40,$36.40,$0.00,$51.00,$0.00,$25.50,$40.39,$40.80,$0.00,$0.00,$0.00,$0.00,$0.00
27001494,EAP,Custom 27001494,,Sponges Laparotomy 6522,$17.00,$0.00,$17.00,$0.00,$12.13,$0.00,$0.00,$12.13,$12.13,$0.00,$17.00,$0.00,$8.50,$13.46,$13.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001501,EAP,Custom 27001501,,Sleeve Knee Regular Dvt,$388.00,$0.00,$388.00,$0.00,$276.92,$0.00,$0.00,$276.92,$276.92,$0.00,$388.00,$0.00,$194.00,$307.30,$310.40,$0.00,$0.00,$0.00,$0.00,$0.00
27001502,EAP,Custom 27001502,,Sleeve Knee X-large Dvt,$469.00,$0.00,$469.00,$0.00,$334.73,$0.00,$0.00,$334.73,$334.73,$0.00,$469.00,$0.00,$234.50,$371.45,$375.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001503,EAP,Custom 27001503,,Sleeve Thigh Regular Dvt,$238.00,$0.00,$238.00,$0.00,$169.86,$0.00,$0.00,$169.86,$169.86,$0.00,$238.00,$0.00,$119.00,$188.50,$190.40,$0.00,$0.00,$0.00,$0.00,$0.00
27001618,EAP,Custom 27001618,,Triadyne Ii (bed),$737.00,$0.00,$737.00,$0.00,$526.00,$0.00,$0.00,$526.00,$526.00,$0.00,$737.00,$0.00,$368.50,$583.70,$589.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001620,EAP,Custom 27001620,,Fluidair Elite (bed),$772.00,$0.00,$772.00,$0.00,$550.98,$0.00,$0.00,$550.98,$550.98,$0.00,$772.00,$0.00,$386.00,$611.42,$617.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001635,EAP,Custom 27001635,,Tube Salem Sump 48 Lengt,$36.00,$0.00,$36.00,$0.00,$25.69,$0.00,$0.00,$25.69,$25.69,$0.00,$36.00,$0.00,$18.00,$28.51,$28.80,$0.00,$0.00,$0.00,$0.00,$0.00
27001636,EAP,Custom 27001636,,Set Urinary Drain W/conta,$20.00,$0.00,$20.00,$0.00,$14.27,$0.00,$0.00,$14.27,$14.27,$0.00,$20.00,$0.00,$10.00,$15.84,$16.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001641,EAP,Custom 27001641,,Tray Douch Disposable,$69.00,$0.00,$69.00,$0.00,$49.25,$0.00,$0.00,$49.25,$49.25,$0.00,$69.00,$0.00,$34.50,$54.65,$55.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001644,EAP,Custom 27001644,,Tray Foley Preconnected 1,$52.00,$0.00,$52.00,$0.00,$37.11,$0.00,$0.00,$37.11,$37.11,$0.00,$52.00,$0.00,$26.00,$41.18,$41.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001645,EAP,Custom 27001645,,Tray Foley Perconnected 1,$52.00,$0.00,$52.00,$0.00,$37.11,$0.00,$0.00,$37.11,$37.11,$0.00,$52.00,$0.00,$26.00,$41.18,$41.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001647,EAP,Custom 27001647,,Arrow Super/extreme Cath Kit,$802.00,$0.00,$802.00,$0.00,$572.39,$0.00,$0.00,$572.39,$572.39,$0.00,$802.00,$0.00,$401.00,$635.18,$641.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001649,EAP,Custom 27001649,,Central Line Dressing Tray,$34.00,$0.00,$34.00,$0.00,$24.27,$0.00,$0.00,$24.27,$24.27,$0.00,$34.00,$0.00,$17.00,$26.93,$27.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001650,EAP,Custom 27001650,,Continuous Cardiac O/put Swans,$604.00,$0.00,$604.00,$0.00,$431.07,$0.00,$0.00,$431.07,$431.07,$0.00,$604.00,$0.00,$302.00,$478.37,$483.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001652,EAP,Custom 27001652,,Pressure Transclucer Kits,$329.00,$0.00,$329.00,$0.00,$234.81,$0.00,$0.00,$234.81,$234.81,$0.00,$329.00,$0.00,$164.50,$260.57,$263.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001653,EAP,Custom 27001653,,Percutaneous Introducer Kits,"$2,364.00",$0.00,"$2,364.00",$0.00,"$1,687.19",$0.00,$0.00,"$1,687.19","$1,687.19",$0.00,"$2,364.00",$0.00,"$1,182.00","$1,872.29","$1,891.20",$0.00,$0.00,$0.00,$0.00,$0.00
27001655,EAP,Custom 27001655,,Sutures,$211.00,$0.00,$211.00,$0.00,$150.59,$0.00,$0.00,$150.59,$150.59,$0.00,$211.00,$0.00,$105.50,$167.11,$168.80,$0.00,$0.00,$0.00,$0.00,$0.00
27001657,EAP,Custom 27001657,,Swan Ganz Catheters,$604.00,$0.00,$604.00,$0.00,$431.07,$0.00,$0.00,$431.07,$431.07,$0.00,$604.00,$0.00,$302.00,$478.37,$483.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001658,EAP,Custom 27001658,,Guidewire .35x.68cm,$64.00,$0.00,$64.00,$0.00,$45.68,$0.00,$0.00,$45.68,$45.68,$0.00,$64.00,$0.00,$32.00,$50.69,$51.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001660,EAP,Custom 27001660,,Huber Needle,$17.00,$0.00,$17.00,$0.00,$12.13,$0.00,$0.00,$12.13,$12.13,$0.00,$17.00,$0.00,$8.50,$13.46,$13.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001665,EAP,Custom 27001665,,14fx15cm Schon Xl Dbl Lmn Vasc,"$6,497.00",$0.00,"$6,497.00",$0.00,"$4,636.91",$0.00,$0.00,"$4,636.91","$4,636.91",$0.00,"$6,497.00",$0.00,"$3,248.50","$5,145.62","$5,197.60",$0.00,$0.00,$0.00,$0.00,$0.00
27001666,EAP,Custom 27001666,,14fx24cm Schon Xl Dbl Lmn Vasc,"$6,497.00",$0.00,"$6,497.00",$0.00,"$4,636.91",$0.00,$0.00,"$4,636.91","$4,636.91",$0.00,"$6,497.00",$0.00,"$3,248.50","$5,145.62","$5,197.60",$0.00,$0.00,$0.00,$0.00,$0.00
27001667,EAP,Custom 27001667,,14fx20cm Schon Xl Dbl Lmn Vasc,"$6,497.00",$0.00,"$6,497.00",$0.00,"$4,636.91",$0.00,$0.00,"$4,636.91","$4,636.91",$0.00,"$6,497.00",$0.00,"$3,248.50","$5,145.62","$5,197.60",$0.00,$0.00,$0.00,$0.00,$0.00
27001670,EAP,Custom 27001670,,Twist Lock Cath Gard Catheter,$80.00,$0.00,$80.00,$0.00,$57.10,$0.00,$0.00,$57.10,$57.10,$0.00,$80.00,$0.00,$40.00,$63.36,$64.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001671,EAP,Custom 27001671,,Needles 18 Ga/7cm (cook),$30.00,$0.00,$30.00,$0.00,$21.41,$0.00,$0.00,$21.41,$21.41,$0.00,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001672,EAP,Custom 27001672,,Cook Tlc Tray,$457.00,$0.00,$457.00,$0.00,$326.16,$0.00,$0.00,$326.16,$326.16,$0.00,$457.00,$0.00,$228.50,$361.94,$365.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001675,EAP,Custom 27001675,,Tubes Extension Plain Pla,$5.00,$0.00,$5.00,$0.00,$3.57,$0.00,$0.00,$3.57,$3.57,$0.00,$5.00,$0.00,$2.50,$3.96,$4.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001679,EAP,Custom 27001679,,Meter Astech Peak Flow,$94.00,$0.00,$94.00,$0.00,$67.09,$0.00,$0.00,$67.09,$67.09,$0.00,$94.00,$0.00,$47.00,$74.45,$75.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001692,EAP,Custom 27001692,,Catheter  Thoracic 28fr,$40.00,$0.00,$40.00,$0.00,$28.55,$0.00,$0.00,$28.55,$28.55,$0.00,$40.00,$0.00,$20.00,$31.68,$32.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001693,EAP,Custom 27001693,,Catheter Thoracic 32fr,$43.00,$0.00,$43.00,$0.00,$30.69,$0.00,$0.00,$30.69,$30.69,$0.00,$43.00,$0.00,$21.50,$34.06,$34.40,$0.00,$0.00,$0.00,$0.00,$0.00
27001694,EAP,Custom 27001694,,Catheter Thoracic 36fr,$43.00,$0.00,$43.00,$0.00,$30.69,$0.00,$0.00,$30.69,$30.69,$0.00,$43.00,$0.00,$21.50,$34.06,$34.40,$0.00,$0.00,$0.00,$0.00,$0.00
27001695,EAP,HCPCS C1729,,Catheter Foley 5cc 14fr,$19.00,$0.00,$19.00,$10.32,$13.56,$0.00,$3.27,$13.56,$13.56,$3.33,$19.00,$0.00,$9.50,$15.05,$15.20,$0.00,$2.97,$0.00,$3.02,$0.00
27001696,EAP,HCPCS C1729,,Catheter Coude Size 14fr,$109.00,$0.00,$109.00,$59.19,$77.79,$0.00,$18.78,$77.79,$77.79,$19.09,$109.00,$0.00,$54.50,$86.33,$87.20,$0.00,$17.06,$0.00,$17.35,$0.00
27001697,EAP,HCPCS C1729,,Catheter Coude Size 16fr,$109.00,$0.00,$109.00,$59.19,$77.79,$0.00,$18.78,$77.79,$77.79,$19.09,$109.00,$0.00,$54.50,$86.33,$87.20,$0.00,$17.06,$0.00,$17.35,$0.00
27001698,EAP,Custom 27001698,,Artery Arterial Catheriza,$102.00,$0.00,$102.00,$0.00,$72.80,$0.00,$0.00,$72.80,$72.80,$0.00,$102.00,$0.00,$51.00,$80.78,$81.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001699,EAP,Custom 27001699,,Artery Radial Catherizati,$69.00,$0.00,$69.00,$0.00,$49.25,$0.00,$0.00,$49.25,$49.25,$0.00,$69.00,$0.00,$34.50,$54.65,$55.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001700,EAP,Custom 27001700,,Tube Salem Sump 48 Lengt,$38.00,$0.00,$38.00,$0.00,$27.12,$0.00,$0.00,$27.12,$27.12,$0.00,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
27001701,EAP,Custom 27001701,,Tube Salem Silicone Size,$38.00,$0.00,$38.00,$0.00,$27.12,$0.00,$0.00,$27.12,$27.12,$0.00,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
27001702,EAP,Custom 27001702,,Tubes Salem Sump 48 Leng,$38.00,$0.00,$38.00,$0.00,$27.12,$0.00,$0.00,$27.12,$27.12,$0.00,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
27001703,EAP,Custom 27001703,,Kit Tracheotomy Care Ster,$30.00,$0.00,$30.00,$0.00,$21.41,$0.00,$0.00,$21.41,$21.41,$0.00,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001706,EAP,Custom 27001706,,Tray Catheter Insrtn Dulm,"$1,009.00",$0.00,"$1,009.00",$0.00,$720.12,$0.00,$0.00,$720.12,$720.12,$0.00,"$1,009.00",$0.00,$504.50,$799.13,$807.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001707,EAP,Custom 27001707,,Scapel Surg W/handle Attached,$142.00,$0.00,$142.00,$0.00,$101.35,$0.00,$0.00,$101.35,$101.35,$0.00,$142.00,$0.00,$71.00,$112.46,$113.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001709,EAP,Custom 27001709,,Triconnector With Valve,$39.00,$0.00,$39.00,$0.00,$27.83,$0.00,$0.00,$27.83,$27.83,$0.00,$39.00,$0.00,$19.50,$30.89,$31.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001713,EAP,Custom 27001713,,Pouch Active Life Squib Drain,$17.00,$0.00,$17.00,$0.00,$12.13,$0.00,$0.00,$12.13,$12.13,$0.00,$17.00,$0.00,$8.50,$13.46,$13.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001715,EAP,Custom 27001715,,Cable Patient 12 Pin #r53,$300.00,$0.00,$300.00,$0.00,$214.11,$0.00,$0.00,$214.11,$214.11,$0.00,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001716,EAP,Custom 27001716,,Electrodes Operative,$122.00,$0.00,$122.00,$0.00,$87.07,$0.00,$0.00,$87.07,$87.07,$0.00,$122.00,$0.00,$61.00,$96.62,$97.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001721,EAP,Custom 27001721,,Pouch Fecal Incontinence,$52.00,$0.00,$52.00,$0.00,$37.11,$0.00,$0.00,$37.11,$37.11,$0.00,$52.00,$0.00,$26.00,$41.18,$41.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001722,EAP,Custom 27001722,,Kit Pressure Monitoring T,$177.00,$0.00,$177.00,$0.00,$126.32,$0.00,$0.00,$126.32,$126.32,$0.00,$177.00,$0.00,$88.50,$140.18,$141.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001723,EAP,Custom 27001723,,Kit  Pressure Monitoring,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$178.43,$178.43,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001725,EAP,Custom 27001725,,Bag 1000ml Pump Set,$39.00,$0.00,$39.00,$0.00,$27.83,$0.00,$0.00,$27.83,$27.83,$0.00,$39.00,$0.00,$19.50,$30.89,$31.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001726,EAP,Custom 27001726,,Needle Port-cath 20ga X 1,$16.00,$0.00,$16.00,$0.00,$11.42,$0.00,$0.00,$11.42,$11.42,$0.00,$16.00,$0.00,$8.00,$12.67,$12.80,$0.00,$0.00,$0.00,$0.00,$0.00
27001727,EAP,Custom 27001727,,Chest Unit Drainage Pleur,$455.00,$0.00,$455.00,$0.00,$324.73,$0.00,$0.00,$324.73,$324.73,$0.00,$455.00,$0.00,$227.50,$360.36,$364.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001732,EAP,Custom 27001732,,Dressing X-large,$697.00,$0.00,$697.00,$0.00,$497.45,$0.00,$0.00,$497.45,$497.45,$0.00,$697.00,$0.00,$348.50,$552.02,$557.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001733,EAP,Custom 27001733,,Trac Dressing Xl,$157.00,$0.00,$157.00,$0.00,$112.05,$0.00,$0.00,$112.05,$112.05,$0.00,$157.00,$0.00,$78.50,$124.34,$125.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001735,EAP,Custom 27001735,,Tube Feeding Ng 8fr 36in Entri,$65.00,$0.00,$65.00,$0.00,$46.39,$0.00,$0.00,$46.39,$46.39,$0.00,$65.00,$0.00,$32.50,$51.48,$52.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001736,EAP,Custom 27001736,,Kit Triple Lumen Catheter,$697.00,$0.00,$697.00,$0.00,$497.45,$0.00,$0.00,$497.45,$497.45,$0.00,$697.00,$0.00,$348.50,$552.02,$557.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001740,EAP,Custom 27001740,,Tube Trach #8 Dct,$335.00,$0.00,$335.00,$0.00,$239.09,$0.00,$0.00,$239.09,$239.09,$0.00,$335.00,$0.00,$167.50,$265.32,$268.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001741,EAP,Custom 27001741,,Tube Trach #6 Dct,$335.00,$0.00,$335.00,$0.00,$239.09,$0.00,$0.00,$239.09,$239.09,$0.00,$335.00,$0.00,$167.50,$265.32,$268.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001742,EAP,Custom 27001742,,Tube Trach #10 Dct,$335.00,$0.00,$335.00,$0.00,$239.09,$0.00,$0.00,$239.09,$239.09,$0.00,$335.00,$0.00,$167.50,$265.32,$268.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001743,EAP,Custom 27001743,,Tube Tracheostomy 4-dcfs,$326.00,$0.00,$326.00,$0.00,$232.67,$0.00,$0.00,$232.67,$232.67,$0.00,$326.00,$0.00,$163.00,$258.19,$260.80,$0.00,$0.00,$0.00,$0.00,$0.00
27001744,EAP,Custom 27001744,,Filter Set 0.22 Micron,$20.00,$0.00,$20.00,$0.00,$14.27,$0.00,$0.00,$14.27,$14.27,$0.00,$20.00,$0.00,$10.00,$15.84,$16.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001746,EAP,Custom 27001746,,Tray Foley Preconnected 1,$59.00,$0.00,$59.00,$0.00,$42.11,$0.00,$0.00,$42.11,$42.11,$0.00,$59.00,$0.00,$29.50,$46.73,$47.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001747,EAP,Custom 27001747,,Tray Foley Perconnected 1,$59.00,$0.00,$59.00,$0.00,$42.11,$0.00,$0.00,$42.11,$42.11,$0.00,$59.00,$0.00,$29.50,$46.73,$47.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001748,EAP,Custom 27001748,,Tray Thoracentesis Dispos,$101.00,$0.00,$101.00,$0.00,$72.08,$0.00,$0.00,$72.08,$72.08,$0.00,$101.00,$0.00,$50.50,$79.99,$80.80,$0.00,$0.00,$0.00,$0.00,$0.00
27001763,EAP,Custom 27001763,,Sleeve Knee Regular Dvt,$388.00,$0.00,$388.00,$0.00,$276.92,$0.00,$0.00,$276.92,$276.92,$0.00,$388.00,$0.00,$194.00,$307.30,$310.40,$0.00,$0.00,$0.00,$0.00,$0.00
27001764,EAP,Custom 27001764,,Sleeve Knee X-large Dvt,$469.00,$0.00,$469.00,$0.00,$334.73,$0.00,$0.00,$334.73,$334.73,$0.00,$469.00,$0.00,$234.50,$371.45,$375.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001765,EAP,Custom 27001765,,Sleeve Thigh Regular Dvt,$238.00,$0.00,$238.00,$0.00,$169.86,$0.00,$0.00,$169.86,$169.86,$0.00,$238.00,$0.00,$119.00,$188.50,$190.40,$0.00,$0.00,$0.00,$0.00,$0.00
27001766,EAP,Custom 27001766,,Sleeve Thigh X-large Dvt,$284.00,$0.00,$284.00,$0.00,$202.69,$0.00,$0.00,$202.69,$202.69,$0.00,$284.00,$0.00,$142.00,$224.93,$227.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001768,EAP,HCPCS A4300,,Temporary Ven Cath Removal,$438.00,$0.00,$438.00,$0.00,$312.60,$0.00,$0.00,$312.60,$312.60,$0.00,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$0.00,$0.00,$0.00,$0.00
27001769,EAP,Custom 27001769,,Tray Catheter Insrtn Dulm,"$1,048.00",$0.00,"$1,048.00",$0.00,$747.96,$0.00,$0.00,$747.96,$747.96,$0.00,"$1,048.00",$0.00,$524.00,$830.02,$838.40,$0.00,$0.00,$0.00,$0.00,$0.00
27001770,EAP,Custom 27001770,,Central Line Dressing Tray,$47.00,$0.00,$47.00,$0.00,$33.54,$0.00,$0.00,$33.54,$33.54,$0.00,$47.00,$0.00,$23.50,$37.22,$37.60,$0.00,$0.00,$0.00,$0.00,$0.00
27001771,EAP,Custom 27001771,,Catheter Repair Kit,$803.00,$0.00,$803.00,$0.00,$573.10,$0.00,$0.00,$573.10,$573.10,$0.00,$803.00,$0.00,$401.50,$635.98,$642.40,$0.00,$0.00,$0.00,$0.00,$0.00
27001773,EAP,Custom 27001773,,Occult Blood Supply,$40.00,$0.00,$40.00,$0.00,$28.55,$0.00,$0.00,$28.55,$28.55,$0.00,$40.00,$0.00,$20.00,$31.68,$32.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001778,EAP,Custom 27001778,,Needle Port-cath 20ga X 1,$36.00,$0.00,$36.00,$0.00,$25.69,$0.00,$0.00,$25.69,$25.69,$0.00,$36.00,$0.00,$18.00,$28.51,$28.80,$0.00,$0.00,$0.00,$0.00,$0.00
27001779,EAP,Custom 27001779,,Tray Catheter Urethral 14,$16.00,$0.00,$16.00,$0.00,$11.42,$0.00,$0.00,$11.42,$11.42,$0.00,$16.00,$0.00,$8.00,$12.67,$12.80,$0.00,$0.00,$0.00,$0.00,$0.00
27001781,EAP,Custom 27001781,,Ace Wrap,$34.00,$0.00,$34.00,$0.00,$24.27,$0.00,$0.00,$24.27,$24.27,$0.00,$34.00,$0.00,$17.00,$26.93,$27.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001782,EAP,Custom 27001782,,Splint,$64.00,$0.00,$64.00,$0.00,$45.68,$0.00,$0.00,$45.68,$45.68,$0.00,$64.00,$0.00,$32.00,$50.69,$51.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001783,EAP,Custom 27001783,,Splint - Supply,$266.00,$0.00,$266.00,$0.00,$189.84,$0.00,$0.00,$189.84,$189.84,$0.00,$266.00,$0.00,$133.00,$210.67,$212.80,$0.00,$0.00,$0.00,$0.00,$0.00
27001785,EAP,Custom 27001785,,Ace Wrap,$34.00,$0.00,$34.00,$0.00,$24.27,$0.00,$0.00,$24.27,$24.27,$0.00,$34.00,$0.00,$17.00,$26.93,$27.20,$0.00,$0.00,$0.00,$0.00,$0.00
27001786,EAP,Custom 27001786,,Ace Wrap Supply,$31.00,$0.00,$31.00,$0.00,$22.12,$0.00,$0.00,$22.12,$22.12,$0.00,$31.00,$0.00,$15.50,$24.55,$24.80,$0.00,$0.00,$0.00,$0.00,$0.00
27001788,EAP,Custom 27001788,,Wrist Brace,$60.00,$0.00,$60.00,$0.00,$42.82,$0.00,$0.00,$42.82,$42.82,$0.00,$60.00,$0.00,$30.00,$47.52,$48.00,$0.00,$0.00,$0.00,$0.00,$0.00
27001789,EAP,Custom 27001789,,Sling/fig. 8,$83.00,$0.00,$83.00,$0.00,$59.24,$0.00,$0.00,$59.24,$59.24,$0.00,$83.00,$0.00,$41.50,$65.74,$66.40,$0.00,$0.00,$0.00,$0.00,$0.00
27002257,EAP,Custom 27002257,,Cast Application Supply,$567.00,$0.00,$567.00,$0.00,$404.67,$0.00,$0.00,$404.67,$404.67,$0.00,$567.00,$0.00,$283.50,$449.06,$453.60,$0.00,$0.00,$0.00,$0.00,$0.00
27002259,EAP,Custom 27002259,,Sling,$108.00,$0.00,$108.00,$0.00,$77.08,$0.00,$0.00,$77.08,$77.08,$0.00,$108.00,$0.00,$54.00,$85.54,$86.40,$0.00,$0.00,$0.00,$0.00,$0.00
27002260,EAP,Custom 27002260,,Ace Bandage,$14.00,$0.00,$14.00,$0.00,$9.99,$0.00,$0.00,$9.99,$9.99,$0.00,$14.00,$0.00,$7.00,$11.09,$11.20,$0.00,$0.00,$0.00,$0.00,$0.00
27002261,EAP,Custom 27002261,,Urinary Drainage Bag,$28.00,$0.00,$28.00,$0.00,$19.98,$0.00,$0.00,$19.98,$19.98,$0.00,$28.00,$0.00,$14.00,$22.18,$22.40,$0.00,$0.00,$0.00,$0.00,$0.00
27002263,EAP,Custom 27002263,,Gastric Lavage Kit,$234.00,$0.00,$234.00,$0.00,$167.01,$0.00,$0.00,$167.01,$167.01,$0.00,$234.00,$0.00,$117.00,$185.33,$187.20,$0.00,$0.00,$0.00,$0.00,$0.00
27002265,EAP,Custom 27002265,,Pelvic Tray,$138.00,$0.00,$138.00,$0.00,$98.49,$0.00,$0.00,$98.49,$98.49,$0.00,$138.00,$0.00,$69.00,$109.30,$110.40,$0.00,$0.00,$0.00,$0.00,$0.00
27002266,EAP,Custom 27002266,,Peak Flow Meter,$343.00,$0.00,$343.00,$0.00,$244.80,$0.00,$0.00,$244.80,$244.80,$0.00,$343.00,$0.00,$171.50,$271.66,$274.40,$0.00,$0.00,$0.00,$0.00,$0.00
27002267,EAP,Custom 27002267,,Ortho Traction Pins,$408.00,$0.00,$408.00,$0.00,$291.19,$0.00,$0.00,$291.19,$291.19,$0.00,$408.00,$0.00,$204.00,$323.14,$326.40,$0.00,$0.00,$0.00,$0.00,$0.00
27002268,EAP,Custom 27002268,,Ace Bandage,$147.00,$0.00,$147.00,$0.00,$104.91,$0.00,$0.00,$104.91,$104.91,$0.00,$147.00,$0.00,$73.50,$116.42,$117.60,$0.00,$0.00,$0.00,$0.00,$0.00
27002473,EAP,Custom 27002473,,Angiocath Iv Bb 18gx1.25in Nw,$19.00,$0.00,$19.00,$0.00,$13.56,$0.00,$0.00,$13.56,$13.56,$0.00,$19.00,$0.00,$9.50,$15.05,$15.20,$0.00,$0.00,$0.00,$0.00,$0.00
27002510,EAP,Custom 27002510,,Nuva Ring,$10.00,$0.00,$10.00,$0.00,$7.14,$0.00,$0.00,$7.14,$7.14,$0.00,$10.00,$0.00,$5.00,$7.92,$8.00,$0.00,$0.00,$0.00,$0.00,$0.00
27002515,EAP,Custom 27002515,,Clavical Straps,$28.00,$0.00,$28.00,$0.00,$19.98,$0.00,$0.00,$19.98,$19.98,$0.00,$28.00,$0.00,$14.00,$22.18,$22.40,$0.00,$0.00,$0.00,$0.00,$0.00
27002516,EAP,Custom 27002516,,Fiberglass Casting,$129.00,$0.00,$129.00,$0.00,$92.07,$0.00,$0.00,$92.07,$92.07,$0.00,$129.00,$0.00,$64.50,$102.17,$103.20,$0.00,$0.00,$0.00,$0.00,$0.00
27002517,EAP,Custom 27002517,,Ankle Stirrup,$149.00,$0.00,$149.00,$0.00,$106.34,$0.00,$0.00,$106.34,$106.34,$0.00,$149.00,$0.00,$74.50,$118.01,$119.20,$0.00,$0.00,$0.00,$0.00,$0.00
27002518,EAP,Custom 27002518,,Knee Immobilizer,$232.00,$0.00,$232.00,$0.00,$165.58,$0.00,$0.00,$165.58,$165.58,$0.00,$232.00,$0.00,$116.00,$183.74,$185.60,$0.00,$0.00,$0.00,$0.00,$0.00
27002519,EAP,Custom 27002519,,Philadephia Collar,$193.00,$0.00,$193.00,$0.00,$137.74,$0.00,$0.00,$137.74,$137.74,$0.00,$193.00,$0.00,$96.50,$152.86,$154.40,$0.00,$0.00,$0.00,$0.00,$0.00
27002520,EAP,Custom 27002520,,Cervical Collar,$43.00,$0.00,$43.00,$0.00,$30.69,$0.00,$0.00,$30.69,$30.69,$0.00,$43.00,$0.00,$21.50,$34.06,$34.40,$0.00,$0.00,$0.00,$0.00,$0.00
27002521,EAP,Custom 27002521,,Pavlik Harness,$178.00,$0.00,$178.00,$0.00,$127.04,$0.00,$0.00,$127.04,$127.04,$0.00,$178.00,$0.00,$89.00,$140.98,$142.40,$0.00,$0.00,$0.00,$0.00,$0.00
27002522,EAP,Custom 27002522,,Cast Shoe,$51.00,$0.00,$51.00,$0.00,$36.40,$0.00,$0.00,$36.40,$36.40,$0.00,$51.00,$0.00,$25.50,$40.39,$40.80,$0.00,$0.00,$0.00,$0.00,$0.00
27002523,EAP,Custom 27002523,,Shoulder Immobilizer,$232.00,$0.00,$232.00,$0.00,$165.58,$0.00,$0.00,$165.58,$165.58,$0.00,$232.00,$0.00,$116.00,$183.74,$185.60,$0.00,$0.00,$0.00,$0.00,$0.00
27002524,EAP,Custom 27002524,,Post Op Shoe,$38.00,$0.00,$38.00,$0.00,$27.12,$0.00,$0.00,$27.12,$27.12,$0.00,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
27002525,EAP,Custom 27002525,,Hinged Knee Brace,$705.00,$0.00,$705.00,$0.00,$503.16,$0.00,$0.00,$503.16,$503.16,$0.00,$705.00,$0.00,$352.50,$558.36,$564.00,$0.00,$0.00,$0.00,$0.00,$0.00
27002526,EAP,Custom 27002526,,Sling/fig. 8,$88.00,$0.00,$88.00,$0.00,$62.81,$0.00,$0.00,$62.81,$62.81,$0.00,$88.00,$0.00,$44.00,$69.70,$70.40,$0.00,$0.00,$0.00,$0.00,$0.00
27002527,EAP,Custom 27002527,,Hinged Knee Sleeve,$129.00,$0.00,$129.00,$0.00,$92.07,$0.00,$0.00,$92.07,$92.07,$0.00,$129.00,$0.00,$64.50,$102.17,$103.20,$0.00,$0.00,$0.00,$0.00,$0.00
27002528,EAP,Custom 27002528,,Universal Knee Brace,$728.00,$0.00,$728.00,$0.00,$519.57,$0.00,$0.00,$519.57,$519.57,$0.00,$728.00,$0.00,$364.00,$576.58,$582.40,$0.00,$0.00,$0.00,$0.00,$0.00
27002529,EAP,Custom 27002529,,Universal Knee Brace,$371.00,$0.00,$371.00,$0.00,$264.78,$0.00,$0.00,$264.78,$264.78,$0.00,$371.00,$0.00,$185.50,$293.83,$296.80,$0.00,$0.00,$0.00,$0.00,$0.00
27002530,EAP,Custom 27002530,,3d Walking Boot,$197.00,$0.00,$197.00,$0.00,$140.60,$0.00,$0.00,$140.60,$140.60,$0.00,$197.00,$0.00,$98.50,$156.02,$157.60,$0.00,$0.00,$0.00,$0.00,$0.00
27002531,EAP,Custom 27002531,,Knee Immobilizer,$232.00,$0.00,$232.00,$0.00,$165.58,$0.00,$0.00,$165.58,$165.58,$0.00,$232.00,$0.00,$116.00,$183.74,$185.60,$0.00,$0.00,$0.00,$0.00,$0.00
27002532,EAP,Custom 27002532,,Shoulder Immobilizer,$232.00,$0.00,$232.00,$0.00,$165.58,$0.00,$0.00,$165.58,$165.58,$0.00,$232.00,$0.00,$116.00,$183.74,$185.60,$0.00,$0.00,$0.00,$0.00,$0.00
27002533,EAP,Custom 27002533,,Philadelphia Collar,$207.00,$0.00,$207.00,$0.00,$147.74,$0.00,$0.00,$147.74,$147.74,$0.00,$207.00,$0.00,$103.50,$163.94,$165.60,$0.00,$0.00,$0.00,$0.00,$0.00
27002534,EAP,Custom 27002534,,Soft Collar,$130.00,$0.00,$130.00,$0.00,$92.78,$0.00,$0.00,$92.78,$92.78,$0.00,$130.00,$0.00,$65.00,$102.96,$104.00,$0.00,$0.00,$0.00,$0.00,$0.00
27002535,EAP,Custom 27002535,,Arm Sling,$94.00,$0.00,$94.00,$0.00,$67.09,$0.00,$0.00,$67.09,$67.09,$0.00,$94.00,$0.00,$47.00,$74.45,$75.20,$0.00,$0.00,$0.00,$0.00,$0.00
27002536,EAP,Custom 27002536,,Active Ankle Brace,$417.00,$0.00,$417.00,$0.00,$297.61,$0.00,$0.00,$297.61,$297.61,$0.00,$417.00,$0.00,$208.50,$330.26,$333.60,$0.00,$0.00,$0.00,$0.00,$0.00
27002537,EAP,Custom 27002537,,Buck's Traction Splint,$172.00,$0.00,$172.00,$0.00,$122.76,$0.00,$0.00,$122.76,$122.76,$0.00,$172.00,$0.00,$86.00,$136.22,$137.60,$0.00,$0.00,$0.00,$0.00,$0.00
27002538,EAP,Custom 27002538,,Knee Brace,$762.00,$0.00,$762.00,$0.00,$543.84,$0.00,$0.00,$543.84,$543.84,$0.00,$762.00,$0.00,$381.00,$603.50,$609.60,$0.00,$0.00,$0.00,$0.00,$0.00
27002539,EAP,Custom 27002539,,Jacksonville Sling,$88.00,$0.00,$88.00,$0.00,$62.81,$0.00,$0.00,$62.81,$62.81,$0.00,$88.00,$0.00,$44.00,$69.70,$70.40,$0.00,$0.00,$0.00,$0.00,$0.00
27002541,EAP,Custom 27002541,,Cast Over Wrap,$94.00,$0.00,$94.00,$0.00,$67.09,$0.00,$0.00,$67.09,$67.09,$0.00,$94.00,$0.00,$47.00,$74.45,$75.20,$0.00,$0.00,$0.00,$0.00,$0.00
27002542,EAP,Custom 27002542,,Cast Over Wrap-fiberglass,$117.00,$0.00,$117.00,$0.00,$83.50,$0.00,$0.00,$83.50,$83.50,$0.00,$117.00,$0.00,$58.50,$92.66,$93.60,$0.00,$0.00,$0.00,$0.00,$0.00
27002543,EAP,Custom 27002543,,Sandbag,$19.00,$0.00,$19.00,$0.00,$13.56,$0.00,$0.00,$13.56,$13.56,$0.00,$19.00,$0.00,$9.50,$15.05,$15.20,$0.00,$0.00,$0.00,$0.00,$0.00
27002544,EAP,Custom 27002544,,Aspen Collar,$154.00,$0.00,$154.00,$0.00,$109.91,$0.00,$0.00,$109.91,$109.91,$0.00,$154.00,$0.00,$77.00,$121.97,$123.20,$0.00,$0.00,$0.00,$0.00,$0.00
27002545,EAP,Custom 27002545,,Miami J. Collar,$195.00,$0.00,$195.00,$0.00,$139.17,$0.00,$0.00,$139.17,$139.17,$0.00,$195.00,$0.00,$97.50,$154.44,$156.00,$0.00,$0.00,$0.00,$0.00,$0.00
27002546,EAP,Custom 27002546,,Atlas Collar,$194.00,$0.00,$194.00,$0.00,$138.46,$0.00,$0.00,$138.46,$138.46,$0.00,$194.00,$0.00,$97.00,$153.65,$155.20,$0.00,$0.00,$0.00,$0.00,$0.00
27002547,EAP,Custom 27002547,,Pediatric Pmt Collar,$63.00,$0.00,$63.00,$0.00,$44.96,$0.00,$0.00,$44.96,$44.96,$0.00,$63.00,$0.00,$31.50,$49.90,$50.40,$0.00,$0.00,$0.00,$0.00,$0.00
27002548,EAP,Custom 27002548,,Abduction Pillow,$96.00,$0.00,$96.00,$0.00,$68.52,$0.00,$0.00,$68.52,$68.52,$0.00,$96.00,$0.00,$48.00,$76.03,$76.80,$0.00,$0.00,$0.00,$0.00,$0.00
27002549,EAP,Custom 27002549,,Neoprene Knee Sleeve,$68.00,$0.00,$68.00,$0.00,$48.53,$0.00,$0.00,$48.53,$48.53,$0.00,$68.00,$0.00,$34.00,$53.86,$54.40,$0.00,$0.00,$0.00,$0.00,$0.00
27002550,EAP,Custom 27002550,,Cuff And Collar,$38.00,$0.00,$38.00,$0.00,$27.12,$0.00,$0.00,$27.12,$27.12,$0.00,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
27002551,EAP,Custom 27002551,,Post Op Shoe,$38.00,$0.00,$38.00,$0.00,$27.12,$0.00,$0.00,$27.12,$27.12,$0.00,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
27002552,EAP,Custom 27002552,,Tlso Pre Fab,"$2,419.00",$0.00,"$2,419.00",$0.00,"$1,726.44",$0.00,$0.00,"$1,726.44","$1,726.44",$0.00,"$2,419.00",$0.00,"$1,209.50","$1,915.85","$1,935.20",$0.00,$0.00,$0.00,$0.00,$0.00
27002564,EAP,CPT® C1751,,"Cvp Kit, Double Lumen",$569.00,$0.00,$569.00,$308.97,$406.10,$0.00,$98.04,$406.10,$406.10,$99.63,$569.00,$0.00,$284.50,$450.65,$455.20,$0.00,$89.05,$0.00,$90.58,$0.00
27002565,EAP,Custom 27002565,,"Ett, Double-lumen",$837.00,$0.00,$837.00,$0.00,$597.37,$0.00,$0.00,$597.37,$597.37,$0.00,$837.00,$0.00,$418.50,$662.90,$669.60,$0.00,$0.00,$0.00,$0.00,$0.00
27002572,EAP,Custom 27002572,,Introducer Kit,$261.00,$0.00,$261.00,$0.00,$186.28,$0.00,$0.00,$186.28,$186.28,$0.00,$261.00,$0.00,$130.50,$206.71,$208.80,$0.00,$0.00,$0.00,$0.00,$0.00
27002573,EAP,Custom 27002573,,Radial Artery Set (arrow),$92.00,$0.00,$92.00,$0.00,$65.66,$0.00,$0.00,$65.66,$65.66,$0.00,$92.00,$0.00,$46.00,$72.86,$73.60,$0.00,$0.00,$0.00,$0.00,$0.00
27002576,EAP,Custom 27002576,,Epidural Tray,$316.00,$0.00,$316.00,$0.00,$225.53,$0.00,$0.00,$225.53,$225.53,$0.00,$316.00,$0.00,$158.00,$250.27,$252.80,$0.00,$0.00,$0.00,$0.00,$0.00
27002579,EAP,Custom 27002579,,Level One Inserts,$101.00,$0.00,$101.00,$0.00,$72.08,$0.00,$0.00,$72.08,$72.08,$0.00,$101.00,$0.00,$50.50,$79.99,$80.80,$0.00,$0.00,$0.00,$0.00,$0.00
27002587,EAP,HCPCS C1751,,Kit Quad Lumen Cather,$148.00,$0.00,$148.00,$80.36,$105.63,$0.00,$25.50,$105.63,$105.63,$25.91,$148.00,$0.00,$74.00,$117.22,$118.40,$0.00,$23.16,$0.00,$23.56,$0.00
27002589,EAP,Custom 27002589,,Aintree Intubation Changer,$83.00,$0.00,$83.00,$0.00,$59.24,$0.00,$0.00,$59.24,$59.24,$0.00,$83.00,$0.00,$41.50,$65.74,$66.40,$0.00,$0.00,$0.00,$0.00,$0.00
27002590,EAP,Custom 27002590,,Kit Triple Lumen Catheter,$646.00,$0.00,$646.00,$0.00,$461.05,$0.00,$0.00,$461.05,$461.05,$0.00,$646.00,$0.00,$323.00,$511.63,$516.80,$0.00,$0.00,$0.00,$0.00,$0.00
27002593,EAP,Custom 27002593,,"Cvp Kit, Double Lumen",$307.00,$0.00,$307.00,$0.00,$219.11,$0.00,$0.00,$219.11,$219.11,$0.00,$307.00,$0.00,$153.50,$243.14,$245.60,$0.00,$0.00,$0.00,$0.00,$0.00
27002594,EAP,Custom 27002594,,"Transducer And Tubing, Disp",$60.00,$0.00,$60.00,$0.00,$42.82,$0.00,$0.00,$42.82,$42.82,$0.00,$60.00,$0.00,$30.00,$47.52,$48.00,$0.00,$0.00,$0.00,$0.00,$0.00
27002595,EAP,Custom 27002595,,Fiberoptic Intubation Scope,$321.00,$0.00,$321.00,$0.00,$229.10,$0.00,$0.00,$229.10,$229.10,$0.00,$321.00,$0.00,$160.50,$254.23,$256.80,$0.00,$0.00,$0.00,$0.00,$0.00
27002598,EAP,Custom 27002598,,Air Embolism Detector,$69.00,$0.00,$69.00,$0.00,$49.25,$0.00,$0.00,$49.25,$49.25,$0.00,$69.00,$0.00,$34.50,$54.65,$55.20,$0.00,$0.00,$0.00,$0.00,$0.00
27002599,EAP,Custom 27002599,,Introducer Kit,$64.00,$0.00,$64.00,$0.00,$45.68,$0.00,$0.00,$45.68,$45.68,$0.00,$64.00,$0.00,$32.00,$50.69,$51.20,$0.00,$0.00,$0.00,$0.00,$0.00
27002600,EAP,Custom 27002600,,Radial Artery Set (arrow),$20.00,$0.00,$20.00,$0.00,$14.27,$0.00,$0.00,$14.27,$14.27,$0.00,$20.00,$0.00,$10.00,$15.84,$16.00,$0.00,$0.00,$0.00,$0.00,$0.00
27002602,EAP,Custom 27002602,,Disp. Sao2 Probe,$61.00,$0.00,$61.00,$0.00,$43.54,$0.00,$0.00,$43.54,$43.54,$0.00,$61.00,$0.00,$30.50,$48.31,$48.80,$0.00,$0.00,$0.00,$0.00,$0.00
27002604,EAP,Custom 27002604,,Epidural Tray,$132.00,$0.00,$132.00,$0.00,$94.21,$0.00,$0.00,$94.21,$94.21,$0.00,$132.00,$0.00,$66.00,$104.54,$105.60,$0.00,$0.00,$0.00,$0.00,$0.00
27002605,EAP,Custom 27002605,,Spinal Tray,$190.00,$0.00,$190.00,$0.00,$135.60,$0.00,$0.00,$135.60,$135.60,$0.00,$190.00,$0.00,$95.00,$150.48,$152.00,$0.00,$0.00,$0.00,$0.00,$0.00
27002609,EAP,Custom 27002609,,Thoracotomy Tray,$132.00,$0.00,$132.00,$0.00,$94.21,$0.00,$0.00,$94.21,$94.21,$0.00,$132.00,$0.00,$66.00,$104.54,$105.60,$0.00,$0.00,$0.00,$0.00,$0.00
27002610,EAP,Custom 27002610,,Tracheotomy Tray,$394.00,$0.00,$394.00,$0.00,$281.20,$0.00,$0.00,$281.20,$281.20,$0.00,$394.00,$0.00,$197.00,$312.05,$315.20,$0.00,$0.00,$0.00,$0.00,$0.00
27002618,EAP,Custom 27002618,,Ioban 2 Drape Incise Smal,$40.00,$0.00,$40.00,$0.00,$28.55,$0.00,$0.00,$28.55,$28.55,$0.00,$40.00,$0.00,$20.00,$31.68,$32.00,$0.00,$0.00,$0.00,$0.00,$0.00
27002620,EAP,Custom 27002620,,Ioban 2 Drape Incise Larg,$434.00,$0.00,$434.00,$0.00,$309.75,$0.00,$0.00,$309.75,$309.75,$0.00,$434.00,$0.00,$217.00,$343.73,$347.20,$0.00,$0.00,$0.00,$0.00,$0.00
27002621,EAP,Custom 27002621,,Needle Spinal 18ga,$15.00,$0.00,$15.00,$0.00,$10.71,$0.00,$0.00,$10.71,$10.71,$0.00,$15.00,$0.00,$7.50,$11.88,$12.00,$0.00,$0.00,$0.00,$0.00,$0.00
27002624,EAP,Custom 27002624,,Catheter Texas Large,$10.00,$0.00,$10.00,$0.00,$7.14,$0.00,$0.00,$7.14,$7.14,$0.00,$10.00,$0.00,$5.00,$7.92,$8.00,$0.00,$0.00,$0.00,$0.00,$0.00
27002625,EAP,Custom 27002625,,Catheter Thoracic 32fr,$40.00,$0.00,$40.00,$0.00,$28.55,$0.00,$0.00,$28.55,$28.55,$0.00,$40.00,$0.00,$20.00,$31.68,$32.00,$0.00,$0.00,$0.00,$0.00,$0.00
27002626,EAP,Custom 27002626,,Catheter Thoracic 36fr,$40.00,$0.00,$40.00,$0.00,$28.55,$0.00,$0.00,$28.55,$28.55,$0.00,$40.00,$0.00,$20.00,$31.68,$32.00,$0.00,$0.00,$0.00,$0.00,$0.00
27002627,EAP,Custom 27002627,,Catheter Urethral Two-eye,$10.00,$0.00,$10.00,$0.00,$7.14,$0.00,$0.00,$7.14,$7.14,$0.00,$10.00,$0.00,$5.00,$7.92,$8.00,$0.00,$0.00,$0.00,$0.00,$0.00
27002628,EAP,Custom 27002628,,Artery Arterial Catheriza,$102.00,$0.00,$102.00,$0.00,$72.80,$0.00,$0.00,$72.80,$72.80,$0.00,$102.00,$0.00,$51.00,$80.78,$81.60,$0.00,$0.00,$0.00,$0.00,$0.00
27002629,EAP,Custom 27002629,,Artery Radial Catherizati,$65.00,$0.00,$65.00,$0.00,$46.39,$0.00,$0.00,$46.39,$46.39,$0.00,$65.00,$0.00,$32.50,$51.48,$52.00,$0.00,$0.00,$0.00,$0.00,$0.00
27002630,EAP,Custom 27002630,,Tube Salem Sump 48 Lengt,$36.00,$0.00,$36.00,$0.00,$25.69,$0.00,$0.00,$25.69,$25.69,$0.00,$36.00,$0.00,$18.00,$28.51,$28.80,$0.00,$0.00,$0.00,$0.00,$0.00
27002631,EAP,Custom 27002631,,Tube Salem Silicone Size,$36.00,$0.00,$36.00,$0.00,$25.69,$0.00,$0.00,$25.69,$25.69,$0.00,$36.00,$0.00,$18.00,$28.51,$28.80,$0.00,$0.00,$0.00,$0.00,$0.00
27002632,EAP,Custom 27002632,,Tubes Salem Sump 48 Leng,$36.00,$0.00,$36.00,$0.00,$25.69,$0.00,$0.00,$25.69,$25.69,$0.00,$36.00,$0.00,$18.00,$28.51,$28.80,$0.00,$0.00,$0.00,$0.00,$0.00
27002636,EAP,Custom 27002636,,Bag Drainage Becker,$197.00,$0.00,$197.00,$0.00,$140.60,$0.00,$0.00,$140.60,$140.60,$0.00,$197.00,$0.00,$98.50,$156.02,$157.60,$0.00,$0.00,$0.00,$0.00,$0.00
27002637,EAP,Custom 27002637,,Scapel Surg W/handle Atta,$142.00,$0.00,$142.00,$0.00,$101.35,$0.00,$0.00,$101.35,$101.35,$0.00,$142.00,$0.00,$71.00,$112.46,$113.60,$0.00,$0.00,$0.00,$0.00,$0.00
27002640,EAP,Custom 27002640,,Set Blood Administration,$34.00,$0.00,$34.00,$0.00,$24.27,$0.00,$0.00,$24.27,$24.27,$0.00,$34.00,$0.00,$17.00,$26.93,$27.20,$0.00,$0.00,$0.00,$0.00,$0.00
27002643,EAP,Custom 27002643,,Cream Baza 5oz,$59.00,$0.00,$59.00,$0.00,$42.11,$0.00,$0.00,$42.11,$42.11,$0.00,$59.00,$0.00,$29.50,$46.73,$47.20,$0.00,$0.00,$0.00,$0.00,$0.00
27002646,EAP,Custom 27002646,,Electrodes Operative,$266.00,$0.00,$266.00,$0.00,$189.84,$0.00,$0.00,$189.84,$189.84,$0.00,$266.00,$0.00,$133.00,$210.67,$212.80,$0.00,$0.00,$0.00,$0.00,$0.00
27002647,EAP,Custom 27002647,,Valve Anti-reflux Salem S,$46.00,$0.00,$46.00,$0.00,$32.83,$0.00,$0.00,$32.83,$32.83,$0.00,$46.00,$0.00,$23.00,$36.43,$36.80,$0.00,$0.00,$0.00,$0.00,$0.00
27002649,EAP,Custom 27002649,,Kit Thoracotomy,$203.00,$0.00,$203.00,$0.00,$144.88,$0.00,$0.00,$144.88,$144.88,$0.00,$203.00,$0.00,$101.50,$160.78,$162.40,$0.00,$0.00,$0.00,$0.00,$0.00
27002653,EAP,Custom 27002653,,Set Pediatric Measured Fi,$39.00,$0.00,$39.00,$0.00,$27.83,$0.00,$0.00,$27.83,$27.83,$0.00,$39.00,$0.00,$19.50,$30.89,$31.20,$0.00,$0.00,$0.00,$0.00,$0.00
27002656,EAP,Custom 27002656,,Pouch Fecal Incontinence,$50.00,$0.00,$50.00,$0.00,$35.69,$0.00,$0.00,$35.69,$35.69,$0.00,$50.00,$0.00,$25.00,$39.60,$40.00,$0.00,$0.00,$0.00,$0.00,$0.00
27002657,EAP,Custom 27002657,,Kit Pressure Monitoring T,$163.00,$0.00,$163.00,$0.00,$116.33,$0.00,$0.00,$116.33,$116.33,$0.00,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$0.00,$0.00,$0.00,$0.00
27002658,EAP,Custom 27002658,,Transducer Disp For Icp,$70.00,$0.00,$70.00,$0.00,$49.96,$0.00,$0.00,$49.96,$49.96,$0.00,$70.00,$0.00,$35.00,$55.44,$56.00,$0.00,$0.00,$0.00,$0.00,$0.00
27002659,EAP,Custom 27002659,,Kit Transducer Monitoring,$313.00,$0.00,$313.00,$0.00,$223.39,$0.00,$0.00,$223.39,$223.39,$0.00,$313.00,$0.00,$156.50,$247.90,$250.40,$0.00,$0.00,$0.00,$0.00,$0.00
27002660,EAP,Custom 27002660,,Kit Pressure Monitoring,$234.00,$0.00,$234.00,$0.00,$167.01,$0.00,$0.00,$167.01,$167.01,$0.00,$234.00,$0.00,$117.00,$185.33,$187.20,$0.00,$0.00,$0.00,$0.00,$0.00
27002662,EAP,Custom 27002662,,Bag 1000ml Pump Set,$37.00,$0.00,$37.00,$0.00,$26.41,$0.00,$0.00,$26.41,$26.41,$0.00,$37.00,$0.00,$18.50,$29.30,$29.60,$0.00,$0.00,$0.00,$0.00,$0.00
27002663,EAP,Custom 27002663,,Kit Pecutaneous Introduce,$276.00,$0.00,$276.00,$0.00,$196.98,$0.00,$0.00,$196.98,$196.98,$0.00,$276.00,$0.00,$138.00,$218.59,$220.80,$0.00,$0.00,$0.00,$0.00,$0.00
27002664,EAP,Custom 27002664,,Chest Unit Drainage Pleur,$420.00,$0.00,$420.00,$0.00,$299.75,$0.00,$0.00,$299.75,$299.75,$0.00,$420.00,$0.00,$210.00,$332.64,$336.00,$0.00,$0.00,$0.00,$0.00,$0.00
27002665,EAP,Custom 27002665,,Chest Unit Dry Suction Sy,$309.00,$0.00,$309.00,$0.00,$220.53,$0.00,$0.00,$220.53,$220.53,$0.00,$309.00,$0.00,$154.50,$244.73,$247.20,$0.00,$0.00,$0.00,$0.00,$0.00
27002666,EAP,Custom 27002666,,Bag Auto-transfusion Ple,$245.00,$0.00,$245.00,$0.00,$174.86,$0.00,$0.00,$174.86,$174.86,$0.00,$245.00,$0.00,$122.50,$194.04,$196.00,$0.00,$0.00,$0.00,$0.00,$0.00
27002670,EAP,Custom 27002670,,Tube Feeding Ng 8fr 36in Entr,$61.00,$0.00,$61.00,$0.00,$43.54,$0.00,$0.00,$43.54,$43.54,$0.00,$61.00,$0.00,$30.50,$48.31,$48.80,$0.00,$0.00,$0.00,$0.00,$0.00
27002671,EAP,Custom 27002671,,Kit Triple Lumen Catheter,$646.00,$0.00,$646.00,$0.00,$461.05,$0.00,$0.00,$461.05,$461.05,$0.00,$646.00,$0.00,$323.00,$511.63,$516.80,$0.00,$0.00,$0.00,$0.00,$0.00
27002672,EAP,Custom 27002672,,Catheter Swan Ganz,$674.00,$0.00,$674.00,$0.00,$481.03,$0.00,$0.00,$481.03,$481.03,$0.00,$674.00,$0.00,$337.00,$533.81,$539.20,$0.00,$0.00,$0.00,$0.00,$0.00
27002673,EAP,Custom 27002673,,Delivery System Closed In,$141.00,$0.00,$141.00,$0.00,$100.63,$0.00,$0.00,$100.63,$100.63,$0.00,$141.00,$0.00,$70.50,$111.67,$112.80,$0.00,$0.00,$0.00,$0.00,$0.00
27002676,EAP,Custom 27002676,,Filter Set 0.22 Micron,$19.00,$0.00,$19.00,$0.00,$13.56,$0.00,$0.00,$13.56,$13.56,$0.00,$19.00,$0.00,$9.50,$15.05,$15.20,$0.00,$0.00,$0.00,$0.00,$0.00
27002677,EAP,Custom 27002677,,Tray Catheter Urethral 14,$16.00,$0.00,$16.00,$0.00,$11.42,$0.00,$0.00,$11.42,$11.42,$0.00,$16.00,$0.00,$8.00,$12.67,$12.80,$0.00,$0.00,$0.00,$0.00,$0.00
27002678,EAP,Custom 27002678,,Tray Foley Preconnected W,$42.00,$0.00,$42.00,$0.00,$29.98,$0.00,$0.00,$29.98,$29.98,$0.00,$42.00,$0.00,$21.00,$33.26,$33.60,$0.00,$0.00,$0.00,$0.00,$0.00
27002679,EAP,Custom 27002679,,Tray Foley Perconnected 1,$52.00,$0.00,$52.00,$0.00,$37.11,$0.00,$0.00,$37.11,$37.11,$0.00,$52.00,$0.00,$26.00,$41.18,$41.60,$0.00,$0.00,$0.00,$0.00,$0.00
27002681,EAP,Custom 27002681,,Tray Urine Meter 18fr,$85.00,$0.00,$85.00,$0.00,$60.66,$0.00,$0.00,$60.66,$60.66,$0.00,$85.00,$0.00,$42.50,$67.32,$68.00,$0.00,$0.00,$0.00,$0.00,$0.00
27002682,EAP,Custom 27002682,,Tray Thoracentesis Dispos,$216.00,$0.00,$216.00,$0.00,$154.16,$0.00,$0.00,$154.16,$154.16,$0.00,$216.00,$0.00,$108.00,$171.07,$172.80,$0.00,$0.00,$0.00,$0.00,$0.00
27002684,EAP,Custom 27002684,,Bag Drainage Ureteral,$92.00,$0.00,$92.00,$0.00,$65.66,$0.00,$0.00,$65.66,$65.66,$0.00,$92.00,$0.00,$46.00,$72.86,$73.60,$0.00,$0.00,$0.00,$0.00,$0.00
27002687,EAP,Custom 27002687,,Sleeve Knee Regular Dvt,$358.00,$0.00,$358.00,$0.00,$255.50,$0.00,$0.00,$255.50,$255.50,$0.00,$358.00,$0.00,$179.00,$283.54,$286.40,$0.00,$0.00,$0.00,$0.00,$0.00
27002688,EAP,Custom 27002688,,Sleeve Knee X-large Dvt,$439.00,$0.00,$439.00,$0.00,$313.31,$0.00,$0.00,$313.31,$313.31,$0.00,$439.00,$0.00,$219.50,$347.69,$351.20,$0.00,$0.00,$0.00,$0.00,$0.00
27002689,EAP,Custom 27002689,,Sleeve Thigh Regular Dvt,$512.00,$0.00,$512.00,$0.00,$365.41,$0.00,$0.00,$365.41,$365.41,$0.00,$512.00,$0.00,$256.00,$405.50,$409.60,$0.00,$0.00,$0.00,$0.00,$0.00
27002697,EAP,Custom 27002697,,Catheter  Suction Plastic 14,$10.00,$0.00,$10.00,$0.00,$7.14,$0.00,$0.00,$7.14,$7.14,$0.00,$10.00,$0.00,$5.00,$7.92,$8.00,$0.00,$0.00,$0.00,$0.00,$0.00
27002701,EAP,Custom 27002701,,Set Pediatric Micro Drip,$28.00,$0.00,$28.00,$0.00,$19.98,$0.00,$0.00,$19.98,$19.98,$0.00,$28.00,$0.00,$14.00,$22.18,$22.40,$0.00,$0.00,$0.00,$0.00,$0.00
27002702,EAP,Custom 27002702,,Set Pediatric Measured Fi,$39.00,$0.00,$39.00,$0.00,$27.83,$0.00,$0.00,$27.83,$27.83,$0.00,$39.00,$0.00,$19.50,$30.89,$31.20,$0.00,$0.00,$0.00,$0.00,$0.00
27002703,EAP,Custom 27002703,,Stockings Antiembolism Thigh,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$15.70,$15.70,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
27002704,EAP,Custom 27002704,,Stockings Antiembolism Thigh,$44.00,$0.00,$44.00,$0.00,$31.40,$0.00,$0.00,$31.40,$31.40,$0.00,$44.00,$0.00,$22.00,$34.85,$35.20,$0.00,$0.00,$0.00,$0.00,$0.00
27002705,EAP,Custom 27002705,,Stockings Antiembolism Thigh,$50.00,$0.00,$50.00,$0.00,$35.69,$0.00,$0.00,$35.69,$35.69,$0.00,$50.00,$0.00,$25.00,$39.60,$40.00,$0.00,$0.00,$0.00,$0.00,$0.00
27002706,EAP,Custom 27002706,,Stockings Antiembolish Ex,$36.00,$0.00,$36.00,$0.00,$25.69,$0.00,$0.00,$25.69,$25.69,$0.00,$36.00,$0.00,$18.00,$28.51,$28.80,$0.00,$0.00,$0.00,$0.00,$0.00
27002707,EAP,Custom 27002707,,Needle Port-cath 20ga X 1,$34.00,$0.00,$34.00,$0.00,$24.27,$0.00,$0.00,$24.27,$24.27,$0.00,$34.00,$0.00,$17.00,$26.93,$27.20,$0.00,$0.00,$0.00,$0.00,$0.00
27002708,EAP,Custom 27002708,,Tray Catheter Urethral 14,$16.00,$0.00,$16.00,$0.00,$11.42,$0.00,$0.00,$11.42,$11.42,$0.00,$16.00,$0.00,$8.00,$12.67,$12.80,$0.00,$0.00,$0.00,$0.00,$0.00
27002709,EAP,Custom 27002709,,Tray Foley Preconnected 1,$52.00,$0.00,$52.00,$0.00,$37.11,$0.00,$0.00,$37.11,$37.11,$0.00,$52.00,$0.00,$26.00,$41.18,$41.60,$0.00,$0.00,$0.00,$0.00,$0.00
27002710,EAP,Custom 27002710,,Bag Urine Leg,$15.00,$0.00,$15.00,$0.00,$10.71,$0.00,$0.00,$10.71,$10.71,$0.00,$15.00,$0.00,$7.50,$11.88,$12.00,$0.00,$0.00,$0.00,$0.00,$0.00
27002884,EAP,Custom 27002884,,Et/co2 Sensors,$34.00,$0.00,$34.00,$0.00,$24.27,$0.00,$0.00,$24.27,$24.27,$0.00,$34.00,$0.00,$17.00,$26.93,$27.20,$0.00,$0.00,$0.00,$0.00,$0.00
27002885,EAP,Custom 27002885,,Cpap Circuit,"$1,347.00",$0.00,"$1,347.00",$0.00,$961.35,$0.00,$0.00,$961.35,$961.35,$0.00,"$1,347.00",$0.00,$673.50,"$1,066.82","$1,077.60",$0.00,$0.00,$0.00,$0.00,$0.00
27002886,EAP,Custom 27002886,,Flutter Valve,$167.00,$0.00,$167.00,$0.00,$119.19,$0.00,$0.00,$119.19,$119.19,$0.00,$167.00,$0.00,$83.50,$132.26,$133.60,$0.00,$0.00,$0.00,$0.00,$0.00
27002892,EAP,Custom 27002892,,Fecal Occult Blood Supply,$40.00,$0.00,$40.00,$0.00,$28.55,$0.00,$0.00,$28.55,$28.55,$0.00,$40.00,$0.00,$20.00,$31.68,$32.00,$0.00,$0.00,$0.00,$0.00,$0.00
27002893,EAP,Custom 27002893,,Tubes Extension Plain Pla,$15.00,$0.00,$15.00,$0.00,$10.71,$0.00,$0.00,$10.71,$10.71,$0.00,$15.00,$0.00,$7.50,$11.88,$12.00,$0.00,$0.00,$0.00,$0.00,$0.00
27002908,EAP,Custom 27002908,,Kit Iv Start Custom,$20.00,$0.00,$20.00,$0.00,$14.27,$0.00,$0.00,$14.27,$14.27,$0.00,$20.00,$0.00,$10.00,$15.84,$16.00,$0.00,$0.00,$0.00,$0.00,$0.00
27002938,EAP,Custom 27002938,,Inflation Device,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$178.43,$178.43,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
27002939,EAP,Custom 27002939,,"Catheter, Thrombectomy","$1,076.00",$0.00,"$1,076.00",$0.00,$767.94,$0.00,$0.00,$767.94,$767.94,$0.00,"$1,076.00",$0.00,$538.00,$852.19,$860.80,$0.00,$0.00,$0.00,$0.00,$0.00
27002940,EAP,HCPCS C1751,,Catheter Iv 180ga X 1x1/4,$16.00,$0.00,$16.00,$8.69,$11.42,$0.00,$2.76,$11.42,$11.42,$2.80,$16.00,$0.00,$8.00,$12.67,$12.80,$0.00,$2.50,$0.00,$2.55,$0.00
27002941,EAP,HCPCS C1751,,Catheter Iv 20ga X 1,$16.00,$0.00,$16.00,$8.69,$11.42,$0.00,$2.76,$11.42,$11.42,$2.80,$16.00,$0.00,$8.00,$12.67,$12.80,$0.00,$2.50,$0.00,$2.55,$0.00
27002942,EAP,HCPCS C1751,,Catheter Iv 22ga X 1,$16.00,$0.00,$16.00,$8.69,$11.42,$0.00,$2.76,$11.42,$11.42,$2.80,$16.00,$0.00,$8.00,$12.67,$12.80,$0.00,$2.50,$0.00,$2.55,$0.00
27002943,EAP,Custom 27002943,,Ioban 2 Drape Incise Medi,$56.00,$0.00,$56.00,$0.00,$39.97,$0.00,$0.00,$39.97,$39.97,$0.00,$56.00,$0.00,$28.00,$44.35,$44.80,$0.00,$0.00,$0.00,$0.00,$0.00
27002944,EAP,Custom 27002944,,Needle Spinal 18ga,$15.00,$0.00,$15.00,$0.00,$10.71,$0.00,$0.00,$10.71,$10.71,$0.00,$15.00,$0.00,$7.50,$11.88,$12.00,$0.00,$0.00,$0.00,$0.00,$0.00
27002945,EAP,Custom 27002945,,Lancet  Grady Orange,$10.00,$0.00,$10.00,$0.00,$7.14,$0.00,$0.00,$7.14,$7.14,$0.00,$10.00,$0.00,$5.00,$7.92,$8.00,$0.00,$0.00,$0.00,$0.00,$0.00
27002946,EAP,HCPCS C1751,,Catheter Iv Cut-down 14g,$44.00,$0.00,$44.00,$23.89,$31.40,$0.00,$7.58,$31.40,$31.40,$7.70,$44.00,$0.00,$22.00,$34.85,$35.20,$0.00,$6.89,$0.00,$7.00,$0.00
27002947,EAP,HCPCS C1751,,Catheter Iv Cut-down 8 1,$44.00,$0.00,$44.00,$23.89,$31.40,$0.00,$7.58,$31.40,$31.40,$7.70,$44.00,$0.00,$22.00,$34.85,$35.20,$0.00,$6.89,$0.00,$7.00,$0.00
27002951,EAP,HCPCS C1729,,Catheter Foley 5cc 14fr,$19.00,$0.00,$19.00,$10.32,$13.56,$0.00,$3.27,$13.56,$13.56,$3.33,$19.00,$0.00,$9.50,$15.05,$15.20,$0.00,$2.97,$0.00,$3.02,$0.00
27002952,EAP,HCPCS C1729,,Catheter Foley 16fr,$18.00,$0.00,$18.00,$9.77,$12.85,$0.00,$3.10,$12.85,$12.85,$3.15,$18.00,$0.00,$9.00,$14.26,$14.40,$0.00,$2.82,$0.00,$2.87,$0.00
27002953,EAP,HCPCS C1729,,Catheter Foley 5cc 18fr,$19.00,$0.00,$19.00,$10.32,$13.56,$0.00,$3.27,$13.56,$13.56,$3.33,$19.00,$0.00,$9.50,$15.05,$15.20,$0.00,$2.97,$0.00,$3.02,$0.00
27002954,EAP,Custom 27002954,,Tube Salem Silicone Size,$36.00,$0.00,$36.00,$0.00,$25.69,$0.00,$0.00,$25.69,$25.69,$0.00,$36.00,$0.00,$18.00,$28.51,$28.80,$0.00,$0.00,$0.00,$0.00,$0.00
27002955,EAP,Custom 27002955,,Tubes Salem Sump 48 Leng,$36.00,$0.00,$36.00,$0.00,$25.69,$0.00,$0.00,$25.69,$25.69,$0.00,$36.00,$0.00,$18.00,$28.51,$28.80,$0.00,$0.00,$0.00,$0.00,$0.00
27002957,EAP,Custom 27002957,,Scaple Surg W/handle Atta,$152.00,$0.00,$152.00,$0.00,$108.48,$0.00,$0.00,$108.48,$108.48,$0.00,$152.00,$0.00,$76.00,$120.38,$121.60,$0.00,$0.00,$0.00,$0.00,$0.00
27002958,EAP,Custom 27002958,,Scaple Surg W/handle Attached,$15.00,$0.00,$15.00,$0.00,$10.71,$0.00,$0.00,$10.71,$10.71,$0.00,$15.00,$0.00,$7.50,$11.88,$12.00,$0.00,$0.00,$0.00,$0.00,$0.00
27002959,EAP,Custom 27002959,,Bore Y Extension Small,$26.00,$0.00,$26.00,$0.00,$18.56,$0.00,$0.00,$18.56,$18.56,$0.00,$26.00,$0.00,$13.00,$20.59,$20.80,$0.00,$0.00,$0.00,$0.00,$0.00
27002961,EAP,Custom 27002961,,Pad Defi,$50.00,$0.00,$50.00,$0.00,$35.69,$0.00,$0.00,$35.69,$35.69,$0.00,$50.00,$0.00,$25.00,$39.60,$40.00,$0.00,$0.00,$0.00,$0.00,$0.00
27002962,EAP,Custom 27002962,,Valve Reflux,$3.00,$0.00,$3.00,$0.00,$2.14,$0.00,$0.00,$2.14,$2.14,$0.00,$3.00,$0.00,$1.50,$2.38,$2.40,$0.00,$0.00,$0.00,$0.00,$0.00
27002963,EAP,Custom 27002963,,"Filter,micron .22 Fluid A",$14.00,$0.00,$14.00,$0.00,$9.99,$0.00,$0.00,$9.99,$9.99,$0.00,$14.00,$0.00,$7.00,$11.09,$11.20,$0.00,$0.00,$0.00,$0.00,$0.00
27002964,EAP,Custom 27002964,,Set Scalp  Vein Infusion 21 G,$3.00,$0.00,$3.00,$0.00,$2.14,$0.00,$0.00,$2.14,$2.14,$0.00,$3.00,$0.00,$1.50,$2.38,$2.40,$0.00,$0.00,$0.00,$0.00,$0.00
27002965,EAP,Custom 27002965,,Mask Sub-micron Small,$10.00,$0.00,$10.00,$0.00,$7.14,$0.00,$0.00,$7.14,$7.14,$0.00,$10.00,$0.00,$5.00,$7.92,$8.00,$0.00,$0.00,$0.00,$0.00,$0.00
27002966,EAP,Custom 27002966,,Kit Triple Lumen Catheter,$646.00,$0.00,$646.00,$0.00,$461.05,$0.00,$0.00,$461.05,$461.05,$0.00,$646.00,$0.00,$323.00,$511.63,$516.80,$0.00,$0.00,$0.00,$0.00,$0.00
27002967,EAP,Custom 27002967,,Catheter Swan Ganz,$674.00,$0.00,$674.00,$0.00,$481.03,$0.00,$0.00,$481.03,$481.03,$0.00,$674.00,$0.00,$337.00,$533.81,$539.20,$0.00,$0.00,$0.00,$0.00,$0.00
27002968,EAP,Custom 27002968,,Probe V-pacing,"$1,403.00",$0.00,"$1,403.00",$0.00,"$1,001.32",$0.00,$0.00,"$1,001.32","$1,001.32",$0.00,"$1,403.00",$0.00,$701.50,"$1,111.18","$1,122.40",$0.00,$0.00,$0.00,$0.00,$0.00
27002969,EAP,Custom 27002969,,Filter Set 0.22 Micron,$10.00,$0.00,$10.00,$0.00,$7.14,$0.00,$0.00,$7.14,$7.14,$0.00,$10.00,$0.00,$5.00,$7.92,$8.00,$0.00,$0.00,$0.00,$0.00,$0.00
27002970,EAP,Custom 27002970,,Tray Foley Preconnected 1,$59.00,$0.00,$59.00,$0.00,$42.11,$0.00,$0.00,$42.11,$42.11,$0.00,$59.00,$0.00,$29.50,$46.73,$47.20,$0.00,$0.00,$0.00,$0.00,$0.00
27002971,EAP,Custom 27002971,,Tray Foley Perconnected 1,$14.00,$0.00,$14.00,$0.00,$9.99,$0.00,$0.00,$9.99,$9.99,$0.00,$14.00,$0.00,$7.00,$11.09,$11.20,$0.00,$0.00,$0.00,$0.00,$0.00
27002972,EAP,Custom 27002972,,Bag Urine Leg,$15.00,$0.00,$15.00,$0.00,$10.71,$0.00,$0.00,$10.71,$10.71,$0.00,$15.00,$0.00,$7.50,$11.88,$12.00,$0.00,$0.00,$0.00,$0.00,$0.00
27002973,EAP,Custom 27002973,,Pounches Sterilization 12,$10.00,$0.00,$10.00,$0.00,$7.14,$0.00,$0.00,$7.14,$7.14,$0.00,$10.00,$0.00,$5.00,$7.92,$8.00,$0.00,$0.00,$0.00,$0.00,$0.00
27002974,EAP,Custom 27002974,,Bag Drainage Ureteral,$103.00,$0.00,$103.00,$0.00,$73.51,$0.00,$0.00,$73.51,$73.51,$0.00,$103.00,$0.00,$51.50,$81.58,$82.40,$0.00,$0.00,$0.00,$0.00,$0.00
27002975,EAP,Custom 27002975,,Needle Hypodermic Sterile,$10.00,$0.00,$10.00,$0.00,$7.14,$0.00,$0.00,$7.14,$7.14,$0.00,$10.00,$0.00,$5.00,$7.92,$8.00,$0.00,$0.00,$0.00,$0.00,$0.00
27002976,EAP,Custom 27002976,,Drape Half,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$4.28,$4.28,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
27002978,EAP,Custom 27002978,,Jcd 5.0-38-20,$17.00,$0.00,$17.00,$0.00,$12.13,$0.00,$0.00,$12.13,$12.13,$0.00,$17.00,$0.00,$8.50,$13.46,$13.60,$0.00,$0.00,$0.00,$0.00,$0.00
27002979,EAP,Custom 27002979,,Jcd 7.0-38-20,$17.00,$0.00,$17.00,$0.00,$12.13,$0.00,$0.00,$12.13,$12.13,$0.00,$17.00,$0.00,$8.50,$13.46,$13.60,$0.00,$0.00,$0.00,$0.00,$0.00
27002980,EAP,Custom 27002980,,Jcd 8.0-38-20,$38.00,$0.00,$38.00,$0.00,$27.12,$0.00,$0.00,$27.12,$27.12,$0.00,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
27002982,EAP,Custom 27002982,,Avantiplus Introducer 6fr 23cm,$80.00,$0.00,$80.00,$0.00,$57.10,$0.00,$0.00,$57.10,$57.10,$0.00,$80.00,$0.00,$40.00,$63.36,$64.00,$0.00,$0.00,$0.00,$0.00,$0.00
27002984,EAP,Custom 27002984,,Nail Cleaner Plastic Non-steri,$65.00,$0.00,$65.00,$0.00,$46.39,$0.00,$0.00,$46.39,$46.39,$0.00,$65.00,$0.00,$32.50,$51.48,$52.00,$0.00,$0.00,$0.00,$0.00,$0.00
27002985,EAP,Custom 27002985,,Super Arrow Flex Introducer-c,$425.00,$0.00,$425.00,$0.00,$303.32,$0.00,$0.00,$303.32,$303.32,$0.00,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$0.00,$0.00,$0.00,$0.00
27002986,EAP,Custom 27002986,,6fr-24cm Flexsheath Introducer,$185.00,$0.00,$185.00,$0.00,$132.03,$0.00,$0.00,$132.03,$132.03,$0.00,$185.00,$0.00,$92.50,$146.52,$148.00,$0.00,$0.00,$0.00,$0.00,$0.00
27002987,EAP,Custom 27002987,,8fr-35cm Flexsheath Introducer,$185.00,$0.00,$185.00,$0.00,$132.03,$0.00,$0.00,$132.03,$132.03,$0.00,$185.00,$0.00,$92.50,$146.52,$148.00,$0.00,$0.00,$0.00,$0.00,$0.00
27002990,EAP,Custom 27002990,,Adapter Morse - Y,$80.00,$0.00,$80.00,$0.00,$57.10,$0.00,$0.00,$57.10,$57.10,$0.00,$80.00,$0.00,$40.00,$63.36,$64.00,$0.00,$0.00,$0.00,$0.00,$0.00
27002991,EAP,Custom 27002991,,Drape C-arm 42 X 64,$20.00,$0.00,$20.00,$0.00,$14.27,$0.00,$0.00,$14.27,$14.27,$0.00,$20.00,$0.00,$10.00,$15.84,$16.00,$0.00,$0.00,$0.00,$0.00,$0.00
27002993,EAP,Custom 27002993,,Kit Catheter Suction 14fr,$810.00,$0.00,$810.00,$0.00,$578.10,$0.00,$0.00,$578.10,$578.10,$0.00,$810.00,$0.00,$405.00,$641.52,$648.00,$0.00,$0.00,$0.00,$0.00,$0.00
27002994,EAP,Custom 27002994,,Kit Percutaneous Introducer,$810.00,$0.00,$810.00,$0.00,$578.10,$0.00,$0.00,$578.10,$578.10,$0.00,$810.00,$0.00,$405.00,$641.52,$648.00,$0.00,$0.00,$0.00,$0.00,$0.00
27002995,EAP,Custom 27002995,,Kanguru Web,$64.00,$0.00,$64.00,$0.00,$45.68,$0.00,$0.00,$45.68,$45.68,$0.00,$64.00,$0.00,$32.00,$50.69,$51.20,$0.00,$0.00,$0.00,$0.00,$0.00
27003005,EAP,Custom 27003005,,Filter Set 0.22 Micron,$19.00,$0.00,$19.00,$0.00,$13.56,$0.00,$0.00,$13.56,$13.56,$0.00,$19.00,$0.00,$9.50,$15.05,$15.20,$0.00,$0.00,$0.00,$0.00,$0.00
27003006,EAP,Custom 27003006,,Tray Foley Preconnected 1,$56.00,$0.00,$56.00,$0.00,$39.97,$0.00,$0.00,$39.97,$39.97,$0.00,$56.00,$0.00,$28.00,$44.35,$44.80,$0.00,$0.00,$0.00,$0.00,$0.00
27003007,EAP,Custom 27003007,,Tray Foley Perconnected 1,$59.00,$0.00,$59.00,$0.00,$42.11,$0.00,$0.00,$42.11,$42.11,$0.00,$59.00,$0.00,$29.50,$46.73,$47.20,$0.00,$0.00,$0.00,$0.00,$0.00
27003008,EAP,Custom 27003008,,Central Line Dressing Tray,$49.00,$0.00,$49.00,$0.00,$34.97,$0.00,$0.00,$34.97,$34.97,$0.00,$49.00,$0.00,$24.50,$38.81,$39.20,$0.00,$0.00,$0.00,$0.00,$0.00
27003028,EAP,Custom 27003028,,Lumbo-sacral Support,$39.00,$0.00,$39.00,$0.00,$27.83,$0.00,$0.00,$27.83,$27.83,$0.00,$39.00,$0.00,$19.50,$30.89,$31.20,$0.00,$0.00,$0.00,$0.00,$0.00
27003040,EAP,Custom 27003040,,"Walker, For Platform Only",$243.00,$0.00,$243.00,$0.00,$173.43,$0.00,$0.00,$173.43,$173.43,$0.00,$243.00,$0.00,$121.50,$192.46,$194.40,$0.00,$0.00,$0.00,$0.00,$0.00
27003045,EAP,Custom 27003045,,Foot Plate-prefb,$577.00,$0.00,$577.00,$0.00,$411.80,$0.00,$0.00,$411.80,$411.80,$0.00,$577.00,$0.00,$288.50,$456.98,$461.60,$0.00,$0.00,$0.00,$0.00,$0.00
27003049,EAP,Custom 27003049,,Dressing Stick,$31.00,$0.00,$31.00,$0.00,$22.12,$0.00,$0.00,$22.12,$22.12,$0.00,$31.00,$0.00,$15.50,$24.55,$24.80,$0.00,$0.00,$0.00,$0.00,$0.00
27003050,EAP,Custom 27003050,,Leg Lifter,$52.00,$0.00,$52.00,$0.00,$37.11,$0.00,$0.00,$37.11,$37.11,$0.00,$52.00,$0.00,$26.00,$41.18,$41.60,$0.00,$0.00,$0.00,$0.00,$0.00
27003051,EAP,Custom 27003051,,Reacher,$117.00,$0.00,$117.00,$0.00,$83.50,$0.00,$0.00,$83.50,$83.50,$0.00,$117.00,$0.00,$58.50,$92.66,$93.60,$0.00,$0.00,$0.00,$0.00,$0.00
27003053,EAP,Custom 27003053,,Abduction Pillow,$404.00,$0.00,$404.00,$0.00,$288.33,$0.00,$0.00,$288.33,$288.33,$0.00,$404.00,$0.00,$202.00,$319.97,$323.20,$0.00,$0.00,$0.00,$0.00,$0.00
27003054,EAP,Custom 27003054,,Compression Glove,$87.00,$0.00,$87.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$87.00,$0.00,$43.50,$68.90,$69.60,$0.00,$0.00,$0.00,$0.00,$0.00
27003055,EAP,Custom 27003055,,Dowel,$49.00,$0.00,$49.00,$0.00,$34.97,$0.00,$0.00,$34.97,$34.97,$0.00,$49.00,$0.00,$24.50,$38.81,$39.20,$0.00,$0.00,$0.00,$0.00,$0.00
27003063,EAP,Custom 27003063,,Simple Hand-based Splint,$52.00,$0.00,$52.00,$0.00,$37.11,$0.00,$0.00,$37.11,$37.11,$0.00,$52.00,$0.00,$26.00,$41.18,$41.60,$0.00,$0.00,$0.00,$0.00,$0.00
27003065,EAP,Custom 27003065,,Custom Finger Splint,$19.00,$0.00,$19.00,$0.00,$13.56,$0.00,$0.00,$13.56,$13.56,$0.00,$19.00,$0.00,$9.50,$15.05,$15.20,$0.00,$0.00,$0.00,$0.00,$0.00
27003069,EAP,Custom 27003069,,Compression Glove,$87.00,$0.00,$87.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$87.00,$0.00,$43.50,$68.90,$69.60,$0.00,$0.00,$0.00,$0.00,$0.00
27003070,EAP,Custom 27003070,,Dowel,$46.00,$0.00,$46.00,$0.00,$32.83,$0.00,$0.00,$32.83,$32.83,$0.00,$46.00,$0.00,$23.00,$36.43,$36.80,$0.00,$0.00,$0.00,$0.00,$0.00
27003073,EAP,Custom 27003073,,Foot Drop Splint,$233.00,$0.00,$233.00,$0.00,$166.29,$0.00,$0.00,$166.29,$166.29,$0.00,$233.00,$0.00,$116.50,$184.54,$186.40,$0.00,$0.00,$0.00,$0.00,$0.00
27003080,EAP,Custom 27003080,,Custom Finger Splint,$10.00,$0.00,$10.00,$0.00,$7.14,$0.00,$0.00,$7.14,$7.14,$0.00,$10.00,$0.00,$5.00,$7.92,$8.00,$0.00,$0.00,$0.00,$0.00,$0.00
27003081,EAP,Custom 27003081,,Safe Position Splint,$101.00,$0.00,$101.00,$0.00,$72.08,$0.00,$0.00,$72.08,$72.08,$0.00,$101.00,$0.00,$50.50,$79.99,$80.80,$0.00,$0.00,$0.00,$0.00,$0.00
27003084,EAP,Custom 27003084,,Compression Glove,$87.00,$0.00,$87.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$87.00,$0.00,$43.50,$68.90,$69.60,$0.00,$0.00,$0.00,$0.00,$0.00
27003085,EAP,Custom 27003085,,Dowel,$49.00,$0.00,$49.00,$0.00,$34.97,$0.00,$0.00,$34.97,$34.97,$0.00,$49.00,$0.00,$24.50,$38.81,$39.20,$0.00,$0.00,$0.00,$0.00,$0.00
27003087,EAP,Custom 27003087,,"Tubigrip, Per Piece",$36.00,$0.00,$36.00,$0.00,$25.69,$0.00,$0.00,$25.69,$25.69,$0.00,$36.00,$0.00,$18.00,$28.51,$28.80,$0.00,$0.00,$0.00,$0.00,$0.00
27003089,EAP,Custom 27003089,,Helsper Button,$710.00,$0.00,$710.00,$0.00,$506.73,$0.00,$0.00,$506.73,$506.73,$0.00,$710.00,$0.00,$355.00,$562.32,$568.00,$0.00,$0.00,$0.00,$0.00,$0.00
27003090,EAP,Custom 27003090,,Laryngectomy Tube,$667.00,$0.00,$667.00,$0.00,$476.04,$0.00,$0.00,$476.04,$476.04,$0.00,$667.00,$0.00,$333.50,$528.26,$533.60,$0.00,$0.00,$0.00,$0.00,$0.00
27003091,EAP,Custom 27003091,,Inhealth Advan.indwelling Pros,$859.00,$0.00,$859.00,$0.00,$613.07,$0.00,$0.00,$613.07,$613.07,$0.00,$859.00,$0.00,$429.50,$680.33,$687.20,$0.00,$0.00,$0.00,$0.00,$0.00
27003092,EAP,Custom 27003092,,Inhealth Indwelling Prosthesis,$878.00,$0.00,$878.00,$0.00,$626.63,$0.00,$0.00,$626.63,$626.63,$0.00,$878.00,$0.00,$439.00,$695.38,$702.40,$0.00,$0.00,$0.00,$0.00,$0.00
27003093,EAP,Custom 27003093,,Inhealth Low Pressure Prosthesis,$491.00,$0.00,$491.00,$0.00,$350.43,$0.00,$0.00,$350.43,$350.43,$0.00,$491.00,$0.00,$245.50,$388.87,$392.80,$0.00,$0.00,$0.00,$0.00,$0.00
27003094,EAP,Custom 27003094,,Duckbill Prosthesis,$309.00,$0.00,$309.00,$0.00,$220.53,$0.00,$0.00,$220.53,$220.53,$0.00,$309.00,$0.00,$154.50,$244.73,$247.20,$0.00,$0.00,$0.00,$0.00,$0.00
27003095,EAP,Custom 27003095,,Provox/atox Prosthesis,$893.00,$0.00,$893.00,$0.00,$637.33,$0.00,$0.00,$637.33,$637.33,$0.00,$893.00,$0.00,$446.50,$707.26,$714.40,$0.00,$0.00,$0.00,$0.00,$0.00
27003096,EAP,Custom 27003096,,Insufflation Test Kit,$863.00,$0.00,$863.00,$0.00,$615.92,$0.00,$0.00,$615.92,$615.92,$0.00,$863.00,$0.00,$431.50,$683.50,$690.40,$0.00,$0.00,$0.00,$0.00,$0.00
27003097,EAP,Custom 27003097,,Plug Insert,$339.00,$0.00,$339.00,$0.00,$241.94,$0.00,$0.00,$241.94,$241.94,$0.00,$339.00,$0.00,$169.50,$268.49,$271.20,$0.00,$0.00,$0.00,$0.00,$0.00
27003098,EAP,Custom 27003098,,Catheters,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$4.28,$4.28,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
27003100,EAP,Custom 27003100,,Barton-mayo Button,$849.00,$0.00,$849.00,$0.00,$605.93,$0.00,$0.00,$605.93,$605.93,$0.00,$849.00,$0.00,$424.50,$672.41,$679.20,$0.00,$0.00,$0.00,$0.00,$0.00
27003101,EAP,Custom 27003101,,Oral Tubing,$5.00,$0.00,$5.00,$0.00,$3.57,$0.00,$0.00,$3.57,$3.57,$0.00,$5.00,$0.00,$2.50,$3.96,$4.00,$0.00,$0.00,$0.00,$0.00,$0.00
27003103,EAP,Custom 27003103,,Occult Blood Supply,$42.00,$0.00,$42.00,$0.00,$29.98,$0.00,$0.00,$29.98,$29.98,$0.00,$42.00,$0.00,$21.00,$33.26,$33.60,$0.00,$0.00,$0.00,$0.00,$0.00
27003104,EAP,Custom 27003104,,Interceed Sup/admin,$424.00,$0.00,$424.00,$0.00,$302.61,$0.00,$0.00,$302.61,$302.61,$0.00,$424.00,$0.00,$212.00,$335.81,$339.20,$0.00,$0.00,$0.00,$0.00,$0.00
27003105,EAP,Custom 27003105,,Pudendal Kit,$102.00,$0.00,$102.00,$0.00,$72.80,$0.00,$0.00,$72.80,$72.80,$0.00,$102.00,$0.00,$51.00,$80.78,$81.60,$0.00,$0.00,$0.00,$0.00,$0.00
27003108,EAP,Custom 27003108,,Dressing Hemostasis,$441.00,$0.00,$441.00,$0.00,$314.74,$0.00,$0.00,$314.74,$314.74,$0.00,$441.00,$0.00,$220.50,$349.27,$352.80,$0.00,$0.00,$0.00,$0.00,$0.00
27003113,EAP,Custom 27003113,,Tegaderm Dressing,$51.00,$0.00,$51.00,$0.00,$36.40,$0.00,$0.00,$36.40,$36.40,$0.00,$51.00,$0.00,$25.50,$40.39,$40.80,$0.00,$0.00,$0.00,$0.00,$0.00
27003114,EAP,Custom 27003114,,Tegaderm Dressing,$20.00,$0.00,$20.00,$0.00,$14.27,$0.00,$0.00,$14.27,$14.27,$0.00,$20.00,$0.00,$10.00,$15.84,$16.00,$0.00,$0.00,$0.00,$0.00,$0.00
27003115,EAP,Custom 27003115,,"Wound Gel, Carrington",$103.00,$0.00,$103.00,$0.00,$73.51,$0.00,$0.00,$73.51,$73.51,$0.00,$103.00,$0.00,$51.50,$81.58,$82.40,$0.00,$0.00,$0.00,$0.00,$0.00
27003116,EAP,Custom 27003116,,"Kara Klenz, Wound Cleanser",$102.00,$0.00,$102.00,$0.00,$72.80,$0.00,$0.00,$72.80,$72.80,$0.00,$102.00,$0.00,$51.00,$80.78,$81.60,$0.00,$0.00,$0.00,$0.00,$0.00
27003117,EAP,Custom 27003117,,"Little Ones, White Collar 4x4",$39.00,$0.00,$39.00,$0.00,$27.83,$0.00,$0.00,$27.83,$27.83,$0.00,$39.00,$0.00,$19.50,$30.89,$31.20,$0.00,$0.00,$0.00,$0.00,$0.00
27003118,EAP,Custom 27003118,,"Pouch, Cut To Fit, Little Ones",$31.00,$0.00,$31.00,$0.00,$22.12,$0.00,$0.00,$22.12,$22.12,$0.00,$31.00,$0.00,$15.50,$24.55,$24.80,$0.00,$0.00,$0.00,$0.00,$0.00
27003119,EAP,Custom 27003119,,"Pouch, Active Life",$36.00,$0.00,$36.00,$0.00,$25.69,$0.00,$0.00,$25.69,$25.69,$0.00,$36.00,$0.00,$18.00,$28.51,$28.80,$0.00,$0.00,$0.00,$0.00,$0.00
27003120,EAP,Custom 27003120,,"Flange, Sur-fit",$42.00,$0.00,$42.00,$0.00,$29.98,$0.00,$0.00,$29.98,$29.98,$0.00,$42.00,$0.00,$21.00,$33.26,$33.60,$0.00,$0.00,$0.00,$0.00,$0.00
27003121,EAP,Custom 27003121,,Pouch Drainable Opaque,$20.00,$0.00,$20.00,$0.00,$14.27,$0.00,$0.00,$14.27,$14.27,$0.00,$20.00,$0.00,$10.00,$15.84,$16.00,$0.00,$0.00,$0.00,$0.00,$0.00
27003124,EAP,Custom 27003124,,Barrier With Convexity,$34.00,$0.00,$34.00,$0.00,$24.27,$0.00,$0.00,$24.27,$24.27,$0.00,$34.00,$0.00,$17.00,$26.93,$27.20,$0.00,$0.00,$0.00,$0.00,$0.00
27003127,EAP,Custom 27003127,,High Flow Continuous,$406.00,$0.00,$406.00,$0.00,$289.76,$0.00,$0.00,$289.76,$289.76,$0.00,$406.00,$0.00,$203.00,$321.55,$324.80,$0.00,$0.00,$0.00,$0.00,$0.00
27003128,EAP,Custom 27003128,,Low Flow Continous,$406.00,$0.00,$406.00,$0.00,$289.76,$0.00,$0.00,$289.76,$289.76,$0.00,$406.00,$0.00,$203.00,$321.55,$324.80,$0.00,$0.00,$0.00,$0.00,$0.00
27003130,EAP,Custom 27003130,,Mdi Spacer Supply,$195.00,$0.00,$195.00,$0.00,$139.17,$0.00,$0.00,$139.17,$139.17,$0.00,$195.00,$0.00,$97.50,$154.44,$156.00,$0.00,$0.00,$0.00,$0.00,$0.00
27003131,EAP,Custom 27003131,,Occult Blood Supply,$44.00,$0.00,$44.00,$0.00,$31.40,$0.00,$0.00,$31.40,$31.40,$0.00,$44.00,$0.00,$22.00,$34.85,$35.20,$0.00,$0.00,$0.00,$0.00,$0.00
27003132,EAP,Custom 27003132,,Wrist Brace,$60.00,$0.00,$60.00,$0.00,$42.82,$0.00,$0.00,$42.82,$42.82,$0.00,$60.00,$0.00,$30.00,$47.52,$48.00,$0.00,$0.00,$0.00,$0.00,$0.00
27003134,EAP,HCPCS J2798,,Mirena (iud) Kit,$994.00,$0.00,$994.00,$0.00,$709.42,$0.00,$0.00,$709.42,$709.42,$0.00,$994.00,$0.00,$497.00,$787.25,$795.20,$0.00,$0.00,$0.00,$0.00,$0.00
27003153,EAP,Custom 27003153,,Nuva Ring Fp,$10.00,$0.00,$10.00,$0.00,$7.14,$0.00,$0.00,$7.14,$7.14,$0.00,$10.00,$0.00,$5.00,$7.92,$8.00,$0.00,$0.00,$0.00,$0.00,$0.00
27004266,EAP,Custom 27004266,,13.5mm/3.2mm Wire Guide,"$1,747.00",$0.00,"$1,747.00",$0.00,"$1,246.83",$0.00,$0.00,"$1,246.83","$1,246.83",$0.00,"$1,747.00",$0.00,$873.50,"$1,383.62","$1,397.60",$0.00,$0.00,$0.00,$0.00,$0.00
27004311,EAP,Custom 27004311,,Long Forceps 230mm,"$2,779.00",$0.00,"$2,779.00",$0.00,"$1,983.37",$0.00,$0.00,"$1,983.37","$1,983.37",$0.00,"$2,779.00",$0.00,"$1,389.50","$2,200.97","$2,223.20",$0.00,$0.00,$0.00,$0.00,$0.00
27004327,EAP,Custom 27004327,,Medium Wire Cutter 160mm,"$4,148.00",$0.00,"$4,148.00",$0.00,"$2,960.43",$0.00,$0.00,"$2,960.43","$2,960.43",$0.00,"$4,148.00",$0.00,"$2,074.00","$3,285.22","$3,318.40",$0.00,$0.00,$0.00,$0.00,$0.00
27004640,EAP,Custom 27004640,,Large Anchoring Hook 30mm,$509.00,$0.00,$509.00,$0.00,$363.27,$0.00,$0.00,$363.27,$363.27,$0.00,$509.00,$0.00,$254.50,$403.13,$407.20,$0.00,$0.00,$0.00,$0.00,$0.00
27007212,EAP,Custom 27007212,,10.0mm Circular Saw 28mm,$290.00,$0.00,$290.00,$0.00,$206.97,$0.00,$0.00,$206.97,$206.97,$0.00,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$0.00,$0.00,$0.00,$0.00
27007213,EAP,Custom 27007213,,12.0mm Circular Saw 28mm,$290.00,$0.00,$290.00,$0.00,$206.97,$0.00,$0.00,$206.97,$206.97,$0.00,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$0.00,$0.00,$0.00,$0.00
27007214,EAP,Custom 27007214,,15.0mm Circular Saw 28mm,$290.00,$0.00,$290.00,$0.00,$206.97,$0.00,$0.00,$206.97,$206.97,$0.00,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$0.00,$0.00,$0.00,$0.00
27007219,EAP,Custom 27007219,,Tibial Nail Driving Adaptor,"$4,208.00",$0.00,"$4,208.00",$0.00,"$3,003.25",$0.00,$0.00,"$3,003.25","$3,003.25",$0.00,"$4,208.00",$0.00,"$2,104.00","$3,332.74","$3,366.40",$0.00,$0.00,$0.00,$0.00,$0.00
27007220,EAP,Custom 27007220,,Saw Blade 27mm Width 50mm/0.6m,$255.00,$0.00,$255.00,$0.00,$181.99,$0.00,$0.00,$181.99,$181.99,$0.00,$255.00,$0.00,$127.50,$201.96,$204.00,$0.00,$0.00,$0.00,$0.00,$0.00
27007221,EAP,Custom 27007221,,Saw Blade 10mm Width 25mm/0.6m,$255.00,$0.00,$255.00,$0.00,$181.99,$0.00,$0.00,$181.99,$181.99,$0.00,$255.00,$0.00,$127.50,$201.96,$204.00,$0.00,$0.00,$0.00,$0.00,$0.00
27007222,EAP,Custom 27007222,,Saw Blade 10mm Width 50mm/0.6m,$255.00,$0.00,$255.00,$0.00,$181.99,$0.00,$0.00,$181.99,$181.99,$0.00,$255.00,$0.00,$127.50,$201.96,$204.00,$0.00,$0.00,$0.00,$0.00,$0.00
27007223,EAP,Custom 27007223,,Saw Blade 20mm Width 50mm/0.6m,$255.00,$0.00,$255.00,$0.00,$181.99,$0.00,$0.00,$181.99,$181.99,$0.00,$255.00,$0.00,$127.50,$201.96,$204.00,$0.00,$0.00,$0.00,$0.00,$0.00
27007224,EAP,Custom 27007224,,Saw Blade 19mm Width 70mm/1.0m,$255.00,$0.00,$255.00,$0.00,$181.99,$0.00,$0.00,$181.99,$181.99,$0.00,$255.00,$0.00,$127.50,$201.96,$204.00,$0.00,$0.00,$0.00,$0.00,$0.00
27007225,EAP,Custom 27007225,,Saw Blade 19mm Width 95mm/0.9m,$325.00,$0.00,$325.00,$0.00,$231.95,$0.00,$0.00,$231.95,$231.95,$0.00,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$0.00,$0.00,$0.00,$0.00
27007226,EAP,Custom 27007226,,Saw Blade 25mm Width 95mm/0.9,$325.00,$0.00,$325.00,$0.00,$231.95,$0.00,$0.00,$231.95,$231.95,$0.00,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$0.00,$0.00,$0.00,$0.00
27007227,EAP,Custom 27007227,,Saw Blade 25mm Width 60mm/0.9,$325.00,$0.00,$325.00,$0.00,$231.95,$0.00,$0.00,$231.95,$231.95,$0.00,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$0.00,$0.00,$0.00,$0.00
27007228,EAP,Custom 27007228,,Saw Blade 18mm Width 70mm/1.2,$255.00,$0.00,$255.00,$0.00,$181.99,$0.00,$0.00,$181.99,$181.99,$0.00,$255.00,$0.00,$127.50,$201.96,$204.00,$0.00,$0.00,$0.00,$0.00,$0.00
27007229,EAP,Custom 27007229,,Saw Blade 19mm Width 95mm/1.25,$325.00,$0.00,$325.00,$0.00,$231.95,$0.00,$0.00,$231.95,$231.95,$0.00,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$0.00,$0.00,$0.00,$0.00
27007230,EAP,Custom 27007230,,Saw Blade 25mm Width 95mm/1.25,$325.00,$0.00,$325.00,$0.00,$231.95,$0.00,$0.00,$231.95,$231.95,$0.00,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$0.00,$0.00,$0.00,$0.00
27007231,EAP,Custom 27007231,,Saw Blade 19mm Width 95mm/1.4,$325.00,$0.00,$325.00,$0.00,$231.95,$0.00,$0.00,$231.95,$231.95,$0.00,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$0.00,$0.00,$0.00,$0.00
27007232,EAP,Custom 27007232,,Saw Blade 25mm Width 95mm/1.4,$325.00,$0.00,$325.00,$0.00,$231.95,$0.00,$0.00,$231.95,$231.95,$0.00,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$0.00,$0.00,$0.00,$0.00
27007233,EAP,Custom 27007233,,Saw Blade 12.5mm Wdth 90mm/0.9,$325.00,$0.00,$325.00,$0.00,$231.95,$0.00,$0.00,$231.95,$231.95,$0.00,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$0.00,$0.00,$0.00,$0.00
27007234,EAP,Custom 27007234,,Saw Blade 14mm Width 50mm/0.6,$255.00,$0.00,$255.00,$0.00,$181.99,$0.00,$0.00,$181.99,$181.99,$0.00,$255.00,$0.00,$127.50,$201.96,$204.00,$0.00,$0.00,$0.00,$0.00,$0.00
27007235,EAP,Custom 27007235,,Saw Blade 27mm Width 70mm/0.8,$255.00,$0.00,$255.00,$0.00,$181.99,$0.00,$0.00,$181.99,$181.99,$0.00,$255.00,$0.00,$127.50,$201.96,$204.00,$0.00,$0.00,$0.00,$0.00,$0.00
27007236,EAP,Custom 27007236,,Saw Blade 50mm Width 70mm/0.8,$255.00,$0.00,$255.00,$0.00,$181.99,$0.00,$0.00,$181.99,$181.99,$0.00,$255.00,$0.00,$127.50,$201.96,$204.00,$0.00,$0.00,$0.00,$0.00,$0.00
27007237,EAP,Custom 27007237,,Saw Blade 27mm Width 70mm/1.0,$255.00,$0.00,$255.00,$0.00,$181.99,$0.00,$0.00,$181.99,$181.99,$0.00,$255.00,$0.00,$127.50,$201.96,$204.00,$0.00,$0.00,$0.00,$0.00,$0.00
27007238,EAP,Custom 27007238,,Saw Blade 27mm Width 70mm/1.2,$255.00,$0.00,$255.00,$0.00,$181.99,$0.00,$0.00,$181.99,$181.99,$0.00,$255.00,$0.00,$127.50,$201.96,$204.00,$0.00,$0.00,$0.00,$0.00,$0.00
27007239,EAP,Custom 27007239,,Saw Blade 6mm Width 25mm/0.6m,$255.00,$0.00,$255.00,$0.00,$181.99,$0.00,$0.00,$181.99,$181.99,$0.00,$255.00,$0.00,$127.50,$201.96,$204.00,$0.00,$0.00,$0.00,$0.00,$0.00
27007240,EAP,Custom 27007240,,Saw Blade 14mm Width 25mm/0.6m,$255.00,$0.00,$255.00,$0.00,$181.99,$0.00,$0.00,$181.99,$181.99,$0.00,$255.00,$0.00,$127.50,$201.96,$204.00,$0.00,$0.00,$0.00,$0.00,$0.00
27007241,EAP,Custom 27007241,,Saw Blade 6mm Width 10mm/0.4mm,$267.00,$0.00,$267.00,$0.00,$190.56,$0.00,$0.00,$190.56,$190.56,$0.00,$267.00,$0.00,$133.50,$211.46,$213.60,$0.00,$0.00,$0.00,$0.00,$0.00
27007242,EAP,Custom 27007242,,Saw Blade 6mm Width 10mm/0.4mm,$290.00,$0.00,$290.00,$0.00,$206.97,$0.00,$0.00,$206.97,$206.97,$0.00,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$0.00,$0.00,$0.00,$0.00
27007243,EAP,Custom 27007243,,Saw Blade 10mm Width 10mm/0.4m,$267.00,$0.00,$267.00,$0.00,$190.56,$0.00,$0.00,$190.56,$190.56,$0.00,$267.00,$0.00,$133.50,$211.46,$213.60,$0.00,$0.00,$0.00,$0.00,$0.00
27007244,EAP,Custom 27007244,,Saw Blade 10mm Width 10mm/0.4m,$290.00,$0.00,$290.00,$0.00,$206.97,$0.00,$0.00,$206.97,$206.97,$0.00,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$0.00,$0.00,$0.00,$0.00
27007245,EAP,Custom 27007245,,Saw Blade 16mm Width 10mm/0.4m,$267.00,$0.00,$267.00,$0.00,$190.56,$0.00,$0.00,$190.56,$190.56,$0.00,$267.00,$0.00,$133.50,$211.46,$213.60,$0.00,$0.00,$0.00,$0.00,$0.00
27007246,EAP,Custom 27007246,,Saw Blade 16mm Width 10mm/0.4m,$290.00,$0.00,$290.00,$0.00,$206.97,$0.00,$0.00,$206.97,$206.97,$0.00,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$0.00,$0.00,$0.00,$0.00
27007247,EAP,Custom 27007247,,Saw Blade 4mm Width 15mm/0.4mm,$267.00,$0.00,$267.00,$0.00,$190.56,$0.00,$0.00,$190.56,$190.56,$0.00,$267.00,$0.00,$133.50,$211.46,$213.60,$0.00,$0.00,$0.00,$0.00,$0.00
27007248,EAP,Custom 27007248,,Saw Blade 4mm Width 15mm/0.4m,$290.00,$0.00,$290.00,$0.00,$206.97,$0.00,$0.00,$206.97,$206.97,$0.00,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$0.00,$0.00,$0.00,$0.00
27007249,EAP,Custom 27007249,,Saw Blade 8mm Width 20mm/0.4mm,$267.00,$0.00,$267.00,$0.00,$190.56,$0.00,$0.00,$190.56,$190.56,$0.00,$267.00,$0.00,$133.50,$211.46,$213.60,$0.00,$0.00,$0.00,$0.00,$0.00
27007250,EAP,Custom 27007250,,Saw Blade 8mm Width 20mm/0.4,$290.00,$0.00,$290.00,$0.00,$206.97,$0.00,$0.00,$206.97,$206.97,$0.00,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$0.00,$0.00,$0.00,$0.00
27007251,EAP,Custom 27007251,,Saw Blade 12mm Width 20mm/0.4,$267.00,$0.00,$267.00,$0.00,$190.56,$0.00,$0.00,$190.56,$190.56,$0.00,$267.00,$0.00,$133.50,$211.46,$213.60,$0.00,$0.00,$0.00,$0.00,$0.00
27007252,EAP,Custom 27007252,,Saw Blade 12mm Width 20mm/0.4,$290.00,$0.00,$290.00,$0.00,$206.97,$0.00,$0.00,$206.97,$206.97,$0.00,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$0.00,$0.00,$0.00,$0.00
27007253,EAP,Custom 27007253,,Saw Blade 6mm Width 30mm/0.4,$267.00,$0.00,$267.00,$0.00,$190.56,$0.00,$0.00,$190.56,$190.56,$0.00,$267.00,$0.00,$133.50,$211.46,$213.60,$0.00,$0.00,$0.00,$0.00,$0.00
27007254,EAP,Custom 27007254,,Saw Blade 6mm Width 30mm/0.4,$290.00,$0.00,$290.00,$0.00,$206.97,$0.00,$0.00,$206.97,$206.97,$0.00,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$0.00,$0.00,$0.00,$0.00
27007255,EAP,Custom 27007255,,Saw Blade 10mm Width 30mm/0.4,$267.00,$0.00,$267.00,$0.00,$190.56,$0.00,$0.00,$190.56,$190.56,$0.00,$267.00,$0.00,$133.50,$211.46,$213.60,$0.00,$0.00,$0.00,$0.00,$0.00
27007256,EAP,Custom 27007256,,Saw Blade 10mm Width 30mm/0.4,$290.00,$0.00,$290.00,$0.00,$206.97,$0.00,$0.00,$206.97,$206.97,$0.00,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$0.00,$0.00,$0.00,$0.00
27007257,EAP,Custom 27007257,,Saw Blade 6mm Width 25mm/0.6,$267.00,$0.00,$267.00,$0.00,$190.56,$0.00,$0.00,$190.56,$190.56,$0.00,$267.00,$0.00,$133.50,$211.46,$213.60,$0.00,$0.00,$0.00,$0.00,$0.00
27007258,EAP,Custom 27007258,,Saw Blade 6mm Width 25mm/0.6,$290.00,$0.00,$290.00,$0.00,$206.97,$0.00,$0.00,$206.97,$206.97,$0.00,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$0.00,$0.00,$0.00,$0.00
27007259,EAP,Custom 27007259,,Saw Blade 10mm Width 25mm/0.6,$267.00,$0.00,$267.00,$0.00,$190.56,$0.00,$0.00,$190.56,$190.56,$0.00,$267.00,$0.00,$133.50,$211.46,$213.60,$0.00,$0.00,$0.00,$0.00,$0.00
27007260,EAP,Custom 27007260,,Saw Blade 10mm Width 25mm/0.6,$290.00,$0.00,$290.00,$0.00,$206.97,$0.00,$0.00,$206.97,$206.97,$0.00,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$0.00,$0.00,$0.00,$0.00
27007261,EAP,Custom 27007261,,Saw Blade 14mm Width 25mm/0.6,$267.00,$0.00,$267.00,$0.00,$190.56,$0.00,$0.00,$190.56,$190.56,$0.00,$267.00,$0.00,$133.50,$211.46,$213.60,$0.00,$0.00,$0.00,$0.00,$0.00
27007262,EAP,Custom 27007262,,Saw Blade 14mm Width 25mm/0.6,$290.00,$0.00,$290.00,$0.00,$206.97,$0.00,$0.00,$206.97,$206.97,$0.00,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$0.00,$0.00,$0.00,$0.00
27007263,EAP,Custom 27007263,,Saw Blade 10mm Width 50mm/0.6,$267.00,$0.00,$267.00,$0.00,$190.56,$0.00,$0.00,$190.56,$190.56,$0.00,$267.00,$0.00,$133.50,$211.46,$213.60,$0.00,$0.00,$0.00,$0.00,$0.00
27007264,EAP,Custom 27007264,,Saw Bld 10 Wdth 50/0.6cut Thk,$290.00,$0.00,$290.00,$0.00,$206.97,$0.00,$0.00,$206.97,$206.97,$0.00,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$0.00,$0.00,$0.00,$0.00
27007265,EAP,Custom 27007265,,Saw Bld 14 Wdth 50/0.6cut Thk,$267.00,$0.00,$267.00,$0.00,$190.56,$0.00,$0.00,$190.56,$190.56,$0.00,$267.00,$0.00,$133.50,$211.46,$213.60,$0.00,$0.00,$0.00,$0.00,$0.00
27007266,EAP,Custom 27007266,,Saw Bld 14 Wdth 50/0.6 Cut Thk,$290.00,$0.00,$290.00,$0.00,$206.97,$0.00,$0.00,$206.97,$206.97,$0.00,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$0.00,$0.00,$0.00,$0.00
27007267,EAP,Custom 27007267,,Saw Bld 20 Wdth 50/0.6 Cut Thk,$267.00,$0.00,$267.00,$0.00,$190.56,$0.00,$0.00,$190.56,$190.56,$0.00,$267.00,$0.00,$133.50,$211.46,$213.60,$0.00,$0.00,$0.00,$0.00,$0.00
27007268,EAP,Custom 27007268,,Saw Bld 20 Wdth 50/0.6 Cut Thk,$290.00,$0.00,$290.00,$0.00,$206.97,$0.00,$0.00,$206.97,$206.97,$0.00,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$0.00,$0.00,$0.00,$0.00
27007269,EAP,Custom 27007269,,Saw Bld 27 Wdth 50/0.6 Cut Thk,$267.00,$0.00,$267.00,$0.00,$190.56,$0.00,$0.00,$190.56,$190.56,$0.00,$267.00,$0.00,$133.50,$211.46,$213.60,$0.00,$0.00,$0.00,$0.00,$0.00
27007270,EAP,Custom 27007270,,Saw Bld 27 Wdth 50/0.6 Cut Thk,$290.00,$0.00,$290.00,$0.00,$206.97,$0.00,$0.00,$206.97,$206.97,$0.00,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$0.00,$0.00,$0.00,$0.00
27007451,EAP,Custom 27007451,,"Peg Fully Thread 2.5mm, 24mm",$398.00,$0.00,$398.00,$0.00,$284.05,$0.00,$0.00,$284.05,$284.05,$0.00,$398.00,$0.00,$199.00,$315.22,$318.40,$0.00,$0.00,$0.00,$0.00,$0.00
27007489,EAP,Custom 27007489,,Mini-clip Str 3mm,"$1,693.00",$0.00,"$1,693.00",$0.00,"$1,208.29",$0.00,$0.00,"$1,208.29","$1,208.29",$0.00,"$1,693.00",$0.00,$846.50,"$1,340.86","$1,354.40",$0.00,$0.00,$0.00,$0.00,$0.00
27007557,EAP,Custom 27007557,,Screwdriver Blade,"$1,268.00",$0.00,"$1,268.00",$0.00,$904.97,$0.00,$0.00,$904.97,$904.97,$0.00,"$1,268.00",$0.00,$634.00,"$1,004.26","$1,014.40",$0.00,$0.00,$0.00,$0.00,$0.00
27007632,EAP,Custom 27007632,,Rotary Mixer,"$8,539.00",$0.00,"$8,539.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$8,539.00",$0.00,"$4,269.50","$6,762.89","$6,831.20",$0.00,$0.00,$0.00,$0.00,$0.00
27007633,EAP,Custom 27007633,,Srs? Fast Set Putty 3cc Steril,"$3,760.00",$0.00,"$3,760.00",$0.00,"$2,683.51",$0.00,$0.00,"$2,683.51","$2,683.51",$0.00,"$3,760.00",$0.00,"$1,880.00","$2,977.92","$3,008.00",$0.00,$0.00,$0.00,$0.00,$0.00
27007634,EAP,Custom 27007634,,Nor? Srs? Bne Void Fill Ro 3cc,"$3,852.00",$0.00,"$3,852.00",$0.00,"$2,749.17",$0.00,$0.00,"$2,749.17","$2,749.17",$0.00,"$3,852.00",$0.00,"$1,926.00","$3,050.78","$3,081.60",$0.00,$0.00,$0.00,$0.00,$0.00
27007635,EAP,Custom 27007635,,Srs? Fast Set Putty 5cc Steril,"$6,218.00",$0.00,"$6,218.00",$0.00,"$4,437.79",$0.00,$0.00,"$4,437.79","$4,437.79",$0.00,"$6,218.00",$0.00,"$3,109.00","$4,924.66","$4,974.40",$0.00,$0.00,$0.00,$0.00,$0.00
27007636,EAP,Custom 27007636,,Nor? Srs? Bne Void Fill Ro 5cc,"$6,310.00",$0.00,"$6,310.00",$0.00,"$4,503.45",$0.00,$0.00,"$4,503.45","$4,503.45",$0.00,"$6,310.00",$0.00,"$3,155.00","$4,997.52","$5,048.00",$0.00,$0.00,$0.00,$0.00,$0.00
27007637,EAP,Custom 27007637,,Srs? Fast Set Putty 10cc Steri,"$12,321.00",$0.00,"$12,321.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$12,321.00",$0.00,"$6,160.50","$9,758.23","$9,856.80",$0.00,$0.00,$0.00,$0.00,$0.00
27007638,EAP,Custom 27007638,,Nor? Srs? Bne Vd Fill Ro Mx 10,"$12,413.00",$0.00,"$12,413.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$12,413.00",$0.00,"$6,206.50","$9,831.10","$9,930.40",$0.00,$0.00,$0.00,$0.00,$0.00
27007639,EAP,Custom 27007639,,Srs? Fast Set Putty 15cc Ster,"$18,167.00",$0.00,"$18,167.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$18,167.00",$0.00,"$9,083.50","$14,388.26","$14,533.60",$0.00,$0.00,$0.00,$0.00,$0.00
27007640,EAP,Custom 27007640,,Pressure Measurement,$904.00,$0.00,$904.00,$0.00,$645.18,$0.00,$0.00,$645.18,$645.18,$0.00,$904.00,$0.00,$452.00,$715.97,$723.20,$0.00,$0.00,$0.00,$0.00,$0.00
27007719,EAP,Custom 27007719,,Univ Lock Troch Stab Pl 131mm,"$2,620.00",$0.00,"$2,620.00",$0.00,"$1,869.89",$0.00,$0.00,"$1,869.89","$1,869.89",$0.00,"$2,620.00",$0.00,"$1,310.00","$2,075.04","$2,096.00",$0.00,$0.00,$0.00,$0.00,$0.00
27007749,EAP,Custom 27007749,,T15/2.5m Hex Cerclage But- Ste,$652.00,$0.00,$652.00,$0.00,$465.33,$0.00,$0.00,$465.33,$465.33,$0.00,$652.00,$0.00,$326.00,$516.38,$521.60,$0.00,$0.00,$0.00,$0.00,$0.00
27007795,EAP,Custom 27007795,,Swans Bur S?2.0m Hd Lgh 6.3mm,$366.00,$0.00,$366.00,$0.00,$261.21,$0.00,$0.00,$261.21,$261.21,$0.00,$366.00,$0.00,$183.00,$289.87,$292.80,$0.00,$0.00,$0.00,$0.00,$0.00
27007796,EAP,Custom 27007796,,Swans Bur M?2.0m Hd Lgh 6.3mm,$366.00,$0.00,$366.00,$0.00,$261.21,$0.00,$0.00,$261.21,$261.21,$0.00,$366.00,$0.00,$183.00,$289.87,$292.80,$0.00,$0.00,$0.00,$0.00,$0.00
27007797,EAP,Custom 27007797,,Swans Bur L?2.0m Hd Lgh 6.3mm,$366.00,$0.00,$366.00,$0.00,$261.21,$0.00,$0.00,$261.21,$261.21,$0.00,$366.00,$0.00,$183.00,$289.87,$292.80,$0.00,$0.00,$0.00,$0.00,$0.00
27007798,EAP,Custom 27007798,,Swans Bur S?3.0m Hd Lgh 9.7mm,$366.00,$0.00,$366.00,$0.00,$261.21,$0.00,$0.00,$261.21,$261.21,$0.00,$366.00,$0.00,$183.00,$289.87,$292.80,$0.00,$0.00,$0.00,$0.00,$0.00
27007799,EAP,Custom 27007799,,Swans Bur M?3.0m Hd Lgh 9.7mm,$366.00,$0.00,$366.00,$0.00,$261.21,$0.00,$0.00,$261.21,$261.21,$0.00,$366.00,$0.00,$183.00,$289.87,$292.80,$0.00,$0.00,$0.00,$0.00,$0.00
27007800,EAP,Custom 27007800,,Swans Bur L?3.0m Hd Lgh 9.7mm,$366.00,$0.00,$366.00,$0.00,$261.21,$0.00,$0.00,$261.21,$261.21,$0.00,$366.00,$0.00,$183.00,$289.87,$292.80,$0.00,$0.00,$0.00,$0.00,$0.00
27007801,EAP,Custom 27007801,,Swans Bur S?4.0m Hd Lgh 12.7mm,$366.00,$0.00,$366.00,$0.00,$261.21,$0.00,$0.00,$261.21,$261.21,$0.00,$366.00,$0.00,$183.00,$289.87,$292.80,$0.00,$0.00,$0.00,$0.00,$0.00
27007802,EAP,Custom 27007802,,Swans Bur M?4.0m Hd Lgh 12.7mm,$148.00,$0.00,$148.00,$0.00,$105.63,$0.00,$0.00,$105.63,$105.63,$0.00,$148.00,$0.00,$74.00,$117.22,$118.40,$0.00,$0.00,$0.00,$0.00,$0.00
27007803,EAP,Custom 27007803,,Swans Bur L?4.0m Hd Lgh 12.7mm,$366.00,$0.00,$366.00,$0.00,$261.21,$0.00,$0.00,$261.21,$261.21,$0.00,$366.00,$0.00,$183.00,$289.87,$292.80,$0.00,$0.00,$0.00,$0.00,$0.00
27007810,EAP,Custom 27007810,,Swans Bur S?5.0m Hd Lgh 15.8mm,$366.00,$0.00,$366.00,$0.00,$261.21,$0.00,$0.00,$261.21,$261.21,$0.00,$366.00,$0.00,$183.00,$289.87,$292.80,$0.00,$0.00,$0.00,$0.00,$0.00
27007811,EAP,Custom 27007811,,Swans Bur M?5.0m Hd Lgh 15.8mm,$366.00,$0.00,$366.00,$0.00,$261.21,$0.00,$0.00,$261.21,$261.21,$0.00,$366.00,$0.00,$183.00,$289.87,$292.80,$0.00,$0.00,$0.00,$0.00,$0.00
27007812,EAP,Custom 27007812,,Swans Bur L?5.0m Hd Lgh 15.8mm,$366.00,$0.00,$366.00,$0.00,$261.21,$0.00,$0.00,$261.21,$261.21,$0.00,$366.00,$0.00,$183.00,$289.87,$292.80,$0.00,$0.00,$0.00,$0.00,$0.00
27007840,EAP,Custom 27007840,,Lindeman Rmer Lgh 45m ?2.3m,$325.00,$0.00,$325.00,$0.00,$231.95,$0.00,$0.00,$231.95,$231.95,$0.00,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$0.00,$0.00,$0.00,$0.00
27007853,EAP,Custom 27007853,,Saw Blade  F/sagittal Saw,$325.00,$0.00,$325.00,$0.00,$231.95,$0.00,$0.00,$231.95,$231.95,$0.00,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$0.00,$0.00,$0.00,$0.00
27007854,EAP,Custom 27007854,,Saw Blde Cresc F/oscillat Saw,$366.00,$0.00,$366.00,$0.00,$261.21,$0.00,$0.00,$261.21,$261.21,$0.00,$366.00,$0.00,$183.00,$289.87,$292.80,$0.00,$0.00,$0.00,$0.00,$0.00
27007864,EAP,Custom 27007864,,Tibial Nail-ex Insertion Handl,"$5,201.00",$0.00,"$5,201.00",$0.00,"$3,711.95",$0.00,$0.00,"$3,711.95","$3,711.95",$0.00,"$5,201.00",$0.00,"$2,600.50","$4,119.19","$4,160.80",$0.00,$0.00,$0.00,$0.00,$0.00
27007865,EAP,Custom 27007865,,Rad Ruler Ti Cannul Fem Nails,"$1,330.00",$0.00,"$1,330.00",$0.00,$949.22,$0.00,$0.00,$949.22,$949.22,$0.00,"$1,330.00",$0.00,$665.00,"$1,053.36","$1,064.00",$0.00,$0.00,$0.00,$0.00,$0.00
27007866,EAP,Custom 27007866,,Rad Ruler Ti Cannul Tib Nails,"$1,330.00",$0.00,"$1,330.00",$0.00,$949.22,$0.00,$0.00,$949.22,$949.22,$0.00,"$1,330.00",$0.00,$665.00,"$1,053.36","$1,064.00",$0.00,$0.00,$0.00,$0.00,$0.00
27007867,EAP,Custom 27007867,,Rad Ruler Ti Cannul Hum Nails,"$1,330.00",$0.00,"$1,330.00",$0.00,$949.22,$0.00,$0.00,$949.22,$949.22,$0.00,"$1,330.00",$0.00,$665.00,"$1,053.36","$1,064.00",$0.00,$0.00,$0.00,$0.00,$0.00
27007868,EAP,Custom 27007868,,Rad Canal Wdth Estimat Im Nail,"$1,330.00",$0.00,"$1,330.00",$0.00,$949.22,$0.00,$0.00,$949.22,$949.22,$0.00,"$1,330.00",$0.00,$665.00,"$1,053.36","$1,064.00",$0.00,$0.00,$0.00,$0.00,$0.00
27007869,EAP,Custom 27007869,,Hold Devic Gde Wire & Ream Rod,"$3,375.00",$0.00,"$3,375.00",$0.00,"$2,408.74",$0.00,$0.00,"$2,408.74","$2,408.74",$0.00,"$3,375.00",$0.00,"$1,687.50","$2,673.00","$2,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
27007871,EAP,Custom 27007871,,15.0 Cannul Drl Bit Lg Qc/280m,"$1,969.00",$0.00,"$1,969.00",$0.00,"$1,405.28",$0.00,$0.00,"$1,405.28","$1,405.28",$0.00,"$1,969.00",$0.00,$984.50,"$1,559.45","$1,575.20",$0.00,$0.00,$0.00,$0.00,$0.00
27007872,EAP,Custom 27007872,,17.0m Cannul Drl Bit Lg Qc/280,"$2,461.00",$0.00,"$2,461.00",$0.00,"$1,756.42",$0.00,$0.00,"$1,756.42","$1,756.42",$0.00,"$2,461.00",$0.00,"$1,230.50","$1,949.11","$1,968.80",$0.00,$0.00,$0.00,$0.00,$0.00
27007873,EAP,Custom 27007873,,13.0mm Protection Sleeve,"$1,490.00",$0.00,"$1,490.00",$0.00,"$1,063.41",$0.00,$0.00,"$1,063.41","$1,063.41",$0.00,"$1,490.00",$0.00,$745.00,"$1,180.08","$1,192.00",$0.00,$0.00,$0.00,$0.00,$0.00
27007874,EAP,Custom 27007874,,13.0/3.2 Wire Gude W/ Troc Tip,$591.00,$0.00,$591.00,$0.00,$421.80,$0.00,$0.00,$421.80,$421.80,$0.00,$591.00,$0.00,$295.50,$468.07,$472.80,$0.00,$0.00,$0.00,$0.00,$0.00
27007875,EAP,Custom 27007875,,13 Flex Can Drl Bit Lg Qc/465,"$2,762.00",$0.00,"$2,762.00",$0.00,"$1,971.24",$0.00,$0.00,"$1,971.24","$1,971.24",$0.00,"$2,762.00",$0.00,"$1,381.00","$2,187.50","$2,209.60",$0.00,$0.00,$0.00,$0.00,$0.00
27007876,EAP,Custom 27007876,,13 Flex Can Drl Bit Lg Qc/465,"$2,891.00",$0.00,"$2,891.00",$0.00,"$2,063.31",$0.00,$0.00,"$2,063.31","$2,063.31",$0.00,"$2,891.00",$0.00,"$1,445.50","$2,289.67","$2,312.80",$0.00,$0.00,$0.00,$0.00,$0.00
27007877,EAP,Custom 27007877,,12.0mm Protection Sleeve,"$1,490.00",$0.00,"$1,490.00",$0.00,"$1,063.41",$0.00,$0.00,"$1,063.41","$1,063.41",$0.00,"$1,490.00",$0.00,$745.00,"$1,180.08","$1,192.00",$0.00,$0.00,$0.00,$0.00,$0.00
27007878,EAP,Custom 27007878,,12.0 Cannul Drl Bit Lg Qc/190,"$2,211.00",$0.00,"$2,211.00",$0.00,"$1,577.99",$0.00,$0.00,"$1,577.99","$1,577.99",$0.00,"$2,211.00",$0.00,"$1,105.50","$1,751.11","$1,768.80",$0.00,$0.00,$0.00,$0.00,$0.00
27007879,EAP,Custom 27007879,,10.0mm Protection Sleeve,"$1,490.00",$0.00,"$1,490.00",$0.00,"$1,063.41",$0.00,$0.00,"$1,063.41","$1,063.41",$0.00,"$1,490.00",$0.00,$745.00,"$1,180.08","$1,192.00",$0.00,$0.00,$0.00,$0.00,$0.00
27007880,EAP,Custom 27007880,,10.0mm Cannulated Awl,"$1,747.00",$0.00,"$1,747.00",$0.00,"$1,246.83",$0.00,$0.00,"$1,246.83","$1,246.83",$0.00,"$1,747.00",$0.00,$873.50,"$1,383.62","$1,397.60",$0.00,$0.00,$0.00,$0.00,$0.00
27007881,EAP,Custom 27007881,,12.0mm Cannulated Awl,"$1,778.00",$0.00,"$1,778.00",$0.00,"$1,268.96",$0.00,$0.00,"$1,268.96","$1,268.96",$0.00,"$1,778.00",$0.00,$889.00,"$1,408.18","$1,422.40",$0.00,$0.00,$0.00,$0.00,$0.00
27007882,EAP,Custom 27007882,,14.0mm Cannulated Awl,"$1,855.00",$0.00,"$1,855.00",$0.00,"$1,323.91",$0.00,$0.00,"$1,323.91","$1,323.91",$0.00,"$1,855.00",$0.00,$927.50,"$1,469.16","$1,484.00",$0.00,$0.00,$0.00,$0.00,$0.00
27007884,EAP,Custom 27007884,,Standard Insertion Handle,"$5,201.00",$0.00,"$5,201.00",$0.00,"$3,711.95",$0.00,$0.00,"$3,711.95","$3,711.95",$0.00,"$5,201.00",$0.00,"$2,600.50","$4,119.19","$4,160.80",$0.00,$0.00,$0.00,$0.00,$0.00
27007885,EAP,Custom 27007885,,Percutaneous Insertion Handle,"$5,201.00",$0.00,"$5,201.00",$0.00,"$3,711.95",$0.00,$0.00,"$3,711.95","$3,711.95",$0.00,"$5,201.00",$0.00,"$2,600.50","$4,119.19","$4,160.80",$0.00,$0.00,$0.00,$0.00,$0.00
27007887,EAP,Custom 27007887,,Rec Loc Aim Arm Lat Ent Fem Nl,"$4,071.00",$0.00,"$4,071.00",$0.00,"$2,905.47",$0.00,$0.00,"$2,905.47","$2,905.47",$0.00,"$4,071.00",$0.00,"$2,035.50","$3,224.23","$3,256.80",$0.00,$0.00,$0.00,$0.00,$0.00
27007893,EAP,Custom 27007893,,Insert Hdle Ti Cann Hum Nls-ex,"$4,522.00",$0.00,"$4,522.00",$0.00,"$3,227.35",$0.00,$0.00,"$3,227.35","$3,227.35",$0.00,"$4,522.00",$0.00,"$2,261.00","$3,581.42","$3,617.60",$0.00,$0.00,$0.00,$0.00,$0.00
27007894,EAP,Custom 27007894,,Sprl Blde Aim Arm Ti Can Hum N,"$4,071.00",$0.00,"$4,071.00",$0.00,"$2,905.47",$0.00,$0.00,"$2,905.47","$2,905.47",$0.00,"$4,071.00",$0.00,"$2,035.50","$3,224.23","$3,256.80",$0.00,$0.00,$0.00,$0.00,$0.00
27007900,EAP,Custom 27007900,,12.0mm/8.0mm Protectn Slve 188,$928.00,$0.00,$928.00,$0.00,$662.31,$0.00,$0.00,$662.31,$662.31,$0.00,$928.00,$0.00,$464.00,$734.98,$742.40,$0.00,$0.00,$0.00,$0.00,$0.00
27007904,EAP,Custom 27007904,,11.5/8.5 Protectn Slve Rec Lck,$635.00,$0.00,$635.00,$0.00,$453.20,$0.00,$0.00,$453.20,$453.20,$0.00,$635.00,$0.00,$317.50,$502.92,$508.00,$0.00,$0.00,$0.00,$0.00,$0.00
27007909,EAP,Custom 27007909,,Tap For 6.5mm Recon Screws,"$1,997.00",$0.00,"$1,997.00",$0.00,"$1,425.26",$0.00,$0.00,"$1,425.26","$1,425.26",$0.00,"$1,997.00",$0.00,$998.50,"$1,581.62","$1,597.60",$0.00,$0.00,$0.00,$0.00,$0.00
27007910,EAP,Custom 27007910,,15.0/13.0 Pro Slve F/spir Bld,"$1,616.00",$0.00,"$1,616.00",$0.00,"$1,153.34",$0.00,$0.00,"$1,153.34","$1,153.34",$0.00,"$1,616.00",$0.00,$808.00,"$1,279.87","$1,292.80",$0.00,$0.00,$0.00,$0.00,$0.00
27007911,EAP,Custom 27007911,,13.0/3.2 Wre Gde Spir Blde Aim,"$1,222.00",$0.00,"$1,222.00",$0.00,$872.14,$0.00,$0.00,$872.14,$872.14,$0.00,"$1,222.00",$0.00,$611.00,$967.82,$977.60,$0.00,$0.00,$0.00,$0.00,$0.00
27007912,EAP,Custom 27007912,,Spir Blde Insert Retrgrde Fem,"$3,061.00",$0.00,"$3,061.00",$0.00,"$2,184.64",$0.00,$0.00,"$2,184.64","$2,184.64",$0.00,"$3,061.00",$0.00,"$1,530.50","$2,424.31","$2,448.80",$0.00,$0.00,$0.00,$0.00,$0.00
27007913,EAP,Custom 27007913,,Speclty Lck Meas Dev Ti Fem Nl,$616.00,$0.00,$616.00,$0.00,$439.64,$0.00,$0.00,$439.64,$439.64,$0.00,$616.00,$0.00,$308.00,$487.87,$492.80,$0.00,$0.00,$0.00,$0.00,$0.00
27007914,EAP,Custom 27007914,,14.0mm/8.0mm Drill Sleeve 130m,$679.00,$0.00,$679.00,$0.00,$484.60,$0.00,$0.00,$484.60,$484.60,$0.00,$679.00,$0.00,$339.50,$537.77,$543.20,$0.00,$0.00,$0.00,$0.00,$0.00
27007919,EAP,Custom 27007919,,Spir Bld Mea Dev Ti Can Hum Nl,"$2,296.00",$0.00,"$2,296.00",$0.00,"$1,638.66",$0.00,$0.00,"$1,638.66","$1,638.66",$0.00,"$2,296.00",$0.00,"$1,148.00","$1,818.43","$1,836.80",$0.00,$0.00,$0.00,$0.00,$0.00
27007920,EAP,Custom 27007920,,Stan Aim Arm Ti Can Hum Nls-ex,"$4,071.00",$0.00,"$4,071.00",$0.00,"$2,905.47",$0.00,$0.00,"$2,905.47","$2,905.47",$0.00,"$4,071.00",$0.00,"$2,035.50","$3,224.23","$3,256.80",$0.00,$0.00,$0.00,$0.00,$0.00
27007921,EAP,Custom 27007921,,Ream Rod Push Rod Wth Ball Hdl,"$1,484.00",$0.00,"$1,484.00",$0.00,"$1,059.13",$0.00,$0.00,"$1,059.13","$1,059.13",$0.00,"$1,484.00",$0.00,$742.00,"$1,175.33","$1,187.20",$0.00,$0.00,$0.00,$0.00,$0.00
27007932,EAP,Custom 27007932,,Hold Slve W/ Lcking Device,"$3,354.00",$0.00,"$3,354.00",$0.00,"$2,393.75",$0.00,$0.00,"$2,393.75","$2,393.75",$0.00,"$3,354.00",$0.00,"$1,677.00","$2,656.37","$2,683.20",$0.00,$0.00,$0.00,$0.00,$0.00
27007935,EAP,Custom 27007935,,Lrg Hexa Scwdrvr 3.5 Wdth Acrs,"$1,199.00",$0.00,"$1,199.00",$0.00,$855.73,$0.00,$0.00,$855.73,$855.73,$0.00,"$1,199.00",$0.00,$599.50,$949.61,$959.20,$0.00,$0.00,$0.00,$0.00,$0.00
27007937,EAP,Custom 27007937,,Shrt Compres Dev Ti Can Tib Nl,"$1,799.00",$0.00,"$1,799.00",$0.00,"$1,283.95",$0.00,$0.00,"$1,283.95","$1,283.95",$0.00,"$1,799.00",$0.00,$899.50,"$1,424.81","$1,439.20",$0.00,$0.00,$0.00,$0.00,$0.00
27007938,EAP,Custom 27007938,,Lng Compres Dev Ti Can Tib Nl,"$1,799.00",$0.00,"$1,799.00",$0.00,"$1,283.95",$0.00,$0.00,"$1,283.95","$1,283.95",$0.00,"$1,799.00",$0.00,$899.50,"$1,424.81","$1,439.20",$0.00,$0.00,$0.00,$0.00,$0.00
27007941,EAP,Custom 27007941,,15.0can Flex Dl Bit Lrg Qc/310,"$2,711.00",$0.00,"$2,711.00",$0.00,"$1,934.84",$0.00,$0.00,"$1,934.84","$1,934.84",$0.00,"$2,711.00",$0.00,"$1,355.50","$2,147.11","$2,168.80",$0.00,$0.00,$0.00,$0.00,$0.00
27007942,EAP,Custom 27007942,,17 Can Flex Drl Bit Lrg Qc/310,"$2,711.00",$0.00,"$2,711.00",$0.00,"$1,934.84",$0.00,$0.00,"$1,934.84","$1,934.84",$0.00,"$2,711.00",$0.00,"$1,355.50","$2,147.11","$2,168.80",$0.00,$0.00,$0.00,$0.00,$0.00
27007943,EAP,Custom 27007943,,11/8 Pro Slve 188mm For Asls,$889.00,$0.00,$889.00,$0.00,$634.48,$0.00,$0.00,$634.48,$634.48,$0.00,$889.00,$0.00,$444.50,$704.09,$711.20,$0.00,$0.00,$0.00,$0.00,$0.00
27007945,EAP,Custom 27007945,,Insert Hndl F/4.5 Lcp Prox Tib,"$5,623.00",$0.00,"$5,623.00",$0.00,"$4,013.14",$0.00,$0.00,"$4,013.14","$4,013.14",$0.00,"$5,623.00",$0.00,"$2,811.50","$4,453.42","$4,498.40",$0.00,$0.00,$0.00,$0.00,$0.00
27007947,EAP,Custom 27007947,,Strt Ball Spike Low Pro Pelvic,"$1,511.00",$0.00,"$1,511.00",$0.00,"$1,078.40",$0.00,$0.00,"$1,078.40","$1,078.40",$0.00,"$1,511.00",$0.00,$755.50,"$1,196.71","$1,208.80",$0.00,$0.00,$0.00,$0.00,$0.00
27007948,EAP,Custom 27007948,,Strt Ball Spike Low Pro Pelvic,"$1,608.00",$0.00,"$1,608.00",$0.00,"$1,147.63",$0.00,$0.00,"$1,147.63","$1,147.63",$0.00,"$1,608.00",$0.00,$804.00,"$1,273.54","$1,286.40",$0.00,$0.00,$0.00,$0.00,$0.00
27007949,EAP,Custom 27007949,,Strt Reduc Forceps Low Pro Pel,"$6,337.00",$0.00,"$6,337.00",$0.00,"$4,522.72",$0.00,$0.00,"$4,522.72","$4,522.72",$0.00,"$6,337.00",$0.00,"$3,168.50","$5,018.90","$5,069.60",$0.00,$0.00,$0.00,$0.00,$0.00
27007952,EAP,Custom 27007952,,Reduct Forceps For Low Pro Pel,"$8,489.00",$0.00,"$8,489.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$8,489.00",$0.00,"$4,244.50","$6,723.29","$6,791.20",$0.00,$0.00,$0.00,$0.00,$0.00
27007954,EAP,Custom 27007954,,Lo Pro Pel Sys Rd Frcp 3.5 Scw,"$7,620.00",$0.00,"$7,620.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$7,620.00",$0.00,"$3,810.00","$6,035.04","$6,096.00",$0.00,$0.00,$0.00,$0.00,$0.00
27007955,EAP,Custom 27007955,,Round Disk,$812.00,$0.00,$812.00,$0.00,$579.52,$0.00,$0.00,$579.52,$579.52,$0.00,$812.00,$0.00,$406.00,$643.10,$649.60,$0.00,$0.00,$0.00,$0.00,$0.00
27007956,EAP,Custom 27007956,,Rectangular Disk,$812.00,$0.00,$812.00,$0.00,$579.52,$0.00,$0.00,$579.52,$579.52,$0.00,$812.00,$0.00,$406.00,$643.10,$649.60,$0.00,$0.00,$0.00,$0.00,$0.00
27007966,EAP,Custom 27007966,,Instn Hndl F/4.5 Lcp Prox Tib,"$5,623.00",$0.00,"$5,623.00",$0.00,"$4,013.14",$0.00,$0.00,"$4,013.14","$4,013.14",$0.00,"$5,623.00",$0.00,"$2,811.50","$4,453.42","$4,498.40",$0.00,$0.00,$0.00,$0.00,$0.00
27007967,EAP,Custom 27007967,,Solid 4.0 Hex Scwdrvr Shft 200,"$1,131.00",$0.00,"$1,131.00",$0.00,$807.19,$0.00,$0.00,$807.19,$807.19,$0.00,"$1,131.00",$0.00,$565.50,$895.75,$904.80,$0.00,$0.00,$0.00,$0.00,$0.00
27007969,EAP,Custom 27007969,,Spiked Round Disk,"$1,247.00",$0.00,"$1,247.00",$0.00,$889.98,$0.00,$0.00,$889.98,$889.98,$0.00,"$1,247.00",$0.00,$623.50,$987.62,$997.60,$0.00,$0.00,$0.00,$0.00,$0.00
27007970,EAP,Custom 27007970,,Spiked Rectangular Disk,"$1,247.00",$0.00,"$1,247.00",$0.00,$889.98,$0.00,$0.00,$889.98,$889.98,$0.00,"$1,247.00",$0.00,$623.50,$987.62,$997.60,$0.00,$0.00,$0.00,$0.00,$0.00
27007974,EAP,Custom 27007974,,Ped Lcp Hip Pl Gdng Blk 3.5scw,"$1,986.00",$0.00,"$1,986.00",$0.00,"$1,417.41",$0.00,$0.00,"$1,417.41","$1,417.41",$0.00,"$1,986.00",$0.00,$993.00,"$1,572.91","$1,588.80",$0.00,$0.00,$0.00,$0.00,$0.00
27007975,EAP,Custom 27007975,,Ped Lcp Hip Pl Gdng Blck 5scw,"$1,986.00",$0.00,"$1,986.00",$0.00,"$1,417.41",$0.00,$0.00,"$1,417.41","$1,417.41",$0.00,"$1,986.00",$0.00,$993.00,"$1,572.91","$1,588.80",$0.00,$0.00,$0.00,$0.00,$0.00
27007977,EAP,Custom 27007977,,Reduction Sleeve 4.3mm/2.8mm,$647.00,$0.00,$647.00,$0.00,$461.76,$0.00,$0.00,$461.76,$461.76,$0.00,$647.00,$0.00,$323.50,$512.42,$517.60,$0.00,$0.00,$0.00,$0.00,$0.00
27007979,EAP,Custom 27007979,,Positioning Device Gdng Blck,"$1,727.00",$0.00,"$1,727.00",$0.00,"$1,232.56",$0.00,$0.00,"$1,232.56","$1,232.56",$0.00,"$1,727.00",$0.00,$863.50,"$1,367.78","$1,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27007980,EAP,Custom 27007980,,Medialization Gde 3.5&5.0 Lcp,"$1,727.00",$0.00,"$1,727.00",$0.00,"$1,232.56",$0.00,$0.00,"$1,232.56","$1,232.56",$0.00,"$1,727.00",$0.00,$863.50,"$1,367.78","$1,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27007981,EAP,Custom 27007981,,Osteotomy Measuring Device,"$1,061.00",$0.00,"$1,061.00",$0.00,$757.24,$0.00,$0.00,$757.24,$757.24,$0.00,"$1,061.00",$0.00,$530.50,$840.31,$848.80,$0.00,$0.00,$0.00,$0.00,$0.00
27007984,EAP,Custom 27007984,,Meas Dev 3.0 Hdles Compres Scw,$722.00,$0.00,$722.00,$0.00,$515.29,$0.00,$0.00,$515.29,$515.29,$0.00,$722.00,$0.00,$361.00,$571.82,$577.60,$0.00,$0.00,$0.00,$0.00,$0.00
27007990,EAP,Custom 27007990,,Meas Dev F/drl Gde W/stp 3.0m,$642.00,$0.00,$642.00,$0.00,$458.20,$0.00,$0.00,$458.20,$458.20,$0.00,$642.00,$0.00,$321.00,$508.46,$513.60,$0.00,$0.00,$0.00,$0.00,$0.00
27007991,EAP,Custom 27007991,,Medium Open Compressor,"$4,431.00",$0.00,"$4,431.00",$0.00,"$3,162.40",$0.00,$0.00,"$3,162.40","$3,162.40",$0.00,"$4,431.00",$0.00,"$2,215.50","$3,509.35","$3,544.80",$0.00,$0.00,$0.00,$0.00,$0.00
27007992,EAP,Custom 27007992,,Lo-pro Wrst Fxtr/schan Scr/200,"$4,535.00",$0.00,"$4,535.00",$0.00,"$3,236.63",$0.00,$0.00,"$3,236.63","$3,236.63",$0.00,"$4,535.00",$0.00,"$2,267.50","$3,591.72","$3,628.00",$0.00,$0.00,$0.00,$0.00,$0.00
27007993,EAP,Custom 27007993,,Lo-pro Wrst Fxtr/schan Scr/220,"$4,535.00",$0.00,"$4,535.00",$0.00,"$3,236.63",$0.00,$0.00,"$3,236.63","$3,236.63",$0.00,"$4,535.00",$0.00,"$2,267.50","$3,591.72","$3,628.00",$0.00,$0.00,$0.00,$0.00,$0.00
27007994,EAP,Custom 27007994,,Low-pro Wrst Fxtr/slf-drlg/200,"$5,757.00",$0.00,"$5,757.00",$0.00,"$4,108.77",$0.00,$0.00,"$4,108.77","$4,108.77",$0.00,"$5,757.00",$0.00,"$2,878.50","$4,559.54","$4,605.60",$0.00,$0.00,$0.00,$0.00,$0.00
27007995,EAP,Custom 27007995,,Low-pro Wrst Fxtr/slf-drlg/220,"$5,757.00",$0.00,"$5,757.00",$0.00,"$4,108.77",$0.00,$0.00,"$4,108.77","$4,108.77",$0.00,"$5,757.00",$0.00,"$2,878.50","$4,559.54","$4,605.60",$0.00,$0.00,$0.00,$0.00,$0.00
27007996,EAP,Custom 27007996,,Tensioner,"$16,191.00",$0.00,"$16,191.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$16,191.00",$0.00,"$8,095.50","$12,823.27","$12,952.80",$0.00,$0.00,$0.00,$0.00,$0.00
27007997,EAP,Custom 27007997,,Slotted Socket Wrench 11mm,"$2,314.00",$0.00,"$2,314.00",$0.00,"$1,651.50",$0.00,$0.00,"$1,651.50","$1,651.50",$0.00,"$2,314.00",$0.00,"$1,157.00","$1,832.69","$1,851.20",$0.00,$0.00,$0.00,$0.00,$0.00
27007998,EAP,Custom 27007998,,Patient Wrench 8mm/11mm,$604.00,$0.00,$604.00,$0.00,$431.07,$0.00,$0.00,$431.07,$431.07,$0.00,$604.00,$0.00,$302.00,$478.37,$483.20,$0.00,$0.00,$0.00,$0.00,$0.00
27007999,EAP,Custom 27007999,,Ratchet Wrench 11mm,"$2,891.00",$0.00,"$2,891.00",$0.00,"$2,063.31",$0.00,$0.00,"$2,063.31","$2,063.31",$0.00,"$2,891.00",$0.00,"$1,445.50","$2,289.67","$2,312.80",$0.00,$0.00,$0.00,$0.00,$0.00
27008000,EAP,Custom 27008000,,Split Tissue Protect Slve 2.5m,"$2,314.00",$0.00,"$2,314.00",$0.00,"$1,651.50",$0.00,$0.00,"$1,651.50","$1,651.50",$0.00,"$2,314.00",$0.00,"$1,157.00","$1,832.69","$1,851.20",$0.00,$0.00,$0.00,$0.00,$0.00
27008001,EAP,Custom 27008001,,Split Tissue Protect Slve 5mm,"$2,314.00",$0.00,"$2,314.00",$0.00,"$1,651.50",$0.00,$0.00,"$1,651.50","$1,651.50",$0.00,"$2,314.00",$0.00,"$1,157.00","$1,832.69","$1,851.20",$0.00,$0.00,$0.00,$0.00,$0.00
27008004,EAP,Custom 27008004,,Schanz Screw Bolt Mr Safe,$906.00,$0.00,$906.00,$0.00,$646.61,$0.00,$0.00,$646.61,$646.61,$0.00,$906.00,$0.00,$453.00,$717.55,$724.80,$0.00,$0.00,$0.00,$0.00,$0.00
27008005,EAP,Custom 27008005,,Pivot Schanz Screw Clamp Mr Sa,"$1,830.00",$0.00,"$1,830.00",$0.00,"$1,306.07",$0.00,$0.00,"$1,306.07","$1,306.07",$0.00,"$1,830.00",$0.00,$915.00,"$1,449.36","$1,464.00",$0.00,$0.00,$0.00,$0.00,$0.00
27008006,EAP,Custom 27008006,,Locking Hinge Mr Safe,$906.00,$0.00,$906.00,$0.00,$646.61,$0.00,$0.00,$646.61,$646.61,$0.00,$906.00,$0.00,$453.00,$717.55,$724.80,$0.00,$0.00,$0.00,$0.00,$0.00
27008007,EAP,Custom 27008007,,Schanz Screw Bolt Post Mount M,"$1,045.00",$0.00,"$1,045.00",$0.00,$745.82,$0.00,$0.00,$745.82,$745.82,$0.00,"$1,045.00",$0.00,$522.50,$827.64,$836.00,$0.00,$0.00,$0.00,$0.00,$0.00
27008008,EAP,Custom 27008008,,Smth Wire/1.5mm Diameter 400m,$308.00,$0.00,$308.00,$0.00,$219.82,$0.00,$0.00,$219.82,$219.82,$0.00,$308.00,$0.00,$154.00,$243.94,$246.40,$0.00,$0.00,$0.00,$0.00,$0.00
27008009,EAP,Custom 27008009,,Smth Wire/1.8mm Diameter 400m,$308.00,$0.00,$308.00,$0.00,$219.82,$0.00,$0.00,$219.82,$219.82,$0.00,$308.00,$0.00,$154.00,$243.94,$246.40,$0.00,$0.00,$0.00,$0.00,$0.00
27008010,EAP,Custom 27008010,,Smth Wire/2.0mm Diameter 400m,$308.00,$0.00,$308.00,$0.00,$219.82,$0.00,$0.00,$219.82,$219.82,$0.00,$308.00,$0.00,$154.00,$243.94,$246.40,$0.00,$0.00,$0.00,$0.00,$0.00
27008011,EAP,Custom 27008011,,Smth Wire 1.5m Dia Hlf Pnt Tip,$308.00,$0.00,$308.00,$0.00,$219.82,$0.00,$0.00,$219.82,$219.82,$0.00,$308.00,$0.00,$154.00,$243.94,$246.40,$0.00,$0.00,$0.00,$0.00,$0.00
27008012,EAP,Custom 27008012,,Smth Wire 1.8m Dia Hlf Pnt Tip,$308.00,$0.00,$308.00,$0.00,$219.82,$0.00,$0.00,$219.82,$219.82,$0.00,$308.00,$0.00,$154.00,$243.94,$246.40,$0.00,$0.00,$0.00,$0.00,$0.00
27008013,EAP,Custom 27008013,,Smth Wire 2.0m Dia Hlf Pnt Tip,$308.00,$0.00,$308.00,$0.00,$219.82,$0.00,$0.00,$219.82,$219.82,$0.00,$308.00,$0.00,$154.00,$243.94,$246.40,$0.00,$0.00,$0.00,$0.00,$0.00
27008014,EAP,Custom 27008014,,Reductn Wre/1.5mm Diam 400m,$962.00,$0.00,$962.00,$0.00,$686.58,$0.00,$0.00,$686.58,$686.58,$0.00,$962.00,$0.00,$481.00,$761.90,$769.60,$0.00,$0.00,$0.00,$0.00,$0.00
27008015,EAP,Custom 27008015,,Reductn Wre/1.8mm Diam 400m,$962.00,$0.00,$962.00,$0.00,$686.58,$0.00,$0.00,$686.58,$686.58,$0.00,$962.00,$0.00,$481.00,$761.90,$769.60,$0.00,$0.00,$0.00,$0.00,$0.00
27008016,EAP,Custom 27008016,,Reductn Wire/2.0mm Diam 400m,$962.00,$0.00,$962.00,$0.00,$686.58,$0.00,$0.00,$686.58,$686.58,$0.00,$962.00,$0.00,$481.00,$761.90,$769.60,$0.00,$0.00,$0.00,$0.00,$0.00
27008017,EAP,Custom 27008017,,Reductn Wre 1.5mm Dia Half Pnt,$962.00,$0.00,$962.00,$0.00,$686.58,$0.00,$0.00,$686.58,$686.58,$0.00,$962.00,$0.00,$481.00,$761.90,$769.60,$0.00,$0.00,$0.00,$0.00,$0.00
27008018,EAP,Custom 27008018,,Reductn Wre 1.8mm Dia Hlf Pnt,$962.00,$0.00,$962.00,$0.00,$686.58,$0.00,$0.00,$686.58,$686.58,$0.00,$962.00,$0.00,$481.00,$761.90,$769.60,$0.00,$0.00,$0.00,$0.00,$0.00
27008019,EAP,Custom 27008019,,Reductn Wre 2.0mm Dia Half Pnt,$962.00,$0.00,$962.00,$0.00,$686.58,$0.00,$0.00,$686.58,$686.58,$0.00,$962.00,$0.00,$481.00,$761.90,$769.60,$0.00,$0.00,$0.00,$0.00,$0.00
27008020,EAP,Custom 27008020,,Wire Bolt/slotted Mr Safe,$197.00,$0.00,$197.00,$0.00,$140.60,$0.00,$0.00,$140.60,$140.60,$0.00,$197.00,$0.00,$98.50,$156.02,$157.60,$0.00,$0.00,$0.00,$0.00,$0.00
27008021,EAP,Custom 27008021,,Wire Bolt/offset Mr Safe,$183.00,$0.00,$183.00,$0.00,$130.61,$0.00,$0.00,$130.61,$130.61,$0.00,$183.00,$0.00,$91.50,$144.94,$146.40,$0.00,$0.00,$0.00,$0.00,$0.00
27008024,EAP,Custom 27008024,,Schanz Scrw Bolt Can Rng Mnt,$906.00,$0.00,$906.00,$0.00,$646.61,$0.00,$0.00,$646.61,$646.61,$0.00,$906.00,$0.00,$453.00,$717.55,$724.80,$0.00,$0.00,$0.00,$0.00,$0.00
27008025,EAP,Custom 27008025,,Schanz Scrw Bolt Can Post Mnt,"$1,045.00",$0.00,"$1,045.00",$0.00,$745.82,$0.00,$0.00,$745.82,$745.82,$0.00,"$1,045.00",$0.00,$522.50,$827.64,$836.00,$0.00,$0.00,$0.00,$0.00,$0.00
27008026,EAP,Custom 27008026,,Square Nut Mr Safe,$337.00,$0.00,$337.00,$0.00,$240.52,$0.00,$0.00,$240.52,$240.52,$0.00,$337.00,$0.00,$168.50,$266.90,$269.60,$0.00,$0.00,$0.00,$0.00,$0.00
27008027,EAP,Custom 27008027,,Nut Mr Safe,$16.00,$0.00,$16.00,$0.00,$11.42,$0.00,$0.00,$11.42,$11.42,$0.00,$16.00,$0.00,$8.00,$12.67,$12.80,$0.00,$0.00,$0.00,$0.00,$0.00
27008028,EAP,Custom 27008028,,Nut 10 Pack Mr Safe,$154.00,$0.00,$154.00,$0.00,$109.91,$0.00,$0.00,$109.91,$109.91,$0.00,$154.00,$0.00,$77.00,$121.97,$123.20,$0.00,$0.00,$0.00,$0.00,$0.00
27008029,EAP,Custom 27008029,,Speed Nut Mr Safe,$652.00,$0.00,$652.00,$0.00,$465.33,$0.00,$0.00,$465.33,$465.33,$0.00,$652.00,$0.00,$326.00,$516.38,$521.60,$0.00,$0.00,$0.00,$0.00,$0.00
27008030,EAP,Custom 27008030,,Wire Post-short Mr Safe,$812.00,$0.00,$812.00,$0.00,$579.52,$0.00,$0.00,$579.52,$579.52,$0.00,$812.00,$0.00,$406.00,$643.10,$649.60,$0.00,$0.00,$0.00,$0.00,$0.00
27008031,EAP,Custom 27008031,,Wire Post-tall Mr Safe,$928.00,$0.00,$928.00,$0.00,$662.31,$0.00,$0.00,$662.31,$662.31,$0.00,$928.00,$0.00,$464.00,$734.98,$742.40,$0.00,$0.00,$0.00,$0.00,$0.00
27008032,EAP,Custom 27008032,,Spacing Washer 1mm Mr Safe,$16.00,$0.00,$16.00,$0.00,$11.42,$0.00,$0.00,$11.42,$11.42,$0.00,$16.00,$0.00,$8.00,$12.67,$12.80,$0.00,$0.00,$0.00,$0.00,$0.00
27008033,EAP,Custom 27008033,,Spacing Washer 2mm Mr Safe,$21.00,$0.00,$21.00,$0.00,$14.99,$0.00,$0.00,$14.99,$14.99,$0.00,$21.00,$0.00,$10.50,$16.63,$16.80,$0.00,$0.00,$0.00,$0.00,$0.00
27008034,EAP,Custom 27008034,,Spacing Washer 4mm Mr Safe,$38.00,$0.00,$38.00,$0.00,$27.12,$0.00,$0.00,$27.12,$27.12,$0.00,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
27008035,EAP,Custom 27008035,,Spherical Washer Couple Mr Saf,$145.00,$0.00,$145.00,$0.00,$103.49,$0.00,$0.00,$103.49,$103.49,$0.00,$145.00,$0.00,$72.50,$114.84,$116.00,$0.00,$0.00,$0.00,$0.00,$0.00
27008036,EAP,Custom 27008036,,Oblique Support Mr Safe,"$2,314.00",$0.00,"$2,314.00",$0.00,"$1,651.50",$0.00,$0.00,"$1,651.50","$1,651.50",$0.00,"$2,314.00",$0.00,"$1,157.00","$1,832.69","$1,851.20",$0.00,$0.00,$0.00,$0.00,$0.00
27008038,EAP,Custom 27008038,,Thread Rod 80 Lng/slot Mr Safe,$280.00,$0.00,$280.00,$0.00,$199.84,$0.00,$0.00,$199.84,$199.84,$0.00,$280.00,$0.00,$140.00,$221.76,$224.00,$0.00,$0.00,$0.00,$0.00,$0.00
27008039,EAP,Custom 27008039,,Thread Rod 100 Lng/slot Mr Sfe,$280.00,$0.00,$280.00,$0.00,$199.84,$0.00,$0.00,$199.84,$199.84,$0.00,$280.00,$0.00,$140.00,$221.76,$224.00,$0.00,$0.00,$0.00,$0.00,$0.00
27008040,EAP,Custom 27008040,,Threaded Rod 120mm Lng Mr Safe,$280.00,$0.00,$280.00,$0.00,$199.84,$0.00,$0.00,$199.84,$199.84,$0.00,$280.00,$0.00,$140.00,$221.76,$224.00,$0.00,$0.00,$0.00,$0.00,$0.00
27008041,EAP,Custom 27008041,,Threaded Rod 150mm Lng Mr Safe,$280.00,$0.00,$280.00,$0.00,$199.84,$0.00,$0.00,$199.84,$199.84,$0.00,$280.00,$0.00,$140.00,$221.76,$224.00,$0.00,$0.00,$0.00,$0.00,$0.00
27008042,EAP,Custom 27008042,,Threaded Rod 200mm Lng Mr Safe,$301.00,$0.00,$301.00,$0.00,$214.82,$0.00,$0.00,$214.82,$214.82,$0.00,$301.00,$0.00,$150.50,$238.39,$240.80,$0.00,$0.00,$0.00,$0.00,$0.00
27008043,EAP,Custom 27008043,,Threaded Rod 250mm Lng Mr Safe,$301.00,$0.00,$301.00,$0.00,$214.82,$0.00,$0.00,$214.82,$214.82,$0.00,$301.00,$0.00,$150.50,$238.39,$240.80,$0.00,$0.00,$0.00,$0.00,$0.00
27008044,EAP,Custom 27008044,,Threaded Rod 300mm Lng Mr Safe,$347.00,$0.00,$347.00,$0.00,$247.65,$0.00,$0.00,$247.65,$247.65,$0.00,$347.00,$0.00,$173.50,$274.82,$277.60,$0.00,$0.00,$0.00,$0.00,$0.00
27008045,EAP,Custom 27008045,,Threaded Rod 350mm Lng Mr Safe,$347.00,$0.00,$347.00,$0.00,$247.65,$0.00,$0.00,$247.65,$247.65,$0.00,$347.00,$0.00,$173.50,$274.82,$277.60,$0.00,$0.00,$0.00,$0.00,$0.00
27008046,EAP,Custom 27008046,,Threaded Rod 400mm Lng Mr Safe,$441.00,$0.00,$441.00,$0.00,$314.74,$0.00,$0.00,$314.74,$314.74,$0.00,$441.00,$0.00,$220.50,$349.27,$352.80,$0.00,$0.00,$0.00,$0.00,$0.00
27008051,EAP,Custom 27008051,,Standoff 20mm Long Mr Safe,$185.00,$0.00,$185.00,$0.00,$132.03,$0.00,$0.00,$132.03,$132.03,$0.00,$185.00,$0.00,$92.50,$146.52,$148.00,$0.00,$0.00,$0.00,$0.00,$0.00
27008052,EAP,Custom 27008052,,Standoff 30mm Long Mr Safe,$208.00,$0.00,$208.00,$0.00,$148.45,$0.00,$0.00,$148.45,$148.45,$0.00,$208.00,$0.00,$104.00,$164.74,$166.40,$0.00,$0.00,$0.00,$0.00,$0.00
27008053,EAP,Custom 27008053,,Standoff 40mm Long Mr Safe,$234.00,$0.00,$234.00,$0.00,$167.01,$0.00,$0.00,$167.01,$167.01,$0.00,$234.00,$0.00,$117.00,$185.33,$187.20,$0.00,$0.00,$0.00,$0.00,$0.00
27008054,EAP,Custom 27008054,,Standoff 50mm Long Mr Safe,$301.00,$0.00,$301.00,$0.00,$214.82,$0.00,$0.00,$214.82,$214.82,$0.00,$301.00,$0.00,$150.50,$238.39,$240.80,$0.00,$0.00,$0.00,$0.00,$0.00
27008055,EAP,Custom 27008055,,Ti Half Ring/80m Diam Mr Safe,"$1,505.00",$0.00,"$1,505.00",$0.00,"$1,074.12",$0.00,$0.00,"$1,074.12","$1,074.12",$0.00,"$1,505.00",$0.00,$752.50,"$1,191.96","$1,204.00",$0.00,$0.00,$0.00,$0.00,$0.00
27008056,EAP,Custom 27008056,,Ti Half Ring/100m Diam Mr Safe,"$1,624.00",$0.00,"$1,624.00",$0.00,"$1,159.05",$0.00,$0.00,"$1,159.05","$1,159.05",$0.00,"$1,624.00",$0.00,$812.00,"$1,286.21","$1,299.20",$0.00,$0.00,$0.00,$0.00,$0.00
27008057,EAP,Custom 27008057,,Ti Half Ring/110m Diam Mr Safe,"$1,667.00",$0.00,"$1,667.00",$0.00,"$1,189.74",$0.00,$0.00,"$1,189.74","$1,189.74",$0.00,"$1,667.00",$0.00,$833.50,"$1,320.26","$1,333.60",$0.00,$0.00,$0.00,$0.00,$0.00
27008058,EAP,Custom 27008058,,Ti Half Ring/120m Diam Mr Safe,"$1,735.00",$0.00,"$1,735.00",$0.00,"$1,238.27",$0.00,$0.00,"$1,238.27","$1,238.27",$0.00,"$1,735.00",$0.00,$867.50,"$1,374.12","$1,388.00",$0.00,$0.00,$0.00,$0.00,$0.00
27008059,EAP,Custom 27008059,,Ti Half Ring/130m Diam Mr Safe,"$1,783.00",$0.00,"$1,783.00",$0.00,"$1,272.53",$0.00,$0.00,"$1,272.53","$1,272.53",$0.00,"$1,783.00",$0.00,$891.50,"$1,412.14","$1,426.40",$0.00,$0.00,$0.00,$0.00,$0.00
27008060,EAP,Custom 27008060,,Ti Half Ring/140m Diam Mr Safe,"$1,850.00",$0.00,"$1,850.00",$0.00,"$1,320.35",$0.00,$0.00,"$1,320.35","$1,320.35",$0.00,"$1,850.00",$0.00,$925.00,"$1,465.20","$1,480.00",$0.00,$0.00,$0.00,$0.00,$0.00
27008061,EAP,Custom 27008061,,Ti Half Ring/150m Diam Mr Safe,"$1,969.00",$0.00,"$1,969.00",$0.00,"$1,405.28",$0.00,$0.00,"$1,405.28","$1,405.28",$0.00,"$1,969.00",$0.00,$984.50,"$1,559.45","$1,575.20",$0.00,$0.00,$0.00,$0.00,$0.00
27008062,EAP,Custom 27008062,,Ti Half Ring/160m Diam Mr Safe,"$2,153.00",$0.00,"$2,153.00",$0.00,"$1,536.60",$0.00,$0.00,"$1,536.60","$1,536.60",$0.00,"$2,153.00",$0.00,"$1,076.50","$1,705.18","$1,722.40",$0.00,$0.00,$0.00,$0.00,$0.00
27008063,EAP,Custom 27008063,,Ti Half Ring/180m Diam Mr Safe,"$2,314.00",$0.00,"$2,314.00",$0.00,"$1,651.50",$0.00,$0.00,"$1,651.50","$1,651.50",$0.00,"$2,314.00",$0.00,"$1,157.00","$1,832.69","$1,851.20",$0.00,$0.00,$0.00,$0.00,$0.00
27008064,EAP,Custom 27008064,,Ti Half Ring/200m Diam Mr Safe,"$2,498.00",$0.00,"$2,498.00",$0.00,"$1,782.82",$0.00,$0.00,"$1,782.82","$1,782.82",$0.00,"$2,498.00",$0.00,"$1,249.00","$1,978.42","$1,998.40",$0.00,$0.00,$0.00,$0.00,$0.00
27008065,EAP,Custom 27008065,,Ti Half Ring/220m Diam Mr Safe,"$2,663.00",$0.00,"$2,663.00",$0.00,"$1,900.58",$0.00,$0.00,"$1,900.58","$1,900.58",$0.00,"$2,663.00",$0.00,"$1,331.50","$2,109.10","$2,130.40",$0.00,$0.00,$0.00,$0.00,$0.00
27008066,EAP,Custom 27008066,,Ti Half Ring/240m Diam Mr Safe,"$2,779.00",$0.00,"$2,779.00",$0.00,"$1,983.37",$0.00,$0.00,"$1,983.37","$1,983.37",$0.00,"$2,779.00",$0.00,"$1,389.50","$2,200.97","$2,223.20",$0.00,$0.00,$0.00,$0.00,$0.00
27008067,EAP,Custom 27008067,,Ti Full Ring/140m Diam Mr Safe,"$3,704.00",$0.00,"$3,704.00",$0.00,"$2,643.54",$0.00,$0.00,"$2,643.54","$2,643.54",$0.00,"$3,704.00",$0.00,"$1,852.00","$2,933.57","$2,963.20",$0.00,$0.00,$0.00,$0.00,$0.00
27008068,EAP,Custom 27008068,,Ti Full Ring/160m Diam Mr Safe,"$4,303.00",$0.00,"$4,303.00",$0.00,"$3,071.05",$0.00,$0.00,"$3,071.05","$3,071.05",$0.00,"$4,303.00",$0.00,"$2,151.50","$3,407.98","$3,442.40",$0.00,$0.00,$0.00,$0.00,$0.00
27008069,EAP,Custom 27008069,,Ti Full Ring/180m Diam Mr Safe,"$4,627.00",$0.00,"$4,627.00",$0.00,"$3,302.29",$0.00,$0.00,"$3,302.29","$3,302.29",$0.00,"$4,627.00",$0.00,"$2,313.50","$3,664.58","$3,701.60",$0.00,$0.00,$0.00,$0.00,$0.00
27008070,EAP,Custom 27008070,,Ti Full Ring/200m Diam Mr Safe,"$5,022.00",$0.00,"$5,022.00",$0.00,"$3,584.20",$0.00,$0.00,"$3,584.20","$3,584.20",$0.00,"$5,022.00",$0.00,"$2,511.00","$3,977.42","$4,017.60",$0.00,$0.00,$0.00,$0.00,$0.00
27008071,EAP,Custom 27008071,,Ti 5/8 Ring/130m Diam Mr Safe,"$2,430.00",$0.00,"$2,430.00",$0.00,"$1,734.29",$0.00,$0.00,"$1,734.29","$1,734.29",$0.00,"$2,430.00",$0.00,"$1,215.00","$1,924.56","$1,944.00",$0.00,$0.00,$0.00,$0.00,$0.00
27008072,EAP,Custom 27008072,,Ti 5/8 Ring/150mm Diam Mr Safe,"$2,663.00",$0.00,"$2,663.00",$0.00,"$1,900.58",$0.00,$0.00,"$1,900.58","$1,900.58",$0.00,"$2,663.00",$0.00,"$1,331.50","$2,109.10","$2,130.40",$0.00,$0.00,$0.00,$0.00,$0.00
27008073,EAP,Custom 27008073,,Ti 5/8 Ring/160mm Diam Mr Safe,"$2,891.00",$0.00,"$2,891.00",$0.00,"$2,063.31",$0.00,$0.00,"$2,063.31","$2,063.31",$0.00,"$2,891.00",$0.00,"$1,445.50","$2,289.67","$2,312.80",$0.00,$0.00,$0.00,$0.00,$0.00
27008074,EAP,Custom 27008074,,Ti 5/8 Ring/180mm Diam Mr Safe,"$3,358.00",$0.00,"$3,358.00",$0.00,"$2,396.60",$0.00,$0.00,"$2,396.60","$2,396.60",$0.00,"$3,358.00",$0.00,"$1,679.00","$2,659.54","$2,686.40",$0.00,$0.00,$0.00,$0.00,$0.00
27008075,EAP,Custom 27008075,,Ti 5/8 Ring/200mm Diam Mr Safe,"$3,470.00",$0.00,"$3,470.00",$0.00,"$2,476.54",$0.00,$0.00,"$2,476.54","$2,476.54",$0.00,"$3,470.00",$0.00,"$1,735.00","$2,748.24","$2,776.00",$0.00,$0.00,$0.00,$0.00,$0.00
27008076,EAP,Custom 27008076,,Ti Fem Arch Pl 180 Dia/90 Degr,"$4,165.00",$0.00,"$4,165.00",$0.00,"$2,972.56",$0.00,$0.00,"$2,972.56","$2,972.56",$0.00,"$4,165.00",$0.00,"$2,082.50","$3,298.68","$3,332.00",$0.00,$0.00,$0.00,$0.00,$0.00
27008077,EAP,Custom 27008077,,Ti Fem Arch Pl 180 Dia/120 Deg,"$4,281.00",$0.00,"$4,281.00",$0.00,"$3,055.35",$0.00,$0.00,"$3,055.35","$3,055.35",$0.00,"$4,281.00",$0.00,"$2,140.50","$3,390.55","$3,424.80",$0.00,$0.00,$0.00,$0.00,$0.00
27008078,EAP,Custom 27008078,,Ti Fem Arch Pl 240 Dia/90 Degr,"$4,515.00",$0.00,"$4,515.00",$0.00,"$3,222.36",$0.00,$0.00,"$3,222.36","$3,222.36",$0.00,"$4,515.00",$0.00,"$2,257.50","$3,575.88","$3,612.00",$0.00,$0.00,$0.00,$0.00,$0.00
27008079,EAP,Custom 27008079,,Ti Fem Arch Pl 240 Dia/120 Deg,"$4,627.00",$0.00,"$4,627.00",$0.00,"$3,302.29",$0.00,$0.00,"$3,302.29","$3,302.29",$0.00,"$4,627.00",$0.00,"$2,313.50","$3,664.58","$3,701.60",$0.00,$0.00,$0.00,$0.00,$0.00
27008080,EAP,Custom 27008080,,Linear Distrac 60 Lng 25mm Tr,"$2,663.00",$0.00,"$2,663.00",$0.00,"$1,900.58",$0.00,$0.00,"$1,900.58","$1,900.58",$0.00,"$2,663.00",$0.00,"$1,331.50","$2,109.10","$2,130.40",$0.00,$0.00,$0.00,$0.00,$0.00
27008081,EAP,Custom 27008081,,Linear Distrac 120lng 85mm Tra,"$2,891.00",$0.00,"$2,891.00",$0.00,"$2,063.31",$0.00,$0.00,"$2,063.31","$2,063.31",$0.00,"$2,891.00",$0.00,"$1,445.50","$2,289.67","$2,312.80",$0.00,$0.00,$0.00,$0.00,$0.00
27008082,EAP,Custom 27008082,,Linear Distrac 180 Lng 145 Tra,"$3,241.00",$0.00,"$3,241.00",$0.00,"$2,313.10",$0.00,$0.00,"$2,313.10","$2,313.10",$0.00,"$3,241.00",$0.00,"$1,620.50","$2,566.87","$2,592.80",$0.00,$0.00,$0.00,$0.00,$0.00
27008083,EAP,Custom 27008083,,Linear Distrac 250 Lng 215 Tra,"$3,934.00",$0.00,"$3,934.00",$0.00,"$2,807.70",$0.00,$0.00,"$2,807.70","$2,807.70",$0.00,"$3,934.00",$0.00,"$1,967.00","$3,115.73","$3,147.20",$0.00,$0.00,$0.00,$0.00,$0.00
27008118,EAP,Custom 27008118,,Sft Tissue Sprder Trocar 35mm,"$1,247.00",$0.00,"$1,247.00",$0.00,$889.98,$0.00,$0.00,$889.98,$889.98,$0.00,"$1,247.00",$0.00,$623.50,$987.62,$997.60,$0.00,$0.00,$0.00,$0.00,$0.00
27008119,EAP,Custom 27008119,,Sft Tissue Sprder Trocar 75,"$1,247.00",$0.00,"$1,247.00",$0.00,$889.98,$0.00,$0.00,$889.98,$889.98,$0.00,"$1,247.00",$0.00,$623.50,$987.62,$997.60,$0.00,$0.00,$0.00,$0.00,$0.00
27008122,EAP,Custom 27008122,,Straight Sharp Hook,$600.00,$0.00,$600.00,$0.00,$428.22,$0.00,$0.00,$428.22,$428.22,$0.00,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$0.00,$0.00,$0.00,$0.00
27008124,EAP,Custom 27008124,,Small Screw Removal Forceps,"$1,770.00",$0.00,"$1,770.00",$0.00,"$1,263.25",$0.00,$0.00,"$1,263.25","$1,263.25",$0.00,"$1,770.00",$0.00,$885.00,"$1,401.84","$1,416.00",$0.00,$0.00,$0.00,$0.00,$0.00
27008125,EAP,Custom 27008125,,Large Screw Removal Forceps,"$2,123.00",$0.00,"$2,123.00",$0.00,"$1,515.19",$0.00,$0.00,"$1,515.19","$1,515.19",$0.00,"$2,123.00",$0.00,"$1,061.50","$1,681.42","$1,698.40",$0.00,$0.00,$0.00,$0.00,$0.00
27008126,EAP,Custom 27008126,,Ti End Cap T25 Strdr 0mext Hu,$631.00,$0.00,$631.00,$0.00,$450.34,$0.00,$0.00,$450.34,$450.34,$0.00,$631.00,$0.00,$315.50,$499.75,$504.80,$0.00,$0.00,$0.00,$0.00,$0.00
27008127,EAP,Custom 27008127,,Ti End Cap T25 Strdrv 0mm Ext,$759.00,$0.00,$759.00,$0.00,$541.70,$0.00,$0.00,$541.70,$541.70,$0.00,$759.00,$0.00,$379.50,$601.13,$607.20,$0.00,$0.00,$0.00,$0.00,$0.00
27008128,EAP,Custom 27008128,,Ti End Cap T25 Strdrv 5mm Ext,$631.00,$0.00,$631.00,$0.00,$450.34,$0.00,$0.00,$450.34,$450.34,$0.00,$631.00,$0.00,$315.50,$499.75,$504.80,$0.00,$0.00,$0.00,$0.00,$0.00
27008129,EAP,Custom 27008129,,Ti End Cap T25 Strdrv 5mm Ext,$759.00,$0.00,$759.00,$0.00,$541.70,$0.00,$0.00,$541.70,$541.70,$0.00,$759.00,$0.00,$379.50,$601.13,$607.20,$0.00,$0.00,$0.00,$0.00,$0.00
27008130,EAP,Custom 27008130,,Ti End Cap T25 Strdrv 10mm Ex,$631.00,$0.00,$631.00,$0.00,$450.34,$0.00,$0.00,$450.34,$450.34,$0.00,$631.00,$0.00,$315.50,$499.75,$504.80,$0.00,$0.00,$0.00,$0.00,$0.00
27008131,EAP,Custom 27008131,,Ti End Cap T25 Strdrv 10mm Ex,$759.00,$0.00,$759.00,$0.00,$541.70,$0.00,$0.00,$541.70,$541.70,$0.00,$759.00,$0.00,$379.50,$601.13,$607.20,$0.00,$0.00,$0.00,$0.00,$0.00
27008132,EAP,Custom 27008132,,Ti End Cap T25 Strdrv 15mm Ext,$631.00,$0.00,$631.00,$0.00,$450.34,$0.00,$0.00,$450.34,$450.34,$0.00,$631.00,$0.00,$315.50,$499.75,$504.80,$0.00,$0.00,$0.00,$0.00,$0.00
27008133,EAP,Custom 27008133,,Ti End Cap T25 Strdrv 15mm Ex,$759.00,$0.00,$759.00,$0.00,$541.70,$0.00,$0.00,$541.70,$541.70,$0.00,$759.00,$0.00,$379.50,$601.13,$607.20,$0.00,$0.00,$0.00,$0.00,$0.00
27008138,EAP,Custom 27008138,,11m Ti Can Prox Hum Nl-ex/150m,"$7,722.00",$0.00,"$7,722.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$7,722.00",$0.00,"$3,861.00","$6,115.82","$6,177.60",$0.00,$0.00,$0.00,$0.00,$0.00
27008139,EAP,Custom 27008139,,11m Ti Can Hum Nail-ex/190-320,"$7,722.00",$0.00,"$7,722.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$7,722.00",$0.00,"$3,861.00","$6,115.82","$6,177.60",$0.00,$0.00,$0.00,$0.00,$0.00
27008140,EAP,Custom 27008140,,Ti End Cap T40 Sdrv 0mext Fem,$682.00,$0.00,$682.00,$0.00,$486.74,$0.00,$0.00,$486.74,$486.74,$0.00,$682.00,$0.00,$341.00,$540.14,$545.60,$0.00,$0.00,$0.00,$0.00,$0.00
27008141,EAP,Custom 27008141,,Ti End Cap T40 Sdrv 0mext Ste,$812.00,$0.00,$812.00,$0.00,$579.52,$0.00,$0.00,$579.52,$579.52,$0.00,$812.00,$0.00,$406.00,$643.10,$649.60,$0.00,$0.00,$0.00,$0.00,$0.00
27008142,EAP,Custom 27008142,,12 Ti End Cap T40 Sdrv 5m Ext,$682.00,$0.00,$682.00,$0.00,$486.74,$0.00,$0.00,$486.74,$486.74,$0.00,$682.00,$0.00,$341.00,$540.14,$545.60,$0.00,$0.00,$0.00,$0.00,$0.00
27008143,EAP,Custom 27008143,,12 Ti End Cap T40 Sdrv 5m Ext,$812.00,$0.00,$812.00,$0.00,$579.52,$0.00,$0.00,$579.52,$579.52,$0.00,$812.00,$0.00,$406.00,$643.10,$649.60,$0.00,$0.00,$0.00,$0.00,$0.00
27008144,EAP,Custom 27008144,,12 Ti End Cap T40 Sdrv 10mm Ex,$682.00,$0.00,$682.00,$0.00,$486.74,$0.00,$0.00,$486.74,$486.74,$0.00,$682.00,$0.00,$341.00,$540.14,$545.60,$0.00,$0.00,$0.00,$0.00,$0.00
27008145,EAP,Custom 27008145,,12 Ti End Cap T40 Sdrv 10mm Ex,$812.00,$0.00,$812.00,$0.00,$579.52,$0.00,$0.00,$579.52,$579.52,$0.00,$812.00,$0.00,$406.00,$643.10,$649.60,$0.00,$0.00,$0.00,$0.00,$0.00
27008146,EAP,Custom 27008146,,12 Ti End Cap T40 Sdrv 15mm Ex,$682.00,$0.00,$682.00,$0.00,$486.74,$0.00,$0.00,$486.74,$486.74,$0.00,$682.00,$0.00,$341.00,$540.14,$545.60,$0.00,$0.00,$0.00,$0.00,$0.00
27008147,EAP,Custom 27008147,,12 Ti End Cap T40 Sdrv 15mm Ex,$812.00,$0.00,$812.00,$0.00,$579.52,$0.00,$0.00,$579.52,$579.52,$0.00,$812.00,$0.00,$406.00,$643.10,$649.60,$0.00,$0.00,$0.00,$0.00,$0.00
27008148,EAP,Custom 27008148,,12 Ti End Cap T40 Sdrv 20mm Ex,$682.00,$0.00,$682.00,$0.00,$486.74,$0.00,$0.00,$486.74,$486.74,$0.00,$682.00,$0.00,$341.00,$540.14,$545.60,$0.00,$0.00,$0.00,$0.00,$0.00
27008149,EAP,Custom 27008149,,12 Ti End Cap T40 Sdrv 20mm Ex,$812.00,$0.00,$812.00,$0.00,$579.52,$0.00,$0.00,$579.52,$579.52,$0.00,$812.00,$0.00,$406.00,$643.10,$649.60,$0.00,$0.00,$0.00,$0.00,$0.00
27008150,EAP,Custom 27008150,,16 Ti End Cap T40 Sdrv 5m Ext,$682.00,$0.00,$682.00,$0.00,$486.74,$0.00,$0.00,$486.74,$486.74,$0.00,$682.00,$0.00,$341.00,$540.14,$545.60,$0.00,$0.00,$0.00,$0.00,$0.00
27008151,EAP,Custom 27008151,,16m Ti End Cap T40 Sdrv 5m Ext,$812.00,$0.00,$812.00,$0.00,$579.52,$0.00,$0.00,$579.52,$579.52,$0.00,$812.00,$0.00,$406.00,$643.10,$649.60,$0.00,$0.00,$0.00,$0.00,$0.00
27008152,EAP,Custom 27008152,,16m Ti End Cap T40 Sdrv 10mm,$682.00,$0.00,$682.00,$0.00,$486.74,$0.00,$0.00,$486.74,$486.74,$0.00,$682.00,$0.00,$341.00,$540.14,$545.60,$0.00,$0.00,$0.00,$0.00,$0.00
27008153,EAP,Custom 27008153,,16m Ti End Cap T40 Sdrv 10mm,$812.00,$0.00,$812.00,$0.00,$579.52,$0.00,$0.00,$579.52,$579.52,$0.00,$812.00,$0.00,$406.00,$643.10,$649.60,$0.00,$0.00,$0.00,$0.00,$0.00
27008154,EAP,Custom 27008154,,16m Ti End Cap T40 Sdrv 15mm,$682.00,$0.00,$682.00,$0.00,$486.74,$0.00,$0.00,$486.74,$486.74,$0.00,$682.00,$0.00,$341.00,$540.14,$545.60,$0.00,$0.00,$0.00,$0.00,$0.00
27008155,EAP,Custom 27008155,,16m Ti End Cap T40 Sdrv 15mm,$812.00,$0.00,$812.00,$0.00,$579.52,$0.00,$0.00,$579.52,$579.52,$0.00,$812.00,$0.00,$406.00,$643.10,$649.60,$0.00,$0.00,$0.00,$0.00,$0.00
27008156,EAP,Custom 27008156,,16 Ti End Cap T40 Sdrv 20mm Ex,$682.00,$0.00,$682.00,$0.00,$486.74,$0.00,$0.00,$486.74,$486.74,$0.00,$682.00,$0.00,$341.00,$540.14,$545.60,$0.00,$0.00,$0.00,$0.00,$0.00
27008157,EAP,Custom 27008157,,16 Ti End Cap T40 Sdrv 20mm Ex,$812.00,$0.00,$812.00,$0.00,$579.52,$0.00,$0.00,$579.52,$579.52,$0.00,$812.00,$0.00,$406.00,$643.10,$649.60,$0.00,$0.00,$0.00,$0.00,$0.00
27008185,EAP,Custom 27008185,,10ti Lat En Fem Nl-ex/300m-480,"$6,829.00",$0.00,"$6,829.00",$0.00,"$4,873.86",$0.00,$0.00,"$4,873.86","$4,873.86",$0.00,"$6,829.00",$0.00,"$3,414.50","$5,408.57","$5,463.20",$0.00,$0.00,$0.00,$0.00,$0.00
27008186,EAP,Custom 27008186,,11ti Lat En Fem Nl-ex/300m-480,"$6,829.00",$0.00,"$6,829.00",$0.00,"$4,873.86",$0.00,$0.00,"$4,873.86","$4,873.86",$0.00,"$6,829.00",$0.00,"$3,414.50","$5,408.57","$5,463.20",$0.00,$0.00,$0.00,$0.00,$0.00
27008187,EAP,Custom 27008187,,11ti Lat En Fem Nl-ex/300m-480,"$6,829.00",$0.00,"$6,829.00",$0.00,"$4,873.86",$0.00,$0.00,"$4,873.86","$4,873.86",$0.00,"$6,829.00",$0.00,"$3,414.50","$5,408.57","$5,463.20",$0.00,$0.00,$0.00,$0.00,$0.00
27008188,EAP,Custom 27008188,,12 Ti Lat En Fem Nl-ex/300-480,"$6,829.00",$0.00,"$6,829.00",$0.00,"$4,873.86",$0.00,$0.00,"$4,873.86","$4,873.86",$0.00,"$6,829.00",$0.00,"$3,414.50","$5,408.57","$5,463.20",$0.00,$0.00,$0.00,$0.00,$0.00
27008189,EAP,Custom 27008189,,12 Ti Lat En Fem Nl-ex/300-480,"$6,829.00",$0.00,"$6,829.00",$0.00,"$4,873.86",$0.00,$0.00,"$4,873.86","$4,873.86",$0.00,"$6,829.00",$0.00,"$3,414.50","$5,408.57","$5,463.20",$0.00,$0.00,$0.00,$0.00,$0.00
27008190,EAP,Custom 27008190,,13ti Lat Ent Fem Nl-ex/300m480,"$6,829.00",$0.00,"$6,829.00",$0.00,"$4,873.86",$0.00,$0.00,"$4,873.86","$4,873.86",$0.00,"$6,829.00",$0.00,"$3,414.50","$5,408.57","$5,463.20",$0.00,$0.00,$0.00,$0.00,$0.00
27008191,EAP,Custom 27008191,,13ti Lat Ent Fem Nl-ex/300m480,"$6,829.00",$0.00,"$6,829.00",$0.00,"$4,873.86",$0.00,$0.00,"$4,873.86","$4,873.86",$0.00,"$6,829.00",$0.00,"$3,414.50","$5,408.57","$5,463.20",$0.00,$0.00,$0.00,$0.00,$0.00
27008192,EAP,Custom 27008192,,14ti Lat Ent Fem Nl-ex/300m480,"$6,829.00",$0.00,"$6,829.00",$0.00,"$4,873.86",$0.00,$0.00,"$4,873.86","$4,873.86",$0.00,"$6,829.00",$0.00,"$3,414.50","$5,408.57","$5,463.20",$0.00,$0.00,$0.00,$0.00,$0.00
27008193,EAP,Custom 27008193,,14ti Lat Ent Fem Nl-ex/300m480,"$6,829.00",$0.00,"$6,829.00",$0.00,"$4,873.86",$0.00,$0.00,"$4,873.86","$4,873.86",$0.00,"$6,829.00",$0.00,"$3,414.50","$5,408.57","$5,463.20",$0.00,$0.00,$0.00,$0.00,$0.00
27008194,EAP,Custom 27008194,,15ti Lat Ent Fem Nl-ex/300m480,"$6,829.00",$0.00,"$6,829.00",$0.00,"$4,873.86",$0.00,$0.00,"$4,873.86","$4,873.86",$0.00,"$6,829.00",$0.00,"$3,414.50","$5,408.57","$5,463.20",$0.00,$0.00,$0.00,$0.00,$0.00
27008195,EAP,Custom 27008195,,15ti Lat Ent Fem Nl-ex/300m480,"$6,829.00",$0.00,"$6,829.00",$0.00,"$4,873.86",$0.00,$0.00,"$4,873.86","$4,873.86",$0.00,"$6,829.00",$0.00,"$3,414.50","$5,408.57","$5,463.20",$0.00,$0.00,$0.00,$0.00,$0.00
27008196,EAP,Custom 27008196,,16ti Lat Ent Fem Nl-ex/300m480,"$6,829.00",$0.00,"$6,829.00",$0.00,"$4,873.86",$0.00,$0.00,"$4,873.86","$4,873.86",$0.00,"$6,829.00",$0.00,"$3,414.50","$5,408.57","$5,463.20",$0.00,$0.00,$0.00,$0.00,$0.00
27008197,EAP,Custom 27008197,,16ti Lat Ent Fem Nl-ex/300m480,"$6,829.00",$0.00,"$6,829.00",$0.00,"$4,873.86",$0.00,$0.00,"$4,873.86","$4,873.86",$0.00,"$6,829.00",$0.00,"$3,414.50","$5,408.57","$5,463.20",$0.00,$0.00,$0.00,$0.00,$0.00
27008198,EAP,Custom 27008198,,Ti En Cp W/t40 Sdr 0m Ext F/t,$682.00,$0.00,$682.00,$0.00,$486.74,$0.00,$0.00,$486.74,$486.74,$0.00,$682.00,$0.00,$341.00,$540.14,$545.60,$0.00,$0.00,$0.00,$0.00,$0.00
27008199,EAP,Custom 27008199,,Ti En Cap W/t40 Sdr 0m Ext F/t,$812.00,$0.00,$812.00,$0.00,$579.52,$0.00,$0.00,$579.52,$579.52,$0.00,$812.00,$0.00,$406.00,$643.10,$649.60,$0.00,$0.00,$0.00,$0.00,$0.00
27008200,EAP,Custom 27008200,,Ti En Cap W/t40 Sdr 5m Ext F/t,$882.00,$0.00,$882.00,$0.00,$629.48,$0.00,$0.00,$629.48,$629.48,$0.00,$882.00,$0.00,$441.00,$698.54,$705.60,$0.00,$0.00,$0.00,$0.00,$0.00
27008201,EAP,Custom 27008201,,Ti En Cap W/t40 Sdr 5m Ext-ste,"$1,010.00",$0.00,"$1,010.00",$0.00,$720.84,$0.00,$0.00,$720.84,$720.84,$0.00,"$1,010.00",$0.00,$505.00,$799.92,$808.00,$0.00,$0.00,$0.00,$0.00,$0.00
27008202,EAP,Custom 27008202,,Ti En Cap W/ T40 Sdr Ext F/ti,$882.00,$0.00,$882.00,$0.00,$629.48,$0.00,$0.00,$629.48,$629.48,$0.00,$882.00,$0.00,$441.00,$698.54,$705.60,$0.00,$0.00,$0.00,$0.00,$0.00
27008203,EAP,Custom 27008203,,Ti En Cap W/t40 Sdr 10m Ext-st,"$1,010.00",$0.00,"$1,010.00",$0.00,$720.84,$0.00,$0.00,$720.84,$720.84,$0.00,"$1,010.00",$0.00,$505.00,$799.92,$808.00,$0.00,$0.00,$0.00,$0.00,$0.00
27008204,EAP,Custom 27008204,,Ti En Cap W/t40 Sdr 15m Ext,$882.00,$0.00,$882.00,$0.00,$629.48,$0.00,$0.00,$629.48,$629.48,$0.00,$882.00,$0.00,$441.00,$698.54,$705.60,$0.00,$0.00,$0.00,$0.00,$0.00
27008205,EAP,Custom 27008205,,Ti En Cap W/t40 Sdr 15m Ext-st,"$1,010.00",$0.00,"$1,010.00",$0.00,$720.84,$0.00,$0.00,$720.84,$720.84,$0.00,"$1,010.00",$0.00,$505.00,$799.92,$808.00,$0.00,$0.00,$0.00,$0.00,$0.00
27008206,EAP,Custom 27008206,,Ti En Cap Tib Nl-ex T40 Sdr 0m,$682.00,$0.00,$682.00,$0.00,$486.74,$0.00,$0.00,$486.74,$486.74,$0.00,$682.00,$0.00,$341.00,$540.14,$545.60,$0.00,$0.00,$0.00,$0.00,$0.00
27008207,EAP,Custom 27008207,,Ti En Cap Tib Nl-ex T40 Sdr 0,$812.00,$0.00,$812.00,$0.00,$579.52,$0.00,$0.00,$579.52,$579.52,$0.00,$812.00,$0.00,$406.00,$643.10,$649.60,$0.00,$0.00,$0.00,$0.00,$0.00
27008208,EAP,Custom 27008208,,Ti En Cap Tib Nl-ex T40 Sdr 5m,$882.00,$0.00,$882.00,$0.00,$629.48,$0.00,$0.00,$629.48,$629.48,$0.00,$882.00,$0.00,$441.00,$698.54,$705.60,$0.00,$0.00,$0.00,$0.00,$0.00
27008209,EAP,Custom 27008209,,Ti En Cap Tib Nl-ex T40 Sdr 5m,"$1,010.00",$0.00,"$1,010.00",$0.00,$720.84,$0.00,$0.00,$720.84,$720.84,$0.00,"$1,010.00",$0.00,$505.00,$799.92,$808.00,$0.00,$0.00,$0.00,$0.00,$0.00
27008210,EAP,Custom 27008210,,Ti En Cap Tib Nl-ex T40 Sdr 10,$882.00,$0.00,$882.00,$0.00,$629.48,$0.00,$0.00,$629.48,$629.48,$0.00,$882.00,$0.00,$441.00,$698.54,$705.60,$0.00,$0.00,$0.00,$0.00,$0.00
27008211,EAP,Custom 27008211,,Ti En Cap Tib Nl-ex T40 Sdr 10,"$1,010.00",$0.00,"$1,010.00",$0.00,$720.84,$0.00,$0.00,$720.84,$720.84,$0.00,"$1,010.00",$0.00,$505.00,$799.92,$808.00,$0.00,$0.00,$0.00,$0.00,$0.00
27008212,EAP,Custom 27008212,,Ti En Cap Tib Nl-ex T40 Sdr 15,$882.00,$0.00,$882.00,$0.00,$629.48,$0.00,$0.00,$629.48,$629.48,$0.00,$882.00,$0.00,$441.00,$698.54,$705.60,$0.00,$0.00,$0.00,$0.00,$0.00
27008213,EAP,Custom 27008213,,Ti En Cap Tib Nl-ex T40 Sdr 15,"$1,010.00",$0.00,"$1,010.00",$0.00,$720.84,$0.00,$0.00,$720.84,$720.84,$0.00,"$1,010.00",$0.00,$505.00,$799.92,$808.00,$0.00,$0.00,$0.00,$0.00,$0.00
27008216,EAP,Custom 27008216,,10m Ti Can Tib Nl-ex/255-435mm,"$6,110.00",$0.00,"$6,110.00",$0.00,"$4,360.71",$0.00,$0.00,"$4,360.71","$4,360.71",$0.00,"$6,110.00",$0.00,"$3,055.00","$4,839.12","$4,888.00",$0.00,$0.00,$0.00,$0.00,$0.00
27008217,EAP,Custom 27008217,,12m Ti Can Tib Nl-ex/255-435mm,"$6,110.00",$0.00,"$6,110.00",$0.00,"$4,360.71",$0.00,$0.00,"$4,360.71","$4,360.71",$0.00,"$6,110.00",$0.00,"$3,055.00","$4,839.12","$4,888.00",$0.00,$0.00,$0.00,$0.00,$0.00
27008219,EAP,Custom 27008219,,Ti En Cap T25 Sdr Hndft Art Nl,$712.00,$0.00,$712.00,$0.00,$508.15,$0.00,$0.00,$508.15,$508.15,$0.00,$712.00,$0.00,$356.00,$563.90,$569.60,$0.00,$0.00,$0.00,$0.00,$0.00
27008220,EAP,Custom 27008220,,Ti En Cap T25 Sdr Hndft Art Nl,$842.00,$0.00,$842.00,$0.00,$600.94,$0.00,$0.00,$600.94,$600.94,$0.00,$842.00,$0.00,$421.00,$666.86,$673.60,$0.00,$0.00,$0.00,$0.00,$0.00
27008221,EAP,Custom 27008221,,Ti En Cap T25 Sdr Hndft Art Nl,$712.00,$0.00,$712.00,$0.00,$508.15,$0.00,$0.00,$508.15,$508.15,$0.00,$712.00,$0.00,$356.00,$563.90,$569.60,$0.00,$0.00,$0.00,$0.00,$0.00
27008222,EAP,Custom 27008222,,Ti En Cap T25 Sdr Hndft Art Nl,$842.00,$0.00,$842.00,$0.00,$600.94,$0.00,$0.00,$600.94,$600.94,$0.00,$842.00,$0.00,$421.00,$666.86,$673.60,$0.00,$0.00,$0.00,$0.00,$0.00
27008223,EAP,Custom 27008223,,10ti Hft Art Can Nl-ex150-240m,"$6,453.00",$0.00,"$6,453.00",$0.00,"$4,605.51",$0.00,$0.00,"$4,605.51","$4,605.51",$0.00,"$6,453.00",$0.00,"$3,226.50","$5,110.78","$5,162.40",$0.00,$0.00,$0.00,$0.00,$0.00
27008224,EAP,Custom 27008224,,Ti En Cap T40 Sdr 0m Ext Retr,$682.00,$0.00,$682.00,$0.00,$486.74,$0.00,$0.00,$486.74,$486.74,$0.00,$682.00,$0.00,$341.00,$540.14,$545.60,$0.00,$0.00,$0.00,$0.00,$0.00
27008225,EAP,Custom 27008225,,Ti Spir Bld 45m Ti Retr Fem Nl,"$2,318.00",$0.00,"$2,318.00",$0.00,"$1,654.36",$0.00,$0.00,"$1,654.36","$1,654.36",$0.00,"$2,318.00",$0.00,"$1,159.00","$1,835.86","$1,854.40",$0.00,$0.00,$0.00,$0.00,$0.00
27008226,EAP,Custom 27008226,,Ti Spir Bld 50m Ti Retr Fem Nl,"$2,318.00",$0.00,"$2,318.00",$0.00,"$1,654.36",$0.00,$0.00,"$1,654.36","$1,654.36",$0.00,"$2,318.00",$0.00,"$1,159.00","$1,835.86","$1,854.40",$0.00,$0.00,$0.00,$0.00,$0.00
27008227,EAP,Custom 27008227,,Ti Spir Bld 50m-ster F/ti Retr,"$2,447.00",$0.00,"$2,447.00",$0.00,"$1,746.42",$0.00,$0.00,"$1,746.42","$1,746.42",$0.00,"$2,447.00",$0.00,"$1,223.50","$1,938.02","$1,957.60",$0.00,$0.00,$0.00,$0.00,$0.00
27008228,EAP,Custom 27008228,,Ti Spir Bld 55m Ti Retr Fem,"$2,318.00",$0.00,"$2,318.00",$0.00,"$1,654.36",$0.00,$0.00,"$1,654.36","$1,654.36",$0.00,"$2,318.00",$0.00,"$1,159.00","$1,835.86","$1,854.40",$0.00,$0.00,$0.00,$0.00,$0.00
27008229,EAP,Custom 27008229,,Ti Spir Bld 55m-ster F/ti Retr,"$2,447.00",$0.00,"$2,447.00",$0.00,"$1,746.42",$0.00,$0.00,"$1,746.42","$1,746.42",$0.00,"$2,447.00",$0.00,"$1,223.50","$1,938.02","$1,957.60",$0.00,$0.00,$0.00,$0.00,$0.00
27008230,EAP,Custom 27008230,,Ti Spir Bld 65m Ti Retr Fem Nl,"$2,318.00",$0.00,"$2,318.00",$0.00,"$1,654.36",$0.00,$0.00,"$1,654.36","$1,654.36",$0.00,"$2,318.00",$0.00,"$1,159.00","$1,835.86","$1,854.40",$0.00,$0.00,$0.00,$0.00,$0.00
27008231,EAP,Custom 27008231,,Ti Spir Bld 65f/ti Ret Fem Nls,"$2,447.00",$0.00,"$2,447.00",$0.00,"$1,746.42",$0.00,$0.00,"$1,746.42","$1,746.42",$0.00,"$2,447.00",$0.00,"$1,223.50","$1,938.02","$1,957.60",$0.00,$0.00,$0.00,$0.00,$0.00
27008232,EAP,Custom 27008232,,Ti Spir Bld 70m Ti Retr Fem Nl,"$2,318.00",$0.00,"$2,318.00",$0.00,"$1,654.36",$0.00,$0.00,"$1,654.36","$1,654.36",$0.00,"$2,318.00",$0.00,"$1,159.00","$1,835.86","$1,854.40",$0.00,$0.00,$0.00,$0.00,$0.00
27008233,EAP,Custom 27008233,,Ti Spir Bld 70m F/ti Retr Fem,"$2,447.00",$0.00,"$2,447.00",$0.00,"$1,746.42",$0.00,$0.00,"$1,746.42","$1,746.42",$0.00,"$2,447.00",$0.00,"$1,223.50","$1,938.02","$1,957.60",$0.00,$0.00,$0.00,$0.00,$0.00
27008234,EAP,Custom 27008234,,Ti Spir Bld 75m Ti Retr Fem Nl,"$2,318.00",$0.00,"$2,318.00",$0.00,"$1,654.36",$0.00,$0.00,"$1,654.36","$1,654.36",$0.00,"$2,318.00",$0.00,"$1,159.00","$1,835.86","$1,854.40",$0.00,$0.00,$0.00,$0.00,$0.00
27008235,EAP,Custom 27008235,,Ti Spir Bld 75 F/ti Ret Fem Nl,"$2,447.00",$0.00,"$2,447.00",$0.00,"$1,746.42",$0.00,$0.00,"$1,746.42","$1,746.42",$0.00,"$2,447.00",$0.00,"$1,223.50","$1,938.02","$1,957.60",$0.00,$0.00,$0.00,$0.00,$0.00
27008236,EAP,Custom 27008236,,Ti Spir Bld 80m Ti Retr Fem Nl,"$2,318.00",$0.00,"$2,318.00",$0.00,"$1,654.36",$0.00,$0.00,"$1,654.36","$1,654.36",$0.00,"$2,318.00",$0.00,"$1,159.00","$1,835.86","$1,854.40",$0.00,$0.00,$0.00,$0.00,$0.00
27008237,EAP,Custom 27008237,,Ti Spir Bld 80 F/ti Ret Fem Nl,"$2,447.00",$0.00,"$2,447.00",$0.00,"$1,746.42",$0.00,$0.00,"$1,746.42","$1,746.42",$0.00,"$2,447.00",$0.00,"$1,223.50","$1,938.02","$1,957.60",$0.00,$0.00,$0.00,$0.00,$0.00
27008238,EAP,Custom 27008238,,Ti Spir Bld 85 Ti Retr Fem Nl,"$2,318.00",$0.00,"$2,318.00",$0.00,"$1,654.36",$0.00,$0.00,"$1,654.36","$1,654.36",$0.00,"$2,318.00",$0.00,"$1,159.00","$1,835.86","$1,854.40",$0.00,$0.00,$0.00,$0.00,$0.00
27008239,EAP,Custom 27008239,,Ti Spir Bld 85m F/ti Retr Fem,"$2,447.00",$0.00,"$2,447.00",$0.00,"$1,746.42",$0.00,$0.00,"$1,746.42","$1,746.42",$0.00,"$2,447.00",$0.00,"$1,223.50","$1,938.02","$1,957.60",$0.00,$0.00,$0.00,$0.00,$0.00
27008240,EAP,Custom 27008240,,Ti Spir Bld 90m Ti Retr Fem Nl,"$2,318.00",$0.00,"$2,318.00",$0.00,"$1,654.36",$0.00,$0.00,"$1,654.36","$1,654.36",$0.00,"$2,318.00",$0.00,"$1,159.00","$1,835.86","$1,854.40",$0.00,$0.00,$0.00,$0.00,$0.00
27008241,EAP,Custom 27008241,,Ti Spir Bld 90m F/ti Retr Fem,"$2,447.00",$0.00,"$2,447.00",$0.00,"$1,746.42",$0.00,$0.00,"$1,746.42","$1,746.42",$0.00,"$2,447.00",$0.00,"$1,223.50","$1,938.02","$1,957.60",$0.00,$0.00,$0.00,$0.00,$0.00
27008242,EAP,Custom 27008242,,Ti Spir Bld 95m Ti Retr Fem Nl,"$2,318.00",$0.00,"$2,318.00",$0.00,"$1,654.36",$0.00,$0.00,"$1,654.36","$1,654.36",$0.00,"$2,318.00",$0.00,"$1,159.00","$1,835.86","$1,854.40",$0.00,$0.00,$0.00,$0.00,$0.00
27008243,EAP,Custom 27008243,,Ti Spir Bld 100m Ti Retr Fem,"$2,318.00",$0.00,"$2,318.00",$0.00,"$1,654.36",$0.00,$0.00,"$1,654.36","$1,654.36",$0.00,"$2,318.00",$0.00,"$1,159.00","$1,835.86","$1,854.40",$0.00,$0.00,$0.00,$0.00,$0.00
27008244,EAP,Custom 27008244,,Ti Spir Bld 100m-st F/ti Ret,"$2,447.00",$0.00,"$2,447.00",$0.00,"$1,746.42",$0.00,$0.00,"$1,746.42","$1,746.42",$0.00,"$2,447.00",$0.00,"$1,223.50","$1,938.02","$1,957.60",$0.00,$0.00,$0.00,$0.00,$0.00
27008247,EAP,Custom 27008247,,10ti Can Ret Fem Nl-ex/160-280,"$6,897.00",$0.00,"$6,897.00",$0.00,"$4,922.39",$0.00,$0.00,"$4,922.39","$4,922.39",$0.00,"$6,897.00",$0.00,"$3,448.50","$5,462.42","$5,517.60",$0.00,$0.00,$0.00,$0.00,$0.00
27008248,EAP,Custom 27008248,,10ti Can Ret/ant Fem Nl300-480,"$6,897.00",$0.00,"$6,897.00",$0.00,"$4,922.39",$0.00,$0.00,"$4,922.39","$4,922.39",$0.00,"$6,897.00",$0.00,"$3,448.50","$5,462.42","$5,517.60",$0.00,$0.00,$0.00,$0.00,$0.00
27008249,EAP,Custom 27008249,,11ti Can Ret Fem Nl-ex/160-280,"$6,897.00",$0.00,"$6,897.00",$0.00,"$4,922.39",$0.00,$0.00,"$4,922.39","$4,922.39",$0.00,"$6,897.00",$0.00,"$3,448.50","$5,462.42","$5,517.60",$0.00,$0.00,$0.00,$0.00,$0.00
27008250,EAP,Custom 27008250,,12mmti Can Retr Fem Nl 160-280,"$6,897.00",$0.00,"$6,897.00",$0.00,"$4,922.39",$0.00,$0.00,"$4,922.39","$4,922.39",$0.00,"$6,897.00",$0.00,"$3,448.50","$5,462.42","$5,517.60",$0.00,$0.00,$0.00,$0.00,$0.00
27008251,EAP,Custom 27008251,,13ti Can Retr Fem Nl-ex160-280,"$6,897.00",$0.00,"$6,897.00",$0.00,"$4,922.39",$0.00,$0.00,"$4,922.39","$4,922.39",$0.00,"$6,897.00",$0.00,"$3,448.50","$5,462.42","$5,517.60",$0.00,$0.00,$0.00,$0.00,$0.00
27008252,EAP,Custom 27008252,,13ti Can Ret/ant Fem Nl300-480,"$6,897.00",$0.00,"$6,897.00",$0.00,"$4,922.39",$0.00,$0.00,"$4,922.39","$4,922.39",$0.00,"$6,897.00",$0.00,"$3,448.50","$5,462.42","$5,517.60",$0.00,$0.00,$0.00,$0.00,$0.00
27008253,EAP,Custom 27008253,,14ti Can Retr Fem Nl-ex160-280,"$6,897.00",$0.00,"$6,897.00",$0.00,"$4,922.39",$0.00,$0.00,"$4,922.39","$4,922.39",$0.00,"$6,897.00",$0.00,"$3,448.50","$5,462.42","$5,517.60",$0.00,$0.00,$0.00,$0.00,$0.00
27008254,EAP,Custom 27008254,,14ti Can Ret/ant Fem Nl300-480,"$6,897.00",$0.00,"$6,897.00",$0.00,"$4,922.39",$0.00,$0.00,"$4,922.39","$4,922.39",$0.00,"$6,897.00",$0.00,"$3,448.50","$5,462.42","$5,517.60",$0.00,$0.00,$0.00,$0.00,$0.00
27008255,EAP,Custom 27008255,,15ti Can Retr Fem Nl-160-280mm,"$6,897.00",$0.00,"$6,897.00",$0.00,"$4,922.39",$0.00,$0.00,"$4,922.39","$4,922.39",$0.00,"$6,897.00",$0.00,"$3,448.50","$5,462.42","$5,517.60",$0.00,$0.00,$0.00,$0.00,$0.00
27008256,EAP,Custom 27008256,,15ti Can Ret/ant Fem Nl300-480,"$6,897.00",$0.00,"$6,897.00",$0.00,"$4,922.39",$0.00,$0.00,"$4,922.39","$4,922.39",$0.00,"$6,897.00",$0.00,"$3,448.50","$5,462.42","$5,517.60",$0.00,$0.00,$0.00,$0.00,$0.00
27008258,EAP,Custom 27008258,,10ti Can Lat Ent Fem Nl300-480,"$6,829.00",$0.00,"$6,829.00",$0.00,"$4,873.86",$0.00,$0.00,"$4,873.86","$4,873.86",$0.00,"$6,829.00",$0.00,"$3,414.50","$5,408.57","$5,463.20",$0.00,$0.00,$0.00,$0.00,$0.00
27008259,EAP,Custom 27008259,,10ti Can Lat Ent Fem Nl300-480,"$6,829.00",$0.00,"$6,829.00",$0.00,"$4,873.86",$0.00,$0.00,"$4,873.86","$4,873.86",$0.00,"$6,829.00",$0.00,"$3,414.50","$5,408.57","$5,463.20",$0.00,$0.00,$0.00,$0.00,$0.00
27008260,EAP,Custom 27008260,,11ti Can Lat Ent Fem Nl300-480,"$6,829.00",$0.00,"$6,829.00",$0.00,"$4,873.86",$0.00,$0.00,"$4,873.86","$4,873.86",$0.00,"$6,829.00",$0.00,"$3,414.50","$5,408.57","$5,463.20",$0.00,$0.00,$0.00,$0.00,$0.00
27008261,EAP,Custom 27008261,,12ti Can Lat Ent Fem Nl300-480,"$6,829.00",$0.00,"$6,829.00",$0.00,"$4,873.86",$0.00,$0.00,"$4,873.86","$4,873.86",$0.00,"$6,829.00",$0.00,"$3,414.50","$5,408.57","$5,463.20",$0.00,$0.00,$0.00,$0.00,$0.00
27008262,EAP,Custom 27008262,,12ti Can Lat Ent Fem Nl300-480,"$6,829.00",$0.00,"$6,829.00",$0.00,"$4,873.86",$0.00,$0.00,"$4,873.86","$4,873.86",$0.00,"$6,829.00",$0.00,"$3,414.50","$5,408.57","$5,463.20",$0.00,$0.00,$0.00,$0.00,$0.00
27008263,EAP,Custom 27008263,,13ti Can Lat Ent Fem Nl300-480,"$6,829.00",$0.00,"$6,829.00",$0.00,"$4,873.86",$0.00,$0.00,"$4,873.86","$4,873.86",$0.00,"$6,829.00",$0.00,"$3,414.50","$5,408.57","$5,463.20",$0.00,$0.00,$0.00,$0.00,$0.00
27008264,EAP,Custom 27008264,,13ti Can Lat Ent Fem Nl300-480,"$6,829.00",$0.00,"$6,829.00",$0.00,"$4,873.86",$0.00,$0.00,"$4,873.86","$4,873.86",$0.00,"$6,829.00",$0.00,"$3,414.50","$5,408.57","$5,463.20",$0.00,$0.00,$0.00,$0.00,$0.00
27008265,EAP,Custom 27008265,,14ti Can Lat Ent Fem Nl300-480,"$6,829.00",$0.00,"$6,829.00",$0.00,"$4,873.86",$0.00,$0.00,"$4,873.86","$4,873.86",$0.00,"$6,829.00",$0.00,"$3,414.50","$5,408.57","$5,463.20",$0.00,$0.00,$0.00,$0.00,$0.00
27008266,EAP,Custom 27008266,,14ti Can Lat Ent Fem Nl300-480,"$6,829.00",$0.00,"$6,829.00",$0.00,"$4,873.86",$0.00,$0.00,"$4,873.86","$4,873.86",$0.00,"$6,829.00",$0.00,"$3,414.50","$5,408.57","$5,463.20",$0.00,$0.00,$0.00,$0.00,$0.00
27008267,EAP,Custom 27008267,,15ti Can Lat Ent Fem Nl300-480,"$6,829.00",$0.00,"$6,829.00",$0.00,"$4,873.86",$0.00,$0.00,"$4,873.86","$4,873.86",$0.00,"$6,829.00",$0.00,"$3,414.50","$5,408.57","$5,463.20",$0.00,$0.00,$0.00,$0.00,$0.00
27008268,EAP,Custom 27008268,,15ti Can Lat Ent Fem Nl300-480,"$6,829.00",$0.00,"$6,829.00",$0.00,"$4,873.86",$0.00,$0.00,"$4,873.86","$4,873.86",$0.00,"$6,829.00",$0.00,"$3,414.50","$5,408.57","$5,463.20",$0.00,$0.00,$0.00,$0.00,$0.00
27008269,EAP,Custom 27008269,,16ti Can Lat Ent Fem Nl300-480,"$6,829.00",$0.00,"$6,829.00",$0.00,"$4,873.86",$0.00,$0.00,"$4,873.86","$4,873.86",$0.00,"$6,829.00",$0.00,"$3,414.50","$5,408.57","$5,463.20",$0.00,$0.00,$0.00,$0.00,$0.00
27008270,EAP,Custom 27008270,,16ti Can Lat Ent Fem Nl300-480,"$6,829.00",$0.00,"$6,829.00",$0.00,"$4,873.86",$0.00,$0.00,"$4,873.86","$4,873.86",$0.00,"$6,829.00",$0.00,"$3,414.50","$5,408.57","$5,463.20",$0.00,$0.00,$0.00,$0.00,$0.00
27008275,EAP,Custom 27008275,,T15/2.5m Hex Ti Cerclage Buttn,$652.00,$0.00,$652.00,$0.00,$465.33,$0.00,$0.00,$465.33,$465.33,$0.00,$652.00,$0.00,$326.00,$516.38,$521.60,$0.00,$0.00,$0.00,$0.00,$0.00
27008276,EAP,Custom 27008276,,T25/3.5m Hex Ti Cerclage Buttn,$652.00,$0.00,$652.00,$0.00,$465.33,$0.00,$0.00,$465.33,$465.33,$0.00,$652.00,$0.00,$326.00,$516.38,$521.60,$0.00,$0.00,$0.00,$0.00,$0.00
27008281,EAP,Custom 27008281,,Saw Bld 95x19 0.89m Cut Thknes,$329.00,$0.00,$329.00,$0.00,$234.81,$0.00,$0.00,$234.81,$234.81,$0.00,$329.00,$0.00,$164.50,$260.57,$263.20,$0.00,$0.00,$0.00,$0.00,$0.00
27008282,EAP,Custom 27008282,,Saw Bld 95x19 1.19m Cut Thknes,$329.00,$0.00,$329.00,$0.00,$234.81,$0.00,$0.00,$234.81,$234.81,$0.00,$329.00,$0.00,$164.50,$260.57,$263.20,$0.00,$0.00,$0.00,$0.00,$0.00
27008283,EAP,Custom 27008283,,Saw Bld 95x19 1.27m Cut Thknes,$329.00,$0.00,$329.00,$0.00,$234.81,$0.00,$0.00,$234.81,$234.81,$0.00,$329.00,$0.00,$164.50,$260.57,$263.20,$0.00,$0.00,$0.00,$0.00,$0.00
27008284,EAP,Custom 27008284,,Saw Bld 95x19 1.37m Cut Thknes,$329.00,$0.00,$329.00,$0.00,$234.81,$0.00,$0.00,$234.81,$234.81,$0.00,$329.00,$0.00,$164.50,$260.57,$263.20,$0.00,$0.00,$0.00,$0.00,$0.00
27008285,EAP,Custom 27008285,,Saw Bld 95x 19 1.47 Cut Thknes,$329.00,$0.00,$329.00,$0.00,$234.81,$0.00,$0.00,$234.81,$234.81,$0.00,$329.00,$0.00,$164.50,$260.57,$263.20,$0.00,$0.00,$0.00,$0.00,$0.00
27008286,EAP,Custom 27008286,,Saw Bld 80x19 0.89 Cut Thkness,$329.00,$0.00,$329.00,$0.00,$234.81,$0.00,$0.00,$234.81,$234.81,$0.00,$329.00,$0.00,$164.50,$260.57,$263.20,$0.00,$0.00,$0.00,$0.00,$0.00
27008287,EAP,Custom 27008287,,Saw Bld 95x19 1.00 Cut Thkness,$329.00,$0.00,$329.00,$0.00,$234.81,$0.00,$0.00,$234.81,$234.81,$0.00,$329.00,$0.00,$164.50,$260.57,$263.20,$0.00,$0.00,$0.00,$0.00,$0.00
27008288,EAP,Custom 27008288,,Saw Bld 95 X 19 1.07cut Thknes,$329.00,$0.00,$329.00,$0.00,$234.81,$0.00,$0.00,$234.81,$234.81,$0.00,$329.00,$0.00,$164.50,$260.57,$263.20,$0.00,$0.00,$0.00,$0.00,$0.00
27008289,EAP,Custom 27008289,,Saw Bld 95x25 0.89 Cut Thkness,$329.00,$0.00,$329.00,$0.00,$234.81,$0.00,$0.00,$234.81,$234.81,$0.00,$329.00,$0.00,$164.50,$260.57,$263.20,$0.00,$0.00,$0.00,$0.00,$0.00
27008290,EAP,Custom 27008290,,Saw Bld 95x25 1.19 Cut Thcknes,$329.00,$0.00,$329.00,$0.00,$234.81,$0.00,$0.00,$234.81,$234.81,$0.00,$329.00,$0.00,$164.50,$260.57,$263.20,$0.00,$0.00,$0.00,$0.00,$0.00
27008291,EAP,Custom 27008291,,Saw Bld 95x25 1.27 Cut Thcknes,$329.00,$0.00,$329.00,$0.00,$234.81,$0.00,$0.00,$234.81,$234.81,$0.00,$329.00,$0.00,$164.50,$260.57,$263.20,$0.00,$0.00,$0.00,$0.00,$0.00
27008292,EAP,Custom 27008292,,Saw Bld 95x25 1.37 Cut Thcknes,$329.00,$0.00,$329.00,$0.00,$234.81,$0.00,$0.00,$234.81,$234.81,$0.00,$329.00,$0.00,$164.50,$260.57,$263.20,$0.00,$0.00,$0.00,$0.00,$0.00
27008293,EAP,Custom 27008293,,Saw Bld 95x25 1.47cut Thckness,$329.00,$0.00,$329.00,$0.00,$234.81,$0.00,$0.00,$234.81,$234.81,$0.00,$329.00,$0.00,$164.50,$260.57,$263.20,$0.00,$0.00,$0.00,$0.00,$0.00
27008294,EAP,Custom 27008294,,Saw Blade 95mm X 25mm 1.00mm,$329.00,$0.00,$329.00,$0.00,$234.81,$0.00,$0.00,$234.81,$234.81,$0.00,$329.00,$0.00,$164.50,$260.57,$263.20,$0.00,$0.00,$0.00,$0.00,$0.00
27008295,EAP,Custom 27008295,,Saw Blade 95mm X 25mm 1.07mm,$329.00,$0.00,$329.00,$0.00,$234.81,$0.00,$0.00,$234.81,$234.81,$0.00,$329.00,$0.00,$164.50,$260.57,$263.20,$0.00,$0.00,$0.00,$0.00,$0.00
27008296,EAP,Custom 27008296,,Saw Blade 90mm X 12.5mm 0.89m,$329.00,$0.00,$329.00,$0.00,$234.81,$0.00,$0.00,$234.81,$234.81,$0.00,$329.00,$0.00,$164.50,$260.57,$263.20,$0.00,$0.00,$0.00,$0.00,$0.00
27008297,EAP,Custom 27008297,,Saw Blade 90mm X 12.5mm 1.19m,$329.00,$0.00,$329.00,$0.00,$234.81,$0.00,$0.00,$234.81,$234.81,$0.00,$329.00,$0.00,$164.50,$260.57,$263.20,$0.00,$0.00,$0.00,$0.00,$0.00
27008298,EAP,Custom 27008298,,Saw Blade 90mm X 12.5mm 1.27m,$329.00,$0.00,$329.00,$0.00,$234.81,$0.00,$0.00,$234.81,$234.81,$0.00,$329.00,$0.00,$164.50,$260.57,$263.20,$0.00,$0.00,$0.00,$0.00,$0.00
27008299,EAP,Custom 27008299,,Saw Blade 90mm X 12.5mm 1.37m,$329.00,$0.00,$329.00,$0.00,$234.81,$0.00,$0.00,$234.81,$234.81,$0.00,$329.00,$0.00,$164.50,$260.57,$263.20,$0.00,$0.00,$0.00,$0.00,$0.00
27008300,EAP,Custom 27008300,,Saw Blade 90mm X 12.5mm 1.47m,$329.00,$0.00,$329.00,$0.00,$234.81,$0.00,$0.00,$234.81,$234.81,$0.00,$329.00,$0.00,$164.50,$260.57,$263.20,$0.00,$0.00,$0.00,$0.00,$0.00
27008301,EAP,Custom 27008301,,Saw Blade 90m X 19-12.5m 0.89m,$329.00,$0.00,$329.00,$0.00,$234.81,$0.00,$0.00,$234.81,$234.81,$0.00,$329.00,$0.00,$164.50,$260.57,$263.20,$0.00,$0.00,$0.00,$0.00,$0.00
27008302,EAP,Custom 27008302,,Saw Blade 90m X19-12.5mm 1.19m,$328.00,$0.00,$328.00,$0.00,$234.09,$0.00,$0.00,$234.09,$234.09,$0.00,$328.00,$0.00,$164.00,$259.78,$262.40,$0.00,$0.00,$0.00,$0.00,$0.00
27008303,EAP,Custom 27008303,,Saw Blade 90mx19-12.5mm 1.27m,$329.00,$0.00,$329.00,$0.00,$234.81,$0.00,$0.00,$234.81,$234.81,$0.00,$329.00,$0.00,$164.50,$260.57,$263.20,$0.00,$0.00,$0.00,$0.00,$0.00
27008304,EAP,Custom 27008304,,Saw Blade 90m X19-12.5m 1.37m,$310.00,$0.00,$310.00,$0.00,$221.25,$0.00,$0.00,$221.25,$221.25,$0.00,$310.00,$0.00,$155.00,$245.52,$248.00,$0.00,$0.00,$0.00,$0.00,$0.00
27008305,EAP,Custom 27008305,,Saw Blade 90mx19-12.5mm 1.47m,$329.00,$0.00,$329.00,$0.00,$234.81,$0.00,$0.00,$234.81,$234.81,$0.00,$329.00,$0.00,$164.50,$260.57,$263.20,$0.00,$0.00,$0.00,$0.00,$0.00
27008306,EAP,Custom 27008306,,Saw Blade 90mx19-12.5mm 1.00m,$329.00,$0.00,$329.00,$0.00,$234.81,$0.00,$0.00,$234.81,$234.81,$0.00,$329.00,$0.00,$164.50,$260.57,$263.20,$0.00,$0.00,$0.00,$0.00,$0.00
27008307,EAP,Custom 27008307,,Saw Blade 90mm X 12.5mm 1.00m,$329.00,$0.00,$329.00,$0.00,$234.81,$0.00,$0.00,$234.81,$234.81,$0.00,$329.00,$0.00,$164.50,$260.57,$263.20,$0.00,$0.00,$0.00,$0.00,$0.00
27008308,EAP,Custom 27008308,,Saw Blade 60mm X 25mm 0.89mm,$329.00,$0.00,$329.00,$0.00,$234.81,$0.00,$0.00,$234.81,$234.81,$0.00,$329.00,$0.00,$164.50,$260.57,$263.20,$0.00,$0.00,$0.00,$0.00,$0.00
27008309,EAP,Custom 27008309,,Plan&reduct Tech In Fx Surgery,$781.00,$0.00,$781.00,$0.00,$557.40,$0.00,$0.00,$557.40,$557.40,$0.00,$781.00,$0.00,$390.50,$618.55,$624.80,$0.00,$0.00,$0.00,$0.00,$0.00
27008312,EAP,Custom 27008312,,The Rational Operative Fx Care,$781.00,$0.00,$781.00,$0.00,$557.40,$0.00,$0.00,$557.40,$557.40,$0.00,$781.00,$0.00,$390.50,$618.55,$624.80,$0.00,$0.00,$0.00,$0.00,$0.00
27008316,EAP,Custom 27008316,,Minimax Fracture Fixation,$630.00,$0.00,$630.00,$0.00,$449.63,$0.00,$0.00,$449.63,$449.63,$0.00,$630.00,$0.00,$315.00,$498.96,$504.00,$0.00,$0.00,$0.00,$0.00,$0.00
27008318,EAP,Custom 27008318,,Intern Fixatn Osteoporotic Bne,$538.00,$0.00,$538.00,$0.00,$383.97,$0.00,$0.00,$383.97,$383.97,$0.00,$538.00,$0.00,$269.00,$426.10,$430.40,$0.00,$0.00,$0.00,$0.00,$0.00
27008321,EAP,Custom 27008321,,Oper Approach Orth Surg&trauma,$635.00,$0.00,$635.00,$0.00,$453.20,$0.00,$0.00,$453.20,$453.20,$0.00,$635.00,$0.00,$317.50,$502.92,$508.00,$0.00,$0.00,$0.00,$0.00,$0.00
27008324,EAP,Custom 27008324,,1.5mm Cortex Scw 6-20mm,$83.00,$0.00,$83.00,$0.00,$59.24,$0.00,$0.00,$59.24,$59.24,$0.00,$83.00,$0.00,$41.50,$65.74,$66.40,$0.00,$0.00,$0.00,$0.00,$0.00
27008325,EAP,Custom 27008325,,1.0cor Scw Self-tapg 6-14mm,$340.00,$0.00,$340.00,$0.00,$242.66,$0.00,$0.00,$242.66,$242.66,$0.00,$340.00,$0.00,$170.00,$269.28,$272.00,$0.00,$0.00,$0.00,$0.00,$0.00
27008326,EAP,Custom 27008326,,1.3mm Cort Scw Slf-tapg 6-18,$329.00,$0.00,$329.00,$0.00,$234.81,$0.00,$0.00,$234.81,$234.81,$0.00,$329.00,$0.00,$164.50,$260.57,$263.20,$0.00,$0.00,$0.00,$0.00,$0.00
27008327,EAP,Custom 27008327,,1.5mm Cort Scw Slf-tapg 6-24,$97.00,$0.00,$97.00,$0.00,$69.23,$0.00,$0.00,$69.23,$69.23,$0.00,$97.00,$0.00,$48.50,$76.82,$77.60,$0.00,$0.00,$0.00,$0.00,$0.00
27008335,EAP,Custom 27008335,,1.8mm Buttress Pin/12-30mm,$170.00,$0.00,$170.00,$0.00,$121.33,$0.00,$0.00,$121.33,$121.33,$0.00,$170.00,$0.00,$85.00,$134.64,$136.00,$0.00,$0.00,$0.00,$0.00,$0.00
27008367,EAP,Custom 27008367,,Schuhli Assembly - 4.5 Cor Scw,"$1,039.00",$0.00,"$1,039.00",$0.00,$741.53,$0.00,$0.00,$741.53,$741.53,$0.00,"$1,039.00",$0.00,$519.50,$822.89,$831.20,$0.00,$0.00,$0.00,$0.00,$0.00
27008368,EAP,Custom 27008368,,Schuhli Assembly- 3.5 Cor Scw,"$1,039.00",$0.00,"$1,039.00",$0.00,$741.53,$0.00,$0.00,$741.53,$741.53,$0.00,"$1,039.00",$0.00,$519.50,$822.89,$831.20,$0.00,$0.00,$0.00,$0.00,$0.00
27008369,EAP,Custom 27008369,,Thrded Wash 3.0 Cannul Scw,$560.00,$0.00,$560.00,$0.00,$399.67,$0.00,$0.00,$399.67,$399.67,$0.00,$560.00,$0.00,$280.00,$443.52,$448.00,$0.00,$0.00,$0.00,$0.00,$0.00
27008370,EAP,Custom 27008370,,Spiked Washer 8.0mm/3.2mm,$497.00,$0.00,$497.00,$0.00,$354.71,$0.00,$0.00,$354.71,$354.71,$0.00,$497.00,$0.00,$248.50,$393.62,$397.60,$0.00,$0.00,$0.00,$0.00,$0.00
27008371,EAP,Custom 27008371,,Spiked Washer 13.5mm/4.0mm,$501.00,$0.00,$501.00,$0.00,$357.56,$0.00,$0.00,$357.56,$357.56,$0.00,$501.00,$0.00,$250.50,$396.79,$400.80,$0.00,$0.00,$0.00,$0.00,$0.00
27008372,EAP,Custom 27008372,,Spiked Washer 13.5mm/5.5mm,$492.00,$0.00,$492.00,$0.00,$351.14,$0.00,$0.00,$351.14,$351.14,$0.00,$492.00,$0.00,$246.00,$389.66,$393.60,$0.00,$0.00,$0.00,$0.00,$0.00
27008373,EAP,Custom 27008373,,Spher Wash/sm Oval 6.5/ 0.3mm,$608.00,$0.00,$608.00,$0.00,$433.93,$0.00,$0.00,$433.93,$433.93,$0.00,$608.00,$0.00,$304.00,$481.54,$486.40,$0.00,$0.00,$0.00,$0.00,$0.00
27008374,EAP,Custom 27008374,,Spher Washer/lrg Rnd 6.5/7.3,$608.00,$0.00,$608.00,$0.00,$433.93,$0.00,$0.00,$433.93,$433.93,$0.00,$608.00,$0.00,$304.00,$481.54,$486.40,$0.00,$0.00,$0.00,$0.00,$0.00
27008375,EAP,Custom 27008375,,Nut For 4.5mm Cortex Screws,$120.00,$0.00,$120.00,$0.00,$85.64,$0.00,$0.00,$85.64,$85.64,$0.00,$120.00,$0.00,$60.00,$95.04,$96.00,$0.00,$0.00,$0.00,$0.00,$0.00
27008376,EAP,Custom 27008376,,Washer 6.5mm,$109.00,$0.00,$109.00,$0.00,$77.79,$0.00,$0.00,$77.79,$77.79,$0.00,$109.00,$0.00,$54.50,$86.33,$87.20,$0.00,$0.00,$0.00,$0.00,$0.00
27008377,EAP,Custom 27008377,,1.3mm Straight Plate 6 Holes,$789.00,$0.00,$789.00,$0.00,$563.11,$0.00,$0.00,$563.11,$563.11,$0.00,$789.00,$0.00,$394.50,$624.89,$631.20,$0.00,$0.00,$0.00,$0.00,$0.00
27008378,EAP,Custom 27008378,,1.3mm Straight Plate 12 Holes,$996.00,$0.00,$996.00,$0.00,$710.85,$0.00,$0.00,$710.85,$710.85,$0.00,$996.00,$0.00,$498.00,$788.83,$796.80,$0.00,$0.00,$0.00,$0.00,$0.00
27008379,EAP,Custom 27008379,,1.3mm Extended H-plate/right,$954.00,$0.00,$954.00,$0.00,$680.87,$0.00,$0.00,$680.87,$680.87,$0.00,$954.00,$0.00,$477.00,$755.57,$763.20,$0.00,$0.00,$0.00,$0.00,$0.00
27008380,EAP,Custom 27008380,,1.3mm Extended H-plate/left,$954.00,$0.00,$954.00,$0.00,$680.87,$0.00,$0.00,$680.87,$680.87,$0.00,$954.00,$0.00,$477.00,$755.57,$763.20,$0.00,$0.00,$0.00,$0.00,$0.00
27008381,EAP,Custom 27008381,,1.3mm T-plte 3 Hles Hd/ 8hles,$913.00,$0.00,$913.00,$0.00,$651.61,$0.00,$0.00,$651.61,$651.61,$0.00,$913.00,$0.00,$456.50,$723.10,$730.40,$0.00,$0.00,$0.00,$0.00,$0.00
27008382,EAP,Custom 27008382,,1.3mm T-plte 4hles Head/8hles,$954.00,$0.00,$954.00,$0.00,$680.87,$0.00,$0.00,$680.87,$680.87,$0.00,$954.00,$0.00,$477.00,$755.57,$763.20,$0.00,$0.00,$0.00,$0.00,$0.00
27008383,EAP,Custom 27008383,,1.3mm Y-plte 3 Hles Head/8hle,$913.00,$0.00,$913.00,$0.00,$651.61,$0.00,$0.00,$651.61,$651.61,$0.00,$913.00,$0.00,$456.50,$723.10,$730.40,$0.00,$0.00,$0.00,$0.00,$0.00
27008384,EAP,Custom 27008384,,Semi-tubul Plate 2 Holes 39m,$228.00,$0.00,$228.00,$0.00,$162.72,$0.00,$0.00,$162.72,$162.72,$0.00,$228.00,$0.00,$114.00,$180.58,$182.40,$0.00,$0.00,$0.00,$0.00,$0.00
27008385,EAP,Custom 27008385,,Semi-tubul Plate 3 Holes 55m,$235.00,$0.00,$235.00,$0.00,$167.72,$0.00,$0.00,$167.72,$167.72,$0.00,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$0.00,$0.00,$0.00,$0.00
27008386,EAP,Custom 27008386,,Semi-tubul Plate 4 Holes 71m,$255.00,$0.00,$255.00,$0.00,$181.99,$0.00,$0.00,$181.99,$181.99,$0.00,$255.00,$0.00,$127.50,$201.96,$204.00,$0.00,$0.00,$0.00,$0.00,$0.00
27008387,EAP,Custom 27008387,,Semi-tubul Plate 5 Holes 87m,$267.00,$0.00,$267.00,$0.00,$190.56,$0.00,$0.00,$190.56,$190.56,$0.00,$267.00,$0.00,$133.50,$211.46,$213.60,$0.00,$0.00,$0.00,$0.00,$0.00
27008388,EAP,Custom 27008388,,Semi-tubulplate 6 Holes 103m,$283.00,$0.00,$283.00,$0.00,$201.98,$0.00,$0.00,$201.98,$201.98,$0.00,$283.00,$0.00,$141.50,$224.14,$226.40,$0.00,$0.00,$0.00,$0.00,$0.00
27008389,EAP,Custom 27008389,,Semi-tubul Plate 7 Holes 119m,$307.00,$0.00,$307.00,$0.00,$219.11,$0.00,$0.00,$219.11,$219.11,$0.00,$307.00,$0.00,$153.50,$243.14,$245.60,$0.00,$0.00,$0.00,$0.00,$0.00
27008390,EAP,Custom 27008390,,Semi-tubul Plate 8 Holes 135m,$325.00,$0.00,$325.00,$0.00,$231.95,$0.00,$0.00,$231.95,$231.95,$0.00,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$0.00,$0.00,$0.00,$0.00
27008391,EAP,Custom 27008391,,Semi-tubul Plate 9 Holes 151m,$337.00,$0.00,$337.00,$0.00,$240.52,$0.00,$0.00,$240.52,$240.52,$0.00,$337.00,$0.00,$168.50,$266.90,$269.60,$0.00,$0.00,$0.00,$0.00,$0.00
27008392,EAP,Custom 27008392,,Semi-tubul Plate 10 Holes 167m,$345.00,$0.00,$345.00,$0.00,$246.23,$0.00,$0.00,$246.23,$246.23,$0.00,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$0.00,$0.00,$0.00,$0.00
27008393,EAP,Custom 27008393,,Semi-tubul Plate 11 Holes/183m,$356.00,$0.00,$356.00,$0.00,$254.08,$0.00,$0.00,$254.08,$254.08,$0.00,$356.00,$0.00,$178.00,$281.95,$284.80,$0.00,$0.00,$0.00,$0.00,$0.00
27008394,EAP,Custom 27008394,,Semi-tubular Plate 12 Hles/199,$375.00,$0.00,$375.00,$0.00,$267.64,$0.00,$0.00,$267.64,$267.64,$0.00,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$0.00,$0.00,$0.00,$0.00
27008662,EAP,Custom 27008662,,100deg Adoles Osteo Plt 50/10,"$2,088.00",$0.00,"$2,088.00",$0.00,"$1,490.21",$0.00,$0.00,"$1,490.21","$1,490.21",$0.00,"$2,088.00",$0.00,"$1,044.00","$1,653.70","$1,670.40",$0.00,$0.00,$0.00,$0.00,$0.00
27008663,EAP,Custom 27008663,,100deg Adoles Osteo Plt 50/10,"$2,219.00",$0.00,"$2,219.00",$0.00,"$1,583.70",$0.00,$0.00,"$1,583.70","$1,583.70",$0.00,"$2,219.00",$0.00,"$1,109.50","$1,757.45","$1,775.20",$0.00,$0.00,$0.00,$0.00,$0.00
27008666,EAP,Custom 27008666,,100deg Adoles Osteo Plt 40/10,"$2,088.00",$0.00,"$2,088.00",$0.00,"$1,490.21",$0.00,$0.00,"$1,490.21","$1,490.21",$0.00,"$2,088.00",$0.00,"$1,044.00","$1,653.70","$1,670.40",$0.00,$0.00,$0.00,$0.00,$0.00
27008667,EAP,Custom 27008667,,100deg Adoles Osteo Plt 40/10,"$2,219.00",$0.00,"$2,219.00",$0.00,"$1,583.70",$0.00,$0.00,"$1,583.70","$1,583.70",$0.00,"$2,219.00",$0.00,"$1,109.50","$1,757.45","$1,775.20",$0.00,$0.00,$0.00,$0.00,$0.00
27008670,EAP,Custom 27008670,,100deg Adoles Osteo Plt 50/15,"$2,088.00",$0.00,"$2,088.00",$0.00,"$1,490.21",$0.00,$0.00,"$1,490.21","$1,490.21",$0.00,"$2,088.00",$0.00,"$1,044.00","$1,653.70","$1,670.40",$0.00,$0.00,$0.00,$0.00,$0.00
27008671,EAP,Custom 27008671,,100deg Adoles Osteo Plt 50/15,"$2,219.00",$0.00,"$2,219.00",$0.00,"$1,583.70",$0.00,$0.00,"$1,583.70","$1,583.70",$0.00,"$2,219.00",$0.00,"$1,109.50","$1,757.45","$1,775.20",$0.00,$0.00,$0.00,$0.00,$0.00
27008674,EAP,Custom 27008674,,100deg Adoles Osteo Plt 60/15,"$2,088.00",$0.00,"$2,088.00",$0.00,"$1,490.21",$0.00,$0.00,"$1,490.21","$1,490.21",$0.00,"$2,088.00",$0.00,"$1,044.00","$1,653.70","$1,670.40",$0.00,$0.00,$0.00,$0.00,$0.00
27008675,EAP,Custom 27008675,,100deg Adoles Osteo Plt 60/15,"$2,219.00",$0.00,"$2,219.00",$0.00,"$1,583.70",$0.00,$0.00,"$1,583.70","$1,583.70",$0.00,"$2,219.00",$0.00,"$1,109.50","$1,757.45","$1,775.20",$0.00,$0.00,$0.00,$0.00,$0.00
27008678,EAP,Custom 27008678,,100deg Adoles Osteo Plt 40/15,"$2,088.00",$0.00,"$2,088.00",$0.00,"$1,490.21",$0.00,$0.00,"$1,490.21","$1,490.21",$0.00,"$2,088.00",$0.00,"$1,044.00","$1,653.70","$1,670.40",$0.00,$0.00,$0.00,$0.00,$0.00
27008679,EAP,Custom 27008679,,100deg Adoles Osteo Plt 40/15,"$2,219.00",$0.00,"$2,219.00",$0.00,"$1,583.70",$0.00,$0.00,"$1,583.70","$1,583.70",$0.00,"$2,219.00",$0.00,"$1,109.50","$1,757.45","$1,775.20",$0.00,$0.00,$0.00,$0.00,$0.00
27008680,EAP,Custom 27008680,,115 Deg Bifurcatd Plte 30/5,"$1,187.00",$0.00,"$1,187.00",$0.00,$847.16,$0.00,$0.00,$847.16,$847.16,$0.00,"$1,187.00",$0.00,$593.50,$940.10,$949.60,$0.00,$0.00,$0.00,$0.00,$0.00
27008681,EAP,Custom 27008681,,115 Deg Bifurcatd Plte 30/5,"$1,318.00",$0.00,"$1,318.00",$0.00,$940.66,$0.00,$0.00,$940.66,$940.66,$0.00,"$1,318.00",$0.00,$659.00,"$1,043.86","$1,054.40",$0.00,$0.00,$0.00,$0.00,$0.00
27008682,EAP,Custom 27008682,,115 Deg Bifurcatd Plte 35/5,"$1,187.00",$0.00,"$1,187.00",$0.00,$847.16,$0.00,$0.00,$847.16,$847.16,$0.00,"$1,187.00",$0.00,$593.50,$940.10,$949.60,$0.00,$0.00,$0.00,$0.00,$0.00
27008683,EAP,Custom 27008683,,115 Deg Bifurcatd Plte 35/5,"$1,318.00",$0.00,"$1,318.00",$0.00,$940.66,$0.00,$0.00,$940.66,$940.66,$0.00,"$1,318.00",$0.00,$659.00,"$1,043.86","$1,054.40",$0.00,$0.00,$0.00,$0.00,$0.00
27010225,EAP,Custom 27010225,,0.8mm Guide Wire 100mm,$611.00,$0.00,$611.00,$0.00,$436.07,$0.00,$0.00,$436.07,$436.07,$0.00,$611.00,$0.00,$305.50,$483.91,$488.80,$0.00,$0.00,$0.00,$0.00,$0.00
27010807,EAP,Custom 27010807,,"Bipolar Cord,disposable",$683.00,$0.00,$683.00,$0.00,$487.46,$0.00,$0.00,$487.46,$487.46,$0.00,$683.00,$0.00,$341.50,$540.94,$546.40,$0.00,$0.00,$0.00,$0.00,$0.00
27010828,EAP,Custom 27010828,,Cast App'l-spica Adult,$749.00,$0.00,$749.00,$0.00,$534.56,$0.00,$0.00,$534.56,$534.56,$0.00,$749.00,$0.00,$374.50,$593.21,$599.20,$0.00,$0.00,$0.00,$0.00,$0.00
27010880,EAP,Custom 27010880,,Colostomy Bag & Supplies,$509.00,$0.00,$509.00,$0.00,$363.27,$0.00,$0.00,$363.27,$363.27,$0.00,$509.00,$0.00,$254.50,$403.13,$407.20,$0.00,$0.00,$0.00,$0.00,$0.00
27010881,EAP,Custom 27010881,,Gen-supp-guide Wire,$160.00,$0.00,$160.00,$0.00,$114.19,$0.00,$0.00,$114.19,$114.19,$0.00,$160.00,$0.00,$80.00,$126.72,$128.00,$0.00,$0.00,$0.00,$0.00,$0.00
27010943,EAP,Custom 27010943,,Endo Stitch* Polysorb* 3/0 7 V,$198.00,$0.00,$198.00,$0.00,$141.31,$0.00,$0.00,$141.31,$141.31,$0.00,$198.00,$0.00,$99.00,$156.82,$158.40,$0.00,$0.00,$0.00,$0.00,$0.00
27010987,EAP,Custom 27010987,,3.2mm Guide Wire 290mm,$501.00,$0.00,$501.00,$0.00,$357.56,$0.00,$0.00,$357.56,$357.56,$0.00,$501.00,$0.00,$250.50,$396.79,$400.80,$0.00,$0.00,$0.00,$0.00,$0.00
27010993,EAP,Custom 27010993,,Humeral Fracture Brace,$196.00,$0.00,$196.00,$0.00,$139.89,$0.00,$0.00,$139.89,$139.89,$0.00,$196.00,$0.00,$98.00,$155.23,$156.80,$0.00,$0.00,$0.00,$0.00,$0.00
27010994,EAP,Custom 27010994,,Wound Care Shoe,$309.00,$0.00,$309.00,$0.00,$220.53,$0.00,$0.00,$220.53,$220.53,$0.00,$309.00,$0.00,$154.50,$244.73,$247.20,$0.00,$0.00,$0.00,$0.00,$0.00
27010997,EAP,Custom 27010997,,3mmx20cm Tunneler,$656.00,$0.00,$656.00,$0.00,$468.19,$0.00,$0.00,$468.19,$468.19,$0.00,$656.00,$0.00,$328.00,$519.55,$524.80,$0.00,$0.00,$0.00,$0.00,$0.00
27011002,EAP,Custom 27011002,,4fr Catheter Cobra 2,$166.00,$0.00,$166.00,$0.00,$118.47,$0.00,$0.00,$118.47,$118.47,$0.00,$166.00,$0.00,$83.00,$131.47,$132.80,$0.00,$0.00,$0.00,$0.00,$0.00
27011008,EAP,Custom 27011008,,5fr-100cm Sim 1 Cath,$60.00,$0.00,$60.00,$0.00,$42.82,$0.00,$0.00,$42.82,$42.82,$0.00,$60.00,$0.00,$30.00,$47.52,$48.00,$0.00,$0.00,$0.00,$0.00,$0.00
27011009,EAP,Custom 27011009,,5mmx19cmx90cm Monorail Bilary,"$4,654.00",$0.00,"$4,654.00",$0.00,"$3,321.56",$0.00,$0.00,"$3,321.56","$3,321.56",$0.00,"$4,654.00",$0.00,"$2,327.00","$3,685.97","$3,723.20",$0.00,$0.00,$0.00,$0.00,$0.00
27011010,EAP,Custom 27011010,,5x135x40cm Unifuse Kit,$550.00,$0.00,$550.00,$0.00,$392.54,$0.00,$0.00,$392.54,$392.54,$0.00,$550.00,$0.00,$275.00,$435.60,$440.00,$0.00,$0.00,$0.00,$0.00,$0.00
27011011,EAP,Custom 27011011,,5x135x50cm Unifuse Kit,$550.00,$0.00,$550.00,$0.00,$392.54,$0.00,$0.00,$392.54,$392.54,$0.00,$550.00,$0.00,$275.00,$435.60,$440.00,$0.00,$0.00,$0.00,$0.00,$0.00
27011013,EAP,Custom 27011013,,6fr Al1 Catheter,$31.00,$0.00,$31.00,$0.00,$22.12,$0.00,$0.00,$22.12,$22.12,$0.00,$31.00,$0.00,$15.50,$24.55,$24.80,$0.00,$0.00,$0.00,$0.00,$0.00
27011015,EAP,Custom 27011015,,6fr Ar1 Catheter,$31.00,$0.00,$31.00,$0.00,$22.12,$0.00,$0.00,$22.12,$22.12,$0.00,$31.00,$0.00,$15.50,$24.55,$24.80,$0.00,$0.00,$0.00,$0.00,$0.00
27011028,EAP,Custom 27011028,,7.1 Fr 100cm Pigtail Cath,$60.00,$0.00,$60.00,$0.00,$42.82,$0.00,$0.00,$42.82,$42.82,$0.00,$60.00,$0.00,$30.00,$47.52,$48.00,$0.00,$0.00,$0.00,$0.00,$0.00
27011029,EAP,Custom 27011029,,8fr X 40cm Skater Biliary Drai,$254.00,$0.00,$254.00,$0.00,$181.28,$0.00,$0.00,$181.28,$181.28,$0.00,$254.00,$0.00,$127.00,$201.17,$203.20,$0.00,$0.00,$0.00,$0.00,$0.00
27011032,EAP,Custom 27011032,,Air Guard Valved Introducer,$335.00,$0.00,$335.00,$0.00,$239.09,$0.00,$0.00,$239.09,$239.09,$0.00,$335.00,$0.00,$167.50,$265.32,$268.00,$0.00,$0.00,$0.00,$0.00,$0.00
27011033,EAP,Custom 27011033,,Bag Drainage Ureteral,$103.00,$0.00,$103.00,$0.00,$73.51,$0.00,$0.00,$73.51,$73.51,$0.00,$103.00,$0.00,$51.50,$81.58,$82.40,$0.00,$0.00,$0.00,$0.00,$0.00
27011037,EAP,Custom 27011037,,Balloon Dial Cath Xxl 12mmx4cm,$856.00,$0.00,$856.00,$0.00,$610.93,$0.00,$0.00,$610.93,$610.93,$0.00,$856.00,$0.00,$428.00,$677.95,$684.80,$0.00,$0.00,$0.00,$0.00,$0.00
27011039,EAP,Custom 27011039,,Balloon Polar Cath 4x60x120,"$2,002.00",$0.00,"$2,002.00",$0.00,"$1,428.83",$0.00,$0.00,"$1,428.83","$1,428.83",$0.00,"$2,002.00",$0.00,"$1,001.00","$1,585.58","$1,601.60",$0.00,$0.00,$0.00,$0.00,$0.00
27011040,EAP,Custom 27011040,,Balloon Polar Cath 5x40x120,"$2,002.00",$0.00,"$2,002.00",$0.00,"$1,428.83",$0.00,$0.00,"$1,428.83","$1,428.83",$0.00,"$2,002.00",$0.00,"$1,001.00","$1,585.58","$1,601.60",$0.00,$0.00,$0.00,$0.00,$0.00
27011041,EAP,Custom 27011041,,Balloon Polar Cath 5x60x120,"$2,002.00",$0.00,"$2,002.00",$0.00,"$1,428.83",$0.00,$0.00,"$1,428.83","$1,428.83",$0.00,"$2,002.00",$0.00,"$1,001.00","$1,585.58","$1,601.60",$0.00,$0.00,$0.00,$0.00,$0.00
27011051,EAP,Custom 27011051,,Basket Stone Removal 8-wire,$963.00,$0.00,$963.00,$0.00,$687.29,$0.00,$0.00,$687.29,$687.29,$0.00,$963.00,$0.00,$481.50,$762.70,$770.40,$0.00,$0.00,$0.00,$0.00,$0.00
27011052,EAP,Custom 27011052,,Bead Block 100-300,$667.00,$0.00,$667.00,$0.00,$476.04,$0.00,$0.00,$476.04,$476.04,$0.00,$667.00,$0.00,$333.50,$528.26,$533.60,$0.00,$0.00,$0.00,$0.00,$0.00
27011053,EAP,Custom 27011053,,Bead Block 300-500,$667.00,$0.00,$667.00,$0.00,$476.04,$0.00,$0.00,$476.04,$476.04,$0.00,$667.00,$0.00,$333.50,$528.26,$533.60,$0.00,$0.00,$0.00,$0.00,$0.00
27011054,EAP,Custom 27011054,,Bead Block 500-700,$667.00,$0.00,$667.00,$0.00,$476.04,$0.00,$0.00,$476.04,$476.04,$0.00,$667.00,$0.00,$333.50,$528.26,$533.60,$0.00,$0.00,$0.00,$0.00,$0.00
27011055,EAP,Custom 27011055,,Bead Block 700-900,$667.00,$0.00,$667.00,$0.00,$476.04,$0.00,$0.00,$476.04,$476.04,$0.00,$667.00,$0.00,$333.50,$528.26,$533.60,$0.00,$0.00,$0.00,$0.00,$0.00
27011056,EAP,Custom 27011056,,Bead Block 900-1200,$667.00,$0.00,$667.00,$0.00,$476.04,$0.00,$0.00,$476.04,$476.04,$0.00,$667.00,$0.00,$333.50,$528.26,$533.60,$0.00,$0.00,$0.00,$0.00,$0.00
27011058,EAP,Custom 27011058,,Cath 20fr 24cm Tenacath Hsg,$157.00,$0.00,$157.00,$0.00,$112.05,$0.00,$0.00,$112.05,$112.05,$0.00,$157.00,$0.00,$78.50,$124.34,$125.60,$0.00,$0.00,$0.00,$0.00,$0.00
27011061,EAP,Custom 27011061,,Cath 5fr 100cm Berenstein,$35.00,$0.00,$35.00,$0.00,$24.98,$0.00,$0.00,$24.98,$24.98,$0.00,$35.00,$0.00,$17.50,$27.72,$28.00,$0.00,$0.00,$0.00,$0.00,$0.00
27011062,EAP,Custom 27011062,,Cath 5fr 100cm Sim2,$61.00,$0.00,$61.00,$0.00,$43.54,$0.00,$0.00,$43.54,$43.54,$0.00,$61.00,$0.00,$30.50,$48.31,$48.80,$0.00,$0.00,$0.00,$0.00,$0.00
27011063,EAP,Custom 27011063,,Cath 5fr 100cm Sim3,$35.00,$0.00,$35.00,$0.00,$24.98,$0.00,$0.00,$24.98,$24.98,$0.00,$35.00,$0.00,$17.50,$27.72,$28.00,$0.00,$0.00,$0.00,$0.00,$0.00
27011065,EAP,Custom 27011065,,Cath 5fr 40cm Berenstein,$40.00,$0.00,$40.00,$0.00,$28.55,$0.00,$0.00,$28.55,$28.55,$0.00,$40.00,$0.00,$20.00,$31.68,$32.00,$0.00,$0.00,$0.00,$0.00,$0.00
27011067,EAP,Custom 27011067,,Cath 5fr 65cm Berenstein,$40.00,$0.00,$40.00,$0.00,$28.55,$0.00,$0.00,$28.55,$28.55,$0.00,$40.00,$0.00,$20.00,$31.68,$32.00,$0.00,$0.00,$0.00,$0.00,$0.00
27011068,EAP,Custom 27011068,,Cath 5fr 65cm Cobra1,$35.00,$0.00,$35.00,$0.00,$24.98,$0.00,$0.00,$24.98,$24.98,$0.00,$35.00,$0.00,$17.50,$27.72,$28.00,$0.00,$0.00,$0.00,$0.00,$0.00
27011069,EAP,Custom 27011069,,Cath 5fr 65cm Cobra2,$35.00,$0.00,$35.00,$0.00,$24.98,$0.00,$0.00,$24.98,$24.98,$0.00,$35.00,$0.00,$17.50,$27.72,$28.00,$0.00,$0.00,$0.00,$0.00,$0.00
27011070,EAP,Custom 27011070,,Cath 5fr 65cm Ns Straight,$60.00,$0.00,$60.00,$0.00,$42.82,$0.00,$0.00,$42.82,$42.82,$0.00,$60.00,$0.00,$30.00,$47.52,$48.00,$0.00,$0.00,$0.00,$0.00,$0.00
27011071,EAP,Custom 27011071,,Cath 5fr 65cm Pig,$40.00,$0.00,$40.00,$0.00,$28.55,$0.00,$0.00,$28.55,$28.55,$0.00,$40.00,$0.00,$20.00,$31.68,$32.00,$0.00,$0.00,$0.00,$0.00,$0.00
27011073,EAP,Custom 27011073,,Cath 5fr 80 Cm Mikalesson,$35.00,$0.00,$35.00,$0.00,$24.98,$0.00,$0.00,$24.98,$24.98,$0.00,$35.00,$0.00,$17.50,$27.72,$28.00,$0.00,$0.00,$0.00,$0.00,$0.00
27011074,EAP,Custom 27011074,,Cath 5fr 80cm Sos1,$166.00,$0.00,$166.00,$0.00,$118.47,$0.00,$0.00,$118.47,$118.47,$0.00,$166.00,$0.00,$83.00,$131.47,$132.80,$0.00,$0.00,$0.00,$0.00,$0.00
27011075,EAP,Custom 27011075,,Cath 5fr 80cm Sos2,$35.00,$0.00,$35.00,$0.00,$24.98,$0.00,$0.00,$24.98,$24.98,$0.00,$35.00,$0.00,$17.50,$27.72,$28.00,$0.00,$0.00,$0.00,$0.00,$0.00
27011077,EAP,Custom 27011077,,Cath Polar Dilator Bal4x80x120,"$2,335.00",$0.00,"$2,335.00",$0.00,"$1,666.49",$0.00,$0.00,"$1,666.49","$1,666.49",$0.00,"$2,335.00",$0.00,"$1,167.50","$1,849.32","$1,868.00",$0.00,$0.00,$0.00,$0.00,$0.00
27011078,EAP,Custom 27011078,,Cath Polar Dilator Bal5x80x120,"$2,002.00",$0.00,"$2,002.00",$0.00,"$1,428.83",$0.00,$0.00,"$1,428.83","$1,428.83",$0.00,"$2,002.00",$0.00,"$1,001.00","$1,585.58","$1,601.60",$0.00,$0.00,$0.00,$0.00,$0.00
27011083,EAP,Custom 27011083,,Cath Triple Lumen 11fr,$413.00,$0.00,$413.00,$0.00,$294.76,$0.00,$0.00,$294.76,$294.76,$0.00,$413.00,$0.00,$206.50,$327.10,$330.40,$0.00,$0.00,$0.00,$0.00,$0.00
27011084,EAP,Custom 27011084,,Catheter Repair Kit,$349.00,$0.00,$349.00,$0.00,$249.08,$0.00,$0.00,$249.08,$249.08,$0.00,$349.00,$0.00,$174.50,$276.41,$279.20,$0.00,$0.00,$0.00,$0.00,$0.00
27011086,EAP,Custom 27011086,,Chest Unit Drainage Pleur,$469.00,$0.00,$469.00,$0.00,$334.73,$0.00,$0.00,$334.73,$334.73,$0.00,$469.00,$0.00,$234.50,$371.45,$375.20,$0.00,$0.00,$0.00,$0.00,$0.00
27011088,EAP,Custom 27011088,,Coil 15-250 Micron (2vl/bx),$477.00,$0.00,$477.00,$0.00,$340.43,$0.00,$0.00,$340.43,$340.43,$0.00,$477.00,$0.00,$238.50,$377.78,$381.60,$0.00,$0.00,$0.00,$0.00,$0.00
27011089,EAP,Custom 27011089,,Coil 250-355 Micron (5vl/bx),$463.00,$0.00,$463.00,$0.00,$330.44,$0.00,$0.00,$330.44,$330.44,$0.00,$463.00,$0.00,$231.50,$366.70,$370.40,$0.00,$0.00,$0.00,$0.00,$0.00
27011090,EAP,Custom 27011090,,Coil 355-500 Micron (5vl/bx),$384.00,$0.00,$384.00,$0.00,$274.06,$0.00,$0.00,$274.06,$274.06,$0.00,$384.00,$0.00,$192.00,$304.13,$307.20,$0.00,$0.00,$0.00,$0.00,$0.00
27011091,EAP,Custom 27011091,,Coil 500-710 Micron (2vl/bx),$477.00,$0.00,$477.00,$0.00,$340.43,$0.00,$0.00,$340.43,$340.43,$0.00,$477.00,$0.00,$238.50,$377.78,$381.60,$0.00,$0.00,$0.00,$0.00,$0.00
27011092,EAP,Custom 27011092,,Coil 710-1000 Micron (2vl/bx),$477.00,$0.00,$477.00,$0.00,$340.43,$0.00,$0.00,$340.43,$340.43,$0.00,$477.00,$0.00,$238.50,$377.78,$381.60,$0.00,$0.00,$0.00,$0.00,$0.00
27011093,EAP,Custom 27011093,,Coil Pusher 16,$544.00,$0.00,$544.00,$0.00,$388.25,$0.00,$0.00,$388.25,$388.25,$0.00,$544.00,$0.00,$272.00,$430.85,$435.20,$0.00,$0.00,$0.00,$0.00,$0.00
27011094,EAP,Custom 27011094,,Coil Pusher Trupush,"$1,228.00",$0.00,"$1,228.00",$0.00,$876.42,$0.00,$0.00,$876.42,$876.42,$0.00,"$1,228.00",$0.00,$614.00,$972.58,$982.40,$0.00,$0.00,$0.00,$0.00,$0.00
27011095,EAP,Custom 27011095,,Connector Ureteral Catheter,$15.00,$0.00,$15.00,$0.00,$10.71,$0.00,$0.00,$10.71,$10.71,$0.00,$15.00,$0.00,$7.50,$11.88,$12.00,$0.00,$0.00,$0.00,$0.00,$0.00
27011096,EAP,Custom 27011096,,Connectory Tuohy,$90.00,$0.00,$90.00,$0.00,$64.23,$0.00,$0.00,$64.23,$64.23,$0.00,$90.00,$0.00,$45.00,$71.28,$72.00,$0.00,$0.00,$0.00,$0.00,$0.00
27011097,EAP,Custom 27011097,,Contra 2,$40.00,$0.00,$40.00,$0.00,$28.55,$0.00,$0.00,$28.55,$28.55,$0.00,$40.00,$0.00,$20.00,$31.68,$32.00,$0.00,$0.00,$0.00,$0.00,$0.00
27011098,EAP,Custom 27011098,,Contra Flush Catheter,$199.00,$0.00,$199.00,$0.00,$142.03,$0.00,$0.00,$142.03,$142.03,$0.00,$199.00,$0.00,$99.50,$157.61,$159.20,$0.00,$0.00,$0.00,$0.00,$0.00
27011099,EAP,Custom 27011099,,Cope Suture Anchor Set,$199.00,$0.00,$199.00,$0.00,$142.03,$0.00,$0.00,$142.03,$142.03,$0.00,$199.00,$0.00,$99.50,$157.61,$159.20,$0.00,$0.00,$0.00,$0.00,$0.00
27011105,EAP,Custom 27011105,,Embolization 38-4-3,$194.00,$0.00,$194.00,$0.00,$138.46,$0.00,$0.00,$138.46,$138.46,$0.00,$194.00,$0.00,$97.00,$153.65,$155.20,$0.00,$0.00,$0.00,$0.00,$0.00
27011106,EAP,Custom 27011106,,Embolization 38-8-15,$194.00,$0.00,$194.00,$0.00,$138.46,$0.00,$0.00,$138.46,$138.46,$0.00,$194.00,$0.00,$97.00,$153.65,$155.20,$0.00,$0.00,$0.00,$0.00,$0.00
27011107,EAP,Custom 27011107,,Embolization Coil 38-5-5,$194.00,$0.00,$194.00,$0.00,$138.46,$0.00,$0.00,$138.46,$138.46,$0.00,$194.00,$0.00,$97.00,$153.65,$155.20,$0.00,$0.00,$0.00,$0.00,$0.00
27011108,EAP,Custom 27011108,,Embolization Coils 38-2-3,$194.00,$0.00,$194.00,$0.00,$138.46,$0.00,$0.00,$138.46,$138.46,$0.00,$194.00,$0.00,$97.00,$153.65,$155.20,$0.00,$0.00,$0.00,$0.00,$0.00
27011109,EAP,Custom 27011109,,Embolization Coils 38-4-2,$194.00,$0.00,$194.00,$0.00,$138.46,$0.00,$0.00,$138.46,$138.46,$0.00,$194.00,$0.00,$97.00,$153.65,$155.20,$0.00,$0.00,$0.00,$0.00,$0.00
27011110,EAP,Custom 27011110,,Embolization Coils 38-5-10,$194.00,$0.00,$194.00,$0.00,$138.46,$0.00,$0.00,$138.46,$138.46,$0.00,$194.00,$0.00,$97.00,$153.65,$155.20,$0.00,$0.00,$0.00,$0.00,$0.00
27011111,EAP,Custom 27011111,,Face Shields,$14.00,$0.00,$14.00,$0.00,$9.99,$0.00,$0.00,$9.99,$9.99,$0.00,$14.00,$0.00,$7.00,$11.09,$11.20,$0.00,$0.00,$0.00,$0.00,$0.00
27011112,EAP,Custom 27011112,,Filling Station Plus (neuro),$94.00,$0.00,$94.00,$0.00,$67.09,$0.00,$0.00,$67.09,$67.09,$0.00,$94.00,$0.00,$47.00,$74.45,$75.20,$0.00,$0.00,$0.00,$0.00,$0.00
27011113,EAP,Custom 27011113,,Filter Jugular G-2,"$4,337.00",$0.00,"$4,337.00",$0.00,"$3,095.32",$0.00,$0.00,"$3,095.32","$3,095.32",$0.00,"$4,337.00",$0.00,"$2,168.50","$3,434.90","$3,469.60",$0.00,$0.00,$0.00,$0.00,$0.00
27011114,EAP,Custom 27011114,,Flo-switch Hp,$380.00,$0.00,$380.00,$0.00,$271.21,$0.00,$0.00,$271.21,$271.21,$0.00,$380.00,$0.00,$190.00,$300.96,$304.00,$0.00,$0.00,$0.00,$0.00,$0.00
27011120,EAP,Custom 27011120,,Forearm Based Outrigger,$172.00,$0.00,$172.00,$0.00,$122.76,$0.00,$0.00,$122.76,$122.76,$0.00,$172.00,$0.00,$86.00,$136.22,$137.60,$0.00,$0.00,$0.00,$0.00,$0.00
27011121,EAP,Custom 27011121,,Gtgw.180cm-45deg Angle,$501.00,$0.00,$501.00,$0.00,$357.56,$0.00,$0.00,$357.56,$357.56,$0.00,$501.00,$0.00,$250.50,$396.79,$400.80,$0.00,$0.00,$0.00,$0.00,$0.00
27011122,EAP,Custom 27011122,,Hemostasis V-pad,$160.00,$0.00,$160.00,$0.00,$114.19,$0.00,$0.00,$114.19,$114.19,$0.00,$160.00,$0.00,$80.00,$126.72,$128.00,$0.00,$0.00,$0.00,$0.00,$0.00
27011124,EAP,Custom 27011124,,Igtcfs-65-fem Celect Perm Cook,"$4,005.00",$0.00,"$4,005.00",$0.00,"$2,858.37",$0.00,$0.00,"$2,858.37","$2,858.37",$0.00,"$4,005.00",$0.00,"$2,002.50","$3,171.96","$3,204.00",$0.00,$0.00,$0.00,$0.00,$0.00
27011125,EAP,HCPCS C1880,,Igtcfs-65-jugcelet Perm Cook,"$4,536.00",$0.00,"$4,536.00","$2,041.20","$3,237.34",$0.00,$781.53,"$3,237.34","$3,237.34",$794.22,"$4,536.00",$0.00,"$2,268.00","$3,592.51","$3,628.80",$0.00,$709.88,$0.00,$722.13,$0.00
27011126,EAP,Custom 27011126,,Inflation Device Monarch-25,$184.00,$0.00,$184.00,$0.00,$131.32,$0.00,$0.00,$131.32,$131.32,$0.00,$184.00,$0.00,$92.00,$145.73,$147.20,$0.00,$0.00,$0.00,$0.00,$0.00
27011127,EAP,Custom 27011127,,Introducer Mpis-401,$94.00,$0.00,$94.00,$0.00,$67.09,$0.00,$0.00,$67.09,$67.09,$0.00,$94.00,$0.00,$47.00,$74.45,$75.20,$0.00,$0.00,$0.00,$0.00,$0.00
27011128,EAP,Custom 27011128,,Introducer Pinnacle 5fr 10cm,$67.00,$0.00,$67.00,$0.00,$47.82,$0.00,$0.00,$47.82,$47.82,$0.00,$67.00,$0.00,$33.50,$53.06,$53.60,$0.00,$0.00,$0.00,$0.00,$0.00
27011129,EAP,Custom 27011129,,Jcd 10.0-38-20,$42.00,$0.00,$42.00,$0.00,$29.98,$0.00,$0.00,$29.98,$29.98,$0.00,$42.00,$0.00,$21.00,$33.26,$33.60,$0.00,$0.00,$0.00,$0.00,$0.00
27011130,EAP,Custom 27011130,,Jcd 12.0-38-20,$44.00,$0.00,$44.00,$0.00,$31.40,$0.00,$0.00,$31.40,$31.40,$0.00,$44.00,$0.00,$22.00,$34.85,$35.20,$0.00,$0.00,$0.00,$0.00,$0.00
27011131,EAP,Custom 27011131,,Jcd 14.0-38-20,$51.00,$0.00,$51.00,$0.00,$36.40,$0.00,$0.00,$36.40,$36.40,$0.00,$51.00,$0.00,$25.50,$40.39,$40.80,$0.00,$0.00,$0.00,$0.00,$0.00
27011132,EAP,Custom 27011132,,Jcd 16.0-38-20,$51.00,$0.00,$51.00,$0.00,$36.40,$0.00,$0.00,$36.40,$36.40,$0.00,$51.00,$0.00,$25.50,$40.39,$40.80,$0.00,$0.00,$0.00,$0.00,$0.00
27011133,EAP,Custom 27011133,,Jcd 4.0-25-20,$31.00,$0.00,$31.00,$0.00,$22.12,$0.00,$0.00,$22.12,$22.12,$0.00,$31.00,$0.00,$15.50,$24.55,$24.80,$0.00,$0.00,$0.00,$0.00,$0.00
27011134,EAP,Custom 27011134,,Jcd 5.0-38-20,$17.00,$0.00,$17.00,$0.00,$12.13,$0.00,$0.00,$12.13,$12.13,$0.00,$17.00,$0.00,$8.50,$13.46,$13.60,$0.00,$0.00,$0.00,$0.00,$0.00
27011135,EAP,Custom 27011135,,Jcd 6.0-38-20,$42.00,$0.00,$42.00,$0.00,$29.98,$0.00,$0.00,$29.98,$29.98,$0.00,$42.00,$0.00,$21.00,$33.26,$33.60,$0.00,$0.00,$0.00,$0.00,$0.00
27011136,EAP,Custom 27011136,,Jcd 7.0-38-20,$17.00,$0.00,$17.00,$0.00,$12.13,$0.00,$0.00,$12.13,$12.13,$0.00,$17.00,$0.00,$8.50,$13.46,$13.60,$0.00,$0.00,$0.00,$0.00,$0.00
27011137,EAP,Custom 27011137,,Jcd 8.0-38-20,$17.00,$0.00,$17.00,$0.00,$12.13,$0.00,$0.00,$12.13,$12.13,$0.00,$17.00,$0.00,$8.50,$13.46,$13.60,$0.00,$0.00,$0.00,$0.00,$0.00
27011138,EAP,Custom 27011138,,Jcd 9.0-38-20,$42.00,$0.00,$42.00,$0.00,$29.98,$0.00,$0.00,$29.98,$29.98,$0.00,$42.00,$0.00,$21.00,$33.26,$33.60,$0.00,$0.00,$0.00,$0.00,$0.00
27011139,EAP,Custom 27011139,,Jcd-20.0-38-20 Dilator,$36.00,$0.00,$36.00,$0.00,$25.69,$0.00,$0.00,$25.69,$25.69,$0.00,$36.00,$0.00,$18.00,$28.51,$28.80,$0.00,$0.00,$0.00,$0.00,$0.00
27011140,EAP,Custom 27011140,,Jcd-22.0-38-20 Dilator,$45.00,$0.00,$45.00,$0.00,$32.12,$0.00,$0.00,$32.12,$32.12,$0.00,$45.00,$0.00,$22.50,$35.64,$36.00,$0.00,$0.00,$0.00,$0.00,$0.00
27011141,EAP,Custom 27011141,,Jcd-24.0-38-20 Dilator,$45.00,$0.00,$45.00,$0.00,$32.12,$0.00,$0.00,$32.12,$32.12,$0.00,$45.00,$0.00,$22.50,$35.64,$36.00,$0.00,$0.00,$0.00,$0.00,$0.00
27011142,EAP,Custom 27011142,,Jcd-d18.0-38-20 Dilator,$51.00,$0.00,$51.00,$0.00,$36.40,$0.00,$0.00,$36.40,$36.40,$0.00,$51.00,$0.00,$25.50,$40.39,$40.80,$0.00,$0.00,$0.00,$0.00,$0.00
27011143,EAP,Custom 27011143,,Kinair Iii W/o Scale,$192.00,$0.00,$192.00,$0.00,$137.03,$0.00,$0.00,$137.03,$137.03,$0.00,$192.00,$0.00,$96.00,$152.06,$153.60,$0.00,$0.00,$0.00,$0.00,$0.00
27011148,EAP,Custom 27011148,,Kit Angio Saftey With J Wire,$178.00,$0.00,$178.00,$0.00,$127.04,$0.00,$0.00,$127.04,$127.04,$0.00,$178.00,$0.00,$89.00,$140.98,$142.40,$0.00,$0.00,$0.00,$0.00,$0.00
27011149,EAP,Custom 27011149,,Kit Fallopian Tube,$349.00,$0.00,$349.00,$0.00,$249.08,$0.00,$0.00,$249.08,$249.08,$0.00,$349.00,$0.00,$174.50,$276.41,$279.20,$0.00,$0.00,$0.00,$0.00,$0.00
27011150,EAP,Custom 27011150,,Kit Gastrostomy 18fr,$541.00,$0.00,$541.00,$0.00,$386.11,$0.00,$0.00,$386.11,$386.11,$0.00,$541.00,$0.00,$270.50,$428.47,$432.80,$0.00,$0.00,$0.00,$0.00,$0.00
27011151,EAP,Custom 27011151,,Kit Mahurkar 12f Triple Lumen,$300.00,$0.00,$300.00,$0.00,$214.11,$0.00,$0.00,$214.11,$214.11,$0.00,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$0.00,$0.00,$0.00,$0.00
27011152,EAP,Custom 27011152,,Kit Pressure Monitoring T,$71.00,$0.00,$71.00,$0.00,$50.67,$0.00,$0.00,$50.67,$50.67,$0.00,$71.00,$0.00,$35.50,$56.23,$56.80,$0.00,$0.00,$0.00,$0.00,$0.00
27011153,EAP,Custom 27011153,,Kit Pressure Monitoring T,$163.00,$0.00,$163.00,$0.00,$116.33,$0.00,$0.00,$116.33,$116.33,$0.00,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$0.00,$0.00,$0.00,$0.00
27011154,EAP,Custom 27011154,,Kit Triple Lumen Catheter,$726.00,$0.00,$726.00,$0.00,$518.15,$0.00,$0.00,$518.15,$518.15,$0.00,$726.00,$0.00,$363.00,$574.99,$580.80,$0.00,$0.00,$0.00,$0.00,$0.00
27011156,EAP,Custom 27011156,,Lancet  Grady Orange,$10.00,$0.00,$10.00,$0.00,$7.14,$0.00,$0.00,$7.14,$7.14,$0.00,$10.00,$0.00,$5.00,$7.92,$8.00,$0.00,$0.00,$0.00,$0.00,$0.00
27011157,EAP,Custom 27011157,,Line Connecting 36 Hp,$69.00,$0.00,$69.00,$0.00,$49.25,$0.00,$0.00,$49.25,$49.25,$0.00,$69.00,$0.00,$34.50,$54.65,$55.20,$0.00,$0.00,$0.00,$0.00,$0.00
27011158,EAP,Custom 27011158,,Line Connecting 48 Hp,$38.00,$0.00,$38.00,$0.00,$27.12,$0.00,$0.00,$27.12,$27.12,$0.00,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
27011160,EAP,Custom 27011160,,Mask Sub-micron Small,$10.00,$0.00,$10.00,$0.00,$7.14,$0.00,$0.00,$7.14,$7.14,$0.00,$10.00,$0.00,$5.00,$7.92,$8.00,$0.00,$0.00,$0.00,$0.00,$0.00
27011161,EAP,Custom 27011161,,Med/surg Semi Supplies,$64.00,$0.00,$64.00,$0.00,$45.68,$0.00,$0.00,$45.68,$45.68,$0.00,$64.00,$0.00,$32.00,$50.69,$51.20,$0.00,$0.00,$0.00,$0.00,$0.00
27011162,EAP,Custom 27011162,,Microsphere Embogold 500-700,$734.00,$0.00,$734.00,$0.00,$523.86,$0.00,$0.00,$523.86,$523.86,$0.00,$734.00,$0.00,$367.00,$581.33,$587.20,$0.00,$0.00,$0.00,$0.00,$0.00
27011163,EAP,Custom 27011163,,Microsphere Embogold 700-900,$734.00,$0.00,$734.00,$0.00,$523.86,$0.00,$0.00,$523.86,$523.86,$0.00,$734.00,$0.00,$367.00,$581.33,$587.20,$0.00,$0.00,$0.00,$0.00,$0.00
27011164,EAP,Custom 27011164,,Microsphere Embogold 900-1200,"$3,669.00",$0.00,"$3,669.00",$0.00,"$2,618.57",$0.00,$0.00,"$2,618.57","$2,618.57",$0.00,"$3,669.00",$0.00,"$1,834.50","$2,905.85","$2,935.20",$0.00,$0.00,$0.00,$0.00,$0.00
27011165,EAP,Custom 27011165,,Needle Chiba 22ga X 15cm,$82.00,$0.00,$82.00,$0.00,$58.52,$0.00,$0.00,$58.52,$58.52,$0.00,$82.00,$0.00,$41.00,$64.94,$65.60,$0.00,$0.00,$0.00,$0.00,$0.00
27011166,EAP,Custom 27011166,,Needle Hypodermic Sterile,$10.00,$0.00,$10.00,$0.00,$7.14,$0.00,$0.00,$7.14,$7.14,$0.00,$10.00,$0.00,$5.00,$7.92,$8.00,$0.00,$0.00,$0.00,$0.00,$0.00
27011167,EAP,Custom 27011167,,Needle Hypodermic Sterile,$10.00,$0.00,$10.00,$0.00,$7.14,$0.00,$0.00,$7.14,$7.14,$0.00,$10.00,$0.00,$5.00,$7.92,$8.00,$0.00,$0.00,$0.00,$0.00,$0.00
27011168,EAP,Custom 27011168,,Needle Port-cath 20ga X 1,$34.00,$0.00,$34.00,$0.00,$24.27,$0.00,$0.00,$24.27,$24.27,$0.00,$34.00,$0.00,$17.00,$26.93,$27.20,$0.00,$0.00,$0.00,$0.00,$0.00
27011169,EAP,Custom 27011169,,Needle Port-cath 20ga X 1,$34.00,$0.00,$34.00,$0.00,$24.27,$0.00,$0.00,$24.27,$24.27,$0.00,$34.00,$0.00,$17.00,$26.93,$27.20,$0.00,$0.00,$0.00,$0.00,$0.00
27011172,EAP,Custom 27011172,,Olcott Torque Device,$65.00,$0.00,$65.00,$0.00,$46.39,$0.00,$0.00,$46.39,$46.39,$0.00,$65.00,$0.00,$32.50,$51.48,$52.00,$0.00,$0.00,$0.00,$0.00,$0.00
27011176,EAP,Custom 27011176,,Perc Gastrostomy Set,"$1,079.00",$0.00,"$1,079.00",$0.00,$770.08,$0.00,$0.00,$770.08,$770.08,$0.00,"$1,079.00",$0.00,$539.50,$854.57,$863.20,$0.00,$0.00,$0.00,$0.00,$0.00
27011177,EAP,Custom 27011177,,Polar Cath Inflation Unit,"$7,912.00",$0.00,"$7,912.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$7,912.00",$0.00,"$3,956.00","$6,266.30","$6,329.60",$0.00,$0.00,$0.00,$0.00,$0.00
27011178,EAP,Custom 27011178,,Port Peritoneal/drain/ascites,"$1,070.00",$0.00,"$1,070.00",$0.00,$763.66,$0.00,$0.00,$763.66,$763.66,$0.00,"$1,070.00",$0.00,$535.00,$847.44,$856.00,$0.00,$0.00,$0.00,$0.00,$0.00
27011179,EAP,Custom 27011179,,Pressure Tubing,$555.00,$0.00,$555.00,$0.00,$396.10,$0.00,$0.00,$396.10,$396.10,$0.00,$555.00,$0.00,$277.50,$439.56,$444.00,$0.00,$0.00,$0.00,$0.00,$0.00
27011181,EAP,Custom 27011181,,Rapad Shield,$131.00,$0.00,$131.00,$0.00,$93.49,$0.00,$0.00,$93.49,$93.49,$0.00,$131.00,$0.00,$65.50,$103.75,$104.80,$0.00,$0.00,$0.00,$0.00,$0.00
27011182,EAP,Custom 27011182,,Recovery Cone Removal System,"$1,985.00",$0.00,"$1,985.00",$0.00,"$1,416.69",$0.00,$0.00,"$1,416.69","$1,416.69",$0.00,"$1,985.00",$0.00,$992.50,"$1,572.12","$1,588.00",$0.00,$0.00,$0.00,$0.00,$0.00
27011183,EAP,Custom 27011183,,Retention Device 10fr,$39.00,$0.00,$39.00,$0.00,$27.83,$0.00,$0.00,$27.83,$27.83,$0.00,$39.00,$0.00,$19.50,$30.89,$31.20,$0.00,$0.00,$0.00,$0.00,$0.00
27011184,EAP,Custom 27011184,,Retention Device 12fr,$38.00,$0.00,$38.00,$0.00,$27.12,$0.00,$0.00,$27.12,$27.12,$0.00,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
27011185,EAP,Custom 27011185,,Retention Device 8fr,$40.00,$0.00,$40.00,$0.00,$28.55,$0.00,$0.00,$28.55,$28.55,$0.00,$40.00,$0.00,$20.00,$31.68,$32.00,$0.00,$0.00,$0.00,$0.00,$0.00
27011190,EAP,Custom 27011190,,Ring Transjugular Set,"$1,404.00",$0.00,"$1,404.00",$0.00,"$1,002.03",$0.00,$0.00,"$1,002.03","$1,002.03",$0.00,"$1,404.00",$0.00,$702.00,"$1,111.97","$1,123.20",$0.00,$0.00,$0.00,$0.00,$0.00
27011194,EAP,Custom 27011194,,Safety Angio Kit,$127.00,$0.00,$127.00,$0.00,$90.64,$0.00,$0.00,$90.64,$90.64,$0.00,$127.00,$0.00,$63.50,$100.58,$101.60,$0.00,$0.00,$0.00,$0.00,$0.00
27011195,EAP,Custom 27011195,,Safety Peg Kit Moni Bolster,"$1,497.00",$0.00,"$1,497.00",$0.00,"$1,068.41",$0.00,$0.00,"$1,068.41","$1,068.41",$0.00,"$1,497.00",$0.00,$748.50,"$1,185.62","$1,197.60",$0.00,$0.00,$0.00,$0.00,$0.00
27011196,EAP,Custom 27011196,,Scaple Surg W/handle Attached,$16.00,$0.00,$16.00,$0.00,$11.42,$0.00,$0.00,$11.42,$11.42,$0.00,$16.00,$0.00,$8.00,$12.67,$12.80,$0.00,$0.00,$0.00,$0.00,$0.00
27011197,EAP,Custom 27011197,,Set Blood Administration,$34.00,$0.00,$34.00,$0.00,$24.27,$0.00,$0.00,$24.27,$24.27,$0.00,$34.00,$0.00,$17.00,$26.93,$27.20,$0.00,$0.00,$0.00,$0.00,$0.00
27011198,EAP,Custom 27011198,,Set Blood Adminstration,$69.00,$0.00,$69.00,$0.00,$49.25,$0.00,$0.00,$49.25,$49.25,$0.00,$69.00,$0.00,$34.50,$54.65,$55.20,$0.00,$0.00,$0.00,$0.00,$0.00
27011199,EAP,Custom 27011199,,Set Blood Adminstration,$65.00,$0.00,$65.00,$0.00,$46.39,$0.00,$0.00,$46.39,$46.39,$0.00,$65.00,$0.00,$32.50,$51.48,$52.00,$0.00,$0.00,$0.00,$0.00,$0.00
27011200,EAP,Custom 27011200,,Set Liver Biopsy Labs-100,"$1,409.00",$0.00,"$1,409.00",$0.00,"$1,005.60",$0.00,$0.00,"$1,005.60","$1,005.60",$0.00,"$1,409.00",$0.00,$704.50,"$1,115.93","$1,127.20",$0.00,$0.00,$0.00,$0.00,$0.00
27011201,EAP,Custom 27011201,,Set Mediport Infusion W/i,$36.00,$0.00,$36.00,$0.00,$25.69,$0.00,$0.00,$25.69,$25.69,$0.00,$36.00,$0.00,$18.00,$28.51,$28.80,$0.00,$0.00,$0.00,$0.00,$0.00
27011202,EAP,Custom 27011202,,Set Neff Perc Access,$244.00,$0.00,$244.00,$0.00,$174.14,$0.00,$0.00,$174.14,$174.14,$0.00,$244.00,$0.00,$122.00,$193.25,$195.20,$0.00,$0.00,$0.00,$0.00,$0.00
27011203,EAP,Custom 27011203,,Set Pca Mini-bore W/int A,$44.00,$0.00,$44.00,$0.00,$31.40,$0.00,$0.00,$31.40,$31.40,$0.00,$44.00,$0.00,$22.00,$34.85,$35.20,$0.00,$0.00,$0.00,$0.00,$0.00
27011204,EAP,Custom 27011204,,Set Scalp  Vein Infusion 21 G,$10.00,$0.00,$10.00,$0.00,$7.14,$0.00,$0.00,$7.14,$7.14,$0.00,$10.00,$0.00,$5.00,$7.92,$8.00,$0.00,$0.00,$0.00,$0.00,$0.00
27011207,EAP,Custom 27011207,,Set Scalp Vein Infusion 2,$10.00,$0.00,$10.00,$0.00,$7.14,$0.00,$0.00,$7.14,$7.14,$0.00,$10.00,$0.00,$5.00,$7.92,$8.00,$0.00,$0.00,$0.00,$0.00,$0.00
27011208,EAP,Custom 27011208,,Set Secondary Piggy Back,$10.00,$0.00,$10.00,$0.00,$7.14,$0.00,$0.00,$7.14,$7.14,$0.00,$10.00,$0.00,$5.00,$7.92,$8.00,$0.00,$0.00,$0.00,$0.00,$0.00
27011209,EAP,Custom 27011209,,Set Urinary Drain W/conta,$20.00,$0.00,$20.00,$0.00,$14.27,$0.00,$0.00,$14.27,$14.27,$0.00,$20.00,$0.00,$10.00,$15.84,$16.00,$0.00,$0.00,$0.00,$0.00,$0.00
27011212,EAP,Custom 27011212,,Simon-nitinol Vena Cava Filte,"$3,605.00",$0.00,"$3,605.00",$0.00,"$2,572.89",$0.00,$0.00,"$2,572.89","$2,572.89",$0.00,"$3,605.00",$0.00,"$1,802.50","$2,855.16","$2,884.00",$0.00,$0.00,$0.00,$0.00,$0.00
27011213,EAP,Custom 27011213,,Simon-nitinol Vena Filter An,"$3,085.00",$0.00,"$3,085.00",$0.00,"$2,201.76",$0.00,$0.00,"$2,201.76","$2,201.76",$0.00,"$3,085.00",$0.00,"$1,542.50","$2,443.32","$2,468.00",$0.00,$0.00,$0.00,$0.00,$0.00
27011214,EAP,Custom 27011214,,Skater Introducer System,$254.00,$0.00,$254.00,$0.00,$181.28,$0.00,$0.00,$181.28,$181.28,$0.00,$254.00,$0.00,$127.00,$201.17,$203.20,$0.00,$0.00,$0.00,$0.00,$0.00
27011215,EAP,HCPCS C1729,,Skater Nephro Cath 8fr X 35cm,$288.00,$0.00,$288.00,$156.38,$205.55,$0.00,$49.62,$205.55,$205.55,$50.43,$288.00,$0.00,$144.00,$228.10,$230.40,$0.00,$45.07,$0.00,$45.85,$0.00
27011216,EAP,Custom 27011216,,Snare Amplatz 10mm,$916.00,$0.00,$916.00,$0.00,$653.75,$0.00,$0.00,$653.75,$653.75,$0.00,$916.00,$0.00,$458.00,$725.47,$732.80,$0.00,$0.00,$0.00,$0.00,$0.00
27011217,EAP,Custom 27011217,,Snare Amplatz 5mm,$916.00,$0.00,$916.00,$0.00,$653.75,$0.00,$0.00,$653.75,$653.75,$0.00,$916.00,$0.00,$458.00,$725.47,$732.80,$0.00,$0.00,$0.00,$0.00,$0.00
27011226,EAP,Custom 27011226,,Sponge Gelfoam Gelatin,$85.00,$0.00,$85.00,$0.00,$60.66,$0.00,$0.00,$60.66,$60.66,$0.00,$85.00,$0.00,$42.50,$67.32,$68.00,$0.00,$0.00,$0.00,$0.00,$0.00
27011227,EAP,HCPCS C1876,,Stent Vascular Covera Covered 10mm X 60mm 80cm Delivery,"$6,750.00",$0.00,"$6,750.00","$3,037.50","$4,817.48",$0.00,"$1,162.99","$4,817.48","$4,817.48","$1,181.87","$6,750.00",$0.00,"$3,375.00","$5,346.00","$5,400.00",$0.00,"$1,056.38",$0.00,"$1,074.60",$0.00
27011228,EAP,Custom 27011228,,Stent Luminex 12x60,"$3,986.00",$0.00,"$3,986.00",$0.00,"$2,844.81",$0.00,$0.00,"$2,844.81","$2,844.81",$0.00,"$3,986.00",$0.00,"$1,993.00","$3,156.91","$3,188.80",$0.00,$0.00,$0.00,$0.00,$0.00
27011229,EAP,Custom 27011229,,Stent Luminexx 7x30,"$3,986.00",$0.00,"$3,986.00",$0.00,"$2,844.81",$0.00,$0.00,"$2,844.81","$2,844.81",$0.00,"$3,986.00",$0.00,"$1,993.00","$3,156.91","$3,188.80",$0.00,$0.00,$0.00,$0.00,$0.00
27011230,EAP,Custom 27011230,,Stent Luminexx 7x40,"$3,986.00",$0.00,"$3,986.00",$0.00,"$2,844.81",$0.00,$0.00,"$2,844.81","$2,844.81",$0.00,"$3,986.00",$0.00,"$1,993.00","$3,156.91","$3,188.80",$0.00,$0.00,$0.00,$0.00,$0.00
27011231,EAP,Custom 27011231,,Stent Luminexx 8x40,"$3,986.00",$0.00,"$3,986.00",$0.00,"$2,844.81",$0.00,$0.00,"$2,844.81","$2,844.81",$0.00,"$3,986.00",$0.00,"$1,993.00","$3,156.91","$3,188.80",$0.00,$0.00,$0.00,$0.00,$0.00
27011232,EAP,Custom 27011232,,Stent Luminexx Stent 8x30,"$3,986.00",$0.00,"$3,986.00",$0.00,"$2,844.81",$0.00,$0.00,"$2,844.81","$2,844.81",$0.00,"$3,986.00",$0.00,"$1,993.00","$3,156.91","$3,188.80",$0.00,$0.00,$0.00,$0.00,$0.00
27011233,EAP,Custom 27011233,,Stiff Micropunture 5fr,$153.00,$0.00,$153.00,$0.00,$109.20,$0.00,$0.00,$109.20,$109.20,$0.00,$153.00,$0.00,$76.50,$121.18,$122.40,$0.00,$0.00,$0.00,$0.00,$0.00
27011234,EAP,Custom 27011234,,Stopcock 1-way Hp,$14.00,$0.00,$14.00,$0.00,$9.99,$0.00,$0.00,$9.99,$9.99,$0.00,$14.00,$0.00,$7.00,$11.09,$11.20,$0.00,$0.00,$0.00,$0.00,$0.00
27011236,EAP,Custom 27011236,,Stopcock 3-way Hp,$20.00,$0.00,$20.00,$0.00,$14.27,$0.00,$0.00,$14.27,$14.27,$0.00,$20.00,$0.00,$10.00,$15.84,$16.00,$0.00,$0.00,$0.00,$0.00,$0.00
27011237,EAP,Custom 27011237,,"Supplies, Non-sterile Penumbra",$66.00,$0.00,$66.00,$0.00,$47.10,$0.00,$0.00,$47.10,$47.10,$0.00,$66.00,$0.00,$33.00,$52.27,$52.80,$0.00,$0.00,$0.00,$0.00,$0.00
27011241,EAP,Custom 27011241,,Threapulse Ii,$581.00,$0.00,$581.00,$0.00,$414.66,$0.00,$0.00,$414.66,$414.66,$0.00,$581.00,$0.00,$290.50,$460.15,$464.80,$0.00,$0.00,$0.00,$0.00,$0.00
27011242,EAP,Custom 27011242,,Tray Catheter Urethral 14,$16.00,$0.00,$16.00,$0.00,$11.42,$0.00,$0.00,$11.42,$11.42,$0.00,$16.00,$0.00,$8.00,$12.67,$12.80,$0.00,$0.00,$0.00,$0.00,$0.00
27011243,EAP,Custom 27011243,,Tray Foley Perconnected 1,$52.00,$0.00,$52.00,$0.00,$37.11,$0.00,$0.00,$37.11,$37.11,$0.00,$52.00,$0.00,$26.00,$41.18,$41.60,$0.00,$0.00,$0.00,$0.00,$0.00
27011244,EAP,Custom 27011244,,Tray Foley Perconnected 1,$60.00,$0.00,$60.00,$0.00,$42.82,$0.00,$0.00,$42.82,$42.82,$0.00,$60.00,$0.00,$30.00,$47.52,$48.00,$0.00,$0.00,$0.00,$0.00,$0.00
27011245,EAP,Custom 27011245,,Tray Foley Preconnected 1,$52.00,$0.00,$52.00,$0.00,$37.11,$0.00,$0.00,$37.11,$37.11,$0.00,$52.00,$0.00,$26.00,$41.18,$41.60,$0.00,$0.00,$0.00,$0.00,$0.00
27011246,EAP,Custom 27011246,,Tray Foley Preconnected 1,$60.00,$0.00,$60.00,$0.00,$42.82,$0.00,$0.00,$42.82,$42.82,$0.00,$60.00,$0.00,$30.00,$47.52,$48.00,$0.00,$0.00,$0.00,$0.00,$0.00
27011252,EAP,Custom 27011252,,Triple Lumen Catheter Size 24,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$178.43,$178.43,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
27011253,EAP,Custom 27011253,,Tube  Feeding Ng  8fr 43in En,$68.00,$0.00,$68.00,$0.00,$48.53,$0.00,$0.00,$48.53,$48.53,$0.00,$68.00,$0.00,$34.00,$53.86,$54.40,$0.00,$0.00,$0.00,$0.00,$0.00
27011254,EAP,Custom 27011254,,Tube Feeding Ng 8fr 36in Entr,$64.00,$0.00,$64.00,$0.00,$45.68,$0.00,$0.00,$45.68,$45.68,$0.00,$64.00,$0.00,$32.00,$50.69,$51.20,$0.00,$0.00,$0.00,$0.00,$0.00
27011255,EAP,Custom 27011255,,Tube Gastrostomy 18fr,$80.00,$0.00,$80.00,$0.00,$57.10,$0.00,$0.00,$57.10,$57.10,$0.00,$80.00,$0.00,$40.00,$63.36,$64.00,$0.00,$0.00,$0.00,$0.00,$0.00
27011256,EAP,Custom 27011256,,Tube Gastrostomy 22fr,$76.00,$0.00,$76.00,$0.00,$54.24,$0.00,$0.00,$54.24,$54.24,$0.00,$76.00,$0.00,$38.00,$60.19,$60.80,$0.00,$0.00,$0.00,$0.00,$0.00
27011257,EAP,Custom 27011257,,Tube Jejunal Feeding 18 Fr O.d,$300.00,$0.00,$300.00,$0.00,$214.11,$0.00,$0.00,$214.11,$214.11,$0.00,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$0.00,$0.00,$0.00,$0.00
27011258,EAP,Custom 27011258,,Tube Jejunostomy Feed 14 Fr,$501.00,$0.00,$501.00,$0.00,$357.56,$0.00,$0.00,$357.56,$357.56,$0.00,$501.00,$0.00,$250.50,$396.79,$400.80,$0.00,$0.00,$0.00,$0.00,$0.00
27011259,EAP,Custom 27011259,,Tube Salem Silicone Size,$39.00,$0.00,$39.00,$0.00,$27.83,$0.00,$0.00,$27.83,$27.83,$0.00,$39.00,$0.00,$19.50,$30.89,$31.20,$0.00,$0.00,$0.00,$0.00,$0.00
27011260,EAP,Custom 27011260,,Tube Salem Sump 48 Lengt,$39.00,$0.00,$39.00,$0.00,$27.83,$0.00,$0.00,$27.83,$27.83,$0.00,$39.00,$0.00,$19.50,$30.89,$31.20,$0.00,$0.00,$0.00,$0.00,$0.00
27011261,EAP,Custom 27011261,,Tube Tj Feeding 18 Fr 45cm End,$651.00,$0.00,$651.00,$0.00,$464.62,$0.00,$0.00,$464.62,$464.62,$0.00,$651.00,$0.00,$325.50,$515.59,$520.80,$0.00,$0.00,$0.00,$0.00,$0.00
27011262,EAP,Custom 27011262,,Tube Tj Feeding 22 Fr 45cm End,$651.00,$0.00,$651.00,$0.00,$464.62,$0.00,$0.00,$464.62,$464.62,$0.00,$651.00,$0.00,$325.50,$515.59,$520.80,$0.00,$0.00,$0.00,$0.00,$0.00
27011263,EAP,Custom 27011263,,Tubes Extension Plain Pla,$15.00,$0.00,$15.00,$0.00,$10.71,$0.00,$0.00,$10.71,$10.71,$0.00,$15.00,$0.00,$7.50,$11.88,$12.00,$0.00,$0.00,$0.00,$0.00,$0.00
27011265,EAP,Custom 27011265,,Tubes Extension Plain Pla,$15.00,$0.00,$15.00,$0.00,$10.71,$0.00,$0.00,$10.71,$10.71,$0.00,$15.00,$0.00,$7.50,$11.88,$12.00,$0.00,$0.00,$0.00,$0.00,$0.00
27011266,EAP,Custom 27011266,,Tubes Salem Sump 48 Leng,$39.00,$0.00,$39.00,$0.00,$27.83,$0.00,$0.00,$27.83,$27.83,$0.00,$39.00,$0.00,$19.50,$30.89,$31.20,$0.00,$0.00,$0.00,$0.00,$0.00
27011267,EAP,Custom 27011267,,Ultrasound Probe Covers,$46.00,$0.00,$46.00,$0.00,$32.83,$0.00,$0.00,$32.83,$32.83,$0.00,$46.00,$0.00,$23.00,$36.43,$36.80,$0.00,$0.00,$0.00,$0.00,$0.00
27011268,EAP,Custom 27011268,,Valve Reflux,$10.00,$0.00,$10.00,$0.00,$7.14,$0.00,$0.00,$7.14,$7.14,$0.00,$10.00,$0.00,$5.00,$7.92,$8.00,$0.00,$0.00,$0.00,$0.00,$0.00
27011269,EAP,Custom 27011269,,Valve Reflux,$10.00,$0.00,$10.00,$0.00,$7.14,$0.00,$0.00,$7.14,$7.14,$0.00,$10.00,$0.00,$5.00,$7.92,$8.00,$0.00,$0.00,$0.00,$0.00,$0.00
27011270,EAP,Custom 27011270,,.014 Nitrex Guidewire,"$1,219.00",$0.00,"$1,219.00",$0.00,$870.00,$0.00,$0.00,$870.00,$870.00,$0.00,"$1,219.00",$0.00,$609.50,$965.45,$975.20,$0.00,$0.00,$0.00,$0.00,$0.00
27011301,EAP,Custom 27011301,,Drsg Anti Sft Sil 8x20 20x50cm,$248.00,$0.00,$248.00,$0.00,$177.00,$0.00,$0.00,$177.00,$177.00,$0.00,$248.00,$0.00,$124.00,$196.42,$198.40,$0.00,$0.00,$0.00,$0.00,$0.00
27011302,EAP,Custom 27011302,,Drsg Anti Sft Sil 8x20 20x50cm,$248.00,$0.00,$248.00,$0.00,$177.00,$0.00,$0.00,$177.00,$177.00,$0.00,$248.00,$0.00,$124.00,$196.42,$198.40,$0.00,$0.00,$0.00,$0.00,$0.00
27011304,EAP,Custom 27011304,,Blood Administration Set,$111.00,$0.00,$111.00,$0.00,$79.22,$0.00,$0.00,$79.22,$79.22,$0.00,$111.00,$0.00,$55.50,$87.91,$88.80,$0.00,$0.00,$0.00,$0.00,$0.00
27011305,EAP,Custom 27011305,,Drsng Anti Sft Sil 6x6 15x15cm,$63.00,$0.00,$63.00,$0.00,$44.96,$0.00,$0.00,$44.96,$44.96,$0.00,$63.00,$0.00,$31.50,$49.90,$50.40,$0.00,$0.00,$0.00,$0.00,$0.00
27011306,EAP,Custom 27011306,,Drsng Anti Sft Sil 6x6 15x15cm,$63.00,$0.00,$63.00,$0.00,$44.96,$0.00,$0.00,$44.96,$44.96,$0.00,$63.00,$0.00,$31.50,$49.90,$50.40,$0.00,$0.00,$0.00,$0.00,$0.00
27011308,EAP,Custom 27011308,,Drsng Anti Sft Sil 4x4 10x10cm,$28.00,$0.00,$28.00,$0.00,$19.98,$0.00,$0.00,$19.98,$19.98,$0.00,$28.00,$0.00,$14.00,$22.18,$22.40,$0.00,$0.00,$0.00,$0.00,$0.00
27011309,EAP,Custom 27011309,,Drsng Anti Sft Sil 4x4 10x10cm,$28.00,$0.00,$28.00,$0.00,$19.98,$0.00,$0.00,$19.98,$19.98,$0.00,$28.00,$0.00,$14.00,$22.18,$22.40,$0.00,$0.00,$0.00,$0.00,$0.00
27011310,EAP,HCPCS C1769,,Volcano Combowire,"$3,669.00",$0.00,"$3,669.00","$1,992.27","$2,618.57",$0.00,$632.15,"$2,618.57","$2,618.57",$642.41,"$3,669.00",$0.00,"$1,834.50","$2,905.85","$2,935.20",$0.00,$574.20,$0.00,$584.10,$0.00
27011320,EAP,Custom 27011320,,Tubes Salem Sump 48 Leng,$38.00,$0.00,$38.00,$0.00,$27.12,$0.00,$0.00,$27.12,$27.12,$0.00,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
27011323,EAP,Custom 27011323,,Jcd 9.0-38-20,$42.00,$0.00,$42.00,$0.00,$29.98,$0.00,$0.00,$29.98,$29.98,$0.00,$42.00,$0.00,$21.00,$33.26,$33.60,$0.00,$0.00,$0.00,$0.00,$0.00
27011324,EAP,Custom 27011324,,Jcd 6.0-38-20,$167.00,$0.00,$167.00,$0.00,$119.19,$0.00,$0.00,$119.19,$119.19,$0.00,$167.00,$0.00,$83.50,$132.26,$133.60,$0.00,$0.00,$0.00,$0.00,$0.00
27011325,EAP,Custom 27011325,,Tube Salem Sump 48 Lengt,$38.00,$0.00,$38.00,$0.00,$27.12,$0.00,$0.00,$27.12,$27.12,$0.00,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
27011326,EAP,Custom 27011326,,Tubes Salem Sump 48 Leng,$38.00,$0.00,$38.00,$0.00,$27.12,$0.00,$0.00,$27.12,$27.12,$0.00,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
27011327,EAP,Custom 27011327,,Jcd 9.0-38-20,$42.00,$0.00,$42.00,$0.00,$29.98,$0.00,$0.00,$29.98,$29.98,$0.00,$42.00,$0.00,$21.00,$33.26,$33.60,$0.00,$0.00,$0.00,$0.00,$0.00
27011328,EAP,Custom 27011328,,Jcd 6.0-38-20,$40.00,$0.00,$40.00,$0.00,$28.55,$0.00,$0.00,$28.55,$28.55,$0.00,$40.00,$0.00,$20.00,$31.68,$32.00,$0.00,$0.00,$0.00,$0.00,$0.00
27011401,EAP,Custom 27011401,,Super Arrow Flex Introducer -,$251.00,$0.00,$251.00,$0.00,$179.14,$0.00,$0.00,$179.14,$179.14,$0.00,$251.00,$0.00,$125.50,$198.79,$200.80,$0.00,$0.00,$0.00,$0.00,$0.00
27011410,EAP,Custom 27011410,,Tube Trach #8 Dct,$131.00,$0.00,$131.00,$0.00,$93.49,$0.00,$0.00,$93.49,$93.49,$0.00,$131.00,$0.00,$65.50,$103.75,$104.80,$0.00,$0.00,$0.00,$0.00,$0.00
27011411,EAP,Custom 27011411,,Tube Trache 8-dcfs,$126.00,$0.00,$126.00,$0.00,$89.93,$0.00,$0.00,$89.93,$89.93,$0.00,$126.00,$0.00,$63.00,$99.79,$100.80,$0.00,$0.00,$0.00,$0.00,$0.00
27011413,EAP,Custom 27011413,,Bag Resusitator Adult,$38.00,$0.00,$38.00,$0.00,$27.12,$0.00,$0.00,$27.12,$27.12,$0.00,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
27011421,EAP,Custom 27011421,,Blade On Titanium Lopro S3,$95.00,$0.00,$95.00,$0.00,$67.80,$0.00,$0.00,$67.80,$67.80,$0.00,$95.00,$0.00,$47.50,$75.24,$76.00,$0.00,$0.00,$0.00,$0.00,$0.00
27011422,EAP,Custom 27011422,,Blade On Titanium Lopro S4,$95.00,$0.00,$95.00,$0.00,$67.80,$0.00,$0.00,$67.80,$67.80,$0.00,$95.00,$0.00,$47.50,$75.24,$76.00,$0.00,$0.00,$0.00,$0.00,$0.00
27011423,EAP,Custom 27011423,,Kit 135cm 2.7fr 20mm Img 1 Syr Rapex Tip Radiopq,"$1,875.00",$0.00,"$1,875.00",$0.00,"$1,338.19",$0.00,$0.00,"$1,338.19","$1,338.19",$0.00,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$0.00,$0.00,$0.00,$0.00
27011425,EAP,Custom 27011425,,Mic Transgastric Jejunal Feeding Kit 18f 45cm,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$356.85,$356.85,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
27011426,EAP,HCPCS C1729,,Catheter Urethral 16fr Foley 2,$224.00,$0.00,$224.00,$121.63,$159.87,$0.00,$38.59,$159.87,$159.87,$39.22,$224.00,$0.00,$112.00,$177.41,$179.20,$0.00,$35.06,$0.00,$35.66,$0.00
27011427,EAP,HCPCS A4649,,Medihoney Dressing 1.5oz Tube,$28.00,$0.00,$28.00,$15.20,$19.98,$0.00,$4.82,$19.98,$19.98,$4.90,$28.00,$0.00,$14.00,$22.18,$22.40,$0.00,$4.38,$0.00,$4.46,$0.00
27011428,EAP,,,Tube Gstrm 12fr 10cm 5-7ml Entuit Bln Rtnt,$90.00,$0.00,$90.00,$0.00,$64.23,$0.00,$0.00,$64.23,$64.23,$0.00,$90.00,$0.00,$45.00,$71.28,$72.00,$0.00,$0.00,$0.00,$0.00,$0.00
27011429,EAP,,,Tube Fd Std 14fr 10cm 5ml Entuit Thrive Bln Rtnt Sm Gstrm,$90.00,$0.00,$90.00,$0.00,$64.23,$0.00,$0.00,$64.23,$64.23,$0.00,$90.00,$0.00,$45.00,$71.28,$72.00,$0.00,$0.00,$0.00,$0.00,$0.00
27011430,EAP,,,Tube Fd Std 16fr 10cm 5ml Entuit Thrive Bln Rtnt Med Gstrm,$90.00,$0.00,$90.00,$0.00,$64.23,$0.00,$0.00,$64.23,$64.23,$0.00,$90.00,$0.00,$45.00,$71.28,$72.00,$0.00,$0.00,$0.00,$0.00,$0.00
27011431,EAP,,,Tube Gstrm Std 18fr 10cm 5ml 60ml Entuit Thrive Bln Rtnt,$90.00,$0.00,$90.00,$0.00,$64.23,$0.00,$0.00,$64.23,$64.23,$0.00,$90.00,$0.00,$45.00,$71.28,$72.00,$0.00,$0.00,$0.00,$0.00,$0.00
27011432,EAP,,,Tube Fd Std 20fr 10cm 20ml Entuit Thrive Bln Rtnt Lg Gstrm,$90.00,$0.00,$90.00,$0.00,$64.23,$0.00,$0.00,$64.23,$64.23,$0.00,$90.00,$0.00,$45.00,$71.28,$72.00,$0.00,$0.00,$0.00,$0.00,$0.00
27011433,EAP,,,Tube Fd Std 22fr 10cm 20ml Entuit Thrive Bln Rtnt Lg Gstrm,$90.00,$0.00,$90.00,$0.00,$64.23,$0.00,$0.00,$64.23,$64.23,$0.00,$90.00,$0.00,$45.00,$71.28,$72.00,$0.00,$0.00,$0.00,$0.00,$0.00
27011434,EAP,,,Tube Fd Std 24fr 10cm 20ml Entuit Thrive Bln Rtnt Lg Gstrm,$90.00,$0.00,$90.00,$0.00,$64.23,$0.00,$0.00,$64.23,$64.23,$0.00,$90.00,$0.00,$45.00,$71.28,$72.00,$0.00,$0.00,$0.00,$0.00,$0.00
27011435,EAP,,,Kit Tracheostomy 12.3mm 9mm Complete Set Inner Cannu,"$1,255.00",$0.00,"$1,255.00",$0.00,$895.69,$0.00,$0.00,$895.69,$895.69,$0.00,"$1,255.00",$0.00,$627.50,$993.96,"$1,004.00",$0.00,$0.00,$0.00,$0.00,$0.00
27011436,EAP,,,Kit Crntmy 25ga 5/8in Strl Rzr Ndl Drp,$701.00,$0.00,$701.00,$0.00,$500.30,$0.00,$0.00,$500.30,$500.30,$0.00,$701.00,$0.00,$350.50,$555.19,$560.80,$0.00,$0.00,$0.00,$0.00,$0.00
27011437,EAP,Custom 27011437,,Blanket Wrm 84x36in Clr Strl Lf 24x48in 3m Br Hgr Full Acc,$63.00,$0.00,$63.00,$0.00,$44.96,$0.00,$0.00,$44.96,$44.96,$0.00,$63.00,$0.00,$31.50,$49.90,$50.40,$0.00,$0.00,$0.00,$0.00,$0.00
27100021,EAP,Custom 27100021,,Pad Gel Hypo-hyperthermia Large,"$2,481.00",$0.00,"$2,481.00",$0.00,"$1,770.69",$0.00,$0.00,"$1,770.69","$1,770.69",$0.00,"$2,481.00",$0.00,"$1,240.50","$1,964.95","$1,984.80",$0.00,$0.00,$0.00,$0.00,$0.00
27100022,EAP,HCPCS A4467,,POSTERIOR ELBOW SPLINT,$112.00,$0.00,$112.00,$0.00,$79.93,$0.00,$0.00,$79.93,$79.93,$0.00,$112.00,$0.00,$56.00,$88.70,$89.60,$0.00,$0.00,$0.00,$0.00,$0.00
27100023,EAP,Custom 27100023,,Mölnlycke Z-flo Fluidized Positioner Pad,$122.00,$0.00,$122.00,$0.00,$87.07,$0.00,$0.00,$87.07,$87.07,$0.00,$122.00,$0.00,$61.00,$96.62,$97.60,$0.00,$0.00,$0.00,$0.00,$0.00
27100031,EAP,Custom 27100031,,Resuscitator Manual Medium 10f,$27.00,$0.00,$27.00,$0.00,$19.27,$0.00,$0.00,$19.27,$19.27,$0.00,$27.00,$0.00,$13.50,$21.38,$21.60,$0.00,$0.00,$0.00,$0.00,$0.00
27100040,EAP,,,Sup Ortho Universal Abd Binder Velcro Closure,$538.00,$0.00,$538.00,$0.00,$383.97,$0.00,$0.00,$383.97,$383.97,$0.00,$538.00,$0.00,$269.00,$426.10,$430.40,$0.00,$0.00,$0.00,$0.00,$0.00
27200003,EAP,Custom 27200003,,Chest Unit Drainage Pleur,$76.00,$0.00,$76.00,$0.00,$54.24,$0.00,$0.00,$54.24,$54.24,$0.00,$76.00,$0.00,$38.00,$60.19,$60.80,$0.00,$0.00,$0.00,$0.00,$0.00
27200008,EAP,HCPCS C1769,,.014 Nitrex Guidewire,"$1,295.00",$0.00,"$1,295.00",$703.19,$924.24,$0.00,$223.12,$924.24,$924.24,$226.74,"$1,295.00",$0.00,$647.50,"$1,025.64","$1,036.00",$0.00,$202.67,$0.00,$206.16,$0.00
27200011,EAP,HCPCS C1729,,Catheter Foley 16fr,$18.00,$0.00,$18.00,$9.77,$12.85,$0.00,$3.10,$12.85,$12.85,$3.15,$18.00,$0.00,$9.00,$14.26,$14.40,$0.00,$2.82,$0.00,$2.87,$0.00
27200019,EAP,HCPCS C1729,,Catheter Foley 5cc 14fr,$6.00,$0.00,$6.00,$3.26,$4.28,$0.00,$1.03,$4.28,$4.28,$1.05,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.94,$0.00,$0.96,$0.00
27200021,EAP,HCPCS C1729,,Catheter Foley 30cc 28fr,$36.00,$0.00,$36.00,$19.55,$25.69,$0.00,$6.20,$25.69,$25.69,$6.30,$36.00,$0.00,$18.00,$28.51,$28.80,$0.00,$5.63,$0.00,$5.73,$0.00
27200024,EAP,HCPCS C1729,,Catheter Foley 3cc 10 Fr,$34.00,$0.00,$34.00,$18.46,$24.27,$0.00,$5.86,$24.27,$24.27,$5.95,$34.00,$0.00,$17.00,$26.93,$27.20,$0.00,$5.32,$0.00,$5.41,$0.00
27200025,EAP,HCPCS C1729,,Catheter Foley 5cc 12fr,$19.00,$0.00,$19.00,$10.32,$13.56,$0.00,$3.27,$13.56,$13.56,$3.33,$19.00,$0.00,$9.50,$15.05,$15.20,$0.00,$2.97,$0.00,$3.02,$0.00
27200026,EAP,Custom 27200026,,Dress Sofsorb Absorb Buttoc Sm,$64.00,$0.00,$64.00,$0.00,$45.68,$0.00,$0.00,$45.68,$45.68,$0.00,$64.00,$0.00,$32.00,$50.69,$51.20,$0.00,$0.00,$0.00,$0.00,$0.00
27200027,EAP,Custom 27200027,,Dress Sofsorb Absorb Butto Lg,$97.00,$0.00,$97.00,$0.00,$69.23,$0.00,$0.00,$69.23,$69.23,$0.00,$97.00,$0.00,$48.50,$76.82,$77.60,$0.00,$0.00,$0.00,$0.00,$0.00
27200028,EAP,Custom 27200028,,Dress Sofsorb Absorb Chest Ssm,$41.00,$0.00,$41.00,$0.00,$29.26,$0.00,$0.00,$29.26,$29.26,$0.00,$41.00,$0.00,$20.50,$32.47,$32.80,$0.00,$0.00,$0.00,$0.00,$0.00
27200029,EAP,Custom 27200029,,Dress Sofsorb Absors Chest Ilg,$41.00,$0.00,$41.00,$0.00,$29.26,$0.00,$0.00,$29.26,$29.26,$0.00,$41.00,$0.00,$20.50,$32.47,$32.80,$0.00,$0.00,$0.00,$0.00,$0.00
27200030,EAP,Custom 27200030,,Dress Sofsorb Absorb Xl Chest,$40.00,$0.00,$40.00,$0.00,$28.55,$0.00,$0.00,$28.55,$28.55,$0.00,$40.00,$0.00,$20.00,$31.68,$32.00,$0.00,$0.00,$0.00,$0.00,$0.00
27200031,EAP,Custom 27200031,,Dressing Leg/hip Adult,$87.00,$0.00,$87.00,$0.00,$62.09,$0.00,$0.00,$62.09,$62.09,$0.00,$87.00,$0.00,$43.50,$68.90,$69.60,$0.00,$0.00,$0.00,$0.00,$0.00
27200032,EAP,Custom 27200032,,Dressing Burn Gauze 17 Ply 36',$40.00,$0.00,$40.00,$0.00,$28.55,$0.00,$0.00,$28.55,$28.55,$0.00,$40.00,$0.00,$20.00,$31.68,$32.00,$0.00,$0.00,$0.00,$0.00,$0.00
27200033,EAP,HCPCS C1751,,Kit Cath Triple Lumen 5.5 Pedi,$159.00,$0.00,$159.00,$86.34,$113.48,$0.00,$27.39,$113.48,$113.48,$27.84,$159.00,$0.00,$79.50,$125.93,$127.20,$0.00,$24.88,$0.00,$25.31,$0.00
27200035,EAP,HCPCS C1751,,Femoral Arterial Line Cath Kit,$873.00,$0.00,$873.00,$474.04,$623.06,$0.00,$150.41,$623.06,$623.06,$152.86,$873.00,$0.00,$436.50,$691.42,$698.40,$0.00,$136.62,$0.00,$138.98,$0.00
27200040,EAP,Custom 27200040,,Kit Transducer Monitoring,$145.00,$0.00,$145.00,$0.00,$103.49,$0.00,$0.00,$103.49,$103.49,$0.00,$145.00,$0.00,$72.50,$114.84,$116.00,$0.00,$0.00,$0.00,$0.00,$0.00
27200041,EAP,Custom 27200041,,Kit  Pressure Monitoring,$108.00,$0.00,$108.00,$0.00,$77.08,$0.00,$0.00,$77.08,$77.08,$0.00,$108.00,$0.00,$54.00,$85.54,$86.40,$0.00,$0.00,$0.00,$0.00,$0.00
27200043,EAP,HCPCS C1729,,Catheter Foley 16fr,$6.00,$0.00,$6.00,$3.26,$4.28,$0.00,$1.03,$4.28,$4.28,$1.05,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.94,$0.00,$0.96,$0.00
27200045,EAP,Custom 27200045,,Paracentesis Tray,$214.00,$0.00,$214.00,$0.00,$152.73,$0.00,$0.00,$152.73,$152.73,$0.00,$214.00,$0.00,$107.00,$169.49,$171.20,$0.00,$0.00,$0.00,$0.00,$0.00
27200047,EAP,Custom 27200047,,Biliary Plastic Stents,"$1,091.00",$0.00,"$1,091.00",$0.00,$778.65,$0.00,$0.00,$778.65,$778.65,$0.00,"$1,091.00",$0.00,$545.50,$864.07,$872.80,$0.00,$0.00,$0.00,$0.00,$0.00
27200048,EAP,HCPCS C1769,,Hydratomes Rx Cannulating Sphi,"$3,556.00",$0.00,"$3,556.00","$1,930.91","$2,537.92",$0.00,$612.68,"$2,537.92","$2,537.92",$622.63,"$3,556.00",$0.00,"$1,778.00","$2,816.35","$2,844.80",$0.00,$556.51,$0.00,$566.12,$0.00
27200049,EAP,HCPCS C1769,,Jagtomes Rx Cannulating Sphinc,"$1,255.00",$0.00,"$1,255.00",$681.47,$895.69,$0.00,$216.23,$895.69,$895.69,$219.74,"$1,255.00",$0.00,$627.50,$993.96,"$1,004.00",$0.00,$196.41,$0.00,$199.80,$0.00
27200050,EAP,Custom 27200050,,Extractor Balloon,"$1,388.00",$0.00,"$1,388.00",$0.00,$990.62,$0.00,$0.00,$990.62,$990.62,$0.00,"$1,388.00",$0.00,$694.00,"$1,099.30","$1,110.40",$0.00,$0.00,$0.00,$0.00,$0.00
27200051,EAP,Custom 27200051,,Trapezoid Retrieval Baskets,"$2,263.00",$0.00,"$2,263.00",$0.00,"$1,615.10",$0.00,$0.00,"$1,615.10","$1,615.10",$0.00,"$2,263.00",$0.00,"$1,131.50","$1,792.30","$1,810.40",$0.00,$0.00,$0.00,$0.00,$0.00
27200052,EAP,Custom 27200052,,Endoprosthesis Metal Stent,"$9,693.00",$0.00,"$9,693.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$9,693.00",$0.00,"$4,846.50","$7,676.86","$7,754.40",$0.00,$0.00,$0.00,$0.00,$0.00
27200053,EAP,Custom 27200053,,Esophageal Stent,"$11,672.00",$0.00,"$11,672.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$11,672.00",$0.00,"$5,836.00","$9,244.22","$9,337.60",$0.00,$0.00,$0.00,$0.00,$0.00
27200054,EAP,Custom 27200054,,Colonic And Duodenal Stent,"$16,179.00",$0.00,"$16,179.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$16,179.00",$0.00,"$8,089.50","$12,813.77","$12,943.20",$0.00,$0.00,$0.00,$0.00,$0.00
27200055,EAP,HCPCS C1726,,Cre Balloons,"$1,523.00",$0.00,"$1,523.00",$826.99,"$1,086.97",$0.00,$262.41,"$1,086.97","$1,086.97",$266.67,"$1,523.00",$0.00,$761.50,"$1,206.22","$1,218.40",$0.00,$238.35,$0.00,$242.46,$0.00
27200056,EAP,Custom 27200056,,Esophageal/pyloric Balloon Dil,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,"$1,248.98","$1,248.98",$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
27200057,EAP,Custom 27200057,,Esophageal/pyloric/colonic  Ba,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,"$1,248.98","$1,248.98",$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
27200058,EAP,Custom 27200058,,O2 Supply-each,$59.00,$0.00,$59.00,$0.00,$42.11,$0.00,$0.00,$42.11,$42.11,$0.00,$59.00,$0.00,$29.50,$46.73,$47.20,$0.00,$0.00,$0.00,$0.00,$0.00
27200060,EAP,Custom 27200060,,Venous Port - Maintenance,$184.00,$0.00,$184.00,$0.00,$131.32,$0.00,$0.00,$131.32,$131.32,$0.00,$184.00,$0.00,$92.00,$145.73,$147.20,$0.00,$0.00,$0.00,$0.00,$0.00
27200061,EAP,Custom 27200061,,Dressing,$42.00,$0.00,$42.00,$0.00,$29.98,$0.00,$0.00,$29.98,$29.98,$0.00,$42.00,$0.00,$21.00,$33.26,$33.60,$0.00,$0.00,$0.00,$0.00,$0.00
27200062,EAP,Custom 27200062,,"Dressing, Burn Supplies",$206.00,$0.00,$206.00,$0.00,$147.02,$0.00,$0.00,$147.02,$147.02,$0.00,$206.00,$0.00,$103.00,$163.15,$164.80,$0.00,$0.00,$0.00,$0.00,$0.00
27200063,EAP,Custom 27200063,,Iv Start Supply,$228.00,$0.00,$228.00,$0.00,$162.72,$0.00,$0.00,$162.72,$162.72,$0.00,$228.00,$0.00,$114.00,$180.58,$182.40,$0.00,$0.00,$0.00,$0.00,$0.00
27200064,EAP,Custom 27200064,,"Dressing, Burn Supplies",$193.00,$0.00,$193.00,$0.00,$137.74,$0.00,$0.00,$137.74,$137.74,$0.00,$193.00,$0.00,$96.50,$152.86,$154.40,$0.00,$0.00,$0.00,$0.00,$0.00
27200065,EAP,Custom 27200065,,Splint Supply,$64.00,$0.00,$64.00,$0.00,$45.68,$0.00,$0.00,$45.68,$45.68,$0.00,$64.00,$0.00,$32.00,$50.69,$51.20,$0.00,$0.00,$0.00,$0.00,$0.00
27200066,EAP,Custom 27200066,,Nephrostomy Bag,$299.00,$0.00,$299.00,$0.00,$213.40,$0.00,$0.00,$213.40,$213.40,$0.00,$299.00,$0.00,$149.50,$236.81,$239.20,$0.00,$0.00,$0.00,$0.00,$0.00
27200067,EAP,Custom 27200067,,Dressing Change,$64.00,$0.00,$64.00,$0.00,$45.68,$0.00,$0.00,$45.68,$45.68,$0.00,$64.00,$0.00,$32.00,$50.69,$51.20,$0.00,$0.00,$0.00,$0.00,$0.00
27200068,EAP,HCPCS C1729,,Catheter Foley,$34.00,$0.00,$34.00,$18.46,$24.27,$0.00,$5.86,$24.27,$24.27,$5.95,$34.00,$0.00,$17.00,$26.93,$27.20,$0.00,$5.32,$0.00,$5.41,$0.00
27200069,EAP,Custom 27200069,,Leg Bag,$34.00,$0.00,$34.00,$0.00,$24.27,$0.00,$0.00,$24.27,$24.27,$0.00,$34.00,$0.00,$17.00,$26.93,$27.20,$0.00,$0.00,$0.00,$0.00,$0.00
27200070,EAP,Custom 27200070,,Urinary Drainage Bag,$47.00,$0.00,$47.00,$0.00,$33.54,$0.00,$0.00,$33.54,$33.54,$0.00,$47.00,$0.00,$23.50,$37.22,$37.60,$0.00,$0.00,$0.00,$0.00,$0.00
27200074,EAP,Custom 27200074,,Acticoat Dressing,$315.00,$0.00,$315.00,$0.00,$224.82,$0.00,$0.00,$224.82,$224.82,$0.00,$315.00,$0.00,$157.50,$249.48,$252.00,$0.00,$0.00,$0.00,$0.00,$0.00
27200075,EAP,Custom 27200075,,Feeding/ng Tube,$19.00,$0.00,$19.00,$0.00,$13.56,$0.00,$0.00,$13.56,$13.56,$0.00,$19.00,$0.00,$9.50,$15.05,$15.20,$0.00,$0.00,$0.00,$0.00,$0.00
27200076,EAP,Custom 27200076,,Triple Lumen Cath,$222.00,$0.00,$222.00,$0.00,$158.44,$0.00,$0.00,$158.44,$158.44,$0.00,$222.00,$0.00,$111.00,$175.82,$177.60,$0.00,$0.00,$0.00,$0.00,$0.00
27200077,EAP,Custom 27200077,,Transvenous Pacing Electrode,$389.00,$0.00,$389.00,$0.00,$277.63,$0.00,$0.00,$277.63,$277.63,$0.00,$389.00,$0.00,$194.50,$308.09,$311.20,$0.00,$0.00,$0.00,$0.00,$0.00
27200080,EAP,Custom 27200080,,"Injection, Iv, Antibiotic",$214.00,$0.00,$214.00,$0.00,$152.73,$0.00,$0.00,$152.73,$152.73,$0.00,$214.00,$0.00,$107.00,$169.49,$171.20,$0.00,$0.00,$0.00,$0.00,$0.00
27200081,EAP,Custom 27200081,,"Steroid Injection, Iv Supply",$192.00,$0.00,$192.00,$0.00,$137.03,$0.00,$0.00,$137.03,$137.03,$0.00,$192.00,$0.00,$96.00,$152.06,$153.60,$0.00,$0.00,$0.00,$0.00,$0.00
27200082,EAP,Custom 27200082,,"Iv Start, Supply",$228.00,$0.00,$228.00,$0.00,$162.72,$0.00,$0.00,$162.72,$162.72,$0.00,$228.00,$0.00,$114.00,$180.58,$182.40,$0.00,$0.00,$0.00,$0.00,$0.00
27200084,EAP,Custom 27200084,,Emerg Infus Catheter,$264.00,$0.00,$264.00,$0.00,$188.42,$0.00,$0.00,$188.42,$188.42,$0.00,$264.00,$0.00,$132.00,$209.09,$211.20,$0.00,$0.00,$0.00,$0.00,$0.00
27200085,EAP,Custom 27200085,,"Ett, Laser",$897.00,$0.00,$897.00,$0.00,$640.19,$0.00,$0.00,$640.19,$640.19,$0.00,$897.00,$0.00,$448.50,$710.42,$717.60,$0.00,$0.00,$0.00,$0.00,$0.00
27200086,EAP,Custom 27200086,,"Ett, Rae",$118.00,$0.00,$118.00,$0.00,$84.22,$0.00,$0.00,$84.22,$84.22,$0.00,$118.00,$0.00,$59.00,$93.46,$94.40,$0.00,$0.00,$0.00,$0.00,$0.00
27200087,EAP,Custom 27200087,,"Ett, Wire Reinf",$362.00,$0.00,$362.00,$0.00,$258.36,$0.00,$0.00,$258.36,$258.36,$0.00,$362.00,$0.00,$181.00,$286.70,$289.60,$0.00,$0.00,$0.00,$0.00,$0.00
27200088,EAP,Custom 27200088,,"Ett, Endotrol/mlt",$138.00,$0.00,$138.00,$0.00,$98.49,$0.00,$0.00,$98.49,$98.49,$0.00,$138.00,$0.00,$69.00,$109.30,$110.40,$0.00,$0.00,$0.00,$0.00,$0.00
27200090,EAP,Custom 27200090,,"Cvp Kit, Single Lumen",$238.00,$0.00,$238.00,$0.00,$169.86,$0.00,$0.00,$169.86,$169.86,$0.00,$238.00,$0.00,$119.00,$188.50,$190.40,$0.00,$0.00,$0.00,$0.00,$0.00
27200091,EAP,HCPCS C1756,,Swan Paceport Cath,$666.00,$0.00,$666.00,$0.00,$475.32,$0.00,$0.00,$475.32,$475.32,$0.00,$666.00,$0.00,$333.00,$527.47,$532.80,$0.00,$0.00,$0.00,$0.00,$0.00
27200092,EAP,HCPCS C1751,,Cvp Kit Triple Lumen,$569.00,$0.00,$569.00,$308.97,$406.10,$0.00,$98.04,$406.10,$406.10,$99.63,$569.00,$0.00,$284.50,$450.65,$455.20,$0.00,$89.05,$0.00,$90.58,$0.00
27200093,EAP,HCPCS C1756,,Swan Ganz Cath-bipolar Pacing,"$1,225.00",$0.00,"$1,225.00",$0.00,$874.28,$0.00,$0.00,$874.28,$874.28,$0.00,"$1,225.00",$0.00,$612.50,$970.20,$980.00,$0.00,$0.00,$0.00,$0.00,$0.00
27200094,EAP,HCPCS C1756,,Swan Pacing Td,"$2,409.00",$0.00,"$2,409.00",$0.00,"$1,719.30",$0.00,$0.00,"$1,719.30","$1,719.30",$0.00,"$2,409.00",$0.00,"$1,204.50","$1,907.93","$1,927.20",$0.00,$0.00,$0.00,$0.00,$0.00
27200096,EAP,Custom 27200096,,Adult Iv Set-up,$26.00,$0.00,$26.00,$0.00,$18.56,$0.00,$0.00,$18.56,$18.56,$0.00,$26.00,$0.00,$13.00,$20.59,$20.80,$0.00,$0.00,$0.00,$0.00,$0.00
27200097,EAP,Custom 27200097,,"Ett, Endotrol/mlt",$60.00,$0.00,$60.00,$0.00,$42.82,$0.00,$0.00,$42.82,$42.82,$0.00,$60.00,$0.00,$30.00,$47.52,$48.00,$0.00,$0.00,$0.00,$0.00,$0.00
27200098,EAP,Custom 27200098,,"Cvp Kit, Single Lumen",$238.00,$0.00,$238.00,$0.00,$169.86,$0.00,$0.00,$169.86,$169.86,$0.00,$238.00,$0.00,$119.00,$188.50,$190.40,$0.00,$0.00,$0.00,$0.00,$0.00
27200099,EAP,HCPCS C1756,,Swan Paceport Cath,$634.00,$0.00,$634.00,$0.00,$452.49,$0.00,$0.00,$452.49,$452.49,$0.00,$634.00,$0.00,$317.00,$502.13,$507.20,$0.00,$0.00,$0.00,$0.00,$0.00
27200100,EAP,Custom 27200100,,Cvp Kit Triple Lumen,$141.00,$0.00,$141.00,$0.00,$100.63,$0.00,$0.00,$100.63,$100.63,$0.00,$141.00,$0.00,$70.50,$111.67,$112.80,$0.00,$0.00,$0.00,$0.00,$0.00
27200101,EAP,HCPCS C1756,,Swan Bipolar,"$1,225.00",$0.00,"$1,225.00",$0.00,$874.28,$0.00,$0.00,$874.28,$874.28,$0.00,"$1,225.00",$0.00,$612.50,$970.20,$980.00,$0.00,$0.00,$0.00,$0.00,$0.00
27200102,EAP,HCPCS C1756,,Swan Pacing Td,"$2,409.00",$0.00,"$2,409.00",$0.00,"$1,719.30",$0.00,$0.00,"$1,719.30","$1,719.30",$0.00,"$2,409.00",$0.00,"$1,204.50","$1,907.93","$1,927.20",$0.00,$0.00,$0.00,$0.00,$0.00
27200104,EAP,HCPCS C1729,,Catheter Foley 30cc 28fr,$37.00,$0.00,$37.00,$20.09,$26.41,$0.00,$6.37,$26.41,$26.41,$6.48,$37.00,$0.00,$18.50,$29.30,$29.60,$0.00,$5.79,$0.00,$5.89,$0.00
27200107,EAP,HCPCS L8680,,Implt Neurostim Elctr Each,"$1,605.00",$0.00,"$1,605.00",$0.00,"$1,145.49",$0.00,$0.00,"$1,145.49","$1,145.49",$0.00,"$1,605.00",$0.00,$802.50,"$1,271.16","$1,284.00",$0.00,$0.00,$0.00,$0.00,$0.00
27200108,EAP,Custom 27200108,,Regional Nerve Block Tray,$88.00,$0.00,$88.00,$0.00,$62.81,$0.00,$0.00,$62.81,$62.81,$0.00,$88.00,$0.00,$44.00,$69.70,$70.40,$0.00,$0.00,$0.00,$0.00,$0.00
27200109,EAP,Custom 27200109,,Epidural Tray,$160.00,$0.00,$160.00,$0.00,$114.19,$0.00,$0.00,$114.19,$114.19,$0.00,$160.00,$0.00,$80.00,$126.72,$128.00,$0.00,$0.00,$0.00,$0.00,$0.00
27200110,EAP,Custom 27200110,,Insulated Block Needle,$46.00,$0.00,$46.00,$0.00,$32.83,$0.00,$0.00,$32.83,$32.83,$0.00,$46.00,$0.00,$23.00,$36.43,$36.80,$0.00,$0.00,$0.00,$0.00,$0.00
27200111,EAP,Custom 27200111,,O2 Therapy-ea 8 Hrs,$296.00,$0.00,$296.00,$0.00,$211.26,$0.00,$0.00,$211.26,$211.26,$0.00,$296.00,$0.00,$148.00,$234.43,$236.80,$0.00,$0.00,$0.00,$0.00,$0.00
27200113,EAP,Custom 27200113,,Peak Flow Meter,$487.00,$0.00,$487.00,$0.00,$347.57,$0.00,$0.00,$347.57,$347.57,$0.00,$487.00,$0.00,$243.50,$385.70,$389.60,$0.00,$0.00,$0.00,$0.00,$0.00
27200114,EAP,Custom 27200114,,Heart Nebulizer,$440.00,$0.00,$440.00,$0.00,$314.03,$0.00,$0.00,$314.03,$314.03,$0.00,$440.00,$0.00,$220.00,$348.48,$352.00,$0.00,$0.00,$0.00,$0.00,$0.00
27200115,EAP,Custom 27200115,,Mini Heart,$424.00,$0.00,$424.00,$0.00,$302.61,$0.00,$0.00,$302.61,$302.61,$0.00,$424.00,$0.00,$212.00,$335.81,$339.20,$0.00,$0.00,$0.00,$0.00,$0.00
27200116,EAP,Custom 27200116,,Mdi Spacer,$192.00,$0.00,$192.00,$0.00,$137.03,$0.00,$0.00,$137.03,$137.03,$0.00,$192.00,$0.00,$96.00,$152.06,$153.60,$0.00,$0.00,$0.00,$0.00,$0.00
27200117,EAP,Custom 27200117,,Inc Spir-disposable,$319.00,$0.00,$319.00,$0.00,$227.67,$0.00,$0.00,$227.67,$227.67,$0.00,$319.00,$0.00,$159.50,$252.65,$255.20,$0.00,$0.00,$0.00,$0.00,$0.00
27200118,EAP,Custom 27200118,,Inner Cannula,$134.00,$0.00,$134.00,$0.00,$95.64,$0.00,$0.00,$95.64,$95.64,$0.00,$134.00,$0.00,$67.00,$106.13,$107.20,$0.00,$0.00,$0.00,$0.00,$0.00
27200119,EAP,Custom 27200119,,Nasal Prongs,$26.00,$0.00,$26.00,$0.00,$18.56,$0.00,$0.00,$18.56,$18.56,$0.00,$26.00,$0.00,$13.00,$20.59,$20.80,$0.00,$0.00,$0.00,$0.00,$0.00
27200120,EAP,Custom 27200120,,Vent Kit Only,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$356.85,$356.85,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
27200124,EAP,Custom 27200124,,Meter Astech Peak Flow,$49.00,$0.00,$49.00,$0.00,$34.97,$0.00,$0.00,$34.97,$34.97,$0.00,$49.00,$0.00,$24.50,$38.81,$39.20,$0.00,$0.00,$0.00,$0.00,$0.00
27200125,EAP,Custom 27200125,,Sleep Apnea Supply Kit,"$1,443.00",$0.00,"$1,443.00",$0.00,"$1,029.87",$0.00,$0.00,"$1,029.87","$1,029.87",$0.00,"$1,443.00",$0.00,$721.50,"$1,142.86","$1,154.40",$0.00,$0.00,$0.00,$0.00,$0.00
27200126,EAP,Custom 27200126,,Tracheostomy-pipe Cleaner,$84.00,$0.00,$84.00,$0.00,$59.95,$0.00,$0.00,$59.95,$59.95,$0.00,$84.00,$0.00,$42.00,$66.53,$67.20,$0.00,$0.00,$0.00,$0.00,$0.00
27200128,EAP,Custom 27200128,,Tube Trach #8 Dct,$377.00,$0.00,$377.00,$0.00,$269.06,$0.00,$0.00,$269.06,$269.06,$0.00,$377.00,$0.00,$188.50,$298.58,$301.60,$0.00,$0.00,$0.00,$0.00,$0.00
27200129,EAP,Custom 27200129,,Tube Trach #6 Dct,$377.00,$0.00,$377.00,$0.00,$269.06,$0.00,$0.00,$269.06,$269.06,$0.00,$377.00,$0.00,$188.50,$298.58,$301.60,$0.00,$0.00,$0.00,$0.00,$0.00
27200130,EAP,Custom 27200130,,Tube Trach #10 Dct,$335.00,$0.00,$335.00,$0.00,$239.09,$0.00,$0.00,$239.09,$239.09,$0.00,$335.00,$0.00,$167.50,$265.32,$268.00,$0.00,$0.00,$0.00,$0.00,$0.00
27200131,EAP,Custom 27200131,,Tube Tracheostomy 4-dcfs,$342.00,$0.00,$342.00,$0.00,$244.09,$0.00,$0.00,$244.09,$244.09,$0.00,$342.00,$0.00,$171.00,$270.86,$273.60,$0.00,$0.00,$0.00,$0.00,$0.00
27200132,EAP,Custom 27200132,,Tube Tracheostomy 8-dcfs,$326.00,$0.00,$326.00,$0.00,$232.67,$0.00,$0.00,$232.67,$232.67,$0.00,$326.00,$0.00,$163.00,$258.19,$260.80,$0.00,$0.00,$0.00,$0.00,$0.00
27200133,EAP,Custom 27200133,,Mini Bal-broncho-alveolar Lava,$10.00,$0.00,$10.00,$0.00,$7.14,$0.00,$0.00,$7.14,$7.14,$0.00,$10.00,$0.00,$5.00,$7.92,$8.00,$0.00,$0.00,$0.00,$0.00,$0.00
27200134,EAP,Custom 27200134,,Cont Oxy Hood-pediatrics,$866.00,$0.00,$866.00,$0.00,$618.06,$0.00,$0.00,$618.06,$618.06,$0.00,$866.00,$0.00,$433.00,$685.87,$692.80,$0.00,$0.00,$0.00,$0.00,$0.00
27200135,EAP,Custom 27200135,,He-ox Rx Airway Obs + Supply,$947.00,$0.00,$947.00,$0.00,$675.87,$0.00,$0.00,$675.87,$675.87,$0.00,$947.00,$0.00,$473.50,$750.02,$757.60,$0.00,$0.00,$0.00,$0.00,$0.00
27200136,EAP,Custom 27200136,,Trach Tube/passy Muir,$554.00,$0.00,$554.00,$0.00,$395.39,$0.00,$0.00,$395.39,$395.39,$0.00,$554.00,$0.00,$277.00,$438.77,$443.20,$0.00,$0.00,$0.00,$0.00,$0.00
27200137,EAP,Custom 27200137,,Intubation Specialty Tube,"$1,545.00",$0.00,"$1,545.00",$0.00,"$1,102.67",$0.00,$0.00,"$1,102.67","$1,102.67",$0.00,"$1,545.00",$0.00,$772.50,"$1,223.64","$1,236.00",$0.00,$0.00,$0.00,$0.00,$0.00
27200138,EAP,Custom 27200138,,Pulse Oximetry Sensor,$292.00,$0.00,$292.00,$0.00,$208.40,$0.00,$0.00,$208.40,$208.40,$0.00,$292.00,$0.00,$146.00,$231.26,$233.60,$0.00,$0.00,$0.00,$0.00,$0.00
27200139,EAP,Custom 27200139,,Vent Circuit Kit,$423.00,$0.00,$423.00,$0.00,$301.90,$0.00,$0.00,$301.90,$301.90,$0.00,$423.00,$0.00,$211.50,$335.02,$338.40,$0.00,$0.00,$0.00,$0.00,$0.00
27200140,EAP,Custom 27200140,,Specialty Vent Circuit Kit,$990.00,$0.00,$990.00,$0.00,$706.56,$0.00,$0.00,$706.56,$706.56,$0.00,$990.00,$0.00,$495.00,$784.08,$792.00,$0.00,$0.00,$0.00,$0.00,$0.00
27200143,EAP,Custom 27200143,,Blood Gas Kit,$112.00,$0.00,$112.00,$0.00,$79.93,$0.00,$0.00,$79.93,$79.93,$0.00,$112.00,$0.00,$56.00,$88.70,$89.60,$0.00,$0.00,$0.00,$0.00,$0.00
27200144,EAP,HCPCS C1729,,Red Rubber Catheter,$54.00,$0.00,$54.00,$29.32,$38.54,$0.00,$9.30,$38.54,$38.54,$9.45,$54.00,$0.00,$27.00,$42.77,$43.20,$0.00,$8.45,$0.00,$8.60,$0.00
27200145,EAP,Custom 27200145,,Air Vest-disposable,$675.00,$0.00,$675.00,$0.00,$481.75,$0.00,$0.00,$481.75,$481.75,$0.00,$675.00,$0.00,$337.50,$534.60,$540.00,$0.00,$0.00,$0.00,$0.00,$0.00
27200148,EAP,Custom 27200148,,"Iv Start, Supply",$65.00,$0.00,$65.00,$0.00,$46.39,$0.00,$0.00,$46.39,$46.39,$0.00,$65.00,$0.00,$32.50,$51.48,$52.00,$0.00,$0.00,$0.00,$0.00,$0.00
27200149,EAP,HCPCS C1769,,Guidewire:pressurewire:radi,"$2,511.00",$0.00,"$2,511.00","$1,363.47","$1,792.10",$0.00,$432.63,"$1,792.10","$1,792.10",$439.66,"$2,511.00",$0.00,"$1,255.50","$1,988.71","$2,008.80",$0.00,$392.97,$0.00,$399.75,$0.00
27200150,EAP,Custom 27200150,,Pericardiocentesis Kit,$591.00,$0.00,$591.00,$0.00,$421.80,$0.00,$0.00,$421.80,$421.80,$0.00,$591.00,$0.00,$295.50,$468.07,$472.80,$0.00,$0.00,$0.00,$0.00,$0.00
27200151,EAP,HCPCS C1769,,Choice Pt X-support Guidewire,$605.00,$0.00,$605.00,$328.52,$431.79,$0.00,$104.24,$431.79,$431.79,$105.93,$605.00,$0.00,$302.50,$479.16,$484.00,$0.00,$94.68,$0.00,$96.32,$0.00
27200152,EAP,HCPCS C1769,,Choice Pt Guidewire,$605.00,$0.00,$605.00,$328.52,$431.79,$0.00,$104.24,$431.79,$431.79,$105.93,$605.00,$0.00,$302.50,$479.16,$484.00,$0.00,$94.68,$0.00,$96.32,$0.00
27200153,EAP,HCPCS C1769,,Glidewire .035 150cm  Angled,$118.00,$0.00,$118.00,$64.07,$84.22,$0.00,$20.33,$84.22,$84.22,$20.66,$118.00,$0.00,$59.00,$93.46,$94.40,$0.00,$18.47,$0.00,$18.79,$0.00
27200154,EAP,HCPCS C1892,,Custom Left Heart Kit W/transd,$69.00,$0.00,$69.00,$37.47,$49.25,$0.00,$11.89,$49.25,$49.25,$12.08,$69.00,$0.00,$34.50,$54.65,$55.20,$0.00,$10.80,$0.00,$10.98,$0.00
27200155,EAP,HCPCS C1892,,Custom Right Heart Kit W/trans,$47.00,$0.00,$47.00,$25.52,$33.54,$0.00,$8.10,$33.54,$33.54,$8.23,$47.00,$0.00,$23.50,$37.22,$37.60,$0.00,$7.36,$0.00,$7.48,$0.00
27200156,EAP,HCPCS C2629,,Micropuncture Set,$102.00,$0.00,$102.00,$55.39,$72.80,$0.00,$17.57,$72.80,$72.80,$17.86,$102.00,$0.00,$51.00,$80.78,$81.60,$0.00,$15.96,$0.00,$16.24,$0.00
27200157,EAP,HCPCS C1769,,.025 X 260CM 7CM EMERALD GUIDEWIRE,$21.00,$0.00,$21.00,$11.40,$14.99,$0.00,$3.62,$14.99,$14.99,$3.68,$21.00,$0.00,$10.50,$16.63,$16.80,$0.00,$3.29,$0.00,$3.34,$0.00
27200158,EAP,HCPCS C1887,,6fr Al 1 St Guiding Cath,$199.00,$0.00,$199.00,$108.06,$142.03,$0.00,$34.29,$142.03,$142.03,$34.84,$199.00,$0.00,$99.50,$157.61,$159.20,$0.00,$31.14,$0.00,$31.68,$0.00
27200159,EAP,HCPCS C1887,,6fr Ar 2 Guiding Cath,$199.00,$0.00,$199.00,$108.06,$142.03,$0.00,$34.29,$142.03,$142.03,$34.84,$199.00,$0.00,$99.50,$157.61,$159.20,$0.00,$31.14,$0.00,$31.68,$0.00
27200160,EAP,HCPCS C1894,,6fr - 10cm  Avanti + Sheath In,$34.00,$0.00,$34.00,$18.46,$24.27,$0.00,$5.86,$24.27,$24.27,$5.95,$34.00,$0.00,$17.00,$26.93,$27.20,$0.00,$5.32,$0.00,$5.41,$0.00
27200161,EAP,HCPCS C1887,,6fr Jl4 St Guiding Cath,$199.00,$0.00,$199.00,$108.06,$142.03,$0.00,$34.29,$142.03,$142.03,$34.84,$199.00,$0.00,$99.50,$157.61,$159.20,$0.00,$31.14,$0.00,$31.68,$0.00
27200162,EAP,HCPCS C1887,,6fr Mpa-1 Guiding Cath,$189.00,$0.00,$189.00,$102.63,$134.89,$0.00,$32.56,$134.89,$134.89,$33.09,$189.00,$0.00,$94.50,$149.69,$151.20,$0.00,$29.58,$0.00,$30.09,$0.00
27200163,EAP,HCPCS C1887,,6ft Jr 4 St Guiding Cath,$199.00,$0.00,$199.00,$108.06,$142.03,$0.00,$34.29,$142.03,$142.03,$34.84,$199.00,$0.00,$99.50,$157.61,$159.20,$0.00,$31.14,$0.00,$31.68,$0.00
27200164,EAP,HCPCS C1887,,7fr Ar 1 Guiding Cath,$161.00,$0.00,$161.00,$87.42,$114.91,$0.00,$27.74,$114.91,$114.91,$28.19,$161.00,$0.00,$80.50,$127.51,$128.80,$0.00,$25.20,$0.00,$25.63,$0.00
27200165,EAP,HCPCS C1887,,7fr Jr 3.5 Guiding Cath,$180.00,$0.00,$180.00,$97.74,$128.47,$0.00,$31.01,$128.47,$128.47,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
27200166,EAP,HCPCS C1887,,7fr H-stick Guiding Cath,$180.00,$0.00,$180.00,$97.74,$128.47,$0.00,$31.01,$128.47,$128.47,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
27200167,EAP,HCPCS C1887,,7fr Jl5 Guiding Cath,$161.00,$0.00,$161.00,$87.42,$114.91,$0.00,$27.74,$114.91,$114.91,$28.19,$161.00,$0.00,$80.50,$127.51,$128.80,$0.00,$25.20,$0.00,$25.63,$0.00
27200168,EAP,HCPCS C1887,,7fr Jr 4 St Guiding Cath,$199.00,$0.00,$199.00,$108.06,$142.03,$0.00,$34.29,$142.03,$142.03,$34.84,$199.00,$0.00,$99.50,$157.61,$159.20,$0.00,$31.14,$0.00,$31.68,$0.00
27200169,EAP,HCPCS C1887,,7fr Jr 5 Guiding Cath,$161.00,$0.00,$161.00,$87.42,$114.91,$0.00,$27.74,$114.91,$114.91,$28.19,$161.00,$0.00,$80.50,$127.51,$128.80,$0.00,$25.20,$0.00,$25.63,$0.00
27200170,EAP,HCPCS C1887,,7fr Mpa-1 Guiding Cath,$161.00,$0.00,$161.00,$87.42,$114.91,$0.00,$27.74,$114.91,$114.91,$28.19,$161.00,$0.00,$80.50,$127.51,$128.80,$0.00,$25.20,$0.00,$25.63,$0.00
27200171,EAP,HCPCS C1887,,7fr Xb 3.5 Guiding Cath,$199.00,$0.00,$199.00,$108.06,$142.03,$0.00,$34.29,$142.03,$142.03,$34.84,$199.00,$0.00,$99.50,$157.61,$159.20,$0.00,$31.14,$0.00,$31.68,$0.00
27200172,EAP,HCPCS C1887,,7fr Xb 3.0 Guiding Cath,$199.00,$0.00,$199.00,$108.06,$142.03,$0.00,$34.29,$142.03,$142.03,$34.84,$199.00,$0.00,$99.50,$157.61,$159.20,$0.00,$31.14,$0.00,$31.68,$0.00
27200173,EAP,HCPCS C1887,,7fr Al 1 St Guiding Cath,$199.00,$0.00,$199.00,$108.06,$142.03,$0.00,$34.29,$142.03,$142.03,$34.84,$199.00,$0.00,$99.50,$157.61,$159.20,$0.00,$31.14,$0.00,$31.68,$0.00
27200174,EAP,HCPCS C1887,,7fr Al 2 Guiding Cath,$161.00,$0.00,$161.00,$87.42,$114.91,$0.00,$27.74,$114.91,$114.91,$28.19,$161.00,$0.00,$80.50,$127.51,$128.80,$0.00,$25.20,$0.00,$25.63,$0.00
27200175,EAP,HCPCS C1887,,7fr Jr 4 Guiding Cath,$161.00,$0.00,$161.00,$87.42,$114.91,$0.00,$27.74,$114.91,$114.91,$28.19,$161.00,$0.00,$80.50,$127.51,$128.80,$0.00,$25.20,$0.00,$25.63,$0.00
27200176,EAP,HCPCS C1887,,7fr Im Guiding Cath,$180.00,$0.00,$180.00,$97.74,$128.47,$0.00,$31.01,$128.47,$128.47,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
27200177,EAP,HCPCS C1887,,6fr Ar 1 Guiding Cath,$161.00,$0.00,$161.00,$87.42,$114.91,$0.00,$27.74,$114.91,$114.91,$28.19,$161.00,$0.00,$80.50,$127.51,$128.80,$0.00,$25.20,$0.00,$25.63,$0.00
27200178,EAP,HCPCS C1887,,6fr Jl4 Sh Guiding Cath,$161.00,$0.00,$161.00,$87.42,$114.91,$0.00,$27.74,$114.91,$114.91,$28.19,$161.00,$0.00,$80.50,$127.51,$128.80,$0.00,$25.20,$0.00,$25.63,$0.00
27200179,EAP,HCPCS C1887,,6fr Jr 4 Sh Guiding Cath,$161.00,$0.00,$161.00,$87.42,$114.91,$0.00,$27.74,$114.91,$114.91,$28.19,$161.00,$0.00,$80.50,$127.51,$128.80,$0.00,$25.20,$0.00,$25.63,$0.00
27200180,EAP,HCPCS C1769,,.035 X 260CM 3CM  EMERALD GUIDEWIRE,$22.00,$0.00,$22.00,$11.95,$15.70,$0.00,$3.79,$15.70,$15.70,$3.85,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.44,$0.00,$3.50,$0.00
27200181,EAP,HCPCS C1887,,6fr Xb 3 Sh Guiding Cath,$199.00,$0.00,$199.00,$108.06,$142.03,$0.00,$34.29,$142.03,$142.03,$34.84,$199.00,$0.00,$99.50,$157.61,$159.20,$0.00,$31.14,$0.00,$31.68,$0.00
27200182,EAP,HCPCS C1887,,7fr Xb 3.5 Sh Guilding Cath,$199.00,$0.00,$199.00,$108.06,$142.03,$0.00,$34.29,$142.03,$142.03,$34.84,$199.00,$0.00,$99.50,$157.61,$159.20,$0.00,$31.14,$0.00,$31.68,$0.00
27200183,EAP,HCPCS C1887,,6fr Xb 3.5 Sh Guiding Cath,$199.00,$0.00,$199.00,$108.06,$142.03,$0.00,$34.29,$142.03,$142.03,$34.84,$199.00,$0.00,$99.50,$157.61,$159.20,$0.00,$31.14,$0.00,$31.68,$0.00
27200184,EAP,HCPCS C1769,,.035 X 150CM 3CM EMERALD GUIDEWIRE,$22.00,$0.00,$22.00,$11.95,$15.70,$0.00,$3.79,$15.70,$15.70,$3.85,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.44,$0.00,$3.50,$0.00
27200185,EAP,HCPCS C1887,,7fr Jl4 Guiding Cath,$161.00,$0.00,$161.00,$87.42,$114.91,$0.00,$27.74,$114.91,$114.91,$28.19,$161.00,$0.00,$80.50,$127.51,$128.80,$0.00,$25.20,$0.00,$25.63,$0.00
27200186,EAP,HCPCS C1887,,7fr Jl4 Sh Guiding Cath,$161.00,$0.00,$161.00,$87.42,$114.91,$0.00,$27.74,$114.91,$114.91,$28.19,$161.00,$0.00,$80.50,$127.51,$128.80,$0.00,$25.20,$0.00,$25.63,$0.00
27200187,EAP,HCPCS C1887,,7fr Xb 4.0 Guiding Cath,$199.00,$0.00,$199.00,$108.06,$142.03,$0.00,$34.29,$142.03,$142.03,$34.84,$199.00,$0.00,$99.50,$157.61,$159.20,$0.00,$31.14,$0.00,$31.68,$0.00
27200188,EAP,HCPCS C1887,,7fr Jr 4 Sh Guiding Cath,$161.00,$0.00,$161.00,$87.42,$114.91,$0.00,$27.74,$114.91,$114.91,$28.19,$161.00,$0.00,$80.50,$127.51,$128.80,$0.00,$25.20,$0.00,$25.63,$0.00
27200189,EAP,HCPCS C1887,,7fr Ar 1 Sh Guiding Cath,$180.00,$0.00,$180.00,$97.74,$128.47,$0.00,$31.01,$128.47,$128.47,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
27200190,EAP,HCPCS C1887,,6fr Al 1 Guiding Cath,$161.00,$0.00,$161.00,$87.42,$114.91,$0.00,$27.74,$114.91,$114.91,$28.19,$161.00,$0.00,$80.50,$127.51,$128.80,$0.00,$25.20,$0.00,$25.63,$0.00
27200191,EAP,HCPCS C1887,,6fr Xb 4.0 Guiding Cath,$199.00,$0.00,$199.00,$108.06,$142.03,$0.00,$34.29,$142.03,$142.03,$34.84,$199.00,$0.00,$99.50,$157.61,$159.20,$0.00,$31.14,$0.00,$31.68,$0.00
27200192,EAP,HCPCS C1887,,7fr Al 1 Guiding Cath,$161.00,$0.00,$161.00,$87.42,$114.91,$0.00,$27.74,$114.91,$114.91,$28.19,$161.00,$0.00,$80.50,$127.51,$128.80,$0.00,$25.20,$0.00,$25.63,$0.00
27200193,EAP,HCPCS C1887,,6fr Jl4 Guiding Cath,$161.00,$0.00,$161.00,$87.42,$114.91,$0.00,$27.74,$114.91,$114.91,$28.19,$161.00,$0.00,$80.50,$127.51,$128.80,$0.00,$25.20,$0.00,$25.63,$0.00
27200194,EAP,HCPCS C1887,,6fr Jr 4 Guiding Cath,$189.00,$0.00,$189.00,$102.63,$134.89,$0.00,$32.56,$134.89,$134.89,$33.09,$189.00,$0.00,$94.50,$149.69,$151.20,$0.00,$29.58,$0.00,$30.09,$0.00
27200195,EAP,HCPCS C1887,,6fr Xb 3 Guiding Cath,$199.00,$0.00,$199.00,$108.06,$142.03,$0.00,$34.29,$142.03,$142.03,$34.84,$199.00,$0.00,$99.50,$157.61,$159.20,$0.00,$31.14,$0.00,$31.68,$0.00
27200196,EAP,HCPCS C1887,,6fr Xb 3.5 Guiding Cath,$199.00,$0.00,$199.00,$108.06,$142.03,$0.00,$34.29,$142.03,$142.03,$34.84,$199.00,$0.00,$99.50,$157.61,$159.20,$0.00,$31.14,$0.00,$31.68,$0.00
27200197,EAP,HCPCS C1887,,6fr H-stick Guiding Cath,$161.00,$0.00,$161.00,$87.42,$114.91,$0.00,$27.74,$114.91,$114.91,$28.19,$161.00,$0.00,$80.50,$127.51,$128.80,$0.00,$25.20,$0.00,$25.63,$0.00
27200198,EAP,HCPCS C1887,,6fr Jl3.5 Guiding Cath,$180.00,$0.00,$180.00,$97.74,$128.47,$0.00,$31.01,$128.47,$128.47,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
27200199,EAP,HCPCS C1887,,6fr Jr 3.5 Guiding Cath,$161.00,$0.00,$161.00,$87.42,$114.91,$0.00,$27.74,$114.91,$114.91,$28.19,$161.00,$0.00,$80.50,$127.51,$128.80,$0.00,$25.20,$0.00,$25.63,$0.00
27200200,EAP,HCPCS C1887,,6fr Al .75 Guiding Cath,$161.00,$0.00,$161.00,$87.42,$114.91,$0.00,$27.74,$114.91,$114.91,$28.19,$161.00,$0.00,$80.50,$127.51,$128.80,$0.00,$25.20,$0.00,$25.63,$0.00
27200201,EAP,HCPCS C1887,,7fr Al .75 Guiding Cath,$161.00,$0.00,$161.00,$87.42,$114.91,$0.00,$27.74,$114.91,$114.91,$28.19,$161.00,$0.00,$80.50,$127.51,$128.80,$0.00,$25.20,$0.00,$25.63,$0.00
27200202,EAP,HCPCS C1894,,7fr - 10cm Avanti + Sheath Int,$34.00,$0.00,$34.00,$18.46,$24.27,$0.00,$5.86,$24.27,$24.27,$5.95,$34.00,$0.00,$17.00,$26.93,$27.20,$0.00,$5.32,$0.00,$5.41,$0.00
27200203,EAP,HCPCS C1894,,8fr - 10cm Avanti + Sheath Int,$34.00,$0.00,$34.00,$18.46,$24.27,$0.00,$5.86,$24.27,$24.27,$5.95,$34.00,$0.00,$17.00,$26.93,$27.20,$0.00,$5.32,$0.00,$5.41,$0.00
27200204,EAP,HCPCS C1769,,.025 X 150cm Emerald Guidewire,$21.00,$0.00,$21.00,$11.40,$14.99,$0.00,$3.62,$14.99,$14.99,$3.68,$21.00,$0.00,$10.50,$16.63,$16.80,$0.00,$3.29,$0.00,$3.34,$0.00
27200205,EAP,HCPCS C1769,,300cm Balanced Middleweight (b,$288.00,$0.00,$288.00,$156.38,$205.55,$0.00,$49.62,$205.55,$205.55,$50.43,$288.00,$0.00,$144.00,$228.10,$230.40,$0.00,$45.07,$0.00,$45.85,$0.00
27200206,EAP,HCPCS C1769,,Amplatz Guidewire Super Stiff,$87.00,$0.00,$87.00,$47.24,$62.09,$0.00,$14.99,$62.09,$62.09,$15.23,$87.00,$0.00,$43.50,$68.90,$69.60,$0.00,$13.62,$0.00,$13.85,$0.00
27200207,EAP,HCPCS C1751,,7fr-100cm Swan-ganz Td Cathete,$189.00,$0.00,$189.00,$102.63,$134.89,$0.00,$32.56,$134.89,$134.89,$33.09,$189.00,$0.00,$94.50,$149.69,$151.20,$0.00,$29.58,$0.00,$30.09,$0.00
27200208,EAP,HCPCS C1894,,5fr - 10cm Avanti+sheath Intro,$34.00,$0.00,$34.00,$18.46,$24.27,$0.00,$5.86,$24.27,$24.27,$5.95,$34.00,$0.00,$17.00,$26.93,$27.20,$0.00,$5.32,$0.00,$5.41,$0.00
27200209,EAP,HCPCS C1887,,7fr Jl4 St Guiding Cath,$161.00,$0.00,$161.00,$87.42,$114.91,$0.00,$27.74,$114.91,$114.91,$28.19,$161.00,$0.00,$80.50,$127.51,$128.80,$0.00,$25.20,$0.00,$25.63,$0.00
27200214,EAP,HCPCS C1884,,Filter Wire Ex-300cm,"$5,361.00",$0.00,"$5,361.00","$2,911.02","$3,826.15",$0.00,$923.67,"$3,826.15","$3,826.15",$938.67,"$5,361.00",$0.00,"$2,680.50","$4,245.91","$4,288.80",$0.00,$839.00,$0.00,$853.47,$0.00
27200215,EAP,HCPCS C1727,,2.50 X 15mm Cutting Balloon,"$2,869.00",$0.00,"$2,869.00",$0.00,"$2,047.61",$0.00,$0.00,"$2,047.61","$2,047.61",$0.00,"$2,869.00",$0.00,"$1,434.50","$2,272.25","$2,295.20",$0.00,$0.00,$0.00,$0.00,$0.00
27200216,EAP,HCPCS C1727,,2.50 X 10cm Cutting Balloon,"$2,869.00",$0.00,"$2,869.00",$0.00,"$2,047.61",$0.00,$0.00,"$2,047.61","$2,047.61",$0.00,"$2,869.00",$0.00,"$1,434.50","$2,272.25","$2,295.20",$0.00,$0.00,$0.00,$0.00,$0.00
27200218,EAP,HCPCS C1757,,.014-145cm Export Catheter,"$1,865.00",$0.00,"$1,865.00",$0.00,"$1,331.05",$0.00,$0.00,"$1,331.05","$1,331.05",$0.00,"$1,865.00",$0.00,$932.50,"$1,477.08","$1,492.00",$0.00,$0.00,$0.00,$0.00,$0.00
27200219,EAP,HCPCS C1756,,Temporary Pace Eletrode Cathet,$591.00,$0.00,$591.00,$0.00,$421.80,$0.00,$0.00,$421.80,$421.80,$0.00,$591.00,$0.00,$295.50,$468.07,$472.80,$0.00,$0.00,$0.00,$0.00,$0.00
27200220,EAP,HCPCS C1727,,"Balloon Cutting Ultra Tube, 2.","$2,574.00",$0.00,"$2,574.00",$0.00,"$1,837.06",$0.00,$0.00,"$1,837.06","$1,837.06",$0.00,"$2,574.00",$0.00,"$1,287.00","$2,038.61","$2,059.20",$0.00,$0.00,$0.00,$0.00,$0.00
27200226,EAP,HCPCS C1725,,4.00 X 15mm Voyager Rx Balloon,$699.00,$0.00,$699.00,$379.56,$498.88,$0.00,$120.43,$498.88,$498.88,$122.39,$699.00,$0.00,$349.50,$553.61,$559.20,$0.00,$109.39,$0.00,$111.28,$0.00
27200227,EAP,HCPCS C1769,,190cm All-star Guidewire,$288.00,$0.00,$288.00,$156.38,$205.55,$0.00,$49.62,$205.55,$205.55,$50.43,$288.00,$0.00,$144.00,$228.10,$230.40,$0.00,$45.07,$0.00,$45.85,$0.00
27200228,EAP,HCPCS C1769,,Choice X-support Guidewire,$605.00,$0.00,$605.00,$328.52,$431.79,$0.00,$104.24,$431.79,$431.79,$105.93,$605.00,$0.00,$302.50,$479.16,$484.00,$0.00,$94.68,$0.00,$96.32,$0.00
27200229,EAP,HCPCS C1769,,Choice Standard Guidewire,$605.00,$0.00,$605.00,$328.52,$431.79,$0.00,$104.24,$431.79,$431.79,$105.93,$605.00,$0.00,$302.50,$479.16,$484.00,$0.00,$94.68,$0.00,$96.32,$0.00
27200230,EAP,HCPCS C1887,,7fr Xb 3.0 Sh Guiding Cath,$199.00,$0.00,$199.00,$108.06,$142.03,$0.00,$34.29,$142.03,$142.03,$34.84,$199.00,$0.00,$99.50,$157.61,$159.20,$0.00,$31.14,$0.00,$31.68,$0.00
27200231,EAP,HCPCS C1887,,6fr Al 2 Guiding Cath,$161.00,$0.00,$161.00,$87.42,$114.91,$0.00,$27.74,$114.91,$114.91,$28.19,$161.00,$0.00,$80.50,$127.51,$128.80,$0.00,$25.20,$0.00,$25.63,$0.00
27200238,EAP,HCPCS C1887,,7fr Ar 2 Guiding Cath,$180.00,$0.00,$180.00,$97.74,$128.47,$0.00,$31.01,$128.47,$128.47,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
27200239,EAP,HCPCS C1887,,7fr Jl3.5 Guiding Cath,$180.00,$0.00,$180.00,$97.74,$128.47,$0.00,$31.01,$128.47,$128.47,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
27200247,EAP,HCPCS C1887,,7fr Lcb Guiding Cath,$199.00,$0.00,$199.00,$108.06,$142.03,$0.00,$34.29,$142.03,$142.03,$34.84,$199.00,$0.00,$99.50,$157.61,$159.20,$0.00,$31.14,$0.00,$31.68,$0.00
27200248,EAP,HCPCS C1887,,7fr Jr 4 Guiding Cath,$161.00,$0.00,$161.00,$87.42,$114.91,$0.00,$27.74,$114.91,$114.91,$28.19,$161.00,$0.00,$80.50,$127.51,$128.80,$0.00,$25.20,$0.00,$25.63,$0.00
27200249,EAP,HCPCS C1887,,7fr Ar 1 Guiding Cath,$161.00,$0.00,$161.00,$87.42,$114.91,$0.00,$27.74,$114.91,$114.91,$28.19,$161.00,$0.00,$80.50,$127.51,$128.80,$0.00,$25.20,$0.00,$25.63,$0.00
27200250,EAP,HCPCS C1769,,"Glide Wire,.035 Straight",$112.00,$0.00,$112.00,$60.82,$79.93,$0.00,$19.30,$79.93,$79.93,$19.61,$112.00,$0.00,$56.00,$88.70,$89.60,$0.00,$17.53,$0.00,$17.83,$0.00
27200251,EAP,HCPCS C1887,,6fr Mpa- 1 Guiding Cath,$180.00,$0.00,$180.00,$97.74,$128.47,$0.00,$31.01,$128.47,$128.47,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
27200252,EAP,HCPCS C1769,,190cm J Tip Bmw Guidewire,$348.00,$0.00,$348.00,$188.96,$248.37,$0.00,$59.96,$248.37,$248.37,$60.93,$348.00,$0.00,$174.00,$275.62,$278.40,$0.00,$54.46,$0.00,$55.40,$0.00
27200253,EAP,HCPCS C1726,,12frx28mmx70cm Inoue Balloon,"$19,725.00",$0.00,"$19,725.00","$10,710.68","$5,158.80",$0.00,"$3,398.52","$5,158.80","$5,158.80","$3,453.69","$19,725.00",$0.00,"$9,862.50","$15,622.20","$15,780.00",$0.00,"$3,086.96",$0.00,"$3,140.22",$0.00
27200254,EAP,HCPCS C1887,,6fr H Stick Sh Guiding Cathete,$161.00,$0.00,$161.00,$87.42,$114.91,$0.00,$27.74,$114.91,$114.91,$28.19,$161.00,$0.00,$80.50,$127.51,$128.80,$0.00,$25.20,$0.00,$25.63,$0.00
27200255,EAP,HCPCS C1887,,6fr Al 1 Sh Guiding Catheter,$161.00,$0.00,$161.00,$87.42,$114.91,$0.00,$27.74,$114.91,$114.91,$28.19,$161.00,$0.00,$80.50,$127.51,$128.80,$0.00,$25.20,$0.00,$25.63,$0.00
27200256,EAP,HCPCS C1887,,6fr Al 2 Sh Guiding Catheter,$161.00,$0.00,$161.00,$87.42,$114.91,$0.00,$27.74,$114.91,$114.91,$28.19,$161.00,$0.00,$80.50,$127.51,$128.80,$0.00,$25.20,$0.00,$25.63,$0.00
27200257,EAP,HCPCS C1725,,2.0 X 9mm Maverick Monorail,$916.00,$0.00,$916.00,$497.39,$653.75,$0.00,$157.82,$653.75,$653.75,$160.38,$916.00,$0.00,$458.00,$725.47,$732.80,$0.00,$143.35,$0.00,$145.83,$0.00
27200258,EAP,HCPCS C1725,,2.5 X 9mm Maverick Monorail,$916.00,$0.00,$916.00,$497.39,$653.75,$0.00,$157.82,$653.75,$653.75,$160.38,$916.00,$0.00,$458.00,$725.47,$732.80,$0.00,$143.35,$0.00,$145.83,$0.00
27200259,EAP,HCPCS C1725,,3.0 X 9mm Maverick Monorail,$872.00,$0.00,$872.00,$473.50,$622.35,$0.00,$150.24,$622.35,$622.35,$152.68,$872.00,$0.00,$436.00,$690.62,$697.60,$0.00,$136.47,$0.00,$138.82,$0.00
27200283,EAP,HCPCS C1769,,Hi-torque Pilot 50 Guide Wire,$302.00,$0.00,$302.00,$163.99,$215.54,$0.00,$52.03,$215.54,$215.54,$52.88,$302.00,$0.00,$151.00,$239.18,$241.60,$0.00,$47.26,$0.00,$48.08,$0.00
27200285,EAP,HCPCS C1769,,Doc Guide Wire Extension,$324.00,$0.00,$324.00,$175.93,$231.24,$0.00,$55.82,$231.24,$231.24,$56.73,$324.00,$0.00,$162.00,$256.61,$259.20,$0.00,$50.71,$0.00,$51.58,$0.00
27200292,EAP,HCPCS C1725,,1.5 X 6 Sprinter Balloon,$853.00,$0.00,$853.00,$463.18,$608.79,$0.00,$146.97,$608.79,$608.79,$149.35,$853.00,$0.00,$426.50,$675.58,$682.40,$0.00,$133.49,$0.00,$135.80,$0.00
27200294,EAP,HCPCS C1751,,7fr Wedge Pressure Cath,$153.00,$0.00,$153.00,$83.08,$109.20,$0.00,$26.36,$109.20,$109.20,$26.79,$153.00,$0.00,$76.50,$121.18,$122.40,$0.00,$23.94,$0.00,$24.36,$0.00
27200295,EAP,Custom 27200295,,Cardiac Cath Pack,$190.00,$0.00,$190.00,$0.00,$135.60,$0.00,$0.00,$135.60,$135.60,$0.00,$190.00,$0.00,$95.00,$150.48,$152.00,$0.00,$0.00,$0.00,$0.00,$0.00
27200296,EAP,Custom 27200296,,Contrast Inject Line-low Press,$7.00,$0.00,$7.00,$0.00,$5.00,$0.00,$0.00,$5.00,$5.00,$0.00,$7.00,$0.00,$3.50,$5.54,$5.60,$0.00,$0.00,$0.00,$0.00,$0.00
27200297,EAP,Custom 27200297,,Implant Tray,$212.00,$0.00,$212.00,$0.00,$151.30,$0.00,$0.00,$151.30,$151.30,$0.00,$212.00,$0.00,$106.00,$167.90,$169.60,$0.00,$0.00,$0.00,$0.00,$0.00
27200298,EAP,HCPCS C1893,,5fr - 10cm Pinnacle Introducer,$38.00,$0.00,$38.00,$20.63,$27.12,$0.00,$6.55,$27.12,$27.12,$6.65,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$5.95,$0.00,$6.05,$0.00
27200299,EAP,HCPCS C1893,,6fr - 10cm Pinnacle Introducer,$40.00,$0.00,$40.00,$21.72,$28.55,$0.00,$6.89,$28.55,$28.55,$7.00,$40.00,$0.00,$20.00,$31.68,$32.00,$0.00,$6.26,$0.00,$6.37,$0.00
27200300,EAP,HCPCS C1893,,7fr - 10cm Pinnacle Introducer,$38.00,$0.00,$38.00,$20.63,$27.12,$0.00,$6.55,$27.12,$27.12,$6.65,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$5.95,$0.00,$6.05,$0.00
27200301,EAP,HCPCS C1893,,8fr - 10cm Pinnacle Introducer,$38.00,$0.00,$38.00,$20.63,$27.12,$0.00,$6.55,$27.12,$27.12,$6.65,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$5.95,$0.00,$6.05,$0.00
27200302,EAP,HCPCS C1893,,6fr - 25cm Pinnacle Introducer,$69.00,$0.00,$69.00,$37.47,$49.25,$0.00,$11.89,$49.25,$49.25,$12.08,$69.00,$0.00,$34.50,$54.65,$55.20,$0.00,$10.80,$0.00,$10.98,$0.00
27200303,EAP,HCPCS C1893,,7fr - 25cm Pinnacle Introducer,$69.00,$0.00,$69.00,$37.47,$49.25,$0.00,$11.89,$49.25,$49.25,$12.08,$69.00,$0.00,$34.50,$54.65,$55.20,$0.00,$10.80,$0.00,$10.98,$0.00
27200304,EAP,HCPCS C1893,,8fr - 25cm Pinnacle Introducer,$69.00,$0.00,$69.00,$37.47,$49.25,$0.00,$11.89,$49.25,$49.25,$12.08,$69.00,$0.00,$34.50,$54.65,$55.20,$0.00,$10.80,$0.00,$10.98,$0.00
27200305,EAP,HCPCS C1887,,6fr Ebu 3.0 Guiding Catheter,$189.00,$0.00,$189.00,$102.63,$134.89,$0.00,$32.56,$134.89,$134.89,$33.09,$189.00,$0.00,$94.50,$149.69,$151.20,$0.00,$29.58,$0.00,$30.09,$0.00
27200306,EAP,HCPCS C1887,,6fr Ebu 3.5 Guiding Catheter,$169.00,$0.00,$169.00,$91.77,$120.62,$0.00,$29.12,$120.62,$120.62,$29.59,$169.00,$0.00,$84.50,$133.85,$135.20,$0.00,$26.45,$0.00,$26.90,$0.00
27200307,EAP,HCPCS C1887,,6fr Ebu 4.0 Guiding Catheter,$169.00,$0.00,$169.00,$91.77,$120.62,$0.00,$29.12,$120.62,$120.62,$29.59,$169.00,$0.00,$84.50,$133.85,$135.20,$0.00,$26.45,$0.00,$26.90,$0.00
27200308,EAP,HCPCS C1887,,7fr Ebu 3.0 Guiding Catheter,$161.00,$0.00,$161.00,$87.42,$114.91,$0.00,$27.74,$114.91,$114.91,$28.19,$161.00,$0.00,$80.50,$127.51,$128.80,$0.00,$25.20,$0.00,$25.63,$0.00
27200309,EAP,HCPCS C1887,,7fr Ebu 3.5 Guiding Catheter,$161.00,$0.00,$161.00,$87.42,$114.91,$0.00,$27.74,$114.91,$114.91,$28.19,$161.00,$0.00,$80.50,$127.51,$128.80,$0.00,$25.20,$0.00,$25.63,$0.00
27200310,EAP,HCPCS C1887,,7fr Ebu 4.0 Guiding Catheter,$161.00,$0.00,$161.00,$87.42,$114.91,$0.00,$27.74,$114.91,$114.91,$28.19,$161.00,$0.00,$80.50,$127.51,$128.80,$0.00,$25.20,$0.00,$25.63,$0.00
27200311,EAP,HCPCS C1887,,8fr Ebu 3.5 Guiding Catheter,$180.00,$0.00,$180.00,$97.74,$128.47,$0.00,$31.01,$128.47,$128.47,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
27200312,EAP,HCPCS C1887,,8fr Ebu 4.0 Guiding Catheter,$180.00,$0.00,$180.00,$97.74,$128.47,$0.00,$31.01,$128.47,$128.47,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
27200313,EAP,HCPCS C1727,,3.0 X 10cm Cutting Balloon Otw,$986.00,$0.00,$986.00,$0.00,$703.71,$0.00,$0.00,$703.71,$703.71,$0.00,$986.00,$0.00,$493.00,$780.91,$788.80,$0.00,$0.00,$0.00,$0.00,$0.00
27200314,EAP,HCPCS C1757,,7fr Export Xt Catheter,"$2,850.00",$0.00,"$2,850.00",$0.00,"$2,034.05",$0.00,$0.00,"$2,034.05","$2,034.05",$0.00,"$2,850.00",$0.00,"$1,425.00","$2,257.20","$2,280.00",$0.00,$0.00,$0.00,$0.00,$0.00
27200315,EAP,HCPCS C1769,,.014 - 300cm Asahi Miraclebros,$691.00,$0.00,$691.00,$375.21,$493.17,$0.00,$119.06,$493.17,$493.17,$120.99,$691.00,$0.00,$345.50,$547.27,$552.80,$0.00,$108.14,$0.00,$110.01,$0.00
27200316,EAP,HCPCS C1769,,.014 - 300cm Asahi Soft Wire,$268.00,$0.00,$268.00,$145.52,$191.27,$0.00,$46.18,$191.27,$191.27,$46.92,$268.00,$0.00,$134.00,$212.26,$214.40,$0.00,$41.94,$0.00,$42.67,$0.00
27200317,EAP,HCPCS C1769,,.014 - 300cm Whisper Ms,$331.00,$0.00,$331.00,$179.73,$236.23,$0.00,$57.03,$236.23,$236.23,$57.96,$331.00,$0.00,$165.50,$262.15,$264.80,$0.00,$51.80,$0.00,$52.70,$0.00
27200318,EAP,HCPCS C1769,,.014 - 300cm All-star Wire,$307.00,$0.00,$307.00,$166.70,$219.11,$0.00,$52.89,$219.11,$219.11,$53.75,$307.00,$0.00,$153.50,$243.14,$245.60,$0.00,$48.05,$0.00,$48.87,$0.00
27200319,EAP,HCPCS C1753,,Eagle Eye Coronary Imaging Cat,"$2,449.00",$0.00,"$2,449.00","$1,329.81","$1,747.85",$0.00,$421.95,"$1,747.85","$1,747.85",$428.80,"$2,449.00",$0.00,"$1,224.50","$1,939.61","$1,959.20",$0.00,$383.27,$0.00,$389.88,$0.00
27200320,EAP,Custom 27200320,,Primewire,"$2,332.00",$0.00,"$2,332.00",$0.00,"$1,664.35",$0.00,$0.00,"$1,664.35","$1,664.35",$0.00,"$2,332.00",$0.00,"$1,166.00","$1,846.94","$1,865.60",$0.00,$0.00,$0.00,$0.00,$0.00
27200321,EAP,HCPCS C1893,,8fr-35cm Super Arrow Flex Intr,$249.00,$0.00,$249.00,$135.21,$177.71,$0.00,$42.90,$177.71,$177.71,$43.60,$249.00,$0.00,$124.50,$197.21,$199.20,$0.00,$38.97,$0.00,$39.64,$0.00
27200322,EAP,Custom 27200322,,Platinum Plus St .018 Guidewir,$288.00,$0.00,$288.00,$0.00,$205.55,$0.00,$0.00,$205.55,$205.55,$0.00,$288.00,$0.00,$144.00,$228.10,$230.40,$0.00,$0.00,$0.00,$0.00,$0.00
27200323,EAP,Custom 27200323,,Platinum Plus St .014 Guidewir,$288.00,$0.00,$288.00,$0.00,$205.55,$0.00,$0.00,$205.55,$205.55,$0.00,$288.00,$0.00,$144.00,$228.10,$230.40,$0.00,$0.00,$0.00,$0.00,$0.00
27200324,EAP,Custom 27200324,,V-18 Control Wire,$340.00,$0.00,$340.00,$0.00,$242.66,$0.00,$0.00,$242.66,$242.66,$0.00,$340.00,$0.00,$170.00,$269.28,$272.00,$0.00,$0.00,$0.00,$0.00,$0.00
27200325,EAP,Custom 27200325,,Steel Core 18 Guidewire,$64.00,$0.00,$64.00,$0.00,$45.68,$0.00,$0.00,$45.68,$45.68,$0.00,$64.00,$0.00,$32.00,$50.69,$51.20,$0.00,$0.00,$0.00,$0.00,$0.00
27200329,EAP,Custom 27200329,,14fr Sheath Introducer,$87.00,$0.00,$87.00,$0.00,$62.09,$0.00,$0.00,$62.09,$62.09,$0.00,$87.00,$0.00,$43.50,$68.90,$69.60,$0.00,$0.00,$0.00,$0.00,$0.00
27200338,EAP,HCPCS C1725,,Voyager Nc 2.5 X 15mm Balloon,$634.00,$0.00,$634.00,$344.26,$452.49,$0.00,$109.24,$452.49,$452.49,$111.01,$634.00,$0.00,$317.00,$502.13,$507.20,$0.00,$99.22,$0.00,$100.93,$0.00
27200373,EAP,HCPCS C1726,,Catheter Baldilat 12 Atm 1.5mm 142cm 12mm Rapex,$413.00,$0.00,$413.00,$224.26,$294.76,$0.00,$71.16,$294.76,$294.76,$72.31,$413.00,$0.00,$206.50,$327.10,$330.40,$0.00,$64.63,$0.00,$65.75,$0.00
27200376,EAP,HCPCS C1726,,Catheter Blndil 21cm .022in 2mm 142cm Lf 12mm Spntr Lgnd,$413.00,$0.00,$413.00,$224.26,$294.76,$0.00,$71.16,$294.76,$294.76,$72.31,$413.00,$0.00,$206.50,$327.10,$330.40,$0.00,$64.63,$0.00,$65.75,$0.00
27200382,EAP,HCPCS C1726,,Sprinter Legend Balloon Rx 3.0,$569.00,$0.00,$569.00,$308.97,$406.10,$0.00,$98.04,$406.10,$406.10,$99.63,$569.00,$0.00,$284.50,$450.65,$455.20,$0.00,$89.05,$0.00,$90.58,$0.00
27200406,EAP,HCPCS C1726,,Sprinter Nc Balloon Rx 3.50x06,$627.00,$0.00,$627.00,$340.46,$447.49,$0.00,$108.03,$447.49,$447.49,$109.78,$627.00,$0.00,$313.50,$496.58,$501.60,$0.00,$98.13,$0.00,$99.82,$0.00
27200408,EAP,HCPCS C1726,,Sprinter Nc Balloon Rx 3.50x12,$627.00,$0.00,$627.00,$340.46,$447.49,$0.00,$108.03,$447.49,$447.49,$109.78,$627.00,$0.00,$313.50,$496.58,$501.60,$0.00,$98.13,$0.00,$99.82,$0.00
27200417,EAP,HCPCS C1726,,Sprinter Nc Balloon Rx 4.00x15,$627.00,$0.00,$627.00,$340.46,$447.49,$0.00,$108.03,$447.49,$447.49,$109.78,$627.00,$0.00,$313.50,$496.58,$501.60,$0.00,$98.13,$0.00,$99.82,$0.00
27200422,EAP,Custom 27200422,,Spacer (mdi),$215.00,$0.00,$215.00,$0.00,$153.45,$0.00,$0.00,$153.45,$153.45,$0.00,$215.00,$0.00,$107.50,$170.28,$172.00,$0.00,$0.00,$0.00,$0.00,$0.00
27200423,EAP,Custom 27200423,,FOOT DROP SPLINT-CUSTOM,$243.00,$0.00,$243.00,$0.00,$173.43,$0.00,$0.00,$173.43,$173.43,$0.00,$243.00,$0.00,$121.50,$192.46,$194.40,$0.00,$0.00,$0.00,$0.00,$0.00
27200425,EAP,Custom 27200425,,"Catheterization Kit, Straight",$60.00,$0.00,$60.00,$0.00,$42.82,$0.00,$0.00,$42.82,$42.82,$0.00,$60.00,$0.00,$30.00,$47.52,$48.00,$0.00,$0.00,$0.00,$0.00,$0.00
27200426,EAP,Custom 27200426,,Blood Administration Set Up,$3.00,$0.00,$3.00,$0.00,$2.14,$0.00,$0.00,$2.14,$2.14,$0.00,$3.00,$0.00,$1.50,$2.38,$2.40,$0.00,$0.00,$0.00,$0.00,$0.00
27200427,EAP,Custom 27200427,,Intra-uterine Press Cath,$92.00,$0.00,$92.00,$0.00,$65.66,$0.00,$0.00,$65.66,$65.66,$0.00,$92.00,$0.00,$46.00,$72.86,$73.60,$0.00,$0.00,$0.00,$0.00,$0.00
27200428,EAP,Custom 27200428,,"Pack, C-section",$157.00,$0.00,$157.00,$0.00,$112.05,$0.00,$0.00,$112.05,$112.05,$0.00,$157.00,$0.00,$78.50,$124.34,$125.60,$0.00,$0.00,$0.00,$0.00,$0.00
27200430,EAP,Custom 27200430,,"Catheterization Kit, Foley",$64.00,$0.00,$64.00,$0.00,$45.68,$0.00,$0.00,$45.68,$45.68,$0.00,$64.00,$0.00,$32.00,$50.69,$51.20,$0.00,$0.00,$0.00,$0.00,$0.00
27200431,EAP,Custom 27200431,,"Catheterization Kit, Straight",$180.00,$0.00,$180.00,$0.00,$128.47,$0.00,$0.00,$128.47,$128.47,$0.00,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$0.00,$0.00,$0.00,$0.00
27200432,EAP,Custom 27200432,,Blood Administration Set Up,$18.00,$0.00,$18.00,$0.00,$12.85,$0.00,$0.00,$12.85,$12.85,$0.00,$18.00,$0.00,$9.00,$14.26,$14.40,$0.00,$0.00,$0.00,$0.00,$0.00
27200433,EAP,Custom 27200433,,Karmen Cannula,"$1,131.00",$0.00,"$1,131.00",$0.00,$807.19,$0.00,$0.00,$807.19,$807.19,$0.00,"$1,131.00",$0.00,$565.50,$895.75,$904.80,$0.00,$0.00,$0.00,$0.00,$0.00
27200434,EAP,HCPCS A4405,,Stomahesive Paste 2 Oz Tube,$108.00,$0.00,$108.00,$0.00,$77.08,$0.00,$0.00,$77.08,$77.08,$0.00,$108.00,$0.00,$54.00,$85.54,$86.40,$0.00,$0.00,$0.00,$0.00,$0.00
27200435,EAP,Custom 27200435,,"Little Ones, Pouch Flange",$18.00,$0.00,$18.00,$0.00,$12.85,$0.00,$0.00,$12.85,$12.85,$0.00,$18.00,$0.00,$9.00,$14.26,$14.40,$0.00,$0.00,$0.00,$0.00,$0.00
27200436,EAP,Custom 27200436,,"Pouch, Urostomy Opaque",$34.00,$0.00,$34.00,$0.00,$24.27,$0.00,$0.00,$24.27,$24.27,$0.00,$34.00,$0.00,$17.00,$26.93,$27.20,$0.00,$0.00,$0.00,$0.00,$0.00
27200437,EAP,Custom 27200437,,Flexible Flange,$42.00,$0.00,$42.00,$0.00,$29.98,$0.00,$0.00,$29.98,$29.98,$0.00,$42.00,$0.00,$21.00,$33.26,$33.60,$0.00,$0.00,$0.00,$0.00,$0.00
27200438,EAP,Custom 27200438,,"Irrigator, Visiflow W/cone",$201.00,$0.00,$201.00,$0.00,$143.45,$0.00,$0.00,$143.45,$143.45,$0.00,$201.00,$0.00,$100.50,$159.19,$160.80,$0.00,$0.00,$0.00,$0.00,$0.00
27200439,EAP,Custom 27200439,,Irrigation Sleeve,$207.00,$0.00,$207.00,$0.00,$147.74,$0.00,$0.00,$147.74,$147.74,$0.00,$207.00,$0.00,$103.50,$163.94,$165.60,$0.00,$0.00,$0.00,$0.00,$0.00
27200440,EAP,HCPCS A4371,,Stomahesive Powder,$56.00,$0.00,$56.00,$30.41,$39.97,$0.00,$3.43,$39.97,$39.97,$9.81,$56.00,$0.00,$28.00,$44.35,$44.80,$0.00,$8.76,$0.00,$8.92,$0.00
27200441,EAP,Custom 27200441,,Mini Pouch,$56.00,$0.00,$56.00,$0.00,$39.97,$0.00,$0.00,$39.97,$39.97,$0.00,$56.00,$0.00,$28.00,$44.35,$44.80,$0.00,$0.00,$0.00,$0.00,$0.00
27200442,EAP,Custom 27200442,,Wound Pouch Med.,$68.00,$0.00,$68.00,$0.00,$48.53,$0.00,$0.00,$48.53,$48.53,$0.00,$68.00,$0.00,$34.00,$53.86,$54.40,$0.00,$0.00,$0.00,$0.00,$0.00
27200443,EAP,HCPCS A4364,,Medical Adhesive,$68.00,$0.00,$68.00,$36.92,$48.53,$0.00,$2.34,$48.53,$48.53,$11.91,$68.00,$0.00,$34.00,$53.86,$54.40,$0.00,$10.64,$0.00,$10.83,$0.00
27200444,EAP,Custom 27200444,,Drain Tube Attachment,$10.00,$0.00,$10.00,$0.00,$7.14,$0.00,$0.00,$7.14,$7.14,$0.00,$10.00,$0.00,$5.00,$7.92,$8.00,$0.00,$0.00,$0.00,$0.00,$0.00
27200446,EAP,HCPCS A4364,,"Skin Bond Cement, 4oz",$76.00,$0.00,$76.00,$41.27,$54.24,$0.00,$2.34,$54.24,$54.24,$13.31,$76.00,$0.00,$38.00,$60.19,$60.80,$0.00,$11.89,$0.00,$12.10,$0.00
27200447,EAP,HCPCS A4455,,"Uni-solve Wipes,adhes. Remover",$103.00,$0.00,$103.00,$55.93,$73.51,$0.00,$1.34,$73.51,$73.51,$18.03,$103.00,$0.00,$51.50,$81.58,$82.40,$0.00,$16.12,$0.00,$16.40,$0.00
27200448,EAP,HCPCS A6197,,Alginate Dressing>16<= 48 Sq In,$19.00,$0.00,$19.00,$0.00,$13.56,$0.00,$0.00,$13.56,$13.56,$0.00,$19.00,$0.00,$9.50,$15.05,$15.20,$0.00,$0.00,$0.00,$0.00,$0.00
27200449,EAP,Custom 27200449,,Ace Wrap Supply,$34.00,$0.00,$34.00,$0.00,$24.27,$0.00,$0.00,$24.27,$24.27,$0.00,$34.00,$0.00,$17.00,$26.93,$27.20,$0.00,$0.00,$0.00,$0.00,$0.00
27200450,EAP,HCPCS C1728,,"Catheter,brachytherapy Seed Ad","$10,554.00",$0.00,"$10,554.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$10,554.00",$0.00,"$5,277.00","$8,358.77","$8,443.20",$0.00,$0.00,$0.00,$0.00,$0.00
27200452,EAP,HCPCS C1757,,Catheter 6fr X 65 Cm 9mm Cleaner Sterile,"$1,756.00",$0.00,"$1,756.00",$0.00,"$1,253.26",$0.00,$0.00,"$1,253.26","$1,253.26",$0.00,"$1,756.00",$0.00,$878.00,"$1,390.75","$1,404.80",$0.00,$0.00,$0.00,$0.00,$0.00
27200453,EAP,HCPCS C1757,,Catheter 6fr X 135 Cm 9mm Cleaner Sterile,"$2,351.00",$0.00,"$2,351.00",$0.00,"$1,677.91",$0.00,$0.00,"$1,677.91","$1,677.91",$0.00,"$2,351.00",$0.00,"$1,175.50","$1,861.99","$1,880.80",$0.00,$0.00,$0.00,$0.00,$0.00
27200454,EAP,HCPCS C1757,,Catheter 7 Fr X 65 Cm 9mm Cleaner Sterile,"$2,143.00",$0.00,"$2,143.00",$0.00,"$1,529.46",$0.00,$0.00,"$1,529.46","$1,529.46",$0.00,"$2,143.00",$0.00,"$1,071.50","$1,697.26","$1,714.40",$0.00,$0.00,$0.00,$0.00,$0.00
27200455,EAP,HCPCS C1757,,Catheter 7fr X 135 Cm 9mm Cleaner Sterile,"$2,660.00",$0.00,"$2,660.00",$0.00,"$1,898.44",$0.00,$0.00,"$1,898.44","$1,898.44",$0.00,"$2,660.00",$0.00,"$1,330.00","$2,106.72","$2,128.00",$0.00,$0.00,$0.00,$0.00,$0.00
27200456,EAP,HCPCS C2629,,Mic G-18 Introducer Kit,$585.00,$0.00,$585.00,$317.66,$417.51,$0.00,$100.79,$417.51,$417.51,$102.43,$585.00,$0.00,$292.50,$463.32,$468.00,$0.00,$91.55,$0.00,$93.13,$0.00
27200457,EAP,HCPCS C1751,,Cath Cen Ven 4fr 1 Lum Try 3cg Shrlk Sty Maximal Brr Pic,$249.00,$0.00,$249.00,$135.21,$177.71,$0.00,$42.90,$177.71,$177.71,$43.60,$249.00,$0.00,$124.50,$197.21,$199.20,$0.00,$38.97,$0.00,$39.64,$0.00
27200458,EAP,HCPCS C1751,,Cath 5fr 1lum Try 3cg Shrlk Sty Maximal Brr Picc P,$260.00,$0.00,$260.00,$141.18,$185.56,$0.00,$44.80,$185.56,$185.56,$45.52,$260.00,$0.00,$130.00,$205.92,$208.00,$0.00,$40.69,$0.00,$41.39,$0.00
27200459,EAP,HCPCS C1751,,Cath 6fr 1lum Try 3cg Shrlk Sty Maximal Brr Picc P,$260.00,$0.00,$260.00,$141.18,$185.56,$0.00,$44.80,$185.56,$185.56,$45.52,$260.00,$0.00,$130.00,$205.92,$208.00,$0.00,$40.69,$0.00,$41.39,$0.00
27200460,EAP,HCPCS C1894,,Micro Microintruducer 7cm 5.0fr Flecura Guidewire,$39.00,$0.00,$39.00,$21.18,$27.83,$0.00,$6.72,$27.83,$27.83,$6.83,$39.00,$0.00,$19.50,$30.89,$31.20,$0.00,$6.10,$0.00,$6.21,$0.00
27200461,EAP,HCPCS C1751,,Tray Cath 5fr 12cm Cen Ven Spctrm 3 Lum Pu .025in Disp D,$320.00,$0.00,$320.00,$173.76,$228.38,$0.00,$55.13,$228.38,$228.38,$56.03,$320.00,$0.00,$160.00,$253.44,$256.00,$0.00,$50.08,$0.00,$50.94,$0.00
27200462,EAP,HCPCS C1887,,Sheath Guid 65cm 6fr Pn Dstn .038in Str Hydphi,$224.00,$0.00,$224.00,$121.63,$159.87,$0.00,$38.59,$159.87,$159.87,$39.22,$224.00,$0.00,$112.00,$177.41,$179.20,$0.00,$35.06,$0.00,$35.66,$0.00
27200467,EAP,HCPCS C1769,,Guidewire Vascular Angle Standard .035in 180cm 3cm,$103.00,$0.00,$103.00,$55.93,$73.51,$0.00,$17.75,$73.51,$73.51,$18.03,$103.00,$0.00,$51.50,$81.58,$82.40,$0.00,$16.12,$0.00,$16.40,$0.00
27200470,EAP,HCPCS C1884,,Embosphere Pre-filled Syringe 300-500 Microns/2ml,$625.00,$0.00,$625.00,$339.38,$446.06,$0.00,$107.68,$446.06,$446.06,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
27200471,EAP,HCPCS C1894,,Introducer Sheath 7fr .1in 80cm Tuohy Borst Sidearm Radiopq,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
27200472,EAP,HCPCS C1769,,Guidewire Vascular 45d .016in 180cm 2mm Angled Flexible Tip,$725.00,$0.00,$725.00,$393.68,$517.43,$0.00,$124.91,$517.43,$517.43,$126.94,$725.00,$0.00,$362.50,$574.20,$580.00,$0.00,$113.46,$0.00,$115.42,$0.00
27200473,EAP,HCPCS C1887,,Catheter Guid Mpc Curve 5fr .056in 90cm Braid Radiopq Soft,$893.00,$0.00,$893.00,$484.90,$637.33,$0.00,$153.86,$637.33,$637.33,$156.36,$893.00,$0.00,$446.50,$707.26,$714.40,$0.00,$139.75,$0.00,$142.17,$0.00
27200474,EAP,HCPCS C1725,,Catheter Angiographic Motarjeme Curve 5fr .046in 100cm Braid,$31.00,$0.00,$31.00,$16.83,$22.12,$0.00,$5.34,$22.12,$22.12,$5.43,$31.00,$0.00,$15.50,$24.55,$24.80,$0.00,$4.85,$0.00,$4.94,$0.00
27200475,EAP,HCPCS C1725,,Catheter Angiographic .035in Pigtail 5fr .052in 90cm Ultra,$305.00,$0.00,$305.00,$165.62,$217.68,$0.00,$52.55,$217.68,$217.68,$53.40,$305.00,$0.00,$152.50,$241.56,$244.00,$0.00,$47.73,$0.00,$48.56,$0.00
27200476,EAP,HCPCS C1769,,Guidewire Vascular Str .018in 180cm 25cm Shapeable Shaft,$398.00,$0.00,$398.00,$216.11,$284.05,$0.00,$68.57,$284.05,$284.05,$69.69,$398.00,$0.00,$199.00,$315.22,$318.40,$0.00,$62.29,$0.00,$63.36,$0.00
27200477,EAP,HCPCS C1769,,Guidewire Vascular .014in 300cm 20cm Exchange Radiopq Distal,$896.00,$0.00,$896.00,$486.53,$639.48,$0.00,$154.38,$639.48,$639.48,$156.88,$896.00,$0.00,$448.00,$709.63,$716.80,$0.00,$140.22,$0.00,$142.64,$0.00
27200478,EAP,HCPCS C1887,,Catheter Infus 45d .014in Micro Str 1.9-2.4fr .017in 155cm,"$1,773.00",$0.00,"$1,773.00",$962.74,"$1,265.39",$0.00,$305.48,"$1,265.39","$1,265.39",$310.44,"$1,773.00",$0.00,$886.50,"$1,404.22","$1,418.40",$0.00,$277.47,$0.00,$282.26,$0.00
27200479,EAP,HCPCS C1887,,Catheter Infus 90d .014in Micro Str 1.9-2.4fr .017in 155cm,"$1,688.00",$0.00,"$1,688.00",$916.58,"$1,204.73",$0.00,$290.83,"$1,204.73","$1,204.73",$295.56,"$1,688.00",$0.00,$844.00,"$1,336.90","$1,350.40",$0.00,$264.17,$0.00,$268.73,$0.00
27200481,EAP,Custom 27200481,,Catheter Vascular Occlusion 1028 Flocontrol Tn,"$6,988.00",$0.00,"$6,988.00",$0.00,"$4,987.34",$0.00,$0.00,"$4,987.34","$4,987.34",$0.00,"$6,988.00",$0.00,"$3,494.00","$5,534.50","$5,590.40",$0.00,$0.00,$0.00,$0.00,$0.00
27200482,EAP,HCPCS C1757,,Catheter Reperfusion 4max,"$3,225.00",$0.00,"$3,225.00",$0.00,"$2,301.68",$0.00,$0.00,"$2,301.68","$2,301.68",$0.00,"$3,225.00",$0.00,"$1,612.50","$2,554.20","$2,580.00",$0.00,$0.00,$0.00,$0.00,$0.00
27200484,EAP,Custom 27200484,,Adhesive Ostomy Med Remain Flexible Silicone,$45.00,$0.00,$45.00,$0.00,$32.12,$0.00,$0.00,$32.12,$32.12,$0.00,$45.00,$0.00,$22.50,$35.64,$36.00,$0.00,$0.00,$0.00,$0.00,$0.00
27200485,EAP,HCPCS C1887,,Catheter Guid 9fr Balloon Cello,"$1,875.00",$0.00,"$1,875.00","$1,018.13","$1,338.19",$0.00,$323.05,"$1,338.19","$1,338.19",$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
27200496,EAP,HCPCS C1894,,Introducer Sheath .035in 7fr .1in 70cm Anl1 Curve,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27200714,EAP,Custom 27200714,,Compression Hose Lg/xlg Knee,$131.00,$0.00,$131.00,$0.00,$93.49,$0.00,$0.00,$93.49,$93.49,$0.00,$131.00,$0.00,$65.50,$103.75,$104.80,$0.00,$0.00,$0.00,$0.00,$0.00
27200751,EAP,Custom 27200751,,"Grasping Forceps, 10mm X 120cm",$744.00,$0.00,$744.00,$0.00,$530.99,$0.00,$0.00,$530.99,$530.99,$0.00,$744.00,$0.00,$372.00,$589.25,$595.20,$0.00,$0.00,$0.00,$0.00,$0.00
27200753,EAP,Custom 27200753,,"Grasping Forceps, 8mm X 120cm",$708.00,$0.00,$708.00,$0.00,$505.30,$0.00,$0.00,$505.30,$505.30,$0.00,$708.00,$0.00,$354.00,$560.74,$566.40,$0.00,$0.00,$0.00,$0.00,$0.00
27200755,EAP,Custom 27200755,,"Grasp Forceps, Stone Retrieval",$705.00,$0.00,$705.00,$0.00,$503.16,$0.00,$0.00,$503.16,$503.16,$0.00,$705.00,$0.00,$352.50,$558.36,$564.00,$0.00,$0.00,$0.00,$0.00,$0.00
27200766,EAP,Custom 27200766,,"Probe, Electrohydraulic Lithot",$428.00,$0.00,$428.00,$0.00,$305.46,$0.00,$0.00,$305.46,$305.46,$0.00,$428.00,$0.00,$214.00,$338.98,$342.40,$0.00,$0.00,$0.00,$0.00,$0.00
27200769,EAP,Custom 27200769,,Bipolar Forceps,$573.00,$0.00,$573.00,$0.00,$408.95,$0.00,$0.00,$408.95,$408.95,$0.00,$573.00,$0.00,$286.50,$453.82,$458.40,$0.00,$0.00,$0.00,$0.00,$0.00
27200834,EAP,Custom 27200834,,Wet Field Cautery,$136.00,$0.00,$136.00,$0.00,$97.06,$0.00,$0.00,$97.06,$97.06,$0.00,$136.00,$0.00,$68.00,$107.71,$108.80,$0.00,$0.00,$0.00,$0.00,$0.00
27201077,EAP,HCPCS C1769,,"Guide Wire, 292.653",$183.00,$0.00,$183.00,$99.37,$130.61,$0.00,$31.53,$130.61,$130.61,$32.04,$183.00,$0.00,$91.50,$144.94,$146.40,$0.00,$28.64,$0.00,$29.13,$0.00
27201301,EAP,Custom 27201301,,"Drill Bit, 357.047","$1,952.00",$0.00,"$1,952.00",$0.00,"$1,393.14",$0.00,$0.00,"$1,393.14","$1,393.14",$0.00,"$1,952.00",$0.00,$976.00,"$1,545.98","$1,561.60",$0.00,$0.00,$0.00,$0.00,$0.00
27201369,EAP,Custom 27201369,,Endo Disposable Lap. Instr.,$977.00,$0.00,$977.00,$0.00,$697.28,$0.00,$0.00,$697.28,$697.28,$0.00,$977.00,$0.00,$488.50,$773.78,$781.60,$0.00,$0.00,$0.00,$0.00,$0.00
27201377,EAP,Custom 27201377,,Ta Premium Dlu Staples,"$1,093.00",$0.00,"$1,093.00",$0.00,$780.07,$0.00,$0.00,$780.07,$780.07,$0.00,"$1,093.00",$0.00,$546.50,$865.66,$874.40,$0.00,$0.00,$0.00,$0.00,$0.00
27201399,EAP,Custom 27201399,,Bipolar Bovie,$14.00,$0.00,$14.00,$0.00,$9.99,$0.00,$0.00,$9.99,$9.99,$0.00,$14.00,$0.00,$7.00,$11.09,$11.20,$0.00,$0.00,$0.00,$0.00,$0.00
27201400,EAP,Custom 27201400,,Micro Clips,$39.00,$0.00,$39.00,$0.00,$27.83,$0.00,$0.00,$27.83,$27.83,$0.00,$39.00,$0.00,$19.50,$30.89,$31.20,$0.00,$0.00,$0.00,$0.00,$0.00
27201403,EAP,Custom 27201403,,Abd Binder,$39.00,$0.00,$39.00,$0.00,$27.83,$0.00,$0.00,$27.83,$27.83,$0.00,$39.00,$0.00,$19.50,$30.89,$31.20,$0.00,$0.00,$0.00,$0.00,$0.00
27201407,EAP,Custom 27201407,,Dermabond,$87.00,$0.00,$87.00,$0.00,$62.09,$0.00,$0.00,$62.09,$62.09,$0.00,$87.00,$0.00,$43.50,$68.90,$69.60,$0.00,$0.00,$0.00,$0.00,$0.00
27201456,EAP,Custom 27201456,,"Grasping Forceps, 10mm X 120cm",$744.00,$0.00,$744.00,$0.00,$530.99,$0.00,$0.00,$530.99,$530.99,$0.00,$744.00,$0.00,$372.00,$589.25,$595.20,$0.00,$0.00,$0.00,$0.00,$0.00
27201458,EAP,Custom 27201458,,"Grasping Forceps, Stone Retrie",$705.00,$0.00,$705.00,$0.00,$503.16,$0.00,$0.00,$503.16,$503.16,$0.00,$705.00,$0.00,$352.50,$558.36,$564.00,$0.00,$0.00,$0.00,$0.00,$0.00
27201474,EAP,Custom 27201474,,"Grasping Forceps, 8mm X 120cm",$707.00,$0.00,$707.00,$0.00,$504.59,$0.00,$0.00,$504.59,$504.59,$0.00,$707.00,$0.00,$353.50,$559.94,$565.60,$0.00,$0.00,$0.00,$0.00,$0.00
27201489,EAP,Custom 27201489,,Irrigation Clip,$214.00,$0.00,$214.00,$0.00,$152.73,$0.00,$0.00,$152.73,$152.73,$0.00,$214.00,$0.00,$107.00,$169.49,$171.20,$0.00,$0.00,$0.00,$0.00,$0.00
27201492,EAP,Custom 27201492,,Jp Drain (hemaduct),$90.00,$0.00,$90.00,$0.00,$64.23,$0.00,$0.00,$64.23,$64.23,$0.00,$90.00,$0.00,$45.00,$71.28,$72.00,$0.00,$0.00,$0.00,$0.00,$0.00
27201536,EAP,Custom 27201536,,Compression Hose Reg. Knee,$101.00,$0.00,$101.00,$0.00,$72.08,$0.00,$0.00,$72.08,$72.08,$0.00,$101.00,$0.00,$50.50,$79.99,$80.80,$0.00,$0.00,$0.00,$0.00,$0.00
27201626,EAP,Custom 27201626,,"Cath,intra-aortic Balloon","$4,716.00",$0.00,"$4,716.00",$0.00,"$3,365.81",$0.00,$0.00,"$3,365.81","$3,365.81",$0.00,"$4,716.00",$0.00,"$2,358.00","$3,735.07","$3,772.80",$0.00,$0.00,$0.00,$0.00,$0.00
27201630,EAP,Custom 27201630,,"Cath,chest Tube Rt. Angled",$135.00,$0.00,$135.00,$0.00,$96.35,$0.00,$0.00,$96.35,$96.35,$0.00,$135.00,$0.00,$67.50,$106.92,$108.00,$0.00,$0.00,$0.00,$0.00,$0.00
27201680,EAP,Custom 27201680,,Catheter Angio .038in Ka2 Crv 5fr .046in 40cm Impr,$165.00,$0.00,$165.00,$0.00,$117.76,$0.00,$0.00,$117.76,$117.76,$0.00,$165.00,$0.00,$82.50,$130.68,$132.00,$0.00,$0.00,$0.00,$0.00,$0.00
27201681,EAP,Custom 27201681,,Catheter Angio .038in Ka2 Crv 5fr .046in 65cm Prfm,$153.00,$0.00,$153.00,$0.00,$109.20,$0.00,$0.00,$109.20,$109.20,$0.00,$153.00,$0.00,$76.50,$121.18,$122.40,$0.00,$0.00,$0.00,$0.00,$0.00
27201700,EAP,Custom 27201700,,Rbc Filter Unit,$83.00,$0.00,$83.00,$0.00,$59.24,$0.00,$0.00,$59.24,$59.24,$0.00,$83.00,$0.00,$41.50,$65.74,$66.40,$0.00,$0.00,$0.00,$0.00,$0.00
27201701,EAP,Custom 27201701,,Plat Filter Unit,$215.00,$0.00,$215.00,$0.00,$153.45,$0.00,$0.00,$153.45,$153.45,$0.00,$215.00,$0.00,$107.50,$170.28,$172.00,$0.00,$0.00,$0.00,$0.00,$0.00
27201702,EAP,Custom 27201702,,Plf1 Filter Unit,$39.00,$0.00,$39.00,$0.00,$27.83,$0.00,$0.00,$27.83,$27.83,$0.00,$39.00,$0.00,$19.50,$30.89,$31.20,$0.00,$0.00,$0.00,$0.00,$0.00
27201800,EAP,HCPCS C1729,,Catheter Foley 16fr,$6.00,$0.00,$6.00,$3.26,$4.28,$0.00,$1.03,$4.28,$4.28,$1.05,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.94,$0.00,$0.96,$0.00
27201801,EAP,HCPCS C1769,,Guidewire .35x150cm Bentson,$76.00,$0.00,$76.00,$41.27,$54.24,$0.00,$13.09,$54.24,$54.24,$13.31,$76.00,$0.00,$38.00,$60.19,$60.80,$0.00,$11.89,$0.00,$12.10,$0.00
27201802,EAP,HCPCS C1750,,24cm Duraflow Catheter,"$2,096.00",$0.00,"$2,096.00","$1,138.13","$1,495.92",$0.00,$361.13,"$1,495.92","$1,495.92",$366.99,"$2,096.00",$0.00,"$1,048.00","$1,660.03","$1,676.80",$0.00,$328.02,$0.00,$333.68,$0.00
27201803,EAP,HCPCS C1750,,28cm Duraflow Catheter,"$1,720.00",$0.00,"$1,720.00",$933.96,"$1,227.56",$0.00,$296.35,"$1,227.56","$1,227.56",$301.16,"$1,720.00",$0.00,$860.00,"$1,362.24","$1,376.00",$0.00,$269.18,$0.00,$273.82,$0.00
27201804,EAP,HCPCS C1752,,24cm Schon Xl Temp Cath,$315.00,$0.00,$315.00,$0.00,$224.82,$0.00,$0.00,$224.82,$224.82,$0.00,$315.00,$0.00,$157.50,$249.48,$252.00,$0.00,$0.00,$0.00,$0.00,$0.00
27201805,EAP,HCPCS C1751,,5x1235x20cm Unifuse Kit,$550.00,$0.00,$550.00,$298.65,$392.54,$0.00,$94.76,$392.54,$392.54,$96.30,$550.00,$0.00,$275.00,$435.60,$440.00,$0.00,$86.08,$0.00,$87.56,$0.00
27201806,EAP,HCPCS C1751,,5x135x10cm Unifuse Kit,$550.00,$0.00,$550.00,$298.65,$392.54,$0.00,$94.76,$392.54,$392.54,$96.30,$550.00,$0.00,$275.00,$435.60,$440.00,$0.00,$86.08,$0.00,$87.56,$0.00
27201807,EAP,HCPCS C1725,,8-4/5/75 Workhorse Pta,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
27201808,EAP,HCPCS C1752,,Temporary Dialysis Cath,$315.00,$0.00,$315.00,$0.00,$224.82,$0.00,$0.00,$224.82,$224.82,$0.00,$315.00,$0.00,$157.50,$249.48,$252.00,$0.00,$0.00,$0.00,$0.00,$0.00
27201809,EAP,HCPCS C1752,,Temporay Dialysis Cath,$740.00,$0.00,$740.00,$0.00,$528.14,$0.00,$0.00,$528.14,$528.14,$0.00,$740.00,$0.00,$370.00,$586.08,$592.00,$0.00,$0.00,$0.00,$0.00,$0.00
27201810,EAP,HCPCS C1725,,Workhorse Pta Balloon,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
27201811,EAP,HCPCS C1725,,Workhorse Pta Balloon,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
27201812,EAP,HCPCS C1725,,Wrkhorse Balloon 5-2/5/75,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
27201813,EAP,HCPCS C1725,,Wrkhrse Balloon 10-4/5/75,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
27201814,EAP,HCPCS C1725,,Wrkhrse Balloon 5-2/5/100,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
27201815,EAP,HCPCS C1725,,Wrkhrse Balloon 6-2/5/75,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
27201816,EAP,HCPCS C1751,,5fr Dual Lumen Picc Line,$533.00,$0.00,$533.00,$289.42,$380.40,$0.00,$91.83,$380.40,$380.40,$93.32,$533.00,$0.00,$266.50,$422.14,$426.40,$0.00,$83.41,$0.00,$84.85,$0.00
27201817,EAP,HCPCS C1751,,5fr Sgle Lumen Pic Line,$419.00,$0.00,$419.00,$227.52,$299.04,$0.00,$72.19,$299.04,$299.04,$73.36,$419.00,$0.00,$209.50,$331.85,$335.20,$0.00,$65.57,$0.00,$66.70,$0.00
27201818,EAP,HCPCS C1757,,Thrombex Device,"$5,955.00",$0.00,"$5,955.00",$0.00,"$4,250.08",$0.00,$0.00,"$4,250.08","$4,250.08",$0.00,"$5,955.00",$0.00,"$2,977.50","$4,716.36","$4,764.00",$0.00,$0.00,$0.00,$0.00,$0.00
27201819,EAP,HCPCS C1769,,Guidewire .035/260m Exchange,$149.00,$0.00,$149.00,$80.91,$106.34,$0.00,$25.67,$106.34,$106.34,$26.09,$149.00,$0.00,$74.50,$118.01,$119.20,$0.00,$23.32,$0.00,$23.72,$0.00
27201820,EAP,HCPCS C1769,,Guidewire .035-150cm Angled Stiff,$167.00,$0.00,$167.00,$90.68,$119.19,$0.00,$28.77,$119.19,$119.19,$29.24,$167.00,$0.00,$83.50,$132.26,$133.60,$0.00,$26.14,$0.00,$26.59,$0.00
27201821,EAP,HCPCS C1751,,12cm Katzen Infusion Cath,"$1,506.00",$0.00,"$1,506.00",$817.76,"$1,074.83",$0.00,$259.48,"$1,074.83","$1,074.83",$263.69,"$1,506.00",$0.00,$753.00,"$1,192.75","$1,204.80",$0.00,$235.69,$0.00,$239.76,$0.00
27201822,EAP,HCPCS C1751,,150/20 Tracker-18 Infusio,"$3,033.00",$0.00,"$3,033.00","$1,646.92","$2,164.65",$0.00,$522.57,"$2,164.65","$2,164.65",$531.05,"$3,033.00",$0.00,"$1,516.50","$2,402.14","$2,426.40",$0.00,$474.66,$0.00,$482.85,$0.00
27201823,EAP,HCPCS C1769,,32-150 Angled Guidewire,$287.00,$0.00,$287.00,$155.84,$204.83,$0.00,$49.45,$204.83,$204.83,$50.25,$287.00,$0.00,$143.50,$227.30,$229.60,$0.00,$44.92,$0.00,$45.69,$0.00
27201824,EAP,HCPCS C1894,,5fr Pinnacle Introducer,$67.00,$0.00,$67.00,$36.38,$47.82,$0.00,$11.54,$47.82,$47.82,$11.73,$67.00,$0.00,$33.50,$53.06,$53.60,$0.00,$10.49,$0.00,$10.67,$0.00
27201825,EAP,HCPCS C1887,,5fr-100cm At Catheter,$37.00,$0.00,$37.00,$20.09,$26.41,$0.00,$6.37,$26.41,$26.41,$6.48,$37.00,$0.00,$18.50,$29.30,$29.60,$0.00,$5.79,$0.00,$5.89,$0.00
27201826,EAP,HCPCS C1751,,A50/20 Fastracker-18 Infu,"$1,590.00",$0.00,"$1,590.00",$863.37,"$1,134.78",$0.00,$273.95,"$1,134.78","$1,134.78",$278.40,"$1,590.00",$0.00,$795.00,"$1,259.28","$1,272.00",$0.00,$248.84,$0.00,$253.13,$0.00
27201827,EAP,HCPCS C1769,,Amplatz Guidewire 260cm,$129.00,$0.00,$129.00,$70.05,$92.07,$0.00,$22.23,$92.07,$92.07,$22.59,$129.00,$0.00,$64.50,$102.17,$103.20,$0.00,$20.19,$0.00,$20.54,$0.00
27201828,EAP,HCPCS C1725,,Catheter  Balloon 6-10/5,$681.00,$0.00,$681.00,$369.78,$486.03,$0.00,$117.33,$486.03,$486.03,$119.24,$681.00,$0.00,$340.50,$539.35,$544.80,$0.00,$106.58,$0.00,$108.42,$0.00
27201829,EAP,HCPCS C1887,,Glidecath C2 Hydeophilic,$175.00,$0.00,$175.00,$95.03,$124.90,$0.00,$30.15,$124.90,$124.90,$30.64,$175.00,$0.00,$87.50,$138.60,$140.00,$0.00,$27.39,$0.00,$27.86,$0.00
27201830,EAP,HCPCS C1769,,Glidewire .035 150cm  Angled,$101.00,$0.00,$101.00,$54.84,$72.08,$0.00,$17.40,$72.08,$72.08,$17.68,$101.00,$0.00,$50.50,$79.99,$80.80,$0.00,$15.81,$0.00,$16.08,$0.00
27201831,EAP,HCPCS C1769,,Guidewire  Amplatz Super,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
27201832,EAP,HCPCS C1769,,Guidewire-long Taper,$313.00,$0.00,$313.00,$169.96,$223.39,$0.00,$53.93,$223.39,$223.39,$54.80,$313.00,$0.00,$156.50,$247.90,$250.40,$0.00,$48.98,$0.00,$49.83,$0.00
27201833,EAP,HCPCS C1769,,Transcend Steerable,$667.00,$0.00,$667.00,$362.18,$476.04,$0.00,$114.92,$476.04,$476.04,$116.79,$667.00,$0.00,$333.50,$528.26,$533.60,$0.00,$104.39,$0.00,$106.19,$0.00
27201834,EAP,HCPCS C1725,,Xxl 14-4/5.8/120,$856.00,$0.00,$856.00,$464.81,$610.93,$0.00,$147.48,$610.93,$610.93,$149.88,$856.00,$0.00,$428.00,$677.95,$684.80,$0.00,$133.96,$0.00,$136.28,$0.00
27201835,EAP,HCPCS C1725,,Xxl/12-5/5.8/120 Balloon,$856.00,$0.00,$856.00,$464.81,$610.93,$0.00,$147.48,$610.93,$610.93,$149.88,$856.00,$0.00,$428.00,$677.95,$684.80,$0.00,$133.96,$0.00,$136.28,$0.00
27201836,EAP,HCPCS C1769,,Guidewire .035-260cm Bentson E,$88.00,$0.00,$88.00,$47.78,$62.81,$0.00,$15.16,$62.81,$62.81,$15.41,$88.00,$0.00,$44.00,$69.70,$70.40,$0.00,$13.77,$0.00,$14.01,$0.00
27201837,EAP,HCPCS C1729,,10.2fr Mp Drain Catheter,$296.00,$0.00,$296.00,$160.73,$211.26,$0.00,$51.00,$211.26,$211.26,$51.83,$296.00,$0.00,$148.00,$234.43,$236.80,$0.00,$46.32,$0.00,$47.12,$0.00
27201838,EAP,HCPCS C1894,,11fr-70cm Introducer Set,$233.00,$0.00,$233.00,$126.52,$166.29,$0.00,$40.14,$166.29,$166.29,$40.80,$233.00,$0.00,$116.50,$184.54,$186.40,$0.00,$36.46,$0.00,$37.09,$0.00
27201839,EAP,HCPCS C1729,,14.0fr Mp Drain Catheter,$289.00,$0.00,$289.00,$156.93,$206.26,$0.00,$49.79,$206.26,$206.26,$50.60,$289.00,$0.00,$144.50,$228.89,$231.20,$0.00,$45.23,$0.00,$46.01,$0.00
27201840,EAP,Custom 27201840,,35-3-5 Embolization Coil,$172.00,$0.00,$172.00,$0.00,$122.76,$0.00,$0.00,$122.76,$122.76,$0.00,$172.00,$0.00,$86.00,$136.22,$137.60,$0.00,$0.00,$0.00,$0.00,$0.00
27201841,EAP,Custom 27201841,,35-5-10 Embolization Coil,$279.00,$0.00,$279.00,$0.00,$199.12,$0.00,$0.00,$199.12,$199.12,$0.00,$279.00,$0.00,$139.50,$220.97,$223.20,$0.00,$0.00,$0.00,$0.00,$0.00
27201842,EAP,Custom 27201842,,35-5-3 Embolization Coil,$228.00,$0.00,$228.00,$0.00,$162.72,$0.00,$0.00,$162.72,$162.72,$0.00,$228.00,$0.00,$114.00,$180.58,$182.40,$0.00,$0.00,$0.00,$0.00,$0.00
27201843,EAP,Custom 27201843,,35-5-8 Embolization Coil,$167.00,$0.00,$167.00,$0.00,$119.19,$0.00,$0.00,$119.19,$119.19,$0.00,$167.00,$0.00,$83.50,$132.26,$133.60,$0.00,$0.00,$0.00,$0.00,$0.00
27201844,EAP,HCPCS C1893,,5fr80cm Neff Catheter,$120.00,$0.00,$120.00,$65.16,$85.64,$0.00,$20.68,$85.64,$85.64,$21.01,$120.00,$0.00,$60.00,$95.04,$96.00,$0.00,$18.78,$0.00,$19.10,$0.00
27201845,EAP,HCPCS C1894,,6fr Balkan Introducer Set,$60.00,$0.00,$60.00,$32.58,$42.82,$0.00,$10.34,$42.82,$42.82,$10.51,$60.00,$0.00,$30.00,$47.52,$48.00,$0.00,$9.39,$0.00,$9.55,$0.00
27201846,EAP,HCPCS C1894,,7fr Balkan Introducer Set,$170.00,$0.00,$170.00,$92.31,$121.33,$0.00,$29.29,$121.33,$121.33,$29.77,$170.00,$0.00,$85.00,$134.64,$136.00,$0.00,$26.61,$0.00,$27.06,$0.00
27201847,EAP,HCPCS C1729,,8.5fr Mp Drain Catheter,$311.00,$0.00,$311.00,$168.87,$221.96,$0.00,$53.58,$221.96,$221.96,$54.45,$311.00,$0.00,$155.50,$246.31,$248.80,$0.00,$48.67,$0.00,$49.51,$0.00
27201848,EAP,HCPCS C1729,,9.5fr Biliary Drain Cath.,$296.00,$0.00,$296.00,$160.73,$211.26,$0.00,$51.00,$211.26,$211.26,$51.83,$296.00,$0.00,$148.00,$234.43,$236.80,$0.00,$46.32,$0.00,$47.12,$0.00
27201849,EAP,HCPCS C1757,,Coil  Embolization 35-4-3,$172.00,$0.00,$172.00,$0.00,$122.76,$0.00,$0.00,$122.76,$122.76,$0.00,$172.00,$0.00,$86.00,$136.22,$137.60,$0.00,$0.00,$0.00,$0.00,$0.00
27201850,EAP,HCPCS C1769,,Dtdw35-80-10 Deflecting,$520.00,$0.00,$520.00,$282.36,$371.12,$0.00,$89.59,$371.12,$371.12,$91.05,$520.00,$0.00,$260.00,$411.84,$416.00,$0.00,$81.38,$0.00,$82.78,$0.00
27201851,EAP,HCPCS C1773,,Filter Retrieval Set,$886.00,$0.00,$886.00,$481.10,$632.34,$0.00,$152.65,$632.34,$632.34,$155.13,$886.00,$0.00,$443.00,$701.71,$708.80,$0.00,$138.66,$0.00,$141.05,$0.00
27201852,EAP,HCPCS C1769,,Guidewire  Cope Mandril,$116.00,$0.00,$116.00,$62.99,$82.79,$0.00,$19.99,$82.79,$82.79,$20.31,$116.00,$0.00,$58.00,$91.87,$92.80,$0.00,$18.15,$0.00,$18.47,$0.00
27201853,EAP,HCPCS C1769,,Lewis Micropunture Set,$130.00,$0.00,$130.00,$70.59,$92.78,$0.00,$22.40,$92.78,$92.78,$22.76,$130.00,$0.00,$65.00,$102.96,$104.00,$0.00,$20.35,$0.00,$20.70,$0.00
27201854,EAP,HCPCS C2629,,Micropuncture Set,$102.00,$0.00,$102.00,$55.39,$72.80,$0.00,$17.57,$72.80,$72.80,$17.86,$102.00,$0.00,$51.00,$80.78,$81.60,$0.00,$15.96,$0.00,$16.24,$0.00
27201855,EAP,HCPCS C1894,,8fr-23cmavanti-introducer,$10.00,$0.00,$10.00,$5.43,$7.14,$0.00,$1.72,$7.14,$7.14,$1.75,$10.00,$0.00,$5.00,$7.92,$8.00,$0.00,$1.57,$0.00,$1.59,$0.00
27201856,EAP,HCPCS C1894,,9fr-23cm Avanti Introduce,$10.00,$0.00,$10.00,$5.43,$7.14,$0.00,$1.72,$7.14,$7.14,$1.75,$10.00,$0.00,$5.00,$7.92,$8.00,$0.00,$1.57,$0.00,$1.59,$0.00
27201857,EAP,HCPCS C1773,,12-20mmx120cm Std Snare,"$1,119.00",$0.00,"$1,119.00",$607.62,$798.63,$0.00,$192.80,$798.63,$798.63,$195.93,"$1,119.00",$0.00,$559.50,$886.25,$895.20,$0.00,$175.12,$0.00,$178.14,$0.00
27201858,EAP,HCPCS C1773,,9-15mmx120cm Std Snare,"$1,119.00",$0.00,"$1,119.00",$607.62,$798.63,$0.00,$192.80,$798.63,$798.63,$195.93,"$1,119.00",$0.00,$559.50,$886.25,$895.20,$0.00,$175.12,$0.00,$178.14,$0.00
27201859,EAP,HCPCS C1725,,Wrkhorse Balloon 10-4/5/100,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
27201860,EAP,HCPCS C1894,,Pinnacle Introducer 5fr 10cm,$80.00,$0.00,$80.00,$43.44,$57.10,$0.00,$13.78,$57.10,$57.10,$14.01,$80.00,$0.00,$40.00,$63.36,$64.00,$0.00,$12.52,$0.00,$12.74,$0.00
27201861,EAP,HCPCS C1725,,Conquest Pta Balloon Dilatatio,$753.00,$0.00,$753.00,$408.88,$537.42,$0.00,$129.74,$537.42,$537.42,$131.84,$753.00,$0.00,$376.50,$596.38,$602.40,$0.00,$117.84,$0.00,$119.88,$0.00
27201862,EAP,HCPCS C1725,,Opti-plast  Balloon Dilatation,$501.00,$0.00,$501.00,$272.04,$357.56,$0.00,$86.32,$357.56,$357.56,$87.72,$501.00,$0.00,$250.50,$396.79,$400.80,$0.00,$78.41,$0.00,$79.76,$0.00
27201863,EAP,HCPCS C1725,,Workhorse Pta Workhorse Balloo,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
27201864,EAP,HCPCS C1769,,Guidewire Straight Fixed Core,$86.00,$0.00,$86.00,$46.70,$61.38,$0.00,$14.82,$61.38,$61.38,$15.06,$86.00,$0.00,$43.00,$68.11,$68.80,$0.00,$13.46,$0.00,$13.69,$0.00
27201865,EAP,HCPCS C1769,,Guidewire 3mm J Fixed Core .03,$46.00,$0.00,$46.00,$24.98,$32.83,$0.00,$7.93,$32.83,$32.83,$8.05,$46.00,$0.00,$23.00,$36.43,$36.80,$0.00,$7.20,$0.00,$7.32,$0.00
27201866,EAP,HCPCS C1894,,Pinnacle Introducer 6fr 10cm,$76.00,$0.00,$76.00,$41.27,$54.24,$0.00,$13.09,$54.24,$54.24,$13.31,$76.00,$0.00,$38.00,$60.19,$60.80,$0.00,$11.89,$0.00,$12.10,$0.00
27201867,EAP,HCPCS C1894,,8fr 10cm Pinnacle Introducer,$72.00,$0.00,$72.00,$39.10,$51.39,$0.00,$12.41,$51.39,$51.39,$12.61,$72.00,$0.00,$36.00,$57.02,$57.60,$0.00,$11.27,$0.00,$11.46,$0.00
27201868,EAP,HCPCS C1894,,Pinnacle Introducer 8fr 10cm,$67.00,$0.00,$67.00,$36.38,$47.82,$0.00,$11.54,$47.82,$47.82,$11.73,$67.00,$0.00,$33.50,$53.06,$53.60,$0.00,$10.49,$0.00,$10.67,$0.00
27201869,EAP,HCPCS C1894,,Pinnacle Introducer 9fr 10cm,$80.00,$0.00,$80.00,$43.44,$57.10,$0.00,$13.78,$57.10,$57.10,$14.01,$80.00,$0.00,$40.00,$63.36,$64.00,$0.00,$12.52,$0.00,$12.74,$0.00
27201870,EAP,HCPCS C1757,,Fogarty 5.5-40cm,$352.00,$0.00,$352.00,$0.00,$251.22,$0.00,$0.00,$251.22,$251.22,$0.00,$352.00,$0.00,$176.00,$278.78,$281.60,$0.00,$0.00,$0.00,$0.00,$0.00
27201871,EAP,HCPCS C1757,,Fogarty 5.5 80cm,$352.00,$0.00,$352.00,$0.00,$251.22,$0.00,$0.00,$251.22,$251.22,$0.00,$352.00,$0.00,$176.00,$278.78,$281.60,$0.00,$0.00,$0.00,$0.00,$0.00
27201872,EAP,HCPCS C1757,,Arrow Trerotola Thromolytic De,"$1,805.00",$0.00,"$1,805.00",$0.00,"$1,288.23",$0.00,$0.00,"$1,288.23","$1,288.23",$0.00,"$1,805.00",$0.00,$902.50,"$1,429.56","$1,444.00",$0.00,$0.00,$0.00,$0.00,$0.00
27201873,EAP,HCPCS C1757,,Complex Fiber Coil 18 X 3mm X,"$1,212.00",$0.00,"$1,212.00",$0.00,$865.00,$0.00,$0.00,$865.00,$865.00,$0.00,"$1,212.00",$0.00,$606.00,$959.90,$969.60,$0.00,$0.00,$0.00,$0.00,$0.00
27201874,EAP,HCPCS C1729,,Skater 10fr,$605.00,$0.00,$605.00,$328.52,$431.79,$0.00,$104.24,$431.79,$431.79,$105.93,$605.00,$0.00,$302.50,$479.16,$484.00,$0.00,$94.68,$0.00,$96.32,$0.00
27201875,EAP,HCPCS C1887,,Lima Guiding Catheter 7fr-55cm,$417.00,$0.00,$417.00,$226.43,$297.61,$0.00,$71.85,$297.61,$297.61,$73.01,$417.00,$0.00,$208.50,$330.26,$333.60,$0.00,$65.26,$0.00,$66.39,$0.00
27201876,EAP,HCPCS C1892,,Meditech Accustick Ii Introduc,$209.00,$0.00,$209.00,$113.49,$149.16,$0.00,$36.01,$149.16,$149.16,$36.59,$209.00,$0.00,$104.50,$165.53,$167.20,$0.00,$32.71,$0.00,$33.27,$0.00
27201877,EAP,HCPCS C1769,,22g X 10cm Chiba Needle,$70.00,$0.00,$70.00,$38.01,$49.96,$0.00,$12.06,$49.96,$49.96,$12.26,$70.00,$0.00,$35.00,$55.44,$56.00,$0.00,$10.96,$0.00,$11.14,$0.00
27201878,EAP,HCPCS C1769,,.038-145 Amplatz Extra Stiff,$76.00,$0.00,$76.00,$41.27,$54.24,$0.00,$13.09,$54.24,$54.24,$13.31,$76.00,$0.00,$38.00,$60.19,$60.80,$0.00,$11.89,$0.00,$12.10,$0.00
27201879,EAP,HCPCS C1751,,9fr Single Lumen Hickman,$241.00,$0.00,$241.00,$130.86,$172.00,$0.00,$41.52,$172.00,$172.00,$42.20,$241.00,$0.00,$120.50,$190.87,$192.80,$0.00,$37.72,$0.00,$38.37,$0.00
27201880,EAP,HCPCS C1751,,9fr Dual Lumen Hickman,$528.00,$0.00,$528.00,$286.70,$376.83,$0.00,$90.97,$376.83,$376.83,$92.45,$528.00,$0.00,$264.00,$418.18,$422.40,$0.00,$82.63,$0.00,$84.06,$0.00
27201881,EAP,HCPCS C1769,,.035-150cm 3mm J Guidewire,$68.00,$0.00,$68.00,$36.92,$48.53,$0.00,$11.72,$48.53,$48.53,$11.91,$68.00,$0.00,$34.00,$53.86,$54.40,$0.00,$10.64,$0.00,$10.83,$0.00
27201882,EAP,HCPCS C1769,,.035-150cm Rosen Guidewire,$65.00,$0.00,$65.00,$35.30,$46.39,$0.00,$11.20,$46.39,$46.39,$11.38,$65.00,$0.00,$32.50,$51.48,$52.00,$0.00,$10.17,$0.00,$10.35,$0.00
27201883,EAP,HCPCS C1752,,"12cm Niagra, Temp Dialysis Cat",$150.00,$0.00,$150.00,$0.00,$107.06,$0.00,$0.00,$107.06,$107.06,$0.00,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$0.00,$0.00,$0.00,$0.00
27201884,EAP,HCPCS C1752,,"15cm Niagra, Temp Dialysis Cat",$64.00,$0.00,$64.00,$0.00,$45.68,$0.00,$0.00,$45.68,$45.68,$0.00,$64.00,$0.00,$32.00,$50.69,$51.20,$0.00,$0.00,$0.00,$0.00,$0.00
27201885,EAP,HCPCS C1725,,8-2/5/100 Workhorse Balloon,$427.00,$0.00,$427.00,$231.86,$304.75,$0.00,$73.57,$304.75,$304.75,$74.76,$427.00,$0.00,$213.50,$338.18,$341.60,$0.00,$66.83,$0.00,$67.98,$0.00
27201886,EAP,HCPCS C1725,,4-2/5/75 Opti-plast Balloon,$501.00,$0.00,$501.00,$272.04,$357.56,$0.00,$86.32,$357.56,$357.56,$87.72,$501.00,$0.00,$250.50,$396.79,$400.80,$0.00,$78.41,$0.00,$79.76,$0.00
27201887,EAP,HCPCS C1725,,3-way Hp Stopcock,$934.00,$0.00,$934.00,$507.16,$666.60,$0.00,$160.92,$666.60,$666.60,$163.54,$934.00,$0.00,$467.00,$739.73,$747.20,$0.00,$146.17,$0.00,$148.69,$0.00
27201888,EAP,HCPCS C1894,,7fr 10cm Pinnacle Introducer,$71.00,$0.00,$71.00,$38.55,$50.67,$0.00,$12.23,$50.67,$50.67,$12.43,$71.00,$0.00,$35.50,$56.23,$56.80,$0.00,$11.11,$0.00,$11.30,$0.00
27201889,EAP,HCPCS C1894,,7fr 10cm Pinnacle Introducer,$135.00,$0.00,$135.00,$73.31,$96.35,$0.00,$23.26,$96.35,$96.35,$23.64,$135.00,$0.00,$67.50,$106.92,$108.00,$0.00,$21.13,$0.00,$21.49,$0.00
27201890,EAP,HCPCS C1725,,12-2/5.8/75 Udt Dilatation Bal,$889.00,$0.00,$889.00,$482.73,$634.48,$0.00,$153.17,$634.48,$634.48,$155.66,$889.00,$0.00,$444.50,$704.09,$711.20,$0.00,$139.13,$0.00,$141.53,$0.00
27201891,EAP,HCPCS C1729,,8fr Flexima Biliary Catheter,$271.00,$0.00,$271.00,$147.15,$193.41,$0.00,$46.69,$193.41,$193.41,$47.45,$271.00,$0.00,$135.50,$214.63,$216.80,$0.00,$42.41,$0.00,$43.14,$0.00
27201892,EAP,HCPCS C1729,,Cx 18.0-38-40-p-32s-bcl,$300.00,$0.00,$300.00,$162.90,$214.11,$0.00,$51.69,$214.11,$214.11,$52.53,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$46.95,$0.00,$47.76,$0.00
27201893,EAP,Custom 27201893,,Tibia Fracture Brace,$485.00,$0.00,$485.00,$0.00,$346.14,$0.00,$0.00,$346.14,$346.14,$0.00,$485.00,$0.00,$242.50,$384.12,$388.00,$0.00,$0.00,$0.00,$0.00,$0.00
27201905,EAP,Custom 27201905,,Scapel Surg W/handle Atta,$142.00,$0.00,$142.00,$0.00,$101.35,$0.00,$0.00,$101.35,$101.35,$0.00,$142.00,$0.00,$71.00,$112.46,$113.60,$0.00,$0.00,$0.00,$0.00,$0.00
27201906,EAP,HCPCS A6250,,Wound Paste,$118.00,$0.00,$118.00,$64.07,$84.22,$0.00,$20.33,$84.22,$84.22,$20.66,$118.00,$0.00,$59.00,$93.46,$94.40,$0.00,$18.47,$0.00,$18.79,$0.00
27201914,EAP,Custom 27201914,,Scapel Surg W/handle Atta,$142.00,$0.00,$142.00,$0.00,$101.35,$0.00,$0.00,$101.35,$101.35,$0.00,$142.00,$0.00,$71.00,$112.46,$113.60,$0.00,$0.00,$0.00,$0.00,$0.00
27201930,EAP,HCPCS C1729,,Catheter Foley 5cc 14fr,$18.00,$0.00,$18.00,$9.77,$12.85,$0.00,$3.10,$12.85,$12.85,$3.15,$18.00,$0.00,$9.00,$14.26,$14.40,$0.00,$2.82,$0.00,$2.87,$0.00
27201931,EAP,HCPCS C1729,,Catheter Foley 16fr,$18.00,$0.00,$18.00,$9.77,$12.85,$0.00,$3.10,$12.85,$12.85,$3.15,$18.00,$0.00,$9.00,$14.26,$14.40,$0.00,$2.82,$0.00,$2.87,$0.00
27201932,EAP,HCPCS C1729,,Catheter Foley 5cc 18fr,$18.00,$0.00,$18.00,$9.77,$12.85,$0.00,$3.10,$12.85,$12.85,$3.15,$18.00,$0.00,$9.00,$14.26,$14.40,$0.00,$2.82,$0.00,$2.87,$0.00
27202362,EAP,Custom 27202362,,Scapel Surg W/handle Atta,$142.00,$0.00,$142.00,$0.00,$101.35,$0.00,$0.00,$101.35,$101.35,$0.00,$142.00,$0.00,$71.00,$112.46,$113.60,$0.00,$0.00,$0.00,$0.00,$0.00
27202368,EAP,Custom 27202368,,Scapel Surg W/handle Att,$142.00,$0.00,$142.00,$0.00,$101.35,$0.00,$0.00,$101.35,$101.35,$0.00,$142.00,$0.00,$71.00,$112.46,$113.60,$0.00,$0.00,$0.00,$0.00,$0.00
27202375,EAP,HCPCS C1729,,Catheter Foley 5cc 14fr,$19.00,$0.00,$19.00,$10.32,$13.56,$0.00,$3.27,$13.56,$13.56,$3.33,$19.00,$0.00,$9.50,$15.05,$15.20,$0.00,$2.97,$0.00,$3.02,$0.00
27202376,EAP,HCPCS C1729,,Catheter Foley 16fr,$19.00,$0.00,$19.00,$10.32,$13.56,$0.00,$3.27,$13.56,$13.56,$3.33,$19.00,$0.00,$9.50,$15.05,$15.20,$0.00,$2.97,$0.00,$3.02,$0.00
27202377,EAP,HCPCS C1729,,Catheter Foley 5cc 18fr,$19.00,$0.00,$19.00,$10.32,$13.56,$0.00,$3.27,$13.56,$13.56,$3.33,$19.00,$0.00,$9.50,$15.05,$15.20,$0.00,$2.97,$0.00,$3.02,$0.00
27202384,EAP,HCPCS C1729,,Catheter Foley 30cc 28fr,$39.00,$0.00,$39.00,$21.18,$27.83,$0.00,$6.72,$27.83,$27.83,$6.83,$39.00,$0.00,$19.50,$30.89,$31.20,$0.00,$6.10,$0.00,$6.21,$0.00
27202388,EAP,HCPCS C1729,,Catheter Foley 16fr,$19.00,$0.00,$19.00,$10.32,$13.56,$0.00,$3.27,$13.56,$13.56,$3.33,$19.00,$0.00,$9.50,$15.05,$15.20,$0.00,$2.97,$0.00,$3.02,$0.00
27202389,EAP,HCPCS C1729,,Catheter Coude Size 14fr,$109.00,$0.00,$109.00,$59.19,$77.79,$0.00,$18.78,$77.79,$77.79,$19.09,$109.00,$0.00,$54.50,$86.33,$87.20,$0.00,$17.06,$0.00,$17.35,$0.00
27202390,EAP,HCPCS C1729,,Catheter Coude Size 16fr,$109.00,$0.00,$109.00,$59.19,$77.79,$0.00,$18.78,$77.79,$77.79,$19.09,$109.00,$0.00,$54.50,$86.33,$87.20,$0.00,$17.06,$0.00,$17.35,$0.00
27202395,EAP,HCPCS C1729,,Catheter Coude Size 14fr,$109.00,$0.00,$109.00,$59.19,$77.79,$0.00,$18.78,$77.79,$77.79,$19.09,$109.00,$0.00,$54.50,$86.33,$87.20,$0.00,$17.06,$0.00,$17.35,$0.00
27202396,EAP,HCPCS C1729,,Catheter Coude 30cc 24fr,$82.00,$0.00,$82.00,$44.53,$58.52,$0.00,$14.13,$58.52,$58.52,$14.36,$82.00,$0.00,$41.00,$64.94,$65.60,$0.00,$12.83,$0.00,$13.05,$0.00
27202397,EAP,Custom 27202397,,Scapel Surg W/handle Atta,$142.00,$0.00,$142.00,$0.00,$101.35,$0.00,$0.00,$101.35,$101.35,$0.00,$142.00,$0.00,$71.00,$112.46,$113.60,$0.00,$0.00,$0.00,$0.00,$0.00
27202403,EAP,Custom 27202403,,Scaple Surg W/handle Atta,$142.00,$0.00,$142.00,$0.00,$101.35,$0.00,$0.00,$101.35,$101.35,$0.00,$142.00,$0.00,$71.00,$112.46,$113.60,$0.00,$0.00,$0.00,$0.00,$0.00
27202406,EAP,HCPCS C1729,,Catheter Coude Size 14fr,$47.00,$0.00,$47.00,$25.52,$33.54,$0.00,$8.10,$33.54,$33.54,$8.23,$47.00,$0.00,$23.50,$37.22,$37.60,$0.00,$7.36,$0.00,$7.48,$0.00
27202407,EAP,HCPCS C1729,,Catheter Coude 30cc 24fr,$87.00,$0.00,$87.00,$47.24,$62.09,$0.00,$14.99,$62.09,$62.09,$15.23,$87.00,$0.00,$43.50,$68.90,$69.60,$0.00,$13.62,$0.00,$13.85,$0.00
27202418,EAP,HCPCS C1729,,Catheter Foley 5cc 14fr,$18.00,$0.00,$18.00,$9.77,$12.85,$0.00,$3.10,$12.85,$12.85,$3.15,$18.00,$0.00,$9.00,$14.26,$14.40,$0.00,$2.82,$0.00,$2.87,$0.00
27202419,EAP,HCPCS C1729,,Catheter Foley 16fr,$18.00,$0.00,$18.00,$9.77,$12.85,$0.00,$3.10,$12.85,$12.85,$3.15,$18.00,$0.00,$9.00,$14.26,$14.40,$0.00,$2.82,$0.00,$2.87,$0.00
27202420,EAP,HCPCS C1729,,Catheter Foley 5cc 18fr,$18.00,$0.00,$18.00,$9.77,$12.85,$0.00,$3.10,$12.85,$12.85,$3.15,$18.00,$0.00,$9.00,$14.26,$14.40,$0.00,$2.82,$0.00,$2.87,$0.00
27202421,EAP,HCPCS C1729,,Catheter Foley 3-way 30cc,$37.00,$0.00,$37.00,$20.09,$26.41,$0.00,$6.37,$26.41,$26.41,$6.48,$37.00,$0.00,$18.50,$29.30,$29.60,$0.00,$5.79,$0.00,$5.89,$0.00
27202432,EAP,HCPCS C1729,,Catheter Foley 5cc 14fr,$18.00,$0.00,$18.00,$9.77,$12.85,$0.00,$3.10,$12.85,$12.85,$3.15,$18.00,$0.00,$9.00,$14.26,$14.40,$0.00,$2.82,$0.00,$2.87,$0.00
27202433,EAP,HCPCS C1729,,Catheter Coude Size 14fr,$109.00,$0.00,$109.00,$59.19,$77.79,$0.00,$18.78,$77.79,$77.79,$19.09,$109.00,$0.00,$54.50,$86.33,$87.20,$0.00,$17.06,$0.00,$17.35,$0.00
27202434,EAP,HCPCS C1729,,Catheter Coude Size 16fr,$102.00,$0.00,$102.00,$55.39,$72.80,$0.00,$17.57,$72.80,$72.80,$17.86,$102.00,$0.00,$51.00,$80.78,$81.60,$0.00,$15.96,$0.00,$16.24,$0.00
27202435,EAP,Custom 27202435,,Scapel Surg W/handle Attached,$142.00,$0.00,$142.00,$0.00,$101.35,$0.00,$0.00,$101.35,$101.35,$0.00,$142.00,$0.00,$71.00,$112.46,$113.60,$0.00,$0.00,$0.00,$0.00,$0.00
27202446,EAP,HCPCS C1729,,Catheter Foley 5cc 14fr,$19.00,$0.00,$19.00,$10.32,$13.56,$0.00,$3.27,$13.56,$13.56,$3.33,$19.00,$0.00,$9.50,$15.05,$15.20,$0.00,$2.97,$0.00,$3.02,$0.00
27202447,EAP,HCPCS C1729,,Catheter Foley 16fr,$18.00,$0.00,$18.00,$9.77,$12.85,$0.00,$3.10,$12.85,$12.85,$3.15,$18.00,$0.00,$9.00,$14.26,$14.40,$0.00,$2.82,$0.00,$2.87,$0.00
27202448,EAP,HCPCS C1729,,Catheter Foley 5cc 18fr,$19.00,$0.00,$19.00,$10.32,$13.56,$0.00,$3.27,$13.56,$13.56,$3.33,$19.00,$0.00,$9.50,$15.05,$15.20,$0.00,$2.97,$0.00,$3.02,$0.00
27202449,EAP,HCPCS C1729,,Catheter Foley 30cc 28fr,$39.00,$0.00,$39.00,$21.18,$27.83,$0.00,$6.72,$27.83,$27.83,$6.83,$39.00,$0.00,$19.50,$30.89,$31.20,$0.00,$6.10,$0.00,$6.21,$0.00
27202462,EAP,HCPCS C1729,,Catheter Foley 5cc 14fr,$19.00,$0.00,$19.00,$10.32,$13.56,$0.00,$3.27,$13.56,$13.56,$3.33,$19.00,$0.00,$9.50,$15.05,$15.20,$0.00,$2.97,$0.00,$3.02,$0.00
27202463,EAP,HCPCS C1729,,Catheter Foley 5cc 18fr,$19.00,$0.00,$19.00,$10.32,$13.56,$0.00,$3.27,$13.56,$13.56,$3.33,$19.00,$0.00,$9.50,$15.05,$15.20,$0.00,$2.97,$0.00,$3.02,$0.00
27202470,EAP,HCPCS C1751,,Cragg-mcnamara 5-65-5 Infusion,$740.00,$0.00,$740.00,$401.82,$528.14,$0.00,$127.50,$528.14,$528.14,$129.57,$740.00,$0.00,$370.00,$586.08,$592.00,$0.00,$115.81,$0.00,$117.81,$0.00
27202471,EAP,HCPCS C1751,,Cragg-mcnamara 5-40-20 Infusio,$315.00,$0.00,$315.00,$171.05,$224.82,$0.00,$54.27,$224.82,$224.82,$55.15,$315.00,$0.00,$157.50,$249.48,$252.00,$0.00,$49.30,$0.00,$50.15,$0.00
27202472,EAP,HCPCS C1751,,Cragg-mcnamara 5-100-10 Infusi,$315.00,$0.00,$315.00,$171.05,$224.82,$0.00,$54.27,$224.82,$224.82,$55.15,$315.00,$0.00,$157.50,$249.48,$252.00,$0.00,$49.30,$0.00,$50.15,$0.00
27202473,EAP,HCPCS C1773,,15mm Amplatz Snare,$916.00,$0.00,$916.00,$497.39,$653.75,$0.00,$157.82,$653.75,$653.75,$160.38,$916.00,$0.00,$458.00,$725.47,$732.80,$0.00,$143.35,$0.00,$145.83,$0.00
27202474,EAP,HCPCS C1773,,25mm Amplatz Snare,$916.00,$0.00,$916.00,$497.39,$653.75,$0.00,$157.82,$653.75,$653.75,$160.38,$916.00,$0.00,$458.00,$725.47,$732.80,$0.00,$143.35,$0.00,$145.83,$0.00
27202475,EAP,HCPCS C1729,,10fr X 35cm Skater Nephrostomy,$254.00,$0.00,$254.00,$137.92,$181.28,$0.00,$43.76,$181.28,$181.28,$44.47,$254.00,$0.00,$127.00,$201.17,$203.20,$0.00,$39.75,$0.00,$40.44,$0.00
27202476,EAP,HCPCS C1750,,Chron Carbothane Cath 14.5f X 19cm,"$1,054.00",$0.00,"$1,054.00",$572.32,$752.24,$0.00,$181.60,$752.24,$752.24,$184.55,"$1,054.00",$0.00,$527.00,$834.77,$843.20,$0.00,$164.95,$0.00,$167.80,$0.00
27202477,EAP,HCPCS C1750,,23cm Sport Pack Perm Dialysis,$921.00,$0.00,$921.00,$500.10,$657.32,$0.00,$158.68,$657.32,$657.32,$161.26,$921.00,$0.00,$460.50,$729.43,$736.80,$0.00,$144.14,$0.00,$146.62,$0.00
27202478,EAP,HCPCS C1750,,28cm Sport Pack Perm Dialysis,"$2,263.00",$0.00,"$2,263.00","$1,228.81","$1,615.10",$0.00,$389.90,"$1,615.10","$1,615.10",$396.23,"$2,263.00",$0.00,"$1,131.50","$1,792.30","$1,810.40",$0.00,$354.16,$0.00,$360.27,$0.00
27202479,EAP,HCPCS C1752,,19cm Q-plus Temp Dialysis Kit,$254.00,$0.00,$254.00,$0.00,$181.28,$0.00,$0.00,$181.28,$181.28,$0.00,$254.00,$0.00,$127.00,$201.17,$203.20,$0.00,$0.00,$0.00,$0.00,$0.00
27202480,EAP,HCPCS C1894,,Sheath Flex 6fr 11cm,$138.00,$0.00,$138.00,$74.93,$98.49,$0.00,$23.78,$98.49,$98.49,$24.16,$138.00,$0.00,$69.00,$109.30,$110.40,$0.00,$21.60,$0.00,$21.97,$0.00
27202481,EAP,HCPCS C1751,,Hickman 10.0 French Triple Lum,"$1,357.00",$0.00,"$1,357.00",$736.85,$968.49,$0.00,$233.80,$968.49,$968.49,$237.60,"$1,357.00",$0.00,$678.50,"$1,074.74","$1,085.60",$0.00,$212.37,$0.00,$216.03,$0.00
27202482,EAP,HCPCS C1725,,Balloon Udt 4-2/5/120,$717.00,$0.00,$717.00,$389.33,$511.72,$0.00,$123.54,$511.72,$511.72,$125.54,$717.00,$0.00,$358.50,$567.86,$573.60,$0.00,$112.21,$0.00,$114.15,$0.00
27202483,EAP,HCPCS C1725,,Conquest Dialation Balloon 5mm,$717.00,$0.00,$717.00,$389.33,$511.72,$0.00,$123.54,$511.72,$511.72,$125.54,$717.00,$0.00,$358.50,$567.86,$573.60,$0.00,$112.21,$0.00,$114.15,$0.00
27202484,EAP,HCPCS C1725,,Conquest Dialation Balloon 5mm,$717.00,$0.00,$717.00,$389.33,$511.72,$0.00,$123.54,$511.72,$511.72,$125.54,$717.00,$0.00,$358.50,$567.86,$573.60,$0.00,$112.21,$0.00,$114.15,$0.00
27202485,EAP,HCPCS C1725,,Conquest Dialation Balloon 6mm,$717.00,$0.00,$717.00,$389.33,$511.72,$0.00,$123.54,$511.72,$511.72,$125.54,$717.00,$0.00,$358.50,$567.86,$573.60,$0.00,$112.21,$0.00,$114.15,$0.00
27202486,EAP,HCPCS C1725,,Conquest Dialation Balloon 6mm,$717.00,$0.00,$717.00,$389.33,$511.72,$0.00,$123.54,$511.72,$511.72,$125.54,$717.00,$0.00,$358.50,$567.86,$573.60,$0.00,$112.21,$0.00,$114.15,$0.00
27202487,EAP,HCPCS C1725,,Conquest Dialation Balloon 7mm,$717.00,$0.00,$717.00,$389.33,$511.72,$0.00,$123.54,$511.72,$511.72,$125.54,$717.00,$0.00,$358.50,$567.86,$573.60,$0.00,$112.21,$0.00,$114.15,$0.00
27202488,EAP,HCPCS C1725,,Conquest Dialation Balloon 7mm,$717.00,$0.00,$717.00,$389.33,$511.72,$0.00,$123.54,$511.72,$511.72,$125.54,$717.00,$0.00,$358.50,$567.86,$573.60,$0.00,$112.21,$0.00,$114.15,$0.00
27202489,EAP,HCPCS C1725,,Conquest Dialation Balloon 8mm,$717.00,$0.00,$717.00,$389.33,$511.72,$0.00,$123.54,$511.72,$511.72,$125.54,$717.00,$0.00,$358.50,$567.86,$573.60,$0.00,$112.21,$0.00,$114.15,$0.00
27202490,EAP,HCPCS C1725,,Conquest Dialation Balloon 8mm,$717.00,$0.00,$717.00,$389.33,$511.72,$0.00,$123.54,$511.72,$511.72,$125.54,$717.00,$0.00,$358.50,$567.86,$573.60,$0.00,$112.21,$0.00,$114.15,$0.00
27202491,EAP,HCPCS C1725,,Conquest Dialation Balloon 10m,$717.00,$0.00,$717.00,$389.33,$511.72,$0.00,$123.54,$511.72,$511.72,$125.54,$717.00,$0.00,$358.50,$567.86,$573.60,$0.00,$112.21,$0.00,$114.15,$0.00
27202492,EAP,HCPCS C1725,,Conquest Dialation Balloon 10m,$717.00,$0.00,$717.00,$389.33,$511.72,$0.00,$123.54,$511.72,$511.72,$125.54,$717.00,$0.00,$358.50,$567.86,$573.60,$0.00,$112.21,$0.00,$114.15,$0.00
27202493,EAP,HCPCS C1725,,Conquest Dialation Balloon 12m,$717.00,$0.00,$717.00,$389.33,$511.72,$0.00,$123.54,$511.72,$511.72,$125.54,$717.00,$0.00,$358.50,$567.86,$573.60,$0.00,$112.21,$0.00,$114.15,$0.00
27202494,EAP,HCPCS C1725,,Balloon Dial Cath 4mmx10cmx120,$717.00,$0.00,$717.00,$389.33,$511.72,$0.00,$123.54,$511.72,$511.72,$125.54,$717.00,$0.00,$358.50,$567.86,$573.60,$0.00,$112.21,$0.00,$114.15,$0.00
27202495,EAP,HCPCS C1751,,Vaxcel Central Venous Cath,$6.00,$0.00,$6.00,$3.26,$4.28,$0.00,$1.03,$4.28,$4.28,$1.05,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.94,$0.00,$0.96,$0.00
27202496,EAP,HCPCS C1725,,4mmx2cmx90xm Monorail Balloon,"$1,407.00",$0.00,"$1,407.00",$764.00,"$1,004.18",$0.00,$242.42,"$1,004.18","$1,004.18",$246.35,"$1,407.00",$0.00,$703.50,"$1,114.34","$1,125.60",$0.00,$220.20,$0.00,$223.99,$0.00
27202497,EAP,HCPCS C1725,,5mmx2cmx90cm Monorail Balloon,"$1,407.00",$0.00,"$1,407.00",$764.00,"$1,004.18",$0.00,$242.42,"$1,004.18","$1,004.18",$246.35,"$1,407.00",$0.00,$703.50,"$1,114.34","$1,125.60",$0.00,$220.20,$0.00,$223.99,$0.00
27202498,EAP,HCPCS C1725,,5mmx15cmx90xcm Monorail Biliar,"$4,654.00",$0.00,"$4,654.00","$2,527.12","$3,321.56",$0.00,$801.86,"$3,321.56","$3,321.56",$814.88,"$4,654.00",$0.00,"$2,327.00","$3,685.97","$3,723.20",$0.00,$728.35,$0.00,$740.92,$0.00
27202499,EAP,HCPCS C1725,,6mmx14cmx90cm Monorail Biliary,"$4,654.00",$0.00,"$4,654.00","$2,527.12","$3,321.56",$0.00,$801.86,"$3,321.56","$3,321.56",$814.88,"$4,654.00",$0.00,"$2,327.00","$3,685.97","$3,723.20",$0.00,$728.35,$0.00,$740.92,$0.00
27202500,EAP,HCPCS C1725,,6mmx18cmx90cm Monorail Bilary,"$4,654.00",$0.00,"$4,654.00","$2,527.12","$3,321.56",$0.00,$801.86,"$3,321.56","$3,321.56",$814.88,"$4,654.00",$0.00,"$2,327.00","$3,685.97","$3,723.20",$0.00,$728.35,$0.00,$740.92,$0.00
27202501,EAP,HCPCS C1769,,.018x190cm Thruway Guidewire,$291.00,$0.00,$291.00,$158.01,$207.69,$0.00,$50.14,$207.69,$207.69,$50.95,$291.00,$0.00,$145.50,$230.47,$232.80,$0.00,$45.54,$0.00,$46.33,$0.00
27202502,EAP,HCPCS C1893,,6frx45cm Renal Guiding Sheath,$260.00,$0.00,$260.00,$141.18,$185.56,$0.00,$44.80,$185.56,$185.56,$45.52,$260.00,$0.00,$130.00,$205.92,$208.00,$0.00,$40.69,$0.00,$41.39,$0.00
27202503,EAP,HCPCS C1725,,6x40x80 Polar Cath Balloon,"$4,496.00",$0.00,"$4,496.00","$2,441.33","$3,208.80",$0.00,$774.64,"$3,208.80","$3,208.80",$787.21,"$4,496.00",$0.00,"$2,248.00","$3,560.83","$3,596.80",$0.00,$703.62,$0.00,$715.76,$0.00
27202504,EAP,HCPCS C1725,,7x60x80 Polar Cath Balloon,"$4,496.00",$0.00,"$4,496.00","$2,441.33","$3,208.80",$0.00,$774.64,"$3,208.80","$3,208.80",$787.21,"$4,496.00",$0.00,"$2,248.00","$3,560.83","$3,596.80",$0.00,$703.62,$0.00,$715.76,$0.00
27202505,EAP,HCPCS C2629,,Banana Peel Sheath,$151.00,$0.00,$151.00,$81.99,$107.77,$0.00,$26.02,$107.77,$107.77,$26.44,$151.00,$0.00,$75.50,$119.59,$120.80,$0.00,$23.63,$0.00,$24.04,$0.00
27202506,EAP,HCPCS C1769,,Guidewite .014x180 Segway Gt,$417.00,$0.00,$417.00,$226.43,$297.61,$0.00,$71.85,$297.61,$297.61,$73.01,$417.00,$0.00,$208.50,$330.26,$333.60,$0.00,$65.26,$0.00,$66.39,$0.00
27202507,EAP,HCPCS C1769,,Guidewire .018x180cm Segway Gt,$417.00,$0.00,$417.00,$226.43,$297.61,$0.00,$71.85,$297.61,$297.61,$73.01,$417.00,$0.00,$208.50,$330.26,$333.60,$0.00,$65.26,$0.00,$66.39,$0.00
27202508,EAP,HCPCS C1769,,Str Guidewire .014x180 Segway,$417.00,$0.00,$417.00,$226.43,$297.61,$0.00,$71.85,$297.61,$297.61,$73.01,$417.00,$0.00,$208.50,$330.26,$333.60,$0.00,$65.26,$0.00,$66.39,$0.00
27202509,EAP,HCPCS C1751,,Infusion Embo Cath Segway,$835.00,$0.00,$835.00,$453.41,$595.94,$0.00,$143.87,$595.94,$595.94,$146.20,$835.00,$0.00,$417.50,$661.32,$668.00,$0.00,$130.68,$0.00,$132.93,$0.00
27202510,EAP,HCPCS C1757,,Complex Helical Coil,$239.00,$0.00,$239.00,$0.00,$170.57,$0.00,$0.00,$170.57,$170.57,$0.00,$239.00,$0.00,$119.50,$189.29,$191.20,$0.00,$0.00,$0.00,$0.00,$0.00
27202511,EAP,HCPCS C1894,,6fr Dial Ease Introducer Sheat,$43.00,$0.00,$43.00,$23.35,$30.69,$0.00,$7.41,$30.69,$30.69,$7.53,$43.00,$0.00,$21.50,$34.06,$34.40,$0.00,$6.73,$0.00,$6.85,$0.00
27202512,EAP,HCPCS C1725,,7-2/7/75 Workhorse Balloon,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
27202513,EAP,HCPCS C1725,,7-4/5/75 Workhorse Balloon,$427.00,$0.00,$427.00,$231.86,$304.75,$0.00,$73.57,$304.75,$304.75,$74.76,$427.00,$0.00,$213.50,$338.18,$341.60,$0.00,$66.83,$0.00,$67.98,$0.00
27202514,EAP,HCPCS C1894,,10fr 25cm Pinnacle Sheath Intr,$67.00,$0.00,$67.00,$36.38,$47.82,$0.00,$11.54,$47.82,$47.82,$11.73,$67.00,$0.00,$33.50,$53.06,$53.60,$0.00,$10.49,$0.00,$10.67,$0.00
27202515,EAP,HCPCS C1894,,5fr 25cm Pinnacle Introducer S,$59.00,$0.00,$59.00,$32.04,$42.11,$0.00,$10.17,$42.11,$42.11,$10.33,$59.00,$0.00,$29.50,$46.73,$47.20,$0.00,$9.23,$0.00,$9.39,$0.00
27202516,EAP,HCPCS C1894,,9fr 25cm Pinnacle Introducer S,$67.00,$0.00,$67.00,$36.38,$47.82,$0.00,$11.54,$47.82,$47.82,$11.73,$67.00,$0.00,$33.50,$53.06,$53.60,$0.00,$10.49,$0.00,$10.67,$0.00
27202517,EAP,HCPCS C1894,,6fr 25cm Pinnacle Introducer S,$67.00,$0.00,$67.00,$36.38,$47.82,$0.00,$11.54,$47.82,$47.82,$11.73,$67.00,$0.00,$33.50,$53.06,$53.60,$0.00,$10.49,$0.00,$10.67,$0.00
27202518,EAP,HCPCS C1894,,7fr 25cm Pinnacle Introducer S,$59.00,$0.00,$59.00,$32.04,$42.11,$0.00,$10.17,$42.11,$42.11,$10.33,$59.00,$0.00,$29.50,$46.73,$47.20,$0.00,$9.23,$0.00,$9.39,$0.00
27202519,EAP,HCPCS C1750,,23cm Hemoglide Perm Cath,"$2,140.00",$0.00,"$2,140.00","$1,162.02","$1,527.32",$0.00,$368.71,"$1,527.32","$1,527.32",$374.70,"$2,140.00",$0.00,"$1,070.00","$1,694.88","$1,712.00",$0.00,$334.91,$0.00,$340.69,$0.00
27202520,EAP,HCPCS C1750,,19cm Hemoglide Perm Cath,$916.00,$0.00,$916.00,$497.39,$653.75,$0.00,$157.82,$653.75,$653.75,$160.38,$916.00,$0.00,$458.00,$725.47,$732.80,$0.00,$143.35,$0.00,$145.83,$0.00
27202521,EAP,HCPCS C1769,,Nitrex Guidewire,$728.00,$0.00,$728.00,$395.30,$519.57,$0.00,$125.43,$519.57,$519.57,$127.47,$728.00,$0.00,$364.00,$576.58,$582.40,$0.00,$113.93,$0.00,$115.90,$0.00
27202522,EAP,HCPCS C1769,,Disposable Tip Deflecting Wire,$567.00,$0.00,$567.00,$307.88,$404.67,$0.00,$97.69,$404.67,$404.67,$99.28,$567.00,$0.00,$283.50,$449.06,$453.60,$0.00,$88.74,$0.00,$90.27,$0.00
27202523,EAP,HCPCS C1894,,10fr Pinnacle Introducer,$76.00,$0.00,$76.00,$41.27,$54.24,$0.00,$13.09,$54.24,$54.24,$13.31,$76.00,$0.00,$38.00,$60.19,$60.80,$0.00,$11.89,$0.00,$12.10,$0.00
27202524,EAP,HCPCS C1752,,Niagra Dialysis Catheter,$203.00,$0.00,$203.00,$0.00,$144.88,$0.00,$0.00,$144.88,$144.88,$0.00,$203.00,$0.00,$101.50,$160.78,$162.40,$0.00,$0.00,$0.00,$0.00,$0.00
27202525,EAP,HCPCS C2629,,5fr Tear-away Introducer,$81.00,$0.00,$81.00,$43.98,$57.81,$0.00,$13.96,$57.81,$57.81,$14.18,$81.00,$0.00,$40.50,$64.15,$64.80,$0.00,$12.68,$0.00,$12.90,$0.00
27202526,EAP,HCPCS C2629,,6fr Tear-away Introducer,$856.00,$0.00,$856.00,$464.81,$610.93,$0.00,$147.48,$610.93,$610.93,$149.88,$856.00,$0.00,$428.00,$677.95,$684.80,$0.00,$133.96,$0.00,$136.28,$0.00
27202527,EAP,HCPCS C2629,,8 Fr Tear Away Introducer,$397.00,$0.00,$397.00,$215.57,$283.34,$0.00,$68.40,$283.34,$283.34,$69.51,$397.00,$0.00,$198.50,$314.42,$317.60,$0.00,$62.13,$0.00,$63.20,$0.00
27202528,EAP,HCPCS C2629,,9fr Tear-away Introducer,$81.00,$0.00,$81.00,$43.98,$57.81,$0.00,$13.96,$57.81,$57.81,$14.18,$81.00,$0.00,$40.50,$64.15,$64.80,$0.00,$12.68,$0.00,$12.90,$0.00
27202529,EAP,HCPCS C2629,,10fr-16cm Introducer,$85.00,$0.00,$85.00,$46.16,$60.66,$0.00,$14.65,$60.66,$60.66,$14.88,$85.00,$0.00,$42.50,$67.32,$68.00,$0.00,$13.30,$0.00,$13.53,$0.00
27202530,EAP,Custom 27202530,,18 Ga Needle  Sterile  Guide,$65.00,$0.00,$65.00,$0.00,$46.39,$0.00,$0.00,$46.39,$46.39,$0.00,$65.00,$0.00,$32.50,$51.48,$52.00,$0.00,$0.00,$0.00,$0.00,$0.00
27202531,EAP,HCPCS C1729,,12fr Flexima Biliary Cath,$291.00,$0.00,$291.00,$158.01,$207.69,$0.00,$50.14,$207.69,$207.69,$50.95,$291.00,$0.00,$145.50,$230.47,$232.80,$0.00,$45.54,$0.00,$46.33,$0.00
27202532,EAP,HCPCS C1757,,2mmx20mm Complex Helical,$257.00,$0.00,$257.00,$0.00,$183.42,$0.00,$0.00,$183.42,$183.42,$0.00,$257.00,$0.00,$128.50,$203.54,$205.60,$0.00,$0.00,$0.00,$0.00,$0.00
27202533,EAP,HCPCS C1725,,4-4/5/75 Balloon Catheter,$681.00,$0.00,$681.00,$369.78,$486.03,$0.00,$117.33,$486.03,$486.03,$119.24,$681.00,$0.00,$340.50,$539.35,$544.80,$0.00,$106.58,$0.00,$108.42,$0.00
27202534,EAP,HCPCS C1769,,46fr-65cm C2 Glidecath,$167.00,$0.00,$167.00,$90.68,$119.19,$0.00,$28.77,$119.19,$119.19,$29.24,$167.00,$0.00,$83.50,$132.26,$133.60,$0.00,$26.14,$0.00,$26.59,$0.00
27202535,EAP,HCPCS C1757,,4mmx30mm Complex Helical,$265.00,$0.00,$265.00,$0.00,$189.13,$0.00,$0.00,$189.13,$189.13,$0.00,$265.00,$0.00,$132.50,$209.88,$212.00,$0.00,$0.00,$0.00,$0.00,$0.00
27202536,EAP,HCPCS C1725,,Bmx 8-3/5.8/75 Balloon Ca,$916.00,$0.00,$916.00,$497.39,$653.75,$0.00,$157.82,$653.75,$653.75,$160.38,$916.00,$0.00,$458.00,$725.47,$732.80,$0.00,$143.35,$0.00,$145.83,$0.00
27202537,EAP,HCPCS C1725,,Bmx14-4/7/100 Ballon Gath,"$1,008.00",$0.00,"$1,008.00",$547.34,$719.41,$0.00,$173.67,$719.41,$719.41,$176.49,"$1,008.00",$0.00,$504.00,$798.34,$806.40,$0.00,$157.75,$0.00,$160.47,$0.00
27202538,EAP,HCPCS C1729,,Catheter  10fr Flexima,$291.00,$0.00,$291.00,$158.01,$207.69,$0.00,$50.14,$207.69,$207.69,$50.95,$291.00,$0.00,$145.50,$230.47,$232.80,$0.00,$45.54,$0.00,$46.33,$0.00
27202539,EAP,HCPCS C1729,,Catheter  14fr Flexima,$282.00,$0.00,$282.00,$153.13,$201.26,$0.00,$48.59,$201.26,$201.26,$49.38,$282.00,$0.00,$141.00,$223.34,$225.60,$0.00,$44.13,$0.00,$44.89,$0.00
27202540,EAP,HCPCS C1751,,Catheter  9cm Katzen,"$1,506.00",$0.00,"$1,506.00",$817.76,"$1,074.83",$0.00,$259.48,"$1,074.83","$1,074.83",$263.69,"$1,506.00",$0.00,$753.00,"$1,192.75","$1,204.80",$0.00,$235.69,$0.00,$239.76,$0.00
27202541,EAP,HCPCS C1725,,Catheter  Balloon  Dc/20,"$2,062.00",$0.00,"$2,062.00","$1,119.67","$1,471.65",$0.00,$355.27,"$1,471.65","$1,471.65",$361.04,"$2,062.00",$0.00,"$1,031.00","$1,633.10","$1,649.60",$0.00,$322.70,$0.00,$328.27,$0.00
27202542,EAP,HCPCS C1725,,Catheter  Balloon Ultra-,$718.00,$0.00,$718.00,$389.87,$512.44,$0.00,$123.71,$512.44,$512.44,$125.72,$718.00,$0.00,$359.00,$568.66,$574.40,$0.00,$112.37,$0.00,$114.31,$0.00
27202543,EAP,HCPCS C1887,,Glidecath: 100cm Straight,$838.00,$0.00,$838.00,$455.03,$598.08,$0.00,$144.38,$598.08,$598.08,$146.73,$838.00,$0.00,$419.00,$663.70,$670.40,$0.00,$131.15,$0.00,$133.41,$0.00
27202544,EAP,HCPCS C1887,,Guidecath  5fr-100cm,$175.00,$0.00,$175.00,$95.03,$124.90,$0.00,$30.15,$124.90,$124.90,$30.64,$175.00,$0.00,$87.50,$138.60,$140.00,$0.00,$27.39,$0.00,$27.86,$0.00
27202545,EAP,HCPCS C1769,,Guidewire .035/150cm,"$1,424.00",$0.00,"$1,424.00",$773.23,"$1,016.31",$0.00,$245.35,"$1,016.31","$1,016.31",$249.33,"$1,424.00",$0.00,$712.00,"$1,127.81","$1,139.20",$0.00,$222.86,$0.00,$226.70,$0.00
27202546,EAP,HCPCS C1769,,Transcend -ex Guidewire,"$1,759.00",$0.00,"$1,759.00",$955.14,"$1,255.40",$0.00,$303.07,"$1,255.40","$1,255.40",$307.99,"$1,759.00",$0.00,$879.50,"$1,393.13","$1,407.20",$0.00,$275.28,$0.00,$280.03,$0.00
27202547,EAP,HCPCS C1725,,Udt6-10/5/120 Ballon Cath,$717.00,$0.00,$717.00,$389.33,$511.72,$0.00,$123.54,$511.72,$511.72,$125.54,$717.00,$0.00,$358.50,$567.86,$573.60,$0.00,$112.21,$0.00,$114.15,$0.00
27202548,EAP,HCPCS C1769,,V-18 Control Guidewires,$313.00,$0.00,$313.00,$169.96,$223.39,$0.00,$53.93,$223.39,$223.39,$54.80,$313.00,$0.00,$156.50,$247.90,$250.40,$0.00,$48.98,$0.00,$49.83,$0.00
27202549,EAP,HCPCS C1725,,Xxl 18-4/5.8/120e Ball Ga,$934.00,$0.00,$934.00,$507.16,$666.60,$0.00,$160.92,$666.60,$666.60,$163.54,$934.00,$0.00,$467.00,$739.73,$747.20,$0.00,$146.17,$0.00,$148.69,$0.00
27202550,EAP,HCPCS C1769,,Guidewire .035-260cm Rosen,$68.00,$0.00,$68.00,$36.92,$48.53,$0.00,$11.72,$48.53,$48.53,$11.91,$68.00,$0.00,$34.00,$53.86,$54.40,$0.00,$10.64,$0.00,$10.83,$0.00
27202551,EAP,HCPCS C1729,,10.2fr Biliary Drain Cath,$289.00,$0.00,$289.00,$156.93,$206.26,$0.00,$49.79,$206.26,$206.26,$50.60,$289.00,$0.00,$144.50,$228.89,$231.20,$0.00,$45.23,$0.00,$46.01,$0.00
27202552,EAP,HCPCS C1729,,12.0fr Biliary Drain Cath,$296.00,$0.00,$296.00,$160.73,$211.26,$0.00,$51.00,$211.26,$211.26,$51.83,$296.00,$0.00,$148.00,$234.43,$236.80,$0.00,$46.32,$0.00,$47.12,$0.00
27202553,EAP,HCPCS C1729,,12.0fr Mp Drain Catheter,$296.00,$0.00,$296.00,$160.73,$211.26,$0.00,$51.00,$211.26,$211.26,$51.83,$296.00,$0.00,$148.00,$234.43,$236.80,$0.00,$46.32,$0.00,$47.12,$0.00
27202554,EAP,HCPCS C1729,,14.0fr Biliary Drain,$296.00,$0.00,$296.00,$160.73,$211.26,$0.00,$51.00,$211.26,$211.26,$51.83,$296.00,$0.00,$148.00,$234.43,$236.80,$0.00,$46.32,$0.00,$47.12,$0.00
27202555,EAP,HCPCS C1769,,35-180 Coons Wire,$192.00,$0.00,$192.00,$104.26,$137.03,$0.00,$33.08,$137.03,$137.03,$33.62,$192.00,$0.00,$96.00,$152.06,$153.60,$0.00,$30.05,$0.00,$30.57,$0.00
27202556,EAP,HCPCS C1757,,35-2-3 Embolization Coil,$172.00,$0.00,$172.00,$0.00,$122.76,$0.00,$0.00,$122.76,$122.76,$0.00,$172.00,$0.00,$86.00,$136.22,$137.60,$0.00,$0.00,$0.00,$0.00,$0.00
27202557,EAP,HCPCS C1725,,7fr-100cm Montef 10re Cat,$54.00,$0.00,$54.00,$29.32,$38.54,$0.00,$9.30,$38.54,$38.54,$9.45,$54.00,$0.00,$27.00,$42.77,$43.20,$0.00,$8.45,$0.00,$8.60,$0.00
27202558,EAP,HCPCS C1894,,8fr Balkanintroducer,$170.00,$0.00,$170.00,$92.31,$121.33,$0.00,$29.29,$121.33,$121.33,$29.77,$170.00,$0.00,$85.00,$134.64,$136.00,$0.00,$26.61,$0.00,$27.06,$0.00
27202559,EAP,HCPCS C1894,,9fr Flexor Introducer,$159.00,$0.00,$159.00,$86.34,$113.48,$0.00,$27.39,$113.48,$113.48,$27.84,$159.00,$0.00,$79.50,$125.93,$127.20,$0.00,$24.88,$0.00,$25.31,$0.00
27202560,EAP,HCPCS C1757,,Coil  Embolization 35-5-5,$172.00,$0.00,$172.00,$0.00,$122.76,$0.00,$0.00,$122.76,$122.76,$0.00,$172.00,$0.00,$86.00,$136.22,$137.60,$0.00,$0.00,$0.00,$0.00,$0.00
27202561,EAP,HCPCS C1751,,135 Cm Mass Transit Max,"$2,960.00",$0.00,"$2,960.00","$1,607.28","$2,112.55",$0.00,$509.99,"$2,112.55","$2,112.55",$518.27,"$2,960.00",$0.00,"$1,480.00","$2,344.32","$2,368.00",$0.00,$463.24,$0.00,$471.23,$0.00
27202562,EAP,HCPCS C1894,,Introducer Pinnacle 7fr 10cm,$67.00,$0.00,$67.00,$36.38,$47.82,$0.00,$11.54,$47.82,$47.82,$11.73,$67.00,$0.00,$33.50,$53.06,$53.60,$0.00,$10.49,$0.00,$10.67,$0.00
27202563,EAP,HCPCS C1725,,Balloon Udt 4-4/5/120,$717.00,$0.00,$717.00,$389.33,$511.72,$0.00,$123.54,$511.72,$511.72,$125.54,$717.00,$0.00,$358.50,$567.86,$573.60,$0.00,$112.21,$0.00,$114.15,$0.00
27202564,EAP,HCPCS C1887,,5fr.100cmhinck Headhunter,$167.00,$0.00,$167.00,$90.68,$119.19,$0.00,$28.77,$119.19,$119.19,$29.24,$167.00,$0.00,$83.50,$132.26,$133.60,$0.00,$26.14,$0.00,$26.59,$0.00
27202565,EAP,HCPCS C1894,,8fr 25cm Pinnacle Introducer S,$59.00,$0.00,$59.00,$32.04,$42.11,$0.00,$10.17,$42.11,$42.11,$10.33,$59.00,$0.00,$29.50,$46.73,$47.20,$0.00,$9.23,$0.00,$9.39,$0.00
27202566,EAP,HCPCS C1887,,5f-90cm Ruc Catheter,$129.00,$0.00,$129.00,$70.05,$92.07,$0.00,$22.23,$92.07,$92.07,$22.59,$129.00,$0.00,$64.50,$102.17,$103.20,$0.00,$20.19,$0.00,$20.54,$0.00
27202567,EAP,HCPCS C2629,,Introducer Tear Away 120fx30cm,$142.00,$0.00,$142.00,$77.11,$101.35,$0.00,$24.47,$101.35,$101.35,$24.86,$142.00,$0.00,$71.00,$112.46,$113.60,$0.00,$22.22,$0.00,$22.61,$0.00
27202568,EAP,HCPCS C2629,,Introducer Tear Away 16f X15cm,$68.00,$0.00,$68.00,$36.92,$48.53,$0.00,$11.72,$48.53,$48.53,$11.91,$68.00,$0.00,$34.00,$53.86,$54.40,$0.00,$10.64,$0.00,$10.83,$0.00
27202569,EAP,HCPCS C2629,,Introducer Tear Away 14f X15cm,$68.00,$0.00,$68.00,$36.92,$48.53,$0.00,$11.72,$48.53,$48.53,$11.91,$68.00,$0.00,$34.00,$53.86,$54.40,$0.00,$10.64,$0.00,$10.83,$0.00
27202570,EAP,HCPCS C2629,,Introducer Tear Away12.5fx15cm,$103.00,$0.00,$103.00,$55.93,$73.51,$0.00,$17.75,$73.51,$73.51,$18.03,$103.00,$0.00,$51.50,$81.58,$82.40,$0.00,$16.12,$0.00,$16.40,$0.00
27202571,EAP,HCPCS C2629,,Introducer Tear Away 6f X 10cm,$159.00,$0.00,$159.00,$86.34,$113.48,$0.00,$27.39,$113.48,$113.48,$27.84,$159.00,$0.00,$79.50,$125.93,$127.20,$0.00,$24.88,$0.00,$25.31,$0.00
27202572,EAP,HCPCS C1769,,"Amplatz Sup Guidewire,035/75gw",$66.00,$0.00,$66.00,$35.84,$47.10,$0.00,$11.37,$47.10,$47.10,$11.56,$66.00,$0.00,$33.00,$52.27,$52.80,$0.00,$10.33,$0.00,$10.51,$0.00
27202573,EAP,HCPCS C1726,,Merci Balloon Guide Catheter,"$2,251.00",$0.00,"$2,251.00","$1,222.29","$1,606.54",$0.00,$387.84,"$1,606.54","$1,606.54",$394.13,"$2,251.00",$0.00,"$1,125.50","$1,782.79","$1,800.80",$0.00,$352.28,$0.00,$358.36,$0.00
27202574,EAP,HCPCS C1751,,Merci Microcatheter,"$1,641.00",$0.00,"$1,641.00",$891.06,"$1,171.18",$0.00,$282.74,"$1,171.18","$1,171.18",$287.33,"$1,641.00",$0.00,$820.50,"$1,299.67","$1,312.80",$0.00,$256.82,$0.00,$261.25,$0.00
27202575,EAP,HCPCS C1757,,Meri V-series Retrieval V2.0,"$10,341.00",$0.00,"$10,341.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$10,341.00",$0.00,"$5,170.50","$8,190.07","$8,272.80",$0.00,$0.00,$0.00,$0.00,$0.00
27202576,EAP,HCPCS C1757,,Meri V-series Retrieval V2.5,"$10,708.00",$0.00,"$10,708.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$10,708.00",$0.00,"$5,354.00","$8,480.74","$8,566.40",$0.00,$0.00,$0.00,$0.00,$0.00
27202577,EAP,HCPCS C1757,,Meri V-series Retrieval V3.0,"$10,708.00",$0.00,"$10,708.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$10,708.00",$0.00,"$5,354.00","$8,480.74","$8,566.40",$0.00,$0.00,$0.00,$0.00,$0.00
27202578,EAP,HCPCS C1757,,Meri V-series Retrieval V2.5,"$10,341.00",$0.00,"$10,341.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$10,341.00",$0.00,"$5,170.50","$8,190.07","$8,272.80",$0.00,$0.00,$0.00,$0.00,$0.00
27202579,EAP,HCPCS C1751,,Catheter Reperfusion 026,"$3,767.00",$0.00,"$3,767.00","$2,045.48","$2,688.51",$0.00,$649.04,"$2,688.51","$2,688.51",$659.57,"$3,767.00",$0.00,"$1,883.50","$2,983.46","$3,013.60",$0.00,$589.54,$0.00,$599.71,$0.00
27202580,EAP,HCPCS C1751,,Catheter Reperfusion 032,"$3,635.00",$0.00,"$3,635.00","$1,973.81","$2,594.30",$0.00,$626.29,"$2,594.30","$2,594.30",$636.46,"$3,635.00",$0.00,"$1,817.50","$2,878.92","$2,908.00",$0.00,$568.88,$0.00,$578.69,$0.00
27202581,EAP,HCPCS C1751,,Catheter Reperfusion 041,"$3,635.00",$0.00,"$3,635.00","$1,973.81","$2,594.30",$0.00,$626.29,"$2,594.30","$2,594.30",$636.46,"$3,635.00",$0.00,"$1,817.50","$2,878.92","$2,908.00",$0.00,$568.88,$0.00,$578.69,$0.00
27202582,EAP,Custom 27202582,,Separator 026,"$7,910.00",$0.00,"$7,910.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$7,910.00",$0.00,"$3,955.00","$6,264.72","$6,328.00",$0.00,$0.00,$0.00,$0.00,$0.00
27202583,EAP,Custom 27202583,,Separator 032,"$7,639.00",$0.00,"$7,639.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$7,639.00",$0.00,"$3,819.50","$6,050.09","$6,111.20",$0.00,$0.00,$0.00,$0.00,$0.00
27202584,EAP,Custom 27202584,,Separator 041,"$7,639.00",$0.00,"$7,639.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$7,639.00",$0.00,"$3,819.50","$6,050.09","$6,111.20",$0.00,$0.00,$0.00,$0.00,$0.00
27202585,EAP,Custom 27202585,,"Tubing, Aspiration","$1,279.00",$0.00,"$1,279.00",$0.00,$912.82,$0.00,$0.00,$912.82,$912.82,$0.00,"$1,279.00",$0.00,$639.50,"$1,012.97","$1,023.20",$0.00,$0.00,$0.00,$0.00,$0.00
27202586,EAP,Custom 27202586,,"Pump, Penumbra Aspiration","$8,340.00",$0.00,"$8,340.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$8,340.00",$0.00,"$4,170.00","$6,605.28","$6,672.00",$0.00,$0.00,$0.00,$0.00,$0.00
27202587,EAP,HCPCS C1751,,"Microcatheter, Microvention","$2,353.00",$0.00,"$2,353.00","$1,277.68","$1,679.34",$0.00,$405.41,"$1,679.34","$1,679.34",$411.99,"$2,353.00",$0.00,"$1,176.50","$1,863.58","$1,882.40",$0.00,$368.24,$0.00,$374.60,$0.00
27202588,EAP,Custom 27202588,,"Controller, V-grip Detachment",$560.00,$0.00,$560.00,$0.00,$399.67,$0.00,$0.00,$399.67,$399.67,$0.00,$560.00,$0.00,$280.00,$443.52,$448.00,$0.00,$0.00,$0.00,$0.00,$0.00
27202589,EAP,HCPCS C1751,,"Catheter, Echelon Micro","$2,072.00",$0.00,"$2,072.00","$1,125.10","$1,478.79",$0.00,$357.00,"$1,478.79","$1,478.79",$362.79,"$2,072.00",$0.00,"$1,036.00","$1,641.02","$1,657.60",$0.00,$324.27,$0.00,$329.86,$0.00
27202590,EAP,HCPCS C1726,,"Balloon, Hyperform 4mm X 7mm","$4,005.00",$0.00,"$4,005.00","$2,174.72","$2,858.37",$0.00,$690.04,"$2,858.37","$2,858.37",$701.24,"$4,005.00",$0.00,"$2,002.50","$3,171.96","$3,204.00",$0.00,$626.78,$0.00,$637.60,$0.00
27202591,EAP,HCPCS C1726,,"Balloon, Hyperform 7mm X 7mm","$4,005.00",$0.00,"$4,005.00","$2,174.72","$2,858.37",$0.00,$690.04,"$2,858.37","$2,858.37",$701.24,"$4,005.00",$0.00,"$2,002.50","$3,171.96","$3,204.00",$0.00,$626.78,$0.00,$637.60,$0.00
27202592,EAP,HCPCS C1726,,"Balloon, Hyperglide 4mm X 15mm","$3,336.00",$0.00,"$3,336.00","$1,811.45","$2,380.90",$0.00,$574.78,"$2,380.90","$2,380.90",$584.11,"$3,336.00",$0.00,"$1,668.00","$2,642.11","$2,668.80",$0.00,$522.08,$0.00,$531.09,$0.00
27202593,EAP,HCPCS C1887,,"Catheter, Envoy 6f Guiding",$884.00,$0.00,$884.00,$480.01,$630.91,$0.00,$152.31,$630.91,$630.91,$154.78,$884.00,$0.00,$442.00,$700.13,$707.20,$0.00,$138.35,$0.00,$140.73,$0.00
27202594,EAP,HCPCS C1751,,"Microcatheter, Rapidtransit","$2,002.00",$0.00,"$2,002.00","$1,087.09","$1,428.83",$0.00,$344.93,"$1,428.83","$1,428.83",$350.53,"$2,002.00",$0.00,"$1,001.00","$1,585.58","$1,601.60",$0.00,$313.31,$0.00,$318.72,$0.00
27202595,EAP,Custom 27202595,,"System,trufill N-bca Liquid Em",$281.00,$0.00,$281.00,$0.00,$200.55,$0.00,$0.00,$200.55,$200.55,$0.00,$281.00,$0.00,$140.50,$222.55,$224.80,$0.00,$0.00,$0.00,$0.00,$0.00
27202596,EAP,HCPCS C1887,,"Catheter, Envoy Xb Guiding",$988.00,$0.00,$988.00,$536.48,$705.14,$0.00,$170.23,$705.14,$705.14,$172.99,$988.00,$0.00,$494.00,$782.50,$790.40,$0.00,$154.62,$0.00,$157.29,$0.00
27202597,EAP,HCPCS C1751,,"Microcatheter, Prowler","$2,169.00",$0.00,"$2,169.00","$1,177.77","$1,548.02",$0.00,$373.71,"$1,548.02","$1,548.02",$379.77,"$2,169.00",$0.00,"$1,084.50","$1,717.85","$1,735.20",$0.00,$339.45,$0.00,$345.30,$0.00
27202598,EAP,HCPCS C1751,,"Microcatheter, Prowler","$2,277.00",$0.00,"$2,277.00","$1,236.41","$1,625.09",$0.00,$392.32,"$1,625.09","$1,625.09",$398.68,"$2,277.00",$0.00,"$1,138.50","$1,803.38","$1,821.60",$0.00,$356.35,$0.00,$362.50,$0.00
27202599,EAP,HCPCS C1769,,Guidewire Bentson .038 260 Exc,$88.00,$0.00,$88.00,$47.78,$62.81,$0.00,$15.16,$62.81,$62.81,$15.41,$88.00,$0.00,$44.00,$69.70,$70.40,$0.00,$13.77,$0.00,$14.01,$0.00
27202600,EAP,HCPCS C1769,,Guidwire Glide .038 150 Angle,$154.00,$0.00,$154.00,$83.62,$109.91,$0.00,$26.53,$109.91,$109.91,$26.96,$154.00,$0.00,$77.00,$121.97,$123.20,$0.00,$24.10,$0.00,$24.52,$0.00
27202601,EAP,HCPCS C1769,,Guidwire Glide .038 180 Angle,$37.00,$0.00,$37.00,$20.09,$26.41,$0.00,$6.37,$26.41,$26.41,$6.48,$37.00,$0.00,$18.50,$29.30,$29.60,$0.00,$5.79,$0.00,$5.89,$0.00
27202602,EAP,HCPCS C1769,,Guidewire Transend Ex .014,"$1,036.00",$0.00,"$1,036.00",$562.55,$739.39,$0.00,$178.50,$739.39,$739.39,$181.40,"$1,036.00",$0.00,$518.00,$820.51,$828.80,$0.00,$162.13,$0.00,$164.93,$0.00
27202603,EAP,HCPCS C1769,,Guidewire Transend Ex .014st,"$1,036.00",$0.00,"$1,036.00",$562.55,$739.39,$0.00,$178.50,$739.39,$739.39,$181.40,"$1,036.00",$0.00,$518.00,$820.51,$828.80,$0.00,$162.13,$0.00,$164.93,$0.00
27202604,EAP,HCPCS C1769,,Guidewire Transend Es 300cm,"$1,320.00",$0.00,"$1,320.00",$716.76,$942.08,$0.00,$227.43,$942.08,$942.08,$231.12,"$1,320.00",$0.00,$660.00,"$1,045.44","$1,056.00",$0.00,$206.58,$0.00,$210.14,$0.00
27202605,EAP,HCPCS C1887,,"Catheter, 7fr Guider Softip",$667.00,$0.00,$667.00,$362.18,$476.04,$0.00,$114.92,$476.04,$476.04,$116.79,$667.00,$0.00,$333.50,$528.26,$533.60,$0.00,$104.39,$0.00,$106.19,$0.00
27202606,EAP,HCPCS C1751,,"Catheter, Renegade Micro","$1,202.00",$0.00,"$1,202.00",$652.69,$857.87,$0.00,$207.10,$857.87,$857.87,$210.46,"$1,202.00",$0.00,$601.00,$951.98,$961.60,$0.00,$188.11,$0.00,$191.36,$0.00
27202607,EAP,HCPCS C1751,,"Microcatheter, Excelsior 1018","$2,169.00",$0.00,"$2,169.00","$1,177.77","$1,548.02",$0.00,$373.71,"$1,548.02","$1,548.02",$379.77,"$2,169.00",$0.00,"$1,084.50","$1,717.85","$1,735.20",$0.00,$339.45,$0.00,$345.30,$0.00
27202608,EAP,HCPCS C1769,,"Guidewire, Synchro2","$1,251.00",$0.00,"$1,251.00",$679.29,$892.84,$0.00,$215.54,$892.84,$892.84,$219.04,"$1,251.00",$0.00,$625.50,$990.79,"$1,000.80",$0.00,$195.78,$0.00,$199.16,$0.00
27202609,EAP,Custom 27202609,,26x12x12cm Aaa Endoprosthesis,"$23,752.00",$0.00,"$23,752.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$23,752.00",$0.00,"$11,876.00","$18,811.58","$19,001.60",$0.00,$0.00,$0.00,$0.00,$0.00
27202610,EAP,Custom 27202610,,26x12x14cm Aaa Endoprosthesis,"$23,752.00",$0.00,"$23,752.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$23,752.00",$0.00,"$11,876.00","$18,811.58","$19,001.60",$0.00,$0.00,$0.00,$0.00,$0.00
27202611,EAP,Custom 27202611,,12x12x13.5cm Lliac Limb Aaa St,"$21,112.00",$0.00,"$21,112.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$21,112.00",$0.00,"$10,556.00","$16,720.70","$16,889.60",$0.00,$0.00,$0.00,$0.00,$0.00
27202612,EAP,Custom 27202612,,18x24x13.5cm Iliac Limb Aaa St,"$24,857.00",$0.00,"$24,857.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$24,857.00",$0.00,"$12,428.50","$19,686.74","$19,885.60",$0.00,$0.00,$0.00,$0.00,$0.00
27202613,EAP,HCPCS C1751,,Cath 6fr 1lum Try 3cg Shrlk Maximal Brr Picc P,"$1,010.00",$0.00,"$1,010.00",$548.43,$720.84,$0.00,$174.02,$720.84,$720.84,$176.84,"$1,010.00",$0.00,$505.00,$799.92,$808.00,$0.00,$158.07,$0.00,$160.79,$0.00
27202614,EAP,Custom 27202614,,"Cather, Balloon, Ultra-thin Di","$1,580.00",$0.00,"$1,580.00",$0.00,"$1,127.65",$0.00,$0.00,"$1,127.65","$1,127.65",$0.00,"$1,580.00",$0.00,$790.00,"$1,251.36","$1,264.00",$0.00,$0.00,$0.00,$0.00,$0.00
27202615,EAP,Custom 27202615,,23x12x12cm Aaa Endoprosthesis,"$23,752.00",$0.00,"$23,752.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$23,752.00",$0.00,"$11,876.00","$18,811.58","$19,001.60",$0.00,$0.00,$0.00,$0.00,$0.00
27202616,EAP,Custom 27202616,,23x12x14cm Aaa Endoprosthesis,"$23,752.00",$0.00,"$23,752.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$23,752.00",$0.00,"$11,876.00","$18,811.58","$19,001.60",$0.00,$0.00,$0.00,$0.00,$0.00
27202617,EAP,Custom 27202617,,23x12x16cm Aaa Endoprosthesis,"$23,752.00",$0.00,"$23,752.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$23,752.00",$0.00,"$11,876.00","$18,811.58","$19,001.60",$0.00,$0.00,$0.00,$0.00,$0.00
27202618,EAP,Custom 27202618,,23x12x18cm Aaa Endoprosthesis,"$23,752.00",$0.00,"$23,752.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$23,752.00",$0.00,"$11,876.00","$18,811.58","$19,001.60",$0.00,$0.00,$0.00,$0.00,$0.00
27202619,EAP,Custom 27202619,,23x14.5x12cm Aaa Endoprosthesi,"$23,752.00",$0.00,"$23,752.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$23,752.00",$0.00,"$11,876.00","$18,811.58","$19,001.60",$0.00,$0.00,$0.00,$0.00,$0.00
27202620,EAP,Custom 27202620,,23x14.5x14cm Aaa Endoprosthesi,"$23,752.00",$0.00,"$23,752.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$23,752.00",$0.00,"$11,876.00","$18,811.58","$19,001.60",$0.00,$0.00,$0.00,$0.00,$0.00
27202621,EAP,Custom 27202621,,23x14.5x16cm Aaa Endoprosthesi,"$23,752.00",$0.00,"$23,752.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$23,752.00",$0.00,"$11,876.00","$18,811.58","$19,001.60",$0.00,$0.00,$0.00,$0.00,$0.00
27202622,EAP,Custom 27202622,,23x14.5x18cm Aaa Endoprosthesi,"$23,752.00",$0.00,"$23,752.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$23,752.00",$0.00,"$11,876.00","$18,811.58","$19,001.60",$0.00,$0.00,$0.00,$0.00,$0.00
27202623,EAP,Custom 27202623,,26x12x12cm Aaa Endoprosthesis,"$23,752.00",$0.00,"$23,752.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$23,752.00",$0.00,"$11,876.00","$18,811.58","$19,001.60",$0.00,$0.00,$0.00,$0.00,$0.00
27202624,EAP,Custom 27202624,,26x12x14cm Aaa Endoprosthesis,"$23,752.00",$0.00,"$23,752.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$23,752.00",$0.00,"$11,876.00","$18,811.58","$19,001.60",$0.00,$0.00,$0.00,$0.00,$0.00
27202625,EAP,Custom 27202625,,26x12x16cm Aaa Endoprosthesis,"$23,752.00",$0.00,"$23,752.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$23,752.00",$0.00,"$11,876.00","$18,811.58","$19,001.60",$0.00,$0.00,$0.00,$0.00,$0.00
27202626,EAP,Custom 27202626,,26x12x18cm Aaa Endoprosthesis,"$23,752.00",$0.00,"$23,752.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$23,752.00",$0.00,"$11,876.00","$18,811.58","$19,001.60",$0.00,$0.00,$0.00,$0.00,$0.00
27202627,EAP,Custom 27202627,,26x14.5x12cm Aaa Endoprosthesi,"$23,752.00",$0.00,"$23,752.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$23,752.00",$0.00,"$11,876.00","$18,811.58","$19,001.60",$0.00,$0.00,$0.00,$0.00,$0.00
27202628,EAP,Custom 27202628,,26x14.5x14cm Aaa Endoprosthesi,"$23,752.00",$0.00,"$23,752.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$23,752.00",$0.00,"$11,876.00","$18,811.58","$19,001.60",$0.00,$0.00,$0.00,$0.00,$0.00
27202629,EAP,Custom 27202629,,26x14.5x16cm Aaa Endoprosthesi,"$23,752.00",$0.00,"$23,752.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$23,752.00",$0.00,"$11,876.00","$18,811.58","$19,001.60",$0.00,$0.00,$0.00,$0.00,$0.00
27202630,EAP,Custom 27202630,,26x14.4x18cm Aaa Endoprosthesi,"$25,581.00",$0.00,"$25,581.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$25,581.00",$0.00,"$12,790.50","$20,260.15","$20,464.80",$0.00,$0.00,$0.00,$0.00,$0.00
27202631,EAP,Custom 27202631,,28.5x12x12cm Aaa Endoprosthesi,"$23,752.00",$0.00,"$23,752.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$23,752.00",$0.00,"$11,876.00","$18,811.58","$19,001.60",$0.00,$0.00,$0.00,$0.00,$0.00
27202632,EAP,Custom 27202632,,28.5x12x14cm Aaa Endoprosthesi,"$23,752.00",$0.00,"$23,752.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$23,752.00",$0.00,"$11,876.00","$18,811.58","$19,001.60",$0.00,$0.00,$0.00,$0.00,$0.00
27202633,EAP,Custom 27202633,,28.5x12x16cm Aaa Endoprosthesi,"$23,752.00",$0.00,"$23,752.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$23,752.00",$0.00,"$11,876.00","$18,811.58","$19,001.60",$0.00,$0.00,$0.00,$0.00,$0.00
27202634,EAP,Custom 27202634,,28.5x12x18cm Aaa Endoprosthesi,"$23,752.00",$0.00,"$23,752.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$23,752.00",$0.00,"$11,876.00","$18,811.58","$19,001.60",$0.00,$0.00,$0.00,$0.00,$0.00
27202635,EAP,Custom 27202635,,28.5x14.5x12cm Aaa Endoprosthe,"$23,752.00",$0.00,"$23,752.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$23,752.00",$0.00,"$11,876.00","$18,811.58","$19,001.60",$0.00,$0.00,$0.00,$0.00,$0.00
27202636,EAP,Custom 27202636,,28.5x14.5x14cm Aaa Endoprosthe,"$23,752.00",$0.00,"$23,752.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$23,752.00",$0.00,"$11,876.00","$18,811.58","$19,001.60",$0.00,$0.00,$0.00,$0.00,$0.00
27202637,EAP,Custom 27202637,,28.5x14.5x16cm Aaa Endoprosthe,"$23,752.00",$0.00,"$23,752.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$23,752.00",$0.00,"$11,876.00","$18,811.58","$19,001.60",$0.00,$0.00,$0.00,$0.00,$0.00
27202638,EAP,Custom 27202638,,28.5x14.4x18cm Aaa Endoprosthe,"$23,752.00",$0.00,"$23,752.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$23,752.00",$0.00,"$11,876.00","$18,811.58","$19,001.60",$0.00,$0.00,$0.00,$0.00,$0.00
27202639,EAP,Custom 27202639,,12x10cm Aaa Endoprosthesis,"$22,940.00",$0.00,"$22,940.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$22,940.00",$0.00,"$11,470.00","$18,168.48","$18,352.00",$0.00,$0.00,$0.00,$0.00,$0.00
27202640,EAP,Custom 27202640,,12x12cm Aaa Endoprosthesis,"$22,940.00",$0.00,"$22,940.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$22,940.00",$0.00,"$11,470.00","$18,168.48","$18,352.00",$0.00,$0.00,$0.00,$0.00,$0.00
27202641,EAP,Custom 27202641,,12x14cm Aaa Endoprosthesis,"$22,940.00",$0.00,"$22,940.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$22,940.00",$0.00,"$11,470.00","$18,168.48","$18,352.00",$0.00,$0.00,$0.00,$0.00,$0.00
27202642,EAP,Custom 27202642,,14.5x10cm Aaa Endoprosthesis,"$22,940.00",$0.00,"$22,940.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$22,940.00",$0.00,"$11,470.00","$18,168.48","$18,352.00",$0.00,$0.00,$0.00,$0.00,$0.00
27202643,EAP,Custom 27202643,,14.4x12 Aaa Endoprosthesis,"$22,940.00",$0.00,"$22,940.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$22,940.00",$0.00,"$11,470.00","$18,168.48","$18,352.00",$0.00,$0.00,$0.00,$0.00,$0.00
27202644,EAP,Custom 27202644,,14.5x14 Aaa Endoprosthesis,"$22,940.00",$0.00,"$22,940.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$22,940.00",$0.00,"$11,470.00","$18,168.48","$18,352.00",$0.00,$0.00,$0.00,$0.00,$0.00
27202645,EAP,Custom 27202645,,16x9.5cm Aaa Endoprosthesis,"$22,940.00",$0.00,"$22,940.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$22,940.00",$0.00,"$11,470.00","$18,168.48","$18,352.00",$0.00,$0.00,$0.00,$0.00,$0.00
27202646,EAP,Custom 27202646,,16x11.5cm Aaa Endoprosthesis,"$22,940.00",$0.00,"$22,940.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$22,940.00",$0.00,"$11,470.00","$18,168.48","$18,352.00",$0.00,$0.00,$0.00,$0.00,$0.00
27202647,EAP,Custom 27202647,,16x13.5cm Aaa Endoprosthesis,"$22,940.00",$0.00,"$22,940.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$22,940.00",$0.00,"$11,470.00","$18,168.48","$18,352.00",$0.00,$0.00,$0.00,$0.00,$0.00
27202648,EAP,Custom 27202648,,18x9.5cm Aaa Endoprosthesis,"$22,940.00",$0.00,"$22,940.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$22,940.00",$0.00,"$11,470.00","$18,168.48","$18,352.00",$0.00,$0.00,$0.00,$0.00,$0.00
27202649,EAP,Custom 27202649,,18x11.5cm Aaa Endoprosthesis,"$22,940.00",$0.00,"$22,940.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$22,940.00",$0.00,"$11,470.00","$18,168.48","$18,352.00",$0.00,$0.00,$0.00,$0.00,$0.00
27202650,EAP,Custom 27202650,,18x13.5cm Aaa Endoprosthesis,"$22,940.00",$0.00,"$22,940.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$22,940.00",$0.00,"$11,470.00","$18,168.48","$18,352.00",$0.00,$0.00,$0.00,$0.00,$0.00
27202651,EAP,Custom 27202651,,20x9.5cm Aaa Endoprosthesis,"$22,940.00",$0.00,"$22,940.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$22,940.00",$0.00,"$11,470.00","$18,168.48","$18,352.00",$0.00,$0.00,$0.00,$0.00,$0.00
27202652,EAP,Custom 27202652,,20x11.5cm Aaa Endoprosthesis,"$22,940.00",$0.00,"$22,940.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$22,940.00",$0.00,"$11,470.00","$18,168.48","$18,352.00",$0.00,$0.00,$0.00,$0.00,$0.00
27202653,EAP,Custom 27202653,,20x13.5cm Aaa Endoprosthesis,"$22,940.00",$0.00,"$22,940.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$22,940.00",$0.00,"$11,470.00","$18,168.48","$18,352.00",$0.00,$0.00,$0.00,$0.00,$0.00
27202654,EAP,Custom 27202654,,12x12x8.5cm Iliac Limb Aaa Ste,"$18,214.00",$0.00,"$18,214.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$18,214.00",$0.00,"$9,107.00","$14,425.49","$14,571.20",$0.00,$0.00,$0.00,$0.00,$0.00
27202655,EAP,Custom 27202655,,13x13x8.5cm Iliac Limb Aaa Ste,"$18,214.00",$0.00,"$18,214.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$18,214.00",$0.00,"$9,107.00","$14,425.49","$14,571.20",$0.00,$0.00,$0.00,$0.00,$0.00
27202656,EAP,Custom 27202656,,14x14x8.5cm Iliac Limb Aaa Ste,"$18,214.00",$0.00,"$18,214.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$18,214.00",$0.00,"$9,107.00","$14,425.49","$14,571.20",$0.00,$0.00,$0.00,$0.00,$0.00
27202657,EAP,Custom 27202657,,15x15x8.5cm Iliac Limb Aaa Ste,"$18,214.00",$0.00,"$18,214.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$18,214.00",$0.00,"$9,107.00","$14,425.49","$14,571.20",$0.00,$0.00,$0.00,$0.00,$0.00
27202658,EAP,Custom 27202658,,16x16x8.5cm Iliac Limb Aaa Ste,"$18,214.00",$0.00,"$18,214.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$18,214.00",$0.00,"$9,107.00","$14,425.49","$14,571.20",$0.00,$0.00,$0.00,$0.00,$0.00
27202659,EAP,Custom 27202659,,18x18x8.5cm Iliac Limb Aaa Ste,"$18,898.00",$0.00,"$18,898.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$18,898.00",$0.00,"$9,449.00","$14,967.22","$15,118.40",$0.00,$0.00,$0.00,$0.00,$0.00
27202660,EAP,Custom 27202660,,20x20x8.5cm Iliac Limb Aaa Ste,"$18,898.00",$0.00,"$18,898.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$18,898.00",$0.00,"$9,449.00","$14,967.22","$15,118.40",$0.00,$0.00,$0.00,$0.00,$0.00
27202661,EAP,Custom 27202661,,12x12x11.5cm Iliac Limb Aaa St,"$19,236.00",$0.00,"$19,236.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$19,236.00",$0.00,"$9,618.00","$15,234.91","$15,388.80",$0.00,$0.00,$0.00,$0.00,$0.00
27202662,EAP,Custom 27202662,,13x13x11.5cmm Iliac Limb Aaa S,"$19,236.00",$0.00,"$19,236.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$19,236.00",$0.00,"$9,618.00","$15,234.91","$15,388.80",$0.00,$0.00,$0.00,$0.00,$0.00
27202663,EAP,Custom 27202663,,14x14x11.5cm Iliac Limb Aaa St,"$19,236.00",$0.00,"$19,236.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$19,236.00",$0.00,"$9,618.00","$15,234.91","$15,388.80",$0.00,$0.00,$0.00,$0.00,$0.00
27202664,EAP,Custom 27202664,,15x15x11.5cm Iliac Limb Aaa St,"$19,236.00",$0.00,"$19,236.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$19,236.00",$0.00,"$9,618.00","$15,234.91","$15,388.80",$0.00,$0.00,$0.00,$0.00,$0.00
27202665,EAP,Custom 27202665,,16x16x11.5cm Iliac Limb Aaa St,"$19,236.00",$0.00,"$19,236.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$19,236.00",$0.00,"$9,618.00","$15,234.91","$15,388.80",$0.00,$0.00,$0.00,$0.00,$0.00
27202666,EAP,Custom 27202666,,18x18x11.5cm Iliac Limb Aaa St,"$19,916.00",$0.00,"$19,916.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$19,916.00",$0.00,"$9,958.00","$15,773.47","$15,932.80",$0.00,$0.00,$0.00,$0.00,$0.00
27202667,EAP,Custom 27202667,,20x20x11.5cm Iliac Limb Aaa St,"$19,916.00",$0.00,"$19,916.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$19,916.00",$0.00,"$9,958.00","$15,773.47","$15,932.80",$0.00,$0.00,$0.00,$0.00,$0.00
27202668,EAP,Custom 27202668,,13x13x13.5cm Iliac Limb Aaa St,"$21,112.00",$0.00,"$21,112.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$21,112.00",$0.00,"$10,556.00","$16,720.70","$16,889.60",$0.00,$0.00,$0.00,$0.00,$0.00
27202669,EAP,Custom 27202669,,14x14x13.5cm Iliac Limb Aaa St,"$21,112.00",$0.00,"$21,112.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$21,112.00",$0.00,"$10,556.00","$16,720.70","$16,889.60",$0.00,$0.00,$0.00,$0.00,$0.00
27202670,EAP,Custom 27202670,,15x15x13.5cm Iliac Limb Aaa St,"$21,112.00",$0.00,"$21,112.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$21,112.00",$0.00,"$10,556.00","$16,720.70","$16,889.60",$0.00,$0.00,$0.00,$0.00,$0.00
27202671,EAP,Custom 27202671,,16x16x13.5cm Iliac Limb Aaa St,"$21,112.00",$0.00,"$21,112.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$21,112.00",$0.00,"$10,556.00","$16,720.70","$16,889.60",$0.00,$0.00,$0.00,$0.00,$0.00
27202672,EAP,Custom 27202672,,18x18x13.5cm Iliac Limb Aaa St,"$21,790.00",$0.00,"$21,790.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$21,790.00",$0.00,"$10,895.00","$17,257.68","$17,432.00",$0.00,$0.00,$0.00,$0.00,$0.00
27202673,EAP,Custom 27202673,,20x20x13.5cm Iliac Limb Aaa St,"$21,790.00",$0.00,"$21,790.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$21,790.00",$0.00,"$10,895.00","$17,257.68","$17,432.00",$0.00,$0.00,$0.00,$0.00,$0.00
27202674,EAP,Custom 27202674,,16x20x11.5cm Iliac Limb Aaa St,"$23,492.00",$0.00,"$23,492.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$23,492.00",$0.00,"$11,746.00","$18,605.66","$18,793.60",$0.00,$0.00,$0.00,$0.00,$0.00
27202675,EAP,Custom 27202675,,18x22x11.5cm Iliac Limb Aaa St,"$23,492.00",$0.00,"$23,492.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$23,492.00",$0.00,"$11,746.00","$18,605.66","$18,793.60",$0.00,$0.00,$0.00,$0.00,$0.00
27202676,EAP,Custom 27202676,,18x24x11.5cm Iliac Limb Aaa St,"$23,492.00",$0.00,"$23,492.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$23,492.00",$0.00,"$11,746.00","$18,605.66","$18,793.60",$0.00,$0.00,$0.00,$0.00,$0.00
27202677,EAP,Custom 27202677,,16x20x13.5cm Iliac Limb Aaa St,"$24,857.00",$0.00,"$24,857.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$24,857.00",$0.00,"$12,428.50","$19,686.74","$19,885.60",$0.00,$0.00,$0.00,$0.00,$0.00
27202678,EAP,Custom 27202678,,18x22x13.5cm Iliac Limb Aaa St,"$24,857.00",$0.00,"$24,857.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$24,857.00",$0.00,"$12,428.50","$19,686.74","$19,885.60",$0.00,$0.00,$0.00,$0.00,$0.00
27202679,EAP,Custom 27202679,,18x24x13.5cm Iliac Limb Aaa St,"$24,857.00",$0.00,"$24,857.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$24,857.00",$0.00,"$12,428.50","$19,686.74","$19,885.60",$0.00,$0.00,$0.00,$0.00,$0.00
27202680,EAP,Custom 27202680,,12x12x5.5cm Iliac Cuff Aaa Ste,"$15,151.00",$0.00,"$15,151.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$15,151.00",$0.00,"$7,575.50","$11,999.59","$12,120.80",$0.00,$0.00,$0.00,$0.00,$0.00
27202681,EAP,Custom 27202681,,13x13x5.5cm Ilaic Cuff Aaa Ste,"$15,151.00",$0.00,"$15,151.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$15,151.00",$0.00,"$7,575.50","$11,999.59","$12,120.80",$0.00,$0.00,$0.00,$0.00,$0.00
27202682,EAP,Custom 27202682,,14x14x5.5cm Iliac Cuff Aaa Ste,"$15,151.00",$0.00,"$15,151.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$15,151.00",$0.00,"$7,575.50","$11,999.59","$12,120.80",$0.00,$0.00,$0.00,$0.00,$0.00
27202683,EAP,Custom 27202683,,15x15x5.5cm Iliac Cuff Aaa Ste,"$15,151.00",$0.00,"$15,151.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$15,151.00",$0.00,"$7,575.50","$11,999.59","$12,120.80",$0.00,$0.00,$0.00,$0.00,$0.00
27202684,EAP,Custom 27202684,,16x15x5.5cm Iliac Cuff Aaa Ste,"$15,151.00",$0.00,"$15,151.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$15,151.00",$0.00,"$7,575.50","$11,999.59","$12,120.80",$0.00,$0.00,$0.00,$0.00,$0.00
27202685,EAP,Custom 27202685,,18x18x5.5cm Iliac Cuff Aaa Ste,"$15,832.00",$0.00,"$15,832.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$15,832.00",$0.00,"$7,916.00","$12,538.94","$12,665.60",$0.00,$0.00,$0.00,$0.00,$0.00
27202686,EAP,Custom 27202686,,20x20x5.5cm Iliac Cuff Aaa Ste,"$15,832.00",$0.00,"$15,832.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$15,832.00",$0.00,"$7,916.00","$12,538.94","$12,665.60",$0.00,$0.00,$0.00,$0.00,$0.00
27202687,EAP,HCPCS C1769,,6mmx5cmx110cm 0.035 Guidewire,"$15,219.00",$0.00,"$15,219.00","$8,263.92","$5,158.80",$0.00,"$2,622.16","$5,158.80","$5,158.80","$2,664.73","$15,219.00",$0.00,"$7,609.50","$12,053.45","$12,175.20",$0.00,"$2,381.77",$0.00,"$2,422.86",$0.00
27202688,EAP,HCPCS C1769,,6mmx10cmx110cm 0.035 Guidewire,"$18,251.00",$0.00,"$18,251.00","$9,910.29","$5,158.80",$0.00,"$3,144.56","$5,158.80","$5,158.80","$3,195.60","$18,251.00",$0.00,"$9,125.50","$14,454.79","$14,600.80",$0.00,"$2,856.28",$0.00,"$2,905.56",$0.00
27202689,EAP,HCPCS C1769,,6mmx15cmx110cm 0.035 Guidewire,"$21,246.00",$0.00,"$21,246.00","$11,536.58","$5,158.80",$0.00,"$3,660.58","$5,158.80","$5,158.80","$3,720.00","$21,246.00",$0.00,"$10,623.00","$16,826.83","$16,996.80",$0.00,"$3,325.00",$0.00,"$3,382.36",$0.00
27202690,EAP,HCPCS C1769,,7mmx5cmx110cm 0.035 Guidewire,"$15,219.00",$0.00,"$15,219.00","$8,263.92","$5,158.80",$0.00,"$2,622.16","$5,158.80","$5,158.80","$2,664.73","$15,219.00",$0.00,"$7,609.50","$12,053.45","$12,175.20",$0.00,"$2,381.77",$0.00,"$2,422.86",$0.00
27202691,EAP,HCPCS C1769,,7mmx10cmx110cm 0.035 Guidewire,"$18,251.00",$0.00,"$18,251.00","$9,910.29","$5,158.80",$0.00,"$3,144.56","$5,158.80","$5,158.80","$3,195.60","$18,251.00",$0.00,"$9,125.50","$14,454.79","$14,600.80",$0.00,"$2,856.28",$0.00,"$2,905.56",$0.00
27202692,EAP,HCPCS C1769,,7mmx15cmx110cm 0.035 Guidewire,"$21,246.00",$0.00,"$21,246.00","$11,536.58","$5,158.80",$0.00,"$3,660.58","$5,158.80","$5,158.80","$3,720.00","$21,246.00",$0.00,"$10,623.00","$16,826.83","$16,996.80",$0.00,"$3,325.00",$0.00,"$3,382.36",$0.00
27202693,EAP,HCPCS C1769,,8mmx5cmx110cm 0.035 Guidewire,"$15,219.00",$0.00,"$15,219.00","$8,263.92","$5,158.80",$0.00,"$2,622.16","$5,158.80","$5,158.80","$2,664.73","$15,219.00",$0.00,"$7,609.50","$12,053.45","$12,175.20",$0.00,"$2,381.77",$0.00,"$2,422.86",$0.00
27202694,EAP,HCPCS C1769,,8mmx10cmx110cm 0.035 Guidewire,"$18,251.00",$0.00,"$18,251.00","$9,910.29","$5,158.80",$0.00,"$3,144.56","$5,158.80","$5,158.80","$3,195.60","$18,251.00",$0.00,"$9,125.50","$14,454.79","$14,600.80",$0.00,"$2,856.28",$0.00,"$2,905.56",$0.00
27202695,EAP,HCPCS C1769,,8mmx15cmx110cm 0.035 Guidewire,"$21,246.00",$0.00,"$21,246.00","$11,536.58","$5,158.80",$0.00,"$3,660.58","$5,158.80","$5,158.80","$3,720.00","$21,246.00",$0.00,"$10,623.00","$16,826.83","$16,996.80",$0.00,"$3,325.00",$0.00,"$3,382.36",$0.00
27202696,EAP,HCPCS C1769,,10mmx5cmx110cm 0.025 Guidewire,"$15,219.00",$0.00,"$15,219.00","$8,263.92","$5,158.80",$0.00,"$2,622.16","$5,158.80","$5,158.80","$2,664.73","$15,219.00",$0.00,"$7,609.50","$12,053.45","$12,175.20",$0.00,"$2,381.77",$0.00,"$2,422.86",$0.00
27202697,EAP,HCPCS C1769,,10mmx10cmx110cm 0.025 Guidewir,"$18,251.00",$0.00,"$18,251.00","$9,910.29","$5,158.80",$0.00,"$3,144.56","$5,158.80","$5,158.80","$3,195.60","$18,251.00",$0.00,"$9,125.50","$14,454.79","$14,600.80",$0.00,"$2,856.28",$0.00,"$2,905.56",$0.00
27202698,EAP,HCPCS C1769,,13mmx5cmx110cm 0.025 Guidewire,"$15,219.00",$0.00,"$15,219.00","$8,263.92","$5,158.80",$0.00,"$2,622.16","$5,158.80","$5,158.80","$2,664.73","$15,219.00",$0.00,"$7,609.50","$12,053.45","$12,175.20",$0.00,"$2,381.77",$0.00,"$2,422.86",$0.00
27202699,EAP,HCPCS C1769,,13mmx2.5cmx110cm 0.025 Guidewi,"$15,219.00",$0.00,"$15,219.00","$8,263.92","$5,158.80",$0.00,"$2,622.16","$5,158.80","$5,158.80","$2,664.73","$15,219.00",$0.00,"$7,609.50","$12,053.45","$12,175.20",$0.00,"$2,381.77",$0.00,"$2,422.86",$0.00
27202700,EAP,Custom 27202700,,16mmx20mmx8.5cm Aaa Stent Graf,"$22,131.00",$0.00,"$22,131.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$22,131.00",$0.00,"$11,065.50","$17,527.75","$17,704.80",$0.00,$0.00,$0.00,$0.00,$0.00
27202701,EAP,Custom 27202701,,18mmx22mmx8.5cm Aaa Stent Graf,"$22,131.00",$0.00,"$22,131.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$22,131.00",$0.00,"$11,065.50","$17,527.75","$17,704.80",$0.00,$0.00,$0.00,$0.00,$0.00
27202702,EAP,Custom 27202702,,18mmx24mmx8.5cm Aaa Stent Graf,"$22,131.00",$0.00,"$22,131.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$22,131.00",$0.00,"$11,065.50","$17,527.75","$17,704.80",$0.00,$0.00,$0.00,$0.00,$0.00
27202703,EAP,Custom 27202703,,20mmx4.0cm Aaa Stent Graft,"$15,151.00",$0.00,"$15,151.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$15,151.00",$0.00,"$7,575.50","$11,999.59","$12,120.80",$0.00,$0.00,$0.00,$0.00,$0.00
27202704,EAP,Custom 27202704,,22mmx4.0cm Aaa Stent Graft,"$15,151.00",$0.00,"$15,151.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$15,151.00",$0.00,"$7,575.50","$11,999.59","$12,120.80",$0.00,$0.00,$0.00,$0.00,$0.00
27202705,EAP,Custom 27202705,,24mmx4.0cm Aaa Stent Graft,"$15,151.00",$0.00,"$15,151.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$15,151.00",$0.00,"$7,575.50","$11,999.59","$12,120.80",$0.00,$0.00,$0.00,$0.00,$0.00
27202706,EAP,Custom 27202706,,26mmx4.0cm Aaa Stent Graft,"$15,151.00",$0.00,"$15,151.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$15,151.00",$0.00,"$7,575.50","$11,999.59","$12,120.80",$0.00,$0.00,$0.00,$0.00,$0.00
27202707,EAP,Custom 27202707,,28mmx4.0cm Aaa Stent Graft,"$15,151.00",$0.00,"$15,151.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$15,151.00",$0.00,"$7,575.50","$11,999.59","$12,120.80",$0.00,$0.00,$0.00,$0.00,$0.00
27202708,EAP,Custom 27202708,,23x3.3cm Aaa Endoprosthesis,"$17,322.00",$0.00,"$17,322.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$17,322.00",$0.00,"$8,661.00","$13,719.02","$13,857.60",$0.00,$0.00,$0.00,$0.00,$0.00
27202709,EAP,Custom 27202709,,26x3.3cm Aaa Endprosthesis,"$17,322.00",$0.00,"$17,322.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$17,322.00",$0.00,"$8,661.00","$13,719.02","$13,857.60",$0.00,$0.00,$0.00,$0.00,$0.00
27202710,EAP,Custom 27202710,,28.5x3.3cm Aaa Endoprosthesis,"$16,083.00",$0.00,"$16,083.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$16,083.00",$0.00,"$8,041.50","$12,737.74","$12,866.40",$0.00,$0.00,$0.00,$0.00,$0.00
27202711,EAP,Custom 27202711,,10x7cm Aaa Endoprosthesis,"$16,083.00",$0.00,"$16,083.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$16,083.00",$0.00,"$8,041.50","$12,737.74","$12,866.40",$0.00,$0.00,$0.00,$0.00,$0.00
27202712,EAP,Custom 27202712,,12x7cm Aaa Endoprosthesis,"$16,083.00",$0.00,"$16,083.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$16,083.00",$0.00,"$8,041.50","$12,737.74","$12,866.40",$0.00,$0.00,$0.00,$0.00,$0.00
27202713,EAP,Custom 27202713,,14.5x7cm Aaa Endoprosthesis,"$16,083.00",$0.00,"$16,083.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$16,083.00",$0.00,"$8,041.50","$12,737.74","$12,866.40",$0.00,$0.00,$0.00,$0.00,$0.00
27202714,EAP,Custom 27202714,,12frx30cm Introducer Sheath,$525.00,$0.00,$525.00,$0.00,$374.69,$0.00,$0.00,$374.69,$374.69,$0.00,$525.00,$0.00,$262.50,$415.80,$420.00,$0.00,$0.00,$0.00,$0.00,$0.00
27202715,EAP,Custom 27202715,,18frx30cm Intruder Sheath,$902.00,$0.00,$902.00,$0.00,$643.76,$0.00,$0.00,$643.76,$643.76,$0.00,$902.00,$0.00,$451.00,$714.38,$721.60,$0.00,$0.00,$0.00,$0.00,$0.00
27202716,EAP,Custom 27202716,,26x10cm Thoracic Endoprosthesi,"$23,023.00",$0.00,"$23,023.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$23,023.00",$0.00,"$11,511.50","$18,234.22","$18,418.40",$0.00,$0.00,$0.00,$0.00,$0.00
27202717,EAP,Custom 27202717,,28x10cm Thoracic Endoprosthesi,"$23,023.00",$0.00,"$23,023.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$23,023.00",$0.00,"$11,511.50","$18,234.22","$18,418.40",$0.00,$0.00,$0.00,$0.00,$0.00
27202718,EAP,Custom 27202718,,28x15cm Thoracic Endoprosthesi,"$23,023.00",$0.00,"$23,023.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$23,023.00",$0.00,"$11,511.50","$18,234.22","$18,418.40",$0.00,$0.00,$0.00,$0.00,$0.00
27202719,EAP,Custom 27202719,,31x10cm Thoracic Endoprosthesi,"$23,023.00",$0.00,"$23,023.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$23,023.00",$0.00,"$11,511.50","$18,234.22","$18,418.40",$0.00,$0.00,$0.00,$0.00,$0.00
27202720,EAP,Custom 27202720,,31x15cm Thoracic Endoprosthesi,"$23,023.00",$0.00,"$23,023.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$23,023.00",$0.00,"$11,511.50","$18,234.22","$18,418.40",$0.00,$0.00,$0.00,$0.00,$0.00
27202721,EAP,Custom 27202721,,34x10cm Thoracic Endoprosthesi,"$23,023.00",$0.00,"$23,023.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$23,023.00",$0.00,"$11,511.50","$18,234.22","$18,418.40",$0.00,$0.00,$0.00,$0.00,$0.00
27202722,EAP,Custom 27202722,,34x15cm Thoracic Endoprosthesi,"$23,023.00",$0.00,"$23,023.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$23,023.00",$0.00,"$11,511.50","$18,234.22","$18,418.40",$0.00,$0.00,$0.00,$0.00,$0.00
27202723,EAP,Custom 27202723,,34x20cm Thoracic Endoprosthesi,"$23,023.00",$0.00,"$23,023.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$23,023.00",$0.00,"$11,511.50","$18,234.22","$18,418.40",$0.00,$0.00,$0.00,$0.00,$0.00
27202724,EAP,Custom 27202724,,37x10cm Thoracic Endoprosthesi,"$23,023.00",$0.00,"$23,023.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$23,023.00",$0.00,"$11,511.50","$18,234.22","$18,418.40",$0.00,$0.00,$0.00,$0.00,$0.00
27202725,EAP,Custom 27202725,,37x15cm Thoracic Endoprosthesi,"$23,023.00",$0.00,"$23,023.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$23,023.00",$0.00,"$11,511.50","$18,234.22","$18,418.40",$0.00,$0.00,$0.00,$0.00,$0.00
27202726,EAP,Custom 27202726,,37x20cm Thoracic Endoprosthesi,"$23,023.00",$0.00,"$23,023.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$23,023.00",$0.00,"$11,511.50","$18,234.22","$18,418.40",$0.00,$0.00,$0.00,$0.00,$0.00
27202727,EAP,Custom 27202727,,40x10cm Thoracic Endoprosthesi,"$23,023.00",$0.00,"$23,023.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$23,023.00",$0.00,"$11,511.50","$18,234.22","$18,418.40",$0.00,$0.00,$0.00,$0.00,$0.00
27202728,EAP,Custom 27202728,,40x15cm Thoracic Endoprosthesi,"$23,023.00",$0.00,"$23,023.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$23,023.00",$0.00,"$11,511.50","$18,234.22","$18,418.40",$0.00,$0.00,$0.00,$0.00,$0.00
27202729,EAP,Custom 27202729,,40x20cm Thoracic Endoprosthesi,"$23,023.00",$0.00,"$23,023.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$23,023.00",$0.00,"$11,511.50","$18,234.22","$18,418.40",$0.00,$0.00,$0.00,$0.00,$0.00
27202730,EAP,Custom 27202730,,20frx30cm Introducer Sheath,"$2,043.00",$0.00,"$2,043.00",$0.00,"$1,458.09",$0.00,$0.00,"$1,458.09","$1,458.09",$0.00,"$2,043.00",$0.00,"$1,021.50","$1,618.06","$1,634.40",$0.00,$0.00,$0.00,$0.00,$0.00
27202731,EAP,Custom 27202731,,22frx30cm Introducer Sheath,"$2,043.00",$0.00,"$2,043.00",$0.00,"$1,458.09",$0.00,$0.00,"$1,458.09","$1,458.09",$0.00,"$2,043.00",$0.00,"$1,021.50","$1,618.06","$1,634.40",$0.00,$0.00,$0.00,$0.00,$0.00
27202732,EAP,Custom 27202732,,24frx30cm Introducer Sheath,"$2,043.00",$0.00,"$2,043.00",$0.00,"$1,458.09",$0.00,$0.00,"$1,458.09","$1,458.09",$0.00,"$2,043.00",$0.00,"$1,021.50","$1,618.06","$1,634.40",$0.00,$0.00,$0.00,$0.00,$0.00
27202733,EAP,Custom 27202733,,Gore Tri-lobe Ballon Catheter,"$3,391.00",$0.00,"$3,391.00",$0.00,"$2,420.16",$0.00,$0.00,"$2,420.16","$2,420.16",$0.00,"$3,391.00",$0.00,"$1,695.50","$2,685.67","$2,712.80",$0.00,$0.00,$0.00,$0.00,$0.00
27202734,EAP,Custom 27202734,,20x12x135mm Aaa Stent Graft,"$25,471.00",$0.00,"$25,471.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$25,471.00",$0.00,"$12,735.50","$20,173.03","$20,376.80",$0.00,$0.00,$0.00,$0.00,$0.00
27202735,EAP,Custom 27202735,,22x13x135mm Aaa Stent Graft,"$25,471.00",$0.00,"$25,471.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$25,471.00",$0.00,"$12,735.50","$20,173.03","$20,376.80",$0.00,$0.00,$0.00,$0.00,$0.00
27202736,EAP,Custom 27202736,,24x14x135mm Aaa Stent Graft,"$25,471.00",$0.00,"$25,471.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$25,471.00",$0.00,"$12,735.50","$20,173.03","$20,376.80",$0.00,$0.00,$0.00,$0.00,$0.00
27202737,EAP,Custom 27202737,,26x15x135mm Aaa Stent Graft,"$25,471.00",$0.00,"$25,471.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$25,471.00",$0.00,"$12,735.50","$20,173.03","$20,376.80",$0.00,$0.00,$0.00,$0.00,$0.00
27202738,EAP,Custom 27202738,,28x16x135mm Aaa Stent Graft,"$25,471.00",$0.00,"$25,471.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$25,471.00",$0.00,"$12,735.50","$20,173.03","$20,376.80",$0.00,$0.00,$0.00,$0.00,$0.00
27202739,EAP,Custom 27202739,,20x12x165mm Aaa Stent Graft,"$1,232.00",$0.00,"$1,232.00",$0.00,$879.28,$0.00,$0.00,$879.28,$879.28,$0.00,"$1,232.00",$0.00,$616.00,$975.74,$985.60,$0.00,$0.00,$0.00,$0.00,$0.00
27202740,EAP,Custom 27202740,,22x13x165mm Aaa Stent Graft,"$1,232.00",$0.00,"$1,232.00",$0.00,$879.28,$0.00,$0.00,$879.28,$879.28,$0.00,"$1,232.00",$0.00,$616.00,$975.74,$985.60,$0.00,$0.00,$0.00,$0.00,$0.00
27202741,EAP,Custom 27202741,,24x14x165mm Aaa Stent Graft,"$1,232.00",$0.00,"$1,232.00",$0.00,$879.28,$0.00,$0.00,$879.28,$879.28,$0.00,"$1,232.00",$0.00,$616.00,$975.74,$985.60,$0.00,$0.00,$0.00,$0.00,$0.00
27202742,EAP,Custom 27202742,,26x15x165mm Aaa Stent Graft,"$1,232.00",$0.00,"$1,232.00",$0.00,$879.28,$0.00,$0.00,$879.28,$879.28,$0.00,"$1,232.00",$0.00,$616.00,$975.74,$985.60,$0.00,$0.00,$0.00,$0.00,$0.00
27202743,EAP,Custom 27202743,,28x16x165mm Aaa Stent Graft,"$1,232.00",$0.00,"$1,232.00",$0.00,$879.28,$0.00,$0.00,$879.28,$879.28,$0.00,"$1,232.00",$0.00,$616.00,$975.74,$985.60,$0.00,$0.00,$0.00,$0.00,$0.00
27202744,EAP,Custom 27202744,,"Cath, Angioplasty Spv","$1,074.00",$0.00,"$1,074.00",$0.00,$766.51,$0.00,$0.00,$766.51,$766.51,$0.00,"$1,074.00",$0.00,$537.00,$850.61,$859.20,$0.00,$0.00,$0.00,$0.00,$0.00
27202745,EAP,HCPCS C1729,,Catheter Drainage Spv,$333.00,$0.00,$333.00,$180.82,$237.66,$0.00,$57.37,$237.66,$237.66,$58.31,$333.00,$0.00,$166.50,$263.74,$266.40,$0.00,$52.11,$0.00,$53.01,$0.00
27202746,EAP,Custom 27202746,,"Cath, Hemodial, Long-term Spv","$1,131.00",$0.00,"$1,131.00",$0.00,$807.19,$0.00,$0.00,$807.19,$807.19,$0.00,"$1,131.00",$0.00,$565.50,$895.75,$904.80,$0.00,$0.00,$0.00,$0.00,$0.00
27202747,EAP,Custom 27202747,,"Cath, Infusion Non-hemo Spv",$431.00,$0.00,$431.00,$0.00,$307.60,$0.00,$0.00,$307.60,$307.60,$0.00,$431.00,$0.00,$215.50,$341.35,$344.80,$0.00,$0.00,$0.00,$0.00,$0.00
27202748,EAP,Custom 27202748,,"Cath, Hemodial, Short-term Spv",$587.00,$0.00,$587.00,$0.00,$418.94,$0.00,$0.00,$418.94,$418.94,$0.00,$587.00,$0.00,$293.50,$464.90,$469.60,$0.00,$0.00,$0.00,$0.00,$0.00
27202749,EAP,Custom 27202749,,"Cath,thrombect/embolect Spv","$2,336.00",$0.00,"$2,336.00",$0.00,"$1,667.20",$0.00,$0.00,"$1,667.20","$1,667.20",$0.00,"$2,336.00",$0.00,"$1,168.00","$1,850.11","$1,868.80",$0.00,$0.00,$0.00,$0.00,$0.00
27202750,EAP,Custom 27202750,,Retrieval Device Spv,$391.00,$0.00,$391.00,$0.00,$279.06,$0.00,$0.00,$279.06,$279.06,$0.00,$391.00,$0.00,$195.50,$309.67,$312.80,$0.00,$0.00,$0.00,$0.00,$0.00
27202751,EAP,Custom 27202751,,"Port, Implantable Spv","$1,930.00",$0.00,"$1,930.00",$0.00,"$1,377.44",$0.00,$0.00,"$1,377.44","$1,377.44",$0.00,"$1,930.00",$0.00,$965.00,"$1,528.56","$1,544.00",$0.00,$0.00,$0.00,$0.00,$0.00
27202752,EAP,Custom 27202752,,"Stent, Covrd, W/delv Spv","$7,595.00",$0.00,"$7,595.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$7,595.00",$0.00,"$3,797.50","$6,015.24","$6,076.00",$0.00,$0.00,$0.00,$0.00,$0.00
27202753,EAP,Custom 27202753,,"Stent, Non-covrd W/delv Spv","$5,824.00",$0.00,"$5,824.00",$0.00,"$4,156.59",$0.00,$0.00,"$4,156.59","$4,156.59",$0.00,"$5,824.00",$0.00,"$2,912.00","$4,612.61","$4,659.20",$0.00,$0.00,$0.00,$0.00,$0.00
27202754,EAP,Custom 27202754,,"Stent, Non-covrd W/o Delv Spv","$3,412.00",$0.00,"$3,412.00",$0.00,"$2,435.14",$0.00,$0.00,"$2,435.14","$2,435.14",$0.00,"$3,412.00",$0.00,"$1,706.00","$2,702.30","$2,729.60",$0.00,$0.00,$0.00,$0.00,$0.00
27202755,EAP,HCPCS C1887,,"Catheter, Guiding Spv",$431.00,$0.00,$431.00,$234.03,$307.60,$0.00,$74.26,$307.60,$307.60,$75.46,$431.00,$0.00,$215.50,$341.35,$344.80,$0.00,$67.45,$0.00,$68.62,$0.00
27202756,EAP,Custom 27202756,,Workhorse Balloon Catheter,"$1,462.00",$0.00,"$1,462.00",$0.00,"$1,043.43",$0.00,$0.00,"$1,043.43","$1,043.43",$0.00,"$1,462.00",$0.00,$731.00,"$1,157.90","$1,169.60",$0.00,$0.00,$0.00,$0.00,$0.00
27202757,EAP,Custom 27202757,,Opta 5 Balloon Catheter,"$1,462.00",$0.00,"$1,462.00",$0.00,"$1,043.43",$0.00,$0.00,"$1,043.43","$1,043.43",$0.00,"$1,462.00",$0.00,$731.00,"$1,157.90","$1,169.60",$0.00,$0.00,$0.00,$0.00,$0.00
27202758,EAP,Custom 27202758,,Arrow-trerotola Device,"$3,506.00",$0.00,"$3,506.00",$0.00,"$2,502.23",$0.00,$0.00,"$2,502.23","$2,502.23",$0.00,"$3,506.00",$0.00,"$1,753.00","$2,776.75","$2,804.80",$0.00,$0.00,$0.00,$0.00,$0.00
27202759,EAP,Custom 27202759,,Flexima Biliary Drain Cath W/l,$439.00,$0.00,$439.00,$0.00,$313.31,$0.00,$0.00,$313.31,$313.31,$0.00,$439.00,$0.00,$219.50,$347.69,$351.20,$0.00,$0.00,$0.00,$0.00,$0.00
27202760,EAP,Custom 27202760,,"Catheter, Occlusion Spv","$2,336.00",$0.00,"$2,336.00",$0.00,"$1,667.20",$0.00,$0.00,"$1,667.20","$1,667.20",$0.00,"$2,336.00",$0.00,"$1,168.00","$1,850.11","$1,868.80",$0.00,$0.00,$0.00,$0.00,$0.00
27202761,EAP,Custom 27202761,,"G - Feeding Kit, 18fr, 2.5l","$1,090.00",$0.00,"$1,090.00",$0.00,$777.93,$0.00,$0.00,$777.93,$777.93,$0.00,"$1,090.00",$0.00,$545.00,$863.28,$872.00,$0.00,$0.00,$0.00,$0.00,$0.00
27202786,EAP,HCPCS C1892,,8fr-14cm Peel Away Sheath,$101.00,$0.00,$101.00,$54.84,$72.08,$0.00,$17.40,$72.08,$72.08,$17.68,$101.00,$0.00,$50.50,$79.99,$80.80,$0.00,$15.81,$0.00,$16.08,$0.00
27202790,EAP,Custom 27202790,,Alligator Retrieval,"$8,967.00",$0.00,"$8,967.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$8,967.00",$0.00,"$4,483.50","$7,101.86","$7,173.60",$0.00,$0.00,$0.00,$0.00,$0.00
27202791,EAP,HCPCS C1769,,Cadence Precision,"$1,703.00",$0.00,"$1,703.00",$924.73,"$1,215.43",$0.00,$293.42,"$1,215.43","$1,215.43",$298.18,"$1,703.00",$0.00,$851.50,"$1,348.78","$1,362.40",$0.00,$266.52,$0.00,$271.12,$0.00
27202792,EAP,HCPCS C1751,,Catheter Echelon 10 Micro,"$2,423.00",$0.00,"$2,423.00","$1,315.69","$1,729.30",$0.00,$417.47,"$1,729.30","$1,729.30",$424.25,"$2,423.00",$0.00,"$1,211.50","$1,919.02","$1,938.40",$0.00,$379.20,$0.00,$385.74,$0.00
27202794,EAP,Custom 27202794,,Catheter Marathon,"$2,152.00",$0.00,"$2,152.00",$0.00,"$1,535.88",$0.00,$0.00,"$1,535.88","$1,535.88",$0.00,"$2,152.00",$0.00,"$1,076.00","$1,704.38","$1,721.60",$0.00,$0.00,$0.00,$0.00,$0.00
27202795,EAP,HCPCS C2628,,Catheter Marksman 105cm,"$3,587.00",$0.00,"$3,587.00",$0.00,"$2,560.04",$0.00,$0.00,"$2,560.04","$2,560.04",$0.00,"$3,587.00",$0.00,"$1,793.50","$2,840.90","$2,869.60",$0.00,$0.00,$0.00,$0.00,$0.00
27202796,EAP,HCPCS C2628,,Catheter Marksman 135cm,"$3,587.00",$0.00,"$3,587.00",$0.00,"$2,560.04",$0.00,$0.00,"$2,560.04","$2,560.04",$0.00,"$3,587.00",$0.00,"$1,793.50","$2,840.90","$2,869.60",$0.00,$0.00,$0.00,$0.00,$0.00
27202797,EAP,Custom 27202797,,Catheter Marksman 150cm,"$3,587.00",$0.00,"$3,587.00",$0.00,"$2,560.04",$0.00,$0.00,"$2,560.04","$2,560.04",$0.00,"$3,587.00",$0.00,"$1,793.50","$2,840.90","$2,869.60",$0.00,$0.00,$0.00,$0.00,$0.00
27202798,EAP,HCPCS C1751,,Catheter Rebar-027 130cm Micro,$989.00,$0.00,$989.00,$537.03,$705.85,$0.00,$170.40,$705.85,$705.85,$173.17,$989.00,$0.00,$494.50,$783.29,$791.20,$0.00,$154.78,$0.00,$157.45,$0.00
27202799,EAP,HCPCS C1751,,Catheter Rebar-027 145cm Micro,$989.00,$0.00,$989.00,$537.03,$705.85,$0.00,$170.40,$705.85,$705.85,$173.17,$989.00,$0.00,$494.50,$783.29,$791.20,$0.00,$154.78,$0.00,$157.45,$0.00
27202800,EAP,HCPCS C1751,,Catheter Rebar-10 153cm Micro,"$1,777.00",$0.00,"$1,777.00",$964.91,"$1,268.24",$0.00,$306.17,"$1,268.24","$1,268.24",$311.14,"$1,777.00",$0.00,$888.50,"$1,407.38","$1,421.60",$0.00,$278.10,$0.00,$282.90,$0.00
27202801,EAP,HCPCS C1751,,Catheter Rebar-14 153cm Micro,"$1,777.00",$0.00,"$1,777.00",$964.91,"$1,268.24",$0.00,$306.17,"$1,268.24","$1,268.24",$311.14,"$1,777.00",$0.00,$888.50,"$1,407.38","$1,421.60",$0.00,$278.10,$0.00,$282.90,$0.00
27202802,EAP,HCPCS C1751,,Catheter Rebar-18 130cm Micro,"$1,023.00",$0.00,"$1,023.00",$555.49,$730.12,$0.00,$176.26,$730.12,$730.12,$179.12,"$1,023.00",$0.00,$511.50,$810.22,$818.40,$0.00,$160.10,$0.00,$162.86,$0.00
27202803,EAP,HCPCS C1751,,Catheter Rebar-18 153 Micro,"$1,292.00",$0.00,"$1,292.00",$701.56,$922.10,$0.00,$222.61,$922.10,$922.10,$226.22,"$1,292.00",$0.00,$646.00,"$1,023.26","$1,033.60",$0.00,$202.20,$0.00,$205.69,$0.00
27202804,EAP,HCPCS C1751,,Catheter Rebar-18 153cm Micro,"$1,435.00",$0.00,"$1,435.00",$779.21,"$1,024.16",$0.00,$247.24,"$1,024.16","$1,024.16",$251.26,"$1,435.00",$0.00,$717.50,"$1,136.52","$1,148.00",$0.00,$224.58,$0.00,$228.45,$0.00
27202806,EAP,Custom 27202806,,Dribath Onyx Heater Us,"$1,793.00",$0.00,"$1,793.00",$0.00,"$1,279.66",$0.00,$0.00,"$1,279.66","$1,279.66",$0.00,"$1,793.00",$0.00,$896.50,"$1,420.06","$1,434.40",$0.00,$0.00,$0.00,$0.00,$0.00
27202808,EAP,HCPCS C1751,,Extended Ultraflow,"$1,793.00",$0.00,"$1,793.00",$973.60,"$1,279.66",$0.00,$308.92,"$1,279.66","$1,279.66",$313.94,"$1,793.00",$0.00,$896.50,"$1,420.06","$1,434.40",$0.00,$280.60,$0.00,$285.45,$0.00
27202809,EAP,HCPCS C1769,,Guidewire Silverspeed .010,$825.00,$0.00,$825.00,$447.98,$588.80,$0.00,$142.14,$588.80,$588.80,$144.45,$825.00,$0.00,$412.50,$653.40,$660.00,$0.00,$129.11,$0.00,$131.34,$0.00
27202810,EAP,HCPCS C1769,,Guidewire Silverspeed .014,$825.00,$0.00,$825.00,$447.98,$588.80,$0.00,$142.14,$588.80,$588.80,$144.45,$825.00,$0.00,$412.50,$653.40,$660.00,$0.00,$129.11,$0.00,$131.34,$0.00
27202811,EAP,HCPCS C1769,,Guidewire Silverspeed .016,$735.00,$0.00,$735.00,$399.11,$524.57,$0.00,$126.64,$524.57,$524.57,$128.69,$735.00,$0.00,$367.50,$582.12,$588.00,$0.00,$115.03,$0.00,$117.01,$0.00
27202812,EAP,HCPCS C1769,,Guidewire X-celerator .010r,"$1,185.00",$0.00,"$1,185.00",$643.46,$845.73,$0.00,$204.17,$845.73,$845.73,$207.48,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$185.45,$0.00,$188.65,$0.00
27202813,EAP,HCPCS C1769,,Guidewire X-celerator-14 Re,"$1,185.00",$0.00,"$1,185.00",$643.46,$845.73,$0.00,$204.17,$845.73,$845.73,$207.48,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$185.45,$0.00,$188.65,$0.00
27202814,EAP,HCPCS C1769,,Guidewire X-pedion 14 2,$897.00,$0.00,$897.00,$487.07,$640.19,$0.00,$154.55,$640.19,$640.19,$157.06,$897.00,$0.00,$448.50,$710.42,$717.60,$0.00,$140.38,$0.00,$142.80,$0.00
27202815,EAP,HCPCS C1769,,Guidewire X-pedion-10 Re 2,$897.00,$0.00,$897.00,$487.07,$640.19,$0.00,$154.55,$640.19,$640.19,$157.06,$897.00,$0.00,$448.50,$710.42,$717.60,$0.00,$140.38,$0.00,$142.80,$0.00
27202816,EAP,HCPCS C1726,,Hyperglide 3.0 X 10mm,"$3,837.00",$0.00,"$3,837.00","$2,083.49","$2,738.47",$0.00,$661.10,"$2,738.47","$2,738.47",$671.83,"$3,837.00",$0.00,"$1,918.50","$3,038.90","$3,069.60",$0.00,$600.49,$0.00,$610.85,$0.00
27202817,EAP,HCPCS C1726,,Hyperglide 3.0 X 15mm,"$3,837.00",$0.00,"$3,837.00","$2,083.49","$2,738.47",$0.00,$661.10,"$2,738.47","$2,738.47",$671.83,"$3,837.00",$0.00,"$1,918.50","$3,038.90","$3,069.60",$0.00,$600.49,$0.00,$610.85,$0.00
27202818,EAP,HCPCS C1726,,Hyperglide 4.0 X 10mm,"$3,837.00",$0.00,"$3,837.00","$2,083.49","$2,738.47",$0.00,$661.10,"$2,738.47","$2,738.47",$671.83,"$3,837.00",$0.00,"$1,918.50","$3,038.90","$3,069.60",$0.00,$600.49,$0.00,$610.85,$0.00
27202819,EAP,HCPCS C1726,,Hyperglide 4.0 X 20mm,"$3,676.00",$0.00,"$3,676.00","$1,996.07","$2,623.56",$0.00,$633.36,"$2,623.56","$2,623.56",$643.64,"$3,676.00",$0.00,"$1,838.00","$2,911.39","$2,940.80",$0.00,$575.29,$0.00,$585.22,$0.00
27202820,EAP,HCPCS C1726,,Hyperglide 5.0 X 15mm,"$3,837.00",$0.00,"$3,837.00","$2,083.49","$2,738.47",$0.00,$661.10,"$2,738.47","$2,738.47",$671.83,"$3,837.00",$0.00,"$1,918.50","$3,038.90","$3,069.60",$0.00,$600.49,$0.00,$610.85,$0.00
27202821,EAP,HCPCS C1726,,Hyperglide 5.0 X 20mm,"$1,472.00",$0.00,"$1,472.00",$799.30,"$1,050.57",$0.00,$253.62,"$1,050.57","$1,050.57",$257.74,"$1,472.00",$0.00,$736.00,"$1,165.82","$1,177.60",$0.00,$230.37,$0.00,$234.34,$0.00
27202822,EAP,HCPCS C1751,,Hyperglide 5.0 X 30,"$4,627.00",$0.00,"$4,627.00","$2,512.46","$3,302.29",$0.00,$797.21,"$3,302.29","$3,302.29",$810.15,"$4,627.00",$0.00,"$2,313.50","$3,664.58","$3,701.60",$0.00,$724.13,$0.00,$736.62,$0.00
27202823,EAP,HCPCS C1726,,Hyperglide System - 30mm,"$3,676.00",$0.00,"$3,676.00","$1,996.07","$2,623.56",$0.00,$633.36,"$2,623.56","$2,623.56",$643.64,"$3,676.00",$0.00,"$1,838.00","$2,911.39","$2,940.80",$0.00,$575.29,$0.00,$585.22,$0.00
27202825,EAP,HCPCS C1769,,Meridian .014 Re,"$1,777.00",$0.00,"$1,777.00",$964.91,"$1,268.24",$0.00,$306.17,"$1,268.24","$1,268.24",$311.14,"$1,777.00",$0.00,$888.50,"$1,407.38","$1,421.60",$0.00,$278.10,$0.00,$282.90,$0.00
27202826,EAP,HCPCS C1884,,Microcatheter Nautica,"$1,882.00",$0.00,"$1,882.00","$1,021.93","$1,343.18",$0.00,$324.26,"$1,343.18","$1,343.18",$329.52,"$1,882.00",$0.00,$941.00,"$1,490.54","$1,505.60",$0.00,$294.53,$0.00,$299.61,$0.00
27202827,EAP,HCPCS C1769,,Mirage Re .008,"$1,490.00",$0.00,"$1,490.00",$809.07,"$1,063.41",$0.00,$256.72,"$1,063.41","$1,063.41",$260.89,"$1,490.00",$0.00,$745.00,"$1,180.08","$1,192.00",$0.00,$233.19,$0.00,$237.21,$0.00
27202828,EAP,Custom 27202828,,Mixer Us 15-17 Mm Vial,"$1,793.00",$0.00,"$1,793.00",$0.00,"$1,279.66",$0.00,$0.00,"$1,279.66","$1,279.66",$0.00,"$1,793.00",$0.00,$896.50,"$1,420.06","$1,434.40",$0.00,$0.00,$0.00,$0.00,$0.00
27202829,EAP,HCPCS C1884,,Onyx 18 Kit Avm Us,"$8,071.00",$0.00,"$8,071.00","$4,382.55","$5,158.80",$0.00,"$1,390.59","$5,158.80","$5,158.80","$1,413.17","$8,071.00",$0.00,"$4,035.50","$6,392.23","$6,456.80",$0.00,"$1,263.11",$0.00,"$1,284.90",$0.00
27202830,EAP,HCPCS C1884,,Onyx 34 Kit Avm Us,"$3,227.00",$0.00,"$3,227.00","$1,752.26","$2,303.11",$0.00,$556.00,"$2,303.11","$2,303.11",$565.02,"$3,227.00",$0.00,"$1,613.50","$2,555.78","$2,581.60",$0.00,$505.03,$0.00,$513.74,$0.00
27202831,EAP,HCPCS C1751,,Onyx Hd500 Kit Aneurys,"$9,325.00",$0.00,"$9,325.00","$5,063.48","$5,158.80",$0.00,"$1,606.65","$5,158.80","$5,158.80","$1,632.73","$9,325.00",$0.00,"$4,662.50","$7,385.40","$7,460.00",$0.00,"$1,459.36",$0.00,"$1,484.54",$0.00
27202833,EAP,Custom 27202833,,Syringe 1ml Single Pa,$268.00,$0.00,$268.00,$0.00,$191.27,$0.00,$0.00,$191.27,$191.27,$0.00,$268.00,$0.00,$134.00,$212.26,$214.40,$0.00,$0.00,$0.00,$0.00,$0.00
27202834,EAP,HCPCS C1726,,Syringe Adapter-carton,"$1,793.00",$0.00,"$1,793.00",$973.60,"$1,279.66",$0.00,$308.92,"$1,279.66","$1,279.66",$313.94,"$1,793.00",$0.00,$896.50,"$1,420.06","$1,434.40",$0.00,$280.60,$0.00,$285.45,$0.00
27202835,EAP,Custom 27202835,,Ultraflow Hpc 1.5f Flow,"$1,793.00",$0.00,"$1,793.00",$0.00,"$1,279.66",$0.00,$0.00,"$1,279.66","$1,279.66",$0.00,"$1,793.00",$0.00,$896.50,"$1,420.06","$1,434.40",$0.00,$0.00,$0.00,$0.00,$0.00
27202850,EAP,Custom 27202850,,Adjustable Outrigger(flex/ext),$365.00,$0.00,$365.00,$0.00,$260.50,$0.00,$0.00,$260.50,$260.50,$0.00,$365.00,$0.00,$182.50,$289.08,$292.00,$0.00,$0.00,$0.00,$0.00,$0.00
27202852,EAP,Custom 27202852,,Adjustable Wrist Hinge,$412.00,$0.00,$412.00,$0.00,$294.04,$0.00,$0.00,$294.04,$294.04,$0.00,$412.00,$0.00,$206.00,$326.30,$329.60,$0.00,$0.00,$0.00,$0.00,$0.00
27202853,EAP,Custom 27202853,,Alumafoam Splint,$17.00,$0.00,$17.00,$0.00,$12.13,$0.00,$0.00,$12.13,$12.13,$0.00,$17.00,$0.00,$8.50,$13.46,$13.60,$0.00,$0.00,$0.00,$0.00,$0.00
27202854,EAP,Custom 27202854,,Aquacel Silver 4x4,$51.00,$0.00,$51.00,$0.00,$36.40,$0.00,$0.00,$36.40,$36.40,$0.00,$51.00,$0.00,$25.50,$40.39,$40.80,$0.00,$0.00,$0.00,$0.00,$0.00
27202855,EAP,Custom 27202855,,Aquacel Silver 6x6,$117.00,$0.00,$117.00,$0.00,$83.50,$0.00,$0.00,$83.50,$83.50,$0.00,$117.00,$0.00,$58.50,$92.66,$93.60,$0.00,$0.00,$0.00,$0.00,$0.00
27202856,EAP,Custom 27202856,,Aquacel Silver 8x12,$163.00,$0.00,$163.00,$0.00,$116.33,$0.00,$0.00,$116.33,$116.33,$0.00,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$0.00,$0.00,$0.00,$0.00
27202857,EAP,Custom 27202857,,Aquacel Silver Rope,$59.00,$0.00,$59.00,$0.00,$42.11,$0.00,$0.00,$42.11,$42.11,$0.00,$59.00,$0.00,$29.50,$46.73,$47.20,$0.00,$0.00,$0.00,$0.00,$0.00
27202858,EAP,Custom 27202858,,Bioconcept Brief,$102.00,$0.00,$102.00,$0.00,$72.80,$0.00,$0.00,$72.80,$72.80,$0.00,$102.00,$0.00,$51.00,$80.78,$81.60,$0.00,$0.00,$0.00,$0.00,$0.00
27202859,EAP,Custom 27202859,,Bioconcept Sleeved Vest,$145.00,$0.00,$145.00,$0.00,$103.49,$0.00,$0.00,$103.49,$103.49,$0.00,$145.00,$0.00,$72.50,$114.84,$116.00,$0.00,$0.00,$0.00,$0.00,$0.00
27202860,EAP,Custom 27202860,,Bioconcepts Brief,$102.00,$0.00,$102.00,$0.00,$72.80,$0.00,$0.00,$72.80,$72.80,$0.00,$102.00,$0.00,$51.00,$80.78,$81.60,$0.00,$0.00,$0.00,$0.00,$0.00
27202861,EAP,Custom 27202861,,Bioconcepts Digi - Sleeve,$17.00,$0.00,$17.00,$0.00,$12.13,$0.00,$0.00,$12.13,$12.13,$0.00,$17.00,$0.00,$8.50,$13.46,$13.60,$0.00,$0.00,$0.00,$0.00,$0.00
27202862,EAP,Custom 27202862,,"Bioconcepts Digi Sleeves 3""",$17.00,$0.00,$17.00,$0.00,$12.13,$0.00,$0.00,$12.13,$12.13,$0.00,$17.00,$0.00,$8.50,$13.46,$13.60,$0.00,$0.00,$0.00,$0.00,$0.00
27202863,EAP,Custom 27202863,,Bioconcepts Forearm Sleeve,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$15.70,$15.70,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
27202865,EAP,Custom 27202865,,Bioconcepts Gloves,$56.00,$0.00,$56.00,$0.00,$39.97,$0.00,$0.00,$39.97,$39.97,$0.00,$56.00,$0.00,$28.00,$44.35,$44.80,$0.00,$0.00,$0.00,$0.00,$0.00
27202867,EAP,Custom 27202867,,Bioconcepts Sleeved Vest,$145.00,$0.00,$145.00,$0.00,$103.49,$0.00,$0.00,$103.49,$103.49,$0.00,$145.00,$0.00,$72.50,$114.84,$116.00,$0.00,$0.00,$0.00,$0.00,$0.00
27202868,EAP,Custom 27202868,,Bioconcepts Ue Sleeve,$56.00,$0.00,$56.00,$0.00,$39.97,$0.00,$0.00,$39.97,$39.97,$0.00,$56.00,$0.00,$28.00,$44.35,$44.80,$0.00,$0.00,$0.00,$0.00,$0.00
27202869,EAP,Custom 27202869,,Chin Strap,$54.00,$0.00,$54.00,$0.00,$38.54,$0.00,$0.00,$38.54,$38.54,$0.00,$54.00,$0.00,$27.00,$42.77,$43.20,$0.00,$0.00,$0.00,$0.00,$0.00
27202870,EAP,Custom 27202870,,Clear Acrylic Cone,$67.00,$0.00,$67.00,$0.00,$47.82,$0.00,$0.00,$47.82,$47.82,$0.00,$67.00,$0.00,$33.50,$53.06,$53.60,$0.00,$0.00,$0.00,$0.00,$0.00
27202871,EAP,Custom 27202871,,Desensitization Kits,$26.00,$0.00,$26.00,$0.00,$18.56,$0.00,$0.00,$18.56,$18.56,$0.00,$26.00,$0.00,$13.00,$20.59,$20.80,$0.00,$0.00,$0.00,$0.00,$0.00
27202872,EAP,Custom 27202872,,Digi Sleeve,$17.00,$0.00,$17.00,$0.00,$12.13,$0.00,$0.00,$12.13,$12.13,$0.00,$17.00,$0.00,$8.50,$13.46,$13.60,$0.00,$0.00,$0.00,$0.00,$0.00
27202874,EAP,Custom 27202874,,Double Finger Stall,$17.00,$0.00,$17.00,$0.00,$12.13,$0.00,$0.00,$12.13,$12.13,$0.00,$17.00,$0.00,$8.50,$13.46,$13.60,$0.00,$0.00,$0.00,$0.00,$0.00
27202875,EAP,Custom 27202875,,Dynamic Finger Flexion Strap,$18.00,$0.00,$18.00,$0.00,$12.85,$0.00,$0.00,$12.85,$12.85,$0.00,$18.00,$0.00,$9.00,$14.26,$14.40,$0.00,$0.00,$0.00,$0.00,$0.00
27202876,EAP,Custom 27202876,,Dynamic Mp Flexion Spring,$130.00,$0.00,$130.00,$0.00,$92.78,$0.00,$0.00,$92.78,$92.78,$0.00,$130.00,$0.00,$65.00,$102.96,$104.00,$0.00,$0.00,$0.00,$0.00,$0.00
27202877,EAP,Custom 27202877,,Elbow Pad,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$15.70,$15.70,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
27202878,EAP,Custom 27202878,,External Fixator Splint,$287.00,$0.00,$287.00,$0.00,$204.83,$0.00,$0.00,$204.83,$204.83,$0.00,$287.00,$0.00,$143.50,$227.30,$229.60,$0.00,$0.00,$0.00,$0.00,$0.00
27202879,EAP,Custom 27202879,,Ezy Wrap Tigger Splint,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$15.70,$15.70,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
27202881,EAP,Custom 27202881,,Finger Cylinder Cast,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$4.28,$4.28,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
27202882,EAP,Custom 27202882,,Finger Knuckle Bender Splint,$104.00,$0.00,$104.00,$0.00,$74.22,$0.00,$0.00,$74.22,$74.22,$0.00,$104.00,$0.00,$52.00,$82.37,$83.20,$0.00,$0.00,$0.00,$0.00,$0.00
27202883,EAP,Custom 27202883,,Green Stick Splint,$160.00,$0.00,$160.00,$0.00,$114.19,$0.00,$0.00,$114.19,$114.19,$0.00,$160.00,$0.00,$80.00,$126.72,$128.00,$0.00,$0.00,$0.00,$0.00,$0.00
27202884,EAP,Custom 27202884,,Individual Outigger-each Digit,$71.00,$0.00,$71.00,$0.00,$50.67,$0.00,$0.00,$50.67,$50.67,$0.00,$71.00,$0.00,$35.50,$56.23,$56.80,$0.00,$0.00,$0.00,$0.00,$0.00
27202885,EAP,Custom 27202885,,Indivisual Outrigger,$71.00,$0.00,$71.00,$0.00,$50.67,$0.00,$0.00,$50.67,$50.67,$0.00,$71.00,$0.00,$35.50,$56.23,$56.80,$0.00,$0.00,$0.00,$0.00,$0.00
27202886,EAP,Custom 27202886,,Joint Jack,$176.00,$0.00,$176.00,$0.00,$125.61,$0.00,$0.00,$125.61,$125.61,$0.00,$176.00,$0.00,$88.00,$139.39,$140.80,$0.00,$0.00,$0.00,$0.00,$0.00
27202887,EAP,Custom 27202887,,Knee Hypercontrol Brace,$217.00,$0.00,$217.00,$0.00,$154.87,$0.00,$0.00,$154.87,$154.87,$0.00,$217.00,$0.00,$108.50,$171.86,$173.60,$0.00,$0.00,$0.00,$0.00,$0.00
27202888,EAP,Custom 27202888,,Lmb Ulnar Deviation Splint,$176.00,$0.00,$176.00,$0.00,$125.61,$0.00,$0.00,$125.61,$125.61,$0.00,$176.00,$0.00,$88.00,$139.39,$140.80,$0.00,$0.00,$0.00,$0.00,$0.00
27202889,EAP,Custom 27202889,,Merit Static Pro Component,$149.00,$0.00,$149.00,$0.00,$106.34,$0.00,$0.00,$106.34,$106.34,$0.00,$149.00,$0.00,$74.50,$118.01,$119.20,$0.00,$0.00,$0.00,$0.00,$0.00
27202890,EAP,Custom 27202890,,Merit Static Progressive Comp,$149.00,$0.00,$149.00,$0.00,$106.34,$0.00,$0.00,$106.34,$106.34,$0.00,$149.00,$0.00,$74.50,$118.01,$119.20,$0.00,$0.00,$0.00,$0.00,$0.00
27202891,EAP,Custom 27202891,,Neoprene Tennis Elbow Strap,$54.00,$0.00,$54.00,$0.00,$38.54,$0.00,$0.00,$38.54,$38.54,$0.00,$54.00,$0.00,$27.00,$42.77,$43.20,$0.00,$0.00,$0.00,$0.00,$0.00
27202892,EAP,Custom 27202892,,Preformed Elbow Hinge Splint,$515.00,$0.00,$515.00,$0.00,$367.56,$0.00,$0.00,$367.56,$367.56,$0.00,$515.00,$0.00,$257.50,$407.88,$412.00,$0.00,$0.00,$0.00,$0.00,$0.00
27202893,EAP,Custom 27202893,,Profore,$59.00,$0.00,$59.00,$0.00,$42.11,$0.00,$0.00,$42.11,$42.11,$0.00,$59.00,$0.00,$29.50,$46.73,$47.20,$0.00,$0.00,$0.00,$0.00,$0.00
27202894,EAP,Custom 27202894,,Redi-fit Breifs,$102.00,$0.00,$102.00,$0.00,$72.80,$0.00,$0.00,$72.80,$72.80,$0.00,$102.00,$0.00,$51.00,$80.78,$81.60,$0.00,$0.00,$0.00,$0.00,$0.00
27202897,EAP,Custom 27202897,,Redi-fit Forearm Sleeves,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$15.70,$15.70,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
27202898,EAP,Custom 27202898,,Redi-fit Sleeved Vest,$145.00,$0.00,$145.00,$0.00,$103.49,$0.00,$0.00,$103.49,$103.49,$0.00,$145.00,$0.00,$72.50,$114.84,$116.00,$0.00,$0.00,$0.00,$0.00,$0.00
27202899,EAP,Custom 27202899,,Redi-fit Ue Sleeves,$56.00,$0.00,$56.00,$0.00,$39.97,$0.00,$0.00,$39.97,$39.97,$0.00,$56.00,$0.00,$28.00,$44.35,$44.80,$0.00,$0.00,$0.00,$0.00,$0.00
27202900,EAP,Custom 27202900,,Reverse Knuckle Bender Splint,$104.00,$0.00,$104.00,$0.00,$74.22,$0.00,$0.00,$74.22,$74.22,$0.00,$104.00,$0.00,$52.00,$82.37,$83.20,$0.00,$0.00,$0.00,$0.00,$0.00
27202901,EAP,Custom 27202901,,Ring Splint,$157.00,$0.00,$157.00,$0.00,$112.05,$0.00,$0.00,$112.05,$112.05,$0.00,$157.00,$0.00,$78.50,$124.34,$125.60,$0.00,$0.00,$0.00,$0.00,$0.00
27202902,EAP,Custom 27202902,,Soft Ulnar Deviation Support,$69.00,$0.00,$69.00,$0.00,$49.25,$0.00,$0.00,$49.25,$49.25,$0.00,$69.00,$0.00,$34.50,$54.65,$55.20,$0.00,$0.00,$0.00,$0.00,$0.00
27202903,EAP,Custom 27202903,,Supination / Pronation Kit,$276.00,$0.00,$276.00,$0.00,$196.98,$0.00,$0.00,$196.98,$196.98,$0.00,$276.00,$0.00,$138.00,$218.59,$220.80,$0.00,$0.00,$0.00,$0.00,$0.00
27202905,EAP,Custom 27202905,,Tap Splint,$211.00,$0.00,$211.00,$0.00,$150.59,$0.00,$0.00,$150.59,$150.59,$0.00,$211.00,$0.00,$105.50,$167.11,$168.80,$0.00,$0.00,$0.00,$0.00,$0.00
27202906,EAP,Custom 27202906,,Ulnar Deviation Slint,$184.00,$0.00,$184.00,$0.00,$131.32,$0.00,$0.00,$131.32,$131.32,$0.00,$184.00,$0.00,$92.00,$145.73,$147.20,$0.00,$0.00,$0.00,$0.00,$0.00
27202908,EAP,Custom 27202908,,Wrap Finger Hooks,$21.00,$0.00,$21.00,$0.00,$14.99,$0.00,$0.00,$14.99,$14.99,$0.00,$21.00,$0.00,$10.50,$16.63,$16.80,$0.00,$0.00,$0.00,$0.00,$0.00
27202909,EAP,Custom 27202909,,Wrap On Finger Hooks(each),$21.00,$0.00,$21.00,$0.00,$14.99,$0.00,$0.00,$14.99,$14.99,$0.00,$21.00,$0.00,$10.50,$16.63,$16.80,$0.00,$0.00,$0.00,$0.00,$0.00
27202910,EAP,Custom 27202910,,Wrist Hinge W/ Dynamic Springs,$480.00,$0.00,$480.00,$0.00,$342.58,$0.00,$0.00,$342.58,$342.58,$0.00,$480.00,$0.00,$240.00,$380.16,$384.00,$0.00,$0.00,$0.00,$0.00,$0.00
27202911,EAP,HCPCS C1769,,Gwire Vasc 185cm .014in Prss Clip Conctr Radiopq Tip Trq Dev,"$1,772.00",$0.00,"$1,772.00",$962.20,"$1,264.68",$0.00,$305.31,"$1,264.68","$1,264.68",$310.26,"$1,772.00",$0.00,$886.00,"$1,403.42","$1,417.60",$0.00,$277.32,$0.00,$282.10,$0.00
27202912,EAP,HCPCS C1769,,Abbott Vascular,$207.00,$0.00,$207.00,$112.40,$147.74,$0.00,$35.67,$147.74,$147.74,$36.24,$207.00,$0.00,$103.50,$163.94,$165.60,$0.00,$32.40,$0.00,$32.95,$0.00
27202913,EAP,HCPCS C1725,,Cath Baldilat .035in 5fr 9mm 75cm 40mm Pta Lp Nc Mustang,$525.00,$0.00,$525.00,$285.08,$374.69,$0.00,$90.45,$374.69,$374.69,$91.92,$525.00,$0.00,$262.50,$415.80,$420.00,$0.00,$82.16,$0.00,$83.58,$0.00
27202914,EAP,HCPCS C1725,,Cath Baldilat .035in 5fr 8mm 75cm 40mm Pta Lp Nc Mustang,$525.00,$0.00,$525.00,$285.08,$374.69,$0.00,$90.45,$374.69,$374.69,$91.92,$525.00,$0.00,$262.50,$415.80,$420.00,$0.00,$82.16,$0.00,$83.58,$0.00
27202915,EAP,HCPCS C1726,,Catheter Baldilat Lp 5.3fr 4mm 75cm 40mm High Pressure,$525.00,$0.00,$525.00,$285.08,$374.69,$0.00,$90.45,$374.69,$374.69,$91.92,$525.00,$0.00,$262.50,$415.80,$420.00,$0.00,$82.16,$0.00,$83.58,$0.00
27202916,EAP,HCPCS C1725,,Cath Baldilat 2.5mm 150cm 80mm Otw Cyte,$720.00,$0.00,$720.00,$390.96,$513.86,$0.00,$124.05,$513.86,$513.86,$126.07,$720.00,$0.00,$360.00,$570.24,$576.00,$0.00,$112.68,$0.00,$114.62,$0.00
27202917,EAP,HCPCS C1725,,Catheter Balloon Dilit Coyote 2 X 220 150cm Otw,$900.00,$0.00,$900.00,$488.70,$642.33,$0.00,$155.07,$642.33,$642.33,$157.58,$900.00,$0.00,$450.00,$712.80,$720.00,$0.00,$140.85,$0.00,$143.28,$0.00
27202918,EAP,HCPCS C1725,,"Balloon Coyote 2.5 X 220, 150cm, Otw",$900.00,$0.00,$900.00,$488.70,$642.33,$0.00,$155.07,$642.33,$642.33,$157.58,$900.00,$0.00,$450.00,$712.80,$720.00,$0.00,$140.85,$0.00,$143.28,$0.00
27202919,EAP,HCPCS C1725,,Catheter Balloon Dilit Coyote 3 X 100 150cm Otw,$900.00,$0.00,$900.00,$488.70,$642.33,$0.00,$155.07,$642.33,$642.33,$157.58,$900.00,$0.00,$450.00,$712.80,$720.00,$0.00,$140.85,$0.00,$143.28,$0.00
27202920,EAP,HCPCS C1725,,Cath Baldilat .035in 5fr 5mm 135cm 200mm Pta Lp Nc Mustang,$525.00,$0.00,$525.00,$285.08,$374.69,$0.00,$90.45,$374.69,$374.69,$91.92,$525.00,$0.00,$262.50,$415.80,$420.00,$0.00,$82.16,$0.00,$83.58,$0.00
27202921,EAP,HCPCS C1725,,Cath Baldilat .035in 5fr 6mm 135cm 100mm Pta Lp Nc Mustang,$486.00,$0.00,$486.00,$263.90,$346.86,$0.00,$83.74,$346.86,$346.86,$85.09,$486.00,$0.00,$243.00,$384.91,$388.80,$0.00,$76.06,$0.00,$77.37,$0.00
27202922,EAP,HCPCS C1768,,Set Introd 40cm 4fr Mpnch Psh+ .018in Ntnl Trnstls Stf Cannu,$105.00,$0.00,$105.00,$57.02,$74.94,$0.00,$18.09,$74.94,$74.94,$18.38,$105.00,$0.00,$52.50,$83.16,$84.00,$0.00,$16.43,$0.00,$16.72,$0.00
27202923,EAP,HCPCS C1769,,Gwire Vasc 1.5mm Rsn Curve .035in 180cm 1.5mm Cvd Cath Exch,$45.00,$0.00,$45.00,$24.44,$32.12,$0.00,$7.75,$32.12,$32.12,$7.88,$45.00,$0.00,$22.50,$35.64,$36.00,$0.00,$7.04,$0.00,$7.16,$0.00
27202924,EAP,Custom 27202924,,Cath Angio .035in Vcf Curve 5fr 65cm 8 Spiraled Sdprt Hflo,$171.00,$0.00,$171.00,$0.00,$122.04,$0.00,$0.00,$122.04,$122.04,$0.00,$171.00,$0.00,$85.50,$135.43,$136.80,$0.00,$0.00,$0.00,$0.00,$0.00
27202925,EAP,Custom 27202925,,Cath Angio .038in Kmp Curve 5fr 65cm Ang Multpur Nyl Ss Trnb,$171.00,$0.00,$171.00,$0.00,$122.04,$0.00,$0.00,$122.04,$122.04,$0.00,$171.00,$0.00,$85.50,$135.43,$136.80,$0.00,$0.00,$0.00,$0.00,$0.00
27202926,EAP,HCPCS C1894,,Sheath Guid 45cm 6fr .087in Chk-flo Flxr .018/.038in Anl0,$125.00,$0.00,$125.00,$67.88,$89.21,$0.00,$21.54,$89.21,$89.21,$21.89,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$19.56,$0.00,$19.90,$0.00
27202927,EAP,HCPCS C1894,,Sheath Guid 45cm 5fr .074in Chk-flo Flxr .018/.038in Anl0,$119.00,$0.00,$119.00,$64.62,$84.93,$0.00,$20.50,$84.93,$84.93,$20.84,$119.00,$0.00,$59.50,$94.25,$95.20,$0.00,$18.62,$0.00,$18.94,$0.00
27202928,EAP,HCPCS C1769,,Gwire Vasc .035in 145cm 20cm Str Flexibile Tip Flpy Bntsn Lg,$51.00,$0.00,$51.00,$27.69,$36.40,$0.00,$8.79,$36.40,$36.40,$8.93,$51.00,$0.00,$25.50,$40.39,$40.80,$0.00,$7.98,$0.00,$8.12,$0.00
27202929,EAP,HCPCS C1894,,Introd Shth 5fr .074in 70cm Anl1 Curve Multpur Tip Ansel,$170.00,$0.00,$170.00,$92.31,$121.33,$0.00,$29.29,$121.33,$121.33,$29.77,$170.00,$0.00,$85.00,$134.64,$136.00,$0.00,$26.61,$0.00,$27.06,$0.00
27202930,EAP,HCPCS C1887,,Cath Guid .035in 5mm Spc 3.1fr 150cm Lp Tpr Tip Sprt Radiopq,"$2,257.00",$0.00,"$2,257.00","$1,225.55","$1,610.82",$0.00,$388.87,"$1,610.82","$1,610.82",$395.18,"$2,257.00",$0.00,"$1,128.50","$1,787.54","$1,805.60",$0.00,$353.22,$0.00,$359.31,$0.00
27202931,EAP,HCPCS C1887,,Cath Guid .014in 3-1.9fr 150cm 3 Radiopq Mrkr Low Cx Prfl,"$2,257.00",$0.00,"$2,257.00","$1,225.55","$1,610.82",$0.00,$388.87,"$1,610.82","$1,610.82",$395.18,"$2,257.00",$0.00,"$1,128.50","$1,787.54","$1,805.60",$0.00,$353.22,$0.00,$359.31,$0.00
27202932,EAP,HCPCS C1769,,Gwire Vasc Std .035in 150cm 3cm Ang Tip Kink Rst Gldwr,$418.00,$0.00,$418.00,$226.97,$298.33,$0.00,$72.02,$298.33,$298.33,$73.19,$418.00,$0.00,$209.00,$331.06,$334.40,$0.00,$65.42,$0.00,$66.55,$0.00
27202933,EAP,HCPCS C1769,,Gwire Vasc Std .035in 260cm 3cm Ang Tip Stf Shft Gldwr,$699.00,$0.00,$699.00,$379.56,$498.88,$0.00,$120.43,$498.88,$498.88,$122.39,$699.00,$0.00,$349.50,$553.61,$559.20,$0.00,$109.39,$0.00,$111.28,$0.00
27202934,EAP,HCPCS C1887,,Cath Angio .038in 5fr 100cm 40cm Tpr Ang Tip Gwire Hydphi,$644.00,$0.00,$644.00,$349.69,$459.62,$0.00,$110.96,$459.62,$459.62,$112.76,$644.00,$0.00,$322.00,$510.05,$515.20,$0.00,$100.79,$0.00,$102.52,$0.00
27202935,EAP,HCPCS C1769,,Gwire Vasc Endoscopic Terumo L260 Cm Od.035 In Straight,$623.00,$0.00,$623.00,$338.29,$444.64,$0.00,$107.34,$444.64,$444.64,$109.08,$623.00,$0.00,$311.50,$493.42,$498.40,$0.00,$97.50,$0.00,$99.18,$0.00
27202936,EAP,Custom 27202936,,Burn Pad 36x24in Abs Drsg Slvr Strl,$221.00,$0.00,$221.00,$0.00,$157.73,$0.00,$0.00,$157.73,$157.73,$0.00,$221.00,$0.00,$110.50,$175.03,$176.80,$0.00,$0.00,$0.00,$0.00,$0.00
27202940,EAP,Custom 27202940,,"Bioconcepts Digi-sleeve (per Digit - 3"").",$17.00,$0.00,$17.00,$0.00,$12.13,$0.00,$0.00,$12.13,$12.13,$0.00,$17.00,$0.00,$8.50,$13.46,$13.60,$0.00,$0.00,$0.00,$0.00,$0.00
27202941,EAP,HCPCS C1769,,Stdj-185-4076,$223.00,$0.00,$223.00,$121.09,$159.16,$0.00,$38.42,$159.16,$159.16,$39.05,$223.00,$0.00,$111.50,$176.62,$178.40,$0.00,$34.90,$0.00,$35.50,$0.00
27202942,EAP,HCPCS C1769,,Stdj-300-4076,$223.00,$0.00,$223.00,$121.09,$159.16,$0.00,$38.42,$159.16,$159.16,$39.05,$223.00,$0.00,$111.50,$176.62,$178.40,$0.00,$34.90,$0.00,$35.50,$0.00
27202943,EAP,HCPCS C1769,,Stdj-86-15 40785,$281.00,$0.00,$281.00,$152.58,$200.55,$0.00,$48.41,$200.55,$200.55,$49.20,$281.00,$0.00,$140.50,$222.55,$224.80,$0.00,$43.98,$0.00,$44.74,$0.00
27202944,EAP,HCPCS C1769,,Sdj-86-5 40785,$281.00,$0.00,$281.00,$152.58,$200.55,$0.00,$48.41,$200.55,$200.55,$49.20,$281.00,$0.00,$140.50,$222.55,$224.80,$0.00,$43.98,$0.00,$44.74,$0.00
27202945,EAP,HCPCS C1725,,Coronary Sinus Balloon Venography Catheter,$325.00,$0.00,$325.00,$176.48,$231.95,$0.00,$56.00,$231.95,$231.95,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
27202950,EAP,Custom 27202950,,C-36-152 Coil Interlock Detach,"$1,258.00",$0.00,"$1,258.00",$0.00,$897.83,$0.00,$0.00,$897.83,$897.83,$0.00,"$1,258.00",$0.00,$629.00,$996.34,"$1,006.40",$0.00,$0.00,$0.00,$0.00,$0.00
27202951,EAP,Custom 27202951,,C-36-154 Coil Interlock Detach,"$1,258.00",$0.00,"$1,258.00",$0.00,$897.83,$0.00,$0.00,$897.83,$897.83,$0.00,"$1,258.00",$0.00,$629.00,$996.34,"$1,006.40",$0.00,$0.00,$0.00,$0.00,$0.00
27202952,EAP,Custom 27202952,,C-36-156 Coil Interlock Detach,"$1,258.00",$0.00,"$1,258.00",$0.00,$897.83,$0.00,$0.00,$897.83,$897.83,$0.00,"$1,258.00",$0.00,$629.00,$996.34,"$1,006.40",$0.00,$0.00,$0.00,$0.00,$0.00
27202953,EAP,Custom 27202953,,C-36-157 Coil Interlock Detach,"$1,258.00",$0.00,"$1,258.00",$0.00,$897.83,$0.00,$0.00,$897.83,$897.83,$0.00,"$1,258.00",$0.00,$629.00,$996.34,"$1,006.40",$0.00,$0.00,$0.00,$0.00,$0.00
27202954,EAP,HCPCS C1887,,Cg510 Glide Catheter Simmon1,"$1,253.00",$0.00,"$1,253.00",$680.38,$894.27,$0.00,$215.89,$894.27,$894.27,$219.39,"$1,253.00",$0.00,$626.50,$992.38,"$1,002.40",$0.00,$196.09,$0.00,$199.48,$0.00
27202955,EAP,HCPCS C1725,,Cg514 Benson-hanafee 1,"$1,193.00",$0.00,"$1,193.00",$536.85,$851.44,$0.00,$205.55,$851.44,$851.44,$208.88,"$1,193.00",$0.00,$596.50,$944.86,$954.40,$0.00,$186.70,$0.00,$189.93,$0.00
27202956,EAP,HCPCS C1880,,Option Ivc Filter,"$1,429.00",$0.00,"$1,429.00",$643.05,"$1,019.88",$0.00,$246.21,"$1,019.88","$1,019.88",$250.21,"$1,429.00",$0.00,$714.50,"$1,131.77","$1,143.20",$0.00,$223.64,$0.00,$227.50,$0.00
27202957,EAP,HCPCS C1894,,Introducer Sheath 5fr,$36.00,$0.00,$36.00,$16.20,$25.69,$0.00,$6.20,$25.69,$25.69,$6.30,$36.00,$0.00,$18.00,$28.51,$28.80,$0.00,$5.63,$0.00,$5.73,$0.00
27202958,EAP,HCPCS C1894,,Introducer Sheath 6fr,$36.00,$0.00,$36.00,$16.20,$25.69,$0.00,$6.20,$25.69,$25.69,$6.30,$36.00,$0.00,$18.00,$28.51,$28.80,$0.00,$5.63,$0.00,$5.73,$0.00
27202959,EAP,HCPCS C1725,,Catheter Glide Simmons 2,$171.00,$0.00,$171.00,$76.95,$122.04,$0.00,$29.46,$122.04,$122.04,$29.94,$171.00,$0.00,$85.50,$135.43,$136.80,$0.00,$26.76,$0.00,$27.22,$0.00
27202960,EAP,HCPCS C1725,,Catheter Vertebral 5fr,$40.00,$0.00,$40.00,$18.00,$28.55,$0.00,$6.89,$28.55,$28.55,$7.00,$40.00,$0.00,$20.00,$31.68,$32.00,$0.00,$6.26,$0.00,$6.37,$0.00
27202961,EAP,HCPCS C1751,,Microcatheter Stc,"$1,264.00",$0.00,"$1,264.00",$686.35,$902.12,$0.00,$217.78,$902.12,$902.12,$221.32,"$1,264.00",$0.00,$632.00,"$1,001.09","$1,011.20",$0.00,$197.82,$0.00,$201.23,$0.00
27202962,EAP,HCPCS C1751,,System Drg Dlv L106 Cm 30cm Ekosonic Intlgnt Cath Microsonic,"$7,074.00",$0.00,"$7,074.00","$3,841.18","$5,048.71",$0.00,"$1,218.81","$5,048.71","$5,048.71","$1,238.60","$7,074.00",$0.00,"$3,537.00","$5,602.61","$5,659.20",$0.00,"$1,107.08",$0.00,"$1,126.18",$0.00
27202963,EAP,HCPCS C1751,,System Drg Dlv L106 Cm 40cm Ekosonic Intlgnt Cath Microsonic,"$6,738.00",$0.00,"$6,738.00","$3,658.73","$4,808.91",$0.00,"$1,160.92","$4,808.91","$4,808.91","$1,179.77","$6,738.00",$0.00,"$3,369.00","$5,336.50","$5,390.40",$0.00,"$1,054.50",$0.00,"$1,072.69",$0.00
27202964,EAP,HCPCS C1751,,System Drg Dlv L106 Cm 50cm Ekosonic Mach 4 Intlgnt Cath,"$6,738.00",$0.00,"$6,738.00","$3,658.73","$4,808.91",$0.00,"$1,160.92","$4,808.91","$4,808.91","$1,179.77","$6,738.00",$0.00,"$3,369.00","$5,336.50","$5,390.40",$0.00,"$1,054.50",$0.00,"$1,072.69",$0.00
27202965,EAP,HCPCS C1751,,System Drg Dlv L135 Cm 12cm Ekosonic Mach 4 Intlgnt Cath,"$6,738.00",$0.00,"$6,738.00","$3,658.73","$4,808.91",$0.00,"$1,160.92","$4,808.91","$4,808.91","$1,179.77","$6,738.00",$0.00,"$3,369.00","$5,336.50","$5,390.40",$0.00,"$1,054.50",$0.00,"$1,072.69",$0.00
27202966,EAP,HCPCS C1751,,System Drg Dlv L135 Cm 30cm Ekosonic Intlgnt Cath Microsonic,"$7,074.00",$0.00,"$7,074.00","$3,841.18","$5,048.71",$0.00,"$1,218.81","$5,048.71","$5,048.71","$1,238.60","$7,074.00",$0.00,"$3,537.00","$5,602.61","$5,659.20",$0.00,"$1,107.08",$0.00,"$1,126.18",$0.00
27202967,EAP,HCPCS C1751,,System Drg Dlv L135 Cm 40cm Ekosonic Intlgnt Cath Microsonic,"$7,074.00",$0.00,"$7,074.00","$3,841.18","$5,048.71",$0.00,"$1,218.81","$5,048.71","$5,048.71","$1,238.60","$7,074.00",$0.00,"$3,537.00","$5,602.61","$5,659.20",$0.00,"$1,107.08",$0.00,"$1,126.18",$0.00
27202968,EAP,HCPCS C1751,,SYSTEM DRG DLV L135 CM 50CM EKOSONIC TX ZN EVAS DEV CATH GWI,"$7,074.00",$0.00,"$7,074.00","$3,841.18","$5,048.71",$0.00,"$1,218.81","$5,048.71","$5,048.71","$1,238.60","$7,074.00",$0.00,"$3,537.00","$5,602.61","$5,659.20",$0.00,"$1,107.08",$0.00,"$1,126.18",$0.00
27202969,EAP,HCPCS C1751,,System Drg Dlv L106 Cm 6cm Ekosonic Intlgnt Cath Microsonic,"$7,074.00",$0.00,"$7,074.00","$3,841.18","$5,048.71",$0.00,"$1,218.81","$5,048.71","$5,048.71","$1,238.60","$7,074.00",$0.00,"$3,537.00","$5,602.61","$5,659.20",$0.00,"$1,107.08",$0.00,"$1,126.18",$0.00
27202970,EAP,HCPCS C1751,,System Drg Dlv L106 Cm 12cm Ekosonic Cath Us Thrmbs 106cm 12,"$7,074.00",$0.00,"$7,074.00","$3,841.18","$5,048.71",$0.00,"$1,218.81","$5,048.71","$5,048.71","$1,238.60","$7,074.00",$0.00,"$3,537.00","$5,602.61","$5,659.20",$0.00,"$1,107.08",$0.00,"$1,126.18",$0.00
27202971,EAP,HCPCS C1751,,System Drg Dlv L106 Cm 18cm Ekosonic Intlgnt Cath Microsonic,"$7,074.00",$0.00,"$7,074.00","$3,841.18","$5,048.71",$0.00,"$1,218.81","$5,048.71","$5,048.71","$1,238.60","$7,074.00",$0.00,"$3,537.00","$5,602.61","$5,659.20",$0.00,"$1,107.08",$0.00,"$1,126.18",$0.00
27202972,EAP,HCPCS C1751,,System Drg Dlv L106 Cm 24cm Ekosonic Intlgnt Cath Microsonic,"$7,074.00",$0.00,"$7,074.00","$3,841.18","$5,048.71",$0.00,"$1,218.81","$5,048.71","$5,048.71","$1,238.60","$7,074.00",$0.00,"$3,537.00","$5,602.61","$5,659.20",$0.00,"$1,107.08",$0.00,"$1,126.18",$0.00
27202973,EAP,HCPCS C1729,,Kit Cath Peritoneum Strt Pleurx 1000ml,"$2,226.00",$0.00,"$2,226.00","$1,208.72","$1,588.70",$0.00,$383.53,"$1,588.70","$1,588.70",$389.75,"$2,226.00",$0.00,"$1,113.00","$1,762.99","$1,780.80",$0.00,$348.37,$0.00,$354.38,$0.00
27202974,EAP,Custom 27202974,,Cable Pcng 6ft Pc Lc Trnvns Sf Dev Temp Conctr Clip Adpr,$49.00,$0.00,$49.00,$0.00,$34.97,$0.00,$0.00,$34.97,$34.97,$0.00,$49.00,$0.00,$24.50,$38.81,$39.20,$0.00,$0.00,$0.00,$0.00,$0.00
27202976,EAP,Custom 27202976,,Shld Rad16x16in Drp Armr Rdbrrier L Pstn Prtc Strl,$72.00,$0.00,$72.00,$0.00,$51.39,$0.00,$0.00,$51.39,$51.39,$0.00,$72.00,$0.00,$36.00,$57.02,$57.60,$0.00,$0.00,$0.00,$0.00,$0.00
27202977,EAP,Custom 27202977,,Trvo Prvue 4x20mm Rtrvr Kit & Trvo Pro 18 Mc,"$13,399.00",$0.00,"$13,399.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$13,399.00",$0.00,"$6,699.50","$10,612.01","$10,719.20",$0.00,$0.00,$0.00,$0.00,$0.00
27202978,EAP,Custom 27202978,,Trvo Xp Prvue 4x20mm Rtrvr Kit & Trvo Pro 18 Mc,"$13,399.00",$0.00,"$13,399.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$13,399.00",$0.00,"$6,699.50","$10,612.01","$10,719.20",$0.00,$0.00,$0.00,$0.00,$0.00
27202979,EAP,Custom 27202979,,Trvo Xp Prvue 3x20mm Rtrvr Kit & Trvo Pro 14 Mc,"$13,399.00",$0.00,"$13,399.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$13,399.00",$0.00,"$6,699.50","$10,612.01","$10,719.20",$0.00,$0.00,$0.00,$0.00,$0.00
27202980,EAP,HCPCS C1769,,Guidewire Vasc 190cm .035in Strbl Str Htrq Scr,$197.00,$0.00,$197.00,$106.97,$140.60,$0.00,$33.94,$140.60,$140.60,$34.49,$197.00,$0.00,$98.50,$156.02,$157.60,$0.00,$30.83,$0.00,$31.36,$0.00
27202981,EAP,HCPCS C1887,,"Turnpike Catheter, Smooth Shaft, 135cm","$1,377.00",$0.00,"$1,377.00",$747.71,$982.76,$0.00,$237.25,$982.76,$982.76,$241.10,"$1,377.00",$0.00,$688.50,"$1,090.58","$1,101.60",$0.00,$215.50,$0.00,$219.22,$0.00
27202982,EAP,HCPCS C1887,,"Turnpike Catheter, Smooth Shaft, 155cm","$1,561.00",$0.00,"$1,561.00",$847.62,"$1,114.09",$0.00,$268.95,"$1,114.09","$1,114.09",$273.32,"$1,561.00",$0.00,$780.50,"$1,236.31","$1,248.80",$0.00,$244.30,$0.00,$248.51,$0.00
27202983,EAP,HCPCS C1769,,Guidewire Vasc 180cm .014in Hbrd Radiopq Str Tip,$394.00,$0.00,$394.00,$213.94,$281.20,$0.00,$67.88,$281.20,$281.20,$68.99,$394.00,$0.00,$197.00,$312.05,$315.20,$0.00,$61.66,$0.00,$62.72,$0.00
27202984,EAP,,,Gdwire Vasc Strght; Sprg L200cm L9 Cm Od.008 In,"$1,238.00",$0.00,"$1,238.00",$0.00,$883.56,$0.00,$0.00,$883.56,$883.56,$0.00,"$1,238.00",$0.00,$619.00,$980.50,$990.40,$0.00,$0.00,$0.00,$0.00,$0.00
27202985,EAP,HCPCS C1769,,Gdwire Vasc 25d L150 Cm Rnd Curve L200 Cm L170,"$1,337.00",$0.00,"$1,337.00",$725.99,$954.22,$0.00,$230.36,$954.22,$954.22,$234.10,"$1,337.00",$0.00,$668.50,"$1,058.90","$1,069.60",$0.00,$209.24,$0.00,$212.85,$0.00
27202986,EAP,HCPCS C1769,,"Gdwire Vasc Slip Coat Stnlss Stl Polymer 25 D, L","$1,337.00",$0.00,"$1,337.00",$725.99,$954.22,$0.00,$230.36,$954.22,$954.22,$234.10,"$1,337.00",$0.00,$668.50,"$1,058.90","$1,069.60",$0.00,$209.24,$0.00,$212.85,$0.00
27202987,EAP,HCPCS C1769,,Gdwire Vasc Slip-coat; Stnlss Stl; Polymer 25 D;,$919.00,$0.00,$919.00,$499.02,$655.89,$0.00,$158.34,$655.89,$655.89,$160.91,$919.00,$0.00,$459.50,$727.85,$735.20,$0.00,$143.82,$0.00,$146.30,$0.00
27202988,EAP,HCPCS C1887,,Arc Catheter,"$4,712.00",$0.00,"$4,712.00","$2,558.62","$3,362.95",$0.00,$811.85,"$3,362.95","$3,362.95",$825.03,"$4,712.00",$0.00,"$2,356.00","$3,731.90","$3,769.60",$0.00,$737.43,$0.00,$750.15,$0.00
27202989,EAP,HCPCS C1887,,Arc Mini Catheter,"$3,625.00",$0.00,"$3,625.00","$1,968.38","$2,587.16",$0.00,$624.57,"$2,587.16","$2,587.16",$634.71,"$3,625.00",$0.00,"$1,812.50","$2,871.00","$2,900.00",$0.00,$567.31,$0.00,$577.10,$0.00
27202990,EAP,HCPCS C1887,,Marksman Catheter,"$2,000.00",$0.00,"$2,000.00","$1,086.00","$1,427.40",$0.00,$344.59,"$1,427.40","$1,427.40",$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
27202991,EAP,HCPCS C1769,,Guidewire Vasc 200cm .014in Str 3cm Traxcess Ntnl,$844.00,$0.00,$844.00,$458.29,$602.36,$0.00,$145.42,$602.36,$602.36,$147.78,$844.00,$0.00,$422.00,$668.45,$675.20,$0.00,$132.09,$0.00,$134.36,$0.00
27202992,EAP,HCPCS C1769,,Guidewire Vasc Traxcess 3x200 Ex,$878.00,$0.00,$878.00,$476.75,$626.63,$0.00,$151.28,$626.63,$626.63,$153.73,$878.00,$0.00,$439.00,$695.38,$702.40,$0.00,$137.41,$0.00,$139.78,$0.00
27202993,EAP,HCPCS C1769,,Guidewire Vasc Dck Traxcess,$338.00,$0.00,$338.00,$183.53,$241.23,$0.00,$58.24,$241.23,$241.23,$59.18,$338.00,$0.00,$169.00,$267.70,$270.40,$0.00,$52.90,$0.00,$53.81,$0.00
27202994,EAP,HCPCS C1725,,Catheter 3.4fr 2.4fr 135cm Crossboss Intvn Rnd,"$3,412.00",$0.00,"$3,412.00","$1,852.72","$2,435.14",$0.00,$587.87,"$2,435.14","$2,435.14",$597.41,"$3,412.00",$0.00,"$1,706.00","$2,702.30","$2,729.60",$0.00,$533.98,$0.00,$543.19,$0.00
27202995,EAP,HCPCS C1725,,Catheter Baldilat 3.7fr 2.9fr 135cm Coron Sdprt,"$4,738.00",$0.00,"$4,738.00","$2,572.73","$3,381.51",$0.00,$816.33,"$3,381.51","$3,381.51",$829.59,"$4,738.00",$0.00,"$2,369.00","$3,752.50","$3,790.40",$0.00,$741.50,$0.00,$754.29,$0.00
27202996,EAP,HCPCS C1769,,Guidewire Vasc 185cm .014in True Lum Slf Ornt,"$1,013.00",$0.00,"$1,013.00",$550.06,$722.98,$0.00,$174.53,$722.98,$722.98,$177.37,"$1,013.00",$0.00,$506.50,$802.30,$810.40,$0.00,$158.53,$0.00,$161.27,$0.00
27202997,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in True Lum Slf Ornt,"$1,013.00",$0.00,"$1,013.00",$550.06,$722.98,$0.00,$174.53,$722.98,$722.98,$177.37,"$1,013.00",$0.00,$506.50,$802.30,$810.40,$0.00,$158.53,$0.00,$161.27,$0.00
27202998,EAP,HCPCS C1769,,Guidewire Vasc 20cm .014in Extn 28d Stingray,$305.00,$0.00,$305.00,$165.62,$217.68,$0.00,$52.55,$217.68,$217.68,$53.40,$305.00,$0.00,$152.50,$241.56,$244.00,$0.00,$47.73,$0.00,$48.56,$0.00
27202999,EAP,HCPCS C1769,,Coronary Intervention Wire.,$0.01,$0.00,$0.01,$0.01,$0.01,$0.00,$0.00,$0.01,$0.01,$0.00,$0.01,$0.00,$0.01,$0.01,$0.01,$0.00,$0.00,$0.00,$0.00,$0.00
27203000,EAP,HCPCS C1887,,Cath Angiogrphc .038in Pigtail 145d Cv 6fr 110cm 2,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27203001,EAP,Custom 27203001,,Unit Therapeutic Incision Mngmnt Sys Peel Plc Kt,"$1,238.00",$0.00,"$1,238.00",$0.00,$883.56,$0.00,$0.00,$883.56,$883.56,$0.00,"$1,238.00",$0.00,$619.00,$980.50,$990.40,$0.00,$0.00,$0.00,$0.00,$0.00
27203002,EAP,HCPCS C1725,,Catheter Baldilat Lp 5.3fr 3mm 75cm 60mm High Pressure,$500.00,$0.00,$500.00,$271.50,$356.85,$0.00,$86.15,$356.85,$356.85,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
27203003,EAP,HCPCS C1725,,Catheter Baldilat .035in 5mm 75cm 40mm High Pressure Lp,$500.00,$0.00,$500.00,$271.50,$356.85,$0.00,$86.15,$356.85,$356.85,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
27203004,EAP,HCPCS C1725,,Catheter Baldilat .035in 6mm 75cm 20mm High Pressure Lp,$500.00,$0.00,$500.00,$271.50,$356.85,$0.00,$86.15,$356.85,$356.85,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
27203005,EAP,HCPCS C1725,,Catheter Baldilat Lp 5.3fr 6mm 135cm 40mm High Pressure,$500.00,$0.00,$500.00,$271.50,$356.85,$0.00,$86.15,$356.85,$356.85,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
27203006,EAP,HCPCS C1725,,Catheter Baldilat Lp 5.3fr 8mm 75cm 20mm High Pressure,$500.00,$0.00,$500.00,$271.50,$356.85,$0.00,$86.15,$356.85,$356.85,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
27203050,EAP,Custom 27203050,,Chiba Needle 22g X 10cm,$30.00,$0.00,$30.00,$0.00,$21.41,$0.00,$0.00,$21.41,$21.41,$0.00,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$0.00,$0.00,$0.00,$0.00
27203051,EAP,Custom 27203051,,Chiba Needle 18g X 10cm,$30.00,$0.00,$30.00,$0.00,$21.41,$0.00,$0.00,$21.41,$21.41,$0.00,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$0.00,$0.00,$0.00,$0.00
27203052,EAP,Custom 27203052,,Chiba Needle 18g X 15cm,$30.00,$0.00,$30.00,$0.00,$21.41,$0.00,$0.00,$21.41,$21.41,$0.00,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$0.00,$0.00,$0.00,$0.00
27203053,EAP,Custom 27203053,,Chiba Needle 18g X 20cm,$30.00,$0.00,$30.00,$0.00,$21.41,$0.00,$0.00,$21.41,$21.41,$0.00,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$0.00,$0.00,$0.00,$0.00
27203054,EAP,Custom 27203054,,Chiba Needle 20g X 10cm,$30.00,$0.00,$30.00,$0.00,$21.41,$0.00,$0.00,$21.41,$21.41,$0.00,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$0.00,$0.00,$0.00,$0.00
27203055,EAP,Custom 27203055,,Chiba Needle 20g X 15cm,$30.00,$0.00,$30.00,$0.00,$21.41,$0.00,$0.00,$21.41,$21.41,$0.00,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$0.00,$0.00,$0.00,$0.00
27203056,EAP,Custom 27203056,,Chiba Needle 20g X 20cm,$30.00,$0.00,$30.00,$0.00,$21.41,$0.00,$0.00,$21.41,$21.41,$0.00,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$0.00,$0.00,$0.00,$0.00
27203057,EAP,Custom 27203057,,6f Dilator,$10.00,$0.00,$10.00,$0.00,$7.14,$0.00,$0.00,$7.14,$7.14,$0.00,$10.00,$0.00,$5.00,$7.92,$8.00,$0.00,$0.00,$0.00,$0.00,$0.00
27203058,EAP,Custom 27203058,,7f Dilator,$18.00,$0.00,$18.00,$0.00,$12.85,$0.00,$0.00,$12.85,$12.85,$0.00,$18.00,$0.00,$9.00,$14.26,$14.40,$0.00,$0.00,$0.00,$0.00,$0.00
27203059,EAP,Custom 27203059,,8f Dilator,$18.00,$0.00,$18.00,$0.00,$12.85,$0.00,$0.00,$12.85,$12.85,$0.00,$18.00,$0.00,$9.00,$14.26,$14.40,$0.00,$0.00,$0.00,$0.00,$0.00
27203060,EAP,Custom 27203060,,10f Dilator,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$15.70,$15.70,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
27203061,EAP,Custom 27203061,,12f Dilator,$30.00,$0.00,$30.00,$0.00,$21.41,$0.00,$0.00,$21.41,$21.41,$0.00,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$0.00,$0.00,$0.00,$0.00
27203062,EAP,Custom 27203062,,14f Dilator,$37.00,$0.00,$37.00,$0.00,$26.41,$0.00,$0.00,$26.41,$26.41,$0.00,$37.00,$0.00,$18.50,$29.30,$29.60,$0.00,$0.00,$0.00,$0.00,$0.00
27203063,EAP,Custom 27203063,,Introducer Needle 17g X 10cm,$100.00,$0.00,$100.00,$0.00,$71.37,$0.00,$0.00,$71.37,$71.37,$0.00,$100.00,$0.00,$50.00,$79.20,$80.00,$0.00,$0.00,$0.00,$0.00,$0.00
27203064,EAP,Custom 27203064,,Introducer Needle 17g X 15cm,$115.00,$0.00,$115.00,$0.00,$82.08,$0.00,$0.00,$82.08,$82.08,$0.00,$115.00,$0.00,$57.50,$91.08,$92.00,$0.00,$0.00,$0.00,$0.00,$0.00
27203065,EAP,Custom 27203065,,Introducer Needle 19g X 6cm,$120.00,$0.00,$120.00,$0.00,$85.64,$0.00,$0.00,$85.64,$85.64,$0.00,$120.00,$0.00,$60.00,$95.04,$96.00,$0.00,$0.00,$0.00,$0.00,$0.00
27203066,EAP,Custom 27203066,,Introducer Needle 19g X 10cm,$130.00,$0.00,$130.00,$0.00,$92.78,$0.00,$0.00,$92.78,$92.78,$0.00,$130.00,$0.00,$65.00,$102.96,$104.00,$0.00,$0.00,$0.00,$0.00,$0.00
27203067,EAP,Custom 27203067,,Introducer Needle 19g X 15cm,$136.00,$0.00,$136.00,$0.00,$97.06,$0.00,$0.00,$97.06,$97.06,$0.00,$136.00,$0.00,$68.00,$107.71,$108.80,$0.00,$0.00,$0.00,$0.00,$0.00
27203068,EAP,Custom 27203068,,Coaxial Sets 19x10x20x15,$79.00,$0.00,$79.00,$0.00,$56.38,$0.00,$0.00,$56.38,$56.38,$0.00,$79.00,$0.00,$39.50,$62.57,$63.20,$0.00,$0.00,$0.00,$0.00,$0.00
27203069,EAP,Custom 27203069,,Coaxial Sets 19x15x20x20,$71.00,$0.00,$71.00,$0.00,$50.67,$0.00,$0.00,$50.67,$50.67,$0.00,$71.00,$0.00,$35.50,$56.23,$56.80,$0.00,$0.00,$0.00,$0.00,$0.00
27203070,EAP,Custom 27203070,,Achieve Gun 18g X 9cm,$135.00,$0.00,$135.00,$0.00,$96.35,$0.00,$0.00,$96.35,$96.35,$0.00,$135.00,$0.00,$67.50,$106.92,$108.00,$0.00,$0.00,$0.00,$0.00,$0.00
27203071,EAP,Custom 27203071,,Achieve Gun 18g X 11cm,$138.00,$0.00,$138.00,$0.00,$98.49,$0.00,$0.00,$98.49,$98.49,$0.00,$138.00,$0.00,$69.00,$109.30,$110.40,$0.00,$0.00,$0.00,$0.00,$0.00
27203072,EAP,Custom 27203072,,Achieve Gun 18g X 15cm,$150.00,$0.00,$150.00,$0.00,$107.06,$0.00,$0.00,$107.06,$107.06,$0.00,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$0.00,$0.00,$0.00,$0.00
27203073,EAP,Custom 27203073,,Achieve Gun 18g X 20cm,$214.00,$0.00,$214.00,$0.00,$152.73,$0.00,$0.00,$152.73,$152.73,$0.00,$214.00,$0.00,$107.00,$169.49,$171.20,$0.00,$0.00,$0.00,$0.00,$0.00
27203074,EAP,Custom 27203074,,Achieve Gun 20g X 11cm,$230.00,$0.00,$230.00,$0.00,$164.15,$0.00,$0.00,$164.15,$164.15,$0.00,$230.00,$0.00,$115.00,$182.16,$184.00,$0.00,$0.00,$0.00,$0.00,$0.00
27203075,EAP,Custom 27203075,,Achieve Gun 20g X 15cm,$237.00,$0.00,$237.00,$0.00,$169.15,$0.00,$0.00,$169.15,$169.15,$0.00,$237.00,$0.00,$118.50,$187.70,$189.60,$0.00,$0.00,$0.00,$0.00,$0.00
27203076,EAP,Custom 27203076,,Achieve Gun 20g X 20cm,$245.00,$0.00,$245.00,$0.00,$174.86,$0.00,$0.00,$174.86,$174.86,$0.00,$245.00,$0.00,$122.50,$194.04,$196.00,$0.00,$0.00,$0.00,$0.00,$0.00
27203077,EAP,Custom 27203077,,Franseen Lung Bx Needle,$122.00,$0.00,$122.00,$0.00,$87.07,$0.00,$0.00,$87.07,$87.07,$0.00,$122.00,$0.00,$61.00,$96.62,$97.60,$0.00,$0.00,$0.00,$0.00,$0.00
27203078,EAP,Custom 27203078,,Vansonnenberg Needle Set,$146.00,$0.00,$146.00,$0.00,$104.20,$0.00,$0.00,$104.20,$104.20,$0.00,$146.00,$0.00,$73.00,$115.63,$116.80,$0.00,$0.00,$0.00,$0.00,$0.00
27203079,EAP,Custom 27203079,,Bonopty Bx Set,"$1,154.00",$0.00,"$1,154.00",$0.00,$823.61,$0.00,$0.00,$823.61,$823.61,$0.00,"$1,154.00",$0.00,$577.00,$913.97,$923.20,$0.00,$0.00,$0.00,$0.00,$0.00
27203080,EAP,Custom 27203080,,Bonopty Bx Penetration Set,"$1,505.00",$0.00,"$1,505.00",$0.00,"$1,074.12",$0.00,$0.00,"$1,074.12","$1,074.12",$0.00,"$1,505.00",$0.00,$752.50,"$1,191.96","$1,204.00",$0.00,$0.00,$0.00,$0.00,$0.00
27203081,EAP,Custom 27203081,,Soft Tissue Bx Tray,$63.00,$0.00,$63.00,$0.00,$44.96,$0.00,$0.00,$44.96,$44.96,$0.00,$63.00,$0.00,$31.50,$49.90,$50.40,$0.00,$0.00,$0.00,$0.00,$0.00
27203082,EAP,Custom 27203082,,Lumbar Puncture Tray,$229.00,$0.00,$229.00,$0.00,$163.44,$0.00,$0.00,$163.44,$163.44,$0.00,$229.00,$0.00,$114.50,$181.37,$183.20,$0.00,$0.00,$0.00,$0.00,$0.00
27203083,EAP,Custom 27203083,,Para/thoracentesis Tray,$138.00,$0.00,$138.00,$0.00,$98.49,$0.00,$0.00,$98.49,$98.49,$0.00,$138.00,$0.00,$69.00,$109.30,$110.40,$0.00,$0.00,$0.00,$0.00,$0.00
27203084,EAP,Custom 27203084,,Uresil Drainage Bag,$111.00,$0.00,$111.00,$0.00,$79.22,$0.00,$0.00,$79.22,$79.22,$0.00,$111.00,$0.00,$55.50,$87.91,$88.80,$0.00,$0.00,$0.00,$0.00,$0.00
27203085,EAP,Custom 27203085,,Gelfoam Sponge,$464.00,$0.00,$464.00,$0.00,$331.16,$0.00,$0.00,$331.16,$331.16,$0.00,$464.00,$0.00,$232.00,$367.49,$371.20,$0.00,$0.00,$0.00,$0.00,$0.00
27203086,EAP,Custom 27203086,,Suture Silk 2-0 30in Black,$21.00,$0.00,$21.00,$0.00,$14.99,$0.00,$0.00,$14.99,$14.99,$0.00,$21.00,$0.00,$10.50,$16.63,$16.80,$0.00,$0.00,$0.00,$0.00,$0.00
27203087,EAP,Custom 27203087,,Steri-drape,$20.00,$0.00,$20.00,$0.00,$14.27,$0.00,$0.00,$14.27,$14.27,$0.00,$20.00,$0.00,$10.00,$15.84,$16.00,$0.00,$0.00,$0.00,$0.00,$0.00
27203088,EAP,Custom 27203088,,Drainge Catheters,$228.00,$0.00,$228.00,$0.00,$162.72,$0.00,$0.00,$162.72,$162.72,$0.00,$228.00,$0.00,$114.00,$180.58,$182.40,$0.00,$0.00,$0.00,$0.00,$0.00
27203090,EAP,Custom 27203090,,Cre Wg 6-8mm Dilation Balloon,$324.00,$0.00,$324.00,$0.00,$231.24,$0.00,$0.00,$231.24,$231.24,$0.00,$324.00,$0.00,$162.00,$256.61,$259.20,$0.00,$0.00,$0.00,$0.00,$0.00
27203091,EAP,Custom 27203091,,Cre Wg 8-10 Dilation Balloon,$324.00,$0.00,$324.00,$0.00,$231.24,$0.00,$0.00,$231.24,$231.24,$0.00,$324.00,$0.00,$162.00,$256.61,$259.20,$0.00,$0.00,$0.00,$0.00,$0.00
27203092,EAP,Custom 27203092,,Cre Wg 10-12 Dilation Balloon,$324.00,$0.00,$324.00,$0.00,$231.24,$0.00,$0.00,$231.24,$231.24,$0.00,$324.00,$0.00,$162.00,$256.61,$259.20,$0.00,$0.00,$0.00,$0.00,$0.00
27203093,EAP,Custom 27203093,,Cre 12-15mm Dilation Balloon,$324.00,$0.00,$324.00,$0.00,$231.24,$0.00,$0.00,$231.24,$231.24,$0.00,$324.00,$0.00,$162.00,$256.61,$259.20,$0.00,$0.00,$0.00,$0.00,$0.00
27203094,EAP,Custom 27203094,,Cre 15-18 Mm Dilation Balloon,$324.00,$0.00,$324.00,$0.00,$231.24,$0.00,$0.00,$231.24,$231.24,$0.00,$324.00,$0.00,$162.00,$256.61,$259.20,$0.00,$0.00,$0.00,$0.00,$0.00
27203095,EAP,Custom 27203095,,Cre 18-20 Mm Dilation Balloon,$324.00,$0.00,$324.00,$0.00,$231.24,$0.00,$0.00,$231.24,$231.24,$0.00,$324.00,$0.00,$162.00,$256.61,$259.20,$0.00,$0.00,$0.00,$0.00,$0.00
27203096,EAP,Custom 27203096,,Alliance Inflation Syringe,$52.00,$0.00,$52.00,$0.00,$37.11,$0.00,$0.00,$37.11,$37.11,$0.00,$52.00,$0.00,$26.00,$41.18,$41.60,$0.00,$0.00,$0.00,$0.00,$0.00
27203097,EAP,Custom 27203097,,2.3mm Interject Inj Needle23g,$732.00,$0.00,$732.00,$0.00,$522.43,$0.00,$0.00,$522.43,$522.43,$0.00,$732.00,$0.00,$366.00,$579.74,$585.60,$0.00,$0.00,$0.00,$0.00,$0.00
27203098,EAP,Custom 27203098,,Dreamwire .035 260str Stnd,$281.00,$0.00,$281.00,$0.00,$200.55,$0.00,$0.00,$200.55,$200.55,$0.00,$281.00,$0.00,$140.50,$222.55,$224.80,$0.00,$0.00,$0.00,$0.00,$0.00
27203099,EAP,Custom 27203099,,Extractor Rx 9-12 Mm,$240.00,$0.00,$240.00,$0.00,$171.29,$0.00,$0.00,$171.29,$171.29,$0.00,$240.00,$0.00,$120.00,$190.08,$192.00,$0.00,$0.00,$0.00,$0.00,$0.00
27203100,EAP,Custom 27203100,,Extractor Rx 12-15 Mm,$229.00,$0.00,$229.00,$0.00,$163.44,$0.00,$0.00,$163.44,$163.44,$0.00,$229.00,$0.00,$114.50,$181.37,$183.20,$0.00,$0.00,$0.00,$0.00,$0.00
27203101,EAP,Custom 27203101,,Extractor Rx 15-18 Mm,$229.00,$0.00,$229.00,$0.00,$163.44,$0.00,$0.00,$163.44,$163.44,$0.00,$229.00,$0.00,$114.50,$181.37,$183.20,$0.00,$0.00,$0.00,$0.00,$0.00
27203102,EAP,Custom 27203102,,22g Blue Sheath (stiffer),$386.00,$0.00,$386.00,$0.00,$275.49,$0.00,$0.00,$275.49,$275.49,$0.00,$386.00,$0.00,$193.00,$305.71,$308.80,$0.00,$0.00,$0.00,$0.00,$0.00
27203103,EAP,Custom 27203103,,22g Green Spring Coil Sheath,$386.00,$0.00,$386.00,$0.00,$275.49,$0.00,$0.00,$275.49,$275.49,$0.00,$386.00,$0.00,$193.00,$305.71,$308.80,$0.00,$0.00,$0.00,$0.00,$0.00
27203104,EAP,Custom 27203104,,Celiac Plexus Neurolysis Needl,$392.00,$0.00,$392.00,$0.00,$279.77,$0.00,$0.00,$279.77,$279.77,$0.00,$392.00,$0.00,$196.00,$310.46,$313.60,$0.00,$0.00,$0.00,$0.00,$0.00
27203105,EAP,Custom 27203105,,19g Bx Needle,$515.00,$0.00,$515.00,$0.00,$367.56,$0.00,$0.00,$367.56,$367.56,$0.00,$515.00,$0.00,$257.50,$407.88,$412.00,$0.00,$0.00,$0.00,$0.00,$0.00
27203106,EAP,Custom 27203106,,Cytology Brush Echo -19,$244.00,$0.00,$244.00,$0.00,$174.14,$0.00,$0.00,$174.14,$174.14,$0.00,$244.00,$0.00,$122.00,$193.25,$195.20,$0.00,$0.00,$0.00,$0.00,$0.00
27203108,EAP,Custom 27203108,,Olympus Endo Jaw(cold Forceps),$15.00,$0.00,$15.00,$0.00,$10.71,$0.00,$0.00,$10.71,$10.71,$0.00,$15.00,$0.00,$7.50,$11.88,$12.00,$0.00,$0.00,$0.00,$0.00,$0.00
27203109,EAP,Custom 27203109,,Roth Net,"$1,278.00",$0.00,"$1,278.00",$0.00,$912.11,$0.00,$0.00,$912.11,$912.11,$0.00,"$1,278.00",$0.00,$639.00,"$1,012.18","$1,022.40",$0.00,$0.00,$0.00,$0.00,$0.00
27203110,EAP,Custom 27203110,,Erbe Probe,$288.00,$0.00,$288.00,$0.00,$205.55,$0.00,$0.00,$205.55,$205.55,$0.00,$288.00,$0.00,$144.00,$228.10,$230.40,$0.00,$0.00,$0.00,$0.00,$0.00
27203111,EAP,Custom 27203111,,Ercp Forcep,$691.00,$0.00,$691.00,$0.00,$493.17,$0.00,$0.00,$493.17,$493.17,$0.00,$691.00,$0.00,$345.50,$547.27,$552.80,$0.00,$0.00,$0.00,$0.00,$0.00
27203112,EAP,Custom 27203112,,Rx Dilatation Balloon 4-4/5.8,$414.00,$0.00,$414.00,$0.00,$295.47,$0.00,$0.00,$295.47,$295.47,$0.00,$414.00,$0.00,$207.00,$327.89,$331.20,$0.00,$0.00,$0.00,$0.00,$0.00
27203113,EAP,Custom 27203113,,Rx Dilatation Balloon 6-4/5.8,$414.00,$0.00,$414.00,$0.00,$295.47,$0.00,$0.00,$295.47,$295.47,$0.00,$414.00,$0.00,$207.00,$327.89,$331.20,$0.00,$0.00,$0.00,$0.00,$0.00
27203114,EAP,Custom 27203114,,Rx Dilatation Balloon 8-4/5.8,$414.00,$0.00,$414.00,$0.00,$295.47,$0.00,$0.00,$295.47,$295.47,$0.00,$414.00,$0.00,$207.00,$327.89,$331.20,$0.00,$0.00,$0.00,$0.00,$0.00
27203115,EAP,Custom 27203115,,Rx Dilatation Balloon 10-4/5.8,$414.00,$0.00,$414.00,$0.00,$295.47,$0.00,$0.00,$295.47,$295.47,$0.00,$414.00,$0.00,$207.00,$327.89,$331.20,$0.00,$0.00,$0.00,$0.00,$0.00
27203116,EAP,Custom 27203116,,Encore 26 Single,$35.00,$0.00,$35.00,$0.00,$24.98,$0.00,$0.00,$24.98,$24.98,$0.00,$35.00,$0.00,$17.50,$27.72,$28.00,$0.00,$0.00,$0.00,$0.00,$0.00
27203117,EAP,Custom 27203117,,Injection Probe 10fr,$431.00,$0.00,$431.00,$0.00,$307.60,$0.00,$0.00,$307.60,$307.60,$0.00,$431.00,$0.00,$215.50,$341.35,$344.80,$0.00,$0.00,$0.00,$0.00,$0.00
27203118,EAP,Custom 27203118,,Injection Probe 7fr,$431.00,$0.00,$431.00,$0.00,$307.60,$0.00,$0.00,$307.60,$307.60,$0.00,$431.00,$0.00,$215.50,$341.35,$344.80,$0.00,$0.00,$0.00,$0.00,$0.00
27203120,EAP,HCPCS C1769,,.014 Nitrex Guidewire,"$1,295.00",$0.00,"$1,295.00",$703.19,$924.24,$0.00,$223.12,$924.24,$924.24,$226.74,"$1,295.00",$0.00,$647.50,"$1,025.64","$1,036.00",$0.00,$202.67,$0.00,$206.16,$0.00
27203121,EAP,Custom 27203121,,Coil Axium Helical  Qc-1.5-2-helix,"$3,686.00",$0.00,"$3,686.00",$0.00,"$2,630.70",$0.00,$0.00,"$2,630.70","$2,630.70",$0.00,"$3,686.00",$0.00,"$1,843.00","$2,919.31","$2,948.80",$0.00,$0.00,$0.00,$0.00,$0.00
27203122,EAP,Custom 27203122,,Coil Axium Helical  Qc-2-1-helix,"$3,721.00",$0.00,"$3,721.00",$0.00,"$2,655.68",$0.00,$0.00,"$2,655.68","$2,655.68",$0.00,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$0.00,$0.00,$0.00,$0.00
27203123,EAP,Custom 27203123,,Coil Axium Helical  Qc-2-2-helix,"$3,885.00",$0.00,"$3,885.00",$0.00,"$2,772.72",$0.00,$0.00,"$2,772.72","$2,772.72",$0.00,"$3,885.00",$0.00,"$1,942.50","$3,076.92","$3,108.00",$0.00,$0.00,$0.00,$0.00,$0.00
27203124,EAP,Custom 27203124,,Coil Axium Helical  Qc-2-3-helix,"$3,770.00",$0.00,"$3,770.00",$0.00,"$2,690.65",$0.00,$0.00,"$2,690.65","$2,690.65",$0.00,"$3,770.00",$0.00,"$1,885.00","$2,985.84","$3,016.00",$0.00,$0.00,$0.00,$0.00,$0.00
27203125,EAP,Custom 27203125,,Coil Axium Helical  Qc-2-4-helix,"$3,885.00",$0.00,"$3,885.00",$0.00,"$2,772.72",$0.00,$0.00,"$2,772.72","$2,772.72",$0.00,"$3,885.00",$0.00,"$1,942.50","$3,076.92","$3,108.00",$0.00,$0.00,$0.00,$0.00,$0.00
27203126,EAP,Custom 27203126,,Coil Axium Helical  Qc-2-6-helix,"$3,819.00",$0.00,"$3,819.00",$0.00,"$2,725.62",$0.00,$0.00,"$2,725.62","$2,725.62",$0.00,"$3,819.00",$0.00,"$1,909.50","$3,024.65","$3,055.20",$0.00,$0.00,$0.00,$0.00,$0.00
27203127,EAP,Custom 27203127,,Coil Axium Helical  Qc-2-8-helix,"$3,986.00",$0.00,"$3,986.00",$0.00,"$2,844.81",$0.00,$0.00,"$2,844.81","$2,844.81",$0.00,"$3,986.00",$0.00,"$1,993.00","$3,156.91","$3,188.80",$0.00,$0.00,$0.00,$0.00,$0.00
27203128,EAP,Custom 27203128,,Coil Axium Helical  Qc-3-4-helix,"$3,854.00",$0.00,"$3,854.00",$0.00,"$2,750.60",$0.00,$0.00,"$2,750.60","$2,750.60",$0.00,"$3,854.00",$0.00,"$1,927.00","$3,052.37","$3,083.20",$0.00,$0.00,$0.00,$0.00,$0.00
27203129,EAP,Custom 27203129,,Coil Axium Helical  Qc-3-6-helix,"$3,986.00",$0.00,"$3,986.00",$0.00,"$2,844.81",$0.00,$0.00,"$2,844.81","$2,844.81",$0.00,"$3,986.00",$0.00,"$1,993.00","$3,156.91","$3,188.80",$0.00,$0.00,$0.00,$0.00,$0.00
27203130,EAP,Custom 27203130,,Coil Axium Helical  Qc-3-8-helix,"$3,885.00",$0.00,"$3,885.00",$0.00,"$2,772.72",$0.00,$0.00,"$2,772.72","$2,772.72",$0.00,"$3,885.00",$0.00,"$1,942.50","$3,076.92","$3,108.00",$0.00,$0.00,$0.00,$0.00,$0.00
27203131,EAP,Custom 27203131,,Coil Axium Helical  Qc-4-8-helix,"$4,071.00",$0.00,"$4,071.00",$0.00,"$2,905.47",$0.00,$0.00,"$2,905.47","$2,905.47",$0.00,"$4,071.00",$0.00,"$2,035.50","$3,224.23","$3,256.80",$0.00,$0.00,$0.00,$0.00,$0.00
27203132,EAP,Custom 27203132,,Coil Axium Helical  Qc-4-10-helix,"$3,885.00",$0.00,"$3,885.00",$0.00,"$2,772.72",$0.00,$0.00,"$2,772.72","$2,772.72",$0.00,"$3,885.00",$0.00,"$1,942.50","$3,076.92","$3,108.00",$0.00,$0.00,$0.00,$0.00,$0.00
27203133,EAP,Custom 27203133,,Coil Axium Helical  Qc-4-12-helix,"$3,920.00",$0.00,"$3,920.00",$0.00,"$2,797.70",$0.00,$0.00,"$2,797.70","$2,797.70",$0.00,"$3,920.00",$0.00,"$1,960.00","$3,104.64","$3,136.00",$0.00,$0.00,$0.00,$0.00,$0.00
27203134,EAP,Custom 27203134,,Coil Axium Helical  Qc-5-15-helix,"$3,920.00",$0.00,"$3,920.00",$0.00,"$2,797.70",$0.00,$0.00,"$2,797.70","$2,797.70",$0.00,"$3,920.00",$0.00,"$1,960.00","$3,104.64","$3,136.00",$0.00,$0.00,$0.00,$0.00,$0.00
27203135,EAP,Custom 27203135,,Coil Axium Helical  Qc-5-20-helix,"$3,955.00",$0.00,"$3,955.00",$0.00,"$2,822.68",$0.00,$0.00,"$2,822.68","$2,822.68",$0.00,"$3,955.00",$0.00,"$1,977.50","$3,132.36","$3,164.00",$0.00,$0.00,$0.00,$0.00,$0.00
27203136,EAP,Custom 27203136,,Coil Axium Helical  Qc-6-20-helix,"$4,005.00",$0.00,"$4,005.00",$0.00,"$2,858.37",$0.00,$0.00,"$2,858.37","$2,858.37",$0.00,"$4,005.00",$0.00,"$2,002.50","$3,171.96","$3,204.00",$0.00,$0.00,$0.00,$0.00,$0.00
27203137,EAP,Custom 27203137,,Coil Axium Helical  Qc-7 -30-helix,"$4,020.00",$0.00,"$4,020.00",$0.00,"$2,869.07",$0.00,$0.00,"$2,869.07","$2,869.07",$0.00,"$4,020.00",$0.00,"$2,010.00","$3,183.84","$3,216.00",$0.00,$0.00,$0.00,$0.00,$0.00
27203138,EAP,Custom 27203138,,Coil Axium Helical  Qc-8-30-helix,"$4,071.00",$0.00,"$4,071.00",$0.00,"$2,905.47",$0.00,$0.00,"$2,905.47","$2,905.47",$0.00,"$4,071.00",$0.00,"$2,035.50","$3,224.23","$3,256.80",$0.00,$0.00,$0.00,$0.00,$0.00
27203139,EAP,Custom 27203139,,Coil Axium Helical  Qc-9-30-helix,"$4,071.00",$0.00,"$4,071.00",$0.00,"$2,905.47",$0.00,$0.00,"$2,905.47","$2,905.47",$0.00,"$4,071.00",$0.00,"$2,035.50","$3,224.23","$3,256.80",$0.00,$0.00,$0.00,$0.00,$0.00
27203140,EAP,Custom 27203140,,Coil Axium Helical  Qc-10-30-helix,"$3,885.00",$0.00,"$3,885.00",$0.00,"$2,772.72",$0.00,$0.00,"$2,772.72","$2,772.72",$0.00,"$3,885.00",$0.00,"$1,942.50","$3,076.92","$3,108.00",$0.00,$0.00,$0.00,$0.00,$0.00
27203141,EAP,Custom 27203141,,Coil Axium Helical  Qc-12-30-helix,"$3,885.00",$0.00,"$3,885.00",$0.00,"$2,772.72",$0.00,$0.00,"$2,772.72","$2,772.72",$0.00,"$3,885.00",$0.00,"$1,942.50","$3,076.92","$3,108.00",$0.00,$0.00,$0.00,$0.00,$0.00
27203142,EAP,Custom 27203142,,Coil Axium Helical  Qc-14-30-helix,"$3,903.00",$0.00,"$3,903.00",$0.00,"$2,785.57",$0.00,$0.00,"$2,785.57","$2,785.57",$0.00,"$3,903.00",$0.00,"$1,951.50","$3,091.18","$3,122.40",$0.00,$0.00,$0.00,$0.00,$0.00
27203143,EAP,Custom 27203143,,Coil Axium Helical  Qc-16-30-helix,"$3,920.00",$0.00,"$3,920.00",$0.00,"$2,797.70",$0.00,$0.00,"$2,797.70","$2,797.70",$0.00,"$3,920.00",$0.00,"$1,960.00","$3,104.64","$3,136.00",$0.00,$0.00,$0.00,$0.00,$0.00
27203144,EAP,Custom 27203144,,Coil Axium Helical  Qc-16-40-helix,"$3,920.00",$0.00,"$3,920.00",$0.00,"$2,797.70",$0.00,$0.00,"$2,797.70","$2,797.70",$0.00,"$3,920.00",$0.00,"$1,960.00","$3,104.64","$3,136.00",$0.00,$0.00,$0.00,$0.00,$0.00
27203145,EAP,Custom 27203145,,Coil Axium Helical  Qc-18-40-helix,"$3,955.00",$0.00,"$3,955.00",$0.00,"$2,822.68",$0.00,$0.00,"$2,822.68","$2,822.68",$0.00,"$3,955.00",$0.00,"$1,977.50","$3,132.36","$3,164.00",$0.00,$0.00,$0.00,$0.00,$0.00
27203146,EAP,Custom 27203146,,Coil Axium Helical  Qc-20-40-helix,"$3,936.00",$0.00,"$3,936.00",$0.00,"$2,809.12",$0.00,$0.00,"$2,809.12","$2,809.12",$0.00,"$3,936.00",$0.00,"$1,968.00","$3,117.31","$3,148.80",$0.00,$0.00,$0.00,$0.00,$0.00
27203147,EAP,Custom 27203147,,Coil Axium Helical  Qc-20-50-helix,"$4,005.00",$0.00,"$4,005.00",$0.00,"$2,858.37",$0.00,$0.00,"$2,858.37","$2,858.37",$0.00,"$4,005.00",$0.00,"$2,002.50","$3,171.96","$3,204.00",$0.00,$0.00,$0.00,$0.00,$0.00
27203148,EAP,Custom 27203148,,Coil Axium 3d  Qc-2-2-3d,"$1,395.00",$0.00,"$1,395.00",$0.00,$995.61,$0.00,$0.00,$995.61,$995.61,$0.00,"$1,395.00",$0.00,$697.50,"$1,104.84","$1,116.00",$0.00,$0.00,$0.00,$0.00,$0.00
27203149,EAP,Custom 27203149,,Coil Axium 3d  Qc-2-4-3d,"$4,105.00",$0.00,"$4,105.00",$0.00,"$2,929.74",$0.00,$0.00,"$2,929.74","$2,929.74",$0.00,"$4,105.00",$0.00,"$2,052.50","$3,251.16","$3,284.00",$0.00,$0.00,$0.00,$0.00,$0.00
27203150,EAP,Custom 27203150,,Coil Axium 3d  Qc-2-6-3d,"$4,020.00",$0.00,"$4,020.00",$0.00,"$2,869.07",$0.00,$0.00,"$2,869.07","$2,869.07",$0.00,"$4,020.00",$0.00,"$2,010.00","$3,183.84","$3,216.00",$0.00,$0.00,$0.00,$0.00,$0.00
27203151,EAP,Custom 27203151,,Coil Axium 3d  Qc-3-4-3d,"$4,170.00",$0.00,"$4,170.00",$0.00,"$2,976.13",$0.00,$0.00,"$2,976.13","$2,976.13",$0.00,"$4,170.00",$0.00,"$2,085.00","$3,302.64","$3,336.00",$0.00,$0.00,$0.00,$0.00,$0.00
27203152,EAP,Custom 27203152,,Coil Axium 3d  Qc-3-6-3d,"$3,245.00",$0.00,"$3,245.00",$0.00,"$2,315.96",$0.00,$0.00,"$2,315.96","$2,315.96",$0.00,"$3,245.00",$0.00,"$1,622.50","$2,570.04","$2,596.00",$0.00,$0.00,$0.00,$0.00,$0.00
27203153,EAP,Custom 27203153,,Coil Axium 3d  Qc-3-8-3d,"$1,395.00",$0.00,"$1,395.00",$0.00,$995.61,$0.00,$0.00,$995.61,$995.61,$0.00,"$1,395.00",$0.00,$697.50,"$1,104.84","$1,116.00",$0.00,$0.00,$0.00,$0.00,$0.00
27203154,EAP,Custom 27203154,,Coil Axium 3d  Qc-4-8-3d,"$1,395.00",$0.00,"$1,395.00",$0.00,$995.61,$0.00,$0.00,$995.61,$995.61,$0.00,"$1,395.00",$0.00,$697.50,"$1,104.84","$1,116.00",$0.00,$0.00,$0.00,$0.00,$0.00
27203155,EAP,Custom 27203155,,Coil Axium 3d  Qc-4-12-3d,"$1,395.00",$0.00,"$1,395.00",$0.00,$995.61,$0.00,$0.00,$995.61,$995.61,$0.00,"$1,395.00",$0.00,$697.50,"$1,104.84","$1,116.00",$0.00,$0.00,$0.00,$0.00,$0.00
27203156,EAP,Custom 27203156,,Coil Axium 3d  Qc-5-10-3d,"$1,395.00",$0.00,"$1,395.00",$0.00,$995.61,$0.00,$0.00,$995.61,$995.61,$0.00,"$1,395.00",$0.00,$697.50,"$1,104.84","$1,116.00",$0.00,$0.00,$0.00,$0.00,$0.00
27203157,EAP,Custom 27203157,,Coil Axium 3d  Qc-5-15-3d,"$1,395.00",$0.00,"$1,395.00",$0.00,$995.61,$0.00,$0.00,$995.61,$995.61,$0.00,"$1,395.00",$0.00,$697.50,"$1,104.84","$1,116.00",$0.00,$0.00,$0.00,$0.00,$0.00
27203158,EAP,Custom 27203158,,Coil Axium 3d  Qc-6-15-3d,"$1,395.00",$0.00,"$1,395.00",$0.00,$995.61,$0.00,$0.00,$995.61,$995.61,$0.00,"$1,395.00",$0.00,$697.50,"$1,104.84","$1,116.00",$0.00,$0.00,$0.00,$0.00,$0.00
27203159,EAP,Custom 27203159,,Coil Axium 3d  Qc-6-20-3d,"$1,395.00",$0.00,"$1,395.00",$0.00,$995.61,$0.00,$0.00,$995.61,$995.61,$0.00,"$1,395.00",$0.00,$697.50,"$1,104.84","$1,116.00",$0.00,$0.00,$0.00,$0.00,$0.00
27203160,EAP,Custom 27203160,,Coil Axium 3d  Qc-7-20-3d,"$1,395.00",$0.00,"$1,395.00",$0.00,$995.61,$0.00,$0.00,$995.61,$995.61,$0.00,"$1,395.00",$0.00,$697.50,"$1,104.84","$1,116.00",$0.00,$0.00,$0.00,$0.00,$0.00
27203161,EAP,Custom 27203161,,Coil Axium 3d  Qc-7-30-3d,"$1,395.00",$0.00,"$1,395.00",$0.00,$995.61,$0.00,$0.00,$995.61,$995.61,$0.00,"$1,395.00",$0.00,$697.50,"$1,104.84","$1,116.00",$0.00,$0.00,$0.00,$0.00,$0.00
27203162,EAP,Custom 27203162,,Coil Axium 3d  Qc-8-20-3d,"$1,395.00",$0.00,"$1,395.00",$0.00,$995.61,$0.00,$0.00,$995.61,$995.61,$0.00,"$1,395.00",$0.00,$697.50,"$1,104.84","$1,116.00",$0.00,$0.00,$0.00,$0.00,$0.00
27203163,EAP,Custom 27203163,,Coil Axium 3d  Qc-8-30-3d,"$1,395.00",$0.00,"$1,395.00",$0.00,$995.61,$0.00,$0.00,$995.61,$995.61,$0.00,"$1,395.00",$0.00,$697.50,"$1,104.84","$1,116.00",$0.00,$0.00,$0.00,$0.00,$0.00
27203164,EAP,Custom 27203164,,Coil Axium 3d  Qc-9-20-3d,"$1,395.00",$0.00,"$1,395.00",$0.00,$995.61,$0.00,$0.00,$995.61,$995.61,$0.00,"$1,395.00",$0.00,$697.50,"$1,104.84","$1,116.00",$0.00,$0.00,$0.00,$0.00,$0.00
27203165,EAP,Custom 27203165,,Coil Axium 3d  Qc-9-30-3d,"$1,395.00",$0.00,"$1,395.00",$0.00,$995.61,$0.00,$0.00,$995.61,$995.61,$0.00,"$1,395.00",$0.00,$697.50,"$1,104.84","$1,116.00",$0.00,$0.00,$0.00,$0.00,$0.00
27203166,EAP,Custom 27203166,,Coil Axium 3d  Qc-10-20-3d,"$1,395.00",$0.00,"$1,395.00",$0.00,$995.61,$0.00,$0.00,$995.61,$995.61,$0.00,"$1,395.00",$0.00,$697.50,"$1,104.84","$1,116.00",$0.00,$0.00,$0.00,$0.00,$0.00
27203167,EAP,Custom 27203167,,Coil Axium 3d  Qc-10-30-3d,"$1,395.00",$0.00,"$1,395.00",$0.00,$995.61,$0.00,$0.00,$995.61,$995.61,$0.00,"$1,395.00",$0.00,$697.50,"$1,104.84","$1,116.00",$0.00,$0.00,$0.00,$0.00,$0.00
27203168,EAP,Custom 27203168,,Coil Axium 3d  Qc-12-40-3d,"$1,395.00",$0.00,"$1,395.00",$0.00,$995.61,$0.00,$0.00,$995.61,$995.61,$0.00,"$1,395.00",$0.00,$697.50,"$1,104.84","$1,116.00",$0.00,$0.00,$0.00,$0.00,$0.00
27203169,EAP,Custom 27203169,,Coil Axium 3d  Qc-14-40-3d,"$1,395.00",$0.00,"$1,395.00",$0.00,$995.61,$0.00,$0.00,$995.61,$995.61,$0.00,"$1,395.00",$0.00,$697.50,"$1,104.84","$1,116.00",$0.00,$0.00,$0.00,$0.00,$0.00
27203170,EAP,Custom 27203170,,Coil Axium 3d  Qc-16-40-3d,"$1,395.00",$0.00,"$1,395.00",$0.00,$995.61,$0.00,$0.00,$995.61,$995.61,$0.00,"$1,395.00",$0.00,$697.50,"$1,104.84","$1,116.00",$0.00,$0.00,$0.00,$0.00,$0.00
27203171,EAP,Custom 27203171,,Coil Axium 3d  Qc-18-40-3d,"$1,395.00",$0.00,"$1,395.00",$0.00,$995.61,$0.00,$0.00,$995.61,$995.61,$0.00,"$1,395.00",$0.00,$697.50,"$1,104.84","$1,116.00",$0.00,$0.00,$0.00,$0.00,$0.00
27203172,EAP,Custom 27203172,,Coil Axium 3d  Qc-20-50-3d,"$1,395.00",$0.00,"$1,395.00",$0.00,$995.61,$0.00,$0.00,$995.61,$995.61,$0.00,"$1,395.00",$0.00,$697.50,"$1,104.84","$1,116.00",$0.00,$0.00,$0.00,$0.00,$0.00
27203173,EAP,Custom 27203173,,Coil Axium 3d  Qc-22-50-3d,"$1,395.00",$0.00,"$1,395.00",$0.00,$995.61,$0.00,$0.00,$995.61,$995.61,$0.00,"$1,395.00",$0.00,$697.50,"$1,104.84","$1,116.00",$0.00,$0.00,$0.00,$0.00,$0.00
27203174,EAP,Custom 27203174,,Coil Axium 3d  Qc-25-50-3d,"$1,395.00",$0.00,"$1,395.00",$0.00,$995.61,$0.00,$0.00,$995.61,$995.61,$0.00,"$1,395.00",$0.00,$697.50,"$1,104.84","$1,116.00",$0.00,$0.00,$0.00,$0.00,$0.00
27203180,EAP,HCPCS C1726,,Roth Net,"$1,278.00",$0.00,"$1,278.00",$693.95,$912.11,$0.00,$220.19,$912.11,$912.11,$223.77,"$1,278.00",$0.00,$639.00,"$1,012.18","$1,022.40",$0.00,$200.01,$0.00,$203.46,$0.00
27203181,EAP,HCPCS C1726,,2.3mm Interject Inj Needle23g,$732.00,$0.00,$732.00,$397.48,$522.43,$0.00,$126.12,$522.43,$522.43,$128.17,$732.00,$0.00,$366.00,$579.74,$585.60,$0.00,$114.56,$0.00,$116.53,$0.00
27203182,EAP,HCPCS C1726,,Ercp Forcep,$691.00,$0.00,$691.00,$375.21,$493.17,$0.00,$119.06,$493.17,$493.17,$120.99,$691.00,$0.00,$345.50,$547.27,$552.80,$0.00,$108.14,$0.00,$110.01,$0.00
27203183,EAP,HCPCS C1726,,19g Bx Needle,$515.00,$0.00,$515.00,$279.65,$367.56,$0.00,$88.73,$367.56,$367.56,$90.17,$515.00,$0.00,$257.50,$407.88,$412.00,$0.00,$80.60,$0.00,$81.99,$0.00
27203184,EAP,HCPCS C1751,,Cather Cco Swan-ganz Sv02 W/o,$479.00,$0.00,$479.00,$260.10,$341.86,$0.00,$82.53,$341.86,$341.86,$83.87,$479.00,$0.00,$239.50,$379.37,$383.20,$0.00,$74.96,$0.00,$76.26,$0.00
27203185,EAP,HCPCS C1751,,Injection Probe 10fr,$431.00,$0.00,$431.00,$234.03,$307.60,$0.00,$74.26,$307.60,$307.60,$75.46,$431.00,$0.00,$215.50,$341.35,$344.80,$0.00,$67.45,$0.00,$68.62,$0.00
27203186,EAP,HCPCS C1751,,Injection Probe 7fr,$431.00,$0.00,$431.00,$234.03,$307.60,$0.00,$74.26,$307.60,$307.60,$75.46,$431.00,$0.00,$215.50,$341.35,$344.80,$0.00,$67.45,$0.00,$68.62,$0.00
27203187,EAP,HCPCS C1726,,Rx Dilatation Balloon 4-4/5.8,$414.00,$0.00,$414.00,$224.80,$295.47,$0.00,$71.33,$295.47,$295.47,$72.49,$414.00,$0.00,$207.00,$327.89,$331.20,$0.00,$64.79,$0.00,$65.91,$0.00
27203188,EAP,HCPCS C1726,,Rx Dilatation Balloon 6-4/5.8,$414.00,$0.00,$414.00,$224.80,$295.47,$0.00,$71.33,$295.47,$295.47,$72.49,$414.00,$0.00,$207.00,$327.89,$331.20,$0.00,$64.79,$0.00,$65.91,$0.00
27203189,EAP,HCPCS C1726,,Rx Dilatation Balloon 8-4/5.8,$414.00,$0.00,$414.00,$224.80,$295.47,$0.00,$71.33,$295.47,$295.47,$72.49,$414.00,$0.00,$207.00,$327.89,$331.20,$0.00,$64.79,$0.00,$65.91,$0.00
27203190,EAP,HCPCS C1726,,Rx Dilatation Balloon 10-4/5.8,$414.00,$0.00,$414.00,$224.80,$295.47,$0.00,$71.33,$295.47,$295.47,$72.49,$414.00,$0.00,$207.00,$327.89,$331.20,$0.00,$64.79,$0.00,$65.91,$0.00
27203191,EAP,HCPCS C1726,,Celiac Plexus Neurolysis Needl,$392.00,$0.00,$392.00,$212.86,$279.77,$0.00,$67.54,$279.77,$279.77,$68.64,$392.00,$0.00,$196.00,$310.46,$313.60,$0.00,$61.35,$0.00,$62.41,$0.00
27203192,EAP,HCPCS C1726,,22g Blue Sheath (stiffer),$386.00,$0.00,$386.00,$209.60,$275.49,$0.00,$66.51,$275.49,$275.49,$67.59,$386.00,$0.00,$193.00,$305.71,$308.80,$0.00,$60.41,$0.00,$61.45,$0.00
27203193,EAP,HCPCS C1726,,22g Green Spring Coil Sheath,$386.00,$0.00,$386.00,$209.60,$275.49,$0.00,$66.51,$275.49,$275.49,$67.59,$386.00,$0.00,$193.00,$305.71,$308.80,$0.00,$60.41,$0.00,$61.45,$0.00
27203194,EAP,HCPCS C1726,,Cre Wg 8-10 Dilation Balloon,$324.00,$0.00,$324.00,$175.93,$231.24,$0.00,$55.82,$231.24,$231.24,$56.73,$324.00,$0.00,$162.00,$256.61,$259.20,$0.00,$50.71,$0.00,$51.58,$0.00
27203195,EAP,HCPCS C1726,,Cre Wg 10-12 Dilation Balloon,$324.00,$0.00,$324.00,$175.93,$231.24,$0.00,$55.82,$231.24,$231.24,$56.73,$324.00,$0.00,$162.00,$256.61,$259.20,$0.00,$50.71,$0.00,$51.58,$0.00
27203196,EAP,HCPCS C1726,,Cre 12-15mm Dilation Balloon,$324.00,$0.00,$324.00,$175.93,$231.24,$0.00,$55.82,$231.24,$231.24,$56.73,$324.00,$0.00,$162.00,$256.61,$259.20,$0.00,$50.71,$0.00,$51.58,$0.00
27203197,EAP,HCPCS C1726,,Cre 15-18 Mm Dilation Balloon,$324.00,$0.00,$324.00,$175.93,$231.24,$0.00,$55.82,$231.24,$231.24,$56.73,$324.00,$0.00,$162.00,$256.61,$259.20,$0.00,$50.71,$0.00,$51.58,$0.00
27203198,EAP,HCPCS C1726,,Cre 18-20 Mm Dilation Balloon,$324.00,$0.00,$324.00,$175.93,$231.24,$0.00,$55.82,$231.24,$231.24,$56.73,$324.00,$0.00,$162.00,$256.61,$259.20,$0.00,$50.71,$0.00,$51.58,$0.00
27203199,EAP,HCPCS C1726,,Erbe Probe,$288.00,$0.00,$288.00,$156.38,$205.55,$0.00,$49.62,$205.55,$205.55,$50.43,$288.00,$0.00,$144.00,$228.10,$230.40,$0.00,$45.07,$0.00,$45.85,$0.00
27203200,EAP,HCPCS C1769,,Dreamwire .035 260str Stnd,$281.00,$0.00,$281.00,$152.58,$200.55,$0.00,$48.41,$200.55,$200.55,$49.20,$281.00,$0.00,$140.50,$222.55,$224.80,$0.00,$43.98,$0.00,$44.74,$0.00
27203201,EAP,HCPCS C1726,,Cytology Brush Echo -19,$232.00,$0.00,$232.00,$125.98,$165.58,$0.00,$39.97,$165.58,$165.58,$40.62,$232.00,$0.00,$116.00,$183.74,$185.60,$0.00,$36.31,$0.00,$36.93,$0.00
27203202,EAP,HCPCS C1726,,Extractor Rx 9-12 Mm,$229.00,$0.00,$229.00,$124.35,$163.44,$0.00,$39.46,$163.44,$163.44,$40.10,$229.00,$0.00,$114.50,$181.37,$183.20,$0.00,$35.84,$0.00,$36.46,$0.00
27203203,EAP,HCPCS C1726,,Extractor Rx 12-15 Mm,$229.00,$0.00,$229.00,$124.35,$163.44,$0.00,$39.46,$163.44,$163.44,$40.10,$229.00,$0.00,$114.50,$181.37,$183.20,$0.00,$35.84,$0.00,$36.46,$0.00
27203204,EAP,HCPCS C1726,,Extractor Rx 15-18 Mm,$229.00,$0.00,$229.00,$124.35,$163.44,$0.00,$39.46,$163.44,$163.44,$40.10,$229.00,$0.00,$114.50,$181.37,$183.20,$0.00,$35.84,$0.00,$36.46,$0.00
27203205,EAP,HCPCS C1726,,Alliance Inflation Syringe,$52.00,$0.00,$52.00,$28.24,$37.11,$0.00,$8.96,$37.11,$37.11,$9.10,$52.00,$0.00,$26.00,$41.18,$41.60,$0.00,$8.14,$0.00,$8.28,$0.00
27203206,EAP,HCPCS C1726,,Encore 26 Single,$35.00,$0.00,$35.00,$19.01,$24.98,$0.00,$6.03,$24.98,$24.98,$6.13,$35.00,$0.00,$17.50,$27.72,$28.00,$0.00,$5.48,$0.00,$5.57,$0.00
27203207,EAP,HCPCS C1726,,Rx Lckng Dvce &bx Cap/olympus,$16.00,$0.00,$16.00,$8.69,$11.42,$0.00,$2.76,$11.42,$11.42,$2.80,$16.00,$0.00,$8.00,$12.67,$12.80,$0.00,$2.50,$0.00,$2.55,$0.00
27203208,EAP,HCPCS C1726,,Olympus Endo Jaw(cold Forceps),$14.00,$0.00,$14.00,$7.60,$9.99,$0.00,$2.41,$9.99,$9.99,$2.45,$14.00,$0.00,$7.00,$11.09,$11.20,$0.00,$2.19,$0.00,$2.23,$0.00
27203210,EAP,HCPCS C1773,,Kit Snr Agn 90d Mic 200cm 2.3-3fr 2mm Cath Loop,"$1,625.00",$0.00,"$1,625.00",$882.38,"$1,159.76",$0.00,$279.98,"$1,159.76","$1,159.76",$284.52,"$1,625.00",$0.00,$812.50,"$1,287.00","$1,300.00",$0.00,$254.31,$0.00,$258.70,$0.00
27203211,EAP,HCPCS C1729,,Cath Drain Edm (ventricular) L 26cm,$480.00,$0.00,$480.00,$260.64,$342.58,$0.00,$82.70,$342.58,$342.58,$84.04,$480.00,$0.00,$240.00,$380.16,$384.00,$0.00,$75.12,$0.00,$76.42,$0.00
27203212,EAP,HCPCS C1729,,"Catheter, Evd Bactiseal 82-1750","$1,924.00",$0.00,"$1,924.00","$1,044.73","$1,373.16",$0.00,$331.50,"$1,373.16","$1,373.16",$336.88,"$1,924.00",$0.00,$962.00,"$1,523.81","$1,539.20",$0.00,$301.11,$0.00,$306.30,$0.00
27203213,EAP,HCPCS C1773,,Kit Snr Agn 90d 200cm 2.3-3fr 4mm Mcth Loop Coil,"$1,625.00",$0.00,"$1,625.00",$882.38,"$1,159.76",$0.00,$279.98,"$1,159.76","$1,159.76",$284.52,"$1,625.00",$0.00,$812.50,"$1,287.00","$1,300.00",$0.00,$254.31,$0.00,$258.70,$0.00
27203214,EAP,HCPCS C1773,,Kit Snr Agn 90d 200cm 2.3-3fr 7mm Mcth Loop Coil,"$1,625.00",$0.00,"$1,625.00",$882.38,"$1,159.76",$0.00,$279.98,"$1,159.76","$1,159.76",$284.52,"$1,625.00",$0.00,$812.50,"$1,287.00","$1,300.00",$0.00,$254.31,$0.00,$258.70,$0.00
27203215,EAP,HCPCS C1887,,Catheter Guid Sim2 Curve 6fr 90cm Env,$901.00,$0.00,$901.00,$489.24,$643.04,$0.00,$155.24,$643.04,$643.04,$157.76,$901.00,$0.00,$450.50,$713.59,$720.80,$0.00,$141.01,$0.00,$143.44,$0.00
27203216,EAP,HCPCS C1887,,Catheter Guid Sim2 Curve 6fr 100cm Env,$901.00,$0.00,$901.00,$489.24,$643.04,$0.00,$155.24,$643.04,$643.04,$157.76,$901.00,$0.00,$450.50,$713.59,$720.80,$0.00,$141.01,$0.00,$143.44,$0.00
27203217,EAP,HCPCS C1769,,Guidewire Vasc 175cm Rnd Prfl Agile Tip Smtr Rot,"$1,575.00",$0.00,"$1,575.00",$855.23,"$1,124.08",$0.00,$271.36,"$1,124.08","$1,124.08",$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
27203220,EAP,HCPCS C1894,,Introducer Shth Lng 5fr 30cm Gry Lf Traw Hi Kink Rst Ulsmth,$102.00,$0.00,$102.00,$55.39,$72.80,$0.00,$17.57,$72.80,$72.80,$17.86,$102.00,$0.00,$51.00,$80.78,$81.60,$0.00,$15.96,$0.00,$16.24,$0.00
27203221,EAP,HCPCS C1894,,Introducer Shth Lng 6fr 30cm Lf Traw Unq Lck Hi Kink Rst,$102.00,$0.00,$102.00,$55.39,$72.80,$0.00,$17.57,$72.80,$72.80,$17.86,$102.00,$0.00,$51.00,$80.78,$81.60,$0.00,$15.96,$0.00,$16.24,$0.00
27203222,EAP,HCPCS C1894,,Sheath Intro Lng 7fr 30cm Traw Fnl Ulsmth Dil Tpr Ptfe,$102.00,$0.00,$102.00,$55.39,$72.80,$0.00,$17.57,$72.80,$72.80,$17.86,$102.00,$0.00,$51.00,$80.78,$81.60,$0.00,$15.96,$0.00,$16.24,$0.00
27203251,EAP,Custom 27203251,,Coil Axium Helical  Qc-1.5-2-helix,"$1,034.00",$0.00,"$1,034.00",$0.00,$737.97,$0.00,$0.00,$737.97,$737.97,$0.00,"$1,034.00",$0.00,$517.00,$818.93,$827.20,$0.00,$0.00,$0.00,$0.00,$0.00
27203270,EAP,Custom 27203270,,Mpc Envoy Guiding Cath,$303.00,$0.00,$303.00,$0.00,$216.25,$0.00,$0.00,$216.25,$216.25,$0.00,$303.00,$0.00,$151.50,$239.98,$242.40,$0.00,$0.00,$0.00,$0.00,$0.00
27203271,EAP,Custom 27203271,,Control Wire .018 V-18,$783.00,$0.00,$783.00,$0.00,$558.83,$0.00,$0.00,$558.83,$558.83,$0.00,$783.00,$0.00,$391.50,$620.14,$626.40,$0.00,$0.00,$0.00,$0.00,$0.00
27203290,EAP,Custom 27203290,,Foot Drop Splint-prefab,$290.00,$0.00,$290.00,$0.00,$206.97,$0.00,$0.00,$206.97,$206.97,$0.00,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$0.00,$0.00,$0.00,$0.00
27203400,EAP,Custom 27203400,,Interlock Detach 36-156 Coil,"$1,258.00",$0.00,"$1,258.00",$0.00,$897.83,$0.00,$0.00,$897.83,$897.83,$0.00,"$1,258.00",$0.00,$629.00,$996.34,"$1,006.40",$0.00,$0.00,$0.00,$0.00,$0.00
27203401,EAP,Custom 27203401,,Dfs100406-20 Micrus Microcoil,$483.00,$0.00,$483.00,$0.00,$344.72,$0.00,$0.00,$344.72,$344.72,$0.00,$483.00,$0.00,$241.50,$382.54,$386.40,$0.00,$0.00,$0.00,$0.00,$0.00
27203402,EAP,Custom 27203402,,Dfs100310-20 Micrus Microcoil,"$1,429.00",$0.00,"$1,429.00",$0.00,"$1,019.88",$0.00,$0.00,"$1,019.88","$1,019.88",$0.00,"$1,429.00",$0.00,$714.50,"$1,131.77","$1,143.20",$0.00,$0.00,$0.00,$0.00,$0.00
27203403,EAP,Custom 27203403,,Dpl100151-20 Micrus Microcoil,"$1,571.00",$0.00,"$1,571.00",$0.00,"$1,121.22",$0.00,$0.00,"$1,121.22","$1,121.22",$0.00,"$1,571.00",$0.00,$785.50,"$1,244.23","$1,256.80",$0.00,$0.00,$0.00,$0.00,$0.00
27203404,EAP,Custom 27203404,,Hel180620-2o Micrus Microcoil,$834.00,$0.00,$834.00,$0.00,$595.23,$0.00,$0.00,$595.23,$595.23,$0.00,$834.00,$0.00,$417.00,$660.53,$667.20,$0.00,$0.00,$0.00,$0.00,$0.00
27203405,EAP,Custom 27203405,,Brs000609-00 Balloon Ascnt,"$1,900.00",$0.00,"$1,900.00",$0.00,"$1,356.03",$0.00,$0.00,"$1,356.03","$1,356.03",$0.00,"$1,900.00",$0.00,$950.00,"$1,504.80","$1,520.00",$0.00,$0.00,$0.00,$0.00,$0.00
27203406,EAP,Custom 27203406,,4.5x20 4.5x20 Viatrac Balloon,"$1,500.00",$0.00,"$1,500.00",$0.00,"$1,070.55",$0.00,$0.00,"$1,070.55","$1,070.55",$0.00,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
27203407,EAP,Custom 27203407,,5x20 Viatrac Balloon,"$1,500.00",$0.00,"$1,500.00",$0.00,"$1,070.55",$0.00,$0.00,"$1,070.55","$1,070.55",$0.00,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
27203408,EAP,Custom 27203408,,6x20 Viatrac Balloon,"$1,500.00",$0.00,"$1,500.00",$0.00,"$1,070.55",$0.00,$0.00,"$1,070.55","$1,070.55",$0.00,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
27203409,EAP,Custom 27203409,,.038 150cm Stiff Angled Glide,$163.00,$0.00,$163.00,$0.00,$116.33,$0.00,$0.00,$116.33,$116.33,$0.00,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$0.00,$0.00,$0.00,$0.00
27203410,EAP,Custom 27203410,,.038 150cm Guidewire Bntsn,$60.00,$0.00,$60.00,$0.00,$42.82,$0.00,$0.00,$42.82,$42.82,$0.00,$60.00,$0.00,$30.00,$47.52,$48.00,$0.00,$0.00,$0.00,$0.00,$0.00
27203411,EAP,Custom 27203411,,9fr-30 Tear-away Introducer,$51.00,$0.00,$51.00,$0.00,$36.40,$0.00,$0.00,$36.40,$36.40,$0.00,$51.00,$0.00,$25.50,$40.39,$40.80,$0.00,$0.00,$0.00,$0.00,$0.00
27203412,EAP,Custom 27203412,,10fr-30cm Tear-away Introducer,$49.00,$0.00,$49.00,$0.00,$34.97,$0.00,$0.00,$34.97,$34.97,$0.00,$49.00,$0.00,$24.50,$38.81,$39.20,$0.00,$0.00,$0.00,$0.00,$0.00
27203413,EAP,Custom 27203413,,16fr-30cm Tear-away Introducer,$49.00,$0.00,$49.00,$0.00,$34.97,$0.00,$0.00,$34.97,$34.97,$0.00,$49.00,$0.00,$24.50,$38.81,$39.20,$0.00,$0.00,$0.00,$0.00,$0.00
27203414,EAP,Custom 27203414,,2.0 Mm X9 Maverick Balloon Catheter,$916.00,$0.00,$916.00,$0.00,$653.75,$0.00,$0.00,$653.75,$653.75,$0.00,$916.00,$0.00,$458.00,$725.47,$732.80,$0.00,$0.00,$0.00,$0.00,$0.00
27203415,EAP,Custom 27203415,,2.5 Mm X9 Maverick Balloon Catheter,$916.00,$0.00,$916.00,$0.00,$653.75,$0.00,$0.00,$653.75,$653.75,$0.00,$916.00,$0.00,$458.00,$725.47,$732.80,$0.00,$0.00,$0.00,$0.00,$0.00
27203416,EAP,Custom 27203416,,Stent Microdelivery System Neurform2 System 3.5 X 30mm,"$8,535.00",$0.00,"$8,535.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$8,535.00",$0.00,"$4,267.50","$6,759.72","$6,828.00",$0.00,$0.00,$0.00,$0.00,$0.00
27203417,EAP,Custom 27203417,,3.0 Mm X9 Maverick Balloon Catheter,$916.00,$0.00,$916.00,$0.00,$653.75,$0.00,$0.00,$653.75,$653.75,$0.00,$916.00,$0.00,$458.00,$725.47,$732.80,$0.00,$0.00,$0.00,$0.00,$0.00
27203418,EAP,Custom 27203418,,Stent Stabilizer Catheter Neurform,"$3,836.00",$0.00,"$3,836.00",$0.00,"$2,737.75",$0.00,$0.00,"$2,737.75","$2,737.75",$0.00,"$3,836.00",$0.00,"$1,918.00","$3,038.11","$3,068.80",$0.00,$0.00,$0.00,$0.00,$0.00
27203419,EAP,Custom 27203419,,Mpc Envoy Guiding Cath,$450.00,$0.00,$450.00,$0.00,$321.17,$0.00,$0.00,$321.17,$321.17,$0.00,$450.00,$0.00,$225.00,$356.40,$360.00,$0.00,$0.00,$0.00,$0.00,$0.00
27203420,EAP,Custom 27203420,,5.5 Accunet Distal Protection Device,"$5,171.00",$0.00,"$5,171.00",$0.00,"$3,690.54",$0.00,$0.00,"$3,690.54","$3,690.54",$0.00,"$5,171.00",$0.00,"$2,585.50","$4,095.43","$4,136.80",$0.00,$0.00,$0.00,$0.00,$0.00
27203421,EAP,Custom 27203421,,2.25 Minivision Stent,"$1,256.00",$0.00,"$1,256.00",$0.00,$896.41,$0.00,$0.00,$896.41,$896.41,$0.00,"$1,256.00",$0.00,$628.00,$994.75,"$1,004.80",$0.00,$0.00,$0.00,$0.00,$0.00
27203422,EAP,Custom 27203422,,4.0x20mm Viatrac Balloon,"$1,500.00",$0.00,"$1,500.00",$0.00,"$1,070.55",$0.00,$0.00,"$1,070.55","$1,070.55",$0.00,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
27203423,EAP,Custom 27203423,,125cm Vetebral Catheter,$65.00,$0.00,$65.00,$0.00,$46.39,$0.00,$0.00,$46.39,$46.39,$0.00,$65.00,$0.00,$32.50,$51.48,$52.00,$0.00,$0.00,$0.00,$0.00,$0.00
27203425,EAP,HCPCS C1887,,Catheter Intvn 5fr .056in .046in 150cm 25cm Rapex,"$1,023.00",$0.00,"$1,023.00",$555.49,$730.12,$0.00,$176.26,$730.12,$730.12,$179.12,"$1,023.00",$0.00,$511.50,$810.22,$818.40,$0.00,$160.10,$0.00,$162.86,$0.00
27203426,EAP,HCPCS C1887,,Catheter Intvn 7fr .078in .062in 150cm 25cm Rapex,"$1,023.00",$0.00,"$1,023.00",$555.49,$730.12,$0.00,$176.26,$730.12,$730.12,$179.12,"$1,023.00",$0.00,$511.50,$810.22,$818.40,$0.00,$160.10,$0.00,$162.86,$0.00
27203427,EAP,HCPCS C1887,,Catheter Intvn 8fr .088in .071in 150cm 25cm Rapex,"$1,023.00",$0.00,"$1,023.00",$555.49,$730.12,$0.00,$176.26,$730.12,$730.12,$179.12,"$1,023.00",$0.00,$511.50,$810.22,$818.40,$0.00,$160.10,$0.00,$162.86,$0.00
27203428,EAP,HCPCS C1887,,Sheath Guid 90cm 3 Radiopq Xcut Vlv Pn Dstn 8fr,$239.00,$0.00,$239.00,$129.78,$170.57,$0.00,$41.18,$170.57,$170.57,$41.85,$239.00,$0.00,$119.50,$189.29,$191.20,$0.00,$37.40,$0.00,$38.05,$0.00
27203429,EAP,HCPCS C1887,,Sheath Guid 65cm 8fr Pn Dstn .038in Str Hydphi,$224.00,$0.00,$224.00,$121.63,$159.87,$0.00,$38.59,$159.87,$159.87,$39.22,$224.00,$0.00,$112.00,$177.41,$179.20,$0.00,$35.06,$0.00,$35.66,$0.00
27203434,EAP,HCPCS C1769,,Moo326420 Guidewire Standard P,"$1,299.00",$0.00,"$1,299.00",$705.36,$927.10,$0.00,$223.81,$927.10,$927.10,$227.44,"$1,299.00",$0.00,$649.50,"$1,028.81","$1,039.20",$0.00,$203.29,$0.00,$206.80,$0.00
27203450,EAP,HCPCS C1751,,105-5092-150 Echelon 14 Micro,"$1,751.00",$0.00,"$1,751.00",$950.79,"$1,249.69",$0.00,$301.69,"$1,249.69","$1,249.69",$306.59,"$1,751.00",$0.00,$875.50,"$1,386.79","$1,400.80",$0.00,$274.03,$0.00,$278.76,$0.00
27203467,EAP,HCPCS C1884,,Spd2-us-050-320 Device Protect,"$1,411.00",$0.00,"$1,411.00",$766.17,"$1,007.03",$0.00,$243.11,"$1,007.03","$1,007.03",$247.05,"$1,411.00",$0.00,$705.50,"$1,117.51","$1,128.80",$0.00,$220.82,$0.00,$224.63,$0.00
27203477,EAP,Custom 27203477,,36-152 Coil Detachable Interlo,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$897.12,$897.12,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
27203478,EAP,Custom 27203478,,36-154 Coil Detachable Interlo,"$1,320.00",$0.00,"$1,320.00",$0.00,$942.08,$0.00,$0.00,$942.08,$942.08,$0.00,"$1,320.00",$0.00,$660.00,"$1,045.44","$1,056.00",$0.00,$0.00,$0.00,$0.00,$0.00
27203479,EAP,Custom 27203479,,36-156 Coil Detachable Interlo,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$897.12,$897.12,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
27203480,EAP,Custom 27203480,,36-157 Coil Detachable Interlo,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$897.12,$897.12,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
27203481,EAP,Custom 27203481,,Marker Straight 2-tip 150cm/6c,"$1,137.00",$0.00,"$1,137.00",$0.00,$811.48,$0.00,$0.00,$811.48,$811.48,$0.00,"$1,137.00",$0.00,$568.50,$900.50,$909.60,$0.00,$0.00,$0.00,$0.00,$0.00
27203483,EAP,HCPCS C1887,,Mpc Envoy Guiding Wire,$450.00,$0.00,$450.00,$244.35,$321.17,$0.00,$77.53,$321.17,$321.17,$78.79,$450.00,$0.00,$225.00,$356.40,$360.00,$0.00,$70.43,$0.00,$71.64,$0.00
27203484,EAP,Custom 27203484,,Starclose Se,$700.00,$0.00,$700.00,$0.00,$499.59,$0.00,$0.00,$499.59,$499.59,$0.00,$700.00,$0.00,$350.00,$554.40,$560.00,$0.00,$0.00,$0.00,$0.00,$0.00
27203485,EAP,Custom 27203485,,Lc Bead 300-500,"$1,335.00",$0.00,"$1,335.00",$0.00,$952.79,$0.00,$0.00,$952.79,$952.79,$0.00,"$1,335.00",$0.00,$667.50,"$1,057.32","$1,068.00",$0.00,$0.00,$0.00,$0.00,$0.00
27203487,EAP,HCPCS C1769,,Guidewire Silverspeed .014,$825.00,$0.00,$825.00,$447.98,$588.80,$0.00,$142.14,$588.80,$588.80,$144.45,$825.00,$0.00,$412.50,$653.40,$660.00,$0.00,$129.11,$0.00,$131.34,$0.00
27203488,EAP,HCPCS C1769,,Guidewire Silverspeed .014,$825.00,$0.00,$825.00,$447.98,$588.80,$0.00,$142.14,$588.80,$588.80,$144.45,$825.00,$0.00,$412.50,$653.40,$660.00,$0.00,$129.11,$0.00,$131.34,$0.00
27203489,EAP,HCPCS C1751,,Catheter Echelon 10 Micro,"$2,423.00",$0.00,"$2,423.00","$1,315.69","$1,729.30",$0.00,$417.47,"$1,729.30","$1,729.30",$424.25,"$2,423.00",$0.00,"$1,211.50","$1,919.02","$1,938.40",$0.00,$379.20,$0.00,$385.74,$0.00
27203490,EAP,HCPCS C1751,,Catheter Echelon 10 Micro,"$2,423.00",$0.00,"$2,423.00","$1,315.69","$1,729.30",$0.00,$417.47,"$1,729.30","$1,729.30",$424.25,"$2,423.00",$0.00,"$1,211.50","$1,919.02","$1,938.40",$0.00,$379.20,$0.00,$385.74,$0.00
27203491,EAP,HCPCS C1751,,Catheter Echelon 14 Micro,"$2,423.00",$0.00,"$2,423.00","$1,315.69","$1,729.30",$0.00,$417.47,"$1,729.30","$1,729.30",$424.25,"$2,423.00",$0.00,"$1,211.50","$1,919.02","$1,938.40",$0.00,$379.20,$0.00,$385.74,$0.00
27203492,EAP,HCPCS C1751,,Catheter Echelon 10micro,"$2,423.00",$0.00,"$2,423.00","$1,315.69","$1,729.30",$0.00,$417.47,"$1,729.30","$1,729.30",$424.25,"$2,423.00",$0.00,"$1,211.50","$1,919.02","$1,938.40",$0.00,$379.20,$0.00,$385.74,$0.00
27203493,EAP,HCPCS C1751,,Catheter Echelon 14 Micro,"$2,423.00",$0.00,"$2,423.00","$1,315.69","$1,729.30",$0.00,$417.47,"$1,729.30","$1,729.30",$424.25,"$2,423.00",$0.00,"$1,211.50","$1,919.02","$1,938.40",$0.00,$379.20,$0.00,$385.74,$0.00
27203494,EAP,Custom 27203494,,Alligator Retrieval,"$8,340.00",$0.00,"$8,340.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$8,340.00",$0.00,"$4,170.00","$6,605.28","$6,672.00",$0.00,$0.00,$0.00,$0.00,$0.00
27203495,EAP,Custom 27203495,,Alligator Retrieval,"$8,340.00",$0.00,"$8,340.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$8,340.00",$0.00,"$4,170.00","$6,605.28","$6,672.00",$0.00,$0.00,$0.00,$0.00,$0.00
27203496,EAP,Custom 27203496,,Alligator Retrieval,"$8,340.00",$0.00,"$8,340.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$8,340.00",$0.00,"$4,170.00","$6,605.28","$6,672.00",$0.00,$0.00,$0.00,$0.00,$0.00
27203497,EAP,Custom 27203497,,Alligator Retrieval,"$8,340.00",$0.00,"$8,340.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$8,340.00",$0.00,"$4,170.00","$6,605.28","$6,672.00",$0.00,$0.00,$0.00,$0.00,$0.00
27203498,EAP,HCPCS C1725,,Catheter Balloon Pta 3.50 X 15,"$3,387.00",$0.00,"$3,387.00","$1,839.14","$2,417.30",$0.00,$583.56,"$2,417.30","$2,417.30",$593.04,"$3,387.00",$0.00,"$1,693.50","$2,682.50","$2,709.60",$0.00,$530.07,$0.00,$539.21,$0.00
27203499,EAP,HCPCS C1725,,Catheter Balloon Pta 3.00 X 15,"$3,387.00",$0.00,"$3,387.00","$1,839.14","$2,417.30",$0.00,$583.56,"$2,417.30","$2,417.30",$593.04,"$3,387.00",$0.00,"$1,693.50","$2,682.50","$2,709.60",$0.00,$530.07,$0.00,$539.21,$0.00
27203500,EAP,HCPCS C1725,,Catheter Balloon Pta 2.50 X 15,"$3,387.00",$0.00,"$3,387.00","$1,839.14","$2,417.30",$0.00,$583.56,"$2,417.30","$2,417.30",$593.04,"$3,387.00",$0.00,"$1,693.50","$2,682.50","$2,709.60",$0.00,$530.07,$0.00,$539.21,$0.00
27203501,EAP,HCPCS C1725,,Catheter Balloon Pta 3.50 X 9.,"$3,387.00",$0.00,"$3,387.00","$1,839.14","$2,417.30",$0.00,$583.56,"$2,417.30","$2,417.30",$593.04,"$3,387.00",$0.00,"$1,693.50","$2,682.50","$2,709.60",$0.00,$530.07,$0.00,$539.21,$0.00
27203502,EAP,HCPCS C1725,,Catheter Balloon Pta 3.00 X 9.,"$3,387.00",$0.00,"$3,387.00","$1,839.14","$2,417.30",$0.00,$583.56,"$2,417.30","$2,417.30",$593.04,"$3,387.00",$0.00,"$1,693.50","$2,682.50","$2,709.60",$0.00,$530.07,$0.00,$539.21,$0.00
27203503,EAP,HCPCS C1725,,Catheter Balloon 2.50 X 9.0mm,"$3,387.00",$0.00,"$3,387.00","$1,839.14","$2,417.30",$0.00,$583.56,"$2,417.30","$2,417.30",$593.04,"$3,387.00",$0.00,"$1,693.50","$2,682.50","$2,709.60",$0.00,$530.07,$0.00,$539.21,$0.00
27203504,EAP,HCPCS C1725,,Catheter Balloon 2.00 X 9.0mm,"$3,387.00",$0.00,"$3,387.00","$1,839.14","$2,417.30",$0.00,$583.56,"$2,417.30","$2,417.30",$593.04,"$3,387.00",$0.00,"$1,693.50","$2,682.50","$2,709.60",$0.00,$530.07,$0.00,$539.21,$0.00
27203505,EAP,HCPCS C1725,,Catheter Balloon Pta 1.50 X 9.,"$3,387.00",$0.00,"$3,387.00","$1,839.14","$2,417.30",$0.00,$583.56,"$2,417.30","$2,417.30",$593.04,"$3,387.00",$0.00,"$1,693.50","$2,682.50","$2,709.60",$0.00,$530.07,$0.00,$539.21,$0.00
27203506,EAP,HCPCS C1751,,Microcatheter Hi-flo Distal Fl,"$2,270.00",$0.00,"$2,270.00","$1,232.61","$1,620.10",$0.00,$391.11,"$1,620.10","$1,620.10",$397.46,"$2,270.00",$0.00,"$1,135.00","$1,797.84","$1,816.00",$0.00,$355.26,$0.00,$361.38,$0.00
27203507,EAP,HCPCS C1751,,Microcathter Hi-pro Distal Fl,"$2,270.00",$0.00,"$2,270.00","$1,232.61","$1,620.10",$0.00,$391.11,"$1,620.10","$1,620.10",$397.46,"$2,270.00",$0.00,"$1,135.00","$1,797.84","$1,816.00",$0.00,$355.26,$0.00,$361.38,$0.00
27203508,EAP,HCPCS C1751,,Microcatheter Pre-shaped 45 2-,"$2,837.00",$0.00,"$2,837.00","$1,540.49","$2,024.77",$0.00,$488.80,"$2,024.77","$2,024.77",$496.74,"$2,837.00",$0.00,"$1,418.50","$2,246.90","$2,269.60",$0.00,$443.99,$0.00,$451.65,$0.00
27203509,EAP,HCPCS C1769,,Guidewire Standard Pre-shap 1,"$2,151.00",$0.00,"$2,151.00","$1,167.99","$1,535.17",$0.00,$370.61,"$1,535.17","$1,535.17",$376.62,"$2,151.00",$0.00,"$1,075.50","$1,703.59","$1,720.80",$0.00,$336.63,$0.00,$342.44,$0.00
27203510,EAP,HCPCS C1769,,Guidewire Standard Pre-shap 2,"$1,838.00",$0.00,"$1,838.00",$998.03,"$1,311.78",$0.00,$316.68,"$1,311.78","$1,311.78",$321.82,"$1,838.00",$0.00,$919.00,"$1,455.70","$1,470.40",$0.00,$287.65,$0.00,$292.61,$0.00
27203511,EAP,HCPCS C1769,,Guidewire Soft Pre-shaped 200c,"$1,838.00",$0.00,"$1,838.00",$998.03,"$1,311.78",$0.00,$316.68,"$1,311.78","$1,311.78",$321.82,"$1,838.00",$0.00,$919.00,"$1,455.70","$1,470.40",$0.00,$287.65,$0.00,$292.61,$0.00
27203512,EAP,HCPCS C1887,,Catheter Utk Slip 5f 125cm,$740.00,$0.00,$740.00,$401.82,$528.14,$0.00,$127.50,$528.14,$528.14,$129.57,$740.00,$0.00,$370.00,$586.08,$592.00,$0.00,$115.81,$0.00,$117.81,$0.00
27203513,EAP,HCPCS C1887,,Catheter Davis 5f .038 100cm,$328.00,$0.00,$328.00,$178.10,$234.09,$0.00,$56.51,$234.09,$234.09,$57.43,$328.00,$0.00,$164.00,$259.78,$262.40,$0.00,$51.33,$0.00,$52.22,$0.00
27203514,EAP,HCPCS C1894,,Sheath Shuttle 7f 90cm,$413.00,$0.00,$413.00,$224.26,$294.76,$0.00,$71.16,$294.76,$294.76,$72.31,$413.00,$0.00,$206.50,$327.10,$330.40,$0.00,$64.63,$0.00,$65.75,$0.00
27203515,EAP,HCPCS C1894,,Sheath Shuttle 6f 90cm,$483.00,$0.00,$483.00,$262.27,$344.72,$0.00,$83.22,$344.72,$344.72,$84.57,$483.00,$0.00,$241.50,$382.54,$386.40,$0.00,$75.59,$0.00,$76.89,$0.00
27203516,EAP,HCPCS C1894,,Sheath Shuttle 6fr 80cm.,$595.00,$0.00,$595.00,$323.09,$424.65,$0.00,$102.52,$424.65,$424.65,$104.18,$595.00,$0.00,$297.50,$471.24,$476.00,$0.00,$93.12,$0.00,$94.72,$0.00
27203517,EAP,HCPCS C1884,,Roadrunners Conners.035x260cm,$160.00,$0.00,$160.00,$86.88,$114.19,$0.00,$27.57,$114.19,$114.19,$28.01,$160.00,$0.00,$80.00,$126.72,$128.00,$0.00,$25.04,$0.00,$25.47,$0.00
27203518,EAP,HCPCS C1887,,Catheter Envoy 6fr X13-mp,$450.00,$0.00,$450.00,$244.35,$321.17,$0.00,$77.53,$321.17,$321.17,$78.79,$450.00,$0.00,$225.00,$356.40,$360.00,$0.00,$70.43,$0.00,$71.64,$0.00
27203519,EAP,HCPCS C1887,,Catheter Envoy 5fr Mipd 9,"$1,048.00",$0.00,"$1,048.00",$569.06,$747.96,$0.00,$180.57,$747.96,$747.96,$183.50,"$1,048.00",$0.00,$524.00,$830.02,$838.40,$0.00,$164.01,$0.00,$166.84,$0.00
27203520,EAP,HCPCS C1887,,Catheter Envoy Straight 9,"$1,048.00",$0.00,"$1,048.00",$569.06,$747.96,$0.00,$180.57,$747.96,$747.96,$183.50,"$1,048.00",$0.00,$524.00,$830.02,$838.40,$0.00,$164.01,$0.00,$166.84,$0.00
27203521,EAP,HCPCS C1751,,Microcathter Prowler Select L,"$2,578.00",$0.00,"$2,578.00","$1,399.85","$1,839.92",$0.00,$444.18,"$1,839.92","$1,839.92",$451.39,"$2,578.00",$0.00,"$1,289.00","$2,041.78","$2,062.40",$0.00,$403.46,$0.00,$410.42,$0.00
27203522,EAP,HCPCS C1751,,Microcatht.prowler Select L 2,"$2,578.00",$0.00,"$2,578.00","$1,399.85","$1,839.92",$0.00,$444.18,"$1,839.92","$1,839.92",$451.39,"$2,578.00",$0.00,"$1,289.00","$2,041.78","$2,062.40",$0.00,$403.46,$0.00,$410.42,$0.00
27203523,EAP,HCPCS C1751,,Microcatht.prowler Select L 3,"$2,578.00",$0.00,"$2,578.00","$1,399.85","$1,839.92",$0.00,$444.18,"$1,839.92","$1,839.92",$451.39,"$2,578.00",$0.00,"$1,289.00","$2,041.78","$2,062.40",$0.00,$403.46,$0.00,$410.42,$0.00
27203524,EAP,HCPCS C1751,,Microcatht.prowler Select L 4,"$2,526.00",$0.00,"$2,526.00","$1,371.62","$1,802.81",$0.00,$435.22,"$1,802.81","$1,802.81",$442.28,"$2,526.00",$0.00,"$1,263.00","$2,000.59","$2,020.80",$0.00,$395.32,$0.00,$402.14,$0.00
27203525,EAP,HCPCS C1751,,Microcathet.prowler Select P 1,"$2,454.00",$0.00,"$2,454.00","$1,332.52","$1,751.42",$0.00,$422.81,"$1,751.42","$1,751.42",$429.68,"$2,454.00",$0.00,"$1,227.00","$1,943.57","$1,963.20",$0.00,$384.05,$0.00,$390.68,$0.00
27203526,EAP,HCPCS C1751,,Microcath.prowler Select P 2,"$1,055.00",$0.00,"$1,055.00",$572.87,$752.95,$0.00,$181.77,$752.95,$752.95,$184.72,"$1,055.00",$0.00,$527.50,$835.56,$844.00,$0.00,$165.11,$0.00,$167.96,$0.00
27203527,EAP,HCPCS C1751,,Catheter Echelon 14 Micro,"$2,120.00",$0.00,"$2,120.00","$1,151.16","$1,513.04",$0.00,$365.27,"$1,513.04","$1,513.04",$371.20,"$2,120.00",$0.00,"$1,060.00","$1,679.04","$1,696.00",$0.00,$331.78,$0.00,$337.50,$0.00
27203528,EAP,HCPCS C1751,,Microcath.prowler Select P 3,"$1,055.00",$0.00,"$1,055.00",$572.87,$752.95,$0.00,$181.77,$752.95,$752.95,$184.72,"$1,055.00",$0.00,$527.50,$835.56,$844.00,$0.00,$165.11,$0.00,$167.96,$0.00
27203529,EAP,HCPCS C1751,,Micrcathters Rapidtransit 17,"$2,235.00",$0.00,"$2,235.00","$1,213.61","$1,595.12",$0.00,$385.08,"$1,595.12","$1,595.12",$391.33,"$2,235.00",$0.00,"$1,117.50","$1,770.12","$1,788.00",$0.00,$349.78,$0.00,$355.81,$0.00
27203530,EAP,HCPCS C1751,,Micrcatheter Rapidtransit 150,"$2,235.00",$0.00,"$2,235.00","$1,213.61","$1,595.12",$0.00,$385.08,"$1,595.12","$1,595.12",$391.33,"$2,235.00",$0.00,"$1,117.50","$1,770.12","$1,788.00",$0.00,$349.78,$0.00,$355.81,$0.00
27203531,EAP,HCPCS C1769,,Guidewire Hydrophilic Coat S 1,$35.00,$0.00,$35.00,$19.01,$24.98,$0.00,$6.03,$24.98,$24.98,$6.13,$35.00,$0.00,$17.50,$27.72,$28.00,$0.00,$5.48,$0.00,$5.57,$0.00
27203532,EAP,HCPCS C1769,,Guidewire Hydrophilic Coat S 2,$39.00,$0.00,$39.00,$21.18,$27.83,$0.00,$6.72,$27.83,$27.83,$6.83,$39.00,$0.00,$19.50,$30.89,$31.20,$0.00,$6.10,$0.00,$6.21,$0.00
27203533,EAP,HCPCS C1769,,Guidewire Hydrophilic Coated T,$585.00,$0.00,$585.00,$317.66,$417.51,$0.00,$100.79,$417.51,$417.51,$102.43,$585.00,$0.00,$292.50,$463.32,$468.00,$0.00,$91.55,$0.00,$93.13,$0.00
27203534,EAP,HCPCS C1769,,Guidewire Hydrophilic Coat 0 1,$33.00,$0.00,$33.00,$17.92,$23.55,$0.00,$5.69,$23.55,$23.55,$5.78,$33.00,$0.00,$16.50,$26.14,$26.40,$0.00,$5.16,$0.00,$5.25,$0.00
27203535,EAP,HCPCS C1769,,Guidewire Hydrophilic Coat 0 2,$149.00,$0.00,$149.00,$80.91,$106.34,$0.00,$25.67,$106.34,$106.34,$26.09,$149.00,$0.00,$74.50,$118.01,$119.20,$0.00,$23.32,$0.00,$23.72,$0.00
27203536,EAP,HCPCS C1769,,Guidewire Hydrophilic Coat 3,$29.00,$0.00,$29.00,$15.75,$20.70,$0.00,$5.00,$20.70,$20.70,$5.08,$29.00,$0.00,$14.50,$22.97,$23.20,$0.00,$4.54,$0.00,$4.62,$0.00
27203537,EAP,Custom 27203537,,Catheter Separator 054,"$8,337.00",$0.00,"$8,337.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$8,337.00",$0.00,"$4,168.50","$6,602.90","$6,669.60",$0.00,$0.00,$0.00,$0.00,$0.00
27203538,EAP,HCPCS C1757,,Catheter Reperfilision 054,"$4,170.00",$0.00,"$4,170.00",$0.00,"$2,976.13",$0.00,$0.00,"$2,976.13","$2,976.13",$0.00,"$4,170.00",$0.00,"$2,085.00","$3,302.64","$3,336.00",$0.00,$0.00,$0.00,$0.00,$0.00
27203539,EAP,HCPCS C1887,,Cath.lumen Delivery Neuron 1,"$1,719.00",$0.00,"$1,719.00",$933.42,"$1,226.85",$0.00,$296.18,"$1,226.85","$1,226.85",$300.98,"$1,719.00",$0.00,$859.50,"$1,361.45","$1,375.20",$0.00,$269.02,$0.00,$273.66,$0.00
27203540,EAP,HCPCS C1887,,Catheter Delivery Neuron 6f St,"$3,436.00",$0.00,"$3,436.00","$1,865.75","$2,452.27",$0.00,$592.01,"$2,452.27","$2,452.27",$601.62,"$3,436.00",$0.00,"$1,718.00","$2,721.31","$2,748.80",$0.00,$537.73,$0.00,$547.01,$0.00
27203541,EAP,HCPCS C1887,,Cath.select Neuron 5f 120 1,$417.00,$0.00,$417.00,$226.43,$297.61,$0.00,$71.85,$297.61,$297.61,$73.01,$417.00,$0.00,$208.50,$330.26,$333.60,$0.00,$65.26,$0.00,$66.39,$0.00
27203542,EAP,HCPCS C1887,,Cath.select Neuron 5f 120 2,$417.00,$0.00,$417.00,$226.43,$297.61,$0.00,$71.85,$297.61,$297.61,$73.01,$417.00,$0.00,$208.50,$330.26,$333.60,$0.00,$65.26,$0.00,$66.39,$0.00
27203543,EAP,HCPCS C1887,,Cath.lumen Delivery Neuron 2,"$1,650.00",$0.00,"$1,650.00",$895.95,"$1,177.61",$0.00,$284.29,"$1,177.61","$1,177.61",$288.90,"$1,650.00",$0.00,$825.00,"$1,306.80","$1,320.00",$0.00,$258.23,$0.00,$262.68,$0.00
27203544,EAP,HCPCS C1887,,Cath.lumen Delivery Neuron 3,"$1,650.00",$0.00,"$1,650.00",$895.95,"$1,177.61",$0.00,$284.29,"$1,177.61","$1,177.61",$288.90,"$1,650.00",$0.00,$825.00,"$1,306.80","$1,320.00",$0.00,$258.23,$0.00,$262.68,$0.00
27203545,EAP,HCPCS C1884,,Device Protection Spider Fx 5.,"$4,170.00",$0.00,"$4,170.00","$2,264.31","$2,976.13",$0.00,$718.47,"$2,976.13","$2,976.13",$730.13,"$4,170.00",$0.00,"$2,085.00","$3,302.64","$3,336.00",$0.00,$652.61,$0.00,$663.86,$0.00
27203546,EAP,HCPCS C1884,,Device Distal Protection Spide,"$4,170.00",$0.00,"$4,170.00","$2,264.31","$2,976.13",$0.00,$718.47,"$2,976.13","$2,976.13",$730.13,"$4,170.00",$0.00,"$2,085.00","$3,302.64","$3,336.00",$0.00,$652.61,$0.00,$663.86,$0.00
27203547,EAP,HCPCS C2628,,Cath.balloon Guide Concent 1,"$2,364.00",$0.00,"$2,364.00",$0.00,"$1,687.19",$0.00,$0.00,"$1,687.19","$1,687.19",$0.00,"$2,364.00",$0.00,"$1,182.00","$1,872.29","$1,891.20",$0.00,$0.00,$0.00,$0.00,$0.00
27203548,EAP,HCPCS C2628,,Catheter Balloon Guide 9f 80cm,"$2,364.00",$0.00,"$2,364.00",$0.00,"$1,687.19",$0.00,$0.00,"$1,687.19","$1,687.19",$0.00,"$2,364.00",$0.00,"$1,182.00","$1,872.29","$1,891.20",$0.00,$0.00,$0.00,$0.00,$0.00
27203549,EAP,HCPCS C2628,,Cath.balloon Guide Concent 2,"$2,251.00",$0.00,"$2,251.00",$0.00,"$1,606.54",$0.00,$0.00,"$1,606.54","$1,606.54",$0.00,"$2,251.00",$0.00,"$1,125.50","$1,782.79","$1,800.80",$0.00,$0.00,$0.00,$0.00,$0.00
27203550,EAP,HCPCS C2628,,Cath.balloon Guide Concent 3,"$2,920.00",$0.00,"$2,920.00",$0.00,"$2,084.00",$0.00,$0.00,"$2,084.00","$2,084.00",$0.00,"$2,920.00",$0.00,"$1,460.00","$2,312.64","$2,336.00",$0.00,$0.00,$0.00,$0.00,$0.00
27203551,EAP,HCPCS C1751,,Cath.distal Access Dac 057 1,"$3,321.00",$0.00,"$3,321.00","$1,803.30","$2,370.20",$0.00,$572.19,"$2,370.20","$2,370.20",$581.48,"$3,321.00",$0.00,"$1,660.50","$2,630.23","$2,656.80",$0.00,$519.74,$0.00,$528.70,$0.00
27203552,EAP,HCPCS C1751,,Cath.distal Access Dac 057 2,"$3,321.00",$0.00,"$3,321.00","$1,803.30","$2,370.20",$0.00,$572.19,"$2,370.20","$2,370.20",$581.48,"$3,321.00",$0.00,"$1,660.50","$2,630.23","$2,656.80",$0.00,$519.74,$0.00,$528.70,$0.00
27203553,EAP,HCPCS C1751,,Catheter Dac 044 - 130cm,"$1,429.00",$0.00,"$1,429.00",$775.95,"$1,019.88",$0.00,$246.21,"$1,019.88","$1,019.88",$250.21,"$1,429.00",$0.00,$714.50,"$1,131.77","$1,143.20",$0.00,$223.64,$0.00,$227.50,$0.00
27203554,EAP,HCPCS C1751,,Catheter Dac 038 - 136cm,"$3,321.00",$0.00,"$3,321.00","$1,803.30","$2,370.20",$0.00,$572.19,"$2,370.20","$2,370.20",$581.48,"$3,321.00",$0.00,"$1,660.50","$2,630.23","$2,656.80",$0.00,$519.74,$0.00,$528.70,$0.00
27203555,EAP,HCPCS C1884,,Sph100200-20 Microcoil Platino,"$3,586.00",$0.00,"$3,586.00","$1,947.20","$2,559.33",$0.00,$617.85,"$2,559.33","$2,559.33",$627.88,"$3,586.00",$0.00,"$1,793.00","$2,840.11","$2,868.80",$0.00,$561.21,$0.00,$570.89,$0.00
27203556,EAP,Custom 27203556,,Marker Strght 2-tip 150cm/6cm,"$2,518.00",$0.00,"$2,518.00",$0.00,"$1,797.10",$0.00,$0.00,"$1,797.10","$1,797.10",$0.00,"$2,518.00",$0.00,"$1,259.00","$1,994.26","$2,014.40",$0.00,$0.00,$0.00,$0.00,$0.00
27203557,EAP,Custom 27203557,,Axium Coil Detacher,$166.00,$0.00,$166.00,$0.00,$118.47,$0.00,$0.00,$118.47,$118.47,$0.00,$166.00,$0.00,$83.00,$131.47,$132.80,$0.00,$0.00,$0.00,$0.00,$0.00
27203558,EAP,HCPCS C1887,,Mpc Envoy Guiding Wire,"$1,048.00",$0.00,"$1,048.00",$569.06,$747.96,$0.00,$180.57,$747.96,$747.96,$183.50,"$1,048.00",$0.00,$524.00,$830.02,$838.40,$0.00,$164.01,$0.00,$166.84,$0.00
27203559,EAP,Custom 27203559,,Starclose Se,$266.00,$0.00,$266.00,$0.00,$189.84,$0.00,$0.00,$189.84,$189.84,$0.00,$266.00,$0.00,$133.00,$210.67,$212.80,$0.00,$0.00,$0.00,$0.00,$0.00
27203560,EAP,Custom 27203560,,Wrap On Finger Hooks(each),$21.00,$0.00,$21.00,$0.00,$14.99,$0.00,$0.00,$14.99,$14.99,$0.00,$21.00,$0.00,$10.50,$16.63,$16.80,$0.00,$0.00,$0.00,$0.00,$0.00
27203561,EAP,HCPCS C1729,,Shunt Prtnvn Dnvr Asct 25-40ml/min Ample Flowrate,"$5,625.00",$0.00,"$5,625.00","$3,054.38","$4,014.56",$0.00,$969.16,"$4,014.56","$4,014.56",$984.89,"$5,625.00",$0.00,"$2,812.50","$4,455.00","$4,500.00",$0.00,$880.31,$0.00,$895.50,$0.00
27203562,EAP,HCPCS C1729,,"Cath, Drainage",$26.00,$0.00,$26.00,$14.12,$18.56,$0.00,$4.48,$18.56,$18.56,$4.55,$26.00,$0.00,$13.00,$20.59,$20.80,$0.00,$4.07,$0.00,$4.14,$0.00
27203563,EAP,HCPCS C1769,,Tray Tracheostomy 24-26-28fr 2 Cannu Tube Shiley C,"$1,219.00",$0.00,"$1,219.00",$661.92,$870.00,$0.00,$210.03,$870.00,$870.00,$213.44,"$1,219.00",$0.00,$609.50,$965.45,$975.20,$0.00,$190.77,$0.00,$194.06,$0.00
27203564,EAP,Custom 27203564,,Cannula Prfsn 22fr Vns 20d Dilat Crct Bbl Trp Fnl,"$32,500.00",$0.00,"$32,500.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$32,500.00",$0.00,"$16,250.00","$25,740.00","$26,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
27203565,EAP,HCPCS C1725,,Catheter Angio Vtk Curve 5fr 125cm Cerebrum Trnb,$33.00,$0.00,$33.00,$17.92,$23.55,$0.00,$5.69,$23.55,$23.55,$5.78,$33.00,$0.00,$16.50,$26.14,$26.40,$0.00,$5.16,$0.00,$5.25,$0.00
27203580,EAP,Custom 27203580,,Safeguard 24cm Pressure Devce,$66.00,$0.00,$66.00,$0.00,$47.10,$0.00,$0.00,$47.10,$47.10,$0.00,$66.00,$0.00,$33.00,$52.27,$52.80,$0.00,$0.00,$0.00,$0.00,$0.00
27203590,EAP,Custom 27203590,,Needle 25g,$119.00,$0.00,$119.00,$0.00,$84.93,$0.00,$0.00,$84.93,$84.93,$0.00,$119.00,$0.00,$59.50,$94.25,$95.20,$0.00,$0.00,$0.00,$0.00,$0.00
27203591,EAP,Custom 27203591,,Resolution235cm,$228.00,$0.00,$228.00,$0.00,$162.72,$0.00,$0.00,$162.72,$162.72,$0.00,$228.00,$0.00,$114.00,$180.58,$182.40,$0.00,$0.00,$0.00,$0.00,$0.00
27203592,EAP,Custom 27203592,,Rx Lithotripter Basket3,$379.00,$0.00,$379.00,$0.00,$270.49,$0.00,$0.00,$270.49,$270.49,$0.00,$379.00,$0.00,$189.50,$300.17,$303.20,$0.00,$0.00,$0.00,$0.00,$0.00
27203593,EAP,Custom 27203593,,Rx Lithotripter Basket4,$379.00,$0.00,$379.00,$0.00,$270.49,$0.00,$0.00,$270.49,$270.49,$0.00,$379.00,$0.00,$189.50,$300.17,$303.20,$0.00,$0.00,$0.00,$0.00,$0.00
27203594,EAP,Custom 27203594,,Rx Lithotripter Basket5,$379.00,$0.00,$379.00,$0.00,$270.49,$0.00,$0.00,$270.49,$270.49,$0.00,$379.00,$0.00,$189.50,$300.17,$303.20,$0.00,$0.00,$0.00,$0.00,$0.00
27203595,EAP,Custom 27203595,,Rx Lithotripter Basket6,$379.00,$0.00,$379.00,$0.00,$270.49,$0.00,$0.00,$270.49,$270.49,$0.00,$379.00,$0.00,$189.50,$300.17,$303.20,$0.00,$0.00,$0.00,$0.00,$0.00
27203596,EAP,Custom 27203596,,Autotome Rx 44-20mm,$622.00,$0.00,$622.00,$0.00,$443.92,$0.00,$0.00,$443.92,$443.92,$0.00,$622.00,$0.00,$311.00,$492.62,$497.60,$0.00,$0.00,$0.00,$0.00,$0.00
27203597,EAP,Custom 27203597,,Autotome Rx 44-20mm,$592.00,$0.00,$592.00,$0.00,$422.51,$0.00,$0.00,$422.51,$422.51,$0.00,$592.00,$0.00,$296.00,$468.86,$473.60,$0.00,$0.00,$0.00,$0.00,$0.00
27203598,EAP,Custom 27203598,,Hydro Tome Rx 450cm,$592.00,$0.00,$592.00,$0.00,$422.51,$0.00,$0.00,$422.51,$422.51,$0.00,$592.00,$0.00,$296.00,$468.86,$473.60,$0.00,$0.00,$0.00,$0.00,$0.00
27203599,EAP,Custom 27203599,,Needleknife Rx,$260.00,$0.00,$260.00,$0.00,$185.56,$0.00,$0.00,$185.56,$185.56,$0.00,$260.00,$0.00,$130.00,$205.92,$208.00,$0.00,$0.00,$0.00,$0.00,$0.00
27203621,EAP,Custom 27203621,,Laceration Tray,$30.00,$0.00,$30.00,$0.00,$21.41,$0.00,$0.00,$21.41,$21.41,$0.00,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$0.00,$0.00,$0.00,$0.00
27203624,EAP,Custom 27203624,,Standard Peg Kit 20,$517.00,$0.00,$517.00,$0.00,$368.98,$0.00,$0.00,$368.98,$368.98,$0.00,$517.00,$0.00,$258.50,$409.46,$413.60,$0.00,$0.00,$0.00,$0.00,$0.00
27203680,EAP,HCPCS C1769,,Hydra-jag/.035/260cm/str,$647.00,$0.00,$647.00,$351.32,$461.76,$0.00,$111.47,$461.76,$461.76,$113.28,$647.00,$0.00,$323.50,$512.42,$517.60,$0.00,$101.26,$0.00,$103.00,$0.00
27203681,EAP,HCPCS C1769,,Hydra-jag/.035/450cm/str,$749.00,$0.00,$749.00,$406.71,$534.56,$0.00,$129.05,$534.56,$534.56,$131.14,$749.00,$0.00,$374.50,$593.21,$599.20,$0.00,$117.22,$0.00,$119.24,$0.00
27203682,EAP,HCPCS C1769,,Jag Hini 025/260 St Bx2,$352.00,$0.00,$352.00,$191.14,$251.22,$0.00,$60.65,$251.22,$251.22,$61.63,$352.00,$0.00,$176.00,$278.78,$281.60,$0.00,$55.09,$0.00,$56.04,$0.00
27203683,EAP,HCPCS C1769,,Jagwire/025/straight  450cm,$533.00,$0.00,$533.00,$289.42,$380.40,$0.00,$91.83,$380.40,$380.40,$93.32,$533.00,$0.00,$266.50,$422.14,$426.40,$0.00,$83.41,$0.00,$84.85,$0.00
27203684,EAP,HCPCS C1769,,Pathfinder 018/450,$544.00,$0.00,$544.00,$295.39,$388.25,$0.00,$93.73,$388.25,$388.25,$95.25,$544.00,$0.00,$272.00,$430.85,$435.20,$0.00,$85.14,$0.00,$86.60,$0.00
27203701,EAP,Custom 27203701,,Barrier Adh Abs Plvs Intcd 4x3,$745.00,$0.00,$745.00,$0.00,$531.71,$0.00,$0.00,$531.71,$531.71,$0.00,$745.00,$0.00,$372.50,$590.04,$596.00,$0.00,$0.00,$0.00,$0.00,$0.00
27203702,EAP,HCPCS C1877,,Catheter Tr Renegade Hi Flo 13,"$1,257.00",$0.00,"$1,257.00",$682.55,$897.12,$0.00,$216.57,$897.12,$897.12,$220.09,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$196.72,$0.00,$200.11,$0.00
27203703,EAP,Custom 27203703,,Catheter Embolic F-idc 2d 3mm,"$1,321.00",$0.00,"$1,321.00",$0.00,$942.80,$0.00,$0.00,$942.80,$942.80,$0.00,"$1,321.00",$0.00,$660.50,"$1,046.23","$1,056.80",$0.00,$0.00,$0.00,$0.00,$0.00
27203704,EAP,Custom 27203704,,Catheter Embolic 2/5mm X 5.8cm,"$1,258.00",$0.00,"$1,258.00",$0.00,$897.83,$0.00,$0.00,$897.83,$897.83,$0.00,"$1,258.00",$0.00,$629.00,$996.34,"$1,006.40",$0.00,$0.00,$0.00,$0.00,$0.00
27203705,EAP,Custom 27203705,,Cm Catheter Embolic 2/5mm X 5.8,"$1,258.00",$0.00,"$1,258.00",$0.00,$897.83,$0.00,$0.00,$897.83,$897.83,$0.00,"$1,258.00",$0.00,$629.00,$996.34,"$1,006.40",$0.00,$0.00,$0.00,$0.00,$0.00
27203706,EAP,Custom 27203706,,Coil Axium Helical Detachable  Qc-3-8-helix,"$2,404.00",$0.00,"$2,404.00",$0.00,"$1,715.73",$0.00,$0.00,"$1,715.73","$1,715.73",$0.00,"$2,404.00",$0.00,"$1,202.00","$1,903.97","$1,923.20",$0.00,$0.00,$0.00,$0.00,$0.00
27203707,EAP,Custom 27203707,,Microcoil Platinum Deltaplush 2mmx4cm,"$3,217.00",$0.00,"$3,217.00",$0.00,"$2,295.97",$0.00,$0.00,"$2,295.97","$2,295.97",$0.00,"$3,217.00",$0.00,"$1,608.50","$2,547.86","$2,573.60",$0.00,$0.00,$0.00,$0.00,$0.00
27203708,EAP,Custom 27203708,,Microcoil Platinum Deltaplush 2mmx6cm,"$3,217.00",$0.00,"$3,217.00",$0.00,"$2,295.97",$0.00,$0.00,"$2,295.97","$2,295.97",$0.00,"$3,217.00",$0.00,"$1,608.50","$2,547.86","$2,573.60",$0.00,$0.00,$0.00,$0.00,$0.00
27203740,EAP,HCPCS C1887,,Catheter Renegade Stc-18 130/2,"$1,664.00",$0.00,"$1,664.00",$903.55,"$1,187.60",$0.00,$286.70,"$1,187.60","$1,187.60",$291.35,"$1,664.00",$0.00,$832.00,"$1,317.89","$1,331.20",$0.00,$260.42,$0.00,$264.91,$0.00
27203741,EAP,Custom 27203741,,Catheter Embolic F-3mm X 12cm,"$1,321.00",$0.00,"$1,321.00",$0.00,$942.80,$0.00,$0.00,$942.80,$942.80,$0.00,"$1,321.00",$0.00,$660.50,"$1,046.23","$1,056.80",$0.00,$0.00,$0.00,$0.00,$0.00
27203742,EAP,Custom 27203742,,Catheter Embolic F-4mm X 8cm,"$1,258.00",$0.00,"$1,258.00",$0.00,$897.83,$0.00,$0.00,$897.83,$897.83,$0.00,"$1,258.00",$0.00,$629.00,$996.34,"$1,006.40",$0.00,$0.00,$0.00,$0.00,$0.00
27203743,EAP,Custom 27203743,,4mm X 15cm Catheter Embolic F-,"$1,321.00",$0.00,"$1,321.00",$0.00,$942.80,$0.00,$0.00,$942.80,$942.80,$0.00,"$1,321.00",$0.00,$660.50,"$1,046.23","$1,056.80",$0.00,$0.00,$0.00,$0.00,$0.00
27203744,EAP,Custom 27203744,,Catheter Embolic F-5mm X 8cm,"$1,258.00",$0.00,"$1,258.00",$0.00,$897.83,$0.00,$0.00,$897.83,$897.83,$0.00,"$1,258.00",$0.00,$629.00,$996.34,"$1,006.40",$0.00,$0.00,$0.00,$0.00,$0.00
27203745,EAP,Custom 27203745,,Coil Embolization 2d Helix 5mm 15cm 8 Coil Occlusion System,"$1,258.00",$0.00,"$1,258.00",$0.00,$897.83,$0.00,$0.00,$897.83,$897.83,$0.00,"$1,258.00",$0.00,$629.00,$996.34,"$1,006.40",$0.00,$0.00,$0.00,$0.00,$0.00
27203746,EAP,Custom 27203746,,Coil Embolization 2d Helix 6mm 10cm 18 Coil Occlusion System,"$1,258.00",$0.00,"$1,258.00",$0.00,$897.83,$0.00,$0.00,$897.83,$897.83,$0.00,"$1,258.00",$0.00,$629.00,$996.34,"$1,006.40",$0.00,$0.00,$0.00,$0.00,$0.00
27203747,EAP,Custom 27203747,,Coil Embolization 2d Helix 6mm 20cm 18 Coil Occlusion System,"$1,258.00",$0.00,"$1,258.00",$0.00,$897.83,$0.00,$0.00,$897.83,$897.83,$0.00,"$1,258.00",$0.00,$629.00,$996.34,"$1,006.40",$0.00,$0.00,$0.00,$0.00,$0.00
27203748,EAP,Custom 27203748,,8MM X 20CM CATHETER EMBOLIC F-,"$1,258.00",$0.00,"$1,258.00",$0.00,$897.83,$0.00,$0.00,$897.83,$897.83,$0.00,"$1,258.00",$0.00,$629.00,$996.34,"$1,006.40",$0.00,$0.00,$0.00,$0.00,$0.00
27203749,EAP,Custom 27203749,,10MM X 20CM CATHETER EMBOLIC F,"$1,258.00",$0.00,"$1,258.00",$0.00,$897.83,$0.00,$0.00,$897.83,$897.83,$0.00,"$1,258.00",$0.00,$629.00,$996.34,"$1,006.40",$0.00,$0.00,$0.00,$0.00,$0.00
27203750,EAP,Custom 27203750,,10MM X 30CM CATHETER EMBOLIC F,"$1,258.00",$0.00,"$1,258.00",$0.00,$897.83,$0.00,$0.00,$897.83,$897.83,$0.00,"$1,258.00",$0.00,$629.00,$996.34,"$1,006.40",$0.00,$0.00,$0.00,$0.00,$0.00
27203751,EAP,Custom 27203751,,CATHETER EMBOLIC F12M X 20CM,"$1,258.00",$0.00,"$1,258.00",$0.00,$897.83,$0.00,$0.00,$897.83,$897.83,$0.00,"$1,258.00",$0.00,$629.00,$996.34,"$1,006.40",$0.00,$0.00,$0.00,$0.00,$0.00
27203752,EAP,Custom 27203752,,Catheter Embolic F 12m X 30cm,"$1,258.00",$0.00,"$1,258.00",$0.00,$897.83,$0.00,$0.00,$897.83,$897.83,$0.00,"$1,258.00",$0.00,$629.00,$996.34,"$1,006.40",$0.00,$0.00,$0.00,$0.00,$0.00
27203753,EAP,Custom 27203753,,Catheter Embolic F 14mm X 20cm,"$1,258.00",$0.00,"$1,258.00",$0.00,$897.83,$0.00,$0.00,$897.83,$897.83,$0.00,"$1,258.00",$0.00,$629.00,$996.34,"$1,006.40",$0.00,$0.00,$0.00,$0.00,$0.00
27203754,EAP,Custom 27203754,,Catheter Embolic F 14mm X 30cm,"$1,258.00",$0.00,"$1,258.00",$0.00,$897.83,$0.00,$0.00,$897.83,$897.83,$0.00,"$1,258.00",$0.00,$629.00,$996.34,"$1,006.40",$0.00,$0.00,$0.00,$0.00,$0.00
27203755,EAP,Custom 27203755,,CATHETER EMBOLIC F-IDC VORTX DCM,"$1,258.00",$0.00,"$1,258.00",$0.00,$897.83,$0.00,$0.00,$897.83,$897.83,$0.00,"$1,258.00",$0.00,$629.00,$996.34,"$1,006.40",$0.00,$0.00,$0.00,$0.00,$0.00
27203756,EAP,Custom 27203756,,Catheter Embolic F-2/4mm X 4.1cm,"$1,258.00",$0.00,"$1,258.00",$0.00,$897.83,$0.00,$0.00,$897.83,$897.83,$0.00,"$1,258.00",$0.00,$629.00,$996.34,"$1,006.40",$0.00,$0.00,$0.00,$0.00,$0.00
27203766,EAP,Custom 27203766,,Catheter Swan Ganz,$207.00,$0.00,$207.00,$0.00,$147.74,$0.00,$0.00,$147.74,$147.74,$0.00,$207.00,$0.00,$103.50,$163.94,$165.60,$0.00,$0.00,$0.00,$0.00,$0.00
27203769,EAP,Custom 27203769,,Tray Thoracentesis/parace,$100.00,$0.00,$100.00,$0.00,$71.37,$0.00,$0.00,$71.37,$71.37,$0.00,$100.00,$0.00,$50.00,$79.20,$80.00,$0.00,$0.00,$0.00,$0.00,$0.00
27203770,EAP,HCPCS C1769,,Miraclebros Guiding Wire 14937-01,"$2,251.00",$0.00,"$2,251.00","$1,222.29","$1,606.54",$0.00,$387.84,"$1,606.54","$1,606.54",$394.13,"$2,251.00",$0.00,"$1,125.50","$1,782.79","$1,800.80",$0.00,$352.28,$0.00,$358.36,$0.00
27203773,EAP,Custom 27203773,,Catheter Guid 14fr Acty Pro 130d Cs-ic Curve Inr,$613.00,$0.00,$613.00,$0.00,$437.50,$0.00,$0.00,$437.50,$437.50,$0.00,$613.00,$0.00,$306.50,$485.50,$490.40,$0.00,$0.00,$0.00,$0.00,$0.00
27203774,EAP,Custom 27203774,,Catheter Gd 16fr 1.5cm Bln Loprfl,"$1,238.00",$0.00,"$1,238.00",$0.00,$883.56,$0.00,$0.00,$883.56,$883.56,$0.00,"$1,238.00",$0.00,$619.00,$980.50,$990.40,$0.00,$0.00,$0.00,$0.00,$0.00
27203775,EAP,Custom 27203775,,Catheter Gd 16fr 3.5cm Bln Loprfl,"$1,238.00",$0.00,"$1,238.00",$0.00,$883.56,$0.00,$0.00,$883.56,$883.56,$0.00,"$1,238.00",$0.00,$619.00,$980.50,$990.40,$0.00,$0.00,$0.00,$0.00,$0.00
27203776,EAP,HCPCS C1724,,Catheter Athrcm 145cm Stlth 360 1.25mm Orbtl Cls,"$9,488.00",$0.00,"$9,488.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$9,488.00",$0.00,"$4,744.00","$7,514.50","$7,590.40",$0.00,$0.00,$0.00,$0.00,$0.00
27203777,EAP,HCPCS C1769,,Guidewire Vasc 360 Orbtl,$488.00,$0.00,$488.00,$264.98,$348.29,$0.00,$84.08,$348.29,$348.29,$85.44,$488.00,$0.00,$244.00,$386.50,$390.40,$0.00,$76.37,$0.00,$77.69,$0.00
27203780,EAP,HCPCS C1766,,Sheath Flex 7fr 10cm,$700.00,$0.00,$700.00,$380.10,$499.59,$0.00,$120.61,$499.59,$499.59,$122.56,$700.00,$0.00,$350.00,$554.40,$560.00,$0.00,$109.55,$0.00,$111.44,$0.00
27203790,EAP,HCPCS C1751,,Microcatheter Microvention,"$2,390.00",$0.00,"$2,390.00","$1,297.77","$1,705.74",$0.00,$411.79,"$1,705.74","$1,705.74",$418.47,"$2,390.00",$0.00,"$1,195.00","$1,892.88","$1,912.00",$0.00,$374.04,$0.00,$380.49,$0.00
27203795,EAP,HCPCS C1751,,Microcatheter Merci,"$1,585.00",$0.00,"$1,585.00",$860.66,"$1,131.21",$0.00,$273.09,"$1,131.21","$1,131.21",$277.52,"$1,585.00",$0.00,$792.50,"$1,255.32","$1,268.00",$0.00,$248.05,$0.00,$252.33,$0.00
27203796,EAP,HCPCS C1757,,2.5 Meri V-series Retrieval Sy,"$10,341.00",$0.00,"$10,341.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$10,341.00",$0.00,"$5,170.50","$8,190.07","$8,272.80",$0.00,$0.00,$0.00,$0.00,$0.00
27203797,EAP,HCPCS C1757,,3.0 Meri V-series Retrieval Sy,"$10,341.00",$0.00,"$10,341.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$10,341.00",$0.00,"$5,170.50","$8,190.07","$8,272.80",$0.00,$0.00,$0.00,$0.00,$0.00
27203798,EAP,HCPCS C1757,,Meri V-series Retrieval System,"$10,341.00",$0.00,"$10,341.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$10,341.00",$0.00,"$5,170.50","$8,190.07","$8,272.80",$0.00,$0.00,$0.00,$0.00,$0.00
27203799,EAP,HCPCS C1751,,026 Catheter Reperfusion,"$3,635.00",$0.00,"$3,635.00","$1,973.81","$2,594.30",$0.00,$626.29,"$2,594.30","$2,594.30",$636.46,"$3,635.00",$0.00,"$1,817.50","$2,878.92","$2,908.00",$0.00,$568.88,$0.00,$578.69,$0.00
27203800,EAP,HCPCS C1751,,032 Catheter Reperfusion,"$3,817.00",$0.00,"$3,817.00","$2,072.63","$2,724.19",$0.00,$657.65,"$2,724.19","$2,724.19",$668.33,"$3,817.00",$0.00,"$1,908.50","$3,023.06","$3,053.60",$0.00,$597.36,$0.00,$607.67,$0.00
27203801,EAP,HCPCS C1751,,041 Catheter Reperfusion,"$3,635.00",$0.00,"$3,635.00","$1,973.81","$2,594.30",$0.00,$626.29,"$2,594.30","$2,594.30",$636.46,"$3,635.00",$0.00,"$1,817.50","$2,878.92","$2,908.00",$0.00,$568.88,$0.00,$578.69,$0.00
27203802,EAP,Custom 27203802,,026 Separator,"$7,639.00",$0.00,"$7,639.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$7,639.00",$0.00,"$3,819.50","$6,050.09","$6,111.20",$0.00,$0.00,$0.00,$0.00,$0.00
27203803,EAP,Custom 27203803,,032 Separator,"$7,639.00",$0.00,"$7,639.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$7,639.00",$0.00,"$3,819.50","$6,050.09","$6,111.20",$0.00,$0.00,$0.00,$0.00,$0.00
27203804,EAP,Custom 27203804,,"Tubing, Aspiration","$1,297.00",$0.00,"$1,297.00",$0.00,$925.67,$0.00,$0.00,$925.67,$925.67,$0.00,"$1,297.00",$0.00,$648.50,"$1,027.22","$1,037.60",$0.00,$0.00,$0.00,$0.00,$0.00
27203805,EAP,Custom 27203805,,"Supplies, Non-sterile Penumbra",$913.00,$0.00,$913.00,$0.00,$651.61,$0.00,$0.00,$651.61,$651.61,$0.00,$913.00,$0.00,$456.50,$723.10,$730.40,$0.00,$0.00,$0.00,$0.00,$0.00
27203806,EAP,Custom 27203806,,"Pump, Penumbra Aspiration","$8,340.00",$0.00,"$8,340.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$8,340.00",$0.00,"$4,170.00","$6,605.28","$6,672.00",$0.00,$0.00,$0.00,$0.00,$0.00
27203807,EAP,Custom 27203807,,Device Accunet Distal Protecti,"$7,006.00",$0.00,"$7,006.00",$0.00,"$5,000.18",$0.00,$0.00,"$5,000.18","$5,000.18",$0.00,"$7,006.00",$0.00,"$3,503.00","$5,548.75","$5,604.80",$0.00,$0.00,$0.00,$0.00,$0.00
27203808,EAP,Custom 27203808,,1008195-20 Balloon Viatrac,"$1,500.00",$0.00,"$1,500.00",$0.00,"$1,070.55",$0.00,$0.00,"$1,070.55","$1,070.55",$0.00,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
27203809,EAP,Custom 27203809,,Qc-2-1 Helix Coil Axium Helica,"$2,404.00",$0.00,"$2,404.00",$0.00,"$1,715.73",$0.00,$0.00,"$1,715.73","$1,715.73",$0.00,"$2,404.00",$0.00,"$1,202.00","$1,903.97","$1,923.20",$0.00,$0.00,$0.00,$0.00,$0.00
27203810,EAP,Custom 27203810,,Qc-3-4-helix Coil Axium Helica,"$2,404.00",$0.00,"$2,404.00",$0.00,"$1,715.73",$0.00,$0.00,"$1,715.73","$1,715.73",$0.00,"$2,404.00",$0.00,"$1,202.00","$1,903.97","$1,923.20",$0.00,$0.00,$0.00,$0.00,$0.00
27203815,EAP,Custom 27203815,,Ballon-trek Mini Rx 2.0mm X 12mm,$685.00,$0.00,$685.00,$0.00,$488.88,$0.00,$0.00,$488.88,$488.88,$0.00,$685.00,$0.00,$342.50,$542.52,$548.00,$0.00,$0.00,$0.00,$0.00,$0.00
27203816,EAP,Custom 27203816,,Ballon-TREK MINI RX 2.0MM X 15MM,$652.00,$0.00,$652.00,$0.00,$465.33,$0.00,$0.00,$465.33,$465.33,$0.00,$652.00,$0.00,$326.00,$516.38,$521.60,$0.00,$0.00,$0.00,$0.00,$0.00
27203817,EAP,Custom 27203817,,Ballon-TREK RX 2.50MM X 12MM,$685.00,$0.00,$685.00,$0.00,$488.88,$0.00,$0.00,$488.88,$488.88,$0.00,$685.00,$0.00,$342.50,$542.52,$548.00,$0.00,$0.00,$0.00,$0.00,$0.00
27203818,EAP,Custom 27203818,,Ballon-TREK RX 2.50MM X 15MM,$652.00,$0.00,$652.00,$0.00,$465.33,$0.00,$0.00,$465.33,$465.33,$0.00,$652.00,$0.00,$326.00,$516.38,$521.60,$0.00,$0.00,$0.00,$0.00,$0.00
27203819,EAP,Custom 27203819,,Ballon-TREK RX 3.0MM X 12MM,$652.00,$0.00,$652.00,$0.00,$465.33,$0.00,$0.00,$465.33,$465.33,$0.00,$652.00,$0.00,$326.00,$516.38,$521.60,$0.00,$0.00,$0.00,$0.00,$0.00
27203820,EAP,HCPCS C1757,,Set Thrombectomy Dvx,"$5,308.00",$0.00,"$5,308.00",$0.00,"$3,788.32",$0.00,$0.00,"$3,788.32","$3,788.32",$0.00,"$5,308.00",$0.00,"$2,654.00","$4,203.94","$4,246.40",$0.00,$0.00,$0.00,$0.00,$0.00
27203821,EAP,HCPCS C1757,,Set Thrombectomy Avx,"$2,452.00",$0.00,"$2,452.00",$0.00,"$1,749.99",$0.00,$0.00,"$1,749.99","$1,749.99",$0.00,"$2,452.00",$0.00,"$1,226.00","$1,941.98","$1,961.60",$0.00,$0.00,$0.00,$0.00,$0.00
27203822,EAP,HCPCS C1757,,Set Thrombectomy Spiroflex,"$6,464.00",$0.00,"$6,464.00",$0.00,"$4,613.36",$0.00,$0.00,"$4,613.36","$4,613.36",$0.00,"$6,464.00",$0.00,"$3,232.00","$5,119.49","$5,171.20",$0.00,$0.00,$0.00,$0.00,$0.00
27203823,EAP,HCPCS C1757,,Set Thrombectomy Spiroflex Vg,"$6,156.00",$0.00,"$6,156.00",$0.00,"$4,393.54",$0.00,$0.00,"$4,393.54","$4,393.54",$0.00,"$6,156.00",$0.00,"$3,078.00","$4,875.55","$4,924.80",$0.00,$0.00,$0.00,$0.00,$0.00
27203824,EAP,Custom 27203824,,Ballon-TREK RX 3.0MM X 15MM,$652.00,$0.00,$652.00,$0.00,$465.33,$0.00,$0.00,$465.33,$465.33,$0.00,$652.00,$0.00,$326.00,$516.38,$521.60,$0.00,$0.00,$0.00,$0.00,$0.00
27203825,EAP,HCPCS C1725,,Balloon Nc Trek 2.0 X 6mm,$652.00,$0.00,$652.00,$354.04,$465.33,$0.00,$112.34,$465.33,$465.33,$114.16,$652.00,$0.00,$326.00,$516.38,$521.60,$0.00,$102.04,$0.00,$103.80,$0.00
27203826,EAP,HCPCS C1725,,Balloon Nc Trek 2.5 X 6mm,$652.00,$0.00,$652.00,$354.04,$465.33,$0.00,$112.34,$465.33,$465.33,$114.16,$652.00,$0.00,$326.00,$516.38,$521.60,$0.00,$102.04,$0.00,$103.80,$0.00
27203827,EAP,HCPCS C1725,,Balloon Nc Trek 2.5 X 8mm,$652.00,$0.00,$652.00,$354.04,$465.33,$0.00,$112.34,$465.33,$465.33,$114.16,$652.00,$0.00,$326.00,$516.38,$521.60,$0.00,$102.04,$0.00,$103.80,$0.00
27203828,EAP,HCPCS C1725,,Balloon Nc Trek 2.5 X 12mm,$652.00,$0.00,$652.00,$354.04,$465.33,$0.00,$112.34,$465.33,$465.33,$114.16,$652.00,$0.00,$326.00,$516.38,$521.60,$0.00,$102.04,$0.00,$103.80,$0.00
27203829,EAP,HCPCS C1725,,Balloon Nc Trek 2.5 X 20mm,$652.00,$0.00,$652.00,$354.04,$465.33,$0.00,$112.34,$465.33,$465.33,$114.16,$652.00,$0.00,$326.00,$516.38,$521.60,$0.00,$102.04,$0.00,$103.80,$0.00
27203830,EAP,HCPCS C1725,,Balloon Nc Trek 2.5 X 25mm,$652.00,$0.00,$652.00,$354.04,$465.33,$0.00,$112.34,$465.33,$465.33,$114.16,$652.00,$0.00,$326.00,$516.38,$521.60,$0.00,$102.04,$0.00,$103.80,$0.00
27203831,EAP,HCPCS C1725,,Balloon Nc Trek 2.75 X 6mm,$652.00,$0.00,$652.00,$354.04,$465.33,$0.00,$112.34,$465.33,$465.33,$114.16,$652.00,$0.00,$326.00,$516.38,$521.60,$0.00,$102.04,$0.00,$103.80,$0.00
27203832,EAP,HCPCS C1725,,Balloon Nc Trek 2.75 X 12mm,$652.00,$0.00,$652.00,$354.04,$465.33,$0.00,$112.34,$465.33,$465.33,$114.16,$652.00,$0.00,$326.00,$516.38,$521.60,$0.00,$102.04,$0.00,$103.80,$0.00
27203833,EAP,HCPCS C1725,,"Balloon, Mini Trek Otw 1.50 X",$652.00,$0.00,$652.00,$354.04,$465.33,$0.00,$112.34,$465.33,$465.33,$114.16,$652.00,$0.00,$326.00,$516.38,$521.60,$0.00,$102.04,$0.00,$103.80,$0.00
27203834,EAP,HCPCS C1725,,"Balloon, Mini Trek Otw 1.50 X",$652.00,$0.00,$652.00,$354.04,$465.33,$0.00,$112.34,$465.33,$465.33,$114.16,$652.00,$0.00,$326.00,$516.38,$521.60,$0.00,$102.04,$0.00,$103.80,$0.00
27203835,EAP,HCPCS C1725,,"Balloon, Mini Trek Otw 2.00 X",$685.00,$0.00,$685.00,$371.96,$488.88,$0.00,$118.02,$488.88,$488.88,$119.94,$685.00,$0.00,$342.50,$542.52,$548.00,$0.00,$107.20,$0.00,$109.05,$0.00
27203836,EAP,HCPCS C1725,,"Balloon, Mini Trek Otw 2.00 X",$652.00,$0.00,$652.00,$354.04,$465.33,$0.00,$112.34,$465.33,$465.33,$114.16,$652.00,$0.00,$326.00,$516.38,$521.60,$0.00,$102.04,$0.00,$103.80,$0.00
27203837,EAP,HCPCS C1725,,"Balloon, Mini Trek Otw 2.00 X",$652.00,$0.00,$652.00,$354.04,$465.33,$0.00,$112.34,$465.33,$465.33,$114.16,$652.00,$0.00,$326.00,$516.38,$521.60,$0.00,$102.04,$0.00,$103.80,$0.00
27203838,EAP,HCPCS C1725,,Balloon Nc Trek 2.75 X 15mm,$652.00,$0.00,$652.00,$354.04,$465.33,$0.00,$112.34,$465.33,$465.33,$114.16,$652.00,$0.00,$326.00,$516.38,$521.60,$0.00,$102.04,$0.00,$103.80,$0.00
27203839,EAP,HCPCS C1725,,Balloon Nc Trek 2.75 X 20mm,$652.00,$0.00,$652.00,$354.04,$465.33,$0.00,$112.34,$465.33,$465.33,$114.16,$652.00,$0.00,$326.00,$516.38,$521.60,$0.00,$102.04,$0.00,$103.80,$0.00
27203840,EAP,HCPCS C1725,,Balloon Nc Trek 3.0 X 6mm,$652.00,$0.00,$652.00,$354.04,$465.33,$0.00,$112.34,$465.33,$465.33,$114.16,$652.00,$0.00,$326.00,$516.38,$521.60,$0.00,$102.04,$0.00,$103.80,$0.00
27203841,EAP,HCPCS C1725,,Balloon Nc Trek 3.0 X 8mm,$652.00,$0.00,$652.00,$354.04,$465.33,$0.00,$112.34,$465.33,$465.33,$114.16,$652.00,$0.00,$326.00,$516.38,$521.60,$0.00,$102.04,$0.00,$103.80,$0.00
27203842,EAP,HCPCS C1725,,Balloon Nc Trek 3.0 X 12mm,$652.00,$0.00,$652.00,$354.04,$465.33,$0.00,$112.34,$465.33,$465.33,$114.16,$652.00,$0.00,$326.00,$516.38,$521.60,$0.00,$102.04,$0.00,$103.80,$0.00
27203843,EAP,HCPCS C1725,,Balloon Nc Trek 3.0 X 15mm,$652.00,$0.00,$652.00,$354.04,$465.33,$0.00,$112.34,$465.33,$465.33,$114.16,$652.00,$0.00,$326.00,$516.38,$521.60,$0.00,$102.04,$0.00,$103.80,$0.00
27203844,EAP,HCPCS C1725,,Balloon Nc Trek 3.0 X 20mm,$685.00,$0.00,$685.00,$371.96,$488.88,$0.00,$118.02,$488.88,$488.88,$119.94,$685.00,$0.00,$342.50,$542.52,$548.00,$0.00,$107.20,$0.00,$109.05,$0.00
27203845,EAP,HCPCS C1725,,Balloon Nc Trek 3.0 X 25mm,$652.00,$0.00,$652.00,$354.04,$465.33,$0.00,$112.34,$465.33,$465.33,$114.16,$652.00,$0.00,$326.00,$516.38,$521.60,$0.00,$102.04,$0.00,$103.80,$0.00
27203846,EAP,HCPCS C1725,,Balloon Nc Trek 3.25 X 12mm,$652.00,$0.00,$652.00,$354.04,$465.33,$0.00,$112.34,$465.33,$465.33,$114.16,$652.00,$0.00,$326.00,$516.38,$521.60,$0.00,$102.04,$0.00,$103.80,$0.00
27203847,EAP,HCPCS C1725,,Balloon Nc Trek 3.25 X 15mm,$652.00,$0.00,$652.00,$354.04,$465.33,$0.00,$112.34,$465.33,$465.33,$114.16,$652.00,$0.00,$326.00,$516.38,$521.60,$0.00,$102.04,$0.00,$103.80,$0.00
27203848,EAP,HCPCS C1725,,Balloon Nc Trek 3.5 X 6mm,$652.00,$0.00,$652.00,$354.04,$465.33,$0.00,$112.34,$465.33,$465.33,$114.16,$652.00,$0.00,$326.00,$516.38,$521.60,$0.00,$102.04,$0.00,$103.80,$0.00
27203849,EAP,HCPCS C1725,,Balloon Nc Trek 3.5 X 8mm,$652.00,$0.00,$652.00,$354.04,$465.33,$0.00,$112.34,$465.33,$465.33,$114.16,$652.00,$0.00,$326.00,$516.38,$521.60,$0.00,$102.04,$0.00,$103.80,$0.00
27203850,EAP,HCPCS C1725,,Balloon Nc Trek 3.5 X 12mm,$652.00,$0.00,$652.00,$354.04,$465.33,$0.00,$112.34,$465.33,$465.33,$114.16,$652.00,$0.00,$326.00,$516.38,$521.60,$0.00,$102.04,$0.00,$103.80,$0.00
27203851,EAP,HCPCS C1725,,Balloon Nc Trek 3.5 X 15mm,$652.00,$0.00,$652.00,$354.04,$465.33,$0.00,$112.34,$465.33,$465.33,$114.16,$652.00,$0.00,$326.00,$516.38,$521.60,$0.00,$102.04,$0.00,$103.80,$0.00
27203852,EAP,HCPCS C1725,,Balloon Nc Trek 3.5 X 20mm,$685.00,$0.00,$685.00,$371.96,$488.88,$0.00,$118.02,$488.88,$488.88,$119.94,$685.00,$0.00,$342.50,$542.52,$548.00,$0.00,$107.20,$0.00,$109.05,$0.00
27203853,EAP,HCPCS C1725,,Balloon Nc Trek 3.5 X 25mm,$652.00,$0.00,$652.00,$354.04,$465.33,$0.00,$112.34,$465.33,$465.33,$114.16,$652.00,$0.00,$326.00,$516.38,$521.60,$0.00,$102.04,$0.00,$103.80,$0.00
27203854,EAP,HCPCS C1725,,Balloon Nc Trek 3.75 X 12mm,$652.00,$0.00,$652.00,$354.04,$465.33,$0.00,$112.34,$465.33,$465.33,$114.16,$652.00,$0.00,$326.00,$516.38,$521.60,$0.00,$102.04,$0.00,$103.80,$0.00
27203855,EAP,HCPCS C1725,,Balloon Nc Trek 3.75 X 15mm,$652.00,$0.00,$652.00,$354.04,$465.33,$0.00,$112.34,$465.33,$465.33,$114.16,$652.00,$0.00,$326.00,$516.38,$521.60,$0.00,$102.04,$0.00,$103.80,$0.00
27203856,EAP,HCPCS C1725,,Balloon Nc Trek 3.75 X 20mm,$652.00,$0.00,$652.00,$354.04,$465.33,$0.00,$112.34,$465.33,$465.33,$114.16,$652.00,$0.00,$326.00,$516.38,$521.60,$0.00,$102.04,$0.00,$103.80,$0.00
27203857,EAP,HCPCS C1725,,Balloon Nc Trek 4.0 X 8mm,$652.00,$0.00,$652.00,$354.04,$465.33,$0.00,$112.34,$465.33,$465.33,$114.16,$652.00,$0.00,$326.00,$516.38,$521.60,$0.00,$102.04,$0.00,$103.80,$0.00
27203858,EAP,HCPCS C1725,,Balloon Nc Trek 4.0 X 12mm,$652.00,$0.00,$652.00,$354.04,$465.33,$0.00,$112.34,$465.33,$465.33,$114.16,$652.00,$0.00,$326.00,$516.38,$521.60,$0.00,$102.04,$0.00,$103.80,$0.00
27203859,EAP,HCPCS C1725,,Balloon Nc Trek 4.0 X 15mm,$652.00,$0.00,$652.00,$354.04,$465.33,$0.00,$112.34,$465.33,$465.33,$114.16,$652.00,$0.00,$326.00,$516.38,$521.60,$0.00,$102.04,$0.00,$103.80,$0.00
27203860,EAP,HCPCS C1725,,Balloon Nc Trek 4.0 X 20mm,$652.00,$0.00,$652.00,$354.04,$465.33,$0.00,$112.34,$465.33,$465.33,$114.16,$652.00,$0.00,$326.00,$516.38,$521.60,$0.00,$102.04,$0.00,$103.80,$0.00
27203861,EAP,HCPCS C1725,,Balloon Nc Trek 5.0 X 8mm,$652.00,$0.00,$652.00,$354.04,$465.33,$0.00,$112.34,$465.33,$465.33,$114.16,$652.00,$0.00,$326.00,$516.38,$521.60,$0.00,$102.04,$0.00,$103.80,$0.00
27203862,EAP,HCPCS C1725,,Balloon Nc Trek 5.0 X 12mm,$652.00,$0.00,$652.00,$354.04,$465.33,$0.00,$112.34,$465.33,$465.33,$114.16,$652.00,$0.00,$326.00,$516.38,$521.60,$0.00,$102.04,$0.00,$103.80,$0.00
27203863,EAP,HCPCS C1725,,Stent Xcience 2.25 X 8mm,"$6,940.00",$0.00,"$6,940.00","$3,768.42","$4,953.08",$0.00,"$1,195.73","$4,953.08","$4,953.08","$1,215.14","$6,940.00",$0.00,"$3,470.00","$5,496.48","$5,552.00",$0.00,"$1,086.11",$0.00,"$1,104.85",$0.00
27203864,EAP,HCPCS C1887,,Catheter Guid Ebu3.75 Curve 8fr .09in 90cm Left,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27203865,EAP,HCPCS C1887,,Atheter Guid Xb3.5 Curve 8fr 90cm Coron Lnchr,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27203867,EAP,HCPCS C1887,,Catheter Guid Jl4 Curve 8fr 90cm Coron Shr Nx Bal,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27203868,EAP,HCPCS C1887,,Catheter Guid Mb1 Curve 8fr .088in 90cm Coron Shr,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27203869,EAP,HCPCS C1887,,Catheter Angio Jacky Radl 3.5 Curve 5fr 110cm,$88.00,$0.00,$88.00,$47.78,$62.81,$0.00,$15.16,$62.81,$62.81,$15.41,$88.00,$0.00,$44.00,$69.70,$70.40,$0.00,$13.77,$0.00,$14.01,$0.00
27203870,EAP,HCPCS C1725,,Chocolate Ptca Balloon Catheter 2.0x10 Mm 5f,$750.00,$0.00,$750.00,$407.25,$535.28,$0.00,$129.22,$535.28,$535.28,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
27203871,EAP,HCPCS C1725,,Chocolate Ptca Balloon Catheter 2.0x15 Mm 5f,$750.00,$0.00,$750.00,$407.25,$535.28,$0.00,$129.22,$535.28,$535.28,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
27203872,EAP,HCPCS C1725,,Chocolate Ptca Balloon Catheter 2.0x20 Mm 5f,$750.00,$0.00,$750.00,$407.25,$535.28,$0.00,$129.22,$535.28,$535.28,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
27203873,EAP,HCPCS C1725,,Chocolate Ptca Balloon Catheter 2.5x10 Mm 5f,$788.00,$0.00,$788.00,$427.88,$562.40,$0.00,$135.77,$562.40,$562.40,$137.97,$788.00,$0.00,$394.00,$624.10,$630.40,$0.00,$123.32,$0.00,$125.45,$0.00
27203874,EAP,HCPCS C1725,,Chocolate Ptca Balloon Catheter 2.5x15 Mm 5f,$750.00,$0.00,$750.00,$407.25,$535.28,$0.00,$129.22,$535.28,$535.28,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
27203875,EAP,HCPCS C1725,,Chocolate Ptca Balloon Catheter 2.5x20 Mm 5f,$750.00,$0.00,$750.00,$407.25,$535.28,$0.00,$129.22,$535.28,$535.28,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
27203876,EAP,HCPCS C1725,,Chocolate Ptca Balloon Catheter 3.0x10 Mm 6f,$750.00,$0.00,$750.00,$407.25,$535.28,$0.00,$129.22,$535.28,$535.28,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
27203878,EAP,HCPCS C1725,,Chocolate Ptca Balloon Catheter 3.0x20 Mm 6f,$750.00,$0.00,$750.00,$407.25,$535.28,$0.00,$129.22,$535.28,$535.28,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
27203879,EAP,HCPCS C1725,,Chocolate Ptca Balloon Catheter 3.5x10 Mm 6f,$750.00,$0.00,$750.00,$407.25,$535.28,$0.00,$129.22,$535.28,$535.28,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
27203880,EAP,HCPCS C1725,,Chocolate Ptca Balloon Catheter 3.5x15 Mm 6f,$750.00,$0.00,$750.00,$407.25,$535.28,$0.00,$129.22,$535.28,$535.28,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
27203881,EAP,HCPCS C1725,,Chocolate Ptca Balloon Catheter 3.5x20 Mm 6f,$750.00,$0.00,$750.00,$407.25,$535.28,$0.00,$129.22,$535.28,$535.28,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
27203882,EAP,HCPCS C1887,,Catheter Dlv Sys .062in 5max Max Trk Tch 125cm 129,"$4,175.00",$0.00,"$4,175.00","$2,267.03","$2,979.70",$0.00,$719.33,"$2,979.70","$2,979.70",$731.01,"$4,175.00",$0.00,"$2,087.50","$3,306.60","$3,340.00",$0.00,$653.39,$0.00,$664.66,$0.00
27203890,EAP,Custom 27203890,,Kit Gel Pad Medium Arctic Sun,"$6,305.00",$0.00,"$6,305.00",$0.00,"$4,499.88",$0.00,$0.00,"$4,499.88","$4,499.88",$0.00,"$6,305.00",$0.00,"$3,152.50","$4,993.56","$5,044.00",$0.00,$0.00,$0.00,$0.00,$0.00
27203891,EAP,Custom 27203891,,Kit Gel Pad Large Arctic Sun,"$6,305.00",$0.00,"$6,305.00",$0.00,"$4,499.88",$0.00,$0.00,"$4,499.88","$4,499.88",$0.00,"$6,305.00",$0.00,"$3,152.50","$4,993.56","$5,044.00",$0.00,$0.00,$0.00,$0.00,$0.00
27203892,EAP,Custom 27203892,,Pad Gel Universal,"$6,005.00",$0.00,"$6,005.00",$0.00,"$4,285.77",$0.00,$0.00,"$4,285.77","$4,285.77",$0.00,"$6,005.00",$0.00,"$3,002.50","$4,755.96","$4,804.00",$0.00,$0.00,$0.00,$0.00,$0.00
27203895,EAP,Custom 27203895,,Ballon-TREK RX 3.50MM X 12MM,$652.00,$0.00,$652.00,$0.00,$465.33,$0.00,$0.00,$465.33,$465.33,$0.00,$652.00,$0.00,$326.00,$516.38,$521.60,$0.00,$0.00,$0.00,$0.00,$0.00
27203896,EAP,Custom 27203896,,Ballon-TREK RX 3.50MM X 15MM,$652.00,$0.00,$652.00,$0.00,$465.33,$0.00,$0.00,$465.33,$465.33,$0.00,$652.00,$0.00,$326.00,$516.38,$521.60,$0.00,$0.00,$0.00,$0.00,$0.00
27203897,EAP,Custom 27203897,,Ballon-TREK RX 4.0MM X 15MM,$652.00,$0.00,$652.00,$0.00,$465.33,$0.00,$0.00,$465.33,$465.33,$0.00,$652.00,$0.00,$326.00,$516.38,$521.60,$0.00,$0.00,$0.00,$0.00,$0.00
27203899,EAP,Custom 27203899,,"Catheter, Tiger 4.5 Radial Access",$31.00,$0.00,$31.00,$0.00,$22.12,$0.00,$0.00,$22.12,$22.12,$0.00,$31.00,$0.00,$15.50,$24.55,$24.80,$0.00,$0.00,$0.00,$0.00,$0.00
27203900,EAP,Custom 27203900,,Device Spec Rtrvl Xtrt Pro Xl 7-6fr 12-15mm 200cm,"$2,500.00",$0.00,"$2,500.00",$0.00,"$1,784.25",$0.00,$0.00,"$1,784.25","$1,784.25",$0.00,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
27203901,EAP,Custom 27203901,,Tray Foley 16fr With Unrinemeter,$35.00,$0.00,$35.00,$0.00,$24.98,$0.00,$0.00,$24.98,$24.98,$0.00,$35.00,$0.00,$17.50,$27.72,$28.00,$0.00,$0.00,$0.00,$0.00,$0.00
27203902,EAP,HCPCS C1751,,Fa-55150-1030 Catheter Marksman,"$3,104.00",$0.00,"$3,104.00","$1,685.47","$2,215.32",$0.00,$534.80,"$2,215.32","$2,215.32",$543.49,"$3,104.00",$0.00,"$1,552.00","$2,458.37","$2,483.20",$0.00,$485.78,$0.00,$494.16,$0.00
27203903,EAP,HCPCS C1725,,Catheter Balloon Udt 16-449 5-10/5/75,$634.00,$0.00,$634.00,$344.26,$452.49,$0.00,$109.24,$452.49,$452.49,$111.01,$634.00,$0.00,$317.00,$502.13,$507.20,$0.00,$99.22,$0.00,$100.93,$0.00
27203904,EAP,HCPCS C1894,,Cl-07690 Sheath Set Super Arrow Flex 90cm,$347.00,$0.00,$347.00,$188.42,$247.65,$0.00,$59.79,$247.65,$247.65,$60.76,$347.00,$0.00,$173.50,$274.82,$277.60,$0.00,$54.31,$0.00,$55.24,$0.00
27203905,EAP,HCPCS C1894,,Cl - 07665 Sheath Set Super Arrow Flex 65cm,$290.00,$0.00,$290.00,$157.47,$206.97,$0.00,$49.97,$206.97,$206.97,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
27203906,EAP,Custom 27203906,,Catheter Tiger Radial Access 5fr 100cm 4.0 40-5011,$33.00,$0.00,$33.00,$0.00,$23.55,$0.00,$0.00,$23.55,$23.55,$0.00,$33.00,$0.00,$16.50,$26.14,$26.40,$0.00,$0.00,$0.00,$0.00,$0.00
27203907,EAP,Custom 27203907,,Catheter Siteseer Al 1 5 Fr 5a0018,$31.00,$0.00,$31.00,$0.00,$22.12,$0.00,$0.00,$22.12,$22.12,$0.00,$31.00,$0.00,$15.50,$24.55,$24.80,$0.00,$0.00,$0.00,$0.00,$0.00
27203908,EAP,HCPCS C1769,,Guidewire Asahi Grand Slam .014x300cm 14940,$234.00,$0.00,$234.00,$127.06,$167.01,$0.00,$40.32,$167.01,$167.01,$40.97,$234.00,$0.00,$117.00,$185.33,$187.20,$0.00,$36.62,$0.00,$37.25,$0.00
27203909,EAP,HCPCS C1887,,La6ebu375 Catheter Guidingebu 3.75,$464.00,$0.00,$464.00,$251.95,$331.16,$0.00,$79.94,$331.16,$331.16,$81.24,$464.00,$0.00,$232.00,$367.49,$371.20,$0.00,$72.62,$0.00,$73.87,$0.00
27203912,EAP,HCPCS C1887,,Catheter Guideliner 5571,"$1,227.00",$0.00,"$1,227.00",$666.26,$875.71,$0.00,$211.41,$875.71,$875.71,$214.84,"$1,227.00",$0.00,$613.50,$971.78,$981.60,$0.00,$192.03,$0.00,$195.34,$0.00
27203913,EAP,HCPCS C1887,,La7ebu375 Catheter Guiding Ebu 3.75,$464.00,$0.00,$464.00,$251.95,$331.16,$0.00,$79.94,$331.16,$331.16,$81.24,$464.00,$0.00,$232.00,$367.49,$371.20,$0.00,$72.62,$0.00,$73.87,$0.00
27203914,EAP,Custom 27203914,,Catheter Siteseer Angled Pigtailed 5fr 5a0070,$31.00,$0.00,$31.00,$0.00,$22.12,$0.00,$0.00,$22.12,$22.12,$0.00,$31.00,$0.00,$15.50,$24.55,$24.80,$0.00,$0.00,$0.00,$0.00,$0.00
27203916,EAP,HCPCS C1892,,French Large Peel Away Introducer 20,$51.00,$0.00,$51.00,$27.69,$36.40,$0.00,$8.79,$36.40,$36.40,$8.93,$51.00,$0.00,$25.50,$40.39,$40.80,$0.00,$7.98,$0.00,$8.12,$0.00
27203917,EAP,HCPCS C1892,,French Large Peel Away Introducer 22,$51.00,$0.00,$51.00,$27.69,$36.40,$0.00,$8.79,$36.40,$36.40,$8.93,$51.00,$0.00,$25.50,$40.39,$40.80,$0.00,$7.98,$0.00,$8.12,$0.00
27203918,EAP,HCPCS C1892,,French Large Peel Away Introducer 24,$51.00,$0.00,$51.00,$27.69,$36.40,$0.00,$8.79,$36.40,$36.40,$8.93,$51.00,$0.00,$25.50,$40.39,$40.80,$0.00,$7.98,$0.00,$8.12,$0.00
27203919,EAP,HCPCS C1892,,French Large Peel Away Introducer 26,$51.00,$0.00,$51.00,$27.69,$36.40,$0.00,$8.79,$36.40,$36.40,$8.93,$51.00,$0.00,$25.50,$40.39,$40.80,$0.00,$7.98,$0.00,$8.12,$0.00
27203920,EAP,HCPCS C1894,,Flexor Ceckflo Introducer,$76.00,$0.00,$76.00,$41.27,$54.24,$0.00,$13.09,$54.24,$54.24,$13.31,$76.00,$0.00,$38.00,$60.19,$60.80,$0.00,$11.89,$0.00,$12.10,$0.00
27203921,EAP,HCPCS C1750,,French X 36 Cm Titan Hemodialysis Catheter,$237.00,$0.00,$237.00,$128.69,$169.15,$0.00,$40.83,$169.15,$169.15,$41.50,$237.00,$0.00,$118.50,$187.70,$189.60,$0.00,$37.09,$0.00,$37.73,$0.00
27203922,EAP,HCPCS C1750,,French X 40 Cm Titan Hemodialysis Catheter,$237.00,$0.00,$237.00,$128.69,$169.15,$0.00,$40.83,$169.15,$169.15,$41.50,$237.00,$0.00,$118.50,$187.70,$189.60,$0.00,$37.09,$0.00,$37.73,$0.00
27203923,EAP,HCPCS C1750,,Set Catheter 15.5fr 55cm 2 Lumen Titan Hd Long Term,$475.00,$0.00,$475.00,$213.75,$339.01,$0.00,$81.84,$339.01,$339.01,$83.17,$475.00,$0.00,$237.50,$376.20,$380.00,$0.00,$74.34,$0.00,$75.62,$0.00
27203925,EAP,HCPCS C1752,,French X 32 Cm Titan Hemodialysis Catheter T- 3 Triple 5,$237.00,$0.00,$237.00,$0.00,$169.15,$0.00,$0.00,$169.15,$169.15,$0.00,$237.00,$0.00,$118.50,$187.70,$189.60,$0.00,$0.00,$0.00,$0.00,$0.00
27203926,EAP,HCPCS C1752,,Titan Hemodialysis Catheter 14f X 30 Cm,$237.00,$0.00,$237.00,$0.00,$169.15,$0.00,$0.00,$169.15,$169.15,$0.00,$237.00,$0.00,$118.50,$187.70,$189.60,$0.00,$0.00,$0.00,$0.00,$0.00
27203927,EAP,HCPCS C1892,,Tear Away Sheath Introducer,$175.00,$0.00,$175.00,$95.03,$124.90,$0.00,$30.15,$124.90,$124.90,$30.64,$175.00,$0.00,$87.50,$138.60,$140.00,$0.00,$27.39,$0.00,$27.86,$0.00
27203928,EAP,Custom 27203928,,Dressing Adherent Mepilex Border 9.2 X 9.2 282400,$37.00,$0.00,$37.00,$0.00,$26.41,$0.00,$0.00,$26.41,$26.41,$0.00,$37.00,$0.00,$18.50,$29.30,$29.60,$0.00,$0.00,$0.00,$0.00,$0.00
27203929,EAP,HCPCS C1892,,Large Peel Away Introducer,$51.00,$0.00,$51.00,$27.69,$36.40,$0.00,$8.79,$36.40,$36.40,$8.93,$51.00,$0.00,$25.50,$40.39,$40.80,$0.00,$7.98,$0.00,$8.12,$0.00
27203930,EAP,HCPCS C1769,,G131660  Introducer Tracheostomy Percutaneous Ciaglia Bm,"$1,124.00",$0.00,"$1,124.00",$610.33,$802.20,$0.00,$193.66,$802.20,$802.20,$196.80,"$1,124.00",$0.00,$562.00,$890.21,$899.20,$0.00,$175.91,$0.00,$178.94,$0.00
27203931,EAP,HCPCS C1769,,G12565  Introducer Tracheostomy Percutaneous Ciaglia Blm,"$1,124.00",$0.00,"$1,124.00",$610.33,$802.20,$0.00,$193.66,$802.20,$802.20,$196.80,"$1,124.00",$0.00,$562.00,$890.21,$899.20,$0.00,$175.91,$0.00,$178.94,$0.00
27203933,EAP,HCPCS C1769,,Um-04018  Femoral Arterial Line Kit,$91.00,$0.00,$91.00,$49.41,$64.95,$0.00,$15.68,$64.95,$64.95,$15.93,$91.00,$0.00,$45.50,$72.07,$72.80,$0.00,$14.24,$0.00,$14.49,$0.00
27203937,EAP,Custom 27203937,,M827057/10.s  T.r.a.c. Pad,$57.00,$0.00,$57.00,$0.00,$40.68,$0.00,$0.00,$40.68,$40.68,$0.00,$57.00,$0.00,$28.50,$45.14,$45.60,$0.00,$0.00,$0.00,$0.00,$0.00
27203938,EAP,HCPCS C1887,,Fa-55150-1030 Catheter Marksman,"$3,259.00",$0.00,"$3,259.00","$1,769.64","$2,325.95",$0.00,$561.51,"$2,325.95","$2,325.95",$570.62,"$3,259.00",$0.00,"$1,629.50","$2,581.13","$2,607.20",$0.00,$510.03,$0.00,$518.83,$0.00
27203939,EAP,HCPCS C1725,,Baloon 2.5 X 15mm Raptor 573-125,$743.00,$0.00,$743.00,$403.45,$530.28,$0.00,$128.02,$530.28,$530.28,$130.09,$743.00,$0.00,$371.50,$588.46,$594.40,$0.00,$116.28,$0.00,$118.29,$0.00
27203940,EAP,Custom 27203940,,Catheter Siteseer Al1 5fr 5a0018,$31.00,$0.00,$31.00,$0.00,$22.12,$0.00,$0.00,$22.12,$22.12,$0.00,$31.00,$0.00,$15.50,$24.55,$24.80,$0.00,$0.00,$0.00,$0.00,$0.00
27203941,EAP,Custom 27203941,,Cl-07665 Sheath Set Super Arrow Flex 65cm,$290.00,$0.00,$290.00,$0.00,$206.97,$0.00,$0.00,$206.97,$206.97,$0.00,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$0.00,$0.00,$0.00,$0.00
27203942,EAP,Custom 27203942,,Needle Guide Sterile 9001c0212,$48.00,$0.00,$48.00,$0.00,$34.26,$0.00,$0.00,$34.26,$34.26,$0.00,$48.00,$0.00,$24.00,$38.02,$38.40,$0.00,$0.00,$0.00,$0.00,$0.00
27203943,EAP,HCPCS C1895,,"Reliance Lead,aicd, Endo Dual Coil","$11,794.00",$0.00,"$11,794.00","$6,404.14","$5,158.80",$0.00,"$2,032.05","$5,158.80","$5,158.80","$2,065.04","$11,794.00",$0.00,"$5,897.00","$9,340.85","$9,435.20",$0.00,"$1,845.76",$0.00,"$1,877.60",$0.00
27203945,EAP,HCPCS C1887,,"6fr Acuity Cath, Guiding W Del Sys",$485.00,$0.00,$485.00,$263.36,$346.14,$0.00,$83.56,$346.14,$346.14,$84.92,$485.00,$0.00,$242.50,$384.12,$388.00,$0.00,$75.90,$0.00,$77.21,$0.00
27203946,EAP,HCPCS C1887,,"8fr Acuity Cath, Guiding W Del Sys","$1,104.00",$0.00,"$1,104.00",$599.47,$787.92,$0.00,$190.21,$787.92,$787.92,$193.30,"$1,104.00",$0.00,$552.00,$874.37,$883.20,$0.00,$172.78,$0.00,$175.76,$0.00
27203947,EAP,HCPCS C1887,,"Ep Ds2c002 Slit/outer Cath, Guiding","$1,551.00",$0.00,"$1,551.00",$842.19,"$1,106.95",$0.00,$267.23,"$1,106.95","$1,106.95",$271.57,"$1,551.00",$0.00,$775.50,"$1,228.39","$1,240.80",$0.00,$242.73,$0.00,$246.92,$0.00
27203950,EAP,HCPCS C1769,,Neuroscout 14 Standard 601314,"$1,111.00",$0.00,"$1,111.00",$603.27,$792.92,$0.00,$191.42,$792.92,$792.92,$194.53,"$1,111.00",$0.00,$555.50,$879.91,$888.80,$0.00,$173.87,$0.00,$176.87,$0.00
27203951,EAP,HCPCS C1769,,Neuroscout 14 Soft Xl 601414,"$1,111.00",$0.00,"$1,111.00",$499.95,$792.92,$0.00,$191.42,$792.92,$792.92,$194.53,"$1,111.00",$0.00,$555.50,$879.91,$888.80,$0.00,$173.87,$0.00,$176.87,$0.00
27203952,EAP,HCPCS C1887,,Prowler 27 Microcatheter,"$2,468.00",$0.00,"$2,468.00","$1,340.12","$1,761.41",$0.00,$425.22,"$1,761.41","$1,761.41",$432.13,"$2,468.00",$0.00,"$1,234.00","$1,954.66","$1,974.40",$0.00,$386.24,$0.00,$392.91,$0.00
27203953,EAP,HCPCS C1887,,Catheter Delivery System Px Slim 130 D 0-.02 In Micro Lm,"$2,749.00",$0.00,"$2,749.00","$1,492.71","$1,961.96",$0.00,$473.64,"$1,961.96","$1,961.96",$481.33,"$2,749.00",$0.00,"$1,374.50","$2,177.21","$2,199.20",$0.00,$430.22,$0.00,$437.64,$0.00
27203954,EAP,HCPCS C1887,,Catheter Delivery Sys Px Slim 45 D 0-.02 In Micro L150 M,"$2,749.00",$0.00,"$2,749.00","$1,492.71","$1,961.96",$0.00,$473.64,"$1,961.96","$1,961.96",$481.33,"$2,749.00",$0.00,"$1,374.50","$2,177.21","$2,199.20",$0.00,$430.22,$0.00,$437.64,$0.00
27203955,EAP,HCPCS C1887,,Catheter Delivery Syspx Slim 90 D 0-.02 In Micro L150 Cm,"$2,749.00",$0.00,"$2,749.00","$1,492.71","$1,961.96",$0.00,$473.64,"$1,961.96","$1,961.96",$481.33,"$2,749.00",$0.00,"$1,374.50","$2,177.21","$2,199.20",$0.00,$430.22,$0.00,$437.64,$0.00
27203956,EAP,HCPCS C1887,,Catheter Delivery Sys Px Slim 130 D 0-.02 In Micro L150m,"$2,749.00",$0.00,"$2,749.00","$1,492.71","$1,961.96",$0.00,$473.64,"$1,961.96","$1,961.96",$481.33,"$2,749.00",$0.00,"$1,374.50","$2,177.21","$2,199.20",$0.00,$430.22,$0.00,$437.64,$0.00
27203957,EAP,HCPCS C1887,,Coil Detachment Handle,$739.00,$0.00,$739.00,$401.28,$527.42,$0.00,$127.33,$527.42,$527.42,$129.39,$739.00,$0.00,$369.50,$585.29,$591.20,$0.00,$115.65,$0.00,$117.65,$0.00
27203958,EAP,HCPCS C1725,,Catheter Delivery System .038in Sims Curve 5fr .04,$329.00,$0.00,$329.00,$178.65,$234.81,$0.00,$56.69,$234.81,$234.81,$57.61,$329.00,$0.00,$164.50,$260.57,$263.20,$0.00,$51.49,$0.00,$52.38,$0.00
27203979,EAP,HCPCS C1725,,Catheter Baldilat 12mm 75cm 40mm High Pressure Lp,$500.00,$0.00,$500.00,$271.50,$356.85,$0.00,$86.15,$356.85,$356.85,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
27203980,EAP,HCPCS C1725,,Catheter Baldilat 10mm 75cm 40mm High Pressure Lp,$500.00,$0.00,$500.00,$271.50,$356.85,$0.00,$86.15,$356.85,$356.85,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
27203999,EAP,Custom 27203999,,Turnpike Catheter Lp 150cm,"$1,488.00",$0.00,"$1,488.00",$0.00,"$1,061.99",$0.00,$0.00,"$1,061.99","$1,061.99",$0.00,"$1,488.00",$0.00,$744.00,"$1,178.50","$1,190.40",$0.00,$0.00,$0.00,$0.00,$0.00
27204010,EAP,Custom 27204010,,Camino Icp Catheter With Licox Bolt Fitting,"$2,352.00",$0.00,"$2,352.00",$0.00,"$1,678.62",$0.00,$0.00,"$1,678.62","$1,678.62",$0.00,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$0.00,$0.00,$0.00,$0.00
27204011,EAP,Custom 27204011,,Brain Tissue Monitoring Kit,"$3,646.00",$0.00,"$3,646.00",$0.00,"$2,602.15",$0.00,$0.00,"$2,602.15","$2,602.15",$0.00,"$3,646.00",$0.00,"$1,823.00","$2,887.63","$2,916.80",$0.00,$0.00,$0.00,$0.00,$0.00
27204012,EAP,Custom 27204012,,Tube Blakemore Adult 20 Fr,$975.00,$0.00,$975.00,$0.00,$695.86,$0.00,$0.00,$695.86,$695.86,$0.00,$975.00,$0.00,$487.50,$772.20,$780.00,$0.00,$0.00,$0.00,$0.00,$0.00
27204013,EAP,Custom 27204013,,"Retriever, Clot,trevo Pro 4 Kit, W Guidewire Tip","$15,192.00",$0.00,"$15,192.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$15,192.00",$0.00,"$7,596.00","$12,032.06","$12,153.60",$0.00,$0.00,$0.00,$0.00,$0.00
27204014,EAP,HCPCS C1886,,S-1304-cps-7-25-ls-bd Safire Blu,"$4,717.00",$0.00,"$4,717.00","$2,561.33","$3,366.52",$0.00,$812.72,"$3,366.52","$3,366.52",$825.91,"$4,717.00",$0.00,"$2,358.50","$3,735.86","$3,773.60",$0.00,$738.21,$0.00,$750.95,$0.00
27204015,EAP,HCPCS C1886,,S-1304-cps-7-25-ms-bd Safire Blu,"$4,717.00",$0.00,"$4,717.00","$2,561.33","$3,366.52",$0.00,$812.72,"$3,366.52","$3,366.52",$825.91,"$4,717.00",$0.00,"$2,358.50","$3,735.86","$3,773.60",$0.00,$738.21,$0.00,$750.95,$0.00
27204016,EAP,HCPCS C1886,,Medium Sweep Therapy Cool Path Bi-directional,"$4,717.00",$0.00,"$4,717.00","$2,561.33","$3,366.52",$0.00,$812.72,"$3,366.52","$3,366.52",$825.91,"$4,717.00",$0.00,"$2,358.50","$3,735.86","$3,773.60",$0.00,$738.21,$0.00,$750.95,$0.00
27204017,EAP,HCPCS C1886,,Large Sweep     Therapy Cool Path Bi-directional,"$4,717.00",$0.00,"$4,717.00","$2,561.33","$3,366.52",$0.00,$812.72,"$3,366.52","$3,366.52",$825.91,"$4,717.00",$0.00,"$2,358.50","$3,735.86","$3,773.60",$0.00,$738.21,$0.00,$750.95,$0.00
27204020,EAP,HCPCS C1733,,Safire Tx Catheter 8mm Large Curl,"$3,388.00",$0.00,"$3,388.00","$1,839.68","$2,418.02",$0.00,$583.74,"$2,418.02","$2,418.02",$593.21,"$3,388.00",$0.00,"$1,694.00","$2,683.30","$2,710.40",$0.00,$530.22,$0.00,$539.37,$0.00
27204021,EAP,HCPCS C1733,,Safire Cath 7f 4mm Lgcrl (us),"$2,138.00",$0.00,"$2,138.00","$1,160.93","$1,525.89",$0.00,$368.37,"$1,525.89","$1,525.89",$374.35,"$2,138.00",$0.00,"$1,069.00","$1,693.30","$1,710.40",$0.00,$334.60,$0.00,$340.37,$0.00
27204022,EAP,HCPCS C1733,,Safire Tx Catheter 8mm Xlarge Curl,"$3,227.00",$0.00,"$3,227.00","$1,752.26","$2,303.11",$0.00,$556.00,"$2,303.11","$2,303.11",$565.02,"$3,227.00",$0.00,"$1,613.50","$2,555.78","$2,581.60",$0.00,$505.03,$0.00,$513.74,$0.00
27204023,EAP,HCPCS C1733,,Safire Cath 7f 5mm Lg Swp (us),"$2,062.00",$0.00,"$2,062.00","$1,119.67","$1,471.65",$0.00,$355.27,"$1,471.65","$1,471.65",$361.04,"$2,062.00",$0.00,"$1,031.00","$1,633.10","$1,649.60",$0.00,$322.70,$0.00,$328.27,$0.00
27204024,EAP,HCPCS C1733,,Safire Cath 7f 5mm Lg Crl (us),"$2,165.00",$0.00,"$2,165.00","$1,175.60","$1,545.16",$0.00,$373.02,"$1,545.16","$1,545.16",$379.07,"$2,165.00",$0.00,"$1,082.50","$1,714.68","$1,732.00",$0.00,$338.82,$0.00,$344.67,$0.00
27204025,EAP,HCPCS C1733,,Safire Cath 7f 4mm Mdcrl (us),"$2,036.00",$0.00,"$2,036.00","$1,105.55","$1,453.09",$0.00,$350.79,"$1,453.09","$1,453.09",$356.49,"$2,036.00",$0.00,"$1,018.00","$1,612.51","$1,628.80",$0.00,$318.63,$0.00,$324.13,$0.00
27204026,EAP,HCPCS C1733,,Safire Cath 7f 4mm Sm Crl (us),"$2,036.00",$0.00,"$2,036.00","$1,105.55","$1,453.09",$0.00,$350.79,"$1,453.09","$1,453.09",$356.49,"$2,036.00",$0.00,"$1,018.00","$1,612.51","$1,628.80",$0.00,$318.63,$0.00,$324.13,$0.00
27204041,EAP,HCPCS C1893,,"Agilis Nxt 8.5f Steer Sm Crl,g2","$2,914.00",$0.00,"$2,914.00","$1,582.30","$2,079.72",$0.00,$502.07,"$2,079.72","$2,079.72",$510.22,"$2,914.00",$0.00,"$1,457.00","$2,307.89","$2,331.20",$0.00,$456.04,$0.00,$463.91,$0.00
27204042,EAP,HCPCS C1893,,"Trns Intro 8.5f 63cm Sl1 032gw,g2",$497.00,$0.00,$497.00,$269.87,$354.71,$0.00,$85.63,$354.71,$354.71,$87.02,$497.00,$0.00,$248.50,$393.62,$397.60,$0.00,$77.78,$0.00,$79.12,$0.00
27204043,EAP,HCPCS C1893,,"Trns Intro 8f 62 Cm Sl1 Tm,g2",$397.00,$0.00,$397.00,$215.57,$283.34,$0.00,$68.40,$283.34,$283.34,$69.51,$397.00,$0.00,$198.50,$314.42,$317.60,$0.00,$62.13,$0.00,$63.20,$0.00
27204044,EAP,HCPCS C1893,,"Trns Intro 8f 62cm Sl2 Tm,g2",$397.00,$0.00,$397.00,$215.57,$283.34,$0.00,$68.40,$283.34,$283.34,$69.51,$397.00,$0.00,$198.50,$314.42,$317.60,$0.00,$62.13,$0.00,$63.20,$0.00
27204045,EAP,HCPCS C1766,,"Trns Intro 8f 63cm Sl1 032gw,g2",$497.00,$0.00,$497.00,$269.87,$354.71,$0.00,$85.63,$354.71,$354.71,$87.02,$497.00,$0.00,$248.50,$393.62,$397.60,$0.00,$77.78,$0.00,$79.12,$0.00
27204046,EAP,HCPCS C1894,,C-lock Hemo 8f 12cm 038gw-g2,$59.00,$0.00,$59.00,$32.04,$42.11,$0.00,$10.17,$42.11,$42.11,$10.33,$59.00,$0.00,$29.50,$46.73,$47.20,$0.00,$9.23,$0.00,$9.39,$0.00
27204047,EAP,HCPCS C1894,,C-lock Hemo 7f 12cm 038gw-g2,$56.00,$0.00,$56.00,$30.41,$39.97,$0.00,$9.65,$39.97,$39.97,$9.81,$56.00,$0.00,$28.00,$44.35,$44.80,$0.00,$8.76,$0.00,$8.92,$0.00
27204048,EAP,HCPCS C1894,,C-lock Hemo 6f 12cm 038gw-g2,$56.00,$0.00,$56.00,$30.41,$39.97,$0.00,$9.65,$39.97,$39.97,$9.81,$56.00,$0.00,$28.00,$44.35,$44.80,$0.00,$8.76,$0.00,$8.92,$0.00
27204049,EAP,HCPCS C1894,,"Duo Hemo 8f 12cm 038gw,g2",$91.00,$0.00,$91.00,$49.41,$64.95,$0.00,$15.68,$64.95,$64.95,$15.93,$91.00,$0.00,$45.50,$72.07,$72.80,$0.00,$14.24,$0.00,$14.49,$0.00
27204050,EAP,HCPCS C1893,,"Hemo Intro 8f 60cm Sept Gw,g2",$482.00,$0.00,$482.00,$261.73,$344.00,$0.00,$83.05,$344.00,$344.00,$84.39,$482.00,$0.00,$241.00,$381.74,$385.60,$0.00,$75.43,$0.00,$76.73,$0.00
27204051,EAP,HCPCS C1893,,"Hemo Intro 8f 60cm Sr0 Tm,g2",$397.00,$0.00,$397.00,$215.57,$283.34,$0.00,$68.40,$283.34,$283.34,$69.51,$397.00,$0.00,$198.50,$314.42,$317.60,$0.00,$62.13,$0.00,$63.20,$0.00
27204052,EAP,HCPCS C1893,,"Hemo Intro 8f 60cm Ramp 038gw,g2",$497.00,$0.00,$497.00,$269.87,$354.71,$0.00,$85.63,$354.71,$354.71,$87.02,$497.00,$0.00,$248.50,$393.62,$397.60,$0.00,$77.78,$0.00,$79.12,$0.00
27204053,EAP,HCPCS C1893,,"Hemo Intro 8.5f 60cm Sept Gw,g2",$482.00,$0.00,$482.00,$261.73,$344.00,$0.00,$83.05,$344.00,$344.00,$84.39,$482.00,$0.00,$241.00,$381.74,$385.60,$0.00,$75.43,$0.00,$76.73,$0.00
27204054,EAP,HCPCS C1893,,"Hemo Intro 8f 60cm Sr4 Tm,g2",$397.00,$0.00,$397.00,$215.57,$283.34,$0.00,$68.40,$283.34,$283.34,$69.51,$397.00,$0.00,$198.50,$314.42,$317.60,$0.00,$62.13,$0.00,$63.20,$0.00
27204055,EAP,HCPCS C1893,,"Hemo Intro 8.5f 63cm Sr0 038gw,g2",$508.00,$0.00,$508.00,$275.84,$362.56,$0.00,$87.53,$362.56,$362.56,$88.95,$508.00,$0.00,$254.00,$402.34,$406.40,$0.00,$79.50,$0.00,$80.87,$0.00
27204056,EAP,HCPCS C1893,,"Hemo Intro 8f 60cm Safl 038gw,g2",$508.00,$0.00,$508.00,$275.84,$362.56,$0.00,$87.53,$362.56,$362.56,$88.95,$508.00,$0.00,$254.00,$402.34,$406.40,$0.00,$79.50,$0.00,$80.87,$0.00
27204057,EAP,HCPCS C1893,,"Hemo Intro 8.5f 63cm Sr2 038gw,g2",$508.00,$0.00,$508.00,$275.84,$362.56,$0.00,$87.53,$362.56,$362.56,$88.95,$508.00,$0.00,$254.00,$402.34,$406.40,$0.00,$79.50,$0.00,$80.87,$0.00
27204058,EAP,HCPCS C1893,,"Hemo Intro 8.5f 60cm Csta Gw,g2",$508.00,$0.00,$508.00,$275.84,$362.56,$0.00,$87.53,$362.56,$362.56,$88.95,$508.00,$0.00,$254.00,$402.34,$406.40,$0.00,$79.50,$0.00,$80.87,$0.00
27204059,EAP,HCPCS C1893,,"Hemo Intro 8f 60cm Sr2 Tm,g2",$397.00,$0.00,$397.00,$215.57,$283.34,$0.00,$68.40,$283.34,$283.34,$69.51,$397.00,$0.00,$198.50,$314.42,$317.60,$0.00,$62.13,$0.00,$63.20,$0.00
27204060,EAP,HCPCS C1766,,Epicardial Catheter System,"$3,278.00",$0.00,"$3,278.00","$1,779.95","$2,339.51",$0.00,$564.78,"$2,339.51","$2,339.51",$573.95,"$3,278.00",$0.00,"$1,639.00","$2,596.18","$2,622.40",$0.00,$513.01,$0.00,$521.86,$0.00
27204061,EAP,HCPCS C1730,,"Ep 5f Quad 5mm 120cm Crd,g2",$795.00,$0.00,$795.00,$431.69,$567.39,$0.00,$136.97,$567.39,$567.39,$139.20,$795.00,$0.00,$397.50,$629.64,$636.00,$0.00,$124.42,$0.00,$126.56,$0.00
27204062,EAP,HCPCS C1730,,"Ep 6f Dec 2/8mm 65cm Csl,g2","$1,087.00",$0.00,"$1,087.00",$590.24,$775.79,$0.00,$187.28,$775.79,$775.79,$190.33,"$1,087.00",$0.00,$543.50,$860.90,$869.60,$0.00,$170.12,$0.00,$173.05,$0.00
27204063,EAP,HCPCS C1730,,"Ep 5f Quad 5mm 120cm Jsn,g2",$835.00,$0.00,$835.00,$453.41,$595.94,$0.00,$143.87,$595.94,$595.94,$146.20,$835.00,$0.00,$417.50,$661.32,$668.00,$0.00,$130.68,$0.00,$132.93,$0.00
27204064,EAP,HCPCS C1730,,"Eps 4f Quad 5mm Crd,g2","$1,031.00",$0.00,"$1,031.00",$559.83,$735.82,$0.00,$177.64,$735.82,$735.82,$180.52,"$1,031.00",$0.00,$515.50,$816.55,$824.80,$0.00,$161.35,$0.00,$164.14,$0.00
27204065,EAP,HCPCS C1730,,"Eps 4f Hex 5mm Crd-2,g2","$1,093.00",$0.00,"$1,093.00",$593.50,$780.07,$0.00,$188.32,$780.07,$780.07,$191.38,"$1,093.00",$0.00,$546.50,$865.66,$874.40,$0.00,$171.05,$0.00,$174.01,$0.00
27204066,EAP,HCPCS C1730,,"Eps 5f Hex Uni 120cm Jsn X,g2",$931.00,$0.00,$931.00,$505.53,$664.45,$0.00,$160.41,$664.45,$664.45,$163.01,$931.00,$0.00,$465.50,$737.35,$744.80,$0.00,$145.70,$0.00,$148.22,$0.00
27204067,EAP,HCPCS C1730,,"Eps 4f Quad 5mm Jsn,g2","$1,031.00",$0.00,"$1,031.00",$559.83,$735.82,$0.00,$177.64,$735.82,$735.82,$180.52,"$1,031.00",$0.00,$515.50,$816.55,$824.80,$0.00,$161.35,$0.00,$164.14,$0.00
27204068,EAP,HCPCS C1730,,"Eps 4f Quad 2mm Jsn,g2","$1,031.00",$0.00,"$1,031.00",$559.83,$735.82,$0.00,$177.64,$735.82,$735.82,$180.52,"$1,031.00",$0.00,$515.50,$816.55,$824.80,$0.00,$161.35,$0.00,$164.14,$0.00
27204069,EAP,HCPCS C1730,,"Ep 6f Dec 5/5mm 120cm Csl,g2","$1,087.00",$0.00,"$1,087.00",$590.24,$775.79,$0.00,$187.28,$775.79,$775.79,$190.33,"$1,087.00",$0.00,$543.50,$860.90,$869.60,$0.00,$170.12,$0.00,$173.05,$0.00
27204070,EAP,HCPCS C1730,,"Eps 5f Quad 5mm Crd Superior,g2",$844.00,$0.00,$844.00,$458.29,$602.36,$0.00,$145.42,$602.36,$602.36,$147.78,$844.00,$0.00,$422.00,$668.45,$675.20,$0.00,$132.09,$0.00,$134.36,$0.00
27204071,EAP,HCPCS C1730,,"Eps 6f Hex Uni 120cm Jsn X,g2",$931.00,$0.00,$931.00,$505.53,$664.45,$0.00,$160.41,$664.45,$664.45,$163.01,$931.00,$0.00,$465.50,$737.35,$744.80,$0.00,$145.70,$0.00,$148.22,$0.00
27204072,EAP,HCPCS C1730,,"Eps 5f Dec 2/8mm 120cm Csl X,g2","$1,119.00",$0.00,"$1,119.00",$607.62,$798.63,$0.00,$192.80,$798.63,$798.63,$195.93,"$1,119.00",$0.00,$559.50,$886.25,$895.20,$0.00,$175.12,$0.00,$178.14,$0.00
27204080,EAP,HCPCS C1731,,"Epl 7f Duo 2/10 2m 95 S-lgcrl,g2","$2,932.00",$0.00,"$2,932.00","$1,592.08","$2,092.57",$0.00,$505.17,"$2,092.57","$2,092.57",$513.37,"$2,932.00",$0.00,"$1,466.00","$2,322.14","$2,345.60",$0.00,$458.86,$0.00,$466.77,$0.00
27204081,EAP,Custom 27204081,,"Eps Ext Cable B/t/q Blu 150 Us,g2 Supreme Quad Cable",$225.00,$0.00,$225.00,$0.00,$160.58,$0.00,$0.00,$160.58,$160.58,$0.00,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$0.00,$0.00,$0.00,$0.00
27204082,EAP,HCPCS C1731,,"Epl 7f Duo Dec 2/2 115cm Med,g2 ""caterpillar""","$2,792.00",$0.00,"$2,792.00","$1,516.06","$1,992.65",$0.00,$481.05,"$1,992.65","$1,992.65",$488.86,"$2,792.00",$0.00,"$1,396.00","$2,211.26","$2,233.60",$0.00,$436.95,$0.00,$444.49,$0.00
27204083,EAP,HCPCS C1731,,Inquiry Afocusil Diagnostic Catheter 20 Pole With Double Loop,"$4,717.00",$0.00,"$4,717.00","$2,561.33","$3,366.52",$0.00,$812.72,"$3,366.52","$3,366.52",$825.91,"$4,717.00",$0.00,"$2,358.50","$3,735.86","$3,773.60",$0.00,$738.21,$0.00,$750.95,$0.00
27204084,EAP,HCPCS C1731,,Inquiry AFocus II EB Fixed Radius Loop Circular Mapping Catheter 20 POLE 20MM DIAMETER,"$2,979.00",$0.00,"$2,979.00","$1,617.60","$2,126.11",$0.00,$513.27,"$2,126.11","$2,126.11",$521.60,"$2,979.00",$0.00,"$1,489.50","$2,359.37","$2,383.20",$0.00,$466.21,$0.00,$474.26,$0.00
27204085,EAP,HCPCS C1730,,Inquiry AFocus II EB Fixed Radius Loop Circular Mapping Catheter 10 POLE 20MM DIAMETER,"$2,979.00",$0.00,"$2,979.00","$1,617.60","$2,126.11",$0.00,$513.27,"$2,126.11","$2,126.11",$521.60,"$2,979.00",$0.00,"$1,489.50","$2,359.37","$2,383.20",$0.00,$466.21,$0.00,$474.26,$0.00
27204086,EAP,HCPCS C1730,,Inquiry AFocus II EB Fixed Radius Loop Circular Mapping Catheter 10 POLE 15MM DIAMETER,"$2,979.00",$0.00,"$2,979.00","$1,617.60","$2,126.11",$0.00,$513.27,"$2,126.11","$2,126.11",$521.60,"$2,979.00",$0.00,"$1,489.50","$2,359.37","$2,383.20",$0.00,$466.21,$0.00,$474.26,$0.00
27204087,EAP,Custom 27204087,,Ensite Navx Surface Electrode Kit,"$2,948.00",$0.00,"$2,948.00",$0.00,"$2,103.99",$0.00,$0.00,"$2,103.99","$2,103.99",$0.00,"$2,948.00",$0.00,"$1,474.00","$2,334.82","$2,358.40",$0.00,$0.00,$0.00,$0.00,$0.00
27204088,EAP,Custom 27204088,,"Velocity, Assembly, Navx Patch, Ensite","$2,948.00",$0.00,"$2,948.00",$0.00,"$2,103.99",$0.00,$0.00,"$2,103.99","$2,103.99",$0.00,"$2,948.00",$0.00,"$1,474.00","$2,334.82","$2,358.40",$0.00,$0.00,$0.00,$0.00,$0.00
27204089,EAP,Custom 27204089,,EnSite Array Catheter - Domestic,"$10,553.00",$0.00,"$10,553.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$10,553.00",$0.00,"$5,276.50","$8,357.98","$8,442.40",$0.00,$0.00,$0.00,$0.00,$0.00
27204090,EAP,HCPCS C1888,,11403001 - KIT PROCEDURE NEVERTOUCLVET L45 CM,"$1,197.00",$0.00,"$1,197.00",$0.00,$854.30,$0.00,$0.00,$854.30,$854.30,$0.00,"$1,197.00",$0.00,$598.50,$948.02,$957.60,$0.00,$0.00,$0.00,$0.00,$0.00
27204091,EAP,HCPCS C1888,,11403002 - KIT PROCEDURE NEVERTOUC,"$1,197.00",$0.00,"$1,197.00",$0.00,$854.30,$0.00,$0.00,$854.30,$854.30,$0.00,"$1,197.00",$0.00,$598.50,$948.02,$957.60,$0.00,$0.00,$0.00,$0.00,$0.00
27204092,EAP,Custom 27204092,,Coil Detachment Handle,$739.00,$0.00,$739.00,$0.00,$527.42,$0.00,$0.00,$527.42,$527.42,$0.00,$739.00,$0.00,$369.50,$585.29,$591.20,$0.00,$0.00,$0.00,$0.00,$0.00
27204093,EAP,Custom 27204093,,Quatro Cath Kit,"$2,341.00",$0.00,"$2,341.00",$0.00,"$1,670.77",$0.00,$0.00,"$1,670.77","$1,670.77",$0.00,"$2,341.00",$0.00,"$1,170.50","$1,854.07","$1,872.80",$0.00,$0.00,$0.00,$0.00,$0.00
27204095,EAP,HCPCS C1887,,Orion 21 Microcatheter,"$2,172.00",$0.00,"$2,172.00","$1,179.40","$1,550.16",$0.00,$374.22,"$1,550.16","$1,550.16",$380.30,"$2,172.00",$0.00,"$1,086.00","$1,720.22","$1,737.60",$0.00,$339.92,$0.00,$345.78,$0.00
27204096,EAP,Custom 27204096,,Mini Attachable Catheter 5f,$591.00,$0.00,$591.00,$0.00,$421.80,$0.00,$0.00,$421.80,$421.80,$0.00,$591.00,$0.00,$295.50,$468.07,$472.80,$0.00,$0.00,$0.00,$0.00,$0.00
27204097,EAP,Custom 27204097,,Captivator Snare Large Oval Stiff,$16.00,$0.00,$16.00,$0.00,$11.42,$0.00,$0.00,$11.42,$11.42,$0.00,$16.00,$0.00,$8.00,$12.67,$12.80,$0.00,$0.00,$0.00,$0.00,$0.00
27204098,EAP,HCPCS C1726,,Cre Wg 8-10mm,$266.00,$0.00,$266.00,$144.44,$189.84,$0.00,$45.83,$189.84,$189.84,$46.57,$266.00,$0.00,$133.00,$210.67,$212.80,$0.00,$41.63,$0.00,$42.35,$0.00
27204099,EAP,HCPCS C1726,,Cre Wg 10-12mm,$266.00,$0.00,$266.00,$144.44,$189.84,$0.00,$45.83,$189.84,$189.84,$46.57,$266.00,$0.00,$133.00,$210.67,$212.80,$0.00,$41.63,$0.00,$42.35,$0.00
27204100,EAP,HCPCS C1726,,Cre Wg 12-15mm,$266.00,$0.00,$266.00,$144.44,$189.84,$0.00,$45.83,$189.84,$189.84,$46.57,$266.00,$0.00,$133.00,$210.67,$212.80,$0.00,$41.63,$0.00,$42.35,$0.00
27204101,EAP,HCPCS C1726,,Cre Wf 15-18mm,$266.00,$0.00,$266.00,$144.44,$189.84,$0.00,$45.83,$189.84,$189.84,$46.57,$266.00,$0.00,$133.00,$210.67,$212.80,$0.00,$41.63,$0.00,$42.35,$0.00
27204102,EAP,HCPCS C1769,,Dreamwire .035 260 Str Stnd,$230.00,$0.00,$230.00,$124.89,$164.15,$0.00,$39.63,$164.15,$164.15,$40.27,$230.00,$0.00,$115.00,$182.16,$184.00,$0.00,$36.00,$0.00,$36.62,$0.00
27204103,EAP,HCPCS C1769,,Glidewire .035 260 Str,$230.00,$0.00,$230.00,$124.89,$164.15,$0.00,$39.63,$164.15,$164.15,$40.27,$230.00,$0.00,$115.00,$182.16,$184.00,$0.00,$36.00,$0.00,$36.62,$0.00
27204105,EAP,Custom 27404105,,Extractor Rx 9-12 Mm,$189.00,$0.00,$189.00,$0.00,$134.89,$0.00,$0.00,$134.89,$134.89,$0.00,$189.00,$0.00,$94.50,$149.69,$151.20,$0.00,$0.00,$0.00,$0.00,$0.00
27204106,EAP,Custom 27204106,,Extractor Rx 12-15 Mm,$189.00,$0.00,$189.00,$0.00,$134.89,$0.00,$0.00,$134.89,$134.89,$0.00,$189.00,$0.00,$94.50,$149.69,$151.20,$0.00,$0.00,$0.00,$0.00,$0.00
27204107,EAP,Custom 272040107,,Cytology Brush,$134.00,$0.00,$134.00,$0.00,$95.64,$0.00,$0.00,$95.64,$95.64,$0.00,$134.00,$0.00,$67.00,$106.13,$107.20,$0.00,$0.00,$0.00,$0.00,$0.00
27204108,EAP,Custom 27204108,,Roth Net,$105.00,$0.00,$105.00,$0.00,$74.94,$0.00,$0.00,$74.94,$74.94,$0.00,$105.00,$0.00,$52.50,$83.16,$84.00,$0.00,$0.00,$0.00,$0.00,$0.00
27204109,EAP,Custom 27204109,,Fiapc Probe,$245.00,$0.00,$245.00,$0.00,$174.86,$0.00,$0.00,$174.86,$174.86,$0.00,$245.00,$0.00,$122.50,$194.04,$196.00,$0.00,$0.00,$0.00,$0.00,$0.00
27204110,EAP,HCPCS C1757,,Solitaire Fr 4x15,"$11,643.00",$0.00,"$11,643.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$11,643.00",$0.00,"$5,821.50","$9,221.26","$9,314.40",$0.00,$0.00,$0.00,$0.00,$0.00
27204111,EAP,HCPCS C1757,,Solitaire Fr 4x20,"$12,225.00",$0.00,"$12,225.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$12,225.00",$0.00,"$6,112.50","$9,682.20","$9,780.00",$0.00,$0.00,$0.00,$0.00,$0.00
27204112,EAP,HCPCS C1757,,Solitaire Fr 6x20,"$11,643.00",$0.00,"$11,643.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$11,643.00",$0.00,"$5,821.50","$9,221.26","$9,314.40",$0.00,$0.00,$0.00,$0.00,$0.00
27204113,EAP,HCPCS C1757,,Solitaire Fr 6x30,"$12,225.00",$0.00,"$12,225.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$12,225.00",$0.00,"$6,112.50","$9,682.20","$9,780.00",$0.00,$0.00,$0.00,$0.00,$0.00
27204114,EAP,HCPCS C1887,,NAVIEN INTRACRANIAL CATHETER 6FX 1,$680.00,$0.00,$680.00,$369.24,$485.32,$0.00,$117.16,$485.32,$485.32,$119.06,$680.00,$0.00,$340.00,$538.56,$544.00,$0.00,$106.42,$0.00,$108.26,$0.00
27204115,EAP,HCPCS C1887,,Navien Intracranial Catheter 6fx 115cm,$714.00,$0.00,$714.00,$387.70,$509.58,$0.00,$123.02,$509.58,$509.58,$125.02,$714.00,$0.00,$357.00,$565.49,$571.20,$0.00,$111.74,$0.00,$113.67,$0.00
27204116,EAP,HCPCS C1887,,Navien Intracranial Catheter 5fx 115cm,"$1,176.00",$0.00,"$1,176.00",$638.57,$839.31,$0.00,$202.62,$839.31,$839.31,$205.91,"$1,176.00",$0.00,$588.00,$931.39,$940.80,$0.00,$184.04,$0.00,$187.22,$0.00
27204117,EAP,HCPCS C1887,,Navien Intracranial Catheter 5fx 125cm,"$1,235.00",$0.00,"$1,235.00",$670.61,$881.42,$0.00,$212.78,$881.42,$881.42,$216.24,"$1,235.00",$0.00,$617.50,$978.12,$988.00,$0.00,$193.28,$0.00,$196.61,$0.00
27204118,EAP,HCPCS C1887,,Navien Intracranial Catheter 5fx 130cm,"$1,176.00",$0.00,"$1,176.00",$638.57,$839.31,$0.00,$202.62,$839.31,$839.31,$205.91,"$1,176.00",$0.00,$588.00,$931.39,$940.80,$0.00,$184.04,$0.00,$187.22,$0.00
27204119,EAP,HCPCS C2629,,Pinnacle Rdc Sheath 6fr,"$2,374.00",$0.00,"$2,374.00","$1,289.08","$1,694.32",$0.00,$409.03,"$1,694.32","$1,694.32",$415.67,"$2,374.00",$0.00,"$1,187.00","$1,880.21","$1,899.20",$0.00,$371.53,$0.00,$377.94,$0.00
27204120,EAP,Custom 27204120,,Tc Catheter,$151.00,$0.00,$151.00,$0.00,$107.77,$0.00,$0.00,$107.77,$107.77,$0.00,$151.00,$0.00,$75.50,$119.59,$120.80,$0.00,$0.00,$0.00,$0.00,$0.00
27204121,EAP,HCPCS C1887,,Van Aman Cathter,$56.00,$0.00,$56.00,$30.41,$39.97,$0.00,$9.65,$39.97,$39.97,$9.81,$56.00,$0.00,$28.00,$44.35,$44.80,$0.00,$8.76,$0.00,$8.92,$0.00
27204122,EAP,HCPCS C1894,,Neuron Max 088 6f Sheath,"$1,226.00",$0.00,"$1,226.00",$665.72,$875.00,$0.00,$211.23,$875.00,$875.00,$214.66,"$1,226.00",$0.00,$613.00,$970.99,$980.80,$0.00,$191.87,$0.00,$195.18,$0.00
27204124,EAP,HCPCS C1788,,Dignity Port 6.6f,$500.00,$0.00,$500.00,$271.50,$356.85,$0.00,$86.15,$356.85,$356.85,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
27204125,EAP,Custom 27204125,,Long Rodch Left Gastric Catheter 5fr 65cm,$56.00,$0.00,$56.00,$0.00,$39.97,$0.00,$0.00,$39.97,$39.97,$0.00,$56.00,$0.00,$28.00,$44.35,$44.80,$0.00,$0.00,$0.00,$0.00,$0.00
27204126,EAP,Custom 27204126,,Long Rodch Left Gastric Catheter 5fr 80cm,$56.00,$0.00,$56.00,$0.00,$39.97,$0.00,$0.00,$39.97,$39.97,$0.00,$56.00,$0.00,$28.00,$44.35,$44.80,$0.00,$0.00,$0.00,$0.00,$0.00
27204127,EAP,HCPCS C1769,,Avigo Guidewire,"$1,168.00",$0.00,"$1,168.00",$634.22,$833.60,$0.00,$201.24,$833.60,$833.60,$204.51,"$1,168.00",$0.00,$584.00,$925.06,$934.40,$0.00,$182.79,$0.00,$185.95,$0.00
27204128,EAP,HCPCS C1887,,Exceisior Xt-27 Microcatheter 135cm/6cm Straight,"$2,807.00",$0.00,"$2,807.00","$1,524.20","$2,003.36",$0.00,$483.63,"$2,003.36","$2,003.36",$491.48,"$2,807.00",$0.00,"$1,403.50","$2,223.14","$2,245.60",$0.00,$439.30,$0.00,$446.87,$0.00
27204129,EAP,HCPCS C1887,,Exceisior Xt-27 Microcatheter 135cm/6cm Pre-shaped,"$2,807.00",$0.00,"$2,807.00","$1,524.20","$2,003.36",$0.00,$483.63,"$2,003.36","$2,003.36",$491.48,"$2,807.00",$0.00,"$1,403.50","$2,223.14","$2,245.60",$0.00,$439.30,$0.00,$446.87,$0.00
27204130,EAP,HCPCS C1887,,Exceisior Xt-27 Microcatheter 150 Cm/80cm Straight,"$2,807.00",$0.00,"$2,807.00","$1,524.20","$2,003.36",$0.00,$483.63,"$2,003.36","$2,003.36",$491.48,"$2,807.00",$0.00,"$1,403.50","$2,223.14","$2,245.60",$0.00,$439.30,$0.00,$446.87,$0.00
27204131,EAP,HCPCS C1887,,Exceisior Xt-27 Microcatheter 150cm/18cm Straight,"$2,807.00",$0.00,"$2,807.00","$1,524.20","$2,003.36",$0.00,$483.63,"$2,003.36","$2,003.36",$491.48,"$2,807.00",$0.00,"$1,403.50","$2,223.14","$2,245.60",$0.00,$439.30,$0.00,$446.87,$0.00
27204132,EAP,HCPCS C1887,,Exceisior Xt-27 Microcatheter 135cm/6cm Pre-shaped,"$2,807.00",$0.00,"$2,807.00","$1,524.20","$2,003.36",$0.00,$483.63,"$2,003.36","$2,003.36",$491.48,"$2,807.00",$0.00,"$1,403.50","$2,223.14","$2,245.60",$0.00,$439.30,$0.00,$446.87,$0.00
27204140,EAP,Custom 27204140,,Kit Catheter Presep Oligon Heparin L16 Cm Od8.5 Fr Centl,"$1,330.00",$0.00,"$1,330.00",$0.00,$949.22,$0.00,$0.00,$949.22,$949.22,$0.00,"$1,330.00",$0.00,$665.00,"$1,053.36","$1,064.00",$0.00,$0.00,$0.00,$0.00,$0.00
27204141,EAP,Custom 27204141,,Kit Catheter Presep Oligon L20 Cm Od8.5 Fr Arterial 3 Ln,"$1,330.00",$0.00,"$1,330.00",$0.00,$949.22,$0.00,$0.00,$949.22,$949.22,$0.00,"$1,330.00",$0.00,$665.00,"$1,053.36","$1,064.00",$0.00,$0.00,$0.00,$0.00,$0.00
27204142,EAP,HCPCS C1894,,Introd Shth 8fr 150cm 12cm 2 Distal Gwire Hmst Vlv Sdprt,$56.00,$0.00,$56.00,$30.41,$39.97,$0.00,$9.65,$39.97,$39.97,$9.81,$56.00,$0.00,$28.00,$44.35,$44.80,$0.00,$8.76,$0.00,$8.92,$0.00
27204143,EAP,HCPCS C1894,,Introd Shth 9fr 150cm 12cm 2 Distal Gwire Hmst Vlv Sdprt,$63.00,$0.00,$63.00,$34.21,$44.96,$0.00,$10.85,$44.96,$44.96,$11.03,$63.00,$0.00,$31.50,$49.90,$50.40,$0.00,$9.86,$0.00,$10.03,$0.00
27204144,EAP,HCPCS C1894,,Introd Cath 12cm 10fr .038in Trnspt Fstcth Hmsts,$70.00,$0.00,$70.00,$38.01,$49.96,$0.00,$12.06,$49.96,$49.96,$12.26,$70.00,$0.00,$35.00,$55.44,$56.00,$0.00,$10.96,$0.00,$11.14,$0.00
27204145,EAP,HCPCS C1893,,Introd Shth 8.5fr 180cm 63cm Superstiff Guiewire Guid Braid,$532.00,$0.00,$532.00,$288.88,$379.69,$0.00,$91.66,$379.69,$379.69,$93.15,$532.00,$0.00,$266.00,$421.34,$425.60,$0.00,$83.26,$0.00,$84.69,$0.00
27204146,EAP,Custom 27204146,,Needle 71cm 18ga Curve Prc Trnspt Brk-1 Adlt,$576.00,$0.00,$576.00,$0.00,$411.09,$0.00,$0.00,$411.09,$411.09,$0.00,$576.00,$0.00,$288.00,$456.19,$460.80,$0.00,$0.00,$0.00,$0.00,$0.00
27204147,EAP,HCPCS C1766,,Introd Shth 8.5fr 91cm 71cm Dual Reach Bidir Erg Hndl Atrm,"$2,642.00",$0.00,"$2,642.00","$1,434.61","$1,885.60",$0.00,$455.20,"$1,885.60","$1,885.60",$462.59,"$2,642.00",$0.00,"$1,321.00","$2,092.46","$2,113.60",$0.00,$413.47,$0.00,$420.61,$0.00
27204148,EAP,HCPCS C1766,,Introd Shth 8.5fr 71cm 50mm Strbl Erg Hndl Atrm Tip Intgr,"$2,642.00",$0.00,"$2,642.00","$1,434.61","$1,885.60",$0.00,$455.20,"$1,885.60","$1,885.60",$462.59,"$2,642.00",$0.00,"$1,321.00","$2,092.46","$2,113.60",$0.00,$413.47,$0.00,$420.61,$0.00
27204149,EAP,HCPCS C1730,,Cable Cath Blue 150cm Rspn Ep Bipol Trplr Qdpl,$213.00,$0.00,$213.00,$115.66,$152.02,$0.00,$36.70,$152.02,$152.02,$37.29,$213.00,$0.00,$106.50,$168.70,$170.40,$0.00,$33.33,$0.00,$33.91,$0.00
27204150,EAP,Custom 27204150,,Cable Cath Blk 150cm Rspn Ep Hexpl,$225.00,$0.00,$225.00,$0.00,$160.58,$0.00,$0.00,$160.58,$160.58,$0.00,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$0.00,$0.00,$0.00,$0.00
27204151,EAP,Custom 27204151,,Cable Cath Blk 150cm Rspn Ep Hexpl Octpl Dcapl,$266.00,$0.00,$266.00,$0.00,$189.84,$0.00,$0.00,$189.84,$189.84,$0.00,$266.00,$0.00,$133.00,$210.67,$212.80,$0.00,$0.00,$0.00,$0.00,$0.00
27204152,EAP,Custom 27204152,,Cable Cath Red 150cm Rspn Ep Hexpl Octpl Dcapl Extn,$266.00,$0.00,$266.00,$0.00,$189.84,$0.00,$0.00,$189.84,$189.84,$0.00,$266.00,$0.00,$133.00,$210.67,$212.80,$0.00,$0.00,$0.00,$0.00,$0.00
27204153,EAP,HCPCS C1730,,Cath Ep 2-5-2mm Spc 1mm 6fr 115cm 4mm Qdpl Med Swp Strbl,"$1,490.00",$0.00,"$1,490.00",$809.07,"$1,063.41",$0.00,$256.72,"$1,063.41","$1,063.41",$260.89,"$1,490.00",$0.00,$745.00,"$1,180.08","$1,192.00",$0.00,$233.19,$0.00,$237.21,$0.00
27204154,EAP,HCPCS C1730,,Cath Ep 5mm Spc 1mm 5fr 115cm 2mm Hexpl Med Swp Strbl Lvwr,"$1,608.00",$0.00,"$1,608.00",$873.14,"$1,147.63",$0.00,$277.05,"$1,147.63","$1,147.63",$281.55,"$1,608.00",$0.00,$804.00,"$1,273.54","$1,286.40",$0.00,$251.65,$0.00,$255.99,$0.00
27204155,EAP,HCPCS C1730,,Cath Ep 4mm Spc 7fr 20mm 110cm 20 Eltrd Mp Inq Afocus 2,"$4,493.00",$0.00,"$4,493.00","$2,439.70","$3,206.65",$0.00,$774.12,"$3,206.65","$3,206.65",$786.69,"$4,493.00",$0.00,"$2,246.50","$3,558.46","$3,594.40",$0.00,$703.15,$0.00,$715.29,$0.00
27204156,EAP,HCPCS C1731,,Cath Ep 99cm 7fr 15-25mm Reflexion Sprl 1-4-1mm Spc 1mm Smtr,"$4,433.00",$0.00,"$4,433.00","$2,407.12","$3,163.83",$0.00,$763.78,"$3,163.83","$3,163.83",$776.18,"$4,433.00",$0.00,"$2,216.50","$3,510.94","$3,546.40",$0.00,$693.76,$0.00,$705.73,$0.00
27204157,EAP,Custom 27204157,,Cable Cath Safire Ep Gntr Intfc,$449.00,$0.00,$449.00,$0.00,$320.45,$0.00,$0.00,$320.45,$320.45,$0.00,$449.00,$0.00,$224.50,$355.61,$359.20,$0.00,$0.00,$0.00,$0.00,$0.00
27204158,EAP,Custom 27204158,,Cable Cath Safire Ep Extn,$461.00,$0.00,$461.00,$0.00,$329.02,$0.00,$0.00,$329.02,$329.02,$0.00,$461.00,$0.00,$230.50,$365.11,$368.80,$0.00,$0.00,$0.00,$0.00,$0.00
27204159,EAP,HCPCS C2630,,Cath Ablt 110cm 7fr 4mm 2-5-2mm Spc 2mm Med Curl Thrp Cl Pth,"$4,493.00",$0.00,"$4,493.00",$0.00,"$3,206.65",$0.00,$0.00,"$3,206.65","$3,206.65",$0.00,"$4,493.00",$0.00,"$2,246.50","$3,558.46","$3,594.40",$0.00,$0.00,$0.00,$0.00,$0.00
27204160,EAP,HCPCS C2630,,Cath Ablt 110cm 7fr 4mm 2-5-2mm Spc 2mm Lg Curl Thrp Cl Pth,"$4,493.00",$0.00,"$4,493.00",$0.00,"$3,206.65",$0.00,$0.00,"$3,206.65","$3,206.65",$0.00,"$4,493.00",$0.00,"$2,246.50","$3,558.46","$3,594.40",$0.00,$0.00,$0.00,$0.00,$0.00
27204161,EAP,HCPCS C1759,,Cath Us 120d Intrcrd Stab 1 Hnd Cntrl M Mode Pls Wv Dplr Ice,"$6,242.00",$0.00,"$6,242.00",$0.00,"$4,454.92",$0.00,$0.00,"$4,454.92","$4,454.92",$0.00,"$6,242.00",$0.00,"$3,121.00","$4,943.66","$4,993.60",$0.00,$0.00,$0.00,$0.00,$0.00
27204162,EAP,HCPCS C1730,,Cath Ep 2-5-2mm Spc Csl Curve 5fr 65cm Mp Dcapl Fix Curve,"$1,183.00",$0.00,"$1,183.00",$642.37,$844.31,$0.00,$203.82,$844.31,$844.31,$207.13,"$1,183.00",$0.00,$591.50,$936.94,$946.40,$0.00,$185.14,$0.00,$188.33,$0.00
27204164,EAP,HCPCS C1887,,Catheter Reperfusion,"$6,176.00",$0.00,"$6,176.00","$3,353.57","$4,407.81",$0.00,"$1,064.09","$4,407.81","$4,407.81","$1,081.37","$6,176.00",$0.00,"$3,088.00","$4,891.39","$4,940.80",$0.00,$966.54,$0.00,$983.22,$0.00
27204168,EAP,HCPCS C1894,,Flexor Ansel Guiding Sheath/ Str,$248.00,$0.00,$248.00,$134.66,$177.00,$0.00,$42.73,$177.00,$177.00,$43.42,$248.00,$0.00,$124.00,$196.42,$198.40,$0.00,$38.81,$0.00,$39.48,$0.00
27204169,EAP,HCPCS C1894,,Flexor Ansel Guiding Sheath/ Mp,$248.00,$0.00,$248.00,$134.66,$177.00,$0.00,$42.73,$177.00,$177.00,$43.42,$248.00,$0.00,$124.00,$196.42,$198.40,$0.00,$38.81,$0.00,$39.48,$0.00
27204170,EAP,HCPCS C1894,,Introducer Shth 10 Fr/ 40cm,$216.00,$0.00,$216.00,$117.29,$154.16,$0.00,$37.22,$154.16,$154.16,$37.82,$216.00,$0.00,$108.00,$171.07,$172.80,$0.00,$33.80,$0.00,$34.39,$0.00
27204171,EAP,HCPCS C1887,,Catheter Angio Sim 3 Crv 5fr,$123.00,$0.00,$123.00,$66.79,$87.79,$0.00,$21.19,$87.79,$87.79,$21.54,$123.00,$0.00,$61.50,$97.42,$98.40,$0.00,$19.25,$0.00,$19.58,$0.00
27204210,EAP,HCPCS C1769,,Guidewire Vascular X-celer Hydro L300 Cm L10 Cm Od.01,$975.00,$0.00,$975.00,$529.43,$695.86,$0.00,$167.99,$695.86,$695.86,$170.71,$975.00,$0.00,$487.50,$772.20,$780.00,$0.00,$152.59,$0.00,$155.22,$0.00
27204211,EAP,HCPCS C2629,,Set Introducer Aprima Hydrophilic L15 Cm Od6 Fr Odsec22a,$212.00,$0.00,$212.00,$115.12,$151.30,$0.00,$36.53,$151.30,$151.30,$37.12,$212.00,$0.00,$106.00,$167.90,$169.60,$0.00,$33.18,$0.00,$33.75,$0.00
27204212,EAP,Custom 27204212,,Biotronik Lead Delivery System,"$1,478.00",$0.00,"$1,478.00",$0.00,"$1,054.85",$0.00,$0.00,"$1,054.85","$1,054.85",$0.00,"$1,478.00",$0.00,$739.00,"$1,170.58","$1,182.40",$0.00,$0.00,$0.00,$0.00,$0.00
27204213,EAP,HCPCS C1751,,Cath Cen Ven 4fr 1 Lum Try 3cg Shrlk Sty Maximal Brr Pip,$1.00,$0.00,$1.00,$0.54,$0.71,$0.00,$0.17,$0.71,$0.71,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
27204214,EAP,HCPCS C1769,,Gwire Vasc .035in 15mm 260cm 4cm 2 Cvd Exch Xstif Lndrqs Ss,$620.00,$0.00,$620.00,$336.66,$442.49,$0.00,$106.82,$442.49,$442.49,$108.56,$620.00,$0.00,$310.00,$491.04,$496.00,$0.00,$97.03,$0.00,$98.70,$0.00
27204216,EAP,Custom 27204216,,Site-rite 6 Ultrasound System 21 Ga Needle Guide Kit,$60.00,$0.00,$60.00,$0.00,$42.82,$0.00,$0.00,$42.82,$42.82,$0.00,$60.00,$0.00,$30.00,$47.52,$48.00,$0.00,$0.00,$0.00,$0.00,$0.00
27204217,EAP,HCPCS C1894,,Micro Microintruducer 7cm 5.0fr Flecura Guidewire,$98.00,$0.00,$98.00,$53.21,$69.94,$0.00,$16.88,$69.94,$69.94,$17.16,$98.00,$0.00,$49.00,$77.62,$78.40,$0.00,$15.34,$0.00,$15.60,$0.00
27204218,EAP,HCPCS C1726,,Balloon Dilatation Catheter  6mmx40mmx135cm,$550.00,$0.00,$550.00,$298.65,$392.54,$0.00,$94.76,$392.54,$392.54,$96.30,$550.00,$0.00,$275.00,$435.60,$440.00,$0.00,$86.08,$0.00,$87.56,$0.00
27204220,EAP,HCPCS C1769,,Sphntm 30mm 5mm 3.9fr Atme Bil Pncr Gwire Cann Chnl C Md,"$4,433.00",$0.00,"$4,433.00","$2,407.12","$3,163.83",$0.00,$763.78,"$3,163.83","$3,163.83",$776.18,"$4,433.00",$0.00,"$2,216.50","$3,510.94","$3,546.40",$0.00,$693.76,$0.00,$705.73,$0.00
27204221,EAP,HCPCS C1887,,CATH GUID CS-A6 CURVE 8FR 49CM CORON SIN OUTR ACTY BRKWY,"$1,053.00",$0.00,"$1,053.00",$571.78,$751.53,$0.00,$181.43,$751.53,$751.53,$184.37,"$1,053.00",$0.00,$526.50,$833.98,$842.40,$0.00,$164.79,$0.00,$167.64,$0.00
27204222,EAP,HCPCS C1887,,CATH GUID CS-A6 CURVE 8FR 54CM CORON SIN OUTR ACTY BRKWY,"$1,053.00",$0.00,"$1,053.00",$571.78,$751.53,$0.00,$181.43,$751.53,$751.53,$184.37,"$1,053.00",$0.00,$526.50,$833.98,$842.40,$0.00,$164.79,$0.00,$167.64,$0.00
27204223,EAP,HCPCS C1887,,CATH GUID CS-EH CURVE 8FR 49CM OUTR ACTY BRKWY,"$1,053.00",$0.00,"$1,053.00",$571.78,$751.53,$0.00,$181.43,$751.53,$751.53,$184.37,"$1,053.00",$0.00,$526.50,$833.98,$842.40,$0.00,$164.79,$0.00,$167.64,$0.00
27204224,EAP,HCPCS C1887,,CATH GUID OUTR ACTY BRKWY CS-EH 61CM 8FR,"$1,053.00",$0.00,"$1,053.00",$571.78,$751.53,$0.00,$181.43,$751.53,$751.53,$184.37,"$1,053.00",$0.00,$526.50,$833.98,$842.40,$0.00,$164.79,$0.00,$167.64,$0.00
27204225,EAP,HCPCS C1887,,CATH GUID CS-H CURVE 8FR 6.78FR 55CM 49CM IS-1 AND LV-1 LEAD,"$1,053.00",$0.00,"$1,053.00",$571.78,$751.53,$0.00,$181.43,$751.53,$751.53,$184.37,"$1,053.00",$0.00,$526.50,$833.98,$842.40,$0.00,$164.79,$0.00,$167.64,$0.00
27204226,EAP,HCPCS C1887,,CATH GUID CS-H CURVE 8FR 54CM CORON SIN OUTR ACTY BRKWY,"$1,053.00",$0.00,"$1,053.00",$571.78,$751.53,$0.00,$181.43,$751.53,$751.53,$184.37,"$1,053.00",$0.00,$526.50,$833.98,$842.40,$0.00,$164.79,$0.00,$167.64,$0.00
27204227,EAP,HCPCS C1887,,CATH GUID 130D CS-IC CURVE 6FR 63CM INR ACTY BRKWY,$461.00,$0.00,$461.00,$250.32,$329.02,$0.00,$79.43,$329.02,$329.02,$80.72,$461.00,$0.00,$230.50,$365.11,$368.80,$0.00,$72.15,$0.00,$73.39,$0.00
27204228,EAP,HCPCS C1894,,INTROD LEAD BL CODE 9.7% HE 21% OZ 27% CO 42.35% N2,"$2,660.00",$0.00,"$2,660.00","$1,444.38","$1,898.44",$0.00,$458.30,"$1,898.44","$1,898.44",$465.74,"$2,660.00",$0.00,"$1,330.00","$2,106.72","$2,128.00",$0.00,$416.29,$0.00,$423.47,$0.00
27204229,EAP,HCPCS C1769,,CATH ENDSCP 8.5FR NSL BIL GWIRE STRL,"$1,463.00",$0.00,"$1,463.00",$794.41,"$1,044.14",$0.00,$252.07,"$1,044.14","$1,044.14",$256.16,"$1,463.00",$0.00,$731.50,"$1,158.70","$1,170.40",$0.00,$228.96,$0.00,$232.91,$0.00
27204230,EAP,HCPCS C1769,,CATH ENDSCP 7.5FR NSL BIL GWIRE STRL,"$1,463.00",$0.00,"$1,463.00",$794.41,"$1,044.14",$0.00,$252.07,"$1,044.14","$1,044.14",$256.16,"$1,463.00",$0.00,$731.50,"$1,158.70","$1,170.40",$0.00,$228.96,$0.00,$232.91,$0.00
27204231,EAP,HCPCS C1887,,CATH GUID CS-MP CURVE 8FR 49CM CORON SIN OUTR ACTY BRKWY,"$1,053.00",$0.00,"$1,053.00",$571.78,$751.53,$0.00,$181.43,$751.53,$751.53,$184.37,"$1,053.00",$0.00,$526.50,$833.98,$842.40,$0.00,$164.79,$0.00,$167.64,$0.00
27204232,EAP,HCPCS C1887,,CATH GUID CS-MP 8FR 54CM 61CM OUTR ACTY BRKWY,"$1,053.00",$0.00,"$1,053.00",$571.78,$751.53,$0.00,$181.43,$751.53,$751.53,$184.37,"$1,053.00",$0.00,$526.50,$833.98,$842.40,$0.00,$164.79,$0.00,$167.64,$0.00
27204233,EAP,HCPCS C1887,,CATH GUID STR 8FR 49CM CORON SIN OUTR ACTY BRKWY,"$1,053.00",$0.00,"$1,053.00",$571.78,$751.53,$0.00,$181.43,$751.53,$751.53,$184.37,"$1,053.00",$0.00,$526.50,$833.98,$842.40,$0.00,$164.79,$0.00,$167.64,$0.00
27204234,EAP,HCPCS C1887,,CATH GUID CS-ST CURVE 8FR 54CM CORON SIN OUTR ACTY BRKWY,"$1,053.00",$0.00,"$1,053.00",$571.78,$751.53,$0.00,$181.43,$751.53,$751.53,$184.37,"$1,053.00",$0.00,$526.50,$833.98,$842.40,$0.00,$164.79,$0.00,$167.64,$0.00
27204235,EAP,HCPCS C1887,,CATH GUID CS-EH ST R CURVE 8FR 49CM CORON SIN OUTR ACTY,"$1,053.00",$0.00,"$1,053.00",$571.78,$751.53,$0.00,$181.43,$751.53,$751.53,$184.37,"$1,053.00",$0.00,$526.50,$833.98,$842.40,$0.00,$164.79,$0.00,$167.64,$0.00
27204236,EAP,HCPCS C1887,,CATH GUID CS-EH ST R CURVE 8FR 54CM OUTR ACTY BRKWY,"$1,053.00",$0.00,"$1,053.00",$571.78,$751.53,$0.00,$181.43,$751.53,$751.53,$184.37,"$1,053.00",$0.00,$526.50,$833.98,$842.40,$0.00,$164.79,$0.00,$167.64,$0.00
27204237,EAP,HCPCS C1887,,CATH GUID CS-W CURVE 8FR 49CM CORON SIN OUTR ACTY BRKWY,"$1,053.00",$0.00,"$1,053.00",$571.78,$751.53,$0.00,$181.43,$751.53,$751.53,$184.37,"$1,053.00",$0.00,$526.50,$833.98,$842.40,$0.00,$164.79,$0.00,$167.64,$0.00
27204238,EAP,HCPCS C1769,,CATH ENDSCP 6FR NSL BIL GWIRE STRL,"$1,463.00",$0.00,"$1,463.00",$794.41,"$1,044.14",$0.00,$252.07,"$1,044.14","$1,044.14",$256.16,"$1,463.00",$0.00,$731.50,"$1,158.70","$1,170.40",$0.00,$228.96,$0.00,$232.91,$0.00
27204239,EAP,HCPCS C1887,,ACUITY CUTAWAY LEAD DELIVERY SYSTEM - PERCUTANEOUS CATHETERS,"$5,010.00",$0.00,"$5,010.00","$2,720.43","$3,575.64",$0.00,$863.20,"$3,575.64","$3,575.64",$877.21,"$5,010.00",$0.00,"$2,505.00","$3,967.92","$4,008.00",$0.00,$784.07,$0.00,$797.59,$0.00
27204240,EAP,HCPCS C1769,,SPHNTM 20MM 7-5FR BIL PNCR GWIRE 3 LUM SHRT NOSE CANN RAPEX,"$4,433.00",$0.00,"$4,433.00","$2,407.12","$3,163.83",$0.00,$763.78,"$3,163.83","$3,163.83",$776.18,"$4,433.00",$0.00,"$2,216.50","$3,510.94","$3,546.40",$0.00,$693.76,$0.00,$705.73,$0.00
27204241,EAP,Custom 27204241,,DEVICE LCK BIOP CAP RAPEX RX BL BIL PNTX ESCP,"$4,433.00",$0.00,"$4,433.00",$0.00,"$3,163.83",$0.00,$0.00,"$3,163.83","$3,163.83",$0.00,"$4,433.00",$0.00,"$2,216.50","$3,510.94","$3,546.40",$0.00,$0.00,$0.00,$0.00,$0.00
27204242,EAP,HCPCS C1725,,CATH BIL 12 ATM 5.8FR 8MM 180CM 2CM RAPEX NVSC BALDILAT HRCN,"$5,911.00",$0.00,"$5,911.00","$3,209.67","$4,218.68",$0.00,"$1,018.44","$4,218.68","$4,218.68","$1,034.97","$5,911.00",$0.00,"$2,955.50","$4,681.51","$4,728.80",$0.00,$925.07,$0.00,$941.03,$0.00
27204243,EAP,HCPCS C1769,,Sphntm 30mm 5mm 4.4fr Atme Rx,"$4,433.00",$0.00,"$4,433.00","$2,407.12","$3,163.83",$0.00,$763.78,"$3,163.83","$3,163.83",$776.18,"$4,433.00",$0.00,"$2,216.50","$3,510.94","$3,546.40",$0.00,$693.76,$0.00,$705.73,$0.00
27204245,EAP,HCPCS C1725,,Mustang Balloon Catheter 3.0mm X 20mm X 135cm,$548.00,$0.00,$548.00,$297.56,$391.11,$0.00,$94.42,$391.11,$391.11,$95.95,$548.00,$0.00,$274.00,$434.02,$438.40,$0.00,$85.76,$0.00,$87.24,$0.00
27204246,EAP,HCPCS C1725,,Mustang Balloon Catheter 3.0mm X 40mm X 135cm,$548.00,$0.00,$548.00,$297.56,$391.11,$0.00,$94.42,$391.11,$391.11,$95.95,$548.00,$0.00,$274.00,$434.02,$438.40,$0.00,$85.76,$0.00,$87.24,$0.00
27204247,EAP,HCPCS C1725,,Mustang Balloon Catheter 4.0mm X 20mm X 135cm,$548.00,$0.00,$548.00,$297.56,$391.11,$0.00,$94.42,$391.11,$391.11,$95.95,$548.00,$0.00,$274.00,$434.02,$438.40,$0.00,$85.76,$0.00,$87.24,$0.00
27204248,EAP,HCPCS C1725,,Mustang Balloon Catheter 4.0mm X 40mm X 135cm,$548.00,$0.00,$548.00,$297.56,$391.11,$0.00,$94.42,$391.11,$391.11,$95.95,$548.00,$0.00,$274.00,$434.02,$438.40,$0.00,$85.76,$0.00,$87.24,$0.00
27204249,EAP,HCPCS C1725,,Mustang Balloon Catheter 4.0mm X 80mm X 135cm,$548.00,$0.00,$548.00,$297.56,$391.11,$0.00,$94.42,$391.11,$391.11,$95.95,$548.00,$0.00,$274.00,$434.02,$438.40,$0.00,$85.76,$0.00,$87.24,$0.00
27204250,EAP,HCPCS C1887,,Cxi Support Catheter Str / 2.6fr-.018-150cm,$501.00,$0.00,$501.00,$272.04,$357.56,$0.00,$86.32,$357.56,$357.56,$87.72,$501.00,$0.00,$250.50,$396.79,$400.80,$0.00,$78.41,$0.00,$79.76,$0.00
27204251,EAP,HCPCS C1725,,Cxi Support Catheter  Ang/ 2.6fr-.018-150cm,$501.00,$0.00,$501.00,$272.04,$357.56,$0.00,$86.32,$357.56,$357.56,$87.72,$501.00,$0.00,$250.50,$396.79,$400.80,$0.00,$78.41,$0.00,$79.76,$0.00
27204252,EAP,HCPCS C1887,,Cxi Support Catheter  Str/ 4.0fr-.035-135cm,$501.00,$0.00,$501.00,$272.04,$357.56,$0.00,$86.32,$357.56,$357.56,$87.72,$501.00,$0.00,$250.50,$396.79,$400.80,$0.00,$78.41,$0.00,$79.76,$0.00
27204253,EAP,HCPCS C1725,,Mustang Balloon Catheter 6.0mm X 80mm X 135cm,$501.00,$0.00,$501.00,$272.04,$357.56,$0.00,$86.32,$357.56,$357.56,$87.72,$501.00,$0.00,$250.50,$396.79,$400.80,$0.00,$78.41,$0.00,$79.76,$0.00
27204254,EAP,HCPCS C1725,,Mustang Balloon Catheter 6.0mm X 100mm X 135cm,$548.00,$0.00,$548.00,$297.56,$391.11,$0.00,$94.42,$391.11,$391.11,$95.95,$548.00,$0.00,$274.00,$434.02,$438.40,$0.00,$85.76,$0.00,$87.24,$0.00
27204255,EAP,HCPCS C1725,,Mustang Balloon Catheter 6.0mm X 120mm X 135cm,$548.00,$0.00,$548.00,$297.56,$391.11,$0.00,$94.42,$391.11,$391.11,$95.95,$548.00,$0.00,$274.00,$434.02,$438.40,$0.00,$85.76,$0.00,$87.24,$0.00
27204256,EAP,HCPCS C1725,,Mustang Balloon Catheter 6.0mm X 150mm X 135cm,$548.00,$0.00,$548.00,$297.56,$391.11,$0.00,$94.42,$391.11,$391.11,$95.95,$548.00,$0.00,$274.00,$434.02,$438.40,$0.00,$85.76,$0.00,$87.24,$0.00
27204257,EAP,HCPCS C1725,,Mustang Balloon Catheter 6.0mm X 220mm X 135cm,$548.00,$0.00,$548.00,$297.56,$391.11,$0.00,$94.42,$391.11,$391.11,$95.95,$548.00,$0.00,$274.00,$434.02,$438.40,$0.00,$85.76,$0.00,$87.24,$0.00
27204258,EAP,HCPCS C1725,,Mustang Balloon Catheter 7.0mm X 40mm X 135cm,$548.00,$0.00,$548.00,$297.56,$391.11,$0.00,$94.42,$391.11,$391.11,$95.95,$548.00,$0.00,$274.00,$434.02,$438.40,$0.00,$85.76,$0.00,$87.24,$0.00
27204259,EAP,HCPCS C1725,,Mustang Balloon Catheter 8.0mm X 40mm X 135cm,$548.00,$0.00,$548.00,$297.56,$391.11,$0.00,$94.42,$391.11,$391.11,$95.95,$548.00,$0.00,$274.00,$434.02,$438.40,$0.00,$85.76,$0.00,$87.24,$0.00
27204260,EAP,HCPCS C1725,,Mustang Balloon Catheter 9.0mm X 40mm X 135cm,$548.00,$0.00,$548.00,$297.56,$391.11,$0.00,$94.42,$391.11,$391.11,$95.95,$548.00,$0.00,$274.00,$434.02,$438.40,$0.00,$85.76,$0.00,$87.24,$0.00
27204261,EAP,HCPCS C1725,,Mustang Balloon Catheter 5.0mm X 40mm X 135cm,$548.00,$0.00,$548.00,$297.56,$391.11,$0.00,$94.42,$391.11,$391.11,$95.95,$548.00,$0.00,$274.00,$434.02,$438.40,$0.00,$85.76,$0.00,$87.24,$0.00
27204262,EAP,HCPCS C1725,,Mustang Balloon Catheter 5.0mm X 100mm X 135cm,$548.00,$0.00,$548.00,$297.56,$391.11,$0.00,$94.42,$391.11,$391.11,$95.95,$548.00,$0.00,$274.00,$434.02,$438.40,$0.00,$85.76,$0.00,$87.24,$0.00
27204263,EAP,HCPCS C1725,,Mustang Balloon Catheter 6.0mm X 40mm X 135cm,$548.00,$0.00,$548.00,$297.56,$391.11,$0.00,$94.42,$391.11,$391.11,$95.95,$548.00,$0.00,$274.00,$434.02,$438.40,$0.00,$85.76,$0.00,$87.24,$0.00
27204270,EAP,HCPCS C1725,,Mustang Balloon Catheter 10.0mm X 40mm X 135cm,$548.00,$0.00,$548.00,$297.56,$391.11,$0.00,$94.42,$391.11,$391.11,$95.95,$548.00,$0.00,$274.00,$434.02,$438.40,$0.00,$85.76,$0.00,$87.24,$0.00
27204280,EAP,HCPCS C1755,,Kyphopast First Fracture Kit-kpe1003,"$10,626.00",$0.00,"$10,626.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$10,626.00",$0.00,"$5,313.00","$8,415.79","$8,500.80",$0.00,$0.00,$0.00,$0.00,$0.00
27204281,EAP,HCPCS C1755,,Kyphopasty Additonal Fracture Kit-kpe1003,"$7,079.00",$0.00,"$7,079.00",$0.00,"$5,052.28",$0.00,$0.00,"$5,052.28","$5,052.28",$0.00,"$7,079.00",$0.00,"$3,539.50","$5,606.57","$5,663.20",$0.00,$0.00,$0.00,$0.00,$0.00
27204282,EAP,HCPCS C1713,,Kyphoplasty Cememnt Mixer-a07a,$237.00,$0.00,$237.00,$128.69,$169.15,$0.00,$40.83,$169.15,$169.15,$41.50,$237.00,$0.00,$118.50,$187.70,$189.60,$0.00,$37.09,$0.00,$37.73,$0.00
27204283,EAP,HCPCS C1713,,Kyphoasty Activos Cement-c10a,$901.00,$0.00,$901.00,$489.24,$643.04,$0.00,$155.24,$643.04,$643.04,$157.76,$901.00,$0.00,$450.50,$713.59,$720.80,$0.00,$141.01,$0.00,$143.44,$0.00
27204284,EAP,HCPCS C1884,,Rx Emosheild Nav6 5.0 Mm,"$4,581.00",$0.00,"$4,581.00","$2,487.48","$3,269.46",$0.00,$789.28,"$3,269.46","$3,269.46",$802.10,"$4,581.00",$0.00,"$2,290.50","$3,628.15","$3,664.80",$0.00,$716.93,$0.00,$729.30,$0.00
27204286,EAP,HCPCS C1884,,Rx Embosheild Nav6 7.2 Mm,"$4,581.00",$0.00,"$4,581.00","$2,487.48","$3,269.46",$0.00,$789.28,"$3,269.46","$3,269.46",$802.10,"$4,581.00",$0.00,"$2,290.50","$3,628.15","$3,664.80",$0.00,$716.93,$0.00,$729.30,$0.00
27204292,EAP,HCPCS C1769,,Guidewire X-pedion-10 Re 2,$778.00,$0.00,$778.00,$422.45,$555.26,$0.00,$134.05,$555.26,$555.26,$136.22,$778.00,$0.00,$389.00,$616.18,$622.40,$0.00,$121.76,$0.00,$123.86,$0.00
27204293,EAP,HCPCS C1769,,Mirage Re .008,"$1,288.00",$0.00,"$1,288.00",$699.38,$919.25,$0.00,$221.92,$919.25,$919.25,$225.52,"$1,288.00",$0.00,$644.00,"$1,020.10","$1,030.40",$0.00,$201.57,$0.00,$205.05,$0.00
27204294,EAP,HCPCS C1887,,Catheter Marathon,"$1,861.00",$0.00,"$1,861.00","$1,010.52","$1,328.20",$0.00,$320.64,"$1,328.20","$1,328.20",$325.85,"$1,861.00",$0.00,$930.50,"$1,473.91","$1,488.80",$0.00,$291.25,$0.00,$296.27,$0.00
27204295,EAP,HCPCS C1757,,Cath Thrmb 130cm 4.3fr .044in Dac Multitransition Radio Pq,"$2,941.00",$0.00,"$2,941.00",$0.00,"$2,098.99",$0.00,$0.00,"$2,098.99","$2,098.99",$0.00,"$2,941.00",$0.00,"$1,470.50","$2,329.27","$2,352.80",$0.00,$0.00,$0.00,$0.00,$0.00
27204298,EAP,HCPCS C1894,,Sheath Long Neuronmax 90/4 Mp 6f 088,"$1,109.00",$0.00,"$1,109.00",$602.19,$791.49,$0.00,$191.08,$791.49,$791.49,$194.18,"$1,109.00",$0.00,$554.50,$878.33,$887.20,$0.00,$173.56,$0.00,$176.55,$0.00
27204299,EAP,Custom 27204299,,Turnpike Catheter Lp 135cm,"$1,313.00",$0.00,"$1,313.00",$0.00,$937.09,$0.00,$0.00,$937.09,$937.09,$0.00,"$1,313.00",$0.00,$656.50,"$1,039.90","$1,050.40",$0.00,$0.00,$0.00,$0.00,$0.00
27204300,EAP,Custom 27204300,,Torque Delivery System 10 Fr,"$1,797.00",$0.00,"$1,797.00",$0.00,"$1,282.52",$0.00,$0.00,"$1,282.52","$1,282.52",$0.00,"$1,797.00",$0.00,$898.50,"$1,423.22","$1,437.60",$0.00,$0.00,$0.00,$0.00,$0.00
27204301,EAP,Custom 27204301,,Spider Standard Surgical Platform,"$1,034.00",$0.00,"$1,034.00",$0.00,$737.97,$0.00,$0.00,$737.97,$737.97,$0.00,"$1,034.00",$0.00,$517.00,$818.93,$827.20,$0.00,$0.00,$0.00,$0.00,$0.00
27204302,EAP,HCPCS C1884,,System Embolic Spiderfx.014 In L320 Cm,"$4,124.00",$0.00,"$4,124.00","$2,239.33","$2,943.30",$0.00,$710.54,"$2,943.30","$2,943.30",$722.08,"$4,124.00",$0.00,"$2,062.00","$3,266.21","$3,299.20",$0.00,$645.41,$0.00,$656.54,$0.00
27204303,EAP,HCPCS C1725,,Cath Ball Dilatation Viatrac 14 Plus Xcelon .014 In L,$739.00,$0.00,$739.00,$401.28,$527.42,$0.00,$127.33,$527.42,$527.42,$129.39,$739.00,$0.00,$369.50,$585.29,$591.20,$0.00,$115.65,$0.00,$117.65,$0.00
27204304,EAP,HCPCS C1894,,Sheath Check-flo Flexor .035 In L55 Cm Od6 Fr  Multi,$68.00,$0.00,$68.00,$36.92,$48.53,$0.00,$11.72,$48.53,$48.53,$11.91,$68.00,$0.00,$34.00,$53.86,$54.40,$0.00,$10.64,$0.00,$10.83,$0.00
27204305,EAP,HCPCS C1894,,Sheath Check-flo Flexor .035 In L55 Cm Od6 Fr Curv Strat,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27204306,EAP,HCPCS C1887,,Cath Cxi Stainless Steel Polymer L135 Cm Od4 Fr,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27204307,EAP,HCPCS C1769,,Guidewire Vas Pt Graph Hydro Poly Straight,"$2,572.00",$0.00,"$2,572.00","$1,396.60","$1,835.64",$0.00,$443.14,"$1,835.64","$1,835.64",$450.34,"$2,572.00",$0.00,"$1,286.00","$2,037.02","$2,057.60",$0.00,$402.52,$0.00,$409.46,$0.00
27204308,EAP,HCPCS C1769,,Guidewire Vascular Pt Graphix Hydro Polymer J L300 Cm,"$2,572.00",$0.00,"$2,572.00","$1,396.60","$1,835.64",$0.00,$443.14,"$1,835.64","$1,835.64",$450.34,"$2,572.00",$0.00,"$1,286.00","$2,037.02","$2,057.60",$0.00,$402.52,$0.00,$409.46,$0.00
27204309,EAP,HCPCS C2628,,Transform Compliant 3mm X 10mm,"$4,222.00",$0.00,"$4,222.00",$0.00,"$3,013.24",$0.00,$0.00,"$3,013.24","$3,013.24",$0.00,"$4,222.00",$0.00,"$2,111.00","$3,343.82","$3,377.60",$0.00,$0.00,$0.00,$0.00,$0.00
27204310,EAP,HCPCS C2628,,Transform Compliant 3mm X 15mm,"$4,021.00",$0.00,"$4,021.00",$0.00,"$2,869.79",$0.00,$0.00,"$2,869.79","$2,869.79",$0.00,"$4,021.00",$0.00,"$2,010.50","$3,184.63","$3,216.80",$0.00,$0.00,$0.00,$0.00,$0.00
27204311,EAP,HCPCS C2628,,Transform Compliant 4mm X 10mm,"$4,021.00",$0.00,"$4,021.00",$0.00,"$2,869.79",$0.00,$0.00,"$2,869.79","$2,869.79",$0.00,"$4,021.00",$0.00,"$2,010.50","$3,184.63","$3,216.80",$0.00,$0.00,$0.00,$0.00,$0.00
27204312,EAP,HCPCS C2628,,Transform Compliant 4mm X 15mm,"$4,222.00",$0.00,"$4,222.00",$0.00,"$3,013.24",$0.00,$0.00,"$3,013.24","$3,013.24",$0.00,"$4,222.00",$0.00,"$2,111.00","$3,343.82","$3,377.60",$0.00,$0.00,$0.00,$0.00,$0.00
27204313,EAP,HCPCS C2628,,Transform Compliant 4mm X 20mm,"$4,021.00",$0.00,"$4,021.00",$0.00,"$2,869.79",$0.00,$0.00,"$2,869.79","$2,869.79",$0.00,"$4,021.00",$0.00,"$2,010.50","$3,184.63","$3,216.80",$0.00,$0.00,$0.00,$0.00,$0.00
27204314,EAP,HCPCS C2628,,Transform Compliant 4mm X 30mm,"$4,021.00",$0.00,"$4,021.00",$0.00,"$2,869.79",$0.00,$0.00,"$2,869.79","$2,869.79",$0.00,"$4,021.00",$0.00,"$2,010.50","$3,184.63","$3,216.80",$0.00,$0.00,$0.00,$0.00,$0.00
27204315,EAP,HCPCS C2628,,Transform Compliant 5mm X 10mm,"$4,021.00",$0.00,"$4,021.00",$0.00,"$2,869.79",$0.00,$0.00,"$2,869.79","$2,869.79",$0.00,"$4,021.00",$0.00,"$2,010.50","$3,184.63","$3,216.80",$0.00,$0.00,$0.00,$0.00,$0.00
27204316,EAP,HCPCS C2628,,TransForm Compliant 5mm x 10mm,"$4,021.00",$0.00,"$4,021.00",$0.00,"$2,869.79",$0.00,$0.00,"$2,869.79","$2,869.79",$0.00,"$4,021.00",$0.00,"$2,010.50","$3,184.63","$3,216.80",$0.00,$0.00,$0.00,$0.00,$0.00
27204317,EAP,HCPCS C2628,,Transform Compliant 5mm X 20mm,"$4,021.00",$0.00,"$4,021.00",$0.00,"$2,869.79",$0.00,$0.00,"$2,869.79","$2,869.79",$0.00,"$4,021.00",$0.00,"$2,010.50","$3,184.63","$3,216.80",$0.00,$0.00,$0.00,$0.00,$0.00
27204318,EAP,HCPCS C2628,,Transform Compliant 5mm X 30mm,"$4,021.00",$0.00,"$4,021.00",$0.00,"$2,869.79",$0.00,$0.00,"$2,869.79","$2,869.79",$0.00,"$4,021.00",$0.00,"$2,010.50","$3,184.63","$3,216.80",$0.00,$0.00,$0.00,$0.00,$0.00
27204319,EAP,HCPCS C2628,,Transform Super Compliant 3mm X 5mm,"$4,222.00",$0.00,"$4,222.00",$0.00,"$3,013.24",$0.00,$0.00,"$3,013.24","$3,013.24",$0.00,"$4,222.00",$0.00,"$2,111.00","$3,343.82","$3,377.60",$0.00,$0.00,$0.00,$0.00,$0.00
27204320,EAP,HCPCS C2628,,Transform Super Compliant 4mm X 10mm,"$4,021.00",$0.00,"$4,021.00",$0.00,"$2,869.79",$0.00,$0.00,"$2,869.79","$2,869.79",$0.00,"$4,021.00",$0.00,"$2,010.50","$3,184.63","$3,216.80",$0.00,$0.00,$0.00,$0.00,$0.00
27204321,EAP,HCPCS C2628,,Transform Super Compliant 4mm X 7mm,"$4,021.00",$0.00,"$4,021.00",$0.00,"$2,869.79",$0.00,$0.00,"$2,869.79","$2,869.79",$0.00,"$4,021.00",$0.00,"$2,010.50","$3,184.63","$3,216.80",$0.00,$0.00,$0.00,$0.00,$0.00
27204322,EAP,HCPCS C2628,,Transform Super Compliant 7mm X 10mm,"$4,021.00",$0.00,"$4,021.00",$0.00,"$2,869.79",$0.00,$0.00,"$2,869.79","$2,869.79",$0.00,"$4,021.00",$0.00,"$2,010.50","$3,184.63","$3,216.80",$0.00,$0.00,$0.00,$0.00,$0.00
27204323,EAP,HCPCS C2628,,Transform Super Compliant 7mm X 15mm,"$4,021.00",$0.00,"$4,021.00",$0.00,"$2,869.79",$0.00,$0.00,"$2,869.79","$2,869.79",$0.00,"$4,021.00",$0.00,"$2,010.50","$3,184.63","$3,216.80",$0.00,$0.00,$0.00,$0.00,$0.00
27204324,EAP,HCPCS C2628,,Transform Super Compliant 7mm X 7mm,"$4,021.00",$0.00,"$4,021.00",$0.00,"$2,869.79",$0.00,$0.00,"$2,869.79","$2,869.79",$0.00,"$4,021.00",$0.00,"$2,010.50","$3,184.63","$3,216.80",$0.00,$0.00,$0.00,$0.00,$0.00
27204330,EAP,Custom 27204330,,Probe Stereo Mammo Revolve L9 Cm Od8 Ga,"$1,378.00",$0.00,"$1,378.00",$0.00,$983.48,$0.00,$0.00,$983.48,$983.48,$0.00,"$1,378.00",$0.00,$689.00,"$1,091.38","$1,102.40",$0.00,$0.00,$0.00,$0.00,$0.00
27204332,EAP,HCPCS C1887,,Cath Cantata 2.5f Superselective Micro 135 Cm,$882.00,$0.00,$882.00,$478.93,$629.48,$0.00,$151.96,$629.48,$629.48,$154.43,$882.00,$0.00,$441.00,$698.54,$705.60,$0.00,$138.03,$0.00,$140.41,$0.00
27204333,EAP,Custom 27204333,,Cath Cantata 2.8f Superselective Micro 135 Cm,$897.00,$0.00,$897.00,$0.00,$640.19,$0.00,$0.00,$640.19,$640.19,$0.00,$897.00,$0.00,$448.50,$710.42,$717.60,$0.00,$0.00,$0.00,$0.00,$0.00
27204334,EAP,Custom 27204334,,Glidesheath Slender 6f,$160.00,$0.00,$160.00,$0.00,$114.19,$0.00,$0.00,$114.19,$114.19,$0.00,$160.00,$0.00,$80.00,$126.72,$128.00,$0.00,$0.00,$0.00,$0.00,$0.00
27204335,EAP,Custom 27204335,,Torque Delivery System 12 Fr,"$1,797.00",$0.00,"$1,797.00",$0.00,"$1,282.52",$0.00,$0.00,"$1,282.52","$1,282.52",$0.00,"$1,797.00",$0.00,$898.50,"$1,423.22","$1,437.60",$0.00,$0.00,$0.00,$0.00,$0.00
27204336,EAP,Custom 27204336,,Amplatzer Sizing Balloons 34 Mm,$821.00,$0.00,$821.00,$0.00,$585.95,$0.00,$0.00,$585.95,$585.95,$0.00,$821.00,$0.00,$410.50,$650.23,$656.80,$0.00,$0.00,$0.00,$0.00,$0.00
27204337,EAP,HCPCS C1759,,Viewflex Ice Plus Catheter,"$8,102.00",$0.00,"$8,102.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$8,102.00",$0.00,"$4,051.00","$6,416.78","$6,481.60",$0.00,$0.00,$0.00,$0.00,$0.00
27204338,EAP,Custom 27204338,,System Fec Mgmt 60cc Ns Lf Dignishield Cath Syr Cl,$298.00,$0.00,$298.00,$0.00,$212.68,$0.00,$0.00,$212.68,$212.68,$0.00,$298.00,$0.00,$149.00,$236.02,$238.40,$0.00,$0.00,$0.00,$0.00,$0.00
27204351,EAP,HCPCS C1725,,Cath Baldilat .014in 5fr 2mm 8mm Coron Rapex Ult Lp Guid,$390.00,$0.00,$390.00,$211.77,$278.34,$0.00,$67.20,$278.34,$278.34,$68.29,$390.00,$0.00,$195.00,$308.88,$312.00,$0.00,$61.04,$0.00,$62.09,$0.00
27204352,EAP,HCPCS C1725,,Cath Baldilat .021in 5fr 2mm 20mm Coron Rapex Flxb Tung Mrkr,$371.00,$0.00,$371.00,$201.45,$264.78,$0.00,$63.92,$264.78,$264.78,$64.96,$371.00,$0.00,$185.50,$293.83,$296.80,$0.00,$58.06,$0.00,$59.06,$0.00
27204354,EAP,HCPCS C1725,,Cath Baldilat .014in 5fr 2.5mm 20mm Coron Rapex Ult Lp Guid,$390.00,$0.00,$390.00,$211.77,$278.34,$0.00,$67.20,$278.34,$278.34,$68.29,$390.00,$0.00,$195.00,$308.88,$312.00,$0.00,$61.04,$0.00,$62.09,$0.00
27204356,EAP,HCPCS C1725,,Cath Baldilat .014in 5fr 3mm 8mm Coron Rapex Ult Lp Guid,$371.00,$0.00,$371.00,$201.45,$264.78,$0.00,$63.92,$264.78,$264.78,$64.96,$371.00,$0.00,$185.50,$293.83,$296.80,$0.00,$58.06,$0.00,$59.06,$0.00
27204358,EAP,HCPCS C1725,,Cath Baldilat .021in 5fr 3mm 25mm Coron Rapex Lp Flxb Tung,$353.00,$0.00,$353.00,$191.68,$251.94,$0.00,$60.82,$251.94,$251.94,$61.81,$353.00,$0.00,$176.50,$279.58,$282.40,$0.00,$55.24,$0.00,$56.20,$0.00
27204359,EAP,HCPCS C1725,,Cath Baldilat .021in 5fr 3.5mm 8mm Coron Rapex Lp Flxb Tung,$353.00,$0.00,$353.00,$191.68,$251.94,$0.00,$60.82,$251.94,$251.94,$61.81,$353.00,$0.00,$176.50,$279.58,$282.40,$0.00,$55.24,$0.00,$56.20,$0.00
27204360,EAP,HCPCS C1725,,Cath Baldilat .014in 5fr 3.5mm 20mm Coron Rapex Ult Lp Guid,$336.00,$0.00,$336.00,$182.45,$239.80,$0.00,$57.89,$239.80,$239.80,$58.83,$336.00,$0.00,$168.00,$266.11,$268.80,$0.00,$52.58,$0.00,$53.49,$0.00
27204361,EAP,HCPCS C1725,,Cath Baldilat .021in 5fr 3.5mm 25mm Coron Rapex Lp Flxb Tung,$353.00,$0.00,$353.00,$191.68,$251.94,$0.00,$60.82,$251.94,$251.94,$61.81,$353.00,$0.00,$176.50,$279.58,$282.40,$0.00,$55.24,$0.00,$56.20,$0.00
27204362,EAP,HCPCS C1725,,Cath Baldilat .021in 5fr 4mm 8mm Coron Rapex Hypotube Slim,$371.00,$0.00,$371.00,$201.45,$264.78,$0.00,$63.92,$264.78,$264.78,$64.96,$371.00,$0.00,$185.50,$293.83,$296.80,$0.00,$58.06,$0.00,$59.06,$0.00
27204363,EAP,HCPCS C1725,,Cath Baldilat .021in 5fr 4mm 12mm Coron Rapex Lp Flxb Tung,$353.00,$0.00,$353.00,$191.68,$251.94,$0.00,$60.82,$251.94,$251.94,$61.81,$353.00,$0.00,$176.50,$279.58,$282.40,$0.00,$55.24,$0.00,$56.20,$0.00
27204364,EAP,HCPCS C1725,,Cath Baldilat .021in 5fr 1.5mm 8mm Coron Otw Flxb Tung Mrkr,$371.00,$0.00,$371.00,$201.45,$264.78,$0.00,$63.92,$264.78,$264.78,$64.96,$371.00,$0.00,$185.50,$293.83,$296.80,$0.00,$58.06,$0.00,$59.06,$0.00
27204365,EAP,HCPCS C1725,,Cath Baldilat 2mm 8mm Coron Rapex Dual Tung Mrkr Flxb Smth,$371.00,$0.00,$371.00,$201.45,$264.78,$0.00,$63.92,$264.78,$264.78,$64.96,$371.00,$0.00,$185.50,$293.83,$296.80,$0.00,$58.06,$0.00,$59.06,$0.00
27204366,EAP,HCPCS C1725,,Cath Baldilat 2.25mm 8mm Coron Rapex Flxb Dual Tung Mrkr,$371.00,$0.00,$371.00,$201.45,$264.78,$0.00,$63.92,$264.78,$264.78,$64.96,$371.00,$0.00,$185.50,$293.83,$296.80,$0.00,$58.06,$0.00,$59.06,$0.00
27204367,EAP,HCPCS C1725,,Cath Baldilat 2.25mm 12mm Coron Rapex Flxb Dual Tung Mrkr,$371.00,$0.00,$371.00,$201.45,$264.78,$0.00,$63.92,$264.78,$264.78,$64.96,$371.00,$0.00,$185.50,$293.83,$296.80,$0.00,$58.06,$0.00,$59.06,$0.00
27204368,EAP,HCPCS C1725,,Cath Baldilat 2.25mm 15mm Coron Rapex Flxb Dual Tung Mrkr,$371.00,$0.00,$371.00,$201.45,$264.78,$0.00,$63.92,$264.78,$264.78,$64.96,$371.00,$0.00,$185.50,$293.83,$296.80,$0.00,$58.06,$0.00,$59.06,$0.00
27204369,EAP,HCPCS C1725,,Cath Baldilat 2.25mm 20mm Coron Rapex Flxb Dual Tung Mrkr,$371.00,$0.00,$371.00,$201.45,$264.78,$0.00,$63.92,$264.78,$264.78,$64.96,$371.00,$0.00,$185.50,$293.83,$296.80,$0.00,$58.06,$0.00,$59.06,$0.00
27204370,EAP,HCPCS C1725,,Cath Baldilat 2.75mm 8mm Coron Rapex Flxb Dual Tung Mrkr,$371.00,$0.00,$371.00,$201.45,$264.78,$0.00,$63.92,$264.78,$264.78,$64.96,$371.00,$0.00,$185.50,$293.83,$296.80,$0.00,$58.06,$0.00,$59.06,$0.00
27204371,EAP,HCPCS C1725,,Cath Baldilat 3.25mm 8mm Coron Rapex Dual Tung Mrkr Flxb,$336.00,$0.00,$336.00,$182.45,$239.80,$0.00,$57.89,$239.80,$239.80,$58.83,$336.00,$0.00,$168.00,$266.11,$268.80,$0.00,$52.58,$0.00,$53.49,$0.00
27204372,EAP,HCPCS C1725,,Cath Baldilat 3.25mm 20mm Coron Rapex Dual Tung Mrkr Flxb,$371.00,$0.00,$371.00,$201.45,$264.78,$0.00,$63.92,$264.78,$264.78,$64.96,$371.00,$0.00,$185.50,$293.83,$296.80,$0.00,$58.06,$0.00,$59.06,$0.00
27204374,EAP,HCPCS C1725,,Cath Baldilat 4.5mm 8mm Coron Rapex Flxb Dual Tung Mrkr Smth,$353.00,$0.00,$353.00,$191.68,$251.94,$0.00,$60.82,$251.94,$251.94,$61.81,$353.00,$0.00,$176.50,$279.58,$282.40,$0.00,$55.24,$0.00,$56.20,$0.00
27204375,EAP,HCPCS C1725,,Cath Baldilat 4.5mm 15mm Coron Rapex Dual Tung Mrkr Flxb,$336.00,$0.00,$336.00,$182.45,$239.80,$0.00,$57.89,$239.80,$239.80,$58.83,$336.00,$0.00,$168.00,$266.11,$268.80,$0.00,$52.58,$0.00,$53.49,$0.00
27204376,EAP,HCPCS C1725,,Cath Baldilat 5mm 15mm Coron Rapex Flxb Dual Tung Mrkr Smth,$371.00,$0.00,$371.00,$201.45,$264.78,$0.00,$63.92,$264.78,$264.78,$64.96,$371.00,$0.00,$185.50,$293.83,$296.80,$0.00,$58.06,$0.00,$59.06,$0.00
27204390,EAP,Custom 27204390,,Cath Cantata Double Markers 2.5 Fr X 100 Cm,$353.00,$0.00,$353.00,$0.00,$251.94,$0.00,$0.00,$251.94,$251.94,$0.00,$353.00,$0.00,$176.50,$279.58,$282.40,$0.00,$0.00,$0.00,$0.00,$0.00
27204391,EAP,Custom 27204391,,Cath Cantata Double Markers  2.5 Fr  X 110 Cm,$353.00,$0.00,$353.00,$0.00,$251.94,$0.00,$0.00,$251.94,$251.94,$0.00,$353.00,$0.00,$176.50,$279.58,$282.40,$0.00,$0.00,$0.00,$0.00,$0.00
27204392,EAP,Custom 27204392,,Cath Cantata Double Markers  2.5 X 135 Cm,$353.00,$0.00,$353.00,$0.00,$251.94,$0.00,$0.00,$251.94,$251.94,$0.00,$353.00,$0.00,$176.50,$279.58,$282.40,$0.00,$0.00,$0.00,$0.00,$0.00
27204393,EAP,Custom 27204393,,Cath Cantata Double Markers 2.5 X 150 Cm,$353.00,$0.00,$353.00,$0.00,$251.94,$0.00,$0.00,$251.94,$251.94,$0.00,$353.00,$0.00,$176.50,$279.58,$282.40,$0.00,$0.00,$0.00,$0.00,$0.00
27204394,EAP,Custom 27204394,,Cath Cantata Double Markers 2.8 Fr X 108 Cm,$353.00,$0.00,$353.00,$0.00,$251.94,$0.00,$0.00,$251.94,$251.94,$0.00,$353.00,$0.00,$176.50,$279.58,$282.40,$0.00,$0.00,$0.00,$0.00,$0.00
27204395,EAP,Custom 27204395,,Cath Cantata Double Markers  2.8 X 110 Cm,$358.00,$0.00,$358.00,$0.00,$255.50,$0.00,$0.00,$255.50,$255.50,$0.00,$358.00,$0.00,$179.00,$283.54,$286.40,$0.00,$0.00,$0.00,$0.00,$0.00
27204396,EAP,Custom 27204396,,Cath Cantata Double Markers 2.8 X 135 Cm,$358.00,$0.00,$358.00,$0.00,$255.50,$0.00,$0.00,$255.50,$255.50,$0.00,$358.00,$0.00,$179.00,$283.54,$286.40,$0.00,$0.00,$0.00,$0.00,$0.00
27204397,EAP,Custom 27204397,,Cath Cantata Double Markers 2.8 X 150 Cm,$358.00,$0.00,$358.00,$0.00,$255.50,$0.00,$0.00,$255.50,$255.50,$0.00,$358.00,$0.00,$179.00,$283.54,$286.40,$0.00,$0.00,$0.00,$0.00,$0.00
27204398,EAP,Custom 27204398,,Cath Cantata  Markers. 2.5 X 100 Cm,$353.00,$0.00,$353.00,$0.00,$251.94,$0.00,$0.00,$251.94,$251.94,$0.00,$353.00,$0.00,$176.50,$279.58,$282.40,$0.00,$0.00,$0.00,$0.00,$0.00
27204399,EAP,Custom 27204399,,Cath Cantata  Markers. 2.5 X 110 Cm,$353.00,$0.00,$353.00,$0.00,$251.94,$0.00,$0.00,$251.94,$251.94,$0.00,$353.00,$0.00,$176.50,$279.58,$282.40,$0.00,$0.00,$0.00,$0.00,$0.00
27204400,EAP,Custom 27204400,,Cath Cantata  Markers.  2.5 X 150 Cm,$353.00,$0.00,$353.00,$0.00,$251.94,$0.00,$0.00,$251.94,$251.94,$0.00,$353.00,$0.00,$176.50,$279.58,$282.40,$0.00,$0.00,$0.00,$0.00,$0.00
27204401,EAP,Custom 27204401,,Cath Cantata  Markers. 2.8 X100 Cm,$358.00,$0.00,$358.00,$0.00,$255.50,$0.00,$0.00,$255.50,$255.50,$0.00,$358.00,$0.00,$179.00,$283.54,$286.40,$0.00,$0.00,$0.00,$0.00,$0.00
27204402,EAP,Custom 27204402,,Cath Cantata  Markers.  2.8 X 110  Cm,$358.00,$0.00,$358.00,$0.00,$255.50,$0.00,$0.00,$255.50,$255.50,$0.00,$358.00,$0.00,$179.00,$283.54,$286.40,$0.00,$0.00,$0.00,$0.00,$0.00
27204403,EAP,Custom 27204403,,Cath Cantata  Markers.  2.8 X 150 Cm,$358.00,$0.00,$358.00,$0.00,$255.50,$0.00,$0.00,$255.50,$255.50,$0.00,$358.00,$0.00,$179.00,$283.54,$286.40,$0.00,$0.00,$0.00,$0.00,$0.00
27204404,EAP,HCPCS C1892,,Sheath Long Neuronmax 90/4 Straight 6f 088,"$1,086.00",$0.00,"$1,086.00",$589.70,$775.08,$0.00,$187.11,$775.08,$775.08,$190.15,"$1,086.00",$0.00,$543.00,$860.11,$868.80,$0.00,$169.96,$0.00,$172.89,$0.00
27204405,EAP,HCPCS C1753,,Catheter Ultrasound Eagle Eye Gold Od5 Fr Short Tip,"$1,999.00",$0.00,"$1,999.00","$1,085.46","$1,426.69",$0.00,$344.42,"$1,426.69","$1,426.69",$350.01,"$1,999.00",$0.00,$999.50,"$1,583.21","$1,599.20",$0.00,$312.84,$0.00,$318.24,$0.00
27204406,EAP,Custom 27204406,,Catheter Steerable 3.2 Outer Diam 2mm Working Channel,"$1,653.00",$0.00,"$1,653.00",$0.00,"$1,179.75",$0.00,$0.00,"$1,179.75","$1,179.75",$0.00,"$1,653.00",$0.00,$826.50,"$1,309.18","$1,322.40",$0.00,$0.00,$0.00,$0.00,$0.00
27204407,EAP,HCPCS C1887,,Trevo Microcatheter,"$1,147.00",$0.00,"$1,147.00",$622.82,$818.61,$0.00,$197.62,$818.61,$818.61,$200.83,"$1,147.00",$0.00,$573.50,$908.42,$917.60,$0.00,$179.51,$0.00,$182.60,$0.00
27204408,EAP,HCPCS C1757,,Retriever Stent Trevo Xp 4 X 20,"$12,766.00",$0.00,"$12,766.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$12,766.00",$0.00,"$6,383.00","$10,110.67","$10,212.80",$0.00,$0.00,$0.00,$0.00,$0.00
27204409,EAP,HCPCS C1757,,Retriever Stent Trevo Xp 3 X 20,"$14,776.00",$0.00,"$14,776.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$14,776.00",$0.00,"$7,388.00","$11,702.59","$11,820.80",$0.00,$0.00,$0.00,$0.00,$0.00
27204416,EAP,HCPCS C1757,,Set Cath 135cm 5fr 3mm Spiroflex Vg Angjt .014in Thrmb Gwire,"$5,925.00",$0.00,"$5,925.00",$0.00,"$4,228.67",$0.00,$0.00,"$4,228.67","$4,228.67",$0.00,"$5,925.00",$0.00,"$2,962.50","$4,692.60","$4,740.00",$0.00,$0.00,$0.00,$0.00,$0.00
27204417,EAP,HCPCS C1714,,CATHETER TURBOHAWK  High Efficiency Cutter- Large Vessel Standard Calcium,"$9,081.00",$0.00,"$9,081.00","$4,930.98","$5,158.80",$0.00,"$1,564.61","$5,158.80","$5,158.80","$1,590.01","$9,081.00",$0.00,"$4,540.50","$7,192.15","$7,264.80",$0.00,"$1,421.18",$0.00,"$1,445.70",$0.00
27204418,EAP,HCPCS C1714,,Catheter Turbohawk  high Efficiency Cutter- Large Vessel Xtended Calcium Tip Lx-c,"$9,081.00",$0.00,"$9,081.00","$4,930.98","$5,158.80",$0.00,"$1,564.61","$5,158.80","$5,158.80","$1,590.01","$9,081.00",$0.00,"$4,540.50","$7,192.15","$7,264.80",$0.00,"$1,421.18",$0.00,"$1,445.70",$0.00
27204419,EAP,HCPCS C1714,,Catheter Turbohawk  Smooth Cutter- Large Vessel Xtended Tip  lx-m,"$9,081.00",$0.00,"$9,081.00","$4,930.98","$5,158.80",$0.00,"$1,564.61","$5,158.80","$5,158.80","$1,590.01","$9,081.00",$0.00,"$4,540.50","$7,192.15","$7,264.80",$0.00,"$1,421.18",$0.00,"$1,445.70",$0.00
27204420,EAP,HCPCS C1714,,Catheter Turbohawk   High Efficiency Cutter- Small Vessel Xtended Calcium Tip Sx-c,"$9,081.00",$0.00,"$9,081.00","$4,930.98","$5,158.80",$0.00,"$1,564.61","$5,158.80","$5,158.80","$1,590.01","$9,081.00",$0.00,"$4,540.50","$7,192.15","$7,264.80",$0.00,"$1,421.18",$0.00,"$1,445.70",$0.00
27204421,EAP,HCPCS C1714,,Catheter Turbohawk  High Efficiency Cutter Small Vessel Standard Calcium Tip Long Catheter  Ss-cl,"$9,081.00",$0.00,"$9,081.00","$4,930.98","$5,158.80",$0.00,"$1,564.61","$5,158.80","$5,158.80","$1,590.01","$9,081.00",$0.00,"$4,540.50","$7,192.15","$7,264.80",$0.00,"$1,421.18",$0.00,"$1,445.70",$0.00
27204422,EAP,HCPCS C1714,,Catheter Turbohawk  Smooth Cutter- Large Vessel Standard Tip   ls-m,"$9,081.00",$0.00,"$9,081.00","$4,930.98","$5,158.80",$0.00,"$1,564.61","$5,158.80","$5,158.80","$1,590.01","$9,081.00",$0.00,"$4,540.50","$7,192.15","$7,264.80",$0.00,"$1,421.18",$0.00,"$1,445.70",$0.00
27204423,EAP,HCPCS C1769,,Gwire Vasc 190cm .014in Core To Tip Str 16cm A Fldr Xt,$414.00,$0.00,$414.00,$224.80,$295.47,$0.00,$71.33,$295.47,$295.47,$72.49,$414.00,$0.00,$207.00,$327.89,$331.20,$0.00,$64.79,$0.00,$65.91,$0.00
27204424,EAP,HCPCS C1769,,Gwire Vasc 300cm .014in Core To Tip Str 16cm A Fldr Xt,$414.00,$0.00,$414.00,$224.80,$295.47,$0.00,$71.33,$295.47,$295.47,$72.49,$414.00,$0.00,$207.00,$327.89,$331.20,$0.00,$64.79,$0.00,$65.91,$0.00
27204426,EAP,Custom 27204426,,Certus Lk Ablation 15cm-17 Gauge,"$6,063.00",$0.00,"$6,063.00",$0.00,"$4,327.16",$0.00,$0.00,"$4,327.16","$4,327.16",$0.00,"$6,063.00",$0.00,"$3,031.50","$4,801.90","$4,850.40",$0.00,$0.00,$0.00,$0.00,$0.00
27204427,EAP,Custom 27204427,,Certus Lk Ablation 20cm-17 Gauge,"$6,063.00",$0.00,"$6,063.00",$0.00,"$4,327.16",$0.00,$0.00,"$4,327.16","$4,327.16",$0.00,"$6,063.00",$0.00,"$3,031.50","$4,801.90","$4,850.40",$0.00,$0.00,$0.00,$0.00,$0.00
27204428,EAP,Custom 27204428,,Certus Ln  Ablation 15cm-17 Gauge,"$6,063.00",$0.00,"$6,063.00",$0.00,"$4,327.16",$0.00,$0.00,"$4,327.16","$4,327.16",$0.00,"$6,063.00",$0.00,"$3,031.50","$4,801.90","$4,850.40",$0.00,$0.00,$0.00,$0.00,$0.00
27204429,EAP,Custom 27204429,,Certus Ln Ablation 20cm-17 Gauge,"$6,063.00",$0.00,"$6,063.00",$0.00,"$4,327.16",$0.00,$0.00,"$4,327.16","$4,327.16",$0.00,"$6,063.00",$0.00,"$3,031.50","$4,801.90","$4,850.40",$0.00,$0.00,$0.00,$0.00,$0.00
27204430,EAP,HCPCS C1769,,Gwire Vasc .035in 150cm 1.5mm Rsn Curve Jtp Fix Core Ptfe,$37.00,$0.00,$37.00,$20.09,$26.41,$0.00,$6.37,$26.41,$26.41,$6.48,$37.00,$0.00,$18.50,$29.30,$29.60,$0.00,$5.79,$0.00,$5.89,$0.00
27204431,EAP,HCPCS C1769,,Gwire Vasc Rsn Curve J Curve Lng .035in 260cm 1.5mm Exch,$82.00,$0.00,$82.00,$44.53,$58.52,$0.00,$14.13,$58.52,$58.52,$14.36,$82.00,$0.00,$41.00,$64.94,$65.60,$0.00,$12.83,$0.00,$13.05,$0.00
27204432,EAP,HCPCS C1773,,Kit Vasc 120cm 15mm 6fr Agn Ntnl Gold Tung Loop Cath Ntnl,$882.00,$0.00,$882.00,$478.93,$629.48,$0.00,$151.96,$629.48,$629.48,$154.43,$882.00,$0.00,$441.00,$698.54,$705.60,$0.00,$138.03,$0.00,$140.41,$0.00
27204433,EAP,HCPCS C1773,,Kit Vasc 120cm 25mm 6fr Agn Ntnl Gold Tung Loop Cath Ntnl,$882.00,$0.00,$882.00,$478.93,$629.48,$0.00,$151.96,$629.48,$629.48,$154.43,$882.00,$0.00,$441.00,$698.54,$705.60,$0.00,$138.03,$0.00,$140.41,$0.00
27204434,EAP,HCPCS C1773,,Kit Vasc 120cm 10mm 4fr Agn Ntnl Gold Tung Loop Cath Ntnl,$882.00,$0.00,$882.00,$478.93,$629.48,$0.00,$151.96,$629.48,$629.48,$154.43,$882.00,$0.00,$441.00,$698.54,$705.60,$0.00,$138.03,$0.00,$140.41,$0.00
27204436,EAP,HCPCS C1757,,Trevo Xp - 4mm X 20mm,"$14,072.00",$0.00,"$14,072.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$14,072.00",$0.00,"$7,036.00","$11,145.02","$11,257.60",$0.00,$0.00,$0.00,$0.00,$0.00
27204437,EAP,HCPCS C1887,,Flowgate Balloon Guide Catheter 8f X 95cm,"$2,746.00",$0.00,"$2,746.00","$1,491.08","$1,959.82",$0.00,$473.12,"$1,959.82","$1,959.82",$480.80,"$2,746.00",$0.00,"$1,373.00","$2,174.83","$2,196.80",$0.00,$429.75,$0.00,$437.16,$0.00
27204438,EAP,CPT® C1725,,Bln Splxxx Sprinter Legend Xxxxxx,$456.00,$0.00,$456.00,$247.61,$325.45,$0.00,$78.57,$325.45,$325.45,$79.84,$456.00,$0.00,$228.00,$361.15,$364.80,$0.00,$71.36,$0.00,$72.60,$0.00
27204439,EAP,HCPCS C1887,,Flowgate Balloon Guide Catheter 8f X 85cm,"$2,746.00",$0.00,"$2,746.00","$1,491.08","$1,959.82",$0.00,$473.12,"$1,959.82","$1,959.82",$480.80,"$2,746.00",$0.00,"$1,373.00","$2,174.83","$2,196.80",$0.00,$429.75,$0.00,$437.16,$0.00
27204440,EAP,Custom 27204440,,Certus Pr Ablation 15cm-17 Gauge,"$5,500.00",$0.00,"$5,500.00",$0.00,"$3,925.35",$0.00,$0.00,"$3,925.35","$3,925.35",$0.00,"$5,500.00",$0.00,"$2,750.00","$4,356.00","$4,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
27204441,EAP,Custom 27204441,,Certus Pr Ablation 20cm-17 Gauge,"$6,063.00",$0.00,"$6,063.00",$0.00,"$4,327.16",$0.00,$0.00,"$4,327.16","$4,327.16",$0.00,"$6,063.00",$0.00,"$3,031.50","$4,801.90","$4,850.40",$0.00,$0.00,$0.00,$0.00,$0.00
27204442,EAP,HCPCS C1724,,Cath Athrcm 135cm .58in Rtbl Rtl 1.25mm Ptfe Shth Precnct,"$1,364.00",$0.00,"$1,364.00",$0.00,$973.49,$0.00,$0.00,$973.49,$973.49,$0.00,"$1,364.00",$0.00,$682.00,"$1,080.29","$1,091.20",$0.00,$0.00,$0.00,$0.00,$0.00
27204443,EAP,HCPCS C1724,,Cath Athrcm 135cm .58in Rtbl Rtl 1.5mm Ptfe Shth Precnct,"$1,364.00",$0.00,"$1,364.00",$0.00,$973.49,$0.00,$0.00,$973.49,$973.49,$0.00,"$1,364.00",$0.00,$682.00,"$1,080.29","$1,091.20",$0.00,$0.00,$0.00,$0.00,$0.00
27204444,EAP,HCPCS C1724,,Cath Athrcm 135cm .58in Rtbl Rtl 1.75mm Precnct Exchgl Rot,"$1,364.00",$0.00,"$1,364.00",$0.00,$973.49,$0.00,$0.00,$973.49,$973.49,$0.00,"$1,364.00",$0.00,$682.00,"$1,080.29","$1,091.20",$0.00,$0.00,$0.00,$0.00,$0.00
27204445,EAP,Custom 27204445,,Pcmkr Crd Thk6mm Sm 50x46mm Endurity 2 Chmbr Is-1 Conctr W Adapter,"$6,669.00",$0.00,"$6,669.00",$0.00,"$4,759.67",$0.00,$0.00,"$4,759.67","$4,759.67",$0.00,"$6,669.00",$0.00,"$3,334.50","$5,281.85","$5,335.20",$0.00,$0.00,$0.00,$0.00,$0.00
27204446,EAP,HCPCS C1887,,Catheter Guid .035in 4.8-3.7fr 90cm Low Crossing P,$418.00,$0.00,$418.00,$226.97,$298.33,$0.00,$72.02,$298.33,$298.33,$73.19,$418.00,$0.00,$209.00,$331.06,$334.40,$0.00,$65.42,$0.00,$66.55,$0.00
27204447,EAP,HCPCS C1887,,Catheter Gd .035in Mpb 9fr 7.2fr 45cm Atn Cmnd Sur,$588.00,$0.00,$588.00,$319.28,$419.66,$0.00,$101.31,$419.66,$419.66,$102.95,$588.00,$0.00,$294.00,$465.70,$470.40,$0.00,$92.02,$0.00,$93.61,$0.00
27204448,EAP,HCPCS C1887,,Catheter Gd 90d 2.4mm 1.9mm 65cm Strl Atn Slct Ii,$540.00,$0.00,$540.00,$293.22,$385.40,$0.00,$93.04,$385.40,$385.40,$94.55,$540.00,$0.00,$270.00,$427.68,$432.00,$0.00,$84.51,$0.00,$85.97,$0.00
27204449,EAP,Custom 27204449,,Catheter Gd 3drc Crv 6fr .070in 100cm Blu Ylw Strl,$120.00,$0.00,$120.00,$0.00,$85.64,$0.00,$0.00,$85.64,$85.64,$0.00,$120.00,$0.00,$60.00,$95.04,$96.00,$0.00,$0.00,$0.00,$0.00,$0.00
27204450,EAP,HCPCS C1750,,Pack Cath 28/45cm 14.5fr Carbothane Mh Mxd 2 Lum Sh Hmdial,$921.00,$0.00,$921.00,$500.10,$657.32,$0.00,$158.68,$657.32,$657.32,$161.26,$921.00,$0.00,$460.50,$729.43,$736.80,$0.00,$144.14,$0.00,$146.62,$0.00
27204451,EAP,HCPCS C1750,,Pack Cath 33/50cm 14.5fr Carbothane Mh Mxd 2 Lum Sh Hmdial,$248.00,$0.00,$248.00,$134.66,$177.00,$0.00,$42.73,$177.00,$177.00,$43.42,$248.00,$0.00,$124.00,$196.42,$198.40,$0.00,$38.81,$0.00,$39.48,$0.00
27204452,EAP,Custom 27204452,,Obt Shth 10cm 5fr Flxb 5mm,"$4,675.00",$0.00,"$4,675.00",$0.00,"$3,336.55",$0.00,$0.00,"$3,336.55","$3,336.55",$0.00,"$4,675.00",$0.00,"$2,337.50","$3,702.60","$3,740.00",$0.00,$0.00,$0.00,$0.00,$0.00
27204453,EAP,Custom 27204453,,Obt Shth 10cm 6fr Flxb 5mm,"$4,908.00",$0.00,"$4,908.00",$0.00,"$3,502.84",$0.00,$0.00,"$3,502.84","$3,502.84",$0.00,"$4,908.00",$0.00,"$2,454.00","$3,887.14","$3,926.40",$0.00,$0.00,$0.00,$0.00,$0.00
27204454,EAP,HCPCS C1769,,Gwire Vasc 300cm .014in Shp Tip Str 3cm Runthrough Ns Ptfe,$235.00,$0.00,$235.00,$127.61,$167.72,$0.00,$40.49,$167.72,$167.72,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
27204455,EAP,HCPCS C1887,,Cath Ep .014in 2.6-1.8fr .021-.018in 130cm 90cm Coron Mic,"$1,621.00",$0.00,"$1,621.00",$880.20,"$1,156.91",$0.00,$279.29,"$1,156.91","$1,156.91",$283.82,"$1,621.00",$0.00,$810.50,"$1,283.83","$1,296.80",$0.00,$253.69,$0.00,$258.06,$0.00
27204456,EAP,HCPCS C1887,,Cath Ep .014in 2.6-1.8fr .021-.018in 150cm 70cm Coron Mic,"$1,621.00",$0.00,"$1,621.00",$880.20,"$1,156.91",$0.00,$279.29,"$1,156.91","$1,156.91",$283.82,"$1,621.00",$0.00,$810.50,"$1,283.83","$1,296.80",$0.00,$253.69,$0.00,$258.06,$0.00
27204457,EAP,HCPCS C1769,,Gwire Vasc .014in 180cm 3cm Str Shp Tip Runthrough Ns Coron,$247.00,$0.00,$247.00,$134.12,$176.28,$0.00,$42.56,$176.28,$176.28,$43.25,$247.00,$0.00,$123.50,$195.62,$197.60,$0.00,$38.66,$0.00,$39.32,$0.00
27204458,EAP,HCPCS C1733,,Arctic Front Advance Cryoablation Catheter 23mm,"$12,401.00",$0.00,"$12,401.00","$6,733.74","$5,158.80",$0.00,"$2,136.63","$5,158.80","$5,158.80","$2,171.32","$12,401.00",$0.00,"$6,200.50","$9,821.59","$9,920.80",$0.00,"$1,940.76",$0.00,"$1,974.24",$0.00
27204459,EAP,HCPCS C1733,,Arctic Front Advance Cryoablation Catheter 28mm,"$12,401.00",$0.00,"$12,401.00","$6,733.74","$5,158.80",$0.00,"$2,136.63","$5,158.80","$5,158.80","$2,171.32","$12,401.00",$0.00,"$6,200.50","$9,821.59","$9,920.80",$0.00,"$1,940.76",$0.00,"$1,974.24",$0.00
27204460,EAP,HCPCS C1733,,Freezor Max Cardiac Cryoablation Catheter Med,"$5,236.00",$0.00,"$5,236.00","$2,843.15","$3,736.93",$0.00,$902.14,"$3,736.93","$3,736.93",$916.78,"$5,236.00",$0.00,"$2,618.00","$4,146.91","$4,188.80",$0.00,$819.43,$0.00,$833.57,$0.00
27204461,EAP,HCPCS C1733,,Freezor Max Cardiac Cryoablation Catheter Lrg,"$5,236.00",$0.00,"$5,236.00","$2,843.15","$3,736.93",$0.00,$902.14,"$3,736.93","$3,736.93",$916.78,"$5,236.00",$0.00,"$2,618.00","$4,146.91","$4,188.80",$0.00,$819.43,$0.00,$833.57,$0.00
27204462,EAP,HCPCS C1733,,Freezor Cardiac Cryoablation Catheter Sm,"$3,444.00",$0.00,"$3,444.00","$1,870.09","$2,457.98",$0.00,$593.38,"$2,457.98","$2,457.98",$603.02,"$3,444.00",$0.00,"$1,722.00","$2,727.65","$2,755.20",$0.00,$538.99,$0.00,$548.28,$0.00
27204463,EAP,HCPCS C1733,,Freezor Cardiac Cryoablation Catheter Med,"$3,444.00",$0.00,"$3,444.00","$1,870.09","$2,457.98",$0.00,$593.38,"$2,457.98","$2,457.98",$603.02,"$3,444.00",$0.00,"$1,722.00","$2,727.65","$2,755.20",$0.00,$538.99,$0.00,$548.28,$0.00
27204464,EAP,HCPCS C1733,,Freezor Cardiac Cryoablation Catheter Lrg,"$3,444.00",$0.00,"$3,444.00","$1,870.09","$2,457.98",$0.00,$593.38,"$2,457.98","$2,457.98",$603.02,"$3,444.00",$0.00,"$1,722.00","$2,727.65","$2,755.20",$0.00,$538.99,$0.00,$548.28,$0.00
27204472,EAP,HCPCS C1766,,Flexcath Advance 12 Steerable Sheath - 12 Fr,"$3,307.00",$0.00,"$3,307.00","$1,795.70","$2,360.21",$0.00,$569.78,"$2,360.21","$2,360.21",$579.03,"$3,307.00",$0.00,"$1,653.50","$2,619.14","$2,645.60",$0.00,$517.55,$0.00,$526.47,$0.00
27204473,EAP,HCPCS C1766,,Flexcath 10 Steerable Sheath - 10 Fr,"$2,067.00",$0.00,"$2,067.00","$1,122.38","$1,475.22",$0.00,$356.13,"$1,475.22","$1,475.22",$361.92,"$2,067.00",$0.00,"$1,033.50","$1,637.06","$1,653.60",$0.00,$323.49,$0.00,$329.07,$0.00
27204474,EAP,HCPCS C1730,,Achieve Mapping Catheter Sm,"$2,618.00",$0.00,"$2,618.00","$1,421.57","$1,868.47",$0.00,$451.07,"$1,868.47","$1,868.47",$458.39,"$2,618.00",$0.00,"$1,309.00","$2,073.46","$2,094.40",$0.00,$409.72,$0.00,$416.79,$0.00
27204475,EAP,HCPCS C1730,,Achieve Mapping Catheter Lrg,"$2,618.00",$0.00,"$2,618.00","$1,421.57","$1,868.47",$0.00,$451.07,"$1,868.47","$1,868.47",$458.39,"$2,618.00",$0.00,"$1,309.00","$2,073.46","$2,094.40",$0.00,$409.72,$0.00,$416.79,$0.00
27204478,EAP,HCPCS C1730,,Cath Ep 5-5-5mm Spc Csl Curve 6fr 65cm Mp Dcapl Fix Curve,$965.00,$0.00,$965.00,$524.00,$688.72,$0.00,$166.26,$688.72,$688.72,$168.96,$965.00,$0.00,$482.50,$764.28,$772.00,$0.00,$151.02,$0.00,$153.63,$0.00
27204479,EAP,HCPCS C1769,,Gwire Vasc 325cm .009in Flpy Wrclp Trq Flxb Lng Tpr 2.8cm,$457.00,$0.00,$457.00,$248.15,$326.16,$0.00,$78.74,$326.16,$326.16,$80.02,$457.00,$0.00,$228.50,$361.94,$365.60,$0.00,$71.52,$0.00,$72.75,$0.00
27204480,EAP,HCPCS C1769,,Gwire Vasc 325cm .009in Flpy Wrclp Trq Flxb Lng Tpr 2.2cm,$457.00,$0.00,$457.00,$248.15,$326.16,$0.00,$78.74,$326.16,$326.16,$80.02,$457.00,$0.00,$228.50,$361.94,$365.60,$0.00,$71.52,$0.00,$72.75,$0.00
27204481,EAP,Custom 27204481,,Lubricant Rotaglide,$301.00,$0.00,$301.00,$0.00,$214.82,$0.00,$0.00,$214.82,$214.82,$0.00,$301.00,$0.00,$150.50,$238.39,$240.80,$0.00,$0.00,$0.00,$0.00,$0.00
27204482,EAP,HCPCS C1887,,Cath Infus Mic 1.9fr 1.25mm .5mm 1.5cm Dlv Drblty Dtch Tip,"$5,498.00",$0.00,"$5,498.00","$2,985.41","$3,923.92",$0.00,$947.28,"$3,923.92","$3,923.92",$962.66,"$5,498.00",$0.00,"$2,749.00","$4,354.42","$4,398.40",$0.00,$860.44,$0.00,$875.28,$0.00
27204483,EAP,HCPCS C1887,,Cath Infus Mic 1.9fr 1.25mm .5mm 3cm Dlv Drblty Dtch Tip,"$5,498.00",$0.00,"$5,498.00","$2,985.41","$3,923.92",$0.00,$947.28,"$3,923.92","$3,923.92",$962.66,"$5,498.00",$0.00,"$2,749.00","$4,354.42","$4,398.40",$0.00,$860.44,$0.00,$875.28,$0.00
27204484,EAP,HCPCS C1769,,Gwire Vasc 190cm .014in Radiopq Mrkr Core To Tip Str 3cm,$207.00,$0.00,$207.00,$112.40,$147.74,$0.00,$35.67,$147.74,$147.74,$36.24,$207.00,$0.00,$103.50,$163.94,$165.60,$0.00,$32.40,$0.00,$32.95,$0.00
27204485,EAP,HCPCS C1769,,Gwire Vasc 300cm .014in Radiopq Mrkr Core To Tip Str 3cm,$207.00,$0.00,$207.00,$112.40,$147.74,$0.00,$35.67,$147.74,$147.74,$36.24,$207.00,$0.00,$103.50,$163.94,$165.60,$0.00,$32.40,$0.00,$32.95,$0.00
27204486,EAP,HCPCS C1769,,Gwire Vasc 300cm .014in Strbl Core To Tip Radiopq Str 3cm,$207.00,$0.00,$207.00,$112.40,$147.74,$0.00,$35.67,$147.74,$147.74,$36.24,$207.00,$0.00,$103.50,$163.94,$165.60,$0.00,$32.40,$0.00,$32.95,$0.00
27204487,EAP,HCPCS C1769,,Gwire Vasc 180cm .014in Radiopq Mrkr Str 3cm A Fldr Fc,$207.00,$0.00,$207.00,$112.40,$147.74,$0.00,$35.67,$147.74,$147.74,$36.24,$207.00,$0.00,$103.50,$163.94,$165.60,$0.00,$32.40,$0.00,$32.95,$0.00
27204488,EAP,HCPCS C1769,,Gwire Vasc 300cm .014in Radiopq Mrkr Str 3cm A Fldr Fc,$207.00,$0.00,$207.00,$112.40,$147.74,$0.00,$35.67,$147.74,$147.74,$36.24,$207.00,$0.00,$103.50,$163.94,$165.60,$0.00,$32.40,$0.00,$32.95,$0.00
27204489,EAP,HCPCS C1769,,Gwire Vasc 190cm .014in Str 3cm Htorq Whspr Ms Ss Hydphi,$217.00,$0.00,$217.00,$117.83,$154.87,$0.00,$37.39,$154.87,$154.87,$37.99,$217.00,$0.00,$108.50,$171.86,$173.60,$0.00,$33.96,$0.00,$34.55,$0.00
27204490,EAP,HCPCS C1757,,Cath Guid .014in Rnd 6fr .07+ In 140cm 6mm S Tp Aspirat Cmpt,"$1,513.00",$0.00,"$1,513.00",$0.00,"$1,079.83",$0.00,$0.00,"$1,079.83","$1,079.83",$0.00,"$1,513.00",$0.00,$756.50,"$1,198.30","$1,210.40",$0.00,$0.00,$0.00,$0.00,$0.00
27204491,EAP,HCPCS C1757,,Cath Guid .014in 1mm 7fr 140cm 6mm Lg Xtrt Lum Rnd S Tp Shrt,"$1,441.00",$0.00,"$1,441.00",$0.00,"$1,028.44",$0.00,$0.00,"$1,028.44","$1,028.44",$0.00,"$1,441.00",$0.00,$720.50,"$1,141.27","$1,152.80",$0.00,$0.00,$0.00,$0.00,$0.00
27204492,EAP,HCPCS C1769,,Gwire Vasc 180cm .035in Jkt Core To Tip Atrm 1.5mm Rad Std J,$117.00,$0.00,$117.00,$63.53,$83.50,$0.00,$20.16,$83.50,$83.50,$20.49,$117.00,$0.00,$58.50,$92.66,$93.60,$0.00,$18.31,$0.00,$18.63,$0.00
27204493,EAP,HCPCS C1769,,Gwire Vasc 260cm .035in Jkt Core To Tip Atrm 1.5mm Rad Std J,$131.00,$0.00,$131.00,$71.13,$93.49,$0.00,$22.57,$93.49,$93.49,$22.94,$131.00,$0.00,$65.50,$103.75,$104.80,$0.00,$20.50,$0.00,$20.86,$0.00
27204494,EAP,HCPCS C1769,,Guidewire Vasc .014in 300cm 3cm Strg Med Sprt Htorq Whspr Ms,$207.00,$0.00,$207.00,$112.40,$147.74,$0.00,$35.67,$147.74,$147.74,$36.24,$207.00,$0.00,$103.50,$163.94,$165.60,$0.00,$32.40,$0.00,$32.95,$0.00
27204495,EAP,HCPCS C1887,,Microcatheter Headway 21,"$2,288.00",$0.00,"$2,288.00","$1,242.38","$1,632.95",$0.00,$394.21,"$1,632.95","$1,632.95",$400.61,"$2,288.00",$0.00,"$1,144.00","$1,812.10","$1,830.40",$0.00,$358.07,$0.00,$364.25,$0.00
27204496,EAP,HCPCS C1887,,Microcatheter Headway Duo 17,"$2,563.00",$0.00,"$2,563.00","$1,391.71","$1,829.21",$0.00,$441.59,"$1,829.21","$1,829.21",$448.76,"$2,563.00",$0.00,"$1,281.50","$2,029.90","$2,050.40",$0.00,$401.11,$0.00,$408.03,$0.00
27204497,EAP,HCPCS C1887,,6fr Jr 5 Guide Catheter,$124.00,$0.00,$124.00,$67.33,$88.50,$0.00,$21.36,$88.50,$88.50,$21.71,$124.00,$0.00,$62.00,$98.21,$99.20,$0.00,$19.41,$0.00,$19.74,$0.00
27204498,EAP,HCPCS C1887,,6fr Lcb Guide Catheter,$124.00,$0.00,$124.00,$67.33,$88.50,$0.00,$21.36,$88.50,$88.50,$21.71,$124.00,$0.00,$62.00,$98.21,$99.20,$0.00,$19.41,$0.00,$19.74,$0.00
27204499,EAP,HCPCS C1887,,7fr Al2 Guide Catheter,$124.00,$0.00,$124.00,$67.33,$88.50,$0.00,$21.36,$88.50,$88.50,$21.71,$124.00,$0.00,$62.00,$98.21,$99.20,$0.00,$19.41,$0.00,$19.74,$0.00
27204500,EAP,HCPCS C1887,,7fr Al 1.5 Guide Catheter,$124.00,$0.00,$124.00,$67.33,$88.50,$0.00,$21.36,$88.50,$88.50,$21.71,$124.00,$0.00,$62.00,$98.21,$99.20,$0.00,$19.41,$0.00,$19.74,$0.00
27204501,EAP,HCPCS C1887,,7fr Al 1.0 Guide Catheter,$124.00,$0.00,$124.00,$67.33,$88.50,$0.00,$21.36,$88.50,$88.50,$21.71,$124.00,$0.00,$62.00,$98.21,$99.20,$0.00,$19.41,$0.00,$19.74,$0.00
27204502,EAP,HCPCS C1887,,6fr Mradial Guide Catheter,$130.00,$0.00,$130.00,$70.59,$92.78,$0.00,$22.40,$92.78,$92.78,$22.76,$130.00,$0.00,$65.00,$102.96,$104.00,$0.00,$20.35,$0.00,$20.70,$0.00
27204503,EAP,HCPCS C1887,,6fr Lara Curve Guide Catheter,$124.00,$0.00,$124.00,$67.33,$88.50,$0.00,$21.36,$88.50,$88.50,$21.71,$124.00,$0.00,$62.00,$98.21,$99.20,$0.00,$19.41,$0.00,$19.74,$0.00
27204504,EAP,HCPCS C1887,,6fr Mac3030 Guide Catheter,$124.00,$0.00,$124.00,$67.33,$88.50,$0.00,$21.36,$88.50,$88.50,$21.71,$124.00,$0.00,$62.00,$98.21,$99.20,$0.00,$19.41,$0.00,$19.74,$0.00
27204505,EAP,HCPCS C1887,,6fr Ima Guide Catheter,$124.00,$0.00,$124.00,$67.33,$88.50,$0.00,$21.36,$88.50,$88.50,$21.71,$124.00,$0.00,$62.00,$98.21,$99.20,$0.00,$19.41,$0.00,$19.74,$0.00
27204506,EAP,HCPCS C1887,,5fr Jr4 Diagnostic Catheter 125cm,$193.00,$0.00,$193.00,$104.80,$137.74,$0.00,$33.25,$137.74,$137.74,$33.79,$193.00,$0.00,$96.50,$152.86,$154.40,$0.00,$30.20,$0.00,$30.73,$0.00
27204507,EAP,HCPCS C1887,,5fr Jl4 Diagnostic Catheter 125cm,$193.00,$0.00,$193.00,$104.80,$137.74,$0.00,$33.25,$137.74,$137.74,$33.79,$193.00,$0.00,$96.50,$152.86,$154.40,$0.00,$30.20,$0.00,$30.73,$0.00
27204508,EAP,HCPCS C1724,,Cath Athrcm 135cm .58in Rtbl Rtl+ 2mm Precnct Exchgl Rot,"$3,409.00",$0.00,"$3,409.00",$0.00,"$2,433.00",$0.00,$0.00,"$2,433.00","$2,433.00",$0.00,"$3,409.00",$0.00,"$1,704.50","$2,699.93","$2,727.20",$0.00,$0.00,$0.00,$0.00,$0.00
27204509,EAP,HCPCS C1724,,Cath Athrcm 135cm Rtbl Rtl+ 2.15mm Bur Precnct Exchgl Rot,"$3,409.00",$0.00,"$3,409.00",$0.00,"$2,433.00",$0.00,$0.00,"$2,433.00","$2,433.00",$0.00,"$3,409.00",$0.00,"$1,704.50","$2,699.93","$2,727.20",$0.00,$0.00,$0.00,$0.00,$0.00
27204510,EAP,HCPCS C1724,,Cath Athrcm 135cm Rtbl Rtl+ 2.25mm Bur Precnct Exchgl Rot,"$3,409.00",$0.00,"$3,409.00",$0.00,"$2,433.00",$0.00,$0.00,"$2,433.00","$2,433.00",$0.00,"$3,409.00",$0.00,"$1,704.50","$2,699.93","$2,727.20",$0.00,$0.00,$0.00,$0.00,$0.00
27204511,EAP,HCPCS C1724,,Cath Athrcm 135cm Rtbl Rtl+ 2.38mm Bur Precnct Exchgl Rot,"$3,409.00",$0.00,"$3,409.00",$0.00,"$2,433.00",$0.00,$0.00,"$2,433.00","$2,433.00",$0.00,"$3,409.00",$0.00,"$1,704.50","$2,699.93","$2,727.20",$0.00,$0.00,$0.00,$0.00,$0.00
27204512,EAP,HCPCS C1724,,Cath Athrcm 135cm Rtbl Rtl+ 2.5mm Bur Precnct Exchgl Rot Adv,"$3,409.00",$0.00,"$3,409.00",$0.00,"$2,433.00",$0.00,$0.00,"$2,433.00","$2,433.00",$0.00,"$3,409.00",$0.00,"$1,704.50","$2,699.93","$2,727.20",$0.00,$0.00,$0.00,$0.00,$0.00
27204513,EAP,HCPCS C1725,,Otw Mini Trek Ii 1.20 X 6mm Bdc,$551.00,$0.00,$551.00,$299.19,$393.25,$0.00,$94.93,$393.25,$393.25,$96.48,$551.00,$0.00,$275.50,$436.39,$440.80,$0.00,$86.23,$0.00,$87.72,$0.00
27204514,EAP,HCPCS C1725,,Otw Mini Trek Ii 1.20 X 8mm Bdc,$551.00,$0.00,$551.00,$299.19,$393.25,$0.00,$94.93,$393.25,$393.25,$96.48,$551.00,$0.00,$275.50,$436.39,$440.80,$0.00,$86.23,$0.00,$87.72,$0.00
27204515,EAP,HCPCS C1725,,Otw Mini Trek Ii 1.20 X 12mm Bdc,$551.00,$0.00,$551.00,$299.19,$393.25,$0.00,$94.93,$393.25,$393.25,$96.48,$551.00,$0.00,$275.50,$436.39,$440.80,$0.00,$86.23,$0.00,$87.72,$0.00
27204516,EAP,HCPCS C1725,,Otw Mini Trek Ii 1.20 X 15mm Bdc,$551.00,$0.00,$551.00,$299.19,$393.25,$0.00,$94.93,$393.25,$393.25,$96.48,$551.00,$0.00,$275.50,$436.39,$440.80,$0.00,$86.23,$0.00,$87.72,$0.00
27204517,EAP,HCPCS C1725,,Otw Mini Trek Ii 1.20 X 20mm Bdc,$551.00,$0.00,$551.00,$299.19,$393.25,$0.00,$94.93,$393.25,$393.25,$96.48,$551.00,$0.00,$275.50,$436.39,$440.80,$0.00,$86.23,$0.00,$87.72,$0.00
27204518,EAP,HCPCS C1725,,Otw Mini Trek Ii 1.50 X 6mm Bdc,$551.00,$0.00,$551.00,$299.19,$393.25,$0.00,$94.93,$393.25,$393.25,$96.48,$551.00,$0.00,$275.50,$436.39,$440.80,$0.00,$86.23,$0.00,$87.72,$0.00
27204519,EAP,HCPCS C1725,,Otw Mini Trek Ii 1.50 X 20mm Bdc,$551.00,$0.00,$551.00,$299.19,$393.25,$0.00,$94.93,$393.25,$393.25,$96.48,$551.00,$0.00,$275.50,$436.39,$440.80,$0.00,$86.23,$0.00,$87.72,$0.00
27204520,EAP,HCPCS C1725,,Otw Mini Trek Ii 2.00 X 6mm Bdc,$551.00,$0.00,$551.00,$299.19,$393.25,$0.00,$94.93,$393.25,$393.25,$96.48,$551.00,$0.00,$275.50,$436.39,$440.80,$0.00,$86.23,$0.00,$87.72,$0.00
27204521,EAP,HCPCS C1725,,Otw Mini Trek Ii 2.00 X 20mm Bdc,$551.00,$0.00,$551.00,$299.19,$393.25,$0.00,$94.93,$393.25,$393.25,$96.48,$551.00,$0.00,$275.50,$436.39,$440.80,$0.00,$86.23,$0.00,$87.72,$0.00
27204522,EAP,HCPCS C1725,,Mini Trek Rx 1.20 X 6mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204523,EAP,HCPCS C1725,,Mini Trek Rx 1.20 X 8mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204524,EAP,HCPCS C1725,,Mini Trek Rx 1.20 X 12mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204525,EAP,HCPCS C1725,,Mini Trek Rx 1.20 X 15mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204526,EAP,HCPCS C1725,,Mini Trek Rx 1.20 X 20mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204527,EAP,HCPCS C1725,,Mini Trek Rx 1.50 X 6mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204528,EAP,HCPCS C1725,,Mini Trek Rx 1.50 X 8mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204529,EAP,HCPCS C1725,,Mini Trek Rx 1.50 X 12mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204530,EAP,HCPCS C1725,,Mini Trek Rx 1.50 X 20mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204531,EAP,HCPCS C1725,,Mini Trek Rx 2.00 X 6mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204532,EAP,HCPCS C1725,,Mini Trek Rx 2.00 X 25mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204533,EAP,HCPCS C1725,,Mini Trek Rx 2.00 X 30mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204534,EAP,HCPCS C1725,,Mini Trek Rx 2.25 X 6mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204535,EAP,HCPCS C1725,,Mini Trek Rx 2.25 X 8mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204536,EAP,HCPCS C1725,,Mini Trek Rx 2.25 X 12mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204537,EAP,HCPCS C1725,,Mini Trek Rx 2.25 X 15mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204538,EAP,HCPCS C1725,,Mini Trek Rx 2.25 X 20mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204539,EAP,HCPCS C1725,,Mini Trek Rx 2.25 X 25mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204540,EAP,HCPCS C1725,,Mini Trek Rx 2.25 X 30mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204541,EAP,HCPCS C1725,,Trek Rx 2.50 X 6mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204542,EAP,HCPCS C1725,,Trek Rx 2.50 X 30mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204543,EAP,HCPCS C1725,,Trek Rx 2.75 X 6mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204544,EAP,HCPCS C1725,,Trek Rx 2.75 X 8mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204545,EAP,HCPCS C1725,,Trek Rx 2.75 X 12mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204546,EAP,HCPCS C1725,,Trek Rx 2.75 X 15mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204547,EAP,HCPCS C1725,,Trek Rx 2.75 X 20mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204548,EAP,HCPCS C1725,,Trek Rx 2.75 X 25mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204549,EAP,HCPCS C1725,,Trek Rx 2.75 X 30mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204550,EAP,HCPCS C1725,,Trek Rx 3.00 X 6mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204551,EAP,HCPCS C1725,,Trek Rx 3.00 X 30mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204552,EAP,HCPCS C1725,,Trek Rx 3.25 X 6mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204553,EAP,HCPCS C1725,,Trek Rx 3.25 X 8mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204554,EAP,HCPCS C1725,,Trek Rx 3.25 X 12mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204555,EAP,HCPCS C1725,,Trek Rx 3.25 X 15mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204556,EAP,HCPCS C1725,,Trek Rx 3.25 X 20mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204557,EAP,HCPCS C1725,,Trek Rx 3.25 X 25mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204558,EAP,HCPCS C1725,,Trek Rx 3.25 X 30mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204559,EAP,HCPCS C1725,,Trek Rx 3.50 X 6mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204560,EAP,HCPCS C1725,,Trek Rx 3.50 X 30mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204561,EAP,HCPCS C1725,,Trek Rx 3.75 X 6mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204562,EAP,HCPCS C1725,,Trek Rx 3.75 X 8mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204563,EAP,HCPCS C1725,,Trek Rx 3.75 X 12mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204564,EAP,HCPCS C1725,,Trek Rx 3.75 X 15mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204565,EAP,HCPCS C1725,,Trek Rx 3.75 X 20mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204566,EAP,HCPCS C1725,,Trek Rx 3.75 X 25mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204567,EAP,HCPCS C1725,,Trek Rx 3.75 X 30mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204568,EAP,HCPCS C1725,,Trek Rx 4.00 X 06mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204569,EAP,HCPCS C1725,,Trek Rx 4.00 X 20mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204570,EAP,HCPCS C1725,,Trek Rx 4.00 X 25mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204571,EAP,HCPCS C1725,,Trek Rx 4.00 X 30mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204572,EAP,HCPCS C1725,,Nc Trek Rx 1.50 X 06mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204573,EAP,HCPCS C1725,,Nc Trek Rx 1.50 X 08mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204574,EAP,HCPCS C1725,,Nc Trek Rx 1.50 X 12mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204575,EAP,HCPCS C1725,,Nc Trek Rx 1.50 X 15mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204576,EAP,HCPCS C1725,,Nc Trek Rx 1.50 X 20mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204577,EAP,HCPCS C1725,,Nc Trek Rx 2.00 X 15mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204578,EAP,HCPCS C1725,,Nc Trek Rx 2.00 X 20mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204579,EAP,HCPCS C1725,,Nc Trek Rx 2.25 X 06mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204580,EAP,HCPCS C1725,,Nc Trek Rx 3.00 X 8mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204581,EAP,HCPCS C1725,,Nc Trek Rx 3.25 X 06mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204582,EAP,HCPCS C1725,,Nc Trek Rx 4.50 X 20mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204583,EAP,HCPCS C1725,,Nc Trek Rx 5.00 X 20mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204584,EAP,HCPCS C1769,,Asahi Prowater Ptca Guide Wire 180cm,$207.00,$0.00,$207.00,$112.40,$147.74,$0.00,$35.67,$147.74,$147.74,$36.24,$207.00,$0.00,$103.50,$163.94,$165.60,$0.00,$32.40,$0.00,$32.95,$0.00
27204585,EAP,HCPCS C1769,,Hi-torque Iron Man Guide Wire,$217.00,$0.00,$217.00,$117.83,$154.87,$0.00,$37.39,$154.87,$154.87,$37.99,$217.00,$0.00,$108.50,$171.86,$173.60,$0.00,$33.96,$0.00,$34.55,$0.00
27204586,EAP,HCPCS C1769,,Asahi Prowater Ptca Guide Wire 300cm,$207.00,$0.00,$207.00,$112.40,$147.74,$0.00,$35.67,$147.74,$147.74,$36.24,$207.00,$0.00,$103.50,$163.94,$165.60,$0.00,$32.40,$0.00,$32.95,$0.00
27204587,EAP,Custom 27204587,,Temporary Pacing Catheter 5fr,$509.00,$0.00,$509.00,$0.00,$363.27,$0.00,$0.00,$363.27,$363.27,$0.00,$509.00,$0.00,$254.50,$403.13,$407.20,$0.00,$0.00,$0.00,$0.00,$0.00
27204588,EAP,HCPCS C1757,,Cath Dx 135cm 4.2fr Fetch 2 .014in Hydphi Rapex Aspirat,$63.00,$0.00,$63.00,$0.00,$44.96,$0.00,$0.00,$44.96,$44.96,$0.00,$63.00,$0.00,$31.50,$49.90,$50.40,$0.00,$0.00,$0.00,$0.00,$0.00
27204589,EAP,HCPCS C1769,,Hi Torque 150 Gide Wire 0.014 Straight Tip 3.0 X 190cm,$207.00,$0.00,$207.00,$112.40,$147.74,$0.00,$35.67,$147.74,$147.74,$36.24,$207.00,$0.00,$103.50,$163.94,$165.60,$0.00,$32.40,$0.00,$32.95,$0.00
27204590,EAP,HCPCS C1725,,Nc Trek Rx 2.00 X 06mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204591,EAP,HCPCS C1725,,Nc Trek Rx 2.50 X 6mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204592,EAP,HCPCS C1725,,Nc Trek Rx 2.75 X 06mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204593,EAP,HCPCS C1725,,Nc Trek Rx 3.00 X 6mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204594,EAP,HCPCS C1725,,Nc Trek Rx 3.50 X 6mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204595,EAP,HCPCS C1725,,Nc Trek Rx 3.50 X 25mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204596,EAP,HCPCS C1725,,Nc Trek Rx 3.75 X 20mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204597,EAP,HCPCS C1725,,Nc Trek Rx 5.00 X 08mm Bdc,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204598,EAP,HCPCS C1769,,Extn Gwire Vasc Asa,$207.00,$0.00,$207.00,$112.40,$147.74,$0.00,$35.67,$147.74,$147.74,$36.24,$207.00,$0.00,$103.50,$163.94,$165.60,$0.00,$32.40,$0.00,$32.95,$0.00
27204599,EAP,HCPCS C1877,,Headway Duo Microtheter,"$2,307.00",$0.00,"$2,307.00","$1,252.70","$1,646.51",$0.00,$397.48,"$1,646.51","$1,646.51",$403.94,"$2,307.00",$0.00,"$1,153.50","$1,827.14","$1,845.60",$0.00,$361.05,$0.00,$367.27,$0.00
27204600,EAP,HCPCS C2628,,Compliant Occlusion Balloon 4.0mm X 10mm,"$3,473.00",$0.00,"$3,473.00",$0.00,"$2,478.68",$0.00,$0.00,"$2,478.68","$2,478.68",$0.00,"$3,473.00",$0.00,"$1,736.50","$2,750.62","$2,778.40",$0.00,$0.00,$0.00,$0.00,$0.00
27204601,EAP,HCPCS C2628,,Compliant Occlusion Balloon 4.0mm X 15mm,"$3,473.00",$0.00,"$3,473.00",$0.00,"$2,478.68",$0.00,$0.00,"$2,478.68","$2,478.68",$0.00,"$3,473.00",$0.00,"$1,736.50","$2,750.62","$2,778.40",$0.00,$0.00,$0.00,$0.00,$0.00
27204602,EAP,HCPCS C2628,,Compliant Occlusion Balloon 4.0mm X 20mm,"$3,473.00",$0.00,"$3,473.00",$0.00,"$2,478.68",$0.00,$0.00,"$2,478.68","$2,478.68",$0.00,"$3,473.00",$0.00,"$1,736.50","$2,750.62","$2,778.40",$0.00,$0.00,$0.00,$0.00,$0.00
27204603,EAP,HCPCS C2628,,Occlusion Balloon Xc Catheter 4mm X 11mm,"$3,647.00",$0.00,"$3,647.00",$0.00,"$2,602.86",$0.00,$0.00,"$2,602.86","$2,602.86",$0.00,"$3,647.00",$0.00,"$1,823.50","$2,888.42","$2,917.60",$0.00,$0.00,$0.00,$0.00,$0.00
27204604,EAP,HCPCS C1725,,Cath Baldilat 5fr 2mm 25mm Otw Flxb Tung Mrkr Trnstls Tip,$551.00,$0.00,$551.00,$299.19,$393.25,$0.00,$94.93,$393.25,$393.25,$96.48,$551.00,$0.00,$275.50,$436.39,$440.80,$0.00,$86.23,$0.00,$87.72,$0.00
27204605,EAP,HCPCS C1725,,Cath Baldilat 5fr 2mm 30mm Otw Flxb Tung Mrkr Trnstls Tip,$551.00,$0.00,$551.00,$299.19,$393.25,$0.00,$94.93,$393.25,$393.25,$96.48,$551.00,$0.00,$275.50,$436.39,$440.80,$0.00,$86.23,$0.00,$87.72,$0.00
27204606,EAP,HCPCS C1725,,Cath Baldilat Ult Lp 5fr 4.5mm 12mm Coron 2 Lum Rapex Flxb,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204607,EAP,HCPCS C1725,,Cath Baldilat Ult Lp 5fr 4.5mm 15mm Coron 2 Lum Rapex Flxb,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204608,EAP,HCPCS C1725,,Cath Baldilat Ult Lp 5fr 5mm 12mm Coron 2 Lum Rapex Flxb,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204609,EAP,HCPCS C1725,,Cath Baldilat Ult Lp 5fr 5mm 15mm Coron 2 Lum Rapex Flxb,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204610,EAP,HCPCS C1725,,Cath Baldilat Rnd 4.5mm 12mm 2 Mrkr Rapex Ml Lr Smth Flxb,$362.00,$0.00,$362.00,$196.57,$258.36,$0.00,$62.37,$258.36,$258.36,$63.38,$362.00,$0.00,$181.00,$286.70,$289.60,$0.00,$56.65,$0.00,$57.63,$0.00
27204611,EAP,HCPCS C1769,,Cath Baldilat Rnd 2mm 12mm 2 Mrkr Rapex Ml Lr Smth Flxb,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
27204612,EAP,Custom 27204612,,Valve Hmsts Coplt 1 Un Bldbck Cntrl Vlv,$137.00,$0.00,$137.00,$0.00,$97.78,$0.00,$0.00,$97.78,$97.78,$0.00,$137.00,$0.00,$68.50,$108.50,$109.60,$0.00,$0.00,$0.00,$0.00,$0.00
27204613,EAP,HCPCS C1757,,Solitaire Fr 4x40,"$11,643.00",$0.00,"$11,643.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$11,643.00",$0.00,"$5,821.50","$9,221.26","$9,314.40",$0.00,$0.00,$0.00,$0.00,$0.00
27204614,EAP,Custom 27204614,,Needle Biop 17ga 13.8cm Trgd Coax Disp Mnpty Mxcor,$153.00,$0.00,$153.00,$0.00,$109.20,$0.00,$0.00,$109.20,$109.20,$0.00,$153.00,$0.00,$76.50,$121.18,$122.40,$0.00,$0.00,$0.00,$0.00,$0.00
27204615,EAP,Custom 27204615,,Needle Biop 18ga 16cm 22mm Mxcor Automate Strl Disp,$412.00,$0.00,$412.00,$0.00,$294.04,$0.00,$0.00,$294.04,$294.04,$0.00,$412.00,$0.00,$206.00,$326.30,$329.60,$0.00,$0.00,$0.00,$0.00,$0.00
27204616,EAP,HCPCS C1769,,Gwire Vasc .012in 200cm 55cm Sft Pshp Acces Lgth Synchro2,"$1,283.00",$0.00,"$1,283.00",$696.67,$915.68,$0.00,$221.05,$915.68,$915.68,$224.64,"$1,283.00",$0.00,$641.50,"$1,016.14","$1,026.40",$0.00,$200.79,$0.00,$204.25,$0.00
27204617,EAP,HCPCS C1769,,Gwire Vasc .012in 300cm 55cm Sft Pshp Acces Lgth Synchro2,"$1,593.00",$0.00,"$1,593.00",$865.00,"$1,136.92",$0.00,$274.47,"$1,136.92","$1,136.92",$278.92,"$1,593.00",$0.00,$796.50,"$1,261.66","$1,274.40",$0.00,$249.30,$0.00,$253.61,$0.00
27204618,EAP,Custom 27204618,,Drsg 6x3.5in Gntl Ps Strp Anmc Flxb Brthbl Ionic Slvr Sil,$53.00,$0.00,$53.00,$0.00,$37.83,$0.00,$0.00,$37.83,$37.83,$0.00,$53.00,$0.00,$26.50,$41.98,$42.40,$0.00,$0.00,$0.00,$0.00,$0.00
27204619,EAP,Custom 27204619,,Drsg 10x3.5in Gntl Ps Strp Anmc Flxb Brthbl Ionic Slvr Sil,$62.00,$0.00,$62.00,$0.00,$44.25,$0.00,$0.00,$44.25,$44.25,$0.00,$62.00,$0.00,$31.00,$49.10,$49.60,$0.00,$0.00,$0.00,$0.00,$0.00
27204620,EAP,Custom 27204620,,Drsg 14x3.5in Gntl Ps Nstn Adh Hi Abs Sil Latex Optfm Ag,$72.00,$0.00,$72.00,$0.00,$51.39,$0.00,$0.00,$51.39,$51.39,$0.00,$72.00,$0.00,$36.00,$57.02,$57.60,$0.00,$0.00,$0.00,$0.00,$0.00
27204621,EAP,Custom 27204621,,Sensor Flw Microflow Bynt Hndl Flxb Neck 1.5mm Disp,"$2,612.00",$0.00,"$2,612.00",$0.00,"$1,864.18",$0.00,$0.00,"$1,864.18","$1,864.18",$0.00,"$2,612.00",$0.00,"$1,306.00","$2,068.70","$2,089.60",$0.00,$0.00,$0.00,$0.00,$0.00
27204622,EAP,Custom 27204622,,Probe Surg Microflow Bynt Hndl Flxb Neck Disp 2mm,"$2,612.00",$0.00,"$2,612.00",$0.00,"$1,864.18",$0.00,$0.00,"$1,864.18","$1,864.18",$0.00,"$2,612.00",$0.00,"$1,306.00","$2,068.70","$2,089.60",$0.00,$0.00,$0.00,$0.00,$0.00
27204623,EAP,Custom 27204623,,Probe Surg Microflow Bynt Hndl Flxb Neck Disp 3mm,"$2,612.00",$0.00,"$2,612.00",$0.00,"$1,864.18",$0.00,$0.00,"$1,864.18","$1,864.18",$0.00,"$2,612.00",$0.00,"$1,306.00","$2,068.70","$2,089.60",$0.00,$0.00,$0.00,$0.00,$0.00
27204624,EAP,HCPCS C1769,,"Gwire Vsc 190cm .014"" Mkr Tp Str 3cm Htrq Bl Mwt U",$207.00,$0.00,$207.00,$112.40,$147.74,$0.00,$35.67,$147.74,$147.74,$36.24,$207.00,$0.00,$103.50,$163.94,$165.60,$0.00,$32.40,$0.00,$32.95,$0.00
27204625,EAP,HCPCS C1788,,Tray Infus Port Std 1 Lum Plflw Cath Introd Ndl,$525.00,$0.00,$525.00,$236.25,$374.69,$0.00,$90.45,$374.69,$374.69,$91.92,$525.00,$0.00,$262.50,$415.80,$420.00,$0.00,$82.16,$0.00,$83.58,$0.00
27204626,EAP,HCPCS C1788,,Tray Infus Port Lp 1 Lum Introd Ndl Tnl Tl Cath 6,$525.00,$0.00,$525.00,$236.25,$374.69,$0.00,$90.45,$374.69,$374.69,$91.92,$525.00,$0.00,$262.50,$415.80,$420.00,$0.00,$82.16,$0.00,$83.58,$0.00
27204627,EAP,HCPCS C1788,,Tray Infus Port J Lp 1 Lum Cath Introd Ndl Gwire,$525.00,$0.00,$525.00,$285.08,$374.69,$0.00,$90.45,$374.69,$374.69,$91.92,$525.00,$0.00,$262.50,$415.80,$420.00,$0.00,$82.16,$0.00,$83.58,$0.00
27204628,EAP,HCPCS C1757,,Flow Restoration Catheter (6-10mm) X 155cm,"$11,238.00",$0.00,"$11,238.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$11,238.00",$0.00,"$5,619.00","$8,900.50","$8,990.40",$0.00,$0.00,$0.00,$0.00,$0.00
27204629,EAP,HCPCS C1757,,Flow Restoration Catheter (11-14mm) X 155cm,"$11,238.00",$0.00,"$11,238.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$11,238.00",$0.00,"$5,619.00","$8,900.50","$8,990.40",$0.00,$0.00,$0.00,$0.00,$0.00
27204630,EAP,HCPCS C1757,,Flow Restoration Catheter (15-18mm) X 155cm,"$11,238.00",$0.00,"$11,238.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$11,238.00",$0.00,"$5,619.00","$8,900.50","$8,990.40",$0.00,$0.00,$0.00,$0.00,$0.00
27204631,EAP,HCPCS C1757,,Aspiration Guide Catheter 20f X 95cm,"$5,738.00",$0.00,"$5,738.00",$0.00,"$4,095.21",$0.00,$0.00,"$4,095.21","$4,095.21",$0.00,"$5,738.00",$0.00,"$2,869.00","$4,544.50","$4,590.40",$0.00,$0.00,$0.00,$0.00,$0.00
27204632,EAP,HCPCS C1773,,Retraction Aspirator Device,$787.00,$0.00,$787.00,$427.34,$561.68,$0.00,$135.60,$561.68,$561.68,$137.80,$787.00,$0.00,$393.50,$623.30,$629.60,$0.00,$123.17,$0.00,$125.29,$0.00
27204633,EAP,HCPCS C1757,,Trevo Xp 6mm X 25mm,"$13,402.00",$0.00,"$13,402.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$13,402.00",$0.00,"$6,701.00","$10,614.38","$10,721.60",$0.00,$0.00,$0.00,$0.00,$0.00
27204634,EAP,HCPCS C1757,,Trevo Xp Provue Retriever 4.0 X 30mm,"$14,072.00",$0.00,"$14,072.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$14,072.00",$0.00,"$7,036.00","$11,145.02","$11,257.60",$0.00,$0.00,$0.00,$0.00,$0.00
27204635,EAP,HCPCS C1887,,"Micrcatheter Std Straight, 2 Tip-marker, 150cm-15cm","$2,324.00",$0.00,"$2,324.00","$1,261.93","$1,658.64",$0.00,$400.41,"$1,658.64","$1,658.64",$406.91,"$2,324.00",$0.00,"$1,162.00","$1,840.61","$1,859.20",$0.00,$363.71,$0.00,$369.98,$0.00
27204636,EAP,HCPCS C1887,,"Microcatheter Standard Pre-shaped 45, 2-tip Mkr, 150cm/7.5cm","$2,381.00",$0.00,"$2,381.00","$1,292.88","$1,699.32",$0.00,$410.23,"$1,699.32","$1,699.32",$416.89,"$2,381.00",$0.00,"$1,190.50","$1,885.75","$1,904.80",$0.00,$372.63,$0.00,$379.06,$0.00
27204637,EAP,HCPCS C1887,,"Micrcatheter Std Pre-shp 90, 2-tip Mkr, 150cm/7.5cm","$2,381.00",$0.00,"$2,381.00","$1,292.88","$1,699.32",$0.00,$410.23,"$1,699.32","$1,699.32",$416.89,"$2,381.00",$0.00,"$1,190.50","$1,885.75","$1,904.80",$0.00,$372.63,$0.00,$379.06,$0.00
27204639,EAP,HCPCS C1769,,Guidewire Vascular Str .035in 150cm Bentson Smooth,$33.00,$0.00,$33.00,$17.92,$23.55,$0.00,$5.69,$23.55,$23.55,$5.78,$33.00,$0.00,$16.50,$26.14,$26.40,$0.00,$5.16,$0.00,$5.25,$0.00
27204640,EAP,HCPCS C1725,,Catheter Baldilat .035in 8fr 18mm 80cm 4cm Gold,$722.00,$0.00,$722.00,$392.05,$515.29,$0.00,$124.40,$515.29,$515.29,$126.42,$722.00,$0.00,$361.00,$571.82,$577.60,$0.00,$112.99,$0.00,$114.94,$0.00
27204641,EAP,HCPCS C1725,,Catheter Baldilat .035in 8fr 16mm 80cm 4cm Gold,$722.00,$0.00,$722.00,$392.05,$515.29,$0.00,$124.40,$515.29,$515.29,$126.42,$722.00,$0.00,$361.00,$571.82,$577.60,$0.00,$112.99,$0.00,$114.94,$0.00
27204642,EAP,HCPCS C1725,,Catheter Baldilat .035in 7fr 14mm 80cm 4cm Gold,$688.00,$0.00,$688.00,$373.58,$491.03,$0.00,$118.54,$491.03,$491.03,$120.46,$688.00,$0.00,$344.00,$544.90,$550.40,$0.00,$107.67,$0.00,$109.53,$0.00
27204643,EAP,HCPCS C1725,,Catheter Xtrt 120cm 14fr Xl .035in Str Tip Gwire,"$1,956.00",$0.00,"$1,956.00","$1,062.11","$1,396.00",$0.00,$337.01,"$1,396.00","$1,396.00",$342.48,"$1,956.00",$0.00,$978.00,"$1,549.15","$1,564.80",$0.00,$306.11,$0.00,$311.40,$0.00
27204644,EAP,HCPCS C1757,,Set Introd 70cm 14fr 15mm Ck-z Trchbr Gnt Rsch,$749.00,$0.00,$749.00,$0.00,$534.56,$0.00,$0.00,$534.56,$534.56,$0.00,$749.00,$0.00,$374.50,$593.21,$599.20,$0.00,$0.00,$0.00,$0.00,$0.00
27204645,EAP,HCPCS C1757,,Coil Embl 132cm .064mm Penumbra Ruby Ace 5max,"$5,484.00",$0.00,"$5,484.00",$0.00,"$3,913.93",$0.00,$0.00,"$3,913.93","$3,913.93",$0.00,"$5,484.00",$0.00,"$2,742.00","$4,343.33","$4,387.20",$0.00,$0.00,$0.00,$0.00,$0.00
27204647,EAP,HCPCS C1894,,Introducer Shth Ped 5fr 21ga 40cm 7cm Gry Hub,$103.00,$0.00,$103.00,$55.93,$73.51,$0.00,$17.75,$73.51,$73.51,$18.03,$103.00,$0.00,$51.50,$81.58,$82.40,$0.00,$16.12,$0.00,$16.40,$0.00
27204648,EAP,HCPCS C1894,,Introducer Shth Ped 6fr 21ga 40cm 7cm Grn Hub,$108.00,$0.00,$108.00,$58.64,$77.08,$0.00,$18.61,$77.08,$77.08,$18.91,$108.00,$0.00,$54.00,$85.54,$86.40,$0.00,$16.90,$0.00,$17.19,$0.00
27204649,EAP,HCPCS C1884,,System Embl Prtc 190cm .014in 110um Crtd Gwire,"$4,397.00",$0.00,"$4,397.00","$2,387.57","$3,138.14",$0.00,$757.58,"$3,138.14","$3,138.14",$769.88,"$4,397.00",$0.00,"$2,198.50","$3,482.42","$3,517.60",$0.00,$688.13,$0.00,$700.00,$0.00
27204650,EAP,HCPCS C1884,,System Embl Prtc 190cm .014in 110um Sprg Crtd,"$4,397.00",$0.00,"$4,397.00","$2,387.57","$3,138.14",$0.00,$757.58,"$3,138.14","$3,138.14",$769.88,"$4,397.00",$0.00,"$2,198.50","$3,482.42","$3,517.60",$0.00,$688.13,$0.00,$700.00,$0.00
27204651,EAP,HCPCS C2630,,Catheter Ablt 115cm 7fr 3.5mm 75mm Curve 2-5-2mm,"$6,561.00",$0.00,"$6,561.00",$0.00,"$4,682.59",$0.00,$0.00,"$4,682.59","$4,682.59",$0.00,"$6,561.00",$0.00,"$3,280.50","$5,196.31","$5,248.80",$0.00,$0.00,$0.00,$0.00,$0.00
27204652,EAP,HCPCS C2630,,Catheter Ablt 115cm 7fr 3.5mm 65mm Curve 2-5-2mm,"$6,561.00",$0.00,"$6,561.00",$0.00,"$4,682.59",$0.00,$0.00,"$4,682.59","$4,682.59",$0.00,"$6,561.00",$0.00,"$3,280.50","$5,196.31","$5,248.80",$0.00,$0.00,$0.00,$0.00,$0.00
27204653,EAP,HCPCS C2630,,Catheter Ablt 115cm 8fr 4mm 1-4-1mm Spc D-d Curve,"$5,249.00",$0.00,"$5,249.00",$0.00,"$3,746.21",$0.00,$0.00,"$3,746.21","$3,746.21",$0.00,"$5,249.00",$0.00,"$2,624.50","$4,157.21","$4,199.20",$0.00,$0.00,$0.00,$0.00,$0.00
27204654,EAP,HCPCS C2630,,Catheter Ablt 115cm 8fr 4mm 1-4-1mm Spc D-f Curve,"$5,249.00",$0.00,"$5,249.00",$0.00,"$3,746.21",$0.00,$0.00,"$3,746.21","$3,746.21",$0.00,"$5,249.00",$0.00,"$2,624.50","$4,157.21","$4,199.20",$0.00,$0.00,$0.00,$0.00,$0.00
27204655,EAP,HCPCS C2630,,Catheter Ablt 115cm 8fr 4mm 1-4-1mm Spc F-f Curve,"$5,249.00",$0.00,"$5,249.00",$0.00,"$3,746.21",$0.00,$0.00,"$3,746.21","$3,746.21",$0.00,"$5,249.00",$0.00,"$2,624.50","$4,157.21","$4,199.20",$0.00,$0.00,$0.00,$0.00,$0.00
27204656,EAP,HCPCS C2630,,Catheter Ablt 115cm 8fr 4mm 1-4-1mm Spc F-j Curve,"$5,249.00",$0.00,"$5,249.00",$0.00,"$3,746.21",$0.00,$0.00,"$3,746.21","$3,746.21",$0.00,"$5,249.00",$0.00,"$2,624.50","$4,157.21","$4,199.20",$0.00,$0.00,$0.00,$0.00,$0.00
27204657,EAP,HCPCS C2630,,Catheter Ablt 115cm 8fr 4mm 1-4-1mm Spc J-j Curve,"$5,249.00",$0.00,"$5,249.00",$0.00,"$3,746.21",$0.00,$0.00,"$3,746.21","$3,746.21",$0.00,"$5,249.00",$0.00,"$2,624.50","$4,157.21","$4,199.20",$0.00,$0.00,$0.00,$0.00,$0.00
27204658,EAP,HCPCS C2630,,Catheter Ablt 115cm 8fr 4mm D Curve Flexability 4,"$5,249.00",$0.00,"$5,249.00",$0.00,"$3,746.21",$0.00,$0.00,"$3,746.21","$3,746.21",$0.00,"$5,249.00",$0.00,"$2,624.50","$4,157.21","$4,199.20",$0.00,$0.00,$0.00,$0.00,$0.00
27204659,EAP,HCPCS C2630,,Catheter Ablt 115cm 8fr 4mm 1-4-1mm Spc F Curve,"$5,249.00",$0.00,"$5,249.00",$0.00,"$3,746.21",$0.00,$0.00,"$3,746.21","$3,746.21",$0.00,"$5,249.00",$0.00,"$2,624.50","$4,157.21","$4,199.20",$0.00,$0.00,$0.00,$0.00,$0.00
27204660,EAP,HCPCS C2630,,Catheter Ablt 115cm 8fr 4mm 1-4-1mm Spc J Curve,"$5,249.00",$0.00,"$5,249.00",$0.00,"$3,746.21",$0.00,$0.00,"$3,746.21","$3,746.21",$0.00,"$5,249.00",$0.00,"$2,624.50","$4,157.21","$4,199.20",$0.00,$0.00,$0.00,$0.00,$0.00
27204661,EAP,HCPCS C1885,,Catheter Angio Jacky Radl Curve 5fr 3.5mm 100cm 2,$438.00,$0.00,$438.00,$0.00,$312.60,$0.00,$0.00,$312.60,$312.60,$0.00,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$0.00,$0.00,$0.00,$0.00
27204662,EAP,HCPCS C1725,,Coronary Balloon,$0.01,$0.00,$0.01,$0.01,$0.01,$0.00,$0.00,$0.01,$0.01,$0.00,$0.01,$0.00,$0.01,$0.01,$0.01,$0.00,$0.00,$0.00,$0.00,$0.00
27204663,EAP,CPT® C1769,,Guidewire Vasc 80cm .035in Jkt Core To Tip Atrm,$80.00,$0.00,$80.00,$43.44,$57.10,$0.00,$13.78,$57.10,$57.10,$14.01,$80.00,$0.00,$40.00,$63.36,$64.00,$0.00,$12.52,$0.00,$12.74,$0.00
27204664,EAP,HCPCS C1769,,035IN 150CM 7CM STANDARD TIP FIX,$20.00,$0.00,$20.00,$10.86,$14.27,$0.00,$3.45,$14.27,$14.27,$3.50,$20.00,$0.00,$10.00,$15.84,$16.00,$0.00,$3.13,$0.00,$3.18,$0.00
27204665,EAP,HCPCS C1887,,Cath Angio Jr3.5 Curve 6fr 100cm Stsr,$105.00,$0.00,$105.00,$57.02,$74.94,$0.00,$18.09,$74.94,$74.94,$18.38,$105.00,$0.00,$52.50,$83.16,$84.00,$0.00,$16.43,$0.00,$16.72,$0.00
27204666,EAP,HCPCS C1887,,Catheter Angiographic Jl3.5 Curve 6fr 100cm Siteseer,$129.00,$0.00,$129.00,$70.05,$92.07,$0.00,$22.23,$92.07,$92.07,$22.59,$129.00,$0.00,$64.50,$102.17,$103.20,$0.00,$20.19,$0.00,$20.54,$0.00
27204667,EAP,HCPCS C1887,,Catheter Angiographic Jl4 Curve 6fr 100cm Siteseer,$245.00,$0.00,$245.00,$133.04,$174.86,$0.00,$42.21,$174.86,$174.86,$42.90,$245.00,$0.00,$122.50,$194.04,$196.00,$0.00,$38.34,$0.00,$39.00,$0.00
27204668,EAP,HCPCS C1887,,Catheter Angiographic Jr5 Curve 5fr 100cm Siteseer,$175.00,$0.00,$175.00,$95.03,$124.90,$0.00,$30.15,$124.90,$124.90,$30.64,$175.00,$0.00,$87.50,$138.60,$140.00,$0.00,$27.39,$0.00,$27.86,$0.00
27204669,EAP,Custom 27204669,,Kit Pricrdcts 8.3fr Perivc Flxm Pgtl Curve 3w,$375.00,$0.00,$375.00,$0.00,$267.64,$0.00,$0.00,$267.64,$267.64,$0.00,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$0.00,$0.00,$0.00,$0.00
27204670,EAP,HCPCS C1887,,Catheter 6a0083 Ss 6f Jl 5.0 100cm,$70.00,$0.00,$70.00,$38.01,$49.96,$0.00,$12.06,$49.96,$49.96,$12.26,$70.00,$0.00,$35.00,$55.44,$56.00,$0.00,$10.96,$0.00,$11.14,$0.00
27204671,EAP,HCPCS C1887,,Catheter Angiographic Mpa1 Curve 5fr 100cm Siteseer,$193.00,$0.00,$193.00,$104.80,$137.74,$0.00,$33.25,$137.74,$137.74,$33.79,$193.00,$0.00,$96.50,$152.86,$154.40,$0.00,$30.20,$0.00,$30.73,$0.00
27204673,EAP,HCPCS C1887,,Catheter Guid Jr4 Curve 6fr 100cm Siteseer Stainless Steel,$294.00,$0.00,$294.00,$159.64,$209.83,$0.00,$50.65,$209.83,$209.83,$51.48,$294.00,$0.00,$147.00,$232.85,$235.20,$0.00,$46.01,$0.00,$46.80,$0.00
27204674,EAP,HCPCS C1887,,"Catheter,6fr Al2 Siteseer",$158.00,$0.00,$158.00,$85.79,$112.76,$0.00,$27.22,$112.76,$112.76,$27.66,$158.00,$0.00,$79.00,$125.14,$126.40,$0.00,$24.73,$0.00,$25.15,$0.00
27204675,EAP,HCPCS C1894,,Set Introd .018in 4fr 10cm 40c,$123.00,$0.00,$123.00,$66.79,$87.79,$0.00,$21.19,$87.79,$87.79,$21.54,$123.00,$0.00,$61.50,$97.42,$98.40,$0.00,$19.25,$0.00,$19.58,$0.00
27204676,EAP,HCPCS C1769,,Set Introd 24-26-28fr Cgl Brhn,$905.00,$0.00,$905.00,$491.42,$645.90,$0.00,$155.93,$645.90,$645.90,$158.46,$905.00,$0.00,$452.50,$716.76,$724.00,$0.00,$141.63,$0.00,$144.08,$0.00
27204677,EAP,HCPCS C1894,,Set Introd .018in 4fr 21ga 40c,$83.00,$0.00,$83.00,$45.07,$59.24,$0.00,$14.30,$59.24,$59.24,$14.53,$83.00,$0.00,$41.50,$65.74,$66.40,$0.00,$12.99,$0.00,$13.21,$0.00
27204678,EAP,Custom 27204678,,Set Introd .018in Long 5fr 21g,$95.00,$0.00,$95.00,$0.00,$67.80,$0.00,$0.00,$67.80,$67.80,$0.00,$95.00,$0.00,$47.50,$75.24,$76.00,$0.00,$0.00,$0.00,$0.00,$0.00
27204679,EAP,Custom 27204679,,Set Introd .018in Long 5fr 70c,$95.00,$0.00,$95.00,$0.00,$67.80,$0.00,$0.00,$67.80,$67.80,$0.00,$95.00,$0.00,$47.50,$75.24,$76.00,$0.00,$0.00,$0.00,$0.00,$0.00
27204680,EAP,HCPCS C1894,,Set Introd 6fr 13cm 20cm Sidea,$40.00,$0.00,$40.00,$21.72,$28.55,$0.00,$6.89,$28.55,$28.55,$7.00,$40.00,$0.00,$20.00,$31.68,$32.00,$0.00,$6.26,$0.00,$6.37,$0.00
27204681,EAP,HCPCS C1894,,Set Introd .038in 11fr 15.5cm,$106.00,$0.00,$106.00,$57.56,$75.65,$0.00,$18.26,$75.65,$75.65,$18.56,$106.00,$0.00,$53.00,$83.95,$84.80,$0.00,$16.59,$0.00,$16.88,$0.00
27204682,EAP,HCPCS C1894,,Set Introd .038in 12fr 15.5cm,$106.00,$0.00,$106.00,$57.56,$75.65,$0.00,$18.26,$75.65,$75.65,$18.56,$106.00,$0.00,$53.00,$83.95,$84.80,$0.00,$16.59,$0.00,$16.88,$0.00
27204683,EAP,HCPCS C1894,,Set Introd .038in 14fr 15.5cm,$106.00,$0.00,$106.00,$57.56,$75.65,$0.00,$18.26,$75.65,$75.65,$18.56,$106.00,$0.00,$53.00,$83.95,$84.80,$0.00,$16.59,$0.00,$16.88,$0.00
27204684,EAP,HCPCS C1894,,Set Introd 18fr 15.5cm Peel-aw,$106.00,$0.00,$106.00,$57.56,$75.65,$0.00,$18.26,$75.65,$75.65,$18.56,$106.00,$0.00,$53.00,$83.95,$84.80,$0.00,$16.59,$0.00,$16.88,$0.00
27204685,EAP,HCPCS C1769,,Set Introd 8fr J Tip Needle Gu,"$1,198.00",$0.00,"$1,198.00",$650.51,$855.01,$0.00,$206.41,$855.01,$855.01,$209.76,"$1,198.00",$0.00,$599.00,$948.82,$958.40,$0.00,$187.49,$0.00,$190.72,$0.00
27204686,EAP,Custom 27204686,,Set Introd .018in Micro Str 7f,$153.00,$0.00,$153.00,$0.00,$109.20,$0.00,$0.00,$109.20,$109.20,$0.00,$153.00,$0.00,$76.50,$121.18,$122.40,$0.00,$0.00,$0.00,$0.00,$0.00
27204687,EAP,HCPCS C1894,,Set Introd 16fr 20-35mm 70cm G,$713.00,$0.00,$713.00,$387.16,$508.87,$0.00,$122.85,$508.87,$508.87,$124.84,$713.00,$0.00,$356.50,$564.70,$570.40,$0.00,$111.58,$0.00,$113.51,$0.00
27204688,EAP,HCPCS C1894,,Set Introd 6fr 8fr 13.75in 3 W,$249.00,$0.00,$249.00,$135.21,$177.71,$0.00,$42.90,$177.71,$177.71,$43.60,$249.00,$0.00,$124.50,$197.21,$199.20,$0.00,$38.97,$0.00,$39.64,$0.00
27204689,EAP,HCPCS C1894,,Set Introd 6fr 8fr 17.75in 3 W,$249.00,$0.00,$249.00,$135.21,$177.71,$0.00,$42.90,$177.71,$177.71,$43.60,$249.00,$0.00,$124.50,$197.21,$199.20,$0.00,$38.97,$0.00,$39.64,$0.00
27204690,EAP,HCPCS C1887,,"Catherer, Guiding",$0.01,$0.00,$0.01,$0.01,$0.01,$0.00,$0.00,$0.01,$0.01,$0.00,$0.01,$0.00,$0.01,$0.01,$0.01,$0.00,$0.00,$0.00,$0.00,$0.00
27204691,EAP,HCPCS C1887,,Catheter Angiographic Cobra 2 Curve 4fr .041in 65c,$613.00,$0.00,$613.00,$332.86,$437.50,$0.00,$105.62,$437.50,$437.50,$107.33,$613.00,$0.00,$306.50,$485.50,$490.40,$0.00,$95.93,$0.00,$97.59,$0.00
27204694,EAP,HCPCS C1769,,Guidewire Vasc 300cm Rnd Prfl Agile Tip Smtr Rot,"$1,500.00",$0.00,"$1,500.00",$814.50,"$1,070.55",$0.00,$258.44,"$1,070.55","$1,070.55",$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
27204695,EAP,HCPCS C1757,,"Indigo Catheter 8, Xtorq Tip 115cm","$7,255.00",$0.00,"$7,255.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$7,255.00",$0.00,"$3,627.50","$5,745.96","$5,804.00",$0.00,$0.00,$0.00,$0.00,$0.00
27204696,EAP,Custom 27204696,,Indigo Separator 8,"$4,700.00",$0.00,"$4,700.00",$0.00,"$3,354.39",$0.00,$0.00,"$3,354.39","$3,354.39",$0.00,"$4,700.00",$0.00,"$2,350.00","$3,722.40","$3,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
27204697,EAP,Custom 27204697,,Max Aspiration Tubing 3,"$1,095.00",$0.00,"$1,095.00",$0.00,$781.50,$0.00,$0.00,$781.50,$781.50,$0.00,"$1,095.00",$0.00,$547.50,$867.24,$876.00,$0.00,$0.00,$0.00,$0.00,$0.00
27204698,EAP,Custom 27204698,,Sealant Hemostatic Needle Free Adapter Floseal Matrix 10ml,$913.00,$0.00,$913.00,$0.00,$651.61,$0.00,$0.00,$651.61,$651.61,$0.00,$913.00,$0.00,$456.50,$723.10,$730.40,$0.00,$0.00,$0.00,$0.00,$0.00
27204699,EAP,Custom 27204699,,Sealant Hemostatic Needle Free Adapter Floseal Matrix 5ml,$499.00,$0.00,$499.00,$0.00,$356.14,$0.00,$0.00,$356.14,$356.14,$0.00,$499.00,$0.00,$249.50,$395.21,$399.20,$0.00,$0.00,$0.00,$0.00,$0.00
27204700,EAP,HCPCS C1887,,Catheter Interventional 6fr .07in .056in 145cm 20c,"$1,183.00",$0.00,"$1,183.00",$642.37,$844.31,$0.00,$203.82,$844.31,$844.31,$207.13,"$1,183.00",$0.00,$591.50,$936.94,$946.40,$0.00,$185.14,$0.00,$188.33,$0.00
27204702,EAP,HCPCS C1766,,Introducer Shth 8.8fr 7fr 55cm Hi Flx Dilat,$138.00,$0.00,$138.00,$74.93,$98.49,$0.00,$23.78,$98.49,$98.49,$24.16,$138.00,$0.00,$69.00,$109.30,$110.40,$0.00,$21.60,$0.00,$21.97,$0.00
27204705,EAP,,,Catheter Echelon 10 Micro,"$1,687.00",$0.00,"$1,687.00",$0.00,"$1,204.01",$0.00,$0.00,"$1,204.01","$1,204.01",$0.00,"$1,687.00",$0.00,$843.50,"$1,336.10","$1,349.60",$0.00,$0.00,$0.00,$0.00,$0.00
27204707,EAP,,,Amplatz Super Stiff Exchange Guidewire .038x260,$96.00,$0.00,$96.00,$0.00,$68.52,$0.00,$0.00,$68.52,$68.52,$0.00,$96.00,$0.00,$48.00,$76.03,$76.80,$0.00,$0.00,$0.00,$0.00,$0.00
27204708,EAP,HCPCS C1769,,Guidewire .016 Fathom,$893.00,$0.00,$893.00,$484.90,$637.33,$0.00,$153.86,$637.33,$637.33,$156.36,$893.00,$0.00,$446.50,$707.26,$714.40,$0.00,$139.75,$0.00,$142.17,$0.00
27204709,EAP,Custom 27204709,,Valve Rotating Hemostatic,$61.00,$0.00,$61.00,$0.00,$43.54,$0.00,$0.00,$43.54,$43.54,$0.00,$61.00,$0.00,$30.50,$48.31,$48.80,$0.00,$0.00,$0.00,$0.00,$0.00
27204710,EAP,Custom 27204710,,Manifold Kit,$61.00,$0.00,$61.00,$0.00,$43.54,$0.00,$0.00,$43.54,$43.54,$0.00,$61.00,$0.00,$30.50,$48.31,$48.80,$0.00,$0.00,$0.00,$0.00,$0.00
27204711,EAP,HCPCS C1887,,Axs Catalyst 5 Distal Access Catheter 0.058in X 11,"$3,878.00",$0.00,"$3,878.00","$2,105.75","$2,767.73",$0.00,$668.16,"$2,767.73","$2,767.73",$679.01,"$3,878.00",$0.00,"$1,939.00","$3,071.38","$3,102.40",$0.00,$606.91,$0.00,$617.38,$0.00
27204712,EAP,HCPCS C1769,,Contol Wire 200cm .018 V-18,$227.00,$0.00,$227.00,$123.26,$162.01,$0.00,$39.11,$162.01,$162.01,$39.75,$227.00,$0.00,$113.50,$179.78,$181.60,$0.00,$35.53,$0.00,$36.14,$0.00
27204714,EAP,HCPCS C1894,,Introducer Shth 8fr 2.9mm 80cm Flxr Strl Acpt .038,$125.00,$0.00,$125.00,$67.88,$89.21,$0.00,$21.54,$89.21,$89.21,$21.89,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$19.56,$0.00,$19.90,$0.00
27204715,EAP,HCPCS C1894,,Introducer Shth 8fr 90cm Sm Vlv Asmbly Radiopq,$145.00,$0.00,$145.00,$78.74,$103.49,$0.00,$24.98,$103.49,$103.49,$25.39,$145.00,$0.00,$72.50,$114.84,$116.00,$0.00,$22.69,$0.00,$23.08,$0.00
27204716,EAP,Custom 27204716,,Kit Pricrdcts 40cm 8fr Pgtl Curve Cath,$313.00,$0.00,$313.00,$0.00,$223.39,$0.00,$0.00,$223.39,$223.39,$0.00,$313.00,$0.00,$156.50,$247.90,$250.40,$0.00,$0.00,$0.00,$0.00,$0.00
27204717,EAP,Custom 27204717,,Catheter Angiographic Cobra 2 Curve 5fr 80cm Torcon Nb,$65.00,$0.00,$65.00,$0.00,$46.39,$0.00,$0.00,$46.39,$46.39,$0.00,$65.00,$0.00,$32.50,$51.48,$52.00,$0.00,$0.00,$0.00,$0.00,$0.00
27204718,EAP,HCPCS C1887,,Catheter Angiographic .046in Uac Curve 5fr .046in 90cm,$35.00,$0.00,$35.00,$19.01,$24.98,$0.00,$6.03,$24.98,$24.98,$6.13,$35.00,$0.00,$17.50,$27.72,$28.00,$0.00,$5.48,$0.00,$5.57,$0.00
27204719,EAP,HCPCS C1725,,Cath Baldilat 4mm 8mm Coron Rapex Nc Trek Angiopls,$300.00,$0.00,$300.00,$162.90,$214.11,$0.00,$51.69,$214.11,$214.11,$52.53,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$46.95,$0.00,$47.76,$0.00
27204720,EAP,HCPCS C1725,,Cath Baldilat 4mm 15mm Coron Rapex Nc Trek Angiopl,$300.00,$0.00,$300.00,$162.90,$214.11,$0.00,$51.69,$214.11,$214.11,$52.53,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$46.95,$0.00,$47.76,$0.00
27204721,EAP,HCPCS C1725,,Cath Baldilat 4mm 20mm Coron Rapex Nc Trek Angiopl,$300.00,$0.00,$300.00,$162.90,$214.11,$0.00,$51.69,$214.11,$214.11,$52.53,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$46.95,$0.00,$47.76,$0.00
27204722,EAP,HCPCS C1894,,Introducer Sheath .035in 10fr .134in 45cm Anl0 Curve Str Tip,$113.00,$0.00,$113.00,$61.36,$80.65,$0.00,$19.47,$80.65,$80.65,$19.79,$113.00,$0.00,$56.50,$89.50,$90.40,$0.00,$17.68,$0.00,$17.99,$0.00
27204723,EAP,HCPCS C1894,,Introducer Sheath .035in 12fr .162in 45cm Anl0 Curve Str Tip,$138.00,$0.00,$138.00,$74.93,$98.49,$0.00,$23.78,$98.49,$98.49,$24.16,$138.00,$0.00,$69.00,$109.30,$110.40,$0.00,$21.60,$0.00,$21.97,$0.00
27204724,EAP,Custom 27204724,,Set Ndl 45mm 15ga Ezio Ss 1 Port Shrp Block Drsg,"$1,663.00",$0.00,"$1,663.00",$0.00,"$1,186.88",$0.00,$0.00,"$1,186.88","$1,186.88",$0.00,"$1,663.00",$0.00,$831.50,"$1,317.10","$1,330.40",$0.00,$0.00,$0.00,$0.00,$0.00
27204725,EAP,HCPCS C1773,,Snare Endscp .98in 47in 1 Loop Gold Plated Tungsten,$900.00,$0.00,$900.00,$488.70,$642.33,$0.00,$155.07,$642.33,$642.33,$157.58,$900.00,$0.00,$450.00,$712.80,$720.00,$0.00,$140.85,$0.00,$143.28,$0.00
27204726,EAP,HCPCS C1773,,Separator Thrmb Indg 6 Latex Free,"$2,700.00",$0.00,"$2,700.00","$1,466.10","$1,926.99",$0.00,$465.20,"$1,926.99","$1,926.99",$472.75,"$2,700.00",$0.00,"$1,350.00","$2,138.40","$2,160.00",$0.00,$422.55,$0.00,$429.84,$0.00
27204729,EAP,HCPCS C1757,,Catheter Thrmb 6fr Indg Aspirat Latex Free,"$4,725.00",$0.00,"$4,725.00",$0.00,"$3,372.23",$0.00,$0.00,"$3,372.23","$3,372.23",$0.00,"$4,725.00",$0.00,"$2,362.50","$3,742.20","$3,780.00",$0.00,$0.00,$0.00,$0.00,$0.00
27204730,EAP,HCPCS C1757,,Catheter Thrmb 132cm 5-6fr .064in .054in Peri Unq,"$2,908.00",$0.00,"$2,908.00",$0.00,"$2,075.44",$0.00,$0.00,"$2,075.44","$2,075.44",$0.00,"$2,908.00",$0.00,"$1,454.00","$2,303.14","$2,326.40",$0.00,$0.00,$0.00,$0.00,$0.00
27204731,EAP,HCPCS C1757,,Catheter Thrmb 150cm 3.4-4.1fr .041in .032in Peri,"$2,908.00",$0.00,"$2,908.00",$0.00,"$2,075.44",$0.00,$0.00,"$2,075.44","$2,075.44",$0.00,"$2,908.00",$0.00,"$1,454.00","$2,303.14","$2,326.40",$0.00,$0.00,$0.00,$0.00,$0.00
27204733,EAP,HCPCS C1757,,Catheter Thrmb 85cm 8fr Indg Aspirat Trq Tip Latex,"$7,225.00",$0.00,"$7,225.00",$0.00,"$5,156.48",$0.00,$0.00,"$5,156.48","$5,156.48",$0.00,"$7,225.00",$0.00,"$3,612.50","$5,722.20","$5,780.00",$0.00,$0.00,$0.00,$0.00,$0.00
27204736,EAP,HCPCS C1887,,Six Fr Asahi Fubuki Guide Catheter Dilator Kit/90cm/straight ,$300.00,$0.00,$300.00,$162.90,$214.11,$0.00,$51.69,$214.11,$214.11,$52.53,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$46.95,$0.00,$47.76,$0.00
27204737,EAP,HCPCS C1887,,Six Fr Asahi Fubuki Guide Catheter Dilator Kit 80cm/straight,$300.00,$0.00,$300.00,$162.90,$214.11,$0.00,$51.69,$214.11,$214.11,$52.53,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$46.95,$0.00,$47.76,$0.00
27204738,EAP,HCPCS C1894,,Introducer Shth 7fr 2.5cm 10cm Dilat Radiopq Mrkr,$56.00,$0.00,$56.00,$30.41,$39.97,$0.00,$9.65,$39.97,$39.97,$9.81,$56.00,$0.00,$28.00,$44.35,$44.80,$0.00,$8.76,$0.00,$8.92,$0.00
27204739,EAP,HCPCS C1894,,Introducer Shth 8fr 2.5cm 10cm Gwire Dilat Radiopq,$56.00,$0.00,$56.00,$30.41,$39.97,$0.00,$9.65,$39.97,$39.97,$9.81,$56.00,$0.00,$28.00,$44.35,$44.80,$0.00,$8.76,$0.00,$8.92,$0.00
27204740,EAP,HCPCS C1894,,Introducer Shth 7fr 2.5cm 25cm Dilat Radiopq Mrkr,$71.00,$0.00,$71.00,$38.55,$50.67,$0.00,$12.23,$50.67,$50.67,$12.43,$71.00,$0.00,$35.50,$56.23,$56.80,$0.00,$11.11,$0.00,$11.30,$0.00
27204741,EAP,HCPCS C1894,,Introducer Shth 8fr 2.5cm 25cm Dilat Radiopq Mrkr,$71.00,$0.00,$71.00,$38.55,$50.67,$0.00,$12.23,$50.67,$50.67,$12.43,$71.00,$0.00,$35.50,$56.23,$56.80,$0.00,$11.11,$0.00,$11.30,$0.00
27204742,EAP,HCPCS C1887,,Catheter Angiographic Judkins Right 4 Curve 5fr 10,$111.00,$0.00,$111.00,$60.27,$79.22,$0.00,$19.12,$79.22,$79.22,$19.44,$111.00,$0.00,$55.50,$87.91,$88.80,$0.00,$17.37,$0.00,$17.67,$0.00
27204747,EAP,Custom 27204747,,Kit Pressure Monitr 14ga Basic Transducer Tuohy Needle,"$1,883.00",$0.00,"$1,883.00",$0.00,"$1,343.90",$0.00,$0.00,"$1,343.90","$1,343.90",$0.00,"$1,883.00",$0.00,$941.50,"$1,491.34","$1,506.40",$0.00,$0.00,$0.00,$0.00,$0.00
27204748,EAP,Custom 27204748,,Kit Craniotomy Cranial Acces Codman,$635.00,$0.00,$635.00,$0.00,$453.20,$0.00,$0.00,$453.20,$453.20,$0.00,$635.00,$0.00,$317.50,$502.92,$508.00,$0.00,$0.00,$0.00,$0.00,$0.00
27204749,EAP,Custom 27204749,,System Drain Complete Nonvented Catheter Latex Free Eds Iii,$373.00,$0.00,$373.00,$0.00,$266.21,$0.00,$0.00,$266.21,$266.21,$0.00,$373.00,$0.00,$186.50,$295.42,$298.40,$0.00,$0.00,$0.00,$0.00,$0.00
27204750,EAP,HCPCS C1751,,Catheter Cen Ven .032in 9.3fr 38cm 75cm 3 Infus Lumen Extn,"$1,995.00",$0.00,"$1,995.00","$1,083.29","$1,423.83",$0.00,$343.73,"$1,423.83","$1,423.83",$349.31,"$1,995.00",$0.00,$997.50,"$1,580.04","$1,596.00",$0.00,$312.22,$0.00,$317.60,$0.00
27204751,EAP,HCPCS C1751,,Catheter Cen Ven 9.3fr 22cm 58mm Ods,"$1,228.00",$0.00,"$1,228.00",$666.80,$876.42,$0.00,$211.58,$876.42,$876.42,$215.01,"$1,228.00",$0.00,$614.00,$972.58,$982.40,$0.00,$192.18,$0.00,$195.50,$0.00
27204752,EAP,HCPCS C1757,,"Dawn Ide, Trevo Xp 6x25 Kit","$12,766.00",$0.00,"$12,766.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$12,766.00",$0.00,"$6,383.00","$10,110.67","$10,212.80",$0.00,$0.00,$0.00,$0.00,$0.00
27204753,EAP,HCPCS C1757,,"Dawn Ide, Trevo Xp 4x30 Kit","$12,766.00",$0.00,"$12,766.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$12,766.00",$0.00,"$6,383.00","$10,110.67","$10,212.80",$0.00,$0.00,$0.00,$0.00,$0.00
27204754,EAP,HCPCS C1769,,Guidewire Vascular .014in 300cm 11cm Radiopq Str T,$450.00,$0.00,$450.00,$244.35,$321.17,$0.00,$77.53,$321.17,$321.17,$78.79,$450.00,$0.00,$225.00,$356.40,$360.00,$0.00,$70.43,$0.00,$71.64,$0.00
27204755,EAP,HCPCS C1769,,Guidewire Vasc 180cm Asahi Ptca Sion Blue,$375.00,$0.00,$375.00,$203.63,$267.64,$0.00,$64.61,$267.64,$267.64,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
27204756,EAP,HCPCS C1769,,Guidewire Vasc 180cm .014in Str 3cm Sion Asahi Ss,$375.00,$0.00,$375.00,$203.63,$267.64,$0.00,$64.61,$267.64,$267.64,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
27204757,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in 3 Radiopq Seg Str 3cm,$375.00,$0.00,$375.00,$203.63,$267.64,$0.00,$64.61,$267.64,$267.64,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
27204758,EAP,HCPCS C1769,,Guidewire Vasc Rg3,$575.00,$0.00,$575.00,$312.23,$410.38,$0.00,$99.07,$410.38,$410.38,$100.68,$575.00,$0.00,$287.50,$455.40,$460.00,$0.00,$89.99,$0.00,$91.54,$0.00
27204759,EAP,HCPCS C1769,,Guidewire Vasc 180cm .014in Radiopq Str Tip 11cm,$450.00,$0.00,$450.00,$244.35,$321.17,$0.00,$77.53,$321.17,$321.17,$78.79,$450.00,$0.00,$225.00,$356.40,$360.00,$0.00,$70.43,$0.00,$71.64,$0.00
27204760,EAP,HCPCS C1769,,Catheter Guid Extra Backup 4.5 Left Curve 6fr .071,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27204761,EAP,HCPCS C1769,,Catheter Guid Xb 5 Left Curve 6fr .071in 100cm,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27204762,EAP,HCPCS C1769,,Catheter Atherectomy .017in .018in 165cm Shapable,"$4,800.00",$0.00,"$4,800.00","$2,606.40","$3,425.76",$0.00,$827.02,"$3,425.76","$3,425.76",$840.44,"$4,800.00",$0.00,"$2,400.00","$3,801.60","$3,840.00",$0.00,$751.20,$0.00,$764.16,$0.00
27204763,EAP,HCPCS C1882,,Catheter Angio .035in Vert Curve 5fr .046in 125cm,$35.00,$0.00,$35.00,$19.01,$24.98,$0.00,$6.03,$24.98,$24.98,$6.13,$35.00,$0.00,$17.50,$27.72,$28.00,$0.00,$5.48,$0.00,$5.57,$0.00
27204764,EAP,HCPCS C1887,,Catheter Guid Jr4 Curve 8fr 90cm Coron Sh Lnchr,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27204765,EAP,HCPCS C1887,,Catheter Guid Al1 Curve 8fr 90cm Coron Sh Lnchr,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27204766,EAP,HCPCS C1887,,Catheter Guid 3drc Curve 8fr 90cm Coron Lnchr,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27204767,EAP,HCPCS C1887,,Catheter Guid 3 Dmn Right Curve 8fr .09in 90cm,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27204768,EAP,HCPCS C1887,,Catheter Guid Al1.5 Curve 8fr .09in 90cm Coron,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27204769,EAP,HCPCS C1887,,Catheter Guid Al1.5 Curve 8fr 90cm Coron Sh Lnchr,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27204770,EAP,HCPCS C1887,,Catheter Guid Al2 Curve 8fr 90cm Coron Lnchr,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27204771,EAP,HCPCS C1887,,Catheter Guid Al2 Curve 8fr .09in 90cm Coron Sh,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27204772,EAP,HCPCS C1887,,Catheter Guid Xb4 Curve 8fr 90cm Coron Lnchr,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27204773,EAP,HCPCS C1887,,Catheter Guid Xb3.5 Curve 8fr 90cm Coron Sh Lnchr,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27204774,EAP,HCPCS C1887,,Catheter Guid Ebu3.75 Curve 8fr .09in 90cm Coron,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27204775,EAP,HCPCS C1887,,Catheter Guid Xb4 Curve 8fr 90cm Coron Sh Lnchr,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27204776,EAP,HCPCS C1887,,Catheter Guid Al1 Curve 8fr 90cm Coron Lnchr,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27204777,EAP,HCPCS C1725,,Catheter Baldilat Lp Taper 4.8fr 6mm 135cm 80mm Ot,$686.00,$0.00,$686.00,$372.50,$489.60,$0.00,$118.19,$489.60,$489.60,$120.11,$686.00,$0.00,$343.00,$543.31,$548.80,$0.00,$107.36,$0.00,$109.21,$0.00
27204778,EAP,Custom 27204778,,Catheter Angio Bcn Sim2 Curve 5fr 125cm Ss Nyl,$33.00,$0.00,$33.00,$0.00,$23.55,$0.00,$0.00,$23.55,$23.55,$0.00,$33.00,$0.00,$16.50,$26.14,$26.40,$0.00,$0.00,$0.00,$0.00,$0.00
27204779,EAP,HCPCS C1887,,Catheter Thrmb 125cm 6fr Neuron Sim Curve Slct,$313.00,$0.00,$313.00,$169.96,$223.39,$0.00,$53.93,$223.39,$223.39,$54.80,$313.00,$0.00,$156.50,$247.90,$250.40,$0.00,$48.98,$0.00,$49.83,$0.00
27204782,EAP,HCPCS C1725,,Catheter Baldilat Lp Taper 3.8fr 4mm 135cm 80mm Otw Inflat,$686.00,$0.00,$686.00,$372.50,$489.60,$0.00,$118.19,$489.60,$489.60,$120.11,$686.00,$0.00,$343.00,$543.31,$548.80,$0.00,$107.36,$0.00,$109.21,$0.00
27204783,EAP,HCPCS C1753,,Catheter Ultrasound .035in 8.5fr 90cm 100cm Otw Radiopq,"$2,500.00",$0.00,"$2,500.00","$1,357.50","$1,784.25",$0.00,$430.74,"$1,784.25","$1,784.25",$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
27204785,EAP,HCPCS C1725,,Catheter Baldilat Ultra Lp Taper 6fr 4mm 150cm 220mm Coyote,$857.00,$0.00,$857.00,$465.35,$611.64,$0.00,$147.66,$611.64,$611.64,$150.05,$857.00,$0.00,$428.50,$678.74,$685.60,$0.00,$134.12,$0.00,$136.43,$0.00
27204786,EAP,HCPCS C1769,,Guidewire Vascular Str Short Taper .014in 300cm 8cm Robust,$343.00,$0.00,$343.00,$186.25,$244.80,$0.00,$59.10,$244.80,$244.80,$60.06,$343.00,$0.00,$171.50,$271.66,$274.40,$0.00,$53.68,$0.00,$54.61,$0.00
27204787,EAP,Custom 27204787,,Omni Flush (vcf) 5fr 100cm,$35.00,$0.00,$35.00,$0.00,$24.98,$0.00,$0.00,$24.98,$24.98,$0.00,$35.00,$0.00,$17.50,$27.72,$28.00,$0.00,$0.00,$0.00,$0.00,$0.00
27204790,EAP,HCPCS C1884,,System Embl Prtc 104.5cm .035in Prox Crbrl Cath,"$4,000.00",$0.00,"$4,000.00","$2,172.00","$2,854.80",$0.00,$689.18,"$2,854.80","$2,854.80",$700.37,"$4,000.00",$0.00,"$2,000.00","$3,168.00","$3,200.00",$0.00,$626.00,$0.00,$636.80,$0.00
27204791,EAP,CPT® C1894,,Set Introd .018in 5fr 21ga 40c,$105.00,$0.00,$105.00,$57.02,$74.94,$0.00,$18.09,$74.94,$74.94,$18.38,$105.00,$0.00,$52.50,$83.16,$84.00,$0.00,$16.43,$0.00,$16.72,$0.00
27204792,EAP,Custom 27204792,,Band Compression Regular 24cm 2 Balloon Air Injec Port,$75.00,$0.00,$75.00,$0.00,$53.53,$0.00,$0.00,$53.53,$53.53,$0.00,$75.00,$0.00,$37.50,$59.40,$60.00,$0.00,$0.00,$0.00,$0.00,$0.00
27204793,EAP,Custom 27204793,,Catheter Angiographic .038in 21ml/sec Radial Tiger Curve Str,$88.00,$0.00,$88.00,$0.00,$62.81,$0.00,$0.00,$62.81,$62.81,$0.00,$88.00,$0.00,$44.00,$69.70,$70.40,$0.00,$0.00,$0.00,$0.00,$0.00
27204795,EAP,HCPCS C1894,,Introducer Sheath .021in Str Thin Wall 6fr 20ga 10cm 45cm,$138.00,$0.00,$138.00,$74.93,$98.49,$0.00,$23.78,$98.49,$98.49,$24.16,$138.00,$0.00,$69.00,$109.30,$110.40,$0.00,$21.60,$0.00,$21.97,$0.00
27204796,EAP,Custom 27204796,,Tray Amniocentesis 20ga 3.5in,$32.00,$0.00,$32.00,$0.00,$22.84,$0.00,$0.00,$22.84,$22.84,$0.00,$32.00,$0.00,$16.00,$25.34,$25.60,$0.00,$0.00,$0.00,$0.00,$0.00
27204797,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in Strbl Radiopq Kink Rst,$38.00,$0.00,$38.00,$20.63,$27.12,$0.00,$6.55,$27.12,$27.12,$6.65,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$5.95,$0.00,$6.05,$0.00
27204798,EAP,Custom 27204798,,Tube Gastrostomy 20fr 14.25x11.25x9in Handrail Chr,$45.00,$0.00,$45.00,$0.00,$32.12,$0.00,$0.00,$32.12,$32.12,$0.00,$45.00,$0.00,$22.50,$35.64,$36.00,$0.00,$0.00,$0.00,$0.00,$0.00
27204799,EAP,Custom 27204799,,Needle Intraosseous 15ga 25mm Ez Connect Wrist Ban,"$1,375.00",$0.00,"$1,375.00",$0.00,$981.34,$0.00,$0.00,$981.34,$981.34,$0.00,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
27204802,EAP,HCPCS C1725,,Catheter Baldilat 5fr 4mm 130cm 80mm Pcltxl,"$3,500.00",$0.00,"$3,500.00","$1,900.50","$2,497.95",$0.00,$603.03,"$2,497.95","$2,497.95",$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
27204806,EAP,HCPCS C1725,,Catheter Baldilat 5fr 5mm 130cm 40mm Pcltxl,"$3,500.00",$0.00,"$3,500.00","$1,900.50","$2,497.95",$0.00,$603.03,"$2,497.95","$2,497.95",$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
27204807,EAP,HCPCS C1725,,Catheter Baldilat 5fr 5mm 130cm 60mm Pcltxl,"$3,500.00",$0.00,"$3,500.00","$1,900.50","$2,497.95",$0.00,$603.03,"$2,497.95","$2,497.95",$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
27204810,EAP,HCPCS C1757,,Solitaire Revascularization Device 4-20-10,"$10,563.00",$0.00,"$10,563.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$10,563.00",$0.00,"$5,281.50","$8,365.90","$8,450.40",$0.00,$0.00,$0.00,$0.00,$0.00
27204811,EAP,HCPCS C1757,,SOLITAIRE PLATINUM 6X20,"$10,563.00",$0.00,"$10,563.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$10,563.00",$0.00,"$5,281.50","$8,365.90","$8,450.40",$0.00,$0.00,$0.00,$0.00,$0.00
27204812,EAP,HCPCS C1757,,Solitaire Platinum Revascularization Device 4-40,"$10,563.00",$0.00,"$10,563.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$7,538.81",$0.00,"$10,563.00",$0.00,"$5,281.50","$8,365.90","$8,450.40",$0.00,$0.00,$0.00,$0.00,$0.00
27204813,EAP,HCPCS C1758,,Catheter Urethral 16fr Foley 2 Way Medium Olive Coude Tip 1,$26.00,$0.00,$26.00,$14.12,$18.56,$0.00,$4.48,$18.56,$18.56,$4.55,$26.00,$0.00,$13.00,$20.59,$20.80,$0.00,$4.07,$0.00,$4.14,$0.00
27204814,EAP,HCPCS C1887,,Catheter Angiographic Cobra 2 Curve 4fr .041in 65cm 2 Braid,$613.00,$0.00,$613.00,$332.86,$437.50,$0.00,$105.62,$437.50,$437.50,$107.33,$613.00,$0.00,$306.50,$485.50,$490.40,$0.00,$95.93,$0.00,$97.59,$0.00
27204817,EAP,HCPCS C1725,,Catheter Baldilat 6mm 130cm 40mm Lutonix Acpt 6fr,"$3,500.00",$0.00,"$3,500.00","$1,900.50","$2,497.95",$0.00,$603.03,"$2,497.95","$2,497.95",$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
27204818,EAP,HCPCS C1725,,Catheter Baldilat 6fr 6mm 130cm 60mm Pcltxl,"$3,500.00",$0.00,"$3,500.00","$1,900.50","$2,497.95",$0.00,$603.03,"$2,497.95","$2,497.95",$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
27204819,EAP,HCPCS C1725,,Catheter Baldilat 6fr 6mm 130cm 80mm Pcltxl,"$3,500.00",$0.00,"$3,500.00","$1,900.50","$2,497.95",$0.00,$603.03,"$2,497.95","$2,497.95",$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
27204822,EAP,HCPCS C1725,,Catheter Baldilat 6fr 6mm 130cm 150mm Pcltxl,"$3,500.00",$0.00,"$3,500.00","$1,900.50","$2,497.95",$0.00,$603.03,"$2,497.95","$2,497.95",$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
27204823,EAP,HCPCS C1894,,Introducer Sheath .038in Stand,$45.00,$0.00,$45.00,$24.44,$32.12,$0.00,$7.75,$32.12,$32.12,$7.88,$45.00,$0.00,$22.50,$35.64,$36.00,$0.00,$7.04,$0.00,$7.16,$0.00
27204824,EAP,Custom 27204824,,Set Tubing 2.6mr 2 Way Communication Irrigation Pump,$200.00,$0.00,$200.00,$0.00,$142.74,$0.00,$0.00,$142.74,$142.74,$0.00,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$0.00,$0.00,$0.00,$0.00
27204825,EAP,HCPCS C1751,,Axs Catalyst 6 Distal Access Catheter,"$4,875.00",$0.00,"$4,875.00","$2,647.13","$3,479.29",$0.00,$839.94,"$3,479.29","$3,479.29",$853.57,"$4,875.00",$0.00,"$2,437.50","$3,861.00","$3,900.00",$0.00,$762.94,$0.00,$776.10,$0.00
27204826,EAP,HCPCS C1751,,Axs Catalyst 5 Distal Access Catheter,"$4,875.00",$0.00,"$4,875.00","$2,647.13","$3,479.29",$0.00,$839.94,"$3,479.29","$3,479.29",$853.57,"$4,875.00",$0.00,"$2,437.50","$3,861.00","$3,900.00",$0.00,$762.94,$0.00,$776.10,$0.00
27204827,EAP,HCPCS C1885,,Catheter Angio Kmp Curve Ang 4fr 65cm Radiopq,$70.00,$0.00,$70.00,$0.00,$49.96,$0.00,$0.00,$49.96,$49.96,$0.00,$70.00,$0.00,$35.00,$55.44,$56.00,$0.00,$0.00,$0.00,$0.00,$0.00
27204828,EAP,Custom 27204828,,Bit Drill 25mm 4mm Strl,$143.00,$0.00,$143.00,$0.00,$102.06,$0.00,$0.00,$102.06,$102.06,$0.00,$143.00,$0.00,$71.50,$113.26,$114.40,$0.00,$0.00,$0.00,$0.00,$0.00
27204830,EAP,Custom 27204830,,Impella Rp Us Hde Pump Set,"$62,500.00",$0.00,"$62,500.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$62,500.00",$0.00,"$31,250.00","$49,500.00","$50,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
27204832,EAP,HCPCS C1894,,Sheath Introd 16fr 6.2mm 5.3mm 28cm Dryseal Dilat,$668.00,$0.00,$668.00,$362.72,$476.75,$0.00,$115.09,$476.75,$476.75,$116.96,$668.00,$0.00,$334.00,$529.06,$534.40,$0.00,$104.54,$0.00,$106.35,$0.00
27204833,EAP,Custom 27204833,,Catheter Baldilat Tpr 10-50mm 65cm Stent Gft Flx,"$1,213.00",$0.00,"$1,213.00",$0.00,$865.72,$0.00,$0.00,$865.72,$865.72,$0.00,"$1,213.00",$0.00,$606.50,$960.70,$970.40,$0.00,$0.00,$0.00,$0.00,$0.00
27204835,EAP,HCPCS C1757,,System Thrmb Zelantedvt,"$7,313.00",$0.00,"$7,313.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$7,313.00",$0.00,"$3,656.50","$5,791.90","$5,850.40",$0.00,$0.00,$0.00,$0.00,$0.00
27204840,EAP,HCPCS C1884,,Axs Infinity Ls .088 Long Guide Sheath 90cm,"$1,463.00",$0.00,"$1,463.00",$794.41,"$1,044.14",$0.00,$252.07,"$1,044.14","$1,044.14",$256.16,"$1,463.00",$0.00,$731.50,"$1,158.70","$1,170.40",$0.00,$228.96,$0.00,$232.91,$0.00
27204841,EAP,HCPCS C1894,,Axs Infinity Ls .088 Long Guide Sheath 80cm,"$1,463.00",$0.00,"$1,463.00",$794.41,"$1,044.14",$0.00,$252.07,"$1,044.14","$1,044.14",$256.16,"$1,463.00",$0.00,$731.50,"$1,158.70","$1,170.40",$0.00,$228.96,$0.00,$232.91,$0.00
27204842,EAP,HCPCS C1773,,Snare Vasc 175cm .16-.32in 3.2fr Ensnr Mini Ntnl 3,"$1,638.00",$0.00,"$1,638.00",$889.43,"$1,169.04",$0.00,$282.22,"$1,169.04","$1,169.04",$286.80,"$1,638.00",$0.00,$819.00,"$1,297.30","$1,310.40",$0.00,$256.35,$0.00,$260.77,$0.00
27204843,EAP,HCPCS C2628,,Er-reboa Catheter,"$4,988.00",$0.00,"$4,988.00",$0.00,"$3,559.94",$0.00,$0.00,"$3,559.94","$3,559.94",$0.00,"$4,988.00",$0.00,"$2,494.00","$3,950.50","$3,990.40",$0.00,$0.00,$0.00,$0.00,$0.00
27204844,EAP,HCPCS C1773,,Snare Vasc 47in .71-1.18in .055in .074in Ensnr,$888.00,$0.00,$888.00,$482.18,$633.77,$0.00,$153.00,$633.77,$633.77,$155.48,$888.00,$0.00,$444.00,$703.30,$710.40,$0.00,$138.97,$0.00,$141.37,$0.00
27204845,EAP,HCPCS C1894,,Percutaneous Sheath Intro Kit 6f .035in X 10cm,$788.00,$0.00,$788.00,$427.88,$562.40,$0.00,$135.77,$562.40,$562.40,$137.97,$788.00,$0.00,$394.00,$624.10,$630.40,$0.00,$123.32,$0.00,$125.45,$0.00
27204846,EAP,HCPCS C1769,,Pericardio Set And Tray,$474.00,$0.00,$474.00,$257.38,$338.29,$0.00,$81.67,$338.29,$338.29,$82.99,$474.00,$0.00,$237.00,$375.41,$379.20,$0.00,$74.18,$0.00,$75.46,$0.00
27204847,EAP,HCPCS C1894,,Set Catheter .035in 15cm 70cm Sidehole Removable Stylet Tip,"$1,875.00",$0.00,"$1,875.00","$1,018.13","$1,338.19",$0.00,$323.05,"$1,338.19","$1,338.19",$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
27204848,EAP,,,"Flexor Ansel Guiding Sheath W/hfd, Check-flo 8f 2.9mm X 70cm Mp",$163.00,$0.00,$163.00,$0.00,$116.33,$0.00,$0.00,$116.33,$116.33,$0.00,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$0.00,$0.00,$0.00,$0.00
27204849,EAP,HCPCS C1894,,Flexor Ansel Guiding Sheath W/check-flo 7f 2.5mm X 45cm Str,$113.00,$0.00,$113.00,$61.36,$80.65,$0.00,$19.47,$80.65,$80.65,$19.79,$113.00,$0.00,$56.50,$89.50,$90.40,$0.00,$17.68,$0.00,$17.99,$0.00
27204850,EAP,HCPCS C1725,,Viatrac 14 Plus Rx 5mm X 30mm X 135cm,$625.00,$0.00,$625.00,$339.38,$446.06,$0.00,$107.68,$446.06,$446.06,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
27204851,EAP,HCPCS C1769,,X-celerator .010 10cm X 300cm,$825.00,$0.00,$825.00,$447.98,$588.80,$0.00,$142.14,$588.80,$588.80,$144.45,$825.00,$0.00,$412.50,$653.40,$660.00,$0.00,$129.11,$0.00,$131.34,$0.00
27204852,EAP,HCPCS C1725,,"Mustang 7fr 12.0mm X 60mm, 135cm",$500.00,$0.00,$500.00,$271.50,$356.85,$0.00,$86.15,$356.85,$356.85,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
27204853,EAP,Custom 27204853,,Sterling Otw 4mm X 60mm X 135cm,$685.00,$0.00,$685.00,$0.00,$488.88,$0.00,$0.00,$488.88,$488.88,$0.00,$685.00,$0.00,$342.50,$542.52,$548.00,$0.00,$0.00,$0.00,$0.00,$0.00
27204854,EAP,HCPCS C1725,,Sterling Otw 5mm X 100mm X 135cm,$685.00,$0.00,$685.00,$371.96,$488.88,$0.00,$118.02,$488.88,$488.88,$119.94,$685.00,$0.00,$342.50,$542.52,$548.00,$0.00,$107.20,$0.00,$109.05,$0.00
27204855,EAP,HCPCS C1725,,Sterling Otw 6mm X 100mm X 135cm,$685.00,$0.00,$685.00,$371.96,$488.88,$0.00,$118.02,$488.88,$488.88,$119.94,$685.00,$0.00,$342.50,$542.52,$548.00,$0.00,$107.20,$0.00,$109.05,$0.00
27204856,EAP,HCPCS C1725,,Coyote 3.5mm X 220mm X 150cm,$856.00,$0.00,$856.00,$464.81,$610.93,$0.00,$147.48,$610.93,$610.93,$149.88,$856.00,$0.00,$428.00,$677.95,$684.80,$0.00,$133.96,$0.00,$136.28,$0.00
27204857,EAP,HCPCS C1894,,Tear-away Intro Sheath 8f 30cm,$477.00,$0.00,$477.00,$259.01,$340.43,$0.00,$82.18,$340.43,$340.43,$83.52,$477.00,$0.00,$238.50,$377.78,$381.60,$0.00,$74.65,$0.00,$75.94,$0.00
27204858,EAP,,,Sterling Otw 4mm X 220mm X 135cm,$830.00,$0.00,$830.00,$0.00,$592.37,$0.00,$0.00,$592.37,$592.37,$0.00,$830.00,$0.00,$415.00,$657.36,$664.00,$0.00,$0.00,$0.00,$0.00,$0.00
27204860,EAP,HCPCS C1887,,Catheter Guid 47cm Cps Dir 115d Upsize Latex Free,"$1,721.00",$0.00,"$1,721.00",$934.50,"$1,228.28",$0.00,$296.52,"$1,228.28","$1,228.28",$301.33,"$1,721.00",$0.00,$860.50,"$1,363.03","$1,376.80",$0.00,$269.34,$0.00,$273.98,$0.00
27204863,EAP,Custom 27204863,,Needle Port 1in 20ga 5ml/sec Grpr Plus Deltec Pcth,$203.00,$0.00,$203.00,$0.00,$144.88,$0.00,$0.00,$144.88,$144.88,$0.00,$203.00,$0.00,$101.50,$160.78,$162.40,$0.00,$0.00,$0.00,$0.00,$0.00
27204864,EAP,Custom 27204864,,Needle Port 1.25in 20ga 5ml/sec Grpr Plus Deltec,$203.00,$0.00,$203.00,$0.00,$144.88,$0.00,$0.00,$144.88,$144.88,$0.00,$203.00,$0.00,$101.50,$160.78,$162.40,$0.00,$0.00,$0.00,$0.00,$0.00
27204865,EAP,Custom 27204865,,Introd Shth 9fr 14cm Hmsts Gwire Plwy .038in Trnsp,$75.00,$0.00,$75.00,$0.00,$53.53,$0.00,$0.00,$53.53,$53.53,$0.00,$75.00,$0.00,$37.50,$59.40,$60.00,$0.00,$0.00,$0.00,$0.00,$0.00
27204870,EAP,HCPCS C1887,,Catheter Delivery System 0-.02in Micro Str 2.6-2.95fr .025in,"$2,325.00",$0.00,"$2,325.00","$1,262.48","$1,659.35",$0.00,$400.59,"$1,659.35","$1,659.35",$407.09,"$2,325.00",$0.00,"$1,162.50","$1,841.40","$1,860.00",$0.00,$363.86,$0.00,$370.14,$0.00
27204871,EAP,Custom 27204871,,Axs Catalyst 5 Distal Access Catheter 0.058in X 115cm,"$3,878.00",$0.00,"$3,878.00",$0.00,"$2,767.73",$0.00,$0.00,"$2,767.73","$2,767.73",$0.00,"$3,878.00",$0.00,"$1,939.00","$3,071.38","$3,102.40",$0.00,$0.00,$0.00,$0.00,$0.00
27204873,EAP,HCPCS C1887,,Terumo Medical Corp- Div Terumo Group,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
27204874,EAP,HCPCS C1887,,Catheter Angio Radl Tiger 4.5 Curve 5fr 110cm,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
27204875,EAP,HCPCS C1887,,Catheter Angio Sarah Radl 4 Curve 5fr 110cm Coron,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
27204876,EAP,HCPCS C1887,,Catheter Angio Radialtiger Curve 6fr 4mm 110cm,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
27204879,EAP,HCPCS C1887,,Catheter Angio Sarah Radl Curve 6fr 4mm 110cm,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
27204880,EAP,HCPCS C1769,,Gui Vas St Str .035in 260cm Flexible Tip,$100.00,$0.00,$100.00,$54.30,$71.37,$0.00,$17.23,$71.37,$71.37,$17.51,$100.00,$0.00,$50.00,$79.20,$80.00,$0.00,$15.65,$0.00,$15.92,$0.00
27204881,EAP,HCPCS C1725,,Cat Baldi Lp 5.3fr 8mm 75cm 100mm High Pres,$463.00,$0.00,$463.00,$251.41,$330.44,$0.00,$79.77,$330.44,$330.44,$81.07,$463.00,$0.00,$231.50,$366.70,$370.40,$0.00,$72.46,$0.00,$73.71,$0.00
27204883,EAP,HCPCS C1894,,Int Sheath .035in 7fr .1in 70cm Anl0 Curve Str Tip,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27204884,EAP,HCPCS C1725,,Cat Bald .018in 6fr 5mm 135mm 60mm Otw Lp Infl,$713.00,$0.00,$713.00,$387.16,$508.87,$0.00,$122.85,$508.87,$508.87,$124.84,$713.00,$0.00,$356.50,$564.70,$570.40,$0.00,$111.58,$0.00,$113.51,$0.00
27204885,EAP,HCPCS C1725,,Cat Bald 6mm 75cm 40mm High Pres Lp Infla Pt,$463.00,$0.00,$463.00,$251.41,$330.44,$0.00,$79.77,$330.44,$330.44,$81.07,$463.00,$0.00,$231.50,$366.70,$370.40,$0.00,$72.46,$0.00,$73.71,$0.00
27204886,EAP,HCPCS C1887,,Cat Guid Micro Str 3-2.4fr .021in 130cm 30cm Rad,$806.00,$0.00,$806.00,$437.66,$575.24,$0.00,$138.87,$575.24,$575.24,$141.12,$806.00,$0.00,$403.00,$638.35,$644.80,$0.00,$126.14,$0.00,$128.32,$0.00
27204887,EAP,HCPCS C1725,,Cat Bald 5fr 9mm 75cm 60mm High Pres Lp Infl,$463.00,$0.00,$463.00,$251.41,$330.44,$0.00,$79.77,$330.44,$330.44,$81.07,$463.00,$0.00,$231.50,$366.70,$370.40,$0.00,$72.46,$0.00,$73.71,$0.00
27204888,EAP,HCPCS C1725,,Cat Bald Lp 5.8fr 12mm 75cm 60mm High Pres,$463.00,$0.00,$463.00,$251.41,$330.44,$0.00,$79.77,$330.44,$330.44,$81.07,$463.00,$0.00,$231.50,$366.70,$370.40,$0.00,$72.46,$0.00,$73.71,$0.00
27204889,EAP,HCPCS C1894,,Sth Gui .018-.038in Anl2 Crve 6fr .087in 90cm Radi,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
27204890,EAP,HCPCS C1725,,Cat Bald Ult Lp Tap 6fr 2.5mm 150cm 100mm Otw,$686.00,$0.00,$686.00,$372.50,$489.60,$0.00,$118.19,$489.60,$489.60,$120.11,$686.00,$0.00,$343.00,$543.31,$548.80,$0.00,$107.36,$0.00,$109.21,$0.00
27204891,EAP,HCPCS C1725,,Cat Bald Lp 5.3fr 7mm 135cm 150mm High Pres,$550.00,$0.00,$550.00,$298.65,$392.54,$0.00,$94.76,$392.54,$392.54,$96.30,$550.00,$0.00,$275.00,$435.60,$440.00,$0.00,$86.08,$0.00,$87.56,$0.00
27204892,EAP,HCPCS C1725,,Cat Bald Lp 5.3fr 5mm 75cm 20mm High Pres,$463.00,$0.00,$463.00,$251.41,$330.44,$0.00,$79.77,$330.44,$330.44,$81.07,$463.00,$0.00,$231.50,$366.70,$370.40,$0.00,$72.46,$0.00,$73.71,$0.00
27204893,EAP,HCPCS C1725,,Cat Bald Lp 5.3fr 9mm 75cm 20mm High Pres,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
27204894,EAP,HCPCS C1725,,Cat Bald 5.8fr 10mm 75cm 60mm High Pres Lp,$463.00,$0.00,$463.00,$251.41,$330.44,$0.00,$79.77,$330.44,$330.44,$81.07,$463.00,$0.00,$231.50,$366.70,$370.40,$0.00,$72.46,$0.00,$73.71,$0.00
27204896,EAP,HCPCS C1725,,Cat Bald Lp 5.3fr 7mm 135cm 100mm High Pres,$463.00,$0.00,$463.00,$251.41,$330.44,$0.00,$79.77,$330.44,$330.44,$81.07,$463.00,$0.00,$231.50,$366.70,$370.40,$0.00,$72.46,$0.00,$73.71,$0.00
27204898,EAP,HCPCS C1725,,Cat Bald 14 Atm Ult Lp 6fr 2.5mm 143cm 20mm,$713.00,$0.00,$713.00,$387.16,$508.87,$0.00,$122.85,$508.87,$508.87,$124.84,$713.00,$0.00,$356.50,$564.70,$570.40,$0.00,$111.58,$0.00,$113.51,$0.00
27204899,EAP,HCPCS C1725,,Cat Bald Lp 5.3fr 6mm 135cm 60mm High Pres,$463.00,$0.00,$463.00,$251.41,$330.44,$0.00,$79.77,$330.44,$330.44,$81.07,$463.00,$0.00,$231.50,$366.70,$370.40,$0.00,$72.46,$0.00,$73.71,$0.00
27204900,EAP,HCPCS C1892,,Introd Shth 7fr .092in 13cm Rbst Vlv Splt Sdprt,$90.00,$0.00,$90.00,$48.87,$64.23,$0.00,$15.51,$64.23,$64.23,$15.76,$90.00,$0.00,$45.00,$71.28,$72.00,$0.00,$14.09,$0.00,$14.33,$0.00
27204901,EAP,HCPCS C1892,,Introd Shth 7fr .092in 25cm Rbst Vlv Splt Sdprt,$105.00,$0.00,$105.00,$57.02,$74.94,$0.00,$18.09,$74.94,$74.94,$18.38,$105.00,$0.00,$52.50,$83.16,$84.00,$0.00,$16.43,$0.00,$16.72,$0.00
27204902,EAP,Custom 27204902,,Starclose Se,$0.01,$0.00,$0.01,$0.00,$0.01,$0.00,$0.00,$0.01,$0.01,$0.00,$0.01,$0.00,$0.01,$0.01,$0.01,$0.00,$0.00,$0.00,$0.00,$0.00
27204903,EAP,Custom 27204903,,System Embolization Nonadhesive Delivery Syringe L,"$5,625.00",$0.00,"$5,625.00",$0.00,"$4,014.56",$0.00,$0.00,"$4,014.56","$4,014.56",$0.00,"$5,625.00",$0.00,"$2,812.50","$4,455.00","$4,500.00",$0.00,$0.00,$0.00,$0.00,$0.00
27204910,EAP,HCPCS C1894,,Shth Gu .018/.038in Anl1 Cve 6fr .087in 45cm Rad,$113.00,$0.00,$113.00,$61.36,$80.65,$0.00,$19.47,$80.65,$80.65,$19.79,$113.00,$0.00,$56.50,$89.50,$90.40,$0.00,$17.68,$0.00,$17.99,$0.00
27204911,EAP,HCPCS C1725,,Cat Bald Ula Lp Tper 6fr 2mm 150cm 100mm,$686.00,$0.00,$686.00,$372.50,$489.60,$0.00,$118.19,$489.60,$489.60,$120.11,$686.00,$0.00,$343.00,$543.31,$548.80,$0.00,$107.36,$0.00,$109.21,$0.00
27204912,EAP,HCPCS C1725,,Catr Bald 14 Atm Lp Taer 7fr 5mm 150cm 150mm,$754.00,$0.00,$754.00,$409.42,$538.13,$0.00,$129.91,$538.13,$538.13,$132.02,$754.00,$0.00,$377.00,$597.17,$603.20,$0.00,$118.00,$0.00,$120.04,$0.00
27204913,EAP,HCPCS C1725,,Catbald Lp 5.3fr 7mm 135cm 60mm High Pres,$463.00,$0.00,$463.00,$251.41,$330.44,$0.00,$79.77,$330.44,$330.44,$81.07,$463.00,$0.00,$231.50,$366.70,$370.40,$0.00,$72.46,$0.00,$73.71,$0.00
27204914,EAP,HCPCS C1725,,Cat Bald .035in 7mm 75cm 60mm High Pres Lp,$463.00,$0.00,$463.00,$251.41,$330.44,$0.00,$79.77,$330.44,$330.44,$81.07,$463.00,$0.00,$231.50,$366.70,$370.40,$0.00,$72.46,$0.00,$73.71,$0.00
27204916,EAP,HCPCS C1725,,Cat Bald .035in 8mm 75cm 60mm High Pre Lp,$463.00,$0.00,$463.00,$251.41,$330.44,$0.00,$79.77,$330.44,$330.44,$81.07,$463.00,$0.00,$231.50,$366.70,$370.40,$0.00,$72.46,$0.00,$73.71,$0.00
27204917,EAP,HCPCS C1725,,Cat Bald Lp 5.8fr 9mm 135cm 60mm High Pres,$463.00,$0.00,$463.00,$251.41,$330.44,$0.00,$79.77,$330.44,$330.44,$81.07,$463.00,$0.00,$231.50,$366.70,$370.40,$0.00,$72.46,$0.00,$73.71,$0.00
27204918,EAP,HCPCS C1725,,Cat Guid Ebu3.75 Curve 7fr .081in 100cm Luch,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27204919,EAP,HCPCS C1725,,Cat Bald .035in 6mm 75cm 60mm High Pres Lp,$463.00,$0.00,$463.00,$251.41,$330.44,$0.00,$79.77,$330.44,$330.44,$81.07,$463.00,$0.00,$231.50,$366.70,$370.40,$0.00,$72.46,$0.00,$73.71,$0.00
27204920,EAP,HCPCS C1830,,Biopsy System Comprehensive Tray 102mm,$350.00,$0.00,$350.00,$0.00,$249.80,$0.00,$0.00,$249.80,$249.80,$0.00,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$0.00,$0.00,$0.00,$0.00
27204921,EAP,HCPCS C1830,,Biopsy System Comprehensive Tray 152mm,$350.00,$0.00,$350.00,$0.00,$249.80,$0.00,$0.00,$249.80,$249.80,$0.00,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$0.00,$0.00,$0.00,$0.00
27204923,EAP,HCPCS C1830,,Oncontrol Biopsy System Tray 152mm,$325.00,$0.00,$325.00,$0.00,$231.95,$0.00,$0.00,$231.95,$231.95,$0.00,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$0.00,$0.00,$0.00,$0.00
27204924,EAP,Custom 27204924,,Oncontrol Coaxial Tray 6cm 11/13 Gauge,$938.00,$0.00,$938.00,$0.00,$669.45,$0.00,$0.00,$669.45,$669.45,$0.00,$938.00,$0.00,$469.00,$742.90,$750.40,$0.00,$0.00,$0.00,$0.00,$0.00
27204925,EAP,Custom 27204925,,Oncontrol Coaxial Tray 10cm 11/13 Gauge,$938.00,$0.00,$938.00,$0.00,$669.45,$0.00,$0.00,$669.45,$669.45,$0.00,$938.00,$0.00,$469.00,$742.90,$750.40,$0.00,$0.00,$0.00,$0.00,$0.00
27204926,EAP,Custom 27204926,,Oncontrol Coaxial Tray 15cm 11/13 Gauge,$938.00,$0.00,$938.00,$0.00,$669.45,$0.00,$0.00,$669.45,$669.45,$0.00,$938.00,$0.00,$469.00,$742.90,$750.40,$0.00,$0.00,$0.00,$0.00,$0.00
27204927,EAP,HCPCS C1769,,Guidewire Vasc 185cm Strl Lf Verrata + Prss Disp,"$1,688.00",$0.00,"$1,688.00",$916.58,"$1,204.73",$0.00,$290.83,"$1,204.73","$1,204.73",$295.56,"$1,688.00",$0.00,$844.00,"$1,336.90","$1,350.40",$0.00,$264.17,$0.00,$268.73,$0.00
27204928,EAP,HCPCS C2628,,Catheter Baldilat 9fr 32mm 120cm 2 Lum Radiopq,"$1,430.00",$0.00,"$1,430.00",$0.00,"$1,020.59",$0.00,$0.00,"$1,020.59","$1,020.59",$0.00,"$1,430.00",$0.00,$715.00,"$1,132.56","$1,144.00",$0.00,$0.00,$0.00,$0.00,$0.00
27204930,EAP,HCPCS C1769,,Gwire Vasc .038in 180cm Strl 3cm Merit Laurea,$80.00,$0.00,$80.00,$43.44,$57.10,$0.00,$13.78,$57.10,$57.10,$14.01,$80.00,$0.00,$40.00,$63.36,$64.00,$0.00,$12.52,$0.00,$12.74,$0.00
27204932,EAP,HCPCS C1769,,Gdwre Vasc Tper .038in 145cm 6cm Str Tip Am,$61.00,$0.00,$61.00,$33.12,$43.54,$0.00,$10.51,$43.54,$43.54,$10.68,$61.00,$0.00,$30.50,$48.31,$48.80,$0.00,$9.55,$0.00,$9.71,$0.00
27204933,EAP,HCPCS C1769,,Set Cat 15.5fr 24cm 3 Lumen Bas Gwire Dil Scal,$278.00,$0.00,$278.00,$150.95,$198.41,$0.00,$47.90,$198.41,$198.41,$48.68,$278.00,$0.00,$139.00,$220.18,$222.40,$0.00,$43.51,$0.00,$44.26,$0.00
27204941,EAP,HCPCS C1769,,Set Cath 20cm 15.5fr 3 Lum Basic Gwire Dilat Scpl,$288.00,$0.00,$288.00,$156.38,$205.55,$0.00,$49.62,$205.55,$205.55,$50.43,$288.00,$0.00,$144.00,$228.10,$230.40,$0.00,$45.07,$0.00,$45.85,$0.00
27204942,EAP,HCPCS C1753,,Catheter Us Kodama,"$1,500.00",$0.00,"$1,500.00",$814.50,"$1,070.55",$0.00,$258.44,"$1,070.55","$1,070.55",$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
27204943,EAP,Custom 27204943,,Glove Compression Large Open Finger Seamless Latex Free Pr,$43.00,$0.00,$43.00,$0.00,$30.69,$0.00,$0.00,$30.69,$30.69,$0.00,$43.00,$0.00,$21.50,$34.06,$34.40,$0.00,$0.00,$0.00,$0.00,$0.00
27204944,EAP,Custom 27204944,,Glove Cmpr Xs 5-6in Lf Istnr F F Thrp Mach Wshbl 80% Nyl 20% Pr,$30.00,$0.00,$30.00,$0.00,$21.41,$0.00,$0.00,$21.41,$21.41,$0.00,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$0.00,$0.00,$0.00,$0.00
27204945,EAP,Custom 27204945,,Glove Cmpr Med Lf Istnr Anemb F F L/r Hnd Edema Cntrl Pr,$30.00,$0.00,$30.00,$0.00,$21.41,$0.00,$0.00,$21.41,$21.41,$0.00,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$0.00,$0.00,$0.00,$0.00
27204946,EAP,Custom 27204946,,Glove Cmpr Sm 23-32 Mmhg 6-7in Lf Istnr F F Thrp Nyl Spndx Pr,$30.00,$0.00,$30.00,$0.00,$21.41,$0.00,$0.00,$21.41,$21.41,$0.00,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$0.00,$0.00,$0.00,$0.00
27204947,EAP,Custom 27204947,,Glove Cmpr Lg 23-32 Mmhg 8-9in Lf Istnr F F Thrp Nyl Spndx Pr,$30.00,$0.00,$30.00,$0.00,$21.41,$0.00,$0.00,$21.41,$21.41,$0.00,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$0.00,$0.00,$0.00,$0.00
27204948,EAP,Custom 27204948,,Glove Cmpr Xs 5-6in Lf Istnr Opn Fngr Ltwt Blnd Smls Sprt Pr,$30.00,$0.00,$30.00,$0.00,$21.41,$0.00,$0.00,$21.41,$21.41,$0.00,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$0.00,$0.00,$0.00,$0.00
27204949,EAP,Custom 27204949,,Glove Cmpr Sm Lf Istnr Opn Fngr Smls 80% Nyl 20% Spndx 23-32 Pr,$30.00,$0.00,$30.00,$0.00,$21.41,$0.00,$0.00,$21.41,$21.41,$0.00,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$0.00,$0.00,$0.00,$0.00
27204950,EAP,Custom 27204950,,Glove Cmpr Md Lf Istnr Opn Fngr Smls 80% Nyl 20% Spndx 23-32 Pr,$30.00,$0.00,$30.00,$0.00,$21.41,$0.00,$0.00,$21.41,$21.41,$0.00,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$0.00,$0.00,$0.00,$0.00
27204951,EAP,Custom 27204951,,Sphere Embl Ylw Embsph 100-300um Mcsph Ns Prefl,$608.00,$0.00,$608.00,$0.00,$433.93,$0.00,$0.00,$433.93,$433.93,$0.00,$608.00,$0.00,$304.00,$481.54,$486.40,$0.00,$0.00,$0.00,$0.00,$0.00
27204952,EAP,Custom 27204952,,Sphere Embl Blue Embsph 300-500um Mcsph Ns Prefl,$608.00,$0.00,$608.00,$0.00,$433.93,$0.00,$0.00,$433.93,$433.93,$0.00,$608.00,$0.00,$304.00,$481.54,$486.40,$0.00,$0.00,$0.00,$0.00,$0.00
27204953,EAP,CPT® C1894,,Set Intro 5fr Mcstk Ntnl Wre Radopq Tip Coax Stf,$38.00,$0.00,$38.00,$20.63,$27.12,$0.00,$6.55,$27.12,$27.12,$6.65,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$5.95,$0.00,$6.05,$0.00
27204954,EAP,CPT® C1894,,Set Intro 5fr Mcstk Radopq Coax Stf Wre Ntnl,$40.00,$0.00,$40.00,$21.72,$28.55,$0.00,$6.89,$28.55,$28.55,$7.00,$40.00,$0.00,$20.00,$31.68,$32.00,$0.00,$6.26,$0.00,$6.37,$0.00
27205000,EAP,HCPCS C1769,,Guidewire Vasc 175cm .014in Radiopq Tip Snsr Elmt,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27205001,EAP,Custom 27205001,,Introd Shth 11fr .144in 25cm Rbst Vlv Splt Sdprt,$105.00,$0.00,$105.00,$0.00,$74.94,$0.00,$0.00,$74.94,$74.94,$0.00,$105.00,$0.00,$52.50,$83.16,$84.00,$0.00,$0.00,$0.00,$0.00,$0.00
27205003,EAP,Custom 27205003,,Introd Shth 10fr .131in 25cm Rbst Vlv Splt Sdprt,$105.00,$0.00,$105.00,$0.00,$74.94,$0.00,$0.00,$74.94,$74.94,$0.00,$105.00,$0.00,$52.50,$83.16,$84.00,$0.00,$0.00,$0.00,$0.00,$0.00
27205004,EAP,Custom 27205004,,Introd Shth 10.5fr .138in 13cm Rbst Vlv Splt Sdprt,$90.00,$0.00,$90.00,$0.00,$64.23,$0.00,$0.00,$64.23,$64.23,$0.00,$90.00,$0.00,$45.00,$71.28,$72.00,$0.00,$0.00,$0.00,$0.00,$0.00
27205005,EAP,Custom 27205005,,Introd Shth 10fr .131in 13cm Rbst Vlv Splt Sdprt,$90.00,$0.00,$90.00,$0.00,$64.23,$0.00,$0.00,$64.23,$64.23,$0.00,$90.00,$0.00,$45.00,$71.28,$72.00,$0.00,$0.00,$0.00,$0.00,$0.00
27205006,EAP,Custom 27205006,,Introd Shth 11fr .144in 13cm Rbst Vlv Splt Sdprt,$90.00,$0.00,$90.00,$0.00,$64.23,$0.00,$0.00,$64.23,$64.23,$0.00,$90.00,$0.00,$45.00,$71.28,$72.00,$0.00,$0.00,$0.00,$0.00,$0.00
27205007,EAP,Custom 27205007,,Introd Shth 12.5fr .164in 13cm Rbst Vlv Splt Sdprt,$90.00,$0.00,$90.00,$0.00,$64.23,$0.00,$0.00,$64.23,$64.23,$0.00,$90.00,$0.00,$45.00,$71.28,$72.00,$0.00,$0.00,$0.00,$0.00,$0.00
27205008,EAP,Custom 27205008,,Introd Shth 12fr .158in 13cm Rbst Vlv Splt Sdprt,$90.00,$0.00,$90.00,$0.00,$64.23,$0.00,$0.00,$64.23,$64.23,$0.00,$90.00,$0.00,$45.00,$71.28,$72.00,$0.00,$0.00,$0.00,$0.00,$0.00
27205009,EAP,Custom 27205009,,Introd Shth 6fr .083in 13cm Rbst Vlv Splt Sdprt,$90.00,$0.00,$90.00,$0.00,$64.23,$0.00,$0.00,$64.23,$64.23,$0.00,$90.00,$0.00,$45.00,$71.28,$72.00,$0.00,$0.00,$0.00,$0.00,$0.00
27205010,EAP,Custom 27205010,,Introd Shth 8.5fr .112in 13cm Rbst Vlv Splt Sdprt,$90.00,$0.00,$90.00,$0.00,$64.23,$0.00,$0.00,$64.23,$64.23,$0.00,$90.00,$0.00,$45.00,$71.28,$72.00,$0.00,$0.00,$0.00,$0.00,$0.00
27205011,EAP,Custom 27205011,,Introd Shth 8fr .105in 13cm Rbst Vlv Splt Sdprt,$90.00,$0.00,$90.00,$0.00,$64.23,$0.00,$0.00,$64.23,$64.23,$0.00,$90.00,$0.00,$45.00,$71.28,$72.00,$0.00,$0.00,$0.00,$0.00,$0.00
27205012,EAP,Custom 27205012,,Introd Shth 9.5fr .125in 13cm Rbst Vlv Splt Sdprt,$90.00,$0.00,$90.00,$0.00,$64.23,$0.00,$0.00,$64.23,$64.23,$0.00,$90.00,$0.00,$45.00,$71.28,$72.00,$0.00,$0.00,$0.00,$0.00,$0.00
27205013,EAP,Custom 27205013,,Introd Shth 9fr .118in 13cm Rbst Vlv Splt Sdprt,$90.00,$0.00,$90.00,$0.00,$64.23,$0.00,$0.00,$64.23,$64.23,$0.00,$90.00,$0.00,$45.00,$71.28,$72.00,$0.00,$0.00,$0.00,$0.00,$0.00
27205014,EAP,Custom 27205014,,Introd Shth 6fr .083in 25cm Rbst Vlv Splt Sdprt,$105.00,$0.00,$105.00,$0.00,$74.94,$0.00,$0.00,$74.94,$74.94,$0.00,$105.00,$0.00,$52.50,$83.16,$84.00,$0.00,$0.00,$0.00,$0.00,$0.00
27205015,EAP,Custom 27205015,,Introd Shth 9fr .118in 25cm Rbst Vlv Splt Sdprt,$105.00,$0.00,$105.00,$0.00,$74.94,$0.00,$0.00,$74.94,$74.94,$0.00,$105.00,$0.00,$52.50,$83.16,$84.00,$0.00,$0.00,$0.00,$0.00,$0.00
27205016,EAP,Custom 27205016,,Introd Shth 8fr .083in 25cm Rbst Vlv Splt Sdprt,$105.00,$0.00,$105.00,$0.00,$74.94,$0.00,$0.00,$74.94,$74.94,$0.00,$105.00,$0.00,$52.50,$83.16,$84.00,$0.00,$0.00,$0.00,$0.00,$0.00
27205017,EAP,HCPCS C1894,,Introd Shth 7fr 13cm 19.5cm 3w Stpck Traw Hmst Vlv,$146.00,$0.00,$146.00,$79.28,$104.20,$0.00,$25.16,$104.20,$104.20,$25.56,$146.00,$0.00,$73.00,$115.63,$116.80,$0.00,$22.85,$0.00,$23.24,$0.00
27205018,EAP,HCPCS C1894,,Introd Shth 9fr 13cm 19.5cm 3w Stpck Traw Hmst Vlv,$146.00,$0.00,$146.00,$79.28,$104.20,$0.00,$25.16,$104.20,$104.20,$25.56,$146.00,$0.00,$73.00,$115.63,$116.80,$0.00,$22.85,$0.00,$23.24,$0.00
27205019,EAP,HCPCS C1894,,Introd Lead 23cm 7fr Sfshth Ult Hmst Vlv Lp Traw,$146.00,$0.00,$146.00,$79.28,$104.20,$0.00,$25.16,$104.20,$104.20,$25.56,$146.00,$0.00,$73.00,$115.63,$116.80,$0.00,$22.85,$0.00,$23.24,$0.00
27205021,EAP,HCPCS C1887,,Catheter Infus Mic .027in Phenom,"$2,000.00",$0.00,"$2,000.00","$1,086.00","$1,427.40",$0.00,$344.59,"$1,427.40","$1,427.40",$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
27205022,EAP,HCPCS C1887,,Catheter Infus 30cm .040in .036in .027in Phenom,"$2,000.00",$0.00,"$2,000.00","$1,086.00","$1,427.40",$0.00,$344.59,"$1,427.40","$1,427.40",$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
27205023,EAP,HCPCS C1887,,Catheter Infs Mic .17in Phenom,"$2,000.00",$0.00,"$2,000.00","$1,086.00","$1,427.40",$0.00,$344.59,"$1,427.40","$1,427.40",$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
27205024,EAP,HCPCS C1887,,Catheter Infus 105cm .061in .055in .044in Phenom,"$2,000.00",$0.00,"$2,000.00","$1,086.00","$1,427.40",$0.00,$344.59,"$1,427.40","$1,427.40",$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
27205025,EAP,HCPCS C1887,,Catheter Infs Mic .45in Phenom,"$2,000.00",$0.00,"$2,000.00","$1,086.00","$1,427.40",$0.00,$344.59,"$1,427.40","$1,427.40",$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
27205026,EAP,HCPCS C1769,,Kit Cath 13.5fr 16cm Strl Mh Q+ Strg Xtn Pu Hmdial,$115.00,$0.00,$115.00,$62.45,$82.08,$0.00,$19.81,$82.08,$82.08,$20.14,$115.00,$0.00,$57.50,$91.08,$92.00,$0.00,$18.00,$0.00,$18.31,$0.00
27205027,EAP,HCPCS C1769,,Kit Cath 19.5cm 13.5fr Pu Mh Q+ Str Extn Hmdial,$115.00,$0.00,$115.00,$62.45,$82.08,$0.00,$19.81,$82.08,$82.08,$20.14,$115.00,$0.00,$57.50,$91.08,$92.00,$0.00,$18.00,$0.00,$18.31,$0.00
27205028,EAP,HCPCS C1769,,Kit Cath Strg 13.5fr 24cm 7cm Mh Q+ 2 Lum Xtn Pu Hmdial,$115.00,$0.00,$115.00,$62.45,$82.08,$0.00,$19.81,$82.08,$82.08,$20.14,$115.00,$0.00,$57.50,$91.08,$92.00,$0.00,$18.00,$0.00,$18.31,$0.00
27205029,EAP,HCPCS C1769,,Guidewire Vascular 15d .018in 180cm 5cm Intermedia,$216.00,$0.00,$216.00,$117.29,$154.16,$0.00,$37.22,$154.16,$154.16,$37.82,$216.00,$0.00,$108.00,$171.07,$172.80,$0.00,$33.80,$0.00,$34.39,$0.00
27205032,EAP,Custom 27205032,,Kit Biopsy Tlab Metal Straight Curve L60 Cm L65 Cm,"$1,350.00",$0.00,"$1,350.00",$0.00,$963.50,$0.00,$0.00,$963.50,$963.50,$0.00,"$1,350.00",$0.00,$675.00,"$1,069.20","$1,080.00",$0.00,$0.00,$0.00,$0.00,$0.00
27205033,EAP,HCPCS C1884,,System Embolic Protection 3.2-4.2fr 6mm 320cm 190c,"$3,488.00",$0.00,"$3,488.00","$1,893.98","$2,489.39",$0.00,$600.96,"$2,489.39","$2,489.39",$610.72,"$3,488.00",$0.00,"$1,744.00","$2,762.50","$2,790.40",$0.00,$545.87,$0.00,$555.29,$0.00
27205035,EAP,Custom 27205035,,Catheter Intvn 180- D 2.4-2.9fr .021in 125cm Swift,"$6,000.00",$0.00,"$6,000.00",$0.00,"$4,282.20",$0.00,$0.00,"$4,282.20","$4,282.20",$0.00,"$6,000.00",$0.00,"$3,000.00","$4,752.00","$4,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
27205036,EAP,HCPCS C1725,,Catheter Baldilat Ultra Lp 5fr 1.5mm 12mm 2 Lumen,$300.00,$0.00,$300.00,$162.90,$214.11,$0.00,$51.69,$214.11,$214.11,$52.53,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$46.95,$0.00,$47.76,$0.00
27205037,EAP,HCPCS C1725,,Catheter Baldilat Ultra Lp 5fr 1.5mm 15mm 2 Lumen,$300.00,$0.00,$300.00,$162.90,$214.11,$0.00,$51.69,$214.11,$214.11,$52.53,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$46.95,$0.00,$47.76,$0.00
27205038,EAP,HCPCS C1725,,Catheter Baldilat 2.25mm 10mm Rapex Legend Semicom,"$1,033.00",$0.00,"$1,033.00",$560.92,$737.25,$0.00,$177.98,$737.25,$737.25,$180.87,"$1,033.00",$0.00,$516.50,$818.14,$826.40,$0.00,$161.66,$0.00,$164.45,$0.00
27205039,EAP,HCPCS C1725,,Catheter Baldilat Lp 5.3fr 4mm 75cm 20mm High Pres,$463.00,$0.00,$463.00,$251.41,$330.44,$0.00,$79.77,$330.44,$330.44,$81.07,$463.00,$0.00,$231.50,$366.70,$370.40,$0.00,$72.46,$0.00,$73.71,$0.00
27205040,EAP,HCPCS C1725,,Catheter Baldilat Ultra Lp 5fr 1.5mm 20mm 2 Lumen,$300.00,$0.00,$300.00,$162.90,$214.11,$0.00,$51.69,$214.11,$214.11,$52.53,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$46.95,$0.00,$47.76,$0.00
27205041,EAP,HCPCS C1725,,Catheter Baldilat Ultra Lp 5fr 1.5mm 6mm 2 Lumen R,$300.00,$0.00,$300.00,$162.90,$214.11,$0.00,$51.69,$214.11,$214.11,$52.53,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$46.95,$0.00,$47.76,$0.00
27205042,EAP,HCPCS C1725,,Catheter Baldilat Ultra Lp 5fr 1.5mm 8mm 2 Lumen R,$300.00,$0.00,$300.00,$162.90,$214.11,$0.00,$51.69,$214.11,$214.11,$52.53,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$46.95,$0.00,$47.76,$0.00
27205051,EAP,HCPCS C1769,,Catheter Gd Strg 6fr 115cm Strl Lf Sofia Disp Strk,"$4,990.00",$0.00,"$4,990.00","$2,709.57","$3,561.36",$0.00,$859.75,"$3,561.36","$3,561.36",$873.71,"$4,990.00",$0.00,"$2,495.00","$3,952.08","$3,992.00",$0.00,$780.94,$0.00,$794.41,$0.00
27205052,EAP,HCPCS C1887,,Catheter Angio Sim 1 Crv 5fr .043in 100cm Gldcath Xp Gld Tch,$122.00,$0.00,$122.00,$66.25,$87.07,$0.00,$21.02,$87.07,$87.07,$21.36,$122.00,$0.00,$61.00,$96.62,$97.60,$0.00,$19.09,$0.00,$19.42,$0.00
27205054,EAP,HCPCS C1887,,Catheter Angio Ang 5fr .043in 100cm Gldcath Xp Gld Tch 1 Brd,$122.00,$0.00,$122.00,$66.25,$87.07,$0.00,$21.02,$87.07,$87.07,$21.36,$122.00,$0.00,$61.00,$96.62,$97.60,$0.00,$19.09,$0.00,$19.42,$0.00
27205055,EAP,HCPCS C1769,,Guidewire Vasc 90d .018in 180cm 25cm Gldwr Gt Hdrph,$430.00,$0.00,$430.00,$233.49,$306.89,$0.00,$74.09,$306.89,$306.89,$75.29,$430.00,$0.00,$215.00,$340.56,$344.00,$0.00,$67.30,$0.00,$68.46,$0.00
27205056,EAP,Custom 27205056,,Catheter Balloon  6x100mm 135c,$285.00,$0.00,$285.00,$0.00,$203.40,$0.00,$0.00,$203.40,$203.40,$0.00,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$0.00,$0.00,$0.00,$0.00
27205057,EAP,HCPCS C1887,,Catheter Angio .035in 135cm Navicross Strg Tip,$427.50,$0.00,$427.50,$232.13,$305.11,$0.00,$73.66,$305.11,$305.11,$74.85,$427.50,$0.00,$213.75,$338.58,$342.00,$0.00,$66.90,$0.00,$68.06,$0.00
27205058,EAP,HCPCS C1887,,Catheter Angio .035in 65cm Navicross Strg Tip,$427.50,$0.00,$427.50,$232.13,$305.11,$0.00,$73.66,$305.11,$305.11,$74.85,$427.50,$0.00,$213.75,$338.58,$342.00,$0.00,$66.90,$0.00,$68.06,$0.00
27205059,EAP,HCPCS C1887,,Catheter Angio .038in 1 Crv 5fr 100cm 15cm Gldcath Xp 2,$121.88,$0.00,$121.88,$66.18,$86.99,$0.00,$21.00,$86.99,$86.99,$21.34,$121.88,$0.00,$60.94,$96.53,$97.50,$0.00,$19.07,$0.00,$19.40,$0.00
27205060,EAP,HCPCS C1887,,Catheter Angio .038in 5fr 100cm 15cm Gldcath Xp 2 Braid Pu,$121.88,$0.00,$121.88,$66.18,$86.99,$0.00,$21.00,$86.99,$86.99,$21.34,$121.88,$0.00,$60.94,$96.53,$97.50,$0.00,$19.07,$0.00,$19.40,$0.00
27205061,EAP,HCPCS C1887,,Catheter Angio .038in 5fr 65cm 15cm Gldcath Xp 2 Braid Pu,$121.88,$0.00,$121.88,$66.18,$86.99,$0.00,$21.00,$86.99,$86.99,$21.34,$121.88,$0.00,$60.94,$96.53,$97.50,$0.00,$19.07,$0.00,$19.40,$0.00
27205062,EAP,HCPCS C1887,,Catheter Angio .038in 5fr 70cm Gldcath Yashiro Tip,$140.00,$0.00,$140.00,$76.02,$99.92,$0.00,$24.12,$99.92,$99.92,$24.51,$140.00,$0.00,$70.00,$110.88,$112.00,$0.00,$21.91,$0.00,$22.29,$0.00
27205063,EAP,HCPCS C1887,,Catheter Angio .038in J Crv 4fr 65cm 15cm Gldcath Gw Hdrph,$121.38,$0.00,$121.38,$65.91,$86.63,$0.00,$20.91,$86.63,$86.63,$21.25,$121.38,$0.00,$60.69,$96.13,$97.10,$0.00,$19.00,$0.00,$19.32,$0.00
27205064,EAP,HCPCS C1887,,Catheter Angio .038in J Crv 5fr 65cm 25cm Gldcath Gw Hdrph,$121.38,$0.00,$121.38,$65.91,$86.63,$0.00,$20.91,$86.63,$86.63,$21.25,$121.38,$0.00,$60.69,$96.13,$97.10,$0.00,$19.00,$0.00,$19.32,$0.00
27205065,EAP,HCPCS C1887,,Catheter Angio .038in Jb2 Crv 4fr 100cm 15cm Gldcath Gw,$121.38,$0.00,$121.38,$65.91,$86.63,$0.00,$20.91,$86.63,$86.63,$21.25,$121.38,$0.00,$60.69,$96.13,$97.10,$0.00,$19.00,$0.00,$19.32,$0.00
27205066,EAP,HCPCS C1887,,Catheter Angio .038in Jb2 Crv 5fr 100cm 40cm Gldcath Tpr Gw,$121.38,$0.00,$121.38,$65.91,$86.63,$0.00,$20.91,$86.63,$86.63,$21.25,$121.38,$0.00,$60.69,$96.13,$97.10,$0.00,$19.00,$0.00,$19.32,$0.00
27205067,EAP,HCPCS C1887,,Catheter Angio .038in Mani Crv 4fr 100cm 15cm Gldcath Gw,$121.38,$0.00,$121.38,$65.91,$86.63,$0.00,$20.91,$86.63,$86.63,$21.25,$121.38,$0.00,$60.69,$96.13,$97.10,$0.00,$19.00,$0.00,$19.32,$0.00
27205068,EAP,HCPCS C1887,,Catheter Angio .038in Mani Crv 5fr 100cm 40cm Gldcath Gw,$121.38,$0.00,$121.38,$65.91,$86.63,$0.00,$20.91,$86.63,$86.63,$21.25,$121.38,$0.00,$60.69,$96.13,$97.10,$0.00,$19.00,$0.00,$19.32,$0.00
27205069,EAP,HCPCS C1887,,Catheter Angio .038in Sim1 Crv 4fr 100cm 15cm Gldcath Gw,$121.38,$0.00,$121.38,$65.91,$86.63,$0.00,$20.91,$86.63,$86.63,$21.25,$121.38,$0.00,$60.69,$96.13,$97.10,$0.00,$19.00,$0.00,$19.32,$0.00
27205070,EAP,HCPCS C1887,,Catheter Angio .038in Sim2 Crv 5fr 65cm Gldcath 1 Braid,$121.38,$0.00,$121.38,$65.91,$86.63,$0.00,$20.91,$86.63,$86.63,$21.25,$121.38,$0.00,$60.69,$96.13,$97.10,$0.00,$19.00,$0.00,$19.32,$0.00
27205071,EAP,HCPCS C1887,,Catheter Angio .038in Sim3 Crv 4fr 100cm 15cm Gldcath Gw,$121.38,$0.00,$121.38,$65.91,$86.63,$0.00,$20.91,$86.63,$86.63,$21.25,$121.38,$0.00,$60.69,$96.13,$97.10,$0.00,$19.00,$0.00,$19.32,$0.00
27205072,EAP,HCPCS C1887,,Catheter Angio 150cm Navicross Radopq Strg Tip Ss Hdrph,$427.50,$0.00,$427.50,$232.13,$305.11,$0.00,$73.66,$305.11,$305.11,$74.85,$427.50,$0.00,$213.75,$338.58,$342.00,$0.00,$66.90,$0.00,$68.06,$0.00
27205073,EAP,HCPCS C1887,,Catheter Angio 30d 12mm 135cm Navicross 3 Radopq Sprt Ss,$427.50,$0.00,$427.50,$232.13,$305.11,$0.00,$73.66,$305.11,$305.11,$74.85,$427.50,$0.00,$213.75,$338.58,$342.00,$0.00,$66.90,$0.00,$68.06,$0.00
27205074,EAP,HCPCS C1887,,Catheter Angio 30d 12mm 65cm Navicross 3 Radopq Sprt Ss,$427.50,$0.00,$427.50,$232.13,$305.11,$0.00,$73.66,$305.11,$305.11,$74.85,$427.50,$0.00,$213.75,$338.58,$342.00,$0.00,$66.90,$0.00,$68.06,$0.00
27205075,EAP,HCPCS C1887,,Catheter Angio 30d 150cm Navicross Sprt Radopq Ang Tip Hdrph,$427.50,$0.00,$427.50,$232.13,$305.11,$0.00,$73.66,$305.11,$305.11,$74.85,$427.50,$0.00,$213.75,$338.58,$342.00,$0.00,$66.90,$0.00,$68.06,$0.00
27205076,EAP,HCPCS C1887,,Catheter Angio 4fr,$140.00,$0.00,$140.00,$76.02,$99.92,$0.00,$24.12,$99.92,$99.92,$24.51,$140.00,$0.00,$70.00,$110.88,$112.00,$0.00,$21.91,$0.00,$22.29,$0.00
27205077,EAP,HCPCS C1887,,Catheter Angio 4fr .041in 150cm Gldcath Gld Tch Ang Tip 2,$121.38,$0.00,$121.38,$65.91,$86.63,$0.00,$20.91,$86.63,$86.63,$21.25,$121.38,$0.00,$60.69,$96.13,$97.10,$0.00,$19.00,$0.00,$19.32,$0.00
27205078,EAP,HCPCS C1887,,Catheter Angio Ang 4fr .041in 120cm Gldcath Gld Tch 2 Brd Ss,$121.38,$0.00,$121.38,$65.91,$86.63,$0.00,$20.91,$86.63,$86.63,$21.25,$121.38,$0.00,$60.69,$96.13,$97.10,$0.00,$19.00,$0.00,$19.32,$0.00
27205080,EAP,HCPCS C1887,,Catheter Angio Cbr 1 Crv 4fr .041in 65cm Gldcath Gld Tch 2,$121.38,$0.00,$121.38,$65.91,$86.63,$0.00,$20.91,$86.63,$86.63,$21.25,$121.38,$0.00,$60.69,$96.13,$97.10,$0.00,$19.00,$0.00,$19.32,$0.00
27205081,EAP,HCPCS C1887,,Catheter Angio Cbr 1 Crv 5fr .047in 65cm Gldcath Gld Tch 1,$121.38,$0.00,$121.38,$65.91,$86.63,$0.00,$20.91,$86.63,$86.63,$21.25,$121.38,$0.00,$60.69,$96.13,$97.10,$0.00,$19.00,$0.00,$19.32,$0.00
27205082,EAP,HCPCS C1887,,Catheter Angio Cbr 2 Crv 4fr .041in 100cm Gldcath Gld Tch 2,$121.38,$0.00,$121.38,$65.91,$86.63,$0.00,$20.91,$86.63,$86.63,$21.25,$121.38,$0.00,$60.69,$96.13,$97.10,$0.00,$19.00,$0.00,$19.32,$0.00
27205083,EAP,HCPCS C1887,,Catheter Angio Cbr 2 Crv 5fr .047in 100cm Gldcath Gld Tch 1,$121.38,$0.00,$121.38,$65.91,$86.63,$0.00,$20.91,$86.63,$86.63,$21.25,$121.38,$0.00,$60.69,$96.13,$97.10,$0.00,$19.00,$0.00,$19.32,$0.00
27205084,EAP,HCPCS C1887,,Catheter Angio Cbr 2 Crv 5fr 65cm 15cm Gldcath Xp 2 Brd Jkt,$121.88,$0.00,$121.88,$66.18,$86.99,$0.00,$21.00,$86.99,$86.99,$21.34,$121.88,$0.00,$60.94,$96.53,$97.50,$0.00,$19.07,$0.00,$19.40,$0.00
27205085,EAP,HCPCS C1887,,Catheter Angio Hdhntr 1 Crv 4fr .041in 100cm Gldcath Gld Tch,$121.38,$0.00,$121.38,$65.91,$86.63,$0.00,$20.91,$86.63,$86.63,$21.25,$121.38,$0.00,$60.69,$96.13,$97.10,$0.00,$19.00,$0.00,$19.32,$0.00
27205086,EAP,HCPCS C1887,,Catheter Angio Mp Crv 4fr .041in 100cm Gldcath Gld Tch 2 Brd,$121.38,$0.00,$121.38,$65.91,$86.63,$0.00,$20.91,$86.63,$86.63,$21.25,$121.38,$0.00,$60.69,$96.13,$97.10,$0.00,$19.00,$0.00,$19.32,$0.00
27205088,EAP,HCPCS C1887,,Catheter Angio Pv Mc 4fr 150cm Gldcath 2 Braid Hdrph Ss,$121.38,$0.00,$121.38,$65.91,$86.63,$0.00,$20.91,$86.63,$86.63,$21.25,$121.38,$0.00,$60.69,$96.13,$97.10,$0.00,$19.00,$0.00,$19.32,$0.00
27205089,EAP,,,Catheter Angio Rbt Crv 5fr 90cm Trnb Ad Acpt .035in Gw,$32.50,$0.00,$32.50,$0.00,$23.20,$0.00,$0.00,$23.20,$23.20,$0.00,$32.50,$0.00,$16.25,$25.74,$26.00,$0.00,$0.00,$0.00,$0.00,$0.00
27205090,EAP,HCPCS C1887,,Catheter Angio Sim2 Crv 4fr 100cm 15cm Gldcath 2 Ss Braid Pu,$121.38,$0.00,$121.38,$65.91,$86.63,$0.00,$20.91,$86.63,$86.63,$21.25,$121.38,$0.00,$60.69,$96.13,$97.10,$0.00,$19.00,$0.00,$19.32,$0.00
27205091,EAP,HCPCS C1887,,Catheter Angio Strg 4fr 150cm Gldcath 2 Braid Hdrph Ss,$121.38,$0.00,$121.38,$65.91,$86.63,$0.00,$20.91,$86.63,$86.63,$21.25,$121.38,$0.00,$60.69,$96.13,$97.10,$0.00,$19.00,$0.00,$19.32,$0.00
27205092,EAP,HCPCS C1887,,Catheter Angio Strg 5fr 150cm Gldcath Xp 2 Braid Hdrph Ss,$121.88,$0.00,$121.88,$66.18,$86.99,$0.00,$21.00,$86.99,$86.99,$21.34,$121.88,$0.00,$60.94,$96.53,$97.50,$0.00,$19.07,$0.00,$19.40,$0.00
27205093,EAP,HCPCS C1887,,Catheter Angio Strg Crv 4fr .041in 100cm Gldcath Gld Tch 2,$121.38,$0.00,$121.38,$65.91,$86.63,$0.00,$20.91,$86.63,$86.63,$21.25,$121.38,$0.00,$60.69,$96.13,$97.10,$0.00,$19.00,$0.00,$19.32,$0.00
27205094,EAP,HCPCS C1887,,Catheter Angio Strg Crv 4fr .041in 120cm Gldcath Gld Tch 2,$121.38,$0.00,$121.38,$65.91,$86.63,$0.00,$20.91,$86.63,$86.63,$21.25,$121.38,$0.00,$60.69,$96.13,$97.10,$0.00,$19.00,$0.00,$19.32,$0.00
27205095,EAP,HCPCS C1887,,Catheter Angio Strg Crv 4fr .041in 65cm Gldcath Gld Tch 2,$121.38,$0.00,$121.38,$65.91,$86.63,$0.00,$20.91,$86.63,$86.63,$21.25,$121.38,$0.00,$60.69,$96.13,$97.10,$0.00,$19.00,$0.00,$19.32,$0.00
27205096,EAP,HCPCS C1887,,Catheter Angio Strg Crv 5fr .043in 65cm Gldcath Xp Gld Tch 1,$121.88,$0.00,$121.88,$66.18,$86.99,$0.00,$21.00,$86.99,$86.99,$21.34,$121.88,$0.00,$60.94,$96.53,$97.50,$0.00,$19.07,$0.00,$19.40,$0.00
27205097,EAP,HCPCS C1887,,Catheter Angio Strg Crv 5fr .047in 65cm Gldcath Gld Tch 1,$121.38,$0.00,$121.38,$65.91,$86.63,$0.00,$20.91,$86.63,$86.63,$21.25,$121.38,$0.00,$60.69,$96.13,$97.10,$0.00,$19.00,$0.00,$19.32,$0.00
27205098,EAP,HCPCS C1725,,Catheter Blndil .035in 6fr 3mm 90cm 120mm Metacross Rx Peri,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205099,EAP,HCPCS C1725,,Catheter Blndil 2.5mm 150cm 200mm Crosperio Otw Pta,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205100,EAP,HCPCS C1725,,Catheter Blndil 3.5fr 1.5mm 150cm 20mm Crosperio Rx Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205101,EAP,HCPCS C1725,,Catheter Blndil 3.5fr 1.5mm 150cm 40mm Crosperio Rx Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205102,EAP,HCPCS C1725,,Catheter Blndil 3.5fr 1.5mm 150cm 80mm Crosperio Rx Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205103,EAP,HCPCS C1725,,Catheter Blndil 3.5fr 1.5mm 90cm 120mm Crosperio Rx Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205104,EAP,HCPCS C1725,,Catheter Blndil 3.5fr 1.5mm 90cm 20mm Crosperio Rx Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205105,EAP,HCPCS C1725,,Catheter Blndil 3.5fr 1.5mm 90cm 40mm Crosperio Rx Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205106,EAP,HCPCS C1725,,Catheter Blndil 3.5fr 1.5mm 90cm 80mm Crosperio Rx Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205107,EAP,HCPCS C1725,,Catheter Blndil 3.5fr 2.5mm 150cm 120mm Crosperio Rx Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205108,EAP,HCPCS C1725,,Catheter Blndil 3.5fr 2.5mm 150cm 200mm Crosperio Rx Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205109,EAP,HCPCS C1725,,Catheter Blndil 3.5fr 2.5mm 150cm 40mm Crosperio Rx Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205110,EAP,HCPCS C1725,,Catheter Blndil 3.5fr 2.5mm 150cm 80mm Crosperio Rx Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205111,EAP,HCPCS C1725,,Catheter Blndil 3.5fr 2.5mm 90cm 120mm Crosperio Rx Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205112,EAP,HCPCS C1725,,Catheter Blndil 3.5fr 2.5mm 90cm 150mm Crosperio Rx Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205113,EAP,HCPCS C1725,,Catheter Blndil 3.5fr 2.5mm 90cm 200mm Crosperio Rx Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205114,EAP,HCPCS C1725,,Catheter Blndil 3.5fr 2.5mm 90cm 40mm Crosperio Rx Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205115,EAP,HCPCS C1725,,Catheter Blndil 3.5fr 2.5mm 90cm 80mm Crosperio Rx Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205116,EAP,HCPCS C1725,,Catheter Blndil 3.5fr 2mm 150cm 150mm Crosperio Rx Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205117,EAP,HCPCS C1725,,Catheter Blndil 3.5fr 2mm 150cm 40mm Crosperio Rx Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205118,EAP,HCPCS C1725,,Catheter Blndil 3.5fr 2mm 150cm 80mm Crosperio Rx Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205119,EAP,HCPCS C1725,,Catheter Blndil 3.5fr 2mm 90cm 120mm Crosperio Rx Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205120,EAP,HCPCS C1725,,Catheter Blndil 3.5fr 2mm 90cm 150mm Crosperio Rx Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205121,EAP,HCPCS C1725,,Catheter Blndil 3.5fr 2mm 90cm 200mm Crosperio Rx Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205122,EAP,HCPCS C1725,,Catheter Blndil 3.5fr 2mm 90cm 40mm Crosperio Rx Tpr Cor Wre,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205123,EAP,HCPCS C1725,,Catheter Blndil 3.5fr 2mm 90cm 80mm Crosperio Rx Tpr Cor Wre,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205124,EAP,HCPCS C1725,,Catheter Blndil 3.5fr 3.5mm 150cm 40mm Crosperio Rx Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205125,EAP,HCPCS C1725,,Catheter Blndil 3.5fr 3.5mm 150cm 80mm Crosperio Rx Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205126,EAP,HCPCS C1725,,Catheter Blndil 3.5fr 3.5mm 90cm 120mm Crosperio Rx Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205127,EAP,HCPCS C1725,,Catheter Blndil 3.5fr 3.5mm 90cm 150mm Crosperio Rx Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205128,EAP,HCPCS C1725,,Catheter Blndil 3.5fr 3.5mm 90cm 200mm Crosperio Rx Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205129,EAP,HCPCS C1725,,Catheter Blndil 3.5fr 3.5mm 90cm 40mm Crosperio Rx Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205130,EAP,HCPCS C1725,,Catheter Blndil 3.5fr 3.5mm 90cm 80mm Crosperio Rx Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205131,EAP,HCPCS C1725,,Catheter Blndil 3.5fr 3mm 150cm 150mm Crosperio Rx Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205132,EAP,HCPCS C1725,,Catheter Blndil 3.5fr 3mm 150cm 40mm Crosperio Rx Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205133,EAP,HCPCS C1725,,Catheter Blndil 3.5fr 3mm 150cm 80mm Crosperio Rx Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205134,EAP,HCPCS C1725,,Catheter Blndil 3.5fr 3mm 90cm 120mm Crosperio Rx Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205135,EAP,HCPCS C1725,,Catheter Blndil 3.5fr 3mm 90cm 150mm Crosperio Rx Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205136,EAP,HCPCS C1725,,Catheter Blndil 3.5fr 3mm 90cm 200mm Crosperio Rx Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205138,EAP,HCPCS C1725,,Catheter Blndil 3.5fr 3mm 90cm 80mm Crosperio Rx Tpr Cor Wre,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205139,EAP,HCPCS C1725,,Catheter Blndil 3.5fr 4mm 150cm 40mm Crosperio Rx Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205140,EAP,HCPCS C1725,,Catheter Blndil 3.5fr 4mm 150cm 80mm Crosperio Rx Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205141,EAP,HCPCS C1725,,Catheter Blndil 3.5fr 4mm 90cm 120mm Crosperio Rx Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205142,EAP,HCPCS C1725,,Catheter Blndil 3.5fr 4mm 90cm 150mm Crosperio Rx Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205143,EAP,HCPCS C1725,,Catheter Blndil 3.5fr 4mm 90cm 40mm Crosperio Rx Tpr Cor Wre,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205144,EAP,HCPCS C1725,,Catheter Blndil 3.5fr 4mm 90cm 80mm Crosperio Rx Tpr Cor Wre,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205145,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 1.5mm 150cm 120mm Crosperio Otw Tpr,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205146,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 1.5mm 150cm 20mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205147,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 1.5mm 150cm 40mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205148,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 1.5mm 150cm 80mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205149,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 1.5mm 65cm 120mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205150,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 1.5mm 65cm 20mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205151,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 1.5mm 65cm 40mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205152,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 1.5mm 65cm 80mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205153,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 1.5mm 90cm 120mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205154,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 1.5mm 90cm 20mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205155,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 1.5mm 90cm 40mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205156,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 1.5mm 90cm 80mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205157,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 2.5mm 150cm 120mm Crosperio Otw Tpr,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205158,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 2.5mm 150cm 150mm Crosperio Otw Tpr,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205159,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 2.5mm 150cm 40mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205161,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 2.5mm 65cm 120mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205162,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 2.5mm 65cm 150mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205163,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 2.5mm 65cm 200mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205164,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 2.5mm 65cm 40mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205165,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 2.5mm 65cm 80mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205166,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 2.5mm 90cm 120mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205167,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 2.5mm 90cm 150mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205168,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 2.5mm 90cm 200mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205169,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 2.5mm 90cm 40mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205170,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 2.5mm 90cm 80mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205171,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 2mm 150cm 120mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205172,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 2mm 150cm 150mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205173,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 2mm 150cm 200mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205174,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 2mm 150cm 40mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205175,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 2mm 150cm 80mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205176,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 2mm 65cm 120mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205177,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 2mm 65cm 150mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205178,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 2mm 65cm 200mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205179,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 2mm 65cm 40mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205180,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 2mm 65cm 80mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205181,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 2mm 90cm 120mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205182,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 2mm 90cm 150mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205183,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 2mm 90cm 200mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205184,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 2mm 90cm 40mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205185,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 2mm 90cm 80mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205186,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 3.5mm 150cm 120mm Crosperio Otw Tpr,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205187,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 3.5mm 150cm 150mm Crosperio Otw Tpr,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205188,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 3.5mm 150cm 200mm Crosperio Otw Tpr,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205189,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 3.5mm 150cm 40mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205190,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 3.5mm 150cm 80mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205191,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 3.5mm 65cm 120mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205192,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 3.5mm 65cm 150mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205193,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 3.5mm 65cm 200mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205194,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 3.5mm 65cm 40mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205195,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 3.5mm 65cm 80mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205196,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 3.5mm 90cm 120mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205197,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 3.5mm 90cm 150mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205198,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 3.5mm 90cm 200mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205199,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 3.5mm 90cm 40mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205200,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 3.5mm 90cm 80mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205201,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 3mm 150cm 120mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205202,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 3mm 150cm 150mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205203,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 3mm 150cm 40mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205204,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 3mm 150cm 80mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205205,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 3mm 65cm 120mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205206,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 3mm 65cm 150mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205207,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 3mm 65cm 200mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205208,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 3mm 65cm 40mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205209,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 3mm 65cm 80mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205210,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 3mm 90cm 120mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205211,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 3mm 90cm 150mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205212,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 3mm 90cm 40mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205213,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 3mm 90cm 80mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205214,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 4mm 150cm 120mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205215,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 4mm 150cm 150mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205216,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 4mm 150cm 40mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205217,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 4mm 150cm 80mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205218,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 4mm 65cm 120mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205219,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 4mm 65cm 150mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205220,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 4mm 65cm 200mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205221,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 4mm 65cm 40mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205222,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 4mm 65cm 80mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205223,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 4mm 90cm 120mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205224,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 4mm 90cm 200mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205225,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 4mm 90cm 40mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205226,EAP,HCPCS C1725,,Catheter Blndil 3.8fr 4mm 90cm 80mm Crosperio Otw Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205227,EAP,HCPCS C1725,,Catheter Blndil 3.9fr 2.5mm 150cm 100mm Crosstella Otw Tpr,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205228,EAP,HCPCS C1725,,Catheter Blndil 3.9fr 2.5mm 150cm 120mm Crosstella Otw Tpr,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205229,EAP,HCPCS C1725,,Catheter Blndil 3.9fr 2.5mm 150cm 150mm Crosstella Otw Tpr,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205230,EAP,HCPCS C1725,,Catheter Blndil 3.9fr 2.5mm 150cm 200mm Crosstella Otw Tpr,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205231,EAP,HCPCS C1725,,Catheter Blndil 3.9fr 2.5mm 150cm 20mm Crosstella Otw Tpr,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205232,EAP,HCPCS C1725,,Catheter Blndil 3.9fr 2.5mm 150cm 40mm Crosstella Otw Tpr,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205233,EAP,HCPCS C1725,,Catheter Blndil 3.9fr 2.5mm 150cm 60mm Crosstella Otw Tpr,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205234,EAP,HCPCS C1725,,Catheter Blndil 3.9fr 2.5mm 150cm 80mm Crosstella Otw Tpr,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205235,EAP,HCPCS C1725,,Catheter Blndil 3.9fr 2.5mm 90cm 100mm Crosstella Otw Tpr,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205236,EAP,HCPCS C1725,,Catheter Blndil 3.9fr 2.5mm 90cm 120mm Crosstella Otw Tpr,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205237,EAP,HCPCS C1725,,Catheter Blndil 3.9fr 2.5mm 90cm 150mm Crosstella Otw Tpr,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205238,EAP,HCPCS C1725,,Catheter Blndil 3.9fr 2.5mm 90cm 200mm Crosstella Otw Tpr,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205239,EAP,HCPCS C1725,,Catheter Blndil 3.9fr 2.5mm 90cm 20mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205240,EAP,HCPCS C1725,,Catheter Blndil 3.9fr 2.5mm 90cm 40mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205241,EAP,HCPCS C1725,,Catheter Blndil 3.9fr 2.5mm 90cm 60mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205242,EAP,HCPCS C1725,,Catheter Blndil 3.9fr 2.5mm 90cm 80mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205243,EAP,HCPCS C1725,,Catheter Blndil 3.9fr 2mm 150cm 100mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205244,EAP,HCPCS C1725,,Catheter Blndil 3.9fr 2mm 150cm 120mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205245,EAP,HCPCS C1725,,Catheter Blndil 3.9fr 2mm 150cm 150mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205246,EAP,HCPCS C1725,,Catheter Blndil 3.9fr 2mm 150cm 200mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205247,EAP,HCPCS C1725,,Catheter Blndil 3.9fr 2mm 150cm 20mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205248,EAP,HCPCS C1725,,Catheter Blndil 3.9fr 2mm 150cm 40mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205249,EAP,HCPCS C1725,,Catheter Blndil 3.9fr 2mm 150cm 60mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205250,EAP,HCPCS C1725,,Catheter Blndil 3.9fr 2mm 150cm 80mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205251,EAP,HCPCS C1725,,Catheter Blndil 3.9fr 2mm 90cm 100mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205252,EAP,HCPCS C1725,,Catheter Blndil 3.9fr 2mm 90cm 120mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205253,EAP,HCPCS C1725,,Catheter Blndil 3.9fr 2mm 90cm 150mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205254,EAP,HCPCS C1725,,Catheter Blndil 3.9fr 2mm 90cm 200mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205255,EAP,HCPCS C1725,,Catheter Blndil 3.9fr 2mm 90cm 20mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205256,EAP,HCPCS C1725,,Catheter Blndil 3.9fr 2mm 90cm 40mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205257,EAP,HCPCS C1725,,Catheter Blndil 3.9fr 2mm 90cm 60mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205258,EAP,HCPCS C1725,,Catheter Blndil 3.9fr 2mm 90cm 80mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205259,EAP,HCPCS C1725,,Catheter Blndil 3.9fr 3mm 150cm 100mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205260,EAP,HCPCS C1725,,Catheter Blndil 3.9fr 3mm 150cm 120mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205261,EAP,HCPCS C1725,,Catheter Blndil 3.9fr 3mm 150cm 150mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205262,EAP,HCPCS C1725,,Catheter Blndil 3.9fr 3mm 150cm 200mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205263,EAP,HCPCS C1725,,Catheter Blndil 3.9fr 3mm 150cm 20mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205264,EAP,HCPCS C1725,,Catheter Blndil 3.9fr 3mm 150cm 40mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205265,EAP,HCPCS C1725,,Catheter Blndil 3.9fr 3mm 150cm 60mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205266,EAP,HCPCS C1725,,Catheter Blndil 3.9fr 3mm 150cm 80mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205267,EAP,HCPCS C1725,,Catheter Blndil 3.9fr 3mm 90cm 100mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205268,EAP,HCPCS C1725,,Catheter Blndil 3.9fr 3mm 90cm 120mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205269,EAP,HCPCS C1725,,Catheter Blndil 3.9fr 3mm 90cm 150mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205270,EAP,HCPCS C1725,,Catheter Blndil 3.9fr 3mm 90cm 200mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205271,EAP,HCPCS C1725,,Catheter Blndil 3.9fr 3mm 90cm 20mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205272,EAP,HCPCS C1725,,Catheter Blndil 3.9fr 3mm 90cm 40mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205273,EAP,HCPCS C1725,,Catheter Blndil 3.9fr 3mm 90cm 60mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205274,EAP,HCPCS C1725,,Catheter Blndil 3.9fr 3mm 90cm 80mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205275,EAP,HCPCS C1725,,Catheter Blndil 3.9fr 4mm 150cm 100mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205276,EAP,HCPCS C1725,,Catheter Blndil 3.9fr 4mm 150cm 120mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205277,EAP,HCPCS C1725,,Catheter Blndil 3.9fr 4mm 150cm 150mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205278,EAP,HCPCS C1725,,Catheter Blndil 3.9fr 4mm 150cm 200mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205279,EAP,HCPCS C1725,,Catheter Blndil 3.9fr 4mm 150cm 20mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205280,EAP,HCPCS C1725,,Catheter Blndil 3.9fr 4mm 150cm 40mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205281,EAP,HCPCS C1725,,Catheter Blndil 3.9fr 4mm 150cm 60mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205282,EAP,HCPCS C1725,,Catheter Blndil 3.9fr 4mm 150cm 80mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205283,EAP,HCPCS C1725,,Catheter Blndil 3.9fr 4mm 90cm 100mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205284,EAP,HCPCS C1725,,Catheter Blndil 3.9fr 4mm 90cm 120mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205285,EAP,HCPCS C1725,,Catheter Blndil 3.9fr 4mm 90cm 150mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205286,EAP,HCPCS C1725,,Catheter Blndil 3.9fr 4mm 90cm 200mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205287,EAP,HCPCS C1725,,Catheter Blndil 3.9fr 4mm 90cm 20mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205288,EAP,HCPCS C1725,,Catheter Blndil 3.9fr 4mm 90cm 40mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205289,EAP,HCPCS C1725,,Catheter Blndil 3.9fr 4mm 90cm 60mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205290,EAP,HCPCS C1725,,Catheter Blndil 3.9fr 4mm 90cm 80mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205291,EAP,HCPCS C1725,,Catheter Blndil 4.3fr 5mm 150cm 100mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205292,EAP,HCPCS C1725,,Catheter Blndil 4.3fr 5mm 150cm 120mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205293,EAP,HCPCS C1725,,Catheter Blndil 4.3fr 5mm 150cm 150mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205294,EAP,HCPCS C1725,,Catheter Blndil 4.3fr 5mm 150cm 200mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205295,EAP,HCPCS C1725,,Catheter Blndil 4.3fr 5mm 150cm 20mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205296,EAP,HCPCS C1725,,Catheter Blndil 4.3fr 5mm 150cm 20mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205297,EAP,HCPCS C1725,,Catheter Blndil 4.3fr 5mm 150cm 40mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205298,EAP,HCPCS C1725,,Catheter Blndil 4.3fr 5mm 150cm 40mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205299,EAP,HCPCS C1725,,Catheter Blndil 4.3fr 5mm 150cm 60mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205300,EAP,HCPCS C1725,,Catheter Blndil 4.3fr 5mm 150cm 80mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205301,EAP,HCPCS C1725,,Catheter Blndil 4.3fr 5mm 90cm 100mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205302,EAP,HCPCS C1725,,Catheter Blndil 4.3fr 5mm 90cm 120mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205303,EAP,HCPCS C1725,,Catheter Blndil 4.3fr 5mm 90cm 150mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205304,EAP,HCPCS C1725,,Catheter Blndil 4.3fr 5mm 90cm 200mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205305,EAP,HCPCS C1725,,Catheter Blndil 4.3fr 5mm 90cm 20mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205306,EAP,HCPCS C1725,,Catheter Blndil 4.3fr 5mm 90cm 40mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205307,EAP,HCPCS C1725,,Catheter Blndil 4.3fr 5mm 90cm 40mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205308,EAP,HCPCS C1725,,Catheter Blndil 4.3fr 5mm 90cm 60mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205309,EAP,HCPCS C1725,,Catheter Blndil 4.3fr 5mm 90cm 80mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205310,EAP,HCPCS C1725,,Catheter Blndil 4.3fr 6mm 150cm 100mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205311,EAP,HCPCS C1725,,Catheter Blndil 4.3fr 6mm 150cm 120mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205312,EAP,HCPCS C1725,,Catheter Blndil 4.3fr 6mm 150cm 150mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205313,EAP,HCPCS C1725,,Catheter Blndil 4.3fr 6mm 150cm 200mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205314,EAP,HCPCS C1725,,Catheter Blndil 4.3fr 6mm 150cm 60mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205315,EAP,HCPCS C1725,,Catheter Blndil 4.3fr 6mm 150cm 80mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205316,EAP,HCPCS C1725,,Catheter Blndil 4.3fr 6mm 90cm 100mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205317,EAP,HCPCS C1725,,Catheter Blndil 4.3fr 6mm 90cm 120mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205318,EAP,HCPCS C1725,,Catheter Blndil 4.3fr 6mm 90cm 150mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205319,EAP,HCPCS C1725,,Catheter Blndil 4.3fr 6mm 90cm 200mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205320,EAP,HCPCS C1725,,Catheter Blndil 4.3fr 6mm 90cm 20mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205321,EAP,HCPCS C1725,,Catheter Blndil 4.3fr 6mm 90cm 60mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205322,EAP,HCPCS C1725,,Catheter Blndil 4.3fr 6mm 90cm 80mm Crosstella Otw Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205323,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 2.5mm 150cm 100mm Crosstella Rx Tpr,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205324,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 2.5mm 150cm 120mm Crosstella Rx Tpr,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205325,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 2.5mm 150cm 150mm Crosstella Rx Tpr,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205326,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 2.5mm 150cm 200mm Crosstella Rx Tpr,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205327,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 2.5mm 150cm 20mm Crosstella Rx Tpr,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205328,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 2.5mm 150cm 40mm Crosstella Rx Tpr,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205329,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 2.5mm 150cm 60mm Crosstella Rx Tpr,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205330,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 2.5mm 150cm 80mm Crosstella Rx Tpr,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205331,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 2.5mm 90cm 100mm Crosstella Rx Tpr,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205332,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 2.5mm 90cm 120mm Crosstella Rx Tpr,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205333,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 2.5mm 90cm 150mm Crosstella Rx Tpr,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205334,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 2.5mm 90cm 200mm Crosstella Rx Tpr,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205335,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 2.5mm 90cm 20mm Crosstella Rx Tpr,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205336,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 2.5mm 90cm 40mm Crosstella Rx Tpr,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205337,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 2.5mm 90cm 60mm Crosstella Rx Tpr,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205338,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 2.5mm 90cm 80mm Crosstella Rx Tpr,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205339,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 2mm 150cm 100mm Crosstella Rx Tpr,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205340,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 2mm 150cm 120mm Crosstella Rx Tpr,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205341,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 2mm 150cm 150mm Crosstella Rx Tpr,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205342,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 2mm 150cm 200mm Crosperio Rx Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205343,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 2mm 150cm 200mm Crosstella Rx Tpr,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205344,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 2mm 150cm 20mm Crosstella Rx Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205345,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 2mm 150cm 40mm Crosstella Rx Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205346,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 2mm 150cm 60mm Crosstella Rx Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205347,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 2mm 150cm 80mm Crosstella Rx Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205348,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 2mm 90cm 100mm Crosstella Rx Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205349,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 2mm 90cm 120mm Crosstella Rx Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205350,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 2mm 90cm 150mm Crosstella Rx Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205351,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 2mm 90cm 200mm Crosperio Rx Tpr Cor,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205352,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 2mm 90cm 200mm Crosstella Rx Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205353,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 2mm 90cm 20mm Crosstella Rx Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205354,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 2mm 90cm 40mm Crosstella Rx Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205355,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 2mm 90cm 60mm Crosstella Rx Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205356,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 2mm 90cm 80mm Crosstella Rx Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205357,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 3mm 150cm 100mm Crosstella Rx Tpr,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205358,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 3mm 150cm 120mm Crosstella Rx Tpr,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205359,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 3mm 150cm 150mm Crosstella Rx Tpr,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205360,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 3mm 150cm 200mm Crosstella Rx Tpr,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205361,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 3mm 150cm 20mm Crosstella Rx Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205362,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 3mm 150cm 40mm Crosstella Rx Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205363,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 3mm 150cm 60mm Crosstella Rx Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205364,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 3mm 150cm 80mm Crosstella Rx Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205365,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 3mm 90cm 100mm Crosstella Rx Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205366,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 3mm 90cm 120mm Crosstella Rx Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205367,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 3mm 90cm 150mm Crosstella Rx Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205368,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 3mm 90cm 200mm Crosstella Rx Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205369,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 3mm 90cm 20mm Crosstella Rx Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205370,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 3mm 90cm 40mm Crosstella Rx Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205371,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 3mm 90cm 60mm Crosstella Rx Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205372,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 3mm 90cm 80mm Crosstella Rx Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205373,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 4mm 150cm 100mm Crosstella Rx Tpr,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205374,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 4mm 150cm 120mm Crosstella Rx Tpr,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205375,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 4mm 150cm 150mm Crosstella Rx Tpr,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205376,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 4mm 150cm 200mm Crosstella Rx Tpr,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205377,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 4mm 150cm 20mm Crosstella Rx Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205378,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 4mm 150cm 40mm Crosstella Rx Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205379,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 4mm 150cm 60mm Crosstella Rx Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205380,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 4mm 150cm 80mm Crosstella Rx Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205381,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 4mm 90cm 100mm Crosstella Rx Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205382,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 4mm 90cm 120mm Crosstella Rx Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205383,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 4mm 90cm 150mm Crosstella Rx Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205384,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 4mm 90cm 200mm Crosstella Rx Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205385,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 4mm 90cm 20mm Crosstella Rx Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205386,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 4mm 90cm 40mm Crosstella Rx Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205387,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 4mm 90cm 60mm Crosstella Rx Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205388,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 4mm 90cm 80mm Crosstella Rx Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205389,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 5mm 150cm 100mm Crosstella Rx Tpr,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205390,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 5mm 150cm 20mm Crosstella Rx Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205391,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 5mm 150cm 40mm Crosstella Rx Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205392,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 5mm 150cm 60mm Crosstella Rx Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205393,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 5mm 150cm 80mm Crosstella Rx Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205394,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 5mm 90cm 40mm Crosstella Rx Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205395,EAP,HCPCS C1725,,Catheter Blndil 4-3.4fr 5mm 90cm 60mm Crosstella Rx Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205396,EAP,HCPCS C1725,,Catheter Blndil 4-3.9fr 6mm 150cm 20mm Crosstella Rx Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205397,EAP,HCPCS C1725,,Catheter Blndil 4-3.9fr 6mm 150cm 40mm Crosstella Rx Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205398,EAP,HCPCS C1725,,Catheter Blndil 4-4.1fr 5mm 150cm 120mm Crosstella Rx Tpr,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205399,EAP,HCPCS C1725,,Catheter Blndil 4-4.1fr 5mm 150cm 150mm Crosstella Rx Tpr,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205401,EAP,HCPCS C1725,,Catheter Blndil 4-4.1fr 5mm 90cm 100mm Crosstella Rx Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205402,EAP,HCPCS C1725,,Catheter Blndil 4-4.1fr 5mm 90cm 120mm Crosstella Rx Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205403,EAP,HCPCS C1725,,Catheter Blndil 4-4.1fr 5mm 90cm 150mm Crosstella Rx Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205404,EAP,HCPCS C1725,,Catheter Blndil 4-4.1fr 5mm 90cm 200mm Crosstella Rx Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205405,EAP,HCPCS C1725,,Catheter Blndil 4-4.1fr 5mm 90cm 20mm Crosstella Rx Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205406,EAP,HCPCS C1725,,Catheter Blndil 4-4.1fr 5mm 90cm 80mm Crosstella Rx Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205407,EAP,HCPCS C1725,,Catheter Blndil 4-4.1fr 6mm 150cm 100mm Crosstella Rx Tpr,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205408,EAP,HCPCS C1725,,Catheter Blndil 4-4.1fr 6mm 150cm 120mm Crosstella Rx Tpr,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205409,EAP,HCPCS C1725,,Catheter Blndil 4-4.1fr 6mm 150cm 150mm Crosstella Rx Tpr,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205410,EAP,HCPCS C1725,,Catheter Blndil 4-4.1fr 6mm 150cm 200mm Crosstella Rx Tpr,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205411,EAP,HCPCS C1725,,Catheter Blndil 4-4.1fr 6mm 150cm 60mm Crosstella Rx Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205412,EAP,HCPCS C1725,,Catheter Blndil 4-4.1fr 6mm 150cm 80mm Crosstella Rx Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205413,EAP,HCPCS C1725,,Catheter Blndil 4-4.1fr 6mm 90cm 100mm Crosstella Rx Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205414,EAP,HCPCS C1725,,Catheter Blndil 4-4.1fr 6mm 90cm 120mm Crosstella Rx Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205415,EAP,HCPCS C1725,,Catheter Blndil 4-4.1fr 6mm 90cm 150mm Crosstella Rx Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205416,EAP,HCPCS C1725,,Catheter Blndil 4-4.1fr 6mm 90cm 200mm Crosstella Rx Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205417,EAP,HCPCS C1725,,Catheter Blndil 4-4.1fr 6mm 90cm 20mm Crosstella Rx Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205419,EAP,HCPCS C1725,,Catheter Blndil 4-4.1fr 6mm 90cm 80mm Crosstella Rx Tpr Cor,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205420,EAP,HCPCS C1725,,Catheter Blndil 4fr 1.5mm 150cm 120mm Crosperio Rx Acpt .014,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205421,EAP,HCPCS C1725,,Catheter Blndil 4fr 2.5mm 150cm 150mm Crosperio Rx Acpt .014,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205422,EAP,HCPCS C1725,,Catheter Blndil 4fr 2mm 150cm 120mm Crosperio Rx Acpt .014in,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205423,EAP,HCPCS C1725,,Catheter Blndil 4fr 2mm 150cm 200mm Crosperio Rx Acpt .014in,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205424,EAP,HCPCS C1725,,Catheter Blndil 4fr 3.5mm 150cm 120mm Crosperio Rx Acpt .014,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205425,EAP,HCPCS C1725,,Catheter Blndil 4fr 3.5mm 150cm 150mm Crosperio Rx Acpt .014,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205427,EAP,HCPCS C1725,,Catheter Blndil 4fr 3mm 150cm 120mm Crosperio Rx Acpt .014in,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205428,EAP,HCPCS C1725,,Catheter Blndil 4fr 3mm 150cm 200mm Crosperio Rx Acpt .014in,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205429,EAP,HCPCS C1725,,Catheter Blndil 4fr 3mm 150cm 200mm Crosperio Rx Otw Acpt,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205430,EAP,HCPCS C1725,,Catheter Blndil 4fr 3mm 90cm 200mm Crosperio Rx Otw Acpt,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205431,EAP,HCPCS C1725,,Catheter Blndil 4fr 4mm 150cm 120mm Crosperio Rx Acpt .014in,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205432,EAP,HCPCS C1725,,Catheter Blndil 4fr 4mm 150cm 150mm Crosperio Rx Acpt .014in,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205433,EAP,HCPCS C1725,,Catheter Blndil 4fr 4mm 150cm 200mm Crosperio Rx Otw Acpt,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205434,EAP,HCPCS C1725,,Catheter Blndil 4mm 90cm 150mm Crosperio Otw Pta,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$383.61,$383.61,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
27205435,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 3mm 135cm 100mm Metacross 2 Lum Otw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205436,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 3mm 135cm 120mm Metacross 2 Lum Otw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205437,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 3mm 135cm 150mm Metacross 2 Lum Otw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205438,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 3mm 135cm 200mm Metacross 2 Lum Otw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205439,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 3mm 135cm 40mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205440,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 3mm 135cm 60mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205441,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 3mm 135cm 80mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205442,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 3mm 65cm 100mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205443,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 3mm 65cm 120mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205444,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 3mm 65cm 150mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205445,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 3mm 65cm 200mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205446,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 3mm 65cm 20mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205447,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 3mm 65cm 40mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205448,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 3mm 65cm 60mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205449,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 3mm 65cm 80mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205450,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 3mm 90cm 100mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205451,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 3mm 90cm 120mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205452,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 3mm 90cm 120mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205453,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 3mm 90cm 150mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205454,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 3mm 90cm 200mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205455,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 3mm 90cm 20mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205456,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 3mm 90cm 40mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205457,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 3mm 90cm 60mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205458,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 3mm 90cm 80mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205459,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 4mm 135cm 100mm Metacross 2 Lum Otw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205460,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 4mm 135cm 150mm Metacross 2 Lum Otw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205461,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 4mm 135cm 200mm Metacross 2 Lum Otw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205462,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 4mm 135cm 20mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205463,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 4mm 135cm 40mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205464,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 4mm 135cm 60mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205465,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 4mm 135cm 80mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205466,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 4mm 65cm 100mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205467,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 4mm 65cm 120mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205468,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 4mm 65cm 150mm Metacross Otw Tpr Cor,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205469,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 4mm 65cm 200mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205470,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 4mm 65cm 20mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205471,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 4mm 65cm 40mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205472,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 4mm 65cm 60mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205473,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 4mm 65cm 80mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205474,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 4mm 90cm 100mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205475,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 4mm 90cm 120mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205476,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 4mm 90cm 150mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205477,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 4mm 90cm 200mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205478,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 4mm 90cm 20mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205479,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 4mm 90cm 40mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205480,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 4mm 90cm 60mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205481,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 4mm 90cm 80mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205482,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 5mm 135cm 100mm Metacross 2 Lum Otw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205483,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 5mm 135cm 120mm Metacross 2 Lum Otw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205484,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 5mm 135cm 150mm Metacross 2 Lum Otw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205485,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 5mm 135cm 40mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205486,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 5mm 135cm 60mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205487,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 5mm 135cm 80mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205488,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 5mm 65cm 100mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205489,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 5mm 65cm 120mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205490,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 5mm 65cm 150mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205491,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 5mm 65cm 200mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205492,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 5mm 65cm 20mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205493,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 5mm 65cm 40mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205494,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 5mm 65cm 60mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205495,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 5mm 65cm 80mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205496,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 5mm 90cm 100mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205497,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 5mm 90cm 120mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205498,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 5mm 90cm 150mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205499,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 5mm 90cm 200mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205500,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 5mm 90cm 20mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205501,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 5mm 90cm 40mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205502,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 5mm 90cm 60mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205503,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 5mm 90cm 80mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205504,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 6mm 135cm 100mm Metacross 2 Lum Otw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205505,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 6mm 135cm 120mm Metacross 2 Lum Otw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205506,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 6mm 135cm 150mm Metacross 2 Lum Otw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205507,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 6mm 135cm 20mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205508,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 6mm 135cm 20mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205509,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 6mm 135cm 40mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205510,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 6mm 135cm 60mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205511,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 6mm 135cm 80mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205512,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 6mm 65cm 100mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205513,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 6mm 65cm 120mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205514,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 6mm 65cm 20mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205515,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 6mm 65cm 60mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205516,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 6mm 90cm 120mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205518,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 6mm 90cm 20mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205519,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 6mm 90cm 60mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205520,EAP,HCPCS C1725,,Catheter Blndil 5.4fr 6mm 90cm 80mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205521,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.6-9fr 9mm 90cm 60mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205522,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 10mm 135cm 20mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205523,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 10mm 135cm 40mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205524,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 10mm 135cm 60mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205526,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 10mm 90cm 20mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205527,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 10mm 90cm 40mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205528,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 10mm 90cm 60mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205529,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 10mm 90cm 80mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205530,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 12mm 135cm 20mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205531,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 12mm 135cm 40mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205532,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 12mm 90cm 20mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205534,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 3mm 135cm 100mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205535,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 3mm 135cm 120mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205536,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 3mm 135cm 150mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205537,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 3mm 135cm 200mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205538,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 3mm 135cm 20mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205539,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 3mm 135cm 60mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205540,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 3mm 135cm 80mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205542,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 3mm 90cm 150mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205543,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 3mm 90cm 200mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205544,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 3mm 90cm 20mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205545,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 3mm 90cm 40mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205546,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 3mm 90cm 80mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205547,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 4mm 135cm 100mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205548,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 4mm 135cm 120mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205549,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 4mm 135cm 150mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205550,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 4mm 135cm 200mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205551,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 4mm 135cm 20mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205552,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 4mm 135cm 40mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205553,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 4mm 135cm 40mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205554,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 4mm 135cm 80mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205555,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 4mm 90cm 100mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205556,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 4mm 90cm 120mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205557,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 4mm 90cm 150mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205559,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 4mm 90cm 20mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205560,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 4mm 90cm 40mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205561,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 4mm 90cm 60mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205562,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 4mm 90cm 60mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205563,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 4mm 90cm 80mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205564,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 5mm 135cm 100mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205565,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 5mm 135cm 120mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205567,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 5mm 135cm 200mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205568,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 5mm 135cm 20mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205569,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 5mm 135cm 40mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205570,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 5mm 135cm 60mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205571,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 5mm 135cm 80mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205572,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 5mm 90cm 100mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205573,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 5mm 90cm 120mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205575,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 5mm 90cm 200mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205576,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 5mm 90cm 20mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205577,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 5mm 90cm 40mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205578,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 5mm 90cm 60mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205579,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 5mm 90cm 80mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205580,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 6mm 135cm 120mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205581,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 6mm 135cm 150mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205583,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 6mm 135cm 20mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205584,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 6mm 135cm 60mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205585,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 6mm 135cm 80mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205586,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 6mm 90cm 100mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205587,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 6mm 90cm 120mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205588,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 6mm 90cm 150mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205589,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 6mm 90cm 200mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205590,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 6mm 90cm 20mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205591,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 6mm 90cm 40mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205592,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 6mm 90cm 60mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205593,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 6mm 90cm 80mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205594,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 7mm 135cm 100mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205595,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 7mm 135cm 120mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205596,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 7mm 135cm 150mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205597,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 7mm 135cm 200mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205598,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 7mm 135cm 20mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205599,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 7mm 135cm 40mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205600,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 7mm 135cm 60mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205601,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 7mm 135cm 80mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205602,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 7mm 90cm 100mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205603,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 7mm 90cm 120mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205604,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 7mm 90cm 150mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205605,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 7mm 90cm 200mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205606,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 7mm 90cm 20mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205607,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 7mm 90cm 40mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205608,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 7mm 90cm 60mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205609,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 7mm 90cm 80mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205610,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 8mm 135cm 20mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205611,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 8mm 135cm 40mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205612,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 8mm 135cm 60mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205613,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 8mm 135cm 80mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205614,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 8mm 90cm 20mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205615,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 8mm 90cm 40mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205616,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 8mm 90cm 60mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205617,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 8mm 90cm 80mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205618,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 9mm 135cm 20mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205619,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 9mm 135cm 40mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205620,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 9mm 135cm 60mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205621,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 9mm 135cm 80mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205622,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 9mm 90cm 20mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205623,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 9mm 90cm 40mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205624,EAP,HCPCS C1725,,Catheter Blndil 5.7-3.9fr 9mm 90cm 80mm Metacross Rx Gw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205625,EAP,HCPCS C1725,,Catheter Blndil 5.7fr 10mm 135cm 20mm Metacross 2 Lum Otw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205626,EAP,HCPCS C1725,,Catheter Blndil 5.7fr 10mm 135cm 40mm Metacross 2 Lum Otw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205627,EAP,HCPCS C1725,,Catheter Blndil 5.7fr 10mm 135cm 60mm Metacross 2 Lum Otw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205628,EAP,HCPCS C1725,,Catheter Blndil 5.7fr 10mm 135cm 80mm Metacross 2 Lum Otw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205629,EAP,HCPCS C1725,,Catheter Blndil 5.7fr 10mm 65cm 20mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205630,EAP,HCPCS C1725,,Catheter Blndil 5.7fr 10mm 65cm 40mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205631,EAP,HCPCS C1725,,Catheter Blndil 5.7fr 10mm 65cm 60mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205633,EAP,HCPCS C1725,,Catheter Blndil 5.7fr 10mm 90cm 20mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205634,EAP,HCPCS C1725,,Catheter Blndil 5.7fr 10mm 90cm 40mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205635,EAP,HCPCS C1725,,Catheter Blndil 5.7fr 10mm 90cm 60mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205636,EAP,HCPCS C1725,,Catheter Blndil 5.7fr 10mm 90cm 80mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205637,EAP,HCPCS C1725,,Catheter Blndil 5.7fr 12mm 135cm 20mm Metacross 2 Lum Otw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205638,EAP,HCPCS C1725,,Catheter Blndil 5.7fr 12mm 135cm 40mm Metacross 2 Lum Otw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205639,EAP,HCPCS C1725,,Catheter Blndil 5.7fr 12mm 65cm 20mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205641,EAP,HCPCS C1725,,Catheter Blndil 5.7fr 12mm 90cm 20mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205642,EAP,HCPCS C1725,,Catheter Blndil 5.7fr 12mm 90cm 40mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205643,EAP,HCPCS C1725,,Catheter Blndil 5.7fr 6mm 135cm 200mm Metacross 2 Lum Otw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205644,EAP,HCPCS C1725,,Catheter Blndil 5.7fr 6mm 65cm 150mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205645,EAP,HCPCS C1725,,Catheter Blndil 5.7fr 6mm 65cm 200mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205646,EAP,HCPCS C1725,,Catheter Blndil 5.7fr 6mm 65cm 80mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205647,EAP,HCPCS C1725,,Catheter Blndil 5.7fr 6mm 90cm 100mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205648,EAP,HCPCS C1725,,Catheter Blndil 5.7fr 6mm 90cm 150mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205649,EAP,HCPCS C1725,,Catheter Blndil 5.7fr 6mm 90cm 200mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205650,EAP,HCPCS C1725,,Catheter Blndil 5.7fr 7mm 135cm 100mm Metacross 2 Lum Otw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205651,EAP,HCPCS C1725,,Catheter Blndil 5.7fr 7mm 135cm 120mm Metacross 2 Lum Otw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205652,EAP,HCPCS C1725,,Catheter Blndil 5.7fr 7mm 135cm 150mm Metacross 2 Lum Otw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205653,EAP,HCPCS C1725,,Catheter Blndil 5.7fr 7mm 135cm 200mm Metacross 2 Lum Otw,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205654,EAP,HCPCS C1725,,Catheter Blndil 5.7fr 7mm 135cm 40mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205655,EAP,HCPCS C1725,,Catheter Blndil 5.7fr 7mm 135cm 60mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205656,EAP,HCPCS C1725,,Catheter Blndil 5.7fr 7mm 135cm 80mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205658,EAP,HCPCS C1725,,Catheter Blndil 5.7fr 7mm 65cm 120mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205659,EAP,HCPCS C1725,,Catheter Blndil 5.7fr 7mm 65cm 150mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205660,EAP,HCPCS C1725,,Catheter Blndil 5.7fr 7mm 65cm 200mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205661,EAP,HCPCS C1725,,Catheter Blndil 5.7fr 7mm 65cm 20mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205662,EAP,HCPCS C1725,,Catheter Blndil 5.7fr 7mm 65cm 40mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205663,EAP,HCPCS C1725,,Catheter Blndil 5.7fr 7mm 65cm 60mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205664,EAP,HCPCS C1725,,Catheter Blndil 5.7fr 7mm 65cm 80mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205666,EAP,HCPCS C1725,,Catheter Blndil 5.7fr 7mm 90cm 120mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205667,EAP,HCPCS C1725,,Catheter Blndil 5.7fr 7mm 90cm 150mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205668,EAP,HCPCS C1725,,Catheter Blndil 5.7fr 7mm 90cm 200mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205669,EAP,HCPCS C1725,,Catheter Blndil 5.7fr 7mm 90cm 40mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205670,EAP,HCPCS C1725,,Catheter Blndil 5.7fr 7mm 90cm 60mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205671,EAP,HCPCS C1725,,Catheter Blndil 5.7fr 7mm 90cm 80mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205672,EAP,HCPCS C1725,,Catheter Blndil 5.7fr 8mm 135cm 20mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205673,EAP,HCPCS C1725,,Catheter Blndil 5.7fr 8mm 135cm 40mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205674,EAP,HCPCS C1725,,Catheter Blndil 5.7fr 8mm 135cm 60mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205675,EAP,HCPCS C1725,,Catheter Blndil 5.7fr 8mm 135cm 80mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205676,EAP,HCPCS C1725,,Catheter Blndil 5.7fr 8mm 65cm 20mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205677,EAP,HCPCS C1725,,Catheter Blndil 5.7fr 8mm 65cm 40mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205678,EAP,HCPCS C1725,,Catheter Blndil 5.7fr 8mm 65cm 60mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205679,EAP,HCPCS C1725,,Catheter Blndil 5.7fr 8mm 65cm 80mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205680,EAP,HCPCS C1725,,Catheter Blndil 5.7fr 8mm 90cm 20mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205682,EAP,HCPCS C1725,,Catheter Blndil 5.7fr 8mm 90cm 60mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205683,EAP,HCPCS C1725,,Catheter Blndil 5.7fr 8mm 90cm 80mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205684,EAP,HCPCS C1725,,Catheter Blndil 5.7fr 9mm 135cm 20mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205685,EAP,HCPCS C1725,,Catheter Blndil 5.7fr 9mm 135cm 40mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205686,EAP,HCPCS C1725,,Catheter Blndil 5.7fr 9mm 135cm 60mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205687,EAP,HCPCS C1725,,Catheter Blndil 5.7fr 9mm 135cm 80mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205688,EAP,HCPCS C1725,,Catheter Blndil 5.7fr 9mm 65cm 20mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205689,EAP,HCPCS C1725,,Catheter Blndil 5.7fr 9mm 65cm 40mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205690,EAP,HCPCS C1725,,Catheter Blndil 5.7fr 9mm 65cm 60mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205691,EAP,HCPCS C1725,,Catheter Blndil 5.7fr 9mm 65cm 80mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205692,EAP,HCPCS C1725,,Catheter Blndil 5.7fr 9mm 90cm 20mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205693,EAP,HCPCS C1725,,Catheter Blndil 5.7fr 9mm 90cm 40mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205694,EAP,HCPCS C1725,,Catheter Blndil 5.7fr 9mm 90cm 60mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205695,EAP,HCPCS C1725,,Catheter Blndil 5.7fr 9mm 90cm 80mm Metacross 2 Lum Otw Tpr,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205696,EAP,HCPCS C1725,,Catheter Blndil 5fr 4mm 135cm 120mm Metacross Otw 2 Lum Shft,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205697,EAP,HCPCS C1725,,Catheter Blndil 5fr 5mm 135cm 200mm Metacross Otw 2 Lum Shft,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205698,EAP,HCPCS C1725,,Catheter Blndil 5fr 5mm 135cm 20mm Metacross Otw 2 Lum Shft,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205700,EAP,HCPCS C1725,,Catheter Blndil 5fr 6mm 90cm 40mm Crosstella Rx Tpr Cor Wre,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$330.09,$330.09,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
27205701,EAP,HCPCS C1725,,Catheter Blndil 5fr 6mm 90cm 40mm Metacross Otw 2 Lum Shft,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205702,EAP,HCPCS C1725,,Catheter Blndil 6fr 4mm 135cm 60mm Metacross Rx Loow Prfl,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205703,EAP,HCPCS C1725,,Catheter Blndil 6mm 135cm 40mm Metacross Rx Sm Prfl Acpt,$285.00,$0.00,$285.00,$154.76,$203.40,$0.00,$49.10,$203.40,$203.40,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
27205704,EAP,HCPCS C1887,,Catheter Intvn .021in 2.8fr 150cm 160cm Progreat Gldwr,"$1,300.00",$0.00,"$1,300.00",$705.90,$927.81,$0.00,$223.98,$927.81,$927.81,$227.62,"$1,300.00",$0.00,$650.00,"$1,029.60","$1,040.00",$0.00,$203.45,$0.00,$206.96,$0.00
27205705,EAP,HCPCS C1887,,Catheter Intvn .021in 750 Psi 2.4fr 150cm 90cm Progreat Mcth,$775.00,$0.00,$775.00,$420.83,$553.12,$0.00,$133.53,$553.12,$553.12,$135.70,$775.00,$0.00,$387.50,$613.80,$620.00,$0.00,$121.29,$0.00,$123.38,$0.00
27205706,EAP,HCPCS C1887,,Catheter Intvn .021in Mic 2.4-2.9fr .022in 130cm Progreat,$775.00,$0.00,$775.00,$420.83,$553.12,$0.00,$133.53,$553.12,$553.12,$135.70,$775.00,$0.00,$387.50,$613.80,$620.00,$0.00,$121.29,$0.00,$123.38,$0.00
27205708,EAP,HCPCS C1887,,Catheter Intvn 2.7-2.9fr .021in 130cm Progreat Mcth Coax,"$1,300.00",$0.00,"$1,300.00",$705.90,$927.81,$0.00,$223.98,$927.81,$927.81,$227.62,"$1,300.00",$0.00,$650.00,"$1,029.60","$1,040.00",$0.00,$203.45,$0.00,$206.96,$0.00
27205709,EAP,HCPCS C1887,,Catheter Intvn 2.7-2.9fr .025in 110cm Progreat Mcth Coax,"$1,300.00",$0.00,"$1,300.00",$705.90,$927.81,$0.00,$223.98,$927.81,$927.81,$227.62,"$1,300.00",$0.00,$650.00,"$1,029.60","$1,040.00",$0.00,$203.45,$0.00,$206.96,$0.00
27205710,EAP,HCPCS C1887,,Catheter Intvn 2.7fr .021in 110cm 50cm Progreat Mcth Shp Tip,$775.00,$0.00,$775.00,$420.83,$553.12,$0.00,$133.53,$553.12,$553.12,$135.70,$775.00,$0.00,$387.50,$613.80,$620.00,$0.00,$121.29,$0.00,$123.38,$0.00
27205711,EAP,HCPCS C1887,,Catheter Intvn Mic 2.4-2.9fr .022in 110cm Progreat Coax,$775.00,$0.00,$775.00,$420.83,$553.12,$0.00,$133.53,$553.12,$553.12,$135.70,$775.00,$0.00,$387.50,$613.80,$620.00,$0.00,$121.29,$0.00,$123.38,$0.00
27205712,EAP,HCPCS C1887,,Catheter Intvn Mic 2.8-3fr .027in 110cm 50cm Progreat Coax,"$1,300.00",$0.00,"$1,300.00",$705.90,$927.81,$0.00,$223.98,$927.81,$927.81,$227.62,"$1,300.00",$0.00,$650.00,"$1,029.60","$1,040.00",$0.00,$203.45,$0.00,$206.96,$0.00
27205713,EAP,HCPCS C1887,,Catheter Intvn Mic 2.8-3fr .027in 130cm 17cm Progreat Mrkr,$775.00,$0.00,$775.00,$420.83,$553.12,$0.00,$133.53,$553.12,$553.12,$135.70,$775.00,$0.00,$387.50,$613.80,$620.00,$0.00,$121.29,$0.00,$123.38,$0.00
27205714,EAP,HCPCS C1887,,Catheter Intvn Mic 2.8fr .027in 150cm 90cm Progreat Hmst Vlv,$775.00,$0.00,$775.00,$420.83,$553.12,$0.00,$133.53,$553.12,$553.12,$135.70,$775.00,$0.00,$387.50,$613.80,$620.00,$0.00,$121.29,$0.00,$123.38,$0.00
27205715,EAP,HCPCS C1887,,Catheter Sprt 30d 12mm 90cm Strl Lf 40cm Navicross Radopq,$427.50,$0.00,$427.50,$232.13,$305.11,$0.00,$73.66,$305.11,$305.11,$74.85,$427.50,$0.00,$213.75,$338.58,$342.00,$0.00,$66.90,$0.00,$68.06,$0.00
27205716,EAP,Custom 27205716,,Device Infl 25cc Strl Solopath Stpck,$110.00,$0.00,$110.00,$0.00,$78.51,$0.00,$0.00,$78.51,$78.51,$0.00,$110.00,$0.00,$55.00,$87.12,$88.00,$0.00,$0.00,$0.00,$0.00,$0.00
27205717,EAP,Custom 27205717,,Device Infl 30 Atm 25ml Strl Solopath Excel Stpck,$110.00,$0.00,$110.00,$0.00,$78.51,$0.00,$0.00,$78.51,$78.51,$0.00,$110.00,$0.00,$55.00,$87.12,$88.00,$0.00,$0.00,$0.00,$0.00,$0.00
27205718,EAP,HCPCS C1769,,Form Submission .018 Ang 300cm Gw Cert,$550.00,$0.00,$550.00,$298.65,$392.54,$0.00,$94.76,$392.54,$392.54,$96.30,$550.00,$0.00,$275.00,$435.60,$440.00,$0.00,$86.08,$0.00,$87.56,$0.00
27205719,EAP,HCPCS C1769,,Guidewire Srg 45d .018in 180cm 3cm Gldwr Gl Ang Flx Tp Hdrph,$301.25,$0.00,$301.25,$163.58,$215.00,$0.00,$51.90,$215.00,$215.00,$52.75,$301.25,$0.00,$150.63,$238.59,$241.00,$0.00,$47.15,$0.00,$47.96,$0.00
27205720,EAP,HCPCS C1769,,Guidewire Srg 45d .018in 180cm 5cm Gldwr Hdrph,$301.25,$0.00,$301.25,$163.58,$215.00,$0.00,$51.90,$215.00,$215.00,$52.75,$301.25,$0.00,$150.63,$238.59,$241.00,$0.00,$47.15,$0.00,$47.96,$0.00
27205721,EAP,HCPCS C1769,,Guidewire Srg 70d .018in 180cm 3cm Gldwr Au Tip Ang Hdrph,$301.25,$0.00,$301.25,$163.58,$215.00,$0.00,$51.90,$215.00,$215.00,$52.75,$301.25,$0.00,$150.63,$238.59,$241.00,$0.00,$47.15,$0.00,$47.96,$0.00
27205722,EAP,HCPCS C1769,,Guidewire Srg Ang .018in 180cm 5cm Gldwr Hdrph,$301.25,$0.00,$301.25,$163.58,$215.00,$0.00,$51.90,$215.00,$215.00,$52.75,$301.25,$0.00,$150.63,$238.59,$241.00,$0.00,$47.15,$0.00,$47.96,$0.00
27205723,EAP,HCPCS C1769,,Guidewire Vasc 3mm Std .035in 150cm 3cm Gldwr Jtp Ntnl Hdrph,$72.50,$0.00,$72.50,$39.37,$51.74,$0.00,$12.49,$51.74,$51.74,$12.69,$72.50,$0.00,$36.25,$57.42,$58.00,$0.00,$11.35,$0.00,$11.54,$0.00
27205724,EAP,HCPCS C1769,,Guidewire Vasc 3mm Std .038in 150cm 3cm Gldwr Jtp Ntnl Hdrph,$72.50,$0.00,$72.50,$39.37,$51.74,$0.00,$12.49,$51.74,$51.74,$12.69,$72.50,$0.00,$36.25,$57.42,$58.00,$0.00,$11.35,$0.00,$11.54,$0.00
27205725,EAP,HCPCS C1769,,Guidewire Vasc 45d .018in 300cm 3cm Gldwr Hdrph,$427.50,$0.00,$427.50,$232.13,$305.11,$0.00,$73.66,$305.11,$305.11,$74.85,$427.50,$0.00,$213.75,$338.58,$342.00,$0.00,$66.90,$0.00,$68.06,$0.00
27205726,EAP,HCPCS C1769,,Guidewire Vasc 45d .018in 300cm 5cm Gldwr Hdrph,$427.50,$0.00,$427.50,$232.13,$305.11,$0.00,$73.66,$305.11,$305.11,$74.85,$427.50,$0.00,$213.75,$338.58,$342.00,$0.00,$66.90,$0.00,$68.06,$0.00
27205727,EAP,HCPCS C1769,,Guidewire Vasc 45d Std .018in 180cm 25cm Grind Flxb,$487.50,$0.00,$487.50,$264.71,$347.93,$0.00,$83.99,$347.93,$347.93,$85.36,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$76.29,$0.00,$77.61,$0.00
27205728,EAP,HCPCS C1769,,Guidewire Vasc 70d .018in 300cm 3cm Gldwr Hdrph,$427.50,$0.00,$427.50,$232.13,$305.11,$0.00,$73.66,$305.11,$305.11,$74.85,$427.50,$0.00,$213.75,$338.58,$342.00,$0.00,$66.90,$0.00,$68.06,$0.00
27205729,EAP,HCPCS C1769,,Guidewire Vasc 70d .018in 300cm 5cm Gldwr Hdrph,$427.50,$0.00,$427.50,$232.13,$305.11,$0.00,$73.66,$305.11,$305.11,$74.85,$427.50,$0.00,$213.75,$338.58,$342.00,$0.00,$66.90,$0.00,$68.06,$0.00
27205730,EAP,HCPCS C1769,,Guidewire Vasc Ang .014in 180cm,$500.00,$0.00,$500.00,$271.50,$356.85,$0.00,$86.15,$356.85,$356.85,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
27205731,EAP,HCPCS C1769,,Guidewire Vasc Ang .014in 300cm,$562.50,$0.00,$562.50,$305.44,$401.46,$0.00,$96.92,$401.46,$401.46,$98.49,$562.50,$0.00,$281.25,$445.50,$450.00,$0.00,$88.03,$0.00,$89.55,$0.00
27205732,EAP,HCPCS C1769,,Guidewire Vasc Ang .018in 150cm 3cm Gldwr Hdrph,$134.38,$0.00,$134.38,$72.97,$95.91,$0.00,$23.15,$95.91,$95.91,$23.53,$134.38,$0.00,$67.19,$106.43,$107.50,$0.00,$21.03,$0.00,$21.39,$0.00
27205733,EAP,HCPCS C1769,,Guidewire Vasc Ang .018in 80cm 3cm Gldwr Hdrph,$134.38,$0.00,$134.38,$72.97,$95.91,$0.00,$23.15,$95.91,$95.91,$23.53,$134.38,$0.00,$67.19,$106.43,$107.50,$0.00,$21.03,$0.00,$21.39,$0.00
27205734,EAP,HCPCS C1769,,Guidewire Vasc Ang .025in 150cm 3cm Gldwr Hdrph,$101.13,$0.00,$101.13,$54.91,$72.18,$0.00,$17.42,$72.18,$72.18,$17.71,$101.13,$0.00,$50.57,$80.09,$80.90,$0.00,$15.83,$0.00,$16.10,$0.00
27205735,EAP,HCPCS C1769,,Guidewire Vasc Ang .025in 180cm 3cm Gldwr Hdrph,$134.38,$0.00,$134.38,$72.97,$95.91,$0.00,$23.15,$95.91,$95.91,$23.53,$134.38,$0.00,$67.19,$106.43,$107.50,$0.00,$21.03,$0.00,$21.39,$0.00
27205736,EAP,HCPCS C1769,,Guidewire Vasc Ang .025in 260cm 3cm Gldwr Hdrph,$144.00,$0.00,$144.00,$78.19,$102.77,$0.00,$24.81,$102.77,$102.77,$25.21,$144.00,$0.00,$72.00,$114.05,$115.20,$0.00,$22.54,$0.00,$22.92,$0.00
27205737,EAP,HCPCS C1769,,Guidewire Vasc Ang .035in 80cm 3cm Gldwr Stf Shft Hdrph,$112.88,$0.00,$112.88,$61.29,$80.56,$0.00,$19.45,$80.56,$80.56,$19.76,$112.88,$0.00,$56.44,$89.40,$90.30,$0.00,$17.67,$0.00,$17.97,$0.00
27205738,EAP,HCPCS C1769,,Guidewire Vasc Ang .038in 150cm 3cm Gldwr Hdrph,$72.50,$0.00,$72.50,$39.37,$51.74,$0.00,$12.49,$51.74,$51.74,$12.69,$72.50,$0.00,$36.25,$57.42,$58.00,$0.00,$11.35,$0.00,$11.54,$0.00
27205739,EAP,HCPCS C1769,,Guidewire Vasc Ang .038in 80cm 3cm Gldwr Hdrph,$72.50,$0.00,$72.50,$39.37,$51.74,$0.00,$12.49,$51.74,$51.74,$12.69,$72.50,$0.00,$36.25,$57.42,$58.00,$0.00,$11.35,$0.00,$11.54,$0.00
27205740,EAP,HCPCS C1769,,Guidewire Vasc Ang .038in 80cm 3cm Gldwr Stf Shft Hdrph,$112.88,$0.00,$112.88,$61.29,$80.56,$0.00,$19.45,$80.56,$80.56,$19.76,$112.88,$0.00,$56.44,$89.40,$90.30,$0.00,$17.67,$0.00,$17.97,$0.00
27205741,EAP,HCPCS C1769,,Guidewire Vasc Ang Lng Tpr .035in 150cm 5cm Gldwr Stf Shft,$112.88,$0.00,$112.88,$61.29,$80.56,$0.00,$19.45,$80.56,$80.56,$19.76,$112.88,$0.00,$56.44,$89.40,$90.30,$0.00,$17.67,$0.00,$17.97,$0.00
27205742,EAP,HCPCS C1769,,Guidewire Vasc Ang Lng Tpr .035in 260cm 5cm Gldwr Stf Shft,$124.63,$0.00,$124.63,$67.67,$88.95,$0.00,$21.47,$88.95,$88.95,$21.82,$124.63,$0.00,$62.32,$98.71,$99.70,$0.00,$19.50,$0.00,$19.84,$0.00
27205743,EAP,HCPCS C1769,,Guidewire Vasc Ang Lng Tpr .038in 150cm 5cm Gldwr Stf Shft,$112.88,$0.00,$112.88,$61.29,$80.56,$0.00,$19.45,$80.56,$80.56,$19.76,$112.88,$0.00,$56.44,$89.40,$90.30,$0.00,$17.67,$0.00,$17.97,$0.00
27205744,EAP,HCPCS C1769,,Guidewire Vasc Ang Std .035in 120cm 3cm Gldwr Jkt Cor To Tip,$72.50,$0.00,$72.50,$39.37,$51.74,$0.00,$12.49,$51.74,$51.74,$12.69,$72.50,$0.00,$36.25,$57.42,$58.00,$0.00,$11.35,$0.00,$11.54,$0.00
27205745,EAP,HCPCS C1769,,Guidewire Vasc Ang Std .035in 150cm 1cm Gldwr Jkt Cor To Tip,$72.50,$0.00,$72.50,$39.37,$51.74,$0.00,$12.49,$51.74,$51.74,$12.69,$72.50,$0.00,$36.25,$57.42,$58.00,$0.00,$11.35,$0.00,$11.54,$0.00
27205746,EAP,HCPCS C1769,,Guidewire Vasc Ang Std .035in 180cm 1cm Gldwr Jkt Cor To Tip,$99.25,$0.00,$99.25,$53.89,$70.83,$0.00,$17.10,$70.83,$70.83,$17.38,$99.25,$0.00,$49.63,$78.61,$79.40,$0.00,$15.53,$0.00,$15.80,$0.00
27205747,EAP,HCPCS C1769,,Guidewire Vasc Ang Std .035in 260cm 1cm Gldwr Jkt Cor To Tip,$111.00,$0.00,$111.00,$60.27,$79.22,$0.00,$19.12,$79.22,$79.22,$19.44,$111.00,$0.00,$55.50,$87.91,$88.80,$0.00,$17.37,$0.00,$17.67,$0.00
27205748,EAP,HCPCS C1769,,Guidewire Vasc Ang Tpr .035in 150cm 1cm Gldwr Hdrph,$112.88,$0.00,$112.88,$61.29,$80.56,$0.00,$19.45,$80.56,$80.56,$19.76,$112.88,$0.00,$56.44,$89.40,$90.30,$0.00,$17.67,$0.00,$17.97,$0.00
27205749,EAP,HCPCS C1769,,Guidewire Vasc Bolia Crv Std .035in 180cm 5cm Gldwr Jkt Cor,$101.13,$0.00,$101.13,$54.91,$72.18,$0.00,$17.42,$72.18,$72.18,$17.71,$101.13,$0.00,$50.57,$80.09,$80.90,$0.00,$15.83,$0.00,$16.10,$0.00
27205750,EAP,HCPCS C1769,,Guidewire Vasc Bolia Crv Std .035in 180cm 8cm Gldwr Jkt Cor,$101.13,$0.00,$101.13,$54.91,$72.18,$0.00,$17.42,$72.18,$72.18,$17.71,$101.13,$0.00,$50.57,$80.09,$80.90,$0.00,$15.83,$0.00,$16.10,$0.00
27205751,EAP,HCPCS C1769,,Guidewire Vasc Std Ang .018in 180cm 3cm Gldwr Trmo Gld Tch,$134.38,$0.00,$134.38,$72.97,$95.91,$0.00,$23.15,$95.91,$95.91,$23.53,$134.38,$0.00,$67.19,$106.43,$107.50,$0.00,$21.03,$0.00,$21.39,$0.00
27205752,EAP,HCPCS C1769,,Guidewire Vasc Std Strg .035in 150cm 1cm Gldwr Jkt Cor To,$72.50,$0.00,$72.50,$39.37,$51.74,$0.00,$12.49,$51.74,$51.74,$12.69,$72.50,$0.00,$36.25,$57.42,$58.00,$0.00,$11.35,$0.00,$11.54,$0.00
27205753,EAP,HCPCS C1769,,Guidewire Vasc Std Strg .035in 180cm 1cm Gldwr Jkt Cor To,$99.25,$0.00,$99.25,$53.89,$70.83,$0.00,$17.10,$70.83,$70.83,$17.38,$99.25,$0.00,$49.63,$78.61,$79.40,$0.00,$15.53,$0.00,$15.80,$0.00
27205754,EAP,HCPCS C1769,,Guidewire Vasc Std Strg .035in 260cm 1cm Gldwr Jkt Cor To,$111.00,$0.00,$111.00,$60.27,$79.22,$0.00,$19.12,$79.22,$79.22,$19.44,$111.00,$0.00,$55.50,$87.91,$88.80,$0.00,$17.37,$0.00,$17.67,$0.00
27205755,EAP,HCPCS C1769,,Guidewire Vasc Strg .018in 150cm 3cm Gldwr Hdrph,$134.38,$0.00,$134.38,$72.97,$95.91,$0.00,$23.15,$95.91,$95.91,$23.53,$134.38,$0.00,$67.19,$106.43,$107.50,$0.00,$21.03,$0.00,$21.39,$0.00
27205756,EAP,HCPCS C1769,,Guidewire Vasc Strg .018in 150cm 3cm Gldwr Shp Tip Hdrph,$137.38,$0.00,$137.38,$74.60,$98.05,$0.00,$23.67,$98.05,$98.05,$24.05,$137.38,$0.00,$68.69,$108.80,$109.90,$0.00,$21.50,$0.00,$21.87,$0.00
27205757,EAP,HCPCS C1769,,Guidewire Vasc Strg .018in 180cm 3cm Gldwr Hdrph,$134.38,$0.00,$134.38,$72.97,$95.91,$0.00,$23.15,$95.91,$95.91,$23.53,$134.38,$0.00,$67.19,$106.43,$107.50,$0.00,$21.03,$0.00,$21.39,$0.00
27205758,EAP,HCPCS C1769,,Guidewire Vasc Strg .018in 260cm 3cm Gldwr Hdrph,$185.00,$0.00,$185.00,$100.46,$132.03,$0.00,$31.87,$132.03,$132.03,$32.39,$185.00,$0.00,$92.50,$146.52,$148.00,$0.00,$28.95,$0.00,$29.45,$0.00
27205759,EAP,HCPCS C1769,,Guidewire Vasc Strg .025in 150cm 3cm Gldwr Hdrph,$101.13,$0.00,$101.13,$54.91,$72.18,$0.00,$17.42,$72.18,$72.18,$17.71,$101.13,$0.00,$50.57,$80.09,$80.90,$0.00,$15.83,$0.00,$16.10,$0.00
27205760,EAP,HCPCS C1769,,Guidewire Vasc Strg .025in 180cm 3cm Gldwr Hdrph,$134.38,$0.00,$134.38,$72.97,$95.91,$0.00,$23.15,$95.91,$95.91,$23.53,$134.38,$0.00,$67.19,$106.43,$107.50,$0.00,$21.03,$0.00,$21.39,$0.00
27205761,EAP,HCPCS C1769,,Guidewire Vasc Strg .025in 260cm 3cm Gldwr Hdrph,$144.00,$0.00,$144.00,$78.19,$102.77,$0.00,$24.81,$102.77,$102.77,$25.21,$144.00,$0.00,$72.00,$114.05,$115.20,$0.00,$22.54,$0.00,$22.92,$0.00
27205762,EAP,HCPCS C1769,,Guidewire Vasc Strg .032in 150cm 3cm Gldwr Hdrph,$74.00,$0.00,$74.00,$40.18,$52.81,$0.00,$12.75,$52.81,$52.81,$12.96,$74.00,$0.00,$37.00,$58.61,$59.20,$0.00,$11.58,$0.00,$11.78,$0.00
27205763,EAP,HCPCS C1769,,Guidewire Vasc Strg .035in 150cm 3cm Gldwr Shp Tip Hdrph,$79.75,$0.00,$79.75,$43.30,$56.92,$0.00,$13.74,$56.92,$56.92,$13.96,$79.75,$0.00,$39.88,$63.16,$63.80,$0.00,$12.48,$0.00,$12.70,$0.00
27205764,EAP,HCPCS C1769,,Guidewire Vasc Strg .035in 180cm 3cm Gldwr Shp Tip Hdrph,$107.00,$0.00,$107.00,$58.10,$76.37,$0.00,$18.44,$76.37,$76.37,$18.73,$107.00,$0.00,$53.50,$84.74,$85.60,$0.00,$16.75,$0.00,$17.03,$0.00
27205765,EAP,HCPCS C1769,,Guidewire Vasc Strg .038in 150cm 3cm Gldwr Hdrph,$72.50,$0.00,$72.50,$39.37,$51.74,$0.00,$12.49,$51.74,$51.74,$12.69,$72.50,$0.00,$36.25,$57.42,$58.00,$0.00,$11.35,$0.00,$11.54,$0.00
27205766,EAP,HCPCS C1769,,Guidewire Vasc Strg .038in 150cm 3cm Gldwr Shp Tip Hdrph,$79.75,$0.00,$79.75,$43.30,$56.92,$0.00,$13.74,$56.92,$56.92,$13.96,$79.75,$0.00,$39.88,$63.16,$63.80,$0.00,$12.48,$0.00,$12.70,$0.00
27205767,EAP,HCPCS C1769,,Guidewire Vasc Strg .038in 150cm 3cm Gldwr Stf Shft Hdrph,$112.88,$0.00,$112.88,$61.29,$80.56,$0.00,$19.45,$80.56,$80.56,$19.76,$112.88,$0.00,$56.44,$89.40,$90.30,$0.00,$17.67,$0.00,$17.97,$0.00
27205768,EAP,HCPCS C1769,,Guidewire Vasc Strg .038in 180cm 3cm Gldwr Hdrph,$99.25,$0.00,$99.25,$53.89,$70.83,$0.00,$17.10,$70.83,$70.83,$17.38,$99.25,$0.00,$49.63,$78.61,$79.40,$0.00,$15.53,$0.00,$15.80,$0.00
27205769,EAP,HCPCS C1769,,Guidewire Vasc Strg .038in 180cm 3cm Gldwr Stf Shft Hdrph,$116.75,$0.00,$116.75,$63.40,$83.32,$0.00,$20.12,$83.32,$83.32,$20.44,$116.75,$0.00,$58.38,$92.47,$93.40,$0.00,$18.27,$0.00,$18.59,$0.00
27205770,EAP,HCPCS C1769,,Guidewire Vasc Strg .038in 260cm 3cm Gldwr Hdrph,$111.00,$0.00,$111.00,$60.27,$79.22,$0.00,$19.12,$79.22,$79.22,$19.44,$111.00,$0.00,$55.50,$87.91,$88.80,$0.00,$17.37,$0.00,$17.67,$0.00
27205771,EAP,HCPCS C1769,,Guidewire Vasc Strg Lng Tpr .035in 150cm 5cm Gldwr Stf Shft,$112.88,$0.00,$112.88,$61.29,$80.56,$0.00,$19.45,$80.56,$80.56,$19.76,$112.88,$0.00,$56.44,$89.40,$90.30,$0.00,$17.67,$0.00,$17.97,$0.00
27205772,EAP,HCPCS C1769,,Guidewire Vasc Strg Lng Tpr .035in 150cm 8cm Gldwr Jkt Cor,$81.75,$0.00,$81.75,$44.39,$58.34,$0.00,$14.09,$58.34,$58.34,$14.31,$81.75,$0.00,$40.88,$64.75,$65.40,$0.00,$12.79,$0.00,$13.01,$0.00
27205773,EAP,HCPCS C1769,,Guidewire Vasc Strg Lng Tpr .038in 150cm 5cm Gldwr Stf Shft,$112.88,$0.00,$112.88,$61.29,$80.56,$0.00,$19.45,$80.56,$80.56,$19.76,$112.88,$0.00,$56.44,$89.40,$90.30,$0.00,$17.67,$0.00,$17.97,$0.00
27205774,EAP,HCPCS C1769,,Guidewire Vasc Strg Tpr .038in 150cm 8cm Gldwr Hdrph,$81.75,$0.00,$81.75,$44.39,$58.34,$0.00,$14.09,$58.34,$58.34,$14.31,$81.75,$0.00,$40.88,$64.75,$65.40,$0.00,$12.79,$0.00,$13.01,$0.00
27205775,EAP,HCPCS C1894,,Introducer Cath 17fr 5.3fr 14fr 25cm Solopath Bln Expandable,"$1,325.00",$0.00,"$1,325.00",$719.48,$945.65,$0.00,$228.29,$945.65,$945.65,$232.00,"$1,325.00",$0.00,$662.50,"$1,049.40","$1,060.00",$0.00,$207.36,$0.00,$210.94,$0.00
27205776,EAP,HCPCS C1894,,Introducer Cath 21fr 13fr 18fr 25cm Strl 20cm Solopath,"$1,325.00",$0.00,"$1,325.00",$719.48,$945.65,$0.00,$228.29,$945.65,$945.65,$232.00,"$1,325.00",$0.00,$662.50,"$1,049.40","$1,060.00",$0.00,$207.36,$0.00,$210.94,$0.00
27205777,EAP,HCPCS C1894,,Introducer Cath 21fr 5.3fr 18fr 35cm Strl 30cm Solopath Bln,"$1,325.00",$0.00,"$1,325.00",$719.48,$945.65,$0.00,$228.29,$945.65,$945.65,$232.00,"$1,325.00",$0.00,$662.50,"$1,049.40","$1,060.00",$0.00,$207.36,$0.00,$210.94,$0.00
27205778,EAP,HCPCS C1894,,Introducer Cath 22fr 14fr 19fr 35cm Strl 30cm Solopath,"$1,325.00",$0.00,"$1,325.00",$719.48,$945.65,$0.00,$228.29,$945.65,$945.65,$232.00,"$1,325.00",$0.00,$662.50,"$1,049.40","$1,060.00",$0.00,$207.36,$0.00,$210.94,$0.00
27205779,EAP,HCPCS C1894,,Introducer Cath 22fr 5.3fr 19fr 25cm 20cm Solopath Bln,"$1,325.00",$0.00,"$1,325.00",$719.48,$945.65,$0.00,$228.29,$945.65,$945.65,$232.00,"$1,325.00",$0.00,$662.50,"$1,049.40","$1,060.00",$0.00,$207.36,$0.00,$210.94,$0.00
27205780,EAP,HCPCS C1894,,Introducer Cath 23fr 5.3fr 20fr 35cm Strl 25cm Solopath Bln,"$1,325.00",$0.00,"$1,325.00",$719.48,$945.65,$0.00,$228.29,$945.65,$945.65,$232.00,"$1,325.00",$0.00,$662.50,"$1,049.40","$1,060.00",$0.00,$207.36,$0.00,$210.94,$0.00
27205781,EAP,HCPCS C1894,,Introducer Cath 24fr 14fr 21fr 35cm Strl 30cm Solopath,"$1,325.00",$0.00,"$1,325.00",$719.48,$945.65,$0.00,$228.29,$945.65,$945.65,$232.00,"$1,325.00",$0.00,$662.50,"$1,049.40","$1,060.00",$0.00,$207.36,$0.00,$210.94,$0.00
27205782,EAP,HCPCS C1894,,Introducer Cath 24fr 5.3fr 21fr 25cm 20cm Solopath Bln,"$1,325.00",$0.00,"$1,325.00",$719.48,$945.65,$0.00,$228.29,$945.65,$945.65,$232.00,"$1,325.00",$0.00,$662.50,"$1,049.40","$1,060.00",$0.00,$207.36,$0.00,$210.94,$0.00
27205783,EAP,HCPCS C1894,,Introducer Cath Loprfl 11.5-17fr 5.3fr 14fr 35cm 30cm,"$1,325.00",$0.00,"$1,325.00",$719.48,$945.65,$0.00,$228.29,$945.65,$945.65,$232.00,"$1,325.00",$0.00,$662.50,"$1,049.40","$1,060.00",$0.00,$207.36,$0.00,$210.94,$0.00
27205784,EAP,HCPCS C1894,,Introducer Cath Loprfl 15-19fr 5.3fr 16fr 25cm 20cm Solopath,"$1,325.00",$0.00,"$1,325.00",$719.48,$945.65,$0.00,$228.29,$945.65,$945.65,$232.00,"$1,325.00",$0.00,$662.50,"$1,049.40","$1,060.00",$0.00,$207.36,$0.00,$210.94,$0.00
27205785,EAP,HCPCS C1894,,Introducer Cath Loprfl 15-19fr 5.3fr 16fr 35cm 30cm Solopath,"$1,325.00",$0.00,"$1,325.00",$719.48,$945.65,$0.00,$228.29,$945.65,$945.65,$232.00,"$1,325.00",$0.00,$662.50,"$1,049.40","$1,060.00",$0.00,$207.36,$0.00,$210.94,$0.00
27205786,EAP,HCPCS C1894,,Introducer Cath Loprfl 15-23fr 5.3fr 20fr 25cm 20cm Solopath,"$1,325.00",$0.00,"$1,325.00",$719.48,$945.65,$0.00,$228.29,$945.65,$945.65,$232.00,"$1,325.00",$0.00,$662.50,"$1,049.40","$1,060.00",$0.00,$207.36,$0.00,$210.94,$0.00
27205787,EAP,HCPCS C1894,,Introducer Shth .035in 4fr 10cm 2.5cm Pn Ro2 Gw Dil Radopq,$57.50,$0.00,$57.50,$31.22,$41.04,$0.00,$9.91,$41.04,$41.04,$10.07,$57.50,$0.00,$28.75,$45.54,$46.00,$0.00,$9.00,$0.00,$9.15,$0.00
27205788,EAP,HCPCS C1894,,Introducer Shth .035in 4fr 6cm 2.5cm Pncl R/o Ii Gw Dil,$52.50,$0.00,$52.50,$28.51,$37.47,$0.00,$9.05,$37.47,$37.47,$9.19,$52.50,$0.00,$26.25,$41.58,$42.00,$0.00,$8.22,$0.00,$8.36,$0.00
27205789,EAP,HCPCS C1894,,Introducer Shth .035in Shrt 7fr 4cm 40cm Pncl R/o Ii Hiflo,$60.00,$0.00,$60.00,$32.58,$42.82,$0.00,$10.34,$42.82,$42.82,$10.51,$60.00,$0.00,$30.00,$47.52,$48.00,$0.00,$9.39,$0.00,$9.55,$0.00
27205790,EAP,HCPCS C1894,,Introducer Shth .035in Shrt 8fr 4cm 2.5cm Pncl R/o Ii Hiflo,$60.00,$0.00,$60.00,$32.58,$42.82,$0.00,$10.34,$42.82,$42.82,$10.51,$60.00,$0.00,$30.00,$47.52,$48.00,$0.00,$9.39,$0.00,$9.55,$0.00
27205791,EAP,HCPCS C1894,,Introducer Shth .038in 5fr 10cm 2.5cm Pn Ro2 Gw Dil Radopq,$57.50,$0.00,$57.50,$31.22,$41.04,$0.00,$9.91,$41.04,$41.04,$10.07,$57.50,$0.00,$28.75,$45.54,$46.00,$0.00,$9.00,$0.00,$9.15,$0.00
27205792,EAP,HCPCS C1894,,Introducer Shth .038in 5fr 6cm 2.5cm Pn Ro2 Gw Dil Radopq,$52.50,$0.00,$52.50,$28.51,$37.47,$0.00,$9.05,$37.47,$37.47,$9.19,$52.50,$0.00,$26.25,$41.58,$42.00,$0.00,$8.22,$0.00,$8.36,$0.00
27205793,EAP,HCPCS C1894,,Introducer Shth .038in 6fr 10cm 2.5cm Pn Ro2 Gw Dil Radopq,$57.50,$0.00,$57.50,$31.22,$41.04,$0.00,$9.91,$41.04,$41.04,$10.07,$57.50,$0.00,$28.75,$45.54,$46.00,$0.00,$9.00,$0.00,$9.15,$0.00
27205794,EAP,HCPCS C1894,,Introducer Shth .038in 6fr 4cm Pncl R/o Ii Hiflo Dil Radopq,$58.13,$0.00,$58.13,$31.56,$41.49,$0.00,$10.02,$41.49,$41.49,$10.18,$58.13,$0.00,$29.07,$46.04,$46.50,$0.00,$9.10,$0.00,$9.25,$0.00
27205795,EAP,HCPCS C1894,,Introducer Shth .038in 6fr 6cm 2.5cm Pn Ro2 Gw Dil Radopq,$52.50,$0.00,$52.50,$28.51,$37.47,$0.00,$9.05,$37.47,$37.47,$9.19,$52.50,$0.00,$26.25,$41.58,$42.00,$0.00,$8.22,$0.00,$8.36,$0.00
27205796,EAP,HCPCS C1894,,Introducer Shth .038in 7fr 10cm 2.5cm Pn Ro2 Gw Dil Radopq,$57.50,$0.00,$57.50,$31.22,$41.04,$0.00,$9.91,$41.04,$41.04,$10.07,$57.50,$0.00,$28.75,$45.54,$46.00,$0.00,$9.00,$0.00,$9.15,$0.00
27205797,EAP,HCPCS C1894,,Introducer Shth .038in 7fr 6cm 2.5cm Pn Ro2 Gw Dil Radopq,$52.50,$0.00,$52.50,$28.51,$37.47,$0.00,$9.05,$37.47,$37.47,$9.19,$52.50,$0.00,$26.25,$41.58,$42.00,$0.00,$8.22,$0.00,$8.36,$0.00
27205798,EAP,HCPCS C1894,,Introducer Shth .038in 8fr 10cm 2.5cm Pn Ro2 Gw Dil Radopq,$57.50,$0.00,$57.50,$31.22,$41.04,$0.00,$9.91,$41.04,$41.04,$10.07,$57.50,$0.00,$28.75,$45.54,$46.00,$0.00,$9.00,$0.00,$9.15,$0.00
27205799,EAP,HCPCS C1894,,Introducer Shth .038in 8fr 6cm 2.5cm Pncl R/o Ii Gw Dil,$52.50,$0.00,$52.50,$28.51,$37.47,$0.00,$9.05,$37.47,$37.47,$9.19,$52.50,$0.00,$26.25,$41.58,$42.00,$0.00,$8.22,$0.00,$8.36,$0.00
27205800,EAP,HCPCS C1894,,Introducer Shth .038in 9fr 10cm 2.5cm Pn Ro2 Gw Dil Radopq,$57.50,$0.00,$57.50,$31.22,$41.04,$0.00,$9.91,$41.04,$41.04,$10.07,$57.50,$0.00,$28.75,$45.54,$46.00,$0.00,$9.00,$0.00,$9.15,$0.00
27205801,EAP,HCPCS C1894,,Introducer Shth .038in 9fr 6cm 2.5cm Pncl R/o Ii Gw Dil,$52.50,$0.00,$52.50,$28.51,$37.47,$0.00,$9.05,$37.47,$37.47,$9.19,$52.50,$0.00,$26.25,$41.58,$42.00,$0.00,$8.22,$0.00,$8.36,$0.00
27205802,EAP,HCPCS C1894,,Introducer Shth 11fr 25cm 2.5cm Pncl Dil Kink Rst Hdrph Ptfe,$49.88,$0.00,$49.88,$27.08,$35.60,$0.00,$8.59,$35.60,$35.60,$8.73,$49.88,$0.00,$24.94,$39.50,$39.90,$0.00,$7.81,$0.00,$7.94,$0.00
27205803,EAP,HCPCS C1894,,Introducer Shth 4fr 10cm 2.5cm Pncl R/o Ii Dil Radopq,$53.50,$0.00,$53.50,$29.05,$38.18,$0.00,$9.22,$38.18,$38.18,$9.37,$53.50,$0.00,$26.75,$42.37,$42.80,$0.00,$8.37,$0.00,$8.52,$0.00
27205804,EAP,HCPCS C1894,,Introducer Shth 4fr 25cm 2.5cm Pncl R/o Ii Dil Radopq,$65.00,$0.00,$65.00,$35.30,$46.39,$0.00,$11.20,$46.39,$46.39,$11.38,$65.00,$0.00,$32.50,$51.48,$52.00,$0.00,$10.17,$0.00,$10.35,$0.00
27205805,EAP,HCPCS C1894,,Introducer Shth 4fr 6cm 2.5cm Pncl R/o Ii Dil Radopq,$46.88,$0.00,$46.88,$25.46,$33.46,$0.00,$8.08,$33.46,$33.46,$8.21,$46.88,$0.00,$23.44,$37.13,$37.50,$0.00,$7.34,$0.00,$7.46,$0.00
27205806,EAP,HCPCS C1894,,Introducer Shth 5fr 10cm 2.5cm Pncl Radopq Dil No Mn Gw,$53.50,$0.00,$53.50,$29.05,$38.18,$0.00,$9.22,$38.18,$38.18,$9.37,$53.50,$0.00,$26.75,$42.37,$42.80,$0.00,$8.37,$0.00,$8.52,$0.00
27205807,EAP,HCPCS C1894,,Introducer Shth 5fr 25cm 2.5cm Pn Ro2 Dil Radopq Kink Rst,$65.00,$0.00,$65.00,$35.30,$46.39,$0.00,$11.20,$46.39,$46.39,$11.38,$65.00,$0.00,$32.50,$51.48,$52.00,$0.00,$10.17,$0.00,$10.35,$0.00
27205808,EAP,HCPCS C1894,,Introducer Shth 5fr 6cm 2.5cm Pncl Radopq Dil No Mn Gw,$46.88,$0.00,$46.88,$25.46,$33.46,$0.00,$8.08,$33.46,$33.46,$8.21,$46.88,$0.00,$23.44,$37.13,$37.50,$0.00,$7.34,$0.00,$7.46,$0.00
27205809,EAP,HCPCS C1894,,Introducer Shth 6fr 10cm 2.5cm Pn Ro2 Dil Radopq Kink Rst,$53.50,$0.00,$53.50,$29.05,$38.18,$0.00,$9.22,$38.18,$38.18,$9.37,$53.50,$0.00,$26.75,$42.37,$42.80,$0.00,$8.37,$0.00,$8.52,$0.00
27205810,EAP,HCPCS C1894,,Introducer Shth 6fr 25cm 2.5cm Pn Ro2 Dil Radopq Kink Rst,$65.00,$0.00,$65.00,$35.30,$46.39,$0.00,$11.20,$46.39,$46.39,$11.38,$65.00,$0.00,$32.50,$51.48,$52.00,$0.00,$10.17,$0.00,$10.35,$0.00
27205811,EAP,HCPCS C1894,,Introducer Shth 6fr 45cm Destination Gd Hdrph Ptfe,$205.00,$0.00,$205.00,$111.32,$146.31,$0.00,$35.32,$146.31,$146.31,$35.89,$205.00,$0.00,$102.50,$162.36,$164.00,$0.00,$32.08,$0.00,$32.64,$0.00
27205812,EAP,HCPCS C1894,,Introducer Shth 6fr 45cm Pn Dstn Gd Hdrph Ptfe,$205.00,$0.00,$205.00,$111.32,$146.31,$0.00,$35.32,$146.31,$146.31,$35.89,$205.00,$0.00,$102.50,$162.36,$164.00,$0.00,$32.08,$0.00,$32.64,$0.00
27205813,EAP,HCPCS C1894,,Introducer Shth 6fr 45cm Pn Dstn Gd Lima Crv Xcut Vlv Hdrph,$205.00,$0.00,$205.00,$111.32,$146.31,$0.00,$35.32,$146.31,$146.31,$35.89,$205.00,$0.00,$102.50,$162.36,$164.00,$0.00,$32.08,$0.00,$32.64,$0.00
27205814,EAP,HCPCS C1894,,Introducer Shth 6fr 45cm Pn Dstn Gd Mp Crv T-b Vlv Hdrph,$205.00,$0.00,$205.00,$111.32,$146.31,$0.00,$35.32,$146.31,$146.31,$35.89,$205.00,$0.00,$102.50,$162.36,$164.00,$0.00,$32.08,$0.00,$32.64,$0.00
27205815,EAP,HCPCS C1894,,Introducer Shth 6fr 45cm Pn Dstn Gd Rdc Crv T-b Vlv Hdrph,$205.00,$0.00,$205.00,$111.32,$146.31,$0.00,$35.32,$146.31,$146.31,$35.89,$205.00,$0.00,$102.50,$162.36,$164.00,$0.00,$32.08,$0.00,$32.64,$0.00
27205816,EAP,HCPCS C1894,,Introducer Shth 6fr 45cm Pn Dstn Hdrph Ptfe,$205.00,$0.00,$205.00,$111.32,$146.31,$0.00,$35.32,$146.31,$146.31,$35.89,$205.00,$0.00,$102.50,$162.36,$164.00,$0.00,$32.08,$0.00,$32.64,$0.00
27205817,EAP,HCPCS C1894,,Introducer Shth 6fr 4cm 40cm Pncl Radopq Dil Gw,$60.00,$0.00,$60.00,$32.58,$42.82,$0.00,$10.34,$42.82,$42.82,$10.51,$60.00,$0.00,$30.00,$47.52,$48.00,$0.00,$9.39,$0.00,$9.55,$0.00
27205818,EAP,HCPCS C1894,,Introducer Shth 6fr 65cm Pn Dstn Gd Strg T-b Vlv Hdrph Ptfe,$225.00,$0.00,$225.00,$122.18,$160.58,$0.00,$38.77,$160.58,$160.58,$39.40,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$35.21,$0.00,$35.82,$0.00
27205819,EAP,HCPCS C1894,,Introducer Shth 6fr 6cm 2.5cm Pn Ro2 Dil Radopq Kink Rst,$46.88,$0.00,$46.88,$25.46,$33.46,$0.00,$8.08,$33.46,$33.46,$8.21,$46.88,$0.00,$23.44,$37.13,$37.50,$0.00,$7.34,$0.00,$7.46,$0.00
27205820,EAP,HCPCS C1894,,Introducer Shth 7fr 45cm Pn Dstn Gd Hs Crv T-b Vlv Hdrph,$205.00,$0.00,$205.00,$111.32,$146.31,$0.00,$35.32,$146.31,$146.31,$35.89,$205.00,$0.00,$102.50,$162.36,$164.00,$0.00,$32.08,$0.00,$32.64,$0.00
27205821,EAP,HCPCS C1894,,Introducer Shth 7fr 45cm Pn Dstn Gd Lima Crv T-b Vlv Hdrph,$205.00,$0.00,$205.00,$111.32,$146.31,$0.00,$35.32,$146.31,$146.31,$35.89,$205.00,$0.00,$102.50,$162.36,$164.00,$0.00,$32.08,$0.00,$32.64,$0.00
27205822,EAP,HCPCS C1894,,Introducer Shth 7fr 45cm Pn Dstn Gd Mp Crv T-b Vlv Hdrph,$205.00,$0.00,$205.00,$111.32,$146.31,$0.00,$35.32,$146.31,$146.31,$35.89,$205.00,$0.00,$102.50,$162.36,$164.00,$0.00,$32.08,$0.00,$32.64,$0.00
27205823,EAP,HCPCS C1894,,Introducer Shth 7fr 45cm Pn Dstn Gd Rdc Crv T-b Vlv Hdrph,$205.00,$0.00,$205.00,$111.32,$146.31,$0.00,$35.32,$146.31,$146.31,$35.89,$205.00,$0.00,$102.50,$162.36,$164.00,$0.00,$32.08,$0.00,$32.64,$0.00
27205824,EAP,HCPCS C1894,,Introducer Shth 7fr 45cm Pn Dstn Gd Strg T-b Vlv Hdrph Ptfe,$205.00,$0.00,$205.00,$111.32,$146.31,$0.00,$35.32,$146.31,$146.31,$35.89,$205.00,$0.00,$102.50,$162.36,$164.00,$0.00,$32.08,$0.00,$32.64,$0.00
27205825,EAP,HCPCS C1894,,Introducer Shth 7fr 4cm Pncl R/o Ii Hiflo Dil Radopq,$58.13,$0.00,$58.13,$31.56,$41.49,$0.00,$10.02,$41.49,$41.49,$10.18,$58.13,$0.00,$29.07,$46.04,$46.50,$0.00,$9.10,$0.00,$9.25,$0.00
27205826,EAP,HCPCS C1894,,Introducer Shth 7fr 65cm Pn Dstn Gd Hdrph Ptfe,$225.00,$0.00,$225.00,$122.18,$160.58,$0.00,$38.77,$160.58,$160.58,$39.40,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$35.21,$0.00,$35.82,$0.00
27205827,EAP,HCPCS C1894,,Introducer Shth 7fr 6cm 2.5cm Pncl Radopq Dil No Mn Gw,$46.88,$0.00,$46.88,$25.46,$33.46,$0.00,$8.08,$33.46,$33.46,$8.21,$46.88,$0.00,$23.44,$37.13,$37.50,$0.00,$7.34,$0.00,$7.46,$0.00
27205828,EAP,HCPCS C1894,,Introducer Shth 8fr 4cm 2.5cm Pncl R/o Ii Hiflo Dil Radopq,$58.13,$0.00,$58.13,$31.56,$41.49,$0.00,$10.02,$41.49,$41.49,$10.18,$58.13,$0.00,$29.07,$46.04,$46.50,$0.00,$9.10,$0.00,$9.25,$0.00
27205829,EAP,HCPCS C1894,,Introducer Shth 8fr 6cm 2.5cm Pn Ro2 Dil Radopq Kink Rst,$46.88,$0.00,$46.88,$25.46,$33.46,$0.00,$8.08,$33.46,$33.46,$8.21,$46.88,$0.00,$23.44,$37.13,$37.50,$0.00,$7.34,$0.00,$7.46,$0.00
27205830,EAP,HCPCS C1894,,Introducer Shth 9fr 10cm 2.5cm Pn Ro2 Dil Radopq Kink Rst,$53.50,$0.00,$53.50,$29.05,$38.18,$0.00,$9.22,$38.18,$38.18,$9.37,$53.50,$0.00,$26.75,$42.37,$42.80,$0.00,$8.37,$0.00,$8.52,$0.00
27205831,EAP,HCPCS C1894,,Introducer Shth 9fr 25cm 2.5cm Pn Ro2 Dil Radopq Kink Rst,$65.00,$0.00,$65.00,$35.30,$46.39,$0.00,$11.20,$46.39,$46.39,$11.38,$65.00,$0.00,$32.50,$51.48,$52.00,$0.00,$10.17,$0.00,$10.35,$0.00
27205832,EAP,HCPCS C1894,,Introducer Shth 9fr 6cm 2.5cm Pncl R/o Ii Dil Radopq,$46.88,$0.00,$46.88,$25.46,$33.46,$0.00,$8.08,$33.46,$33.46,$8.21,$46.88,$0.00,$23.44,$37.13,$37.50,$0.00,$7.34,$0.00,$7.46,$0.00
27205833,EAP,HCPCS C1894,,Sheath Escp 7fr 45cm Pn Dstn Gd Destination Hdrph Ptfe,$205.00,$0.00,$205.00,$111.32,$146.31,$0.00,$35.32,$146.31,$146.31,$35.89,$205.00,$0.00,$102.50,$162.36,$164.00,$0.00,$32.08,$0.00,$32.64,$0.00
27205834,EAP,HCPCS C1887,,Sheath Gd .038in 6fr 45cm 2cm Pn Dstn T-b Vlv Strg Hdrph,$205.00,$0.00,$205.00,$111.32,$146.31,$0.00,$35.32,$146.31,$146.31,$35.89,$205.00,$0.00,$102.50,$162.36,$164.00,$0.00,$32.08,$0.00,$32.64,$0.00
27205835,EAP,HCPCS C1887,,Sheath Gd .038in 7fr 45cm 2cm Pn Dstn T-b Vlv Strg Hdrph,$205.00,$0.00,$205.00,$111.32,$146.31,$0.00,$35.32,$146.31,$146.31,$35.89,$205.00,$0.00,$102.50,$162.36,$164.00,$0.00,$32.08,$0.00,$32.64,$0.00
27205836,EAP,HCPCS C1894,,Sheath Gd .038in Hs Crv 5fr 45cm 2cm Pn Dstn Xcut Vlv Hdrph,$205.00,$0.00,$205.00,$111.32,$146.31,$0.00,$35.32,$146.31,$146.31,$35.89,$205.00,$0.00,$102.50,$162.36,$164.00,$0.00,$32.08,$0.00,$32.64,$0.00
27205837,EAP,HCPCS C1894,,Sheath Gd .038in Lima Crv 5fr 45cm 2cm Pn Dstn Xcut Vlv,$205.00,$0.00,$205.00,$111.32,$146.31,$0.00,$35.32,$146.31,$146.31,$35.89,$205.00,$0.00,$102.50,$162.36,$164.00,$0.00,$32.08,$0.00,$32.64,$0.00
27205838,EAP,HCPCS C1894,,Sheath Gd .038in Mp Crv 5fr 45cm 2cm Pn Dstn Xcut Vlv Kink,$205.00,$0.00,$205.00,$111.32,$146.31,$0.00,$35.32,$146.31,$146.31,$35.89,$205.00,$0.00,$102.50,$162.36,$164.00,$0.00,$32.08,$0.00,$32.64,$0.00
27205839,EAP,HCPCS C1894,,Sheath Gd .038in Mp Crv 6fr 90cm 5cm Pn Dstn T-b Vlv Hdrph,$230.00,$0.00,$230.00,$124.89,$164.15,$0.00,$39.63,$164.15,$164.15,$40.27,$230.00,$0.00,$115.00,$182.16,$184.00,$0.00,$36.00,$0.00,$36.62,$0.00
27205840,EAP,HCPCS C1894,,Sheath Gd .038in Mp Crv 7fr 90cm 5cm Pn Dstn T-b Vlv Hdrph,$230.00,$0.00,$230.00,$124.89,$164.15,$0.00,$39.63,$164.15,$164.15,$40.27,$230.00,$0.00,$115.00,$182.16,$184.00,$0.00,$36.00,$0.00,$36.62,$0.00
27205841,EAP,HCPCS C1894,,Sheath Gd .038in Mp Crv 7fr 90cm 5cm Pn Dstn Xcut Vlv Hdrph,$230.00,$0.00,$230.00,$124.89,$164.15,$0.00,$39.63,$164.15,$164.15,$40.27,$230.00,$0.00,$115.00,$182.16,$184.00,$0.00,$36.00,$0.00,$36.62,$0.00
27205842,EAP,HCPCS C1894,,Sheath Gd 22fr X 35cm Solopath,"$1,525.00",$0.00,"$1,525.00",$828.08,"$1,088.39",$0.00,$262.75,"$1,088.39","$1,088.39",$267.02,"$1,525.00",$0.00,$762.50,"$1,207.80","$1,220.00",$0.00,$238.66,$0.00,$242.78,$0.00
27205843,EAP,HCPCS C1894,,Sheath Gd 23fr 13.5fr 19fr 25cm 20cm Solopath Expandable,"$1,525.00",$0.00,"$1,525.00",$828.08,"$1,088.39",$0.00,$262.75,"$1,088.39","$1,088.39",$267.02,"$1,525.00",$0.00,$762.50,"$1,207.80","$1,220.00",$0.00,$238.66,$0.00,$242.78,$0.00
27205844,EAP,HCPCS C1894,,Sheath Gd 23fr 13.5fr 19fr 35cm 30cm Solopath Expandable,"$1,525.00",$0.00,"$1,525.00",$828.08,"$1,088.39",$0.00,$262.75,"$1,088.39","$1,088.39",$267.02,"$1,525.00",$0.00,$762.50,"$1,207.80","$1,220.00",$0.00,$238.66,$0.00,$242.78,$0.00
27205845,EAP,HCPCS C1894,,Sheath Gd 24fr X 35cm Solopath,"$1,525.00",$0.00,"$1,525.00",$828.08,"$1,088.39",$0.00,$262.75,"$1,088.39","$1,088.39",$267.02,"$1,525.00",$0.00,$762.50,"$1,207.80","$1,220.00",$0.00,$238.66,$0.00,$242.78,$0.00
27205846,EAP,HCPCS C1894,,Sheath Gd 26fr 15fr 22fr 35cm 30cm Solopath Expandable,"$1,525.00",$0.00,"$1,525.00",$828.08,"$1,088.39",$0.00,$262.75,"$1,088.39","$1,088.39",$267.02,"$1,525.00",$0.00,$762.50,"$1,207.80","$1,220.00",$0.00,$238.66,$0.00,$242.78,$0.00
27205847,EAP,HCPCS C1894,,Sheath Gd 28.5fr 15fr 24fr 25cm 20cm Solopath Expandable,"$1,525.00",$0.00,"$1,525.00",$828.08,"$1,088.39",$0.00,$262.75,"$1,088.39","$1,088.39",$267.02,"$1,525.00",$0.00,$762.50,"$1,207.80","$1,220.00",$0.00,$238.66,$0.00,$242.78,$0.00
27205848,EAP,HCPCS C1894,,Sheath Gd 4fr Strl Pncl Prcs Acc Sys Tl Intgr Fit Echgn Tpr,$81.25,$0.00,$81.25,$44.12,$57.99,$0.00,$14.00,$57.99,$57.99,$14.23,$81.25,$0.00,$40.63,$64.35,$65.00,$0.00,$12.72,$0.00,$12.94,$0.00
27205849,EAP,HCPCS C1894,,Sheath Gd Hs Crv 7fr 45cm 5cm Pn Dstn Radopq Xcut Vlv Ss,$205.00,$0.00,$205.00,$111.32,$146.31,$0.00,$35.32,$146.31,$146.31,$35.89,$205.00,$0.00,$102.50,$162.36,$164.00,$0.00,$32.08,$0.00,$32.64,$0.00
27205850,EAP,HCPCS C1894,,Sheath Gd Mp Crv 6fr 45cm 5cm Pn Dstn Radopq Xcut Vlv Ss,$205.00,$0.00,$205.00,$111.32,$146.31,$0.00,$35.32,$146.31,$146.31,$35.89,$205.00,$0.00,$102.50,$162.36,$164.00,$0.00,$32.08,$0.00,$32.64,$0.00
27205851,EAP,HCPCS C1894,,Sheath Gd Mp Crv 6fr 90cm 15cm Pn Dstn Radopq Xcut Vlv Ss,$230.00,$0.00,$230.00,$124.89,$164.15,$0.00,$39.63,$164.15,$164.15,$40.27,$230.00,$0.00,$115.00,$182.16,$184.00,$0.00,$36.00,$0.00,$36.62,$0.00
27205852,EAP,HCPCS C1894,,Sheath Gd Mp Crv 7fr 45cm 5cm Pn Dstn Radopq Xcut Vlv Ss,$205.00,$0.00,$205.00,$111.32,$146.31,$0.00,$35.32,$146.31,$146.31,$35.89,$205.00,$0.00,$102.50,$162.36,$164.00,$0.00,$32.08,$0.00,$32.64,$0.00
27205853,EAP,HCPCS C1894,,Sheath Gd Rnl 2 Crv 5fr 45cm 5cm Pn Dstn Radopq Xcut Vlv Ss,$205.00,$0.00,$205.00,$111.32,$146.31,$0.00,$35.32,$146.31,$146.31,$35.89,$205.00,$0.00,$102.50,$162.36,$164.00,$0.00,$32.08,$0.00,$32.64,$0.00
27205854,EAP,HCPCS C1894,,Sheath Gd Strg 5fr 45cm 35cm Pn Dstn Radopq Xcut Vlv Ss Ptfe,$205.00,$0.00,$205.00,$111.32,$146.31,$0.00,$35.32,$146.31,$146.31,$35.89,$205.00,$0.00,$102.50,$162.36,$164.00,$0.00,$32.08,$0.00,$32.64,$0.00
27205855,EAP,HCPCS C1894,,Sheath Gd Strg 6fr 45cm 35cm Pn Dstn Radopq Xcut Vlv Ss Ptfe,$205.00,$0.00,$205.00,$111.32,$146.31,$0.00,$35.32,$146.31,$146.31,$35.89,$205.00,$0.00,$102.50,$162.36,$164.00,$0.00,$32.08,$0.00,$32.64,$0.00
27205856,EAP,HCPCS C1894,,Sheath Gd Strg 6fr 90cm 15cm Pn Dstn Radopq Xcut Vlv Ss Ptfe,$230.00,$0.00,$230.00,$124.89,$164.15,$0.00,$39.63,$164.15,$164.15,$40.27,$230.00,$0.00,$115.00,$182.16,$184.00,$0.00,$36.00,$0.00,$36.62,$0.00
27205857,EAP,HCPCS C1894,,Sheath Gd Strg 6fr 90cm 15cm Pn Dstn T-b Radopq Vlv Ss Ptfe,$230.00,$0.00,$230.00,$124.89,$164.15,$0.00,$39.63,$164.15,$164.15,$40.27,$230.00,$0.00,$115.00,$182.16,$184.00,$0.00,$36.00,$0.00,$36.62,$0.00
27205858,EAP,HCPCS C1894,,Sheath Gd Strg 7fr 45cm 35cm Pn Dstn Radopq Xcut Vlv Ss Ptfe,$205.00,$0.00,$205.00,$111.32,$146.31,$0.00,$35.32,$146.31,$146.31,$35.89,$205.00,$0.00,$102.50,$162.36,$164.00,$0.00,$32.08,$0.00,$32.64,$0.00
27205859,EAP,HCPCS C1894,,Sheath Gd Strg 7fr 45cm 5cm Pn Dstn Radopq Xcut Vlv Ss Ptfe,$205.00,$0.00,$205.00,$111.32,$146.31,$0.00,$35.32,$146.31,$146.31,$35.89,$205.00,$0.00,$102.50,$162.36,$164.00,$0.00,$32.08,$0.00,$32.64,$0.00
27205860,EAP,HCPCS C1894,,Sheath Gd Strg 7fr 65cm 35cm Pn Dstn Radopq Xcut Vlv Ss Ptfe,$225.00,$0.00,$225.00,$122.18,$160.58,$0.00,$38.77,$160.58,$160.58,$39.40,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$35.21,$0.00,$35.82,$0.00
27205861,EAP,HCPCS C1894,,Sheath Gd Strg 7fr 90cm 15cm Pn Dstn Radopq Xcut Vlv Ss Ptfe,$230.00,$0.00,$230.00,$124.89,$164.15,$0.00,$39.63,$164.15,$164.15,$40.27,$230.00,$0.00,$115.00,$182.16,$184.00,$0.00,$36.00,$0.00,$36.62,$0.00
27205862,EAP,HCPCS C1894,,Sheath Gd Strg 7fr 90cm 15cm Pn Dstn T-b Radopq Vlv Ss Ptfe,$230.00,$0.00,$230.00,$124.89,$164.15,$0.00,$39.63,$164.15,$164.15,$40.27,$230.00,$0.00,$115.00,$182.16,$184.00,$0.00,$36.00,$0.00,$36.62,$0.00
27205863,EAP,HCPCS C1894,,Sheath Gd Strg 8fr 45cm 35cm Pn Dstn T-b Radopq Vlv Ss Ptfe,$205.00,$0.00,$205.00,$111.32,$146.31,$0.00,$35.32,$146.31,$146.31,$35.89,$205.00,$0.00,$102.50,$162.36,$164.00,$0.00,$32.08,$0.00,$32.64,$0.00
27205864,EAP,HCPCS C1894,,Sheath Gd Strg 8fr 65cm 35cm Pn Dstn T-b Radopq Vlv Ss Ptfe,$225.00,$0.00,$225.00,$122.18,$160.58,$0.00,$38.77,$160.58,$160.58,$39.40,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$35.21,$0.00,$35.82,$0.00
27205865,EAP,HCPCS C1894,,Sheath Gd Strg 8fr 90cm 60cm Pn Dstn T-b Radopq Vlv Ss Ptfe,$230.00,$0.00,$230.00,$124.89,$164.15,$0.00,$39.63,$164.15,$164.15,$40.27,$230.00,$0.00,$115.00,$182.16,$184.00,$0.00,$36.00,$0.00,$36.62,$0.00
27205866,EAP,HCPCS C1894,,System Intro .018in 4fr 21ga 40cm Glideaccess Echgn Ndl Gw,$66.25,$0.00,$66.25,$35.97,$47.28,$0.00,$11.41,$47.28,$47.28,$11.60,$66.25,$0.00,$33.13,$52.47,$53.00,$0.00,$10.37,$0.00,$10.55,$0.00
27205867,EAP,HCPCS C1894,,System Intro .018in 4fr 21ga 40cm Glideaccess Non Echgn Ndl,$76.88,$0.00,$76.88,$41.75,$54.87,$0.00,$13.25,$54.87,$54.87,$13.46,$76.88,$0.00,$38.44,$60.89,$61.50,$0.00,$12.03,$0.00,$12.24,$0.00
27205868,EAP,HCPCS C1894,,System Intro .018in 4fr 40cm Glideaccess Coax Gw Echgn Ndl,$79.38,$0.00,$79.38,$43.10,$56.65,$0.00,$13.68,$56.65,$56.65,$13.90,$79.38,$0.00,$39.69,$62.87,$63.50,$0.00,$12.42,$0.00,$12.64,$0.00
27205869,EAP,HCPCS C1894,,System Intro .018in 5fr 21ga 40cm Glideaccess Echgn Ndl Gw,$66.25,$0.00,$66.25,$35.97,$47.28,$0.00,$11.41,$47.28,$47.28,$11.60,$66.25,$0.00,$33.13,$52.47,$53.00,$0.00,$10.37,$0.00,$10.55,$0.00
27205870,EAP,HCPCS C1894,,System Intro .018in 5fr 21ga 40cm Glideaccess Non Echgn Ndl,$76.88,$0.00,$76.88,$41.75,$54.87,$0.00,$13.25,$54.87,$54.87,$13.46,$76.88,$0.00,$38.44,$60.89,$61.50,$0.00,$12.03,$0.00,$12.24,$0.00
27205871,EAP,HCPCS C1894,,System Intro .018in 5fr 40cm Glideaccess Coax Gw Echgn Ndl,$79.38,$0.00,$79.38,$43.10,$56.65,$0.00,$13.68,$56.65,$56.65,$13.90,$79.38,$0.00,$39.69,$62.87,$63.50,$0.00,$12.42,$0.00,$12.64,$0.00
27205872,EAP,HCPCS C1894,,System Intro 5fr 21-19ga 45cm 10cm Pncl Prcs Acc Sys Stf,$81.25,$0.00,$81.25,$44.12,$57.99,$0.00,$14.00,$57.99,$57.99,$14.23,$81.25,$0.00,$40.63,$64.35,$65.00,$0.00,$12.72,$0.00,$12.94,$0.00
27205873,EAP,HCPCS C1894,,System Intro Reg 4fr Echgn Ndl Fxcr Gw Ninitol,$81.25,$0.00,$81.25,$44.12,$57.99,$0.00,$14.00,$57.99,$57.99,$14.23,$81.25,$0.00,$40.63,$64.35,$65.00,$0.00,$12.72,$0.00,$12.94,$0.00
27205874,EAP,HCPCS C1894,,System Intro Reg 4fr Echgn Ndl Gw Ss,$75.00,$0.00,$75.00,$40.73,$53.53,$0.00,$12.92,$53.53,$53.53,$13.13,$75.00,$0.00,$37.50,$59.40,$60.00,$0.00,$11.74,$0.00,$11.94,$0.00
27205875,EAP,HCPCS C1894,,System Intro Reg 5fr Echgn Ndl Fxcr Gw Ninitol,$81.25,$0.00,$81.25,$44.12,$57.99,$0.00,$14.00,$57.99,$57.99,$14.23,$81.25,$0.00,$40.63,$64.35,$65.00,$0.00,$12.72,$0.00,$12.94,$0.00
27205876,EAP,HCPCS C1894,,System Intro Reg 5fr Echgn Ndl Gw Ss,$75.00,$0.00,$75.00,$40.73,$53.53,$0.00,$12.92,$53.53,$53.53,$13.13,$75.00,$0.00,$37.50,$59.40,$60.00,$0.00,$11.74,$0.00,$11.94,$0.00
27205877,EAP,HCPCS C1894,,System Intro Reg 6fr Echgn Ndl Fxcr Gw Ninitol,$81.25,$0.00,$81.25,$44.12,$57.99,$0.00,$14.00,$57.99,$57.99,$14.23,$81.25,$0.00,$40.63,$64.35,$65.00,$0.00,$12.72,$0.00,$12.94,$0.00
27205878,EAP,HCPCS C1894,,System Intro Reg 6fr Echgn Ndl Gw Ss,$75.00,$0.00,$75.00,$40.73,$53.53,$0.00,$12.92,$53.53,$53.53,$13.13,$75.00,$0.00,$37.50,$59.40,$60.00,$0.00,$11.74,$0.00,$11.94,$0.00
27205879,EAP,HCPCS C1894,,System Intro Reg 7fr Echgn Ndl Fxcr Gw Ninitol,$81.25,$0.00,$81.25,$44.12,$57.99,$0.00,$14.00,$57.99,$57.99,$14.23,$81.25,$0.00,$40.63,$64.35,$65.00,$0.00,$12.72,$0.00,$12.94,$0.00
27205880,EAP,HCPCS C1894,,System Intro Reg 7fr Echgn Ndl Gw Ss,$75.00,$0.00,$75.00,$40.73,$53.53,$0.00,$12.92,$53.53,$53.53,$13.13,$75.00,$0.00,$37.50,$59.40,$60.00,$0.00,$11.74,$0.00,$11.94,$0.00
27205881,EAP,HCPCS C1894,,System Intro Reg 8fr Echgn Ndl Gw Ss,$75.00,$0.00,$75.00,$40.73,$53.53,$0.00,$12.92,$53.53,$53.53,$13.13,$75.00,$0.00,$37.50,$59.40,$60.00,$0.00,$11.74,$0.00,$11.94,$0.00
27205882,EAP,HCPCS C1894,,System Intro Strg 4fr Echgn Ndl Fxcr Gw Ss,$75.00,$0.00,$75.00,$40.73,$53.53,$0.00,$12.92,$53.53,$53.53,$13.13,$75.00,$0.00,$37.50,$59.40,$60.00,$0.00,$11.74,$0.00,$11.94,$0.00
27205883,EAP,HCPCS C1894,,System Intro Strg 5fr Echgn Ndl Fxcr Gw Ss,$75.00,$0.00,$75.00,$33.75,$53.53,$0.00,$12.92,$53.53,$53.53,$13.13,$75.00,$0.00,$37.50,$59.40,$60.00,$0.00,$11.74,$0.00,$11.94,$0.00
27205884,EAP,HCPCS C1894,,System Intro Tpr 8fr 19-21ga 45cm 10cm Prcs Acc Sys Pncl,$81.25,$0.00,$81.25,$36.56,$57.99,$0.00,$14.00,$57.99,$57.99,$14.23,$81.25,$0.00,$40.63,$64.35,$65.00,$0.00,$12.72,$0.00,$12.94,$0.00
27205908,EAP,,,Stabilit Full Fracture Kit - 2 Level Kit,"$4,500.00",$0.00,"$4,500.00",$0.00,"$3,211.65",$0.00,$0.00,"$3,211.65","$3,211.65",$0.00,"$4,500.00",$0.00,"$2,250.00","$3,564.00","$3,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
27205910,EAP,Custom 27205910,,Set Ndl 15ga 15mm Strl Lf Arw,"$1,563.00",$0.00,"$1,563.00",$0.00,"$1,115.51",$0.00,$0.00,"$1,115.51","$1,115.51",$0.00,"$1,563.00",$0.00,$781.50,"$1,237.90","$1,250.40",$0.00,$0.00,$0.00,$0.00,$0.00
27205911,EAP,Custom 27205911,,Kit Peritoneal Lavage .035in 8,$85.00,$0.00,$85.00,$0.00,$60.66,$0.00,$0.00,$60.66,$60.66,$0.00,$85.00,$0.00,$42.50,$67.32,$68.00,$0.00,$0.00,$0.00,$0.00,$0.00
27205912,EAP,Custom 27205912,,Lens Irrigation Therapeutic Tu,$780.00,$0.00,$780.00,$0.00,$556.69,$0.00,$0.00,$556.69,$556.69,$0.00,$780.00,$0.00,$390.00,$617.76,$624.00,$0.00,$0.00,$0.00,$0.00,$0.00
27205913,EAP,Custom 27205913,,Dressing Nasal Standard 8cm Co,$430.00,$0.00,$430.00,$0.00,$306.89,$0.00,$0.00,$306.89,$306.89,$0.00,$430.00,$0.00,$215.00,$340.56,$344.00,$0.00,$0.00,$0.00,$0.00,$0.00
27205914,EAP,HCPCS C1769,,Tray Surg 14fr 18ga 29cm 5cm 1,$417.00,$0.00,$417.00,$226.43,$297.61,$0.00,$71.85,$297.61,$297.61,$73.01,$417.00,$0.00,$208.50,$330.26,$333.60,$0.00,$65.26,$0.00,$66.39,$0.00
27205915,EAP,Custom 27205915,,Kit Incision And Drainage Ecc,$400.00,$0.00,$400.00,$0.00,$285.48,$0.00,$0.00,$285.48,$285.48,$0.00,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$0.00,$0.00,$0.00,$0.00
27205916,EAP,HCPCS C1727,,Balloon Catheter Introducer Ki,$375.00,$0.00,$375.00,$0.00,$267.64,$0.00,$0.00,$267.64,$267.64,$0.00,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$0.00,$0.00,$0.00,$0.00
27205917,EAP,Custom 27205917,,Kit Introd .035in 9fr 18ga 10c,$309.00,$0.00,$309.00,$0.00,$220.53,$0.00,$0.00,$220.53,$220.53,$0.00,$309.00,$0.00,$154.50,$244.73,$247.20,$0.00,$0.00,$0.00,$0.00,$0.00
27205918,EAP,Custom 27205918,,Kit Prss Monitr 1 Ln Trndcr 1,$261.00,$0.00,$261.00,$0.00,$186.28,$0.00,$0.00,$186.28,$186.28,$0.00,$261.00,$0.00,$130.50,$206.71,$208.80,$0.00,$0.00,$0.00,$0.00,$0.00
27205920,EAP,HCPCS C1769,,Guidewire Vasc .038in 180cm Strl 3cm Merit Laureat,$80.00,$0.00,$80.00,$43.44,$57.10,$0.00,$13.78,$57.10,$57.10,$14.01,$80.00,$0.00,$40.00,$63.36,$64.00,$0.00,$12.52,$0.00,$12.74,$0.00
27205921,EAP,HCPCS C1769,,Guidewire Vasc Ang .035in 150cm 3cm Laureate Fxcr,$75.00,$0.00,$75.00,$40.73,$53.53,$0.00,$12.92,$53.53,$53.53,$13.13,$75.00,$0.00,$37.50,$59.40,$60.00,$0.00,$11.74,$0.00,$11.94,$0.00
27205922,EAP,HCPCS C1751,,Catheter Cen Ven 9fr 3mm 1.3mm .7mm 90cm 2 Lumen T,$355.00,$0.00,$355.00,$192.77,$253.36,$0.00,$61.16,$253.36,$253.36,$62.16,$355.00,$0.00,$177.50,$281.16,$284.00,$0.00,$55.56,$0.00,$56.52,$0.00
27205923,EAP,HCPCS C1769,,Guidewire Vascular Taper .038in 145cm 6cm Str Tip,$60.00,$0.00,$60.00,$32.58,$42.82,$0.00,$10.34,$42.82,$42.82,$10.51,$60.00,$0.00,$30.00,$47.52,$48.00,$0.00,$9.39,$0.00,$9.55,$0.00
27205930,EAP,HCPCS C1729,,Catheter Urethral Standard 24f,$259.00,$0.00,$259.00,$140.64,$184.85,$0.00,$44.62,$184.85,$184.85,$45.35,$259.00,$0.00,$129.50,$205.13,$207.20,$0.00,$40.53,$0.00,$41.23,$0.00
27205931,EAP,Custom 27205931,,Needle Biop 13 1/16in 15ga 15/,$214.00,$0.00,$214.00,$0.00,$152.73,$0.00,$0.00,$152.73,$152.73,$0.00,$214.00,$0.00,$107.00,$169.49,$171.20,$0.00,$0.00,$0.00,$0.00,$0.00
27205932,EAP,Custom 27205932,,Speculum Vag Med Grn Ns Lf Er-,$168.00,$0.00,$168.00,$0.00,$119.90,$0.00,$0.00,$119.90,$119.90,$0.00,$168.00,$0.00,$84.00,$133.06,$134.40,$0.00,$0.00,$0.00,$0.00,$0.00
27205933,EAP,Custom 27205933,,Needle Spinal Long Bevel Quinc,$90.00,$0.00,$90.00,$0.00,$64.23,$0.00,$0.00,$64.23,$64.23,$0.00,$90.00,$0.00,$45.00,$71.28,$72.00,$0.00,$0.00,$0.00,$0.00,$0.00
27205934,EAP,HCPCS C1729,,Tray Catheterization 16fr 2 Co,$73.00,$0.00,$73.00,$39.64,$52.10,$0.00,$12.58,$52.10,$52.10,$12.78,$73.00,$0.00,$36.50,$57.82,$58.40,$0.00,$11.42,$0.00,$11.62,$0.00
27205938,EAP,Custom 27205938,,Sensor Oximeter 18in Adhesive,$34.00,$0.00,$34.00,$0.00,$24.27,$0.00,$0.00,$24.27,$24.27,$0.00,$34.00,$0.00,$17.00,$26.93,$27.20,$0.00,$0.00,$0.00,$0.00,$0.00
27205939,EAP,Custom 27205939,,Kit Laceration,$26.00,$0.00,$26.00,$0.00,$18.56,$0.00,$0.00,$18.56,$18.56,$0.00,$26.00,$0.00,$13.00,$20.59,$20.80,$0.00,$0.00,$0.00,$0.00,$0.00
27205940,EAP,HCPCS C1729,,Catheter Urethral 12fr 2 Way 1,$26.00,$0.00,$26.00,$14.12,$18.56,$0.00,$4.48,$18.56,$18.56,$4.55,$26.00,$0.00,$13.00,$20.59,$20.80,$0.00,$4.07,$0.00,$4.14,$0.00
27205941,EAP,HCPCS C1729,,Catheter Urethral 14fr Foley 2,$26.00,$0.00,$26.00,$14.12,$18.56,$0.00,$4.48,$18.56,$18.56,$4.55,$26.00,$0.00,$13.00,$20.59,$20.80,$0.00,$4.07,$0.00,$4.14,$0.00
27205942,EAP,Custom 27205942,,Kit Arterial Line .018in 20ga,$25.00,$0.00,$25.00,$0.00,$17.84,$0.00,$0.00,$17.84,$17.84,$0.00,$25.00,$0.00,$12.50,$19.80,$20.00,$0.00,$0.00,$0.00,$0.00,$0.00
27205943,EAP,,,Envelope Defibrillator 3.35x3in Resorb Aigisrx Mino,"$2,488.00",$0.00,"$2,488.00",$0.00,"$1,775.69",$0.00,$0.00,"$1,775.69","$1,775.69",$0.00,"$2,488.00",$0.00,"$1,244.00","$1,970.50","$1,990.40",$0.00,$0.00,$0.00,$0.00,$0.00
27205944,EAP,HCPCS c1769,,Guidewire Vasc 190cm Mic J Asahi Gaia 1st Coron,$150.00,$0.00,$150.00,$0.00,$107.06,$0.00,$0.00,$107.06,$107.06,$0.00,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$0.00,$0.00,$0.00,$0.00
27205945,EAP,HCPCS c1769,,Guidewire Vasc 300cm Jtp Mic Asahi Gaia 1st Coron,$150.00,$0.00,$150.00,$0.00,$107.06,$0.00,$0.00,$107.06,$107.06,$0.00,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$0.00,$0.00,$0.00,$0.00
27205946,EAP,HCPCS C1769,,Guidewire Vasc 190cm Gaia 2 Mctip J Asahi,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27205947,EAP,HCPCS C1769,,Guidewire Vasc 300cm Jtp Mic Asahi Gaia Sec Coron,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27205948,EAP,HCPCS C1769,,Guidewire Vasc 190cm Gaia 3 Mctip J Asahi,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27205949,EAP,HCPCS C1769,,Guidewire Vasc 300cm 3rd Mic J Asahi Gaia Coron,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27205950,EAP,,,Catheter Angio Brnstn 1 Crv 5fr .046in 125cm Prfm Wng Hub,$138.00,$0.00,$138.00,$0.00,$98.49,$0.00,$0.00,$98.49,$98.49,$0.00,$138.00,$0.00,$69.00,$109.30,$110.40,$0.00,$0.00,$0.00,$0.00,$0.00
27206307,EAP,Custom 27206307,,Sheath Guid Str 8fr 45cm 35cm 3 Radiopq Cross Cut,"$1,550.00",$0.00,"$1,550.00",$0.00,"$1,106.24",$0.00,$0.00,"$1,106.24","$1,106.24",$0.00,"$1,550.00",$0.00,$775.00,"$1,227.60","$1,240.00",$0.00,$0.00,$0.00,$0.00,$0.00
27206308,EAP,HCPCS C1894,,Introducer Shth 23fr 55.7cm 69.9cm Micra Stpck Radopq Dil,"$1,500.00",$0.00,"$1,500.00",$814.50,"$1,070.55",$0.00,$258.44,"$1,070.55","$1,070.55",$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
27206309,EAP,HCPCS C1769,,"Guidewire Hi-torque Comm Es .014"" 300cm",$988.00,$0.00,$988.00,$536.48,$705.14,$0.00,$170.23,$705.14,$705.14,$172.99,$988.00,$0.00,$494.00,$782.50,$790.40,$0.00,$154.62,$0.00,$157.29,$0.00
27219613,EAP,HCPCS C1751,,Tray Catheterization 16fr Urine Meter Foley Statlo,$40.00,$0.00,$40.00,$21.72,$28.55,$0.00,$6.89,$28.55,$28.55,$7.00,$40.00,$0.00,$20.00,$31.68,$32.00,$0.00,$6.26,$0.00,$6.37,$0.00
27219614,EAP,Custom 27219614,,5fr Micro Stick,$50.00,$0.00,$50.00,$0.00,$35.69,$0.00,$0.00,$35.69,$35.69,$0.00,$50.00,$0.00,$25.00,$39.60,$40.00,$0.00,$0.00,$0.00,$0.00,$0.00
27219615,EAP,,,Tube Gstrm 18fr 10cm 5-10ml Entuit Enfit Bln Rtnt Fd,$90.00,$0.00,$90.00,$0.00,$64.23,$0.00,$0.00,$64.23,$64.23,$0.00,$90.00,$0.00,$45.00,$71.28,$72.00,$0.00,$0.00,$0.00,$0.00,$0.00
27219616,EAP,,,Tube Fd 20fr 10cm 20ml Entuit Bln Rtnt Mr Conditional Lg,$90.00,$0.00,$90.00,$0.00,$64.23,$0.00,$0.00,$64.23,$64.23,$0.00,$90.00,$0.00,$45.00,$71.28,$72.00,$0.00,$0.00,$0.00,$0.00,$0.00
27219617,EAP,,,Tube Fd 22fr 10cm 20ml Entuit Bln Rtnt Mr Conditional Lg,$90.00,$0.00,$90.00,$0.00,$64.23,$0.00,$0.00,$64.23,$64.23,$0.00,$90.00,$0.00,$45.00,$71.28,$72.00,$0.00,$0.00,$0.00,$0.00,$0.00
27219618,EAP,HCPCS C1769,,Set Gstrm Lg 20-24fr 22-26fr Strl Entuit Srt Coons Dil Plwy,$213.00,$0.00,$213.00,$115.66,$152.02,$0.00,$36.70,$152.02,$152.02,$37.29,$213.00,$0.00,$106.50,$168.70,$170.40,$0.00,$33.33,$0.00,$33.91,$0.00
27219620,EAP,,,Inst Ablat Spinestar 5-10 Gen2,"$7,250.00",$0.00,"$7,250.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$7,250.00",$0.00,"$3,625.00","$5,742.00","$5,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
27219621,EAP,,,Kit Angio 65in Acist Cvi Angiotouch 3w Hi-prs Stpck Prm,"$1,500.00",$0.00,"$1,500.00",$0.00,"$1,070.55",$0.00,$0.00,"$1,070.55","$1,070.55",$0.00,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
27219622,EAP,HCPCS C2623,,Catheter Blndil 5mm 40cm 40mm Lutonix Drg Coat Acpt .035in,"$3,500.00",$0.00,"$3,500.00","$1,900.50","$2,497.95",$0.00,$603.03,"$2,497.95","$2,497.95",$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
27219623,EAP,HCPCS C2623,,Catheter Blndil 5mm 40cm 60mm Lutonix Drg Coat Acpt .035in,"$3,500.00",$0.00,"$3,500.00","$1,900.50","$2,497.95",$0.00,$603.03,"$2,497.95","$2,497.95",$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
27219624,EAP,HCPCS C2623,,Catheter Blndil 5mm 40cm 80mm Lutonix Drg Coat Acpt .035in,"$3,500.00",$0.00,"$3,500.00","$1,900.50","$2,497.95",$0.00,$603.03,"$2,497.95","$2,497.95",$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
27219625,EAP,HCPCS C2623,,Catheter Blndil 5mm 40cm 100mm Lutonix Drg Coat Acpt .035in,"$3,500.00",$0.00,"$3,500.00","$1,900.50","$2,497.95",$0.00,$603.03,"$2,497.95","$2,497.95",$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
27219626,EAP,HCPCS C2623,,Catheter Blndil 6mm 40cm 40mm Lutonix Drg Coat Acpt .035in,"$3,500.00",$0.00,"$3,500.00","$1,900.50","$2,497.95",$0.00,$603.03,"$2,497.95","$2,497.95",$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
27219627,EAP,HCPCS C2623,,Catheter Blndil 6mm 40cm 60mm Lutonix Drg Coat Acpt .035in,"$3,500.00",$0.00,"$3,500.00","$1,900.50","$2,497.95",$0.00,$603.03,"$2,497.95","$2,497.95",$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
27219628,EAP,HCPCS C2623,,Catheter Blndil 6mm 40cm 80mm Lutonix Drg Coat Acpt .035in,"$3,500.00",$0.00,"$3,500.00","$1,900.50","$2,497.95",$0.00,$603.03,"$2,497.95","$2,497.95",$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
27219629,EAP,HCPCS C2623,,Catheter Blndil 6mm 40cm 100mm Lutonix Drg Coat Acpt .035in,"$3,500.00",$0.00,"$3,500.00","$1,900.50","$2,497.95",$0.00,$603.03,"$2,497.95","$2,497.95",$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
27219630,EAP,HCPCS C2623,,Catheter Blndil 7mm 40cm 40mm Lutonix Drg Coat Acpt .035in,"$3,500.00",$0.00,"$3,500.00","$1,900.50","$2,497.95",$0.00,$603.03,"$2,497.95","$2,497.95",$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
27219631,EAP,HCPCS C2623,,Catheter Blndil 7mm 40cm 60mm Lutonix Drg Coat Acpt .035in,"$3,500.00",$0.00,"$3,500.00","$1,900.50","$2,497.95",$0.00,$603.03,"$2,497.95","$2,497.95",$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
27219632,EAP,HCPCS C2623,,Catheter Blndil 8mm 40cm 40mm Lutonix Drg Coat Acpt .035in,"$3,500.00",$0.00,"$3,500.00","$1,900.50","$2,497.95",$0.00,$603.03,"$2,497.95","$2,497.95",$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
27219633,EAP,HCPCS C2623,,Catheter Blndil 7fr 8mm 40cm 60mm Lutonix Drg Coat Acpt .035,"$3,500.00",$0.00,"$3,500.00","$1,900.50","$2,497.95",$0.00,$603.03,"$2,497.95","$2,497.95",$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
27219634,EAP,HCPCS C2623,,Catheter Blndil 4mm 75cm 40mm Lutonix Drg Coat Acpt .035in,"$3,500.00",$0.00,"$3,500.00","$1,900.50","$2,497.95",$0.00,$603.03,"$2,497.95","$2,497.95",$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
27219635,EAP,HCPCS C2623,,Catheter Blndil 4mm 75cm 60mm Lutonix Drg Coat Acpt .035in,"$3,500.00",$0.00,"$3,500.00","$1,900.50","$2,497.95",$0.00,$603.03,"$2,497.95","$2,497.95",$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
27219636,EAP,HCPCS C2623,,Catheter Blndil 4mm 75cm 80mm Lutonix Drg Coat Acpt .035in,"$3,500.00",$0.00,"$3,500.00","$1,900.50","$2,497.95",$0.00,$603.03,"$2,497.95","$2,497.95",$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
27219637,EAP,HCPCS C2623,,Catheter Blndil 4mm 75cm 100mm Lutonix Drg Coat Acpt .035in,"$3,500.00",$0.00,"$3,500.00","$1,900.50","$2,497.95",$0.00,$603.03,"$2,497.95","$2,497.95",$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
27219638,EAP,HCPCS C2623,,Catheter Blndil 5mm 75cm 40mm Lutonix Drg Coat Acpt .035in,"$3,500.00",$0.00,"$3,500.00","$1,900.50","$2,497.95",$0.00,$603.03,"$2,497.95","$2,497.95",$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
27219639,EAP,HCPCS C2623,,Catheter Blndil 5mm 75cm 60mm Lutonix Drg Coat Acpt .035in,"$3,500.00",$0.00,"$3,500.00","$1,900.50","$2,497.95",$0.00,$603.03,"$2,497.95","$2,497.95",$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
27219640,EAP,HCPCS C2623,,Catheter Blndil 5mm 75cm 80mm Lutonix Drg Coat Acpt .035in,"$3,500.00",$0.00,"$3,500.00","$1,900.50","$2,497.95",$0.00,$603.03,"$2,497.95","$2,497.95",$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
27219641,EAP,HCPCS C2623,,Catheter Blndil 5mm 75cm 100mm Lutonix Drg Coat Acpt .035in,"$3,500.00",$0.00,"$3,500.00","$1,900.50","$2,497.95",$0.00,$603.03,"$2,497.95","$2,497.95",$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
27219642,EAP,HCPCS C2623,,Catheter Blndil 6mm 75cm 40mm Lutonix Drg Coat Acpt .035in,"$3,500.00",$0.00,"$3,500.00","$1,900.50","$2,497.95",$0.00,$603.03,"$2,497.95","$2,497.95",$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
27219643,EAP,HCPCS C2623,,Catheter Blndil 6mm 75cm 60mm Lutonix Drg Coat Acpt .035in,"$3,500.00",$0.00,"$3,500.00","$1,900.50","$2,497.95",$0.00,$603.03,"$2,497.95","$2,497.95",$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
27219644,EAP,HCPCS C2623,,Catheter Blndil 6mm 75cm 80mm Lutonix Drg Coat Acpt .035in,"$3,500.00",$0.00,"$3,500.00","$1,900.50","$2,497.95",$0.00,$603.03,"$2,497.95","$2,497.95",$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
27219645,EAP,HCPCS C2623,,Catheter Blndil 6mm 75cm 100mm Lutonix Drg Coat Acpt .035in,"$3,500.00",$0.00,"$3,500.00","$1,900.50","$2,497.95",$0.00,$603.03,"$2,497.95","$2,497.95",$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
27219646,EAP,HCPCS C2623,,Catheter Blndil 7mm 75cm 40mm Lutonix Drg Coat Acpt .035in,"$3,500.00",$0.00,"$3,500.00","$1,900.50","$2,497.95",$0.00,$603.03,"$2,497.95","$2,497.95",$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
27219647,EAP,HCPCS C2623,,Catheter Blndil 7mm 75cm 60mm Lutonix Drg Coat Acpt .035in,"$3,500.00",$0.00,"$3,500.00","$1,900.50","$2,497.95",$0.00,$603.03,"$2,497.95","$2,497.95",$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
27219648,EAP,HCPCS C2623,,Catheter Blndil 8mm 75cm 40mm Lutonix Drg Coat Acpt .035in,"$3,500.00",$0.00,"$3,500.00","$1,900.50","$2,497.95",$0.00,$603.03,"$2,497.95","$2,497.95",$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
27219649,EAP,HCPCS C2623,,Catheter Blndil 8mm 75cm 60mm Lutonix Drg Coat Acpt .035in,"$3,500.00",$0.00,"$3,500.00","$1,900.50","$2,497.95",$0.00,$603.03,"$2,497.95","$2,497.95",$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
27219650,EAP,HCPCS C2623,,Catheter Blndil 9mm 75cm 40mm Lutonix Drg Coat Acpt .035in,"$3,500.00",$0.00,"$3,500.00","$1,900.50","$2,497.95",$0.00,$603.03,"$2,497.95","$2,497.95",$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
27219651,EAP,HCPCS C2623,,Catheter Blndil 9mm 75cm 60mm Lutonix Drg Coat Acpt .035in,"$3,500.00",$0.00,"$3,500.00","$1,900.50","$2,497.95",$0.00,$603.03,"$2,497.95","$2,497.95",$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
27219652,EAP,HCPCS C2623,,Catheter Blndil 10mm 75cm 40mm Lutonix Drg Coat Acpt .035in,"$3,500.00",$0.00,"$3,500.00","$1,900.50","$2,497.95",$0.00,$603.03,"$2,497.95","$2,497.95",$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
27219653,EAP,HCPCS C2623,,Catheter Blndil 10mm 75cm 60mm Lutonix Drg Coat Acpt .035in,"$3,500.00",$0.00,"$3,500.00","$1,900.50","$2,497.95",$0.00,$603.03,"$2,497.95","$2,497.95",$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
27219654,EAP,HCPCS C2623,,Catheter Blndil 12mm 75cm 40mm Lutonix Drg Coat Acpt .035in,"$3,500.00",$0.00,"$3,500.00","$1,900.50","$2,497.95",$0.00,$603.03,"$2,497.95","$2,497.95",$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
27219655,EAP,HCPCS C2623,,Catheter Blndil 8mm 100cm 40mm Lutonix Drg Coat Acpt .035in,"$3,500.00",$0.00,"$3,500.00","$1,900.50","$2,497.95",$0.00,$603.03,"$2,497.95","$2,497.95",$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
27219656,EAP,HCPCS C2623,,Catheter Blndil 8mm 100cm 60mm Lutonix Drg Coat Acpt .035in,"$3,500.00",$0.00,"$3,500.00","$1,900.50","$2,497.95",$0.00,$603.03,"$2,497.95","$2,497.95",$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
27219657,EAP,HCPCS C2623,,Catheter Blndil 9mm 100cm 40mm Lutonix Drg Coat Acpt .035in,"$3,500.00",$0.00,"$3,500.00","$1,900.50","$2,497.95",$0.00,$603.03,"$2,497.95","$2,497.95",$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
27219658,EAP,HCPCS C2623,,Catheter Blndil 9mm 100cm 60mm Lutonix Drg Coat Acpt .035in,"$3,500.00",$0.00,"$3,500.00","$1,900.50","$2,497.95",$0.00,$603.03,"$2,497.95","$2,497.95",$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
27219659,EAP,HCPCS C2623,,Catheter Blndil 10mm 100cm 40mm Lutonix Drg Coat Acpt .035in,"$3,500.00",$0.00,"$3,500.00","$1,900.50","$2,497.95",$0.00,$603.03,"$2,497.95","$2,497.95",$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
27219660,EAP,HCPCS C2623,,Catheter Blndil 8fr 10mm 100cm 60mm Lutonix Drg Coat Acpt,"$3,500.00",$0.00,"$3,500.00","$1,900.50","$2,497.95",$0.00,$603.03,"$2,497.95","$2,497.95",$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
27219661,EAP,HCPCS C2623,,Catheter Blndil 12mm 100cm 40mm Lutonix Drg Coat Acpt .035in,"$3,500.00",$0.00,"$3,500.00","$1,900.50","$2,497.95",$0.00,$603.03,"$2,497.95","$2,497.95",$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
27219662,EAP,,,Tube Fd 24fr 10cm 20ml Entuit Bln Rtnt Mr Conditional Lg,$90.00,$0.00,$90.00,$0.00,$64.23,$0.00,$0.00,$64.23,$64.23,$0.00,$90.00,$0.00,$45.00,$71.28,$72.00,$0.00,$0.00,$0.00,$0.00,$0.00
27219663,EAP,,,Catheter Infs 2 2/3fr 45cm Clarivein,"$1,250.00",$0.00,$990.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$990.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
27219664,EAP,,,Catheter Infs 4 4/3fr 65cm Clarivein,"$1,250.00",$0.00,$990.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$990.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
27219665,EAP,HCPCS C1729,,Stent Intracranial Pulserider T L10 Mm Od4 Mm,"$31,250.00",$0.00,"$31,250.00","$16,968.75","$5,158.80",$0.00,"$5,384.22","$5,158.80","$5,158.80","$5,471.63","$31,250.00",$0.00,"$15,625.00","$24,750.00","$25,000.00",$0.00,"$4,890.63",$0.00,"$4,975.00",$0.00
27219667,EAP,HCPCS C1769,,Guidewire Vasc Strg .035in 260cm 6cm Hiwire Bntsn Atrm X,$57.00,$0.00,$57.00,$30.95,$40.68,$0.00,$9.82,$40.68,$40.68,$9.98,$57.00,$0.00,$28.50,$45.14,$45.60,$0.00,$8.92,$0.00,$9.07,$0.00
27219668,EAP,HCPCS C1887,,Catheter Gd 10d 2.1-3.5fr 135cm 7mm Twnps 2 Lum Otw Trq Brd,"$1,123.00",$0.00,"$1,123.00",$609.79,$801.49,$0.00,$193.49,$801.49,$801.49,$196.63,"$1,123.00",$0.00,$561.50,$889.42,$898.40,$0.00,$175.75,$0.00,$178.78,$0.00
27219669,EAP,,,Drill Srg Vertecor Bn,$550.00,$0.00,$550.00,$0.00,$392.54,$0.00,$0.00,$392.54,$392.54,$0.00,$550.00,$0.00,$275.00,$435.60,$440.00,$0.00,$0.00,$0.00,$0.00,$0.00
27219670,EAP,,,Catheter Chlgm Spyscope Ds Acc Dlv Disp,"$6,875.00",$0.00,"$6,875.00",$0.00,"$4,906.69",$0.00,$0.00,"$4,906.69","$4,906.69",$0.00,"$6,875.00",$0.00,"$3,437.50","$5,445.00","$5,500.00",$0.00,$0.00,$0.00,$0.00,$0.00
27219671,EAP,HCPCS C1887,,Catheter Intvn 5.1fr 150cm 13cm Trapliner Rx Gd Xtn Radopq,"$1,625.00",$0.00,"$1,625.00",$882.38,"$1,159.76",$0.00,$279.98,"$1,159.76","$1,159.76",$284.52,"$1,625.00",$0.00,$812.50,"$1,287.00","$1,300.00",$0.00,$254.31,$0.00,$258.70,$0.00
27219672,EAP,HCPCS C1887,,Catheter Intvn 5.7fr 150cm 13cm Trapliner Rx Gd Xtn Radopq,"$1,625.00",$0.00,"$1,625.00",$882.38,"$1,159.76",$0.00,$279.98,"$1,159.76","$1,159.76",$284.52,"$1,625.00",$0.00,$812.50,"$1,287.00","$1,300.00",$0.00,$254.31,$0.00,$258.70,$0.00
27219673,EAP,HCPCS C1887,,Catheter Intvn 6.5fr 150cm 13cm Trapliner Rx Gd Xtn Radopq,"$1,625.00",$0.00,"$1,625.00",$882.38,"$1,159.76",$0.00,$279.98,"$1,159.76","$1,159.76",$284.52,"$1,625.00",$0.00,$812.50,"$1,287.00","$1,300.00",$0.00,$254.31,$0.00,$258.70,$0.00
27219674,EAP,HCPCS C1750,,Catheter Hmdial 14.5fr 19cm Mh Mxd Sportpack 2 Lum Kink Rst,$225.00,$0.00,$225.00,$122.18,$160.58,$0.00,$38.77,$160.58,$160.58,$39.40,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$35.21,$0.00,$35.82,$0.00
27219675,EAP,HCPCS C1894,,Sheath Gd 8fr 2.9mm 40cm Strl Flxr Chfl Blkn Disp Acpt .038,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219676,EAP,HCPCS C1887,,Microcatheter Crbrvasc Thnwl 2fr .019in 130cm 70cm Progreat,"$1,625.00",$0.00,"$1,625.00",$882.38,"$1,159.76",$0.00,$279.98,"$1,159.76","$1,159.76",$284.52,"$1,625.00",$0.00,$812.50,"$1,287.00","$1,300.00",$0.00,$254.31,$0.00,$258.70,$0.00
27219677,EAP,HCPCS C1887,,Microcatheter Crbrvasc Thnwl 2fr .019in 150cm 90cm Progreat,"$1,625.00",$0.00,"$1,625.00",$882.38,"$1,159.76",$0.00,$279.98,"$1,159.76","$1,159.76",$284.52,"$1,625.00",$0.00,$812.50,"$1,287.00","$1,300.00",$0.00,$254.31,$0.00,$258.70,$0.00
27219678,EAP,HCPCS C1769,,Embrotrap Ii Revascularization Device (5x21),"$9,500.00",$0.00,"$9,500.00","$5,158.50","$5,158.80",$0.00,"$1,636.80","$5,158.80","$5,158.80","$1,663.37","$9,500.00",$0.00,"$4,750.00","$7,524.00","$7,600.00",$0.00,"$1,486.75",$0.00,"$1,512.40",$0.00
27219679,EAP,HCPCS C1769,,Embrotrap Ii Revascularization Device (5x33),"$9,500.00",$0.00,"$9,500.00","$5,158.50","$5,158.80",$0.00,"$1,636.80","$5,158.80","$5,158.80","$1,663.37","$9,500.00",$0.00,"$4,750.00","$7,524.00","$7,600.00",$0.00,"$1,486.75",$0.00,"$1,512.40",$0.00
27219680,EAP,,,Catheter Angio.038in Chgb Crv 5fr,$313.00,$0.00,$313.00,$0.00,$223.39,$0.00,$0.00,$223.39,$223.39,$0.00,$313.00,$0.00,$156.50,$247.90,$250.40,$0.00,$0.00,$0.00,$0.00,$0.00
27219681,EAP,,,Catheter Angio Rosch Infr Mes Crv Tpr 5fr 65cm Strl 41,$313.00,$0.00,$313.00,$0.00,$223.39,$0.00,$0.00,$223.39,$223.39,$0.00,$313.00,$0.00,$156.50,$247.90,$250.40,$0.00,$0.00,$0.00,$0.00,$0.00
27219682,EAP,HCPCS C1725,,Catheter Angiographic Angle 4fr.041in 65cm 15cm 2 Braid,$123.00,$0.00,$123.00,$66.79,$87.79,$0.00,$21.19,$87.79,$87.79,$21.54,$123.00,$0.00,$61.50,$97.42,$98.40,$0.00,$19.25,$0.00,$19.58,$0.00
27219690,EAP,Custom 27219690,,Device Indfltr Plus 30 10ml Inflat 30 Atm Disp,$175.00,$0.00,$175.00,$0.00,$124.90,$0.00,$0.00,$124.90,$124.90,$0.00,$175.00,$0.00,$87.50,$138.60,$140.00,$0.00,$0.00,$0.00,$0.00,$0.00
27219691,EAP,Custom 27219691,,Kit Inflat Indfltr Plus 30 .096in Coron Rot Hmst,$138.00,$0.00,$138.00,$0.00,$98.49,$0.00,$0.00,$98.49,$98.49,$0.00,$138.00,$0.00,$69.00,$109.30,$110.40,$0.00,$0.00,$0.00,$0.00,$0.00
27219692,EAP,Custom 27219692,,Device Indfltr Plus 30 10ml Rot Hmst Vlv Gwire,$138.00,$0.00,$138.00,$0.00,$98.49,$0.00,$0.00,$98.49,$98.49,$0.00,$138.00,$0.00,$69.00,$109.30,$110.40,$0.00,$0.00,$0.00,$0.00,$0.00
27219693,EAP,Custom 27219693,,Kit Inflat Indfltr .096in Rot Hmst Vlv Gwire,$138.00,$0.00,$138.00,$0.00,$98.49,$0.00,$0.00,$98.49,$98.49,$0.00,$138.00,$0.00,$69.00,$109.30,$110.40,$0.00,$0.00,$0.00,$0.00,$0.00
27219694,EAP,Custom 27219694,,Device 20/30 Indfltr 20ml Rot Hmst Vlv Gwire,$138.00,$0.00,$138.00,$0.00,$98.49,$0.00,$0.00,$98.49,$98.49,$0.00,$138.00,$0.00,$69.00,$109.30,$110.40,$0.00,$0.00,$0.00,$0.00,$0.00
27219695,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in Radiopq Str Rbn 3cm,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219696,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in Radiopq J Rbn 4.5cm,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219697,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in Radiopq Str Rbn 3cm,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219698,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in Jtp Shaping Rbn,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219699,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in Strbl Core To Tip,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219700,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in Jtp Core To Tip,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219701,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in Core To Tip Radiopq J,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219702,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in Radiopq Kink Rst J 3cm,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219703,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in Radiopq Kink Rst Str 3,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219704,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in J 3cm Htrq Bl Mwt,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219705,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in Jtp Shaping Rbn,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219706,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in Radiopq Kink Rst Str 3,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219707,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in Jtp Shaping Rbn,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219708,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in Jtp Shaping Rbn,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219709,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in .01in Radiopq Coil Str,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219710,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in .01in Radiopq Coil J,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219711,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in .01in Radiopq Coil Str,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219712,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in Jtp Core To Tip,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219713,EAP,Custom 27219713,,Valve Hmsts .096- In Coplt 20 Atm Inflat Trq Dev,$168.00,$0.00,$168.00,$0.00,$119.90,$0.00,$0.00,$119.90,$119.90,$0.00,$168.00,$0.00,$84.00,$133.06,$134.40,$0.00,$0.00,$0.00,$0.00,$0.00
27219714,EAP,Custom 27219714,,Valve Hmsts .096- In Coplt Kit Bldbck Cntrl Vlv,$163.00,$0.00,$163.00,$0.00,$116.33,$0.00,$0.00,$116.33,$116.33,$0.00,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$0.00,$0.00,$0.00,$0.00
27219715,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in Str 3cm Htorq Whspr Ls,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219716,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in J 3cm Htorq Whspr Ls,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219717,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in Str 3cm Htorq Whspr Ls,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219718,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in J 3cm Htorq Whspr Ms,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219719,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in J 3cm Htorq Whspr Ms,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219720,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in J 3cm Htrq Bl Mwt U,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219721,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in Radiopq J 3cm Htrq Bl,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219722,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in W/o Mrkr Shaping Rbn,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219723,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in Str 3cm Htrq Bl Mwt U,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219724,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in J 3cm Htrq Bl Mwt U,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219725,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in Radiopq Cover Str Rbn,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219726,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in Radiopq J 3cm Htrq Bl,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219727,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in Radiopq Str 3cm Htrq,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219728,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in Radiopq J 3cm Htrq Bl,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219729,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in Mrkr Tip Str 3cm Htrq,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219730,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in J 3cm Htrq Bl Mwt U Ii,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219731,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in Str 3cm Htrq Bl Mwt U,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219732,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in J 3cm Htrq Bl Mwt U Ii,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219733,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in Radiopq Mrkr Core To,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219734,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in Radiopq Mrkr Core To,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219735,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in Jtp Core To Tip,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219736,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in Radiopq Core To Tip,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219737,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in Radiopq Mrkr Core To,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219738,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in Radiopq Mrkr Core To,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219739,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in Radiopq Mrkr Core To,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219740,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in Radiopq Mrkr Core To,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219741,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in Radiopq Mrkr Str 3cm,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219742,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in Radiopq Mrkr J 3cm,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219743,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in Radiopq Mrkr Str 3cm,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219744,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in Radiopq Mrkr J 3cm,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219745,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in Radiopq Mrkr Str 3cm,$375.00,$0.00,$375.00,$203.63,$267.64,$0.00,$64.61,$267.64,$267.64,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
27219746,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in Radiopq Mrkr Str 3cm,$375.00,$0.00,$375.00,$203.63,$267.64,$0.00,$64.61,$267.64,$267.64,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
27219747,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in Radiopq Mrkr Str 3cm,$375.00,$0.00,$375.00,$203.63,$267.64,$0.00,$64.61,$267.64,$267.64,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
27219748,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in Radiopq Mrkr Str 3cm,$375.00,$0.00,$375.00,$203.63,$267.64,$0.00,$64.61,$267.64,$267.64,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
27219749,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in Radiopq Mrkr Str Tpr 3,$375.00,$0.00,$375.00,$203.63,$267.64,$0.00,$64.61,$267.64,$267.64,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
27219750,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in Radiopq Mrkr Str Tpr 3,$375.00,$0.00,$375.00,$203.63,$267.64,$0.00,$64.61,$267.64,$267.64,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
27219751,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in Radiopq Str Tpr 3cm,$375.00,$0.00,$375.00,$203.63,$267.64,$0.00,$64.61,$267.64,$267.64,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
27219752,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in Radiopq Mrkr Str Tpr 3,$375.00,$0.00,$375.00,$203.63,$267.64,$0.00,$64.61,$267.64,$267.64,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
27219753,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in Radiopq Mrkr Str 3cm,$375.00,$0.00,$375.00,$203.63,$267.64,$0.00,$64.61,$267.64,$267.64,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
27219754,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in Radiopq Mrkr Str 3cm,$375.00,$0.00,$375.00,$203.63,$267.64,$0.00,$64.61,$267.64,$267.64,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
27219755,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in Mrkr Str 3cm Htrq Bl,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219756,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in Radiopq J 3cm Htrq Bl,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219757,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in Radiopq Str 3cm Htrq,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219758,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in Radiopq J 3cm Htrq Bl,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219759,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in W/o Mrkr Str 3cm Htrq,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219760,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in J 3cm Htrq Bl Mwt Elt,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219761,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in Str 3cm Htrq Bl Mwt,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219762,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in J 3cm Htrq Bl Mwt Elt,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219763,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in Str 3cm Htorq Bal,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219764,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in Str 3cm Htorq Bal,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219765,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in J 3cm Htorq Bal,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219766,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in J 3cm Htorq Bal,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219767,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in Str 3cm Htorq Bal,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219768,EAP,HCPCS C1769,,Guidewire Vasc 175cm .014in Str 3cm Htorq Bal,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219769,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in Radiopq Str 3cm Htorq,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219770,EAP,Custom 27219770,,Valve Hmsts .115in Duostat Rot,$58.00,$0.00,$58.00,$0.00,$41.39,$0.00,$0.00,$41.39,$41.39,$0.00,$58.00,$0.00,$29.00,$45.94,$46.40,$0.00,$0.00,$0.00,$0.00,$0.00
27219771,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in Str 30cm Htrq Wg Ss,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219772,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in J Tpr 3cm Htrq Trns Ss,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219773,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in Str Tpr 3cm Htrq Trns,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219774,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in Str Tip Tpr 3cm Htrq,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219775,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in Jtp Lght Sprt Shaping,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219776,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in Str 2cm Htrq Wg Ss,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219777,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in X Sprt Str 2cm Htrq Fl,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219778,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in Str Tip Lght Sprt,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219779,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in Str Sprg Tpr 3cm Htrq,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219780,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in Str Sprg Tpr 3cm Htrq,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219781,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in Jtp Lght Sprt Shaping,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219782,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in Lght Sprt Str 30cm,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219783,EAP,HCPCS C1769,,Guidewire Vasc 190cm .018in Lght Sprt Str 2cm Htrq,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219784,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in Str Tip Str 2cm Htrq,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219785,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in Str 2cm Htrq Fl2 Ss,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219786,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in Str 2cm Htorq Std Ss,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219787,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in J 2cm Htorq Std Ss,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219788,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in Str 2cm Htorq Std Ss,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219789,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in Radiopq J 3cm Htrq Inm,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219790,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in Str 3cm Htrq Inm Mcgld,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219791,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in J 3cm Htrq Inm Hdrct,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219792,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in Str 3cm Htrq Inm Hdrct,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219793,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in Str 3cm Htrq Inm Hdrct,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219794,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in Str Rbn 30cm Htrq Wg,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219795,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in Str Shaping Rbn 2cm,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219796,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in Lght Sprt Str 30cm,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219797,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in Lght Sprt Str Tip 2cm,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219798,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in Str 2cm Htrq Fl2 Ss,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219799,EAP,Custom 27219799,,Kit Gwire .009-.018in .115in Introd Trq Dev Rot,$88.00,$0.00,$88.00,$0.00,$62.81,$0.00,$0.00,$62.81,$62.81,$0.00,$88.00,$0.00,$44.00,$69.70,$70.40,$0.00,$0.00,$0.00,$0.00,$0.00
27219800,EAP,Custom 27219800,,Kit Gwire .01-.018in,$88.00,$0.00,$88.00,$0.00,$62.81,$0.00,$0.00,$62.81,$62.81,$0.00,$88.00,$0.00,$44.00,$69.70,$70.40,$0.00,$0.00,$0.00,$0.00,$0.00
27219801,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in X Sprt J 3cm Htorq,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219802,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in Str Tip Core To Tip,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219803,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in X Sprt J 3cm Htrq,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219804,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in Str Tip Str 3cm,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219805,EAP,HCPCS C1725,,Catheter Baldilat 1.5mm 143cm 6mm Otw Smth Rnd Tip,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
27219806,EAP,HCPCS C1725,,Catheter Baldilat 1.5mm 143cm 8mm Otw Smth Rnd Tip,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
27219807,EAP,HCPCS C1725,,Catheter Baldilat 1.5mm 143cm 12mm Otw Smth Rnd,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
27219808,EAP,HCPCS C1725,,Catheter Baldilat 1.5mm 143cm 15mm Otw Smth Rnd,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
27219809,EAP,HCPCS C1725,,Catheter Baldilat 1.5mm 143cm 20mm Otw Smth Rnd,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
27219810,EAP,HCPCS C1725,,Catheter Baldilat 2mm 143cm 6mm Otw Smth Rnd Tip,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
27219811,EAP,HCPCS C1725,,Catheter Baldilat 2mm 143cm 12mm Otw Smth Rnd Tip,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
27219812,EAP,HCPCS C1725,,Catheter Baldilat 2.25mm 143cm 6mm Otw Smth Rnd,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
27219813,EAP,HCPCS C1725,,Catheter Baldilat 2.25mm 143cm 20mm Otw Smth Rnd,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
27219814,EAP,HCPCS C1725,,Catheter Baldilat 2.5mm 143cm 15mm Otw Smth Rnd,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
27219815,EAP,HCPCS C1725,,Catheter Baldilat 2.5mm 143cm 20mm Otw Smth Rnd,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
27219816,EAP,HCPCS C1725,,Catheter Baldilat 2.5mm 143cm 25mm Otw Smth Rnd,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
27219817,EAP,HCPCS C1725,,Catheter Baldilat 2.75mm 143cm 6mm Otw Smth Rnd,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
27219818,EAP,HCPCS C1725,,Catheter Baldilat 2.75mm 143cm 8mm Otw Smth Rnd,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
27219819,EAP,HCPCS C1725,,Catheter Baldilat 2.75mm 143cm 12mm Otw Smth Rnd,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
27219820,EAP,HCPCS C1725,,Catheter Baldilat 2.75mm 143cm 20mm Otw Smth Rnd,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
27219821,EAP,HCPCS C1725,,Catheter Baldilat 3mm 143cm 6mm Otw Smth Rnd Tip,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
27219822,EAP,HCPCS C1725,,Catheter Baldilat 3mm 143cm 12mm Otw Smth Rnd Tip,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
27219823,EAP,HCPCS C1725,,Catheter Baldilat 3mm 143cm 15mm Otw Smth Rnd Tip,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
27219824,EAP,HCPCS C1725,,Catheter Baldilat 3mm 143cm 20mm Otw Smth Rnd Tip,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
27219825,EAP,HCPCS C1725,,Catheter Baldilat 3mm 143cm 25mm Otw Smth Rnd Tip,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
27219826,EAP,HCPCS C1725,,Catheter Baldilat 3.25mm 143cm 8mm Otw Smth Rnd,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
27219827,EAP,HCPCS C1725,,Catheter Baldilat 3.25mm 143cm 12mm Otw Smth Rnd,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
27219828,EAP,HCPCS C1725,,Catheter Baldilat 3.25mm 143cm 15mm Otw Smth Rnd,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
27219829,EAP,HCPCS C1725,,Catheter Baldilat 3.25mm 143cm 20mm Otw Smth Rnd,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
27219830,EAP,HCPCS C1725,,Catheter Baldilat 3.5mm 143cm 6mm Otw Smth Rnd Tip,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
27219831,EAP,HCPCS C1725,,Catheter Baldilat 3.5mm 143cm 12mm Otw Smth Rnd,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
27219832,EAP,HCPCS C1725,,Catheter Baldilat 3.5mm 143cm 15mm Otw Smth Rnd,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
27219833,EAP,HCPCS C1725,,Catheter Baldilat 3.5mm 143cm 20mm Otw Smth Rnd,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
27219834,EAP,HCPCS C1725,,Catheter Baldilat 3.5mm 143cm 25mm Otw Smth Rnd,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
27219835,EAP,HCPCS C1725,,Catheter Baldilat 3.75mm 143cm 12mm Otw Smth Rnd,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
27219836,EAP,HCPCS C1725,,Catheter Baldilat 3.75mm 143cm 15mm Otw Smth Rnd,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
27219837,EAP,HCPCS C1725,,Catheter Baldilat 3.75mm 143cm 20mm Otw Smth Rnd,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
27219838,EAP,HCPCS C1725,,Catheter Baldilat 4mm 143cm 8mm Otw Smth Rnd Tip,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
27219839,EAP,HCPCS C1725,,Catheter Baldilat 4mm 143cm 12mm Otw Smth Rnd Tip,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
27219840,EAP,HCPCS C1725,,Catheter Baldilat 4.5mm 143cm 8mm Otw Smth Rnd Tip,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
27219841,EAP,HCPCS C1725,,Catheter Baldilat 4.5mm 143cm 12mm Otw Smth Rnd,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
27219842,EAP,HCPCS C1725,,Catheter Baldilat 4.5mm 143cm 15mm Otw Smth Rnd,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
27219843,EAP,HCPCS C1725,,Catheter Baldilat 4.5mm 143cm 20mm Otw Smth Rnd,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
27219844,EAP,HCPCS C1725,,Catheter Baldilat 5mm 143cm 8mm Otw Smth Rnd Tip,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
27219845,EAP,HCPCS C1725,,Catheter Baldilat 5mm 143cm 20mm Otw Smth Rnd Tip,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
27219846,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in Str 3cm Htorq Adv Lt,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219847,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in Str 3cm Htorq Adv,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219848,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in J 3cm Htorq Adv,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219849,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in Str 3cm Htorq Adv,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219850,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in J 3cm Htorq Adv,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
27219851,EAP,HCPCS C1769,,Guidewire Vasc 300cm Ptca Asahi Ultimatebros 3,"$1,875.00",$0.00,"$1,875.00","$1,018.13","$1,338.19",$0.00,$323.05,"$1,338.19","$1,338.19",$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
27219852,EAP,HCPCS C1769,,Guidewire Vasc 180cm Ptca Asahi Ultimatebros 3,"$1,875.00",$0.00,"$1,875.00","$1,018.13","$1,338.19",$0.00,$323.05,"$1,338.19","$1,338.19",$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
27219853,EAP,HCPCS C1769,,Guidewire Vasc 300cm 3cm Str Asahi Suoh Ptca,"$1,875.00",$0.00,"$1,875.00","$1,018.13","$1,338.19",$0.00,$323.05,"$1,338.19","$1,338.19",$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
27219854,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in Sion Asahi Ptca Blue,"$1,875.00",$0.00,"$1,875.00","$1,018.13","$1,338.19",$0.00,$323.05,"$1,338.19","$1,338.19",$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
27219855,EAP,HCPCS C1769,,Guidewire Vasc 300cm Wire J Asahi Ptca Sion Blue,"$1,875.00",$0.00,"$1,875.00","$1,018.13","$1,338.19",$0.00,$323.05,"$1,338.19","$1,338.19",$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
27219856,EAP,HCPCS C1769,,Guidewire Vasc 190cm Str 3cm Asahi Suoh Ptca,"$1,875.00",$0.00,"$1,875.00","$1,018.13","$1,338.19",$0.00,$323.05,"$1,338.19","$1,338.19",$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
27219857,EAP,HCPCS C1769,,Guidewire Vasc 190cm Pshp Mini 3cm Asahi Suoh Ptca,"$1,875.00",$0.00,"$1,875.00","$1,018.13","$1,338.19",$0.00,$323.05,"$1,338.19","$1,338.19",$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
27219858,EAP,HCPCS C1769,,Guidewire Vasc 180cm Wire J Asahi Ptca Sion Blue,"$1,875.00",$0.00,"$1,875.00","$1,018.13","$1,338.19",$0.00,$323.05,"$1,338.19","$1,338.19",$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
27219859,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in Core To Tip J 3cm A,$938.00,$0.00,$938.00,$509.33,$669.45,$0.00,$161.61,$669.45,$669.45,$164.24,$938.00,$0.00,$469.00,$742.90,$750.40,$0.00,$146.80,$0.00,$149.33,$0.00
27219860,EAP,HCPCS C1769,,Guidewire Vasc 180cm .014in Jtp 3cm A Fldr Fc Plmr,$938.00,$0.00,$938.00,$509.33,$669.45,$0.00,$161.61,$669.45,$669.45,$164.24,$938.00,$0.00,$469.00,$742.90,$750.40,$0.00,$146.80,$0.00,$149.33,$0.00
27219861,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in Radiopq Core To Tip,"$1,875.00",$0.00,"$1,875.00","$1,018.13","$1,338.19",$0.00,$323.05,"$1,338.19","$1,338.19",$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
27219862,EAP,HCPCS C1769,,Guidewire Vasc 180cm .014in Core To Tip Str 11cm A,"$1,875.00",$0.00,"$1,875.00","$1,018.13","$1,338.19",$0.00,$323.05,"$1,338.19","$1,338.19",$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
27219863,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in Hbrd Radiopq Str Tip,"$1,875.00",$0.00,"$1,875.00","$1,018.13","$1,338.19",$0.00,$323.05,"$1,338.19","$1,338.19",$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
27219864,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in Core To Tip J 3cm A,$938.00,$0.00,$938.00,$509.33,$669.45,$0.00,$161.61,$669.45,$669.45,$164.24,$938.00,$0.00,$469.00,$742.90,$750.40,$0.00,$146.80,$0.00,$149.33,$0.00
27219865,EAP,HCPCS C1769,,Guidewire Vasc 180cm .014in Core To Tip J 3cm A,$938.00,$0.00,$938.00,$509.33,$669.45,$0.00,$161.61,$669.45,$669.45,$164.24,$938.00,$0.00,$469.00,$742.90,$750.40,$0.00,$146.80,$0.00,$149.33,$0.00
27219866,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in Core To Tip Str 3cm A,$938.00,$0.00,$938.00,$509.33,$669.45,$0.00,$161.61,$669.45,$669.45,$164.24,$938.00,$0.00,$469.00,$742.90,$750.40,$0.00,$146.80,$0.00,$149.33,$0.00
27219867,EAP,HCPCS C1769,,Guidewire Vasc 180cm .014in Core To Tip Str 3cm A,$938.00,$0.00,$938.00,$509.33,$669.45,$0.00,$161.61,$669.45,$669.45,$164.24,$938.00,$0.00,$469.00,$742.90,$750.40,$0.00,$146.80,$0.00,$149.33,$0.00
27219868,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in Core To Tip J 3cm,$938.00,$0.00,$938.00,$509.33,$669.45,$0.00,$161.61,$669.45,$669.45,$164.24,$938.00,$0.00,$469.00,$742.90,$750.40,$0.00,$146.80,$0.00,$149.33,$0.00
27219869,EAP,HCPCS C1769,,Guidewire Vasc 180cm .014in Core To Tip J 3cm,$938.00,$0.00,$938.00,$509.33,$669.45,$0.00,$161.61,$669.45,$669.45,$164.24,$938.00,$0.00,$469.00,$742.90,$750.40,$0.00,$146.80,$0.00,$149.33,$0.00
27219870,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in Hbrd Radiopq Str Tip 3,$938.00,$0.00,$938.00,$509.33,$669.45,$0.00,$161.61,$669.45,$669.45,$164.24,$938.00,$0.00,$469.00,$742.90,$750.40,$0.00,$146.80,$0.00,$149.33,$0.00
27219871,EAP,HCPCS C1769,,Guidewire Vasc 180cm .014in Hbrd Radiopq Str Tip 3,$938.00,$0.00,$938.00,$509.33,$669.45,$0.00,$161.61,$669.45,$669.45,$164.24,$938.00,$0.00,$469.00,$742.90,$750.40,$0.00,$146.80,$0.00,$149.33,$0.00
27219872,EAP,HCPCS C1769,,Guidewire Vasc 300cm Ptca A Cfnz Pro,"$1,875.00",$0.00,"$1,875.00","$1,018.13","$1,338.19",$0.00,$323.05,"$1,338.19","$1,338.19",$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
27219873,EAP,HCPCS C1769,,Guidewire Vasc 180cm .009in Radiopq Str Tip 20cm A,"$1,875.00",$0.00,"$1,875.00","$1,018.13","$1,338.19",$0.00,$323.05,"$1,338.19","$1,338.19",$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
27219874,EAP,HCPCS C1769,,Guidewire Vasc 180cm .014in Radiopq Core To Tip J,$938.00,$0.00,$938.00,$509.33,$669.45,$0.00,$161.61,$669.45,$669.45,$164.24,$938.00,$0.00,$469.00,$742.90,$750.40,$0.00,$146.80,$0.00,$149.33,$0.00
27219875,EAP,HCPCS C1769,,Guidewire Vasc 180cm .014in Radiopq Str Tip 11cm,"$1,875.00",$0.00,"$1,875.00","$1,018.13","$1,338.19",$0.00,$323.05,"$1,338.19","$1,338.19",$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
27219876,EAP,HCPCS C1769,,Guidewire Vasc 180cm .014in Radiopq Str Tip 11cm,"$1,875.00",$0.00,"$1,875.00","$1,018.13","$1,338.19",$0.00,$323.05,"$1,338.19","$1,338.19",$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
27219877,EAP,HCPCS C1769,,Guidewire Vasc 180cm .014in Radiopq Str Tip 3cm,$938.00,$0.00,$938.00,$509.33,$669.45,$0.00,$161.61,$669.45,$669.45,$164.24,$938.00,$0.00,$469.00,$742.90,$750.40,$0.00,$146.80,$0.00,$149.33,$0.00
27219878,EAP,HCPCS C1769,,Guidewire Vasc 180cm J Asahi Sft Ptca,$938.00,$0.00,$938.00,$509.33,$669.45,$0.00,$161.61,$669.45,$669.45,$164.24,$938.00,$0.00,$469.00,$742.90,$750.40,$0.00,$146.80,$0.00,$149.33,$0.00
27219879,EAP,HCPCS C1769,,Guidewire Vasc 180cm .014in Radiopq Core To Tip,$938.00,$0.00,$938.00,$509.33,$669.45,$0.00,$161.61,$669.45,$669.45,$164.24,$938.00,$0.00,$469.00,$742.90,$750.40,$0.00,$146.80,$0.00,$149.33,$0.00
27219880,EAP,HCPCS C1769,,Guidewire Vasc 180cm .014in Radiopq Core To Tip J,$938.00,$0.00,$938.00,$509.33,$669.45,$0.00,$161.61,$669.45,$669.45,$164.24,$938.00,$0.00,$469.00,$742.90,$750.40,$0.00,$146.80,$0.00,$149.33,$0.00
27219881,EAP,HCPCS C1769,,Guidewire Vasc 180cm .014in Radiopq Str Tip 3cm,$938.00,$0.00,$938.00,$509.33,$669.45,$0.00,$161.61,$669.45,$669.45,$164.24,$938.00,$0.00,$469.00,$742.90,$750.40,$0.00,$146.80,$0.00,$149.33,$0.00
27219882,EAP,HCPCS C1769,,Guidewire Vasc 180cm .014in Radiopq Core To Tip,$938.00,$0.00,$938.00,$509.33,$669.45,$0.00,$161.61,$669.45,$669.45,$164.24,$938.00,$0.00,$469.00,$742.90,$750.40,$0.00,$146.80,$0.00,$149.33,$0.00
27219883,EAP,HCPCS C1769,,Guidewire Vasc 180cm .014in .009in Radiopq Str Tip,"$1,875.00",$0.00,"$1,875.00","$1,018.13","$1,338.19",$0.00,$323.05,"$1,338.19","$1,338.19",$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
27219884,EAP,HCPCS C1769,,Guidewire Vasc 180cm .014in Radiopq Str Tip 3cm,$938.00,$0.00,$938.00,$509.33,$669.45,$0.00,$161.61,$669.45,$669.45,$164.24,$938.00,$0.00,$469.00,$742.90,$750.40,$0.00,$146.80,$0.00,$149.33,$0.00
27219885,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in Radiopq Core To Tip J,$938.00,$0.00,$938.00,$509.33,$669.45,$0.00,$161.61,$669.45,$669.45,$164.24,$938.00,$0.00,$469.00,$742.90,$750.40,$0.00,$146.80,$0.00,$149.33,$0.00
27219886,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in Radiopq Core To Tip,"$1,875.00",$0.00,"$1,875.00","$1,018.13","$1,338.19",$0.00,$323.05,"$1,338.19","$1,338.19",$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
27219887,EAP,HCPCS C1769,,Guidewire Vasc 300cm J Asahi Sft Ptca,$938.00,$0.00,$938.00,$509.33,$669.45,$0.00,$161.61,$669.45,$669.45,$164.24,$938.00,$0.00,$469.00,$742.90,$750.40,$0.00,$146.80,$0.00,$149.33,$0.00
27219888,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in Radiopq Core To Tip J,$938.00,$0.00,$938.00,$509.33,$669.45,$0.00,$161.61,$669.45,$669.45,$164.24,$938.00,$0.00,$469.00,$742.90,$750.40,$0.00,$146.80,$0.00,$149.33,$0.00
27219889,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in Radiopq Core To Tip,$938.00,$0.00,$938.00,$509.33,$669.45,$0.00,$161.61,$669.45,$669.45,$164.24,$938.00,$0.00,$469.00,$742.90,$750.40,$0.00,$146.80,$0.00,$149.33,$0.00
27219890,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in Radiopq Core To Tip,$938.00,$0.00,$938.00,$509.33,$669.45,$0.00,$161.61,$669.45,$669.45,$164.24,$938.00,$0.00,$469.00,$742.90,$750.40,$0.00,$146.80,$0.00,$149.33,$0.00
27219891,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in Radiopq Str Tpr Tip 3,"$1,875.00",$0.00,"$1,875.00","$1,018.13","$1,338.19",$0.00,$323.05,"$1,338.19","$1,338.19",$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
27219892,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in Radiopq Core To Tip,$938.00,$0.00,$938.00,$509.33,$669.45,$0.00,$161.61,$669.45,$669.45,$164.24,$938.00,$0.00,$469.00,$742.90,$750.40,$0.00,$146.80,$0.00,$149.33,$0.00
27219893,EAP,HCPCS C1769,,Introd Gwire .009-.018in Coron,$75.00,$0.00,$75.00,$40.73,$53.53,$0.00,$12.92,$53.53,$53.53,$13.13,$75.00,$0.00,$37.50,$59.40,$60.00,$0.00,$11.74,$0.00,$11.94,$0.00
27219894,EAP,Custom 27219894,,Device Trq Gwire Acpt .009-.018 In Gwire,$125.00,$0.00,$125.00,$0.00,$89.21,$0.00,$0.00,$89.21,$89.21,$0.00,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$0.00,$0.00,$0.00,$0.00
27219896,EAP,HCPCS C1887,,Catheter Infs Mic 2.1-1.7fr 5fr .017in 155cm .34ml 150cm,"$1,588.00",$0.00,"$1,588.00",$862.28,"$1,133.36",$0.00,$273.60,"$1,133.36","$1,133.36",$278.05,"$1,588.00",$0.00,$794.00,"$1,257.70","$1,270.40",$0.00,$248.52,$0.00,$252.81,$0.00
27219897,EAP,HCPCS C1757,,Retriever Escp Trevo Xp Provue,"$13,641.00",$0.00,"$13,641.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$13,641.00",$0.00,"$6,820.50","$10,803.67","$10,912.80",$0.00,$0.00,$0.00,$0.00,$0.00
27219898,EAP,HCPCS C1725,,Catheter Baldilat Lp 5.3fr 4mm 75cm 60mm High Pressure,$463.00,$0.00,$463.00,$251.41,$330.44,$0.00,$79.77,$330.44,$330.44,$81.07,$463.00,$0.00,$231.50,$366.70,$370.40,$0.00,$72.46,$0.00,$73.71,$0.00
27219899,EAP,HCPCS C1894,,Introducer Sheath .035in Anl1 Curve 11.4fr 10fr 45cm High,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$142.74,$142.74,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
27219900,EAP,HCPCS C1751,,Catheter Cv 9.3fr 22cm Strl Lf Cl Ln Heat Exch Kt,"$1,288.00",$0.00,"$1,288.00",$699.38,$919.25,$0.00,$221.92,$919.25,$919.25,$225.52,"$1,288.00",$0.00,$644.00,"$1,020.10","$1,030.40",$0.00,$201.57,$0.00,$205.05,$0.00
27219901,EAP,HCPCS C1751,,Kit Cath 9.3fr 38cm Icy Cv,"$2,053.00",$0.00,"$2,053.00","$1,114.78","$1,465.23",$0.00,$353.72,"$1,465.23","$1,465.23",$359.46,"$2,053.00",$0.00,"$1,026.50","$1,625.98","$1,642.40",$0.00,$321.29,$0.00,$326.84,$0.00
27219902,EAP,HCPCS C1887,,Kit Cath 9.3fr 45cm Quattro Heat Exch 3 Lum Ll Applause Hep,"$2,299.00",$0.00,"$2,299.00","$1,248.36","$1,640.80",$0.00,$396.11,"$1,640.80","$1,640.80",$402.54,"$2,299.00",$0.00,"$1,149.50","$1,820.81","$1,839.20",$0.00,$359.79,$0.00,$366.00,$0.00
27219903,EAP,,,Kit Iv Clgrd 3k Srt,$455.00,$0.00,$455.00,$0.00,$324.73,$0.00,$0.00,$324.73,$324.73,$0.00,$455.00,$0.00,$227.50,$360.36,$364.00,$0.00,$0.00,$0.00,$0.00,$0.00
27219904,EAP,,,Tubing Xtn 9ft,$511.00,$0.00,$511.00,$0.00,$364.70,$0.00,$0.00,$364.70,$364.70,$0.00,$511.00,$0.00,$255.50,$404.71,$408.80,$0.00,$0.00,$0.00,$0.00,$0.00
27219905,EAP,,,Pack Srg 6ft Ivtm Cool Line Srt Up Disp,"$6,725.00",$0.00,"$6,725.00",$0.00,"$4,799.63",$0.00,$0.00,"$4,799.63","$4,799.63",$0.00,"$6,725.00",$0.00,"$3,362.50","$5,326.20","$5,380.00",$0.00,$0.00,$0.00,$0.00,$0.00
27219906,EAP,,,Pack Srg 6ft Ivtm Icy Srt Up Disp,"$9,640.00",$0.00,"$9,640.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$9,640.00",$0.00,"$4,820.00","$7,634.88","$7,712.00",$0.00,$0.00,$0.00,$0.00,$0.00
27219907,EAP,,,Pack Srg 6ft Ivtm Quattro Srt Up Disp,"$10,579.00",$0.00,"$10,579.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$10,579.00",$0.00,"$5,289.50","$8,378.57","$8,463.20",$0.00,$0.00,$0.00,$0.00,$0.00
27219908,EAP,HCPCS C1887,,Catheter Advanced Support Guidewire Center Cross Ultra,$498.00,$0.00,$498.00,$270.41,$355.42,$0.00,$85.80,$355.42,$355.42,$87.20,$498.00,$0.00,$249.00,$394.42,$398.40,$0.00,$77.94,$0.00,$79.28,$0.00
27219909,EAP,HCPCS C1887,,Catheter Angioplasty Microcross 0.014 In,$988.00,$0.00,$988.00,$536.48,$705.14,$0.00,$170.23,$705.14,$705.14,$172.99,$988.00,$0.00,$494.00,$782.50,$790.40,$0.00,$154.62,$0.00,$157.29,$0.00
27219910,EAP,HCPCS C1887,,Catheter Angioplasty Microcross 0.018 In,$988.00,$0.00,$988.00,$536.48,$705.14,$0.00,$170.23,$705.14,$705.14,$172.99,$988.00,$0.00,$494.00,$782.50,$790.40,$0.00,$154.62,$0.00,$157.29,$0.00
27219911,EAP,,,Drain Incs Strl Lf Oas Bld Rcvr Dry Sct Ats Cmpt 1 Pt Tube,$93.00,$0.00,$93.00,$0.00,$66.37,$0.00,$0.00,$66.37,$66.37,$0.00,$93.00,$0.00,$46.50,$73.66,$74.40,$0.00,$0.00,$0.00,$0.00,$0.00
27219912,EAP,,,Separator Thrmb Strl Lf Indg Sys 4 Disp,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,"$1,570.14","$1,570.14",$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
27219913,EAP,,,Catheter Sct 16mm 105cm Strl Lf Clottriever Disp,"$11,988.00",$0.00,"$11,988.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$11,988.00",$0.00,"$5,994.00","$9,494.50","$9,590.40",$0.00,$0.00,$0.00,$0.00,$0.00
27219914,EAP,,,Catheter Sct 4.6mm 15cm Strl Lf Clottriever Shth Disp,"$3,238.00",$0.00,"$3,238.00",$0.00,"$2,310.96",$0.00,$0.00,"$2,310.96","$2,310.96",$0.00,"$3,238.00",$0.00,"$1,619.00","$2,564.50","$2,590.40",$0.00,$0.00,$0.00,$0.00,$0.00
27219915,EAP,HCPCS C1757,,Set Thrombectomy 6fr 3mm 120cm 15mm Otw Contrast Injec Port,"$5,013.00",$0.00,"$5,013.00",$0.00,"$3,577.78",$0.00,$0.00,"$3,577.78","$3,577.78",$0.00,"$5,013.00",$0.00,"$2,506.50","$3,970.30","$4,010.40",$0.00,$0.00,$0.00,$0.00,$0.00
27219916,EAP,HCPCS C1769,,Guidewire Vasc Ang .035in 150cm Hiwire Radopq Flx Tp Stf,$423.00,$0.00,$423.00,$229.69,$301.90,$0.00,$72.88,$301.90,$301.90,$74.06,$423.00,$0.00,$211.50,$335.02,$338.40,$0.00,$66.20,$0.00,$67.34,$0.00
27219917,EAP,,,Catheter Angiographic Kmp Curve 5fr 40cm Torcon Nb Advantage,$194.00,$0.00,$194.00,$0.00,$138.46,$0.00,$0.00,$138.46,$138.46,$0.00,$194.00,$0.00,$97.00,$153.65,$155.20,$0.00,$0.00,$0.00,$0.00,$0.00
27219918,EAP,HCPCS C1769,,Guidewire Vasc 3cm Strg .014in 190cm 25cm Spectre 2 Cor Kink,$47.00,$0.00,$47.00,$25.52,$33.54,$0.00,$8.10,$33.54,$33.54,$8.23,$47.00,$0.00,$23.50,$37.22,$37.60,$0.00,$7.36,$0.00,$7.48,$0.00
27219919,EAP,HCPCS C1769,,Guidewire Vasc 3cm Strg .014in 300cm 25cm Spectre 2 Cor Kink,$48.00,$0.00,$48.00,$26.06,$34.26,$0.00,$8.27,$34.26,$34.26,$8.40,$48.00,$0.00,$24.00,$38.02,$38.40,$0.00,$7.51,$0.00,$7.64,$0.00
27219920,EAP,HCPCS C1753,,Catheter Ultrasound 20mhz 3.4fr 135cm Scanner Transducer,"$1,688.00",$0.00,"$1,688.00",$916.58,"$1,204.73",$0.00,$290.83,"$1,204.73","$1,204.73",$295.56,"$1,688.00",$0.00,$844.00,"$1,336.90","$1,350.40",$0.00,$264.17,$0.00,$268.73,$0.00
27219921,EAP,HCPCS C1887,,Catheter Gd Mpc Crv 6fr 100cm Env Lg Inr Lum Radopq Brd Sft,$928.00,$0.00,$928.00,$503.90,$662.31,$0.00,$159.89,$662.31,$662.31,$162.49,$928.00,$0.00,$464.00,$734.98,$742.40,$0.00,$145.23,$0.00,$147.74,$0.00
27219922,EAP,HCPCS C1725,,Catheter Blndil 8mm 90cm 20mm Pr Ctbln Otw Tpr Tip Infl Port,"$1,759.00",$0.00,"$1,759.00",$955.14,"$1,255.40",$0.00,$303.07,"$1,255.40","$1,255.40",$307.99,"$1,759.00",$0.00,$879.50,"$1,393.13","$1,407.20",$0.00,$275.28,$0.00,$280.03,$0.00
27219923,EAP,,,Pad Thrp Unv Sm Ns Lf Arcticgel Inlt/otlt Cnct Ddrgl Disp,$218.00,$0.00,$218.00,$0.00,$155.59,$0.00,$0.00,$155.59,$155.59,$0.00,$218.00,$0.00,$109.00,$172.66,$174.40,$0.00,$0.00,$0.00,$0.00,$0.00
27219924,EAP,HCPCS C1769,,Guidewire Vasc .014in 180cm Strl Lf Cnfnz Pro 12 Disp,$333.00,$0.00,$333.00,$180.82,$237.66,$0.00,$57.37,$237.66,$237.66,$58.31,$333.00,$0.00,$166.50,$263.74,$266.40,$0.00,$52.11,$0.00,$53.01,$0.00
27219925,EAP,HCPCS C1769,,Guidewire Vasc .014in 300cm Strl Lf Fielder Fc Disp,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$142.74,$142.74,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
27219926,EAP,HCPCS C1769,,Guidewire Vasc .014in 180cm Strl Lf Fielder Fc Disp,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$142.74,$142.74,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
27219927,EAP,HCPCS C1769,,Guidewire Vasc .014in 300cm Strl Lf Grand Slam Disp,$288.00,$0.00,$288.00,$156.38,$205.55,$0.00,$49.62,$205.55,$205.55,$50.43,$288.00,$0.00,$144.00,$228.10,$230.40,$0.00,$45.07,$0.00,$45.85,$0.00
27219928,EAP,HCPCS C1769,,Guidewire Vasc .014in 180cm Strl Lf Mrclbrs 6 Disp,$333.00,$0.00,$333.00,$180.82,$237.66,$0.00,$57.37,$237.66,$237.66,$58.31,$333.00,$0.00,$166.50,$263.74,$266.40,$0.00,$52.11,$0.00,$53.01,$0.00
27219929,EAP,HCPCS C1769,,Guidewire Vasc .014in 300cm Strl Lf Mrclbrs 6 Disp,$333.00,$0.00,$333.00,$180.82,$237.66,$0.00,$57.37,$237.66,$237.66,$58.31,$333.00,$0.00,$166.50,$263.74,$266.40,$0.00,$52.11,$0.00,$53.01,$0.00
27219930,EAP,HCPCS C1769,,Guidewire Vasc .014in 300cm Strl Lf Mrclbrs 3 Disp,$333.00,$0.00,$333.00,$180.82,$237.66,$0.00,$57.37,$237.66,$237.66,$58.31,$333.00,$0.00,$166.50,$263.74,$266.40,$0.00,$52.11,$0.00,$53.01,$0.00
27219931,EAP,HCPCS C1769,,Guidewire Vasc .014in 180cm Strl Lf P-h2o Disp,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$142.74,$142.74,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
27219932,EAP,HCPCS C1769,,Guidewire Vasc .014in 300cm Strl Lf P-h2o Disp,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$142.74,$142.74,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
27219933,EAP,HCPCS C1769,,Guidewire Vasc .014in 300cm 45cm Snchr14,"$1,798.00",$0.00,"$1,798.00",$976.31,"$1,283.23",$0.00,$309.79,"$1,283.23","$1,283.23",$314.82,"$1,798.00",$0.00,$899.00,"$1,424.02","$1,438.40",$0.00,$281.39,$0.00,$286.24,$0.00
27219934,EAP,,,Medtronic Aortic And Peripheral Vascular - Div Med,"$4,750.00",$0.00,"$4,750.00",$0.00,"$3,390.08",$0.00,$0.00,"$3,390.08","$3,390.08",$0.00,"$4,750.00",$0.00,"$2,375.00","$3,762.00","$3,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
27219935,EAP,HCPCS C1894,,Introducer Gw Grdn Ii Nc Hmsts Vlv,"$1,688.00",$0.00,"$1,688.00",$916.58,"$1,204.73",$0.00,$290.83,"$1,204.73","$1,204.73",$295.56,"$1,688.00",$0.00,$844.00,"$1,336.90","$1,350.40",$0.00,$264.17,$0.00,$268.73,$0.00
27219936,EAP,,,Bronchoscope Flxb 600mm 3.8mm 1.2mm Slim Ambu,$650.00,$0.00,$650.00,$0.00,$463.91,$0.00,$0.00,$463.91,$463.91,$0.00,$650.00,$0.00,$325.00,$514.80,$520.00,$0.00,$0.00,$0.00,$0.00,$0.00
27219937,EAP,,,Bronchoscope Flxb 600mm 5mm 2.2mm Ambu Ascope 3,$985.00,$0.00,$985.00,$0.00,$702.99,$0.00,$0.00,$702.99,$702.99,$0.00,$985.00,$0.00,$492.50,$780.12,$788.00,$0.00,$0.00,$0.00,$0.00,$0.00
27219938,EAP,,,Blade Lrnscp Mac S3 Spctrm Ti Disp Glidescope,$100.00,$0.00,$100.00,$0.00,$71.37,$0.00,$0.00,$71.37,$71.37,$0.00,$100.00,$0.00,$50.00,$79.20,$80.00,$0.00,$0.00,$0.00,$0.00,$0.00
27219939,EAP,,,Blade Lrnscp Mac S4 Spctrm Ti Disp Glidescope,$100.00,$0.00,$100.00,$0.00,$71.37,$0.00,$0.00,$71.37,$71.37,$0.00,$100.00,$0.00,$50.00,$79.20,$80.00,$0.00,$0.00,$0.00,$0.00,$0.00
27219940,EAP,,,Introducer Tube 15fr 70cm Strl Lf Clbrt Cde Boug Ldpe Adlt,$322.00,$0.00,$322.00,$0.00,$229.81,$0.00,$0.00,$229.81,$229.81,$0.00,$322.00,$0.00,$161.00,$255.02,$257.60,$0.00,$0.00,$0.00,$0.00,$0.00
27219941,EAP,,,Catheter Primafit Sage,$27.00,$0.00,$27.00,$0.00,$19.27,$0.00,$0.00,$19.27,$19.27,$0.00,$27.00,$0.00,$13.50,$21.38,$21.60,$0.00,$0.00,$0.00,$0.00,$0.00
27219942,EAP,HCPCS C1729,,Drain Incision Small Stature 1 Chamber Suction Control,$51.00,$0.00,$51.00,$27.69,$36.40,$0.00,$8.79,$36.40,$36.40,$8.93,$51.00,$0.00,$25.50,$40.39,$40.80,$0.00,$7.98,$0.00,$8.12,$0.00
27219943,EAP,HCPCS C1729,,Catheter External Drain Large 1.9mm Latex Free Bactiseal Evd,"$1,229.00",$0.00,"$1,229.00",$667.35,$877.14,$0.00,$211.75,$877.14,$877.14,$215.19,"$1,229.00",$0.00,$614.50,$973.37,$983.20,$0.00,$192.34,$0.00,$195.66,$0.00
27219945,EAP,Custom 27219945,,Tracheostomy Tray,$279.00,$0.00,$279.00,$0.00,$199.12,$0.00,$0.00,$199.12,$199.12,$0.00,$279.00,$0.00,$139.50,$220.97,$223.20,$0.00,$0.00,$0.00,$0.00,$0.00
27219946,EAP,Custom 27219946,,Canister Wound Drain C500ml Gel Tube Clmp Conctr Charcoal,$84.00,$0.00,$84.00,$0.00,$59.95,$0.00,$0.00,$59.95,$59.95,$0.00,$84.00,$0.00,$42.00,$66.53,$67.20,$0.00,$0.00,$0.00,$0.00,$0.00
27219947,EAP,Custom 27219947,,Pad Wound Drain Tube Clmp Conctr Sensatrac Vac Sterile,$43.00,$0.00,$43.00,$0.00,$30.69,$0.00,$0.00,$30.69,$30.69,$0.00,$43.00,$0.00,$21.50,$34.06,$34.40,$0.00,$0.00,$0.00,$0.00,$0.00
27219948,EAP,Custom 27219948,,Airway Esophageal 3 Standard Str Mask Latex Free Auraonce,$47.00,$0.00,$47.00,$0.00,$33.54,$0.00,$0.00,$33.54,$33.54,$0.00,$47.00,$0.00,$23.50,$37.22,$37.60,$0.00,$0.00,$0.00,$0.00,$0.00
27219949,EAP,HCPCS C1769,,Guidewire Vascular .035in 26 13/16in 1 End Mark Spring Str,$44.00,$0.00,$44.00,$23.89,$31.40,$0.00,$7.58,$31.40,$31.40,$7.70,$44.00,$0.00,$22.00,$34.85,$35.20,$0.00,$6.89,$0.00,$7.00,$0.00
27219950,EAP,Custom 27219950,,Kit Arterial Line .018in 20ga 22ga 1.75in Catheter Radiopq,$29.00,$0.00,$29.00,$0.00,$20.70,$0.00,$0.00,$20.70,$20.70,$0.00,$29.00,$0.00,$14.50,$22.97,$23.20,$0.00,$0.00,$0.00,$0.00,$0.00
27219953,EAP,Custom 27219953,,Solution Dialysate 2 Compartment Bag Peel Seam Pureflow,$125.00,$0.00,$125.00,$0.00,$89.21,$0.00,$0.00,$89.21,$89.21,$0.00,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$0.00,$0.00,$0.00,$0.00
27219954,EAP,Custom 27219954,,Device Securing 6fr Kit Blue Retrival Probe White Catheter,$232.00,$0.00,$232.00,$0.00,$165.58,$0.00,$0.00,$165.58,$165.58,$0.00,$232.00,$0.00,$116.00,$183.74,$185.60,$0.00,$0.00,$0.00,$0.00,$0.00
27219955,EAP,Custom 27219955,,Device Securing Standard 8fr Kit Retrieval Probe Catheter,$232.00,$0.00,$232.00,$0.00,$165.58,$0.00,$0.00,$165.58,$165.58,$0.00,$232.00,$0.00,$116.00,$183.74,$185.60,$0.00,$0.00,$0.00,$0.00,$0.00
27219956,EAP,Custom 27219956,,Device Securing Standard 10fr Kit Retrieval Probe Catheter,$232.00,$0.00,$232.00,$0.00,$165.58,$0.00,$0.00,$165.58,$165.58,$0.00,$232.00,$0.00,$116.00,$183.74,$185.60,$0.00,$0.00,$0.00,$0.00,$0.00
27219957,EAP,Custom 27219957,,Device Scr Std 14fr Ylw Ns Lf Amt Bridle Preattach Clip Sty,$232.00,$0.00,$232.00,$0.00,$165.58,$0.00,$0.00,$165.58,$165.58,$0.00,$232.00,$0.00,$116.00,$183.74,$185.60,$0.00,$0.00,$0.00,$0.00,$0.00
27219959,EAP,Custom 27219959,,Kit Cath .032in 8.5fr 18ga 16cm Lf 2.5in Blu Flxtp Arwg+ard,$327.00,$0.00,$327.00,$0.00,$233.38,$0.00,$0.00,$233.38,$233.38,$0.00,$327.00,$0.00,$163.50,$258.98,$261.60,$0.00,$0.00,$0.00,$0.00,$0.00
27219960,EAP,Custom 27219960,,Kit Urostomy Cut To Fit 2.25- In 2.75in 9in 2 Piece Belt Tab,$42.00,$0.00,$42.00,$0.00,$29.98,$0.00,$0.00,$29.98,$29.98,$0.00,$42.00,$0.00,$21.00,$33.26,$33.60,$0.00,$0.00,$0.00,$0.00,$0.00
27219961,EAP,Custom 27219961,,Suture Absorbable 3-0 Sh-1 27in Braid Coated Vicryl Undyed,$185.00,$0.00,$185.00,$0.00,$132.03,$0.00,$0.00,$132.03,$132.03,$0.00,$185.00,$0.00,$92.50,$146.52,$148.00,$0.00,$0.00,$0.00,$0.00,$0.00
27219962,EAP,Custom 27219962,,Kit Repr 21-18ga Pilt Tube Syr Reinflate Cuf 10ml,$27.00,$0.00,$27.00,$0.00,$19.27,$0.00,$0.00,$19.27,$19.27,$0.00,$27.00,$0.00,$13.50,$21.38,$21.60,$0.00,$0.00,$0.00,$0.00,$0.00
27219963,EAP,Custom 27219963,,Dressing Abthera Snsa Trc Foam Opn Abd Neg Prss,$920.00,$0.00,$920.00,$0.00,$656.60,$0.00,$0.00,$656.60,$656.60,$0.00,$920.00,$0.00,$460.00,$728.64,$736.00,$0.00,$0.00,$0.00,$0.00,$0.00
27219964,EAP,Custom 27219964,,Dressing Hdrcld 8x8in Cmfl Plus Abs Wtprf Top Flm,$57.00,$0.00,$57.00,$0.00,$40.68,$0.00,$0.00,$40.68,$40.68,$0.00,$57.00,$0.00,$28.50,$45.14,$45.60,$0.00,$0.00,$0.00,$0.00,$0.00
27219967,EAP,Custom 27219967,,Device Securing 12fr Kit Dk Blue,$225.00,$0.00,$225.00,$0.00,$160.58,$0.00,$0.00,$160.58,$160.58,$0.00,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$0.00,$0.00,$0.00,$0.00
27219968,EAP,Custom 27219968,,Device Securing 18fr Kit Lt Blue,$225.00,$0.00,$225.00,$0.00,$160.58,$0.00,$0.00,$160.58,$160.58,$0.00,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$0.00,$0.00,$0.00,$0.00
27219969,EAP,HCPCS C1752,,Kit Cath Strg 13fr 30cm Strl Pwr-trialysis 3 Lum Kink Rst,$563.00,$0.00,$563.00,$0.00,$401.81,$0.00,$0.00,$401.81,$401.81,$0.00,$563.00,$0.00,$281.50,$445.90,$450.40,$0.00,$0.00,$0.00,$0.00,$0.00
27219970,EAP,HCPCS C1752,,Kit Cath 13fr 20cm Strl Pwr-trialysis 3 Lum Shrt Term Dlys,$563.00,$0.00,$563.00,$0.00,$401.81,$0.00,$0.00,$401.81,$401.81,$0.00,$563.00,$0.00,$281.50,$445.90,$450.40,$0.00,$0.00,$0.00,$0.00,$0.00
27219971,EAP,HCPCS C1752,,Catheter Hmdial 15cm Schn Xl Kink Rst Tip Clip Sh Rem Sty,$119.00,$0.00,$119.00,$0.00,$84.93,$0.00,$0.00,$84.93,$84.93,$0.00,$119.00,$0.00,$59.50,$94.25,$95.20,$0.00,$0.00,$0.00,$0.00,$0.00
27219972,EAP,HCPCS C1752,,Set Cath 24cm Schn Xl Bsc Sil Acute Hmdial,$238.00,$0.00,$238.00,$0.00,$169.86,$0.00,$0.00,$169.86,$169.86,$0.00,$238.00,$0.00,$119.00,$188.50,$190.40,$0.00,$0.00,$0.00,$0.00,$0.00
27219974,EAP,HCPCS C1755,,Kit Epidural Catheterization,$146.00,$0.00,$146.00,$0.00,$104.20,$0.00,$0.00,$104.20,$104.20,$0.00,$146.00,$0.00,$73.00,$115.63,$116.80,$0.00,$0.00,$0.00,$0.00,$0.00
27219975,EAP,Custom 27219975,,Kit Dressing Midline Custom Change Tray,$48.00,$0.00,$48.00,$0.00,$34.26,$0.00,$0.00,$34.26,$34.26,$0.00,$48.00,$0.00,$24.00,$38.02,$38.40,$0.00,$0.00,$0.00,$0.00,$0.00
27219976,EAP,HCPCS C1725,,Catheter Blndil 2.25mm 142cm 35mm Mozec Rx Nyl Ptca,$248.00,$0.00,$248.00,$134.66,$177.00,$0.00,$42.73,$177.00,$177.00,$43.42,$248.00,$0.00,$124.00,$196.42,$198.40,$0.00,$38.81,$0.00,$39.48,$0.00
27219977,EAP,HCPCS C1725,,Catheter Blndil 2.5mm 142cm 35mm Mozec Rx Nyl Ptca,$248.00,$0.00,$248.00,$134.66,$177.00,$0.00,$42.73,$177.00,$177.00,$43.42,$248.00,$0.00,$124.00,$196.42,$198.40,$0.00,$38.81,$0.00,$39.48,$0.00
27219978,EAP,HCPCS C1725,,Catheter Blndil 2.75mm 142cm 35mm Mozec Rx Nyl Ptca,$248.00,$0.00,$248.00,$134.66,$177.00,$0.00,$42.73,$177.00,$177.00,$43.42,$248.00,$0.00,$124.00,$196.42,$198.40,$0.00,$38.81,$0.00,$39.48,$0.00
27219979,EAP,HCPCS C1725,,Catheter Blndil 3mm Lf Crds Mozec Rx Ptca,$248.00,$0.00,$248.00,$134.66,$177.00,$0.00,$42.73,$177.00,$177.00,$43.42,$248.00,$0.00,$124.00,$196.42,$198.40,$0.00,$38.81,$0.00,$39.48,$0.00
27219980,EAP,HCPCS C1725,,Catheter Blndil 3.5mm 142cm 35mm Mozec Rx Nyl Ptca,$248.00,$0.00,$248.00,$134.66,$177.00,$0.00,$42.73,$177.00,$177.00,$43.42,$248.00,$0.00,$124.00,$196.42,$198.40,$0.00,$38.81,$0.00,$39.48,$0.00
27219981,EAP,HCPCS C1725,,Catheter Blndil 4mm 142cm 35mm Mozec Rx Nyl Ptca,$248.00,$0.00,$248.00,$134.66,$177.00,$0.00,$42.73,$177.00,$177.00,$43.42,$248.00,$0.00,$124.00,$196.42,$198.40,$0.00,$38.81,$0.00,$39.48,$0.00
27219982,EAP,HCPCS C1894,,Set Intro 8fr 80cm Lf S Arwflx 3w Stpck Shth Radopq Intgr,$331.00,$0.00,$331.00,$179.73,$236.23,$0.00,$57.03,$236.23,$236.23,$57.96,$331.00,$0.00,$165.50,$262.15,$264.80,$0.00,$51.80,$0.00,$52.70,$0.00
27219983,EAP,Custom 27219983,,Cath Umb 3.5f Pu 15in,$34.00,$0.00,$34.00,$0.00,$24.27,$0.00,$0.00,$24.27,$24.27,$0.00,$34.00,$0.00,$17.00,$26.93,$27.20,$0.00,$0.00,$0.00,$0.00,$0.00
27219984,EAP,Custom 27219984,,Cath Umb 5f Pu 15in,$34.00,$0.00,$34.00,$0.00,$24.27,$0.00,$0.00,$24.27,$24.27,$0.00,$34.00,$0.00,$17.00,$26.93,$27.20,$0.00,$0.00,$0.00,$0.00,$0.00
27219985,EAP,Custom 27219985,,"Catheter, 8f Thoracic",$35.00,$0.00,$35.00,$0.00,$24.98,$0.00,$0.00,$24.98,$24.98,$0.00,$35.00,$0.00,$17.50,$27.72,$28.00,$0.00,$0.00,$0.00,$0.00,$0.00
27219986,EAP,Custom 27219986,,Cath Trocar Fnl 10f 9in,$35.00,$0.00,$35.00,$0.00,$24.98,$0.00,$0.00,$24.98,$24.98,$0.00,$35.00,$0.00,$17.50,$27.72,$28.00,$0.00,$0.00,$0.00,$0.00,$0.00
27219987,EAP,Custom 27219987,,Cath Trocar 12fr,$35.00,$0.00,$35.00,$0.00,$24.98,$0.00,$0.00,$24.98,$24.98,$0.00,$35.00,$0.00,$17.50,$27.72,$28.00,$0.00,$0.00,$0.00,$0.00,$0.00
27219988,EAP,Custom 27219988,,"Kit, Chest Tube",$74.00,$0.00,$74.00,$0.00,$52.81,$0.00,$0.00,$52.81,$52.81,$0.00,$74.00,$0.00,$37.00,$58.61,$59.20,$0.00,$0.00,$0.00,$0.00,$0.00
27219989,EAP,Custom 27219989,,Umbilical Vessel Catheter Tray 88-160408,$127.00,$0.00,$127.00,$0.00,$90.64,$0.00,$0.00,$90.64,$90.64,$0.00,$127.00,$0.00,$63.50,$100.58,$101.60,$0.00,$0.00,$0.00,$0.00,$0.00
27219990,EAP,HCPCS C1887,,Catheter Gd Strg 5fr .068in .055in 115cm 17cm Sofia Dist Acc,"$3,040.00",$0.00,"$3,040.00","$1,650.72","$2,169.65",$0.00,$523.78,"$2,169.65","$2,169.65",$532.28,"$3,040.00",$0.00,"$1,520.00","$2,407.68","$2,432.00",$0.00,$475.76,$0.00,$483.97,$0.00
27219991,EAP,HCPCS C1887,,Catheter Gd Strg 5fr .068in .055in 125cm 17cm Sofia Dist Acc,"$3,230.00",$0.00,"$3,230.00","$1,753.89","$2,305.25",$0.00,$556.51,"$2,305.25","$2,305.25",$565.55,"$3,230.00",$0.00,"$1,615.00","$2,558.16","$2,584.00",$0.00,$505.50,$0.00,$514.22,$0.00
27219992,EAP,HCPCS C1725,,Catheter Blndil 1mm 5mm Strl Lf Sphr Ii Pro Perc Ptca,$563.00,$0.00,$563.00,$305.71,$401.81,$0.00,$97.00,$401.81,$401.81,$98.58,$563.00,$0.00,$281.50,$445.90,$450.40,$0.00,$88.11,$0.00,$89.63,$0.00
27219993,EAP,HCPCS C1725,,Catheter Blndil 1mm 8mm Strl Lf Sphr Ii Pro Perc Ptca,$563.00,$0.00,$563.00,$305.71,$401.81,$0.00,$97.00,$401.81,$401.81,$98.58,$563.00,$0.00,$281.50,$445.90,$450.40,$0.00,$88.11,$0.00,$89.63,$0.00
27219994,EAP,HCPCS C1725,,Catheter Blndil 1mm 10mm Strl Lf Sphr Ii Pro Perc Ptca,$563.00,$0.00,$563.00,$305.71,$401.81,$0.00,$97.00,$401.81,$401.81,$98.58,$563.00,$0.00,$281.50,$445.90,$450.40,$0.00,$88.11,$0.00,$89.63,$0.00
27219995,EAP,HCPCS C1725,,Catheter Blndil 1mm 15mm Strl Lf Sphr Ii Pro Perc Ptca,$563.00,$0.00,$563.00,$305.71,$401.81,$0.00,$97.00,$401.81,$401.81,$98.58,$563.00,$0.00,$281.50,$445.90,$450.40,$0.00,$88.11,$0.00,$89.63,$0.00
27219996,EAP,HCPCS C1725,,Catheter Blndil 1.25mm 5mm Sphr Ii Pro Cor,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27219997,EAP,HCPCS C1725,,Catheter Blndil 1.25mm 8mm Sphr Ii Pro Cor,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27219998,EAP,HCPCS C1725,,Catheter Blndil 1.25mm 10mm Sphr Ii Pro Cor,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27219999,EAP,HCPCS C1725,,Catheter Blndil 1.25mm 15mm Sphr Ii Pro Cor,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220000,EAP,HCPCS C1725,,Catheter Blndil 1.5mm Strl Lf 10mm Sphr Ii Pro Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220001,EAP,HCPCS C1725,,Catheter Blndil 1.5mm Strl Lf 12mm Sphr Ii Pro Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220002,EAP,HCPCS C1725,,Catheter Blndil 1.5mm Strl Lf 15mm Sphr Ii Pro Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220003,EAP,HCPCS C1725,,Catheter Blndil 1.5mm Strl Lf 20mm Sphr Ii Pro Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220004,EAP,HCPCS C1725,,Catheter Blndil 1.75mm Strl Lf 10mm Sphr Ii Pro Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220005,EAP,HCPCS C1725,,Catheter Blndil 1.75mm Strl Lf 15mm Sphr Ii Pro Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220006,EAP,HCPCS C1725,,Catheter Blndil 1.75mm Strl Lf 20mm Sphr Ii Pro Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220007,EAP,HCPCS C1725,,Catheter Blndil 2mm Strl Lf 10mm Sphr Ii Pro Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220008,EAP,HCPCS C1725,,Catheter Blndil 2mm Strl Lf 12mm Sphr Ii Pro Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220009,EAP,HCPCS C1725,,Catheter Blndil 2mm Strl Lf 15mm Sphr Ii Pro Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220010,EAP,HCPCS C1725,,Catheter Blndil 2mm Strl Lf 20mm Sphr Ii Pro Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220011,EAP,HCPCS C1725,,Catheter Blndil 2.25mm Strl Lf 10mm Sphr Ii Pro Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220012,EAP,HCPCS C1725,,Catheter Blndil 2.25mm Strl Lf 15mm Sphr Ii Pro Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220013,EAP,HCPCS C1725,,Catheter Blndil 2.25mm Strl Lf 20mm Sphr Ii Pro Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220014,EAP,HCPCS C1725,,Catheter Blndil 2.5mm Strl Lf 10mm Sphr Ii Pro Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220015,EAP,HCPCS C1725,,Catheter Blndil 2.5mm Strl Lf 12mm Sphr Ii Pro Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220016,EAP,HCPCS C1725,,Catheter Blndil 2.5mm Strl Lf 15mm Sphr Ii Pro Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220017,EAP,HCPCS C1725,,Catheter Blndil 2.5mm Strl Lf 20mm Sphr Ii Pro Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220018,EAP,HCPCS C1725,,Catheter Blndil 2.5mm Strl Lf 30mm Sphr Ii Pro Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220019,EAP,HCPCS C1725,,Catheter Blndil 2.75mm Strl Lf 10mm Sphr Ii Pro Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220020,EAP,HCPCS C1725,,Catheter Blndil 2.75mm Strl Lf 15mm Sphr Ii Pro Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220021,EAP,HCPCS C1725,,Catheter Blndil 2.75mm Strl Lf 20mm Sphr Ii Pro Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220022,EAP,HCPCS C1725,,Catheter Blndil 3mm Strl Lf 10mm Sphr Ii Pro Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220023,EAP,HCPCS C1725,,Catheter Blndil 3mm Strl Lf 12mm Sphr Ii Pro Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220024,EAP,HCPCS C1725,,Catheter Blndil 3mm Strl Lf 15mm Sphr Ii Pro Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220025,EAP,HCPCS C1725,,Catheter Blndil 3mm Strl Lf 20mm Sphr Ii Pro Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220026,EAP,HCPCS C1725,,Catheter Blndil 3mm Strl Lf 30mm Sphr Ii Pro Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220027,EAP,HCPCS C1725,,Catheter Blndil 3.25mm Strl Lf 10mm Sphr Ii Pro Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220028,EAP,HCPCS C1725,,Catheter Blndil 3.25mm Strl Lf 15mm Sphr Ii Pro Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220029,EAP,HCPCS C1725,,Catheter Blndil 3.25mm Strl Lf 15mm Sphr Ii Pro Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220030,EAP,HCPCS C1725,,Catheter Blndil 3.5mm Strl Lf 10mm Sphr Ii Pro Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220031,EAP,HCPCS C1725,,Catheter Blndil 3.5mm Strl Lf 15mm Sphr Ii Pro Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220032,EAP,HCPCS C1725,,Catheter Blndil 3.5mm Strl Lf 20mm Sphr Ii Pro Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220033,EAP,HCPCS C1725,,Catheter Blndil 3.5mm Strl Lf 30mm Sphr Ii Pro Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220034,EAP,HCPCS C1725,,Catheter Blndil 4mm Strl Lf 10mm Sphr Ii Pro Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220035,EAP,HCPCS C1725,,Catheter Blndil 4mm Strl Lf 15mm Sphr Ii Pro Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220036,EAP,HCPCS C1725,,Catheter Blndil 4mm Strl Lf 20mm Sphr Ii Pro Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220037,EAP,HCPCS C1725,,Catheter Blndil 2mm Strl Lf 8mm Sphr Nc + Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220038,EAP,HCPCS C1725,,Catheter Blndil 2mm Strl Lf 10mm Sphr Nc + Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220039,EAP,HCPCS C1725,,Catheter Blndil 2mm Strl Lf 12mm Sphr Nc + Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220040,EAP,HCPCS C1725,,Catheter Blndil 2mm Strl Lf 15mm Sphr Nc + Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220041,EAP,HCPCS C1725,,Catheter Blndil 2mm Strl Lf 18mm Sphr Nc + Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220042,EAP,HCPCS C1725,,Catheter Blndil 2.25mm Strl Lf 8mm Sphr Nc + Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220043,EAP,HCPCS C1725,,Catheter Blndil 2.25mm Strl Lf 10mm Sphr Nc + Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220044,EAP,HCPCS C1725,,Catheter Blndil 2.25mm Strl Lf 12mm Sphr Nc + Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220045,EAP,HCPCS C1725,,Catheter Blndil 2.25mm Strl Lf 15mm Sphr Nc + Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220046,EAP,HCPCS C1725,,Catheter Blndil 2.25mm Strl Lf 18mm Sphr Nc + Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220047,EAP,HCPCS C1725,,Catheter Blndil 2.5mm Strl Lf 8mm Sphr Nc + Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220048,EAP,HCPCS C1725,,Catheter Blndil 2.5mm Strl Lf 10mm Sphr Nc + Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220049,EAP,HCPCS C1725,,Catheter Blndil 2.5mm Strl Lf 12mm Sphr Nc + Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220050,EAP,HCPCS C1725,,Catheter Blndil 2.5mm Strl Lf 16mm Sphr Nc + Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220051,EAP,HCPCS C1725,,Catheter Blndil 2.5mm Strl Lf 18mm Sphr Nc + Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220052,EAP,HCPCS C1725,,Catheter Blndil 2.75mm Strl Lf 8mm Sphr Nc + Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220053,EAP,HCPCS C1725,,Catheter Blndil 2.75mm Strl Lf 10mm Sphr Nc + Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220054,EAP,HCPCS C1725,,Catheter Blndil 2.75mm Strl Lf 12mm Sphr Nc + Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220055,EAP,HCPCS C1725,,Catheter Blndil 2.75mm Strl Lf 15mm Sphr Nc + Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220056,EAP,HCPCS C1725,,Catheter Blndil 2.75mm Strl Lf 18mm Sphr Nc + Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220057,EAP,HCPCS C1725,,Catheter Blndil 3mm Strl Lf 8mm Sphr Nc + Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220058,EAP,HCPCS C1725,,Catheter Blndil 3mm Strl Lf 10mm Sphr Nc + Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220059,EAP,HCPCS C1725,,Catheter Blndil 3mm Strl Lf 12mm Sphr Nc + Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220060,EAP,HCPCS C1725,,Catheter Blndil 3mm Strl Lf 15mm Sphr Nc + Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220061,EAP,HCPCS C1725,,Catheter Blndil 3mm Strl Lf 18mm Sphr Nc + Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220062,EAP,HCPCS C1725,,Catheter Blndil 3.25mm Strl Lf 8mm Sphr Nc + Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220063,EAP,HCPCS C1725,,Catheter Blndil 3.25mm Strl Lf 10mm Sphr Nc + Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220064,EAP,HCPCS C1725,,Catheter Blndil 3.25mm Strl Lf 12mm Sphr Ii Pro Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220065,EAP,HCPCS C1725,,Catheter Blndil 3.25mm Strl Lf 15mm Sphr Nc + Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220066,EAP,HCPCS C1725,,Catheter Blndil 3.25mm Strl Lf 18mm Sphr Nc + Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220067,EAP,HCPCS C1725,,Catheter Blndil 3.5mm Strl Lf 8mm Sphr Nc + Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220068,EAP,HCPCS C1725,,Catheter Blndil 3.5mm Strl Lf 10mm Sphr Nc + Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220069,EAP,HCPCS C1725,,Catheter Blndil 3.5mm Strl Lf 12mm Sphr Nc + Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220070,EAP,HCPCS C1725,,Catheter Blndil 3.5mm Strl Lf 15mm Sphr Nc + Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220071,EAP,HCPCS C1725,,Catheter Blndil 3.5mm Strl Lf 18mm Sphr Nc + Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220072,EAP,HCPCS C1725,,Catheter Blndil 3.75mm Ns Lf 8mm Sphr Nc + Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220073,EAP,HCPCS C1725,,Catheter Blndil 3.75mm Strl Lf 10mm Sphr Nc + Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220074,EAP,HCPCS C1725,,Catheter Blndil 3.75mm Strl Lf 12mm Sphr Nc + Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220075,EAP,HCPCS C1725,,Catheter Blndil 3.75mm Strl Lf 15mm Sphr Nc + Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220076,EAP,HCPCS C1725,,Catheter Blndil 3.75mm Strl Lf 18mm Sphr Nc + Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220077,EAP,HCPCS C1725,,Catheter Blndil 4mm Strl Lf 8mm Sphr Nc + Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220078,EAP,HCPCS C1725,,Catheter Blndil 4mm Strl Lf 10mm Sphr Nc + Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220079,EAP,HCPCS C1725,,Catheter Blndil 4mm Strl Lf 12mm Sphr Nc + Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220080,EAP,HCPCS C1725,,Catheter Blndil 4mm Strl Lf 15mm Sphr Nc + Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220081,EAP,HCPCS C1725,,Catheter Blndil 4mm Strl Lf 18mm Sphr Nc + Ptca,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
27220082,EAP,HCPCS C1757,,Catheter Asp .082-.085in .071in 115cm Axs Vecta 71 Scout,"$5,625.00",$0.00,"$5,625.00",$0.00,"$4,014.56",$0.00,$0.00,"$4,014.56","$4,014.56",$0.00,"$5,625.00",$0.00,"$2,812.50","$4,455.00","$4,500.00",$0.00,$0.00,$0.00,$0.00,$0.00
27220083,EAP,HCPCS C1757,,Catheter Asp .082-.085in .071in 125cm Axs Vecta 71 Scout,"$6,750.00",$0.00,"$6,750.00",$0.00,"$4,817.48",$0.00,$0.00,"$4,817.48","$4,817.48",$0.00,"$6,750.00",$0.00,"$3,375.00","$5,346.00","$5,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
27220084,EAP,HCPCS C1757,,Cath Thromb Axs Vecta 71 2-4 Mm L132 Cm L150 Cm Od.082-.085,"$6,750.00",$0.00,"$6,750.00",$0.00,"$4,817.48",$0.00,$0.00,"$4,817.48","$4,817.48",$0.00,"$6,750.00",$0.00,"$3,375.00","$5,346.00","$5,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
27220085,EAP,HCPCS C1730,,"Cath, Ep, 5-5-5mm Spc Cs Lt Crv 6fr 65cm Rspn Mp Dcapl Fx",$130.00,$0.00,$130.00,$70.59,$92.78,$0.00,$22.40,$92.78,$92.78,$22.76,$130.00,$0.00,$65.00,$102.96,$104.00,$0.00,$20.35,$0.00,$20.70,$0.00
27220086,EAP,HCPCS C1730,,"Cath, Ep, 5-5-5-5-5mm Spc Crnnd 2 Crv 5fr 115cm Strbl 8",$365.00,$0.00,$365.00,$198.20,$260.50,$0.00,$62.89,$260.50,$260.50,$63.91,$365.00,$0.00,$182.50,$289.08,$292.00,$0.00,$57.12,$0.00,$58.11,$0.00
27220087,EAP,HCPCS C1730,,"Cath, Ep, 2-10-2mm Spc Sup Lg Curl Crv 7fr 95cm 2mm Lvwr",$804.00,$0.00,$804.00,$436.57,$573.81,$0.00,$138.53,$573.81,$573.81,$140.77,$804.00,$0.00,$402.00,$636.77,$643.20,$0.00,$125.83,$0.00,$128.00,$0.00
27220088,EAP,HCPCS C1730,,Catheter Ep 5mm Spc Crnnd Crv 5fr 120cm Rspn Qdpl,$98.00,$0.00,$98.00,$53.21,$69.94,$0.00,$16.88,$69.94,$69.94,$17.16,$98.00,$0.00,$49.00,$77.62,$78.40,$0.00,$15.34,$0.00,$15.60,$0.00
27220089,EAP,HCPCS C1730,,"Cath, Ep, 5mm Spacing Jsn Curve 5fr 120cm",$98.00,$0.00,$98.00,$53.21,$69.94,$0.00,$16.88,$69.94,$69.94,$17.16,$98.00,$0.00,$49.00,$77.62,$78.40,$0.00,$15.34,$0.00,$15.60,$0.00
27220090,EAP,,,Cable Cath 150cm Blk Rspn Hexpl Octpl Dcapl Ep Repro,$99.00,$0.00,$99.00,$0.00,$70.66,$0.00,$0.00,$70.66,$70.66,$0.00,$99.00,$0.00,$49.50,$78.41,$79.20,$0.00,$0.00,$0.00,$0.00,$0.00
27220091,EAP,,,Catheter Ep 150cm Rspn Lvwr Hexpl Octpl Dcapl,$99.00,$0.00,$99.00,$0.00,$70.66,$0.00,$0.00,$70.66,$70.66,$0.00,$99.00,$0.00,$49.50,$78.41,$79.20,$0.00,$0.00,$0.00,$0.00,$0.00
27220092,EAP,,,Cable Cath Xtn Sjm Gntr,$222.00,$0.00,$222.00,$0.00,$158.44,$0.00,$0.00,$158.44,$158.44,$0.00,$222.00,$0.00,$111.00,$175.82,$177.60,$0.00,$0.00,$0.00,$0.00,$0.00
27220093,EAP,HCPCS C1894,,Introducer Sheath .038in Large 18fr 30cm 42cm Radiopq Band,$318.00,$0.00,$318.00,$172.67,$226.96,$0.00,$54.79,$226.96,$226.96,$55.68,$318.00,$0.00,$159.00,$251.86,$254.40,$0.00,$49.77,$0.00,$50.63,$0.00
27220094,EAP,,,Catheter Angio Chuang 2.5 Crv 5fr 80cm Trnb Ad Bcntp Mp Ss,$313.00,$0.00,$313.00,$0.00,$223.39,$0.00,$0.00,$223.39,$223.39,$0.00,$313.00,$0.00,$156.50,$247.90,$250.40,$0.00,$0.00,$0.00,$0.00,$0.00
27220095,EAP,,,Ft Retraction Aspirator Device Se,"$3,238.00",$0.00,"$3,238.00",$0.00,"$2,310.96",$0.00,$0.00,"$2,310.96","$2,310.96",$0.00,"$3,238.00",$0.00,"$1,619.00","$2,564.50","$2,590.40",$0.00,$0.00,$0.00,$0.00,$0.00
27220096,EAP,,,Flowtriever Bundle,"$22,500.00",$0.00,"$22,500.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$22,500.00",$0.00,"$11,250.00","$17,820.00","$18,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
27220097,EAP,,,Tube Nasogastric 10fr 1.22mr 24 Port Vented Vinyl Pediatric,$37.00,$0.00,$37.00,$0.00,$26.41,$0.00,$0.00,$26.41,$26.41,$0.00,$37.00,$0.00,$18.50,$29.30,$29.60,$0.00,$0.00,$0.00,$0.00,$0.00
27220098,EAP,,,Tube Ng 8fr 36in Lf Entflx Fd Sty Y St,$27.00,$0.00,$27.00,$0.00,$19.27,$0.00,$0.00,$19.27,$19.27,$0.00,$27.00,$0.00,$13.50,$21.38,$21.60,$0.00,$0.00,$0.00,$0.00,$0.00
27220099,EAP,,,Cuff Blood Pressure Clearsight Small Finger,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$446.06,$446.06,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
27220100,EAP,,,Cuff Blood Pressure Clearsight Medium Finger,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$446.06,$446.06,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
27220101,EAP,,,Cuff Blood Pressure Clearsight Large Finger,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$446.06,$446.06,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
27220102,EAP,,,Powermidline Catheter Max Barrier Tray 4f Sl,$333.00,$0.00,$333.00,$0.00,$237.66,$0.00,$0.00,$237.66,$237.66,$0.00,$333.00,$0.00,$166.50,$263.74,$266.40,$0.00,$0.00,$0.00,$0.00,$0.00
27220103,EAP,,,Central Line 10cm 18g Basic,$145.00,$0.00,$145.00,$0.00,$103.49,$0.00,$0.00,$103.49,$103.49,$0.00,$145.00,$0.00,$72.50,$114.84,$116.00,$0.00,$0.00,$0.00,$0.00,$0.00
27220104,EAP,,,Central Line 10cm 18g Full,$238.00,$0.00,$238.00,$0.00,$169.86,$0.00,$0.00,$169.86,$169.86,$0.00,$238.00,$0.00,$119.00,$188.50,$190.40,$0.00,$0.00,$0.00,$0.00,$0.00
27220105,EAP,,,Central Line 8cm 18g Basic,$145.00,$0.00,$145.00,$0.00,$103.49,$0.00,$0.00,$103.49,$103.49,$0.00,$145.00,$0.00,$72.50,$114.84,$116.00,$0.00,$0.00,$0.00,$0.00,$0.00
27220106,EAP,,,Central Line 8cm 18g Full,$238.00,$0.00,$238.00,$0.00,$169.86,$0.00,$0.00,$169.86,$169.86,$0.00,$238.00,$0.00,$119.00,$188.50,$190.40,$0.00,$0.00,$0.00,$0.00,$0.00
27220107,EAP,,,Soehendra Biliary Dilation Catheter,$198.00,$0.00,$198.00,$0.00,$141.31,$0.00,$0.00,$141.31,$141.31,$0.00,$198.00,$0.00,$99.00,$156.82,$158.40,$0.00,$0.00,$0.00,$0.00,$0.00
27220108,EAP,,,Spybite Biopsy Forceps,"$1,338.00",$0.00,"$1,338.00",$0.00,$954.93,$0.00,$0.00,$954.93,$954.93,$0.00,"$1,338.00",$0.00,$669.00,"$1,059.70","$1,070.40",$0.00,$0.00,$0.00,$0.00,$0.00
27220109,EAP,,,Pancreatic Stent 5fr,$115.00,$0.00,$115.00,$0.00,$82.08,$0.00,$0.00,$82.08,$82.08,$0.00,$115.00,$0.00,$57.50,$91.08,$92.00,$0.00,$0.00,$0.00,$0.00,$0.00
27220110,EAP,,,Ligating Device,$220.00,$0.00,$220.00,$0.00,$157.01,$0.00,$0.00,$157.01,$157.01,$0.00,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$0.00,$0.00,$0.00,$0.00
27220111,EAP,,,Echotip Procore Biopsy Needle,"$1,013.00",$0.00,"$1,013.00",$0.00,$722.98,$0.00,$0.00,$722.98,$722.98,$0.00,"$1,013.00",$0.00,$506.50,$802.30,$810.40,$0.00,$0.00,$0.00,$0.00,$0.00
27220112,EAP,,,Misc Central Line Supply,$220.00,$0.00,$220.00,$0.00,$157.01,$0.00,$0.00,$157.01,$157.01,$0.00,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$0.00,$0.00,$0.00,$0.00
27220113,EAP,HCPCS C1726,,Catheter Blndil 5mm 135cm 20mm Pr Ctbln Otw Tpr Tip Infl,"$1,759.00",$0.00,"$1,759.00",$955.14,"$1,255.40",$0.00,$303.07,"$1,255.40","$1,255.40",$307.99,"$1,759.00",$0.00,$879.50,"$1,393.13","$1,407.20",$0.00,$275.28,$0.00,$280.03,$0.00
27220114,EAP,HCPCS C1753,,Catheter Baldilat Lp 5.3fr 4mm 135cm 60mm High Pressure,$463.00,$0.00,$463.00,$251.41,$330.44,$0.00,$79.77,$330.44,$330.44,$81.07,$463.00,$0.00,$231.50,$366.70,$370.40,$0.00,$72.46,$0.00,$73.71,$0.00
27220117,EAP,HCPCS C1887,,Catheter Axs Catalyst 7 .068 Id X132cm,"$5,288.00",$0.00,"$5,288.00","$2,871.38","$3,774.05",$0.00,$911.10,"$3,774.05","$3,774.05",$925.89,"$5,288.00",$0.00,"$2,644.00","$4,188.10","$4,230.40",$0.00,$827.57,$0.00,$841.85,$0.00
27220118,EAP,HCPCS C1887,,Catheter Axs Catalyst 7 .068 Id X125cm,"$5,288.00",$0.00,"$5,288.00","$2,871.38","$3,774.05",$0.00,$911.10,"$3,774.05","$3,774.05",$925.89,"$5,288.00",$0.00,"$2,644.00","$4,188.10","$4,230.40",$0.00,$827.57,$0.00,$841.85,$0.00
27220119,EAP,HCPCS C1887,,Catheter Axs Catalyst 7 .068 Id X115cm,"$5,288.00",$0.00,"$5,288.00","$2,871.38","$3,774.05",$0.00,$911.10,"$3,774.05","$3,774.05",$925.89,"$5,288.00",$0.00,"$2,644.00","$4,188.10","$4,230.40",$0.00,$827.57,$0.00,$841.85,$0.00
27220120,EAP,HCPCS C1751,,"Kit Triple Lumen Cvc, 7fr 20 Cm",$360.00,$0.00,$360.00,$195.48,$256.93,$0.00,$62.03,$256.93,$256.93,$63.03,$360.00,$0.00,$180.00,$285.12,$288.00,$0.00,$56.34,$0.00,$57.31,$0.00
27220121,EAP,HCPCS C1751,,Misc Swan Ganz Catheter,$700.00,$0.00,$700.00,$380.10,$499.59,$0.00,$120.61,$499.59,$499.59,$122.56,$700.00,$0.00,$350.00,$554.40,$560.00,$0.00,$109.55,$0.00,$111.44,$0.00
27220122,EAP,Custom 27220122,,Catheter Urethral 8fr Foley 2 Way Latex Dover Silicone,$107.00,$0.00,$107.00,$0.00,$76.37,$0.00,$0.00,$76.37,$76.37,$0.00,$107.00,$0.00,$53.50,$84.74,$85.60,$0.00,$0.00,$0.00,$0.00,$0.00
27220123,EAP,Custom 27220123,,Dressing Wound Square 6x6in 2 Layer Absorbent Nonwoven Soft,$56.00,$0.00,$56.00,$0.00,$39.97,$0.00,$0.00,$39.97,$39.97,$0.00,$56.00,$0.00,$28.00,$44.35,$44.80,$0.00,$0.00,$0.00,$0.00,$0.00
27220124,EAP,Custom 27220124,,Tray Spnl 20ga 3.5in Strl Lf 3 Spng Stk Prp Well Bndg Adlt,$49.00,$0.00,$49.00,$0.00,$34.97,$0.00,$0.00,$34.97,$34.97,$0.00,$49.00,$0.00,$24.50,$38.81,$39.20,$0.00,$0.00,$0.00,$0.00,$0.00
27220125,EAP,Custom 27220125,,Tray Spnl 22ga 1.5in 10ml Strl Spec Vl Prenumber Cap Pt Id,$44.00,$0.00,$44.00,$0.00,$31.40,$0.00,$0.00,$31.40,$31.40,$0.00,$44.00,$0.00,$22.00,$34.85,$35.20,$0.00,$0.00,$0.00,$0.00,$0.00
27220126,EAP,Custom 27220126,,Dressing Burn 36x36in 17 Ply Gauze,$41.00,$0.00,$41.00,$0.00,$29.26,$0.00,$0.00,$29.26,$29.26,$0.00,$41.00,$0.00,$20.50,$32.47,$32.80,$0.00,$0.00,$0.00,$0.00,$0.00
27220127,EAP,Custom 27220127,,Bandage Compression 10ydx4in 5ydx4in 1 Self Adherent Elast,$26.00,$0.00,$26.00,$0.00,$18.56,$0.00,$0.00,$18.56,$18.56,$0.00,$26.00,$0.00,$13.00,$20.59,$20.80,$0.00,$0.00,$0.00,$0.00,$0.00
27220129,EAP,Custom 27220129,,Valve Drn Sm 30ml Pnmst Grad Grmnt Atch Mlt Chst Tube Cnct,$70.00,$0.00,$70.00,$0.00,$49.96,$0.00,$0.00,$49.96,$49.96,$0.00,$70.00,$0.00,$35.00,$55.44,$56.00,$0.00,$0.00,$0.00,$0.00,$0.00
27220130,EAP,Custom 27220130,,Dressing Prfy H2o Calcium Alg Na Cmc Gntl Dbrd,$31.00,$0.00,$31.00,$0.00,$22.12,$0.00,$0.00,$22.12,$22.12,$0.00,$31.00,$0.00,$15.50,$24.55,$24.80,$0.00,$0.00,$0.00,$0.00,$0.00
27220131,EAP,Custom 27220131,,Dressing Biatain Ag 4x4in 1 Pc Rem Abs Wnd Alg,$27.00,$0.00,$27.00,$0.00,$19.27,$0.00,$0.00,$19.27,$19.27,$0.00,$27.00,$0.00,$13.50,$21.38,$21.60,$0.00,$0.00,$0.00,$0.00,$0.00
27220132,EAP,Custom 27220132,,Dressing Brn 48x4in Strl Lf Actct Flx 3 Anmc Brr 1 Lyr Knit,$200.00,$0.00,$200.00,$0.00,$142.74,$0.00,$0.00,$142.74,$142.74,$0.00,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$0.00,$0.00,$0.00,$0.00
27220133,EAP,Custom 27220133,,Dressing Wnd 8x8in Medihoney Abs Lght Ddrgl Clld Sht,$67.00,$0.00,$67.00,$0.00,$47.82,$0.00,$0.00,$47.82,$47.82,$0.00,$67.00,$0.00,$33.50,$53.06,$53.60,$0.00,$0.00,$0.00,$0.00,$0.00
27220134,EAP,Custom 27220134,,Gel Drsg Lf Medihoney Tub 400gm,$188.00,$0.00,$188.00,$0.00,$134.18,$0.00,$0.00,$134.18,$134.18,$0.00,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$0.00,$0.00,$0.00,$0.00
27220135,EAP,Custom 27220135,,Tray Dressing Cardinal Central Line  Grady Custom,$43.00,$0.00,$43.00,$0.00,$30.69,$0.00,$0.00,$30.69,$30.69,$0.00,$43.00,$0.00,$21.50,$34.06,$34.40,$0.00,$0.00,$0.00,$0.00,$0.00
27220136,EAP,,,Pack Srg Crd Cath Haz,$173.00,$0.00,$173.00,$0.00,$123.47,$0.00,$0.00,$123.47,$123.47,$0.00,$173.00,$0.00,$86.50,$137.02,$138.40,$0.00,$0.00,$0.00,$0.00,$0.00
27220137,EAP,,,Device Inflat 12fr 3in Pressure Gauge Latex Free Encore 26,$94.00,$0.00,$94.00,$0.00,$67.09,$0.00,$0.00,$67.09,$67.09,$0.00,$94.00,$0.00,$47.00,$74.45,$75.20,$0.00,$0.00,$0.00,$0.00,$0.00
27220138,EAP,,,Device Cmpr Lg 29cm Tr Band 2 Bln Trns Adj Strap Air Trtn,$83.00,$0.00,$83.00,$0.00,$59.24,$0.00,$0.00,$59.24,$59.24,$0.00,$83.00,$0.00,$41.50,$65.74,$66.40,$0.00,$0.00,$0.00,$0.00,$0.00
27220139,EAP,,,Umbilical Catheter 3.5,$85.00,$0.00,$85.00,$0.00,$60.66,$0.00,$0.00,$60.66,$60.66,$0.00,$85.00,$0.00,$42.50,$67.32,$68.00,$0.00,$0.00,$0.00,$0.00,$0.00
27220140,EAP,HCPCS C1725,,Catheter Baldilat 3.5mm 142cm 25mm Rapex Elongate,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220141,EAP,HCPCS C1725,,Catheter Baldilat 3.5mm 142cm 30mm Rapex Elongate,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220142,EAP,HCPCS C1725,,Catheter Baldilat 3.5mm 142cm 38mm Rapex Elongate,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220143,EAP,HCPCS C1725,,Catheter Baldilat 4mm 142cm 9mm Rapex Elongate Tip,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220144,EAP,HCPCS C1725,,Catheter Baldilat 4mm 142cm 14mm Rapex Elongate,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220145,EAP,HCPCS C1725,,Catheter Baldilat 4mm 142cm 17mm Rapex Elongate,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220146,EAP,HCPCS C1725,,Catheter Baldilat 4mm 142cm 20mm Rapex Elongate,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220147,EAP,HCPCS C1725,,Catheter Baldilat 4mm 142cm 30mm Rapex Elongate,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220148,EAP,HCPCS C1725,,Catheter Baldilat 4.5mm 142cm 9mm Rapex Elongate,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220149,EAP,HCPCS C1725,,Catheter Baldilat 4.5mm 142cm 14mm Rapex Elongate,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220150,EAP,HCPCS C1725,,Catheter Baldilat 4.5mm 142cm 17mm Rapex Elongate,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220151,EAP,HCPCS C1725,,Catheter Baldilat 4.5mm 142cm 20mm Rapex Elongate,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220152,EAP,HCPCS C1725,,Catheter Baldilat 2mm 139cm 6mm Rapex Post Dil,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220153,EAP,HCPCS C1725,,Catheter Baldilat 2.25mm 139cm 6mm Rapex Post Dil,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220154,EAP,HCPCS C1725,,Catheter Baldilat 2.5mm 139cm 6mm Rapex Post Dil,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220155,EAP,HCPCS C1725,,Catheter Baldilat 2.75mm 139cm 6mm Rapex Post Dil,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220156,EAP,HCPCS C1725,,Catheter Baldilat 3mm 139cm 6mm Rapex Post Dil,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220157,EAP,HCPCS C1725,,Catheter Baldilat 3.25mm 139cm 6mm Rapex Post Dil,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220158,EAP,HCPCS C1725,,Catheter Baldilat 3.5mm 139cm 6mm Rapex Post Dil,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220159,EAP,HCPCS C1725,,Catheter Baldilat 4mm 139cm 6mm Rapex Post Dil,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220160,EAP,HCPCS C1725,,Catheter Baldilat 2mm 139cm 10mm Rapex Post Dil,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220161,EAP,HCPCS C1725,,Catheter Baldilat 2.25mm 139cm 10mm Rapex Post Dil,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220162,EAP,HCPCS C1725,,Catheter Baldilat 2.5mm 139cm 10mm Rapex Post Dil,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220163,EAP,HCPCS C1725,,Catheter Baldilat 2.75mm 139cm 10mm Rapex Post Dil,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220164,EAP,HCPCS C1725,,Catheter Baldilat 3mm 139cm 10mm Rapex Post Dil,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220165,EAP,HCPCS C1725,,Catheter Baldilat 3.25mm 139cm 10mm Rapex Post Dil,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220166,EAP,HCPCS C1725,,Catheter Baldilat 3.5mm 139cm 10mm Rapex Post Dil,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220167,EAP,HCPCS C1725,,Catheter Baldilat 3.75mm 139cm 10mm Rapex Post Dil,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220168,EAP,HCPCS C1725,,Catheter Baldilat 4mm 139cm 10mm Rapex Post Dil,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220169,EAP,HCPCS C1725,,Catheter Baldilat 2mm 139cm 12mm Rapex Post Dil,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220170,EAP,HCPCS C1725,,Catheter Baldilat 2.25mm 139cm 12mm Rapex Post Dil,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220171,EAP,HCPCS C1725,,Catheter Baldilat 2.5mm 139cm 12mm Rapex Post Dil,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220172,EAP,HCPCS C1725,,Catheter Baldilat 2.75mm 139cm 12mm Rapex Post Dil,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220173,EAP,HCPCS C1725,,Catheter Baldilat 3mm 139cm 12mm Rapex Post Dil,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220174,EAP,HCPCS C1725,,Catheter Baldilat 3.25mm 139cm 12mm Rapex Post Dil,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220175,EAP,HCPCS C1725,,Catheter Baldilat 3.5mm 139cm 12mm Rapex Post Dil,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220176,EAP,HCPCS C1725,,Catheter Baldilat 3.75mm 139cm 12mm Rapex Post Dil,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220177,EAP,HCPCS C1725,,Catheter Baldilat 4mm 139cm 12mm Rapex Post Dil,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220178,EAP,HCPCS C1725,,Catheter Baldilat 2mm 139cm 15mm Rapex Post Dil,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220179,EAP,HCPCS C1725,,Catheter Baldilat 2.25mm 139cm 15mm Rapex Post Dil,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220180,EAP,HCPCS C1725,,Catheter Baldilat 2.5mm 139cm 15mm Rapex Post Dil,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220181,EAP,HCPCS C1725,,Catheter Baldilat 2.75mm 139cm 15mm Rapex Post Dil,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220182,EAP,HCPCS C1725,,Catheter Baldilat 3mm 139cm 15mm Rapex Post Dil,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220183,EAP,HCPCS C1725,,Catheter Baldilat 3.25mm 139cm 15mm Rapex Post Dil,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220184,EAP,HCPCS C1725,,Catheter Baldilat 3.5mm 139cm 15mm Rapex Post Dil,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220185,EAP,HCPCS C1725,,Catheter Baldilat 3.75mm 139cm 15mm Rapex Post Dil,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220186,EAP,HCPCS C1725,,Catheter Baldilat 4mm 139cm 15mm Rapex Post Dil,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220187,EAP,HCPCS C1725,,Catheter Baldilat 2mm 139cm 20mm Rapex Post Dil,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220188,EAP,HCPCS C1725,,Catheter Baldilat 2.25mm 139cm 20mm Rapex Post Dil,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220189,EAP,HCPCS C1725,,Catheter Baldilat 2.5mm 139cm 20mm Rapex Post Dil,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220190,EAP,HCPCS C1725,,Catheter Baldilat 2.75mm 139cm 20mm Rapex Post Dil,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220191,EAP,HCPCS C1725,,Catheter Baldilat 3mm 139cm 20mm Rapex Post Dil,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220192,EAP,HCPCS C1725,,Catheter Baldilat 3.25mm 139cm 20mm Rapex Post Dil,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220193,EAP,HCPCS C1725,,Catheter Baldilat 3.5mm 139cm 20mm Rapex Post Dil,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220194,EAP,HCPCS C1725,,Catheter Baldilat 3.75mm 139cm 20mm Rapex Post Dil,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220195,EAP,HCPCS C1725,,Catheter Baldilat 4mm 139cm 20mm Rapex Post Dil,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220196,EAP,HCPCS C1725,,Catheter Baldilat 2.25mm 139cm 25mm Rapex Post Dil,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220197,EAP,HCPCS C1725,,Catheter Baldilat 2.5mm 139cm 25mm Rapex Post Dil,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220198,EAP,HCPCS C1725,,Catheter Baldilat 3mm 139cm 25mm Rapex Post Dil,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220199,EAP,HCPCS C1725,,Catheter Baldilat 3.5mm 139cm 25mm Rapex Post Dil,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220200,EAP,HCPCS C1725,,Catheter Baldilat 4mm 139cm 25mm Rapex Post Dil,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220201,EAP,HCPCS C1725,,Catheter Baldilat 2.5mm 139cm 30mm Rapex Post Dil,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220202,EAP,HCPCS C1725,,Catheter Baldilat 3mm 139cm 30mm Rapex Post Dil,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220203,EAP,HCPCS C1725,,Catheter Baldilat 3.5mm 139cm 30mm Rapex Post Dil,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220204,EAP,HCPCS C1725,,Catheter Baldilat 1.5mm 139cm 6mm Rapex,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220205,EAP,HCPCS C1725,,Catheter Baldilat 2mm 139cm 6mm Rapex,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220206,EAP,HCPCS C1725,,Catheter Baldilat 2.25mm 139cm 6mm Rapex,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220207,EAP,HCPCS C1725,,Catheter Baldilat 2.5mm 139cm 6mm Rapex,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220208,EAP,HCPCS C1725,,Catheter Baldilat 1.5mm 139cm 10mm Rapex,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220209,EAP,HCPCS C1725,,Catheter Baldilat 2mm 139cm 10mm Rapex,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220210,EAP,HCPCS C1725,,Catheter Baldilat 2.25mm 139cm 10mm Rapex,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220211,EAP,HCPCS C1725,,Catheter Baldilat 2.5mm 139cm 10mm Rapex,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220212,EAP,HCPCS C1725,,Catheter Baldilat 2.75mm 139cm 10mm Rapex,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220213,EAP,HCPCS C1725,,Catheter Baldilat 3mm 139cm 10mm Rapex,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220214,EAP,HCPCS C1725,,Catheter Baldilat 3.5mm 139cm 10mm Rapex,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220215,EAP,HCPCS C1725,,Catheter Baldilat 4mm 139cm 10mm Rapex,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220216,EAP,HCPCS C1725,,Catheter Baldilat 1.5mm 139cm 12mm Rapex,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220217,EAP,HCPCS C1725,,Catheter Baldilat 2mm 139cm 12mm Rapex,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220218,EAP,HCPCS C1725,,Catheter Baldilat 2.25mm 139cm 12mm Rapex,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220219,EAP,HCPCS C1725,,Catheter Baldilat 2.5mm 139cm 12mm Rapex,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220220,EAP,HCPCS C1725,,Catheter Baldilat 2.75mm 139cm 12mm Rapex,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220221,EAP,HCPCS C1725,,Catheter Baldilat 3mm 139cm 12mm Rapex,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220222,EAP,HCPCS C1725,,Catheter Baldilat 3.5mm 139cm 12mm Rapex,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220223,EAP,HCPCS C1725,,Catheter Baldilat 4mm 139cm 12mm Rapex,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220224,EAP,HCPCS C1725,,Catheter Baldilat 1.5mm 139cm 15mm Rapex,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220225,EAP,HCPCS C1725,,Catheter Baldilat 2mm 139cm 15mm Rapex,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220226,EAP,HCPCS C1725,,Catheter Baldilat 2.25mm 139cm 15mm Rapex,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220227,EAP,HCPCS C1725,,Catheter Baldilat 2.5mm 139cm 15mm Rapex,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220228,EAP,HCPCS C1725,,Catheter Baldilat 2.75mm 139cm 15mm Rapex,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220229,EAP,HCPCS C1725,,Catheter Baldilat 3mm 139cm 15mm Rapex,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220230,EAP,HCPCS C1725,,Catheter Baldilat 3.25mm 139cm 15mm Rapex,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220231,EAP,HCPCS C1725,,Catheter Baldilat 3.5mm 139cm 15mm Rapex,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220232,EAP,HCPCS C1725,,Catheter Baldilat 3.75mm 139cm 15mm Rapex,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220233,EAP,HCPCS C1725,,Catheter Baldilat 4mm 139cm 15mm Rapex,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220234,EAP,HCPCS C1725,,Catheter Baldilat 1.5mm 139cm 20mm Rapex,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220235,EAP,HCPCS C1725,,Catheter Baldilat 2mm 139cm 20mm Rapex,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220236,EAP,HCPCS C1725,,Catheter Baldilat 2.25mm 139cm 20mm Rapex,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220237,EAP,HCPCS C1725,,Catheter Baldilat 2.5mm 139cm 20mm Rapex,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220238,EAP,HCPCS C1725,,Catheter Baldilat 2.75mm 139cm 20mm Rapex,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220239,EAP,HCPCS C1725,,Catheter Baldilat 3mm 139cm 20mm Rapex,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220240,EAP,HCPCS C1725,,Catheter Baldilat 3.5mm 139cm 20mm Rapex,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220241,EAP,HCPCS C1725,,Catheter Baldilat 3.75mm 139cm 20mm Rapex,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220242,EAP,HCPCS C1725,,Catheter Baldilat 4mm 139cm 20mm Rapex,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220243,EAP,HCPCS C1725,,Catheter Baldilat 2mm 139cm 30mm Rapex,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220244,EAP,HCPCS C1725,,Catheter Baldilat 2.5mm 139cm 30mm Rapex,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220245,EAP,HCPCS C1725,,Catheter Baldilat 2.75mm 139cm 30mm Rapex,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220246,EAP,HCPCS C1725,,Catheter Baldilat 3mm 139cm 30mm Rapex,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220247,EAP,HCPCS C1725,,Catheter Baldilat 3.5mm 139cm 30mm Rapex,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
27220248,EAP,HCPCS C1725,,Catheter Baldilat 2mm 8mm Mozec Ptca,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220249,EAP,HCPCS C1725,,Catheter Baldilat 2mm 10mm Mozec Ptca,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220250,EAP,HCPCS C1725,,Catheter Baldilat 2mm 142cm 13mm Rapex Radiopq Nc,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220251,EAP,HCPCS C1725,,Catheter Baldilat 2mm 15mm Mozec Ptca,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220252,EAP,HCPCS C1725,,Catheter Baldilat 2mm 18mm Mozec Ptca,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220253,EAP,HCPCS C1725,,Catheter Baldilat 2mm 23mm Mozec Ptca,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220254,EAP,HCPCS C1725,,Catheter Baldilat 2mm 28mm Mozec Ptca,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220255,EAP,HCPCS C1725,,Catheter Baldilat 2mm 35mm Mozec Ptca,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220256,EAP,HCPCS C1725,,Catheter Baldilat 2.25mm 142cm 8mm Rapex Nyl Mozec,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220257,EAP,HCPCS C1725,,Catheter Baldilat 2.25mm 142cm 10mm Rapex Nyl,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220258,EAP,HCPCS C1725,,Catheter Baldilat 2.25mm 142cm 13mm Rapex Nyl,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220259,EAP,HCPCS C1725,,Catheter Baldilat 2.25mm 142cm 15mm Rapex Nyl,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220260,EAP,HCPCS C1725,,Catheter Baldilat 2.25mm 142cm 18mm Rapex Nyl,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220261,EAP,HCPCS C1725,,Catheter Baldilat 2.25mm 142cm 23mm Rapex Nyl,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220262,EAP,HCPCS C1725,,Catheter Baldilat 2.5mm Rapex Latex Free Crds,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220263,EAP,HCPCS C1725,,Catheter Baldilat 2.5mm Rapex Latex Free Crds,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220264,EAP,HCPCS C1725,,Catheter Baldilat 2.5mm 142cm 10mm Rapex Nyl Mozec,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220265,EAP,HCPCS C1725,,Catheter Baldilat 2.5mm 142cm 13mm Rapex Nyl Mozec,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220266,EAP,HCPCS C1725,,Catheter Baldilat 2.5mm 142cm 15mm Rapex Nyl Mozec,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220267,EAP,HCPCS C1725,,Catheter Baldilat 2.5mm 142cm 18mm Rapex Nyl Mozec,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220268,EAP,HCPCS C1725,,Catheter Baldilat 2.5mm 142cm 23mm Rapex Nyl Mozec,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220269,EAP,HCPCS C1725,,Catheter Baldilat 2.5mm 142cm 28mm Rapex Nyl Mozec,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220270,EAP,HCPCS C1725,,Catheter Baldilat 2.75mm 142cm 8mm Rapex Nyl Mozec,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220271,EAP,HCPCS C1725,,Catheter Baldilat 2.75mm 142cm 10mm Rapex Nyl,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220272,EAP,HCPCS C1725,,Catheter Baldilat 2.75mm 142cm 13mm Rapex Nyl,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220273,EAP,HCPCS C1725,,Catheter Baldilat 2.75mm 142cm 15mm Rapex Nyl,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220274,EAP,HCPCS C1725,,Catheter Baldilat 2.75mm 142cm 18mm Rapex Nyl,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220275,EAP,HCPCS C1725,,Catheter Baldilat 2.75mm 142cm 23mm Rapex Nyl,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220276,EAP,HCPCS C1725,,Catheter Baldilat 2.75mm 142cm 28mm Rapex Nyl,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220277,EAP,HCPCS C1725,,Catheter Baldilat 3mm 142cm 8mm Rapex Nyl Mozec,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220278,EAP,HCPCS C1725,,Catheter Baldilat 3mm 142cm 10mm Rapex Nyl Mozec,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220279,EAP,HCPCS C1725,,Catheter Baldilat 3mm 142cm 13mm Rapex Nyl Mozec,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220280,EAP,HCPCS C1725,,Catheter Baldilat 3mm 142cm 15mm Rapex Nyl Mozec,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220281,EAP,HCPCS C1725,,Catheter Baldilat 3mm 142cm 18mm Rapex Nyl Mozec,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220282,EAP,HCPCS C1725,,Catheter Baldilat 3mm 142cm 23mm Rapex Nyl Mozec,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220283,EAP,HCPCS C1725,,Catheter Baldilat 3mm 142cm 28mm Rapex Nyl Mozec,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220284,EAP,HCPCS C1725,,Catheter Baldilat 3.5mm 142cm 8mm Rapex Nyl Mozec,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220285,EAP,HCPCS C1725,,Catheter Baldilat 3.5mm 142cm 10mm Rapex Nyl Mozec,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220286,EAP,HCPCS C1725,,Catheter Baldilat 3.5mm 142cm 13mm Rapex Nyl Mozec,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220287,EAP,HCPCS C1725,,Catheter Baldilat 3.5mm 142cm 15mm Rapex Nyl Mozec,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220288,EAP,HCPCS C1725,,Catheter Baldilat 3.5mm 142cm 18mm Rapex Nyl Mozec,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220289,EAP,HCPCS C1725,,Catheter Baldilat 3.5mm 142cm 23mm Rapex Nyl Mozec,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220290,EAP,HCPCS C1725,,Catheter Baldilat 3.5mm 142cm 28mm Rapex Nyl Mozec,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220291,EAP,HCPCS C1725,,Catheter Baldilat 4mm 142cm 8mm Rapex Nyl Mozec,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220292,EAP,HCPCS C1725,,Catheter Baldilat 4mm 142cm 10mm Rapex Nyl Mozec,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220293,EAP,HCPCS C1725,,Catheter Baldilat 4mm 142cm 13mm Rapex Nyl Mozec,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220294,EAP,HCPCS C1725,,Catheter Baldilat 4mm 142cm 15mm Rapex Nyl Mozec,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220295,EAP,HCPCS C1725,,Catheter Baldilat 4mm 142cm 18mm Rapex Nyl Mozec,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220296,EAP,HCPCS C1725,,Catheter Baldilat 4mm 142cm 23mm Rapex Nyl Mozec,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220297,EAP,HCPCS C1725,,Catheter Baldilat 4mm 142cm 28mm Rapex Nyl Mozec,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220298,EAP,HCPCS C1725,,Catheter Baldilat 4.5mm 142cm 8mm Rapex Nyl Mozec,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220299,EAP,HCPCS C1725,,Catheter Baldilat 4.5mm 142cm 10mm Rapex Nyl Mozec,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220300,EAP,HCPCS C1725,,Catheter Baldilat 4.5mm 142cm 13mm Rapex Nyl Mozec,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220301,EAP,HCPCS C1725,,Catheter Baldilat 4.5mm 142cm 15mm Rapex Nyl Mozec,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220302,EAP,HCPCS C1725,,Catheter Baldilat 4.5mm 142cm 18mm Rapex Nyl Mozec,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220303,EAP,HCPCS C1725,,Catheter Baldilat 4.5mm 142cm 23mm Rapex Nyl Mozec,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220304,EAP,HCPCS C1725,,Catheter Baldilat 4.5mm 142cm 28mm Rapex Nyl Mozec,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220305,EAP,HCPCS C1725,,Catheter Baldilat 4.5mm 142cm 35mm Rapex Nyl Mozec,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220306,EAP,HCPCS C1725,,Catheter Baldilat 1.5mm 142cm 9mm Rapex Elongate,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220307,EAP,HCPCS C1725,,Catheter Baldilat 1.5mm 142cm 12mm Rapex Elongate,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220308,EAP,HCPCS C1725,,Catheter Baldilat 1.5mm 142cm 15mm Rapex Elongate,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220309,EAP,HCPCS C1725,,Catheter Baldilat 2mm 142cm 9mm Rapex Elongate Tip,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220310,EAP,HCPCS C1725,,Catheter Baldilat 2mm 142cm 12mm Rapex Elongate,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220311,EAP,HCPCS C1725,,Catheter Baldilat 2mm 142cm 15mm Rapex Elongate,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220312,EAP,HCPCS C1725,,Catheter Baldilat 2.25mm 142cm 9mm Rapex Elongate,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220313,EAP,HCPCS C1725,,Catheter Baldilat 2.25mm 142cm 14mm Rapex Elongate,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220314,EAP,HCPCS C1725,,Catheter Baldilat 2.25mm 142cm 17mm Rapex Elongate,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220315,EAP,HCPCS C1725,,Catheter Baldilat 2.25mm 142cm 20mm Rapex Elongate,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220316,EAP,HCPCS C1725,,Catheter Baldilat 2.5mm 142cm 9mm Rapex Elongate,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220317,EAP,HCPCS C1725,,Catheter Baldilat 2.5mm 142cm 14mm Rapex Elongate,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220318,EAP,HCPCS C1725,,Catheter Baldilat 2.5mm 142cm 17mm Rapex Elongate,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220319,EAP,HCPCS C1725,,Catheter Baldilat 2.5mm 142cm 20mm Rapex Elongate,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220320,EAP,HCPCS C1725,,Catheter Baldilat 2.5mm 142cm 25mm Rapex Elongate,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220321,EAP,HCPCS C1725,,Catheter Baldilat 2.5mm 142cm 30mm Rapex Elongate,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220322,EAP,HCPCS C1725,,Catheter Baldilat 2.2mm 38mm Mozec Ptca,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220323,EAP,HCPCS C1725,,Catheter Baldilat 2.5mm 142cm 41mm Rapex Elongate,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220324,EAP,HCPCS C1725,,Catheter Baldilat 2.75mm 142cm 9mm Rapex Elongate,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220325,EAP,HCPCS C1725,,Catheter Baldilat 2.75mm 142cm 14mm Rapex Elongate,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220326,EAP,HCPCS C1725,,Catheter Baldilat 2.75mm 142cm 17mm Rapex Elongate,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220327,EAP,HCPCS C1725,,Catheter Baldilat 2.75mm 142cm 20mm Rapex Elongate,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220328,EAP,HCPCS C1725,,Catheter Baldilat 3mm 142cm 9mm Rapex Elongate Tip,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220329,EAP,HCPCS C1725,,Catheter Baldilat 3mm 142cm 14mm Rapex Elongate,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220330,EAP,HCPCS C1725,,Catheter Baldilat 3mm 142cm 17mm Rapex Elongate,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220331,EAP,HCPCS C1725,,Catheter Baldilat 3mm 142cm 20mm Rapex Elongate,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220332,EAP,HCPCS C1725,,Catheter Baldilat 3mm 142cm 25mm Rapex Elongate,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220333,EAP,HCPCS C1725,,Catheter Baldilat 3mm 142cm 30mm Rapex Elongate,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220334,EAP,HCPCS C1725,,Catheter Baldilat 3mm 142cm 38mm Rapex Elongate,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220335,EAP,HCPCS C1725,,Catheter Baldilat 3mm 142cm 41mm Rapex Elongate,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220336,EAP,HCPCS C1725,,Catheter Baldilat 3.5mm 142cm 9mm Rapex Elongate,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220337,EAP,HCPCS C1725,,Catheter Baldilat 3.5mm 142cm 14mm Rapex Elongate,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220338,EAP,HCPCS C1725,,Catheter Baldilat 3.5mm 142cm 17mm Rapex Elongate,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220339,EAP,HCPCS C1725,,Catheter Baldilat 3.5mm 142cm 20mm Rapex Elongate,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$107.06,$107.06,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
27220340,EAP,HCPCS C1725,,Catheter Angiographic Angle 5fr .047in 65cm 25cm 1 Braid,$123.00,$0.00,$123.00,$66.79,$87.79,$0.00,$21.19,$87.79,$87.79,$21.54,$123.00,$0.00,$61.50,$97.42,$98.40,$0.00,$19.25,$0.00,$19.58,$0.00
27220341,EAP,HCPCS C1887,,Catheter Intvn 900- Psi 2.2-2.9fr 6- Mm .02in 110,"$2,488.00",$0.00,"$2,488.00","$1,350.98","$1,775.69",$0.00,$428.67,"$1,775.69","$1,775.69",$435.63,"$2,488.00",$0.00,"$1,244.00","$1,970.50","$1,990.40",$0.00,$389.37,$0.00,$396.09,$0.00
27220342,EAP,HCPCS C1887,,Catheter Blnocc 900- Psi 2.2-2.9fr 6- Mm .02in 130,"$2,488.00",$0.00,"$2,488.00","$1,350.98","$1,775.69",$0.00,$428.67,"$1,775.69","$1,775.69",$435.63,"$2,488.00",$0.00,"$1,244.00","$1,970.50","$1,990.40",$0.00,$389.37,$0.00,$396.09,$0.00
27220343,EAP,HCPCS C1887,,Catheter Blnocc 900- Psi 2.2-2.9fr 6- Mm .02in 150,"$2,488.00",$0.00,"$2,488.00","$1,350.98","$1,775.69",$0.00,$428.67,"$1,775.69","$1,775.69",$435.63,"$2,488.00",$0.00,"$1,244.00","$1,970.50","$1,990.40",$0.00,$389.37,$0.00,$396.09,$0.00
27220344,EAP,HCPCS C1887,,Catheter Infus 110cm 2 Lum Ang Tip Radiopq Gwire,"$2,488.00",$0.00,"$2,488.00","$1,350.98","$1,775.69",$0.00,$428.67,"$1,775.69","$1,775.69",$435.63,"$2,488.00",$0.00,"$1,244.00","$1,970.50","$1,990.40",$0.00,$389.37,$0.00,$396.09,$0.00
27220345,EAP,HCPCS C1887,,Catheter Infus 130cm 2 Lum Ang Tip Radiopq Gwire,"$2,488.00",$0.00,"$2,488.00","$1,350.98","$1,775.69",$0.00,$428.67,"$1,775.69","$1,775.69",$435.63,"$2,488.00",$0.00,"$1,244.00","$1,970.50","$1,990.40",$0.00,$389.37,$0.00,$396.09,$0.00
27220346,EAP,HCPCS C1887,,Catheter Infus 150cm 2 Lum Ang Tip Radiopq Gwire,"$2,488.00",$0.00,"$2,488.00","$1,350.98","$1,775.69",$0.00,$428.67,"$1,775.69","$1,775.69",$435.63,"$2,488.00",$0.00,"$1,244.00","$1,970.50","$1,990.40",$0.00,$389.37,$0.00,$396.09,$0.00
27220347,EAP,HCPCS C1887,,Catheter Angio Jl 4 Crv 5fr .047in 100cm Infnt Thrlmn Radopq,$97.00,$0.00,$97.00,$52.67,$69.23,$0.00,$16.71,$69.23,$69.23,$16.98,$97.00,$0.00,$48.50,$76.82,$77.60,$0.00,$15.18,$0.00,$15.44,$0.00
27220348,EAP,HCPCS C1887,,Catheter Angio Al 1 Crv 6fr 100cm Infnt Lt Cor,$97.00,$0.00,$97.00,$52.67,$69.23,$0.00,$16.71,$69.23,$69.23,$16.98,$97.00,$0.00,$48.50,$76.82,$77.60,$0.00,$15.18,$0.00,$15.44,$0.00
27220349,EAP,,,Kit Picc Dressing Change Tray 215,$59.00,$0.00,$59.00,$0.00,$42.11,$0.00,$0.00,$42.11,$42.11,$0.00,$59.00,$0.00,$29.50,$46.73,$47.20,$0.00,$0.00,$0.00,$0.00,$0.00
27220352,EAP,HCPCS C1769,,Guidewire Vasc 90d 60d 2cm .018in 180cm 25cm Gldwr Gt Tip,$393.00,$0.00,$393.00,$213.40,$280.48,$0.00,$67.71,$280.48,$280.48,$68.81,$393.00,$0.00,$196.50,$311.26,$314.40,$0.00,$61.50,$0.00,$62.57,$0.00
27220353,EAP,,,Device Inflat 12fr Pressure Gauge Encore 26 20ml,$367.00,$0.00,$367.00,$0.00,$261.93,$0.00,$0.00,$261.93,$261.93,$0.00,$367.00,$0.00,$183.50,$290.66,$293.60,$0.00,$0.00,$0.00,$0.00,$0.00
27300022,EAP,,,Stocking Compression 20-30 Mmhg Large Bk Od15.5-18,$49.00,$0.00,$49.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$49.00,$0.00,$24.50,$38.81,$39.20,$0.00,$0.00,$0.00,$0.00,$0.00
27300023,EAP,,,Stocking Compression 20-30 Mmhg X-large Bk Od17.5-20,$49.00,$0.00,$49.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$49.00,$0.00,$24.50,$38.81,$39.20,$0.00,$0.00,$0.00,$0.00,$0.00
27400001,EAP,HCPCS A5121,,"Skin Barrier, Solid 6X6 or Equival",$36.00,$0.00,$36.00,$0.00,$25.69,$0.00,$0.00,$25.69,$25.69,$0.00,$36.00,$0.00,$18.00,$28.51,$28.80,$0.00,$0.00,$0.00,$0.00,$0.00
27400002,EAP,HCPCS A5122,,"Skin Barrier, Solid 8x8 Or Equivalent",$135.00,$0.00,$135.00,$0.00,$96.35,$0.00,$0.00,$96.35,$96.35,$0.00,$135.00,$0.00,$67.50,$106.92,$108.00,$0.00,$0.00,$0.00,$0.00,$0.00
27400003,EAP,HCPCS L0170,,Neck Ext. Splint,$94.00,$0.00,$556.60,$42.30,$67.09,$16.73,$556.60,$67.09,$67.09,$16.46,$94.00,$0.00,$47.00,$74.45,$75.20,$56.40,$529.98,$0.00,$540.87,$0.00
27400004,EAP,HCPCS L0150,,Cervical Collar,$202.00,$0.00,$202.00,$90.90,$144.17,$35.96,$0.00,$144.17,$144.17,$35.37,$202.00,$0.00,$101.00,$159.98,$161.60,$121.20,$0.00,$0.00,$89.77,$0.00
27400005,EAP,HCPCS L0172,,Aspen Collar,$524.00,$0.00,$524.00,$235.80,$373.98,$93.27,$112.86,$373.98,$373.98,$91.75,$524.00,$0.00,$262.00,$415.01,$419.20,$314.40,$107.46,$0.00,$109.67,$0.00
27400006,EAP,HCPCS L0174,,Miami Collar,$938.00,$0.00,$938.00,$422.10,$669.45,$166.96,$202.73,$669.45,$669.45,$164.24,$938.00,$0.00,$469.00,$742.90,$750.40,$562.80,$193.04,$0.00,$197.01,$0.00
27400007,EAP,HCPCS L0190,,Somi Brace,"$1,827.00",$0.00,"$1,827.00",$0.00,"$1,303.93",$0.00,$0.00,"$1,303.93","$1,303.93",$0.00,"$1,827.00",$0.00,$913.50,"$1,446.98","$1,461.60",$0.00,$0.00,$0.00,$0.00,$0.00
27400008,EAP,HCPCS L0200,,Cervical Thoracic Orthosis(cto,"$1,679.00",$0.00,"$1,679.00",$755.55,"$1,198.30",$298.86,$0.00,"$1,198.30","$1,198.30",$293.98,"$1,679.00",$0.00,$839.50,"$1,329.77","$1,343.20","$1,007.40",$0.00,$0.00,$370.34,$0.00
27400009,EAP,HCPCS L0450,,Tlso Brace,$929.00,$0.00,$929.00,$0.00,$663.03,$0.00,$0.00,$663.03,$663.03,$0.00,$929.00,$0.00,$464.50,$735.77,$743.20,$0.00,$0.00,$0.00,$0.00,$0.00
27400010,EAP,HCPCS L0472,,Jewett Brace,"$1,496.00",$0.00,"$1,496.00",$0.00,"$1,067.70",$0.00,$0.00,"$1,067.70","$1,067.70",$0.00,"$1,496.00",$0.00,$748.00,"$1,184.83","$1,196.80",$0.00,$0.00,$0.00,$0.00,$0.00
27400011,EAP,HCPCS L0486,,Custom To Fit Tlso,"$6,431.00",$0.00,"$6,431.00","$2,893.95","$4,589.80","$1,144.72","$1,391.48","$4,589.80","$4,589.80","$1,126.02","$6,431.00",$0.00,"$3,215.50","$5,093.35","$5,144.80","$3,858.60","$1,324.93",$0.00,"$1,352.17",$0.00
27400012,EAP,HCPCS L0637,,Lso Cybertech,"$4,041.00",$0.00,"$4,041.00",$0.00,"$2,884.06",$0.00,$0.00,"$2,884.06","$2,884.06",$0.00,"$4,041.00",$0.00,"$2,020.50","$3,200.47","$3,232.80",$0.00,$0.00,$0.00,$0.00,$0.00
27400013,EAP,HCPCS L0638,,Lso Brace,"$3,917.00",$0.00,"$3,917.00",$0.00,"$2,795.56",$0.00,"$1,046.64","$2,795.56","$2,795.56",$685.84,"$3,917.00",$0.00,"$1,958.50","$3,102.26","$3,133.60",$0.00,$996.58,$0.00,$0.00,$0.00
27400014,EAP,HCPCS L0700,,Ctlso Brace,"$6,393.00",$0.00,"$6,393.00",$0.00,"$4,562.68",$0.00,$0.00,"$4,562.68","$4,562.68",$0.00,"$6,393.00",$0.00,"$3,196.50","$5,063.26","$5,114.40",$0.00,$0.00,$0.00,$0.00,$0.00
27400015,EAP,HCPCS L1686,,Hip Abduction Brace,"$4,383.00",$0.00,"$4,383.00",$0.00,"$3,128.15",$0.00,$0.00,"$3,128.15","$3,128.15",$0.00,"$4,383.00",$0.00,"$2,191.50","$3,471.34","$3,506.40",$0.00,$0.00,$0.00,$0.00,$0.00
27400017,EAP,HCPCS L1830,,Knee Immobilizer,$371.00,$0.00,$371.00,$0.00,$264.78,$0.00,$0.00,$264.78,$264.78,$0.00,$371.00,$0.00,$185.50,$293.83,$296.80,$0.00,$0.00,$0.00,$0.00,$0.00
27400019,EAP,HCPCS L1940,,Ankle Foot Orthosis,$345.00,$0.00,$394.54,$155.25,$246.23,$61.41,$394.54,$246.23,$246.23,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$207.00,$375.67,$0.00,$383.39,$0.00
27400020,EAP,HCPCS L1834,,Knee Ext. Splint,$243.00,$0.00,$243.00,$0.00,$173.43,$0.00,$0.00,$173.43,$173.43,$0.00,$243.00,$0.00,$121.50,$192.46,$194.40,$0.00,$0.00,$0.00,$0.00,$0.00
27400021,EAP,HCPCS L3650,,Shoulder Immobilizer,$371.00,$0.00,$371.00,$0.00,$264.78,$0.00,$0.00,$264.78,$264.78,$0.00,$371.00,$0.00,$185.50,$293.83,$296.80,$0.00,$0.00,$0.00,$0.00,$0.00
27400022,EAP,HCPCS L3670,,Shoulder Abduction,$388.00,$0.00,$388.00,$0.00,$276.92,$0.00,$0.00,$276.92,$276.92,$0.00,$388.00,$0.00,$194.00,$307.30,$310.40,$0.00,$0.00,$0.00,$0.00,$0.00
27400024,EAP,HCPCS L3702,,Custom Elbow,$97.00,$0.00,$208.54,$43.65,$69.23,$17.27,$208.54,$69.23,$69.23,$16.98,$97.00,$0.00,$48.50,$76.82,$77.60,$58.20,$198.56,$0.00,$202.65,$0.00
27400025,EAP,HCPCS L3967,,Airplane Splint,$406.00,$0.00,"$1,392.15",$182.70,$289.76,$72.27,$0.00,$289.76,$289.76,$71.09,$406.00,$0.00,$203.00,$321.55,$324.80,$243.60,$0.00,$0.00,"$1,392.15",$0.00
27400026,EAP,HCPCS L3905,,Dynamic Wrist Splint,$107.00,$0.00,$716.21,$0.00,$76.37,$0.00,$716.21,$76.37,$76.37,$18.73,$107.00,$0.00,$53.50,$84.74,$85.60,$0.00,$681.95,$0.00,$0.00,$0.00
27400027,EAP,HCPCS L3935,,Any Finger Splint,$198.00,$0.00,$198.00,$89.10,$141.31,$35.24,$159.57,$141.31,$141.31,$34.67,$198.00,$0.00,$99.00,$156.82,$158.40,$118.80,$151.93,$0.00,$155.06,$0.00
27400028,EAP,HCPCS L3808,,Ulnar/radial Gutter,$69.00,$0.00,$247.75,$31.05,$49.25,$12.28,$247.75,$49.25,$49.25,$12.08,$69.00,$0.00,$34.50,$54.65,$55.20,$41.40,$235.90,$0.00,$240.75,$0.00
27400029,EAP,HCPCS L3906,,Wrist Cockup Splint,$202.00,$0.00,$304.68,$90.90,$144.17,$35.96,$304.68,$144.17,$144.17,$35.37,$202.00,$0.00,$101.00,$159.98,$161.60,$121.20,$290.10,$0.00,$296.07,$0.00
27400030,EAP,HCPCS L3925,,SPRING WIRE ASSIST SPLINT PREFAB,$195.00,$0.00,$195.00,$87.75,$139.17,$34.71,$39.19,$139.17,$139.17,$34.14,$195.00,$0.00,$97.50,$154.44,$156.00,$117.00,$37.31,$0.00,$38.08,$0.00
27400033,EAP,HCPCS L3671,,Custom Humerus,$420.00,$0.00,$420.00,$0.00,$299.75,$0.00,$0.00,$299.75,$299.75,$0.00,$420.00,$0.00,$210.00,$332.64,$336.00,$0.00,$0.00,$0.00,$0.00,$0.00
27400034,EAP,HCPCS L3982,,RESTING HAND SPLINT-CUSTOM,$214.00,$0.00,$214.00,$0.00,$152.73,$0.00,$0.00,$152.73,$152.73,$0.00,$214.00,$0.00,$107.00,$169.49,$171.20,$0.00,$0.00,$0.00,$0.00,$0.00
27400038,EAP,HCPCS L3334,,Heel Lift,$127.00,$0.00,$127.00,$0.00,$90.64,$0.00,$0.00,$90.64,$90.64,$0.00,$127.00,$0.00,$63.50,$100.58,$101.60,$0.00,$0.00,$0.00,$0.00,$0.00
27400039,EAP,HCPCS L3710,,Hinged Elbow Brace,$431.00,$0.00,$431.00,$193.95,$307.60,$76.72,$104.70,$307.60,$307.60,$75.46,$431.00,$0.00,$215.50,$341.35,$344.80,$258.60,$99.70,$0.00,$101.75,$0.00
27400040,EAP,HCPCS L3806,,Dorsal Block Splint W/kleine,$47.00,$0.00,$47.00,$0.00,$33.54,$0.00,$0.00,$33.54,$33.54,$0.00,$47.00,$0.00,$23.50,$37.22,$37.60,$0.00,$0.00,$0.00,$0.00,$0.00
27400050,EAP,HCPCS L3913,,Simple Hand Based Spl,$55.00,$0.00,$195.60,$24.75,$39.25,$9.79,$195.60,$39.25,$39.25,$9.63,$55.00,$0.00,$27.50,$43.56,$44.00,$33.00,$186.25,$0.00,$190.08,$0.00
27400051,EAP,HCPCS L3808,,Dorsal Block Splint,$34.00,$0.00,$247.75,$15.30,$24.27,$6.05,$247.75,$24.27,$24.27,$5.95,$34.00,$0.00,$17.00,$26.93,$27.20,$20.40,$235.90,$0.00,$240.75,$0.00
27400052,EAP,HCPCS L3931,,Whfo Finger Exten W/wrist Supp,$126.00,$0.00,$126.00,$0.00,$89.93,$0.00,$0.00,$89.93,$89.93,$0.00,$126.00,$0.00,$63.00,$99.79,$100.80,$0.00,$0.00,$0.00,$0.00,$0.00
27400053,EAP,HCPCS L3807,,Ball Splint/finger Abd Splint,$161.00,$0.00,$180.59,$72.45,$114.91,$28.66,$180.59,$114.91,$114.91,$28.19,$161.00,$0.00,$80.50,$127.51,$128.80,$96.60,$171.95,$0.00,$175.48,$0.00
27400054,EAP,HCPCS L3908,,Canv/leath/ezy-on Wrist Splint,$99.00,$0.00,$99.00,$44.55,$70.66,$17.62,$43.26,$70.66,$70.66,$17.33,$99.00,$0.00,$49.50,$78.41,$79.20,$59.40,$41.19,$0.00,$42.04,$0.00
27400055,EAP,HCPCS L3808,,Gauntlet With Thumb Spica,$91.00,$0.00,$247.75,$40.95,$64.95,$16.20,$247.75,$64.95,$64.95,$15.93,$91.00,$0.00,$45.50,$72.07,$72.80,$54.60,$235.90,$0.00,$240.75,$0.00
27400056,EAP,HCPCS L3807,,Prefab Burn Splint,$349.00,$0.00,$349.00,$157.05,$249.08,$62.12,$180.59,$249.08,$249.08,$61.11,$349.00,$0.00,$174.50,$276.41,$279.20,$209.40,$171.95,$0.00,$175.48,$0.00
27400057,EAP,HCPCS L3807,,Spasticity Splint,$164.00,$0.00,$180.59,$73.80,$117.05,$29.19,$180.59,$117.05,$117.05,$28.72,$164.00,$0.00,$82.00,$129.89,$131.20,$98.40,$171.95,$0.00,$175.48,$0.00
27400058,EAP,HCPCS L3763,,Forearm Sarmiento,$195.00,$0.00,$926.06,$87.75,$139.17,$34.71,$926.06,$139.17,$139.17,$34.14,$195.00,$0.00,$97.50,$154.44,$156.00,$117.00,$881.77,$0.00,$899.90,$0.00
27400059,EAP,HCPCS L3931,,Whfo - Palmer,$312.00,$0.00,$312.00,$0.00,$222.67,$0.00,$0.00,$222.67,$222.67,$0.00,$312.00,$0.00,$156.00,$247.10,$249.60,$0.00,$0.00,$0.00,$0.00,$0.00
27400060,EAP,HCPCS L3808,,Thumb Spica,$72.00,$0.00,$247.75,$32.40,$51.39,$12.82,$247.75,$51.39,$51.39,$12.61,$72.00,$0.00,$36.00,$57.02,$57.60,$43.20,$235.90,$0.00,$240.75,$0.00
27400061,EAP,HCPCS L3808,,Whfo Wr Gaunlet/thumb Spica,$185.00,$0.00,$247.75,$83.25,$132.03,$32.93,$247.75,$132.03,$132.03,$32.39,$185.00,$0.00,$92.50,$146.52,$148.00,$111.00,$235.90,$0.00,$240.75,$0.00
27400062,EAP,HCPCS L3808,,"Whfo,long Opponens No Attachme",$65.00,$0.00,$247.75,$29.25,$46.39,$11.57,$247.75,$46.39,$46.39,$11.38,$65.00,$0.00,$32.50,$51.48,$52.00,$39.00,$235.90,$0.00,$240.75,$0.00
27400066,EAP,HCPCS L3808,,Safe Position Splint,$107.00,$0.00,$247.75,$48.15,$76.37,$19.05,$247.75,$76.37,$76.37,$18.73,$107.00,$0.00,$53.50,$84.74,$85.60,$64.20,$235.90,$0.00,$240.75,$0.00
27400067,EAP,HCPCS L4398,,Foam Foot Drop Stop-prefab,$47.00,$0.00,$47.00,$0.00,$33.54,$0.00,$0.00,$33.54,$33.54,$0.00,$47.00,$0.00,$23.50,$37.22,$37.60,$0.00,$0.00,$0.00,$0.00,$0.00
27400070,EAP,HCPCS L3808,,Canv/leath/ezy-on Wrist Splint,$19.00,$0.00,$247.75,$8.55,$13.56,$3.38,$247.75,$13.56,$13.56,$3.33,$19.00,$0.00,$9.50,$15.05,$15.20,$11.40,$235.90,$0.00,$240.75,$0.00
27400071,EAP,HCPCS L3905,,Forearm Based Outrigger,$160.00,$0.00,$716.21,$0.00,$114.19,$0.00,$716.21,$114.19,$114.19,$28.01,$160.00,$0.00,$80.00,$126.72,$128.00,$0.00,$681.95,$0.00,$0.00,$0.00
27400078,EAP,HCPCS L1834,,Knee Extension Splint(s/p Bka),$215.00,$0.00,$215.00,$0.00,$153.45,$0.00,$0.00,$153.45,$153.45,$0.00,$215.00,$0.00,$107.50,$170.28,$172.00,$0.00,$0.00,$0.00,$0.00,$0.00
27400080,EAP,HCPCS L3807,,Resting Hand Splint-prefab,$328.00,$0.00,$328.00,$147.60,$234.09,$58.38,$180.59,$234.09,$234.09,$57.43,$328.00,$0.00,$164.00,$259.78,$262.40,$196.80,$171.95,$0.00,$175.48,$0.00
27400085,EAP,HCPCS L3921,,Hand Based Outrigger,$118.00,$0.00,$231.97,$53.10,$84.22,$21.00,$231.97,$84.22,$84.22,$20.66,$118.00,$0.00,$59.00,$93.46,$94.40,$70.80,$220.87,$0.00,$225.41,$0.00
27400086,EAP,HCPCS A4467,,Posterior Elbow Splint-prefab,$105.00,$0.00,$105.00,$0.00,$74.94,$0.00,$0.00,$74.94,$74.94,$0.00,$105.00,$0.00,$52.50,$83.16,$84.00,$0.00,$0.00,$0.00,$0.00,$0.00
27400087,EAP,HCPCS L4396,,Foot Drop Splint Prefab,$278.00,$0.00,$278.00,$125.10,$198.41,$49.48,$133.19,$198.41,$198.41,$48.68,$278.00,$0.00,$139.00,$220.18,$222.40,$166.80,$126.82,$0.00,$129.42,$0.00
27400090,EAP,HCPCS L1960,,Foot Drop Splint-custom,$237.00,$0.00,$409.08,$0.00,$169.15,$0.00,$409.08,$169.15,$169.15,$41.50,$237.00,$0.00,$118.50,$187.70,$189.60,$0.00,$389.51,$0.00,$0.00,$0.00
27400091,EAP,HCPCS L3808,,Resting Hand/volar Wrist Custom,$209.00,$0.00,$247.75,$94.05,$149.16,$37.20,$247.75,$149.16,$149.16,$36.59,$209.00,$0.00,$104.50,$165.53,$167.20,$125.40,$235.90,$0.00,$240.75,$0.00
27400097,EAP,HCPCS L3931,,Resting Hand Prefab Hand Rehab,$199.00,$0.00,$199.00,$0.00,$142.03,$0.00,$0.00,$142.03,$142.03,$0.00,$199.00,$0.00,$99.50,$157.61,$159.20,$0.00,$0.00,$0.00,$0.00,$0.00
27400098,EAP,HCPCS L3808,,CUSTOM RESTING HAND,$198.00,$0.00,$247.75,$89.10,$141.31,$35.24,$247.75,$141.31,$141.31,$34.67,$198.00,$0.00,$99.00,$156.82,$158.40,$118.80,$235.90,$0.00,$240.75,$0.00
27400099,EAP,HCPCS L0810,,Halo And Vest,"$7,045.00",$0.00,"$7,045.00",$0.00,"$5,028.02",$0.00,$0.00,"$5,028.02","$5,028.02",$0.00,"$7,045.00",$0.00,"$3,522.50","$5,579.64","$5,636.00",$0.00,$0.00,$0.00,$0.00,$0.00
27400105,EAP,HCPCS L3808,,Extensor Tendon Splint,$132.00,$0.00,$247.75,$59.40,$94.21,$23.50,$247.75,$94.21,$94.21,$23.11,$132.00,$0.00,$66.00,$104.54,$105.60,$79.20,$235.90,$0.00,$240.75,$0.00
27400108,EAP,HCPCS L3980,,Humeral Fx Brace,$179.00,$0.00,$223.26,$80.55,$127.75,$31.86,$223.26,$127.75,$127.75,$31.34,$179.00,$0.00,$89.50,$141.77,$143.20,$107.40,$212.58,$0.00,$216.95,$0.00
27400109,EAP,HCPCS L3760,,Hinged Elbow Brace,"$1,285.00",$0.00,"$1,285.00",$0.00,$917.10,$0.00,$0.00,$917.10,$917.10,$0.00,"$1,285.00",$0.00,$642.50,"$1,017.72","$1,028.00",$0.00,$0.00,$0.00,$0.00,$0.00
27400113,EAP,HCPCS A4467,,Posterior Elbow Splint-prefab,$105.00,$0.00,$105.00,$0.00,$74.94,$0.00,$0.00,$74.94,$74.94,$0.00,$105.00,$0.00,$52.50,$83.16,$84.00,$0.00,$0.00,$0.00,$0.00,$0.00
27400114,EAP,,,Splint Orthopedic 5ydx6in Fast,$46.00,$0.00,$46.00,$0.00,$32.83,$0.00,$0.00,$32.83,$32.83,$0.00,$46.00,$0.00,$23.00,$36.43,$36.80,$0.00,$0.00,$0.00,$0.00,$0.00
27400115,EAP,HCPCS L1830,,Immobilizer Orthopedic Univers,$45.00,$0.00,$45.00,$0.00,$32.12,$0.00,$0.00,$32.12,$32.12,$0.00,$45.00,$0.00,$22.50,$35.64,$36.00,$0.00,$0.00,$0.00,$0.00,$0.00
27400116,EAP,HCPCS L0150,,Collar Cerv 2-5yr Short 35-45in Chin Dot Tracheostomy Open,$108.00,$0.00,$108.00,$48.60,$77.08,$19.22,$0.00,$77.08,$77.08,$18.91,$108.00,$0.00,$54.00,$85.54,$86.40,$64.80,$0.00,$0.00,$89.77,$0.00
27400117,EAP,HCPCS L0150,,Collar Cerv 3-6yr Regular 37-48in Chin Dot Tracheostomy Open,$109.00,$0.00,$109.00,$49.05,$77.79,$19.40,$0.00,$77.79,$77.79,$19.09,$109.00,$0.00,$54.50,$86.33,$87.20,$65.40,$0.00,$0.00,$89.77,$0.00
27400118,EAP,HCPCS L0172,,Collar Cerv Short Latex Free Adult,$103.00,$0.00,$112.86,$46.35,$73.51,$18.33,$112.86,$73.51,$73.51,$18.03,$103.00,$0.00,$51.50,$81.58,$82.40,$61.80,$107.46,$0.00,$109.67,$0.00
27400119,EAP,HCPCS L0172,,Collar Cerv Regular Chin Rest Tracheostomy Opening,$100.00,$0.00,$112.86,$45.00,$71.37,$17.80,$112.86,$71.37,$71.37,$17.51,$100.00,$0.00,$50.00,$79.20,$80.00,$60.00,$107.46,$0.00,$109.67,$0.00
27400120,EAP,HCPCS L0172,,Collar Cerv Tall Chin Rest Tracheostomy Opening Adjustable,$97.00,$0.00,$112.86,$43.65,$69.23,$17.27,$112.86,$69.23,$69.23,$16.98,$97.00,$0.00,$48.50,$76.82,$77.60,$58.20,$107.46,$0.00,$109.67,$0.00
27400121,EAP,HCPCS L0113,,Collar Cerv 1-3yr Tot 33-40in Chin Dot Tracheostomy Open,$101.00,$0.00,$101.00,$0.00,$72.08,$0.00,$0.00,$72.08,$72.08,$0.00,$101.00,$0.00,$50.50,$79.99,$80.80,$0.00,$0.00,$0.00,$0.00,$0.00
27400122,EAP,HCPCS L0172,,Collar Cerv Short Chin Rest Tracheostomy Opening Adjustable,$115.00,$0.00,$115.00,$51.75,$82.08,$20.47,$112.86,$82.08,$82.08,$20.14,$115.00,$0.00,$57.50,$91.08,$92.00,$69.00,$107.46,$0.00,$109.67,$0.00
27400123,EAP,HCPCS L0172,,Collar Cerv 9-24 Month Regular 29-37in Chin Dot Tracheostomy,$114.00,$0.00,$114.00,$51.30,$81.36,$20.29,$112.86,$81.36,$81.36,$19.96,$114.00,$0.00,$57.00,$90.29,$91.20,$68.40,$107.46,$0.00,$109.67,$0.00
27400124,EAP,HCPCS L0172,,Collar Crv Unv Occian Bck Intuitech,$188.00,$0.00,$188.00,$84.60,$134.18,$33.46,$112.86,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$112.80,$107.46,$0.00,$109.67,$0.00
27500001,EAP,HCPCS C1721,,2207-36 Current Dr Icd,"$52,001.00",$0.00,"$52,001.00","$23,400.45","$5,158.80",$0.00,"$8,138.89","$5,158.80","$37,113.11","$8,138.89","$52,001.00",$0.00,"$26,000.50","$41,184.79","$41,600.80",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27500003,EAP,HCPCS C1722,,1207-36 Current Vr Icd,"$43,036.00",$0.00,"$43,036.00","$19,366.20","$5,158.80",$0.00,"$7,414.89","$5,158.80","$30,714.79","$7,535.26","$43,036.00",$0.00,"$21,518.00","$34,084.51","$34,428.80",$0.00,"$6,735.13",$0.00,"$6,851.33",$0.00
27500004,EAP,HCPCS C1722,,"Aicd, Single Chamber",$0.01,$0.00,$0.01,$0.00,$0.01,$0.00,$0.00,$0.01,$0.01,$0.00,$0.01,$0.00,$0.01,$0.01,$0.01,$0.00,$0.00,$0.00,$0.00,$0.00
27500006,EAP,HCPCS C1779,,Capsurenovusfix Lead,"$8,340.00",$0.00,"$8,340.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,952.26",$0.00,"$8,340.00",$0.00,"$4,170.00","$6,605.28","$6,672.00",$0.00,$0.00,$0.00,$0.00,$0.00
27500007,EAP,HCPCS C1785,,Philos Dr Pacemaker,"$10,400.00",$0.00,"$10,400.00","$4,680.00","$5,158.80",$0.00,"$1,791.87","$5,158.80","$7,422.48","$1,820.96","$10,400.00",$0.00,"$5,200.00","$8,236.80","$8,320.00",$0.00,"$1,627.60",$0.00,"$1,655.68",$0.00
27500008,EAP,HCPCS C1785,,Rhaspsody Dr 2530 Pacemaker,"$14,582.00",$0.00,"$14,582.00","$6,561.90","$5,158.80",$0.00,"$2,512.41","$5,158.80","$10,407.17","$2,553.19","$14,582.00",$0.00,"$7,291.00","$11,548.94","$11,665.60",$0.00,"$2,282.08",$0.00,"$2,321.45",$0.00
27500009,EAP,HCPCS C1785,,5386 Identity Adx Xlr Pcmkr,"$12,195.00",$0.00,"$12,195.00","$5,487.75","$5,158.80",$0.00,"$2,101.14","$5,158.80","$8,703.57","$2,135.25","$12,195.00",$0.00,"$6,097.50","$9,658.44","$9,756.00",$0.00,"$1,908.52",$0.00,"$1,941.44",$0.00
27500010,EAP,HCPCS C1785,,Philos Ii Dr System,"$14,735.00",$0.00,"$14,735.00","$6,630.75","$5,158.80",$0.00,"$2,538.77","$5,158.80","$10,516.37","$2,579.98","$14,735.00",$0.00,"$7,367.50","$11,670.12","$11,788.00",$0.00,"$2,306.03",$0.00,"$2,345.81",$0.00
27500011,EAP,HCPCS C1785,,Sensia Dr Pacemaker,"$12,195.00",$0.00,"$12,195.00","$5,487.75","$5,158.80",$0.00,"$2,101.14","$5,158.80","$8,703.57","$2,135.25","$12,195.00",$0.00,"$6,097.50","$9,658.44","$9,756.00",$0.00,"$1,908.52",$0.00,"$1,941.44",$0.00
27500012,EAP,HCPCS C1785,,Symphony Dr 2550 Pacemaker,"$15,349.00",$0.00,"$15,349.00","$6,907.05","$5,158.80",$0.00,"$2,644.56","$5,158.80","$10,954.58","$2,687.49","$15,349.00",$0.00,"$7,674.50","$12,156.41","$12,279.20",$0.00,"$2,402.12",$0.00,"$2,443.56",$0.00
27500013,EAP,HCPCS C1785,,Repy Dr Pacemaker,"$15,063.00",$0.00,"$15,063.00","$6,778.35","$5,158.80",$0.00,"$2,595.28","$5,158.80","$10,750.46","$2,637.41","$15,063.00",$0.00,"$7,531.50","$11,929.90","$12,050.40",$0.00,"$2,357.36",$0.00,"$2,398.03",$0.00
27500014,EAP,HCPCS C1785,,Cylos Dr/cls Pacemaker,"$12,195.00",$0.00,"$12,195.00","$5,487.75","$5,158.80",$0.00,"$2,101.14","$5,158.80","$8,703.57","$2,135.25","$12,195.00",$0.00,"$6,097.50","$9,658.44","$9,756.00",$0.00,"$1,908.52",$0.00,"$1,941.44",$0.00
27500015,EAP,HCPCS C1785,,Adapta Dr Pacemaker,"$16,139.00",$0.00,"$16,139.00","$7,262.55","$5,158.80",$0.00,"$2,780.67","$5,158.80","$11,518.40","$2,825.81","$16,139.00",$0.00,"$8,069.50","$12,782.09","$12,911.20",$0.00,"$2,525.75",$0.00,"$2,569.33",$0.00
27500016,EAP,HCPCS C1785,,Philos Dr System,"$12,195.00",$0.00,"$12,195.00","$5,487.75","$5,158.80",$0.00,"$2,101.14","$5,158.80","$8,703.57","$2,135.25","$12,195.00",$0.00,"$6,097.50","$9,658.44","$9,756.00",$0.00,"$1,908.52",$0.00,"$1,941.44",$0.00
27500017,EAP,HCPCS C1785,,Rhaspsody Dr 2530 System,"$16,497.00",$0.00,"$16,497.00","$7,423.65","$5,158.80",$0.00,"$2,842.35","$5,158.80","$11,773.91","$2,888.49","$16,497.00",$0.00,"$8,248.50","$13,065.62","$13,197.60",$0.00,"$2,581.78",$0.00,"$2,626.32",$0.00
27500018,EAP,HCPCS C1785,,Symphony Dr 2550 System,"$18,420.00",$0.00,"$18,420.00","$8,289.00","$5,158.80",$0.00,"$3,173.67","$5,158.80","$13,146.35","$3,225.19","$18,420.00",$0.00,"$9,210.00","$14,588.64","$14,736.00",$0.00,"$2,882.73",$0.00,"$2,932.46",$0.00
27500019,EAP,HCPCS C1785,,Reply Dr System,"$17,932.00",$0.00,"$17,932.00","$8,069.40","$5,158.80",$0.00,"$3,089.59","$5,158.80","$12,798.07","$3,139.75","$17,932.00",$0.00,"$8,966.00","$14,202.14","$14,345.60",$0.00,"$2,806.36",$0.00,"$2,854.77",$0.00
27500020,EAP,HCPCS C1785,,Cylos Dr/cls System,"$15,063.00",$0.00,"$15,063.00","$6,778.35","$5,158.80",$0.00,"$2,595.28","$5,158.80","$10,750.46","$2,637.41","$15,063.00",$0.00,"$7,531.50","$11,929.90","$12,050.40",$0.00,"$2,357.36",$0.00,"$2,398.03",$0.00
27500021,EAP,HCPCS C1785,,S403 Altrua Pacemaker,"$22,045.00",$0.00,"$22,045.00","$9,920.25","$5,158.80",$0.00,"$3,798.24","$5,158.80","$15,733.52","$3,859.90","$22,045.00",$0.00,"$11,022.50","$17,459.64","$17,636.00",$0.00,"$3,450.04",$0.00,"$3,509.56",$0.00
27500024,EAP,HCPCS C1786,,Sensia Sr Pacemaker,"$11,110.00",$0.00,"$11,110.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$7,929.21",$0.00,"$11,110.00",$0.00,"$5,555.00","$8,799.12","$8,888.00",$0.00,$0.00,$0.00,$0.00,$0.00
27500025,EAP,HCPCS C1786,,Rhapsody Sr 2210 Pacemaker,"$11,130.00",$0.00,"$11,130.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$7,943.48",$0.00,"$11,130.00",$0.00,"$5,565.00","$8,814.96","$8,904.00",$0.00,$0.00,$0.00,$0.00,$0.00
27500026,EAP,HCPCS C1786,,Philos Sr Pacemaker,"$11,130.00",$0.00,"$11,130.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$7,943.48",$0.00,"$11,130.00",$0.00,"$5,565.00","$8,814.96","$8,904.00",$0.00,$0.00,$0.00,$0.00,$0.00
27500027,EAP,HCPCS C1786,,Rhapsody Sr 2210 System,"$11,835.00",$0.00,"$11,835.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$8,446.64",$0.00,"$11,835.00",$0.00,"$5,917.50","$9,373.32","$9,468.00",$0.00,$0.00,$0.00,$0.00,$0.00
27500028,EAP,HCPCS C1786,,Philos Sr System,"$12,664.00",$0.00,"$12,664.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,038.30",$0.00,"$12,664.00",$0.00,"$6,332.00","$10,029.89","$10,131.20",$0.00,$0.00,$0.00,$0.00,$0.00
27500029,EAP,HCPCS C1786,,Philos Ii Sr Pacemaker,"$12,854.00",$0.00,"$12,854.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,173.90",$0.00,"$12,854.00",$0.00,"$6,427.00","$10,180.37","$10,283.20",$0.00,$0.00,$0.00,$0.00,$0.00
27500030,EAP,HCPCS C1786,,Sympnony Sr 2550 Pacemaker,"$13,047.00",$0.00,"$13,047.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,311.64",$0.00,"$13,047.00",$0.00,"$6,523.50","$10,333.22","$10,437.60",$0.00,$0.00,$0.00,$0.00,$0.00
27500031,EAP,HCPCS C1786,,Phillos Ii Sr Pcmkr Syst,"$13,813.00",$0.00,"$13,813.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,858.34",$0.00,"$13,813.00",$0.00,"$6,906.50","$10,939.90","$11,050.40",$0.00,$0.00,$0.00,$0.00,$0.00
27500032,EAP,HCPCS C1786,,Symphony Sr 2550 System,"$13,628.00",$0.00,"$13,628.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,726.30",$0.00,"$13,628.00",$0.00,"$6,814.00","$10,793.38","$10,902.40",$0.00,$0.00,$0.00,$0.00,$0.00
27500033,EAP,HCPCS C1786,,Cylos Vr/cls Pacemaker,"$12,195.00",$0.00,"$12,195.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$8,703.57",$0.00,"$12,195.00",$0.00,"$6,097.50","$9,658.44","$9,756.00",$0.00,$0.00,$0.00,$0.00,$0.00
27500034,EAP,HCPCS C1786,,Reply Sr System,"$16,497.00",$0.00,"$16,497.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$11,773.91",$0.00,"$16,497.00",$0.00,"$8,248.50","$13,065.62","$13,197.60",$0.00,$0.00,$0.00,$0.00,$0.00
27500035,EAP,HCPCS C1786,,Cylos Vr/cls System,"$13,628.00",$0.00,"$13,628.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,726.30",$0.00,"$13,628.00",$0.00,"$6,814.00","$10,793.38","$10,902.40",$0.00,$0.00,$0.00,$0.00,$0.00
27500036,EAP,HCPCS C1786,,Reply Sr System,"$16,497.00",$0.00,"$16,497.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$11,773.91",$0.00,"$16,497.00",$0.00,"$8,248.50","$13,065.62","$13,197.60",$0.00,$0.00,$0.00,$0.00,$0.00
27500039,EAP,HCPCS C1898,,1688tc Pacemaker Lead,"$1,793.00",$0.00,"$1,793.00",$806.85,"$1,279.66",$0.00,$308.92,"$1,279.66","$1,279.66",$313.94,"$1,793.00",$0.00,$896.50,"$1,420.06","$1,434.40",$0.00,$280.60,$0.00,$285.45,$0.00
27500040,EAP,HCPCS C1898,,Tendril St Pkg Lead,"$1,920.00",$0.00,"$1,920.00",$864.00,"$1,370.30",$0.00,$330.81,"$1,370.30","$1,370.30",$336.18,"$1,920.00",$0.00,$960.00,"$1,520.64","$1,536.00",$0.00,$300.48,$0.00,$305.66,$0.00
27500041,EAP,HCPCS C1898,,Tendril 1688 Lead,"$1,793.00",$0.00,"$1,793.00",$806.85,"$1,279.66",$0.00,$308.92,"$1,279.66","$1,279.66",$313.94,"$1,793.00",$0.00,$896.50,"$1,420.06","$1,434.40",$0.00,$280.60,$0.00,$285.45,$0.00
27500042,EAP,HCPCS C1898,,Tendril Sdx Lead,"$1,793.00",$0.00,"$1,793.00",$806.85,"$1,279.66",$0.00,$308.92,"$1,279.66","$1,279.66",$313.94,"$1,793.00",$0.00,$896.50,"$1,420.06","$1,434.40",$0.00,$280.60,$0.00,$285.45,$0.00
27500043,EAP,HCPCS C1898,,Tendril St 1700 Lead,"$1,793.00",$0.00,"$1,793.00",$806.85,"$1,279.66",$0.00,$308.92,"$1,279.66","$1,279.66",$313.94,"$1,793.00",$0.00,$896.50,"$1,420.06","$1,434.40",$0.00,$280.60,$0.00,$285.45,$0.00
27500044,EAP,HCPCS C1900,,Coronary Sinus Lead System,"$1,920.00",$0.00,"$1,920.00",$0.00,"$1,370.30",$0.00,$330.81,"$1,370.30","$1,370.30",$0.00,"$1,920.00",$0.00,$960.00,"$1,520.64","$1,536.00",$0.00,$300.48,$0.00,$0.00,$0.00
27500045,EAP,HCPCS C1900,,Scout Pro Lead System,"$1,920.00",$0.00,"$1,920.00",$0.00,"$1,370.30",$0.00,$330.81,"$1,370.30","$1,370.30",$0.00,"$1,920.00",$0.00,$960.00,"$1,520.64","$1,536.00",$0.00,$300.48,$0.00,$0.00,$0.00
27500046,EAP,HCPCS C1900,,Corox Bipolar Lead,"$5,739.00",$0.00,"$5,739.00",$0.00,"$4,095.92",$0.00,$988.80,"$4,095.92","$4,095.92",$0.00,"$5,739.00",$0.00,"$2,869.50","$4,545.29","$4,591.20",$0.00,$898.15,$0.00,$0.00,$0.00
27500047,EAP,HCPCS C1900,,Corox Unipolar Lead,"$5,739.00",$0.00,"$5,739.00",$0.00,"$4,095.92",$0.00,$988.80,"$4,095.92","$4,095.92",$0.00,"$5,739.00",$0.00,"$2,869.50","$4,545.29","$4,591.20",$0.00,$898.15,$0.00,$0.00,$0.00
27500055,EAP,HCPCS C1882,,Crt-d Dtba1qq Viva Quad Xt Us Is4 Df4 Crt,"$50,260.00",$0.00,"$50,260.00","$22,617.00","$5,158.80",$0.00,"$8,138.89","$5,158.80","$35,870.56","$8,138.89","$50,260.00",$0.00,"$25,130.00","$39,805.92","$40,208.00",$0.00,"$7,751.33",$0.00,"$8,001.39",$0.00
27500056,EAP,HCPCS C1882,,Dfbr Crd Viva Qd Xt Crt-d Icd Df-1 Biphasic Wvfrm 35ml 80gm,"$50,228.00",$0.00,"$50,228.00","$22,602.60","$5,158.80",$0.00,"$8,138.89","$5,158.80","$35,847.72","$8,138.89","$50,228.00",$0.00,"$25,114.00","$39,780.58","$40,182.40",$0.00,"$7,751.33",$0.00,"$7,996.30",$0.00
27500057,EAP,HCPCS C1882,,Dfbr Crd Viva Crt D Qd S Is-4 Df1 Us,"$47,766.00",$0.00,"$47,766.00","$21,494.70","$5,158.80",$0.00,"$8,138.89","$5,158.80","$34,090.59","$8,138.89","$47,766.00",$0.00,"$23,883.00","$37,830.67","$38,212.80",$0.00,"$7,475.38",$0.00,"$7,604.35",$0.00
27500058,EAP,HCPCS C1882,,Dfbr Crd Viva Crt D Qd S Is-4 Df4 Us,"$47,766.00",$0.00,"$47,766.00","$21,494.70","$5,158.80",$0.00,"$8,138.89","$5,158.80","$34,090.59","$8,138.89","$47,766.00",$0.00,"$23,883.00","$37,830.67","$38,212.80",$0.00,"$7,475.38",$0.00,"$7,604.35",$0.00
27500059,EAP,HCPCS C1900,,Lead Attain Performa Usa Crt,"$5,840.00",$0.00,"$5,840.00",$0.00,"$4,168.01",$0.00,"$1,006.20","$4,168.01","$4,168.01",$0.00,"$5,840.00",$0.00,"$2,920.00","$4,625.28","$4,672.00",$0.00,$913.96,$0.00,$0.00,$0.00
27500060,EAP,HCPCS C1900,,Attain Bipoldr Lead,"$6,276.00",$0.00,"$6,276.00",$0.00,"$4,479.18",$0.00,"$1,081.32","$4,479.18","$4,479.18",$0.00,"$6,276.00",$0.00,"$3,138.00","$4,970.59","$5,020.80",$0.00,$982.19,$0.00,$0.00,$0.00
27500062,EAP,HCPCS C1900,,Lv Quickflex Lead,"$5,739.00",$0.00,"$5,739.00",$0.00,"$4,095.92",$0.00,$988.80,"$4,095.92","$4,095.92",$0.00,"$5,739.00",$0.00,"$2,869.50","$4,545.29","$4,591.20",$0.00,$898.15,$0.00,$0.00,$0.00
27500063,EAP,HCPCS C1900,,Lv Quicksite Leads,"$5,739.00",$0.00,"$5,739.00",$0.00,"$4,095.92",$0.00,$988.80,"$4,095.92","$4,095.92",$0.00,"$5,739.00",$0.00,"$2,869.50","$4,545.29","$4,591.20",$0.00,$898.15,$0.00,$0.00,$0.00
27500070,EAP,HCPCS C1786,,Zepher Dr Pacemaker,"$14,346.00",$0.00,"$14,346.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$10,238.74",$0.00,"$14,346.00",$0.00,"$7,173.00","$11,362.03","$11,476.80",$0.00,$0.00,$0.00,$0.00,$0.00
27500078,EAP,HCPCS C1721,,Teligen Rf He Dr Dual Icd,"$50,042.00",$0.00,"$50,042.00","$22,518.90","$5,158.80",$0.00,"$8,138.89","$5,158.80","$35,714.98","$8,138.89","$50,042.00",$0.00,"$25,021.00","$39,633.26","$40,033.60",$0.00,"$7,751.33",$0.00,"$7,966.69",$0.00
27500079,EAP,HCPCS C1721,,Confient Rf He Dual Icd,"$41,702.00",$0.00,"$41,702.00","$18,765.90","$5,158.80",$0.00,"$7,185.05","$5,158.80","$29,762.72","$7,301.69","$41,702.00",$0.00,"$20,851.00","$33,027.98","$33,361.60",$0.00,"$6,526.36",$0.00,"$6,638.96",$0.00
27500080,EAP,HCPCS C1722,,Teligen Rf He Vr Icd,"$41,702.00",$0.00,"$41,702.00","$18,765.90","$5,158.80",$0.00,"$7,185.05","$5,158.80","$29,762.72","$7,301.69","$41,702.00",$0.00,"$20,851.00","$33,027.98","$33,361.60",$0.00,"$6,526.36",$0.00,"$6,638.96",$0.00
27500081,EAP,HCPCS C1722,,Vitality 2 El Vr Icd,"$38,365.00",$0.00,"$38,365.00","$17,264.25","$5,158.80",$0.00,"$6,610.10","$5,158.80","$27,381.10","$6,717.40","$38,365.00",$0.00,"$19,182.50","$30,385.08","$30,692.00",$0.00,"$6,004.12",$0.00,"$6,107.71",$0.00
27500082,EAP,HCPCS C1786,,Altrua 40 Sr Pacemaker,"$11,343.00",$0.00,"$11,343.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$8,095.50",$0.00,"$11,343.00",$0.00,"$5,671.50","$8,983.66","$9,074.40",$0.00,$0.00,$0.00,$0.00,$0.00
27500083,EAP,HCPCS C1785,,Altrua 40 Dr El Dual Pacemaker,"$6,340.00",$0.00,"$6,340.00","$2,853.00","$4,524.86",$0.00,"$1,092.35","$4,524.86","$4,524.86","$1,110.08","$6,340.00",$0.00,"$3,170.00","$5,021.28","$5,072.00",$0.00,$992.21,$0.00,"$1,009.33",$0.00
27500084,EAP,HCPCS C1785,,Altrua 40 Dr Dual Pacemaker,"$6,340.00",$0.00,"$6,340.00","$2,853.00","$4,524.86",$0.00,"$1,092.35","$4,524.86","$4,524.86","$1,110.08","$6,340.00",$0.00,"$3,170.00","$5,021.28","$5,072.00",$0.00,$992.21,$0.00,"$1,009.33",$0.00
27500085,EAP,HCPCS C1882,,Cognis Rf He Crt-d,"$73,393.00",$0.00,"$73,393.00","$33,026.85","$5,158.80",$0.00,"$8,138.89","$5,158.80","$52,380.58","$8,138.89","$73,393.00",$0.00,"$36,696.50","$58,127.26","$58,714.40",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27500086,EAP,HCPCS C1882,,Livian Rf He Crt-d,"$56,714.00",$0.00,"$56,714.00","$25,521.30","$5,158.80",$0.00,"$8,138.89","$5,158.80","$40,476.78","$8,138.89","$56,714.00",$0.00,"$28,357.00","$44,917.49","$45,371.20",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27500087,EAP,HCPCS C1882,,Livian Rf Crt-d,"$56,714.00",$0.00,"$56,714.00","$25,521.30","$5,158.80",$0.00,"$8,138.89","$5,158.80","$40,476.78","$8,138.89","$56,714.00",$0.00,"$28,357.00","$44,917.49","$45,371.20",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27500088,EAP,HCPCS C1882,,Contak Renewal Tr Crt-p,"$21,350.00",$0.00,"$21,350.00","$9,607.50","$5,158.80",$0.00,"$3,678.50","$5,158.80","$15,237.50","$3,738.21","$21,350.00",$0.00,"$10,675.00","$16,909.20","$17,080.00",$0.00,"$3,341.28",$0.00,"$3,398.92",$0.00
27500089,EAP,HCPCS C1895,,Reliance G Af Lead,"$15,012.00",$0.00,"$15,012.00","$6,755.40","$5,158.80",$0.00,"$2,586.49","$5,158.80","$10,714.06","$2,628.48","$15,012.00",$0.00,"$7,506.00","$11,889.50","$12,009.60",$0.00,"$2,349.38",$0.00,"$2,389.91",$0.00
27500090,EAP,HCPCS C1895,,Reliance G Pf Lead,"$15,012.00",$0.00,"$15,012.00","$6,755.40","$5,158.80",$0.00,"$2,586.49","$5,158.80","$10,714.06","$2,628.48","$15,012.00",$0.00,"$7,506.00","$11,889.50","$12,009.60",$0.00,"$2,349.38",$0.00,"$2,389.91",$0.00
27500091,EAP,HCPCS C1895,,Relaince Af Lead,"$12,676.00",$0.00,"$12,676.00","$5,704.20","$5,158.80",$0.00,"$2,184.01","$5,158.80","$9,046.86","$2,219.47","$12,676.00",$0.00,"$6,338.00","$10,039.39","$10,140.80",$0.00,"$1,983.79",$0.00,"$2,018.02",$0.00
27500092,EAP,HCPCS C1895,,Relaince Pf Lead,"$12,676.00",$0.00,"$12,676.00","$5,704.20","$5,158.80",$0.00,"$2,184.01","$5,158.80","$9,046.86","$2,219.47","$12,676.00",$0.00,"$6,338.00","$10,039.39","$10,140.80",$0.00,"$1,983.79",$0.00,"$2,018.02",$0.00
27500093,EAP,HCPCS C1898,,"Myocardial Lead,pmkr,other Than Trans","$1,650.00",$0.00,"$1,650.00",$742.50,"$1,177.61",$0.00,$284.29,"$1,177.61","$1,177.61",$288.90,"$1,650.00",$0.00,$825.00,"$1,306.80","$1,320.00",$0.00,$258.23,$0.00,$262.68,$0.00
27500094,EAP,HCPCS C1898,,Flexion - Oscor Lead,"$1,650.00",$0.00,"$1,650.00",$742.50,"$1,177.61",$0.00,$284.29,"$1,177.61","$1,177.61",$288.90,"$1,650.00",$0.00,$825.00,"$1,306.80","$1,320.00",$0.00,$258.23,$0.00,$262.68,$0.00
27500095,EAP,HCPCS C1898,,"Fineline Ii Sterox Lead,pmkr,other Than Trans","$1,650.00",$0.00,"$1,650.00",$742.50,"$1,177.61",$0.00,$284.29,"$1,177.61","$1,177.61",$288.90,"$1,650.00",$0.00,$825.00,"$1,306.80","$1,320.00",$0.00,$258.23,$0.00,$262.68,$0.00
27500096,EAP,HCPCS C1898,,"Fineline Ii Sterox  Ez Lead,pmkr,other Than Trans","$1,650.00",$0.00,"$1,650.00",$742.50,"$1,177.61",$0.00,$284.29,"$1,177.61","$1,177.61",$288.90,"$1,650.00",$0.00,$825.00,"$1,306.80","$1,320.00",$0.00,$258.23,$0.00,$262.68,$0.00
27500097,EAP,HCPCS C1898,,"Flextend Lead,pmkr,other Than Trans","$1,650.00",$0.00,"$1,650.00",$742.50,"$1,177.61",$0.00,$284.29,"$1,177.61","$1,177.61",$288.90,"$1,650.00",$0.00,$825.00,"$1,306.80","$1,320.00",$0.00,$258.23,$0.00,$262.68,$0.00
27500098,EAP,HCPCS C1898,,"Dextrus Lead,pmkr,other Than Trans","$1,650.00",$0.00,"$1,650.00",$742.50,"$1,177.61",$0.00,$284.29,"$1,177.61","$1,177.61",$288.90,"$1,650.00",$0.00,$825.00,"$1,306.80","$1,320.00",$0.00,$258.23,$0.00,$262.68,$0.00
27500099,EAP,HCPCS C1900,,Acuity Steerable/spiral Lead,"$6,672.00",$0.00,"$6,672.00",$0.00,"$4,761.81",$0.00,"$1,149.55","$4,761.81","$4,761.81",$0.00,"$6,672.00",$0.00,"$3,336.00","$5,284.22","$5,337.60",$0.00,"$1,044.17",$0.00,$0.00,$0.00
27500100,EAP,HCPCS C1900,,Easytrack 3,"$5,004.00",$0.00,"$5,004.00",$0.00,"$3,571.35",$0.00,$862.16,"$3,571.35","$3,571.35",$0.00,"$5,004.00",$0.00,"$2,502.00","$3,963.17","$4,003.20",$0.00,$783.13,$0.00,$0.00,$0.00
27500101,EAP,HCPCS C1900,,Easytrack 2,"$5,004.00",$0.00,"$5,004.00",$0.00,"$3,571.35",$0.00,$862.16,"$3,571.35","$3,571.35",$0.00,"$5,004.00",$0.00,"$2,502.00","$3,963.17","$4,003.20",$0.00,$783.13,$0.00,$0.00,$0.00
27500102,EAP,HCPCS C1721,,Evera Mri Xt Dr Device- Single Chamber,"$41,500.00",$0.00,"$41,500.00","$18,675.00","$5,158.80",$0.00,"$7,150.24","$5,158.80","$29,618.55","$7,266.32","$41,500.00",$0.00,"$20,750.00","$32,868.00","$33,200.00",$0.00,"$6,494.75",$0.00,"$6,606.80",$0.00
27500103,EAP,HCPCS C1722,,Evera Mri Xt Vr Device - Dual Chamber,"$36,500.00",$0.00,"$36,500.00","$19,819.50","$5,158.80",$0.00,"$6,288.77","$5,158.80","$5,158.80","$6,390.86","$36,500.00",$0.00,"$18,250.00","$28,908.00","$29,200.00",$0.00,"$5,712.25",$0.00,"$5,810.80",$0.00
27500105,EAP,HCPCS C1721,,Fortify Assura Dr 40 Df4 Con Icd/defib/resync,$0.01,$0.00,$0.01,$0.00,$0.01,$0.00,$0.00,$0.01,$0.01,$0.00,$0.01,$0.00,$0.01,$0.01,$0.01,$0.00,$0.00,$0.00,$0.00,$0.00
27500106,EAP,HCPCS C1722,,Drbr Crd Visia Af Mri Df4 Vr,$0.01,$0.00,$0.01,$0.00,$0.01,$0.00,$0.00,$0.01,$0.01,$0.00,$0.01,$0.00,$0.01,$0.01,$0.01,$0.00,$0.00,$0.00,$0.00,$0.00
27500150,EAP,HCPCS C1785,,"Pacemaker, Dual Accent Dr","$19,351.00",$0.00,"$19,351.00","$8,707.95","$5,158.80",$0.00,"$3,334.08","$5,158.80","$13,810.81","$3,388.21","$19,351.00",$0.00,"$9,675.50","$15,325.99","$15,480.80",$0.00,"$3,028.43",$0.00,"$3,080.68",$0.00
27500151,EAP,HCPCS C1786,,"Pacemaker, Single Accent Sr","$17,681.00",$0.00,"$17,681.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$12,618.93",$0.00,"$17,681.00",$0.00,"$8,840.50","$14,003.35","$14,144.80",$0.00,$0.00,$0.00,$0.00,$0.00
27500152,EAP,HCPCS C2621,,"Pacemaker, Bi-v Anthem Crt-p","$11,209.00",$0.00,"$11,209.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$7,999.86",$0.00,"$11,209.00",$0.00,"$5,604.50","$8,877.53","$8,967.20",$0.00,$0.00,$0.00,$0.00,$0.00
27500153,EAP,HCPCS C1898,,Lead Pcng 45cm Bipol Act Fix Solia S Strd Elut,"$1,125.00",$0.00,"$1,125.00",$506.25,$802.91,$0.00,$193.83,$802.91,$802.91,$196.98,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$176.06,$0.00,$179.10,$0.00
27500154,EAP,HCPCS C1898,,Lead Pcng 53cm Solia S Ecrdl Strd Elute Bipol Act,"$1,125.00",$0.00,"$1,125.00",$506.25,$802.91,$0.00,$193.83,$802.91,$802.91,$196.98,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$176.06,$0.00,$179.10,$0.00
27500155,EAP,HCPCS C1898,,Lead Pcng 60cm Promri Solia S Strd Elut,"$1,125.00",$0.00,"$1,125.00",$506.25,$802.91,$0.00,$193.83,$802.91,$802.91,$196.98,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$176.06,$0.00,$179.10,$0.00
27500160,EAP,HCPCS C1898,,Myopore Epicardial Lead 35 Cm,"$1,330.00",$0.00,"$1,330.00",$598.50,$949.22,$0.00,$229.15,$949.22,$949.22,$232.87,"$1,330.00",$0.00,$665.00,"$1,053.36","$1,064.00",$0.00,$208.15,$0.00,$211.74,$0.00
27500162,EAP,HCPCS C1882,,Pacemaker Crd Viva Crt-p,"$28,585.00",$0.00,"$28,585.00","$12,863.25","$5,158.80",$0.00,"$4,925.05","$5,158.80","$20,401.11","$5,005.00","$28,585.00",$0.00,"$14,292.50","$22,639.32","$22,868.00",$0.00,"$4,473.55",$0.00,"$4,550.73",$0.00
27500163,EAP,HCPCS C1786,,Pacemaker Crd Advisa Sr Mr Surescan 1 Chmbr Unplr,"$11,000.00",$0.00,"$11,000.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$7,850.70",$0.00,"$11,000.00",$0.00,"$5,500.00","$8,712.00","$8,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
27500200,EAP,HCPCS C1786,,Reply Sr System,"$11,822.00",$0.00,"$11,822.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$8,437.36",$0.00,"$11,822.00",$0.00,"$5,911.00","$9,363.02","$9,457.60",$0.00,$0.00,$0.00,$0.00,$0.00
27500201,EAP,HCPCS C1786,,Reply Sr,"$10,344.00",$0.00,"$10,344.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$7,382.51",$0.00,"$10,344.00",$0.00,"$5,172.00","$8,192.45","$8,275.20",$0.00,$0.00,$0.00,$0.00,$0.00
27500202,EAP,HCPCS C1722,,Paradym Rf Crt 9750 System,"$71,524.00",$0.00,"$71,524.00","$32,185.80","$5,158.80",$0.00,"$8,138.89","$5,158.80","$51,046.68","$8,138.89","$71,524.00",$0.00,"$35,762.00","$56,647.01","$57,219.20",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27500203,EAP,HCPCS C1722,,Paradym Rf Crt 9750,"$53,791.00",$0.00,"$53,791.00","$24,205.95","$5,158.80",$0.00,"$8,138.89","$5,158.80","$38,390.64","$8,138.89","$53,791.00",$0.00,"$26,895.50","$42,602.47","$43,032.80",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27500204,EAP,HCPCS C1722,,Paradym 9250 Rf Vr,"$39,900.00",$0.00,"$39,900.00","$17,955.00","$5,158.80",$0.00,"$6,874.57","$5,158.80","$28,476.63","$6,986.17","$39,900.00",$0.00,"$19,950.00","$31,600.80","$31,920.00",$0.00,"$6,244.35",$0.00,"$6,352.08",$0.00
27500205,EAP,HCPCS C1900,,Quickflex+++pmm#:89271,"$4,729.00",$0.00,"$4,729.00",$0.00,"$3,375.09",$0.00,$814.78,"$3,375.09","$3,375.09",$0.00,"$4,729.00",$0.00,"$2,364.50","$3,745.37","$3,783.20",$0.00,$740.09,$0.00,$0.00,$0.00
27500206,EAP,HCPCS C1900,,Quickflex+++pmm#:89272,"$4,729.00",$0.00,"$4,729.00",$0.00,"$3,375.09",$0.00,$814.78,"$3,375.09","$3,375.09",$0.00,"$4,729.00",$0.00,"$2,364.50","$3,745.37","$3,783.20",$0.00,$740.09,$0.00,$0.00,$0.00
27500207,EAP,HCPCS C1900,,Quickflex+++pmm#:89273,"$4,729.00",$0.00,"$4,729.00",$0.00,"$3,375.09",$0.00,$814.78,"$3,375.09","$3,375.09",$0.00,"$4,729.00",$0.00,"$2,364.50","$3,745.37","$3,783.20",$0.00,$740.09,$0.00,$0.00,$0.00
27500208,EAP,HCPCS C1900,,Quickflex Micro,"$5,202.00",$0.00,"$5,202.00",$0.00,"$3,712.67",$0.00,$896.28,"$3,712.67","$3,712.67",$0.00,"$5,202.00",$0.00,"$2,601.00","$4,119.98","$4,161.60",$0.00,$814.11,$0.00,$0.00,$0.00
27500209,EAP,HCPCS C1900,,Quickflex Micro,"$5,202.00",$0.00,"$5,202.00",$0.00,"$3,712.67",$0.00,$896.28,"$3,712.67","$3,712.67",$0.00,"$5,202.00",$0.00,"$2,601.00","$4,119.98","$4,161.60",$0.00,$814.11,$0.00,$0.00,$0.00
27500210,EAP,HCPCS C1898,,Optisense,"$1,330.00",$0.00,"$1,330.00",$598.50,$949.22,$0.00,$229.15,$949.22,$949.22,$232.87,"$1,330.00",$0.00,$665.00,"$1,053.36","$1,064.00",$0.00,$208.15,$0.00,$211.74,$0.00
27500211,EAP,HCPCS C1898,,Optisense,"$1,330.00",$0.00,"$1,330.00",$598.50,$949.22,$0.00,$229.15,$949.22,$949.22,$232.87,"$1,330.00",$0.00,$665.00,"$1,053.36","$1,064.00",$0.00,$208.15,$0.00,$211.74,$0.00
27500212,EAP,HCPCS C1898,,Optisense+++pmm#:89078,"$1,478.00",$0.00,"$1,478.00",$665.10,"$1,054.85",$0.00,$254.65,"$1,054.85","$1,054.85",$258.79,"$1,478.00",$0.00,$739.00,"$1,170.58","$1,182.40",$0.00,$231.31,$0.00,$235.30,$0.00
27500213,EAP,HCPCS C1898,,Optisense,"$1,330.00",$0.00,"$1,330.00",$598.50,$949.22,$0.00,$229.15,$949.22,$949.22,$232.87,"$1,330.00",$0.00,$665.00,"$1,053.36","$1,064.00",$0.00,$208.15,$0.00,$211.74,$0.00
27500214,EAP,HCPCS C1898,,Optisense,"$1,330.00",$0.00,"$1,330.00",$598.50,$949.22,$0.00,$229.15,$949.22,$949.22,$232.87,"$1,330.00",$0.00,$665.00,"$1,053.36","$1,064.00",$0.00,$208.15,$0.00,$211.74,$0.00
27500215,EAP,HCPCS C1898,,Tendril St Optim,"$1,330.00",$0.00,"$1,330.00",$598.50,$949.22,$0.00,$229.15,$949.22,$949.22,$232.87,"$1,330.00",$0.00,$665.00,"$1,053.36","$1,064.00",$0.00,$208.15,$0.00,$211.74,$0.00
27500216,EAP,HCPCS C1898,,Tendril St Optim,"$1,330.00",$0.00,"$1,330.00",$598.50,$949.22,$0.00,$229.15,$949.22,$949.22,$232.87,"$1,330.00",$0.00,$665.00,"$1,053.36","$1,064.00",$0.00,$208.15,$0.00,$211.74,$0.00
27500217,EAP,HCPCS C1898,,Tendril St Optim,"$1,330.00",$0.00,"$1,330.00",$598.50,$949.22,$0.00,$229.15,$949.22,$949.22,$232.87,"$1,330.00",$0.00,$665.00,"$1,053.36","$1,064.00",$0.00,$208.15,$0.00,$211.74,$0.00
27500218,EAP,HCPCS C1898,,Isoflex Optim,"$1,330.00",$0.00,"$1,330.00",$598.50,$949.22,$0.00,$229.15,$949.22,$949.22,$232.87,"$1,330.00",$0.00,$665.00,"$1,053.36","$1,064.00",$0.00,$208.15,$0.00,$211.74,$0.00
27500219,EAP,HCPCS C1898,,Isoflex Optim,"$1,330.00",$0.00,"$1,330.00",$598.50,$949.22,$0.00,$229.15,$949.22,$949.22,$232.87,"$1,330.00",$0.00,$665.00,"$1,053.36","$1,064.00",$0.00,$208.15,$0.00,$211.74,$0.00
27500220,EAP,HCPCS C1898,,Isoflex Optim,"$1,330.00",$0.00,"$1,330.00",$598.50,$949.22,$0.00,$229.15,$949.22,$949.22,$232.87,"$1,330.00",$0.00,$665.00,"$1,053.36","$1,064.00",$0.00,$208.15,$0.00,$211.74,$0.00
27500221,EAP,HCPCS C1898,,Isoflex Optim,"$1,330.00",$0.00,"$1,330.00",$598.50,$949.22,$0.00,$229.15,$949.22,$949.22,$232.87,"$1,330.00",$0.00,$665.00,"$1,053.36","$1,064.00",$0.00,$208.15,$0.00,$211.74,$0.00
27500222,EAP,HCPCS C1898,,Isoflex Optim,"$1,330.00",$0.00,"$1,330.00",$598.50,$949.22,$0.00,$229.15,$949.22,$949.22,$232.87,"$1,330.00",$0.00,$665.00,"$1,053.36","$1,064.00",$0.00,$208.15,$0.00,$211.74,$0.00
27500223,EAP,HCPCS C1786,,5157m/s,"$10,344.00",$0.00,"$10,344.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$7,382.51",$0.00,"$10,344.00",$0.00,"$5,172.00","$8,192.45","$8,275.20",$0.00,$0.00,$0.00,$0.00,$0.00
27500224,EAP,HCPCS C1785,,5357m/s,"$11,822.00",$0.00,"$11,822.00","$5,319.90","$5,158.80",$0.00,"$2,036.87","$5,158.80","$8,437.36","$2,069.94","$11,822.00",$0.00,"$5,911.00","$9,363.02","$9,457.60",$0.00,"$1,850.14",$0.00,"$1,882.06",$0.00
27500225,EAP,HCPCS C1895,,Durata,"$11,822.00",$0.00,"$11,822.00","$5,319.90","$5,158.80",$0.00,"$2,036.87","$5,158.80","$8,437.36","$2,069.94","$11,822.00",$0.00,"$5,911.00","$9,363.02","$9,457.60",$0.00,"$1,850.14",$0.00,"$1,882.06",$0.00
27500226,EAP,HCPCS C1895,,Durata,"$11,822.00",$0.00,"$11,822.00","$5,319.90","$5,158.80",$0.00,"$2,036.87","$5,158.80","$8,437.36","$2,069.94","$11,822.00",$0.00,"$5,911.00","$9,363.02","$9,457.60",$0.00,"$1,850.14",$0.00,"$1,882.06",$0.00
27500227,EAP,HCPCS C1895,,Durata+++pmm#:87533,"$12,413.00",$0.00,"$12,413.00","$5,585.85","$5,158.80",$0.00,"$2,138.70","$5,158.80","$8,859.16","$2,173.42","$12,413.00",$0.00,"$6,206.50","$9,831.10","$9,930.40",$0.00,"$1,942.63",$0.00,"$1,976.15",$0.00
27500228,EAP,HCPCS C1895,,Durata,"$11,822.00",$0.00,"$11,822.00","$5,319.90","$5,158.80",$0.00,"$2,036.87","$5,158.80","$8,437.36","$2,069.94","$11,822.00",$0.00,"$5,911.00","$9,363.02","$9,457.60",$0.00,"$1,850.14",$0.00,"$1,882.06",$0.00
27500229,EAP,HCPCS C1895,,Durata,"$11,822.00",$0.00,"$11,822.00","$5,319.90","$5,158.80",$0.00,"$2,036.87","$5,158.80","$8,437.36","$2,069.94","$11,822.00",$0.00,"$5,911.00","$9,363.02","$9,457.60",$0.00,"$1,850.14",$0.00,"$1,882.06",$0.00
27500230,EAP,HCPCS C1895,,Durata Df4 - Active Tbp Single Shock,"$11,822.00",$0.00,"$11,822.00","$5,319.90","$5,158.80",$0.00,"$2,036.87","$5,158.80","$8,437.36","$2,069.94","$11,822.00",$0.00,"$5,911.00","$9,363.02","$9,457.60",$0.00,"$1,850.14",$0.00,"$1,882.06",$0.00
27500231,EAP,HCPCS C1895,,Durata Df4 - Active Tbp Single Shock,"$11,822.00",$0.00,"$11,822.00","$5,319.90","$5,158.80",$0.00,"$2,036.87","$5,158.80","$8,437.36","$2,069.94","$11,822.00",$0.00,"$5,911.00","$9,363.02","$9,457.60",$0.00,"$1,850.14",$0.00,"$1,882.06",$0.00
27500232,EAP,HCPCS C1895,,Durata Df4 - Active Tbp Single Shock,"$11,822.00",$0.00,"$11,822.00","$5,319.90","$5,158.80",$0.00,"$2,036.87","$5,158.80","$8,437.36","$2,069.94","$11,822.00",$0.00,"$5,911.00","$9,363.02","$9,457.60",$0.00,"$1,850.14",$0.00,"$1,882.06",$0.00
27500233,EAP,HCPCS C1895,,Durata,"$11,822.00",$0.00,"$11,822.00","$5,319.90","$5,158.80",$0.00,"$2,036.87","$5,158.80","$8,437.36","$2,069.94","$11,822.00",$0.00,"$5,911.00","$9,363.02","$9,457.60",$0.00,"$1,850.14",$0.00,"$1,882.06",$0.00
27500234,EAP,HCPCS C1895,,Durata,"$11,822.00",$0.00,"$11,822.00","$5,319.90","$5,158.80",$0.00,"$2,036.87","$5,158.80","$8,437.36","$2,069.94","$11,822.00",$0.00,"$5,911.00","$9,363.02","$9,457.60",$0.00,"$1,850.14",$0.00,"$1,882.06",$0.00
27500235,EAP,HCPCS C1895,,Durata,"$11,822.00",$0.00,"$11,822.00","$5,319.90","$5,158.80",$0.00,"$2,036.87","$5,158.80","$8,437.36","$2,069.94","$11,822.00",$0.00,"$5,911.00","$9,363.02","$9,457.60",$0.00,"$1,850.14",$0.00,"$1,882.06",$0.00
27500236,EAP,HCPCS C1895,,Durata+++pmm#:96295,"$12,413.00",$0.00,"$12,413.00","$5,585.85","$5,158.80",$0.00,"$2,138.70","$5,158.80","$8,859.16","$2,173.42","$12,413.00",$0.00,"$6,206.50","$9,831.10","$9,930.40",$0.00,"$1,942.63",$0.00,"$1,976.15",$0.00
27500237,EAP,HCPCS C1895,,Durata+++pmm#:96296,"$12,413.00",$0.00,"$12,413.00","$5,585.85","$5,158.80",$0.00,"$2,138.70","$5,158.80","$8,859.16","$2,173.42","$12,413.00",$0.00,"$6,206.50","$9,831.10","$9,930.40",$0.00,"$1,942.63",$0.00,"$1,976.15",$0.00
27500238,EAP,HCPCS C1895,,Durata,"$11,822.00",$0.00,"$11,822.00","$5,319.90","$5,158.80",$0.00,"$2,036.87","$5,158.80","$8,437.36","$2,069.94","$11,822.00",$0.00,"$5,911.00","$9,363.02","$9,457.60",$0.00,"$1,850.14",$0.00,"$1,882.06",$0.00
27500239,EAP,HCPCS C1895,,Durata Sj4 - Passive,"$12,413.00",$0.00,"$12,413.00","$5,585.85","$5,158.80",$0.00,"$2,138.70","$5,158.80","$8,859.16","$2,173.42","$12,413.00",$0.00,"$6,206.50","$9,831.10","$9,930.40",$0.00,"$1,942.63",$0.00,"$1,976.15",$0.00
27500240,EAP,HCPCS C1895,,Durata Df4 - Passive Tbp Dual Shock,"$11,822.00",$0.00,"$11,822.00","$5,319.90","$5,158.80",$0.00,"$2,036.87","$5,158.80","$8,437.36","$2,069.94","$11,822.00",$0.00,"$5,911.00","$9,363.02","$9,457.60",$0.00,"$1,850.14",$0.00,"$1,882.06",$0.00
27500241,EAP,HCPCS C1895,,Durata Df4 - Passive Tbp Dual Shock,"$11,822.00",$0.00,"$11,822.00","$5,319.90","$5,158.80",$0.00,"$2,036.87","$5,158.80","$8,437.36","$2,069.94","$11,822.00",$0.00,"$5,911.00","$9,363.02","$9,457.60",$0.00,"$1,850.14",$0.00,"$1,882.06",$0.00
27500242,EAP,HCPCS C1895,,Durata Sj4 - Passive,"$12,413.00",$0.00,"$12,413.00","$5,585.85","$5,158.80",$0.00,"$2,138.70","$5,158.80","$8,859.16","$2,173.42","$12,413.00",$0.00,"$6,206.50","$9,831.10","$9,930.40",$0.00,"$1,942.63",$0.00,"$1,976.15",$0.00
27500243,EAP,HCPCS C1895,,Durata Df4 - Passive Tbp Dual Shock,"$11,822.00",$0.00,"$11,822.00","$5,319.90","$5,158.80",$0.00,"$2,036.87","$5,158.80","$8,437.36","$2,069.94","$11,822.00",$0.00,"$5,911.00","$9,363.02","$9,457.60",$0.00,"$1,850.14",$0.00,"$1,882.06",$0.00
27500244,EAP,HCPCS C1895,,Durata Df4 - Passive Tbp Dual Shock,"$11,822.00",$0.00,"$11,822.00","$5,319.90","$5,158.80",$0.00,"$2,036.87","$5,158.80","$8,437.36","$2,069.94","$11,822.00",$0.00,"$5,911.00","$9,363.02","$9,457.60",$0.00,"$1,850.14",$0.00,"$1,882.06",$0.00
27500245,EAP,HCPCS C1893,,Cps Direct? Sl Ii Straight 47cm,"$1,478.00",$0.00,"$1,478.00",$665.10,"$1,054.85",$0.00,$254.65,"$1,054.85","$1,054.85",$258.79,"$1,478.00",$0.00,$739.00,"$1,170.58","$1,182.40",$0.00,$231.31,$0.00,$235.30,$0.00
27500246,EAP,HCPCS C1893,,Cps Direct? Sl Ii 135 Degrees 47cm,"$1,478.00",$0.00,"$1,478.00",$665.10,"$1,054.85",$0.00,$254.65,"$1,054.85","$1,054.85",$258.79,"$1,478.00",$0.00,$739.00,"$1,170.58","$1,182.40",$0.00,$231.31,$0.00,$235.30,$0.00
27500247,EAP,HCPCS C1893,,Cps Direct? Sl Ii Wide 47cm,"$1,478.00",$0.00,"$1,478.00",$665.10,"$1,054.85",$0.00,$254.65,"$1,054.85","$1,054.85",$258.79,"$1,478.00",$0.00,$739.00,"$1,170.58","$1,182.40",$0.00,$231.31,$0.00,$235.30,$0.00
27500248,EAP,HCPCS C1893,,Cps Direct? Sl Ii X-wide 47cm,"$1,478.00",$0.00,"$1,478.00",$665.10,"$1,054.85",$0.00,$254.65,"$1,054.85","$1,054.85",$258.79,"$1,478.00",$0.00,$739.00,"$1,170.58","$1,182.40",$0.00,$231.31,$0.00,$235.30,$0.00
27500249,EAP,HCPCS C1893,,Cps Direct? Sl Ii Right Side 47cm,"$1,478.00",$0.00,"$1,478.00",$665.10,"$1,054.85",$0.00,$254.65,"$1,054.85","$1,054.85",$258.79,"$1,478.00",$0.00,$739.00,"$1,170.58","$1,182.40",$0.00,$231.31,$0.00,$235.30,$0.00
27500250,EAP,HCPCS C1893,,Cps Direct? Sl Ii Straight 54cm,"$1,478.00",$0.00,"$1,478.00",$665.10,"$1,054.85",$0.00,$254.65,"$1,054.85","$1,054.85",$258.79,"$1,478.00",$0.00,$739.00,"$1,170.58","$1,182.40",$0.00,$231.31,$0.00,$235.30,$0.00
27500251,EAP,HCPCS C1893,,Cps Direct? Sl Ii 115 Degrees 54cm,"$1,478.00",$0.00,"$1,478.00",$665.10,"$1,054.85",$0.00,$254.65,"$1,054.85","$1,054.85",$258.79,"$1,478.00",$0.00,$739.00,"$1,170.58","$1,182.40",$0.00,$231.31,$0.00,$235.30,$0.00
27500252,EAP,HCPCS C1893,,Cps Direct? Sl Ii 135 Degrees 54cm,"$1,478.00",$0.00,"$1,478.00",$665.10,"$1,054.85",$0.00,$254.65,"$1,054.85","$1,054.85",$258.79,"$1,478.00",$0.00,$739.00,"$1,170.58","$1,182.40",$0.00,$231.31,$0.00,$235.30,$0.00
27500253,EAP,HCPCS C1893,,Cps Direct? Sl Ii Wide 54cm,"$1,478.00",$0.00,"$1,478.00",$665.10,"$1,054.85",$0.00,$254.65,"$1,054.85","$1,054.85",$258.79,"$1,478.00",$0.00,$739.00,"$1,170.58","$1,182.40",$0.00,$231.31,$0.00,$235.30,$0.00
27500254,EAP,HCPCS C1893,,Cps Direct? Sl Ii X-wide 54cm,"$1,478.00",$0.00,"$1,478.00",$665.10,"$1,054.85",$0.00,$254.65,"$1,054.85","$1,054.85",$258.79,"$1,478.00",$0.00,$739.00,"$1,170.58","$1,182.40",$0.00,$231.31,$0.00,$235.30,$0.00
27500255,EAP,HCPCS C1893,,Cps Aim S,$591.00,$0.00,$591.00,$265.95,$421.80,$0.00,$101.83,$421.80,$421.80,$103.48,$591.00,$0.00,$295.50,$468.07,$472.80,$0.00,$92.49,$0.00,$94.09,$0.00
27500256,EAP,HCPCS C1893,,Cps Aim Sl,$591.00,$0.00,$591.00,$265.95,$421.80,$0.00,$101.83,$421.80,$421.80,$103.48,$591.00,$0.00,$295.50,$468.07,$472.80,$0.00,$92.49,$0.00,$94.09,$0.00
27500257,EAP,HCPCS C1893,,Cps Aim S,$591.00,$0.00,$591.00,$265.95,$421.80,$0.00,$101.83,$421.80,$421.80,$103.48,$591.00,$0.00,$295.50,$468.07,$472.80,$0.00,$92.49,$0.00,$94.09,$0.00
27500258,EAP,HCPCS C1893,,Cps Aim Sl,$591.00,$0.00,$591.00,$265.95,$421.80,$0.00,$101.83,$421.80,$421.80,$103.48,$591.00,$0.00,$295.50,$468.07,$472.80,$0.00,$92.49,$0.00,$94.09,$0.00
27500259,EAP,HCPCS C1893,,Cps Aim Sl,$591.00,$0.00,$591.00,$265.95,$421.80,$0.00,$101.83,$421.80,$421.80,$103.48,$591.00,$0.00,$295.50,$468.07,$472.80,$0.00,$92.49,$0.00,$94.09,$0.00
27500260,EAP,HCPCS C1893,,Cps Aim Sl,$591.00,$0.00,$591.00,$265.95,$421.80,$0.00,$101.83,$421.80,$421.80,$103.48,$591.00,$0.00,$295.50,$468.07,$472.80,$0.00,$92.49,$0.00,$94.09,$0.00
27500261,EAP,HCPCS C1893,,Cps Aim Sl,$591.00,$0.00,$591.00,$265.95,$421.80,$0.00,$101.83,$421.80,$421.80,$103.48,$591.00,$0.00,$295.50,$468.07,$472.80,$0.00,$92.49,$0.00,$94.09,$0.00
27500262,EAP,HCPCS C1786,,Pacemakers Single Accent Sr Rf,"$15,665.00",$0.00,"$15,665.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$11,180.11",$0.00,"$15,665.00",$0.00,"$7,832.50","$12,406.68","$12,532.00",$0.00,$0.00,$0.00,$0.00,$0.00
27500263,EAP,HCPCS C1722,,Atlas Plus C Header,"$39,900.00",$0.00,"$39,900.00","$17,955.00","$5,158.80",$0.00,"$6,874.57","$5,158.80","$28,476.63","$6,986.17","$39,900.00",$0.00,"$19,950.00","$31,600.80","$31,920.00",$0.00,"$6,244.35",$0.00,"$6,352.08",$0.00
27500264,EAP,HCPCS C1898,,Myopore Epicardial Lead 54 Cm,"$1,330.00",$0.00,"$1,330.00",$598.50,$949.22,$0.00,$229.15,$949.22,$949.22,$232.87,"$1,330.00",$0.00,$665.00,"$1,053.36","$1,064.00",$0.00,$208.15,$0.00,$211.74,$0.00
27500265,EAP,HCPCS C1898,,Passive Fixation Pacing Lead  J-shape  Silicone Insulation,"$1,478.00",$0.00,"$1,478.00",$665.10,"$1,054.85",$0.00,$254.65,"$1,054.85","$1,054.85",$258.79,"$1,478.00",$0.00,$739.00,"$1,170.58","$1,182.40",$0.00,$231.31,$0.00,$235.30,$0.00
27500266,EAP,HCPCS C1898,,Passive Fixation Pacing Lead  J-shape  Silicone Insulation,"$1,478.00",$0.00,"$1,478.00",$665.10,"$1,054.85",$0.00,$254.65,"$1,054.85","$1,054.85",$258.79,"$1,478.00",$0.00,$739.00,"$1,170.58","$1,182.40",$0.00,$231.31,$0.00,$235.30,$0.00
27500267,EAP,HCPCS C1898,,Passive Fixation Pacing Lead  Straight  Silicone Insulation,"$1,478.00",$0.00,"$1,478.00",$665.10,"$1,054.85",$0.00,$254.65,"$1,054.85","$1,054.85",$258.79,"$1,478.00",$0.00,$739.00,"$1,170.58","$1,182.40",$0.00,$231.31,$0.00,$235.30,$0.00
27500268,EAP,HCPCS C1898,,Passive Fixation Pacing Lead  Straight  Silicone Insulation,"$1,478.00",$0.00,"$1,478.00",$665.10,"$1,054.85",$0.00,$254.65,"$1,054.85","$1,054.85",$258.79,"$1,478.00",$0.00,$739.00,"$1,170.58","$1,182.40",$0.00,$231.31,$0.00,$235.30,$0.00
27500269,EAP,HCPCS C1898,,Active Fixation Pacing Lead  Electrically Active Helix  Sili,"$1,478.00",$0.00,"$1,478.00",$665.10,"$1,054.85",$0.00,$254.65,"$1,054.85","$1,054.85",$258.79,"$1,478.00",$0.00,$739.00,"$1,170.58","$1,182.40",$0.00,$231.31,$0.00,$235.30,$0.00
27500270,EAP,HCPCS C1898,,Active Fixation Pacing Lead  Electrically Active Helix  Sili,"$1,478.00",$0.00,"$1,478.00",$665.10,"$1,054.85",$0.00,$254.65,"$1,054.85","$1,054.85",$258.79,"$1,478.00",$0.00,$739.00,"$1,170.58","$1,182.40",$0.00,$231.31,$0.00,$235.30,$0.00
27500271,EAP,HCPCS C1898,,Active Fixation Pacing Lead  Electrically Active Helix  Sili,"$1,478.00",$0.00,"$1,478.00",$665.10,"$1,054.85",$0.00,$254.65,"$1,054.85","$1,054.85",$258.79,"$1,478.00",$0.00,$739.00,"$1,170.58","$1,182.40",$0.00,$231.31,$0.00,$235.30,$0.00
27500272,EAP,HCPCS C1898,,Active Fixation  Single Coil  Silicone Insulation  65 Cm,"$11,822.00",$0.00,"$11,822.00","$5,319.90","$5,158.80",$0.00,"$2,036.87","$5,158.80","$8,437.36","$2,069.94","$11,822.00",$0.00,"$5,911.00","$9,363.02","$9,457.60",$0.00,"$1,850.14",$0.00,"$1,882.06",$0.00
27500273,EAP,HCPCS C1898,,Passive Fixation  Dual Coil  Silicone Insulation  65 Cm  18,"$11,822.00",$0.00,"$11,822.00","$5,319.90","$5,158.80",$0.00,"$2,036.87","$5,158.80","$8,437.36","$2,069.94","$11,822.00",$0.00,"$5,911.00","$9,363.02","$9,457.60",$0.00,"$1,850.14",$0.00,"$1,882.06",$0.00
27500274,EAP,HCPCS C1898,,Active Fixation  Dual Coil  Silicone Insulation  60 Cm  16 C,"$11,822.00",$0.00,"$11,822.00","$5,319.90","$5,158.80",$0.00,"$2,036.87","$5,158.80","$8,437.36","$2,069.94","$11,822.00",$0.00,"$5,911.00","$9,363.02","$9,457.60",$0.00,"$1,850.14",$0.00,"$1,882.06",$0.00
27500275,EAP,HCPCS C1898,,Active Fixation  Dual Coil  Silicone Insulation  65 Cm  18 C,"$11,822.00",$0.00,"$11,822.00","$5,319.90","$5,158.80",$0.00,"$2,036.87","$5,158.80","$8,437.36","$2,069.94","$11,822.00",$0.00,"$5,911.00","$9,363.02","$9,457.60",$0.00,"$1,850.14",$0.00,"$1,882.06",$0.00
27500276,EAP,HCPCS C1900,,Left Ventricular Lead With 3d Pre-shaped Helix At Distal End,"$5,911.00",$0.00,"$5,911.00",$0.00,"$4,218.68",$0.00,"$1,018.44","$4,218.68","$4,218.68",$0.00,"$5,911.00",$0.00,"$2,955.50","$4,681.51","$4,728.80",$0.00,$925.07,$0.00,$0.00,$0.00
27500277,EAP,HCPCS C1900,,Left Ventricular Lead With Pre-shaped Bend And Thread Fixati,"$5,911.00",$0.00,"$5,911.00",$0.00,"$4,218.68",$0.00,"$1,018.44","$4,218.68","$4,218.68",$0.00,"$5,911.00",$0.00,"$2,955.50","$4,681.51","$4,728.80",$0.00,$925.07,$0.00,$0.00,$0.00
27500278,EAP,HCPCS C1900,,Left Ventricular Lead With 2d Pre-shaped Bend At Distal End,"$5,911.00",$0.00,"$5,911.00",$0.00,"$4,218.68",$0.00,"$1,018.44","$4,218.68","$4,218.68",$0.00,"$5,911.00",$0.00,"$2,955.50","$4,681.51","$4,728.80",$0.00,$925.07,$0.00,$0.00,$0.00
27500279,EAP,HCPCS C1895,,Is-1  Silicone  35cm  V Placement,"$1,478.00",$0.00,"$1,478.00",$665.10,"$1,054.85",$0.00,$254.65,"$1,054.85","$1,054.85",$258.79,"$1,478.00",$0.00,$739.00,"$1,170.58","$1,182.40",$0.00,$231.31,$0.00,$235.30,$0.00
27500280,EAP,HCPCS C1895,,Is-1  Silicone  54cm  V Placement,"$1,478.00",$0.00,"$1,478.00",$665.10,"$1,054.85",$0.00,$254.65,"$1,054.85","$1,054.85",$258.79,"$1,478.00",$0.00,$739.00,"$1,170.58","$1,182.40",$0.00,$231.31,$0.00,$235.30,$0.00
27500281,EAP,HCPCS C1892,,Is-1  Polyurethane  44cm  7f Introducer  11mm Electrode Spac,"$1,478.00",$0.00,"$1,478.00",$665.10,"$1,054.85",$0.00,$254.65,"$1,054.85","$1,054.85",$258.79,"$1,478.00",$0.00,$739.00,"$1,170.58","$1,182.40",$0.00,$231.31,$0.00,$235.30,$0.00
27500282,EAP,HCPCS C1892,,Is-1  Polyurethane  52cm  7f Introducer  11mm Electrode Spac,"$1,478.00",$0.00,"$1,478.00",$665.10,"$1,054.85",$0.00,$254.65,"$1,054.85","$1,054.85",$258.79,"$1,478.00",$0.00,$739.00,"$1,170.58","$1,182.40",$0.00,$231.31,$0.00,$235.30,$0.00
27500283,EAP,HCPCS C1892,,Is-1  Polyurethane  58cm  7f Introducer  11mm Electrode Spac,"$1,478.00",$0.00,"$1,478.00",$665.10,"$1,054.85",$0.00,$254.65,"$1,054.85","$1,054.85",$258.79,"$1,478.00",$0.00,$739.00,"$1,170.58","$1,182.40",$0.00,$231.31,$0.00,$235.30,$0.00
27500284,EAP,HCPCS C1892,,Is-1  Polyurethane  7f  11mm Electrode Spacing  48cm  Prefor,"$1,478.00",$0.00,"$1,478.00",$665.10,"$1,054.85",$0.00,$254.65,"$1,054.85","$1,054.85",$258.79,"$1,478.00",$0.00,$739.00,"$1,170.58","$1,182.40",$0.00,$231.31,$0.00,$235.30,$0.00
27500285,EAP,HCPCS C1892,,Is-1  Polyurethane  7f  11mm Electrode Spacing  52cm  Prefor,"$1,478.00",$0.00,"$1,478.00",$665.10,"$1,054.85",$0.00,$254.65,"$1,054.85","$1,054.85",$258.79,"$1,478.00",$0.00,$739.00,"$1,170.58","$1,182.40",$0.00,$231.31,$0.00,$235.30,$0.00
27500286,EAP,HCPCS C1892,,Is-1  Polyurethane  7f  11mm Electrode Spacing  52cm  Straig,"$1,478.00",$0.00,"$1,478.00",$665.10,"$1,054.85",$0.00,$254.65,"$1,054.85","$1,054.85",$258.79,"$1,478.00",$0.00,$739.00,"$1,170.58","$1,182.40",$0.00,$231.31,$0.00,$235.30,$0.00
27500287,EAP,HCPCS C1892,,Is-1  Polyurethane  7f  11mm Electrode Spacing  58cm  Straig,"$1,478.00",$0.00,"$1,478.00",$665.10,"$1,054.85",$0.00,$254.65,"$1,054.85","$1,054.85",$258.79,"$1,478.00",$0.00,$739.00,"$1,170.58","$1,182.40",$0.00,$231.31,$0.00,$235.30,$0.00
27500288,EAP,HCPCS C1892,,Is-1  Polyurethane  7f  11mm Electrode Spacing  44cm  Prefor,"$1,478.00",$0.00,"$1,478.00",$665.10,"$1,054.85",$0.00,$254.65,"$1,054.85","$1,054.85",$258.79,"$1,478.00",$0.00,$739.00,"$1,170.58","$1,182.40",$0.00,$231.31,$0.00,$235.30,$0.00
27500289,EAP,HCPCS C1892,,Is-1  Polyurethane  7f  11mm Electrode Spacing  52cm  Prefor,"$1,478.00",$0.00,"$1,478.00",$665.10,"$1,054.85",$0.00,$254.65,"$1,054.85","$1,054.85",$258.79,"$1,478.00",$0.00,$739.00,"$1,170.58","$1,182.40",$0.00,$231.31,$0.00,$235.30,$0.00
27500290,EAP,HCPCS C1785,,Reply Dr V2,"$12,413.00",$0.00,"$12,413.00","$5,585.85","$5,158.80",$0.00,"$2,138.70","$5,158.80","$8,859.16","$2,173.42","$12,413.00",$0.00,"$6,206.50","$9,831.10","$9,930.40",$0.00,"$1,942.63",$0.00,"$1,976.15",$0.00
27500291,EAP,HCPCS C1785,,Reply Dr V2  System,"$14,777.00",$0.00,"$14,777.00","$6,649.65","$5,158.80",$0.00,"$2,546.00","$5,158.80","$10,546.34","$2,587.33","$14,777.00",$0.00,"$7,388.50","$11,703.38","$11,821.60",$0.00,"$2,312.60",$0.00,"$2,352.50",$0.00
27500292,EAP,HCPCS C1785,,Esprit Dr,"$11,822.00",$0.00,"$11,822.00","$5,319.90","$5,158.80",$0.00,"$2,036.87","$5,158.80","$8,437.36","$2,069.94","$11,822.00",$0.00,"$5,911.00","$9,363.02","$9,457.60",$0.00,"$1,850.14",$0.00,"$1,882.06",$0.00
27500293,EAP,HCPCS C1785,,Esprit Dr System,"$14,777.00",$0.00,"$14,777.00","$6,649.65","$5,158.80",$0.00,"$2,546.00","$5,158.80","$10,546.34","$2,587.33","$14,777.00",$0.00,"$7,388.50","$11,703.38","$11,821.60",$0.00,"$2,312.60",$0.00,"$2,352.50",$0.00
27500294,EAP,HCPCS C1786,,Reply Sr V2,"$9,753.00",$0.00,"$9,753.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$6,960.72",$0.00,"$9,753.00",$0.00,"$4,876.50","$7,724.38","$7,802.40",$0.00,$0.00,$0.00,$0.00,$0.00
27500295,EAP,HCPCS C1786,,Reply Sr V2 System,"$11,231.00",$0.00,"$11,231.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$8,015.56",$0.00,"$11,231.00",$0.00,"$5,615.50","$8,894.95","$8,984.80",$0.00,$0.00,$0.00,$0.00,$0.00
27500296,EAP,HCPCS C1786,,Esprit Sr,"$10,344.00",$0.00,"$10,344.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$7,382.51",$0.00,"$10,344.00",$0.00,"$5,172.00","$8,192.45","$8,275.20",$0.00,$0.00,$0.00,$0.00,$0.00
27500297,EAP,HCPCS C1786,,Esprit Sr System,"$11,822.00",$0.00,"$11,822.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$8,437.36",$0.00,"$11,822.00",$0.00,"$5,911.00","$9,363.02","$9,457.60",$0.00,$0.00,$0.00,$0.00,$0.00
27500298,EAP,HCPCS C1882,,Paradym Crt-d 8750,"$55,268.00",$0.00,"$55,268.00","$24,870.60","$5,158.80",$0.00,"$8,138.89","$5,158.80","$39,444.77","$8,138.89","$55,268.00",$0.00,"$27,634.00","$43,772.26","$44,214.40",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27500299,EAP,HCPCS C1882,,Paradym Crt-d 8750 System,"$65,318.00",$0.00,"$65,318.00","$29,393.10","$5,158.80",$0.00,"$8,138.89","$5,158.80","$46,617.46","$8,138.89","$65,318.00",$0.00,"$32,659.00","$51,731.86","$52,254.40",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27500300,EAP,HCPCS C1882,,Paradym 8250 Vr,"$41,378.00",$0.00,"$41,378.00","$18,620.10","$5,158.80",$0.00,"$7,129.22","$5,158.80","$29,531.48","$7,244.96","$41,378.00",$0.00,"$20,689.00","$32,771.38","$33,102.40",$0.00,"$6,475.66",$0.00,"$6,587.38",$0.00
27500301,EAP,HCPCS C1882,,Paradym 8550 Dr,"$48,767.00",$0.00,"$48,767.00","$21,945.15","$5,158.80",$0.00,"$8,138.89","$5,158.80","$34,805.01","$8,138.89","$48,767.00",$0.00,"$24,383.50","$38,623.46","$39,013.60",$0.00,"$7,632.04",$0.00,"$7,763.71",$0.00
27500302,EAP,HCPCS C1785,,Reply Dr,"$11,822.00",$0.00,"$11,822.00","$5,319.90","$5,158.80",$0.00,"$2,036.87","$5,158.80","$8,437.36","$2,069.94","$11,822.00",$0.00,"$5,911.00","$9,363.02","$9,457.60",$0.00,"$1,850.14",$0.00,"$1,882.06",$0.00
27500303,EAP,HCPCS C1785,,Reply Dr System,"$14,777.00",$0.00,"$14,777.00","$6,649.65","$5,158.80",$0.00,"$2,546.00","$5,158.80","$10,546.34","$2,587.33","$14,777.00",$0.00,"$7,388.50","$11,703.38","$11,821.60",$0.00,"$2,312.60",$0.00,"$2,352.50",$0.00
27500304,EAP,HCPCS C1883,,Is-1/df-1  Silicone 58cm Integrated Bipolar  Active Fixation,"$11,822.00",$0.00,"$11,822.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$8,437.36",$0.00,"$11,822.00",$0.00,"$5,911.00","$9,363.02","$9,457.60",$0.00,$0.00,$0.00,$0.00,$0.00
27500305,EAP,HCPCS C1722,,Paradym 9550 Rf Dr,"$45,811.00",$0.00,"$45,811.00","$20,614.95","$5,158.80",$0.00,"$7,893.01","$5,158.80","$32,695.31","$8,021.14","$45,811.00",$0.00,"$22,905.50","$36,282.31","$36,648.80",$0.00,"$7,169.42",$0.00,"$7,293.11",$0.00
27500310,EAP,HCPCS C1722,,Defib Cardiac Protecta Vr Implantable Cardioverter,"$39,900.00",$0.00,"$39,900.00","$17,955.00","$5,158.80",$0.00,"$6,874.57","$5,158.80","$28,476.63","$6,986.17","$39,900.00",$0.00,"$19,950.00","$31,600.80","$31,920.00",$0.00,"$6,244.35",$0.00,"$6,352.08",$0.00
27500311,EAP,HCPCS C1882,,Defibrillator Cardiac Consulta D.59 In W2.01 In X H2.72d,"$45,811.00",$0.00,"$45,811.00","$20,614.95","$5,158.80",$0.00,"$7,893.01","$5,158.80","$32,695.31","$8,021.14","$45,811.00",$0.00,"$22,905.50","$36,282.31","$36,648.80",$0.00,"$7,169.42",$0.00,"$7,293.11",$0.00
27500312,EAP,HCPCS C1786,,Dfbr Crd Inventra 7 Vr-t Dx Impltable Home Monitr,"$49,688.00",$0.00,"$49,688.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$35,462.33",$0.00,"$49,688.00",$0.00,"$24,844.00","$39,352.90","$39,750.40",$0.00,$0.00,$0.00,$0.00,$0.00
27500350,EAP,HCPCS C1721,,Evera Xt Dr System - Mmem,"$58,889.00",$0.00,"$58,889.00","$26,500.05","$5,158.80",$0.00,"$8,138.89","$5,158.80","$42,029.08","$8,138.89","$58,889.00",$0.00,"$29,444.50","$46,640.09","$47,111.20",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27500351,EAP,HCPCS C1721,,Evera Xt Dr System - Mmee,"$58,889.00",$0.00,"$58,889.00","$26,500.05","$5,158.80",$0.00,"$8,138.89","$5,158.80","$42,029.08","$8,138.89","$58,889.00",$0.00,"$29,444.50","$46,640.09","$47,111.20",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27500352,EAP,HCPCS C1721,,Evera S Dr System - Mmem,"$58,889.00",$0.00,"$58,889.00","$26,500.05","$5,158.80",$0.00,"$8,138.89","$5,158.80","$42,029.08","$8,138.89","$58,889.00",$0.00,"$29,444.50","$46,640.09","$47,111.20",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27500353,EAP,HCPCS C1721,,Evera S Dr System - Mmee,"$58,889.00",$0.00,"$58,889.00","$26,500.05","$5,158.80",$0.00,"$8,138.89","$5,158.80","$42,029.08","$8,138.89","$58,889.00",$0.00,"$29,444.50","$46,640.09","$47,111.20",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27500354,EAP,HCPCS C1721,,Protecta Xt Dr System - Mmem,"$58,889.00",$0.00,"$58,889.00","$26,500.05","$5,158.80",$0.00,"$8,138.89","$5,158.80","$42,029.08","$8,138.89","$58,889.00",$0.00,"$29,444.50","$46,640.09","$47,111.20",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27500355,EAP,HCPCS C1721,,Protecta Xt Dr System - Mmee,"$58,889.00",$0.00,"$58,889.00","$26,500.05","$5,158.80",$0.00,"$8,138.89","$5,158.80","$42,029.08","$8,138.89","$58,889.00",$0.00,"$29,444.50","$46,640.09","$47,111.20",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27500356,EAP,HCPCS C1722,,Evera Xt Vr System - Mmem,"$51,722.00",$0.00,"$51,722.00","$23,274.90","$5,158.80",$0.00,"$8,138.89","$5,158.80","$36,913.99","$8,138.89","$51,722.00",$0.00,"$25,861.00","$40,963.82","$41,377.60",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27500357,EAP,HCPCS C1722,,Evera Xt Vr System - Mmee,"$51,722.00",$0.00,"$51,722.00","$23,274.90","$5,158.80",$0.00,"$8,138.89","$5,158.80","$36,913.99","$8,138.89","$51,722.00",$0.00,"$25,861.00","$40,963.82","$41,377.60",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27500358,EAP,HCPCS C1722,,Evera S Vr System - Mmem,"$51,722.00",$0.00,"$51,722.00","$23,274.90","$5,158.80",$0.00,"$8,138.89","$5,158.80","$36,913.99","$8,138.89","$51,722.00",$0.00,"$25,861.00","$40,963.82","$41,377.60",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27500359,EAP,HCPCS C1722,,Evera S Vr System - Mmee,"$51,722.00",$0.00,"$51,722.00","$23,274.90","$5,158.80",$0.00,"$8,138.89","$5,158.80","$36,913.99","$8,138.89","$51,722.00",$0.00,"$25,861.00","$40,963.82","$41,377.60",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27500360,EAP,HCPCS C1722,,Protecta Xt Vr System - Emem,"$51,722.00",$0.00,"$51,722.00","$23,274.90","$5,158.80",$0.00,"$8,138.89","$5,158.80","$36,913.99","$8,138.89","$51,722.00",$0.00,"$25,861.00","$40,963.82","$41,377.60",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27500361,EAP,HCPCS C1722,,Protecta Xt Vr System - Emee,"$51,722.00",$0.00,"$51,722.00","$23,274.90","$5,158.80",$0.00,"$8,138.89","$5,158.80","$36,913.99","$8,138.89","$51,722.00",$0.00,"$25,861.00","$40,963.82","$41,377.60",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27500362,EAP,HCPCS C1721,,Icd-dr Ddbb1d1 Evera Xt Us Is1/df1,"$45,811.00",$0.00,"$45,811.00","$20,614.95","$5,158.80",$0.00,"$7,893.01","$5,158.80","$32,695.31","$8,021.14","$45,811.00",$0.00,"$22,905.50","$36,282.31","$36,648.80",$0.00,"$7,169.42",$0.00,"$7,293.11",$0.00
27500363,EAP,HCPCS C1721,,Icd-dr Ddbb1d4 Evera Xt Us Is1/df4,"$45,811.00",$0.00,"$45,811.00","$20,614.95","$5,158.80",$0.00,"$7,893.01","$5,158.80","$32,695.31","$8,021.14","$45,811.00",$0.00,"$22,905.50","$36,282.31","$36,648.80",$0.00,"$7,169.42",$0.00,"$7,293.11",$0.00
27500364,EAP,HCPCS C1721,,Icd-dr Ddbc3d1 Evera S Is1/df1 Glob,"$45,811.00",$0.00,"$45,811.00","$20,614.95","$5,158.80",$0.00,"$7,893.01","$5,158.80","$32,695.31","$8,021.14","$45,811.00",$0.00,"$22,905.50","$36,282.31","$36,648.80",$0.00,"$7,169.42",$0.00,"$7,293.11",$0.00
27500365,EAP,HCPCS C1721,,Icd-dr Ddbc3d4 Evera S Is1/df4 Glob,"$45,811.00",$0.00,"$45,811.00","$20,614.95","$5,158.80",$0.00,"$7,893.01","$5,158.80","$32,695.31","$8,021.14","$45,811.00",$0.00,"$22,905.50","$36,282.31","$36,648.80",$0.00,"$7,169.42",$0.00,"$7,293.11",$0.00
27500366,EAP,HCPCS C1721,,Icd D314drg Protecta Xt Dr Is-1/df-1 Us,"$45,811.00",$0.00,"$45,811.00","$20,614.95","$5,158.80",$0.00,"$7,893.01","$5,158.80","$32,695.31","$8,021.14","$45,811.00",$0.00,"$22,905.50","$36,282.31","$36,648.80",$0.00,"$7,169.42",$0.00,"$7,293.11",$0.00
27500367,EAP,HCPCS C1721,,Icd D314drm Protecta Xt Dr Us Mr Df4,"$45,811.00",$0.00,"$45,811.00","$20,614.95","$5,158.80",$0.00,"$7,893.01","$5,158.80","$32,695.31","$8,021.14","$45,811.00",$0.00,"$22,905.50","$36,282.31","$36,648.80",$0.00,"$7,169.42",$0.00,"$7,293.11",$0.00
27500368,EAP,HCPCS C1722,,Icd-vr Dvbb1d1 Evera Xt Is1/df1 Us,"$39,900.00",$0.00,"$39,900.00","$17,955.00","$5,158.80",$0.00,"$6,874.57","$5,158.80","$28,476.63","$6,986.17","$39,900.00",$0.00,"$19,950.00","$31,600.80","$31,920.00",$0.00,"$6,244.35",$0.00,"$6,352.08",$0.00
27500369,EAP,HCPCS C1722,,Icd-vr Dvbb1d4 Evera Xt Us Is1/df4,"$39,900.00",$0.00,"$39,900.00","$17,955.00","$5,158.80",$0.00,"$6,874.57","$5,158.80","$28,476.63","$6,986.17","$39,900.00",$0.00,"$19,950.00","$31,600.80","$31,920.00",$0.00,"$6,244.35",$0.00,"$6,352.08",$0.00
27500370,EAP,HCPCS C1722,,Icd-vr Dvbc3d1 Evera S Is1/df1 Glob,"$39,900.00",$0.00,"$39,900.00","$17,955.00","$5,158.80",$0.00,"$6,874.57","$5,158.80","$28,476.63","$6,986.17","$39,900.00",$0.00,"$19,950.00","$31,600.80","$31,920.00",$0.00,"$6,244.35",$0.00,"$6,352.08",$0.00
27500371,EAP,HCPCS C1722,,Icd-vr Dvbc3d4 Evera S Df4 Glob,"$39,900.00",$0.00,"$39,900.00","$17,955.00","$5,158.80",$0.00,"$6,874.57","$5,158.80","$28,476.63","$6,986.17","$39,900.00",$0.00,"$19,950.00","$31,600.80","$31,920.00",$0.00,"$6,244.35",$0.00,"$6,352.08",$0.00
27500372,EAP,HCPCS C1722,,Icd D314vrg Protecta Xt Vr Us Mr Bcp,"$39,900.00",$0.00,"$39,900.00","$17,955.00","$5,158.80",$0.00,"$6,874.57","$5,158.80","$28,476.63","$6,986.17","$39,900.00",$0.00,"$19,950.00","$31,600.80","$31,920.00",$0.00,"$6,244.35",$0.00,"$6,352.08",$0.00
27500373,EAP,HCPCS C1722,,Icd D314vrm Protecta Xt Vr Us Mr Df4 Bcp,"$39,900.00",$0.00,"$39,900.00","$17,955.00","$5,158.80",$0.00,"$6,874.57","$5,158.80","$28,476.63","$6,986.17","$39,900.00",$0.00,"$19,950.00","$31,600.80","$31,920.00",$0.00,"$6,244.35",$0.00,"$6,352.08",$0.00
27500374,EAP,HCPCS C1882,,Crt D314trg Protecta Xt Crt-d Us Mr,"$53,791.00",$0.00,"$53,791.00","$24,205.95","$5,158.80",$0.00,"$8,138.89","$5,158.80","$38,390.64","$8,138.89","$53,791.00",$0.00,"$26,895.50","$42,602.47","$43,032.80",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27500375,EAP,HCPCS C1882,,Crt D314trm Protecta Xt Crt-d Us Mr Df4,"$53,791.00",$0.00,"$53,791.00","$24,205.95","$5,158.80",$0.00,"$8,138.89","$5,158.80","$38,390.64","$8,138.89","$53,791.00",$0.00,"$26,895.50","$42,602.47","$43,032.80",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27500376,EAP,HCPCS C1882,,Protecta Xt Crtd Sys - Mmmm,"$71,524.00",$0.00,"$71,524.00","$32,185.80","$5,158.80",$0.00,"$8,138.89","$5,158.80","$51,046.68","$8,138.89","$71,524.00",$0.00,"$35,762.00","$56,647.01","$57,219.20",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27500377,EAP,HCPCS C1882,,Protecta Xt Crtd Sys - Mmme,"$71,524.00",$0.00,"$71,524.00","$32,185.80","$5,158.80",$0.00,"$8,138.89","$5,158.80","$51,046.68","$8,138.89","$71,524.00",$0.00,"$35,762.00","$56,647.01","$57,219.20",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27500378,EAP,HCPCS C1882,,Protecta Xt Crtd Sys - Mmpm,"$71,524.00",$0.00,"$71,524.00","$32,185.80","$5,158.80",$0.00,"$8,138.89","$5,158.80","$51,046.68","$8,138.89","$71,524.00",$0.00,"$35,762.00","$56,647.01","$57,219.20",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27500379,EAP,HCPCS C1882,,Protecta Xt Crtd Sys - Mmpe,"$71,524.00",$0.00,"$71,524.00","$32,185.80","$5,158.80",$0.00,"$8,138.89","$5,158.80","$51,046.68","$8,138.89","$71,524.00",$0.00,"$35,762.00","$56,647.01","$57,219.20",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27500380,EAP,HCPCS C1882,,Protecta Xt Crtd Sys - Mmam,"$71,524.00",$0.00,"$71,524.00","$32,185.80","$5,158.80",$0.00,"$8,138.89","$5,158.80","$51,046.68","$8,138.89","$71,524.00",$0.00,"$35,762.00","$56,647.01","$57,219.20",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27500381,EAP,HCPCS C1882,,Protecta Xt Crtd Sys - Mmae,"$71,524.00",$0.00,"$71,524.00","$32,185.80","$5,158.80",$0.00,"$8,138.89","$5,158.80","$51,046.68","$8,138.89","$71,524.00",$0.00,"$35,762.00","$56,647.01","$57,219.20",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27500382,EAP,HCPCS C1779,,Lead 5038s-58 Capsure Vdd Quad Av 11.5cm,"$2,069.00",$0.00,"$2,069.00",$0.00,"$1,476.65",$0.00,$0.00,"$1,476.65","$1,476.65",$0.00,"$2,069.00",$0.00,"$1,034.50","$1,638.65","$1,655.20",$0.00,$0.00,$0.00,$0.00,$0.00
27500383,EAP,HCPCS C1779,,Lead 5038-58  Lead-quad Sngl-p A/v 58cm,"$2,069.00",$0.00,"$2,069.00",$0.00,"$1,476.65",$0.00,$0.00,"$1,476.65","$1,476.65",$0.00,"$2,069.00",$0.00,"$1,034.50","$1,638.65","$1,655.20",$0.00,$0.00,$0.00,$0.00,$0.00
27500384,EAP,HCPCS C1779,,Lead 5038l-65  Capsure Vdd Lead 65cm,"$2,069.00",$0.00,"$2,069.00",$0.00,"$1,476.65",$0.00,$0.00,"$1,476.65","$1,476.65",$0.00,"$2,069.00",$0.00,"$1,034.50","$1,638.65","$1,655.20",$0.00,$0.00,$0.00,$0.00,$0.00
27500385,EAP,HCPCS C1785,,Ipg A2dr01 Advisa Mri Dr.,"$15,073.00",$0.00,"$15,073.00","$6,782.85","$5,158.80",$0.00,"$2,597.00","$5,158.80","$10,757.60","$2,639.16","$15,073.00",$0.00,"$7,536.50","$11,937.82","$12,058.40",$0.00,"$2,358.92",$0.00,"$2,399.62",$0.00
27500386,EAP,HCPCS C1785,,Ipg Rvdr01 Revo Mri 1.5t,"$14,187.00",$0.00,"$14,187.00","$6,384.15","$5,158.80",$0.00,"$2,444.35","$5,158.80","$10,125.26","$2,484.03","$14,187.00",$0.00,"$7,093.50","$11,236.10","$11,349.60",$0.00,"$2,220.27",$0.00,"$2,258.57",$0.00
27500387,EAP,HCPCS C1785,,Advisa Mri System - Peem,"$18,029.00",$0.00,"$18,029.00","$8,113.05","$5,158.80",$0.00,"$3,106.31","$5,158.80","$12,867.30","$3,156.73","$18,029.00",$0.00,"$9,014.50","$14,278.97","$14,423.20",$0.00,"$2,821.54",$0.00,"$2,870.22",$0.00
27500388,EAP,HCPCS C1785,,Revo Mri System - Peem,"$17,142.00",$0.00,"$17,142.00","$7,713.90","$5,158.80",$0.00,"$2,953.48","$5,158.80","$12,234.25","$3,001.43","$17,142.00",$0.00,"$8,571.00","$13,576.46","$13,713.60",$0.00,"$2,682.72",$0.00,"$2,729.01",$0.00
27500389,EAP,HCPCS C1882,,Crt-d Dtbb1d1 Viva Sis1/df1 Us,"$53,791.00",$0.00,"$53,791.00","$24,205.95","$5,158.80",$0.00,"$8,138.89","$5,158.80","$38,390.64","$8,138.89","$53,791.00",$0.00,"$26,895.50","$42,602.47","$43,032.80",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27500390,EAP,HCPCS C1882,,Crt-d Dtbb1d4 Viva Sis1/df4 Us,"$53,791.00",$0.00,"$53,791.00","$24,205.95","$5,158.80",$0.00,"$8,138.89","$5,158.80","$38,390.64","$8,138.89","$53,791.00",$0.00,"$26,895.50","$42,602.47","$43,032.80",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27500391,EAP,HCPCS C1882,,Viva S Crtd System - Mmmm,"$71,524.00",$0.00,"$71,524.00","$32,185.80","$5,158.80",$0.00,"$8,138.89","$5,158.80","$51,046.68","$8,138.89","$71,524.00",$0.00,"$35,762.00","$56,647.01","$57,219.20",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27500392,EAP,HCPCS C1882,,Viva S Crtd System - Mmpm,"$71,524.00",$0.00,"$71,524.00","$32,185.80","$5,158.80",$0.00,"$8,138.89","$5,158.80","$51,046.68","$8,138.89","$71,524.00",$0.00,"$35,762.00","$56,647.01","$57,219.20",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27500393,EAP,HCPCS C1882,,Viva S Crtd System - Mmam,"$71,524.00",$0.00,"$71,524.00","$32,185.80","$5,158.80",$0.00,"$8,138.89","$5,158.80","$51,046.68","$8,138.89","$71,524.00",$0.00,"$35,762.00","$56,647.01","$57,219.20",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27500394,EAP,HCPCS C1786,,Pcmkr Crd Thk6mm Sm 50x41mm Endurity 1 Chmbr Is-1 Conctr,"$11,942.00",$0.00,"$11,942.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$8,523.01",$0.00,"$11,942.00",$0.00,"$5,971.00","$9,458.06","$9,553.60",$0.00,$0.00,$0.00,$0.00,$0.00
27500395,EAP,HCPCS C1785,,Pcmkr Crd Thk6mm Sm 50x47mm Assurity Dr 2 Chmbr Is-1 Conctr,"$18,765.00",$0.00,"$18,765.00","$8,444.25","$5,158.80",$0.00,"$3,233.12","$5,158.80","$13,392.58","$3,285.60","$18,765.00",$0.00,"$9,382.50","$14,861.88","$15,012.00",$0.00,"$2,936.72",$0.00,"$2,987.39",$0.00
27500396,EAP,HCPCS C1785,,Pcmkr Crd Thk6mm Sm 46x50x6 Endurity Dr 2 Chmbr Is-1 Conctr,"$16,141.00",$0.00,"$16,141.00","$7,263.45","$5,158.80",$0.00,"$2,781.01","$5,158.80","$11,519.83","$2,826.16","$16,141.00",$0.00,"$8,070.50","$12,783.67","$12,912.80",$0.00,"$2,526.07",$0.00,"$2,569.65",$0.00
27500397,EAP,HCPCS C1786,,Pcmkr Crd Thk6mm Sm 50x47mm Assurity Sr 1 Chmbr Is-1 Conctr,"$14,960.00",$0.00,"$14,960.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$10,676.95",$0.00,"$14,960.00",$0.00,"$7,480.00","$11,848.32","$11,968.00",$0.00,$0.00,$0.00,$0.00,$0.00
27500398,EAP,HCPCS C1786,,Pcmkr Crd Thk6mm Sm 41x50 X6 Endurity Sr 1 Chmbr Is-1 Conctr,"$12,335.00",$0.00,"$12,335.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$8,803.49",$0.00,"$12,335.00",$0.00,"$6,167.50","$9,769.32","$9,868.00",$0.00,$0.00,$0.00,$0.00,$0.00
27500399,EAP,HCPCS C1785,,Pcmkr Crd Thk6mm Sm 50x47mm Assurity Dr Rf Chmbr Is-1 Conctr,"$19,946.00",$0.00,"$19,946.00","$8,975.70","$5,158.80",$0.00,"$3,436.60","$5,158.80","$14,235.46","$3,492.39","$19,946.00",$0.00,"$9,973.00","$15,797.23","$15,956.80",$0.00,"$3,121.55",$0.00,"$3,175.40",$0.00
27500400,EAP,HCPCS C1785,,Pcmkr Crd Thk6mm Sm Endurity Dr Rf Chmbr Is-1 Conctr Atcpt,"$17,322.00",$0.00,"$17,322.00","$7,794.90","$5,158.80",$0.00,"$2,984.49","$5,158.80","$12,362.71","$3,032.94","$17,322.00",$0.00,"$8,661.00","$13,719.02","$13,857.60",$0.00,"$2,710.89",$0.00,"$2,757.66",$0.00
27500401,EAP,HCPCS C1786,,Pcmkr Crd Thk6mm Sm 50x47mm Assurity 1 Chmbr Is-1 Conctr,"$16,141.00",$0.00,"$16,141.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$11,519.83",$0.00,"$16,141.00",$0.00,"$8,070.50","$12,783.67","$12,912.80",$0.00,$0.00,$0.00,$0.00,$0.00
27500402,EAP,HCPCS C1786,,Pcmkr Crd Thk6mm Sm 50x47mm Endurity 1 Chmbr Is-1 Conctr,"$13,516.00",$0.00,"$13,516.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,646.37",$0.00,"$13,516.00",$0.00,"$6,758.00","$10,704.67","$10,812.80",$0.00,$0.00,$0.00,$0.00,$0.00
27500403,EAP,HCPCS C2621,,Pcmkr Crd Thk6mm 59x56mm Alr Qd Rf Is4-llll Conctr Is-1,"$18,372.00",$0.00,"$18,372.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$13,112.10",$0.00,"$18,372.00",$0.00,"$9,186.00","$14,550.62","$14,697.60",$0.00,$0.00,$0.00,$0.00,$0.00
27500404,EAP,HCPCS C2621,,Pcmkr Crd Thk6mm 59x55mm Alr Rf Is-1 Conctr Corvue Thor,"$15,747.00",$0.00,"$15,747.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$11,238.63",$0.00,"$15,747.00",$0.00,"$7,873.50","$12,471.62","$12,597.60",$0.00,$0.00,$0.00,$0.00,$0.00
27500405,EAP,HCPCS C2621,,Pcmkr Crd Thk6mm 59x56mm Alr Qd Pkg Is4-llll Conctr Is-1,"$19,553.00",$0.00,"$19,553.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$13,954.98",$0.00,"$19,553.00",$0.00,"$9,776.50","$15,485.98","$15,642.40",$0.00,$0.00,$0.00,$0.00,$0.00
27500406,EAP,HCPCS C2621,,Pcmkr Crd Thk6mm 59x55mm Alr Pkg Is-1 Conctr Corvue Thor,"$16,928.00",$0.00,"$16,928.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$12,081.51",$0.00,"$16,928.00",$0.00,"$8,464.00","$13,406.98","$13,542.40",$0.00,$0.00,$0.00,$0.00,$0.00
27500407,EAP,HCPCS C2621,,Pcmkr Crd Thk6mm 59x56mm Alr Qd Rf Sys Is4-llll Conctr Is-1,"$29,001.00",$0.00,"$29,001.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$20,698.01",$0.00,"$29,001.00",$0.00,"$14,500.50","$22,968.79","$23,200.80",$0.00,$0.00,$0.00,$0.00,$0.00
27500408,EAP,HCPCS C2621,,Pcmkr Crd Thk6mm 59x55mm Alr Rf Sys Is-1 Conctr Corvue Thor,"$26,377.00",$0.00,"$26,377.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$18,825.26",$0.00,"$26,377.00",$0.00,"$13,188.50","$20,890.58","$21,101.60",$0.00,$0.00,$0.00,$0.00,$0.00
27500409,EAP,HCPCS C2621,,Pcmkr Crd Thk6mm 59x56mm Alr Crt-p Sys Is4-llll Conctr Is-1,"$30,182.00",$0.00,"$30,182.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$21,540.89",$0.00,"$30,182.00",$0.00,"$15,091.00","$23,904.14","$24,145.60",$0.00,$0.00,$0.00,$0.00,$0.00
27500410,EAP,HCPCS C2621,,Pcmkr Crd Thk6mm 59x55mm Alr Crt-p Sys Is-1 Con Corvue Thor,"$27,558.00",$0.00,"$27,558.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$19,668.14",$0.00,"$27,558.00",$0.00,"$13,779.00","$21,825.94","$22,046.40",$0.00,$0.00,$0.00,$0.00,$0.00
27500411,EAP,HCPCS C1785,,Pcmkr Cd 7.5mm Md Ellipse 44.5x47mm Ing Rythmiq,"$10,498.00",$0.00,"$10,498.00","$4,724.10","$5,158.80",$0.00,"$1,808.75","$5,158.80","$7,492.42","$1,838.12","$10,498.00",$0.00,"$5,249.00","$8,314.42","$8,398.40",$0.00,"$1,642.94",$0.00,"$1,671.28",$0.00
27500412,EAP,HCPCS C1786,,Pcmkr Cd 7.5mm Md Ellipse 44.5x45.7mm Ing Rythmiq,"$9,186.00",$0.00,"$9,186.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$6,556.05",$0.00,"$9,186.00",$0.00,"$4,593.00","$7,275.31","$7,348.80",$0.00,$0.00,$0.00,$0.00,$0.00
27500413,EAP,HCPCS C1896,,Dual Chamber Adaptive Rate Ingenior Dr System 8n22,"$13,123.00",$0.00,"$13,123.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,365.89",$0.00,"$13,123.00",$0.00,"$6,561.50","$10,393.42","$10,498.40",$0.00,$0.00,$0.00,$0.00,$0.00
27500414,EAP,HCPCS C1896,,Single Chmbr Adptiv Rt Ingenio Sr System 8n32,"$10,236.00",$0.00,"$10,236.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$7,305.43",$0.00,"$10,236.00",$0.00,"$5,118.00","$8,106.91","$8,188.80",$0.00,$0.00,$0.00,$0.00,$0.00
27500415,EAP,HCPCS C1722,,Itrevia Vr-t Df-1 Hgh Eng W/ti W/hm Monitoring,"$34,906.00",$0.00,"$34,906.00","$15,707.70","$5,158.80",$0.00,"$6,014.13","$5,158.80","$24,912.41","$6,111.76","$34,906.00",$0.00,"$17,453.00","$27,645.55","$27,924.80",$0.00,"$5,462.79",$0.00,"$5,557.04",$0.00
27500416,EAP,HCPCS C1721,,Dfbr Crd Evera Mri Surescan Df-1 Pin Plg Xt Dr,"$41,500.00",$0.00,"$41,500.00","$18,675.00","$5,158.80",$0.00,"$7,150.24","$5,158.80","$29,618.55","$7,266.32","$41,500.00",$0.00,"$20,750.00","$32,868.00","$33,200.00",$0.00,"$6,494.75",$0.00,"$6,606.80",$0.00
27500417,EAP,HCPCS C1721,,Evera Mri Xt Dr Icd (dual Chamber Icd) Df4 Header,"$41,500.00",$0.00,"$41,500.00","$18,675.00","$5,158.80",$0.00,"$7,150.24","$5,158.80","$29,618.55","$7,266.32","$41,500.00",$0.00,"$20,750.00","$32,868.00","$33,200.00",$0.00,"$6,494.75",$0.00,"$6,606.80",$0.00
27500418,EAP,HCPCS C1722,,Dfbr Crd Visia Af Mri Df4 Vr,"$36,500.00",$0.00,"$36,500.00","$16,425.00","$5,158.80",$0.00,"$6,288.77","$5,158.80","$26,050.05","$6,390.86","$36,500.00",$0.00,"$18,250.00","$28,908.00","$29,200.00",$0.00,"$5,712.25",$0.00,"$5,810.80",$0.00
27500419,EAP,HCPCS C1722,,Visia Vr Icd (single Chamber Icd)  Df 1 Header,"$36,500.00",$0.00,"$36,500.00","$16,425.00","$5,158.80",$0.00,"$6,288.77","$5,158.80","$26,050.05","$6,390.86","$36,500.00",$0.00,"$18,250.00","$28,908.00","$29,200.00",$0.00,"$5,712.25",$0.00,"$5,810.80",$0.00
27500420,EAP,HCPCS C1786,,Pacemaker Cardiac .75cm 4.45x4.81cm 1 Chamber Is1 Conctr,"$8,600.00",$0.00,"$8,600.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$6,137.82",$0.00,"$8,600.00",$0.00,"$4,300.00","$6,811.20","$6,880.00",$0.00,$0.00,$0.00,$0.00,$0.00
27500421,EAP,HCPCS C1722,,Defibrillator Cardiac .99cm 5.37x7.79cm 1 Chamber Is-1 Df-4,"$33,750.00",$0.00,"$33,750.00","$15,187.50","$5,158.80",$0.00,"$5,814.96","$5,158.80","$24,087.38","$5,909.36","$33,750.00",$0.00,"$16,875.00","$26,730.00","$27,000.00",$0.00,"$5,281.88",$0.00,"$5,373.00",$0.00
27500422,EAP,HCPCS C1721,,Defibrillator Cardiac .99cm 5.37x7.68cm 2 Chamber Extend,"$37,500.00",$0.00,"$37,500.00","$16,875.00","$5,158.80",$0.00,"$6,461.06","$5,158.80","$26,763.75","$6,565.95","$37,500.00",$0.00,"$18,750.00","$29,700.00","$30,000.00",$0.00,"$5,868.75",$0.00,"$5,970.00",$0.00
27500423,EAP,HCPCS C1721,,Defibrillator Cardiac .99cm 5.37x7.79cm 2 Chamber Extend,"$37,500.00",$0.00,"$37,500.00","$16,875.00","$5,158.80",$0.00,"$6,461.06","$5,158.80","$26,763.75","$6,565.95","$37,500.00",$0.00,"$18,750.00","$29,700.00","$30,000.00",$0.00,"$5,868.75",$0.00,"$5,970.00",$0.00
27500424,EAP,HCPCS C1882,,Defibrillator Cardiac .99cm 5.37x8.08cm Is-1 Df-1 Lv-1,"$44,750.00",$0.00,"$44,750.00","$20,137.50","$5,158.80",$0.00,"$7,710.20","$5,158.80","$31,938.08","$7,835.37","$44,750.00",$0.00,"$22,375.00","$35,442.00","$35,800.00",$0.00,"$7,003.38",$0.00,"$7,124.20",$0.00
27500425,EAP,HCPCS C1893,,Acuity Pro Implant Tools/lead Delivery System,"$15,250.00",$0.00,"$15,250.00","$6,862.50","$5,158.80",$0.00,"$2,627.50","$5,158.80","$10,883.93","$2,670.15","$15,250.00",$0.00,"$7,625.00","$12,078.00","$12,200.00",$0.00,"$2,386.63",$0.00,"$2,427.80",$0.00
27500426,EAP,HCPCS C2621,,Pacemaker Cardiac 3d .75cm 16.2cu Cm Spiral 2.6fr 4.45x6.13,"$15,250.00",$0.00,"$15,250.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$10,883.93",$0.00,"$15,250.00",$0.00,"$7,625.00","$12,078.00","$12,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
27500427,EAP,HCPCS C1882,,Defibrillator Cardiac .99in Mini 5.37x8.18cm Is-1 Df-4 Is-4,"$44,750.00",$0.00,"$44,750.00","$20,137.50","$5,158.80",$0.00,"$7,710.20","$5,158.80","$31,938.08","$7,835.37","$44,750.00",$0.00,"$22,375.00","$35,442.00","$35,800.00",$0.00,"$7,003.38",$0.00,"$7,124.20",$0.00
27500428,EAP,HCPCS C1882,,Defibrillator Cardiac .99in Mini 5.37x8.08cm Is-1 Df-1 Is-4,"$44,750.00",$0.00,"$44,750.00","$20,137.50","$5,158.80",$0.00,"$7,710.20","$5,158.80","$31,938.08","$7,835.37","$44,750.00",$0.00,"$22,375.00","$35,442.00","$35,800.00",$0.00,"$7,003.38",$0.00,"$7,124.20",$0.00
27500429,EAP,HCPCS C1900,,Lead Pacing X4 95 Cmconctr Acuity Left Ventricle Spiral L,"$6,750.00",$0.00,"$6,750.00",$0.00,"$4,817.48",$0.00,"$1,162.99","$4,817.48","$4,817.48",$0.00,"$6,750.00",$0.00,"$3,375.00","$5,346.00","$5,400.00",$0.00,"$1,056.38",$0.00,$0.00,$0.00
27500430,EAP,HCPCS C1900,,Lead Pacing X4 86cm Conctr Acuity Left Ventricle Spiral L,"$6,750.00",$0.00,"$6,750.00",$0.00,"$4,817.48",$0.00,"$1,162.99","$4,817.48","$4,817.48",$0.00,"$6,750.00",$0.00,"$3,375.00","$5,346.00","$5,400.00",$0.00,"$1,056.38",$0.00,$0.00,$0.00
27500431,EAP,HCPCS C1900,,Lead Pacing X4 95cm Conctr Acuity Left Ventricle Straight,"$6,750.00",$0.00,"$6,750.00",$0.00,"$4,817.48",$0.00,"$1,162.99","$4,817.48","$4,817.48",$0.00,"$6,750.00",$0.00,"$3,375.00","$5,346.00","$5,400.00",$0.00,"$1,056.38",$0.00,$0.00,$0.00
27500432,EAP,HCPCS C1900,,Lead Pacing X4 86 Cm Conctr Acuity Left Ventricle Spiral S,"$6,750.00",$0.00,"$6,750.00",$0.00,"$4,817.48",$0.00,"$1,162.99","$4,817.48","$4,817.48",$0.00,"$6,750.00",$0.00,"$3,375.00","$5,346.00","$5,400.00",$0.00,"$1,056.38",$0.00,$0.00,$0.00
27500433,EAP,HCPCS C1900,,Lead Pacing X4 95 Cm Conctr Acuity Left Ventricle Spiral S,"$6,750.00",$0.00,"$6,750.00",$0.00,"$4,817.48",$0.00,"$1,162.99","$4,817.48","$4,817.48",$0.00,"$6,750.00",$0.00,"$3,375.00","$5,346.00","$5,400.00",$0.00,"$1,056.38",$0.00,$0.00,$0.00
27500434,EAP,HCPCS C1900,,Lead Pacing X4 86 Cm Conctr Acuity Left Ventricle Straight,"$6,750.00",$0.00,"$6,750.00",$0.00,"$4,817.48",$0.00,"$1,162.99","$4,817.48","$4,817.48",$0.00,"$6,750.00",$0.00,"$3,375.00","$5,346.00","$5,400.00",$0.00,"$1,056.38",$0.00,$0.00,$0.00
27500435,EAP,HCPCS C1882,,Inventra 7 Vr-t Dx,"$49,688.00",$0.00,"$49,688.00","$22,359.60","$5,158.80",$0.00,"$8,138.89","$5,158.80","$35,462.33","$8,138.89","$49,688.00",$0.00,"$24,844.00","$39,352.90","$39,750.40",$0.00,"$7,751.33",$0.00,"$7,910.33",$0.00
27500440,EAP,HCPCS C1785,,Pacemaker Crd Promri 2 Chmbr Eluna Dr-t,"$14,000.00",$0.00,"$14,000.00","$6,300.00","$5,158.80",$0.00,"$2,412.13","$5,158.80","$9,991.80","$2,451.29","$14,000.00",$0.00,"$7,000.00","$11,088.00","$11,200.00",$0.00,"$2,191.00",$0.00,"$2,228.80",$0.00
27500441,EAP,HCPCS C1785,,Pacemaker Crd Promri Eluna Dr-t Lead Cllr Home,"$16,500.00",$0.00,"$16,500.00","$7,425.00","$5,158.80",$0.00,"$2,842.87","$5,158.80","$11,776.05","$2,889.02","$16,500.00",$0.00,"$8,250.00","$13,068.00","$13,200.00",$0.00,"$2,582.25",$0.00,"$2,626.80",$0.00
27500442,EAP,HCPCS C1786,,Pacemaker Crd Eluna Sr-t Promri,"$12,125.00",$0.00,"$12,125.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$8,653.61",$0.00,"$12,125.00",$0.00,"$6,062.50","$9,603.00","$9,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
27500443,EAP,HCPCS C1786,,Pacemaker Crd Promri Eluna Sr-t Lead Cllr Home,"$13,250.00",$0.00,"$13,250.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,456.53",$0.00,"$13,250.00",$0.00,"$6,625.00","$10,494.00","$10,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
27503012,EAP,HCPCS C1785,,"Altrua 60 Pmkr, Dual, Rate-resp","$12,375.00",$0.00,"$12,375.00","$5,568.75","$5,158.80",$0.00,"$2,132.15","$5,158.80","$8,832.04","$2,166.76","$12,375.00",$0.00,"$6,187.50","$9,801.00","$9,900.00",$0.00,"$1,936.69",$0.00,"$1,970.10",$0.00
27503013,EAP,HCPCS C1786,,"Altrua Pmkr, Single, Rate-resp","$10,553.00",$0.00,"$10,553.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$7,531.68",$0.00,"$10,553.00",$0.00,"$5,276.50","$8,357.98","$8,442.40",$0.00,$0.00,$0.00,$0.00,$0.00
27503014,EAP,HCPCS C1721,,Energen Dr Aicd Dual Chamber,"$46,552.00",$0.00,"$46,552.00","$20,948.40","$5,158.80",$0.00,"$8,020.68","$5,158.80","$33,224.16","$8,138.89","$46,552.00",$0.00,"$23,276.00","$36,869.18","$37,241.60",$0.00,"$7,285.39",$0.00,"$7,411.08",$0.00
27503015,EAP,HCPCS C1722,,Energen Vr Aicd Single Chamber,"$38,792.00",$0.00,"$38,792.00","$17,456.40","$5,158.80",$0.00,"$6,683.67","$5,158.80","$27,685.85","$6,792.17","$38,792.00",$0.00,"$19,396.00","$30,723.26","$31,033.60",$0.00,"$6,070.95",$0.00,"$6,175.69",$0.00
27503016,EAP,HCPCS C1895,,"Reliance Gore Lead,aicd, Endo Dual Coil","$13,964.00",$0.00,"$13,964.00","$6,283.80","$5,158.80",$0.00,"$2,405.93","$5,158.80","$9,966.11","$2,444.98","$13,964.00",$0.00,"$6,982.00","$11,059.49","$11,171.20",$0.00,"$2,185.37",$0.00,"$2,223.07",$0.00
27503017,EAP,HCPCS C2621,,Contak Renewal Tr Crt-p,"$19,861.00",$0.00,"$19,861.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$14,174.80",$0.00,"$19,861.00",$0.00,"$9,930.50","$15,729.91","$15,888.80",$0.00,$0.00,$0.00,$0.00,$0.00
27503018,EAP,HCPCS C1900,,"Acuity Steerable Lead, Coronary Venous","$6,208.00",$0.00,"$6,208.00",$0.00,"$4,430.65",$0.00,"$1,069.61","$4,430.65","$4,430.65",$0.00,"$6,208.00",$0.00,"$3,104.00","$4,916.74","$4,966.40",$0.00,$971.55,$0.00,$0.00,$0.00
27503019,EAP,HCPCS C1900,,"Acuity Spiral Lead,coronary Venous","$6,208.00",$0.00,"$6,208.00",$0.00,"$4,430.65",$0.00,"$1,069.61","$4,430.65","$4,430.65",$0.00,"$6,208.00",$0.00,"$3,104.00","$4,916.74","$4,966.40",$0.00,$971.55,$0.00,$0.00,$0.00
27503020,EAP,HCPCS C1900,,"Easytrak 2 Lead,coronary Venous","$4,656.00",$0.00,"$4,656.00",$0.00,"$3,322.99",$0.00,$802.21,"$3,322.99","$3,322.99",$0.00,"$4,656.00",$0.00,"$2,328.00","$3,687.55","$3,724.80",$0.00,$728.66,$0.00,$0.00,$0.00
27503021,EAP,HCPCS C1900,,"Easytrak 3 Lead,coronary Venous","$4,656.00",$0.00,"$4,656.00",$0.00,"$3,322.99",$0.00,$802.21,"$3,322.99","$3,322.99",$0.00,"$4,656.00",$0.00,"$2,328.00","$3,687.55","$3,724.80",$0.00,$728.66,$0.00,$0.00,$0.00
27503022,EAP,HCPCS C1721,,Fortify Dr Aicd Dual Chamber,"$64,394.00",$0.00,"$64,394.00","$28,977.30","$5,158.80",$0.00,"$8,138.89","$5,158.80","$45,958.00","$8,138.89","$64,394.00",$0.00,"$32,197.00","$51,000.05","$51,515.20",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503023,EAP,HCPCS C1785,,Accent Dr,"$17,142.00",$0.00,"$17,142.00","$7,713.90","$5,158.80",$0.00,"$2,953.48","$5,158.80","$12,234.25","$3,001.43","$17,142.00",$0.00,"$8,571.00","$13,576.46","$13,713.60",$0.00,"$2,682.72",$0.00,"$2,729.01",$0.00
27503024,EAP,HCPCS C1786,,Accent Sr,"$1,566.00",$0.00,"$1,566.00",$0.00,"$1,117.65",$0.00,$0.00,"$1,117.65","$1,117.65",$0.00,"$1,566.00",$0.00,$783.00,"$1,240.27","$1,252.80",$0.00,$0.00,$0.00,$0.00,$0.00
27503025,EAP,HCPCS C1898,,Tendril Sts 2088tc/46,"$1,478.00",$0.00,"$1,478.00",$665.10,"$1,054.85",$0.00,$254.65,"$1,054.85","$1,054.85",$258.79,"$1,478.00",$0.00,$739.00,"$1,170.58","$1,182.40",$0.00,$231.31,$0.00,$235.30,$0.00
27503028,EAP,HCPCS C1721,,Fortify Assura Dr 40,"$61,328.00",$0.00,"$61,328.00","$27,597.60","$5,158.80",$0.00,"$8,138.89","$5,158.80","$43,769.79","$8,138.89","$61,328.00",$0.00,"$30,664.00","$48,571.78","$49,062.40",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503029,EAP,HCPCS C1721,,Fortify Assura Dr 40 Df4 Connector,"$61,328.00",$0.00,"$61,328.00","$27,597.60","$5,158.80",$0.00,"$8,138.89","$5,158.80","$43,769.79","$8,138.89","$61,328.00",$0.00,"$30,664.00","$48,571.78","$49,062.40",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503030,EAP,HCPCS C1721,,Ellipse Dr 36,"$61,328.00",$0.00,"$61,328.00","$27,597.60","$5,158.80",$0.00,"$8,138.89","$5,158.80","$43,769.79","$8,138.89","$61,328.00",$0.00,"$30,664.00","$48,571.78","$49,062.40",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503031,EAP,HCPCS C1722,,Ellipse Dr 36 Df4 Connector,"$61,328.00",$0.00,"$61,328.00","$27,597.60","$5,158.80",$0.00,"$8,138.89","$5,158.80","$43,769.79","$8,138.89","$61,328.00",$0.00,"$30,664.00","$48,571.78","$49,062.40",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503032,EAP,HCPCS C1722,,Fortify Assura Vr 40,"$53,200.00",$0.00,"$53,200.00","$23,940.00","$5,158.80",$0.00,"$8,138.89","$5,158.80","$37,968.84","$8,138.89","$53,200.00",$0.00,"$26,600.00","$42,134.40","$42,560.00",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503033,EAP,HCPCS C1722,,Fortify Assura Vr 40 Df4 Connector,"$53,200.00",$0.00,"$53,200.00","$23,940.00","$5,158.80",$0.00,"$8,138.89","$5,158.80","$37,968.84","$8,138.89","$53,200.00",$0.00,"$26,600.00","$42,134.40","$42,560.00",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503034,EAP,HCPCS C1722,,Ellipse Vr 36,"$53,200.00",$0.00,"$53,200.00","$23,940.00","$5,158.80",$0.00,"$8,138.89","$5,158.80","$37,968.84","$8,138.89","$53,200.00",$0.00,"$26,600.00","$42,134.40","$42,560.00",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503035,EAP,HCPCS C1722,,Ellipse Vr 36 Df4 Connector,"$53,200.00",$0.00,"$53,200.00","$23,940.00","$5,158.80",$0.00,"$8,138.89","$5,158.80","$37,968.84","$8,138.89","$53,200.00",$0.00,"$26,600.00","$42,134.40","$42,560.00",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503036,EAP,HCPCS C1882,,Quadra Assura Crt-d 40,"$8,512.00",$0.00,"$8,512.00","$3,830.40","$5,158.80",$0.00,"$1,466.58","$5,158.80","$6,075.01","$1,490.38","$8,512.00",$0.00,"$4,256.00","$6,741.50","$6,809.60",$0.00,"$1,332.13",$0.00,"$1,355.11",$0.00
27503037,EAP,HCPCS C1882,,Quadra Assura Crt-d 40 Df4 Connector,"$85,120.00",$0.00,"$85,120.00","$38,304.00","$5,158.80",$0.00,"$8,138.89","$5,158.80","$60,750.14","$8,138.89","$85,120.00",$0.00,"$42,560.00","$67,415.04","$68,096.00",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503038,EAP,HCPCS C1882,,Unify Assura Crt-d 40,"$85,120.00",$0.00,"$85,120.00","$38,304.00","$5,158.80",$0.00,"$8,138.89","$5,158.80","$60,750.14","$8,138.89","$85,120.00",$0.00,"$42,560.00","$67,415.04","$68,096.00",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503039,EAP,HCPCS C1882,,Unify Assura Crt-d 40 Df4 Connector,"$85,120.00",$0.00,"$85,120.00","$38,304.00","$5,158.80",$0.00,"$8,138.89","$5,158.80","$60,750.14","$8,138.89","$85,120.00",$0.00,"$42,560.00","$67,415.04","$68,096.00",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503040,EAP,HCPCS C1898,,Tendril Sts 2088tc/65,"$1,478.00",$0.00,"$1,478.00",$665.10,"$1,054.85",$0.00,$254.65,"$1,054.85","$1,054.85",$258.79,"$1,478.00",$0.00,$739.00,"$1,170.58","$1,182.40",$0.00,$231.31,$0.00,$235.30,$0.00
27503041,EAP,HCPCS C1898,,Tendril Sts 2088tc/100,"$1,478.00",$0.00,"$1,478.00",$665.10,"$1,054.85",$0.00,$254.65,"$1,054.85","$1,054.85",$258.79,"$1,478.00",$0.00,$739.00,"$1,170.58","$1,182.40",$0.00,$231.31,$0.00,$235.30,$0.00
27503042,EAP,HCPCS C1785,,"Adapta Vdd, Is-i","$4,729.00",$0.00,"$4,729.00","$2,128.05","$3,375.09",$0.00,$814.78,"$3,375.09","$3,375.09",$828.01,"$4,729.00",$0.00,"$2,364.50","$3,745.37","$3,783.20",$0.00,$740.09,$0.00,$752.86,$0.00
27503043,EAP,HCPCS C1898,,Capsure Vdd2 Lead 5038s-52,$828.00,$0.00,$828.00,$372.60,$590.94,$0.00,$142.66,$590.94,$590.94,$144.98,$828.00,$0.00,$414.00,$655.78,$662.40,$0.00,$129.58,$0.00,$131.82,$0.00
27503044,EAP,HCPCS C1898,,Capsure Vdd2 Lead 5032s-58,$828.00,$0.00,$828.00,$372.60,$590.94,$0.00,$142.66,$590.94,$590.94,$144.98,$828.00,$0.00,$414.00,$655.78,$662.40,$0.00,$129.58,$0.00,$131.82,$0.00
27503045,EAP,HCPCS C1898,,Capsure Vdd2 Lead 50038-58,$828.00,$0.00,$828.00,$372.60,$590.94,$0.00,$142.66,$590.94,$590.94,$144.98,$828.00,$0.00,$414.00,$655.78,$662.40,$0.00,$129.58,$0.00,$131.82,$0.00
27503046,EAP,HCPCS C1898,,Capsure Vdd2 Lead 5038-65,$828.00,$0.00,$828.00,$372.60,$590.94,$0.00,$142.66,$590.94,$590.94,$144.98,$828.00,$0.00,$414.00,$655.78,$662.40,$0.00,$129.58,$0.00,$131.82,$0.00
27503050,EAP,HCPCS C1785,,Accent Dr  Pacemaker Generator,"$17,142.00",$0.00,"$17,142.00","$7,713.90","$5,158.80",$0.00,"$2,953.48","$5,158.80","$12,234.25","$3,001.43","$17,142.00",$0.00,"$8,571.00","$13,576.46","$13,713.60",$0.00,"$2,682.72",$0.00,"$2,729.01",$0.00
27503051,EAP,HCPCS C1786,,Accent Sr Pacemaker Generator,"$15,665.00",$0.00,"$15,665.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$11,180.11",$0.00,"$15,665.00",$0.00,"$7,832.50","$12,406.68","$12,532.00",$0.00,$0.00,$0.00,$0.00,$0.00
27503052,EAP,HCPCS C1898,,Tendril Sts 2088tc/46 Lead/electrode/access,"$1,478.00",$0.00,"$1,478.00",$665.10,"$1,054.85",$0.00,$254.65,"$1,054.85","$1,054.85",$258.79,"$1,478.00",$0.00,$739.00,"$1,170.58","$1,182.40",$0.00,$231.31,$0.00,$235.30,$0.00
27503053,EAP,HCPCS C1898,,Tendril Sts 2088tc/52 Lead/electrode/access,"$1,478.00",$0.00,"$1,478.00",$665.10,"$1,054.85",$0.00,$254.65,"$1,054.85","$1,054.85",$258.79,"$1,478.00",$0.00,$739.00,"$1,170.58","$1,182.40",$0.00,$231.31,$0.00,$235.30,$0.00
27503055,EAP,HCPCS C1721,,Fortify Assura Dr 40 Df4 Connector Icd/defib/resync,"$61,328.00",$0.00,"$61,328.00","$27,597.60","$5,158.80",$0.00,"$8,138.89","$5,158.80","$43,769.79","$8,138.89","$61,328.00",$0.00,"$30,664.00","$48,571.78","$49,062.40",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503056,EAP,HCPCS C1721,,Fortify Assura Dr 40 Df4 Connector Icd/defib/resync,"$61,328.00",$0.00,"$61,328.00","$27,597.60","$5,158.80",$0.00,"$8,138.89","$5,158.80","$43,769.79","$8,138.89","$61,328.00",$0.00,"$30,664.00","$48,571.78","$49,062.40",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503057,EAP,HCPCS C1721,,Ellipse Dr 36 Df4 Connector Icd/defib/resync,"$61,328.00",$0.00,"$61,328.00","$27,597.60","$5,158.80",$0.00,"$8,138.89","$5,158.80","$43,769.79","$8,138.89","$61,328.00",$0.00,"$30,664.00","$48,571.78","$49,062.40",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503058,EAP,HCPCS C1721,,Ellipse Dr 36 Df4 Connector Icd/defib/resync,"$61,328.00",$0.00,"$61,328.00","$27,597.60","$5,158.80",$0.00,"$8,138.89","$5,158.80","$43,769.79","$8,138.89","$61,328.00",$0.00,"$30,664.00","$48,571.78","$49,062.40",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503059,EAP,HCPCS C1722,,Fortify Assura Vr 40 Df4 Connector Icd/defib/resync,"$53,200.00",$0.00,"$53,200.00","$23,940.00","$5,158.80",$0.00,"$8,138.89","$5,158.80","$37,968.84","$8,138.89","$53,200.00",$0.00,"$26,600.00","$42,134.40","$42,560.00",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503060,EAP,HCPCS C1722,,Fortify Assura Vr 40 Df4 Connector Icd/defib/resync,"$53,200.00",$0.00,"$53,200.00","$23,940.00","$5,158.80",$0.00,"$8,138.89","$5,158.80","$37,968.84","$8,138.89","$53,200.00",$0.00,"$26,600.00","$42,134.40","$42,560.00",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503061,EAP,HCPCS C1722,,Ellipse Vr 36 Df4 Connector Icd/defib/resync,"$53,200.00",$0.00,"$53,200.00","$23,940.00","$5,158.80",$0.00,"$8,138.89","$5,158.80","$37,968.84","$8,138.89","$53,200.00",$0.00,"$26,600.00","$42,134.40","$42,560.00",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503062,EAP,HCPCS C1722,,Ellipse Vr 36 Df4 Connector Icd/defib/resync,"$53,200.00",$0.00,"$53,200.00","$23,940.00","$5,158.80",$0.00,"$8,138.89","$5,158.80","$37,968.84","$8,138.89","$53,200.00",$0.00,"$26,600.00","$42,134.40","$42,560.00",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503063,EAP,HCPCS C1882,,Quadra Assura Crt-d 40 Df4 Connector Icd/defib/resync,"$8,512.00",$0.00,"$8,512.00","$3,830.40","$5,158.80",$0.00,"$1,466.58","$5,158.80","$6,075.01","$1,490.38","$8,512.00",$0.00,"$4,256.00","$6,741.50","$6,809.60",$0.00,"$1,332.13",$0.00,"$1,355.11",$0.00
27503064,EAP,HCPCS C1882,,Quadra Assura Crt-d 40 Df4 Connector Icd/defib/resync,"$85,120.00",$0.00,"$85,120.00","$38,304.00","$5,158.80",$0.00,"$8,138.89","$5,158.80","$60,750.14","$8,138.89","$85,120.00",$0.00,"$42,560.00","$67,415.04","$68,096.00",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503065,EAP,HCPCS C1882,,Unify Assura Crt-d 40 Df4 Connector    Icd/defib/resync,"$85,120.00",$0.00,"$85,120.00","$38,304.00","$5,158.80",$0.00,"$8,138.89","$5,158.80","$60,750.14","$8,138.89","$85,120.00",$0.00,"$42,560.00","$67,415.04","$68,096.00",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503066,EAP,HCPCS C1882,,Unify Assura Crt-d 40 Df4 Connector    Icd/defib/resync,"$85,120.00",$0.00,"$85,120.00","$38,304.00","$5,158.80",$0.00,"$8,138.89","$5,158.80","$60,750.14","$8,138.89","$85,120.00",$0.00,"$42,560.00","$67,415.04","$68,096.00",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503067,EAP,HCPCS C1898,,Tendril Sts 2088tc/100  Lead/electrode/access,"$1,478.00",$0.00,"$1,478.00",$665.10,"$1,054.85",$0.00,$254.65,"$1,054.85","$1,054.85",$258.79,"$1,478.00",$0.00,$739.00,"$1,170.58","$1,182.40",$0.00,$231.31,$0.00,$235.30,$0.00
27503068,EAP,HCPCS C1898,,Tendril Sts 2088tc/65    Lead/electrode/access,"$1,478.00",$0.00,"$1,478.00",$665.10,"$1,054.85",$0.00,$254.65,"$1,054.85","$1,054.85",$258.79,"$1,478.00",$0.00,$739.00,"$1,170.58","$1,182.40",$0.00,$231.31,$0.00,$235.30,$0.00
27503070,EAP,HCPCS C1898,,Lead 4076110  Pkg Assy Lead 4076 Mdt Us,"$1,478.00",$0.00,"$1,478.00",$665.10,"$1,054.85",$0.00,$254.65,"$1,054.85","$1,054.85",$258.79,"$1,478.00",$0.00,$739.00,"$1,170.58","$1,182.40",$0.00,$231.31,$0.00,$235.30,$0.00
27503071,EAP,HCPCS C1898,,Lead 407625  Pkg Assy Lead 4076 Mdt Us M,"$1,478.00",$0.00,"$1,478.00",$665.10,"$1,054.85",$0.00,$254.65,"$1,054.85","$1,054.85",$258.79,"$1,478.00",$0.00,$739.00,"$1,170.58","$1,182.40",$0.00,$231.31,$0.00,$235.30,$0.00
27503072,EAP,HCPCS C1898,,Lead 407635 Capsurefix Novus,"$1,478.00",$0.00,"$1,478.00",$665.10,"$1,054.85",$0.00,$254.65,"$1,054.85","$1,054.85",$258.79,"$1,478.00",$0.00,$739.00,"$1,170.58","$1,182.40",$0.00,$231.31,$0.00,$235.30,$0.00
27503073,EAP,HCPCS C1898,,Lead 407645  Pkg Assy Lead 4076 Mdt Us M,"$1,478.00",$0.00,"$1,478.00",$665.10,"$1,054.85",$0.00,$254.65,"$1,054.85","$1,054.85",$258.79,"$1,478.00",$0.00,$739.00,"$1,170.58","$1,182.40",$0.00,$231.31,$0.00,$235.30,$0.00
27503074,EAP,HCPCS C1898,,Lead 407652  Pkg Assy Lead 4076 Mdt Us M,"$1,478.00",$0.00,"$1,478.00",$665.10,"$1,054.85",$0.00,$254.65,"$1,054.85","$1,054.85",$258.79,"$1,478.00",$0.00,$739.00,"$1,170.58","$1,182.40",$0.00,$231.31,$0.00,$235.30,$0.00
27503075,EAP,HCPCS C1898,,Lead 407658  Pkg Assy Lead 4076 Mdt Us M,"$1,478.00",$0.00,"$1,478.00",$665.10,"$1,054.85",$0.00,$254.65,"$1,054.85","$1,054.85",$258.79,"$1,478.00",$0.00,$739.00,"$1,170.58","$1,182.40",$0.00,$231.31,$0.00,$235.30,$0.00
27503076,EAP,HCPCS C1898,,Lead 407665 Capsurefix Novus,"$1,478.00",$0.00,"$1,478.00",$665.10,"$1,054.85",$0.00,$254.65,"$1,054.85","$1,054.85",$258.79,"$1,478.00",$0.00,$739.00,"$1,170.58","$1,182.40",$0.00,$231.31,$0.00,$235.30,$0.00
27503077,EAP,HCPCS C1898,,Lead 407685 Capsurefix Novus,"$1,478.00",$0.00,"$1,478.00",$665.10,"$1,054.85",$0.00,$254.65,"$1,054.85","$1,054.85",$258.79,"$1,478.00",$0.00,$739.00,"$1,170.58","$1,182.40",$0.00,$231.31,$0.00,$235.30,$0.00
27503081,EAP,HCPCS C1898,,Lead 5076-35  Lead-bipolar Sil Screw-in,"$1,478.00",$0.00,"$1,478.00",$665.10,"$1,054.85",$0.00,$254.65,"$1,054.85","$1,054.85",$258.79,"$1,478.00",$0.00,$739.00,"$1,170.58","$1,182.40",$0.00,$231.31,$0.00,$235.30,$0.00
27503082,EAP,HCPCS C1898,,Lead 5076-65  Lead-bipolar Sil Screw-in,"$1,478.00",$0.00,"$1,478.00",$665.10,"$1,054.85",$0.00,$254.65,"$1,054.85","$1,054.85",$258.79,"$1,478.00",$0.00,$739.00,"$1,170.58","$1,182.40",$0.00,$231.31,$0.00,$235.30,$0.00
27503083,EAP,HCPCS C1898,,Lead 5076-85  Lead-bipolar Sil Screw-in,"$1,478.00",$0.00,"$1,478.00",$665.10,"$1,054.85",$0.00,$254.65,"$1,054.85","$1,054.85",$258.79,"$1,478.00",$0.00,$739.00,"$1,170.58","$1,182.40",$0.00,$231.31,$0.00,$235.30,$0.00
27503084,EAP,HCPCS C1898,,Lead 5076110 Capsurefix Novus Pacing,"$1,478.00",$0.00,"$1,478.00",$665.10,"$1,054.85",$0.00,$254.65,"$1,054.85","$1,054.85",$258.79,"$1,478.00",$0.00,$739.00,"$1,170.58","$1,182.40",$0.00,$231.31,$0.00,$235.30,$0.00
27503085,EAP,HCPCS C1895,,Lead 6947100  Lead-quadripolar Rv/svc 10,"$11,822.00",$0.00,"$11,822.00","$5,319.90","$5,158.80",$0.00,"$2,036.87","$5,158.80","$8,437.36","$2,069.94","$11,822.00",$0.00,"$5,911.00","$9,363.02","$9,457.60",$0.00,"$1,850.14",$0.00,"$1,882.06",$0.00
27503086,EAP,HCPCS C1895,,Lead 694758  Lead-quadripolar Rv/svc 58c,"$11,822.00",$0.00,"$11,822.00","$5,319.90","$5,158.80",$0.00,"$2,036.87","$5,158.80","$8,437.36","$2,069.94","$11,822.00",$0.00,"$5,911.00","$9,363.02","$9,457.60",$0.00,"$1,850.14",$0.00,"$1,882.06",$0.00
27503087,EAP,HCPCS C1895,,Lead 694765  Sprint Quad Can Rv/svc,"$11,822.00",$0.00,"$11,822.00","$5,319.90","$5,158.80",$0.00,"$2,036.87","$5,158.80","$8,437.36","$2,069.94","$11,822.00",$0.00,"$5,911.00","$9,363.02","$9,457.60",$0.00,"$1,850.14",$0.00,"$1,882.06",$0.00
27503088,EAP,HCPCS C1895,,Lead 694775  Lead-quadripolar Rv/svc 75c,"$11,822.00",$0.00,"$11,822.00","$5,319.90","$5,158.80",$0.00,"$2,036.87","$5,158.80","$8,437.36","$2,069.94","$11,822.00",$0.00,"$5,911.00","$9,363.02","$9,457.60",$0.00,"$1,850.14",$0.00,"$1,882.06",$0.00
27503089,EAP,HCPCS C1895,,Lead 6947m55 Df4 Active Dc Sprint 55 Cm,"$11,822.00",$0.00,"$11,822.00","$5,319.90","$5,158.80",$0.00,"$2,036.87","$5,158.80","$8,437.36","$2,069.94","$11,822.00",$0.00,"$5,911.00","$9,363.02","$9,457.60",$0.00,"$1,850.14",$0.00,"$1,882.06",$0.00
27503090,EAP,HCPCS C1895,,Lead 6947m62 Df4 Active Dc Sprint 62 Cm,"$11,822.00",$0.00,"$11,822.00","$5,319.90","$5,158.80",$0.00,"$2,036.87","$5,158.80","$8,437.36","$2,069.94","$11,822.00",$0.00,"$5,911.00","$9,363.02","$9,457.60",$0.00,"$1,850.14",$0.00,"$1,882.06",$0.00
27503091,EAP,HCPCS C1895,,Lead 6947m72 Df4 Active Dc Sprint 72 Cm,"$11,822.00",$0.00,"$11,822.00","$5,319.90","$5,158.80",$0.00,"$2,036.87","$5,158.80","$8,437.36","$2,069.94","$11,822.00",$0.00,"$5,911.00","$9,363.02","$9,457.60",$0.00,"$1,850.14",$0.00,"$1,882.06",$0.00
27503092,EAP,HCPCS C1895,,Lead 6947m97 Df4 Active Dc Sprint 97 Cm,"$11,822.00",$0.00,"$11,822.00","$5,319.90","$5,158.80",$0.00,"$2,036.87","$5,158.80","$8,437.36","$2,069.94","$11,822.00",$0.00,"$5,911.00","$9,363.02","$9,457.60",$0.00,"$1,850.14",$0.00,"$1,882.06",$0.00
27503093,EAP,HCPCS C1786,,Pacemaker Single Chamber Adapta Sr,"$10,344.00",$0.00,"$10,344.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$7,382.51",$0.00,"$10,344.00",$0.00,"$5,172.00","$8,192.45","$8,275.20",$0.00,$0.00,$0.00,$0.00,$0.00
27503094,EAP,HCPCS C1882,,Generator Crt-d Maximo Ii,"$53,791.00",$0.00,"$53,791.00","$24,205.95","$5,158.80",$0.00,"$8,138.89","$5,158.80","$38,390.64","$8,138.89","$53,791.00",$0.00,"$26,895.50","$42,602.47","$43,032.80",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503095,EAP,HCPCS C1721,,Icd Dual Chamber Maximo Ii Dr,"$45,811.00",$0.00,"$45,811.00","$20,614.95","$5,158.80",$0.00,"$7,893.01","$5,158.80","$32,695.31","$8,021.14","$45,811.00",$0.00,"$22,905.50","$36,282.31","$36,648.80",$0.00,"$7,169.42",$0.00,"$7,293.11",$0.00
27503096,EAP,HCPCS C1721,,Dfbr Crd Mxmo 2 Vr Impltable Cardvrt Sys,"$38,422.00",$0.00,"$38,422.00","$17,289.90","$5,158.80",$0.00,"$6,619.92","$5,158.80","$27,421.78","$6,727.38","$38,422.00",$0.00,"$19,211.00","$30,430.22","$30,737.60",$0.00,"$6,013.04",$0.00,"$6,116.78",$0.00
27503097,EAP,HCPCS C1900,,Philos Dr,"$8,572.00",$0.00,"$8,572.00",$0.00,"$5,158.80",$0.00,"$1,476.91","$5,158.80","$6,117.84",$0.00,"$8,572.00",$0.00,"$4,286.00","$6,789.02","$6,857.60",$0.00,"$1,341.52",$0.00,$0.00,$0.00
27503098,EAP,HCPCS C1900,,Philos Sr,"$8,276.00",$0.00,"$8,276.00",$0.00,"$5,158.80",$0.00,"$1,425.91","$5,158.80","$5,906.58",$0.00,"$8,276.00",$0.00,"$4,138.00","$6,554.59","$6,620.80",$0.00,"$1,295.19",$0.00,$0.00,$0.00
27503099,EAP,HCPCS C1900,,Philos Dr System,"$10,049.00",$0.00,"$10,049.00",$0.00,"$5,158.80",$0.00,"$1,731.39","$5,158.80","$7,171.97",$0.00,"$10,049.00",$0.00,"$5,024.50","$7,958.81","$8,039.20",$0.00,"$1,572.67",$0.00,$0.00,$0.00
27503100,EAP,HCPCS C1900,,Philos Sr System,"$9,458.00",$0.00,"$9,458.00",$0.00,"$5,158.80",$0.00,"$1,629.57","$5,158.80","$6,750.17",$0.00,"$9,458.00",$0.00,"$4,729.00","$7,490.74","$7,566.40",$0.00,"$1,480.18",$0.00,$0.00,$0.00
27503101,EAP,HCPCS C1900,,Arox 60 Bp Lead,"$1,478.00",$0.00,"$1,478.00",$0.00,"$1,054.85",$0.00,$254.65,"$1,054.85","$1,054.85",$0.00,"$1,478.00",$0.00,$739.00,"$1,170.58","$1,182.40",$0.00,$231.31,$0.00,$0.00,$0.00
27503102,EAP,HCPCS C1900,,Arox 53 Bp Lead,"$1,478.00",$0.00,"$1,478.00",$0.00,"$1,054.85",$0.00,$254.65,"$1,054.85","$1,054.85",$0.00,"$1,478.00",$0.00,$739.00,"$1,170.58","$1,182.40",$0.00,$231.31,$0.00,$0.00,$0.00
27503103,EAP,HCPCS C1898,,Selox St 53 Lead,"$1,330.00",$0.00,"$1,330.00",$598.50,$949.22,$0.00,$229.15,$949.22,$949.22,$232.87,"$1,330.00",$0.00,$665.00,"$1,053.36","$1,064.00",$0.00,$208.15,$0.00,$211.74,$0.00
27503104,EAP,HCPCS C1898,,Selox St 60 Lead,"$1,330.00",$0.00,"$1,330.00",$598.50,$949.22,$0.00,$229.15,$949.22,$949.22,$232.87,"$1,330.00",$0.00,$665.00,"$1,053.36","$1,064.00",$0.00,$208.15,$0.00,$211.74,$0.00
27503105,EAP,HCPCS C1898,,Selox Jt 53 Lead,"$1,330.00",$0.00,"$1,330.00",$598.50,$949.22,$0.00,$229.15,$949.22,$949.22,$232.87,"$1,330.00",$0.00,$665.00,"$1,053.36","$1,064.00",$0.00,$208.15,$0.00,$211.74,$0.00
27503106,EAP,HCPCS C1898,,Selox Jt 45 Lead,"$1,330.00",$0.00,"$1,330.00",$598.50,$949.22,$0.00,$229.15,$949.22,$949.22,$232.87,"$1,330.00",$0.00,$665.00,"$1,053.36","$1,064.00",$0.00,$208.15,$0.00,$211.74,$0.00
27503107,EAP,HCPCS C1900,,Philos Ii Dr System,"$11,822.00",$0.00,"$11,822.00",$0.00,"$5,158.80",$0.00,"$2,036.87","$5,158.80","$8,437.36",$0.00,"$11,822.00",$0.00,"$5,911.00","$9,363.02","$9,457.60",$0.00,"$1,850.14",$0.00,$0.00,$0.00
27503108,EAP,HCPCS C1900,,Cylos Dr With Cls Autonomic Response,"$10,049.00",$0.00,"$10,049.00",$0.00,"$5,158.80",$0.00,"$1,731.39","$5,158.80","$7,171.97",$0.00,"$10,049.00",$0.00,"$5,024.50","$7,958.81","$8,039.20",$0.00,"$1,572.67",$0.00,$0.00,$0.00
27503109,EAP,HCPCS C1900,,Cylos Vr With Cls Autonomic Response,"$10,049.00",$0.00,"$10,049.00",$0.00,"$5,158.80",$0.00,"$1,731.39","$5,158.80","$7,171.97",$0.00,"$10,049.00",$0.00,"$5,024.50","$7,958.81","$8,039.20",$0.00,"$1,572.67",$0.00,$0.00,$0.00
27503110,EAP,HCPCS C1895,,Linox Sd Steroid 65/16,"$8,867.00",$0.00,"$8,867.00","$3,990.15","$5,158.80",$0.00,"$1,527.74","$5,158.80","$6,328.38","$1,552.54","$8,867.00",$0.00,"$4,433.50","$7,022.66","$7,093.60",$0.00,"$1,387.69",$0.00,"$1,411.63",$0.00
27503111,EAP,HCPCS C1895,,Linox Sd Steroid 75/18,"$8,867.00",$0.00,"$8,867.00","$3,990.15","$5,158.80",$0.00,"$1,527.74","$5,158.80","$6,328.38","$1,552.54","$8,867.00",$0.00,"$4,433.50","$7,022.66","$7,093.60",$0.00,"$1,387.69",$0.00,"$1,411.63",$0.00
27503112,EAP,HCPCS C1898,,Setrox S 53 Lead,"$1,330.00",$0.00,"$1,330.00",$598.50,$949.22,$0.00,$229.15,$949.22,$949.22,$232.87,"$1,330.00",$0.00,$665.00,"$1,053.36","$1,064.00",$0.00,$208.15,$0.00,$211.74,$0.00
27503113,EAP,HCPCS C1898,,Setrox S 60 Lead,"$1,330.00",$0.00,"$1,330.00",$598.50,$949.22,$0.00,$229.15,$949.22,$949.22,$232.87,"$1,330.00",$0.00,$665.00,"$1,053.36","$1,064.00",$0.00,$208.15,$0.00,$211.74,$0.00
27503114,EAP,HCPCS C1777,,Linox S 65 Steroid,"$8,867.00",$0.00,"$8,867.00","$3,990.15","$5,158.80",$0.00,"$1,527.74","$5,158.80","$6,328.38","$1,552.54","$8,867.00",$0.00,"$4,433.50","$7,022.66","$7,093.60",$0.00,"$1,387.69",$0.00,"$1,411.63",$0.00
27503115,EAP,HCPCS C1777,,Linox S 75 Steroid,"$8,867.00",$0.00,"$8,867.00","$3,990.15","$5,158.80",$0.00,"$1,527.74","$5,158.80","$6,328.38","$1,552.54","$8,867.00",$0.00,"$4,433.50","$7,022.66","$7,093.60",$0.00,"$1,387.69",$0.00,"$1,411.63",$0.00
27503116,EAP,HCPCS C1895,,Linox Td Steroid 65/16 Cm,"$8,867.00",$0.00,"$8,867.00","$3,990.15","$5,158.80",$0.00,"$1,527.74","$5,158.80","$6,328.38","$1,552.54","$8,867.00",$0.00,"$4,433.50","$7,022.66","$7,093.60",$0.00,"$1,387.69",$0.00,"$1,411.63",$0.00
27503117,EAP,HCPCS C1777,,Linox T 65 Steroid,"$8,867.00",$0.00,"$8,867.00","$3,990.15","$5,158.80",$0.00,"$1,527.74","$5,158.80","$6,328.38","$1,552.54","$8,867.00",$0.00,"$4,433.50","$7,022.66","$7,093.60",$0.00,"$1,387.69",$0.00,"$1,411.63",$0.00
27503118,EAP,HCPCS C1900,,Corox Otw 75 Bp Lead,"$5,911.00",$0.00,"$5,911.00",$0.00,"$4,218.68",$0.00,"$1,018.44","$4,218.68","$4,218.68",$0.00,"$5,911.00",$0.00,"$2,955.50","$4,681.51","$4,728.80",$0.00,$925.07,$0.00,$0.00,$0.00
27503119,EAP,HCPCS C1900,,Corox Otw 85 Bp Lead,"$5,911.00",$0.00,"$5,911.00",$0.00,"$4,218.68",$0.00,"$1,018.44","$4,218.68","$4,218.68",$0.00,"$5,911.00",$0.00,"$2,955.50","$4,681.51","$4,728.80",$0.00,$925.07,$0.00,$0.00,$0.00
27503120,EAP,HCPCS C1900,,Corox Otw 75 Bp-s Lead,"$5,911.00",$0.00,"$5,911.00",$0.00,"$4,218.68",$0.00,"$1,018.44","$4,218.68","$4,218.68",$0.00,"$5,911.00",$0.00,"$2,955.50","$4,681.51","$4,728.80",$0.00,$925.07,$0.00,$0.00,$0.00
27503121,EAP,HCPCS C1900,,Corox Otw 85 Bp-s Lead,"$5,911.00",$0.00,"$5,911.00",$0.00,"$4,218.68",$0.00,"$1,018.44","$4,218.68","$4,218.68",$0.00,"$5,911.00",$0.00,"$2,955.50","$4,681.51","$4,728.80",$0.00,$925.07,$0.00,$0.00,$0.00
27503122,EAP,HCPCS C1882,,Lumax 340 Hf-t High Energy With Hm Landline,"$52,461.00",$0.00,"$52,461.00","$23,607.45","$5,158.80",$0.00,"$8,138.89","$5,158.80","$37,441.42","$8,138.89","$52,461.00",$0.00,"$26,230.50","$41,549.11","$41,968.80",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503123,EAP,HCPCS C1900,,Cylos Vr System With Cls Autonomic Response,"$11,231.00",$0.00,"$11,231.00",$0.00,"$5,158.80",$0.00,"$1,935.05","$5,158.80","$8,015.56",$0.00,"$11,231.00",$0.00,"$5,615.50","$8,894.95","$8,984.80",$0.00,"$1,757.65",$0.00,$0.00,$0.00
27503124,EAP,HCPCS C1721,,Lumax 340 Dr-t High Energy With Hm Mobile Gsm,"$42,855.00",$0.00,"$42,855.00","$19,284.75","$5,158.80",$0.00,"$7,383.70","$5,158.80","$30,585.61","$7,503.57","$42,855.00",$0.00,"$21,427.50","$33,941.16","$34,284.00",$0.00,"$6,706.81",$0.00,"$6,822.52",$0.00
27503125,EAP,HCPCS C1721,,Lumax 340 Dr-t High Energy System With Hm Mobile Gsm,"$51,722.00",$0.00,"$51,722.00","$23,274.90","$5,158.80",$0.00,"$8,138.89","$5,158.80","$36,913.99","$8,138.89","$51,722.00",$0.00,"$25,861.00","$40,963.82","$41,377.60",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503126,EAP,HCPCS C1721,,Lumax 340 Dr-t High Energy System With Hm Landline,"$48,767.00",$0.00,"$48,767.00","$21,945.15","$5,158.80",$0.00,"$8,138.89","$5,158.80","$34,805.01","$8,138.89","$48,767.00",$0.00,"$24,383.50","$38,623.46","$39,013.60",$0.00,"$7,632.04",$0.00,"$7,763.71",$0.00
27503127,EAP,HCPCS C1882,,Lumax 340 Hf-t High Energy With Hm Mobile Gsm,"$56,895.00",$0.00,"$56,895.00","$25,602.75","$5,158.80",$0.00,"$8,138.89","$5,158.80","$40,605.96","$8,138.89","$56,895.00",$0.00,"$28,447.50","$45,060.84","$45,516.00",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503128,EAP,HCPCS C1882,,Lumax 340 Hf-t High Energy System With Hm Mobile Gsm,"$74,628.00",$0.00,"$74,628.00","$33,582.60","$5,158.80",$0.00,"$8,138.89","$5,158.80","$53,262.00","$8,138.89","$74,628.00",$0.00,"$37,314.00","$59,105.38","$59,702.40",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503130,EAP,HCPCS C1882,,Lumax 340 Hf-t High Energy System With Hm Landline,"$68,716.00",$0.00,"$68,716.00","$30,922.20","$5,158.80",$0.00,"$8,138.89","$5,158.80","$49,042.61","$8,138.89","$68,716.00",$0.00,"$34,358.00","$54,423.07","$54,972.80",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503131,EAP,HCPCS C1722,,Lumax 340 Vr-t High Energy With Hm Mobile Gsm,"$35,467.00",$0.00,"$35,467.00","$15,960.15","$5,158.80",$0.00,"$6,110.79","$5,158.80","$25,312.80","$6,209.99","$35,467.00",$0.00,"$17,733.50","$28,089.86","$28,373.60",$0.00,"$5,550.59",$0.00,"$5,646.35",$0.00
27503132,EAP,HCPCS C1772,,Lumax 340 Vr-t High Energy System With Hm Mobile Gsm,"$44,334.00",$0.00,"$44,334.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$31,641.18",$0.00,"$44,334.00",$0.00,"$22,167.00","$35,112.53","$35,467.20",$0.00,$0.00,$0.00,$0.00,$0.00
27503133,EAP,HCPCS C1900,,Arox 45 Jbp Lead,"$1,478.00",$0.00,"$1,478.00",$0.00,"$1,054.85",$0.00,$254.65,"$1,054.85","$1,054.85",$0.00,"$1,478.00",$0.00,$739.00,"$1,170.58","$1,182.40",$0.00,$231.31,$0.00,$0.00,$0.00
27503135,EAP,HCPCS C1882,,DEFIBRILLATOR CARDIAC 2.43X3.13IN COGNIS THK.39IN VENTRICULA,"$53,791.00",$0.00,"$53,791.00","$24,205.95","$5,158.80",$0.00,"$8,138.89","$5,158.80","$38,390.64","$8,138.89","$53,791.00",$0.00,"$26,895.50","$42,602.47","$43,032.80",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503136,EAP,HCPCS C1722,,DFBR CRD THK1.1CM 6.3X7.1CM VTL 2VR HE 1 CHMBR IMPLTABLE 35,"$33,989.00",$0.00,"$33,989.00","$15,295.05","$5,158.80",$0.00,"$5,856.13","$5,158.80","$24,257.95","$5,951.20","$33,989.00",$0.00,"$16,994.50","$26,919.29","$27,191.20",$0.00,"$5,319.28",$0.00,"$5,411.05",$0.00
27503137,EAP,HCPCS C1722,,DFBR CRD .99CM 6.17X7.45CM TELIGEN VR DF-1 IS-1 BIPHASIC,"$36,945.00",$0.00,"$36,945.00","$16,625.25","$5,158.80",$0.00,"$6,365.44","$5,158.80","$26,367.65","$6,468.77","$36,945.00",$0.00,"$18,472.50","$29,260.44","$29,556.00",$0.00,"$5,781.89",$0.00,"$5,881.64",$0.00
27503138,EAP,HCPCS C1721,,DFBR CRD TELIGEN DR HE DF-1 CONCTR NONPROGRAMMBALE CARDVRT,"$44,334.00",$0.00,"$44,334.00","$19,950.30","$5,158.80",$0.00,"$7,638.53","$5,158.80","$31,641.18","$7,762.53","$44,334.00",$0.00,"$22,167.00","$35,112.53","$35,467.20",$0.00,"$6,938.27",$0.00,"$7,057.97",$0.00
27503139,EAP,HCPCS C1722,,DFBR CRD PUNCTUA VR ICD 1 CHMBR IMPLTABLE CARDVRT,"$33,989.00",$0.00,"$33,989.00","$15,295.05","$5,158.80",$0.00,"$5,856.13","$5,158.80","$24,257.95","$5,951.20","$33,989.00",$0.00,"$16,994.50","$26,919.29","$27,191.20",$0.00,"$5,319.28",$0.00,"$5,411.05",$0.00
27503140,EAP,HCPCS C1772,,DFBR CRD THK9.9MM 61.7MMX32.5MM PUNCTUA AV IMPLTABLE 2CH,"$36,945.00",$0.00,"$36,945.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$26,367.65",$0.00,"$36,945.00",$0.00,"$18,472.50","$29,260.44","$29,556.00",$0.00,$0.00,$0.00,$0.00,$0.00
27503141,EAP,HCPCS C1882,,DFBR CRD PUNCTUA CRT-D RSYN THRP HI ENRG IMPLTABLE CARDVRT,"$50,244.00",$0.00,"$50,244.00","$22,609.80","$5,158.80",$0.00,"$8,138.89","$5,158.80","$35,859.14","$8,138.89","$50,244.00",$0.00,"$25,122.00","$39,793.25","$40,195.20",$0.00,"$7,751.33",$0.00,"$7,998.84",$0.00
27503142,EAP,HCPCS C1882,,DFBR CRD INCEPTA CRT-D IMPLTABLE CARDVRT HI ENRG DF1 IS1 PLS,"$53,791.00",$0.00,"$53,791.00","$24,205.95","$5,158.80",$0.00,"$8,138.89","$5,158.80","$38,390.64","$8,138.89","$53,791.00",$0.00,"$26,895.50","$42,602.47","$43,032.80",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503143,EAP,HCPCS C1722,,DFBR CRD THK14.5MM 63.5X77.5MM LIVIAN RF IS-1 DF-1 IMPLTABLE,"$50,244.00",$0.00,"$50,244.00","$22,609.80","$5,158.80",$0.00,"$8,138.89","$5,158.80","$35,859.14","$8,138.89","$50,244.00",$0.00,"$25,122.00","$39,793.25","$40,195.20",$0.00,"$7,751.33",$0.00,"$7,998.84",$0.00
27503144,EAP,HCPCS C1722,,DFBR CRD THK14.5MM 63.5X77.5MM LIVIAN RF IMPLTABLE CRD RSYN,"$50,244.00",$0.00,"$50,244.00","$22,609.80","$5,158.80",$0.00,"$8,138.89","$5,158.80","$35,859.14","$8,138.89","$50,244.00",$0.00,"$25,122.00","$39,793.25","$40,195.20",$0.00,"$7,751.33",$0.00,"$7,998.84",$0.00
27503145,EAP,HCPCS C1722,,DFBR CRD THK14.5MM 67X82.5MM LIVIAN RF HE IMPLTABLE RSYN,"$50,244.00",$0.00,"$50,244.00","$22,609.80","$5,158.80",$0.00,"$8,138.89","$5,158.80","$35,859.14","$8,138.89","$50,244.00",$0.00,"$25,122.00","$39,793.25","$40,195.20",$0.00,"$7,751.33",$0.00,"$7,998.84",$0.00
27503146,EAP,HCPCS C1722,,Dfbr Crd Livian Rf He Cardvrt,"$50,244.00",$0.00,"$50,244.00","$22,609.80","$5,158.80",$0.00,"$8,138.89","$5,158.80","$35,859.14","$8,138.89","$50,244.00",$0.00,"$25,122.00","$39,793.25","$40,195.20",$0.00,"$7,751.33",$0.00,"$7,998.84",$0.00
27503147,EAP,HCPCS C2621,,INVIVE / EASYTRAK or ACUITY: CARDIAC RESYNCHRONIZATION THERA,"$26,452.00",$0.00,"$26,452.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$18,878.79",$0.00,"$26,452.00",$0.00,"$13,226.00","$20,949.98","$21,161.60",$0.00,$0.00,$0.00,$0.00,$0.00
27503148,EAP,HCPCS C1785,,PCMKR CRD THK7.5MM 61X44.5MM INVIVE SMRT DELAY BIVENTRICLE,"$18,324.00",$0.00,"$18,324.00","$8,245.80","$5,158.80",$0.00,"$3,157.13","$5,158.80","$13,077.84","$3,208.39","$18,324.00",$0.00,"$9,162.00","$14,512.61","$14,659.20",$0.00,"$2,867.71",$0.00,"$2,917.18",$0.00
27503149,EAP,HCPCS C1785,,PCMKR CRD THK7.5MM 61X44.5MM INVIVE SMRT DELAY BIVENTRICLE,"$18,324.00",$0.00,"$18,324.00","$8,245.80","$5,158.80",$0.00,"$3,157.13","$5,158.80","$13,077.84","$3,208.39","$18,324.00",$0.00,"$9,162.00","$14,512.61","$14,659.20",$0.00,"$2,867.71",$0.00,"$2,917.18",$0.00
27503150,EAP,HCPCS C1722,,DFBR CRD INCEPTA VR IMPLTABLE CARDVRT HI ENRG DF4 CONCTR,"$51,722.00",$0.00,"$51,722.00","$23,274.90","$5,158.80",$0.00,"$8,138.89","$5,158.80","$36,913.99","$8,138.89","$51,722.00",$0.00,"$25,861.00","$40,963.82","$41,377.60",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503151,EAP,HCPCS C1721,,DFBR CRD INCEPTA VR IMPLTABLE CARDVRT HI ENRG DF4 CONCTR,"$51,722.00",$0.00,"$51,722.00","$23,274.90","$5,158.80",$0.00,"$8,138.89","$5,158.80","$36,913.99","$8,138.89","$51,722.00",$0.00,"$25,861.00","$40,963.82","$41,377.60",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503152,EAP,HCPCS C1722,,DFBR CRD THK.39IN 2.43X2.93IN INCEPTA VR 1 CHMBR IMPLTABLE,"$39,900.00",$0.00,"$39,900.00","$17,955.00","$5,158.80",$0.00,"$6,874.57","$5,158.80","$28,476.63","$6,986.17","$39,900.00",$0.00,"$19,950.00","$31,600.80","$31,920.00",$0.00,"$6,244.35",$0.00,"$6,352.08",$0.00
27503153,EAP,HCPCS C1722,,DFBR CRD THK.39IN 2.43X2.93IN INCEPTA VR 1 CHMBR DF-4,"$39,900.00",$0.00,"$39,900.00","$17,955.00","$5,158.80",$0.00,"$6,874.57","$5,158.80","$28,476.63","$6,986.17","$39,900.00",$0.00,"$19,950.00","$31,600.80","$31,920.00",$0.00,"$6,244.35",$0.00,"$6,352.08",$0.00
27503154,EAP,HCPCS C1721,,DFBR CRD INCEPTA VR IMPLTABLE CARDVRT HI ENRG,"$51,722.00",$0.00,"$51,722.00","$23,274.90","$5,158.80",$0.00,"$8,138.89","$5,158.80","$36,913.99","$8,138.89","$51,722.00",$0.00,"$25,861.00","$40,963.82","$41,377.60",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503155,EAP,HCPCS C1882,,DFBR CRD INCEPTA VR IMPLTABLE CARDVRT HI ENRG,"$51,722.00",$0.00,"$51,722.00","$23,274.90","$5,158.80",$0.00,"$8,138.89","$5,158.80","$36,913.99","$8,138.89","$51,722.00",$0.00,"$25,861.00","$40,963.82","$41,377.60",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503156,EAP,HCPCS C1882,,INCEPTA LV-1 / EASYTRAK or ACUITY / ENDOTAK: CARDIAC RESYNCH,"$71,524.00",$0.00,"$71,524.00","$32,185.80","$5,158.80",$0.00,"$8,138.89","$5,158.80","$51,046.68","$8,138.89","$71,524.00",$0.00,"$35,762.00","$56,647.01","$57,219.20",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503157,EAP,HCPCS C1721,,DFBR CRD INCEPTA DR IMPLTABLE CARDVRT HI ENRG DF4 CONCTR,"$58,889.00",$0.00,"$58,889.00","$26,500.05","$5,158.80",$0.00,"$8,138.89","$5,158.80","$42,029.08","$8,138.89","$58,889.00",$0.00,"$29,444.50","$46,640.09","$47,111.20",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503158,EAP,HCPCS C1721,,DFBR CRD INCEPTA DR IMPLTABLE CARDVRT HI ENRG DF4 CONCTR,"$58,889.00",$0.00,"$58,889.00","$26,500.05","$5,158.80",$0.00,"$8,138.89","$5,158.80","$42,029.08","$8,138.89","$58,889.00",$0.00,"$29,444.50","$46,640.09","$47,111.20",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503159,EAP,HCPCS C1721,,DFBR CRD THK.39IN 2.43X2.69-2.89IN INCEPTA DR 2CH IMPLTABLE,"$45,811.00",$0.00,"$45,811.00","$20,614.95","$5,158.80",$0.00,"$7,893.01","$5,158.80","$32,695.31","$8,021.14","$45,811.00",$0.00,"$22,905.50","$36,282.31","$36,648.80",$0.00,"$7,169.42",$0.00,"$7,293.11",$0.00
27503160,EAP,HCPCS C1779,,PCMKR CRD 7.5IN MOD ELIP 44.5X47IN ADVANTIO 2CH IS-1 CONCTR,"$11,822.00",$0.00,"$11,822.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$8,437.36",$0.00,"$11,822.00",$0.00,"$5,911.00","$9,363.02","$9,457.60",$0.00,$0.00,$0.00,$0.00,$0.00
27503161,EAP,HCPCS C2619,,ADVANTIO DR IMPLANTABLE PACEMAKER SYSTEM (INCLUDES 2 LEADS),"$14,777.00",$0.00,"$14,777.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$10,546.34",$0.00,"$14,777.00",$0.00,"$7,388.50","$11,703.38","$11,821.60",$0.00,$0.00,$0.00,$0.00,$0.00
27503162,EAP,HCPCS C1785,,PCMKR CRD THK7.5MM 44.5X45.7MM ADVANTIO RIGHTRATE ATR VNTRC,"$10,344.00",$0.00,"$10,344.00","$4,654.80","$5,158.80",$0.00,"$1,782.22","$5,158.80","$7,382.51","$1,811.15","$10,344.00",$0.00,"$5,172.00","$8,192.45","$8,275.20",$0.00,"$1,618.84",$0.00,"$1,646.76",$0.00
27503163,EAP,HCPCS C1785,,ADVANTIO SR IMPLANTABLE PACEMAKER  SYSTEM (INCLUDES 1 LEAD),"$11,527.00",$0.00,"$11,527.00","$5,187.15","$5,158.80",$0.00,"$1,986.04","$5,158.80","$8,226.82","$2,018.29","$11,527.00",$0.00,"$5,763.50","$9,129.38","$9,221.60",$0.00,"$1,803.98",$0.00,"$1,835.10",$0.00
27503164,EAP,HCPCS C1721,,DFBR CRD INCEPTA DR IMPLTABLE CARDVRT HI ENRG,"$58,889.00",$0.00,"$58,889.00","$26,500.05","$5,158.80",$0.00,"$8,138.89","$5,158.80","$42,029.08","$8,138.89","$58,889.00",$0.00,"$29,444.50","$46,640.09","$47,111.20",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503165,EAP,HCPCS C1721,,DFBR CRD INCEPTA DR IMPLTABLE CARDVRT HI ENRG,"$58,889.00",$0.00,"$58,889.00","$26,500.05","$5,158.80",$0.00,"$8,138.89","$5,158.80","$42,029.08","$8,138.89","$58,889.00",$0.00,"$29,444.50","$46,640.09","$47,111.20",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503166,EAP,HCPCS C1721,,DFBR CRD THK.39IN 2.43X2.69-2.89IN INCEPTA DR 2CH IMPLTABLE,"$45,811.00",$0.00,"$45,811.00","$20,614.95","$5,158.80",$0.00,"$7,893.01","$5,158.80","$32,695.31","$8,021.14","$45,811.00",$0.00,"$22,905.50","$36,282.31","$36,648.80",$0.00,"$7,169.42",$0.00,"$7,293.11",$0.00
27503167,EAP,HCPCS C1722,,DFBR CRD THK9.9MM 61.7MM X 79.5MM ENERGEN VR VNTRC IMPLTABLE,"$36,945.00",$0.00,"$36,945.00","$16,625.25","$5,158.80",$0.00,"$6,365.44","$5,158.80","$26,367.65","$6,468.77","$36,945.00",$0.00,"$18,472.50","$29,260.44","$29,556.00",$0.00,"$5,781.89",$0.00,"$5,881.64",$0.00
27503168,EAP,HCPCS C1722,,ENERGEN VR DF4 ICD SYSTEMS (1 RELIANCE NON-GORE LEAD),"$49,062.00",$0.00,"$49,062.00","$22,077.90","$5,158.80",$0.00,"$8,138.89","$5,158.80","$35,015.55","$8,138.89","$49,062.00",$0.00,"$24,531.00","$38,857.10","$39,249.60",$0.00,"$7,678.20",$0.00,"$7,810.67",$0.00
27503169,EAP,HCPCS C1785,,PCMKR CRD 2.8V 8MM MOD ELIP 43X49MM ALTRUA 60DR ATR VNTRC,"$11,527.00",$0.00,"$11,527.00","$5,187.15","$5,158.80",$0.00,"$1,986.04","$5,158.80","$8,226.82","$2,018.29","$11,527.00",$0.00,"$5,763.50","$9,129.38","$9,221.60",$0.00,"$1,803.98",$0.00,"$1,835.10",$0.00
27503170,EAP,HCPCS C1785,,PCMKR CRD ALTRUA 60 DDDR 2 CHMBR IS-1 MV BLND SNSR STOR EGMS,"$11,527.00",$0.00,"$11,527.00","$5,187.15","$5,158.80",$0.00,"$1,986.04","$5,158.80","$8,226.82","$2,018.29","$11,527.00",$0.00,"$5,763.50","$9,129.38","$9,221.60",$0.00,"$1,803.98",$0.00,"$1,835.10",$0.00
27503171,EAP,HCPCS C1785,,PCMKR CRD 8MM MOD ELLIPSE 43X49MM ALTRUA 60 ATR VNTRC 2,"$11,527.00",$0.00,"$11,527.00","$5,187.15","$5,158.80",$0.00,"$1,986.04","$5,158.80","$8,226.82","$2,018.29","$11,527.00",$0.00,"$5,763.50","$9,129.38","$9,221.60",$0.00,"$1,803.98",$0.00,"$1,835.10",$0.00
27503172,EAP,HCPCS C1785,,PCMKR CRD THK8MM 49X43MM ALTRUA 60DR ATR VNTRC IMPLTABLE 2,"$14,482.00",$0.00,"$14,482.00","$6,516.90","$5,158.80",$0.00,"$2,495.18","$5,158.80","$10,335.80","$2,535.68","$14,482.00",$0.00,"$7,241.00","$11,469.74","$11,585.60",$0.00,"$2,266.43",$0.00,"$2,305.53",$0.00
27503173,EAP,HCPCS C1900,,PCMKR CRD THK8MM 42X42MM ALTRUA 60SR ATR VNTRC IMPLTABLE 1,"$10,049.00",$0.00,"$10,049.00",$0.00,"$5,158.80",$0.00,"$1,731.39","$5,158.80","$7,171.97",$0.00,"$10,049.00",$0.00,"$5,024.50","$7,958.81","$8,039.20",$0.00,"$1,572.67",$0.00,$0.00,$0.00
27503174,EAP,HCPCS C1785,,PCMKR CRD THK3MM 42MMX42MM ALTRUA 60SR IMPLTABLE 1 CHMBR RR,"$11,231.00",$0.00,"$11,231.00","$5,053.95","$5,158.80",$0.00,"$1,935.05","$5,158.80","$8,015.56","$1,966.46","$11,231.00",$0.00,"$5,615.50","$8,894.95","$8,984.80",$0.00,"$1,757.65",$0.00,"$1,787.98",$0.00
27503175,EAP,HCPCS C1722,,DFBR CRD .99CM THK.39IN SM 2.43X3.13IN COGNIS ATR VNTRC IS-1,"$53,791.00",$0.00,"$53,791.00","$24,205.95","$5,158.80",$0.00,"$8,138.89","$5,158.80","$38,390.64","$8,138.89","$53,791.00",$0.00,"$26,895.50","$42,602.47","$43,032.80",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503176,EAP,HCPCS C1772,,DFBR CRD ENERGEN VR IMPLTABLE CARDVRT HI ENRG DF4 CONCTR,"$49,062.00",$0.00,"$49,062.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$35,015.55",$0.00,"$49,062.00",$0.00,"$24,531.00","$38,857.10","$39,249.60",$0.00,$0.00,$0.00,$0.00,$0.00
27503177,EAP,HCPCS C1882,,DFBR CRD COGNIS CNTK RNWL 3 RF HI ENRG,"$71,524.00",$0.00,"$71,524.00","$32,185.80","$5,158.80",$0.00,"$8,138.89","$5,158.80","$51,046.68","$8,138.89","$71,524.00",$0.00,"$35,762.00","$56,647.01","$57,219.20",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503178,EAP,HCPCS C1882,,DFBR CRD 1.45CM 6.7X8.25CM CONFIENT RF HE ATR VNTRC 2CH,"$36,945.00",$0.00,"$36,945.00","$16,625.25","$5,158.80",$0.00,"$6,365.44","$5,158.80","$26,367.65","$6,468.77","$36,945.00",$0.00,"$18,472.50","$29,260.44","$29,556.00",$0.00,"$5,781.89",$0.00,"$5,881.64",$0.00
27503179,EAP,HCPCS C2621,,PCMKR CRD CNTK RNWL TR ATR VNTRC 2 WRNCH IS-1 IMPLTABLE,"$18,916.00",$0.00,"$18,916.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$13,500.35",$0.00,"$18,916.00",$0.00,"$9,458.00","$14,981.47","$15,132.80",$0.00,$0.00,$0.00,$0.00,$0.00
27503180,EAP,HCPCS C2621,,PCMKR CRD CNTK RNWL TR LV-1 IMPLTABLE,"$18,916.00",$0.00,"$18,916.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$13,500.35",$0.00,"$18,916.00",$0.00,"$9,458.00","$14,981.47","$15,132.80",$0.00,$0.00,$0.00,$0.00,$0.00
27503181,EAP,HCPCS C1722,,DFBR CRD THK.39IN 2.43X2.69-2.89IN ENERGEN VR VNTRC 1 CHMBR,"$36,945.00",$0.00,"$36,945.00","$16,625.25","$5,158.80",$0.00,"$6,365.44","$5,158.80","$26,367.65","$6,468.77","$36,945.00",$0.00,"$18,472.50","$29,260.44","$29,556.00",$0.00,"$5,781.89",$0.00,"$5,881.64",$0.00
27503182,EAP,HCPCS C1898,,LEAD PCNG 53CM 6.7FR 10MM SPC RIGHT AV BIPOL XTD-RETRAC HLX,"$1,330.00",$0.00,"$1,330.00",$598.50,$949.22,$0.00,$229.15,$949.22,$949.22,$232.87,"$1,330.00",$0.00,$665.00,"$1,053.36","$1,064.00",$0.00,$208.15,$0.00,$211.74,$0.00
27503183,EAP,HCPCS C1722,,ENERGEN VR ICD SYSTEM (1 RELIANCE NON-GORE LEAD),"$49,062.00",$0.00,"$49,062.00","$22,077.90","$5,158.80",$0.00,"$8,138.89","$5,158.80","$35,015.55","$8,138.89","$49,062.00",$0.00,"$24,531.00","$38,857.10","$39,249.60",$0.00,"$7,678.20",$0.00,"$7,810.67",$0.00
27503184,EAP,HCPCS C1722,,DFBR CRD ENERGEN VR IMPLTABLE CARDVRT HI ENRG,"$49,062.00",$0.00,"$49,062.00","$22,077.90","$5,158.80",$0.00,"$8,138.89","$5,158.80","$35,015.55","$8,138.89","$49,062.00",$0.00,"$24,531.00","$38,857.10","$39,249.60",$0.00,"$7,678.20",$0.00,"$7,810.67",$0.00
27503185,EAP,HCPCS C1721,,DFBR CRD THK9.9MM 61.7X74.5MM ENERGEN DR ATR ENTRICULAR,"$44,334.00",$0.00,"$44,334.00","$19,950.30","$5,158.80",$0.00,"$7,638.53","$5,158.80","$31,641.18","$7,762.53","$44,334.00",$0.00,"$22,167.00","$35,112.53","$35,467.20",$0.00,"$6,938.27",$0.00,"$7,057.97",$0.00
27503186,EAP,HCPCS C1721,,ENERGEN DR DF4 ICD SYSTEMS (2 RELIANCE NON-GORE LEADS),"$57,781.00",$0.00,"$57,781.00","$26,001.45","$5,158.80",$0.00,"$8,138.89","$5,158.80","$41,238.30","$8,138.89","$57,781.00",$0.00,"$28,890.50","$45,762.55","$46,224.80",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503187,EAP,HCPCS C1721,,DFBR CRD ENERGEN DR IMPLTABLE CARDVRT HI ENRG DF4 CONCTR,"$57,781.00",$0.00,"$57,781.00","$26,001.45","$5,158.80",$0.00,"$8,138.89","$5,158.80","$41,238.30","$8,138.89","$57,781.00",$0.00,"$28,890.50","$45,762.55","$46,224.80",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503188,EAP,HCPCS C1721,,DFBR CRD SM ENERGEN DR DF-4 2CH IMPLTABLE CARDVRT BTR-PWR,"$44,334.00",$0.00,"$44,334.00","$19,950.30","$5,158.80",$0.00,"$7,638.53","$5,158.80","$31,641.18","$7,762.53","$44,334.00",$0.00,"$22,167.00","$35,112.53","$35,467.20",$0.00,"$6,938.27",$0.00,"$7,057.97",$0.00
27503189,EAP,HCPCS C1721,,ENERGEN DR ICD SYSTEM (2 RELIANCE NON-GORE LEADS),"$57,781.00",$0.00,"$57,781.00","$26,001.45","$5,158.80",$0.00,"$8,138.89","$5,158.80","$41,238.30","$8,138.89","$57,781.00",$0.00,"$28,890.50","$45,762.55","$46,224.80",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503190,EAP,HCPCS C1722,,DFBR CRD ENERGEN VR IMPLTABLE CARDVRT HI ENRG,"$57,781.00",$0.00,"$57,781.00","$26,001.45","$5,158.80",$0.00,"$8,138.89","$5,158.80","$41,238.30","$8,138.89","$57,781.00",$0.00,"$28,890.50","$45,762.55","$46,224.80",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503191,EAP,HCPCS C1882,,ENERGEN RF HE DF4 (with brady lead),"$71,524.00",$0.00,"$71,524.00","$32,185.80","$5,158.80",$0.00,"$8,138.89","$5,158.80","$51,046.68","$8,138.89","$71,524.00",$0.00,"$35,762.00","$56,647.01","$57,219.20",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503192,EAP,HCPCS C1882,,ENERGEN RF HE DF4 (without brady lead),"$71,524.00",$0.00,"$71,524.00","$32,185.80","$5,158.80",$0.00,"$8,138.89","$5,158.80","$51,046.68","$8,138.89","$71,524.00",$0.00,"$35,762.00","$56,647.01","$57,219.20",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503193,EAP,HCPCS C1721,,DFBR CRD THK9.9MM 79.5MMX61.7MM ENERGEN CRT-D VNTRC,"$53,791.00",$0.00,"$53,791.00","$24,205.95","$5,158.80",$0.00,"$8,138.89","$5,158.80","$38,390.64","$8,138.89","$53,791.00",$0.00,"$26,895.50","$42,602.47","$43,032.80",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503194,EAP,HCPCS C1721,,DFBR CRD ENERGEN CRT-D IMPLTABLE CARDVRT,"$53,791.00",$0.00,"$53,791.00","$24,205.95","$5,158.80",$0.00,"$8,138.89","$5,158.80","$38,390.64","$8,138.89","$53,791.00",$0.00,"$26,895.50","$42,602.47","$43,032.80",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503195,EAP,HCPCS C1882,,ENERGEN RF HE  (with brady lead),"$71,524.00",$0.00,"$71,524.00","$32,185.80","$5,158.80",$0.00,"$8,138.89","$5,158.80","$51,046.68","$8,138.89","$71,524.00",$0.00,"$35,762.00","$56,647.01","$57,219.20",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503211,EAP,HCPCS C1721,,Fortify Assura Next Nene Dr 40,"$45,811.00",$0.00,"$45,811.00","$20,614.95","$5,158.80",$0.00,"$7,893.01","$5,158.80","$32,695.31","$8,021.14","$45,811.00",$0.00,"$22,905.50","$36,282.31","$36,648.80",$0.00,"$7,169.42",$0.00,"$7,293.11",$0.00
27503212,EAP,HCPCS C1721,,Fortify Assura Next Gene Dr 40 Df4 Conn,"$45,811.00",$0.00,"$45,811.00","$20,614.95","$5,158.80",$0.00,"$7,893.01","$5,158.80","$32,695.31","$8,021.14","$45,811.00",$0.00,"$22,905.50","$36,282.31","$36,648.80",$0.00,"$7,169.42",$0.00,"$7,293.11",$0.00
27503213,EAP,HCPCS C1722,,Ellipse Next Gene Dr 36,"$45,811.00",$0.00,"$45,811.00","$20,614.95","$5,158.80",$0.00,"$7,893.01","$5,158.80","$32,695.31","$8,021.14","$45,811.00",$0.00,"$22,905.50","$36,282.31","$36,648.80",$0.00,"$7,169.42",$0.00,"$7,293.11",$0.00
27503214,EAP,HCPCS C1722,,Ellipse Next Gene Dr 36 Df4 Conn,"$45,811.00",$0.00,"$45,811.00","$20,614.95","$5,158.80",$0.00,"$7,893.01","$5,158.80","$32,695.31","$8,021.14","$45,811.00",$0.00,"$22,905.50","$36,282.31","$36,648.80",$0.00,"$7,169.42",$0.00,"$7,293.11",$0.00
27503215,EAP,HCPCS C1722,,Fortify Assura Next Gene Vr 40,"$39,900.00",$0.00,"$39,900.00","$17,955.00","$5,158.80",$0.00,"$6,874.57","$5,158.80","$28,476.63","$6,986.17","$39,900.00",$0.00,"$19,950.00","$31,600.80","$31,920.00",$0.00,"$6,244.35",$0.00,"$6,352.08",$0.00
27503216,EAP,HCPCS C1722,,Fortify Assura Next Gene Vr 40 Df4 Conn,"$39,900.00",$0.00,"$39,900.00","$17,955.00","$5,158.80",$0.00,"$6,874.57","$5,158.80","$28,476.63","$6,986.17","$39,900.00",$0.00,"$19,950.00","$31,600.80","$31,920.00",$0.00,"$6,244.35",$0.00,"$6,352.08",$0.00
27503217,EAP,HCPCS C1722,,Ellipse Next Gene Vr 36,"$39,900.00",$0.00,"$39,900.00","$17,955.00","$5,158.80",$0.00,"$6,874.57","$5,158.80","$28,476.63","$6,986.17","$39,900.00",$0.00,"$19,950.00","$31,600.80","$31,920.00",$0.00,"$6,244.35",$0.00,"$6,352.08",$0.00
27503218,EAP,HCPCS C1722,,Ellipse Next Gene Vr 36 Df4 Conn,"$39,900.00",$0.00,"$39,900.00","$17,955.00","$5,158.80",$0.00,"$6,874.57","$5,158.80","$28,476.63","$6,986.17","$39,900.00",$0.00,"$19,950.00","$31,600.80","$31,920.00",$0.00,"$6,244.35",$0.00,"$6,352.08",$0.00
27503219,EAP,HCPCS C1721,,Fortify Assura Next Gene Dr 40 System,"$58,889.00",$0.00,"$58,889.00","$26,500.05","$5,158.80",$0.00,"$8,138.89","$5,158.80","$42,029.08","$8,138.89","$58,889.00",$0.00,"$29,444.50","$46,640.09","$47,111.20",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503220,EAP,HCPCS C1721,,Fortify Assura Next Gene Dr 40 Df4 Conn System,"$58,889.00",$0.00,"$58,889.00","$26,500.05","$5,158.80",$0.00,"$8,138.89","$5,158.80","$42,029.08","$8,138.89","$58,889.00",$0.00,"$29,444.50","$46,640.09","$47,111.20",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503221,EAP,HCPCS C1722,,Ellipse Next Gene Dr 36 System,"$58,889.00",$0.00,"$58,889.00","$26,500.05","$5,158.80",$0.00,"$8,138.89","$5,158.80","$42,029.08","$8,138.89","$58,889.00",$0.00,"$29,444.50","$46,640.09","$47,111.20",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503222,EAP,HCPCS C1722,,Ellipse Next Gene Dr 36 Df4 Conn System,"$58,889.00",$0.00,"$58,889.00","$26,500.05","$5,158.80",$0.00,"$8,138.89","$5,158.80","$42,029.08","$8,138.89","$58,889.00",$0.00,"$29,444.50","$46,640.09","$47,111.20",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503223,EAP,HCPCS C1722,,Fortify Assura Next Gene Vr 40 System,"$51,722.00",$0.00,"$51,722.00","$23,274.90","$5,158.80",$0.00,"$8,138.89","$5,158.80","$36,913.99","$8,138.89","$51,722.00",$0.00,"$25,861.00","$40,963.82","$41,377.60",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503224,EAP,HCPCS C1722,,Fortify Assura Next Gene Vr 40 Df4 Conn System,"$51,722.00",$0.00,"$51,722.00","$23,274.90","$5,158.80",$0.00,"$8,138.89","$5,158.80","$36,913.99","$8,138.89","$51,722.00",$0.00,"$25,861.00","$40,963.82","$41,377.60",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503225,EAP,HCPCS C1722,,Ellipse Next Gene Vr 36 System,"$51,722.00",$0.00,"$51,722.00","$23,274.90","$5,158.80",$0.00,"$8,138.89","$5,158.80","$36,913.99","$8,138.89","$51,722.00",$0.00,"$25,861.00","$40,963.82","$41,377.60",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503226,EAP,HCPCS C1722,,Ellipse Next Gene Vr 36 36 Df4 Conn System,"$51,722.00",$0.00,"$51,722.00","$23,274.90","$5,158.80",$0.00,"$8,138.89","$5,158.80","$36,913.99","$8,138.89","$51,722.00",$0.00,"$25,861.00","$40,963.82","$41,377.60",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503227,EAP,HCPCS C1882,,Quadra Assura Next Gene Crt-d 40,"$59,111.00",$0.00,"$59,111.00","$26,599.95","$5,158.80",$0.00,"$8,138.89","$5,158.80","$42,187.52","$8,138.89","$59,111.00",$0.00,"$29,555.50","$46,815.91","$47,288.80",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503228,EAP,HCPCS C1882,,Quadra Assura Next Gene Crt-d 40 Df4 Cc,"$59,111.00",$0.00,"$59,111.00","$26,599.95","$5,158.80",$0.00,"$8,138.89","$5,158.80","$42,187.52","$8,138.89","$59,111.00",$0.00,"$29,555.50","$46,815.91","$47,288.80",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503229,EAP,HCPCS C1882,,Unify Assura Next Gene Crt-d 40,"$53,791.00",$0.00,"$53,791.00","$24,205.95","$5,158.80",$0.00,"$8,138.89","$5,158.80","$38,390.64","$8,138.89","$53,791.00",$0.00,"$26,895.50","$42,602.47","$43,032.80",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503230,EAP,HCPCS C1882,,Unify Assura Next Gene Crt-d 40 Df4 Conn,"$53,791.00",$0.00,"$53,791.00","$24,205.95","$5,158.80",$0.00,"$8,138.89","$5,158.80","$38,390.64","$8,138.89","$53,791.00",$0.00,"$26,895.50","$42,602.47","$43,032.80",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503231,EAP,HCPCS C1882,,Quadra Assura Next Gene Crt-d 40 System,"$78,677.00",$0.00,"$78,677.00","$35,404.65","$5,158.80",$0.00,"$8,138.89","$5,158.80","$56,151.77","$8,138.89","$78,677.00",$0.00,"$39,338.50","$62,312.18","$62,941.60",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503232,EAP,HCPCS C1882,,Quadra Assura Next Gene Crt-d Df4 Conn System,"$78,677.00",$0.00,"$78,677.00","$35,404.65","$5,158.80",$0.00,"$8,138.89","$5,158.80","$56,151.77","$8,138.89","$78,677.00",$0.00,"$39,338.50","$62,312.18","$62,941.60",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503233,EAP,HCPCS C1882,,Unify Assura Next Gene Crt-d 40 System,"$71,524.00",$0.00,"$71,524.00","$32,185.80","$5,158.80",$0.00,"$8,138.89","$5,158.80","$51,046.68","$8,138.89","$71,524.00",$0.00,"$35,762.00","$56,647.01","$57,219.20",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503234,EAP,HCPCS C1882,,Unify Assura Next Gene Crt-d 40 Df4 Conn System,"$71,524.00",$0.00,"$71,524.00","$32,185.80","$5,158.80",$0.00,"$8,138.89","$5,158.80","$51,046.68","$8,138.89","$71,524.00",$0.00,"$35,762.00","$56,647.01","$57,219.20",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503235,EAP,HCPCS C1722,,Generator Pulse Sq-rx And Q-trak Electrode,"$71,926.00",$0.00,"$71,926.00","$32,366.70","$5,158.80",$0.00,"$8,138.89","$5,158.80","$51,333.59","$8,138.89","$71,926.00",$0.00,"$35,963.00","$56,965.39","$57,540.80",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503236,EAP,CPT® C1722,,Generator Pulse Sq-rx,"$59,249.00",$0.00,"$59,249.00","$26,662.05","$5,158.80",$0.00,"$8,138.89","$5,158.80","$42,286.01","$8,138.89","$59,249.00",$0.00,"$29,624.50","$46,925.21","$47,399.20",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27503237,EAP,HCPCS C1785,,Pcmkr Crd Thk6mm Sm 50x47mm Assurity 2 Chmbr Is-1 Conctr,"$19,566.00",$0.00,"$19,566.00","$8,804.70","$5,158.80",$0.00,"$3,371.12","$5,158.80","$13,964.25","$3,425.85","$19,566.00",$0.00,"$9,783.00","$15,496.27","$15,652.80",$0.00,"$3,062.08",$0.00,"$3,114.91",$0.00
27503238,EAP,HCPCS C1785,,Pcmkr Crd Thk6mm Sm 50x46mm Endurity 2 Chmbr Is-1 Conctr,"$15,432.00",$0.00,"$15,432.00","$6,944.40","$5,158.80",$0.00,"$2,658.86","$5,158.80","$11,013.82","$2,702.02","$15,432.00",$0.00,"$7,716.00","$12,222.14","$12,345.60",$0.00,"$2,415.11",$0.00,"$2,456.77",$0.00
27503239,EAP,HCPCS C1785,,Pcmkr Crd Thk6mm Sm 50x47mm Assurity Chmbr Is-1 Conctr Atcpt,"$20,669.00",$0.00,"$20,669.00","$9,301.05","$5,158.80",$0.00,"$3,561.17","$5,158.80","$14,751.47","$3,618.98","$20,669.00",$0.00,"$10,334.50","$16,369.85","$16,535.20",$0.00,"$3,234.70",$0.00,"$3,290.50",$0.00
27503240,EAP,HCPCS C1785,,Pcmkr Crd Thk6mm Sm 50x47mm Assurity 1 Chmbr Is-1 Conctr,"$17,774.00",$0.00,"$17,774.00","$7,998.30","$5,158.80",$0.00,"$3,062.37","$5,158.80","$12,685.30","$3,112.09","$17,774.00",$0.00,"$8,887.00","$14,077.01","$14,219.20",$0.00,"$2,781.63",$0.00,"$2,829.62",$0.00
27503241,EAP,HCPCS C1785,,Entovis Dr-t Promri With Landline Hm(r) Bradycardia,"$19,759.00",$0.00,"$19,759.00","$8,891.55","$5,158.80",$0.00,"$3,404.38","$5,158.80","$14,102.00","$3,459.64","$19,759.00",$0.00,"$9,879.50","$15,649.13","$15,807.20",$0.00,"$3,092.28",$0.00,"$3,145.63",$0.00
27503242,EAP,HCPCS C1785,,Entovis Dr-t Promri System With Landline Hm(r) Bradycardia,"$22,460.00",$0.00,"$22,460.00","$10,107.00","$5,158.80",$0.00,"$3,869.75","$5,158.80","$16,029.70","$3,932.57","$22,460.00",$0.00,"$11,230.00","$17,788.32","$17,968.00",$0.00,"$3,514.99",$0.00,"$3,575.63",$0.00
27503243,EAP,HCPCS C1785,,Entovis Dr-t Promri System With Cellular Hm(r) Bradycardia,"$22,460.00",$0.00,"$22,460.00","$10,107.00","$5,158.80",$0.00,"$3,869.75","$5,158.80","$16,029.70","$3,932.57","$22,460.00",$0.00,"$11,230.00","$17,788.32","$17,968.00",$0.00,"$3,514.99",$0.00,"$3,575.63",$0.00
27503244,EAP,HCPCS C1786,,Entovis Sr-t Promri With Landline Hm(r) Bradycardia,"$18,408.00",$0.00,"$18,408.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$13,137.79",$0.00,"$18,408.00",$0.00,"$9,204.00","$14,579.14","$14,726.40",$0.00,$0.00,$0.00,$0.00,$0.00
27503245,EAP,HCPCS C1786,,Entovis Sr-t Promri With Cellular Hm(r) Bradycardia,"$18,408.00",$0.00,"$18,408.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$13,137.79",$0.00,"$18,408.00",$0.00,"$9,204.00","$14,579.14","$14,726.40",$0.00,$0.00,$0.00,$0.00,$0.00
27503246,EAP,HCPCS C1786,,Entovis Sr-t Promri System With Landline Hm(r) Bradycardia,"$19,759.00",$0.00,"$19,759.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$14,102.00",$0.00,"$19,759.00",$0.00,"$9,879.50","$15,649.13","$15,807.20",$0.00,$0.00,$0.00,$0.00,$0.00
27503247,EAP,HCPCS C1786,,Entovis Sr-t Promri System With Cellular Hm(r) Bradycardia,"$19,759.00",$0.00,"$19,759.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$14,102.00",$0.00,"$19,759.00",$0.00,"$9,879.50","$15,649.13","$15,807.20",$0.00,$0.00,$0.00,$0.00,$0.00
27503248,EAP,HCPCS C1785,,Evia Dr-t With Cls With Landline Hmbradycardiadual Chamber,"$11,023.00",$0.00,"$11,023.00","$4,960.35","$5,158.80",$0.00,"$1,899.21","$5,158.80","$7,867.12","$1,930.04","$11,023.00",$0.00,"$5,511.50","$8,730.22","$8,818.40",$0.00,"$1,725.10",$0.00,"$1,754.86",$0.00
27503249,EAP,HCPCS C1785,,Evia Dr-t With Cls With Cellular Gsm Hmbradycardiadual Chamber,"$17,003.00",$0.00,"$17,003.00","$7,651.35","$5,158.80",$0.00,"$2,929.53","$5,158.80","$12,135.04","$2,977.09","$17,003.00",$0.00,"$8,501.50","$13,466.38","$13,602.40",$0.00,"$2,660.97",$0.00,"$2,706.88",$0.00
27503250,EAP,HCPCS C1785,,Evia Dr-t System With Cls  With Landline Hmbradycardiadual Chamber Sys,"$13,779.00",$0.00,"$13,779.00","$6,200.55","$5,158.80",$0.00,"$2,374.05","$5,158.80","$9,834.07","$2,412.59","$13,779.00",$0.00,"$6,889.50","$10,912.97","$11,023.20",$0.00,"$2,156.41",$0.00,"$2,193.62",$0.00
27503251,EAP,HCPCS C1785,,Evia Dr-t System With Cls A With Cellular Gsm Hmbradycardiadual Cham,"$19,704.00",$0.00,"$19,704.00","$8,866.80","$5,158.80",$0.00,"$3,394.90","$5,158.80","$14,062.74","$3,450.01","$19,704.00",$0.00,"$9,852.00","$15,605.57","$15,763.20",$0.00,"$3,083.68",$0.00,"$3,136.88",$0.00
27503252,EAP,HCPCS C1786,,Evia Sr-t With Cls With Landline Hmbradycardiasingle Chamber,"$9,646.00",$0.00,"$9,646.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$6,884.35",$0.00,"$9,646.00",$0.00,"$4,823.00","$7,639.63","$7,716.80",$0.00,$0.00,$0.00,$0.00,$0.00
27503253,EAP,HCPCS C1786,,Evia Sr-t With Cls With Cellular Gsm Hmbradycardiasingle Chamber,"$15,653.00",$0.00,"$15,653.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$11,171.55",$0.00,"$15,653.00",$0.00,"$7,826.50","$12,397.18","$12,522.40",$0.00,$0.00,$0.00,$0.00,$0.00
27503254,EAP,HCPCS C1786,,Evia Sr-t System With Cls  With Landline Hmbradycardiasingle Chamber S,"$11,023.00",$0.00,"$11,023.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$7,867.12",$0.00,"$11,023.00",$0.00,"$5,511.50","$8,730.22","$8,818.40",$0.00,$0.00,$0.00,$0.00,$0.00
27503255,EAP,HCPCS C1786,,Evia Sr-t System With Cls With Cellular Gsm Hmbradycardiasingle Chamb,"$17,003.00",$0.00,"$17,003.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$12,135.04",$0.00,"$17,003.00",$0.00,"$8,501.50","$13,466.38","$13,602.40",$0.00,$0.00,$0.00,$0.00,$0.00
27503256,EAP,HCPCS C2621,,Evia Hf-t With Landline Hmcrtdevice,"$21,771.00",$0.00,"$21,771.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$15,537.96",$0.00,"$21,771.00",$0.00,"$10,885.50","$17,242.63","$17,416.80",$0.00,$0.00,$0.00,$0.00,$0.00
27503257,EAP,HCPCS C2621,,Evia Hf-t With Cellular Gsm Hmcrtdevice,"$22,597.00",$0.00,"$22,597.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$16,127.48",$0.00,"$22,597.00",$0.00,"$11,298.50","$17,896.82","$18,077.60",$0.00,$0.00,$0.00,$0.00,$0.00
27503258,EAP,HCPCS C2621,,Evia Hf-t System With Landline Hmcrtsystem,"$31,141.00",$0.00,"$31,141.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$22,225.33",$0.00,"$31,141.00",$0.00,"$15,570.50","$24,663.67","$24,912.80",$0.00,$0.00,$0.00,$0.00,$0.00
27503259,EAP,HCPCS C2621,,Evia Hf-t System With Cellular Gsm Hmcrtsystem,"$31,692.00",$0.00,"$31,692.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$22,618.58",$0.00,"$31,692.00",$0.00,"$15,846.00","$25,100.06","$25,353.60",$0.00,$0.00,$0.00,$0.00,$0.00
27503260,EAP,HCPCS C1900,,Corox Otw-l 75-bp Leadcrtlead,"$5,512.00",$0.00,"$5,512.00",$0.00,"$3,933.91",$0.00,$949.69,"$3,933.91","$3,933.91",$0.00,"$5,512.00",$0.00,"$2,756.00","$4,365.50","$4,409.60",$0.00,$862.63,$0.00,$0.00,$0.00
27503261,EAP,HCPCS C1900,,Corox Otw-l 85-bp Leadcrtlead,"$5,512.00",$0.00,"$5,512.00",$0.00,"$3,933.91",$0.00,$949.69,"$3,933.91","$3,933.91",$0.00,"$5,512.00",$0.00,"$2,756.00","$4,365.50","$4,409.60",$0.00,$862.63,$0.00,$0.00,$0.00
27503262,EAP,HCPCS C1898,,Lead Pcng 45cm Ecrdl Bipol Act Fix Is 1 Conctr Ring Eltrd,$551.00,$0.00,$551.00,$247.95,$393.25,$0.00,$94.93,$393.25,$393.25,$96.48,$551.00,$0.00,$275.50,$436.39,$440.80,$0.00,$86.23,$0.00,$87.72,$0.00
27503263,EAP,HCPCS C1785,,Gntr Pcmkr Entovis Dr-t Promri Crd,"$19,759.00",$0.00,"$19,759.00","$8,891.55","$5,158.80",$0.00,"$3,404.38","$5,158.80","$14,102.00","$3,459.64","$19,759.00",$0.00,"$9,879.50","$15,649.13","$15,807.20",$0.00,"$3,092.28",$0.00,"$3,145.63",$0.00
27503265,EAP,HCPCS C1882,,Dfbr Crd .99cm Thn 5.37x8.08cm Inogen Easyview Right Atr Rv,"$38,056.00",$0.00,"$38,056.00","$17,125.20","$5,158.80",$0.00,"$6,556.86","$5,158.80","$27,160.57","$6,663.30","$38,056.00",$0.00,"$19,028.00","$30,140.35","$30,444.80",$0.00,"$5,955.76",$0.00,"$6,058.52",$0.00
27503266,EAP,HCPCS C1785,,Pacemaker Crd .75cm 4.45x5.02cm Acld; Ltd Nxt;,"$10,213.00",$0.00,"$10,213.00","$4,595.85","$5,158.80",$0.00,"$1,759.65","$5,158.80","$7,289.02","$1,788.21","$10,213.00",$0.00,"$5,106.50","$8,088.70","$8,170.40",$0.00,"$1,598.33",$0.00,"$1,625.91",$0.00
27503267,EAP,HCPCS C1721,,Pacemaker Crd 7.5mm 42.9x43.3mm Adapta Sr Atr,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58","$5,158.80","$6,244.88","$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
27503268,EAP,Custom 27503268,,Envelope Defibrillator Medium 2.5x2.75in Pacemaker,"$1,738.00",$0.00,"$1,738.00",$0.00,"$1,240.41",$0.00,$0.00,"$1,240.41","$1,240.41",$0.00,"$1,738.00",$0.00,$869.00,"$1,376.50","$1,390.40",$0.00,$0.00,$0.00,$0.00,$0.00
27503269,EAP,Custom 27503269,,Catheter Balloon Occlusion .01in 2mm 2.5-2.8fr 4mm,"$3,312.00",$0.00,"$3,312.00",$0.00,"$2,363.77",$0.00,$0.00,"$2,363.77","$2,363.77",$0.00,"$3,312.00",$0.00,"$1,656.00","$2,623.10","$2,649.60",$0.00,$0.00,$0.00,$0.00,$0.00
27503270,EAP,HCPCS C2621,,Quadra Allure Mp Rf Crt-p,"$16,625.00",$0.00,"$16,625.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$11,865.26",$0.00,"$16,625.00",$0.00,"$8,312.50","$13,167.00","$13,300.00",$0.00,$0.00,$0.00,$0.00,$0.00
27503271,EAP,HCPCS C2621,,"Quadra Allure Mp Rf Crt-p, Merlinpkg","$17,625.00",$0.00,"$17,625.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$12,578.96",$0.00,"$17,625.00",$0.00,"$8,812.50","$13,959.00","$14,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
27503272,EAP,HCPCS C2621,,Quadra Allure Mp Rf Crt-p System,"$23,875.00",$0.00,"$23,875.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$17,039.59",$0.00,"$23,875.00",$0.00,"$11,937.50","$18,909.00","$19,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
27503273,EAP,HCPCS C2621,,"Quadra Allure Mp Crt-p System, Merlinpkg","$25,000.00",$0.00,"$25,000.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$17,842.50",$0.00,"$25,000.00",$0.00,"$12,500.00","$19,800.00","$20,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
27503274,EAP,HCPCS C1898,,Lead Pcng 45cm Solia S Bp Actfx Strd Elut,"$1,125.00",$0.00,"$1,125.00",$506.25,$802.91,$0.00,$193.83,$802.91,$802.91,$196.98,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$176.06,$0.00,$179.10,$0.00
27503275,EAP,HCPCS C1898,,Lead Pcng 53cm Solia S Strd Elute Bp Actfx Ecrdl,"$1,125.00",$0.00,"$1,125.00",$506.25,$802.91,$0.00,$193.83,$802.91,$802.91,$196.98,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$176.06,$0.00,$179.10,$0.00
27503300,EAP,HCPCS C1785,,Pacemaker Crd 2 Chmbr Dr-t Etrinsa,"$9,500.00",$0.00,"$9,500.00","$4,275.00","$5,158.80",$0.00,"$1,636.80","$5,158.80","$6,780.15","$1,663.37","$9,500.00",$0.00,"$4,750.00","$7,524.00","$7,600.00",$0.00,"$1,486.75",$0.00,"$1,512.40",$0.00
27503301,EAP,HCPCS C1785,,Etrinsa Dr-t System With Cls  With Home Monitoring,"$12,000.00",$0.00,"$12,000.00","$5,400.00","$5,158.80",$0.00,"$2,067.54","$5,158.80","$8,564.40","$2,101.10","$12,000.00",$0.00,"$6,000.00","$9,504.00","$9,600.00",$0.00,"$1,878.00",$0.00,"$1,910.40",$0.00
27503302,EAP,HCPCS C1786,,Pacemaker Crd 1 Chmbr Etrinsa Sr-t,"$8,375.00",$0.00,"$8,375.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,977.24",$0.00,"$8,375.00",$0.00,"$4,187.50","$6,633.00","$6,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
27503303,EAP,HCPCS C1786,,Etrinsa Sr-t System With Cls  With Home Monitoring,"$9,500.00",$0.00,"$9,500.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$6,780.15",$0.00,"$9,500.00",$0.00,"$4,750.00","$7,524.00","$7,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
27503305,EAP,HCPCS C2621,,Percepta Bipolar Crtp,"$29,835.00",$0.00,"$29,835.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$21,293.24",$0.00,"$29,835.00",$0.00,"$14,917.50","$23,629.32","$23,868.00",$0.00,$0.00,$0.00,$0.00,$0.00
27503320,EAP,CPT® C1898,,Lead Pcng Strg 52cm Ingevity Mri Psv Fx Rv,"$1,125.00",$0.00,"$1,125.00",$506.25,$802.91,$0.00,$193.83,$802.91,$802.91,$196.98,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$176.06,$0.00,$179.10,$0.00
27503321,EAP,CPT® C1898,,Lead Pcng J Crv 45cm Ingevity Mri Psv Fx Prefrm Atr,"$1,125.00",$0.00,"$1,125.00",$506.25,$802.91,$0.00,$193.83,$802.91,$802.91,$196.98,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$176.06,$0.00,$179.10,$0.00
27503322,EAP,CPT® C1898,,Lead Pcng J Crv 52cm Ingevity Mri Psv Fx Prefrm Atr,"$1,125.00",$0.00,"$1,125.00",$506.25,$802.91,$0.00,$193.83,$802.91,$802.91,$196.98,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$176.06,$0.00,$179.10,$0.00
27503323,EAP,,,Lead Pcng Strg 45cm Ingevity Mri Act Bp Flx Tp Sty Av,"$1,125.00",$0.00,"$1,125.00",$0.00,$802.91,$0.00,$0.00,$802.91,$802.91,$0.00,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$0.00,$0.00,$0.00,$0.00
27503324,EAP,CPT® C1898,,Lead Pcng Strg 52cm Ingevity Mri Act Bp Flx Tp Sty Av,"$1,125.00",$0.00,"$1,125.00",$506.25,$802.91,$0.00,$193.83,$802.91,$802.91,$196.98,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$176.06,$0.00,$179.10,$0.00
27503326,EAP,HCPCS C1785,,Pacemaker Crd Azure Wirelessly,"$13,750.00",$0.00,"$13,750.00","$6,187.50","$5,158.80",$0.00,"$2,369.06","$5,158.80","$9,813.38","$2,407.52","$13,750.00",$0.00,"$6,875.00","$10,890.00","$11,000.00",$0.00,"$2,151.88",$0.00,"$2,189.00",$0.00
27503327,EAP,HCPCS c1786,,Pacemaker Crd Azure,"$12,000.00",$0.00,"$12,000.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$8,564.40",$0.00,"$12,000.00",$0.00,"$6,000.00","$9,504.00","$9,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
27503329,EAP,HCPCS C1898,,Lead Pcng 10mm Spc Sm Strg 6.2fr 2mm 45cm Strl Cp Nv Bp Scr,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$892.13,$892.13,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
27503330,EAP,HCPCS C1786,,Edora Promri Sr-t-sing Chmbr Pacemaker-rate-ad,"$13,375.00",$0.00,"$13,375.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,545.74",$0.00,"$13,375.00",$0.00,"$6,687.50","$10,593.00","$10,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
27503331,EAP,HCPCS C1785,,Pm Cardiac Acld Lat Nxt Dr-el 4.45 X 5.88 X 0.75,"$7,625.00",$0.00,"$7,625.00","$3,431.25","$5,158.80",$0.00,"$1,313.75","$5,158.80","$5,441.96","$1,335.08","$7,625.00",$0.00,"$3,812.50","$6,039.00","$6,100.00",$0.00,"$1,193.31",$0.00,"$1,213.90",$0.00
27503332,EAP,HCPCS C1722,,Dfbr Crd .99cm 5.37x7.36cm Resonate Heartlogic,"$23,893.00",$0.00,"$23,893.00","$10,751.85","$5,158.80",$0.00,"$4,116.64","$5,158.80","$17,052.43","$4,183.47","$23,893.00",$0.00,"$11,946.50","$18,923.26","$19,114.40",$0.00,"$3,739.25",$0.00,"$3,803.77",$0.00
27800001,EAP,HCPCS V2790,,Prokera,"$2,140.00",$0.00,"$2,140.00",$963.00,"$1,527.32",$0.00,$368.71,"$1,527.32","$1,527.32",$374.70,"$2,140.00",$0.00,"$1,070.00","$1,694.88","$1,712.00",$0.00,$334.91,$0.00,$340.69,$0.00
27800002,EAP,Custom 27800002,,Coil Embl 20mm .014in 3mm Trfl Psh Cmplx Pltn Nyl,$406.00,$0.00,$406.00,$0.00,$289.76,$0.00,$0.00,$289.76,$289.76,$0.00,$406.00,$0.00,$203.00,$321.55,$324.80,$0.00,$0.00,$0.00,$0.00,$0.00
27800003,EAP,Custom 27800003,,Coil Embl 30mm .014in 4mm Trfl Psh Cmplx Pltn Nyl,$406.00,$0.00,$406.00,$0.00,$289.76,$0.00,$0.00,$289.76,$289.76,$0.00,$406.00,$0.00,$203.00,$321.55,$324.80,$0.00,$0.00,$0.00,$0.00,$0.00
27800004,EAP,Custom 27800004,,Pusher Surg 195cm Trupush Embl Coil .016in,"$1,244.00",$0.00,"$1,244.00",$0.00,$887.84,$0.00,$0.00,$887.84,$887.84,$0.00,"$1,244.00",$0.00,$622.00,$985.25,$995.20,$0.00,$0.00,$0.00,$0.00,$0.00
27800005,EAP,Custom 27800005,,Coil Embl 30cm 20mm .038in Azur Frme Elc Dtch Loop,"$3,188.00",$0.00,"$3,188.00",$0.00,"$2,275.28",$0.00,$0.00,"$2,275.28","$2,275.28",$0.00,"$3,188.00",$0.00,"$1,594.00","$2,524.90","$2,550.40",$0.00,$0.00,$0.00,$0.00,$0.00
27800006,EAP,Custom 27800006,,Coil Embl 30cm 20mm Azur Dtch Ddrgl Peri 35 Sys,"$3,000.00",$0.00,"$3,000.00",$0.00,"$2,141.10",$0.00,$0.00,"$2,141.10","$2,141.10",$0.00,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
27800007,EAP,Custom 27800007,,Coil Embl 30cm 15mm Azur Dtch Ddrgl Peri 35 Sys,"$3,000.00",$0.00,"$3,000.00",$0.00,"$2,141.10",$0.00,$0.00,"$2,141.10","$2,141.10",$0.00,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
27800008,EAP,Custom 27800008,,Azur Cx 35 Detachable 20mm/39cm,"$2,800.00",$0.00,"$2,800.00",$0.00,"$1,998.36",$0.00,$0.00,"$1,998.36","$1,998.36",$0.00,"$2,800.00",$0.00,"$1,400.00","$2,217.60","$2,240.00",$0.00,$0.00,$0.00,$0.00,$0.00
27800010,EAP,HCPCS C1882,,Defibrillator Cardiac Icd Df-1 Biphasic Waveform V,"$47,875.00",$0.00,"$47,875.00","$21,543.75","$5,158.80",$0.00,"$8,138.89","$5,158.80","$34,168.39","$8,138.89","$47,875.00",$0.00,"$23,937.50","$37,917.00","$38,300.00",$0.00,"$7,492.44",$0.00,"$7,621.70",$0.00
27800011,EAP,HCPCS C1876,,Stent Vasc 8mm 40mm 75cm Slf Xpd Ilc Art Ep Ntnl Acpt 6fr,"$2,887.00",$0.00,"$2,887.00","$1,299.15","$2,060.45",$0.00,$497.42,"$2,060.45","$2,060.45",$505.49,"$2,887.00",$0.00,"$1,443.50","$2,286.50","$2,309.60",$0.00,$451.82,$0.00,$459.61,$0.00
27800012,EAP,HCPCS C1876,,Stent Bil 8mm 6fr 37mm 75cm Bln Expandable Prmnt Xpr Ld Mtl,"$2,955.00",$0.00,"$2,955.00","$1,329.75","$2,108.98",$0.00,$509.13,"$2,108.98","$2,108.98",$517.40,"$2,955.00",$0.00,"$1,477.50","$2,340.36","$2,364.00",$0.00,$462.46,$0.00,$470.44,$0.00
27800013,EAP,HCPCS C1876,,Stent Bil 8mm 6fr 27mm 75cm Bln Expandable Prmnt Xpr Ld Mtl,"$2,955.00",$0.00,"$2,955.00","$1,329.75","$2,108.98",$0.00,$509.13,"$2,108.98","$2,108.98",$517.40,"$2,955.00",$0.00,"$1,477.50","$2,340.36","$2,364.00",$0.00,$462.46,$0.00,$470.44,$0.00
27800014,EAP,Custom 27800014,,Dvc Embl 25mm 4.5mm Ppln Flx 55d 75% Cocr 25% Pltn,"$37,389.00",$0.00,"$37,389.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$26,684.53",$0.00,"$37,389.00",$0.00,"$18,694.50","$29,612.09","$29,911.20",$0.00,$0.00,$0.00,$0.00,$0.00
27800015,EAP,HCPCS C1874,,Stent Tracheobronchial 16mm Cover Icast 6mm 6fr,"$6,009.00",$0.00,"$6,009.00","$2,704.05","$4,288.62",$0.00,"$1,035.32","$4,288.62","$4,288.62","$1,052.13","$6,009.00",$0.00,"$3,004.50","$4,759.13","$4,807.20",$0.00,$940.41,$0.00,$956.63,$0.00
27800016,EAP,Custom 27800016,,Dvc Embl 20mm 4.75mm Ppln Flx 55d 75% Ccr 25% Pltn,"$34,230.00",$0.00,"$34,230.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,429.95",$0.00,"$34,230.00",$0.00,"$17,115.00","$27,110.16","$27,384.00",$0.00,$0.00,$0.00,$0.00,$0.00
27800017,EAP,HCPCS C1752,,Mahurkar Elite Se Catheter Only 16cm,$121.00,$0.00,$121.00,$0.00,$86.36,$0.00,$0.00,$86.36,$86.36,$0.00,$121.00,$0.00,$60.50,$95.83,$96.80,$0.00,$0.00,$0.00,$0.00,$0.00
27800018,EAP,HCPCS C1752,,Mahurkar Elite Se Catheter Only 20cm,$127.00,$0.00,$127.00,$0.00,$90.64,$0.00,$0.00,$90.64,$90.64,$0.00,$127.00,$0.00,$63.50,$100.58,$101.60,$0.00,$0.00,$0.00,$0.00,$0.00
27800019,EAP,HCPCS C1752,,Mahurkar Elite Se Catheter Only 24cm,$121.00,$0.00,$121.00,$0.00,$86.36,$0.00,$0.00,$86.36,$86.36,$0.00,$121.00,$0.00,$60.50,$95.83,$96.80,$0.00,$0.00,$0.00,$0.00,$0.00
27800020,EAP,HCPCS C1874,,Stent Tracheobronchial 16mm Cvr Icast 120cm 7mm 7f,"$6,009.00",$0.00,"$6,009.00","$2,704.05","$4,288.62",$0.00,"$1,035.32","$4,288.62","$4,288.62","$1,052.13","$6,009.00",$0.00,"$3,004.50","$4,759.13","$4,807.20",$0.00,$940.41,$0.00,$956.63,$0.00
27800021,EAP,HCPCS C2616,,"Yttrium-90,per Source","$60,196.00",$0.00,"$60,196.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$42,961.89",$0.00,"$60,196.00",$0.00,"$30,098.00","$47,675.23","$48,156.80",$0.00,$0.00,$0.00,$0.00,$0.00
27800022,EAP,HCPCS C1874,,Stent Endoprsth 5cm 5mm Hep Ntnl Eptfe Vbhn 120cm,"$8,123.00",$0.00,"$8,123.00","$3,655.35","$5,158.80",$0.00,"$1,399.55","$5,158.80","$5,797.39","$1,422.27","$8,123.00",$0.00,"$4,061.50","$6,433.42","$6,498.40",$0.00,"$1,271.25",$0.00,"$1,293.18",$0.00
27800023,EAP,HCPCS C1874,,Stent Endoprsth 10cm 5mm Hep Ntnl Eptfe Vbhn 120cm,"$8,123.00",$0.00,"$8,123.00","$3,655.35","$5,158.80",$0.00,"$1,399.55","$5,158.80","$5,797.39","$1,422.27","$8,123.00",$0.00,"$4,061.50","$6,433.42","$6,498.40",$0.00,"$1,271.25",$0.00,"$1,293.18",$0.00
27800024,EAP,HCPCS C1874,,Stent Endoprsth 5cm 7mm Hep Ntnl Eptfe Vbhn 120cm,"$8,123.00",$0.00,"$8,123.00","$3,655.35","$5,158.80",$0.00,"$1,399.55","$5,158.80","$5,797.39","$1,422.27","$8,123.00",$0.00,"$4,061.50","$6,433.42","$6,498.40",$0.00,"$1,271.25",$0.00,"$1,293.18",$0.00
27800025,EAP,HCPCS C1874,,Stent Endoprsth 10cm 7mm Hep Ntnl Eptfe Vbhn 120cm,"$8,123.00",$0.00,"$8,123.00","$3,655.35","$5,158.80",$0.00,"$1,399.55","$5,158.80","$5,797.39","$1,422.27","$8,123.00",$0.00,"$4,061.50","$6,433.42","$6,498.40",$0.00,"$1,271.25",$0.00,"$1,293.18",$0.00
27800026,EAP,HCPCS C1757,,Mindframe Capture Lp 3x2 Revascularization Device,"$11,643.00",$0.00,"$11,643.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$8,309.61",$0.00,"$11,643.00",$0.00,"$5,821.50","$9,221.26","$9,314.40",$0.00,$0.00,$0.00,$0.00,$0.00
27800029,EAP,HCPCS C1876,,Stent Vasc 13mm 2.5mm Lvis Jr Intrlum Ntnl 3 Flr,"$17,219.00",$0.00,"$17,219.00","$7,748.55","$5,158.80",$0.00,"$2,966.75","$5,158.80","$12,289.20","$3,014.91","$17,219.00",$0.00,"$8,609.50","$13,637.45","$13,775.20",$0.00,"$2,694.77",$0.00,"$2,741.26",$0.00
27800030,EAP,HCPCS C1876,,Stent Vasc 17mm 2.5mm Lvis Jr Intrlum Ntnl 3 Flr,"$17,219.00",$0.00,"$17,219.00","$7,748.55","$5,158.80",$0.00,"$2,966.75","$5,158.80","$12,289.20","$3,014.91","$17,219.00",$0.00,"$8,609.50","$13,637.45","$13,775.20",$0.00,"$2,694.77",$0.00,"$2,741.26",$0.00
27800031,EAP,HCPCS C1876,,Stent Vasc 23mm 2.5mm Lvis Jr Intrlum Ntnl 3 Flr,"$17,219.00",$0.00,"$17,219.00","$7,748.55","$5,158.80",$0.00,"$2,966.75","$5,158.80","$12,289.20","$3,014.91","$17,219.00",$0.00,"$8,609.50","$13,637.45","$13,775.20",$0.00,"$2,694.77",$0.00,"$2,741.26",$0.00
27800032,EAP,HCPCS C1876,,Stent Vasc 34mm 2.5mm Lvis Jr Intrlum Ntnl 3 Flr,"$17,219.00",$0.00,"$17,219.00","$7,748.55","$5,158.80",$0.00,"$2,966.75","$5,158.80","$12,289.20","$3,014.91","$17,219.00",$0.00,"$8,609.50","$13,637.45","$13,775.20",$0.00,"$2,694.77",$0.00,"$2,741.26",$0.00
27800033,EAP,HCPCS C1764,,System Crd Monitr Rvl Impltable Ins Loop,"$13,900.00",$0.00,"$13,900.00","$6,255.00","$5,158.80",$0.00,"$2,394.90","$5,158.80","$9,920.43","$2,433.78","$13,900.00",$0.00,"$6,950.00","$11,008.80","$11,120.00",$0.00,"$2,175.35",$0.00,"$2,212.88",$0.00
27800035,EAP,HCPCS C1778,,Lead Nrstm 50cm Prcs .014in Trl Lnr Str Tip Preld,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$892.13,$892.13,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
27800039,EAP,HCPCS C1876,,Stent Endo 100cm 12mm 8fr 60mm 75cm Flexible Deliv,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,"$1,873.46","$1,873.46",$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
27800040,EAP,HCPCS C1876,,Stent Endo 100cm 14mm 40mm 75cm Unconstrain Flex,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,"$1,873.46","$1,873.46",$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
27800041,EAP,HCPCS C1876,,Stent Endo 100cm 14mm 9fr 60mm 75cm Cath,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,"$1,873.46","$1,873.46",$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
27800042,EAP,HCPCS C1874,,Stent Endoprsth 8mm 7fr 5cm 120cm Delivery System,"$7,738.00",$0.00,"$7,738.00","$3,482.10","$5,158.80",$0.00,"$1,333.22","$5,158.80","$5,522.61","$1,354.86","$7,738.00",$0.00,"$3,869.00","$6,128.50","$6,190.40",$0.00,"$1,211.00",$0.00,"$1,231.89",$0.00
27800043,EAP,HCPCS C1876,,Stent Vasc 6.5mm 6fr 100mm 120cm Otw Slf,"$1,988.00",$0.00,"$1,988.00",$894.60,"$1,418.84",$0.00,$342.52,"$1,418.84","$1,418.84",$348.08,"$1,988.00",$0.00,$994.00,"$1,574.50","$1,590.40",$0.00,$311.12,$0.00,$316.49,$0.00
27800044,EAP,HCPCS C1874,,Graft Evas 32mm 8.1mm 20fr 124mm Znth 2 Intnl Stnt,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11","$5,158.80","$19,626.75","$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
27800045,EAP,HCPCS C1874,,Graft Evas 2 Brch 12mm 8.1mm 20fr 91mm 62mm Znth I,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17","$5,158.80","$6,616.00","$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
27800046,EAP,,,Space Oar Hydrogel,"$7,125.00",$0.00,"$7,125.00",$0.00,"$5,085.11",$0.00,$0.00,"$5,085.11","$5,085.11",$0.00,"$7,125.00",$0.00,"$3,562.50","$5,643.00","$5,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
27800053,EAP,HCPCS C1757,,Ace68 Reperfusion Catheter Kit,"$6,988.00",$0.00,"$6,988.00",$0.00,"$4,987.34",$0.00,$0.00,"$4,987.34","$4,987.34",$0.00,"$6,988.00",$0.00,"$3,494.00","$5,534.50","$5,590.40",$0.00,$0.00,$0.00,$0.00,$0.00
27800055,EAP,HCPCS C1880,,Option Elite Vena Cava Filter System,"$2,941.00",$0.00,"$2,941.00","$1,323.45","$2,098.99",$0.00,$506.72,"$2,098.99","$2,098.99",$514.95,"$2,941.00",$0.00,"$1,470.50","$2,329.27","$2,352.80",$0.00,$460.27,$0.00,$468.21,$0.00
27800056,EAP,Custom 27800056,,Coil Embl 3cm 2mm Nst 4.8 Loop Sft Enh Radopc Mciol .01n,$279.00,$0.00,$279.00,$0.00,$199.12,$0.00,$0.00,$199.12,$199.12,$0.00,$279.00,$0.00,$139.50,$220.97,$223.20,$0.00,$0.00,$0.00,$0.00,$0.00
27800057,EAP,Custom 27800057,,Coil Embl 3cm 3mm Nst 3.2 Loop Sft Enh Radopc Mciol .01n,$279.00,$0.00,$279.00,$0.00,$199.12,$0.00,$0.00,$199.12,$199.12,$0.00,$279.00,$0.00,$139.50,$220.97,$223.20,$0.00,$0.00,$0.00,$0.00,$0.00
27800058,EAP,Custom 27800058,,Coil Embl 5cm 3mm Nst 5.3 Loop Sft Enh Radopc Mciol .01n,$271.00,$0.00,$271.00,$0.00,$193.41,$0.00,$0.00,$193.41,$193.41,$0.00,$271.00,$0.00,$135.50,$214.63,$216.80,$0.00,$0.00,$0.00,$0.00,$0.00
27800059,EAP,Custom 27800059,,Coil Embl 7cm 6mm Nst 3.7 Loop Sft Enh Radopc .035in Pln,$294.00,$0.00,$294.00,$0.00,$209.83,$0.00,$0.00,$209.83,$209.83,$0.00,$294.00,$0.00,$147.00,$232.85,$235.20,$0.00,$0.00,$0.00,$0.00,$0.00
27800060,EAP,Custom 27800060,,Coil Embl 7cm 8mm Nst 2.8 Loop Sft Enh Radopc .035in Pln,$294.00,$0.00,$294.00,$0.00,$209.83,$0.00,$0.00,$209.83,$209.83,$0.00,$294.00,$0.00,$147.00,$232.85,$235.20,$0.00,$0.00,$0.00,$0.00,$0.00
27800061,EAP,Custom 27800061,,Coil Embl 14cm 16mm Nst 2.8 Loop Sft Enh Radopc .035in N,$320.00,$0.00,$320.00,$0.00,$228.38,$0.00,$0.00,$228.38,$228.38,$0.00,$320.00,$0.00,$160.00,$253.44,$256.00,$0.00,$0.00,$0.00,$0.00,$0.00
27800062,EAP,HCPCS C1874,,Drug Eluting Stent,$0.01,$0.00,$0.01,$0.00,$0.01,$0.00,$0.00,$0.01,$0.01,$0.00,$0.01,$0.00,$0.01,$0.01,$0.01,$0.00,$0.00,$0.00,$0.00,$0.00
27800063,EAP,HCPCS C1876,,Bare Metal Stent,$0.01,$0.00,$0.01,$0.00,$0.01,$0.00,$0.00,$0.01,$0.01,$0.00,$0.01,$0.00,$0.01,$0.01,$0.01,$0.00,$0.00,$0.00,$0.00,$0.00
27800064,EAP,HCPCS C1894,,Glidesheath Slender Ss (.021) 5fr 10cm,$138.00,$0.00,$138.00,$62.10,$98.49,$0.00,$23.78,$98.49,$98.49,$24.16,$138.00,$0.00,$69.00,$109.30,$110.40,$0.00,$21.60,$0.00,$21.97,$0.00
27800065,EAP,HCPCS C1894,,Glidesheath Slender Ss (.021) 7fr 10cm,$138.00,$0.00,$138.00,$62.10,$98.49,$0.00,$23.78,$98.49,$98.49,$24.16,$138.00,$0.00,$69.00,$109.30,$110.40,$0.00,$21.60,$0.00,$21.97,$0.00
27800066,EAP,HCPCS A4648,,Visicoil Lung Gold Seeds 0.50mm X 0.50cm Length,$338.00,$0.00,$338.00,$152.10,$241.23,$0.00,$58.24,$241.23,$241.23,$59.18,$338.00,$0.00,$169.00,$267.70,$270.40,$0.00,$52.90,$0.00,$53.81,$0.00
27800100,EAP,,,Catheter Dlv Sys 130cm 5fr .04in Neuron .035in,$329.00,$0.00,$329.00,$0.00,$234.81,$0.00,$0.00,$234.81,$234.81,$0.00,$329.00,$0.00,$164.50,$260.57,$263.20,$0.00,$0.00,$0.00,$0.00,$0.00
27800101,EAP,HCPCS C1817,,Occluder Cardio 15mm Spt Sft Wire Frm Flrscp Img,"$17,493.00",$0.00,"$17,493.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$12,484.75",$0.00,"$17,493.00",$0.00,"$8,746.50","$13,854.46","$13,994.40",$0.00,$0.00,$0.00,$0.00,$0.00
27800102,EAP,HCPCS C1817,,Occluder Cardio 20mm Spt Sft Wire Frm Flrscp Img,"$17,493.00",$0.00,"$17,493.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$12,484.75",$0.00,"$17,493.00",$0.00,"$8,746.50","$13,854.46","$13,994.40",$0.00,$0.00,$0.00,$0.00,$0.00
27800103,EAP,HCPCS C1817,,Occluder Cardio 25mm Spt Sft Wire Frm Flrscp Img,"$17,493.00",$0.00,"$17,493.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$12,484.75",$0.00,"$17,493.00",$0.00,"$8,746.50","$13,854.46","$13,994.40",$0.00,$0.00,$0.00,$0.00,$0.00
27800104,EAP,HCPCS C1817,,Occluder Cardio 30mm Spt Sft Wire Frm Flrscp Img,"$17,493.00",$0.00,"$17,493.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$12,484.75",$0.00,"$17,493.00",$0.00,"$8,746.50","$13,854.46","$13,994.40",$0.00,$0.00,$0.00,$0.00,$0.00
27800105,EAP,CPT® C1887,,Catheter Angiography Guiding Upsized Cps Direct 13,$730.00,$0.00,$730.00,$328.50,$521.00,$0.00,$125.78,$521.00,$521.00,$127.82,$730.00,$0.00,$365.00,$578.16,$584.00,$0.00,$114.25,$0.00,$116.22,$0.00
27801001,EAP,HCPCS C1721,,Livian Dual Crt-d Device,"$102,209.00",$0.00,"$102,209.00","$45,994.05","$5,158.80",$0.00,"$8,138.89","$5,158.80","$72,946.56","$8,138.89","$102,209.00",$0.00,"$51,104.50","$80,949.53","$81,767.20",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27801002,EAP,HCPCS C1721,,Entrust At Dual Icd,"$63,028.00",$0.00,"$63,028.00","$28,362.60","$5,158.80",$0.00,"$8,138.89","$5,158.80","$44,983.08","$8,138.89","$63,028.00",$0.00,"$31,514.00","$49,918.18","$50,422.40",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27801003,EAP,HCPCS C1721,,Maximo Dr Dual Icd,"$48,414.00",$0.00,"$48,414.00","$21,786.30","$5,158.80",$0.00,"$8,138.89","$5,158.80","$34,553.07","$8,138.89","$48,414.00",$0.00,"$24,207.00","$38,343.89","$38,731.20",$0.00,"$7,576.79",$0.00,"$7,707.51",$0.00
27801004,EAP,HCPCS C1722,,Entrust Vr Single Icd,"$51,104.00",$0.00,"$51,104.00","$22,996.80","$5,158.80",$0.00,"$8,138.89","$5,158.80","$36,472.92","$8,138.89","$51,104.00",$0.00,"$25,552.00","$40,474.37","$40,883.20",$0.00,"$7,751.33",$0.00,"$8,135.76",$0.00
27801005,EAP,HCPCS C1722,,Maximo Vr Sindle Icd,"$39,450.00",$0.00,"$39,450.00","$17,752.50","$5,158.80",$0.00,"$6,797.04","$5,158.80","$28,155.47","$6,907.38","$39,450.00",$0.00,"$19,725.00","$31,244.40","$31,560.00",$0.00,"$6,173.93",$0.00,"$6,280.44",$0.00
27801006,EAP,HCPCS C1722,,Virtuoso Single Icd,"$51,104.00",$0.00,"$51,104.00","$22,996.80","$5,158.80",$0.00,"$8,138.89","$5,158.80","$36,472.92","$8,138.89","$51,104.00",$0.00,"$25,552.00","$40,474.37","$40,883.20",$0.00,"$7,751.33",$0.00,"$8,135.76",$0.00
27801007,EAP,HCPCS C1721,,Ventak Prizm Dr Icd,"$53,793.00",$0.00,"$53,793.00","$24,206.85","$5,158.80",$0.00,"$8,138.89","$5,158.80","$38,392.06","$8,138.89","$53,793.00",$0.00,"$26,896.50","$42,604.06","$43,034.40",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27801008,EAP,HCPCS C1895,,Sprint 6947 Rv Lead,"$16,139.00",$0.00,"$16,139.00","$7,262.55","$5,158.80",$0.00,"$2,780.67","$5,158.80","$11,518.40","$2,825.81","$16,139.00",$0.00,"$8,069.50","$12,782.09","$12,911.20",$0.00,"$2,525.75",$0.00,"$2,569.33",$0.00
27801009,EAP,HCPCS C1895,,Linox Sd Lead,"$10,761.00",$0.00,"$10,761.00","$4,842.45","$5,158.80",$0.00,"$1,854.07","$5,158.80","$7,680.13","$1,884.17","$10,761.00",$0.00,"$5,380.50","$8,522.71","$8,608.80",$0.00,"$1,684.10",$0.00,"$1,713.15",$0.00
27801010,EAP,HCPCS C1895,,Isoline Passive Fix Lead,"$15,063.00",$0.00,"$15,063.00","$6,778.35","$5,158.80",$0.00,"$2,595.28","$5,158.80","$10,750.46","$2,637.41","$15,063.00",$0.00,"$7,531.50","$11,929.90","$12,050.40",$0.00,"$2,357.36",$0.00,"$2,398.03",$0.00
27801011,EAP,HCPCS C1895,,Tachycardia Lead,"$15,063.00",$0.00,"$15,063.00","$6,778.35","$5,158.80",$0.00,"$2,595.28","$5,158.80","$10,750.46","$2,637.41","$15,063.00",$0.00,"$7,531.50","$11,929.90","$12,050.40",$0.00,"$2,357.36",$0.00,"$2,398.03",$0.00
27801012,EAP,HCPCS C1895,,7120 Durata Pkg Lead,"$15,063.00",$0.00,"$15,063.00","$6,778.35","$5,158.80",$0.00,"$2,595.28","$5,158.80","$10,750.46","$2,637.41","$15,063.00",$0.00,"$7,531.50","$11,929.90","$12,050.40",$0.00,"$2,357.36",$0.00,"$2,398.03",$0.00
27801013,EAP,HCPCS C1721,,Atlas Plus Dr Dual Icd,"$50,207.00",$0.00,"$50,207.00","$22,593.15","$5,158.80",$0.00,"$8,138.89","$5,158.80","$35,832.74","$8,138.89","$50,207.00",$0.00,"$25,103.50","$39,763.94","$40,165.60",$0.00,"$7,751.33",$0.00,"$7,992.95",$0.00
27801014,EAP,HCPCS C1722,,Atlas Plus Vr Sngl Icd,"$39,450.00",$0.00,"$39,450.00","$17,752.50","$5,158.80",$0.00,"$6,797.04","$5,158.80","$28,155.47","$6,907.38","$39,450.00",$0.00,"$19,725.00","$31,244.40","$31,560.00",$0.00,"$6,173.93",$0.00,"$6,280.44",$0.00
27801015,EAP,HCPCS C1722,,Atlas Plus C Header Icd,"$39,450.00",$0.00,"$39,450.00","$17,752.50","$5,158.80",$0.00,"$6,797.04","$5,158.80","$28,155.47","$6,907.38","$39,450.00",$0.00,"$19,725.00","$31,244.40","$31,560.00",$0.00,"$6,173.93",$0.00,"$6,280.44",$0.00
27801016,EAP,HCPCS C1722,,Atlas Ii Vr Sngl Icd,"$39,450.00",$0.00,"$39,450.00","$17,752.50","$5,158.80",$0.00,"$6,797.04","$5,158.80","$28,155.47","$6,907.38","$39,450.00",$0.00,"$19,725.00","$31,244.40","$31,560.00",$0.00,"$6,173.93",$0.00,"$6,280.44",$0.00
27801017,EAP,HCPCS C1722,,Lumax 340 Vr-t Single Icd,"$39,450.00",$0.00,"$39,450.00","$17,752.50","$5,158.80",$0.00,"$6,797.04","$5,158.80","$28,155.47","$6,907.38","$39,450.00",$0.00,"$19,725.00","$31,244.40","$31,560.00",$0.00,"$6,173.93",$0.00,"$6,280.44",$0.00
27801018,EAP,HCPCS C1721,,Lumax 340 Dr-t Dual Icd,"$46,622.00",$0.00,"$46,622.00","$20,979.90","$5,158.80",$0.00,"$8,032.74","$5,158.80","$33,274.12","$8,138.89","$46,622.00",$0.00,"$23,311.00","$36,924.62","$37,297.60",$0.00,"$7,296.34",$0.00,"$7,422.22",$0.00
27801019,EAP,HCPCS C1721,,Atlas Ii+ Dr Dual Icd,"$66,346.00",$0.00,"$66,346.00","$29,855.70","$5,158.80",$0.00,"$8,138.89","$5,158.80","$47,351.14","$8,138.89","$66,346.00",$0.00,"$33,173.00","$52,546.03","$53,076.80",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27801020,EAP,HCPCS C1898,,Bradycardia Lead,"$1,920.00",$0.00,"$1,920.00",$864.00,"$1,370.30",$0.00,$330.81,"$1,370.30","$1,370.30",$336.18,"$1,920.00",$0.00,$960.00,"$1,520.64","$1,536.00",$0.00,$300.48,$0.00,$305.66,$0.00
27801021,EAP,HCPCS C1721,,Ovatio Oh60u Dr 6550 Icd,"$53,793.00",$0.00,"$53,793.00","$24,206.85","$5,158.80",$0.00,"$8,138.89","$5,158.80","$38,392.06","$8,138.89","$53,793.00",$0.00,"$26,896.50","$42,604.06","$43,034.40",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27801022,EAP,HCPCS C1722,,Ovatio Oh61u Vr Icd,"$43,036.00",$0.00,"$43,036.00","$19,366.20","$5,158.80",$0.00,"$7,414.89","$5,158.80","$30,714.79","$7,535.26","$43,036.00",$0.00,"$21,518.00","$34,084.51","$34,428.80",$0.00,"$6,735.13",$0.00,"$6,851.33",$0.00
27801023,EAP,HCPCS C1882,,Ovatio Crt 6750 Icd,"$69,035.00",$0.00,"$69,035.00","$31,065.75","$5,158.80",$0.00,"$8,138.89","$5,158.80","$49,270.28","$8,138.89","$69,035.00",$0.00,"$34,517.50","$54,675.72","$55,228.00",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27801024,EAP,HCPCS C1882,,Lumax 340 Hf-t Crt,"$63,656.00",$0.00,"$63,656.00","$28,645.20","$5,158.80",$0.00,"$8,138.89","$5,158.80","$45,431.29","$8,138.89","$63,656.00",$0.00,"$31,828.00","$50,415.55","$50,924.80",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27801025,EAP,HCPCS C1882,,Concerto Bi-v Icd,"$81,588.00",$0.00,"$81,588.00","$36,714.60","$5,158.80",$0.00,"$8,138.89","$5,158.80","$58,229.36","$8,138.89","$81,588.00",$0.00,"$40,794.00","$64,617.70","$65,270.40",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27801026,EAP,HCPCS C1895,,Linox S 65,"$10,761.00",$0.00,"$10,761.00","$4,842.45","$5,158.80",$0.00,"$1,854.07","$5,158.80","$7,680.13","$1,884.17","$10,761.00",$0.00,"$5,380.50","$8,522.71","$8,608.80",$0.00,"$1,684.10",$0.00,"$1,713.15",$0.00
27801027,EAP,HCPCS C1895,,Kainox S 60,"$10,761.00",$0.00,"$10,761.00","$4,842.45","$5,158.80",$0.00,"$1,854.07","$5,158.80","$7,680.13","$1,884.17","$10,761.00",$0.00,"$5,380.50","$8,522.71","$8,608.80",$0.00,"$1,684.10",$0.00,"$1,713.15",$0.00
27801028,EAP,HCPCS C1882,,Promote Bi-v,"$73,870.00",$0.00,"$73,870.00","$33,241.50","$5,158.80",$0.00,"$8,138.89","$5,158.80","$52,721.02","$8,138.89","$73,870.00",$0.00,"$36,935.00","$58,505.04","$59,096.00",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27801029,EAP,HCPCS C1882,,Maximo Ii Crt-d,"$77,107.00",$0.00,"$77,107.00","$34,698.15","$5,158.80",$0.00,"$8,138.89","$5,158.80","$55,031.27","$8,138.89","$77,107.00",$0.00,"$38,553.50","$61,068.74","$61,685.60",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27801030,EAP,HCPCS C1895,,Setrox S 45 Lead,"$1,793.00",$0.00,"$1,793.00",$806.85,"$1,279.66",$0.00,$308.92,"$1,279.66","$1,279.66",$313.94,"$1,793.00",$0.00,$896.50,"$1,420.06","$1,434.40",$0.00,$280.60,$0.00,$285.45,$0.00
27801031,EAP,HCPCS C1895,,Setrox S 53 Lead,"$1,793.00",$0.00,"$1,793.00",$806.85,"$1,279.66",$0.00,$308.92,"$1,279.66","$1,279.66",$313.94,"$1,793.00",$0.00,$896.50,"$1,420.06","$1,434.40",$0.00,$280.60,$0.00,$285.45,$0.00
27801032,EAP,HCPCS C1882,,Paradym Crt-d 8750,"$82,842.00",$0.00,"$82,842.00","$37,278.90","$5,158.80",$0.00,"$8,138.89","$5,158.80","$59,124.34","$8,138.89","$82,842.00",$0.00,"$41,421.00","$65,610.86","$66,273.60",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27801033,EAP,HCPCS C1721,,Maximo Ii Dr Dual Icd,"$55,588.00",$0.00,"$55,588.00","$25,014.60","$5,158.80",$0.00,"$8,138.89","$5,158.80","$39,673.16","$8,138.89","$55,588.00",$0.00,"$27,794.00","$44,025.70","$44,470.40",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27801034,EAP,HCPCS C1722,,Maximo Ii Vr Single Icd,"$46,622.00",$0.00,"$46,622.00","$20,979.90","$5,158.80",$0.00,"$8,032.74","$5,158.80","$33,274.12","$8,138.89","$46,622.00",$0.00,"$23,311.00","$36,924.62","$37,297.60",$0.00,"$7,296.34",$0.00,"$7,422.22",$0.00
27801035,EAP,HCPCS C1722,,1211-36 Current Vr Icd,"$59,175.00",$0.00,"$59,175.00","$26,628.75","$5,158.80",$0.00,"$8,138.89","$5,158.80","$42,233.20","$8,138.89","$59,175.00",$0.00,"$29,587.50","$46,866.60","$47,340.00",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27801040,EAP,HCPCS C1880,,Vena Tech Lp Filter,"$3,618.00",$0.00,"$3,618.00","$1,628.10","$2,582.17",$0.00,$623.36,"$2,582.17","$2,582.17",$633.48,"$3,618.00",$0.00,"$1,809.00","$2,865.46","$2,894.40",$0.00,$566.22,$0.00,$575.99,$0.00
27801041,EAP,HCPCS C1876,,6fr-75cm 10x49 Wall,"$3,307.00",$0.00,"$3,307.00","$1,488.15","$2,360.21",$0.00,$569.78,"$2,360.21","$2,360.21",$579.03,"$3,307.00",$0.00,"$1,653.50","$2,619.14","$2,645.60",$0.00,$517.55,$0.00,$526.47,$0.00
27801042,EAP,HCPCS C1876,,6fr-8x80-75cmwallst,"$3,307.00",$0.00,"$3,307.00","$1,488.15","$2,360.21",$0.00,$569.78,"$2,360.21","$2,360.21",$579.03,"$3,307.00",$0.00,"$1,653.50","$2,619.14","$2,645.60",$0.00,$517.55,$0.00,$526.47,$0.00
27801043,EAP,HCPCS C1876,,7fr-75cm 10x94 Wall,"$5,303.00",$0.00,"$5,303.00","$2,386.35","$3,784.75",$0.00,$913.68,"$3,784.75","$3,784.75",$928.51,"$5,303.00",$0.00,"$2,651.50","$4,199.98","$4,242.40",$0.00,$829.92,$0.00,$844.24,$0.00
27801044,EAP,HCPCS C2625,,8fr-26cm Ureteral S,$404.00,$0.00,$404.00,$181.80,$288.33,$0.00,$69.61,$288.33,$288.33,$70.74,$404.00,$0.00,$202.00,$319.97,$323.20,$0.00,$63.23,$0.00,$64.32,$0.00
27801045,EAP,HCPCS C1876,,8mmx40mm Wallstent,"$5,303.00",$0.00,"$5,303.00","$2,386.35","$3,784.75",$0.00,$913.68,"$3,784.75","$3,784.75",$928.51,"$5,303.00",$0.00,"$2,651.50","$4,199.98","$4,242.40",$0.00,$829.92,$0.00,$844.24,$0.00
27801046,EAP,HCPCS C1874,,9frx16x90-75cm Wall,"$5,303.00",$0.00,"$5,303.00","$2,386.35","$3,784.75",$0.00,$913.68,"$3,784.75","$3,784.75",$928.51,"$5,303.00",$0.00,"$2,651.50","$4,199.98","$4,242.40",$0.00,$829.92,$0.00,$844.24,$0.00
27801047,EAP,HCPCS C1874,,Wall Graft  7mm X 3,"$6,506.00",$0.00,"$6,506.00","$2,927.70","$4,643.33",$0.00,"$1,120.95","$4,643.33","$4,643.33","$1,139.15","$6,506.00",$0.00,"$3,253.00","$5,152.75","$5,204.80",$0.00,"$1,018.19",$0.00,"$1,035.76",$0.00
27801048,EAP,HCPCS C1874,,Wallgraft  10 X 50m,"$6,506.00",$0.00,"$6,506.00","$2,927.70","$4,643.33",$0.00,"$1,120.95","$4,643.33","$4,643.33","$1,139.15","$6,506.00",$0.00,"$3,253.00","$5,152.75","$5,204.80",$0.00,"$1,018.19",$0.00,"$1,035.76",$0.00
27801049,EAP,HCPCS C1874,,Wallgraft  12 X 70m,"$7,505.00",$0.00,"$7,505.00","$3,377.25","$5,158.80",$0.00,"$1,293.07","$5,158.80","$5,356.32","$1,314.07","$7,505.00",$0.00,"$3,752.50","$5,943.96","$6,004.00",$0.00,"$1,174.53",$0.00,"$1,194.80",$0.00
27801050,EAP,HCPCS C1876,,21v7-7-80-8.0-30 St,"$5,245.00",$0.00,"$5,245.00","$2,360.25","$3,743.36",$0.00,$903.69,"$3,743.36","$3,743.36",$918.36,"$5,245.00",$0.00,"$2,622.50","$4,154.04","$4,196.00",$0.00,$820.84,$0.00,$835.00,$0.00
27801051,EAP,HCPCS C2625,,8.5fr-22cm Nephrour,$361.00,$0.00,$361.00,$162.45,$257.65,$0.00,$62.20,$257.65,$257.65,$63.21,$361.00,$0.00,$180.50,$285.91,$288.80,$0.00,$56.50,$0.00,$57.47,$0.00
27801052,EAP,HCPCS C2625,,8.5fr-24cm Nephrour,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$249.80,$249.80,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
27801053,EAP,HCPCS C2625,,8.5fr-28cm Nephrour,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$249.80,$249.80,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
27801054,EAP,HCPCS C1876,,Ziv7-80-8.0-60 Sten,"$5,245.00",$0.00,"$5,245.00","$2,360.25","$3,743.36",$0.00,$903.69,"$3,743.36","$3,743.36",$918.36,"$5,245.00",$0.00,"$2,622.50","$4,154.04","$4,196.00",$0.00,$820.84,$0.00,$835.00,$0.00
27801055,EAP,HCPCS C1875,,6x 40 Fluency Stent Graft Old,"$7,656.00",$0.00,"$7,656.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,464.09",$0.00,"$7,656.00",$0.00,"$3,828.00","$6,063.55","$6,124.80",$0.00,$0.00,$0.00,$0.00,$0.00
27801056,EAP,HCPCS C1876,,10 X 40   Luminexx Stent,"$4,186.00",$0.00,"$4,186.00","$1,883.70","$2,987.55",$0.00,$721.23,"$2,987.55","$2,987.55",$732.94,"$4,186.00",$0.00,"$2,093.00","$3,315.31","$3,348.80",$0.00,$655.11,$0.00,$666.41,$0.00
27801057,EAP,HCPCS C1880,,Simon Nitinol Filte,"$2,836.00",$0.00,"$2,836.00","$1,276.20","$2,024.05",$0.00,$488.63,"$2,024.05","$2,024.05",$496.56,"$2,836.00",$0.00,"$1,418.00","$2,246.11","$2,268.80",$0.00,$443.83,$0.00,$451.49,$0.00
27801058,EAP,HCPCS C1874,,Wall Stent 8fr/ 12x,"$3,605.00",$0.00,"$3,605.00","$1,622.25","$2,572.89",$0.00,$621.12,"$2,572.89","$2,572.89",$631.21,"$3,605.00",$0.00,"$1,802.50","$2,855.16","$2,884.00",$0.00,$564.18,$0.00,$573.92,$0.00
27801059,EAP,HCPCS C1874,,Wall Stent 8fr/ 12x,"$5,778.00",$0.00,"$5,778.00","$2,600.10","$4,123.76",$0.00,$995.52,"$4,123.76","$4,123.76","$1,011.68","$5,778.00",$0.00,"$2,889.00","$4,576.18","$4,622.40",$0.00,$904.26,$0.00,$919.86,$0.00
27801060,EAP,HCPCS C1875,,10x40 Luminexx Sten,"$7,321.00",$0.00,"$7,321.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,225.00",$0.00,"$7,321.00",$0.00,"$3,660.50","$5,798.23","$5,856.80",$0.00,$0.00,$0.00,$0.00,$0.00
27801061,EAP,HCPCS C2625,,8.5fr-26cm Nephro-u,$361.00,$0.00,$361.00,$162.45,$257.65,$0.00,$62.20,$257.65,$257.65,$63.21,$361.00,$0.00,$180.50,$285.91,$288.80,$0.00,$56.50,$0.00,$57.47,$0.00
27801062,EAP,HCPCS C1875,,8 X 40 Fluency Sten,"$9,054.00",$0.00,"$9,054.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$6,461.84",$0.00,"$9,054.00",$0.00,"$4,527.00","$7,170.77","$7,243.20",$0.00,$0.00,$0.00,$0.00,$0.00
27801063,EAP,HCPCS C1880,,Filter Recovery Femoral,"$3,669.00",$0.00,"$3,669.00","$1,651.05","$2,618.57",$0.00,$632.15,"$2,618.57","$2,618.57",$642.41,"$3,669.00",$0.00,"$1,834.50","$2,905.85","$2,935.20",$0.00,$574.20,$0.00,$584.10,$0.00
27801064,EAP,HCPCS C2625,,8fr-28cm Ureteral S,$360.00,$0.00,$360.00,$162.00,$256.93,$0.00,$62.03,$256.93,$256.93,$63.03,$360.00,$0.00,$180.00,$285.12,$288.00,$0.00,$56.34,$0.00,$57.31,$0.00
27801065,EAP,HCPCS C1788,,Low Profile Port,$751.00,$0.00,$751.00,$337.95,$535.99,$0.00,$129.39,$535.99,$535.99,$131.49,$751.00,$0.00,$375.50,$594.79,$600.80,$0.00,$117.53,$0.00,$119.56,$0.00
27801066,EAP,HCPCS C1880,,Filter-femoral,"$3,156.00",$0.00,"$3,156.00","$1,420.20","$2,252.44",$0.00,$543.76,"$2,252.44","$2,252.44",$552.59,"$3,156.00",$0.00,"$1,578.00","$2,499.55","$2,524.80",$0.00,$493.91,$0.00,$502.44,$0.00
27801067,EAP,HCPCS C1880,,Greenfield Filter-j,"$3,156.00",$0.00,"$3,156.00","$1,420.20","$2,252.44",$0.00,$543.76,"$2,252.44","$2,252.44",$552.59,"$3,156.00",$0.00,"$1,578.00","$2,499.55","$2,524.80",$0.00,$493.91,$0.00,$502.44,$0.00
27801068,EAP,HCPCS C2625,,Stent Ureteral 8fr 24cm,$418.00,$0.00,$418.00,$188.10,$298.33,$0.00,$72.02,$298.33,$298.33,$73.19,$418.00,$0.00,$209.00,$331.06,$334.40,$0.00,$65.42,$0.00,$66.55,$0.00
27801069,EAP,HCPCS C2625,,Stent Ureteral 8fr 22cm,$398.00,$0.00,$398.00,$179.10,$284.05,$0.00,$68.57,$284.05,$284.05,$69.69,$398.00,$0.00,$199.00,$315.22,$318.40,$0.00,$62.29,$0.00,$63.36,$0.00
27801070,EAP,HCPCS C1876,,80-6.0x40cm Stent,"$5,245.00",$0.00,"$5,245.00","$2,360.25","$3,743.36",$0.00,$903.69,"$3,743.36","$3,743.36",$918.36,"$5,245.00",$0.00,"$2,622.50","$4,154.04","$4,196.00",$0.00,$820.84,$0.00,$835.00,$0.00
27801071,EAP,HCPCS C1880,,Filter Birds Nest Vena Cava Fe,"$3,442.00",$0.00,"$3,442.00","$1,548.90","$2,456.56",$0.00,$593.04,"$2,456.56","$2,456.56",$602.67,"$3,442.00",$0.00,"$1,721.00","$2,726.06","$2,753.60",$0.00,$538.67,$0.00,$547.97,$0.00
27801072,EAP,HCPCS C1880,,Filter Birds Nest Vena Cava Ju,"$3,442.00",$0.00,"$3,442.00","$1,548.90","$2,456.56",$0.00,$593.04,"$2,456.56","$2,456.56",$602.67,"$3,442.00",$0.00,"$1,721.00","$2,726.06","$2,753.60",$0.00,$538.67,$0.00,$547.97,$0.00
27801073,EAP,HCPCS C1880,,Filter Gunther-tulip Femoral,"$3,586.00",$0.00,"$3,586.00","$1,613.70","$2,559.33",$0.00,$617.85,"$2,559.33","$2,559.33",$627.88,"$3,586.00",$0.00,"$1,793.00","$2,840.11","$2,868.80",$0.00,$561.21,$0.00,$570.89,$0.00
27801074,EAP,HCPCS C1880,,Filter Gunther-tulip Jugular,"$3,216.00",$0.00,"$3,216.00","$1,447.20","$2,295.26",$0.00,$554.10,"$2,295.26","$2,295.26",$563.10,"$3,216.00",$0.00,"$1,608.00","$2,547.07","$2,572.80",$0.00,$503.30,$0.00,$511.99,$0.00
27801075,EAP,HCPCS C1880,,Trapeaze Femoralve,"$4,154.00",$0.00,"$4,154.00","$1,869.30","$2,964.71",$0.00,$715.71,"$2,964.71","$2,964.71",$727.33,"$4,154.00",$0.00,"$2,077.00","$3,289.97","$3,323.20",$0.00,$650.10,$0.00,$661.32,$0.00
27801076,EAP,HCPCS C1875,,"Covered Stent, 5mmx","$8,174.00",$0.00,"$8,174.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,833.78",$0.00,"$8,174.00",$0.00,"$4,087.00","$6,473.81","$6,539.20",$0.00,$0.00,$0.00,$0.00,$0.00
27801077,EAP,HCPCS C1874,,"Covered Stent, 6mmx","$8,174.00",$0.00,"$8,174.00","$3,678.30","$5,158.80",$0.00,"$1,408.34","$5,158.80","$5,833.78","$1,431.20","$8,174.00",$0.00,"$4,087.00","$6,473.81","$6,539.20",$0.00,"$1,279.23",$0.00,"$1,301.30",$0.00
27801078,EAP,HCPCS C1874,,"Covered Stent, 8mmx","$8,174.00",$0.00,"$8,174.00","$3,678.30","$5,158.80",$0.00,"$1,408.34","$5,158.80","$5,833.78","$1,431.20","$8,174.00",$0.00,"$4,087.00","$6,473.81","$6,539.20",$0.00,"$1,279.23",$0.00,"$1,301.30",$0.00
27801079,EAP,HCPCS C1874,,"Covered Stent, 9mmx","$8,174.00",$0.00,"$8,174.00","$3,678.30","$5,158.80",$0.00,"$1,408.34","$5,158.80","$5,833.78","$1,431.20","$8,174.00",$0.00,"$4,087.00","$6,473.81","$6,539.20",$0.00,"$1,279.23",$0.00,"$1,301.30",$0.00
27801080,EAP,HCPCS C1874,,"Covered Stent, 10mm","$8,174.00",$0.00,"$8,174.00","$3,678.30","$5,158.80",$0.00,"$1,408.34","$5,158.80","$5,833.78","$1,431.20","$8,174.00",$0.00,"$4,087.00","$6,473.81","$6,539.20",$0.00,"$1,279.23",$0.00,"$1,301.30",$0.00
27801081,EAP,HCPCS C1874,,"Covered Stent, 12mm","$18,351.00",$0.00,"$18,351.00","$8,257.95","$5,158.80",$0.00,"$3,161.79","$5,158.80","$13,097.11","$3,213.11","$18,351.00",$0.00,"$9,175.50","$14,533.99","$14,680.80",$0.00,"$2,871.93",$0.00,"$2,921.48",$0.00
27801082,EAP,HCPCS C1874,,Coil Complex Helica,"$1,287.00",$0.00,"$1,287.00",$579.15,$918.53,$0.00,$221.74,$918.53,$918.53,$225.34,"$1,287.00",$0.00,$643.50,"$1,019.30","$1,029.60",$0.00,$201.42,$0.00,$204.89,$0.00
27801083,EAP,HCPCS C1760,,Closure Device Vasc,"$5,062.00",$0.00,"$5,062.00","$2,277.90","$3,612.75",$0.00,$872.16,"$3,612.75","$3,612.75",$886.32,"$5,062.00",$0.00,"$2,531.00","$4,009.10","$4,049.60",$0.00,$792.20,$0.00,$805.87,$0.00
27801084,EAP,HCPCS C1876,,Zilver Stent 10x40,"$4,170.00",$0.00,"$4,170.00","$1,876.50","$2,976.13",$0.00,$718.47,"$2,976.13","$2,976.13",$730.13,"$4,170.00",$0.00,"$2,085.00","$3,302.64","$3,336.00",$0.00,$652.61,$0.00,$663.86,$0.00
27801085,EAP,HCPCS C1876,,Zilver Stent 10x30,"$4,170.00",$0.00,"$4,170.00","$1,876.50","$2,976.13",$0.00,$718.47,"$2,976.13","$2,976.13",$730.13,"$4,170.00",$0.00,"$2,085.00","$3,302.64","$3,336.00",$0.00,$652.61,$0.00,$663.86,$0.00
27801086,EAP,HCPCS C1876,,Zilver Stent 8x60,"$4,170.00",$0.00,"$4,170.00","$1,876.50","$2,976.13",$0.00,$718.47,"$2,976.13","$2,976.13",$730.13,"$4,170.00",$0.00,"$2,085.00","$3,302.64","$3,336.00",$0.00,$652.61,$0.00,$663.86,$0.00
27801087,EAP,HCPCS C1876,,Zilver Stent 8x40,"$4,170.00",$0.00,"$4,170.00","$1,876.50","$2,976.13",$0.00,$718.47,"$2,976.13","$2,976.13",$730.13,"$4,170.00",$0.00,"$2,085.00","$3,302.64","$3,336.00",$0.00,$652.61,$0.00,$663.86,$0.00
27801088,EAP,HCPCS C1876,,Zilver Stent 8x30,"$3,113.00",$0.00,"$3,113.00","$1,400.85","$2,221.75",$0.00,$536.35,"$2,221.75","$2,221.75",$545.06,"$3,113.00",$0.00,"$1,556.50","$2,465.50","$2,490.40",$0.00,$487.18,$0.00,$495.59,$0.00
27801089,EAP,HCPCS C1876,,Zilver Stent 7x40,"$4,170.00",$0.00,"$4,170.00","$1,876.50","$2,976.13",$0.00,$718.47,"$2,976.13","$2,976.13",$730.13,"$4,170.00",$0.00,"$2,085.00","$3,302.64","$3,336.00",$0.00,$652.61,$0.00,$663.86,$0.00
27801090,EAP,HCPCS C1876,,Zilver Stent 7x30,"$4,170.00",$0.00,"$4,170.00","$1,876.50","$2,976.13",$0.00,$718.47,"$2,976.13","$2,976.13",$730.13,"$4,170.00",$0.00,"$2,085.00","$3,302.64","$3,336.00",$0.00,$652.61,$0.00,$663.86,$0.00
27801091,EAP,HCPCS C1876,,Zilver Stent 6x40,"$4,170.00",$0.00,"$4,170.00","$1,876.50","$2,976.13",$0.00,$718.47,"$2,976.13","$2,976.13",$730.13,"$4,170.00",$0.00,"$2,085.00","$3,302.64","$3,336.00",$0.00,$652.61,$0.00,$663.86,$0.00
27801092,EAP,HCPCS C1876,,Zilver Stent 6x30,"$4,170.00",$0.00,"$4,170.00","$1,876.50","$2,976.13",$0.00,$718.47,"$2,976.13","$2,976.13",$730.13,"$4,170.00",$0.00,"$2,085.00","$3,302.64","$3,336.00",$0.00,$652.61,$0.00,$663.86,$0.00
27801093,EAP,HCPCS C1760,,Bmrang Cls Device5-,"$5,004.00",$0.00,"$5,004.00","$2,251.80","$3,571.35",$0.00,$862.16,"$3,571.35","$3,571.35",$876.16,"$5,004.00",$0.00,"$2,502.00","$3,963.17","$4,003.20",$0.00,$783.13,$0.00,$796.64,$0.00
27801094,EAP,HCPCS C1760,,Bmrang Cls Dvice 6-,$113.00,$0.00,$113.00,$50.85,$80.65,$0.00,$19.47,$80.65,$80.65,$19.79,$113.00,$0.00,$56.50,$89.50,$90.40,$0.00,$17.68,$0.00,$17.99,$0.00
27801095,EAP,HCPCS C1760,,6ft Proglide Closur,$863.00,$0.00,$863.00,$388.35,$615.92,$0.00,$148.69,$615.92,$615.92,$151.10,$863.00,$0.00,$431.50,$683.50,$690.40,$0.00,$135.06,$0.00,$137.39,$0.00
27801096,EAP,Custom 27801096,,Coil Microplex 18re,"$2,050.00",$0.00,"$2,050.00",$0.00,"$1,463.09",$0.00,$0.00,"$1,463.09","$1,463.09",$0.00,"$2,050.00",$0.00,"$1,025.00","$1,623.60","$1,640.00",$0.00,$0.00,$0.00,$0.00,$0.00
27801097,EAP,Custom 27801097,,Coil Microplex 18re,"$1,500.00",$0.00,"$1,500.00",$0.00,"$1,070.55",$0.00,$0.00,"$1,070.55","$1,070.55",$0.00,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
27801098,EAP,Custom 27801098,,Coil Microplex 18so,"$1,500.00",$0.00,"$1,500.00",$0.00,"$1,070.55",$0.00,$0.00,"$1,070.55","$1,070.55",$0.00,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
27801099,EAP,Custom 27801099,,Coil Microplex 18so,"$1,500.00",$0.00,"$1,500.00",$0.00,"$1,070.55",$0.00,$0.00,"$1,070.55","$1,070.55",$0.00,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
27801100,EAP,Custom 27801100,,Coil Microplex 18so,"$1,500.00",$0.00,"$1,500.00",$0.00,"$1,070.55",$0.00,$0.00,"$1,070.55","$1,070.55",$0.00,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
27801101,EAP,Custom 27801101,,Coil Microplex 18so,"$1,500.00",$0.00,"$1,500.00",$0.00,"$1,070.55",$0.00,$0.00,"$1,070.55","$1,070.55",$0.00,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
27801102,EAP,Custom 27801102,,Coil Microplex 18so,"$1,500.00",$0.00,"$1,500.00",$0.00,"$1,070.55",$0.00,$0.00,"$1,070.55","$1,070.55",$0.00,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
27801103,EAP,Custom 27801103,,Coil Microplex 18so,"$1,500.00",$0.00,"$1,500.00",$0.00,"$1,070.55",$0.00,$0.00,"$1,070.55","$1,070.55",$0.00,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
27801104,EAP,Custom 27801104,,"Coil, Trufill Pusha",$466.00,$0.00,$466.00,$0.00,$332.58,$0.00,$0.00,$332.58,$332.58,$0.00,$466.00,$0.00,$233.00,$369.07,$372.80,$0.00,$0.00,$0.00,$0.00,$0.00
27801105,EAP,Custom 27801105,,Coil Trufil Complx,$466.00,$0.00,$466.00,$0.00,$332.58,$0.00,$0.00,$332.58,$332.58,$0.00,$466.00,$0.00,$233.00,$369.07,$372.80,$0.00,$0.00,$0.00,$0.00,$0.00
27801106,EAP,Custom 27801106,,Coil Trufil Complex,$466.00,$0.00,$466.00,$0.00,$332.58,$0.00,$0.00,$332.58,$332.58,$0.00,$466.00,$0.00,$233.00,$369.07,$372.80,$0.00,$0.00,$0.00,$0.00,$0.00
27801107,EAP,Custom 27801107,,Coil Trufil Complex,$230.00,$0.00,$230.00,$0.00,$164.15,$0.00,$0.00,$164.15,$164.15,$0.00,$230.00,$0.00,$115.00,$182.16,$184.00,$0.00,$0.00,$0.00,$0.00,$0.00
27801108,EAP,Custom 27801108,,Coil Trufil Embolic,"$7,924.00",$0.00,"$7,924.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,655.36",$0.00,"$7,924.00",$0.00,"$3,962.00","$6,275.81","$6,339.20",$0.00,$0.00,$0.00,$0.00,$0.00
27801109,EAP,HCPCS C1874,,Wallstent Iliac Spv,"$8,767.00",$0.00,"$8,767.00","$3,945.15","$5,158.80",$0.00,"$1,510.51","$5,158.80","$6,257.01","$1,535.03","$8,767.00",$0.00,"$4,383.50","$6,943.46","$7,013.60",$0.00,"$1,372.04",$0.00,"$1,395.71",$0.00
27801110,EAP,HCPCS C1874,,"Stent, Biliary, Pal","$9,320.00",$0.00,"$9,320.00","$4,194.00","$5,158.80",$0.00,"$1,605.79","$5,158.80","$6,651.68","$1,631.86","$9,320.00",$0.00,"$4,660.00","$7,381.44","$7,456.00",$0.00,"$1,458.58",$0.00,"$1,483.74",$0.00
27801111,EAP,HCPCS C1874,,"Wallstent, Tracheob","$8,767.00",$0.00,"$8,767.00","$3,945.15","$5,158.80",$0.00,"$1,510.51","$5,158.80","$6,257.01","$1,535.03","$8,767.00",$0.00,"$4,383.50","$6,943.46","$7,013.60",$0.00,"$1,372.04",$0.00,"$1,395.71",$0.00
27801112,EAP,HCPCS C1874,,"Wallstent, Enteral","$8,767.00",$0.00,"$8,767.00","$3,945.15","$5,158.80",$0.00,"$1,510.51","$5,158.80","$6,257.01","$1,535.03","$8,767.00",$0.00,"$4,383.50","$6,943.46","$7,013.60",$0.00,"$1,372.04",$0.00,"$1,395.71",$0.00
27801113,EAP,HCPCS C1874,,Viatorr Sents 8mmx6,"$12,472.00",$0.00,"$12,472.00","$5,612.40","$5,158.80",$0.00,"$2,148.86","$5,158.80","$8,901.27","$2,183.75","$12,472.00",$0.00,"$6,236.00","$9,877.82","$9,977.60",$0.00,"$1,951.87",$0.00,"$1,985.54",$0.00
27801114,EAP,HCPCS C1874,,Viatorr Sents 8mmx7,"$16,213.00",$0.00,"$16,213.00","$7,295.85","$5,158.80",$0.00,"$2,793.42","$5,158.80","$11,571.22","$2,838.77","$16,213.00",$0.00,"$8,106.50","$12,840.70","$12,970.40",$0.00,"$2,537.33",$0.00,"$2,581.11",$0.00
27801115,EAP,HCPCS C1874,,Viatorr Sents 8mmx8,"$16,213.00",$0.00,"$16,213.00","$7,295.85","$5,158.80",$0.00,"$2,793.42","$5,158.80","$11,571.22","$2,838.77","$16,213.00",$0.00,"$8,106.50","$12,840.70","$12,970.40",$0.00,"$2,537.33",$0.00,"$2,581.11",$0.00
27801116,EAP,HCPCS C1874,,Viatorr Sents 10mmx,"$16,213.00",$0.00,"$16,213.00","$7,295.85","$5,158.80",$0.00,"$2,793.42","$5,158.80","$11,571.22","$2,838.77","$16,213.00",$0.00,"$8,106.50","$12,840.70","$12,970.40",$0.00,"$2,537.33",$0.00,"$2,581.11",$0.00
27801117,EAP,HCPCS C1874,,Viatorr Sents 10mmx,"$16,213.00",$0.00,"$16,213.00","$7,295.85","$5,158.80",$0.00,"$2,793.42","$5,158.80","$11,571.22","$2,838.77","$16,213.00",$0.00,"$8,106.50","$12,840.70","$12,970.40",$0.00,"$2,537.33",$0.00,"$2,581.11",$0.00
27801118,EAP,HCPCS C1874,,Viatorr Sents 10mmx,"$16,213.00",$0.00,"$16,213.00","$7,295.85","$5,158.80",$0.00,"$2,793.42","$5,158.80","$11,571.22","$2,838.77","$16,213.00",$0.00,"$8,106.50","$12,840.70","$12,970.40",$0.00,"$2,537.33",$0.00,"$2,581.11",$0.00
27801119,EAP,HCPCS C1874,,Viatorr Sents 10mmx,"$16,213.00",$0.00,"$16,213.00","$7,295.85","$5,158.80",$0.00,"$2,793.42","$5,158.80","$11,571.22","$2,838.77","$16,213.00",$0.00,"$8,106.50","$12,840.70","$12,970.40",$0.00,"$2,537.33",$0.00,"$2,581.11",$0.00
27801120,EAP,HCPCS C1874,,Viatorr Sents 10mmx,"$16,213.00",$0.00,"$16,213.00","$7,295.85","$5,158.80",$0.00,"$2,793.42","$5,158.80","$11,571.22","$2,838.77","$16,213.00",$0.00,"$8,106.50","$12,840.70","$12,970.40",$0.00,"$2,537.33",$0.00,"$2,581.11",$0.00
27801121,EAP,HCPCS C1874,,Viatorr Sents 12mmx,"$16,213.00",$0.00,"$16,213.00","$7,295.85","$5,158.80",$0.00,"$2,793.42","$5,158.80","$11,571.22","$2,838.77","$16,213.00",$0.00,"$8,106.50","$12,840.70","$12,970.40",$0.00,"$2,537.33",$0.00,"$2,581.11",$0.00
27801122,EAP,HCPCS C1874,,Viatorr Sents 12mmx,"$16,213.00",$0.00,"$16,213.00","$7,295.85","$5,158.80",$0.00,"$2,793.42","$5,158.80","$11,571.22","$2,838.77","$16,213.00",$0.00,"$8,106.50","$12,840.70","$12,970.40",$0.00,"$2,537.33",$0.00,"$2,581.11",$0.00
27801123,EAP,HCPCS C1874,,Viatorr Sents 12mmx,"$16,213.00",$0.00,"$16,213.00","$7,295.85","$5,158.80",$0.00,"$2,793.42","$5,158.80","$11,571.22","$2,838.77","$16,213.00",$0.00,"$8,106.50","$12,840.70","$12,970.40",$0.00,"$2,537.33",$0.00,"$2,581.11",$0.00
27801124,EAP,HCPCS C1874,,Viatorr Sents 8mmx4,"$15,988.00",$0.00,"$15,988.00","$7,194.60","$5,158.80",$0.00,"$2,754.65","$5,158.80","$11,410.64","$2,799.37","$15,988.00",$0.00,"$7,994.00","$12,662.50","$12,790.40",$0.00,"$2,502.12",$0.00,"$2,545.29",$0.00
27801125,EAP,HCPCS C1874,,Viatorr Sents 8mmx5,"$16,213.00",$0.00,"$16,213.00","$7,295.85","$5,158.80",$0.00,"$2,793.42","$5,158.80","$11,571.22","$2,838.77","$16,213.00",$0.00,"$8,106.50","$12,840.70","$12,970.40",$0.00,"$2,537.33",$0.00,"$2,581.11",$0.00
27801126,EAP,HCPCS C1876,,Wall Stent 18mmx40m,"$3,972.00",$0.00,"$3,972.00","$1,787.40","$2,834.82",$0.00,$684.36,"$2,834.82","$2,834.82",$695.47,"$3,972.00",$0.00,"$1,986.00","$3,145.82","$3,177.60",$0.00,$621.62,$0.00,$632.34,$0.00
27801127,EAP,HCPCS C1876,,Wall Stent 16mmx20m,"$3,918.00",$0.00,"$3,918.00","$1,763.10","$2,796.28",$0.00,$675.05,"$2,796.28","$2,796.28",$686.01,"$3,918.00",$0.00,"$1,959.00","$3,103.06","$3,134.40",$0.00,$613.17,$0.00,$623.75,$0.00
27801128,EAP,HCPCS C1874,,Viabhnend.cov.stent,"$15,609.00",$0.00,"$15,609.00","$7,024.05","$5,158.80",$0.00,"$2,689.35","$5,158.80","$11,140.14","$2,733.01","$15,609.00",$0.00,"$7,804.50","$12,362.33","$12,487.20",$0.00,"$2,442.81",$0.00,"$2,484.95",$0.00
27801129,EAP,HCPCS C1874,,Viabhnend.cov.stent,"$14,496.00",$0.00,"$14,496.00","$6,523.20","$5,158.80",$0.00,"$2,497.59","$5,158.80","$10,345.80","$2,538.13","$14,496.00",$0.00,"$7,248.00","$11,480.83","$11,596.80",$0.00,"$2,268.62",$0.00,"$2,307.76",$0.00
27801130,EAP,HCPCS C1874,,Viabhnend.cov.stent,"$17,381.00",$0.00,"$17,381.00","$7,821.45","$5,158.80",$0.00,"$2,994.66","$5,158.80","$12,404.82","$3,043.27","$17,381.00",$0.00,"$8,690.50","$13,765.75","$13,904.80",$0.00,"$2,720.13",$0.00,"$2,767.06",$0.00
27801131,EAP,HCPCS C1874,,Viabhnend.cov.stent,"$20,235.00",$0.00,"$20,235.00","$9,105.75","$5,158.80",$0.00,"$3,486.39","$5,158.80","$14,441.72","$3,542.99","$20,235.00",$0.00,"$10,117.50","$16,026.12","$16,188.00",$0.00,"$3,166.78",$0.00,"$3,221.41",$0.00
27801134,EAP,HCPCS C1874,,Percut(mmxcm)8x4cov,"$13,684.00",$0.00,"$13,684.00","$6,157.80","$5,158.80",$0.00,"$2,357.68","$5,158.80","$9,766.27","$2,395.96","$13,684.00",$0.00,"$6,842.00","$10,837.73","$10,947.20",$0.00,"$2,141.55",$0.00,"$2,178.49",$0.00
27801135,EAP,HCPCS C1874,,Percut(mmxcm)8x6cov,"$13,684.00",$0.00,"$13,684.00","$6,157.80","$5,158.80",$0.00,"$2,357.68","$5,158.80","$9,766.27","$2,395.96","$13,684.00",$0.00,"$6,842.00","$10,837.73","$10,947.20",$0.00,"$2,141.55",$0.00,"$2,178.49",$0.00
27801136,EAP,HCPCS C1874,,Percut(mmxcm)8x8cov,"$13,684.00",$0.00,"$13,684.00","$6,157.80","$5,158.80",$0.00,"$2,357.68","$5,158.80","$9,766.27","$2,395.96","$13,684.00",$0.00,"$6,842.00","$10,837.73","$10,947.20",$0.00,"$2,141.55",$0.00,"$2,178.49",$0.00
27801137,EAP,HCPCS C1874,,Percut(mmxcm)8x10co,"$13,684.00",$0.00,"$13,684.00","$6,157.80","$5,158.80",$0.00,"$2,357.68","$5,158.80","$9,766.27","$2,395.96","$13,684.00",$0.00,"$6,842.00","$10,837.73","$10,947.20",$0.00,"$2,141.55",$0.00,"$2,178.49",$0.00
27801138,EAP,HCPCS C1874,,Percut(mmxcm)10x4co,"$13,684.00",$0.00,"$13,684.00","$6,157.80","$5,158.80",$0.00,"$2,357.68","$5,158.80","$9,766.27","$2,395.96","$13,684.00",$0.00,"$6,842.00","$10,837.73","$10,947.20",$0.00,"$2,141.55",$0.00,"$2,178.49",$0.00
27801139,EAP,HCPCS C1874,,Percut(mmxcm)10x6 C,"$13,684.00",$0.00,"$13,684.00","$6,157.80","$5,158.80",$0.00,"$2,357.68","$5,158.80","$9,766.27","$2,395.96","$13,684.00",$0.00,"$6,842.00","$10,837.73","$10,947.20",$0.00,"$2,141.55",$0.00,"$2,178.49",$0.00
27801140,EAP,HCPCS C1875,,Percut(mmxcm)10x8 C,"$13,684.00",$0.00,"$13,684.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,766.27",$0.00,"$13,684.00",$0.00,"$6,842.00","$10,837.73","$10,947.20",$0.00,$0.00,$0.00,$0.00,$0.00
27801141,EAP,HCPCS C1874,,Percut(mmxcm)10x10,"$13,684.00",$0.00,"$13,684.00","$6,157.80","$5,158.80",$0.00,"$2,357.68","$5,158.80","$9,766.27","$2,395.96","$13,684.00",$0.00,"$6,842.00","$10,837.73","$10,947.20",$0.00,"$2,141.55",$0.00,"$2,178.49",$0.00
27801142,EAP,HCPCS C1874,,Percut(mmxcm)8x6unc,"$13,684.00",$0.00,"$13,684.00","$6,157.80","$5,158.80",$0.00,"$2,357.68","$5,158.80","$9,766.27","$2,395.96","$13,684.00",$0.00,"$6,842.00","$10,837.73","$10,947.20",$0.00,"$2,141.55",$0.00,"$2,178.49",$0.00
27801143,EAP,HCPCS C1874,,Percut(mmxcm)8x10un,"$13,684.00",$0.00,"$13,684.00","$6,157.80","$5,158.80",$0.00,"$2,357.68","$5,158.80","$9,766.27","$2,395.96","$13,684.00",$0.00,"$6,842.00","$10,837.73","$10,947.20",$0.00,"$2,141.55",$0.00,"$2,178.49",$0.00
27801144,EAP,HCPCS C1874,,Percut(mmxcm)10x6un,"$13,684.00",$0.00,"$13,684.00","$6,157.80","$5,158.80",$0.00,"$2,357.68","$5,158.80","$9,766.27","$2,395.96","$13,684.00",$0.00,"$6,842.00","$10,837.73","$10,947.20",$0.00,"$2,141.55",$0.00,"$2,178.49",$0.00
27801145,EAP,HCPCS C1874,,Percut(mmxcm)10x8un,"$13,684.00",$0.00,"$13,684.00","$6,157.80","$5,158.80",$0.00,"$2,357.68","$5,158.80","$9,766.27","$2,395.96","$13,684.00",$0.00,"$6,842.00","$10,837.73","$10,947.20",$0.00,"$2,141.55",$0.00,"$2,178.49",$0.00
27801146,EAP,HCPCS C1874,,Percut(mmxcm)10x10u,"$13,684.00",$0.00,"$13,684.00","$6,157.80","$5,158.80",$0.00,"$2,357.68","$5,158.80","$9,766.27","$2,395.96","$13,684.00",$0.00,"$6,842.00","$10,837.73","$10,947.20",$0.00,"$2,141.55",$0.00,"$2,178.49",$0.00
27801147,EAP,HCPCS C1874,,Endsc(mmxcm) 8x4 Co,"$12,810.00",$0.00,"$12,810.00","$5,764.50","$5,158.80",$0.00,"$2,207.10","$5,158.80","$9,142.50","$2,242.93","$12,810.00",$0.00,"$6,405.00","$10,145.52","$10,248.00",$0.00,"$2,004.77",$0.00,"$2,039.35",$0.00
27801148,EAP,HCPCS C1874,,Endsc(mmxcm) 8x6 Co,"$12,810.00",$0.00,"$12,810.00","$5,764.50","$5,158.80",$0.00,"$2,207.10","$5,158.80","$9,142.50","$2,242.93","$12,810.00",$0.00,"$6,405.00","$10,145.52","$10,248.00",$0.00,"$2,004.77",$0.00,"$2,039.35",$0.00
27801149,EAP,HCPCS C1874,,Endsc(mmxcm) 8x8 Co,"$12,810.00",$0.00,"$12,810.00","$5,764.50","$5,158.80",$0.00,"$2,207.10","$5,158.80","$9,142.50","$2,242.93","$12,810.00",$0.00,"$6,405.00","$10,145.52","$10,248.00",$0.00,"$2,004.77",$0.00,"$2,039.35",$0.00
27801150,EAP,HCPCS C1874,,Endsc(mmxcm) 8x10 C,"$12,810.00",$0.00,"$12,810.00","$5,764.50","$5,158.80",$0.00,"$2,207.10","$5,158.80","$9,142.50","$2,242.93","$12,810.00",$0.00,"$6,405.00","$10,145.52","$10,248.00",$0.00,"$2,004.77",$0.00,"$2,039.35",$0.00
27801151,EAP,HCPCS C1874,,Endsc(mmxcm) 10x4 C,"$12,902.00",$0.00,"$12,902.00","$5,805.90","$5,158.80",$0.00,"$2,222.95","$5,158.80","$9,208.16","$2,259.04","$12,902.00",$0.00,"$6,451.00","$10,218.38","$10,321.60",$0.00,"$2,019.16",$0.00,"$2,054.00",$0.00
27801152,EAP,HCPCS C1874,,Endsc (mmxcm) 10x6,"$12,810.00",$0.00,"$12,810.00","$5,764.50","$5,158.80",$0.00,"$2,207.10","$5,158.80","$9,142.50","$2,242.93","$12,810.00",$0.00,"$6,405.00","$10,145.52","$10,248.00",$0.00,"$2,004.77",$0.00,"$2,039.35",$0.00
27801153,EAP,HCPCS C1874,,Endsc(mmxcm) 10x8 C,"$12,810.00",$0.00,"$12,810.00","$5,764.50","$5,158.80",$0.00,"$2,207.10","$5,158.80","$9,142.50","$2,242.93","$12,810.00",$0.00,"$6,405.00","$10,145.52","$10,248.00",$0.00,"$2,004.77",$0.00,"$2,039.35",$0.00
27801154,EAP,HCPCS C1874,,Endsc(mmxcm)10x10 C,"$12,810.00",$0.00,"$12,810.00","$5,764.50","$5,158.80",$0.00,"$2,207.10","$5,158.80","$9,142.50","$2,242.93","$12,810.00",$0.00,"$6,405.00","$10,145.52","$10,248.00",$0.00,"$2,004.77",$0.00,"$2,039.35",$0.00
27801155,EAP,HCPCS C1874,,Endsc(mmxcm) 8x6 Un,"$12,810.00",$0.00,"$12,810.00","$5,764.50","$5,158.80",$0.00,"$2,207.10","$5,158.80","$9,142.50","$2,242.93","$12,810.00",$0.00,"$6,405.00","$10,145.52","$10,248.00",$0.00,"$2,004.77",$0.00,"$2,039.35",$0.00
27801156,EAP,HCPCS C1874,,Endsc(mmxcm) 8x8 Un,"$12,810.00",$0.00,"$12,810.00","$5,764.50","$5,158.80",$0.00,"$2,207.10","$5,158.80","$9,142.50","$2,242.93","$12,810.00",$0.00,"$6,405.00","$10,145.52","$10,248.00",$0.00,"$2,004.77",$0.00,"$2,039.35",$0.00
27801157,EAP,HCPCS C1874,,Endsc(mmxcm)8x10 Un,"$12,810.00",$0.00,"$12,810.00","$5,764.50","$5,158.80",$0.00,"$2,207.10","$5,158.80","$9,142.50","$2,242.93","$12,810.00",$0.00,"$6,405.00","$10,145.52","$10,248.00",$0.00,"$2,004.77",$0.00,"$2,039.35",$0.00
27801158,EAP,HCPCS C1874,,Endsc(mmxcm)10x6 Un,"$12,810.00",$0.00,"$12,810.00","$5,764.50","$5,158.80",$0.00,"$2,207.10","$5,158.80","$9,142.50","$2,242.93","$12,810.00",$0.00,"$6,405.00","$10,145.52","$10,248.00",$0.00,"$2,004.77",$0.00,"$2,039.35",$0.00
27801159,EAP,HCPCS C1874,,Endsc(mmxcm)10x8 Un,"$12,810.00",$0.00,"$12,810.00","$5,764.50","$5,158.80",$0.00,"$2,207.10","$5,158.80","$9,142.50","$2,242.93","$12,810.00",$0.00,"$6,405.00","$10,145.52","$10,248.00",$0.00,"$2,004.77",$0.00,"$2,039.35",$0.00
27801160,EAP,HCPCS C1874,,Endsc(mmxcm)10x10un,"$12,810.00",$0.00,"$12,810.00","$5,764.50","$5,158.80",$0.00,"$2,207.10","$5,158.80","$9,142.50","$2,242.93","$12,810.00",$0.00,"$6,405.00","$10,145.52","$10,248.00",$0.00,"$2,004.77",$0.00,"$2,039.35",$0.00
27801161,EAP,HCPCS C1874,,"Stent,iliac,wallste","$6,980.00",$0.00,"$6,980.00","$3,141.00","$4,981.63",$0.00,"$1,202.62","$4,981.63","$4,981.63","$1,222.14","$6,980.00",$0.00,"$3,490.00","$5,528.16","$5,584.00",$0.00,"$1,092.37",$0.00,"$1,111.22",$0.00
27801162,EAP,HCPCS C1880,,Vena Cava Filter,"$4,656.00",$0.00,"$4,656.00","$2,095.20","$3,322.99",$0.00,$802.21,"$3,322.99","$3,322.99",$815.23,"$4,656.00",$0.00,"$2,328.00","$3,687.55","$3,724.80",$0.00,$728.66,$0.00,$741.24,$0.00
27801163,EAP,HCPCS C1874,,"Ste.,bil Memmotherm","$6,980.00",$0.00,"$6,980.00","$3,141.00","$4,981.63",$0.00,"$1,202.62","$4,981.63","$4,981.63","$1,222.14","$6,980.00",$0.00,"$3,490.00","$5,528.16","$5,584.00",$0.00,"$1,092.37",$0.00,"$1,111.22",$0.00
27801164,EAP,HCPCS C1874,,"Ste.,bil Wallstent,","$5,991.00",$0.00,"$5,991.00","$2,695.95","$4,275.78",$0.00,"$1,032.22","$4,275.78","$4,275.78","$1,048.98","$5,991.00",$0.00,"$2,995.50","$4,744.87","$4,792.80",$0.00,$937.59,$0.00,$953.77,$0.00
27801165,EAP,HCPCS C1874,,"Ste,bil W/s Rp-20,4","$5,991.00",$0.00,"$5,991.00","$2,695.95","$4,275.78",$0.00,"$1,032.22","$4,275.78","$4,275.78","$1,048.98","$5,991.00",$0.00,"$2,995.50","$4,744.87","$4,792.80",$0.00,$937.59,$0.00,$953.77,$0.00
27801166,EAP,HCPCS C1874,,"Ste.,bil Wallstent","$10,078.00",$0.00,"$10,078.00","$4,535.10","$5,158.80",$0.00,"$1,736.39","$5,158.80","$7,192.67","$1,764.58","$10,078.00",$0.00,"$5,039.00","$7,981.78","$8,062.40",$0.00,"$1,577.21",$0.00,"$1,604.42",$0.00
27801167,EAP,HCPCS C1874,,"Ste.,ent W/stent,un","$10,078.00",$0.00,"$10,078.00","$4,535.10","$5,158.80",$0.00,"$1,736.39","$5,158.80","$7,192.67","$1,764.58","$10,078.00",$0.00,"$5,039.00","$7,981.78","$8,062.40",$0.00,"$1,577.21",$0.00,"$1,604.42",$0.00
27801168,EAP,HCPCS C1874,,"St.,wallgraft Unist","$11,656.00",$0.00,"$11,656.00","$5,245.20","$5,158.80",$0.00,"$2,008.27","$5,158.80","$8,318.89","$2,040.87","$11,656.00",$0.00,"$5,828.00","$9,231.55","$9,324.80",$0.00,"$1,824.16",$0.00,"$1,855.64",$0.00
27801169,EAP,HCPCS C1874,,"Ste., W/g Unistep-2","$11,656.00",$0.00,"$11,656.00","$5,245.20","$5,158.80",$0.00,"$2,008.27","$5,158.80","$8,318.89","$2,040.87","$11,656.00",$0.00,"$5,828.00","$9,231.55","$9,324.80",$0.00,"$1,824.16",$0.00,"$1,855.64",$0.00
27801170,EAP,HCPCS L8670,,Aortic Ext Endopros,"$10,150.00",$0.00,"$10,150.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$7,244.06",$0.00,"$10,150.00",$0.00,"$5,075.00","$8,038.80","$8,120.00",$0.00,$0.00,$0.00,$0.00,$0.00
27801171,EAP,Custom 27801171,,Pfo Implant,"$24,270.00",$0.00,"$24,270.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$17,321.50",$0.00,"$24,270.00",$0.00,"$12,135.00","$19,221.84","$19,416.00",$0.00,$0.00,$0.00,$0.00,$0.00
27801172,EAP,Custom 27801172,,Asd Implant,"$14,800.00",$0.00,"$14,800.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$10,562.76",$0.00,"$14,800.00",$0.00,"$7,400.00","$11,721.60","$11,840.00",$0.00,$0.00,$0.00,$0.00,$0.00
27801173,EAP,HCPCS C1760,,"Closure Device, Vas","$1,363.00",$0.00,"$1,363.00",$613.35,$972.77,$0.00,$234.84,$972.77,$972.77,$238.65,"$1,363.00",$0.00,$681.50,"$1,079.50","$1,090.40",$0.00,$213.31,$0.00,$216.99,$0.00
27801190,EAP,HCPCS C1876,,3.0x8mm Vision Rx S,"$2,920.00",$0.00,"$2,920.00","$1,314.00","$2,084.00",$0.00,$503.10,"$2,084.00","$2,084.00",$511.27,"$2,920.00",$0.00,"$1,460.00","$2,312.64","$2,336.00",$0.00,$456.98,$0.00,$464.86,$0.00
27801191,EAP,HCPCS C1876,,3.5x8mm Vision Rx S,"$3,836.00",$0.00,"$3,836.00","$1,726.20","$2,737.75",$0.00,$660.92,"$2,737.75","$2,737.75",$671.65,"$3,836.00",$0.00,"$1,918.00","$3,038.11","$3,068.80",$0.00,$600.33,$0.00,$610.69,$0.00
27801192,EAP,HCPCS C1876,,4.0x8mm Vision Rx S,"$3,836.00",$0.00,"$3,836.00","$1,726.20","$2,737.75",$0.00,$660.92,"$2,737.75","$2,737.75",$671.65,"$3,836.00",$0.00,"$1,918.00","$3,038.11","$3,068.80",$0.00,$600.33,$0.00,$610.69,$0.00
27801193,EAP,HCPCS C1876,,3.0x12mm Vision Rx,"$3,836.00",$0.00,"$3,836.00","$1,726.20","$2,737.75",$0.00,$660.92,"$2,737.75","$2,737.75",$671.65,"$3,836.00",$0.00,"$1,918.00","$3,038.11","$3,068.80",$0.00,$600.33,$0.00,$610.69,$0.00
27801194,EAP,HCPCS C1876,,3.5x12mm Vision Rx,"$2,920.00",$0.00,"$2,920.00","$1,314.00","$2,084.00",$0.00,$503.10,"$2,084.00","$2,084.00",$511.27,"$2,920.00",$0.00,"$1,460.00","$2,312.64","$2,336.00",$0.00,$456.98,$0.00,$464.86,$0.00
27801195,EAP,HCPCS C1876,,4.0x12mm Vision Rx,"$3,836.00",$0.00,"$3,836.00","$1,726.20","$2,737.75",$0.00,$660.92,"$2,737.75","$2,737.75",$671.65,"$3,836.00",$0.00,"$1,918.00","$3,038.11","$3,068.80",$0.00,$600.33,$0.00,$610.69,$0.00
27801196,EAP,HCPCS C1876,,3.0x15mm Vision Rx,"$2,920.00",$0.00,"$2,920.00","$1,314.00","$2,084.00",$0.00,$503.10,"$2,084.00","$2,084.00",$511.27,"$2,920.00",$0.00,"$1,460.00","$2,312.64","$2,336.00",$0.00,$456.98,$0.00,$464.86,$0.00
27801197,EAP,HCPCS C1876,,3.5x15mm Vision Rx,"$2,920.00",$0.00,"$2,920.00","$1,314.00","$2,084.00",$0.00,$503.10,"$2,084.00","$2,084.00",$511.27,"$2,920.00",$0.00,"$1,460.00","$2,312.64","$2,336.00",$0.00,$456.98,$0.00,$464.86,$0.00
27801198,EAP,HCPCS C1876,,4.0x15mm Vision Rx,"$2,920.00",$0.00,"$2,920.00","$1,314.00","$2,084.00",$0.00,$503.10,"$2,084.00","$2,084.00",$511.27,"$2,920.00",$0.00,"$1,460.00","$2,312.64","$2,336.00",$0.00,$456.98,$0.00,$464.86,$0.00
27801199,EAP,HCPCS C1876,,3.0x18mm Vision Rx,"$2,920.00",$0.00,"$2,920.00","$1,314.00","$2,084.00",$0.00,$503.10,"$2,084.00","$2,084.00",$511.27,"$2,920.00",$0.00,"$1,460.00","$2,312.64","$2,336.00",$0.00,$456.98,$0.00,$464.86,$0.00
27801200,EAP,HCPCS C1876,,3.5x18mm Vision Rx,"$3,836.00",$0.00,"$3,836.00","$1,726.20","$2,737.75",$0.00,$660.92,"$2,737.75","$2,737.75",$671.65,"$3,836.00",$0.00,"$1,918.00","$3,038.11","$3,068.80",$0.00,$600.33,$0.00,$610.69,$0.00
27801201,EAP,HCPCS C1876,,4.0x18mm Vision Rx,"$3,836.00",$0.00,"$3,836.00","$1,726.20","$2,737.75",$0.00,$660.92,"$2,737.75","$2,737.75",$671.65,"$3,836.00",$0.00,"$1,918.00","$3,038.11","$3,068.80",$0.00,$600.33,$0.00,$610.69,$0.00
27801202,EAP,HCPCS C1874,,3.0x23mm Vision Rx,"$3,836.00",$0.00,"$3,836.00","$1,726.20","$2,737.75",$0.00,$660.92,"$2,737.75","$2,737.75",$671.65,"$3,836.00",$0.00,"$1,918.00","$3,038.11","$3,068.80",$0.00,$600.33,$0.00,$610.69,$0.00
27801203,EAP,HCPCS C1876,,3.5x23mm Vision Rx,"$3,836.00",$0.00,"$3,836.00","$1,726.20","$2,737.75",$0.00,$660.92,"$2,737.75","$2,737.75",$671.65,"$3,836.00",$0.00,"$1,918.00","$3,038.11","$3,068.80",$0.00,$600.33,$0.00,$610.69,$0.00
27801204,EAP,HCPCS C1876,,4.0x23mm Vision Rx,"$3,836.00",$0.00,"$3,836.00","$1,726.20","$2,737.75",$0.00,$660.92,"$2,737.75","$2,737.75",$671.65,"$3,836.00",$0.00,"$1,918.00","$3,038.11","$3,068.80",$0.00,$600.33,$0.00,$610.69,$0.00
27801205,EAP,HCPCS C1876,,3.0x28mm Vision Rx,"$2,920.00",$0.00,"$2,920.00","$1,314.00","$2,084.00",$0.00,$503.10,"$2,084.00","$2,084.00",$511.27,"$2,920.00",$0.00,"$1,460.00","$2,312.64","$2,336.00",$0.00,$456.98,$0.00,$464.86,$0.00
27801206,EAP,HCPCS C1876,,3.5x28mm Vision Rx,"$3,836.00",$0.00,"$3,836.00","$1,726.20","$2,737.75",$0.00,$660.92,"$2,737.75","$2,737.75",$671.65,"$3,836.00",$0.00,"$1,918.00","$3,038.11","$3,068.80",$0.00,$600.33,$0.00,$610.69,$0.00
27801207,EAP,HCPCS C1876,,4.0x28mm Vision Rx,"$3,836.00",$0.00,"$3,836.00","$1,726.20","$2,737.75",$0.00,$660.92,"$2,737.75","$2,737.75",$671.65,"$3,836.00",$0.00,"$1,918.00","$3,038.11","$3,068.80",$0.00,$600.33,$0.00,$610.69,$0.00
27801214,EAP,HCPCS C1874,,3.0 X 12mm Graftmas,"$17,938.00",$0.00,"$17,938.00","$8,072.10","$5,158.80",$0.00,"$3,090.63","$5,158.80","$12,802.35","$3,140.80","$17,938.00",$0.00,"$8,969.00","$14,206.90","$14,350.40",$0.00,"$2,807.30",$0.00,"$2,855.73",$0.00
27801215,EAP,HCPCS C1876,,2.50 X 8mm Mini-vis,"$3,836.00",$0.00,"$3,836.00","$1,726.20","$2,737.75",$0.00,$660.92,"$2,737.75","$2,737.75",$671.65,"$3,836.00",$0.00,"$1,918.00","$3,038.11","$3,068.80",$0.00,$600.33,$0.00,$610.69,$0.00
27801216,EAP,HCPCS C1876,,2.50 X 12 Mm Mini V,"$2,920.00",$0.00,"$2,920.00","$1,314.00","$2,084.00",$0.00,$503.10,"$2,084.00","$2,084.00",$511.27,"$2,920.00",$0.00,"$1,460.00","$2,312.64","$2,336.00",$0.00,$456.98,$0.00,$464.86,$0.00
27801217,EAP,HCPCS C1876,,2.5 X 15mm Mini-vis,"$2,920.00",$0.00,"$2,920.00","$1,314.00","$2,084.00",$0.00,$503.10,"$2,084.00","$2,084.00",$511.27,"$2,920.00",$0.00,"$1,460.00","$2,312.64","$2,336.00",$0.00,$456.98,$0.00,$464.86,$0.00
27801218,EAP,HCPCS C1876,,2.5 X 18mm Mini-vis,"$3,836.00",$0.00,"$3,836.00","$1,726.20","$2,737.75",$0.00,$660.92,"$2,737.75","$2,737.75",$671.65,"$3,836.00",$0.00,"$1,918.00","$3,038.11","$3,068.80",$0.00,$600.33,$0.00,$610.69,$0.00
27801219,EAP,HCPCS C1876,,205 X 23mm Mini-vis,"$7,782.00",$0.00,"$7,782.00","$3,501.90","$5,158.80",$0.00,"$1,340.80","$5,158.80","$5,554.01","$1,362.57","$7,782.00",$0.00,"$3,891.00","$6,163.34","$6,225.60",$0.00,"$1,217.88",$0.00,"$1,238.89",$0.00
27801220,EAP,HCPCS C1876,,2.5 X 28mm Mini-vis,"$2,920.00",$0.00,"$2,920.00","$1,314.00","$2,084.00",$0.00,$503.10,"$2,084.00","$2,084.00",$511.27,"$2,920.00",$0.00,"$1,460.00","$2,312.64","$2,336.00",$0.00,$456.98,$0.00,$464.86,$0.00
27801221,EAP,HCPCS C1874,,3.0 X 12 Graftmaste,"$17,938.00",$0.00,"$17,938.00","$8,072.10","$5,158.80",$0.00,"$3,090.63","$5,158.80","$12,802.35","$3,140.80","$17,938.00",$0.00,"$8,969.00","$14,206.90","$14,350.40",$0.00,"$2,807.30",$0.00,"$2,855.73",$0.00
27801222,EAP,HCPCS C1722,,Lumax 340 Vr Icd Sy,"$49,886.00",$0.00,"$49,886.00","$22,448.70","$5,158.80",$0.00,"$8,138.89","$5,158.80","$35,603.64","$8,138.89","$49,886.00",$0.00,"$24,943.00","$39,509.71","$39,908.80",$0.00,"$7,751.33",$0.00,"$7,941.85",$0.00
27801223,EAP,HCPCS C1721,,Intrinsic Dr Dual I,"$10,215.00",$0.00,"$10,215.00","$4,596.75","$5,158.80",$0.00,"$1,759.99","$5,158.80","$7,290.45","$1,788.56","$10,215.00",$0.00,"$5,107.50","$8,090.28","$8,172.00",$0.00,"$1,598.65",$0.00,"$1,626.23",$0.00
27801224,EAP,HCPCS C1721,,Gem Iii Dr Dual Icd,"$3,890.00",$0.00,"$3,890.00","$1,750.50","$2,776.29",$0.00,$670.23,"$2,776.29","$2,776.29",$681.11,"$3,890.00",$0.00,"$1,945.00","$3,080.88","$3,112.00",$0.00,$608.79,$0.00,$619.29,$0.00
27801225,EAP,HCPCS C1722,,Gem Iii Vr Single I,"$11,351.00",$0.00,"$11,351.00","$5,107.95","$5,158.80",$0.00,"$1,955.72","$5,158.80","$8,101.21","$1,987.47","$11,351.00",$0.00,"$5,675.50","$8,989.99","$9,080.80",$0.00,"$1,776.43",$0.00,"$1,807.08",$0.00
27801226,EAP,HCPCS C1721,,Confient He Dual Ic,"$15,364.00",$0.00,"$15,364.00","$6,913.80","$5,158.80",$0.00,"$2,647.14","$5,158.80","$10,965.29","$2,690.11","$15,364.00",$0.00,"$7,682.00","$12,168.29","$12,291.20",$0.00,"$2,404.47",$0.00,"$2,445.95",$0.00
27801227,EAP,HCPCS C1760,,Angioseal Vasc Clos,"$1,906.00",$0.00,"$1,906.00",$857.70,"$1,360.31",$0.00,$328.39,"$1,360.31","$1,360.31",$333.73,"$1,906.00",$0.00,$953.00,"$1,509.55","$1,524.80",$0.00,$298.29,$0.00,$303.44,$0.00
27801228,EAP,HCPCS C1898,,Setrox S Lead,"$2,869.00",$0.00,"$2,869.00","$1,291.05","$2,047.61",$0.00,$494.31,"$2,047.61","$2,047.61",$502.34,"$2,869.00",$0.00,"$1,434.50","$2,272.25","$2,295.20",$0.00,$449.00,$0.00,$456.74,$0.00
27801229,EAP,HCPCS C1898,,Selox Sr Lead,"$2,681.00",$0.00,"$2,681.00","$1,206.45","$1,913.43",$0.00,$461.92,"$1,913.43","$1,913.43",$469.42,"$2,681.00",$0.00,"$1,340.50","$2,123.35","$2,144.80",$0.00,$419.58,$0.00,$426.82,$0.00
27801230,EAP,HCPCS C1722,,Ovatio Vr Single Ic,"$14,505.00",$0.00,"$14,505.00","$6,527.25","$5,158.80",$0.00,"$2,499.14","$5,158.80","$10,352.22","$2,539.71","$14,505.00",$0.00,"$7,252.50","$11,487.96","$11,604.00",$0.00,"$2,270.03",$0.00,"$2,309.20",$0.00
27801231,EAP,HCPCS C1721,,Ovatio Dr Dual Icd,"$61,398.00",$0.00,"$61,398.00","$27,629.10","$5,158.80",$0.00,"$8,138.89","$5,158.80","$43,819.75","$8,138.89","$61,398.00",$0.00,"$30,699.00","$48,627.22","$49,118.40",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27801232,EAP,HCPCS C1721,,Vitality 2 El Dr Du,"$19,454.00",$0.00,"$19,454.00","$8,754.30","$5,158.80",$0.00,"$3,351.83","$5,158.80","$13,884.32","$3,406.24","$19,454.00",$0.00,"$9,727.00","$15,407.57","$15,563.20",$0.00,"$3,044.55",$0.00,"$3,097.08",$0.00
27801233,EAP,HCPCS C1721,,Vitality 2 Dr Dual,"$12,969.00",$0.00,"$12,969.00","$5,836.05","$5,158.80",$0.00,"$2,234.49","$5,158.80","$9,255.98","$2,270.77","$12,969.00",$0.00,"$6,484.50","$10,271.45","$10,375.20",$0.00,"$2,029.65",$0.00,"$2,064.66",$0.00
27801234,EAP,HCPCS C1721,,Vitality Avt Dr Dua,"$19,454.00",$0.00,"$19,454.00","$8,754.30","$5,158.80",$0.00,"$3,351.83","$5,158.80","$13,884.32","$3,406.24","$19,454.00",$0.00,"$9,727.00","$15,407.57","$15,563.20",$0.00,"$3,044.55",$0.00,"$3,097.08",$0.00
27801235,EAP,HCPCS C1721,,Vitality He Dual Ic,"$3,369.00",$0.00,"$3,369.00","$1,516.05","$2,404.46",$0.00,$580.46,"$2,404.46","$2,404.46",$589.88,"$3,369.00",$0.00,"$1,684.50","$2,668.25","$2,695.20",$0.00,$527.25,$0.00,$536.34,$0.00
27801236,EAP,HCPCS C1721,,Vitality El Dual Ic,"$3,243.00",$0.00,"$3,243.00","$1,459.35","$2,314.53",$0.00,$558.75,"$2,314.53","$2,314.53",$567.82,"$3,243.00",$0.00,"$1,621.50","$2,568.46","$2,594.40",$0.00,$507.53,$0.00,$516.29,$0.00
27801237,EAP,HCPCS C1721,,Vitality Ds Dr Dual,"$79,815.00",$0.00,"$79,815.00","$35,916.75","$5,158.80",$0.00,"$8,138.89","$5,158.80","$56,963.97","$8,138.89","$79,815.00",$0.00,"$39,907.50","$63,213.48","$63,852.00",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27801238,EAP,HCPCS C1722,,Vitality 2 El Vr Sn,"$3,243.00",$0.00,"$3,243.00","$1,459.35","$2,314.53",$0.00,$558.75,"$2,314.53","$2,314.53",$567.82,"$3,243.00",$0.00,"$1,621.50","$2,568.46","$2,594.40",$0.00,$507.53,$0.00,$516.29,$0.00
27801239,EAP,HCPCS C1722,,Vitality 2 Vr Sngl,"$79,815.00",$0.00,"$79,815.00","$35,916.75","$5,158.80",$0.00,"$8,138.89","$5,158.80","$56,963.97","$8,138.89","$79,815.00",$0.00,"$39,907.50","$63,213.48","$63,852.00",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27801240,EAP,HCPCS C1722,,Vitality Ds Vr Sngl,"$16,836.00",$0.00,"$16,836.00","$7,576.20","$5,158.80",$0.00,"$2,900.76","$5,158.80","$12,015.85","$2,947.85","$16,836.00",$0.00,"$8,418.00","$13,334.11","$13,468.80",$0.00,"$2,634.83",$0.00,"$2,680.29",$0.00
27801241,EAP,HCPCS C1895,,Reliance G Active F,"$9,730.00",$0.00,"$9,730.00","$4,378.50","$5,158.80",$0.00,"$1,676.43","$5,158.80","$6,944.30","$1,703.65","$9,730.00",$0.00,"$4,865.00","$7,706.16","$7,784.00",$0.00,"$1,522.75",$0.00,"$1,549.02",$0.00
27801242,EAP,HCPCS C1895,,Reliance G Active F,"$10,102.00",$0.00,"$10,102.00","$4,545.90","$5,158.80",$0.00,"$1,740.52","$5,158.80","$7,209.80","$1,768.78","$10,102.00",$0.00,"$5,051.00","$8,000.78","$8,081.60",$0.00,"$1,580.96",$0.00,"$1,608.24",$0.00
27801243,EAP,HCPCS C1895,,Reliance G Passive,"$9,730.00",$0.00,"$9,730.00","$4,378.50","$5,158.80",$0.00,"$1,676.43","$5,158.80","$6,944.30","$1,703.65","$9,730.00",$0.00,"$4,865.00","$7,706.16","$7,784.00",$0.00,"$1,522.75",$0.00,"$1,549.02",$0.00
27801244,EAP,HCPCS C1895,,Reliance G Passive,"$9,730.00",$0.00,"$9,730.00","$4,378.50","$5,158.80",$0.00,"$1,676.43","$5,158.80","$6,944.30","$1,703.65","$9,730.00",$0.00,"$4,865.00","$7,706.16","$7,784.00",$0.00,"$1,522.75",$0.00,"$1,549.02",$0.00
27801245,EAP,HCPCS C1895,,Reliance Active Fix,"$6,985.00",$0.00,"$6,985.00","$3,143.25","$4,985.19",$0.00,"$1,203.48","$4,985.19","$4,985.19","$1,223.02","$6,985.00",$0.00,"$3,492.50","$5,532.12","$5,588.00",$0.00,"$1,093.15",$0.00,"$1,112.01",$0.00
27801246,EAP,HCPCS C1895,,Reliance Active Fix,"$7,253.00",$0.00,"$7,253.00","$3,263.85","$5,158.80",$0.00,"$1,249.66","$5,158.80","$5,176.47","$1,269.94","$7,253.00",$0.00,"$3,626.50","$5,744.38","$5,802.40",$0.00,"$1,135.09",$0.00,"$1,154.68",$0.00
27801247,EAP,HCPCS C1895,,Reliance Passive Fi,"$9,730.00",$0.00,"$9,730.00","$4,378.50","$5,158.80",$0.00,"$1,676.43","$5,158.80","$6,944.30","$1,703.65","$9,730.00",$0.00,"$4,865.00","$7,706.16","$7,784.00",$0.00,"$1,522.75",$0.00,"$1,549.02",$0.00
27801248,EAP,HCPCS C1895,,Reliance Passive Fi,"$9,730.00",$0.00,"$9,730.00","$4,378.50","$5,158.80",$0.00,"$1,676.43","$5,158.80","$6,944.30","$1,703.65","$9,730.00",$0.00,"$4,865.00","$7,706.16","$7,784.00",$0.00,"$1,522.75",$0.00,"$1,549.02",$0.00
27801249,EAP,HCPCS C1721,,Atlas Dr Dual Icd,"$9,730.00",$0.00,"$9,730.00","$4,378.50","$5,158.80",$0.00,"$1,676.43","$5,158.80","$6,944.30","$1,703.65","$9,730.00",$0.00,"$4,865.00","$7,706.16","$7,784.00",$0.00,"$1,522.75",$0.00,"$1,549.02",$0.00
27801250,EAP,HCPCS C1895,,Riata Dual Coil Lea,"$17,833.00",$0.00,"$17,833.00","$8,024.85","$5,158.80",$0.00,"$3,072.54","$5,158.80","$12,727.41","$3,122.42","$17,833.00",$0.00,"$8,916.50","$14,123.74","$14,266.40",$0.00,"$2,790.86",$0.00,"$2,839.01",$0.00
27801251,EAP,HCPCS C1895,,Riata Dual Coil Lea,"$17,833.00",$0.00,"$17,833.00","$8,024.85","$5,158.80",$0.00,"$3,072.54","$5,158.80","$12,727.41","$3,122.42","$17,833.00",$0.00,"$8,916.50","$14,123.74","$14,266.40",$0.00,"$2,790.86",$0.00,"$2,839.01",$0.00
27801252,EAP,HCPCS C1895,,Riata I Dual Coil L,"$17,833.00",$0.00,"$17,833.00","$8,024.85","$5,158.80",$0.00,"$3,072.54","$5,158.80","$12,727.41","$3,122.42","$17,833.00",$0.00,"$8,916.50","$14,123.74","$14,266.40",$0.00,"$2,790.86",$0.00,"$2,839.01",$0.00
27801253,EAP,HCPCS C1895,,Riata Single Coil L,"$17,833.00",$0.00,"$17,833.00","$8,024.85","$5,158.80",$0.00,"$3,072.54","$5,158.80","$12,727.41","$3,122.42","$17,833.00",$0.00,"$8,916.50","$14,123.74","$14,266.40",$0.00,"$2,790.86",$0.00,"$2,839.01",$0.00
27801254,EAP,HCPCS C1895,,Riata Single Coil L,"$17,833.00",$0.00,"$17,833.00","$8,024.85","$5,158.80",$0.00,"$3,072.54","$5,158.80","$12,727.41","$3,122.42","$17,833.00",$0.00,"$8,916.50","$14,123.74","$14,266.40",$0.00,"$2,790.86",$0.00,"$2,839.01",$0.00
27801255,EAP,HCPCS C1895,,Riata St Dual Coil,"$13,714.00",$0.00,"$13,714.00","$6,171.30","$5,158.80",$0.00,"$2,362.85","$5,158.80","$9,787.68","$2,401.21","$13,714.00",$0.00,"$6,857.00","$10,861.49","$10,971.20",$0.00,"$2,146.24",$0.00,"$2,183.27",$0.00
27801256,EAP,HCPCS C1895,,Riata St Sngl Coil,"$11,221.00",$0.00,"$11,221.00","$5,049.45","$5,158.80",$0.00,"$1,933.32","$5,158.80","$8,008.43","$1,964.71","$11,221.00",$0.00,"$5,610.50","$8,887.03","$8,976.80",$0.00,"$1,756.09",$0.00,"$1,786.38",$0.00
27801257,EAP,HCPCS C1895,,Spl Leads,"$5,189.00",$0.00,"$5,189.00","$2,335.05","$3,703.39",$0.00,$894.04,"$3,703.39","$3,703.39",$908.55,"$5,189.00",$0.00,"$2,594.50","$4,109.69","$4,151.20",$0.00,$812.08,$0.00,$826.09,$0.00
27801258,EAP,HCPCS C1895,,Tvl-adx Leads,"$5,189.00",$0.00,"$5,189.00","$2,335.05","$3,703.39",$0.00,$894.04,"$3,703.39","$3,703.39",$908.55,"$5,189.00",$0.00,"$2,594.50","$4,109.69","$4,151.20",$0.00,$812.08,$0.00,$826.09,$0.00
27801259,EAP,HCPCS C1895,,Bipolar Endocard Pa,"$2,792.00",$0.00,"$2,792.00","$1,256.40","$1,992.65",$0.00,$481.05,"$1,992.65","$1,992.65",$488.86,"$2,792.00",$0.00,"$1,396.00","$2,211.26","$2,233.60",$0.00,$436.95,$0.00,$444.49,$0.00
27801260,EAP,HCPCS C1721,,Lumax 300 Dr-t Dual,"$3,243.00",$0.00,"$3,243.00","$1,459.35","$2,314.53",$0.00,$558.75,"$2,314.53","$2,314.53",$567.82,"$3,243.00",$0.00,"$1,621.50","$2,568.46","$2,594.40",$0.00,$507.53,$0.00,$516.29,$0.00
27801261,EAP,HCPCS C1722,,Lumax 300 Vr-t Sing,"$15,437.00",$0.00,"$15,437.00","$6,946.65","$5,158.80",$0.00,"$2,659.72","$5,158.80","$11,017.39","$2,702.90","$15,437.00",$0.00,"$7,718.50","$12,226.10","$12,349.60",$0.00,"$2,415.89",$0.00,"$2,457.57",$0.00
27801262,EAP,HCPCS C1895,,Riata Lead,"$14,592.00",$0.00,"$14,592.00","$6,566.40","$5,158.80",$0.00,"$2,514.13","$5,158.80","$10,414.31","$2,554.94","$14,592.00",$0.00,"$7,296.00","$11,556.86","$11,673.60",$0.00,"$2,283.65",$0.00,"$2,323.05",$0.00
27801263,EAP,HCPCS C1895,,Riata St Lead,"$14,592.00",$0.00,"$14,592.00","$6,566.40","$5,158.80",$0.00,"$2,514.13","$5,158.80","$10,414.31","$2,554.94","$14,592.00",$0.00,"$7,296.00","$11,556.86","$11,673.60",$0.00,"$2,283.65",$0.00,"$2,323.05",$0.00
27801264,EAP,HCPCS C1777,,Riata St Pkg,"$14,592.00",$0.00,"$14,592.00","$6,566.40","$5,158.80",$0.00,"$2,514.13","$5,158.80","$10,414.31","$2,554.94","$14,592.00",$0.00,"$7,296.00","$11,556.86","$11,673.60",$0.00,"$2,283.65",$0.00,"$2,323.05",$0.00
27801265,EAP,HCPCS C1721,,Atlas Ii Dr Dual Ic,"$9,730.00",$0.00,"$9,730.00","$4,378.50","$5,158.80",$0.00,"$1,676.43","$5,158.80","$6,944.30","$1,703.65","$9,730.00",$0.00,"$4,865.00","$7,706.16","$7,784.00",$0.00,"$1,522.75",$0.00,"$1,549.02",$0.00
27801266,EAP,HCPCS C1779,,4457 Fineline 11 Le,"$2,973.00",$0.00,"$2,973.00",$0.00,"$2,121.83",$0.00,$0.00,"$2,121.83","$2,121.83",$0.00,"$2,973.00",$0.00,"$1,486.50","$2,354.62","$2,378.40",$0.00,$0.00,$0.00,$0.00,$0.00
27801267,EAP,HCPCS C1721,,Teligen Is Vr Sngl,"$61,398.00",$0.00,"$61,398.00","$27,629.10","$5,158.80",$0.00,"$8,138.89","$5,158.80","$43,819.75","$8,138.89","$61,398.00",$0.00,"$30,699.00","$48,627.22","$49,118.40",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27801268,EAP,HCPCS C1882,,Insync Maximo Dual,"$68,113.00",$0.00,"$68,113.00","$30,650.85","$5,158.80",$0.00,"$8,138.89","$5,158.80","$48,612.25","$8,138.89","$68,113.00",$0.00,"$34,056.50","$53,945.50","$54,490.40",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27801269,EAP,HCPCS C1721,,Ovatio Oh60u Dr 655,"$40,295.00",$0.00,"$40,295.00","$18,132.75","$5,158.80",$0.00,"$6,942.63","$5,158.80","$28,758.54","$7,055.33","$40,295.00",$0.00,"$20,147.50","$31,913.64","$32,236.00",$0.00,"$6,306.17",$0.00,"$6,414.96",$0.00
27801270,EAP,HCPCS C1722,,Ovatio Oh61u Vr Sys,"$57,559.00",$0.00,"$57,559.00","$25,901.55","$5,158.80",$0.00,"$8,138.89","$5,158.80","$41,079.86","$8,138.89","$57,559.00",$0.00,"$28,779.50","$45,586.73","$46,047.20",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27801271,EAP,HCPCS C1882,,Ovatio Crt 6750 Sys,"$46,048.00",$0.00,"$46,048.00","$20,721.60","$5,158.80",$0.00,"$7,933.84","$5,158.80","$32,864.46","$8,062.64","$46,048.00",$0.00,"$23,024.00","$36,470.02","$36,838.40",$0.00,"$7,206.51",$0.00,"$7,330.84",$0.00
27801272,EAP,HCPCS C1721,,Lumax 340 Dr-t Syst,"$69,071.00",$0.00,"$69,071.00","$31,081.95","$5,158.80",$0.00,"$8,138.89","$5,158.80","$49,295.97","$8,138.89","$69,071.00",$0.00,"$34,535.50","$54,704.23","$55,256.80",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27801273,EAP,HCPCS C1721,,Lumos Dr-t System,"$65,235.00",$0.00,"$65,235.00","$29,355.75","$5,158.80",$0.00,"$8,138.89","$5,158.80","$46,558.22","$8,138.89","$65,235.00",$0.00,"$32,617.50","$51,666.12","$52,188.00",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27801274,EAP,HCPCS C1722,,Lumax 340 Vr-t Syst,"$61,398.00",$0.00,"$61,398.00","$27,629.10","$5,158.80",$0.00,"$8,138.89","$5,158.80","$43,819.75","$8,138.89","$61,398.00",$0.00,"$30,699.00","$48,627.22","$49,118.40",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27801275,EAP,HCPCS C1722,,Lumos Vr-t System,"$57,559.00",$0.00,"$57,559.00","$25,901.55","$5,158.80",$0.00,"$8,138.89","$5,158.80","$41,079.86","$8,138.89","$57,559.00",$0.00,"$28,779.50","$45,586.73","$46,047.20",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27801276,EAP,HCPCS C1882,,Lumax 340 Hf-t Syst,"$100,923.00",$0.00,"$100,923.00","$45,415.35","$5,158.80",$0.00,"$8,138.89","$5,158.80","$72,028.75","$8,138.89","$100,923.00",$0.00,"$50,461.50","$79,931.02","$80,738.40",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27801277,EAP,HCPCS C1876,,2.25 X 12mm Mini-vi,"$2,920.00",$0.00,"$2,920.00","$1,314.00","$2,084.00",$0.00,$503.10,"$2,084.00","$2,084.00",$511.27,"$2,920.00",$0.00,"$1,460.00","$2,312.64","$2,336.00",$0.00,$456.98,$0.00,$464.86,$0.00
27801278,EAP,HCPCS C1876,,4.5 X 13mm Ultra Rx,"$2,586.00",$0.00,"$2,586.00","$1,163.70","$1,845.63",$0.00,$445.55,"$1,845.63","$1,845.63",$452.79,"$2,586.00",$0.00,"$1,293.00","$2,048.11","$2,068.80",$0.00,$404.71,$0.00,$411.69,$0.00
27801279,EAP,HCPCS C1876,,4.5 X 18mm Ultra Rx,"$9,175.00",$0.00,"$9,175.00","$4,128.75","$5,158.80",$0.00,"$1,580.81","$5,158.80","$6,548.20","$1,606.47","$9,175.00",$0.00,"$4,587.50","$7,266.60","$7,340.00",$0.00,"$1,435.89",$0.00,"$1,460.66",$0.00
27801280,EAP,HCPCS C1876,,4.5 X 28mm Ultra Rx,"$9,175.00",$0.00,"$9,175.00","$4,128.75","$5,158.80",$0.00,"$1,580.81","$5,158.80","$6,548.20","$1,606.47","$9,175.00",$0.00,"$4,587.50","$7,266.60","$7,340.00",$0.00,"$1,435.89",$0.00,"$1,460.66",$0.00
27801282,EAP,HCPCS C1874,,3.0 X 16mm Graftmas,"$7,990.00",$0.00,"$7,990.00","$3,595.50","$5,158.80",$0.00,"$1,376.64","$5,158.80","$5,702.46","$1,398.99","$7,990.00",$0.00,"$3,995.00","$6,328.08","$6,392.00",$0.00,"$1,250.44",$0.00,"$1,272.01",$0.00
27801283,EAP,HCPCS C1874,,3.5 X 16mm Graftmas,"$7,990.00",$0.00,"$7,990.00","$3,595.50","$5,158.80",$0.00,"$1,376.64","$5,158.80","$5,702.46","$1,398.99","$7,990.00",$0.00,"$3,995.00","$6,328.08","$6,392.00",$0.00,"$1,250.44",$0.00,"$1,272.01",$0.00
27801284,EAP,HCPCS C1776,,2mm Mini Snare,"$1,870.00",$0.00,"$1,870.00",$841.50,"$1,334.62",$0.00,$322.19,"$1,334.62","$1,334.62",$327.42,"$1,870.00",$0.00,$935.00,"$1,481.04","$1,496.00",$0.00,$292.66,$0.00,$297.70,$0.00
27801285,EAP,HCPCS C1776,,4mm Mini Snare,"$1,870.00",$0.00,"$1,870.00",$841.50,"$1,334.62",$0.00,$322.19,"$1,334.62","$1,334.62",$327.42,"$1,870.00",$0.00,$935.00,"$1,481.04","$1,496.00",$0.00,$292.66,$0.00,$297.70,$0.00
27801357,EAP,HCPCS C1874,,Endeavor Sprint Des,"$5,755.00",$0.00,"$5,755.00","$2,589.75","$4,107.34",$0.00,$991.56,"$4,107.34","$4,107.34","$1,007.65","$5,755.00",$0.00,"$2,877.50","$4,557.96","$4,604.00",$0.00,$900.66,$0.00,$916.20,$0.00
27801367,EAP,HCPCS C1760,,Mynx Vascular Closu,"$5,839.00",$0.00,"$5,839.00","$2,627.55","$4,167.29",$0.00,"$1,006.03","$4,167.29","$4,167.29","$1,022.36","$5,839.00",$0.00,"$2,919.50","$4,624.49","$4,671.20",$0.00,$913.80,$0.00,$929.57,$0.00
27801369,EAP,HCPCS C1785,,Philos Ii Dr Pacema,"$11,477.00",$0.00,"$11,477.00","$5,164.65","$5,158.80",$0.00,"$1,977.43","$5,158.80","$8,191.13","$2,009.53","$11,477.00",$0.00,"$5,738.50","$9,089.78","$9,181.60",$0.00,"$1,796.15",$0.00,"$1,827.14",$0.00
27801370,EAP,HCPCS C1882,,Insync Maximo,"$63,656.00",$0.00,"$63,656.00","$28,645.20","$5,158.80",$0.00,"$8,138.89","$5,158.80","$45,431.29","$8,138.89","$63,656.00",$0.00,"$31,828.00","$50,415.55","$50,924.80",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27801371,EAP,Custom 27801371,,Coil Embl 14cm 3mm .018in Nst 14.9 Loop Sft Radopc,$270.00,$0.00,$270.00,$0.00,$192.70,$0.00,$0.00,$192.70,$192.70,$0.00,$270.00,$0.00,$135.00,$213.84,$216.00,$0.00,$0.00,$0.00,$0.00,$0.00
27801372,EAP,Custom 27801372,,Coil Embl 14cm 4mm Nst 11.1 Loop Sft Radopc .018in,$270.00,$0.00,$270.00,$0.00,$192.70,$0.00,$0.00,$192.70,$192.70,$0.00,$270.00,$0.00,$135.00,$213.84,$216.00,$0.00,$0.00,$0.00,$0.00,$0.00
27801373,EAP,Custom 27801373,,Coil Embl 14cm 5mm Nst 8.9 Loop Sft Enh Radopc,$270.00,$0.00,$270.00,$0.00,$192.70,$0.00,$0.00,$192.70,$192.70,$0.00,$270.00,$0.00,$135.00,$213.84,$216.00,$0.00,$0.00,$0.00,$0.00,$0.00
27801374,EAP,Custom 27801374,,Coil Embl 5cm 2mm Nst 8 Loop Sft Enh Radopc Mciol,$229.00,$0.00,$229.00,$0.00,$163.44,$0.00,$0.00,$163.44,$163.44,$0.00,$229.00,$0.00,$114.50,$181.37,$183.20,$0.00,$0.00,$0.00,$0.00,$0.00
27801375,EAP,Custom 27801375,,Coil Embl 5cm 5mm Nst Pltn Synth Fbr Acpt .018in,$229.00,$0.00,$229.00,$0.00,$163.44,$0.00,$0.00,$163.44,$163.44,$0.00,$229.00,$0.00,$114.50,$181.37,$183.20,$0.00,$0.00,$0.00,$0.00,$0.00
27801376,EAP,Custom 27801376,,Coil Embl 7cm 10mm Nst 2.2 Loop Sft Enh Radopc,$249.00,$0.00,$249.00,$0.00,$177.71,$0.00,$0.00,$177.71,$177.71,$0.00,$249.00,$0.00,$124.50,$197.21,$199.20,$0.00,$0.00,$0.00,$0.00,$0.00
27801377,EAP,Custom 27801377,,Coil Embl 7cm 2mm Nst 11.1 Loop Sft Enh Radopc,$249.00,$0.00,$249.00,$0.00,$177.71,$0.00,$0.00,$177.71,$177.71,$0.00,$249.00,$0.00,$124.50,$197.21,$199.20,$0.00,$0.00,$0.00,$0.00,$0.00
27801378,EAP,Custom 27801378,,Coil Embl 7cm 5mm Nst 4.5 Loop Sft Enh Radopc,$249.00,$0.00,$249.00,$0.00,$177.71,$0.00,$0.00,$177.71,$177.71,$0.00,$249.00,$0.00,$124.50,$197.21,$199.20,$0.00,$0.00,$0.00,$0.00,$0.00
27801379,EAP,Custom 27801379,,Coil Embl 7cm 6mm Nst 3.7 Loop Sft Enh Radopc,$249.00,$0.00,$249.00,$0.00,$177.71,$0.00,$0.00,$177.71,$177.71,$0.00,$249.00,$0.00,$124.50,$197.21,$199.20,$0.00,$0.00,$0.00,$0.00,$0.00
27801381,EAP,Custom 27801381,,3 CM VERSATILE RNG FILL ADV COILS  1MM-3MM,"$4,547.00",$0.00,"$4,547.00",$0.00,"$3,245.19",$0.00,$0.00,"$3,245.19","$3,245.19",$0.00,"$4,547.00",$0.00,"$2,273.50","$3,601.22","$3,637.60",$0.00,$0.00,$0.00,$0.00,$0.00
27801382,EAP,Custom 27801382,,6cm Versatile Rng Fill Adv Coils  3mm-6mm,"$4,547.00",$0.00,"$4,547.00",$0.00,"$3,245.19",$0.00,$0.00,"$3,245.19","$3,245.19",$0.00,"$4,547.00",$0.00,"$2,273.50","$3,601.22","$3,637.60",$0.00,$0.00,$0.00,$0.00,$0.00
27801383,EAP,Custom 27801383,,10cm Versatile Rng Fill Adv Coils  3mm-6mm,"$4,547.00",$0.00,"$4,547.00",$0.00,"$3,245.19",$0.00,$0.00,"$3,245.19","$3,245.19",$0.00,"$4,547.00",$0.00,"$2,273.50","$3,601.22","$3,637.60",$0.00,$0.00,$0.00,$0.00,$0.00
27801384,EAP,Custom 27801384,,15cm Versatile Rng Fill Adv Coils  3mm-6mm,"$4,547.00",$0.00,"$4,547.00",$0.00,"$3,245.19",$0.00,$0.00,"$3,245.19","$3,245.19",$0.00,"$4,547.00",$0.00,"$2,273.50","$3,601.22","$3,637.60",$0.00,$0.00,$0.00,$0.00,$0.00
27801385,EAP,Custom 27801385,,20cm Versatile Rng Fill Adv Coils  6mm-10mm,"$4,547.00",$0.00,"$4,547.00",$0.00,"$3,245.19",$0.00,$0.00,"$3,245.19","$3,245.19",$0.00,"$4,547.00",$0.00,"$2,273.50","$3,601.22","$3,637.60",$0.00,$0.00,$0.00,$0.00,$0.00
27801386,EAP,Custom 27801386,,30cm Versatile Rng Fill Adv Coils  6mm-10mm,"$4,547.00",$0.00,"$4,547.00",$0.00,"$3,245.19",$0.00,$0.00,"$3,245.19","$3,245.19",$0.00,"$4,547.00",$0.00,"$2,273.50","$3,601.22","$3,637.60",$0.00,$0.00,$0.00,$0.00,$0.00
27801387,EAP,Custom 27801387,,30cm Versatile Rng Fill Adv Coils  10mm-15mm,"$4,547.00",$0.00,"$4,547.00",$0.00,"$3,245.19",$0.00,$0.00,"$3,245.19","$3,245.19",$0.00,"$4,547.00",$0.00,"$2,273.50","$3,601.22","$3,637.60",$0.00,$0.00,$0.00,$0.00,$0.00
27801388,EAP,Custom 27801388,,30cm Versatile Rng Fill Adv Coils  10mm-15mm,"$4,547.00",$0.00,"$4,547.00",$0.00,"$3,245.19",$0.00,$0.00,"$3,245.19","$3,245.19",$0.00,"$4,547.00",$0.00,"$2,273.50","$3,601.22","$3,637.60",$0.00,$0.00,$0.00,$0.00,$0.00
27801389,EAP,Custom 27801389,,40cm Versatile Rng Fill Adv Coils  15mm-20mm,"$4,547.00",$0.00,"$4,547.00",$0.00,"$3,245.19",$0.00,$0.00,"$3,245.19","$3,245.19",$0.00,"$4,547.00",$0.00,"$2,273.50","$3,601.22","$3,637.60",$0.00,$0.00,$0.00,$0.00,$0.00
27801392,EAP,HCPCS C1757,,Catheter Thrombectomy Solitaire 6mm 40mm,"$10,563.00",$0.00,"$10,563.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$7,538.81",$0.00,"$10,563.00",$0.00,"$5,281.50","$8,365.90","$8,450.40",$0.00,$0.00,$0.00,$0.00,$0.00
27801400,EAP,Custom 27801400,,Coil Embl 7cm 8mm Nst 2.8 Loop Sft Enh Radopc,$249.00,$0.00,$249.00,$0.00,$177.71,$0.00,$0.00,$177.71,$177.71,$0.00,$249.00,$0.00,$124.50,$197.21,$199.20,$0.00,$0.00,$0.00,$0.00,$0.00
27801401,EAP,Custom 27801401,,Coil Embl 7cm 12mm Nst 1.9 Loop .035in Pltn Peri,$249.00,$0.00,$249.00,$0.00,$177.71,$0.00,$0.00,$177.71,$177.71,$0.00,$249.00,$0.00,$124.50,$197.21,$199.20,$0.00,$0.00,$0.00,$0.00,$0.00
27801403,EAP,Custom 27801403,,Coil Embl 7cm 14mm Nst 1.6 Loop Sft Enh Radopc,$249.00,$0.00,$249.00,$0.00,$177.71,$0.00,$0.00,$177.71,$177.71,$0.00,$249.00,$0.00,$124.50,$197.21,$199.20,$0.00,$0.00,$0.00,$0.00,$0.00
27801404,EAP,Custom 27801404,,Coil Embl 7cm 16mm Nst 1.4 Loop Sft Enh Radopc,$249.00,$0.00,$249.00,$0.00,$177.71,$0.00,$0.00,$177.71,$177.71,$0.00,$249.00,$0.00,$124.50,$197.21,$199.20,$0.00,$0.00,$0.00,$0.00,$0.00
27801405,EAP,Custom 27801405,,Coil Embl 7cm 18mm Nst 1.2 Loop Sft Enh Radopc,$249.00,$0.00,$249.00,$0.00,$177.71,$0.00,$0.00,$177.71,$177.71,$0.00,$249.00,$0.00,$124.50,$197.21,$199.20,$0.00,$0.00,$0.00,$0.00,$0.00
27801406,EAP,Custom 27801406,,Coil Embl 7cm 20mm Nst 1.1 Loop Sft Enh Radopc,$249.00,$0.00,$249.00,$0.00,$177.71,$0.00,$0.00,$177.71,$177.71,$0.00,$249.00,$0.00,$124.50,$197.21,$199.20,$0.00,$0.00,$0.00,$0.00,$0.00
27801407,EAP,Custom 27801407,,Coil Embl 7cm 5mm Nst Pltn Synth Fbr Acpt .035in,$249.00,$0.00,$249.00,$0.00,$177.71,$0.00,$0.00,$177.71,$177.71,$0.00,$249.00,$0.00,$124.50,$197.21,$199.20,$0.00,$0.00,$0.00,$0.00,$0.00
27801409,EAP,Custom 27801409,,Coil Embl 4cm 4-2mm Trnd Mcl Mlfrm Sft .018in Pltn,$270.00,$0.00,$270.00,$0.00,$192.70,$0.00,$0.00,$192.70,$192.70,$0.00,$270.00,$0.00,$135.00,$213.84,$216.00,$0.00,$0.00,$0.00,$0.00,$0.00
27801410,EAP,Custom 27801410,,Coil Embl 5cm 5-2mm Trnd Mcl Cath .018in Pltn Strl,$270.00,$0.00,$270.00,$0.00,$192.70,$0.00,$0.00,$192.70,$192.70,$0.00,$270.00,$0.00,$135.00,$213.84,$216.00,$0.00,$0.00,$0.00,$0.00,$0.00
27801411,EAP,Custom 27801411,,Coil Embl 9cm 7-3mm Trnd Mlfrm Sft Xsect Ideally,$270.00,$0.00,$270.00,$0.00,$192.70,$0.00,$0.00,$192.70,$192.70,$0.00,$270.00,$0.00,$135.00,$213.84,$216.00,$0.00,$0.00,$0.00,$0.00,$0.00
27801412,EAP,HCPCS C1887,,"Cath, Sofia 6fr 131cm","$5,302.00",$0.00,"$5,302.00","$2,385.90","$3,784.04",$0.00,$913.51,"$3,784.04","$3,784.04",$928.34,"$5,302.00",$0.00,"$2,651.00","$4,199.18","$4,241.60",$0.00,$829.76,$0.00,$844.08,$0.00
27801413,EAP,HCPCS C1887,,"Cath, Sofia 6fr 125cm","$5,302.00",$0.00,"$5,302.00","$2,385.90","$3,784.04",$0.00,$913.51,"$3,784.04","$3,784.04",$928.34,"$5,302.00",$0.00,"$2,651.00","$4,199.18","$4,241.60",$0.00,$829.76,$0.00,$844.08,$0.00
27801414,EAP,Custom 27801414,,Plug Cardio 7mm 10mm Amplzr Ntnl Type Ii Dlv Sys,"$2,080.00",$0.00,"$2,080.00",$0.00,"$1,484.50",$0.00,$0.00,"$1,484.50","$1,484.50",$0.00,"$2,080.00",$0.00,"$1,040.00","$1,647.36","$1,664.00",$0.00,$0.00,$0.00,$0.00,$0.00
27801415,EAP,Custom 27801415,,Plug Cardio 9mm 12mm Amplzr Ntnl Type Ii Dlv Sys,"$2,080.00",$0.00,"$2,080.00",$0.00,"$1,484.50",$0.00,$0.00,"$1,484.50","$1,484.50",$0.00,"$2,080.00",$0.00,"$1,040.00","$1,647.36","$1,664.00",$0.00,$0.00,$0.00,$0.00,$0.00
27801417,EAP,Custom 27801417,,Coil Embl 12.5cm 10-5mm Trnd Sm Std Pltn,$270.00,$0.00,$270.00,$0.00,$192.70,$0.00,$0.00,$192.70,$192.70,$0.00,$270.00,$0.00,$135.00,$213.84,$216.00,$0.00,$0.00,$0.00,$0.00,$0.00
27801418,EAP,Custom 27801418,,Coil Embl 5.8cm 6-3mm Trnd Sft .035in Std Sm Pltn,$270.00,$0.00,$270.00,$0.00,$192.70,$0.00,$0.00,$192.70,$192.70,$0.00,$270.00,$0.00,$135.00,$213.84,$216.00,$0.00,$0.00,$0.00,$0.00,$0.00
27801419,EAP,Custom 27801419,,Coil Embl 8cm 8-4mm Trnd .035in Std Sm Pltn,$270.00,$0.00,$270.00,$0.00,$192.70,$0.00,$0.00,$192.70,$192.70,$0.00,$270.00,$0.00,$135.00,$213.84,$216.00,$0.00,$0.00,$0.00,$0.00,$0.00
27801420,EAP,Custom 27801420,,Coil Embl 8.2cm 8-5mm Trnd Mlfrm Pltn,$270.00,$0.00,$270.00,$0.00,$192.70,$0.00,$0.00,$192.70,$192.70,$0.00,$270.00,$0.00,$135.00,$213.84,$216.00,$0.00,$0.00,$0.00,$0.00,$0.00
27801421,EAP,Custom 27801421,,Coil Embl 2cm 1mm Axium Prm X Sft 3d,"$3,988.00",$0.00,"$3,988.00",$0.00,"$2,846.24",$0.00,$0.00,"$2,846.24","$2,846.24",$0.00,"$3,988.00",$0.00,"$1,994.00","$3,158.50","$3,190.40",$0.00,$0.00,$0.00,$0.00,$0.00
27801422,EAP,Custom 27801422,,Coil Embl 3cm 1mm Axium Prm X Sft 3d,"$3,988.00",$0.00,"$3,988.00",$0.00,"$2,846.24",$0.00,$0.00,"$2,846.24","$2,846.24",$0.00,"$3,988.00",$0.00,"$1,994.00","$3,158.50","$3,190.40",$0.00,$0.00,$0.00,$0.00,$0.00
27801423,EAP,Custom 27801423,,Coil Embl 4cm 1mm Axium Prm X Sft 3d,"$3,988.00",$0.00,"$3,988.00",$0.00,"$2,846.24",$0.00,$0.00,"$2,846.24","$2,846.24",$0.00,"$3,988.00",$0.00,"$1,994.00","$3,158.50","$3,190.40",$0.00,$0.00,$0.00,$0.00,$0.00
27801424,EAP,Custom 27801424,,Coil Embl 2cm 1.5mm Axium Prm X Sft 3d,"$3,988.00",$0.00,"$3,988.00",$0.00,"$2,846.24",$0.00,$0.00,"$2,846.24","$2,846.24",$0.00,"$3,988.00",$0.00,"$1,994.00","$3,158.50","$3,190.40",$0.00,$0.00,$0.00,$0.00,$0.00
27801425,EAP,Custom 27801425,,Coil Embl 3cm 1.5mm Axium Prm X Sft 3d,"$3,988.00",$0.00,"$3,988.00",$0.00,"$2,846.24",$0.00,$0.00,"$2,846.24","$2,846.24",$0.00,"$3,988.00",$0.00,"$1,994.00","$3,158.50","$3,190.40",$0.00,$0.00,$0.00,$0.00,$0.00
27801426,EAP,Custom 27801426,,Coil Embl 4cm 1.5mm Axium Prm X Sft 3d,"$3,988.00",$0.00,"$3,988.00",$0.00,"$2,846.24",$0.00,$0.00,"$2,846.24","$2,846.24",$0.00,"$3,988.00",$0.00,"$1,994.00","$3,158.50","$3,190.40",$0.00,$0.00,$0.00,$0.00,$0.00
27801427,EAP,Custom 27801427,,Coil Embl 2cm 2mm Axium Prm X Sft 3d,"$3,988.00",$0.00,"$3,988.00",$0.00,"$2,846.24",$0.00,$0.00,"$2,846.24","$2,846.24",$0.00,"$3,988.00",$0.00,"$1,994.00","$3,158.50","$3,190.40",$0.00,$0.00,$0.00,$0.00,$0.00
27801428,EAP,Custom 27801428,,Coil Embl 3cm 2mm Axium Prm X Sft 3d,"$3,988.00",$0.00,"$3,988.00",$0.00,"$2,846.24",$0.00,$0.00,"$2,846.24","$2,846.24",$0.00,"$3,988.00",$0.00,"$1,994.00","$3,158.50","$3,190.40",$0.00,$0.00,$0.00,$0.00,$0.00
27801429,EAP,Custom 27801429,,Coil Embl 4cm 2mm Axium Prm X Sft 3d,"$3,988.00",$0.00,"$3,988.00",$0.00,"$2,846.24",$0.00,$0.00,"$2,846.24","$2,846.24",$0.00,"$3,988.00",$0.00,"$1,994.00","$3,158.50","$3,190.40",$0.00,$0.00,$0.00,$0.00,$0.00
27801430,EAP,Custom 27801430,,Coil Embl 3cm 2.5mm Axium Prm X Sft 3d,"$3,988.00",$0.00,"$3,988.00",$0.00,"$2,846.24",$0.00,$0.00,"$2,846.24","$2,846.24",$0.00,"$3,988.00",$0.00,"$1,994.00","$3,158.50","$3,190.40",$0.00,$0.00,$0.00,$0.00,$0.00
27801431,EAP,Custom 27801431,,Coil Embl 6cm 2.5mm Axium Prm X Sft 3d,"$3,988.00",$0.00,"$3,988.00",$0.00,"$2,846.24",$0.00,$0.00,"$2,846.24","$2,846.24",$0.00,"$3,988.00",$0.00,"$1,994.00","$3,158.50","$3,190.40",$0.00,$0.00,$0.00,$0.00,$0.00
27801432,EAP,Custom 27801432,,Coil Embl 4cm 3mm Axium Prm X Sft 3d,"$3,988.00",$0.00,"$3,988.00",$0.00,"$2,846.24",$0.00,$0.00,"$2,846.24","$2,846.24",$0.00,"$3,988.00",$0.00,"$1,994.00","$3,158.50","$3,190.40",$0.00,$0.00,$0.00,$0.00,$0.00
27801433,EAP,Custom 27801433,,Coil Embl 6cm 3mm Axium Prm X Sft 3d,"$3,988.00",$0.00,"$3,988.00",$0.00,"$2,846.24",$0.00,$0.00,"$2,846.24","$2,846.24",$0.00,"$3,988.00",$0.00,"$1,994.00","$3,158.50","$3,190.40",$0.00,$0.00,$0.00,$0.00,$0.00
27801434,EAP,Custom 27801434,,Coil Embl 8cm 3mm Axium Prm X Sft 3d,"$3,988.00",$0.00,"$3,988.00",$0.00,"$2,846.24",$0.00,$0.00,"$2,846.24","$2,846.24",$0.00,"$3,988.00",$0.00,"$1,994.00","$3,158.50","$3,190.40",$0.00,$0.00,$0.00,$0.00,$0.00
27801435,EAP,Custom 27801435,,Coil Embl 6cm 3.5mm Axium Prm X Sft 3d,"$3,988.00",$0.00,"$3,988.00",$0.00,"$2,846.24",$0.00,$0.00,"$2,846.24","$2,846.24",$0.00,"$3,988.00",$0.00,"$1,994.00","$3,158.50","$3,190.40",$0.00,$0.00,$0.00,$0.00,$0.00
27801436,EAP,Custom 27801436,,Coil Embl 8cm 3.5mm Axium Prm X Sft 3d,"$3,988.00",$0.00,"$3,988.00",$0.00,"$2,846.24",$0.00,$0.00,"$2,846.24","$2,846.24",$0.00,"$3,988.00",$0.00,"$1,994.00","$3,158.50","$3,190.40",$0.00,$0.00,$0.00,$0.00,$0.00
27801437,EAP,Custom 27801437,,Coil Embl 10cm 3.5mm Axium Prm X Sft 3d,"$3,988.00",$0.00,"$3,988.00",$0.00,"$2,846.24",$0.00,$0.00,"$2,846.24","$2,846.24",$0.00,"$3,988.00",$0.00,"$1,994.00","$3,158.50","$3,190.40",$0.00,$0.00,$0.00,$0.00,$0.00
27801438,EAP,Custom 27801438,,Coil Embl 1cm 1mm Axium Prm X Sft Hlx,"$2,988.00",$0.00,"$2,988.00",$0.00,"$2,132.54",$0.00,$0.00,"$2,132.54","$2,132.54",$0.00,"$2,988.00",$0.00,"$1,494.00","$2,366.50","$2,390.40",$0.00,$0.00,$0.00,$0.00,$0.00
27801439,EAP,Custom 27801439,,Coil Embl 2cm 1mm Axium Prm Dtch X Sft Hlx,"$2,988.00",$0.00,"$2,988.00",$0.00,"$2,132.54",$0.00,$0.00,"$2,132.54","$2,132.54",$0.00,"$2,988.00",$0.00,"$1,494.00","$2,366.50","$2,390.40",$0.00,$0.00,$0.00,$0.00,$0.00
27801440,EAP,Custom 27801440,,Coil Embl 3cm 1mm Axium Prm Dtch X Sft Hlx,"$2,988.00",$0.00,"$2,988.00",$0.00,"$2,132.54",$0.00,$0.00,"$2,132.54","$2,132.54",$0.00,"$2,988.00",$0.00,"$1,494.00","$2,366.50","$2,390.40",$0.00,$0.00,$0.00,$0.00,$0.00
27801441,EAP,Custom 27801441,,Coil Embl 1cm 1.5mm Axium Prm Dtch X Sft Hlx,"$2,988.00",$0.00,"$2,988.00",$0.00,"$2,132.54",$0.00,$0.00,"$2,132.54","$2,132.54",$0.00,"$2,988.00",$0.00,"$1,494.00","$2,366.50","$2,390.40",$0.00,$0.00,$0.00,$0.00,$0.00
27801442,EAP,Custom 27801442,,Coil Embl 2cm 1.5mm Axium Prm Dtch X Sft Hlx,"$2,988.00",$0.00,"$2,988.00",$0.00,"$2,132.54",$0.00,$0.00,"$2,132.54","$2,132.54",$0.00,"$2,988.00",$0.00,"$1,494.00","$2,366.50","$2,390.40",$0.00,$0.00,$0.00,$0.00,$0.00
27801443,EAP,Custom 27801443,,Coil Embl 3cm 1.5mm Axium Prm Dtch X Sft Hlx,"$2,988.00",$0.00,"$2,988.00",$0.00,"$2,132.54",$0.00,$0.00,"$2,132.54","$2,132.54",$0.00,"$2,988.00",$0.00,"$1,494.00","$2,366.50","$2,390.40",$0.00,$0.00,$0.00,$0.00,$0.00
27801444,EAP,Custom 27801444,,Coil Embl 4cm 1.5mm Axium Prm Dtch X Sft Hlx,"$2,988.00",$0.00,"$2,988.00",$0.00,"$2,132.54",$0.00,$0.00,"$2,132.54","$2,132.54",$0.00,"$2,988.00",$0.00,"$1,494.00","$2,366.50","$2,390.40",$0.00,$0.00,$0.00,$0.00,$0.00
27801445,EAP,Custom 27801445,,Coil Embl 1cm 2mm Axium Prm Dtch X Sft Hlx,"$2,988.00",$0.00,"$2,988.00",$0.00,"$2,132.54",$0.00,$0.00,"$2,132.54","$2,132.54",$0.00,"$2,988.00",$0.00,"$1,494.00","$2,366.50","$2,390.40",$0.00,$0.00,$0.00,$0.00,$0.00
27801446,EAP,Custom 27801446,,Coil Embl 2cm 2mm Axium Prm Dtch X Sft Hlx,"$2,988.00",$0.00,"$2,988.00",$0.00,"$2,132.54",$0.00,$0.00,"$2,132.54","$2,132.54",$0.00,"$2,988.00",$0.00,"$1,494.00","$2,366.50","$2,390.40",$0.00,$0.00,$0.00,$0.00,$0.00
27801447,EAP,Custom 27801447,,Coil Embl 3cm 2mm Axium Prm Dtch X Sft Hlx,"$2,988.00",$0.00,"$2,988.00",$0.00,"$2,132.54",$0.00,$0.00,"$2,132.54","$2,132.54",$0.00,"$2,988.00",$0.00,"$1,494.00","$2,366.50","$2,390.40",$0.00,$0.00,$0.00,$0.00,$0.00
27801448,EAP,Custom 27801448,,Coil Embl 4cm 2mm Axium Prm Dtch X Sft Hlx,"$2,988.00",$0.00,"$2,988.00",$0.00,"$2,132.54",$0.00,$0.00,"$2,132.54","$2,132.54",$0.00,"$2,988.00",$0.00,"$1,494.00","$2,366.50","$2,390.40",$0.00,$0.00,$0.00,$0.00,$0.00
27801449,EAP,Custom 27801449,,Coil Embl 6cm 2mm Axium Prm X Sft Hlx,"$2,988.00",$0.00,"$2,988.00",$0.00,"$2,132.54",$0.00,$0.00,"$2,132.54","$2,132.54",$0.00,"$2,988.00",$0.00,"$1,494.00","$2,366.50","$2,390.40",$0.00,$0.00,$0.00,$0.00,$0.00
27801450,EAP,HCPCS C1877,,"Stent, Non-coat/cov W/o Del","$12,969.00",$0.00,"$12,969.00","$5,836.05","$5,158.80",$0.00,"$2,234.49","$5,158.80","$9,255.98","$2,270.77","$12,969.00",$0.00,"$6,484.50","$10,271.45","$10,375.20",$0.00,"$2,029.65",$0.00,"$2,064.66",$0.00
27801451,EAP,HCPCS C1876,,Mini Vision Rx 2.75 X 08 Mm Us,"$1,791.00",$0.00,"$1,791.00",$805.95,"$1,278.24",$0.00,$308.58,"$1,278.24","$1,278.24",$313.59,"$1,791.00",$0.00,$895.50,"$1,418.47","$1,432.80",$0.00,$280.29,$0.00,$285.13,$0.00
27801452,EAP,HCPCS C1876,,Mini Vision Rx 2.75 X 12 Mm Us,"$1,791.00",$0.00,"$1,791.00",$805.95,"$1,278.24",$0.00,$308.58,"$1,278.24","$1,278.24",$313.59,"$1,791.00",$0.00,$895.50,"$1,418.47","$1,432.80",$0.00,$280.29,$0.00,$285.13,$0.00
27801453,EAP,HCPCS C1876,,Mini Vision Rx 2.75 X 15 Mm Us,"$1,791.00",$0.00,"$1,791.00",$805.95,"$1,278.24",$0.00,$308.58,"$1,278.24","$1,278.24",$313.59,"$1,791.00",$0.00,$895.50,"$1,418.47","$1,432.80",$0.00,$280.29,$0.00,$285.13,$0.00
27801454,EAP,HCPCS C1876,,Mini Vision Rx 2.75 X 18 Mm Us,"$1,791.00",$0.00,"$1,791.00",$805.95,"$1,278.24",$0.00,$308.58,"$1,278.24","$1,278.24",$313.59,"$1,791.00",$0.00,$895.50,"$1,418.47","$1,432.80",$0.00,$280.29,$0.00,$285.13,$0.00
27801455,EAP,HCPCS C1876,,Mini Vision Rx 2.75 X 23 Mm Us,"$1,791.00",$0.00,"$1,791.00",$805.95,"$1,278.24",$0.00,$308.58,"$1,278.24","$1,278.24",$313.59,"$1,791.00",$0.00,$895.50,"$1,418.47","$1,432.80",$0.00,$280.29,$0.00,$285.13,$0.00
27801456,EAP,HCPCS C1876,,Mini Vision Rx 2.75 X 28 Mm Us,$207.00,$0.00,$207.00,$93.15,$147.74,$0.00,$35.67,$147.74,$147.74,$36.24,$207.00,$0.00,$103.50,$163.94,$165.60,$0.00,$32.40,$0.00,$32.95,$0.00
27801457,EAP,HCPCS C1721,,Ilesto Dr-t High Energy With Ti With Landline Hmtachycardia,"$54,233.00",$0.00,"$54,233.00","$24,404.85","$5,158.80",$0.00,"$8,138.89","$5,158.80","$38,706.09","$8,138.89","$54,233.00",$0.00,"$27,116.50","$42,952.54","$43,386.40",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27801458,EAP,HCPCS C1721,,Ilesto Dr-t High Energy With Ti With Cellular Gsm Hmtachycardia,"$56,934.00",$0.00,"$56,934.00","$25,620.30","$5,158.80",$0.00,"$8,138.89","$5,158.80","$40,633.80","$8,138.89","$56,934.00",$0.00,"$28,467.00","$45,091.73","$45,547.20",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27801459,EAP,HCPCS C1722,,Ilesto Dx High Energy With Atrial Diagnostics & Ti With Landline Hmtac,"$54,233.00",$0.00,"$54,233.00","$24,404.85","$5,158.80",$0.00,"$8,138.89","$5,158.80","$38,706.09","$8,138.89","$54,233.00",$0.00,"$27,116.50","$42,952.54","$43,386.40",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27801460,EAP,HCPCS C1722,,Ilesto Dx High Energy With Atrial Diagnostics & Ti With Cellular Gsm H,"$56,934.00",$0.00,"$56,934.00","$25,620.30","$5,158.80",$0.00,"$8,138.89","$5,158.80","$40,633.80","$8,138.89","$56,934.00",$0.00,"$28,467.00","$45,091.73","$45,547.20",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27801461,EAP,HCPCS C1722,,Ilesto Vr-t High Energy With Ti With Landline Hmtachycardia,"$50,182.00",$0.00,"$50,182.00","$22,581.90","$5,158.80",$0.00,"$8,138.89","$5,158.80","$35,814.89","$8,138.89","$50,182.00",$0.00,"$25,091.00","$39,744.14","$40,145.60",$0.00,"$7,751.33",$0.00,"$7,988.97",$0.00
27801462,EAP,HCPCS C1722,,Ilesto Vr-t High Energy With Ti With Cellular Gsm Hmtachycardia,"$52,883.00",$0.00,"$52,883.00","$23,797.35","$5,158.80",$0.00,"$8,138.89","$5,158.80","$37,742.60","$8,138.89","$52,883.00",$0.00,"$26,441.50","$41,883.34","$42,306.40",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27801463,EAP,HCPCS C1895,,Linoxsmart Sd Steroid 60/16tachycardialead,"$11,023.00",$0.00,"$11,023.00","$4,960.35","$5,158.80",$0.00,"$1,899.21","$5,158.80","$7,867.12","$1,930.04","$11,023.00",$0.00,"$5,511.50","$8,730.22","$8,818.40",$0.00,"$1,725.10",$0.00,"$1,754.86",$0.00
27801464,EAP,HCPCS C1895,,Linoxsmart Sd Steroid 65/16tachycardialead,"$11,023.00",$0.00,"$11,023.00","$4,960.35","$5,158.80",$0.00,"$1,899.21","$5,158.80","$7,867.12","$1,930.04","$11,023.00",$0.00,"$5,511.50","$8,730.22","$8,818.40",$0.00,"$1,725.10",$0.00,"$1,754.86",$0.00
27801465,EAP,HCPCS C1895,,Linoxsmart Sd Steroid 65/18tachycardialead,"$11,023.00",$0.00,"$11,023.00","$4,960.35","$5,158.80",$0.00,"$1,899.21","$5,158.80","$7,867.12","$1,930.04","$11,023.00",$0.00,"$5,511.50","$8,730.22","$8,818.40",$0.00,"$1,725.10",$0.00,"$1,754.86",$0.00
27801466,EAP,HCPCS C1895,,Linoxsmart Sd Steroid 75/18tachycardialead,"$11,023.00",$0.00,"$11,023.00","$4,960.35","$5,158.80",$0.00,"$1,899.21","$5,158.80","$7,867.12","$1,930.04","$11,023.00",$0.00,"$5,511.50","$8,730.22","$8,818.40",$0.00,"$1,725.10",$0.00,"$1,754.86",$0.00
27801467,EAP,HCPCS C1777,,Linoxsmart S Steroid 60tachycardialead,"$11,023.00",$0.00,"$11,023.00","$4,960.35","$5,158.80",$0.00,"$1,899.21","$5,158.80","$7,867.12","$1,930.04","$11,023.00",$0.00,"$5,511.50","$8,730.22","$8,818.40",$0.00,"$1,725.10",$0.00,"$1,754.86",$0.00
27801468,EAP,HCPCS C1777,,Linoxsmart S Steroid 65tachycardialead,"$11,023.00",$0.00,"$11,023.00","$4,960.35","$5,158.80",$0.00,"$1,899.21","$5,158.80","$7,867.12","$1,930.04","$11,023.00",$0.00,"$5,511.50","$8,730.22","$8,818.40",$0.00,"$1,725.10",$0.00,"$1,754.86",$0.00
27801469,EAP,HCPCS C1777,,Linoxsmart S Steroid 75tachycardialead,"$11,023.00",$0.00,"$11,023.00","$4,960.35","$5,158.80",$0.00,"$1,899.21","$5,158.80","$7,867.12","$1,930.04","$11,023.00",$0.00,"$5,511.50","$8,730.22","$8,818.40",$0.00,"$1,725.10",$0.00,"$1,754.86",$0.00
27801470,EAP,HCPCS C1777,,Linoxsmart S Dx 65/15tachycardialead,"$11,023.00",$0.00,"$11,023.00","$4,960.35","$5,158.80",$0.00,"$1,899.21","$5,158.80","$7,867.12","$1,930.04","$11,023.00",$0.00,"$5,511.50","$8,730.22","$8,818.40",$0.00,"$1,725.10",$0.00,"$1,754.86",$0.00
27801471,EAP,HCPCS C1895,,Linoxsmart Td Steroid 65/16 Cmtachycardialead,"$11,023.00",$0.00,"$11,023.00","$4,960.35","$5,158.80",$0.00,"$1,899.21","$5,158.80","$7,867.12","$1,930.04","$11,023.00",$0.00,"$5,511.50","$8,730.22","$8,818.40",$0.00,"$1,725.10",$0.00,"$1,754.86",$0.00
27801472,EAP,HCPCS C1895,,Linoxsmart Td Steroid 65/18 Cmtachycardialead,"$11,023.00",$0.00,"$11,023.00","$4,960.35","$5,158.80",$0.00,"$1,899.21","$5,158.80","$7,867.12","$1,930.04","$11,023.00",$0.00,"$5,511.50","$8,730.22","$8,818.40",$0.00,"$1,725.10",$0.00,"$1,754.86",$0.00
27801473,EAP,HCPCS C1777,,Linoxsmart T Steroid 65tachycardialead,"$11,023.00",$0.00,"$11,023.00","$4,960.35","$5,158.80",$0.00,"$1,899.21","$5,158.80","$7,867.12","$1,930.04","$11,023.00",$0.00,"$5,511.50","$8,730.22","$8,818.40",$0.00,"$1,725.10",$0.00,"$1,754.86",$0.00
27801474,EAP,HCPCS C1882,,Ilesto Hf-t High Energy With Ti With Landline Hmcrt Heart Failure,"$65,477.00",$0.00,"$65,477.00","$29,464.65","$5,158.80",$0.00,"$8,138.89","$5,158.80","$46,730.93","$8,138.89","$65,477.00",$0.00,"$32,738.50","$51,857.78","$52,381.60",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27801475,EAP,HCPCS C1882,,Ilesto Hf-t High Energy With Ti With Cellular Gsm Hmcrt Heart Failure,"$68,178.00",$0.00,"$68,178.00","$30,680.10","$5,158.80",$0.00,"$8,138.89","$5,158.80","$48,658.64","$8,138.89","$68,178.00",$0.00,"$34,089.00","$53,996.98","$54,542.40",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27801476,EAP,Custom 27801476,,Coil Embl 8cm 2mm Axium Prm X Sft Hlx,"$2,988.00",$0.00,"$2,988.00",$0.00,"$2,132.54",$0.00,$0.00,"$2,132.54","$2,132.54",$0.00,"$2,988.00",$0.00,"$1,494.00","$2,366.50","$2,390.40",$0.00,$0.00,$0.00,$0.00,$0.00
27801478,EAP,Custom 27801478,,Coil Embl 4cm 2.5mm Axium Prm Dtch X Sft Hlx,"$2,988.00",$0.00,"$2,988.00",$0.00,"$2,132.54",$0.00,$0.00,"$2,132.54","$2,132.54",$0.00,"$2,988.00",$0.00,"$1,494.00","$2,366.50","$2,390.40",$0.00,$0.00,$0.00,$0.00,$0.00
27801479,EAP,Custom 27801479,,Coil Embl 6cm 2.5mm Axium Prm Dtch X Sft Hlx,"$2,988.00",$0.00,"$2,988.00",$0.00,"$2,132.54",$0.00,$0.00,"$2,132.54","$2,132.54",$0.00,"$2,988.00",$0.00,"$1,494.00","$2,366.50","$2,390.40",$0.00,$0.00,$0.00,$0.00,$0.00
27801480,EAP,Custom 27801480,,Coil Embl 8cm 2.5mm Axium Prm X Sft Hlx,"$2,988.00",$0.00,"$2,988.00",$0.00,"$2,132.54",$0.00,$0.00,"$2,132.54","$2,132.54",$0.00,"$2,988.00",$0.00,"$1,494.00","$2,366.50","$2,390.40",$0.00,$0.00,$0.00,$0.00,$0.00
27801481,EAP,Custom 27801481,,Coil Embl 4cm 3mm Axium Prm Dtch X Sft Hlx,"$2,988.00",$0.00,"$2,988.00",$0.00,"$2,132.54",$0.00,$0.00,"$2,132.54","$2,132.54",$0.00,"$2,988.00",$0.00,"$1,494.00","$2,366.50","$2,390.40",$0.00,$0.00,$0.00,$0.00,$0.00
27801482,EAP,Custom 27801482,,Coil Embl 6cm 3mm Axium Prm Dtch X Sft Hlx,"$2,988.00",$0.00,"$2,988.00",$0.00,"$2,132.54",$0.00,$0.00,"$2,132.54","$2,132.54",$0.00,"$2,988.00",$0.00,"$1,494.00","$2,366.50","$2,390.40",$0.00,$0.00,$0.00,$0.00,$0.00
27801483,EAP,Custom 27801483,,Coil Embl 8cm 3mm Axium Prm Dtch X Sft Hlx,"$2,988.00",$0.00,"$2,988.00",$0.00,"$2,132.54",$0.00,$0.00,"$2,132.54","$2,132.54",$0.00,"$2,988.00",$0.00,"$1,494.00","$2,366.50","$2,390.40",$0.00,$0.00,$0.00,$0.00,$0.00
27801484,EAP,Custom 27801484,,Coil Embl 10cm 3mm Axium Prm X Sft Hlx,"$2,988.00",$0.00,"$2,988.00",$0.00,"$2,132.54",$0.00,$0.00,"$2,132.54","$2,132.54",$0.00,"$2,988.00",$0.00,"$1,494.00","$2,366.50","$2,390.40",$0.00,$0.00,$0.00,$0.00,$0.00
27801486,EAP,Custom 27801486,,Coil Embl 2cm 3mm Mreye 2.1 Loop Pltn A/v Strl,$196.00,$0.00,$196.00,$0.00,$139.89,$0.00,$0.00,$139.89,$139.89,$0.00,$196.00,$0.00,$98.00,$155.23,$156.80,$0.00,$0.00,$0.00,$0.00,$0.00
27801487,EAP,Custom 27801487,,Coil Embl 3cm 2mm Mreye 4.8 Loop .035in Pltn Strl,$196.00,$0.00,$196.00,$0.00,$139.89,$0.00,$0.00,$139.89,$139.89,$0.00,$196.00,$0.00,$98.00,$155.23,$156.80,$0.00,$0.00,$0.00,$0.00,$0.00
27801488,EAP,Custom 27801488,,Coil Embl 3cm 3mm Mreye 3.1 Loop Pltn A/v Strl,$196.00,$0.00,$196.00,$0.00,$139.89,$0.00,$0.00,$139.89,$139.89,$0.00,$196.00,$0.00,$98.00,$155.23,$156.80,$0.00,$0.00,$0.00,$0.00,$0.00
27801489,EAP,Custom 27801489,,Coil Embl 4cm 3mm Mreye 4.2 Loop Pltn A/v Strl,$196.00,$0.00,$196.00,$0.00,$139.89,$0.00,$0.00,$139.89,$139.89,$0.00,$196.00,$0.00,$98.00,$155.23,$156.80,$0.00,$0.00,$0.00,$0.00,$0.00
27801490,EAP,Custom 27801490,,Coil Embl 5cm 6mm Mreye 2.7 Loop End Hole Grt Radl,$196.00,$0.00,$196.00,$0.00,$139.89,$0.00,$0.00,$139.89,$139.89,$0.00,$196.00,$0.00,$98.00,$155.23,$156.80,$0.00,$0.00,$0.00,$0.00,$0.00
27801491,EAP,Custom 27801491,,Coil Embl 5cm 7mm Mreye 2.3 Loop .035in Pltn Strl,$196.00,$0.00,$196.00,$0.00,$139.89,$0.00,$0.00,$139.89,$139.89,$0.00,$196.00,$0.00,$98.00,$155.23,$156.80,$0.00,$0.00,$0.00,$0.00,$0.00
27801492,EAP,Custom 27801492,,Coil Embl 5cm 10mm Mreye 1.6 Loop Pltn Acpt .035in,$196.00,$0.00,$196.00,$0.00,$139.89,$0.00,$0.00,$139.89,$139.89,$0.00,$196.00,$0.00,$98.00,$155.23,$156.80,$0.00,$0.00,$0.00,$0.00,$0.00
27801493,EAP,Custom 27801493,,Coil Embl 8cm 5mm Mreye 5.1 Loop .035in Pltn Strl,$196.00,$0.00,$196.00,$0.00,$139.89,$0.00,$0.00,$139.89,$139.89,$0.00,$196.00,$0.00,$98.00,$155.23,$156.80,$0.00,$0.00,$0.00,$0.00,$0.00
27801494,EAP,HCPCS C1752,,Tray Catheter Power-trialysis Straight L30 Cm Od13,$693.00,$0.00,$693.00,$0.00,$494.59,$0.00,$0.00,$494.59,$494.59,$0.00,$693.00,$0.00,$346.50,$548.86,$554.40,$0.00,$0.00,$0.00,$0.00,$0.00
27801495,EAP,Custom 27801495,,Coil Embl 8cm 8mm Mreye 3.2 Loop .035in Pltn Strl,$196.00,$0.00,$196.00,$0.00,$139.89,$0.00,$0.00,$139.89,$139.89,$0.00,$196.00,$0.00,$98.00,$155.23,$156.80,$0.00,$0.00,$0.00,$0.00,$0.00
27801496,EAP,Custom 27801496,,Coil Embl 8cm 10mm Mreye 2.5 Loop .035in Pltn Strl,$196.00,$0.00,$196.00,$0.00,$139.89,$0.00,$0.00,$139.89,$139.89,$0.00,$196.00,$0.00,$98.00,$155.23,$156.80,$0.00,$0.00,$0.00,$0.00,$0.00
27801497,EAP,HCPCS C1788,,Port Implinfn 11.4fr 12fr Vtx Peelpro 2 Dtch Cath,"$1,455.00",$0.00,"$1,455.00",$654.75,"$1,038.43",$0.00,$250.69,"$1,038.43","$1,038.43",$254.76,"$1,455.00",$0.00,$727.50,"$1,152.36","$1,164.00",$0.00,$227.71,$0.00,$231.64,$0.00
27801498,EAP,HCPCS C1757,,Solitaire Catheter Thrombectomy 6x40,"$10,563.00",$0.00,"$10,563.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$7,538.81",$0.00,"$10,563.00",$0.00,"$5,281.50","$8,365.90","$8,450.40",$0.00,$0.00,$0.00,$0.00,$0.00
27801499,EAP,HCPCS C1777,,Lead Pcng 62cm Rv Trplr Scr In Xtd-retrac Hlx,"$6,100.00",$0.00,"$6,100.00","$2,745.00","$4,353.57",$0.00,"$1,051.00","$4,353.57","$4,353.57","$1,068.06","$6,100.00",$0.00,"$3,050.00","$4,831.20","$4,880.00",$0.00,$954.65,$0.00,$971.12,$0.00
27801500,EAP,Custom 27801500,,Coil Embl .018in 2mm 2cm Azur Cx Hdrcl Dtch Loop S,"$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,"$1,516.61","$1,516.61",$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
27801501,EAP,Custom 27801501,,Coil Embl .018in 2mm 4cm Azur Cx Hdrcl Dtch Loop S,"$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,"$1,516.61","$1,516.61",$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
27801502,EAP,Custom 27801502,,Coil Embl .018in 3mm 4cm Azur Cx Hdrcl Dtch Loop S,"$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,"$1,516.61","$1,516.61",$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
27801503,EAP,Custom 27801503,,Coil Embl .018in 3mm 8cm Azur Cx Hdrcl Dtch Loop S,"$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,"$1,516.61","$1,516.61",$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
27801504,EAP,HCPCS C1752,,Catheter Hmdial Lg 12.5fr 16cm Grn Mhrkr Elt Dbl-d,$178.00,$0.00,$178.00,$0.00,$127.04,$0.00,$0.00,$127.04,$127.04,$0.00,$178.00,$0.00,$89.00,$140.98,$142.40,$0.00,$0.00,$0.00,$0.00,$0.00
27801505,EAP,HCPCS C1752,,Catheter Hmdial Lg 12.5fr 20cm Grn Mhrkr Elt Dbl-d,$178.00,$0.00,$178.00,$0.00,$127.04,$0.00,$0.00,$127.04,$127.04,$0.00,$178.00,$0.00,$89.00,$140.98,$142.40,$0.00,$0.00,$0.00,$0.00,$0.00
27801507,EAP,HCPCS C1764,,System Crd Monitr Rvl Linq Ins,$0.01,$0.00,$0.01,$0.00,$0.01,$0.00,$0.00,$0.01,$0.01,$0.00,$0.01,$0.00,$0.01,$0.01,$0.01,$0.00,$0.00,$0.00,$0.00,$0.00
27801508,EAP,Custom 27801508,,Device Perclose,$0.01,$0.00,$0.01,$0.00,$0.01,$0.00,$0.00,$0.01,$0.01,$0.00,$0.01,$0.00,$0.01,$0.01,$0.01,$0.00,$0.00,$0.00,$0.00,$0.00
27801509,EAP,HCPCS C1760,,Device Closure 8fr .038in 70cm Hemostatic Bioabsor,$525.00,$0.00,$525.00,$236.25,$374.69,$0.00,$90.45,$374.69,$374.69,$91.92,$525.00,$0.00,$262.50,$415.80,$420.00,$0.00,$82.16,$0.00,$83.58,$0.00
27801510,EAP,HCPCS C1876,,Stent Vascular Taper 8-6mm 30mm Self Expandable Er,"$6,113.00",$0.00,"$4,841.50",$0.00,$0.00,$0.00,"$1,053.24",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,841.50",$0.00,$0.00,$956.68,$0.00,$0.00,$0.00
27801520,EAP,HCPCS C1874,,Stent Eprsth 5mm 5cm Strl 120cm Vbhn Flxb Slf Xpd,"$8,188.00",$0.00,"$8,188.00","$3,684.60","$5,158.80",$0.00,"$1,410.75","$5,158.80","$5,843.78","$1,433.65","$8,188.00",$0.00,"$4,094.00","$6,484.90","$6,550.40",$0.00,"$1,281.42",$0.00,"$1,303.53",$0.00
27801521,EAP,Custom 27801521,,Implant Ep Pack,$162.00,$0.00,$162.00,$0.00,$115.62,$0.00,$0.00,$115.62,$115.62,$0.00,$162.00,$0.00,$81.00,$128.30,$129.60,$0.00,$0.00,$0.00,$0.00,$0.00
27801522,EAP,Custom 27801522,,Coil Embl 15cm 12mm .038in Azur Dtch .035in Pltn,"$2,975.00",$0.00,"$2,975.00",$0.00,"$2,123.26",$0.00,$0.00,"$2,123.26","$2,123.26",$0.00,"$2,975.00",$0.00,"$1,487.50","$2,356.20","$2,380.00",$0.00,$0.00,$0.00,$0.00,$0.00
27801523,EAP,Custom 27801523,,Coil Embl 20cm 10mm Azur Dtch Ddrgl Peri 35 Sys,"$3,188.00",$0.00,"$3,188.00",$0.00,"$2,275.28",$0.00,$0.00,"$2,275.28","$2,275.28",$0.00,"$3,188.00",$0.00,"$1,594.00","$2,524.90","$2,550.40",$0.00,$0.00,$0.00,$0.00,$0.00
27801524,EAP,Custom 27801524,,Coil Embl 15cm 15mm Azur Hdrcl 18 Coils Dtch,"$2,127.00",$0.00,"$2,127.00",$0.00,"$1,518.04",$0.00,$0.00,"$1,518.04","$1,518.04",$0.00,"$2,127.00",$0.00,"$1,063.50","$1,684.58","$1,701.60",$0.00,$0.00,$0.00,$0.00,$0.00
27801525,EAP,Custom 27801525,,Coil Embl 20cm 10mm Azur Hdrcl 18 Coils Dtch,"$2,249.00",$0.00,"$2,249.00",$0.00,"$1,605.11",$0.00,$0.00,"$1,605.11","$1,605.11",$0.00,"$2,249.00",$0.00,"$1,124.50","$1,781.21","$1,799.20",$0.00,$0.00,$0.00,$0.00,$0.00
27801526,EAP,Custom 27801526,,Coil Embl 20cm 8mm .022in Azur Hdrcl Frme 6 Loop,"$1,020.00",$0.00,"$1,020.00",$0.00,$727.97,$0.00,$0.00,$727.97,$727.97,$0.00,"$1,020.00",$0.00,$510.00,$807.84,$816.00,$0.00,$0.00,$0.00,$0.00,$0.00
27801527,EAP,Custom 27801527,,Coil Embl 34cm 14mm Azur Hdrcl Dtch Nonhydrogel,"$2,975.00",$0.00,"$2,975.00",$0.00,"$2,123.26",$0.00,$0.00,"$2,123.26","$2,123.26",$0.00,"$2,975.00",$0.00,"$1,487.50","$2,356.20","$2,380.00",$0.00,$0.00,$0.00,$0.00,$0.00
27801528,EAP,Custom 27801528,,Coil Embl 4mm .018in 15cm  Azur Dtch Pltn,"$2,127.00",$0.00,"$2,127.00",$0.00,"$1,518.04",$0.00,$0.00,"$1,518.04","$1,518.04",$0.00,"$2,127.00",$0.00,"$1,063.50","$1,684.58","$1,701.60",$0.00,$0.00,$0.00,$0.00,$0.00
27801529,EAP,Custom 27801529,,Coil Embl 3mm .018in 10cm  Azur Dtch Pltn,"$1,987.00",$0.00,"$1,987.00",$0.00,"$1,418.12",$0.00,$0.00,"$1,418.12","$1,418.12",$0.00,"$1,987.00",$0.00,$993.50,"$1,573.70","$1,589.60",$0.00,$0.00,$0.00,$0.00,$0.00
27801530,EAP,Custom 27801530,,Coil Embl 6mm .018in 20cm  Azur Dtch Pltn,"$2,244.00",$0.00,"$2,244.00",$0.00,"$1,601.54",$0.00,$0.00,"$1,601.54","$1,601.54",$0.00,"$2,244.00",$0.00,"$1,122.00","$1,777.25","$1,795.20",$0.00,$0.00,$0.00,$0.00,$0.00
27801531,EAP,Custom 27801531,,Coil Embl 4mm .018in 20cm  Azur Dtch Pltn,"$2,244.00",$0.00,"$2,244.00",$0.00,"$1,601.54",$0.00,$0.00,"$1,601.54","$1,601.54",$0.00,"$2,244.00",$0.00,"$1,122.00","$1,777.25","$1,795.20",$0.00,$0.00,$0.00,$0.00,$0.00
27802002,EAP,Custom 27802002,,Coil Embl 14cm 6mm Nst 7.4 Loop Sft Radopc .018in,$270.00,$0.00,$270.00,$0.00,$192.70,$0.00,$0.00,$192.70,$192.70,$0.00,$270.00,$0.00,$135.00,$213.84,$216.00,$0.00,$0.00,$0.00,$0.00,$0.00
27802003,EAP,Custom 27802003,,Coil Embl 14cm 8mm Nst 5.6 Loop Sft Radopc .018in,$270.00,$0.00,$270.00,$0.00,$192.70,$0.00,$0.00,$192.70,$192.70,$0.00,$270.00,$0.00,$135.00,$213.84,$216.00,$0.00,$0.00,$0.00,$0.00,$0.00
27802004,EAP,Custom 27802004,,Coil Embl 14cm 10mm Nst 4.5 Loop Sft Radopc .018in,$270.00,$0.00,$270.00,$0.00,$192.70,$0.00,$0.00,$192.70,$192.70,$0.00,$270.00,$0.00,$135.00,$213.84,$216.00,$0.00,$0.00,$0.00,$0.00,$0.00
27802005,EAP,Custom 27802005,,Coil Embl 14cm 8mm Nst 5.6 Loop Pltn Synth Fbr Art,$270.00,$0.00,$270.00,$0.00,$192.70,$0.00,$0.00,$192.70,$192.70,$0.00,$270.00,$0.00,$135.00,$213.84,$216.00,$0.00,$0.00,$0.00,$0.00,$0.00
27802006,EAP,Custom 27802006,,Coil Embl 14cm 10mm Nst 4.5 Loop Sft .035in Pltn,$270.00,$0.00,$270.00,$0.00,$192.70,$0.00,$0.00,$192.70,$192.70,$0.00,$270.00,$0.00,$135.00,$213.84,$216.00,$0.00,$0.00,$0.00,$0.00,$0.00
27802008,EAP,Custom 27802008,,Coil Embl 9.5cm 8-4mm Trnd Mcl Mciol Sft Spc Push,$270.00,$0.00,$270.00,$0.00,$192.70,$0.00,$0.00,$192.70,$192.70,$0.00,$270.00,$0.00,$135.00,$213.84,$216.00,$0.00,$0.00,$0.00,$0.00,$0.00
27802009,EAP,Custom 27802009,,Coil Embl 4.1cm 5-3mm Trnd Sft .035in Std Sm Pltn,$270.00,$0.00,$270.00,$0.00,$192.70,$0.00,$0.00,$192.70,$192.70,$0.00,$270.00,$0.00,$135.00,$213.84,$216.00,$0.00,$0.00,$0.00,$0.00,$0.00
27802010,EAP,Custom 27802010,,Coil Embl 8cm 7-3mm Trnd Pltn Arteriovenous Acpt,$270.00,$0.00,$270.00,$0.00,$192.70,$0.00,$0.00,$192.70,$192.70,$0.00,$270.00,$0.00,$135.00,$213.84,$216.00,$0.00,$0.00,$0.00,$0.00,$0.00
27802011,EAP,Custom 27802011,,Coil Embl 14cm 6mm Nst Sft Cath Xtd Embl Endhole,$270.00,$0.00,$270.00,$0.00,$192.70,$0.00,$0.00,$192.70,$192.70,$0.00,$270.00,$0.00,$135.00,$213.84,$216.00,$0.00,$0.00,$0.00,$0.00,$0.00
27802012,EAP,Custom 27802012,,Coil Embl 7cm 4mm Nst 5.6 Loop Sft Enh Radopc .035,$249.00,$0.00,$249.00,$0.00,$177.71,$0.00,$0.00,$177.71,$177.71,$0.00,$249.00,$0.00,$124.50,$197.21,$199.20,$0.00,$0.00,$0.00,$0.00,$0.00
27802013,EAP,Custom 27802013,,Coil Embolization .035in 10mm 7cm 2.2 Loop Soft Enhanced,$249.00,$0.00,$249.00,$0.00,$177.71,$0.00,$0.00,$177.71,$177.71,$0.00,$249.00,$0.00,$124.50,$197.21,$199.20,$0.00,$0.00,$0.00,$0.00,$0.00
27802014,EAP,Custom 27802014,,Coil Embl 14cm 20mm Nst 2.2 Loop Sft Enh Radopc,$270.00,$0.00,$270.00,$0.00,$192.70,$0.00,$0.00,$192.70,$192.70,$0.00,$270.00,$0.00,$135.00,$213.84,$216.00,$0.00,$0.00,$0.00,$0.00,$0.00
27802015,EAP,Custom 27802015,,Coil Embl 3cm 2mm Nst 4.8 Loop Sft Enh Radopc,$229.00,$0.00,$229.00,$0.00,$163.44,$0.00,$0.00,$163.44,$163.44,$0.00,$229.00,$0.00,$114.50,$181.37,$183.20,$0.00,$0.00,$0.00,$0.00,$0.00
27802016,EAP,Custom 27802016,,Coil Embl 3cm 3mm Nst 3.2 Loop Sft Enh Radopc,$229.00,$0.00,$229.00,$0.00,$163.44,$0.00,$0.00,$163.44,$163.44,$0.00,$229.00,$0.00,$114.50,$181.37,$183.20,$0.00,$0.00,$0.00,$0.00,$0.00
27802017,EAP,Custom 27802017,,Coil Embl 5cm 3mm Nst 5.3 Loop Sft Enh Radopc,$229.00,$0.00,$229.00,$0.00,$163.44,$0.00,$0.00,$163.44,$163.44,$0.00,$229.00,$0.00,$114.50,$181.37,$183.20,$0.00,$0.00,$0.00,$0.00,$0.00
27802018,EAP,Custom 27802018,,Coil Embl 7cm 6mm Nst 3.7 Loop Sft Enh Radopc .035,$249.00,$0.00,$249.00,$0.00,$177.71,$0.00,$0.00,$177.71,$177.71,$0.00,$249.00,$0.00,$124.50,$197.21,$199.20,$0.00,$0.00,$0.00,$0.00,$0.00
27802020,EAP,Custom 27802020,,Coil Embl 14cm 16mm Nst 2.8 Loop Sft Xtd Enh,$270.00,$0.00,$270.00,$0.00,$192.70,$0.00,$0.00,$192.70,$192.70,$0.00,$270.00,$0.00,$135.00,$213.84,$216.00,$0.00,$0.00,$0.00,$0.00,$0.00
27802021,EAP,Custom 27802021,,Coil Embl 7cm 3mm Nst 7.4 Loop Sft Enh Radopc,$249.00,$0.00,$249.00,$0.00,$177.71,$0.00,$0.00,$177.71,$177.71,$0.00,$249.00,$0.00,$124.50,$197.21,$199.20,$0.00,$0.00,$0.00,$0.00,$0.00
27802022,EAP,Custom 27802022,,Coil Embl 7cm 4mm .018in Nst Cath Loop Sft Str Wg,$249.00,$0.00,$249.00,$0.00,$177.71,$0.00,$0.00,$177.71,$177.71,$0.00,$249.00,$0.00,$124.50,$197.21,$199.20,$0.00,$0.00,$0.00,$0.00,$0.00
27802023,EAP,Custom 27802023,,Coil Embl 2cm 3-2mm Trnd Mciol Mlfrm Sft .018in,$270.00,$0.00,$270.00,$0.00,$192.70,$0.00,$0.00,$192.70,$192.70,$0.00,$270.00,$0.00,$135.00,$213.84,$216.00,$0.00,$0.00,$0.00,$0.00,$0.00
27802024,EAP,Custom 27802024,,Coil Embl 7cm 3mm Nst 7.4 Loop Pltn Synth Fbr Strl,$249.00,$0.00,$249.00,$0.00,$177.71,$0.00,$0.00,$177.71,$177.71,$0.00,$249.00,$0.00,$124.50,$197.21,$199.20,$0.00,$0.00,$0.00,$0.00,$0.00
27802025,EAP,HCPCS C1882,,Quadra Assura Mp Crt-d,"$42,750.00",$0.00,"$42,750.00","$19,237.50","$5,158.80",$0.00,"$7,365.61","$5,158.80","$30,510.68","$7,485.18","$42,750.00",$0.00,"$21,375.00","$33,858.00","$34,200.00",$0.00,"$6,690.38",$0.00,"$6,805.80",$0.00
27802026,EAP,HCPCS C1882,,Quadra Assura Mp Crt-d Df4 Connector,"$42,750.00",$0.00,"$42,750.00","$19,237.50","$5,158.80",$0.00,"$7,365.61","$5,158.80","$30,510.68","$7,485.18","$42,750.00",$0.00,"$21,375.00","$33,858.00","$34,200.00",$0.00,"$6,690.38",$0.00,"$6,805.80",$0.00
27802027,EAP,HCPCS C1882,,"Quadra Assura Mp Crt-d, Merlinpkg","$43,875.00",$0.00,"$43,875.00","$19,743.75","$5,158.80",$0.00,"$7,559.44","$5,158.80","$31,313.59","$7,682.16","$43,875.00",$0.00,"$21,937.50","$34,749.00","$35,100.00",$0.00,"$6,866.44",$0.00,"$6,984.90",$0.00
27802028,EAP,HCPCS C1882,,"Quadra Assura Mp Crt-d Df4, Merlinpkg","$43,875.00",$0.00,"$43,875.00","$19,743.75","$5,158.80",$0.00,"$7,559.44","$5,158.80","$31,313.59","$7,682.16","$43,875.00",$0.00,"$21,937.50","$34,749.00","$35,100.00",$0.00,"$6,866.44",$0.00,"$6,984.90",$0.00
27802029,EAP,HCPCS C1882,,Quadra Assura Mp Crt-d System,"$56,250.00",$0.00,"$56,250.00","$25,312.50","$5,158.80",$0.00,"$8,138.89","$5,158.80","$40,145.63","$8,138.89","$56,250.00",$0.00,"$28,125.00","$44,550.00","$45,000.00",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27802030,EAP,HCPCS C1882,,Quadra Assura Mp Crt-d Df4 Connector System,"$56,250.00",$0.00,"$56,250.00","$25,312.50","$5,158.80",$0.00,"$8,138.89","$5,158.80","$40,145.63","$8,138.89","$56,250.00",$0.00,"$28,125.00","$44,550.00","$45,000.00",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27802031,EAP,HCPCS C1882,,"Quadra Assura Mp Crt-d System, Merlinpkg","$58,500.00",$0.00,"$58,500.00","$26,325.00","$5,158.80",$0.00,"$8,138.89","$5,158.80","$41,751.45","$8,138.89","$58,500.00",$0.00,"$29,250.00","$46,332.00","$46,800.00",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27802032,EAP,HCPCS C1882,,"Quadra Assura Mp Crt-d Df4 System, Merlinpkg","$58,500.00",$0.00,"$58,500.00","$26,325.00","$5,158.80",$0.00,"$8,138.89","$5,158.80","$41,751.45","$8,138.89","$58,500.00",$0.00,"$29,250.00","$46,332.00","$46,800.00",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27802033,EAP,HCPCS C1900,,"Quartet, Small-s 75cm","$5,375.00",$0.00,"$5,375.00",$0.00,"$3,836.14",$0.00,$926.09,"$3,836.14","$3,836.14",$0.00,"$5,375.00",$0.00,"$2,687.50","$4,257.00","$4,300.00",$0.00,$841.19,$0.00,$0.00,$0.00
27802034,EAP,HCPCS C1900,,"Quartet, Small-s 86cm","$5,375.00",$0.00,"$5,375.00",$0.00,"$3,836.14",$0.00,$926.09,"$3,836.14","$3,836.14",$0.00,"$5,375.00",$0.00,"$2,687.50","$4,257.00","$4,300.00",$0.00,$841.19,$0.00,$0.00,$0.00
27802035,EAP,HCPCS C1900,,"Quartet, Wide Spacing 75cm","$5,375.00",$0.00,"$5,375.00",$0.00,"$3,836.14",$0.00,$926.09,"$3,836.14","$3,836.14",$0.00,"$5,375.00",$0.00,"$2,687.50","$4,257.00","$4,300.00",$0.00,$841.19,$0.00,$0.00,$0.00
27802036,EAP,HCPCS C1900,,"Quartet, Wide Spacing 86cm","$5,375.00",$0.00,"$5,375.00",$0.00,"$3,836.14",$0.00,$926.09,"$3,836.14","$3,836.14",$0.00,"$5,375.00",$0.00,"$2,687.50","$4,257.00","$4,300.00",$0.00,$841.19,$0.00,$0.00,$0.00
27802040,EAP,HCPCS C1874,,Stent Vasc 80mm 6mm Gore Tigris Cbas Ntnl Flplmr,"$3,738.00",$0.00,"$3,738.00","$1,682.10","$2,667.81",$0.00,$644.04,"$2,667.81","$2,667.81",$654.49,"$3,738.00",$0.00,"$1,869.00","$2,960.50","$2,990.40",$0.00,$585.00,$0.00,$595.09,$0.00
27802041,EAP,HCPCS C1874,,Stent Vasc 60mm 5mm Gore Tigris Cbas Ntnl Flplmr,"$3,738.00",$0.00,"$3,738.00","$1,682.10","$2,667.81",$0.00,$644.04,"$2,667.81","$2,667.81",$654.49,"$3,738.00",$0.00,"$1,869.00","$2,960.50","$2,990.40",$0.00,$585.00,$0.00,$595.09,$0.00
27802042,EAP,HCPCS C1874,,Stent Vasc 80mm 5mm Gore Tigris Cbas Ntnl Flplmr,"$3,738.00",$0.00,"$3,738.00","$1,682.10","$2,667.81",$0.00,$644.04,"$2,667.81","$2,667.81",$654.49,"$3,738.00",$0.00,"$1,869.00","$2,960.50","$2,990.40",$0.00,$585.00,$0.00,$595.09,$0.00
27802044,EAP,HCPCS C1874,,Stent Vasc 40mm 6mm Gore Tigris Cbas Ntnl Flplmr,"$3,738.00",$0.00,"$3,738.00","$1,682.10","$2,667.81",$0.00,$644.04,"$2,667.81","$2,667.81",$654.49,"$3,738.00",$0.00,"$1,869.00","$2,960.50","$2,990.40",$0.00,$585.00,$0.00,$595.09,$0.00
27802045,EAP,HCPCS C1874,,Stent Vasc 60mm 6mm Gore Tigris Cbas Ntnl Flplmr,"$3,738.00",$0.00,"$3,738.00","$1,682.10","$2,667.81",$0.00,$644.04,"$2,667.81","$2,667.81",$654.49,"$3,738.00",$0.00,"$1,869.00","$2,960.50","$2,990.40",$0.00,$585.00,$0.00,$595.09,$0.00
27802046,EAP,HCPCS C1874,,Stent Coron 40mm 5mm Gore Tigris Vasc Cbas Ntnl,"$3,738.00",$0.00,"$3,738.00","$1,682.10","$2,667.81",$0.00,$644.04,"$2,667.81","$2,667.81",$654.49,"$3,738.00",$0.00,"$1,869.00","$2,960.50","$2,990.40",$0.00,$585.00,$0.00,$595.09,$0.00
27802047,EAP,HCPCS C1874,,Stent Vasc 100mm 6mm Gore Tigris Cbas Ntnl Flplmr,"$3,738.00",$0.00,"$3,738.00","$1,682.10","$2,667.81",$0.00,$644.04,"$2,667.81","$2,667.81",$654.49,"$3,738.00",$0.00,"$1,869.00","$2,960.50","$2,990.40",$0.00,$585.00,$0.00,$595.09,$0.00
27802048,EAP,HCPCS C1874,,Stent Vasc 40mm 7mm Gore Tigris Cbas Ntnl Flplmr,"$3,738.00",$0.00,"$3,738.00","$1,682.10","$2,667.81",$0.00,$644.04,"$2,667.81","$2,667.81",$654.49,"$3,738.00",$0.00,"$1,869.00","$2,960.50","$2,990.40",$0.00,$585.00,$0.00,$595.09,$0.00
27802050,EAP,HCPCS C1874,,Stent Vasc 80mm 7mm Gore Tigris Cbas Ntnl Flplmr,"$3,738.00",$0.00,"$3,738.00","$1,682.10","$2,667.81",$0.00,$644.04,"$2,667.81","$2,667.81",$654.49,"$3,738.00",$0.00,"$1,869.00","$2,960.50","$2,990.40",$0.00,$585.00,$0.00,$595.09,$0.00
27802051,EAP,HCPCS C1874,,Stent Vasc 100mm 7mm Gore Tigris Cbas Ntnl Flplmr,"$3,738.00",$0.00,"$3,738.00","$1,682.10","$2,667.81",$0.00,$644.04,"$2,667.81","$2,667.81",$654.49,"$3,738.00",$0.00,"$1,869.00","$2,960.50","$2,990.40",$0.00,$585.00,$0.00,$595.09,$0.00
27803013,EAP,HCPCS C1781,,Mesh Implt,$650.00,$0.00,$650.00,$292.50,$463.91,$0.00,$111.99,$463.91,$463.91,$113.81,$650.00,$0.00,$325.00,$514.80,$520.00,$0.00,$101.73,$0.00,$103.48,$0.00
27803015,EAP,Custom 27803015,,Coil Embolization .018in Standard Length 2d 2mm 4c,$943.00,$0.00,$943.00,$0.00,$673.02,$0.00,$0.00,$673.02,$673.02,$0.00,$943.00,$0.00,$471.50,$746.86,$754.40,$0.00,$0.00,$0.00,$0.00,$0.00
27803030,EAP,HCPCS C1897,,Sjm Percutaneous Lead,"$2,869.00",$0.00,"$2,869.00",$0.00,"$2,047.61",$0.00,$0.00,"$2,047.61","$2,047.61",$0.00,"$2,869.00",$0.00,"$1,434.50","$2,272.25","$2,295.20",$0.00,$0.00,$0.00,$0.00,$0.00
27803050,EAP,Custom 27803050,,Biliary Metal Stents,"$5,087.00",$0.00,"$5,087.00",$0.00,"$3,630.59",$0.00,$0.00,"$3,630.59","$3,630.59",$0.00,"$5,087.00",$0.00,"$2,543.50","$4,028.90","$4,069.60",$0.00,$0.00,$0.00,$0.00,$0.00
27803051,EAP,Custom 27803051,,Ultraflex Diamond Metal Stent,"$9,045.00",$0.00,"$9,045.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$6,455.42",$0.00,"$9,045.00",$0.00,"$4,522.50","$7,163.64","$7,236.00",$0.00,$0.00,$0.00,$0.00,$0.00
27803052,EAP,Custom 27803052,,Polyflex Esophageal Stent,"$13,618.00",$0.00,"$13,618.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,719.17",$0.00,"$13,618.00",$0.00,"$6,809.00","$10,785.46","$10,894.40",$0.00,$0.00,$0.00,$0.00,$0.00
27803053,EAP,Custom 27803053,,Stent Coron 8mm 2.5mm Abs Gt1 Poly L Lactd Pld,"$3,625.00",$0.00,"$3,625.00",$0.00,"$2,587.16",$0.00,$0.00,"$2,587.16","$2,587.16",$0.00,"$3,625.00",$0.00,"$1,812.50","$2,871.00","$2,900.00",$0.00,$0.00,$0.00,$0.00,$0.00
27803055,EAP,HCPCS C1874,,Stent Coron 12mm 2.5mm Abs Gt1 Poly L Lactd Pld,"$3,625.00",$0.00,"$3,625.00","$1,631.25","$2,587.16",$0.00,$624.57,"$2,587.16","$2,587.16",$634.71,"$3,625.00",$0.00,"$1,812.50","$2,871.00","$2,900.00",$0.00,$567.31,$0.00,$577.10,$0.00
27803056,EAP,HCPCS C1874,,Stent Coron 18mm 2.5mm Abs Gt1 Poly L Lactd Pld,"$3,625.00",$0.00,"$3,625.00","$1,631.25","$2,587.16",$0.00,$624.57,"$2,587.16","$2,587.16",$634.71,"$3,625.00",$0.00,"$1,812.50","$2,871.00","$2,900.00",$0.00,$567.31,$0.00,$577.10,$0.00
27803057,EAP,HCPCS C1874,,Stent Coron 23mm 2.5mm Abs Gt1 Poly L Lactd Pld,"$3,625.00",$0.00,"$3,625.00","$1,631.25","$2,587.16",$0.00,$624.57,"$2,587.16","$2,587.16",$634.71,"$3,625.00",$0.00,"$1,812.50","$2,871.00","$2,900.00",$0.00,$567.31,$0.00,$577.10,$0.00
27803058,EAP,HCPCS C1874,,Stent Coron 28mm 2.5mm Abs Gt1 Poly L Lactd Pld,"$3,625.00",$0.00,"$3,625.00","$1,631.25","$2,587.16",$0.00,$624.57,"$2,587.16","$2,587.16",$634.71,"$3,625.00",$0.00,"$1,812.50","$2,871.00","$2,900.00",$0.00,$567.31,$0.00,$577.10,$0.00
27803059,EAP,HCPCS C1874,,Stent Coron 8mm 3mm Abs Gt1 Poly L Lactd Pld Lactd,"$3,625.00",$0.00,"$3,625.00","$1,631.25","$2,587.16",$0.00,$624.57,"$2,587.16","$2,587.16",$634.71,"$3,625.00",$0.00,"$1,812.50","$2,871.00","$2,900.00",$0.00,$567.31,$0.00,$577.10,$0.00
27803061,EAP,HCPCS C1874,,Stent Coron 12mm 3mm Abs Gt1 Poly L Lactd Pld,"$3,625.00",$0.00,"$3,625.00","$1,631.25","$2,587.16",$0.00,$624.57,"$2,587.16","$2,587.16",$634.71,"$3,625.00",$0.00,"$1,812.50","$2,871.00","$2,900.00",$0.00,$567.31,$0.00,$577.10,$0.00
27803062,EAP,HCPCS C1874,,Stent Coron 18mm 3mm Abs Gt1 Poly L Lactd Pld,"$3,625.00",$0.00,"$3,625.00","$1,631.25","$2,587.16",$0.00,$624.57,"$2,587.16","$2,587.16",$634.71,"$3,625.00",$0.00,"$1,812.50","$2,871.00","$2,900.00",$0.00,$567.31,$0.00,$577.10,$0.00
27803063,EAP,HCPCS C1874,,Stent Coron 23mm 3mm Abs Gt1 Poly L Lactd Pld,"$3,625.00",$0.00,"$3,625.00","$1,631.25","$2,587.16",$0.00,$624.57,"$2,587.16","$2,587.16",$634.71,"$3,625.00",$0.00,"$1,812.50","$2,871.00","$2,900.00",$0.00,$567.31,$0.00,$577.10,$0.00
27803064,EAP,HCPCS C1874,,Stent Coron 28mm 3mm Abs Gt1 Poly L Lactd Pld,"$3,625.00",$0.00,"$3,625.00","$1,631.25","$2,587.16",$0.00,$624.57,"$2,587.16","$2,587.16",$634.71,"$3,625.00",$0.00,"$1,812.50","$2,871.00","$2,900.00",$0.00,$567.31,$0.00,$577.10,$0.00
27803065,EAP,HCPCS C1874,,Stent Coron 12mm 3.5mm Abs Gt1 Poly L Lactd Pld,"$3,625.00",$0.00,"$3,625.00","$1,631.25","$2,587.16",$0.00,$624.57,"$2,587.16","$2,587.16",$634.71,"$3,625.00",$0.00,"$1,812.50","$2,871.00","$2,900.00",$0.00,$567.31,$0.00,$577.10,$0.00
27803066,EAP,HCPCS C1874,,Stent Coron 18mm 3.5mm Abs Gt1 Poly L Lactd Pld,"$3,625.00",$0.00,"$3,625.00","$1,631.25","$2,587.16",$0.00,$624.57,"$2,587.16","$2,587.16",$634.71,"$3,625.00",$0.00,"$1,812.50","$2,871.00","$2,900.00",$0.00,$567.31,$0.00,$577.10,$0.00
27803067,EAP,HCPCS C1874,,Stent Coron 23mm 3.5mm Abs Gt1 Poly L Lactd Pld,"$3,625.00",$0.00,"$3,625.00","$1,631.25","$2,587.16",$0.00,$624.57,"$2,587.16","$2,587.16",$634.71,"$3,625.00",$0.00,"$1,812.50","$2,871.00","$2,900.00",$0.00,$567.31,$0.00,$577.10,$0.00
27803068,EAP,HCPCS C1874,,Stent Coron 28mm 3.5mm Abs Gt1 Poly L Lactd Pld,"$3,625.00",$0.00,"$3,625.00","$1,631.25","$2,587.16",$0.00,$624.57,"$2,587.16","$2,587.16",$634.71,"$3,625.00",$0.00,"$1,812.50","$2,871.00","$2,900.00",$0.00,$567.31,$0.00,$577.10,$0.00
27803070,EAP,Custom 27803070,,Rx Stent 7x5 Cm,$169.00,$0.00,$169.00,$0.00,$120.62,$0.00,$0.00,$120.62,$120.62,$0.00,$169.00,$0.00,$84.50,$133.85,$135.20,$0.00,$0.00,$0.00,$0.00,$0.00
27803071,EAP,Custom 27803071,,Rx Stent 7x7 Cm,$161.00,$0.00,$161.00,$0.00,$114.91,$0.00,$0.00,$114.91,$114.91,$0.00,$161.00,$0.00,$80.50,$127.51,$128.80,$0.00,$0.00,$0.00,$0.00,$0.00
27803072,EAP,Custom 27803072,,Rx Stent 7x12 Cm,$161.00,$0.00,$161.00,$0.00,$114.91,$0.00,$0.00,$114.91,$114.91,$0.00,$161.00,$0.00,$80.50,$127.51,$128.80,$0.00,$0.00,$0.00,$0.00,$0.00
27803073,EAP,Custom 27803073,,Rx Stent 10x5,$161.00,$0.00,$161.00,$0.00,$114.91,$0.00,$0.00,$114.91,$114.91,$0.00,$161.00,$0.00,$80.50,$127.51,$128.80,$0.00,$0.00,$0.00,$0.00,$0.00
27803074,EAP,Custom 27803074,,Rx Stent 10x7cm,$161.00,$0.00,$161.00,$0.00,$114.91,$0.00,$0.00,$114.91,$114.91,$0.00,$161.00,$0.00,$80.50,$127.51,$128.80,$0.00,$0.00,$0.00,$0.00,$0.00
27803075,EAP,Custom 27803075,,Rx Stent 10x10 Cm,$161.00,$0.00,$161.00,$0.00,$114.91,$0.00,$0.00,$114.91,$114.91,$0.00,$161.00,$0.00,$80.50,$127.51,$128.80,$0.00,$0.00,$0.00,$0.00,$0.00
27803076,EAP,Custom 27803076,,Rx Stent 10x12 Cm,$161.00,$0.00,$161.00,$0.00,$114.91,$0.00,$0.00,$114.91,$114.91,$0.00,$161.00,$0.00,$80.50,$127.51,$128.80,$0.00,$0.00,$0.00,$0.00,$0.00
27803077,EAP,Custom 27803077,,Rx Stent 8.5 X5 Cm,$161.00,$0.00,$161.00,$0.00,$114.91,$0.00,$0.00,$114.91,$114.91,$0.00,$161.00,$0.00,$80.50,$127.51,$128.80,$0.00,$0.00,$0.00,$0.00,$0.00
27803078,EAP,Custom 27803078,,Rx Stent 8.5 X7cm,$161.00,$0.00,$161.00,$0.00,$114.91,$0.00,$0.00,$114.91,$114.91,$0.00,$161.00,$0.00,$80.50,$127.51,$128.80,$0.00,$0.00,$0.00,$0.00,$0.00
27803079,EAP,Custom 27803079,,Rx Stent 8.5 X 10cm,$161.00,$0.00,$161.00,$0.00,$114.91,$0.00,$0.00,$114.91,$114.91,$0.00,$161.00,$0.00,$80.50,$127.51,$128.80,$0.00,$0.00,$0.00,$0.00,$0.00
27803080,EAP,Custom 27803080,,Rx Stent 8.5x12 Cm,$161.00,$0.00,$161.00,$0.00,$114.91,$0.00,$0.00,$114.91,$114.91,$0.00,$161.00,$0.00,$80.50,$127.51,$128.80,$0.00,$0.00,$0.00,$0.00,$0.00
27803081,EAP,Custom 27803081,,Rx Stent 7x10 Cm,$161.00,$0.00,$161.00,$0.00,$114.91,$0.00,$0.00,$114.91,$114.91,$0.00,$161.00,$0.00,$80.50,$127.51,$128.80,$0.00,$0.00,$0.00,$0.00,$0.00
27803082,EAP,HCPCS C1874,,Graft Evas 74mm 24mm 16fr Znth Sprlz Z-trk Abd,"$7,713.00",$0.00,"$7,713.00","$3,470.85","$5,158.80",$0.00,"$1,328.91","$5,158.80","$5,504.77","$1,350.48","$7,713.00",$0.00,"$3,856.50","$6,108.70","$6,170.40",$0.00,"$1,207.08",$0.00,"$1,227.91",$0.00
27803083,EAP,HCPCS C1874,,Graft Evas 56mm 24mm 6mm 5.3mm Znth Sprlz Aaa Ilc,"$7,713.00",$0.00,"$7,713.00","$3,470.85","$5,158.80",$0.00,"$1,328.91","$5,158.80","$5,504.77","$1,350.48","$7,713.00",$0.00,"$3,856.50","$6,108.70","$6,170.40",$0.00,"$1,207.08",$0.00,"$1,227.91",$0.00
27803090,EAP,HCPCS C1777,,7120 Durata Pkg Lead,"$15,063.00",$0.00,"$15,063.00","$6,778.35","$5,158.80",$0.00,"$2,595.28","$5,158.80","$10,750.46","$2,637.41","$15,063.00",$0.00,"$7,531.50","$11,929.90","$12,050.40",$0.00,"$2,357.36",$0.00,"$2,398.03",$0.00
27803091,EAP,HCPCS C1777,,7121 Durata Pkg Lead,"$15,063.00",$0.00,"$15,063.00","$6,778.35","$5,158.80",$0.00,"$2,595.28","$5,158.80","$10,750.46","$2,637.41","$15,063.00",$0.00,"$7,531.50","$11,929.90","$12,050.40",$0.00,"$2,357.36",$0.00,"$2,398.03",$0.00
27803092,EAP,HCPCS C1874,,Wallflex Esop Pcoverdstent Spv,"$9,055.00",$0.00,"$9,055.00","$4,074.75","$5,158.80",$0.00,"$1,560.13","$5,158.80","$6,462.55","$1,585.46","$9,055.00",$0.00,"$4,527.50","$7,171.56","$7,244.00",$0.00,"$1,417.11",$0.00,"$1,441.56",$0.00
27803093,EAP,HCPCS C1896,,Subcutaneous Ld System 6996-sq,"$8,967.00",$0.00,"$8,967.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$6,399.75",$0.00,"$8,967.00",$0.00,"$4,483.50","$7,101.86","$7,173.60",$0.00,$0.00,$0.00,$0.00,$0.00
27803094,EAP,HCPCS C1877,,Transhepatic Biliary Stent Spv,"$6,456.00",$0.00,"$6,456.00","$2,905.20","$4,607.65",$0.00,"$1,112.34","$4,607.65","$4,607.65","$1,130.39","$6,456.00",$0.00,"$3,228.00","$5,113.15","$5,164.80",$0.00,"$1,010.36",$0.00,"$1,027.80",$0.00
27803095,EAP,HCPCS C1897,,"Lead, Neurostim Test Kit","$3,411.00",$0.00,"$3,411.00",$0.00,"$2,434.43",$0.00,$0.00,"$2,434.43","$2,434.43",$0.00,"$3,411.00",$0.00,"$1,705.50","$2,701.51","$2,728.80",$0.00,$0.00,$0.00,$0.00,$0.00
27803096,EAP,HCPCS C1725,,Pta Dilatation Catheter 18 Spv,"$1,435.00",$0.00,"$1,435.00",$645.75,"$1,024.16",$0.00,$247.24,"$1,024.16","$1,024.16",$251.26,"$1,435.00",$0.00,$717.50,"$1,136.52","$1,148.00",$0.00,$224.58,$0.00,$228.45,$0.00
27803097,EAP,HCPCS C1725,,Pta Dilatation Catheter 16 Spv,"$1,435.00",$0.00,"$1,435.00",$645.75,"$1,024.16",$0.00,$247.24,"$1,024.16","$1,024.16",$251.26,"$1,435.00",$0.00,$717.50,"$1,136.52","$1,148.00",$0.00,$224.58,$0.00,$228.45,$0.00
27803098,EAP,HCPCS C1880,,80078352 - Filter Option Ivc,"$1,429.00",$0.00,"$1,429.00",$643.05,"$1,019.88",$0.00,$246.21,"$1,019.88","$1,019.88",$250.21,"$1,429.00",$0.00,$714.50,"$1,131.77","$1,143.20",$0.00,$223.64,$0.00,$227.50,$0.00
27803099,EAP,HCPCS A4301,,Femoral Arterial Line Kit,$972.00,$0.00,$972.00,$0.00,$693.72,$0.00,$0.00,$693.72,$693.72,$0.00,$972.00,$0.00,$486.00,$769.82,$777.60,$0.00,$0.00,$0.00,$0.00,$0.00
27803100,EAP,HCPCS C2625,,Rx Stent 7x5 Cm,$161.00,$0.00,$161.00,$72.45,$114.91,$0.00,$27.74,$114.91,$114.91,$28.19,$161.00,$0.00,$80.50,$127.51,$128.80,$0.00,$25.20,$0.00,$25.63,$0.00
27803101,EAP,HCPCS C2625,,Rx Stent 7x7 Cm,$161.00,$0.00,$161.00,$72.45,$114.91,$0.00,$27.74,$114.91,$114.91,$28.19,$161.00,$0.00,$80.50,$127.51,$128.80,$0.00,$25.20,$0.00,$25.63,$0.00
27803102,EAP,HCPCS C2625,,Rx Stent 7x10 Cm,$161.00,$0.00,$161.00,$72.45,$114.91,$0.00,$27.74,$114.91,$114.91,$28.19,$161.00,$0.00,$80.50,$127.51,$128.80,$0.00,$25.20,$0.00,$25.63,$0.00
27803103,EAP,HCPCS C2625,,Rx Stent 7x12 Cm,$161.00,$0.00,$161.00,$72.45,$114.91,$0.00,$27.74,$114.91,$114.91,$28.19,$161.00,$0.00,$80.50,$127.51,$128.80,$0.00,$25.20,$0.00,$25.63,$0.00
27803104,EAP,HCPCS C2625,,Rx Stent 10x5,$161.00,$0.00,$161.00,$72.45,$114.91,$0.00,$27.74,$114.91,$114.91,$28.19,$161.00,$0.00,$80.50,$127.51,$128.80,$0.00,$25.20,$0.00,$25.63,$0.00
27803105,EAP,HCPCS C2625,,Rx Stent 10x7cm,$161.00,$0.00,$161.00,$72.45,$114.91,$0.00,$27.74,$114.91,$114.91,$28.19,$161.00,$0.00,$80.50,$127.51,$128.80,$0.00,$25.20,$0.00,$25.63,$0.00
27803106,EAP,HCPCS C2625,,Rx Stent 10x10 Cm,$161.00,$0.00,$161.00,$72.45,$114.91,$0.00,$27.74,$114.91,$114.91,$28.19,$161.00,$0.00,$80.50,$127.51,$128.80,$0.00,$25.20,$0.00,$25.63,$0.00
27803107,EAP,HCPCS C2625,,Rx Stent 10x12 Cm,$161.00,$0.00,$161.00,$72.45,$114.91,$0.00,$27.74,$114.91,$114.91,$28.19,$161.00,$0.00,$80.50,$127.51,$128.80,$0.00,$25.20,$0.00,$25.63,$0.00
27803108,EAP,HCPCS C2625,,Rx Stent 8.5 X5 Cm,$161.00,$0.00,$161.00,$72.45,$114.91,$0.00,$27.74,$114.91,$114.91,$28.19,$161.00,$0.00,$80.50,$127.51,$128.80,$0.00,$25.20,$0.00,$25.63,$0.00
27803109,EAP,HCPCS C2625,,Rx Stent 8.5 X7cm,$161.00,$0.00,$161.00,$72.45,$114.91,$0.00,$27.74,$114.91,$114.91,$28.19,$161.00,$0.00,$80.50,$127.51,$128.80,$0.00,$25.20,$0.00,$25.63,$0.00
27803110,EAP,HCPCS C2625,,Rx Stent 8.5 X 10cm,$161.00,$0.00,$161.00,$72.45,$114.91,$0.00,$27.74,$114.91,$114.91,$28.19,$161.00,$0.00,$80.50,$127.51,$128.80,$0.00,$25.20,$0.00,$25.63,$0.00
27803111,EAP,HCPCS C2625,,Rx Stent 8.5x12 Cm,$161.00,$0.00,$161.00,$72.45,$114.91,$0.00,$27.74,$114.91,$114.91,$28.19,$161.00,$0.00,$80.50,$127.51,$128.80,$0.00,$25.20,$0.00,$25.63,$0.00
27803152,EAP,HCPCS C1760,,Starclose Se,$288.00,$0.00,$288.00,$129.60,$205.55,$0.00,$49.62,$205.55,$205.55,$50.43,$288.00,$0.00,$144.00,$228.10,$230.40,$0.00,$45.07,$0.00,$45.85,$0.00
27803160,EAP,HCPCS C2625,,3.0 Xmm Vision Rx Stent,"$4,987.00",$0.00,"$4,987.00","$2,244.15","$3,559.22",$0.00,$859.24,"$3,559.22","$3,559.22",$873.18,"$4,987.00",$0.00,"$2,493.50","$3,949.70","$3,989.60",$0.00,$780.47,$0.00,$793.93,$0.00
27803161,EAP,HCPCS C2625,,2.50 X 8mm Mini-vision Stent,"$4,987.00",$0.00,"$4,987.00","$2,244.15","$3,559.22",$0.00,$859.24,"$3,559.22","$3,559.22",$873.18,"$4,987.00",$0.00,"$2,493.50","$3,949.70","$3,989.60",$0.00,$780.47,$0.00,$793.93,$0.00
27803162,EAP,Custom 27803162,,Lc Bead 500-700,"$4,654.00",$0.00,"$4,654.00",$0.00,"$3,321.56",$0.00,$0.00,"$3,321.56","$3,321.56",$0.00,"$4,654.00",$0.00,"$2,327.00","$3,685.97","$3,723.20",$0.00,$0.00,$0.00,$0.00,$0.00
27803163,EAP,Custom 27803163,,Lc Bead 300-500,"$4,654.00",$0.00,"$4,654.00",$0.00,"$3,321.56",$0.00,$0.00,"$3,321.56","$3,321.56",$0.00,"$4,654.00",$0.00,"$2,327.00","$3,685.97","$3,723.20",$0.00,$0.00,$0.00,$0.00,$0.00
27803164,EAP,HCPCS C1880,,80078352 - Filter Option Ivc,"$1,429.00",$0.00,"$1,429.00",$643.05,"$1,019.88",$0.00,$246.21,"$1,019.88","$1,019.88",$250.21,"$1,429.00",$0.00,$714.50,"$1,131.77","$1,143.20",$0.00,$223.64,$0.00,$227.50,$0.00
27803172,EAP,HCPCS C1874,,Vbh081502 Catheter Viabahn 8mm,"$5,107.00",$0.00,"$5,107.00","$2,298.15","$3,644.87",$0.00,$879.91,"$3,644.87","$3,644.87",$894.19,"$5,107.00",$0.00,"$2,553.50","$4,044.74","$4,085.60",$0.00,$799.25,$0.00,$813.03,$0.00
27803173,EAP,HCPCS C1874,,Vbh071502 Catheter Viabahn 8mm,"$5,107.00",$0.00,"$5,107.00","$2,298.15","$3,644.87",$0.00,$879.91,"$3,644.87","$3,644.87",$894.19,"$5,107.00",$0.00,"$2,553.50","$4,044.74","$4,085.60",$0.00,$799.25,$0.00,$813.03,$0.00
27803184,EAP,HCPCS C1894,,9fr-30 Tear-away Introducer,$579.00,$0.00,$579.00,$260.55,$413.23,$0.00,$99.76,$413.23,$413.23,$101.38,$579.00,$0.00,$289.50,$458.57,$463.20,$0.00,$90.61,$0.00,$92.18,$0.00
27803185,EAP,HCPCS C1894,,10fr-30cm Tear Away Introducer,$579.00,$0.00,$579.00,$260.55,$413.23,$0.00,$99.76,$413.23,$413.23,$101.38,$579.00,$0.00,$289.50,$458.57,$463.20,$0.00,$90.61,$0.00,$92.18,$0.00
27803186,EAP,HCPCS C1894,,16fr-3ocm Tear-away Introducer,$579.00,$0.00,$579.00,$260.55,$413.23,$0.00,$99.76,$413.23,$413.23,$101.38,$579.00,$0.00,$289.50,$458.57,$463.20,$0.00,$90.61,$0.00,$92.18,$0.00
27803187,EAP,HCPCS C1769,,Wire Guide Lunderquist Extra S,$347.00,$0.00,$347.00,$156.15,$247.65,$0.00,$59.79,$247.65,$247.65,$60.76,$347.00,$0.00,$173.50,$274.82,$277.60,$0.00,$54.31,$0.00,$55.24,$0.00
27803188,EAP,HCPCS C1894,,Sheath Prelude,$277.00,$0.00,$277.00,$124.65,$197.69,$0.00,$47.73,$197.69,$197.69,$48.50,$277.00,$0.00,$138.50,$219.38,$221.60,$0.00,$43.35,$0.00,$44.10,$0.00
27803189,EAP,HCPCS C2625,,3.0 X 8mm Vision Rx Stent,"$2,920.00",$0.00,"$2,920.00","$1,314.00","$2,084.00",$0.00,$503.10,"$2,084.00","$2,084.00",$511.27,"$2,920.00",$0.00,"$1,460.00","$2,312.64","$2,336.00",$0.00,$456.98,$0.00,$464.86,$0.00
27803190,EAP,HCPCS C2625,,2.50 X 8mm Mini-vision Stent,"$3,836.00",$0.00,"$3,836.00","$1,726.20","$2,737.75",$0.00,$660.92,"$2,737.75","$2,737.75",$671.65,"$3,836.00",$0.00,"$1,918.00","$3,038.11","$3,068.80",$0.00,$600.33,$0.00,$610.69,$0.00
27803191,EAP,Custom 27803191,,Lc Bead 500-700,"$1,335.00",$0.00,"$1,335.00",$0.00,$952.79,$0.00,$0.00,$952.79,$952.79,$0.00,"$1,335.00",$0.00,$667.50,"$1,057.32","$1,068.00",$0.00,$0.00,$0.00,$0.00,$0.00
27803192,EAP,HCPCS C1876,,Stent Microdelive Wingspan 4 1,"$20,400.00",$0.00,"$20,400.00","$9,180.00","$5,158.80",$0.00,"$3,514.82","$5,158.80","$14,559.48","$3,571.88","$20,400.00",$0.00,"$10,200.00","$16,156.80","$16,320.00",$0.00,"$3,192.60",$0.00,"$3,247.68",$0.00
27803193,EAP,HCPCS C1876,,Stent Microdelive Wingspan 4 2,"$20,400.00",$0.00,"$20,400.00","$9,180.00","$5,158.80",$0.00,"$3,514.82","$5,158.80","$14,559.48","$3,571.88","$20,400.00",$0.00,"$10,200.00","$16,156.80","$16,320.00",$0.00,"$3,192.60",$0.00,"$3,247.68",$0.00
27803194,EAP,HCPCS C1876,,Stent Microdelive Wingspan 3 1,"$20,400.00",$0.00,"$20,400.00","$9,180.00","$5,158.80",$0.00,"$3,514.82","$5,158.80","$14,559.48","$3,571.88","$20,400.00",$0.00,"$10,200.00","$16,156.80","$16,320.00",$0.00,"$3,192.60",$0.00,"$3,247.68",$0.00
27803195,EAP,HCPCS C1876,,Stent Microdelive Wingspan 3 2,"$20,400.00",$0.00,"$20,400.00","$9,180.00","$5,158.80",$0.00,"$3,514.82","$5,158.80","$14,559.48","$3,571.88","$20,400.00",$0.00,"$10,200.00","$16,156.80","$16,320.00",$0.00,"$3,192.60",$0.00,"$3,247.68",$0.00
27803196,EAP,HCPCS C1876,,Stent Microdelivery 3.0 X 15.0,"$20,400.00",$0.00,"$20,400.00","$9,180.00","$5,158.80",$0.00,"$3,514.82","$5,158.80","$14,559.48","$3,571.88","$20,400.00",$0.00,"$10,200.00","$16,156.80","$16,320.00",$0.00,"$3,192.60",$0.00,"$3,247.68",$0.00
27803197,EAP,HCPCS C1876,,Stent Microdelive Wingspan 3 3,"$20,400.00",$0.00,"$20,400.00","$9,180.00","$5,158.80",$0.00,"$3,514.82","$5,158.80","$14,559.48","$3,571.88","$20,400.00",$0.00,"$10,200.00","$16,156.80","$16,320.00",$0.00,"$3,192.60",$0.00,"$3,247.68",$0.00
27803198,EAP,HCPCS C1876,,Stent Microdelivery Wingspan,"$20,400.00",$0.00,"$20,400.00","$9,180.00","$5,158.80",$0.00,"$3,514.82","$5,158.80","$14,559.48","$3,571.88","$20,400.00",$0.00,"$10,200.00","$16,156.80","$16,320.00",$0.00,"$3,192.60",$0.00,"$3,247.68",$0.00
27803199,EAP,HCPCS C1876,,Stent Mircrodelivery Wingspan2,"$20,400.00",$0.00,"$20,400.00","$9,180.00","$5,158.80",$0.00,"$3,514.82","$5,158.80","$14,559.48","$3,571.88","$20,400.00",$0.00,"$10,200.00","$16,156.80","$16,320.00",$0.00,"$3,192.60",$0.00,"$3,247.68",$0.00
27803200,EAP,HCPCS C1876,,Stent Microdelivery 4.5x30mm,"$19,181.00",$0.00,"$19,181.00","$8,631.45","$5,158.80",$0.00,"$3,304.79","$5,158.80","$13,689.48","$3,358.44","$19,181.00",$0.00,"$9,590.50","$15,191.35","$15,344.80",$0.00,"$3,001.83",$0.00,"$3,053.62",$0.00
27803201,EAP,HCPCS C1876,,Stent Microdelivery 4.5x20mm,"$19,181.00",$0.00,"$19,181.00","$8,631.45","$5,158.80",$0.00,"$3,304.79","$5,158.80","$13,689.48","$3,358.44","$19,181.00",$0.00,"$9,590.50","$15,191.35","$15,344.80",$0.00,"$3,001.83",$0.00,"$3,053.62",$0.00
27803202,EAP,HCPCS C1876,,Stent Micrdelivery 4.0 X20mm,"$19,181.00",$0.00,"$19,181.00","$8,631.45","$5,158.80",$0.00,"$3,304.79","$5,158.80","$13,689.48","$3,358.44","$19,181.00",$0.00,"$9,590.50","$15,191.35","$15,344.80",$0.00,"$3,001.83",$0.00,"$3,053.62",$0.00
27803203,EAP,HCPCS C1876,,Stent Microdelivery 3.5x20mm,"$19,181.00",$0.00,"$19,181.00","$8,631.45","$5,158.80",$0.00,"$3,304.79","$5,158.80","$13,689.48","$3,358.44","$19,181.00",$0.00,"$9,590.50","$15,191.35","$15,344.80",$0.00,"$3,001.83",$0.00,"$3,053.62",$0.00
27803204,EAP,HCPCS C1876,,Neuroform Atlas Stent System,"$17,038.00",$0.00,"$17,038.00","$7,667.10","$5,158.80",$0.00,"$2,935.56","$5,158.80","$12,160.02","$2,983.22","$17,038.00",$0.00,"$8,519.00","$13,494.10","$13,630.40",$0.00,"$2,666.45",$0.00,"$2,712.45",$0.00
27803205,EAP,Custom 27803205,,Coil Tornado 5/3 .036,$298.00,$0.00,$298.00,$0.00,$212.68,$0.00,$0.00,$212.68,$212.68,$0.00,$298.00,$0.00,$149.00,$236.02,$238.40,$0.00,$0.00,$0.00,$0.00,$0.00
27803206,EAP,Custom 27803206,,Coil Tornado 4/3 .035,$298.00,$0.00,$298.00,$0.00,$212.68,$0.00,$0.00,$212.68,$212.68,$0.00,$298.00,$0.00,$149.00,$236.02,$238.40,$0.00,$0.00,$0.00,$0.00,$0.00
27803207,EAP,HCPCS C1874,,Cath.viabahn 8mm X 15cm 1,"$5,107.00",$0.00,"$5,107.00","$2,298.15","$3,644.87",$0.00,$879.91,"$3,644.87","$3,644.87",$894.19,"$5,107.00",$0.00,"$2,553.50","$4,044.74","$4,085.60",$0.00,$799.25,$0.00,$813.03,$0.00
27803208,EAP,HCPCS C1874,,Cath.viabahn 8mm X 15cm 2,"$5,107.00",$0.00,"$5,107.00","$2,298.15","$3,644.87",$0.00,$879.91,"$3,644.87","$3,644.87",$894.19,"$5,107.00",$0.00,"$2,553.50","$4,044.74","$4,085.60",$0.00,$799.25,$0.00,$813.03,$0.00
27803209,EAP,HCPCS C1876,,Microcatheter Enterprise 4.5x3,"$17,347.00",$0.00,"$17,347.00","$7,806.15","$5,158.80",$0.00,"$2,988.80","$5,158.80","$12,380.55","$3,037.32","$17,347.00",$0.00,"$8,673.50","$13,738.82","$13,877.60",$0.00,"$2,714.81",$0.00,"$2,761.64",$0.00
27803210,EAP,HCPCS C1876,,Microcath.enterprise 4.5x2 1,"$17,347.00",$0.00,"$17,347.00","$7,806.15","$5,158.80",$0.00,"$2,988.80","$5,158.80","$12,380.55","$3,037.32","$17,347.00",$0.00,"$8,673.50","$13,738.82","$13,877.60",$0.00,"$2,714.81",$0.00,"$2,761.64",$0.00
27803211,EAP,HCPCS C1876,,Microcath.enterprise 4.5x2 2,"$17,347.00",$0.00,"$17,347.00","$7,806.15","$5,158.80",$0.00,"$2,988.80","$5,158.80","$12,380.55","$3,037.32","$17,347.00",$0.00,"$8,673.50","$13,738.82","$13,877.60",$0.00,"$2,714.81",$0.00,"$2,761.64",$0.00
27803212,EAP,HCPCS C1876,,Stent Icast 6mm X 22mm,"$8,391.00",$0.00,"$8,391.00","$3,775.95","$5,158.80",$0.00,"$1,445.73","$5,158.80","$5,988.66","$1,469.20","$8,391.00",$0.00,"$4,195.50","$6,645.67","$6,712.80",$0.00,"$1,313.19",$0.00,"$1,335.85",$0.00
27803213,EAP,HCPCS C1876,,Stent Carot Protege Rx 40x13 1,"$2,941.00",$0.00,"$2,941.00","$1,323.45","$2,098.99",$0.00,$506.72,"$2,098.99","$2,098.99",$514.95,"$2,941.00",$0.00,"$1,470.50","$2,329.27","$2,352.80",$0.00,$460.27,$0.00,$468.21,$0.00
27803214,EAP,HCPCS C1876,,Stent Carotid Protege Rx 30x13,"$6,843.00",$0.00,"$6,843.00","$3,079.35","$4,883.85",$0.00,"$1,179.01","$4,883.85","$4,883.85","$1,198.15","$6,843.00",$0.00,"$3,421.50","$5,419.66","$5,474.40",$0.00,"$1,070.93",$0.00,"$1,089.41",$0.00
27803215,EAP,HCPCS C1876,,Stent Carot Protege Rx 40x13 2,"$2,941.00",$0.00,"$2,941.00","$1,323.45","$2,098.99",$0.00,$506.72,"$2,098.99","$2,098.99",$514.95,"$2,941.00",$0.00,"$1,470.50","$2,329.27","$2,352.80",$0.00,$460.27,$0.00,$468.21,$0.00
27803216,EAP,HCPCS C1876,,Stent Carotid Protege Rx,"$6,843.00",$0.00,"$6,843.00","$3,079.35","$4,883.85",$0.00,"$1,179.01","$4,883.85","$4,883.85","$1,198.15","$6,843.00",$0.00,"$3,421.50","$5,419.66","$5,474.40",$0.00,"$1,070.93",$0.00,"$1,089.41",$0.00
27803217,EAP,HCPCS C1760,,Sph100250-20 Microcoil Platinu,"$3,169.00",$0.00,"$3,169.00","$1,426.05","$2,261.72",$0.00,$546.00,"$2,261.72","$2,261.72",$554.87,"$3,169.00",$0.00,"$1,584.50","$2,509.85","$2,535.20",$0.00,$495.95,$0.00,$504.50,$0.00
27803218,EAP,HCPCS C1726,,Sph100300-20 Microcoil Platinu,"$3,186.00",$0.00,"$3,186.00","$1,433.70","$2,273.85",$0.00,$548.93,"$2,273.85","$2,273.85",$557.84,"$3,186.00",$0.00,"$1,593.00","$2,523.31","$2,548.80",$0.00,$498.61,$0.00,$507.21,$0.00
27803219,EAP,HCPCS C1894,,Sph100350-20 Microcoil Platinu,"$3,198.00",$0.00,"$3,198.00","$1,439.10","$2,282.41",$0.00,$551.00,"$2,282.41","$2,282.41",$559.94,"$3,198.00",$0.00,"$1,599.00","$2,532.82","$2,558.40",$0.00,$500.49,$0.00,$509.12,$0.00
27803220,EAP,HCPCS C1769,,Wire Guide Lunderquist Extra S,$28.00,$0.00,$28.00,$12.60,$19.98,$0.00,$4.82,$19.98,$19.98,$4.90,$28.00,$0.00,$14.00,$22.18,$22.40,$0.00,$4.38,$0.00,$4.46,$0.00
27803221,EAP,HCPCS C1894,,Prelude Sheath,$43.00,$0.00,$43.00,$23.35,$30.69,$0.00,$7.41,$30.69,$30.69,$7.53,$43.00,$0.00,$21.50,$34.06,$34.40,$0.00,$6.73,$0.00,$6.85,$0.00
27803230,EAP,HCPCS C1729,,10.2fr 22cm  Nephroureterostom,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$249.80,$249.80,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
27803231,EAP,HCPCS C1729,,10.2fr 24cm Nephroureterostomy,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$249.80,$249.80,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
27803232,EAP,HCPCS C1892,,16fr Check-flo Sheath 30cm Rad,$378.00,$0.00,$378.00,$170.10,$269.78,$0.00,$65.13,$269.78,$269.78,$66.18,$378.00,$0.00,$189.00,$299.38,$302.40,$0.00,$59.16,$0.00,$60.18,$0.00
27803233,EAP,HCPCS C1751,,5fr/65cm Mpa Catheter,$312.00,$0.00,$312.00,$140.40,$222.67,$0.00,$53.76,$222.67,$222.67,$54.63,$312.00,$0.00,$156.00,$247.10,$249.60,$0.00,$48.83,$0.00,$49.67,$0.00
27803234,EAP,HCPCS C1892,,7fr Tear-away Introducer,$462.00,$0.00,$462.00,$207.90,$329.73,$0.00,$79.60,$329.73,$329.73,$80.89,$462.00,$0.00,$231.00,$365.90,$369.60,$0.00,$72.30,$0.00,$73.55,$0.00
27803235,EAP,HCPCS C1874,,8x60 Luminexx Stent,"$4,186.00",$0.00,"$4,186.00","$1,883.70","$2,987.55",$0.00,$721.23,"$2,987.55","$2,987.55",$732.94,"$4,186.00",$0.00,"$2,093.00","$3,315.31","$3,348.80",$0.00,$655.11,$0.00,$666.41,$0.00
27803236,EAP,HCPCS C1769,,Amplatz Super Stiff Guidewire,$92.00,$0.00,$92.00,$49.96,$65.66,$0.00,$15.85,$65.66,$65.66,$16.11,$92.00,$0.00,$46.00,$72.86,$73.60,$0.00,$14.40,$0.00,$14.65,$0.00
27803237,EAP,HCPCS C1726,,Ballon Cather 4-2/5/75,$916.00,$0.00,$916.00,$412.20,$653.75,$0.00,$157.82,$653.75,$653.75,$160.38,$916.00,$0.00,$458.00,$725.47,$732.80,$0.00,$143.35,$0.00,$145.83,$0.00
27803238,EAP,HCPCS C1726,,Balloon Bmq 10-4/5.8/75,$884.00,$0.00,$884.00,$397.80,$630.91,$0.00,$152.31,$630.91,$630.91,$154.78,$884.00,$0.00,$442.00,$700.13,$707.20,$0.00,$138.35,$0.00,$140.73,$0.00
27803239,EAP,HCPCS C1726,,Balloon Udt 4-10/5/75,$681.00,$0.00,$681.00,$306.45,$486.03,$0.00,$117.33,$486.03,$486.03,$119.24,$681.00,$0.00,$340.50,$539.35,$544.80,$0.00,$106.58,$0.00,$108.42,$0.00
27803240,EAP,HCPCS C1726,,Balloon Udt 5-10/5/75,$681.00,$0.00,$681.00,$306.45,$486.03,$0.00,$117.33,$486.03,$486.03,$119.24,$681.00,$0.00,$340.50,$539.35,$544.80,$0.00,$106.58,$0.00,$108.42,$0.00
27803241,EAP,HCPCS C1751,,Cath 5fr 100cm Vertebral Curve,$45.00,$0.00,$45.00,$20.25,$32.12,$0.00,$7.75,$32.12,$32.12,$7.88,$45.00,$0.00,$22.50,$35.64,$36.00,$0.00,$7.04,$0.00,$7.16,$0.00
27803242,EAP,HCPCS C1751,,Cath Dbl Lumen 9fr,$517.00,$0.00,$517.00,$232.65,$368.98,$0.00,$89.08,$368.98,$368.98,$90.52,$517.00,$0.00,$258.50,$409.46,$413.60,$0.00,$80.91,$0.00,$82.31,$0.00
27803243,EAP,HCPCS C1887,,Cath Guiding 7fr Sh,$186.00,$0.00,$186.00,$83.70,$132.75,$0.00,$32.05,$132.75,$132.75,$32.57,$186.00,$0.00,$93.00,$147.31,$148.80,$0.00,$29.11,$0.00,$29.61,$0.00
27803244,EAP,HCPCS C1751,,Cath Micro Mc 2.8f 130cm,"$1,890.00",$0.00,"$1,890.00",$850.50,"$1,348.89",$0.00,$325.64,"$1,348.89","$1,348.89",$330.92,"$1,890.00",$0.00,$945.00,"$1,496.88","$1,512.00",$0.00,$295.79,$0.00,$300.89,$0.00
27803245,EAP,Custom 27803245,,Cytology Brushes 3x120x1.7,$34.00,$0.00,$34.00,$0.00,$24.27,$0.00,$0.00,$24.27,$24.27,$0.00,$34.00,$0.00,$17.00,$26.93,$27.20,$0.00,$0.00,$0.00,$0.00,$0.00
27803246,EAP,HCPCS C1751,,Dual Picc Line,$307.00,$0.00,$307.00,$138.15,$219.11,$0.00,$52.89,$219.11,$219.11,$53.75,$307.00,$0.00,$153.50,$243.14,$245.60,$0.00,$48.05,$0.00,$48.87,$0.00
27803247,EAP,Custom 27803247,,Gasttostomy (peg Kit) Pull Typ,$271.00,$0.00,$271.00,$0.00,$193.41,$0.00,$0.00,$193.41,$193.41,$0.00,$271.00,$0.00,$135.50,$214.63,$216.80,$0.00,$0.00,$0.00,$0.00,$0.00
27803248,EAP,Custom 27803248,,"Gelfoam, Sponge",$103.00,$0.00,$103.00,$0.00,$73.51,$0.00,$0.00,$73.51,$73.51,$0.00,$103.00,$0.00,$51.50,$81.58,$82.40,$0.00,$0.00,$0.00,$0.00,$0.00
27803249,EAP,HCPCS C1874,,Ic Ast Stent 5mm X 2mm,"$8,391.00",$0.00,"$8,391.00","$3,775.95","$5,158.80",$0.00,"$1,445.73","$5,158.80","$5,988.66","$1,469.20","$8,391.00",$0.00,"$4,195.50","$6,645.67","$6,712.80",$0.00,"$1,313.19",$0.00,"$1,335.85",$0.00
27803250,EAP,HCPCS C1721,,Paradym Dr Dual Icd,"$55,047.00",$0.00,"$55,047.00","$24,771.15","$5,158.80",$0.00,"$8,138.89","$5,158.80","$39,287.04","$8,138.89","$55,047.00",$0.00,"$27,523.50","$43,597.22","$44,037.60",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27803251,EAP,HCPCS C1722,,Paradym Vr Single Icd,"$46,706.00",$0.00,"$46,706.00","$21,017.70","$5,158.80",$0.00,"$8,047.21","$5,158.80","$33,334.07","$8,138.89","$46,706.00",$0.00,"$23,353.00","$36,991.15","$37,364.80",$0.00,"$7,309.49",$0.00,"$7,435.60",$0.00
27803252,EAP,Custom 27803252,,"Lc Bead,100-300um","$4,887.00",$0.00,"$4,887.00",$0.00,"$3,487.85",$0.00,$0.00,"$3,487.85","$3,487.85",$0.00,"$4,887.00",$0.00,"$2,443.50","$3,870.50","$3,909.60",$0.00,$0.00,$0.00,$0.00,$0.00
27803253,EAP,,,Picc Line Tray W/o Device,$134.00,$0.00,$134.00,$0.00,$95.64,$0.00,$0.00,$95.64,$95.64,$0.00,$134.00,$0.00,$67.00,$106.13,$107.20,$0.00,$0.00,$0.00,$0.00,$0.00
27803254,EAP,HCPCS C1769,,Pinnacle Guidewire 6fr Straigh,$278.00,$0.00,$278.00,$125.10,$198.41,$0.00,$47.90,$198.41,$198.41,$48.68,$278.00,$0.00,$139.00,$220.18,$222.40,$0.00,$43.51,$0.00,$44.26,$0.00
27803255,EAP,HCPCS C1894,,Sheath Gd Lima Crv 6fr 45cm 5cm Pn Dstn Xcut Vlv Radopq Ss,$205.00,$0.00,$205.00,$111.32,$146.31,$0.00,$35.32,$146.31,$146.31,$35.89,$205.00,$0.00,$102.50,$162.36,$164.00,$0.00,$32.08,$0.00,$32.64,$0.00
27803256,EAP,HCPCS A4300,,Port-a-cath Ii Low Profile Dua,"$1,429.00",$0.00,"$1,429.00",$0.00,"$1,019.88",$0.00,$0.00,"$1,019.88","$1,019.88",$0.00,"$1,429.00",$0.00,$714.50,"$1,131.77","$1,143.20",$0.00,$0.00,$0.00,$0.00,$0.00
27803257,EAP,HCPCS C1752,,Set Schon Xl Temp Dialysis 15c,"$1,635.00",$0.00,"$1,635.00",$0.00,"$1,166.90",$0.00,$0.00,"$1,166.90","$1,166.90",$0.00,"$1,635.00",$0.00,$817.50,"$1,294.92","$1,308.00",$0.00,$0.00,$0.00,$0.00,$0.00
27803258,EAP,HCPCS C1751,,Single Picc Line,$216.00,$0.00,$216.00,$97.20,$154.16,$0.00,$37.22,$154.16,$154.16,$37.82,$216.00,$0.00,$108.00,$171.07,$172.80,$0.00,$33.80,$0.00,$34.39,$0.00
27803259,EAP,HCPCS C1751,,Triple Lumen Catheter Size 20,$384.00,$0.00,$384.00,$172.80,$274.06,$0.00,$66.16,$274.06,$274.06,$67.24,$384.00,$0.00,$192.00,$304.13,$307.20,$0.00,$60.10,$0.00,$61.13,$0.00
27803260,EAP,HCPCS C1729,,Tube Gastrostomy 24fr,$59.00,$0.00,$59.00,$26.55,$42.11,$0.00,$10.17,$42.11,$42.11,$10.33,$59.00,$0.00,$29.50,$46.73,$47.20,$0.00,$9.23,$0.00,$9.39,$0.00
27803261,EAP,HCPCS C1751,,"Uhf Pigtail Sizing Cath 5 Fr,1",$315.00,$0.00,$315.00,$141.75,$224.82,$0.00,$54.27,$224.82,$224.82,$55.15,$315.00,$0.00,$157.50,$249.48,$252.00,$0.00,$49.30,$0.00,$50.15,$0.00
27803262,EAP,HCPCS C1751,,"Uhf Pigtail Sizing Cath 5fr,2",$71.00,$0.00,$71.00,$31.95,$50.67,$0.00,$12.23,$50.67,$50.67,$12.43,$71.00,$0.00,$35.50,$56.23,$56.80,$0.00,$11.11,$0.00,$11.30,$0.00
27803263,EAP,HCPCS C1751,,Venous Access,$165.00,$0.00,$165.00,$74.25,$117.76,$0.00,$28.43,$117.76,$117.76,$28.89,$165.00,$0.00,$82.50,$130.68,$132.00,$0.00,$25.82,$0.00,$26.27,$0.00
27803264,EAP,HCPCS A4300,,Isp Port Plas Lumen,$734.00,$0.00,$734.00,$0.00,$523.86,$0.00,$0.00,$523.86,$523.86,$0.00,$734.00,$0.00,$367.00,$581.33,$587.20,$0.00,$0.00,$0.00,$0.00,$0.00
27803265,EAP,Custom 27803265,,Jcd 12.0-38-20,$19.00,$0.00,$19.00,$0.00,$13.56,$0.00,$0.00,$13.56,$13.56,$0.00,$19.00,$0.00,$9.50,$15.05,$15.20,$0.00,$0.00,$0.00,$0.00,$0.00
27803270,EAP,Custom 27803270,,Tray Central Line Dressing Without Biopatch,$102.00,$0.00,$102.00,$0.00,$72.80,$0.00,$0.00,$72.80,$72.80,$0.00,$102.00,$0.00,$51.00,$80.78,$81.60,$0.00,$0.00,$0.00,$0.00,$0.00
27803294,EAP,HCPCS C1725,,Band Tr  24cm,$123.00,$0.00,$123.00,$55.35,$87.79,$0.00,$21.19,$87.79,$87.79,$21.54,$123.00,$0.00,$61.50,$97.42,$98.40,$0.00,$19.25,$0.00,$19.58,$0.00
27803295,EAP,HCPCS C1725,,Band Tr 29cm,$123.00,$0.00,$123.00,$55.35,$87.79,$0.00,$21.19,$87.79,$87.79,$21.54,$123.00,$0.00,$61.50,$97.42,$98.40,$0.00,$19.25,$0.00,$19.58,$0.00
27803302,EAP,Custom 27803302,,Embolization Coil - Azur 35d System 10mm X 20cm,"$3,754.00",$0.00,"$3,754.00",$0.00,"$2,679.23",$0.00,$0.00,"$2,679.23","$2,679.23",$0.00,"$3,754.00",$0.00,"$1,877.00","$2,973.17","$3,003.20",$0.00,$0.00,$0.00,$0.00,$0.00
27803303,EAP,Custom 27803303,,Embolization Coil - Azur 35d System 12mm X 20cm,"$3,754.00",$0.00,"$3,754.00",$0.00,"$2,679.23",$0.00,$0.00,"$2,679.23","$2,679.23",$0.00,"$3,754.00",$0.00,"$1,877.00","$2,973.17","$3,003.20",$0.00,$0.00,$0.00,$0.00,$0.00
27803304,EAP,Custom 27803304,,Embolization Coil - Azur 35d System 15mm X 20cm,"$3,754.00",$0.00,"$3,754.00",$0.00,"$2,679.23",$0.00,$0.00,"$2,679.23","$2,679.23",$0.00,"$3,754.00",$0.00,"$1,877.00","$2,973.17","$3,003.20",$0.00,$0.00,$0.00,$0.00,$0.00
27803305,EAP,Custom 27803305,,Embolization Coil - Azur 35d System 12mm X 30cm,"$4,005.00",$0.00,"$4,005.00",$0.00,"$2,858.37",$0.00,$0.00,"$2,858.37","$2,858.37",$0.00,"$4,005.00",$0.00,"$2,002.50","$3,171.96","$3,204.00",$0.00,$0.00,$0.00,$0.00,$0.00
27803306,EAP,Custom 27803306,,Embolization Coil -azur 35d System 15mm X 30cm,"$4,005.00",$0.00,"$4,005.00",$0.00,"$2,858.37",$0.00,$0.00,"$2,858.37","$2,858.37",$0.00,"$4,005.00",$0.00,"$2,002.50","$3,171.96","$3,204.00",$0.00,$0.00,$0.00,$0.00,$0.00
27803307,EAP,Custom 27803307,,Embolization Coil - Azur 35d System 20mm X 30cm,"$4,005.00",$0.00,"$4,005.00",$0.00,"$2,858.37",$0.00,$0.00,"$2,858.37","$2,858.37",$0.00,"$4,005.00",$0.00,"$2,002.50","$3,171.96","$3,204.00",$0.00,$0.00,$0.00,$0.00,$0.00
27803308,EAP,HCPCS C1876,,Stent Bilinary Xpert Otw 5x30x120 Cm,"$5,755.00",$0.00,"$5,755.00","$2,589.75","$4,107.34",$0.00,$991.56,"$4,107.34","$4,107.34","$1,007.65","$5,755.00",$0.00,"$2,877.50","$4,557.96","$4,604.00",$0.00,$900.66,$0.00,$916.20,$0.00
27803309,EAP,HCPCS C1876,,Stent Bilinary Xpert Otw 5x40x120 Cm,"$5,755.00",$0.00,"$5,755.00","$2,589.75","$4,107.34",$0.00,$991.56,"$4,107.34","$4,107.34","$1,007.65","$5,755.00",$0.00,"$2,877.50","$4,557.96","$4,604.00",$0.00,$900.66,$0.00,$916.20,$0.00
27803310,EAP,HCPCS C1876,,Stent Bilinary Xpert Otw 6x30x120 Cm,"$5,755.00",$0.00,"$5,755.00","$2,589.75","$4,107.34",$0.00,$991.56,"$4,107.34","$4,107.34","$1,007.65","$5,755.00",$0.00,"$2,877.50","$4,557.96","$4,604.00",$0.00,$900.66,$0.00,$916.20,$0.00
27803311,EAP,HCPCS C1876,,Stent Bilinary Xpert Otw 6x40x120 Cm,"$5,755.00",$0.00,"$5,755.00","$2,589.75","$4,107.34",$0.00,$991.56,"$4,107.34","$4,107.34","$1,007.65","$5,755.00",$0.00,"$2,877.50","$4,557.96","$4,604.00",$0.00,$900.66,$0.00,$916.20,$0.00
27803312,EAP,HCPCS C1876,,Stent Corotid Straight Rx Acculink 6x40,"$6,590.00",$0.00,"$6,590.00","$2,965.50","$4,703.28",$0.00,"$1,135.42","$4,703.28","$4,703.28","$1,153.86","$6,590.00",$0.00,"$3,295.00","$5,219.28","$5,272.00",$0.00,"$1,031.34",$0.00,"$1,049.13",$0.00
27803313,EAP,HCPCS C1876,,Stent Corotid Straight Rx Acculink 7x40,"$6,590.00",$0.00,"$6,590.00","$2,965.50","$4,703.28",$0.00,"$1,135.42","$4,703.28","$4,703.28","$1,153.86","$6,590.00",$0.00,"$3,295.00","$5,219.28","$5,272.00",$0.00,"$1,031.34",$0.00,"$1,049.13",$0.00
27803314,EAP,HCPCS C1876,,Stent Corotid Straight Rx Acculink 8x40,"$6,590.00",$0.00,"$6,590.00","$2,965.50","$4,703.28",$0.00,"$1,135.42","$4,703.28","$4,703.28","$1,153.86","$6,590.00",$0.00,"$3,295.00","$5,219.28","$5,272.00",$0.00,"$1,031.34",$0.00,"$1,049.13",$0.00
27803315,EAP,HCPCS C1876,,Stent Corotid Straight Rx Acculink 9x40,"$6,590.00",$0.00,"$6,590.00","$2,965.50","$4,703.28",$0.00,"$1,135.42","$4,703.28","$4,703.28","$1,153.86","$6,590.00",$0.00,"$3,295.00","$5,219.28","$5,272.00",$0.00,"$1,031.34",$0.00,"$1,049.13",$0.00
27803316,EAP,HCPCS C1876,,Stent Corotid Straight Rx Acculink 10x40,"$6,590.00",$0.00,"$6,590.00","$2,965.50","$4,703.28",$0.00,"$1,135.42","$4,703.28","$4,703.28","$1,153.86","$6,590.00",$0.00,"$3,295.00","$5,219.28","$5,272.00",$0.00,"$1,031.34",$0.00,"$1,049.13",$0.00
27803317,EAP,HCPCS C1876,,Stent Corotid Tapped Rx Acculink 6-8x40,"$6,590.00",$0.00,"$6,590.00","$2,965.50","$4,703.28",$0.00,"$1,135.42","$4,703.28","$4,703.28","$1,153.86","$6,590.00",$0.00,"$3,295.00","$5,219.28","$5,272.00",$0.00,"$1,031.34",$0.00,"$1,049.13",$0.00
27803318,EAP,HCPCS C1876,,Stent Corotid Tapped Rx Acculink 7-10x40,"$6,590.00",$0.00,"$6,590.00","$2,965.50","$4,703.28",$0.00,"$1,135.42","$4,703.28","$4,703.28","$1,153.86","$6,590.00",$0.00,"$3,295.00","$5,219.28","$5,272.00",$0.00,"$1,031.34",$0.00,"$1,049.13",$0.00
27803319,EAP,HCPCS C1882,,Defibrillator Crd Amplia Mri Crt-d Vntrc Left Df4,"$52,375.00",$0.00,"$52,375.00","$23,568.75","$5,158.80",$0.00,"$8,138.89","$5,158.80","$37,380.04","$8,138.89","$52,375.00",$0.00,"$26,187.50","$41,481.00","$41,900.00",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27803320,EAP,HCPCS C1882,,Defibrillator Crd Amplia Mri Crt-d 2 Plr Left,"$52,375.00",$0.00,"$52,375.00","$23,568.75","$5,158.80",$0.00,"$8,138.89","$5,158.80","$37,380.04","$8,138.89","$52,375.00",$0.00,"$26,187.50","$41,481.00","$41,900.00",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27803420,EAP,HCPCS C1769,,Guidewire Amplatz Super Stiff 0.038 X 260,$50.00,$0.00,$50.00,$22.50,$35.69,$0.00,$8.61,$35.69,$35.69,$8.75,$50.00,$0.00,$25.00,$39.60,$40.00,$0.00,$7.83,$0.00,$7.96,$0.00
27803421,EAP,HCPCS C1769,,Guidewire Hydrophilic Nitinol,$388.00,$0.00,$388.00,$174.60,$276.92,$0.00,$66.85,$276.92,$276.92,$67.94,$388.00,$0.00,$194.00,$307.30,$310.40,$0.00,$60.72,$0.00,$61.77,$0.00
27803441,EAP,Custom 27803441,,Stent Metal Bare Int35012ux,"$2,422.00",$0.00,"$2,422.00",$0.00,"$1,728.58",$0.00,$0.00,"$1,728.58","$1,728.58",$0.00,"$2,422.00",$0.00,"$1,211.00","$1,918.22","$1,937.60",$0.00,$0.00,$0.00,$0.00,$0.00
27803450,EAP,Custom 27803450,,Target Detachable Colis 360 Soft 4mm X 6cm,"$2,270.00",$0.00,"$2,270.00",$0.00,"$1,620.10",$0.00,$0.00,"$1,620.10","$1,620.10",$0.00,"$2,270.00",$0.00,"$1,135.00","$1,797.84","$1,816.00",$0.00,$0.00,$0.00,$0.00,$0.00
27803451,EAP,Custom 27803451,,Target Detachable Colis Ultra 3mmx8cm,"$2,401.00",$0.00,"$2,401.00",$0.00,"$1,713.59",$0.00,$0.00,"$1,713.59","$1,713.59",$0.00,"$2,401.00",$0.00,"$1,200.50","$1,901.59","$1,920.80",$0.00,$0.00,$0.00,$0.00,$0.00
27803452,EAP,Custom 27803452,,Inzone Detachment System,$260.00,$0.00,$260.00,$0.00,$185.56,$0.00,$0.00,$185.56,$185.56,$0.00,$260.00,$0.00,$130.00,$205.92,$208.00,$0.00,$0.00,$0.00,$0.00,$0.00
27803490,EAP,HCPCS C2625,,Rx Stent/11.5 X 5,$64.00,$0.00,$64.00,$28.80,$45.68,$0.00,$11.03,$45.68,$45.68,$11.21,$64.00,$0.00,$32.00,$50.69,$51.20,$0.00,$10.02,$0.00,$10.19,$0.00
27803491,EAP,HCPCS C2625,,Rx Stent/11.5 X 7,$64.00,$0.00,$64.00,$28.80,$45.68,$0.00,$11.03,$45.68,$45.68,$11.21,$64.00,$0.00,$32.00,$50.69,$51.20,$0.00,$10.02,$0.00,$10.19,$0.00
27803492,EAP,HCPCS C2625,,Rx Stent/11.5 X 10,$64.00,$0.00,$64.00,$28.80,$45.68,$0.00,$11.03,$45.68,$45.68,$11.21,$64.00,$0.00,$32.00,$50.69,$51.20,$0.00,$10.02,$0.00,$10.19,$0.00
27803493,EAP,HCPCS C2625,,Rx Stent/11.5 X 12,$64.00,$0.00,$64.00,$28.80,$45.68,$0.00,$11.03,$45.68,$45.68,$11.21,$64.00,$0.00,$32.00,$50.69,$51.20,$0.00,$10.02,$0.00,$10.19,$0.00
27803494,EAP,HCPCS C2625,,Rx Stent/11.5 X 15,$64.00,$0.00,$64.00,$28.80,$45.68,$0.00,$11.03,$45.68,$45.68,$11.21,$64.00,$0.00,$32.00,$50.69,$51.20,$0.00,$10.02,$0.00,$10.19,$0.00
27803496,EAP,HCPCS C1874,,"Icast Covered Stent 6mm X16mm, 120 Cm Cath Length","$8,340.00",$0.00,"$8,340.00","$3,753.00","$5,158.80",$0.00,"$1,436.94","$5,158.80","$5,952.26","$1,460.27","$8,340.00",$0.00,"$4,170.00","$6,605.28","$6,672.00",$0.00,"$1,305.21",$0.00,"$1,327.73",$0.00
27803499,EAP,Custom 27803499,,Central Line Tray W /biopatch,$264.00,$0.00,$264.00,$0.00,$188.42,$0.00,$0.00,$188.42,$188.42,$0.00,$264.00,$0.00,$132.00,$209.09,$211.20,$0.00,$0.00,$0.00,$0.00,$0.00
27803510,EAP,HCPCS C2628,,Boston Scientific Occlusion Balloon Catheter 27mm X 100m,$885.00,$0.00,$885.00,$0.00,$631.62,$0.00,$0.00,$631.62,$631.62,$0.00,$885.00,$0.00,$442.50,$700.92,$708.00,$0.00,$0.00,$0.00,$0.00,$0.00
27803520,EAP,HCPCS C1876,,Wallflex Bil Uncovered 10x60,"$6,005.00",$0.00,"$6,005.00","$2,702.25","$4,285.77",$0.00,"$1,034.63","$4,285.77","$4,285.77","$1,051.43","$6,005.00",$0.00,"$3,002.50","$4,755.96","$4,804.00",$0.00,$939.78,$0.00,$956.00,$0.00
27803521,EAP,HCPCS C1876,,Wallflex Bil Uncovered 10x80,"$6,005.00",$0.00,"$6,005.00","$2,702.25","$4,285.77",$0.00,"$1,034.63","$4,285.77","$4,285.77","$1,051.43","$6,005.00",$0.00,"$3,002.50","$4,755.96","$4,804.00",$0.00,$939.78,$0.00,$956.00,$0.00
27803522,EAP,HCPCS C1876,,Wallflex Bil  Uncovered 10x100,"$6,005.00",$0.00,"$6,005.00","$2,702.25","$4,285.77",$0.00,"$1,034.63","$4,285.77","$4,285.77","$1,051.43","$6,005.00",$0.00,"$3,002.50","$4,755.96","$4,804.00",$0.00,$939.78,$0.00,$956.00,$0.00
27803523,EAP,HCPCS C1876,,Wallflex Bil Uncovered 10x40,"$6,005.00",$0.00,"$6,005.00","$2,702.25","$4,285.77",$0.00,"$1,034.63","$4,285.77","$4,285.77","$1,051.43","$6,005.00",$0.00,"$3,002.50","$4,755.96","$4,804.00",$0.00,$939.78,$0.00,$956.00,$0.00
27803524,EAP,HCPCS C1874,,Wallflex Bil Covered 10x40,"$9,476.00",$0.00,"$9,476.00","$4,264.20","$5,158.80",$0.00,"$1,632.67","$5,158.80","$6,763.02","$1,659.17","$9,476.00",$0.00,"$4,738.00","$7,504.99","$7,580.80",$0.00,"$1,482.99",$0.00,"$1,508.58",$0.00
27803525,EAP,HCPCS C1874,,Wallflex Bil Covered 10x60,"$9,476.00",$0.00,"$9,476.00","$4,264.20","$5,158.80",$0.00,"$1,632.67","$5,158.80","$6,763.02","$1,659.17","$9,476.00",$0.00,"$4,738.00","$7,504.99","$7,580.80",$0.00,"$1,482.99",$0.00,"$1,508.58",$0.00
27803526,EAP,HCPCS C1874,,Wallflex Bil Covered 10x80,"$9,476.00",$0.00,"$9,476.00","$4,264.20","$5,158.80",$0.00,"$1,632.67","$5,158.80","$6,763.02","$1,659.17","$9,476.00",$0.00,"$4,738.00","$7,504.99","$7,580.80",$0.00,"$1,482.99",$0.00,"$1,508.58",$0.00
27803527,EAP,HCPCS C1874,,Wallflex Bil Pc Covered 10x40,"$9,142.00",$0.00,"$9,142.00","$4,113.90","$5,158.80",$0.00,"$1,575.12","$5,158.80","$6,524.65","$1,600.69","$9,142.00",$0.00,"$4,571.00","$7,240.46","$7,313.60",$0.00,"$1,430.72",$0.00,"$1,455.41",$0.00
27803528,EAP,HCPCS C1874,,Wallflex Bil Pc Covered 10x60,"$9,142.00",$0.00,"$9,142.00","$4,113.90","$5,158.80",$0.00,"$1,575.12","$5,158.80","$6,524.65","$1,600.69","$9,142.00",$0.00,"$4,571.00","$7,240.46","$7,313.60",$0.00,"$1,430.72",$0.00,"$1,455.41",$0.00
27803529,EAP,HCPCS C1874,,Wallflex Bil Pc Covered 10x80,"$9,142.00",$0.00,"$9,142.00","$4,113.90","$5,158.80",$0.00,"$1,575.12","$5,158.80","$6,524.65","$1,600.69","$9,142.00",$0.00,"$4,571.00","$7,240.46","$7,313.60",$0.00,"$1,430.72",$0.00,"$1,455.41",$0.00
27803531,EAP,HCPCS C1876,,Wallflex Ent Duo 27/22x6 230cm,"$8,756.00",$0.00,"$8,756.00","$3,940.20","$5,158.80",$0.00,"$1,508.62","$5,158.80","$6,249.16","$1,533.11","$8,756.00",$0.00,"$4,378.00","$6,934.75","$7,004.80",$0.00,"$1,370.31",$0.00,"$1,393.96",$0.00
27803532,EAP,HCPCS C1876,,Wallflex Ent Duo 27/22x9 230cm,"$8,756.00",$0.00,"$8,756.00","$3,940.20","$5,158.80",$0.00,"$1,508.62","$5,158.80","$6,249.16","$1,533.11","$8,756.00",$0.00,"$4,378.00","$6,934.75","$7,004.80",$0.00,"$1,370.31",$0.00,"$1,393.96",$0.00
27803533,EAP,HCPCS C1876,,Wallflex Ent Duo 27/22x12 230cm,"$8,756.00",$0.00,"$8,756.00","$3,940.20","$5,158.80",$0.00,"$1,508.62","$5,158.80","$6,249.16","$1,533.11","$8,756.00",$0.00,"$4,378.00","$6,934.75","$7,004.80",$0.00,"$1,370.31",$0.00,"$1,393.96",$0.00
27803534,EAP,HCPCS C1876,,Wallflex Ent Col 30/25x6 230cm,"$8,756.00",$0.00,"$8,756.00","$3,940.20","$5,158.80",$0.00,"$1,508.62","$5,158.80","$6,249.16","$1,533.11","$8,756.00",$0.00,"$4,378.00","$6,934.75","$7,004.80",$0.00,"$1,370.31",$0.00,"$1,393.96",$0.00
27803535,EAP,HCPCS C1876,,Wallflex Ent Col 30/25x9 230cm,"$8,756.00",$0.00,"$8,756.00","$3,940.20","$5,158.80",$0.00,"$1,508.62","$5,158.80","$6,249.16","$1,533.11","$8,756.00",$0.00,"$4,378.00","$6,934.75","$7,004.80",$0.00,"$1,370.31",$0.00,"$1,393.96",$0.00
27803536,EAP,HCPCS C1876,,Wallflex Ent Col 30/25x12 230cm,"$8,756.00",$0.00,"$8,756.00","$3,940.20","$5,158.80",$0.00,"$1,508.62","$5,158.80","$6,249.16","$1,533.11","$8,756.00",$0.00,"$4,378.00","$6,934.75","$7,004.80",$0.00,"$1,370.31",$0.00,"$1,393.96",$0.00
27803537,EAP,HCPCS C1876,,Wallflex Ent Col 27/22x6 230cm,"$8,756.00",$0.00,"$8,756.00","$3,940.20","$5,158.80",$0.00,"$1,508.62","$5,158.80","$6,249.16","$1,533.11","$8,756.00",$0.00,"$4,378.00","$6,934.75","$7,004.80",$0.00,"$1,370.31",$0.00,"$1,393.96",$0.00
27803538,EAP,HCPCS C1876,,Wallflex Ent Col 27/22x9 230cm,"$8,756.00",$0.00,"$8,756.00","$3,940.20","$5,158.80",$0.00,"$1,508.62","$5,158.80","$6,249.16","$1,533.11","$8,756.00",$0.00,"$4,378.00","$6,934.75","$7,004.80",$0.00,"$1,370.31",$0.00,"$1,393.96",$0.00
27803539,EAP,HCPCS C1876,,Wallflex Ent Col 27/22x12 230cm,"$8,756.00",$0.00,"$8,756.00","$3,940.20","$5,158.80",$0.00,"$1,508.62","$5,158.80","$6,249.16","$1,533.11","$8,756.00",$0.00,"$4,378.00","$6,934.75","$7,004.80",$0.00,"$1,370.31",$0.00,"$1,393.96",$0.00
27803541,EAP,HCPCS C1874,,Wallflex Esoph Full Cov 18/10,"$8,507.00",$0.00,"$8,507.00","$3,828.15","$5,158.80",$0.00,"$1,465.71","$5,158.80","$6,071.45","$1,489.51","$8,507.00",$0.00,"$4,253.50","$6,737.54","$6,805.60",$0.00,"$1,331.35",$0.00,"$1,354.31",$0.00
27803542,EAP,HCPCS C1874,,Wallflex Esoph Full Cov 18/12,"$8,507.00",$0.00,"$8,507.00","$3,828.15","$5,158.80",$0.00,"$1,465.71","$5,158.80","$6,071.45","$1,489.51","$8,507.00",$0.00,"$4,253.50","$6,737.54","$6,805.60",$0.00,"$1,331.35",$0.00,"$1,354.31",$0.00
27803543,EAP,HCPCS C1874,,Wallflex Esoph Full Cov 18/15,"$8,507.00",$0.00,"$8,507.00","$3,828.15","$5,158.80",$0.00,"$1,465.71","$5,158.80","$6,071.45","$1,489.51","$8,507.00",$0.00,"$4,253.50","$6,737.54","$6,805.60",$0.00,"$1,331.35",$0.00,"$1,354.31",$0.00
27803544,EAP,HCPCS C1874,,Wallflex Esoph Full Cov 23/10,"$8,507.00",$0.00,"$8,507.00","$3,828.15","$5,158.80",$0.00,"$1,465.71","$5,158.80","$6,071.45","$1,489.51","$8,507.00",$0.00,"$4,253.50","$6,737.54","$6,805.60",$0.00,"$1,331.35",$0.00,"$1,354.31",$0.00
27803545,EAP,HCPCS C1874,,Wallflex Esoph Full Cov 23/12,"$8,507.00",$0.00,"$8,507.00","$3,828.15","$5,158.80",$0.00,"$1,465.71","$5,158.80","$6,071.45","$1,489.51","$8,507.00",$0.00,"$4,253.50","$6,737.54","$6,805.60",$0.00,"$1,331.35",$0.00,"$1,354.31",$0.00
27803546,EAP,HCPCS C1874,,Wallflex Esoph Full Cov 23/15,"$8,507.00",$0.00,"$8,507.00","$3,828.15","$5,158.80",$0.00,"$1,465.71","$5,158.80","$6,071.45","$1,489.51","$8,507.00",$0.00,"$4,253.50","$6,737.54","$6,805.60",$0.00,"$1,331.35",$0.00,"$1,354.31",$0.00
27803547,EAP,HCPCS C1874,,Wallflex Esoph Part Cov 18/10,"$8,507.00",$0.00,"$8,507.00","$3,828.15","$5,158.80",$0.00,"$1,465.71","$5,158.80","$6,071.45","$1,489.51","$8,507.00",$0.00,"$4,253.50","$6,737.54","$6,805.60",$0.00,"$1,331.35",$0.00,"$1,354.31",$0.00
27803548,EAP,HCPCS C1874,,Wallflex Esoph Part Cov 18/12,"$8,507.00",$0.00,"$8,507.00","$3,828.15","$5,158.80",$0.00,"$1,465.71","$5,158.80","$6,071.45","$1,489.51","$8,507.00",$0.00,"$4,253.50","$6,737.54","$6,805.60",$0.00,"$1,331.35",$0.00,"$1,354.31",$0.00
27803549,EAP,HCPCS C1874,,Wallflex Esoph Part Cov 18/23x103,"$8,507.00",$0.00,"$8,507.00","$3,828.15","$5,158.80",$0.00,"$1,465.71","$5,158.80","$6,071.45","$1,489.51","$8,507.00",$0.00,"$4,253.50","$6,737.54","$6,805.60",$0.00,"$1,331.35",$0.00,"$1,354.31",$0.00
27803550,EAP,HCPCS C1874,,Wallflex Esoph Part Cov 23/128x105,"$8,507.00",$0.00,"$8,507.00","$3,828.15","$5,158.80",$0.00,"$1,465.71","$5,158.80","$6,071.45","$1,489.51","$8,507.00",$0.00,"$4,253.50","$6,737.54","$6,805.60",$0.00,"$1,331.35",$0.00,"$1,354.31",$0.00
27803551,EAP,HCPCS C1874,,Wallflex Esoph Part Cov 23/28x125,"$8,507.00",$0.00,"$8,507.00","$3,828.15","$5,158.80",$0.00,"$1,465.71","$5,158.80","$6,071.45","$1,489.51","$8,507.00",$0.00,"$4,253.50","$6,737.54","$6,805.60",$0.00,"$1,331.35",$0.00,"$1,354.31",$0.00
27803552,EAP,HCPCS C1874,,Wallflex Esoph Part Cov 23/28x155,"$8,507.00",$0.00,"$8,507.00","$3,828.15","$5,158.80",$0.00,"$1,465.71","$5,158.80","$6,071.45","$1,489.51","$8,507.00",$0.00,"$4,253.50","$6,737.54","$6,805.60",$0.00,"$1,331.35",$0.00,"$1,354.31",$0.00
27803554,EAP,HCPCS C1874,,Polyflex Esoph 20/16mm X 90mm,"$6,756.00",$0.00,"$6,756.00","$3,040.20","$4,821.76",$0.00,"$1,164.03","$4,821.76","$4,821.76","$1,182.92","$6,756.00",$0.00,"$3,378.00","$5,350.75","$5,404.80",$0.00,"$1,057.31",$0.00,"$1,075.56",$0.00
27803555,EAP,HCPCS C1874,,Polyflex Esoph 20/16mm X 120mm,"$6,756.00",$0.00,"$6,756.00","$3,040.20","$4,821.76",$0.00,"$1,164.03","$4,821.76","$4,821.76","$1,182.92","$6,756.00",$0.00,"$3,378.00","$5,350.75","$5,404.80",$0.00,"$1,057.31",$0.00,"$1,075.56",$0.00
27803556,EAP,HCPCS C1874,,Polyflex Esoph 20/16mm X 150mm,"$6,756.00",$0.00,"$6,756.00","$3,040.20","$4,821.76",$0.00,"$1,164.03","$4,821.76","$4,821.76","$1,182.92","$6,756.00",$0.00,"$3,378.00","$5,350.75","$5,404.80",$0.00,"$1,057.31",$0.00,"$1,075.56",$0.00
27803557,EAP,HCPCS C1874,,Polyflex Esoph 23/18mm X 90mm,"$6,756.00",$0.00,"$6,756.00","$3,040.20","$4,821.76",$0.00,"$1,164.03","$4,821.76","$4,821.76","$1,182.92","$6,756.00",$0.00,"$3,378.00","$5,350.75","$5,404.80",$0.00,"$1,057.31",$0.00,"$1,075.56",$0.00
27803558,EAP,HCPCS C1874,,Polyflex Esoph 23/18mm X 120mm,"$6,756.00",$0.00,"$6,756.00","$3,040.20","$4,821.76",$0.00,"$1,164.03","$4,821.76","$4,821.76","$1,182.92","$6,756.00",$0.00,"$3,378.00","$5,350.75","$5,404.80",$0.00,"$1,057.31",$0.00,"$1,075.56",$0.00
27803559,EAP,HCPCS C1874,,Polyflex Esoph 23/18mm X 150mm,"$6,756.00",$0.00,"$6,756.00","$3,040.20","$4,821.76",$0.00,"$1,164.03","$4,821.76","$4,821.76","$1,182.92","$6,756.00",$0.00,"$3,378.00","$5,350.75","$5,404.80",$0.00,"$1,057.31",$0.00,"$1,075.56",$0.00
27803560,EAP,HCPCS C1874,,Polyflex Esoph 25/21mm X 90mm,"$6,756.00",$0.00,"$6,756.00","$3,040.20","$4,821.76",$0.00,"$1,164.03","$4,821.76","$4,821.76","$1,182.92","$6,756.00",$0.00,"$3,378.00","$5,350.75","$5,404.80",$0.00,"$1,057.31",$0.00,"$1,075.56",$0.00
27803561,EAP,HCPCS C1874,,Polyflex Esoph 25/21mm X 120mm,"$6,756.00",$0.00,"$6,756.00","$3,040.20","$4,821.76",$0.00,"$1,164.03","$4,821.76","$4,821.76","$1,182.92","$6,756.00",$0.00,"$3,378.00","$5,350.75","$5,404.80",$0.00,"$1,057.31",$0.00,"$1,075.56",$0.00
27803562,EAP,HCPCS C1874,,Polyflex Esoph 25/21mm X 150mm,"$6,756.00",$0.00,"$6,756.00","$3,040.20","$4,821.76",$0.00,"$1,164.03","$4,821.76","$4,821.76","$1,182.92","$6,756.00",$0.00,"$3,378.00","$5,350.75","$5,404.80",$0.00,"$1,057.31",$0.00,"$1,075.56",$0.00
27803576,EAP,Custom 44697837,,Stent Bare Metal  Int30012ux,"$2,422.00",$0.00,"$2,422.00",$0.00,"$1,728.58",$0.00,$0.00,"$1,728.58","$1,728.58",$0.00,"$2,422.00",$0.00,"$1,211.00","$1,918.22","$1,937.60",$0.00,$0.00,$0.00,$0.00,$0.00
27803585,EAP,Custom 44697928,,Stent Bare Metal  Int40015ux,"$2,422.00",$0.00,"$2,422.00",$0.00,"$1,728.58",$0.00,$0.00,"$1,728.58","$1,728.58",$0.00,"$2,422.00",$0.00,"$1,211.00","$1,918.22","$1,937.60",$0.00,$0.00,$0.00,$0.00,$0.00
27803600,EAP,HCPCS C1713,,Plate Xlng 134mm Ss 2.7/3.5mm Scr 6 Hole Var Ang,$840.58,$0.00,$840.58,$378.26,$599.92,$0.00,$144.83,$599.92,$599.92,$147.18,$840.58,$0.00,$420.29,$665.74,$672.46,$0.00,$131.55,$0.00,$133.82,$0.00
27803601,EAP,HCPCS C1713,,Screw Bone 3.5mm 30mm Lineum Ti Oct Spn Smth Shnk,"$1,877.60",$0.00,"$1,877.60",$844.92,"$1,340.04",$0.00,$323.50,"$1,340.04","$1,340.04",$328.75,"$1,877.60",$0.00,$938.80,"$1,487.06","$1,502.08",$0.00,$293.84,$0.00,$298.91,$0.00
27803602,EAP,HCPCS C1713,,Rod Spnl 90mm 4.75mm Str Perc Ccm Plus,$300.00,$0.00,$300.00,$135.00,$214.11,$0.00,$51.69,$214.11,$214.11,$52.53,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$46.95,$0.00,$47.76,$0.00
27803603,EAP,HCPCS C1713,,Screw Bone 1.5mm 8mm Hexalobe Pthrd Hand Lag,$129.00,$0.00,$129.00,$58.05,$92.07,$0.00,$22.23,$92.07,$92.07,$22.59,$129.00,$0.00,$64.50,$102.17,$103.20,$0.00,$20.19,$0.00,$20.54,$0.00
27803604,EAP,HCPCS C1713,,Screw Bone 1.5mm 11mm Ti Hand Mtcrpl Phalanges,$129.00,$0.00,$129.00,$58.05,$92.07,$0.00,$22.23,$92.07,$92.07,$22.59,$129.00,$0.00,$64.50,$102.17,$103.20,$0.00,$20.19,$0.00,$20.54,$0.00
27803605,EAP,HCPCS C1713,,Spacer Spnl 22mmx10mm Cpstn Cntrl 12d Peek Intrbd,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,"$1,070.55","$1,070.55",$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
27803606,EAP,HCPCS C1713,,Screw Bone 4.5mm 45mm Solera Cd Hzn Cocr Spn,"$1,558.20",$0.00,"$1,558.20",$701.19,"$1,112.09",$0.00,$268.47,"$1,112.09","$1,112.09",$272.83,"$1,558.20",$0.00,$779.10,"$1,234.09","$1,246.56",$0.00,$243.86,$0.00,$248.07,$0.00
27803607,EAP,HCPCS C1713,,Screw Bone 5.5mm 35mm Ats Spn Multiax 4.75mm Rod,"$1,558.20",$0.00,"$1,558.20",$701.19,"$1,112.09",$0.00,$268.47,"$1,112.09","$1,112.09",$272.83,"$1,558.20",$0.00,$779.10,"$1,234.09","$1,246.56",$0.00,$243.86,$0.00,$248.07,$0.00
27803608,EAP,HCPCS C1713,,Screw Bone 6.5mm 35mm Ats Spn Multiax 4.75mm Rod,"$1,558.20",$0.00,"$1,558.20",$701.19,"$1,112.09",$0.00,$268.47,"$1,112.09","$1,112.09",$272.83,"$1,558.20",$0.00,$779.10,"$1,234.09","$1,246.56",$0.00,$243.86,$0.00,$248.07,$0.00
27803609,EAP,HCPCS C1713,,Cage Spnl 15-20mm 12mm,"$4,498.00",$0.00,"$4,498.00","$2,442.41","$3,210.22",$0.00,$774.98,"$3,210.22","$3,210.22",$787.56,"$4,498.00",$0.00,"$2,249.00","$3,562.42","$3,598.40",$0.00,$703.94,$0.00,$716.08,$0.00
27803610,EAP,HCPCS C1713,,Spacer Spnl 50x18x8mm Crnt Xl Peek Tlif Rdlcnt,"$4,500.00",$0.00,"$4,500.00","$2,025.00","$3,211.65",$0.00,$775.33,"$3,211.65","$3,211.65",$787.91,"$4,500.00",$0.00,"$2,250.00","$3,564.00","$3,600.00",$0.00,$704.25,$0.00,$716.40,$0.00
27803611,EAP,HCPCS C1713,,Cage Spnl 45x18x12mm Crnt Xl Peek-optm Lat Lmbr,"$4,500.00",$0.00,"$4,500.00","$2,025.00","$3,211.65",$0.00,$775.33,"$3,211.65","$3,211.65",$787.91,"$4,500.00",$0.00,"$2,250.00","$3,564.00","$3,600.00",$0.00,$704.25,$0.00,$716.40,$0.00
27803612,EAP,HCPCS C1713,,Spacer Spnl 38x16x28mm Brigade 12d Spn Ant,"$5,513.00",$0.00,"$5,513.00","$2,480.85","$3,934.63",$0.00,$949.86,"$3,934.63","$3,934.63",$965.28,"$5,513.00",$0.00,"$2,756.50","$4,366.30","$4,410.40",$0.00,$862.78,$0.00,$877.67,$0.00
27803613,EAP,HCPCS C1713,,Screw Bone 5mm 62.5mm Trgn Fem Lp,$259.20,$0.00,$259.20,$116.64,$184.99,$0.00,$44.66,$184.99,$184.99,$45.38,$259.20,$0.00,$129.60,$205.29,$207.36,$0.00,$40.56,$0.00,$41.26,$0.00
27803614,EAP,HCPCS C1713,,Nail 10mm 38cm Right Troc Trgn Im 130d Set Antgrd,"$2,280.00",$0.00,"$2,280.00","$1,026.00","$1,627.24",$0.00,$392.83,"$1,627.24","$1,627.24",$399.21,"$2,280.00",$0.00,"$1,140.00","$1,805.76","$1,824.00",$0.00,$356.82,$0.00,$362.98,$0.00
27803616,EAP,HCPCS C1713,,Nail 10mm 38cm Tib Mt-nail Im Ti,"$2,108.00",$0.00,"$2,108.00",$948.60,"$1,504.48",$0.00,$363.20,"$1,504.48","$1,504.48",$369.09,"$2,108.00",$0.00,"$1,054.00","$1,669.54","$1,686.40",$0.00,$329.90,$0.00,$335.59,$0.00
27803618,EAP,HCPCS C1713,,Screw Bone 11mm 30mm Intertan Troch Cmpr,$388.00,$0.00,$388.00,$174.60,$276.92,$0.00,$66.85,$276.92,$276.92,$67.94,$388.00,$0.00,$194.00,$307.30,$310.40,$0.00,$60.72,$0.00,$61.77,$0.00
27803620,EAP,HCPCS C1713,,Kit Scr 90mm 4.5mm Intertan Troch Ti Lag Cmpr,$836.00,$0.00,$836.00,$376.20,$596.65,$0.00,$144.04,$596.65,$596.65,$146.38,$836.00,$0.00,$418.00,$662.11,$668.80,$0.00,$130.83,$0.00,$133.09,$0.00
27803621,EAP,HCPCS C1713,,Plate 2mm Str Frac Bone,"$1,416.00",$0.00,"$1,416.00",$637.20,"$1,010.60",$0.00,$243.97,"$1,010.60","$1,010.60",$247.93,"$1,416.00",$0.00,$708.00,"$1,121.47","$1,132.80",$0.00,$221.60,$0.00,$225.43,$0.00
27803622,EAP,HCPCS C1713,,Nail 10mm 39cm Tib Mt-nail Im Ti,"$2,108.00",$0.00,"$2,108.00",$948.60,"$1,504.48",$0.00,$363.20,"$1,504.48","$1,504.48",$369.09,"$2,108.00",$0.00,"$1,054.00","$1,669.54","$1,686.40",$0.00,$329.90,$0.00,$335.59,$0.00
27803788,EAP,HCPCS C1726,,Dfs100410-20microcoil Platinum Deltapapaq4m,"$2,923.00",$0.00,"$2,923.00","$1,315.35","$2,086.15",$0.00,$503.62,"$2,086.15","$2,086.15",$511.79,"$2,923.00",$0.00,"$1,461.50","$2,315.02","$2,338.40",$0.00,$457.45,$0.00,$465.34,$0.00
27803789,EAP,HCPCS C1717,,"Brachytx, Non-str,hdr Ir-192",$700.00,$0.00,$700.00,$315.00,$499.59,$322.02,$120.61,$499.59,$499.59,$122.56,$700.00,$338.12,$350.00,$554.40,$560.00,$466.93,$109.55,$0.00,$111.44,$322.02
27803795,EAP,HCPCS C1757,,Catheter Thrmb 6fr 65cm Cleanerxt Rot 2 Pwr Cell L,"$1,488.00",$0.00,"$1,488.00",$0.00,"$1,061.99",$0.00,$0.00,"$1,061.99","$1,061.99",$0.00,"$1,488.00",$0.00,$744.00,"$1,178.50","$1,190.40",$0.00,$0.00,$0.00,$0.00,$0.00
27803803,EAP,HCPCS C1726,,Hel181830-20microcoil Platinum Helipaq18,"$1,895.00",$0.00,"$1,895.00",$852.75,"$1,352.46",$0.00,$326.50,"$1,352.46","$1,352.46",$331.80,"$1,895.00",$0.00,$947.50,"$1,500.84","$1,516.00",$0.00,$296.57,$0.00,$301.68,$0.00
27803857,EAP,HCPCS C1726,,Dfs100250-20microcoil Platinum Deltapaq2,"$2,923.00",$0.00,"$2,923.00","$1,315.35","$2,086.15",$0.00,$503.62,"$2,086.15","$2,086.15",$511.79,"$2,923.00",$0.00,"$1,461.50","$2,315.02","$2,338.40",$0.00,$457.45,$0.00,$465.34,$0.00
27803858,EAP,HCPCS C1726,,Dfs100408-20 Microcoil Platinum Deltapaq4m,"$2,923.00",$0.00,"$2,923.00","$1,315.35","$2,086.15",$0.00,$503.62,"$2,086.15","$2,086.15",$511.79,"$2,923.00",$0.00,"$1,461.50","$2,315.02","$2,338.40",$0.00,$457.45,$0.00,$465.34,$0.00
27803860,EAP,HCPCS C1726,,Dfs100510-20microcoil Platinum Deltapaq5m,"$2,923.00",$0.00,"$2,923.00","$1,315.35","$2,086.15",$0.00,$503.62,"$2,086.15","$2,086.15",$511.79,"$2,923.00",$0.00,"$1,461.50","$2,315.02","$2,338.40",$0.00,$457.45,$0.00,$465.34,$0.00
27803861,EAP,HCPCS C1726,,Dfs100515-20 Microcoil Platinum Deltapaq5m,"$2,923.00",$0.00,"$2,923.00","$1,315.35","$2,086.15",$0.00,$503.62,"$2,086.15","$2,086.15",$511.79,"$2,923.00",$0.00,"$1,461.50","$2,315.02","$2,338.40",$0.00,$457.45,$0.00,$465.34,$0.00
27803863,EAP,HCPCS C1726,,Dpl 100153-20microcoil Platinum Deltaplush,"$3,217.00",$0.00,"$3,217.00","$1,447.65","$2,295.97",$0.00,$554.27,"$2,295.97","$2,295.97",$563.27,"$3,217.00",$0.00,"$1,608.50","$2,547.86","$2,573.60",$0.00,$503.46,$0.00,$512.15,$0.00
27803864,EAP,HCPCS C1726,,Dpl 100201-20 Microcoil Platinum Deltaplush,"$3,654.00",$0.00,"$3,654.00","$1,644.30","$2,607.86",$0.00,$629.57,"$2,607.86","$2,607.86",$639.79,"$3,654.00",$0.00,"$1,827.00","$2,893.97","$2,923.20",$0.00,$571.85,$0.00,$581.72,$0.00
27803865,EAP,HCPCS C1726,,Dpl100202-20 Microcoil Platinum Deltaplush,"$3,654.00",$0.00,"$3,654.00","$1,644.30","$2,607.86",$0.00,$629.57,"$2,607.86","$2,607.86",$639.79,"$3,654.00",$0.00,"$1,827.00","$2,893.97","$2,923.20",$0.00,$571.85,$0.00,$581.72,$0.00
27803866,EAP,HCPCS C1726,,Dpl 100203-20 Microcoil Platinum Deliaplush,"$3,217.00",$0.00,"$3,217.00","$1,447.65","$2,295.97",$0.00,$554.27,"$2,295.97","$2,295.97",$563.27,"$3,217.00",$0.00,"$1,608.50","$2,547.86","$2,573.60",$0.00,$503.46,$0.00,$512.15,$0.00
27803867,EAP,HCPCS C1726,,Dpl 100206-20micocoil Platinum Deltaplush,"$3,654.00",$0.00,"$3,654.00","$1,644.30","$2,607.86",$0.00,$629.57,"$2,607.86","$2,607.86",$639.79,"$3,654.00",$0.00,"$1,827.00","$2,893.97","$2,923.20",$0.00,$571.85,$0.00,$581.72,$0.00
27803868,EAP,HCPCS C1726,,Hel 180730-20 Microcoil Platinum Helipaq 7m,"$1,701.00",$0.00,"$1,701.00",$765.45,"$1,214.00",$0.00,$293.07,"$1,214.00","$1,214.00",$297.83,"$1,701.00",$0.00,$850.50,"$1,347.19","$1,360.80",$0.00,$266.21,$0.00,$270.80,$0.00
27803869,EAP,HCPCS C1726,,Hel180930-20microcoil Platinum Helipaq9m,"$1,701.00",$0.00,"$1,701.00",$765.45,"$1,214.00",$0.00,$293.07,"$1,214.00","$1,214.00",$297.83,"$1,701.00",$0.00,$850.50,"$1,347.19","$1,360.80",$0.00,$266.21,$0.00,$270.80,$0.00
27803870,EAP,HCPCS C1726,,Hel181030-20 Microcoil Platinum Helipaq10,"$1,701.00",$0.00,"$1,701.00",$765.45,"$1,214.00",$0.00,$293.07,"$1,214.00","$1,214.00",$297.83,"$1,701.00",$0.00,$850.50,"$1,347.19","$1,360.80",$0.00,$266.21,$0.00,$270.80,$0.00
27803871,EAP,HCPCS C1726,,Hel181230-20 Microcoil Platinum Helipaq12,"$2,051.00",$0.00,"$2,051.00",$922.95,"$1,463.80",$0.00,$353.38,"$1,463.80","$1,463.80",$359.11,"$2,051.00",$0.00,"$1,025.50","$1,624.39","$1,640.80",$0.00,$320.98,$0.00,$326.52,$0.00
27803872,EAP,HCPCS C1726,,Hel181430-20 Microcoil Platinum Helipaq14,"$1,805.00",$0.00,"$1,805.00",$812.25,"$1,288.23",$0.00,$310.99,"$1,288.23","$1,288.23",$316.04,"$1,805.00",$0.00,$902.50,"$1,429.56","$1,444.00",$0.00,$282.48,$0.00,$287.36,$0.00
27803873,EAP,HCPCS C1726,,Hel181630-20 Microcoil Platinum Helipaq16,"$1,601.00",$0.00,"$1,601.00",$720.45,"$1,142.63",$0.00,$275.84,"$1,142.63","$1,142.63",$280.32,"$1,601.00",$0.00,$800.50,"$1,267.99","$1,280.80",$0.00,$250.56,$0.00,$254.88,$0.00
27803875,EAP,HCPCS C1726,,Hel182030-20 Microcoil Platinum Helipaq 20,"$1,895.00",$0.00,"$1,895.00",$852.75,"$1,352.46",$0.00,$326.50,"$1,352.46","$1,352.46",$331.80,"$1,895.00",$0.00,$947.50,"$1,500.84","$1,516.00",$0.00,$296.57,$0.00,$301.68,$0.00
27803876,EAP,HCPCS C1726,,Dpl 100152-20 Microcoil Platinum Deltaplush,"$3,217.00",$0.00,"$3,217.00","$1,447.65","$2,295.97",$0.00,$554.27,"$2,295.97","$2,295.97",$563.27,"$3,217.00",$0.00,"$1,608.50","$2,547.86","$2,573.60",$0.00,$503.46,$0.00,$512.15,$0.00
27803880,EAP,Custom 27803880,,Device Perclose,$789.00,$0.00,$789.00,$0.00,$563.11,$0.00,$0.00,$563.11,$563.11,$0.00,$789.00,$0.00,$394.50,$624.89,$631.20,$0.00,$0.00,$0.00,$0.00,$0.00
27803881,EAP,HCPCS C1760,,Sph100500-20 Mircrocoil Platin,"$3,686.00",$0.00,"$3,686.00","$1,658.70","$2,630.70",$0.00,$635.08,"$2,630.70","$2,630.70",$645.39,"$3,686.00",$0.00,"$1,843.00","$2,919.31","$2,948.80",$0.00,$576.86,$0.00,$586.81,$0.00
27803882,EAP,HCPCS C1760,,Sph100620-20 Microcoil Platinu,"$3,885.00",$0.00,"$3,885.00","$1,748.25","$2,772.72",$0.00,$669.37,"$2,772.72","$2,772.72",$680.23,"$3,885.00",$0.00,"$1,942.50","$3,076.92","$3,108.00",$0.00,$608.00,$0.00,$618.49,$0.00
27803883,EAP,HCPCS C1760,,Sph100700-20 Microcoil Platinu,"$3,770.00",$0.00,"$3,770.00","$1,696.50","$2,690.65",$0.00,$649.55,"$2,690.65","$2,690.65",$660.10,"$3,770.00",$0.00,"$1,885.00","$2,985.84","$3,016.00",$0.00,$590.01,$0.00,$600.18,$0.00
27803884,EAP,HCPCS C1760,,Sph100720-20 Microcoil Platinu,"$3,885.00",$0.00,"$3,885.00","$1,748.25","$2,772.72",$0.00,$669.37,"$2,772.72","$2,772.72",$680.23,"$3,885.00",$0.00,"$1,942.50","$3,076.92","$3,108.00",$0.00,$608.00,$0.00,$618.49,$0.00
27803885,EAP,HCPCS C1760,,Sph100800-20 Microil Platinum,"$3,819.00",$0.00,"$3,819.00","$1,718.55","$2,725.62",$0.00,$657.99,"$2,725.62","$2,725.62",$668.68,"$3,819.00",$0.00,"$1,909.50","$3,024.65","$3,055.20",$0.00,$597.67,$0.00,$607.98,$0.00
27803886,EAP,HCPCS C1760,,Sph100825-20 Microcoil Platinu,"$3,986.00",$0.00,"$3,986.00","$1,793.70","$2,844.81",$0.00,$686.77,"$2,844.81","$2,844.81",$697.92,"$3,986.00",$0.00,"$1,993.00","$3,156.91","$3,188.80",$0.00,$623.81,$0.00,$634.57,$0.00
27803887,EAP,HCPCS C1760,,Sph100925-20 Microcoil Platinu,"$3,986.00",$0.00,"$3,986.00","$1,793.70","$2,844.81",$0.00,$686.77,"$2,844.81","$2,844.81",$697.92,"$3,986.00",$0.00,"$1,993.00","$3,156.91","$3,188.80",$0.00,$623.81,$0.00,$634.57,$0.00
27803888,EAP,HCPCS C1760,,Sph101000-20 Microcoil Platinu,"$3,885.00",$0.00,"$3,885.00","$1,748.25","$2,772.72",$0.00,$669.37,"$2,772.72","$2,772.72",$680.23,"$3,885.00",$0.00,"$1,942.50","$3,076.92","$3,108.00",$0.00,$608.00,$0.00,$618.49,$0.00
27803889,EAP,HCPCS C1760,,Sph181100-20 Microcoil Platinu,"$3,885.00",$0.00,"$3,885.00","$1,748.25","$2,772.72",$0.00,$669.37,"$2,772.72","$2,772.72",$680.23,"$3,885.00",$0.00,"$1,942.50","$3,076.92","$3,108.00",$0.00,$608.00,$0.00,$618.49,$0.00
27803890,EAP,HCPCS C1760,,Sph181200-20 Microcoil Platinu,"$3,920.00",$0.00,"$3,920.00","$1,764.00","$2,797.70",$0.00,$675.40,"$2,797.70","$2,797.70",$686.36,"$3,920.00",$0.00,"$1,960.00","$3,104.64","$3,136.00",$0.00,$613.48,$0.00,$624.06,$0.00
27803891,EAP,HCPCS C1760,,Sph181300-20 Microcoil Platinu,"$3,920.00",$0.00,"$3,920.00","$1,764.00","$2,797.70",$0.00,$675.40,"$2,797.70","$2,797.70",$686.36,"$3,920.00",$0.00,"$1,960.00","$3,104.64","$3,136.00",$0.00,$613.48,$0.00,$624.06,$0.00
27803892,EAP,HCPCS C1760,,Sph181400-20 Microcoil Platinu,"$3,955.00",$0.00,"$3,955.00","$1,779.75","$2,822.68",$0.00,$681.43,"$2,822.68","$2,822.68",$692.49,"$3,955.00",$0.00,"$1,977.50","$3,132.36","$3,164.00",$0.00,$618.96,$0.00,$629.64,$0.00
27803893,EAP,HCPCS C1760,,Sph181500-20 Microcoil Platinu,"$4,005.00",$0.00,"$4,005.00","$1,802.25","$2,858.37",$0.00,$690.04,"$2,858.37","$2,858.37",$701.24,"$4,005.00",$0.00,"$2,002.50","$3,171.96","$3,204.00",$0.00,$626.78,$0.00,$637.60,$0.00
27803894,EAP,HCPCS C1760,,Sph181600-20 Microcoil Platinu,"$4,020.00",$0.00,"$4,020.00","$1,809.00","$2,869.07",$0.00,$692.63,"$2,869.07","$2,869.07",$703.87,"$4,020.00",$0.00,"$2,010.00","$3,183.84","$3,216.00",$0.00,$629.13,$0.00,$639.98,$0.00
27803895,EAP,HCPCS C1760,,Sph181700-20 Microcoil Platinu,"$4,071.00",$0.00,"$4,071.00","$1,831.95","$2,905.47",$0.00,$701.41,"$2,905.47","$2,905.47",$712.80,"$4,071.00",$0.00,"$2,035.50","$3,224.23","$3,256.80",$0.00,$637.11,$0.00,$648.10,$0.00
27803896,EAP,HCPCS C1760,,Sph181800-20 Microcoil Platinu,"$4,071.00",$0.00,"$4,071.00","$1,831.95","$2,905.47",$0.00,$701.41,"$2,905.47","$2,905.47",$712.80,"$4,071.00",$0.00,"$2,035.50","$3,224.23","$3,256.80",$0.00,$637.11,$0.00,$648.10,$0.00
27803897,EAP,HCPCS C1760,,Src140306-20 Microcoil Platinu,"$3,885.00",$0.00,"$3,885.00","$1,748.25","$2,772.72",$0.00,$669.37,"$2,772.72","$2,772.72",$680.23,"$3,885.00",$0.00,"$1,942.50","$3,076.92","$3,108.00",$0.00,$608.00,$0.00,$618.49,$0.00
27803898,EAP,HCPCS C1760,,Src140445-20microcoil Platinum,"$3,885.00",$0.00,"$3,885.00","$1,748.25","$2,772.72",$0.00,$669.37,"$2,772.72","$2,772.72",$680.23,"$3,885.00",$0.00,"$1,942.50","$3,076.92","$3,108.00",$0.00,$608.00,$0.00,$618.49,$0.00
27803899,EAP,HCPCS C1760,,Src140406-20 Microcoil Platinu,"$3,903.00",$0.00,"$3,903.00","$1,756.35","$2,785.57",$0.00,$672.47,"$2,785.57","$2,785.57",$683.38,"$3,903.00",$0.00,"$1,951.50","$3,091.18","$3,122.40",$0.00,$610.82,$0.00,$621.36,$0.00
27803900,EAP,HCPCS C1760,,Src140408-20 Microcoil Platinu,"$3,920.00",$0.00,"$3,920.00","$1,764.00","$2,797.70",$0.00,$675.40,"$2,797.70","$2,797.70",$686.36,"$3,920.00",$0.00,"$1,960.00","$3,104.64","$3,136.00",$0.00,$613.48,$0.00,$624.06,$0.00
27803901,EAP,HCPCS C1760,,Src140507-20 Microcoil Micrusp,"$3,920.00",$0.00,"$3,920.00","$1,764.00","$2,797.70",$0.00,$675.40,"$2,797.70","$2,797.70",$686.36,"$3,920.00",$0.00,"$1,960.00","$3,104.64","$3,136.00",$0.00,$613.48,$0.00,$624.06,$0.00
27803902,EAP,HCPCS C1760,,Src140512-20 Microcoil Platinu,"$3,955.00",$0.00,"$3,955.00","$1,779.75","$2,822.68",$0.00,$681.43,"$2,822.68","$2,822.68",$692.49,"$3,955.00",$0.00,"$1,977.50","$3,132.36","$3,164.00",$0.00,$618.96,$0.00,$629.64,$0.00
27803903,EAP,HCPCS C1760,,Src140609-20 Microcoil Platinu,"$3,936.00",$0.00,"$3,936.00","$1,771.20","$2,809.12",$0.00,$678.15,"$2,809.12","$2,809.12",$689.16,"$3,936.00",$0.00,"$1,968.00","$3,117.31","$3,148.80",$0.00,$615.98,$0.00,$626.61,$0.00
27803904,EAP,HCPCS C1760,,Src140615-20 Microcoil Plainum,"$4,005.00",$0.00,"$4,005.00","$1,802.25","$2,858.37",$0.00,$690.04,"$2,858.37","$2,858.37",$701.24,"$4,005.00",$0.00,"$2,002.50","$3,171.96","$3,204.00",$0.00,$626.78,$0.00,$637.60,$0.00
27803905,EAP,HCPCS C1760,,Src140711-20 Microcoil Platinu,"$3,955.00",$0.00,"$3,955.00","$1,779.75","$2,822.68",$0.00,$681.43,"$2,822.68","$2,822.68",$692.49,"$3,955.00",$0.00,"$1,977.50","$3,132.36","$3,164.00",$0.00,$618.96,$0.00,$629.64,$0.00
27803906,EAP,HCPCS C1760,,Src140717-20 Microcoil Platinu,"$4,105.00",$0.00,"$4,105.00","$1,847.25","$2,929.74",$0.00,$707.27,"$2,929.74","$2,929.74",$718.75,"$4,105.00",$0.00,"$2,052.50","$3,251.16","$3,284.00",$0.00,$642.43,$0.00,$653.52,$0.00
27803907,EAP,HCPCS C1760,,Src140812-20 Microcoil Platinu,"$4,020.00",$0.00,"$4,020.00","$1,809.00","$2,869.07",$0.00,$692.63,"$2,869.07","$2,869.07",$703.87,"$4,020.00",$0.00,"$2,010.00","$3,183.84","$3,216.00",$0.00,$629.13,$0.00,$639.98,$0.00
27803908,EAP,HCPCS C1760,,Src140820-20 Microcoil Platinu,"$4,170.00",$0.00,"$4,170.00","$1,876.50","$2,976.13",$0.00,$718.47,"$2,976.13","$2,976.13",$730.13,"$4,170.00",$0.00,"$2,085.00","$3,302.64","$3,336.00",$0.00,$652.61,$0.00,$663.86,$0.00
27803909,EAP,HCPCS C1760,,Src140922-20 Microcoil Platinu,"$4,204.00",$0.00,"$4,204.00","$1,891.80","$3,000.39",$0.00,$724.33,"$3,000.39","$3,000.39",$736.09,"$4,204.00",$0.00,"$2,102.00","$3,329.57","$3,363.20",$0.00,$657.93,$0.00,$669.28,$0.00
27803910,EAP,HCPCS C1760,,Src141016-20 Microcoil Platinu,"$4,105.00",$0.00,"$4,105.00","$1,847.25","$2,929.74",$0.00,$707.27,"$2,929.74","$2,929.74",$718.75,"$4,105.00",$0.00,"$2,052.50","$3,251.16","$3,284.00",$0.00,$642.43,$0.00,$653.52,$0.00
27803911,EAP,HCPCS C1760,,Src141025-20 Microcoil Platinu,"$4,255.00",$0.00,"$4,255.00","$1,914.75","$3,036.79",$0.00,$733.12,"$3,036.79","$3,036.79",$745.02,"$4,255.00",$0.00,"$2,127.50","$3,369.96","$3,404.00",$0.00,$665.91,$0.00,$677.40,$0.00
27803912,EAP,HCPCS C1760,,Src141118-20 Microcoil Platinu,"$4,170.00",$0.00,"$4,170.00","$1,876.50","$2,976.13",$0.00,$718.47,"$2,976.13","$2,976.13",$730.13,"$4,170.00",$0.00,"$2,085.00","$3,302.64","$3,336.00",$0.00,$652.61,$0.00,$663.86,$0.00
27803913,EAP,HCPCS C1760,,Src141127-20 Microcoil Platinu,"$4,304.00",$0.00,"$4,304.00","$1,936.80","$3,071.76",$0.00,$741.56,"$3,071.76","$3,071.76",$753.60,"$4,304.00",$0.00,"$2,152.00","$3,408.77","$3,443.20",$0.00,$673.58,$0.00,$685.20,$0.00
27803914,EAP,HCPCS C1760,,Src141219-20 Microcoil [platin,"$4,204.00",$0.00,"$4,204.00","$1,891.80","$3,000.39",$0.00,$724.33,"$3,000.39","$3,000.39",$736.09,"$4,204.00",$0.00,"$2,102.00","$3,329.57","$3,363.20",$0.00,$657.93,$0.00,$669.28,$0.00
27803915,EAP,HCPCS C1760,,Src141230-20 Microcoil Platinu,"$4,355.00",$0.00,"$4,355.00","$1,959.75","$3,108.16",$0.00,$750.34,"$3,108.16","$3,108.16",$762.53,"$4,355.00",$0.00,"$2,177.50","$3,449.16","$3,484.00",$0.00,$681.56,$0.00,$693.32,$0.00
27803916,EAP,HCPCS C1760,,Fsr100201-20 Microcoil Platinu,"$3,135.00",$0.00,"$3,135.00","$1,410.75","$2,237.45",$0.00,$540.14,"$2,237.45","$2,237.45",$548.91,"$3,135.00",$0.00,"$1,567.50","$2,482.92","$2,508.00",$0.00,$490.63,$0.00,$499.09,$0.00
27803917,EAP,HCPCS C1760,,Fsr100202-20 Microcoil Platinu,"$3,169.00",$0.00,"$3,169.00","$1,426.05","$2,261.72",$0.00,$546.00,"$2,261.72","$2,261.72",$554.87,"$3,169.00",$0.00,"$1,584.50","$2,509.85","$2,535.20",$0.00,$495.95,$0.00,$504.50,$0.00
27803918,EAP,HCPCS C1760,,Fsr100203-20 Microcoil Platinu,"$3,186.00",$0.00,"$3,186.00","$1,433.70","$2,273.85",$0.00,$548.93,"$2,273.85","$2,273.85",$557.84,"$3,186.00",$0.00,"$1,593.00","$2,523.31","$2,548.80",$0.00,$498.61,$0.00,$507.21,$0.00
27803919,EAP,HCPCS C1760,,Frs100204-20 Microcoil Platinu,"$3,203.00",$0.00,"$3,203.00","$1,441.35","$2,285.98",$0.00,$551.86,"$2,285.98","$2,285.98",$560.82,"$3,203.00",$0.00,"$1,601.50","$2,536.78","$2,562.40",$0.00,$501.27,$0.00,$509.92,$0.00
27803920,EAP,HCPCS C1760,,Fsr100206-20 Microcoil Platinu,"$3,236.00",$0.00,"$3,236.00","$1,456.20","$2,309.53",$0.00,$557.55,"$2,309.53","$2,309.53",$566.60,"$3,236.00",$0.00,"$1,618.00","$2,562.91","$2,588.80",$0.00,$506.43,$0.00,$515.17,$0.00
27803921,EAP,HCPCS C1760,,Fsr100208-20 Microcoil Platinu,"$3,270.00",$0.00,"$3,270.00","$1,471.50","$2,333.80",$0.00,$563.40,"$2,333.80","$2,333.80",$572.55,"$3,270.00",$0.00,"$1,635.00","$2,589.84","$2,616.00",$0.00,$511.76,$0.00,$520.58,$0.00
27803922,EAP,HCPCS C1760,,Fsr100252-20 Microcoil Platinu,"$3,169.00",$0.00,"$3,169.00","$1,426.05","$2,261.72",$0.00,$546.00,"$2,261.72","$2,261.72",$554.87,"$3,169.00",$0.00,"$1,584.50","$2,509.85","$2,535.20",$0.00,$495.95,$0.00,$504.50,$0.00
27803923,EAP,HCPCS C1760,,Fsr100254-20 Microcoil Platinu,"$3,203.00",$0.00,"$3,203.00","$1,441.35","$2,285.98",$0.00,$551.86,"$2,285.98","$2,285.98",$560.82,"$3,203.00",$0.00,"$1,601.50","$2,536.78","$2,562.40",$0.00,$501.27,$0.00,$509.92,$0.00
27803924,EAP,HCPCS C1760,,Fsr100256-20 Microcoil Platinu,"$3,236.00",$0.00,"$3,236.00","$1,456.20","$2,309.53",$0.00,$557.55,"$2,309.53","$2,309.53",$566.60,"$3,236.00",$0.00,"$1,618.00","$2,562.91","$2,588.80",$0.00,$506.43,$0.00,$515.17,$0.00
27803925,EAP,HCPCS C1760,,Fsr100258-20 Microcoil Platinu,"$3,270.00",$0.00,"$3,270.00","$1,471.50","$2,333.80",$0.00,$563.40,"$2,333.80","$2,333.80",$572.55,"$3,270.00",$0.00,"$1,635.00","$2,589.84","$2,616.00",$0.00,$511.76,$0.00,$520.58,$0.00
27803926,EAP,HCPCS C1760,,Fsr100306-20 Microcoil Platinu,"$3,236.00",$0.00,"$3,236.00","$1,456.20","$2,309.53",$0.00,$557.55,"$2,309.53","$2,309.53",$566.60,"$3,236.00",$0.00,"$1,618.00","$2,562.91","$2,588.80",$0.00,$506.43,$0.00,$515.17,$0.00
27803927,EAP,HCPCS C1760,,Fsr100308-20 Microcoil Platinu,"$3,270.00",$0.00,"$3,270.00","$1,471.50","$2,333.80",$0.00,$563.40,"$2,333.80","$2,333.80",$572.55,"$3,270.00",$0.00,"$1,635.00","$2,589.84","$2,616.00",$0.00,$511.76,$0.00,$520.58,$0.00
27803928,EAP,HCPCS C1760,,Fsr100406-20 Microcoil Platinu,"$3,236.00",$0.00,"$3,236.00","$1,456.20","$2,309.53",$0.00,$557.55,"$2,309.53","$2,309.53",$566.60,"$3,236.00",$0.00,"$1,618.00","$2,562.91","$2,588.80",$0.00,$506.43,$0.00,$515.17,$0.00
27803929,EAP,HCPCS C1760,,Fsr100408-20 Microcoil Platinu,"$3,270.00",$0.00,"$3,270.00","$1,471.50","$2,333.80",$0.00,$563.40,"$2,333.80","$2,333.80",$572.55,"$3,270.00",$0.00,"$1,635.00","$2,589.84","$2,616.00",$0.00,$511.76,$0.00,$520.58,$0.00
27803940,EAP,HCPCS C1888,,"Endovascular Laser Catheter, Abl","$1,226.00",$0.00,"$1,226.00",$0.00,$875.00,$0.00,$0.00,$875.00,$875.00,$0.00,"$1,226.00",$0.00,$613.00,$970.99,$980.80,$0.00,$0.00,$0.00,$0.00,$0.00
27803941,EAP,HCPCS C1874,,Viator Stent 10 X 4,"$11,885.00",$0.00,"$11,885.00","$5,348.25","$5,158.80",$0.00,"$2,047.73","$5,158.80","$8,482.32","$2,080.97","$11,885.00",$0.00,"$5,942.50","$9,412.92","$9,508.00",$0.00,"$1,860.00",$0.00,"$1,892.09",$0.00
27803942,EAP,HCPCS C1874,,Viator Stent 10 X 5,"$11,885.00",$0.00,"$11,885.00","$5,348.25","$5,158.80",$0.00,"$2,047.73","$5,158.80","$8,482.32","$2,080.97","$11,885.00",$0.00,"$5,942.50","$9,412.92","$9,508.00",$0.00,"$1,860.00",$0.00,"$1,892.09",$0.00
27803943,EAP,HCPCS C1874,,Viator Stent 10 X 6,"$11,885.00",$0.00,"$11,885.00","$5,348.25","$5,158.80",$0.00,"$2,047.73","$5,158.80","$8,482.32","$2,080.97","$11,885.00",$0.00,"$5,942.50","$9,412.92","$9,508.00",$0.00,"$1,860.00",$0.00,"$1,892.09",$0.00
27803944,EAP,HCPCS C1874,,Viator Stent 10 X 7,"$11,885.00",$0.00,"$11,885.00","$5,348.25","$5,158.80",$0.00,"$2,047.73","$5,158.80","$8,482.32","$2,080.97","$11,885.00",$0.00,"$5,942.50","$9,412.92","$9,508.00",$0.00,"$1,860.00",$0.00,"$1,892.09",$0.00
27803945,EAP,HCPCS C1874,,Viator Stent 10 X 8,"$11,885.00",$0.00,"$11,885.00","$5,348.25","$5,158.80",$0.00,"$2,047.73","$5,158.80","$8,482.32","$2,080.97","$11,885.00",$0.00,"$5,942.50","$9,412.92","$9,508.00",$0.00,"$1,860.00",$0.00,"$1,892.09",$0.00
27803950,EAP,HCPCS V2790,,Prokera (amniograft) Ring 16mm,"$3,167.00",$0.00,"$3,167.00","$1,425.15","$2,260.29",$0.00,$545.66,"$2,260.29","$2,260.29",$554.52,"$3,167.00",$0.00,"$1,583.50","$2,508.26","$2,533.60",$0.00,$495.64,$0.00,$504.19,$0.00
27803951,EAP,HCPCS C1882,,Crt-d 40 Unify (icd),"$89,408.00",$0.00,"$89,408.00","$40,233.60","$5,158.80",$0.00,"$8,138.89","$5,158.80","$63,810.49","$8,138.89","$89,408.00",$0.00,"$44,704.00","$70,811.14","$71,526.40",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27803952,EAP,HCPCS C1722,,Fortify Icd-vr40,"$60,048.00",$0.00,"$60,048.00","$27,021.60","$5,158.80",$0.00,"$8,138.89","$5,158.80","$42,856.26","$8,138.89","$60,048.00",$0.00,"$30,024.00","$47,558.02","$48,038.40",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27803960,EAP,HCPCS C1886,,"Catheter, Ablation",$310.00,$0.00,$310.00,$139.50,$221.25,$0.00,$53.41,$221.25,$221.25,$54.28,$310.00,$0.00,$155.00,$245.52,$248.00,$0.00,$48.52,$0.00,$49.35,$0.00
27803961,EAP,HCPCS C2617,,Gore Viatorr Tips Endoprosthesis 4cm X  2cm X12mm,"$4,843.00",$0.00,"$4,843.00","$2,179.35","$3,456.45",$0.00,$834.42,"$3,456.45","$3,456.45",$847.97,"$4,843.00",$0.00,"$2,421.50","$3,835.66","$3,874.40",$0.00,$757.93,$0.00,$771.01,$0.00
27803962,EAP,HCPCS C2617,,Gore Viatorr Tips Endoprosthesis 6cm X 2cm X 12mm,"$4,843.00",$0.00,"$4,843.00","$2,179.35","$3,456.45",$0.00,$834.42,"$3,456.45","$3,456.45",$847.97,"$4,843.00",$0.00,"$2,421.50","$3,835.66","$3,874.40",$0.00,$757.93,$0.00,$771.01,$0.00
27803963,EAP,HCPCS C2617,,Gore Viatorr Tips Endoprosthesis 8cm X 2cm X 12mm,"$4,843.00",$0.00,"$4,843.00","$2,179.35","$3,456.45",$0.00,$834.42,"$3,456.45","$3,456.45",$847.97,"$4,843.00",$0.00,"$2,421.50","$3,835.66","$3,874.40",$0.00,$757.93,$0.00,$771.01,$0.00
27803964,EAP,HCPCS C2617,,Gore Viabil Endoprosthesis 10mm X 4cm X 40cm,"$3,216.00",$0.00,"$3,216.00","$1,447.20","$2,295.26",$0.00,$554.10,"$2,295.26","$2,295.26",$563.10,"$3,216.00",$0.00,"$1,608.00","$2,547.07","$2,572.80",$0.00,$503.30,$0.00,$511.99,$0.00
27803965,EAP,HCPCS C2617,,Gore Viabil Endoprosthesis 10mm X 6cm X 40cm,"$3,216.00",$0.00,"$3,216.00","$1,447.20","$2,295.26",$0.00,$554.10,"$2,295.26","$2,295.26",$563.10,"$3,216.00",$0.00,"$1,608.00","$2,547.07","$2,572.80",$0.00,$503.30,$0.00,$511.99,$0.00
27803966,EAP,HCPCS C2617,,Gore Viabil Endoprosthesis 10mm X 8cm X 40cm,"$3,216.00",$0.00,"$3,216.00","$1,746.29","$2,295.26",$0.00,$554.10,"$2,295.26","$2,295.26",$563.10,"$3,216.00",$0.00,"$1,608.00","$2,547.07","$2,572.80",$0.00,$503.30,$0.00,$511.99,$0.00
27803967,EAP,HCPCS C2617,,Gore Viabil Endoprosthesis 10mm X 10cm X 40cm,"$3,216.00",$0.00,"$3,216.00","$1,447.20","$2,295.26",$0.00,$554.10,"$2,295.26","$2,295.26",$563.10,"$3,216.00",$0.00,"$1,608.00","$2,547.07","$2,572.80",$0.00,$503.30,$0.00,$511.99,$0.00
27803968,EAP,HCPCS C1713,,Amplatz Anchor System 8 X 30,$117.00,$0.00,$117.00,$52.65,$83.50,$0.00,$20.16,$83.50,$83.50,$20.49,$117.00,$0.00,$58.50,$92.66,$93.60,$0.00,$18.31,$0.00,$18.63,$0.00
27803969,EAP,HCPCS C1713,,Amplatz Anchor System 10 X 30,$117.00,$0.00,$117.00,$52.65,$83.50,$0.00,$20.16,$83.50,$83.50,$20.49,$117.00,$0.00,$58.50,$92.66,$93.60,$0.00,$18.31,$0.00,$18.63,$0.00
27803970,EAP,HCPCS C1876,,M001711300  Stent Wall 6fr 8/80/75cm,"$4,931.00",$0.00,"$4,931.00","$2,218.95","$3,519.25",$0.00,$849.59,"$3,519.25","$3,519.25",$863.38,"$4,931.00",$0.00,"$2,465.50","$3,905.35","$3,944.80",$0.00,$771.70,$0.00,$785.02,$0.00
27803971,EAP,HCPCS C1894,,Retriever Merci L6 90060,"$10,536.00",$0.00,"$10,536.00","$4,741.20","$5,158.80",$0.00,"$1,815.30","$5,158.80","$7,519.54","$1,844.77","$10,536.00",$0.00,"$5,268.00","$8,344.51","$8,428.80",$0.00,"$1,648.88",$0.00,"$1,677.33",$0.00
27804055,EAP,HCPCS C1874,,Test Name New,"$7,990.00",$0.00,"$7,990.00","$3,595.50","$5,158.80",$0.00,"$1,376.64","$5,158.80","$5,702.46","$1,398.99","$7,990.00",$0.00,"$3,995.00","$6,328.08","$6,392.00",$0.00,"$1,250.44",$0.00,"$1,272.01",$0.00
27804056,EAP,Custom 27804056,,"Retriever Mercl L6, 90060","$10,536.00",$0.00,"$10,536.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$7,519.54",$0.00,"$10,536.00",$0.00,"$5,268.00","$8,344.51","$8,428.80",$0.00,$0.00,$0.00,$0.00,$0.00
27804060,EAP,HCPCS C1764,,"Implantable Cardiac Monitor, Confirm Ic","$11,676.00",$0.00,"$11,676.00","$5,254.20","$5,158.80",$0.00,"$2,011.72","$5,158.80","$8,333.16","$2,044.37","$11,676.00",$0.00,"$5,838.00","$9,247.39","$9,340.80",$0.00,"$1,827.29",$0.00,"$1,858.82",$0.00
27804067,EAP,HCPCS C1880,,Md800f Filter Peripheral Vena Cava Femoral,"$2,933.00",$0.00,"$2,933.00","$1,319.85","$2,093.28",$0.00,$505.34,"$2,093.28","$2,093.28",$513.54,"$2,933.00",$0.00,"$1,466.50","$2,322.94","$2,346.40",$0.00,$459.01,$0.00,$466.93,$0.00
27804068,EAP,HCPCS C1880,,Md800j Filter Peripheral Vena Cava Jugular,"$3,080.00",$0.00,"$3,080.00","$1,386.00","$2,198.20",$0.00,$530.67,"$2,198.20","$2,198.20",$539.28,"$3,080.00",$0.00,"$1,540.00","$2,439.36","$2,464.00",$0.00,$482.02,$0.00,$490.34,$0.00
27804070,EAP,HCPCS C1757,,Sfr-4-15 Device Thrombectomy Solitaire Fr 4x15,"$18,930.00",$0.00,"$18,930.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$13,510.34",$0.00,"$18,930.00",$0.00,"$9,465.00","$14,992.56","$15,144.00",$0.00,$0.00,$0.00,$0.00,$0.00
27804071,EAP,HCPCS C1757,,Sfr-4-20 Device Thrombectomy Solitaire Fr 4x20,"$18,930.00",$0.00,"$18,930.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$13,510.34",$0.00,"$18,930.00",$0.00,"$9,465.00","$14,992.56","$15,144.00",$0.00,$0.00,$0.00,$0.00,$0.00
27804072,EAP,HCPCS C1757,,Sfr-6-20 Device Thrombectomy Solitaire Fr 6x20,"$18,930.00",$0.00,"$18,930.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$13,510.34",$0.00,"$18,930.00",$0.00,"$9,465.00","$14,992.56","$15,144.00",$0.00,$0.00,$0.00,$0.00,$0.00
27804073,EAP,HCPCS C1757,,Sfr-6-30 Device Thrombectomy Solitaire Fr 6x30,"$18,930.00",$0.00,"$18,930.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$13,510.34",$0.00,"$18,930.00",$0.00,"$9,465.00","$14,992.56","$15,144.00",$0.00,$0.00,$0.00,$0.00,$0.00
27804080,EAP,Custom 27804080,,G08261 Embolization Coil,$278.00,$0.00,$278.00,$0.00,$198.41,$0.00,$0.00,$198.41,$198.41,$0.00,$278.00,$0.00,$139.00,$220.18,$222.40,$0.00,$0.00,$0.00,$0.00,$0.00
27804088,EAP,HCPCS C1777,,"Reliance Df4 Lead, Aicd, Endo Single Coil","$13,964.00",$0.00,"$13,964.00","$6,283.80","$5,158.80",$0.00,"$2,405.93","$5,158.80","$9,966.11","$2,444.98","$13,964.00",$0.00,"$6,982.00","$11,059.49","$11,171.20",$0.00,"$2,185.37",$0.00,"$2,223.07",$0.00
27804089,EAP,HCPCS C1777,,"Reliance Gore Df4 Lead,aicd, Endo Single Coil","$13,964.00",$0.00,"$13,964.00","$6,283.80","$5,158.80",$0.00,"$2,405.93","$5,158.80","$9,966.11","$2,444.98","$13,964.00",$0.00,"$6,982.00","$11,059.49","$11,171.20",$0.00,"$2,185.37",$0.00,"$2,223.07",$0.00
27804090,EAP,HCPCS C1882,,"Energen Df4 Crt-d Aicd, Other Than Sing/dual","$68,273.00",$0.00,"$68,273.00","$30,722.85","$5,158.80",$0.00,"$8,138.89","$5,158.80","$48,726.44","$8,138.89","$68,273.00",$0.00,"$34,136.50","$54,072.22","$54,618.40",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27804091,EAP,HCPCS C1882,,"Energen Crt-d Aicd, Other Than Sing/dual","$68,273.00",$0.00,"$68,273.00","$30,722.85","$5,158.80",$0.00,"$8,138.89","$5,158.80","$48,726.44","$8,138.89","$68,273.00",$0.00,"$34,136.50","$54,072.22","$54,618.40",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27804092,EAP,HCPCS C1882,,"Unify Quadra Aicd, Other Than Sing/dual","$89,376.00",$0.00,"$89,376.00","$40,219.20","$5,158.80",$0.00,"$8,138.89","$5,158.80","$63,787.65","$8,138.89","$89,376.00",$0.00,"$44,688.00","$70,785.79","$71,500.80",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27804093,EAP,HCPCS C1898,,"Tc-1888 Tendril Lead Pmkr, Other Than Trans","$1,551.00",$0.00,"$1,551.00",$697.95,"$1,106.95",$0.00,$267.23,"$1,106.95","$1,106.95",$271.57,"$1,551.00",$0.00,$775.50,"$1,228.39","$1,240.80",$0.00,$242.73,$0.00,$246.92,$0.00
27804094,EAP,HCPCS C1900,,"Q-1458 Quartet Lead, Aicd, Endo Single Coil","$8,566.00",$0.00,"$8,566.00",$0.00,"$5,158.80",$0.00,"$1,475.88","$5,158.80","$6,113.55",$0.00,"$8,566.00",$0.00,"$4,283.00","$6,784.27","$6,852.80",$0.00,"$1,340.58",$0.00,$0.00,$0.00
27804098,EAP,HCPCS C1876,,Enterprise 22mm Stent No-tip,"$16,138.00",$0.00,"$16,138.00","$7,262.10","$5,158.80",$0.00,"$2,780.50","$5,158.80","$11,517.69","$2,825.63","$16,138.00",$0.00,"$8,069.00","$12,781.30","$12,910.40",$0.00,"$2,525.60",$0.00,"$2,569.17",$0.00
27804099,EAP,HCPCS C1876,,Enterprise 38mm Stent No-tip,"$16,138.00",$0.00,"$16,138.00","$7,262.10","$5,158.80",$0.00,"$2,780.50","$5,158.80","$11,517.69","$2,825.63","$16,138.00",$0.00,"$8,069.00","$12,781.30","$12,910.40",$0.00,"$2,525.60",$0.00,"$2,569.17",$0.00
27804100,EAP,HCPCS C1876,,Enterprise 37mm Stent No-tip,"$16,138.00",$0.00,"$16,138.00","$7,262.10","$5,158.80",$0.00,"$2,780.50","$5,158.80","$11,517.69","$2,825.63","$16,138.00",$0.00,"$8,069.00","$12,781.30","$12,910.40",$0.00,"$2,525.60",$0.00,"$2,569.17",$0.00
27804103,EAP,Custom 27804103,,"Px 400,straight","$2,749.00",$0.00,"$2,749.00",$0.00,"$1,961.96",$0.00,$0.00,"$1,961.96","$1,961.96",$0.00,"$2,749.00",$0.00,"$1,374.50","$2,177.21","$2,199.20",$0.00,$0.00,$0.00,$0.00,$0.00
27804104,EAP,Custom 27804104,,"Px 400, 45","$2,749.00",$0.00,"$2,749.00",$0.00,"$1,961.96",$0.00,$0.00,"$1,961.96","$1,961.96",$0.00,"$2,749.00",$0.00,"$1,374.50","$2,177.21","$2,199.20",$0.00,$0.00,$0.00,$0.00,$0.00
27804105,EAP,Custom 27804105,,"Px 400, J","$2,749.00",$0.00,"$2,749.00",$0.00,"$1,961.96",$0.00,$0.00,"$1,961.96","$1,961.96",$0.00,"$2,749.00",$0.00,"$1,374.50","$2,177.21","$2,199.20",$0.00,$0.00,$0.00,$0.00,$0.00
27804106,EAP,Custom 27804106,,Start Up Kit,$798.00,$0.00,$798.00,$0.00,$569.53,$0.00,$0.00,$569.53,$569.53,$0.00,$798.00,$0.00,$399.00,$632.02,$638.40,$0.00,$0.00,$0.00,$0.00,$0.00
27804107,EAP,Custom 27804107,,Senor Flotrac,$993.00,$0.00,$993.00,$0.00,$708.70,$0.00,$0.00,$708.70,$708.70,$0.00,$993.00,$0.00,$496.50,$786.46,$794.40,$0.00,$0.00,$0.00,$0.00,$0.00
27804108,EAP,Custom 27804108,,"Coil 400 Complex Standard, 15mm X 57cm","$7,642.00",$0.00,"$7,642.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,454.10",$0.00,"$7,642.00",$0.00,"$3,821.00","$6,052.46","$6,113.60",$0.00,$0.00,$0.00,$0.00,$0.00
27804109,EAP,Custom 27804109,,"Coil 400 Complex Standard, 16mm X 60cm","$7,685.00",$0.00,"$7,685.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,484.78",$0.00,"$7,685.00",$0.00,"$3,842.50","$6,086.52","$6,148.00",$0.00,$0.00,$0.00,$0.00,$0.00
27804110,EAP,HCPCS C1752,,Cath. Schon(5615200) Xl Sil. 035 In L20 Cm Guidewire Inr,$571.00,$0.00,$571.00,$0.00,$407.52,$0.00,$0.00,$407.52,$407.52,$0.00,$571.00,$0.00,$285.50,$452.23,$456.80,$0.00,$0.00,$0.00,$0.00,$0.00
27804111,EAP,HCPCS C1752,,Cath. Schon(5615150) Xl Silicone .035 In L15 Cm Guidewir,$544.00,$0.00,$544.00,$0.00,$388.25,$0.00,$0.00,$388.25,$388.25,$0.00,$544.00,$0.00,$272.00,$430.85,$435.20,$0.00,$0.00,$0.00,$0.00,$0.00
27804112,EAP,HCPCS C1752,,Cath. Schon(5605300) 30cm Full Hemo,$571.00,$0.00,$571.00,$0.00,$407.52,$0.00,$0.00,$407.52,$407.52,$0.00,$571.00,$0.00,$285.50,$452.23,$456.80,$0.00,$0.00,$0.00,$0.00,$0.00
27804113,EAP,HCPCS A4648,,Implantable Tissue Marker,$520.00,$0.00,$520.00,$234.00,$371.12,$0.00,$89.59,$371.12,$371.12,$91.05,$520.00,$0.00,$260.00,$411.84,$416.00,$0.00,$81.38,$0.00,$82.78,$0.00
27804116,EAP,Custom 27804116,,"Coil 400 Complex Standard, 18mm X 57cm","$7,642.00",$0.00,"$7,642.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,454.10",$0.00,"$7,642.00",$0.00,"$3,821.00","$6,052.46","$6,113.60",$0.00,$0.00,$0.00,$0.00,$0.00
27804117,EAP,Custom 27804117,,"Coil 400 Complex Standard, 20mm X 60cm","$7,685.00",$0.00,"$7,685.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,484.78",$0.00,"$7,685.00",$0.00,"$3,842.50","$6,086.52","$6,148.00",$0.00,$0.00,$0.00,$0.00,$0.00
27804118,EAP,Custom 27804118,,"Coil 400 Complex Standard, 22mm X 60cm","$7,685.00",$0.00,"$7,685.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,484.78",$0.00,"$7,685.00",$0.00,"$3,842.50","$6,086.52","$6,148.00",$0.00,$0.00,$0.00,$0.00,$0.00
27804119,EAP,Custom 27804119,,"Coil 400 Complex Standard, 24mm X 57cm","$7,642.00",$0.00,"$7,642.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,454.10",$0.00,"$7,642.00",$0.00,"$3,821.00","$6,052.46","$6,113.60",$0.00,$0.00,$0.00,$0.00,$0.00
27804120,EAP,Custom 27804120,,"Coil 400 Complex Standard, 28mm X 60 Cm","$8,572.00",$0.00,"$8,572.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$6,117.84",$0.00,"$8,572.00",$0.00,"$4,286.00","$6,789.02","$6,857.60",$0.00,$0.00,$0.00,$0.00,$0.00
27804121,EAP,Custom 27804121,,Px 400 90,"$2,749.00",$0.00,"$2,749.00",$0.00,"$1,961.96",$0.00,$0.00,"$1,961.96","$1,961.96",$0.00,"$2,749.00",$0.00,"$1,374.50","$2,177.21","$2,199.20",$0.00,$0.00,$0.00,$0.00,$0.00
27804122,EAP,Custom 27804122,,"Coil 400 Complex Standard, 32mm X 60 Cm","$8,572.00",$0.00,"$8,572.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$6,117.84",$0.00,"$8,572.00",$0.00,"$4,286.00","$6,789.02","$6,857.60",$0.00,$0.00,$0.00,$0.00,$0.00
27804123,EAP,Custom 27804123,,"Coil 400 Complex Soft, 3 Mm X 3 Cm","$7,034.00",$0.00,"$7,034.00",$0.00,"$5,020.17",$0.00,$0.00,"$5,020.17","$5,020.17",$0.00,"$7,034.00",$0.00,"$3,517.00","$5,570.93","$5,627.20",$0.00,$0.00,$0.00,$0.00,$0.00
27804124,EAP,Custom 27804124,,"Coil 400 Complex Extra Soft, 4mm X 10cm","$8,157.00",$0.00,"$8,157.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,821.65",$0.00,"$8,157.00",$0.00,"$4,078.50","$6,460.34","$6,525.60",$0.00,$0.00,$0.00,$0.00,$0.00
27804125,EAP,Custom 27804125,,"Coil 400 Complex Soft, 13mm X 35cm","$7,980.00",$0.00,"$7,980.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,695.33",$0.00,"$7,980.00",$0.00,"$3,990.00","$6,320.16","$6,384.00",$0.00,$0.00,$0.00,$0.00,$0.00
27804126,EAP,Custom 27804126,,"Coil 400 Complex Soft, 13mm X 48cm","$8,364.00",$0.00,"$8,364.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,969.39",$0.00,"$8,364.00",$0.00,"$4,182.00","$6,624.29","$6,691.20",$0.00,$0.00,$0.00,$0.00,$0.00
27804127,EAP,Custom 27804127,,"Coil 400 Complex Soft, 14mm X 40cm","$8,128.00",$0.00,"$8,128.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,800.95",$0.00,"$8,128.00",$0.00,"$4,064.00","$6,437.38","$6,502.40",$0.00,$0.00,$0.00,$0.00,$0.00
27804128,EAP,Custom 27804128,,"Coil 400 Complex Soft, 14mm X 50cm","$8,424.00",$0.00,"$8,424.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$6,012.21",$0.00,"$8,424.00",$0.00,"$4,212.00","$6,671.81","$6,739.20",$0.00,$0.00,$0.00,$0.00,$0.00
27804129,EAP,Custom 27804129,,"Coil 400 Complex Soft, 16mm X 45cm","$8,276.00",$0.00,"$8,276.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,906.58",$0.00,"$8,276.00",$0.00,"$4,138.00","$6,554.59","$6,620.80",$0.00,$0.00,$0.00,$0.00,$0.00
27804130,EAP,Custom 27804130,,"Coil 400 J, 7cm","$6,680.00",$0.00,"$6,680.00",$0.00,"$4,767.52",$0.00,$0.00,"$4,767.52","$4,767.52",$0.00,"$6,680.00",$0.00,"$3,340.00","$5,290.56","$5,344.00",$0.00,$0.00,$0.00,$0.00,$0.00
27804131,EAP,Custom 27804131,,"Coil 400 J, 10cm","$7,448.00",$0.00,"$7,448.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,315.64",$0.00,"$7,448.00",$0.00,"$3,724.00","$5,898.82","$5,958.40",$0.00,$0.00,$0.00,$0.00,$0.00
27804132,EAP,Custom 27804132,,"Coil 400 J, 15cm","$7,743.00",$0.00,"$7,743.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,526.18",$0.00,"$7,743.00",$0.00,"$3,871.50","$6,132.46","$6,194.40",$0.00,$0.00,$0.00,$0.00,$0.00
27804133,EAP,Custom 27804133,,"Coil 400 J, 25cm","$8,334.00",$0.00,"$8,334.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,947.98",$0.00,"$8,334.00",$0.00,"$4,167.00","$6,600.53","$6,667.20",$0.00,$0.00,$0.00,$0.00,$0.00
27804134,EAP,Custom 27804134,,"Coil 400 Complex Standard, 3 Mm X 6 Cm","$6,532.00",$0.00,"$6,532.00",$0.00,"$4,661.89",$0.00,$0.00,"$4,661.89","$4,661.89",$0.00,"$6,532.00",$0.00,"$3,266.00","$5,173.34","$5,225.60",$0.00,$0.00,$0.00,$0.00,$0.00
27804135,EAP,Custom 27804135,,"Coil 400 Complex Standard, 3 Mm X 10 Cm","$6,651.00",$0.00,"$6,651.00",$0.00,"$4,746.82",$0.00,$0.00,"$4,746.82","$4,746.82",$0.00,"$6,651.00",$0.00,"$3,325.50","$5,267.59","$5,320.80",$0.00,$0.00,$0.00,$0.00,$0.00
27804136,EAP,Custom 27804136,,"Coil 400 Complex Standard, 4 Mm X 8 Cm","$6,591.00",$0.00,"$6,591.00",$0.00,"$4,704.00",$0.00,$0.00,"$4,704.00","$4,704.00",$0.00,"$6,591.00",$0.00,"$3,295.50","$5,220.07","$5,272.80",$0.00,$0.00,$0.00,$0.00,$0.00
27804137,EAP,Custom 27804137,,"Coil 400 Complex Standard, 4 Mm X 12 Cm","$6,708.00",$0.00,"$6,708.00",$0.00,"$4,787.50",$0.00,$0.00,"$4,787.50","$4,787.50",$0.00,"$6,708.00",$0.00,"$3,354.00","$5,312.74","$5,366.40",$0.00,$0.00,$0.00,$0.00,$0.00
27804138,EAP,Custom 27804138,,"Coil 400 Complex Standard, 5 Mm X 6 Cm","$6,532.00",$0.00,"$6,532.00",$0.00,"$4,661.89",$0.00,$0.00,"$4,661.89","$4,661.89",$0.00,"$6,532.00",$0.00,"$3,266.00","$5,173.34","$5,225.60",$0.00,$0.00,$0.00,$0.00,$0.00
27804139,EAP,Custom 27804139,,"Coil 400 Complex Standard, 5mm X 10cm","$6,651.00",$0.00,"$6,651.00",$0.00,"$4,746.82",$0.00,$0.00,"$4,746.82","$4,746.82",$0.00,"$6,651.00",$0.00,"$3,325.50","$5,267.59","$5,320.80",$0.00,$0.00,$0.00,$0.00,$0.00
27804140,EAP,Custom 27804140,,"Coil 400 Complex Standard, 6mm X 10cm","$6,651.00",$0.00,"$6,651.00",$0.00,"$4,746.82",$0.00,$0.00,"$4,746.82","$4,746.82",$0.00,"$6,651.00",$0.00,"$3,325.50","$5,267.59","$5,320.80",$0.00,$0.00,$0.00,$0.00,$0.00
27804141,EAP,Custom 27804141,,"Coil 400 Complex Standard, 6mm X 15cm","$6,798.00",$0.00,"$6,798.00",$0.00,"$4,851.73",$0.00,$0.00,"$4,851.73","$4,851.73",$0.00,"$6,798.00",$0.00,"$3,399.00","$5,384.02","$5,438.40",$0.00,$0.00,$0.00,$0.00,$0.00
27804142,EAP,Custom 27804142,,"Coil 400 Complex Standard, 7mm X 10cm","$6,651.00",$0.00,"$6,651.00",$0.00,"$4,746.82",$0.00,$0.00,"$4,746.82","$4,746.82",$0.00,"$6,651.00",$0.00,"$3,325.50","$5,267.59","$5,320.80",$0.00,$0.00,$0.00,$0.00,$0.00
27804143,EAP,Custom 27804143,,"Coil 400 Complex Soft, 3 Mm X 4 Cm","$7,063.00",$0.00,"$7,063.00",$0.00,"$5,040.86",$0.00,$0.00,"$5,040.86","$5,040.86",$0.00,"$7,063.00",$0.00,"$3,531.50","$5,593.90","$5,650.40",$0.00,$0.00,$0.00,$0.00,$0.00
27804144,EAP,Custom 27804144,,"Coil 400 Complex Soft, 3 Mm X 6 Cm","$7,123.00",$0.00,"$7,123.00",$0.00,"$5,083.69",$0.00,$0.00,"$5,083.69","$5,083.69",$0.00,"$7,123.00",$0.00,"$3,561.50","$5,641.42","$5,698.40",$0.00,$0.00,$0.00,$0.00,$0.00
27804145,EAP,Custom 27804145,,"Coil 400 Complex Soft, 3 Mm X 10 Cm","$7,241.00",$0.00,"$7,241.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,167.90",$0.00,"$7,241.00",$0.00,"$3,620.50","$5,734.87","$5,792.80",$0.00,$0.00,$0.00,$0.00,$0.00
27804146,EAP,Custom 27804146,,"Coil 400 Complex Soft, 4 Mm X 4 Cm","$7,063.00",$0.00,"$7,063.00",$0.00,"$5,040.86",$0.00,$0.00,"$5,040.86","$5,040.86",$0.00,"$7,063.00",$0.00,"$3,531.50","$5,593.90","$5,650.40",$0.00,$0.00,$0.00,$0.00,$0.00
27804147,EAP,Custom 27804147,,"Coil 400 Complex Soft, 4 Mm X 6 Cm","$7,123.00",$0.00,"$7,123.00",$0.00,"$5,083.69",$0.00,$0.00,"$5,083.69","$5,083.69",$0.00,"$7,123.00",$0.00,"$3,561.50","$5,641.42","$5,698.40",$0.00,$0.00,$0.00,$0.00,$0.00
27804148,EAP,Custom 27804148,,"Coil 400 Complex Soft, 4 Mm X 8 Cm","$7,182.00",$0.00,"$7,182.00",$0.00,"$5,125.79",$0.00,$0.00,"$5,125.79","$5,125.79",$0.00,"$7,182.00",$0.00,"$3,591.00","$5,688.14","$5,745.60",$0.00,$0.00,$0.00,$0.00,$0.00
27804149,EAP,Custom 27804149,,"Coil 400 Complex Soft, 4 Mm X 12 Cm","$7,300.00",$0.00,"$7,300.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,210.01",$0.00,"$7,300.00",$0.00,"$3,650.00","$5,781.60","$5,840.00",$0.00,$0.00,$0.00,$0.00,$0.00
27804150,EAP,Custom 27804150,,"Coil 400 Complex Soft, 5mm X 9cm","$7,211.00",$0.00,"$7,211.00",$0.00,"$5,146.49",$0.00,$0.00,"$5,146.49","$5,146.49",$0.00,"$7,211.00",$0.00,"$3,605.50","$5,711.11","$5,768.80",$0.00,$0.00,$0.00,$0.00,$0.00
27804151,EAP,Custom 27804151,,"Coil 400 Complex Soft, 5mm X 13cm","$7,331.00",$0.00,"$7,331.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,232.13",$0.00,"$7,331.00",$0.00,"$3,665.50","$5,806.15","$5,864.80",$0.00,$0.00,$0.00,$0.00,$0.00
27804152,EAP,Custom 27804152,,"Coil 400 Complex Standard, 10mm X 30cm","$7,241.00",$0.00,"$7,241.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,167.90",$0.00,"$7,241.00",$0.00,"$3,620.50","$5,734.87","$5,792.80",$0.00,$0.00,$0.00,$0.00,$0.00
27804153,EAP,Custom 27804153,,"Coil 400 Complex Standard, 10mm X 40cm","$7,389.00",$0.00,"$7,389.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,273.53",$0.00,"$7,389.00",$0.00,"$3,694.50","$5,852.09","$5,911.20",$0.00,$0.00,$0.00,$0.00,$0.00
27804154,EAP,Custom 27804154,,"Coil 400 Complex Standard, 11mm X 35cm","$7,316.00",$0.00,"$7,316.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,221.43",$0.00,"$7,316.00",$0.00,"$3,658.00","$5,794.27","$5,852.80",$0.00,$0.00,$0.00,$0.00,$0.00
27804155,EAP,Custom 27804155,,"Coil 400 Complex Standard, 11mm X 45cm","$7,464.00",$0.00,"$7,464.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,327.06",$0.00,"$7,464.00",$0.00,"$3,732.00","$5,911.49","$5,971.20",$0.00,$0.00,$0.00,$0.00,$0.00
27804156,EAP,Custom 27804156,,"Coil 400 Complex Standard, 12mm X 35cm","$7,316.00",$0.00,"$7,316.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,221.43",$0.00,"$7,316.00",$0.00,"$3,658.00","$5,794.27","$5,852.80",$0.00,$0.00,$0.00,$0.00,$0.00
27804157,EAP,Custom 27804157,,"Coil 400 Complex Standard, 12mm X 45cm","$7,464.00",$0.00,"$7,464.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,327.06",$0.00,"$7,464.00",$0.00,"$3,732.00","$5,911.49","$5,971.20",$0.00,$0.00,$0.00,$0.00,$0.00
27804158,EAP,Custom 27804158,,"Coil 400 Complex Standard, 13mm X 35cm","$7,316.00",$0.00,"$7,316.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,221.43",$0.00,"$7,316.00",$0.00,"$3,658.00","$5,794.27","$5,852.80",$0.00,$0.00,$0.00,$0.00,$0.00
27804159,EAP,Custom 27804159,,"Coil 400 Complex Standard, 13mm X 48cm","$7,507.00",$0.00,"$7,507.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,357.75",$0.00,"$7,507.00",$0.00,"$3,753.50","$5,945.54","$6,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
27804160,EAP,Custom 27804160,,"Coil 400 Complex Standard, 14mm X 50cm","$7,537.00",$0.00,"$7,537.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,379.16",$0.00,"$7,537.00",$0.00,"$3,768.50","$5,969.30","$6,029.60",$0.00,$0.00,$0.00,$0.00,$0.00
27804161,EAP,Custom 27804161,,"Coil 400 Complex Soft, 6mm X 10cm","$7,241.00",$0.00,"$7,241.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,167.90",$0.00,"$7,241.00",$0.00,"$3,620.50","$5,734.87","$5,792.80",$0.00,$0.00,$0.00,$0.00,$0.00
27804162,EAP,Custom 27804162,,"Coil 400 Complex Soft, 6mm X 15cm","$7,389.00",$0.00,"$7,389.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,273.53",$0.00,"$7,389.00",$0.00,"$3,694.50","$5,852.09","$5,911.20",$0.00,$0.00,$0.00,$0.00,$0.00
27804163,EAP,Custom 27804163,,"Coil 400 Complex Soft, 6mm X 20cm","$7,537.00",$0.00,"$7,537.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,379.16",$0.00,"$7,537.00",$0.00,"$3,768.50","$5,969.30","$6,029.60",$0.00,$0.00,$0.00,$0.00,$0.00
27804164,EAP,Custom 27804164,,"Coil 400 Complex Soft, 7 Mm X 10 Cm","$7,241.00",$0.00,"$7,241.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,167.90",$0.00,"$7,241.00",$0.00,"$3,620.50","$5,734.87","$5,792.80",$0.00,$0.00,$0.00,$0.00,$0.00
27804165,EAP,Custom 27804165,,"Coil 400 Complex Soft, 7mm X 15cm","$7,389.00",$0.00,"$7,389.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,273.53",$0.00,"$7,389.00",$0.00,"$3,694.50","$5,852.09","$5,911.20",$0.00,$0.00,$0.00,$0.00,$0.00
27804166,EAP,Custom 27804166,,"Coil 400 Complex Soft, 7mm X 20cm","$7,537.00",$0.00,"$7,537.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,379.16",$0.00,"$7,537.00",$0.00,"$3,768.50","$5,969.30","$6,029.60",$0.00,$0.00,$0.00,$0.00,$0.00
27804167,EAP,Custom 27804167,,"Coil 400 Complex Soft, 8mm X 15cm","$7,389.00",$0.00,"$7,389.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,273.53",$0.00,"$7,389.00",$0.00,"$3,694.50","$5,852.09","$5,911.20",$0.00,$0.00,$0.00,$0.00,$0.00
27804168,EAP,Custom 27804168,,"Coil 400 Complex Soft, 8mm X 20cm","$7,389.00",$0.00,"$7,389.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,273.53",$0.00,"$7,389.00",$0.00,"$3,694.50","$5,852.09","$5,911.20",$0.00,$0.00,$0.00,$0.00,$0.00
27804169,EAP,Custom 27804169,,"Coil 400 Complex Soft, 8mm X 30cm","$7,832.00",$0.00,"$7,832.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,589.70",$0.00,"$7,832.00",$0.00,"$3,916.00","$6,202.94","$6,265.60",$0.00,$0.00,$0.00,$0.00,$0.00
27804170,EAP,Custom 27804170,,"Coil 400 Curve Extra Soft, 3mm X 8cm","$7,241.00",$0.00,"$7,241.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,167.90",$0.00,"$7,241.00",$0.00,"$3,620.50","$5,734.87","$5,792.80",$0.00,$0.00,$0.00,$0.00,$0.00
27804171,EAP,Custom 27804171,,"Coil 400 Curve Extra Soft, 3mm X 10cm","$7,699.00",$0.00,"$7,699.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,494.78",$0.00,"$7,699.00",$0.00,"$3,849.50","$6,097.61","$6,159.20",$0.00,$0.00,$0.00,$0.00,$0.00
27804172,EAP,Custom 27804172,,"Coil 400 Curve Extra Soft, 4mm X 4cm","$6,000.00",$0.00,"$6,000.00",$0.00,"$4,282.20",$0.00,$0.00,"$4,282.20","$4,282.20",$0.00,"$6,000.00",$0.00,"$3,000.00","$4,752.00","$4,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
27804173,EAP,Custom 27804173,,"Coil 400 Curve Extra Soft, 4mm X 6cm","$6,000.00",$0.00,"$6,000.00",$0.00,"$4,282.20",$0.00,$0.00,"$4,282.20","$4,282.20",$0.00,"$6,000.00",$0.00,"$3,000.00","$4,752.00","$4,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
27804174,EAP,Custom 27804174,,"Coil 400 Curve Extra Soft, 4mm X 8cm","$7,241.00",$0.00,"$7,241.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,167.90",$0.00,"$7,241.00",$0.00,"$3,620.50","$5,734.87","$5,792.80",$0.00,$0.00,$0.00,$0.00,$0.00
27804175,EAP,Custom 27804175,,"Coil 400 Curve Extra Soft, 4mm X 10cm","$7,699.00",$0.00,"$7,699.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,494.78",$0.00,"$7,699.00",$0.00,"$3,849.50","$6,097.61","$6,159.20",$0.00,$0.00,$0.00,$0.00,$0.00
27804176,EAP,Custom 27804176,,"Coil 400 Complex Extra Soft, 2mm X 2cm","$5,674.00",$0.00,"$5,674.00",$0.00,"$4,049.53",$0.00,$0.00,"$4,049.53","$4,049.53",$0.00,"$5,674.00",$0.00,"$2,837.00","$4,493.81","$4,539.20",$0.00,$0.00,$0.00,$0.00,$0.00
27804177,EAP,Custom 27804177,,"Coil 400 Complex Extra Soft, 2mm X 3cm","$5,986.00",$0.00,"$5,986.00",$0.00,"$4,272.21",$0.00,$0.00,"$4,272.21","$4,272.21",$0.00,"$5,986.00",$0.00,"$2,993.00","$4,740.91","$4,788.80",$0.00,$0.00,$0.00,$0.00,$0.00
27804178,EAP,Custom 27804178,,"Coil 400 Complex Extra Soft, 2mm X 4cm","$6,296.00",$0.00,"$6,296.00",$0.00,"$4,493.46",$0.00,$0.00,"$4,493.46","$4,493.46",$0.00,"$6,296.00",$0.00,"$3,148.00","$4,986.43","$5,036.80",$0.00,$0.00,$0.00,$0.00,$0.00
27804179,EAP,Custom 27804179,,"Coil 400 Complex Soft, 9mm X 25cm","$7,685.00",$0.00,"$7,685.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,484.78",$0.00,"$7,685.00",$0.00,"$3,842.50","$6,086.52","$6,148.00",$0.00,$0.00,$0.00,$0.00,$0.00
27804180,EAP,Custom 27804180,,"Coil 400 Complex Soft, 9mm X 35cm","$7,980.00",$0.00,"$7,980.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,695.33",$0.00,"$7,980.00",$0.00,"$3,990.00","$6,320.16","$6,384.00",$0.00,$0.00,$0.00,$0.00,$0.00
27804181,EAP,Custom 27804181,,"Coil 400 Complex Soft, 10mm X 20cm","$7,537.00",$0.00,"$7,537.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,379.16",$0.00,"$7,537.00",$0.00,"$3,768.50","$5,969.30","$6,029.60",$0.00,$0.00,$0.00,$0.00,$0.00
27804182,EAP,Custom 27804182,,"Coil 400 Complex Soft, 10mm X 30cm","$7,832.00",$0.00,"$7,832.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,589.70",$0.00,"$7,832.00",$0.00,"$3,916.00","$6,202.94","$6,265.60",$0.00,$0.00,$0.00,$0.00,$0.00
27804183,EAP,Custom 27804183,,"Coil 400 Complex Soft, 10mm X 40cm","$8,128.00",$0.00,"$8,128.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,800.95",$0.00,"$8,128.00",$0.00,"$4,064.00","$6,437.38","$6,502.40",$0.00,$0.00,$0.00,$0.00,$0.00
27804184,EAP,Custom 27804184,,"Coil 400 Complex Soft, 11mm X 35cm","$7,980.00",$0.00,"$7,980.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,695.33",$0.00,"$7,980.00",$0.00,"$3,990.00","$6,320.16","$6,384.00",$0.00,$0.00,$0.00,$0.00,$0.00
27804185,EAP,Custom 27804185,,"Coil 400 Complex Soft, 11mm X 45cm","$8,276.00",$0.00,"$8,276.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,906.58",$0.00,"$8,276.00",$0.00,"$4,138.00","$6,554.59","$6,620.80",$0.00,$0.00,$0.00,$0.00,$0.00
27804186,EAP,Custom 27804186,,"Coil 400 Complex Soft, 12mm X 35cm","$7,980.00",$0.00,"$7,980.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,695.33",$0.00,"$7,980.00",$0.00,"$3,990.00","$6,320.16","$6,384.00",$0.00,$0.00,$0.00,$0.00,$0.00
27804187,EAP,Custom 27804187,,"Coil 400 Complex Soft, 12mm X 45cm","$8,276.00",$0.00,"$8,276.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,906.58",$0.00,"$8,276.00",$0.00,"$4,138.00","$6,554.59","$6,620.80",$0.00,$0.00,$0.00,$0.00,$0.00
27804188,EAP,Custom 27804188,,"Coil 400 Curve Extra Soft, 2mm X 1cm","$5,070.00",$0.00,"$5,070.00",$0.00,"$3,618.46",$0.00,$0.00,"$3,618.46","$3,618.46",$0.00,"$5,070.00",$0.00,"$2,535.00","$4,015.44","$4,056.00",$0.00,$0.00,$0.00,$0.00,$0.00
27804189,EAP,Custom 27804189,,"Coil 400 Curve Extra Soft, 2mm X 2cm","$5,379.00",$0.00,"$5,379.00",$0.00,"$3,838.99",$0.00,$0.00,"$3,838.99","$3,838.99",$0.00,"$5,379.00",$0.00,"$2,689.50","$4,260.17","$4,303.20",$0.00,$0.00,$0.00,$0.00,$0.00
27804190,EAP,Custom 27804190,,"Coil 400 Curve Extra Soft, 2mm X 3cm","$5,690.00",$0.00,"$5,690.00",$0.00,"$4,060.95",$0.00,$0.00,"$4,060.95","$4,060.95",$0.00,"$5,690.00",$0.00,"$2,845.00","$4,506.48","$4,552.00",$0.00,$0.00,$0.00,$0.00,$0.00
27804191,EAP,Custom 27804191,,"Coil 400 Curve Extra Soft, 2mm X 4cm","$6,000.00",$0.00,"$6,000.00",$0.00,"$4,282.20",$0.00,$0.00,"$4,282.20","$4,282.20",$0.00,"$6,000.00",$0.00,"$3,000.00","$4,752.00","$4,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
27804192,EAP,Custom 27804192,,"Coil 400 Curve Extra Soft, 3mm X 2cm","$5,379.00",$0.00,"$5,379.00",$0.00,"$3,838.99",$0.00,$0.00,"$3,838.99","$3,838.99",$0.00,"$5,379.00",$0.00,"$2,689.50","$4,260.17","$4,303.20",$0.00,$0.00,$0.00,$0.00,$0.00
27804193,EAP,Custom 27804193,,"Coil 400 Curve Extra Soft, 3mm X 3cm","$5,690.00",$0.00,"$5,690.00",$0.00,"$4,060.95",$0.00,$0.00,"$4,060.95","$4,060.95",$0.00,"$5,690.00",$0.00,"$2,845.00","$4,506.48","$4,552.00",$0.00,$0.00,$0.00,$0.00,$0.00
27804194,EAP,Custom 27804194,,"Coil 400 Curve Extra Soft, 3mm X 4cm","$6,000.00",$0.00,"$6,000.00",$0.00,"$4,282.20",$0.00,$0.00,"$4,282.20","$4,282.20",$0.00,"$6,000.00",$0.00,"$3,000.00","$4,752.00","$4,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
27804195,EAP,Custom 27804195,,"Coil 400 Curve Extra Soft, 3mm X 5cm","$6,310.00",$0.00,"$6,310.00",$0.00,"$4,503.45",$0.00,$0.00,"$4,503.45","$4,503.45",$0.00,"$6,310.00",$0.00,"$3,155.00","$4,997.52","$5,048.00",$0.00,$0.00,$0.00,$0.00,$0.00
27804196,EAP,Custom 27804196,,"Coil 400 Curve Extra Soft, 3mm X 6cm","$6,620.00",$0.00,"$6,620.00",$0.00,"$4,724.69",$0.00,$0.00,"$4,724.69","$4,724.69",$0.00,"$6,620.00",$0.00,"$3,310.00","$5,243.04","$5,296.00",$0.00,$0.00,$0.00,$0.00,$0.00
27804197,EAP,Custom 27804197,,"Coil 400 Complex Extra Soft, 3mm X 3cm","$5,986.00",$0.00,"$5,986.00",$0.00,"$4,272.21",$0.00,$0.00,"$4,272.21","$4,272.21",$0.00,"$5,986.00",$0.00,"$2,993.00","$4,740.91","$4,788.80",$0.00,$0.00,$0.00,$0.00,$0.00
27804198,EAP,Custom 27804198,,"Coil 400 Complex Extra Soft, 3mm X 4cm","$6,296.00",$0.00,"$6,296.00",$0.00,"$4,493.46",$0.00,$0.00,"$4,493.46","$4,493.46",$0.00,"$6,296.00",$0.00,"$3,148.00","$4,986.43","$5,036.80",$0.00,$0.00,$0.00,$0.00,$0.00
27804199,EAP,Custom 27804199,,"Coil 400 Complex Extra Soft, 3mm X 5cm","$6,606.00",$0.00,"$6,606.00",$0.00,"$4,714.70",$0.00,$0.00,"$4,714.70","$4,714.70",$0.00,"$6,606.00",$0.00,"$3,303.00","$5,231.95","$5,284.80",$0.00,$0.00,$0.00,$0.00,$0.00
27804200,EAP,Custom 27804200,,"Coil 400 Complex Extra Soft, 3mm X 6cm","$6,916.00",$0.00,"$6,916.00",$0.00,"$4,935.95",$0.00,$0.00,"$4,935.95","$4,935.95",$0.00,"$6,916.00",$0.00,"$3,458.00","$5,477.47","$5,532.80",$0.00,$0.00,$0.00,$0.00,$0.00
27804201,EAP,Custom 27804201,,"Coil 400 Complex Extra Soft, 3mm X 8cm","$7,537.00",$0.00,"$7,537.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,379.16",$0.00,"$7,537.00",$0.00,"$3,768.50","$5,969.30","$6,029.60",$0.00,$0.00,$0.00,$0.00,$0.00
27804202,EAP,Custom 27804202,,"Coil 400 Complex Extra Soft, 3mm X 10cm","$8,157.00",$0.00,"$8,157.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,821.65",$0.00,"$8,157.00",$0.00,"$4,078.50","$6,460.34","$6,525.60",$0.00,$0.00,$0.00,$0.00,$0.00
27804203,EAP,Custom 27804203,,"Coil 400 Complex Extra Soft, 4mm X 4cm","$6,296.00",$0.00,"$6,296.00",$0.00,"$4,493.46",$0.00,$0.00,"$4,493.46","$4,493.46",$0.00,"$6,296.00",$0.00,"$3,148.00","$4,986.43","$5,036.80",$0.00,$0.00,$0.00,$0.00,$0.00
27804204,EAP,Custom 27804204,,"Coil 400 Complex Extra Soft, 4mm X 6cm","$6,916.00",$0.00,"$6,916.00",$0.00,"$4,935.95",$0.00,$0.00,"$4,935.95","$4,935.95",$0.00,"$6,916.00",$0.00,"$3,458.00","$5,477.47","$5,532.80",$0.00,$0.00,$0.00,$0.00,$0.00
27804205,EAP,Custom 27804205,,"Coil 400 Complex Extra Soft, 4mm X 8cm","$7,537.00",$0.00,"$7,537.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,379.16",$0.00,"$7,537.00",$0.00,"$3,768.50","$5,969.30","$6,029.60",$0.00,$0.00,$0.00,$0.00,$0.00
27804206,EAP,Custom 27804206,,"Coil 400 Complex Standard, 7 Mm X 15 Cm","$6,798.00",$0.00,"$6,798.00",$0.00,"$4,851.73",$0.00,$0.00,"$4,851.73","$4,851.73",$0.00,"$6,798.00",$0.00,"$3,399.00","$5,384.02","$5,438.40",$0.00,$0.00,$0.00,$0.00,$0.00
27804207,EAP,Custom 27804207,,"Coil 400 Complex Standard, 7mm X 20cm","$6,946.00",$0.00,"$6,946.00",$0.00,"$4,957.36",$0.00,$0.00,"$4,957.36","$4,957.36",$0.00,"$6,946.00",$0.00,"$3,473.00","$5,501.23","$5,556.80",$0.00,$0.00,$0.00,$0.00,$0.00
27804208,EAP,Custom 27804208,,"Coil 400 Complex Standard, 8 Mm X 15 Cm","$6,798.00",$0.00,"$6,798.00",$0.00,"$4,851.73",$0.00,$0.00,"$4,851.73","$4,851.73",$0.00,"$6,798.00",$0.00,"$3,399.00","$5,384.02","$5,438.40",$0.00,$0.00,$0.00,$0.00,$0.00
27804209,EAP,Custom 27804209,,"Coil 400 Complex Standard, 8mm X 20cm","$6,798.00",$0.00,"$6,798.00",$0.00,"$4,851.73",$0.00,$0.00,"$4,851.73","$4,851.73",$0.00,"$6,798.00",$0.00,"$3,399.00","$5,384.02","$5,438.40",$0.00,$0.00,$0.00,$0.00,$0.00
27804210,EAP,Custom 27804210,,"Coil 400 Complex Standard, 8mm X 30cm","$7,241.00",$0.00,"$7,241.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,167.90",$0.00,"$7,241.00",$0.00,"$3,620.50","$5,734.87","$5,792.80",$0.00,$0.00,$0.00,$0.00,$0.00
27804211,EAP,Custom 27804211,,"Coil 400 Complex Standard, 9 Mm X 15 Cm","$6,798.00",$0.00,"$6,798.00",$0.00,"$4,851.73",$0.00,$0.00,"$4,851.73","$4,851.73",$0.00,"$6,798.00",$0.00,"$3,399.00","$5,384.02","$5,438.40",$0.00,$0.00,$0.00,$0.00,$0.00
27804212,EAP,Custom 27804212,,"Coil 400 Complex Standard, 9mm X 25cm","$7,094.00",$0.00,"$7,094.00",$0.00,"$5,062.99",$0.00,$0.00,"$5,062.99","$5,062.99",$0.00,"$7,094.00",$0.00,"$3,547.00","$5,618.45","$5,675.20",$0.00,$0.00,$0.00,$0.00,$0.00
27804213,EAP,Custom 27804213,,"Coil 400 Complex Standard, 9mm X 35cm","$7,300.00",$0.00,"$7,300.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,210.01",$0.00,"$7,300.00",$0.00,"$3,650.00","$5,781.60","$5,840.00",$0.00,$0.00,$0.00,$0.00,$0.00
27804214,EAP,Custom 27804214,,"Coil 400 Complex Standard, 10 Mm X 20 Cm","$6,946.00",$0.00,"$6,946.00",$0.00,"$4,957.36",$0.00,$0.00,"$4,957.36","$4,957.36",$0.00,"$6,946.00",$0.00,"$3,473.00","$5,501.23","$5,556.80",$0.00,$0.00,$0.00,$0.00,$0.00
27804250,EAP,HCPCS C1751,,Catheter Central Venous Pro-fuse Triniflex Od8 Fr Attace,$591.00,$0.00,$591.00,$265.95,$421.80,$0.00,$101.83,$421.80,$421.80,$103.48,$591.00,$0.00,$295.50,$468.07,$472.80,$0.00,$92.49,$0.00,$94.09,$0.00
27804251,EAP,CPT® C1751,,Catheter Powerglide 20 G  8 Cm Full Kit,$356.00,$0.00,$356.00,$160.20,$254.08,$0.00,$61.34,$254.08,$254.08,$62.33,$356.00,$0.00,$178.00,$281.95,$284.80,$0.00,$55.71,$0.00,$56.68,$0.00
27804252,EAP,CPT® C1751,,Catheter Powerglide 20 G  10 Cm Full Kit,$356.00,$0.00,$356.00,$160.20,$254.08,$0.00,$61.34,$254.08,$254.08,$62.33,$356.00,$0.00,$178.00,$281.95,$284.80,$0.00,$55.71,$0.00,$56.68,$0.00
27804254,EAP,HCPCS C1713,,Screw Bone Mini Long Post 7.5mm 55mm Polyax Mpa Ts,"$1,550.00",$0.00,"$1,550.00",$697.50,"$1,106.24",$0.00,$267.06,"$1,106.24","$1,106.24",$271.39,"$1,550.00",$0.00,$775.00,"$1,227.60","$1,240.00",$0.00,$242.58,$0.00,$246.76,$0.00
27804260,EAP,HCPCS C1722,,Defibrillator Crd 12.7mm 83.1x69.1mm Eblm Pls,"$53,750.00",$0.00,"$53,750.00","$24,187.50","$5,158.80",$0.00,"$8,138.89","$5,158.80","$38,361.38","$8,138.89","$53,750.00",$0.00,"$26,875.00","$42,570.00","$43,000.00",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27804261,EAP,HCPCS C1896,,Electrode Dfbr 45cm 3 Plr S-icd Coil Conctr Pin,"$12,500.00",$0.00,"$12,500.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$8,921.25",$0.00,"$12,500.00",$0.00,"$6,250.00","$9,900.00","$10,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
27804870,EAP,HCPCS C1760,,Device Closure .035in 6fr 70cm Valuelink Gwire Insertion,$525.00,$0.00,$525.00,$285.08,$374.69,$0.00,$90.45,$374.69,$374.69,$91.92,$525.00,$0.00,$262.50,$415.80,$420.00,$0.00,$82.16,$0.00,$83.58,$0.00
27804871,EAP,Custom 27804871,,Coil Embolization .02in Complex 11mm 35cm Soft The Penumbra,"$6,750.00",$0.00,"$6,750.00",$0.00,"$4,817.48",$0.00,$0.00,"$4,817.48","$4,817.48",$0.00,"$6,750.00",$0.00,"$3,375.00","$5,346.00","$5,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
27804872,EAP,Custom 27804872,,Coil Embolization .02in Complex 5mm 13cm Soft The Penumbra,"$6,108.00",$0.00,"$6,108.00",$0.00,"$4,359.28",$0.00,$0.00,"$4,359.28","$4,359.28",$0.00,"$6,108.00",$0.00,"$3,054.00","$4,837.54","$4,886.40",$0.00,$0.00,$0.00,$0.00,$0.00
27804880,EAP,Custom 27804880,,Coil Embolization .02in Complex 6mm 15cm Soft The Penumbra,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,"$4,460.63","$4,460.63",$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
27804881,EAP,Custom 27804881,,Coil Embolization .02in Complex 7mm 20cm Soft The Penumbra,"$6,375.00",$0.00,"$6,375.00",$0.00,"$4,549.84",$0.00,$0.00,"$4,549.84","$4,549.84",$0.00,"$6,375.00",$0.00,"$3,187.50","$5,049.00","$5,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
27804882,EAP,Custom 27804882,,Coil Embolization .02in Complex 8mm 20cm Soft The Penumbra,"$6,375.00",$0.00,"$6,375.00",$0.00,"$4,549.84",$0.00,$0.00,"$4,549.84","$4,549.84",$0.00,"$6,375.00",$0.00,"$3,187.50","$5,049.00","$5,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
27804883,EAP,Custom 27804883,,Coil Embolization .02in Complex 9mm 25cm Soft The Penumbra,"$6,500.00",$0.00,"$6,500.00",$0.00,"$4,639.05",$0.00,$0.00,"$4,639.05","$4,639.05",$0.00,"$6,500.00",$0.00,"$3,250.00","$5,148.00","$5,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
27804884,EAP,Custom 27804884,,Coil Embolization .02in Standard Complex 11mm 35cm Complex,"$6,188.00",$0.00,"$6,188.00",$0.00,"$4,416.38",$0.00,$0.00,"$4,416.38","$4,416.38",$0.00,"$6,188.00",$0.00,"$3,094.00","$4,900.90","$4,950.40",$0.00,$0.00,$0.00,$0.00,$0.00
27804885,EAP,Custom 27804885,,Coil Embolization .02in Standard Complex 6mm 15cm Complex,"$5,175.00",$0.00,"$5,175.00",$0.00,"$3,693.40",$0.00,$0.00,"$3,693.40","$3,693.40",$0.00,"$5,175.00",$0.00,"$2,587.50","$4,098.60","$4,140.00",$0.00,$0.00,$0.00,$0.00,$0.00
27804886,EAP,Custom 27804886,,Coil Embolization .02in Standard Complex 7mm 20cm Complex,"$5,875.00",$0.00,"$5,875.00",$0.00,"$4,192.99",$0.00,$0.00,"$4,192.99","$4,192.99",$0.00,"$5,875.00",$0.00,"$2,937.50","$4,653.00","$4,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805011,EAP,Custom 27805011,,20 FR SAFETY PEG KIT PULL,$142.00,$0.00,$142.00,$0.00,$101.35,$0.00,$0.00,$101.35,$101.35,$0.00,$142.00,$0.00,$71.00,$112.46,$113.60,$0.00,$0.00,$0.00,$0.00,$0.00
27805012,EAP,Custom 27805012,,24 FR SAFETY PEG KIT PULL,$142.00,$0.00,$142.00,$0.00,$101.35,$0.00,$0.00,$101.35,$101.35,$0.00,$142.00,$0.00,$71.00,$112.46,$113.60,$0.00,$0.00,$0.00,$0.00,$0.00
27805013,EAP,Custom 27805013,,"18 FR Replacement G-Tube, Right An 18",$42.00,$0.00,$42.00,$0.00,$29.98,$0.00,$0.00,$29.98,$29.98,$0.00,$42.00,$0.00,$21.00,$33.26,$33.60,$0.00,$0.00,$0.00,$0.00,$0.00
27805014,EAP,Custom 27805014,,"20 FR REPLACEMENT G-TUBE, RIGHT-AN 20",$40.00,$0.00,$40.00,$0.00,$28.55,$0.00,$0.00,$28.55,$28.55,$0.00,$40.00,$0.00,$20.00,$31.68,$32.00,$0.00,$0.00,$0.00,$0.00,$0.00
27805015,EAP,Custom 27805015,,"22 FR REPLACEMENT G-TUBE, RIGHT-AN",$40.00,$0.00,$40.00,$0.00,$28.55,$0.00,$0.00,$28.55,$28.55,$0.00,$40.00,$0.00,$20.00,$31.68,$32.00,$0.00,$0.00,$0.00,$0.00,$0.00
27805016,EAP,HCPCS C2625,,Rx Stent 7x7cm,$133.00,$0.00,$133.00,$59.85,$94.92,$0.00,$22.92,$94.92,$94.92,$23.29,$133.00,$0.00,$66.50,$105.34,$106.40,$0.00,$20.81,$0.00,$21.17,$0.00
27805017,EAP,HCPCS C2625,,Rx Stent 7x10cm,$133.00,$0.00,$133.00,$59.85,$94.92,$0.00,$22.92,$94.92,$94.92,$23.29,$133.00,$0.00,$66.50,$105.34,$106.40,$0.00,$20.81,$0.00,$21.17,$0.00
27805018,EAP,HCPCS C2625,,Rx Stent 10x5cm,$133.00,$0.00,$133.00,$59.85,$94.92,$0.00,$22.92,$94.92,$94.92,$23.29,$133.00,$0.00,$66.50,$105.34,$106.40,$0.00,$20.81,$0.00,$21.17,$0.00
27805019,EAP,HCPCS C2625,,Rx Stent 10x10cm,$133.00,$0.00,$133.00,$59.85,$94.92,$0.00,$22.92,$94.92,$94.92,$23.29,$133.00,$0.00,$66.50,$105.34,$106.40,$0.00,$20.81,$0.00,$21.17,$0.00
27805020,EAP,Custom 27805020,,Pill Cam Capsule,$532.00,$0.00,$532.00,$0.00,$379.69,$0.00,$0.00,$379.69,$379.69,$0.00,$532.00,$0.00,$266.00,$421.34,$425.60,$0.00,$0.00,$0.00,$0.00,$0.00
27805021,EAP,HCPCS L8614,,Cochlear  Implant,"$106,399.00",$0.00,"$106,399.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$75,936.97",$0.00,"$106,399.00",$0.00,"$53,199.50","$84,268.01","$85,119.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805022,EAP,HCPCS C1878,,Radiesse Voice Material For Vocal Cord Medialization,$638.00,$0.00,$638.00,$0.00,$455.34,$0.00,$0.00,$455.34,$455.34,$0.00,$638.00,$0.00,$319.00,$505.30,$510.40,$0.00,$0.00,$0.00,$0.00,$0.00
27805040,EAP,Custom 27805040,,Sensor Monitor Flotrac Adult L60 In Vamp Latex Free,$961.00,$0.00,$961.00,$0.00,$685.87,$0.00,$0.00,$685.87,$685.87,$0.00,$961.00,$0.00,$480.50,$761.11,$768.80,$0.00,$0.00,$0.00,$0.00,$0.00
27805041,EAP,Custom 27805041,,Sensor Monitor  Flotrac Adlt L60 In Vamp Bifurcated Pres,$961.00,$0.00,$961.00,$0.00,$685.87,$0.00,$0.00,$685.87,$685.87,$0.00,$961.00,$0.00,$480.50,$761.11,$768.80,$0.00,$0.00,$0.00,$0.00,$0.00
27805044,EAP,Custom 27805044,,"Accessory Kit, Slit Suture Sleeve, Ss-1056",$72.00,$0.00,$72.00,$0.00,$51.39,$0.00,$0.00,$51.39,$51.39,$0.00,$72.00,$0.00,$36.00,$57.02,$57.60,$0.00,$0.00,$0.00,$0.00,$0.00
27805045,EAP,Custom 27805045,,Coil Embl 14cm 6mm Nst Sft Cath Xtd Embl Endhole .035in4,$320.00,$0.00,$320.00,$0.00,$228.38,$0.00,$0.00,$228.38,$228.38,$0.00,$320.00,$0.00,$160.00,$253.44,$256.00,$0.00,$0.00,$0.00,$0.00,$0.00
27805046,EAP,HCPCS C1751,,Cath Infus .038in 5fr 100cm 10cm Peri Vlv Crgg-mcnam,$240.00,$0.00,$240.00,$108.00,$171.29,$0.00,$41.35,$171.29,$171.29,$42.02,$240.00,$0.00,$120.00,$190.08,$192.00,$0.00,$37.56,$0.00,$38.21,$0.00
27805048,EAP,HCPCS C1874,,Xience Xpedition Sv Des 2.25 Mm X 8 Mm,"$6,208.00",$0.00,"$6,208.00","$2,793.60","$4,430.65",$0.00,"$1,069.61","$4,430.65","$4,430.65","$1,086.97","$6,208.00",$0.00,"$3,104.00","$4,916.74","$4,966.40",$0.00,$971.55,$0.00,$988.31,$0.00
27805049,EAP,HCPCS C1874,,Xience Xpedition Sv Des 2.25 Mm X 12 Mm,"$6,208.00",$0.00,"$6,208.00","$2,793.60","$4,430.65",$0.00,"$1,069.61","$4,430.65","$4,430.65","$1,086.97","$6,208.00",$0.00,"$3,104.00","$4,916.74","$4,966.40",$0.00,$971.55,$0.00,$988.31,$0.00
27805050,EAP,HCPCS C1874,,Xience Xpedition Sv Des 2.25 Mm X 15 Mm,"$6,208.00",$0.00,"$6,208.00","$2,793.60","$4,430.65",$0.00,"$1,069.61","$4,430.65","$4,430.65","$1,086.97","$6,208.00",$0.00,"$3,104.00","$4,916.74","$4,966.40",$0.00,$971.55,$0.00,$988.31,$0.00
27805051,EAP,HCPCS C1874,,Xience Xpedition Sv Des 2.25 Mm X 18 Mm,"$6,208.00",$0.00,"$6,208.00","$2,793.60","$4,430.65",$0.00,"$1,069.61","$4,430.65","$4,430.65","$1,086.97","$6,208.00",$0.00,"$3,104.00","$4,916.74","$4,966.40",$0.00,$971.55,$0.00,$988.31,$0.00
27805052,EAP,HCPCS C1874,,Xience Xpedition Sv Des 2.25 Mm X 23 Mm,"$6,208.00",$0.00,"$6,208.00","$2,793.60","$4,430.65",$0.00,"$1,069.61","$4,430.65","$4,430.65","$1,086.97","$6,208.00",$0.00,"$3,104.00","$4,916.74","$4,966.40",$0.00,$971.55,$0.00,$988.31,$0.00
27805053,EAP,HCPCS C1874,,Xience Xpedition Sv Des 2.25 Mm X 28 Mm,"$6,208.00",$0.00,"$6,208.00","$2,793.60","$4,430.65",$0.00,"$1,069.61","$4,430.65","$4,430.65","$1,086.97","$6,208.00",$0.00,"$3,104.00","$4,916.74","$4,966.40",$0.00,$971.55,$0.00,$988.31,$0.00
27805054,EAP,HCPCS C1874,,Xience Xpedition Des 2.50 Mm X 8 Mm,"$6,208.00",$0.00,"$6,208.00","$2,793.60","$4,430.65",$0.00,"$1,069.61","$4,430.65","$4,430.65","$1,086.97","$6,208.00",$0.00,"$3,104.00","$4,916.74","$4,966.40",$0.00,$971.55,$0.00,$988.31,$0.00
27805055,EAP,HCPCS C1874,,Xience Xpedition Des 2.50 Mm X 12 Mm,"$6,208.00",$0.00,"$6,208.00","$2,793.60","$4,430.65",$0.00,"$1,069.61","$4,430.65","$4,430.65","$1,086.97","$6,208.00",$0.00,"$3,104.00","$4,916.74","$4,966.40",$0.00,$971.55,$0.00,$988.31,$0.00
27805056,EAP,HCPCS C1874,,Xience Xpedition Des 2.50 Mm X 15 Mm,"$6,208.00",$0.00,"$6,208.00","$2,793.60","$4,430.65",$0.00,"$1,069.61","$4,430.65","$4,430.65","$1,086.97","$6,208.00",$0.00,"$3,104.00","$4,916.74","$4,966.40",$0.00,$971.55,$0.00,$988.31,$0.00
27805057,EAP,HCPCS C1874,,Xience Xpedition Des 2.50 Mm X 18 Mm,"$6,208.00",$0.00,"$6,208.00","$2,793.60","$4,430.65",$0.00,"$1,069.61","$4,430.65","$4,430.65","$1,086.97","$6,208.00",$0.00,"$3,104.00","$4,916.74","$4,966.40",$0.00,$971.55,$0.00,$988.31,$0.00
27805058,EAP,HCPCS C1874,,Xience Xpedition Des 2.50 Mm X 23 Mm,"$6,208.00",$0.00,"$6,208.00","$2,793.60","$4,430.65",$0.00,"$1,069.61","$4,430.65","$4,430.65","$1,086.97","$6,208.00",$0.00,"$3,104.00","$4,916.74","$4,966.40",$0.00,$971.55,$0.00,$988.31,$0.00
27805059,EAP,HCPCS C1874,,Xience Xpedition Des 2.50 Mm X 28 Mm,"$6,208.00",$0.00,"$6,208.00","$2,793.60","$4,430.65",$0.00,"$1,069.61","$4,430.65","$4,430.65","$1,086.97","$6,208.00",$0.00,"$3,104.00","$4,916.74","$4,966.40",$0.00,$971.55,$0.00,$988.31,$0.00
27805060,EAP,HCPCS C1874,,Xience Xpedition Ll Des 2.50 Mm X 33 Mm,"$6,429.00",$0.00,"$6,429.00","$2,893.05","$4,588.38",$0.00,"$1,107.68","$4,588.38","$4,588.38","$1,125.67","$6,429.00",$0.00,"$3,214.50","$5,091.77","$5,143.20",$0.00,"$1,006.14",$0.00,"$1,023.50",$0.00
27805061,EAP,HCPCS C1874,,Xience Xpedition Ll Des 2.50 Mm X 38 Mm,"$6,429.00",$0.00,"$6,429.00","$2,893.05","$4,588.38",$0.00,"$1,107.68","$4,588.38","$4,588.38","$1,125.67","$6,429.00",$0.00,"$3,214.50","$5,091.77","$5,143.20",$0.00,"$1,006.14",$0.00,"$1,023.50",$0.00
27805062,EAP,HCPCS C1874,,Xience Xpedition Des 2.75 Mm X 8 Mm,"$6,208.00",$0.00,"$6,208.00","$2,793.60","$4,430.65",$0.00,"$1,069.61","$4,430.65","$4,430.65","$1,086.97","$6,208.00",$0.00,"$3,104.00","$4,916.74","$4,966.40",$0.00,$971.55,$0.00,$988.31,$0.00
27805063,EAP,HCPCS C1874,,Xience Xpedition Des 2.75 Mm X 12 Mm,"$6,208.00",$0.00,"$6,208.00","$2,793.60","$4,430.65",$0.00,"$1,069.61","$4,430.65","$4,430.65","$1,086.97","$6,208.00",$0.00,"$3,104.00","$4,916.74","$4,966.40",$0.00,$971.55,$0.00,$988.31,$0.00
27805064,EAP,HCPCS C1874,,Xience Xpedition Des 2.75 Mm X 15 Mm,"$6,208.00",$0.00,"$6,208.00","$2,793.60","$4,430.65",$0.00,"$1,069.61","$4,430.65","$4,430.65","$1,086.97","$6,208.00",$0.00,"$3,104.00","$4,916.74","$4,966.40",$0.00,$971.55,$0.00,$988.31,$0.00
27805065,EAP,HCPCS C1874,,Xience Xpedition Des 2.75 Mm X 18 Mm,"$6,208.00",$0.00,"$6,208.00","$2,793.60","$4,430.65",$0.00,"$1,069.61","$4,430.65","$4,430.65","$1,086.97","$6,208.00",$0.00,"$3,104.00","$4,916.74","$4,966.40",$0.00,$971.55,$0.00,$988.31,$0.00
27805066,EAP,HCPCS C1874,,Xience Xpedition Des 2.75 Mm X 23 Mm,"$6,208.00",$0.00,"$6,208.00","$2,793.60","$4,430.65",$0.00,"$1,069.61","$4,430.65","$4,430.65","$1,086.97","$6,208.00",$0.00,"$3,104.00","$4,916.74","$4,966.40",$0.00,$971.55,$0.00,$988.31,$0.00
27805067,EAP,HCPCS C1874,,Xience Xpedition Des 2.75 Mm X 28 Mm,"$6,208.00",$0.00,"$6,208.00","$2,793.60","$4,430.65",$0.00,"$1,069.61","$4,430.65","$4,430.65","$1,086.97","$6,208.00",$0.00,"$3,104.00","$4,916.74","$4,966.40",$0.00,$971.55,$0.00,$988.31,$0.00
27805068,EAP,HCPCS C1874,,Xience Xpedition Ll Des 2.75 Mm X 33 Mm,"$6,429.00",$0.00,"$6,429.00","$2,893.05","$4,588.38",$0.00,"$1,107.68","$4,588.38","$4,588.38","$1,125.67","$6,429.00",$0.00,"$3,214.50","$5,091.77","$5,143.20",$0.00,"$1,006.14",$0.00,"$1,023.50",$0.00
27805069,EAP,HCPCS C1874,,Xience Xpedition Ll Des 2.75 Mm X 38 Mm,"$6,429.00",$0.00,"$6,429.00","$2,893.05","$4,588.38",$0.00,"$1,107.68","$4,588.38","$4,588.38","$1,125.67","$6,429.00",$0.00,"$3,214.50","$5,091.77","$5,143.20",$0.00,"$1,006.14",$0.00,"$1,023.50",$0.00
27805070,EAP,HCPCS C1874,,Xience Xpedition Des 3.00 Mm X 8 Mm,"$6,208.00",$0.00,"$6,208.00","$2,793.60","$4,430.65",$0.00,"$1,069.61","$4,430.65","$4,430.65","$1,086.97","$6,208.00",$0.00,"$3,104.00","$4,916.74","$4,966.40",$0.00,$971.55,$0.00,$988.31,$0.00
27805071,EAP,HCPCS C1874,,Xience Xpedition Des 3.00 Mm X 12 Mm,"$6,208.00",$0.00,"$6,208.00","$2,793.60","$4,430.65",$0.00,"$1,069.61","$4,430.65","$4,430.65","$1,086.97","$6,208.00",$0.00,"$3,104.00","$4,916.74","$4,966.40",$0.00,$971.55,$0.00,$988.31,$0.00
27805072,EAP,HCPCS C1874,,Xience Xpedition Des 3.00 Mm X 15 Mm,"$6,208.00",$0.00,"$6,208.00","$2,793.60","$4,430.65",$0.00,"$1,069.61","$4,430.65","$4,430.65","$1,086.97","$6,208.00",$0.00,"$3,104.00","$4,916.74","$4,966.40",$0.00,$971.55,$0.00,$988.31,$0.00
27805073,EAP,HCPCS C1874,,Xience Xpedition Des 3.00 Mm X 18 Mm,"$6,208.00",$0.00,"$6,208.00","$2,793.60","$4,430.65",$0.00,"$1,069.61","$4,430.65","$4,430.65","$1,086.97","$6,208.00",$0.00,"$3,104.00","$4,916.74","$4,966.40",$0.00,$971.55,$0.00,$988.31,$0.00
27805074,EAP,HCPCS C1874,,Xience Xpedition Des 3.00 Mm X 23 Mm,"$6,208.00",$0.00,"$6,208.00","$2,793.60","$4,430.65",$0.00,"$1,069.61","$4,430.65","$4,430.65","$1,086.97","$6,208.00",$0.00,"$3,104.00","$4,916.74","$4,966.40",$0.00,$971.55,$0.00,$988.31,$0.00
27805075,EAP,HCPCS C1874,,Xience Xpedition Des 3.00 Mm X 28 Mm,"$6,208.00",$0.00,"$6,208.00","$2,793.60","$4,430.65",$0.00,"$1,069.61","$4,430.65","$4,430.65","$1,086.97","$6,208.00",$0.00,"$3,104.00","$4,916.74","$4,966.40",$0.00,$971.55,$0.00,$988.31,$0.00
27805076,EAP,HCPCS C1874,,Xience Xpedition Ll Des 3.00 Mm X 33 Mm,"$6,429.00",$0.00,"$6,429.00","$2,893.05","$4,588.38",$0.00,"$1,107.68","$4,588.38","$4,588.38","$1,125.67","$6,429.00",$0.00,"$3,214.50","$5,091.77","$5,143.20",$0.00,"$1,006.14",$0.00,"$1,023.50",$0.00
27805077,EAP,HCPCS C1874,,Xience Xpedition Ll Des 3.00 Mm X 38 Mm,"$6,429.00",$0.00,"$6,429.00","$2,893.05","$4,588.38",$0.00,"$1,107.68","$4,588.38","$4,588.38","$1,125.67","$6,429.00",$0.00,"$3,214.50","$5,091.77","$5,143.20",$0.00,"$1,006.14",$0.00,"$1,023.50",$0.00
27805078,EAP,HCPCS C1874,,Xience Xpedition Des 3.25 Mm X 8 Mm,"$6,208.00",$0.00,"$6,208.00","$2,793.60","$4,430.65",$0.00,"$1,069.61","$4,430.65","$4,430.65","$1,086.97","$6,208.00",$0.00,"$3,104.00","$4,916.74","$4,966.40",$0.00,$971.55,$0.00,$988.31,$0.00
27805079,EAP,HCPCS C1874,,Xience Xpedition Des 3.25 Mm X 12 Mm,"$6,208.00",$0.00,"$6,208.00","$2,793.60","$4,430.65",$0.00,"$1,069.61","$4,430.65","$4,430.65","$1,086.97","$6,208.00",$0.00,"$3,104.00","$4,916.74","$4,966.40",$0.00,$971.55,$0.00,$988.31,$0.00
27805080,EAP,HCPCS C1874,,Xience Xpedition Des 3.25 Mm X 15 Mm,"$6,208.00",$0.00,"$6,208.00","$2,793.60","$4,430.65",$0.00,"$1,069.61","$4,430.65","$4,430.65","$1,086.97","$6,208.00",$0.00,"$3,104.00","$4,916.74","$4,966.40",$0.00,$971.55,$0.00,$988.31,$0.00
27805081,EAP,HCPCS C1874,,Xience Xpedition Des 3.25 Mm X 18 Mm,"$6,208.00",$0.00,"$6,208.00","$2,793.60","$4,430.65",$0.00,"$1,069.61","$4,430.65","$4,430.65","$1,086.97","$6,208.00",$0.00,"$3,104.00","$4,916.74","$4,966.40",$0.00,$971.55,$0.00,$988.31,$0.00
27805082,EAP,HCPCS C1874,,Xience Xpedition Des 3.25 Mm X 23 Mm,"$6,208.00",$0.00,"$6,208.00","$2,793.60","$4,430.65",$0.00,"$1,069.61","$4,430.65","$4,430.65","$1,086.97","$6,208.00",$0.00,"$3,104.00","$4,916.74","$4,966.40",$0.00,$971.55,$0.00,$988.31,$0.00
27805083,EAP,HCPCS C1874,,Xience Xpedition Des 3.25 Mm X 28 Mm,"$6,208.00",$0.00,"$6,208.00","$2,793.60","$4,430.65",$0.00,"$1,069.61","$4,430.65","$4,430.65","$1,086.97","$6,208.00",$0.00,"$3,104.00","$4,916.74","$4,966.40",$0.00,$971.55,$0.00,$988.31,$0.00
27805084,EAP,HCPCS C1874,,Xience Xpedition Ll Des 3.25 Mm X 33 Mm,"$6,429.00",$0.00,"$6,429.00","$2,893.05","$4,588.38",$0.00,"$1,107.68","$4,588.38","$4,588.38","$1,125.67","$6,429.00",$0.00,"$3,214.50","$5,091.77","$5,143.20",$0.00,"$1,006.14",$0.00,"$1,023.50",$0.00
27805085,EAP,HCPCS C1874,,Xience Xpedition Ll Des 3.25 Mm X 38 Mm,"$6,429.00",$0.00,"$6,429.00","$2,893.05","$4,588.38",$0.00,"$1,107.68","$4,588.38","$4,588.38","$1,125.67","$6,429.00",$0.00,"$3,214.50","$5,091.77","$5,143.20",$0.00,"$1,006.14",$0.00,"$1,023.50",$0.00
27805086,EAP,HCPCS C1874,,Xience Xpedition Des 3.50 Mm X 8 Mm,"$6,208.00",$0.00,"$6,208.00","$2,793.60","$4,430.65",$0.00,"$1,069.61","$4,430.65","$4,430.65","$1,086.97","$6,208.00",$0.00,"$3,104.00","$4,916.74","$4,966.40",$0.00,$971.55,$0.00,$988.31,$0.00
27805087,EAP,HCPCS C1874,,Xience Xpedition Des 3.50 Mm X 12 Mm,"$6,208.00",$0.00,"$6,208.00","$2,793.60","$4,430.65",$0.00,"$1,069.61","$4,430.65","$4,430.65","$1,086.97","$6,208.00",$0.00,"$3,104.00","$4,916.74","$4,966.40",$0.00,$971.55,$0.00,$988.31,$0.00
27805088,EAP,HCPCS C1874,,Xience Xpedition Des 3.50 Mm X 15 Mm,"$6,208.00",$0.00,"$6,208.00","$2,793.60","$4,430.65",$0.00,"$1,069.61","$4,430.65","$4,430.65","$1,086.97","$6,208.00",$0.00,"$3,104.00","$4,916.74","$4,966.40",$0.00,$971.55,$0.00,$988.31,$0.00
27805089,EAP,HCPCS C1874,,Xience Xpedition Des 3.50 Mm X 18 Mm,"$6,208.00",$0.00,"$6,208.00","$2,793.60","$4,430.65",$0.00,"$1,069.61","$4,430.65","$4,430.65","$1,086.97","$6,208.00",$0.00,"$3,104.00","$4,916.74","$4,966.40",$0.00,$971.55,$0.00,$988.31,$0.00
27805090,EAP,HCPCS C1874,,Xience Xpedition Des 3.50 Mm X 23 Mm,"$6,208.00",$0.00,"$6,208.00","$2,793.60","$4,430.65",$0.00,"$1,069.61","$4,430.65","$4,430.65","$1,086.97","$6,208.00",$0.00,"$3,104.00","$4,916.74","$4,966.40",$0.00,$971.55,$0.00,$988.31,$0.00
27805091,EAP,HCPCS C1874,,Xience Xpedition Des 3.50 Mm X 28 Mm,"$6,208.00",$0.00,"$6,208.00","$2,793.60","$4,430.65",$0.00,"$1,069.61","$4,430.65","$4,430.65","$1,086.97","$6,208.00",$0.00,"$3,104.00","$4,916.74","$4,966.40",$0.00,$971.55,$0.00,$988.31,$0.00
27805092,EAP,HCPCS C1874,,Xience Xpedition Ll Des 3.50 Mm X 33 Mm,"$6,429.00",$0.00,"$6,429.00","$2,893.05","$4,588.38",$0.00,"$1,107.68","$4,588.38","$4,588.38","$1,125.67","$6,429.00",$0.00,"$3,214.50","$5,091.77","$5,143.20",$0.00,"$1,006.14",$0.00,"$1,023.50",$0.00
27805093,EAP,HCPCS C1874,,Xience Xpedition Ll Des 3.50 Mm X 38 Mm,"$6,429.00",$0.00,"$6,429.00","$2,893.05","$4,588.38",$0.00,"$1,107.68","$4,588.38","$4,588.38","$1,125.67","$6,429.00",$0.00,"$3,214.50","$5,091.77","$5,143.20",$0.00,"$1,006.14",$0.00,"$1,023.50",$0.00
27805094,EAP,HCPCS C1874,,Xience Xpedition Des 4.00 Mm X 8 Mm,"$6,208.00",$0.00,"$6,208.00","$2,793.60","$4,430.65",$0.00,"$1,069.61","$4,430.65","$4,430.65","$1,086.97","$6,208.00",$0.00,"$3,104.00","$4,916.74","$4,966.40",$0.00,$971.55,$0.00,$988.31,$0.00
27805095,EAP,HCPCS C1874,,Xience Xpedition Des 4.00 Mm X 12 Mm,"$6,208.00",$0.00,"$6,208.00","$2,793.60","$4,430.65",$0.00,"$1,069.61","$4,430.65","$4,430.65","$1,086.97","$6,208.00",$0.00,"$3,104.00","$4,916.74","$4,966.40",$0.00,$971.55,$0.00,$988.31,$0.00
27805096,EAP,HCPCS C1874,,Xience Xpedition Des 4.00 Mm X 15 Mm,"$6,208.00",$0.00,"$6,208.00","$2,793.60","$4,430.65",$0.00,"$1,069.61","$4,430.65","$4,430.65","$1,086.97","$6,208.00",$0.00,"$3,104.00","$4,916.74","$4,966.40",$0.00,$971.55,$0.00,$988.31,$0.00
27805097,EAP,HCPCS C1874,,Xience Xpedition Des 4.00 Mm X 18 Mm,"$6,208.00",$0.00,"$6,208.00","$2,793.60","$4,430.65",$0.00,"$1,069.61","$4,430.65","$4,430.65","$1,086.97","$6,208.00",$0.00,"$3,104.00","$4,916.74","$4,966.40",$0.00,$971.55,$0.00,$988.31,$0.00
27805098,EAP,HCPCS C1874,,Xience Xpedition Des 4.00 Mm X 23 Mm,"$6,208.00",$0.00,"$6,208.00","$2,793.60","$4,430.65",$0.00,"$1,069.61","$4,430.65","$4,430.65","$1,086.97","$6,208.00",$0.00,"$3,104.00","$4,916.74","$4,966.40",$0.00,$971.55,$0.00,$988.31,$0.00
27805099,EAP,HCPCS C1874,,Xience Xpedition Des 4.00 Mm X 28 Mm,"$6,208.00",$0.00,"$6,208.00","$2,793.60","$4,430.65",$0.00,"$1,069.61","$4,430.65","$4,430.65","$1,086.97","$6,208.00",$0.00,"$3,104.00","$4,916.74","$4,966.40",$0.00,$971.55,$0.00,$988.31,$0.00
27805101,EAP,Custom 27805101,,Pipeline Embolization Device,"$41,378.00",$0.00,"$41,378.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$29,531.48",$0.00,"$41,378.00",$0.00,"$20,689.00","$32,771.38","$33,102.40",$0.00,$0.00,$0.00,$0.00,$0.00
27805102,EAP,HCPCS C1874,,Xience Xpedition Ll Des 4.00 Mm X 33 Mm,"$6,429.00",$0.00,"$6,429.00","$2,893.05","$4,588.38",$0.00,"$1,107.68","$4,588.38","$4,588.38","$1,125.67","$6,429.00",$0.00,"$3,214.50","$5,091.77","$5,143.20",$0.00,"$1,006.14",$0.00,"$1,023.50",$0.00
27805103,EAP,HCPCS C1874,,Xience Xpedition Ll Des 4.00 Mm X 38 Mm,"$6,429.00",$0.00,"$6,429.00","$2,893.05","$4,588.38",$0.00,"$1,107.68","$4,588.38","$4,588.38","$1,125.67","$6,429.00",$0.00,"$3,214.50","$5,091.77","$5,143.20",$0.00,"$1,006.14",$0.00,"$1,023.50",$0.00
27805104,EAP,Custom 27805104,,Coil Embl 4.1cm 5-3mm Trnd .035in Std Sm Pltn Arterioves,$264.00,$0.00,$264.00,$0.00,$188.42,$0.00,$0.00,$188.42,$188.42,$0.00,$264.00,$0.00,$132.00,$209.09,$211.20,$0.00,$0.00,$0.00,$0.00,$0.00
27805106,EAP,HCPCS C1876,,Se Biliary Stent  6mmx40mmx120cm,"$4,138.00",$0.00,"$4,138.00","$1,862.10","$2,953.29",$0.00,$712.96,"$2,953.29","$2,953.29",$724.53,"$4,138.00",$0.00,"$2,069.00","$3,277.30","$3,310.40",$0.00,$647.60,$0.00,$658.77,$0.00
27805107,EAP,HCPCS C1876,,Se Peripheral Stent 7mmx80mmx120cm,"$5,024.00",$0.00,"$5,024.00","$2,260.80","$3,585.63",$0.00,$865.61,"$3,585.63","$3,585.63",$879.66,"$5,024.00",$0.00,"$2,512.00","$3,979.01","$4,019.20",$0.00,$786.26,$0.00,$799.82,$0.00
27805108,EAP,Custom 27805108,,"Coil 400 Complex Standard, 22 Mm X 60 Cm","$7,685.00",$0.00,"$7,685.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,484.78",$0.00,"$7,685.00",$0.00,"$3,842.50","$6,086.52","$6,148.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805112,EAP,HCPCS Q4107,,Coil Embolization 7cm 3mm Nester 7.4 Loop Microcoil .018,$295.00,$0.00,$295.00,$0.00,$210.54,$0.00,$0.00,$210.54,$210.54,$0.00,$295.00,$0.00,$147.50,$233.64,$236.00,$0.00,$0.00,$0.00,$0.00,$0.00
27805113,EAP,Custom 27805113,,Coil Embolization 7cm 4mm Nester 5.6 Loop Microcoil .018,"$3,403.00",$0.00,"$3,403.00",$0.00,"$2,428.72",$0.00,$0.00,"$2,428.72","$2,428.72",$0.00,"$3,403.00",$0.00,"$1,701.50","$2,695.18","$2,722.40",$0.00,$0.00,$0.00,$0.00,$0.00
27805115,EAP,Custom 27805115,,"Coil 400 Complex Standard, 24 Mm X 57 Cm","$7,642.00",$0.00,"$7,642.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,454.10",$0.00,"$7,642.00",$0.00,"$3,821.00","$6,052.46","$6,113.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805116,EAP,Custom 27805116,,"Coil 400 Complex Standard, 28 Mm X 60 Cm","$8,572.00",$0.00,"$8,572.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$6,117.84",$0.00,"$8,572.00",$0.00,"$4,286.00","$6,789.02","$6,857.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805118,EAP,Custom 27805118,,Coil Embl 2cm 1mm Trgt Dtch Ult 360d,"$5,097.00",$0.00,"$5,097.00",$0.00,"$3,637.73",$0.00,$0.00,"$3,637.73","$3,637.73",$0.00,"$5,097.00",$0.00,"$2,548.50","$4,036.82","$4,077.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805119,EAP,Custom 27805119,,Coil Embl 3cm 1mm Trgt Dtch Ult 360d,"$5,097.00",$0.00,"$5,097.00",$0.00,"$3,637.73",$0.00,$0.00,"$3,637.73","$3,637.73",$0.00,"$5,097.00",$0.00,"$2,548.50","$4,036.82","$4,077.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805120,EAP,Custom 27805120,,Coil Embl 2cm 1.5mm Trgt Dtch Ult 360d,"$5,097.00",$0.00,"$5,097.00",$0.00,"$3,637.73",$0.00,$0.00,"$3,637.73","$3,637.73",$0.00,"$5,097.00",$0.00,"$2,548.50","$4,036.82","$4,077.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805121,EAP,Custom 27805121,,Coil Embl 3cm 1.5mm Trgt Dtch Ult 360d,"$5,097.00",$0.00,"$5,097.00",$0.00,"$3,637.73",$0.00,$0.00,"$3,637.73","$3,637.73",$0.00,"$5,097.00",$0.00,"$2,548.50","$4,036.82","$4,077.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805122,EAP,Custom 27805122,,Coil Embl 4cm 1.5mm Trgt Dtch Ult 360d,"$5,097.00",$0.00,"$5,097.00",$0.00,"$3,637.73",$0.00,$0.00,"$3,637.73","$3,637.73",$0.00,"$5,097.00",$0.00,"$2,548.50","$4,036.82","$4,077.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805123,EAP,Custom 27805123,,Coil Embl 3cm 2mm Trgt Dtch Ult 360d,"$5,097.00",$0.00,"$5,097.00",$0.00,"$3,637.73",$0.00,$0.00,"$3,637.73","$3,637.73",$0.00,"$5,097.00",$0.00,"$2,548.50","$4,036.82","$4,077.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805124,EAP,Custom 27805124,,Coil Embl 4cm 2mm Trgt Dtch Ult 360d,"$5,097.00",$0.00,"$5,097.00",$0.00,"$3,637.73",$0.00,$0.00,"$3,637.73","$3,637.73",$0.00,"$5,097.00",$0.00,"$2,548.50","$4,036.82","$4,077.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805125,EAP,Custom 27805125,,Coil Embl 6cm 2mm Trgt Dtch Ult 360d,"$5,097.00",$0.00,"$5,097.00",$0.00,"$3,637.73",$0.00,$0.00,"$3,637.73","$3,637.73",$0.00,"$5,097.00",$0.00,"$2,548.50","$4,036.82","$4,077.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805126,EAP,Custom 27805126,,Coil Embl 4cm 2.5mm Trgt Dtch Ult 360d,"$5,097.00",$0.00,"$5,097.00",$0.00,"$3,637.73",$0.00,$0.00,"$3,637.73","$3,637.73",$0.00,"$5,097.00",$0.00,"$2,548.50","$4,036.82","$4,077.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805127,EAP,Custom 27805127,,Coil Embl 4cm 3mm Trgt Dtch Ult 360d,"$5,097.00",$0.00,"$5,097.00",$0.00,"$3,637.73",$0.00,$0.00,"$3,637.73","$3,637.73",$0.00,"$5,097.00",$0.00,"$2,548.50","$4,036.82","$4,077.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805128,EAP,Custom 27805128,,Coil Embl 6cm 3mm Trgt Dtch Ult 360d,"$5,097.00",$0.00,"$5,097.00",$0.00,"$3,637.73",$0.00,$0.00,"$3,637.73","$3,637.73",$0.00,"$5,097.00",$0.00,"$2,548.50","$4,036.82","$4,077.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805129,EAP,Custom 27805129,,Coil Embl 8cm 3mm Trgt Dtch Ult 360d,"$5,097.00",$0.00,"$5,097.00",$0.00,"$3,637.73",$0.00,$0.00,"$3,637.73","$3,637.73",$0.00,"$5,097.00",$0.00,"$2,548.50","$4,036.82","$4,077.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805130,EAP,Custom 27805130,,Coil Embl 10cm 3mm Trgt Dtch Ult 360d,"$5,097.00",$0.00,"$5,097.00",$0.00,"$3,637.73",$0.00,$0.00,"$3,637.73","$3,637.73",$0.00,"$5,097.00",$0.00,"$2,548.50","$4,036.82","$4,077.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805131,EAP,Custom 27805131,,Coil Embl 6cm 4mm Trgt Dtch Ult 360d,"$5,352.00",$0.00,"$5,352.00",$0.00,"$3,819.72",$0.00,$0.00,"$3,819.72","$3,819.72",$0.00,"$5,352.00",$0.00,"$2,676.00","$4,238.78","$4,281.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805132,EAP,Custom 27805132,,Coil Embl 8cm 4mm Trgt Dtch Ult 360d,"$5,097.00",$0.00,"$5,097.00",$0.00,"$3,637.73",$0.00,$0.00,"$3,637.73","$3,637.73",$0.00,"$5,097.00",$0.00,"$2,548.50","$4,036.82","$4,077.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805133,EAP,Custom 27805133,,Coil Embl 10cm 5mm Trgt Dtch Ult 360d,"$5,097.00",$0.00,"$5,097.00",$0.00,"$3,637.73",$0.00,$0.00,"$3,637.73","$3,637.73",$0.00,"$5,097.00",$0.00,"$2,548.50","$4,036.82","$4,077.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805134,EAP,Custom 27805134,,Coil Embl 15cm 5mm Trgt Dtch Ult 360d,"$5,097.00",$0.00,"$5,097.00",$0.00,"$3,637.73",$0.00,$0.00,"$3,637.73","$3,637.73",$0.00,"$5,097.00",$0.00,"$2,548.50","$4,036.82","$4,077.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805135,EAP,Custom CUSTOM,,System Embl Dtch Inzone,$37.00,$0.00,$37.00,$0.00,$26.41,$0.00,$0.00,$26.41,$26.41,$0.00,$37.00,$0.00,$18.50,$29.30,$29.60,$0.00,$0.00,$0.00,$0.00,$0.00
27805137,EAP,HCPCS C1898,,LEAD PCNG BRKWY DLV SYS IMPLTABLE HRT FAIL ACTY,"$5,010.00",$0.00,"$5,010.00","$2,254.50","$3,575.64",$0.00,$863.20,"$3,575.64","$3,575.64",$877.21,"$5,010.00",$0.00,"$2,505.00","$3,967.92","$4,008.00",$0.00,$784.07,$0.00,$797.59,$0.00
27805138,EAP,HCPCS C1900,,LEAD PCNG 59CM 9FR ECRDL BIPOL ACT FIX 1 COIL RTRCT HLX TIP,"$11,822.00",$0.00,"$11,822.00",$0.00,"$5,158.80",$0.00,"$2,036.87","$5,158.80","$8,437.36",$0.00,"$11,822.00",$0.00,"$5,911.00","$9,363.02","$9,457.60",$0.00,"$1,850.14",$0.00,$0.00,$0.00
27805139,EAP,HCPCS C1777,,LEAD PCNG 64CM 9FR ECRDM 1 COIL ACT FIX BIPOL CARDVRT DFBR,"$11,231.00",$0.00,"$11,231.00","$5,053.95","$5,158.80",$0.00,"$1,935.05","$5,158.80","$8,015.56","$1,966.46","$11,231.00",$0.00,"$5,615.50","$8,894.95","$8,984.80",$0.00,"$1,757.65",$0.00,"$1,787.98",$0.00
27805140,EAP,HCPCS C1898,,LEAD PCNG 54CM MYOCRD BIPOL SUTLS INNOMEDICA SIL,"$1,330.00",$0.00,"$1,330.00",$598.50,$949.22,$0.00,$229.15,$949.22,$949.22,$232.87,"$1,330.00",$0.00,$665.00,"$1,053.36","$1,064.00",$0.00,$208.15,$0.00,$211.74,$0.00
27805141,EAP,HCPCS C1898,,LEAD PCNG 52CM 3.2MM ECRDM ATR VNTRC PCMKR FLXTND,"$1,330.00",$0.00,"$1,330.00",$598.50,$949.22,$0.00,$229.15,$949.22,$949.22,$232.87,"$1,330.00",$0.00,$665.00,"$1,053.36","$1,064.00",$0.00,$208.15,$0.00,$211.74,$0.00
27805142,EAP,HCPCS C1895,,LEAD PCNG 90CM ECRDM DUAL COIL PSV FIX CARDVRT DFBR,"$11,231.00",$0.00,"$11,231.00","$5,053.95","$5,158.80",$0.00,"$1,935.05","$5,158.80","$8,015.56","$1,966.46","$11,231.00",$0.00,"$5,615.50","$8,894.95","$8,984.80",$0.00,"$1,757.65",$0.00,"$1,787.98",$0.00
27805143,EAP,HCPCS C1898,,LEAD PCNG 64CM 9FR 18CM SPC ECRDM IS-1 CONCTR DUAL COIL,"$11,231.00",$0.00,"$11,231.00","$5,053.95","$5,158.80",$0.00,"$1,935.05","$5,158.80","$8,015.56","$1,966.46","$11,231.00",$0.00,"$5,615.50","$8,894.95","$8,984.80",$0.00,"$1,757.65",$0.00,"$1,787.98",$0.00
27805144,EAP,HCPCS C1898,,LEAD PCNG 59CM 9FR 18CM SPC ECRDL BIPOL PSV FIX 2 COIL TN,"$11,231.00",$0.00,"$11,231.00","$5,053.95","$5,158.80",$0.00,"$1,935.05","$5,158.80","$8,015.56","$1,966.46","$11,231.00",$0.00,"$5,615.50","$8,894.95","$8,984.80",$0.00,"$1,757.65",$0.00,"$1,787.98",$0.00
27805145,EAP,HCPCS C1876,,STENT BIL 10MM 8FR 80MM 3.2MM .035IN RAPEX UNCVR GWIRE,$461.00,$0.00,$461.00,$207.45,$329.02,$0.00,$79.43,$329.02,$329.02,$80.72,$461.00,$0.00,$230.50,$365.11,$368.80,$0.00,$72.15,$0.00,$73.39,$0.00
27805146,EAP,HCPCS C1876,,STENT BIL 10MM 8FR 60MM .035IN RAPEX UNCVR GWIRE DLV SYS,$461.00,$0.00,$461.00,$207.45,$329.02,$0.00,$79.43,$329.02,$329.02,$80.72,$461.00,$0.00,$230.50,$365.11,$368.80,$0.00,$72.15,$0.00,$73.39,$0.00
27805147,EAP,HCPCS C1876,,STENT BIL 8MM 8FR 100MM .035IN RAPEX NCT UNCVR DLV SYS,$461.00,$0.00,$461.00,$207.45,$329.02,$0.00,$79.43,$329.02,$329.02,$80.72,$461.00,$0.00,$230.50,$365.11,$368.80,$0.00,$72.15,$0.00,$73.39,$0.00
27805148,EAP,HCPCS C1777,,LEAD PCNG 64CM 9FR ECRDM 1 COIL PSV FIX BIPOL CARDVRT DFBR,"$11,231.00",$0.00,"$11,231.00","$5,053.95","$5,158.80",$0.00,"$1,935.05","$5,158.80","$8,015.56","$1,966.46","$11,231.00",$0.00,"$5,615.50","$8,894.95","$8,984.80",$0.00,"$1,757.65",$0.00,"$1,787.98",$0.00
27805149,EAP,HCPCS C1898,,LEAD PCNG 59CM 9FR 18CM SPC ECRDM 1 COIL PSV FIX BIPOL,"$11,231.00",$0.00,"$11,231.00","$5,053.95","$5,158.80",$0.00,"$1,935.05","$5,158.80","$8,015.56","$1,966.46","$11,231.00",$0.00,"$5,615.50","$8,894.95","$8,984.80",$0.00,"$1,757.65",$0.00,"$1,787.98",$0.00
27805150,EAP,HCPCS C1777,,ENDOTAK RELIANCE PF (Passive Fixation) LEADS,"$11,231.00",$0.00,"$11,231.00","$5,053.95","$5,158.80",$0.00,"$1,935.05","$5,158.80","$8,015.56","$1,966.46","$11,231.00",$0.00,"$5,615.50","$8,894.95","$8,984.80",$0.00,"$1,757.65",$0.00,"$1,787.98",$0.00
27805151,EAP,HCPCS C1777,,ENDOTAK RELIANCE S PF (Passive Fixation) LEADS,"$11,231.00",$0.00,"$11,231.00","$5,053.95","$5,158.80",$0.00,"$1,935.05","$5,158.80","$8,015.56","$1,966.46","$11,231.00",$0.00,"$5,615.50","$8,894.95","$8,984.80",$0.00,"$1,757.65",$0.00,"$1,787.98",$0.00
27805152,EAP,HCPCS C1898,,LEAD PCNG 90CM 18CM SPC ECRDM BIPOL PSV FIX 2 COIL IS-1 DF-1,"$11,822.00",$0.00,"$11,822.00","$5,319.90","$5,158.80",$0.00,"$2,036.87","$5,158.80","$8,437.36","$2,069.94","$11,822.00",$0.00,"$5,911.00","$9,363.02","$9,457.60",$0.00,"$1,850.14",$0.00,"$1,882.06",$0.00
27805153,EAP,HCPCS C1895,,LEAD PCNG ECRDM DUAL COIL ICD PSV FIX CARDVRT DFBR IMPLTABLE,"$11,822.00",$0.00,"$11,822.00","$5,319.90","$5,158.80",$0.00,"$2,036.87","$5,158.80","$8,437.36","$2,069.94","$11,822.00",$0.00,"$5,911.00","$9,363.02","$9,457.60",$0.00,"$1,850.14",$0.00,"$1,882.06",$0.00
27805154,EAP,HCPCS C1898,,LEAD PCNG 64CM 9FR 18CM SPC ECRDL BIPOL PSV FIX 2 COIL TN,"$11,822.00",$0.00,"$11,822.00","$5,319.90","$5,158.80",$0.00,"$2,036.87","$5,158.80","$8,437.36","$2,069.94","$11,822.00",$0.00,"$5,911.00","$9,363.02","$9,457.60",$0.00,"$1,850.14",$0.00,"$1,882.06",$0.00
27805155,EAP,HCPCS C1875,,STENT BIL 8MM 8.5FR  80MM 70MM .035IN RAPEX PRT RMLM COVERED,"$1,053.00",$0.00,"$1,053.00",$0.00,$751.53,$0.00,$0.00,$751.53,$751.53,$0.00,"$1,053.00",$0.00,$526.50,$833.98,$842.40,$0.00,$0.00,$0.00,$0.00,$0.00
27805156,EAP,HCPCS C1898,,LEAD PCNG 59CM 9FR 18CM SPC ECRDM BIPOL PSV FIX 2 COIL IS-1,"$11,822.00",$0.00,"$11,822.00","$5,319.90","$5,158.80",$0.00,"$2,036.87","$5,158.80","$8,437.36","$2,069.94","$11,822.00",$0.00,"$5,911.00","$9,363.02","$9,457.60",$0.00,"$1,850.14",$0.00,"$1,882.06",$0.00
27805157,EAP,HCPCS C1900,,LEAD PCNG 80CM 4.1-2.6FR SPRL LV CORON VNS ACTY,"$5,911.00",$0.00,"$5,911.00",$0.00,"$4,218.68",$0.00,"$1,018.44","$4,218.68","$4,218.68",$0.00,"$5,911.00",$0.00,"$2,955.50","$4,681.51","$4,728.80",$0.00,$925.07,$0.00,$0.00,$0.00
27805158,EAP,HCPCS C1779,,LEAD PCNG 90CM 4.1-2.6FR SPRL LV CORON VNS IMPLTABLE ACTY,"$5,911.00",$0.00,"$5,911.00",$0.00,"$4,218.68",$0.00,$0.00,"$4,218.68","$4,218.68",$0.00,"$5,911.00",$0.00,"$2,955.50","$4,681.51","$4,728.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805159,EAP,HCPCS C1777,,LEAD PCNG ECRDM 1 COIL ICD CARDVRT DFBR IMPLTABLE ETAK RLNC,"$11,822.00",$0.00,"$11,822.00","$5,319.90","$5,158.80",$0.00,"$2,036.87","$5,158.80","$8,437.36","$2,069.94","$11,822.00",$0.00,"$5,911.00","$9,363.02","$9,457.60",$0.00,"$1,850.14",$0.00,"$1,882.06",$0.00
27805160,EAP,HCPCS C1900,,LEAD PCNG 80CM CORON VNS STRBL BIPOL ACTY STRD ELUT,"$5,911.00",$0.00,"$5,911.00",$0.00,"$4,218.68",$0.00,"$1,018.44","$4,218.68","$4,218.68",$0.00,"$5,911.00",$0.00,"$2,955.50","$4,681.51","$4,728.80",$0.00,$925.07,$0.00,$0.00,$0.00
27805161,EAP,HCPCS C2625,,STENT BIL 7FR 5CM RAPEX NONCORONARY TEMP DLV SYS PLST DISP,"$5,911.00",$0.00,"$5,911.00","$2,659.95","$4,218.68",$0.00,"$1,018.44","$4,218.68","$4,218.68","$1,034.97","$5,911.00",$0.00,"$2,955.50","$4,681.51","$4,728.80",$0.00,$925.07,$0.00,$941.03,$0.00
27805162,EAP,HCPCS C1777,,LEAD PCNG ECRDM 1 COIL ICD CARDVRT DFBR IMPLTABLE ETAK RLNC,"$11,822.00",$0.00,"$11,822.00","$5,319.90","$5,158.80",$0.00,"$2,036.87","$5,158.80","$8,437.36","$2,069.94","$11,822.00",$0.00,"$5,911.00","$9,363.02","$9,457.60",$0.00,"$1,850.14",$0.00,"$1,882.06",$0.00
27805163,EAP,HCPCS C1777,,Lead Dfbr Etak Rlnc G Act Fix,"$13,300.00",$0.00,"$13,300.00","$5,985.00","$5,158.80",$0.00,"$2,291.52","$5,158.80","$9,492.21","$2,328.72","$13,300.00",$0.00,"$6,650.00","$10,533.60","$10,640.00",$0.00,"$2,081.45",$0.00,"$2,117.36",$0.00
27805164,EAP,HCPCS C1777,,Lead Dfbr Etak Rlnc G Psv Fix,"$13,300.00",$0.00,"$13,300.00","$5,985.00","$5,158.80",$0.00,"$2,291.52","$5,158.80","$9,492.21","$2,328.72","$13,300.00",$0.00,"$6,650.00","$10,533.60","$10,640.00",$0.00,"$2,081.45",$0.00,"$2,117.36",$0.00
27805165,EAP,HCPCS C1898,,LEAD PCNG 90CM 18CM SPC ECRDM DUAL COIL ACT DISTAL TIP ELTRD,"$11,822.00",$0.00,"$11,822.00","$5,319.90","$5,158.80",$0.00,"$2,036.87","$5,158.80","$8,437.36","$2,069.94","$11,822.00",$0.00,"$5,911.00","$9,363.02","$9,457.60",$0.00,"$1,850.14",$0.00,"$1,882.06",$0.00
27805166,EAP,HCPCS C1785,,PCMKR CRD THK8MM 49X43MM ALTRUA 40DR ATR VNTRC IMPLTABLE 2,"$11,527.00",$0.00,"$11,527.00","$5,187.15","$5,158.80",$0.00,"$1,986.04","$5,158.80","$8,226.82","$2,018.29","$11,527.00",$0.00,"$5,763.50","$9,129.38","$9,221.60",$0.00,"$1,803.98",$0.00,"$1,835.10",$0.00
27805167,EAP,HCPCS C1786,,PCMKR CRD 8MM 43X49MM ALTRUA 40 IS-1 CONCTR,"$11,527.00",$0.00,"$11,527.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$8,226.82",$0.00,"$11,527.00",$0.00,"$5,763.50","$9,129.38","$9,221.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805168,EAP,HCPCS C1785,,PCMKR CRD THK8MM 44X42MM ALTRUA 40DR ATR VNTRC IMPLTABLE 2,"$11,527.00",$0.00,"$11,527.00","$5,187.15","$5,158.80",$0.00,"$1,986.04","$5,158.80","$8,226.82","$2,018.29","$11,527.00",$0.00,"$5,763.50","$9,129.38","$9,221.60",$0.00,"$1,803.98",$0.00,"$1,835.10",$0.00
27805169,EAP,HCPCS C1786,,PCMKR CRD THK8MM 42X42MM ALTRUA 40SR 1 CHMBR RT RSPN,"$10,049.00",$0.00,"$10,049.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$7,171.97",$0.00,"$10,049.00",$0.00,"$5,024.50","$7,958.81","$8,039.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805170,EAP,HCPCS C1785,,Pcmkr Crd Altura 2 Lead Sys,"$14,482.00",$0.00,"$14,482.00","$6,516.90","$5,158.80",$0.00,"$2,495.18","$5,158.80","$10,335.80","$2,535.68","$14,482.00",$0.00,"$7,241.00","$11,469.74","$11,585.60",$0.00,"$2,266.43",$0.00,"$2,305.53",$0.00
27805171,EAP,HCPCS C1898,,LEAD PCNG 70CM 9FR 18CM SPC ECRDM DUALCOIL XTD-RETRAC DF-1,"$11,822.00",$0.00,"$11,822.00","$5,319.90","$5,158.80",$0.00,"$2,036.87","$5,158.80","$8,437.36","$2,069.94","$11,822.00",$0.00,"$5,911.00","$9,363.02","$9,457.60",$0.00,"$1,850.14",$0.00,"$1,882.06",$0.00
27805172,EAP,HCPCS C1898,,LEAD PCNG 64CM 9FR ECRDM BIPOL ACT FIX DUAL COIL XTD-RETRAC,"$11,822.00",$0.00,"$11,822.00","$5,319.90","$5,158.80",$0.00,"$2,036.87","$5,158.80","$8,437.36","$2,069.94","$11,822.00",$0.00,"$5,911.00","$9,363.02","$9,457.60",$0.00,"$1,850.14",$0.00,"$1,882.06",$0.00
27805173,EAP,HCPCS C1898,,LEAD PCNG 59CM 18CM SPC ECRDM BIPOL ACT FIX XTD-RETRAC 2,"$11,822.00",$0.00,"$11,822.00","$5,319.90","$5,158.80",$0.00,"$2,036.87","$5,158.80","$8,437.36","$2,069.94","$11,822.00",$0.00,"$5,911.00","$9,363.02","$9,457.60",$0.00,"$1,850.14",$0.00,"$1,882.06",$0.00
27805174,EAP,HCPCS C1898,,LEAD PCNG 64CM HLX ECRDM 1 COIL BIPOL ACT FIX XTD-RETRAC,"$11,822.00",$0.00,"$11,822.00","$5,319.90","$5,158.80",$0.00,"$2,036.87","$5,158.80","$8,437.36","$2,069.94","$11,822.00",$0.00,"$5,911.00","$9,363.02","$9,457.60",$0.00,"$1,850.14",$0.00,"$1,882.06",$0.00
27805175,EAP,HCPCS C1777,,ENDOTAK RELIANCE G AF (Active Fixation) LEADS,"$13,300.00",$0.00,"$13,300.00","$5,985.00","$5,158.80",$0.00,"$2,291.52","$5,158.80","$9,492.21","$2,328.72","$13,300.00",$0.00,"$6,650.00","$10,533.60","$10,640.00",$0.00,"$2,081.45",$0.00,"$2,117.36",$0.00
27805176,EAP,HCPCS C1777,,Lead Dfbr Etak Rlnc G Act Fix,"$13,300.00",$0.00,"$13,300.00","$5,985.00","$5,158.80",$0.00,"$2,291.52","$5,158.80","$9,492.21","$2,328.72","$13,300.00",$0.00,"$6,650.00","$10,533.60","$10,640.00",$0.00,"$2,081.45",$0.00,"$2,117.36",$0.00
27805177,EAP,HCPCS C1876,,STENT TRCHBR 7MM 8MM 30MM SLF XPD ARWY DLV SYS PLFX SIL,"$1,478.00",$0.00,"$1,478.00",$665.10,"$1,054.85",$0.00,$254.65,"$1,054.85","$1,054.85",$258.79,"$1,478.00",$0.00,$739.00,"$1,170.58","$1,182.40",$0.00,$231.31,$0.00,$235.30,$0.00
27805178,EAP,HCPCS C1882,,COGNIS / ACUITY/ ENDOTAK - CARDIAC RESYNCHRONIZATION THERAPY,"$71,524.00",$0.00,"$71,524.00","$32,185.80","$5,158.80",$0.00,"$8,138.89","$5,158.80","$51,046.68","$8,138.89","$71,524.00",$0.00,"$35,762.00","$56,647.01","$57,219.20",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27805179,EAP,HCPCS C1898,,LEAD PCNG 90CM 9FR 18CM SPC ECRDM DUAL COIL ACT FIX BIPOL,"$11,231.00",$0.00,"$11,231.00","$5,053.95","$5,158.80",$0.00,"$1,935.05","$5,158.80","$8,015.56","$1,966.46","$11,231.00",$0.00,"$5,615.50","$8,894.95","$8,984.80",$0.00,"$1,757.65",$0.00,"$1,787.98",$0.00
27805180,EAP,HCPCS C1898,,LEAD PCNG 64CM 9FR 18CM SPC ECRDL DUAL COIL IMPLTABLE,"$11,231.00",$0.00,"$11,231.00","$5,053.95","$5,158.80",$0.00,"$1,935.05","$5,158.80","$8,015.56","$1,966.46","$11,231.00",$0.00,"$5,615.50","$8,894.95","$8,984.80",$0.00,"$1,757.65",$0.00,"$1,787.98",$0.00
27805181,EAP,HCPCS C1898,,LEAD PCNG 59CM 9FR 18CM SPC ECRDL BIPOL ACT FIX 2 COIL,"$11,231.00",$0.00,"$11,231.00","$5,053.95","$5,158.80",$0.00,"$1,935.05","$5,158.80","$8,015.56","$1,966.46","$11,231.00",$0.00,"$5,615.50","$8,894.95","$8,984.80",$0.00,"$1,757.65",$0.00,"$1,787.98",$0.00
27805182,EAP,HCPCS C1896,,LEAD PCNG ECRDL 1 COIL ACT FIX CARDVRT DFBR IMPLTABLE ETAK,"$11,231.00",$0.00,"$11,231.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$8,015.56",$0.00,"$11,231.00",$0.00,"$5,615.50","$8,894.95","$8,984.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805183,EAP,HCPCS C1898,,LEAD PCNG 45CM 6.7FR 10MM SPC RIGHT AV XTD-RETRAC ACT FIX,"$1,330.00",$0.00,"$1,330.00",$598.50,$949.22,$0.00,$229.15,$949.22,$949.22,$232.87,"$1,330.00",$0.00,$665.00,"$1,053.36","$1,064.00",$0.00,$208.15,$0.00,$211.74,$0.00
27805184,EAP,HCPCS C1777,,ENDOTAK RELIANCE AF (Active Fixation) LEADS,"$11,231.00",$0.00,"$11,231.00","$5,053.95","$5,158.80",$0.00,"$1,935.05","$5,158.80","$8,015.56","$1,966.46","$11,231.00",$0.00,"$5,615.50","$8,894.95","$8,984.80",$0.00,"$1,757.65",$0.00,"$1,787.98",$0.00
27805185,EAP,HCPCS C1898,,LEAD PCNG 60CM 6.7FR 10MM SPC RIGHT AV ECRDL IS-1 CONCTR,"$1,330.00",$0.00,"$1,330.00",$598.50,$949.22,$0.00,$229.15,$949.22,$949.22,$232.87,"$1,330.00",$0.00,$665.00,"$1,053.36","$1,064.00",$0.00,$208.15,$0.00,$211.74,$0.00
27805186,EAP,HCPCS C1900,,Easytrack 2,"$4,433.00",$0.00,"$4,433.00",$0.00,"$3,163.83",$0.00,$763.78,"$3,163.83","$3,163.83",$0.00,"$4,433.00",$0.00,"$2,216.50","$3,510.94","$3,546.40",$0.00,$693.76,$0.00,$0.00,$0.00
27805187,EAP,HCPCS C1898,,Lead Pcng Sm Act Fix Rlnc,"$11,231.00",$0.00,"$11,231.00","$5,053.95","$5,158.80",$0.00,"$1,935.05","$5,158.80","$8,015.56","$1,966.46","$11,231.00",$0.00,"$5,615.50","$8,894.95","$8,984.80",$0.00,"$1,757.65",$0.00,"$1,787.98",$0.00
27805188,EAP,HCPCS C1887,,RAPIDO ADVANCE LEAD DELIVERY SYSTEM,"$2,941.00",$0.00,"$2,941.00","$1,323.45","$2,098.99",$0.00,$506.72,"$2,098.99","$2,098.99",$514.95,"$2,941.00",$0.00,"$1,470.50","$2,329.27","$2,352.80",$0.00,$460.27,$0.00,$468.21,$0.00
27805189,EAP,HCPCS C1900,,LEAD PCNG 80CM 5.4FR CORON VNS LV IS 1 BIPOL OTW EZTRK 2,"$4,433.00",$0.00,"$4,433.00",$0.00,"$3,163.83",$0.00,$763.78,"$3,163.83","$3,163.83",$0.00,"$4,433.00",$0.00,"$2,216.50","$3,510.94","$3,546.40",$0.00,$693.76,$0.00,$0.00,$0.00
27805190,EAP,HCPCS C1898,,LEAD PCNG CORON VNS IS 1 EZTRK 2,"$4,433.00",$0.00,"$4,433.00","$1,994.85","$3,163.83",$0.00,$763.78,"$3,163.83","$3,163.83",$776.18,"$4,433.00",$0.00,"$2,216.50","$3,510.94","$3,546.40",$0.00,$693.76,$0.00,$705.73,$0.00
27805191,EAP,HCPCS C1898,,LEAD PCNG 100CM 7-5FR 8.5MM .035IN CORON VNS LV IS-1 DUAL,"$4,433.00",$0.00,"$4,433.00","$1,994.85","$3,163.83",$0.00,$763.78,"$3,163.83","$3,163.83",$776.18,"$4,433.00",$0.00,"$2,216.50","$3,510.94","$3,546.40",$0.00,$693.76,$0.00,$705.73,$0.00
27805192,EAP,HCPCS C1898,,LEAD PCNG 80CM 8FR J ECRDL RIGHT ARTIAL BIPOL IS-1 LV-1 DUAL,"$4,433.00",$0.00,"$4,433.00","$1,994.85","$3,163.83",$0.00,$763.78,"$3,163.83","$3,163.83",$776.18,"$4,433.00",$0.00,"$2,216.50","$3,510.94","$3,546.40",$0.00,$693.76,$0.00,$705.73,$0.00
27805193,EAP,HCPCS C1898,,LEAD PCNG 90CM CORON VNS LV LV-1 DUAL ELTRD CONCTR BIPOL PSV,"$4,433.00",$0.00,"$4,433.00","$1,994.85","$3,163.83",$0.00,$763.78,"$3,163.83","$3,163.83",$776.18,"$4,433.00",$0.00,"$2,216.50","$3,510.94","$3,546.40",$0.00,$693.76,$0.00,$705.73,$0.00
27805194,EAP,HCPCS C1779,,LEAD PCNG 35CM MYOCARDIUM VNTRC IS-1 CONCTR SCR FIX UNPLR,"$1,330.00",$0.00,"$1,330.00",$0.00,$949.22,$0.00,$0.00,$949.22,$949.22,$0.00,"$1,330.00",$0.00,$665.00,"$1,053.36","$1,064.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805195,EAP,HCPCS C1898,,LEAD PCNG 80CM 8FR CORON VNS BIPOL DUAL ELTRD SPRL FIX IS-1,"$4,433.00",$0.00,"$4,433.00","$1,994.85","$3,163.83",$0.00,$763.78,"$3,163.83","$3,163.83",$776.18,"$4,433.00",$0.00,"$2,216.50","$3,510.94","$3,546.40",$0.00,$693.76,$0.00,$705.73,$0.00
27805196,EAP,HCPCS C1898,,LEAD PCNG 90CM CORON VNS LV IS-1 EZTRK 3IS-1 STRD ELUT SIL,"$4,433.00",$0.00,"$4,433.00","$1,994.85","$3,163.83",$0.00,$763.78,"$3,163.83","$3,163.83",$776.18,"$4,433.00",$0.00,"$2,216.50","$3,510.94","$3,546.40",$0.00,$693.76,$0.00,$705.73,$0.00
27805197,EAP,HCPCS C1779,,LEAD PCNG 35CM MYOCARDIUM EPICARDIUM RV IS-1 CONCTR OTHR,"$1,330.00",$0.00,"$1,330.00",$0.00,$949.22,$0.00,$0.00,$949.22,$949.22,$0.00,"$1,330.00",$0.00,$665.00,"$1,053.36","$1,064.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805198,EAP,HCPCS C1899,,LEAD PCNG 59CM ECRDL 4 ST DUAL COIL IMPLTABLE CARDVRT DFBR,"$11,822.00",$0.00,"$11,822.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$8,437.36",$0.00,"$11,822.00",$0.00,"$5,911.00","$9,363.02","$9,457.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805199,EAP,HCPCS C1898,,LEAD PCNG 64CM ECRDL 4 ST DUAL COIL ACT FIX IMPLTABLE,"$11,822.00",$0.00,"$11,822.00","$5,319.90","$5,158.80",$0.00,"$2,036.87","$5,158.80","$8,437.36","$2,069.94","$11,822.00",$0.00,"$5,911.00","$9,363.02","$9,457.60",$0.00,"$1,850.14",$0.00,"$1,882.06",$0.00
27805200,EAP,HCPCS C1898,,LEAD PCNG 59CM ECRDM 4-ST DUAL COIL ACT DF4 TRM CONCTR,"$11,822.00",$0.00,"$11,822.00","$5,319.90","$5,158.80",$0.00,"$2,036.87","$5,158.80","$8,437.36","$2,069.94","$11,822.00",$0.00,"$5,911.00","$9,363.02","$9,457.60",$0.00,"$1,850.14",$0.00,"$1,882.06",$0.00
27805201,EAP,HCPCS C1898,,LEAD PCNG 64CM ECRDM 4-ST DUAL COIL ACT DF4 TRM CONCTR,"$11,822.00",$0.00,"$11,822.00","$5,319.90","$5,158.80",$0.00,"$2,036.87","$5,158.80","$8,437.36","$2,069.94","$11,822.00",$0.00,"$5,911.00","$9,363.02","$9,457.60",$0.00,"$1,850.14",$0.00,"$1,882.06",$0.00
27805202,EAP,HCPCS C1898,,LEAD PCNG 59CM ECRDM 4-ST DUAL COIL PSV DF4 TRM CONCTR,"$11,822.00",$0.00,"$11,822.00","$5,319.90","$5,158.80",$0.00,"$2,036.87","$5,158.80","$8,437.36","$2,069.94","$11,822.00",$0.00,"$5,911.00","$9,363.02","$9,457.60",$0.00,"$1,850.14",$0.00,"$1,882.06",$0.00
27805203,EAP,HCPCS C1898,,LEAD PCNG 64CM ECRDL 4 ST DUAL COIL ACT FIX IMPLTABLE,"$11,822.00",$0.00,"$11,822.00","$5,319.90","$5,158.80",$0.00,"$2,036.87","$5,158.80","$8,437.36","$2,069.94","$11,822.00",$0.00,"$5,911.00","$9,363.02","$9,457.60",$0.00,"$1,850.14",$0.00,"$1,882.06",$0.00
27805204,EAP,HCPCS C1898,,LEAD PCNG 59CM ECRDL 4 ST DUAL COIL PSV FIX IMPLTABLE,"$11,822.00",$0.00,"$11,822.00","$5,319.90","$5,158.80",$0.00,"$2,036.87","$5,158.80","$8,437.36","$2,069.94","$11,822.00",$0.00,"$5,911.00","$9,363.02","$9,457.60",$0.00,"$1,850.14",$0.00,"$1,882.06",$0.00
27805205,EAP,HCPCS C1898,,LEAD PCNG 64CM ECRDL 4 ST DUAL COIL PSV FIX IMPLTABLE,"$11,822.00",$0.00,"$11,822.00","$5,319.90","$5,158.80",$0.00,"$2,036.87","$5,158.80","$8,437.36","$2,069.94","$11,822.00",$0.00,"$5,911.00","$9,363.02","$9,457.60",$0.00,"$1,850.14",$0.00,"$1,882.06",$0.00
27805206,EAP,HCPCS C1777,,LEAD PCNG 59CM ECRDM 4-ST 1 COIL ACT DF4 TRM CONCTR CARDVRT,"$11,822.00",$0.00,"$11,822.00","$5,319.90","$5,158.80",$0.00,"$2,036.87","$5,158.80","$8,437.36","$2,069.94","$11,822.00",$0.00,"$5,911.00","$9,363.02","$9,457.60",$0.00,"$1,850.14",$0.00,"$1,882.06",$0.00
27805207,EAP,HCPCS C1777,,LEAD PCNG 64CM ECRDL 4 ST 1 COIL PSV FIX IMPLTABLE CARDVRT,"$11,822.00",$0.00,"$11,822.00","$5,319.90","$5,158.80",$0.00,"$2,036.87","$5,158.80","$8,437.36","$2,069.94","$11,822.00",$0.00,"$5,911.00","$9,363.02","$9,457.60",$0.00,"$1,850.14",$0.00,"$1,882.06",$0.00
27805208,EAP,HCPCS C1777,,LEAD PCNG 59CM ECRDL 4 ST 1 COIL PSV FIX IMPLTABLE CARDVRT,"$11,822.00",$0.00,"$11,822.00","$5,319.90","$5,158.80",$0.00,"$2,036.87","$5,158.80","$8,437.36","$2,069.94","$11,822.00",$0.00,"$5,911.00","$9,363.02","$9,457.60",$0.00,"$1,850.14",$0.00,"$1,882.06",$0.00
27805209,EAP,HCPCS C1777,,LEAD PCNG 64CM ECRDL 4 ST 1 COIL PSV FIX IMPLTABLE CARDVRT,"$11,822.00",$0.00,"$11,822.00","$5,319.90","$5,158.80",$0.00,"$2,036.87","$5,158.80","$8,437.36","$2,069.94","$11,822.00",$0.00,"$5,911.00","$9,363.02","$9,457.60",$0.00,"$1,850.14",$0.00,"$1,882.06",$0.00
27805210,EAP,HCPCS C1900,,INVIVE / EASYTRAK or ACUITY / w RV or AV LEAD: CARDIAC RESYN,"$26,452.00",$0.00,"$26,452.00",$0.00,"$5,158.80",$0.00,"$4,557.55","$5,158.80","$18,878.79",$0.00,"$26,452.00",$0.00,"$13,226.00","$20,949.98","$21,161.60",$0.00,"$4,139.74",$0.00,$0.00,$0.00
27805211,EAP,HCPCS C1900,,INVIVE / EASYTRAK or ACUITY / w RV & AV LEAD: CARDIAC RESYNC,"$26,452.00",$0.00,"$26,452.00",$0.00,"$5,158.80",$0.00,"$4,557.55","$5,158.80","$18,878.79",$0.00,"$26,452.00",$0.00,"$13,226.00","$20,949.98","$21,161.60",$0.00,"$4,139.74",$0.00,$0.00,$0.00
27805212,EAP,HCPCS C1722,,INCEPTA LV-1 / EASYTRAK or ACUITY / ENDOTAK w ATRIAL LEAD: C,"$71,524.00",$0.00,"$71,524.00","$32,185.80","$5,158.80",$0.00,"$8,138.89","$5,158.80","$51,046.68","$8,138.89","$71,524.00",$0.00,"$35,762.00","$56,647.01","$57,219.20",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27805213,EAP,HCPCS C1898,,LEAD PCNG 59CM 2.4MM STR ATR VNTRC BIPOL ACT FIX RTRCT HLX,"$1,330.00",$0.00,"$1,330.00",$598.50,$949.22,$0.00,$229.15,$949.22,$949.22,$232.87,"$1,330.00",$0.00,$665.00,"$1,053.36","$1,064.00",$0.00,$208.15,$0.00,$211.74,$0.00
27805214,EAP,HCPCS C1898,,LEAD PCNG 45CM ECRDM ATR VNTRC IS-1 CONCTR ACT FIX BIPOL SIL,"$1,330.00",$0.00,"$1,330.00",$598.50,$949.22,$0.00,$229.15,$949.22,$949.22,$232.87,"$1,330.00",$0.00,$665.00,"$1,053.36","$1,064.00",$0.00,$208.15,$0.00,$211.74,$0.00
27805215,EAP,HCPCS C1898,,LEAD PCNG ECRDL RIGHT ATR RV IS-1 CONCTR BIPOL XTD-RETRAC,"$1,463.00",$0.00,"$1,463.00",$658.35,"$1,044.14",$0.00,$252.07,"$1,044.14","$1,044.14",$256.16,"$1,463.00",$0.00,$731.50,"$1,158.70","$1,170.40",$0.00,$228.96,$0.00,$232.91,$0.00
27805216,EAP,HCPCS C1898,,LEAD PCNG ECRDM RIGHT ATR LV BIPOL IS-1 SCR FIX SIL INSL FLN,"$1,330.00",$0.00,"$1,330.00",$598.50,$949.22,$0.00,$229.15,$949.22,$949.22,$232.87,"$1,330.00",$0.00,$665.00,"$1,053.36","$1,064.00",$0.00,$208.15,$0.00,$211.74,$0.00
27805217,EAP,HCPCS C1898,,LEAD PCNG 52CM 7FR RIGHT ATR VNTRC ECRDM IS-1 CONCTR BIPOL,"$1,330.00",$0.00,"$1,330.00",$598.50,$949.22,$0.00,$229.15,$949.22,$949.22,$232.87,"$1,330.00",$0.00,$665.00,"$1,053.36","$1,064.00",$0.00,$208.15,$0.00,$211.74,$0.00
27805218,EAP,HCPCS C1898,,LEAD PCNG 45CM 6FR ECRDL OTHR THAN TRNVNS VDD 1 PASS BIPOL,"$1,330.00",$0.00,"$1,330.00",$598.50,$949.22,$0.00,$229.15,$949.22,$949.22,$232.87,"$1,330.00",$0.00,$665.00,"$1,053.36","$1,064.00",$0.00,$208.15,$0.00,$211.74,$0.00
27805219,EAP,HCPCS C1898,,LEAD PCNG 58CM 5FR ECRDM AV BIPOL ACT FIX SCR IN IS-1 FLN2,"$1,330.00",$0.00,"$1,330.00",$598.50,$949.22,$0.00,$229.15,$949.22,$949.22,$232.87,"$1,330.00",$0.00,$665.00,"$1,053.36","$1,064.00",$0.00,$208.15,$0.00,$211.74,$0.00
27805220,EAP,HCPCS C1898,,LEAD PCNG 52CM 7FR STR ECRDM RIGHT ATR LV BIPOL IS-1 SCR FIX,"$1,330.00",$0.00,"$1,330.00",$598.50,$949.22,$0.00,$229.15,$949.22,$949.22,$232.87,"$1,330.00",$0.00,$665.00,"$1,053.36","$1,064.00",$0.00,$208.15,$0.00,$211.74,$0.00
27805221,EAP,HCPCS C1779,,LEAD PCNG 45CM 7FR THK1.7MM STR ATR VNTRC BIPOL ACT FIX FLN2,"$1,330.00",$0.00,"$1,330.00",$0.00,$949.22,$0.00,$0.00,$949.22,$949.22,$0.00,"$1,330.00",$0.00,$665.00,"$1,053.36","$1,064.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805222,EAP,HCPCS C1898,,LEAD PCNG 52CM OTHR THAN TRNVNS VDD 1 PASS IMPLTABLE FLN2,"$1,330.00",$0.00,"$1,330.00",$598.50,$949.22,$0.00,$229.15,$949.22,$949.22,$232.87,"$1,330.00",$0.00,$665.00,"$1,053.36","$1,064.00",$0.00,$208.15,$0.00,$211.74,$0.00
27805223,EAP,HCPCS C1898,,LEAD PCNG 45CM 8FR J ECRDM RIGHT ATR BIPOL IS-1 PSV FIX POLY,"$1,330.00",$0.00,"$1,330.00",$598.50,$949.22,$0.00,$229.15,$949.22,$949.22,$232.87,"$1,330.00",$0.00,$665.00,"$1,053.36","$1,064.00",$0.00,$208.15,$0.00,$211.74,$0.00
27805224,EAP,HCPCS C1900,,LEAD PCNG 58CM 6FR ECRDM VNTRC BIPOL IS-1 PSV FIX FLN2,"$1,330.00",$0.00,"$1,330.00",$0.00,$949.22,$0.00,$229.15,$949.22,$949.22,$0.00,"$1,330.00",$0.00,$665.00,"$1,053.36","$1,064.00",$0.00,$208.15,$0.00,$0.00,$0.00
27805225,EAP,HCPCS C1779,,LEAD PCNG 52CM 9FR RV ECRDM BIPOL IS-1 PSV FIX TRNVNS VDD 1,"$1,330.00",$0.00,"$1,330.00",$0.00,$949.22,$0.00,$0.00,$949.22,$949.22,$0.00,"$1,330.00",$0.00,$665.00,"$1,053.36","$1,064.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805226,EAP,HCPCS C1898,,LEAD PCNG RV ECRDM BIPOL PSV FIX IS-1 FLN2 STRX PU,"$1,330.00",$0.00,"$1,330.00",$598.50,$949.22,$0.00,$229.15,$949.22,$949.22,$232.87,"$1,330.00",$0.00,$665.00,"$1,053.36","$1,064.00",$0.00,$208.15,$0.00,$211.74,$0.00
27805227,EAP,HCPCS C1900,,LEAD PCNG 52CM VNTRC ECRDL OTHR THAN TRNVNS VDD 1 PASS BIPOL,"$1,330.00",$0.00,"$1,330.00",$0.00,$949.22,$0.00,$229.15,$949.22,$949.22,$0.00,"$1,330.00",$0.00,$665.00,"$1,053.36","$1,064.00",$0.00,$208.15,$0.00,$0.00,$0.00
27805228,EAP,Custom 27805228,,Sensor Flotrac Vamp Adult 60in 152cm Sterile,$961.00,$0.00,$961.00,$0.00,$685.87,$0.00,$0.00,$685.87,$685.87,$0.00,$961.00,$0.00,$480.50,$761.11,$768.80,$0.00,$0.00,$0.00,$0.00,$0.00
27805229,EAP,Custom 27805229,,Sensor Monitor  Flotrac Adlt L60 In Vamp Bifurcated Pres,$961.00,$0.00,$961.00,$0.00,$685.87,$0.00,$0.00,$685.87,$685.87,$0.00,$961.00,$0.00,$480.50,$761.11,$768.80,$0.00,$0.00,$0.00,$0.00,$0.00
27805231,EAP,HCPCS C1874,,Stent Endoprsth 8mm 5cm 120cm .035in Dlv Sys Tip To Hubl,"$7,966.00",$0.00,"$7,966.00","$3,584.70","$5,158.80",$0.00,"$1,372.50","$5,158.80","$5,685.33","$1,394.78","$7,966.00",$0.00,"$3,983.00","$6,309.07","$6,372.80",$0.00,"$1,246.68",$0.00,"$1,268.19",$0.00
27805232,EAP,HCPCS C1874,,Stent Endoprsth 8mm 10cm 120cm .035in Dlv Sys Tip To Hul,"$9,148.00",$0.00,"$9,148.00","$4,116.60","$5,158.80",$0.00,"$1,576.15","$5,158.80","$6,528.93","$1,601.74","$9,148.00",$0.00,"$4,574.00","$7,245.22","$7,318.40",$0.00,"$1,431.66",$0.00,"$1,456.36",$0.00
27805233,EAP,HCPCS C1874,,Stent Endoprsth 10mm 5cm 120cm .035in Dlv Sys Tip To Hul,"$7,966.00",$0.00,"$7,966.00","$3,584.70","$5,158.80",$0.00,"$1,372.50","$5,158.80","$5,685.33","$1,394.78","$7,966.00",$0.00,"$3,983.00","$6,309.07","$6,372.80",$0.00,"$1,246.68",$0.00,"$1,268.19",$0.00
27805234,EAP,HCPCS C1874,,Stent Endoprsth 10mm 10cm 120cm .035in Dlv Sys Tip To Hb,"$9,148.00",$0.00,"$9,148.00","$4,116.60","$5,158.80",$0.00,"$1,576.15","$5,158.80","$6,528.93","$1,601.74","$9,148.00",$0.00,"$4,574.00","$7,245.22","$7,318.40",$0.00,"$1,431.66",$0.00,"$1,456.36",$0.00
27805235,EAP,HCPCS C1874,,Stent Endoprsth 6mm 7fr 5cm 120cm .035in Hep Bioactive C,"$7,061.00",$0.00,"$7,061.00","$3,177.45","$5,039.44",$0.00,"$1,216.57","$5,039.44","$5,039.44","$1,236.32","$7,061.00",$0.00,"$3,530.50","$5,592.31","$5,648.80",$0.00,"$1,105.05",$0.00,"$1,124.11",$0.00
27805236,EAP,HCPCS C1874,,Stent Endoprsth 6mm 10cm 120cm .035in Dlv Sys Tip To Hul,"$9,604.00",$0.00,"$9,604.00","$4,321.80","$5,158.80",$0.00,"$1,654.72","$5,158.80","$6,854.37","$1,681.58","$9,604.00",$0.00,"$4,802.00","$7,606.37","$7,683.20",$0.00,"$1,503.03",$0.00,"$1,528.96",$0.00
27805240,EAP,HCPCS V2790,,Graft Crnl 16mm Prokera Amnio Membr Crprs Ring Set,"$2,646.00",$0.00,"$2,646.00","$1,190.70","$1,888.45",$0.00,$455.89,"$1,888.45","$1,888.45",$463.29,"$2,646.00",$0.00,"$1,323.00","$2,095.63","$2,116.80",$0.00,$414.10,$0.00,$421.24,$0.00
27805252,EAP,Custom 27805252,,Pipeline  Embolization  Device  2.75 Cm 10mm,"$38,126.00",$0.00,"$38,126.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$27,210.53",$0.00,"$38,126.00",$0.00,"$19,063.00","$30,195.79","$30,500.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805253,EAP,Custom 27805253,,Pipeline  Embolization  Device 2.75 Cm 12mm,"$38,126.00",$0.00,"$38,126.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$27,210.53",$0.00,"$38,126.00",$0.00,"$19,063.00","$30,195.79","$30,500.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805254,EAP,Custom 27805254,,PIPELINE  EMBOLIZATION  DEVICE 2.75CM 16MM,"$38,126.00",$0.00,"$38,126.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$27,210.53",$0.00,"$38,126.00",$0.00,"$19,063.00","$30,195.79","$30,500.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805255,EAP,Custom 27805255,,Pipeline  Embolization  Device 3.00cm 10mm,"$38,126.00",$0.00,"$38,126.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$27,210.53",$0.00,"$38,126.00",$0.00,"$19,063.00","$30,195.79","$30,500.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805256,EAP,Custom 27805256,,Pipeline  Embolization  Device 3.00cm 12mm,"$38,126.00",$0.00,"$38,126.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$27,210.53",$0.00,"$38,126.00",$0.00,"$19,063.00","$30,195.79","$30,500.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805257,EAP,Custom 27805257,,Pipeline  Embolization  Device  3.00cm 16mm,"$38,126.00",$0.00,"$38,126.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$27,210.53",$0.00,"$38,126.00",$0.00,"$19,063.00","$30,195.79","$30,500.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805258,EAP,Custom 27805258,,Pipeline  Embolization  Device  3.50cm 10mm,"$38,126.00",$0.00,"$38,126.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$27,210.53",$0.00,"$38,126.00",$0.00,"$19,063.00","$30,195.79","$30,500.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805259,EAP,Custom 27805259,,PIPELINE  EMBOLIZATION  DEVICE 3.5CM 12MM,"$38,126.00",$0.00,"$38,126.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$27,210.53",$0.00,"$38,126.00",$0.00,"$19,063.00","$30,195.79","$30,500.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805260,EAP,Custom 27805260,,PIPELINE  EMBOLIZATION  DEVICE 3.5CM 16MM,"$38,126.00",$0.00,"$38,126.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$27,210.53",$0.00,"$38,126.00",$0.00,"$19,063.00","$30,195.79","$30,500.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805265,EAP,HCPCS C1777,,Linox Smart Dx 65/17,"$11,822.00",$0.00,"$11,822.00","$5,319.90","$5,158.80",$0.00,"$2,036.87","$5,158.80","$8,437.36","$2,069.94","$11,822.00",$0.00,"$5,911.00","$9,363.02","$9,457.60",$0.00,"$1,850.14",$0.00,"$1,882.06",$0.00
27805266,EAP,HCPCS C1777,,Linox Smart Dx 65/15,"$11,822.00",$0.00,"$11,822.00","$5,319.90","$5,158.80",$0.00,"$2,036.87","$5,158.80","$8,437.36","$2,069.94","$11,822.00",$0.00,"$5,911.00","$9,363.02","$9,457.60",$0.00,"$1,850.14",$0.00,"$1,882.06",$0.00
27805267,EAP,HCPCS C1777,,Lumax 740 Vr-t Dx W/gsm Hm,"$45,811.00",$0.00,"$45,811.00","$20,614.95","$5,158.80",$0.00,"$7,893.01","$5,158.80","$32,695.31","$8,021.14","$45,811.00",$0.00,"$22,905.50","$36,282.31","$36,648.80",$0.00,"$7,169.42",$0.00,"$7,293.11",$0.00
27805268,EAP,HCPCS C1777,,Lumax 740 Vr-t Dx System W/gsm Hm,"$57,560.00",$0.00,"$57,560.00","$25,902.00","$5,158.80",$0.00,"$8,138.89","$5,158.80","$41,080.57","$8,138.89","$57,560.00",$0.00,"$28,780.00","$45,587.52","$46,048.00",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27805269,EAP,HCPCS C1781,,"Mesh Surg Craniocurve .6mm Occptl Crnm Etch Lbl Antm, 01-9520","$11,822.00",$0.00,"$11,822.00","$5,319.90","$5,158.80",$0.00,"$2,036.87","$5,158.80","$8,437.36","$2,069.94","$11,822.00",$0.00,"$5,911.00","$9,363.02","$9,457.60",$0.00,"$1,850.14",$0.00,"$1,882.06",$0.00
27805270,EAP,Custom 27805270,,Target Coils 360 Standard 3mm X 6cm,"$4,559.00",$0.00,"$4,559.00",$0.00,"$3,253.76",$0.00,$0.00,"$3,253.76","$3,253.76",$0.00,"$4,559.00",$0.00,"$2,279.50","$3,610.73","$3,647.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805271,EAP,Custom 27805271,,Target Coils 360 Standard 3mm X 8cm,"$4,559.00",$0.00,"$4,559.00",$0.00,"$3,253.76",$0.00,$0.00,"$3,253.76","$3,253.76",$0.00,"$4,559.00",$0.00,"$2,279.50","$3,610.73","$3,647.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805272,EAP,Custom 27805272,,Target Coils 360 Standard 4mm X 8cm,"$4,559.00",$0.00,"$4,559.00",$0.00,"$3,253.76",$0.00,$0.00,"$3,253.76","$3,253.76",$0.00,"$4,559.00",$0.00,"$2,279.50","$3,610.73","$3,647.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805273,EAP,Custom 27805273,,Target Coils 360 Standard 4mm X 10cm,"$4,559.00",$0.00,"$4,559.00",$0.00,"$3,253.76",$0.00,$0.00,"$3,253.76","$3,253.76",$0.00,"$4,559.00",$0.00,"$2,279.50","$3,610.73","$3,647.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805274,EAP,Custom 27805274,,Target Coils 360 Standard 4mm X 15cm,"$4,559.00",$0.00,"$4,559.00",$0.00,"$3,253.76",$0.00,$0.00,"$3,253.76","$3,253.76",$0.00,"$4,559.00",$0.00,"$2,279.50","$3,610.73","$3,647.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805275,EAP,Custom 27805275,,Target Coils 360 Standard 5mm X 15cm,"$4,559.00",$0.00,"$4,559.00",$0.00,"$3,253.76",$0.00,$0.00,"$3,253.76","$3,253.76",$0.00,"$4,559.00",$0.00,"$2,279.50","$3,610.73","$3,647.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805276,EAP,Custom 27805276,,Target Coils 360 Standard 5mm X 20cm,"$4,559.00",$0.00,"$4,559.00",$0.00,"$3,253.76",$0.00,$0.00,"$3,253.76","$3,253.76",$0.00,"$4,559.00",$0.00,"$2,279.50","$3,610.73","$3,647.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805277,EAP,Custom 27805277,,Target Coils 360 Standard 6mm X 15cm,"$5,097.00",$0.00,"$5,097.00",$0.00,"$3,637.73",$0.00,$0.00,"$3,637.73","$3,637.73",$0.00,"$5,097.00",$0.00,"$2,548.50","$4,036.82","$4,077.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805278,EAP,Custom 27805278,,Target Coils 360 Standard 6mm X 20cm,"$5,097.00",$0.00,"$5,097.00",$0.00,"$3,637.73",$0.00,$0.00,"$3,637.73","$3,637.73",$0.00,"$5,097.00",$0.00,"$2,548.50","$4,036.82","$4,077.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805279,EAP,Custom 27805279,,Target Coils 360 Standard 6mm X 30cm,"$5,097.00",$0.00,"$5,097.00",$0.00,"$3,637.73",$0.00,$0.00,"$3,637.73","$3,637.73",$0.00,"$5,097.00",$0.00,"$2,548.50","$4,036.82","$4,077.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805280,EAP,Custom 27805280,,Target Coils 360 Standard 7mm X 15cm,"$5,097.00",$0.00,"$5,097.00",$0.00,"$3,637.73",$0.00,$0.00,"$3,637.73","$3,637.73",$0.00,"$5,097.00",$0.00,"$2,548.50","$4,036.82","$4,077.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805281,EAP,Custom 27805281,,Target Coils 360 Standard 7mm X 20cm,"$5,097.00",$0.00,"$5,097.00",$0.00,"$3,637.73",$0.00,$0.00,"$3,637.73","$3,637.73",$0.00,"$5,097.00",$0.00,"$2,548.50","$4,036.82","$4,077.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805282,EAP,Custom 27805282,,Target Coils 360 Standard 7mm X 30cm,"$5,097.00",$0.00,"$5,097.00",$0.00,"$3,637.73",$0.00,$0.00,"$3,637.73","$3,637.73",$0.00,"$5,097.00",$0.00,"$2,548.50","$4,036.82","$4,077.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805283,EAP,Custom 27805283,,Target Coils 360 Standard 8mm X 20cm,"$5,097.00",$0.00,"$5,097.00",$0.00,"$3,637.73",$0.00,$0.00,"$3,637.73","$3,637.73",$0.00,"$5,097.00",$0.00,"$2,548.50","$4,036.82","$4,077.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805284,EAP,Custom 27805284,,Target Coils 360 Standard 8mm X 30cm,"$5,097.00",$0.00,"$5,097.00",$0.00,"$3,637.73",$0.00,$0.00,"$3,637.73","$3,637.73",$0.00,"$5,097.00",$0.00,"$2,548.50","$4,036.82","$4,077.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805285,EAP,Custom 27805285,,Target Coils 360 Standard 9mm X 20cm,"$5,097.00",$0.00,"$5,097.00",$0.00,"$3,637.73",$0.00,$0.00,"$3,637.73","$3,637.73",$0.00,"$5,097.00",$0.00,"$2,548.50","$4,036.82","$4,077.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805286,EAP,Custom 27805286,,Target Coils 360 Standard 9mm X 30cm,"$5,097.00",$0.00,"$5,097.00",$0.00,"$3,637.73",$0.00,$0.00,"$3,637.73","$3,637.73",$0.00,"$5,097.00",$0.00,"$2,548.50","$4,036.82","$4,077.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805287,EAP,Custom 27805287,,Target Coils 360 Standard 10mm X 30cm,"$5,097.00",$0.00,"$5,097.00",$0.00,"$3,637.73",$0.00,$0.00,"$3,637.73","$3,637.73",$0.00,"$5,097.00",$0.00,"$2,548.50","$4,036.82","$4,077.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805288,EAP,Custom 27805288,,Target Coils 360 Standard 11mm X 30cm,"$5,097.00",$0.00,"$5,097.00",$0.00,"$3,637.73",$0.00,$0.00,"$3,637.73","$3,637.73",$0.00,"$5,097.00",$0.00,"$2,548.50","$4,036.82","$4,077.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805289,EAP,Custom 27805289,,Target Coils 360 Standard 12mm X 30cm,"$5,097.00",$0.00,"$5,097.00",$0.00,"$3,637.73",$0.00,$0.00,"$3,637.73","$3,637.73",$0.00,"$5,097.00",$0.00,"$2,548.50","$4,036.82","$4,077.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805290,EAP,Custom 27805290,,Target Coils 360 Standard 13mm X 30cm,"$5,097.00",$0.00,"$5,097.00",$0.00,"$3,637.73",$0.00,$0.00,"$3,637.73","$3,637.73",$0.00,"$5,097.00",$0.00,"$2,548.50","$4,036.82","$4,077.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805291,EAP,Custom 27805291,,Target Coils 360 Standard 14mm X 30cm,"$5,097.00",$0.00,"$5,097.00",$0.00,"$3,637.73",$0.00,$0.00,"$3,637.73","$3,637.73",$0.00,"$5,097.00",$0.00,"$2,548.50","$4,036.82","$4,077.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805292,EAP,Custom 27805292,,Target Coils 360 Standard 15mm X 40cm,"$5,097.00",$0.00,"$5,097.00",$0.00,"$3,637.73",$0.00,$0.00,"$3,637.73","$3,637.73",$0.00,"$5,097.00",$0.00,"$2,548.50","$4,036.82","$4,077.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805293,EAP,Custom 27805293,,Target Coils 360 Soft 2mm X 4cm,"$4,827.00",$0.00,"$4,827.00",$0.00,"$3,445.03",$0.00,$0.00,"$3,445.03","$3,445.03",$0.00,"$4,827.00",$0.00,"$2,413.50","$3,822.98","$3,861.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805294,EAP,Custom 27805294,,Target Coils 360 Soft 3mm X 6cm,"$4,827.00",$0.00,"$4,827.00",$0.00,"$3,445.03",$0.00,$0.00,"$3,445.03","$3,445.03",$0.00,"$4,827.00",$0.00,"$2,413.50","$3,822.98","$3,861.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805295,EAP,Custom 27805295,,Target Coils 360 Soft 3mm X 8cm,"$4,827.00",$0.00,"$4,827.00",$0.00,"$3,445.03",$0.00,$0.00,"$3,445.03","$3,445.03",$0.00,"$4,827.00",$0.00,"$2,413.50","$3,822.98","$3,861.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805296,EAP,Custom 27805296,,Target Coils 360 Soft 3mm X 10cm,"$4,827.00",$0.00,"$4,827.00",$0.00,"$3,445.03",$0.00,$0.00,"$3,445.03","$3,445.03",$0.00,"$4,827.00",$0.00,"$2,413.50","$3,822.98","$3,861.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805297,EAP,Custom 27805297,,Target Coils 360 Soft 4mm X 6cm,"$4,827.00",$0.00,"$4,827.00",$0.00,"$3,445.03",$0.00,$0.00,"$3,445.03","$3,445.03",$0.00,"$4,827.00",$0.00,"$2,413.50","$3,822.98","$3,861.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805298,EAP,Custom 27805298,,Target Coils 360 Soft 4mm X 8cm,"$4,827.00",$0.00,"$4,827.00",$0.00,"$3,445.03",$0.00,$0.00,"$3,445.03","$3,445.03",$0.00,"$4,827.00",$0.00,"$2,413.50","$3,822.98","$3,861.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805299,EAP,Custom 27805299,,Target Coils 360 Soft 4mm X 10cm,"$4,827.00",$0.00,"$4,827.00",$0.00,"$3,445.03",$0.00,$0.00,"$3,445.03","$3,445.03",$0.00,"$4,827.00",$0.00,"$2,413.50","$3,822.98","$3,861.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805300,EAP,Custom 27805300,,Target Coils 360 Soft 4mm X 15cm,"$4,827.00",$0.00,"$4,827.00",$0.00,"$3,445.03",$0.00,$0.00,"$3,445.03","$3,445.03",$0.00,"$4,827.00",$0.00,"$2,413.50","$3,822.98","$3,861.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805301,EAP,Custom 27805301,,Target Coils 360 Soft 5mm X 10cm,"$4,827.00",$0.00,"$4,827.00",$0.00,"$3,445.03",$0.00,$0.00,"$3,445.03","$3,445.03",$0.00,"$4,827.00",$0.00,"$2,413.50","$3,822.98","$3,861.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805302,EAP,Custom 27805302,,Target Coils 360 Soft 5mm X 15cm,"$4,827.00",$0.00,"$4,827.00",$0.00,"$3,445.03",$0.00,$0.00,"$3,445.03","$3,445.03",$0.00,"$4,827.00",$0.00,"$2,413.50","$3,822.98","$3,861.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805303,EAP,Custom 27805303,,Target Coils 360 Soft 5mm X 20cm,"$4,827.00",$0.00,"$4,827.00",$0.00,"$3,445.03",$0.00,$0.00,"$3,445.03","$3,445.03",$0.00,"$4,827.00",$0.00,"$2,413.50","$3,822.98","$3,861.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805304,EAP,Custom 27805304,,Target Coils 360 Soft 6mm X 10cm,"$4,827.00",$0.00,"$4,827.00",$0.00,"$3,445.03",$0.00,$0.00,"$3,445.03","$3,445.03",$0.00,"$4,827.00",$0.00,"$2,413.50","$3,822.98","$3,861.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805305,EAP,Custom 27805305,,Target Coils 360 Soft 6mm X 15cm,"$4,827.00",$0.00,"$4,827.00",$0.00,"$3,445.03",$0.00,$0.00,"$3,445.03","$3,445.03",$0.00,"$4,827.00",$0.00,"$2,413.50","$3,822.98","$3,861.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805306,EAP,Custom 27805306,,Target Coils 360 Soft 6mm X 20cm,"$4,827.00",$0.00,"$4,827.00",$0.00,"$3,445.03",$0.00,$0.00,"$3,445.03","$3,445.03",$0.00,"$4,827.00",$0.00,"$2,413.50","$3,822.98","$3,861.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805307,EAP,Custom 27805307,,Target Coils 360 Soft 6mm X 30cm,"$4,827.00",$0.00,"$4,827.00",$0.00,"$3,445.03",$0.00,$0.00,"$3,445.03","$3,445.03",$0.00,"$4,827.00",$0.00,"$2,413.50","$3,822.98","$3,861.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805308,EAP,Custom 27805308,,Target Coils 360 Soft 7mm X 15cm,"$4,827.00",$0.00,"$4,827.00",$0.00,"$3,445.03",$0.00,$0.00,"$3,445.03","$3,445.03",$0.00,"$4,827.00",$0.00,"$2,413.50","$3,822.98","$3,861.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805309,EAP,Custom 27805309,,Target Coils 360 Soft 7mm X 20cm,"$4,827.00",$0.00,"$4,827.00",$0.00,"$3,445.03",$0.00,$0.00,"$3,445.03","$3,445.03",$0.00,"$4,827.00",$0.00,"$2,413.50","$3,822.98","$3,861.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805310,EAP,Custom 27805310,,Target Coils 360 Soft 7mm X 30cm,"$4,827.00",$0.00,"$4,827.00",$0.00,"$3,445.03",$0.00,$0.00,"$3,445.03","$3,445.03",$0.00,"$4,827.00",$0.00,"$2,413.50","$3,822.98","$3,861.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805311,EAP,Custom 27805311,,Target Coils 360 Soft 8mm X 20cm,"$4,827.00",$0.00,"$4,827.00",$0.00,"$3,445.03",$0.00,$0.00,"$3,445.03","$3,445.03",$0.00,"$4,827.00",$0.00,"$2,413.50","$3,822.98","$3,861.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805312,EAP,Custom 27805312,,Target Coils 360 Soft 8mm X 30cm,"$4,827.00",$0.00,"$4,827.00",$0.00,"$3,445.03",$0.00,$0.00,"$3,445.03","$3,445.03",$0.00,"$4,827.00",$0.00,"$2,413.50","$3,822.98","$3,861.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805313,EAP,Custom 27805313,,Target Coils 360 Soft 9mm X 20cm,"$4,827.00",$0.00,"$4,827.00",$0.00,"$3,445.03",$0.00,$0.00,"$3,445.03","$3,445.03",$0.00,"$4,827.00",$0.00,"$2,413.50","$3,822.98","$3,861.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805314,EAP,Custom 27805314,,Target Coils 360 Soft 9mm X 30cm,"$4,827.00",$0.00,"$4,827.00",$0.00,"$3,445.03",$0.00,$0.00,"$3,445.03","$3,445.03",$0.00,"$4,827.00",$0.00,"$2,413.50","$3,822.98","$3,861.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805315,EAP,Custom 27805315,,Target Coils 360 Soft 10mm X 30cm,"$4,827.00",$0.00,"$4,827.00",$0.00,"$3,445.03",$0.00,$0.00,"$3,445.03","$3,445.03",$0.00,"$4,827.00",$0.00,"$2,413.50","$3,822.98","$3,861.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805316,EAP,Custom 27805316,,Target Coils 360 Soft 11mm X 30cm,"$4,827.00",$0.00,"$4,827.00",$0.00,"$3,445.03",$0.00,$0.00,"$3,445.03","$3,445.03",$0.00,"$4,827.00",$0.00,"$2,413.50","$3,822.98","$3,861.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805317,EAP,Custom 27805317,,Target Coils 360 Soft 12mm X 30cm,"$4,827.00",$0.00,"$4,827.00",$0.00,"$3,445.03",$0.00,$0.00,"$3,445.03","$3,445.03",$0.00,"$4,827.00",$0.00,"$2,413.50","$3,822.98","$3,861.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805318,EAP,Custom 27805318,,Target Coils 360 Soft 13mm X 30cm,"$4,827.00",$0.00,"$4,827.00",$0.00,"$3,445.03",$0.00,$0.00,"$3,445.03","$3,445.03",$0.00,"$4,827.00",$0.00,"$2,413.50","$3,822.98","$3,861.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805319,EAP,Custom 27805319,,Target Coils 360 Soft 14mm X 30cm,"$4,827.00",$0.00,"$4,827.00",$0.00,"$3,445.03",$0.00,$0.00,"$3,445.03","$3,445.03",$0.00,"$4,827.00",$0.00,"$2,413.50","$3,822.98","$3,861.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805320,EAP,Custom 27805320,,Target Coils Helical Ultra 1mm X 1cm,"$3,483.00",$0.00,"$3,483.00",$0.00,"$2,485.82",$0.00,$0.00,"$2,485.82","$2,485.82",$0.00,"$3,483.00",$0.00,"$1,741.50","$2,758.54","$2,786.40",$0.00,$0.00,$0.00,$0.00,$0.00
27805321,EAP,Custom 27805321,,Target Coils Helical Ultra 1mm X 2cm,"$3,483.00",$0.00,"$3,483.00",$0.00,"$2,485.82",$0.00,$0.00,"$2,485.82","$2,485.82",$0.00,"$3,483.00",$0.00,"$1,741.50","$2,758.54","$2,786.40",$0.00,$0.00,$0.00,$0.00,$0.00
27805322,EAP,Custom 27805322,,Target Coils Helical Ultra 1mm X 3cm,"$3,483.00",$0.00,"$3,483.00",$0.00,"$2,485.82",$0.00,$0.00,"$2,485.82","$2,485.82",$0.00,"$3,483.00",$0.00,"$1,741.50","$2,758.54","$2,786.40",$0.00,$0.00,$0.00,$0.00,$0.00
27805323,EAP,Custom 27805323,,Target Coils Helical Ultra 1.5mm X 1cm,"$3,483.00",$0.00,"$3,483.00",$0.00,"$2,485.82",$0.00,$0.00,"$2,485.82","$2,485.82",$0.00,"$3,483.00",$0.00,"$1,741.50","$2,758.54","$2,786.40",$0.00,$0.00,$0.00,$0.00,$0.00
27805324,EAP,Custom 27805324,,Target Coils Helical Ultra 1.5mm X 2cm,"$3,483.00",$0.00,"$3,483.00",$0.00,"$2,485.82",$0.00,$0.00,"$2,485.82","$2,485.82",$0.00,"$3,483.00",$0.00,"$1,741.50","$2,758.54","$2,786.40",$0.00,$0.00,$0.00,$0.00,$0.00
27805325,EAP,Custom 27805325,,Target Coils Helical Ultra 1.5mm X 3cm,"$3,483.00",$0.00,"$3,483.00",$0.00,"$2,485.82",$0.00,$0.00,"$2,485.82","$2,485.82",$0.00,"$3,483.00",$0.00,"$1,741.50","$2,758.54","$2,786.40",$0.00,$0.00,$0.00,$0.00,$0.00
27805326,EAP,Custom 27805326,,Target Coils Helical Ultra 1.5mm X 4cm,"$3,483.00",$0.00,"$3,483.00",$0.00,"$2,485.82",$0.00,$0.00,"$2,485.82","$2,485.82",$0.00,"$3,483.00",$0.00,"$1,741.50","$2,758.54","$2,786.40",$0.00,$0.00,$0.00,$0.00,$0.00
27805327,EAP,Custom 27805327,,Target Coils Helical Ultra 2mm X 1cm,"$3,483.00",$0.00,"$3,483.00",$0.00,"$2,485.82",$0.00,$0.00,"$2,485.82","$2,485.82",$0.00,"$3,483.00",$0.00,"$1,741.50","$2,758.54","$2,786.40",$0.00,$0.00,$0.00,$0.00,$0.00
27805328,EAP,Custom 27805328,,Target Coils Helical Ultra 2mm X 2cm,"$3,483.00",$0.00,"$3,483.00",$0.00,"$2,485.82",$0.00,$0.00,"$2,485.82","$2,485.82",$0.00,"$3,483.00",$0.00,"$1,741.50","$2,758.54","$2,786.40",$0.00,$0.00,$0.00,$0.00,$0.00
27805329,EAP,Custom 27805329,,Target Coils Helical Ultra 2mm X 3cm,"$3,483.00",$0.00,"$3,483.00",$0.00,"$2,485.82",$0.00,$0.00,"$2,485.82","$2,485.82",$0.00,"$3,483.00",$0.00,"$1,741.50","$2,758.54","$2,786.40",$0.00,$0.00,$0.00,$0.00,$0.00
27805330,EAP,Custom 27805330,,Target Coils Helical Ultra 2mm X 4cm,"$3,483.00",$0.00,"$3,483.00",$0.00,"$2,485.82",$0.00,$0.00,"$2,485.82","$2,485.82",$0.00,"$3,483.00",$0.00,"$1,741.50","$2,758.54","$2,786.40",$0.00,$0.00,$0.00,$0.00,$0.00
27805331,EAP,Custom 27805331,,Target Coils Helical Ultra 2mm X 6cm,"$3,483.00",$0.00,"$3,483.00",$0.00,"$2,485.82",$0.00,$0.00,"$2,485.82","$2,485.82",$0.00,"$3,483.00",$0.00,"$1,741.50","$2,758.54","$2,786.40",$0.00,$0.00,$0.00,$0.00,$0.00
27805332,EAP,Custom 27805332,,Target Coils Helical Ultra 2mm X 8cm,"$3,483.00",$0.00,"$3,483.00",$0.00,"$2,485.82",$0.00,$0.00,"$2,485.82","$2,485.82",$0.00,"$3,483.00",$0.00,"$1,741.50","$2,758.54","$2,786.40",$0.00,$0.00,$0.00,$0.00,$0.00
27805333,EAP,Custom 27805333,,Target Coils Helical Ultra 2.5mm X 3cm,"$3,483.00",$0.00,"$3,483.00",$0.00,"$2,485.82",$0.00,$0.00,"$2,485.82","$2,485.82",$0.00,"$3,483.00",$0.00,"$1,741.50","$2,758.54","$2,786.40",$0.00,$0.00,$0.00,$0.00,$0.00
27805334,EAP,Custom 27805334,,Target Coils Helical Ultra 2.5mm X 4cm,"$3,483.00",$0.00,"$3,483.00",$0.00,"$2,485.82",$0.00,$0.00,"$2,485.82","$2,485.82",$0.00,"$3,483.00",$0.00,"$1,741.50","$2,758.54","$2,786.40",$0.00,$0.00,$0.00,$0.00,$0.00
27805335,EAP,Custom 27805335,,Target Coils Helical Ultra 2.5mm X 6cm,"$3,483.00",$0.00,"$3,483.00",$0.00,"$2,485.82",$0.00,$0.00,"$2,485.82","$2,485.82",$0.00,"$3,483.00",$0.00,"$1,741.50","$2,758.54","$2,786.40",$0.00,$0.00,$0.00,$0.00,$0.00
27805336,EAP,Custom 27805336,,Target Coils Helical Ultra 3mm X 4cm,"$3,483.00",$0.00,"$3,483.00",$0.00,"$2,485.82",$0.00,$0.00,"$2,485.82","$2,485.82",$0.00,"$3,483.00",$0.00,"$1,741.50","$2,758.54","$2,786.40",$0.00,$0.00,$0.00,$0.00,$0.00
27805337,EAP,Custom 27805337,,Target Coils Helical Ultra 3mm X 6cm,"$3,483.00",$0.00,"$3,483.00",$0.00,"$2,485.82",$0.00,$0.00,"$2,485.82","$2,485.82",$0.00,"$3,483.00",$0.00,"$1,741.50","$2,758.54","$2,786.40",$0.00,$0.00,$0.00,$0.00,$0.00
27805338,EAP,Custom 27805338,,Target Coils Helical Ultra 3mm X 8cm,"$3,483.00",$0.00,"$3,483.00",$0.00,"$2,485.82",$0.00,$0.00,"$2,485.82","$2,485.82",$0.00,"$3,483.00",$0.00,"$1,741.50","$2,758.54","$2,786.40",$0.00,$0.00,$0.00,$0.00,$0.00
27805339,EAP,Custom 27805339,,Target Coils Helical Ultra 3mm X 10cm,"$3,483.00",$0.00,"$3,483.00",$0.00,"$2,485.82",$0.00,$0.00,"$2,485.82","$2,485.82",$0.00,"$3,483.00",$0.00,"$1,741.50","$2,758.54","$2,786.40",$0.00,$0.00,$0.00,$0.00,$0.00
27805340,EAP,Custom 27805340,,Target Coils Helical Ultra 4mm X 6cm,"$3,483.00",$0.00,"$3,483.00",$0.00,"$2,485.82",$0.00,$0.00,"$2,485.82","$2,485.82",$0.00,"$3,483.00",$0.00,"$1,741.50","$2,758.54","$2,786.40",$0.00,$0.00,$0.00,$0.00,$0.00
27805341,EAP,Custom 27805341,,Target Coils Helical Ultra 4mm X 8cm,"$3,483.00",$0.00,"$3,483.00",$0.00,"$2,485.82",$0.00,$0.00,"$2,485.82","$2,485.82",$0.00,"$3,483.00",$0.00,"$1,741.50","$2,758.54","$2,786.40",$0.00,$0.00,$0.00,$0.00,$0.00
27805342,EAP,Custom 27805342,,Target Coils Helical Ultra 4mm X 15cm,"$3,483.00",$0.00,"$3,483.00",$0.00,"$2,485.82",$0.00,$0.00,"$2,485.82","$2,485.82",$0.00,"$3,483.00",$0.00,"$1,741.50","$2,758.54","$2,786.40",$0.00,$0.00,$0.00,$0.00,$0.00
27805343,EAP,Custom 27805343,,Target Xl Detachable Coils 360 Soft 6 X 20cm,"$5,903.00",$0.00,"$5,903.00",$0.00,"$4,212.97",$0.00,$0.00,"$4,212.97","$4,212.97",$0.00,"$5,903.00",$0.00,"$2,951.50","$4,675.18","$4,722.40",$0.00,$0.00,$0.00,$0.00,$0.00
27805344,EAP,Custom 27805344,,Target Xl Detachable Coils 360 Soft 7 X 20cm,"$5,903.00",$0.00,"$5,903.00",$0.00,"$4,212.97",$0.00,$0.00,"$4,212.97","$4,212.97",$0.00,"$5,903.00",$0.00,"$2,951.50","$4,675.18","$4,722.40",$0.00,$0.00,$0.00,$0.00,$0.00
27805345,EAP,Custom 27805345,,Target Xl Detachable Coils 360 Soft 8 X 30cm,"$5,903.00",$0.00,"$5,903.00",$0.00,"$4,212.97",$0.00,$0.00,"$4,212.97","$4,212.97",$0.00,"$5,903.00",$0.00,"$2,951.50","$4,675.18","$4,722.40",$0.00,$0.00,$0.00,$0.00,$0.00
27805346,EAP,Custom 27805346,,Target Xl Detachable Coils 360 Soft 9 X 30cm,"$5,903.00",$0.00,"$5,903.00",$0.00,"$4,212.97",$0.00,$0.00,"$4,212.97","$4,212.97",$0.00,"$5,903.00",$0.00,"$2,951.50","$4,675.18","$4,722.40",$0.00,$0.00,$0.00,$0.00,$0.00
27805347,EAP,Custom 27805347,,Target Xl Detachable Coils 360 Soft 10 X 40cm,"$5,903.00",$0.00,"$5,903.00",$0.00,"$4,212.97",$0.00,$0.00,"$4,212.97","$4,212.97",$0.00,"$5,903.00",$0.00,"$2,951.50","$4,675.18","$4,722.40",$0.00,$0.00,$0.00,$0.00,$0.00
27805348,EAP,Custom 27805348,,Target Xl Detachable Coils 360 Soft 12 X 45cm,"$5,903.00",$0.00,"$5,903.00",$0.00,"$4,212.97",$0.00,$0.00,"$4,212.97","$4,212.97",$0.00,"$5,903.00",$0.00,"$2,951.50","$4,675.18","$4,722.40",$0.00,$0.00,$0.00,$0.00,$0.00
27805349,EAP,Custom 27805349,,Target Xl Detachable Coils 360 Soft 14 X 50cm,"$6,441.00",$0.00,"$6,441.00",$0.00,"$4,596.94",$0.00,$0.00,"$4,596.94","$4,596.94",$0.00,"$6,441.00",$0.00,"$3,220.50","$5,101.27","$5,152.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805350,EAP,Custom 27805350,,Target Xl Detachable Coils 360 Soft 16 X 50cm,"$6,441.00",$0.00,"$6,441.00",$0.00,"$4,596.94",$0.00,$0.00,"$4,596.94","$4,596.94",$0.00,"$6,441.00",$0.00,"$3,220.50","$5,101.27","$5,152.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805351,EAP,Custom 27805351,,Target Xl Detachable Coils 360 Soft 18 X 50cm,"$6,441.00",$0.00,"$6,441.00",$0.00,"$4,596.94",$0.00,$0.00,"$4,596.94","$4,596.94",$0.00,"$6,441.00",$0.00,"$3,220.50","$5,101.27","$5,152.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805352,EAP,Custom 27805352,,Target Xl Detachable Coils 360 Soft 20 X 50cm,"$6,441.00",$0.00,"$6,441.00",$0.00,"$4,596.94",$0.00,$0.00,"$4,596.94","$4,596.94",$0.00,"$6,441.00",$0.00,"$3,220.50","$5,101.27","$5,152.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805353,EAP,Custom 27805353,,Target Xl Detachable Coils 360 Standard  6 X 20cm,"$5,903.00",$0.00,"$5,903.00",$0.00,"$4,212.97",$0.00,$0.00,"$4,212.97","$4,212.97",$0.00,"$5,903.00",$0.00,"$2,951.50","$4,675.18","$4,722.40",$0.00,$0.00,$0.00,$0.00,$0.00
27805354,EAP,Custom 27805354,,Target Xl Detachable Coils 360 Standard  7 X 20cm,"$5,903.00",$0.00,"$5,903.00",$0.00,"$4,212.97",$0.00,$0.00,"$4,212.97","$4,212.97",$0.00,"$5,903.00",$0.00,"$2,951.50","$4,675.18","$4,722.40",$0.00,$0.00,$0.00,$0.00,$0.00
27805355,EAP,Custom 27805355,,Target Xl Detachable Coils 360 Standard  8 X 30cm,"$5,903.00",$0.00,"$5,903.00",$0.00,"$4,212.97",$0.00,$0.00,"$4,212.97","$4,212.97",$0.00,"$5,903.00",$0.00,"$2,951.50","$4,675.18","$4,722.40",$0.00,$0.00,$0.00,$0.00,$0.00
27805356,EAP,Custom 27805356,,Target Xl Detachable Coils 360 Standard  9 X 30cm,"$5,903.00",$0.00,"$5,903.00",$0.00,"$4,212.97",$0.00,$0.00,"$4,212.97","$4,212.97",$0.00,"$5,903.00",$0.00,"$2,951.50","$4,675.18","$4,722.40",$0.00,$0.00,$0.00,$0.00,$0.00
27805357,EAP,Custom 27805357,,Target Xl Detachable Coils 360 Standard  10 X 40cm,"$5,903.00",$0.00,"$5,903.00",$0.00,"$4,212.97",$0.00,$0.00,"$4,212.97","$4,212.97",$0.00,"$5,903.00",$0.00,"$2,951.50","$4,675.18","$4,722.40",$0.00,$0.00,$0.00,$0.00,$0.00
27805358,EAP,Custom 27805358,,Target Xl Detachable Coils 360 Standard  12 X 45cm,"$5,903.00",$0.00,"$5,903.00",$0.00,"$4,212.97",$0.00,$0.00,"$4,212.97","$4,212.97",$0.00,"$5,903.00",$0.00,"$2,951.50","$4,675.18","$4,722.40",$0.00,$0.00,$0.00,$0.00,$0.00
27805359,EAP,Custom 27805359,,Target Xl Detachable Coils 360 Standard  14 X 50cm,"$6,441.00",$0.00,"$6,441.00",$0.00,"$4,596.94",$0.00,$0.00,"$4,596.94","$4,596.94",$0.00,"$6,441.00",$0.00,"$3,220.50","$5,101.27","$5,152.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805360,EAP,Custom 27805360,,Target Xl Detachable Coils 360 Standard  16 X 50cm,"$6,441.00",$0.00,"$6,441.00",$0.00,"$4,596.94",$0.00,$0.00,"$4,596.94","$4,596.94",$0.00,"$6,441.00",$0.00,"$3,220.50","$5,101.27","$5,152.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805361,EAP,Custom 27805361,,Target Xl Detachable Coils 360 Standard  18 X 50cm,"$6,441.00",$0.00,"$6,441.00",$0.00,"$4,596.94",$0.00,$0.00,"$4,596.94","$4,596.94",$0.00,"$6,441.00",$0.00,"$3,220.50","$5,101.27","$5,152.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805362,EAP,Custom 27805362,,Target Xl Detachable Coils 360 Standard  20 X 50cm,"$6,441.00",$0.00,"$6,441.00",$0.00,"$4,596.94",$0.00,$0.00,"$4,596.94","$4,596.94",$0.00,"$6,441.00",$0.00,"$3,220.50","$5,101.27","$5,152.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805363,EAP,Custom 27805363,,Target Xl Detachable Coils 360 Standard  22 X 50cm,"$6,441.00",$0.00,"$6,441.00",$0.00,"$4,596.94",$0.00,$0.00,"$4,596.94","$4,596.94",$0.00,"$6,441.00",$0.00,"$3,220.50","$5,101.27","$5,152.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805364,EAP,Custom 27805364,,Target Xl Detachable Coils 360 Standard  24 X 50cm,"$6,441.00",$0.00,"$6,441.00",$0.00,"$4,596.94",$0.00,$0.00,"$4,596.94","$4,596.94",$0.00,"$6,441.00",$0.00,"$3,220.50","$5,101.27","$5,152.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805365,EAP,Custom 27805365,,Target Xl Detachable Coils Helical 10 X 40cm,"$4,290.00",$0.00,"$4,290.00",$0.00,"$3,061.77",$0.00,$0.00,"$3,061.77","$3,061.77",$0.00,"$4,290.00",$0.00,"$2,145.00","$3,397.68","$3,432.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805366,EAP,Custom 27805366,,Target Xl Detachable Coils Helical 12 X 50cm,"$4,290.00",$0.00,"$4,290.00",$0.00,"$3,061.77",$0.00,$0.00,"$3,061.77","$3,061.77",$0.00,"$4,290.00",$0.00,"$2,145.00","$3,397.68","$3,432.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805367,EAP,Custom 27805367,,Target Xl Detachable Coils Helical 14 X 50cm,"$4,827.00",$0.00,"$4,827.00",$0.00,"$3,445.03",$0.00,$0.00,"$3,445.03","$3,445.03",$0.00,"$4,827.00",$0.00,"$2,413.50","$3,822.98","$3,861.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805368,EAP,Custom 27805368,,Target Xl Detachable Coils Helical 16 X 50cm,"$4,827.00",$0.00,"$4,827.00",$0.00,"$3,445.03",$0.00,$0.00,"$3,445.03","$3,445.03",$0.00,"$4,827.00",$0.00,"$2,413.50","$3,822.98","$3,861.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805369,EAP,Custom 27805369,,Target Xl Detachable Coils Helical 18 X 50cm,"$4,827.00",$0.00,"$4,827.00",$0.00,"$3,445.03",$0.00,$0.00,"$3,445.03","$3,445.03",$0.00,"$4,827.00",$0.00,"$2,413.50","$3,822.98","$3,861.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805370,EAP,Custom 27805370,,Target Xl Detachable Coils Helical 20 X 50cm,"$4,827.00",$0.00,"$4,827.00",$0.00,"$3,445.03",$0.00,$0.00,"$3,445.03","$3,445.03",$0.00,"$4,827.00",$0.00,"$2,413.50","$3,822.98","$3,861.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805371,EAP,Custom 27805371,,Target Xl Detachable Coils Helical 22 X 50cm,"$4,827.00",$0.00,"$4,827.00",$0.00,"$3,445.03",$0.00,$0.00,"$3,445.03","$3,445.03",$0.00,"$4,827.00",$0.00,"$2,413.50","$3,822.98","$3,861.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805372,EAP,Custom 27805372,,Target Xl Detachable Coils Helical 24 X 50cm,"$4,827.00",$0.00,"$4,827.00",$0.00,"$3,445.03",$0.00,$0.00,"$3,445.03","$3,445.03",$0.00,"$4,827.00",$0.00,"$2,413.50","$3,822.98","$3,861.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805373,EAP,Custom 27805373,,Target Xl Detachable Coils Helical 5 X 15cm,"$4,290.00",$0.00,"$4,290.00",$0.00,"$3,061.77",$0.00,$0.00,"$3,061.77","$3,061.77",$0.00,"$4,290.00",$0.00,"$2,145.00","$3,397.68","$3,432.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805374,EAP,Custom 27805374,,Target Xl Detachable Coils Helical 6 X 20cm,"$4,290.00",$0.00,"$4,290.00",$0.00,"$3,061.77",$0.00,$0.00,"$3,061.77","$3,061.77",$0.00,"$4,290.00",$0.00,"$2,145.00","$3,397.68","$3,432.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805375,EAP,Custom 27805375,,Target Xl Detachable Coils Helical 7 X 20cm,"$4,290.00",$0.00,"$4,290.00",$0.00,"$3,061.77",$0.00,$0.00,"$3,061.77","$3,061.77",$0.00,"$4,290.00",$0.00,"$2,145.00","$3,397.68","$3,432.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805376,EAP,Custom 27805376,,Target Xl Detachable Coils Helical 8 X 30cm,"$4,290.00",$0.00,"$4,290.00",$0.00,"$3,061.77",$0.00,$0.00,"$3,061.77","$3,061.77",$0.00,"$4,290.00",$0.00,"$2,145.00","$3,397.68","$3,432.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805377,EAP,Custom 27805377,,Target Xl Detachable Coils Helical 9 X 30cm,"$4,290.00",$0.00,"$4,290.00",$0.00,"$3,061.77",$0.00,$0.00,"$3,061.77","$3,061.77",$0.00,"$4,290.00",$0.00,"$2,145.00","$3,397.68","$3,432.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805378,EAP,HCPCS C1781,,"Mesh Surg Craniocurve .6mm Left Prtl Sm Crnm Etch Lbl Antm, 01-9521","$13,300.00",$0.00,"$13,300.00","$5,985.00","$5,158.80",$0.00,"$2,291.52","$5,158.80","$9,492.21","$2,328.72","$13,300.00",$0.00,"$6,650.00","$10,533.60","$10,640.00",$0.00,"$2,081.45",$0.00,"$2,117.36",$0.00
27805379,EAP,HCPCS C1781,,"Mesh Surg Craniocurve .6mm Right Prtl Sm Crnm Etch Lbl Antm, 01-9522","$13,300.00",$0.00,"$13,300.00","$5,985.00","$5,158.80",$0.00,"$2,291.52","$5,158.80","$9,492.21","$2,328.72","$13,300.00",$0.00,"$6,650.00","$10,533.60","$10,640.00",$0.00,"$2,081.45",$0.00,"$2,117.36",$0.00
27805380,EAP,HCPCS C1781,,"Mesh Surg Craniocurve .6mm Left Prtl Lg Crnm Etch Lbl Antm, 01-9523","$14,777.00",$0.00,"$14,777.00","$6,649.65","$5,158.80",$0.00,"$2,546.00","$5,158.80","$10,546.34","$2,587.33","$14,777.00",$0.00,"$7,388.50","$11,703.38","$11,821.60",$0.00,"$2,312.60",$0.00,"$2,352.50",$0.00
27805381,EAP,HCPCS C1781,,"Mesh Surg Craniocurve .6mm Right Prtl Lg Crnm Etch Lbl Antm, 01-9524","$14,777.00",$0.00,"$14,777.00","$6,649.65","$5,158.80",$0.00,"$2,546.00","$5,158.80","$10,546.34","$2,587.33","$14,777.00",$0.00,"$7,388.50","$11,703.38","$11,821.60",$0.00,"$2,312.60",$0.00,"$2,352.50",$0.00
27805382,EAP,HCPCS C1876,,Protege Everflex Stent 6x40x120,"$3,990.00",$0.00,"$3,990.00","$1,795.50","$2,847.66",$0.00,$687.46,"$2,847.66","$2,847.66",$698.62,"$3,990.00",$0.00,"$1,995.00","$3,160.08","$3,192.00",$0.00,$624.44,$0.00,$635.21,$0.00
27805383,EAP,HCPCS C1876,,Protege Everflex Stent 6x60x120,"$3,990.00",$0.00,"$3,990.00","$1,795.50","$2,847.66",$0.00,$687.46,"$2,847.66","$2,847.66",$698.62,"$3,990.00",$0.00,"$1,995.00","$3,160.08","$3,192.00",$0.00,$624.44,$0.00,$635.21,$0.00
27805384,EAP,HCPCS C1876,,Protege Everflex Stent 6x80x120,"$3,990.00",$0.00,"$3,990.00","$1,795.50","$2,847.66",$0.00,$687.46,"$2,847.66","$2,847.66",$698.62,"$3,990.00",$0.00,"$1,995.00","$3,160.08","$3,192.00",$0.00,$624.44,$0.00,$635.21,$0.00
27805385,EAP,HCPCS C1876,,Protege Everflex Stent 8x40x120,"$3,990.00",$0.00,"$3,990.00","$1,795.50","$2,847.66",$0.00,$687.46,"$2,847.66","$2,847.66",$698.62,"$3,990.00",$0.00,"$1,995.00","$3,160.08","$3,192.00",$0.00,$624.44,$0.00,$635.21,$0.00
27805386,EAP,HCPCS C1876,,Protege Everflex Stent 8x60x120,"$3,990.00",$0.00,"$3,990.00","$1,795.50","$2,847.66",$0.00,$687.46,"$2,847.66","$2,847.66",$698.62,"$3,990.00",$0.00,"$1,995.00","$3,160.08","$3,192.00",$0.00,$624.44,$0.00,$635.21,$0.00
27805387,EAP,HCPCS C1876,,Protege Everflex Stent 8x80x120,"$3,990.00",$0.00,"$3,990.00","$1,795.50","$2,847.66",$0.00,$687.46,"$2,847.66","$2,847.66",$698.62,"$3,990.00",$0.00,"$1,995.00","$3,160.08","$3,192.00",$0.00,$624.44,$0.00,$635.21,$0.00
27805388,EAP,HCPCS C1876,,Protege Stent 10x40x120,"$3,990.00",$0.00,"$3,990.00","$1,795.50","$2,847.66",$0.00,$687.46,"$2,847.66","$2,847.66",$698.62,"$3,990.00",$0.00,"$1,995.00","$3,160.08","$3,192.00",$0.00,$624.44,$0.00,$635.21,$0.00
27805389,EAP,HCPCS C1876,,Protege Stent 10x60x120,"$3,990.00",$0.00,"$3,990.00","$1,795.50","$2,847.66",$0.00,$687.46,"$2,847.66","$2,847.66",$698.62,"$3,990.00",$0.00,"$1,995.00","$3,160.08","$3,192.00",$0.00,$624.44,$0.00,$635.21,$0.00
27805390,EAP,HCPCS C1876,,Protege Stent 12x40x80,"$3,990.00",$0.00,"$3,990.00","$1,795.50","$2,847.66",$0.00,$687.46,"$2,847.66","$2,847.66",$698.62,"$3,990.00",$0.00,"$1,995.00","$3,160.08","$3,192.00",$0.00,$624.44,$0.00,$635.21,$0.00
27805391,EAP,HCPCS C1876,,Protege Stent 12x60x80,"$3,990.00",$0.00,"$3,990.00","$1,795.50","$2,847.66",$0.00,$687.46,"$2,847.66","$2,847.66",$698.62,"$3,990.00",$0.00,"$1,995.00","$3,160.08","$3,192.00",$0.00,$624.44,$0.00,$635.21,$0.00
27805392,EAP,HCPCS C1876,,Protege Stent 14x40x80,"$3,990.00",$0.00,"$3,990.00","$1,795.50","$2,847.66",$0.00,$687.46,"$2,847.66","$2,847.66",$698.62,"$3,990.00",$0.00,"$1,995.00","$3,160.08","$3,192.00",$0.00,$624.44,$0.00,$635.21,$0.00
27805393,EAP,HCPCS C1876,,Protege Stent 14x80x80,"$3,990.00",$0.00,"$3,990.00","$1,795.50","$2,847.66",$0.00,$687.46,"$2,847.66","$2,847.66",$698.62,"$3,990.00",$0.00,"$1,995.00","$3,160.08","$3,192.00",$0.00,$624.44,$0.00,$635.21,$0.00
27805394,EAP,HCPCS C1876,,Protege Everflex Stent 6x150x120,"$5,319.00",$0.00,"$5,319.00","$2,393.55","$3,796.17",$0.00,$916.44,"$3,796.17","$3,796.17",$931.31,"$5,319.00",$0.00,"$2,659.50","$4,212.65","$4,255.20",$0.00,$832.42,$0.00,$846.78,$0.00
27805395,EAP,HCPCS C1751,,Cath Art 8fr 110cm Td Co Sg Hep,"$1,013.00",$0.00,"$1,013.00",$455.85,$722.98,$0.00,$174.53,$722.98,$722.98,$177.37,"$1,013.00",$0.00,$506.50,$802.30,$810.40,$0.00,$158.53,$0.00,$161.27,$0.00
27805407,EAP,HCPCS C1876,,Stent Duodenal Wallflex .035 In L9 Cm L230 Cm Od22-27 Mm,"$7,537.00",$0.00,"$7,537.00","$3,391.65","$5,158.80",$0.00,"$1,298.59","$5,158.80","$5,379.16","$1,319.67","$7,537.00",$0.00,"$3,768.50","$5,969.30","$6,029.60",$0.00,"$1,179.54",$0.00,"$1,199.89",$0.00
27805409,EAP,HCPCS L8699,,Onyx 18 Kit Avm Us,"$6,984.00",$0.00,"$6,984.00",$0.00,"$4,984.48",$0.00,$0.00,"$4,984.48","$4,984.48",$0.00,"$6,984.00",$0.00,"$3,492.00","$5,531.33","$5,587.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805410,EAP,HCPCS L8699,,Onyx 34 Kit Avm Us,"$6,651.00",$0.00,"$6,651.00",$0.00,"$4,746.82",$0.00,$0.00,"$4,746.82","$4,746.82",$0.00,"$6,651.00",$0.00,"$3,325.50","$5,267.59","$5,320.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805412,EAP,HCPCS C1874,,Stent Bil 8mm 8.5fr 60mm Flly Covered Trnshep Wallflex,"$7,978.00",$0.00,"$7,978.00","$3,590.10","$5,158.80",$0.00,"$1,374.57","$5,158.80","$5,693.90","$1,396.88","$7,978.00",$0.00,"$3,989.00","$6,318.58","$6,382.40",$0.00,"$1,248.56",$0.00,"$1,270.10",$0.00
27805413,EAP,HCPCS C1874,,Stent Bil 8mm 8.5fr 80mm Flly Covered Trnshep Wallflex,"$7,978.00",$0.00,"$7,978.00","$3,590.10","$5,158.80",$0.00,"$1,374.57","$5,158.80","$5,693.90","$1,396.88","$7,978.00",$0.00,"$3,989.00","$6,318.58","$6,382.40",$0.00,"$1,248.56",$0.00,"$1,270.10",$0.00
27805414,EAP,HCPCS C1874,,Stent Bil 10mm 8.5fr 40mm Flly Covered Trnshep Wallflex,"$7,978.00",$0.00,"$7,978.00","$3,590.10","$5,158.80",$0.00,"$1,374.57","$5,158.80","$5,693.90","$1,396.88","$7,978.00",$0.00,"$3,989.00","$6,318.58","$6,382.40",$0.00,"$1,248.56",$0.00,"$1,270.10",$0.00
27805415,EAP,HCPCS C1876,,Stent Bil 10mm 8.5fr 60mm Flly Covered Trnshep Wallflex,"$7,978.00",$0.00,"$7,978.00","$3,590.10","$5,158.80",$0.00,"$1,374.57","$5,158.80","$5,693.90","$1,396.88","$7,978.00",$0.00,"$3,989.00","$6,318.58","$6,382.40",$0.00,"$1,248.56",$0.00,"$1,270.10",$0.00
27805416,EAP,HCPCS C1876,,Stent Bil 10mm 8.5fr 80mm Flly Covered Trnshep Wallflex,"$7,978.00",$0.00,"$7,978.00","$3,590.10","$5,158.80",$0.00,"$1,374.57","$5,158.80","$5,693.90","$1,396.88","$7,978.00",$0.00,"$3,989.00","$6,318.58","$6,382.40",$0.00,"$1,248.56",$0.00,"$1,270.10",$0.00
27805417,EAP,HCPCS C1876,,Stent Bil 10mm 80mm Uncvr Wallflex,"$5,395.00",$0.00,"$5,395.00","$2,427.75","$3,850.41",$0.00,$929.53,"$3,850.41","$3,850.41",$944.62,"$5,395.00",$0.00,"$2,697.50","$4,272.84","$4,316.00",$0.00,$844.32,$0.00,$858.88,$0.00
27805418,EAP,HCPCS C1876,,Stent Bil 80mm 60mm Uncvr Wallflex,"$5,395.00",$0.00,"$5,395.00","$2,427.75","$3,850.41",$0.00,$929.53,"$3,850.41","$3,850.41",$944.62,"$5,395.00",$0.00,"$2,697.50","$4,272.84","$4,316.00",$0.00,$844.32,$0.00,$858.88,$0.00
27805419,EAP,HCPCS C1876,,Stent Bil 80mm 80mm Uncvr Wallflex,"$5,395.00",$0.00,"$5,395.00","$2,427.75","$3,850.41",$0.00,$929.53,"$3,850.41","$3,850.41",$944.62,"$5,395.00",$0.00,"$2,697.50","$4,272.84","$4,316.00",$0.00,$844.32,$0.00,$858.88,$0.00
27805420,EAP,HCPCS C1876,,Stent Bil 80mm 10mm Uncvr Wallflex,"$5,395.00",$0.00,"$5,395.00","$2,427.75","$3,850.41",$0.00,$929.53,"$3,850.41","$3,850.41",$944.62,"$5,395.00",$0.00,"$2,697.50","$4,272.84","$4,316.00",$0.00,$844.32,$0.00,$858.88,$0.00
27805421,EAP,HCPCS C1876,,Stent Bil 10mm 80mm Uncvr Wallflex,"$5,395.00",$0.00,"$5,395.00","$2,427.75","$3,850.41",$0.00,$929.53,"$3,850.41","$3,850.41",$944.62,"$5,395.00",$0.00,"$2,697.50","$4,272.84","$4,316.00",$0.00,$844.32,$0.00,$858.88,$0.00
27805422,EAP,HCPCS C1876,,Stent Bil 10mm 10mm Uncvr Wallflex,"$5,395.00",$0.00,"$5,395.00","$2,427.75","$3,850.41",$0.00,$929.53,"$3,850.41","$3,850.41",$944.62,"$5,395.00",$0.00,"$2,697.50","$4,272.84","$4,316.00",$0.00,$844.32,$0.00,$858.88,$0.00
27805423,EAP,HCPCS C1876,,Stent Bil 10mm 40mm Uncvr Wallflex,"$5,395.00",$0.00,"$5,395.00","$2,427.75","$3,850.41",$0.00,$929.53,"$3,850.41","$3,850.41",$944.62,"$5,395.00",$0.00,"$2,697.50","$4,272.84","$4,316.00",$0.00,$844.32,$0.00,$858.88,$0.00
27805424,EAP,HCPCS C1876,,Stent Bil 10mm 60mm Uncvr Wallflex,"$5,395.00",$0.00,"$5,395.00","$2,427.75","$3,850.41",$0.00,$929.53,"$3,850.41","$3,850.41",$944.62,"$5,395.00",$0.00,"$2,697.50","$4,272.84","$4,316.00",$0.00,$844.32,$0.00,$858.88,$0.00
27805431,EAP,Custom 27805431,,Pipeline  Embolization  Device  3.00mm X 25mm,"$38,029.00",$0.00,"$38,029.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$27,141.30",$0.00,"$38,029.00",$0.00,"$19,014.50","$30,118.97","$30,423.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805432,EAP,Custom 27805432,,Bowtie Shape - 10g Mammomark - Biopsy Site Identtfier,$689.00,$0.00,$689.00,$0.00,$491.74,$0.00,$0.00,$491.74,$491.74,$0.00,$689.00,$0.00,$344.50,$545.69,$551.20,$0.00,$0.00,$0.00,$0.00,$0.00
27805437,EAP, C1817,,Amplatzer Septal Occluder 20 Mm,"$16,714.00",$0.00,"$16,714.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$11,928.78",$0.00,"$16,714.00",$0.00,"$8,357.00","$13,237.49","$13,371.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805438,EAP, C1817,,Amplatzer Septal Occluder 22 Mm,"$16,714.00",$0.00,"$16,714.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$11,928.78",$0.00,"$16,714.00",$0.00,"$8,357.00","$13,237.49","$13,371.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805439,EAP,HCPCS C1817,,Amplatzer Septal Occluder 24 Mm,"$16,714.00",$0.00,"$16,714.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$11,928.78",$0.00,"$16,714.00",$0.00,"$8,357.00","$13,237.49","$13,371.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805440,EAP,CPT® C1817,,Amplatzer Septal Occluder 26 Mm,"$16,714.00",$0.00,"$16,714.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$11,928.78",$0.00,"$16,714.00",$0.00,"$8,357.00","$13,237.49","$13,371.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805441,EAP,CPT® C1896,,Q-trak Electrode,"$13,779.00",$0.00,"$13,779.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,834.07",$0.00,"$13,779.00",$0.00,"$6,889.50","$10,912.97","$11,023.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805442,EAP,HCPCS C1781,,Occluder Septal 15mm,"$18,552.00",$0.00,"$18,552.00","$8,348.40","$5,158.80",$0.00,"$3,196.42","$5,158.80","$13,240.56","$3,248.31","$18,552.00",$0.00,"$9,276.00","$14,693.18","$14,841.60",$0.00,"$2,903.39",$0.00,"$2,953.48",$0.00
27805443,EAP,HCPCS C1781,,Occluder Septal 20mm,"$18,552.00",$0.00,"$18,552.00","$8,348.40","$5,158.80",$0.00,"$3,196.42","$5,158.80","$13,240.56","$3,248.31","$18,552.00",$0.00,"$9,276.00","$14,693.18","$14,841.60",$0.00,"$2,903.39",$0.00,"$2,953.48",$0.00
27805444,EAP,HCPCS C1781,,Occluder Septal 25mm,"$18,552.00",$0.00,"$18,552.00","$8,348.40","$5,158.80",$0.00,"$3,196.42","$5,158.80","$13,240.56","$3,248.31","$18,552.00",$0.00,"$9,276.00","$14,693.18","$14,841.60",$0.00,"$2,903.39",$0.00,"$2,953.48",$0.00
27805445,EAP,HCPCS C1781,,Occluder Septal 30mm,"$18,552.00",$0.00,"$18,552.00","$8,348.40","$5,158.80",$0.00,"$3,196.42","$5,158.80","$13,240.56","$3,248.31","$18,552.00",$0.00,"$9,276.00","$14,693.18","$14,841.60",$0.00,"$2,903.39",$0.00,"$2,953.48",$0.00
27805446,EAP,HCPCS C1781,,Occluder Septal 35mm,"$18,552.00",$0.00,"$18,552.00","$8,348.40","$5,158.80",$0.00,"$3,196.42","$5,158.80","$13,240.56","$3,248.31","$18,552.00",$0.00,"$9,276.00","$14,693.18","$14,841.60",$0.00,"$2,903.39",$0.00,"$2,953.48",$0.00
27805447,EAP,Custom 27805447,,Pipeline  Embolization  Device  3.00mm X 30mm,"$38,029.00",$0.00,"$38,029.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$27,141.30",$0.00,"$38,029.00",$0.00,"$19,014.50","$30,118.97","$30,423.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805448,EAP,Custom 27805448,,Pipeline  Embolization  Device  3.00mm X 35mm,"$38,029.00",$0.00,"$38,029.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$27,141.30",$0.00,"$38,029.00",$0.00,"$19,014.50","$30,118.97","$30,423.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805449,EAP,Custom 27805449,,Pipeline  Embolization  Device  3.25mm X 25mm,"$38,029.00",$0.00,"$38,029.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$27,141.30",$0.00,"$38,029.00",$0.00,"$19,014.50","$30,118.97","$30,423.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805450,EAP,Custom 27805450,,Pipeline  Embolization  Device  3.25mm X 30mm,"$38,029.00",$0.00,"$38,029.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$27,141.30",$0.00,"$38,029.00",$0.00,"$19,014.50","$30,118.97","$30,423.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805451,EAP,Custom 27805451,,Pipeline  Embolization  Device  3.25mm X 35mm,"$38,029.00",$0.00,"$38,029.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$27,141.30",$0.00,"$38,029.00",$0.00,"$19,014.50","$30,118.97","$30,423.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805452,EAP,Custom 27805452,,Pipeline  Embolization  Device  3.50mm X 25mm,"$38,029.00",$0.00,"$38,029.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$27,141.30",$0.00,"$38,029.00",$0.00,"$19,014.50","$30,118.97","$30,423.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805453,EAP,Custom 27805453,,Pipeline  Embolization  Device  3.50mm X 30mm,"$38,029.00",$0.00,"$38,029.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$27,141.30",$0.00,"$38,029.00",$0.00,"$19,014.50","$30,118.97","$30,423.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805454,EAP,Custom 27805454,,Pipeline  Embolization  Device  3.50mm X 35mm,"$38,029.00",$0.00,"$38,029.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$27,141.30",$0.00,"$38,029.00",$0.00,"$19,014.50","$30,118.97","$30,423.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805455,EAP,Custom 27805455,,Pipeline  Embolization  Device  3.75mm X 25mm,"$38,029.00",$0.00,"$38,029.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$27,141.30",$0.00,"$38,029.00",$0.00,"$19,014.50","$30,118.97","$30,423.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805456,EAP,Custom 27805456,,Pipeline  Embolization  Device  3.75mm X 30mm,"$38,029.00",$0.00,"$38,029.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$27,141.30",$0.00,"$38,029.00",$0.00,"$19,014.50","$30,118.97","$30,423.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805457,EAP,Custom 27805457,,Pipeline  Embolization  Device  3.75mm X 35mm,"$38,029.00",$0.00,"$38,029.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$27,141.30",$0.00,"$38,029.00",$0.00,"$19,014.50","$30,118.97","$30,423.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805458,EAP,Custom 27805458,,Pipeline  Embolization  Device  4.00mm X 25mm,"$38,029.00",$0.00,"$38,029.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$27,141.30",$0.00,"$38,029.00",$0.00,"$19,014.50","$30,118.97","$30,423.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805459,EAP,Custom 27805459,,Pipeline  Embolization  Device  4.00mm X 30mm,"$38,029.00",$0.00,"$38,029.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$27,141.30",$0.00,"$38,029.00",$0.00,"$19,014.50","$30,118.97","$30,423.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805460,EAP,Custom 27805460,,Pipeline  Embolization  Device  4.00mm X 35mm,"$38,029.00",$0.00,"$38,029.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$27,141.30",$0.00,"$38,029.00",$0.00,"$19,014.50","$30,118.97","$30,423.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805461,EAP,Custom 27805461,,Pipeline  Embolization  Device  4.25mm X 25mm,"$38,029.00",$0.00,"$38,029.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$27,141.30",$0.00,"$38,029.00",$0.00,"$19,014.50","$30,118.97","$30,423.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805462,EAP,Custom 27805462,,Pipeline  Embolization  Device  4.25mm X 30mm,"$38,029.00",$0.00,"$38,029.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$27,141.30",$0.00,"$38,029.00",$0.00,"$19,014.50","$30,118.97","$30,423.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805463,EAP,Custom 27805463,,Pipeline  Embolization  Device  4.25mm X 35mm,"$38,029.00",$0.00,"$38,029.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$27,141.30",$0.00,"$38,029.00",$0.00,"$19,014.50","$30,118.97","$30,423.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805464,EAP,Custom 27805464,,Pipeline  Embolization  Device  4.50mm X 25mm,"$38,029.00",$0.00,"$38,029.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$27,141.30",$0.00,"$38,029.00",$0.00,"$19,014.50","$30,118.97","$30,423.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805465,EAP,Custom 27805465,,Pipeline  Embolization  Device  4.50mm X 30mm,"$38,029.00",$0.00,"$38,029.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$27,141.30",$0.00,"$38,029.00",$0.00,"$19,014.50","$30,118.97","$30,423.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805466,EAP,Custom 27805466,,Pipeline  Embolization  Device  4.50mm X 35mm,"$38,029.00",$0.00,"$38,029.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$27,141.30",$0.00,"$38,029.00",$0.00,"$19,014.50","$30,118.97","$30,423.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805467,EAP,Custom 27805467,,Pipeline  Embolization  Device  4.75mm X 25mm,"$38,029.00",$0.00,"$38,029.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$27,141.30",$0.00,"$38,029.00",$0.00,"$19,014.50","$30,118.97","$30,423.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805468,EAP,Custom 27805468,,Pipeline  Embolization  Device  4.75mm X 30mm,"$38,029.00",$0.00,"$38,029.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$27,141.30",$0.00,"$38,029.00",$0.00,"$19,014.50","$30,118.97","$30,423.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805469,EAP,Custom 27805469,,Pipeline  Embolization  Device  4.75mm X 35mm,"$38,029.00",$0.00,"$38,029.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$27,141.30",$0.00,"$38,029.00",$0.00,"$19,014.50","$30,118.97","$30,423.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805470,EAP,Custom 27805470,,Pipeline  Embolization  Device  5.00mm X 25mm,"$38,029.00",$0.00,"$38,029.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$27,141.30",$0.00,"$38,029.00",$0.00,"$19,014.50","$30,118.97","$30,423.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805471,EAP,Custom 27805471,,Pipeline  Embolization  Device  5.00mm X 30mm,"$38,029.00",$0.00,"$38,029.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$27,141.30",$0.00,"$38,029.00",$0.00,"$19,014.50","$30,118.97","$30,423.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805472,EAP,Custom 27805472,,Pipeline  Embolization  Device  5.00mm X 35mm,"$38,029.00",$0.00,"$38,029.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$27,141.30",$0.00,"$38,029.00",$0.00,"$19,014.50","$30,118.97","$30,423.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805473,EAP,Custom 27805473,,Pipeline  Embolization  Device  2.50mm X 10mm,"$35,550.00",$0.00,"$35,550.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,372.04",$0.00,"$35,550.00",$0.00,"$17,775.00","$28,155.60","$28,440.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805474,EAP,Custom 27805474,,Pipeline  Embolization  Device  2.50mm X 12mm,"$35,550.00",$0.00,"$35,550.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,372.04",$0.00,"$35,550.00",$0.00,"$17,775.00","$28,155.60","$28,440.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805475,EAP,Custom 27805475,,Pipeline  Embolization  Device  2.50mm X 14mm,"$35,550.00",$0.00,"$35,550.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,372.04",$0.00,"$35,550.00",$0.00,"$17,775.00","$28,155.60","$28,440.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805476,EAP,Custom 27805476,,Pipeline  Embolization  Device  2.50mm X 16mm,"$35,550.00",$0.00,"$35,550.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,372.04",$0.00,"$35,550.00",$0.00,"$17,775.00","$28,155.60","$28,440.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805477,EAP,Custom 27805477,,Pipeline  Embolization  Device  2.50mm X 18mm,"$35,550.00",$0.00,"$35,550.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,372.04",$0.00,"$35,550.00",$0.00,"$17,775.00","$28,155.60","$28,440.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805478,EAP,Custom 27805478,,Pipeline  Embolization  Device  2.50mm X 20mm,"$35,550.00",$0.00,"$35,550.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,372.04",$0.00,"$35,550.00",$0.00,"$17,775.00","$28,155.60","$28,440.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805479,EAP,Custom 27805479,,Pipeline  Embolization  Device  2.75mm X 14mm,"$35,550.00",$0.00,"$35,550.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,372.04",$0.00,"$35,550.00",$0.00,"$17,775.00","$28,155.60","$28,440.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805480,EAP,Custom 27805480,,Pipeline  Embolization  Device  2.75mm X 18mm,"$35,550.00",$0.00,"$35,550.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,372.04",$0.00,"$35,550.00",$0.00,"$17,775.00","$28,155.60","$28,440.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805481,EAP,Custom 27805481,,Pipeline  Embolization  Device  2.75mm X 20mm,"$35,550.00",$0.00,"$35,550.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,372.04",$0.00,"$35,550.00",$0.00,"$17,775.00","$28,155.60","$28,440.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805482,EAP,Custom 27805482,,Pipeline  Embolization  Device  3.00mm X 14mm,"$35,550.00",$0.00,"$35,550.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,372.04",$0.00,"$35,550.00",$0.00,"$17,775.00","$28,155.60","$28,440.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805483,EAP,Custom 27805483,,Pipeline  Embolization  Device  3.00mm X 18mm,"$35,550.00",$0.00,"$35,550.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,372.04",$0.00,"$35,550.00",$0.00,"$17,775.00","$28,155.60","$28,440.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805484,EAP,Custom 27805484,,Pipeline  Embolization  Device  3.00mm X 20mm,"$35,550.00",$0.00,"$35,550.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,372.04",$0.00,"$35,550.00",$0.00,"$17,775.00","$28,155.60","$28,440.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805485,EAP,Custom 27805485,,Pipeline  Embolization  Device  3.25mm X 10mm,"$35,550.00",$0.00,"$35,550.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,372.04",$0.00,"$35,550.00",$0.00,"$17,775.00","$28,155.60","$28,440.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805486,EAP,Custom 27805486,,Pipeline  Embolization  Device  3.25mm X 12mm,"$35,550.00",$0.00,"$35,550.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,372.04",$0.00,"$35,550.00",$0.00,"$17,775.00","$28,155.60","$28,440.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805487,EAP,Custom 27805487,,Pipeline  Embolization  Device  3.25mm X 14mm,"$35,550.00",$0.00,"$35,550.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,372.04",$0.00,"$35,550.00",$0.00,"$17,775.00","$28,155.60","$28,440.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805488,EAP,Custom 27805488,,Pipeline  Embolization  Device  3.25mm X 16mm,"$35,550.00",$0.00,"$35,550.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,372.04",$0.00,"$35,550.00",$0.00,"$17,775.00","$28,155.60","$28,440.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805489,EAP,Custom 27805489,,Pipeline  Embolization  Device  3.25mm X 18mm,"$35,550.00",$0.00,"$35,550.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,372.04",$0.00,"$35,550.00",$0.00,"$17,775.00","$28,155.60","$28,440.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805490,EAP,Custom 27805490,,Pipeline  Embolization  Device  3.25mm X 20mm,"$35,550.00",$0.00,"$35,550.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,372.04",$0.00,"$35,550.00",$0.00,"$17,775.00","$28,155.60","$28,440.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805491,EAP,Custom 27805491,,Pipeline  Embolization  Device  3.50mm X 14mm,"$35,550.00",$0.00,"$35,550.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,372.04",$0.00,"$35,550.00",$0.00,"$17,775.00","$28,155.60","$28,440.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805492,EAP,Custom 27805492,,Pipeline  Embolization  Device  3.50mm X 18mm,"$35,550.00",$0.00,"$35,550.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,372.04",$0.00,"$35,550.00",$0.00,"$17,775.00","$28,155.60","$28,440.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805493,EAP,Custom 27805493,,Pipeline  Embolization  Device  3.50mm X 20mm,"$35,550.00",$0.00,"$35,550.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,372.04",$0.00,"$35,550.00",$0.00,"$17,775.00","$28,155.60","$28,440.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805494,EAP,Custom 27805494,,Pipeline  Embolization  Device  3.75mm X 10mm,"$35,550.00",$0.00,"$35,550.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,372.04",$0.00,"$35,550.00",$0.00,"$17,775.00","$28,155.60","$28,440.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805495,EAP,Custom 27805495,,Pipeline  Embolization  Device  3.75mm X 12mm,"$35,550.00",$0.00,"$35,550.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,372.04",$0.00,"$35,550.00",$0.00,"$17,775.00","$28,155.60","$28,440.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805496,EAP,Custom 27805496,,Pipeline  Embolization  Device  3.75mm X 14mm,"$35,550.00",$0.00,"$35,550.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,372.04",$0.00,"$35,550.00",$0.00,"$17,775.00","$28,155.60","$28,440.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805497,EAP,Custom 27805497,,Pipeline  Embolization  Device  3.75mm X 16mm,"$35,550.00",$0.00,"$35,550.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,372.04",$0.00,"$35,550.00",$0.00,"$17,775.00","$28,155.60","$28,440.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805498,EAP,Custom 27805498,,Pipeline  Embolization  Device  3.75mm X 18mm,"$35,550.00",$0.00,"$35,550.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,372.04",$0.00,"$35,550.00",$0.00,"$17,775.00","$28,155.60","$28,440.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805499,EAP,Custom 27805499,,Pipeline  Embolization  Device  3.75mm X 20mm,"$35,550.00",$0.00,"$35,550.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,372.04",$0.00,"$35,550.00",$0.00,"$17,775.00","$28,155.60","$28,440.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805500,EAP,Custom 27805500,,Pipeline  Embolization  Device  4.00mm X 10mm,"$35,550.00",$0.00,"$35,550.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,372.04",$0.00,"$35,550.00",$0.00,"$17,775.00","$28,155.60","$28,440.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805501,EAP,Custom 27805501,,Pipeline  Embolization  Device  4.00mm X 12mm,"$35,550.00",$0.00,"$35,550.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,372.04",$0.00,"$35,550.00",$0.00,"$17,775.00","$28,155.60","$28,440.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805502,EAP,Custom 27805502,,Pipeline  Embolization  Device  4.00mm X 14mm,"$35,550.00",$0.00,"$35,550.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,372.04",$0.00,"$35,550.00",$0.00,"$17,775.00","$28,155.60","$28,440.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805503,EAP,Custom 27805503,,Pipeline  Embolization  Device  4.00mm X 16mm,"$35,550.00",$0.00,"$35,550.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,372.04",$0.00,"$35,550.00",$0.00,"$17,775.00","$28,155.60","$28,440.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805504,EAP,Custom 27805504,,Pipeline  Embolization  Device  4.00mm X 18mm,"$35,550.00",$0.00,"$35,550.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,372.04",$0.00,"$35,550.00",$0.00,"$17,775.00","$28,155.60","$28,440.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805505,EAP,Custom 27805505,,Pipeline  Embolization  Device  4.00mm X 20mm,"$35,550.00",$0.00,"$35,550.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,372.04",$0.00,"$35,550.00",$0.00,"$17,775.00","$28,155.60","$28,440.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805506,EAP,Custom 27805506,,Pipeline  Embolization  Device  4.25mm X 10mm,"$35,550.00",$0.00,"$35,550.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,372.04",$0.00,"$35,550.00",$0.00,"$17,775.00","$28,155.60","$28,440.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805507,EAP,Custom 27805507,,Pipeline  Embolization  Device  4.25mm X 12mm,"$35,550.00",$0.00,"$35,550.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,372.04",$0.00,"$35,550.00",$0.00,"$17,775.00","$28,155.60","$28,440.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805508,EAP,Custom 27805508,,Pipeline  Embolization  Device  4.25mm X 14mm,"$35,550.00",$0.00,"$35,550.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,372.04",$0.00,"$35,550.00",$0.00,"$17,775.00","$28,155.60","$28,440.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805509,EAP,Custom 27805509,,Pipeline  Embolization  Device  4.25mm X 16mm,"$35,550.00",$0.00,"$35,550.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,372.04",$0.00,"$35,550.00",$0.00,"$17,775.00","$28,155.60","$28,440.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805510,EAP,Custom 27805510,,Pipeline  Embolization  Device  4.25mm X 18mm,"$35,550.00",$0.00,"$35,550.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,372.04",$0.00,"$35,550.00",$0.00,"$17,775.00","$28,155.60","$28,440.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805511,EAP,Custom 27805511,,Pipeline  Embolization  Device  4.25mm X 20mm,"$35,550.00",$0.00,"$35,550.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,372.04",$0.00,"$35,550.00",$0.00,"$17,775.00","$28,155.60","$28,440.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805512,EAP,Custom 27805512,,Pipeline  Embolization  Device  4.50mm X 10mm,"$35,550.00",$0.00,"$35,550.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,372.04",$0.00,"$35,550.00",$0.00,"$17,775.00","$28,155.60","$28,440.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805513,EAP,Custom 27805513,,Pipeline  Embolization  Device  4.50mm X 12mm,"$35,550.00",$0.00,"$35,550.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,372.04",$0.00,"$35,550.00",$0.00,"$17,775.00","$28,155.60","$28,440.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805514,EAP,Custom 27805514,,Pipeline  Embolization  Device  4.50mm X 14mm,"$35,550.00",$0.00,"$35,550.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,372.04",$0.00,"$35,550.00",$0.00,"$17,775.00","$28,155.60","$28,440.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805515,EAP,Custom 27805515,,Pipeline  Embolization  Device  4.50mm X 16mm,"$35,550.00",$0.00,"$35,550.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,372.04",$0.00,"$35,550.00",$0.00,"$17,775.00","$28,155.60","$28,440.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805516,EAP,Custom 27805516,,Pipeline  Embolization  Device  4.50mm X 18mm,"$35,550.00",$0.00,"$35,550.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,372.04",$0.00,"$35,550.00",$0.00,"$17,775.00","$28,155.60","$28,440.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805517,EAP,Custom 27805517,,Pipeline  Embolization  Device  4.50mm X 20mm,"$35,550.00",$0.00,"$35,550.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,372.04",$0.00,"$35,550.00",$0.00,"$17,775.00","$28,155.60","$28,440.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805518,EAP,Custom 27805518,,Pipeline  Embolization  Device  4.75mm X 10mm,"$35,550.00",$0.00,"$35,550.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,372.04",$0.00,"$35,550.00",$0.00,"$17,775.00","$28,155.60","$28,440.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805519,EAP,Custom 27805519,,Pipeline  Embolization  Device  4.75mm X 12mm,"$35,550.00",$0.00,"$35,550.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,372.04",$0.00,"$35,550.00",$0.00,"$17,775.00","$28,155.60","$28,440.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805520,EAP,Custom 27805520,,Pipeline  Embolization  Device  4.75mm X 14mm,"$35,550.00",$0.00,"$35,550.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,372.04",$0.00,"$35,550.00",$0.00,"$17,775.00","$28,155.60","$28,440.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805521,EAP,Custom 27805521,,Pipeline  Embolization  Device  4.75mm X 16mm,"$35,550.00",$0.00,"$35,550.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,372.04",$0.00,"$35,550.00",$0.00,"$17,775.00","$28,155.60","$28,440.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805522,EAP,Custom 27805522,,Pipeline  Embolization  Device  4.75mm X 18mm,"$35,550.00",$0.00,"$35,550.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,372.04",$0.00,"$35,550.00",$0.00,"$17,775.00","$28,155.60","$28,440.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805523,EAP,Custom 27805523,,Pipeline  Embolization  Device  4.75mm X 20mm,"$35,550.00",$0.00,"$35,550.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,372.04",$0.00,"$35,550.00",$0.00,"$17,775.00","$28,155.60","$28,440.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805524,EAP,Custom 27805524,,Pipeline  Embolization  Device  5.00mm X 10mm,"$35,550.00",$0.00,"$35,550.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,372.04",$0.00,"$35,550.00",$0.00,"$17,775.00","$28,155.60","$28,440.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805525,EAP,Custom 27805525,,Pipeline  Embolization  Device  5.00mm X 12mm,"$35,550.00",$0.00,"$35,550.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,372.04",$0.00,"$35,550.00",$0.00,"$17,775.00","$28,155.60","$28,440.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805526,EAP,Custom 27805526,,Pipeline  Embolization  Device  5.00mm X 14mm,"$35,550.00",$0.00,"$35,550.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,372.04",$0.00,"$35,550.00",$0.00,"$17,775.00","$28,155.60","$28,440.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805527,EAP,Custom 27805527,,Pipeline  Embolization  Device  5.00mm X 16mm,"$35,550.00",$0.00,"$35,550.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,372.04",$0.00,"$35,550.00",$0.00,"$17,775.00","$28,155.60","$28,440.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805528,EAP,Custom 27805528,,Pipeline  Embolization  Device  5.00mm X 18mm,"$35,550.00",$0.00,"$35,550.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,372.04",$0.00,"$35,550.00",$0.00,"$17,775.00","$28,155.60","$28,440.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805529,EAP,Custom 27805529,,Pipeline  Embolization  Device  5.00mm X 20mm,"$35,550.00",$0.00,"$35,550.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,372.04",$0.00,"$35,550.00",$0.00,"$17,775.00","$28,155.60","$28,440.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805530,EAP,HCPCS C1876,,Stent Coron 4mm 18mm .014in Rapex Flxb Lp Mtlnk Vsn Cocr,$717.00,$0.00,$717.00,$322.65,$511.72,$0.00,$123.54,$511.72,$511.72,$125.54,$717.00,$0.00,$358.50,$567.86,$573.60,$0.00,$112.21,$0.00,$114.15,$0.00
27805531,EAP,HCPCS C1876,,Stent Coron 4mm 28mm .014in Rapex Flxb Lp Mtlnk Vsn Cocr,$717.00,$0.00,$717.00,$322.65,$511.72,$0.00,$123.54,$511.72,$511.72,$125.54,$717.00,$0.00,$358.50,$567.86,$573.60,$0.00,$112.21,$0.00,$114.15,$0.00
27805532,EAP,HCPCS C1874,,Stent Coron 3.5mm 24mm Drg Eluding Endvr Sprnt Zotarolimus,"$1,847.00",$0.00,"$1,847.00",$831.15,"$1,318.20",$0.00,$318.23,"$1,318.20","$1,318.20",$323.39,"$1,847.00",$0.00,$923.50,"$1,462.82","$1,477.60",$0.00,$289.06,$0.00,$294.04,$0.00
27805533,EAP,HCPCS C1874,,Stent Coron 3.5mm 12mm Drg Eluding Endvr Sprnt Zotarolimus,"$1,847.00",$0.00,"$1,847.00",$831.15,"$1,318.20",$0.00,$318.23,"$1,318.20","$1,318.20",$323.39,"$1,847.00",$0.00,$923.50,"$1,462.82","$1,477.60",$0.00,$289.06,$0.00,$294.04,$0.00
27805534,EAP,HCPCS C1874,,Stent Coron 3.5mm 18mm Drg Eluding Endvr Sprnt Zotarolimus,"$1,847.00",$0.00,"$1,847.00",$831.15,"$1,318.20",$0.00,$318.23,"$1,318.20","$1,318.20",$323.39,"$1,847.00",$0.00,$923.50,"$1,462.82","$1,477.60",$0.00,$289.06,$0.00,$294.04,$0.00
27805535,EAP,HCPCS C1874,,Stent Coron 2.5mm 12mm Drg Eluding Endvr Sprnt Zotarolimus,"$1,847.00",$0.00,"$1,847.00",$831.15,"$1,318.20",$0.00,$318.23,"$1,318.20","$1,318.20",$323.39,"$1,847.00",$0.00,$923.50,"$1,462.82","$1,477.60",$0.00,$289.06,$0.00,$294.04,$0.00
27805536,EAP,Custom 27805536,,Coil Target 3d 3mm X 6cm,"$4,502.00",$0.00,"$4,502.00",$0.00,"$3,213.08",$0.00,$0.00,"$3,213.08","$3,213.08",$0.00,"$4,502.00",$0.00,"$2,251.00","$3,565.58","$3,601.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805537,EAP,Custom 27805537,,Coil Target 3d 4mm X 8cm,"$4,502.00",$0.00,"$4,502.00",$0.00,"$3,213.08",$0.00,$0.00,"$3,213.08","$3,213.08",$0.00,"$4,502.00",$0.00,"$2,251.00","$3,565.58","$3,601.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805538,EAP,Custom 27805538,,Coil Target 3d 5mm X 10cm,"$4,502.00",$0.00,"$4,502.00",$0.00,"$3,213.08",$0.00,$0.00,"$3,213.08","$3,213.08",$0.00,"$4,502.00",$0.00,"$2,251.00","$3,565.58","$3,601.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805539,EAP,Custom 27805539,,Coil Target 3d 6mm X 15cm,"$4,502.00",$0.00,"$4,502.00",$0.00,"$3,213.08",$0.00,$0.00,"$3,213.08","$3,213.08",$0.00,"$4,502.00",$0.00,"$2,251.00","$3,565.58","$3,601.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805540,EAP,Custom 27805540,,Coil Target 3d 7mm X 15cm,"$4,502.00",$0.00,"$4,502.00",$0.00,"$3,213.08",$0.00,$0.00,"$3,213.08","$3,213.08",$0.00,"$4,502.00",$0.00,"$2,251.00","$3,565.58","$3,601.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805541,EAP,Custom 27805541,,Coil Target 3d 8mm X 25cm,"$4,502.00",$0.00,"$4,502.00",$0.00,"$3,213.08",$0.00,$0.00,"$3,213.08","$3,213.08",$0.00,"$4,502.00",$0.00,"$2,251.00","$3,565.58","$3,601.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805542,EAP,Custom 27805542,,Coil Target 3d 10mm X 30cm,"$4,502.00",$0.00,"$4,502.00",$0.00,"$3,213.08",$0.00,$0.00,"$3,213.08","$3,213.08",$0.00,"$4,502.00",$0.00,"$2,251.00","$3,565.58","$3,601.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805543,EAP,Custom 27805543,,Coil Embl 10cm 4mm Trgt Dtch Ult 360d,"$4,752.00",$0.00,"$4,752.00",$0.00,"$3,391.50",$0.00,$0.00,"$3,391.50","$3,391.50",$0.00,"$4,752.00",$0.00,"$2,376.00","$3,763.58","$3,801.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805544,EAP,Custom 27805544,,Coil Target 360 Ultra 3.5mm X 8cm,"$5,401.00",$0.00,"$5,401.00",$0.00,"$3,854.69",$0.00,$0.00,"$3,854.69","$3,854.69",$0.00,"$5,401.00",$0.00,"$2,700.50","$4,277.59","$4,320.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805545,EAP,Custom 27805545,,Coil Target 360 Ultra 4.5mm X 10cm,"$5,671.00",$0.00,"$5,671.00",$0.00,"$4,047.39",$0.00,$0.00,"$4,047.39","$4,047.39",$0.00,"$5,671.00",$0.00,"$2,835.50","$4,491.43","$4,536.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805546,EAP,Custom 27805546,,Coil Target 360 Nano 2mm X 3cm,"$5,671.00",$0.00,"$5,671.00",$0.00,"$4,047.39",$0.00,$0.00,"$4,047.39","$4,047.39",$0.00,"$5,671.00",$0.00,"$2,835.50","$4,491.43","$4,536.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805547,EAP,Custom 27805547,,Coil Target 360 Nano 2mm X 4cm,"$5,671.00",$0.00,"$5,671.00",$0.00,"$4,047.39",$0.00,$0.00,"$4,047.39","$4,047.39",$0.00,"$5,671.00",$0.00,"$2,835.50","$4,491.43","$4,536.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805548,EAP,Custom 27805548,,Coil Target 360 Nano 2.5mm X 4cm,"$5,401.00",$0.00,"$5,401.00",$0.00,"$3,854.69",$0.00,$0.00,"$3,854.69","$3,854.69",$0.00,"$5,401.00",$0.00,"$2,700.50","$4,277.59","$4,320.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805549,EAP,Custom 27805549,,Coil Target 360 Nano 3mm X 4cm,"$5,671.00",$0.00,"$5,671.00",$0.00,"$4,047.39",$0.00,$0.00,"$4,047.39","$4,047.39",$0.00,"$5,671.00",$0.00,"$2,835.50","$4,491.43","$4,536.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805550,EAP,Custom 27805550,,Coil Target 360 Nano 3mm X 6cm,"$5,401.00",$0.00,"$5,401.00",$0.00,"$3,854.69",$0.00,$0.00,"$3,854.69","$3,854.69",$0.00,"$5,401.00",$0.00,"$2,700.50","$4,277.59","$4,320.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805551,EAP,Custom 27805551,,Coil Target 360 Nano 3.5mm X 6cm,"$5,671.00",$0.00,"$5,671.00",$0.00,"$4,047.39",$0.00,$0.00,"$4,047.39","$4,047.39",$0.00,"$5,671.00",$0.00,"$2,835.50","$4,491.43","$4,536.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805552,EAP,Custom 27805552,,Sensation Plus 40cc Iab 7.5,"$3,004.00",$0.00,"$3,004.00",$0.00,"$2,143.95",$0.00,$0.00,"$2,143.95","$2,143.95",$0.00,"$3,004.00",$0.00,"$1,502.00","$2,379.17","$2,403.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805553,EAP,Custom 27805553,,Sensation Plus 50cc Iab 8.0,"$3,154.00",$0.00,"$3,154.00",$0.00,"$2,251.01",$0.00,$0.00,"$2,251.01","$2,251.01",$0.00,"$3,154.00",$0.00,"$1,577.00","$2,497.97","$2,523.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805554,EAP,HCPCS C1760,,Vascade Vascular Closure Device 5fr,$550.00,$0.00,$550.00,$247.50,$392.54,$0.00,$94.76,$392.54,$392.54,$96.30,$550.00,$0.00,$275.00,$435.60,$440.00,$0.00,$86.08,$0.00,$87.56,$0.00
27805555,EAP,HCPCS C1760,,Vascade Vascular Closure Device 6/7fr,$550.00,$0.00,$550.00,$247.50,$392.54,$0.00,$94.76,$392.54,$392.54,$96.30,$550.00,$0.00,$275.00,$435.60,$440.00,$0.00,$86.08,$0.00,$87.56,$0.00
27805556,EAP,HCPCS C1876,,Stent Bil 9mm 6fr 20mm 80cm .035in 7.5-8.5mm Gwire Lum Slf,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805557,EAP,HCPCS C1876,,Stent Bil 9mm 6fr 30mm 80cm .035in 7.5-8.5mm Gwire Lum Slf,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805558,EAP,HCPCS C1876,,Stent Bil 9mm 6fr 40mm 80cm .035in Slf Xpd Flxb Lp Tntlm,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805559,EAP,HCPCS C1876,,Stent Bil 9mm 6fr 60mm 80cm .35in 7.5-8.5mm Slf Expandable,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805560,EAP,HCPCS C1876,,Stent Bil 9mm 6fr 80mm 80cm .035in 7.5-8.5mm Gwire Lum Slf,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805561,EAP,HCPCS C1876,,Stent Bil 10mm 6fr 20mm 80cm .035in 8.5-9.5mm Slf Xpd Lp,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805562,EAP,HCPCS C1876,,Stent Bil 10mm 6fr 30mm 80cm .035in 8.5-9.5mm Slf Xpd Lp,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805563,EAP,HCPCS C1876,,Stent Bil 10mm 6fr 40mm 80cm 8.5-9.5mm .035in Slf Xpd Flxb,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805564,EAP,HCPCS C1876,,Stent Bil 10mm 6fr 60mm 80cm .035in 8.5-9.5mm Slf Xpd Dlv,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805565,EAP,HCPCS C1876,,Stent Bil 10mm 6fr 80mm 80cm .035in 8.5-9.5mm Slf Xpd Lp,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805566,EAP,HCPCS C1876,,Stent Bil 12mm 6fr 20mm 80cm .35in 9.5-11mm Slf Xpd Lp Prcs,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805567,EAP,HCPCS C1876,,Stent Bil 12mm 6fr 30mm 80cm .035in 9.5-11mm Slf Xpd Lp Prcs,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805568,EAP,HCPCS C1876,,Stent Bil 12mm 6fr 80mm 80cm .035in Otw Slf Xpd Lp Tntlm,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805569,EAP,HCPCS C1876,,Stent Bil 14mm 6fr 20mm 80cm .035in 11.5-13mm Slf Xpd Lp,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805570,EAP,HCPCS C1876,,Stent Bil 14mm 6fr 30mm 80cm .035in 11.5-13mm Slf Xpd Lp,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805571,EAP,HCPCS C1876,,Stent Bil 14mm 6fr 60mm 80cm .035in Slf Xpd Cmpt Flxb Lp,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805572,EAP,HCPCS C1876,,Stent Bil 9mm 6fr 20mm 120cm .035in Slf Xpd Flxb Lp Tntlm,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805573,EAP,HCPCS C1876,,Stent Bil 9mm 6fr 30mm 120cm Lg Dia Lp Slf Xpd Opn Ltc Dsgn,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805574,EAP,HCPCS C1876,,Stent Bil 9mm 6fr 40mm 120cm .035in 7.5-8.5mm Gwire Lum Slf,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805575,EAP,HCPCS C1876,,Stent Bil 9mm 6fr 60mm 120cm .035in 7.5-8.5mm Gwire Lum Slf,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805576,EAP,HCPCS C1876,,Stent Bil 9mm 6fr 80mm 120cm .035in 7.5-8.5mm Gwire Lum Slf,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805577,EAP,HCPCS C1876,,Stent Bil 10mm 6fr 20mm 120cm .035in 8.5-9.5mm Gwire Lum Slf,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805578,EAP,HCPCS C1876,,Stent Bil 10mm 6fr 30mm 120cm .018in 8.5-9.5mm Gwire Lum Slf,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805579,EAP,HCPCS C1876,,Stent Bil 10mm 6fr 80mm 120cm .035in 8.5-9.5mm Gwire Lum Slf,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805580,EAP,HCPCS C1876,,Stent Bil 12mm 6fr 20mm 120cm Lg Dia Lp Slf Xpd Opn Ltc Dsgn,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805581,EAP,HCPCS C1876,,Stent Bil 12mm 6fr 30mm 120cm .035in 9.5-11mm Gwire Lum Slf,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805582,EAP,HCPCS C1876,,Stent Bil 12mm 6fr 40mm 120cm .035in 9.5-11mm Gwire Lum Slf,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805583,EAP,HCPCS C1876,,Stent Bil 12mm 6fr 60mm 120cm Lp Slf Xpd Flxb Radl Strth Gps,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805584,EAP,HCPCS C1876,,Stent Bil 12mm 9.5-11fr 80mm 120cm .035in Slf Xpd Flxb Lp,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805585,EAP,HCPCS C1876,,Stent Bil 14mm 6fr 20mm 120cm .035in Slf Xpd Cmpt Flxb Lp,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805586,EAP,HCPCS C1876,,Stent Bil 14mm 6fr 30mm 120cm .035in 11.5-13mm Gwire Lum Slf,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805587,EAP,HCPCS C1876,,Stent Bil 14mm 6fr 40mm 120cm .035in 11.5-13mm Gwire Lum Slf,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805588,EAP,HCPCS C1876,,Stent Bil 14mm 6fr 60mm 120cm .035in Slf Xpd Flxb Lp Tntlm,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805589,EAP,HCPCS C1876,,Stent Bil 14mm 6fr 80mm 120cm .035in Slf Xpd Flxb Lp Tntlm,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805590,EAP,CPT® C1876,,Integrity Rx Coronary Stent System Mm,"$1,930.00",$0.00,"$1,930.00",$868.50,"$1,377.44",$0.00,$332.53,"$1,377.44","$1,377.44",$337.93,"$1,930.00",$0.00,$965.00,"$1,528.56","$1,544.00",$0.00,$302.05,$0.00,$307.26,$0.00
27805591,EAP,HCPCS C1876,,Stent Prtg Everflex 6mm 6fr 80cm 20mm .035in Peri Otw Slf,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805592,EAP,HCPCS C1876,,Stent Everflex 6mm 6fr 80cm 30mm .035in Peri Otw Slf Xpd,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805593,EAP,HCPCS C1876,,Stent Everflex 6mm 6fr 80cm 40mm .035in Peri Slf Xpd Flxb,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805594,EAP,HCPCS C1876,,Stent Bil 6mm 6fr 60mm 80cm .035in Slf Xpd Flxb Drblty Sprl,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805595,EAP,HCPCS C1876,,Stent Bil 6mm 6fr 80mm 80cm .035in 3 Wv Peak Dsgn Slf,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805596,EAP,HCPCS C1876,,Stent Bil 6mm 6fr 100mm 80cm .035in Otw Slf Xpd Flxb Drble,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805597,EAP,HCPCS C1876,,Stent Bil 6mm 6fr 120mm 80cm .035in 3 Wv Peak Dsgn Slf,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805598,EAP,HCPCS C1876,,Stent Bil 6mm 6fr 150mm 80cm .035in Otw Slf Xpd Flxb Drble,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805599,EAP,HCPCS C1876,,Stent Bil 7mm 6fr 20mm 80cm .035in Sprl 3 Wv Peak Dsgn Gwire,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805600,EAP,HCPCS C1876,,Stent Everflex Prtg 7mm 6fr 80cm 30mm .035in Peri 3 Wv Peak,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805601,EAP,HCPCS C1876,,Stent Everflex 7mm 6fr 80cm 40mm .035in Peri 3 Wv Peak,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805602,EAP,HCPCS C1876,,Stent Prtg Everflex 7mm 6fr 80cm 60mm .035in Peri 3 Wv Peak,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805603,EAP,HCPCS C1876,,Stent Bil 7mm 6fr 80mm 80cm .035in 3 Wv Peak Introd Shth Slf,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805604,EAP,HCPCS C1876,,Stent Bil 7mm 6fr 100mm 80cm .035in 3 Wv Peak Dsgn Slf Xpd,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805605,EAP,HCPCS C1876,,Stent Bil 7mm 6fr 120mm 80cm .035in 3 Wv Peak Dsgn Slf Xpd,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805606,EAP,HCPCS C1876,,Stent Bil 7mm 6fr 150mm 80cm .035in 3 Wv Peak Dsgn Slf Xpd,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805607,EAP,HCPCS C1876,,Stent Bil 8mm 6fr 20mm 80cm .035in 3 Wv Peak Dsgn Otw Slf,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805608,EAP,HCPCS C1876,,Stent Prtg Everflex 8mm 6fr 80mm 30cm .035in Peri 3 Wv Peak,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805609,EAP,HCPCS C1876,,Stent Everflex 8mm 6fr 80cm 40mm .035in Peri Slf Xpd Flxb,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805610,EAP,HCPCS C1876,,Stent Vasc 8mm 6fr 60mm 80cm .035in Slf Xpd Gwire Drblty,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805611,EAP,HCPCS C1876,,Stent Prtg Everflex 8mm 6fr 80mm 80cm .035in Peri 3 Wv Peak,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805612,EAP,HCPCS C1876,,Stent Bil 8mm 6fr 100mm 80cm .035in 3 Wv Peak Dsgn Slf Xpd,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805613,EAP,HCPCS C1876,,Stent Bil 8mm 6fr 120mm 80cm .035in 3 Wv Peak Dsgn Slf Xpd,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805614,EAP,HCPCS C1876,,Stent Bil 8mm 6fr 150mm 80cm .035in 3 Wv Peak Dsgn Slf Xpd,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805615,EAP,HCPCS C1876,,Stent Everflex 6mm 6fr 120cm 20mm .035in Peri Slf Xpd Flxb,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805616,EAP,HCPCS C1876,,Stent Bil 6mm 6fr 30mm 120cm .035in Slf Xpd Flxb Drblty Sprl,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805617,EAP,HCPCS C1876,,Stent Everflex 6mm 6fr 120cm 100mm .035in Peri 3 Wv Peak,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805618,EAP,HCPCS C1876,,Stent Everflex 6mm 6fr 120cm 120mm .035in Peri 3 Wv Peak,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805619,EAP,HCPCS C1876,,Stent Vasc 6mm 6fr 200mm 120cm .035in Slf Expandable Flxb,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805620,EAP,HCPCS C1876,,Stent Vasc 7mm 6fr 20mm 120cm .035in 3 Wv Peak Slf,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805621,EAP,HCPCS C1876,,Stent Everflex 7mm 6fr 120cm 30mm .035in Peri 3 Wv Peak Slf,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805622,EAP,HCPCS C1876,,Stent Vasc 7mm 6fr 40mm 120cm .035in Slf Expandable Flxb,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805623,EAP,HCPCS C1876,,Stent Bil 7mm 6fr 60mm 120cm 3 Wv Peak Dsgn Slf Xpd Flxb,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805624,EAP,HCPCS C1876,,Stent Vasc 7mm 6fr 80mm 120cm .035in 3 Wv Peak Introd Shth,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805625,EAP,HCPCS C1876,,Stent Vasc 7mm 6fr 100mm 120cm .035in 3 Wv Peak Introd Shth,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805626,EAP,HCPCS C1876,,Stent Vasc 7mm 6fr 120mm 120cm .035in 3 Wv Peak Introd Shth,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805627,EAP,HCPCS C1876,,Stent Bil 7mm 6fr 150mm 120cm .035in 3 Wv Peak Dsgn Slf,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805628,EAP,HCPCS C1876,,Stent Vasc 7mm 6fr 200mm 120cm .035in 5.5-6.5mm Slf,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805629,EAP,HCPCS C1876,,Stent Prtg Everflex 8mm 6fr 120mm 20cm .035in Peri 3 Wv Peak,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805630,EAP,HCPCS C1876,,Stent Bil 8mm 6fr 30mm 120cm .035in Slf Xpd Flxb Drble Sprl,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805631,EAP,HCPCS C1876,,Stent Everflex Prtg 8mm 6fr 120cm 100mm .035in Peri 3 Wv,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805632,EAP,HCPCS C1876,,Stent Prtg Everflex 8mm 6fr 120cm 120mm .035in Peri Otw Slf,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805633,EAP,HCPCS C1876,,Stent Prtg Everflex 8mm 6fr 120cm 150mm .035in Peri 3 Wv,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805634,EAP,HCPCS C1876,,Stent Vasc 8mm 6fr 200mm 120cm .035in 6.5-7.5mm Slf Xpd Shth,"$3,721.00",$0.00,"$3,721.00","$1,674.45","$2,655.68",$0.00,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$0.00,"$1,860.50","$2,947.03","$2,976.80",$0.00,$582.34,$0.00,$592.38,$0.00
27805635,EAP,HCPCS C1876,,Stent Vasc 10-8mm 40mm Tpr Slf Expandable Erg Hndl Flxb Crtd,"$6,739.00",$0.00,"$6,739.00","$3,032.55","$4,809.62",$0.00,"$1,161.10","$4,809.62","$4,809.62","$1,179.94","$6,739.00",$0.00,"$3,369.50","$5,337.29","$5,391.20",$0.00,"$1,054.65",$0.00,"$1,072.85",$0.00
27805636,EAP,HCPCS C1876,,Stent Vasc 9-7mm 40mm Tpr Slf Expandable Erg Hndl Flxb Crtd,"$6,739.00",$0.00,"$6,739.00","$3,032.55","$4,809.62",$0.00,"$1,161.10","$4,809.62","$4,809.62","$1,179.94","$6,739.00",$0.00,"$3,369.50","$5,337.29","$5,391.20",$0.00,"$1,054.65",$0.00,"$1,072.85",$0.00
27805637,EAP,HCPCS C1876,,Stent Vasc 8-6mm 40mm Tpr Slf Expandable Erg Hndl Flxb Crtd,"$6,739.00",$0.00,"$6,739.00","$3,032.55","$4,809.62",$0.00,"$1,161.10","$4,809.62","$4,809.62","$1,179.94","$6,739.00",$0.00,"$3,369.50","$5,337.29","$5,391.20",$0.00,"$1,054.65",$0.00,"$1,072.85",$0.00
27805638,EAP,Custom 27805638,,Og Cmplx Fill Coil 2x1.5,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805639,EAP,Custom 27805639,,Og Cmplx Fill Coil 2x2,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805640,EAP,Custom 27805640,,Og Cmplx Fill Coil 3x4,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805641,EAP,Custom 27805641,,Og Cmplx Fill Coil 3x6,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805642,EAP,Custom 27805642,,Og Cmplx Fill Coil 3x8,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805643,EAP,Custom 27805643,,Og Tdl Cmplx Fill Coil 4x4,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805644,EAP,Custom 27805644,,Og Tdl Cmplx Fill Coil 4x7,"$4,327.00",$0.00,"$4,327.00",$0.00,"$3,088.18",$0.00,$0.00,"$3,088.18","$3,088.18",$0.00,"$4,327.00",$0.00,"$2,163.50","$3,426.98","$3,461.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805645,EAP,Custom 27805645,,Og Tdl Cmplx Fill Coil 4x10,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805646,EAP,Custom 27805646,,Og Tdl Cmplx Fill Coil 4x12,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805647,EAP,Custom 27805647,,Og Tdl Cmplx Fill Coil 5x5,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805648,EAP,Custom 27805648,,Og Tdl Cmplx Fill Coil 5x10,"$4,327.00",$0.00,"$4,327.00",$0.00,"$3,088.18",$0.00,$0.00,"$3,088.18","$3,088.18",$0.00,"$4,327.00",$0.00,"$2,163.50","$3,426.98","$3,461.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805649,EAP,Custom 27805649,,Coil Embolization .012in 5mm 15cm Complex Fill Detachable,"$3,738.00",$0.00,"$3,738.00",$0.00,"$2,667.81",$0.00,$0.00,"$2,667.81","$2,667.81",$0.00,"$3,738.00",$0.00,"$1,869.00","$2,960.50","$2,990.40",$0.00,$0.00,$0.00,$0.00,$0.00
27805650,EAP,Custom 27805650,,Og Tdl Cmplx Fill Coil 6x10,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805651,EAP,Custom 27805651,,Og Tdl Cmplx Fill Coil 6x15,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805652,EAP,Custom 27805652,,Og Tdl Cmplx Fill Coil 6x20,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805653,EAP,Custom 27805653,,Og Tdl Cmplx Fill Coil 7x15,"$4,327.00",$0.00,"$4,327.00",$0.00,"$3,088.18",$0.00,$0.00,"$3,088.18","$3,088.18",$0.00,"$4,327.00",$0.00,"$2,163.50","$3,426.98","$3,461.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805654,EAP,Custom 27805654,,Og Tdl Cmplx Fill Coil 7x21,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805655,EAP,Custom 27805655,,Og Tdl Cmplx Fill Coil 8x15,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805656,EAP,Custom 27805656,,Og Tdl Cmplx Fill Coil 8x24,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805657,EAP,Custom 27805657,,Og Tdl Cmplx Fill Coil 9x15,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805658,EAP,Custom 27805658,,Og Tdl Cmplx Fill Coil 9x25,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805659,EAP,Custom 27805659,,Og Tdl Cmplx Fill Coil 10x30,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805660,EAP,Custom 27805660,,Og Tdl Cmplx Fill Coil 12x30,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805661,EAP,Custom 27805661,,Og Cmplx Fill Coil 3.5x7.5,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805662,EAP,Custom 27805662,,Og Tdl Cmplx Frame Coil 6x20,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805663,EAP,Custom 27805663,,Og Tdl Cmplx Frame Coil 7x25,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805664,EAP,Custom 27805664,,Og Tdl Cmplx Frame Coil 8x30,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805665,EAP,Custom 27805665,,Og Tdl Cmplx Frame Coil 9x30,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805666,EAP,Custom 27805666,,Og Tdl Cmplx Frame Coil 10x30,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805667,EAP,Custom 27805667,,Og Tdl Cmplx Frame Coil 12x30,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805668,EAP,Custom 27805668,,Og Tdl Cmplx Frame Coil 14x30,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805669,EAP,Custom 27805669,,Og Tdl Cmplx Frame Coil 16x30,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805670,EAP,Custom 27805670,,Og Tdl Cmplx Frame Coil 18x30,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805671,EAP,Custom 27805671,,Og Tdl Cmplx Frame Coil 20x30,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805672,EAP,Custom 27805672,,G2 Complex Fill Coil 2x1.5,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805673,EAP,Custom 27805673,,G2 Complex Fill Coil 2x2,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805674,EAP,Custom 27805674,,G2 Complex Fill Coil 3x4,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805675,EAP,Custom 27805675,,G2 Complex Fill Coil 3x6,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805676,EAP,Custom 27805676,,G2 Complex Fill Coil 3x8,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805677,EAP,Custom 27805677,,G2 Tdl Complex Fill Coil 4x7,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805678,EAP,Custom 27805678,,G2 Tdl Complex Fill Coil 4x10,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805679,EAP,Custom 27805679,,G2 Tdl Complex Fill Coil 4x12,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805680,EAP,Custom 27805680,,G2 Tdl Complex Fill Coil 5x10,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805681,EAP,Custom 27805681,,G2 Tdl Complex Fill Coil 5x15,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805682,EAP,Custom 27805682,,G2 Tdl Complex Fill Coil 6x15,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805683,EAP,Custom 27805683,,G2 Tdl Complex Fill Coil 6x20,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805684,EAP,Custom 27805684,,G2 Tdl Complex Fill Coil 7x15,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805685,EAP,Custom 27805685,,G2 Tdl Complex Fill Coil 7x21,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805686,EAP,Custom 27805686,,G2 Tdl Complex Fill Coil 8x15,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805687,EAP,Custom 27805687,,G2 Tdl Complex Fill Coil 8x24,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805688,EAP,Custom 27805688,,G2 Tdl Complex Fill Coil 9x25,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805689,EAP,Custom 27805689,,G2 Tdl Complex Fill Coil 10x30,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805690,EAP,Custom 27805690,,G2 Tdl Complex Fill Coil 12x30,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805691,EAP,Custom 27805691,,G2 Complex Fill Coil 2.5x5,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805692,EAP,Custom 27805692,,G2 Complex Fill Coil 2.5x3.5,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805693,EAP,Custom 27805693,,G2 Complex Fill Coil 3.5x9,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805694,EAP,Custom 27805694,,G2 Complex Fill Coil 3.5x7.5,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805695,EAP,Custom 27805695,,G2 Complex Xtrasoft Coil 2x1.5,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805696,EAP,Custom 27805696,,G2 Complex Xtrasoft Coil 2x2,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805697,EAP,Custom 27805697,,G2 Complex Xtrasoft Coil 3x4,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805698,EAP,Custom 27805698,,G2 Complex Xtrasoft Coil 3x6,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805700,EAP,Custom 27805700,,G2 Tdl Complex Xtrasoft Coil 4,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805701,EAP,Custom 27805701,,G2 Complex Xtrasoft Coil 2.5x5,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805702,EAP,Custom 27805702,,G2 Complex Xtrasoft Coil 2.5x2,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805703,EAP,Custom 27805703,,G2 Complex Xtrasoft Coil 2.5x3,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805704,EAP,Custom 27805704,,G2 Complex Xtrasoft Coil 3.5x5,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805705,EAP,Custom 27805705,,G2 Complex Xtrasoft Coil 3.5x9,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805706,EAP,Custom 27805706,,G2 Complex Xtrasoft Coil 3.5x7,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805707,EAP,Custom 27805707,,G2 Helical Xtrasoft Coil 2x4,"$3,148.00",$0.00,"$3,148.00",$0.00,"$2,246.73",$0.00,$0.00,"$2,246.73","$2,246.73",$0.00,"$3,148.00",$0.00,"$1,574.00","$2,493.22","$2,518.40",$0.00,$0.00,$0.00,$0.00,$0.00
27805708,EAP,Custom 27805708,,G2 Helical Xtrasoft Coil 2x6,"$3,148.00",$0.00,"$3,148.00",$0.00,"$2,246.73",$0.00,$0.00,"$2,246.73","$2,246.73",$0.00,"$3,148.00",$0.00,"$1,574.00","$2,493.22","$2,518.40",$0.00,$0.00,$0.00,$0.00,$0.00
27805709,EAP,Custom 27805709,,G2 Helical Xtrasoft Coil 2x8,"$3,148.00",$0.00,"$3,148.00",$0.00,"$2,246.73",$0.00,$0.00,"$2,246.73","$2,246.73",$0.00,"$3,148.00",$0.00,"$1,574.00","$2,493.22","$2,518.40",$0.00,$0.00,$0.00,$0.00,$0.00
27805710,EAP,Custom 27805710,,Og Cmplx Xtrasoft Coil 2x1.5,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805711,EAP,Custom 27805711,,Og Cmplx Xtrasoft Coil 2x2,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805712,EAP,Custom 27805712,,Og Cmplx Xtrasoft Coil 3x3,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805713,EAP,Custom 27805713,,Og Cmplx Xtrasoft Coil 3x4,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805714,EAP,Custom 27805714,,Og Cmplx Xtrasoft Coil 3x6,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805715,EAP,Custom 27805715,,Og Cmplx Xtrasoft Coil 3x8,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805716,EAP,Custom 27805716,,Og Cmplx Xtrasoft Coil 4x4,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805717,EAP,Custom 27805717,,Og Cmplx Xtrasoft Coil 4x6,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805718,EAP,Custom 27805718,,Og Cmplx Xtrasoft Coil 4x8,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805719,EAP,Custom 27805719,,Og Cmplx Xtrasoft Coil 4x10,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805720,EAP,Custom 27805720,,Og Cmplx Xtrasoft Coil 2.5x5,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805721,EAP,Custom 27805721,,Og Cmplx Xtrasoft Coil 2.5x2.5,"$4,327.00",$0.00,"$4,327.00",$0.00,"$3,088.18",$0.00,$0.00,"$3,088.18","$3,088.18",$0.00,"$4,327.00",$0.00,"$2,163.50","$3,426.98","$3,461.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805722,EAP,Custom 27805722,,Og Cmplx Xtrasoft Coil 2.5x3.5,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805723,EAP,Custom 27805723,,Og Cmplx Xtrasoft Coil 3.5x5,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805724,EAP,Custom 27805724,,Og Cmplx Xtrasoft Coil 3.5x9,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805725,EAP,Custom 27805725,,Og Cmplx Xtrasoft Coil 3.5x7.5,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805726,EAP,Custom 27805726,,Og Helical Xtrsoft Coil 2x4,"$3,148.00",$0.00,"$3,148.00",$0.00,"$2,246.73",$0.00,$0.00,"$2,246.73","$2,246.73",$0.00,"$3,148.00",$0.00,"$1,574.00","$2,493.22","$2,518.40",$0.00,$0.00,$0.00,$0.00,$0.00
27805727,EAP,Custom 27805727,,Og Helical Xtrsoft Coil 2x6,"$3,148.00",$0.00,"$3,148.00",$0.00,"$2,246.73",$0.00,$0.00,"$2,246.73","$2,246.73",$0.00,"$3,148.00",$0.00,"$1,574.00","$2,493.22","$2,518.40",$0.00,$0.00,$0.00,$0.00,$0.00
27805728,EAP,Custom 27805728,,Og Helical Xtrsoft Coil 2x8,"$3,148.00",$0.00,"$3,148.00",$0.00,"$2,246.73",$0.00,$0.00,"$2,246.73","$2,246.73",$0.00,"$3,148.00",$0.00,"$1,574.00","$2,493.22","$2,518.40",$0.00,$0.00,$0.00,$0.00,$0.00
27805729,EAP,Custom 27805729,,G2 Tdl Complex Xtrasoft Coil 4x8,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805730,EAP,Custom 27805730,,G2 Tdl Complex Xtrasoft Coil 4x10,"$4,121.00",$0.00,"$4,121.00",$0.00,"$2,941.16",$0.00,$0.00,"$2,941.16","$2,941.16",$0.00,"$4,121.00",$0.00,"$2,060.50","$3,263.83","$3,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805731,EAP,Custom 27805731,,Kit Prss Monitr 14ga Cdmn Mcsnsr Basic Trndcr Tuo Ndl,"$2,074.00",$0.00,"$2,074.00",$0.00,"$1,480.21",$0.00,$0.00,"$1,480.21","$1,480.21",$0.00,"$2,074.00",$0.00,"$1,037.00","$1,642.61","$1,659.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805732,EAP,Custom 27805732,,Kit Prss Monitr Mcsnsr .7mm Sbdrl Inprench Skl Bolt,"$2,147.00",$0.00,"$2,147.00",$0.00,"$1,532.31",$0.00,$0.00,"$1,532.31","$1,532.31",$0.00,"$2,147.00",$0.00,"$1,073.50","$1,700.42","$1,717.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805733,EAP,Custom 27805733,,Kit Prss Monitr 38cm Cdmn Intrcran Vntrc Trndcr Cath Tnl,"$2,235.00",$0.00,"$2,235.00",$0.00,"$1,595.12",$0.00,$0.00,"$1,595.12","$1,595.12",$0.00,"$2,235.00",$0.00,"$1,117.50","$1,770.12","$1,788.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805734,EAP,Custom 27805734,,Stent Lvis 4.5 23mm,"$17,913.00",$0.00,"$17,913.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$12,784.51",$0.00,"$17,913.00",$0.00,"$8,956.50","$14,187.10","$14,330.40",$0.00,$0.00,$0.00,$0.00,$0.00
27805735,EAP,Custom 27805735,,Device Cmpr Gold Fmstp Pneum Dome Intgr Dgt Mnmtr Adj Belt,$290.00,$0.00,$290.00,$0.00,$206.97,$0.00,$0.00,$206.97,$206.97,$0.00,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$0.00,$0.00,$0.00,$0.00
27805736,EAP,Custom 27805736,,Prtcl Embl 2 Vl Lq Sys Trfl Nbca 1gm,"$11,437.00",$0.00,"$11,437.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$8,162.59",$0.00,"$11,437.00",$0.00,"$5,718.50","$9,058.10","$9,149.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805737,EAP,Custom 27805737,,Prtcl Embl 1 Vl Lq Sys Trfl Nbca 1gm,"$6,546.00",$0.00,"$6,546.00",$0.00,"$4,671.88",$0.00,$0.00,"$4,671.88","$4,671.88",$0.00,"$6,546.00",$0.00,"$3,273.00","$5,184.43","$5,236.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805738,EAP,HCPCS C1760,,Device Clsr 8fr Angsl Vip Vasc Hmst Strl Latex Free Disp,$723.00,$0.00,$723.00,$325.35,$516.01,$0.00,$124.57,$516.01,$516.01,$126.59,$723.00,$0.00,$361.50,$572.62,$578.40,$0.00,$113.15,$0.00,$115.10,$0.00
27805739,EAP,Custom 27805739,,Stent 3.5 X 19 Coil Assist Headway 21,"$16,121.00",$0.00,"$16,121.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$11,505.56",$0.00,"$16,121.00",$0.00,"$8,060.50","$12,767.83","$12,896.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805740,EAP,Custom 27805740,,Stent 3.5 X 24 Coil Assist  Headway 21,"$16,121.00",$0.00,"$16,121.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$11,505.56",$0.00,"$16,121.00",$0.00,"$8,060.50","$12,767.83","$12,896.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805741,EAP,Custom 27805741,,Stent 4.5 X 16 Coil Assist Headway 21,"$16,121.00",$0.00,"$16,121.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$11,505.56",$0.00,"$16,121.00",$0.00,"$8,060.50","$12,767.83","$12,896.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805742,EAP,Custom 27805742,,Stent 4.5 X 34 Coil Assist Headway 21,"$16,121.00",$0.00,"$16,121.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$11,505.56",$0.00,"$16,121.00",$0.00,"$8,060.50","$12,767.83","$12,896.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805743,EAP,Custom 27805743,,Stent 5.5 X 27 Coil Assist Headway 21,"$16,121.00",$0.00,"$16,121.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$11,505.56",$0.00,"$16,121.00",$0.00,"$8,060.50","$12,767.83","$12,896.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805744,EAP,Custom 27805744,,Stent 5.5 X 34 Coil Assist Headway 21,"$16,121.00",$0.00,"$16,121.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$11,505.56",$0.00,"$16,121.00",$0.00,"$8,060.50","$12,767.83","$12,896.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805745,EAP,Custom 27805745,,Stent 3.5 X 18 Coil Assist Headway 17,"$18,980.00",$0.00,"$18,980.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$13,546.03",$0.00,"$18,980.00",$0.00,"$9,490.00","$15,032.16","$15,184.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805746,EAP,Custom 27805746,,Stent 3.5 X 23 Coil Assist Headway 17,"$18,980.00",$0.00,"$18,980.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$13,546.03",$0.00,"$18,980.00",$0.00,"$9,490.00","$15,032.16","$15,184.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805747,EAP,Custom 27805747,,Stent 3.5 X 28 Coil Assist Headway 17,"$18,981.00",$0.00,"$18,981.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$13,546.74",$0.00,"$18,981.00",$0.00,"$9,490.50","$15,032.95","$15,184.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805748,EAP,Custom 27805748,,Stent 3.5 X 33 Coil Assist Headway 17,"$18,981.00",$0.00,"$18,981.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$13,546.74",$0.00,"$18,981.00",$0.00,"$9,490.50","$15,032.95","$15,184.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805750,EAP,HCPCS C1764,,System Crd Monitr Rvl Linq Ins,"$14,592.00",$0.00,"$14,592.00","$6,566.40","$5,158.80",$0.00,"$2,514.13","$5,158.80","$10,414.31","$2,554.94","$14,592.00",$0.00,"$7,296.00","$11,556.86","$11,673.60",$0.00,"$2,283.65",$0.00,"$2,323.05",$0.00
27805751,EAP,HCPCS C1880,,Filter Embl Vc Femoral Navalign Dlv Set Strl Disp Pltn Celect,"$3,032.00",$0.00,"$3,032.00","$1,364.40","$2,163.94",$0.00,$522.40,"$2,163.94","$2,163.94",$530.88,"$3,032.00",$0.00,"$1,516.00","$2,401.34","$2,425.60",$0.00,$474.51,$0.00,$482.69,$0.00
27805752,EAP,HCPCS C1880,,Filter Embl Vc Jug Navalign Dlv Set Strl Disp Pltn Celect,"$3,032.00",$0.00,"$3,032.00","$1,364.40","$2,163.94",$0.00,$522.40,"$2,163.94","$2,163.94",$530.88,"$3,032.00",$0.00,"$1,516.00","$2,401.34","$2,425.60",$0.00,$474.51,$0.00,$482.69,$0.00
27805753,EAP,HCPCS C1880,,Filter Embl Navalign Dlv Uniset Strl Disp Pltn Celect,"$3,032.00",$0.00,"$3,032.00","$1,364.40","$2,163.94",$0.00,$522.40,"$2,163.94","$2,163.94",$530.88,"$3,032.00",$0.00,"$1,516.00","$2,401.34","$2,425.60",$0.00,$474.51,$0.00,$482.69,$0.00
27805754,EAP,Custom 27805754,,Syr Inflat Dfl Indfltr Embl Coil Trf Dcs 2 Pltn,$816.00,$0.00,$816.00,$0.00,$582.38,$0.00,$0.00,$582.38,$582.38,$0.00,$816.00,$0.00,$408.00,$646.27,$652.80,$0.00,$0.00,$0.00,$0.00,$0.00
27805755,EAP,HCPCS C1876,,Stent Coron 8mm 2mm Cocr Mtlnk Mvsn 2 Radiopq Mrkr Bln,"$1,791.00",$0.00,"$1,791.00",$805.95,"$1,278.24",$0.00,$308.58,"$1,278.24","$1,278.24",$313.59,"$1,791.00",$0.00,$895.50,"$1,418.47","$1,432.80",$0.00,$280.29,$0.00,$285.13,$0.00
27805756,EAP,HCPCS C1876,,Stent Coron 12mm 2mm Cocr Mtlnk Mvsn 2 Radiopq Mrkr Bln,"$1,791.00",$0.00,"$1,791.00",$805.95,"$1,278.24",$0.00,$308.58,"$1,278.24","$1,278.24",$313.59,"$1,791.00",$0.00,$895.50,"$1,418.47","$1,432.80",$0.00,$280.29,$0.00,$285.13,$0.00
27805757,EAP,HCPCS C1876,,Stent Coron 15mm 2mm Cocr Mtlnk Mvsn 2 Radiopq Mrkr Bln,"$1,791.00",$0.00,"$1,791.00",$805.95,"$1,278.24",$0.00,$308.58,"$1,278.24","$1,278.24",$313.59,"$1,791.00",$0.00,$895.50,"$1,418.47","$1,432.80",$0.00,$280.29,$0.00,$285.13,$0.00
27805758,EAP,HCPCS C1876,,Stent Coron 18mm 2mm Cocr Mtlnk Mvsn 2 Radiopq Mrkr Bln,"$1,791.00",$0.00,"$1,791.00",$805.95,"$1,278.24",$0.00,$308.58,"$1,278.24","$1,278.24",$313.59,"$1,791.00",$0.00,$895.50,"$1,418.47","$1,432.80",$0.00,$280.29,$0.00,$285.13,$0.00
27805759,EAP,HCPCS C1876,,Stent Coron 23mm 2mm Cocr Mtlnk Mvsn 2 Radiopq Mrkr Bln,"$1,791.00",$0.00,"$1,791.00",$805.95,"$1,278.24",$0.00,$308.58,"$1,278.24","$1,278.24",$313.59,"$1,791.00",$0.00,$895.50,"$1,418.47","$1,432.80",$0.00,$280.29,$0.00,$285.13,$0.00
27805760,EAP,HCPCS C1876,,Stent Coron 28mm 2mm Cocr Mtlnk Mvsn 2 Radiopq Mrkr Bln,"$1,791.00",$0.00,"$1,791.00",$805.95,"$1,278.24",$0.00,$308.58,"$1,278.24","$1,278.24",$313.59,"$1,791.00",$0.00,$895.50,"$1,418.47","$1,432.80",$0.00,$280.29,$0.00,$285.13,$0.00
27805761,EAP,HCPCS C1876,,Stent Coron 15mm 2.25mm Cocr Mtlnk Mvsn 2 Radiopq Mrkr Bln,"$1,791.00",$0.00,"$1,791.00",$805.95,"$1,278.24",$0.00,$308.58,"$1,278.24","$1,278.24",$313.59,"$1,791.00",$0.00,$895.50,"$1,418.47","$1,432.80",$0.00,$280.29,$0.00,$285.13,$0.00
27805762,EAP,HCPCS C1876,,Stent Coron 18mm 2.25mm Cocr Mtlnk Mvsn 2 Radiopq Mrkr Bln,"$1,791.00",$0.00,"$1,791.00",$805.95,"$1,278.24",$0.00,$308.58,"$1,278.24","$1,278.24",$313.59,"$1,791.00",$0.00,$895.50,"$1,418.47","$1,432.80",$0.00,$280.29,$0.00,$285.13,$0.00
27805763,EAP,HCPCS C1876,,Stent Coron 23mm 2.25mm Cocr Mtlnk Mvsn 2 Radiopq Mrkr Bln,"$1,791.00",$0.00,"$1,791.00",$805.95,"$1,278.24",$0.00,$308.58,"$1,278.24","$1,278.24",$313.59,"$1,791.00",$0.00,$895.50,"$1,418.47","$1,432.80",$0.00,$280.29,$0.00,$285.13,$0.00
27805764,EAP,HCPCS C1876,,Stent Coron 28mm 2.25mm Cocr Mtlnk Mvsn 2 Radiopq Mrkr Bln,"$1,791.00",$0.00,"$1,791.00",$805.95,"$1,278.24",$0.00,$308.58,"$1,278.24","$1,278.24",$313.59,"$1,791.00",$0.00,$895.50,"$1,418.47","$1,432.80",$0.00,$280.29,$0.00,$285.13,$0.00
27805765,EAP,Custom 27805765,,Cath Angio 5fr 8mm 110cm 2 Lum Bln Syr Wdg Prss Strl Latex,$138.00,$0.00,$138.00,$0.00,$98.49,$0.00,$0.00,$98.49,$98.49,$0.00,$138.00,$0.00,$69.00,$109.30,$110.40,$0.00,$0.00,$0.00,$0.00,$0.00
27805766,EAP,HCPCS V2790,,Amniofix 16mm Disc,$971.00,$0.00,$971.00,$436.95,$693.00,$0.00,$167.30,$693.00,$693.00,$170.01,$971.00,$0.00,$485.50,$769.03,$776.80,$0.00,$151.96,$0.00,$154.58,$0.00
27805767,EAP,HCPCS V2790,,Amniofix 2x3cm,"$2,756.00",$0.00,"$2,756.00","$1,240.20","$1,966.96",$0.00,$474.85,"$1,966.96","$1,966.96",$482.55,"$2,756.00",$0.00,"$1,378.00","$2,182.75","$2,204.80",$0.00,$431.31,$0.00,$438.76,$0.00
27805768,EAP,HCPCS V2790,,Amniofix 3x3cm,"$3,662.00",$0.00,"$3,662.00","$1,647.90","$2,613.57",$0.00,$630.94,"$2,613.57","$2,613.57",$641.19,"$3,662.00",$0.00,"$1,831.00","$2,900.30","$2,929.60",$0.00,$573.10,$0.00,$582.99,$0.00
27805769,EAP,HCPCS V2790,,Amniofix 4x4cm,"$3,925.00",$0.00,"$3,925.00","$1,766.25","$2,801.27",$0.00,$676.26,"$2,801.27","$2,801.27",$687.24,"$3,925.00",$0.00,"$1,962.50","$3,108.60","$3,140.00",$0.00,$614.26,$0.00,$624.86,$0.00
27805770,EAP,HCPCS V2790,,Amniofix 4x6cm,"$5,629.00",$0.00,"$5,629.00","$2,533.05","$4,017.42",$0.00,$969.85,"$4,017.42","$4,017.42",$985.59,"$5,629.00",$0.00,"$2,814.50","$4,458.17","$4,503.20",$0.00,$880.94,$0.00,$896.14,$0.00
27805771,EAP,HCPCS V2790,,Amniofix 2x12cm,"$2,612.00",$0.00,"$2,612.00","$1,175.40","$1,864.18",$0.00,$450.03,"$1,864.18","$1,864.18",$457.34,"$2,612.00",$0.00,"$1,306.00","$2,068.70","$2,089.60",$0.00,$408.78,$0.00,$415.83,$0.00
27805772,EAP,HCPCS V2790,,Amniofix 6x16cm,"$9,005.00",$0.00,"$9,005.00","$4,052.25","$5,158.80",$0.00,"$1,551.52","$5,158.80","$6,426.87","$1,576.70","$9,005.00",$0.00,"$4,502.50","$7,131.96","$7,204.00",$0.00,"$1,409.28",$0.00,"$1,433.60",$0.00
27805773,EAP,HCPCS V2790,,Amniofix 9x20cm,"$21,453.00",$0.00,"$21,453.00","$9,653.85","$5,158.80",$0.00,"$3,696.24","$5,158.80","$15,311.01","$3,756.25","$21,453.00",$0.00,"$10,726.50","$16,990.78","$17,162.40",$0.00,"$3,357.39",$0.00,"$3,415.32",$0.00
27805774,EAP,HCPCS V2790,,Amniofix Wrap 2x2 Cm,"$1,903.00",$0.00,"$1,903.00",$856.35,"$1,358.17",$0.00,$327.88,"$1,358.17","$1,358.17",$333.20,"$1,903.00",$0.00,$951.50,"$1,507.18","$1,522.40",$0.00,$297.82,$0.00,$302.96,$0.00
27805775,EAP,HCPCS V2790,,Amniofix Wrap 2x4 Cm,"$3,399.00",$0.00,"$3,399.00","$1,529.55","$2,425.87",$0.00,$585.63,"$2,425.87","$2,425.87",$595.14,"$3,399.00",$0.00,"$1,699.50","$2,692.01","$2,719.20",$0.00,$531.94,$0.00,$541.12,$0.00
27805776,EAP,HCPCS V2790,,Amniofix Wrap 4x6 Cm,"$5,772.00",$0.00,"$5,772.00","$2,597.40","$4,119.48",$0.00,$994.49,"$4,119.48","$4,119.48","$1,010.63","$5,772.00",$0.00,"$2,886.00","$4,571.42","$4,617.60",$0.00,$903.32,$0.00,$918.90,$0.00
27805777,EAP,HCPCS C1777,,Lead Dfbr 65cm 8fr Optisure Ecrdm Optim 1 Coil Df1is-1,"$10,761.00",$0.00,"$10,761.00","$4,842.45","$5,158.80",$0.00,"$1,854.07","$5,158.80","$7,680.13","$1,884.17","$10,761.00",$0.00,"$5,380.50","$8,522.71","$8,608.80",$0.00,"$1,684.10",$0.00,"$1,713.15",$0.00
27805778,EAP,HCPCS C1777,,Lead Dfbr 52cm 8fr Optisure Ecrdm 1 Coil Df4 Conctr True,"$10,761.00",$0.00,"$10,761.00","$4,842.45","$5,158.80",$0.00,"$1,854.07","$5,158.80","$7,680.13","$1,884.17","$10,761.00",$0.00,"$5,380.50","$8,522.71","$8,608.80",$0.00,"$1,684.10",$0.00,"$1,713.15",$0.00
27805779,EAP,HCPCS C1777,,Lead Dfbr 58cm 8fr Optisure Ecrdm Optim 1 Coil Df4 Conctr,"$10,761.00",$0.00,"$10,761.00","$4,842.45","$5,158.80",$0.00,"$1,854.07","$5,158.80","$7,680.13","$1,884.17","$10,761.00",$0.00,"$5,380.50","$8,522.71","$8,608.80",$0.00,"$1,684.10",$0.00,"$1,713.15",$0.00
27805780,EAP,HCPCS C1777,,Lead Dfbr 65cm 8fr Optisure Ecrdm 1 Coil Df4 Conctr True,"$10,761.00",$0.00,"$10,761.00","$4,842.45","$5,158.80",$0.00,"$1,854.07","$5,158.80","$7,680.13","$1,884.17","$10,761.00",$0.00,"$5,380.50","$8,522.71","$8,608.80",$0.00,"$1,684.10",$0.00,"$1,713.15",$0.00
27805781,EAP,HCPCS C1895,,Lead Dfbr 65cm 8fr Optisure Ecrdm 2 Coil Df1 Df4 Conctr True,"$10,761.00",$0.00,"$10,761.00","$4,842.45","$5,158.80",$0.00,"$1,854.07","$5,158.80","$7,680.13","$1,884.17","$10,761.00",$0.00,"$5,380.50","$8,522.71","$8,608.80",$0.00,"$1,684.10",$0.00,"$1,713.15",$0.00
27805782,EAP,HCPCS C1895,,Lead Dfbr 52cm 8fr Optisure Ecrdm 2 Coil Df4 Conctr True,"$10,761.00",$0.00,"$10,761.00","$4,842.45","$5,158.80",$0.00,"$1,854.07","$5,158.80","$7,680.13","$1,884.17","$10,761.00",$0.00,"$5,380.50","$8,522.71","$8,608.80",$0.00,"$1,684.10",$0.00,"$1,713.15",$0.00
27805783,EAP,HCPCS C1895,,Lead Dfbr 58cm 8fr Optisure Ecrdm 2 Coil Df4 Conctr True,"$10,761.00",$0.00,"$10,761.00","$4,842.45","$5,158.80",$0.00,"$1,854.07","$5,158.80","$7,680.13","$1,884.17","$10,761.00",$0.00,"$5,380.50","$8,522.71","$8,608.80",$0.00,"$1,684.10",$0.00,"$1,713.15",$0.00
27805784,EAP,HCPCS C1895,,Lead Dfbr 65cm 8fr Optisure Ecrdm 2 Coil Df4 220 Dual Shock,"$10,761.00",$0.00,"$10,761.00","$4,842.45","$5,158.80",$0.00,"$1,854.07","$5,158.80","$7,680.13","$1,884.17","$10,761.00",$0.00,"$5,380.50","$8,522.71","$8,608.80",$0.00,"$1,684.10",$0.00,"$1,713.15",$0.00
27805785,EAP,HCPCS C1895,,Lead Dfbr 65cm 8fr Optisure Ecrdm 2 Coil Df4 230 Dual Shock,"$10,761.00",$0.00,"$10,761.00","$4,842.45","$5,158.80",$0.00,"$1,854.07","$5,158.80","$7,680.13","$1,884.17","$10,761.00",$0.00,"$5,380.50","$8,522.71","$8,608.80",$0.00,"$1,684.10",$0.00,"$1,713.15",$0.00
27805786,EAP,HCPCS C1895,,Lead Dfbr 65cm 8fr Optisure Ecrdm 2 Coil Df4 Pass Dual Shock,"$10,761.00",$0.00,"$10,761.00","$4,842.45","$5,158.80",$0.00,"$1,854.07","$5,158.80","$7,680.13","$1,884.17","$10,761.00",$0.00,"$5,380.50","$8,522.71","$8,608.80",$0.00,"$1,684.10",$0.00,"$1,713.15",$0.00
27805787,EAP,HCPCS C1777,,Lead Pcng 64cm 9fr Ecrdm 1 Coil Act Fix Bipol Cardvrt Dfbr,"$9,175.00",$0.00,"$9,175.00","$4,128.75","$5,158.80",$0.00,"$1,580.81","$5,158.80","$6,548.20","$1,606.47","$9,175.00",$0.00,"$4,587.50","$7,266.60","$7,340.00",$0.00,"$1,435.89",$0.00,"$1,460.66",$0.00
27805788,EAP,HCPCS C1874,,Stent Coron 8mm 2.25mm .034-.029in 5fr Everolimus,"$3,806.00",$0.00,"$3,806.00","$1,712.70","$2,716.34",$0.00,$655.75,"$2,716.34","$2,716.34",$666.40,"$3,806.00",$0.00,"$1,903.00","$3,014.35","$3,044.80",$0.00,$595.64,$0.00,$605.92,$0.00
27805789,EAP,HCPCS C1874,,Stent Coron 12mm 2.25mm .034-.029in 5fr Everolimus,"$3,806.00",$0.00,"$3,806.00","$1,712.70","$2,716.34",$0.00,$655.75,"$2,716.34","$2,716.34",$666.40,"$3,806.00",$0.00,"$1,903.00","$3,014.35","$3,044.80",$0.00,$595.64,$0.00,$605.92,$0.00
27805790,EAP,HCPCS C1874,,Stent Coron 15mm 2.25mm .034-.029in 5fr Everolimus,"$3,806.00",$0.00,"$3,806.00","$1,712.70","$2,716.34",$0.00,$655.75,"$2,716.34","$2,716.34",$666.40,"$3,806.00",$0.00,"$1,903.00","$3,014.35","$3,044.80",$0.00,$595.64,$0.00,$605.92,$0.00
27805791,EAP,HCPCS C1874,,Stent Coron 18mm 2.25mm .034-.029in 5fr Everolimus,"$3,806.00",$0.00,"$3,806.00","$1,712.70","$2,716.34",$0.00,$655.75,"$2,716.34","$2,716.34",$666.40,"$3,806.00",$0.00,"$1,903.00","$3,014.35","$3,044.80",$0.00,$595.64,$0.00,$605.92,$0.00
27805792,EAP,HCPCS C1874,,Stent Coron 23mm 2.25mm .034-.029in 5fr Everolimus,"$3,806.00",$0.00,"$3,806.00","$1,712.70","$2,716.34",$0.00,$655.75,"$2,716.34","$2,716.34",$666.40,"$3,806.00",$0.00,"$1,903.00","$3,014.35","$3,044.80",$0.00,$595.64,$0.00,$605.92,$0.00
27805793,EAP,HCPCS C1874,,Stent Coron 28mm 2.25mm .034-.029in 5fr Everolimus,"$3,806.00",$0.00,"$3,806.00","$1,712.70","$2,716.34",$0.00,$655.75,"$2,716.34","$2,716.34",$666.40,"$3,806.00",$0.00,"$1,903.00","$3,014.35","$3,044.80",$0.00,$595.64,$0.00,$605.92,$0.00
27805794,EAP,HCPCS C1874,,Stent Coron 8mm 2.5mm .034-.029in 5fr Cocr,"$3,806.00",$0.00,"$3,806.00","$1,712.70","$2,716.34",$0.00,$655.75,"$2,716.34","$2,716.34",$666.40,"$3,806.00",$0.00,"$1,903.00","$3,014.35","$3,044.80",$0.00,$595.64,$0.00,$605.92,$0.00
27805795,EAP,HCPCS C1874,,Stent Coron 12mm 2.5mm .034-.029in 5fr Everolimus,"$3,806.00",$0.00,"$3,806.00","$1,712.70","$2,716.34",$0.00,$655.75,"$2,716.34","$2,716.34",$666.40,"$3,806.00",$0.00,"$1,903.00","$3,014.35","$3,044.80",$0.00,$595.64,$0.00,$605.92,$0.00
27805796,EAP,HCPCS C1874,,Stent Coron 15mm 2.5mm .034-.029in 5fr Everolimus,"$3,806.00",$0.00,"$3,806.00","$1,712.70","$2,716.34",$0.00,$655.75,"$2,716.34","$2,716.34",$666.40,"$3,806.00",$0.00,"$1,903.00","$3,014.35","$3,044.80",$0.00,$595.64,$0.00,$605.92,$0.00
27805797,EAP,HCPCS C1874,,Stent Coron 18mm 2.5mm .034-.029in 5fr Everolimus,"$3,806.00",$0.00,"$3,806.00","$1,712.70","$2,716.34",$0.00,$655.75,"$2,716.34","$2,716.34",$666.40,"$3,806.00",$0.00,"$1,903.00","$3,014.35","$3,044.80",$0.00,$595.64,$0.00,$605.92,$0.00
27805798,EAP,HCPCS C1874,,Stent Coron 23mm 2.5mm .034-.029in 5fr Everolimus,"$3,806.00",$0.00,"$3,806.00","$1,712.70","$2,716.34",$0.00,$655.75,"$2,716.34","$2,716.34",$666.40,"$3,806.00",$0.00,"$1,903.00","$3,014.35","$3,044.80",$0.00,$595.64,$0.00,$605.92,$0.00
27805799,EAP,HCPCS C1874,,Stent Coron 28mm 2.5mm .034-.029in 5fr Everolimus,"$3,806.00",$0.00,"$3,806.00","$1,712.70","$2,716.34",$0.00,$655.75,"$2,716.34","$2,716.34",$666.40,"$3,806.00",$0.00,"$1,903.00","$3,014.35","$3,044.80",$0.00,$595.64,$0.00,$605.92,$0.00
27805800,EAP,HCPCS C1874,,Stent Coron 33mm 2.5mm .034-.029in 5fr Everolimus,"$3,806.00",$0.00,"$3,806.00","$1,712.70","$2,716.34",$0.00,$655.75,"$2,716.34","$2,716.34",$666.40,"$3,806.00",$0.00,"$1,903.00","$3,014.35","$3,044.80",$0.00,$595.64,$0.00,$605.92,$0.00
27805801,EAP,HCPCS C1874,,Stent Coron 38mm 2.5mm .034-.029in 5fr Everolimus,"$3,996.00",$0.00,"$3,996.00","$1,798.20","$2,851.95",$0.00,$688.49,"$2,851.95","$2,851.95",$699.67,"$3,996.00",$0.00,"$1,998.00","$3,164.83","$3,196.80",$0.00,$625.37,$0.00,$636.16,$0.00
27805802,EAP,HCPCS C1874,,Stent Coron 8mm 2.75mm .034-.029in 5fr Everolimus,"$3,806.00",$0.00,"$3,806.00","$1,712.70","$2,716.34",$0.00,$655.75,"$2,716.34","$2,716.34",$666.40,"$3,806.00",$0.00,"$1,903.00","$3,014.35","$3,044.80",$0.00,$595.64,$0.00,$605.92,$0.00
27805803,EAP,HCPCS C1874,,Stent Coron 12mm 2.75mm .034-.029in 5fr Everolimus,"$3,806.00",$0.00,"$3,806.00","$1,712.70","$2,716.34",$0.00,$655.75,"$2,716.34","$2,716.34",$666.40,"$3,806.00",$0.00,"$1,903.00","$3,014.35","$3,044.80",$0.00,$595.64,$0.00,$605.92,$0.00
27805804,EAP,HCPCS C1874,,Stent Coron 15mm 2.75mm .034-.029in 5fr Everolimus,"$3,806.00",$0.00,"$3,806.00","$1,712.70","$2,716.34",$0.00,$655.75,"$2,716.34","$2,716.34",$666.40,"$3,806.00",$0.00,"$1,903.00","$3,014.35","$3,044.80",$0.00,$595.64,$0.00,$605.92,$0.00
27805805,EAP,HCPCS C1874,,Stent Coron 18mm 2.75mm .034-.029in 5fr Everolimus,"$3,806.00",$0.00,"$3,806.00","$1,712.70","$2,716.34",$0.00,$655.75,"$2,716.34","$2,716.34",$666.40,"$3,806.00",$0.00,"$1,903.00","$3,014.35","$3,044.80",$0.00,$595.64,$0.00,$605.92,$0.00
27805806,EAP,HCPCS C1874,,Stent Coron 23mm 2.75mm .034-.029in 5fr Everolimus,"$3,806.00",$0.00,"$3,806.00","$1,712.70","$2,716.34",$0.00,$655.75,"$2,716.34","$2,716.34",$666.40,"$3,806.00",$0.00,"$1,903.00","$3,014.35","$3,044.80",$0.00,$595.64,$0.00,$605.92,$0.00
27805807,EAP,HCPCS C1874,,Stent Coron 28mm 2.75mm .034-.029in 5fr Everolimus,"$3,806.00",$0.00,"$3,806.00","$1,712.70","$2,716.34",$0.00,$655.75,"$2,716.34","$2,716.34",$666.40,"$3,806.00",$0.00,"$1,903.00","$3,014.35","$3,044.80",$0.00,$595.64,$0.00,$605.92,$0.00
27805808,EAP,HCPCS C1874,,Stent Coron 33mm 2.75mm .034-.029in 5fr Everolimus,"$3,806.00",$0.00,"$3,806.00","$1,712.70","$2,716.34",$0.00,$655.75,"$2,716.34","$2,716.34",$666.40,"$3,806.00",$0.00,"$1,903.00","$3,014.35","$3,044.80",$0.00,$595.64,$0.00,$605.92,$0.00
27805809,EAP,HCPCS C1874,,Stent Coron 38mm 2.75mm .034-.029in 5fr Everolimus,"$3,806.00",$0.00,"$3,806.00","$1,712.70","$2,716.34",$0.00,$655.75,"$2,716.34","$2,716.34",$666.40,"$3,806.00",$0.00,"$1,903.00","$3,014.35","$3,044.80",$0.00,$595.64,$0.00,$605.92,$0.00
27805810,EAP,HCPCS C1874,,Stent Coron 8mm 3mm .034-.029in 5fr Everolimus,"$3,806.00",$0.00,"$3,806.00","$1,712.70","$2,716.34",$0.00,$655.75,"$2,716.34","$2,716.34",$666.40,"$3,806.00",$0.00,"$1,903.00","$3,014.35","$3,044.80",$0.00,$595.64,$0.00,$605.92,$0.00
27805811,EAP,HCPCS C1874,,Stent Coron 12mm 3mm .034-.029in 5fr Everolimus,"$3,806.00",$0.00,"$3,806.00","$1,712.70","$2,716.34",$0.00,$655.75,"$2,716.34","$2,716.34",$666.40,"$3,806.00",$0.00,"$1,903.00","$3,014.35","$3,044.80",$0.00,$595.64,$0.00,$605.92,$0.00
27805812,EAP,HCPCS C1874,,Stent Coron 15mm 3mm .034-.029in 5fr Everolimus,"$3,806.00",$0.00,"$3,806.00","$1,712.70","$2,716.34",$0.00,$655.75,"$2,716.34","$2,716.34",$666.40,"$3,806.00",$0.00,"$1,903.00","$3,014.35","$3,044.80",$0.00,$595.64,$0.00,$605.92,$0.00
27805813,EAP,HCPCS C1874,,Stent Coron 18mm 3mm .034-.029in 5fr Everolimus,"$3,996.00",$0.00,"$3,996.00","$1,798.20","$2,851.95",$0.00,$688.49,"$2,851.95","$2,851.95",$699.67,"$3,996.00",$0.00,"$1,998.00","$3,164.83","$3,196.80",$0.00,$625.37,$0.00,$636.16,$0.00
27805814,EAP,HCPCS C1874,,Stent Coron 23mm 3mm .034-.029in 5fr Everolimus,"$3,996.00",$0.00,"$3,996.00","$1,798.20","$2,851.95",$0.00,$688.49,"$2,851.95","$2,851.95",$699.67,"$3,996.00",$0.00,"$1,998.00","$3,164.83","$3,196.80",$0.00,$625.37,$0.00,$636.16,$0.00
27805815,EAP,HCPCS C1874,,Stent Coron 28mm 3mm .034-.029in 5fr Everolimus,"$3,806.00",$0.00,"$3,806.00","$1,712.70","$2,716.34",$0.00,$655.75,"$2,716.34","$2,716.34",$666.40,"$3,806.00",$0.00,"$1,903.00","$3,014.35","$3,044.80",$0.00,$595.64,$0.00,$605.92,$0.00
27805816,EAP,HCPCS C1874,,Stent Coron 33mm 3mm .034-.029in 5fr Everolimus,"$3,806.00",$0.00,"$3,806.00","$1,712.70","$2,716.34",$0.00,$655.75,"$2,716.34","$2,716.34",$666.40,"$3,806.00",$0.00,"$1,903.00","$3,014.35","$3,044.80",$0.00,$595.64,$0.00,$605.92,$0.00
27805817,EAP,HCPCS C1874,,Stent Coron 38mm 3mm .034-.029in 5fr Everolimus,"$3,996.00",$0.00,"$3,996.00","$1,798.20","$2,851.95",$0.00,$688.49,"$2,851.95","$2,851.95",$699.67,"$3,996.00",$0.00,"$1,998.00","$3,164.83","$3,196.80",$0.00,$625.37,$0.00,$636.16,$0.00
27805818,EAP,HCPCS C1874,,Stent Coron 8mm 3.25mm .034-.029in 5fr Everolimus,"$3,806.00",$0.00,"$3,806.00","$1,712.70","$2,716.34",$0.00,$655.75,"$2,716.34","$2,716.34",$666.40,"$3,806.00",$0.00,"$1,903.00","$3,014.35","$3,044.80",$0.00,$595.64,$0.00,$605.92,$0.00
27805819,EAP,HCPCS C1874,,Stent Coron 12mm 3.25mm .034-.029in 5fr Everolimus,"$3,806.00",$0.00,"$3,806.00","$1,712.70","$2,716.34",$0.00,$655.75,"$2,716.34","$2,716.34",$666.40,"$3,806.00",$0.00,"$1,903.00","$3,014.35","$3,044.80",$0.00,$595.64,$0.00,$605.92,$0.00
27805820,EAP,HCPCS C1874,,Stent Coron 15mm 3.25mm .034-.029in 5fr Everolimus,"$3,806.00",$0.00,"$3,806.00","$1,712.70","$2,716.34",$0.00,$655.75,"$2,716.34","$2,716.34",$666.40,"$3,806.00",$0.00,"$1,903.00","$3,014.35","$3,044.80",$0.00,$595.64,$0.00,$605.92,$0.00
27805821,EAP,HCPCS C1874,,Stent Coron 18mm 3.25mm .034-.029in 5fr Everolimus,"$3,806.00",$0.00,"$3,806.00","$1,712.70","$2,716.34",$0.00,$655.75,"$2,716.34","$2,716.34",$666.40,"$3,806.00",$0.00,"$1,903.00","$3,014.35","$3,044.80",$0.00,$595.64,$0.00,$605.92,$0.00
27805822,EAP,HCPCS C1874,,Stent Coron 23mm 3.25mm .034-.029in 5fr Everolimus,"$3,806.00",$0.00,"$3,806.00","$1,712.70","$2,716.34",$0.00,$655.75,"$2,716.34","$2,716.34",$666.40,"$3,806.00",$0.00,"$1,903.00","$3,014.35","$3,044.80",$0.00,$595.64,$0.00,$605.92,$0.00
27805823,EAP,HCPCS C1874,,Stent Coron 28mm 3.25mm .034-.029in 5fr Everolimus,"$3,806.00",$0.00,"$3,806.00","$1,712.70","$2,716.34",$0.00,$655.75,"$2,716.34","$2,716.34",$666.40,"$3,806.00",$0.00,"$1,903.00","$3,014.35","$3,044.80",$0.00,$595.64,$0.00,$605.92,$0.00
27805824,EAP,HCPCS C1874,,Stent Coron 33mm 3.25mm .034-.029in 5fr Everolimus,"$3,996.00",$0.00,"$3,996.00","$1,798.20","$2,851.95",$0.00,$688.49,"$2,851.95","$2,851.95",$699.67,"$3,996.00",$0.00,"$1,998.00","$3,164.83","$3,196.80",$0.00,$625.37,$0.00,$636.16,$0.00
27805825,EAP,HCPCS C1874,,Stent Coron 38mm 3.25mm .034-.029in 5fr Everolimus,"$3,806.00",$0.00,"$3,806.00","$1,712.70","$2,716.34",$0.00,$655.75,"$2,716.34","$2,716.34",$666.40,"$3,806.00",$0.00,"$1,903.00","$3,014.35","$3,044.80",$0.00,$595.64,$0.00,$605.92,$0.00
27805826,EAP,HCPCS C1874,,Stent Coron 8mm 3.5mm .034-.029in 5fr Everolimus,"$3,806.00",$0.00,"$3,806.00","$1,712.70","$2,716.34",$0.00,$655.75,"$2,716.34","$2,716.34",$666.40,"$3,806.00",$0.00,"$1,903.00","$3,014.35","$3,044.80",$0.00,$595.64,$0.00,$605.92,$0.00
27805827,EAP,HCPCS C1874,,Stent Coron 12mm 3.5mm .034-.029in 5fr Everolimus,"$3,996.00",$0.00,"$3,996.00","$1,798.20","$2,851.95",$0.00,$688.49,"$2,851.95","$2,851.95",$699.67,"$3,996.00",$0.00,"$1,998.00","$3,164.83","$3,196.80",$0.00,$625.37,$0.00,$636.16,$0.00
27805828,EAP,HCPCS C1874,,Stent Coron 15mm 3.5mm .034-.029in 5fr Everolimus,"$3,806.00",$0.00,"$3,806.00","$1,712.70","$2,716.34",$0.00,$655.75,"$2,716.34","$2,716.34",$666.40,"$3,806.00",$0.00,"$1,903.00","$3,014.35","$3,044.80",$0.00,$595.64,$0.00,$605.92,$0.00
27805829,EAP,HCPCS C1874,,Stent Coron 18mm 3.5mm .034-.029in 5fr Everolimus,"$3,806.00",$0.00,"$3,806.00","$1,712.70","$2,716.34",$0.00,$655.75,"$2,716.34","$2,716.34",$666.40,"$3,806.00",$0.00,"$1,903.00","$3,014.35","$3,044.80",$0.00,$595.64,$0.00,$605.92,$0.00
27805830,EAP,HCPCS C1874,,Stent Coron 23mm 3.5mm .034-.029in 5fr Everolimus,"$3,996.00",$0.00,"$3,996.00","$1,798.20","$2,851.95",$0.00,$688.49,"$2,851.95","$2,851.95",$699.67,"$3,996.00",$0.00,"$1,998.00","$3,164.83","$3,196.80",$0.00,$625.37,$0.00,$636.16,$0.00
27805831,EAP,HCPCS C1874,,Stent Coron 28mm 3.5mm .034-.029in 5fr Everolimus,"$3,806.00",$0.00,"$3,806.00","$1,712.70","$2,716.34",$0.00,$655.75,"$2,716.34","$2,716.34",$666.40,"$3,806.00",$0.00,"$1,903.00","$3,014.35","$3,044.80",$0.00,$595.64,$0.00,$605.92,$0.00
27805832,EAP,HCPCS C1874,,Stent Coron 33mm 3.5mm .034-.029in 5fr Everolimus,"$3,806.00",$0.00,"$3,806.00","$1,712.70","$2,716.34",$0.00,$655.75,"$2,716.34","$2,716.34",$666.40,"$3,806.00",$0.00,"$1,903.00","$3,014.35","$3,044.80",$0.00,$595.64,$0.00,$605.92,$0.00
27805833,EAP,HCPCS C1874,,Stent Coron 38mm 3.5mm .034-.029in 5fr Everolimus,"$3,996.00",$0.00,"$3,996.00","$1,798.20","$2,851.95",$0.00,$688.49,"$2,851.95","$2,851.95",$699.67,"$3,996.00",$0.00,"$1,998.00","$3,164.83","$3,196.80",$0.00,$625.37,$0.00,$636.16,$0.00
27805834,EAP,HCPCS C1877,,Stent Trchbr 15mm 14fr 5cm Introd Slf Xpd Gnt Rsch,"$5,249.00",$0.00,"$5,249.00","$2,362.05","$3,746.21",$0.00,$904.38,"$3,746.21","$3,746.21",$919.06,"$5,249.00",$0.00,"$2,624.50","$4,157.21","$4,199.20",$0.00,$821.47,$0.00,$835.64,$0.00
27805836,EAP,HCPCS C1877,,Stent Trchbr 20mm 16fr 5cm Introd Slf Xpd Gnt Rsch,"$5,249.00",$0.00,"$5,249.00","$2,362.05","$3,746.21",$0.00,$904.38,"$3,746.21","$3,746.21",$919.06,"$5,249.00",$0.00,"$2,624.50","$4,157.21","$4,199.20",$0.00,$821.47,$0.00,$835.64,$0.00
27805837,EAP,HCPCS C1877,,Stent Trchbr 25mm 16fr 5cm Introd Slf Xpd Gnt Rsch,"$5,249.00",$0.00,"$5,249.00","$2,362.05","$3,746.21",$0.00,$904.38,"$3,746.21","$3,746.21",$919.06,"$5,249.00",$0.00,"$2,624.50","$4,157.21","$4,199.20",$0.00,$821.47,$0.00,$835.64,$0.00
27805838,EAP,HCPCS C1877,,Stent Trchbr 30mm 16fr 5cm Introd Slf Xpd Gnt Rsch,"$5,249.00",$0.00,"$5,249.00","$2,362.05","$3,746.21",$0.00,$904.38,"$3,746.21","$3,746.21",$919.06,"$5,249.00",$0.00,"$2,624.50","$4,157.21","$4,199.20",$0.00,$821.47,$0.00,$835.64,$0.00
27805839,EAP,HCPCS C1877,,Stent Trchbr 35mm 16fr 5cm Introd Slf Xpd Gnt Rsch,"$5,249.00",$0.00,"$5,249.00","$2,362.05","$3,746.21",$0.00,$904.38,"$3,746.21","$3,746.21",$919.06,"$5,249.00",$0.00,"$2,624.50","$4,157.21","$4,199.20",$0.00,$821.47,$0.00,$835.64,$0.00
27805841,EAP,HCPCS C1874,,Stent Coron 8mm 4mm 2.3-2.7fr Everolimus Elut Pltn,"$3,412.00",$0.00,"$3,412.00","$1,535.40","$2,435.14",$0.00,$587.87,"$2,435.14","$2,435.14",$597.41,"$3,412.00",$0.00,"$1,706.00","$2,702.30","$2,729.60",$0.00,$533.98,$0.00,$543.19,$0.00
27805842,EAP,HCPCS C1874,,Stent Coron 12mm 4mm 2.3-2.7fr Everolimus Elut,"$3,412.00",$0.00,"$3,412.00","$1,535.40","$2,435.14",$0.00,$587.87,"$2,435.14","$2,435.14",$597.41,"$3,412.00",$0.00,"$1,706.00","$2,702.30","$2,729.60",$0.00,$533.98,$0.00,$543.19,$0.00
27805843,EAP,HCPCS C1874,,Stent Coron 16mm 4mm 2.3-2.7fr Everolimus Elut,"$3,412.00",$0.00,"$3,412.00","$1,535.40","$2,435.14",$0.00,$587.87,"$2,435.14","$2,435.14",$597.41,"$3,412.00",$0.00,"$1,706.00","$2,702.30","$2,729.60",$0.00,$533.98,$0.00,$543.19,$0.00
27805844,EAP,HCPCS C1874,,Stent Coron 20mm 4mm 2.3-2.7fr Everolimus Elut,"$3,412.00",$0.00,"$3,412.00","$1,535.40","$2,435.14",$0.00,$587.87,"$2,435.14","$2,435.14",$597.41,"$3,412.00",$0.00,"$1,706.00","$2,702.30","$2,729.60",$0.00,$533.98,$0.00,$543.19,$0.00
27805845,EAP,HCPCS C1874,,Stent Coron 24mm 4mm 2.3-2.7fr Everolimus Elut,"$3,412.00",$0.00,"$3,412.00","$1,535.40","$2,435.14",$0.00,$587.87,"$2,435.14","$2,435.14",$597.41,"$3,412.00",$0.00,"$1,706.00","$2,702.30","$2,729.60",$0.00,$533.98,$0.00,$543.19,$0.00
27805846,EAP,HCPCS C1874,,Stent Coron 28mm 4mm 2.3-2.7fr Everolimus Elut,"$3,412.00",$0.00,"$3,412.00","$1,535.40","$2,435.14",$0.00,$587.87,"$2,435.14","$2,435.14",$597.41,"$3,412.00",$0.00,"$1,706.00","$2,702.30","$2,729.60",$0.00,$533.98,$0.00,$543.19,$0.00
27805847,EAP,HCPCS C1874,,Stent Coron 32mm 4mm 2.3-2.7fr Everolimus Elut,"$3,412.00",$0.00,"$3,412.00","$1,535.40","$2,435.14",$0.00,$587.87,"$2,435.14","$2,435.14",$597.41,"$3,412.00",$0.00,"$1,706.00","$2,702.30","$2,729.60",$0.00,$533.98,$0.00,$543.19,$0.00
27805848,EAP,HCPCS C1874,,Stent Coron 38mm 4mm 2.3-2.7fr Everolimus Elut,"$3,412.00",$0.00,"$3,412.00","$1,535.40","$2,435.14",$0.00,$587.87,"$2,435.14","$2,435.14",$597.41,"$3,412.00",$0.00,"$1,706.00","$2,702.30","$2,729.60",$0.00,$533.98,$0.00,$543.19,$0.00
27805850,EAP,HCPCS C1900,,Lead Pcng 78cm 5.3fr 5.1fr .014-.018in Lv Qdpl,"$5,840.00",$0.00,"$5,840.00",$0.00,"$4,168.01",$0.00,"$1,006.20","$4,168.01","$4,168.01",$0.00,"$5,840.00",$0.00,"$2,920.00","$4,625.28","$4,672.00",$0.00,$913.96,$0.00,$0.00,$0.00
27805851,EAP,HCPCS C1900,,Lead Pcng Lv Atn Starfix,"$5,840.00",$0.00,"$5,840.00",$0.00,"$4,168.01",$0.00,"$1,006.20","$4,168.01","$4,168.01",$0.00,"$5,840.00",$0.00,"$2,920.00","$4,625.28","$4,672.00",$0.00,$913.96,$0.00,$0.00,$0.00
27805852,EAP,HCPCS C1900,,Lead Pcng 78cm 5.3fr 5.1fr .014-.018in Offst S Lv,"$5,840.00",$0.00,"$5,840.00",$0.00,"$4,168.01",$0.00,"$1,006.20","$4,168.01","$4,168.01",$0.00,"$5,840.00",$0.00,"$2,920.00","$4,625.28","$4,672.00",$0.00,$913.96,$0.00,$0.00,$0.00
27805853,EAP,HCPCS C1900,,Lead Pcng 88cm 5.3fr 5.1fr .014-.018in Offst S Lv,"$5,840.00",$0.00,"$5,840.00",$0.00,"$4,168.01",$0.00,"$1,006.20","$4,168.01","$4,168.01",$0.00,"$5,840.00",$0.00,"$2,920.00","$4,625.28","$4,672.00",$0.00,$913.96,$0.00,$0.00,$0.00
27805856,EAP,HCPCS C1874,,Stent Coron 16mm 4mm 2.3-2.7fr Everolimus Elut,"$34,227.00",$0.00,"$34,227.00","$15,402.15","$5,158.80",$0.00,"$5,897.14","$5,158.80","$24,427.81","$5,992.87","$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,"$5,356.53",$0.00,"$5,448.94",$0.00
27805860,EAP,HCPCS C1767,,Generator Esurg Demipulse Ncp,"$57,141.00",$0.00,"$57,141.00",$0.00,"$5,158.80",$0.00,"$8,138.89","$5,158.80","$40,781.53",$0.00,"$57,141.00",$0.00,"$28,570.50","$45,255.67","$45,712.80",$0.00,"$7,751.33",$0.00,$0.00,$0.00
27805861,EAP,HCPCS C1778,,Lead Nrstm 43cm 3mm Perenniaflex Vagus Nrv Sil,"$17,920.00",$0.00,"$17,920.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$12,789.50",$0.00,"$17,920.00",$0.00,"$8,960.00","$14,192.64","$14,336.00",$0.00,$0.00,$0.00,$0.00,$0.00
27805862,EAP,HCPCS C1876,,"Stnt Trchbr 9mm 7fr 59mm 120cm .035"" Cvd Ult Lw Cx","$6,591.00",$0.00,"$6,591.00","$2,965.95","$4,704.00",$0.00,"$1,135.60","$4,704.00","$4,704.00","$1,154.03","$6,591.00",$0.00,"$3,295.50","$5,220.07","$5,272.80",$0.00,"$1,031.49",$0.00,"$1,049.29",$0.00
27805863,EAP,Custom 27805863,,Pipeline Embol. Device 3.00mm X 25mm,"$36,219.00",$0.00,"$36,219.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,849.50",$0.00,"$36,219.00",$0.00,"$18,109.50","$28,685.45","$28,975.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805864,EAP,Custom 27805864,,Pipeline Embol. Device 3.00mm X 30mm,"$36,219.00",$0.00,"$36,219.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,849.50",$0.00,"$36,219.00",$0.00,"$18,109.50","$28,685.45","$28,975.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805865,EAP,Custom 27805865,,Pipeline Embol. Device 3.00mm X 35mm,"$36,219.00",$0.00,"$36,219.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,849.50",$0.00,"$36,219.00",$0.00,"$18,109.50","$28,685.45","$28,975.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805866,EAP,Custom 27805866,,Pipeline Embol. Device 3.25mm X 25mm,"$36,219.00",$0.00,"$36,219.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,849.50",$0.00,"$36,219.00",$0.00,"$18,109.50","$28,685.45","$28,975.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805867,EAP,Custom 27805867,,Pipeline Embol. Device 3.25mm X 30mm,"$36,219.00",$0.00,"$36,219.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,849.50",$0.00,"$36,219.00",$0.00,"$18,109.50","$28,685.45","$28,975.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805868,EAP,Custom 27805868,,Pipeline Embol. Device 3.25mm X 35mm,"$36,219.00",$0.00,"$36,219.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,849.50",$0.00,"$36,219.00",$0.00,"$18,109.50","$28,685.45","$28,975.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805869,EAP,Custom 27805869,,Pipeline Embol. Device 3.50mm X 25mm,"$36,219.00",$0.00,"$36,219.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,849.50",$0.00,"$36,219.00",$0.00,"$18,109.50","$28,685.45","$28,975.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805870,EAP,Custom 27805870,,Pipeline Embol. Device 3.50mm X 30mm,"$36,219.00",$0.00,"$36,219.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,849.50",$0.00,"$36,219.00",$0.00,"$18,109.50","$28,685.45","$28,975.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805871,EAP,Custom 27805871,,Pipeline Embol. Device 3.50mm X 35mm,"$36,219.00",$0.00,"$36,219.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,849.50",$0.00,"$36,219.00",$0.00,"$18,109.50","$28,685.45","$28,975.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805872,EAP,Custom 27805872,,Pipeline Embol. Device 3.75mm X 25mm,"$36,219.00",$0.00,"$36,219.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,849.50",$0.00,"$36,219.00",$0.00,"$18,109.50","$28,685.45","$28,975.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805873,EAP,Custom 27805873,,Pipeline Embol. Device 3.75mm X 30mm,"$36,219.00",$0.00,"$36,219.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,849.50",$0.00,"$36,219.00",$0.00,"$18,109.50","$28,685.45","$28,975.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805874,EAP,Custom 27805874,,Pipeline Embol. Device 3.75mm X 35mm,"$36,219.00",$0.00,"$36,219.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,849.50",$0.00,"$36,219.00",$0.00,"$18,109.50","$28,685.45","$28,975.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805875,EAP,Custom 27805875,,Pipeline Embol. Device 4.00mm X 25mm,"$36,219.00",$0.00,"$36,219.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,849.50",$0.00,"$36,219.00",$0.00,"$18,109.50","$28,685.45","$28,975.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805876,EAP,Custom 27805876,,Pipeline Embol. Device 4.00mm X 30mm,"$36,219.00",$0.00,"$36,219.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,849.50",$0.00,"$36,219.00",$0.00,"$18,109.50","$28,685.45","$28,975.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805877,EAP,Custom 27805877,,Pipeline Embol. Device 4.00mm X 35mm,"$36,219.00",$0.00,"$36,219.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,849.50",$0.00,"$36,219.00",$0.00,"$18,109.50","$28,685.45","$28,975.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805878,EAP,Custom 27805878,,Pipeline Embol. Device 4.25mm X 25mm,"$36,219.00",$0.00,"$36,219.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,849.50",$0.00,"$36,219.00",$0.00,"$18,109.50","$28,685.45","$28,975.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805879,EAP,Custom 27805879,,Pipeline Embol. Device 4.25mm X 30mm,"$36,219.00",$0.00,"$36,219.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,849.50",$0.00,"$36,219.00",$0.00,"$18,109.50","$28,685.45","$28,975.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805880,EAP,Custom 27805880,,Pipeline Embol. Device 4.25mm X 35mm,"$36,219.00",$0.00,"$36,219.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,849.50",$0.00,"$36,219.00",$0.00,"$18,109.50","$28,685.45","$28,975.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805881,EAP,Custom 27805881,,Pipeline Embol. Device 4.50mm X 25mm,"$36,219.00",$0.00,"$36,219.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,849.50",$0.00,"$36,219.00",$0.00,"$18,109.50","$28,685.45","$28,975.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805882,EAP,Custom 27805882,,Pipeline Embol. Device 4.50mm X 30mm,"$36,219.00",$0.00,"$36,219.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,849.50",$0.00,"$36,219.00",$0.00,"$18,109.50","$28,685.45","$28,975.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805883,EAP,Custom 27805883,,Pipeline Embol. Device 4.50mm X 35mm,"$36,219.00",$0.00,"$36,219.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,849.50",$0.00,"$36,219.00",$0.00,"$18,109.50","$28,685.45","$28,975.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805884,EAP,Custom 27805884,,Pipeline Embol. Device 4.75mm X 25mm,"$36,219.00",$0.00,"$36,219.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,849.50",$0.00,"$36,219.00",$0.00,"$18,109.50","$28,685.45","$28,975.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805885,EAP,Custom 27805885,,Pipeline Embol. Device 4.75mm X 30mm,"$36,219.00",$0.00,"$36,219.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,849.50",$0.00,"$36,219.00",$0.00,"$18,109.50","$28,685.45","$28,975.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805886,EAP,Custom 27805886,,Pipeline Embol. Device 4.75mm X 35mm,"$36,219.00",$0.00,"$36,219.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,849.50",$0.00,"$36,219.00",$0.00,"$18,109.50","$28,685.45","$28,975.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805887,EAP,Custom 27805887,,Pipeline Embol. Device 5.00mm X 25mm,"$36,219.00",$0.00,"$36,219.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,849.50",$0.00,"$36,219.00",$0.00,"$18,109.50","$28,685.45","$28,975.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805888,EAP,Custom 27805888,,Pipeline Embol. Device 5.00mm X 30mm,"$36,219.00",$0.00,"$36,219.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,849.50",$0.00,"$36,219.00",$0.00,"$18,109.50","$28,685.45","$28,975.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805889,EAP,Custom 27805889,,Pipeline Embol. Device 5.00mm X 35mm,"$36,219.00",$0.00,"$36,219.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,849.50",$0.00,"$36,219.00",$0.00,"$18,109.50","$28,685.45","$28,975.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805890,EAP,Custom 27805890,,Pipeline Embol. Device 2.50mm X 10mm,"$33,856.00",$0.00,"$33,856.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,163.03",$0.00,"$33,856.00",$0.00,"$16,928.00","$26,813.95","$27,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805891,EAP,Custom 27805891,,Pipeline Embol. Device 2.50mm X 12mm,"$33,856.00",$0.00,"$33,856.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,163.03",$0.00,"$33,856.00",$0.00,"$16,928.00","$26,813.95","$27,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805892,EAP,Custom 27805892,,Pipeline Embol. Device 2.50mm X 14mm,"$33,856.00",$0.00,"$33,856.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,163.03",$0.00,"$33,856.00",$0.00,"$16,928.00","$26,813.95","$27,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805893,EAP,Custom 27805893,,Pipeline Embol. Device 2.50mm X 16mm,"$33,856.00",$0.00,"$33,856.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,163.03",$0.00,"$33,856.00",$0.00,"$16,928.00","$26,813.95","$27,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805894,EAP,Custom 27805894,,Pipeline Embol. Device 2.50mm X 18mm,"$33,856.00",$0.00,"$33,856.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,163.03",$0.00,"$33,856.00",$0.00,"$16,928.00","$26,813.95","$27,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805895,EAP,Custom 27805895,,Pipeline Embol. Device 2.50mm X 20mm,"$33,856.00",$0.00,"$33,856.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,163.03",$0.00,"$33,856.00",$0.00,"$16,928.00","$26,813.95","$27,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805896,EAP,Custom 27805896,,Pipeline Embol. Device 2.75mm X 10mm,"$33,856.00",$0.00,"$33,856.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,163.03",$0.00,"$33,856.00",$0.00,"$16,928.00","$26,813.95","$27,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805897,EAP,Custom 27805897,,Pipeline Embol. Device 2.75mm X 12mm,"$33,856.00",$0.00,"$33,856.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,163.03",$0.00,"$33,856.00",$0.00,"$16,928.00","$26,813.95","$27,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805898,EAP,Custom 27805898,,Pipeline Embol. Device 2.75mm X 14mm,"$33,856.00",$0.00,"$33,856.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,163.03",$0.00,"$33,856.00",$0.00,"$16,928.00","$26,813.95","$27,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805899,EAP,Custom 27805899,,Pipeline Embol. Device 2.75mm X 16mm,"$33,856.00",$0.00,"$33,856.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,163.03",$0.00,"$33,856.00",$0.00,"$16,928.00","$26,813.95","$27,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805900,EAP,Custom 27805900,,Pipeline Embol. Device 2.75mm X 18mm,"$33,856.00",$0.00,"$33,856.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,163.03",$0.00,"$33,856.00",$0.00,"$16,928.00","$26,813.95","$27,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805901,EAP,Custom 27805901,,Pipeline Embol. Device 2.75mm X 20mm,"$33,856.00",$0.00,"$33,856.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,163.03",$0.00,"$33,856.00",$0.00,"$16,928.00","$26,813.95","$27,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805902,EAP,Custom 27805902,,Pipeline Embol. Device 3.00mm X 10mm,"$33,856.00",$0.00,"$33,856.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,163.03",$0.00,"$33,856.00",$0.00,"$16,928.00","$26,813.95","$27,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805903,EAP,Custom 27805903,,Pipeline Embol. Device 3.00mm X 12mm,"$33,856.00",$0.00,"$33,856.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,163.03",$0.00,"$33,856.00",$0.00,"$16,928.00","$26,813.95","$27,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805904,EAP,Custom 27805904,,Pipeline Embol. Device 3.00mm X 14mm,"$33,856.00",$0.00,"$33,856.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,163.03",$0.00,"$33,856.00",$0.00,"$16,928.00","$26,813.95","$27,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805905,EAP,Custom 27805905,,Pipeline Embol. Device 3.00mm X 16mm,"$33,856.00",$0.00,"$33,856.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,163.03",$0.00,"$33,856.00",$0.00,"$16,928.00","$26,813.95","$27,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805906,EAP,Custom 27805906,,Pipeline Embol. Device 3.00mm X 18mm,"$33,856.00",$0.00,"$33,856.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,163.03",$0.00,"$33,856.00",$0.00,"$16,928.00","$26,813.95","$27,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805907,EAP,Custom 27805907,,Pipeline Embol. Device 3.00mm X 20mm,"$33,856.00",$0.00,"$33,856.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,163.03",$0.00,"$33,856.00",$0.00,"$16,928.00","$26,813.95","$27,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805908,EAP,Custom 27805908,,Pipeline Embol. Device 3.25mm X 10mm,"$33,856.00",$0.00,"$33,856.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,163.03",$0.00,"$33,856.00",$0.00,"$16,928.00","$26,813.95","$27,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805909,EAP,Custom 27805909,,Pipeline Embol. Device 3.25mm X 12mm,"$33,856.00",$0.00,"$33,856.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,163.03",$0.00,"$33,856.00",$0.00,"$16,928.00","$26,813.95","$27,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805910,EAP,Custom 27805910,,Pipeline Embol. Device 3.25mm X 14mm,"$33,856.00",$0.00,"$33,856.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,163.03",$0.00,"$33,856.00",$0.00,"$16,928.00","$26,813.95","$27,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805911,EAP,Custom 27805911,,Pipeline Embol. Device 3.25mm X 16mm,"$33,856.00",$0.00,"$33,856.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,163.03",$0.00,"$33,856.00",$0.00,"$16,928.00","$26,813.95","$27,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805912,EAP,Custom 27805912,,Pipeline Embol. Device 3.25mm X 18mm,"$33,856.00",$0.00,"$33,856.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,163.03",$0.00,"$33,856.00",$0.00,"$16,928.00","$26,813.95","$27,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805913,EAP,Custom 27805913,,Pipeline Embol. Device 3.25mm X 20mm,"$33,856.00",$0.00,"$33,856.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,163.03",$0.00,"$33,856.00",$0.00,"$16,928.00","$26,813.95","$27,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805914,EAP,Custom 27805914,,Pipeline Embol. Device 3.50mm X 10mm,"$33,856.00",$0.00,"$33,856.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,163.03",$0.00,"$33,856.00",$0.00,"$16,928.00","$26,813.95","$27,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805915,EAP,Custom 27805915,,Pipeline Embol. Device 3.50mm X 12mm,"$33,856.00",$0.00,"$33,856.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,163.03",$0.00,"$33,856.00",$0.00,"$16,928.00","$26,813.95","$27,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805916,EAP,Custom 27805916,,Pipeline Embol. Device 3.50mm X 14mm,"$33,856.00",$0.00,"$33,856.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,163.03",$0.00,"$33,856.00",$0.00,"$16,928.00","$26,813.95","$27,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805917,EAP,Custom 27805917,,Pipeline Embol. Device 3.50mm X 16mm,"$33,856.00",$0.00,"$33,856.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,163.03",$0.00,"$33,856.00",$0.00,"$16,928.00","$26,813.95","$27,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805918,EAP,Custom 27805918,,Pipeline Embol. Device 3.50mm X 18mm,"$33,856.00",$0.00,"$33,856.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,163.03",$0.00,"$33,856.00",$0.00,"$16,928.00","$26,813.95","$27,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805919,EAP,Custom 27805919,,Pipeline Embol. Device 3.50mm X 20mm,"$33,856.00",$0.00,"$33,856.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,163.03",$0.00,"$33,856.00",$0.00,"$16,928.00","$26,813.95","$27,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805920,EAP,Custom 27805920,,Pipeline Embol. Device 3.75mm X 10mm,"$33,856.00",$0.00,"$33,856.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,163.03",$0.00,"$33,856.00",$0.00,"$16,928.00","$26,813.95","$27,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805921,EAP,Custom 27805921,,Pipeline Embol. Device 3.75mm X 12mm,"$33,856.00",$0.00,"$33,856.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,163.03",$0.00,"$33,856.00",$0.00,"$16,928.00","$26,813.95","$27,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805922,EAP,Custom 27805922,,Pipeline Embol. Device 3.75mm X 14mm,"$33,856.00",$0.00,"$33,856.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,163.03",$0.00,"$33,856.00",$0.00,"$16,928.00","$26,813.95","$27,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805923,EAP,Custom 27805923,,Pipeline Embol. Device 3.75mm X 16mm,"$33,856.00",$0.00,"$33,856.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,163.03",$0.00,"$33,856.00",$0.00,"$16,928.00","$26,813.95","$27,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805924,EAP,Custom 27805924,,Pipeline Embol. Device 3.75mm X 18mm,"$33,856.00",$0.00,"$33,856.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,163.03",$0.00,"$33,856.00",$0.00,"$16,928.00","$26,813.95","$27,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805925,EAP,Custom 27805925,,Pipeline Embol. Device 3.75mm X 20mm,"$33,856.00",$0.00,"$33,856.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,163.03",$0.00,"$33,856.00",$0.00,"$16,928.00","$26,813.95","$27,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805926,EAP,Custom 27805926,,Pipeline Embol. Device 4.00mm X 10mm,"$33,856.00",$0.00,"$33,856.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,163.03",$0.00,"$33,856.00",$0.00,"$16,928.00","$26,813.95","$27,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805927,EAP,Custom 27805927,,Pipeline Embol. Device 4.00mm X 12mm,"$33,856.00",$0.00,"$33,856.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,163.03",$0.00,"$33,856.00",$0.00,"$16,928.00","$26,813.95","$27,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805928,EAP,Custom 27805928,,Pipeline Embol. Device 4.00mm X 14mm,"$33,856.00",$0.00,"$33,856.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,163.03",$0.00,"$33,856.00",$0.00,"$16,928.00","$26,813.95","$27,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805929,EAP,Custom 27805929,,Pipeline Embol. Device 4.00mm X 16mm,"$33,856.00",$0.00,"$33,856.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,163.03",$0.00,"$33,856.00",$0.00,"$16,928.00","$26,813.95","$27,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805930,EAP,Custom 27805930,,Pipeline Embol. Device 4.00mm X 18mm,"$33,856.00",$0.00,"$33,856.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,163.03",$0.00,"$33,856.00",$0.00,"$16,928.00","$26,813.95","$27,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805931,EAP,Custom 27805931,,Pipeline Embol. Device 4.00mm X 20mm,"$33,856.00",$0.00,"$33,856.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,163.03",$0.00,"$33,856.00",$0.00,"$16,928.00","$26,813.95","$27,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805932,EAP,Custom 27805932,,Pipeline Embol. Device 4.25mm X 10mm,"$33,856.00",$0.00,"$33,856.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,163.03",$0.00,"$33,856.00",$0.00,"$16,928.00","$26,813.95","$27,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805933,EAP,Custom 27805933,,Pipeline Embol. Device 4.25mm X 12mm,"$33,856.00",$0.00,"$33,856.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,163.03",$0.00,"$33,856.00",$0.00,"$16,928.00","$26,813.95","$27,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805934,EAP,Custom 27805934,,Pipeline Embol. Device 4.25mm X 14mm,"$33,856.00",$0.00,"$33,856.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,163.03",$0.00,"$33,856.00",$0.00,"$16,928.00","$26,813.95","$27,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805935,EAP,Custom 27805935,,Pipeline Embol. Device 4.25mm X 16mm,"$33,856.00",$0.00,"$33,856.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,163.03",$0.00,"$33,856.00",$0.00,"$16,928.00","$26,813.95","$27,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805936,EAP,Custom 27805936,,Pipeline Embol. Device 4.25mm X 18mm,"$33,856.00",$0.00,"$33,856.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,163.03",$0.00,"$33,856.00",$0.00,"$16,928.00","$26,813.95","$27,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805937,EAP,Custom 27805937,,Pipeline Embol. Device 4.25mm X 20mm,"$33,856.00",$0.00,"$33,856.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,163.03",$0.00,"$33,856.00",$0.00,"$16,928.00","$26,813.95","$27,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805938,EAP,Custom 27805938,,Pipeline Embol. Device 4.50mm X 10mm,"$33,856.00",$0.00,"$33,856.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,163.03",$0.00,"$33,856.00",$0.00,"$16,928.00","$26,813.95","$27,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805939,EAP,Custom 27805939,,Pipeline Embol. Device 4.50mm X 12mm,"$33,856.00",$0.00,"$33,856.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,163.03",$0.00,"$33,856.00",$0.00,"$16,928.00","$26,813.95","$27,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805940,EAP,Custom 27805940,,Pipeline Embol. Device 4.50mm X 14mm,"$33,856.00",$0.00,"$33,856.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,163.03",$0.00,"$33,856.00",$0.00,"$16,928.00","$26,813.95","$27,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805941,EAP,Custom 27805941,,Pipeline Embol. Device 4.50mm X 16mm,"$33,856.00",$0.00,"$33,856.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,163.03",$0.00,"$33,856.00",$0.00,"$16,928.00","$26,813.95","$27,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805942,EAP,Custom 27805942,,Pipeline Embol. Device 4.50mm X 18mm,"$33,856.00",$0.00,"$33,856.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,163.03",$0.00,"$33,856.00",$0.00,"$16,928.00","$26,813.95","$27,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805943,EAP,Custom 27805943,,Pipeline Embol. Device 4.50mm X 20mm,"$33,856.00",$0.00,"$33,856.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,163.03",$0.00,"$33,856.00",$0.00,"$16,928.00","$26,813.95","$27,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805944,EAP,Custom 27805944,,Pipeline Embol. Device 4.75mm X 10mm,"$33,856.00",$0.00,"$33,856.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,163.03",$0.00,"$33,856.00",$0.00,"$16,928.00","$26,813.95","$27,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805945,EAP,Custom 27805945,,Pipeline Embol. Device 4.75mm X 12mm,"$33,856.00",$0.00,"$33,856.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,163.03",$0.00,"$33,856.00",$0.00,"$16,928.00","$26,813.95","$27,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805946,EAP,Custom 27805946,,Pipeline Embol. Device 4.75mm X 14mm,"$33,856.00",$0.00,"$33,856.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,163.03",$0.00,"$33,856.00",$0.00,"$16,928.00","$26,813.95","$27,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805947,EAP,Custom 27805947,,Pipeline Embol. Device 4.75mm X 16mm,"$33,856.00",$0.00,"$33,856.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,163.03",$0.00,"$33,856.00",$0.00,"$16,928.00","$26,813.95","$27,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805948,EAP,Custom 27805948,,Pipeline Embol. Device 4.75mm X 18mm,"$33,856.00",$0.00,"$33,856.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,163.03",$0.00,"$33,856.00",$0.00,"$16,928.00","$26,813.95","$27,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805949,EAP,Custom 27805949,,Pipeline Embol. Device 4.75mm X 20mm,"$33,856.00",$0.00,"$33,856.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,163.03",$0.00,"$33,856.00",$0.00,"$16,928.00","$26,813.95","$27,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805950,EAP,Custom 27805950,,Pipeline Embol. Device 5.00mm X 10mm,"$33,856.00",$0.00,"$33,856.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,163.03",$0.00,"$33,856.00",$0.00,"$16,928.00","$26,813.95","$27,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805951,EAP,Custom 27805951,,Pipeline Embol. Device 5.00mm X 12mm,"$33,856.00",$0.00,"$33,856.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,163.03",$0.00,"$33,856.00",$0.00,"$16,928.00","$26,813.95","$27,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805952,EAP,Custom 27805952,,Pipeline Embol. Device 5.00mm X 14mm,"$33,856.00",$0.00,"$33,856.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,163.03",$0.00,"$33,856.00",$0.00,"$16,928.00","$26,813.95","$27,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805953,EAP,Custom 27805953,,Pipeline Embol. Device 5.00mm X 16mm,"$33,856.00",$0.00,"$33,856.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,163.03",$0.00,"$33,856.00",$0.00,"$16,928.00","$26,813.95","$27,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805954,EAP,Custom 27805954,,Pipeline Embol. Device 5.00mm X 18mm,"$33,856.00",$0.00,"$33,856.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,163.03",$0.00,"$33,856.00",$0.00,"$16,928.00","$26,813.95","$27,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805955,EAP,Custom 27805955,,Pipeline Embol. Device 5.00mm X 20mm,"$33,856.00",$0.00,"$33,856.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,163.03",$0.00,"$33,856.00",$0.00,"$16,928.00","$26,813.95","$27,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
27805956,EAP,Custom 27805956,,"Pipeline Flex, 3.00mm X 25mm","$36,689.00",$0.00,"$36,689.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$26,184.94",$0.00,"$36,689.00",$0.00,"$18,344.50","$29,057.69","$29,351.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805957,EAP,Custom 27805957,,"Pipeline Flex, 3.00mm X 30mm","$36,689.00",$0.00,"$36,689.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$26,184.94",$0.00,"$36,689.00",$0.00,"$18,344.50","$29,057.69","$29,351.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805958,EAP,Custom 27805958,,"Pipeline Flex, 3.00mm X 35mm","$36,689.00",$0.00,"$36,689.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$26,184.94",$0.00,"$36,689.00",$0.00,"$18,344.50","$29,057.69","$29,351.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805959,EAP,Custom 27805959,,"Pipeline Flex, 3.25mm X 25mm","$36,689.00",$0.00,"$36,689.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$26,184.94",$0.00,"$36,689.00",$0.00,"$18,344.50","$29,057.69","$29,351.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805960,EAP,Custom 27805960,,"Pipeline Flex, 3.25mm X 30mm","$36,689.00",$0.00,"$36,689.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$26,184.94",$0.00,"$36,689.00",$0.00,"$18,344.50","$29,057.69","$29,351.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805961,EAP,Custom 27805961,,"Pipeline Flex, 3.25mm X 35mm","$36,689.00",$0.00,"$36,689.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$26,184.94",$0.00,"$36,689.00",$0.00,"$18,344.50","$29,057.69","$29,351.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805962,EAP,Custom 27805962,,"Pipeline Flex, 3.50mm X 25mm","$36,689.00",$0.00,"$36,689.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$26,184.94",$0.00,"$36,689.00",$0.00,"$18,344.50","$29,057.69","$29,351.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805963,EAP,Custom 27805963,,"Pipeline Flex, 3.50mm X 30mm","$36,689.00",$0.00,"$36,689.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$26,184.94",$0.00,"$36,689.00",$0.00,"$18,344.50","$29,057.69","$29,351.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805964,EAP,Custom 27805964,,"Pipeline Flex, 3.50mm X 35mm","$36,689.00",$0.00,"$36,689.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$26,184.94",$0.00,"$36,689.00",$0.00,"$18,344.50","$29,057.69","$29,351.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805965,EAP,Custom 27805965,,"Pipeline Flex, 3.75mm X 25mm","$36,689.00",$0.00,"$36,689.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$26,184.94",$0.00,"$36,689.00",$0.00,"$18,344.50","$29,057.69","$29,351.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805966,EAP,Custom 27805966,,"Pipeline Flex, 3.75mm X 30mm","$36,689.00",$0.00,"$36,689.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$26,184.94",$0.00,"$36,689.00",$0.00,"$18,344.50","$29,057.69","$29,351.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805967,EAP,Custom 27805967,,"Pipeline Flex, 3.75mm X 35mm","$36,689.00",$0.00,"$36,689.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$26,184.94",$0.00,"$36,689.00",$0.00,"$18,344.50","$29,057.69","$29,351.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805968,EAP,Custom 27805968,,"Pipeline Flex, 4.00mm X 25mm","$36,689.00",$0.00,"$36,689.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$26,184.94",$0.00,"$36,689.00",$0.00,"$18,344.50","$29,057.69","$29,351.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805969,EAP,Custom 27805969,,"Pipeline Flex, 4.00mm X 30mm","$36,689.00",$0.00,"$36,689.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$26,184.94",$0.00,"$36,689.00",$0.00,"$18,344.50","$29,057.69","$29,351.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805970,EAP,Custom 27805970,,"Pipeline Flex, 4.00mm X 35mm","$36,689.00",$0.00,"$36,689.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$26,184.94",$0.00,"$36,689.00",$0.00,"$18,344.50","$29,057.69","$29,351.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805971,EAP,Custom 27805971,,"Pipeline Flex, 4.25mm X 25mm","$36,689.00",$0.00,"$36,689.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$26,184.94",$0.00,"$36,689.00",$0.00,"$18,344.50","$29,057.69","$29,351.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805972,EAP,Custom 27805972,,"Pipeline Flex, 4.25mm X 30mm","$36,689.00",$0.00,"$36,689.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$26,184.94",$0.00,"$36,689.00",$0.00,"$18,344.50","$29,057.69","$29,351.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805973,EAP,Custom 27805973,,"Pipeline Flex, 4.25mm X 35mm","$36,689.00",$0.00,"$36,689.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$26,184.94",$0.00,"$36,689.00",$0.00,"$18,344.50","$29,057.69","$29,351.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805974,EAP,Custom 27805974,,"Pipeline Flex, 4.50mm X 25mm","$36,689.00",$0.00,"$36,689.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$26,184.94",$0.00,"$36,689.00",$0.00,"$18,344.50","$29,057.69","$29,351.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805975,EAP,Custom 27805975,,"Pipeline Flex, 4.50mm X 30mm","$36,689.00",$0.00,"$36,689.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$26,184.94",$0.00,"$36,689.00",$0.00,"$18,344.50","$29,057.69","$29,351.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805976,EAP,Custom 27805976,,"Pipeline Flex, 4.50mm X 35mm","$36,689.00",$0.00,"$36,689.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$26,184.94",$0.00,"$36,689.00",$0.00,"$18,344.50","$29,057.69","$29,351.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805977,EAP,Custom 27805977,,"Pipeline Flex, 4.75mm X 25mm","$36,689.00",$0.00,"$36,689.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$26,184.94",$0.00,"$36,689.00",$0.00,"$18,344.50","$29,057.69","$29,351.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805978,EAP,Custom 27805978,,"Pipeline Flex, 4.75mm X 30mm","$36,689.00",$0.00,"$36,689.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$26,184.94",$0.00,"$36,689.00",$0.00,"$18,344.50","$29,057.69","$29,351.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805979,EAP,Custom 27805979,,"Pipeline Flex, 4.75mm X 35mm","$36,689.00",$0.00,"$36,689.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$26,184.94",$0.00,"$36,689.00",$0.00,"$18,344.50","$29,057.69","$29,351.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805980,EAP,Custom 27805980,,"Pipeline Flex, 5.00mm X 25mm","$36,689.00",$0.00,"$36,689.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$26,184.94",$0.00,"$36,689.00",$0.00,"$18,344.50","$29,057.69","$29,351.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805981,EAP,Custom 27805981,,"Pipeline Flex, 5.00mm X 30mm","$36,689.00",$0.00,"$36,689.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$26,184.94",$0.00,"$36,689.00",$0.00,"$18,344.50","$29,057.69","$29,351.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805982,EAP,Custom 27805982,,"Pipeline Flex, 5.00mm X 35mm","$36,689.00",$0.00,"$36,689.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$26,184.94",$0.00,"$36,689.00",$0.00,"$18,344.50","$29,057.69","$29,351.20",$0.00,$0.00,$0.00,$0.00,$0.00
27805983,EAP,Custom 27805983,,"Pipeline Flex, 2.50mm X 10mm","$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805984,EAP,Custom 27805984,,"Pipeline Flex, 2.50mm X 12mm","$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805985,EAP,Custom 27805985,,"Pipeline Flex, 2.50mm X 14mm","$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805986,EAP,Custom 27805986,,"Pipeline Flex, 2.50mm X 16mm","$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805987,EAP,Custom 27805987,,"Pipeline Flex, 2.50mm X 18mm","$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805988,EAP,Custom 27805988,,"Pipeline Flex, 2.50mm X 20mm","$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805989,EAP,Custom 27805989,,"Pipeline Flex, 2.75mm X 10mm","$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805990,EAP,Custom 27805990,,"Pipeline Flex, 2.75mm X 12mm","$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805991,EAP,Custom 27805991,,"Pipeline Flex, 2.75mm X 14mm","$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805992,EAP,Custom 27805992,,"Pipeline Flex, 2.75mm X 16mm","$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805993,EAP,Custom 27805993,,"Pipeline Flex, 2.75mm X 18mm","$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805994,EAP,Custom 27805994,,"Pipeline Flex, 2.75mm X 20mm","$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805995,EAP,Custom 27805995,,"Pipeline Flex, 3.00mm X 10mm","$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805996,EAP,Custom 27805996,,"Pipeline Flex, 3.00mm X 12mm","$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805997,EAP,Custom 27805997,,"Pipeline Flex, 3.00mm X 14mm","$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805998,EAP,Custom 27805998,,"Pipeline Flex, 3.00mm X 16mm","$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27805999,EAP,Custom 27805999,,"Pipeline Flex, 3.00mm X 18mm","$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806000,EAP,Custom 27806000,,"Pipeline Flex, 3.00mm X 20mm","$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806001,EAP,Custom 27806001,,"Pipeline Flex, 3.25mm X 10mm","$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806002,EAP,Custom 27806002,,"Pipeline Flex, 3.25mm X 12mm","$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806003,EAP,Custom 27806003,,"Pipeline Flex, 3.25mm X 14mm","$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806004,EAP,Custom 27806004,,"Pipeline Flex, 3.25mm X 16mm","$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806005,EAP,Custom 27806005,,"Pipeline Flex, 3.25mm X 18mm","$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806006,EAP,Custom 27806006,,"Pipeline Flex, 3.25mm X 20mm","$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806007,EAP,Custom 27806007,,"Pipeline Flex, 3.50mm X 10mm","$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806008,EAP,Custom 27806008,,"Pipeline Flex, 3.50mm X 12mm","$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806009,EAP,Custom 27806009,,"Pipeline Flex, 3.50mm X 14mm","$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806010,EAP,Custom 27806010,,"Pipeline Flex, 3.50mm X 16mm","$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806011,EAP,Custom 27806011,,"Pipeline Flex, 3.50mm X 18mm","$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806012,EAP,Custom 27806012,,"Pipeline Flex, 3.50mm X 20mm","$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806013,EAP,Custom 27806013,,"Pipeline Flex, 3.75mm X 10mm","$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806014,EAP,Custom 27806014,,"Pipeline Flex, 3.75mm X 12mm","$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806015,EAP,Custom 27806015,,"Pipeline Flex, 3.75mm X 14mm","$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806016,EAP,Custom 27806016,,"Pipeline Flex, 3.75mm X 16mm","$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806017,EAP,Custom 27806017,,"Pipeline Flex, 3.75mm X 18mm","$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806018,EAP,Custom 27806018,,"Pipeline Flex, 3.75mm X 20mm","$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806019,EAP,Custom 27806019,,"Pipeline Flex, 4.00mm X 10mm","$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806020,EAP,Custom 27806020,,"Pipeline Flex, 4.00mm X 12mm","$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806021,EAP,Custom 27806021,,"Pipeline Flex, 4.00mm X 14mm","$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806022,EAP,Custom 27806022,,"Pipeline Flex, 4.00mm X 16mm","$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806023,EAP,Custom 27806023,,"Pipeline Flex, 4.00mm X 18mm","$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806024,EAP,Custom 27806024,,"Pipeline Flex, 4.00mm X 20mm","$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806025,EAP,Custom 27806025,,"Pipeline Flex, 4.25mm X 10mm","$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806026,EAP,Custom 27806026,,"Pipeline Flex, 4.25mm X 12mm","$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806027,EAP,Custom 27806027,,"Pipeline Flex, 4.25mm X 14mm","$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806028,EAP,Custom 27806028,,"Pipeline Flex, 4.25mm X 16mm","$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806029,EAP,Custom 27806029,,"Pipeline Flex, 4.25mm X 18mm","$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806030,EAP,Custom 27806030,,"Pipeline Flex, 4.25mm X 20mm","$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806031,EAP,Custom 27806031,,"Pipeline Flex, 4.50mm X 10mm","$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806032,EAP,Custom 27806032,,"Pipeline Flex, 4.50mm X 12mm","$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806033,EAP,Custom 27806033,,"Pipeline Flex, 4.50mm X 14mm","$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806034,EAP,Custom 27806034,,"Pipeline Flex, 4.50mm X 16mm","$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806035,EAP,Custom 27806035,,"Pipeline Flex, 4.50mm X 18mm","$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806036,EAP,Custom 27806036,,"Pipeline Flex, 4.50mm X 20mm","$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806037,EAP,Custom 27806037,,"Pipeline Flex, 4.75mm X 10mm","$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806038,EAP,Custom 27806038,,"Pipeline Flex, 4.75mm X 12mm","$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806039,EAP,Custom 27806039,,"Pipeline Flex, 4.75mm X 14mm","$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806040,EAP,Custom 27806040,,"Pipeline Flex, 4.75mm X 16mm","$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806041,EAP,Custom 27806041,,"Pipeline Flex, 4.75mm X 18mm","$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806042,EAP,Custom 27806042,,"Pipeline Flex, 4.75mm X 20mm","$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806043,EAP,Custom 27806043,,"Pipeline Flex, 5.00mm X 10mm","$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806044,EAP,Custom 27806044,,"Pipeline Flex, 5.00mm X 12mm","$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806045,EAP,Custom 27806045,,"Pipeline Flex, 5.00mm X 14mm","$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806046,EAP,Custom 27806046,,"Pipeline Flex, 5.00mm X 16mm","$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806047,EAP,Custom 27806047,,"Pipeline Flex, 5.00mm X 18mm","$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806048,EAP,Custom 27806048,,"Pipeline Flex, 5.00mm X 20mm","$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806050,EAP,Custom 27806050,,Device Embl  25mm 3mm  Pipeline Flx 55d Nrvsc 75%,"$36,689.00",$0.00,"$36,689.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$26,184.94",$0.00,"$36,689.00",$0.00,"$18,344.50","$29,057.69","$29,351.20",$0.00,$0.00,$0.00,$0.00,$0.00
27806051,EAP,Custom 27806051,,DEVICE EMBL  30MM 3MM  PIPELINE FLX 55D NRVSC 75%,"$36,689.00",$0.00,"$36,689.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$26,184.94",$0.00,"$36,689.00",$0.00,"$18,344.50","$29,057.69","$29,351.20",$0.00,$0.00,$0.00,$0.00,$0.00
27806052,EAP,Custom 27806052,,DEVICE EMBL  35MM 3MM  PIPELINE FLX 55D NRVSC 75%,"$36,689.00",$0.00,"$36,689.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$26,184.94",$0.00,"$36,689.00",$0.00,"$18,344.50","$29,057.69","$29,351.20",$0.00,$0.00,$0.00,$0.00,$0.00
27806053,EAP,Custom 27806053,,DEVICE EMBL  25MM 3.25MM  PIPELINE FLX 55D NRVSC 75%,"$36,689.00",$0.00,"$36,689.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$26,184.94",$0.00,"$36,689.00",$0.00,"$18,344.50","$29,057.69","$29,351.20",$0.00,$0.00,$0.00,$0.00,$0.00
27806054,EAP,Custom 27806054,,DEVICE EMBL  30MM 3.25MM  PIPELINE FLX 55D NRVSC 75%,"$36,689.00",$0.00,"$36,689.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$26,184.94",$0.00,"$36,689.00",$0.00,"$18,344.50","$29,057.69","$29,351.20",$0.00,$0.00,$0.00,$0.00,$0.00
27806055,EAP,Custom 27806055,,DEVICE EMBL  35MM 3.25MM  PIPELINE FLX 55D NRVSC 75%,"$36,689.00",$0.00,"$36,689.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$26,184.94",$0.00,"$36,689.00",$0.00,"$18,344.50","$29,057.69","$29,351.20",$0.00,$0.00,$0.00,$0.00,$0.00
27806056,EAP,Custom 27806056,,DEVICE EMBL  25MM 3.5MM  PIPELINE FLX 55D NRVSC 75%,"$36,689.00",$0.00,"$36,689.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$26,184.94",$0.00,"$36,689.00",$0.00,"$18,344.50","$29,057.69","$29,351.20",$0.00,$0.00,$0.00,$0.00,$0.00
27806057,EAP,Custom 27806057,,DEVICE EMBL  30MM 3.5MM  PIPELINE FLX 55D NRVSC 75%,"$36,689.00",$0.00,"$36,689.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$26,184.94",$0.00,"$36,689.00",$0.00,"$18,344.50","$29,057.69","$29,351.20",$0.00,$0.00,$0.00,$0.00,$0.00
27806058,EAP,Custom 27806058,,DEVICE EMBL  35MM 3.5MM  PIPELINE FLX 55D NRVSC 75%,"$36,689.00",$0.00,"$36,689.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$26,184.94",$0.00,"$36,689.00",$0.00,"$18,344.50","$29,057.69","$29,351.20",$0.00,$0.00,$0.00,$0.00,$0.00
27806059,EAP,Custom 27806059,,DEVICE EMBL  25MM 3.75MM  PIPELINE FLX 55D NRVSC 75%,"$36,689.00",$0.00,"$36,689.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$26,184.94",$0.00,"$36,689.00",$0.00,"$18,344.50","$29,057.69","$29,351.20",$0.00,$0.00,$0.00,$0.00,$0.00
27806060,EAP,Custom 27806060,,DEVICE EMBL  30MM 3.75MM  PIPELINE FLX 55D NRVSC 75%,"$36,689.00",$0.00,"$36,689.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$26,184.94",$0.00,"$36,689.00",$0.00,"$18,344.50","$29,057.69","$29,351.20",$0.00,$0.00,$0.00,$0.00,$0.00
27806061,EAP,Custom 27806061,,DEVICE EMBL  35MM 3.75MM  PIPELINE FLX 55D NRVSC 75%,"$36,689.00",$0.00,"$36,689.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$26,184.94",$0.00,"$36,689.00",$0.00,"$18,344.50","$29,057.69","$29,351.20",$0.00,$0.00,$0.00,$0.00,$0.00
27806062,EAP,Custom 27806062,,DEVICE EMBL  25MM 4MM  PIPELINE FLX 55D NRVSC 75%,"$36,689.00",$0.00,"$36,689.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$26,184.94",$0.00,"$36,689.00",$0.00,"$18,344.50","$29,057.69","$29,351.20",$0.00,$0.00,$0.00,$0.00,$0.00
27806063,EAP,Custom 27806063,,DEVICE EMBL  30MM 4MM  PIPELINE FLX 55D NRVSC 75%,"$36,689.00",$0.00,"$36,689.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$26,184.94",$0.00,"$36,689.00",$0.00,"$18,344.50","$29,057.69","$29,351.20",$0.00,$0.00,$0.00,$0.00,$0.00
27806064,EAP,Custom 27806064,,DEVICE EMBL  35MM 4MM  PIPELINE FLX 55D NRVSC 75%,"$36,689.00",$0.00,"$36,689.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$26,184.94",$0.00,"$36,689.00",$0.00,"$18,344.50","$29,057.69","$29,351.20",$0.00,$0.00,$0.00,$0.00,$0.00
27806065,EAP,Custom 27806065,,DEVICE EMBL  25MM 4.25MM  PIPELINE FLX 55D NRVSC 75%,"$36,689.00",$0.00,"$36,689.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$26,184.94",$0.00,"$36,689.00",$0.00,"$18,344.50","$29,057.69","$29,351.20",$0.00,$0.00,$0.00,$0.00,$0.00
27806066,EAP,Custom 27806066,,DEVICE EMBL  30MM 4.25MM  PIPELINE FLX 55D NRVSC 75%,"$36,689.00",$0.00,"$36,689.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$26,184.94",$0.00,"$36,689.00",$0.00,"$18,344.50","$29,057.69","$29,351.20",$0.00,$0.00,$0.00,$0.00,$0.00
27806067,EAP,Custom 27806067,,DEVICE EMBL  35MM 4.25MM  PIPELINE FLX 55D NRVSC 75%,"$36,689.00",$0.00,"$36,689.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$26,184.94",$0.00,"$36,689.00",$0.00,"$18,344.50","$29,057.69","$29,351.20",$0.00,$0.00,$0.00,$0.00,$0.00
27806068,EAP,Custom 27806068,,DEVICE EMBL  30MM 4.5MM  PIPELINE FLX 55D NRVSC 75%,"$36,689.00",$0.00,"$36,689.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$26,184.94",$0.00,"$36,689.00",$0.00,"$18,344.50","$29,057.69","$29,351.20",$0.00,$0.00,$0.00,$0.00,$0.00
27806069,EAP,Custom 27806069,,DEVICE EMBL  35MM 4.5MM  PIPELINE FLX 55D NRVSC 75%,"$36,689.00",$0.00,"$36,689.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$26,184.94",$0.00,"$36,689.00",$0.00,"$18,344.50","$29,057.69","$29,351.20",$0.00,$0.00,$0.00,$0.00,$0.00
27806070,EAP,Custom 27806070,,DEVICE EMBL  25MM 4.75MM  PIPELINE FLX 55D NRVSC 75%,"$36,689.00",$0.00,"$36,689.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$26,184.94",$0.00,"$36,689.00",$0.00,"$18,344.50","$29,057.69","$29,351.20",$0.00,$0.00,$0.00,$0.00,$0.00
27806071,EAP,Custom 27806071,,DEVICE EMBL  30MM 4.75MM  PIPELINE FLX 55D NRVSC 75%,"$36,689.00",$0.00,"$36,689.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$26,184.94",$0.00,"$36,689.00",$0.00,"$18,344.50","$29,057.69","$29,351.20",$0.00,$0.00,$0.00,$0.00,$0.00
27806072,EAP,Custom 27806072,,DEVICE EMBL  35MM 4.75MM  PIPELINE FLX 55D NRVSC 75%,"$36,689.00",$0.00,"$36,689.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$26,184.94",$0.00,"$36,689.00",$0.00,"$18,344.50","$29,057.69","$29,351.20",$0.00,$0.00,$0.00,$0.00,$0.00
27806073,EAP,Custom 27806073,,DEVICE EMBL  25MM 5MM  PIPELINE FLX 55D NRVSC 75%,"$36,689.00",$0.00,"$36,689.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$26,184.94",$0.00,"$36,689.00",$0.00,"$18,344.50","$29,057.69","$29,351.20",$0.00,$0.00,$0.00,$0.00,$0.00
27806074,EAP,Custom 27806074,,DEVICE EMBL  30MM 5MM  PIPELINE FLX 55D NRVSC 75%,"$36,689.00",$0.00,"$36,689.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$26,184.94",$0.00,"$36,689.00",$0.00,"$18,344.50","$29,057.69","$29,351.20",$0.00,$0.00,$0.00,$0.00,$0.00
27806075,EAP,Custom 27806075,,DEVICE EMBL  35MM 5MM  PIPELINE FLX 55D NRVSC 75%,"$36,689.00",$0.00,"$36,689.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$26,184.94",$0.00,"$36,689.00",$0.00,"$18,344.50","$29,057.69","$29,351.20",$0.00,$0.00,$0.00,$0.00,$0.00
27806076,EAP,Custom 27806076,,DEVICE EMBL  10MM 2.5MM  PIPELINE FLX 55D NRVSC 75%,"$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806077,EAP,Custom 27806077,,DEVICE EMBL  12MM 2.5MM  PIPELINE FLX 55D NRVSC 75%,"$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806078,EAP,Custom 27806078,,DEVICE EMBL  16MM 2.5MM  PIPELINE FLX 55D NRVSC 75%,"$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806079,EAP,Custom 27806079,,DEVICE EMBL  18MM 2.5MM  PIPELINE FLX 55D NRVSC 75%,"$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806080,EAP,Custom 27806080,,DEVICE EMBL  20MM 2.5MM  PIPELINE FLX 55D NRVSC 75%,"$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806081,EAP,Custom 27806081,,DEVICE EMBL  10MM 2.75MM  PIPELINE FLX 55D NRVSC 75%,"$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806082,EAP,Custom 27806082,,DEVICE EMBL  12MM 2.75MM  PIPELINE FLX 55D NRVSC 75%,"$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806083,EAP,Custom 27806083,,DEVICE EMBL  14MM 2.75MM  PIPELINE FLX 55D NRVSC 75%,"$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806084,EAP,Custom 27806084,,DEVICE EMBL  16MM 2.75MM  PIPELINE FLX 55D NRVSC 75%,"$35,938.00",$0.00,"$35,938.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$25,648.95",$0.00,"$35,938.00",$0.00,"$17,969.00","$28,462.90","$28,750.40",$0.00,$0.00,$0.00,$0.00,$0.00
27806085,EAP,Custom 27806085,,DEVICE EMBL  18MM 2.75MM  PIPELINE FLX 55D NRVSC 75%,"$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806086,EAP,Custom 27806086,,DEVICE EMBL  20MM 2.75MM  PIPELINE FLX 55D NRVSC 75%,"$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806087,EAP,Custom 27806087,,DEVICE EMBL  10MM 3MM  PIPELINE FLX 55D NRVSC 75%,"$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806088,EAP,Custom 27806088,,DEVICE EMBL  12MM 3MM  PIPELINE FLX 55D NRVSC 75%,"$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806089,EAP,Custom 27806089,,DEVICE EMBL  14MM 3MM  PIPELINE FLX 55D NRVSC 75%,"$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806090,EAP,Custom 27806090,,DEVICE EMBL  16MM 3MM  PIPELINE FLX 55D NRVSC 75%,"$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806091,EAP,Custom 27806091,,DEVICE EMBL  18MM 3MM  PIPELINE FLX 55D NRVSC 75%,"$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806092,EAP,Custom 27806092,,DEVICE EMBL  20MM 3MM  PIPELINE FLX 55D NRVSC 75%,"$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806093,EAP,Custom 27806093,,DEVICE EMBL  10MM 3.25MM  PIPELINE FLX 55D NRVSC 75%,"$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806094,EAP,Custom 27806094,,DEVICE EMBL  12MM 3.25MM  PIPELINE FLX 55D NRVSC 75%,"$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806095,EAP,Custom 27806095,,DEVICE EMBL  14MM 3.25MM  PIPELINE FLX 55D NRVSC 75%,"$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806096,EAP,Custom 27806096,,DEVICE EMBL  16MM 3.25MM  PIPELINE FLX 55D NRVSC 75%,"$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806097,EAP,Custom 27806097,,DEVICE EMBL  18MM 3.25MM  PIPELINE FLX 55D NRVSC 75%,"$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806098,EAP,Custom 27806098,,DEVICE EMBL  20MM 3.25MM  PIPELINE FLX 55D NRVSC 75%,"$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806099,EAP,Custom 27806099,,DEVICE EMBL  10MM 3.5MM  PIPELINE FLX 55D NRVSC 75%,"$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806100,EAP,Custom 27806100,,DEVICE EMBL  12MM 3.5MM  PIPELINE FLX 55D NRVSC 75%,"$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806101,EAP,Custom 27806101,,DEVICE EMBL  14MM 3.5MM  PIPELINE FLX 55D NRVSC 75%,"$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806102,EAP,Custom 27806102,,DEVICE EMBL  16MM 3.5MM  PIPELINE FLX 55D NRVSC 75%,"$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806103,EAP,Custom 27806103,,DEVICE EMBL  18MM 3.5MM  PIPELINE FLX 55D NRVSC 75%,"$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806104,EAP,Custom 27806104,,DEVICE EMBL  20MM 3.5MM  PIPELINE FLX 55D NRVSC 75%,"$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806105,EAP,Custom 27806105,,DEVICE EMBL  10MM 3.75MM  PIPELINE FLX 55D NRVSC 75%,"$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806106,EAP,Custom 27806106,,DEVICE EMBL  12MM 3.75MM  PIPELINE FLX 55D NRVSC 75%,"$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806107,EAP,Custom 27806107,,DEVICE EMBL  14MM 3.75MM  PIPELINE FLX 55D NRVSC 75%,"$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806108,EAP,Custom 27806108,,DEVICE EMBL  16MM 3.75MM  PIPELINE FLX 55D NRVSC 75%,"$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806109,EAP,Custom 27806109,,DEVICE EMBL  18MM 3.75MM  PIPELINE FLX 55D NRVSC 75%,"$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806110,EAP,Custom 27806110,,DEVICE EMBL  20MM 3.75MM  PIPELINE FLX 55D NRVSC 75%,"$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806111,EAP,Custom 27806111,,DEVICE EMBL  10MM 4MM  PIPELINE FLX 55D NRVSC 75%,"$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806112,EAP,Custom 27806112,,DEVICE EMBL  12MM 4MM  PIPELINE FLX 55D NRVSC 75%,"$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806113,EAP,Custom 27806113,,DEVICE EMBL  14MM 4MM  PIPELINE FLX 55D NRVSC 75%,"$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806114,EAP,Custom 27806114,,DEVICE EMBL  16MM 4MM  PIPELINE FLX 55D NRVSC 75%,"$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806115,EAP,Custom 27806115,,DEVICE EMBL  18MM 4MM  PIPELINE FLX 55D NRVSC 75%,"$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806116,EAP,Custom 27806116,,DEVICE EMBL  20MM 4MM  PIPELINE FLX 55D NRVSC 75%,"$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806117,EAP,Custom 27806117,,DEVICE EMBL  10MM 4.25MM  PIPELINE FLX 55D NRVSC 75%,"$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806118,EAP,Custom 27806118,,DEVICE EMBL  12MM 4.25MM  PIPELINE FLX 55D NRVSC 75%,"$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806119,EAP,Custom 27806119,,DEVICE EMBL  14MM 4.25MM  PIPELINE FLX 55D NRVSC 75%,"$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806120,EAP,Custom 27806120,,DEVICE EMBL  16MM 4.25MM  PIPELINE FLX 55D NRVSC 75%,"$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806121,EAP,Custom 27806121,,DEVICE EMBL  18MM 4.25MM  PIPELINE FLX 55D NRVSC 75%,"$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806122,EAP,Custom 27806122,,DEVICE EMBL  20MM 4.25MM  PIPELINE FLX 55D NRVSC 75%,"$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806123,EAP,Custom 27806123,,DEVICE EMBL  10MM 4.5MM  PIPELINE FLX 55D NRVSC 75%,"$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806124,EAP,Custom 27806124,,DEVICE EMBL  12MM 4.5MM  PIPELINE FLX 55D NRVSC 75%,"$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806125,EAP,Custom 27806125,,DEVICE EMBL  14MM 4.5MM  PIPELINE FLX 55D NRVSC 75%,"$34,227.00",$0.00,"$27,107.78",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$27,107.78",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
27806126,EAP,Custom 27806126,,DEVICE EMBL  16MM 4.5MM  PIPELINE FLX 55D NRVSC 75%,"$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806127,EAP,Custom 27806127,,DEVICE EMBL  18MM 4.5MM  PIPELINE FLX 55D NRVSC 75%,"$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806128,EAP,Custom 27806128,,DEVICE EMBL  20MM 4.5MM  PIPELINE FLX 55D NRVSC 75%,"$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806129,EAP,Custom 27806129,,DEVICE EMBL  10MM 4.75MM  PIPELINE FLX 55D NRVSC 75%,"$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806130,EAP,Custom 27806130,,DEVICE EMBL  12MM 4.75MM  PIPELINE FLX 55D NRVSC 75%,"$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806131,EAP,Custom 27806131,,DEVICE EMBL  14MM 4.75MM  PIPELINE FLX 55D NRVSC 75%,"$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806132,EAP,Custom 27806132,,DEVICE EMBL  16MM 4.75MM  PIPELINE FLX 55D NRVSC 75%,"$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806133,EAP,Custom 27806133,,DEVICE EMBL  18MM 4.75MM  PIPELINE FLX 55D NRVSC 75%,"$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806134,EAP,Custom 27806134,,DEVICE EMBL  10MM 5MM  PIPELINE FLX 55D NRVSC 75%,"$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806135,EAP,Custom 27806135,,DEVICE EMBL  12MM 5MM  PIPELINE FLX 55D NRVSC 75%,"$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806136,EAP,Custom 27806136,,DEVICE EMBL  14MM 5MM  PIPELINE FLX 55D NRVSC 75%,"$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806137,EAP,Custom 27806137,,DEVICE EMBL  16MM 5MM  PIPELINE FLX 55D NRVSC 75%,"$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806138,EAP,Custom 27806138,,DEVICE EMBL  18MM 5MM  PIPELINE FLX 55D NRVSC 75%,"$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806139,EAP,Custom 27806139,,DEVICE EMBL  20MM 5MM  PIPELINE FLX 55D NRVSC 75%,"$34,227.00",$0.00,"$34,227.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$24,427.81",$0.00,"$34,227.00",$0.00,"$17,113.50","$27,107.78","$27,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
27806156,EAP,HCPCS C2625,,Stent Uret 10.2fr 28cm Pgtl Curve Lp Radiopq Sdprt,$281.00,$0.00,$281.00,$126.45,$200.55,$0.00,$48.41,$200.55,$200.55,$49.20,$281.00,$0.00,$140.50,$222.55,$224.80,$0.00,$43.98,$0.00,$44.74,$0.00
27806157,EAP,HCPCS C1876,,Stent Vasc 4.5mm 6fr 20mm 120cm Otw Slf Expandable,"$4,988.00",$0.00,"$4,988.00","$2,244.60","$3,559.94",$0.00,$859.41,"$3,559.94","$3,559.94",$873.36,"$4,988.00",$0.00,"$2,494.00","$3,950.50","$3,990.40",$0.00,$780.62,$0.00,$794.09,$0.00
27806158,EAP,HCPCS C1876,,Stent Vasc 4.5mm 6fr 30mm 120cm Otw Slf Expandable,"$4,988.00",$0.00,"$4,988.00","$2,244.60","$3,559.94",$0.00,$859.41,"$3,559.94","$3,559.94",$873.36,"$4,988.00",$0.00,"$2,494.00","$3,950.50","$3,990.40",$0.00,$780.62,$0.00,$794.09,$0.00
27806159,EAP,HCPCS C1876,,Stent Bil 4.5mm 6fr 40mm 120cm Brd Slf Xpd Rapex,"$4,988.00",$0.00,"$4,988.00","$2,244.60","$3,559.94",$0.00,$859.41,"$3,559.94","$3,559.94",$873.36,"$4,988.00",$0.00,"$2,494.00","$3,950.50","$3,990.40",$0.00,$780.62,$0.00,$794.09,$0.00
27806165,EAP,HCPCS C1769,,Coil Embl 8cm 4mm .0125in Axium 1 Hand Op Dtch,$575.00,$0.00,$575.00,$258.75,$410.38,$0.00,$99.07,$410.38,$410.38,$100.68,$575.00,$0.00,$287.50,$455.40,$460.00,$0.00,$89.99,$0.00,$91.54,$0.00
27806166,EAP,HCPCS C1880,,Coil Embl 30cm 8mm Helipaq 18 Mciol Hlcl Loop Dtch,"$1,000.00",$0.00,"$1,000.00",$450.00,$713.70,$0.00,$172.30,$713.70,$713.70,$175.09,"$1,000.00",$0.00,$500.00,$792.00,$800.00,$0.00,$156.50,$0.00,$159.20,$0.00
27806167,EAP,HCPCS C1887,,Coil Embl 6cm 3mm .0115in Axium 1 Hand Op Dtch,"$1,668.00",$0.00,"$1,668.00",$750.60,"$1,190.45",$0.00,$287.39,"$1,190.45","$1,190.45",$292.05,"$1,668.00",$0.00,$834.00,"$1,321.06","$1,334.40",$0.00,$261.04,$0.00,$265.55,$0.00
27806168,EAP,HCPCS C1887,,Coil Embl 50cm 25mm .0145in Axium 1 Hand Op Dtch,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,"$1,124.08","$1,124.08",$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
27806169,EAP,Custom 27806169,,System Embolization Nonadhesive Delivery Syringe Lower,"$5,908.00",$0.00,"$5,908.00",$0.00,"$4,216.54",$0.00,$0.00,"$4,216.54","$4,216.54",$0.00,"$5,908.00",$0.00,"$2,954.00","$4,679.14","$4,726.40",$0.00,$0.00,$0.00,$0.00,$0.00
27806170,EAP,Custom 27806170,,Coil Embolization Sphere 10mm 30cm 10 Microcoil Spherical,"$2,830.00",$0.00,"$2,830.00",$0.00,"$2,019.77",$0.00,$0.00,"$2,019.77","$2,019.77",$0.00,"$2,830.00",$0.00,"$1,415.00","$2,241.36","$2,264.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806171,EAP,Custom 27806171,,Coil Embolization 9mm 14cm 14 Microcoil 2 Helical Multiple,"$2,960.00",$0.00,"$2,960.00",$0.00,"$2,112.55",$0.00,$0.00,"$2,112.55","$2,112.55",$0.00,"$2,960.00",$0.00,"$1,480.00","$2,344.32","$2,368.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806172,EAP,Custom 27806172,,Coil Embl 10cm 2mm Deltapaq 10 Mciol Loop Dtch Sft Rst Dflc,"$2,294.00",$0.00,"$2,294.00",$0.00,"$1,637.23",$0.00,$0.00,"$1,637.23","$1,637.23",$0.00,"$2,294.00",$0.00,"$1,147.00","$1,816.85","$1,835.20",$0.00,$0.00,$0.00,$0.00,$0.00
27806173,EAP,Custom 27806173,,Coil Embolization 4mm 6cm 10 Microcoil Stretch Resistant,"$2,294.00",$0.00,"$2,294.00",$0.00,"$1,637.23",$0.00,$0.00,"$1,637.23","$1,637.23",$0.00,"$2,294.00",$0.00,"$1,147.00","$1,816.85","$1,835.20",$0.00,$0.00,$0.00,$0.00,$0.00
27806174,EAP,Custom 27806174,,Coil Embolization 8mm 30cm 18 Microcoil Helical Loop,"$1,358.00",$0.00,"$1,358.00",$0.00,$969.20,$0.00,$0.00,$969.20,$969.20,$0.00,"$1,358.00",$0.00,$679.00,"$1,075.54","$1,086.40",$0.00,$0.00,$0.00,$0.00,$0.00
27806175,EAP,Custom 27806175,,Coil Embolization Helix 4mm .0125in 8cm 1 Hand Operation,"$1,893.00",$0.00,"$1,893.00",$0.00,"$1,351.03",$0.00,$0.00,"$1,351.03","$1,351.03",$0.00,"$1,893.00",$0.00,$946.50,"$1,499.26","$1,514.40",$0.00,$0.00,$0.00,$0.00,$0.00
27806176,EAP,Custom 27806176,,Coil Embolization 3d 3mm .0115in 6cm 1 Hand Operation,"$2,555.00",$0.00,"$2,555.00",$0.00,"$1,823.50",$0.00,$0.00,"$1,823.50","$1,823.50",$0.00,"$2,555.00",$0.00,"$1,277.50","$2,023.56","$2,044.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806177,EAP,Custom 27806177,,Coil Embolization 3d 25mm .0145in 50cm 1 Hand Operation,"$2,555.00",$0.00,"$2,555.00",$0.00,"$1,823.50",$0.00,$0.00,"$1,823.50","$1,823.50",$0.00,"$2,555.00",$0.00,"$1,277.50","$2,023.56","$2,044.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806178,EAP,HCPCS C1757,,System Dlv Angjt Pwr Pls Y Spk Irr 1 Wy Stpck Thrmb Cath,$425.00,$0.00,$425.00,$0.00,$303.32,$0.00,$0.00,$303.32,$303.32,$0.00,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$0.00,$0.00,$0.00,$0.00
27806179,EAP,HCPCS C1874,,Stent Vascular 4.5mm 28mm W/o Distal Tip Enterprise Nitinol,"$13,910.00",$0.00,"$13,910.00","$6,259.50","$5,158.80",$0.00,"$2,396.62","$5,158.80","$9,927.57","$2,435.53","$13,910.00",$0.00,"$6,955.00","$11,016.72","$11,128.00",$0.00,"$2,176.92",$0.00,"$2,214.47",$0.00
27806180,EAP,HCPCS C1874,,Stent Vascular 4.5mm 37mm W/o Distal Tip Enterprise Nitinol,"$13,910.00",$0.00,"$13,910.00","$6,259.50","$5,158.80",$0.00,"$2,396.62","$5,158.80","$9,927.57","$2,435.53","$13,910.00",$0.00,"$6,955.00","$11,016.72","$11,128.00",$0.00,"$2,176.92",$0.00,"$2,214.47",$0.00
27806181,EAP,HCPCS C1769,,Guidewire Vascular J .014in 205cm 42cm Soft Tip Steerable,"$1,150.00",$0.00,"$1,150.00",$517.50,$820.76,$0.00,$198.14,$820.76,$820.76,$201.36,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$179.98,$0.00,$183.08,$0.00
27806182,EAP,HCPCS C1769,,Guidewire Vascular J .014in 205cm 43cm Soft Tip Steerable,"$1,150.00",$0.00,"$1,150.00",$517.50,$820.76,$0.00,$198.14,$820.76,$820.76,$201.36,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$179.98,$0.00,$183.08,$0.00
27806183,EAP,HCPCS C1722,,Defibrillator Crd .99cm 5.37x7.36cm Dynagen,"$33,750.00",$0.00,"$33,750.00","$15,187.50","$5,158.80",$0.00,"$5,814.96","$5,158.80","$24,087.38","$5,909.36","$33,750.00",$0.00,"$16,875.00","$26,730.00","$27,000.00",$0.00,"$5,281.88",$0.00,"$5,373.00",$0.00
27806184,EAP,HCPCS C1788,,Catheter Central Venous Pro-fuse Triniflex Od8 Fr Attachable,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$356.85,$356.85,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
27806185,EAP,Custom 27806185,,Xpede Cement And Mixer With Size 2 Multi-tap,$675.00,$0.00,$675.00,$0.00,$481.75,$0.00,$0.00,$481.75,$481.75,$0.00,$675.00,$0.00,$337.50,$534.60,$540.00,$0.00,$0.00,$0.00,$0.00,$0.00
27806189,EAP,Custom 27806189,,Graft Evas 10cm 12mm Xcldr Cntrlt Leg Stent Xtd,"$11,275.00",$0.00,"$11,275.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$8,046.97",$0.00,"$11,275.00",$0.00,"$5,637.50","$8,929.80","$9,020.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806190,EAP,Custom 27806190,,Graft Evas 3.3cm 23mm 19-21mm Aorta,"$7,938.00",$0.00,"$7,938.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,665.35",$0.00,"$7,938.00",$0.00,"$3,969.00","$6,286.90","$6,350.40",$0.00,$0.00,$0.00,$0.00,$0.00
27806195,EAP,HCPCS C1882,,Claria Mri Quad Crt-d Device,"$52,375.00",$0.00,"$52,375.00","$23,568.75","$5,158.80",$0.00,"$8,138.89","$5,158.80","$37,380.04","$8,138.89","$52,375.00",$0.00,"$26,187.50","$41,481.00","$41,900.00",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27806196,EAP,HCPCS C1882,,Dfbr Crd 13mm 51x74mm Claria Mri Crt-d Surescan,"$52,375.00",$0.00,"$52,375.00","$23,568.75","$5,158.80",$0.00,"$8,138.89","$5,158.80","$37,380.04","$8,138.89","$52,375.00",$0.00,"$26,187.50","$41,481.00","$41,900.00",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27806197,EAP,HCPCS C1882,,Dfbr Crd 13mm 51x71mm Surescan Claria Mri,"$52,375.00",$0.00,"$52,375.00","$23,568.75","$5,158.80",$0.00,"$8,138.89","$5,158.80","$37,380.04","$8,138.89","$52,375.00",$0.00,"$26,187.50","$41,481.00","$41,900.00",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27806198,EAP,HCPCS C1882,,Dfbr Crd 13mm 51x73mm Claria Mri Crt-d Surescan,"$52,375.00",$0.00,"$52,375.00","$23,568.75","$5,158.80",$0.00,"$8,138.89","$5,158.80","$37,380.04","$8,138.89","$52,375.00",$0.00,"$26,187.50","$41,481.00","$41,900.00",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27806199,EAP,HCPCS C1882,,Claria Mri Crt-d System Mmam,"$67,375.00",$0.00,"$67,375.00","$30,318.75","$5,158.80",$0.00,"$8,138.89","$5,158.80","$48,085.54","$8,138.89","$67,375.00",$0.00,"$33,687.50","$53,361.00","$53,900.00",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27806200,EAP,Custom 27806200,,Target Xl Soft 2mm X 3cm -coil,"$5,904.00",$0.00,"$5,904.00",$0.00,"$4,213.68",$0.00,$0.00,"$4,213.68","$4,213.68",$0.00,"$5,904.00",$0.00,"$2,952.00","$4,675.97","$4,723.20",$0.00,$0.00,$0.00,$0.00,$0.00
27806201,EAP,Custom 27806201,,Target Xl Soft 2mm X 6cm -coil,"$5,904.00",$0.00,"$5,904.00",$0.00,"$4,213.68",$0.00,$0.00,"$4,213.68","$4,213.68",$0.00,"$5,904.00",$0.00,"$2,952.00","$4,675.97","$4,723.20",$0.00,$0.00,$0.00,$0.00,$0.00
27806202,EAP,Custom 27806202,,Target Xl Soft 3mm X 6cm -coil,"$5,904.00",$0.00,"$5,904.00",$0.00,"$4,213.68",$0.00,$0.00,"$4,213.68","$4,213.68",$0.00,"$5,904.00",$0.00,"$2,952.00","$4,675.97","$4,723.20",$0.00,$0.00,$0.00,$0.00,$0.00
27806203,EAP,Custom 27806203,,Target Xl Soft 3mm X 9cm - Coil,"$5,904.00",$0.00,"$5,904.00",$0.00,"$4,213.68",$0.00,$0.00,"$4,213.68","$4,213.68",$0.00,"$5,904.00",$0.00,"$2,952.00","$4,675.97","$4,723.20",$0.00,$0.00,$0.00,$0.00,$0.00
27806204,EAP,Custom 27806204,,Target Xl Soft 4mm X 8cm - Coil,"$5,904.00",$0.00,"$5,904.00",$0.00,"$4,213.68",$0.00,$0.00,"$4,213.68","$4,213.68",$0.00,"$5,904.00",$0.00,"$2,952.00","$4,675.97","$4,723.20",$0.00,$0.00,$0.00,$0.00,$0.00
27806205,EAP,Custom 27806205,,Target Xl Soft 4mm X 12cm -coil,"$5,904.00",$0.00,"$5,904.00",$0.00,"$4,213.68",$0.00,$0.00,"$4,213.68","$4,213.68",$0.00,"$5,904.00",$0.00,"$2,952.00","$4,675.97","$4,723.20",$0.00,$0.00,$0.00,$0.00,$0.00
27806206,EAP,Custom 27806206,,Target Xl Soft 5mm X 10cm Coil,"$5,904.00",$0.00,"$5,904.00",$0.00,"$4,213.68",$0.00,$0.00,"$4,213.68","$4,213.68",$0.00,"$5,904.00",$0.00,"$2,952.00","$4,675.97","$4,723.20",$0.00,$0.00,$0.00,$0.00,$0.00
27806207,EAP,Custom 27806207,,Target Xl Soft 5mm X 15cm -coil,"$5,904.00",$0.00,"$5,904.00",$0.00,"$4,213.68",$0.00,$0.00,"$4,213.68","$4,213.68",$0.00,"$5,904.00",$0.00,"$2,952.00","$4,675.97","$4,723.20",$0.00,$0.00,$0.00,$0.00,$0.00
27806208,EAP,Custom 27806208,,Dev Emb  25mm 3mm,"$13,979.00",$0.00,"$13,979.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,976.81",$0.00,"$13,979.00",$0.00,"$6,989.50","$11,071.37","$11,183.20",$0.00,$0.00,$0.00,$0.00,$0.00
27806209,EAP,HCPCS C1725,,Pleurx Peritoneal Catheter Kit,"$2,916.00",$0.00,"$2,916.00","$1,312.20","$2,081.15",$0.00,$502.41,"$2,081.15","$2,081.15",$510.57,"$2,916.00",$0.00,"$1,458.00","$2,309.47","$2,332.80",$0.00,$456.35,$0.00,$464.23,$0.00
27806210,EAP,HCPCS C1882,,Claria Mri Quad Crtd System Mmqm,"$67,375.00",$0.00,"$67,375.00","$30,318.75","$5,158.80",$0.00,"$8,138.89","$5,158.80","$48,085.54","$8,138.89","$67,375.00",$0.00,"$33,687.50","$53,361.00","$53,900.00",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27806211,EAP,HCPCS C1876,,Stent Vasc 4.5mm 6fr 60mm 120cm Otw Slf Expandable,"$4,988.00",$0.00,"$4,988.00","$2,244.60","$3,559.94",$0.00,$859.41,"$3,559.94","$3,559.94",$873.36,"$4,988.00",$0.00,"$2,494.00","$3,950.50","$3,990.40",$0.00,$780.62,$0.00,$794.09,$0.00
27806212,EAP,HCPCS C1876,,Stent Vasc 4.5mm 6fr 80mm 120cm Otw Slf Expandable,"$4,988.00",$0.00,"$4,988.00","$2,244.60","$3,559.94",$0.00,$859.41,"$3,559.94","$3,559.94",$873.36,"$4,988.00",$0.00,"$2,494.00","$3,950.50","$3,990.40",$0.00,$780.62,$0.00,$794.09,$0.00
27806213,EAP,HCPCS C1876,,Stent Vasc 4.5mm 6fr 100mm 120cm Otw Slf,"$4,988.00",$0.00,"$4,988.00","$2,244.60","$3,559.94",$0.00,$859.41,"$3,559.94","$3,559.94",$873.36,"$4,988.00",$0.00,"$2,494.00","$3,950.50","$3,990.40",$0.00,$780.62,$0.00,$794.09,$0.00
27806214,EAP,HCPCS C1876,,Stent Vasc 4.5mm 6fr 120mm 120cm Otw Slf,"$4,988.00",$0.00,"$4,988.00","$2,244.60","$3,559.94",$0.00,$859.41,"$3,559.94","$3,559.94",$873.36,"$4,988.00",$0.00,"$2,494.00","$3,950.50","$3,990.40",$0.00,$780.62,$0.00,$794.09,$0.00
27806215,EAP,HCPCS C1876,,Stent Vasc 5mm 6fr 20mm 120cm Peri Supera,"$4,988.00",$0.00,"$4,988.00","$2,244.60","$3,559.94",$0.00,$859.41,"$3,559.94","$3,559.94",$873.36,"$4,988.00",$0.00,"$2,494.00","$3,950.50","$3,990.40",$0.00,$780.62,$0.00,$794.09,$0.00
27806216,EAP,HCPCS C1876,,Stent Vasc 5mm 6fr 30mm 120cm Peri Supera,"$4,988.00",$0.00,"$4,988.00","$2,244.60","$3,559.94",$0.00,$859.41,"$3,559.94","$3,559.94",$873.36,"$4,988.00",$0.00,"$2,494.00","$3,950.50","$3,990.40",$0.00,$780.62,$0.00,$794.09,$0.00
27806217,EAP,HCPCS C1876,,Stent Vasc 5mm 6fr 40mm 120cm Peri Supera,"$4,988.00",$0.00,"$4,988.00","$2,244.60","$3,559.94",$0.00,$859.41,"$3,559.94","$3,559.94",$873.36,"$4,988.00",$0.00,"$2,494.00","$3,950.50","$3,990.40",$0.00,$780.62,$0.00,$794.09,$0.00
27806218,EAP,HCPCS C1876,,Stent Vasc 5mm 6fr 60mm 120cm Peri Supera,"$4,988.00",$0.00,"$4,988.00","$2,244.60","$3,559.94",$0.00,$859.41,"$3,559.94","$3,559.94",$873.36,"$4,988.00",$0.00,"$2,494.00","$3,950.50","$3,990.40",$0.00,$780.62,$0.00,$794.09,$0.00
27806219,EAP,HCPCS C1876,,Stent Vasc 5mm 6fr 80mm 120cm Peri Supera,"$4,988.00",$0.00,"$4,988.00","$2,244.60","$3,559.94",$0.00,$859.41,"$3,559.94","$3,559.94",$873.36,"$4,988.00",$0.00,"$2,494.00","$3,950.50","$3,990.40",$0.00,$780.62,$0.00,$794.09,$0.00
27806220,EAP,HCPCS C1876,,Stent Vasc 5mm 6fr 100mm 120cm Peri Supera,"$4,988.00",$0.00,"$4,988.00","$2,244.60","$3,559.94",$0.00,$859.41,"$3,559.94","$3,559.94",$873.36,"$4,988.00",$0.00,"$2,494.00","$3,950.50","$3,990.40",$0.00,$780.62,$0.00,$794.09,$0.00
27806221,EAP,HCPCS C1876,,Stent Vasc 5mm 6fr 120mm 120cm Peri Supera,"$4,988.00",$0.00,"$4,988.00","$2,244.60","$3,559.94",$0.00,$859.41,"$3,559.94","$3,559.94",$873.36,"$4,988.00",$0.00,"$2,494.00","$3,950.50","$3,990.40",$0.00,$780.62,$0.00,$794.09,$0.00
27806222,EAP,HCPCS C1876,,Stent Vasc 5.5mm 6fr 20mm 120cm Otw Slf Expandable,"$4,988.00",$0.00,"$4,988.00","$2,244.60","$3,559.94",$0.00,$859.41,"$3,559.94","$3,559.94",$873.36,"$4,988.00",$0.00,"$2,494.00","$3,950.50","$3,990.40",$0.00,$780.62,$0.00,$794.09,$0.00
27806223,EAP,HCPCS C1876,,Stent Vasc 5.5mm 6fr 30mm 120cm Otw Slf Expandable,"$4,988.00",$0.00,"$4,988.00","$2,244.60","$3,559.94",$0.00,$859.41,"$3,559.94","$3,559.94",$873.36,"$4,988.00",$0.00,"$2,494.00","$3,950.50","$3,990.40",$0.00,$780.62,$0.00,$794.09,$0.00
27806224,EAP,HCPCS C1876,,Stent Vasc 5.5mm 6fr 40mm 120cm Otw Slf Expandable,"$4,988.00",$0.00,"$4,988.00","$2,244.60","$3,559.94",$0.00,$859.41,"$3,559.94","$3,559.94",$873.36,"$4,988.00",$0.00,"$2,494.00","$3,950.50","$3,990.40",$0.00,$780.62,$0.00,$794.09,$0.00
27806225,EAP,HCPCS C1876,,Stent Vasc 5.5mm 6fr 60mm 120cm Otw Slf Expandable,"$4,988.00",$0.00,"$4,988.00","$2,244.60","$3,559.94",$0.00,$859.41,"$3,559.94","$3,559.94",$873.36,"$4,988.00",$0.00,"$2,494.00","$3,950.50","$3,990.40",$0.00,$780.62,$0.00,$794.09,$0.00
27806227,EAP,HCPCS C1876,,Stent Bil 5.5mm 6fr 100mm 120cm Mimetic Dsgn Flxb,"$4,988.00",$0.00,"$4,988.00","$2,244.60","$3,559.94",$0.00,$859.41,"$3,559.94","$3,559.94",$873.36,"$4,988.00",$0.00,"$2,494.00","$3,950.50","$3,990.40",$0.00,$780.62,$0.00,$794.09,$0.00
27806228,EAP,HCPCS C1876,,Stent Bil 5.5mm 6fr 120mm 120cm Mimetic Dsgn Flxb,"$4,988.00",$0.00,"$4,988.00","$2,244.60","$3,559.94",$0.00,$859.41,"$3,559.94","$3,559.94",$873.36,"$4,988.00",$0.00,"$2,494.00","$3,950.50","$3,990.40",$0.00,$780.62,$0.00,$794.09,$0.00
27806229,EAP,HCPCS C1876,,Stent Vasc 6mm 6fr 20mm 120cm Peri Supera,"$4,988.00",$0.00,"$4,988.00","$2,244.60","$3,559.94",$0.00,$859.41,"$3,559.94","$3,559.94",$873.36,"$4,988.00",$0.00,"$2,494.00","$3,950.50","$3,990.40",$0.00,$780.62,$0.00,$794.09,$0.00
27806230,EAP,HCPCS C1876,,Stent Vasc 6mm 6fr 30mm 120cm Peri Supera,"$4,988.00",$0.00,"$4,988.00","$2,244.60","$3,559.94",$0.00,$859.41,"$3,559.94","$3,559.94",$873.36,"$4,988.00",$0.00,"$2,494.00","$3,950.50","$3,990.40",$0.00,$780.62,$0.00,$794.09,$0.00
27806231,EAP,HCPCS C1876,,Stent Vasc 6mm 6fr 40mm 120cm Peri Supera,"$4,988.00",$0.00,"$4,988.00","$2,244.60","$3,559.94",$0.00,$859.41,"$3,559.94","$3,559.94",$873.36,"$4,988.00",$0.00,"$2,494.00","$3,950.50","$3,990.40",$0.00,$780.62,$0.00,$794.09,$0.00
27806232,EAP,HCPCS C1876,,Stent Vasc 6mm 6fr 60mm 120cm Peri Supera,"$4,988.00",$0.00,"$4,988.00","$2,244.60","$3,559.94",$0.00,$859.41,"$3,559.94","$3,559.94",$873.36,"$4,988.00",$0.00,"$2,494.00","$3,950.50","$3,990.40",$0.00,$780.62,$0.00,$794.09,$0.00
27806233,EAP,HCPCS C1876,,Stent Vasc 6mm 6fr 80mm 120cm Peri Supera,"$4,988.00",$0.00,"$4,988.00","$2,244.60","$3,559.94",$0.00,$859.41,"$3,559.94","$3,559.94",$873.36,"$4,988.00",$0.00,"$2,494.00","$3,950.50","$3,990.40",$0.00,$780.62,$0.00,$794.09,$0.00
27806234,EAP,HCPCS C1876,,Stent Vasc 6mm 6fr 100mm 120cm Peri Supera,"$4,988.00",$0.00,"$4,988.00","$2,244.60","$3,559.94",$0.00,$859.41,"$3,559.94","$3,559.94",$873.36,"$4,988.00",$0.00,"$2,494.00","$3,950.50","$3,990.40",$0.00,$780.62,$0.00,$794.09,$0.00
27806235,EAP,HCPCS C1876,,Stent Vasc 6mm 6fr 120mm 120cm Peri Supera,"$4,988.00",$0.00,"$4,988.00","$2,244.60","$3,559.94",$0.00,$859.41,"$3,559.94","$3,559.94",$873.36,"$4,988.00",$0.00,"$2,494.00","$3,950.50","$3,990.40",$0.00,$780.62,$0.00,$794.09,$0.00
27806236,EAP,HCPCS C1876,,Stent Vasc 6mm 6fr 150mm 120cm Peri Supera,"$4,988.00",$0.00,"$4,988.00","$2,244.60","$3,559.94",$0.00,$859.41,"$3,559.94","$3,559.94",$873.36,"$4,988.00",$0.00,"$2,494.00","$3,950.50","$3,990.40",$0.00,$780.62,$0.00,$794.09,$0.00
27806237,EAP,HCPCS C1876,,Stent Vasc 6.5mm 6fr 20mm 120cm Otw Slf Expandable,"$4,988.00",$0.00,"$4,988.00","$2,244.60","$3,559.94",$0.00,$859.41,"$3,559.94","$3,559.94",$873.36,"$4,988.00",$0.00,"$2,494.00","$3,950.50","$3,990.40",$0.00,$780.62,$0.00,$794.09,$0.00
27806238,EAP,HCPCS C1876,,Stent Vasc 6.5mm 6fr 30mm 120cm Otw Slf Expandable,"$4,988.00",$0.00,"$4,988.00","$2,244.60","$3,559.94",$0.00,$859.41,"$3,559.94","$3,559.94",$873.36,"$4,988.00",$0.00,"$2,494.00","$3,950.50","$3,990.40",$0.00,$780.62,$0.00,$794.09,$0.00
27806239,EAP,HCPCS C1876,,Stent Vasc 6.5mm 6fr 40mm 120cm Otw Slf Expandable,"$4,988.00",$0.00,"$4,988.00","$2,244.60","$3,559.94",$0.00,$859.41,"$3,559.94","$3,559.94",$873.36,"$4,988.00",$0.00,"$2,494.00","$3,950.50","$3,990.40",$0.00,$780.62,$0.00,$794.09,$0.00
27806240,EAP,HCPCS C1876,,Stent Vasc 6.5mm 6fr 60mm 120cm Otw Slf Expandable,"$4,988.00",$0.00,"$4,988.00","$2,244.60","$3,559.94",$0.00,$859.41,"$3,559.94","$3,559.94",$873.36,"$4,988.00",$0.00,"$2,494.00","$3,950.50","$3,990.40",$0.00,$780.62,$0.00,$794.09,$0.00
27806241,EAP,HCPCS C1876,,Stent Vasc 6.5mm 6fr 120mm 120cm Otw Slf Expandable,"$4,988.00",$0.00,"$4,988.00","$2,244.60","$3,559.94",$0.00,$859.41,"$3,559.94","$3,559.94",$873.36,"$4,988.00",$0.00,"$2,494.00","$3,950.50","$3,990.40",$0.00,$780.62,$0.00,$794.09,$0.00
27806242,EAP,HCPCS C1876,,Stent Vasc 6.5mm 6fr 150mm 120cm Otw Slf Expandable,"$4,988.00",$0.00,"$4,988.00","$2,244.60","$3,559.94",$0.00,$859.41,"$3,559.94","$3,559.94",$873.36,"$4,988.00",$0.00,"$2,494.00","$3,950.50","$3,990.40",$0.00,$780.62,$0.00,$794.09,$0.00
27806243,EAP,HCPCS C1876,,Stent Bil 5.5mm 6fr 150mm 120cm Mimetic Dsgn Flxb,"$4,988.00",$0.00,"$4,988.00","$2,244.60","$3,559.94",$0.00,$859.41,"$3,559.94","$3,559.94",$873.36,"$4,988.00",$0.00,"$2,494.00","$3,950.50","$3,990.40",$0.00,$780.62,$0.00,$794.09,$0.00
27806244,EAP,Custom 27806244,,STENT VASC 6.5MM 6FR 80MM 120CM OTW SLF EXPANDABLE,"$4,988.00",$0.00,"$4,988.00",$0.00,"$3,559.94",$0.00,$0.00,"$3,559.94","$3,559.94",$0.00,"$4,988.00",$0.00,"$2,494.00","$3,950.50","$3,990.40",$0.00,$0.00,$0.00,$0.00,$0.00
27806245,EAP,Custom 27806245,,Dev Emb  30mm 3mm,"$13,979.00",$0.00,"$13,979.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,976.81",$0.00,"$13,979.00",$0.00,"$6,989.50","$11,071.37","$11,183.20",$0.00,$0.00,$0.00,$0.00,$0.00
27806246,EAP,Custom 27806246,,Dev Emb  25mm 3.25,"$13,979.00",$0.00,"$13,979.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,976.81",$0.00,"$13,979.00",$0.00,"$6,989.50","$11,071.37","$11,183.20",$0.00,$0.00,$0.00,$0.00,$0.00
27806247,EAP,Custom 27806247,,Dev Emb  35mm 3mm,"$13,979.00",$0.00,"$13,979.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,976.81",$0.00,"$13,979.00",$0.00,"$6,989.50","$11,071.37","$11,183.20",$0.00,$0.00,$0.00,$0.00,$0.00
27806248,EAP,Custom 27806248,,Dev Emb  30mm 3.25,"$13,979.00",$0.00,"$13,979.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,976.81",$0.00,"$13,979.00",$0.00,"$6,989.50","$11,071.37","$11,183.20",$0.00,$0.00,$0.00,$0.00,$0.00
27806249,EAP,Custom 27806249,,Dev Emb  35mm 3.25,"$13,979.00",$0.00,"$13,979.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,976.81",$0.00,"$13,979.00",$0.00,"$6,989.50","$11,071.37","$11,183.20",$0.00,$0.00,$0.00,$0.00,$0.00
27806250,EAP,Custom 27806250,,Dev Emb  25mm 3.5m,"$13,979.00",$0.00,"$13,979.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,976.81",$0.00,"$13,979.00",$0.00,"$6,989.50","$11,071.37","$11,183.20",$0.00,$0.00,$0.00,$0.00,$0.00
27806251,EAP,Custom 27806251,,Dev Emb  30mm 3.5m,"$13,979.00",$0.00,"$13,979.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,976.81",$0.00,"$13,979.00",$0.00,"$6,989.50","$11,071.37","$11,183.20",$0.00,$0.00,$0.00,$0.00,$0.00
27806252,EAP,Custom 27806252,,Dev Emb 55d 3.5mm,"$13,979.00",$0.00,"$13,979.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,976.81",$0.00,"$13,979.00",$0.00,"$6,989.50","$11,071.37","$11,183.20",$0.00,$0.00,$0.00,$0.00,$0.00
27806253,EAP,Custom 27806253,,Dev Emb  25mm 3.75,"$13,979.00",$0.00,"$13,979.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,976.81",$0.00,"$13,979.00",$0.00,"$6,989.50","$11,071.37","$11,183.20",$0.00,$0.00,$0.00,$0.00,$0.00
27806254,EAP,Custom 27806254,,Dev Emb  30mm 3.75,"$13,979.00",$0.00,"$13,979.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,976.81",$0.00,"$13,979.00",$0.00,"$6,989.50","$11,071.37","$11,183.20",$0.00,$0.00,$0.00,$0.00,$0.00
27806255,EAP,Custom 27806255,,Dev Emb 55d 3.75mm,"$13,979.00",$0.00,"$13,979.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,976.81",$0.00,"$13,979.00",$0.00,"$6,989.50","$11,071.37","$11,183.20",$0.00,$0.00,$0.00,$0.00,$0.00
27806256,EAP,Custom 27806256,,Dev Emb  25mm 4mm,"$13,979.00",$0.00,"$13,979.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,976.81",$0.00,"$13,979.00",$0.00,"$6,989.50","$11,071.37","$11,183.20",$0.00,$0.00,$0.00,$0.00,$0.00
27806257,EAP,Custom 27806257,,Dev Emb  30mm 4mm,"$13,979.00",$0.00,"$13,979.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,976.81",$0.00,"$13,979.00",$0.00,"$6,989.50","$11,071.37","$11,183.20",$0.00,$0.00,$0.00,$0.00,$0.00
27806258,EAP,Custom 27806258,,Dev Emb 55d 4mm 35,"$13,979.00",$0.00,"$13,979.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,976.81",$0.00,"$13,979.00",$0.00,"$6,989.50","$11,071.37","$11,183.20",$0.00,$0.00,$0.00,$0.00,$0.00
27806259,EAP,Custom 27806259,,Dev Emb  25mm 4.25,"$13,979.00",$0.00,"$13,979.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,976.81",$0.00,"$13,979.00",$0.00,"$6,989.50","$11,071.37","$11,183.20",$0.00,$0.00,$0.00,$0.00,$0.00
27806260,EAP,Custom 27806260,,Dev Emb  30mm 4.25,"$13,979.00",$0.00,"$13,979.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,976.81",$0.00,"$13,979.00",$0.00,"$6,989.50","$11,071.37","$11,183.20",$0.00,$0.00,$0.00,$0.00,$0.00
27806261,EAP,Custom 27806261,,Dev Emb 55d 4.25mm,"$13,979.00",$0.00,"$13,979.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,976.81",$0.00,"$13,979.00",$0.00,"$6,989.50","$11,071.37","$11,183.20",$0.00,$0.00,$0.00,$0.00,$0.00
27806262,EAP,Custom 27806262,,Dev Emb  30mm 4.5m,"$13,979.00",$0.00,"$13,979.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,976.81",$0.00,"$13,979.00",$0.00,"$6,989.50","$11,071.37","$11,183.20",$0.00,$0.00,$0.00,$0.00,$0.00
27806263,EAP,Custom 27806263,,Dev Emb 55d 4.5mm,"$13,979.00",$0.00,"$13,979.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,976.81",$0.00,"$13,979.00",$0.00,"$6,989.50","$11,071.37","$11,183.20",$0.00,$0.00,$0.00,$0.00,$0.00
27806264,EAP,Custom 27806264,,Dev Emb  25mm 4.75,"$13,979.00",$0.00,"$13,979.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,976.81",$0.00,"$13,979.00",$0.00,"$6,989.50","$11,071.37","$11,183.20",$0.00,$0.00,$0.00,$0.00,$0.00
27806265,EAP,Custom 27806265,,Dev Emb  30mm 4.75,"$13,979.00",$0.00,"$13,979.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,976.81",$0.00,"$13,979.00",$0.00,"$6,989.50","$11,071.37","$11,183.20",$0.00,$0.00,$0.00,$0.00,$0.00
27806266,EAP,Custom 27806266,,Dev Emb 55d 4.75mm,"$13,979.00",$0.00,"$13,979.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,976.81",$0.00,"$13,979.00",$0.00,"$6,989.50","$11,071.37","$11,183.20",$0.00,$0.00,$0.00,$0.00,$0.00
27806267,EAP,Custom 27806267,,Dev Emb 55d 5mm 25,"$13,979.00",$0.00,"$13,979.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,976.81",$0.00,"$13,979.00",$0.00,"$6,989.50","$11,071.37","$11,183.20",$0.00,$0.00,$0.00,$0.00,$0.00
27806268,EAP,Custom 27806268,,Dev Emb  30mm 5mm,"$13,979.00",$0.00,"$13,979.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,976.81",$0.00,"$13,979.00",$0.00,"$6,989.50","$11,071.37","$11,183.20",$0.00,$0.00,$0.00,$0.00,$0.00
27806269,EAP,Custom 27806269,,Dev Emb 55d 5mm 33,"$13,979.00",$0.00,"$13,979.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,976.81",$0.00,"$13,979.00",$0.00,"$6,989.50","$11,071.37","$11,183.20",$0.00,$0.00,$0.00,$0.00,$0.00
27806270,EAP,Custom 27806270,,Dev Emb 55d 2.5mm,"$13,041.00",$0.00,"$13,041.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,307.36",$0.00,"$13,041.00",$0.00,"$6,520.50","$10,328.47","$10,432.80",$0.00,$0.00,$0.00,$0.00,$0.00
27806271,EAP,Custom 27806271,,Dev Emb  12mm 2.5m,"$13,041.00",$0.00,"$13,041.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,307.36",$0.00,"$13,041.00",$0.00,"$6,520.50","$10,328.47","$10,432.80",$0.00,$0.00,$0.00,$0.00,$0.00
27806272,EAP,Custom 27806272,,Dev Emb  16mm 2.5m,"$32,603.00",$0.00,"$32,603.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$23,268.76",$0.00,"$32,603.00",$0.00,"$16,301.50","$25,821.58","$26,082.40",$0.00,$0.00,$0.00,$0.00,$0.00
27806273,EAP,Custom 27806273,,Dev Emb  18mm 2.5m,"$13,041.00",$0.00,"$13,041.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,307.36",$0.00,"$13,041.00",$0.00,"$6,520.50","$10,328.47","$10,432.80",$0.00,$0.00,$0.00,$0.00,$0.00
27806274,EAP,Custom 27806274,,Dev Emb 55d 2.5mm,"$13,041.00",$0.00,"$13,041.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,307.36",$0.00,"$13,041.00",$0.00,"$6,520.50","$10,328.47","$10,432.80",$0.00,$0.00,$0.00,$0.00,$0.00
27806275,EAP,Custom 27806275,,Dev Emb  10mm 2.75,"$13,041.00",$0.00,"$13,041.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,307.36",$0.00,"$13,041.00",$0.00,"$6,520.50","$10,328.47","$10,432.80",$0.00,$0.00,$0.00,$0.00,$0.00
27806276,EAP,Custom 27806276,,Dev Emb  12mm 2.75,"$13,041.00",$0.00,"$13,041.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,307.36",$0.00,"$13,041.00",$0.00,"$6,520.50","$10,328.47","$10,432.80",$0.00,$0.00,$0.00,$0.00,$0.00
27806277,EAP,Custom 27806277,,Dev Emb  14mm 2.75,"$13,041.00",$0.00,"$13,041.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,307.36",$0.00,"$13,041.00",$0.00,"$6,520.50","$10,328.47","$10,432.80",$0.00,$0.00,$0.00,$0.00,$0.00
27806278,EAP,Custom 27806278,,Dev Emb 55d 2.75mm,"$13,041.00",$0.00,"$13,041.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,307.36",$0.00,"$13,041.00",$0.00,"$6,520.50","$10,328.47","$10,432.80",$0.00,$0.00,$0.00,$0.00,$0.00
27806279,EAP,Custom 27806279,,Dev Emb  18mm 2.75,"$13,041.00",$0.00,"$13,041.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,307.36",$0.00,"$13,041.00",$0.00,"$6,520.50","$10,328.47","$10,432.80",$0.00,$0.00,$0.00,$0.00,$0.00
27806280,EAP,Custom 27806280,,Dev Emb 55d 2.75mm,"$13,041.00",$0.00,"$13,041.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,307.36",$0.00,"$13,041.00",$0.00,"$6,520.50","$10,328.47","$10,432.80",$0.00,$0.00,$0.00,$0.00,$0.00
27806281,EAP,Custom 27806281,,Dev Emb  10mm 3mm,"$13,041.00",$0.00,"$13,041.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,307.36",$0.00,"$13,041.00",$0.00,"$6,520.50","$10,328.47","$10,432.80",$0.00,$0.00,$0.00,$0.00,$0.00
27806282,EAP,Custom 27806282,,Dev Emb  12mm 3mm,"$13,041.00",$0.00,"$13,041.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,307.36",$0.00,"$13,041.00",$0.00,"$6,520.50","$10,328.47","$10,432.80",$0.00,$0.00,$0.00,$0.00,$0.00
27806283,EAP,Custom 27806283,,Dev Emb 55d 3mm 14,"$13,041.00",$0.00,"$13,041.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,307.36",$0.00,"$13,041.00",$0.00,"$6,520.50","$10,328.47","$10,432.80",$0.00,$0.00,$0.00,$0.00,$0.00
27806284,EAP,Custom 27806284,,Dev Emb  16mm 3mm,"$13,041.00",$0.00,"$13,041.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,307.36",$0.00,"$13,041.00",$0.00,"$6,520.50","$10,328.47","$10,432.80",$0.00,$0.00,$0.00,$0.00,$0.00
27806285,EAP,Custom 27806285,,Dev Emb 55d 3mm 18,"$13,041.00",$0.00,"$13,041.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,307.36",$0.00,"$13,041.00",$0.00,"$6,520.50","$10,328.47","$10,432.80",$0.00,$0.00,$0.00,$0.00,$0.00
27806286,EAP,Custom 27806286,,Dev Emb 55d 3mm 20,"$13,041.00",$0.00,"$13,041.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,307.36",$0.00,"$13,041.00",$0.00,"$6,520.50","$10,328.47","$10,432.80",$0.00,$0.00,$0.00,$0.00,$0.00
27806287,EAP,Custom 27806287,,Dev Emb  10mm 3.25,"$13,041.00",$0.00,"$13,041.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,307.36",$0.00,"$13,041.00",$0.00,"$6,520.50","$10,328.47","$10,432.80",$0.00,$0.00,$0.00,$0.00,$0.00
27806288,EAP,Custom 27806288,,Dev Emb  12mm 3.25,"$13,041.00",$0.00,"$13,041.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,307.36",$0.00,"$13,041.00",$0.00,"$6,520.50","$10,328.47","$10,432.80",$0.00,$0.00,$0.00,$0.00,$0.00
27806289,EAP,Custom 27806289,,Dev Emb 55d 3.25mm,"$13,041.00",$0.00,"$13,041.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,307.36",$0.00,"$13,041.00",$0.00,"$6,520.50","$10,328.47","$10,432.80",$0.00,$0.00,$0.00,$0.00,$0.00
27806290,EAP,Custom 27806290,,Dev Emb  16mm 3.25,"$13,041.00",$0.00,"$13,041.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,307.36",$0.00,"$13,041.00",$0.00,"$6,520.50","$10,328.47","$10,432.80",$0.00,$0.00,$0.00,$0.00,$0.00
27806291,EAP,Custom 27806291,,Dev Emb 55d 3.25mm,"$13,041.00",$0.00,"$13,041.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,307.36",$0.00,"$13,041.00",$0.00,"$6,520.50","$10,328.47","$10,432.80",$0.00,$0.00,$0.00,$0.00,$0.00
27806292,EAP,Custom 27806292,,Dev Emb 55d 3.25mm,"$13,041.00",$0.00,"$13,041.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,307.36",$0.00,"$13,041.00",$0.00,"$6,520.50","$10,328.47","$10,432.80",$0.00,$0.00,$0.00,$0.00,$0.00
27806293,EAP,Custom 27806293,,Dev Emb  10mm 3.5m,"$13,041.00",$0.00,"$13,041.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,307.36",$0.00,"$13,041.00",$0.00,"$6,520.50","$10,328.47","$10,432.80",$0.00,$0.00,$0.00,$0.00,$0.00
27806294,EAP,Custom 27806294,,Dev Emb 55d 3.5mm,"$13,041.00",$0.00,"$13,041.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,307.36",$0.00,"$13,041.00",$0.00,"$6,520.50","$10,328.47","$10,432.80",$0.00,$0.00,$0.00,$0.00,$0.00
27806295,EAP,Custom 27806295,,Dev Emb 55d 3.5mm,"$13,041.00",$0.00,"$13,041.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,307.36",$0.00,"$13,041.00",$0.00,"$6,520.50","$10,328.47","$10,432.80",$0.00,$0.00,$0.00,$0.00,$0.00
27806296,EAP,Custom 27806296,,Dev Emb 55d 3.5mm,"$13,041.00",$0.00,"$13,041.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,307.36",$0.00,"$13,041.00",$0.00,"$6,520.50","$10,328.47","$10,432.80",$0.00,$0.00,$0.00,$0.00,$0.00
27806297,EAP,Custom 27806297,,Dev Emb 55d 3.5mm,"$13,041.00",$0.00,"$13,041.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,307.36",$0.00,"$13,041.00",$0.00,"$6,520.50","$10,328.47","$10,432.80",$0.00,$0.00,$0.00,$0.00,$0.00
27806298,EAP,Custom 27806298,,Dev Emb 55d 3.5mm,"$13,041.00",$0.00,"$13,041.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,307.36",$0.00,"$13,041.00",$0.00,"$6,520.50","$10,328.47","$10,432.80",$0.00,$0.00,$0.00,$0.00,$0.00
27806299,EAP,Custom 27806299,,Dev Emb  10mm 3.75,"$13,041.00",$0.00,"$13,041.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,307.36",$0.00,"$13,041.00",$0.00,"$6,520.50","$10,328.47","$10,432.80",$0.00,$0.00,$0.00,$0.00,$0.00
27806300,EAP,Custom 27806300,,Dev Emb  12mm 3.75,"$13,041.00",$0.00,"$13,041.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,307.36",$0.00,"$13,041.00",$0.00,"$6,520.50","$10,328.47","$10,432.80",$0.00,$0.00,$0.00,$0.00,$0.00
27806301,EAP,Custom 27806301,,Dev Emb 55d 3.75mm,"$13,041.00",$0.00,"$13,041.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,307.36",$0.00,"$13,041.00",$0.00,"$6,520.50","$10,328.47","$10,432.80",$0.00,$0.00,$0.00,$0.00,$0.00
27806302,EAP,Custom 27806302,,Dev Emb  16mm 3.75,"$13,041.00",$0.00,"$13,041.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,307.36",$0.00,"$13,041.00",$0.00,"$6,520.50","$10,328.47","$10,432.80",$0.00,$0.00,$0.00,$0.00,$0.00
27806303,EAP,Custom 27806303,,Dev Emb 55d 3.75mm,"$13,041.00",$0.00,"$13,041.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,307.36",$0.00,"$13,041.00",$0.00,"$6,520.50","$10,328.47","$10,432.80",$0.00,$0.00,$0.00,$0.00,$0.00
27806304,EAP,Custom 27806304,,Dev Emb 55d 3.75mm,"$13,041.00",$0.00,"$13,041.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,307.36",$0.00,"$13,041.00",$0.00,"$6,520.50","$10,328.47","$10,432.80",$0.00,$0.00,$0.00,$0.00,$0.00
27806305,EAP,Custom 27806305,,Dev Emb 55d 4mm 10,"$13,041.00",$0.00,"$13,041.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,307.36",$0.00,"$13,041.00",$0.00,"$6,520.50","$10,328.47","$10,432.80",$0.00,$0.00,$0.00,$0.00,$0.00
27806306,EAP,Custom 27806306,,Dev Emb 55d 4mm 12,"$13,041.00",$0.00,"$13,041.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,307.36",$0.00,"$13,041.00",$0.00,"$6,520.50","$10,328.47","$10,432.80",$0.00,$0.00,$0.00,$0.00,$0.00
27806307,EAP,Custom 27806307,,Dev Emb 55d 4mm 14,"$13,041.00",$0.00,"$13,041.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,307.36",$0.00,"$13,041.00",$0.00,"$6,520.50","$10,328.47","$10,432.80",$0.00,$0.00,$0.00,$0.00,$0.00
27806308,EAP,Custom 27806308,,Dev Emb 55d 4mm 16,"$13,041.00",$0.00,"$13,041.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,307.36",$0.00,"$13,041.00",$0.00,"$6,520.50","$10,328.47","$10,432.80",$0.00,$0.00,$0.00,$0.00,$0.00
27806309,EAP,Custom 27806309,,Dev Emb 55d 4mm 18,"$13,041.00",$0.00,"$13,041.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,307.36",$0.00,"$13,041.00",$0.00,"$6,520.50","$10,328.47","$10,432.80",$0.00,$0.00,$0.00,$0.00,$0.00
27806310,EAP,Custom 27806310,,Dev Emb 55d 4mm 20,"$13,041.00",$0.00,"$13,041.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,307.36",$0.00,"$13,041.00",$0.00,"$6,520.50","$10,328.47","$10,432.80",$0.00,$0.00,$0.00,$0.00,$0.00
27806311,EAP,Custom 27806311,,Dev Emb  10mm 4.25,"$13,041.00",$0.00,"$13,041.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,307.36",$0.00,"$13,041.00",$0.00,"$6,520.50","$10,328.47","$10,432.80",$0.00,$0.00,$0.00,$0.00,$0.00
27806312,EAP,Custom 27806312,,Dev Emb 55d 4.25mm,"$13,041.00",$0.00,"$13,041.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,307.36",$0.00,"$13,041.00",$0.00,"$6,520.50","$10,328.47","$10,432.80",$0.00,$0.00,$0.00,$0.00,$0.00
27806313,EAP,Custom 27806313,,Dev Emb 55d 4.25mm,"$13,041.00",$0.00,"$13,041.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,307.36",$0.00,"$13,041.00",$0.00,"$6,520.50","$10,328.47","$10,432.80",$0.00,$0.00,$0.00,$0.00,$0.00
27806314,EAP,Custom 27806314,,Dev Emb 55d 4.25mm,"$13,041.00",$0.00,"$13,041.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,307.36",$0.00,"$13,041.00",$0.00,"$6,520.50","$10,328.47","$10,432.80",$0.00,$0.00,$0.00,$0.00,$0.00
27806315,EAP,Custom 27806315,,Dev Emb 55d 4.25mm,"$13,041.00",$0.00,"$13,041.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,307.36",$0.00,"$13,041.00",$0.00,"$6,520.50","$10,328.47","$10,432.80",$0.00,$0.00,$0.00,$0.00,$0.00
27806316,EAP,Custom 27806316,,Dev Emb 55d 4.25mm,"$13,041.00",$0.00,"$13,041.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,307.36",$0.00,"$13,041.00",$0.00,"$6,520.50","$10,328.47","$10,432.80",$0.00,$0.00,$0.00,$0.00,$0.00
27806317,EAP,Custom 27806317,,Dev Emb  10mm 4.5m,"$13,041.00",$0.00,"$13,041.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,307.36",$0.00,"$13,041.00",$0.00,"$6,520.50","$10,328.47","$10,432.80",$0.00,$0.00,$0.00,$0.00,$0.00
27806318,EAP,Custom 27806318,,Dev Emb 55d 4.5mm,"$13,041.00",$0.00,"$13,041.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,307.36",$0.00,"$13,041.00",$0.00,"$6,520.50","$10,328.47","$10,432.80",$0.00,$0.00,$0.00,$0.00,$0.00
27806319,EAP,Custom 27806319,,Dev Emb 55d 4.5mm,"$13,041.00",$0.00,"$13,041.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,307.36",$0.00,"$13,041.00",$0.00,"$6,520.50","$10,328.47","$10,432.80",$0.00,$0.00,$0.00,$0.00,$0.00
27806320,EAP,Custom 27806320,,Dev Emb 55d 4.5mm,"$13,041.00",$0.00,"$13,041.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,307.36",$0.00,"$13,041.00",$0.00,"$6,520.50","$10,328.47","$10,432.80",$0.00,$0.00,$0.00,$0.00,$0.00
27806321,EAP,Custom 27806321,,Dev Emb 55d 4.5mm,"$13,041.00",$0.00,"$13,041.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,307.36",$0.00,"$13,041.00",$0.00,"$6,520.50","$10,328.47","$10,432.80",$0.00,$0.00,$0.00,$0.00,$0.00
27806322,EAP,Custom 27806322,,Dev Emb  10mm 4.75,"$13,041.00",$0.00,"$13,041.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,307.36",$0.00,"$13,041.00",$0.00,"$6,520.50","$10,328.47","$10,432.80",$0.00,$0.00,$0.00,$0.00,$0.00
27806323,EAP,Custom 27806323,,Dev Emb 55d 4.75mm,"$13,041.00",$0.00,"$13,041.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,307.36",$0.00,"$13,041.00",$0.00,"$6,520.50","$10,328.47","$10,432.80",$0.00,$0.00,$0.00,$0.00,$0.00
27806324,EAP,Custom 27806324,,Dev Emb 55d 4.75mm,"$13,041.00",$0.00,"$13,041.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,307.36",$0.00,"$13,041.00",$0.00,"$6,520.50","$10,328.47","$10,432.80",$0.00,$0.00,$0.00,$0.00,$0.00
27806325,EAP,Custom 27806325,,Dev Emb 55d 4.75mm,"$13,041.00",$0.00,"$13,041.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,307.36",$0.00,"$13,041.00",$0.00,"$6,520.50","$10,328.47","$10,432.80",$0.00,$0.00,$0.00,$0.00,$0.00
27806326,EAP,Custom 27806326,,Dev Emb 55d 4.75mm,"$13,041.00",$0.00,"$13,041.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,307.36",$0.00,"$13,041.00",$0.00,"$6,520.50","$10,328.47","$10,432.80",$0.00,$0.00,$0.00,$0.00,$0.00
27806327,EAP,Custom 27806327,,Dev Emb  10mm 5mm,"$13,041.00",$0.00,"$13,041.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,307.36",$0.00,"$13,041.00",$0.00,"$6,520.50","$10,328.47","$10,432.80",$0.00,$0.00,$0.00,$0.00,$0.00
27806328,EAP,Custom 27806328,,Dev Emb  12mm 5mm,"$13,041.00",$0.00,"$13,041.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,307.36",$0.00,"$13,041.00",$0.00,"$6,520.50","$10,328.47","$10,432.80",$0.00,$0.00,$0.00,$0.00,$0.00
27806329,EAP,Custom 27806329,,Dev Emb 55d 5mm 14,"$13,041.00",$0.00,"$13,041.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,307.36",$0.00,"$13,041.00",$0.00,"$6,520.50","$10,328.47","$10,432.80",$0.00,$0.00,$0.00,$0.00,$0.00
27806330,EAP,Custom 27806330,,Dev Emb 55d 5mm 16,"$13,041.00",$0.00,"$13,041.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,307.36",$0.00,"$13,041.00",$0.00,"$6,520.50","$10,328.47","$10,432.80",$0.00,$0.00,$0.00,$0.00,$0.00
27806331,EAP,Custom 27806331,,Dev Emb 55d 5mm 18,"$13,041.00",$0.00,"$13,041.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,307.36",$0.00,"$13,041.00",$0.00,"$6,520.50","$10,328.47","$10,432.80",$0.00,$0.00,$0.00,$0.00,$0.00
27806332,EAP,Custom 27806332,,Dev Emb 55d 5mm 20,"$13,041.00",$0.00,"$13,041.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$9,307.36",$0.00,"$13,041.00",$0.00,"$6,520.50","$10,328.47","$10,432.80",$0.00,$0.00,$0.00,$0.00,$0.00
27806333,EAP,,,Innova 5mm X 20mm X 75cm,"$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,"$1,516.61","$1,516.61",$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806334,EAP,HCPCS C1876,,Innova 5mm X 40mm X 75cm,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,"$1,516.61","$1,516.61",$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
27806335,EAP,HCPCS C1876,,Innova 5mm X 60mm X 75cm,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,"$1,516.61","$1,516.61",$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
27806336,EAP,HCPCS C1876,,Innova 5mm X 80mm X 75cm,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,"$1,516.61","$1,516.61",$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
27806337,EAP,HCPCS C1876,,Innova 5mm X 100mm X 75cm,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,"$1,516.61","$1,516.61",$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
27806338,EAP,HCPCS C1876,,Innova 5mm X 120mm X 75cm,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,"$1,516.61","$1,516.61",$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
27806339,EAP,HCPCS C1876,,Innova 6mm X 20mm X 75cm,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,"$1,516.61","$1,516.61",$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
27806340,EAP,HCPCS C1876,,Stent Vasc Blue 40mm 6mm Innova Slf Xpd Radiopq,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,"$1,516.61","$1,516.61",$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
27806341,EAP,HCPCS C1876,,Stent Vasc Blue 60mm 6mm Innova Sprfc Fem Art Slf,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,"$1,516.61","$1,516.61",$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
27806342,EAP,HCPCS C1876,,Stent Vasc Blue 80mm 6mm Innova Sprfc Fem Art Slf,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,"$1,516.61","$1,516.61",$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
27806343,EAP,HCPCS C1876,,Stent Vasc Blue 100mm 6mm Innova Sprfc Fem Art Slf,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,"$1,516.61","$1,516.61",$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
27806344,EAP,HCPCS C1876,,Innova 6mm X 120mm X 75cm,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,"$1,516.61","$1,516.61",$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
27806345,EAP,HCPCS C1876,,Innova 7mm X 20mm X 75cm,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,"$1,516.61","$1,516.61",$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
27806346,EAP,HCPCS C1876,,Stent Vasc Blue 40mm 7mm Innova Sprfc Fem Art Slf,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,"$1,516.61","$1,516.61",$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
27806347,EAP,HCPCS C1876,,Stent Vasc Blue 60mm 7mm Innova Sprfc Fem Art Slf,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,"$1,516.61","$1,516.61",$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
27806348,EAP,HCPCS C1876,,Stent Vasc Blue 80mm 7mm Innova Sprfc Fem Art Slf,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,"$1,516.61","$1,516.61",$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
27806349,EAP,HCPCS C1876,,Stent Vasc Blue 100mm 7mm Innova Sprfc Fem Art Slf,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,"$1,516.61","$1,516.61",$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
27806350,EAP,HCPCS C1876,,Innova 7mm X 120mm X 75cm,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,"$1,516.61","$1,516.61",$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
27806351,EAP,HCPCS C1876,,Stent Vasc Blue 20mm 7mm Innova Sprfc Fem Art Slf,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,"$1,516.61","$1,516.61",$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
27806352,EAP,HCPCS C1876,,Stent Vasc Blue 40mm 8mm Innova Sprfc Fem Art Slf,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,"$1,516.61","$1,516.61",$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
27806353,EAP,HCPCS C1876,,Stent Vasc Blue 60mm 8mm Innova Slf Xpd Radiopq,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,"$1,516.61","$1,516.61",$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
27806354,EAP,HCPCS C1876,,Stent Vasc Blue 80mm 8mm Innova Sprfc Fem Art Slf,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,"$1,516.61","$1,516.61",$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
27806355,EAP,HCPCS C1876,,Innova 8mm X 100mm X 75cm,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,"$1,516.61","$1,516.61",$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
27806356,EAP,HCPCS C1876,,Innova 8mm X 120mm X 75cm,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,"$1,516.61","$1,516.61",$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
27806357,EAP,HCPCS C1876,,Innova 5mm X 20mm X 130cm,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,"$1,516.61","$1,516.61",$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
27806358,EAP,HCPCS C1876,,Stent Vasc Blue 40mm 5mm Innova Slf Xpd Radiopq,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,"$1,516.61","$1,516.61",$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
27806359,EAP,HCPCS C1876,,Stent Vasc Blue 60mm 5mm Innova Slf Xpd Radiopq,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,"$1,516.61","$1,516.61",$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
27806360,EAP,HCPCS C1876,,Stent Vasc Blue 80mm 5mm Innova Sprfc Fem Art Slf,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,"$1,516.61","$1,516.61",$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
27806361,EAP,HCPCS C1876,,Stent Vasc Blue 100mm 5mm Innova Slf Xpd Radiopq,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,"$1,516.61","$1,516.61",$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
27806362,EAP,HCPCS C1876,,Stent Vasc Blue 120mm 5mm Innova Sprfc Fem Art Slf,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,"$1,516.61","$1,516.61",$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
27806363,EAP,HCPCS C1876,,Innova 6mm X 20mm X 130cm,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,"$1,516.61","$1,516.61",$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
27806364,EAP,HCPCS C1876,,Stent Vasc Blue 40mm 6mm Innova Sprfc Fem Art Slf,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,"$1,516.61","$1,516.61",$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
27806365,EAP,HCPCS C1876,,Stent Vasc 60mm 6mm Innova Slf Xpd Radiopq,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,"$1,516.61","$1,516.61",$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
27806366,EAP,HCPCS C1876,,Stent Vasc Blue 80mm 6mm Innova Sprfc Fem Art Slf,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,"$1,516.61","$1,516.61",$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
27806367,EAP,HCPCS C1876,,Stent Vasc 100mm 6mm Innova Slf Xpd Radiopq,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,"$1,516.61","$1,516.61",$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
27806368,EAP,HCPCS C1876,,Stent Vasc Blue 120mm 6mm Innova Sprfc Fem Art Slf,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,"$1,516.61","$1,516.61",$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
27806369,EAP,HCPCS C1876,,Innova 7mm X 20mm X 130cm,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,"$1,516.61","$1,516.61",$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
27806370,EAP,HCPCS C1876,,Stent Vasc Blue 40mm 7mm Innova Sprfc Fem Art Slf,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,"$1,516.61","$1,516.61",$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
27806371,EAP,HCPCS C1876,,Stent Vasc Blue 60mm 7mm Innova Sprfc Fem Art Slf,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,"$1,516.61","$1,516.61",$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
27806372,EAP,HCPCS C1876,,Stent Vasc Blue 80mm 7mm Innova Sprfc Fem Art Slf,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,"$1,516.61","$1,516.61",$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
27806373,EAP,HCPCS C1876,,Stent Vasc Blue 100mm 7mm Innova Sprfc Fem Art Slf,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,"$1,516.61","$1,516.61",$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
27806374,EAP,HCPCS C1876,,Stent Vasc Blue 120mm 7mm Innova Sprfc Fem Art Slf,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,"$1,516.61","$1,516.61",$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
27806375,EAP,HCPCS C1876,,Innova 8mm X 20mm X 130cm,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,"$1,516.61","$1,516.61",$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
27806376,EAP,HCPCS C1876,,Innova 8mm X 40mm X 130cm,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,"$1,516.61","$1,516.61",$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
27806377,EAP,HCPCS C1876,,Innova 8mm X 60mm X 130cm,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,"$1,516.61","$1,516.61",$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
27806378,EAP,HCPCS C1876,,Innova 8mm X 80mm X 130cm,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,"$1,516.61","$1,516.61",$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
27806379,EAP,HCPCS C1876,,Innova 8mm X 100mm X 130cm,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,"$1,516.61","$1,516.61",$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
27806380,EAP,HCPCS C1876,,Innova 8mm X 120mm X 130cm,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,"$1,516.61","$1,516.61",$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
27806381,EAP,Custom 27806381,,Coil Embl 18d .018in 2mm 2cm Azur Hdrcl Dtch Pltn Ddrgl Peri,"$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,"$1,516.61","$1,516.61",$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806382,EAP,Custom 27806382,,Coil Embl 18d .018in 2mm 4cm Azur Hdrcl Dtch Pltn Ddrgl Peri,"$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,"$1,516.61","$1,516.61",$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806383,EAP,Custom 27806383,,Coil Embl 3mm .018in 2cm Azur Hdrcl 18 Coil Dtch Pltn Ddrgl,"$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,"$1,516.61","$1,516.61",$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806384,EAP,Custom 27806384,,Coil Embl .018in 3mm .021in 5cm 135cm Azur Dtch Pltn Ddrgl,"$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,"$1,516.61","$1,516.61",$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806385,EAP,Custom 27806385,,Coil Embl .018in 4mm 5cm Azur,"$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,"$1,516.61","$1,516.61",$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806386,EAP,Custom 27806386,,System Embl 5mm .018in 5cm Azur Hdrcl 18 Dtch Pltn Ddrgl,"$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,"$1,516.61","$1,516.61",$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806387,EAP,HCPCS C1882,,"Claria Mri Crt-d System, Mmae","$67,375.00",$0.00,"$67,375.00","$30,318.75","$5,158.80",$0.00,"$8,138.89","$5,158.80","$48,085.54","$8,138.89","$67,375.00",$0.00,"$33,687.50","$53,361.00","$53,900.00",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27806388,EAP,HCPCS C1882,,"Claria Mri Quad Crtd System, Mmqe","$67,375.00",$0.00,"$67,375.00","$30,318.75","$5,158.80",$0.00,"$8,138.89","$5,158.80","$48,085.54","$8,138.89","$67,375.00",$0.00,"$33,687.50","$53,361.00","$53,900.00",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
27806389,EAP,Custom 27806389,,System Embl 5mm .018in 10cm Azur Hdrcl 18 Dtch Pltn Ddrgl,"$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,"$1,516.61","$1,516.61",$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806390,EAP,Custom 27806390,,System Embl 5mm .018in 15cm Azur 18 Dtch Hdrcl Peri,"$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,"$1,516.61","$1,516.61",$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806391,EAP,Custom 27806391,,System Embl 5mm .018in 20cm Azur 18 Dtch Hdrcl Peri,"$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,"$1,516.61","$1,516.61",$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806392,EAP,Custom 27806392,,Coil Embl 4mm .018in 10cm 135cm Azur Dtch Pltn Ddrgl Peri,"$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,"$1,516.61","$1,516.61",$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806393,EAP,Custom 27806393,,Coil Embl .018in 6mm .021in 10cm 135cm Azur Dtch Pltn Ddrgl,"$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,"$1,516.61","$1,516.61",$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806394,EAP,Custom 27806394,,Coil Embl .018in 8mm .021in 10cm 135cm Azur Dtch Pltn Ddrgl,"$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,"$1,516.61","$1,516.61",$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806395,EAP,Custom 27806395,,Coil Embl .018in 10mm .021in 10cm 135cm Azur Dtch Pltn Ddrgl,"$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,"$1,516.61","$1,516.61",$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806396,EAP,Custom 27806396,,Coil Embl 6mm .018in 15cm 135cm Azur 18 Coil Dtch Hdrcl Pltn,"$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,"$1,516.61","$1,516.61",$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806397,EAP,Custom 27806397,,Coil Embl .018in 8mm .021in 15cm 135cm Azur Dtch Pltn Ddrgl,"$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,"$1,516.61","$1,516.61",$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806398,EAP,Custom 27806398,,Coil Embl .018in 10mm .021in 15cm 135cm Azur Dtch Pltn Ddrgl,"$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,"$1,516.61","$1,516.61",$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806399,EAP,Custom 27806399,,Coil Embl .018in 12mm .021in 15cm 135cm Azur Dtch Pltn Ddrgl,"$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,"$1,516.61","$1,516.61",$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806400,EAP,HCPCS C2617,,Set Stent 2 Pigtail Curve 8fr 26cm Radiopq Graduat,$269.00,$0.00,$269.00,$121.05,$191.99,$0.00,$46.35,$191.99,$191.99,$47.10,$269.00,$0.00,$134.50,$213.05,$215.20,$0.00,$42.10,$0.00,$42.82,$0.00
27806401,EAP,HCPCS C1874,,Graft Evas 106mm 12mm H&l-b 1-shot Znth Fenestrate,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17","$5,158.80","$6,616.00","$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
27806405,EAP,Custom 27806405,,Coil Embl 8mm 20cm Azur Hdrcl 18 Coils Dtch,"$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,"$1,516.61","$1,516.61",$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806406,EAP,Custom 27806406,,Coil Embl .018in 12mm .021in 20cm 135cm Azur Dtch Pltn Ddrgl,"$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,"$1,516.61","$1,516.61",$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806407,EAP,Custom 27806407,,Coil Embl 15mm 20cm Azur Hdrcl 18 Coils Dtch,"$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,"$1,516.61","$1,516.61",$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806408,EAP,Custom 27806408,,Coil Embl 20mm .018in 20cm Strl Azur Hdrcl Dtch Pltn Ddrgl,"$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,"$1,516.61","$1,516.61",$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806409,EAP,Custom 27806409,,Coil Embl 15mm .018in 30cm Strl Azur Hdrcl 18 Coil Dtch Pltn,"$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,"$1,516.61","$1,516.61",$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806410,EAP,Custom 27806410,,Coil Embl 20mm .018in 30cm Strl Azur 18 Coil Dtch Hdrcl Pltn,"$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,"$1,516.61","$1,516.61",$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806411,EAP,Custom 27806411,,Coil Embl .018in 4mm .021-.027in 13cm Strl Azur Cx Dtch Pltn,"$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,"$1,516.61","$1,516.61",$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806412,EAP,Custom 27806412,,Coil Embl .018in 5mm .021-.027in 16cm Azur Cx Dtch Sft Flxb,"$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,"$1,516.61","$1,516.61",$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806413,EAP,Custom 27806413,,Coil Embl .018in 6mm .021-.027in 20cm Azur Cx Dtch Sft Flxb,"$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,"$1,516.61","$1,516.61",$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806414,EAP,Custom 27806414,,Coil Embl .018in 7mm .021-.027in 24cm Azur Cx Dtch Sft Flxb,"$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,"$1,516.61","$1,516.61",$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806415,EAP,Custom 27806415,,Coil Embl .018in 8mm .021-.027in 28cm Azur Cx Hdrcl Dtch Sft,"$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,"$1,516.61","$1,516.61",$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806416,EAP,Custom 27806416,,Coil Embl .018in 9mm .021-.027in 28cm Azur Cx Hdrcl Dtch Sft,"$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,"$1,516.61","$1,516.61",$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806417,EAP,Custom 27806417,,Coil Embl .018in 10mm .021-.027in 32cm Azur Cx Hdrcl Dtch,"$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,"$1,516.61","$1,516.61",$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806418,EAP,Custom 27806418,,Coil Embl .018in 12mm .021-.027in 38cm Azur Cx Hdrcl Dtch,"$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,"$1,516.61","$1,516.61",$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806419,EAP,Custom 27806419,,Coil Embl .018in 14mm .021-.027in 34cm Azur Cx Hdrcl Dtch,"$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,"$1,516.61","$1,516.61",$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806420,EAP,Custom 27806420,,Coil Embl .018in 16mm .021-.027in 39cm Azur Cx Hdrcl Dtch,"$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,"$1,516.61","$1,516.61",$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806421,EAP,Custom 27806421,,Coil Embl .018in 18mm .021-.027in 36cm Azur Cx Hdrcl Dtch,"$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,"$1,516.61","$1,516.61",$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806422,EAP,Custom 27806422,,Coil Embl .018in 20mm .021-.027in 40cm Azur Cx Hdrcl Dtch,"$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,"$1,516.61","$1,516.61",$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806423,EAP,Custom 27806423,,Coil Embl .035in 4mm .038in 5cm 135cm Azur Dtch Pltn Ddrgl,"$3,125.00",$0.00,"$3,125.00",$0.00,"$2,230.31",$0.00,$0.00,"$2,230.31","$2,230.31",$0.00,"$3,125.00",$0.00,"$1,562.50","$2,475.00","$2,500.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806424,EAP,Custom 27806424,,Coil Embl 4mm 10cm Azur Dtch Ddrgl Peri 35 Sys,"$3,125.00",$0.00,"$3,125.00",$0.00,"$2,230.31",$0.00,$0.00,"$2,230.31","$2,230.31",$0.00,"$3,125.00",$0.00,"$1,562.50","$2,475.00","$2,500.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806425,EAP,Custom 27806425,,Coil Embl .035in 6mm .038in 10cm 135cm Azur Dtch Pltn Ddrgl,"$3,125.00",$0.00,"$3,125.00",$0.00,"$2,230.31",$0.00,$0.00,"$2,230.31","$2,230.31",$0.00,"$3,125.00",$0.00,"$1,562.50","$2,475.00","$2,500.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806426,EAP,Custom 27806426,,Coil Embl .035in 4mm 15cm Azur Dtch Ddrgl Peri,"$3,125.00",$0.00,"$3,125.00",$0.00,"$2,230.31",$0.00,$0.00,"$2,230.31","$2,230.31",$0.00,"$3,125.00",$0.00,"$1,562.50","$2,475.00","$2,500.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806427,EAP,Custom 27806427,,Coil Embl .035in 6mm .038in 15cm 135cm Azur Dtch Pltn Ddrgl,"$3,125.00",$0.00,"$3,125.00",$0.00,"$2,230.31",$0.00,$0.00,"$2,230.31","$2,230.31",$0.00,"$3,125.00",$0.00,"$1,562.50","$2,475.00","$2,500.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806428,EAP,Custom 27806428,,Coil Embl .035in 8mm .038in 15cm 135cm Azur Dtch Pltn Ddrgl,"$3,125.00",$0.00,"$3,125.00",$0.00,"$2,230.31",$0.00,$0.00,"$2,230.31","$2,230.31",$0.00,"$3,125.00",$0.00,"$1,562.50","$2,475.00","$2,500.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806429,EAP,Custom 27806429,,Coil Embl .035in 10mm .038in 15cm 135cm Azur Dtch Pltn Ddrgl,"$3,125.00",$0.00,"$3,125.00",$0.00,"$2,230.31",$0.00,$0.00,"$2,230.31","$2,230.31",$0.00,"$3,125.00",$0.00,"$1,562.50","$2,475.00","$2,500.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806430,EAP,Custom 27806430,,Coil Embl 6mm 20cm Azur Dtch Ddrgl Peri 35 Sys,"$3,125.00",$0.00,"$3,125.00",$0.00,"$2,230.31",$0.00,$0.00,"$2,230.31","$2,230.31",$0.00,"$3,125.00",$0.00,"$1,562.50","$2,475.00","$2,500.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806431,EAP,Custom 27806431,,Coil Embl .035in 8mm .038in 20cm 135cm Azur Dtch Pltn Ddrgl,"$3,125.00",$0.00,"$3,125.00",$0.00,"$2,230.31",$0.00,$0.00,"$2,230.31","$2,230.31",$0.00,"$3,125.00",$0.00,"$1,562.50","$2,475.00","$2,500.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806432,EAP,Custom 27806432,,Coil Embl .035in 12mm .038in 20cm 135cm Azur Dtch Pltn Ddrgl,"$3,125.00",$0.00,"$3,125.00",$0.00,"$2,230.31",$0.00,$0.00,"$2,230.31","$2,230.31",$0.00,"$3,125.00",$0.00,"$1,562.50","$2,475.00","$2,500.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806433,EAP,Custom 27806433,,Coil Embl .035in 15mm .038in 20cm 135cm Azur Dtch Pltn Ddrgl,"$3,125.00",$0.00,"$3,125.00",$0.00,"$2,230.31",$0.00,$0.00,"$2,230.31","$2,230.31",$0.00,"$3,125.00",$0.00,"$1,562.50","$2,475.00","$2,500.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806434,EAP,Custom 27806434,,Coil Embl 20mm 20cm Azur Dtch Ddrgl Peri 35 Sys,"$3,125.00",$0.00,"$3,125.00",$0.00,"$2,230.31",$0.00,$0.00,"$2,230.31","$2,230.31",$0.00,"$3,125.00",$0.00,"$1,562.50","$2,475.00","$2,500.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806435,EAP,Custom 27806435,,Coil Embl 12mm 30cm Azur Dtch Ddrgl Peri 35 Sys,"$3,125.00",$0.00,"$3,125.00",$0.00,"$2,230.31",$0.00,$0.00,"$2,230.31","$2,230.31",$0.00,"$3,125.00",$0.00,"$1,562.50","$2,475.00","$2,500.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806436,EAP,Custom 27806436,,Coil Embl .035in 4mm 7cm Azur Cx Dtch Sft Sld Cor Flxb Ddrgl,"$3,125.00",$0.00,"$3,125.00",$0.00,"$2,230.31",$0.00,$0.00,"$2,230.31","$2,230.31",$0.00,"$3,125.00",$0.00,"$1,562.50","$2,475.00","$2,500.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806437,EAP,Custom 27806437,,Coil Embl .035in 5mm 11cm Azur Cx Dtch Sft Sld Cor Flxb,"$3,125.00",$0.00,"$3,125.00",$0.00,"$2,230.31",$0.00,$0.00,"$2,230.31","$2,230.31",$0.00,"$3,125.00",$0.00,"$1,562.50","$2,475.00","$2,500.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806438,EAP,Custom 27806438,,Coil Embl .035in 6mm 9cm Azur Cx Dtch Sft Sld Cor Flxb Ddrgl,"$3,125.00",$0.00,"$3,125.00",$0.00,"$2,230.31",$0.00,$0.00,"$2,230.31","$2,230.31",$0.00,"$3,125.00",$0.00,"$1,562.50","$2,475.00","$2,500.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806439,EAP,Custom 27806439,,Coil Embl .035in 6mm 17cm Azur Cx Dtch Cx Sect Cvrgls Flxb,"$3,125.00",$0.00,"$3,125.00",$0.00,"$2,230.31",$0.00,$0.00,"$2,230.31","$2,230.31",$0.00,"$3,125.00",$0.00,"$1,562.50","$2,475.00","$2,500.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806440,EAP,Custom 27806440,,Coil Embl .035in 8mm 12cm Azur Cx Dtch Sft Sld Cor Flxb,"$3,125.00",$0.00,"$3,125.00",$0.00,"$2,230.31",$0.00,$0.00,"$2,230.31","$2,230.31",$0.00,"$3,125.00",$0.00,"$1,562.50","$2,475.00","$2,500.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806441,EAP,Custom 27806441,,Coil Embl .035in 8mm 24cm Azur Cx Dtch Sft Sld Cor Flxb,"$3,125.00",$0.00,"$3,125.00",$0.00,"$2,230.31",$0.00,$0.00,"$2,230.31","$2,230.31",$0.00,"$3,125.00",$0.00,"$1,562.50","$2,475.00","$2,500.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806442,EAP,Custom 27806442,,Coil Embl .035in 10mm 19cm Azur Cx Dtch Sft Sld Cor Flxb,"$3,125.00",$0.00,"$3,125.00",$0.00,"$2,230.31",$0.00,$0.00,"$2,230.31","$2,230.31",$0.00,"$3,125.00",$0.00,"$1,562.50","$2,475.00","$2,500.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806443,EAP,Custom 27806443,,Coil Embl .035in 13mm 24cm Azur Cx Dtch Sft Sld Cor Flxb,"$3,125.00",$0.00,"$3,125.00",$0.00,"$2,230.31",$0.00,$0.00,"$2,230.31","$2,230.31",$0.00,"$3,125.00",$0.00,"$1,562.50","$2,475.00","$2,500.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806444,EAP,Custom 27806444,,Coil Embl .035in 16mm 32cm Azur Cx Dtch Sft Sld Cor Flxb,"$3,125.00",$0.00,"$3,125.00",$0.00,"$2,230.31",$0.00,$0.00,"$2,230.31","$2,230.31",$0.00,"$3,125.00",$0.00,"$1,562.50","$2,475.00","$2,500.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806445,EAP,Custom 27806445,,Coil Embl .035in 10mm .038in 26cm 150cm Azur Frme Elc Dtch,"$3,125.00",$0.00,"$3,125.00",$0.00,"$2,230.31",$0.00,$0.00,"$2,230.31","$2,230.31",$0.00,"$3,125.00",$0.00,"$1,562.50","$2,475.00","$2,500.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806446,EAP,Custom 27806446,,Coil Embl 8mm 20cm Azur Frm,"$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,"$1,516.61","$1,516.61",$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806447,EAP,Custom 27806447,,Coil Embl .018in 10mm .021in 26cm 150cm Azur Frme Elc Dtch,"$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,"$1,516.61","$1,516.61",$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806448,EAP,Custom 27806448,,Coil Embl .018in 14mm 34mm Azur Frme Nonhydrogel Dtch Loop,"$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,"$1,516.61","$1,516.61",$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806449,EAP,Custom 27806449,,Coil Embl .018in 20mm .021in 50cm 150cm Azur Frme Elc Dtch,"$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,"$1,516.61","$1,516.61",$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
27806450,EAP,Custom 27806450,,Coil Embl Azur Dtch Cntrlr,$425.00,$0.00,$425.00,$0.00,$303.32,$0.00,$0.00,$303.32,$303.32,$0.00,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$0.00,$0.00,$0.00,$0.00
27806451,EAP,HCPCS C1880,,"Kit Aln Removal And/or Repositioning, 2in1 Rs","$1,063.00",$0.00,"$1,063.00",$478.35,$758.66,$0.00,$183.15,$758.66,$758.66,$186.12,"$1,063.00",$0.00,$531.50,$841.90,$850.40,$0.00,$166.36,$0.00,$169.23,$0.00
27806493,EAP,HCPCS C1874,,Graft Evas 91mm 12fr Znth Aaa Vscr Fen Distal Bfur,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17","$5,158.80","$6,616.00","$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
27806494,EAP,HCPCS C1874,,Graft Evas 124mm 32mm H&l-b 1-shot Znth 2 Prox,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11","$5,158.80","$19,626.75","$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
27806596,EAP,HCPCS C1874,,Graft Evas 121mm 12mm 7.7mm 20fr Znth H&l-b 1-shot,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17","$5,158.80","$6,616.00","$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
27806798,EAP,HCPCS C1874,,Graft Evas 76mm 16fr Znth Aaa Vscr Fen Distal Bfur,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17","$5,158.80","$6,616.00","$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
27806899,EAP,HCPCS C1874,,Graft Evas 76mm 20fr Znth Aaa Vscr Fen Distal Bfur,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17","$5,158.80","$6,616.00","$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
27807101,EAP,HCPCS C1874,,Graft Evas 91mm 16fr Znth Aaa Vscr Fen Distal Bfur,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17","$5,158.80","$6,616.00","$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
27807202,EAP,HCPCS C1874,,Graft Evas 91mm 20fr Znth Aaa Vscr Fen Distal Bfur,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17","$5,158.80","$6,616.00","$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
27807303,EAP,HCPCS C1874,,Graft Evas 106mm 16fr Znth Aaa Vscr Fen Distal,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17","$5,158.80","$6,616.00","$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
27807404,EAP,HCPCS C1874,,Graft Evas 106mm 20fr Znth Aaa Vscr Fen Distal,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17","$5,158.80","$6,616.00","$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
27807505,EAP,HCPCS C1874,,Graft Evas 121mm 16fr Znth Aaa Vscr Fen Distal,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17","$5,158.80","$6,616.00","$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
27807606,EAP,HCPCS C1874,,Graft Evas 121mm 20fr Znth Aaa Vscr Fen Distal,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17","$5,158.80","$6,616.00","$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
27807707,EAP,HCPCS C1874,,Graft Evas 76mm 12fr Znth Aaa Vscr Fen Distal Bfur,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17","$5,158.80","$6,616.00","$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
27807808,EAP,HCPCS C1874,,Graft Evas 76mm 16fr Znth Aaa Vscr Fen Distal Bfur,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17","$5,158.80","$6,616.00","$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
27807909,EAP,HCPCS C1874,,Graft Evas 76mm 20fr Znth Aaa Vscr Fen Distal Bfur,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17","$5,158.80","$6,616.00","$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
27808010,EAP,HCPCS C1874,,Graft Evas 76mm 24fr Znth Aaa Vscr Fen Distal Bfur,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17","$5,158.80","$6,616.00","$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
27808111,EAP,HCPCS C1874,,Graft Evas 91mm 12fr Znth Aaa Vscr Fen Distal Bfur,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17","$5,158.80","$6,616.00","$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
27808212,EAP,HCPCS C1874,,Graft Evas 91mm 16fr Znth Aaa Vscr Fen Distal Bfur,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17","$5,158.80","$6,616.00","$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
27808313,EAP,HCPCS C1874,,Graft Evas 91mm 20fr Znth Aaa Vscr Fen Distal Bfur,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17","$5,158.80","$6,616.00","$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
27808414,EAP,HCPCS C1874,,Graft Evas 91mm 24fr Znth Aaa Vscr Fen Distal Bfur,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17","$5,158.80","$6,616.00","$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
27808515,EAP,HCPCS C1874,,Graft Evas 106mm 12fr Znth Aaa Vscr Fen Distal,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17","$5,158.80","$6,616.00","$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
27808616,EAP,HCPCS C1874,,Graft Evas 106mm 16fr Znth Aaa Vscr Fen Distal,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17","$5,158.80","$6,616.00","$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
27808717,EAP,HCPCS C1874,,Graft Evas 106mm 20fr Znth H&l-b 1-shot Vscr Fen,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17","$5,158.80","$6,616.00","$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
27808818,EAP,HCPCS C1874,,Graft Evas 106mm 24fr Znth Aaa Vscr Fen Distal,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17","$5,158.80","$6,616.00","$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
27808919,EAP,HCPCS C1874,,Graft Evas 121mm 12fr Znth Aaa Vscr Fen Distal,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17","$5,158.80","$6,616.00","$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
27809020,EAP,HCPCS C1874,,Graft Evas 121mm 16fr Znth Aaa Vscr Fen Distal,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17","$5,158.80","$6,616.00","$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
27809021,EAP,HCPCS C1876,,Tent Vasc Strg 10mm 30mm Xact Slf Xpd Cls Cell Fl,"$4,938.00",$0.00,"$4,938.00","$2,222.10","$3,524.25",$0.00,$850.79,"$3,524.25","$3,524.25",$864.60,"$4,938.00",$0.00,"$2,469.00","$3,910.90","$3,950.40",$0.00,$772.80,$0.00,$786.13,$0.00
27809121,EAP,HCPCS C1874,,Graft Evas 121mm 20fr Znth Aaa Vscr Fen Distal,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17","$5,158.80","$6,616.00","$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
27809222,EAP,HCPCS C1874,,Graft Evas 121mm 24fr Znth Aaa Vscr Fen Distal,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17","$5,158.80","$6,616.00","$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
27809323,EAP,HCPCS C1874,,Graft Evas 76mm 12fr Znth Aaa Vscr Fen Distal Bfur,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17","$5,158.80","$6,616.00","$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
27809424,EAP,HCPCS C1874,,Graft Evas 76mm 20mm 8.1mm 20fr Znth Aaa Distal,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17","$5,158.80","$6,616.00","$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
27809525,EAP,HCPCS C1874,,Graft Evas 76mm 24fr Znth 1-shot Aaa 2 Brch Vscr,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17","$5,158.80","$6,616.00","$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
27809626,EAP,HCPCS C1874,,Graft Evas 91mm 12fr Znth Aaa Vscr Fen Distal Bfur,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17","$5,158.80","$6,616.00","$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
27809727,EAP,HCPCS C1874,,Graft Evas 91mm 16fr Znth Aaa Fenst Distal Bfur,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17","$5,158.80","$6,616.00","$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
27809828,EAP,HCPCS C1874,,Graft Evas 91mm 20fr Znth Aaa Vscr Fen Distal Bfur,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17","$5,158.80","$6,616.00","$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
27809929,EAP,HCPCS C1874,,Graft Evas 91mm 24fr Znth Aaa Vscr Fen Distal Bfur,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17","$5,158.80","$6,616.00","$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
27809930,EAP,HCPCS C1876,,Stent Endoth 12mm 8fr 40mm 100cm Flex Recons,"$2,438.00",$0.00,"$2,438.00","$1,097.10","$1,740.00",$0.00,$420.06,"$1,740.00","$1,740.00",$426.87,"$2,438.00",$0.00,"$1,219.00","$1,930.90","$1,950.40",$0.00,$381.55,$0.00,$388.13,$0.00
27809931,EAP,HCPCS C1788,,Set Hmdial 33ml Lf Aqdx Bld Crct Uf-500,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,"$1,605.83","$1,605.83",$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
27810030,EAP,HCPCS C1874,,Graft Evas 106mm 12fr Znth Aaa Vscr Fen Distal,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17","$5,158.80","$6,616.00","$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
27810131,EAP,HCPCS C1874,,Graft Evas 106mm 16fr Znth Aaa Vscr Fen Distal,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17","$5,158.80","$6,616.00","$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
27810232,EAP,HCPCS C1874,,Graft Evas 106mm 20fr Znth Aaa Vscr Fen Distal,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17","$5,158.80","$6,616.00","$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
27810333,EAP,HCPCS C1874,,Graft Evas 106mm 24fr Znth Aaa Vscr Fen Distal,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17","$5,158.80","$6,616.00","$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
27810434,EAP,HCPCS C1874,,Graft Evas 121mm 12fr Znth Aaa Vscr Fen Distal,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17","$5,158.80","$6,616.00","$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
27810535,EAP,HCPCS C1874,,Graft Evas 121mm 16fr Znth Aaa Vscr Fen Distal,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17","$5,158.80","$6,616.00","$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
27810636,EAP,HCPCS C1874,,Graft Evas 121mm 20fr Znth Aaa Vscr Fen Distal,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17","$5,158.80","$6,616.00","$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
27810737,EAP,HCPCS C1874,,Graft Evas 121mm 24fr Znth Aaa Vscr Fen Distal,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17","$5,158.80","$6,616.00","$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
27810838,EAP,HCPCS C1874,,Graft Evas 76mm 16fr Znth Aaa Vscr Fen Distal Bfur,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17","$5,158.80","$6,616.00","$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
27810939,EAP,HCPCS C1874,,Graft Evas 76mm 24mm 7.7mm 20fr Znth H&l-b 1-shot,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17","$5,158.80","$6,616.00","$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
27811040,EAP,HCPCS C1874,,Graft Evas 76mm 26mm 7.7mm 20fr Znth H&l-b 1-shot,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11","$5,158.80","$19,626.75","$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
27811141,EAP,HCPCS C1874,,Graft Evas 76mm 28mm 7.7mm 20fr Znth H&l-b 1-shot,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11","$5,158.80","$19,626.75","$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
27811242,EAP,HCPCS C1874,,Graft Evas 76mm 30mm 7.7mm 20fr Znth H&l-b 1-shot,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11","$5,158.80","$19,626.75","$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
27811343,EAP,HCPCS C1874,,Graft Evas 76mm 32mm 7.7mm 20fr Znth H&l-b 1-shot,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11","$5,158.80","$19,626.75","$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
27811444,EAP,HCPCS C1874,,Graft Evas 91mm 24mm 7.7mm 20fr Znth H&l-b 1-shot,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11","$5,158.80","$19,626.75","$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
27811545,EAP,HCPCS C1874,,Graft Evas 91mm 26mm 7.7mm 20fr Znth H&l-b 1-shot,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11","$5,158.80","$19,626.75","$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
27811646,EAP,HCPCS C1874,,Graft Evas 91mm 28mm 7.7mm 20fr Znth H&l-b 1-shot,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11","$5,158.80","$19,626.75","$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
27811747,EAP,HCPCS C1874,,Graft Evas 91mm 30mm 7.7mm 20fr Znth H&l-b 1-shot,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11","$5,158.80","$19,626.75","$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
27811848,EAP,HCPCS C1874,,Graft Evas 91mm 32mm 7.7mm 20fr Znth H&l-b 1-shot,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11","$5,158.80","$19,626.75","$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
27811949,EAP,HCPCS C1874,,Graft Evas 106mm 24mm 7.7mm 20fr Znth H&l-b 1-shot,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11","$5,158.80","$19,626.75","$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
27812050,EAP,HCPCS C1874,,Graft Evas 106mm 26mm 7.7mm 20fr Znth H&l-b 1-shot,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11","$5,158.80","$19,626.75","$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
27812151,EAP,HCPCS C1874,,Graft Evas 106mm 28mm 7.7mm 20fr Znth H&l-b 1-shot,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11","$5,158.80","$19,626.75","$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
27812252,EAP,HCPCS C1874,,Graft Evas 106mm 30mm 7.7mm 20fr Znth H&l-b 1-shot,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11","$5,158.80","$19,626.75","$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
27812353,EAP,HCPCS C1874,,Graft Evas 106mm 32mm 7.7mm 20fr Znth H&l-b 1-shot,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11","$5,158.80","$19,626.75","$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
27812454,EAP,HCPCS C1874,,Graft Evas 121mm 24mm 7.7mm 20fr Znth H&l-b 1-shot,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11","$5,158.80","$19,626.75","$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
27812555,EAP,HCPCS C1874,,Graft Evas 121mm 26mm 7.7mm 20fr Znth H&l-b 1-shot,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11","$5,158.80","$19,626.75","$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
27812656,EAP,HCPCS C1874,,Graft Evas 121mm 28mm 7.7mm 20fr Znth H&l-b 1-shot,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11","$5,158.80","$19,626.75","$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
27812757,EAP,HCPCS C1874,,Graft Evas 121mm 30mm 7.7mm 20fr Znth H&l-b 1-shot,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11","$5,158.80","$19,626.75","$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
27812858,EAP,HCPCS C1874,,Graft Evas 121mm 32mm 7.7mm 20fr Znth H&l-b 1-shot,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11","$5,158.80","$19,626.75","$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
27812959,EAP,HCPCS C1874,,Graft Evas 84mm 34mm 7.7mm 20fr Znth H&l-b 1-shot,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11","$5,158.80","$19,626.75","$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
27813060,EAP,HCPCS C1874,,Graft Evas 84mm 36mm 8.5mm 20fr Znth H&l-b 1-shot,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11","$5,158.80","$19,626.75","$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
27813161,EAP,HCPCS C1874,,Graft Evas 99mm 34mm 7.7mm 20fr Znth H&l-b 1-shot,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11","$5,158.80","$19,626.75","$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
27813262,EAP,HCPCS C1874,,Graft Evas 99mm 36mm 8.5mm 20fr Znth H&l-b 1-shot,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11","$5,158.80","$19,626.75","$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
27813363,EAP,HCPCS C1874,,Graft Evas 114mm 34mm 7.7mm 20fr Znth H&l-b 1-shot,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11","$5,158.80","$19,626.75","$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
27813464,EAP,HCPCS C1874,,Graft Evas 114mm 36mm 8.5mm 20fr Znth H&l-b 1-shot,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11","$5,158.80","$19,626.75","$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
27813565,EAP,HCPCS C1874,,Graft Evas 129mm 34mm 7.7mm 20fr Znth H&l-b 1-shot,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11","$5,158.80","$19,626.75","$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
27813666,EAP,HCPCS C1874,,Graft Evas 129mm 36mm 8.5mm 20fr Znth H&l-b 1-shot,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11","$5,158.80","$19,626.75","$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
27813767,EAP,HCPCS C1874,,Graft Evas 94mm 24mm 7.7mm 20fr Znth H&l-b 1-shot,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11","$5,158.80","$19,626.75","$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
27813868,EAP,HCPCS C1874,,Graft Evas 94mm 26mm 7.7mm 20fr Znth H&l-b 1-shot,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11","$5,158.80","$19,626.75","$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
27813969,EAP,HCPCS C1874,,Graft Evas 94mm 20fr Znth Aaa Vscr Fen Prox Bfur,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11","$5,158.80","$19,626.75","$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
27814070,EAP,HCPCS C1874,,Graft Evas 94mm 30mm 7.7mm 20fr Znth H&l-b 1-shot,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11","$5,158.80","$19,626.75","$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
27814171,EAP,HCPCS C1874,,Graft Evas 94mm 32mm 7.7mm 20fr Znth H&l-b 1-shot,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11","$5,158.80","$19,626.75","$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
27814272,EAP,HCPCS C1874,,Graft Evas 109mm 24mm 7.7mm 20fr Znth H&l-b 1-shot,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11","$5,158.80","$19,626.75","$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
27814373,EAP,HCPCS C1874,,Graft Evas 109mm 26mm H&l-b 1-shot Znth 2 Prox,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11","$5,158.80","$19,626.75","$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
27814474,EAP,HCPCS C1874,,Graft Evas 109mm 28mm H&l-b 1-shot Znth 2 Prox,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11","$5,158.80","$19,626.75","$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
27814575,EAP,HCPCS C1874,,Graft Evas 109mm 30mm H&l-b 1-shot Znth 2 Prox,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11","$5,158.80","$19,626.75","$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
27814676,EAP,HCPCS C1874,,Graft Evas 109mm 32mm H&l-b 1-shot Znth 2 Prox,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11","$5,158.80","$19,626.75","$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
27814777,EAP,HCPCS C1874,,Graft Evas 124mm 24mm 7.7mm 20fr Znth H&l-b 1-shot,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11","$5,158.80","$19,626.75","$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
27814878,EAP,HCPCS C1874,,Graft Evas 124mm 12fr Znth Aaa Vscr Fen Distal,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11","$5,158.80","$19,626.75","$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
27814979,EAP,HCPCS C1874,,Graft Evas 124mm 2fr Znth Aaa Fenst Prox Body 28mm,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11","$5,158.80","$19,626.75","$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
27815080,EAP,HCPCS C1874,,Graft Evas 124mm 30mm H&l-b 1-shot Znth 2 Prox,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11","$5,158.80","$19,626.75","$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
27815282,EAP,HCPCS C1874,,Graft Evas 107mm 34mm H&l-b 1-shot Znth 2 Prox,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11","$5,158.80","$19,626.75","$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
27815383,EAP,HCPCS C1874,,Graft Evas 107mm 36mm H&l-b 1-shot Znth 2 Prox,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11","$5,158.80","$19,626.75","$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
27815484,EAP,HCPCS C1874,,Graft Evas 122mm 34mm 20fr H L-b 1-shot Znth 2,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11","$5,158.80","$19,626.75","$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
27815585,EAP,HCPCS C1874,,Graft Evas 122mm 36mm 8.5mm 22fr Znth H&l-b 1-shot,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11","$5,158.80","$19,626.75","$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
27815686,EAP,HCPCS C1874,,Graft Evas 137mm 34mm H&l-b 1-shot Znth 2 Prox,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11","$5,158.80","$19,626.75","$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
27815787,EAP,HCPCS C1874,,Graft Evas 137mm 36mm Znth H&l-b 1-shot 2 Prox,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11","$5,158.80","$19,626.75","$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
27815888,EAP,HCPCS C1874,,Graft Evas 109mm 20mm 7.7mm 20fr Znth Fenestrate 2,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17","$5,158.80","$6,616.00","$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
27815889,EAP,HCPCS C1881,,Catheter Intvn Mic 2.7fr L130c,$818.13,$0.00,$818.13,$0.00,$583.90,$0.00,$0.00,$583.90,$583.90,$0.00,$818.13,$0.00,$409.07,$647.96,$654.50,$0.00,$0.00,$0.00,$0.00,$0.00
27815890,EAP,Custom 27815890,,Coil Embol L14cm Loop Od5mm 0.018in Platinum Hydrogel Polyme,$818.13,$0.00,$818.13,$0.00,$583.90,$0.00,$0.00,$583.90,$583.90,$0.00,$818.13,$0.00,$409.07,$647.96,$654.50,$0.00,$0.00,$0.00,$0.00,$0.00
27815891,EAP,Custom 27815891,,Coil Embol L20cm Od6mm 0.018in Hydrocoil Pushable Azur 18p,$818.13,$0.00,$818.13,$0.00,$583.90,$0.00,$0.00,$583.90,$583.90,$0.00,$818.13,$0.00,$409.07,$647.96,$654.50,$0.00,$0.00,$0.00,$0.00,$0.00
27815892,EAP,Custom 27815892,,Coil Embol L20cm Loop Od8mm 0.018in Platinum Hydrogel Polyme,$923.33,$0.00,$923.33,$0.00,$658.98,$0.00,$0.00,$658.98,$658.98,$0.00,$923.33,$0.00,$461.67,$731.28,$738.66,$0.00,$0.00,$0.00,$0.00,$0.00
27815893,EAP,Custom 27815893,,Coil Embol L14cm Loop Od6mm 0.035in Platinum Hydrogel Polyme,$923.33,$0.00,$923.33,$0.00,$658.98,$0.00,$0.00,$658.98,$658.98,$0.00,$923.33,$0.00,$461.67,$731.28,$738.66,$0.00,$0.00,$0.00,$0.00,$0.00
27815894,EAP,Custom 27815894,,Coil Embol L20cm Loop Od8mm 0.035in Platinum Hydrogel Polyme,$923.33,$0.00,$923.33,$0.00,$658.98,$0.00,$0.00,$658.98,$658.98,$0.00,$923.33,$0.00,$461.67,$731.28,$738.66,$0.00,$0.00,$0.00,$0.00,$0.00
27815895,EAP,Custom 27815895,,Coil Embol L20cm Loop Od10mm 0.035in Platinum Hydrogel Polym,$923.33,$0.00,$923.33,$0.00,$658.98,$0.00,$0.00,$658.98,$658.98,$0.00,$923.33,$0.00,$461.67,$731.28,$738.66,$0.00,$0.00,$0.00,$0.00,$0.00
27815896,EAP,Custom 27815896,,Coil Embol L20cm Loop Od15mm 0,$923.33,$0.00,$923.33,$0.00,$658.98,$0.00,$0.00,$658.98,$658.98,$0.00,$923.33,$0.00,$461.67,$731.28,$738.66,$0.00,$0.00,$0.00,$0.00,$0.00
27815897,EAP,Custom 27815897,,Coil Embol L20cm Loop Od16mm 0,$818.13,$0.00,$818.13,$0.00,$583.90,$0.00,$0.00,$583.90,$583.90,$0.00,$818.13,$0.00,$409.07,$647.96,$654.50,$0.00,$0.00,$0.00,$0.00,$0.00
27815898,EAP,Custom 27815898,,Coil Embl .018in 10mm 14cm Azur Hdrcl Psh Peri 18 Sys,$350.63,$0.00,$350.63,$0.00,$250.24,$0.00,$0.00,$250.24,$250.24,$0.00,$350.63,$0.00,$175.32,$277.70,$280.50,$0.00,$0.00,$0.00,$0.00,$0.00
27815899,EAP,Custom 27815899,,Coil Embl .018in 2mm 2cm Azur Hdrcl Psh Perm Mech Ocl Ddrgl,$350.63,$0.00,$350.63,$0.00,$250.24,$0.00,$0.00,$250.24,$250.24,$0.00,$350.63,$0.00,$175.32,$277.70,$280.50,$0.00,$0.00,$0.00,$0.00,$0.00
27815900,EAP,Custom 27815900,,Coil Embl .018in 3mm 2cm Azur Hdrcl Psh Loop Pltn Ddrgl Peri,$467.50,$0.00,$467.50,$0.00,$333.65,$0.00,$0.00,$333.65,$333.65,$0.00,$467.50,$0.00,$233.75,$370.26,$374.00,$0.00,$0.00,$0.00,$0.00,$0.00
27815901,EAP,Custom 27815901,,Coil Embl .018in 3mm 4cm Azur Hdrcl Psh Perm Mech Ocl Ddrgl,$350.63,$0.00,$350.63,$0.00,$250.24,$0.00,$0.00,$250.24,$250.24,$0.00,$350.63,$0.00,$175.32,$277.70,$280.50,$0.00,$0.00,$0.00,$0.00,$0.00
27815902,EAP,Custom 27815902,,Coil Embl .018in 4mm 2cm Azur Hdrcl Psh Peri 18 Sys,$467.50,$0.00,$467.50,$0.00,$333.65,$0.00,$0.00,$333.65,$333.65,$0.00,$467.50,$0.00,$233.75,$370.26,$374.00,$0.00,$0.00,$0.00,$0.00,$0.00
27815903,EAP,Custom 27815903,,Coil Embl .018in 4mm 4cm Azur Hdrcl Psh Peri 18 Sys,$584.38,$0.00,$584.38,$0.00,$417.07,$0.00,$0.00,$417.07,$417.07,$0.00,$584.38,$0.00,$292.19,$462.83,$467.50,$0.00,$0.00,$0.00,$0.00,$0.00
27815904,EAP,Custom 27815904,,Coil Embl .018in 4mm 6cm Azur Hdrcl Psh Peri 18 Sys,$689.58,$0.00,$689.58,$0.00,$492.15,$0.00,$0.00,$492.15,$492.15,$0.00,$689.58,$0.00,$344.79,$546.15,$551.66,$0.00,$0.00,$0.00,$0.00,$0.00
27815905,EAP,Custom 27815905,,Coil Embl .018in 4mm 6cm Azur Hdrcl Psh Perm Mech Ocl Ddrgl,$701.25,$0.00,$701.25,$0.00,$500.48,$0.00,$0.00,$500.48,$500.48,$0.00,$701.25,$0.00,$350.63,$555.39,$561.00,$0.00,$0.00,$0.00,$0.00,$0.00
27815906,EAP,Custom 27815906,,Coil Embl .018in 5mm 10cm Azur Hdrcl Psh Peri 18 Sys,$467.50,$0.00,$467.50,$0.00,$333.65,$0.00,$0.00,$333.65,$333.65,$0.00,$467.50,$0.00,$233.75,$370.26,$374.00,$0.00,$0.00,$0.00,$0.00,$0.00
27815907,EAP,Custom 27815907,,Coil Embl .018in 5mm 4cm Azur Hdrcl Psh Peri 18 Sys,$584.38,$0.00,$584.38,$0.00,$417.07,$0.00,$0.00,$417.07,$417.07,$0.00,$584.38,$0.00,$292.19,$462.83,$467.50,$0.00,$0.00,$0.00,$0.00,$0.00
27815908,EAP,Custom 27815908,,Coil Embl .018in 5mm 6cm Azur Hdrcl Psh 18 Sys,$689.58,$0.00,$689.58,$0.00,$492.15,$0.00,$0.00,$492.15,$492.15,$0.00,$689.58,$0.00,$344.79,$546.15,$551.66,$0.00,$0.00,$0.00,$0.00,$0.00
27815909,EAP,Custom 27815909,,Coil Embl .018in 5mm 6cm Azur Hdrcl Psh Perm Mech Ocl Ddrgl,$701.25,$0.00,$701.25,$0.00,$500.48,$0.00,$0.00,$500.48,$500.48,$0.00,$701.25,$0.00,$350.63,$555.39,$561.00,$0.00,$0.00,$0.00,$0.00,$0.00
27815910,EAP,Custom 27815910,,Coil Embl .018in 6mm 10cm Azur Hdrcl Psh Peri 18 Sys,$818.13,$0.00,$818.13,$0.00,$583.90,$0.00,$0.00,$583.90,$583.90,$0.00,$818.13,$0.00,$409.07,$647.96,$654.50,$0.00,$0.00,$0.00,$0.00,$0.00
27815911,EAP,Custom 27815911,,Coil Embl .018in 6mm 14cm Azur Hdrcl Psh Peri 18 Sys,$584.38,$0.00,$584.38,$0.00,$417.07,$0.00,$0.00,$417.07,$417.07,$0.00,$584.38,$0.00,$292.19,$462.83,$467.50,$0.00,$0.00,$0.00,$0.00,$0.00
27815912,EAP,Custom 27815912,,Coil Embl .018in 6mm 6cm Azur Hdrcl Psh Peri 18 Sys,$701.25,$0.00,$701.25,$0.00,$500.48,$0.00,$0.00,$500.48,$500.48,$0.00,$701.25,$0.00,$350.63,$555.39,$561.00,$0.00,$0.00,$0.00,$0.00,$0.00
27815913,EAP,Custom 27815913,,Coil Embl .018in 8mm 10cm Azur Hdrcl Psh Peri 18 Sys,$818.13,$0.00,$818.13,$0.00,$583.90,$0.00,$0.00,$583.90,$583.90,$0.00,$818.13,$0.00,$409.07,$647.96,$654.50,$0.00,$0.00,$0.00,$0.00,$0.00
27815914,EAP,Custom 27815914,,Coil Embl .018in 8mm 14cm Azur Hdrcl Psh Peri 18 Sys,$923.33,$0.00,$923.33,$0.00,$658.98,$0.00,$0.00,$658.98,$658.98,$0.00,$923.33,$0.00,$461.67,$731.28,$738.66,$0.00,$0.00,$0.00,$0.00,$0.00
27815915,EAP,Custom 27815915,,Coil Embl .035in 10mm 14cm Azur Hdrcl Psh Peri 35 Sys,$923.33,$0.00,$923.33,$0.00,$658.98,$0.00,$0.00,$658.98,$658.98,$0.00,$923.33,$0.00,$461.67,$731.28,$738.66,$0.00,$0.00,$0.00,$0.00,$0.00
27815916,EAP,Custom 27815916,,Coil Embl .035in 15mm 14cm Azur Hdrcl Psh Loop Pltn Ddrgl,$572.70,$0.00,$572.70,$0.00,$408.74,$0.00,$0.00,$408.74,$408.74,$0.00,$572.70,$0.00,$286.35,$453.58,$458.16,$0.00,$0.00,$0.00,$0.00,$0.00
27815917,EAP,Custom 27815917,,Coil Embl .035in 4mm 4cm Azur Hdrcl Psh Peri 35 Sys,$806.45,$0.00,$806.45,$0.00,$575.56,$0.00,$0.00,$575.56,$575.56,$0.00,$806.45,$0.00,$403.23,$638.71,$645.16,$0.00,$0.00,$0.00,$0.00,$0.00
27815918,EAP,Custom 27815918,,Coil Embl .035in 5mm 10cm Azur Hdrcl Psh,$806.45,$0.00,$806.45,$0.00,$575.56,$0.00,$0.00,$575.56,$575.56,$0.00,$806.45,$0.00,$403.23,$638.71,$645.16,$0.00,$0.00,$0.00,$0.00,$0.00
27815919,EAP,Custom 27815919,,Coil Embl .035in 6mm 10cm Azur Hdrcl Psh,$806.45,$0.00,$806.45,$0.00,$575.56,$0.00,$0.00,$575.56,$575.56,$0.00,$806.45,$0.00,$403.23,$638.71,$645.16,$0.00,$0.00,$0.00,$0.00,$0.00
27815920,EAP,Custom 27815920,,Coil Embl .035in 8mm 10cm Azur Hdrcl Psh Peri 35 Sys,$923.33,$0.00,$923.33,$0.00,$658.98,$0.00,$0.00,$658.98,$658.98,$0.00,$923.33,$0.00,$461.67,$731.28,$738.66,$0.00,$0.00,$0.00,$0.00,$0.00
27815922,EAP,Custom 27815922,,Coil Embol L20cm Od10mm 0.018in Hydrocoil Pushable Azur 18p,$775.00,$0.00,$775.00,$0.00,$553.12,$0.00,$0.00,$553.12,$553.12,$0.00,$775.00,$0.00,$387.50,$613.80,$620.00,$0.00,$0.00,$0.00,$0.00,$0.00
27815923,EAP,HCPCS C1874,,Stent Endoprsth 29mm 7mm 11mm 7fr Gore Vbhn 135cm,"$6,725.00",$0.00,"$6,725.00","$3,026.25","$4,799.63",$0.00,"$1,158.68","$4,799.63","$4,799.63","$1,177.49","$6,725.00",$0.00,"$3,362.50","$5,326.20","$5,380.00",$0.00,"$1,052.46",$0.00,"$1,070.62",$0.00
27815924,EAP,HCPCS C1874,,Stent Endoprsth 29mm 8mm 11mm 7fr Gore Vbhn 135cm,"$6,725.00",$0.00,"$6,725.00","$3,026.25","$4,799.63",$0.00,"$1,158.68","$4,799.63","$4,799.63","$1,177.49","$6,725.00",$0.00,"$3,362.50","$5,326.20","$5,380.00",$0.00,"$1,052.46",$0.00,"$1,070.62",$0.00
27815925,EAP,HCPCS C1874,,Stent Endoprsth 29mm 11mm 16sq Mm 8fr Gore Vbhn,"$8,138.00",$0.00,"$8,138.00","$3,662.10","$5,158.80",$0.00,"$1,402.14","$5,158.80","$5,808.09","$1,424.90","$8,138.00",$0.00,"$4,069.00","$6,445.30","$6,510.40",$0.00,"$1,273.60",$0.00,"$1,295.57",$0.00
27815926,EAP,HCPCS C1874,,Stent Endoprsth 39mm 7mm 11mm 7fr Gore Vbhn 135cm,"$8,138.00",$0.00,"$8,138.00","$3,662.10","$5,158.80",$0.00,"$1,402.14","$5,158.80","$5,808.09","$1,424.90","$8,138.00",$0.00,"$4,069.00","$6,445.30","$6,510.40",$0.00,"$1,273.60",$0.00,"$1,295.57",$0.00
27815927,EAP,HCPCS C1874,,Stent Endoprsth 39mm 8mm 11mm 7fr Gore Vbhn 135cm,"$8,138.00",$0.00,"$8,138.00","$3,662.10","$5,158.80",$0.00,"$1,402.14","$5,158.80","$5,808.09","$1,424.90","$8,138.00",$0.00,"$4,069.00","$6,445.30","$6,510.40",$0.00,"$1,273.60",$0.00,"$1,295.57",$0.00
27815928,EAP,HCPCS c1874,,Stent Endoprsth 39mm 11mm 16sq Mm 8fr Gore Vbhn,"$8,138.00",$0.00,"$8,138.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,808.09",$0.00,"$8,138.00",$0.00,"$4,069.00","$6,445.30","$6,510.40",$0.00,$0.00,$0.00,$0.00,$0.00
27815929,EAP,HCPCS C1874,,Stent Endoprsth 59mm 7mm 11mm 7fr Gore Vbhn 135cm,"$8,138.00",$0.00,"$8,138.00","$3,662.10","$5,158.80",$0.00,"$1,402.14","$5,158.80","$5,808.09","$1,424.90","$8,138.00",$0.00,"$4,069.00","$6,445.30","$6,510.40",$0.00,"$1,273.60",$0.00,"$1,295.57",$0.00
27815930,EAP,HCPCS C1874,,Stent Endoprsth 59mm 8mm 11mm 7fr Gore Vbhn 135cm,"$8,138.00",$0.00,"$8,138.00","$3,662.10","$5,158.80",$0.00,"$1,402.14","$5,158.80","$5,808.09","$1,424.90","$8,138.00",$0.00,"$4,069.00","$6,445.30","$6,510.40",$0.00,"$1,273.60",$0.00,"$1,295.57",$0.00
27815931,EAP,HCPCS C1874,,Stent Endoprsth 59mm 11mm 16sq Mm 8fr Gore Vbhn,"$8,138.00",$0.00,"$8,138.00","$3,662.10","$5,158.80",$0.00,"$1,402.14","$5,158.80","$5,808.09","$1,424.90","$8,138.00",$0.00,"$4,069.00","$6,445.30","$6,510.40",$0.00,"$1,273.60",$0.00,"$1,295.57",$0.00
27815932,EAP,,,Catheter Infus 18fr Trevo Pro Mic Nrvsc,"$1,269.00",$0.00,"$1,269.00",$0.00,$905.69,$0.00,$0.00,$905.69,$905.69,$0.00,"$1,269.00",$0.00,$634.50,"$1,005.05","$1,015.20",$0.00,$0.00,$0.00,$0.00,$0.00
27815933,EAP,HCPCS C1874,,Stent Eprsth 8mm 7fr 10cm 120cm Vbhn Dlv Sys Hep Sprfc Fem,"$8,738.00",$0.00,"$8,738.00","$3,932.10","$5,158.80",$0.00,"$1,505.51","$5,158.80","$6,236.31","$1,529.95","$8,738.00",$0.00,"$4,369.00","$6,920.50","$6,990.40",$0.00,"$1,367.50",$0.00,"$1,391.09",$0.00
27815934,EAP,,,Coil Embolization 4mm 12cm Complex Fill Trufill Dcs Orbit,"$3,738.00",$0.00,"$3,738.00",$0.00,"$2,667.81",$0.00,$0.00,"$2,667.81","$2,667.81",$0.00,"$3,738.00",$0.00,"$1,869.00","$2,960.50","$2,990.40",$0.00,$0.00,$0.00,$0.00,$0.00
27815935,EAP,HCPCS C1876,,Stent Cor .02in 2.5mm 19mm 140cm Tryton Rx Dlv Sys Radopq Sd,"$1,300.00",$0.00,"$1,300.00",$585.00,$927.81,$0.00,$223.98,$927.81,$927.81,$227.62,"$1,300.00",$0.00,$650.00,"$1,029.60","$1,040.00",$0.00,$203.45,$0.00,$206.96,$0.00
27815936,EAP,HCPCS C1876,,Stent Cor .02in 2.5-3mm 19mm 140cm Tryton Rx Dlv Sys Radopq,"$1,300.00",$0.00,"$1,300.00",$585.00,$927.81,$0.00,$223.98,$927.81,$927.81,$227.62,"$1,300.00",$0.00,$650.00,"$1,029.60","$1,040.00",$0.00,$203.45,$0.00,$206.96,$0.00
27815937,EAP,HCPCS C1876,,Stent Cor .02in 2.5-3.5mm 19mm 140cm Tryton Rx Dlv Sys,"$1,300.00",$0.00,"$1,300.00",$585.00,$927.81,$0.00,$223.98,$927.81,$927.81,$227.62,"$1,300.00",$0.00,$650.00,"$1,029.60","$1,040.00",$0.00,$203.45,$0.00,$206.96,$0.00
27815939,EAP,HCPCS C1876,,Stent Cor .02in 3.5-4mm 15mm 140cm Tryton Rx Dlv Sys Radopq,"$1,300.00",$0.00,"$1,300.00",$585.00,$927.81,$0.00,$223.98,$927.81,$927.81,$227.62,"$1,300.00",$0.00,$650.00,"$1,029.60","$1,040.00",$0.00,$203.45,$0.00,$206.96,$0.00
27815940,EAP,Custom 27815940,,Pin Half 5mm 4mm 300mm 50mm Tr,$256.00,$0.00,$256.00,$0.00,$182.71,$0.00,$0.00,$182.71,$182.71,$0.00,$256.00,$0.00,$128.00,$202.75,$204.80,$0.00,$0.00,$0.00,$0.00,$0.00
27815941,EAP,HCPCS C1874,,System Cor Stnt 4.5mm 12mm 140cm Rslt Onyx Rx Dlv Sys Radopq,"$3,425.00",$0.00,"$3,425.00","$1,541.25","$2,444.42",$0.00,$590.11,"$2,444.42","$2,444.42",$599.69,"$3,425.00",$0.00,"$1,712.50","$2,712.60","$2,740.00",$0.00,$536.01,$0.00,$545.26,$0.00
27815942,EAP,Custom 27815942,,Coil Embl 3d 3mm 6cm Axium Frm V01,"$4,488.00",$0.00,"$4,488.00",$0.00,"$3,203.09",$0.00,$0.00,"$3,203.09","$3,203.09",$0.00,"$4,488.00",$0.00,"$2,244.00","$3,554.50","$3,590.40",$0.00,$0.00,$0.00,$0.00,$0.00
27815943,EAP,Custom 27815943,,Coil Embl 3d 3mm 8cm Axium Frm V01,"$4,488.00",$0.00,"$4,488.00",$0.00,"$3,203.09",$0.00,$0.00,"$3,203.09","$3,203.09",$0.00,"$4,488.00",$0.00,"$2,244.00","$3,554.50","$3,590.40",$0.00,$0.00,$0.00,$0.00,$0.00
27815944,EAP,Custom 27815944,,Coil Embl 3d 3mm 10cm Axium Frm V01,"$4,488.00",$0.00,"$4,488.00",$0.00,"$3,203.09",$0.00,$0.00,"$3,203.09","$3,203.09",$0.00,"$4,488.00",$0.00,"$2,244.00","$3,554.50","$3,590.40",$0.00,$0.00,$0.00,$0.00,$0.00
27815945,EAP,Custom 27815945,,Coil Embl 3d 3.5mm 6cm Axium Prm Frm V01,"$4,488.00",$0.00,"$4,488.00",$0.00,"$3,203.09",$0.00,$0.00,"$3,203.09","$3,203.09",$0.00,"$4,488.00",$0.00,"$2,244.00","$3,554.50","$3,590.40",$0.00,$0.00,$0.00,$0.00,$0.00
27815946,EAP,Custom 27815946,,Coil Embl 3d 3.5mm 8cm Axium Frm Nrvsc V01,"$4,488.00",$0.00,"$4,488.00",$0.00,"$3,203.09",$0.00,$0.00,"$3,203.09","$3,203.09",$0.00,"$4,488.00",$0.00,"$2,244.00","$3,554.50","$3,590.40",$0.00,$0.00,$0.00,$0.00,$0.00
27815947,EAP,Custom 27815947,,Coil Embl 3d 3.5mm 10cm Axium Frm Nrvsc V01,"$4,488.00",$0.00,"$4,488.00",$0.00,"$3,203.09",$0.00,$0.00,"$3,203.09","$3,203.09",$0.00,"$4,488.00",$0.00,"$2,244.00","$3,554.50","$3,590.40",$0.00,$0.00,$0.00,$0.00,$0.00
27815948,EAP,Custom 27815948,,Coil Embl 3d 4mm 6cm Axium Frm V01,"$4,488.00",$0.00,"$4,488.00",$0.00,"$3,203.09",$0.00,$0.00,"$3,203.09","$3,203.09",$0.00,"$4,488.00",$0.00,"$2,244.00","$3,554.50","$3,590.40",$0.00,$0.00,$0.00,$0.00,$0.00
27815949,EAP,Custom 27815949,,Coil Embl 3d 4mm 8cm Axium Frm V01,"$4,488.00",$0.00,"$4,488.00",$0.00,"$3,203.09",$0.00,$0.00,"$3,203.09","$3,203.09",$0.00,"$4,488.00",$0.00,"$2,244.00","$3,554.50","$3,590.40",$0.00,$0.00,$0.00,$0.00,$0.00
27815950,EAP,Custom 27815950,,Coil Embl 3d 4mm 10cm Axium Frm V01,"$4,488.00",$0.00,"$4,488.00",$0.00,"$3,203.09",$0.00,$0.00,"$3,203.09","$3,203.09",$0.00,"$4,488.00",$0.00,"$2,244.00","$3,554.50","$3,590.40",$0.00,$0.00,$0.00,$0.00,$0.00
27815951,EAP,Custom 27815951,,Coil Embl 3d 4mm 12cm Axium Frm V01,"$4,488.00",$0.00,"$4,488.00",$0.00,"$3,203.09",$0.00,$0.00,"$3,203.09","$3,203.09",$0.00,"$4,488.00",$0.00,"$2,244.00","$3,554.50","$3,590.40",$0.00,$0.00,$0.00,$0.00,$0.00
27815952,EAP,Custom 27815952,,Coil Embl 3d 4mm 15cm Axium Frm Nrvsc V01,"$4,488.00",$0.00,"$4,488.00",$0.00,"$3,203.09",$0.00,$0.00,"$3,203.09","$3,203.09",$0.00,"$4,488.00",$0.00,"$2,244.00","$3,554.50","$3,590.40",$0.00,$0.00,$0.00,$0.00,$0.00
27815953,EAP,Custom 27815953,,Coil Embl 3d 5mm 8cm Axium Frm V01,"$4,488.00",$0.00,"$4,488.00",$0.00,"$3,203.09",$0.00,$0.00,"$3,203.09","$3,203.09",$0.00,"$4,488.00",$0.00,"$2,244.00","$3,554.50","$3,590.40",$0.00,$0.00,$0.00,$0.00,$0.00
27815954,EAP,Custom 27815954,,Coil Embl 3d 5mm 10cm Axium Frm V01,"$4,488.00",$0.00,"$4,488.00",$0.00,"$3,203.09",$0.00,$0.00,"$3,203.09","$3,203.09",$0.00,"$4,488.00",$0.00,"$2,244.00","$3,554.50","$3,590.40",$0.00,$0.00,$0.00,$0.00,$0.00
27815955,EAP,Custom 27815955,,Coil Embl 3d 5mm 15cm Axium Frm V01,"$4,488.00",$0.00,"$4,488.00",$0.00,"$3,203.09",$0.00,$0.00,"$3,203.09","$3,203.09",$0.00,"$4,488.00",$0.00,"$2,244.00","$3,554.50","$3,590.40",$0.00,$0.00,$0.00,$0.00,$0.00
27815956,EAP,Custom 27815956,,Coil Embl 3d 5mm 20cm Axium Frm Nrvsc V01,"$4,488.00",$0.00,"$4,488.00",$0.00,"$3,203.09",$0.00,$0.00,"$3,203.09","$3,203.09",$0.00,"$4,488.00",$0.00,"$2,244.00","$3,554.50","$3,590.40",$0.00,$0.00,$0.00,$0.00,$0.00
27815957,EAP,Custom 27815957,,Coil Embl 3d 6mm 10cm Axium Frm V01,"$4,488.00",$0.00,"$4,488.00",$0.00,"$3,203.09",$0.00,$0.00,"$3,203.09","$3,203.09",$0.00,"$4,488.00",$0.00,"$2,244.00","$3,554.50","$3,590.40",$0.00,$0.00,$0.00,$0.00,$0.00
27815958,EAP,Custom 27815958,,Coil Embl 3d 6mm 15cm Axium Frm V01,"$4,488.00",$0.00,"$4,488.00",$0.00,"$3,203.09",$0.00,$0.00,"$3,203.09","$3,203.09",$0.00,"$4,488.00",$0.00,"$2,244.00","$3,554.50","$3,590.40",$0.00,$0.00,$0.00,$0.00,$0.00
27815959,EAP,Custom 27815959,,Coil Embl 3d 6mm 20cm Axium Frm V01,"$4,488.00",$0.00,"$4,488.00",$0.00,"$3,203.09",$0.00,$0.00,"$3,203.09","$3,203.09",$0.00,"$4,488.00",$0.00,"$2,244.00","$3,554.50","$3,590.40",$0.00,$0.00,$0.00,$0.00,$0.00
27815960,EAP,Custom 27815960,,Coil Embl 3d 6mm 25cm Axium Frm Nrvsc V01,"$4,488.00",$0.00,"$4,488.00",$0.00,"$3,203.09",$0.00,$0.00,"$3,203.09","$3,203.09",$0.00,"$4,488.00",$0.00,"$2,244.00","$3,554.50","$3,590.40",$0.00,$0.00,$0.00,$0.00,$0.00
27815961,EAP,Custom 27815961,,Coil Embl 3d 7mm 12cm Axium Frm Nrvsc V01,"$4,488.00",$0.00,"$4,488.00",$0.00,"$3,203.09",$0.00,$0.00,"$3,203.09","$3,203.09",$0.00,"$4,488.00",$0.00,"$2,244.00","$3,554.50","$3,590.40",$0.00,$0.00,$0.00,$0.00,$0.00
27815962,EAP,Custom 27815962,,Coil Embl 3d 7mm 15cm Axium Frm V01,"$4,488.00",$0.00,"$4,488.00",$0.00,"$3,203.09",$0.00,$0.00,"$3,203.09","$3,203.09",$0.00,"$4,488.00",$0.00,"$2,244.00","$3,554.50","$3,590.40",$0.00,$0.00,$0.00,$0.00,$0.00
27815963,EAP,Custom 27815963,,Coil Embl 3d 7mm 20cm Axium Frm V01,"$4,488.00",$0.00,"$4,488.00",$0.00,"$3,203.09",$0.00,$0.00,"$3,203.09","$3,203.09",$0.00,"$4,488.00",$0.00,"$2,244.00","$3,554.50","$3,590.40",$0.00,$0.00,$0.00,$0.00,$0.00
27815964,EAP,Custom 27815964,,Coil Embl 3d 7mm 30cm Axium Frm V01,"$4,488.00",$0.00,"$4,488.00",$0.00,"$3,203.09",$0.00,$0.00,"$3,203.09","$3,203.09",$0.00,"$4,488.00",$0.00,"$2,244.00","$3,554.50","$3,590.40",$0.00,$0.00,$0.00,$0.00,$0.00
27815965,EAP,Custom 27815965,,Coil Embl 3d 8mm 15cm Axium Frm V01,"$5,238.00",$0.00,"$5,238.00",$0.00,"$3,738.36",$0.00,$0.00,"$3,738.36","$3,738.36",$0.00,"$5,238.00",$0.00,"$2,619.00","$4,148.50","$4,190.40",$0.00,$0.00,$0.00,$0.00,$0.00
27815966,EAP,Custom 27815966,,Coil Embl 3d 8mm 20cm Axium Frm V01,"$5,238.00",$0.00,"$5,238.00",$0.00,"$3,738.36",$0.00,$0.00,"$3,738.36","$3,738.36",$0.00,"$5,238.00",$0.00,"$2,619.00","$4,148.50","$4,190.40",$0.00,$0.00,$0.00,$0.00,$0.00
27815967,EAP,Custom 27815967,,Coil Embl 3d 8mm 30cm Axium Frm V01,"$5,238.00",$0.00,"$5,238.00",$0.00,"$3,738.36",$0.00,$0.00,"$3,738.36","$3,738.36",$0.00,"$5,238.00",$0.00,"$2,619.00","$4,148.50","$4,190.40",$0.00,$0.00,$0.00,$0.00,$0.00
27815968,EAP,Custom 27815968,,Coil Embl 3d 9mm 20cm Axium Frm V01,"$5,238.00",$0.00,"$5,238.00",$0.00,"$3,738.36",$0.00,$0.00,"$3,738.36","$3,738.36",$0.00,"$5,238.00",$0.00,"$2,619.00","$4,148.50","$4,190.40",$0.00,$0.00,$0.00,$0.00,$0.00
27815969,EAP,Custom 27815969,,Coil Embl 3d 9mm 30cm Axium Prm Frm V01,"$5,238.00",$0.00,"$5,238.00",$0.00,"$3,738.36",$0.00,$0.00,"$3,738.36","$3,738.36",$0.00,"$5,238.00",$0.00,"$2,619.00","$4,148.50","$4,190.40",$0.00,$0.00,$0.00,$0.00,$0.00
27815970,EAP,Custom 27815970,,Coil Embl 3d 10mm 20cm Axium Frm V01,"$5,238.00",$0.00,"$5,238.00",$0.00,"$3,738.36",$0.00,$0.00,"$3,738.36","$3,738.36",$0.00,"$5,238.00",$0.00,"$2,619.00","$4,148.50","$4,190.40",$0.00,$0.00,$0.00,$0.00,$0.00
27815971,EAP,Custom 27815971,,Coil Embl 3d 10mm 30cm Axium Frm V01,"$5,238.00",$0.00,"$5,238.00",$0.00,"$3,738.36",$0.00,$0.00,"$3,738.36","$3,738.36",$0.00,"$5,238.00",$0.00,"$2,619.00","$4,148.50","$4,190.40",$0.00,$0.00,$0.00,$0.00,$0.00
27815972,EAP,Custom 27815972,,Coil Embl 3d 10mm 40cm Axium Frm Nrvsc V01,"$5,238.00",$0.00,"$5,238.00",$0.00,"$3,738.36",$0.00,$0.00,"$3,738.36","$3,738.36",$0.00,"$5,238.00",$0.00,"$2,619.00","$4,148.50","$4,190.40",$0.00,$0.00,$0.00,$0.00,$0.00
27815973,EAP,Custom 27815973,,Coil Embl 3d 12mm 30cm Axium Frm V01,"$5,238.00",$0.00,"$5,238.00",$0.00,"$3,738.36",$0.00,$0.00,"$3,738.36","$3,738.36",$0.00,"$5,238.00",$0.00,"$2,619.00","$4,148.50","$4,190.40",$0.00,$0.00,$0.00,$0.00,$0.00
27815974,EAP,Custom 27815974,,Coil Embl 3d 12mm 40cm Axium Frm V01,"$5,238.00",$0.00,"$5,238.00",$0.00,"$3,738.36",$0.00,$0.00,"$3,738.36","$3,738.36",$0.00,"$5,238.00",$0.00,"$2,619.00","$4,148.50","$4,190.40",$0.00,$0.00,$0.00,$0.00,$0.00
27815975,EAP,Custom 27815975,,Coil Embl 3d 12mm 50cm Axium Frm Nrvsc V01,"$5,238.00",$0.00,"$5,238.00",$0.00,"$3,738.36",$0.00,$0.00,"$3,738.36","$3,738.36",$0.00,"$5,238.00",$0.00,"$2,619.00","$4,148.50","$4,190.40",$0.00,$0.00,$0.00,$0.00,$0.00
27815976,EAP,Custom 27815976,,Coil Embl 3d 14mm 30cm Axium Frm V01,"$5,238.00",$0.00,"$5,238.00",$0.00,"$3,738.36",$0.00,$0.00,"$3,738.36","$3,738.36",$0.00,"$5,238.00",$0.00,"$2,619.00","$4,148.50","$4,190.40",$0.00,$0.00,$0.00,$0.00,$0.00
27815977,EAP,Custom 27815977,,Coil Embl 3d 14mm 40cm Axium Frm V01,"$5,238.00",$0.00,"$5,238.00",$0.00,"$3,738.36",$0.00,$0.00,"$3,738.36","$3,738.36",$0.00,"$5,238.00",$0.00,"$2,619.00","$4,148.50","$4,190.40",$0.00,$0.00,$0.00,$0.00,$0.00
27815978,EAP,Custom 27815978,,Coil Embl 3d 14mm 50cm Axium Frm Nrvsc V01,"$5,238.00",$0.00,"$5,238.00",$0.00,"$3,738.36",$0.00,$0.00,"$3,738.36","$3,738.36",$0.00,"$5,238.00",$0.00,"$2,619.00","$4,148.50","$4,190.40",$0.00,$0.00,$0.00,$0.00,$0.00
27815979,EAP,Custom 27815979,,Coil Embl 3d 16mm 40cm Axium Frm V01,"$5,238.00",$0.00,"$5,238.00",$0.00,"$3,738.36",$0.00,$0.00,"$3,738.36","$3,738.36",$0.00,"$5,238.00",$0.00,"$2,619.00","$4,148.50","$4,190.40",$0.00,$0.00,$0.00,$0.00,$0.00
27815980,EAP,Custom 27815980,,Coil Embl 3d 16mm 50cm Axium Frm Nrvsc V01,"$5,238.00",$0.00,"$5,238.00",$0.00,"$3,738.36",$0.00,$0.00,"$3,738.36","$3,738.36",$0.00,"$5,238.00",$0.00,"$2,619.00","$4,148.50","$4,190.40",$0.00,$0.00,$0.00,$0.00,$0.00
27815981,EAP,Custom 27815981,,Coil Embl 3d 18mm 40cm Axium Frm V01,"$5,238.00",$0.00,"$5,238.00",$0.00,"$3,738.36",$0.00,$0.00,"$3,738.36","$3,738.36",$0.00,"$5,238.00",$0.00,"$2,619.00","$4,148.50","$4,190.40",$0.00,$0.00,$0.00,$0.00,$0.00
27815982,EAP,Custom 27815982,,Coil Embl 3d 18mm 50cm Axium Frm Nrvsc V01,"$5,238.00",$0.00,"$5,238.00",$0.00,"$3,738.36",$0.00,$0.00,"$3,738.36","$3,738.36",$0.00,"$5,238.00",$0.00,"$2,619.00","$4,148.50","$4,190.40",$0.00,$0.00,$0.00,$0.00,$0.00
27815983,EAP,Custom 27815983,,Coil Embl 3d 20mm 50cm Axium Frm V01,"$5,238.00",$0.00,"$5,238.00",$0.00,"$3,738.36",$0.00,$0.00,"$3,738.36","$3,738.36",$0.00,"$5,238.00",$0.00,"$2,619.00","$4,148.50","$4,190.40",$0.00,$0.00,$0.00,$0.00,$0.00
27815984,EAP,Custom 27815984,,Coil Embl 3d 22mm 50cm Axium Frm V01,"$5,238.00",$0.00,"$5,238.00",$0.00,"$3,738.36",$0.00,$0.00,"$3,738.36","$3,738.36",$0.00,"$5,238.00",$0.00,"$2,619.00","$4,148.50","$4,190.40",$0.00,$0.00,$0.00,$0.00,$0.00
27815985,EAP,Custom 27815985,,Coil Embl 3d 25mm 50cm Axium Frm V01,"$5,238.00",$0.00,"$5,238.00",$0.00,"$3,738.36",$0.00,$0.00,"$3,738.36","$3,738.36",$0.00,"$5,238.00",$0.00,"$2,619.00","$4,148.50","$4,190.40",$0.00,$0.00,$0.00,$0.00,$0.00
27815986,EAP,HCPCS C1876,,Stent 4.5mm 30mm 5.0mm Neuroform Atlas,"$18,125.00",$0.00,"$18,125.00","$8,156.25","$5,158.80",$0.00,"$3,122.85","$5,158.80","$12,935.81","$3,173.54","$18,125.00",$0.00,"$9,062.50","$14,355.00","$14,500.00",$0.00,"$2,836.56",$0.00,"$2,885.50",$0.00
27815987,EAP,HCPCS C1876,,Neuroform Atlas 4.5x21mm,"$17,038.00",$0.00,"$17,038.00","$7,667.10","$5,158.80",$0.00,"$2,935.56","$5,158.80","$12,160.02","$2,983.22","$17,038.00",$0.00,"$8,519.00","$13,494.10","$13,630.40",$0.00,"$2,666.45",$0.00,"$2,712.45",$0.00
27815988,EAP,HCPCS C1876,,Neuroform Atlas 4.0x24mm,"$17,038.00",$0.00,"$17,038.00","$7,667.10","$5,158.80",$0.00,"$2,935.56","$5,158.80","$12,160.02","$2,983.22","$17,038.00",$0.00,"$8,519.00","$13,494.10","$13,630.40",$0.00,"$2,666.45",$0.00,"$2,712.45",$0.00
27815989,EAP,HCPCS C1876,,Neuroform Atlas 4.0x21mm,"$17,038.00",$0.00,"$17,038.00","$7,667.10","$5,158.80",$0.00,"$2,935.56","$5,158.80","$12,160.02","$2,983.22","$17,038.00",$0.00,"$8,519.00","$13,494.10","$13,630.40",$0.00,"$2,666.45",$0.00,"$2,712.45",$0.00
27815990,EAP,HCPCS C1876,,Neuroform Atlas 3.0x24mm,"$17,038.00",$0.00,"$17,038.00","$7,667.10","$5,158.80",$0.00,"$2,935.56","$5,158.80","$12,160.02","$2,983.22","$17,038.00",$0.00,"$8,519.00","$13,494.10","$13,630.40",$0.00,"$2,666.45",$0.00,"$2,712.45",$0.00
27815991,EAP,HCPCS C1876,,Neuroform Atlas 3.0x21mm,"$17,038.00",$0.00,"$17,038.00","$7,667.10","$5,158.80",$0.00,"$2,935.56","$5,158.80","$12,160.02","$2,983.22","$17,038.00",$0.00,"$8,519.00","$13,494.10","$13,630.40",$0.00,"$2,666.45",$0.00,"$2,712.45",$0.00
27815992,EAP,HCPCS C1876,,Neuroform Atlas 3.0x15mm,"$17,038.00",$0.00,"$17,038.00","$7,667.10","$5,158.80",$0.00,"$2,935.56","$5,158.80","$12,160.02","$2,983.22","$17,038.00",$0.00,"$8,519.00","$13,494.10","$13,630.40",$0.00,"$2,666.45",$0.00,"$2,712.45",$0.00
27815993,EAP,HCPCS C1874,,Stent Trchbr 16mm 22fr 40mm 61cm Gmtr Otw Flly,"$5,750.00",$0.00,"$5,750.00","$2,587.50","$4,103.78",$0.00,$990.70,"$4,103.78","$4,103.78","$1,006.78","$5,750.00",$0.00,"$2,875.00","$4,554.00","$4,600.00",$0.00,$899.88,$0.00,$915.40,$0.00
27815994,EAP,HCPCS C1874,,Stent Trchbr 12mm 16fr 30mm 62cm Gmtr Otw Flly,"$5,750.00",$0.00,"$5,750.00","$2,587.50","$4,103.78",$0.00,$990.70,"$4,103.78","$4,103.78","$1,006.78","$5,750.00",$0.00,"$2,875.00","$4,554.00","$4,600.00",$0.00,$899.88,$0.00,$915.40,$0.00
27815995,EAP,HCPCS C1874,,Stent Trchbr 14mm 16fr 20mm 63cm Gmtr Otw Flly,"$5,750.00",$0.00,"$5,750.00","$2,587.50","$4,103.78",$0.00,$990.70,"$4,103.78","$4,103.78","$1,006.78","$5,750.00",$0.00,"$2,875.00","$4,554.00","$4,600.00",$0.00,$899.88,$0.00,$915.40,$0.00
27815996,EAP,HCPCS C1874,,Stent Trchbr 14mm 16fr 40mm 61cm Gmtr Otw Flly,"$5,750.00",$0.00,"$5,750.00","$2,587.50","$4,103.78",$0.00,$990.70,"$4,103.78","$4,103.78","$1,006.78","$5,750.00",$0.00,"$2,875.00","$4,554.00","$4,600.00",$0.00,$899.88,$0.00,$915.40,$0.00
27815997,EAP,HCPCS C1874,,Stent Trchbr 20mm 22fr 40mm 61cm Gmtr Otw Flly,"$5,750.00",$0.00,"$5,750.00","$2,587.50","$4,103.78",$0.00,$990.70,"$4,103.78","$4,103.78","$1,006.78","$5,750.00",$0.00,"$2,875.00","$4,554.00","$4,600.00",$0.00,$899.88,$0.00,$915.40,$0.00
27815998,EAP,HCPCS C1874,,Stent Trchbr 20mm 60mm Otw Flly Covered Aero,"$5,750.00",$0.00,"$5,750.00","$2,587.50","$4,103.78",$0.00,$990.70,"$4,103.78","$4,103.78","$1,006.78","$5,750.00",$0.00,"$2,875.00","$4,554.00","$4,600.00",$0.00,$899.88,$0.00,$915.40,$0.00
27815999,EAP,HCPCS C1874,,Stent Trchbr 16mm 60mm Flly Covered Purse Stng Dir,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,"$3,746.93","$3,746.93",$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
27816000,EAP,HCPCS C1874,,Stent Trchbr 14mm 40mm Flly Covered Purse Stng Dir,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,"$3,746.93","$3,746.93",$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
27816001,EAP,Custom 27816001,,Sizer Surg Aerosizer Stent Msr Dev,$375.00,$0.00,$375.00,$0.00,$267.64,$0.00,$0.00,$267.64,$267.64,$0.00,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$0.00,$0.00,$0.00,$0.00
27816002,EAP,HCPCS C1874,,Stent Esph 16fr 18mm 67cm 70mm Full Cover Prox,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,"$3,746.93","$3,746.93",$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
27816003,EAP,HCPCS C1874,,Stent Esph 18mm 22fr 100cm Rem Covered Radiopq,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,"$3,746.93","$3,746.93",$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
27816004,EAP,HCPCS C1874,,Stent Esph 22fr 18mm 120cm Rem Covered Alimaxx-e,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,"$3,746.93","$3,746.93",$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
27816005,EAP,HCPCS C1874,,Stent Esph 22mm 22fr 70cm Rem Covered Radiopq,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,"$3,746.93","$3,746.93",$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
27816006,EAP,HCPCS C1874,,Stent Esph 22fr 100cm Sys Alimaxx-e Mtl,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,"$3,746.93","$3,746.93",$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
27816007,EAP,HCPCS C1874,,Stent Esph 22fr 120cm Slf Xpd Alimaxx-e Mtl Disp,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,"$3,746.93","$3,746.93",$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
27816008,EAP,HCPCS C1874,,Stent Esph 12mm 70cm Flly Covered Alimaxx-es,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,"$3,746.93","$3,746.93",$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
27816009,EAP,HCPCS C1874,,Stent Esph 22mm 100cm Pu Cover Antimigration Strut,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,"$3,746.93","$3,746.93",$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
27816010,EAP,HCPCS C1874,,Stent Esph 12mm 16fr 120mm 62cm Gmtr Flly Covered,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,"$3,746.93","$3,746.93",$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
27816011,EAP,HCPCS C1874,,Stent Esph 14mm 70cm Flly Covered Alimaxx-es,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,"$3,746.93","$3,746.93",$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
27816012,EAP,HCPCS C1874,,Stent Esph 14mm 16fr 100mm 64cm Flly Covered Smth,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,"$3,746.93","$3,746.93",$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
27816013,EAP,HCPCS C1874,,Stent Esph 14mm 16fr 62cm 120mm Flly Covered Gmtr,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,"$3,746.93","$3,746.93",$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
27816014,EAP,HCPCS C1874,,Stent Esph 16mm 70cm Gmtr Flly Covered Pu Cover,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,"$3,746.93","$3,746.93",$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
27816015,EAP,HCPCS C1874,,Stent Esph 16mm 16fr 100mm 64cm Flly Covered Smth,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,"$3,746.93","$3,746.93",$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
27816016,EAP,HCPCS C1874,,Stent Esph 16mm 62cm 120mm Flly Covered Gmtr Pu,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,"$3,746.93","$3,746.93",$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
27816017,EAP,HCPCS C1874,,Stent Trchbr 18mm 22fr 56mm Lp Otw Full Cover Flxb,"$5,750.00",$0.00,"$5,750.00","$2,587.50","$4,103.78",$0.00,$990.70,"$4,103.78","$4,103.78","$1,006.78","$5,750.00",$0.00,"$2,875.00","$4,554.00","$4,600.00",$0.00,$899.88,$0.00,$915.40,$0.00
27816018,EAP,HCPCS C1874,,Stent Trchbr 16mm 22fr 56mm Lp Otw Full Cover Flxb,"$5,750.00",$0.00,"$5,750.00","$2,587.50","$4,103.78",$0.00,$990.70,"$4,103.78","$4,103.78","$1,006.78","$5,750.00",$0.00,"$2,875.00","$4,554.00","$4,600.00",$0.00,$899.88,$0.00,$915.40,$0.00
27816019,EAP,HCPCS C1874,,Stent Trchbr 10mm 16fr 20mm 63cm Gmtr Otw Flly,"$5,750.00",$0.00,"$5,750.00","$2,587.50","$4,103.78",$0.00,$990.70,"$4,103.78","$4,103.78","$1,006.78","$5,750.00",$0.00,"$2,875.00","$4,554.00","$4,600.00",$0.00,$899.88,$0.00,$915.40,$0.00
27816020,EAP,HCPCS C1874,,Stent Trchbr 10mm 16fr 40mm 61cm Gmtr Otw Flly,"$5,750.00",$0.00,"$5,750.00","$2,587.50","$4,103.78",$0.00,$990.70,"$4,103.78","$4,103.78","$1,006.78","$5,750.00",$0.00,"$2,875.00","$4,554.00","$4,600.00",$0.00,$899.88,$0.00,$915.40,$0.00
27816021,EAP,HCPCS C1874,,Stent Trchbr 12mm 16fr 20mm 63cm Flly Cover,"$5,750.00",$0.00,"$5,750.00","$2,587.50","$4,103.78",$0.00,$990.70,"$4,103.78","$4,103.78","$1,006.78","$5,750.00",$0.00,"$2,875.00","$4,554.00","$4,600.00",$0.00,$899.88,$0.00,$915.40,$0.00
27816022,EAP,HCPCS C1874,,Stent Trchbr 14mm 16fr 30mm 62cm Gmtr Otw Flly,"$5,750.00",$0.00,"$5,750.00","$2,587.50","$4,103.78",$0.00,$990.70,"$4,103.78","$4,103.78","$1,006.78","$5,750.00",$0.00,"$2,875.00","$4,554.00","$4,600.00",$0.00,$899.88,$0.00,$915.40,$0.00
27816023,EAP,HCPCS C1874,,Stent Trch 20mm 80mm Flly Covered Aero,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,"$3,746.93","$3,746.93",$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
27816024,EAP,HCPCS C1874,,Stent Trchbr 18mm 40mm Flly Covered Dir Vis Sys,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,"$3,746.93","$3,746.93",$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
27816025,EAP,HCPCS C1874,,Stent Trchbr 18mm 60mm Flly Covered Dir Vis Sys,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,"$3,746.93","$3,746.93",$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
27816026,EAP,HCPCS C1874,,Stent Trchbr 18mm 80mm Flly Covered Dir Vsn Dlv,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,"$3,746.93","$3,746.93",$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
27816027,EAP,HCPCS C1874,,Stent Trchbr 16mm 30mm 40mm 39mm Otw Dir Vis Novel,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,"$3,746.93","$3,746.93",$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
27816028,EAP,HCPCS C1874,,Stent Trchbr 16mm 80mm Flly Covered Dir Vsn Dlv,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,"$3,746.93","$3,746.93",$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
27816029,EAP,HCPCS C1874,,Stent Trchbr 12mm 20mm Flly Covered Dir Vsn Dlv,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,"$3,746.93","$3,746.93",$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
27816030,EAP,HCPCS C1874,,Stent Trchbr 12mm 28fr 30mm 40cm Gmtr Lp Full,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,"$3,746.93","$3,746.93",$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
27816031,EAP,HCPCS C1874,,Stent Trchbr 28fr 12mm 40mm 39cm Gmtr Lp Full,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,"$3,746.93","$3,746.93",$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
27816032,EAP,HCPCS C1874,,Stent Trchbr 14mm 20mm Flly Covered Dir Vsn Dlv,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,"$3,746.93","$3,746.93",$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
27816033,EAP,HCPCS C1874,,Stent Trchbr 14mm 30mm Flly Covered Dir Vis Sys,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,"$3,746.93","$3,746.93",$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
27816034,EAP,HCPCS C1874,,Stent Trchbr 20mm 40mm Flly Covered Dir Vis Sys,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,"$3,746.93","$3,746.93",$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
27816036,EAP,HCPCS C1874,,Stent Trchbr 20mm 80mm Flly Covered Dir Vis Sys,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,"$3,746.93","$3,746.93",$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
27816037,EAP,HCPCS C1874,,Stent Esph 19mm 24mm 70mm Flly Covered,"$5,750.00",$0.00,"$5,750.00","$2,587.50","$4,103.78",$0.00,$990.70,"$4,103.78","$4,103.78","$1,006.78","$5,750.00",$0.00,"$2,875.00","$4,554.00","$4,600.00",$0.00,$899.88,$0.00,$915.40,$0.00
27816038,EAP,Custom 27816038,,Holder Tube 100mm Blue Tio Unq Oral Arwy Dsgn Cnv,$20.00,$0.00,$20.00,$0.00,$14.27,$0.00,$0.00,$14.27,$14.27,$0.00,$20.00,$0.00,$10.00,$15.84,$16.00,$0.00,$0.00,$0.00,$0.00,$0.00
27816039,EAP,Custom 27816039,,Block Bite Tio 110mm,$20.00,$0.00,$20.00,$0.00,$14.27,$0.00,$0.00,$14.27,$14.27,$0.00,$20.00,$0.00,$10.00,$15.84,$16.00,$0.00,$0.00,$0.00,$0.00,$0.00
27816040,EAP,Custom 27816040,,Holder Tube 90mm Ylw Tio Unq Oral Arwy Dsgn Cnv,$20.00,$0.00,$20.00,$0.00,$14.27,$0.00,$0.00,$14.27,$14.27,$0.00,$20.00,$0.00,$10.00,$15.84,$16.00,$0.00,$0.00,$0.00,$0.00,$0.00
27816041,EAP,Custom 27816041,,Device Basixcompak 20ml Anlg Lmscnt Dspl Inflat,$62.50,$0.00,$62.50,$0.00,$44.61,$0.00,$0.00,$44.61,$44.61,$0.00,$62.50,$0.00,$31.25,$49.50,$50.00,$0.00,$0.00,$0.00,$0.00,$0.00
27816042,EAP,HCPCS C1874,,Stent Esph 19mm 24fr 150mm 90cm Otw Flly Covered,"$5,750.00",$0.00,"$5,750.00","$2,587.50","$4,103.78",$0.00,$990.70,"$4,103.78","$4,103.78","$1,006.78","$5,750.00",$0.00,"$2,875.00","$4,554.00","$4,600.00",$0.00,$899.88,$0.00,$915.40,$0.00
27816043,EAP,HCPCS C1874,,Stent Esph 23mm 24fr 70mm 90cm 28mm Otw Flly Cover,"$5,750.00",$0.00,"$5,750.00","$2,587.50","$4,103.78",$0.00,$990.70,"$4,103.78","$4,103.78","$1,006.78","$5,750.00",$0.00,"$2,875.00","$4,554.00","$4,600.00",$0.00,$899.88,$0.00,$915.40,$0.00
27816050,EAP,HCPCS C1876,,System Coron Stent 38mm 4.5mm Mtlnk Ul Xcelon,"$1,188.00",$0.00,"$1,188.00",$534.60,$847.88,$0.00,$204.69,$847.88,$847.88,$208.01,"$1,188.00",$0.00,$594.00,$940.90,$950.40,$0.00,$185.92,$0.00,$189.13,$0.00
27816051,EAP,HCPCS C1876,,System Coron Stent 18mm 5mm Mtlnk Ul Xcelon Mcgld,"$1,188.00",$0.00,"$1,188.00",$534.60,$847.88,$0.00,$204.69,$847.88,$847.88,$208.01,"$1,188.00",$0.00,$594.00,$940.90,$950.40,$0.00,$185.92,$0.00,$189.13,$0.00
27816052,EAP,HCPCS C1876,,System Coron Stent 38mm 5mm Mtlnk Ul Xcelon Mcgld,"$1,188.00",$0.00,"$1,188.00",$534.60,$847.88,$0.00,$204.69,$847.88,$847.88,$208.01,"$1,188.00",$0.00,$594.00,$940.90,$950.40,$0.00,$185.92,$0.00,$189.13,$0.00
27816053,EAP,HCPCS C1876,,System Coron Stent 8mm 2.75mm Mtlnk Mvsn Cocr Otw,"$1,188.00",$0.00,"$1,188.00",$534.60,$847.88,$0.00,$204.69,$847.88,$847.88,$208.01,"$1,188.00",$0.00,$594.00,$940.90,$950.40,$0.00,$185.92,$0.00,$189.13,$0.00
27816054,EAP,HCPCS C1876,,System Coron Stent 12mm 2.75mm Mtlnk Mvsn Cocr Otw,"$1,188.00",$0.00,"$1,188.00",$534.60,$847.88,$0.00,$204.69,$847.88,$847.88,$208.01,"$1,188.00",$0.00,$594.00,$940.90,$950.40,$0.00,$185.92,$0.00,$189.13,$0.00
27816055,EAP,HCPCS C1876,,System Coron Stent 15mm 2.75mm Mtlnk Mvsn Cocr Otw,"$1,188.00",$0.00,"$1,188.00",$534.60,$847.88,$0.00,$204.69,$847.88,$847.88,$208.01,"$1,188.00",$0.00,$594.00,$940.90,$950.40,$0.00,$185.92,$0.00,$189.13,$0.00
27816056,EAP,HCPCS C1876,,System Coron Stent 18mm 2.75mm Mtlnk Mvsn Cocr Otw,"$1,188.00",$0.00,"$1,188.00",$534.60,$847.88,$0.00,$204.69,$847.88,$847.88,$208.01,"$1,188.00",$0.00,$594.00,$940.90,$950.40,$0.00,$185.92,$0.00,$189.13,$0.00
27816057,EAP,HCPCS C1876,,System Coron Stent 23mm 2.75mm Mtlnk Mvsn Cocr Otw,"$1,188.00",$0.00,"$1,188.00",$534.60,$847.88,$0.00,$204.69,$847.88,$847.88,$208.01,"$1,188.00",$0.00,$594.00,$940.90,$950.40,$0.00,$185.92,$0.00,$189.13,$0.00
27816058,EAP,HCPCS C1876,,System Coron Stent 28mm 2.75mm Mtlnk Mvsn Cocr Otw,"$1,188.00",$0.00,"$1,188.00",$534.60,$847.88,$0.00,$204.69,$847.88,$847.88,$208.01,"$1,188.00",$0.00,$594.00,$940.90,$950.40,$0.00,$185.92,$0.00,$189.13,$0.00
27816059,EAP,HCPCS C1876,,System Coron Stent 8mm 3mm Mtlnk Mvsn Cocr Otw,"$1,188.00",$0.00,"$1,188.00",$534.60,$847.88,$0.00,$204.69,$847.88,$847.88,$208.01,"$1,188.00",$0.00,$594.00,$940.90,$950.40,$0.00,$185.92,$0.00,$189.13,$0.00
27816060,EAP,HCPCS C1876,,System Coron Stent 12mm 3mm Mtlnk Mvsn Cocr Otw,"$1,188.00",$0.00,"$1,188.00",$534.60,$847.88,$0.00,$204.69,$847.88,$847.88,$208.01,"$1,188.00",$0.00,$594.00,$940.90,$950.40,$0.00,$185.92,$0.00,$189.13,$0.00
27816061,EAP,HCPCS C1876,,System Coron Stent 15mm 3mm Mtlnk Mvsn Cocr Otw,"$1,188.00",$0.00,"$1,188.00",$534.60,$847.88,$0.00,$204.69,$847.88,$847.88,$208.01,"$1,188.00",$0.00,$594.00,$940.90,$950.40,$0.00,$185.92,$0.00,$189.13,$0.00
27816062,EAP,HCPCS C1876,,System Coron Stent 18mm 3mm Mtlnk Mvsn Cocr Otw,"$1,188.00",$0.00,"$1,188.00",$534.60,$847.88,$0.00,$204.69,$847.88,$847.88,$208.01,"$1,188.00",$0.00,$594.00,$940.90,$950.40,$0.00,$185.92,$0.00,$189.13,$0.00
27816063,EAP,HCPCS C1876,,System Coron Stent 23mm 3mm Mtlnk Mvsn Cocr Otw,"$1,188.00",$0.00,"$1,188.00",$534.60,$847.88,$0.00,$204.69,$847.88,$847.88,$208.01,"$1,188.00",$0.00,$594.00,$940.90,$950.40,$0.00,$185.92,$0.00,$189.13,$0.00
27816064,EAP,HCPCS C1876,,System Coron Stent 28mm 3mm Mtlnk Mvsn Cocr Otw,"$1,188.00",$0.00,"$1,188.00",$534.60,$847.88,$0.00,$204.69,$847.88,$847.88,$208.01,"$1,188.00",$0.00,$594.00,$940.90,$950.40,$0.00,$185.92,$0.00,$189.13,$0.00
27816065,EAP,HCPCS C1876,,System Coron Stent 8mm 3.5mm Mtlnk Mvsn Cocr Otw,"$1,188.00",$0.00,"$1,188.00",$534.60,$847.88,$0.00,$204.69,$847.88,$847.88,$208.01,"$1,188.00",$0.00,$594.00,$940.90,$950.40,$0.00,$185.92,$0.00,$189.13,$0.00
27816066,EAP,HCPCS C1876,,System Coron Stent 12mm 3.5mm Mtlnk Mvsn Cocr Otw,"$1,188.00",$0.00,"$1,188.00",$534.60,$847.88,$0.00,$204.69,$847.88,$847.88,$208.01,"$1,188.00",$0.00,$594.00,$940.90,$950.40,$0.00,$185.92,$0.00,$189.13,$0.00
27816067,EAP,HCPCS C1876,,System Coron Stent 15mm 3.5mm Mtlnk Mvsn Cocr Otw,"$1,188.00",$0.00,"$1,188.00",$534.60,$847.88,$0.00,$204.69,$847.88,$847.88,$208.01,"$1,188.00",$0.00,$594.00,$940.90,$950.40,$0.00,$185.92,$0.00,$189.13,$0.00
27816068,EAP,HCPCS C1876,,System Coron Stent 18mm 3.5mm Mtlnk Mvsn Cocr Otw,"$1,188.00",$0.00,"$1,188.00",$534.60,$847.88,$0.00,$204.69,$847.88,$847.88,$208.01,"$1,188.00",$0.00,$594.00,$940.90,$950.40,$0.00,$185.92,$0.00,$189.13,$0.00
27816069,EAP,HCPCS C1876,,System Coron Stent 23mm 3.5mm Mtlnk Mvsn Cocr Otw,"$1,188.00",$0.00,"$1,188.00",$534.60,$847.88,$0.00,$204.69,$847.88,$847.88,$208.01,"$1,188.00",$0.00,$594.00,$940.90,$950.40,$0.00,$185.92,$0.00,$189.13,$0.00
27816070,EAP,HCPCS C1876,,System Coron Stent 28mm 3.5mm Mtlnk Mvsn Cocr Otw,"$1,188.00",$0.00,"$1,188.00",$534.60,$847.88,$0.00,$204.69,$847.88,$847.88,$208.01,"$1,188.00",$0.00,$594.00,$940.90,$950.40,$0.00,$185.92,$0.00,$189.13,$0.00
27816071,EAP,HCPCS C1876,,System Coron Stent 8mm 4mm Mtlnk Mvsn Cocr Otw,"$1,188.00",$0.00,"$1,188.00",$534.60,$847.88,$0.00,$204.69,$847.88,$847.88,$208.01,"$1,188.00",$0.00,$594.00,$940.90,$950.40,$0.00,$185.92,$0.00,$189.13,$0.00
27816072,EAP,HCPCS C1876,,System Coron Stent 12mm 4mm Mtlnk Mvsn Cocr Otw,"$1,188.00",$0.00,"$1,188.00",$534.60,$847.88,$0.00,$204.69,$847.88,$847.88,$208.01,"$1,188.00",$0.00,$594.00,$940.90,$950.40,$0.00,$185.92,$0.00,$189.13,$0.00
27816073,EAP,HCPCS C1876,,System Coron Stent 15mm 4mm Mtlnk Mvsn Cocr Otw,"$1,188.00",$0.00,"$1,188.00",$534.60,$847.88,$0.00,$204.69,$847.88,$847.88,$208.01,"$1,188.00",$0.00,$594.00,$940.90,$950.40,$0.00,$185.92,$0.00,$189.13,$0.00
27816074,EAP,HCPCS C1876,,System Coron Stent 18mm 4mm Mtlnk Mvsn Cocr Otw,"$1,188.00",$0.00,"$1,188.00",$534.60,$847.88,$0.00,$204.69,$847.88,$847.88,$208.01,"$1,188.00",$0.00,$594.00,$940.90,$950.40,$0.00,$185.92,$0.00,$189.13,$0.00
27816075,EAP,HCPCS C1876,,System Coron Stent 23mm 4mm Mtlnk Mvsn Cocr Otw,"$1,188.00",$0.00,"$1,188.00",$534.60,$847.88,$0.00,$204.69,$847.88,$847.88,$208.01,"$1,188.00",$0.00,$594.00,$940.90,$950.40,$0.00,$185.92,$0.00,$189.13,$0.00
27816076,EAP,HCPCS C1876,,System Coron Stent 28mm 4mm Mtlnk Mvsn Cocr Otw,"$1,188.00",$0.00,"$1,188.00",$534.60,$847.88,$0.00,$204.69,$847.88,$847.88,$208.01,"$1,188.00",$0.00,$594.00,$940.90,$950.40,$0.00,$185.92,$0.00,$189.13,$0.00
27816077,EAP,HCPCS C1874,,System Coron Stent 38mm 4mm Xience Srr Everolimus,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816078,EAP,HCPCS C1874,,System Coron Stent 33mm 4mm Xience Srr Everolimus,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816079,EAP,HCPCS C1874,,System Coron Stent 28mm 4mm Xience Srr Everolimus,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816080,EAP,HCPCS C1874,,System Coron Stent 23mm 4mm Xience Srr Everolimus,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816081,EAP,HCPCS C1874,,System Coron Stent 18mm 4mm Xience Srr Everolimus,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816082,EAP,HCPCS C1874,,System Coron Stent 15mm 4mm Xience Srr Everolimus,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816083,EAP,HCPCS C1874,,System Coron Stent 12mm 4mm Xience Srr Everolimus,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816084,EAP,HCPCS C1874,,System Coron Stent 8mm 4mm Xience Srr Everolimus,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816085,EAP,HCPCS C1874,,System Coron Stent 38mm 3.5mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816086,EAP,HCPCS C1874,,System Coron Stent 33mm 3.5mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816087,EAP,HCPCS C1874,,System Coron Stent 28mm 3.5mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816088,EAP,HCPCS C1874,,System Coron Stent 23mm 3.5mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816089,EAP,HCPCS C1874,,System Coron Stent 18mm 3.5mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816090,EAP,HCPCS C1874,,System Coron Stent 15mm 3.5mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816091,EAP,HCPCS C1874,,System Coron Stent 12mm 3.5mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816092,EAP,HCPCS C1874,,System Coron Stent 8mm 3.5mm Xience Srr Everolimus,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816093,EAP,HCPCS C1874,,System Coron Stent 38mm 3.25mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816094,EAP,HCPCS C1874,,System Coron Stent 33mm 3.25mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816095,EAP,HCPCS C1874,,System Coron Stent 28mm 3.25mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816096,EAP,HCPCS C1874,,System Coron Stent 23mm 3.25mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816097,EAP,HCPCS C1874,,System Coron Stent 18mm 3.25mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816098,EAP,HCPCS C1874,,System Coron Stent 15mm 3.25mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816099,EAP,HCPCS C1874,,System Coron Stent 12mm 3.25mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816100,EAP,HCPCS C1874,,System Coron Stent 8mm 3.25mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816101,EAP,HCPCS C1874,,System Coron Stent 38mm 3mm Xience Srr Everolimus,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816102,EAP,HCPCS C1874,,System Coron Stent 33mm 3mm Xience Srr Everolimus,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816103,EAP,HCPCS C1874,,System Coron Stent 28mm 3mm Xience Srr Everolimus,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816104,EAP,HCPCS C1874,,System Coron Stent 23mm 3mm Xience Srr Everolimus,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816105,EAP,HCPCS C1874,,System Coron Stent 18mm 3mm Xience Srr Everolimus,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816106,EAP,HCPCS C1874,,System Coron Stent 15mm 3mm Xience Srr Everolimus,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816107,EAP,HCPCS C1874,,System Coron Stent 12mm 3mm Xience Srr Everolimus,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816108,EAP,HCPCS C1874,,System Coron Stent 8mm 3mm Xience Srr Everolimus,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816109,EAP,HCPCS C1874,,System Coron Stent 38mm 2.75mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816110,EAP,HCPCS C1874,,System Coron Stent 33mm 2.75mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816111,EAP,HCPCS C1874,,System Coron Stent 28mm 2.75mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816112,EAP,HCPCS C1874,,System Coron Stent 23mm 2.75mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816113,EAP,HCPCS C1874,,System Coron Stent 18mm 2.75mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816114,EAP,HCPCS C1874,,System Coron Stent 15mm 2.75mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816115,EAP,HCPCS C1874,,System Coron Stent 12mm 2.75mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816116,EAP,HCPCS C1874,,System Coron Stent 8mm 2.75mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816117,EAP,HCPCS C1874,,System Coron Stent 38mm 2.5mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816118,EAP,HCPCS C1874,,System Coron Stent 33mm 2.5mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816119,EAP,HCPCS C1874,,System Coron Stent 28mm 2.5mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816120,EAP,HCPCS C1874,,System Coron Stent 23mm 2.5mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816121,EAP,HCPCS C1874,,System Coron Stent 18mm 2.5mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816122,EAP,HCPCS C1874,,System Coron Stent 15mm 2.5mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816123,EAP,HCPCS C1874,,System Coron Stent 8mm 4mm Xience Alpine,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816124,EAP,HCPCS C1874,,System Coron Stent 15mm 4mm Xience Alpine,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816125,EAP,HCPCS C1874,,System Coron Stent 23mm 4mm Xience Alpine,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816126,EAP,HCPCS C1874,,System Coron Stent 28mm 4mm Xience Alpine,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816127,EAP,HCPCS C1874,,System Coron Stent 33mm 4mm Xience Alpine,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816128,EAP,HCPCS C1874,,System Coron Stent 8mm 2.25mm Xience Alpine,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816129,EAP,HCPCS C1874,,System Coron Stent 12mm 2.25mm Xience Alpine,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816130,EAP,HCPCS C1874,,System Coron Stent 15mm 2.25mm Xience Alpine,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816131,EAP,HCPCS C1874,,System Coron Stent 18mm 2.25mm Xience Alpine,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816132,EAP,HCPCS C1874,,System Coron Stent 23mm 2.25mm Xience Alpine,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816133,EAP,HCPCS C1874,,System Coron Stent 28mm 2.25mm Xience Alpine,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816134,EAP,HCPCS C1874,,System Coron Stent 8mm 2.5mm Xience Alpine,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816135,EAP,HCPCS C1874,,System Coron Stent 12mm 2.5mm Xience Alpine,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816136,EAP,HCPCS C1874,,System Coron Stent 15mm 2.5mm Xience Alpine,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816137,EAP,HCPCS C1874,,System Coron Stent 18mm 2.5mm Xience Alpine,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816138,EAP,HCPCS C1874,,System Coron Stent 23mm 2.5mm Xience Alpine,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816139,EAP,HCPCS C1874,,System Coron Stent 28mm 2.5mm Xience Alpine,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816140,EAP,HCPCS C1874,,System Coron Stent 33mm 2.5mm Xience Alpine,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816141,EAP,HCPCS C1874,,System Coron Stent 38mm 2.5mm Xience Alpine,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816142,EAP,HCPCS C1874,,System Coron Stent 8mm 2.75mm Xience Alpine,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816143,EAP,HCPCS C1874,,System Coron Stent 12mm 2.75mm Xience Alpine,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816144,EAP,HCPCS C1874,,System Coron Stent 15mm 2.75mm Xience Alpine,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816145,EAP,HCPCS C1874,,System Coron Stent 18mm 2.75mm Xience Alpine,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816146,EAP,HCPCS C1874,,System Coron Stent 23mm 2.75mm Xience Alpine,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816147,EAP,HCPCS C1874,,System Coron Stent 28mm 2.75mm Xience Alpine,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816148,EAP,HCPCS C1874,,System Coron Stent 33mm 2.75mm Xience Alpine,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816149,EAP,HCPCS C1874,,System Coron Stent 38mm 2.75mm Xience Alpine,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816150,EAP,HCPCS C1874,,System Coron Stent 8mm 3mm Xience Alpine,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816151,EAP,HCPCS C1874,,System Coron Stent 12mm 3mm Xience Alpine,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816152,EAP,HCPCS C1874,,System Coron Stent 15mm 3mm Xience Alpine,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816153,EAP,HCPCS C1874,,System Coron Stent 18mm 3mm Xience Alpine,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816154,EAP,HCPCS C1874,,System Coron Stent 23mm 3mm Xience Alpine,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816155,EAP,HCPCS C1874,,System Coron Stent 28mm 3mm Xience Alpine,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816156,EAP,HCPCS C1874,,System Coron Stent 33mm 3mm Xience Alpine,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816157,EAP,HCPCS C1874,,System Coron Stent 38mm 3mm Xience Alpine,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816158,EAP,HCPCS C1874,,System Coron Stent 8mm 3.25mm Xience Alpine,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816159,EAP,HCPCS C1874,,System Coron Stent 12mm 3.25mm Xience Alpine,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816160,EAP,HCPCS C1874,,System Coron Stent 15mm 3.25mm Xience Alpine,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816161,EAP,HCPCS C1874,,System Coron Stent 18mm 3.25mm Xience Alpine,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816162,EAP,HCPCS C1874,,System Coron Stent 23mm 3.25mm Xience Alpine,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816163,EAP,HCPCS C1874,,System Coron Stent 28mm 3.25mm Xience Alpine,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816164,EAP,HCPCS C1874,,System Coron Stent 33mm 3.25mm Xience Alpine,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816165,EAP,HCPCS C1874,,System Coron Stent 38mm 3.25mm Xience Alpine,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816166,EAP,HCPCS C1874,,System Coron Stent 8mm 3.5mm Xience Alpine,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816167,EAP,HCPCS C1874,,System Coron Stent 12mm 3.5mm Xience Alpine,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816168,EAP,HCPCS C1874,,System Coron Stent 15mm 3.5mm Xience Alpine,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816169,EAP,HCPCS C1874,,System Coron Stent 18mm 3.5mm Xience Alpine,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816170,EAP,HCPCS C1874,,System Coron Stent 23mm 3.5mm Xience Alpine,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816171,EAP,HCPCS C1874,,System Coron Stent 28mm 3.5mm Xience Alpine,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816172,EAP,HCPCS C1874,,System Coron Stent 33mm 3.5mm Xience Alpine,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816173,EAP,HCPCS C1874,,System Coron Stent 38mm 3.5mm Xience Alpine,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816174,EAP,HCPCS C1874,,System Coron Stent 8mm 4mm Xience Alpine,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816175,EAP,HCPCS C1874,,System Coron Stent 12mm 4mm Xience Alpine,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816176,EAP,HCPCS C1874,,System Coron Stent 15mm 4mm Xience Alpine,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816177,EAP,HCPCS C1874,,System Coron Stent 18mm 4mm Xience Alpine,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816178,EAP,HCPCS C1874,,System Coron Stent 23mm 4mm Xience Alpine,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816179,EAP,HCPCS C1874,,System Coron Stent 28mm 4mm Xience Alpine,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816180,EAP,HCPCS C1874,,System Coron Stent 33mm 4mm Xience Alpine,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816181,EAP,HCPCS C1874,,System Coron Stent 38mm 4mm Xience Alpine,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816182,EAP,HCPCS C1874,,System Coron Stent 12mm 2.5mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816183,EAP,HCPCS C1874,,System Coron Stent 8mm 2.25mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816184,EAP,HCPCS C1874,,System Coron Stent 12mm 2.25mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816185,EAP,HCPCS C1874,,System Coron Stent 15mm 2.25mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816186,EAP,HCPCS C1874,,System Coron Stent 18mm 2.25mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
27816187,EAP,,,Coil Embolization 360d 5mm 15cm Detachable Soft Target,"$4,539.00",$0.00,"$4,539.00",$0.00,"$3,239.48",$0.00,$0.00,"$3,239.48","$3,239.48",$0.00,"$4,539.00",$0.00,"$2,269.50","$3,594.89","$3,631.20",$0.00,$0.00,$0.00,$0.00,$0.00
27816188,EAP,,,Coil Embolization Standard Large 22mm 50cm Detachable Smooth,"$5,904.00",$0.00,"$5,904.00",$0.00,"$4,213.68",$0.00,$0.00,"$4,213.68","$4,213.68",$0.00,"$5,904.00",$0.00,"$2,952.00","$4,675.97","$4,723.20",$0.00,$0.00,$0.00,$0.00,$0.00
27816190,EAP,,,Coil Embl .02in Cmplx 4mm 10cm The Penumbra Coil 400 Xsft,"$6,900.00",$0.00,"$6,900.00",$0.00,"$4,924.53",$0.00,$0.00,"$4,924.53","$4,924.53",$0.00,"$6,900.00",$0.00,"$3,450.00","$5,464.80","$5,520.00",$0.00,$0.00,$0.00,$0.00,$0.00
27816191,EAP,,,Coil Embl .02in Cmplx 4mm 8cm The Penumbra Coil 400 Sft,"$6,075.00",$0.00,"$6,075.00",$0.00,"$4,335.73",$0.00,$0.00,"$4,335.73","$4,335.73",$0.00,"$6,075.00",$0.00,"$3,037.50","$4,811.40","$4,860.00",$0.00,$0.00,$0.00,$0.00,$0.00
27816192,EAP,,,Coil Embl Crv 4mm 10cm The Penumbra Coil 400 Xsft,"$6,513.00",$0.00,"$6,513.00",$0.00,"$4,648.33",$0.00,$0.00,"$4,648.33","$4,648.33",$0.00,"$6,513.00",$0.00,"$3,256.50","$5,158.30","$5,210.40",$0.00,$0.00,$0.00,$0.00,$0.00
27816193,EAP,,,Coil Embolization Curve 4mm 8cm Xsoft The Penumbra Coil 400,"$6,125.00",$0.00,"$6,125.00",$0.00,"$4,371.41",$0.00,$0.00,"$4,371.41","$4,371.41",$0.00,"$6,125.00",$0.00,"$3,062.50","$4,851.00","$4,900.00",$0.00,$0.00,$0.00,$0.00,$0.00
27816194,EAP,,,Coil Embolization 10cm J Soft Fill Coil 400 Nitinol,"$6,300.00",$0.00,"$6,300.00",$0.00,"$4,496.31",$0.00,$0.00,"$4,496.31","$4,496.31",$0.00,"$6,300.00",$0.00,"$3,150.00","$4,989.60","$5,040.00",$0.00,$0.00,$0.00,$0.00,$0.00
27816195,EAP,,,Coil Embolization 15cm J Coil 400,"$6,550.00",$0.00,"$6,550.00",$0.00,"$4,674.74",$0.00,$0.00,"$4,674.74","$4,674.74",$0.00,"$6,550.00",$0.00,"$3,275.00","$5,187.60","$5,240.00",$0.00,$0.00,$0.00,$0.00,$0.00
27816196,EAP,Custom 27816196,,Graft Evas 26mm 22-23mm 3.3cm Aorta,"$8,135.00",$0.00,"$8,135.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,805.95",$0.00,"$8,135.00",$0.00,"$4,067.50","$6,442.92","$6,508.00",$0.00,$0.00,$0.00,$0.00,$0.00
27816197,EAP,Custom 27816197,,Graft Evas 28.5mm 24-26mm 3.3cm Aorta,"$8,135.00",$0.00,"$8,135.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,805.95",$0.00,"$8,135.00",$0.00,"$4,067.50","$6,442.92","$6,508.00",$0.00,$0.00,$0.00,$0.00,$0.00
27816198,EAP,Custom 27816198,,Graft Evas 32mm 27-29mm 4.5cm Xcldr Stnt Xtd Abrsn Rst,"$8,135.00",$0.00,"$8,135.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,805.95",$0.00,"$8,135.00",$0.00,"$4,067.50","$6,442.92","$6,508.00",$0.00,$0.00,$0.00,$0.00,$0.00
27816199,EAP,Custom 27816199,,Graft Evas 36mm 30-32mm 4.5cm Xcldr Sinusoidal Stnt Sl Cuf,"$8,135.00",$0.00,"$8,135.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,805.95",$0.00,"$8,135.00",$0.00,"$4,067.50","$6,442.92","$6,508.00",$0.00,$0.00,$0.00,$0.00,$0.00
27816200,EAP,Custom 27816200,,Graft Evas 12mm 10cm Gore Xcldr Cntrlt Lg,"$11,558.00",$0.00,"$11,558.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$8,248.94",$0.00,"$11,558.00",$0.00,"$5,779.00","$9,153.94","$9,246.40",$0.00,$0.00,$0.00,$0.00,$0.00
27816201,EAP,Custom 27816201,,Graft Evas 12mm 12cm Gore Xcldr Cntrlt Lg,"$11,558.00",$0.00,"$11,558.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$8,248.94",$0.00,"$11,558.00",$0.00,"$5,779.00","$9,153.94","$9,246.40",$0.00,$0.00,$0.00,$0.00,$0.00
27816202,EAP,Custom 27816202,,Graft Evas 12mm 14cm Gore Xcldr Cntrlt Lg,"$11,558.00",$0.00,"$11,558.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$8,248.94",$0.00,"$11,558.00",$0.00,"$5,779.00","$9,153.94","$9,246.40",$0.00,$0.00,$0.00,$0.00,$0.00
27816203,EAP,Custom 27816203,,Graft Evas 14.5mm 10cm Gore Xcldr Cntrlt Lg,"$11,558.00",$0.00,"$11,558.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$8,248.94",$0.00,"$11,558.00",$0.00,"$5,779.00","$9,153.94","$9,246.40",$0.00,$0.00,$0.00,$0.00,$0.00
27816204,EAP,Custom 27816204,,Graft Evas 14.5mm 12cm Gore Xcldr Cntrlt Lg,"$11,558.00",$0.00,"$11,558.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$8,248.94",$0.00,"$11,558.00",$0.00,"$5,779.00","$9,153.94","$9,246.40",$0.00,$0.00,$0.00,$0.00,$0.00
27816205,EAP,Custom 27816205,,Graft Evas 14.5mm 12-13.5mm 14cm Gore Xcldr Cntrlt Lg Aaa,"$11,558.00",$0.00,"$11,558.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$8,248.94",$0.00,"$11,558.00",$0.00,"$5,779.00","$9,153.94","$9,246.40",$0.00,$0.00,$0.00,$0.00,$0.00
27816206,EAP,Custom 27816206,,Graft Evas 16mm 13.5-14.5mm 11.5cm Xcldr Stnt Abrsn Rst,"$11,558.00",$0.00,"$11,558.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$8,248.94",$0.00,"$11,558.00",$0.00,"$5,779.00","$9,153.94","$9,246.40",$0.00,$0.00,$0.00,$0.00,$0.00
27816207,EAP,Custom 27816207,,Graft Evas 16mm 13.5-14.5mm 13.5cm Xcldr Stnt Abrsn Rst,"$11,558.00",$0.00,"$11,558.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$8,248.94",$0.00,"$11,558.00",$0.00,"$5,779.00","$9,153.94","$9,246.40",$0.00,$0.00,$0.00,$0.00,$0.00
27816208,EAP,Custom 27816208,,Graft Evas 18mm 14.5-16.5mm 9.5cm Xcldr Stnt Abrsn Rst,"$11,558.00",$0.00,"$11,558.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$8,248.94",$0.00,"$11,558.00",$0.00,"$5,779.00","$9,153.94","$9,246.40",$0.00,$0.00,$0.00,$0.00,$0.00
27816209,EAP,Custom 27816209,,Graft Evas 18mm 14.5-16.5mm 11.5cm Xcldr Stnt Abrsn Rst,"$11,558.00",$0.00,"$11,558.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$8,248.94",$0.00,"$11,558.00",$0.00,"$5,779.00","$9,153.94","$9,246.40",$0.00,$0.00,$0.00,$0.00,$0.00
27816210,EAP,Custom 27816210,,Graft Evas 18mm 14.5-16.5mm 13.5cm Xcldr Stnt Abrsn Rst,"$11,558.00",$0.00,"$11,558.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$8,248.94",$0.00,"$11,558.00",$0.00,"$5,779.00","$9,153.94","$9,246.40",$0.00,$0.00,$0.00,$0.00,$0.00
27816211,EAP,Custom 27816211,,Graft Evas 20mm 16.5-18.5mm 9.5cm Xcldr Stnt Abrsn Rst,"$11,558.00",$0.00,"$11,558.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$8,248.94",$0.00,"$11,558.00",$0.00,"$5,779.00","$9,153.94","$9,246.40",$0.00,$0.00,$0.00,$0.00,$0.00
27816212,EAP,Custom 27816212,,Graft Evas 20mm 16.5-18.5mm 13.5cm Grtx Xcldr Sinusoidal,"$11,558.00",$0.00,"$11,558.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$8,248.94",$0.00,"$11,558.00",$0.00,"$5,779.00","$9,153.94","$9,246.40",$0.00,$0.00,$0.00,$0.00,$0.00
27816213,EAP,Custom 27816213,,Graft Evas 23mm 18.5-21.5mm 12cm Xcldr Stnt Abrsn Rst,"$11,558.00",$0.00,"$11,558.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$8,248.94",$0.00,"$11,558.00",$0.00,"$5,779.00","$9,153.94","$9,246.40",$0.00,$0.00,$0.00,$0.00,$0.00
27816214,EAP,Custom 27816214,,Graft Evas 23mm 18.5-21.5mm 14cm Xcldr Stnt Abrsn Rst,"$11,558.00",$0.00,"$11,558.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$8,248.94",$0.00,"$11,558.00",$0.00,"$5,779.00","$9,153.94","$9,246.40",$0.00,$0.00,$0.00,$0.00,$0.00
27816215,EAP,Custom 27816215,,Graft Evas 27mm 21.5-25mm 10cm Grtx Xcldr Sinusoidal Stnt Sl,"$11,558.00",$0.00,"$11,558.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$8,248.94",$0.00,"$11,558.00",$0.00,"$5,779.00","$9,153.94","$9,246.40",$0.00,$0.00,$0.00,$0.00,$0.00
27816216,EAP,Custom 27816216,,Graft Evas 27mm 21.5-25mm 12cm Xcldr Stnt Abrsn Rst,"$11,558.00",$0.00,"$11,558.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$8,248.94",$0.00,"$11,558.00",$0.00,"$5,779.00","$9,153.94","$9,246.40",$0.00,$0.00,$0.00,$0.00,$0.00
27816217,EAP,Custom 27816217,,Graft Evas 27mm 21.5-25mm 14cm Xcldr Stnt Abrsn Rst,"$11,558.00",$0.00,"$11,558.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$8,248.94",$0.00,"$11,558.00",$0.00,"$5,779.00","$9,153.94","$9,246.40",$0.00,$0.00,$0.00,$0.00,$0.00
27816218,EAP,Custom 27816218,,Graft Stnt 10mm 7cm Gore Xcldr Xtd Ilc Aaa,"$8,135.00",$0.00,"$8,135.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,805.95",$0.00,"$8,135.00",$0.00,"$4,067.50","$6,442.92","$6,508.00",$0.00,$0.00,$0.00,$0.00,$0.00
27816219,EAP,Custom 27816219,,Graft Evas 12mm 7cm Xcldr Stnt Xtd Sl Cuf Ntnl Eptfe Ilc Aaa,"$8,135.00",$0.00,"$8,135.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,805.95",$0.00,"$8,135.00",$0.00,"$4,067.50","$6,442.92","$6,508.00",$0.00,$0.00,$0.00,$0.00,$0.00
27816220,EAP,Custom 27816220,,Graft Evas 14.5mm 12-13.5mm 7cm Gore Xcldr Xtd Ilc Art Acpt,"$8,135.00",$0.00,"$8,135.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,805.95",$0.00,"$8,135.00",$0.00,"$4,067.50","$6,442.92","$6,508.00",$0.00,$0.00,$0.00,$0.00,$0.00
27816221,EAP,Custom 27816221,,Graft Evas 23mm 12mm 19-21mm 10-11mm 12cm Gore Xcldr C3 Bond,"$28,188.00",$0.00,"$28,188.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$20,117.78",$0.00,"$28,188.00",$0.00,"$14,094.00","$22,324.90","$22,550.40",$0.00,$0.00,$0.00,$0.00,$0.00
27816222,EAP,Custom 27816222,,Graft Evas 23mm 12mm 19-21mm 10-11mm 14cm Gore Xcldr C3 Bond,"$28,188.00",$0.00,"$28,188.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$20,117.78",$0.00,"$28,188.00",$0.00,"$14,094.00","$22,324.90","$22,550.40",$0.00,$0.00,$0.00,$0.00,$0.00
27816223,EAP,Custom 27816223,,Graft Evas 23mm 12mm 19-21mm 10-11mm 16cm Gore Xcldr C3 Bond,"$28,188.00",$0.00,"$28,188.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$20,117.78",$0.00,"$28,188.00",$0.00,"$14,094.00","$22,324.90","$22,550.40",$0.00,$0.00,$0.00,$0.00,$0.00
27816224,EAP,Custom 27816224,,Graft Evas 23mm 12mm 19-21mm 10-11mm 18cm Gore Xcldr C3 Bond,"$28,188.00",$0.00,"$28,188.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$20,117.78",$0.00,"$28,188.00",$0.00,"$14,094.00","$22,324.90","$22,550.40",$0.00,$0.00,$0.00,$0.00,$0.00
27816225,EAP,Custom 27816225,,Graft Evas 23mm 14.5mm 19-21mm 12-13.5mm 12cm Gore Xcldr C3,"$28,188.00",$0.00,"$28,188.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$20,117.78",$0.00,"$28,188.00",$0.00,"$14,094.00","$22,324.90","$22,550.40",$0.00,$0.00,$0.00,$0.00,$0.00
27816226,EAP,Custom 27816226,,Graft Evas 23mm 14.5mm 19-21mm 12-13.5mm 14cm Gore Xcldr C3,"$28,188.00",$0.00,"$28,188.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$20,117.78",$0.00,"$28,188.00",$0.00,"$14,094.00","$22,324.90","$22,550.40",$0.00,$0.00,$0.00,$0.00,$0.00
27816227,EAP,Custom 27816227,,Graft Evas 23mm 14.5mm 19-21mm 12-13.5mm 16cm Gore Xcldr C3,"$28,188.00",$0.00,"$28,188.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$20,117.78",$0.00,"$28,188.00",$0.00,"$14,094.00","$22,324.90","$22,550.40",$0.00,$0.00,$0.00,$0.00,$0.00
27816228,EAP,Custom 27816228,,Graft Evas 23mm 14.5mm 19-21mm 12-13.5mm 18cm Gore Xcldr C3,"$28,188.00",$0.00,"$28,188.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$20,117.78",$0.00,"$28,188.00",$0.00,"$14,094.00","$22,324.90","$22,550.40",$0.00,$0.00,$0.00,$0.00,$0.00
27816229,EAP,Custom 27816229,,Graft Evas 26mm 12mm 22-23mm 10-11mm 12cm Gore Xcldr C3 Bond,"$28,188.00",$0.00,"$28,188.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$20,117.78",$0.00,"$28,188.00",$0.00,"$14,094.00","$22,324.90","$22,550.40",$0.00,$0.00,$0.00,$0.00,$0.00
27816230,EAP,Custom 27816230,,Graft Evas 26mm 12mm 22-23mm 10-11mm 14cm Gore Xcldr C3 Bond,"$28,188.00",$0.00,"$28,188.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$20,117.78",$0.00,"$28,188.00",$0.00,"$14,094.00","$22,324.90","$22,550.40",$0.00,$0.00,$0.00,$0.00,$0.00
27816231,EAP,Custom 27816231,,Graft Evas 26mm 12mm 22-23mm 10-11mm 16cm Gore Xcldr C3 Bond,"$28,188.00",$0.00,"$28,188.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$20,117.78",$0.00,"$28,188.00",$0.00,"$14,094.00","$22,324.90","$22,550.40",$0.00,$0.00,$0.00,$0.00,$0.00
27816232,EAP,Custom 27816232,,Graft Evas 26mm 12mm 22-23mm 10-11mm 18cm Gore Xcldr C3 Bond,"$28,188.00",$0.00,"$28,188.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$20,117.78",$0.00,"$28,188.00",$0.00,"$14,094.00","$22,324.90","$22,550.40",$0.00,$0.00,$0.00,$0.00,$0.00
27816233,EAP,Custom 27816233,,Graft Evas 26mm 14.5mm 22-23mm 12-13.5mm 12cm Gore Xcldr C3,"$28,188.00",$0.00,"$28,188.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$20,117.78",$0.00,"$28,188.00",$0.00,"$14,094.00","$22,324.90","$22,550.40",$0.00,$0.00,$0.00,$0.00,$0.00
27816234,EAP,Custom 27816234,,Graft Evas 26mm 14.5mm 14cm Gore Xcldr C3 Trnkipsl Lg Aaa,"$28,188.00",$0.00,"$28,188.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$20,117.78",$0.00,"$28,188.00",$0.00,"$14,094.00","$22,324.90","$22,550.40",$0.00,$0.00,$0.00,$0.00,$0.00
27816235,EAP,Custom 27816235,,Graft Evas 26mm 14.5mm 16cm Gore Xcldr C3 Trnkipsl Lg Aaa,"$28,188.00",$0.00,"$28,188.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$20,117.78",$0.00,"$28,188.00",$0.00,"$14,094.00","$22,324.90","$22,550.40",$0.00,$0.00,$0.00,$0.00,$0.00
27816236,EAP,Custom 27816236,,Graft Evas 26mm 14.5mm 22-23mm 12-13.5mm 18cm Gore Xcldr C3,"$28,188.00",$0.00,"$28,188.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$20,117.78",$0.00,"$28,188.00",$0.00,"$14,094.00","$22,324.90","$22,550.40",$0.00,$0.00,$0.00,$0.00,$0.00
27816237,EAP,Custom 27816237,,Graft Evas 28.5mm 12mm 24-26mm 10-11mm 12cm Gore Xcldr C3,"$28,188.00",$0.00,"$28,188.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$20,117.78",$0.00,"$28,188.00",$0.00,"$14,094.00","$22,324.90","$22,550.40",$0.00,$0.00,$0.00,$0.00,$0.00
27816238,EAP,Custom 27816238,,Graft Evas 28.5mm 12mm 24-26mm 10-11mm 14cm Gore Xcldr C3,"$28,188.00",$0.00,"$28,188.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$20,117.78",$0.00,"$28,188.00",$0.00,"$14,094.00","$22,324.90","$22,550.40",$0.00,$0.00,$0.00,$0.00,$0.00
27816239,EAP,Custom 27816239,,Graft Evas 28.5mm 12mm 24-26mm 10-11mm 16cm Gore Xcldr C3,"$28,188.00",$0.00,"$28,188.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$20,117.78",$0.00,"$28,188.00",$0.00,"$14,094.00","$22,324.90","$22,550.40",$0.00,$0.00,$0.00,$0.00,$0.00
27816240,EAP,Custom 27816240,,Graft Evas 28.5mm 12mm 24-26mm 10-11mm 18cm Gore Xcldr C3,"$28,188.00",$0.00,"$28,188.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$20,117.78",$0.00,"$28,188.00",$0.00,"$14,094.00","$22,324.90","$22,550.40",$0.00,$0.00,$0.00,$0.00,$0.00
27816241,EAP,Custom 27816241,,Graft Evas 28.5mm 14.5mm 24-26mm 12-13.5mm 14cm Gore Xcldr C,"$28,188.00",$0.00,"$28,188.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$20,117.78",$0.00,"$28,188.00",$0.00,"$14,094.00","$22,324.90","$22,550.40",$0.00,$0.00,$0.00,$0.00,$0.00
27816242,EAP,Custom 27816242,,Graft Evas 28.5mm 14.5mm 24-26mm 12-13.5mm 16cm Gore Xcldr C,"$28,188.00",$0.00,"$28,188.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$20,117.78",$0.00,"$28,188.00",$0.00,"$14,094.00","$22,324.90","$22,550.40",$0.00,$0.00,$0.00,$0.00,$0.00
27816243,EAP,Custom 27816243,,Graft Evas 28.5mm 14.5mm 24-26mm 12-13.5mm 18cm Gore Xcldr C,"$28,188.00",$0.00,"$28,188.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$20,117.78",$0.00,"$28,188.00",$0.00,"$14,094.00","$22,324.90","$22,550.40",$0.00,$0.00,$0.00,$0.00,$0.00
27816244,EAP,Custom 27816244,,Graft Evas 31mm 14.5mm 13cm Xcldr C3 Stnt Dlv Sys Grtx Ntnl,"$28,188.00",$0.00,"$28,188.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$20,117.78",$0.00,"$28,188.00",$0.00,"$14,094.00","$22,324.90","$22,550.40",$0.00,$0.00,$0.00,$0.00,$0.00
27816245,EAP,Custom 27816245,,Graft Evas 31mm 14.5mm 15cm Xcldr C3 Stnt Dlv Sys Grtx Ntnl,"$28,188.00",$0.00,"$28,188.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$20,117.78",$0.00,"$28,188.00",$0.00,"$14,094.00","$22,324.90","$22,550.40",$0.00,$0.00,$0.00,$0.00,$0.00
27816246,EAP,Custom 27816246,,Graft Evas 31mm 14.5mm 17cm Xcldr C3 Stnt Dlv Sys Grtx Ntnl,"$28,188.00",$0.00,"$28,188.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$20,117.78",$0.00,"$28,188.00",$0.00,"$14,094.00","$22,324.90","$22,550.40",$0.00,$0.00,$0.00,$0.00,$0.00
27816247,EAP,Custom 27816247,,Graft Evas 35mm 14.5mm 30-32mm 12-13.5mm 14cm Strl Gore,"$28,188.00",$0.00,"$28,188.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$20,117.78",$0.00,"$28,188.00",$0.00,"$14,094.00","$22,324.90","$22,550.40",$0.00,$0.00,$0.00,$0.00,$0.00
27816248,EAP,Custom 27816248,,Graft Evas 35mm 14.5mm 16cm Xcldr C3 Stnt Dlv Sys Grtx Ntnl,"$28,188.00",$0.00,"$28,188.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$20,117.78",$0.00,"$28,188.00",$0.00,"$14,094.00","$22,324.90","$22,550.40",$0.00,$0.00,$0.00,$0.00,$0.00
27816249,EAP,Custom 27816249,,Graft Evas 35mm 14.5mm 30-32mm 12-13.5mm 18cm Gore Xcldr C3,"$28,188.00",$0.00,"$28,188.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$20,117.78",$0.00,"$28,188.00",$0.00,"$14,094.00","$22,324.90","$22,550.40",$0.00,$0.00,$0.00,$0.00,$0.00
27816250,EAP,HCPCS C1752,,Catheter Hmdial 20cm Schn Xl Kink Rst Tip Clip Sh Rem Sty,$119.00,$0.00,$119.00,$0.00,$84.93,$0.00,$0.00,$84.93,$84.93,$0.00,$119.00,$0.00,$59.50,$94.25,$95.20,$0.00,$0.00,$0.00,$0.00,$0.00
27816251,EAP,HCPCS C1876,,Stent Intrcran T 2.7-3.5mm 8mm Pulserider Arch,"$31,250.00",$0.00,"$31,250.00","$14,062.50","$5,158.80",$0.00,"$5,384.22","$5,158.80","$22,303.13","$5,471.63","$31,250.00",$0.00,"$15,625.00","$24,750.00","$25,000.00",$0.00,"$4,890.63",$0.00,"$4,975.00",$0.00
27816252,EAP,HCPCS C1876,,Stent Intrcran T 3.5-4.5mm 8mm Pulserider Arch,"$31,250.00",$0.00,"$31,250.00","$14,062.50","$5,158.80",$0.00,"$5,384.22","$5,158.80","$22,303.13","$5,471.63","$31,250.00",$0.00,"$15,625.00","$24,750.00","$25,000.00",$0.00,"$4,890.63",$0.00,"$4,975.00",$0.00
27816253,EAP,HCPCS C1876,,Stent Intrcran T 2.7-3.5mm 10mm Pulserider Arch,"$31,250.00",$0.00,"$31,250.00","$14,062.50","$5,158.80",$0.00,"$5,384.22","$5,158.80","$22,303.13","$5,471.63","$31,250.00",$0.00,"$15,625.00","$24,750.00","$25,000.00",$0.00,"$4,890.63",$0.00,"$4,975.00",$0.00
27816254,EAP,HCPCS C1876,,Stent Intrcran Y 2.7-3.5mm 8mm Pulserider Arch,"$31,250.00",$0.00,"$31,250.00","$14,062.50","$5,158.80",$0.00,"$5,384.22","$5,158.80","$22,303.13","$5,471.63","$31,250.00",$0.00,"$15,625.00","$24,750.00","$25,000.00",$0.00,"$4,890.63",$0.00,"$4,975.00",$0.00
27816255,EAP,HCPCS C1876,,Stent Intrcran Y 3.5-4.5mm 8mm Pulserider Arch,"$31,250.00",$0.00,"$31,250.00","$14,062.50","$5,158.80",$0.00,"$5,384.22","$5,158.80","$22,303.13","$5,471.63","$31,250.00",$0.00,"$15,625.00","$24,750.00","$25,000.00",$0.00,"$4,890.63",$0.00,"$4,975.00",$0.00
27816256,EAP,HCPCS C1876,,Stent Intrcran Y 2.7-3.5mm 10mm Pulserider Arch,"$31,250.00",$0.00,"$31,250.00","$14,062.50","$5,158.80",$0.00,"$5,384.22","$5,158.80","$22,303.13","$5,471.63","$31,250.00",$0.00,"$15,625.00","$24,750.00","$25,000.00",$0.00,"$4,890.63",$0.00,"$4,975.00",$0.00
27816257,EAP,HCPCS C1876,,Stent Intrcran Y 3.5-4.5mm 10mm Pulserider Arch,"$31,250.00",$0.00,"$31,250.00","$14,062.50","$5,158.80",$0.00,"$5,384.22","$5,158.80","$22,303.13","$5,471.63","$31,250.00",$0.00,"$15,625.00","$24,750.00","$25,000.00",$0.00,"$4,890.63",$0.00,"$4,975.00",$0.00
27816259,EAP,HCPCS C1874,,System Cor Stnt 4.5mm 15mm 140cm Rslt Onyx Rx Dlv Sys Radopq,"$3,425.00",$0.00,"$3,425.00","$1,541.25","$2,444.42",$0.00,$590.11,"$2,444.42","$2,444.42",$599.69,"$3,425.00",$0.00,"$1,712.50","$2,712.60","$2,740.00",$0.00,$536.01,$0.00,$545.26,$0.00
27816260,EAP,HCPCS C1874,,System Cor Stnt 4.5mm 18mm 140cm Rslt Onyx Rx Dlv Sys Radopq,"$3,425.00",$0.00,"$3,425.00","$1,541.25","$2,444.42",$0.00,$590.11,"$2,444.42","$2,444.42",$599.69,"$3,425.00",$0.00,"$1,712.50","$2,712.60","$2,740.00",$0.00,$536.01,$0.00,$545.26,$0.00
27816261,EAP,HCPCS C1874,,System Cor Stnt 4.5mm 22mm 140cm Rslt Onyx Rx Dlv Sys Radopq,"$3,425.00",$0.00,"$3,425.00","$1,541.25","$2,444.42",$0.00,$590.11,"$2,444.42","$2,444.42",$599.69,"$3,425.00",$0.00,"$1,712.50","$2,712.60","$2,740.00",$0.00,$536.01,$0.00,$545.26,$0.00
27816262,EAP,HCPCS C1874,,System Cor Stnt 4.5mm 26mm 140cm Rslt Onyx Rx Dlv Sys Radopq,"$3,425.00",$0.00,"$3,425.00","$1,541.25","$2,444.42",$0.00,$590.11,"$2,444.42","$2,444.42",$599.69,"$3,425.00",$0.00,"$1,712.50","$2,712.60","$2,740.00",$0.00,$536.01,$0.00,$545.26,$0.00
27816263,EAP,HCPCS C1874,,System Cor Stnt 4.5mm 30mm 140cm Rslt Onyx Rx Dlv Sys Radopq,"$3,425.00",$0.00,"$3,425.00","$1,541.25","$2,444.42",$0.00,$590.11,"$2,444.42","$2,444.42",$599.69,"$3,425.00",$0.00,"$1,712.50","$2,712.60","$2,740.00",$0.00,$536.01,$0.00,$545.26,$0.00
27816264,EAP,HCPCS C1874,,System Cor Stnt 5mm 12mm 140cm Rslt Onyx Rx Dlv Sys Radopq 1,"$3,425.00",$0.00,"$3,425.00","$1,541.25","$2,444.42",$0.00,$590.11,"$2,444.42","$2,444.42",$599.69,"$3,425.00",$0.00,"$1,712.50","$2,712.60","$2,740.00",$0.00,$536.01,$0.00,$545.26,$0.00
27816265,EAP,HCPCS C1874,,System Cor Stnt 5mm 15mm 140cm Rslt Onyx Rx Dlv Sys Radopq 1,"$3,425.00",$0.00,"$3,425.00","$1,541.25","$2,444.42",$0.00,$590.11,"$2,444.42","$2,444.42",$599.69,"$3,425.00",$0.00,"$1,712.50","$2,712.60","$2,740.00",$0.00,$536.01,$0.00,$545.26,$0.00
27816266,EAP,HCPCS C1874,,System Cor Stnt 5mm 18mm 140cm Rslt Onyx Rx Dlv Sys Radopq 1,"$3,425.00",$0.00,"$3,425.00","$1,541.25","$2,444.42",$0.00,$590.11,"$2,444.42","$2,444.42",$599.69,"$3,425.00",$0.00,"$1,712.50","$2,712.60","$2,740.00",$0.00,$536.01,$0.00,$545.26,$0.00
27816267,EAP,HCPCS C1874,,System Cor Stnt 5mm 22mm 140cm Rslt Onyx Rx Dlv Sys Radopq 1,"$3,425.00",$0.00,"$3,425.00","$1,541.25","$2,444.42",$0.00,$590.11,"$2,444.42","$2,444.42",$599.69,"$3,425.00",$0.00,"$1,712.50","$2,712.60","$2,740.00",$0.00,$536.01,$0.00,$545.26,$0.00
27816268,EAP,HCPCS C1874,,System Cor Stnt 5mm 26mm 140cm Rslt Onyx Rx Dlv Sys Radopq 1,"$3,425.00",$0.00,"$3,425.00","$1,541.25","$2,444.42",$0.00,$590.11,"$2,444.42","$2,444.42",$599.69,"$3,425.00",$0.00,"$1,712.50","$2,712.60","$2,740.00",$0.00,$536.01,$0.00,$545.26,$0.00
27816269,EAP,HCPCS C1874,,System Cor Stnt 5mm 30mm 140cm Rslt Onyx Rx Dlv Sys Radopq 1,"$3,425.00",$0.00,"$3,425.00","$1,541.25","$2,444.42",$0.00,$590.11,"$2,444.42","$2,444.42",$599.69,"$3,425.00",$0.00,"$1,712.50","$2,712.60","$2,740.00",$0.00,$536.01,$0.00,$545.26,$0.00
27816270,EAP,HCPCS C1757,,Catheter Thrmb .044in 140cm Strl Lf Indg Sys Asp Kt Cor,"$4,850.00",$0.00,"$4,850.00",$0.00,"$3,461.45",$0.00,$0.00,"$3,461.45","$3,461.45",$0.00,"$4,850.00",$0.00,"$2,425.00","$3,841.20","$3,880.00",$0.00,$0.00,$0.00,$0.00,$0.00
27816279,EAP,HCPCS C1874,,Stent Eprsth 8mm 10cm Strl 120cm Vbhn Flxb Slf Xpd Radopq,"$9,160.00",$0.00,"$9,160.00","$4,122.00","$5,158.80",$0.00,"$1,578.22","$5,158.80","$6,537.49","$1,603.84","$9,160.00",$0.00,"$4,580.00","$7,254.72","$7,328.00",$0.00,"$1,433.54",$0.00,"$1,458.27",$0.00
27816280,EAP,Custom 27816280,,Stent Eprsth 21mm 10cm Strl Gore Tag Cnfrm Flxb Radopq Eptfe,"$41,640.00",$0.00,"$41,640.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$29,718.47",$0.00,"$41,640.00",$0.00,"$20,820.00","$32,978.88","$33,312.00",$0.00,$0.00,$0.00,$0.00,$0.00
27816281,EAP,Custom 27816281,,Stent Eprsth 21-26mm 10cm Strl Gore Tag Cnfrm Flxb Radopq,"$41,640.00",$0.00,"$41,640.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$29,718.47",$0.00,"$41,640.00",$0.00,"$20,820.00","$32,978.88","$33,312.00",$0.00,$0.00,$0.00,$0.00,$0.00
27816282,EAP,Custom 27816282,,Stent Eprsth 26mm 10cm Strl Gore Tag Flxb Radopq Ntnl Fep,"$41,640.00",$0.00,"$41,640.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$29,718.47",$0.00,"$41,640.00",$0.00,"$20,820.00","$32,978.88","$33,312.00",$0.00,$0.00,$0.00,$0.00,$0.00
27816283,EAP,Custom 27816283,,Stent Eprsth 28mm 10cm Strl Gore Tag Flxb Radopq Ntnl Fep,"$41,640.00",$0.00,"$41,640.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$29,718.47",$0.00,"$41,640.00",$0.00,"$20,820.00","$32,978.88","$33,312.00",$0.00,$0.00,$0.00,$0.00,$0.00
27816284,EAP,Custom 27816284,,Stent Eprsth 28mm 15cm Strl Gore Tag Flxb Radopq Ntnl Fep,"$41,640.00",$0.00,"$41,640.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$29,718.47",$0.00,"$41,640.00",$0.00,"$20,820.00","$32,978.88","$33,312.00",$0.00,$0.00,$0.00,$0.00,$0.00
27816285,EAP,Custom 27816285,,Stent Eprsth 26-31mm 10cm Strl Gore Tag Cnfrm Flxb Radopq,"$41,640.00",$0.00,"$41,640.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$29,718.47",$0.00,"$41,640.00",$0.00,"$20,820.00","$32,978.88","$33,312.00",$0.00,$0.00,$0.00,$0.00,$0.00
27816286,EAP,Custom 27816286,,Stent Eprsth 31mm 10cm Strl Gore Tag Flxb Radopq Ntnl Fep,"$41,640.00",$0.00,"$41,640.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$29,718.47",$0.00,"$41,640.00",$0.00,"$20,820.00","$32,978.88","$33,312.00",$0.00,$0.00,$0.00,$0.00,$0.00
27816287,EAP,Custom 27816287,,Stent Eprsth 31mm 15cm Strl Gore Tag Cnfrm Flxb Radopq Eptfe,"$41,640.00",$0.00,"$41,640.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$29,718.47",$0.00,"$41,640.00",$0.00,"$20,820.00","$32,978.88","$33,312.00",$0.00,$0.00,$0.00,$0.00,$0.00
27816288,EAP,Custom 27816288,,Stent Eprsth 34mm 10cm Strl Gore Tag Flxb Radopq Ntnl Fep,"$41,640.00",$0.00,"$41,640.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$29,718.47",$0.00,"$41,640.00",$0.00,"$20,820.00","$32,978.88","$33,312.00",$0.00,$0.00,$0.00,$0.00,$0.00
27816289,EAP,Custom 27816289,,Stent Eprsth 34mm 15cm Strl Gore Tag Cnfrm Flxb Radopq Eptfe,"$41,640.00",$0.00,"$41,640.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$29,718.47",$0.00,"$41,640.00",$0.00,"$20,820.00","$32,978.88","$33,312.00",$0.00,$0.00,$0.00,$0.00,$0.00
27816290,EAP,Custom 27816290,,Stent Eprsth 34mm 20cm Strl Gore Tag Cnfrm Flxb Radopq Eptfe,"$41,640.00",$0.00,"$41,640.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$29,718.47",$0.00,"$41,640.00",$0.00,"$20,820.00","$32,978.88","$33,312.00",$0.00,$0.00,$0.00,$0.00,$0.00
27816291,EAP,Custom 27816291,,Stent Eprsth 37mm 10cm Strl Gore Tag Cnfrm Flxb Radopq Eptfe,"$41,640.00",$0.00,"$41,640.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$29,718.47",$0.00,"$41,640.00",$0.00,"$20,820.00","$32,978.88","$33,312.00",$0.00,$0.00,$0.00,$0.00,$0.00
27816292,EAP,Custom 27816292,,Stent Eprsth 37mm 15cm Strl Gore Tag Cnfrm Flxb Radopq Eptfe,"$41,640.00",$0.00,"$41,640.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$29,718.47",$0.00,"$41,640.00",$0.00,"$20,820.00","$32,978.88","$33,312.00",$0.00,$0.00,$0.00,$0.00,$0.00
27816293,EAP,Custom 27816293,,Stent Eprsth 37mm 20cm Strl Gore Tag Cnfrm Flxb Radopq Eptfe,"$41,640.00",$0.00,"$41,640.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$29,718.47",$0.00,"$41,640.00",$0.00,"$20,820.00","$32,978.88","$33,312.00",$0.00,$0.00,$0.00,$0.00,$0.00
27816294,EAP,Custom 27816294,,Stent Eprsth 40mm 10cm Strl Gore Tag Cnfrm Flxb Radopq Eptfe,"$41,640.00",$0.00,"$41,640.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$29,718.47",$0.00,"$41,640.00",$0.00,"$20,820.00","$32,978.88","$33,312.00",$0.00,$0.00,$0.00,$0.00,$0.00
27816295,EAP,Custom 27816295,,Stent Eprsth 40mm 15cm Strl Gore Tag Cnfrm Flxb Radopq Eptfe,"$41,640.00",$0.00,"$41,640.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$29,718.47",$0.00,"$41,640.00",$0.00,"$20,820.00","$32,978.88","$33,312.00",$0.00,$0.00,$0.00,$0.00,$0.00
27816296,EAP,Custom 27816296,,Stent Eprsth 40mm 20cm Strl Gore Tag Cnfrm Flxb Radopq Eptfe,"$41,640.00",$0.00,"$41,640.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$29,718.47",$0.00,"$41,640.00",$0.00,"$20,820.00","$32,978.88","$33,312.00",$0.00,$0.00,$0.00,$0.00,$0.00
27816297,EAP,Custom 27816297,,Stent Eprsth 45mm 10cm Strl Gore Tag Cnfrm Flxb Radopq Eptfe,"$41,640.00",$0.00,"$41,640.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$29,718.47",$0.00,"$41,640.00",$0.00,"$20,820.00","$32,978.88","$33,312.00",$0.00,$0.00,$0.00,$0.00,$0.00
27816298,EAP,Custom 27816298,,Stent Eprsth 45mm 15cm Strl Gore Tag Cnfrm Flxb Radopq Eptfe,"$41,640.00",$0.00,"$41,640.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$29,718.47",$0.00,"$41,640.00",$0.00,"$20,820.00","$32,978.88","$33,312.00",$0.00,$0.00,$0.00,$0.00,$0.00
27816299,EAP,Custom 27816299,,Stent Eprsth 45mm 20cm Strl Gore Tag Cnfrm Flxb Radopq Eptfe,"$41,640.00",$0.00,"$41,640.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$29,718.47",$0.00,"$41,640.00",$0.00,"$20,820.00","$32,978.88","$33,312.00",$0.00,$0.00,$0.00,$0.00,$0.00
27816300,EAP,,,Plug Ocl 3mm 12x5.3mm Mvp Mech Dtch Full Resheathable Ntnl,"$3,738.00",$0.00,"$3,738.00",$0.00,"$2,667.81",$0.00,$0.00,"$2,667.81","$2,667.81",$0.00,"$3,738.00",$0.00,"$1,869.00","$2,960.50","$2,990.40",$0.00,$0.00,$0.00,$0.00,$0.00
27816301,EAP,,,Plug Ocl 5mm 12x6.5mm Strl Lf Mvp Mech Dtch Full,"$3,738.00",$0.00,"$3,738.00",$0.00,"$2,667.81",$0.00,$0.00,"$2,667.81","$2,667.81",$0.00,"$3,738.00",$0.00,"$1,869.00","$2,960.50","$2,990.40",$0.00,$0.00,$0.00,$0.00,$0.00
27816302,EAP,,,Plug Ocl Mic 7mm Strl Lf Mvp Mech Vasc Disp V03,"$3,738.00",$0.00,"$3,738.00",$0.00,"$2,667.81",$0.00,$0.00,"$2,667.81","$2,667.81",$0.00,"$3,738.00",$0.00,"$1,869.00","$2,960.50","$2,990.40",$0.00,$0.00,$0.00,$0.00,$0.00
27816303,EAP,,,Plug Ocl 9mm Strl Lf Mvp V03,"$3,738.00",$0.00,"$3,738.00",$0.00,"$2,667.81",$0.00,$0.00,"$2,667.81","$2,667.81",$0.00,"$3,738.00",$0.00,"$1,869.00","$2,960.50","$2,990.40",$0.00,$0.00,$0.00,$0.00,$0.00
27816304,EAP,Custom 27816304,,Graft Evas 10mm 10cm Gore Xcldr Brch Cmpnt Ilc Aaa,"$27,548.00",$0.00,"$27,548.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$19,661.01",$0.00,"$27,548.00",$0.00,"$13,774.00","$21,818.02","$22,038.40",$0.00,$0.00,$0.00,$0.00,$0.00
27816305,EAP,Custom 27816305,,Graft Evas 12mm 10cm Gore Xcldr Brch Cmpnt Ilc Aaa,"$27,548.00",$0.00,"$27,548.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$19,661.01",$0.00,"$27,548.00",$0.00,"$13,774.00","$21,818.02","$22,038.40",$0.00,$0.00,$0.00,$0.00,$0.00
27816306,EAP,Custom 27816306,,Graft Evas 14.5mm 10cm Gore Xcldr Brch Cmpnt Ilc Aaa,"$27,548.00",$0.00,"$27,548.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$19,661.01",$0.00,"$27,548.00",$0.00,"$13,774.00","$21,818.02","$22,038.40",$0.00,$0.00,$0.00,$0.00,$0.00
27816307,EAP,Custom 27816307,,Graft Evas 14.5mm 7cm Gore Xcldr Intnl Cmpnt Ilc Aaa,"$7,688.00",$0.00,"$7,688.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,486.93",$0.00,"$7,688.00",$0.00,"$3,844.00","$6,088.90","$6,150.40",$0.00,$0.00,$0.00,$0.00,$0.00
27816308,EAP,HCPCS C1783,,Stent Opth 50um 230um 80um 360um Strl Istent Inj 2 Preld 1,"$3,688.00",$0.00,"$3,688.00","$1,659.60","$2,632.13",$0.00,$635.42,"$2,632.13","$2,632.13",$645.74,"$3,688.00",$0.00,"$1,844.00","$2,920.90","$2,950.40",$0.00,$577.17,$0.00,$587.13,$0.00
27816309,EAP,HCPCS C1874,,Axios Stent And Electrocautery 15x10,"$11,625.00",$0.00,"$11,625.00","$5,231.25","$5,158.80",$0.00,"$2,002.93","$5,158.80","$8,296.76","$2,035.44","$11,625.00",$0.00,"$5,812.50","$9,207.00","$9,300.00",$0.00,"$1,819.31",$0.00,"$1,850.70",$0.00
27816310,EAP,HCPCS C1874,,Wallflex Biliary Stent,"$6,738.00",$0.00,"$6,738.00","$3,032.10","$4,808.91",$0.00,"$1,160.92","$4,808.91","$4,808.91","$1,179.77","$6,738.00",$0.00,"$3,369.00","$5,336.50","$5,390.40",$0.00,"$1,054.50",$0.00,"$1,072.69",$0.00
27816311,EAP,HCPCS C1768,,Envelope Tiss 5x5.4cm Cormatrix Cangaroo Sm Sft,"$12,063.00",$0.00,"$12,063.00","$5,428.35","$5,158.80",$0.00,"$2,078.39","$5,158.80","$8,609.36","$2,112.13","$12,063.00",$0.00,"$6,031.50","$9,553.90","$9,650.40",$0.00,"$1,887.86",$0.00,"$1,920.43",$0.00
27816312,EAP,HCPCS C1768,,Envelope Tiss 6.9x6.5cm Cormatrix Cangaroo Med Sft,"$12,063.00",$0.00,"$12,063.00","$5,428.35","$5,158.80",$0.00,"$2,078.39","$5,158.80","$8,609.36","$2,112.13","$12,063.00",$0.00,"$6,031.50","$9,553.90","$9,650.40",$0.00,"$1,887.86",$0.00,"$1,920.43",$0.00
27816313,EAP,HCPCS C1768,,Envelope Tiss 8x6.9cm Cormatrix Cangaroo Lg Sft,"$12,063.00",$0.00,"$12,063.00","$5,428.35","$5,158.80",$0.00,"$2,078.39","$5,158.80","$8,609.36","$2,112.13","$12,063.00",$0.00,"$6,031.50","$9,553.90","$9,650.40",$0.00,"$1,887.86",$0.00,"$1,920.43",$0.00
27816314,EAP,HCPCS C1768,,Envelope Tiss 9.5x6.9cm Cormatrix Cangaroo Xl Sft,"$12,063.00",$0.00,"$12,063.00","$5,428.35","$5,158.80",$0.00,"$2,078.39","$5,158.80","$8,609.36","$2,112.13","$12,063.00",$0.00,"$6,031.50","$9,553.90","$9,650.40",$0.00,"$1,887.86",$0.00,"$1,920.43",$0.00
27816315,EAP,HCPCS C1768,,Envelope Tiss 10.8x8.9cm Cangaroo 2xl Sft Reinf,"$16,563.00",$0.00,"$16,563.00","$7,453.35","$5,158.80",$0.00,"$2,853.72","$5,158.80","$11,821.01","$2,900.05","$16,563.00",$0.00,"$8,281.50","$13,117.90","$13,250.40",$0.00,"$2,592.11",$0.00,"$2,636.83",$0.00
27816316,EAP,HCPCS C1874,,Stent Endoprsth 2.5cm 5mm Hep Ntnl Eptfe Vbhn 120,"$8,808.00",$0.00,"$8,808.00","$3,963.60","$5,158.80",$0.00,"$1,517.57","$5,158.80","$6,286.27","$1,542.21","$8,808.00",$0.00,"$4,404.00","$6,975.94","$7,046.40",$0.00,"$1,378.45",$0.00,"$1,402.23",$0.00
27816317,EAP,HCPCS C1874,,Stent Endoprsth 2.5cm 6mm Hep Ntnl Eptfe Vbhn 120,"$8,808.00",$0.00,"$8,808.00","$3,963.60","$5,158.80",$0.00,"$1,517.57","$5,158.80","$6,286.27","$1,542.21","$8,808.00",$0.00,"$4,404.00","$6,975.94","$7,046.40",$0.00,"$1,378.45",$0.00,"$1,402.23",$0.00
27816318,EAP,HCPCS C1874,,Stent Endoprsth 2.5cm 8mm Hep Ntnl Eptfe Vbhn 120,"$8,808.00",$0.00,"$8,808.00","$3,963.60","$5,158.80",$0.00,"$1,517.57","$5,158.80","$6,286.27","$1,542.21","$8,808.00",$0.00,"$4,404.00","$6,975.94","$7,046.40",$0.00,"$1,378.45",$0.00,"$1,402.23",$0.00
27816320,EAP,HCPCS C1874,,System Coron Stent 8mm 2.5mm Elunir Thk90um,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,"$1,248.98","$1,248.98",$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
27816321,EAP,HCPCS C1874,,System Coron Stent 12mm 2.5mm Elunir Thk90um,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,"$1,248.98","$1,248.98",$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
27816322,EAP,HCPCS C1874,,System Coron Stent 15mm 2.5mm Elunir Thk90um,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,"$1,248.98","$1,248.98",$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
27816323,EAP,HCPCS C1874,,System Coron Stent 17mm 2.5mm Elunir Thk90um,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,"$1,248.98","$1,248.98",$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
27816324,EAP,HCPCS C1874,,System Coron Stent 20mm 2.5mm Elunir Thk90um,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,"$1,248.98","$1,248.98",$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
27816325,EAP,HCPCS C1874,,System Coron Stent 24mm 2.5mm Elunir Thk90um,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,"$1,248.98","$1,248.98",$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
27816326,EAP,HCPCS C1874,,System Coron Stent 28mm 2.5mm Elunir Thk90um,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,"$1,248.98","$1,248.98",$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
27816327,EAP,HCPCS C1874,,System Coron Stent 33mm 2.5mm Elunir Thk90um,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,"$1,248.98","$1,248.98",$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
27816328,EAP,HCPCS C1874,,System Coron Stent 8mm 2.75mm Elunir Thk90um,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,"$1,248.98","$1,248.98",$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
27816329,EAP,HCPCS C1874,,System Coron Stent 12mm 2.75mm Elunir Thk90um,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,"$1,248.98","$1,248.98",$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
27816330,EAP,HCPCS C1874,,System Coron Stent 15mm 2.75mm Elunir Thk90um,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,"$1,248.98","$1,248.98",$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
27816331,EAP,HCPCS C1874,,System Coron Stent 17mm 2.75mm Elunir Thk90um,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,"$1,248.98","$1,248.98",$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
27816332,EAP,HCPCS C1874,,System Coron Stent 20mm 2.75mm Elunir Thk90um,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,"$1,248.98","$1,248.98",$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
27816333,EAP,HCPCS C1874,,Stent Coron 24mm 2.75mm Carbosil 20 55d,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,"$1,248.98","$1,248.98",$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
27816334,EAP,HCPCS C1874,,System Coron Stent 28mm 2.75mm Elunir Thk90um,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,"$1,248.98","$1,248.98",$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
27816335,EAP,HCPCS C1874,,System Coron Stent 33mm 2.75mm Elunir Thk90um,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,"$1,248.98","$1,248.98",$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
27816336,EAP,HCPCS C1874,,System Coron Stent 38mm 2.75mm Elunir Thk90um,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,"$1,248.98","$1,248.98",$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
27816337,EAP,HCPCS C1874,,System Coron Stent 44mm 2.75mm Elunir Thk90um,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,"$1,248.98","$1,248.98",$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
27816338,EAP,HCPCS C1874,,System Coron Stent 8mm 3mm Elunir Thk90um Carbosil,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,"$1,248.98","$1,248.98",$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
27816339,EAP,HCPCS C1874,,System Coron Stent 12mm 3mm Elunir Thk90um,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,"$1,248.98","$1,248.98",$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
27816340,EAP,HCPCS C1874,,System Coron Stent 15mm 3mm Elunir Thk90um,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,"$1,248.98","$1,248.98",$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
27816341,EAP,HCPCS C1874,,System Coron Stent 17mm 3mm Elunir Thk90um,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,"$1,248.98","$1,248.98",$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
27816342,EAP,HCPCS C1874,,System Coron Stent 20mm 3mm Elunir Thk90um,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,"$1,248.98","$1,248.98",$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
27816343,EAP,HCPCS C1874,,System Coron Stent 24mm 3mm Elunir Thk90um,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,"$1,248.98","$1,248.98",$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
27816344,EAP,HCPCS C1874,,System Coron Stent 28mm 3mm Elunir Thk90um,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,"$1,248.98","$1,248.98",$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
27816345,EAP,HCPCS C1874,,System Coron Stent 33mm 3mm Elunir Thk90um,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,"$1,248.98","$1,248.98",$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
27816346,EAP,HCPCS C1874,,System Coron Stent 38mm 3mm Elunir Thk90um,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,"$1,248.98","$1,248.98",$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
27816347,EAP,HCPCS C1874,,System Coron Stent 44mm 3mm Elunir Thk90um,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,"$1,248.98","$1,248.98",$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
27816348,EAP,HCPCS C1874,,System Coron Stent 8mm 3.5mm Elunir Thk90um,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,"$1,248.98","$1,248.98",$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
27816349,EAP,HCPCS C1874,,System Coron Stent 12mm 3.5mm Elunir Thk90um,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,"$1,248.98","$1,248.98",$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
27816350,EAP,HCPCS C1874,,System Coron Stent 15mm 3.5mm Elunir Thk90um,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,"$1,248.98","$1,248.98",$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
27816351,EAP,HCPCS C1874,,System Coron Stent 17mm 3.5mm Elunir Thk90um,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,"$1,248.98","$1,248.98",$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
27816352,EAP,HCPCS C1874,,System Coron Stent 20mm 3.5mm Elunir Thk90um,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,"$1,248.98","$1,248.98",$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
27816353,EAP,HCPCS C1874,,System Coron Stent 24mm 3.5mm Elunir Thk90um,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,"$1,248.98","$1,248.98",$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
27816354,EAP,HCPCS C1874,,System Coron Stent 28mm 3.5mm Elunir Thk90um,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,"$1,248.98","$1,248.98",$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
27816355,EAP,HCPCS C1874,,System Coron Stent 33mm 3.5mm Elunir Thk90um,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,"$1,248.98","$1,248.98",$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
27816356,EAP,HCPCS C1874,,System Coron Stent 38mm 3.5mm Elunir Thk90um,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,"$1,248.98","$1,248.98",$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
27816357,EAP,HCPCS C1874,,System Coron Stent 44mm 3.5mm Elunir Thk90um,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,"$1,248.98","$1,248.98",$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
27816358,EAP,HCPCS C1874,,System Coron Stent 8mm 4mm Elunir Thk90um Carbosil,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,"$1,248.98","$1,248.98",$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
27816359,EAP,HCPCS C1874,,System Coron Stent 12mm 4mm Elunir Thk90um,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,"$1,248.98","$1,248.98",$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
27816360,EAP,HCPCS C1874,,System Coron Stent 15mm 4mm Elunir Thk90um,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,"$1,248.98","$1,248.98",$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
27816361,EAP,HCPCS C1874,,System Coron Stent 17mm 4mm Elunir Thk90um,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,"$1,248.98","$1,248.98",$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
27816362,EAP,HCPCS C1874,,System Coron Stent 20mm 4mm Elunir Thk90um,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,"$1,248.98","$1,248.98",$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
27816363,EAP,HCPCS C1874,,System Coron Stent 24mm 4mm Elunir Thk90um,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,"$1,248.98","$1,248.98",$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
27816364,EAP,HCPCS C1874,,System Coron Stent 28mm 4mm Elunir Thk90um,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,"$1,248.98","$1,248.98",$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
27816365,EAP,HCPCS C1874,,System Coron Stent 33mm 4mm Elunir Thk90um,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,"$1,248.98","$1,248.98",$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
27816366,EAP,HCPCS C1874,,System Coron Stent 38mm 4mm Elunir Thk90um,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,"$1,248.98","$1,248.98",$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
27816367,EAP,HCPCS C1874,,System Coron Stent 44mm 4mm Elunir Thk90um,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,"$1,248.98","$1,248.98",$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
27816371,EAP,HCPCS C1874,,Stent Endoprosthesis Viabahn Heparin Nitinol Eptfe L25 Cm L120 Cm Od6 Mm,"$15,988.00",$0.00,"$15,988.00","$7,194.60","$5,158.80",$0.00,"$2,754.65","$5,158.80","$11,410.64","$2,799.37","$15,988.00",$0.00,"$7,994.00","$12,662.50","$12,790.40",$0.00,"$2,502.12",$0.00,"$2,545.29",$0.00
28000001,EAP,CPT® 96522,,Refill/maint Implant Pump,$497.00,$0.00,$497.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$497.00,$0.00,$248.50,$393.62,$397.60,$0.00,$0.00,$0.00,$0.00,$0.00
30000001,EAP,CPT® 36415,,"PHLEBOTOMY,VEN-1OPC",$43.00,$1.51,$43.00,$23.35,$3.00,$3.00,$1.51,$3.00,$3.00,$7.53,$43.00,$3.15,$21.50,$34.06,$34.40,$4.35,$6.73,$3.00,$6.85,$3.00
30000002,EAP,CPT® 80053,,Comp Metabolic Panel,$477.00,$5.91,$477.00,$18.83,$15.44,$14.37,$5.91,$15.44,$15.44,$15.61,$477.00,$11.09,$29.54,$377.78,$381.60,$15.31,$16.64,$10.56,$11.65,$10.56
30000003,EAP,CPT® 81340,,"T Cell Receptor (tcr) Beta Gene  Rearrang, Pcr (so)",$682.00,$0.00,$682.00,$0.00,$285.02,$0.00,$0.00,$285.02,$285.02,$0.00,$682.00,$0.00,$341.00,$540.14,$545.60,$0.00,$0.00,$0.00,$0.00,$0.00
30000004,EAP,CPT® 84999,,Unlisted Chemistry Procedure (so)gene,$141.00,$0.00,$141.00,$0.00,$100.63,$0.00,$24.29,$100.63,$100.63,$24.69,$141.00,$0.00,$0.00,$111.67,$112.80,$0.00,$22.07,$0.00,$0.00,$0.00
30000005,EAP,CPT® 81340,,T -cell Antigen  Receptor Beta  (so) Clon,$682.00,$0.00,$682.00,$0.00,$285.02,$0.00,$0.00,$285.02,$285.02,$0.00,$682.00,$0.00,$341.00,$540.14,$545.60,$0.00,$0.00,$0.00,$0.00,$0.00
30000006,EAP,CPT® 81342,,T -cell Antigen  Receptor Gamma (so) Clon,$942.00,$0.00,$942.00,$0.00,$274.90,$0.00,$0.00,$274.90,$274.90,$0.00,$942.00,$0.00,$471.00,$746.06,$753.60,$0.00,$0.00,$0.00,$0.00,$0.00
30000007,EAP,CPT® 84999,,Unlisted Chemistry Procedure (so) Clon,$141.00,$0.00,$141.00,$0.00,$100.63,$0.00,$24.29,$100.63,$100.63,$24.69,$141.00,$0.00,$0.00,$111.67,$112.80,$0.00,$22.07,$0.00,$0.00,$0.00
30000008,EAP,CPT® 81381,,HLA- B57:01 DETERMINATION-PCR (QUEST),$463.00,$35.05,$463.00,$168.61,$129.03,$128.71,$85.54,$129.03,$129.03,$46.99,$463.00,$178.40,$231.50,$366.70,$370.40,$246.36,$50.07,$169.90,$35.05,$169.90
30000009,EAP,CPT® 81380,,HLA -B HIGH RESOLUTION- PCR (QUEST),$579.00,$0.00,$579.00,$0.00,$241.81,$0.00,$0.00,$241.81,$241.81,$0.00,$579.00,$0.00,$289.50,$458.57,$463.20,$0.00,$0.00,$0.00,$0.00,$0.00
30000010,EAP,CPT® 87798,,"Ebola -cdc,rt-pcr,evd",$137.00,$19.63,$137.00,$34.98,$28.64,$37.59,$19.63,$28.64,$28.64,$28.98,$137.00,$36.84,$54.82,$108.50,$109.60,$50.88,$30.88,$35.09,$21.62,$35.09
30000018,EAP,CPT® 80346,,"Benzodiazpne,ur-eia",$340.00,$0.00,$340.00,$0.00,$242.66,$0.00,$0.00,$242.66,$242.66,$0.00,$340.00,$0.00,$170.00,$269.28,$272.00,$0.00,$0.00,$0.00,$0.00,$0.00
30000019,EAP,CPT® 80353,,Cocain Metab.ur-eia,$340.00,$0.00,$340.00,$0.00,$242.66,$0.00,$0.00,$242.66,$242.66,$0.00,$340.00,$0.00,$170.00,$269.28,$272.00,$0.00,$0.00,$0.00,$0.00,$0.00
30000020,EAP,CPT® 83992,,"Phencyclidne,ur-eia",$340.00,$0.00,$340.00,$0.00,$21.46,$0.00,$0.00,$21.46,$21.46,$0.00,$340.00,$0.00,$41.08,$269.28,$272.00,$0.00,$0.00,$0.00,$0.00,$0.00
30000021,EAP,CPT® 80361,,"Opiates,ur-eia",$450.00,$0.00,$450.00,$0.02,$321.17,$80.10,$13.36,$321.17,$321.17,$30.51,$450.00,$0.00,$225.00,$356.40,$360.00,$270.00,$32.51,$0.00,$22.76,$0.00
30000022,EAP,CPT® 80349,,"Thc, Ur-eia",$340.00,$0.00,$340.00,$0.00,$242.66,$0.00,$0.00,$242.66,$242.66,$0.00,$340.00,$0.00,$170.00,$269.28,$272.00,$0.00,$0.00,$0.00,$0.00,$0.00
30000023,EAP,CPT® 80345,,"Barbiturate,ur-eia",$314.00,$0.00,$314.00,$0.00,$224.10,$0.00,$0.00,$224.10,$224.10,$0.00,$314.00,$0.00,$157.00,$248.69,$251.20,$0.00,$0.00,$0.00,$0.00,$0.00
30000024,EAP,CPT® 80150,,Amikacin-random,$265.00,$0.00,$265.00,$0.00,$22.01,$0.00,$0.00,$22.01,$22.01,$0.00,$265.00,$0.00,$42.12,$209.88,$212.00,$0.00,$0.00,$0.00,$0.00,$0.00
30000025,EAP,CPT® 80335,,Amitriptyline-random,$93.00,$0.00,$93.00,$0.00,$66.37,$0.00,$12.30,$66.37,$66.37,$0.00,$93.00,$0.00,$46.50,$73.66,$74.40,$0.00,$28.17,$0.00,$0.00,$0.00
30000026,EAP,CPT® 80159,,Clozapine (so),$299.00,$10.35,$299.00,$32.97,$25.23,$25.17,$10.35,$25.23,$25.23,$23.71,$299.00,$21.16,$149.50,$236.81,$239.20,$29.22,$25.26,$20.15,$17.68,$20.15
30000027,EAP,CPT® 80156,,Carbamazpine-random,$279.00,$8.14,$279.00,$25.97,$21.26,$11.90,$8.14,$21.26,$21.26,$21.51,$279.00,$15.30,$40.68,$220.97,$223.20,$21.13,$22.92,$14.57,$16.05,$14.57
30000028,EAP,CPT® 80158,,Cyclosporine,$238.00,$6.57,$238.00,$10.62,$8.70,$24.57,$10.10,$8.70,$8.70,$8.81,$238.00,$18.95,$16.66,$188.50,$190.40,$26.17,$9.39,$18.05,$6.57,$18.05
30000029,EAP,CPT® 80335,,Desipramine-random,$124.00,$0.00,$124.00,$0.00,$88.50,$0.00,$12.30,$88.50,$88.50,$0.00,$124.00,$0.00,$62.00,$98.21,$99.20,$0.00,$28.17,$0.00,$0.00,$0.00
30000030,EAP,CPT® 80162,,"Digoxin, Total",$281.00,$7.43,$281.00,$23.67,$19.39,$18.07,$7.43,$19.39,$19.39,$19.61,$281.00,$13.94,$37.10,$222.55,$224.80,$19.26,$20.90,$13.28,$14.63,$13.28
30000031,EAP,CPT® 80164,,"Valproic Acid, Total",$319.00,$7.57,$319.00,$20.25,$16.57,$14.24,$7.57,$16.57,$16.57,$16.77,$319.00,$14.22,$31.72,$252.65,$255.20,$19.63,$17.87,$13.54,$12.51,$13.54
30000032,EAP,CPT® 80335,,Doxepin-random,$123.00,$0.00,$123.00,$0.00,$87.79,$0.00,$12.30,$87.79,$87.79,$0.00,$123.00,$0.00,$61.50,$97.42,$98.40,$0.00,$28.17,$0.00,$0.00,$0.00
30000033,EAP,CPT® 80168,,Ethosuximide-random,$86.00,$0.00,$86.00,$0.00,$23.86,$0.00,$0.00,$23.86,$23.86,$0.00,$86.00,$0.00,$45.66,$68.11,$68.80,$0.00,$0.00,$0.00,$0.00,$0.00
30000034,EAP,CPT® 80170,,Gentamicin-random,$201.00,$9.16,$201.00,$29.21,$23.93,$22.30,$9.16,$23.93,$23.93,$24.21,$201.00,$17.20,$45.80,$159.19,$160.80,$23.75,$25.80,$16.38,$18.06,$16.38
30000035,EAP,CPT® 80173,,Haloperidol,$120.00,$0.00,$120.00,$0.00,$21.26,$0.00,$0.00,$21.26,$21.26,$0.00,$120.00,$0.00,$40.68,$95.04,$96.00,$0.00,$0.00,$0.00,$0.00,$0.00
30000036,EAP,CPT® 80335,,Imipramine-random,$135.00,$0.00,$135.00,$0.00,$96.35,$0.00,$12.30,$96.35,$96.35,$0.00,$135.00,$0.00,$67.50,$106.92,$108.00,$0.00,$28.17,$0.00,$0.00,$0.00
30000037,EAP,CPT® 80176,,Lidocaine-random,$160.00,$0.00,$160.00,$0.00,$21.45,$0.00,$0.00,$21.45,$21.45,$0.00,$160.00,$0.00,$41.04,$126.72,$128.00,$0.00,$0.00,$0.00,$0.00,$0.00
30000038,EAP,CPT® 80178,,Lithium-random,$225.00,$3.70,$225.00,$11.79,$9.65,$9.00,$3.70,$9.65,$9.65,$9.78,$225.00,$6.94,$18.48,$178.20,$180.00,$9.58,$10.42,$6.61,$7.29,$6.61
30000039,EAP,CPT® 80335,,Nortriptyline-random,$117.00,$0.00,$117.00,$0.00,$83.50,$0.00,$12.30,$83.50,$83.50,$0.00,$117.00,$0.00,$58.50,$92.66,$93.60,$0.00,$28.17,$0.00,$0.00,$0.00
30000040,EAP,CPT® 80184,,Phenobarb-random,$236.00,$7.71,$236.00,$19.88,$16.72,$15.15,$7.71,$16.72,$16.72,$16.93,$236.00,$16.07,$32.02,$186.91,$188.80,$22.19,$18.04,$15.30,$12.62,$15.30
30000041,EAP,CPT® 80185,,Dilantin-random,$287.00,$7.42,$287.00,$23.62,$19.36,$18.04,$7.42,$19.36,$19.36,$19.58,$287.00,$13.91,$37.04,$227.30,$229.60,$19.21,$20.87,$13.25,$14.61,$13.25
30000042,EAP,CPT® 80186,,Phenytoin Free (so),$205.00,$7.70,$205.00,$24.53,$20.10,$18.73,$7.70,$20.10,$20.10,$20.34,$205.00,$14.45,$38.46,$162.36,$164.00,$19.95,$21.67,$13.76,$15.17,$13.76
30000043,EAP,CPT® 80188,,Primidone/myso-rand.,$188.00,$0.00,$188.00,$0.00,$24.23,$0.00,$0.00,$24.23,$24.23,$0.00,$188.00,$0.00,$46.36,$148.90,$150.40,$0.00,$0.00,$0.00,$0.00,$0.00
30000044,EAP,CPT® 80192,,Procainamide-random,$191.00,$0.00,$191.00,$0.00,$24.46,$0.00,$0.00,$24.46,$24.46,$0.00,$191.00,$0.00,$46.82,$151.27,$152.80,$0.00,$0.00,$0.00,$0.00,$0.00
30000045,EAP,CPT® 80194,,Quinidine-random,$160.00,$0.00,$160.00,$0.00,$21.31,$0.00,$0.00,$21.31,$21.31,$0.00,$160.00,$0.00,$40.78,$126.72,$128.00,$0.00,$0.00,$0.00,$0.00,$0.00
30000046,EAP,CPT® 80307,,Salicylate-quant,$353.00,$32.55,$353.00,$99.36,$76.45,$62.83,$32.55,$76.45,$76.45,$71.85,$353.00,$65.25,$176.50,$279.58,$282.40,$90.10,$76.56,$62.14,$53.59,$62.14
30000047,EAP,CPT® 80198,,Theophylline-random,$173.00,$0.00,$173.00,$25.22,$20.66,$19.25,$0.00,$20.66,$20.66,$20.90,$173.00,$14.85,$39.54,$137.02,$138.40,$20.50,$0.00,$14.14,$15.58,$14.14
30000048,EAP,CPT® 80200,,Tobramycin-random,$263.00,$0.00,$263.00,$0.00,$21.87,$0.00,$0.00,$21.87,$21.87,$0.00,$263.00,$0.00,$41.86,$208.30,$210.40,$0.00,$0.00,$0.00,$0.00,$0.00
30000049,EAP,CPT® 80201,,Topiramate/topamaz,$94.00,$6.67,$94.00,$21.25,$17.40,$16.23,$6.67,$17.40,$17.40,$17.61,$94.00,$12.52,$33.32,$74.45,$75.20,$17.28,$18.76,$11.92,$13.13,$11.92
30000050,EAP,CPT® 80202,,Vancomycin-random,$292.00,$7.57,$292.00,$20.25,$16.57,$14.24,$7.57,$16.57,$16.57,$16.77,$292.00,$14.22,$31.72,$231.26,$233.60,$19.63,$17.87,$13.54,$12.51,$13.54
30000051,EAP,CPT® 80299,,Methotrexate-random,$218.00,$9.39,$218.00,$24.21,$17.58,$15.07,$9.39,$17.58,$17.58,$17.79,$218.00,$19.57,$33.64,$172.66,$174.40,$27.03,$18.95,$18.64,$13.27,$18.64
30000052,EAP,CPT® 80171,,"Gabapentin, Whl Bld/ser/plasma",$433.00,$0.00,$433.00,$0.00,$18.09,$0.00,$0.00,$18.09,$18.09,$0.00,$433.00,$0.00,$216.50,$342.94,$346.40,$0.00,$0.00,$0.00,$0.00,$0.00
30000053,EAP,CPT® 80299,,Amiodarone/cordarone,$218.00,$9.39,$218.00,$24.21,$17.58,$15.07,$9.39,$17.58,$17.58,$17.79,$218.00,$19.57,$33.64,$172.66,$174.40,$27.03,$18.95,$18.64,$13.27,$18.64
30000054,EAP,CPT® 80175,,Lamotrigine (so),$433.00,$7.42,$433.00,$23.62,$18.09,$18.04,$7.42,$18.09,$18.09,$17.00,$433.00,$13.91,$216.50,$342.94,$346.40,$19.21,$18.11,$13.25,$12.68,$13.25
30000055,EAP,CPT® 80299,,Olanzapine/zyprexa,$218.00,$9.39,$218.00,$24.21,$17.58,$15.07,$9.39,$17.58,$17.58,$17.79,$218.00,$19.57,$33.64,$172.66,$174.40,$27.03,$18.95,$18.64,$13.27,$18.64
30000056,EAP,CPT® 82013,,Acetylcholinesterase-amnio,$37.00,$0.00,$37.00,$0.00,$16.31,$0.00,$0.00,$16.31,$16.31,$0.00,$37.00,$0.00,$31.22,$29.30,$29.60,$0.00,$0.00,$0.00,$0.00,$0.00
30000057,EAP,CPT® 82017,,"Carnitine, Ester",$132.00,$0.00,$132.00,$0.00,$24.63,$0.00,$0.00,$24.63,$24.63,$0.00,$132.00,$0.00,$47.14,$104.54,$105.60,$0.00,$0.00,$0.00,$0.00,$0.00
30000058,EAP,CPT® 82270,,Fecal Occult Blood Test,$58.00,$0.00,$58.00,$0.00,$4.69,$0.00,$0.00,$4.69,$4.69,$0.00,$58.00,$0.00,$8.98,$45.94,$46.40,$0.00,$0.00,$0.00,$0.00,$0.00
30000060,EAP,CPT® 82330,,"Calcium, Ionized",$342.00,$7.65,$342.00,$24.37,$19.95,$18.60,$7.65,$19.95,$19.95,$20.18,$342.00,$14.36,$38.18,$270.86,$273.60,$19.84,$21.50,$13.68,$15.05,$13.68
30000062,EAP,CPT® 82948,,"Glucose-2hr Pp,wb",$311.00,$0.00,$311.00,$0.00,$4.63,$0.00,$0.00,$4.63,$4.63,$0.00,$311.00,$0.00,$8.86,$246.31,$248.80,$0.00,$0.00,$0.00,$0.00,$0.00
30000063,EAP,CPT® 82948,,"Glucose-fbs,wb",$311.00,$0.00,$311.00,$0.00,$4.63,$0.00,$0.00,$4.63,$4.63,$0.00,$311.00,$0.00,$8.86,$246.31,$248.80,$0.00,$0.00,$0.00,$0.00,$0.00
30000064,EAP,CPT® 82948,,"Glucose-fbs,wb Micro",$311.00,$0.00,$311.00,$0.00,$4.63,$0.00,$0.00,$4.63,$4.63,$0.00,$311.00,$0.00,$8.86,$246.31,$248.80,$0.00,$0.00,$0.00,$0.00,$0.00
30000065,EAP,CPT® 82948,,"Glucose-random,wb",$311.00,$0.00,$311.00,$0.00,$4.63,$0.00,$0.00,$4.63,$4.63,$0.00,$311.00,$0.00,$8.86,$246.31,$248.80,$0.00,$0.00,$0.00,$0.00,$0.00
30000066,EAP,CPT® 82948,,"GLU-RANDOM,WB MICRO",$311.00,$0.00,$311.00,$0.00,$4.63,$0.00,$0.00,$4.63,$4.63,$0.00,$311.00,$0.00,$8.86,$246.31,$248.80,$0.00,$0.00,$0.00,$0.00,$0.00
30000067,EAP,CPT® 83020,,Newborn Screen,$204.00,$6.58,$204.00,$17.42,$14.27,$6.58,$7.21,$14.27,$14.27,$14.44,$204.00,$13.51,$27.32,$161.57,$163.20,$18.66,$15.38,$12.87,$10.77,$12.87
30000068,EAP,CPT® 83516,,T-transglutamin Igg,$176.00,$6.44,$176.00,$19.04,$15.61,$15.70,$6.44,$15.61,$15.61,$15.80,$176.00,$12.11,$29.88,$139.39,$140.80,$16.72,$16.84,$11.53,$11.79,$11.53
30000069,EAP,CPT® 83520,,Anti Gm1 Ab Titer,$464.00,$8.69,$464.00,$23.07,$18.91,$17.62,$8.69,$18.91,$18.91,$19.12,$464.00,$18.13,$36.18,$367.49,$371.20,$25.04,$20.37,$17.27,$14.26,$17.27
30000070,EAP,CPT® 83520,,Anti Asialo-gm-ab,$464.00,$8.69,$464.00,$23.07,$18.91,$17.62,$8.69,$18.91,$18.91,$19.12,$464.00,$18.13,$36.18,$367.49,$371.20,$25.04,$20.37,$17.27,$14.26,$17.27
30000071,EAP,CPT® 83520,,Anti Gq1b Ab Titer,$464.00,$8.69,$464.00,$23.07,$18.91,$17.62,$8.69,$18.91,$18.91,$19.12,$464.00,$18.13,$36.18,$367.49,$371.20,$25.04,$20.37,$17.27,$14.26,$17.27
30000072,EAP,CPT® 83520,,Anti Gd 1b Ab Titer,$464.00,$8.69,$464.00,$23.07,$18.91,$17.62,$8.69,$18.91,$18.91,$19.12,$464.00,$18.13,$36.18,$367.49,$371.20,$25.04,$20.37,$17.27,$14.26,$17.27
30000073,EAP,CPT® 83520,,Mitochondrial Ab,$464.00,$8.69,$464.00,$23.07,$18.91,$17.62,$8.69,$18.91,$18.91,$19.12,$464.00,$18.13,$36.18,$367.49,$371.20,$25.04,$20.37,$17.27,$14.26,$17.27
30000074,EAP,CPT® 83605,,"Lactate, Plasma",$311.00,$5.97,$311.00,$19.04,$15.59,$14.53,$5.97,$15.59,$15.59,$15.78,$311.00,$12.15,$29.84,$246.31,$248.80,$16.78,$16.82,$11.57,$11.77,$11.57
30000083,EAP,CPT® 84030,,"Phenylalanine (pku), Blood",$48.00,$0.00,$48.00,$0.00,$8.04,$0.00,$0.00,$8.04,$8.04,$0.00,$48.00,$0.00,$15.38,$38.02,$38.40,$0.00,$0.00,$0.00,$0.00,$0.00
30000084,EAP,CPT® 84066,,Prostatic Acid Phosphatase,$95.00,$5.40,$95.00,$17.21,$14.10,$13.15,$5.40,$14.10,$14.10,$14.27,$95.00,$10.14,$27.00,$75.24,$76.00,$14.01,$15.20,$9.66,$10.64,$9.66
30000085,EAP,CPT® 84100,,"Phosphorus, Serum",$136.00,$2.65,$136.00,$8.46,$6.93,$6.45,$2.65,$6.93,$6.93,$7.01,$136.00,$4.98,$13.26,$107.71,$108.80,$6.87,$7.47,$4.74,$5.23,$4.74
30000086,EAP,CPT® 84152,,"Psa, Total Screening",$237.00,$0.00,$237.00,$32.79,$26.85,$25.03,$0.00,$26.85,$26.85,$0.00,$237.00,$20.28,$51.40,$187.70,$189.60,$26.67,$0.00,$18.39,$20.27,$19.31
30000087,EAP,CPT® 84163,,Preg Assoc Plasma Protein,$94.00,$7.07,$94.00,$11.45,$9.37,$7.33,$8.42,$9.37,$9.37,$9.48,$94.00,$15.80,$17.94,$74.45,$75.20,$21.82,$10.10,$15.05,$7.07,$15.05
30000089,EAP,CPT® 84702,,D-HCG FREE & INTACT,$381.00,$7.07,$381.00,$11.45,$9.37,$7.33,$8.42,$9.37,$9.37,$9.48,$381.00,$15.80,$17.94,$301.75,$304.80,$21.82,$10.10,$15.05,$7.07,$15.05
30000090,EAP,CPT® 85461,,Fetal Screen Rhig,$150.00,$0.00,$150.00,$0.00,$9.69,$0.00,$0.00,$9.69,$9.69,$0.00,$150.00,$0.00,$18.52,$118.80,$120.00,$0.00,$0.00,$0.00,$0.00,$0.00
30000091,EAP,CPT® 85557,,"Osmotic Fragility,erythrocytes",$264.00,$0.00,$264.00,$0.00,$19.50,$0.00,$0.00,$19.50,$19.50,$0.00,$264.00,$0.00,$37.32,$209.09,$211.20,$0.00,$0.00,$0.00,$0.00,$0.00
30000092,EAP,CPT® 85660,,Donor Hgb S (arc),$183.00,$3.08,$183.00,$9.83,$8.06,$7.50,$3.08,$8.06,$8.06,$8.15,$183.00,$5.79,$15.42,$144.94,$146.40,$7.99,$8.68,$5.51,$6.08,$5.51
30000093,EAP,CPT® 86003,,Epicoccum Purpurascn,$209.00,$2.92,$209.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$209.00,$5.48,$14.60,$165.53,$167.20,$7.57,$8.22,$5.22,$5.76,$5.22
30000095,EAP,CPT® 86022,,Platelet Ab Screen (arc),$420.00,$0.00,$420.00,$0.00,$26.82,$0.00,$0.00,$26.82,$26.82,$0.00,$420.00,$0.00,$51.32,$332.64,$336.00,$0.00,$0.00,$0.00,$0.00,$0.00
30000096,EAP,CPT® 86147,,Antiphospholipid Igg,$726.00,$14.24,$726.00,$45.37,$37.14,$21.84,$14.24,$37.14,$37.14,$37.58,$726.00,$26.72,$71.08,$574.99,$580.80,$36.90,$40.04,$25.45,$28.03,$25.45
30000097,EAP,CPT® 86147,,Antiphospholipid Igm,$726.00,$14.24,$726.00,$45.37,$37.14,$21.84,$14.24,$37.14,$37.14,$37.58,$726.00,$26.72,$71.08,$574.99,$580.80,$36.90,$40.04,$25.45,$28.03,$25.45
30000098,EAP,CPT® 86235,,Antihistone Ab,$332.00,$10.04,$332.00,$31.97,$26.18,$24.41,$10.04,$26.18,$26.18,$26.49,$332.00,$18.83,$50.12,$262.94,$265.60,$26.00,$28.23,$17.93,$19.76,$17.93
30000099,EAP,CPT® 86255,,Murine Typhus Igg,$59.00,$6.75,$59.00,$21.48,$17.60,$16.40,$6.75,$17.60,$17.60,$17.81,$59.00,$12.65,$33.68,$46.73,$47.20,$17.47,$18.97,$12.05,$13.28,$12.05
30000100,EAP,CPT® 86331,,Pigeon Serum,$38.00,$0.00,$38.00,$0.00,$17.50,$0.00,$0.00,$17.50,$17.50,$0.00,$38.00,$0.00,$33.50,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
30000101,EAP,CPT® 86331,,T. Candidus,$38.00,$0.00,$38.00,$0.00,$17.50,$0.00,$0.00,$17.50,$17.50,$0.00,$38.00,$0.00,$33.50,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
30000102,EAP,CPT® 86331,,T.vulgaris,$38.00,$0.00,$38.00,$0.00,$17.50,$0.00,$0.00,$17.50,$17.50,$0.00,$38.00,$0.00,$33.50,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
30000103,EAP,CPT® 86331,,S. Viridis,$38.00,$0.00,$38.00,$0.00,$17.50,$0.00,$0.00,$17.50,$17.50,$0.00,$38.00,$0.00,$33.50,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
30000104,EAP,CPT® 86355,,"Cd19,total B %",$218.00,$21.10,$218.00,$42.00,$34.39,$22.53,$21.10,$34.39,$34.39,$34.80,$218.00,$39.62,$65.82,$172.66,$174.40,$54.71,$37.08,$37.73,$25.95,$37.73
30000105,EAP,CPT® 86357,,"Natural Killer (nk)cells,total",$218.00,$21.10,$218.00,$42.00,$34.39,$22.53,$21.10,$34.39,$34.39,$34.80,$218.00,$39.62,$65.82,$172.66,$174.40,$54.71,$37.08,$37.73,$25.95,$37.73
30000106,EAP,CPT® 86357,,"Cd56+16,nk%",$218.00,$21.10,$218.00,$42.00,$34.39,$22.53,$21.10,$34.39,$34.39,$34.80,$218.00,$39.62,$65.82,$172.66,$174.40,$54.71,$37.08,$37.73,$25.95,$37.73
30000107,EAP,CPT® 86485,,Candida Skin Test,$264.00,$0.00,$264.00,$25.67,$12.53,$22.05,$18.61,$12.53,$12.53,$18.61,$264.00,$23.06,$132.00,$209.09,$211.20,$32.04,$19.83,$0.00,$13.88,$21.96
30000108,EAP,CPT® 86603,,Adenovirus Ab,$65.00,$0.00,$65.00,$22.94,$18.79,$11.13,$0.00,$18.79,$18.79,$19.01,$65.00,$13.51,$35.96,$51.48,$52.00,$18.66,$0.00,$12.87,$14.18,$12.87
30000109,EAP,CPT® 86612,,Blastomyces Ab,$100.00,$0.00,$100.00,$0.00,$18.84,$0.00,$0.00,$18.84,$18.84,$0.00,$100.00,$0.00,$36.06,$79.20,$80.00,$0.00,$0.00,$0.00,$0.00,$0.00
30000110,EAP,CPT® 86635,,Coccidiodes Ab,$141.00,$0.00,$141.00,$0.00,$16.75,$0.00,$0.00,$16.75,$16.75,$0.00,$141.00,$0.00,$32.06,$111.67,$112.80,$0.00,$0.00,$0.00,$0.00,$0.00
30000113,EAP,CPT® 86710,,Influenza A Ab,$135.00,$0.00,$135.00,$0.00,$19.80,$0.00,$0.00,$19.80,$19.80,$0.00,$135.00,$0.00,$37.88,$106.92,$108.00,$0.00,$0.00,$0.00,$0.00,$0.00
30000114,EAP,CPT® 86710,,Influenza B Ab,$135.00,$0.00,$135.00,$0.00,$19.80,$0.00,$0.00,$19.80,$19.80,$0.00,$135.00,$0.00,$37.88,$106.92,$108.00,$0.00,$0.00,$0.00,$0.00,$0.00
30000115,EAP,CPT® 86710,,Parainfluenza-1 Ab,$135.00,$0.00,$135.00,$0.00,$19.80,$0.00,$0.00,$19.80,$19.80,$0.00,$135.00,$0.00,$37.88,$106.92,$108.00,$0.00,$0.00,$0.00,$0.00,$0.00
30000116,EAP,CPT® 86710,,Parainfluenza-2 Ab,$135.00,$0.00,$135.00,$0.00,$19.80,$0.00,$0.00,$19.80,$19.80,$0.00,$135.00,$0.00,$37.88,$106.92,$108.00,$0.00,$0.00,$0.00,$0.00,$0.00
30000117,EAP,CPT® 86710,,Parainfluenza-3 Ab,$135.00,$0.00,$135.00,$0.00,$19.80,$0.00,$0.00,$19.80,$19.80,$0.00,$135.00,$0.00,$37.88,$106.92,$108.00,$0.00,$0.00,$0.00,$0.00,$0.00
30000118,EAP,CPT® 86735,,Mumps Igm,$131.00,$7.31,$131.00,$23.26,$19.06,$11.13,$7.31,$19.06,$19.06,$19.28,$131.00,$13.70,$36.46,$103.75,$104.80,$18.92,$20.54,$13.05,$14.38,$13.05
30000119,EAP,CPT® 86735,,Mumps Igg,$131.00,$7.31,$131.00,$23.26,$19.06,$11.13,$7.31,$19.06,$19.06,$19.28,$131.00,$13.70,$36.46,$103.75,$104.80,$18.92,$20.54,$13.05,$14.38,$13.05
30000120,EAP,CPT® 86744,,Micropolyspora Faeni,$40.00,$0.00,$40.00,$0.00,$19.25,$0.00,$0.00,$19.25,$19.25,$0.00,$40.00,$0.00,$36.86,$31.68,$32.00,$0.00,$0.00,$0.00,$0.00,$0.00
30000121,EAP,CPT® 86756,,Rsv Ab,$186.00,$0.00,$186.00,$0.00,$18.82,$0.00,$0.00,$18.82,$18.82,$0.00,$186.00,$0.00,$36.02,$147.31,$148.80,$0.00,$0.00,$0.00,$0.00,$0.00
30000124,EAP,CPT® 86850,,Antibody Screen (arc),$334.00,$4.92,$334.00,$6.82,$15.95,$47.44,$4.92,$15.95,$15.95,$17.89,$334.00,$49.62,$37.22,$264.53,$267.20,$68.93,$19.06,$9.77,$13.35,$47.25
30000126,EAP,CPT® 86850,,Antibody Screen,$334.00,$4.92,$334.00,$6.82,$15.95,$47.44,$4.92,$15.95,$15.95,$17.89,$334.00,$49.62,$37.22,$264.53,$267.20,$68.93,$19.06,$9.77,$13.35,$47.25
30000128,EAP,CPT® 86860,,Rbc Elution (arc),$514.00,$0.00,$514.00,$40.63,$18.99,$137.60,$7.19,$18.99,$18.99,$7.19,$514.00,$143.92,$44.66,$407.09,$411.20,$199.96,$7.66,$0.00,$5.36,$137.07
30000129,EAP,CPT® 86860,,Rbc Elution,$514.00,$0.00,$514.00,$40.63,$18.99,$137.60,$7.19,$18.99,$18.99,$7.19,$514.00,$143.92,$44.66,$407.09,$411.20,$199.96,$7.66,$0.00,$5.36,$137.07
30000130,EAP,CPT® 86870,,Antibody Id,$579.00,$0.00,$579.00,$55.56,$29.24,$271.76,$7.19,$29.24,$29.24,$7.19,$579.00,$284.24,$69.46,$458.57,$463.20,$394.92,$7.66,$0.00,$5.36,$270.71
30000131,EAP,CPT® 86870,,Antibody Id (arc),$579.00,$0.00,$579.00,$55.56,$29.24,$271.76,$7.19,$29.24,$29.24,$7.19,$579.00,$284.24,$69.46,$458.57,$463.20,$394.92,$7.66,$0.00,$5.36,$270.71
30000136,EAP,CPT® 86880,,Direct Coombs (arc),$141.00,$3.02,$141.00,$9.60,$7.84,$32.06,$3.02,$7.84,$7.84,$7.93,$141.00,$33.53,$15.00,$111.67,$112.80,$46.58,$8.45,$5.39,$5.91,$31.93
30000146,EAP,CPT® 86900,,"Blood Typing, Serologic, Abo (arc)",$150.00,$1.67,$150.00,$5.34,$4.35,$104.55,$1.67,$4.35,$4.35,$4.41,$150.00,$109.35,$8.34,$118.80,$120.00,$150.00,$4.70,$2.99,$3.29,$104.14
30000149,EAP,CPT® 86901,,"Blood Typing, Serologic, Rh (d) (arc)",$150.00,$1.67,$150.00,$5.34,$4.35,$32.06,$1.67,$4.35,$4.35,$17.04,$150.00,$33.53,$8.34,$118.80,$120.00,$46.58,$18.16,$2.99,$12.71,$31.93
30000153,EAP,CPT® 86902,,Blood Type Ag Donor Ea,$756.00,$3.20,$756.00,$6.82,$5.38,$271.76,$3.20,$5.38,$5.38,$5.05,$756.00,$284.24,$378.00,$598.75,$604.80,$394.92,$5.38,$6.35,$3.77,$270.71
30000154,EAP,CPT® 86902,,Blood Type Ag Donor Ea (arc),$756.00,$3.20,$756.00,$6.82,$5.38,$271.76,$3.20,$5.38,$5.38,$5.05,$756.00,$284.24,$378.00,$598.75,$604.80,$394.92,$5.38,$6.35,$3.77,$270.71
30000155,EAP,CPT® 86904,,Ag Screen Pt Serum Ea Unit (arc),$146.00,$0.00,$146.00,$0.00,$13.88,$0.00,$0.00,$13.88,$13.88,$0.00,$146.00,$0.00,$26.56,$115.63,$116.80,$0.00,$0.00,$0.00,$0.00,$0.00
30000160,EAP,CPT® 86905,,Patient Ag Typing (arc),$322.00,$2.14,$322.00,$6.82,$5.58,$271.76,$2.14,$5.58,$5.58,$5.65,$322.00,$284.24,$10.68,$255.02,$257.60,$322.00,$6.02,$3.83,$4.21,$270.71
30000161,EAP,CPT® 86905,,Patient Ag Typing,$322.00,$2.14,$322.00,$6.82,$5.58,$271.76,$2.14,$5.58,$5.58,$5.65,$322.00,$284.24,$10.68,$255.02,$257.60,$322.00,$6.02,$3.83,$4.21,$270.71
30000179,EAP,CPT® 86906,,Rh Phenotype (arc),$715.00,$0.00,$715.00,$0.00,$11.31,$0.00,$0.00,$11.31,$11.31,$0.00,$715.00,$0.00,$21.66,$566.28,$572.00,$0.00,$0.00,$0.00,$0.00,$0.00
30000180,EAP,CPT® 86920,,Crossmatch Is Ea Unit,$286.00,$0.00,$286.00,$44.82,$26.20,$137.60,$23.69,$26.20,$26.20,$50.08,$286.00,$143.92,$62.02,$226.51,$228.80,$199.96,$44.76,$0.00,$45.53,$137.07
30000182,EAP,CPT® 86920,,COMPATIBILITY EA- MT,$286.00,$0.00,$286.00,$44.82,$26.20,$137.60,$23.69,$26.20,$26.20,$50.08,$286.00,$143.92,$62.02,$226.51,$228.80,$199.96,$44.76,$0.00,$45.53,$137.07
30000185,EAP,CPT® 86921,,Crossmatch Incub Ea Unit,$457.00,$0.00,$457.00,$40.63,$21.27,$137.60,$19.26,$21.27,$21.27,$80.02,$457.00,$143.92,$50.44,$361.94,$365.60,$199.96,$71.52,$0.00,$72.75,$137.07
30000187,EAP,CPT® 86921,,Platelet Crossmatch (arc),$457.00,$0.00,$457.00,$40.63,$21.27,$137.60,$19.26,$21.27,$21.27,$80.02,$457.00,$143.92,$50.44,$361.94,$365.60,$199.96,$71.52,$0.00,$72.75,$137.07
30000190,EAP,CPT® 86922,,Crossmatch Ahg (arc),$480.00,$0.00,$480.00,$48.09,$23.93,$137.60,$21.48,$23.93,$23.93,$84.04,$480.00,$143.92,$56.24,$380.16,$384.00,$199.96,$75.12,$0.00,$76.42,$137.07
30000191,EAP,CPT® 86922,,Crossmatch Ahg,$480.00,$0.00,$480.00,$48.09,$23.93,$137.60,$21.48,$23.93,$23.93,$84.04,$480.00,$143.92,$56.24,$380.16,$384.00,$199.96,$75.12,$0.00,$76.42,$137.07
30000192,EAP,CPT® 86923,,Crossmatch Electronic,$421.00,$0.00,$421.00,$35.96,$18.99,$137.60,$18.28,$18.99,$18.99,$73.71,$421.00,$143.92,$44.66,$333.43,$336.80,$199.96,$65.89,$0.00,$67.02,$137.07
30000195,EAP,CPT® 86940,,Hemolysins/agglutinins Auto Ea (arc),$152.00,$0.00,$152.00,$0.00,$11.97,$0.00,$0.00,$11.97,$11.97,$0.00,$152.00,$0.00,$22.92,$120.38,$121.60,$0.00,$0.00,$0.00,$0.00,$0.00
30000196,EAP,CPT® 86941,,Hemolysins/agglutinins Incubated (arc),$152.00,$0.00,$152.00,$0.00,$17.68,$0.00,$0.00,$17.68,$17.68,$0.00,$152.00,$0.00,$33.84,$120.38,$121.60,$0.00,$0.00,$0.00,$0.00,$0.00
30000198,EAP,CPT® 86970,,Rbc Pretx Chem (arc),$740.00,$0.00,$740.00,$0.00,$15.95,$0.00,$0.00,$15.95,$15.95,$0.00,$740.00,$0.00,$37.22,$586.08,$592.00,$0.00,$0.00,$0.00,$0.00,$0.00
30000199,EAP,CPT® 86971,,Rbc Pretx Enz (arc),$350.00,$0.00,$350.00,$0.00,$15.95,$0.00,$0.00,$15.95,$15.95,$0.00,$350.00,$0.00,$37.22,$277.20,$280.00,$0.00,$0.00,$0.00,$0.00,$0.00
30000200,EAP,CPT® 86972,,Rbc Pretx Dens Grad (arc),$888.00,$0.00,$888.00,$0.00,$25.45,$0.00,$0.00,$25.45,$25.45,$0.00,$888.00,$0.00,$60.36,$703.30,$710.40,$0.00,$0.00,$0.00,$0.00,$0.00
30000201,EAP,CPT® 86975,,Rbc Pretx Drug (arc),$740.00,$0.00,$740.00,$0.00,$21.27,$0.00,$0.00,$21.27,$21.27,$0.00,$740.00,$0.00,$50.44,$586.08,$592.00,$0.00,$0.00,$0.00,$0.00,$0.00
30000202,EAP,CPT® 86976,,"Rbc Dilution Of Serum, Per Aliquot (arc)",$73.00,$0.00,$73.00,$0.00,$23.93,$0.00,$0.00,$23.93,$23.93,$0.00,$73.00,$0.00,$56.24,$57.82,$58.40,$0.00,$0.00,$0.00,$0.00,$0.00
30000203,EAP,CPT® 86977,,"Rbc Incubation With Inhibitors, Per Aliquot (arc)",$199.00,$0.00,$199.00,$0.00,$21.27,$0.00,$0.00,$21.27,$21.27,$0.00,$199.00,$0.00,$50.44,$157.61,$159.20,$0.00,$0.00,$0.00,$0.00,$0.00
30000204,EAP,CPT® 86978,,Rbc Pretx Ab Id Diff Ea Absorp (arc),$584.00,$0.00,$584.00,$0.00,$21.27,$0.00,$0.00,$21.27,$21.27,$0.00,$584.00,$0.00,$50.44,$462.53,$467.20,$0.00,$0.00,$0.00,$0.00,$0.00
30000205,EAP,CPT® 86985,,Aliquot Blood Products Ea,$380.00,$0.00,$380.00,$33.15,$15.95,$137.60,$0.00,$15.95,$15.95,$66.53,$380.00,$143.92,$37.22,$300.96,$304.00,$199.96,$0.00,$0.00,$60.50,$137.07
30000208,EAP,CPT® 87015,,Concentration,$120.00,$3.74,$120.00,$11.90,$9.75,$9.09,$3.74,$9.75,$9.75,$9.87,$120.00,$7.01,$18.66,$95.04,$96.00,$9.69,$10.52,$6.68,$7.36,$6.68
30000209,EAP,CPT® 87046,,"Stool Cult, Aerobic-campy",$144.00,$2.60,$144.00,$16.83,$13.77,$11.90,$5.28,$13.77,$13.77,$3.49,$144.00,$9.91,$26.36,$114.05,$115.20,$13.69,$3.71,$9.44,$2.60,$9.44
30000210,EAP,CPT® 87046,,"Stool, Cult, Aerobic-yersinnia",$144.00,$2.60,$144.00,$16.83,$13.77,$11.90,$5.28,$13.77,$13.77,$3.49,$144.00,$9.91,$26.36,$114.05,$115.20,$13.69,$3.71,$9.44,$2.60,$9.44
30000211,EAP,CPT® 87176,,"Homogenization, Tissue",$92.00,$3.29,$92.00,$10.49,$8.59,$8.01,$3.29,$8.59,$8.59,$8.69,$92.00,$6.17,$16.44,$72.86,$73.60,$8.53,$9.26,$5.88,$6.48,$5.88
30000212,EAP,CPT® 87177,,Wet Prep,$109.00,$4.98,$109.00,$15.87,$12.99,$12.11,$4.98,$12.99,$12.99,$13.15,$109.00,$9.35,$24.86,$86.33,$87.20,$12.91,$14.01,$8.90,$9.81,$8.90
30000213,EAP,CPT® 87220,,Skin Prep: 10% Koh,$184.00,$2.39,$184.00,$7.62,$6.23,$5.81,$2.39,$6.23,$6.23,$6.30,$184.00,$4.48,$11.92,$145.73,$147.20,$6.19,$6.71,$4.27,$4.70,$4.27
30000214,EAP,CPT® 87250,,Herpes Viral Culture,$370.00,$10.94,$370.00,$34.86,$28.55,$19.75,$10.94,$28.55,$28.55,$28.89,$370.00,$20.54,$54.64,$293.04,$296.00,$28.36,$30.78,$19.56,$21.54,$19.56
30000215,EAP,CPT® 87497,,"Cytomegalovirus, Dna","$1,009.00",$23.96,"$1,009.00",$76.36,$62.54,$58.29,$23.96,$62.54,$62.54,$63.28,"$1,009.00",$44.98,$119.70,$799.13,$807.20,$62.12,$67.43,$42.84,$47.20,$42.84
30000217,EAP,CPT® 87536,,Hiv /rna Pcr Quant,$817.00,$47.60,$817.00,$92.50,$75.77,$95.41,$47.60,$75.77,$75.77,$66.37,$817.00,$89.36,$145.02,$647.06,$653.60,$123.40,$70.72,$85.10,$49.50,$85.10
30000218,EAP,CPT® 87536,,"Hiv-1 Rna Ultra, Qnt",$817.00,$47.60,$817.00,$92.50,$75.77,$95.41,$47.60,$75.77,$75.77,$66.37,$817.00,$89.36,$145.02,$647.06,$653.60,$123.40,$70.72,$85.10,$49.50,$85.10
30000220,EAP,CPT® 87798,,"Ebv Dna-pcr, Qual",$907.00,$19.63,$907.00,$34.98,$28.64,$37.59,$19.63,$28.64,$28.64,$28.98,$907.00,$36.84,$54.82,$718.34,$725.60,$50.88,$30.88,$35.09,$21.62,$35.09
30000221,EAP,CPT® 89050,,Csf Exam-hematology,$214.00,$2.64,$214.00,$8.41,$6.90,$6.43,$2.64,$6.90,$6.90,$6.99,$214.00,$4.96,$13.22,$169.49,$171.20,$6.84,$7.45,$4.72,$5.22,$4.72
30000222,EAP,CPT® 89050,,Fluid Exam-heme,$214.00,$2.64,$214.00,$8.41,$6.90,$6.43,$2.64,$6.90,$6.90,$6.99,$214.00,$4.96,$13.22,$169.49,$171.20,$6.84,$7.45,$4.72,$5.22,$4.72
30000223,EAP,CPT® 89060,,Synovial Fluid Crystal Id,$150.00,$4.01,$150.00,$12.75,$10.44,$9.74,$4.01,$10.44,$10.44,$10.56,$150.00,$7.70,$19.98,$118.80,$120.00,$10.63,$11.26,$7.33,$7.88,$7.33
30000225,EAP,CPT® 87081,,"Pertussis,state Lab",$579.00,$3.70,$579.00,$11.81,$9.69,$4.30,$3.70,$9.69,$9.69,$9.79,$579.00,$6.96,$18.52,$458.57,$463.20,$9.61,$10.43,$6.63,$7.30,$6.63
30000228,EAP,CPT® 88275,,"Fish,aml, Aml1/eto,translocation8,21,probe",$432.00,$25.78,$432.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$432.00,$53.75,$112.22,$342.14,$345.60,$74.23,$63.21,$51.19,$44.25,$51.19
30000229,EAP,CPT® 88271,,"Fish,aml, Aml1/eto,translocation8,21,100-300 Cells",$432.00,$11.98,$432.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$432.00,$22.49,$59.86,$342.14,$345.60,$31.06,$33.72,$21.42,$23.60,$21.42
30000230,EAP,CPT® 88275,,"Fish,mll,11g23,gene Rearrang,probe",$394.00,$25.78,$394.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$394.00,$53.75,$112.22,$312.05,$315.20,$74.23,$63.21,$51.19,$44.25,$51.19
30000231,EAP,CPT® 88271,,"Fish,mll,11g23,gene Rearrang,100-300 Cells",$394.00,$11.98,$394.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$394.00,$22.49,$59.86,$312.05,$315.20,$31.06,$33.72,$21.42,$23.60,$21.42
30000232,EAP,CPT® 88235,,"Sc Anemia,dna Probe,fetus",$261.00,$82.38,$261.00,$261.00,$215.00,$200.40,$82.38,$215.00,$215.00,$217.53,$261.00,$157.82,$261.00,$206.71,$208.80,$217.94,$231.78,$150.30,$162.25,$150.30
30000234,EAP,HCPCS 88271,,"Fish,dup 22q11.2, Probe",$328.00,$11.98,$328.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$328.00,$22.49,$59.86,$259.78,$262.40,$31.06,$33.72,$21.42,$23.60,$21.42
30000235,EAP,CPT® 88271,,"Fish,dup 22q11.2, 100-300 Cells",$362.00,$11.98,$362.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$362.00,$22.49,$59.86,$286.70,$289.60,$31.06,$33.72,$21.42,$23.60,$21.42
30000236,EAP,CPT® 84432,,Thyroglobulin Panel,$68.00,$8.98,$68.00,$28.64,$23.45,$9.90,$8.98,$23.45,$23.45,$23.73,$68.00,$16.86,$44.88,$53.86,$54.40,$23.29,$25.28,$16.06,$17.70,$16.06
30000237,EAP,CPT® 86800,,"Thyroglobulin Panel, Antibody",$69.00,$8.89,$69.00,$28.36,$23.22,$16.45,$8.89,$23.22,$23.22,$23.50,$69.00,$16.71,$44.44,$54.65,$55.20,$23.07,$25.04,$15.91,$17.53,$15.91
30000240,EAP,CPT® 83520,,"Vasc Endothelial Gf,elisa",$577.00,$8.69,$577.00,$23.07,$18.91,$17.62,$8.69,$18.91,$18.91,$19.12,$577.00,$18.13,$36.18,$456.98,$461.60,$25.04,$20.37,$17.27,$14.26,$17.27
30000241,EAP,CPT® 83605,,Poct Lactate Venous (meter),$218.00,$5.97,$218.00,$19.04,$15.59,$14.53,$5.97,$15.59,$15.59,$15.78,$218.00,$12.15,$29.84,$172.66,$174.40,$16.78,$16.82,$11.57,$11.77,$11.57
30000242,EAP,CPT® 84484,,Poct Troponin Venous (meter),$286.00,$6.28,$286.00,$17.56,$14.37,$8.93,$6.28,$14.37,$14.37,$14.54,$286.00,$13.09,$27.50,$226.51,$228.80,$18.08,$15.50,$12.47,$10.85,$12.47
30000251,EAP,CPT® 86828,,Hla I/ii Ab Scr Plt Trans (arc),$593.00,$0.00,$593.00,$0.00,$55.25,$0.00,$0.00,$55.25,$55.25,$0.00,$593.00,$0.00,$296.50,$469.66,$474.40,$0.00,$0.00,$0.00,$0.00,$0.00
30000300,EAP,CPT® 80358,,Methadone - Urine,$341.00,$0.00,$341.00,$0.00,$243.37,$0.00,$0.00,$243.37,$243.37,$0.00,$341.00,$0.00,$170.50,$270.07,$272.80,$0.00,$0.00,$0.00,$0.00,$0.00
30000302,EAP,CPT® 86885,,Abid Ea Selected Cell,$170.00,$3.20,$170.00,$10.19,$8.35,$137.60,$3.20,$8.35,$8.35,$8.44,$170.00,$143.92,$15.98,$134.64,$136.00,$170.00,$9.00,$5.72,$6.30,$137.07
30000411,EAP,CPT® 86927,,Ffp Thawing Ea Unit,$289.00,$0.00,$289.00,$25.67,$10.25,$137.60,$49.79,$10.25,$10.25,$50.60,$289.00,$143.92,$24.80,$228.89,$231.20,$199.96,$45.23,$0.00,$46.01,$137.07
30000412,EAP,CPT® 84702,,D-hcg Free & Intact,$218.00,$7.07,$218.00,$11.45,$9.37,$7.33,$8.42,$9.37,$9.37,$9.48,$218.00,$15.80,$17.94,$172.66,$174.40,$21.82,$10.10,$15.05,$7.07,$15.05
30000413,EAP,CPT® 86920,,"Charge: Xmatch, Saline",$286.00,$0.00,$286.00,$44.82,$26.20,$137.60,$23.69,$26.20,$26.20,$50.08,$286.00,$143.92,$62.02,$226.51,$228.80,$199.96,$44.76,$0.00,$45.53,$137.07
30000420,EAP,CPT® 36415,,Venipuncture,$43.00,$1.51,$43.00,$23.35,$3.00,$3.00,$1.51,$3.00,$3.00,$7.53,$43.00,$3.15,$21.50,$34.06,$34.40,$4.35,$6.73,$3.00,$6.85,$3.00
30000425,EAP,CPT® 86923,,Crossmatch - Mass Transfusion,$286.00,$0.00,$286.00,$35.96,$18.99,$137.60,$18.28,$18.99,$18.99,$50.08,$286.00,$143.92,$44.66,$226.51,$228.80,$199.96,$44.76,$0.00,$45.53,$137.07
30000426,EAP,CPT® 86480,,Quantiferon-tb Gold,$318.00,$34.67,$318.00,$110.49,$90.49,$84.35,$34.67,$90.49,$90.49,$91.55,$318.00,$65.08,$173.18,$251.86,$254.40,$89.87,$97.55,$61.98,$68.28,$61.98
30000427,EAP,CPT® 86022,,Serotonin Release Assay (sra) Unfractionated,$290.00,$0.00,$290.00,$0.00,$26.82,$0.00,$0.00,$26.82,$26.82,$0.00,$290.00,$0.00,$51.32,$229.68,$232.00,$0.00,$0.00,$0.00,$0.00,$0.00
30000428,EAP,CPT® 86022,,Serotonin Release Assay (sra) Lmwh,$290.00,$0.00,$290.00,$0.00,$26.82,$0.00,$0.00,$26.82,$26.82,$0.00,$290.00,$0.00,$51.32,$229.68,$232.00,$0.00,$0.00,$0.00,$0.00,$0.00
30000429,EAP,CPT® 81599,,MATERNI T21™ PLUS,"$1,318.00",$0.00,"$1,318.00",$0.00,$940.66,$234.60,$0.00,$940.66,$940.66,$230.77,"$1,318.00",$0.00,$659.00,"$1,043.86","$1,054.40",$790.80,$0.00,$0.00,$209.83,$0.00
30000502,EAP,CPT® 83516,,Immunoassay Nonantibody,$77.00,$6.44,$77.00,$19.04,$15.61,$15.70,$6.44,$15.61,$15.61,$15.80,$77.00,$12.11,$29.88,$60.98,$61.60,$16.72,$16.84,$11.53,$11.79,$11.53
30000503,EAP,CPT® 86235,,Nuclear Antigen Antibody,$87.00,$10.04,$87.00,$31.97,$26.18,$24.41,$10.04,$26.18,$26.18,$26.49,$87.00,$18.83,$50.12,$68.90,$69.60,$26.00,$28.23,$17.93,$19.76,$17.93
30000504,EAP,CPT® 86003,,Allergen Specific Ige,$40.00,$2.92,$40.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$40.00,$5.48,$14.60,$31.68,$32.00,$7.57,$8.22,$5.22,$5.76,$5.22
30000505,EAP,CPT® 86735,,Mumps Antibody,$32.00,$7.31,$32.00,$23.26,$19.06,$11.13,$7.31,$19.06,$19.06,$19.28,$32.00,$13.70,$32.00,$25.34,$25.60,$18.92,$20.54,$13.05,$14.38,$13.05
30000506,EAP,CPT® 86644,,Cmv Antibody,$24.00,$8.06,$24.00,$20.75,$16.99,$19.58,$8.06,$16.99,$16.99,$17.19,$24.00,$15.11,$24.00,$19.01,$19.20,$20.87,$18.31,$14.39,$12.82,$14.39
30000507,EAP,CPT® 86710,,Influenza Virus Antibody,$25.00,$0.00,$25.00,$0.00,$19.80,$0.00,$0.00,$19.80,$19.80,$0.00,$25.00,$0.00,$25.00,$19.80,$20.00,$0.00,$0.00,$0.00,$0.00,$0.00
30000508,EAP,CPT® 84702,,Chorionic Gonadotropin Test,$147.00,$7.07,$147.00,$11.45,$9.37,$7.33,$8.42,$9.37,$9.37,$9.48,$147.00,$15.80,$17.94,$116.42,$117.60,$21.82,$10.10,$15.05,$7.07,$15.05
30000509,EAP,CPT® 80299,,Quantitative Assay Drug,$404.00,$9.39,$404.00,$24.21,$17.58,$15.07,$9.39,$17.58,$17.58,$17.79,$404.00,$19.57,$33.64,$319.97,$323.20,$27.03,$18.95,$18.64,$13.27,$18.64
30000510,EAP,CPT® 80299,,Quantitative Assay Drug,$201.00,$9.39,$201.00,$24.21,$17.58,$15.07,$9.39,$17.58,$17.58,$17.79,$201.00,$19.57,$33.64,$159.19,$160.80,$27.03,$18.95,$18.64,$13.27,$18.64
30000515,EAP,CPT® 86022,,Platelet Antibodies,$347.00,$0.00,$347.00,$0.00,$26.82,$0.00,$0.00,$26.82,$26.82,$0.00,$347.00,$0.00,$51.32,$274.82,$277.60,$0.00,$0.00,$0.00,$0.00,$0.00
30000519,EAP,CPT® 86003,,Allergen Specific Ige,$471.00,$2.92,$471.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$471.00,$5.48,$14.60,$373.03,$376.80,$7.57,$8.22,$5.22,$5.76,$5.22
30000521,EAP,CPT® 86235,,Nuclear Antigen Antibody,$176.00,$10.04,$176.00,$31.97,$26.18,$24.41,$10.04,$26.18,$26.18,$26.49,$176.00,$18.83,$50.12,$139.39,$140.80,$26.00,$28.23,$17.93,$19.76,$17.93
30000525,EAP,CPT® 82962,,Blood Glucose Check,$53.00,$1.66,$53.00,$4.17,$3.42,$3.19,$1.66,$3.42,$3.42,$3.45,$53.00,$3.44,$6.54,$41.98,$42.40,$4.76,$3.68,$3.28,$2.58,$3.28
30000526,EAP,CPT® 86003,,Allegen - Mosquito Q,$120.00,$2.92,$120.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$120.00,$5.48,$14.60,$95.04,$96.00,$7.57,$8.22,$5.22,$5.76,$5.22
30000527,EAP,CPT® 83916,,"Oligoclonal Bands,csf(so)",$51.00,$13.79,$51.00,$35.86,$29.36,$27.37,$13.79,$29.36,$29.36,$29.69,$51.00,$28.76,$51.00,$40.39,$40.80,$39.72,$31.64,$27.39,$22.15,$27.39
30000528,EAP,CPT® 84157,,"Protein,total And Electrophoresis,csf(so)",$101.00,$2.05,$101.00,$6.54,$5.35,$4.99,$2.05,$5.35,$5.35,$5.42,$101.00,$4.20,$10.24,$79.99,$80.80,$5.80,$5.77,$4.00,$4.04,$4.00
30000529,EAP,CPT® 84166,,"Protein,total And Electrophoresis,qnt,csf(so)",$87.00,$9.97,$87.00,$31.78,$26.04,$24.27,$9.97,$26.04,$26.04,$26.34,$87.00,$18.72,$49.84,$68.90,$69.60,$25.85,$28.07,$17.83,$19.65,$17.83
30000530,EAP,CPT® 85810,,"Viscosity, Serum(so)",$77.00,$0.00,$77.00,$0.00,$17.05,$0.00,$0.00,$17.05,$17.05,$0.00,$77.00,$0.00,$32.64,$60.98,$61.60,$0.00,$0.00,$0.00,$0.00,$0.00
30000570,EAP,CPT® 86341,,Ia-2 Islet Cell Ab (so),$193.00,$11.87,$193.00,$35.27,$28.89,$19.44,$11.87,$28.89,$28.89,$29.24,$193.00,$24.75,$55.30,$152.86,$154.40,$34.18,$31.16,$23.57,$21.81,$23.57
30000571,EAP,CPT® 86355,,Lymph Sub 1 B Cells Tot (so),$214.00,$21.10,$214.00,$42.00,$34.39,$22.53,$21.10,$34.39,$34.39,$34.80,$214.00,$39.62,$65.82,$169.49,$171.20,$54.71,$37.08,$37.73,$25.95,$37.73
30000572,EAP,CPT® 86357,,Lymph Sub 1 Nk Cells Tot (so),$204.00,$21.10,$204.00,$42.00,$34.39,$22.53,$21.10,$34.39,$34.39,$34.80,$204.00,$39.62,$65.82,$161.57,$163.20,$54.71,$37.08,$37.73,$25.95,$37.73
30000573,EAP,CPT® 86359,,Lymph Sub 1 T Cells Tot (so),$218.00,$21.10,$218.00,$42.00,$34.39,$22.53,$21.10,$34.39,$34.39,$34.80,$218.00,$39.62,$65.82,$172.66,$174.40,$54.71,$37.08,$37.73,$25.95,$37.73
30000574,EAP,CPT® 86360,,Lymph Sub 1 T Cell Ratio (so),$323.00,$26.28,$323.00,$83.77,$68.60,$45.07,$26.28,$68.60,$68.60,$69.42,$323.00,$49.33,$131.30,$255.82,$258.40,$68.12,$73.96,$46.98,$51.77,$46.98
30000602,EAP,CPT® 88271,,Cytogenetics Dna Probe,$94.00,$11.98,$94.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$94.00,$22.49,$59.86,$74.45,$75.20,$31.06,$33.72,$21.42,$23.60,$21.42
30000604,EAP,CPT® 86603,,Adenovirus Antibody,$88.00,$0.00,$88.00,$22.94,$18.79,$11.13,$0.00,$18.79,$18.79,$19.01,$88.00,$13.51,$35.96,$69.70,$70.40,$18.66,$0.00,$12.87,$14.18,$12.87
30000605,EAP,CPT® 84182,,Protein Western Blot Test,$513.00,$14.70,$513.00,$32.08,$26.28,$24.49,$14.70,$26.28,$26.28,$26.60,$513.00,$30.67,$50.30,$406.30,$410.40,$42.35,$28.34,$29.21,$19.84,$29.21
30000610,EAP,CPT® 86316,,Immunoassay Tumor Other,$219.00,$11.65,$219.00,$37.10,$30.38,$28.32,$11.65,$30.38,$30.38,$30.73,$219.00,$21.85,$58.14,$173.45,$175.20,$30.17,$32.75,$20.81,$22.92,$20.81
30000611,EAP,CPT® 88305,,Tissue Exam By Pathologist,$205.00,$32.05,$205.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$205.00,$49.62,$140.98,$162.36,$164.00,$68.93,$82.47,$32.05,$57.73,$47.25
30000612,EAP,CPT® 88311,,Decalcify Tissue,$104.00,$0.00,$104.00,$29.41,$6.15,$0.00,$11.06,$6.15,$6.15,$18.15,$104.00,$0.00,$12.30,$82.37,$83.20,$0.00,$19.34,$9.00,$13.54,$0.00
30000613,EAP,CPT® 88313,,Special Stains Group 2,$145.00,$31.93,$145.00,$91.98,$60.64,$32.06,$37.20,$60.64,$60.64,$52.76,$145.00,$33.53,$110.70,$114.84,$116.00,$46.58,$56.22,$64.47,$39.35,$31.93
30000614,EAP,CPT® 85097,,Bone Marrow Interpretation,$700.00,$25.77,$700.00,$119.97,$46.75,$602.38,$25.77,$46.75,$46.75,$75.35,$700.00,$630.05,$213.48,$554.40,$560.00,$700.00,$80.29,$51.21,$56.20,$600.04
30000615,EAP,CPT® 82507,,Assay Of Citrate,$192.00,$0.00,$192.00,$0.00,$40.60,$0.00,$0.00,$40.60,$40.60,$0.00,$192.00,$0.00,$77.70,$152.06,$153.60,$0.00,$0.00,$0.00,$0.00,$0.00
30000616,EAP,CPT® 82131,,Amino Acids Single Quant,$68.00,$11.57,$68.00,$30.07,$24.63,$22.95,$11.57,$24.63,$24.63,$24.92,$68.00,$24.13,$47.14,$53.86,$54.40,$33.32,$26.55,$22.98,$18.58,$22.98
30000617,EAP,CPT® 86480,,Tb Test Cell Immun Measure,$603.00,$34.67,$603.00,$110.49,$90.49,$84.35,$34.67,$90.49,$90.49,$91.55,$603.00,$65.08,$173.18,$477.58,$482.40,$89.87,$97.55,$61.98,$68.28,$61.98
30000618,EAP,CPT® 83516,,Immunoassay Nonantibody,"$2,340.00",$6.44,"$2,340.00",$19.04,$15.61,$15.70,$6.44,$15.61,$15.61,$15.80,"$2,340.00",$12.11,$29.88,"$1,853.28","$1,872.00",$16.72,$16.84,$11.53,$11.79,$11.53
30000621,EAP,CPT® 82943,,Assay Of Glucagon,$82.00,$0.00,$82.00,$0.00,$20.86,$0.00,$0.00,$20.86,$20.86,$0.00,$82.00,$0.00,$39.94,$64.94,$65.60,$0.00,$0.00,$0.00,$0.00,$0.00
30000622,EAP,CPT® 82040,,Assay Of Serum Albumin,$10.00,$2.77,$10.00,$5.13,$4.20,$6.32,$2.77,$4.20,$4.20,$4.25,$10.00,$5.20,$8.04,$7.92,$8.00,$7.18,$4.53,$4.95,$3.17,$4.95
30000623,EAP,CPT® 84270,,Assay Of Sex Hormone Globul,$35.00,$0.00,$35.00,$0.00,$31.73,$0.00,$0.00,$31.73,$31.73,$0.00,$35.00,$0.00,$35.00,$27.72,$28.00,$0.00,$0.00,$0.00,$0.00,$0.00
30000624,EAP,CPT® 84403,,Assay Of Total Testosterone,$50.00,$14.44,$50.00,$46.01,$37.70,$35.13,$14.44,$37.70,$37.70,$38.15,$50.00,$27.10,$50.00,$39.60,$40.00,$37.42,$40.65,$25.81,$28.45,$25.81
30000625,EAP,CPT® 83520,,Immunoassay Quant Nos Nonab,"$1,124.00",$8.69,"$1,124.00",$23.07,$18.91,$17.62,$8.69,$18.91,$18.91,$19.12,"$1,124.00",$18.13,$36.18,$890.21,$899.20,$25.04,$20.37,$17.27,$14.26,$17.27
30000626,EAP,CPT® 87906,,Genotype Dna Hiv Reverse T,$192.00,$43.01,$192.00,$77.75,$61.36,$150.39,$72.01,$61.36,$61.36,$57.67,$192.00,$135.17,$96.00,$152.06,$153.60,$186.66,$61.44,$128.73,$43.01,$128.73
30000627,EAP,CPT® 87903,,Phenotype Dna Hiv W/culture,$884.00,$0.00,$884.00,$0.00,$493.83,$0.00,$0.00,$493.83,$493.83,$0.00,$884.00,$0.00,$884.00,$700.13,$707.20,$0.00,$0.00,$0.00,$0.00,$0.00
30000628,EAP,CPT® 87904,,Phenotype Dna Hiv W/clt Add,$178.00,$0.00,$178.00,$0.00,$32.28,$0.00,$0.00,$32.28,$32.28,$0.00,$178.00,$0.00,$61.78,$140.98,$142.40,$0.00,$0.00,$0.00,$0.00,$0.00
30000629,EAP,CPT® 83785,,Assay Of Manganese,$69.00,$0.00,$69.00,$0.00,$35.90,$0.00,$0.00,$35.90,$35.90,$0.00,$69.00,$0.00,$68.72,$54.65,$55.20,$0.00,$0.00,$0.00,$0.00,$0.00
30000630,EAP,CPT® 82300,,Assay Of Cadmium,$67.00,$0.00,$67.00,$0.00,$33.79,$0.00,$0.00,$33.79,$33.79,$0.00,$67.00,$0.00,$64.66,$53.06,$53.60,$0.00,$0.00,$0.00,$0.00,$0.00
30000631,EAP,CPT® 82570,,Assay Of Urine Creatinine,$77.00,$2.90,$77.00,$9.23,$7.56,$5.60,$2.90,$7.56,$7.56,$7.64,$77.00,$5.44,$14.46,$60.98,$61.60,$7.51,$8.14,$5.18,$5.70,$5.18
30000632,EAP,CPT® 83885,,Assay Of Nickel,$69.00,$0.00,$69.00,$0.00,$35.77,$0.00,$0.00,$35.77,$35.77,$0.00,$69.00,$0.00,$68.46,$54.65,$55.20,$0.00,$0.00,$0.00,$0.00,$0.00
30000633,EAP,CPT® 83018,,Quantitative Screen Metals,$114.00,$0.00,$114.00,$0.00,$32.06,$0.00,$0.00,$32.06,$32.06,$0.00,$114.00,$0.00,$61.36,$90.29,$91.20,$0.00,$0.00,$0.00,$0.00,$0.00
30000634,EAP,CPT® 83785,,Assay Of Manganese,$79.00,$0.00,$79.00,$0.00,$35.90,$0.00,$0.00,$35.90,$35.90,$0.00,$79.00,$0.00,$68.72,$62.57,$63.20,$0.00,$0.00,$0.00,$0.00,$0.00
30000635,EAP,CPT® 82525,,Assay Of Copper,$62.00,$6.95,$62.00,$22.12,$18.12,$16.89,$6.95,$18.12,$18.12,$18.33,$62.00,$13.03,$34.68,$49.10,$49.60,$17.99,$19.53,$12.41,$13.67,$12.41
30000636,EAP,CPT® 83520,,Immunoassay Quant Nos Nonab,$947.00,$8.69,$947.00,$23.07,$18.91,$17.62,$8.69,$18.91,$18.91,$19.12,$947.00,$18.13,$36.18,$750.02,$757.60,$25.04,$20.37,$17.27,$14.26,$17.27
30000637,EAP,CPT® 80361,,Assay Of Dihydrocodeinone,$272.00,$0.00,$272.00,$0.02,$194.13,$48.42,$13.36,$194.13,$194.13,$30.51,$272.00,$0.00,$136.00,$215.42,$217.60,$163.20,$32.51,$0.00,$22.76,$0.00
30000706,EAP,CPT® 81479,,Rhd Variant By Snp (arc),"$1,136.00",$0.00,"$1,136.00",$0.00,$810.76,$202.21,$195.73,$810.76,$810.76,"$1,045.61","$1,136.00",$0.00,$568.00,$899.71,$908.80,$681.60,"$1,114.12",$0.00,$779.89,$0.00
30000710,EAP,CPT® 81479,,Rhce Variant By Snp (arc),$982.00,$0.00,"$1,114.12",$0.00,$700.85,$174.80,$169.19,$700.85,$700.85,"$1,045.61",$982.00,$0.00,$491.00,$777.74,$785.60,$589.20,"$1,114.12",$0.00,$779.89,$0.00
30000715,EAP,CPT® 86355,,Cd19 B-cells (flow Cytometry) So,$84.00,$21.10,$84.00,$42.00,$34.39,$22.53,$21.10,$34.39,$34.39,$34.80,$84.00,$39.62,$65.82,$66.53,$67.20,$54.71,$37.08,$37.73,$25.95,$37.73
30000716,EAP,CPT® 81403,,Xhea Licensed Rbc Panel (arc),$821.00,$93.24,$821.00,$228.00,$585.95,$146.14,$93.24,$585.95,$585.95,$220.85,$821.00,$194.46,$410.50,$650.23,$656.80,$268.54,$235.32,$185.20,$164.72,$185.20
30000750,EAP,CPT® 85335,,Adamts 13 Inhibitor (so),$379.00,$0.00,$379.00,$0.00,$18.80,$0.00,$0.00,$18.80,$18.80,$0.00,$379.00,$0.00,$35.98,$300.17,$303.20,$0.00,$0.00,$0.00,$0.00,$0.00
30000751,EAP,CPT® 87900,,Hiv Genotyping,"$1,355.00",$0.00,"$1,355.00",$0.00,$161.40,$0.00,$0.00,$161.40,$161.40,$0.00,"$1,355.00",$0.00,$308.90,"$1,073.16","$1,084.00",$0.00,$0.00,$0.00,$0.00,$0.00
30000753,EAP,CPT® 86830,,Hla Ab Id (arc),$565.00,$0.00,$565.00,$0.00,$112.58,$0.00,$0.00,$112.58,$112.58,$0.00,$565.00,$0.00,$282.50,$447.48,$452.00,$0.00,$0.00,$0.00,$0.00,$0.00
30000755,EAP,CPT® 81310,,"Npm (exon 12) Mutation,gene Analy(so)",$699.00,$0.00,$699.00,$0.00,$247.14,$0.00,$0.00,$247.14,$247.14,$0.00,$699.00,$0.00,$349.50,$553.61,$559.20,$0.00,$0.00,$0.00,$0.00,$0.00
30000761,EAP,CPT® 81245,,"FLT3 ITD and TKD Mutation,Variants(SO)",$509.00,$0.00,$509.00,$0.00,$165.92,$0.00,$0.00,$165.92,$165.92,$0.00,$509.00,$0.00,$254.50,$403.13,$407.20,$0.00,$0.00,$0.00,$0.00,$0.00
30000762,EAP,CPT® 81246,,CEBPA Mutation(SO),$658.00,$0.00,$658.00,$0.00,$469.61,$0.00,$0.00,$469.61,$469.61,$0.00,$658.00,$0.00,$329.00,$521.14,$526.40,$0.00,$0.00,$0.00,$0.00,$0.00
30000764,EAP,CPT® 81450,,Myeloproliferative Neoplasm Mut(SO),"$1,891.00",$0.00,"$1,891.00",$0.00,"$1,349.61",$0.00,$382.39,"$1,349.61","$1,349.61",$0.00,"$1,891.00",$0.00,$945.50,"$1,497.67","$1,512.80",$0.00,$295.94,$0.00,$0.00,$0.00
30000766,EAP,CPT® 81261,,"Lympho Clonal Panel, IGK,PCR(SO)","$1,003.00",$0.00,"$1,003.00",$0.00,$270.11,$0.00,$110.76,$270.11,$270.11,$286.64,"$1,003.00",$0.00,$501.50,$794.38,$802.40,$0.00,$305.42,$0.00,$0.00,$0.00
30000767,EAP,CPT® 81264,,"Lympho Clonal Panel,TRB PCR(SO)","$1,043.00",$0.00,"$1,043.00",$0.00,$203.72,$0.00,$86.96,$203.72,$203.72,$115.59,"$1,043.00",$0.00,$521.50,$826.06,$834.40,$0.00,$123.17,$0.00,$0.00,$0.00
30000768,EAP,CPT® 81340,,"Lympho Clonal Panel,TRG PCR(SO)",$601.00,$0.00,$601.00,$0.00,$285.02,$0.00,$0.00,$285.02,$285.02,$0.00,$601.00,$0.00,$300.50,$475.99,$480.80,$0.00,$0.00,$0.00,$0.00,$0.00
30000769,EAP,CPT® 81342,,"Lympho Clonal Panel, PCR,Unlisted Proc(SO)",$713.00,$0.00,$713.00,$0.00,$274.90,$0.00,$0.00,$274.90,$274.90,$0.00,$713.00,$0.00,$356.50,$564.70,$570.40,$0.00,$0.00,$0.00,$0.00,$0.00
30000770,EAP,CPT® 84999,,B-Cell Clonality Panel (IGH)(SO),$551.00,$0.00,$551.00,$0.00,$393.25,$0.00,$94.93,$393.25,$393.25,$96.48,$551.00,$0.00,$0.00,$436.39,$440.80,$0.00,$86.23,$0.00,$0.00,$0.00
30000771,EAP,CPT® 81261,,B-Cell Clonality Panel (IGK)(SO),$746.00,$0.00,$746.00,$0.00,$270.11,$0.00,$110.76,$270.11,$270.11,$286.64,$746.00,$0.00,$373.00,$590.83,$596.80,$0.00,$305.42,$0.00,$0.00,$0.00
30000772,EAP,CPT® 81264,,"B-Cell Clonality Panel,Unlisted Proc(SO)",$628.00,$0.00,$628.00,$0.00,$203.72,$0.00,$86.96,$203.72,$203.72,$115.59,$628.00,$0.00,$314.00,$497.38,$502.40,$0.00,$123.17,$0.00,$0.00,$0.00
30000773,EAP,CPT® 84999,,"MYD88, Mutation Analysis(SO)",$958.00,$0.00,$958.00,$0.00,$683.72,$0.00,$165.06,$683.72,$683.72,$167.74,$958.00,$0.00,$0.00,$758.74,$766.40,$0.00,$149.93,$0.00,$0.00,$0.00
30000774,EAP,CPT® 81479,,"KIT D816, Mutation Analysis(SO)","$1,420.00",$0.00,"$1,420.00",$0.00,"$1,013.45",$252.76,$244.66,"$1,013.45","$1,013.45","$1,045.61","$1,420.00",$0.00,$710.00,"$1,124.64","$1,136.00",$852.00,"$1,114.12",$0.00,$779.89,$0.00
30000777,EAP,CPT® 88271,,"Fish, ALL, TEL/ AML1 Transl,100-300 Cells(SO)",$357.00,$11.98,$357.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$357.00,$22.49,$59.86,$282.74,$285.60,$31.06,$33.72,$21.42,$23.60,$21.42
30000778,EAP,CPT® 88275,,"Chromosome Analysis, Lymph Node,BM(SO)","$1,347.00",$25.78,"$1,347.00",$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,"$1,347.00",$53.75,$112.22,"$1,066.82","$1,077.60",$74.23,$63.21,$51.19,$44.25,$51.19
30000779,EAP,CPT® 88237,,"ChromAnaly, Lymph Node,20-25 Cells(SO)","$1,736.00",$72.38,"$1,736.00",$157.39,$128.90,$171.89,$72.38,$128.90,$128.90,$130.42,"$1,736.00",$150.94,$246.70,"$1,374.91","$1,388.80",$208.44,$138.97,$143.75,$97.28,$143.75
30000780,EAP,CPT® 88264,,"Fish, B-Cell Malignancy, IGH, 14q32(SO)",$510.00,$72.80,$510.00,$222.21,$181.98,$169.62,$72.80,$181.98,$181.98,$184.12,$510.00,$151.84,$348.28,$403.92,$408.00,$209.68,$196.18,$144.61,$137.33,$144.61
30000781,EAP,CPT® 88271,,"Fish, B-Cell Malig, IGH, 14q32,100-300 Cells(SO)",$395.00,$11.98,$395.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$395.00,$22.49,$59.86,$312.84,$316.00,$31.06,$33.72,$21.42,$23.60,$21.42
30000782,EAP,CPT® 88275,,ZAP -70(SO),$231.00,$25.78,$231.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$231.00,$53.75,$112.22,$182.95,$184.80,$74.23,$63.21,$51.19,$44.25,$51.19
30000783,EAP,CPT® 88184,,"ZAP -70,Add Marker(SO)",$303.00,$34.11,$303.00,$80.30,$79.23,$271.76,$34.11,$79.23,$79.23,$54.16,$303.00,$284.24,$133.74,$239.98,$242.40,$303.00,$57.71,$68.07,$40.40,$270.71
30000784,EAP,CPT® 88185,,"CLL Prognostic Panel,First Marker(SO)",$130.00,$0.00,$130.00,$49.02,$47.05,$0.00,$12.52,$47.05,$47.05,$26.63,$130.00,$0.00,$71.72,$102.96,$104.00,$0.00,$28.37,$22.33,$19.86,$0.00
30000785,EAP,CPT® 88184,,"CLL Prognostic Panel,Add Marker(SO)-1",$303.00,$34.11,$303.00,$80.30,$79.23,$271.76,$34.11,$79.23,$79.23,$54.16,$303.00,$284.24,$133.74,$239.98,$242.40,$303.00,$57.71,$68.07,$40.40,$270.71
30000786,EAP,CPT® 88185,,"CLL Prognostic Panel,Add Marker(SO)-2",$130.00,$0.00,$130.00,$49.02,$47.05,$0.00,$12.52,$47.05,$47.05,$26.63,$130.00,$0.00,$71.72,$102.96,$104.00,$0.00,$28.37,$22.33,$19.86,$0.00
30000787,EAP,CPT® 88185,,"CLL Prognostic Panel,IGH(SO)",$463.00,$0.00,$463.00,$49.02,$47.05,$0.00,$12.52,$47.05,$47.05,$26.63,$463.00,$0.00,$71.72,$366.70,$370.40,$0.00,$28.37,$22.33,$19.86,$0.00
30000788,EAP,CPT® 81263,,"CLL Prognostic Panel,Beta-2(SO)",$639.00,$86.22,$639.00,$525.04,$401.79,$400.79,$164.75,$401.79,$401.79,$115.59,$639.00,$309.25,$319.50,$506.09,$511.20,$427.05,$123.17,$294.52,$86.22,$294.52
30000789,EAP,CPT® 82232,,"CLL Prognostic Panel,DNA Probe(SO)-1",$409.00,$9.05,$409.00,$28.84,$23.62,$22.02,$9.05,$23.62,$23.62,$23.91,$409.00,$16.99,$45.22,$323.93,$327.20,$23.46,$25.48,$16.18,$17.83,$16.18
30000790,EAP,CPT® 88271,,"CLL Prognostic Panel,DNA Probe(SO)-2",$218.00,$11.98,$218.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$218.00,$22.49,$59.86,$172.66,$174.40,$31.06,$33.72,$21.42,$23.60,$21.42
30000791,EAP,CPT® 88271,,"CLL Prognostic Panel,DNA Probe(SO)-3",$218.00,$11.98,$218.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$218.00,$22.49,$59.86,$172.66,$174.40,$31.06,$33.72,$21.42,$23.60,$21.42
30000792,EAP,CPT® 88271,,"CLL Prognostic Panel,DNA Probe(SO)-4",$218.00,$11.98,$218.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$218.00,$22.49,$59.86,$172.66,$174.40,$31.06,$33.72,$21.42,$23.60,$21.42
30000793,EAP,CPT® 88271,,"CLL Prognostic Panel,DNA Probe(SO)-5",$218.00,$11.98,$218.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$218.00,$22.49,$59.86,$172.66,$174.40,$31.06,$33.72,$21.42,$23.60,$21.42
30000794,EAP,CPT® 88271,,"CLL Prognostic Panel,100-300 Cells(SO)-1",$218.00,$11.98,$218.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$218.00,$22.49,$59.86,$172.66,$174.40,$31.06,$33.72,$21.42,$23.60,$21.42
30000795,EAP,CPT® 88275,,"CLL Prognostic Panel,100-300 Cells(SO)-2",$218.00,$25.78,$218.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$218.00,$53.75,$112.22,$172.66,$174.40,$74.23,$63.21,$51.19,$44.25,$51.19
30000796,EAP,CPT® 88275,,"CLL Prognostic Panel,100-300 Cells(SO)-3",$218.00,$25.78,$218.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$218.00,$53.75,$112.22,$172.66,$174.40,$74.23,$63.21,$51.19,$44.25,$51.19
30000797,EAP,CPT® 88275,,"CLL Prognostic Panel,100-300 Cells(SO)-4",$218.00,$25.78,$218.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$218.00,$53.75,$112.22,$172.66,$174.40,$74.23,$63.21,$51.19,$44.25,$51.19
30000798,EAP,CPT® 88275,,"CLL Prognostic Panel,100-300 Cells(SO)-5",$218.00,$25.78,$218.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$218.00,$53.75,$112.22,$172.66,$174.40,$74.23,$63.21,$51.19,$44.25,$51.19
30000799,EAP,CPT® 88275,,"CLL Prognostic Panel,BM(SO)",$233.00,$25.78,$233.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$233.00,$53.75,$112.22,$184.54,$186.40,$74.23,$63.21,$51.19,$44.25,$51.19
30000800,EAP,CPT® 88237,,"CLL Prognostic Panel,20-25 Cells(SO)",$423.00,$72.38,$423.00,$157.39,$128.90,$171.89,$72.38,$128.90,$128.90,$130.42,$423.00,$150.94,$246.70,$335.02,$338.40,$208.44,$138.97,$143.75,$97.28,$143.75
30000801,EAP,CPT® 88264,,"CHROM, CLL/LPD,BM(SO)",$656.00,$72.80,$656.00,$222.21,$181.98,$169.62,$72.80,$181.98,$181.98,$184.12,$656.00,$151.84,$348.28,$519.55,$524.80,$209.68,$196.18,$144.61,$137.33,$144.61
30000802,EAP,CPT® 88237,,"CHROM, CLL/LPD, 20-25 Cells(SO)",$656.00,$72.38,$656.00,$157.39,$128.90,$171.89,$72.38,$128.90,$128.90,$130.42,$656.00,$150.94,$246.70,$519.55,$524.80,$208.44,$138.97,$143.75,$97.28,$143.75
30000803,EAP,CPT® 88264,,"CHROM, CLL/LPD,Interp(SO)",$656.00,$72.80,$656.00,$222.21,$181.98,$169.62,$72.80,$181.98,$181.98,$184.12,$656.00,$151.84,$348.28,$519.55,$524.80,$209.68,$196.18,$144.61,$137.33,$144.61
30000805,EAP,CPT® 88271,,"Fish, ALL, Pre-B,100-300 Cells(SO)","$1,002.00",$11.98,"$1,002.00",$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,"$1,002.00",$22.49,$59.86,$793.58,$801.60,$31.06,$33.72,$21.42,$23.60,$21.42
30000806,EAP,CPT® 88275,,"Fish, MALT Lymph, rea18q21,DNA Probe(SO)-1",$303.00,$25.78,$303.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$303.00,$53.75,$112.22,$239.98,$242.40,$74.23,$63.21,$51.19,$44.25,$51.19
30000807,EAP,CPT® 88271,,"Fish, MALT Lymph, rea18q21,DNA Probe(SO)-2",$303.00,$11.98,$303.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$303.00,$22.49,$59.86,$239.98,$242.40,$31.06,$33.72,$21.42,$23.60,$21.42
30000808,EAP,CPT® 88271,,"Fish, MALT Lymph, rea18q21100-300 Cells(SO)",$303.00,$11.98,$303.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$303.00,$22.49,$59.86,$239.98,$242.40,$31.06,$33.72,$21.42,$23.60,$21.42
30000809,EAP,CPT® 88275,,"Fish, TCL1, 14q32.1,DNA Probe(SO)-1",$231.00,$25.78,$231.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$231.00,$53.75,$112.22,$182.95,$184.80,$74.23,$63.21,$51.19,$44.25,$51.19
30000810,EAP,CPT® 88271,,"Fish, TCL1, 14q32.1,DNA Probe(SO)-2",$231.00,$11.98,$231.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$231.00,$22.49,$59.86,$182.95,$184.80,$31.06,$33.72,$21.42,$23.60,$21.42
30000811,EAP,CPT® 88271,,"Fish, TCL1, 14q32.1,100-300 Cells(SO)",$231.00,$11.98,$231.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$231.00,$22.49,$59.86,$182.95,$184.80,$31.06,$33.72,$21.42,$23.60,$21.42
30000812,EAP,CPT® 88275,,"Fish, T-Cell Receptor Alpha/ Delta,DNA Probe(SO)-1",$231.00,$25.78,$231.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$231.00,$53.75,$112.22,$182.95,$184.80,$74.23,$63.21,$51.19,$44.25,$51.19
30000813,EAP,CPT® 88271,,"Fish, T-Cell Receptor Alpha/ Delta,DNA Probe(SO)-2",$231.00,$11.98,$231.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$231.00,$22.49,$59.86,$182.95,$184.80,$31.06,$33.72,$21.42,$23.60,$21.42
30000814,EAP,CPT® 88271,,"Fish, T-Cell Receptor Alpha/ Delta,100-300 Cells(SO)",$231.00,$11.98,$231.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$231.00,$22.49,$59.86,$182.95,$184.80,$31.06,$33.72,$21.42,$23.60,$21.42
30000815,EAP,CPT® 88275,,"Chrom. Microarray, Hematologic Malig.(SO)","$2,718.00",$25.78,"$2,718.00",$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,"$2,718.00",$53.75,$112.22,"$2,152.66","$2,174.40",$74.23,$63.21,$51.19,$44.25,$51.19
30000816,EAP,CPT® 81406,,"Fish, Mult Myel, IGH/ MAFB,DNA Probe(SO)-1",$323.00,$0.00,$323.00,$0.00,$230.53,$0.00,$0.00,$230.53,$230.53,$0.00,$323.00,$0.00,$161.50,$255.82,$258.40,$0.00,$0.00,$0.00,$0.00,$0.00
30000817,EAP,CPT® 88271,,"Fish, Mult Myel, IGH/ MAFB,DNA Probe(SO)-2",$231.00,$11.98,$231.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$231.00,$22.49,$59.86,$182.95,$184.80,$31.06,$33.72,$21.42,$23.60,$21.42
30000818,EAP,CPT® 88271,,"Fish, Mult Myel, IGH/ MAFB,100-300 Cells(SO)",$231.00,$11.98,$231.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$231.00,$22.49,$59.86,$182.95,$184.80,$31.06,$33.72,$21.42,$23.60,$21.42
30000819,EAP,CPT® 88275,,"Fish, Mult Myel, 1q21,DNA Probe(SO)-1",$231.00,$25.78,$231.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$231.00,$53.75,$112.22,$182.95,$184.80,$74.23,$63.21,$51.19,$44.25,$51.19
30000820,EAP,CPT® 88271,,"Fish, Mult Myel, 1q21,DNA Probe(SO)-2",$231.00,$11.98,$231.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$231.00,$22.49,$59.86,$182.95,$184.80,$31.06,$33.72,$21.42,$23.60,$21.42
30000821,EAP,CPT® 88271,,"Fish, Mult Myel, 1q21,100-300 Cells(SO)",$231.00,$11.98,$231.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$231.00,$22.49,$59.86,$182.95,$184.80,$31.06,$33.72,$21.42,$23.60,$21.42
30000822,EAP,CPT® 88275,,"Fish, Myeloid Neopl, MECOM,DNA Probe(SO)-1",$251.00,$25.78,$251.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$251.00,$53.75,$112.22,$198.79,$200.80,$74.23,$63.21,$51.19,$44.25,$51.19
30000823,EAP,CPT® 88271,,"Fish, Myeloid Neopl, MECOM,DNA Probe(SO)-2",$251.00,$11.98,$251.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$251.00,$22.49,$59.86,$198.79,$200.80,$31.06,$33.72,$21.42,$23.60,$21.42
30000824,EAP,CPT® 88271,,"Fish, Myeloid Neopl, MECOM,DNA Probe(SO)-3",$251.00,$11.98,$251.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$251.00,$22.49,$59.86,$198.79,$200.80,$31.06,$33.72,$21.42,$23.60,$21.42
30000825,EAP,CPT® 88271,,"Fish, Myeloid Neoplasms, MECOM,100-300 Cells(SO)",$251.00,$11.98,$251.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$251.00,$22.49,$59.86,$198.79,$200.80,$31.06,$33.72,$21.42,$23.60,$21.42
30000826,EAP,CPT® 88275,,"Fish, High-Grade LymphPanel,DNA Probe(SO)-1",$312.00,$25.78,$312.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$312.00,$53.75,$112.22,$247.10,$249.60,$74.23,$63.21,$51.19,$44.25,$51.19
30000827,EAP,CPT® 88271,,"Fish, High-Grade LymphPanel,DNA Probe(SO)-2",$312.00,$11.98,$312.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$312.00,$22.49,$59.86,$247.10,$249.60,$31.06,$33.72,$21.42,$23.60,$21.42
30000828,EAP,CPT® 88271,,"Fish, High-Grade LymphPanel,DNA Probe(SO)-3",$312.00,$11.98,$312.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$312.00,$22.49,$59.86,$247.10,$249.60,$31.06,$33.72,$21.42,$23.60,$21.42
30000829,EAP,CPT® 88271,,"Fish, High-Grade LymphPanel,DNA Probe(SO)-4",$312.00,$11.98,$312.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$312.00,$22.49,$59.86,$247.10,$249.60,$31.06,$33.72,$21.42,$23.60,$21.42
30000830,EAP,CPT® 88271,,"Fish, High-Grade LymphPanel,DNA Probe(SO)-5",$312.00,$11.98,$312.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$312.00,$22.49,$59.86,$247.10,$249.60,$31.06,$33.72,$21.42,$23.60,$21.42
30000831,EAP,CPT® 88271,,"Fish, High-Grade LymphPanel,DNA Probe(SO)-6",$312.00,$11.98,$312.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$312.00,$22.49,$59.86,$247.10,$249.60,$31.06,$33.72,$21.42,$23.60,$21.42
30000832,EAP,CPT® 88271,,"Fish, High-Grade LymphPanel,100-300 Cells(SO)-1",$312.00,$11.98,$312.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$312.00,$22.49,$59.86,$247.10,$249.60,$31.06,$33.72,$21.42,$23.60,$21.42
30000833,EAP,CPT® 88275,,"Fish, High-Grade LymphPanel,100-300 Cells(SO)-2",$312.00,$25.78,$312.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$312.00,$53.75,$112.22,$247.10,$249.60,$74.23,$63.21,$51.19,$44.25,$51.19
30000834,EAP,CPT® 88275,,"Fish, High-Grade LymphPanel,100-300 Cells(SO)-3",$312.00,$25.78,$312.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$312.00,$53.75,$112.22,$247.10,$249.60,$74.23,$63.21,$51.19,$44.25,$51.19
30000835,EAP,CPT® 88275,,"CLL Prognostic Panel, Comp,First Marker(SO)",$129.00,$25.78,$129.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$129.00,$53.75,$112.22,$102.17,$103.20,$74.23,$63.21,$51.19,$44.25,$51.19
30000836,EAP,CPT® 88184,,"CLL Prognostic Panel, Comp,Add  Marker(SO)-1",$500.00,$34.11,$500.00,$80.30,$79.23,$271.76,$34.11,$79.23,$79.23,$54.16,$500.00,$284.24,$133.74,$396.00,$400.00,$394.92,$57.71,$68.07,$40.40,$270.71
30000837,EAP,CPT® 88185,,"CLL Prognostic Panel, Comp,Add  Marker(SO)-2",$77.00,$0.00,$77.00,$49.02,$47.05,$0.00,$12.52,$47.05,$47.05,$26.63,$77.00,$0.00,$71.72,$60.98,$61.60,$0.00,$28.37,$22.33,$19.86,$0.00
30000838,EAP,CPT® 88185,,"CLL Prognostic Panel,Comp,Beta-2(SO)",$77.00,$0.00,$77.00,$49.02,$47.05,$0.00,$12.52,$47.05,$47.05,$26.63,$77.00,$0.00,$71.72,$60.98,$61.60,$0.00,$28.37,$22.33,$19.86,$0.00
30000839,EAP,CPT® 82232,,"CLL Prognostic Panel, Comp,DNA Probe(SO)-1",$242.00,$9.05,$242.00,$28.84,$23.62,$22.02,$9.05,$23.62,$23.62,$23.91,$242.00,$16.99,$45.22,$191.66,$193.60,$23.46,$25.48,$16.18,$17.83,$16.18
30000840,EAP,CPT® 88271,,"CLL Prognostic Panel, Comp,DNA Probe(SO)-2",$129.00,$11.98,$129.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$129.00,$22.49,$59.86,$102.17,$103.20,$31.06,$33.72,$21.42,$23.60,$21.42
30000841,EAP,CPT® 88271,,"CLL Prognostic Panel, Comp,DNA Probe(SO)-3",$129.00,$11.98,$129.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$129.00,$22.49,$59.86,$102.17,$103.20,$31.06,$33.72,$21.42,$23.60,$21.42
30000842,EAP,CPT® 88271,,"CLL Prognostic Panel, Comp,DNA Probe(SO)-4",$129.00,$11.98,$129.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$129.00,$22.49,$59.86,$102.17,$103.20,$31.06,$33.72,$21.42,$23.60,$21.42
30000843,EAP,CPT® 88271,,"CLL Prognostic Panel, Comp,DNA Probe(SO)-5",$129.00,$11.98,$129.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$129.00,$22.49,$59.86,$102.17,$103.20,$31.06,$33.72,$21.42,$23.60,$21.42
30000844,EAP,CPT® 88271,,"CLL Prognostic Panel, Comp,100-300 Cells(SO)-1",$129.00,$11.98,$129.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$129.00,$22.49,$59.86,$102.17,$103.20,$31.06,$33.72,$21.42,$23.60,$21.42
30000845,EAP,CPT® 88275,,"CLL Prognostic Panel, Comp,100-300 Cells(SO)-2",$129.00,$25.78,$129.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$129.00,$53.75,$112.22,$102.17,$103.20,$74.23,$63.21,$51.19,$44.25,$51.19
30000846,EAP,CPT® 88275,,"CLL Prognostic Panel, Comp,100-300 Cells(SO)-3",$129.00,$25.78,$129.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$129.00,$53.75,$112.22,$102.17,$103.20,$74.23,$63.21,$51.19,$44.25,$51.19
30000847,EAP,CPT® 88275,,"CLL Prognostic Panel, Comp,100-300 Cells(SO)-4",$129.00,$25.78,$129.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$129.00,$53.75,$112.22,$102.17,$103.20,$74.23,$63.21,$51.19,$44.25,$51.19
30000848,EAP,CPT® 88275,,"CLL Prognostic Panel, Comp,100-300 Cells(SO)-5",$129.00,$25.78,$129.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$129.00,$53.75,$112.22,$102.17,$103.20,$74.23,$63.21,$51.19,$44.25,$51.19
30000849,EAP,CPT® 88275,,"CLL Lymphoma Follow-up Panel,First Marker(SO)",$119.00,$25.78,$119.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$119.00,$53.75,$112.22,$94.25,$95.20,$74.23,$63.21,$51.19,$44.25,$51.19
30000850,EAP,CPT® 88184,,"CLL Lymphoma Follow-up Panel,Add Marker(SO)-1",$500.00,$34.11,$500.00,$80.30,$79.23,$271.76,$34.11,$79.23,$79.23,$54.16,$500.00,$284.24,$133.74,$396.00,$400.00,$394.92,$57.71,$68.07,$40.40,$270.71
30000851,EAP,CPT® 88185,,"CLL Lymphoma Follow-up Panel,Add Marker(SO)-2",$71.00,$0.00,$71.00,$49.02,$47.05,$0.00,$12.52,$47.05,$47.05,$26.63,$71.00,$0.00,$71.00,$56.23,$56.80,$0.00,$28.37,$22.33,$19.86,$0.00
30000852,EAP,CPT® 88185,,"CLL Lymphoma Follow-up Panel,Add Marker(SO)-3",$71.00,$0.00,$71.00,$49.02,$47.05,$0.00,$12.52,$47.05,$47.05,$26.63,$71.00,$0.00,$71.00,$56.23,$56.80,$0.00,$28.37,$22.33,$19.86,$0.00
30000853,EAP,CPT® 88185,,"CLL Lymphoma Follow-up Panel,Add Marker(SO)-4",$71.00,$0.00,$71.00,$49.02,$47.05,$0.00,$12.52,$47.05,$47.05,$26.63,$71.00,$0.00,$71.00,$56.23,$56.80,$0.00,$28.37,$22.33,$19.86,$0.00
30000854,EAP,CPT® 88185,,"CLL Lymphoma Follow-up Panel,Add Marker(SO)-5",$71.00,$0.00,$71.00,$49.02,$47.05,$0.00,$12.52,$47.05,$47.05,$26.63,$71.00,$0.00,$71.00,$56.23,$56.80,$0.00,$28.37,$22.33,$19.86,$0.00
30000855,EAP,CPT® 88185,,"CLL Lymphoma Follow-up Panel,Add Marker(SO)-6",$71.00,$0.00,$71.00,$49.02,$47.05,$0.00,$12.52,$47.05,$47.05,$26.63,$71.00,$0.00,$71.00,$56.23,$56.80,$0.00,$28.37,$22.33,$19.86,$0.00
30000856,EAP,CPT® 88185,,"CLL Lymphoma Follow-up Panel,Add Marker(SO)-7",$71.00,$0.00,$71.00,$49.02,$47.05,$0.00,$12.52,$47.05,$47.05,$26.63,$71.00,$0.00,$71.00,$56.23,$56.80,$0.00,$28.37,$22.33,$19.86,$0.00
30000857,EAP,CPT® 88185,,"CLL Lymphoma Follow-up Panel,Add Marker(SO)-8",$71.00,$0.00,$71.00,$49.02,$47.05,$0.00,$12.52,$47.05,$47.05,$26.63,$71.00,$0.00,$71.00,$56.23,$56.80,$0.00,$28.37,$22.33,$19.86,$0.00
30000858,EAP,CPT® 88185,,"CLL Lymphoma Follow-up Panel,Add Marker(SO)-9",$71.00,$0.00,$71.00,$49.02,$47.05,$0.00,$12.52,$47.05,$47.05,$26.63,$71.00,$0.00,$71.00,$56.23,$56.80,$0.00,$28.37,$22.33,$19.86,$0.00
30000859,EAP,CPT® 88185,,"CLL Lymphoma Follow-up Panel,Add Marker(SO)-10",$71.00,$0.00,$71.00,$49.02,$47.05,$0.00,$12.52,$47.05,$47.05,$26.63,$71.00,$0.00,$71.00,$56.23,$56.80,$0.00,$28.37,$22.33,$19.86,$0.00
30000860,EAP,CPT® 88185,,"CLL Lymphoma Follow-up Panel,Add Marker(SO)-11",$71.00,$0.00,$71.00,$49.02,$47.05,$0.00,$12.52,$47.05,$47.05,$26.63,$71.00,$0.00,$71.00,$56.23,$56.80,$0.00,$28.37,$22.33,$19.86,$0.00
30000861,EAP,CPT® 88185,,"CLL Lymphoma Follow-up Panel,Add Marker(SO)-12",$71.00,$0.00,$71.00,$49.02,$47.05,$0.00,$12.52,$47.05,$47.05,$26.63,$71.00,$0.00,$71.00,$56.23,$56.80,$0.00,$28.37,$22.33,$19.86,$0.00
30000862,EAP,CPT® 88185,,"CLL Lymphoma Follow-up Panel,Add Marker(SO)-13",$71.00,$0.00,$71.00,$49.02,$47.05,$0.00,$12.52,$47.05,$47.05,$26.63,$71.00,$0.00,$71.00,$56.23,$56.80,$0.00,$28.37,$22.33,$19.86,$0.00
30000863,EAP,CPT® 88185,,"CLL Lymphoma Follow-up Panel,Add Marker(SO)-14",$71.00,$0.00,$71.00,$49.02,$47.05,$0.00,$12.52,$47.05,$47.05,$26.63,$71.00,$0.00,$71.00,$56.23,$56.80,$0.00,$28.37,$22.33,$19.86,$0.00
30000864,EAP,CPT® 88185,,"CLL Lymphoma Follow-up Panel,9-15 Markers(SO)",$71.00,$0.00,$71.00,$49.02,$47.05,$0.00,$12.52,$47.05,$47.05,$26.63,$71.00,$0.00,$71.00,$56.23,$56.80,$0.00,$28.37,$22.33,$19.86,$0.00
30000865,EAP,CPT® 88188,,"Cll Lymphoma Follow-up Panel,9-15 Markers(so)",$71.00,$0.00,$71.00,$0.00,$50.67,$0.00,$0.00,$50.67,$50.67,$0.00,$71.00,$0.00,$71.00,$56.23,$56.80,$0.00,$0.00,$0.00,$0.00,$0.00
30005065,EAP,CPT® 82948,,"Glu-random,wb Micro",$311.00,$0.00,$311.00,$0.00,$4.63,$0.00,$0.00,$4.63,$4.63,$0.00,$311.00,$0.00,$8.86,$246.31,$248.80,$0.00,$0.00,$0.00,$0.00,$0.00
30040001,EAP,CPT® 86885,,Abid Ea Selected Cell (arc),$150.00,$3.20,$150.00,$10.19,$8.35,$137.60,$3.20,$8.35,$8.35,$8.44,$150.00,$143.92,$15.98,$118.80,$120.00,$150.00,$9.00,$5.72,$6.30,$137.07
30050138,EAP,CPT® 86880,,Direct Coombs,$141.00,$3.02,$141.00,$9.60,$7.84,$32.06,$3.02,$7.84,$7.84,$7.93,$141.00,$33.53,$15.00,$111.67,$112.80,$46.58,$8.45,$5.39,$5.91,$31.93
30050139,EAP,CPT® 86880,,"Dct,anti-igg",$141.00,$3.02,$141.00,$9.60,$7.84,$32.06,$3.02,$7.84,$7.84,$7.93,$141.00,$33.53,$15.00,$111.67,$112.80,$46.58,$8.45,$5.39,$5.91,$31.93
30050140,EAP,CPT® 86880,,"Dct,anti-c3d",$141.00,$3.02,$141.00,$9.60,$7.84,$32.06,$3.02,$7.84,$7.84,$7.93,$141.00,$33.53,$15.00,$111.67,$112.80,$46.58,$8.45,$5.39,$5.91,$31.93
30050141,EAP,CPT® 86886,,Antibody Titer,$147.00,$2.90,$147.00,$8.28,$6.79,$137.60,$2.90,$6.79,$6.79,$6.87,$147.00,$143.92,$13.00,$116.42,$117.60,$147.00,$7.32,$5.18,$5.12,$137.07
30050148,EAP,CPT® 86900,,"Blood Typing, Serologic, Abo",$150.00,$1.67,$150.00,$5.34,$4.35,$104.55,$1.67,$4.35,$4.35,$4.41,$150.00,$109.35,$8.34,$118.80,$120.00,$150.00,$4.70,$2.99,$3.29,$104.14
30050149,EAP,CPT® 86901,,"Blood Typing, Serologic, Rh (d)",$150.00,$1.67,$150.00,$5.34,$4.35,$32.06,$1.67,$4.35,$4.35,$17.04,$150.00,$33.53,$8.34,$118.80,$120.00,$46.58,$18.16,$2.99,$12.71,$31.93
30050300,EAP,CPT® 80354,,Fentanyl - Urine,$236.00,$0.00,$236.00,$0.00,$168.43,$0.00,$0.00,$168.43,$168.43,$0.00,$236.00,$0.00,$118.00,$186.91,$188.80,$0.00,$0.00,$0.00,$0.00,$0.00
30050301,EAP,CPT® 80324,,Amphetamine - Urine,$236.00,$0.00,$236.00,$0.02,$168.43,$42.01,$10.67,$168.43,$168.43,$22.96,$236.00,$0.00,$118.00,$186.91,$188.80,$141.60,$24.47,$0.00,$17.13,$0.00
30050302,EAP,CPT® 80307,,Methaqualone - Urine,$219.00,$32.55,$219.00,$99.36,$76.45,$38.98,$32.55,$76.45,$76.45,$71.85,$219.00,$65.25,$109.50,$173.45,$175.20,$90.10,$76.56,$62.14,$53.59,$62.14
30050303,EAP,CPT® 80367,,Propoxyphene - Urine,$236.00,$0.00,$236.00,$0.00,$168.43,$0.00,$0.00,$168.43,$168.43,$0.00,$236.00,$0.00,$118.00,$186.91,$188.80,$0.00,$0.00,$0.00,$0.00,$0.00
30050420,EAP,CPT® 85347,,Act,$94.00,$2.38,$94.00,$7.59,$6.22,$5.79,$2.38,$6.22,$6.22,$6.30,$94.00,$4.49,$11.90,$74.45,$75.20,$6.21,$6.71,$4.28,$4.70,$4.28
30050421,EAP,CPT® 83018,,Quantitative Screen Metals,$210.00,$0.00,$210.00,$0.00,$32.06,$0.00,$0.00,$32.06,$32.06,$0.00,$210.00,$0.00,$61.36,$166.32,$168.00,$0.00,$0.00,$0.00,$0.00,$0.00
30050422,EAP,CPT® 84311,,Spectrophotometry,$262.00,$4.08,$262.00,$12.47,$10.20,$9.52,$4.08,$10.20,$10.20,$10.32,$262.00,$8.51,$19.54,$207.50,$209.60,$11.75,$11.00,$8.10,$7.70,$8.10
30050423,EAP,CPT® 83519,,Ria Nonantibody,"$1,449.00",$9.26,"$1,449.00",$24.08,$19.73,$18.39,$9.26,$19.73,$19.73,$19.96,"$1,449.00",$19.32,$37.76,"$1,147.61","$1,159.20",$26.68,$21.27,$18.40,$14.89,$18.40
30050424,EAP,CPT® 86765,,Rubeola Antibody,$100.00,$7.21,$100.00,$22.96,$18.81,$11.13,$7.21,$18.81,$18.81,$19.03,$100.00,$13.52,$36.00,$79.20,$80.00,$18.68,$20.27,$12.88,$14.19,$12.88
30050425,EAP,CPT® 86022,,Platelet Antibodies,$112.00,$0.00,$112.00,$0.00,$26.82,$0.00,$0.00,$26.82,$26.82,$0.00,$112.00,$0.00,$51.32,$88.70,$89.60,$0.00,$0.00,$0.00,$0.00,$0.00
30050426,EAP,CPT® 82480,,Assay Serum Cholinesterase,$43.00,$0.00,$43.00,$0.00,$11.51,$0.00,$0.00,$11.51,$11.51,$0.00,$43.00,$0.00,$22.02,$34.06,$34.40,$0.00,$0.00,$0.00,$0.00,$0.00
30050427,EAP,CPT® 82638,,Assay Of Dibucaine Number,$49.00,$0.00,$49.00,$0.00,$17.88,$0.00,$0.00,$17.88,$17.88,$0.00,$49.00,$0.00,$34.22,$38.81,$39.20,$0.00,$0.00,$0.00,$0.00,$0.00
30050428,EAP,CPT® 88360,,Tumor Immunohistochem/manual,$911.00,$65.32,$911.00,$184.86,$65.70,$137.60,$65.32,$65.70,$65.70,$114.71,$911.00,$143.92,$121.34,$721.51,$728.80,$199.96,$122.23,$83.20,$85.56,$137.07
30050435,EAP,CPT® 86790,,Virus Antibody Nos,$336.00,$7.21,$336.00,$22.96,$18.81,$11.13,$7.21,$18.81,$18.81,$19.03,$336.00,$13.52,$36.00,$266.11,$268.80,$18.68,$20.27,$12.88,$14.19,$12.88
30050436,EAP,CPT® 87380,,Hepatitis Delta Ag Eia,$202.00,$0.00,$202.00,$0.00,$23.98,$0.00,$0.00,$23.98,$23.98,$0.00,$202.00,$0.00,$45.88,$159.98,$161.60,$0.00,$0.00,$0.00,$0.00,$0.00
30050437,EAP,CPT® 87502,,Influenza Dna Amp Probe,$636.00,$48.23,$636.00,$92.50,$73.04,$95.42,$48.23,$73.04,$73.04,$68.64,$636.00,$100.59,$318.00,$503.71,$508.80,$138.91,$73.14,$95.80,$51.20,$95.80
30050438,EAP,CPT® 83520,,Immunoassay Auant Nos Nonab,"$2,501.00",$8.69,"$2,501.00",$23.07,$18.91,$17.62,$8.69,$18.91,$18.91,$19.12,"$2,501.00",$18.13,$36.18,"$1,980.79","$2,000.80",$25.04,$20.37,$17.27,$14.26,$17.27
30050439,EAP,CPT® 84145,,Procalcitonin - Serum,$207.00,$14.99,$207.00,$47.77,$27.76,$36.45,$14.99,$27.76,$27.76,$28.27,$207.00,$28.58,$103.50,$163.94,$165.60,$39.47,$30.12,$27.22,$21.08,$27.22
30050440,EAP,CPT® 85999,,"Eosinophil Smear, Urine",$63.00,$0.00,$63.00,$0.00,$44.96,$0.00,$0.00,$44.96,$44.96,$0.00,$63.00,$0.00,$0.00,$49.90,$50.40,$0.00,$0.00,$0.00,$0.00,$0.00
30050441,EAP,HCPCS 89055,,Fecal Leukocyte Smear,$118.00,$0.00,$118.00,$0.00,$3.43,$0.00,$0.00,$3.43,$3.43,$0.00,$118.00,$0.00,$6.56,$93.46,$94.40,$0.00,$0.00,$0.00,$0.00,$0.00
30050442,EAP,CPT® 87498,,"Enterovirus Rna, Qual, Rt-pcr So",$111.00,$0.00,$111.00,$0.00,$28.64,$0.00,$0.00,$28.64,$28.64,$0.00,$111.00,$0.00,$54.82,$87.91,$88.80,$0.00,$0.00,$0.00,$0.00,$0.00
30050443,EAP,CPT® 89055,,Fecal Leukocyte Smear,$118.00,$0.00,$118.00,$0.00,$3.43,$0.00,$0.00,$3.43,$3.43,$0.00,$118.00,$0.00,$6.56,$93.46,$94.40,$0.00,$0.00,$0.00,$0.00,$0.00
30050445,EAP,CPT® 81403,,"JAK2-EXONS-12,13 SEQ",$967.00,$93.24,$967.00,$228.00,$690.15,$172.13,$93.24,$690.15,$690.15,$220.85,$967.00,$194.46,$483.50,$765.86,$773.60,$268.54,$235.32,$185.20,$164.72,$185.20
30050446,EAP,CPT® 86021,,Proteinase -3 Antibody (so),$150.00,$8.42,$150.00,$26.84,$21.98,$20.49,$8.42,$21.98,$21.98,$22.24,$150.00,$15.80,$42.06,$118.80,$120.00,$21.82,$23.70,$15.05,$16.59,$15.05
30050447,EAP,CPT® 81261,,"B-cell Recep Igh Gene Rearrangement , Pcr (so)",$694.00,$0.00,$694.00,$0.00,$270.11,$0.00,$110.76,$270.11,$270.11,$286.64,$694.00,$0.00,$347.00,$549.65,$555.20,$0.00,$305.42,$0.00,$0.00,$0.00
30050448,EAP,CPT® 81264,,"B-cell Recep Igk Gene Rearrangement , Pcr (so)",$694.00,$0.00,$694.00,$0.00,$203.72,$0.00,$86.96,$203.72,$203.72,$115.59,$694.00,$0.00,$347.00,$549.65,$555.20,$0.00,$123.17,$0.00,$0.00,$0.00
30050449,EAP,CPT® 88271,,MOLECULAR CYTOGENETICS; DNA PROBE( FISH) (SO),"$1,064.00",$11.98,"$1,064.00",$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,"$1,064.00",$22.49,$59.86,$842.69,$851.20,$31.06,$33.72,$21.42,$23.60,$21.42
30050450,EAP,CPT® 88274,,Interphase In Situ Hybridization (25-99) Cells (so),$533.00,$21.34,$533.00,$62.06,$50.82,$47.37,$21.34,$50.82,$50.82,$51.42,$533.00,$44.50,$97.26,$422.14,$426.40,$61.45,$54.79,$42.38,$38.35,$42.38
30050451,EAP,CPT® 81342,,"T - Cell Receptor Gamma Gene Rearrangement, Pcr (so)","$1,163.00",$0.00,"$1,163.00",$0.00,$274.90,$0.00,$0.00,$274.90,$274.90,$0.00,"$1,163.00",$0.00,$581.50,$921.10,$930.40,$0.00,$0.00,$0.00,$0.00,$0.00
30050452,EAP,CPT® 88271,,Molecular Cytogenetics; Dna Probe( Fish) (so),$501.00,$11.98,$501.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$501.00,$22.49,$59.86,$396.79,$400.80,$31.06,$33.72,$21.42,$23.60,$21.42
30050454,EAP,CPT® 88271,,MOLECULAR CYTOGENETICS; DNA PROBE( FISH) (SO),$555.00,$11.98,$555.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$555.00,$22.49,$59.86,$439.56,$444.00,$31.06,$33.72,$21.42,$23.60,$21.42
30050455,EAP,CPT® 88275,,INTERPHASE IN SITU HYBRIDIZATION (100-300) CELLS (SO),$278.00,$25.78,$278.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$278.00,$53.75,$112.22,$220.18,$222.40,$74.23,$63.21,$51.19,$44.25,$51.19
30050456,EAP,CPT® 81331,,"Prader-willi/angelman Syndrome , Dna Methylation (so)",$672.00,$0.00,$672.00,$0.00,$479.61,$0.00,$0.00,$479.61,$479.61,$0.00,$672.00,$0.00,$336.00,$532.22,$537.60,$0.00,$0.00,$0.00,$0.00,$0.00
30050457,EAP,CPT® 88275,,Interphase In Situ Hybridization (100-300) Cells (so),$251.00,$25.78,$251.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$251.00,$53.75,$112.22,$198.79,$200.80,$74.23,$63.21,$51.19,$44.25,$51.19
30050458,EAP,CPT® 88271,,MOLECULAR CYTOGENETICS; DNA PROBE( FISH) (SO),$478.00,$11.98,$478.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$478.00,$22.49,$59.86,$378.58,$382.40,$31.06,$33.72,$21.42,$23.60,$21.42
30050459,EAP,CPT® 88275,,INTERPHASE IN SITU HYBRIDIZATION (100-300) CELLS (SO),$240.00,$25.78,$240.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$240.00,$53.75,$112.22,$190.08,$192.00,$74.23,$63.21,$51.19,$44.25,$51.19
30050460,EAP,CPT® 88271,,Molecular Cytogenetics; Dna Probe( Fish) (so)cml,$478.00,$11.98,$478.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$478.00,$22.49,$59.86,$378.58,$382.40,$31.06,$33.72,$21.42,$23.60,$21.42
30050461,EAP,CPT® 88275,,Interphase In Situ Hybridization (100-300) Cells (so)cml,$240.00,$25.78,$240.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$240.00,$53.75,$112.22,$190.08,$192.00,$74.23,$63.21,$51.19,$44.25,$51.19
30050462,EAP,CPT® 81315,,Pml/rara T(15;17) Quant (pcr) (so),$762.00,$0.00,$762.00,$0.00,$282.83,$0.00,$0.00,$282.83,$282.83,$0.00,$762.00,$0.00,$381.00,$603.50,$609.60,$0.00,$0.00,$0.00,$0.00,$0.00
30050463,EAP,CPT® 81210,,Braf Mutation Analysis (so),"$1,066.00",$86.22,"$1,066.00",$234.22,$179.25,$178.80,$88.31,$179.25,$179.25,$115.59,"$1,066.00",$184.17,$533.00,$844.27,$852.80,$254.33,$123.17,$175.40,$86.22,$175.40
30050464,EAP,CPT® 82172,,Apoliprotein (so),$57.00,$10.62,$57.00,$27.63,$22.62,$19.23,$10.62,$22.62,$22.62,$22.90,$57.00,$22.14,$43.30,$45.14,$45.60,$30.58,$24.40,$21.09,$17.08,$21.09
30050465,EAP,CPT® 86738,,"Mycoplasma Pneumoniae Antibody (igg), Ifa, Csf (so)",$98.00,$7.41,$98.00,$23.60,$19.34,$11.13,$7.41,$19.34,$19.34,$19.57,$98.00,$13.90,$37.02,$77.62,$78.40,$19.20,$20.85,$13.24,$14.60,$13.24
30050466,EAP,CPT® 81401,,Cbfb/myh11 Inv(16) Quant Pcr (so),$640.00,$56.09,$640.00,$56.09,$456.77,$113.92,$68.97,$456.77,$456.77,$131.58,$640.00,$143.85,$320.00,$506.88,$512.00,$198.65,$140.20,$137.00,$98.14,$137.00
30050467,EAP,CPT® 81404,,C-kit Mutation Analysis (so),"$2,080.00",$138.36,"$2,080.00",$399.00,"$1,484.50",$370.24,$138.36,"$1,484.50","$1,484.50",$286.64,"$2,080.00",$288.57,"$1,040.00","$1,647.36","$1,664.00",$398.50,$305.42,$274.83,$213.79,$274.83
30050468,EAP,CPT® 87798,,"Bordetella Pertussis/parapertussis Dna, Pcr (so)",$566.00,$19.63,$566.00,$34.98,$28.64,$37.59,$19.63,$28.64,$28.64,$28.98,$566.00,$36.84,$54.82,$448.27,$452.80,$50.88,$30.88,$35.09,$21.62,$35.09
30050469,EAP,CPT® 86255,,"Nmda- Receptor Antibody , Csf(mayo)",$464.00,$6.75,$464.00,$21.48,$17.60,$16.40,$6.75,$17.60,$17.60,$17.81,$464.00,$12.65,$33.68,$367.49,$371.20,$17.47,$18.97,$12.05,$13.28,$12.05
30050470,EAP,CPT® 87661,,"Trichomonas Vaginalis Rna, Qualitative, Tma (so)",$153.00,$18.76,$153.00,$34.98,$26.77,$37.59,$19.63,$26.77,$26.77,$25.16,$153.00,$36.84,$76.50,$121.18,$122.40,$50.88,$26.81,$35.09,$18.76,$35.09
30050471,EAP,CPT® 86256,,Agna-1 (mayo),$108.00,$6.75,$108.00,$21.48,$17.60,$16.40,$6.75,$17.60,$17.60,$17.81,$108.00,$12.65,$33.68,$85.54,$86.40,$17.47,$18.97,$12.05,$13.28,$12.05
30050472,EAP,CPT® 86256,,Amphiphysin (mayo),$70.00,$6.75,$70.00,$21.48,$17.60,$16.40,$6.75,$17.60,$17.60,$17.81,$70.00,$12.65,$33.68,$55.44,$56.00,$17.47,$18.97,$12.05,$13.28,$12.05
30050473,EAP,CPT® 86256,,Anna-1 (mayo),$70.00,$6.75,$70.00,$21.48,$17.60,$16.40,$6.75,$17.60,$17.60,$17.81,$70.00,$12.65,$33.68,$55.44,$56.00,$17.47,$18.97,$12.05,$13.28,$12.05
30050474,EAP,CPT® 86256,,Anna-2 (mayo),$70.00,$6.75,$70.00,$21.48,$17.60,$16.40,$6.75,$17.60,$17.60,$17.81,$70.00,$12.65,$33.68,$55.44,$56.00,$17.47,$18.97,$12.05,$13.28,$12.05
30050475,EAP,CPT® 86256,,Anna-3 (mayo),$70.00,$6.75,$70.00,$21.48,$17.60,$16.40,$6.75,$17.60,$17.60,$17.81,$70.00,$12.65,$33.68,$55.44,$56.00,$17.47,$18.97,$12.05,$13.28,$12.05
30050476,EAP,CPT® 86256,,Crmp-5-igg,$70.00,$6.75,$70.00,$21.48,$17.60,$16.40,$6.75,$17.60,$17.60,$17.81,$70.00,$12.65,$33.68,$55.44,$56.00,$17.47,$18.97,$12.05,$13.28,$12.05
30050477,EAP,CPT® 86256,,Pca-1 (mayo),$70.00,$6.75,$70.00,$21.48,$17.60,$16.40,$6.75,$17.60,$17.60,$17.81,$70.00,$12.65,$33.68,$55.44,$56.00,$17.47,$18.97,$12.05,$13.28,$12.05
30050478,EAP,CPT® 86256,,Pca-2 (mayo),$70.00,$6.75,$70.00,$21.48,$17.60,$16.40,$6.75,$17.60,$17.60,$17.81,$70.00,$12.65,$33.68,$55.44,$56.00,$17.47,$18.97,$12.05,$13.28,$12.05
30050479,EAP,CPT® 86256,,Pca-tr (mayo),$70.00,$6.75,$70.00,$21.48,$17.60,$16.40,$6.75,$17.60,$17.60,$17.81,$70.00,$12.65,$33.68,$55.44,$56.00,$17.47,$18.97,$12.05,$13.28,$12.05
30050481,EAP,CPT® 87912,,"Hepatitis B Virus Drug Resistance, Genotype (so)",$606.00,$0.00,$606.00,$0.00,$359.15,$0.00,$0.00,$359.15,$359.15,$0.00,$606.00,$0.00,$303.00,$479.95,$484.80,$0.00,$0.00,$0.00,$0.00,$0.00
30050482,EAP,CPT® 81402,,"Follicular Lymphoma, Pcr (so)","$1,191.00",$0.00,"$1,191.00",$0.00,$850.02,$0.00,$0.00,$850.02,$850.02,$0.00,"$1,191.00",$0.00,$595.50,$943.27,$952.80,$0.00,$0.00,$0.00,$0.00,$0.00
30050483,EAP,CPT® 81401,,"Mantle Cell Lymphoma, Pcr (so)","$1,329.00",$56.09,"$1,329.00",$56.09,$948.51,$236.56,$68.97,$948.51,$948.51,$131.58,"$1,329.00",$143.85,$664.50,"$1,052.57","$1,063.20",$198.65,$140.20,$137.00,$98.14,$137.00
30050484,EAP,CPT® 88271,,Molecular Cytogenetics: Dna Probe (fish) (so) Nhl,$511.00,$11.98,$511.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$511.00,$22.49,$59.86,$404.71,$408.80,$31.06,$33.72,$21.42,$23.60,$21.42
30050485,EAP,CPT® 88275,,Interphase In Situ Hybridization(100-300) Cells (so) Nhl,$256.00,$25.78,$256.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$256.00,$53.75,$112.22,$202.75,$204.80,$74.23,$63.21,$51.19,$44.25,$51.19
30050486,EAP,CPT® 88271,,Molecular Cytogenetics: Dna Probe (fish) (so) Fol,$613.00,$11.98,$613.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$613.00,$22.49,$59.86,$485.50,$490.40,$31.06,$33.72,$21.42,$23.60,$21.42
30050487,EAP,CPT® 88275,,Interphase In Situ Hybridization(100-300) Cells (so) Fol,$307.00,$25.78,$307.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$307.00,$53.75,$112.22,$243.14,$245.60,$74.23,$63.21,$51.19,$44.25,$51.19
30050488,EAP,CPT® 83520,,Ganglioside Gq1b Antibody (igg)(so),$288.00,$8.69,$288.00,$23.07,$18.91,$17.62,$8.69,$18.91,$18.91,$19.12,$288.00,$18.13,$36.18,$228.10,$230.40,$25.04,$20.37,$17.27,$14.26,$17.27
30050489,EAP,CPT® 81210,,"Melanoma, Braf V600 Mutation (so)","$1,464.00",$86.22,"$1,464.00",$234.22,$179.25,$178.80,$88.31,$179.25,$179.25,$115.59,"$1,464.00",$184.17,$732.00,"$1,159.49","$1,171.20",$254.33,$123.17,$175.40,$86.22,$175.40
30050490,EAP,CPT® 81404,,"Nras, Mutation Analysis (so)",$762.00,$135.64,$762.00,$399.00,$543.84,$135.64,$138.36,$543.84,$543.84,$286.64,$762.00,$288.57,$381.00,$603.50,$609.60,$398.50,$305.42,$274.83,$213.79,$274.83
30050491,EAP,CPT® 83520,,Interleukin -2 (il-2) (so),$321.00,$8.69,$321.00,$23.07,$18.91,$17.62,$8.69,$18.91,$18.91,$19.12,$321.00,$18.13,$36.18,$254.23,$256.80,$25.04,$20.37,$17.27,$14.26,$17.27
30050492,EAP,CPT® 86255,,Nmo/aqp4-igg Cba (mayo),$69.00,$6.75,$69.00,$21.48,$17.60,$16.40,$6.75,$17.60,$17.60,$17.81,$69.00,$12.65,$33.68,$54.65,$55.20,$17.47,$18.97,$12.05,$13.28,$12.05
30050493,EAP,CPT® 86341,,Gad65 Abs (mayo),$66.00,$11.87,$66.00,$35.27,$28.89,$19.44,$11.87,$28.89,$28.89,$29.24,$66.00,$24.75,$55.30,$52.27,$52.80,$34.18,$31.16,$23.57,$21.81,$23.57
30050495,EAP,CPT® 86255,,"Nmo/aqp4-igg Cba, Csf (mayo)",$578.00,$6.75,$578.00,$21.48,$17.60,$16.40,$6.75,$17.60,$17.60,$17.81,$578.00,$12.65,$33.68,$457.78,$462.40,$17.47,$18.97,$12.05,$13.28,$12.05
30050496,EAP,CPT® 81170,,Abl Kinase Domain Mutation In Cml (so),"$1,136.00",$151.04,"$1,136.00",$431.24,$329.51,$202.21,$151.04,$329.51,$329.51,$309.68,"$1,136.00",$315.00,$568.00,$899.71,$908.80,$435.00,$329.97,$300.00,$230.98,$300.00
30050497,EAP,CPT® 86003,,Allergen Specific (mold Group),$249.00,$2.92,$249.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$249.00,$5.48,$14.60,$197.21,$199.20,$7.57,$8.22,$5.22,$5.76,$5.22
30050500,EAP,CPT® 80361,,Monacetylmorphine-free-6,$546.00,$0.00,$546.00,$0.02,$389.68,$97.19,$13.36,$389.68,$389.68,$30.51,$546.00,$0.00,$273.00,$432.43,$436.80,$327.60,$32.51,$0.00,$22.76,$0.00
30050501,EAP,CPT® 87902,,Hepatits C Viral Rna Ns3 Genotype (so),"$1,294.00",$96.09,"$1,294.00",$155.47,$127.33,$300.79,$144.01,$127.33,$127.33,$128.84,"$1,294.00",$270.32,$243.70,"$1,024.85","$1,035.20",$373.30,$137.28,$257.45,$96.09,$257.45
30050503,EAP,CPT® 88342,,Platelet Function Plavix( Clopidogrel),$296.00,$54.62,$296.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$296.00,$143.92,$106.46,$234.43,$236.80,$199.96,$89.59,$70.23,$62.72,$137.07
30050520,EAP,CPT® 86361,,T Cell; Absolute Cd4 Count,$115.00,$13.85,$115.00,$46.56,$38.11,$13.85,$14.98,$38.11,$38.11,$38.56,$115.00,$28.12,$72.94,$91.08,$92.00,$38.83,$41.08,$26.78,$28.76,$26.78
30050521,EAP,CPT® 85004,,Automated Differential Wbc Count,$83.00,$0.00,$83.00,$0.00,$9.45,$0.00,$0.00,$9.45,$9.45,$0.00,$83.00,$0.00,$18.08,$65.74,$66.40,$0.00,$0.00,$0.00,$0.00,$0.00
30050550,EAP,CPT® 83520,,Phospholipase A2 Ab Quant (so),$412.00,$8.69,$412.00,$23.07,$18.91,$17.62,$8.69,$18.91,$18.91,$19.12,$412.00,$18.13,$36.18,$326.30,$329.60,$25.04,$20.37,$17.27,$14.26,$17.27
30050560,EAP,CPT® 86255,,Phospholipase A2 Scrn (so),$263.00,$6.75,$263.00,$21.48,$17.60,$16.40,$6.75,$17.60,$17.60,$17.81,$263.00,$12.65,$33.68,$208.30,$210.40,$17.47,$18.97,$12.05,$13.28,$12.05
30050561,EAP,CPT® 81162,,Brca1&2 Seq & Full Dup/del (so),"$3,685.00",$655.93,"$3,685.00","$3,253.24","$2,485.86",$655.93,"$1,020.84","$2,485.86","$2,485.86","$2,336.20","$3,685.00","$1,916.12","$1,842.50","$2,918.52","$2,948.00","$2,646.08","$2,489.27","$1,824.88","$1,742.49","$1,824.88"
30050562,EAP,HCPCS C9803,,Op Specimen Collection For (sars-cov-2) Covid-19,$57.00,$0.00,$57.00,$30.95,$40.68,$22.05,$9.82,$40.68,$40.68,$9.98,$57.00,$23.06,$28.50,$45.14,$45.60,$32.04,$8.92,$0.00,$9.07,$21.96
30100001,EAP,CPT® 80299,,Oxycarbazepine So,$122.00,$9.39,$122.00,$24.21,$17.58,$15.07,$9.39,$17.58,$17.58,$17.79,$122.00,$19.57,$33.64,$96.62,$97.60,$27.03,$18.95,$18.64,$13.27,$18.64
30100003,EAP,CPT® 80051,,"Chem 4, Electrolyte Panel",$230.00,$3.93,$230.00,$12.49,$10.24,$9.55,$3.93,$10.24,$10.24,$10.36,$230.00,$7.36,$19.60,$182.16,$184.00,$10.16,$11.04,$7.01,$7.73,$7.01
30100005,EAP,CPT® 80053,,"Comprehensive Metabolic Panel, Evd",$477.00,$5.91,$477.00,$18.83,$15.44,$14.37,$5.91,$15.44,$15.44,$15.61,$477.00,$11.09,$29.54,$377.78,$381.60,$15.31,$16.64,$10.56,$11.65,$10.56
30100006,EAP,CPT® 80047,,"Basic Metabolic Panel, Evd",$374.00,$0.00,$374.00,$0.00,$12.36,$0.00,$0.00,$12.36,$12.36,$0.00,$374.00,$0.00,$187.00,$296.21,$299.20,$0.00,$0.00,$0.00,$0.00,$0.00
30100007,EAP,CPT® 80061,,"Chem 3, Lipid Panel",$285.00,$7.50,$285.00,$23.87,$19.57,$18.22,$7.50,$19.57,$19.57,$19.79,$285.00,$14.06,$37.44,$225.72,$228.00,$19.42,$21.09,$13.39,$14.76,$13.39
30100008,EAP,CPT® 80069,,"RENAL FUNCTION PANEL, EVD",$230.00,$4.86,$230.00,$15.48,$12.68,$11.82,$4.86,$12.68,$12.68,$12.83,$230.00,$9.11,$24.26,$182.16,$184.00,$12.59,$13.67,$8.68,$9.57,$8.68
30100009,EAP,CPT® 80069,,Renal Panel,$230.00,$4.86,$230.00,$15.48,$12.68,$11.82,$4.86,$12.68,$12.68,$12.83,$230.00,$9.11,$24.26,$182.16,$184.00,$12.59,$13.67,$8.68,$9.57,$8.68
30100010,EAP,CPT® 83986,,"Ph, Misc Fluids",$64.00,$0.00,$64.00,$6.38,$5.22,$4.87,$0.00,$5.22,$5.22,$5.28,$64.00,$3.76,$10.00,$50.69,$51.20,$5.19,$0.00,$3.58,$3.94,$3.58
30100011,EAP,CPT® 80076,,HEPATIC PROFILE,$333.00,$4.58,$333.00,$14.57,$11.93,$11.11,$4.58,$11.93,$11.93,$12.08,$333.00,$8.58,$22.84,$263.74,$266.40,$11.85,$12.87,$8.17,$9.01,$8.17
30100013,EAP,CPT® 80346,,Clonazepam/klonopin,$252.00,$0.00,$252.00,$0.00,$179.85,$0.00,$0.00,$179.85,$179.85,$0.00,$252.00,$0.00,$126.00,$199.58,$201.60,$0.00,$0.00,$0.00,$0.00,$0.00
30100014,EAP,CPT® 80197,,Tacrolimus,$393.00,$7.69,$393.00,$24.49,$20.04,$18.69,$7.69,$20.04,$20.04,$20.27,$393.00,$14.42,$38.34,$311.26,$314.40,$19.91,$21.59,$13.73,$15.11,$13.73
30100015,EAP,CPT® 80299,,"Digitoxin, Serum",$218.00,$9.39,$218.00,$24.21,$17.58,$15.07,$9.39,$17.58,$17.58,$17.79,$218.00,$19.57,$33.64,$172.66,$174.40,$27.03,$18.95,$18.64,$13.27,$18.64
30100016,EAP,CPT® 80299,,Felbamate-random,$218.00,$9.39,$218.00,$24.21,$17.58,$15.07,$9.39,$17.58,$17.58,$17.79,$218.00,$19.57,$33.64,$172.66,$174.40,$27.03,$18.95,$18.64,$13.27,$18.64
30100017,EAP,CPT® 80299,,Bupropion/wellbutrin,$218.00,$9.39,$218.00,$24.21,$17.58,$15.07,$9.39,$17.58,$17.58,$17.79,$218.00,$19.57,$33.64,$172.66,$174.40,$27.03,$18.95,$18.64,$13.27,$18.64
30100018,EAP,CPT® 80307,,Acetaminophen,$532.00,$32.55,$532.00,$99.36,$76.45,$94.70,$32.55,$76.45,$76.45,$71.85,$532.00,$65.25,$266.00,$421.34,$425.60,$90.10,$76.56,$62.14,$53.59,$62.14
30100019,EAP,CPT® 80076,,"Hepatic Function Panel, Evd",$333.00,$4.58,$333.00,$14.57,$11.93,$11.11,$4.58,$11.93,$11.93,$12.08,$333.00,$8.58,$22.84,$263.74,$266.40,$11.85,$12.87,$8.17,$9.01,$8.17
30100020,EAP,CPT® 82009,,ACETOACETATE-QUALITATIVE,$64.00,$0.00,$64.00,$0.00,$4.80,$0.00,$0.00,$4.80,$4.80,$0.00,$64.00,$0.00,$9.18,$50.69,$51.20,$0.00,$0.00,$0.00,$0.00,$0.00
30100021,EAP,CPT® 82010,,B-oh Butyric Acid,$194.00,$4.58,$194.00,$14.57,$11.93,$9.14,$4.58,$11.93,$11.93,$12.08,$194.00,$8.58,$22.84,$153.65,$155.20,$11.85,$12.87,$8.17,$9.01,$8.17
30100022,EAP,CPT® 82024,,"Acth, Plasma",$466.00,$21.60,$466.00,$68.86,$56.40,$52.56,$21.60,$56.40,$56.40,$57.06,$466.00,$40.55,$107.94,$369.07,$372.80,$56.00,$60.80,$38.62,$42.56,$38.62
30100023,EAP,CPT® 82040,,Albumin (bcg),$76.00,$2.77,$76.00,$5.13,$4.20,$6.32,$2.77,$4.20,$4.20,$4.25,$76.00,$5.20,$8.04,$60.19,$60.80,$7.18,$4.53,$4.95,$3.17,$4.95
30100024,EAP,CPT® 82042,,"Albumin,fluid",$129.00,$3.92,$129.00,$9.23,$7.56,$7.04,$3.92,$7.56,$7.56,$7.64,$129.00,$8.17,$14.46,$102.17,$103.20,$11.28,$8.14,$7.78,$5.70,$7.78
30100025,EAP,CPT® 82043,,"Microalbumin, Ur",$224.00,$3.23,$224.00,$10.31,$8.45,$7.87,$3.23,$8.45,$8.45,$8.55,$224.00,$6.07,$16.18,$177.41,$179.20,$8.38,$9.11,$5.78,$6.37,$5.78
30100026,EAP,CPT® 83615,,"Lactate Dehydrogenase (ldh), Evd",$139.00,$3.38,$139.00,$10.76,$8.81,$8.04,$3.38,$8.81,$8.81,$7.46,$139.00,$6.34,$16.88,$110.09,$111.20,$8.76,$7.94,$6.04,$5.56,$6.04
30100027,EAP,CPT® 80320,,Ethanol,$363.00,$0.02,$363.00,$0.02,$259.07,$64.61,$7.42,$259.07,$259.07,$15.96,$363.00,$120.15,$181.50,$287.50,$290.40,$217.80,$17.01,$114.43,$11.90,$114.43
30100028,EAP,CPT® 82085,,"Aldolase, Serum",$122.00,$5.44,$122.00,$17.31,$14.17,$13.21,$5.44,$14.17,$14.17,$14.33,$122.00,$10.20,$27.12,$96.62,$97.60,$14.08,$15.27,$9.71,$10.69,$9.71
30100029,EAP,CPT® 82088,,"Aldosterone, Serum",$177.00,$22.80,$177.00,$72.64,$59.50,$55.46,$22.80,$59.50,$59.50,$60.21,$177.00,$42.79,$113.88,$140.18,$141.60,$59.09,$64.15,$40.75,$44.91,$40.75
30100030,EAP,CPT® 82088,,"Aldosterone, Ur-24hr",$177.00,$22.80,$177.00,$72.64,$59.50,$55.46,$22.80,$59.50,$59.50,$60.21,$177.00,$42.79,$113.88,$140.18,$141.60,$59.09,$64.15,$40.75,$44.91,$40.75
30100031,EAP,CPT® 82103,,Alpha-1-antitrypsin,$301.00,$7.52,$301.00,$23.96,$19.61,$18.29,$7.52,$19.61,$19.61,$19.85,$301.00,$14.11,$37.54,$238.39,$240.80,$19.49,$21.15,$13.44,$14.80,$13.44
30100032,EAP,CPT® 82104,,Alpha-1 At Phenotype,$138.00,$0.00,$138.00,$0.00,$21.11,$0.00,$0.00,$21.11,$21.11,$0.00,$138.00,$0.00,$40.40,$109.30,$110.40,$0.00,$0.00,$0.00,$0.00,$0.00
30100033,EAP,CPT® 82105,,Alpha-fetoprotein,$258.00,$9.39,$258.00,$29.91,$24.49,$22.83,$9.39,$24.49,$24.49,$24.79,$258.00,$17.61,$46.88,$204.34,$206.40,$24.32,$26.41,$16.77,$18.49,$16.77
30100034,EAP,CPT® 82105,,"Afp,maternal Serum",$239.00,$9.39,$239.00,$29.91,$24.49,$22.83,$9.39,$24.49,$24.49,$24.79,$239.00,$17.61,$46.88,$189.29,$191.20,$24.32,$26.41,$16.77,$18.49,$16.77
30100035,EAP,CPT® 82105,,Alpha-fetoprotein,$258.00,$9.39,$258.00,$29.91,$24.49,$22.83,$9.39,$24.49,$24.49,$24.79,$258.00,$17.61,$46.88,$204.34,$206.40,$24.32,$26.41,$16.77,$18.49,$16.77
30100036,EAP,CPT® 82106,,"Afp, Amniotic Fluid",$239.00,$9.39,$239.00,$29.91,$24.49,$22.83,$9.39,$24.49,$24.49,$24.79,$239.00,$17.85,$46.88,$189.29,$191.20,$24.65,$26.41,$17.00,$18.49,$17.00
30100037,EAP,CPT® 82108,,Aluminum,$88.00,$0.00,$88.00,$30.05,$24.61,$25.32,$0.00,$24.61,$24.61,$24.91,$88.00,$26.75,$47.10,$69.70,$70.40,$36.95,$0.00,$25.48,$18.58,$25.48
30100038,EAP,CPT® 82128,,"Metabolic Screen,ur",$278.00,$0.00,$278.00,$0.00,$20.24,$0.00,$0.00,$20.24,$20.24,$0.00,$278.00,$0.00,$38.74,$220.18,$222.40,$0.00,$0.00,$0.00,$0.00,$0.00
30100039,EAP,CPT® 82128,,"Amino Acid-scn,urine",$278.00,$0.00,$278.00,$0.00,$20.24,$0.00,$0.00,$20.24,$20.24,$0.00,$278.00,$0.00,$38.74,$220.18,$222.40,$0.00,$0.00,$0.00,$0.00,$0.00
30100040,EAP,CPT® 82131,,Homocysteine,$158.00,$11.57,$158.00,$30.07,$24.63,$22.95,$11.57,$24.63,$24.63,$24.92,$158.00,$24.13,$47.14,$125.14,$126.40,$33.32,$26.55,$22.98,$18.58,$22.98
30100041,EAP,CPT® 82131,,"Cystine, Urine-24hr",$165.00,$11.57,$165.00,$30.07,$24.63,$22.95,$11.57,$24.63,$24.63,$24.92,$165.00,$24.13,$47.14,$130.68,$132.00,$33.32,$26.55,$22.98,$18.58,$22.98
30100042,EAP,CPT® 82139,,"Amino Acids-qnt,plas",$490.00,$0.00,$490.00,$0.00,$24.63,$0.00,$0.00,$24.63,$24.63,$0.00,$490.00,$0.00,$47.14,$388.08,$392.00,$0.00,$0.00,$0.00,$0.00,$0.00
30100043,EAP,CPT® 82139,,Amino Acids - Qnt,$490.00,$0.00,$490.00,$0.00,$24.63,$0.00,$0.00,$24.63,$24.63,$0.00,$490.00,$0.00,$47.14,$388.08,$392.00,$0.00,$0.00,$0.00,$0.00,$0.00
30100044,EAP,CPT® 82140,,"Ammonia,blood",$317.00,$8.16,$317.00,$17.62,$14.44,$19.83,$8.16,$14.44,$14.44,$14.62,$317.00,$15.30,$27.64,$251.06,$253.60,$21.13,$15.57,$14.57,$10.90,$14.57
30100045,EAP,CPT® 83605,,"Lactate ( Lactic Acid),evd",$311.00,$5.97,$311.00,$19.04,$15.59,$14.53,$5.97,$15.59,$15.59,$15.78,$311.00,$12.15,$29.84,$246.31,$248.80,$16.78,$16.82,$11.57,$11.77,$11.57
30100046,EAP,CPT® 82150,,"Amylase,serum",$304.00,$3.62,$304.00,$11.56,$9.46,$8.82,$3.62,$9.46,$9.46,$9.58,$304.00,$6.80,$18.12,$240.77,$243.20,$9.40,$10.20,$6.48,$7.14,$6.48
30100047,EAP,CPT® 82150,,"Amylase,fluid",$304.00,$3.62,$304.00,$11.56,$9.46,$8.82,$3.62,$9.46,$9.46,$9.58,$304.00,$6.80,$18.12,$240.77,$243.20,$9.40,$10.20,$6.48,$7.14,$6.48
30100048,EAP,CPT® 82150,,"AMYLASE,URINE",$304.00,$3.62,$304.00,$11.56,$9.46,$8.82,$3.62,$9.46,$9.46,$9.58,$304.00,$6.80,$18.12,$240.77,$243.20,$9.40,$10.20,$6.48,$7.14,$6.48
30100049,EAP,CPT® 82157,,Androstenedione,$253.00,$16.38,$253.00,$52.19,$42.74,$39.84,$16.38,$42.74,$42.74,$43.24,$253.00,$30.74,$81.80,$200.38,$202.40,$42.46,$46.07,$29.28,$32.25,$29.28
30100050,EAP,CPT® 82164,,Angio-1 Convert Enz.,$297.00,$8.17,$297.00,$26.04,$21.31,$19.87,$8.17,$21.31,$21.31,$21.56,$297.00,$15.33,$40.78,$235.22,$237.60,$21.17,$22.97,$14.60,$16.08,$14.60
30100051,EAP,CPT® 82164,,Angio-1 Conv Enz-csf,$297.00,$8.17,$297.00,$26.04,$21.31,$19.87,$8.17,$21.31,$21.31,$21.56,$297.00,$15.33,$40.78,$235.22,$237.60,$21.17,$22.97,$14.60,$16.08,$14.60
30100052,EAP,CPT® 82175,,"Arsenic,urine-24hr",$97.00,$0.00,$97.00,$33.81,$27.70,$25.82,$0.00,$27.70,$27.70,$28.02,$97.00,$19.92,$53.02,$76.82,$77.60,$27.51,$0.00,$18.97,$20.90,$18.97
30100053,EAP,CPT® 82180,,"Vitamin C, Serum",$157.00,$5.53,$157.00,$15.73,$12.90,$13.45,$5.53,$12.90,$12.90,$13.05,$157.00,$10.38,$24.68,$124.34,$125.60,$14.34,$13.91,$9.89,$9.73,$9.89
30100054,EAP,CPT® 80345,,Pentobarbital-quant,$223.00,$0.00,$223.00,$0.00,$159.16,$0.00,$0.00,$159.16,$159.16,$0.00,$223.00,$0.00,$111.50,$176.62,$178.40,$0.00,$0.00,$0.00,$0.00,$0.00
30100055,EAP,CPT® 82232,,Beta-2 Microglobulin,$201.00,$9.05,$201.00,$28.84,$23.62,$22.02,$9.05,$23.62,$23.62,$23.91,$201.00,$16.99,$45.22,$159.19,$160.80,$23.46,$25.48,$16.18,$17.83,$16.18
30100056,EAP,CPT® 82239,,"Bile Acids, Serum",$241.00,$9.58,$241.00,$30.53,$25.01,$20.40,$9.58,$25.01,$25.01,$25.32,$241.00,$17.98,$47.88,$190.87,$192.80,$24.82,$26.97,$17.12,$18.88,$17.12
30100057,EAP,CPT® 82247,,"Bilirubin,total",$118.00,$2.81,$118.00,$8.94,$7.33,$6.83,$2.81,$7.33,$7.33,$7.42,$118.00,$5.27,$14.04,$93.46,$94.40,$7.28,$7.91,$5.02,$5.54,$5.02
30100058,EAP,CPT® 82150,,"Amylase, Evd",$304.00,$3.62,$304.00,$11.56,$9.46,$8.82,$3.62,$9.46,$9.46,$9.58,$304.00,$6.80,$18.12,$240.77,$243.20,$9.40,$10.20,$6.48,$7.14,$6.48
30100059,EAP,CPT® 82247,,"BILI, TOTAL-FLUID",$118.00,$2.81,$118.00,$8.94,$7.33,$6.83,$2.81,$7.33,$7.33,$7.42,$118.00,$5.27,$14.04,$93.46,$94.40,$7.28,$7.91,$5.02,$5.54,$5.02
30100060,EAP,CPT® 82248,,"Bilirubin,direct",$118.00,$2.81,$118.00,$8.94,$7.33,$6.83,$2.81,$7.33,$7.33,$7.42,$118.00,$5.27,$14.04,$93.46,$94.40,$7.28,$7.91,$5.02,$5.54,$5.02
30100061,EAP,CPT® 82248,,"Bili, Direct - Fluid",$118.00,$2.81,$118.00,$8.94,$7.33,$6.83,$2.81,$7.33,$7.33,$7.42,$118.00,$5.27,$14.04,$93.46,$94.40,$7.28,$7.91,$5.02,$5.54,$5.02
30100062,EAP,CPT® 84100,,"Phosphorus, Evd",$136.00,$2.65,$136.00,$8.46,$6.93,$6.45,$2.65,$6.93,$6.93,$7.01,$136.00,$4.98,$13.26,$107.71,$108.80,$6.87,$7.47,$4.74,$5.23,$4.74
30100063,EAP,CPT® 83735,,"Magnesium,evd",$171.00,$3.75,$171.00,$11.95,$9.78,$9.11,$3.75,$9.78,$9.78,$9.89,$171.00,$7.04,$18.72,$135.43,$136.80,$9.72,$10.54,$6.70,$7.38,$6.70
30100064,EAP,CPT® 87536,,"Hiv -1 Rna, Quant,rt-pcr (quest)",$278.00,$47.60,$278.00,$92.50,$75.77,$95.41,$47.60,$75.77,$75.77,$66.37,$278.00,$89.36,$145.02,$220.18,$222.40,$123.40,$70.72,$85.10,$49.50,$85.10
30100065,EAP,CPT® 83519,,Pth-realated Protein So,$422.00,$9.26,$422.00,$24.08,$19.73,$18.39,$9.26,$19.73,$19.73,$19.96,$422.00,$19.32,$37.76,$334.22,$337.60,$26.68,$21.27,$18.40,$14.89,$18.40
30100066,EAP,CPT® 82270,,"OCCULT BLOOD, STOOL",$58.00,$0.00,$58.00,$0.00,$4.69,$0.00,$0.00,$4.69,$4.69,$0.00,$58.00,$0.00,$8.98,$45.94,$46.40,$0.00,$0.00,$0.00,$0.00,$0.00
30100067,EAP,CPT® 82271,,"Occult Blood, Gastric",$58.00,$0.00,$58.00,$5.72,$4.69,$4.43,$0.00,$4.69,$4.69,$0.00,$58.00,$5.59,$8.98,$45.94,$46.40,$7.71,$0.00,$5.32,$3.54,$5.32
30100068,EAP,CPT® 82306,,"Vitamin D, Serum",$282.00,$16.56,$282.00,$52.78,$43.22,$40.29,$16.56,$43.22,$43.22,$43.72,$282.00,$31.08,$82.72,$223.34,$225.60,$42.92,$46.59,$29.60,$32.61,$29.60
30100069,EAP,CPT® 82308,,"Calcitonin, Serum",$139.00,$0.00,$139.00,$47.77,$39.10,$36.45,$0.00,$39.10,$39.10,$39.55,$139.00,$28.13,$74.82,$110.09,$111.20,$38.85,$0.00,$26.79,$29.50,$26.79
30100070,EAP,CPT® 82310,,Calcium,$93.00,$2.89,$93.00,$9.21,$7.53,$7.02,$2.89,$7.53,$7.53,$7.46,$93.00,$5.42,$14.40,$73.66,$74.40,$7.48,$7.94,$5.16,$5.56,$5.16
30100071,EAP,CPT® 82310,,"Calcium,synvl Fluid",$93.00,$2.89,$93.00,$9.21,$7.53,$7.02,$2.89,$7.53,$7.53,$7.46,$93.00,$5.42,$14.40,$73.66,$74.40,$7.48,$7.94,$5.16,$5.56,$5.16
30100072,EAP,CPT® 82310,,"CALCIUM, URINE",$93.00,$2.89,$93.00,$9.21,$7.53,$7.02,$2.89,$7.53,$7.53,$7.46,$93.00,$5.42,$14.40,$73.66,$74.40,$7.48,$7.94,$5.16,$5.56,$5.16
30100073,EAP,CPT® 82330,,"Calcium,ionized,wb",$342.00,$7.65,$342.00,$24.37,$19.95,$18.60,$7.65,$19.95,$19.95,$20.18,$342.00,$14.36,$38.18,$270.86,$273.60,$19.84,$21.50,$13.68,$15.05,$13.68
30100074,EAP,CPT® 82365,,Stone Analysis,$364.00,$6.45,$364.00,$22.98,$18.83,$6.45,$7.22,$18.83,$18.83,$19.05,$364.00,$13.55,$36.02,$288.29,$291.20,$18.71,$20.30,$12.90,$14.21,$12.90
30100075,EAP,CPT® 82374,,Co2 Content,$35.00,$2.73,$35.00,$8.71,$7.14,$5.85,$2.73,$7.14,$7.14,$7.22,$35.00,$5.12,$13.66,$27.72,$28.00,$7.08,$7.70,$4.88,$5.39,$4.88
30100076,EAP,CPT® 82378,,Cea,$305.00,$10.61,$305.00,$33.81,$27.70,$25.81,$10.61,$27.70,$27.70,$28.02,$305.00,$19.91,$53.02,$241.56,$244.00,$27.49,$29.86,$18.96,$20.90,$18.96
30100077,EAP,CPT® 82379,,"Carnitine, Total",$159.00,$0.00,$159.00,$0.00,$24.63,$0.00,$0.00,$24.63,$24.63,$0.00,$159.00,$0.00,$47.14,$125.93,$127.20,$0.00,$0.00,$0.00,$0.00,$0.00
30100078,EAP,CPT® 82379,,"Carnitine, Free",$159.00,$0.00,$159.00,$0.00,$24.63,$0.00,$0.00,$24.63,$24.63,$0.00,$159.00,$0.00,$47.14,$125.93,$127.20,$0.00,$0.00,$0.00,$0.00,$0.00
30100079,EAP,CPT® 82380,,"Carotene, Serum",$121.00,$0.00,$121.00,$0.00,$13.47,$0.00,$0.00,$13.47,$13.47,$0.00,$121.00,$0.00,$25.78,$95.83,$96.80,$0.00,$0.00,$0.00,$0.00,$0.00
30100080,EAP,CPT® 82384,,"Catecholamines,plasm",$173.00,$14.13,$173.00,$45.01,$36.87,$34.36,$14.13,$36.87,$36.87,$37.30,$173.00,$26.51,$70.56,$137.02,$138.40,$36.61,$39.74,$25.25,$27.82,$25.25
30100081,EAP,CPT® 82384,,"Catecholam.,ur Frac",$173.00,$14.13,$173.00,$45.01,$36.87,$34.36,$14.13,$36.87,$36.87,$37.30,$173.00,$26.51,$70.56,$137.02,$138.40,$36.61,$39.74,$25.25,$27.82,$25.25
30100082,EAP,CPT® 82390,,"Ceruloplasmin,serum",$236.00,$6.01,$236.00,$19.15,$15.68,$8.48,$6.01,$15.68,$15.68,$15.87,$236.00,$11.28,$30.02,$186.91,$188.80,$15.57,$16.91,$10.74,$11.83,$10.74
30100083,EAP,CPT® 82415,,Chloramphen-peak,$145.00,$0.00,$145.00,$0.00,$18.50,$0.00,$0.00,$18.50,$18.50,$0.00,$145.00,$0.00,$35.40,$114.84,$116.00,$0.00,$0.00,$0.00,$0.00,$0.00
30100084,EAP,CPT® 82435,,Chloride,$117.00,$0.00,$117.00,$0.00,$6.70,$0.00,$0.00,$6.70,$6.70,$0.00,$117.00,$0.00,$12.84,$92.66,$93.60,$0.00,$0.00,$0.00,$0.00,$0.00
30100085,EAP,CPT® 82436,,"Chloride, Urine",$123.00,$2.90,$123.00,$8.96,$7.34,$5.60,$2.90,$7.34,$7.34,$7.42,$123.00,$6.04,$14.04,$97.42,$98.40,$8.34,$7.91,$5.75,$5.54,$5.75
30100086,EAP,CPT® 82438,,"Chloride,fluid",$105.00,$0.00,$105.00,$0.00,$7.14,$0.00,$0.00,$7.14,$7.14,$0.00,$105.00,$0.00,$13.66,$83.16,$84.00,$0.00,$0.00,$0.00,$0.00,$0.00
30100087,EAP,CPT® 87798,,"Toxoplasma Gondii Dna,qual,pcr So",$425.00,$19.63,$425.00,$34.98,$28.64,$37.59,$19.63,$28.64,$28.64,$28.98,$425.00,$36.84,$54.82,$336.60,$340.00,$50.88,$30.88,$35.09,$21.62,$35.09
30100088,EAP,CPT® 82465,,Cholesterol,$92.00,$2.44,$92.00,$7.75,$6.36,$5.92,$2.44,$6.36,$6.36,$6.43,$92.00,$4.57,$12.16,$72.86,$73.60,$6.31,$6.85,$4.35,$4.79,$4.35
30100090,EAP,CPT® 82384,,"Catacholamines,frac,ur So",$46.00,$14.13,$46.00,$45.01,$36.87,$34.36,$14.13,$36.87,$36.87,$37.30,$46.00,$26.51,$46.00,$36.43,$36.80,$36.61,$39.74,$25.25,$27.82,$25.25
30100096,EAP,CPT® 82507,,"Citric Acid, Ur-24hr",$129.00,$0.00,$129.00,$0.00,$40.60,$0.00,$0.00,$40.60,$40.60,$0.00,$129.00,$0.00,$77.70,$102.17,$103.20,$0.00,$0.00,$0.00,$0.00,$0.00
30100097,EAP,CPT® 82523,,Pyridinoline,$88.00,$10.45,$88.00,$33.31,$27.29,$16.33,$10.45,$27.29,$27.29,$27.60,$88.00,$19.61,$52.22,$69.70,$70.40,$27.09,$29.41,$18.68,$20.59,$18.68
30100098,EAP,CPT® 82525,,"Copper, Serum",$128.00,$6.95,$128.00,$22.12,$18.12,$16.89,$6.95,$18.12,$18.12,$18.33,$128.00,$13.03,$34.68,$101.38,$102.40,$17.99,$19.53,$12.41,$13.67,$12.41
30100099,EAP,CPT® 82525,,"Copper, Urine-24hr",$128.00,$6.95,$128.00,$22.12,$18.12,$16.89,$6.95,$18.12,$18.12,$18.33,$128.00,$13.03,$34.68,$101.38,$102.40,$17.99,$19.53,$12.41,$13.67,$12.41
30100100,EAP,CPT® 82530,,"Cortisol Free, Ur-24h",$305.00,$9.35,$305.00,$29.78,$24.41,$22.74,$9.35,$24.41,$24.41,$24.70,$305.00,$17.55,$46.70,$241.56,$244.00,$24.23,$26.31,$16.71,$18.42,$16.71
30100101,EAP,CPT® 82533,,"Cortisol,serum",$657.00,$9.12,$657.00,$29.07,$23.81,$22.19,$9.12,$23.81,$23.81,$24.09,$657.00,$17.12,$45.56,$520.34,$525.60,$23.64,$25.67,$16.30,$17.97,$16.30
30100102,EAP,CPT® 82542,,"Thiopurine Methyl Transferase, Qt",$782.00,$6.62,$782.00,$32.19,$8.77,$24.58,$12.13,$8.77,$8.77,$8.87,$782.00,$25.29,$16.78,$619.34,$625.60,$34.93,$9.45,$24.09,$6.62,$24.09
30100103,EAP,CPT® 82550,,"Cpk,total-serum",$189.00,$3.64,$189.00,$11.61,$9.51,$8.86,$3.64,$9.51,$9.51,$7.46,$189.00,$6.84,$18.20,$149.69,$151.20,$9.44,$7.94,$6.51,$5.56,$6.51
30100104,EAP,CPT® 82656,,Pancreatic Elastase-1 So,$224.00,$6.44,$224.00,$19.04,$15.61,$15.70,$6.44,$15.61,$15.61,$39.22,$224.00,$12.11,$29.88,$177.41,$179.20,$16.72,$35.06,$11.53,$35.66,$11.53
30100105,EAP,CPT® 82553,,Ckmb-meia,$323.00,$6.46,$323.00,$20.59,$16.86,$15.72,$6.46,$16.86,$16.86,$17.05,$323.00,$12.13,$32.26,$255.82,$258.40,$16.75,$18.17,$11.55,$12.72,$11.55
30100106,EAP,CPT® 82565,,Creatinine,$129.00,$2.86,$129.00,$9.14,$7.48,$6.97,$2.86,$7.48,$7.48,$7.46,$129.00,$5.38,$14.32,$102.17,$103.20,$7.42,$7.94,$5.12,$5.56,$5.12
30100107,EAP,CPT® 82570,,"Creatinine,fluid",$122.00,$2.90,$122.00,$9.23,$7.56,$5.60,$2.90,$7.56,$7.56,$7.64,$122.00,$5.44,$14.46,$96.62,$97.60,$7.51,$8.14,$5.18,$5.70,$5.18
30100108,EAP,CPT® 82570,,"Creat,amniotic Fld",$129.00,$2.90,$129.00,$9.23,$7.56,$5.60,$2.90,$7.56,$7.56,$7.64,$129.00,$5.44,$14.46,$102.17,$103.20,$7.51,$8.14,$5.18,$5.70,$5.18
30100109,EAP,CPT® 82570,,"Creatinine, Urine",$122.00,$2.90,$122.00,$9.23,$7.56,$5.60,$2.90,$7.56,$7.56,$7.64,$122.00,$5.44,$14.46,$96.62,$97.60,$7.51,$8.14,$5.18,$5.70,$5.18
30100110,EAP,CPT® 82108,,"Aluminum, 24hr Urine So",$69.00,$0.00,$69.00,$30.05,$24.61,$25.32,$0.00,$24.61,$24.61,$24.91,$69.00,$26.75,$47.10,$54.65,$55.20,$36.95,$0.00,$25.48,$18.58,$25.48
30100111,EAP,CPT® 82575,,Creatinine Clearance,$248.00,$0.00,$248.00,$0.00,$13.79,$0.00,$0.00,$13.79,$13.79,$0.00,$248.00,$0.00,$26.40,$196.42,$198.40,$0.00,$0.00,$0.00,$0.00,$0.00
30100112,EAP,CPT® 82595,,"Cryoglobulin,serum",$89.00,$3.61,$89.00,$11.54,$9.45,$8.81,$3.61,$9.45,$9.45,$9.57,$89.00,$6.79,$18.08,$70.49,$71.20,$9.38,$10.19,$6.47,$7.13,$6.47
30100113,EAP,CPT® 82595,,"Cryocrit,serum",$89.00,$3.61,$89.00,$11.54,$9.45,$8.81,$3.61,$9.45,$9.45,$9.57,$89.00,$6.79,$18.08,$70.49,$71.20,$9.38,$10.19,$6.47,$7.13,$6.47
30100114,EAP,CPT® 82600,,Cyanide,$136.00,$0.00,$136.00,$0.00,$28.33,$0.00,$0.00,$28.33,$28.33,$0.00,$136.00,$0.00,$54.22,$107.71,$108.80,$0.00,$0.00,$0.00,$0.00,$0.00
30100115,EAP,CPT® 82607,,"Vitamin B12,serum",$402.00,$8.44,$402.00,$26.88,$22.01,$20.51,$8.44,$22.01,$22.01,$22.26,$402.00,$15.83,$42.12,$318.38,$321.60,$21.87,$23.72,$15.08,$16.60,$15.08
30100116,EAP,CPT® 82627,,"Dhea-so4, Serum",$432.00,$12.44,$432.00,$39.65,$32.46,$25.22,$12.44,$32.46,$32.46,$32.84,$432.00,$23.34,$62.14,$342.14,$345.60,$32.23,$35.00,$22.23,$24.50,$22.23
30100117,EAP,CPT® 82634,,"Deoxycortisol,11-bld",$129.00,$0.00,$129.00,$0.00,$42.74,$0.00,$0.00,$42.74,$42.74,$0.00,$129.00,$0.00,$81.80,$102.17,$103.20,$0.00,$0.00,$0.00,$0.00,$0.00
30100118,EAP,CPT® 80327,,Dihydrotestosterone,$129.00,$0.00,$129.00,$0.00,$92.07,$0.00,$0.00,$92.07,$92.07,$0.00,$129.00,$0.00,$64.50,$102.17,$103.20,$0.00,$0.00,$0.00,$0.00,$0.00
30100119,EAP,CPT® 82652,,"Vit D,1,25-dihydroxy",$358.00,$21.54,$358.00,$68.63,$56.20,$52.39,$21.54,$56.20,$56.20,$56.86,$358.00,$40.43,$107.56,$283.54,$286.40,$55.83,$60.58,$38.50,$42.41,$38.50
30100120,EAP,CPT® 82664,,"Amylase, Isoenzymes",$506.00,$30.97,$506.00,$61.24,$50.16,$46.75,$30.97,$50.16,$50.16,$50.75,$506.00,$64.58,$96.00,$400.75,$404.80,$89.18,$54.07,$61.50,$37.85,$61.50
30100121,EAP,CPT® 82668,,"Erythropoietin,serum",$248.00,$10.52,$248.00,$33.49,$27.45,$25.58,$10.52,$27.45,$27.45,$27.76,$248.00,$19.73,$52.52,$196.42,$198.40,$27.25,$29.58,$18.79,$20.71,$18.79
30100122,EAP,CPT® 82670,,Estradiol,$405.00,$15.63,$405.00,$49.80,$40.80,$38.02,$15.63,$40.80,$40.80,$41.28,$405.00,$29.34,$78.08,$320.76,$324.00,$40.51,$43.98,$27.94,$30.79,$27.94
30100123,EAP,CPT® 82677,,"Estriol(free),serum",$139.00,$13.53,$139.00,$43.11,$35.31,$32.91,$13.53,$35.31,$35.31,$35.72,$139.00,$25.39,$67.58,$110.09,$111.20,$35.06,$38.06,$24.18,$26.64,$24.18
30100124,EAP,CPT® 82677,,"Estriol, Urine-ref",$139.00,$13.53,$139.00,$43.11,$35.31,$32.91,$13.53,$35.31,$35.31,$35.72,$139.00,$25.39,$67.58,$110.09,$111.20,$35.06,$38.06,$24.18,$26.64,$24.18
30100125,EAP,CPT® 82677,,"Estriol, Maternal Serum",$139.00,$13.53,$139.00,$43.11,$35.31,$32.91,$13.53,$35.31,$35.31,$35.72,$139.00,$25.39,$67.58,$110.09,$111.20,$35.06,$38.06,$24.18,$26.64,$24.18
30100126,EAP,CPT® 82679,,"Estrone, Serum",$118.00,$13.96,$118.00,$44.48,$36.45,$33.96,$13.96,$36.45,$36.45,$36.88,$118.00,$26.20,$69.76,$93.46,$94.40,$36.18,$39.29,$24.95,$27.50,$24.95
30100127,EAP,CPT® 82693,,"Ethylene Glycol,bld",$368.00,$0.00,$368.00,$0.00,$21.75,$0.00,$0.00,$21.75,$21.75,$0.00,$368.00,$0.00,$41.64,$291.46,$294.40,$0.00,$0.00,$0.00,$0.00,$0.00
30100128,EAP,CPT® 82705,,"Stool Fat, Qual",$65.00,$0.00,$65.00,$0.00,$7.43,$0.00,$0.00,$7.43,$7.43,$0.00,$65.00,$0.00,$14.22,$51.48,$52.00,$0.00,$0.00,$0.00,$0.00,$0.00
30100129,EAP,CPT® 82710,,"Fecal Fat, Quant",$90.00,$9.40,$90.00,$29.96,$24.53,$22.87,$9.40,$24.53,$24.53,$24.81,$90.00,$17.64,$46.94,$71.28,$72.00,$24.36,$26.44,$16.80,$18.51,$16.80
30100130,EAP,CPT® 82725,,"Fatty Acids,ess-ser",$210.00,$0.00,$210.00,$0.00,$19.44,$0.00,$0.00,$19.44,$19.44,$0.00,$210.00,$0.00,$37.20,$166.32,$168.00,$0.00,$0.00,$0.00,$0.00,$0.00
30100131,EAP,CPT® 82728,,"Ferritin,serum",$249.00,$7.63,$249.00,$24.30,$19.89,$18.54,$7.63,$19.89,$19.89,$20.13,$249.00,$14.31,$38.06,$197.21,$199.20,$19.76,$21.45,$13.63,$15.01,$13.63
30100132,EAP,CPT® 82731,,Fetal Fibronectin,$620.00,$36.04,$620.00,$114.84,$94.04,$87.65,$36.04,$94.04,$94.04,$95.14,$620.00,$67.63,$179.98,$491.04,$496.00,$93.39,$101.37,$64.41,$70.96,$64.41
30100133,EAP,CPT® 82746,,"Folate,serum",$294.00,$8.22,$294.00,$26.22,$21.47,$20.01,$8.22,$21.47,$21.47,$21.72,$294.00,$15.44,$41.08,$232.85,$235.20,$21.32,$23.15,$14.70,$16.20,$14.70
30100134,EAP,CPT® 82747,,"Folate, Rbc",$438.00,$9.69,$438.00,$30.87,$25.29,$23.44,$9.69,$25.29,$25.29,$25.59,$438.00,$18.53,$48.40,$346.90,$350.40,$25.59,$27.27,$17.65,$19.09,$17.65
30100135,EAP,CPT® 82775,,Galactose-1-put,$224.00,$0.00,$224.00,$0.00,$30.75,$0.00,$0.00,$30.75,$30.75,$0.00,$224.00,$0.00,$58.86,$177.41,$179.20,$0.00,$0.00,$0.00,$0.00,$0.00
30100136,EAP,CPT® 82775,,Galactose-1-phos,$224.00,$0.00,$224.00,$0.00,$30.75,$0.00,$0.00,$30.75,$30.75,$0.00,$224.00,$0.00,$58.86,$177.41,$179.20,$0.00,$0.00,$0.00,$0.00,$0.00
30100137,EAP,CPT® 82784,,"Immunoglob-a,serum",$276.00,$5.20,$276.00,$16.58,$13.58,$9.90,$5.20,$13.58,$13.58,$13.73,$276.00,$9.77,$25.98,$218.59,$220.80,$13.49,$14.63,$9.30,$10.24,$9.30
30100138,EAP,CPT® 82784,,"Immunoglob-g,serum",$276.00,$5.20,$276.00,$16.58,$13.58,$9.90,$5.20,$13.58,$13.58,$13.73,$276.00,$9.77,$25.98,$218.59,$220.80,$13.49,$14.63,$9.30,$10.24,$9.30
30100139,EAP,CPT® 82784,,"Immunoglob-m,serum",$276.00,$5.20,$276.00,$16.58,$13.58,$9.90,$5.20,$13.58,$13.58,$13.73,$276.00,$9.77,$25.98,$218.59,$220.80,$13.49,$14.63,$9.30,$10.24,$9.30
30100140,EAP,CPT® 82784,,"Immuno-igg,csf",$167.00,$5.20,$167.00,$16.58,$13.58,$9.90,$5.20,$13.58,$13.58,$13.73,$167.00,$9.77,$25.98,$132.26,$133.60,$13.49,$14.63,$9.30,$10.24,$9.30
30100141,EAP,CPT® 82784,,"Immunoglob-igd,serum",$253.00,$5.20,$253.00,$16.58,$13.58,$9.90,$5.20,$13.58,$13.58,$13.73,$253.00,$9.77,$25.98,$200.38,$202.40,$13.49,$14.63,$9.30,$10.24,$9.30
30100142,EAP,CPT® 82785,,"Immunoglob-ige,serum",$204.00,$9.21,$204.00,$29.34,$24.05,$22.41,$9.21,$24.05,$24.05,$24.33,$204.00,$17.28,$46.02,$161.57,$163.20,$23.87,$25.92,$16.46,$18.15,$16.46
30100143,EAP,CPT® 82800,,"Ph, Ven.",$202.00,$5.54,$202.00,$15.09,$12.37,$11.51,$5.54,$12.37,$12.37,$12.52,$202.00,$11.55,$23.66,$159.98,$161.60,$15.95,$13.34,$11.00,$9.34,$11.00
30100144,EAP,CPT® 82800,,"Ph, Art.",$202.00,$5.54,$202.00,$15.09,$12.37,$11.51,$5.54,$12.37,$12.37,$12.52,$202.00,$11.55,$23.66,$159.98,$161.60,$15.95,$13.34,$11.00,$9.34,$11.00
30100145,EAP,CPT® 82800,,"Ph, Cord, Art.",$202.00,$5.54,$202.00,$15.09,$12.37,$11.51,$5.54,$12.37,$12.37,$12.52,$202.00,$11.55,$23.66,$159.98,$161.60,$15.95,$13.34,$11.00,$9.34,$11.00
30100148,EAP,CPT® 82803,,Blood Gas-venous,$464.00,$13.12,$464.00,$34.50,$28.25,$26.33,$13.12,$28.25,$28.25,$28.59,$464.00,$27.37,$54.08,$367.49,$371.20,$37.80,$30.46,$26.07,$21.33,$26.07
30100149,EAP,CPT® 82803,,Blood Gas-arterial,$464.00,$13.12,$464.00,$34.50,$28.25,$26.33,$13.12,$28.25,$28.25,$28.59,$464.00,$27.37,$54.08,$367.49,$371.20,$37.80,$30.46,$26.07,$21.33,$26.07
30100150,EAP,CPT® 82803,,Blood Gas-micro,$464.00,$13.12,$464.00,$34.50,$28.25,$26.33,$13.12,$28.25,$28.25,$28.59,$464.00,$27.37,$54.08,$367.49,$371.20,$37.80,$30.46,$26.07,$21.33,$26.07
30100151,EAP,CPT® 82803,,Blood Gas-cord Art.,$464.00,$13.12,$464.00,$34.50,$28.25,$26.33,$13.12,$28.25,$28.25,$28.59,$464.00,$27.37,$54.08,$367.49,$371.20,$37.80,$30.46,$26.07,$21.33,$26.07
30100152,EAP,CPT® 82803,,BLOOD GAS-CORD VEN.,$464.00,$13.12,$464.00,$34.50,$28.25,$26.33,$13.12,$28.25,$28.25,$28.59,$464.00,$27.37,$54.08,$367.49,$371.20,$37.80,$30.46,$26.07,$21.33,$26.07
30100153,EAP,CPT® 82172,,Apolipoproteina 1 (so),$176.00,$10.62,$176.00,$27.63,$22.62,$19.23,$10.62,$22.62,$22.62,$22.90,$176.00,$22.14,$43.30,$139.39,$140.80,$30.58,$24.40,$21.09,$17.08,$21.09
30100158,EAP,CPT® 82805,,"Bld. Gas+sat. Prof, Art",$485.00,$31.27,$485.00,$50.57,$41.43,$38.62,$39.66,$41.43,$41.43,$41.93,$485.00,$82.71,$79.30,$384.12,$388.00,$114.22,$44.67,$78.77,$31.27,$78.77
30100159,EAP,CPT® 82805,,"Bld. Gas+sat. Prof, Ven",$485.00,$31.27,$485.00,$50.57,$41.43,$38.62,$39.66,$41.43,$41.43,$41.93,$485.00,$82.71,$79.30,$384.12,$388.00,$114.22,$44.67,$78.77,$31.27,$78.77
30100160,EAP,CPT® 82805,,"Bld. Gas+sat. Prof, Mcr",$485.00,$31.27,$485.00,$50.57,$41.43,$38.62,$39.66,$41.43,$41.43,$41.93,$485.00,$82.71,$79.30,$384.12,$388.00,$114.22,$44.67,$78.77,$31.27,$78.77
30100161,EAP,CPT® 82810,,"Saturation Prof, Ven.",$103.00,$4.92,$103.00,$15.55,$12.74,$11.88,$4.92,$12.74,$12.74,$12.89,$103.00,$10.26,$24.40,$81.58,$82.40,$14.17,$13.74,$9.77,$9.62,$9.77
30100162,EAP,CPT® 82810,,"Saturation Prof, Art.",$103.00,$4.92,$103.00,$15.55,$12.74,$11.88,$4.92,$12.74,$12.74,$12.89,$103.00,$10.26,$24.40,$81.58,$82.40,$14.17,$13.74,$9.77,$9.62,$9.77
30100163,EAP,CPT® 82810,,"Saturation Prof, Micro",$103.00,$4.92,$103.00,$15.55,$12.74,$11.88,$4.92,$12.74,$12.74,$12.89,$103.00,$10.26,$24.40,$81.58,$82.40,$14.17,$13.74,$9.77,$9.62,$9.77
30100165,EAP,CPT® 82941,,"Gastrin,serum",$278.00,$0.00,$278.00,$31.44,$25.75,$23.75,$0.00,$25.75,$25.75,$26.05,$278.00,$18.51,$49.28,$220.18,$222.40,$25.56,$0.00,$17.63,$19.43,$17.63
30100167,EAP,CPT® 82945,,"Glucose,fluid",$311.00,$2.20,$311.00,$7.00,$5.73,$5.34,$2.20,$5.73,$5.73,$5.80,$311.00,$4.13,$10.96,$246.31,$248.80,$5.70,$6.18,$3.93,$4.32,$3.93
30100168,EAP,CPT® 82945,,"Glucose,csf",$311.00,$2.20,$311.00,$7.00,$5.73,$5.34,$2.20,$5.73,$5.73,$5.80,$311.00,$4.13,$10.96,$246.31,$248.80,$5.70,$6.18,$3.93,$4.32,$3.93
30100169,EAP,CPT® 82945,,"GLUCOSE,URINE(QUANT)",$311.00,$2.20,$311.00,$7.00,$5.73,$5.34,$2.20,$5.73,$5.73,$5.80,$311.00,$4.13,$10.96,$246.31,$248.80,$5.70,$6.18,$3.93,$4.32,$3.93
30100171,EAP,CPT® 82947,,Glucose,$326.00,$2.20,$326.00,$7.00,$5.73,$5.34,$2.20,$5.73,$5.73,$5.80,$326.00,$4.13,$10.96,$258.19,$260.80,$5.70,$6.18,$3.93,$4.32,$3.93
30100173,EAP,CPT® 82947,,"Glucose,fasting Bld",$326.00,$2.20,$326.00,$7.00,$5.73,$5.34,$2.20,$5.73,$5.73,$5.80,$326.00,$4.13,$10.96,$258.19,$260.80,$5.70,$6.18,$3.93,$4.32,$3.93
30100174,EAP,CPT® 82947,,Glucose-wb,$326.00,$2.20,$326.00,$7.00,$5.73,$5.34,$2.20,$5.73,$5.73,$5.80,$326.00,$4.13,$10.96,$258.19,$260.80,$5.70,$6.18,$3.93,$4.32,$3.93
30100176,EAP,CPT® 82947,,"Gtt,oral-1hr Indiv",$326.00,$2.20,$326.00,$7.00,$5.73,$5.34,$2.20,$5.73,$5.73,$5.80,$326.00,$4.13,$10.96,$258.19,$260.80,$5.70,$6.18,$3.93,$4.32,$3.93
30100177,EAP,CPT® 82947,,"GTT,ORAL-2HR INDIV",$326.00,$2.20,$326.00,$7.00,$5.73,$5.34,$2.20,$5.73,$5.73,$5.80,$326.00,$4.13,$10.96,$258.19,$260.80,$5.70,$6.18,$3.93,$4.32,$3.93
30100178,EAP,CPT® 82947,,"Poct, Glucose (meter)",$84.00,$2.20,$84.00,$7.00,$5.73,$5.34,$2.20,$5.73,$5.73,$5.80,$84.00,$4.13,$10.96,$66.53,$67.20,$5.70,$6.18,$3.93,$4.32,$3.93
30100180,EAP,HCPCS G0480,,Drug Test Definitive 1-7 Classes,$293.00,$50.48,$293.00,$159.10,$209.11,$52.15,$50.48,$209.11,$209.11,$110.57,$293.00,$120.15,$146.50,$232.06,$234.40,$165.92,$117.81,$114.43,$82.47,$114.43
30100181,EAP,HCPCS G0481,,Drug Test Definitive 8-14 Classes,$322.00,$0.00,$322.00,$0.00,$229.81,$0.00,$0.00,$229.81,$229.81,$0.00,$322.00,$0.00,$161.00,$255.02,$257.60,$0.00,$0.00,$0.00,$0.00,$0.00
30100182,EAP,HCPCS G0482,,Drug Test Definitive 15-21 Classes,$354.00,$0.00,$354.00,$0.00,$252.65,$0.00,$0.00,$252.65,$252.65,$0.00,$354.00,$0.00,$177.00,$280.37,$283.20,$0.00,$0.00,$0.00,$0.00,$0.00
30100183,EAP,HCPCS G0483,,Drug Test Definitive 22+ Classes,$389.00,$0.00,$389.00,$0.00,$277.63,$0.00,$0.00,$277.63,$277.63,$0.00,$389.00,$0.00,$194.50,$308.09,$311.20,$0.00,$0.00,$0.00,$0.00,$0.00
30100186,EAP,CPT® 82948,,"Glu-2hr Pp, Wb-micro",$311.00,$0.00,$311.00,$0.00,$4.63,$0.00,$0.00,$4.63,$4.63,$0.00,$311.00,$0.00,$8.86,$246.31,$248.80,$0.00,$0.00,$0.00,$0.00,$0.00
30100187,EAP,CPT® 82950,,"Glucose,bld-2hr Pp",$311.00,$2.65,$311.00,$8.46,$6.93,$6.46,$2.65,$6.93,$6.93,$7.02,$311.00,$4.99,$13.28,$246.31,$248.80,$6.89,$7.48,$4.75,$5.24,$4.75
30100188,EAP,CPT® 82950,,"Glucose, 1hr (75gm)",$311.00,$2.65,$311.00,$8.46,$6.93,$6.46,$2.65,$6.93,$6.93,$7.02,$311.00,$4.99,$13.28,$246.31,$248.80,$6.89,$7.48,$4.75,$5.24,$4.75
30100189,EAP,CPT® 82950,,"GLUCOSE,1HR (50GM)",$311.00,$2.65,$311.00,$8.46,$6.93,$6.46,$2.65,$6.93,$6.93,$7.02,$311.00,$4.99,$13.28,$246.31,$248.80,$6.89,$7.48,$4.75,$5.24,$4.75
30100192,EAP,CPT® 82951,,"Gtt,prenatal(75 Gm)",$201.00,$7.21,$201.00,$22.96,$18.80,$11.90,$7.21,$18.80,$18.80,$19.02,$201.00,$13.51,$35.98,$159.19,$160.80,$18.66,$20.26,$12.87,$14.18,$12.87
30100193,EAP,CPT® 82951,,"Gtt,oral-3hr Gtt",$201.00,$7.21,$201.00,$22.96,$18.80,$11.90,$7.21,$18.80,$18.80,$19.02,$201.00,$13.51,$35.98,$159.19,$160.80,$18.66,$20.26,$12.87,$14.18,$12.87
30100194,EAP,CPT® 82951,,"Gtt,oral-4hr Gtt",$201.00,$7.21,$201.00,$22.96,$18.80,$11.90,$7.21,$18.80,$18.80,$19.02,$201.00,$13.51,$35.98,$159.19,$160.80,$18.66,$20.26,$12.87,$14.18,$12.87
30100195,EAP,CPT® 82951,,"Gtt,oral-5hr Gtt",$201.00,$7.21,$201.00,$22.96,$18.80,$11.90,$7.21,$18.80,$18.80,$19.02,$201.00,$13.51,$35.98,$159.19,$160.80,$18.66,$20.26,$12.87,$14.18,$12.87
30100196,EAP,CPT® 82951,,"Gtt,oral-6hr Gtt",$201.00,$7.21,$201.00,$22.96,$18.80,$11.90,$7.21,$18.80,$18.80,$19.02,$201.00,$13.51,$35.98,$159.19,$160.80,$18.66,$20.26,$12.87,$14.18,$12.87
30100197,EAP,CPT® 82951,,"GTT,PRENATAL(100GM)",$201.00,$7.21,$201.00,$22.96,$18.80,$11.90,$7.21,$18.80,$18.80,$19.02,$201.00,$13.51,$35.98,$159.19,$160.80,$18.66,$20.26,$12.87,$14.18,$12.87
30100200,EAP,CPT® 82952,,3rd Hour-gtt Specimen,$103.00,$2.19,$103.00,$7.00,$5.72,$5.34,$2.19,$5.72,$5.72,$5.80,$103.00,$4.12,$10.96,$81.58,$82.40,$5.68,$6.18,$3.92,$4.32,$3.92
30100201,EAP,CPT® 82952,,4th Hour-gtt Specimen,$103.00,$2.19,$103.00,$7.00,$5.72,$5.34,$2.19,$5.72,$5.72,$5.80,$103.00,$4.12,$10.96,$81.58,$82.40,$5.68,$6.18,$3.92,$4.32,$3.92
30100202,EAP,CPT® 82952,,5TH HOUR GTT SPECIMEN,$103.00,$2.19,$103.00,$7.00,$5.72,$5.34,$2.19,$5.72,$5.72,$5.80,$103.00,$4.12,$10.96,$81.58,$82.40,$5.68,$6.18,$3.92,$4.32,$3.92
30100203,EAP,CPT® 82955,,"G6pd, Rbc Quant",$244.00,$4.93,$244.00,$13.89,$11.40,$4.93,$5.43,$11.40,$11.40,$11.54,$244.00,$10.19,$21.82,$193.25,$195.20,$14.07,$12.30,$9.70,$8.61,$9.70
30100205,EAP,CPT® 82977,,"GGTP,SERUM",$162.00,$4.03,$162.00,$12.84,$10.51,$9.52,$4.03,$10.51,$10.51,$7.46,$162.00,$7.56,$20.12,$128.30,$129.60,$10.44,$7.94,$7.20,$5.56,$7.20
30100206,EAP,CPT® 83001,,"Fsh,serum",$465.00,$10.39,$465.00,$33.13,$27.14,$25.29,$10.39,$27.14,$27.14,$27.46,$465.00,$19.51,$51.94,$368.28,$372.00,$26.94,$29.26,$18.58,$20.48,$18.58
30100207,EAP,CPT® 83002,,"Lh,serum",$515.00,$10.36,$515.00,$33.01,$27.04,$23.75,$10.36,$27.04,$27.04,$27.36,$515.00,$19.45,$51.76,$407.88,$412.00,$26.85,$29.16,$18.52,$20.41,$18.52
30100208,EAP,CPT® 83003,,Growth Hormone,$129.00,$0.00,$129.00,$0.00,$20.79,$0.00,$0.00,$20.79,$20.79,$0.00,$129.00,$0.00,$39.78,$102.17,$103.20,$0.00,$0.00,$0.00,$0.00,$0.00
30100209,EAP,CPT® 83010,,"Haptoglobin,serum",$336.00,$4.11,$336.00,$6.66,$5.44,$17.12,$7.04,$5.44,$5.44,$5.51,$336.00,$13.21,$10.42,$266.11,$268.80,$18.24,$5.87,$12.58,$4.11,$12.58
30100211,EAP,CPT® 83020,,Hgb Elect - Family,$218.00,$6.58,$218.00,$17.42,$14.27,$6.58,$7.21,$14.27,$14.27,$14.44,$218.00,$13.51,$27.32,$172.66,$174.40,$18.66,$15.38,$12.87,$10.77,$12.87
30100212,EAP,CPT® 83020,,Hgb Electrophoresis,$218.00,$6.58,$218.00,$17.42,$14.27,$6.58,$7.21,$14.27,$14.27,$14.44,$218.00,$13.51,$27.32,$172.66,$174.40,$18.66,$15.38,$12.87,$10.77,$12.87
30100213,EAP,CPT® 83020,,Citrate Agar Elect.,$218.00,$6.58,$218.00,$17.42,$14.27,$6.58,$7.21,$14.27,$14.27,$14.44,$218.00,$13.51,$27.32,$172.66,$174.40,$18.66,$15.38,$12.87,$10.77,$12.87
30100214,EAP,CPT® 83020,,Hgb Elect. Quant,$218.00,$6.58,$218.00,$17.42,$14.27,$6.58,$7.21,$14.27,$14.27,$14.44,$218.00,$13.51,$27.32,$172.66,$174.40,$18.66,$15.38,$12.87,$10.77,$12.87
30100215,EAP,CPT® 83020,,HGB ELECT. CORD BLD,$218.00,$6.58,$218.00,$17.42,$14.27,$6.58,$7.21,$14.27,$14.27,$14.44,$218.00,$13.51,$27.32,$172.66,$174.40,$18.66,$15.38,$12.87,$10.77,$12.87
30100216,EAP,CPT® 83021,,"Hgb Phenotyping, Family Member",$218.00,$6.62,$218.00,$10.72,$8.77,$24.58,$10.10,$8.77,$8.77,$8.87,$218.00,$18.96,$16.78,$172.66,$174.40,$26.19,$9.45,$18.06,$6.62,$18.06
30100217,EAP,CPT® 83021,,"Hgb A, S, And C Quant, Hplc",$218.00,$6.62,$218.00,$10.72,$8.77,$24.58,$10.10,$8.77,$8.77,$8.87,$218.00,$18.96,$16.78,$172.66,$174.40,$26.19,$9.45,$18.06,$6.62,$18.06
30100218,EAP,CPT® 83021,,"Hgb Phenotyping, Complete",$218.00,$6.62,$218.00,$10.72,$8.77,$24.58,$10.10,$8.77,$8.77,$8.87,$218.00,$18.96,$16.78,$172.66,$174.40,$26.19,$9.45,$18.06,$6.62,$18.06
30100219,EAP,CPT® 83021,,"Fetal Hgb Quant, Hplc",$218.00,$6.62,$218.00,$10.72,$8.77,$24.58,$10.10,$8.77,$8.77,$8.87,$218.00,$18.96,$16.78,$172.66,$174.40,$26.19,$9.45,$18.06,$6.62,$18.06
30100221,EAP,CPT® 83036,,HGB GLUCOSE A1C,$219.00,$5.44,$219.00,$17.31,$14.17,$13.21,$5.44,$14.17,$14.17,$14.33,$219.00,$10.20,$27.12,$173.45,$175.20,$14.08,$15.27,$9.71,$10.69,$9.71
30100222,EAP,CPT® 83051,,"Hgb,plasma-quant",$165.00,$0.00,$165.00,$0.00,$10.67,$0.00,$0.00,$10.67,$10.67,$0.00,$165.00,$0.00,$20.42,$130.68,$132.00,$0.00,$0.00,$0.00,$0.00,$0.00
30100223,EAP,CPT® 83060,,"Sulfhemoglobin,bld",$164.00,$0.00,$164.00,$0.00,$12.08,$0.00,$0.00,$12.08,$12.08,$0.00,$164.00,$0.00,$23.12,$129.89,$131.20,$0.00,$0.00,$0.00,$0.00,$0.00
30100224,EAP,CPT® 83065,,"Hgb Denaturat.,heat",$146.00,$0.00,$146.00,$0.00,$10.06,$0.00,$0.00,$10.06,$10.06,$0.00,$146.00,$0.00,$19.24,$115.63,$116.80,$0.00,$0.00,$0.00,$0.00,$0.00
30100225,EAP,CPT® 83068,,"Hgb Pp't,isopropanol",$176.00,$0.00,$176.00,$0.00,$12.37,$0.00,$0.00,$12.37,$12.37,$0.00,$176.00,$0.00,$23.66,$139.39,$140.80,$0.00,$0.00,$0.00,$0.00,$0.00
30100226,EAP,CPT® 83069,,"Hemoglobin,urine-qnt",$88.00,$0.00,$88.00,$0.00,$5.76,$0.00,$0.00,$5.76,$5.76,$0.00,$88.00,$0.00,$11.02,$69.70,$70.40,$0.00,$0.00,$0.00,$0.00,$0.00
30100227,EAP,CPT® 83070,,"Hemosiderin, Urine",$59.00,$0.00,$59.00,$0.00,$6.93,$0.00,$0.00,$6.93,$6.93,$0.00,$59.00,$0.00,$13.28,$46.73,$47.20,$0.00,$0.00,$0.00,$0.00,$0.00
30100228,EAP,CPT® 83080,,Hexosaminidase-1,$525.00,$0.00,$525.00,$0.00,$24.63,$0.00,$0.00,$24.63,$24.63,$0.00,$525.00,$0.00,$47.14,$415.80,$420.00,$0.00,$0.00,$0.00,$0.00,$0.00
30100229,EAP,CPT® 83150,,Homovanillic Acid-24h,$94.00,$0.00,$94.00,$0.00,$28.25,$0.00,$0.00,$28.25,$28.25,$0.00,$94.00,$0.00,$54.08,$74.45,$75.20,$0.00,$0.00,$0.00,$0.00,$0.00
30100230,EAP,CPT® 83491,,"Steroids-17oh,24h Ur",$94.00,$0.00,$94.00,$0.00,$25.57,$0.00,$0.00,$25.57,$25.57,$0.00,$94.00,$0.00,$48.94,$74.45,$75.20,$0.00,$0.00,$0.00,$0.00,$0.00
30100231,EAP,CPT® 83497,,"Serotonin,urine-24",$154.00,$7.22,$154.00,$22.98,$18.83,$17.55,$7.22,$18.83,$18.83,$19.05,$154.00,$13.55,$36.02,$121.97,$123.20,$18.71,$20.30,$12.90,$14.21,$12.90
30100232,EAP,CPT® 83498,,"Progesterone,17a-oh",$289.00,$15.20,$289.00,$48.43,$39.66,$36.97,$15.20,$39.66,$39.66,$40.13,$289.00,$28.53,$75.90,$228.89,$231.20,$39.40,$42.76,$27.17,$29.93,$27.17
30100233,EAP,CPT® 83516,,T-transglutaminase Iga,$176.00,$6.44,$176.00,$19.04,$15.61,$15.70,$6.44,$15.61,$15.61,$15.80,$176.00,$12.11,$29.88,$139.39,$140.80,$16.72,$16.84,$11.53,$11.79,$11.53
30100234,EAP,CPT® 83516,,Gliadin Ab Igg,$304.00,$6.44,$304.00,$19.04,$15.61,$15.70,$6.44,$15.61,$15.61,$15.80,$304.00,$12.11,$29.88,$240.77,$243.20,$16.72,$16.84,$11.53,$11.79,$11.53
30100235,EAP,CPT® 83516,,Gliadin Ab Iga,$304.00,$6.44,$304.00,$19.04,$15.61,$15.70,$6.44,$15.61,$15.61,$15.80,$304.00,$12.11,$29.88,$240.77,$243.20,$16.72,$16.84,$11.53,$11.79,$11.53
30100236,EAP,CPT® 83519,,Igf Binding Protein-3,$253.00,$9.26,$253.00,$24.08,$19.73,$18.39,$9.26,$19.73,$19.73,$19.96,$253.00,$19.32,$37.76,$200.38,$202.40,$26.68,$21.27,$18.40,$14.89,$18.40
30100237,EAP,CPT® 83519,,Gad-65 Autoantibody,$253.00,$9.26,$253.00,$24.08,$19.73,$18.39,$9.26,$19.73,$19.73,$19.96,$253.00,$19.32,$37.76,$200.38,$202.40,$26.68,$21.27,$18.40,$14.89,$18.40
30100238,EAP,CPT® 84490,,"Trypsin,fecal",$116.00,$0.00,$116.00,$0.00,$11.11,$0.00,$0.00,$11.11,$11.11,$0.00,$116.00,$0.00,$21.26,$91.87,$92.80,$0.00,$0.00,$0.00,$0.00,$0.00
30100239,EAP,CPT® 80155,,Caffeine (so),$554.00,$0.00,$554.00,$0.00,$19.30,$0.00,$0.00,$19.30,$19.30,$0.00,$554.00,$0.00,$277.00,$438.77,$443.20,$0.00,$0.00,$0.00,$0.00,$0.00
30100240,EAP,CPT® 83525,,"Insulin, Serum",$327.00,$6.40,$327.00,$20.38,$16.69,$15.55,$6.40,$16.69,$16.69,$16.89,$327.00,$12.00,$31.96,$258.98,$261.60,$16.57,$18.00,$11.43,$12.60,$11.43
30100241,EAP,CPT® 83540,,"Iron-total,serum",$200.00,$3.62,$200.00,$11.54,$9.46,$8.81,$3.62,$9.46,$9.46,$9.58,$200.00,$6.79,$18.10,$158.40,$160.00,$9.38,$10.20,$6.47,$7.14,$6.47
30100242,EAP,CPT® 83540,,"Iron, Liver Tissue",$186.00,$3.62,$186.00,$11.54,$9.46,$8.81,$3.62,$9.46,$9.46,$9.58,$186.00,$6.79,$18.10,$147.31,$148.80,$9.38,$10.20,$6.47,$7.14,$6.47
30100243,EAP,CPT® 83582,,"Steroids-17kg,24h Ur",$93.00,$0.00,$93.00,$0.00,$20.69,$0.00,$0.00,$20.69,$20.69,$0.00,$93.00,$0.00,$39.60,$73.66,$74.40,$0.00,$0.00,$0.00,$0.00,$0.00
30100244,EAP,CPT® 83593,,"Steroids-17keto,24hr",$367.00,$0.00,$367.00,$0.00,$38.40,$0.00,$0.00,$38.40,$38.40,$0.00,$367.00,$0.00,$73.50,$290.66,$293.60,$0.00,$0.00,$0.00,$0.00,$0.00
30100247,EAP,CPT® 83605,,"Lactic Acid, Blood",$311.00,$5.97,$311.00,$19.04,$15.59,$14.53,$5.97,$15.59,$15.59,$15.78,$311.00,$12.15,$29.84,$246.31,$248.80,$16.78,$16.82,$11.57,$11.77,$11.57
30100248,EAP,CPT® 83605,,"Lactic Acid, Csf",$311.00,$5.97,$311.00,$19.04,$15.59,$14.53,$5.97,$15.59,$15.59,$15.78,$311.00,$12.15,$29.84,$246.31,$248.80,$16.78,$16.82,$11.57,$11.77,$11.57
30100249,EAP,CPT® 83605,,"LACTIC ACID, FLUID",$311.00,$5.97,$311.00,$19.04,$15.59,$14.53,$5.97,$15.59,$15.59,$15.78,$311.00,$12.15,$29.84,$246.31,$248.80,$16.78,$16.82,$11.57,$11.77,$11.57
30100251,EAP,CPT® 83615,,"Ldh,total-serum",$139.00,$3.38,$139.00,$10.76,$8.81,$8.04,$3.38,$8.81,$8.81,$7.46,$139.00,$6.34,$16.88,$110.09,$111.20,$8.76,$7.94,$6.04,$5.56,$6.04
30100252,EAP,CPT® 83615,,"Ldh,fluid",$139.00,$3.38,$139.00,$10.76,$8.81,$8.04,$3.38,$8.81,$8.81,$7.46,$139.00,$6.34,$16.88,$110.09,$111.20,$8.76,$7.94,$6.04,$5.56,$6.04
30100253,EAP,CPT® 83615,,"LDH,CSF",$139.00,$3.38,$139.00,$10.76,$8.81,$8.04,$3.38,$8.81,$8.81,$7.46,$139.00,$6.34,$16.88,$110.09,$111.20,$8.76,$7.94,$6.04,$5.56,$6.04
30100254,EAP,CPT® 83655,,"Lead,blood",$200.00,$6.77,$200.00,$21.59,$17.67,$16.47,$6.77,$17.67,$17.67,$11.75,$200.00,$12.72,$33.82,$158.40,$160.00,$17.56,$12.52,$12.11,$8.76,$12.11
30100255,EAP,CPT® 83655,,"Lead,urine-24hr",$195.00,$6.77,$195.00,$21.59,$17.67,$16.47,$6.77,$17.67,$17.67,$11.75,$195.00,$12.72,$33.82,$154.44,$156.00,$17.56,$12.52,$12.11,$8.76,$12.11
30100256,EAP,CPT® 83661,,Fetal Lung Maturity,$263.00,$0.00,$263.00,$0.00,$32.09,$0.00,$0.00,$32.09,$32.09,$0.00,$263.00,$0.00,$61.42,$208.30,$210.40,$0.00,$0.00,$0.00,$0.00,$0.00
30100258,EAP,CPT® 83690,,"LIPASE, SERUM",$251.00,$3.85,$251.00,$12.29,$10.06,$9.38,$3.85,$10.06,$10.06,$10.17,$251.00,$7.23,$19.24,$198.79,$200.80,$9.99,$10.84,$6.89,$7.59,$6.89
30100259,EAP,CPT® 83698,,Plac (lp-pla2) Test,$453.00,$0.00,$453.00,$0.00,$49.56,$0.00,$0.00,$49.56,$49.56,$0.00,$453.00,$0.00,$94.86,$358.78,$362.40,$0.00,$0.00,$0.00,$0.00,$0.00
30100260,EAP,CPT® 83718,,"CHOL,HDL",$119.00,$4.59,$119.00,$14.61,$11.96,$11.14,$4.59,$11.96,$11.96,$12.10,$119.00,$8.60,$22.88,$94.25,$95.20,$11.88,$12.89,$8.19,$9.02,$8.19
30100262,EAP,CPT® 83721,,"CHOL-LDL, DIRECT",$149.00,$5.34,$149.00,$17.01,$13.93,$12.99,$5.34,$13.93,$13.93,$14.10,$149.00,$11.03,$26.66,$118.01,$119.20,$15.23,$15.03,$10.50,$10.52,$10.50
30100263,EAP,CPT® 83735,,Magnesium,$171.00,$3.75,$171.00,$11.95,$9.78,$9.11,$3.75,$9.78,$9.78,$9.89,$171.00,$7.04,$18.72,$135.43,$136.80,$9.72,$10.54,$6.70,$7.38,$6.70
30100264,EAP,CPT® 83735,,"MAGNESIUM, URINE",$171.00,$3.75,$171.00,$11.95,$9.78,$9.11,$3.75,$9.78,$9.78,$9.89,$171.00,$7.04,$18.72,$135.43,$136.80,$9.72,$10.54,$6.70,$7.38,$6.70
30100266,EAP,CPT® 83825,,"Mercury,urine-24hr",$84.00,$0.00,$84.00,$28.98,$23.74,$22.12,$0.00,$23.74,$23.74,$24.02,$84.00,$17.07,$45.44,$66.53,$67.20,$23.58,$0.00,$16.26,$17.92,$16.26
30100267,EAP,CPT® 83835,,"Metaneph.tot,ur",$471.00,$9.48,$471.00,$30.21,$24.74,$23.05,$9.48,$24.74,$24.74,$25.02,$471.00,$17.79,$47.34,$373.03,$376.80,$24.56,$26.66,$16.94,$18.66,$16.94
30100268,EAP,CPT® 83835,,"Metanephrines, Frac, Plasma",$504.00,$9.48,$504.00,$30.21,$24.74,$23.05,$9.48,$24.74,$24.74,$25.02,$504.00,$17.79,$47.34,$399.17,$403.20,$24.56,$26.66,$16.94,$18.66,$16.94
30100269,EAP,CPT® 83835,,"Metanephrines, Urine, Random",$504.00,$9.48,$504.00,$30.21,$24.74,$23.05,$9.48,$24.74,$24.74,$25.02,$504.00,$17.79,$47.34,$399.17,$403.20,$24.56,$26.66,$16.94,$18.66,$16.94
30100270,EAP,CPT® 83864,,Mucopolysaccha,$388.00,$0.00,$388.00,$0.00,$29.07,$0.00,$0.00,$29.07,$29.07,$0.00,$388.00,$0.00,$55.64,$307.30,$310.40,$0.00,$0.00,$0.00,$0.00,$0.00
30100271,EAP,CPT® 83874,,"Myoglobin-qual,urine",$182.00,$7.23,$182.00,$23.03,$18.86,$17.58,$7.23,$18.86,$18.86,$19.08,$182.00,$13.57,$36.08,$144.14,$145.60,$18.73,$20.33,$12.92,$14.23,$12.92
30100272,EAP,CPT® 83880,,B-type Natriurtic Peptide,$372.00,$19.77,$372.00,$60.51,$49.56,$46.19,$19.77,$49.56,$49.56,$50.15,$372.00,$41.22,$94.86,$294.62,$297.60,$56.93,$53.43,$39.26,$37.40,$39.26
30100273,EAP,CPT® 83883,,Alpha2-macroglbulin,$178.00,$7.61,$178.00,$24.24,$19.85,$9.90,$7.61,$19.85,$19.85,$20.09,$178.00,$14.28,$38.00,$140.98,$142.40,$19.72,$21.40,$13.60,$14.98,$13.60
30100274,EAP,CPT® 83883,,"Albumin-immuno,ser",$178.00,$7.61,$178.00,$24.24,$19.85,$9.90,$7.61,$19.85,$19.85,$20.09,$178.00,$14.28,$38.00,$140.98,$142.40,$19.72,$21.40,$13.60,$14.98,$13.60
30100275,EAP,CPT® 83883,,"Albumin,csf-immuno",$178.00,$7.61,$178.00,$24.24,$19.85,$9.90,$7.61,$19.85,$19.85,$20.09,$178.00,$14.28,$38.00,$140.98,$142.40,$19.72,$21.40,$13.60,$14.98,$13.60
30100276,EAP,CPT® 83883,,"Albumin,urine-immuno",$178.00,$7.61,$178.00,$24.24,$19.85,$9.90,$7.61,$19.85,$19.85,$20.09,$178.00,$14.28,$38.00,$140.98,$142.40,$19.72,$21.40,$13.60,$14.98,$13.60
30100277,EAP,CPT® 83883,,C-1 Esterase Inhib,$168.00,$7.61,$168.00,$24.24,$19.85,$9.90,$7.61,$19.85,$19.85,$20.09,$168.00,$14.28,$38.00,$133.06,$134.40,$19.72,$21.40,$13.60,$14.98,$13.60
30100278,EAP,CPT® 83883,,Free Kappa,$178.00,$7.61,$178.00,$24.24,$19.85,$9.90,$7.61,$19.85,$19.85,$20.09,$178.00,$14.28,$38.00,$140.98,$142.40,$19.72,$21.40,$13.60,$14.98,$13.60
30100279,EAP,CPT® 83883,,Free Lambda,$178.00,$7.61,$178.00,$24.24,$19.85,$9.90,$7.61,$19.85,$19.85,$20.09,$178.00,$14.28,$38.00,$140.98,$142.40,$19.72,$21.40,$13.60,$14.98,$13.60
30100280,EAP,CPT® 80323,,Nicotine,$422.00,$0.00,$422.00,$0.02,$301.18,$75.12,$20.62,$301.18,$301.18,$44.34,$422.00,$0.00,$211.00,$334.22,$337.60,$253.20,$47.25,$0.00,$33.07,$0.00
30100296,EAP,CPT® 83915,,5'-nucleotidase,$64.00,$0.00,$64.00,$0.00,$16.29,$0.00,$0.00,$16.29,$16.29,$0.00,$64.00,$0.00,$31.16,$50.69,$51.20,$0.00,$0.00,$0.00,$0.00,$0.00
30100297,EAP,CPT® 83921,,Methylmalonic Acid,$243.00,$10.67,$243.00,$29.32,$24.04,$22.39,$10.67,$24.04,$24.04,$24.32,$243.00,$22.27,$46.00,$192.46,$194.40,$30.75,$25.91,$21.21,$18.14,$21.21
30100298,EAP,CPT® 83921,,Orotic Acid,$243.00,$10.67,$243.00,$29.32,$24.04,$22.39,$10.67,$24.04,$24.04,$24.32,$243.00,$22.27,$46.00,$192.46,$194.40,$30.75,$25.91,$21.21,$18.14,$21.21
30100299,EAP,CPT® 83930,,"Osmolality,crystal",$241.00,$3.70,$241.00,$11.79,$9.65,$4.43,$3.70,$9.65,$9.65,$9.78,$241.00,$6.94,$18.48,$190.87,$192.80,$9.58,$10.42,$6.61,$7.29,$6.61
30100300,EAP,CPT® 83930,,Osmolality,$241.00,$3.70,$241.00,$11.79,$9.65,$4.43,$3.70,$9.65,$9.65,$9.78,$241.00,$6.94,$18.48,$190.87,$192.80,$9.58,$10.42,$6.61,$7.29,$6.61
30100301,EAP,CPT® 83935,,"Osmolality,fluid",$247.00,$3.82,$247.00,$12.15,$9.95,$9.11,$3.82,$9.95,$9.95,$10.07,$247.00,$7.16,$19.04,$195.62,$197.60,$9.89,$10.73,$6.82,$7.51,$6.82
30100302,EAP,CPT® 83935,,"Osmolality,urine",$247.00,$3.82,$247.00,$12.15,$9.95,$9.11,$3.82,$9.95,$9.95,$10.07,$247.00,$7.16,$19.04,$195.62,$197.60,$9.89,$10.73,$6.82,$7.51,$6.82
30100303,EAP,CPT® 83945,,"Oxalate, Urine-24hr",$53.00,$0.00,$53.00,$0.00,$18.80,$0.00,$0.00,$18.80,$18.80,$0.00,$53.00,$0.00,$35.98,$41.98,$42.40,$0.00,$0.00,$0.00,$0.00,$0.00
30100304,EAP,CPT® 83970,,Parathormone Intact,$502.00,$23.09,$502.00,$73.58,$60.27,$56.17,$23.09,$60.27,$60.27,$60.97,$502.00,$43.34,$115.34,$397.58,$401.60,$59.86,$64.97,$41.28,$45.48,$41.28
30100306,EAP,CPT® 83986,,"Ph, Stool",$78.00,$0.00,$78.00,$6.38,$5.22,$4.87,$0.00,$5.22,$5.22,$5.28,$78.00,$3.76,$10.00,$61.78,$62.40,$5.19,$0.00,$3.58,$3.94,$3.58
30100307,EAP,CPT® 84075,,Alk Phosphatase,$105.00,$2.90,$105.00,$9.23,$7.56,$7.04,$2.90,$7.56,$7.56,$7.46,$105.00,$5.44,$14.46,$83.16,$84.00,$7.51,$7.94,$5.18,$5.56,$5.18
30100308,EAP,CPT® 84075,,"Alk Phos,fluid",$110.00,$2.90,$110.00,$9.23,$7.56,$7.04,$2.90,$7.56,$7.56,$7.46,$110.00,$5.44,$14.46,$87.12,$88.00,$7.51,$7.94,$5.18,$5.56,$5.18
30100309,EAP,CPT® 84080,,Alk Phos Isoenzymes,$301.00,$8.27,$301.00,$26.36,$21.59,$20.12,$8.27,$21.59,$21.59,$21.84,$301.00,$15.52,$41.32,$238.39,$240.80,$21.43,$23.27,$14.78,$16.29,$14.78
30100310,EAP,CPT® 84081,,Pg Agglutinin Test,$194.00,$0.00,$194.00,$0.00,$24.12,$0.00,$0.00,$24.12,$24.12,$0.00,$194.00,$0.00,$46.18,$153.65,$155.20,$0.00,$0.00,$0.00,$0.00,$0.00
30100311,EAP,CPT® 84100,,Phosphorus,$136.00,$2.65,$136.00,$8.46,$6.93,$6.45,$2.65,$6.93,$6.93,$7.01,$136.00,$4.98,$13.26,$107.71,$108.80,$6.87,$7.47,$4.74,$5.23,$4.74
30100312,EAP,CPT® 84100,,"Phosporus, Serum",$136.00,$2.65,$136.00,$8.46,$6.93,$6.45,$2.65,$6.93,$6.93,$7.01,$136.00,$4.98,$13.26,$107.71,$108.80,$6.87,$7.47,$4.74,$5.23,$4.74
30100313,EAP,CPT® 84105,,"Phosphorus, Urine",$149.00,$2.91,$149.00,$9.23,$7.56,$7.04,$2.91,$7.56,$7.56,$7.64,$149.00,$6.07,$14.46,$118.01,$119.20,$8.38,$8.14,$5.78,$5.70,$5.78
30100314,EAP,CPT® 84110,,Porphobilinogen-24hr,$75.00,$4.72,$75.00,$15.05,$12.34,$11.48,$4.72,$12.34,$12.34,$12.47,$75.00,$8.86,$23.60,$59.40,$60.00,$12.24,$13.29,$8.44,$9.30,$8.44
30100315,EAP,CPT® 84120,,"Porphyrins,ur-quant",$109.00,$0.00,$109.00,$0.00,$21.47,$0.00,$0.00,$21.47,$21.47,$0.00,$109.00,$0.00,$41.10,$86.33,$87.20,$0.00,$0.00,$0.00,$0.00,$0.00
30100316,EAP,CPT® 84132,,"Potassium, Wb",$141.00,$2.57,$141.00,$8.21,$6.70,$6.26,$2.57,$6.70,$6.70,$6.79,$141.00,$5.00,$12.84,$111.67,$112.80,$6.90,$7.24,$4.76,$5.07,$4.76
30100317,EAP,CPT® 84132,,Potassium,$141.00,$2.57,$141.00,$8.21,$6.70,$6.26,$2.57,$6.70,$6.70,$6.79,$141.00,$5.00,$12.84,$111.67,$112.80,$6.90,$7.24,$4.76,$5.07,$4.76
30100318,EAP,CPT® 84132,,"Potassium,plasma",$141.00,$2.57,$141.00,$8.21,$6.70,$6.26,$2.57,$6.70,$6.70,$6.79,$141.00,$5.00,$12.84,$111.67,$112.80,$6.90,$7.24,$4.76,$5.07,$4.76
30100319,EAP,CPT® 84133,,"Potassium,fluid",$106.00,$2.42,$106.00,$7.68,$6.28,$4.74,$2.42,$6.28,$6.28,$6.35,$106.00,$4.97,$12.02,$83.95,$84.80,$6.86,$6.77,$4.73,$4.74,$4.73
30100320,EAP,CPT® 84133,,"Potassium, Urine",$106.00,$2.42,$106.00,$7.68,$6.28,$4.74,$2.42,$6.28,$6.28,$6.35,$106.00,$4.97,$12.02,$83.95,$84.80,$6.86,$6.77,$4.73,$4.74,$4.73
30100321,EAP,CPT® 84134,,Prealbumin,$256.00,$8.16,$256.00,$26.01,$21.30,$9.90,$8.16,$21.30,$21.30,$21.55,$256.00,$15.32,$40.76,$202.75,$204.80,$21.16,$22.96,$14.59,$16.07,$14.59
30100322,EAP,CPT® 84135,,"Pregnanediol,ur-24hr",$224.00,$0.00,$224.00,$0.00,$27.94,$0.00,$0.00,$27.94,$27.94,$0.00,$224.00,$0.00,$53.46,$177.41,$179.20,$0.00,$0.00,$0.00,$0.00,$0.00
30100323,EAP,CPT® 84138,,"Pregnanetriol,ur-24h",$223.00,$0.00,$223.00,$0.00,$27.65,$0.00,$0.00,$27.65,$27.65,$0.00,$223.00,$0.00,$52.92,$176.62,$178.40,$0.00,$0.00,$0.00,$0.00,$0.00
30100324,EAP,CPT® 84144,,"Progesterone, Serum",$224.00,$11.67,$224.00,$36.32,$29.74,$28.39,$11.67,$29.74,$29.74,$30.08,$224.00,$21.90,$56.92,$177.41,$179.20,$30.25,$32.05,$20.86,$22.44,$20.86
30100325,EAP,CPT® 84146,,"Prolactin,serum",$427.00,$10.84,$427.00,$34.54,$28.30,$26.37,$10.84,$28.30,$28.30,$28.63,$427.00,$20.35,$54.16,$338.18,$341.60,$28.10,$30.51,$19.38,$21.36,$19.38
30100326,EAP,CPT® 84153,,Prostatic Antigen,$335.00,$10.29,$335.00,$32.79,$26.85,$25.03,$10.29,$26.85,$26.85,$27.17,$335.00,$19.31,$51.40,$265.32,$268.00,$26.67,$28.95,$18.39,$20.27,$18.39
30100327,EAP,CPT® 84155,,"Protein,total",$132.00,$0.00,$132.00,$0.00,$5.35,$0.00,$2.05,$5.35,$5.35,$5.42,$132.00,$0.00,$10.24,$104.54,$105.60,$0.00,$5.77,$0.00,$0.00,$0.00
30100328,EAP,CPT® 84155,,"Protein, Csf",$132.00,$0.00,$132.00,$0.00,$5.35,$0.00,$2.05,$5.35,$5.35,$5.42,$132.00,$0.00,$10.24,$104.54,$105.60,$0.00,$5.77,$0.00,$0.00,$0.00
30100329,EAP,CPT® 84155,,"Protein,total",$132.00,$0.00,$132.00,$0.00,$5.35,$0.00,$2.05,$5.35,$5.35,$5.42,$132.00,$0.00,$10.24,$104.54,$105.60,$0.00,$5.77,$0.00,$0.00,$0.00
30100330,EAP,CPT® 84156,,"Protein,ur (quant)",$129.00,$2.05,$129.00,$6.54,$5.35,$4.99,$2.05,$5.35,$5.35,$5.42,$129.00,$3.85,$10.24,$102.17,$103.20,$5.32,$5.77,$3.67,$4.04,$3.67
30100331,EAP,CPT® 84157,,"Protein,fluid",$152.00,$2.05,$152.00,$6.54,$5.35,$4.99,$2.05,$5.35,$5.35,$5.42,$152.00,$4.20,$10.24,$120.38,$121.60,$5.80,$5.77,$4.00,$4.04,$4.00
30100332,EAP,CPT® 84157,,"Protein, Csf",$152.00,$2.05,$152.00,$6.54,$5.35,$4.99,$2.05,$5.35,$5.35,$5.42,$152.00,$4.20,$10.24,$120.38,$121.60,$5.80,$5.77,$4.00,$4.04,$4.00
30100333,EAP,CPT® 84165,,"Protein Elect, Serum",$350.00,$6.01,$350.00,$19.15,$15.68,$14.61,$6.01,$15.68,$15.68,$15.87,$350.00,$11.28,$30.02,$277.20,$280.00,$15.57,$16.91,$10.74,$11.83,$10.74
30100334,EAP,CPT® 84166,,"Protein Electrophoresis, Csf",$350.00,$9.97,$350.00,$31.78,$26.04,$24.27,$9.97,$26.04,$26.04,$26.34,$350.00,$18.72,$49.84,$277.20,$280.00,$25.85,$28.07,$17.83,$19.65,$17.83
30100335,EAP,CPT® 84166,,"Protein Elect, Urine",$350.00,$9.97,$350.00,$31.78,$26.04,$24.27,$9.97,$26.04,$26.04,$26.34,$350.00,$18.72,$49.84,$277.20,$280.00,$25.85,$28.07,$17.83,$19.65,$17.83
30100336,EAP,CPT® 84202,,"Protoporphyrin,rbc",$74.00,$0.00,$74.00,$0.00,$20.95,$0.00,$0.00,$20.95,$20.95,$0.00,$74.00,$0.00,$40.10,$58.61,$59.20,$0.00,$0.00,$0.00,$0.00,$0.00
30100337,EAP,CPT® 84207,,Vitamine B6; Pyridoxine,$800.00,$0.00,$800.00,$0.00,$41.02,$0.00,$0.00,$41.02,$41.02,$0.00,$800.00,$0.00,$78.50,$633.60,$640.00,$0.00,$0.00,$0.00,$0.00,$0.00
30100338,EAP,CPT® 84210,,"Pyruvic Acid, Blood",$118.00,$0.00,$118.00,$19.36,$15.85,$14.77,$0.00,$15.85,$15.85,$0.00,$118.00,$15.20,$30.34,$93.46,$94.40,$21.00,$0.00,$14.48,$11.96,$14.48
30100339,EAP,CPT® 84238,,Acetcholn Reptor Ad,$203.00,$20.45,$203.00,$65.19,$53.39,$49.77,$20.45,$53.39,$53.39,$54.01,$203.00,$38.40,$102.18,$160.78,$162.40,$53.03,$57.55,$36.57,$40.29,$36.57
30100340,EAP,CPT® 84244,,"Renin, Blood",$325.00,$12.31,$325.00,$39.22,$32.12,$29.93,$12.31,$32.12,$32.12,$32.50,$325.00,$23.09,$61.46,$257.40,$260.00,$31.89,$34.63,$21.99,$24.24,$21.99
30100341,EAP,CPT® 84295,,"Sodium, Wb",$200.00,$2.70,$200.00,$8.57,$7.02,$6.55,$2.70,$7.02,$7.02,$7.11,$200.00,$5.05,$13.44,$158.40,$160.00,$6.97,$7.57,$4.81,$5.30,$4.81
30100342,EAP,CPT® 84295,,Sodium,$200.00,$2.70,$200.00,$8.57,$7.02,$6.55,$2.70,$7.02,$7.02,$7.11,$200.00,$5.05,$13.44,$158.40,$160.00,$6.97,$7.57,$4.81,$5.30,$4.81
30100343,EAP,CPT® 84295,,Sodium-direct Ise,$200.00,$2.70,$200.00,$8.57,$7.02,$6.55,$2.70,$7.02,$7.02,$7.11,$200.00,$5.05,$13.44,$158.40,$160.00,$6.97,$7.57,$4.81,$5.30,$4.81
30100344,EAP,CPT® 84300,,"Sodium, Urine",$131.00,$2.72,$131.00,$6.16,$5.05,$6.62,$2.72,$5.05,$5.05,$5.11,$131.00,$5.31,$9.66,$103.75,$104.80,$7.34,$5.45,$5.06,$3.81,$5.06
30100345,EAP,CPT® 84302,,"Sodium,fluid",$131.00,$0.00,$131.00,$0.00,$5.05,$0.00,$0.00,$5.05,$5.05,$0.00,$131.00,$0.00,$9.66,$103.75,$104.80,$0.00,$0.00,$0.00,$0.00,$0.00
30100346,EAP,CPT® 84305,,Igf-1(somatomedin C),$275.00,$11.89,$275.00,$37.92,$31.04,$21.41,$11.89,$31.04,$31.04,$31.41,$275.00,$22.32,$59.40,$217.80,$220.00,$30.83,$33.46,$21.26,$23.42,$21.26
30100347,EAP,CPT® 84375,,Oligosaccharide,$134.00,$0.00,$134.00,$0.00,$28.62,$0.00,$0.00,$28.62,$28.62,$0.00,$134.00,$0.00,$54.78,$106.13,$107.20,$0.00,$0.00,$0.00,$0.00,$0.00
30100348,EAP,CPT® 84402,,"Testosterone, Free",$95.00,$14.25,$95.00,$45.42,$37.18,$34.65,$14.25,$37.18,$37.18,$37.60,$95.00,$26.74,$71.14,$75.24,$76.00,$36.93,$40.06,$25.47,$28.04,$25.47
30100349,EAP,CPT® 84403,,"Testosterone, Total",$384.00,$14.44,$384.00,$46.01,$37.70,$35.13,$14.44,$37.70,$37.70,$38.15,$384.00,$27.10,$72.16,$304.13,$307.20,$37.42,$40.65,$25.81,$28.45,$25.81
30100350,EAP,CPT® 84403,,"Testosterone, Serum",$384.00,$14.44,$384.00,$46.01,$37.70,$35.13,$14.44,$37.70,$37.70,$38.15,$384.00,$27.10,$72.16,$304.13,$307.20,$37.42,$40.65,$25.81,$28.45,$25.81
30100351,EAP,CPT® 84425,,Vitamine B1; Thyamin,$276.00,$11.88,$276.00,$37.85,$31.01,$28.89,$11.88,$31.01,$31.01,$31.36,$276.00,$22.29,$59.34,$218.59,$220.80,$30.78,$33.42,$21.23,$23.39,$21.23
30100352,EAP,CPT® 84430,,Thiocyanate-quant,$199.00,$0.00,$199.00,$0.00,$8.42,$0.00,$0.00,$8.42,$8.42,$0.00,$199.00,$0.00,$16.12,$157.61,$159.20,$0.00,$0.00,$0.00,$0.00,$0.00
30100353,EAP,CPT® 84432,,"Thyroglobulin, Quant",$214.00,$8.98,$214.00,$28.64,$23.45,$9.90,$8.98,$23.45,$23.45,$23.73,$214.00,$16.86,$44.88,$169.49,$171.20,$23.29,$25.28,$16.06,$17.70,$16.06
30100354,EAP,CPT® 84436,,"Thyroxine,total(t4)",$323.00,$3.84,$323.00,$12.24,$10.03,$8.73,$3.84,$10.03,$10.03,$10.16,$323.00,$7.21,$19.22,$255.82,$258.40,$9.96,$10.83,$6.87,$7.58,$6.87
30100355,EAP,CPT® 84439,,Free Thyroxine,$215.00,$5.05,$215.00,$16.07,$13.17,$11.90,$5.05,$13.17,$13.17,$13.32,$215.00,$9.47,$25.20,$170.28,$172.00,$13.08,$14.20,$9.02,$9.94,$9.02
30100356,EAP,CPT® 84442,,Thyroxine Bind.glob.,$63.00,$8.27,$63.00,$20.75,$16.99,$20.12,$8.27,$16.99,$16.99,$17.19,$63.00,$15.52,$32.52,$49.90,$50.40,$21.43,$18.31,$14.78,$12.82,$14.78
30100357,EAP,CPT® 84443,,"Tsh,serum-irma",$275.00,$9.40,$275.00,$29.96,$24.53,$22.87,$9.40,$24.53,$24.53,$24.81,$275.00,$17.64,$46.94,$217.80,$220.00,$24.36,$26.44,$16.80,$18.51,$16.80
30100358,EAP,CPT® 84446,,"Vitamin E, Serum",$178.00,$7.93,$178.00,$25.29,$20.70,$19.29,$7.93,$20.70,$20.70,$20.95,$178.00,$14.89,$39.62,$140.98,$142.40,$20.56,$22.32,$14.18,$15.62,$14.18
30100359,EAP,CPT® 84450,,"Sgot(ast),serum",$64.00,$2.90,$64.00,$9.23,$7.55,$7.04,$2.90,$7.55,$7.55,$7.46,$64.00,$5.44,$14.44,$50.69,$51.20,$7.51,$7.94,$5.18,$5.56,$5.18
30100360,EAP,CPT® 84460,,Sgpt(alt)-rate,$64.00,$2.96,$64.00,$9.44,$7.73,$6.74,$2.96,$7.73,$7.73,$7.46,$64.00,$5.57,$14.80,$50.69,$51.20,$7.69,$7.94,$5.30,$5.56,$5.30
30100361,EAP,CPT® 84466,,Transferrin,$343.00,$7.14,$343.00,$22.75,$18.64,$9.90,$7.14,$18.64,$18.64,$18.87,$343.00,$13.40,$35.68,$271.66,$274.40,$18.50,$20.10,$12.76,$14.07,$12.76
30100362,EAP,CPT® 84478,,Triglyceride-serum,$150.00,$3.21,$150.00,$10.24,$8.40,$7.82,$3.21,$8.40,$8.40,$7.46,$150.00,$6.03,$16.08,$118.80,$120.00,$8.32,$7.94,$5.74,$5.56,$5.74
30100363,EAP,CPT® 84478,,Triglyceride,$150.00,$3.21,$150.00,$10.24,$8.40,$7.82,$3.21,$8.40,$8.40,$7.46,$150.00,$6.03,$16.08,$118.80,$120.00,$8.32,$7.94,$5.74,$5.56,$5.74
30100364,EAP,CPT® 84478,,"Triglyceride,fluid",$150.00,$3.21,$150.00,$10.24,$8.40,$7.82,$3.21,$8.40,$8.40,$7.46,$150.00,$6.03,$16.08,$118.80,$120.00,$8.32,$7.94,$5.74,$5.56,$5.74
30100365,EAP,CPT® 84478,,Triglyceride,$131.00,$3.21,$131.00,$10.24,$8.40,$7.82,$3.21,$8.40,$8.40,$7.46,$131.00,$6.03,$16.08,$103.75,$104.80,$8.32,$7.94,$5.74,$5.56,$5.74
30100366,EAP,CPT® 84480,,T3-triiodothyronine,$299.00,$7.10,$299.00,$22.75,$18.61,$7.10,$7.93,$18.61,$18.61,$18.83,$299.00,$14.89,$35.62,$236.81,$239.20,$20.56,$20.06,$14.18,$14.04,$14.18
30100367,EAP,CPT® 84484,,Troponin-1,$420.00,$6.28,$420.00,$17.56,$14.37,$8.93,$6.28,$14.37,$14.37,$14.54,$420.00,$13.09,$27.50,$332.64,$336.00,$18.08,$15.50,$12.47,$10.85,$12.47
30100368,EAP,CPT® 84484,,Troponin-t,$420.00,$6.28,$420.00,$17.56,$14.37,$8.93,$6.28,$14.37,$14.37,$14.54,$420.00,$13.09,$27.50,$332.64,$336.00,$18.08,$15.50,$12.47,$10.85,$12.47
30100369,EAP,CPT® 84520,,Urea Nitrogen,$148.00,$0.00,$148.00,$0.00,$5.76,$0.00,$2.22,$5.76,$5.76,$0.00,$148.00,$0.00,$11.02,$117.22,$118.40,$0.00,$6.21,$0.00,$0.00,$0.00
30100370,EAP,CPT® 84540,,"Urea Nitrogen,fluid",$173.00,$2.80,$173.00,$8.46,$6.93,$5.85,$2.80,$6.93,$6.93,$7.02,$173.00,$5.84,$13.28,$137.02,$138.40,$8.06,$7.48,$5.56,$5.24,$5.56
30100371,EAP,CPT® 84540,,"Urea Nitrogen,urine",$173.00,$2.80,$173.00,$8.46,$6.93,$5.85,$2.80,$6.93,$6.93,$7.02,$173.00,$5.84,$13.28,$137.02,$138.40,$8.06,$7.48,$5.56,$5.24,$5.56
30100372,EAP,CPT® 84550,,Uric Acid - Serum,$141.00,$2.53,$141.00,$8.05,$6.59,$6.15,$2.53,$6.59,$6.59,$6.67,$141.00,$4.75,$12.62,$111.67,$112.80,$6.55,$7.10,$4.52,$4.97,$4.52
30100373,EAP,CPT® 84550,,Uric Acid,$141.00,$2.53,$141.00,$8.05,$6.59,$6.15,$2.53,$6.59,$6.59,$6.67,$141.00,$4.75,$12.62,$111.67,$112.80,$6.55,$7.10,$4.52,$4.97,$4.52
30100374,EAP,CPT® 84560,,"Uric Acid,syn Fluid",$141.00,$2.65,$141.00,$8.46,$6.93,$6.32,$2.65,$6.93,$6.93,$7.02,$141.00,$5.33,$13.28,$111.67,$112.80,$7.37,$7.48,$5.08,$5.24,$5.08
30100375,EAP,CPT® 84560,,"Uric Acid, Urine",$141.00,$2.65,$141.00,$8.46,$6.93,$6.32,$2.65,$6.93,$6.93,$7.02,$141.00,$5.33,$13.28,$111.67,$112.80,$7.37,$7.48,$5.08,$5.24,$5.08
30100376,EAP,CPT® 84585,,"Vma, Urine-24hr",$85.00,$0.00,$85.00,$0.00,$22.64,$0.00,$0.00,$22.64,$22.64,$0.00,$85.00,$0.00,$43.32,$67.32,$68.00,$0.00,$0.00,$0.00,$0.00,$0.00
30100377,EAP,CPT® 84586,,Vasoac Intes Polypep,$156.00,$0.00,$156.00,$63.00,$51.59,$20.94,$0.00,$51.59,$51.59,$52.20,$156.00,$37.10,$98.74,$123.55,$124.80,$51.23,$0.00,$35.33,$38.93,$35.33
30100378,EAP,CPT® 84588,,Adh Result,$263.00,$0.00,$263.00,$0.00,$49.56,$0.00,$0.00,$49.56,$49.56,$0.00,$263.00,$0.00,$94.86,$208.30,$210.40,$0.00,$0.00,$0.00,$0.00,$0.00
30100379,EAP,CPT® 84590,,"Vitamin A, Serum",$245.00,$0.00,$245.00,$20.68,$16.93,$15.79,$0.00,$16.93,$16.93,$17.13,$245.00,$12.19,$32.40,$194.04,$196.00,$16.83,$0.00,$11.61,$12.77,$11.61
30100380,EAP,CPT® 84600,,"Volatile, Drug Screen",$333.00,$0.00,$333.00,$0.00,$23.47,$0.00,$0.00,$23.47,$23.47,$0.00,$333.00,$0.00,$44.90,$263.74,$266.40,$0.00,$0.00,$0.00,$0.00,$0.00
30100381,EAP,CPT® 84620,,"D-xylose, Serum",$139.00,$0.00,$139.00,$0.00,$17.29,$0.00,$0.00,$17.29,$17.29,$0.00,$139.00,$0.00,$33.10,$110.09,$111.20,$0.00,$0.00,$0.00,$0.00,$0.00
30100382,EAP,CPT® 84620,,"D-xylose, Urine",$139.00,$0.00,$139.00,$0.00,$17.29,$0.00,$0.00,$17.29,$17.29,$0.00,$139.00,$0.00,$33.10,$110.09,$111.20,$0.00,$0.00,$0.00,$0.00,$0.00
30100383,EAP,CPT® 84630,,"Zinc, Serum",$82.00,$6.37,$82.00,$20.29,$16.63,$15.50,$6.37,$16.63,$16.63,$16.82,$82.00,$11.96,$31.82,$64.94,$65.60,$16.52,$17.92,$11.39,$12.55,$11.39
30100384,EAP,CPT® 84681,,"C-peptide, Random",$374.00,$11.65,$374.00,$28.34,$23.20,$28.32,$11.65,$23.20,$23.20,$23.47,$374.00,$21.85,$44.40,$296.21,$299.20,$30.17,$25.01,$20.81,$17.50,$20.81
30100385,EAP,CPT® 84681,,"C-peptide, Fasting",$374.00,$11.65,$374.00,$28.34,$23.20,$28.32,$11.65,$23.20,$23.20,$23.47,$374.00,$21.85,$44.40,$296.21,$299.20,$30.17,$25.01,$20.81,$17.50,$20.81
30100386,EAP,CPT® 84681,,"C-peptide, Stimulat.",$374.00,$11.65,$374.00,$28.34,$23.20,$28.32,$11.65,$23.20,$23.20,$23.47,$374.00,$21.85,$44.40,$296.21,$299.20,$30.17,$25.01,$20.81,$17.50,$20.81
30100387,EAP,CPT® 84702,,"*hcg, Serum, Quant",$381.00,$7.07,$381.00,$11.45,$9.37,$7.33,$8.42,$9.37,$9.37,$9.48,$381.00,$15.80,$17.94,$301.75,$304.80,$21.82,$10.10,$15.05,$7.07,$15.05
30100388,EAP,CPT® 84702,,"B-hcg,mat.serum",$208.00,$7.07,$208.00,$11.45,$9.37,$7.33,$8.42,$9.37,$9.37,$9.48,$208.00,$15.80,$17.94,$164.74,$166.40,$21.82,$10.10,$15.05,$7.07,$15.05
30100389,EAP,CPT® 84702,,"Hcg,serum-quant",$381.00,$7.07,$381.00,$11.45,$9.37,$7.33,$8.42,$9.37,$9.37,$9.48,$381.00,$15.80,$17.94,$301.75,$304.80,$21.82,$10.10,$15.05,$7.07,$15.05
30100390,EAP,CPT® 84703,,Pregnancy Test,$61.00,$0.00,$61.00,$0.00,$9.37,$0.00,$0.00,$9.37,$9.37,$0.00,$61.00,$0.00,$17.94,$48.31,$48.80,$0.00,$0.00,$0.00,$0.00,$0.00
30100392,EAP,CPT® 84999,,Lysosomal Enz.scrn,"$2,458.00",$0.00,"$2,458.00",$0.00,"$1,754.27",$0.00,$423.50,"$1,754.27","$1,754.27",$430.38,"$2,458.00",$0.00,$0.00,"$1,946.74","$1,966.40",$0.00,$384.68,$0.00,$0.00,$0.00
30100393,EAP,CPT® 84466,,"B-2 Transferrin, Fld",$487.00,$7.14,$487.00,$22.75,$18.64,$9.90,$7.14,$18.64,$18.64,$18.87,$487.00,$13.40,$35.68,$385.70,$389.60,$18.50,$20.10,$12.76,$14.07,$12.76
30100395,EAP,CPT® 80048,,Basic Metabolic Panel,$374.00,$4.73,$374.00,$15.07,$12.36,$11.51,$4.73,$12.36,$12.36,$12.52,$374.00,$8.88,$23.66,$296.21,$299.20,$12.27,$13.34,$8.46,$9.34,$8.46
30100396,EAP,CPT® 88720,,"Bilirubin,total-transcutaneous",$57.00,$2.81,$57.00,$8.94,$7.33,$6.83,$2.81,$7.33,$7.33,$9.98,$57.00,$5.27,$28.50,$45.14,$45.60,$7.28,$8.92,$5.02,$9.07,$5.02
30100401,EAP,CPT® 82274,,"Fecal Occult Blood,fit",$134.00,$8.89,$134.00,$28.36,$23.22,$16.45,$8.89,$23.22,$23.22,$25.48,$134.00,$16.72,$44.44,$106.13,$107.20,$23.08,$27.15,$15.92,$19.01,$15.92
30100403,EAP,CPT® 82306,,"25-hydroxyvit D (d2,d3)(so)",$86.00,$16.56,$86.00,$52.78,$43.22,$40.29,$16.56,$43.22,$43.22,$43.72,$86.00,$31.08,$82.72,$68.11,$68.80,$42.92,$46.59,$29.60,$32.61,$29.60
30100410,EAP,CPT® 82009,,Acetoacetate-qualitative,$64.00,$0.00,$64.00,$0.00,$4.80,$0.00,$0.00,$4.80,$4.80,$0.00,$64.00,$0.00,$9.18,$50.69,$51.20,$0.00,$0.00,$0.00,$0.00,$0.00
30100411,EAP,CPT® 82043,,Microalbumin,$224.00,$3.23,$224.00,$10.31,$8.45,$7.87,$3.23,$8.45,$8.45,$8.55,$224.00,$6.07,$16.18,$177.41,$179.20,$8.38,$9.11,$5.78,$6.37,$5.78
30100412,EAP,CPT® 82270,,"Occult Blood, Stool",$58.00,$0.00,$58.00,$0.00,$4.69,$0.00,$0.00,$4.69,$4.69,$0.00,$58.00,$0.00,$8.98,$45.94,$46.40,$0.00,$0.00,$0.00,$0.00,$0.00
30100413,EAP,CPT® 82465,,Cholesterol,$92.00,$2.44,$92.00,$7.75,$6.36,$5.92,$2.44,$6.36,$6.36,$6.43,$92.00,$4.57,$12.16,$72.86,$73.60,$6.31,$6.85,$4.35,$4.79,$4.35
30100414,EAP,CPT® 82550,,"Cpk,total-serum",$189.00,$3.64,$189.00,$11.61,$9.51,$8.86,$3.64,$9.51,$9.51,$7.46,$189.00,$6.84,$18.20,$149.69,$151.20,$9.44,$7.94,$6.51,$5.56,$6.51
30100415,EAP,CPT® 82565,,"Poct, Creatinine (meter)",$129.00,$2.86,$129.00,$9.14,$7.48,$6.97,$2.86,$7.48,$7.48,$7.46,$129.00,$5.38,$14.32,$102.17,$103.20,$7.42,$7.94,$5.12,$5.56,$5.12
30100416,EAP,CPT® 82570,,Creatinine Urine,$122.00,$2.90,$122.00,$9.23,$7.56,$5.60,$2.90,$7.56,$7.56,$7.64,$122.00,$5.44,$14.46,$96.62,$97.60,$7.51,$8.14,$5.18,$5.70,$5.18
30100417,EAP,CPT® 82947,,"Gtt, Oral-2hr Indiv",$326.00,$2.20,$326.00,$7.00,$5.73,$5.34,$2.20,$5.73,$5.73,$5.80,$326.00,$4.13,$10.96,$258.19,$260.80,$5.70,$6.18,$3.93,$4.32,$3.93
30100420,EAP,CPT® 82950,,"Glucose, Bld-2hr Pp",$311.00,$2.65,$311.00,$8.46,$6.93,$6.46,$2.65,$6.93,$6.93,$7.02,$311.00,$4.99,$13.28,$246.31,$248.80,$6.89,$7.48,$4.75,$5.24,$4.75
30100421,EAP,CPT® 83036,,Hgb Glycosy A1c-ddcl,$219.00,$5.44,$219.00,$17.31,$14.17,$13.21,$5.44,$14.17,$14.17,$14.33,$219.00,$10.20,$27.12,$173.45,$175.20,$14.08,$15.27,$9.71,$10.69,$9.71
30100422,EAP,CPT® 83690,,"Lipase, Serum",$251.00,$3.85,$251.00,$12.29,$10.06,$9.38,$3.85,$10.06,$10.06,$10.17,$251.00,$7.23,$19.24,$198.79,$200.80,$9.99,$10.84,$6.89,$7.59,$6.89
30100423,EAP,CPT® 83718,,"Chol,hdl",$119.00,$4.59,$119.00,$14.61,$11.96,$11.14,$4.59,$11.96,$11.96,$12.10,$119.00,$8.60,$22.88,$94.25,$95.20,$11.88,$12.89,$8.19,$9.02,$8.19
30100424,EAP,CPT® 83718,,"Chol, Hdl",$119.00,$4.59,$119.00,$14.61,$11.96,$11.14,$4.59,$11.96,$11.96,$12.10,$119.00,$8.60,$22.88,$94.25,$95.20,$11.88,$12.89,$8.19,$9.02,$8.19
30100425,EAP,CPT® 83721,,"Chol-ldl, Direct",$149.00,$5.34,$149.00,$17.01,$13.93,$12.99,$5.34,$13.93,$13.93,$14.10,$149.00,$11.03,$26.66,$118.01,$119.20,$15.23,$15.03,$10.50,$10.52,$10.50
30100426,EAP,CPT® 83721,,"Chol-ldl, Direct",$149.00,$5.34,$149.00,$17.01,$13.93,$12.99,$5.34,$13.93,$13.93,$14.10,$149.00,$11.03,$26.66,$118.01,$119.20,$15.23,$15.03,$10.50,$10.52,$10.50
30100427,EAP,CPT® 83735,,"Magneseum, Serum",$171.00,$3.75,$171.00,$11.95,$9.78,$9.11,$3.75,$9.78,$9.78,$9.89,$171.00,$7.04,$18.72,$135.43,$136.80,$9.72,$10.54,$6.70,$7.38,$6.70
30100430,EAP,CPT® 80048,,"Chem 8, Metabolic Panel",$374.00,$4.73,$374.00,$15.07,$12.36,$11.51,$4.73,$12.36,$12.36,$12.52,$374.00,$8.88,$23.66,$296.21,$299.20,$12.27,$13.34,$8.46,$9.34,$8.46
30100431,EAP,CPT® 82270,,Occult Blood,$58.00,$0.00,$58.00,$0.00,$4.69,$0.00,$0.00,$4.69,$4.69,$0.00,$58.00,$0.00,$8.98,$45.94,$46.40,$0.00,$0.00,$0.00,$0.00,$0.00
30100432,EAP,CPT® 82977,,Ggt-serum,$162.00,$4.03,$162.00,$12.84,$10.51,$9.52,$4.03,$10.51,$10.51,$7.46,$162.00,$7.56,$20.12,$128.30,$129.60,$10.44,$7.94,$7.20,$5.56,$7.20
30100434,EAP,CPT® 80069,,Renal Panel,$230.00,$4.86,$230.00,$15.48,$12.68,$11.82,$4.86,$12.68,$12.68,$12.83,$230.00,$9.11,$24.26,$182.16,$184.00,$12.59,$13.67,$8.68,$9.57,$8.68
30100435,EAP,CPT® 80076,,Hepatic Profile,$333.00,$4.58,$333.00,$14.57,$11.93,$11.11,$4.58,$11.93,$11.93,$12.08,$333.00,$8.58,$22.84,$263.74,$266.40,$11.85,$12.87,$8.17,$9.01,$8.17
30100436,EAP,CPT® 80076,,Hepatic Profile,$333.00,$4.58,$333.00,$14.57,$11.93,$11.11,$4.58,$11.93,$11.93,$12.08,$333.00,$8.58,$22.84,$263.74,$266.40,$11.85,$12.87,$8.17,$9.01,$8.17
30100437,EAP,CPT® 82465,,"Cholesterol,fluid",$92.00,$2.44,$92.00,$7.75,$6.36,$5.92,$2.44,$6.36,$6.36,$6.43,$92.00,$4.57,$12.16,$72.86,$73.60,$6.31,$6.85,$4.35,$4.79,$4.35
30100439,EAP,CPT® 82947,,"Glucose,fasting Bld",$326.00,$2.20,$326.00,$7.00,$5.73,$5.34,$2.20,$5.73,$5.73,$5.80,$326.00,$4.13,$10.96,$258.19,$260.80,$5.70,$6.18,$3.93,$4.32,$3.93
30100441,EAP,CPT® 82950,,"Glucose,1hr (50gm)",$311.00,$2.65,$311.00,$8.46,$6.93,$6.46,$2.65,$6.93,$6.93,$7.02,$311.00,$4.99,$13.28,$246.31,$248.80,$6.89,$7.48,$4.75,$5.24,$4.75
30100442,EAP,CPT® 82977,,"Ggtp,serum",$162.00,$4.03,$162.00,$12.84,$10.51,$9.52,$4.03,$10.51,$10.51,$7.46,$162.00,$7.56,$20.12,$128.30,$129.60,$10.44,$7.94,$7.20,$5.56,$7.20
30100443,EAP,CPT® 83735,,"Magnesium, Urine",$171.00,$3.75,$171.00,$11.95,$9.78,$9.11,$3.75,$9.78,$9.78,$9.89,$171.00,$7.04,$18.72,$135.43,$136.80,$9.72,$10.54,$6.70,$7.38,$6.70
30100444,EAP,CPT® 80375,,Thiopurine Metabolites Serum (so),$323.00,$0.00,$323.00,$0.02,$230.53,$57.49,$12.37,$230.53,$230.53,$21.44,$323.00,$0.00,$161.50,$255.82,$258.40,$193.80,$22.85,$0.00,$15.99,$0.00
30100450,EAP,CPT® 82803,,Hemodynamics,$464.00,$13.12,$464.00,$34.50,$28.25,$26.33,$13.12,$28.25,$28.25,$28.59,$464.00,$27.37,$54.08,$367.49,$371.20,$37.80,$30.46,$26.07,$21.33,$26.07
30100451,EAP,CPT® 82803,,Abg Analysis,$464.00,$13.12,$464.00,$34.50,$28.25,$26.33,$13.12,$28.25,$28.25,$28.59,$464.00,$27.37,$54.08,$367.49,$371.20,$37.80,$30.46,$26.07,$21.33,$26.07
30100455,EAP,CPT® 82040,,Albumin (bcg),$76.00,$2.77,$76.00,$5.13,$4.20,$6.32,$2.77,$4.20,$4.20,$4.25,$76.00,$5.20,$8.04,$60.19,$60.80,$7.18,$4.53,$4.95,$3.17,$4.95
30100456,EAP,CPT® 81381,,HLA B5701,$463.00,$35.05,$463.00,$168.61,$129.03,$128.71,$85.54,$129.03,$129.03,$46.99,$463.00,$178.40,$231.50,$366.70,$370.40,$246.36,$50.07,$169.90,$35.05,$169.90
30100475,EAP,CPT® 82172,,Apolipoprotein (so),$181.00,$10.62,$181.00,$27.63,$22.62,$19.23,$10.62,$22.62,$22.62,$22.90,$181.00,$22.14,$43.30,$143.35,$144.80,$30.58,$24.40,$21.09,$17.08,$21.09
30100476,EAP,CPT® 82247,,Total Bilirubin (so),$88.00,$2.81,$88.00,$8.94,$7.33,$6.83,$2.81,$7.33,$7.33,$7.42,$88.00,$5.27,$14.04,$69.70,$70.40,$7.28,$7.91,$5.02,$5.54,$5.02
30100477,EAP,CPT® 82977,,Ggt (so),$187.00,$4.03,$187.00,$12.84,$10.51,$9.52,$4.03,$10.51,$10.51,$7.46,$187.00,$7.56,$20.12,$148.10,$149.60,$10.44,$7.94,$7.20,$5.56,$7.20
30100478,EAP,CPT® 83010,,Haptoglobin Quant (so),$265.00,$4.11,$265.00,$6.66,$5.44,$17.12,$7.04,$5.44,$5.44,$5.51,$265.00,$13.21,$10.42,$209.88,$212.00,$18.24,$5.87,$12.58,$4.11,$12.58
30100479,EAP,CPT® 83883,,Nephelometry (so),$222.00,$7.61,$222.00,$24.24,$19.85,$9.90,$7.61,$19.85,$19.85,$20.09,$222.00,$14.28,$38.00,$175.82,$177.60,$19.72,$21.40,$13.60,$14.98,$13.60
30100480,EAP,CPT® 84460,,Alt (s0),$90.00,$2.96,$90.00,$9.44,$7.73,$6.74,$2.96,$7.73,$7.73,$7.46,$90.00,$5.57,$14.80,$71.28,$72.00,$7.69,$7.94,$5.30,$5.56,$5.30
30100481,EAP,CPT® 88360,,Pd-l1 Ihc W/interp (s0),$485.00,$65.32,$485.00,$184.86,$65.70,$137.60,$65.32,$65.70,$65.70,$114.71,$485.00,$143.92,$121.34,$384.12,$388.00,$199.96,$122.23,$83.20,$85.56,$137.07
30100482,EAP,CPT® 88341,,Lynch Syn Pan Addl Slide (so),$572.00,$0.00,$572.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$572.00,$0.00,$286.00,$453.02,$457.60,$0.00,$71.83,$64.47,$50.28,$0.00
30100483,EAP,CPT® 88342,,Lynch Syn Pan  1st Slide (so),$651.00,$54.62,$651.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$651.00,$143.92,$106.46,$515.59,$520.80,$199.96,$89.59,$70.23,$62.72,$137.07
30100490,EAP,CPT® 80177,,Levetiracetam (so),$334.00,$7.42,$334.00,$23.62,$18.09,$18.04,$7.42,$18.09,$18.09,$17.00,$334.00,$13.91,$167.00,$264.53,$267.20,$19.21,$18.11,$13.25,$12.68,$13.25
30100499,EAP,CPT® 83520,,Anti Mag Q,$77.00,$8.69,$77.00,$23.07,$18.91,$17.62,$8.69,$18.91,$18.91,$19.12,$77.00,$18.13,$36.18,$60.98,$61.60,$25.04,$20.37,$17.27,$14.26,$17.27
30100500,EAP,CPT® 80342,,"Fluphenazine, Serum",$148.00,$0.00,$148.00,$0.00,$105.63,$0.00,$0.00,$105.63,$105.63,$0.00,$148.00,$0.00,$74.00,$117.22,$118.40,$0.00,$0.00,$0.00,$0.00,$0.00
30100501,EAP,CPT® 82438,,"Feces, Chloride (so)",$96.00,$0.00,$96.00,$0.00,$7.14,$0.00,$0.00,$7.14,$7.14,$0.00,$96.00,$0.00,$13.66,$76.03,$76.80,$0.00,$0.00,$0.00,$0.00,$0.00
30100502,EAP,CPT® 84302,,"Feces, Sodium (so)",$95.00,$0.00,$95.00,$0.00,$5.05,$0.00,$0.00,$5.05,$5.05,$0.00,$95.00,$0.00,$9.66,$75.24,$76.00,$0.00,$0.00,$0.00,$0.00,$0.00
30100503,EAP,CPT® 84311,,"Feces,electrophoresis (so)",$200.00,$4.08,$200.00,$12.47,$10.20,$9.52,$4.08,$10.20,$10.20,$10.32,$200.00,$8.51,$19.54,$158.40,$160.00,$11.75,$11.00,$8.10,$7.70,$8.10
30100505,EAP,CPT® 84311,,"Feces, Potassium (so)",$200.00,$4.08,$200.00,$12.47,$10.20,$9.52,$4.08,$10.20,$10.20,$10.32,$200.00,$8.51,$19.54,$158.40,$160.00,$11.75,$11.00,$8.10,$7.70,$8.10
30100600,EAP,CPT® 82248,,"Bilirubin,direct",$118.00,$2.81,$118.00,$8.94,$7.33,$6.83,$2.81,$7.33,$7.33,$7.42,$118.00,$5.27,$14.04,$93.46,$94.40,$7.28,$7.91,$5.02,$5.54,$5.02
30100602,EAP,CPT® 80299,,Voriconazole Quant Assay (so),$204.00,$9.39,$204.00,$24.21,$17.58,$15.07,$9.39,$17.58,$17.58,$17.79,$204.00,$19.57,$33.64,$161.57,$163.20,$27.03,$18.95,$18.64,$13.27,$18.64
30100622,EAP,CPT® 80203,,Zonisamide (so),$419.00,$7.42,$419.00,$23.62,$18.09,$18.04,$7.42,$18.09,$18.09,$17.00,$419.00,$13.91,$209.50,$331.85,$335.20,$19.21,$18.11,$13.25,$12.68,$13.25
30100634,EAP,CPT® 84181,,Western Blot Test,"$1,387.00",$0.00,"$1,387.00",$0.00,$24.87,$0.00,$0.00,$24.87,$24.87,$0.00,"$1,387.00",$0.00,$47.60,"$1,098.50","$1,109.60",$0.00,$0.00,$0.00,$0.00,$0.00
30100635,EAP,CPT® 82530,,Cortisol;free,$202.00,$9.35,$202.00,$29.78,$24.41,$22.74,$9.35,$24.41,$24.41,$24.70,$202.00,$17.55,$46.70,$159.98,$161.60,$24.23,$26.31,$16.71,$18.42,$16.71
30100636,EAP,CPT® 82570,,Other Source,$91.00,$2.90,$91.00,$9.23,$7.56,$5.60,$2.90,$7.56,$7.56,$7.64,$91.00,$5.44,$14.46,$72.07,$72.80,$7.51,$8.14,$5.18,$5.70,$5.18
30100637,EAP,CPT® 83789,,"Quantitative, Each Specimen",$143.00,$0.00,$143.00,$0.00,$8.77,$0.00,$0.00,$8.77,$8.77,$0.00,$143.00,$0.00,$16.78,$113.26,$114.40,$0.00,$0.00,$0.00,$0.00,$0.00
30100643,EAP,CPT® 83789,,"Quantitative, Each Specimen",$242.00,$0.00,$242.00,$0.00,$8.77,$0.00,$0.00,$8.77,$8.77,$0.00,$242.00,$0.00,$16.78,$191.66,$193.60,$0.00,$0.00,$0.00,$0.00,$0.00
30100644,EAP,CPT® 83520,,"Quantitative, Not Otherwise Specified",$116.00,$8.69,$116.00,$23.07,$18.91,$17.62,$8.69,$18.91,$18.91,$19.12,$116.00,$18.13,$36.18,$91.87,$92.80,$25.04,$20.37,$17.27,$14.26,$17.27
30100645,EAP,CPT® 84999,,Unlisted Chemistry Procedure,$62.00,$0.00,$62.00,$0.00,$44.25,$0.00,$10.68,$44.25,$44.25,$10.86,$62.00,$0.00,$0.00,$49.10,$49.60,$0.00,$9.70,$0.00,$0.00,$0.00
30100652,EAP,CPT® 82017,,Acylcarnities Quant,$187.00,$0.00,$187.00,$0.00,$24.63,$0.00,$0.00,$24.63,$24.63,$0.00,$187.00,$0.00,$47.14,$148.10,$149.60,$0.00,$0.00,$0.00,$0.00,$0.00
30100653,EAP,CPT® 82139,,"Amino Acids,6 Or More Amino Acids,quantitative,each",$292.00,$0.00,$292.00,$0.00,$24.63,$0.00,$0.00,$24.63,$24.63,$0.00,$292.00,$0.00,$47.14,$231.26,$233.60,$0.00,$0.00,$0.00,$0.00,$0.00
30100654,EAP,CPT® 82379,,"Carnitine(total And Free),quantitative,each Specimen",$225.00,$0.00,$225.00,$0.00,$24.63,$0.00,$0.00,$24.63,$24.63,$0.00,$225.00,$0.00,$47.14,$178.20,$180.00,$0.00,$0.00,$0.00,$0.00,$0.00
30100656,EAP,CPT® 82542,,"Quantitative,single Stationary & Mobile Phase, Qt",$296.00,$6.62,$296.00,$32.19,$8.77,$24.58,$12.13,$8.77,$8.77,$8.87,$296.00,$25.29,$16.78,$234.43,$236.80,$34.93,$9.45,$24.09,$6.62,$24.09
30100660,EAP,CPT® 82962,,Poct Glucose Meter,$84.00,$1.66,$84.00,$4.17,$3.42,$3.19,$1.66,$3.42,$3.42,$3.45,$84.00,$3.44,$6.54,$66.53,$67.20,$4.76,$3.68,$3.28,$2.58,$3.28
30100662,EAP,CPT® 84600,,Propylene Glycol (nms),$243.00,$0.00,$243.00,$0.00,$23.47,$0.00,$0.00,$23.47,$23.47,$0.00,$243.00,$0.00,$44.90,$192.46,$194.40,$0.00,$0.00,$0.00,$0.00,$0.00
30100665,EAP,CPT® 83825,,"Mercury,blood(q)",$41.00,$0.00,$41.00,$28.98,$23.74,$22.12,$0.00,$23.74,$23.74,$24.02,$41.00,$17.07,$41.00,$32.47,$32.80,$23.58,$0.00,$16.26,$17.92,$16.26
30100666,EAP,CPT® 80347,,Quantitative Benzo Panel(q),$398.00,$0.00,$398.00,$0.00,$284.05,$0.00,$0.00,$284.05,$284.05,$0.00,$398.00,$0.00,$199.00,$315.22,$318.40,$0.00,$0.00,$0.00,$0.00,$0.00
30100668,EAP,CPT® 86161,,"C1 Inhibitor , Functional  (so)",$171.00,$6.71,$171.00,$21.39,$17.53,$16.33,$6.71,$17.53,$17.53,$17.73,$171.00,$12.60,$33.56,$135.43,$136.80,$17.40,$18.90,$12.00,$13.23,$12.00
30100669,EAP,CPT® 86774,,Tetanus Antitoxoid   (so),$83.00,$8.28,$83.00,$26.38,$21.61,$11.13,$8.28,$21.61,$21.61,$21.86,$83.00,$15.54,$41.36,$65.74,$66.40,$21.46,$23.29,$14.80,$16.31,$14.80
30100670,EAP,CPT® 86343,,Histamine Release -cu  (so),$236.00,$0.00,$236.00,$0.00,$18.20,$0.00,$0.00,$18.20,$18.20,$0.00,$236.00,$0.00,$34.82,$186.91,$188.80,$0.00,$0.00,$0.00,$0.00,$0.00
30100671,EAP,CPT® 83520,,Tryptase  (so),$211.00,$8.69,$211.00,$23.07,$18.91,$17.62,$8.69,$18.91,$18.91,$19.12,$211.00,$18.13,$36.18,$167.11,$168.80,$25.04,$20.37,$17.27,$14.26,$17.27
30100672,EAP,CPT® 82106,,Alpha- Fetoprotein  Af (so),$41.00,$9.39,$41.00,$29.91,$24.49,$22.83,$9.39,$24.49,$24.49,$24.79,$41.00,$17.85,$41.00,$32.47,$32.80,$24.65,$26.41,$17.00,$18.49,$17.00
30100673,EAP,CPT® 83033,,Fetal Hemoglobin  Af (so),$76.00,$0.00,$76.00,$0.00,$8.70,$0.00,$0.00,$8.70,$8.70,$0.00,$76.00,$0.00,$16.66,$60.19,$60.80,$0.00,$0.00,$0.00,$0.00,$0.00
30100674,EAP,CPT® 82664,,Acetylcholinesterase  Af (so),$168.00,$30.97,$168.00,$61.24,$50.16,$46.75,$30.97,$50.16,$50.16,$50.75,$168.00,$64.58,$96.00,$133.06,$134.40,$89.18,$54.07,$61.50,$37.85,$61.50
30100680,EAP,CPT® 82105,,Maternal Serum Afp (so),$47.00,$9.39,$47.00,$29.91,$24.49,$22.83,$9.39,$24.49,$24.49,$24.79,$47.00,$17.61,$46.88,$37.22,$37.60,$24.32,$26.41,$16.77,$18.49,$16.77
30100681,EAP,CPT® 86160,,C1 Esterase Inhibitor  Protein (so),$86.00,$6.71,$86.00,$21.39,$17.53,$16.33,$6.71,$17.53,$17.53,$17.73,$86.00,$12.60,$33.56,$68.11,$68.80,$17.40,$18.90,$12.00,$13.23,$12.00
30100682,EAP,CPT® 84591,,Vitamin B-5( Pantothenic Acid) (so),$178.00,$0.00,$178.00,$0.00,$16.93,$0.00,$0.00,$16.93,$16.93,$0.00,$178.00,$0.00,$32.40,$140.98,$142.40,$0.00,$0.00,$0.00,$0.00,$0.00
30100683,EAP,CPT® 82397,,Leptin (so),$262.00,$7.90,$262.00,$25.17,$20.63,$19.22,$7.90,$20.63,$20.63,$20.87,$262.00,$14.83,$39.48,$207.50,$209.60,$20.47,$22.24,$14.12,$15.57,$14.12
30100684,EAP,CPT® 85415,,Plasminogen Activator Inhibitor-a (pai-1) (so),$220.00,$0.00,$220.00,$0.00,$25.10,$0.00,$0.00,$25.10,$25.10,$0.00,$220.00,$0.00,$48.04,$174.24,$176.00,$0.00,$0.00,$0.00,$0.00,$0.00
30100685,EAP,CPT® 83516,,"Ribosomal P Antibody , Csf (so)",$271.00,$6.44,$271.00,$19.04,$15.61,$15.70,$6.44,$15.61,$15.61,$15.80,$271.00,$12.11,$29.88,$214.63,$216.80,$16.72,$16.84,$11.53,$11.79,$11.53
30100686,EAP,CPT® 83516,,Serine Protease 3 Antibody (so)arup,$341.00,$6.44,$341.00,$19.04,$15.61,$15.70,$6.44,$15.61,$15.61,$15.80,$341.00,$12.11,$29.88,$270.07,$272.80,$16.72,$16.84,$11.53,$11.79,$11.53
30100687,EAP,CPT® 82610,,Cystatin C (so),$246.00,$9.32,$246.00,$24.24,$19.85,$9.90,$9.32,$19.85,$19.85,$20.09,$246.00,$19.45,$123.00,$194.83,$196.80,$26.85,$21.40,$18.52,$14.98,$18.52
30100688,EAP,CPT® 80180,,Mycophenolic Acid (so),$169.00,$0.00,$169.00,$0.00,$8.12,$0.00,$0.00,$8.12,$8.12,$0.00,$169.00,$0.00,$84.50,$133.85,$135.20,$0.00,$0.00,$0.00,$0.00,$0.00
30100689,EAP,CPT® 83516,,"Saccharmyces Cerevisiae Ab, Igg (arup)",$196.00,$6.44,$196.00,$19.04,$15.61,$15.70,$6.44,$15.61,$15.61,$15.80,$196.00,$12.11,$29.88,$155.23,$156.80,$16.72,$16.84,$11.53,$11.79,$11.53
30100690,EAP,CPT® 83516,,"Laminaribioside Carbohydrate Ab, Igg (arup)",$196.00,$6.44,$196.00,$19.04,$15.61,$15.70,$6.44,$15.61,$15.61,$15.80,$196.00,$12.11,$29.88,$155.23,$156.80,$16.72,$16.84,$11.53,$11.79,$11.53
30100691,EAP,CPT® 83516,,"Mannobioside Carbohydrate Ab, Igg (arup)",$196.00,$6.44,$196.00,$19.04,$15.61,$15.70,$6.44,$15.61,$15.61,$15.80,$196.00,$12.11,$29.88,$155.23,$156.80,$16.72,$16.84,$11.53,$11.79,$11.53
30100692,EAP,CPT® 86671,,"Chitobioside Carbohydrate Ab, Iga (arup)",$80.00,$6.86,$80.00,$21.84,$17.90,$11.13,$6.86,$17.90,$17.90,$18.11,$80.00,$12.86,$34.26,$63.36,$64.00,$17.76,$19.30,$12.25,$13.51,$12.25
30100693,EAP,CPT® 83789,,Levamisole (so) Nms,$298.00,$0.00,$298.00,$0.00,$8.77,$0.00,$0.00,$8.77,$8.77,$0.00,$298.00,$0.00,$16.78,$236.02,$238.40,$0.00,$0.00,$0.00,$0.00,$0.00
30100702,EAP,CPT® 84182,,Zic4 Ab Protein West Blot (so),$441.00,$14.70,$441.00,$32.08,$26.28,$24.49,$14.70,$26.28,$26.28,$26.60,$441.00,$30.67,$50.30,$349.27,$352.80,$42.35,$28.34,$29.21,$19.84,$29.21
30100703,EAP,CPT® 83789,,Diurectics Screen Urine (so),$228.00,$0.00,$228.00,$0.00,$8.77,$0.00,$0.00,$8.77,$8.77,$0.00,$228.00,$0.00,$16.78,$180.58,$182.40,$0.00,$0.00,$0.00,$0.00,$0.00
30100704,EAP,CPT® 82785,,Abpa  Ige (so),$191.00,$9.21,$191.00,$29.34,$24.05,$22.41,$9.21,$24.05,$24.05,$24.33,$191.00,$17.28,$46.02,$151.27,$152.80,$23.87,$25.92,$16.46,$18.15,$16.46
30100705,EAP,CPT® 84146,,Macroprolactin (so),$322.00,$10.84,$322.00,$34.54,$28.30,$26.37,$10.84,$28.30,$28.30,$28.63,$322.00,$20.35,$54.16,$255.02,$257.60,$28.10,$30.51,$19.38,$21.36,$19.38
30100706,EAP,CPT® 82570,,Thiosulfate Urine,$280.00,$2.90,$280.00,$9.23,$7.56,$5.60,$2.90,$7.56,$7.56,$7.64,$280.00,$5.44,$14.46,$221.76,$224.00,$7.51,$8.14,$5.18,$5.70,$5.18
30100708,EAP,CPT® 83921,,Succinlylacetone Urine (so),$250.00,$10.67,$250.00,$29.32,$24.04,$22.39,$10.67,$24.04,$24.04,$24.32,$250.00,$22.27,$46.00,$198.00,$200.00,$30.75,$25.91,$21.21,$18.14,$21.21
30100709,EAP,CPT® 83520,,Vwf Propeptide (so),$412.00,$8.69,$412.00,$23.07,$18.91,$17.62,$8.69,$18.91,$18.91,$19.12,$412.00,$18.13,$36.18,$326.30,$329.60,$25.04,$20.37,$17.27,$14.26,$17.27
30100710,EAP,CPT® 80061,,Nmr Lipoprofile Panel  (so),$285.00,$7.50,$285.00,$23.87,$19.57,$18.22,$7.50,$19.57,$19.57,$19.79,$285.00,$14.06,$37.44,$225.72,$228.00,$19.42,$21.09,$13.39,$14.76,$13.39
30100711,EAP,CPT® 83704,,Nmr Lipoprofile Bld (so),$285.00,$0.00,$285.00,$0.00,$46.07,$0.00,$0.00,$46.07,$46.07,$0.00,$285.00,$0.00,$88.16,$225.72,$228.00,$0.00,$0.00,$0.00,$0.00,$0.00
30100712,EAP,CPT® 83520,,Factor H Comp (so),$412.00,$8.69,$412.00,$23.07,$18.91,$17.62,$8.69,$18.91,$18.91,$19.12,$412.00,$18.13,$36.18,$326.30,$329.60,$25.04,$20.37,$17.27,$14.26,$17.27
30100714,EAP,CPT® 82542,,Thiosulfate Chromotography,$221.00,$6.62,$221.00,$32.19,$8.77,$24.58,$12.13,$8.77,$8.77,$8.87,$221.00,$25.29,$16.78,$175.03,$176.80,$34.93,$9.45,$24.09,$6.62,$24.09
30100715,EAP,CPT® 82656,,Pancreatitic Elastase Serum (so),$326.00,$6.44,$326.00,$19.04,$15.61,$15.70,$6.44,$15.61,$15.61,$57.08,$326.00,$12.11,$29.88,$258.19,$260.80,$16.72,$51.02,$11.53,$51.90,$11.53
30100716,EAP,CPT® 80299,,Itraconazole (so),$204.00,$9.39,$204.00,$24.21,$17.58,$15.07,$9.39,$17.58,$17.58,$17.79,$204.00,$19.57,$33.64,$161.57,$163.20,$27.03,$18.95,$18.64,$13.27,$18.64
30100717,EAP,CPT® 80365,,"Oxycodone And Metabolite Total, Urine (so)",$124.00,$0.00,$124.00,$0.02,$88.50,$22.07,$13.36,$88.50,$88.50,$21.71,$124.00,$120.15,$62.00,$98.21,$99.20,$74.40,$19.41,$0.00,$19.74,$114.43
30100718,EAP,CPT® 80361,,Hydromorphone Opi 1 Urine (so),$512.00,$0.00,$512.00,$0.02,$365.41,$91.14,$13.36,$365.41,$365.41,$30.51,$512.00,$0.00,$256.00,$405.50,$409.60,$307.20,$32.51,$0.00,$22.76,$0.00
30100719,EAP,CPT® 83520,,Thrombin-antithrom Quant (so),$409.00,$8.69,$409.00,$23.07,$18.91,$17.62,$8.69,$18.91,$18.91,$19.12,$409.00,$18.13,$36.18,$323.93,$327.20,$25.04,$20.37,$17.27,$14.26,$17.27
30100720,EAP,CPT® 84182,,Redombx (antirecoverin Ab) (so),$441.00,$14.70,$441.00,$32.08,$26.28,$24.49,$14.70,$26.28,$26.28,$26.60,$441.00,$30.67,$50.30,$349.27,$352.80,$42.35,$28.34,$29.21,$19.84,$29.21
30100721,EAP,CPT® 80299,,Baclofin Quant,$430.00,$9.39,$430.00,$24.21,$17.58,$15.07,$9.39,$17.58,$17.58,$17.79,$430.00,$19.57,$33.64,$340.56,$344.00,$27.03,$18.95,$18.64,$13.27,$18.64
30100722,EAP,CPT® 82726,,Very Long Fatty Acids (so),$407.00,$0.00,$407.00,$0.00,$8.77,$0.00,$0.00,$8.77,$8.77,$0.00,$407.00,$0.00,$16.78,$322.34,$325.60,$0.00,$0.00,$0.00,$0.00,$0.00
30100723,EAP,CPT® 83051,,Hgb Free Plasma (so),$181.00,$0.00,$181.00,$0.00,$10.67,$0.00,$0.00,$10.67,$10.67,$0.00,$181.00,$0.00,$20.42,$143.35,$144.80,$0.00,$0.00,$0.00,$0.00,$0.00
30100724,EAP,CPT® 83789,,Levamisole,$298.00,$0.00,$298.00,$0.00,$8.77,$0.00,$0.00,$8.77,$8.77,$0.00,$298.00,$0.00,$16.78,$236.02,$238.40,$0.00,$0.00,$0.00,$0.00,$0.00
30100725,EAP,CPT® 83520,,Interleuk 2 Rec Cd25 (so),$412.00,$8.69,$412.00,$23.07,$18.91,$17.62,$8.69,$18.91,$18.91,$19.12,$412.00,$18.13,$36.18,$326.30,$329.60,$25.04,$20.37,$17.27,$14.26,$17.27
30100726,EAP,CPT® 82542,,Cannabinoid Quant (so),$221.00,$6.62,$221.00,$32.19,$8.77,$24.58,$12.13,$8.77,$8.77,$8.87,$221.00,$25.29,$16.78,$175.03,$176.80,$34.93,$9.45,$24.09,$6.62,$24.09
30100729,EAP,CPT® 82378,,Cea Cyst Fluid (so),$286.00,$10.61,$286.00,$33.81,$27.70,$25.81,$10.61,$27.70,$27.70,$28.02,$286.00,$19.91,$53.02,$226.51,$228.80,$27.49,$29.86,$18.96,$20.90,$18.96
30100730,EAP,CPT® 83520,,Paraneo Autoab Quant Ria(so),$121.00,$8.69,$121.00,$23.07,$18.91,$17.62,$8.69,$18.91,$18.91,$19.12,$121.00,$18.13,$36.18,$95.83,$96.80,$25.04,$20.37,$17.27,$14.26,$17.27
30100731,EAP,CPT® 82542,,"Cc/ms Spec Anal-ghb, Ql (so)",$239.00,$6.62,$239.00,$32.19,$8.77,$24.58,$12.13,$8.77,$8.77,$8.87,$239.00,$25.29,$16.78,$189.29,$191.20,$34.93,$9.45,$24.09,$6.62,$24.09
30100732,EAP,CPT® 83880,,Cardio Iq Nt Probnp (so),$312.00,$19.77,$312.00,$60.51,$49.56,$46.19,$19.77,$49.56,$49.56,$50.15,$312.00,$41.22,$94.86,$247.10,$249.60,$56.93,$53.43,$39.26,$37.40,$39.26
30100740,EAP,CPT® 80299,,Adalimumab Quant (so),$211.00,$9.39,$211.00,$24.21,$17.58,$15.07,$9.39,$17.58,$17.58,$17.79,$211.00,$19.57,$33.64,$167.11,$168.80,$27.03,$18.95,$18.64,$13.27,$18.64
30100741,EAP,CPT® 82397,,Anti Adalimumab Ab (so),$278.00,$7.90,$278.00,$25.17,$20.63,$19.22,$7.90,$20.63,$20.63,$20.87,$278.00,$14.83,$39.48,$220.18,$222.40,$20.47,$22.24,$14.12,$15.57,$14.12
30100742,EAP,CPT® 80354,,Acetyl Fentanyl Qual (so),$132.00,$0.00,$132.00,$0.00,$94.21,$0.00,$0.00,$94.21,$94.21,$0.00,$132.00,$0.00,$66.00,$104.54,$105.60,$0.00,$0.00,$0.00,$0.00,$0.00
30100750,EAP,CPT® 83088,,Histamine 24hr Urine (so),$243.00,$0.00,$243.00,$0.00,$43.12,$0.00,$0.00,$43.12,$43.12,$0.00,$243.00,$0.00,$82.52,$192.46,$194.40,$0.00,$0.00,$0.00,$0.00,$0.00
30100751,EAP,CPT® 80299,,Metoprolol Quant (so),$211.00,$9.39,$211.00,$24.21,$17.58,$15.07,$9.39,$17.58,$17.58,$17.79,$211.00,$19.57,$33.64,$167.11,$168.80,$27.03,$18.95,$18.64,$13.27,$18.64
30100752,EAP,CPT® 80361,,Morphine Glucuronide (so),$141.00,$0.00,$141.00,$0.02,$100.63,$25.10,$13.36,$100.63,$100.63,$30.51,$141.00,$0.00,$70.50,$111.67,$112.80,$84.60,$32.51,$0.00,$22.76,$0.00
30100755,EAP,CPT® 84182,,Recombx Mata Autoab (so),$468.00,$14.70,$468.00,$32.08,$26.28,$24.49,$14.70,$26.28,$26.28,$26.60,$468.00,$30.67,$50.30,$370.66,$374.40,$42.35,$28.34,$29.21,$19.84,$29.21
30100756,EAP,CPT® 83789,,Bile Acids Urine (so),$236.00,$0.00,$236.00,$0.00,$8.77,$0.00,$0.00,$8.77,$8.77,$0.00,$236.00,$0.00,$16.78,$186.91,$188.80,$0.00,$0.00,$0.00,$0.00,$0.00
30100757,EAP,CPT® 84311,,Fluvoxamine (so),$197.00,$4.08,$197.00,$12.47,$10.20,$9.52,$4.08,$10.20,$10.20,$10.32,$197.00,$8.51,$19.54,$156.02,$157.60,$11.75,$11.00,$8.10,$7.70,$8.10
30100758,EAP,CPT® 84311,,Fungitell Serum (so),$197.00,$4.08,$197.00,$12.47,$10.20,$9.52,$4.08,$10.20,$10.20,$10.32,$197.00,$8.51,$19.54,$156.02,$157.60,$11.75,$11.00,$8.10,$7.70,$8.10
30100759,EAP,CPT® 83520,,Ganglioside Gd1b Ab (so),$326.00,$8.69,$326.00,$23.07,$18.91,$17.62,$8.69,$18.91,$18.91,$19.12,$326.00,$18.13,$36.18,$258.19,$260.80,$25.04,$20.37,$17.27,$14.26,$17.27
30100760,EAP,CPT® 83520,,Ganglioside Gm-1 Ab (so),$326.00,$8.69,$326.00,$23.07,$18.91,$17.62,$8.69,$18.91,$18.91,$19.12,$326.00,$18.13,$36.18,$258.19,$260.80,$25.04,$20.37,$17.27,$14.26,$17.27
30100761,EAP,CPT® 83051,,Hemoglobin Free Plasma (so),$104.00,$0.00,$104.00,$0.00,$10.67,$0.00,$0.00,$10.67,$10.67,$0.00,$104.00,$0.00,$20.42,$82.37,$83.20,$0.00,$0.00,$0.00,$0.00,$0.00
30100762,EAP,CPT® 83520,,Interleukin-6 Ruo,$222.00,$8.69,$222.00,$23.07,$18.91,$17.62,$8.69,$18.91,$18.91,$19.12,$222.00,$18.13,$36.18,$175.82,$177.60,$25.04,$20.37,$17.27,$14.26,$17.27
30105004,EAP,CPT® 80053,,Comprehensive Metabolic Panel,$477.00,$5.91,$477.00,$18.83,$15.44,$14.37,$5.91,$15.44,$15.44,$15.61,$477.00,$11.09,$29.54,$377.78,$381.60,$15.31,$16.64,$10.56,$11.65,$10.56
30105007,EAP,CPT® 80061,,Lipid Panel,$285.00,$7.50,$285.00,$23.87,$19.57,$18.22,$7.50,$19.57,$19.57,$19.79,$285.00,$14.06,$37.44,$225.72,$228.00,$19.42,$21.09,$13.39,$14.76,$13.39
30105047,EAP,CPT® 82150,,"Amylase,urine",$304.00,$3.62,$304.00,$11.56,$9.46,$8.82,$3.62,$9.46,$9.46,$9.58,$304.00,$6.80,$18.12,$240.77,$243.20,$9.40,$10.20,$6.48,$7.14,$6.48
30105057,EAP,CPT® 82247,,"Bili, Total-fluid",$118.00,$2.81,$118.00,$8.94,$7.33,$6.83,$2.81,$7.33,$7.33,$7.42,$118.00,$5.27,$14.04,$93.46,$94.40,$7.28,$7.91,$5.02,$5.54,$5.02
30105071,EAP,CPT® 82310,,"Calcium, Urine",$93.00,$2.89,$93.00,$9.21,$7.53,$7.02,$2.89,$7.53,$7.53,$7.46,$93.00,$5.42,$14.40,$73.66,$74.40,$7.48,$7.94,$5.16,$5.56,$5.16
30105151,EAP,CPT® 82803,,Blood Gas-cord Ven.,$464.00,$13.12,$464.00,$34.50,$28.25,$26.33,$13.12,$28.25,$28.25,$28.59,$464.00,$27.37,$54.08,$367.49,$371.20,$37.80,$30.46,$26.07,$21.33,$26.07
30105168,EAP,CPT® 82945,,"Glucose,urine(quant)",$311.00,$2.20,$311.00,$7.00,$5.73,$5.34,$2.20,$5.73,$5.73,$5.80,$311.00,$4.13,$10.96,$246.31,$248.80,$5.70,$6.18,$3.93,$4.32,$3.93
30105171,EAP,CPT® 82947,,"Gtt,oral-2hr Indiv",$326.00,$2.20,$326.00,$7.00,$5.73,$5.34,$2.20,$5.73,$5.73,$5.80,$326.00,$4.13,$10.96,$258.19,$260.80,$5.70,$6.18,$3.93,$4.32,$3.93
30105196,EAP,CPT® 82951,,"Gtt,prenatal(100gm)",$201.00,$7.21,$201.00,$22.96,$18.80,$11.90,$7.21,$18.80,$18.80,$19.02,$201.00,$13.51,$35.98,$159.19,$160.80,$18.66,$20.26,$12.87,$14.18,$12.87
30105201,EAP,CPT® 82952,,5th Hour Gtt Specimen,$103.00,$2.19,$103.00,$7.00,$5.72,$5.34,$2.19,$5.72,$5.72,$5.80,$103.00,$4.12,$10.96,$81.58,$82.40,$5.68,$6.18,$3.92,$4.32,$3.92
30105214,EAP,CPT® 83020,,Hgb Elect. Cord Bld,$218.00,$6.58,$218.00,$17.42,$14.27,$6.58,$7.21,$14.27,$14.27,$14.44,$218.00,$13.51,$27.32,$172.66,$174.40,$18.66,$15.38,$12.87,$10.77,$12.87
30105248,EAP,CPT® 83605,,"Lactic Acid, Fluid",$311.00,$5.97,$311.00,$19.04,$15.59,$14.53,$5.97,$15.59,$15.59,$15.78,$311.00,$12.15,$29.84,$246.31,$248.80,$16.78,$16.82,$11.57,$11.77,$11.57
30105252,EAP,CPT® 83615,,"Ldh,csf",$139.00,$3.38,$139.00,$10.76,$8.81,$8.04,$3.38,$8.81,$8.81,$7.46,$139.00,$6.34,$16.88,$110.09,$111.20,$8.76,$7.94,$6.04,$5.56,$6.04
30105255,EAP,CPT® 83519,,Ria Nonantibody,"$1,096.00",$9.26,"$1,096.00",$24.08,$19.73,$18.39,$9.26,$19.73,$19.73,$19.96,"$1,096.00",$19.32,$37.76,$868.03,$876.80,$26.68,$21.27,$18.40,$14.89,$18.40
30105256,EAP,CPT® 84260,,Assay Of Serotonin,$199.00,$0.00,$199.00,$0.00,$45.23,$0.00,$0.00,$45.23,$45.23,$0.00,$199.00,$0.00,$86.56,$157.61,$159.20,$0.00,$0.00,$0.00,$0.00,$0.00
30105257,EAP,CPT® 84252,,Assay Of Vitamin B-12,$284.00,$0.00,$284.00,$0.00,$29.55,$0.00,$0.00,$29.55,$29.55,$0.00,$284.00,$0.00,$56.56,$224.93,$227.20,$0.00,$0.00,$0.00,$0.00,$0.00
30105258,EAP,CPT® 83018,,"Quantitative, Each",$182.00,$0.00,$182.00,$0.00,$32.06,$0.00,$0.00,$32.06,$32.06,$0.00,$182.00,$0.00,$61.36,$144.14,$145.60,$0.00,$0.00,$0.00,$0.00,$0.00
30105261,EAP,CPT® 83519,,"Quantitative, By Radioimmunoassay(eg:ria)",$723.00,$9.26,$723.00,$24.08,$19.73,$18.39,$9.26,$19.73,$19.73,$19.96,$723.00,$19.32,$37.76,$572.62,$578.40,$26.68,$21.27,$18.40,$14.89,$18.40
30105262,EAP,CPT® 83519,,"Quantitative, By Radioimmunoassay(eg:ria)",$696.00,$9.26,$696.00,$24.08,$19.73,$18.39,$9.26,$19.73,$19.73,$19.96,$696.00,$19.32,$37.76,$551.23,$556.80,$26.68,$21.27,$18.40,$14.89,$18.40
30105263,EAP,CPT® 82378,,Cea Pancreatic Cyst Fluid (so),$158.00,$10.61,$158.00,$33.81,$27.70,$25.81,$10.61,$27.70,$27.70,$28.02,$158.00,$19.91,$53.02,$125.14,$126.40,$27.49,$29.86,$18.96,$20.90,$18.96
30105264,EAP,CPT® 84432,,Thyroglobulin (so) Th,$75.00,$8.98,$75.00,$28.64,$23.45,$9.90,$8.98,$23.45,$23.45,$23.73,$75.00,$16.86,$44.88,$59.40,$60.00,$23.29,$25.28,$16.06,$17.70,$16.06
30105265,EAP,CPT® 86800,,Thyroglobulin  Antibody (so) Th,$54.00,$8.89,$54.00,$28.36,$23.22,$16.45,$8.89,$23.22,$23.22,$23.50,$54.00,$16.71,$44.44,$42.77,$43.20,$23.07,$25.04,$15.91,$17.53,$15.91
30105268,EAP,CPT® 82108,,"Aluminum, 24- Hour Urine (so)",$69.00,$0.00,$69.00,$30.05,$24.61,$25.32,$0.00,$24.61,$24.61,$24.91,$69.00,$26.75,$47.10,$54.65,$55.20,$36.95,$0.00,$25.48,$18.58,$25.48
30105269,EAP,CPT® 83789,,"Ethambutol, Serum (nms)",$211.00,$0.00,$211.00,$0.00,$8.77,$0.00,$0.00,$8.77,$8.77,$0.00,$211.00,$0.00,$16.78,$167.11,$168.80,$0.00,$0.00,$0.00,$0.00,$0.00
30105270,EAP,CPT® 83789,,"Pyrazinamide, Serum (nms)",$507.00,$0.00,$507.00,$0.00,$8.77,$0.00,$0.00,$8.77,$8.77,$0.00,$507.00,$0.00,$16.78,$401.54,$405.60,$0.00,$0.00,$0.00,$0.00,$0.00
30105271,EAP,CPT® 84999,,Nephrocheck Acute Kidney Injury,$297.00,$0.00,$297.00,$0.00,$211.97,$0.00,$51.17,$211.97,$211.97,$52.00,$297.00,$0.00,$0.00,$235.22,$237.60,$0.00,$46.48,$0.00,$0.00,$0.00
30105275,EAP,CPT® 80186,,Free Phenytoin,$157.00,$7.70,$157.00,$24.53,$20.10,$18.73,$7.70,$20.10,$20.10,$20.34,$157.00,$14.45,$38.46,$124.34,$125.60,$19.95,$21.67,$13.76,$15.17,$13.76
30150004,EAP,CPT® 80053,,"Comp, Metabolic Panel",$477.00,$5.91,$477.00,$18.83,$15.44,$14.37,$5.91,$15.44,$15.44,$15.61,$477.00,$11.09,$29.54,$377.78,$381.60,$15.31,$16.64,$10.56,$11.65,$10.56
30150007,EAP,CPT® 80061,,Lipoprotein Profile,$285.00,$7.50,$285.00,$23.87,$19.57,$18.22,$7.50,$19.57,$19.57,$19.79,$285.00,$14.06,$37.44,$225.72,$228.00,$19.42,$21.09,$13.39,$14.76,$13.39
30150171,EAP,CPT® 82947,,Glucose,$326.00,$2.20,$326.00,$7.00,$5.73,$5.34,$2.20,$5.73,$5.73,$5.80,$326.00,$4.13,$10.96,$258.19,$260.80,$5.70,$6.18,$3.93,$4.32,$3.93
30150172,EAP,CPT® 82480,,Cholinesterase; Serum,$39.00,$0.00,$39.00,$0.00,$11.51,$0.00,$0.00,$11.51,$11.51,$0.00,$39.00,$0.00,$22.02,$30.89,$31.20,$0.00,$0.00,$0.00,$0.00,$0.00
30150173,EAP,CPT® 82482,,Rbc,$40.00,$0.00,$40.00,$0.00,$11.22,$0.00,$0.00,$11.22,$11.22,$0.00,$40.00,$0.00,$21.48,$31.68,$32.00,$0.00,$0.00,$0.00,$0.00,$0.00
30150174,EAP,CPT® 86255,,"Fluor Noninfec Agnt Ab Scr,ea",$64.00,$6.75,$64.00,$21.48,$17.60,$16.40,$6.75,$17.60,$17.60,$17.81,$64.00,$12.65,$33.68,$50.69,$51.20,$17.47,$18.97,$12.05,$13.28,$12.05
30150176,EAP,CPT® 86628,,Candida,$254.00,$0.00,$254.00,$0.00,$17.53,$0.00,$0.00,$17.53,$17.53,$0.00,$254.00,$0.00,$33.56,$201.17,$203.20,$0.00,$0.00,$0.00,$0.00,$0.00
30150177,EAP,CPT® 83789,,"Quantitative, Each Specimen",$235.00,$0.00,$235.00,$0.00,$8.77,$0.00,$0.00,$8.77,$8.77,$0.00,$235.00,$0.00,$16.78,$186.12,$188.00,$0.00,$0.00,$0.00,$0.00,$0.00
30150178,EAP,CPT® 86235,,"Extractable Nuclear Antigen,antibody To, Any Method",$159.00,$10.04,$159.00,$31.97,$26.18,$24.41,$10.04,$26.18,$26.18,$26.49,$159.00,$18.83,$50.12,$125.93,$127.20,$26.00,$28.23,$17.93,$19.76,$17.93
30150179,EAP,CPT® 87798,,"Amplified Probe Technique,each Organism",$605.00,$19.63,$605.00,$34.98,$28.64,$37.59,$19.63,$28.64,$28.64,$28.98,$605.00,$36.84,$54.82,$479.16,$484.00,$50.88,$30.88,$35.09,$21.62,$35.09
30150180,EAP,CPT® 86658,,Enterovirus - A,$51.00,$7.28,$51.00,$23.23,$19.03,$11.13,$7.28,$19.03,$19.03,$19.25,$51.00,$13.68,$36.40,$40.39,$40.80,$18.89,$20.51,$13.03,$14.36,$13.03
30150181,EAP,CPT® 86658,,Enterovirus - B,$51.00,$7.28,$51.00,$23.23,$19.03,$11.13,$7.28,$19.03,$19.03,$19.25,$51.00,$13.68,$36.40,$40.39,$40.80,$18.89,$20.51,$13.03,$14.36,$13.03
30150182,EAP,CPT® 86750,,Plasmodium(malaria),$60.00,$0.00,$60.00,$0.00,$19.25,$0.00,$0.00,$19.25,$19.25,$0.00,$60.00,$0.00,$36.86,$47.52,$48.00,$0.00,$0.00,$0.00,$0.00,$0.00
30150183,EAP,CPT® 86750,,Plasmodium(malaria),$60.00,$0.00,$60.00,$0.00,$19.25,$0.00,$0.00,$19.25,$19.25,$0.00,$60.00,$0.00,$36.86,$47.52,$48.00,$0.00,$0.00,$0.00,$0.00,$0.00
30150184,EAP,CPT® 83520,,"Quantitative, Not Otherwise Specified",$720.00,$8.69,$720.00,$23.07,$18.91,$17.62,$8.69,$18.91,$18.91,$19.12,$720.00,$18.13,$36.18,$570.24,$576.00,$25.04,$20.37,$17.27,$14.26,$17.27
30150185,EAP,CPT® 86635,,Coccidioides,$68.00,$0.00,$68.00,$0.00,$16.75,$0.00,$0.00,$16.75,$16.75,$0.00,$68.00,$0.00,$32.06,$53.86,$54.40,$0.00,$0.00,$0.00,$0.00,$0.00
30150193,EAP,CPT® 83519,,"Quantitative, By Radioimmunoassay",$687.00,$9.26,$687.00,$24.08,$19.73,$18.39,$9.26,$19.73,$19.73,$19.96,$687.00,$19.32,$37.76,$544.10,$549.60,$26.68,$21.27,$18.40,$14.89,$18.40
30150194,EAP,CPT® 88271,,"Molecular Cytogenetics; Dna Probe, Each",$307.00,$11.98,$307.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$307.00,$22.49,$59.86,$243.14,$245.60,$31.06,$33.72,$21.42,$23.60,$21.42
30150195,EAP,CPT® 88275,,"Interphase Insitu Hybrid, Ana 10-30 Cells",$400.00,$25.78,$400.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$400.00,$53.75,$112.22,$316.80,$320.00,$74.23,$63.21,$51.19,$44.25,$51.19
30150196,EAP,CPT® 86255,,"Fluor Noninfect Agent Ab Scr, Ea Ab",$106.00,$6.75,$106.00,$21.48,$17.60,$16.40,$6.75,$17.60,$17.60,$17.81,$106.00,$12.65,$33.68,$83.95,$84.80,$17.47,$18.97,$12.05,$13.28,$12.05
30150197,EAP,CPT® 83625,,"Isoenzymes, Separation And Quantitation",$48.00,$0.00,$48.00,$0.00,$16.90,$0.00,$0.00,$16.90,$16.90,$0.00,$48.00,$0.00,$32.34,$38.02,$38.40,$0.00,$0.00,$0.00,$0.00,$0.00
30150202,EAP,CPT® 82379,,"Carnitine, Urine (quest 30338)",$324.00,$0.00,$324.00,$0.00,$24.63,$0.00,$0.00,$24.63,$24.63,$0.00,$324.00,$0.00,$47.14,$256.61,$259.20,$0.00,$0.00,$0.00,$0.00,$0.00
30150203,EAP,CPT® 84143,,C17-HYDROXYPREGNENOLONE(QUEST 8352),$150.00,$0.00,$150.00,$0.00,$33.32,$0.00,$0.00,$33.32,$33.32,$0.00,$150.00,$0.00,$63.78,$118.80,$120.00,$0.00,$0.00,$0.00,$0.00,$0.00
30150204,EAP,CPT® 86332,,IMMUNE COMPLEX DETECTION BY C1Q BINDING(Q 36735),$34.00,$13.64,$38.36,$34.00,$35.59,$33.17,$13.64,$35.59,$35.59,$36.00,$34.00,$25.59,$34.00,$26.93,$27.20,$34.00,$38.36,$24.37,$26.85,$24.37
30150205,EAP,CPT® 81229,,"CHROMOSOMAL MICROARRAY, PRENATAL (QUEST 90927)","$3,881.00",$584.01,"$3,881.00",$697.68,"$2,769.87",$690.82,$584.01,"$2,769.87","$2,769.87","$2,725.40","$3,881.00","$1,218.00","$1,940.50","$3,073.75","$3,104.80","$1,682.00","$2,903.98","$1,160.00","$2,032.79","$1,160.00"
30150206,EAP,CPT® 86003,,"ALLERGY PANEL,MOLD GROUP (QUEST 7911)",$254.00,$2.92,$254.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$254.00,$5.48,$14.60,$201.17,$203.20,$7.57,$8.22,$5.22,$5.76,$5.22
30150207,EAP,CPT® 88271,,"FISH,PDGFRB,5q331.(QUEST 90510)DNA PROBE",$511.00,$11.98,$511.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$511.00,$22.49,$59.86,$404.71,$408.80,$31.06,$33.72,$21.42,$23.60,$21.42
30150208,EAP,CPT® 88275,,"FISH,PDGFRB,5q331.(QUEST 90510)100-300cells",$256.00,$25.78,$256.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$256.00,$53.75,$112.22,$202.75,$204.80,$74.23,$63.21,$51.19,$44.25,$51.19
30150209,EAP,CPT® 86235,,MYOSITIS ASSESS AUTOAB (Q10185)NUC AG AB,$414.00,$10.04,$414.00,$31.97,$26.18,$24.41,$10.04,$26.18,$26.18,$26.49,$414.00,$18.83,$50.12,$327.89,$331.20,$26.00,$28.23,$17.93,$19.76,$17.93
30150210,EAP,CPT® 83516,,MYOSITIS ASSESS AUTOAB (Q10185)Non AB,"$1,103.00",$6.44,"$1,103.00",$19.04,$15.61,$15.70,$6.44,$15.61,$15.61,$15.80,"$1,103.00",$12.11,$29.88,$873.58,$882.40,$16.72,$16.84,$11.53,$11.79,$11.53
30150211,EAP,CPT® 80356,,MONOACETLYMORPNINE MAM (SO),$176.00,$0.00,$176.00,$0.00,$125.61,$0.00,$0.00,$125.61,$125.61,$0.00,$176.00,$0.00,$88.00,$139.39,$140.80,$0.00,$0.00,$0.00,$0.00,$0.00
30150212,EAP,CPT® 80377,,Hypoglycemic Mass Spec (so),$389.00,$0.00,$389.00,$0.00,$277.63,$0.00,$0.00,$277.63,$277.63,$0.00,$389.00,$0.00,$194.50,$308.09,$311.20,$0.00,$0.00,$0.00,$0.00,$0.00
30159005,EAP,CPT® 89055,,Fecal Leukocyte Smear,$118.00,$0.00,$118.00,$0.00,$3.43,$0.00,$0.00,$3.43,$3.43,$0.00,$118.00,$0.00,$6.56,$93.46,$94.40,$0.00,$0.00,$0.00,$0.00,$0.00
30159016,EAP,CPT® 82570,,Urine Creatinine (so),$79.00,$2.90,$79.00,$9.23,$7.56,$5.60,$2.90,$7.56,$7.56,$7.64,$79.00,$5.44,$14.46,$62.57,$63.20,$7.51,$8.14,$5.18,$5.70,$5.18
30159017,EAP,CPT® 83918,,Organic Acids (so),$667.00,$0.00,$667.00,$29.32,$24.04,$22.39,$0.00,$24.04,$24.04,$24.32,$667.00,$24.78,$46.00,$528.26,$533.60,$34.22,$0.00,$23.60,$18.14,$23.60
30159018,EAP,CPT® 83018,,"Cobalt, Plasma (so)",$159.00,$0.00,$159.00,$0.00,$32.06,$0.00,$0.00,$32.06,$32.06,$0.00,$159.00,$0.00,$61.36,$125.93,$127.20,$0.00,$0.00,$0.00,$0.00,$0.00
30159019,EAP,CPT® 84999,,Macroamylase,$76.00,$0.00,$76.00,$0.00,$54.24,$0.00,$13.09,$54.24,$54.24,$13.31,$76.00,$0.00,$0.00,$60.19,$60.80,$0.00,$11.89,$0.00,$0.00,$0.00
30159020,EAP,CPT® 81511,,Integrated Maternal Serum Screen (so),"$1,231.00",$77.29,"$1,231.00",$399.00,$878.56,$219.12,$77.29,$878.56,$878.56,$144.26,"$1,231.00",$161.18,$615.50,$974.95,$984.80,$222.58,$153.71,$153.50,$107.60,$153.50
30159021,EAP,CPT® 84163,,Pregnancy Associated Plasma Protein (so),$180.00,$7.07,$180.00,$11.45,$9.37,$7.33,$8.42,$9.37,$9.37,$9.48,$180.00,$15.80,$17.94,$142.56,$144.00,$21.82,$10.10,$15.05,$7.07,$15.05
30159024,EAP,CPT® 82172,,Apolipoprotein (so),$155.00,$10.62,$155.00,$27.63,$22.62,$19.23,$10.62,$22.62,$22.62,$22.90,$155.00,$22.14,$43.30,$122.76,$124.00,$30.58,$24.40,$21.09,$17.08,$21.09
30159025,EAP,CPT® 82247,,"Bilirubin, Total (so)",$80.00,$2.81,$80.00,$8.94,$7.33,$6.83,$2.81,$7.33,$7.33,$7.42,$80.00,$5.27,$14.04,$63.36,$64.00,$7.28,$7.91,$5.02,$5.54,$5.02
30159026,EAP,CPT® 82977,,Gamma - Ggt (so),$144.00,$4.03,$144.00,$12.84,$10.51,$9.52,$4.03,$10.51,$10.51,$7.46,$144.00,$7.56,$20.12,$114.05,$115.20,$10.44,$7.94,$7.20,$5.56,$7.20
30159027,EAP,CPT® 83010,,"Haptoglobin, Quant (so)",$125.00,$4.11,$125.00,$6.66,$5.44,$17.12,$7.04,$5.44,$5.44,$5.51,$125.00,$13.21,$10.42,$99.00,$100.00,$18.24,$5.87,$12.58,$4.11,$12.58
30159028,EAP,CPT® 83883,,"Nephelometry, Each Analyte (so)",$145.00,$7.61,$145.00,$24.24,$19.85,$9.90,$7.61,$19.85,$19.85,$20.09,$145.00,$14.28,$38.00,$114.84,$116.00,$19.72,$21.40,$13.60,$14.98,$13.60
30159029,EAP,CPT® 84460,,Alt (alanine Aminotransferase) (so),$80.00,$2.96,$80.00,$9.44,$7.73,$6.74,$2.96,$7.73,$7.73,$7.46,$80.00,$5.57,$14.80,$63.36,$64.00,$7.69,$7.94,$5.30,$5.56,$5.30
30159062,EAP,CPT® 84210,,"Pyruvate, Csf (so)",$254.00,$0.00,$254.00,$19.36,$15.85,$14.77,$0.00,$15.85,$15.85,$0.00,$254.00,$15.20,$30.34,$201.17,$203.20,$21.00,$0.00,$14.48,$11.96,$14.48
30159063,EAP,CPT® 86787,,"Varicella - Zoster Virus Antibody , Csf (so)",$109.00,$7.21,$109.00,$22.96,$18.81,$17.53,$7.21,$18.81,$18.81,$19.03,$109.00,$13.52,$36.00,$86.33,$87.20,$18.68,$20.27,$12.88,$14.19,$12.88
30159064,EAP,CPT® 80350,,"Cannabinoids, Synthetic, 1-3",$148.00,$0.00,$148.00,$0.00,$105.63,$0.00,$0.00,$105.63,$105.63,$0.00,$148.00,$0.00,$74.00,$117.22,$118.40,$0.00,$0.00,$0.00,$0.00,$0.00
30159065,EAP,CPT® 80335,,"Clomipramine, Serum (nms), Qt",$266.00,$0.00,$266.00,$0.00,$189.84,$0.00,$12.30,$189.84,$189.84,$0.00,$266.00,$0.00,$133.00,$210.67,$212.80,$0.00,$28.17,$0.00,$0.00,$0.00
30159066,EAP,CPT® 82657,,"Alpha - Galactosidase, Leukocytes (mayo)",$385.00,$0.00,$385.00,$0.00,$8.77,$0.00,$0.00,$8.77,$8.77,$0.00,$385.00,$0.00,$16.78,$304.92,$308.00,$0.00,$0.00,$0.00,$0.00,$0.00
30159067,EAP,CPT® 80307,,"Hypoglycemic Agent Screen, Serum (mayo)",$361.00,$32.55,$361.00,$99.36,$76.45,$64.26,$32.55,$76.45,$76.45,$71.85,$361.00,$65.25,$180.50,$285.91,$288.80,$90.10,$76.56,$62.14,$53.59,$62.14
30159068,EAP,CPT® 80347,,Benzodiazepines (so)nms,$163.00,$0.00,$163.00,$0.00,$116.33,$0.00,$0.00,$116.33,$116.33,$0.00,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$0.00,$0.00,$0.00,$0.00
30159069,EAP,CPT® 80320,,"Alcohol( Ethanol), (so)nms",$49.00,$0.00,$120.15,$0.02,$34.97,$8.72,$7.42,$34.97,$34.97,$15.96,$49.00,$120.15,$24.50,$38.81,$39.20,$29.40,$17.01,$0.00,$11.90,$114.43
30159070,EAP,CPT® 80307,,"Drug Screen, Qualitative,(so)nms",$286.00,$32.55,$286.00,$99.36,$76.45,$50.91,$32.55,$76.45,$76.45,$71.85,$286.00,$65.25,$143.00,$226.51,$228.80,$90.10,$76.56,$62.14,$53.59,$62.14
30159071,EAP,CPT® 80307,,"Single Drug Class (elisa), (so)nms",$216.00,$32.55,$216.00,$99.36,$76.45,$38.45,$32.55,$76.45,$76.45,$71.85,$216.00,$65.25,$108.00,$171.07,$172.80,$90.10,$76.56,$62.14,$53.59,$62.14
30159072,EAP,CPT® 83519,,Ach Receptor (muscle Binding Abs) Mayo,$141.00,$9.26,$141.00,$24.08,$19.73,$18.39,$9.26,$19.73,$19.73,$19.96,$141.00,$19.32,$37.76,$111.67,$112.80,$26.68,$21.27,$18.40,$14.89,$18.40
30159073,EAP,CPT® 83519,,Achr Ganglionic Neuronal Abs (mayo),$141.00,$9.26,$141.00,$24.08,$19.73,$18.39,$9.26,$19.73,$19.73,$19.96,$141.00,$19.32,$37.76,$111.67,$112.80,$26.68,$21.27,$18.40,$14.89,$18.40
30159074,EAP,CPT® 83519,,Neuronal Vgkc Autoantibody (mayo),$141.00,$9.26,$141.00,$24.08,$19.73,$18.39,$9.26,$19.73,$19.73,$19.96,$141.00,$19.32,$37.76,$111.67,$112.80,$26.68,$21.27,$18.40,$14.89,$18.40
30159075,EAP,CPT® 83519,,N-type Calcium Channel Abs (mayo),$141.00,$9.26,$141.00,$24.08,$19.73,$18.39,$9.26,$19.73,$19.73,$19.96,$141.00,$19.32,$37.76,$111.67,$112.80,$26.68,$21.27,$18.40,$14.89,$18.40
30159076,EAP,CPT® 83519,,P/q -type Calcium Channel Abs (mayo),$141.00,$9.26,$141.00,$24.08,$19.73,$18.39,$9.26,$19.73,$19.73,$19.96,$141.00,$19.32,$37.76,$111.67,$112.80,$26.68,$21.27,$18.40,$14.89,$18.40
30159077,EAP,CPT® 83519,,Ach Receptor (muscle) Modulating Abs (mayo),$141.00,$9.26,$141.00,$24.08,$19.73,$18.39,$9.26,$19.73,$19.73,$19.96,$141.00,$19.32,$37.76,$111.67,$112.80,$26.68,$21.27,$18.40,$14.89,$18.40
30159078,EAP,CPT® 83520,,Striational (striated Muscle) Abs (mayo),$141.00,$8.69,$141.00,$23.07,$18.91,$17.62,$8.69,$18.91,$18.91,$19.12,$141.00,$18.13,$36.18,$111.67,$112.80,$25.04,$20.37,$17.27,$14.26,$17.27
30159079,EAP,CPT® 84182,,Amphiphysin Western Blot (mayo),$63.00,$14.70,$63.00,$32.08,$26.28,$24.49,$14.70,$26.28,$26.28,$26.60,$63.00,$30.67,$50.30,$49.90,$50.40,$42.35,$28.34,$29.21,$19.84,$29.21
30159080,EAP,CPT® 84182,,Crmp-5-igg Western Blot (mayo),$63.00,$14.70,$63.00,$32.08,$26.28,$24.49,$14.70,$26.28,$26.28,$26.60,$63.00,$30.67,$50.30,$49.90,$50.40,$42.35,$28.34,$29.21,$19.84,$29.21
30159081,EAP,CPT® 84182,,Paraneoplastic Autoantibody Western Blot (mayo),$63.00,$14.70,$63.00,$32.08,$26.28,$24.49,$14.70,$26.28,$26.28,$26.60,$63.00,$30.67,$50.30,$49.90,$50.40,$42.35,$28.34,$29.21,$19.84,$29.21
30159082,EAP,CPT® 83519,,Alpha Subunit (so),$244.00,$9.26,$244.00,$24.08,$19.73,$18.39,$9.26,$19.73,$19.73,$19.96,$244.00,$19.32,$37.76,$193.25,$195.20,$26.68,$21.27,$18.40,$14.89,$18.40
30159083,EAP,CPT® 80299,,"Metformin  Quantitative, Serum (arup)",$308.00,$9.39,$308.00,$24.21,$17.58,$15.07,$9.39,$17.58,$17.58,$17.79,$308.00,$19.57,$33.64,$243.94,$246.40,$27.03,$18.95,$18.64,$13.27,$18.64
30159084,EAP,CPT® 83872,,"Mucin Clot, Synovial (so)",$60.00,$0.00,$60.00,$0.00,$8.56,$0.00,$0.00,$8.56,$8.56,$0.00,$60.00,$0.00,$16.38,$47.52,$48.00,$0.00,$0.00,$0.00,$0.00,$0.00
30159085,EAP,CPT® 82379,,"Carnitine, Urine (so)",$324.00,$0.00,$324.00,$0.00,$24.63,$0.00,$0.00,$24.63,$24.63,$0.00,$324.00,$0.00,$47.14,$256.61,$259.20,$0.00,$0.00,$0.00,$0.00,$0.00
30159086,EAP,CPT® 83519,,"Musk  Quantitative , Antibody (so)","$1,787.00",$9.26,"$1,787.00",$24.08,$19.73,$18.39,$9.26,$19.73,$19.73,$19.96,"$1,787.00",$19.32,$37.76,"$1,415.30","$1,429.60",$26.68,$21.27,$18.40,$14.89,$18.40
30159087,EAP,CPT® 82542,,"Cannabinoid Metabolite, Urine (nms), Qt",$284.00,$6.62,$284.00,$32.19,$8.77,$24.58,$12.13,$8.77,$8.77,$8.87,$284.00,$25.29,$16.78,$224.93,$227.20,$34.93,$9.45,$24.09,$6.62,$24.09
30159088,EAP,CPT® 83520,,Tsh Receptor Binding Ab Trab (so),$263.00,$8.69,$263.00,$23.07,$18.91,$17.62,$8.69,$18.91,$18.91,$19.12,$263.00,$18.13,$36.18,$208.30,$210.40,$25.04,$20.37,$17.27,$14.26,$17.27
30159089,EAP,CPT® 84143,,"Hydroxypregnenolone-17, Lc/ms/ms (so)",$150.00,$0.00,$150.00,$0.00,$33.32,$0.00,$0.00,$33.32,$33.32,$0.00,$150.00,$0.00,$63.78,$118.80,$120.00,$0.00,$0.00,$0.00,$0.00,$0.00
30159090,EAP,CPT® 80299,,Infliximab Drug Concentration,$401.00,$9.39,$401.00,$24.21,$17.58,$15.07,$9.39,$17.58,$17.58,$17.79,$401.00,$19.57,$33.64,$317.59,$320.80,$27.03,$18.95,$18.64,$13.27,$18.64
30159091,EAP,CPT® 82397,,Anti-infliximab Ab,$718.00,$7.90,$718.00,$25.17,$20.63,$19.22,$7.90,$20.63,$20.63,$20.87,$718.00,$14.83,$39.48,$568.66,$574.40,$20.47,$22.24,$14.12,$15.57,$14.12
30160020,EAP,CPT® 82172,,Apolipoprotein A1 (so),$175.00,$10.62,$175.00,$27.63,$22.62,$19.23,$10.62,$22.62,$22.62,$22.90,$175.00,$22.14,$43.30,$138.60,$140.00,$30.58,$24.40,$21.09,$17.08,$21.09
30160023,EAP,CPT® 84182,,Redombx Car Antirecoverin (so),$468.00,$14.70,$468.00,$32.08,$26.28,$24.49,$14.70,$26.28,$26.28,$26.60,$468.00,$30.67,$50.30,$370.66,$374.40,$42.35,$28.34,$29.21,$19.84,$29.21
30160024,EAP,CPT® 83520,,Prothrom Frag 1.2 (so),$414.00,$8.69,$414.00,$23.07,$18.91,$17.62,$8.69,$18.91,$18.91,$19.12,$414.00,$18.13,$36.18,$327.89,$331.20,$25.04,$20.37,$17.27,$14.26,$17.27
30160025,EAP,CPT® 80369,,Baclofin (so),$402.00,$0.00,$402.00,$0.00,$286.91,$0.00,$0.00,$286.91,$286.91,$0.00,$402.00,$0.00,$201.00,$318.38,$321.60,$0.00,$0.00,$0.00,$0.00,$0.00
30160027,EAP,CPT® 82042,,"Albumin, Csf (so)",$18.00,$3.92,$18.00,$9.23,$7.56,$7.04,$3.92,$7.56,$7.56,$7.64,$18.00,$8.17,$14.46,$14.26,$14.40,$11.28,$8.14,$7.78,$5.70,$7.78
30160028,EAP,CPT® 82272,,"Occult Blood Guaiac, Fecal",$65.00,$0.00,$65.00,$0.00,$4.69,$0.00,$0.00,$4.69,$4.69,$0.00,$65.00,$0.00,$8.98,$51.48,$52.00,$0.00,$0.00,$0.00,$0.00,$0.00
30160029,EAP,CPT® 80365,,"Oxycodone And Metabolite, Quant Serum (so-quest)",$303.00,$0.00,$303.00,$0.02,$216.25,$53.93,$13.36,$216.25,$216.25,$53.05,$303.00,$120.15,$151.50,$239.98,$242.40,$181.80,$47.42,$0.00,$48.24,$114.43
30160030,EAP,CPT® 82397,,"Anti-mullerian Hormone (amh), Male (so)",$288.00,$7.90,$288.00,$25.17,$20.63,$19.22,$7.90,$20.63,$20.63,$20.87,$288.00,$14.83,$39.48,$228.10,$230.40,$20.47,$22.24,$14.12,$15.57,$14.12
30160031,EAP,CPT® 82397,,"Anti-mullerian Hormone (amh), Female (so)",$288.00,$7.90,$288.00,$25.17,$20.63,$19.22,$7.90,$20.63,$20.63,$20.87,$288.00,$14.83,$39.48,$228.10,$230.40,$20.47,$22.24,$14.12,$15.57,$14.12
30160032,EAP,CPT® 83520,,Infliximab Ab - Rd (so),$480.00,$8.69,$480.00,$23.07,$18.91,$85.44,$8.69,$18.91,$18.91,$19.12,$480.00,$120.15,$36.18,$380.16,$384.00,$25.04,$20.37,$17.27,$14.26,$114.43
30160033,EAP,CPT® 80299,,Infliximab Rd (so),$425.00,$9.39,$425.00,$24.21,$17.58,$15.07,$9.39,$17.58,$17.58,$17.79,$425.00,$19.57,$33.64,$336.60,$340.00,$27.03,$18.95,$18.64,$13.27,$18.64
30160034,EAP,CPT® 83520,,Infliximab Ab Ibd (so),$480.00,$8.69,$480.00,$23.07,$18.91,$17.62,$8.69,$18.91,$18.91,$19.12,$480.00,$18.13,$36.18,$380.16,$384.00,$25.04,$20.37,$17.27,$14.26,$17.27
30160035,EAP,CPT® 80299,,Infliximab Ibd (so),$425.00,$9.39,$425.00,$24.21,$17.58,$15.07,$9.39,$17.58,$17.58,$17.79,$425.00,$19.57,$33.64,$336.60,$340.00,$27.03,$18.95,$18.64,$13.27,$18.64
30160036,EAP,CPT® 80050,,Champva General Health Panel,$830.00,$0.00,$830.00,$0.00,$42.54,$0.00,$24.73,$42.54,$42.54,$145.33,$830.00,$0.00,$91.78,$657.36,$664.00,$0.00,$129.90,$0.00,$0.00,$0.00
30160040,EAP,CPT® 82570,,Urine Creatinine Qd (so),$27.00,$2.90,$27.00,$9.23,$7.56,$5.60,$2.90,$7.56,$7.56,$7.64,$27.00,$5.44,$14.46,$21.38,$21.60,$7.51,$8.14,$5.18,$5.70,$5.18
30160041,EAP,CPT® 84156,,Urine Protein Qd (so,$27.00,$2.05,$27.00,$6.54,$5.35,$4.99,$2.05,$5.35,$5.35,$5.42,$27.00,$3.85,$10.24,$21.38,$21.60,$5.32,$5.77,$3.67,$4.04,$3.67
30160042,EAP,CPT® 83001,,Follicle Stimulating Hormone (so),$54.00,$10.39,$54.00,$33.13,$27.14,$25.29,$10.39,$27.14,$27.14,$27.46,$54.00,$19.51,$51.94,$42.77,$43.20,$26.94,$29.26,$18.58,$20.48,$18.58
30160043,EAP,CPT® 83002,,Luteinizing Hormone (so),$54.00,$10.36,$54.00,$33.01,$27.04,$23.75,$10.36,$27.04,$27.04,$27.36,$54.00,$19.45,$51.76,$42.77,$43.20,$26.85,$29.16,$18.52,$20.41,$18.52
30160044,EAP,CPT® 84182,,Myositis Specific 11 Ab Protein Western Blot  (so),$103.00,$14.70,$103.00,$32.08,$26.28,$24.49,$14.70,$26.28,$26.28,$26.60,$103.00,$30.67,$50.30,$81.58,$82.40,$42.35,$28.34,$29.21,$19.84,$29.21
30160050,EAP,CPT® 83520,,Interleukin-6 (il-6) (so),$250.00,$8.69,$250.00,$23.07,$18.91,$17.62,$8.69,$18.91,$18.91,$19.12,$250.00,$18.13,$36.18,$198.00,$200.00,$25.04,$20.37,$17.27,$14.26,$17.27
30160055,EAP,CPT® 82140,,Stone Risk Profile - Ammonia (so),$21.00,$8.16,$21.00,$17.62,$14.44,$19.83,$8.16,$14.44,$14.44,$14.62,$21.00,$15.30,$21.00,$16.63,$16.80,$21.00,$15.57,$14.57,$10.90,$14.57
30160056,EAP,CPT® 82340,,Stone Risk Profile - Calcium Urine Quant (so),$21.00,$0.00,$21.00,$0.00,$8.81,$0.00,$0.00,$8.81,$8.81,$0.00,$21.00,$0.00,$16.86,$16.63,$16.80,$0.00,$0.00,$0.00,$0.00,$0.00
30160057,EAP,CPT® 82507,,Stone Risk Profile - Citrate (so),$21.00,$0.00,$40.60,$0.00,$40.60,$0.00,$0.00,$40.60,$40.60,$0.00,$21.00,$0.00,$21.00,$16.63,$16.80,$0.00,$0.00,$0.00,$0.00,$0.00
30160058,EAP,CPT® 82570,,Stone Risk Profile - Creatinine (so),$21.00,$2.90,$21.00,$9.23,$7.56,$5.60,$2.90,$7.56,$7.56,$7.64,$21.00,$5.44,$14.46,$16.63,$16.80,$7.51,$8.14,$5.18,$5.70,$5.18
30160059,EAP,CPT® 83735,,Stone Risk Profile - Magnesium (so),$21.00,$3.75,$21.00,$11.95,$9.78,$9.11,$3.75,$9.78,$9.78,$9.89,$21.00,$7.04,$18.72,$16.63,$16.80,$9.72,$10.54,$6.70,$7.38,$6.70
30160060,EAP,CPT® 83945,,Stone Risk Profile - Oxalate (so),$21.00,$0.00,$21.00,$0.00,$18.80,$0.00,$0.00,$18.80,$18.80,$0.00,$21.00,$0.00,$21.00,$16.63,$16.80,$0.00,$0.00,$0.00,$0.00,$0.00
30160061,EAP,CPT® 83986,,Stone Risk Profile - Ph Body Fluid (so),$21.00,$0.00,$21.00,$6.38,$5.22,$4.87,$0.00,$5.22,$5.22,$5.28,$21.00,$3.76,$10.00,$16.63,$16.80,$5.19,$0.00,$3.58,$3.94,$3.58
30160062,EAP,CPT® 84105,,Stone Risk Profile - Phosphate Urine (so),$21.00,$2.91,$21.00,$9.23,$7.56,$7.04,$2.91,$7.56,$7.56,$7.64,$21.00,$6.07,$14.46,$16.63,$16.80,$8.38,$8.14,$5.78,$5.70,$5.78
30160063,EAP,CPT® 84133,,Stone Risk Profile - Potassium Urine (so),$21.00,$2.42,$21.00,$7.68,$6.28,$4.74,$2.42,$6.28,$6.28,$6.35,$21.00,$4.97,$12.02,$16.63,$16.80,$6.86,$6.77,$4.73,$4.74,$4.73
30160064,EAP,CPT® 84300,,Stone Risk Profile - Sodium Urine (so),$21.00,$2.72,$21.00,$6.16,$5.05,$6.62,$2.72,$5.05,$5.05,$5.11,$21.00,$5.31,$9.66,$16.63,$16.80,$7.34,$5.45,$5.06,$3.81,$5.06
30160065,EAP,CPT® 84392,,Stone Risk Profile - Sulfate Urine (so),$21.00,$0.00,$21.00,$0.00,$6.93,$0.00,$0.00,$6.93,$6.93,$0.00,$21.00,$0.00,$13.28,$16.63,$16.80,$0.00,$0.00,$0.00,$0.00,$0.00
30160066,EAP,CPT® 84560,,Stone Risk Profile - Uric Acid (so),$21.00,$2.65,$21.00,$8.46,$6.93,$6.32,$2.65,$6.93,$6.93,$7.02,$21.00,$5.33,$13.28,$16.63,$16.80,$7.37,$7.48,$5.08,$5.24,$5.08
30160070,EAP,CPT® 84155,,"Assay Protein, Serum (so)",$32.00,$0.00,$32.00,$0.00,$5.35,$0.00,$0.00,$5.35,$5.35,$5.42,$32.00,$0.00,$10.24,$25.34,$25.60,$0.00,$0.00,$0.00,$0.00,$0.00
30160071,EAP,CPT® 84165,,Protein Electrophoresis Urine (so),$32.00,$0.00,$32.00,$19.15,$15.68,$14.61,$0.00,$15.68,$15.68,$15.87,$32.00,$11.28,$30.02,$25.34,$25.60,$15.57,$0.00,$10.74,$11.83,$10.74
30160072,EAP,CPT® 82570,,Assay Creatinine Urine (so),$35.00,$0.00,$35.00,$9.23,$7.56,$5.60,$0.00,$7.56,$7.56,$7.64,$35.00,$5.44,$14.46,$27.72,$28.00,$7.51,$0.00,$5.18,$5.70,$5.18
30160073,EAP,CPT® 84156,,Assay Protein Urine (so),$35.00,$0.00,$35.00,$6.54,$5.35,$4.99,$0.00,$5.35,$5.35,$5.42,$35.00,$3.85,$10.24,$27.72,$28.00,$5.32,$0.00,$3.67,$4.04,$3.67
30160074,EAP,CPT® 84166,,"Protein Electrophoresis, Urine (so)",$35.00,$0.00,$35.00,$31.78,$26.04,$24.27,$0.00,$26.04,$26.04,$26.34,$35.00,$18.72,$35.00,$27.72,$28.00,$25.85,$0.00,$17.83,$19.65,$17.83
30200001,EAP,CPT® 86000,,Proteus Ox-19 Ab,$399.00,$0.00,$399.00,$0.00,$10.19,$0.00,$0.00,$10.19,$10.19,$0.00,$399.00,$0.00,$19.50,$316.01,$319.20,$0.00,$0.00,$0.00,$0.00,$0.00
30200002,EAP,CPT® 86000,,Typhoid O Antibody,$399.00,$0.00,$399.00,$0.00,$10.19,$0.00,$0.00,$10.19,$10.19,$0.00,$399.00,$0.00,$19.50,$316.01,$319.20,$0.00,$0.00,$0.00,$0.00,$0.00
30200003,EAP,CPT® 86000,,Typhoid H Antibody,$399.00,$0.00,$399.00,$0.00,$10.19,$0.00,$0.00,$10.19,$10.19,$0.00,$399.00,$0.00,$19.50,$316.01,$319.20,$0.00,$0.00,$0.00,$0.00,$0.00
30200004,EAP,CPT® 86003,,*alternaria Alternata Ige,$209.00,$2.92,$209.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$209.00,$5.48,$14.60,$165.53,$167.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200005,EAP,CPT® 86003,,*penicillium Notatum Ige,$209.00,$2.92,$209.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$209.00,$5.48,$14.60,$165.53,$167.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200006,EAP,CPT® 86003,,*kentucky/june Bluegrass Ige,$209.00,$2.92,$209.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$209.00,$5.48,$14.60,$165.53,$167.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200007,EAP,CPT® 86003,,*mouse Epithelia Ige,$209.00,$2.92,$209.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$209.00,$5.48,$14.60,$165.53,$167.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200008,EAP,CPT® 86003,,*clam Ige,$209.00,$2.92,$209.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$209.00,$5.48,$14.60,$165.53,$167.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200009,EAP,CPT® 86003,,*walnut (food) Ige,$209.00,$2.92,$209.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$209.00,$5.48,$14.60,$165.53,$167.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200010,EAP,CPT® 86003,,*scallop Ige,$209.00,$2.92,$209.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$209.00,$5.48,$14.60,$165.53,$167.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200011,EAP,CPT® 86003,,Ige Allergen Sesame Seed,$209.00,$2.92,$209.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$209.00,$5.48,$14.60,$165.53,$167.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200012,EAP,CPT® 86003,,Ige Allergen Nettle,$209.00,$2.92,$209.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$209.00,$5.48,$14.60,$165.53,$167.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200013,EAP,CPT® 86003,,Ige Allergen Sheep Sorrel,$209.00,$2.92,$209.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$209.00,$5.48,$14.60,$165.53,$167.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200014,EAP,CPT® 86003,,Mk82 Latex-rst,$209.00,$2.92,$209.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$209.00,$5.48,$14.60,$165.53,$167.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200015,EAP,CPT® 86003,,Curvularia Lunato,$209.00,$2.92,$209.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$209.00,$5.48,$14.60,$165.53,$167.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200016,EAP,CPT® 86003,,Heluminthosporium I.,$209.00,$2.92,$209.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$209.00,$5.48,$14.60,$165.53,$167.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200017,EAP,CPT® 86003,,"Egg, Chicken",$209.00,$2.92,$209.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$209.00,$5.48,$14.60,$165.53,$167.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200018,EAP,CPT® 86003,,"Milk, Cow's",$209.00,$2.92,$209.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$209.00,$5.48,$14.60,$165.53,$167.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200019,EAP,CPT® 86003,,Wheat,$209.00,$2.92,$209.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$209.00,$5.48,$14.60,$165.53,$167.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200020,EAP,CPT® 86003,,Oat,$209.00,$2.92,$209.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$209.00,$5.48,$14.60,$165.53,$167.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200021,EAP,CPT® 86003,,Corn,$209.00,$2.92,$209.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$209.00,$5.48,$14.60,$165.53,$167.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200022,EAP,CPT® 86003,,Soybean,$209.00,$2.92,$209.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$209.00,$5.48,$14.60,$165.53,$167.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200023,EAP,CPT® 86003,,Peanut,$209.00,$2.92,$209.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$209.00,$5.48,$14.60,$165.53,$167.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200024,EAP,CPT® 86003,,Tuna,$224.00,$2.92,$224.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$224.00,$5.48,$14.60,$177.41,$179.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200025,EAP,CPT® 86003,,Codfish,$209.00,$2.92,$209.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$209.00,$5.48,$14.60,$165.53,$167.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200026,EAP,CPT® 86003,,Allergen Specific Ige,$224.00,$2.92,$224.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$224.00,$5.48,$14.60,$177.41,$179.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200027,EAP,CPT® 86003,,Shrimp,$209.00,$2.92,$209.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$209.00,$5.48,$14.60,$165.53,$167.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200028,EAP,CPT® 86003,,Beef,$224.00,$2.92,$224.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$224.00,$5.48,$14.60,$177.41,$179.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200029,EAP,CPT® 86003,,Rice,$224.00,$2.92,$224.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$224.00,$5.48,$14.60,$177.41,$179.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200030,EAP,CPT® 86003,,White Potato,$224.00,$2.92,$224.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$224.00,$5.48,$14.60,$177.41,$179.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200031,EAP,CPT® 86003,,Yellow Onion,$224.00,$2.92,$224.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$224.00,$5.48,$14.60,$177.41,$179.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200032,EAP,CPT® 86003,,Honey Bee,$209.00,$2.92,$209.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$209.00,$5.48,$14.60,$165.53,$167.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200033,EAP,CPT® 86003,,White Faced Hornet,$209.00,$2.92,$209.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$209.00,$5.48,$14.60,$165.53,$167.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200034,EAP,CPT® 86003,,Yellow Jacket,$209.00,$2.92,$209.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$209.00,$5.48,$14.60,$165.53,$167.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200035,EAP,CPT® 86003,,Paper Wasp,$209.00,$2.92,$209.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$209.00,$5.48,$14.60,$165.53,$167.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200036,EAP,CPT® 86003,,Yellow Faced Hornet,$209.00,$2.92,$209.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$209.00,$5.48,$14.60,$165.53,$167.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200037,EAP,CPT® 86003,,Short Ragweed,$209.00,$2.92,$209.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$209.00,$5.48,$14.60,$165.53,$167.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200038,EAP,CPT® 86003,,Yellow Dock,$209.00,$2.92,$209.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$209.00,$5.48,$14.60,$165.53,$167.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200039,EAP,CPT® 86003,,Lamb's Quarters,$209.00,$2.92,$209.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$209.00,$5.48,$14.60,$165.53,$167.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200040,EAP,CPT® 86003,,Pigweed,$209.00,$2.92,$209.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$209.00,$5.48,$14.60,$165.53,$167.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200041,EAP,CPT® 86003,,Marsh Elder,$209.00,$2.92,$209.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$209.00,$5.48,$14.60,$165.53,$167.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200042,EAP,CPT® 86003,,English Plantain,$209.00,$2.92,$209.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$209.00,$5.48,$14.60,$165.53,$167.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200043,EAP,CPT® 86003,,Cocklebur,$209.00,$2.92,$209.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$209.00,$5.48,$14.60,$165.53,$167.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200044,EAP,CPT® 86003,,Bermuda Grass,$209.00,$2.92,$209.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$209.00,$5.48,$14.60,$165.53,$167.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200045,EAP,CPT® 86003,,Perennial Ryegrass,$209.00,$2.92,$209.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$209.00,$5.48,$14.60,$165.53,$167.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200046,EAP,CPT® 86003,,Timothy,$209.00,$2.92,$209.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$209.00,$5.48,$14.60,$165.53,$167.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200047,EAP,CPT® 86003,,Johnson Grass,$209.00,$2.92,$209.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$209.00,$5.48,$14.60,$165.53,$167.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200048,EAP,CPT® 86003,,Bahia Grass,$209.00,$2.92,$209.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$209.00,$5.48,$14.60,$165.53,$167.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200049,EAP,CPT® 86003,,White Oak,$209.00,$2.92,$209.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$209.00,$5.48,$14.60,$165.53,$167.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200050,EAP,CPT® 86003,,Elm,$209.00,$2.92,$209.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$209.00,$5.48,$14.60,$165.53,$167.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200051,EAP,CPT® 86003,,Black Walnut,$209.00,$2.92,$209.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$209.00,$5.48,$14.60,$165.53,$167.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200052,EAP,CPT® 86003,,White Ash,$209.00,$2.92,$209.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$209.00,$5.48,$14.60,$165.53,$167.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200053,EAP,CPT® 86003,,White Pine,$209.00,$2.92,$209.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$209.00,$5.48,$14.60,$165.53,$167.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200054,EAP,CPT® 86003,,Pecan,$209.00,$2.92,$209.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$209.00,$5.48,$14.60,$165.53,$167.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200055,EAP,CPT® 86003,,Cottonwood,$209.00,$2.92,$209.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$209.00,$5.48,$14.60,$165.53,$167.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200056,EAP,CPT® 86003,,Sycamore,$209.00,$2.92,$209.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$209.00,$5.48,$14.60,$165.53,$167.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200057,EAP,CPT® 86003,,Birch,$209.00,$2.92,$209.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$209.00,$5.48,$14.60,$165.53,$167.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200058,EAP,CPT® 86003,,Eucalyptus,$209.00,$2.92,$209.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$209.00,$5.48,$14.60,$165.53,$167.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200059,EAP,CPT® 86003,,Red Cedar,$209.00,$2.92,$209.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$209.00,$5.48,$14.60,$165.53,$167.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200060,EAP,CPT® 86003,,Red Maple,$209.00,$2.92,$209.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$209.00,$5.48,$14.60,$165.53,$167.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200061,EAP,CPT® 86003,,Cat Hair,$209.00,$2.92,$209.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$209.00,$5.48,$14.60,$165.53,$167.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200062,EAP,CPT® 86003,,Dog Hair,$209.00,$2.92,$209.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$209.00,$5.48,$14.60,$165.53,$167.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200063,EAP,CPT® 86003,,Horse Hair,$209.00,$2.92,$209.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$209.00,$5.48,$14.60,$165.53,$167.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200064,EAP,CPT® 86003,,Feather Mix,$209.00,$2.92,$209.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$209.00,$5.48,$14.60,$165.53,$167.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200065,EAP,CPT® 86003,,D.pteronyssinus,$209.00,$2.92,$209.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$209.00,$5.48,$14.60,$165.53,$167.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200066,EAP,CPT® 86003,,D.farinae Mite,$209.00,$2.92,$209.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$209.00,$5.48,$14.60,$165.53,$167.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200067,EAP,CPT® 86003,,Cockroach,$209.00,$2.92,$209.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$209.00,$5.48,$14.60,$165.53,$167.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200068,EAP,CPT® 86003,,Pen. Brevicomp,$209.00,$2.92,$209.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$209.00,$5.48,$14.60,$165.53,$167.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200069,EAP,CPT® 86003,,"Clado, Herbarium",$209.00,$2.92,$209.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$209.00,$5.48,$14.60,$165.53,$167.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200070,EAP,CPT® 86003,,Candida Albicans,$209.00,$2.92,$209.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$209.00,$5.48,$14.60,$165.53,$167.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200071,EAP,CPT® 86003,,Alternaria Tenuis,$209.00,$2.92,$209.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$209.00,$5.48,$14.60,$165.53,$167.20,$7.57,$8.22,$5.22,$5.76,$5.22
30200072,EAP,CPT® 86021,,Perinuclear Ab Scrn,$326.00,$8.42,$326.00,$26.84,$21.98,$20.49,$8.42,$21.98,$21.98,$22.24,$326.00,$15.80,$42.06,$258.19,$260.80,$21.82,$23.70,$15.05,$16.59,$15.05
30200073,EAP,CPT® 86021,,Cytoplasmic Ab Scrn,$326.00,$8.42,$326.00,$26.84,$21.98,$20.49,$8.42,$21.98,$21.98,$22.24,$326.00,$15.80,$42.06,$258.19,$260.80,$21.82,$23.70,$15.05,$16.59,$15.05
30200074,EAP,CPT® 86022,,Plt Ab: Hla Class 1,$420.00,$0.00,$420.00,$0.00,$26.82,$0.00,$0.00,$26.82,$26.82,$0.00,$420.00,$0.00,$51.32,$332.64,$336.00,$0.00,$0.00,$0.00,$0.00,$0.00
30200075,EAP,CPT® 86022,,Plt Ab: Gp Iib/iiia,$420.00,$0.00,$420.00,$0.00,$26.82,$0.00,$0.00,$26.82,$26.82,$0.00,$420.00,$0.00,$51.32,$332.64,$336.00,$0.00,$0.00,$0.00,$0.00,$0.00
30200076,EAP,CPT® 86022,,Plt Ab: Gp Ib/ix,$420.00,$0.00,$420.00,$0.00,$26.82,$0.00,$0.00,$26.82,$26.82,$0.00,$420.00,$0.00,$51.32,$332.64,$336.00,$0.00,$0.00,$0.00,$0.00,$0.00
30200077,EAP,CPT® 86022,,Plt Ab: Gp Ia/iib,$420.00,$0.00,$420.00,$0.00,$26.82,$0.00,$0.00,$26.82,$26.82,$0.00,$420.00,$0.00,$51.32,$332.64,$336.00,$0.00,$0.00,$0.00,$0.00,$0.00
30200078,EAP,CPT® 86022,,Plt Ab: Gp Iv,$420.00,$0.00,$420.00,$0.00,$26.82,$0.00,$0.00,$26.82,$26.82,$0.00,$420.00,$0.00,$51.32,$332.64,$336.00,$0.00,$0.00,$0.00,$0.00,$0.00
30200079,EAP,CPT® 86038,,Ana Screen,$276.00,$6.76,$276.00,$21.55,$17.65,$16.45,$6.76,$17.65,$17.65,$17.86,$276.00,$12.69,$33.78,$218.59,$220.80,$17.53,$19.03,$12.09,$13.32,$12.09
30200080,EAP,CPT® 86060,,Strep Aso,$76.00,$4.08,$76.00,$12.47,$10.21,$9.94,$4.08,$10.21,$10.21,$10.32,$76.00,$7.67,$19.54,$60.19,$60.80,$10.59,$11.00,$7.30,$7.70,$7.30
30200081,EAP,CPT® 86140,,C-reactive Protein,$235.00,$0.00,$235.00,$0.00,$7.56,$0.00,$0.00,$7.56,$7.56,$0.00,$235.00,$0.00,$14.46,$186.12,$188.00,$0.00,$0.00,$0.00,$0.00,$0.00
30200082,EAP,CPT® 86141,,C-reactive Protein-hs,$250.00,$7.25,$250.00,$23.07,$18.91,$17.62,$7.25,$18.91,$18.91,$19.12,$250.00,$13.60,$36.18,$198.00,$200.00,$18.78,$20.37,$12.95,$14.26,$12.95
30200083,EAP,CPT® 86141,,"Crp-hs,micro",$250.00,$7.25,$250.00,$23.07,$18.91,$17.62,$7.25,$18.91,$18.91,$19.12,$250.00,$13.60,$36.18,$198.00,$200.00,$18.78,$20.37,$12.95,$14.26,$12.95
30200084,EAP,CPT® 86160,,Complement-3c,$340.00,$6.71,$340.00,$21.39,$17.53,$16.33,$6.71,$17.53,$17.53,$17.73,$340.00,$12.60,$33.56,$269.28,$272.00,$17.40,$18.90,$12.00,$13.23,$12.00
30200085,EAP,CPT® 86160,,Complement-4,$340.00,$6.71,$340.00,$21.39,$17.53,$16.33,$6.71,$17.53,$17.53,$17.73,$340.00,$12.60,$33.56,$269.28,$272.00,$17.40,$18.90,$12.00,$13.23,$12.00
30200086,EAP,CPT® 86160,,"Complement-c3,synvl",$340.00,$6.71,$340.00,$21.39,$17.53,$16.33,$6.71,$17.53,$17.53,$17.73,$340.00,$12.60,$33.56,$269.28,$272.00,$17.40,$18.90,$12.00,$13.23,$12.00
30200087,EAP,CPT® 86160,,"Complement-c4,synvl",$340.00,$6.71,$340.00,$21.39,$17.53,$16.33,$6.71,$17.53,$17.53,$17.73,$340.00,$12.60,$33.56,$269.28,$272.00,$17.40,$18.90,$12.00,$13.23,$12.00
30200088,EAP,CPT® 86162,,"Complement Tot,ch50",$229.00,$11.37,$229.00,$36.23,$29.67,$27.65,$11.37,$29.67,$29.67,$30.02,$229.00,$21.34,$56.78,$181.37,$183.20,$29.46,$31.99,$20.32,$22.39,$20.32
30200089,EAP,CPT® 86162,,"Complemnt Tot,ch100",$229.00,$11.37,$229.00,$36.23,$29.67,$27.65,$11.37,$29.67,$29.67,$30.02,$229.00,$21.34,$56.78,$181.37,$183.20,$29.46,$31.99,$20.32,$22.39,$20.32
30200090,EAP,CPT® 86171,,Fungal Serology,$157.00,$0.00,$157.00,$0.00,$10.21,$0.00,$0.00,$10.21,$10.21,$0.00,$157.00,$0.00,$19.54,$124.34,$125.60,$0.00,$0.00,$0.00,$0.00,$0.00
30200091,EAP,CPT® 86171,,Parasitic Serology,$157.00,$0.00,$157.00,$0.00,$10.21,$0.00,$0.00,$10.21,$10.21,$0.00,$157.00,$0.00,$19.54,$124.34,$125.60,$0.00,$0.00,$0.00,$0.00,$0.00
30200092,EAP,CPT® 86171,,Viral Serology,$157.00,$0.00,$157.00,$0.00,$10.21,$0.00,$0.00,$10.21,$10.21,$0.00,$157.00,$0.00,$19.54,$124.34,$125.60,$0.00,$0.00,$0.00,$0.00,$0.00
30200093,EAP,CPT® 86171,,Misc. Serology,$157.00,$0.00,$157.00,$0.00,$10.21,$0.00,$0.00,$10.21,$10.21,$0.00,$157.00,$0.00,$19.54,$124.34,$125.60,$0.00,$0.00,$0.00,$0.00,$0.00
30200094,EAP,CPT® 86215,,Strep Antid-nase B,$182.00,$7.41,$182.00,$23.62,$19.35,$18.03,$7.41,$19.35,$19.35,$19.57,$182.00,$13.91,$37.02,$144.14,$145.60,$19.21,$20.85,$13.25,$14.60,$13.25
30200095,EAP,CPT® 86225,,"Ds-dna Ab,crithidia",$303.00,$7.69,$303.00,$24.49,$20.06,$18.69,$7.69,$20.06,$20.06,$20.30,$303.00,$14.43,$38.40,$239.98,$242.40,$19.92,$21.63,$13.74,$15.14,$13.74
30200096,EAP,CPT® 86225,,"Ds-dna Ab,eia",$328.00,$7.69,$328.00,$24.49,$20.06,$18.69,$7.69,$20.06,$20.06,$20.30,$328.00,$14.43,$38.40,$259.78,$262.40,$19.92,$21.63,$13.74,$15.14,$13.74
30200097,EAP,CPT® 86235,,"Jo-1 Ab Screen, Eia",$332.00,$10.04,$332.00,$31.97,$26.18,$24.41,$10.04,$26.18,$26.18,$26.49,$332.00,$18.83,$50.12,$262.94,$265.60,$26.00,$28.23,$17.93,$19.76,$17.93
30200098,EAP,CPT® 86235,,"Scl-70 Ab Screen, Eia",$332.00,$10.04,$332.00,$31.97,$26.18,$24.41,$10.04,$26.18,$26.18,$26.49,$332.00,$18.83,$50.12,$262.94,$265.60,$26.00,$28.23,$17.93,$19.76,$17.93
30200099,EAP,CPT® 86235,,Anticentromere Scrn,$332.00,$10.04,$332.00,$31.97,$26.18,$24.41,$10.04,$26.18,$26.18,$26.49,$332.00,$18.83,$50.12,$262.94,$265.60,$26.00,$28.23,$17.93,$19.76,$17.93
30200100,EAP,CPT® 86235,,Smith (sm) Ab Screen,$314.00,$10.04,$314.00,$31.97,$26.18,$24.41,$10.04,$26.18,$26.18,$26.49,$314.00,$18.83,$50.12,$248.69,$251.20,$26.00,$28.23,$17.93,$19.76,$17.93
30200101,EAP,CPT® 86235,,Rnp Ab Screen,$314.00,$10.04,$314.00,$31.97,$26.18,$24.41,$10.04,$26.18,$26.18,$26.49,$314.00,$18.83,$50.12,$248.69,$251.20,$26.00,$28.23,$17.93,$19.76,$17.93
30200102,EAP,CPT® 86235,,Ssa (ro) Ab Screen,$314.00,$10.04,$314.00,$31.97,$26.18,$24.41,$10.04,$26.18,$26.18,$26.49,$314.00,$18.83,$50.12,$248.69,$251.20,$26.00,$28.23,$17.93,$19.76,$17.93
30200103,EAP,CPT® 86235,,Ssb (la) Ab Screen,$314.00,$10.04,$314.00,$31.97,$26.18,$24.41,$10.04,$26.18,$26.18,$26.49,$314.00,$18.83,$50.12,$248.69,$251.20,$26.00,$28.23,$17.93,$19.76,$17.93
30200104,EAP,CPT® 86255,,Perinuclear Ab,$63.00,$6.75,$63.00,$21.48,$17.60,$16.40,$6.75,$17.60,$17.60,$17.81,$63.00,$12.65,$33.68,$49.90,$50.40,$17.47,$18.97,$12.05,$13.28,$12.05
30200105,EAP,CPT® 86255,,Smooth Muscle Ab,$59.00,$6.75,$59.00,$21.48,$17.60,$16.40,$6.75,$17.60,$17.60,$17.81,$59.00,$12.65,$33.68,$46.73,$47.20,$17.47,$18.97,$12.05,$13.28,$12.05
30200106,EAP,CPT® 86255,,Parietal Cell Ab,$59.00,$6.75,$59.00,$21.48,$17.60,$16.40,$6.75,$17.60,$17.60,$17.81,$59.00,$12.65,$33.68,$46.73,$47.20,$17.47,$18.97,$12.05,$13.28,$12.05
30200107,EAP,CPT® 86256,,Adrenal Ab Screen,$88.00,$6.75,$88.00,$21.48,$17.60,$16.40,$6.75,$17.60,$17.60,$17.81,$88.00,$12.65,$33.68,$69.70,$70.40,$17.47,$18.97,$12.05,$13.28,$12.05
30200108,EAP,CPT® 86256,,Basement Mem Ab Scrn,$88.00,$6.75,$88.00,$21.48,$17.60,$16.40,$6.75,$17.60,$17.60,$17.81,$88.00,$12.65,$33.68,$69.70,$70.40,$17.47,$18.97,$12.05,$13.28,$12.05
30200109,EAP,CPT® 86256,,Rmsf Antibody Igg,$88.00,$6.75,$88.00,$21.48,$17.60,$16.40,$6.75,$17.60,$17.60,$17.81,$88.00,$12.65,$33.68,$69.70,$70.40,$17.47,$18.97,$12.05,$13.28,$12.05
30200110,EAP,CPT® 86256,,Rmsf Antibody Igm,$88.00,$6.75,$88.00,$21.48,$17.60,$16.40,$6.75,$17.60,$17.60,$17.81,$88.00,$12.65,$33.68,$69.70,$70.40,$17.47,$18.97,$12.05,$13.28,$12.05
30200111,EAP,CPT® 86300,,Cancer Antigen 15-3,$144.00,$11.65,$144.00,$37.10,$30.38,$28.32,$11.65,$30.38,$30.38,$30.73,$144.00,$21.85,$58.14,$114.05,$115.20,$30.17,$32.75,$20.81,$22.92,$20.81
30200112,EAP,CPT® 86300,,Cancer Ag 27-29,$144.00,$11.65,$144.00,$37.10,$30.38,$28.32,$11.65,$30.38,$30.38,$30.73,$144.00,$21.85,$58.14,$114.05,$115.20,$30.17,$32.75,$20.81,$22.92,$20.81
30200113,EAP,CPT® 86301,,Carbohydrate Ag 19-9,$208.00,$11.65,$208.00,$37.10,$30.38,$28.32,$11.65,$30.38,$30.38,$30.73,$208.00,$21.85,$58.14,$164.74,$166.40,$30.17,$32.75,$20.81,$22.92,$20.81
30200114,EAP,CPT® 86308,,Infect Mono Screen,$205.00,$2.90,$205.00,$9.23,$7.56,$7.04,$2.90,$7.56,$7.56,$7.64,$205.00,$5.44,$14.46,$162.36,$164.00,$7.51,$8.14,$5.18,$5.70,$5.18
30200115,EAP,CPT® 86316,,Cancer Antigen 125,$533.00,$11.65,$533.00,$37.10,$30.38,$28.32,$11.65,$30.38,$30.38,$30.73,$533.00,$21.85,$58.14,$422.14,$426.40,$30.17,$32.75,$20.81,$22.92,$20.81
30200116,EAP,CPT® 86317,,Diphtheria Ab,$225.00,$8.38,$225.00,$21.41,$17.52,$20.40,$8.38,$17.52,$17.52,$17.72,$225.00,$15.74,$33.54,$178.20,$180.00,$21.74,$18.89,$14.99,$13.22,$14.99
30200117,EAP,CPT® 86317,,Dnp Antibody,$225.00,$8.38,$225.00,$21.41,$17.52,$20.40,$8.38,$17.52,$17.52,$17.72,$225.00,$15.74,$33.54,$178.20,$180.00,$21.74,$18.89,$14.99,$13.22,$14.99
30200118,EAP,CPT® 86329,,Hypersens Pneumo Scr,$206.00,$7.85,$206.00,$25.03,$20.51,$19.11,$7.85,$20.51,$20.51,$20.75,$206.00,$14.75,$39.24,$163.15,$164.80,$20.37,$22.11,$14.05,$15.48,$14.05
30200119,EAP,CPT® 86332,,Immune Complex(c1q),$117.00,$13.64,$117.00,$43.46,$35.59,$33.17,$13.64,$35.59,$35.59,$36.00,$117.00,$25.59,$68.10,$92.66,$93.60,$35.34,$38.36,$24.37,$26.85,$24.37
30200120,EAP,CPT® 86334,,"Immunofixation,ser",$417.00,$12.50,$417.00,$39.83,$32.62,$30.41,$12.50,$32.62,$32.62,$33.00,$417.00,$23.46,$62.42,$330.26,$333.60,$32.39,$35.16,$22.34,$24.61,$22.34
30200121,EAP,CPT® 86335,,"Immunofixation,urine",$439.00,$16.41,$439.00,$52.33,$42.85,$39.94,$16.41,$42.85,$42.85,$43.34,$439.00,$30.82,$82.00,$347.69,$351.20,$42.56,$46.18,$29.35,$32.33,$29.35
30200122,EAP,CPT® 86336,,Inhibin-a,$77.00,$8.72,$77.00,$23.10,$18.90,$21.21,$8.72,$18.90,$18.90,$19.12,$77.00,$16.37,$36.18,$60.98,$61.60,$22.61,$20.37,$15.59,$14.26,$15.59
30200123,EAP,CPT® 86337,,Insulin Auto Ab,$237.00,$0.00,$237.00,$38.17,$31.27,$29.13,$0.00,$31.27,$31.27,$31.64,$237.00,$22.48,$59.84,$187.70,$189.60,$31.04,$0.00,$21.41,$23.60,$21.41
30200124,EAP,CPT® 86340,,Intrinsic Factor Ab,$228.00,$8.44,$228.00,$26.88,$22.01,$16.85,$8.44,$22.01,$22.01,$22.26,$228.00,$15.83,$42.12,$180.58,$182.40,$21.87,$23.72,$15.08,$16.60,$15.08
30200125,EAP,CPT® 86341,,Pancreatic Islet Ab,$80.00,$11.87,$80.00,$35.27,$28.89,$19.44,$11.87,$28.89,$28.89,$29.24,$80.00,$24.75,$55.30,$63.36,$64.00,$34.18,$31.16,$23.57,$21.81,$23.57
30200126,EAP,CPT® 86344,,Phagocytic Charge,$522.00,$0.00,$522.00,$0.00,$11.66,$0.00,$0.00,$11.66,$11.66,$0.00,$522.00,$0.00,$22.32,$413.42,$417.60,$0.00,$0.00,$0.00,$0.00,$0.00
30200127,EAP,CPT® 86359,,"Cd3, Total T%",$232.00,$21.10,$232.00,$42.00,$34.39,$22.53,$21.10,$34.39,$34.39,$34.80,$232.00,$39.62,$65.82,$183.74,$185.60,$54.71,$37.08,$37.73,$25.95,$37.73
30200128,EAP,CPT® 86360,,Lymph Subsets:cd4&cd8,$500.00,$26.28,$500.00,$83.77,$68.60,$45.07,$26.28,$68.60,$68.60,$69.42,$500.00,$49.33,$131.30,$396.00,$400.00,$68.12,$73.96,$46.98,$51.77,$46.98
30200129,EAP,CPT® 86376,,L-k Microsomal Ab,$298.00,$8.14,$298.00,$25.95,$21.25,$19.80,$8.14,$21.25,$21.25,$21.49,$298.00,$15.28,$40.66,$236.02,$238.40,$21.10,$22.90,$14.55,$16.03,$14.55
30200130,EAP,CPT® 86376,,Microsomal Ab,$315.00,$8.14,$315.00,$25.95,$21.25,$19.80,$8.14,$21.25,$21.25,$21.49,$315.00,$15.28,$40.66,$249.48,$252.00,$21.10,$22.90,$14.55,$16.03,$14.55
30200131,EAP,CPT® 86403,,Rapid Strep Test,$196.00,$5.81,$196.00,$18.17,$14.88,$13.87,$5.81,$14.88,$14.88,$11.75,$196.00,$12.12,$28.48,$155.23,$156.80,$16.73,$12.52,$11.54,$8.76,$11.54
30200132,EAP,CPT® 86403,,Crypto.antigen Scrn,$196.00,$5.81,$196.00,$18.17,$14.88,$13.87,$5.81,$14.88,$14.88,$11.75,$196.00,$12.12,$28.48,$155.23,$156.80,$16.73,$12.52,$11.54,$8.76,$11.54
30200133,EAP,CPT® 86403,,"Crypto.ag,csf-qual",$196.00,$5.81,$196.00,$18.17,$14.88,$13.87,$5.81,$14.88,$14.88,$11.75,$196.00,$12.12,$28.48,$155.23,$156.80,$16.73,$12.52,$11.54,$8.76,$11.54
30200134,EAP,CPT® 86403,,"H.flu Ag,urine",$196.00,$5.81,$196.00,$18.17,$14.88,$13.87,$5.81,$14.88,$14.88,$11.75,$196.00,$12.12,$28.48,$155.23,$156.80,$16.73,$12.52,$11.54,$8.76,$11.54
30200135,EAP,CPT® 86403,,"N.mening Ag,urine",$196.00,$5.81,$196.00,$18.17,$14.88,$13.87,$5.81,$14.88,$14.88,$11.75,$196.00,$12.12,$28.48,$155.23,$156.80,$16.73,$12.52,$11.54,$8.76,$11.54
30200136,EAP,CPT® 86403,,"St.pneumo Ag,urine",$196.00,$5.81,$196.00,$18.17,$14.88,$13.87,$5.81,$14.88,$14.88,$11.75,$196.00,$12.12,$28.48,$155.23,$156.80,$16.73,$12.52,$11.54,$8.76,$11.54
30200137,EAP,CPT® 86403,,"Strep-b Ag,urine",$196.00,$5.81,$196.00,$18.17,$14.88,$13.87,$5.81,$14.88,$14.88,$11.75,$196.00,$12.12,$28.48,$155.23,$156.80,$16.73,$12.52,$11.54,$8.76,$11.54
30200138,EAP,CPT® 86406,,"Crypto.ag,csf-quant",$237.00,$5.95,$237.00,$18.97,$15.53,$14.47,$5.95,$15.53,$15.53,$15.72,$237.00,$11.17,$29.74,$187.70,$189.60,$15.43,$16.75,$10.64,$11.72,$10.64
30200139,EAP,CPT® 86406,,"Crypto.ag,bld-quant",$237.00,$5.95,$237.00,$18.97,$15.53,$14.47,$5.95,$15.53,$15.53,$15.72,$237.00,$11.17,$29.74,$187.70,$189.60,$15.43,$16.75,$10.64,$11.72,$10.64
30200140,EAP,CPT® 86431,,"Rheumatoid Factor, Bld",$166.00,$3.18,$166.00,$10.10,$8.29,$7.72,$3.18,$8.29,$8.29,$8.39,$166.00,$5.95,$15.86,$131.47,$132.80,$8.22,$8.94,$5.67,$6.26,$5.67
30200141,EAP,CPT® 86431,,"Rheumatoid Factor, Syn Fld",$166.00,$3.18,$166.00,$10.10,$8.29,$7.72,$3.18,$8.29,$8.29,$8.39,$166.00,$5.95,$15.86,$131.47,$132.80,$8.22,$8.94,$5.67,$6.26,$5.67
30200145,EAP,CPT® 86357,,Natural Killer Cellls So,$86.00,$21.10,$86.00,$42.00,$34.39,$22.53,$21.10,$34.39,$34.39,$34.80,$86.00,$39.62,$65.82,$68.11,$68.80,$54.71,$37.08,$37.73,$25.95,$37.73
30200146,EAP,CPT® 86341,,Ia-2 Ab (so),$193.00,$11.87,$193.00,$35.27,$28.89,$19.44,$11.87,$28.89,$28.89,$29.24,$193.00,$24.75,$55.30,$152.86,$154.40,$34.18,$31.16,$23.57,$21.81,$23.57
30200147,EAP,CPT® 86355,,Lymph Subset B Cell Tot (so),$214.00,$21.10,$214.00,$42.00,$34.39,$22.53,$21.10,$34.39,$34.39,$34.80,$214.00,$39.62,$65.82,$169.49,$171.20,$54.71,$37.08,$37.73,$25.95,$37.73
30200148,EAP,CPT® 86357,,Lymph Subset Nk Cell Tot (so),$204.00,$21.10,$204.00,$42.00,$34.39,$22.53,$21.10,$34.39,$34.39,$34.80,$204.00,$39.62,$65.82,$161.57,$163.20,$54.71,$37.08,$37.73,$25.95,$37.73
30200149,EAP,CPT® 86580,,"PPD, TB SKIN",$90.00,$4.35,$90.00,$10.74,$7.19,$22.05,$4.35,$7.19,$7.19,$9.56,$90.00,$23.06,$20.46,$71.28,$72.00,$32.04,$10.18,$9.36,$7.13,$21.96
30200150,EAP,CPT® 86780,,Fta - Abs,$196.00,$7.41,$196.00,$23.60,$18.97,$18.02,$7.41,$18.97,$18.97,$34.32,$196.00,$13.90,$98.00,$155.23,$156.80,$19.20,$30.67,$13.24,$31.20,$13.24
30200157,EAP,CPT® 86592,,Rpr (qual),$139.00,$2.39,$139.00,$7.62,$6.23,$5.60,$2.39,$6.23,$6.23,$5.46,$139.00,$4.48,$11.92,$110.09,$111.20,$6.19,$5.82,$4.27,$4.07,$4.27
30200158,EAP,CPT® 86592,,"Rpr(qual),capillary",$139.00,$2.39,$139.00,$7.62,$6.23,$5.60,$2.39,$6.23,$6.23,$5.46,$139.00,$4.48,$11.92,$110.09,$111.20,$6.19,$5.82,$4.27,$4.07,$4.27
30200159,EAP,CPT® 86592,,"Vdrl,csf",$139.00,$2.39,$139.00,$7.62,$6.23,$5.60,$2.39,$6.23,$6.23,$5.46,$139.00,$4.48,$11.92,$110.09,$111.20,$6.19,$5.82,$4.27,$4.07,$4.27
30200160,EAP,CPT® 86593,,"Vdrl-csf,quant",$139.00,$2.46,$139.00,$7.84,$6.43,$5.99,$2.46,$6.43,$6.43,$24.34,$139.00,$4.62,$12.32,$110.09,$111.20,$6.38,$21.75,$4.40,$22.13,$4.40
30200161,EAP,CPT® 86593,,Rpr (quant),$139.00,$2.46,$139.00,$7.84,$6.43,$5.99,$2.46,$6.43,$6.43,$24.34,$139.00,$4.62,$12.32,$110.09,$111.20,$6.38,$21.75,$4.40,$22.13,$4.40
30200162,EAP,CPT® 86606,,Aspergillus Fumigatus,$47.00,$8.42,$47.00,$26.84,$21.98,$11.13,$8.42,$21.98,$21.98,$22.24,$47.00,$15.80,$42.06,$37.22,$37.60,$21.82,$23.70,$15.05,$16.59,$15.05
30200163,EAP,CPT® 86611,,B.henselae Igg,$79.00,$5.69,$79.00,$18.15,$14.85,$11.13,$5.69,$14.85,$14.85,$15.04,$79.00,$10.69,$28.44,$62.57,$63.20,$14.76,$16.02,$10.18,$11.21,$10.18
30200164,EAP,CPT® 86611,,B.henselae Igm,$79.00,$5.69,$79.00,$18.15,$14.85,$11.13,$5.69,$14.85,$14.85,$15.04,$79.00,$10.69,$28.44,$62.57,$63.20,$14.76,$16.02,$10.18,$11.21,$10.18
30200165,EAP,CPT® 86611,,B.quintana Igg,$79.00,$5.69,$79.00,$18.15,$14.85,$11.13,$5.69,$14.85,$14.85,$15.04,$79.00,$10.69,$28.44,$62.57,$63.20,$14.76,$16.02,$10.18,$11.21,$10.18
30200166,EAP,CPT® 86611,,B.quintana Igm,$79.00,$5.69,$79.00,$18.15,$14.85,$11.13,$5.69,$14.85,$14.85,$15.04,$79.00,$10.69,$28.44,$62.57,$63.20,$14.76,$16.02,$10.18,$11.21,$10.18
30200167,EAP,CPT® 86617,,Lyme Ab Westernblot,$103.00,$0.00,$103.00,$0.00,$22.61,$0.00,$0.00,$22.61,$22.61,$0.00,$103.00,$0.00,$43.28,$81.58,$82.40,$0.00,$0.00,$0.00,$0.00,$0.00
30200168,EAP,CPT® 86618,,Lyme Ab Total,$361.00,$9.52,$361.00,$30.37,$24.87,$11.13,$9.52,$24.87,$24.87,$25.16,$361.00,$17.88,$47.60,$285.91,$288.80,$24.69,$26.81,$17.03,$18.76,$17.03
30200169,EAP,CPT® 86618,,Lyme Ab-igm,$361.00,$9.52,$361.00,$30.37,$24.87,$11.13,$9.52,$24.87,$24.87,$25.16,$361.00,$17.88,$47.60,$285.91,$288.80,$24.69,$26.81,$17.03,$18.76,$17.03
30200170,EAP,CPT® 86622,,B. Abortus Igg,$132.00,$4.99,$132.00,$15.91,$13.05,$11.13,$4.99,$13.05,$13.05,$13.19,$132.00,$9.38,$24.96,$104.54,$105.60,$12.95,$14.05,$8.93,$9.84,$8.93
30200171,EAP,CPT® 86622,,B. Abortus Igm,$132.00,$4.99,$132.00,$15.91,$13.05,$11.13,$4.99,$13.05,$13.05,$13.19,$132.00,$9.38,$24.96,$104.54,$105.60,$12.95,$14.05,$8.93,$9.84,$8.93
30200172,EAP,CPT® 86631,,Chlam Pnuemo Igg,$123.00,$0.00,$123.00,$0.00,$17.27,$0.00,$6.61,$17.27,$17.27,$17.47,$123.00,$0.00,$33.04,$97.42,$98.40,$0.00,$18.62,$0.00,$0.00,$0.00
30200173,EAP,CPT® 86631,,Chlam Pnuemo Iga,$123.00,$0.00,$123.00,$0.00,$17.27,$0.00,$6.61,$17.27,$17.27,$17.47,$123.00,$0.00,$33.04,$97.42,$98.40,$0.00,$18.62,$0.00,$0.00,$0.00
30200174,EAP,CPT® 86631,,Chlam Trach Igg,$123.00,$0.00,$123.00,$0.00,$17.27,$0.00,$6.61,$17.27,$17.27,$17.47,$123.00,$0.00,$33.04,$97.42,$98.40,$0.00,$18.62,$0.00,$0.00,$0.00
30200175,EAP,CPT® 86631,,Chlam Trach Iga,$123.00,$0.00,$123.00,$0.00,$17.27,$0.00,$6.61,$17.27,$17.27,$17.47,$123.00,$0.00,$33.04,$97.42,$98.40,$0.00,$18.62,$0.00,$0.00,$0.00
30200176,EAP,CPT® 86631,,Chlam Psittaci Icg,$123.00,$0.00,$123.00,$0.00,$17.27,$0.00,$6.61,$17.27,$17.27,$17.47,$123.00,$0.00,$33.04,$97.42,$98.40,$0.00,$18.62,$0.00,$0.00,$0.00
30200177,EAP,CPT® 86631,,Chlam Psittaci Iga,$123.00,$0.00,$123.00,$0.00,$17.27,$0.00,$6.61,$17.27,$17.27,$17.47,$123.00,$0.00,$33.04,$97.42,$98.40,$0.00,$18.62,$0.00,$0.00,$0.00
30200178,EAP,CPT® 86632,,Chlam Pnuemo Igm,$130.00,$0.00,$130.00,$0.00,$18.53,$0.00,$0.00,$18.53,$18.53,$0.00,$130.00,$0.00,$35.48,$102.96,$104.00,$0.00,$0.00,$0.00,$0.00,$0.00
30200179,EAP,CPT® 86632,,Chlam Trach Igm,$130.00,$0.00,$130.00,$0.00,$18.53,$0.00,$0.00,$18.53,$18.53,$0.00,$130.00,$0.00,$35.48,$102.96,$104.00,$0.00,$0.00,$0.00,$0.00,$0.00
30200180,EAP,CPT® 86638,,"Q Fever Igg, Acute",$253.00,$0.00,$253.00,$0.00,$17.70,$0.00,$0.00,$17.70,$17.70,$0.00,$253.00,$0.00,$33.88,$200.38,$202.40,$0.00,$0.00,$0.00,$0.00,$0.00
30200181,EAP,CPT® 86638,,"Q Fever Igg, Conval.",$253.00,$0.00,$253.00,$0.00,$17.70,$0.00,$0.00,$17.70,$17.70,$0.00,$253.00,$0.00,$33.88,$200.38,$202.40,$0.00,$0.00,$0.00,$0.00,$0.00
30200182,EAP,CPT® 86644,,Cmv Igg,$190.00,$8.06,$190.00,$20.75,$16.99,$19.58,$8.06,$16.99,$16.99,$17.19,$190.00,$15.11,$32.52,$150.48,$152.00,$20.87,$18.31,$14.39,$12.82,$14.39
30200183,EAP,CPT® 86644,,Cmv Igg Ab-eia,$202.00,$8.06,$202.00,$20.75,$16.99,$19.58,$8.06,$16.99,$16.99,$17.19,$202.00,$15.11,$32.52,$159.98,$161.60,$20.87,$18.31,$14.39,$12.82,$14.39
30200184,EAP,CPT® 86645,,Cmv Igm,$128.00,$9.42,$128.00,$30.03,$24.60,$11.13,$9.42,$24.60,$24.60,$24.90,$128.00,$17.69,$47.08,$101.38,$102.40,$24.43,$26.53,$16.85,$18.57,$16.85
30200185,EAP,CPT® 86645,,Cmv Igm Ab-eia,$138.00,$9.42,$138.00,$30.03,$24.60,$11.13,$9.42,$24.60,$24.60,$24.90,$138.00,$17.69,$47.08,$109.30,$110.40,$24.43,$26.53,$16.85,$18.57,$16.85
30200186,EAP,CPT® 86651,,"Encep, California, Csf, Igg",$125.00,$0.00,$125.00,$0.00,$19.25,$0.00,$0.00,$19.25,$19.25,$0.00,$125.00,$0.00,$36.86,$99.00,$100.00,$0.00,$0.00,$0.00,$0.00,$0.00
30200187,EAP,CPT® 86651,,"Encep, California, Csf, Igm",$125.00,$0.00,$125.00,$0.00,$19.25,$0.00,$0.00,$19.25,$19.25,$0.00,$125.00,$0.00,$36.86,$99.00,$100.00,$0.00,$0.00,$0.00,$0.00,$0.00
30200188,EAP,CPT® 86651,,Calfornia Equine Igm,$118.00,$0.00,$118.00,$0.00,$19.25,$0.00,$0.00,$19.25,$19.25,$0.00,$118.00,$0.00,$36.86,$93.46,$94.40,$0.00,$0.00,$0.00,$0.00,$0.00
30200189,EAP,CPT® 86651,,Calif. Equine Encephalitis,$118.00,$0.00,$118.00,$0.00,$19.25,$0.00,$0.00,$19.25,$19.25,$0.00,$118.00,$0.00,$36.86,$93.46,$94.40,$0.00,$0.00,$0.00,$0.00,$0.00
30200190,EAP,CPT® 86652,,"Encep, E. Equine, Csf,igg",$125.00,$0.00,$125.00,$0.00,$19.25,$0.00,$0.00,$19.25,$19.25,$0.00,$125.00,$0.00,$36.86,$99.00,$100.00,$0.00,$0.00,$0.00,$0.00,$0.00
30200191,EAP,CPT® 86652,,"Encep, E. Equine, Csf,igm",$125.00,$0.00,$125.00,$0.00,$19.25,$0.00,$0.00,$19.25,$19.25,$0.00,$125.00,$0.00,$36.86,$99.00,$100.00,$0.00,$0.00,$0.00,$0.00,$0.00
30200192,EAP,CPT® 86652,,Eastern Equine Igm,$118.00,$0.00,$118.00,$0.00,$19.25,$0.00,$0.00,$19.25,$19.25,$0.00,$118.00,$0.00,$36.86,$93.46,$94.40,$0.00,$0.00,$0.00,$0.00,$0.00
30200193,EAP,CPT® 86652,,Eastern Equine Encephalitis,$118.00,$0.00,$118.00,$0.00,$19.25,$0.00,$0.00,$19.25,$19.25,$0.00,$118.00,$0.00,$36.86,$93.46,$94.40,$0.00,$0.00,$0.00,$0.00,$0.00
30200194,EAP,CPT® 86653,,"Encep,st. Louis, Csf Igg",$125.00,$0.00,$125.00,$0.00,$19.25,$0.00,$0.00,$19.25,$19.25,$0.00,$125.00,$0.00,$36.86,$99.00,$100.00,$0.00,$0.00,$0.00,$0.00,$0.00
30200195,EAP,CPT® 86653,,"Encep,st. Louis, Csf Igm",$125.00,$0.00,$125.00,$0.00,$19.25,$0.00,$0.00,$19.25,$19.25,$0.00,$125.00,$0.00,$36.86,$99.00,$100.00,$0.00,$0.00,$0.00,$0.00,$0.00
30200196,EAP,CPT® 86653,,St. Louis Equine Igm,$118.00,$0.00,$118.00,$0.00,$19.25,$0.00,$0.00,$19.25,$19.25,$0.00,$118.00,$0.00,$36.86,$93.46,$94.40,$0.00,$0.00,$0.00,$0.00,$0.00
30200197,EAP,CPT® 86653,,St. Louis Equine Encephalitis,$118.00,$0.00,$118.00,$0.00,$19.25,$0.00,$0.00,$19.25,$19.25,$0.00,$118.00,$0.00,$36.86,$93.46,$94.40,$0.00,$0.00,$0.00,$0.00,$0.00
30200198,EAP,CPT® 86654,,"Encep, W. Equine, Csf,igg",$125.00,$0.00,$125.00,$0.00,$19.25,$0.00,$0.00,$19.25,$19.25,$0.00,$125.00,$0.00,$36.86,$99.00,$100.00,$0.00,$0.00,$0.00,$0.00,$0.00
30200199,EAP,CPT® 86654,,"Encep, W. Equine, Csf,igm",$125.00,$0.00,$125.00,$0.00,$19.25,$0.00,$0.00,$19.25,$19.25,$0.00,$125.00,$0.00,$36.86,$99.00,$100.00,$0.00,$0.00,$0.00,$0.00,$0.00
30200200,EAP,CPT® 86654,,Western Equine Igm,$118.00,$0.00,$118.00,$0.00,$19.25,$0.00,$0.00,$19.25,$19.25,$0.00,$118.00,$0.00,$36.86,$93.46,$94.40,$0.00,$0.00,$0.00,$0.00,$0.00
30200201,EAP,CPT® 86654,,Western Equine Encephalitis,$118.00,$0.00,$118.00,$0.00,$19.25,$0.00,$0.00,$19.25,$19.25,$0.00,$118.00,$0.00,$36.86,$93.46,$94.40,$0.00,$0.00,$0.00,$0.00,$0.00
30200202,EAP,CPT® 86658,,Coxsackie B1 Titer,$113.00,$7.28,$113.00,$23.23,$19.03,$11.13,$7.28,$19.03,$19.03,$19.25,$113.00,$13.68,$36.40,$89.50,$90.40,$18.89,$20.51,$13.03,$14.36,$13.03
30200203,EAP,CPT® 86658,,Coxsackie B2 Titer,$113.00,$7.28,$113.00,$23.23,$19.03,$11.13,$7.28,$19.03,$19.03,$19.25,$113.00,$13.68,$36.40,$89.50,$90.40,$18.89,$20.51,$13.03,$14.36,$13.03
30200204,EAP,CPT® 86658,,Coxsackie B3 Titer,$113.00,$7.28,$113.00,$23.23,$19.03,$11.13,$7.28,$19.03,$19.03,$19.25,$113.00,$13.68,$36.40,$89.50,$90.40,$18.89,$20.51,$13.03,$14.36,$13.03
30200205,EAP,CPT® 86658,,Coxsackie B4 Titer,$113.00,$7.28,$113.00,$23.23,$19.03,$11.13,$7.28,$19.03,$19.03,$19.25,$113.00,$13.68,$36.40,$89.50,$90.40,$18.89,$20.51,$13.03,$14.36,$13.03
30200206,EAP,CPT® 86658,,Coxsackie B5 Titer,$113.00,$7.28,$113.00,$23.23,$19.03,$11.13,$7.28,$19.03,$19.03,$19.25,$113.00,$13.68,$36.40,$89.50,$90.40,$18.89,$20.51,$13.03,$14.36,$13.03
30200207,EAP,CPT® 86658,,Coxsackie B6 Titer,$113.00,$7.28,$113.00,$23.23,$19.03,$11.13,$7.28,$19.03,$19.03,$19.25,$113.00,$13.68,$36.40,$89.50,$90.40,$18.89,$20.51,$13.03,$14.36,$13.03
30200208,EAP,CPT® 86658,,Echovirus 4 Titer,$113.00,$7.28,$113.00,$23.23,$19.03,$11.13,$7.28,$19.03,$19.03,$19.25,$113.00,$13.68,$36.40,$89.50,$90.40,$18.89,$20.51,$13.03,$14.36,$13.03
30200209,EAP,CPT® 86658,,Echovirus 9 Titer,$113.00,$7.28,$113.00,$23.23,$19.03,$11.13,$7.28,$19.03,$19.03,$19.25,$113.00,$13.68,$36.40,$89.50,$90.40,$18.89,$20.51,$13.03,$14.36,$13.03
30200210,EAP,CPT® 86658,,Echovirus 11 Titer,$113.00,$7.28,$113.00,$23.23,$19.03,$11.13,$7.28,$19.03,$19.03,$19.25,$113.00,$13.68,$36.40,$89.50,$90.40,$18.89,$20.51,$13.03,$14.36,$13.03
30200211,EAP,CPT® 86658,,Coxsackie A2 Titer,$113.00,$7.28,$113.00,$23.23,$19.03,$11.13,$7.28,$19.03,$19.03,$19.25,$113.00,$13.68,$36.40,$89.50,$90.40,$18.89,$20.51,$13.03,$14.36,$13.03
30200212,EAP,CPT® 86658,,Coxsackie A4 Titer,$113.00,$7.28,$113.00,$23.23,$19.03,$11.13,$7.28,$19.03,$19.03,$19.25,$113.00,$13.68,$36.40,$89.50,$90.40,$18.89,$20.51,$13.03,$14.36,$13.03
30200213,EAP,CPT® 86658,,Coxsackie A10 Titer,$113.00,$7.28,$113.00,$23.23,$19.03,$11.13,$7.28,$19.03,$19.03,$19.25,$113.00,$13.68,$36.40,$89.50,$90.40,$18.89,$20.51,$13.03,$14.36,$13.03
30200214,EAP,CPT® 86658,,Coxsackie A16 Titer,$113.00,$7.28,$113.00,$23.23,$19.03,$11.13,$7.28,$19.03,$19.03,$19.25,$113.00,$13.68,$36.40,$89.50,$90.40,$18.89,$20.51,$13.03,$14.36,$13.03
30200215,EAP,CPT® 86664,,Ebv Nuclear Ab,$206.00,$8.56,$206.00,$27.27,$22.34,$11.13,$8.56,$22.34,$22.34,$22.61,$206.00,$16.05,$42.76,$163.15,$164.80,$22.17,$24.09,$15.29,$16.86,$15.29
30200216,EAP,CPT® 86665,,Ebv Capsid Igg Ab,$231.00,$10.15,$231.00,$32.35,$26.48,$11.13,$10.15,$26.48,$26.48,$26.81,$231.00,$19.05,$50.70,$182.95,$184.80,$26.30,$28.56,$18.14,$19.99,$18.14
30200217,EAP,CPT® 86665,,Ebv Capsid Igm Ab,$231.00,$10.15,$231.00,$32.35,$26.48,$11.13,$10.15,$26.48,$26.48,$26.81,$231.00,$19.05,$50.70,$182.95,$184.80,$26.30,$28.56,$18.14,$19.99,$18.14
30200218,EAP,CPT® 86666,,Ehrlichia Igg,$157.00,$0.00,$157.00,$0.00,$14.85,$0.00,$0.00,$14.85,$14.85,$0.00,$157.00,$0.00,$28.44,$124.34,$125.60,$0.00,$0.00,$0.00,$0.00,$0.00
30200219,EAP,CPT® 86666,,Ehrlichia Igm,$157.00,$0.00,$157.00,$0.00,$14.85,$0.00,$0.00,$14.85,$14.85,$0.00,$157.00,$0.00,$28.44,$124.34,$125.60,$0.00,$0.00,$0.00,$0.00,$0.00
30200220,EAP,CPT® 86668,,Tularemia Antibody,$72.00,$0.00,$72.00,$0.00,$15.18,$0.00,$0.00,$15.18,$15.18,$0.00,$72.00,$0.00,$29.06,$57.02,$57.60,$0.00,$0.00,$0.00,$0.00,$0.00
30200221,EAP,CPT® 86671,,S.cerevisiae Igg,$139.00,$6.86,$139.00,$21.84,$17.90,$11.13,$6.86,$17.90,$17.90,$18.11,$139.00,$12.86,$34.26,$110.09,$111.20,$17.76,$19.30,$12.25,$13.51,$12.25
30200222,EAP,CPT® 86671,,S.cerevisiae Iga,$139.00,$6.86,$139.00,$21.84,$17.90,$11.13,$6.86,$17.90,$17.90,$18.11,$139.00,$12.86,$34.26,$110.09,$111.20,$17.76,$19.30,$12.25,$13.51,$12.25
30200223,EAP,CPT® 86671,,Sporothrix Igg,$139.00,$6.86,$139.00,$21.84,$17.90,$11.13,$6.86,$17.90,$17.90,$18.11,$139.00,$12.86,$34.26,$110.09,$111.20,$17.76,$19.30,$12.25,$13.51,$12.25
30200224,EAP,CPT® 86671,,Sporothrix Igm,$139.00,$6.86,$139.00,$21.84,$17.90,$11.13,$6.86,$17.90,$17.90,$18.11,$139.00,$12.86,$34.26,$110.09,$111.20,$17.76,$19.30,$12.25,$13.51,$12.25
30200225,EAP,CPT® 86671,,Sporothrix Iga,$139.00,$6.86,$139.00,$21.84,$17.90,$11.13,$6.86,$17.90,$17.90,$18.11,$139.00,$12.86,$34.26,$110.09,$111.20,$17.76,$19.30,$12.25,$13.51,$12.25
30200226,EAP,CPT® 86677,,H. Pylori Igg,$207.00,$8.48,$207.00,$25.86,$21.19,$11.13,$8.48,$21.19,$21.19,$21.44,$207.00,$17.69,$40.56,$163.94,$165.60,$24.43,$22.85,$16.85,$15.99,$16.85
30200227,EAP,CPT® 86677,,H.pylori Iga,$207.00,$8.48,$207.00,$25.86,$21.19,$11.13,$8.48,$21.19,$21.19,$21.44,$207.00,$17.69,$40.56,$163.94,$165.60,$24.43,$22.85,$16.85,$15.99,$16.85
30200228,EAP,CPT® 86677,,H.pylori Igg Ab-eia,$222.00,$8.48,$222.00,$25.86,$21.19,$11.13,$8.48,$21.19,$21.19,$21.44,$222.00,$17.69,$40.56,$175.82,$177.60,$24.43,$22.85,$16.85,$15.99,$16.85
30200229,EAP,CPT® 86682,,Cysticercus Igg,$128.00,$7.27,$128.00,$23.19,$18.99,$11.13,$7.27,$18.99,$18.99,$19.20,$128.00,$13.66,$36.34,$101.38,$102.40,$18.86,$20.46,$13.01,$14.32,$13.01
30200230,EAP,CPT® 86682,,Echinococcus Igg,$128.00,$7.27,$128.00,$23.19,$18.99,$11.13,$7.27,$18.99,$18.99,$19.20,$128.00,$13.66,$36.34,$101.38,$102.40,$18.86,$20.46,$13.01,$14.32,$13.01
30200231,EAP,CPT® 86682,,Filaria Ab,$128.00,$7.27,$128.00,$23.19,$18.99,$11.13,$7.27,$18.99,$18.99,$19.20,$128.00,$13.66,$36.34,$101.38,$102.40,$18.86,$20.46,$13.01,$14.32,$13.01
30200232,EAP,CPT® 86682,,Strongyloides Igg,$128.00,$7.27,$128.00,$23.19,$18.99,$11.13,$7.27,$18.99,$18.99,$19.20,$128.00,$13.66,$36.34,$101.38,$102.40,$18.86,$20.46,$13.01,$14.32,$13.01
30200233,EAP,CPT® 86682,,Schistosoma Igg,$128.00,$7.27,$128.00,$23.19,$18.99,$11.13,$7.27,$18.99,$18.99,$19.20,$128.00,$13.66,$36.34,$101.38,$102.40,$18.86,$20.46,$13.01,$14.32,$13.01
30200235,EAP,CPT® 86689,,Hiv-ab Western Blot,$401.00,$0.00,$401.00,$0.00,$28.26,$0.00,$0.00,$28.26,$28.26,$0.00,$401.00,$0.00,$54.10,$317.59,$320.80,$0.00,$0.00,$0.00,$0.00,$0.00
30200236,EAP,CPT® 86692,,Hepatitis Delta Ab,$198.00,$9.60,$198.00,$30.60,$25.06,$10.47,$9.60,$25.06,$25.06,$25.35,$198.00,$18.02,$47.96,$156.82,$158.40,$24.88,$27.01,$17.16,$18.91,$17.16
30200237,EAP,CPT® 86694,,Hsv 1/2 Igm,$180.00,$8.06,$180.00,$20.75,$16.99,$19.58,$8.06,$16.99,$16.99,$17.19,$180.00,$15.11,$32.52,$142.56,$144.00,$20.87,$18.31,$14.39,$12.82,$14.39
30200238,EAP,CPT® 86694,,Hsv Igm Ab Titer,$193.00,$8.06,$193.00,$20.75,$16.99,$19.58,$8.06,$16.99,$16.99,$17.19,$193.00,$15.11,$32.52,$152.86,$154.40,$20.87,$18.31,$14.39,$12.82,$14.39
30200239,EAP,CPT® 86694,,"Hsv2 Igg/igm Ab,csf",$180.00,$8.06,$180.00,$20.75,$16.99,$19.58,$8.06,$16.99,$16.99,$17.19,$180.00,$15.11,$32.52,$142.56,$144.00,$20.87,$18.31,$14.39,$12.82,$14.39
30200240,EAP,CPT® 86694,,"Hsv-2 Igm Ab,csf",$180.00,$8.06,$180.00,$20.75,$16.99,$19.58,$8.06,$16.99,$16.99,$17.19,$180.00,$15.11,$32.52,$142.56,$144.00,$20.87,$18.31,$14.39,$12.82,$14.39
30200241,EAP,CPT® 86694,,Hsv Igg,$180.00,$8.06,$180.00,$20.75,$16.99,$19.58,$8.06,$16.99,$16.99,$17.19,$180.00,$15.11,$32.52,$142.56,$144.00,$20.87,$18.31,$14.39,$12.82,$14.39
30200244,EAP,CPT® 86695,,HSV-I IGG,$129.00,$7.37,$129.00,$23.51,$19.25,$11.13,$7.37,$19.25,$19.25,$19.49,$129.00,$13.85,$36.86,$102.17,$103.20,$19.13,$20.76,$13.19,$14.54,$13.19
30200245,EAP,CPT® 86696,,HSV - II IGG,$141.00,$10.83,$141.00,$34.50,$28.26,$26.34,$10.83,$28.26,$28.26,$28.60,$141.00,$20.32,$54.10,$111.67,$112.80,$28.06,$30.48,$19.35,$21.33,$19.35
30200246,EAP,CPT® 86698,,Histoplasma Ab (s),$75.00,$6.99,$75.00,$22.28,$18.25,$11.13,$6.99,$18.25,$18.25,$18.46,$75.00,$14.48,$34.92,$59.40,$60.00,$20.00,$19.67,$13.79,$13.77,$13.79
30200247,EAP,CPT® 86703,,Hiv-1/2,$267.00,$7.66,$267.00,$24.44,$20.02,$14.37,$7.66,$20.02,$20.02,$17.58,$267.00,$14.40,$38.34,$211.46,$213.60,$19.88,$18.73,$13.71,$13.11,$13.71
30200248,EAP,CPT® 86704,,Hbv Core Ab,$287.00,$6.75,$287.00,$21.48,$17.60,$16.40,$6.75,$17.60,$17.60,$17.81,$287.00,$12.65,$33.68,$227.30,$229.60,$17.47,$18.97,$12.05,$13.28,$12.05
30200249,EAP,CPT® 86705,,Hepatitis-b Core M,$287.00,$6.59,$287.00,$21.00,$17.18,$16.03,$6.59,$17.18,$17.18,$17.39,$287.00,$12.36,$32.88,$227.30,$229.60,$17.07,$18.53,$11.77,$12.97,$11.77
30200250,EAP,CPT® 86706,,Hbv Surface Ab,$259.00,$6.01,$259.00,$19.15,$15.68,$11.33,$6.01,$15.68,$15.68,$15.87,$259.00,$11.28,$30.02,$205.13,$207.20,$15.57,$16.91,$10.74,$11.83,$10.74
30200251,EAP,CPT® 86707,,Hbv E Ab,$135.00,$6.47,$135.00,$20.63,$16.89,$15.75,$6.47,$16.89,$16.89,$17.08,$135.00,$12.15,$32.32,$106.92,$108.00,$16.78,$18.20,$11.57,$12.74,$11.57
30200252,EAP,CPT® 86708,,"Hav Ab, Total",$304.00,$0.00,$304.00,$0.00,$18.09,$0.00,$0.00,$18.09,$18.09,$0.00,$304.00,$0.00,$34.62,$240.77,$243.20,$0.00,$0.00,$0.00,$0.00,$0.00
30200253,EAP,CPT® 86709,,Hav Igm Ab,$277.00,$6.30,$277.00,$20.06,$16.44,$15.32,$6.30,$16.44,$16.44,$16.63,$277.00,$11.82,$31.46,$219.38,$221.60,$16.33,$17.72,$11.26,$12.41,$11.26
30200254,EAP,CPT® 86713,,L. Pneumoph. Ab - Total,$147.00,$0.00,$147.00,$0.00,$22.35,$0.00,$0.00,$22.35,$22.35,$0.00,$147.00,$0.00,$42.78,$116.42,$117.60,$0.00,$0.00,$0.00,$0.00,$0.00
30200255,EAP,CPT® 86720,,Leptospirosis Ab,$80.00,$0.00,$80.00,$23.51,$19.25,$11.13,$0.00,$19.25,$19.25,$0.00,$80.00,$17.01,$36.86,$63.36,$64.00,$23.49,$0.00,$16.20,$14.54,$16.20
30200256,EAP,CPT® 86631,,Lgv Antibody Screen,$193.00,$0.00,$193.00,$0.00,$17.27,$0.00,$6.61,$17.27,$17.27,$17.47,$193.00,$0.00,$33.04,$152.86,$154.40,$0.00,$18.62,$0.00,$0.00,$0.00
30200257,EAP,CPT® 86738,,Mycoplasma Igg,$96.00,$7.41,$96.00,$23.60,$19.34,$11.13,$7.41,$19.34,$19.34,$19.57,$96.00,$13.90,$37.02,$76.03,$76.80,$19.20,$20.85,$13.24,$14.60,$13.24
30200258,EAP,CPT® 86738,,Mycoplasma Igm,$96.00,$7.41,$96.00,$23.60,$19.34,$11.13,$7.41,$19.34,$19.34,$19.57,$96.00,$13.90,$37.02,$76.03,$76.80,$19.20,$20.85,$13.24,$14.60,$13.24
30200259,EAP,CPT® 86747,,Parvovirus Igg,$125.00,$0.00,$125.00,$26.79,$21.95,$11.13,$0.00,$21.95,$21.95,$22.21,$125.00,$15.78,$42.00,$99.00,$100.00,$21.79,$0.00,$15.03,$16.56,$15.03
30200260,EAP,CPT® 86747,,Parvovirus Igm,$125.00,$0.00,$125.00,$26.79,$21.95,$11.13,$0.00,$21.95,$21.95,$22.21,$125.00,$15.78,$42.00,$99.00,$100.00,$21.79,$0.00,$15.03,$16.56,$15.03
30200261,EAP,CPT® 86753,,Ent. Histolytica Ab,$97.00,$0.00,$97.00,$0.00,$18.09,$0.00,$0.00,$18.09,$18.09,$0.00,$97.00,$0.00,$34.64,$76.82,$77.60,$0.00,$0.00,$0.00,$0.00,$0.00
30200262,EAP,CPT® 86762,,Rubella Immune Scrn,$232.00,$8.06,$232.00,$20.75,$16.99,$19.58,$8.06,$16.99,$16.99,$17.19,$232.00,$15.11,$32.52,$183.74,$185.60,$20.87,$18.31,$14.39,$12.82,$14.39
30200263,EAP,CPT® 86762,,Rubella Igg,$218.00,$8.06,$218.00,$20.75,$16.99,$19.58,$8.06,$16.99,$16.99,$17.19,$218.00,$15.11,$32.52,$172.66,$174.40,$20.87,$18.31,$14.39,$12.82,$14.39
30200264,EAP,CPT® 86762,,Rubella Igm,$218.00,$8.06,$218.00,$20.75,$16.99,$19.58,$8.06,$16.99,$16.99,$17.19,$218.00,$15.11,$32.52,$172.66,$174.40,$20.87,$18.31,$14.39,$12.82,$14.39
30200265,EAP,CPT® 86765,,Rubeola (measles) Igm,$131.00,$7.21,$131.00,$22.96,$18.81,$11.13,$7.21,$18.81,$18.81,$19.03,$131.00,$13.52,$36.00,$103.75,$104.80,$18.68,$20.27,$12.88,$14.19,$12.88
30200266,EAP,CPT® 86765,,Rubeola (measles) Igg,$131.00,$7.21,$131.00,$22.96,$18.81,$11.13,$7.21,$18.81,$18.81,$19.03,$131.00,$13.52,$36.00,$103.75,$104.80,$18.68,$20.27,$12.88,$14.19,$12.88
30200267,EAP,CPT® 86777,,Toxoplasma Igg,$251.00,$8.06,$251.00,$20.75,$16.99,$19.58,$8.06,$16.99,$16.99,$17.19,$251.00,$15.11,$32.52,$198.79,$200.80,$20.87,$18.31,$14.39,$12.82,$14.39
30200268,EAP,CPT® 86777,,"Toxo Ab-igg,csf",$251.00,$8.06,$251.00,$20.75,$16.99,$19.58,$8.06,$16.99,$16.99,$17.19,$251.00,$15.11,$32.52,$198.79,$200.80,$20.87,$18.31,$14.39,$12.82,$14.39
30200269,EAP,CPT® 86777,,Toxo Igg Ab-eia,$270.00,$8.06,$270.00,$20.75,$16.99,$19.58,$8.06,$16.99,$16.99,$17.19,$270.00,$15.11,$32.52,$213.84,$216.00,$20.87,$18.31,$14.39,$12.82,$14.39
30200270,EAP,CPT® 86778,,Toxoplasma Igm,$134.00,$8.06,$134.00,$25.67,$21.03,$11.13,$8.06,$21.03,$21.03,$21.27,$134.00,$15.13,$40.24,$106.13,$107.20,$20.89,$22.67,$14.41,$15.87,$14.41
30200271,EAP,CPT® 86778,,"Toxo Ab-igm,csf",$134.00,$8.06,$134.00,$25.67,$21.03,$11.13,$8.06,$21.03,$21.03,$21.27,$134.00,$15.13,$40.24,$106.13,$107.20,$20.89,$22.67,$14.41,$15.87,$14.41
30200272,EAP,CPT® 86780,,"Treponemal Igg, Csf",$196.00,$7.41,$196.00,$23.60,$18.97,$18.02,$7.41,$18.97,$18.97,$34.32,$196.00,$13.90,$98.00,$155.23,$156.80,$19.20,$30.67,$13.24,$31.20,$13.24
30200273,EAP,CPT® 86780,,Treponemal-igg-eia,$196.00,$7.41,$196.00,$23.60,$18.97,$18.02,$7.41,$18.97,$18.97,$34.32,$196.00,$13.90,$98.00,$155.23,$156.80,$19.20,$30.67,$13.24,$31.20,$13.24
30200274,EAP,CPT® 86780,,Treponemal -igm-eia,$181.00,$7.41,$181.00,$23.60,$18.97,$18.02,$7.41,$18.97,$18.97,$31.69,$181.00,$13.90,$90.50,$143.35,$144.80,$19.20,$28.33,$13.24,$28.82,$13.24
30200275,EAP,CPT® 86787,,Varicella Zoster Igm,$239.00,$7.21,$239.00,$22.96,$18.81,$17.53,$7.21,$18.81,$18.81,$19.03,$239.00,$13.52,$36.00,$189.29,$191.20,$18.68,$20.27,$12.88,$14.19,$12.88
30200276,EAP,CPT® 86787,,Varicella Zoster,$257.00,$7.21,$257.00,$22.96,$18.81,$17.53,$7.21,$18.81,$18.81,$19.03,$257.00,$13.52,$36.00,$203.54,$205.60,$18.68,$20.27,$12.88,$14.19,$12.88
30200277,EAP,CPT® 86788,,"W. Nile Ab, Igm",$352.00,$0.00,$352.00,$0.00,$24.60,$0.00,$0.00,$24.60,$24.60,$0.00,$352.00,$0.00,$47.08,$278.78,$281.60,$0.00,$0.00,$0.00,$0.00,$0.00
30200278,EAP,CPT® 86788,,"W. Nile Ab, Igm, Csf",$352.00,$0.00,$352.00,$0.00,$24.60,$0.00,$0.00,$24.60,$24.60,$0.00,$352.00,$0.00,$47.08,$278.78,$281.60,$0.00,$0.00,$0.00,$0.00,$0.00
30200279,EAP,CPT® 86789,,"W. Nile Ab, Igg",$352.00,$0.00,$352.00,$0.00,$16.99,$0.00,$0.00,$16.99,$16.99,$0.00,$352.00,$0.00,$32.52,$278.78,$281.60,$0.00,$0.00,$0.00,$0.00,$0.00
30200280,EAP,CPT® 86789,,"W. Nile Ab, Igg, Csf",$352.00,$0.00,$352.00,$0.00,$16.99,$0.00,$0.00,$16.99,$16.99,$0.00,$352.00,$0.00,$32.52,$278.78,$281.60,$0.00,$0.00,$0.00,$0.00,$0.00
30200281,EAP,CPT® 86790,,Htlv I/ii Ab,$300.00,$7.21,$300.00,$22.96,$18.81,$11.13,$7.21,$18.81,$18.81,$19.03,$300.00,$13.52,$36.00,$237.60,$240.00,$18.68,$20.27,$12.88,$14.19,$12.88
30200282,EAP,CPT® 86800,,"Thyroglob Ab, Quant",$337.00,$8.89,$337.00,$28.36,$23.22,$16.45,$8.89,$23.22,$23.22,$23.50,$337.00,$16.71,$44.44,$266.90,$269.60,$23.07,$25.04,$15.91,$17.53,$15.91
30200283,EAP,CPT® 86800,,Thyroglobulin Ab,$359.00,$8.89,$359.00,$28.36,$23.22,$16.45,$8.89,$23.22,$23.22,$23.50,$359.00,$16.71,$44.44,$284.33,$287.20,$23.07,$25.04,$15.91,$17.53,$15.91
30200284,EAP,CPT® 86803,,Hcv Ab (2nd Gen),$346.00,$7.98,$346.00,$25.42,$20.84,$18.13,$7.98,$20.84,$20.84,$11.75,$346.00,$14.98,$39.88,$274.03,$276.80,$20.69,$12.52,$14.27,$8.76,$14.27
30200285,EAP,CPT® 86812,,Hla-b27,$588.00,$14.43,$588.00,$46.01,$37.68,$34.50,$14.43,$37.68,$37.68,$38.13,$588.00,$27.10,$72.12,$465.70,$470.40,$37.42,$40.62,$25.81,$28.44,$25.81
30200286,EAP,CPT® 86922,,"Charge: Xmatch, Coombs",$204.00,$0.00,$204.00,$48.09,$23.93,$137.60,$21.48,$23.93,$23.93,$35.72,$204.00,$143.92,$56.24,$161.57,$163.20,$199.96,$31.93,$0.00,$32.48,$137.07
30200287,EAP,CPT® 86922,,"Charge: Xmatch, Coombs",$204.00,$0.00,$204.00,$48.09,$23.93,$137.60,$21.48,$23.93,$23.93,$35.72,$204.00,$143.92,$56.24,$161.57,$163.20,$199.96,$31.93,$0.00,$32.48,$137.07
30200289,EAP,CPT® 86359,,Lymph Subset T Cel Tot (so),$218.00,$21.10,$218.00,$42.00,$34.39,$22.53,$21.10,$34.39,$34.39,$34.80,$218.00,$39.62,$65.82,$172.66,$174.40,$54.71,$37.08,$37.73,$25.95,$37.73
30200292,EAP,CPT® 86360,,Lymph Subset Abs Ct Ratio (so),$322.00,$26.28,$322.00,$83.77,$68.60,$45.07,$26.28,$68.60,$68.60,$69.42,$322.00,$49.33,$131.30,$255.02,$257.60,$68.12,$73.96,$46.98,$51.77,$46.98
30200310,EAP,CPT® 86256,,Smooth Muscle Ab Titer,$88.00,$6.75,$88.00,$21.48,$17.60,$16.40,$6.75,$17.60,$17.60,$17.81,$88.00,$12.65,$33.68,$69.70,$70.40,$17.47,$18.97,$12.05,$13.28,$12.05
30200315,EAP,CPT® 85027,,Cbc & Plat,$184.00,$3.61,$184.00,$11.54,$9.45,$7.73,$3.61,$9.45,$9.45,$9.57,$184.00,$6.79,$18.08,$145.73,$147.20,$9.38,$10.19,$6.47,$7.13,$6.47
30200330,EAP,CPT® 86355,,Lymphocyte Sub 6  B Cells (so),$226.00,$21.10,$226.00,$42.00,$34.39,$22.53,$21.10,$34.39,$34.39,$34.80,$226.00,$39.62,$65.82,$178.99,$180.80,$54.71,$37.08,$37.73,$25.95,$37.73
30200331,EAP,CPT® 86357,,Lymphocyte Sub 6 Nk Total (so),$219.00,$21.10,$219.00,$42.00,$34.39,$22.53,$21.10,$34.39,$34.39,$34.80,$219.00,$39.62,$65.82,$173.45,$175.20,$54.71,$37.08,$37.73,$25.95,$37.73
30200332,EAP,CPT® 86359,,Lymphocyte Sub 6 T Cell Total (so),$229.00,$21.10,$229.00,$42.00,$34.39,$22.53,$21.10,$34.39,$34.39,$34.80,$229.00,$39.62,$65.82,$181.37,$183.20,$54.71,$37.08,$37.73,$25.95,$37.73
30200333,EAP,CPT® 86360,,Lymphocyte Sub 6 T Cells Abs(so),$324.00,$26.28,$324.00,$83.77,$68.60,$45.07,$26.28,$68.60,$68.60,$69.42,$324.00,$49.33,$131.30,$256.61,$259.20,$68.12,$73.96,$46.98,$51.77,$46.98
30200334,EAP,CPT® 86356,,Lymphocyte Sub 6 Ag (so),$198.00,$0.00,$198.00,$0.00,$38.11,$0.00,$0.00,$38.11,$38.11,$0.00,$198.00,$0.00,$99.00,$156.82,$158.40,$0.00,$0.00,$0.00,$0.00,$0.00
30200335,EAP,CPT® 86021,,Neutraphil Ab Id (so),$244.00,$8.42,$244.00,$26.84,$21.98,$20.49,$8.42,$21.98,$21.98,$22.24,$244.00,$15.80,$42.06,$193.25,$195.20,$21.82,$23.70,$15.05,$16.59,$15.05
30200336,EAP,CPT® 86828,,Neutraphil Ab Id Hla I&ii (so),$591.00,$0.00,$591.00,$0.00,$55.25,$0.00,$0.00,$55.25,$55.25,$0.00,$591.00,$0.00,$295.50,$468.07,$472.80,$0.00,$0.00,$0.00,$0.00,$0.00
30200337,EAP,CPT® 86658,,Echovirus Ab Csf (so),$185.00,$7.28,$185.00,$23.23,$19.03,$11.13,$7.28,$19.03,$19.03,$19.25,$185.00,$13.68,$36.40,$146.52,$148.00,$18.89,$20.51,$13.03,$14.36,$13.03
30200338,EAP,CPT® 83519,,Enceph Auto Eval Csf Ria (so),$422.00,$9.26,$422.00,$24.08,$19.73,$18.39,$9.26,$19.73,$19.73,$19.96,$422.00,$19.32,$37.76,$334.22,$337.60,$26.68,$21.27,$18.40,$14.89,$18.40
30200339,EAP,CPT® 86255,,Enceph Ab Screen Csf (so),$240.00,$6.75,$240.00,$21.48,$17.60,$16.40,$6.75,$17.60,$17.60,$17.81,$240.00,$12.65,$33.68,$190.08,$192.00,$17.47,$18.97,$12.05,$13.28,$12.05
30200340,EAP,CPT® 86341,,Enceph Islet Cell Ab Csf (so),$194.00,$11.87,$194.00,$35.27,$28.89,$19.44,$11.87,$28.89,$28.89,$29.24,$194.00,$24.75,$55.30,$153.65,$155.20,$34.18,$31.16,$23.57,$21.81,$23.57
30200341,EAP,CPT® 86606,,Aspergillus Ab (so),$120.00,$8.42,$120.00,$26.84,$21.98,$11.13,$8.42,$21.98,$21.98,$22.24,$120.00,$15.80,$42.06,$95.04,$96.00,$21.82,$23.70,$15.05,$16.59,$15.05
30200342,EAP,CPT® 86612,,Blastomyces Ab (so),$150.00,$0.00,$150.00,$0.00,$18.84,$0.00,$0.00,$18.84,$18.84,$0.00,$150.00,$0.00,$36.06,$118.80,$120.00,$0.00,$0.00,$0.00,$0.00,$0.00
30200343,EAP,CPT® 86305,,Human Epididymis Prot 4 (so),$333.00,$0.00,$333.00,$0.00,$29.81,$0.00,$0.00,$29.81,$29.81,$0.00,$333.00,$0.00,$166.50,$263.74,$266.40,$0.00,$0.00,$0.00,$0.00,$0.00
30200344,EAP,CPT® 86635,,Coccidioides Ab (so),$164.00,$0.00,$164.00,$0.00,$16.75,$0.00,$0.00,$16.75,$16.75,$0.00,$164.00,$0.00,$32.06,$129.89,$131.20,$0.00,$0.00,$0.00,$0.00,$0.00
30200345,EAP,CPT® 86698,,Histoplasma Ab (so),$116.00,$6.99,$116.00,$22.28,$18.25,$11.13,$6.99,$18.25,$18.25,$18.46,$116.00,$14.48,$34.92,$91.87,$92.80,$20.00,$19.67,$13.79,$13.77,$13.79
30200346,EAP,CPT® 87449,,Fungitell Csf (so),$182.00,$0.00,$182.00,$0.00,$17.52,$0.00,$0.00,$17.52,$17.52,$0.00,$182.00,$0.00,$33.52,$144.14,$145.60,$0.00,$0.00,$0.00,$0.00,$0.00
30200347,EAP,CPT® 86790,,Chikungunya Ab (so),$172.00,$7.21,$172.00,$22.96,$18.81,$11.13,$7.21,$18.81,$18.81,$19.03,$172.00,$13.52,$36.00,$136.22,$137.60,$18.68,$20.27,$12.88,$14.19,$12.88
30200349,EAP,CPT® 86580,,Tb Skin Test,$90.00,$4.35,$90.00,$10.74,$7.19,$22.05,$4.35,$7.19,$7.19,$9.56,$90.00,$23.06,$20.46,$71.28,$72.00,$32.04,$10.18,$9.36,$7.13,$21.96
30200350,EAP,CPT® 86580,,Step 2 Ppd #1,$75.00,$4.35,$75.00,$10.74,$7.19,$22.05,$4.35,$7.19,$7.19,$9.56,$75.00,$23.06,$20.46,$59.40,$60.00,$32.04,$10.18,$9.36,$7.13,$21.96
30200370,EAP,CPT® 86701,,Focus Hiv-1 Confirmation,$198.00,$4.97,$198.00,$15.85,$12.96,$10.01,$4.97,$12.96,$12.96,$11.39,$198.00,$9.33,$24.82,$156.82,$158.40,$12.89,$12.14,$8.89,$8.50,$8.89
30200371,EAP,CPT® 86702,,Focus Hiv-2 Confirmation,$240.00,$7.56,$240.00,$24.10,$19.74,$14.37,$7.56,$19.74,$19.74,$17.33,$240.00,$14.20,$37.76,$190.08,$192.00,$19.60,$18.46,$13.52,$12.92,$13.52
30200372,EAP,CPT® 83516,,Aquaporin 4 Recep Ab (so),$292.00,$6.44,$292.00,$19.04,$15.61,$15.70,$6.44,$15.61,$15.61,$15.80,$292.00,$12.11,$29.88,$231.26,$233.60,$16.72,$16.84,$11.53,$11.79,$11.53
30200373,EAP,CPT® 86003,,Abpa Allergen Spec Ige (so),$137.00,$2.92,$137.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$137.00,$5.48,$14.60,$108.50,$109.60,$7.57,$8.22,$5.22,$5.76,$5.22
30200374,EAP,CPT® 86606,,Aspergillus Ab (so),$113.00,$8.42,$113.00,$26.84,$21.98,$11.13,$8.42,$21.98,$21.98,$22.24,$113.00,$15.80,$42.06,$89.50,$90.40,$21.82,$23.70,$15.05,$16.59,$15.05
30200375,EAP,CPT® 86161,,C3 Nephritic Factor (so),$266.00,$6.71,$266.00,$21.39,$17.53,$16.33,$6.71,$17.53,$17.53,$17.73,$266.00,$12.60,$33.56,$210.67,$212.80,$17.40,$18.90,$12.00,$13.23,$12.00
30200376,EAP,CPT® 86406,,Toxo Titr Pregnancy (so),$152.00,$5.95,$152.00,$18.97,$15.53,$14.47,$5.95,$15.53,$15.53,$15.72,$152.00,$11.17,$29.74,$120.38,$121.60,$15.43,$16.75,$10.64,$11.72,$10.64
30200377,EAP,CPT® 86777,,Toxoplasma Ab (so),$190.00,$8.06,$190.00,$20.75,$16.99,$19.58,$8.06,$16.99,$16.99,$17.19,$190.00,$15.11,$32.52,$150.48,$152.00,$20.87,$18.31,$14.39,$12.82,$14.39
30200378,EAP,CPT® 86778,,Toxoplasma Ab Igm (so),$194.00,$8.06,$194.00,$25.67,$21.03,$11.13,$8.06,$21.03,$21.03,$21.27,$194.00,$15.13,$40.24,$153.65,$155.20,$20.89,$22.67,$14.41,$15.87,$14.41
30200379,EAP,CPT® 86038,,Ana Ifa With Reflex (so),$201.00,$6.76,$201.00,$21.55,$17.65,$16.45,$6.76,$17.65,$17.65,$17.86,$201.00,$12.69,$33.78,$159.19,$160.80,$17.53,$19.03,$12.09,$13.32,$12.09
30200380,EAP,CPT® 86021,,Wbc Ab Id (neutrophil) (so),$236.00,$8.42,$236.00,$26.84,$21.98,$20.49,$8.42,$21.98,$21.98,$22.24,$236.00,$15.80,$42.06,$186.91,$188.80,$21.82,$23.70,$15.05,$16.59,$15.05
30200381,EAP,CPT® 86828,,Hla I & Ii Ab Qual (so),$593.00,$0.00,$593.00,$0.00,$55.25,$0.00,$0.00,$55.25,$55.25,$0.00,$593.00,$0.00,$296.50,$469.66,$474.40,$0.00,$0.00,$0.00,$0.00,$0.00
30200382,EAP,CPT® 86255,,Ampa Recept Fluor Ab Screen (so),$536.00,$6.75,$536.00,$21.48,$17.60,$16.40,$6.75,$17.60,$17.60,$17.81,$536.00,$12.65,$33.68,$424.51,$428.80,$17.47,$18.97,$12.05,$13.28,$12.05
30200383,EAP,CPT® 86833,,Hla Ii Post Trans Dsa (so),$326.00,$0.00,$326.00,$0.00,$160.93,$0.00,$0.00,$160.93,$160.93,$0.00,$326.00,$0.00,$163.00,$258.19,$260.80,$0.00,$0.00,$0.00,$0.00,$0.00
30200384,EAP,CPT® 86832,,Hla I Post Trans Dsa (so),$324.00,$0.00,$324.00,$0.00,$177.16,$0.00,$0.00,$177.16,$177.16,$0.00,$324.00,$0.00,$162.00,$256.61,$259.20,$0.00,$0.00,$0.00,$0.00,$0.00
30200385,EAP,CPT® 86829,,Hla I/ii Post Trans Dsa (so),$245.00,$0.00,$245.00,$0.00,$41.44,$0.00,$0.00,$41.44,$41.44,$0.00,$245.00,$0.00,$122.50,$194.04,$196.00,$0.00,$0.00,$0.00,$0.00,$0.00
30200386,EAP,CPT® 86671,,Crohns Prognostic Fung Ab (so),$145.00,$6.86,$145.00,$21.84,$17.90,$11.13,$6.86,$17.90,$17.90,$18.11,$145.00,$12.86,$34.26,$114.84,$116.00,$17.76,$19.30,$12.25,$13.51,$12.25
30200387,EAP,CPT® 83516,,Crohns Prognostic Nonab (so),$275.00,$6.44,$275.00,$19.04,$15.61,$15.70,$6.44,$15.61,$15.61,$15.80,$275.00,$12.11,$29.88,$217.80,$220.00,$16.72,$16.84,$11.53,$11.79,$11.53
30200388,EAP,CPT® 83519,,Paraneo Autoab Eval Ria(so),$121.00,$9.26,$121.00,$24.08,$19.73,$18.39,$9.26,$19.73,$19.73,$19.96,$121.00,$19.32,$37.76,$95.83,$96.80,$26.68,$21.27,$18.40,$14.89,$18.40
30200389,EAP,CPT® 86256,,Paraneo Autoab Titer Ria(so),$80.00,$6.75,$80.00,$21.48,$17.60,$16.40,$6.75,$17.60,$17.60,$17.81,$80.00,$12.65,$33.68,$63.36,$64.00,$17.47,$18.97,$12.05,$13.28,$12.05
30200390,EAP,CPT® 86255,,Nmda Recep Ab Serum,$230.00,$6.75,$230.00,$21.48,$17.60,$16.40,$6.75,$17.60,$17.60,$17.81,$230.00,$12.65,$33.68,$182.16,$184.00,$17.47,$18.97,$12.05,$13.28,$12.05
30200400,EAP,CPT® 82963,,Beta Glucosidase So,"$1,168.00",$0.00,"$1,168.00",$0.00,$31.37,$0.00,$0.00,$31.37,$31.37,$0.00,"$1,168.00",$0.00,$60.02,$925.06,$934.40,$0.00,$0.00,$0.00,$0.00,$0.00
30200401,EAP,CPT® 87389,,Hiv 1/2 Ag/ab 4th Generation So,$101.00,$13.47,$101.00,$42.93,$34.12,$19.38,$13.47,$34.12,$34.12,$32.07,$101.00,$25.28,$50.50,$79.99,$80.80,$34.92,$34.17,$24.08,$23.92,$24.08
30200449,EAP,CPT® 86580,,Tb Skin Test,$90.00,$4.35,$90.00,$10.74,$7.19,$22.05,$4.35,$7.19,$7.19,$9.56,$90.00,$23.06,$20.46,$71.28,$72.00,$32.04,$10.18,$9.36,$7.13,$21.96
30200450,EAP,CPT® 86021,,Proteinase-3 Antibody,$206.00,$8.42,$206.00,$26.84,$21.98,$20.49,$8.42,$21.98,$21.98,$22.24,$206.00,$15.80,$42.06,$163.15,$164.80,$21.82,$23.70,$15.05,$16.59,$15.05
30200451,EAP,CPT® 86021,,Myeloperoxidase Antibody,$184.00,$8.42,$184.00,$26.84,$21.98,$20.49,$8.42,$21.98,$21.98,$22.24,$184.00,$15.80,$42.06,$145.73,$147.20,$21.82,$23.70,$15.05,$16.59,$15.05
30200452,EAP,CPT® 86022,,"Platelet Igg Ab,indirect",$301.00,$0.00,$301.00,$0.00,$26.82,$0.00,$0.00,$26.82,$26.82,$0.00,$301.00,$0.00,$51.32,$238.39,$240.80,$0.00,$0.00,$0.00,$0.00,$0.00
30200453,EAP,CPT® 86023,,Platelet Glycoprot. Ab,$438.00,$0.00,$438.00,$0.00,$18.19,$0.00,$0.00,$18.19,$18.19,$0.00,$438.00,$0.00,$34.80,$346.90,$350.40,$0.00,$0.00,$0.00,$0.00,$0.00
30200454,EAP,CPT® 86200,,Cyclic Citurullinate Antibody,$391.00,$7.25,$391.00,$23.07,$18.91,$17.62,$7.25,$18.91,$18.91,$19.12,$391.00,$13.60,$36.18,$309.67,$312.80,$18.78,$20.37,$12.95,$14.26,$12.95
30200455,EAP,CPT® 86256,,Parietal Antibody Titer,$88.00,$6.75,$88.00,$21.48,$17.60,$16.40,$6.75,$17.60,$17.60,$17.81,$88.00,$12.65,$33.68,$69.70,$70.40,$17.47,$18.97,$12.05,$13.28,$12.05
30200480,EAP,CPT® 83789,,Tpmt Activity,$690.00,$0.00,$690.00,$0.00,$8.77,$0.00,$0.00,$8.77,$8.77,$0.00,$690.00,$0.00,$16.78,$546.48,$552.00,$0.00,$0.00,$0.00,$0.00,$0.00
30200481,EAP,CPT® 86689,,Htlv Ab. Western Blot,$290.00,$0.00,$290.00,$0.00,$28.26,$0.00,$0.00,$28.26,$28.26,$0.00,$290.00,$0.00,$54.10,$229.68,$232.00,$0.00,$0.00,$0.00,$0.00,$0.00
30200491,EAP,CPT® 86316,,"Immunoassay, Tumor Antigen, Quant",$315.00,$11.65,$315.00,$37.10,$30.38,$28.32,$11.65,$30.38,$30.38,$30.73,$315.00,$21.85,$58.14,$249.48,$252.00,$30.17,$32.75,$20.81,$22.92,$20.81
30200492,EAP,CPT® 86651,,Encephal Antibody Calif,$36.00,$0.00,$36.00,$0.00,$19.25,$0.00,$0.00,$19.25,$19.25,$0.00,$36.00,$0.00,$36.00,$28.51,$28.80,$0.00,$0.00,$0.00,$0.00,$0.00
30200493,EAP,CPT® 86652,,Encephal Antibody East Equ,$36.00,$0.00,$36.00,$0.00,$19.25,$0.00,$0.00,$19.25,$19.25,$0.00,$36.00,$0.00,$36.00,$28.51,$28.80,$0.00,$0.00,$0.00,$0.00,$0.00
30200494,EAP,CPT® 86653,,Encephal Antibody St Louis,$36.00,$0.00,$36.00,$0.00,$19.25,$0.00,$0.00,$19.25,$19.25,$0.00,$36.00,$0.00,$36.00,$28.51,$28.80,$0.00,$0.00,$0.00,$0.00,$0.00
30200495,EAP,CPT® 86654,,Encephal Antibody West Equ,$36.00,$0.00,$36.00,$0.00,$19.25,$0.00,$0.00,$19.25,$19.25,$0.00,$36.00,$0.00,$36.00,$28.51,$28.80,$0.00,$0.00,$0.00,$0.00,$0.00
30200496,EAP,CPT® 88360,,Tumor Immunohistochem/manual,"$1,842.00",$65.32,"$1,842.00",$184.86,$65.70,$137.60,$65.32,$65.70,$65.70,$114.71,"$1,842.00",$143.92,$121.34,"$1,458.86","$1,473.60",$199.96,$122.23,$83.20,$85.56,$137.07
30200498,EAP,CPT® 82787,,"Igg1, 2, 3 Or 4, Each",$84.00,$4.49,$84.00,$14.30,$11.71,$7.02,$4.49,$11.71,$11.71,$11.84,$84.00,$8.42,$22.40,$66.53,$67.20,$11.63,$12.62,$8.02,$8.83,$8.02
30200499,EAP,CPT® 86343,,Leukocyte Histamine Release,$418.00,$0.00,$418.00,$0.00,$18.20,$0.00,$0.00,$18.20,$18.20,$0.00,$418.00,$0.00,$34.82,$331.06,$334.40,$0.00,$0.00,$0.00,$0.00,$0.00
30200500,EAP,CPT® 86580,,Tb Intradermal Test,$128.00,$4.35,$128.00,$10.74,$7.19,$22.05,$4.35,$7.19,$7.19,$9.56,$128.00,$23.06,$20.46,$101.38,$102.40,$32.04,$10.18,$9.36,$7.13,$21.96
30200501,EAP,CPT® 83789,,"Mass Spectrometry Quant,nonspec",$126.00,$0.00,$126.00,$0.00,$8.77,$0.00,$0.00,$8.77,$8.77,$0.00,$126.00,$0.00,$16.78,$99.79,$100.80,$0.00,$0.00,$0.00,$0.00,$0.00
30200503,EAP,CPT® 88189,,"Flowcytometry/read, 16 & > Markers",$248.00,$44.14,$248.00,$120.43,$177.00,$44.14,$44.46,$177.00,$177.00,$115.43,$248.00,$93.43,$210.82,$196.42,$198.40,$88.72,$122.99,$88.72,$86.09,$88.72
30200504,EAP,CPT® 88188,,"Flowcytometry/read, 9-15 Markers",$278.00,$0.00,$278.00,$0.00,$198.41,$0.00,$0.00,$198.41,$198.41,$0.00,$278.00,$0.00,$161.74,$220.18,$222.40,$0.00,$0.00,$0.00,$0.00,$0.00
30200505,EAP,CPT® 88187,,"Flowcytometry/read, 2-8 Markers",$180.00,$19.59,$180.00,$77.02,$128.47,$32.04,$19.59,$128.47,$128.47,$70.22,$180.00,$50.66,$130.50,$142.56,$144.00,$39.31,$74.83,$39.31,$52.38,$39.31
30200506,EAP,CPT® 88368,,"Insitu Hybridization, Manual","$1,076.00",$65.14,"$1,076.00",$154.04,$145.54,$271.76,$65.14,$145.54,$145.54,$199.20,"$1,076.00",$284.24,$207.74,$852.19,$860.80,$394.92,$212.25,$90.40,$148.57,$270.71
30200507,EAP,CPT® 86480,,"Tb Test,cell Immun Meas By Gamma Interfron",$690.00,$34.67,$690.00,$110.49,$90.49,$84.35,$34.67,$90.49,$90.49,$91.55,$690.00,$65.08,$173.18,$546.48,$552.00,$89.87,$97.55,$61.98,$68.28,$61.98
30200508,EAP,CPT® 87799,,"Jc Virus Pcr, Urine (q)",$849.00,$0.00,$849.00,$0.00,$62.54,$0.00,$23.96,$62.54,$62.54,$0.00,$849.00,$0.00,$119.70,$672.41,$679.20,$0.00,$132.87,$0.00,$0.00,$0.00
30200509,EAP,CPT® 87799,,"Bk Virus Pcr, Urine (q)",$726.00,$0.00,$726.00,$0.00,$62.54,$0.00,$23.96,$62.54,$62.54,$0.00,$726.00,$0.00,$119.70,$574.99,$580.80,$0.00,$113.62,$0.00,$0.00,$0.00
30200510,EAP,CPT® 83519,,Thyrotrpn Bndng Inhib Ab (q),$254.00,$9.26,$254.00,$24.08,$19.73,$18.39,$9.26,$19.73,$19.73,$19.96,$254.00,$19.32,$37.76,$201.17,$203.20,$26.68,$21.27,$18.40,$14.89,$18.40
30200511,EAP,CPT® 83520,,Prothrombin Fragment (e),$226.00,$8.69,$226.00,$23.07,$18.91,$17.62,$8.69,$18.91,$18.91,$19.12,$226.00,$18.13,$36.18,$178.99,$180.80,$25.04,$20.37,$17.27,$14.26,$17.27
30200512,EAP,CPT® 87912,,"Heptis B Resist, Geno (q)",$606.00,$0.00,$606.00,$0.00,$359.15,$0.00,$0.00,$359.15,$359.15,$0.00,$606.00,$0.00,$303.00,$479.95,$484.80,$0.00,$0.00,$0.00,$0.00,$0.00
30200600,EAP,CPT® 88184,,Flowcytometry/ Tc 1 Marker,$300.00,$34.11,$300.00,$80.30,$79.23,$271.76,$34.11,$79.23,$79.23,$54.16,$300.00,$284.24,$133.74,$237.60,$240.00,$300.00,$57.71,$68.07,$40.40,$270.71
30200601,EAP,CPT® 88185,,Flowcytometry/tc Add-on,$28.00,$0.00,$47.05,$28.00,$47.05,$0.00,$12.52,$47.05,$47.05,$26.63,$28.00,$0.00,$28.00,$22.18,$22.40,$0.00,$28.37,$22.33,$19.86,$0.00
30200602,EAP,CPT® 86813,,Hla Typing A B Or C,$413.00,$0.00,$413.00,$0.00,$84.66,$0.00,$0.00,$84.66,$84.66,$0.00,$413.00,$0.00,$162.04,$327.10,$330.40,$0.00,$0.00,$0.00,$0.00,$0.00
30200603,EAP,CPT® 87252,,Virus Inoculation Tissue - Acyclovir,$496.00,$14.59,$496.00,$39.42,$32.28,$19.64,$14.59,$32.28,$32.28,$32.66,$496.00,$27.37,$61.78,$392.83,$396.80,$37.80,$34.79,$26.07,$24.36,$26.07
30200604,EAP,CPT® 87253,,Virus Inoculate Tissue Addl - Acyclovir,$471.00,$0.00,$471.00,$0.00,$23.78,$0.00,$0.00,$23.78,$23.78,$0.00,$471.00,$0.00,$45.52,$373.03,$376.80,$0.00,$0.00,$0.00,$0.00,$0.00
30200605,EAP,CPT® 85246,,Blood Clot Factor Viii Test,$106.00,$12.83,$106.00,$40.90,$33.51,$31.22,$12.83,$33.51,$33.51,$33.89,$106.00,$24.09,$64.12,$83.95,$84.80,$33.26,$36.11,$22.94,$25.28,$22.94
30200606,EAP,CPT® 83033,,Fetal Hemoglobin Assay Qual,$95.00,$0.00,$95.00,$0.00,$8.70,$0.00,$0.00,$8.70,$8.70,$0.00,$95.00,$0.00,$16.66,$75.24,$76.00,$0.00,$0.00,$0.00,$0.00,$0.00
30200629,EAP,CPT® 80347,,Assay Of Benzodiazepines,$562.00,$0.00,$562.00,$0.00,$401.10,$0.00,$0.00,$401.10,$401.10,$0.00,$562.00,$0.00,$281.00,$445.10,$449.60,$0.00,$0.00,$0.00,$0.00,$0.00
30200630,EAP,CPT® 88237,,Tissue Culture Bone Marrow,$562.00,$72.38,$562.00,$157.39,$128.90,$171.89,$72.38,$128.90,$128.90,$130.42,$562.00,$150.94,$246.70,$445.10,$449.60,$208.44,$138.97,$143.75,$97.28,$143.75
30200631,EAP,CPT® 88264,,Chromosome Analysis 20-25,$691.00,$72.80,$691.00,$222.21,$181.98,$169.62,$72.80,$181.98,$181.98,$184.12,$691.00,$151.84,$348.28,$547.27,$552.80,$209.68,$196.18,$144.61,$137.33,$144.61
30200633,EAP,CPT® 88237,,Tissue Culture Bone Marrow,$263.00,$72.38,$263.00,$157.39,$128.90,$171.89,$72.38,$128.90,$128.90,$130.42,$263.00,$150.94,$246.70,$208.30,$210.40,$208.44,$138.97,$143.75,$97.28,$143.75
30200634,EAP,CPT® 88262,,Chromosome Analysis 15-20,$220.00,$69.72,$220.00,$220.00,$181.98,$169.62,$69.72,$181.98,$181.98,$184.12,$220.00,$131.76,$220.00,$174.24,$176.00,$181.96,$196.18,$125.49,$137.33,$125.49
30200636,EAP,CPT® 86343,,Leukocyte Histamine Release,$52.00,$0.00,$52.00,$0.00,$18.20,$0.00,$0.00,$18.20,$18.20,$0.00,$52.00,$0.00,$34.82,$41.18,$41.60,$0.00,$0.00,$0.00,$0.00,$0.00
30200637,EAP,CPT® 83088,,Assay Of Histamine,$50.00,$0.00,$50.00,$0.00,$43.12,$0.00,$0.00,$43.12,$43.12,$0.00,$50.00,$0.00,$50.00,$39.60,$40.00,$0.00,$0.00,$0.00,$0.00,$0.00
30200638,EAP,CPT® 86021,,Wbc Antibody Identification,$31.00,$8.42,$31.00,$26.84,$21.98,$20.49,$8.42,$21.98,$21.98,$22.24,$31.00,$15.80,$31.00,$24.55,$24.80,$21.82,$23.70,$15.05,$16.59,$15.05
30200639,EAP,CPT® 86376,,Microsomal Antibody,$29.00,$8.14,$29.00,$25.95,$21.25,$19.80,$8.14,$21.25,$21.25,$21.49,$29.00,$15.28,$29.00,$22.97,$23.20,$21.10,$22.90,$14.55,$16.03,$14.55
30200640,EAP,CPT® 84443,,Assay Thyroid Stim Hormone,$42.00,$9.40,$42.00,$29.96,$24.53,$22.87,$9.40,$24.53,$24.53,$24.81,$42.00,$17.64,$42.00,$33.26,$33.60,$24.36,$26.44,$16.80,$18.51,$16.80
30200641,EAP,CPT® 86800,,Thyroglobulin Antibody,$75.00,$8.89,$75.00,$28.36,$23.22,$16.45,$8.89,$23.22,$23.22,$23.50,$75.00,$16.71,$44.44,$59.40,$60.00,$23.07,$25.04,$15.91,$17.53,$15.91
30200649,EAP,CPT® 88321,,Microslide Consultation,$364.00,$0.00,$364.00,$0.00,$79.11,$0.00,$0.00,$79.11,$79.11,$0.00,$364.00,$0.00,$180.64,$288.29,$291.20,$0.00,$0.00,$0.00,$0.00,$0.00
30200650,EAP,CPT® 86343,,Leukocyte Histamine Release,$48.00,$0.00,$48.00,$0.00,$18.20,$0.00,$0.00,$18.20,$18.20,$0.00,$48.00,$0.00,$34.82,$38.02,$38.40,$0.00,$0.00,$0.00,$0.00,$0.00
30200651,EAP,CPT® 83088,,Assay Of Histamine,$49.00,$0.00,$49.00,$0.00,$43.12,$0.00,$0.00,$43.12,$43.12,$0.00,$49.00,$0.00,$49.00,$38.81,$39.20,$0.00,$0.00,$0.00,$0.00,$0.00
30200652,EAP,CPT® 86021,,Wbc Antibody Identification,$29.00,$8.42,$29.00,$26.84,$21.98,$20.49,$8.42,$21.98,$21.98,$22.24,$29.00,$15.80,$29.00,$22.97,$23.20,$21.82,$23.70,$15.05,$16.59,$15.05
30200653,EAP,CPT® 86376,,Microsomal Antibody,$27.00,$8.14,$27.00,$25.95,$21.25,$19.80,$8.14,$21.25,$21.25,$21.49,$27.00,$15.28,$27.00,$21.38,$21.60,$21.10,$22.90,$14.55,$16.03,$14.55
30200654,EAP,CPT® 84443,,Assay Thyroid Stim Hormone,$39.00,$9.40,$39.00,$29.96,$24.53,$22.87,$9.40,$24.53,$24.53,$24.81,$39.00,$17.64,$39.00,$30.89,$31.20,$24.36,$26.44,$16.80,$18.51,$16.80
30200655,EAP,CPT® 86800,,Thyroglobulin Antibody,$69.00,$8.89,$69.00,$28.36,$23.22,$16.45,$8.89,$23.22,$23.22,$23.50,$69.00,$16.71,$44.44,$54.65,$55.20,$23.07,$25.04,$15.91,$17.53,$15.91
30200656,EAP,CPT® 88271,,Cytogenetics Dna Probe,$77.00,$11.98,$77.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$77.00,$22.49,$59.86,$60.98,$61.60,$31.06,$33.72,$21.42,$23.60,$21.42
30200657,EAP,CPT® 88273,,Cytogenetics 10-30,$107.00,$0.00,$107.00,$0.00,$46.91,$0.00,$0.00,$46.91,$46.91,$0.00,$107.00,$0.00,$89.78,$84.74,$85.60,$0.00,$0.00,$0.00,$0.00,$0.00
30200660,EAP,CPT® 88182,,Cell Marker Study,$93.00,$0.00,$93.00,$0.00,$66.30,$0.00,$0.00,$66.30,$66.30,$0.00,$93.00,$0.00,$93.00,$73.66,$74.40,$0.00,$0.00,$0.00,$0.00,$0.00
30200661,EAP,CPT® 86817,,Hla Typing Dr/dq,$743.00,$0.00,$743.00,$0.00,$94.00,$0.00,$0.00,$94.00,$94.00,$0.00,$743.00,$0.00,$179.90,$588.46,$594.40,$0.00,$0.00,$0.00,$0.00,$0.00
30200671,EAP,CPT® 88360,,Tumor Immunohistochem/manual,$310.00,$65.32,$310.00,$184.86,$65.70,$137.60,$65.32,$65.70,$65.70,$114.71,$310.00,$143.92,$121.34,$245.52,$248.00,$199.96,$122.23,$83.20,$85.56,$137.07
30200672,EAP,CPT® 88321,,Microslide Consultation,$84.00,$0.00,$84.00,$0.00,$79.11,$0.00,$0.00,$79.11,$79.11,$0.00,$84.00,$0.00,$84.00,$66.53,$67.20,$0.00,$0.00,$0.00,$0.00,$0.00
30200673,EAP,CPT® 84600,,Assay Of Volatiles,$324.00,$0.00,$324.00,$0.00,$23.47,$0.00,$0.00,$23.47,$23.47,$0.00,$324.00,$0.00,$44.90,$256.61,$259.20,$0.00,$0.00,$0.00,$0.00,$0.00
30200674,EAP,CPT® 84600,,Assay Of Volatiles,$324.00,$0.00,$324.00,$0.00,$23.47,$0.00,$0.00,$23.47,$23.47,$0.00,$324.00,$0.00,$44.90,$256.61,$259.20,$0.00,$0.00,$0.00,$0.00,$0.00
30200675,EAP,CPT® 85210,,Blood Clot Factor Ii Test,$111.00,$0.00,$111.00,$0.00,$18.96,$0.00,$0.00,$18.96,$18.96,$0.00,$111.00,$0.00,$36.28,$87.91,$88.80,$0.00,$0.00,$0.00,$0.00,$0.00
30200676,EAP,CPT® 85210,,Blood Clot Factor Ii Test,$126.00,$0.00,$126.00,$0.00,$18.96,$0.00,$0.00,$18.96,$18.96,$0.00,$126.00,$0.00,$36.28,$99.79,$100.80,$0.00,$0.00,$0.00,$0.00,$0.00
30200677,EAP,CPT® 85260,,Blood Clot Factor X Test,$105.00,$0.00,$105.00,$0.00,$26.14,$0.00,$0.00,$26.14,$26.14,$0.00,$105.00,$0.00,$50.04,$83.16,$84.00,$0.00,$0.00,$0.00,$0.00,$0.00
30200679,EAP,CPT® 88271,,Cytogenetics Dna Probe,$101.00,$11.98,$101.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$101.00,$22.49,$59.86,$79.99,$80.80,$31.06,$33.72,$21.42,$23.60,$21.42
30200680,EAP,CPT® 88275,,Cytogenetics 100-300,$117.00,$25.78,$117.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$117.00,$53.75,$112.22,$92.66,$93.60,$74.23,$63.21,$51.19,$44.25,$51.19
30200681,EAP,CPT® 88184,,Flowcytometry/ Tc 1 Marker,$300.00,$34.11,$565.00,$80.30,$79.23,$271.76,$34.11,$79.23,$79.23,$54.16,$565.00,$284.24,$133.74,$237.60,$452.00,$300.00,$57.71,$68.07,$40.40,$270.71
30200682,EAP,CPT® 88185,,Flowcytometry/tc Add-on,$30.00,$0.00,$47.05,$33.00,$47.05,$0.00,$12.52,$47.05,$47.05,$26.63,$33.00,$0.00,$33.00,$23.76,$26.40,$0.00,$28.37,$22.33,$19.86,$0.00
30200683,EAP,CPT® 88184,,Flowcytometry/ Tc 1 Marker,$300.00,$34.11,$300.00,$80.30,$79.23,$271.76,$34.11,$79.23,$79.23,$54.16,$300.00,$284.24,$133.74,$237.60,$240.00,$300.00,$57.71,$68.07,$40.40,$270.71
30200684,EAP,CPT® 88185,,Flowcytometry/tc Add-on,$14.00,$0.00,$47.05,$14.00,$47.05,$0.00,$12.52,$47.05,$47.05,$26.63,$14.00,$0.00,$14.00,$11.09,$11.20,$0.00,$28.37,$22.33,$19.86,$0.00
30200685,EAP,CPT® 88182,,Cell Marker Study,$93.00,$0.00,$93.00,$0.00,$66.30,$0.00,$0.00,$66.30,$66.30,$0.00,$93.00,$0.00,$93.00,$73.66,$74.40,$0.00,$0.00,$0.00,$0.00,$0.00
30200686,EAP,CPT® 85520,,Heparin Assay,$210.00,$7.33,$210.00,$23.35,$19.11,$17.82,$7.33,$19.11,$19.11,$19.34,$210.00,$13.74,$36.58,$166.32,$168.00,$18.98,$20.61,$13.09,$14.43,$13.09
30200687,EAP,CPT® 87252,,Virus Inoculation Tissue,$496.00,$14.59,$496.00,$39.42,$32.28,$19.64,$14.59,$32.28,$32.28,$32.66,$496.00,$27.37,$61.78,$392.83,$396.80,$37.80,$34.79,$26.07,$24.36,$26.07
30200688,EAP,CPT® 87253,,Virus Inoculate Tissue Addl,$476.00,$0.00,$476.00,$0.00,$23.78,$0.00,$0.00,$23.78,$23.78,$0.00,$476.00,$0.00,$45.52,$376.99,$380.80,$0.00,$0.00,$0.00,$0.00,$0.00
30200693,EAP,CPT® 87449,,Ag Detect Nos Eia Mult,$317.00,$0.00,$317.00,$0.00,$17.52,$0.00,$0.00,$17.52,$17.52,$0.00,$317.00,$0.00,$33.52,$251.06,$253.60,$0.00,$0.00,$0.00,$0.00,$0.00
30200694,EAP,CPT® 82570,,Assay Of Urine Creatinine,$165.00,$2.90,$165.00,$9.23,$7.56,$5.60,$2.90,$7.56,$7.56,$7.64,$165.00,$5.44,$14.46,$130.68,$132.00,$7.51,$8.14,$5.18,$5.70,$5.18
30200695,EAP,CPT® 84378,,Sugars Single Quant,$224.00,$0.00,$224.00,$0.00,$16.83,$0.00,$0.00,$16.83,$16.83,$0.00,$224.00,$0.00,$32.20,$177.41,$179.20,$0.00,$0.00,$0.00,$0.00,$0.00
30200696,EAP,CPT® 80500,,Lab Pathology Consultation,$112.00,$0.00,$112.00,$0.00,$18.15,$0.00,$0.00,$18.15,$18.15,$0.00,$112.00,$0.00,$43.34,$88.70,$89.60,$0.00,$0.00,$0.00,$0.00,$0.00
30200697,EAP,CPT® 87252,,Virus Inoculation Tissue,$496.00,$14.59,$496.00,$39.42,$32.28,$19.64,$14.59,$32.28,$32.28,$32.66,$496.00,$27.37,$61.78,$392.83,$396.80,$37.80,$34.79,$26.07,$24.36,$26.07
30200698,EAP,CPT® 87253,,Virus Inoculate Tissue Addl,$476.00,$0.00,$476.00,$0.00,$23.78,$0.00,$0.00,$23.78,$23.78,$0.00,$476.00,$0.00,$45.52,$376.99,$380.80,$0.00,$0.00,$0.00,$0.00,$0.00
30200708,EAP,CPT® 88368,,Insitu Hybridization Manual,$501.00,$65.14,$501.00,$154.04,$145.54,$271.76,$65.14,$145.54,$145.54,$199.20,$501.00,$284.24,$207.74,$396.79,$400.80,$394.92,$212.25,$90.40,$148.57,$270.71
30200711,EAP,CPT® 80307,,"Drug Screen, Any Number Drug Classes",$410.00,$32.55,$410.00,$99.36,$76.45,$72.98,$32.55,$76.45,$76.45,$71.85,$410.00,$65.25,$205.00,$324.72,$328.00,$90.10,$76.56,$62.14,$53.59,$62.14
30200712,EAP,CPT® 87252,,Virus Inoculation Tissue,$345.00,$14.59,$345.00,$39.42,$32.28,$19.64,$14.59,$32.28,$32.28,$32.66,$345.00,$27.37,$61.78,$273.24,$276.00,$37.80,$34.79,$26.07,$24.36,$26.07
30200713,EAP,CPT® 88184,,Flowcytometry/ Tc 1 Marker,$500.00,$34.11,$500.00,$80.30,$79.23,$271.76,$34.11,$79.23,$79.23,$54.16,$500.00,$284.24,$133.74,$396.00,$400.00,$394.92,$57.71,$68.07,$40.40,$270.71
30200714,EAP,CPT® 88185,,Flowcytometry/tc Add-on,$58.00,$0.00,$58.00,$49.02,$47.05,$0.00,$12.52,$47.05,$47.05,$26.63,$58.00,$0.00,$58.00,$45.94,$46.40,$0.00,$28.37,$22.33,$19.86,$0.00
30200719,EAP,CPT® 88360,,Tumor Immunohistochem/manual,$310.00,$65.32,$310.00,$184.86,$65.70,$137.60,$65.32,$65.70,$65.70,$114.71,$310.00,$143.92,$121.34,$245.52,$248.00,$199.96,$122.23,$83.20,$85.56,$137.07
30200720,EAP,CPT® 88275,,Cytogenetics 100-300,$131.00,$25.78,$131.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$131.00,$53.75,$112.22,$103.75,$104.80,$74.23,$63.21,$51.19,$44.25,$51.19
30200721,EAP,CPT® 88271,,Cytogenetics Dna Probe,$75.00,$11.98,$75.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$75.00,$22.49,$59.86,$59.40,$60.00,$31.06,$33.72,$21.42,$23.60,$21.42
30200732,EAP,CPT® 87530,,Hsv Dna Quant,$76.00,$0.00,$76.00,$0.00,$62.54,$0.00,$0.00,$62.54,$62.54,$0.00,$76.00,$0.00,$76.00,$60.19,$60.80,$0.00,$0.00,$0.00,$0.00,$0.00
30200740,EAP,CPT® 87556,,M.tuberculo Dna Amp Probe,$227.00,$20.99,$227.00,$34.98,$28.64,$37.59,$20.99,$28.64,$28.64,$39.75,$227.00,$43.76,$54.82,$179.78,$181.60,$60.44,$35.53,$41.68,$36.14,$41.68
30200746,EAP,CPT® 83018,,Quantitative Screen Metals,$61.00,$0.00,$61.00,$0.00,$32.06,$0.00,$0.00,$32.06,$32.06,$0.00,$61.00,$0.00,$61.00,$48.31,$48.80,$0.00,$0.00,$0.00,$0.00,$0.00
30200747,EAP,CPT® 83655,,Assay Of Lead,$46.00,$6.77,$46.00,$21.59,$17.67,$16.47,$6.77,$17.67,$17.67,$11.75,$46.00,$12.72,$33.82,$36.43,$36.80,$17.56,$12.52,$12.11,$8.76,$12.11
30200748,EAP,CPT® 83825,,Assay Of Mercury,$41.00,$0.00,$41.00,$28.98,$23.74,$22.12,$0.00,$23.74,$23.74,$24.02,$41.00,$17.07,$41.00,$32.47,$32.80,$23.58,$0.00,$16.26,$17.92,$16.26
30200749,EAP,CPT® 84255,,Assay Of Selenium,$55.00,$0.00,$55.00,$0.00,$37.27,$0.00,$0.00,$37.27,$37.27,$0.00,$55.00,$0.00,$55.00,$43.56,$44.00,$0.00,$0.00,$0.00,$0.00,$0.00
30200750,EAP,CPT® 88182,,Cell Marker Study,$87.00,$0.00,$87.00,$0.00,$66.30,$0.00,$0.00,$66.30,$66.30,$0.00,$87.00,$0.00,$87.00,$68.90,$69.60,$0.00,$0.00,$0.00,$0.00,$0.00
30200751,EAP,CPT® 88342,,Immunohistochemistry,$278.00,$54.62,$278.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$278.00,$143.92,$106.46,$220.18,$222.40,$199.96,$89.59,$70.23,$62.72,$137.07
30200752,EAP,CPT® 88230,,Tissue Culture Lymphocyte,$206.00,$65.17,$206.00,$206.00,$170.10,$158.54,$65.17,$170.10,$170.10,$172.08,$206.00,$122.31,$206.00,$163.15,$164.80,$168.91,$183.36,$116.49,$128.35,$116.49
30200753,EAP,CPT® 88263,,Chromosome Analysis 45,$267.00,$0.00,$267.00,$0.00,$219.42,$0.00,$0.00,$219.42,$219.42,$0.00,$267.00,$0.00,$267.00,$211.46,$213.60,$0.00,$0.00,$0.00,$0.00,$0.00
30200754,EAP,CPT® 88285,,Chromosome Count Additional,$34.00,$0.00,$34.00,$0.00,$27.74,$0.00,$0.00,$27.74,$27.74,$0.00,$34.00,$0.00,$34.00,$26.93,$27.20,$0.00,$0.00,$0.00,$0.00,$0.00
30200756,EAP,CPT® 82441,,Test For Chlorohydrocarbons,$183.00,$0.00,$183.00,$0.00,$8.76,$0.00,$0.00,$8.76,$8.76,$0.00,$183.00,$0.00,$16.76,$144.94,$146.40,$0.00,$0.00,$0.00,$0.00,$0.00
30200757,EAP,CPT® 82570,,Assay Of Urine Creatinine,$83.00,$2.90,$83.00,$9.23,$7.56,$5.60,$2.90,$7.56,$7.56,$7.64,$83.00,$5.44,$14.46,$65.74,$66.40,$7.51,$8.14,$5.18,$5.70,$5.18
30200758,EAP,CPT® 84600,,Assay Of Volatiles,$100.00,$0.00,$100.00,$0.00,$23.47,$0.00,$0.00,$23.47,$23.47,$0.00,$100.00,$0.00,$44.90,$79.20,$80.00,$0.00,$0.00,$0.00,$0.00,$0.00
30200759,EAP,CPT® 85576,,Blood Platelet Aggregation,$151.00,$12.54,$151.00,$38.30,$31.37,$29.24,$12.54,$31.37,$31.37,$31.73,$151.00,$26.16,$60.02,$119.59,$120.80,$36.12,$33.81,$24.91,$23.67,$24.91
30200760,EAP,CPT® 85049,,Automated Platelet Count,$24.00,$2.51,$24.00,$7.98,$6.53,$6.09,$2.51,$6.53,$6.53,$6.62,$24.00,$4.70,$12.50,$19.01,$19.20,$6.50,$7.05,$4.48,$4.93,$4.48
30200776,EAP,CPT® 88184,,Flowcytometry/ Tc 1 Marker,$303.00,$34.11,$303.00,$80.30,$79.23,$271.76,$34.11,$79.23,$79.23,$54.16,$303.00,$284.24,$133.74,$239.98,$242.40,$303.00,$57.71,$68.07,$40.40,$270.71
30200777,EAP,CPT® 88185,,Flowcytometry/tc Add-on,$26.00,$0.00,$47.05,$26.00,$47.05,$0.00,$12.52,$47.05,$47.05,$26.63,$26.00,$0.00,$26.00,$20.59,$20.80,$0.00,$28.37,$22.33,$19.86,$0.00
30200778,EAP,CPT® 88187,,Flowcytometry/read 2-8,$180.00,$19.59,$180.00,$77.02,$128.47,$32.04,$19.59,$128.47,$128.47,$70.22,$180.00,$50.66,$130.50,$142.56,$144.00,$39.31,$74.83,$39.31,$52.38,$39.31
30200784,EAP,CPT® 80500,,Lab Pathology Consultation,$53.00,$0.00,$53.00,$0.00,$18.15,$0.00,$0.00,$18.15,$18.15,$0.00,$53.00,$0.00,$43.34,$41.98,$42.40,$0.00,$0.00,$0.00,$0.00,$0.00
30200785,EAP,CPT® 82657,,Enzyme Cell Activity,$25.00,$0.00,$25.00,$0.00,$8.77,$0.00,$0.00,$8.77,$8.77,$0.00,$25.00,$0.00,$16.78,$19.80,$20.00,$0.00,$0.00,$0.00,$0.00,$0.00
30200790,EAP,CPT® 86022,,Platelet Antibodies,$184.00,$0.00,$184.00,$0.00,$26.82,$0.00,$0.00,$26.82,$26.82,$0.00,$184.00,$0.00,$51.32,$145.73,$147.20,$0.00,$0.00,$0.00,$0.00,$0.00
30200791,EAP,CPT® 86022,,Platelet Antibodies,$106.00,$0.00,$106.00,$0.00,$26.82,$0.00,$0.00,$26.82,$26.82,$0.00,$106.00,$0.00,$51.32,$83.95,$84.80,$0.00,$0.00,$0.00,$0.00,$0.00
30200792,EAP,CPT® 88239,,Tissue Culture Tumor,$306.00,$82.52,$306.00,$263.00,$215.39,$200.75,$82.52,$215.39,$215.39,$217.93,$306.00,$154.90,$306.00,$242.35,$244.80,$213.90,$232.21,$147.52,$162.54,$147.52
30200793,EAP,CPT® 88237,,Tissue Culture Bone Marrow,$263.00,$72.38,$263.00,$157.39,$128.90,$171.89,$72.38,$128.90,$128.90,$130.42,$263.00,$150.94,$246.70,$208.30,$210.40,$208.44,$138.97,$143.75,$97.28,$143.75
30200804,EAP,CPT® 88271,,Cytogenetics Dna Probe,$82.00,$11.98,$82.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$82.00,$22.49,$59.86,$64.94,$65.60,$31.06,$33.72,$21.42,$23.60,$21.42
30200805,EAP,CPT® 88275,,Cytogenetics 100-300,$146.00,$25.78,$146.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$146.00,$53.75,$112.22,$115.63,$116.80,$74.23,$63.21,$51.19,$44.25,$51.19
30200806,EAP,CPT® 86780,,Treponema Pallidum,$163.00,$7.41,$163.00,$23.60,$18.97,$18.02,$7.41,$18.97,$18.97,$28.54,$163.00,$13.90,$81.50,$129.10,$130.40,$19.20,$25.51,$13.24,$25.95,$13.24
30200818,EAP,CPT® 86003,,Allergen Specific Ige,$451.00,$2.92,$451.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$451.00,$5.48,$14.60,$357.19,$360.80,$7.57,$8.22,$5.22,$5.76,$5.22
30200819,EAP,CPT® 86003,,Allergen Specific Ige,$451.00,$2.92,$451.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$451.00,$5.48,$14.60,$357.19,$360.80,$7.57,$8.22,$5.22,$5.76,$5.22
30200820,EAP,CPT® 86003,,Allergen Specific Ige,$451.00,$2.92,$451.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$451.00,$5.48,$14.60,$357.19,$360.80,$7.57,$8.22,$5.22,$5.76,$5.22
30200827,EAP,CPT® 88271,,Cytogenetics Dna Probe,$106.00,$11.98,$106.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$106.00,$22.49,$59.86,$83.95,$84.80,$31.06,$33.72,$21.42,$23.60,$21.42
30200828,EAP,CPT® 88272,,Cytogenetics 3-5,$126.00,$0.00,$126.00,$0.00,$39.09,$0.00,$0.00,$39.09,$39.09,$0.00,$126.00,$0.00,$74.82,$99.79,$100.80,$0.00,$0.00,$0.00,$0.00,$0.00
30200830,EAP,CPT® 88237,,Tissue Culture Bone Marrow,$416.00,$72.38,$416.00,$157.39,$128.90,$171.89,$72.38,$128.90,$128.90,$130.42,$416.00,$150.94,$246.70,$329.47,$332.80,$208.44,$138.97,$143.75,$97.28,$143.75
30200831,EAP,CPT® 88271,,Cytogenetics Dna Probe,$342.00,$11.98,$342.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$342.00,$22.49,$59.86,$270.86,$273.60,$31.06,$33.72,$21.42,$23.60,$21.42
30200832,EAP,CPT® 88275,,Cytogenetics 100-300,$400.00,$25.78,$400.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$400.00,$53.75,$112.22,$316.80,$320.00,$74.23,$63.21,$51.19,$44.25,$51.19
30200840,EAP,CPT® 88237,,Tissue Culture Bone Marrow,$290.00,$72.38,$290.00,$157.39,$128.90,$171.89,$72.38,$128.90,$128.90,$130.42,$290.00,$150.94,$246.70,$229.68,$232.00,$208.44,$138.97,$143.75,$97.28,$143.75
30200841,EAP,CPT® 88262,,Chromosome Analysis 15-20,$243.00,$69.72,$243.00,$222.21,$181.98,$169.62,$69.72,$181.98,$181.98,$184.12,$243.00,$131.76,$243.00,$192.46,$194.40,$181.96,$196.18,$125.49,$137.33,$125.49
30200843,EAP,CPT® 87449,,Ag Detect Nos Eia Mult,$253.00,$0.00,$253.00,$0.00,$17.52,$0.00,$0.00,$17.52,$17.52,$0.00,$253.00,$0.00,$33.52,$200.38,$202.40,$0.00,$0.00,$0.00,$0.00,$0.00
30200844,EAP,CPT® 87449,,Ag Detect Nos Eia Mult,$253.00,$0.00,$253.00,$0.00,$17.52,$0.00,$0.00,$17.52,$17.52,$0.00,$253.00,$0.00,$33.52,$200.38,$202.40,$0.00,$0.00,$0.00,$0.00,$0.00
30200845,EAP,CPT® 88291,,Cyto/molecular Report,$29.00,$0.00,$29.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$29.00,$0.00,$29.00,$22.97,$23.20,$0.00,$0.00,$0.00,$0.00,$0.00
30200846,EAP,CPT® 88271,,Cytogenetics Dna Probe,$107.00,$11.98,$107.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$107.00,$22.49,$59.86,$84.74,$85.60,$31.06,$33.72,$21.42,$23.60,$21.42
30200847,EAP,CPT® 88275,,Cytogenetics 100-300,$136.00,$25.78,$136.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$136.00,$53.75,$112.22,$107.71,$108.80,$74.23,$63.21,$51.19,$44.25,$51.19
30200848,EAP,CPT® 88271,,Cytogenetics Dna Probe,$80.00,$11.98,$80.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$80.00,$22.49,$59.86,$63.36,$64.00,$31.06,$33.72,$21.42,$23.60,$21.42
30200849,EAP,CPT® 88272,,Cytogenetics 3-5,$106.00,$0.00,$106.00,$0.00,$39.09,$0.00,$0.00,$39.09,$39.09,$0.00,$106.00,$0.00,$74.82,$83.95,$84.80,$0.00,$0.00,$0.00,$0.00,$0.00
30200856,EAP,CPT® 87186,,Microbe Susceptible Mic,$308.00,$4.83,$308.00,$15.41,$12.62,$11.77,$4.83,$12.62,$12.62,$12.77,$308.00,$9.08,$24.16,$243.94,$246.40,$12.54,$13.60,$8.65,$9.52,$8.65
30200863,EAP,CPT® 82136,,Amino Acids Quant 2-5,$338.00,$0.00,$338.00,$0.00,$24.63,$0.00,$0.00,$24.63,$24.63,$0.00,$338.00,$0.00,$47.14,$267.70,$270.40,$0.00,$0.00,$0.00,$0.00,$0.00
30200864,EAP,CPT® 88271,,Cytogenetics Dna Probe,$80.00,$11.98,$80.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$80.00,$22.49,$59.86,$63.36,$64.00,$31.06,$33.72,$21.42,$23.60,$21.42
30200865,EAP,CPT® 88275,,Cytogenetics 100-300,$139.00,$25.78,$139.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$139.00,$53.75,$112.22,$110.09,$111.20,$74.23,$63.21,$51.19,$44.25,$51.19
30200867,EAP,CPT® 87385,,Histoplasma Capsul Ag Eia,$215.00,$6.70,$215.00,$21.36,$17.52,$16.32,$6.70,$17.52,$17.52,$17.71,$215.00,$13.91,$33.52,$170.28,$172.00,$19.21,$18.87,$13.25,$13.21,$13.25
30200868,EAP,CPT® 87798,,Detect Agent Nos Dna Amp,$389.00,$19.63,$389.00,$34.98,$28.64,$37.59,$19.63,$28.64,$28.64,$28.98,$389.00,$36.84,$54.82,$308.09,$311.20,$50.88,$30.88,$35.09,$21.62,$35.09
30200869,EAP,CPT® 82175,,Assay Of Arsenic,$34.00,$0.00,$34.00,$33.81,$27.70,$25.82,$0.00,$27.70,$27.70,$28.02,$34.00,$19.92,$34.00,$26.93,$27.20,$27.51,$0.00,$18.97,$20.90,$18.97
30200895,EAP,CPT® 84481,,"T3, Free",$148.00,$9.48,$148.00,$30.21,$24.74,$23.05,$9.48,$24.74,$24.74,$25.02,$148.00,$17.79,$47.34,$117.22,$118.40,$24.56,$26.66,$16.94,$18.66,$16.94
30200896,EAP,CPT® 84481,,Free Assay(ft-3),$157.00,$9.48,$157.00,$30.21,$24.74,$23.05,$9.48,$24.74,$24.74,$25.02,$157.00,$17.79,$47.34,$124.34,$125.60,$24.56,$26.66,$16.94,$18.66,$16.94
30200898,EAP,CPT® 83789,,Mass Spectrometry Quant,$118.00,$0.00,$118.00,$0.00,$8.77,$0.00,$0.00,$8.77,$8.77,$0.00,$118.00,$0.00,$16.78,$93.46,$94.40,$0.00,$0.00,$0.00,$0.00,$0.00
30200900,EAP,CPT® 82154,,Androstanediol Glucuronide,$437.00,$0.00,$437.00,$0.00,$42.10,$0.00,$0.00,$42.10,$42.10,$0.00,$437.00,$0.00,$80.58,$346.10,$349.60,$0.00,$0.00,$0.00,$0.00,$0.00
30200908,EAP,CPT® 82010,,Acetone Assay,$285.00,$4.58,$285.00,$14.57,$11.93,$9.14,$4.58,$11.93,$11.93,$12.08,$285.00,$8.58,$22.84,$225.72,$228.00,$11.85,$12.87,$8.17,$9.01,$8.17
30200910,EAP,CPT® 82010,,Acetone Assay,$153.00,$4.58,$153.00,$14.57,$11.93,$9.14,$4.58,$11.93,$11.93,$12.08,$153.00,$8.58,$22.84,$121.18,$122.40,$11.85,$12.87,$8.17,$9.01,$8.17
30200912,EAP,CPT® 87252,,Virus Inoculation Tissue,$488.00,$14.59,$488.00,$39.42,$32.28,$19.64,$14.59,$32.28,$32.28,$32.66,$488.00,$27.37,$61.78,$386.50,$390.40,$37.80,$34.79,$26.07,$24.36,$26.07
30200913,EAP,CPT® 87253,,Virus Inoculate Tissue Addl,$488.00,$0.00,$488.00,$0.00,$23.78,$0.00,$0.00,$23.78,$23.78,$0.00,$488.00,$0.00,$45.52,$386.50,$390.40,$0.00,$0.00,$0.00,$0.00,$0.00
30200915,EAP,CPT® 82017,,Acylcarnities Quant,$247.00,$0.00,$247.00,$0.00,$24.63,$0.00,$0.00,$24.63,$24.63,$0.00,$247.00,$0.00,$47.14,$195.62,$197.60,$0.00,$0.00,$0.00,$0.00,$0.00
30200919,EAP,CPT® 84311,,Spectrophotometry,$241.00,$4.08,$241.00,$12.47,$10.20,$9.52,$4.08,$10.20,$10.20,$10.32,$241.00,$8.51,$19.54,$190.87,$192.80,$11.75,$11.00,$8.10,$7.70,$8.10
30200921,EAP,CPT® 84311,,Spectrophotometry,$241.00,$4.08,$241.00,$12.47,$10.20,$9.52,$4.08,$10.20,$10.20,$10.32,$241.00,$8.51,$19.54,$190.87,$192.80,$11.75,$11.00,$8.10,$7.70,$8.10
30200923,EAP,CPT® 87260,,Adenovirus Ag If,$128.00,$0.00,$128.00,$0.00,$17.52,$0.00,$0.00,$17.52,$17.52,$0.00,$128.00,$0.00,$33.52,$101.38,$102.40,$0.00,$0.00,$0.00,$0.00,$0.00
30200925,EAP,CPT® 87798,,Detect Agent Nos Dna Amp,$559.00,$19.63,$559.00,$34.98,$28.64,$37.59,$19.63,$28.64,$28.64,$28.98,$559.00,$36.84,$54.82,$442.73,$447.20,$50.88,$30.88,$35.09,$21.62,$35.09
30200927,EAP,CPT® 86316,,Immunoassay Tumor Other,$178.00,$11.65,$178.00,$37.10,$30.38,$28.32,$11.65,$30.38,$30.38,$30.73,$178.00,$21.85,$58.14,$140.98,$142.40,$30.17,$32.75,$20.81,$22.92,$20.81
30200929,EAP,CPT® 82088,,Assay Of Aldosterone,$297.00,$22.80,$297.00,$72.64,$59.50,$55.46,$22.80,$59.50,$59.50,$60.21,$297.00,$42.79,$113.88,$235.22,$237.60,$59.09,$64.15,$40.75,$44.91,$40.75
30200937,EAP,CPT® 82103,,Alpha-1-antitrypsin Total,$137.00,$7.52,$137.00,$23.96,$19.61,$18.29,$7.52,$19.61,$19.61,$19.85,$137.00,$14.11,$37.54,$108.50,$109.60,$19.49,$21.15,$13.44,$14.80,$13.44
30200939,EAP,CPT® 86316,,Immunoassay Tumor Other,$178.00,$11.65,$178.00,$37.10,$30.38,$28.32,$11.65,$30.38,$30.38,$30.73,$178.00,$21.85,$58.14,$140.98,$142.40,$30.17,$32.75,$20.81,$22.92,$20.81
30200941,EAP,CPT® 86147,,Cardiolipin Antibody,$66.00,$14.24,$66.00,$45.37,$37.14,$21.84,$14.24,$37.14,$37.14,$37.58,$66.00,$26.72,$66.00,$52.27,$52.80,$36.90,$40.04,$25.45,$28.03,$25.45
30200943,EAP,CPT® 83520,,Immunoassay Quant Nos Nonab,$331.00,$8.69,$331.00,$23.07,$18.91,$17.62,$8.69,$18.91,$18.91,$19.12,$331.00,$18.13,$36.18,$262.15,$264.80,$25.04,$20.37,$17.27,$14.26,$17.27
30200945,EAP,CPT® 86146,,Glycoprotein Antibody,$134.00,$14.24,$134.00,$45.37,$37.14,$21.84,$14.24,$37.14,$37.14,$37.58,$134.00,$26.72,$71.08,$106.13,$107.20,$36.90,$40.04,$25.45,$28.03,$25.45
30200946,EAP,CPT® 86147,,Cardiolipin Antibody,$134.00,$14.24,$134.00,$45.37,$37.14,$21.84,$14.24,$37.14,$37.14,$37.58,$134.00,$26.72,$71.08,$106.13,$107.20,$36.90,$40.04,$25.45,$28.03,$25.45
30200947,EAP,CPT® 86148,,Phospholipid Antibody,$104.00,$0.00,$104.00,$0.00,$23.45,$0.00,$0.00,$23.45,$23.45,$0.00,$104.00,$0.00,$44.88,$82.37,$83.20,$0.00,$0.00,$0.00,$0.00,$0.00
30200949,EAP,CPT® 85300,,"Antithrombin Iii Test,activity",$588.00,$6.63,$588.00,$21.14,$17.30,$16.13,$6.63,$17.30,$17.30,$17.50,$588.00,$12.44,$33.10,$465.70,$470.40,$17.18,$18.65,$11.85,$13.06,$11.85
30200950,EAP,CPT® 85301,,"Antithrombin Iii Test,antigen Assay",$588.00,$6.04,$588.00,$19.27,$15.79,$14.71,$6.04,$15.79,$15.79,$15.98,$588.00,$11.35,$30.22,$465.70,$470.40,$15.67,$17.03,$10.81,$11.92,$10.81
30200952,EAP,CPT® 82172,,Assay Of Apolipoprotein,$41.00,$10.62,$41.00,$27.63,$22.62,$19.23,$10.62,$22.62,$22.62,$22.90,$41.00,$22.14,$41.00,$32.47,$32.80,$30.58,$24.40,$21.09,$17.08,$21.09
30200954,EAP,CPT® 86651,,"Antibody Encephalitis, California (la Crosse)",$25.00,$0.00,$25.00,$0.00,$19.25,$0.00,$0.00,$19.25,$19.25,$0.00,$25.00,$0.00,$25.00,$19.80,$20.00,$0.00,$0.00,$0.00,$0.00,$0.00
30200955,EAP,CPT® 86652,,"Antibody Encephalitis, Eastern Equine",$25.00,$0.00,$25.00,$0.00,$19.25,$0.00,$0.00,$19.25,$19.25,$0.00,$25.00,$0.00,$25.00,$19.80,$20.00,$0.00,$0.00,$0.00,$0.00,$0.00
30200956,EAP,CPT® 86653,,"Antibody Encephalitis, St. Louis",$25.00,$0.00,$25.00,$0.00,$19.25,$0.00,$0.00,$19.25,$19.25,$0.00,$25.00,$0.00,$25.00,$19.80,$20.00,$0.00,$0.00,$0.00,$0.00,$0.00
30200957,EAP,CPT® 86654,,"Antibody Encephalitis, Western Equine",$25.00,$0.00,$25.00,$0.00,$19.25,$0.00,$0.00,$19.25,$19.25,$0.00,$25.00,$0.00,$25.00,$19.80,$20.00,$0.00,$0.00,$0.00,$0.00,$0.00
30200959,EAP,CPT® 82175,,Assay Of Arsenic,$117.00,$0.00,$117.00,$33.81,$27.70,$25.82,$0.00,$27.70,$27.70,$28.02,$117.00,$19.92,$53.02,$92.66,$93.60,$27.51,$0.00,$18.97,$20.90,$18.97
30200961,EAP,CPT® 84311,,Spectrophotometry,$357.00,$4.08,$357.00,$12.47,$10.20,$9.52,$4.08,$10.20,$10.20,$10.32,$357.00,$8.51,$19.54,$282.74,$285.60,$11.75,$11.00,$8.10,$7.70,$8.10
30200963,EAP,CPT® 86003,,Allergen Specific Ige,$155.00,$2.92,$155.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$155.00,$5.48,$14.60,$122.76,$124.00,$7.57,$8.22,$5.22,$5.76,$5.22
30200965,EAP,CPT® 87305,,Aspergillus Ag Eia,$139.00,$6.70,$139.00,$21.36,$17.52,$16.32,$6.70,$17.52,$17.52,$17.71,$139.00,$12.58,$33.52,$110.09,$111.20,$17.37,$18.87,$11.98,$13.21,$11.98
30200967,EAP,CPT® 80299,,Quantitative Assay Drug,$280.00,$9.39,$280.00,$24.21,$17.58,$15.07,$9.39,$17.58,$17.58,$17.79,$280.00,$19.57,$33.64,$221.76,$224.00,$27.03,$18.95,$18.64,$13.27,$18.64
30200969,EAP,CPT® 86337,,Insulin Antibodies,$411.00,$0.00,$411.00,$38.17,$31.27,$29.13,$0.00,$31.27,$31.27,$31.64,$411.00,$22.48,$59.84,$325.51,$328.80,$31.04,$0.00,$21.41,$23.60,$21.41
30200976,EAP,CPT® 86753,,Protozoa Antibody Nos,$55.00,$0.00,$55.00,$0.00,$18.09,$0.00,$0.00,$18.09,$18.09,$0.00,$55.00,$0.00,$34.64,$43.56,$44.00,$0.00,$0.00,$0.00,$0.00,$0.00
30200978,EAP,CPT® 87798,,Detect Agent Nos Dna Amp,$530.00,$19.63,$530.00,$34.98,$28.64,$37.59,$19.63,$28.64,$28.64,$28.98,$530.00,$36.84,$54.82,$419.76,$424.00,$50.88,$30.88,$35.09,$21.62,$35.09
30200980,EAP,CPT® 80299,,Quantitative Assay Drug,$301.00,$9.39,$301.00,$24.21,$17.58,$15.07,$9.39,$17.58,$17.58,$17.79,$301.00,$19.57,$33.64,$238.39,$240.80,$27.03,$18.95,$18.64,$13.27,$18.64
30200982,EAP,CPT® 87471,,Bartonella Dna Amp Probe,$435.00,$0.00,$435.00,$0.00,$28.64,$0.00,$0.00,$28.64,$28.64,$0.00,$435.00,$0.00,$54.82,$344.52,$348.00,$0.00,$0.00,$0.00,$0.00,$0.00
30200997,EAP,CPT® 80299,,Quantitative Assay Drug,$189.00,$9.39,$189.00,$24.21,$17.58,$15.07,$9.39,$17.58,$17.58,$17.79,$189.00,$19.57,$33.64,$149.69,$151.20,$27.03,$18.95,$18.64,$13.27,$18.64
30200999,EAP,CPT® 86146,,Glycoprotein Antibody,$116.00,$14.24,$116.00,$45.37,$37.14,$21.84,$14.24,$37.14,$37.14,$37.58,$116.00,$26.72,$71.08,$91.87,$92.80,$36.90,$40.04,$25.45,$28.03,$25.45
30201001,EAP,CPT® 82143,,Amniotic Fluid Scan,$50.00,$0.00,$50.00,$0.00,$10.03,$0.00,$0.00,$10.03,$10.03,$0.00,$50.00,$0.00,$19.22,$39.60,$40.00,$0.00,$0.00,$0.00,$0.00,$0.00
30201003,EAP,CPT® 87799,,Detect Agent Nos Dna Quant,"$1,286.00",$0.00,"$1,286.00",$0.00,$62.54,$0.00,$23.96,$62.54,$62.54,$0.00,"$1,286.00",$0.00,$119.70,"$1,018.51","$1,028.80",$0.00,$201.26,$0.00,$0.00,$0.00
30201005,EAP,CPT® 86615,,Bordetella Antibody,$77.00,$0.00,$77.00,$0.00,$19.25,$0.00,$0.00,$19.25,$19.25,$0.00,$77.00,$0.00,$36.86,$60.98,$61.60,$0.00,$0.00,$0.00,$0.00,$0.00
30201007,EAP,CPT® 82523,,Collagen Crosslinks,$180.00,$10.45,$180.00,$33.31,$27.29,$16.33,$10.45,$27.29,$27.29,$27.60,$180.00,$19.61,$52.22,$142.56,$144.00,$27.09,$29.41,$18.68,$20.59,$18.68
30201009,EAP,CPT® 83520,,Immunoassay Quant Nos Nonab,$210.00,$8.69,$210.00,$23.07,$18.91,$17.62,$8.69,$18.91,$18.91,$19.12,$210.00,$18.13,$36.18,$166.32,$168.00,$25.04,$20.37,$17.27,$14.26,$17.27
30201011,EAP,CPT® 86160,,Complement Antigen,$258.00,$6.71,$258.00,$21.39,$17.53,$16.33,$6.71,$17.53,$17.53,$17.73,$258.00,$12.60,$33.56,$204.34,$206.40,$17.40,$18.90,$12.00,$13.23,$12.00
30201013,EAP,CPT® 86329,,Immunodiffusion,$150.00,$7.85,$150.00,$25.03,$20.51,$19.11,$7.85,$20.51,$20.51,$20.75,$150.00,$14.75,$39.24,$118.80,$120.00,$20.37,$22.11,$14.05,$15.48,$14.05
30201015,EAP,CPT® 86301,,Immunoassay Tumor Ca 19-9,$92.00,$11.65,$92.00,$37.10,$30.38,$28.32,$11.65,$30.38,$30.38,$30.73,$92.00,$21.85,$58.14,$72.86,$73.60,$30.17,$32.75,$20.81,$22.92,$20.81
30201017,EAP,CPT® 86403,,Particle Agglutination Test,$216.00,$5.81,$216.00,$18.17,$14.88,$13.87,$5.81,$14.88,$14.88,$11.75,$216.00,$12.12,$28.48,$171.07,$172.80,$16.73,$12.52,$11.54,$8.76,$11.54
30201019,EAP,CPT® 80157,,Assay Of Carbamazepine Free,$155.00,$0.00,$155.00,$0.00,$19.36,$0.00,$0.00,$19.36,$19.36,$0.00,$155.00,$0.00,$37.04,$122.76,$124.00,$0.00,$0.00,$0.00,$0.00,$0.00
30201021,EAP,CPT® 82375,,Assay Carboxyhb Quant,$60.00,$0.00,$60.00,$0.00,$4.20,$0.00,$0.00,$4.20,$4.20,$0.00,$60.00,$0.00,$8.04,$47.52,$48.00,$0.00,$0.00,$0.00,$0.00,$0.00
30201023,EAP,CPT® 83516,,Immunoassay Nonantibody,$194.00,$6.44,$194.00,$19.04,$15.61,$15.70,$6.44,$15.61,$15.61,$15.80,$194.00,$12.11,$29.88,$153.65,$155.20,$16.72,$16.84,$11.53,$11.79,$11.53
30201025,EAP,CPT® 86147,,Cariolipin Antibody,$66.00,$14.24,$66.00,$45.37,$37.14,$21.84,$14.24,$37.14,$37.14,$37.58,$66.00,$26.72,$66.00,$52.27,$52.80,$36.90,$40.04,$25.45,$28.03,$25.45
30201027,EAP,CPT® 82384,,Assay Three Catecholamines,$86.00,$14.13,$86.00,$45.01,$36.87,$34.36,$14.13,$36.87,$36.87,$37.30,$86.00,$26.51,$70.56,$68.11,$68.80,$36.61,$39.74,$25.25,$27.82,$25.25
30201028,EAP,CPT® 82570,,Assay Of Urine Creatinine,$34.00,$2.90,$34.00,$9.23,$7.56,$5.60,$2.90,$7.56,$7.56,$7.64,$34.00,$5.44,$14.46,$26.93,$27.20,$7.51,$8.14,$5.18,$5.70,$5.18
30201030,EAP,CPT® 88184,,Flowcytometry/tc 1 Marker,$500.00,$34.11,$500.00,$80.30,$79.23,$271.76,$34.11,$79.23,$79.23,$54.16,$500.00,$284.24,$133.74,$396.00,$400.00,$394.92,$57.71,$68.07,$40.40,$270.71
30201031,EAP,CPT® 88185,,Flowcytometry/tc Add-on,$48.00,$0.00,$48.00,$48.00,$47.05,$0.00,$12.52,$47.05,$47.05,$26.63,$48.00,$0.00,$48.00,$38.02,$38.40,$0.00,$28.37,$22.33,$19.86,$0.00
30201032,EAP,CPT® 88187,,Flowcytometry/read 2-8,$180.00,$19.59,$180.00,$77.02,$128.47,$32.04,$19.59,$128.47,$128.47,$70.22,$180.00,$50.66,$130.50,$142.56,$144.00,$39.31,$74.83,$39.31,$52.38,$39.31
30201034,EAP,CPT® 82378,,Carcinoembryinic Antigen,$60.00,$10.61,$60.00,$33.81,$27.70,$25.81,$10.61,$27.70,$27.70,$28.02,$60.00,$19.91,$53.02,$47.52,$48.00,$27.49,$29.86,$18.96,$20.90,$18.96
30201036,EAP,CPT® 82378,,Carcinoembryinic Antigen,$60.00,$10.61,$60.00,$33.81,$27.70,$25.81,$10.61,$27.70,$27.70,$28.02,$60.00,$19.91,$53.02,$47.52,$48.00,$27.49,$29.86,$18.96,$20.90,$18.96
30201038,EAP,CPT® 86631,,Chlamydia Antibody,$79.00,$0.00,$79.00,$0.00,$17.27,$0.00,$6.61,$17.27,$17.27,$17.47,$79.00,$0.00,$33.04,$62.57,$63.20,$0.00,$18.62,$0.00,$0.00,$0.00
30201039,EAP,CPT® 86632,,Chlamydia Igm Antibody,$82.00,$0.00,$82.00,$0.00,$18.53,$0.00,$0.00,$18.53,$18.53,$0.00,$82.00,$0.00,$35.48,$64.94,$65.60,$0.00,$0.00,$0.00,$0.00,$0.00
30201041,EAP,CPT® 82480,,Assay Serum Cholinesterase,$58.00,$0.00,$58.00,$0.00,$11.51,$0.00,$0.00,$11.51,$11.51,$0.00,$58.00,$0.00,$22.02,$45.94,$46.40,$0.00,$0.00,$0.00,$0.00,$0.00
30201043,EAP,CPT® 82495,,Assay Of Chromium,$97.00,$0.00,$97.00,$0.00,$29.61,$0.00,$0.00,$29.61,$29.61,$0.00,$97.00,$0.00,$56.68,$76.82,$77.60,$0.00,$0.00,$0.00,$0.00,$0.00
30201045,EAP,CPT® 86316,,Immunoassay Tumor Other,$293.00,$11.65,$293.00,$37.10,$30.38,$28.32,$11.65,$30.38,$30.38,$30.73,$293.00,$21.85,$58.14,$232.06,$234.40,$30.17,$32.75,$20.81,$22.92,$20.81
30201049,EAP,CPT® 86157,,Cold Agglutinin Titer,$24.00,$0.00,$24.00,$0.00,$11.77,$0.00,$0.00,$11.77,$11.77,$0.00,$24.00,$0.00,$22.54,$19.01,$19.20,$0.00,$0.00,$0.00,$0.00,$0.00
30201051,EAP,CPT® 82523,,Collagen Crosslinks,$99.00,$10.45,$99.00,$33.31,$27.29,$16.33,$10.45,$27.29,$27.29,$27.60,$99.00,$19.61,$52.22,$78.41,$79.20,$27.09,$29.41,$18.68,$20.59,$18.68
30201053,EAP,CPT® 86160,,Complement Antigen,$258.00,$6.71,$258.00,$21.39,$17.53,$16.33,$6.71,$17.53,$17.53,$17.73,$258.00,$12.60,$33.56,$204.34,$206.40,$17.40,$18.90,$12.00,$13.23,$12.00
30201055,EAP,CPT® 86160,,Complement Antigen,$231.00,$6.71,$231.00,$21.39,$17.53,$16.33,$6.71,$17.53,$17.53,$17.73,$231.00,$12.60,$33.56,$182.95,$184.80,$17.40,$18.90,$12.00,$13.23,$12.00
30201057,EAP,CPT® 86160,,Complement Antigen,$265.00,$6.71,$265.00,$21.39,$17.53,$16.33,$6.71,$17.53,$17.53,$17.73,$265.00,$12.60,$33.56,$209.88,$212.00,$17.40,$18.90,$12.00,$13.23,$12.00
30201059,EAP,CPT® 86160,,Complement Antigen,$265.00,$6.71,$265.00,$21.39,$17.53,$16.33,$6.71,$17.53,$17.53,$17.73,$265.00,$12.60,$33.56,$209.88,$212.00,$17.40,$18.90,$12.00,$13.23,$12.00
30201061,EAP,CPT® 86160,,Complement Antigen,$258.00,$6.71,$258.00,$21.39,$17.53,$16.33,$6.71,$17.53,$17.53,$17.73,$258.00,$12.60,$33.56,$204.34,$206.40,$17.40,$18.90,$12.00,$13.23,$12.00
30201063,EAP,CPT® 83519,,Ria Nonantibody,$667.00,$9.26,$667.00,$24.08,$19.73,$18.39,$9.26,$19.73,$19.73,$19.96,$667.00,$19.32,$37.76,$528.26,$533.60,$26.68,$21.27,$18.40,$14.89,$18.40
30201065,EAP,CPT® 82530,,Cortisol Free,$182.00,$9.35,$182.00,$29.78,$24.41,$22.74,$9.35,$24.41,$24.41,$24.70,$182.00,$17.55,$46.70,$144.14,$145.60,$24.23,$26.31,$16.71,$18.42,$16.71
30201067,EAP,CPT® 80299,,Quantitative Assay Drug,$151.00,$9.39,$151.00,$24.21,$17.58,$15.07,$9.39,$17.58,$17.58,$17.79,$151.00,$19.57,$33.64,$119.59,$120.80,$27.03,$18.95,$18.64,$13.27,$18.64
30201069,EAP,CPT® 82552,,Assay Of Cpk In Blood,$61.00,$0.00,$61.00,$0.00,$19.56,$0.00,$0.00,$19.56,$19.56,$0.00,$61.00,$0.00,$37.42,$48.31,$48.80,$0.00,$0.00,$0.00,$0.00,$0.00
30201071,EAP,CPT® 86343,,Leukocyte Histamine Release,$386.00,$0.00,$386.00,$0.00,$18.20,$0.00,$0.00,$18.20,$18.20,$0.00,$386.00,$0.00,$34.82,$305.71,$308.80,$0.00,$0.00,$0.00,$0.00,$0.00
30201073,EAP,CPT® 84443,,Assay Thyroid Stim Hormone,$146.00,$9.40,$146.00,$29.96,$24.53,$22.87,$9.40,$24.53,$24.53,$24.81,$146.00,$17.64,$46.94,$115.63,$116.80,$24.36,$26.44,$16.80,$18.51,$16.80
30201074,EAP,CPT® 86343,,Leukocyte Histamine Release,$204.00,$0.00,$204.00,$0.00,$18.20,$0.00,$0.00,$18.20,$18.20,$0.00,$204.00,$0.00,$34.82,$161.57,$163.20,$0.00,$0.00,$0.00,$0.00,$0.00
30201075,EAP,CPT® 86376,,Microsomal Antibody,$108.00,$8.14,$108.00,$25.95,$21.25,$19.80,$8.14,$21.25,$21.25,$21.49,$108.00,$15.28,$40.66,$85.54,$86.40,$21.10,$22.90,$14.55,$16.03,$14.55
30201076,EAP,CPT® 86800,,Thyroglobulin Antibody,$272.00,$8.89,$272.00,$28.36,$23.22,$16.45,$8.89,$23.22,$23.22,$23.50,$272.00,$16.71,$44.44,$215.42,$217.60,$23.07,$25.04,$15.91,$17.53,$15.91
30201078,EAP,CPT® 80299,,Quantitative Assay Drug,$227.00,$9.39,$227.00,$24.21,$17.58,$15.07,$9.39,$17.58,$17.58,$17.79,$227.00,$19.57,$33.64,$179.78,$181.60,$27.03,$18.95,$18.64,$13.27,$18.64
30201080,EAP,CPT® 86682,,Helminth Antibody,$181.00,$7.27,$181.00,$23.19,$18.99,$11.13,$7.27,$18.99,$18.99,$19.20,$181.00,$13.66,$36.34,$143.35,$144.80,$18.86,$20.46,$13.01,$14.32,$13.01
30201082,EAP,CPT® 82135,,Assay Aminolevulinic Acid,$164.00,$0.00,$164.00,$0.00,$24.04,$0.00,$0.00,$24.04,$24.04,$0.00,$164.00,$0.00,$46.00,$129.89,$131.20,$0.00,$0.00,$0.00,$0.00,$0.00
30201084,EAP,CPT® 82135,,Assay Aminolevulinic Acid,$164.00,$0.00,$164.00,$0.00,$24.04,$0.00,$0.00,$24.04,$24.04,$0.00,$164.00,$0.00,$46.00,$129.89,$131.20,$0.00,$0.00,$0.00,$0.00,$0.00
30201086,EAP,CPT® 86790,,Virus Antibody Nos,$244.00,$7.21,$244.00,$22.96,$18.81,$11.13,$7.21,$18.81,$18.81,$19.03,$244.00,$13.52,$36.00,$193.25,$195.20,$18.68,$20.27,$12.88,$14.19,$12.88
30201088,EAP,CPT® 80299,,Quantitative Assay Drug,$201.00,$9.39,$201.00,$24.21,$17.58,$15.07,$9.39,$17.58,$17.58,$17.79,$201.00,$19.57,$33.64,$159.19,$160.80,$27.03,$18.95,$18.64,$13.27,$18.64
30201090,EAP,CPT® 82533,,Total Cortisol,$367.00,$9.12,$367.00,$29.07,$23.81,$22.19,$9.12,$23.81,$23.81,$24.09,$367.00,$17.12,$45.56,$290.66,$293.60,$23.64,$25.67,$16.30,$17.97,$16.30
30201092,EAP,CPT® 86648,,Diptheria Antibody,$97.00,$0.00,$97.00,$0.00,$22.21,$0.00,$0.00,$22.21,$22.21,$0.00,$97.00,$0.00,$42.50,$76.82,$77.60,$0.00,$0.00,$0.00,$0.00,$0.00
30201093,EAP,CPT® 86774,,Tetanus Antibody,$87.00,$8.28,$87.00,$26.38,$21.61,$11.13,$8.28,$21.61,$21.61,$21.86,$87.00,$15.54,$41.36,$68.90,$69.60,$21.46,$23.29,$14.80,$16.31,$14.80
30201097,EAP,CPT® 80307,,Drug Screen Single,$75.00,$0.00,$98.96,$75.00,$76.45,$98.96,$32.55,$76.45,$76.45,$13.13,$75.00,$0.00,$37.50,$59.40,$60.00,$75.00,$76.56,$62.14,$53.59,$0.00
30201105,EAP,CPT® 80299,,Quantitative Assay Drug,$282.00,$9.39,$282.00,$24.21,$17.58,$15.07,$9.39,$17.58,$17.58,$17.79,$282.00,$19.57,$33.64,$223.34,$225.60,$27.03,$18.95,$18.64,$13.27,$18.64
30201107,EAP,CPT® 82438,,Assay Other Fluid Chlorides,$110.00,$0.00,$110.00,$0.00,$7.14,$0.00,$0.00,$7.14,$7.14,$0.00,$110.00,$0.00,$13.66,$87.12,$88.00,$0.00,$0.00,$0.00,$0.00,$0.00
30201108,EAP,CPT® 84302,,Assay Of Sweat Sodium,$120.00,$0.00,$120.00,$0.00,$5.05,$0.00,$0.00,$5.05,$5.05,$0.00,$120.00,$0.00,$9.66,$95.04,$96.00,$0.00,$0.00,$0.00,$0.00,$0.00
30201109,EAP,CPT® 84311,,Spectrophotometry,$90.00,$4.08,$90.00,$12.47,$10.20,$9.52,$4.08,$10.20,$10.20,$10.32,$90.00,$8.51,$19.54,$71.28,$72.00,$11.75,$11.00,$8.10,$7.70,$8.10
30201111,EAP,CPT® 86255,,Fluorescent Antibody Screen,$155.00,$6.75,$155.00,$21.48,$17.60,$16.40,$6.75,$17.60,$17.60,$17.81,$155.00,$12.65,$33.68,$122.76,$124.00,$17.47,$18.97,$12.05,$13.28,$12.05
30201113,EAP,CPT® 87337,,Entamoeb Hist Group Ag Eia,$89.00,$6.70,$89.00,$21.36,$17.52,$16.32,$6.70,$17.52,$17.52,$17.71,$89.00,$12.58,$33.52,$70.49,$71.20,$17.37,$18.87,$11.98,$13.21,$11.98
30201115,EAP,CPT® 87798,,Detect Agent Nos Dna Amp,$375.00,$19.63,$375.00,$34.98,$28.64,$37.59,$19.63,$28.64,$28.64,$28.98,$375.00,$36.84,$54.82,$297.00,$300.00,$50.88,$30.88,$35.09,$21.62,$35.09
30201117,EAP,CPT® 87799,,Detect Agent Nos Dna Quant,$890.00,$0.00,$890.00,$0.00,$62.54,$0.00,$23.96,$62.54,$62.54,$0.00,$890.00,$0.00,$119.70,$704.88,$712.00,$0.00,$139.29,$0.00,$0.00,$0.00
30201119,EAP,CPT® 84202,,Assay Rbc Protoporphyrin,$24.00,$0.00,$24.00,$0.00,$20.95,$0.00,$0.00,$20.95,$20.95,$0.00,$24.00,$0.00,$24.00,$19.01,$19.20,$0.00,$0.00,$0.00,$0.00,$0.00
30201121,EAP,CPT® 82672,,Assay Of Estrogen,$131.00,$0.00,$131.00,$0.00,$24.32,$0.00,$0.00,$24.32,$24.32,$0.00,$131.00,$0.00,$46.54,$103.75,$104.80,$0.00,$0.00,$0.00,$0.00,$0.00
30201129,EAP,CPT® 88271,,Cytogenetics Dna Probe,$178.00,$11.98,$178.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$178.00,$22.49,$59.86,$140.98,$142.40,$31.06,$33.72,$21.42,$23.60,$21.42
30201130,EAP,CPT® 88275,,Cytogenetics 100-300,$235.00,$25.78,$235.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$235.00,$53.75,$112.22,$186.12,$188.00,$74.23,$63.21,$51.19,$44.25,$51.19
30201133,EAP,CPT® 88271,,Cytogenetics Dna Probe,$230.00,$11.98,$230.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$230.00,$22.49,$59.86,$182.16,$184.00,$31.06,$33.72,$21.42,$23.60,$21.42
30201134,EAP,CPT® 88275,,Cytogenetics 100-300,$293.00,$25.78,$293.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$293.00,$53.75,$112.22,$232.06,$234.40,$74.23,$63.21,$51.19,$44.25,$51.19
30201137,EAP,CPT® 88271,,Cytogenetics Dna Probe,$218.00,$11.98,$218.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$218.00,$22.49,$59.86,$172.66,$174.40,$31.06,$33.72,$21.42,$23.60,$21.42
30201138,EAP,CPT® 88275,,Cytogenetics 100-300,$282.00,$25.78,$282.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$282.00,$53.75,$112.22,$223.34,$225.60,$74.23,$63.21,$51.19,$44.25,$51.19
30201147,EAP,CPT® 80299,,Quantitative Assay Drug,$279.00,$9.39,$279.00,$24.21,$17.58,$15.07,$9.39,$17.58,$17.58,$17.79,$279.00,$19.57,$33.64,$220.97,$223.20,$27.03,$18.95,$18.64,$13.27,$18.64
30201151,EAP,CPT® 83789,,Mass Spectrometry Quant,$104.00,$0.00,$104.00,$0.00,$8.77,$0.00,$0.00,$8.77,$8.77,$0.00,$104.00,$0.00,$16.78,$82.37,$83.20,$0.00,$0.00,$0.00,$0.00,$0.00
30201153,EAP,CPT® 86001,,Allergen Specific Igg,$244.00,$0.00,$244.00,$0.00,$7.62,$0.00,$0.00,$7.62,$7.62,$0.00,$244.00,$0.00,$14.60,$193.25,$195.20,$0.00,$0.00,$0.00,$0.00,$0.00
30201155,EAP,CPT® 82679,,Assay Of Estrone,$35.00,$13.96,$39.29,$35.00,$36.45,$33.96,$13.96,$36.45,$36.45,$36.88,$35.00,$26.20,$35.00,$27.72,$28.00,$35.00,$39.29,$24.95,$27.50,$24.95
30201156,EAP,CPT® 82670,,Assay Of Estradiol,$198.00,$15.63,$198.00,$49.80,$40.80,$38.02,$15.63,$40.80,$40.80,$41.28,$198.00,$29.34,$78.08,$156.82,$158.40,$40.51,$43.98,$27.94,$30.79,$27.94
30201157,EAP,CPT® 82677,,Assay Of Estriol,$35.00,$13.53,$38.06,$35.00,$35.31,$32.91,$13.53,$35.31,$35.31,$35.72,$35.00,$25.39,$35.00,$27.72,$28.00,$35.00,$38.06,$24.18,$26.64,$24.18
30201159,EAP,CPT® 83883,,Assay Nephelometry Not Spec,$213.00,$7.61,$213.00,$24.24,$19.85,$9.90,$7.61,$19.85,$19.85,$20.09,$213.00,$14.28,$38.00,$168.70,$170.40,$19.72,$21.40,$13.60,$14.98,$13.60
30201165,EAP,CPT® 83727,,Assay Of Irh Hormone,"$1,260.00",$0.00,"$1,260.00",$0.00,$25.10,$0.00,$0.00,$25.10,$25.10,$0.00,"$1,260.00",$0.00,$48.04,$997.92,"$1,008.00",$0.00,$0.00,$0.00,$0.00,$0.00
30201167,EAP,CPT® 87338,,Hpylori Stool Eia,$175.00,$0.00,$175.00,$0.00,$21.00,$0.00,$0.00,$21.00,$21.00,$0.00,$175.00,$0.00,$40.20,$138.60,$140.00,$0.00,$0.00,$0.00,$0.00,$0.00
30201169,EAP,CPT® 86684,,Hemophilus Influenza,$198.00,$0.00,$198.00,$0.00,$23.13,$0.00,$0.00,$23.13,$23.13,$0.00,$198.00,$0.00,$44.28,$156.82,$158.40,$0.00,$0.00,$0.00,$0.00,$0.00
30201171,EAP,CPT® 84702,,Chorionic Gonadotropin Test,$147.00,$7.07,$147.00,$11.45,$9.37,$7.33,$8.42,$9.37,$9.37,$9.48,$147.00,$15.80,$17.94,$116.42,$117.60,$21.82,$10.10,$15.05,$7.07,$15.05
30201173,EAP,CPT® 82175,,Assay Of Arsenic,$43.00,$0.00,$43.00,$33.81,$27.70,$25.82,$0.00,$27.70,$27.70,$28.02,$43.00,$19.92,$43.00,$34.06,$34.40,$27.51,$0.00,$18.97,$20.90,$18.97
30201174,EAP,CPT® 83655,,Assay Of Lead,$54.00,$6.77,$54.00,$21.59,$17.67,$16.47,$6.77,$17.67,$17.67,$11.75,$54.00,$12.72,$33.82,$42.77,$43.20,$17.56,$12.52,$12.11,$8.76,$12.11
30201175,EAP,CPT® 83825,,Assay Of Mercury,$38.00,$0.00,$38.00,$28.98,$23.74,$22.12,$0.00,$23.74,$23.74,$24.02,$38.00,$17.07,$38.00,$30.10,$30.40,$23.58,$0.00,$16.26,$17.92,$16.26
30201177,EAP,CPT® 82175,,Assay Of Arsenic,$69.00,$0.00,$69.00,$33.81,$27.70,$25.82,$0.00,$27.70,$27.70,$28.02,$69.00,$19.92,$53.02,$54.65,$55.20,$27.51,$0.00,$18.97,$20.90,$18.97
30201178,EAP,CPT® 82300,,Assay Of Cadmium,$75.00,$0.00,$75.00,$0.00,$33.79,$0.00,$0.00,$33.79,$33.79,$0.00,$75.00,$0.00,$64.66,$59.40,$60.00,$0.00,$0.00,$0.00,$0.00,$0.00
30201179,EAP,CPT® 82570,,Assay Of Urine Creatinine,$91.00,$2.90,$91.00,$9.23,$7.56,$5.60,$2.90,$7.56,$7.56,$7.64,$91.00,$5.44,$14.46,$72.07,$72.80,$7.51,$8.14,$5.18,$5.70,$5.18
30201180,EAP,CPT® 83655,,Assay Of Lead,$76.00,$6.77,$76.00,$21.59,$17.67,$16.47,$6.77,$17.67,$17.67,$11.75,$76.00,$12.72,$33.82,$60.19,$60.80,$17.56,$12.52,$12.11,$8.76,$12.11
30201181,EAP,CPT® 83825,,Assay Of Mercury,$62.00,$0.00,$62.00,$28.98,$23.74,$22.12,$0.00,$23.74,$23.74,$24.02,$62.00,$17.07,$45.44,$49.10,$49.60,$23.58,$0.00,$16.26,$17.92,$16.26
30201183,EAP,CPT® 86804,,Hep C Ab Test Confirm,$413.00,$0.00,$413.00,$0.00,$22.61,$0.00,$0.00,$22.61,$22.61,$0.00,$413.00,$0.00,$43.28,$327.10,$330.40,$0.00,$0.00,$0.00,$0.00,$0.00
30201185,EAP,CPT® 87299,,Antibody Detection Nos If,$88.00,$0.00,$88.00,$0.00,$17.52,$0.00,$0.00,$17.52,$17.52,$0.00,$88.00,$0.00,$33.52,$69.70,$70.40,$0.00,$0.00,$0.00,$0.00,$0.00
30201187,EAP,CPT® 86970,,Rbc Pretreatment,$548.00,$0.00,$548.00,$0.00,$15.95,$0.00,$0.00,$15.95,$15.95,$0.00,$548.00,$0.00,$37.22,$434.02,$438.40,$0.00,$0.00,$0.00,$0.00,$0.00
30201189,EAP,CPT® 87798,,Detect Agent Nos Dna Amp,$525.00,$19.63,$525.00,$34.98,$28.64,$37.59,$19.63,$28.64,$28.64,$28.98,$525.00,$36.84,$54.82,$415.80,$420.00,$50.88,$30.88,$35.09,$21.62,$35.09
30201191,EAP,CPT® 86698,,Histoplasma,$72.00,$6.99,$72.00,$22.28,$18.25,$11.13,$6.99,$18.25,$18.25,$18.46,$72.00,$14.48,$34.92,$57.02,$57.60,$20.00,$19.67,$13.79,$13.77,$13.79
30201193,EAP,CPT® 86689,,Htlv/hiv Confirmatory Test,$148.00,$0.00,$148.00,$0.00,$28.26,$0.00,$0.00,$28.26,$28.26,$0.00,$148.00,$0.00,$54.10,$117.22,$118.40,$0.00,$0.00,$0.00,$0.00,$0.00
30201195,EAP,CPT® 86702,,Hiv-2,$141.00,$7.56,$141.00,$24.10,$19.74,$14.37,$7.56,$19.74,$19.74,$17.33,$141.00,$14.20,$37.76,$111.67,$112.80,$19.60,$18.46,$13.52,$12.92,$13.52
30201202,EAP,CPT® 83090,,Assay Of Homocystine,$231.00,$0.00,$231.00,$0.00,$24.63,$0.00,$0.00,$24.63,$24.63,$0.00,$231.00,$0.00,$47.14,$182.95,$184.80,$0.00,$0.00,$0.00,$0.00,$0.00
30201204,EAP,CPT® 82570,,Assay Of Urine Creatinine,$54.00,$2.90,$54.00,$9.23,$7.56,$5.60,$2.90,$7.56,$7.56,$7.64,$54.00,$5.44,$14.46,$42.77,$43.20,$7.51,$8.14,$5.18,$5.70,$5.18
30201205,EAP,CPT® 82150,,Assay Of Amylase,$109.00,$3.62,$109.00,$11.56,$9.46,$8.82,$3.62,$9.46,$9.46,$9.58,$109.00,$6.80,$18.12,$86.33,$87.20,$9.40,$10.20,$6.48,$7.14,$6.48
30201207,EAP,CPT® 87529,,Hsv Dna Amp Probe,$194.00,$19.63,$194.00,$34.98,$28.64,$37.59,$19.63,$28.64,$28.64,$28.98,$194.00,$36.84,$54.82,$153.65,$155.20,$50.88,$30.88,$35.09,$21.62,$35.09
30201209,EAP,CPT® 87530,,Hsv Dna Quant,$256.00,$0.00,$256.00,$0.00,$62.54,$0.00,$0.00,$62.54,$62.54,$0.00,$256.00,$0.00,$119.70,$202.75,$204.80,$0.00,$0.00,$0.00,$0.00,$0.00
30201211,EAP,CPT® 87532,,Hhv-6 Dna Amp Probe,$333.00,$0.00,$333.00,$0.00,$28.64,$0.00,$0.00,$28.64,$28.64,$0.00,$333.00,$0.00,$54.82,$263.74,$266.40,$0.00,$0.00,$0.00,$0.00,$0.00
30201213,EAP,CPT® 83632,,Placental Lactogen,$441.00,$0.00,$441.00,$0.00,$29.51,$0.00,$0.00,$29.51,$29.51,$0.00,$441.00,$0.00,$56.48,$349.27,$352.80,$0.00,$0.00,$0.00,$0.00,$0.00
30201220,EAP,CPT® 86331,,Immunodiffusion Ouchterlony,$19.00,$0.00,$19.00,$0.00,$17.50,$0.00,$0.00,$17.50,$17.50,$0.00,$19.00,$0.00,$19.00,$15.05,$15.20,$0.00,$0.00,$0.00,$0.00,$0.00
30201221,EAP,CPT® 86606,,Aspergillus Antibody,$27.00,$8.42,$27.00,$26.84,$21.98,$11.13,$8.42,$21.98,$21.98,$22.24,$27.00,$15.80,$27.00,$21.38,$21.60,$21.82,$23.70,$15.05,$16.59,$15.05
30201222,EAP,CPT® 86744,,Nocardia Antibody,$24.00,$0.00,$24.00,$0.00,$19.25,$0.00,$0.00,$19.25,$19.25,$0.00,$24.00,$0.00,$24.00,$19.01,$19.20,$0.00,$0.00,$0.00,$0.00,$0.00
30201224,EAP,CPT® 86341,,Islet Cell Antibody,$193.00,$11.87,$193.00,$35.27,$28.89,$19.44,$11.87,$28.89,$28.89,$29.24,$193.00,$24.75,$55.30,$152.86,$154.40,$34.18,$31.16,$23.57,$21.81,$23.57
30201226,EAP,CPT® 82784,,Assay Iga/igd/igg/igm Each,$34.00,$5.20,$34.00,$16.58,$13.58,$9.90,$5.20,$13.58,$13.58,$13.73,$34.00,$9.77,$25.98,$26.93,$27.20,$13.49,$14.63,$9.30,$10.24,$9.30
30201227,EAP,CPT® 82787,,Igg 1 2 3 Or 4 Each,$28.00,$4.49,$28.00,$14.30,$11.71,$7.02,$4.49,$11.71,$11.71,$11.84,$28.00,$8.42,$22.40,$22.18,$22.40,$11.63,$12.62,$8.02,$8.83,$8.02
30201229,EAP,CPT® 86336,,Inhibin A,$128.00,$8.72,$128.00,$23.10,$18.90,$21.21,$8.72,$18.90,$18.90,$19.12,$128.00,$16.37,$36.18,$101.38,$102.40,$22.61,$20.37,$15.59,$14.26,$15.59
30201231,EAP,CPT® 83520,,Immunoassay Quant Nos Nonab,$432.00,$8.69,$432.00,$23.07,$18.91,$17.62,$8.69,$18.91,$18.91,$19.12,$432.00,$18.13,$36.18,$342.14,$345.60,$25.04,$20.37,$17.27,$14.26,$17.27
30201233,EAP,CPT® 83789,,Mass Spectrometry Quant,$116.00,$0.00,$116.00,$0.00,$8.77,$0.00,$0.00,$8.77,$8.77,$0.00,$116.00,$0.00,$16.78,$91.87,$92.80,$0.00,$0.00,$0.00,$0.00,$0.00
30201235,EAP,CPT® 86886,,Coombs Test Indirect Titer,$163.00,$2.90,$163.00,$8.28,$6.79,$137.60,$2.90,$6.79,$6.79,$6.87,$163.00,$143.92,$13.00,$129.10,$130.40,$163.00,$7.32,$5.18,$5.12,$137.07
30201236,EAP,CPT® 86900,,"Blood Typing, Serologic, Abo",$328.00,$1.67,$328.00,$5.34,$4.35,$104.55,$1.67,$4.35,$4.35,$4.41,$328.00,$109.35,$8.34,$259.78,$262.40,$151.93,$4.70,$2.99,$3.29,$104.14
30201238,EAP,CPT® 80299,,Quantitative Assay Drug,$210.00,$9.39,$210.00,$24.21,$17.58,$15.07,$9.39,$17.58,$17.58,$17.79,$210.00,$19.57,$33.64,$166.32,$168.00,$27.03,$18.95,$18.64,$13.27,$18.64
30201248,EAP,CPT® 83630,,Lactoferrin Fecal (qual),$164.00,$0.00,$164.00,$0.00,$28.66,$0.00,$0.00,$28.66,$28.66,$0.00,$164.00,$0.00,$54.84,$129.89,$131.20,$0.00,$0.00,$0.00,$0.00,$0.00
30201250,EAP,CPT® 87278,,Legion Pneumophilia Ag If,$148.00,$0.00,$148.00,$0.00,$17.52,$0.00,$0.00,$17.52,$17.52,$0.00,$148.00,$0.00,$33.52,$117.22,$118.40,$0.00,$0.00,$0.00,$0.00,$0.00
30201252,EAP,CPT® 86717,,Leishmania Antibody,$151.00,$0.00,$151.00,$0.00,$17.89,$0.00,$0.00,$17.89,$17.89,$0.00,$151.00,$0.00,$34.24,$119.59,$120.80,$0.00,$0.00,$0.00,$0.00,$0.00
30201254,EAP,CPT® 83690,,Assay Of Lipase,$84.00,$3.85,$84.00,$12.29,$10.06,$9.38,$3.85,$10.06,$10.06,$10.17,$84.00,$7.23,$19.24,$66.53,$67.20,$9.99,$10.84,$6.89,$7.59,$6.89
30201256,EAP,CPT® 83695,,Assay Of Lipoprotein(a),$109.00,$7.25,$109.00,$23.07,$18.91,$17.62,$7.25,$18.91,$18.91,$19.12,$109.00,$15.04,$36.18,$86.33,$87.20,$20.76,$20.37,$14.32,$14.26,$14.32
30201258,EAP,CPT® 82465,,Assay Bld/serum Cholesterol,$9.00,$2.44,$9.00,$7.75,$6.36,$5.92,$2.44,$6.36,$6.36,$6.43,$9.00,$4.57,$9.00,$7.13,$7.20,$6.31,$6.85,$4.35,$4.79,$4.35
30201259,EAP,CPT® 82664,,Electrophoretic Test,$189.00,$30.97,$189.00,$61.24,$50.16,$46.75,$30.97,$50.16,$50.16,$50.75,$189.00,$64.58,$96.00,$149.69,$151.20,$89.18,$54.07,$61.50,$37.85,$61.50
30201260,EAP,CPT® 84478,,Assay Of Triglycerides,$18.00,$3.21,$18.00,$10.24,$8.40,$7.82,$3.21,$8.40,$8.40,$7.46,$18.00,$6.03,$16.08,$14.26,$14.40,$8.32,$7.94,$5.74,$5.56,$5.74
30201261,EAP,CPT® 84999,,Clinical Chemistry Test,$24.00,$0.00,$24.00,$0.00,$17.13,$0.00,$4.14,$17.13,$17.13,$4.20,$24.00,$0.00,$0.00,$19.01,$19.20,$0.00,$3.76,$0.00,$0.00,$0.00
30201263,EAP,CPT® 86609,,Bacterium Antibody,$175.00,$0.00,$175.00,$0.00,$18.81,$0.00,$0.00,$18.81,$18.81,$0.00,$175.00,$0.00,$36.00,$138.60,$140.00,$0.00,$0.00,$0.00,$0.00,$0.00
30201265,EAP,CPT® 86376,,Microsomal Antibody,$205.00,$8.14,$205.00,$25.95,$21.25,$19.80,$8.14,$21.25,$21.25,$21.49,$205.00,$15.28,$40.66,$162.36,$164.00,$21.10,$22.90,$14.55,$16.03,$14.55
30201267,EAP,CPT® 83516,,Immunoassay Nonantibody,$121.00,$6.44,$121.00,$19.04,$15.61,$15.70,$6.44,$15.61,$15.61,$15.80,$121.00,$12.11,$29.88,$95.83,$96.80,$16.72,$16.84,$11.53,$11.79,$11.53
30201268,EAP,CPT® 83520,,Immunoassay Quant Nos Nonab,$133.00,$8.69,$133.00,$23.07,$18.91,$17.62,$8.69,$18.91,$18.91,$19.12,$133.00,$18.13,$36.18,$105.34,$106.40,$25.04,$20.37,$17.27,$14.26,$17.27
30201269,EAP,CPT® 86038,,Antinuclear Antibodies,$72.00,$6.76,$72.00,$21.55,$17.65,$16.45,$6.76,$17.65,$17.65,$17.86,$72.00,$12.69,$33.78,$57.02,$57.60,$17.53,$19.03,$12.09,$13.32,$12.09
30201270,EAP,CPT® 84160,,Assay Of Protein Any Source,$129.00,$0.00,$129.00,$0.00,$7.56,$0.00,$0.00,$7.56,$7.56,$0.00,$129.00,$0.00,$14.46,$102.17,$103.20,$0.00,$0.00,$0.00,$0.00,$0.00
30201271,EAP,CPT® 86235,,Nuclear Antigen Antibody,$93.00,$10.04,$93.00,$31.97,$26.18,$24.41,$10.04,$26.18,$26.18,$26.49,$93.00,$18.83,$50.12,$73.66,$74.40,$26.00,$28.23,$17.93,$19.76,$17.93
30201272,EAP,CPT® 86255,,Fluorescent Antibody Screen,$76.00,$6.75,$76.00,$21.48,$17.60,$16.40,$6.75,$17.60,$17.60,$17.81,$76.00,$12.65,$33.68,$60.19,$60.80,$17.47,$18.97,$12.05,$13.28,$12.05
30201273,EAP,CPT® 86376,,Microsomal Antibody,$57.00,$8.14,$57.00,$25.95,$21.25,$19.80,$8.14,$21.25,$21.25,$21.49,$57.00,$15.28,$40.66,$45.14,$45.60,$21.10,$22.90,$14.55,$16.03,$14.55
30201274,EAP,CPT® 86431,,Rheumatoid Factor Quant,$97.00,$3.18,$97.00,$10.10,$8.29,$7.72,$3.18,$8.29,$8.29,$8.39,$97.00,$5.95,$15.86,$76.82,$77.60,$8.22,$8.94,$5.67,$6.26,$5.67
30201276,EAP,CPT® 86618,,Lyme Disease Antibody,$70.00,$9.52,$70.00,$30.37,$24.87,$11.13,$9.52,$24.87,$24.87,$25.16,$70.00,$17.88,$47.60,$55.44,$56.00,$24.69,$26.81,$17.03,$18.76,$17.03
30201278,EAP,CPT® 87476,,Lyme Dis Dna Amp Probe,$387.00,$0.00,$387.00,$0.00,$28.64,$0.00,$0.00,$28.64,$28.64,$0.00,$387.00,$0.00,$54.82,$306.50,$309.60,$0.00,$0.00,$0.00,$0.00,$0.00
30201280,EAP,CPT® 87476,,Lyme Dis Dna Amp Probe,$387.00,$0.00,$387.00,$0.00,$28.64,$0.00,$0.00,$28.64,$28.64,$0.00,$387.00,$0.00,$54.82,$306.50,$309.60,$0.00,$0.00,$0.00,$0.00,$0.00
30201282,EAP,CPT® 86355,,B Cells Total Count,$115.00,$21.10,$115.00,$42.00,$34.39,$22.53,$21.10,$34.39,$34.39,$34.80,$115.00,$39.62,$65.82,$91.08,$92.00,$54.71,$37.08,$37.73,$25.95,$37.73
30201283,EAP,CPT® 86357,,Nk Cells Total Count,$115.00,$21.10,$115.00,$42.00,$34.39,$22.53,$21.10,$34.39,$34.39,$34.80,$115.00,$39.62,$65.82,$91.08,$92.00,$54.71,$37.08,$37.73,$25.95,$37.73
30201284,EAP,CPT® 86359,,T Cells Total Count,$115.00,$21.10,$115.00,$42.00,$34.39,$22.53,$21.10,$34.39,$34.39,$34.80,$115.00,$39.62,$65.82,$91.08,$92.00,$54.71,$37.08,$37.73,$25.95,$37.73
30201285,EAP,CPT® 86360,,T Cell Absolute Count/ratio,$158.00,$26.28,$158.00,$83.77,$68.60,$45.07,$26.28,$68.60,$68.60,$69.42,$158.00,$49.33,$131.30,$125.14,$126.40,$68.12,$73.96,$46.98,$51.77,$46.98
30201286,EAP,Custom 30201286,,Mac Sensitivity,$150.00,$0.00,$150.00,$0.00,$107.06,$0.00,$0.00,$107.06,$107.06,$0.00,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$0.00,$0.00,$0.00,$0.00
30201287,EAP,CPT® 87190,,Microbe Suscept Mycobacteri,$32.00,$0.00,$32.00,$0.00,$8.25,$0.00,$0.00,$8.25,$8.25,$0.00,$32.00,$0.00,$15.80,$25.34,$25.60,$0.00,$0.00,$0.00,$0.00,$0.00
30201289,EAP,CPT® 88271,,Cytogenetics Dna Probe,$266.00,$11.98,$266.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$266.00,$22.49,$59.86,$210.67,$212.80,$31.06,$33.72,$21.42,$23.60,$21.42
30201290,EAP,CPT® 88275,,Cytogenetics 100-300,$325.00,$25.78,$325.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$325.00,$53.75,$112.22,$257.40,$260.00,$74.23,$63.21,$51.19,$44.25,$51.19
30201295,EAP,CPT® 83825,,Assay Of Mercury,$50.00,$0.00,$50.00,$28.98,$23.74,$22.12,$0.00,$23.74,$23.74,$24.02,$50.00,$17.07,$45.44,$39.60,$40.00,$23.58,$0.00,$16.26,$17.92,$16.26
30201297,EAP,CPT® 83825,,Assay Of Mercury,$75.00,$0.00,$75.00,$28.98,$23.74,$22.12,$0.00,$23.74,$23.74,$24.02,$75.00,$17.07,$45.44,$59.40,$60.00,$23.58,$0.00,$16.26,$17.92,$16.26
30201299,EAP,CPT® 83835,,Assay Of Metanephrines,$230.00,$9.48,$230.00,$30.21,$24.74,$23.05,$9.48,$24.74,$24.74,$25.02,$230.00,$17.79,$47.34,$182.16,$184.00,$24.56,$26.66,$16.94,$18.66,$16.94
30201300,EAP,CPT® 82570,,Assay Of Urine Creatinine,$52.00,$2.90,$52.00,$9.23,$7.56,$5.60,$2.90,$7.56,$7.56,$7.64,$52.00,$5.44,$14.46,$41.18,$41.60,$7.51,$8.14,$5.18,$5.70,$5.18
30201302,EAP,CPT® 83835,,Assay Of Metanephrines,$573.00,$9.48,$573.00,$30.21,$24.74,$23.05,$9.48,$24.74,$24.74,$25.02,$573.00,$17.79,$47.34,$453.82,$458.40,$24.56,$26.66,$16.94,$18.66,$16.94
30201304,EAP,CPT® 80358,,Assay Of Methadone,$198.00,$0.00,$198.00,$0.00,$141.31,$0.00,$0.00,$141.31,$141.31,$0.00,$198.00,$0.00,$99.00,$156.82,$158.40,$0.00,$0.00,$0.00,$0.00,$0.00
30201306,EAP,CPT® 82542,,Column Chromotography Quant,$288.00,$6.62,$288.00,$32.19,$8.77,$24.58,$12.13,$8.77,$8.77,$8.87,$288.00,$25.29,$16.78,$228.10,$230.40,$34.93,$9.45,$24.09,$6.62,$24.09
30201310,EAP,CPT® 83921,,Organic Acid Single Quant,$289.00,$10.67,$289.00,$29.32,$24.04,$22.39,$10.67,$24.04,$24.04,$24.32,$289.00,$22.27,$46.00,$228.89,$231.20,$30.75,$25.91,$21.21,$18.14,$21.21
30201312,EAP,CPT® 83519,,Ria Nonantibody,"$1,415.00",$9.26,"$1,415.00",$24.08,$19.73,$18.39,$9.26,$19.73,$19.73,$19.96,"$1,415.00",$19.32,$37.76,"$1,120.68","$1,132.00",$26.68,$21.27,$18.40,$14.89,$18.40
30201314,EAP,CPT® 87190,,Microbe Suscept Mycobacteri,$41.00,$0.00,$41.00,$0.00,$8.25,$0.00,$0.00,$8.25,$8.25,$0.00,$41.00,$0.00,$15.80,$32.47,$32.80,$0.00,$0.00,$0.00,$0.00,$0.00
30201316,EAP,CPT® 87581,,M.pneumon Dna Probe,$522.00,$0.00,$522.00,$0.00,$28.64,$0.00,$0.00,$28.64,$28.64,$0.00,$522.00,$0.00,$54.82,$413.42,$417.60,$0.00,$0.00,$0.00,$0.00,$0.00
30201318,EAP,CPT® 83873,,Assay Of Csf Protein,$54.00,$0.00,$54.00,$0.00,$25.12,$0.00,$0.00,$25.12,$25.12,$0.00,$54.00,$0.00,$48.08,$42.77,$43.20,$0.00,$0.00,$0.00,$0.00,$0.00
30201320,EAP,CPT® 83874,,Assay Of Myoglobin,$54.00,$7.23,$54.00,$23.03,$18.86,$17.58,$7.23,$18.86,$18.86,$19.08,$54.00,$13.57,$36.08,$42.77,$43.20,$18.73,$20.33,$12.92,$14.23,$12.92
30201322,EAP,CPT® 86255,,Fluorescent Antibody Screen,$368.00,$6.75,$368.00,$21.48,$17.60,$16.40,$6.75,$17.60,$17.60,$17.81,$368.00,$12.65,$33.68,$291.46,$294.40,$17.47,$18.97,$12.05,$13.28,$12.05
30201324,EAP,CPT® 80323,,Assay Of Nicotine,$212.00,$0.00,$212.00,$0.02,$151.30,$37.74,$20.62,$151.30,$151.30,$44.34,$212.00,$0.00,$106.00,$167.90,$169.60,$127.20,$47.25,$0.00,$33.07,$0.00
30201326,EAP,CPT® 84999,,Clinical Chemistry Test,$132.00,$0.00,$132.00,$0.00,$94.21,$0.00,$22.74,$94.21,$94.21,$23.11,$132.00,$0.00,$0.00,$104.54,$105.60,$0.00,$20.66,$0.00,$0.00,$0.00
30201328,EAP,CPT® 83945,,Assay Of Oxalate,$48.00,$0.00,$48.00,$0.00,$18.80,$0.00,$0.00,$18.80,$18.80,$0.00,$48.00,$0.00,$35.98,$38.02,$38.40,$0.00,$0.00,$0.00,$0.00,$0.00
30201330,EAP,CPT® 87279,,Parainfluenza Ag If,$42.00,$0.00,$42.00,$0.00,$17.52,$0.00,$0.00,$17.52,$17.52,$0.00,$42.00,$0.00,$33.52,$33.26,$33.60,$0.00,$0.00,$0.00,$0.00,$0.00
30201334,EAP,CPT® 86255,,Fluorescent Antibody Screen,$241.00,$6.75,$241.00,$21.48,$17.60,$16.40,$6.75,$17.60,$17.60,$17.81,$241.00,$12.65,$33.68,$190.87,$192.80,$17.47,$18.97,$12.05,$13.28,$12.05
30201335,EAP,CPT® 86255,,Fluorescent Antibody Screen,$214.00,$6.75,$214.00,$21.48,$17.60,$16.40,$6.75,$17.60,$17.60,$17.81,$214.00,$12.65,$33.68,$169.49,$171.20,$17.47,$18.97,$12.05,$13.28,$12.05
30201336,EAP,CPT® 86255,,Fluorescent Antibody Screen,$166.00,$6.75,$166.00,$21.48,$17.60,$16.40,$6.75,$17.60,$17.60,$17.81,$166.00,$12.65,$33.68,$131.47,$132.80,$17.47,$18.97,$12.05,$13.28,$12.05
30201338,EAP,CPT® 87799,,Detect Agent Nos Dna Quant,$626.00,$0.00,$626.00,$0.00,$62.54,$0.00,$23.96,$62.54,$62.54,$0.00,$626.00,$0.00,$119.70,$495.79,$500.80,$0.00,$97.97,$0.00,$0.00,$0.00
30201340,EAP,CPT® 82657,,Enzyme Cell Activity,$228.00,$0.00,$228.00,$0.00,$8.77,$0.00,$0.00,$8.77,$8.77,$0.00,$228.00,$0.00,$16.78,$180.58,$182.40,$0.00,$0.00,$0.00,$0.00,$0.00
30201342,EAP,CPT® 83992,,Assay For Phencyclidine,$269.00,$0.00,$269.00,$0.00,$21.46,$0.00,$0.00,$21.46,$21.46,$0.00,$269.00,$0.00,$41.08,$213.05,$215.20,$0.00,$0.00,$0.00,$0.00,$0.00
30201344,EAP,CPT® 82570,,Assay Of Urine Creatinine,$84.00,$2.90,$84.00,$9.23,$7.56,$5.60,$2.90,$7.56,$7.56,$7.64,$84.00,$5.44,$14.46,$66.53,$67.20,$7.51,$8.14,$5.18,$5.70,$5.18
30201345,EAP,CPT® 84600,,Assay Of Volatiles,$101.00,$0.00,$101.00,$0.00,$23.47,$0.00,$0.00,$23.47,$23.47,$0.00,$101.00,$0.00,$44.90,$79.99,$80.80,$0.00,$0.00,$0.00,$0.00,$0.00
30201354,EAP,CPT® 84110,,Assay Of Porphobilinogen,$54.00,$4.72,$54.00,$15.05,$12.34,$11.48,$4.72,$12.34,$12.34,$12.47,$54.00,$8.86,$23.60,$42.77,$43.20,$12.24,$13.29,$8.44,$9.30,$8.44
30201358,EAP,CPT® 84120,,Assay Of Urine Porphyrins,$55.00,$0.00,$55.00,$0.00,$21.47,$0.00,$0.00,$21.47,$21.47,$0.00,$55.00,$0.00,$41.10,$43.56,$44.00,$0.00,$0.00,$0.00,$0.00,$0.00
30201362,EAP,CPT® 80299,,Quantitative Assay Drug,$414.00,$9.39,$414.00,$24.21,$17.58,$15.07,$9.39,$17.58,$17.58,$17.79,$414.00,$19.57,$33.64,$327.89,$331.20,$27.03,$18.95,$18.64,$13.27,$18.64
30201363,EAP,CPT® 84206,,Proinsulin So,$488.00,$13.44,$488.00,$31.76,$26.01,$24.24,$13.44,$26.01,$26.01,$26.31,$488.00,$28.02,$49.78,$386.50,$390.40,$38.70,$28.04,$26.69,$19.63,$26.69
30201364,EAP,CPT® 84206,,Assay Of Proinsulin,$644.00,$13.44,$644.00,$31.76,$26.01,$24.24,$13.44,$26.01,$26.01,$26.31,$644.00,$28.02,$49.78,$510.05,$515.20,$38.70,$28.04,$26.69,$19.63,$26.69
30201368,EAP,CPT® 85303,,"Blood Clot Inhibitor Test;protein C,activity",$428.00,$7.74,$428.00,$24.67,$20.19,$18.82,$7.74,$20.19,$20.19,$20.43,$428.00,$14.53,$38.64,$338.98,$342.40,$20.07,$21.77,$13.84,$15.24,$13.84
30201369,EAP,CPT® 85306,,"Blood Clot Inhibitor Test;protein S,free",$513.00,$0.00,$513.00,$0.00,$22.37,$0.00,$0.00,$22.37,$22.37,$0.00,$513.00,$0.00,$42.82,$406.30,$410.40,$0.00,$0.00,$0.00,$0.00,$0.00
30201371,EAP,CPT® 85305,,"Blood Clot Inhibitor Assay;protein S,total",$493.00,$0.00,$493.00,$0.00,$16.93,$0.00,$0.00,$16.93,$16.93,$0.00,$493.00,$0.00,$32.40,$390.46,$394.40,$0.00,$0.00,$0.00,$0.00,$0.00
30201373,EAP,CPT® 84153,,Assay Of Psa Total,$41.00,$0.00,$32.47,$0.00,$0.00,$0.00,$10.29,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$32.47,$0.00,$0.00,$28.95,$0.00,$0.00,$0.00
30201374,EAP,CPT® 84154,,Assay Of Psa Free,$42.00,$0.00,$42.00,$0.00,$26.85,$0.00,$0.00,$26.85,$26.85,$0.00,$42.00,$0.00,$42.00,$33.26,$33.60,$0.00,$0.00,$0.00,$0.00,$0.00
30201376,EAP,CPT® 83970,,Assay Of Parathormone,$177.00,$23.09,$177.00,$73.58,$60.27,$56.17,$23.09,$60.27,$60.27,$60.97,$177.00,$43.34,$115.34,$140.18,$141.60,$59.86,$64.97,$41.28,$45.48,$41.28
30201378,EAP,CPT® 83519,,Ria Nonantibody,$545.00,$9.26,$545.00,$24.08,$19.73,$18.39,$9.26,$19.73,$19.73,$19.96,$545.00,$19.32,$37.76,$431.64,$436.00,$26.68,$21.27,$18.40,$14.89,$18.40
30201380,EAP,CPT® 84220,,Assay Of Pyruvate Kinase,$232.00,$0.00,$232.00,$0.00,$13.77,$0.00,$0.00,$13.77,$13.77,$0.00,$232.00,$0.00,$26.36,$183.74,$185.60,$0.00,$0.00,$0.00,$0.00,$0.00
30201382,EAP,CPT® 80299,,Quantitative Assay Drug,$255.00,$9.39,$255.00,$24.21,$17.58,$15.07,$9.39,$17.58,$17.58,$17.79,$255.00,$19.57,$33.64,$201.96,$204.00,$27.03,$18.95,$18.64,$13.27,$18.64
30201384,EAP,CPT® 86317,,Immunoassay Infectious Agent,$143.00,$8.38,$143.00,$21.41,$17.52,$20.40,$8.38,$17.52,$17.52,$17.72,$143.00,$15.74,$33.54,$113.26,$114.40,$21.74,$18.89,$14.99,$13.22,$14.99
30201386,EAP,CPT® 80195,,Assay Of Sirolimus,$279.00,$0.00,$279.00,$0.00,$20.04,$0.00,$0.00,$20.04,$20.04,$0.00,$279.00,$0.00,$38.34,$220.97,$223.20,$0.00,$0.00,$0.00,$0.00,$0.00
30201388,EAP,CPT® 87299,,Antibody Detection Nos If,$91.00,$0.00,$91.00,$0.00,$17.52,$0.00,$0.00,$17.52,$17.52,$0.00,$91.00,$0.00,$33.52,$72.07,$72.80,$0.00,$0.00,$0.00,$0.00,$0.00
30201390,EAP,CPT® 86003,,Allergen Specific Ige,$120.00,$2.92,$120.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$120.00,$5.48,$14.60,$95.04,$96.00,$7.57,$8.22,$5.22,$5.76,$5.22
30201392,EAP,CPT® 86003,,Allergen Specific Ige,$130.00,$2.92,$130.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$130.00,$5.48,$14.60,$102.96,$104.00,$7.57,$8.22,$5.22,$5.76,$5.22
30201478,EAP,CPT® 82480,,Assay Serum Cholinesterase,$42.00,$0.00,$42.00,$0.00,$11.51,$0.00,$0.00,$11.51,$11.51,$0.00,$42.00,$0.00,$22.02,$33.26,$33.60,$0.00,$0.00,$0.00,$0.00,$0.00
30201479,EAP,CPT® 82482,,Assay Rbc Cholinesterase,$42.00,$0.00,$42.00,$0.00,$11.22,$0.00,$0.00,$11.22,$11.22,$0.00,$42.00,$0.00,$21.48,$33.26,$33.60,$0.00,$0.00,$0.00,$0.00,$0.00
30201481,EAP,CPT® 85635,,Reptilase Test,$178.00,$0.00,$178.00,$0.00,$14.38,$0.00,$0.00,$14.38,$14.38,$0.00,$178.00,$0.00,$27.52,$140.98,$142.40,$0.00,$0.00,$0.00,$0.00,$0.00
30201483,EAP,CPT® 87798,,Detect Agent Nos Dna Amp,$372.00,$19.63,$372.00,$34.98,$28.64,$37.59,$19.63,$28.64,$28.64,$28.98,$372.00,$36.84,$54.82,$294.62,$297.60,$50.88,$30.88,$35.09,$21.62,$35.09
30201485,EAP,CPT® 84482,,T3 Reverse,$148.00,$0.00,$148.00,$28.09,$23.01,$21.45,$0.00,$23.01,$23.01,$0.00,$148.00,$16.55,$44.04,$117.22,$118.40,$22.85,$0.00,$15.76,$17.36,$15.76
30201487,EAP,CPT® 83516,,Immunoassay Nonantibody,$194.00,$6.44,$194.00,$19.04,$15.61,$15.70,$6.44,$15.61,$15.61,$15.80,$194.00,$12.11,$29.88,$153.65,$155.20,$16.72,$16.84,$11.53,$11.79,$11.53
30201489,EAP,CPT® 86757,,Rickettsia Antibody,$98.00,$0.00,$98.00,$0.00,$28.26,$0.00,$0.00,$28.26,$28.26,$0.00,$98.00,$0.00,$54.10,$77.62,$78.40,$0.00,$0.00,$0.00,$0.00,$0.00
30201493,EAP,CPT® 80299,,Quantitative Assay Drug,$172.00,$9.39,$172.00,$24.21,$17.58,$15.07,$9.39,$17.58,$17.58,$17.79,$172.00,$19.57,$33.64,$136.22,$137.60,$27.03,$18.95,$18.64,$13.27,$18.64
30201495,EAP,CPT® 83520,,Immunoassay Quant Nos Nonab,$205.00,$8.69,$205.00,$23.07,$18.91,$17.62,$8.69,$18.91,$18.91,$19.12,$205.00,$18.13,$36.18,$162.36,$164.00,$25.04,$20.37,$17.27,$14.26,$17.27
30201497,EAP,CPT® 86671,,Fungus Antibody,$100.00,$6.86,$100.00,$21.84,$17.90,$11.13,$6.86,$17.90,$17.90,$18.11,$100.00,$12.86,$34.26,$79.20,$80.00,$17.76,$19.30,$12.25,$13.51,$12.25
30201499,EAP,CPT® 86671,,Fungus Antibody,$47.00,$6.86,$47.00,$21.84,$17.90,$11.13,$6.86,$17.90,$17.90,$18.11,$47.00,$12.86,$34.26,$37.22,$37.60,$17.76,$19.30,$12.25,$13.51,$12.25
30201501,EAP,CPT® 86682,,Helminth Antibody,$192.00,$7.27,$192.00,$23.19,$18.99,$11.13,$7.27,$18.99,$18.99,$19.20,$192.00,$13.66,$36.34,$152.06,$153.60,$18.86,$20.46,$13.01,$14.32,$13.01
30201503,EAP,CPT® 84255,,Assay Of Selenium,$98.00,$0.00,$98.00,$0.00,$37.27,$0.00,$0.00,$37.27,$37.27,$0.00,$98.00,$0.00,$71.34,$77.62,$78.40,$0.00,$0.00,$0.00,$0.00,$0.00
30201505,EAP,CPT® 82570,,Assay Of Urine Creatinine,$72.00,$2.90,$72.00,$9.23,$7.56,$5.60,$2.90,$7.56,$7.56,$7.64,$72.00,$5.44,$14.46,$57.02,$57.60,$7.51,$8.14,$5.18,$5.70,$5.18
30201506,EAP,CPT® 84255,,Assay Of Selenium,$71.00,$0.00,$71.00,$0.00,$37.27,$0.00,$0.00,$37.27,$37.27,$0.00,$71.00,$0.00,$71.00,$56.23,$56.80,$0.00,$0.00,$0.00,$0.00,$0.00
30201508,EAP,CPT® 84270,,Assay Of Sex Hormone Globul,$42.00,$0.00,$42.00,$0.00,$31.73,$0.00,$0.00,$31.73,$31.73,$0.00,$42.00,$0.00,$42.00,$33.26,$33.60,$0.00,$0.00,$0.00,$0.00,$0.00
30201510,EAP,CPT® 86609,,Bacterium Antibody,$24.00,$0.00,$24.00,$0.00,$18.81,$0.00,$0.00,$18.81,$18.81,$0.00,$24.00,$0.00,$24.00,$19.01,$19.20,$0.00,$0.00,$0.00,$0.00,$0.00
30201512,EAP,CPT® 86403,,Particle Agglutination Test,$203.00,$5.81,$203.00,$18.17,$14.88,$13.87,$5.81,$14.88,$14.88,$11.75,$203.00,$12.12,$28.48,$160.78,$162.40,$16.73,$12.52,$11.54,$8.76,$11.54
30201514,EAP,CPT® 80299,,Quantitative Assay Drug,$198.00,$9.39,$198.00,$24.21,$17.58,$15.07,$9.39,$17.58,$17.58,$17.79,$198.00,$19.57,$33.64,$156.82,$158.40,$27.03,$18.95,$18.64,$13.27,$18.64
30201516,EAP,CPT® 87186,,Microbe Susceptible Mic,$323.00,$4.83,$323.00,$15.41,$12.62,$11.77,$4.83,$12.62,$12.62,$12.77,$323.00,$9.08,$24.16,$255.82,$258.40,$12.54,$13.60,$8.65,$9.52,$8.65
30201522,EAP,CPT® 86780,,Treponema Pallidum,$107.00,$7.41,$107.00,$23.60,$18.97,$18.02,$7.41,$18.97,$18.97,$18.73,$107.00,$13.90,$53.50,$84.74,$85.60,$19.20,$16.75,$13.24,$17.03,$13.24
30201524,EAP,CPT® 84482,,T3 Reverse,$148.00,$0.00,$148.00,$28.09,$23.01,$21.45,$0.00,$23.01,$23.01,$0.00,$148.00,$16.55,$44.04,$117.22,$118.40,$22.85,$0.00,$15.76,$17.36,$15.76
30201531,EAP,CPT® 82040,,Assay Of Serum Albumin,$8.00,$2.77,$8.00,$5.13,$4.20,$6.32,$2.77,$4.20,$4.20,$4.25,$8.00,$5.20,$8.00,$6.34,$6.40,$7.18,$4.53,$4.95,$3.17,$4.95
30201532,EAP,CPT® 84270,,Assay Of Sex Hormone Globul,$38.00,$0.00,$38.00,$0.00,$31.73,$0.00,$0.00,$31.73,$31.73,$0.00,$38.00,$0.00,$38.00,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
30201533,EAP,CPT® 84403,,Assay Of Total Testosterone,$52.00,$14.44,$52.00,$46.01,$37.70,$35.13,$14.44,$37.70,$37.70,$38.15,$52.00,$27.10,$52.00,$41.18,$41.60,$37.42,$40.65,$25.81,$28.45,$25.81
30201535,EAP,CPT® 84402,,Assay Of Testosterone,$50.00,$14.25,$50.00,$45.42,$37.18,$34.65,$14.25,$37.18,$37.18,$37.60,$50.00,$26.74,$50.00,$39.60,$40.00,$36.93,$40.06,$25.47,$28.04,$25.47
30201536,EAP,CPT® 84403,,Assay Of Total Testosterone,$50.00,$14.44,$50.00,$46.01,$37.70,$35.13,$14.44,$37.70,$37.70,$38.15,$50.00,$27.10,$50.00,$39.60,$40.00,$37.42,$40.65,$25.81,$28.45,$25.81
30201538,EAP,CPT® 84402,,Assay Of Testosterone,$50.00,$14.25,$50.00,$45.42,$37.18,$34.65,$14.25,$37.18,$37.18,$37.60,$50.00,$26.74,$50.00,$39.60,$40.00,$36.93,$40.06,$25.47,$28.04,$25.47
30201540,EAP,CPT® 86744,,Nocardia Antibody,$93.00,$0.00,$93.00,$0.00,$19.25,$0.00,$0.00,$19.25,$19.25,$0.00,$93.00,$0.00,$36.86,$73.66,$74.40,$0.00,$0.00,$0.00,$0.00,$0.00
30201542,EAP,CPT® 83018,,Quantitative Screen Metals,$259.00,$0.00,$259.00,$0.00,$32.06,$0.00,$0.00,$32.06,$32.06,$0.00,$259.00,$0.00,$61.36,$205.13,$207.20,$0.00,$0.00,$0.00,$0.00,$0.00
30201544,EAP,CPT® 82570,,Assay Of Urine Creatinine,$101.00,$2.90,$101.00,$9.23,$7.56,$5.60,$2.90,$7.56,$7.56,$7.64,$101.00,$5.44,$14.46,$79.99,$80.80,$7.51,$8.14,$5.18,$5.70,$5.18
30201545,EAP,CPT® 84430,,Assay Of Thiocyanate,$133.00,$0.00,$133.00,$0.00,$8.42,$0.00,$0.00,$8.42,$8.42,$0.00,$133.00,$0.00,$16.12,$105.34,$106.40,$0.00,$0.00,$0.00,$0.00,$0.00
30201546,EAP,CPT® 84445,,Thyroid Stimulating Immunoglobulin So,$135.00,$9.34,$135.00,$15.09,$12.36,$69.20,$28.45,$12.36,$12.36,$12.52,$135.00,$53.40,$23.66,$106.92,$108.00,$73.75,$13.34,$50.86,$9.34,$50.86
30201547,EAP,CPT® 84445,,Assay Of Tsi,$172.00,$9.34,$172.00,$15.09,$12.36,$69.20,$28.45,$12.36,$12.36,$12.52,$172.00,$53.40,$23.66,$136.22,$137.60,$73.75,$13.34,$50.86,$9.34,$50.86
30201549,EAP,CPT® 83519,,Ria Nonantibody,$405.00,$9.26,$405.00,$24.08,$19.73,$18.39,$9.26,$19.73,$19.73,$19.96,$405.00,$19.32,$37.76,$320.76,$324.00,$26.68,$21.27,$18.40,$14.89,$18.40
30201551,EAP,CPT® 86682,,Helminth Antibody,$70.00,$7.27,$70.00,$23.19,$18.99,$11.13,$7.27,$18.99,$18.99,$19.20,$70.00,$13.66,$36.34,$55.44,$56.00,$18.86,$20.46,$13.01,$14.32,$13.01
30201553,EAP,CPT® 87798,,Detect Agent Nos Dna Amp,$533.00,$19.63,$533.00,$34.98,$28.64,$37.59,$19.63,$28.64,$28.64,$28.98,$533.00,$36.84,$54.82,$422.14,$426.40,$50.88,$30.88,$35.09,$21.62,$35.09
30201555,EAP,CPT® 80299,,Quantitative Assay Drug,$242.00,$9.39,$242.00,$24.21,$17.58,$15.07,$9.39,$17.58,$17.58,$17.79,$242.00,$19.57,$33.64,$191.66,$193.60,$27.03,$18.95,$18.64,$13.27,$18.64
30201559,EAP,CPT® 86753,,Prorozoa Antibody Nos,$39.00,$0.00,$39.00,$0.00,$18.09,$0.00,$0.00,$18.09,$18.09,$0.00,$39.00,$0.00,$34.64,$30.89,$31.20,$0.00,$0.00,$0.00,$0.00,$0.00
30201561,EAP,CPT® 83520,,Immunoassay Quant Nos Nonab,$238.00,$8.69,$238.00,$23.07,$18.91,$17.62,$8.69,$18.91,$18.91,$19.12,$238.00,$18.13,$36.18,$188.50,$190.40,$25.04,$20.37,$17.27,$14.26,$17.27
30201563,EAP,CPT® 87799,,Detect Agent Nos Dna Quant,$956.00,$0.00,$956.00,$0.00,$62.54,$0.00,$23.96,$62.54,$62.54,$0.00,$956.00,$0.00,$119.70,$757.15,$764.80,$0.00,$149.61,$0.00,$0.00,$0.00
30201565,EAP,CPT® 84425,,Assay Of Vitamin B-1,$102.00,$11.88,$102.00,$37.85,$31.01,$28.89,$11.88,$31.01,$31.01,$31.36,$102.00,$22.29,$59.34,$80.78,$81.60,$30.78,$33.42,$21.23,$23.39,$21.23
30201566,EAP,CPT® 84425,,Vitamin B1 Plasma (thiamine) So,$65.00,$11.88,$65.00,$37.85,$31.01,$28.89,$11.88,$31.01,$31.01,$31.36,$65.00,$22.29,$59.34,$51.48,$52.00,$30.78,$33.42,$21.23,$23.39,$21.23
30201567,EAP,CPT® 84425,,Assay Of Vitamin B-1,$157.00,$11.88,$157.00,$37.85,$31.01,$28.89,$11.88,$31.01,$31.01,$31.36,$157.00,$22.29,$59.34,$124.34,$125.60,$30.78,$33.42,$21.23,$23.39,$21.23
30201569,EAP,CPT® 84597,,Assay Of Vitamin K,$566.00,$0.00,$566.00,$0.00,$20.01,$0.00,$0.00,$20.01,$20.01,$0.00,$566.00,$0.00,$38.30,$448.27,$452.80,$0.00,$0.00,$0.00,$0.00,$0.00
30201571,EAP,CPT® 84591,,Assay Of Nos Vitamin,$121.00,$0.00,$121.00,$0.00,$16.93,$0.00,$0.00,$16.93,$16.93,$0.00,$121.00,$0.00,$32.40,$95.83,$96.80,$0.00,$0.00,$0.00,$0.00,$0.00
30201573,EAP,CPT® 84207,,Assay Of Vtamin B-6,$452.00,$0.00,$452.00,$0.00,$41.02,$0.00,$0.00,$41.02,$41.02,$0.00,$452.00,$0.00,$78.50,$357.98,$361.60,$0.00,$0.00,$0.00,$0.00,$0.00
30201575,EAP,CPT® 82570,,Assay Of Urine Creatinine,$24.00,$2.90,$24.00,$9.23,$7.56,$5.60,$2.90,$7.56,$7.56,$7.64,$24.00,$5.44,$14.46,$19.01,$19.20,$7.51,$8.14,$5.18,$5.70,$5.18
30201576,EAP,CPT® 84585,,Assay Of Urine Vma,$30.00,$0.00,$30.00,$0.00,$22.64,$0.00,$0.00,$22.64,$22.64,$0.00,$30.00,$0.00,$30.00,$23.76,$24.00,$0.00,$0.00,$0.00,$0.00,$0.00
30201578,EAP,CPT® 85247,,Blood Clot Factor Viii Test,$298.00,$0.00,$298.00,$0.00,$33.51,$0.00,$0.00,$33.51,$33.51,$0.00,$298.00,$0.00,$64.12,$236.02,$238.40,$0.00,$0.00,$0.00,$0.00,$0.00
30201580,EAP,CPT® 80299,,Quantitative Assay Drug,$404.00,$9.39,$404.00,$24.21,$17.58,$15.07,$9.39,$17.58,$17.58,$17.79,$404.00,$19.57,$33.64,$319.97,$323.20,$27.03,$18.95,$18.64,$13.27,$18.64
30201581,EAP,CPT® 86788,,West Nile Ab Csf So,$176.00,$0.00,$176.00,$0.00,$24.60,$0.00,$0.00,$24.60,$24.60,$0.00,$176.00,$0.00,$47.08,$139.39,$140.80,$0.00,$0.00,$0.00,$0.00,$0.00
30201582,EAP,CPT® 86788,,West Nile Virus Ag Igm,$300.00,$0.00,$300.00,$0.00,$24.60,$0.00,$0.00,$24.60,$24.60,$0.00,$300.00,$0.00,$47.08,$237.60,$240.00,$0.00,$0.00,$0.00,$0.00,$0.00
30201583,EAP,CPT® 86789,,West Nile Virus Antibody,$300.00,$0.00,$300.00,$0.00,$16.99,$0.00,$0.00,$16.99,$16.99,$0.00,$300.00,$0.00,$32.52,$237.60,$240.00,$0.00,$0.00,$0.00,$0.00,$0.00
30201584,EAP,CPT® 86788,,West Nile Ab Serum So,$148.00,$0.00,$148.00,$0.00,$24.60,$0.00,$0.00,$24.60,$24.60,$0.00,$148.00,$0.00,$47.08,$117.22,$118.40,$0.00,$0.00,$0.00,$0.00,$0.00
30201585,EAP,CPT® 86788,,West Nile Virus Ag Igm,$120.00,$0.00,$120.00,$0.00,$24.60,$0.00,$0.00,$24.60,$24.60,$0.00,$120.00,$0.00,$47.08,$95.04,$96.00,$0.00,$0.00,$0.00,$0.00,$0.00
30201586,EAP,CPT® 86789,,West Nile Virus Antibody,$120.00,$0.00,$120.00,$0.00,$16.99,$0.00,$0.00,$16.99,$16.99,$0.00,$120.00,$0.00,$32.52,$95.04,$96.00,$0.00,$0.00,$0.00,$0.00,$0.00
30201588,EAP,CPT® 84311,,Spectrophotometry,$241.00,$4.08,$241.00,$12.47,$10.20,$9.52,$4.08,$10.20,$10.20,$10.32,$241.00,$8.51,$19.54,$190.87,$192.80,$11.75,$11.00,$8.10,$7.70,$8.10
30201590,EAP,CPT® 82570,,Assay Of Urine Creatinine,$68.00,$2.90,$68.00,$9.23,$7.56,$5.60,$2.90,$7.56,$7.56,$7.64,$68.00,$5.44,$14.46,$53.86,$54.40,$7.51,$8.14,$5.18,$5.70,$5.18
30201591,EAP,CPT® 83497,,Assay Of 5-hiaa,$147.00,$7.22,$147.00,$22.98,$18.83,$17.55,$7.22,$18.83,$18.83,$19.05,$147.00,$13.55,$36.02,$116.42,$117.60,$18.71,$20.30,$12.90,$14.21,$12.90
30201593,EAP,CPT® 83516,,Immunoassay Nonantibody,$280.00,$6.44,$280.00,$19.04,$15.61,$15.70,$6.44,$15.61,$15.61,$15.80,$280.00,$12.11,$29.88,$221.76,$224.00,$16.72,$16.84,$11.53,$11.79,$11.53
30201601,EAP,CPT® 88360,,Tumor Immunohistochem/manual,$310.00,$65.32,$310.00,$184.86,$65.70,$137.60,$65.32,$65.70,$65.70,$114.71,$310.00,$143.92,$121.34,$245.52,$248.00,$199.96,$122.23,$83.20,$85.56,$137.07
30201612,EAP,CPT® 88381,,Microdissection Manual,$36.00,$0.00,$210.18,$36.00,$155.30,$0.00,$78.74,$155.30,$155.30,$197.25,$36.00,$0.00,$18.00,$28.51,$28.80,$0.00,$210.18,$156.67,$147.12,$0.00
30201614,EAP,CPT® 83516,,Immunoassay Nonantibody,$265.00,$6.44,$265.00,$19.04,$15.61,$15.70,$6.44,$15.61,$15.61,$15.80,$265.00,$12.11,$29.88,$209.88,$212.00,$16.72,$16.84,$11.53,$11.79,$11.53
30201616,EAP,CPT® 83516,,Immunoassay Nonantibody,$460.00,$6.44,$460.00,$19.04,$15.61,$15.70,$6.44,$15.61,$15.61,$15.80,$460.00,$12.11,$29.88,$364.32,$368.00,$16.72,$16.84,$11.53,$11.79,$11.53
30201618,EAP,CPT® 87538,,Hiv-2 Dna Amp Probe,$506.00,$19.63,$506.00,$34.98,$28.64,$37.59,$19.63,$28.64,$28.64,$88.60,$506.00,$36.84,$54.82,$400.75,$404.80,$50.88,$79.19,$35.09,$80.56,$35.09
30201620,EAP,CPT® 84432,,Assay Of Thyroglobulin,$213.00,$8.98,$213.00,$28.64,$23.45,$9.90,$8.98,$23.45,$23.45,$23.73,$213.00,$16.86,$44.88,$168.70,$170.40,$23.29,$25.28,$16.06,$17.70,$16.06
30201628,EAP,CPT® 86317,,Immunoassay Infectious Agent,$33.00,$8.38,$33.00,$21.41,$17.52,$20.40,$8.38,$17.52,$17.52,$17.72,$33.00,$15.74,$33.00,$26.14,$26.40,$21.74,$18.89,$14.99,$13.22,$14.99
30201630,EAP,CPT® 86382,,Neutralization Test Viral,$46.00,$0.00,$46.00,$0.00,$24.69,$0.00,$0.00,$24.69,$24.69,$0.00,$46.00,$0.00,$46.00,$36.43,$36.80,$0.00,$0.00,$0.00,$0.00,$0.00
30201632,EAP,CPT® 83088,,Assay Of Histamine,$76.00,$0.00,$76.00,$0.00,$43.12,$0.00,$0.00,$43.12,$43.12,$0.00,$76.00,$0.00,$76.00,$60.19,$60.80,$0.00,$0.00,$0.00,$0.00,$0.00
30201634,EAP,CPT® 88271,,Cytogenetics Dna Probe,$69.00,$11.98,$69.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$69.00,$22.49,$59.86,$54.65,$55.20,$31.06,$33.72,$21.42,$23.60,$21.42
30201635,EAP,CPT® 88275,,Cytogenetics 100-300,$137.00,$25.78,$137.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$137.00,$53.75,$112.22,$108.50,$109.60,$74.23,$63.21,$51.19,$44.25,$51.19
30201638,EAP,CPT® 88272,,Cytogenetics 3-5,$508.00,$0.00,$508.00,$0.00,$39.09,$0.00,$0.00,$39.09,$39.09,$0.00,$508.00,$0.00,$74.82,$402.34,$406.40,$0.00,$0.00,$0.00,$0.00,$0.00
30201640,EAP,CPT® 86787,,Varicella-zoster Antibody,$185.00,$7.21,$185.00,$22.96,$18.81,$17.53,$7.21,$18.81,$18.81,$19.03,$185.00,$13.52,$36.00,$146.52,$148.00,$18.68,$20.27,$12.88,$14.19,$12.88
30201642,EAP,CPT® 88360,,Tumor Immunohistoche/manual,$297.00,$65.32,$297.00,$184.86,$65.70,$137.60,$65.32,$65.70,$65.70,$114.71,$297.00,$143.92,$121.34,$235.22,$237.60,$199.96,$122.23,$83.20,$85.56,$137.07
30201650,EAP,CPT® 86694,,Herpes Simplex Test,$150.00,$8.06,$150.00,$20.75,$16.99,$19.58,$8.06,$16.99,$16.99,$17.19,$150.00,$15.11,$32.52,$118.80,$120.00,$20.87,$18.31,$14.39,$12.82,$14.39
30201652,EAP,CPT® 88271,,Cytogenetics Dna Probe,$62.00,$11.98,$62.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$62.00,$22.49,$59.86,$49.10,$49.60,$31.06,$33.72,$21.42,$23.60,$21.42
30201653,EAP,CPT® 88275,,Cytogenetics 100-300,$151.00,$25.78,$151.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$151.00,$53.75,$112.22,$119.59,$120.80,$74.23,$63.21,$51.19,$44.25,$51.19
30201656,EAP,CPT® 86382,,Neutralization Test Viral,$47.00,$0.00,$47.00,$0.00,$24.69,$0.00,$0.00,$24.69,$24.69,$0.00,$47.00,$0.00,$47.00,$37.22,$37.60,$0.00,$0.00,$0.00,$0.00,$0.00
30201658,EAP,CPT® 86317,,Immunoassay Infectious Agent,$33.00,$8.38,$33.00,$21.41,$17.52,$20.40,$8.38,$17.52,$17.52,$17.72,$33.00,$15.74,$33.00,$26.14,$26.40,$21.74,$18.89,$14.99,$13.22,$14.99
30201660,EAP,CPT® 88271,,Cytogenetics Dna Probe,$77.00,$11.98,$77.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$77.00,$22.49,$59.86,$60.98,$61.60,$31.06,$33.72,$21.42,$23.60,$21.42
30201661,EAP,CPT® 88275,,Cytogenetics 100-300,$117.00,$25.78,$117.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$117.00,$53.75,$112.22,$92.66,$93.60,$74.23,$63.21,$51.19,$44.25,$51.19
30201664,EAP,CPT® 83516,,Immunoassay Nonantibody,$289.00,$6.44,$289.00,$19.04,$15.61,$15.70,$6.44,$15.61,$15.61,$15.80,$289.00,$12.11,$29.88,$228.89,$231.20,$16.72,$16.84,$11.53,$11.79,$11.53
30201665,EAP,CPT® 82784,,Assay Iga/igd/igg/igm Each,$28.00,$5.20,$28.00,$16.58,$13.58,$9.90,$5.20,$13.58,$13.58,$13.73,$28.00,$9.77,$25.98,$22.18,$22.40,$13.49,$14.63,$9.30,$10.24,$9.30
30201667,EAP,CPT® 88271,,Cytogenetics Dna Probe,$85.00,$11.98,$85.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$85.00,$22.49,$59.86,$67.32,$68.00,$31.06,$33.72,$21.42,$23.60,$21.42
30201668,EAP,CPT® 88275,,Cytogenetics 100-300,$139.00,$25.78,$139.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$139.00,$53.75,$112.22,$110.09,$111.20,$74.23,$63.21,$51.19,$44.25,$51.19
30201671,EAP,CPT® 86817,,Hla Typing Dr/dq,"$1,108.00",$0.00,"$1,108.00",$0.00,$94.00,$0.00,$0.00,$94.00,$94.00,$0.00,"$1,108.00",$0.00,$179.90,$877.54,$886.40,$0.00,$0.00,$0.00,$0.00,$0.00
30201672,EAP,CPT® 86813,,Hla Typing A B Or C,"$1,254.00",$0.00,"$1,254.00",$0.00,$84.66,$0.00,$0.00,$84.66,$84.66,$0.00,"$1,254.00",$0.00,$162.04,$993.17,"$1,003.20",$0.00,$0.00,$0.00,$0.00,$0.00
30201673,EAP,CPT® 86808,,Cytotoxic Antibody Screening,$349.00,$0.00,$349.00,$0.00,$43.33,$0.00,$0.00,$43.33,$43.33,$0.00,$349.00,$0.00,$82.94,$276.41,$279.20,$0.00,$0.00,$0.00,$0.00,$0.00
30201687,EAP,CPT® 88271,,Cytogenetics Dna Probe,$102.00,$11.98,$102.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$102.00,$22.49,$59.86,$80.78,$81.60,$31.06,$33.72,$21.42,$23.60,$21.42
30201688,EAP,CPT® 88275,,Cytogenetics 100-300,$176.00,$25.78,$176.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$176.00,$53.75,$112.22,$139.39,$140.80,$74.23,$63.21,$51.19,$44.25,$51.19
30201691,EAP,CPT® 86255,,Fluorescent Antibody Screen,$660.00,$6.75,$660.00,$21.48,$17.60,$16.40,$6.75,$17.60,$17.60,$17.81,$660.00,$12.65,$33.68,$522.72,$528.00,$17.47,$18.97,$12.05,$13.28,$12.05
30201693,EAP,CPT® 83519,,Ria Nonantibody,"$1,320.00",$9.26,"$1,320.00",$24.08,$19.73,$18.39,$9.26,$19.73,$19.73,$19.96,"$1,320.00",$19.32,$37.76,"$1,045.44","$1,056.00",$26.68,$21.27,$18.40,$14.89,$18.40
30201706,EAP,CPT® 83520,,Immunoassay Quant Nos Nonab,$205.00,$8.69,$205.00,$23.07,$18.91,$17.62,$8.69,$18.91,$18.91,$19.12,$205.00,$18.13,$36.18,$162.36,$164.00,$25.04,$20.37,$17.27,$14.26,$17.27
30201707,EAP,CPT® 86021,,Wbc Antibody Identification,$92.00,$8.42,$92.00,$26.84,$21.98,$20.49,$8.42,$21.98,$21.98,$22.24,$92.00,$15.80,$42.06,$72.86,$73.60,$21.82,$23.70,$15.05,$16.59,$15.05
30201708,EAP,CPT® 86255,,Fluorescent Antibody Screen,$104.00,$6.75,$104.00,$21.48,$17.60,$16.40,$6.75,$17.60,$17.60,$17.81,$104.00,$12.65,$33.68,$82.37,$83.20,$17.47,$18.97,$12.05,$13.28,$12.05
30201709,EAP,CPT® 86609,,Bacterium Antibody,$84.00,$0.00,$84.00,$0.00,$18.81,$0.00,$0.00,$18.81,$18.81,$0.00,$84.00,$0.00,$36.00,$66.53,$67.20,$0.00,$0.00,$0.00,$0.00,$0.00
30201710,EAP,CPT® 86671,,Fungus Antibody,$83.00,$6.86,$83.00,$21.84,$17.90,$11.13,$6.86,$17.90,$17.90,$18.11,$83.00,$12.86,$34.26,$65.74,$66.40,$17.76,$19.30,$12.25,$13.51,$12.25
30201711,EAP,CPT® 86689,,Hiv-2 Wb,$207.00,$0.00,$207.00,$0.00,$28.26,$0.00,$0.00,$28.26,$28.26,$0.00,$207.00,$0.00,$54.10,$163.94,$165.60,$0.00,$0.00,$0.00,$0.00,$0.00
30201712,EAP,CPT® 86038,,Antinuclear Antibodies,$24.00,$6.76,$24.00,$21.55,$17.65,$16.45,$6.76,$17.65,$17.65,$17.86,$24.00,$12.69,$24.00,$19.01,$19.20,$17.53,$19.03,$12.09,$13.32,$12.09
30201713,EAP,CPT® 86376,,Microsomal Antibody,$49.00,$8.14,$49.00,$25.95,$21.25,$19.80,$8.14,$21.25,$21.25,$21.49,$49.00,$15.28,$40.66,$38.81,$39.20,$21.10,$22.90,$14.55,$16.03,$14.55
30201714,EAP,CPT® 86658,,Enterovirus Antibody,$27.00,$7.28,$27.00,$23.23,$19.03,$11.13,$7.28,$19.03,$19.03,$19.25,$27.00,$13.68,$27.00,$21.38,$21.60,$18.89,$20.51,$13.03,$14.36,$13.03
30201715,EAP,CPT® 86652,,"Antibody Encephalitis, Eastern Equine",$25.00,$0.00,$25.00,$0.00,$19.25,$0.00,$0.00,$19.25,$19.25,$0.00,$25.00,$0.00,$25.00,$19.80,$20.00,$0.00,$0.00,$0.00,$0.00,$0.00
30201718,EAP,CPT® 86765,,Rubeola Antibody,$31.00,$7.21,$31.00,$22.96,$18.81,$11.13,$7.21,$18.81,$18.81,$19.03,$31.00,$13.52,$31.00,$24.55,$24.80,$18.68,$20.27,$12.88,$14.19,$12.88
30201719,EAP,CPT® 86653,,Encephalitis Antibody,$25.00,$0.00,$25.00,$0.00,$19.25,$0.00,$0.00,$19.25,$19.25,$0.00,$25.00,$0.00,$25.00,$19.80,$20.00,$0.00,$0.00,$0.00,$0.00,$0.00
30201720,EAP,CPT® 86787,,Varicella-zoster Antibody,$29.00,$7.21,$29.00,$22.96,$18.81,$17.53,$7.21,$18.81,$18.81,$19.03,$29.00,$13.52,$29.00,$22.97,$23.20,$18.68,$20.27,$12.88,$14.19,$12.88
30201721,EAP,CPT® 86654,,Encephalitis Antibody,$25.00,$0.00,$25.00,$0.00,$19.25,$0.00,$0.00,$19.25,$19.25,$0.00,$25.00,$0.00,$25.00,$19.80,$20.00,$0.00,$0.00,$0.00,$0.00,$0.00
30201722,EAP,CPT® 86645,,Cmv Antibody Igm,$35.00,$9.42,$35.00,$30.03,$24.60,$11.13,$9.42,$24.60,$24.60,$24.90,$35.00,$17.69,$35.00,$27.72,$28.00,$24.43,$26.53,$16.85,$18.57,$16.85
30201724,EAP,CPT® 86403,,Particle Agglutination Test,$90.00,$5.81,$90.00,$18.17,$14.88,$13.87,$5.81,$14.88,$14.88,$11.75,$90.00,$12.12,$28.48,$71.28,$72.00,$16.73,$12.52,$11.54,$8.76,$11.54
30201725,EAP,CPT® 86406,,Particle Agglutination Test,$136.00,$5.95,$136.00,$18.97,$15.53,$14.47,$5.95,$15.53,$15.53,$15.72,$136.00,$11.17,$29.74,$107.71,$108.80,$15.43,$16.75,$10.64,$11.72,$10.64
30201726,EAP,CPT® 86403,,Particle Agglutination Test,$99.00,$5.81,$99.00,$18.17,$14.88,$13.87,$5.81,$14.88,$14.88,$11.75,$99.00,$12.12,$28.48,$78.41,$79.20,$16.73,$12.52,$11.54,$8.76,$11.54
30201727,EAP,CPT® 88342,,Immunohistochemistry,$278.00,$54.62,$278.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$278.00,$143.92,$106.46,$220.18,$222.40,$199.96,$89.59,$70.23,$62.72,$137.07
30201728,EAP,CPT® 88360,,Tumor Immunohistochem/manual,$638.00,$65.32,$638.00,$184.86,$65.70,$137.60,$65.32,$65.70,$65.70,$114.71,$638.00,$143.92,$121.34,$505.30,$510.40,$199.96,$122.23,$83.20,$85.56,$137.07
30201729,EAP,CPT® 86256,,Fluorescent Antibody Titer,$131.00,$6.75,$131.00,$21.48,$17.60,$16.40,$6.75,$17.60,$17.60,$17.81,$131.00,$12.65,$33.68,$103.75,$104.80,$17.47,$18.97,$12.05,$13.28,$12.05
30201730,EAP,CPT® 88368,,Insitu Hybridization Manual,$454.00,$65.14,$454.00,$154.04,$145.54,$271.76,$65.14,$145.54,$145.54,$199.20,$454.00,$284.24,$207.74,$359.57,$363.20,$394.92,$212.25,$90.40,$148.57,$270.71
30201731,EAP,CPT® 88342,,Immunohistochemistry,$556.00,$54.62,$556.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$556.00,$143.92,$106.46,$440.35,$444.80,$199.96,$89.59,$70.23,$62.72,$137.07
30201735,EAP,CPT® 86022,,Nait Platelet Ab (so),$361.00,$0.00,$361.00,$0.00,$26.82,$0.00,$0.00,$26.82,$26.82,$0.00,$361.00,$0.00,$51.32,$285.91,$288.80,$0.00,$0.00,$0.00,$0.00,$0.00
30201736,EAP,CPT® 86255,,Fluorescent Antibody Screen,$34.00,$6.75,$34.00,$21.48,$17.60,$16.40,$6.75,$17.60,$17.60,$17.81,$34.00,$12.65,$33.68,$26.93,$27.20,$17.47,$18.97,$12.05,$13.28,$12.05
30201737,EAP,CPT® 86727,,Lymph Choriomeningitis Ab,$19.00,$0.00,$19.00,$0.00,$18.79,$0.00,$0.00,$18.79,$18.79,$0.00,$19.00,$0.00,$19.00,$15.05,$15.20,$0.00,$0.00,$0.00,$0.00,$0.00
30201738,EAP,CPT® 84181,,Western Blot Test,$316.00,$0.00,$316.00,$0.00,$24.87,$0.00,$0.00,$24.87,$24.87,$0.00,$316.00,$0.00,$47.60,$250.27,$252.80,$0.00,$0.00,$0.00,$0.00,$0.00
30201750,EAP,CPT® 80299,,Quantitative Assay Drug,$337.00,$9.39,$337.00,$24.21,$17.58,$15.07,$9.39,$17.58,$17.58,$17.79,$337.00,$19.57,$33.64,$266.90,$269.60,$27.03,$18.95,$18.64,$13.27,$18.64
30201754,EAP,CPT® 82985,,Glycated Protein,$149.00,$8.44,$149.00,$26.88,$22.01,$20.51,$8.44,$22.01,$22.01,$22.26,$149.00,$17.60,$42.12,$118.01,$119.20,$24.30,$23.72,$16.76,$16.60,$16.76
30201758,EAP,CPT® 83519,,Ria Nonantibody,$93.00,$9.26,$93.00,$24.08,$19.73,$18.39,$9.26,$19.73,$19.73,$19.96,$93.00,$19.32,$37.76,$73.66,$74.40,$26.68,$21.27,$18.40,$14.89,$18.40
30201759,EAP,CPT® 86255,,Fluorescent Antibody Screen,$44.00,$6.75,$44.00,$21.48,$17.60,$16.40,$6.75,$17.60,$17.60,$17.81,$44.00,$12.65,$33.68,$34.85,$35.20,$17.47,$18.97,$12.05,$13.28,$12.05
30201760,EAP,CPT® 86256,,Fluorescent Antibody Titer,$44.00,$6.75,$44.00,$21.48,$17.60,$16.40,$6.75,$17.60,$17.60,$17.81,$44.00,$12.65,$33.68,$34.85,$35.20,$17.47,$18.97,$12.05,$13.28,$12.05
30201761,EAP,CPT® 86003,,Allergen Specific Ige,$130.00,$2.92,$130.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$130.00,$5.48,$14.60,$102.96,$104.00,$7.57,$8.22,$5.22,$5.76,$5.22
30201762,EAP,CPT® 83519,,Ria Nonantibody,$349.00,$9.26,$349.00,$24.08,$19.73,$18.39,$9.26,$19.73,$19.73,$19.96,$349.00,$19.32,$37.76,$276.41,$279.20,$26.68,$21.27,$18.40,$14.89,$18.40
30201766,EAP,CPT® 87186,,Microbe Susceptible Mic,$271.00,$4.83,$271.00,$15.41,$12.62,$11.77,$4.83,$12.62,$12.62,$12.77,$271.00,$9.08,$24.16,$214.63,$216.80,$12.54,$13.60,$8.65,$9.52,$8.65
30201767,EAP,CPT® 83520,,Immunoassay Quant Nos Nonab,$490.00,$8.69,$490.00,$23.07,$18.91,$17.62,$8.69,$18.91,$18.91,$19.12,$490.00,$18.13,$36.18,$388.08,$392.00,$25.04,$20.37,$17.27,$14.26,$17.27
30201768,EAP,CPT® 82107,,Alpha-fetoprotein 13,$276.00,$0.00,$276.00,$0.00,$94.04,$0.00,$0.00,$94.04,$94.04,$0.00,$276.00,$0.00,$179.98,$218.59,$220.80,$0.00,$0.00,$0.00,$0.00,$0.00
30201769,EAP,CPT® 87496,,Cytomeg Dna Amp Probe,$206.00,$19.63,$206.00,$34.98,$28.64,$37.59,$19.63,$28.64,$28.64,$28.98,$206.00,$36.84,$54.82,$163.15,$164.80,$50.88,$30.88,$35.09,$21.62,$35.09
30201770,EAP,CPT® 82374,,Assay Blood Carbon Dioxide,$91.00,$2.73,$91.00,$8.71,$7.14,$5.85,$2.73,$7.14,$7.14,$7.22,$91.00,$5.12,$13.66,$72.07,$72.80,$7.08,$7.70,$4.88,$5.39,$4.88
30201771,EAP,CPT® 86255,,Fluorescent Antibody Screen,$69.00,$6.75,$69.00,$21.48,$17.60,$16.40,$6.75,$17.60,$17.60,$17.81,$69.00,$12.65,$33.68,$54.65,$55.20,$17.47,$18.97,$12.05,$13.28,$12.05
30201772,EAP,CPT® 86256,,Fluorescent Antibody Titer,$69.00,$6.75,$69.00,$21.48,$17.60,$16.40,$6.75,$17.60,$17.60,$17.81,$69.00,$12.65,$33.68,$54.65,$55.20,$17.47,$18.97,$12.05,$13.28,$12.05
30201773,EAP,CPT® 82310,,Assay Of Calcium,$36.00,$2.89,$36.00,$9.21,$7.53,$7.02,$2.89,$7.53,$7.53,$7.46,$36.00,$5.42,$14.40,$28.51,$28.80,$7.48,$7.94,$5.16,$5.56,$5.16
30201774,EAP,CPT® 83970,,Assay Of Parathormone,$71.00,$23.09,$71.00,$71.00,$60.27,$56.17,$23.09,$60.27,$60.27,$60.97,$71.00,$43.34,$71.00,$56.23,$56.80,$59.86,$64.97,$41.28,$45.48,$41.28
30201786,EAP,CPT® 84146,,Assay Of Prolactin,$73.00,$10.84,$73.00,$34.54,$28.30,$26.37,$10.84,$28.30,$28.30,$28.63,$73.00,$20.35,$54.16,$57.82,$58.40,$28.10,$30.51,$19.38,$21.36,$19.38
30201789,EAP,CPT® 83520,,Immunoassay Quant Nos Nonab,$390.00,$8.69,$390.00,$23.07,$18.91,$17.62,$8.69,$18.91,$18.91,$19.12,$390.00,$18.13,$36.18,$308.88,$312.00,$25.04,$20.37,$17.27,$14.26,$17.27
30201790,EAP,CPT® 87798,,Detect Agent Nos Dna Amp,$316.00,$19.63,$316.00,$34.98,$28.64,$37.59,$19.63,$28.64,$28.64,$28.98,$316.00,$36.84,$54.82,$250.27,$252.80,$50.88,$30.88,$35.09,$21.62,$35.09
30201793,EAP,CPT® 86698,,Histoplasma,$26.00,$6.99,$26.00,$22.28,$18.25,$11.13,$6.99,$18.25,$18.25,$18.46,$26.00,$14.48,$26.00,$20.59,$20.80,$20.00,$19.67,$13.79,$13.77,$13.79
30201797,EAP,CPT® 86611,,Bartonella Antibody,$98.00,$5.69,$98.00,$18.15,$14.85,$11.13,$5.69,$14.85,$14.85,$15.04,$98.00,$10.69,$28.44,$77.62,$78.40,$14.76,$16.02,$10.18,$11.21,$10.18
30201798,EAP,CPT® 86768,,Salmonella Antibody,$47.00,$0.00,$47.00,$0.00,$19.25,$0.00,$0.00,$19.25,$19.25,$0.00,$47.00,$0.00,$36.86,$37.22,$37.60,$0.00,$0.00,$0.00,$0.00,$0.00
30201801,EAP,CPT® 80299,,Quantitative Assay Drug,$212.00,$9.39,$212.00,$24.21,$17.58,$15.07,$9.39,$17.58,$17.58,$17.79,$212.00,$19.57,$33.64,$167.90,$169.60,$27.03,$18.95,$18.64,$13.27,$18.64
30201802,EAP,CPT® 87798,,Detect Agent Nos Dna Amp,$441.00,$19.63,$441.00,$34.98,$28.64,$37.59,$19.63,$28.64,$28.64,$28.98,$441.00,$36.84,$54.82,$349.27,$352.80,$50.88,$30.88,$35.09,$21.62,$35.09
30201816,EAP,CPT® 83519,,Ria Nonantibody,$560.00,$9.26,$560.00,$24.08,$19.73,$18.39,$9.26,$19.73,$19.73,$19.96,$560.00,$19.32,$37.76,$443.52,$448.00,$26.68,$21.27,$18.40,$14.89,$18.40
30201817,EAP,CPT® 80299,,Quantitative Assay Drug,$370.00,$9.39,$370.00,$24.21,$17.58,$15.07,$9.39,$17.58,$17.58,$17.79,$370.00,$19.57,$33.64,$293.04,$296.00,$27.03,$18.95,$18.64,$13.27,$18.64
30201818,EAP,CPT® 87906,,Genotype Dna Hiv Reverse T,$818.00,$43.01,$818.00,$77.75,$61.36,$150.39,$72.01,$61.36,$61.36,$57.67,$818.00,$135.17,$409.00,$647.86,$654.40,$186.66,$61.44,$128.73,$43.01,$128.73
30201819,EAP,CPT® 86727,,Lymph Choriomeningitis Ab,$96.00,$0.00,$96.00,$0.00,$18.79,$0.00,$0.00,$18.79,$18.79,$0.00,$96.00,$0.00,$35.96,$76.03,$76.80,$0.00,$0.00,$0.00,$0.00,$0.00
30201820,EAP,CPT® 87906,,Genotype Dna Hiv Reverse T,"$1,658.00",$43.01,"$1,658.00",$77.75,$61.36,$150.39,$72.01,$61.36,$61.36,$57.67,"$1,658.00",$135.17,$829.00,"$1,313.14","$1,326.40",$186.66,$61.44,$128.73,$43.01,$128.73
30201821,EAP,CPT® 88365,,Ebv Ish W/interp (so),$574.00,$77.27,$574.00,$233.88,$98.25,$137.60,$90.54,$98.25,$98.25,$103.59,$574.00,$143.92,$156.90,$454.61,$459.20,$199.96,$110.38,$137.95,$77.27,$137.07
30201822,EAP,CPT® 88365,,Ebv Ish W/o Interp (so),$574.00,$77.27,$574.00,$233.88,$98.25,$137.60,$90.54,$98.25,$98.25,$103.59,$574.00,$143.92,$156.90,$454.61,$459.20,$199.96,$110.38,$137.95,$77.27,$137.07
30201823,EAP,CPT® 88275,,Fish Burkitt Nhl T(8;14)(so),$620.00,$25.78,$620.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$620.00,$53.75,$112.22,$491.04,$496.00,$74.23,$63.21,$51.19,$44.25,$51.19
30201824,EAP,CPT® 88271,,Fish Burkitt Dna Probe (so),$404.00,$11.98,$404.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$404.00,$22.49,$59.86,$319.97,$323.20,$31.06,$33.72,$21.42,$23.60,$21.42
30201825,EAP,CPT® 87902,,Hcv Rna Genotype 1 Ns5b (so),"$1,241.00",$96.09,"$1,241.00",$155.47,$127.33,$300.79,$144.01,$127.33,$127.33,$128.84,"$1,241.00",$270.32,$243.70,$982.87,$992.80,$373.30,$137.28,$257.45,$96.09,$257.45
30201834,EAP,CPT® 82656,,Pancreatic Elastase Fecal,$273.00,$6.44,$273.00,$19.04,$15.61,$15.70,$6.44,$15.61,$15.61,$47.80,$273.00,$12.11,$29.88,$216.22,$218.40,$16.72,$42.72,$11.53,$43.46,$11.53
30201835,EAP,CPT® 87798,,Detect Agent Nos Dna Amp,$304.00,$19.63,$304.00,$34.98,$28.64,$37.59,$19.63,$28.64,$28.64,$28.98,$304.00,$36.84,$54.82,$240.77,$243.20,$50.88,$30.88,$35.09,$21.62,$35.09
30201836,EAP,CPT® 86356,,Mononuclear Cell Antigen,$152.00,$0.00,$152.00,$0.00,$38.11,$0.00,$0.00,$38.11,$38.11,$0.00,$152.00,$0.00,$76.00,$120.38,$121.60,$0.00,$0.00,$0.00,$0.00,$0.00
30201837,EAP,CPT® 86355,,Cells Total Count,$49.00,$21.10,$49.00,$42.00,$34.39,$22.53,$21.10,$34.39,$34.39,$34.80,$49.00,$39.62,$49.00,$38.81,$39.20,$49.00,$37.08,$37.73,$25.95,$37.73
30201838,EAP,CPT® 86359,,Cells Total Count,$49.00,$21.10,$49.00,$42.00,$34.39,$22.53,$21.10,$34.39,$34.39,$34.80,$49.00,$39.62,$49.00,$38.81,$39.20,$49.00,$37.08,$37.73,$25.95,$37.73
30201839,EAP,CPT® 88365,,Institu Hybridization (fish),$260.00,$77.27,$260.00,$233.88,$98.25,$137.60,$90.54,$98.25,$98.25,$103.59,$260.00,$143.92,$156.90,$205.92,$208.00,$199.96,$110.38,$137.95,$77.27,$137.07
30201840,EAP,CPT® 86808,,Cytotoxic Antibody Screening,$325.00,$0.00,$325.00,$0.00,$43.33,$0.00,$0.00,$43.33,$43.33,$0.00,$325.00,$0.00,$82.94,$257.40,$260.00,$0.00,$0.00,$0.00,$0.00,$0.00
30201841,EAP,CPT® 86816,,Hla Typing Dr/dq,$344.00,$0.00,$344.00,$0.00,$40.67,$0.00,$0.00,$40.67,$40.67,$0.00,$344.00,$0.00,$77.84,$272.45,$275.20,$0.00,$0.00,$0.00,$0.00,$0.00
30201842,EAP,CPT® 86255,,Fluorescent Antibody Screen,$25.00,$6.75,$25.00,$21.48,$17.60,$16.40,$6.75,$17.60,$17.60,$17.81,$25.00,$12.65,$25.00,$19.80,$20.00,$17.47,$18.97,$12.05,$13.28,$12.05
30201843,EAP,CPT® 86256,,Fluorescent Antibody Titer,$25.00,$6.75,$25.00,$21.48,$17.60,$16.40,$6.75,$17.60,$17.60,$17.81,$25.00,$12.65,$25.00,$19.80,$20.00,$17.47,$18.97,$12.05,$13.28,$12.05
30201844,EAP,CPT® 86003,,Allergen Specific Ige,$411.00,$2.92,$411.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$411.00,$5.48,$14.60,$325.51,$328.80,$7.57,$8.22,$5.22,$5.76,$5.22
30201845,EAP,CPT® 86317,,"Immunoassay For Infectious Agent,ab,quant",$31.00,$8.38,$31.00,$21.41,$17.52,$20.40,$8.38,$17.52,$17.52,$17.72,$31.00,$15.74,$31.00,$24.55,$24.80,$21.74,$18.89,$14.99,$13.22,$14.99
30201846,EAP,CPT® 86001,,Allergen Specific Igg Quant,$175.00,$0.00,$175.00,$0.00,$7.62,$0.00,$0.00,$7.62,$7.62,$0.00,$175.00,$0.00,$14.60,$138.60,$140.00,$0.00,$0.00,$0.00,$0.00,$0.00
30201847,EAP,CPT® 86003,,Allergen Specific Ige,$175.00,$2.92,$175.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$175.00,$5.48,$14.60,$138.60,$140.00,$7.57,$8.22,$5.22,$5.76,$5.22
30201848,EAP,CPT® 86147,,Anti-cardiolipin Igg,$726.00,$14.24,$726.00,$45.37,$37.14,$21.84,$14.24,$37.14,$37.14,$37.58,$726.00,$26.72,$71.08,$574.99,$580.80,$36.90,$40.04,$25.45,$28.03,$25.45
30201849,EAP,CPT® 86147,,Anti-cardiolipin Igm,$726.00,$14.24,$726.00,$45.37,$37.14,$21.84,$14.24,$37.14,$37.14,$37.58,$726.00,$26.72,$71.08,$574.99,$580.80,$36.90,$40.04,$25.45,$28.03,$25.45
30201850,EAP,CPT® 86757,,Rmsf Igm Titer,$164.00,$0.00,$164.00,$0.00,$28.26,$0.00,$0.00,$28.26,$28.26,$0.00,$164.00,$0.00,$54.10,$129.89,$131.20,$0.00,$0.00,$0.00,$0.00,$0.00
30201856,EAP,CPT® 81342,,T-CELL  REARRANGEMENT- PCR  (RQD),$762.00,$0.00,$762.00,$0.00,$274.90,$0.00,$0.00,$274.90,$274.90,$0.00,$762.00,$0.00,$381.00,$603.50,$609.60,$0.00,$0.00,$0.00,$0.00,$0.00
30201865,EAP,Custom 30201865,,Bcr/abl T(9;22) Fish (gen),$758.00,$0.00,$758.00,$0.00,$540.98,$0.00,$0.00,$540.98,$540.98,$0.00,$758.00,$0.00,$379.00,$600.34,$606.40,$0.00,$0.00,$0.00,$0.00,$0.00
30201869,EAP,CPT® 81275,,KRAS Gene Mutation Detection (RQD),$940.00,$97.29,$940.00,$258.05,$197.48,$196.99,$97.29,$197.48,$197.48,$220.85,$940.00,$202.91,$470.00,$744.48,$752.00,$280.21,$235.32,$193.25,$164.72,$193.25
30201879,EAP,CPT® 87906,,"Integrase, Quest",$956.00,$43.01,$956.00,$77.75,$61.36,$150.39,$72.01,$61.36,$61.36,$57.67,$956.00,$135.17,$478.00,$757.15,$764.80,$186.66,$61.44,$128.73,$43.01,$128.73
30201900,EAP,CPT® 87999,,"Trofile, Dna Monogram -quest","$3,182.00",$0.00,"$3,182.00",$0.00,"$2,270.99",$0.00,$0.00,"$2,270.99","$2,270.99",$0.00,"$3,182.00",$0.00,$0.00,"$2,520.14","$2,545.60",$0.00,$0.00,$0.00,$0.00,$0.00
30201914,EAP,CPT® 81342,,T-CELL  REARRANGEMENT-PCR QD,$762.00,$0.00,$762.00,$0.00,$274.90,$0.00,$0.00,$274.90,$274.90,$0.00,$762.00,$0.00,$381.00,$603.50,$609.60,$0.00,$0.00,$0.00,$0.00,$0.00
30201926,EAP,CPT® 81275,,KRAS Gene Mutation Detect(RQD),$940.00,$97.29,$940.00,$258.05,$197.48,$196.99,$97.29,$197.48,$197.48,$220.85,$940.00,$202.91,$470.00,$744.48,$752.00,$280.21,$235.32,$193.25,$164.72,$193.25
30201933,EAP,CPT® 81270,,Jak2 V617f Mutation Quant (so),$969.00,$51.27,$969.00,$163.41,$125.06,$124.75,$51.27,$125.06,$125.06,$84.58,$969.00,$96.24,$484.50,$767.45,$775.20,$132.91,$90.12,$91.66,$63.08,$91.66
30201934,EAP,CPT® 87906,,"INTEGRASE, QUEST",$782.00,$43.01,$782.00,$77.75,$61.36,$150.39,$72.01,$61.36,$61.36,$57.67,$782.00,$135.17,$391.00,$619.34,$625.60,$186.66,$61.44,$128.73,$43.01,$128.73
30201936,EAP,CPT® 81402,,MPL ANAL Mutation Anal (RQD),"$1,634.00",$0.00,"$1,634.00",$0.00,"$1,166.19",$0.00,$0.00,"$1,166.19","$1,166.19",$0.00,"$1,634.00",$0.00,$817.00,"$1,294.13","$1,307.20",$0.00,$0.00,$0.00,$0.00,$0.00
30201955,EAP,CPT® 87999,,"TROFILE, DNA Monogram -Quest","$3,030.00",$0.00,"$3,030.00",$0.00,"$2,162.51",$0.00,$0.00,"$2,162.51","$2,162.51",$0.00,"$3,030.00",$0.00,$0.00,"$2,399.76","$2,424.00",$0.00,$0.00,$0.00,$0.00,$0.00
30201958,EAP,CPT® 86703,,Focus Hiv 1/2 Ab Scrn,$267.00,$7.66,$267.00,$24.44,$20.02,$14.37,$7.66,$20.02,$20.02,$17.58,$267.00,$19.20,$38.34,$211.46,$213.60,$19.88,$18.73,$18.29,$13.11,$18.29
30201959,EAP,CPT® 86689,,Focus Hiv Wb,$401.00,$0.00,$401.00,$0.00,$28.26,$0.00,$0.00,$28.26,$28.26,$0.00,$401.00,$0.00,$54.10,$317.59,$320.80,$0.00,$0.00,$0.00,$0.00,$0.00
30201960,EAP,CPT® 86360,,Focus Lymphocyte Subsets,$500.00,$26.28,$500.00,$83.77,$68.60,$45.07,$26.28,$68.60,$68.60,$69.42,$500.00,$49.33,$131.30,$396.00,$400.00,$68.12,$73.96,$46.98,$51.77,$46.98
30201961,EAP,CPT® 86317,,Strep Pneumoniae Igg Ab Panel (so),$280.00,$8.38,$280.00,$21.41,$17.52,$20.40,$8.38,$17.52,$17.52,$17.72,$280.00,$15.74,$33.54,$221.76,$224.00,$21.74,$18.89,$14.99,$13.22,$14.99
30201962,EAP,Custom 30201962,,Fragile X Southern Blot (so),$208.00,$0.00,$208.00,$0.00,$148.45,$0.00,$0.00,$148.45,$148.45,$0.00,$208.00,$0.00,$104.00,$164.74,$166.40,$0.00,$0.00,$0.00,$0.00,$0.00
30201965,EAP,CPT® 81291,,Mthfr  Mutation Analysis (so),$327.00,$32.89,$327.00,$77.82,$59.55,$59.40,$32.89,$59.55,$59.55,$46.99,$327.00,$68.61,$163.50,$258.98,$261.60,$94.74,$50.07,$65.34,$35.05,$65.34
30201966,EAP,CPT® 81241,,FACTOR V LEIDEN MUTATION,$327.00,$35.05,$327.00,$108.94,$83.37,$83.16,$36.94,$83.37,$83.37,$46.99,$327.00,$77.04,$163.50,$258.98,$261.60,$106.39,$50.07,$73.37,$35.05,$73.37
30201967,EAP,CPT® 81240,,FACTOR II (PT) GENE MUTATION,$327.00,$33.07,$327.00,$87.73,$67.13,$66.96,$33.07,$67.13,$67.13,$46.99,$327.00,$68.97,$163.50,$258.98,$261.60,$95.25,$50.07,$65.69,$35.05,$65.69
30201968,EAP,CPT® 81220,,CYSTIC FIB 97 MUTATION RQD,"$1,025.00",$182.45,"$1,201.65",$681.72,$731.54,$182.45,$280.23,$731.54,$731.54,"$1,127.75","$1,025.00",$584.43,$512.50,$811.80,$820.00,$807.07,"$1,201.65",$556.60,$841.15,$556.60
30201974,EAP,CPT® 81406,,MEN2 (RET) DNA SEQ(ATHENA),"$6,272.00",$0.00,"$6,272.00",$0.00,"$4,476.33",$0.00,$0.00,"$4,476.33","$4,476.33",$0.00,"$6,272.00",$0.00,"$3,136.00","$4,967.42","$5,017.60",$0.00,$0.00,$0.00,$0.00,$0.00
30201975,EAP,CPT® 81401,,Huntington's Dna (so),"$1,272.00",$56.09,"$1,272.00",$56.09,$907.83,$226.42,$68.97,$907.83,$907.83,$131.58,"$1,272.00",$143.85,$636.00,"$1,007.42","$1,017.60",$198.65,$140.20,$137.00,$98.14,$137.00
30201977,EAP,CPT® 81256,,HERED HEMOCHROM DNA ANAL RQD,$568.00,$35.05,$568.00,$116.53,$89.17,$88.95,$36.56,$89.17,$89.17,$46.99,$568.00,$68.63,$284.00,$449.86,$454.40,$94.77,$50.07,$65.36,$35.05,$65.36
30201980,EAP,CPT® 86003,,Allergen Specific Ige (so),$40.00,$2.92,$40.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$40.00,$5.48,$14.60,$31.68,$32.00,$7.57,$8.22,$5.22,$5.76,$5.22
30201983,EAP,CPT® 86003,,Allergen Specific (food) Ige (so),$40.00,$2.92,$40.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$40.00,$5.48,$14.60,$31.68,$32.00,$7.57,$8.22,$5.22,$5.76,$5.22
30201984,EAP,CPT® 86003,,Allergen Specific (enviro) Ige (so),$40.00,$2.92,$40.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$40.00,$5.48,$14.60,$31.68,$32.00,$7.57,$8.22,$5.22,$5.76,$5.22
30201985,EAP,CPT® 80074,,Acute Hepatitis Panel,$890.00,$0.00,$890.00,$0.00,$69.54,$0.00,$0.00,$69.54,$69.54,$0.00,$890.00,$0.00,$133.08,$704.88,$712.00,$0.00,$0.00,$0.00,$0.00,$0.00
30201986,EAP,CPT® 86790,,"Hantavirus Antibody (igg, Igm) (so)",$280.00,$7.21,$280.00,$22.96,$18.81,$11.13,$7.21,$18.81,$18.81,$19.03,$280.00,$13.52,$36.00,$221.76,$224.00,$18.68,$20.27,$12.88,$14.19,$12.88
30201987,EAP,CPT® 86332,,Immune Complex Detection By C1q Binding (so),$34.00,$13.64,$38.36,$34.00,$35.59,$33.17,$13.64,$35.59,$35.59,$36.00,$34.00,$25.59,$34.00,$26.93,$27.20,$34.00,$38.36,$24.37,$26.85,$24.37
30201988,EAP,CPT® 86255,,Ampa -receptor Antibody (so) Mayo,$474.00,$6.75,$474.00,$21.48,$17.60,$16.40,$6.75,$17.60,$17.60,$17.81,$474.00,$12.65,$33.68,$375.41,$379.20,$17.47,$18.97,$12.05,$13.28,$12.05
30201989,EAP,CPT® 86255,,"Nmda -receptor Antibody, Serum (mml)",$448.00,$6.75,$448.00,$21.48,$17.60,$16.40,$6.75,$17.60,$17.60,$17.81,$448.00,$12.65,$33.68,$354.82,$358.40,$17.47,$18.97,$12.05,$13.28,$12.05
30201990,EAP,CPT® 86790,,"Chikungunya Antibodies (igg, Igm) (so)",$380.00,$7.21,$380.00,$22.96,$18.81,$11.13,$7.21,$18.81,$18.81,$19.03,$380.00,$13.52,$36.00,$300.96,$304.00,$18.68,$20.27,$12.88,$14.19,$12.88
30201991,EAP,CPT® 86790,,"Chikungunya Antibodies (igg, Titration) (so)",$380.00,$7.21,$380.00,$22.96,$18.81,$11.13,$7.21,$18.81,$18.81,$19.03,$380.00,$13.52,$36.00,$300.96,$304.00,$18.68,$20.27,$12.88,$14.19,$12.88
30201992,EAP,CPT® 86790,,Chikungunya Antibodies (igm Titration) (so),$380.00,$7.21,$380.00,$22.96,$18.81,$11.13,$7.21,$18.81,$18.81,$19.03,$380.00,$13.52,$36.00,$300.96,$304.00,$18.68,$20.27,$12.88,$14.19,$12.88
30201993,EAP,CPT® 86357,,Natural Killer Cells (so),$86.00,$21.10,$86.00,$42.00,$34.39,$22.53,$21.10,$34.39,$34.39,$34.80,$86.00,$39.62,$65.82,$68.11,$68.80,$54.71,$37.08,$37.73,$25.95,$37.73
30201994,EAP,CPT® 83516,,Myositis Antibody Panel (mml),$798.00,$6.44,$798.00,$19.04,$15.61,$15.70,$6.44,$15.61,$15.61,$15.80,$798.00,$12.11,$29.88,$632.02,$638.40,$16.72,$16.84,$11.53,$11.79,$11.53
30201995,EAP,CPT® 82017,,"Acylcarnitine,plasma(so)",$118.00,$0.00,$118.00,$0.00,$24.63,$0.00,$0.00,$24.63,$24.63,$0.00,$118.00,$0.00,$47.14,$93.46,$94.40,$0.00,$0.00,$0.00,$0.00,$0.00
30201996,EAP,CPT® 87305,,"Aspergillus Antigen, Eia, Serum(so)",$115.00,$6.70,$115.00,$21.36,$17.52,$16.32,$6.70,$17.52,$17.52,$17.71,$115.00,$12.58,$33.52,$91.08,$92.00,$17.37,$18.87,$11.98,$13.21,$11.98
30201997,EAP,CPT® 87254,,"Viral Respiratory,rapid Culture With Reflex(so)",$428.00,$0.00,$428.00,$0.00,$28.55,$0.00,$10.94,$28.55,$28.55,$7.22,$428.00,$0.00,$54.64,$338.98,$342.40,$0.00,$7.70,$0.00,$0.00,$0.00
30201998,EAP,CPT® 82397,,Anti-mullerian Hormone Assessr™(so),$288.00,$7.90,$288.00,$25.17,$20.63,$19.22,$7.90,$20.63,$20.63,$20.87,$288.00,$14.83,$39.48,$228.10,$230.40,$20.47,$22.24,$14.12,$15.57,$14.12
30201999,EAP,CPT® 87906,,Hiv-1 Integrase Genotype(so),$227.00,$43.01,$227.00,$77.75,$61.36,$150.39,$72.01,$61.36,$61.36,$57.67,$227.00,$135.17,$113.50,$179.78,$181.60,$186.66,$61.44,$128.73,$43.01,$128.73
30202000,EAP,CPT® 87798,,"Hpv 8 Dna,qual(so)",$421.00,$19.63,$421.00,$34.98,$28.64,$37.59,$19.63,$28.64,$28.64,$28.98,$421.00,$36.84,$54.82,$333.43,$336.80,$50.88,$30.88,$35.09,$21.62,$35.09
30202001,EAP,CPT® 86316,,"Chromgranin A,ecl",$223.00,$11.65,$223.00,$37.10,$30.38,$28.32,$11.65,$30.38,$30.38,$30.73,$223.00,$21.85,$58.14,$176.62,$178.40,$30.17,$32.75,$20.81,$22.92,$20.81
30202002,EAP,CPT® 83516,,Euromyelitis Optica(so),"$1,374.00",$6.44,"$1,374.00",$19.04,$15.61,$15.70,$6.44,$15.61,$15.61,$15.80,"$1,374.00",$12.11,$29.88,"$1,088.21","$1,099.20",$16.72,$16.84,$11.53,$11.79,$11.53
30202003,EAP,CPT® 86336,,Inhibin A(so),$90.00,$8.72,$90.00,$23.10,$18.90,$21.21,$8.72,$18.90,$18.90,$19.12,$90.00,$16.37,$36.18,$71.28,$72.00,$22.61,$20.37,$15.59,$14.26,$15.59
30202004,EAP,CPT® 82397,,Inhibin B(so),$415.00,$7.90,$415.00,$25.17,$20.63,$19.22,$7.90,$20.63,$20.63,$20.87,$415.00,$14.83,$39.48,$328.68,$332.00,$20.47,$22.24,$14.12,$15.57,$14.12
30202005,EAP,CPT® 88271,,"Fish, Myeloma Chrom Cep 9,11,15 Dna Probe (so)",$638.00,$11.98,$638.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$638.00,$22.49,$59.86,$505.30,$510.40,$31.06,$33.72,$21.42,$23.60,$21.42
30202006,EAP,CPT® 88275,,"Fish, Myeloma Chrom Cep 9,11,15 Hybridization(so)",$354.00,$25.78,$354.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$354.00,$53.75,$112.22,$280.37,$283.20,$74.23,$63.21,$51.19,$44.25,$51.19
30202007,EAP,CPT® 88271,,"Fish, Myeloma 17p-,rea14q32 (so) Dna Probe (so)","$4,261.00",$11.98,"$4,261.00",$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,"$4,261.00",$22.49,$59.86,"$3,374.71","$3,408.80",$31.06,$33.72,$21.42,$23.60,$21.42
30202008,EAP,CPT® 88275,,"Fish, Myeloma 17p-,rea14q32(so) Hybridization(so)",$597.00,$25.78,$597.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$597.00,$53.75,$112.22,$472.82,$477.60,$74.23,$63.21,$51.19,$44.25,$51.19
30202009,EAP,CPT® 88271,,"Fish, Myeloma Igh Panel(so) Dna Probe (so)","$2,078.00",$11.98,"$2,078.00",$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,"$2,078.00",$22.49,$59.86,"$1,645.78","$1,662.40",$31.06,$33.72,$21.42,$23.60,$21.42
30202010,EAP,CPT® 88275,,"Fish, Myeloma Igh Panel(so) Hybridization(so)","$1,039.00",$25.78,"$1,039.00",$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,"$1,039.00",$53.75,$112.22,$822.89,$831.20,$74.23,$63.21,$51.19,$44.25,$51.19
30202011,EAP,CPT® 81596,,"Liver Fibrosis, Fibro Test-actitest Panel (so)","$1,009.00",$36.35,"$1,009.00",$93.82,$72.19,$179.60,$36.35,$72.19,$72.19,$67.84,"$1,009.00",$75.80,$504.50,$799.13,$807.20,$104.68,$72.29,$72.19,$50.60,$72.19
30202012,EAP,CPT® 87535,,"Hiv-1, Rna Qualitative Tma(so)",$337.00,$19.63,$337.00,$34.98,$28.64,$37.59,$19.63,$28.64,$28.64,$28.98,$337.00,$36.84,$54.82,$266.90,$269.60,$50.88,$30.88,$35.09,$21.62,$35.09
30202013,EAP,CPT® 87140,,"Viral Id, Respiratory(so)",$349.00,$0.00,$349.00,$0.00,$8.14,$0.00,$0.00,$8.14,$8.14,$0.00,$349.00,$0.00,$15.58,$276.41,$279.20,$0.00,$0.00,$0.00,$0.00,$0.00
30202015,EAP,CPT® 81420,,Qnatal  Advanced(so),"$2,523.00",$0.00,"$2,523.00","$1,042.71","$1,800.67",$0.00,$382.15,"$1,800.67","$1,800.67",$754.02,"$2,523.00",$797.00,"$1,261.50","$1,998.22","$2,018.40","$1,100.62",$803.42,$759.05,$562.40,$759.05
30202016,EAP,CPT® 83835,,"Metanephrines,frac,ur(so)",$75.00,$9.48,$75.00,$30.21,$24.74,$23.05,$9.48,$24.74,$24.74,$25.02,$75.00,$17.79,$47.34,$59.40,$60.00,$24.56,$26.66,$16.94,$18.66,$16.94
30202017,EAP,CPT® 87305,,"Aspergillus Antigen,eia(so)",$104.00,$6.70,$104.00,$21.36,$17.52,$16.32,$6.70,$17.52,$17.52,$17.71,$104.00,$12.58,$33.52,$82.37,$83.20,$17.37,$18.87,$11.98,$13.21,$11.98
30202018,EAP,CPT® 86701,,Hiv-1 Confirmation,$198.00,$4.97,$198.00,$15.85,$12.96,$10.01,$4.97,$12.96,$12.96,$11.39,$198.00,$9.33,$24.82,$156.82,$158.40,$12.89,$12.14,$8.89,$8.50,$8.89
30202019,EAP,CPT® 86702,,Hiv-2 Confirmation,$240.00,$7.56,$240.00,$24.10,$19.74,$14.37,$7.56,$19.74,$19.74,$17.33,$240.00,$14.20,$37.76,$190.08,$192.00,$19.60,$18.46,$13.52,$12.92,$13.52
30202020,EAP,CPT® 86666,,Anaplasma Phaggocytopilium Ab (so),$495.00,$0.00,$495.00,$0.00,$14.85,$0.00,$0.00,$14.85,$14.85,$0.00,$495.00,$0.00,$28.44,$392.04,$396.00,$0.00,$0.00,$0.00,$0.00,$0.00
30202021,EAP,CPT® 87798,,"Pneumocysttis Jirovecii, Qual Rt Pcr (so)",$452.00,$19.63,$452.00,$34.98,$28.64,$37.59,$19.63,$28.64,$28.64,$28.98,$452.00,$36.84,$54.82,$357.98,$361.60,$50.88,$30.88,$35.09,$21.62,$35.09
30202022,EAP,CPT® 86790,,Chikungunya Ab Reflex To Titer (so),$200.00,$7.21,$200.00,$22.96,$18.81,$11.13,$7.21,$18.81,$18.81,$19.03,$200.00,$13.52,$36.00,$158.40,$160.00,$18.68,$20.27,$12.88,$14.19,$12.88
30202024,EAP,CPT® 81255,,Tay-sachs Disease Mutation Anal (so),$347.00,$0.00,$347.00,$0.00,$247.65,$0.00,$0.00,$247.65,$247.65,$0.00,$347.00,$0.00,$173.50,$274.82,$277.60,$0.00,$0.00,$0.00,$0.00,$0.00
30202025,EAP,CPT® 86738,,Mycoplasma Pneumoniae Ab Cf Csf (so),$121.00,$7.41,$121.00,$23.60,$19.34,$11.13,$7.41,$19.34,$19.34,$19.57,$121.00,$13.90,$37.02,$95.83,$96.80,$19.20,$20.85,$13.24,$14.60,$13.24
30202026,EAP,CPT® 87902,,Hepatitis C Viral Rna Ns3 Genotype(so),$329.00,$96.09,$329.00,$155.47,$127.33,$300.79,$144.01,$127.33,$127.33,$128.84,$329.00,$270.32,$243.70,$260.57,$263.20,$329.00,$137.28,$257.45,$96.09,$257.45
30202027,EAP,CPT® 87902,,"Hepatitis C Viral Rna, (so)",$651.00,$96.09,$651.00,$155.47,$127.33,$300.79,$144.01,$127.33,$127.33,$128.84,$651.00,$270.32,$243.70,$515.59,$520.80,$373.30,$137.28,$257.45,$96.09,$257.45
30250310,EAP,CPT® 86256,,Mitochondrial Ab Titer,$88.00,$6.75,$88.00,$21.48,$17.60,$16.40,$6.75,$17.60,$17.60,$17.81,$88.00,$12.65,$33.68,$69.70,$70.40,$17.47,$18.97,$12.05,$13.28,$12.05
30250311,EAP,CPT® 83519,,Alp Sub Pit Glycoprotein Horm,$959.00,$9.26,$959.00,$24.08,$19.73,$18.39,$9.26,$19.73,$19.73,$19.96,$959.00,$19.32,$37.76,$759.53,$767.20,$26.68,$21.27,$18.40,$14.89,$18.40
30250312,EAP,CPT® 87624,,mRNA,$98.00,$15.99,$98.00,$34.98,$26.70,$37.59,$19.63,$26.70,$26.70,$21.44,$98.00,$36.84,$49.00,$77.62,$78.40,$50.88,$22.85,$35.09,$15.99,$35.09
30250313,EAP,CPT® 86021,,C-anca Titer,$34.00,$8.42,$34.00,$26.84,$21.98,$20.49,$8.42,$21.98,$21.98,$22.24,$34.00,$15.80,$34.00,$26.93,$27.20,$21.82,$23.70,$15.05,$16.59,$15.05
30250314,EAP,CPT® 86021,,P-anca Titer,$34.00,$8.42,$34.00,$26.84,$21.98,$20.49,$8.42,$21.98,$21.98,$22.24,$34.00,$15.80,$34.00,$26.93,$27.20,$21.82,$23.70,$15.05,$16.59,$15.05
30250315,EAP,CPT® 86021,,Atypical P-anca Titer,$80.00,$8.42,$80.00,$26.84,$21.98,$20.49,$8.42,$21.98,$21.98,$22.24,$80.00,$15.80,$42.06,$63.36,$64.00,$21.82,$23.70,$15.05,$16.59,$15.05
30250316,EAP,CPT® 86638,,Q Fever Igg Phase I Titer,$43.00,$0.00,$43.00,$0.00,$17.70,$0.00,$0.00,$17.70,$17.70,$0.00,$43.00,$0.00,$33.88,$34.06,$34.40,$0.00,$0.00,$0.00,$0.00,$0.00
30250317,EAP,CPT® 86638,,Q Fever Igg Phase Ii Titer,$43.00,$0.00,$43.00,$0.00,$17.70,$0.00,$0.00,$17.70,$17.70,$0.00,$43.00,$0.00,$33.88,$34.06,$34.40,$0.00,$0.00,$0.00,$0.00,$0.00
30250318,EAP,CPT® 86638,,Q Fever Igm Phase I Titer,$43.00,$0.00,$43.00,$0.00,$17.70,$0.00,$0.00,$17.70,$17.70,$0.00,$43.00,$0.00,$33.88,$34.06,$34.40,$0.00,$0.00,$0.00,$0.00,$0.00
30250320,EAP,CPT® 86611,,B.henselae Igg Titer,$63.00,$5.69,$63.00,$18.15,$14.85,$11.13,$5.69,$14.85,$14.85,$15.04,$63.00,$10.69,$28.44,$49.90,$50.40,$14.76,$16.02,$10.18,$11.21,$10.18
30250321,EAP,CPT® 86611,,B.henselae Igm Titer,$63.00,$5.69,$63.00,$18.15,$14.85,$11.13,$5.69,$14.85,$14.85,$15.04,$63.00,$10.69,$28.44,$49.90,$50.40,$14.76,$16.02,$10.18,$11.21,$10.18
30250322,EAP,CPT® 86611,,B.quintana Igg Titer,$63.00,$5.69,$63.00,$18.15,$14.85,$11.13,$5.69,$14.85,$14.85,$15.04,$63.00,$10.69,$28.44,$49.90,$50.40,$14.76,$16.02,$10.18,$11.21,$10.18
30250323,EAP,CPT® 86611,,B.quintana Igm Titer,$63.00,$5.69,$63.00,$18.15,$14.85,$11.13,$5.69,$14.85,$14.85,$15.04,$63.00,$10.69,$28.44,$49.90,$50.40,$14.76,$16.02,$10.18,$11.21,$10.18
30250325,EAP,CPT® 86003,,Allergen Specific Ige Tilapia (so),$249.00,$2.92,$249.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$249.00,$5.48,$14.60,$197.21,$199.20,$7.57,$8.22,$5.22,$5.76,$5.22
30250326,EAP,CPT® 86003,,Allergen Specific Ige Trout (so),$170.00,$2.92,$170.00,$9.30,$7.62,$4.16,$2.92,$7.62,$7.62,$7.72,$170.00,$5.48,$14.60,$134.64,$136.00,$7.57,$8.22,$5.22,$5.76,$5.22
30250327,EAP,CPT® 86790,,Hepatitis A  Igg,$300.00,$7.21,$300.00,$22.96,$18.81,$11.13,$7.21,$18.81,$18.81,$19.03,$300.00,$13.52,$36.00,$237.60,$240.00,$18.68,$20.27,$12.88,$14.19,$12.88
30250328,EAP,CPT® 87389,,Hiv-1 Ag With Hiv-1/2 Ab,$297.00,$13.47,$297.00,$42.93,$34.12,$19.38,$13.47,$34.12,$34.12,$32.07,$297.00,$25.28,$148.50,$235.22,$237.60,$34.92,$34.17,$24.08,$23.92,$24.08
30250329,EAP,CPT® 86255,,"Ds-dna An, Crithidia Titer",$188.00,$6.75,$188.00,$21.48,$17.60,$16.40,$6.75,$17.60,$17.60,$17.81,$188.00,$12.65,$33.68,$148.90,$150.40,$17.47,$18.97,$12.05,$13.28,$12.05
30250340,EAP,CPT® 86361,,Absolute Cd4 Count,$122.00,$13.85,$122.00,$46.56,$38.11,$13.85,$14.98,$38.11,$38.11,$38.56,$122.00,$28.12,$72.94,$96.62,$97.60,$38.83,$41.08,$26.78,$28.76,$26.78
30250342,EAP,CPT® 86038,,Ana Ifa W/reflex (so),$208.00,$6.76,$208.00,$21.55,$17.65,$16.45,$6.76,$17.65,$17.65,$17.86,$208.00,$12.69,$33.78,$164.74,$166.40,$17.53,$19.03,$12.09,$13.32,$12.09
30250380,EAP,CPT® 86790,,Chikungunya Igg Titer(so),$192.00,$7.21,$192.00,$22.96,$18.81,$11.13,$7.21,$18.81,$18.81,$19.03,$192.00,$13.52,$36.00,$152.06,$153.60,$18.68,$20.27,$12.88,$14.19,$12.88
30250381,EAP,CPT® 86790,,Chikungunya Igm Titer(so),$192.00,$7.21,$192.00,$22.96,$18.81,$11.13,$7.21,$18.81,$18.81,$19.03,$192.00,$13.52,$36.00,$152.06,$153.60,$18.68,$20.27,$12.88,$14.19,$12.88
30250382,EAP,CPT® 86039,,"Ana Screen Ifa, W/titer And Pattern",$142.00,$0.00,$142.00,$0.00,$16.30,$0.00,$0.00,$16.30,$16.30,$0.00,$142.00,$0.00,$31.20,$112.46,$113.60,$0.00,$0.00,$0.00,$0.00,$0.00
30250383,EAP,CPT® 86713,,"Legionella Pneumophila Ab (igg), Ifa (so)",$105.00,$0.00,$105.00,$0.00,$22.35,$0.00,$0.00,$22.35,$22.35,$0.00,$105.00,$0.00,$42.78,$83.16,$84.00,$0.00,$0.00,$0.00,$0.00,$0.00
30250384,EAP,CPT® 86255,,Copeptin (so),$43.00,$6.75,$43.00,$21.48,$17.60,$16.40,$6.75,$17.60,$17.60,$17.81,$43.00,$12.65,$33.68,$34.06,$34.40,$17.47,$18.97,$12.05,$13.28,$12.05
30250390,EAP,CPT® 86695,,Hsv 1 Igg (so),$57.00,$7.37,$57.00,$23.51,$19.25,$11.13,$7.37,$19.25,$19.25,$19.49,$57.00,$13.85,$36.86,$45.14,$45.60,$19.13,$20.76,$13.19,$14.54,$13.19
30250391,EAP,CPT® 86696,,Hsv 2 Igg (so),$57.00,$10.83,$57.00,$34.50,$28.26,$26.34,$10.83,$28.26,$28.26,$28.60,$57.00,$20.32,$54.10,$45.14,$45.60,$28.06,$30.48,$19.35,$21.33,$19.35
30250392,EAP,CPT® 86696,,Hsv 2 Igg Inhibition (so),$388.00,$10.83,$388.00,$34.50,$28.26,$26.34,$10.83,$28.26,$28.26,$28.60,$388.00,$20.32,$54.10,$307.30,$310.40,$28.06,$30.48,$19.35,$21.33,$19.35
30250395,EAP,CPT® 86235,,Myositis Specific 11 Ab Nuclear Ag (so),$103.00,$10.04,$103.00,$31.97,$26.18,$24.41,$10.04,$26.18,$26.18,$26.49,$103.00,$18.83,$50.12,$81.58,$82.40,$26.00,$28.23,$17.93,$19.76,$17.93
30250396,EAP,CPT® 88365,,KAPPA/LAMBDA ISH,$250.00,$77.27,$250.00,$233.88,$98.25,$137.60,$90.54,$98.25,$98.25,$103.59,$250.00,$143.92,$156.90,$198.00,$200.00,$199.96,$110.38,$137.95,$77.27,$137.07
30250397,EAP,CPT® 88366,,KAPPA/LAMBDA ISH,$250.00,$0.00,$250.00,$0.00,$149.94,$0.00,$0.00,$149.94,$149.94,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
30250400,EAP,CPT® 86328,,Ia Infectious Ag Ab Sars-cov2 Covid 19,$150.00,$23.48,$150.00,$103.12,$107.06,$26.70,$25.84,$107.06,$107.06,$26.26,$150.00,$47.49,$75.00,$118.80,$120.00,$65.58,$23.48,$45.23,$23.88,$45.23
30250401,EAP,CPT® 86769,,Sars-cov-2 Covid-19 Antibody,$55.00,$0.00,$55.00,$0.00,$39.25,$0.00,$0.00,$39.25,$39.25,$0.00,$55.00,$0.00,$27.50,$43.56,$44.00,$0.00,$0.00,$0.00,$0.00,$0.00
30500001,EAP,CPT® 85002,,"Bleeding Time, Temp",$109.00,$0.00,$109.00,$0.00,$6.57,$0.00,$0.00,$6.57,$6.57,$0.00,$109.00,$0.00,$12.58,$86.33,$87.20,$0.00,$0.00,$0.00,$0.00,$0.00
30500002,EAP,CPT® 85007,,Misc. Smear,$101.00,$1.92,$101.00,$6.11,$5.02,$4.68,$1.92,$5.02,$5.02,$5.08,$101.00,$3.99,$9.62,$79.99,$80.80,$5.51,$5.41,$3.80,$3.79,$3.80
30500003,EAP,CPT® 85576,,Bld Plat Agg - Teg,$402.00,$12.54,$402.00,$38.30,$31.37,$29.24,$12.54,$31.37,$31.37,$31.73,$402.00,$26.16,$60.02,$318.38,$321.60,$36.12,$33.81,$24.91,$23.67,$24.91
30500004,EAP,CPT® 85384,,Fibrinogen Act - Teg,$188.00,$4.89,$188.00,$15.14,$12.40,$11.56,$4.89,$12.40,$12.40,$12.55,$188.00,$10.21,$23.74,$148.90,$150.40,$14.09,$13.37,$9.72,$9.36,$9.72
30500005,EAP,CPT® 85008,,Rbc Morphology Exam,$83.00,$1.92,$83.00,$6.11,$5.02,$3.67,$1.92,$5.02,$5.02,$5.08,$83.00,$3.60,$9.62,$65.74,$66.40,$4.97,$5.41,$3.43,$3.79,$3.43
30500006,EAP,CPT® 85008,,"Rbc, Schistocyte Cnt",$83.00,$1.92,$83.00,$6.11,$5.02,$3.67,$1.92,$5.02,$5.02,$5.08,$83.00,$3.60,$9.62,$65.74,$66.40,$4.97,$5.41,$3.43,$3.79,$3.43
30500007,EAP,CPT® 85013,,Hematocrit Count,$51.00,$0.00,$51.00,$0.00,$3.46,$0.00,$0.00,$3.46,$3.46,$0.00,$51.00,$0.00,$6.62,$40.39,$40.80,$0.00,$0.00,$0.00,$0.00,$0.00
30500008,EAP,CPT® 85013,,"Hematocrit, Fld - Spun",$51.00,$0.00,$51.00,$0.00,$3.46,$0.00,$0.00,$3.46,$3.46,$0.00,$51.00,$0.00,$6.62,$40.39,$40.80,$0.00,$0.00,$0.00,$0.00,$0.00
30500009,EAP,CPT® 85347,,"Coag Time, Activated-teg",$266.00,$2.38,$266.00,$7.59,$6.22,$5.79,$2.38,$6.22,$6.22,$6.30,$266.00,$4.49,$11.90,$210.67,$212.80,$6.21,$6.71,$4.28,$4.70,$4.28
30500010,EAP,CPT® 85013,,"Hematocrit, Spun Cap",$51.00,$0.00,$51.00,$0.00,$3.46,$0.00,$0.00,$3.46,$3.46,$0.00,$51.00,$0.00,$6.62,$40.39,$40.80,$0.00,$0.00,$0.00,$0.00,$0.00
30500011,EAP,CPT® 85013,,"Hematocrit,csf-spun",$51.00,$0.00,$51.00,$0.00,$3.46,$0.00,$0.00,$3.46,$3.46,$0.00,$51.00,$0.00,$6.62,$40.39,$40.80,$0.00,$0.00,$0.00,$0.00,$0.00
30500012,EAP,CPT® 85014,,Hematocrit,$58.00,$0.00,$58.00,$0.00,$3.46,$0.00,$0.00,$3.46,$3.46,$0.00,$58.00,$0.00,$6.62,$45.94,$46.40,$0.00,$0.00,$0.00,$0.00,$0.00
30500013,EAP,CPT® 85390,,Fibrinolysins Scrn -teg,$122.00,$0.00,$122.00,$0.00,$7.54,$0.00,$0.00,$7.54,$7.54,$0.00,$122.00,$0.00,$14.44,$96.62,$97.60,$0.00,$0.00,$0.00,$0.00,$0.00
30500015,EAP,CPT® 85018,,"Hemoglobin, Micro(meter)",$51.00,$1.32,$51.00,$4.22,$3.46,$3.23,$1.32,$3.46,$3.46,$3.50,$51.00,$2.49,$6.62,$40.39,$40.80,$3.44,$3.73,$2.37,$2.61,$2.37
30500016,EAP,CPT® 86022,,Platelet Antibody Screen Indirect (so),$362.00,$0.00,$362.00,$0.00,$26.82,$0.00,$0.00,$26.82,$26.82,$0.00,$362.00,$0.00,$51.32,$286.70,$289.60,$0.00,$0.00,$0.00,$0.00,$0.00
30500017,EAP,CPT® 85018,,Hgb & Hct,$51.00,$1.32,$51.00,$4.22,$3.46,$3.23,$1.32,$3.46,$3.46,$3.50,$51.00,$2.49,$6.62,$40.39,$40.80,$3.44,$3.73,$2.37,$2.61,$2.37
30500018,EAP,CPT® 85018,,"Hgb, Venous (meter)",$51.00,$1.32,$51.00,$4.22,$3.46,$3.23,$1.32,$3.46,$3.46,$3.50,$51.00,$2.49,$6.62,$40.39,$40.80,$3.44,$3.73,$2.37,$2.61,$2.37
30500021,EAP,CPT® 85025,,"CBC, PLAT & DIFF",$222.00,$4.34,$222.00,$13.86,$9.59,$7.20,$4.34,$9.59,$9.59,$11.48,$222.00,$8.16,$21.72,$175.82,$177.60,$11.27,$12.23,$7.77,$8.56,$7.77
30500022,EAP,CPT® 85027,,CBC & PLAT,$184.00,$3.61,$184.00,$11.54,$9.45,$7.73,$3.61,$9.45,$9.45,$9.57,$184.00,$6.79,$18.08,$145.73,$147.20,$9.38,$10.19,$6.47,$7.13,$6.47
30500024,EAP,CPT® 85046,,"Reticulocytes, Automated",$140.00,$3.12,$140.00,$9.92,$8.15,$6.06,$3.12,$8.15,$8.15,$8.24,$140.00,$5.85,$15.60,$110.88,$112.00,$8.08,$8.78,$5.57,$6.15,$5.57
30500026,EAP,CPT® 85048,,"EOSINOPHIL COUNT, WB",$74.00,$0.00,$74.00,$0.00,$3.71,$0.00,$0.00,$3.71,$3.71,$0.00,$74.00,$0.00,$7.10,$58.61,$59.20,$0.00,$0.00,$0.00,$0.00,$0.00
30500027,EAP,CPT® 85049,,Platelet Count (wb),$117.00,$2.51,$117.00,$7.98,$6.53,$6.09,$2.51,$6.53,$6.53,$6.62,$117.00,$4.70,$12.50,$92.66,$93.60,$6.50,$7.05,$4.48,$4.93,$4.48
30500028,EAP,CPT® 85097,,Bone Marrow Exam,$781.00,$25.77,$781.00,$119.97,$46.75,$602.38,$25.77,$46.75,$46.75,$75.35,$781.00,$630.05,$213.48,$618.55,$624.80,$781.00,$80.29,$51.21,$56.20,$600.04
30500029,EAP,CPT® 85210,,Factor  Ii Assay,$391.00,$0.00,$391.00,$0.00,$18.96,$0.00,$0.00,$18.96,$18.96,$0.00,$391.00,$0.00,$36.28,$309.67,$312.80,$0.00,$0.00,$0.00,$0.00,$0.00
30500030,EAP,CPT® 85220,,Factor   V Assay,$524.00,$0.00,$524.00,$0.00,$25.77,$0.00,$0.00,$25.77,$25.77,$0.00,$524.00,$0.00,$49.32,$415.01,$419.20,$0.00,$0.00,$0.00,$0.00,$0.00
30500031,EAP,CPT® 85230,,Factor Vii Assay,$538.00,$10.01,$538.00,$31.92,$26.14,$24.37,$10.01,$26.14,$26.14,$26.46,$538.00,$18.80,$50.04,$426.10,$430.40,$25.96,$28.19,$17.90,$19.74,$17.90
30500032,EAP,CPT® 85240,,Factor Viii Assay,$538.00,$10.01,$538.00,$31.92,$26.14,$24.37,$10.01,$26.14,$26.14,$26.46,$538.00,$18.80,$50.04,$426.10,$430.40,$25.96,$28.19,$17.90,$19.74,$17.90
30500033,EAP,CPT® 85245,,Vw Factor Activity,$680.00,$12.83,$680.00,$40.90,$33.51,$31.22,$12.83,$33.51,$33.51,$33.89,$680.00,$24.09,$64.12,$538.56,$544.00,$33.26,$36.11,$22.94,$25.28,$22.94
30500034,EAP,CPT® 85245,,Ristocetin Cofactor,$680.00,$12.83,$680.00,$40.90,$33.51,$31.22,$12.83,$33.51,$33.51,$33.89,$680.00,$24.09,$64.12,$538.56,$544.00,$33.26,$36.11,$22.94,$25.28,$22.94
30500035,EAP,CPT® 85246,,Von Willebrand Ag,$680.00,$12.83,$680.00,$40.90,$33.51,$31.22,$12.83,$33.51,$33.51,$33.89,$680.00,$24.09,$64.12,$538.56,$544.00,$33.26,$36.11,$22.94,$25.28,$22.94
30500036,EAP,CPT® 85250,,Factor  Ix Assay,$565.00,$10.65,$565.00,$33.95,$27.79,$25.91,$10.65,$27.79,$27.79,$28.12,$565.00,$19.99,$53.20,$447.48,$452.00,$27.61,$29.96,$19.04,$20.97,$19.04
30500037,EAP,CPT® 85260,,Factor   X Assay,$538.00,$0.00,$538.00,$0.00,$26.14,$0.00,$0.00,$26.14,$26.14,$0.00,$538.00,$0.00,$50.04,$426.10,$430.40,$0.00,$0.00,$0.00,$0.00,$0.00
30500038,EAP,CPT® 85270,,Factor  Xi Assay,$538.00,$0.00,$538.00,$0.00,$26.14,$0.00,$10.01,$26.14,$26.14,$0.00,$538.00,$0.00,$50.04,$426.10,$430.40,$0.00,$28.19,$0.00,$0.00,$0.00
30500039,EAP,CPT® 85280,,Factor Xii Assay,$572.00,$0.00,$572.00,$0.00,$28.25,$0.00,$10.83,$28.25,$28.25,$28.59,$572.00,$0.00,$54.08,$453.02,$457.60,$0.00,$30.46,$0.00,$0.00,$0.00
30500040,EAP,CPT® 85291,,Factor Xiii Screen,$627.00,$0.00,$627.00,$0.00,$12.98,$0.00,$0.00,$12.98,$12.98,$0.00,$627.00,$0.00,$24.84,$496.58,$501.60,$0.00,$0.00,$0.00,$0.00,$0.00
30500041,EAP,CPT® 85300,,Protein S Activity,$483.00,$6.63,$483.00,$21.14,$17.30,$16.13,$6.63,$17.30,$17.30,$17.50,$483.00,$12.44,$33.10,$382.54,$386.40,$17.18,$18.65,$11.85,$13.06,$11.85
30500042,EAP,CPT® 85300,,Factor At-iii Assay,$483.00,$6.63,$483.00,$21.14,$17.30,$16.13,$6.63,$17.30,$17.30,$17.50,$483.00,$12.44,$33.10,$382.54,$386.40,$17.18,$18.65,$11.85,$13.06,$11.85
30500043,EAP,CPT® 85301,,At-iii Antigen,$981.00,$6.04,$981.00,$19.27,$15.79,$14.71,$6.04,$15.79,$15.79,$15.98,$981.00,$11.35,$30.22,$776.95,$784.80,$15.67,$17.03,$10.81,$11.92,$10.81
30500044,EAP,CPT® 85303,,Protein C Activity,$456.00,$7.74,$456.00,$24.67,$20.19,$18.82,$7.74,$20.19,$20.19,$20.43,$456.00,$14.53,$38.64,$361.15,$364.80,$20.07,$21.77,$13.84,$15.24,$13.84
30500045,EAP,CPT® 85307,,Act Prot-c Resist (fv-leiden),$259.00,$8.57,$259.00,$27.31,$22.37,$18.78,$8.57,$22.37,$22.37,$22.64,$259.00,$16.09,$42.82,$205.13,$207.20,$22.21,$24.12,$15.32,$16.88,$15.32
30500046,EAP,CPT® 85379,,D-dimer,$338.00,$5.69,$338.00,$18.15,$14.85,$13.85,$5.69,$14.85,$14.85,$15.04,$338.00,$10.69,$28.44,$267.70,$270.40,$14.76,$16.02,$10.18,$11.21,$10.18
30500047,EAP,CPT® 85384,,Fibrinogen Quant.,$272.00,$4.89,$272.00,$15.14,$12.40,$11.56,$4.89,$12.40,$12.40,$12.55,$272.00,$10.21,$23.74,$215.42,$217.60,$14.09,$13.37,$9.72,$9.36,$9.72
30500048,EAP,CPT® 85410,,Alpha-2-antiplasmin,$183.00,$0.00,$183.00,$0.00,$11.26,$0.00,$0.00,$11.26,$11.26,$0.00,$183.00,$0.00,$21.54,$144.94,$146.40,$0.00,$0.00,$0.00,$0.00,$0.00
30500049,EAP,CPT® 85420,,Plasminogen Activ.,$146.00,$0.00,$146.00,$0.00,$9.55,$0.00,$0.00,$9.55,$9.55,$0.00,$146.00,$0.00,$18.26,$115.63,$116.80,$0.00,$0.00,$0.00,$0.00,$0.00
30500050,EAP,CPT® 85441,,Heinz Body Direct,$57.00,$0.00,$57.00,$0.00,$6.14,$0.00,$0.00,$6.14,$6.14,$0.00,$57.00,$0.00,$11.76,$45.14,$45.60,$0.00,$0.00,$0.00,$0.00,$0.00
30500051,EAP,CPT® 85445,,Heinz Body Induced,$83.00,$0.00,$83.00,$0.00,$9.95,$0.00,$0.00,$9.95,$9.95,$0.00,$83.00,$0.00,$19.04,$65.74,$66.40,$0.00,$0.00,$0.00,$0.00,$0.00
30500052,EAP,CPT® 85460,,K-b Hgb Fetal Screen **,$51.00,$2.66,$51.00,$4.31,$3.53,$10.53,$4.33,$3.53,$3.53,$3.57,$51.00,$8.12,$6.76,$40.39,$40.80,$11.21,$3.80,$7.73,$2.66,$7.73
30500053,EAP,CPT® 85475,,"Hemolysis,acid-ham's",$59.00,$0.00,$59.00,$0.00,$7.61,$0.00,$0.00,$7.61,$7.61,$0.00,$59.00,$0.00,$14.56,$46.73,$47.20,$0.00,$0.00,$0.00,$0.00,$0.00
30500054,EAP,CPT® 85475,,"Hemolysis, Sucrose",$59.00,$0.00,$59.00,$0.00,$7.61,$0.00,$0.00,$7.61,$7.61,$0.00,$59.00,$0.00,$14.56,$46.73,$47.20,$0.00,$0.00,$0.00,$0.00,$0.00
30500055,EAP,CPT® 85520,,Heparin Assay,$404.00,$7.33,$404.00,$23.35,$19.11,$17.82,$7.33,$19.11,$19.11,$19.34,$404.00,$13.74,$36.58,$319.97,$323.20,$18.98,$20.61,$13.09,$14.43,$13.09
30500056,EAP,CPT® 85536,,Iron Stores-bm,$186.00,$0.00,$186.00,$0.00,$9.45,$0.00,$0.00,$9.45,$9.45,$0.00,$186.00,$0.00,$18.08,$147.31,$148.80,$0.00,$0.00,$0.00,$0.00,$0.00
30500057,EAP,CPT® 85540,,Wbc Lap Stain,$168.00,$0.00,$168.00,$0.00,$8.82,$0.00,$0.00,$8.82,$8.82,$0.00,$168.00,$0.00,$16.88,$133.06,$134.40,$0.00,$0.00,$0.00,$0.00,$0.00
30500058,EAP,CPT® 85549,,Lysozyme,$182.00,$10.48,$182.00,$33.42,$27.39,$25.52,$10.48,$27.39,$27.39,$27.71,$182.00,$19.69,$52.42,$144.14,$145.60,$27.19,$29.53,$18.75,$20.67,$18.75
30500059,EAP,CPT® 85576,,"Plt Agg, Thrombin",$577.00,$12.54,$577.00,$38.30,$31.37,$29.24,$12.54,$31.37,$31.37,$31.73,$577.00,$26.16,$60.02,$456.98,$461.60,$36.12,$33.81,$24.91,$23.67,$24.91
30500060,EAP,CPT® 85576,,"Plt Agg, Adp",$577.00,$12.54,$577.00,$38.30,$31.37,$29.24,$12.54,$31.37,$31.37,$31.73,$577.00,$26.16,$60.02,$456.98,$461.60,$36.12,$33.81,$24.91,$23.67,$24.91
30500061,EAP,CPT® 85576,,"Plt Agg, Collagen",$577.00,$12.54,$577.00,$38.30,$31.37,$29.24,$12.54,$31.37,$31.37,$31.73,$577.00,$26.16,$60.02,$456.98,$461.60,$36.12,$33.81,$24.91,$23.67,$24.91
30500062,EAP,CPT® 85576,,"Plt Agg, Ristocetin",$577.00,$12.54,$577.00,$38.30,$31.37,$29.24,$12.54,$31.37,$31.37,$31.73,$577.00,$26.16,$60.02,$456.98,$461.60,$36.12,$33.81,$24.91,$23.67,$24.91
30500063,EAP,CPT® 85576,,"Plt Agg, Aracdnc Acid",$577.00,$12.54,$577.00,$38.30,$31.37,$29.24,$12.54,$31.37,$31.37,$31.73,$577.00,$26.16,$60.02,$456.98,$461.60,$36.12,$33.81,$24.91,$23.67,$24.91
30500064,EAP,CPT® 85576,,Pfa-collagen/epi,$615.00,$12.54,$615.00,$38.30,$31.37,$29.24,$12.54,$31.37,$31.37,$31.73,$615.00,$26.16,$60.02,$487.08,$492.00,$36.12,$33.81,$24.91,$23.67,$24.91
30500065,EAP,CPT® 85576,,Pfa-collagen/adp,$615.00,$12.54,$615.00,$38.30,$31.37,$29.24,$12.54,$31.37,$31.37,$31.73,$615.00,$26.16,$60.02,$487.08,$492.00,$36.12,$33.81,$24.91,$23.67,$24.91
30500066,EAP,CPT® 86022,,Platelet Agg-heprin,$493.00,$0.00,$493.00,$0.00,$26.82,$0.00,$0.00,$26.82,$26.82,$0.00,$493.00,$0.00,$51.32,$390.46,$394.40,$0.00,$0.00,$0.00,$0.00,$0.00
30500067,EAP,CPT® 85597,,Plat Neutralization,$521.00,$0.00,$521.00,$0.00,$26.25,$0.00,$0.00,$26.25,$26.25,$0.00,$521.00,$0.00,$50.24,$412.63,$416.80,$0.00,$0.00,$0.00,$0.00,$0.00
30500068,EAP,CPT® 85610,,Pt(prothrombin Time),$146.00,$2.20,$146.00,$7.00,$5.74,$5.35,$2.20,$5.74,$5.74,$5.81,$146.00,$4.50,$10.98,$115.63,$116.80,$6.22,$6.19,$4.29,$4.33,$4.29
30500069,EAP,CPT® 85610,,"Pt,coumadin Therapy",$146.00,$2.20,$146.00,$7.00,$5.74,$5.35,$2.20,$5.74,$5.74,$5.81,$146.00,$4.50,$10.98,$115.63,$116.80,$6.22,$6.19,$4.29,$4.33,$4.29
30500070,EAP,CPT® 85610,,"Pt, Coumatrak",$146.00,$2.20,$146.00,$7.00,$5.74,$5.35,$2.20,$5.74,$5.74,$5.81,$146.00,$4.50,$10.98,$115.63,$116.80,$6.22,$6.19,$4.29,$4.33,$4.29
30500071,EAP,CPT® 85611,,Pt+normal Plasma,$133.00,$0.00,$133.00,$0.00,$5.75,$0.00,$0.00,$5.75,$5.75,$0.00,$133.00,$0.00,$11.02,$105.34,$106.40,$0.00,$0.00,$0.00,$0.00,$0.00
30500072,EAP,CPT® 85611,,"Pt, Hepzyme-treated",$133.00,$0.00,$133.00,$0.00,$5.75,$0.00,$0.00,$5.75,$5.75,$0.00,$133.00,$0.00,$11.02,$105.34,$106.40,$0.00,$0.00,$0.00,$0.00,$0.00
30500073,EAP,CPT® 85613,,Dilute Russell's Viper Venom,$275.00,$5.36,$275.00,$17.08,$13.97,$13.03,$5.36,$13.97,$13.97,$14.13,$275.00,$10.06,$26.74,$217.80,$220.00,$13.89,$15.06,$9.58,$10.54,$9.58
30500074,EAP,CPT® 85651,,Sed Rate Westergren,$123.00,$0.00,$123.00,$0.00,$5.18,$0.00,$0.00,$5.18,$5.18,$0.00,$123.00,$0.00,$9.92,$97.42,$98.40,$0.00,$0.00,$0.00,$0.00,$0.00
30500075,EAP,CPT® 85660,,DONOR HGB S-ARC,$183.00,$3.08,$183.00,$9.83,$8.06,$7.50,$3.08,$8.06,$8.06,$8.15,$183.00,$5.79,$15.42,$144.94,$146.40,$7.99,$8.68,$5.51,$6.08,$5.51
30500076,EAP,CPT® 85660,,Donor Hgb S-gmh,$183.00,$3.08,$183.00,$9.83,$8.06,$7.50,$3.08,$8.06,$8.06,$8.15,$183.00,$5.79,$15.42,$144.94,$146.40,$7.99,$8.68,$5.51,$6.08,$5.51
30500077,EAP,CPT® 85660,,Sickledex,$183.00,$3.08,$183.00,$9.83,$8.06,$7.50,$3.08,$8.06,$8.06,$8.15,$183.00,$5.79,$15.42,$144.94,$146.40,$7.99,$8.68,$5.51,$6.08,$5.51
30500078,EAP,CPT® 85670,,Thrombin Time,$132.00,$3.22,$132.00,$10.28,$8.44,$7.85,$3.22,$8.44,$8.44,$8.53,$132.00,$6.06,$16.14,$104.54,$105.60,$8.37,$9.08,$5.77,$6.36,$5.77
30500079,EAP,CPT® 85730,,"Appt, Hepzyme-treated",$196.00,$3.36,$196.00,$10.72,$8.76,$7.91,$3.36,$8.76,$8.76,$8.86,$196.00,$6.31,$16.76,$155.23,$156.80,$8.71,$9.44,$6.01,$6.61,$6.01
30500080,EAP,CPT® 85730,,Aptt,$196.00,$3.36,$196.00,$10.72,$8.76,$7.91,$3.36,$8.76,$8.76,$8.86,$196.00,$6.31,$16.76,$155.23,$156.80,$8.71,$9.44,$6.01,$6.61,$6.01
30500082,EAP,CPT® 85730,,Aptt Heparin Therapy,$196.00,$3.36,$196.00,$10.72,$8.76,$7.91,$3.36,$8.76,$8.76,$8.86,$196.00,$6.31,$16.76,$155.23,$156.80,$8.71,$9.44,$6.01,$6.61,$6.01
30500083,EAP,CPT® 85730,,Ptt-saline,$196.00,$3.36,$196.00,$10.72,$8.76,$7.91,$3.36,$8.76,$8.76,$8.86,$196.00,$6.31,$16.76,$155.23,$156.80,$8.71,$9.44,$6.01,$6.61,$6.01
30500084,EAP,CPT® 85732,,Aptt + Apc,$205.00,$0.00,$205.00,$0.00,$9.45,$0.00,$0.00,$9.45,$9.45,$0.00,$205.00,$0.00,$18.08,$162.36,$164.00,$0.00,$0.00,$0.00,$0.00,$0.00
30500085,EAP,CPT® 85732,,Factor Def Scrn-coag,$205.00,$0.00,$205.00,$0.00,$9.45,$0.00,$0.00,$9.45,$9.45,$0.00,$205.00,$0.00,$18.08,$162.36,$164.00,$0.00,$0.00,$0.00,$0.00,$0.00
30500086,EAP,CPT® 85732,,Factor Inhib Screen,$205.00,$0.00,$205.00,$0.00,$9.45,$0.00,$0.00,$9.45,$9.45,$0.00,$205.00,$0.00,$18.08,$162.36,$164.00,$0.00,$0.00,$0.00,$0.00,$0.00
30500087,EAP,CPT® 85810,,"Viscosity, Serum",$243.00,$0.00,$243.00,$0.00,$17.05,$0.00,$0.00,$17.05,$17.05,$0.00,$243.00,$0.00,$32.64,$192.46,$194.40,$0.00,$0.00,$0.00,$0.00,$0.00
30500088,EAP,CPT® 86078,,Transfusion Reaction,$470.00,$0.00,$470.00,$0.00,$46.82,$0.00,$0.00,$46.82,$46.82,$0.00,$470.00,$0.00,$103.62,$372.24,$376.00,$0.00,$0.00,$0.00,$0.00,$0.00
30500090,EAP,CPT® 85048,,"Eosinophil Count, Wb",$74.00,$0.00,$74.00,$0.00,$3.71,$0.00,$0.00,$3.71,$3.71,$0.00,$74.00,$0.00,$7.10,$58.61,$59.20,$0.00,$0.00,$0.00,$0.00,$0.00
30500091,EAP,CPT® 85652,,"Sed Rate, Capillary Photometry",$106.00,$1.51,$106.00,$4.81,$3.94,$3.68,$1.51,$3.94,$3.94,$3.98,$106.00,$2.84,$7.54,$83.95,$84.80,$3.92,$4.24,$2.70,$2.97,$2.70
30500092,EAP,CPT® 85415,,Plasminogen Act Inhib (so),$268.00,$0.00,$268.00,$0.00,$25.10,$0.00,$0.00,$25.10,$25.10,$0.00,$268.00,$0.00,$48.04,$212.26,$214.40,$0.00,$0.00,$0.00,$0.00,$0.00
30500102,EAP,CPT® 85008,,Rbc Morphology Exam,$83.00,$1.92,$83.00,$6.11,$5.02,$3.67,$1.92,$5.02,$5.02,$5.08,$83.00,$3.60,$9.62,$65.74,$66.40,$4.97,$5.41,$3.43,$3.79,$3.43
30500103,EAP,CPT® 85013,,"Hematocrit, Spun Cap",$51.00,$0.00,$51.00,$0.00,$3.46,$0.00,$0.00,$3.46,$3.46,$0.00,$51.00,$0.00,$6.62,$40.39,$40.80,$0.00,$0.00,$0.00,$0.00,$0.00
30500104,EAP,CPT® 85018,,Hgb & Hct,$51.00,$1.32,$51.00,$4.22,$3.46,$3.23,$1.32,$3.46,$3.46,$3.50,$51.00,$2.49,$6.62,$40.39,$40.80,$3.44,$3.73,$2.37,$2.61,$2.37
30500105,EAP,CPT® 85025,,"Cbc, Plat & Diff",$222.00,$4.34,$222.00,$13.86,$9.59,$7.20,$4.34,$9.59,$9.59,$11.48,$222.00,$8.16,$21.72,$175.82,$177.60,$11.27,$12.23,$7.77,$8.56,$7.77
30500106,EAP,CPT® 85027,,Cbc & Plat,$184.00,$3.61,$184.00,$11.54,$9.45,$7.73,$3.61,$9.45,$9.45,$9.57,$184.00,$6.79,$18.08,$145.73,$147.20,$9.38,$10.19,$6.47,$7.13,$6.47
30500108,EAP,CPT® 85008,,Rbc Morphology,$83.00,$1.92,$83.00,$6.11,$5.02,$3.67,$1.92,$5.02,$5.02,$5.08,$83.00,$3.60,$9.62,$65.74,$66.40,$4.97,$5.41,$3.43,$3.79,$3.43
30500109,EAP,CPT® 85013,,"Hematocrit, Spun",$51.00,$0.00,$51.00,$0.00,$3.46,$0.00,$0.00,$3.46,$3.46,$0.00,$51.00,$0.00,$6.62,$40.39,$40.80,$0.00,$0.00,$0.00,$0.00,$0.00
30500110,EAP,CPT® 85660,,Sickledex,$183.00,$3.08,$183.00,$9.83,$8.06,$7.50,$3.08,$8.06,$8.06,$8.15,$183.00,$5.79,$15.42,$144.94,$146.40,$7.99,$8.68,$5.51,$6.08,$5.51
30500112,EAP,CPT® 85025,,"Cbc, Plat & Diff, Idp",$222.00,$4.34,$222.00,$13.86,$9.59,$7.20,$4.34,$9.59,$9.59,$11.48,$222.00,$8.16,$21.72,$175.82,$177.60,$11.27,$12.23,$7.77,$8.56,$7.77
30500113,EAP,CPT® 86146,,Beta-2 Glycoprotein Antibodies,$300.00,$14.24,$300.00,$45.37,$37.14,$21.84,$14.24,$37.14,$37.14,$37.58,$300.00,$26.72,$71.08,$237.60,$240.00,$36.90,$40.04,$25.45,$28.03,$25.45
30500114,EAP,CPT® 85397,,Von Willebran Protease Act Q,$476.00,$15.54,$476.00,$40.90,$33.51,$31.22,$15.54,$33.51,$33.51,$31.50,$476.00,$32.40,$238.00,$376.99,$380.80,$44.75,$33.56,$30.86,$23.49,$30.86
30500115,EAP,CPT® 85730,,Silica Clotting Time,$196.00,$3.36,$196.00,$10.72,$8.76,$7.91,$3.36,$8.76,$8.76,$8.86,$196.00,$6.31,$16.76,$155.23,$156.80,$8.71,$9.44,$6.01,$6.61,$6.01
30500117,EAP,CPT® 83520,,Thrombin Anti Thrmbon Complex (e),$323.00,$8.69,$323.00,$23.07,$18.91,$17.62,$8.69,$18.91,$18.91,$19.12,$323.00,$18.13,$36.18,$255.82,$258.40,$25.04,$20.37,$17.27,$14.26,$17.27
30500118,EAP,HCPCS 85999,,"Eosinophil Smear, Urine",$63.00,$0.00,$63.00,$0.00,$44.96,$0.00,$0.00,$44.96,$44.96,$0.00,$63.00,$0.00,$0.00,$49.90,$50.40,$0.00,$0.00,$0.00,$0.00,$0.00
30500119,EAP,CPT® 85999,,"Esoinophil Smear, Urine",$63.00,$0.00,$63.00,$0.00,$44.96,$0.00,$0.00,$44.96,$44.96,$0.00,$63.00,$0.00,$0.00,$49.90,$50.40,$0.00,$0.00,$0.00,$0.00,$0.00
30500121,EAP,CPT® 85362,,Fibrin Monomer (so),$291.00,$3.85,$291.00,$12.29,$10.06,$9.38,$3.85,$10.06,$10.06,$10.17,$291.00,$7.23,$19.24,$230.47,$232.80,$9.99,$10.84,$6.89,$7.59,$6.89
30500122,EAP,CPT® 85307,,Activated Protein C Resistance (so),$122.00,$8.57,$122.00,$27.31,$22.37,$18.78,$8.57,$22.37,$22.37,$22.64,$122.00,$16.09,$42.82,$96.62,$97.60,$22.21,$24.12,$15.32,$16.88,$15.32
30500123,EAP,CPT® 86355,,Lymphocyte Subset Bal - B Cells Total (so),$118.00,$21.10,$118.00,$42.00,$34.39,$22.53,$21.10,$34.39,$34.39,$34.80,$118.00,$39.62,$65.82,$93.46,$94.40,$54.71,$37.08,$37.73,$25.95,$37.73
30500124,EAP,CPT® 86359,,Lymphocyte Subset Bal - T Cells Total (so),$118.00,$21.10,$118.00,$42.00,$34.39,$22.53,$21.10,$34.39,$34.39,$34.80,$118.00,$39.62,$65.82,$93.46,$94.40,$54.71,$37.08,$37.73,$25.95,$37.73
30500125,EAP,CPT® 86360,,Lymphocyte Subset Bal - Absolute Cd4/cd8 With Ratio (so),$118.00,$26.28,$118.00,$83.77,$68.60,$45.07,$26.28,$68.60,$68.60,$69.42,$118.00,$49.33,$118.00,$93.46,$94.40,$68.12,$73.96,$46.98,$51.77,$46.98
30500126,EAP,CPT® 85460,,Hemoglobin Fetal Stain Family Member,$51.00,$2.66,$51.00,$4.31,$3.53,$10.53,$4.33,$3.53,$3.53,$3.57,$51.00,$8.12,$6.76,$40.39,$40.80,$11.21,$3.80,$7.73,$2.66,$7.73
30500130,EAP,CPT® 80299,,Apixaban Quantitative Assay,$156.00,$9.39,$156.00,$24.21,$17.58,$15.07,$9.39,$17.58,$17.58,$17.79,$156.00,$19.57,$33.64,$123.55,$124.80,$27.03,$18.95,$18.64,$13.27,$18.64
30500131,EAP,CPT® 80299,,Rivaroxaban Quantitative Assay,$156.00,$9.39,$156.00,$24.21,$17.58,$15.07,$9.39,$17.58,$17.58,$17.79,$156.00,$19.57,$33.64,$123.55,$124.80,$27.03,$18.95,$18.64,$13.27,$18.64
30600001,EAP,CPT® 87040,,Blood Cult. Routine,$433.00,$5.77,$433.00,$18.40,$15.07,$14.05,$5.77,$15.07,$15.07,$15.25,$433.00,$10.84,$28.84,$342.94,$346.40,$14.96,$16.24,$10.32,$11.37,$10.32
30600002,EAP,CPT® 87045,,Stool Culture,$208.00,$5.28,$208.00,$16.83,$13.77,$11.90,$5.28,$13.77,$13.77,$36.42,$208.00,$9.91,$26.36,$164.74,$166.40,$13.69,$32.55,$9.44,$33.11,$9.44
30600003,EAP,CPT® 87070,,Bone Marrow Culture,$347.00,$4.82,$347.00,$15.37,$12.57,$11.72,$4.82,$12.57,$12.57,$12.73,$347.00,$9.05,$24.06,$274.82,$277.60,$12.50,$13.56,$8.62,$9.49,$8.62
30600004,EAP,CPT® 87070,,Csf Culture,$347.00,$4.82,$347.00,$15.37,$12.57,$11.72,$4.82,$12.57,$12.57,$12.73,$347.00,$9.05,$24.06,$274.82,$277.60,$12.50,$13.56,$8.62,$9.49,$8.62
30600005,EAP,CPT® 87070,,Exudate Culture,$347.00,$4.82,$347.00,$15.37,$12.57,$11.72,$4.82,$12.57,$12.57,$12.73,$347.00,$9.05,$24.06,$274.82,$277.60,$12.50,$13.56,$8.62,$9.49,$8.62
30600006,EAP,CPT® 87070,,Fluid/tissue Cult.,$347.00,$4.82,$347.00,$15.37,$12.57,$11.72,$4.82,$12.57,$12.57,$12.73,$347.00,$9.05,$24.06,$274.82,$277.60,$12.50,$13.56,$8.62,$9.49,$8.62
30600007,EAP,CPT® 87070,,Genital Culture,$347.00,$4.82,$347.00,$15.37,$12.57,$11.72,$4.82,$12.57,$12.57,$12.73,$347.00,$9.05,$24.06,$274.82,$277.60,$12.50,$13.56,$8.62,$9.49,$8.62
30600008,EAP,CPT® 87070,,"Misc Cult,referral",$316.00,$4.82,$316.00,$15.37,$12.57,$11.72,$4.82,$12.57,$12.57,$12.73,$316.00,$9.05,$24.06,$250.27,$252.80,$12.50,$13.56,$8.62,$9.49,$8.62
30600009,EAP,CPT® 87070,,Misc. Culture,$347.00,$4.82,$347.00,$15.37,$12.57,$11.72,$4.82,$12.57,$12.57,$12.73,$347.00,$9.05,$24.06,$274.82,$277.60,$12.50,$13.56,$8.62,$9.49,$8.62
30600010,EAP,CPT® 87070,,SPUTUM CULTURE,$347.00,$4.82,$347.00,$15.37,$12.57,$11.72,$4.82,$12.57,$12.57,$12.73,$347.00,$9.05,$24.06,$274.82,$277.60,$12.50,$13.56,$8.62,$9.49,$8.62
30600011,EAP,CPT® 87081,,Throat Culture,$280.00,$3.70,$280.00,$11.81,$9.69,$4.30,$3.70,$9.69,$9.69,$9.79,$280.00,$6.96,$18.52,$221.76,$224.00,$9.61,$10.43,$6.63,$7.30,$6.63
30600012,EAP,CPT® 87075,,Anaerobe Culture,$289.00,$5.29,$289.00,$16.87,$13.81,$11.07,$5.29,$13.81,$13.81,$13.98,$289.00,$9.94,$26.44,$228.89,$231.20,$13.73,$14.89,$9.47,$10.42,$9.47
30600013,EAP,CPT® 87899,,"Malaria Rapid Antigen Test,evd",$405.00,$0.00,$405.00,$0.00,$17.52,$0.00,$0.00,$17.52,$17.52,$0.00,$405.00,$0.00,$33.52,$320.76,$324.00,$0.00,$0.00,$0.00,$0.00,$0.00
30600014,EAP,CPT® 87076,,CULTURE I.D.-AEROBE BIOCHEM,$237.00,$0.00,$237.00,$0.00,$11.80,$0.00,$0.00,$11.80,$11.80,$0.00,$237.00,$0.00,$22.58,$187.70,$189.60,$0.00,$0.00,$0.00,$0.00,$0.00
30600015,EAP,CPT® 87801,,"Ebola- Amplified Probe Technique, Evd",$572.00,$0.00,$572.00,$0.00,$86.66,$0.00,$0.00,$86.66,$86.66,$0.00,$572.00,$0.00,$109.64,$453.02,$457.60,$0.00,$0.00,$0.00,$0.00,$0.00
30600016,EAP,CPT® 87081,,"Gc Cult,vag/cervix",$280.00,$3.70,$280.00,$11.81,$9.69,$4.30,$3.70,$9.69,$9.69,$9.79,$280.00,$6.96,$18.52,$221.76,$224.00,$9.61,$10.43,$6.63,$7.30,$6.63
30600017,EAP,CPT® 87081,,"Gc Cult,urethral",$280.00,$3.70,$280.00,$11.81,$9.69,$4.30,$3.70,$9.69,$9.69,$9.79,$280.00,$6.96,$18.52,$221.76,$224.00,$9.61,$10.43,$6.63,$7.30,$6.63
30600018,EAP,CPT® 87081,,"Gc Cult,anal",$280.00,$3.70,$280.00,$11.81,$9.69,$4.30,$3.70,$9.69,$9.69,$9.79,$280.00,$6.96,$18.52,$221.76,$224.00,$9.61,$10.43,$6.63,$7.30,$6.63
30600019,EAP,CPT® 87081,,"Gc Cult,throat",$280.00,$3.70,$280.00,$11.81,$9.69,$4.30,$3.70,$9.69,$9.69,$9.79,$280.00,$6.96,$18.52,$221.76,$224.00,$9.61,$10.43,$6.63,$7.30,$6.63
30600020,EAP,CPT® 87081,,Gc Culture Eye,$280.00,$3.70,$280.00,$11.81,$9.69,$4.30,$3.70,$9.69,$9.69,$9.79,$280.00,$6.96,$18.52,$221.76,$224.00,$9.61,$10.43,$6.63,$7.30,$6.63
30600021,EAP,CPT® 87086,,Urine Culture,$302.00,$4.52,$302.00,$14.39,$11.79,$10.99,$4.52,$11.79,$11.79,$11.93,$302.00,$8.47,$22.56,$239.18,$241.60,$11.70,$12.71,$8.07,$8.90,$8.07
30600022,EAP,CPT® 87088,,Urine Culture-presump. Id,$302.00,$0.00,$302.00,$0.00,$11.82,$0.00,$0.00,$11.82,$11.82,$0.00,$302.00,$0.00,$22.62,$239.18,$241.60,$0.00,$0.00,$0.00,$0.00,$0.00
30600023,EAP,CPT® 87101,,Fungus Cult. Derm.,$199.00,$4.31,$199.00,$13.73,$11.26,$10.49,$4.31,$11.26,$11.26,$11.38,$199.00,$8.10,$21.54,$157.61,$159.20,$11.18,$12.13,$7.71,$8.49,$7.71
30600024,EAP,CPT® 87102,,"Fungus Culture,misc.",$211.00,$4.70,$211.00,$14.98,$12.26,$11.43,$4.70,$12.26,$12.26,$12.42,$211.00,$8.83,$23.48,$167.11,$168.80,$12.19,$13.24,$8.41,$9.26,$8.41
30600025,EAP,CPT® 87103,,Fungus Cult. Blood,$229.00,$0.00,$229.00,$0.00,$13.17,$0.00,$10.30,$13.17,$13.17,$13.32,$229.00,$0.00,$25.20,$181.37,$183.20,$0.00,$14.20,$0.00,$0.00,$0.00
30600026,EAP,CPT® 87106,,Culture I.d.-yeast Biochem,$261.00,$0.00,$261.00,$0.00,$15.07,$0.00,$0.00,$15.07,$15.07,$0.00,$261.00,$0.00,$28.84,$206.71,$208.80,$0.00,$0.00,$0.00,$0.00,$0.00
30600027,EAP,CPT® 87107,,Culture I.d.- Mold Biochem,$261.00,$0.00,$261.00,$0.00,$15.07,$0.00,$0.00,$15.07,$15.07,$0.00,$261.00,$0.00,$28.84,$206.71,$208.80,$0.00,$0.00,$0.00,$0.00,$0.00
30600028,EAP,CPT® 87110,,"Chlam Cult,referral",$128.00,$0.00,$128.00,$0.00,$28.60,$0.00,$0.00,$28.60,$28.60,$0.00,$128.00,$0.00,$54.74,$101.38,$102.40,$0.00,$0.00,$0.00,$0.00,$0.00
30600029,EAP,CPT® 87116,,Afb Culture-misc,$249.00,$6.04,$249.00,$12.97,$10.60,$6.58,$6.04,$10.60,$10.60,$43.60,$249.00,$11.34,$20.28,$197.21,$199.20,$15.66,$38.97,$10.80,$39.64,$10.80
30600030,EAP,CPT® 87116,,"Afb Culture, Blood",$249.00,$6.04,$249.00,$12.97,$10.60,$6.58,$6.04,$10.60,$10.60,$43.60,$249.00,$11.34,$20.28,$197.21,$199.20,$15.66,$38.97,$10.80,$39.64,$10.80
30600031,EAP,CPT® 87147,,Culture I.d.-immunologic,$105.00,$0.00,$105.00,$0.00,$6.51,$0.00,$0.00,$6.51,$6.51,$0.00,$105.00,$0.00,$12.46,$83.16,$84.00,$0.00,$0.00,$0.00,$0.00,$0.00
30600032,EAP,CPT® 87149,,Culture I.d.-probe Biochem,$473.00,$11.22,$473.00,$35.16,$28.79,$21.67,$11.22,$28.79,$28.79,$29.14,$473.00,$21.05,$55.10,$374.62,$378.40,$29.07,$31.05,$20.05,$21.73,$20.05
30600033,EAP,CPT® 87172,,Pinworm Exam,$135.00,$0.00,$135.00,$0.00,$6.23,$0.00,$0.00,$6.23,$6.23,$0.00,$135.00,$0.00,$11.92,$106.92,$108.00,$0.00,$0.00,$0.00,$0.00,$0.00
30600034,EAP,CPT® 87177,,"Ova & Parasites, Urn",$244.00,$4.98,$244.00,$15.87,$12.99,$12.11,$4.98,$12.99,$12.99,$13.15,$244.00,$9.35,$24.86,$193.25,$195.20,$12.91,$14.01,$8.90,$9.81,$8.90
30600035,EAP,CPT® 87177,,"O&p,ethylacetate",$223.00,$4.98,$223.00,$15.87,$12.99,$12.11,$4.98,$12.99,$12.99,$13.15,$223.00,$9.35,$24.86,$176.62,$178.40,$12.91,$14.01,$8.90,$9.81,$8.90
30600036,EAP,CPT® 87186,,Sens.special Panel,$214.00,$4.83,$214.00,$15.41,$12.62,$11.77,$4.83,$12.62,$12.62,$12.77,$214.00,$9.08,$24.16,$169.49,$171.20,$12.54,$13.60,$8.65,$9.52,$8.65
30600037,EAP,CPT® 87186,,Sens.gram Pos Cocci,$214.00,$4.83,$214.00,$15.41,$12.62,$11.77,$4.83,$12.62,$12.62,$12.77,$214.00,$9.08,$24.16,$169.49,$171.20,$12.54,$13.60,$8.65,$9.52,$8.65
30600038,EAP,CPT® 87205,,Gram Stain,$63.00,$2.39,$63.00,$4.17,$3.43,$5.81,$2.39,$3.43,$3.43,$3.47,$63.00,$4.48,$6.56,$49.90,$50.40,$6.19,$3.69,$4.27,$2.58,$4.27
30600039,EAP,CPT® 87502,,Influenza Virus -a/b  Amplified Probe,$275.00,$48.23,$275.00,$92.50,$73.04,$95.42,$48.23,$73.04,$73.04,$68.64,$275.00,$100.59,$137.50,$217.80,$220.00,$138.91,$73.14,$95.80,$51.20,$95.80
30600040,EAP,CPT® 87150,,Group B Strep - Amplified Probe,$384.00,$0.00,$384.00,$0.00,$28.10,$0.00,$0.00,$28.10,$28.10,$0.00,$384.00,$0.00,$192.00,$304.13,$307.20,$0.00,$0.00,$0.00,$0.00,$0.00
30600041,EAP,CPT® 87503,,Influenza Virus (h1n1) (amplified Probe),$275.00,$0.00,$275.00,$0.00,$10.95,$0.00,$0.00,$10.95,$10.95,$0.00,$275.00,$0.00,$137.50,$217.80,$220.00,$0.00,$0.00,$0.00,$0.00,$0.00
30600042,EAP,CPT® 87206,,PAS/KOH PREP,$154.00,$3.02,$154.00,$9.60,$7.84,$7.33,$3.02,$7.84,$7.84,$7.93,$154.00,$5.66,$15.00,$121.97,$123.20,$7.82,$8.45,$5.39,$5.91,$5.39
30600044,EAP,CPT® 87328,,Cryptosporidium Scrn.,$193.00,$6.96,$193.00,$21.36,$17.52,$16.32,$6.96,$17.52,$17.52,$17.71,$193.00,$14.51,$33.52,$152.86,$154.40,$20.04,$18.87,$13.82,$13.21,$13.82
30600045,EAP,CPT® 87207,,Malaria/parasite Smr,$223.00,$3.36,$223.00,$10.69,$8.75,$8.15,$3.36,$8.75,$8.75,$8.84,$223.00,$6.29,$16.74,$176.62,$178.40,$8.69,$9.42,$5.99,$6.59,$5.99
30600046,EAP,CPT® 87207,,Rbc Inclusion Body,$223.00,$3.36,$223.00,$10.69,$8.75,$8.15,$3.36,$8.75,$8.75,$8.84,$223.00,$6.29,$16.74,$176.62,$178.40,$8.69,$9.42,$5.99,$6.59,$5.99
30600047,EAP,CPT® 87209,,Microsporidium,$381.00,$10.06,$381.00,$32.06,$26.24,$24.46,$10.06,$26.24,$26.24,$26.54,$381.00,$18.88,$50.22,$301.75,$304.80,$26.07,$28.28,$17.98,$19.80,$17.98
30600048,EAP,CPT® 87209,,"O&p,pva/trichrome",$357.00,$10.06,$357.00,$32.06,$26.24,$24.46,$10.06,$26.24,$26.24,$26.54,$357.00,$18.88,$50.22,$282.74,$285.60,$26.07,$28.28,$17.98,$19.80,$17.98
30600049,EAP,CPT® 87799,,Eb Virus Dna Quant Pcr (so),$786.00,$0.00,$786.00,$0.00,$62.54,$0.00,$23.96,$62.54,$62.54,$0.00,$786.00,$0.00,$119.70,$622.51,$628.80,$0.00,$123.01,$0.00,$0.00,$0.00
30600050,EAP,CPT® 87252,,Cmv Culture Inoc Tissue (so),$390.00,$14.59,$390.00,$39.42,$32.28,$19.64,$14.59,$32.28,$32.28,$32.66,$390.00,$27.37,$61.78,$308.88,$312.00,$37.80,$34.79,$26.07,$24.36,$26.07
30600051,EAP,CPT® 87254,,Cmv Culture Inoc Shell (so),$240.00,$0.00,$240.00,$0.00,$28.55,$0.00,$10.94,$28.55,$28.55,$7.22,$240.00,$0.00,$54.64,$190.08,$192.00,$0.00,$7.70,$0.00,$0.00,$0.00
30600052,EAP,CPT® 87210,,"O & P DIRECT, SMEAR",$210.00,$2.93,$210.00,$7.62,$6.23,$5.60,$2.93,$6.23,$6.23,$6.30,$210.00,$6.11,$11.92,$166.32,$168.00,$8.44,$6.71,$5.82,$4.70,$5.82
30600053,EAP,CPT® 87220,,Koh Level,$184.00,$2.39,$184.00,$7.62,$6.23,$5.81,$2.39,$6.23,$6.23,$6.30,$184.00,$4.48,$11.92,$145.73,$147.20,$6.19,$6.71,$4.27,$4.70,$4.27
30600055,EAP,CPT® 87252,,"Viral Cult,referral",$240.00,$14.59,$240.00,$39.42,$32.28,$19.64,$14.59,$32.28,$32.28,$32.66,$240.00,$27.37,$61.78,$190.08,$192.00,$37.80,$34.79,$26.07,$24.36,$26.07
30600056,EAP,CPT® 87320,,Chlamydia Screen,$718.00,$0.00,$718.00,$0.00,$17.52,$0.00,$0.00,$17.52,$17.52,$0.00,$718.00,$0.00,$33.52,$568.66,$574.40,$0.00,$0.00,$0.00,$0.00,$0.00
30600057,EAP,CPT® 87324,,"C.diff. Assay,stool",$193.00,$6.70,$193.00,$21.36,$17.52,$16.32,$6.70,$17.52,$17.52,$17.71,$193.00,$12.58,$33.52,$152.86,$154.40,$17.37,$18.87,$11.98,$13.21,$11.98
30600059,EAP,CPT® 87329,,Eia Giardia Screen,$193.00,$6.70,$193.00,$21.36,$17.52,$16.32,$6.70,$17.52,$17.52,$17.71,$193.00,$12.58,$33.52,$152.86,$154.40,$17.37,$18.87,$11.98,$13.21,$11.98
30600060,EAP,CPT® 87337,,H.pylori Ag -stool,$330.00,$6.70,$330.00,$21.36,$17.52,$16.32,$6.70,$17.52,$17.52,$17.71,$330.00,$12.58,$33.52,$261.36,$264.00,$17.37,$18.87,$11.98,$13.21,$11.98
30600061,EAP,CPT® 87340,,Hbv Surface Ag,$257.00,$5.78,$257.00,$18.42,$15.08,$14.06,$5.78,$15.08,$15.08,$15.26,$257.00,$10.85,$28.86,$203.54,$205.60,$14.98,$16.26,$10.33,$11.38,$10.33
30600062,EAP,CPT® 87340,,Hbv Surf Ag-ob,$257.00,$5.78,$257.00,$18.42,$15.08,$14.06,$5.78,$15.08,$15.08,$15.26,$257.00,$10.85,$28.86,$203.54,$205.60,$14.98,$16.26,$10.33,$11.38,$10.33
30600063,EAP,CPT® 87350,,Hbv E Ag,$88.00,$6.44,$88.00,$20.54,$16.83,$15.69,$6.44,$16.83,$16.83,$17.02,$88.00,$12.11,$32.20,$69.70,$70.40,$16.72,$18.14,$11.53,$12.70,$11.53
30600064,EAP,CPT® 87385,,Histoplasma Ag,$314.00,$6.70,$314.00,$21.36,$17.52,$16.32,$6.70,$17.52,$17.52,$17.71,$314.00,$13.91,$33.52,$248.69,$251.20,$19.21,$18.87,$13.25,$13.21,$13.25
30600065,EAP,CPT® 87390,,Hiv-ag-p24,$233.00,$0.00,$233.00,$0.00,$25.76,$0.00,$0.00,$25.76,$25.76,$0.00,$233.00,$0.00,$49.30,$184.54,$186.40,$0.00,$0.00,$0.00,$0.00,$0.00
30600066,EAP,CPT® 87425,,"Rotavirus Ag, Stool",$225.00,$0.00,$225.00,$0.00,$17.52,$0.00,$0.00,$17.52,$17.52,$0.00,$225.00,$0.00,$33.52,$178.20,$180.00,$0.00,$0.00,$0.00,$0.00,$0.00
30600068,EAP,CPT® 87430,,STREP A AG-THROAT,$162.00,$8.46,$162.00,$21.36,$17.52,$16.32,$8.46,$17.52,$17.52,$17.71,$162.00,$17.65,$33.52,$128.30,$129.60,$24.37,$18.87,$16.81,$13.21,$16.81
30600070,EAP,CPT® 87450,,"L. Pneumo-1 Ag, Urine",$274.00,$5.37,$274.00,$17.10,$13.99,$11.03,$5.37,$13.99,$13.99,$14.15,$274.00,$10.07,$26.78,$217.01,$219.20,$13.91,$15.08,$9.59,$10.56,$9.59
30600071,EAP,CPT® 87491,,Chlamydia Detection,$340.00,$19.63,$340.00,$34.98,$28.64,$37.59,$19.63,$28.64,$28.64,$28.98,$340.00,$36.84,$54.82,$269.28,$272.00,$50.88,$30.88,$35.09,$21.62,$35.09
30600072,EAP,CPT® 87496,,Cmv Dna-pcr Fluids,$878.00,$19.63,$878.00,$34.98,$28.64,$37.59,$19.63,$28.64,$28.64,$28.98,$878.00,$36.84,$54.82,$695.38,$702.40,$50.88,$30.88,$35.09,$21.62,$35.09
30600073,EAP,CPT® 87516,,Hbv Dna-pcr,$330.00,$0.00,$330.00,$0.00,$28.64,$0.00,$0.00,$28.64,$28.64,$0.00,$330.00,$0.00,$54.82,$261.36,$264.00,$0.00,$0.00,$0.00,$0.00,$0.00
30600074,EAP,CPT® 87177,,Coccidia Smear,$223.00,$4.98,$223.00,$15.87,$12.99,$12.11,$4.98,$12.99,$12.99,$13.15,$223.00,$9.35,$24.86,$176.62,$178.40,$12.91,$14.01,$8.90,$9.81,$8.90
30600075,EAP,CPT® 87521,,Hcv Rna-pcr,$730.00,$0.00,$730.00,$0.00,$28.64,$0.00,$0.00,$28.64,$28.64,$0.00,$730.00,$0.00,$54.82,$578.16,$584.00,$0.00,$0.00,$0.00,$0.00,$0.00
30600076,EAP,CPT® 87522,,"Hcv Rna-pcr, Quant",$993.00,$23.96,$993.00,$76.36,$62.54,$58.29,$23.96,$62.54,$62.54,$63.28,$993.00,$44.98,$119.70,$786.46,$794.40,$62.12,$67.43,$42.84,$47.20,$42.84
30600077,EAP,CPT® 87529,,Hsv Dna-pcr,$875.00,$19.63,$875.00,$34.98,$28.64,$37.59,$19.63,$28.64,$28.64,$28.98,$875.00,$36.84,$54.82,$693.00,$700.00,$50.88,$30.88,$35.09,$21.62,$35.09
30600078,EAP,CPT® 87535,,Hiv-1 Dna-pcr,$655.00,$19.63,$655.00,$34.98,$28.64,$37.59,$19.63,$28.64,$28.64,$28.98,$655.00,$36.84,$54.82,$518.76,$524.00,$50.88,$30.88,$35.09,$21.62,$35.09
30600079,EAP,CPT® 87536,,"Hiv-1 Rna B Dna, Quant",$767.00,$47.60,$767.00,$92.50,$75.77,$95.41,$47.60,$75.77,$75.77,$66.37,$767.00,$89.36,$145.02,$607.46,$613.60,$123.40,$70.72,$85.10,$49.50,$85.10
30600080,EAP,CPT® 87556,,Direct M. Tb Test,$308.00,$20.99,$308.00,$34.98,$28.64,$37.59,$20.99,$28.64,$28.64,$53.93,$308.00,$43.76,$54.82,$243.94,$246.40,$60.44,$48.20,$41.68,$49.03,$41.68
30600081,EAP,CPT® 87591,,Gc Detection,$340.00,$18.76,$340.00,$34.98,$28.64,$37.59,$19.63,$28.64,$28.64,$25.16,$340.00,$36.84,$54.82,$269.28,$272.00,$50.88,$26.81,$35.09,$18.76,$35.09
30600082,EAP,CPT® 87798,,"Enterovirus Pcr, Csf",$972.00,$19.63,$972.00,$34.98,$28.64,$37.59,$19.63,$28.64,$28.64,$28.98,$972.00,$36.84,$54.82,$769.82,$777.60,$50.88,$30.88,$35.09,$21.62,$35.09
30600083,EAP,CPT® 87798,,Thyroid Perox Ab; Tpo,$972.00,$19.63,$972.00,$34.98,$28.64,$37.59,$19.63,$28.64,$28.64,$28.98,$972.00,$36.84,$54.82,$769.82,$777.60,$50.88,$30.88,$35.09,$21.62,$35.09
30600084,EAP,CPT® 87798,,"Jcv Dna-pcr,csf",$907.00,$19.63,$907.00,$34.98,$28.64,$37.59,$19.63,$28.64,$28.64,$28.98,$907.00,$36.84,$54.82,$718.34,$725.60,$50.88,$30.88,$35.09,$21.62,$35.09
30600085,EAP,CPT® 87798,,"Vzv Dna-pcr,csf",$907.00,$19.63,$907.00,$34.98,$28.64,$37.59,$19.63,$28.64,$28.64,$28.98,$907.00,$36.84,$54.82,$718.34,$725.60,$50.88,$30.88,$35.09,$21.62,$35.09
30600086,EAP,CPT® 87804,,Influenza-a Ag,$363.00,$8.34,$363.00,$21.36,$17.52,$16.32,$8.34,$17.52,$17.52,$17.71,$363.00,$17.38,$33.52,$287.50,$290.40,$24.00,$18.87,$16.55,$13.21,$16.55
30600087,EAP,CPT® 87804,,Influenza-b Ag,$363.00,$8.34,$363.00,$21.36,$17.52,$16.32,$8.34,$17.52,$17.52,$17.71,$363.00,$17.38,$33.52,$287.50,$290.40,$24.00,$18.87,$16.55,$13.21,$16.55
30600088,EAP,CPT® 87807,,Rsv Assay,$638.00,$6.70,$638.00,$21.36,$17.52,$16.32,$6.70,$17.52,$17.52,$17.71,$638.00,$13.76,$33.52,$505.30,$510.40,$19.00,$18.87,$13.10,$13.21,$13.10
30600089,EAP,CPT® 87901,,Hiv Genotyping,"$1,776.00",$96.09,"$1,776.00",$155.47,$127.33,$300.79,$144.01,$127.33,$127.33,$128.84,"$1,776.00",$270.32,$243.70,"$1,406.59","$1,420.80",$373.30,$137.28,$257.45,$96.09,$257.45
30600090,EAP,CPT® 87902,,Hcv Genotyping,"$1,922.00",$96.09,"$1,922.00",$155.47,$127.33,$300.79,$144.01,$127.33,$127.33,$128.84,"$1,922.00",$270.32,$243.70,"$1,522.22","$1,537.60",$373.30,$137.28,$257.45,$96.09,$257.45
30600094,EAP,CPT® 86757,,Richettsia Antibody Igm,$48.00,$0.00,$48.00,$0.00,$28.26,$0.00,$0.00,$28.26,$28.26,$0.00,$48.00,$0.00,$48.00,$38.02,$38.40,$0.00,$0.00,$0.00,$0.00,$0.00
30600095,EAP,CPT® 87798,,"Parvovirus B19 Pcr, Qual",$313.00,$19.63,$313.00,$34.98,$28.64,$37.59,$19.63,$28.64,$28.64,$28.98,$313.00,$36.84,$54.82,$247.90,$250.40,$50.88,$30.88,$35.09,$21.62,$35.09
30600096,EAP,CPT® 87517,,"Hbv Dna-pcr,quant",$345.00,$23.96,$345.00,$76.36,$62.54,$58.29,$23.96,$62.54,$62.54,$63.28,$345.00,$44.98,$119.70,$273.24,$276.00,$62.12,$67.43,$42.84,$47.20,$42.84
30600100,EAP,CPT® 87046,,"E.coli O157, Culture(so)",$64.00,$2.60,$64.00,$16.83,$13.77,$11.90,$5.28,$13.77,$13.77,$3.49,$64.00,$9.91,$26.36,$50.69,$51.20,$13.69,$3.71,$9.44,$2.60,$9.44
30600105,EAP,CPT® 87497,,"Cmv,dna,pcr, Quant",$681.00,$23.96,$681.00,$76.36,$62.54,$58.29,$23.96,$62.54,$62.54,$63.28,$681.00,$44.98,$119.70,$539.35,$544.80,$62.12,$67.43,$42.84,$47.20,$42.84
30600106,EAP,CPT® 87252,,Cmv Inoc Tissue (so),$390.00,$14.59,$390.00,$39.42,$32.28,$19.64,$14.59,$32.28,$32.28,$32.66,$390.00,$27.37,$61.78,$308.88,$312.00,$37.80,$34.79,$26.07,$24.36,$26.07
30600107,EAP,CPT® 87254,,Cmv Inoc Shell Via (so),$240.00,$0.00,$240.00,$0.00,$28.55,$0.00,$10.94,$28.55,$28.55,$7.22,$240.00,$0.00,$54.64,$190.08,$192.00,$0.00,$7.70,$0.00,$0.00,$0.00
30600108,EAP,CPT® 87902,,Hep C Dna Geno Quant (so),"$1,233.00",$96.09,"$1,233.00",$155.47,$127.33,$300.79,$144.01,$127.33,$127.33,$128.84,"$1,233.00",$270.32,$243.70,$976.54,$986.40,$373.30,$137.28,$257.45,$96.09,$257.45
30600109,EAP,CPT® 87799,,Ebv Dna Detect Nos (so),$786.00,$0.00,$786.00,$0.00,$62.54,$0.00,$23.96,$62.54,$62.54,$0.00,$786.00,$0.00,$119.70,$622.51,$628.80,$0.00,$123.01,$0.00,$0.00,$0.00
30600200,EAP,CPT® 87205,,Gram Stain,$63.00,$2.39,$63.00,$4.17,$3.43,$5.81,$2.39,$3.43,$3.43,$3.47,$63.00,$4.48,$6.56,$49.90,$50.40,$6.19,$3.69,$4.27,$2.58,$4.27
30600201,EAP,CPT® 87205,,Sezary Cell Prep,$63.00,$2.39,$63.00,$4.17,$3.43,$5.81,$2.39,$3.43,$3.43,$3.47,$63.00,$4.48,$6.56,$49.90,$50.40,$6.19,$3.69,$4.27,$2.58,$4.27
30600202,EAP,CPT® 87206,,Pas/koh Prep,$154.00,$3.02,$154.00,$9.60,$7.84,$7.33,$3.02,$7.84,$7.84,$7.93,$154.00,$5.66,$15.00,$121.97,$123.20,$7.82,$8.45,$5.39,$5.91,$5.39
30600203,EAP,CPT® 87206,,Afb Stain,$154.00,$3.02,$154.00,$9.60,$7.84,$7.33,$3.02,$7.84,$7.84,$7.93,$154.00,$5.66,$15.00,$121.97,$123.20,$7.82,$8.45,$5.39,$5.91,$5.39
30600204,EAP,CPT® 87210,,"O & P Direct, Smear",$210.00,$2.93,$210.00,$7.62,$6.23,$5.60,$2.93,$6.23,$6.23,$6.30,$210.00,$6.11,$11.92,$166.32,$168.00,$8.44,$6.71,$5.82,$4.70,$5.82
30600205,EAP,CPT® 87210,,India Ink Prep,$210.00,$2.93,$210.00,$7.62,$6.23,$5.60,$2.93,$6.23,$6.23,$6.30,$210.00,$6.11,$11.92,$166.32,$168.00,$8.44,$6.71,$5.82,$4.70,$5.82
30600206,EAP,CPT® 87210,,Vaginal Wet Prep,$210.00,$2.93,$210.00,$7.62,$6.23,$5.60,$2.93,$6.23,$6.23,$6.30,$210.00,$6.11,$11.92,$166.32,$168.00,$8.44,$6.71,$5.82,$4.70,$5.82
30600207,EAP,CPT® 87430,,Strep A Ag-throat,$162.00,$8.46,$162.00,$21.36,$17.52,$16.32,$8.46,$17.52,$17.52,$17.71,$162.00,$17.65,$33.52,$128.30,$129.60,$24.37,$18.87,$16.81,$13.21,$16.81
30600208,EAP,CPT® 87205,,Gram Stain For Gc,$63.00,$2.39,$63.00,$4.17,$3.43,$5.81,$2.39,$3.43,$3.43,$3.47,$63.00,$4.48,$6.56,$49.90,$50.40,$6.19,$3.69,$4.27,$2.58,$4.27
30600209,EAP,CPT® 87206,,Koh Prep,$154.00,$3.02,$154.00,$9.60,$7.84,$7.33,$3.02,$7.84,$7.84,$7.93,$154.00,$5.66,$15.00,$121.97,$123.20,$7.82,$8.45,$5.39,$5.91,$5.39
30600210,EAP,CPT® 87210,,Vaginal Wet Prep,$210.00,$2.93,$210.00,$7.62,$6.23,$5.60,$2.93,$6.23,$6.23,$6.30,$210.00,$6.11,$11.92,$166.32,$168.00,$8.44,$6.71,$5.82,$4.70,$5.82
30600211,EAP,CPT® 87430,,Rapid Strep,$162.00,$8.46,$162.00,$21.36,$17.52,$16.32,$8.46,$17.52,$17.52,$17.71,$162.00,$17.65,$33.52,$128.30,$129.60,$24.37,$18.87,$16.81,$13.21,$16.81
30600212,EAP,CPT® 87205,,Gram Stain,$63.00,$2.39,$63.00,$4.17,$3.43,$5.81,$2.39,$3.43,$3.43,$3.47,$63.00,$4.48,$6.56,$49.90,$50.40,$6.19,$3.69,$4.27,$2.58,$4.27
30600213,EAP,CPT® 87188,,Microbe Suscept Macrobroth,$41.00,$0.00,$41.00,$0.00,$9.69,$0.00,$0.00,$9.69,$9.69,$0.00,$41.00,$0.00,$18.54,$32.47,$32.80,$0.00,$0.00,$0.00,$0.00,$0.00
30600215,EAP,CPT® 87290,,Varicella Zoster Ag If,$66.00,$0.00,$66.00,$0.00,$17.52,$0.00,$0.00,$17.52,$17.52,$0.00,$66.00,$0.00,$33.52,$52.27,$52.80,$0.00,$0.00,$0.00,$0.00,$0.00
30600216,EAP,CPT® 87299,,Antibody Detection Nos If,$83.00,$0.00,$83.00,$0.00,$17.52,$0.00,$0.00,$17.52,$17.52,$0.00,$83.00,$0.00,$33.52,$65.74,$66.40,$0.00,$0.00,$0.00,$0.00,$0.00
30600218,EAP,CPT® 87015,,Pneumocycstis Carni Dfa-concen,$91.00,$3.74,$91.00,$11.90,$9.75,$9.09,$3.74,$9.75,$9.75,$9.87,$91.00,$7.01,$18.66,$72.07,$72.80,$9.69,$10.52,$6.68,$7.36,$6.68
30600219,EAP,CPT® 87281,,Pneumocycstis Carni Dfa-id (q),$110.00,$0.00,$110.00,$0.00,$17.52,$0.00,$0.00,$17.52,$17.52,$0.00,$110.00,$0.00,$33.52,$87.12,$88.00,$0.00,$0.00,$0.00,$0.00,$0.00
30600220,EAP,CPT® 87799,,"Toxoplasma Gondii Dna , Quant Pcr (so)",$967.00,$0.00,$967.00,$0.00,$62.54,$0.00,$23.96,$62.54,$62.54,$0.00,$967.00,$0.00,$119.70,$765.86,$773.60,$0.00,$151.34,$0.00,$0.00,$0.00
30600221,EAP,CPT® 87798,,Bordetella Pertussis/parapertussis Qual/pcr(so),$551.00,$19.63,$551.00,$34.98,$28.64,$37.59,$19.63,$28.64,$28.64,$28.98,$551.00,$36.84,$54.82,$436.39,$440.80,$50.88,$30.88,$35.09,$21.62,$35.09
30600222,EAP,CPT® 87912,,Hepatitis B Virus Drug Resistance Genotype Bcp/precore (so),$590.00,$0.00,$590.00,$0.00,$359.15,$0.00,$0.00,$359.15,$359.15,$0.00,$590.00,$0.00,$295.00,$467.28,$472.00,$0.00,$0.00,$0.00,$0.00,$0.00
30600223,EAP,CPT® 87902,,"Hepatitis C Viral Genotype , Lipa (so)",$350.00,$96.09,$350.00,$155.47,$127.33,$300.79,$144.01,$127.33,$127.33,$128.84,$350.00,$270.32,$243.70,$277.20,$280.00,$350.00,$137.28,$257.45,$96.09,$257.45
30600224,EAP,CPT® 87661,,"Trichomonas Vaginalis Rna, Qual",$246.00,$18.76,$246.00,$34.98,$26.77,$37.59,$19.63,$26.77,$26.77,$25.16,$246.00,$36.84,$123.00,$194.83,$196.80,$50.88,$26.81,$35.09,$18.76,$35.09
30600225,EAP,CPT® 87493,,"Clostridium Difficile Toxin, Gene ,pcr",$262.00,$19.63,$262.00,$34.98,$28.10,$37.59,$19.63,$28.10,$28.10,$45.87,$262.00,$39.13,$131.00,$207.50,$209.60,$54.04,$41.00,$37.27,$41.71,$37.27
30600227,EAP,CPT® 87632,,Respiratory Pcr Panel Iv (so),"$3,460.00",$0.00,"$3,460.00",$0.00,$297.68,$0.00,$0.00,$297.68,$297.68,$0.00,"$3,460.00",$0.00,"$1,730.00","$2,740.32","$2,768.00",$0.00,$0.00,$0.00,$0.00,$0.00
30600228,EAP,CPT® 87530,,Herpes Sim Pcr Quant (so),$342.00,$0.00,$342.00,$0.00,$62.54,$0.00,$0.00,$62.54,$62.54,$0.00,$342.00,$0.00,$119.70,$270.86,$273.60,$0.00,$0.00,$0.00,$0.00,$0.00
30630620,EAP,CPT® 87798,,Jc Polyoma Quant Amp (so),$393.00,$19.63,$393.00,$34.98,$28.64,$37.59,$19.63,$28.64,$28.64,$28.98,$393.00,$36.84,$54.82,$311.26,$314.40,$50.88,$30.88,$35.09,$21.62,$35.09
30630621,EAP,CPT® 87799,,Jc Polyoma Quant Pcr (so),$582.00,$0.00,$582.00,$0.00,$62.54,$0.00,$23.96,$62.54,$62.54,$0.00,$582.00,$0.00,$119.70,$460.94,$465.60,$0.00,$91.08,$0.00,$0.00,$0.00
30630622,EAP,CPT® 87798,,Aspergillus Dna Qual Pcr (so),$393.00,$19.63,$393.00,$34.98,$28.64,$37.59,$19.63,$28.64,$28.64,$28.98,$393.00,$36.84,$54.82,$311.26,$314.40,$50.88,$30.88,$35.09,$21.62,$35.09
30630623,EAP,CPT® 87081,,Brucella Screen (so),$143.00,$3.70,$143.00,$11.81,$9.69,$4.30,$3.70,$9.69,$9.69,$9.79,$143.00,$6.96,$18.52,$113.26,$114.40,$9.61,$10.43,$6.63,$7.30,$6.63
30630624,EAP,CPT® 87799,,Herpes Virus 8 Dna Pcr (so),$582.00,$0.00,$582.00,$0.00,$62.54,$0.00,$23.96,$62.54,$62.54,$0.00,$582.00,$0.00,$119.70,$460.94,$465.60,$0.00,$91.08,$0.00,$0.00,$0.00
30650009,EAP,CPT® 87070,,Sputum Culture,$347.00,$4.82,$347.00,$15.37,$12.57,$11.72,$4.82,$12.57,$12.57,$12.73,$347.00,$9.05,$24.06,$274.82,$277.60,$12.50,$13.56,$8.62,$9.49,$8.62
30650014,EAP,CPT® 87077,,Culture I.d.-aerobe Biochem,$237.00,$4.52,$237.00,$14.41,$11.80,$11.00,$4.52,$11.80,$11.80,$11.94,$237.00,$8.48,$22.58,$187.70,$189.60,$11.72,$12.72,$8.08,$8.90,$8.08
30650094,EAP,CPT® 86757,,Richettsia Antibody Igg,$48.00,$0.00,$48.00,$0.00,$28.26,$0.00,$0.00,$28.26,$28.26,$0.00,$48.00,$0.00,$48.00,$38.02,$38.40,$0.00,$0.00,$0.00,$0.00,$0.00
30650206,EAP,CPT® 87210,,Trichomonas Prep,$210.00,$2.93,$210.00,$7.62,$6.23,$5.60,$2.93,$6.23,$6.23,$6.30,$210.00,$6.11,$11.92,$166.32,$168.00,$8.44,$6.71,$5.82,$4.70,$5.82
30650311,EAP,CPT® 87530,,Hsv Dna Quant,$460.00,$0.00,$460.00,$0.00,$62.54,$0.00,$0.00,$62.54,$62.54,$0.00,$460.00,$0.00,$119.70,$364.32,$368.00,$0.00,$0.00,$0.00,$0.00,$0.00
30650312,EAP,CPT® 87798,,"T.pallidum Pcr Ql,csf Q",$404.00,$19.63,$404.00,$34.98,$28.64,$37.59,$19.63,$28.64,$28.64,$28.98,$404.00,$36.84,$54.82,$319.97,$323.20,$50.88,$30.88,$35.09,$21.62,$35.09
30650313,EAP,CPT® 87624,,Papillomavirus Human,$93.00,$15.99,$93.00,$34.98,$26.70,$37.59,$19.63,$26.70,$26.70,$21.44,$93.00,$36.84,$46.50,$73.66,$74.40,$50.88,$22.85,$35.09,$15.99,$35.09
30650315,EAP,CPT® 87798,,Ehrlichia Chaff Pcr (so),$449.00,$19.63,$449.00,$34.98,$28.64,$37.59,$19.63,$28.64,$28.64,$28.98,$449.00,$36.84,$54.82,$355.61,$359.20,$50.88,$30.88,$35.09,$21.62,$35.09
30650316,EAP,CPT® 87529,,Hsv Pcr Qual Amino (so),$351.00,$19.63,$351.00,$34.98,$28.64,$37.59,$19.63,$28.64,$28.64,$28.98,$351.00,$36.84,$54.82,$277.99,$280.80,$50.88,$30.88,$35.09,$21.62,$35.09
30650317,EAP,CPT® 87900,,Hcv Ns3/4 Pheno (so),"$1,355.00",$0.00,"$1,355.00",$0.00,$161.40,$0.00,$0.00,$161.40,$161.40,$0.00,"$1,355.00",$0.00,$308.90,"$1,073.16","$1,084.00",$0.00,$0.00,$0.00,$0.00,$0.00
30650318,EAP,CPT® 87902,,Hcv Ns3/4 Geno (so),"$1,233.00",$96.09,"$1,233.00",$155.47,$127.33,$300.79,$144.01,$127.33,$127.33,$128.84,"$1,233.00",$270.32,$243.70,$976.54,$986.40,$373.30,$137.28,$257.45,$96.09,$257.45
30650319,EAP,CPT® 87798,,Jc Poly Qual Pcr (so),$449.00,$19.63,$449.00,$34.98,$28.64,$37.59,$19.63,$28.64,$28.64,$28.98,$449.00,$36.84,$54.82,$355.61,$359.20,$50.88,$30.88,$35.09,$21.62,$35.09
30650320,EAP,CPT® 87906,,Hiv Coreceptor Tropism Ultra (so),"$1,172.00",$43.01,"$1,172.00",$77.75,$61.36,$150.39,$72.01,$61.36,$61.36,$57.67,"$1,172.00",$135.17,$586.00,$928.22,$937.60,$186.66,$61.44,$128.73,$43.01,$128.73
30650321,EAP,CPT® 87902,,Hcv Rna Ns5a Drug (so),"$1,233.00",$96.09,"$1,233.00",$155.47,$127.33,$300.79,$144.01,$127.33,$127.33,$128.84,"$1,233.00",$270.32,$243.70,$976.54,$986.40,$373.30,$137.28,$257.45,$96.09,$257.45
30650322,EAP,CPT® 87902,,Hcv Rna Ns5b Resist (so),"$1,233.00",$96.09,"$1,233.00",$155.47,$127.33,$300.79,$144.01,$127.33,$127.33,$128.84,"$1,233.00",$270.32,$243.70,$976.54,$986.40,$373.30,$137.28,$257.45,$96.09,$257.45
30650323,EAP,CPT® 87632,,Resp Virus Pcr Iv (6-11) (so),"$3,561.00",$0.00,"$3,561.00",$0.00,$297.68,$0.00,$0.00,$297.68,$297.68,$0.00,"$3,561.00",$0.00,"$1,780.50","$2,820.31","$2,848.80",$0.00,$0.00,$0.00,$0.00,$0.00
30650324,EAP,CPT® 87530,,Hsv Dna Pcr Quant (so),$338.00,$0.00,$338.00,$0.00,$62.54,$0.00,$0.00,$62.54,$62.54,$0.00,$338.00,$0.00,$119.70,$267.70,$270.40,$0.00,$0.00,$0.00,$0.00,$0.00
30650325,EAP,CPT® 87902,,Hcv Ns5a Drug Resist (so),$772.00,$96.09,$772.00,$155.47,$127.33,$300.79,$144.01,$127.33,$127.33,$128.84,$772.00,$270.32,$243.70,$611.42,$617.60,$373.30,$137.28,$257.45,$96.09,$257.45
30650326,EAP,CPT® 87625,,Hpv Genotyping,$247.00,$0.00,$247.00,$0.00,$26.70,$0.00,$0.00,$26.70,$26.70,$0.00,$247.00,$0.00,$123.50,$195.62,$197.60,$0.00,$0.00,$0.00,$0.00,$0.00
30650330,EAP,CPT® 87015,,Cyclospora & Isospora Concentration (so),$70.00,$3.74,$70.00,$11.90,$9.75,$9.09,$3.74,$9.75,$9.75,$9.87,$70.00,$7.01,$18.66,$55.44,$56.00,$9.69,$10.52,$6.68,$7.36,$6.68
30650331,EAP,CPT® 87207,,Cyclospora & Isospora Stain (so),$70.00,$3.36,$70.00,$10.69,$8.75,$8.15,$3.36,$8.75,$8.75,$8.84,$70.00,$6.29,$16.74,$55.44,$56.00,$8.69,$9.42,$5.99,$6.59,$5.99
30650340,EAP,CPT® 87635,,Covid-19 Lab Test Non-cdc,$508.00,$51.31,$508.00,$116.99,$362.56,$100.00,$66.23,$362.56,$362.56,$88.95,$508.00,$105.00,$254.00,$402.34,$406.40,$74.40,$79.50,$51.31,$80.87,$100.00
30650341,EAP,CPT® 87635,,Sars-cov-2 Covid-19 Amp Prb (so),$173.00,$27.07,$173.00,$116.99,$123.47,$51.31,$66.23,$123.47,$123.47,$30.29,$173.00,$53.88,$86.50,$137.02,$138.40,$74.40,$27.07,$51.31,$27.54,$51.31
30650350,EAP,CPT® 87633,,Respiratory Virus Panel 12-25 Targets,"$1,043.00",$0.00,"$1,043.00",$0.00,$514.55,$0.00,$0.00,$514.55,$514.55,$0.00,"$1,043.00",$0.00,$521.50,$826.06,$834.40,$0.00,$0.00,$0.00,$0.00,$0.00
30650351,EAP,CPT® 87798,,Bordetella Pertussis,$88.00,$19.63,$88.00,$34.98,$28.64,$37.59,$19.63,$28.64,$28.64,$28.98,$88.00,$36.84,$54.82,$69.70,$70.40,$50.88,$30.88,$35.09,$21.62,$35.09
30650352,EAP,CPT® 87486,,Chlamydophila/chlamydia Pneumoniae,$88.00,$0.00,$88.00,$0.00,$28.64,$0.00,$0.00,$28.64,$28.64,$0.00,$88.00,$0.00,$54.82,$69.70,$70.40,$0.00,$0.00,$0.00,$0.00,$0.00
30650353,EAP,CPT® 87581,,Mycoplasma Pneumoniae,$88.00,$0.00,$88.00,$0.00,$28.64,$0.00,$0.00,$28.64,$28.64,$0.00,$88.00,$0.00,$54.82,$69.70,$70.40,$0.00,$0.00,$0.00,$0.00,$0.00
30650354,EAP,CPT® 87798,,Bordetella Parapertussis,$88.00,$19.63,$88.00,$34.98,$28.64,$37.59,$19.63,$28.64,$28.64,$28.98,$88.00,$36.84,$54.82,$69.70,$70.40,$50.88,$30.88,$35.09,$21.62,$35.09
30700001,EAP,CPT® 81000,,"PH, URINE-DIPSTICK",$110.00,$2.03,$110.00,$5.65,$4.63,$4.31,$2.03,$4.63,$4.63,$4.68,$110.00,$4.22,$8.86,$87.12,$88.00,$5.83,$4.99,$4.02,$3.49,$4.02
30700002,EAP,CPT® 85025,,"Cbc, Plat, Wbcdiff, Evd",$222.00,$4.34,$222.00,$13.86,$9.59,$7.20,$4.34,$9.59,$9.59,$11.48,$222.00,$8.16,$21.72,$175.82,$177.60,$11.27,$12.23,$7.77,$8.56,$7.77
30700004,EAP,CPT® 81002,,Urine Dip Stick,$95.00,$0.00,$95.00,$0.00,$3.74,$0.00,$0.00,$3.74,$3.74,$0.00,$95.00,$0.00,$7.14,$75.24,$76.00,$0.00,$0.00,$0.00,$0.00,$0.00
30700007,EAP,CPT® 81001,,Urinalysis Complete,$205.00,$1.77,$205.00,$5.65,$4.63,$4.31,$1.77,$4.63,$4.63,$4.68,$205.00,$3.33,$8.86,$162.36,$164.00,$4.60,$4.99,$3.17,$3.49,$3.17
30700019,EAP,CPT® 81003,,Urinalysis,$168.00,$1.25,$168.00,$4.01,$3.28,$3.06,$1.25,$3.28,$3.28,$3.33,$168.00,$2.36,$6.28,$133.06,$134.40,$3.26,$3.55,$2.25,$2.48,$2.25
30700027,EAP,CPT® 81005,,"Ph, Urine(quant)",$115.00,$0.00,$115.00,$0.00,$3.16,$0.00,$0.00,$3.16,$3.16,$0.00,$115.00,$0.00,$6.06,$91.08,$92.00,$0.00,$0.00,$0.00,$0.00,$0.00
30700035,EAP,CPT® 81015,,Urinalysis-micro Only,$192.00,$0.00,$192.00,$0.00,$4.43,$0.00,$0.00,$4.43,$4.43,$0.00,$192.00,$0.00,$8.48,$152.06,$153.60,$0.00,$0.00,$0.00,$0.00,$0.00
30700041,EAP,CPT® 81025,,PREGNANCY TEST-URINE,$35.00,$4.33,$35.00,$11.26,$9.24,$8.61,$4.33,$9.24,$9.24,$9.36,$35.00,$9.04,$17.68,$27.72,$28.00,$12.48,$9.97,$8.61,$6.98,$8.61
30700042,EAP,CPT® 81050,,"Urine, Timed Collect",$119.00,$1.83,$119.00,$5.36,$4.37,$4.08,$1.83,$4.37,$4.37,$4.43,$119.00,$3.82,$8.38,$94.25,$95.20,$5.28,$4.72,$3.64,$3.30,$3.64
30700050,EAP,CPT® 81003,,Urinalysis-biochem,$168.00,$1.25,$168.00,$4.01,$3.28,$3.06,$1.25,$3.28,$3.28,$3.33,$168.00,$2.36,$6.28,$133.06,$134.40,$3.26,$3.55,$2.25,$2.48,$2.25
30700080,EAP,CPT® 81000,,"Ph, Urine-dipstick",$110.00,$2.03,$110.00,$5.65,$4.63,$4.31,$2.03,$4.63,$4.63,$4.68,$110.00,$4.22,$8.86,$87.12,$88.00,$5.83,$4.99,$4.02,$3.49,$4.02
30700081,EAP,CPT® 81001,,Urinalysis With Microscopy,$205.00,$1.77,$205.00,$5.65,$4.63,$4.31,$1.77,$4.63,$4.63,$4.68,$205.00,$3.33,$8.86,$162.36,$164.00,$4.60,$4.99,$3.17,$3.49,$3.17
30700082,EAP,CPT® 81003,,Urinalysis,$168.00,$1.25,$168.00,$4.01,$3.28,$3.06,$1.25,$3.28,$3.28,$3.33,$168.00,$2.36,$6.28,$133.06,$134.40,$3.26,$3.55,$2.25,$2.48,$2.25
30700083,EAP,CPT® 81003,,"Urinalysis, Top",$168.00,$1.25,$168.00,$4.01,$3.28,$3.06,$1.25,$3.28,$3.28,$3.33,$168.00,$2.36,$6.28,$133.06,$134.40,$3.26,$3.55,$2.25,$2.48,$2.25
30700084,EAP,CPT® 81025,,Pregnancy Test-urine,$35.00,$4.33,$35.00,$11.26,$9.24,$8.61,$4.33,$9.24,$9.24,$9.36,$35.00,$9.04,$17.68,$27.72,$28.00,$12.48,$9.97,$8.61,$6.98,$8.61
30700085,EAP,CPT® 81025,,"Preg Test,urine",$35.00,$4.33,$35.00,$11.26,$9.24,$8.61,$4.33,$9.24,$9.24,$9.36,$35.00,$9.04,$17.68,$27.72,$28.00,$12.48,$9.97,$8.61,$6.98,$8.61
30700086,EAP,CPT® 81050,,"Urine, Timed Collect",$125.00,$1.83,$125.00,$5.36,$4.37,$4.08,$1.83,$4.37,$4.37,$4.43,$125.00,$3.82,$8.38,$99.00,$100.00,$5.28,$4.72,$3.64,$3.30,$3.64
30700090,EAP,CPT® 81000,,"Urobilinogen, Qualitativ",$110.00,$2.03,$110.00,$5.65,$4.63,$4.31,$2.03,$4.63,$4.63,$4.68,$110.00,$4.22,$8.86,$87.12,$88.00,$5.83,$4.99,$4.02,$3.49,$4.02
30700091,EAP,CPT® 81001,,Urinalysis Comp,$205.00,$1.77,$205.00,$5.65,$4.63,$4.31,$1.77,$4.63,$4.63,$4.68,$205.00,$3.33,$8.86,$162.36,$164.00,$4.60,$4.99,$3.17,$3.49,$3.17
30700092,EAP,CPT® 81003,,Urinalysis-biochem,$168.00,$1.25,$168.00,$4.01,$3.28,$3.06,$1.25,$3.28,$3.28,$3.33,$168.00,$2.36,$6.28,$133.06,$134.40,$3.26,$3.55,$2.25,$2.48,$2.25
30700093,EAP,CPT® 81025,,Urine Pregnancy Test,$35.00,$4.33,$35.00,$11.26,$9.24,$8.61,$4.33,$9.24,$9.24,$9.36,$35.00,$9.04,$17.68,$27.72,$28.00,$12.48,$9.97,$8.61,$6.98,$8.61
30700094,EAP,CPT® 81000,,"Sugar, Clinitest",$110.00,$2.03,$110.00,$5.65,$4.63,$4.31,$2.03,$4.63,$4.63,$4.68,$110.00,$4.22,$8.86,$87.12,$88.00,$5.83,$4.99,$4.02,$3.49,$4.02
30700095,EAP,CPT® 81000,,"Bile, Urine",$110.00,$2.03,$110.00,$5.65,$4.63,$4.31,$2.03,$4.63,$4.63,$4.68,$110.00,$4.22,$8.86,$87.12,$88.00,$5.83,$4.99,$4.02,$3.49,$4.02
30700096,EAP,CPT® 81000,,Specific Gravity,$110.00,$2.03,$110.00,$5.65,$4.63,$4.31,$2.03,$4.63,$4.63,$4.68,$110.00,$4.22,$8.86,$87.12,$88.00,$5.83,$4.99,$4.02,$3.49,$4.02
30700097,EAP,CPT® 81000,,"Urobilinogen, Qualitativ",$110.00,$2.03,$110.00,$5.65,$4.63,$4.31,$2.03,$4.63,$4.63,$4.68,$110.00,$4.22,$8.86,$87.12,$88.00,$5.83,$4.99,$4.02,$3.49,$4.02
30700120,EAP,CPT® 81025,,Urine Pregnancy Test,$35.00,$4.33,$35.00,$11.26,$9.24,$8.61,$4.33,$9.24,$9.24,$9.36,$35.00,$9.04,$17.68,$27.72,$28.00,$12.48,$9.97,$8.61,$6.98,$8.61
30750027,EAP,CPT® 81005,,"Clinitest, Stool",$115.00,$0.00,$115.00,$0.00,$3.16,$0.00,$0.00,$3.16,$3.16,$0.00,$115.00,$0.00,$6.06,$91.08,$92.00,$0.00,$0.00,$0.00,$0.00,$0.00
30750028,EAP,CPT® 81005,,"Spec.gravity,refrac",$115.00,$0.00,$115.00,$0.00,$3.16,$0.00,$0.00,$3.16,$3.16,$0.00,$115.00,$0.00,$6.06,$91.08,$92.00,$0.00,$0.00,$0.00,$0.00,$0.00
30750029,EAP,CPT® 81005,,"Clinitest,urine",$115.00,$0.00,$115.00,$0.00,$3.16,$0.00,$0.00,$3.16,$3.16,$0.00,$115.00,$0.00,$6.06,$91.08,$92.00,$0.00,$0.00,$0.00,$0.00,$0.00
30750030,EAP,CPT® 81005,,"Protein, Ur-qual",$115.00,$0.00,$115.00,$0.00,$3.16,$0.00,$0.00,$3.16,$3.16,$0.00,$115.00,$0.00,$6.06,$91.08,$92.00,$0.00,$0.00,$0.00,$0.00,$0.00
30750031,EAP,CPT® 81005,,"Glucose, Ur-qual",$115.00,$0.00,$115.00,$0.00,$3.16,$0.00,$0.00,$3.16,$3.16,$0.00,$115.00,$0.00,$6.06,$91.08,$92.00,$0.00,$0.00,$0.00,$0.00,$0.00
30750032,EAP,CPT® 81005,,"Ketones,ur",$115.00,$0.00,$115.00,$0.00,$3.16,$0.00,$0.00,$3.16,$3.16,$0.00,$115.00,$0.00,$6.06,$91.08,$92.00,$0.00,$0.00,$0.00,$0.00,$0.00
30750033,EAP,CPT® 81005,,"Urobilinogen,ur-ql",$115.00,$0.00,$115.00,$0.00,$3.16,$0.00,$0.00,$3.16,$3.16,$0.00,$115.00,$0.00,$6.06,$91.08,$92.00,$0.00,$0.00,$0.00,$0.00,$0.00
30750034,EAP,CPT® 81005,,"Glucose, Ur-qual",$115.00,$0.00,$115.00,$0.00,$3.16,$0.00,$0.00,$3.16,$3.16,$0.00,$115.00,$0.00,$6.06,$91.08,$92.00,$0.00,$0.00,$0.00,$0.00,$0.00
30750035,EAP,CPT® 81005,,"Protein, Ur-qual",$115.00,$0.00,$115.00,$0.00,$3.16,$0.00,$0.00,$3.16,$3.16,$0.00,$115.00,$0.00,$6.06,$91.08,$92.00,$0.00,$0.00,$0.00,$0.00,$0.00
30750036,EAP,CPT® 81005,,"Glucose, Ur-qual",$115.00,$0.00,$115.00,$0.00,$3.16,$0.00,$0.00,$3.16,$3.16,$0.00,$115.00,$0.00,$6.06,$91.08,$92.00,$0.00,$0.00,$0.00,$0.00,$0.00
30750037,EAP,CPT® 81005,,"Ketones,ur",$115.00,$0.00,$115.00,$0.00,$3.16,$0.00,$0.00,$3.16,$3.16,$0.00,$115.00,$0.00,$6.06,$91.08,$92.00,$0.00,$0.00,$0.00,$0.00,$0.00
30750080,EAP,CPT® 81000,,"Ph, Urine-dipstick",$110.00,$2.03,$110.00,$5.65,$4.63,$4.31,$2.03,$4.63,$4.63,$4.68,$110.00,$4.22,$8.86,$87.12,$88.00,$5.83,$4.99,$4.02,$3.49,$4.02
30900004,EAP,CPT® 89060,,"Crystals,fluid",$150.00,$4.01,$150.00,$12.75,$10.44,$9.74,$4.01,$10.44,$10.44,$10.56,$150.00,$7.70,$19.98,$118.80,$120.00,$10.63,$11.26,$7.33,$7.88,$7.33
30900005,EAP,CPT® 89190,,Nasal Smear For Eos,$126.00,$0.00,$126.00,$0.00,$6.93,$0.00,$0.00,$6.93,$6.93,$0.00,$126.00,$0.00,$13.28,$99.79,$100.80,$0.00,$0.00,$0.00,$0.00,$0.00
30900006,EAP,CPT® 89320,,Semen Examination,$75.00,$0.00,$75.00,$0.00,$8.42,$0.00,$0.00,$8.42,$8.42,$0.00,$75.00,$0.00,$16.12,$59.40,$60.00,$0.00,$0.00,$0.00,$0.00,$0.00
30900009,EAP,CPT® 81511,,Mss Sequential Screen-2 (so),$498.00,$77.29,$498.00,$399.00,$355.42,$88.64,$77.29,$355.42,$355.42,$144.26,$498.00,$161.18,$249.00,$394.42,$398.40,$222.58,$153.71,$153.50,$107.60,$153.50
30900011,EAP,CPT® 84163,,Pregnancy Associated Plasma Protein (so),$180.00,$7.07,$180.00,$11.45,$9.37,$7.33,$8.42,$9.37,$9.37,$9.48,$180.00,$15.80,$17.94,$142.56,$144.00,$21.82,$10.10,$15.05,$7.07,$15.05
30900012,EAP,CPT® 84702,,"Hcg,quantitative",$32.00,$7.07,$32.00,$11.45,$9.37,$7.33,$8.42,$9.37,$9.37,$9.48,$32.00,$15.80,$17.94,$25.34,$25.60,$21.82,$10.10,$15.05,$7.07,$15.05
30900013,EAP,CPT® 86021,,C-anca Titer (so),$34.00,$8.42,$34.00,$26.84,$21.98,$20.49,$8.42,$21.98,$21.98,$22.24,$34.00,$15.80,$34.00,$26.93,$27.20,$21.82,$23.70,$15.05,$16.59,$15.05
30900014,EAP,CPT® 86021,,P-anca Titer (so),$34.00,$8.42,$34.00,$26.84,$21.98,$20.49,$8.42,$21.98,$21.98,$22.24,$34.00,$15.80,$34.00,$26.93,$27.20,$21.82,$23.70,$15.05,$16.59,$15.05
30900015,EAP,CPT® 86021,,Atypical P-anca Titer (so),$80.00,$8.42,$80.00,$26.84,$21.98,$20.49,$8.42,$21.98,$21.98,$22.24,$80.00,$15.80,$42.06,$63.36,$64.00,$21.82,$23.70,$15.05,$16.59,$15.05
30900020,EAP,CPT® 86638,,Q Fever Igg Phase I Titer (so),$43.00,$0.00,$43.00,$0.00,$17.70,$0.00,$0.00,$17.70,$17.70,$0.00,$43.00,$0.00,$33.88,$34.06,$34.40,$0.00,$0.00,$0.00,$0.00,$0.00
30900021,EAP,CPT® 86638,,Q Fever Igg Phase Ii Titer (so),$43.00,$0.00,$43.00,$0.00,$17.70,$0.00,$0.00,$17.70,$17.70,$0.00,$43.00,$0.00,$33.88,$34.06,$34.40,$0.00,$0.00,$0.00,$0.00,$0.00
30900022,EAP,CPT® 86638,,Q Fever Igg Phase I Titer (so),$43.00,$0.00,$43.00,$0.00,$17.70,$0.00,$0.00,$17.70,$17.70,$0.00,$43.00,$0.00,$33.88,$34.06,$34.40,$0.00,$0.00,$0.00,$0.00,$0.00
30900023,EAP,CPT® 86638,,Q Fever Igg Phase Ii (so),$43.00,$0.00,$43.00,$0.00,$17.70,$0.00,$0.00,$17.70,$17.70,$0.00,$43.00,$0.00,$33.88,$34.06,$34.40,$0.00,$0.00,$0.00,$0.00,$0.00
30900024,EAP,CPT® 86611,,B.henselae Igg Titer (so),$63.00,$5.69,$63.00,$18.15,$14.85,$11.13,$5.69,$14.85,$14.85,$15.04,$63.00,$10.69,$28.44,$49.90,$50.40,$14.76,$16.02,$10.18,$11.21,$10.18
30900025,EAP,CPT® 86611,,B.henselae Igm Titer (so),$63.00,$5.69,$63.00,$18.15,$14.85,$11.13,$5.69,$14.85,$14.85,$15.04,$63.00,$10.69,$28.44,$49.90,$50.40,$14.76,$16.02,$10.18,$11.21,$10.18
30900026,EAP,CPT® 86611,,B.quintana Igg Titer (so),$63.00,$5.69,$63.00,$18.15,$14.85,$11.13,$5.69,$14.85,$14.85,$15.04,$63.00,$10.69,$28.44,$49.90,$50.40,$14.76,$16.02,$10.18,$11.21,$10.18
30900027,EAP,CPT® 86611,,B.quintana Igm Titer (so),$63.00,$5.69,$63.00,$18.15,$14.85,$11.13,$5.69,$14.85,$14.85,$15.04,$63.00,$10.69,$28.44,$49.90,$50.40,$14.76,$16.02,$10.18,$11.21,$10.18
31000001,EAP,CPT® 88271,,Cytogenetics Dna Probe,$384.00,$11.98,$384.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$384.00,$22.49,$59.86,$304.13,$307.20,$31.06,$33.72,$21.42,$23.60,$21.42
31000002,EAP,CPT® 88305,,Level Iv Surgical Path Exam,$771.00,$32.05,$771.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$771.00,$49.62,$140.98,$610.63,$616.80,$68.93,$82.47,$32.05,$57.73,$47.25
31000004,EAP,CPT® 88331,,Path Consult Inraop 1 Bloc,$160.00,$29.37,$160.00,$128.36,$29.37,$137.60,$49.90,$29.37,$29.37,$87.82,$160.00,$143.92,$57.46,$126.72,$128.00,$160.00,$93.58,$34.94,$65.50,$137.07
31000006,EAP,CPT® 81314,,PDGFRA MUTATION ANALYSIS (QUEST),$990.00,$0.00,$990.00,$0.00,$329.51,$0.00,$0.00,$329.51,$329.51,$0.00,$990.00,$0.00,$495.00,$784.08,$792.00,$0.00,$0.00,$0.00,$0.00,$0.00
31000007,EAP,CPT® 88275,,Cytogenetics 100-300,$447.00,$25.78,$447.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$447.00,$53.75,$112.22,$354.02,$357.60,$74.23,$63.21,$51.19,$44.25,$51.19
31000010,EAP,CPT® 88120,,"Cytopath In Situ Hybridization,urinary Tract Spec W/mors",$930.00,$0.00,$930.00,$0.00,$406.29,$0.00,$0.00,$406.29,$406.29,$0.00,$930.00,$0.00,$465.00,$736.56,$744.00,$0.00,$0.00,$0.00,$0.00,$0.00
31000011,EAP,CPT® 88271,,Cytogenetics Dna Probe,$62.00,$11.98,$62.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$62.00,$22.49,$59.86,$49.10,$49.60,$31.06,$33.72,$21.42,$23.60,$21.42
31000013,EAP,CPT® 88230,,Tissue Culture For Non-neoplastic Disorders;lymphocyte,$384.00,$65.17,$384.00,$207.69,$170.10,$158.54,$65.17,$170.10,$170.10,$172.08,$384.00,$122.31,$325.54,$304.13,$307.20,$168.91,$183.36,$116.49,$128.35,$116.49
31000015,EAP,CPT® 88271,,Cytogenetics Dna Probe,$287.00,$11.98,$287.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$287.00,$22.49,$59.86,$227.30,$229.60,$31.06,$33.72,$21.42,$23.60,$21.42
31000016,EAP,CPT® 88275,,Cytogenetics 100-300,$349.00,$25.78,$349.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$349.00,$53.75,$112.22,$276.41,$279.20,$74.23,$63.21,$51.19,$44.25,$51.19
31000018,EAP,CPT® 88360,,Er/pr Her2 W/reflex To Her2 Fish (so),$727.00,$65.32,$727.00,$184.86,$65.70,$137.60,$65.32,$65.70,$65.70,$114.71,$727.00,$143.92,$121.34,$575.78,$581.60,$199.96,$122.23,$83.20,$85.56,$137.07
31000019,EAP,CPT® 88368,,"Fish, Her-2/neu (so)",$737.00,$65.14,$737.00,$154.04,$145.54,$271.76,$65.14,$145.54,$145.54,$199.20,$737.00,$284.24,$207.74,$583.70,$589.60,$394.92,$212.25,$90.40,$148.57,$270.71
31000020,EAP,CPT® 88271,,Molecular Cytogenetics: Dna Probe (fish) (so) Pdgfrb,$511.00,$11.98,$511.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$511.00,$22.49,$59.86,$404.71,$408.80,$31.06,$33.72,$21.42,$23.60,$21.42
31000021,EAP,CPT® 88275,,Interphase In Situ Hybridization(100-300) Cells (so) Pdgfrb,$256.00,$25.78,$256.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$256.00,$53.75,$112.22,$202.75,$204.80,$74.23,$63.21,$51.19,$44.25,$51.19
31000022,EAP,CPT® 88342,,"Lynch Syndrome Tumor Panel, Ihc  (so)",$707.00,$54.62,$707.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$707.00,$143.92,$106.46,$559.94,$565.60,$199.96,$89.59,$70.23,$62.72,$137.07
31000025,EAP,CPT® 88368,,"Fish, Mdm2 Gene Amphlification (arup)","$1,325.00",$65.14,"$1,325.00",$154.04,$145.54,$271.76,$65.14,$145.54,$145.54,$199.20,"$1,325.00",$284.24,$207.74,"$1,049.40","$1,060.00",$394.92,$212.25,$90.40,$148.57,$270.71
31000026,EAP,CPT® 88271,,Molecular Cytogenetics: Dna Probe (fish) (so) Mn,$298.00,$11.98,$298.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$298.00,$22.49,$59.86,$236.02,$238.40,$31.06,$33.72,$21.42,$23.60,$21.42
31000027,EAP,CPT® 88275,,Interphase In Situ Hybridization(100-300) Cells (so) Mn,$127.00,$25.78,$127.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$127.00,$53.75,$112.22,$100.58,$101.60,$74.23,$63.21,$51.19,$44.25,$51.19
31000028,EAP,CPT® 88271,,"Fish, Hes/leukemia, 4q12 Rea(fip1l-pdgfra",$665.00,$11.98,$665.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$665.00,$22.49,$59.86,$526.68,$532.00,$31.06,$33.72,$21.42,$23.60,$21.42
31000029,EAP,CPT® 88275,,Interphase In Situ Hybridization(100-300) Cells (so) Hes,$221.00,$25.78,$221.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$221.00,$53.75,$112.22,$175.03,$176.80,$74.23,$63.21,$51.19,$44.25,$51.19
31000030,EAP,CPT® 88271,,Molecular Cytogenetics: Dna Probe (fish) (so) Fg,$499.00,$11.98,$499.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$499.00,$22.49,$59.86,$395.21,$399.20,$31.06,$33.72,$21.42,$23.60,$21.42
31000031,EAP,CPT® 88275,,Interphase In Situ Hybridization(100-300) Cells (so) Fg,$248.00,$25.78,$248.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$248.00,$53.75,$112.22,$196.42,$198.40,$74.23,$63.21,$51.19,$44.25,$51.19
31000032,EAP,CPT® 88271,,Molecular Cytogenetics: Dna Probe (fish) (so) Ne,$714.00,$11.98,$714.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$714.00,$22.49,$59.86,$565.49,$571.20,$31.06,$33.72,$21.42,$23.60,$21.42
31000033,EAP,CPT® 88275,,Interphase In Situ Hybridization(100-300) Cells (so) Ne,$142.00,$25.78,$142.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$142.00,$53.75,$112.22,$112.46,$113.60,$74.23,$63.21,$51.19,$44.25,$51.19
31000034,EAP,CPT® 88271,,Molecular Cytogenetics: Dna Probe (fish) (so) Eto,$563.00,$11.98,$563.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$563.00,$22.49,$59.86,$445.90,$450.40,$31.06,$33.72,$21.42,$23.60,$21.42
31000035,EAP,CPT® 88275,,Interphase In Situ Hybridization(100-300) Cells (so) Eto,$282.00,$25.78,$282.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$282.00,$53.75,$112.22,$223.34,$225.60,$74.23,$63.21,$51.19,$44.25,$51.19
31000036,EAP,CPT® 88271,,Molecular Cytogenetics: Dna Probe (fish) (so) Mll,$511.00,$11.98,$511.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$511.00,$22.49,$59.86,$404.71,$408.80,$31.06,$33.72,$21.42,$23.60,$21.42
31000037,EAP,CPT® 88275,,Interphase In Situ Hybridization(100-300) Cells (so) Mll,$256.00,$25.78,$256.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$256.00,$53.75,$112.22,$202.75,$204.80,$74.23,$63.21,$51.19,$44.25,$51.19
31000038,EAP,CPT® 88184,,Flow Cytometry; First Marker (so) Pcn,$303.00,$34.11,$303.00,$80.30,$79.23,$271.76,$34.11,$79.23,$79.23,$54.16,$303.00,$284.24,$133.74,$239.98,$242.40,$303.00,$57.71,$68.07,$40.40,$270.71
31000039,EAP,CPT® 88185,,Flow Cytometry;each Add Marker (so) Pcn,$233.00,$0.00,$233.00,$49.02,$47.05,$0.00,$12.52,$47.05,$47.05,$26.63,$233.00,$0.00,$71.72,$184.54,$186.40,$0.00,$28.37,$22.33,$19.86,$0.00
31000042,EAP,CPT® 81200,,Canavan Disease Mutation Analysis (so),$649.00,$0.00,$649.00,$0.00,$463.19,$0.00,$0.00,$463.19,$463.19,$0.00,$649.00,$0.00,$324.50,$514.01,$519.20,$0.00,$0.00,$0.00,$0.00,$0.00
31000043,EAP,CPT® 88235,,Tissue Culture For  Am-fld Or Cv-cells (so) Sc,$261.00,$82.38,$261.00,$261.00,$215.00,$200.40,$82.38,$215.00,$215.00,$217.53,$261.00,$157.82,$261.00,$206.71,$208.80,$217.94,$231.78,$150.30,$162.25,$150.30
31000045,EAP,CPT® 88271,,Molecular Cytogenetics: Dna Probe (fish) (so) Dup,$350.00,$11.98,$350.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$350.00,$22.49,$59.86,$277.20,$280.00,$31.06,$33.72,$21.42,$23.60,$21.42
31000046,EAP,CPT® 88275,,Interphase In Situ Hybridization(100-300) Cells (so) Dup,$350.00,$25.78,$350.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$350.00,$53.75,$112.22,$277.20,$280.00,$74.23,$63.21,$51.19,$44.25,$51.19
31000051,EAP,CPT® 88271,,Molecular Cytogenetics: Dna Probe (fish) (so) Mm,$499.00,$11.98,$499.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$499.00,$22.49,$59.86,$395.21,$399.20,$31.06,$33.72,$21.42,$23.60,$21.42
31000052,EAP,CPT® 88275,,Interphase In Situ Hybridization(100-300) Cells (so) Mm,$248.00,$25.78,$248.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$248.00,$53.75,$112.22,$196.42,$198.40,$74.23,$63.21,$51.19,$44.25,$51.19
31000055,EAP,CPT® 81401,,"Eml4 Alk Gene Fusion, Pcr (so)","$1,177.00",$56.09,"$1,177.00",$56.09,$840.02,$209.51,$68.97,$840.02,$840.02,$131.58,"$1,177.00",$143.85,$588.50,$932.18,$941.60,$198.65,$140.20,$137.00,$98.14,$137.00
31000060,EAP,CPT® 88271,,Molecular Cytogenetics: Dna Probe (fish) (so)rara,$751.00,$11.98,$751.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$751.00,$22.49,$59.86,$594.79,$600.80,$31.06,$33.72,$21.42,$23.60,$21.42
31000061,EAP,CPT® 88275,,Interphase In Situ Hybridization(100-300) Cells (so) Rara,$374.00,$25.78,$374.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$374.00,$53.75,$112.22,$296.21,$299.20,$74.23,$63.21,$51.19,$44.25,$51.19
31000062,EAP,CPT® 88271,,Molecular Cytogenetics: Dna Probe (fish) (so) Ros1,$682.00,$11.98,$682.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$682.00,$22.49,$59.86,$540.14,$545.60,$31.06,$33.72,$21.42,$23.60,$21.42
31000063,EAP,CPT® 88274,,Interphase In Situ Hybridization (25-99 Cells (so) Ros1,$342.00,$21.34,$342.00,$62.06,$50.82,$47.37,$21.34,$50.82,$50.82,$51.42,$342.00,$44.50,$97.26,$270.86,$273.60,$61.45,$54.79,$42.38,$38.35,$42.38
31000066,EAP,CPT® 88274,,Fanconi Anemia Tissue Cx (so),$384.00,$21.34,$384.00,$62.06,$50.82,$47.37,$21.34,$50.82,$50.82,$51.42,$384.00,$44.50,$97.26,$304.13,$307.20,$61.45,$54.79,$42.38,$38.35,$42.38
31000067,EAP,CPT® 88271,,Fanconi Anemia Chrom Anal (so),$241.00,$11.98,$241.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$241.00,$22.49,$59.86,$190.87,$192.80,$31.06,$33.72,$21.42,$23.60,$21.42
31000068,EAP,CPT® 88271,,Fish Sry/x Centromere Dna (so),$241.00,$11.98,$241.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$241.00,$22.49,$59.86,$190.87,$192.80,$31.06,$33.72,$21.42,$23.60,$21.42
31000069,EAP,CPT® 88273,,Fish Sry/x Centromere Ish (so),$392.00,$0.00,$392.00,$0.00,$46.91,$0.00,$0.00,$46.91,$46.91,$0.00,$392.00,$0.00,$89.78,$310.46,$313.60,$0.00,$0.00,$0.00,$0.00,$0.00
31000070,EAP,CPT® 88291,,Fish Sry/x Centro Interp (so),$222.00,$0.00,$222.00,$0.00,$158.44,$0.00,$0.00,$158.44,$158.44,$0.00,$222.00,$0.00,$53.96,$175.82,$177.60,$0.00,$0.00,$0.00,$0.00,$0.00
31000071,EAP,CPT® 88274,,Fish Conception Prod Ish (so),$384.00,$21.34,$384.00,$62.06,$50.82,$47.37,$21.34,$50.82,$50.82,$51.42,$384.00,$44.50,$97.26,$304.13,$307.20,$61.45,$54.79,$42.38,$38.35,$42.38
31000072,EAP,CPT® 88271,,Fish Conception Prod Dna (so),$241.00,$11.98,$241.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$241.00,$22.49,$59.86,$190.87,$192.80,$31.06,$33.72,$21.42,$23.60,$21.42
31000099,EAP,CPT® 81275,,COLORECTAL CAN. MUT. PANEL KRA SO,"$1,616.00",$97.29,"$1,616.00",$258.05,$197.48,$196.99,$97.29,$197.48,$197.48,$220.85,"$1,616.00",$202.91,$808.00,"$1,279.87","$1,292.80",$280.21,$235.32,$193.25,$164.72,$193.25
31000100,EAP,CPT® 81210,,COLORECTAL CAN. MUT. PANEL BRA SO,"$1,616.00",$86.22,"$1,616.00",$234.22,$179.25,$178.80,$88.31,$179.25,$179.25,$115.59,"$1,616.00",$184.17,$808.00,"$1,279.87","$1,292.80",$254.33,$123.17,$175.40,$86.22,$175.40
31000101,EAP,CPT® 88304,,Seminal Vesicle,$299.00,$20.69,$299.00,$54.15,$51.07,$47.44,$20.69,$51.07,$51.07,$35.46,$299.00,$49.62,$108.12,$236.81,$239.20,$68.93,$37.78,$29.89,$26.45,$47.25
31000102,EAP,CPT® 81382,,Hla Ii Typing 1 (so),$944.00,$0.00,$944.00,$0.00,$168.73,$0.00,$0.00,$168.73,$168.73,$0.00,$944.00,$0.00,$472.00,$747.65,$755.20,$0.00,$0.00,$0.00,$0.00,$0.00
31000103,EAP,CPT® 81379,,Hla I Typing Comp (so),"$2,634.00",$0.00,"$2,634.00",$0.00,$457.54,$0.00,$0.00,$457.54,$457.54,$0.00,"$2,634.00",$0.00,"$1,317.00","$2,086.13","$2,107.20",$0.00,$0.00,$0.00,$0.00,$0.00
31000118,EAP,CPT® 81331,,Congen Hyoptonia Ube3a (so),$593.00,$0.00,$593.00,$0.00,$423.22,$0.00,$0.00,$423.22,$423.22,$0.00,$593.00,$0.00,$296.50,$469.66,$474.40,$0.00,$0.00,$0.00,$0.00,$0.00
31000119,EAP,CPT® 81400,,Congen Hypotonia L1 (so),$850.00,$0.00,$850.00,$0.00,$606.65,$0.00,$0.00,$606.65,$606.65,$0.00,$850.00,$0.00,$425.00,$673.20,$680.00,$0.00,$0.00,$0.00,$0.00,$0.00
31000120,EAP,CPT® 81404,,Congen Hypotonia L5 (so),"$1,736.00",$138.36,"$1,736.00",$399.00,"$1,238.98",$309.01,$138.36,"$1,238.98","$1,238.98",$286.64,"$1,736.00",$288.57,$868.00,"$1,374.91","$1,388.80",$398.50,$305.42,$274.83,$213.79,$274.83
31000121,EAP,CPT® 88365,,Insitu Hybrid Fish (so),$579.00,$77.27,$579.00,$233.88,$98.25,$137.60,$90.54,$98.25,$98.25,$103.59,$579.00,$143.92,$156.90,$458.57,$463.20,$199.96,$110.38,$137.95,$77.27,$137.07
31000122,EAP,CPT® 88381,,Mgmt Microdissection Pcr (so),$506.00,$0.00,$506.00,$160.12,$155.30,$0.00,$78.74,$155.30,$155.30,$197.25,$506.00,$0.00,$253.00,$400.75,$404.80,$0.00,$210.18,$156.67,$147.12,$0.00
31000123,EAP,CPT® 81287,,Mgmt Gene Analysis (so),$584.00,$0.00,$584.00,$0.00,$416.80,$0.00,$0.00,$416.80,$416.80,$0.00,$584.00,$0.00,$292.00,$462.53,$467.20,$0.00,$0.00,$0.00,$0.00,$0.00
31000124,EAP,CPT® 81479,,Calr Mutation Analysis (so),$942.00,$0.00,"$1,114.12",$0.00,$672.31,$167.68,$162.30,$672.31,$672.31,"$1,045.61",$942.00,$0.00,$471.00,$746.06,$753.60,$565.20,"$1,114.12",$0.00,$779.89,$0.00
31000126,EAP,CPT® 81406,,CADASIL,"$4,326.00",$0.00,"$4,326.00",$0.00,"$3,087.47",$0.00,$0.00,"$3,087.47","$3,087.47",$0.00,"$4,326.00",$0.00,"$2,163.00","$3,426.19","$3,460.80",$0.00,$0.00,$0.00,$0.00,$0.00
31000135,EAP,CPT® 81218,,Aml Prognostic Cebpa (so),$523.00,$0.00,$523.00,$0.00,$329.51,$0.00,$0.00,$329.51,$329.51,$0.00,$523.00,$0.00,$261.50,$414.22,$418.40,$0.00,$0.00,$0.00,$0.00,$0.00
31000136,EAP,CPT® 81245,,Aml Prognostic Flt3 (so),$376.00,$0.00,$376.00,$0.00,$165.92,$0.00,$0.00,$165.92,$165.92,$0.00,$376.00,$0.00,$188.00,$297.79,$300.80,$0.00,$0.00,$0.00,$0.00,$0.00
31000137,EAP,CPT® 81246,,Aml Prognostic Flt3 Anal (so),$272.00,$0.00,$272.00,$0.00,$194.13,$0.00,$0.00,$194.13,$194.13,$0.00,$272.00,$0.00,$136.00,$215.42,$217.60,$0.00,$0.00,$0.00,$0.00,$0.00
31000138,EAP,CPT® 81310,,Aml Prognostic Npm1 (so),$699.00,$0.00,$699.00,$0.00,$247.14,$0.00,$0.00,$247.14,$247.14,$0.00,$699.00,$0.00,$349.50,$553.61,$559.20,$0.00,$0.00,$0.00,$0.00,$0.00
31000139,EAP,CPT® 81450,,Myeloid Neo Mutation (so),"$2,685.00",$0.00,"$2,685.00",$0.00,"$1,916.28",$0.00,$382.39,"$1,916.28","$1,916.28",$0.00,"$2,685.00",$0.00,"$1,342.50","$2,126.52","$2,148.00",$0.00,$420.20,$0.00,$0.00,$0.00
31000145,EAP,CPT® 81275,,"KRAS GENE ANALYSIS; VARIANTS IN EXON 2 (EG, CODONS 12 & 13)",$457.00,$97.29,$457.00,$258.05,$197.48,$196.99,$97.29,$197.48,$197.48,$220.85,$457.00,$202.91,$228.50,$361.94,$365.60,$280.21,$235.32,$193.25,$164.72,$193.25
31000146,EAP,CPT® 81276,,"KRAS GENE ANALYSIS; ADD'L VARIANT(S) (EG, CODON 61, CODON 146)",$457.00,$0.00,$457.00,$0.00,$197.19,$0.00,$0.00,$197.19,$197.19,$0.00,$457.00,$0.00,$228.50,$361.94,$365.60,$0.00,$0.00,$0.00,$0.00,$0.00
31000147,EAP,CPT® 81210,,Thyroseq - Braf Analysis (so),$301.00,$86.22,$301.00,$234.22,$179.25,$178.80,$88.31,$179.25,$179.25,$115.59,$301.00,$184.17,$150.50,$238.39,$240.80,$254.33,$123.17,$175.40,$86.22,$175.40
31000148,EAP,CPT® 81275,,Thyroseq - Kras Analysis (so),$331.00,$97.29,$331.00,$258.05,$197.48,$196.99,$97.29,$197.48,$197.48,$220.85,$331.00,$202.91,$165.50,$262.15,$264.80,$280.21,$235.32,$193.25,$164.72,$193.25
31000149,EAP,CPT® 81322,,Thyroseq - Pten Analysis (so),$90.00,$23.94,$123.17,$76.31,$58.40,$58.25,$23.94,$58.40,$58.40,$115.59,$90.00,$48.93,$45.00,$71.28,$72.00,$67.57,$123.17,$46.60,$86.22,$46.60
31000150,EAP,CPT® 81401,,Thryoseq - Mopath Level 2 (so),$235.00,$41.83,$235.00,$56.09,$167.72,$41.83,$68.97,$167.72,$167.72,$131.58,$235.00,$143.85,$117.50,$186.12,$188.00,$198.65,$140.20,$137.00,$98.14,$137.00
31000151,EAP,CPT® 81403,,Thryoseq - Mopath Level 4 (so),$318.00,$56.60,$318.00,$228.00,$226.96,$56.60,$93.24,$226.96,$226.96,$220.85,$318.00,$194.46,$159.00,$251.86,$254.40,$268.54,$235.32,$185.20,$164.72,$185.20
31000152,EAP,CPT® 81404,,Thryoseq - Mopath Level 5 (so),$471.00,$83.84,$471.00,$399.00,$336.15,$83.84,$138.36,$336.15,$336.15,$286.64,$471.00,$288.57,$235.50,$373.03,$376.80,$398.50,$305.42,$274.83,$213.79,$274.83
31000153,EAP,CPT® 81405,,Thryoseq - Mopath Level 6 (so),$517.00,$92.03,$517.00,$399.00,$368.98,$92.03,$151.72,$368.98,$368.98,$422.91,$517.00,$316.42,$258.50,$409.46,$413.60,$436.96,$450.62,$301.35,$315.43,$301.35
31000154,EAP,CPT® 81479,,Thryoseq - Unlisted Mopath (so),$2.00,$0.00,"$1,114.12",$0.00,$1.43,$0.36,$0.34,$1.43,$1.43,"$1,045.61",$2.00,$0.00,$1.00,$1.58,$1.60,$1.20,"$1,114.12",$0.00,$779.89,$0.00
31000155,EAP,CPT® 81219,,JAK2 R/X CALR (SO),$493.00,$0.00,$493.00,$0.00,$165.68,$0.00,$0.00,$165.68,$165.68,$0.00,$493.00,$0.00,$246.50,$390.46,$394.40,$0.00,$0.00,$0.00,$0.00,$0.00
31000156,EAP,CPT® 81270,,Jak2 V617f (so),$493.00,$51.27,$493.00,$163.41,$125.06,$124.75,$51.27,$125.06,$125.06,$84.58,$493.00,$96.24,$246.50,$390.46,$394.40,$132.91,$90.12,$91.66,$63.08,$91.66
31000157,EAP,CPT® 81479,,JAK2 R/X-CSF3R (SO),$493.00,$0.00,"$1,114.12",$0.00,$351.85,$87.75,$84.94,$351.85,$351.85,"$1,045.61",$493.00,$0.00,$246.50,$390.46,$394.40,$295.80,"$1,114.12",$0.00,$779.89,$0.00
31000158,EAP,CPT® 81402,,JAK2 R/X-MPL (SO),$493.00,$0.00,$493.00,$0.00,$351.85,$0.00,$0.00,$351.85,$351.85,$0.00,$493.00,$0.00,$246.50,$390.46,$394.40,$0.00,$0.00,$0.00,$0.00,$0.00
31000159,EAP,CPT® 81403,,JAK2 R/X-EXON12 (SO),$493.00,$87.75,$493.00,$228.00,$351.85,$87.75,$93.24,$351.85,$351.85,$220.85,$493.00,$194.46,$246.50,$390.46,$394.40,$268.54,$235.32,$185.20,$164.72,$185.20
31000160,EAP,CPT® 81311,,Nras Gene Analysis Variants Exon 2&3 (so),$457.00,$0.00,$457.00,$0.00,$295.79,$0.00,$0.00,$295.79,$295.79,$0.00,$457.00,$0.00,$228.50,$361.94,$365.60,$0.00,$0.00,$0.00,$0.00,$0.00
31000161,EAP,CPT® 81403,,Hras Gene Analysis (so),$457.00,$81.35,$457.00,$228.00,$326.16,$81.35,$93.24,$326.16,$326.16,$220.85,$457.00,$194.46,$228.50,$361.94,$365.60,$268.54,$235.32,$185.20,$164.72,$185.20
31000162,EAP,CPT® 81450,,"Leukovantage, Myloproliferative Neoplasm (so)","$4,217.00",$0.00,"$4,217.00",$0.00,"$3,009.67",$0.00,$382.39,"$3,009.67","$3,009.67",$0.00,"$4,217.00",$0.00,"$2,108.50","$3,339.86","$3,373.60",$0.00,$659.96,$0.00,$0.00,$0.00
31000163,EAP,CPT® 81450,,Leukovantage Acute Myeloid Leukemia (so),"$4,445.00",$0.00,"$4,445.00",$0.00,"$3,172.40",$0.00,$382.39,"$3,172.40","$3,172.40",$0.00,"$4,445.00",$0.00,"$2,222.50","$3,520.44","$3,556.00",$0.00,$695.64,$0.00,$0.00,$0.00
31000164,EAP,CPT® 81450,,Leukovantage Myelodysplastic Syndrome (so),"$4,371.00",$0.00,"$4,371.00",$0.00,"$3,119.58",$0.00,$382.39,"$3,119.58","$3,119.58",$0.00,"$4,371.00",$0.00,"$2,185.50","$3,461.83","$3,496.80",$0.00,$684.06,$0.00,$0.00,$0.00
31000165,EAP,CPT® 81270,,Jak2 V617f Mutation Analysis (so),$520.00,$51.27,$520.00,$163.41,$125.06,$124.75,$51.27,$125.06,$125.06,$84.58,$520.00,$96.24,$260.00,$411.84,$416.00,$132.91,$90.12,$91.66,$63.08,$91.66
31000170,EAP,CPT® 88360,,"Pd-l1 Lung (pembrolizumab), Ihc (so)",$850.00,$65.32,$850.00,$184.86,$65.70,$137.60,$65.32,$65.70,$65.70,$114.71,$850.00,$143.92,$121.34,$673.20,$680.00,$199.96,$122.23,$83.20,$85.56,$137.07
31000171,EAP,CPT® 88360,,"Pd-l1 Lung (nivolumab), Ihc (so)",$850.00,$65.32,$850.00,$184.86,$65.70,$137.60,$65.32,$65.70,$65.70,$114.71,$850.00,$143.92,$121.34,$673.20,$680.00,$199.96,$122.23,$83.20,$85.56,$137.07
31000172,EAP,CPT® 88360,,"Pd-l1 Lung (atezolizumab), Ihc (so)",$850.00,$65.32,$850.00,$184.86,$65.70,$137.60,$65.32,$65.70,$65.70,$114.71,$850.00,$143.92,$121.34,$673.20,$680.00,$199.96,$122.23,$83.20,$85.56,$137.07
31000173,EAP,CPT® 88360,,"Pd-l1 Bladder (atezolizumab), Ihc (so)",$850.00,$65.32,$850.00,$184.86,$65.70,$137.60,$65.32,$65.70,$65.70,$114.71,$850.00,$143.92,$121.34,$673.20,$680.00,$199.96,$122.23,$83.20,$85.56,$137.07
31000174,EAP,CPT® 88360,,"Pd-l1 Non-lung (pembrolizumab), Ihc (so)",$938.00,$65.32,$938.00,$184.86,$65.70,$137.60,$65.32,$65.70,$65.70,$114.71,$938.00,$143.92,$121.34,$742.90,$750.40,$199.96,$122.23,$83.20,$85.56,$137.07
31000175,EAP,CPT® 88184,,"Pd-l1 Monocyte Expression, Sle Flare, 1st Marker (so)",$325.00,$34.11,$325.00,$80.30,$79.23,$271.76,$34.11,$79.23,$79.23,$54.16,$325.00,$284.24,$133.74,$257.40,$260.00,$325.00,$57.71,$68.07,$40.40,$270.71
31000176,EAP,CPT® 88185,,"Pd-l1 Monocyte Expression, Sle Flare, Addl Marker (so)",$325.00,$0.00,$325.00,$49.02,$47.05,$0.00,$12.52,$47.05,$47.05,$26.63,$325.00,$0.00,$71.72,$257.40,$260.00,$0.00,$28.37,$22.33,$19.86,$0.00
31000180,EAP,HCPCS 0225U,,Nfct Ds Dna&rna 21 Targets Sars-cov-2 Amp Probe,$463.00,$0.00,$463.00,$0.00,$330.44,$0.00,$0.00,$330.44,$330.44,$0.00,$463.00,$0.00,$231.50,$366.70,$370.40,$0.00,$0.00,$0.00,$0.00,$0.00
31000185,EAP,CPT® 81225,,CYP2C19 GENOTYPE,$735.00,$0.00,$735.00,$0.00,$291.80,$0.00,$0.00,$291.80,$291.80,$0.00,$735.00,$0.00,$367.50,$582.12,$588.00,$0.00,$0.00,$0.00,$0.00,$0.00
31100001,EAP,CPT® 88289,,Add High Reso,$510.00,$0.00,$510.00,$0.00,$50.28,$0.00,$0.00,$50.28,$50.28,$0.00,$510.00,$0.00,$96.22,$403.92,$408.00,$0.00,$0.00,$0.00,$0.00,$0.00
31100002,EAP,CPT® 88283,,Addition Band Charge,$504.00,$0.00,$504.00,$0.00,$52.06,$0.00,$0.00,$52.06,$52.06,$0.00,$504.00,$0.00,$99.64,$399.17,$403.20,$0.00,$0.00,$0.00,$0.00,$0.00
31100003,EAP,CPT® 88285,,Addition Cell Charge,$270.00,$0.00,$270.00,$0.00,$27.74,$0.00,$0.00,$27.74,$27.74,$0.00,$270.00,$0.00,$53.08,$213.84,$216.00,$0.00,$0.00,$0.00,$0.00,$0.00
31100004,EAP,CPT® 88280,,Addition Karyo Charge,$300.00,$16.85,$300.00,$44.73,$36.64,$34.15,$16.85,$36.64,$36.64,$37.08,$300.00,$35.14,$70.14,$237.60,$240.00,$48.53,$39.50,$33.47,$27.65,$33.47
31100005,EAP,CPT® 88267,,Ca - 15 Cells Charge,"$2,058.00",$100.57,"$2,058.00",$320.50,$262.47,$244.64,$100.57,$262.47,$262.47,$265.55,"$2,058.00",$198.00,$502.34,"$1,629.94","$1,646.40",$273.43,$282.94,$188.57,$198.06,$188.57
31100006,EAP,CPT® 88248,,Ca - Fragile X Charge,"$2,643.00",$0.00,"$2,643.00",$0.00,$252.84,$0.00,$0.00,$252.84,$252.84,$0.00,"$2,643.00",$0.00,$483.92,"$2,093.26","$2,114.40",$0.00,$0.00,$0.00,$0.00,$0.00
31100007,EAP,CPT® 88264,,Cell Analysis Chrg,"$1,401.00",$72.80,"$1,401.00",$222.21,$181.98,$169.62,$72.80,$181.98,$181.98,$184.12,"$1,401.00",$151.84,$348.28,"$1,109.59","$1,120.80",$209.68,$196.18,$144.61,$137.33,$144.61
31100008,EAP,CPT® 88262,,Cell Cnt/karyo Typ,"$1,905.00",$69.72,"$1,905.00",$222.21,$181.98,$169.62,$69.72,$181.98,$181.98,$184.12,"$1,905.00",$131.76,$348.28,"$1,508.76","$1,524.00",$181.96,$196.18,$125.49,$137.33,$125.49
31100009,EAP,CPT® 88164,,"Cytology, Female Gen",$64.00,$0.00,$64.00,$0.00,$15.42,$0.00,$0.00,$15.42,$15.42,$0.00,$64.00,$0.00,$29.52,$50.69,$51.20,$0.00,$0.00,$0.00,$0.00,$0.00
31100010,EAP,CPT® 88142,,"Cytology, Gyn Lbp",$291.00,$11.33,$291.00,$36.12,$29.58,$26.74,$11.33,$29.58,$29.58,$29.94,$291.00,$21.27,$56.62,$230.47,$232.80,$29.38,$31.90,$20.26,$22.33,$20.26
31100011,EAP,CPT® 88104,,"Cytology,pulmonary",$353.00,$31.93,$353.00,$98.04,$33.52,$32.06,$35.92,$33.52,$33.52,$50.14,$353.00,$33.53,$60.16,$279.58,$282.40,$46.58,$53.42,$40.34,$37.40,$31.93
31100017,EAP,CPT® 88172,,Cytopathology Eval Of Fina,$178.00,$19.45,$178.00,$75.63,$22.55,$137.60,$29.03,$22.55,$22.55,$66.47,$178.00,$143.92,$44.44,$140.98,$142.40,$178.00,$70.82,$19.45,$49.57,$137.07
31100018,EAP,CPT® 88184,,Cytoplasmic Charge,$424.00,$34.11,$424.00,$80.30,$79.23,$271.76,$34.11,$79.23,$79.23,$54.16,$424.00,$284.24,$133.74,$335.81,$339.20,$394.92,$57.71,$68.07,$40.40,$270.71
31100019,EAP,CPT® 88172,,Fine Needle Aspiration,$178.00,$19.45,$178.00,$75.63,$22.55,$137.60,$29.03,$22.55,$22.55,$66.47,$178.00,$143.92,$44.44,$140.98,$142.40,$178.00,$70.82,$19.45,$49.57,$137.07
31100020,EAP,CPT® 88185,,Flow Cytometry - Addt'l Marker,$169.00,$0.00,$169.00,$49.02,$47.05,$0.00,$12.52,$47.05,$47.05,$26.63,$169.00,$0.00,$71.72,$133.85,$135.20,$0.00,$28.37,$22.33,$19.86,$0.00
31100021,EAP,CPT® 88188,,"Flow Cytometry, Interp.",$305.00,$0.00,$305.00,$0.00,$217.68,$0.00,$0.00,$217.68,$217.68,$0.00,$305.00,$0.00,$161.74,$241.56,$244.00,$0.00,$0.00,$0.00,$0.00,$0.00
31100022,EAP,CPT® 88161,,"Fna-breast,cyto",$207.00,$21.96,$207.00,$86.37,$29.49,$22.05,$33.93,$29.49,$29.49,$40.98,$207.00,$23.06,$66.78,$163.94,$165.60,$32.04,$43.67,$43.22,$30.57,$21.96
31100023,EAP,CPT® 88104,,"Fna-cell Blk,,misc",$353.00,$31.93,$353.00,$98.04,$33.52,$32.06,$35.92,$33.52,$33.52,$50.14,$353.00,$33.53,$60.16,$279.58,$282.40,$46.58,$53.42,$40.34,$37.40,$31.93
31100024,EAP,CPT® 88104,,"Fna-cell Blk,breast",$353.00,$31.93,$353.00,$98.04,$33.52,$32.06,$35.92,$33.52,$33.52,$50.14,$353.00,$33.53,$60.16,$279.58,$282.40,$46.58,$53.42,$40.34,$37.40,$31.93
31100025,EAP,CPT® 88161,,"Fna-misc,cyto",$207.00,$21.96,$207.00,$86.37,$29.49,$22.05,$33.93,$29.49,$29.49,$40.98,$207.00,$23.06,$66.78,$163.94,$165.60,$32.04,$43.67,$43.22,$30.57,$21.96
31100026,EAP,CPT® 88104,,"Fna-pulmonary,cyto",$353.00,$31.93,$353.00,$98.04,$33.52,$32.06,$35.92,$33.52,$33.52,$50.14,$353.00,$33.53,$60.16,$279.58,$282.40,$46.58,$53.42,$40.34,$37.40,$31.93
31100027,EAP,CPT® 88184,,Hairy Cell Leukemia,$424.00,$34.11,$424.00,$80.30,$79.23,$271.76,$34.11,$79.23,$79.23,$54.16,$424.00,$284.24,$133.74,$335.81,$339.20,$394.92,$57.71,$68.07,$40.40,$270.71
31100029,EAP,CPT® 88280,,Karyo Typing Charge,$300.00,$16.85,$300.00,$44.73,$36.64,$34.15,$16.85,$36.64,$36.64,$37.08,$300.00,$35.14,$70.14,$237.60,$240.00,$48.53,$39.50,$33.47,$27.65,$33.47
31100030,EAP,CPT® 88184,,Lymphoma Prof-basic,$424.00,$34.11,$424.00,$80.30,$79.23,$271.76,$34.11,$79.23,$79.23,$54.16,$424.00,$284.24,$133.74,$335.81,$339.20,$394.92,$57.71,$68.07,$40.40,$270.71
31100031,EAP,CPT® 88184,,Nuclear Charge,$424.00,$34.11,$424.00,$80.30,$79.23,$271.76,$34.11,$79.23,$79.23,$54.16,$424.00,$284.24,$133.74,$335.81,$339.20,$394.92,$57.71,$68.07,$40.40,$270.71
31100032,EAP,CPT® 88142,,Pap Smear,$291.00,$11.33,$291.00,$36.12,$29.58,$26.74,$11.33,$29.58,$29.58,$29.94,$291.00,$21.27,$56.62,$230.47,$232.80,$29.38,$31.90,$20.26,$22.33,$20.26
31100033,EAP,CPT® 88130,,Sex Chromatin:buccal,$166.00,$0.00,$166.00,$0.00,$21.97,$0.00,$0.00,$21.97,$21.97,$0.00,$166.00,$0.00,$42.04,$131.47,$132.80,$0.00,$0.00,$0.00,$0.00,$0.00
31100034,EAP,CPT® 88235,,"Tis Cult, Amino Charg","$2,252.00",$82.38,"$2,252.00",$262.54,$215.00,$200.40,$82.38,$215.00,$215.00,$217.53,"$2,252.00",$157.82,$411.48,"$1,783.58","$1,801.60",$217.94,$231.78,$150.30,$162.25,$150.30
31100035,EAP,CPT® 88230,,"Tis Cult, Lymph Charge","$1,783.00",$65.17,"$1,783.00",$207.69,$170.10,$158.54,$65.17,$170.10,$170.10,$172.08,"$1,783.00",$122.31,$325.54,"$1,412.14","$1,426.40",$168.91,$183.36,$116.49,$128.35,$116.49
31100036,EAP,CPT® 88239,,"Tis Cult, Other Charge","$2,255.00",$82.52,"$2,255.00",$263.00,$215.39,$200.75,$82.52,$215.39,$215.39,$217.93,"$2,255.00",$154.90,$412.24,"$1,785.96","$1,804.00",$213.90,$232.21,$147.52,$162.54,$147.52
31100037,EAP,CPT® 88237,,"Tissue Culture, Chrg",$726.00,$72.38,$726.00,$157.39,$128.90,$171.89,$72.38,$128.90,$128.90,$130.42,$726.00,$150.94,$246.70,$574.99,$580.80,$208.44,$138.97,$143.75,$97.28,$143.75
31100038,EAP,CPT® 88184,,Plasma Cell Neo Flow Tc/marker 1 (so),$500.00,$34.11,$500.00,$80.30,$79.23,$271.76,$34.11,$79.23,$79.23,$54.16,$500.00,$284.24,$133.74,$396.00,$400.00,$394.92,$57.71,$68.07,$40.40,$270.71
31100039,EAP,CPT® 88185,,Plasma Cell Neo Flow Tc/add On (so),$90.00,$0.00,$90.00,$49.02,$47.05,$0.00,$12.52,$47.05,$47.05,$26.63,$90.00,$0.00,$71.72,$71.28,$72.00,$0.00,$28.37,$22.33,$19.86,$0.00
31100040,EAP,CPT® 88187,,Plasma Cell Neo Flow Read 2 - 8(so),$90.00,$16.02,$90.00,$77.02,$64.23,$16.02,$19.59,$64.23,$64.23,$70.22,$90.00,$50.66,$90.00,$71.28,$72.00,$39.31,$74.83,$39.31,$52.38,$39.31
31100042,EAP,CPT® 88271,,Fish Aml M3 Rara Dna (so),$407.00,$11.98,$407.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$407.00,$22.49,$59.86,$322.34,$325.60,$31.06,$33.72,$21.42,$23.60,$21.42
31100043,EAP,CPT® 88275,,Fish Aml M3 Rara 100-300 (so),$615.00,$25.78,$615.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$615.00,$53.75,$112.22,$487.08,$492.00,$74.23,$63.21,$51.19,$44.25,$51.19
31100044,EAP,CPT® 88364,,"Fish, Oligoden 1p/19q (so)",$566.00,$0.00,$566.00,$173.19,$97.60,$0.00,$67.87,$97.60,$97.60,$97.04,$566.00,$0.00,$283.00,$448.27,$452.80,$0.00,$103.40,$104.09,$72.38,$0.00
31100046,EAP,CPT® 88299,,Fshd Cytogenetic Study (so),"$2,331.00",$0.00,"$2,331.00",$0.00,"$1,663.63",$0.00,$0.00,"$1,663.63","$1,663.63",$0.00,"$2,331.00",$0.00,$0.00,"$1,846.15","$1,864.80",$0.00,$0.00,$0.00,$0.00,$0.00
31100047,EAP,CPT® 88275,,Fish Hes 4qrea 100-300 (so),$389.00,$25.78,$389.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$389.00,$53.75,$112.22,$308.09,$311.20,$74.23,$63.21,$51.19,$44.25,$51.19
31100048,EAP,CPT® 88271,,Fish Hes 4qrea Leuk Dna (so),$389.00,$11.98,$389.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$389.00,$22.49,$59.86,$308.09,$311.20,$31.06,$33.72,$21.42,$23.60,$21.42
31100049,EAP,CPT® 88271,,Fish Fgfr1 8p11-12 Dna(so),$225.00,$11.98,$225.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$225.00,$22.49,$59.86,$178.20,$180.00,$31.06,$33.72,$21.42,$23.60,$21.42
31100050,EAP,CPT® 88275,,Fish Fgfr1 8p11-12 Dna(so),$225.00,$25.78,$225.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$225.00,$53.75,$112.22,$178.20,$180.00,$74.23,$63.21,$51.19,$44.25,$51.19
31100051,EAP,CPT® 88271,,Fish Neonatal Screen Dna (so),$126.00,$11.98,$126.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$126.00,$22.49,$59.86,$99.79,$100.80,$31.06,$33.72,$21.42,$23.60,$21.42
31100052,EAP,CPT® 88275,,Fish Neonatal Screen (so),$126.00,$25.78,$126.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$126.00,$53.75,$112.22,$99.79,$100.80,$74.23,$63.21,$51.19,$44.25,$51.19
31100053,EAP,CPT® 88275,,Fish Fgfr1 8p11-12 100-300 (so),$615.00,$25.78,$615.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$615.00,$53.75,$112.22,$487.08,$492.00,$74.23,$63.21,$51.19,$44.25,$51.19
31100095,EAP,CPT® 88143,,Cytopatah C/v Thin Layer Redo,$110.00,$0.00,$110.00,$0.00,$29.58,$0.00,$0.00,$29.58,$29.58,$0.00,$110.00,$0.00,$56.62,$87.12,$88.00,$0.00,$0.00,$0.00,$0.00,$0.00
31100096,EAP,CPT® 88173,,Cytopath Eval Fna Report,$409.00,$47.25,$409.00,$202.60,$64.24,$47.44,$78.38,$64.24,$64.24,$107.58,$409.00,$49.62,$137.06,$323.93,$327.20,$68.93,$114.63,$83.20,$80.24,$47.25
31100097,EAP,CPT® 88174,,Cytopath C/v Auto In Fluid,$94.00,$0.00,$94.00,$0.00,$31.19,$0.00,$0.00,$31.19,$31.19,$0.00,$94.00,$0.00,$59.70,$74.45,$75.20,$0.00,$0.00,$0.00,$0.00,$0.00
31100098,EAP,CPT® 88175,,Cytopath C/v Auto Fluid Redo,$116.00,$0.00,$116.00,$0.00,$38.64,$0.00,$0.00,$38.64,$38.64,$0.00,$116.00,$0.00,$73.96,$91.87,$92.80,$0.00,$0.00,$0.00,$0.00,$0.00
31100110,EAP,Custom 31100110,,"Fish, B-cell Cll Panel (so)",$367.00,$0.00,$367.00,$0.00,$261.93,$0.00,$0.00,$261.93,$261.93,$0.00,$367.00,$0.00,$183.50,$290.66,$293.60,$0.00,$0.00,$0.00,$0.00,$0.00
31100111,EAP,CPT® 88271,,Molecular Cytogen; Dna Probe  (so),$367.00,$11.98,$367.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$367.00,$22.49,$59.86,$290.66,$293.60,$31.06,$33.72,$21.42,$23.60,$21.42
31100112,EAP,CPT® 88275,,Interphase In Situ Hybird (so),$367.00,$25.78,$367.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$367.00,$53.75,$112.22,$290.66,$293.60,$74.23,$63.21,$51.19,$44.25,$51.19
31100113,EAP,Custom 31100113,,"Fish, Locus -specific Probe (x1) (so)",$367.00,$0.00,$367.00,$0.00,$261.93,$0.00,$0.00,$261.93,$261.93,$0.00,$367.00,$0.00,$183.50,$290.66,$293.60,$0.00,$0.00,$0.00,$0.00,$0.00
31100114,EAP,CPT® 88271,,Molecular Cytogentics; Dna Probe (so),$367.00,$11.98,$367.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$367.00,$22.49,$59.86,$290.66,$293.60,$31.06,$33.72,$21.42,$23.60,$21.42
31100115,EAP,Custom 31100115,,Chromosome Analysis Hem Malig (so),$343.00,$0.00,$343.00,$0.00,$244.80,$0.00,$0.00,$244.80,$244.80,$0.00,$343.00,$0.00,$171.50,$271.66,$274.40,$0.00,$0.00,$0.00,$0.00,$0.00
31100116,EAP,CPT® 88237,,Tissue Culture For Neoplastic Disorder (so),$343.00,$72.38,$343.00,$157.39,$128.90,$171.89,$72.38,$128.90,$128.90,$130.42,$343.00,$150.94,$246.70,$271.66,$274.40,$208.44,$138.97,$143.75,$97.28,$143.75
31100117,EAP,CPT® 88264,,Chromosome Analysis  20-25 Cells (so),$370.00,$72.80,$370.00,$222.21,$181.98,$169.62,$72.80,$181.98,$181.98,$184.12,$370.00,$151.84,$348.28,$293.04,$296.00,$209.68,$196.18,$144.61,$137.33,$144.61
31100118,EAP,CPT® 88120,,"Bladder Cancer,fish (so)",$493.00,$0.00,$493.00,$0.00,$406.29,$0.00,$0.00,$406.29,$406.29,$0.00,$493.00,$0.00,$246.50,$390.46,$394.40,$0.00,$0.00,$0.00,$0.00,$0.00
31100119,EAP,Custom 31100119,,"Fish, Prenatal Screen (so)",$367.00,$0.00,$367.00,$0.00,$261.93,$0.00,$0.00,$261.93,$261.93,$0.00,$367.00,$0.00,$183.50,$290.66,$293.60,$0.00,$0.00,$0.00,$0.00,$0.00
31100120,EAP,CPT® 88271,,Molecular Cytogen; Dna Probe (so),$367.00,$11.98,$367.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$367.00,$22.49,$59.86,$290.66,$293.60,$31.06,$33.72,$21.42,$23.60,$21.42
31100121,EAP,CPT® 88275,,Interphase Insitu Hybird  (so),$367.00,$25.78,$367.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$367.00,$53.75,$112.22,$290.66,$293.60,$74.23,$63.21,$51.19,$44.25,$51.19
31100122,EAP,CPT® 88275,,Interphase In Situ Hybirdization (so),$367.00,$25.78,$367.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$367.00,$53.75,$112.22,$290.66,$293.60,$74.23,$63.21,$51.19,$44.25,$51.19
31100123,EAP,CPT® 88271,,Molecular Cytogenetics;dna Probe (fish) (so),$325.00,$11.98,$325.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$325.00,$22.49,$59.86,$257.40,$260.00,$31.06,$33.72,$21.42,$23.60,$21.42
31100124,EAP,CPT® 88275,,Interphase In Situ Hybirdization (so),$325.00,$25.78,$325.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$325.00,$53.75,$112.22,$257.40,$260.00,$74.23,$63.21,$51.19,$44.25,$51.19
31100126,EAP,CPT® 88184,,"Pnh Flow Cytometry, 1st Mrk (so)",$94.00,$34.11,$284.24,$80.30,$79.23,$271.76,$34.11,$79.23,$79.23,$54.16,$94.00,$284.24,$94.00,$74.45,$75.20,$94.00,$57.71,$68.07,$40.40,$270.71
31100127,EAP,CPT® 88185,,"Pnh Flow Cytometry, Ea Addl Mrk (so)",$94.00,$0.00,$94.00,$49.02,$47.05,$0.00,$12.52,$47.05,$47.05,$26.63,$94.00,$0.00,$71.72,$74.45,$75.20,$0.00,$28.37,$22.33,$19.86,$0.00
31100130,EAP,CPT® 88184,,Flow Cytometry; First Marker (so),$303.00,$34.11,$303.00,$80.30,$79.23,$271.76,$34.11,$79.23,$79.23,$54.16,$303.00,$284.24,$133.74,$239.98,$242.40,$303.00,$57.71,$68.07,$40.40,$270.71
31100132,EAP,CPT® 88185,,Flow Cytometry;16 Or More Markers (so),$134.00,$0.00,$134.00,$49.02,$47.05,$0.00,$12.52,$47.05,$47.05,$26.63,$134.00,$0.00,$71.72,$106.13,$107.20,$0.00,$28.37,$22.33,$19.86,$0.00
31100133,EAP,Custom 31100133,,Fish  Aml M3-pml/rara Trans 15 17 (so),$343.00,$0.00,$343.00,$0.00,$244.80,$0.00,$0.00,$244.80,$244.80,$0.00,$343.00,$0.00,$171.50,$271.66,$274.40,$0.00,$0.00,$0.00,$0.00,$0.00
31100134,EAP,CPT® 88271,,Molecular Cytogen Dna Probe (so),$343.00,$11.98,$343.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$343.00,$22.49,$59.86,$271.66,$274.40,$31.06,$33.72,$21.42,$23.60,$21.42
31100135,EAP,CPT® 88275,,Interphase In Situ Hybrid (so),$343.00,$25.78,$343.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$343.00,$53.75,$112.22,$271.66,$274.40,$74.23,$63.21,$51.19,$44.25,$51.19
31100136,EAP,Custom 31100136,,Cll - Lymphoma Diagnostic Panel (so),$94.00,$0.00,$94.00,$0.00,$67.09,$0.00,$0.00,$67.09,$67.09,$0.00,$94.00,$0.00,$47.00,$74.45,$75.20,$0.00,$0.00,$0.00,$0.00,$0.00
31100137,EAP,CPT® 88184,,Flow Cytometry; First Marker (so),$303.00,$34.11,$303.00,$80.30,$79.23,$271.76,$34.11,$79.23,$79.23,$54.16,$303.00,$284.24,$133.74,$239.98,$242.40,$303.00,$57.71,$68.07,$40.40,$270.71
31100141,EAP,CPT® 88112,,Enriched Prep Surepath,$551.00,$34.47,$551.00,$89.63,$45.22,$47.44,$34.47,$45.22,$45.22,$124.75,$551.00,$49.62,$116.38,$436.39,$440.80,$68.93,$132.92,$39.62,$93.05,$47.25
31100142,EAP,CPT® 80356,,6-mam Opiates (so),$176.00,$0.00,$176.00,$0.00,$125.61,$0.00,$0.00,$125.61,$125.61,$0.00,$176.00,$0.00,$88.00,$139.39,$140.80,$0.00,$0.00,$0.00,$0.00,$0.00
31150011,EAP,CPT® 88104,,"Cytology, Urinary",$353.00,$31.93,$353.00,$98.04,$33.52,$32.06,$35.92,$33.52,$33.52,$50.14,$353.00,$33.53,$60.16,$279.58,$282.40,$46.58,$53.42,$40.34,$37.40,$31.93
31150012,EAP,CPT® 88104,,"Cytology,fluid",$353.00,$31.93,$353.00,$98.04,$33.52,$32.06,$35.92,$33.52,$33.52,$50.14,$353.00,$33.53,$60.16,$279.58,$282.40,$46.58,$53.42,$40.34,$37.40,$31.93
31150013,EAP,CPT® 88104,,"Cytology,breast",$353.00,$31.93,$353.00,$98.04,$33.52,$32.06,$35.92,$33.52,$33.52,$50.14,$353.00,$33.53,$60.16,$279.58,$282.40,$46.58,$53.42,$40.34,$37.40,$31.93
31150014,EAP,CPT® 88104,,"Cytology,cns",$353.00,$31.93,$353.00,$98.04,$33.52,$32.06,$35.92,$33.52,$33.52,$50.14,$353.00,$33.53,$60.16,$279.58,$282.40,$46.58,$53.42,$40.34,$37.40,$31.93
31150015,EAP,CPT® 88104,,"Cytology,misc",$353.00,$31.93,$353.00,$98.04,$33.52,$32.06,$35.92,$33.52,$33.52,$50.14,$353.00,$33.53,$60.16,$279.58,$282.40,$46.58,$53.42,$40.34,$37.40,$31.93
31200001,EAP,CPT® 88300,,Tooth,$288.00,$8.17,$288.00,$21.48,$18.95,$22.05,$8.17,$18.95,$18.95,$16.80,$288.00,$23.06,$38.76,$228.10,$230.40,$32.04,$17.90,$11.16,$12.53,$21.96
31200002,EAP,CPT® 88300,,Foreign Body,$288.00,$8.17,$288.00,$21.48,$18.95,$22.05,$8.17,$18.95,$18.95,$16.80,$288.00,$23.06,$38.76,$228.10,$230.40,$32.04,$17.90,$11.16,$12.53,$21.96
31200003,EAP,CPT® 88300,,"Cataract,os /od",$288.00,$8.17,$288.00,$21.48,$18.95,$22.05,$8.17,$18.95,$18.95,$16.80,$288.00,$23.06,$38.76,$228.10,$230.40,$32.04,$17.90,$11.16,$12.53,$21.96
31200004,EAP,CPT® 88300,,Intrauterine Device,$288.00,$8.17,$288.00,$21.48,$18.95,$22.05,$8.17,$18.95,$18.95,$16.80,$288.00,$23.06,$38.76,$228.10,$230.40,$32.04,$17.90,$11.16,$12.53,$21.96
31200005,EAP,CPT® 88302,,"Appendix,incidential",$389.00,$15.79,$389.00,$40.63,$42.29,$22.05,$15.79,$42.29,$42.29,$41.19,$389.00,$23.06,$87.44,$308.09,$311.20,$32.04,$43.89,$24.13,$30.72,$21.96
31200006,EAP,CPT® 88302,,"Foreskin, Newborn",$389.00,$15.79,$389.00,$40.63,$42.29,$22.05,$15.79,$42.29,$42.29,$41.19,$389.00,$23.06,$87.44,$308.09,$311.20,$32.04,$43.89,$24.13,$30.72,$21.96
31200007,EAP,CPT® 88302,,"Testis,castration",$389.00,$15.79,$389.00,$40.63,$42.29,$22.05,$15.79,$42.29,$42.29,$41.19,$389.00,$23.06,$87.44,$308.09,$311.20,$32.04,$43.89,$24.13,$30.72,$21.96
31200008,EAP,CPT® 88302,,Nerve,$389.00,$15.79,$389.00,$40.63,$42.29,$22.05,$15.79,$42.29,$42.29,$41.19,$389.00,$23.06,$87.44,$308.09,$311.20,$32.04,$43.89,$24.13,$30.72,$21.96
31200009,EAP,CPT® 88302,,Skin Plastic Repair,$389.00,$15.79,$389.00,$40.63,$42.29,$22.05,$15.79,$42.29,$42.29,$41.19,$389.00,$23.06,$87.44,$308.09,$311.20,$32.04,$43.89,$24.13,$30.72,$21.96
31200010,EAP,CPT® 88302,,"Amput,digit-traumat.",$389.00,$15.79,$389.00,$40.63,$42.29,$22.05,$15.79,$42.29,$42.29,$41.19,$389.00,$23.06,$87.44,$308.09,$311.20,$32.04,$43.89,$24.13,$30.72,$21.96
31200011,EAP,CPT® 88302,,Hernia Sac,$389.00,$15.79,$389.00,$40.63,$42.29,$22.05,$15.79,$42.29,$42.29,$41.19,$389.00,$23.06,$87.44,$308.09,$311.20,$32.04,$43.89,$24.13,$30.72,$21.96
31200012,EAP,CPT® 88302,,Hydrocele,$389.00,$15.79,$389.00,$40.63,$42.29,$22.05,$15.79,$42.29,$42.29,$41.19,$389.00,$23.06,$87.44,$308.09,$311.20,$32.04,$43.89,$24.13,$30.72,$21.96
31200013,EAP,CPT® 88302,,"Vas Deferens, Steril.",$389.00,$15.79,$389.00,$40.63,$42.29,$22.05,$15.79,$42.29,$42.29,$41.19,$389.00,$23.06,$87.44,$308.09,$311.20,$32.04,$43.89,$24.13,$30.72,$21.96
31200014,EAP,CPT® 88302,,Vaginal Mucosa,$389.00,$15.79,$389.00,$40.63,$42.29,$22.05,$15.79,$42.29,$42.29,$41.19,$389.00,$23.06,$87.44,$308.09,$311.20,$32.04,$43.89,$24.13,$30.72,$21.96
31200015,EAP,CPT® 88304,,Nasal Polyp,$495.00,$20.69,$495.00,$54.15,$51.07,$47.44,$20.69,$51.07,$51.07,$35.46,$495.00,$49.62,$108.12,$392.04,$396.00,$68.93,$37.78,$29.89,$26.45,$47.25
31200016,EAP,CPT® 88304,,Colostomy Stoma,$495.00,$20.69,$495.00,$54.15,$51.07,$47.44,$20.69,$51.07,$51.07,$35.46,$495.00,$49.62,$108.12,$392.04,$396.00,$68.93,$37.78,$29.89,$26.45,$47.25
31200017,EAP,CPT® 88304,,"Foreskin,non-newborn",$495.00,$20.69,$495.00,$54.15,$51.07,$47.44,$20.69,$51.07,$51.07,$35.46,$495.00,$49.62,$108.12,$392.04,$396.00,$68.93,$37.78,$29.89,$26.45,$47.25
31200018,EAP,CPT® 88304,,"Bone/frag,non-pathologic",$495.00,$20.69,$495.00,$54.15,$51.07,$47.44,$20.69,$51.07,$51.07,$35.46,$495.00,$49.62,$108.12,$392.04,$396.00,$68.93,$37.78,$29.89,$26.45,$47.25
31200019,EAP,CPT® 88304,,Cartilage Shavings,$495.00,$20.69,$495.00,$54.15,$51.07,$47.44,$20.69,$51.07,$51.07,$35.46,$495.00,$49.62,$108.12,$392.04,$396.00,$68.93,$37.78,$29.89,$26.45,$47.25
31200020,EAP,CPT® 88304,,Carpal Tunnel Tissue,$495.00,$20.69,$495.00,$54.15,$51.07,$47.44,$20.69,$51.07,$51.07,$35.46,$495.00,$49.62,$108.12,$392.04,$396.00,$68.93,$37.78,$29.89,$26.45,$47.25
31200021,EAP,CPT® 88304,,Dupuytren's Contrac.,$495.00,$20.69,$495.00,$54.15,$51.07,$47.44,$20.69,$51.07,$51.07,$35.46,$495.00,$49.62,$108.12,$392.04,$396.00,$68.93,$37.78,$29.89,$26.45,$47.25
31200022,EAP,CPT® 88304,,"Femoral Head,n-fract",$495.00,$20.69,$495.00,$54.15,$51.07,$47.44,$20.69,$51.07,$51.07,$35.46,$495.00,$49.62,$108.12,$392.04,$396.00,$68.93,$37.78,$29.89,$26.45,$47.25
31200023,EAP,CPT® 88304,,"Cyst,misc",$495.00,$20.69,$495.00,$54.15,$51.07,$47.44,$20.69,$51.07,$51.07,$35.46,$495.00,$49.62,$108.12,$392.04,$396.00,$68.93,$37.78,$29.89,$26.45,$47.25
31200024,EAP,CPT® 88304,,"Cyst,synovial",$495.00,$20.69,$495.00,$54.15,$51.07,$47.44,$20.69,$51.07,$51.07,$35.46,$495.00,$49.62,$108.12,$392.04,$396.00,$68.93,$37.78,$29.89,$26.45,$47.25
31200025,EAP,CPT® 88304,,"Cyst,ganglion",$495.00,$20.69,$495.00,$54.15,$51.07,$47.44,$20.69,$51.07,$51.07,$35.46,$495.00,$49.62,$108.12,$392.04,$396.00,$68.93,$37.78,$29.89,$26.45,$47.25
31200026,EAP,CPT® 88304,,Fissure / Fistula,$495.00,$20.69,$495.00,$54.15,$51.07,$47.44,$20.69,$51.07,$51.07,$35.46,$495.00,$49.62,$108.12,$392.04,$396.00,$68.93,$37.78,$29.89,$26.45,$47.25
31200027,EAP,CPT® 88304,,Intervertebral Disc,$495.00,$20.69,$495.00,$54.15,$51.07,$47.44,$20.69,$51.07,$51.07,$35.46,$495.00,$49.62,$108.12,$392.04,$396.00,$68.93,$37.78,$29.89,$26.45,$47.25
31200028,EAP,CPT® 88304,,"Joint, Loose Body",$495.00,$20.69,$495.00,$54.15,$51.07,$47.44,$20.69,$51.07,$51.07,$35.46,$495.00,$49.62,$108.12,$392.04,$396.00,$68.93,$37.78,$29.89,$26.45,$47.25
31200029,EAP,CPT® 88304,,Tendon Sheath,$495.00,$20.69,$495.00,$54.15,$51.07,$47.44,$20.69,$51.07,$51.07,$35.46,$495.00,$49.62,$108.12,$392.04,$396.00,$68.93,$37.78,$29.89,$26.45,$47.25
31200030,EAP,CPT® 88304,,"Cyst,dental",$495.00,$20.69,$495.00,$54.15,$51.07,$47.44,$20.69,$51.07,$51.07,$35.46,$495.00,$49.62,$108.12,$392.04,$396.00,$68.93,$37.78,$29.89,$26.45,$47.25
31200031,EAP,CPT® 88304,,"Neuroma,traumatic",$495.00,$20.69,$495.00,$54.15,$51.07,$47.44,$20.69,$51.07,$51.07,$35.46,$495.00,$49.62,$108.12,$392.04,$396.00,$68.93,$37.78,$29.89,$26.45,$47.25
31200032,EAP,CPT® 88304,,"Skin Biopsy,punch",$495.00,$20.69,$495.00,$54.15,$51.07,$47.44,$20.69,$51.07,$51.07,$35.46,$495.00,$49.62,$108.12,$392.04,$396.00,$68.93,$37.78,$29.89,$26.45,$47.25
31200033,EAP,CPT® 88304,,"Skin Excision,debrid",$495.00,$20.69,$495.00,$54.15,$51.07,$47.44,$20.69,$51.07,$51.07,$35.46,$495.00,$49.62,$108.12,$392.04,$396.00,$68.93,$37.78,$29.89,$26.45,$47.25
31200034,EAP,CPT® 88304,,"Cyst,pilonidal",$495.00,$20.69,$495.00,$54.15,$51.07,$47.44,$20.69,$51.07,$51.07,$35.46,$495.00,$49.62,$108.12,$392.04,$396.00,$68.93,$37.78,$29.89,$26.45,$47.25
31200035,EAP,CPT® 88304,,"Soft Tissue,debrid",$495.00,$20.69,$495.00,$54.15,$51.07,$47.44,$20.69,$51.07,$51.07,$35.46,$495.00,$49.62,$108.12,$392.04,$396.00,$68.93,$37.78,$29.89,$26.45,$47.25
31200036,EAP,CPT® 88304,,"Soft Tissue,lipoma",$495.00,$20.69,$495.00,$54.15,$51.07,$47.44,$20.69,$51.07,$51.07,$35.46,$495.00,$49.62,$108.12,$392.04,$396.00,$68.93,$37.78,$29.89,$26.45,$47.25
31200037,EAP,CPT® 88304,,Aneurysm,$495.00,$20.69,$495.00,$54.15,$51.07,$47.44,$20.69,$51.07,$51.07,$35.46,$495.00,$49.62,$108.12,$392.04,$396.00,$68.93,$37.78,$29.89,$26.45,$47.25
31200038,EAP,CPT® 88304,,"Vein, Varicosity",$495.00,$20.69,$495.00,$54.15,$51.07,$47.44,$20.69,$51.07,$51.07,$35.46,$495.00,$49.62,$108.12,$392.04,$396.00,$68.93,$37.78,$29.89,$26.45,$47.25
31200039,EAP,CPT® 88304,,Embolis/thrombus,$495.00,$20.69,$495.00,$54.15,$51.07,$47.44,$20.69,$51.07,$51.07,$35.46,$495.00,$49.62,$108.12,$392.04,$396.00,$68.93,$37.78,$29.89,$26.45,$47.25
31200040,EAP,CPT® 88304,,Hematoma,$495.00,$20.69,$495.00,$54.15,$51.07,$47.44,$20.69,$51.07,$51.07,$35.46,$495.00,$49.62,$108.12,$392.04,$396.00,$68.93,$37.78,$29.89,$26.45,$47.25
31200041,EAP,CPT® 88304,,Hemorrhoids,$495.00,$20.69,$495.00,$54.15,$51.07,$47.44,$20.69,$51.07,$51.07,$35.46,$495.00,$49.62,$108.12,$392.04,$396.00,$68.93,$37.78,$29.89,$26.45,$47.25
31200042,EAP,CPT® 88304,,"Artery/vein, Plaque",$495.00,$20.69,$495.00,$54.15,$51.07,$47.44,$20.69,$51.07,$51.07,$35.46,$495.00,$49.62,$108.12,$392.04,$396.00,$68.93,$37.78,$29.89,$26.45,$47.25
31200043,EAP,CPT® 88304,,Cholesteatoma,$495.00,$20.69,$495.00,$54.15,$51.07,$47.44,$20.69,$51.07,$51.07,$35.46,$495.00,$49.62,$108.12,$392.04,$396.00,$68.93,$37.78,$29.89,$26.45,$47.25
31200044,EAP,CPT® 88304,,Conjunctiva Biopsy,$495.00,$20.69,$495.00,$54.15,$51.07,$47.44,$20.69,$51.07,$51.07,$35.46,$495.00,$49.62,$108.12,$392.04,$396.00,$68.93,$37.78,$29.89,$26.45,$47.25
31200045,EAP,CPT® 88304,,Cornea,$495.00,$20.69,$495.00,$54.15,$51.07,$47.44,$20.69,$51.07,$51.07,$35.46,$495.00,$49.62,$108.12,$392.04,$396.00,$68.93,$37.78,$29.89,$26.45,$47.25
31200046,EAP,CPT® 88304,,Salivary Mucocele,$495.00,$20.69,$495.00,$54.15,$51.07,$47.44,$20.69,$51.07,$51.07,$35.46,$495.00,$49.62,$108.12,$392.04,$396.00,$68.93,$37.78,$29.89,$26.45,$47.25
31200047,EAP,CPT® 88304,,Tonsil/adenoids,$495.00,$20.69,$495.00,$54.15,$51.07,$47.44,$20.69,$51.07,$51.07,$35.46,$495.00,$49.62,$108.12,$392.04,$396.00,$68.93,$37.78,$29.89,$26.45,$47.25
31200048,EAP,CPT® 88304,,Gall Blad./bile Duct,$495.00,$20.69,$495.00,$54.15,$51.07,$47.44,$20.69,$51.07,$51.07,$35.46,$495.00,$49.62,$108.12,$392.04,$396.00,$68.93,$37.78,$29.89,$26.45,$47.25
31200049,EAP,CPT® 88304,,Spermatocele,$495.00,$20.69,$495.00,$54.15,$51.07,$47.44,$20.69,$51.07,$51.07,$35.46,$495.00,$49.62,$108.12,$392.04,$396.00,$68.93,$37.78,$29.89,$26.45,$47.25
31200050,EAP,CPT® 88304,,Varicocele,$495.00,$20.69,$495.00,$54.15,$51.07,$47.44,$20.69,$51.07,$51.07,$35.46,$495.00,$49.62,$108.12,$392.04,$396.00,$68.93,$37.78,$29.89,$26.45,$47.25
31200051,EAP,CPT® 88304,,Vas Deferens,$495.00,$20.69,$495.00,$54.15,$51.07,$47.44,$20.69,$51.07,$51.07,$35.46,$495.00,$49.62,$108.12,$392.04,$396.00,$68.93,$37.78,$29.89,$26.45,$47.25
31200052,EAP,CPT® 88304,,"Cyst,bartholin",$495.00,$20.69,$495.00,$54.15,$51.07,$47.44,$20.69,$51.07,$51.07,$35.46,$495.00,$49.62,$108.12,$392.04,$396.00,$68.93,$37.78,$29.89,$26.45,$47.25
31200053,EAP,CPT® 88304,,"Cyst,hydat-morgagni",$495.00,$20.69,$495.00,$54.15,$51.07,$47.44,$20.69,$51.07,$51.07,$35.46,$495.00,$49.62,$108.12,$392.04,$396.00,$68.93,$37.78,$29.89,$26.45,$47.25
31200054,EAP,CPT® 88305,,"Breast Bx,core Img",$617.00,$32.05,$617.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$617.00,$49.62,$140.98,$488.66,$493.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200055,EAP,CPT® 88305,,Bronchus Biopsy,$617.00,$32.05,$617.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$617.00,$49.62,$140.98,$488.66,$493.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200056,EAP,CPT® 88305,,"Trachea, Biopsy",$617.00,$32.05,$617.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$617.00,$49.62,$140.98,$488.66,$493.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200057,EAP,CPT® 88305,,"Larynx, Biopsy",$617.00,$32.05,$617.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$617.00,$49.62,$140.98,$488.66,$493.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200058,EAP,CPT® 88305,,Nasopharynx,$617.00,$32.05,$617.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$617.00,$49.62,$140.98,$488.66,$493.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200059,EAP,CPT® 88305,,Nasal Mucosa Biopsy,$617.00,$32.05,$617.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$617.00,$49.62,$140.98,$488.66,$493.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200060,EAP,CPT® 88305,,Stomach Polyp,$617.00,$32.05,$617.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$617.00,$49.62,$140.98,$488.66,$493.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200061,EAP,CPT® 88305,,Duodenum Biopsy,$617.00,$32.05,$617.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$617.00,$49.62,$140.98,$488.66,$493.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200062,EAP,CPT® 88305,,Colorectal Polyp,$617.00,$32.05,$617.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$617.00,$49.62,$140.98,$488.66,$493.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200063,EAP,CPT® 88305,,Peritoneum Biopsy,$617.00,$32.05,$617.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$617.00,$49.62,$140.98,$488.66,$493.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200064,EAP,CPT® 88305,,Ur Bladder Biopsy,$617.00,$32.05,$617.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$617.00,$49.62,$140.98,$488.66,$493.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200065,EAP,CPT® 88305,,Prostate Chips,$617.00,$32.05,$617.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$617.00,$49.62,$140.98,$488.66,$493.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200066,EAP,CPT® 88305,,Cell Block,$617.00,$32.05,$617.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$617.00,$49.62,$140.98,$488.66,$493.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200067,EAP,CPT® 88305,,"Femoral Head, Fract.",$617.00,$32.05,$617.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$617.00,$49.62,$140.98,$488.66,$493.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200068,EAP,CPT® 88305,,Synovium,$617.00,$32.05,$617.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$617.00,$49.62,$140.98,$488.66,$493.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200069,EAP,CPT® 88305,,Meninges Resection,$617.00,$32.05,$617.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$617.00,$49.62,$140.98,$488.66,$493.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200070,EAP,CPT® 88305,,"Skin Biopsy,shave",$617.00,$32.05,$617.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$617.00,$49.62,$140.98,$488.66,$493.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200071,EAP,CPT® 88305,,"Skin Excision,other",$617.00,$32.05,$617.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$617.00,$49.62,$140.98,$488.66,$493.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200072,EAP,CPT® 88305,,"Soft Tissue,other",$617.00,$32.05,$617.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$617.00,$49.62,$140.98,$488.66,$493.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200073,EAP,CPT® 88305,,Breast Biopsy,$617.00,$32.05,$617.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$617.00,$49.62,$140.98,$488.66,$493.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200074,EAP,CPT® 88305,,"Breast,reduction",$617.00,$32.05,$617.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$617.00,$49.62,$140.98,$488.66,$493.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200075,EAP,CPT® 88305,,Artery/vein Biopsy,$617.00,$32.05,$617.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$617.00,$49.62,$140.98,$488.66,$493.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200076,EAP,CPT® 88305,,Lymph Node Biopsy,$617.00,$32.05,$617.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$617.00,$49.62,$140.98,$488.66,$493.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200077,EAP,CPT® 88305,,Bone Marrow Biopsy,$617.00,$32.05,$617.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$617.00,$49.62,$140.98,$488.66,$493.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200078,EAP,CPT® 88305,,Spleen,$617.00,$32.05,$617.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$617.00,$49.62,$140.98,$488.66,$493.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200079,EAP,CPT® 88305,,"Amput,extrm-traumat.",$617.00,$32.05,$617.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$617.00,$49.62,$140.98,$488.66,$493.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200080,EAP,CPT® 88305,,Joint Resection,$617.00,$32.05,$617.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$617.00,$49.62,$140.98,$488.66,$493.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200081,EAP,CPT® 88305,,Muscle Biopsy,$617.00,$32.05,$617.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$617.00,$49.62,$140.98,$488.66,$493.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200082,EAP,CPT® 88305,,"Amput,digit-nontraum",$617.00,$32.05,$617.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$617.00,$49.62,$140.98,$488.66,$493.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200083,EAP,CPT® 88305,,Heart Valve,$617.00,$32.05,$617.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$617.00,$49.62,$140.98,$488.66,$493.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200084,EAP,CPT® 88305,,"Lip, Wedge Biopsy",$617.00,$32.05,$617.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$617.00,$49.62,$140.98,$488.66,$493.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200085,EAP,CPT® 88305,,Tongue Biopsy,$617.00,$32.05,$617.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$617.00,$49.62,$140.98,$488.66,$493.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200086,EAP,CPT® 88305,,Tonsil Biopsy,$617.00,$32.05,$617.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$617.00,$49.62,$140.98,$488.66,$493.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200087,EAP,CPT® 88305,,Oral/gingiva Biopsy,$617.00,$32.05,$617.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$617.00,$49.62,$140.98,$488.66,$493.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200088,EAP,CPT® 88305,,Salivary Gland Bx,$617.00,$32.05,$617.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$617.00,$49.62,$140.98,$488.66,$493.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200089,EAP,CPT® 88305,,Parathyroid Gland,$617.00,$32.05,$617.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$617.00,$49.62,$140.98,$488.66,$493.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200090,EAP,CPT® 88305,,Pituitary Tumor,$617.00,$32.05,$617.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$617.00,$49.62,$140.98,$488.66,$493.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200091,EAP,CPT® 88305,,Nerve Biopsy,$617.00,$32.05,$617.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$617.00,$49.62,$140.98,$488.66,$493.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200092,EAP,CPT® 88305,,Pleural Biopsy,$617.00,$32.05,$617.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$617.00,$49.62,$140.98,$488.66,$493.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200093,EAP,CPT® 88305,,Pericardium Biopsy,$617.00,$32.05,$617.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$617.00,$49.62,$140.98,$488.66,$493.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200094,EAP,CPT® 88305,,Thyroglossal Duct,$617.00,$32.05,$617.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$617.00,$49.62,$140.98,$488.66,$493.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200095,EAP,CPT® 88305,,Esophagus Biopsy,$617.00,$32.05,$617.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$617.00,$49.62,$140.98,$488.66,$493.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200096,EAP,CPT® 88305,,Stomach Biopsy,$617.00,$32.05,$617.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$617.00,$49.62,$140.98,$488.66,$493.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200097,EAP,CPT® 88305,,Sm.intestine Biopsy,$617.00,$32.05,$617.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$617.00,$49.62,$140.98,$488.66,$493.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200098,EAP,CPT® 88305,,Colon Biopsy,$617.00,$32.05,$617.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$617.00,$49.62,$140.98,$488.66,$493.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200099,EAP,CPT® 88305,,Omentum Biopsy,$617.00,$32.05,$617.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$617.00,$49.62,$140.98,$488.66,$493.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200100,EAP,CPT® 88305,,Kidney Biopsy,$617.00,$32.05,$617.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$617.00,$49.62,$140.98,$488.66,$493.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200101,EAP,CPT® 88305,,Ureter Biopsy,$617.00,$32.05,$617.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$617.00,$49.62,$140.98,$488.66,$493.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200102,EAP,CPT® 88305,,Urethra Biopsy,$617.00,$32.05,$617.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$617.00,$49.62,$140.98,$488.66,$493.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200103,EAP,CPT® 88305,,Prostate Biopsy,$617.00,$32.05,$617.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$617.00,$49.62,$140.98,$488.66,$493.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200104,EAP,CPT® 88305,,Endocervical Scrape,$617.00,$32.05,$617.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$617.00,$49.62,$140.98,$488.66,$493.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200105,EAP,CPT® 88305,,Endometrial Scrape,$617.00,$32.05,$617.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$617.00,$49.62,$140.98,$488.66,$493.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200106,EAP,CPT® 88305,,Cervical Biopsy,$617.00,$32.05,$617.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$617.00,$49.62,$140.98,$488.66,$493.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200107,EAP,CPT® 88305,,"Vagina, Biopsy",$617.00,$32.05,$617.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$617.00,$49.62,$140.98,$488.66,$493.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200108,EAP,CPT® 88305,,Vulva / Labia Biopsy,$617.00,$32.05,$617.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$617.00,$49.62,$140.98,$488.66,$493.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200109,EAP,CPT® 88305,,Ovary,$617.00,$32.05,$617.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$617.00,$49.62,$140.98,$488.66,$493.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200110,EAP,CPT® 88305,,Endometrial Polyp,$617.00,$32.05,$617.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$617.00,$49.62,$140.98,$488.66,$493.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200111,EAP,CPT® 88305,,"Uterus, Prolapse",$617.00,$32.05,$617.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$617.00,$49.62,$140.98,$488.66,$493.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200112,EAP,CPT® 88305,,Fallopian Tube Biopsy,$617.00,$32.05,$617.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$617.00,$49.62,$140.98,$488.66,$493.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200113,EAP,CPT® 88305,,"Fallop. Tube,ectopic",$617.00,$32.05,$617.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$617.00,$49.62,$140.98,$488.66,$493.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200114,EAP,CPT® 88305,,"Ovary,wedge Biopsy",$617.00,$32.05,$617.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$617.00,$49.62,$140.98,$488.66,$493.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200115,EAP,CPT® 88305,,"POC, SPONTANEOUS",$617.00,$32.05,$617.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$617.00,$49.62,$140.98,$488.66,$493.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200116,EAP,CPT® 88305,,"Placenta, N-3rd Trim.",$617.00,$32.05,$617.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$617.00,$49.62,$140.98,$488.66,$493.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200117,EAP,CPT® 88307,,Stomach Resection,$774.00,$116.80,$774.00,$351.05,$130.18,$271.76,$137.71,$130.18,$130.18,$156.60,$774.00,$284.24,$240.00,$613.01,$619.20,$394.92,$166.86,$194.49,$116.80,$270.71
31200118,EAP,CPT® 88307,,"Colon, Seg Resection",$774.00,$116.80,$774.00,$351.05,$130.18,$271.76,$137.71,$130.18,$130.18,$156.60,$774.00,$284.24,$240.00,$613.01,$619.20,$394.92,$166.86,$194.49,$116.80,$270.71
31200119,EAP,CPT® 88307,,"Pancreas, Biopsy",$774.00,$116.80,$774.00,$351.05,$130.18,$271.76,$137.71,$130.18,$130.18,$156.60,$774.00,$284.24,$240.00,$613.01,$619.20,$394.92,$166.86,$194.49,$116.80,$270.71
31200120,EAP,CPT® 88307,,Liver Resection,$774.00,$116.80,$774.00,$351.05,$130.18,$271.76,$137.71,$130.18,$130.18,$156.60,$774.00,$284.24,$240.00,$613.01,$619.20,$394.92,$166.86,$194.49,$116.80,$270.71
31200121,EAP,CPT® 88307,,Ureter Resection,$774.00,$116.80,$774.00,$351.05,$130.18,$271.76,$137.71,$130.18,$130.18,$156.60,$774.00,$284.24,$240.00,$613.01,$619.20,$394.92,$166.86,$194.49,$116.80,$270.71
31200122,EAP,CPT® 88307,,Testis Biopsy,$774.00,$116.80,$774.00,$351.05,$130.18,$271.76,$137.71,$130.18,$130.18,$156.60,$774.00,$284.24,$240.00,$613.01,$619.20,$394.92,$166.86,$194.49,$116.80,$270.71
31200123,EAP,CPT® 88307,,Prostate Resection,$774.00,$116.80,$774.00,$351.05,$130.18,$271.76,$137.71,$130.18,$130.18,$156.60,$774.00,$284.24,$240.00,$613.01,$619.20,$394.92,$166.86,$194.49,$116.80,$270.71
31200124,EAP,CPT® 88307,,Bone Biopsy,$774.00,$116.80,$774.00,$351.05,$130.18,$271.76,$137.71,$130.18,$130.18,$156.60,$774.00,$284.24,$240.00,$613.01,$619.20,$394.92,$166.86,$194.49,$116.80,$270.71
31200125,EAP,CPT® 88307,,"Tumor,dental",$774.00,$116.80,$774.00,$351.05,$130.18,$271.76,$137.71,$130.18,$130.18,$156.60,$774.00,$284.24,$240.00,$613.01,$619.20,$394.92,$166.86,$194.49,$116.80,$270.71
31200126,EAP,CPT® 88307,,"Meninges,tumor",$774.00,$116.80,$774.00,$351.05,$130.18,$271.76,$137.71,$130.18,$130.18,$156.60,$774.00,$284.24,$240.00,$613.01,$619.20,$394.92,$166.86,$194.49,$116.80,$270.71
31200127,EAP,CPT® 88307,,"Breast,simple Mast.",$774.00,$116.80,$774.00,$351.05,$130.18,$271.76,$137.71,$130.18,$130.18,$156.60,$774.00,$284.24,$240.00,$613.01,$619.20,$394.92,$166.86,$194.49,$116.80,$270.71
31200128,EAP,CPT® 88307,,Lymph Node Resectn,$774.00,$116.80,$774.00,$351.05,$130.18,$271.76,$137.71,$130.18,$130.18,$156.60,$774.00,$284.24,$240.00,$613.01,$619.20,$394.92,$166.86,$194.49,$116.80,$270.71
31200129,EAP,CPT® 88307,,Liver Biopsy,$774.00,$116.80,$774.00,$351.05,$130.18,$271.76,$137.71,$130.18,$130.18,$156.60,$774.00,$284.24,$240.00,$613.01,$619.20,$394.92,$166.86,$194.49,$116.80,$270.71
31200130,EAP,CPT® 88307,,"Amput,extrm-non Traum",$774.00,$116.80,$774.00,$351.05,$130.18,$271.76,$137.71,$130.18,$130.18,$156.60,$774.00,$284.24,$240.00,$613.01,$619.20,$394.92,$166.86,$194.49,$116.80,$270.71
31200131,EAP,CPT® 88307,,"Bone/frag,pathologic",$774.00,$116.80,$774.00,$351.05,$130.18,$271.76,$137.71,$130.18,$130.18,$156.60,$774.00,$284.24,$240.00,$613.01,$619.20,$394.92,$166.86,$194.49,$116.80,$270.71
31200132,EAP,CPT® 88307,,"Mediastinum,mass",$774.00,$116.80,$774.00,$351.05,$130.18,$271.76,$137.71,$130.18,$130.18,$156.60,$774.00,$284.24,$240.00,$613.01,$619.20,$394.92,$166.86,$194.49,$116.80,$270.71
31200133,EAP,CPT® 88307,,"Soft Tissue,bx/excis",$774.00,$116.80,$774.00,$351.05,$130.18,$271.76,$137.71,$130.18,$130.18,$156.60,$774.00,$284.24,$240.00,$613.01,$619.20,$394.92,$166.86,$194.49,$116.80,$270.71
31200134,EAP,CPT® 88307,,"Eye, Enucleation",$774.00,$116.80,$774.00,$351.05,$130.18,$271.76,$137.71,$130.18,$130.18,$156.60,$774.00,$284.24,$240.00,$613.01,$619.20,$394.92,$166.86,$194.49,$116.80,$270.71
31200135,EAP,CPT® 88307,,Thyroid Resection,$774.00,$116.80,$774.00,$351.05,$130.18,$271.76,$137.71,$130.18,$130.18,$156.60,$774.00,$284.24,$240.00,$613.01,$619.20,$394.92,$166.86,$194.49,$116.80,$270.71
31200136,EAP,CPT® 88307,,Adrenal Resection,$774.00,$116.80,$774.00,$351.05,$130.18,$271.76,$137.71,$130.18,$130.18,$156.60,$774.00,$284.24,$240.00,$613.01,$619.20,$394.92,$166.86,$194.49,$116.80,$270.71
31200137,EAP,CPT® 88307,,Brain Biopsy,$774.00,$116.80,$774.00,$351.05,$130.18,$271.76,$137.71,$130.18,$130.18,$156.60,$774.00,$284.24,$240.00,$613.01,$619.20,$394.92,$166.86,$194.49,$116.80,$270.71
31200138,EAP,CPT® 88307,,"Lung, Wedge Biopsy",$774.00,$116.80,$774.00,$351.05,$130.18,$271.76,$137.71,$130.18,$130.18,$156.60,$774.00,$284.24,$240.00,$613.01,$619.20,$394.92,$166.86,$194.49,$116.80,$270.71
31200139,EAP,CPT® 88307,,Myocardium Biopsy,$774.00,$116.80,$774.00,$351.05,$130.18,$271.76,$137.71,$130.18,$130.18,$156.60,$774.00,$284.24,$240.00,$613.01,$619.20,$394.92,$166.86,$194.49,$116.80,$270.71
31200140,EAP,CPT® 88307,,Thymus Tumor,$774.00,$116.80,$774.00,$351.05,$130.18,$271.76,$137.71,$130.18,$130.18,$156.60,$774.00,$284.24,$240.00,$613.01,$619.20,$394.92,$166.86,$194.49,$116.80,$270.71
31200141,EAP,CPT® 88307,,Small Intes. Resectn,$774.00,$116.80,$774.00,$351.05,$130.18,$271.76,$137.71,$130.18,$130.18,$156.60,$774.00,$284.24,$240.00,$613.01,$619.20,$394.92,$166.86,$194.49,$116.80,$270.71
31200142,EAP,CPT® 88307,,Nephrectomy,$774.00,$116.80,$774.00,$351.05,$130.18,$271.76,$137.71,$130.18,$130.18,$156.60,$774.00,$284.24,$240.00,$613.01,$619.20,$394.92,$166.86,$194.49,$116.80,$270.71
31200143,EAP,CPT® 88307,,Testis Resection,$774.00,$116.80,$774.00,$351.05,$130.18,$271.76,$137.71,$130.18,$130.18,$156.60,$774.00,$284.24,$240.00,$613.01,$619.20,$394.92,$166.86,$194.49,$116.80,$270.71
31200144,EAP,CPT® 88307,,Uterus,$774.00,$116.80,$774.00,$351.05,$130.18,$271.76,$137.71,$130.18,$130.18,$156.60,$774.00,$284.24,$240.00,$613.01,$619.20,$394.92,$166.86,$194.49,$116.80,$270.71
31200145,EAP,CPT® 88307,,Cervical Cone,$774.00,$116.80,$774.00,$351.05,$130.18,$271.76,$137.71,$130.18,$130.18,$156.60,$774.00,$284.24,$240.00,$613.01,$619.20,$394.92,$166.86,$194.49,$116.80,$270.71
31200146,EAP,CPT® 88307,,"Placenta, Third Trim.",$774.00,$116.80,$774.00,$351.05,$130.18,$271.76,$137.71,$130.18,$130.18,$156.60,$774.00,$284.24,$240.00,$613.01,$619.20,$394.92,$166.86,$194.49,$116.80,$270.71
31200147,EAP,CPT® 88307,,"Ovary,tumor",$774.00,$116.80,$774.00,$351.05,$130.18,$271.76,$137.71,$130.18,$130.18,$156.60,$774.00,$284.24,$240.00,$613.01,$619.20,$394.92,$166.86,$194.49,$116.80,$270.71
31200148,EAP,CPT® 88309,,Small Intes. Tumor,"$1,051.00",$164.53,"$1,051.00",$538.24,$178.45,$602.38,$209.20,$178.45,$178.45,$220.59,"$1,051.00",$630.05,$328.48,$832.39,$840.80,$875.37,$235.05,$274.45,$164.53,$600.04
31200149,EAP,CPT® 88309,,"Colon, Seg Resec,tumor","$1,051.00",$164.53,"$1,051.00",$538.24,$178.45,$602.38,$209.20,$178.45,$178.45,$220.59,"$1,051.00",$630.05,$328.48,$832.39,$840.80,$875.37,$235.05,$274.45,$164.53,$600.04
31200150,EAP,CPT® 88309,,Ur Bladder Resection,"$1,051.00",$164.53,"$1,051.00",$538.24,$178.45,$602.38,$209.20,$178.45,$178.45,$220.59,"$1,051.00",$630.05,$328.48,$832.39,$840.80,$875.37,$235.05,$274.45,$164.53,$600.04
31200151,EAP,CPT® 88309,,"Testis Resect,tumor","$1,051.00",$164.53,"$1,051.00",$538.24,$178.45,$602.38,$209.20,$178.45,$178.45,$220.59,"$1,051.00",$630.05,$328.48,$832.39,$840.80,$875.37,$235.05,$274.45,$164.53,$600.04
31200152,EAP,CPT® 88309,,Bone Resection,"$1,051.00",$164.53,"$1,051.00",$538.24,$178.45,$602.38,$209.20,$178.45,$178.45,$220.59,"$1,051.00",$630.05,$328.48,$832.39,$840.80,$875.37,$235.05,$274.45,$164.53,$600.04
31200153,EAP,CPT® 88309,,"Soft Tissue,tumor","$1,051.00",$164.53,"$1,051.00",$538.24,$178.45,$602.38,$209.20,$178.45,$178.45,$220.59,"$1,051.00",$630.05,$328.48,$832.39,$840.80,$875.37,$235.05,$274.45,$164.53,$600.04
31200154,EAP,CPT® 88309,,"Breast,mast.w/nodes","$1,051.00",$164.53,"$1,051.00",$538.24,$178.45,$602.38,$209.20,$178.45,$178.45,$220.59,"$1,051.00",$630.05,$328.48,$832.39,$840.80,$875.37,$235.05,$274.45,$164.53,$600.04
31200155,EAP,CPT® 88309,,"Larynx, Resectn/node","$1,051.00",$164.53,"$1,051.00",$538.24,$178.45,$602.38,$209.20,$178.45,$178.45,$220.59,"$1,051.00",$630.05,$328.48,$832.39,$840.80,$875.37,$235.05,$274.45,$164.53,$600.04
31200156,EAP,CPT® 88309,,"Tongue, Resectn,tumor","$1,051.00",$164.53,"$1,051.00",$538.24,$178.45,$602.38,$209.20,$178.45,$178.45,$220.59,"$1,051.00",$630.05,$328.48,$832.39,$840.80,$875.37,$235.05,$274.45,$164.53,$600.04
31200157,EAP,CPT® 88309,,"Tonsil Resectn,tumor","$1,051.00",$164.53,"$1,051.00",$538.24,$178.45,$602.38,$209.20,$178.45,$178.45,$220.59,"$1,051.00",$630.05,$328.48,$832.39,$840.80,$875.37,$235.05,$274.45,$164.53,$600.04
31200158,EAP,CPT® 88309,,Lung Resection,"$1,051.00",$164.53,"$1,051.00",$538.24,$178.45,$602.38,$209.20,$178.45,$178.45,$220.59,"$1,051.00",$630.05,$328.48,$832.39,$840.80,$875.37,$235.05,$274.45,$164.53,$600.04
31200159,EAP,CPT® 88309,,Esophagus Resection,"$1,051.00",$164.53,"$1,051.00",$538.24,$178.45,$602.38,$209.20,$178.45,$178.45,$220.59,"$1,051.00",$630.05,$328.48,$832.39,$840.80,$875.37,$235.05,$274.45,$164.53,$600.04
31200160,EAP,CPT® 88309,,"Colon, Total Resectn","$1,051.00",$164.53,"$1,051.00",$538.24,$178.45,$602.38,$209.20,$178.45,$178.45,$220.59,"$1,051.00",$630.05,$328.48,$832.39,$840.80,$875.37,$235.05,$274.45,$164.53,$600.04
31200161,EAP,CPT® 88309,,Pancreas,"$1,051.00",$164.53,"$1,051.00",$538.24,$178.45,$602.38,$209.20,$178.45,$178.45,$220.59,"$1,051.00",$630.05,$328.48,$832.39,$840.80,$875.37,$235.05,$274.45,$164.53,$600.04
31200162,EAP,CPT® 88309,,"Prostate,resectn Rad","$1,051.00",$164.53,"$1,051.00",$538.24,$178.45,$602.38,$209.20,$178.45,$178.45,$220.59,"$1,051.00",$630.05,$328.48,$832.39,$840.80,$875.37,$235.05,$274.45,$164.53,$600.04
31200163,EAP,CPT® 88309,,"Uterus, Tumor","$1,051.00",$164.53,"$1,051.00",$538.24,$178.45,$602.38,$209.20,$178.45,$178.45,$220.59,"$1,051.00",$630.05,$328.48,$832.39,$840.80,$875.37,$235.05,$274.45,$164.53,$600.04
31200164,EAP,CPT® 88309,,"Fetus, W/dissection","$1,051.00",$164.53,"$1,051.00",$538.24,$178.45,$602.38,$209.20,$178.45,$178.45,$220.59,"$1,051.00",$630.05,$328.48,$832.39,$840.80,$875.37,$235.05,$274.45,$164.53,$600.04
31200165,EAP,CPT® 88309,,Vulva  Resection,"$1,051.00",$164.53,"$1,051.00",$538.24,$178.45,$602.38,$209.20,$178.45,$178.45,$220.59,"$1,051.00",$630.05,$328.48,$832.39,$840.80,$875.37,$235.05,$274.45,$164.53,$600.04
31200166,EAP,CPT® 88312,,STAIN GRP I - ACID FAST BACT,$415.00,$38.01,$415.00,$129.78,$72.35,$47.44,$51.35,$72.35,$72.35,$50.97,$415.00,$49.62,$128.88,$328.68,$332.00,$68.93,$54.31,$79.24,$38.01,$47.25
31200167,EAP,CPT® 88312,,STAIN GRP I - BIELSCHOWSKY,$415.00,$38.01,$415.00,$129.78,$72.35,$47.44,$51.35,$72.35,$72.35,$50.97,$415.00,$49.62,$128.88,$328.68,$332.00,$68.93,$54.31,$79.24,$38.01,$47.25
31200168,EAP,CPT® 88312,,STAIN GRP I - C E VIOLET,$415.00,$38.01,$415.00,$129.78,$72.35,$47.44,$51.35,$72.35,$72.35,$50.97,$415.00,$49.62,$128.88,$328.68,$332.00,$68.93,$54.31,$79.24,$38.01,$47.25
31200169,EAP,CPT® 88312,,STAIN GRP I - FITE STAIN,$415.00,$38.01,$415.00,$129.78,$72.35,$47.44,$51.35,$72.35,$72.35,$50.97,$415.00,$49.62,$128.88,$328.68,$332.00,$68.93,$54.31,$79.24,$38.01,$47.25
31200170,EAP,CPT® 88312,,STAIN GRP I - GRAM STAIN,$415.00,$38.01,$415.00,$129.78,$72.35,$47.44,$51.35,$72.35,$72.35,$50.97,$415.00,$49.62,$128.88,$328.68,$332.00,$68.93,$54.31,$79.24,$38.01,$47.25
31200171,EAP,CPT® 88312,,STAIN GRP I - GR METH SILVER,$415.00,$38.01,$415.00,$129.78,$72.35,$47.44,$51.35,$72.35,$72.35,$50.97,$415.00,$49.62,$128.88,$328.68,$332.00,$68.93,$54.31,$79.24,$38.01,$47.25
31200172,EAP,CPT® 88312,,SPECAL STAIN GROUP I,$415.00,$38.01,$415.00,$129.78,$72.35,$47.44,$51.35,$72.35,$72.35,$50.97,$415.00,$49.62,$128.88,$328.68,$332.00,$68.93,$54.31,$79.24,$38.01,$47.25
31200173,EAP,CPT® 88312,,STAIN GRP I - RETICUL STAIN,$415.00,$38.01,$415.00,$129.78,$72.35,$47.44,$51.35,$72.35,$72.35,$50.97,$415.00,$49.62,$128.88,$328.68,$332.00,$68.93,$54.31,$79.24,$38.01,$47.25
31200174,EAP,CPT® 88312,,STAIN GRP I - STEINER-SPIRO,$415.00,$38.01,$415.00,$129.78,$72.35,$47.44,$51.35,$72.35,$72.35,$50.97,$415.00,$49.62,$128.88,$328.68,$332.00,$68.93,$54.31,$79.24,$38.01,$47.25
31200175,EAP,CPT® 88313,,STAIN GRP II - ALCIAN BLUE,$363.00,$31.93,$363.00,$91.98,$60.64,$32.06,$37.20,$60.64,$60.64,$52.76,$363.00,$33.53,$110.70,$287.50,$290.40,$46.58,$56.22,$64.47,$39.35,$31.93
31200176,EAP,CPT® 88313,,STAIN GRP II - COLLO IRON,$363.00,$31.93,$363.00,$91.98,$60.64,$32.06,$37.20,$60.64,$60.64,$52.76,$363.00,$33.53,$110.70,$287.50,$290.40,$46.58,$56.22,$64.47,$39.35,$31.93
31200177,EAP,CPT® 88313,,STAIN GRP II - COLLO IRON W HY,$363.00,$31.93,$363.00,$91.98,$60.64,$32.06,$37.20,$60.64,$60.64,$52.76,$363.00,$33.53,$110.70,$287.50,$290.40,$46.58,$56.22,$64.47,$39.35,$31.93
31200178,EAP,CPT® 88313,,STAIN GRP II - DIFF QUCK,$363.00,$31.93,$363.00,$91.98,$60.64,$32.06,$37.20,$60.64,$60.64,$52.76,$363.00,$33.53,$110.70,$287.50,$290.40,$46.58,$56.22,$64.47,$39.35,$31.93
31200179,EAP,CPT® 88313,,STAIN GRP II - CONGO RED,$363.00,$31.93,$363.00,$91.98,$60.64,$32.06,$37.20,$60.64,$60.64,$52.76,$363.00,$33.53,$110.70,$287.50,$290.40,$46.58,$56.22,$64.47,$39.35,$31.93
31200180,EAP,CPT® 88313,,STAIN GRP II - CRYSTAL VIOLET,$363.00,$31.93,$363.00,$91.98,$60.64,$32.06,$37.20,$60.64,$60.64,$52.76,$363.00,$33.53,$110.70,$287.50,$290.40,$46.58,$56.22,$64.47,$39.35,$31.93
31200181,EAP,CPT® 88313,,STAIN GRP II - ELASTIC,$363.00,$31.93,$363.00,$91.98,$60.64,$32.06,$37.20,$60.64,$60.64,$52.76,$363.00,$33.53,$110.70,$287.50,$290.40,$46.58,$56.22,$64.47,$39.35,$31.93
31200182,EAP,CPT® 88313,,STAIN GRP II - GIEMSA,$363.00,$31.93,$363.00,$91.98,$60.64,$32.06,$37.20,$60.64,$60.64,$52.76,$363.00,$33.53,$110.70,$287.50,$290.40,$46.58,$56.22,$64.47,$39.35,$31.93
31200183,EAP,CPT® 88313,,STAIN GRP II - IRON,$363.00,$31.93,$363.00,$91.98,$60.64,$32.06,$37.20,$60.64,$60.64,$52.76,$363.00,$33.53,$110.70,$287.50,$290.40,$46.58,$56.22,$64.47,$39.35,$31.93
31200184,EAP,CPT® 88313,,STAIN GRP II - LUXOL BLUE,$363.00,$31.93,$363.00,$91.98,$60.64,$32.06,$37.20,$60.64,$60.64,$52.76,$363.00,$33.53,$110.70,$287.50,$290.40,$46.58,$56.22,$64.47,$39.35,$31.93
31200185,EAP,CPT® 88313,,STAIN GRP II - MASSON TRI,$363.00,$31.93,$363.00,$91.98,$60.64,$32.06,$37.20,$60.64,$60.64,$52.76,$363.00,$33.53,$110.70,$287.50,$290.40,$46.58,$56.22,$64.47,$39.35,$31.93
31200186,EAP,CPT® 88313,,STAIN GRP II - MUCICARMINE,$363.00,$31.93,$363.00,$91.98,$60.64,$32.06,$37.20,$60.64,$60.64,$52.76,$363.00,$33.53,$110.70,$287.50,$290.40,$46.58,$56.22,$64.47,$39.35,$31.93
31200187,EAP,CPT® 88313,,STAIN GRP II - OIL RED O,$363.00,$31.93,$363.00,$91.98,$60.64,$32.06,$37.20,$60.64,$60.64,$52.76,$363.00,$33.53,$110.70,$287.50,$290.40,$46.58,$56.22,$64.47,$39.35,$31.93
31200188,EAP,CPT® 88313,,STAIN GRP II - PAS,$363.00,$31.93,$363.00,$91.98,$60.64,$32.06,$37.20,$60.64,$60.64,$52.76,$363.00,$33.53,$110.70,$287.50,$290.40,$46.58,$56.22,$64.47,$39.35,$31.93
31200189,EAP,CPT® 88313,,STAIN GRP II - PAS ALC BLUE,$363.00,$31.93,$363.00,$91.98,$60.64,$32.06,$37.20,$60.64,$60.64,$52.76,$363.00,$33.53,$110.70,$287.50,$290.40,$46.58,$56.22,$64.47,$39.35,$31.93
31200190,EAP,CPT® 88313,,STAIN GRP II - PAS W / WO DIAD,$363.00,$31.93,$363.00,$91.98,$60.64,$32.06,$37.20,$60.64,$60.64,$52.76,$363.00,$33.53,$110.70,$287.50,$290.40,$46.58,$56.22,$64.47,$39.35,$31.93
31200191,EAP,CPT® 88313,,STAIN GRP II - SUDAN BLK B,$363.00,$31.93,$363.00,$91.98,$60.64,$32.06,$37.20,$60.64,$60.64,$52.76,$363.00,$33.53,$110.70,$287.50,$290.40,$46.58,$56.22,$64.47,$39.35,$31.93
31200192,EAP,CPT® 88313,,STAIN GRP II - TOLU BLUE,$363.00,$31.93,$363.00,$91.98,$60.64,$32.06,$37.20,$60.64,$60.64,$52.76,$363.00,$33.53,$110.70,$287.50,$290.40,$46.58,$56.22,$64.47,$39.35,$31.93
31200193,EAP,CPT® 88313,,Stain Grp Ii - Sudan Black,$363.00,$31.93,$363.00,$91.98,$60.64,$32.06,$37.20,$60.64,$60.64,$52.76,$363.00,$33.53,$110.70,$287.50,$290.40,$46.58,$56.22,$64.47,$39.35,$31.93
31200194,EAP,CPT® 88313,,Stain Grp Ii - Nasd Cl-ac-est,$363.00,$31.93,$363.00,$91.98,$60.64,$32.06,$37.20,$60.64,$60.64,$52.76,$363.00,$33.53,$110.70,$287.50,$290.40,$46.58,$56.22,$64.47,$39.35,$31.93
31200195,EAP,CPT® 88313,,Stain Grp Ii - Nafl Inhi Nasd,$363.00,$31.93,$363.00,$91.98,$60.64,$32.06,$37.20,$60.64,$60.64,$52.76,$363.00,$33.53,$110.70,$287.50,$290.40,$46.58,$56.22,$64.47,$39.35,$31.93
31200196,EAP,CPT® 88313,,Stain Grp Ii - Pas,$363.00,$31.93,$363.00,$91.98,$60.64,$32.06,$37.20,$60.64,$60.64,$52.76,$363.00,$33.53,$110.70,$287.50,$290.40,$46.58,$56.22,$64.47,$39.35,$31.93
31200197,EAP,CPT® 88313,,Stain Grp Ii - Naphth Ester,$363.00,$31.93,$363.00,$91.98,$60.64,$32.06,$37.20,$60.64,$60.64,$52.76,$363.00,$33.53,$110.70,$287.50,$290.40,$46.58,$56.22,$64.47,$39.35,$31.93
31200198,EAP,CPT® 88313,,Stain Grp Ii - T Resist Ap,$363.00,$31.93,$363.00,$91.98,$60.64,$32.06,$37.20,$60.64,$60.64,$52.76,$363.00,$33.53,$110.70,$287.50,$290.40,$46.58,$56.22,$64.47,$39.35,$31.93
31200199,EAP,CPT® 88313,,Stain Grp Ii - Fontana Masson,$513.00,$31.93,$513.00,$91.98,$60.64,$32.06,$37.20,$60.64,$60.64,$52.76,$513.00,$33.53,$110.70,$406.30,$410.40,$46.58,$56.22,$64.47,$39.35,$31.93
31200200,EAP,CPT® 88313,,Stain Grp Ii - Bile Stain,$513.00,$31.93,$513.00,$91.98,$60.64,$32.06,$37.20,$60.64,$60.64,$52.76,$513.00,$33.53,$110.70,$406.30,$410.40,$46.58,$56.22,$64.47,$39.35,$31.93
31200201,EAP,CPT® 88313,,Stain Grp Ii - Calcium Stain,$513.00,$31.93,$513.00,$91.98,$60.64,$32.06,$37.20,$60.64,$60.64,$52.76,$513.00,$33.53,$110.70,$406.30,$410.40,$46.58,$56.22,$64.47,$39.35,$31.93
31200202,EAP,CPT® 88313,,Stain Grp Ii - Melanin (bleach),$513.00,$31.93,$513.00,$91.98,$60.64,$32.06,$37.20,$60.64,$60.64,$52.76,$513.00,$33.53,$110.70,$406.30,$410.40,$46.58,$56.22,$64.47,$39.35,$31.93
31200203,EAP,CPT® 88342,,A-1 Antitrypsin,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200204,EAP,CPT® 88342,,"Actin,muscle Spec.",$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200205,EAP,CPT® 88342,,Alpha-fetoprotein,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200206,EAP,CPT® 88342,,B72.3-breast,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200207,EAP,CPT® 88342,,Ca 125-ovarian Ca,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200208,EAP,CPT® 88342,,Ca-19-9-carbohydrat,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200209,EAP,CPT® 88342,,Calcitonin,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200210,EAP,CPT® 88342,,Cea-p,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200211,EAP,CPT® 88342,,Chromogranin,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200212,EAP,CPT® 88342,,Cytokeratin-ae1/ae3,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200213,EAP,CPT® 88342,,Cytokeratin-cam5.2,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200214,EAP,CPT® 88342,,Cytomegalovirus,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200215,EAP,CPT® 88342,,Desmin,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200216,EAP,CPT® 88342,,Ema,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200217,EAP,CPT® 88342,,Factor Viii,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200219,EAP,CPT® 88342,,*stain: Oncoprotein (bcl2),$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200220,EAP,CPT® 88342,,*stain: Cd30/ber H2 (ki-1),$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200221,EAP,CPT® 88342,,*stain: B-1 Glyco,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200222,EAP,CPT® 88342,,*stain: Calponin,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200223,EAP,CPT® 88342,,*stain: Calretinin,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200224,EAP,CPT® 88342,,*stain: A-1 Antichymotryps,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200225,EAP,CPT® 88342,,*stain: Cytokeratin 20,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200226,EAP,CPT® 88342,,*stain: Cd10,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200227,EAP,CPT® 88342,,*stain: Cd138,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200228,EAP,CPT® 88342,,*stain: Cd23,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200229,EAP,CPT® 88342,,*stain: Cd3,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200230,EAP,CPT® 88342,,*stain: Cd31,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200231,EAP,CPT® 88342,,*stain: Cd34,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200232,EAP,CPT® 88342,,*stain: Cd43,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200233,EAP,CPT® 88342,,*stain: Cd5,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200234,EAP,CPT® 88342,,*stain: Cd79,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200235,EAP,CPT® 88360,,*stain: Ki-67 (mib-1),$616.00,$65.32,$616.00,$184.86,$65.70,$137.60,$65.32,$65.70,$65.70,$114.71,$616.00,$143.92,$121.34,$487.87,$492.80,$199.96,$122.23,$83.20,$85.56,$137.07
31200236,EAP,CPT® 88342,,*stain: Cytokeratin 7,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200237,EAP,CPT® 88342,,*stain: Hepatocyte,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200238,EAP,CPT® 88342,,*stain: Hi Mol Wt Keratin,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200239,EAP,CPT® 88342,,*stain: Inhibin Alpha,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200240,EAP,CPT® 88342,,*stain: Myeloperoxidase,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200241,EAP,CPT® 88342,,*stain: P16,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200242,EAP,CPT® 88342,,*stain: P53,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200243,EAP,CPT® 88342,,*stain: Tdt,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200244,EAP,CPT® 88342,,*stain: Ttf-1,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200245,EAP,CPT® 88342,,*stain: Villin,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200246,EAP,CPT® 88342,,Immunoperoxidase,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200247,EAP,CPT® 88360,,Estrogen Receptor,$616.00,$65.32,$616.00,$184.86,$65.70,$137.60,$65.32,$65.70,$65.70,$114.71,$616.00,$143.92,$121.34,$487.87,$492.80,$199.96,$122.23,$83.20,$85.56,$137.07
31200248,EAP,CPT® 88360,,Progesterone Recep.,$616.00,$65.32,$616.00,$184.86,$65.70,$137.60,$65.32,$65.70,$65.70,$114.71,$616.00,$143.92,$121.34,$487.87,$492.80,$199.96,$122.23,$83.20,$85.56,$137.07
31200249,EAP,CPT® 88342,,Glial Fibrillary Ap,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200250,EAP,CPT® 88342,,Glucagon,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200251,EAP,CPT® 88342,,Hepatitis B Core,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200252,EAP,CPT® 88342,,Hepatitis B Surface,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200253,EAP,CPT® 88342,,Herpes Simplex Prob,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200254,EAP,CPT® 88342,,Human Chorionic Gon,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200255,EAP,CPT® 88342,,Human Growth Hormon,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200256,EAP,CPT® 88342,,Insulin,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200257,EAP,CPT® 88342,,Kappa,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200258,EAP,CPT® 88342,,L-26 B Cell Marker,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200259,EAP,CPT® 88342,,Lambda,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200260,EAP,CPT® 88342,,Leu M1,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200261,EAP,CPT® 88342,,Leukocyte Common Ag,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200262,EAP,CPT® 88342,,Leuteinizing Hormon,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200263,EAP,CPT® 88342,,Macrophage-ham-56,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200264,EAP,CPT® 88342,,Melanoma-hmb-45,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200265,EAP,CPT® 88342,,Neuron Spec Enolase,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200266,EAP,CPT® 88342,,Placental Alk Phos,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200267,EAP,CPT® 88342,,Placental Lactogen,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200268,EAP,CPT® 88342,,Prolactin,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200269,EAP,CPT® 88342,,Prostate Acid Phos,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200270,EAP,CPT® 88342,,Prostate Spec Ag,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200271,EAP,CPT® 88342,,S-100 Neural Ag,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200272,EAP,CPT® 88342,,Serotonin,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200273,EAP,CPT® 88342,,Synatophysin,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200274,EAP,CPT® 88342,,Thyroglobulin,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200275,EAP,CPT® 88342,,Uchl-1,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200276,EAP,CPT® 88342,,Vimentin,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200277,EAP,CPT® 88342,,Em:kappa,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200278,EAP,CPT® 88342,,Em:lambda,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200279,EAP,CPT® 88346,,Em:igg,$810.00,$56.43,$810.00,$124.62,$57.29,$271.76,$56.43,$57.29,$57.29,$83.33,$810.00,$284.24,$112.24,$641.52,$648.00,$394.92,$88.79,$90.76,$62.15,$270.71
31200280,EAP,CPT® 88346,,Em:iga,$810.00,$56.43,$810.00,$124.62,$57.29,$271.76,$56.43,$57.29,$57.29,$83.33,$810.00,$284.24,$112.24,$641.52,$648.00,$394.92,$88.79,$90.76,$62.15,$270.71
31200281,EAP,CPT® 88346,,Em:igm,$810.00,$56.43,$810.00,$124.62,$57.29,$271.76,$56.43,$57.29,$57.29,$83.33,$810.00,$284.24,$112.24,$641.52,$648.00,$394.92,$88.79,$90.76,$62.15,$270.71
31200282,EAP,CPT® 88346,,Em:c3,$810.00,$56.43,$810.00,$124.62,$57.29,$271.76,$56.43,$57.29,$57.29,$83.33,$810.00,$284.24,$112.24,$641.52,$648.00,$394.92,$88.79,$90.76,$62.15,$270.71
31200283,EAP,CPT® 88346,,Em:c4,$810.00,$56.43,$810.00,$124.62,$57.29,$271.76,$56.43,$57.29,$57.29,$83.33,$810.00,$284.24,$112.24,$641.52,$648.00,$394.92,$88.79,$90.76,$62.15,$270.71
31200284,EAP,CPT® 88346,,Em:c1q,$810.00,$56.43,$810.00,$124.62,$57.29,$271.76,$56.43,$57.29,$57.29,$83.33,$810.00,$284.24,$112.24,$641.52,$648.00,$394.92,$88.79,$90.76,$62.15,$270.71
31200285,EAP,CPT® 88346,,Em:fibrogen,$810.00,$56.43,$810.00,$124.62,$57.29,$271.76,$56.43,$57.29,$57.29,$83.33,$810.00,$284.24,$112.24,$641.52,$648.00,$394.92,$88.79,$90.76,$62.15,$270.71
31200286,EAP,CPT® 88346,,"Immunof,dir Charge",$755.00,$56.43,$755.00,$124.62,$57.29,$271.76,$56.43,$57.29,$57.29,$83.33,$755.00,$284.24,$112.24,$597.96,$604.00,$394.92,$88.79,$90.76,$62.15,$270.71
31200287,EAP,CPT® 88346,,"Immunof, Ind Charge",$511.00,$56.43,$511.00,$124.62,$57.29,$271.76,$56.43,$57.29,$57.29,$83.33,$511.00,$284.24,$112.24,$404.71,$408.80,$394.92,$88.79,$90.76,$62.15,$270.71
31200288,EAP,CPT® 88360,,*stain: Her2neu,$616.00,$65.32,$616.00,$184.86,$65.70,$137.60,$65.32,$65.70,$65.70,$114.71,$616.00,$143.92,$121.34,$487.87,$492.80,$199.96,$122.23,$83.20,$85.56,$137.07
31200290,EAP,CPT® 88342,,*stain: Ber Ep4,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200291,EAP,CPT® 88342,,*stain: Cd117 (c-kit),$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200292,EAP,CPT® 88342,,*stain: Cdx2,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200293,EAP,CPT® 88342,,*stain: Cea (monoclonal),$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200294,EAP,CPT® 88342,,*stain: Cyclin D1,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200295,EAP,CPT® 88342,,*stain: Cytokeratin 19,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200296,EAP,CPT® 88342,,*stain: Cytokeratin 5,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200297,EAP,CPT® 88342,,*stain: Cytokeratin 5/6,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200298,EAP,CPT® 88342,,*stain: Cytokeratin 6,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200299,EAP,CPT® 88342,,*stain: E-cadherin,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200300,EAP,CPT® 88342,,*stain: Egfr,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200301,EAP,CPT® 88342,,*stain: Galectin-3,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200302,EAP,CPT® 88342,,*stain: Gcdfp-15,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200303,EAP,CPT® 88342,,*stain: Hbme-1,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200304,EAP,CPT® 88342,,*stain: Helicobacter Pylori,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200305,EAP,CPT® 88342,,*stain: Hhv-8 (human Herpes-8),$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200306,EAP,CPT® 88342,,*stain: Melan A (mart-1),$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200307,EAP,CPT® 88342,,*stain: P10,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200308,EAP,CPT® 88342,,*stain: P63,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200309,EAP,CPT® 88342,,*stain: Treponema,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200310,EAP,CPT® 88342,,*stain: Wt-1,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200311,EAP,CPT® 88342,,*stain:pin Cocktail(p63=p504s),$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200312,EAP,CPT® 88342,,*stain:sma(smooth Muscle Actin,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200313,EAP,CPT® 88342,,Stain: Cd56,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200314,EAP,CPT® 88342,,Stain: Cd99,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200315,EAP,CPT® 88342,,Stain: Glypican-3,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200316,EAP,CPT® 88342,,Stain: Moc-1,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200317,EAP,CPT® 88342,,Immunohisto Chemistry,$278.00,$54.62,$278.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$278.00,$143.92,$106.46,$220.18,$222.40,$199.96,$89.59,$70.23,$62.72,$137.07
31200320,EAP,CPT® 88342,,Ihc Marker (stain Only) (so),$333.00,$54.62,$333.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$333.00,$143.92,$106.46,$263.74,$266.40,$199.96,$89.59,$70.23,$62.72,$137.07
31200321,EAP,CPT® 88361,,Inscape  Er/pr/her Quant-ihc  (so),$736.00,$0.00,$736.00,$0.00,$93.17,$0.00,$0.00,$93.17,$93.17,$0.00,$736.00,$0.00,$212.60,$582.91,$588.80,$0.00,$0.00,$0.00,$0.00,$0.00
31200322,EAP,CPT® 88361,,Inscape Er/pr Quant -ihc  (so),$510.00,$0.00,$510.00,$0.00,$93.17,$0.00,$0.00,$93.17,$93.17,$0.00,$510.00,$0.00,$212.60,$403.92,$408.00,$0.00,$0.00,$0.00,$0.00,$0.00
31200323,EAP,CPT® 88342,,Ercc1  Ihc With Interp (so),$278.00,$54.62,$278.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$278.00,$143.92,$106.46,$220.18,$222.40,$199.96,$89.59,$70.23,$62.72,$137.07
31200330,EAP,CPT® 88305,,Accessort Digit  Diagnostic,$367.00,$32.05,$367.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$367.00,$49.62,$140.98,$290.66,$293.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200331,EAP,CPT® 88305,,Acromioclavicular Joint,$367.00,$32.05,$367.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$367.00,$49.62,$140.98,$290.66,$293.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200332,EAP,CPT® 88304,,Adhesions  Pelvic,$367.00,$20.69,$367.00,$54.15,$51.07,$47.44,$20.69,$51.07,$51.07,$35.46,$367.00,$49.62,$108.12,$290.66,$293.60,$68.93,$37.78,$29.89,$26.45,$47.25
31200333,EAP,CPT® 88304,,Adipose Tissue (fat/fatty Tissue),$367.00,$20.69,$367.00,$54.15,$51.07,$47.44,$20.69,$51.07,$51.07,$35.46,$367.00,$49.62,$108.12,$290.66,$293.60,$68.93,$37.78,$29.89,$26.45,$47.25
31200334,EAP,CPT® 88305,,Ampulla Of Vater,$367.00,$32.05,$367.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$367.00,$49.62,$140.98,$290.66,$293.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200335,EAP,CPT® 88307,,Amputation-extremity  Non-traumatic,$367.00,$116.80,$367.00,$351.05,$130.18,$271.76,$137.71,$130.18,$130.18,$156.60,$367.00,$284.24,$240.00,$290.66,$293.60,$367.00,$166.86,$194.49,$116.80,$270.71
31200336,EAP,CPT® 88307,,Arachnoid Mater-tumor Resection,$367.00,$116.80,$367.00,$351.05,$130.18,$271.76,$137.71,$130.18,$130.18,$156.60,$367.00,$284.24,$240.00,$290.66,$293.60,$367.00,$166.86,$194.49,$116.80,$270.71
31200337,EAP,CPT® 88305,,Arteriovenous Malformation (avm),$469.00,$32.05,$469.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$469.00,$49.62,$140.98,$371.45,$375.20,$68.93,$82.47,$32.05,$57.73,$47.25
31200338,EAP,CPT® 88307,,Arteriovenous Malformation (avm)  Complex,$469.00,$116.80,$469.00,$351.05,$130.18,$271.76,$137.71,$130.18,$130.18,$156.60,$469.00,$284.24,$240.00,$371.45,$375.20,$394.92,$166.86,$194.49,$116.80,$270.71
31200339,EAP,CPT® 88307,,Axillary Tail/axilla - Lymph Nodes Resection,$469.00,$116.80,$469.00,$351.05,$130.18,$271.76,$137.71,$130.18,$130.18,$156.60,$469.00,$284.24,$240.00,$371.45,$375.20,$394.92,$166.86,$194.49,$116.80,$270.71
31200340,EAP,CPT® 88305,,Bone Marrow Particle Clot,$469.00,$32.05,$469.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$469.00,$49.62,$140.98,$371.45,$375.20,$68.93,$82.47,$32.05,$57.73,$47.25
31200341,EAP,CPT® 88305,,Breast Excision Of Discrete Lesion,$469.00,$32.05,$469.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$469.00,$49.62,$140.98,$371.45,$375.20,$68.93,$82.47,$32.05,$57.73,$47.25
31200342,EAP,CPT® 88305,,Breast Needle Core Tissue Biopsy,$469.00,$32.05,$469.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$469.00,$49.62,$140.98,$371.45,$375.20,$68.93,$82.47,$32.05,$57.73,$47.25
31200343,EAP,CPT® 88305,,Breast  Incisional Biopsy,$469.00,$32.05,$469.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$469.00,$49.62,$140.98,$371.45,$375.20,$68.93,$82.47,$32.05,$57.73,$47.25
31200344,EAP,CPT® 88307,,Breast  Quadrantectomy/partial Mastectomy/segmentectomy,$469.00,$116.80,$469.00,$351.05,$130.18,$271.76,$137.71,$130.18,$130.18,$156.60,$469.00,$284.24,$240.00,$371.45,$375.20,$394.92,$166.86,$194.49,$116.80,$270.71
31200345,EAP,CPT® 88307,,Cervix Amputation Without Uterus,$469.00,$116.80,$469.00,$351.05,$130.18,$271.76,$137.71,$130.18,$130.18,$156.60,$469.00,$284.24,$240.00,$371.45,$375.20,$394.92,$166.86,$194.49,$116.80,$270.71
31200346,EAP,CPT® 88305,,"Colon ""donut""",$469.00,$32.05,$469.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$469.00,$49.62,$140.98,$371.45,$375.20,$68.93,$82.47,$32.05,$57.73,$47.25
31200347,EAP,CPT® 88304,,Colon Donut,$469.00,$20.69,$469.00,$54.15,$51.07,$47.44,$20.69,$51.07,$51.07,$35.46,$469.00,$49.62,$108.12,$371.45,$375.20,$68.93,$37.78,$29.89,$26.45,$47.25
31200348,EAP,CPT® 88307,,Cyst - Bone,$469.00,$116.80,$469.00,$351.05,$130.18,$271.76,$137.71,$130.18,$130.18,$156.60,$469.00,$284.24,$240.00,$371.45,$375.20,$394.92,$166.86,$194.49,$116.80,$270.71
31200349,EAP,CPT® 88305,,Cyst - Cervix,$469.00,$32.05,$469.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$469.00,$49.62,$140.98,$371.45,$375.20,$68.93,$82.47,$32.05,$57.73,$47.25
31200350,EAP,CPT® 88307,,Cyst - Dermoid Of Soft Tissue/ovary (eg Teratoma),$469.00,$116.80,$469.00,$351.05,$130.18,$271.76,$137.71,$130.18,$130.18,$156.60,$469.00,$284.24,$240.00,$371.45,$375.20,$394.92,$166.86,$194.49,$116.80,$270.71
31200351,EAP,CPT® 88304,,Cyst - Dermoid Skin,$469.00,$20.69,$469.00,$54.15,$51.07,$47.44,$20.69,$51.07,$51.07,$35.46,$469.00,$49.62,$108.12,$371.45,$375.20,$68.93,$37.78,$29.89,$26.45,$47.25
31200352,EAP,CPT® 88304,,Cyst - Epidermoid,$585.00,$20.69,$585.00,$54.15,$51.07,$47.44,$20.69,$51.07,$51.07,$35.46,$585.00,$49.62,$108.12,$463.32,$468.00,$68.93,$37.78,$29.89,$26.45,$47.25
31200353,EAP,CPT® 88305,,Cyst - Ovarian  Non-neoplastic,$585.00,$32.05,$585.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$585.00,$49.62,$140.98,$463.32,$468.00,$68.93,$82.47,$32.05,$57.73,$47.25
31200354,EAP,CPT® 88307,,Cyst  Nos  Neoplastic,$585.00,$116.80,$585.00,$351.05,$130.18,$271.76,$137.71,$130.18,$130.18,$156.60,$585.00,$284.24,$240.00,$463.32,$468.00,$394.92,$166.86,$194.49,$116.80,$270.71
31200355,EAP,CPT® 88305,,Cyst  Nos  Nonneoplastic,$585.00,$32.05,$585.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$585.00,$49.62,$140.98,$463.32,$468.00,$68.93,$82.47,$32.05,$57.73,$47.25
31200356,EAP,CPT® 88302,,Cystocele,$585.00,$15.79,$585.00,$40.63,$42.29,$22.05,$15.79,$42.29,$42.29,$41.19,$585.00,$23.06,$87.44,$463.32,$468.00,$32.04,$43.89,$24.13,$30.72,$21.96
31200357,EAP,CPT® 88309,,Diaphragm - Resection For Tumor,$585.00,$164.53,$630.05,$538.24,$178.45,$602.38,$209.20,$178.45,$178.45,$220.59,$585.00,$630.05,$328.48,$463.32,$468.00,$585.00,$235.05,$274.45,$164.53,$600.04
31200358,EAP,CPT® 88307,,Diaphragm - Resection Other Than For Tumor,$585.00,$116.80,$585.00,$351.05,$130.18,$271.76,$137.71,$130.18,$130.18,$156.60,$585.00,$284.24,$240.00,$463.32,$468.00,$394.92,$166.86,$194.49,$116.80,$270.71
31200359,EAP,CPT® 88307,,Dura Mater - Tumor Resection,$585.00,$116.80,$585.00,$351.05,$130.18,$271.76,$137.71,$130.18,$130.18,$156.60,$585.00,$284.24,$240.00,$463.32,$468.00,$394.92,$166.86,$194.49,$116.80,$270.71
31200360,EAP,CPT® 88305,,Endometrial Polyp,$585.00,$32.05,$585.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$585.00,$49.62,$140.98,$463.32,$468.00,$68.93,$82.47,$32.05,$57.73,$47.25
31200361,EAP,CPT® 88309,,Endoscopic Mucosal Resection (emr),$585.00,$164.53,$630.05,$538.24,$178.45,$602.38,$209.20,$178.45,$178.45,$220.59,$585.00,$630.05,$328.48,$463.32,$468.00,$585.00,$235.05,$274.45,$164.53,$600.04
31200362,EAP,CPT® 88305,,Epiglottis Biopsy/simple Excision,$585.00,$32.05,$585.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$585.00,$49.62,$140.98,$463.32,$468.00,$68.93,$82.47,$32.05,$57.73,$47.25
31200363,EAP,CPT® 88305,,Esophageal Polyp,$585.00,$32.05,$585.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$585.00,$49.62,$140.98,$463.32,$468.00,$68.93,$82.47,$32.05,$57.73,$47.25
31200364,EAP,CPT® 88304,,Fat/fatty Tissue Nos,$585.00,$20.69,$585.00,$54.15,$51.07,$47.44,$20.69,$51.07,$51.07,$35.46,$585.00,$49.62,$108.12,$463.32,$468.00,$68.93,$37.78,$29.89,$26.45,$47.25
31200365,EAP,CPT® 88305,,Gastric Polyp,$585.00,$32.05,$585.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$585.00,$49.62,$140.98,$463.32,$468.00,$68.93,$82.47,$32.05,$57.73,$47.25
31200366,EAP,CPT® 88305,,Mucosa Biopsy - Gingiva,$585.00,$32.05,$585.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$585.00,$49.62,$140.98,$463.32,$468.00,$68.93,$82.47,$32.05,$57.73,$47.25
31200367,EAP,CPT® 88305,,Mucosa Biopsy - Nasal,$585.00,$32.05,$585.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$585.00,$49.62,$140.98,$463.32,$468.00,$68.93,$82.47,$32.05,$57.73,$47.25
31200368,EAP,CPT® 88305,,Mucosa Biopsy - Nos,$585.00,$32.05,$585.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$585.00,$49.62,$140.98,$463.32,$468.00,$68.93,$82.47,$32.05,$57.73,$47.25
31200369,EAP,CPT® 88304,,Nasal Septum,$585.00,$20.69,$585.00,$54.15,$51.07,$47.44,$20.69,$51.07,$51.07,$35.46,$585.00,$49.62,$108.12,$463.32,$468.00,$68.93,$37.78,$29.89,$26.45,$47.25
31200370,EAP,CPT® 88307,,Omentum Resection,$585.00,$116.80,$585.00,$351.05,$130.18,$271.76,$137.71,$130.18,$130.18,$156.60,$585.00,$284.24,$240.00,$463.32,$468.00,$394.92,$166.86,$194.49,$116.80,$270.71
31200371,EAP,CPT® 88309,,Omentum Resection - For Tumor,$585.00,$164.53,$630.05,$538.24,$178.45,$602.38,$209.20,$178.45,$178.45,$220.59,$585.00,$630.05,$328.48,$463.32,$468.00,$585.00,$235.05,$274.45,$164.53,$600.04
31200372,EAP,CPT® 88305,,Oral Cyst,$585.00,$32.05,$585.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$585.00,$49.62,$140.98,$463.32,$468.00,$68.93,$82.47,$32.05,$57.73,$47.25
31200373,EAP,CPT® 88305,,Panniculus,$585.00,$32.05,$585.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$585.00,$49.62,$140.98,$463.32,$468.00,$68.93,$82.47,$32.05,$57.73,$47.25
31200374,EAP,CPT® 88305,,Penis Biopsy,$585.00,$32.05,$585.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$585.00,$49.62,$140.98,$463.32,$468.00,$68.93,$82.47,$32.05,$57.73,$47.25
31200375,EAP,CPT® 88309,,Penis Resection For Tumor,$585.00,$164.53,$630.05,$538.24,$178.45,$602.38,$209.20,$178.45,$178.45,$220.59,$585.00,$630.05,$328.48,$463.32,$468.00,$585.00,$235.05,$274.45,$164.53,$600.04
31200376,EAP,CPT® 88305,,Pericardiium Biopsy Or Tissue,$585.00,$32.05,$585.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$585.00,$49.62,$140.98,$463.32,$468.00,$68.93,$82.47,$32.05,$57.73,$47.25
31200377,EAP,CPT® 88309,,Pericardium Resection - For Tumor,$585.00,$164.53,$630.05,$538.24,$178.45,$602.38,$209.20,$178.45,$178.45,$220.59,$585.00,$630.05,$328.48,$463.32,$468.00,$585.00,$235.05,$274.45,$164.53,$600.04
31200378,EAP,CPT® 88309,,Peritoneum Resection - For Tumor,$585.00,$164.53,$630.05,$538.24,$178.45,$602.38,$209.20,$178.45,$178.45,$220.59,$585.00,$630.05,$328.48,$463.32,$468.00,$585.00,$235.05,$274.45,$164.53,$600.04
31200379,EAP,CPT® 88305,,Pia Mater - Other Than Tumor Resection,$585.00,$32.05,$585.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$585.00,$49.62,$140.98,$463.32,$468.00,$68.93,$82.47,$32.05,$57.73,$47.25
31200380,EAP,CPT® 88307,,Pia Mater - Tumor Resection,$585.00,$116.80,$585.00,$351.05,$130.18,$271.76,$137.71,$130.18,$130.18,$156.60,$585.00,$284.24,$240.00,$463.32,$468.00,$394.92,$166.86,$194.49,$116.80,$270.71
31200381,EAP,CPT® 88307,,Pleura Resection,$585.00,$116.80,$585.00,$351.05,$130.18,$271.76,$137.71,$130.18,$130.18,$156.60,$585.00,$284.24,$240.00,$463.32,$468.00,$394.92,$166.86,$194.49,$116.80,$270.71
31200382,EAP,CPT® 88305,,Retroperitoneal Biopsy,$585.00,$32.05,$585.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$585.00,$49.62,$140.98,$463.32,$468.00,$68.93,$82.47,$32.05,$57.73,$47.25
31200383,EAP,CPT® 88304,,Scar - Soft Tissue,$585.00,$20.69,$585.00,$54.15,$51.07,$47.44,$20.69,$51.07,$51.07,$35.46,$585.00,$49.62,$108.12,$463.32,$468.00,$68.93,$37.78,$29.89,$26.45,$47.25
31200384,EAP,CPT® 88305,,Skin  Wart (eg  Verruca Vulgaris),$585.00,$32.05,$585.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$585.00,$49.62,$140.98,$463.32,$468.00,$68.93,$82.47,$32.05,$57.73,$47.25
31200385,EAP,CPT® 88305,,Spinal Cord Biopsy,$585.00,$32.05,$585.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$585.00,$49.62,$140.98,$463.32,$468.00,$68.93,$82.47,$32.05,$57.73,$47.25
31200386,EAP,CPT® 88307,,Spinal Cord Tumor Excision,$585.00,$116.80,$585.00,$351.05,$130.18,$271.76,$137.71,$130.18,$130.18,$156.60,$585.00,$284.24,$240.00,$463.32,$468.00,$394.92,$166.86,$194.49,$116.80,$270.71
31200387,EAP,CPT® 88304,,Stoma (any Site),$585.00,$20.69,$585.00,$54.15,$51.07,$47.44,$20.69,$51.07,$51.07,$35.46,$585.00,$49.62,$108.12,$463.32,$468.00,$68.93,$37.78,$29.89,$26.45,$47.25
31200388,EAP,CPT® 88305,,Stomach Polyp,$585.00,$32.05,$585.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$585.00,$49.62,$140.98,$463.32,$468.00,$68.93,$82.47,$32.05,$57.73,$47.25
31200389,EAP,CPT® 88302,,Supernumerary Digit,$585.00,$15.79,$585.00,$40.63,$42.29,$22.05,$15.79,$42.29,$42.29,$41.19,$585.00,$23.06,$87.44,$463.32,$468.00,$32.04,$43.89,$24.13,$30.72,$21.96
31200390,EAP,CPT® 88305,,Supernumerary Digit Diagnostic,$585.00,$32.05,$585.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$585.00,$49.62,$140.98,$463.32,$468.00,$68.93,$82.47,$32.05,$57.73,$47.25
31200391,EAP,CPT® 88307,,Surgical Margin  Complicated Exam,$585.00,$116.80,$585.00,$351.05,$130.18,$271.76,$137.71,$130.18,$130.18,$156.60,$585.00,$284.24,$240.00,$463.32,$468.00,$394.92,$166.86,$194.49,$116.80,$270.71
31200392,EAP,CPT® 88302,,Thymus  Incidential,$585.00,$15.79,$585.00,$40.63,$42.29,$22.05,$15.79,$42.29,$42.29,$41.19,$585.00,$23.06,$87.44,$463.32,$468.00,$32.04,$43.89,$24.13,$30.72,$21.96
31200393,EAP,CPT® 88302,,Uvula - Incidental,$585.00,$15.79,$585.00,$40.63,$42.29,$22.05,$15.79,$42.29,$42.29,$41.19,$585.00,$23.06,$87.44,$463.32,$468.00,$32.04,$43.89,$24.13,$30.72,$21.96
31200394,EAP,CPT® 88305,,Vocal Cord Biopsy,$585.00,$32.05,$585.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$585.00,$49.62,$140.98,$463.32,$468.00,$68.93,$82.47,$32.05,$57.73,$47.25
31200395,EAP,CPT® 88307,,Vocal Cord Resection,$585.00,$116.80,$585.00,$351.05,$130.18,$271.76,$137.71,$130.18,$130.18,$156.60,$585.00,$284.24,$240.00,$463.32,$468.00,$394.92,$166.86,$194.49,$116.80,$270.71
31200396,EAP,CPT® 88307,,Bone Cyst,$585.00,$116.80,$585.00,$351.05,$130.18,$271.76,$137.71,$130.18,$130.18,$156.60,$585.00,$284.24,$240.00,$463.32,$468.00,$394.92,$166.86,$194.49,$116.80,$270.71
31200397,EAP,CPT® 88305,,Breast Biopsy  Without Margin Exam,$585.00,$32.05,$585.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$585.00,$49.62,$140.98,$463.32,$468.00,$68.93,$82.47,$32.05,$57.73,$47.25
31200398,EAP,CPT® 88307,,Cyst - Ovarian  Neoplastic,$585.00,$116.80,$585.00,$351.05,$130.18,$271.76,$137.71,$130.18,$130.18,$156.60,$585.00,$284.24,$240.00,$463.32,$468.00,$394.92,$166.86,$194.49,$116.80,$270.71
31200399,EAP,CPT® 88305,,Cyst - Sinsus,$737.00,$32.05,$737.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$737.00,$49.62,$140.98,$583.70,$589.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200400,EAP,CPT® 88305,,Diaphragm Biopsy Or Tissue,$737.00,$32.05,$737.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$737.00,$49.62,$140.98,$583.70,$589.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200401,EAP,CPT® 88304,,Diverticulum - Bladder/urethra,$737.00,$20.69,$737.00,$54.15,$51.07,$47.44,$20.69,$51.07,$51.07,$35.46,$737.00,$49.62,$108.12,$583.70,$589.60,$68.93,$37.78,$29.89,$26.45,$47.25
31200402,EAP,CPT® 88305,,Dura Mater,$737.00,$32.05,$737.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$737.00,$49.62,$140.98,$583.70,$589.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200403,EAP,CPT® 88302,,Enterocele,$737.00,$15.79,$737.00,$40.63,$42.29,$22.05,$15.79,$42.29,$42.29,$41.19,$737.00,$23.06,$87.44,$583.70,$589.60,$32.04,$43.89,$24.13,$30.72,$21.96
31200404,EAP,CPT® 88305,,Ethmoid Tissue,$737.00,$32.05,$737.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$737.00,$49.62,$140.98,$583.70,$589.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200405,EAP,CPT® 88305,,Fat Pad  Biopsy,$737.00,$32.05,$737.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$737.00,$49.62,$140.98,$583.70,$589.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200406,EAP,CPT® 88305,,Leep Biopsy,$737.00,$32.05,$737.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$737.00,$49.62,$140.98,$583.70,$589.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200407,EAP,CPT® 88304,,Ligament,$737.00,$20.69,$737.00,$54.15,$51.07,$47.44,$20.69,$51.07,$51.07,$35.46,$737.00,$49.62,$108.12,$583.70,$589.60,$68.93,$37.78,$29.89,$26.45,$47.25
31200408,EAP,CPT® 88307,,Lymph Node For Lymphoma Workup,$737.00,$116.80,$737.00,$351.05,$130.18,$271.76,$137.71,$130.18,$130.18,$156.60,$737.00,$284.24,$240.00,$583.70,$589.60,$394.92,$166.86,$194.49,$116.80,$270.71
31200409,EAP,CPT® 88304,,Meningematoma/meninghematoma,$737.00,$20.69,$737.00,$54.15,$51.07,$47.44,$20.69,$51.07,$51.07,$35.46,$737.00,$49.62,$108.12,$583.70,$589.60,$68.93,$37.78,$29.89,$26.45,$47.25
31200410,EAP,CPT® 88305,,Mucosa Biopsy - Oral,$737.00,$32.05,$737.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$737.00,$49.62,$140.98,$583.70,$589.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200411,EAP,CPT® 88304,,Nail  Nail Bed Or Scrapping For Fungus,$737.00,$20.69,$737.00,$54.15,$51.07,$47.44,$20.69,$51.07,$51.07,$35.46,$737.00,$49.62,$108.12,$583.70,$589.60,$68.93,$37.78,$29.89,$26.45,$47.25
31200412,EAP,CPT® 88307,,Nerve Tumor,$737.00,$116.80,$737.00,$351.05,$130.18,$271.76,$137.71,$130.18,$130.18,$156.60,$737.00,$284.24,$240.00,$583.70,$589.60,$394.92,$166.86,$194.49,$116.80,$270.71
31200413,EAP,CPT® 88305,,Neurofibroma/neuroma,$737.00,$32.05,$737.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$737.00,$49.62,$140.98,$583.70,$589.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200414,EAP,CPT® 88305,,Osteochondroma (exostosis),$737.00,$32.05,$737.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$737.00,$49.62,$140.98,$583.70,$589.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200415,EAP,CPT® 88307,,Pericardium Resection,$737.00,$116.80,$737.00,$351.05,$130.18,$271.76,$137.71,$130.18,$130.18,$156.60,$737.00,$284.24,$240.00,$583.70,$589.60,$394.92,$166.86,$194.49,$116.80,$270.71
31200416,EAP,CPT® 88307,,Peritoneum Resection,$737.00,$116.80,$737.00,$351.05,$130.18,$271.76,$137.71,$130.18,$130.18,$156.60,$737.00,$284.24,$240.00,$583.70,$589.60,$394.92,$166.86,$194.49,$116.80,$270.71
31200417,EAP,CPT® 88309,,Pleura Resection - For Tumor,$737.00,$164.53,$737.00,$538.24,$178.45,$602.38,$209.20,$178.45,$178.45,$220.59,$737.00,$630.05,$328.48,$583.70,$589.60,$737.00,$235.05,$274.45,$164.53,$600.04
31200418,EAP,CPT® 88307,,Retroperitoneal Mass,$737.00,$116.80,$737.00,$351.05,$130.18,$271.76,$137.71,$130.18,$130.18,$156.60,$737.00,$284.24,$240.00,$583.70,$589.60,$394.92,$166.86,$194.49,$116.80,$270.71
31200419,EAP,CPT® 88305,,Rib  Marrow Squeeze,$737.00,$32.05,$737.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$737.00,$49.62,$140.98,$583.70,$589.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200420,EAP,CPT® 88305,,Scar - Keloid,$737.00,$32.05,$737.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$737.00,$49.62,$140.98,$583.70,$589.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200421,EAP,CPT® 88304,,Scar - Skin (simple/cicatrix),$737.00,$20.69,$737.00,$54.15,$51.07,$47.44,$20.69,$51.07,$51.07,$35.46,$737.00,$49.62,$108.12,$583.70,$589.60,$68.93,$37.78,$29.89,$26.45,$47.25
31200422,EAP,CPT® 88305,,Scar - Skin (tumor Excision/re-excision,$737.00,$32.05,$737.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$737.00,$49.62,$140.98,$583.70,$589.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200423,EAP,CPT® 88302,,Sinus Contents,"$1,001.00",$15.79,"$1,001.00",$40.63,$42.29,$22.05,$15.79,$42.29,$42.29,$41.19,"$1,001.00",$23.06,$87.44,$792.79,$800.80,$32.04,$43.89,$24.13,$30.72,$21.96
31200424,EAP,CPT® 88305,,Sinus Mucosa Stripping,"$1,001.00",$32.05,"$1,001.00",$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,"$1,001.00",$49.62,$140.98,$792.79,$800.80,$68.93,$82.47,$32.05,$57.73,$47.25
31200425,EAP,CPT® 88305,,Surgical Margin  Uncomplicated Exam,"$1,001.00",$32.05,"$1,001.00",$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,"$1,001.00",$49.62,$140.98,$792.79,$800.80,$68.93,$82.47,$32.05,$57.73,$47.25
31200426,EAP,CPT® 88305,,Thyroid Biopsy,"$1,001.00",$32.05,"$1,001.00",$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,"$1,001.00",$49.62,$140.98,$792.79,$800.80,$68.93,$82.47,$32.05,$57.73,$47.25
31200427,EAP,CPT® 88304,,Turbinates (nasal Conchae),"$1,001.00",$20.69,"$1,001.00",$54.15,$51.07,$47.44,$20.69,$51.07,$51.07,$35.46,"$1,001.00",$49.62,$108.12,$792.79,$800.80,$68.93,$37.78,$29.89,$26.45,$47.25
31200428,EAP,CPT® 88302,,Uvula Simple Excision,"$1,001.00",$15.79,"$1,001.00",$40.63,$42.29,$22.05,$15.79,$42.29,$42.29,$41.19,"$1,001.00",$23.06,$87.44,$792.79,$800.80,$32.04,$43.89,$24.13,$30.72,$21.96
31200429,EAP,CPT® 88305,,Vein Biopsy/segment,"$1,001.00",$32.05,"$1,001.00",$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,"$1,001.00",$49.62,$140.98,$792.79,$800.80,$68.93,$82.47,$32.05,$57.73,$47.25
31200450,EAP,CPT® 88342,,"P40 Protein, Ihc",$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200455,EAP,CPT® 88309,,"Teratoma , Extensive Resection","$1,001.00",$164.53,"$1,001.00",$538.24,$178.45,$602.38,$209.20,$178.45,$178.45,$220.59,"$1,001.00",$630.05,$328.48,$792.79,$800.80,$875.37,$235.05,$274.45,$164.53,$600.04
31200456,EAP,CPT® 88342,,"Napsin-a,ihc",$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200457,EAP,CPT® 88304,,"Appendix, Non-incidental",$469.00,$20.69,$469.00,$54.15,$51.07,$47.44,$20.69,$51.07,$51.07,$35.46,$469.00,$49.62,$108.12,$371.45,$375.20,$68.93,$37.78,$29.89,$26.45,$47.25
31200458,EAP,CPT® 88307,,Sentinel Lymph Node(s),$737.00,$116.80,$737.00,$351.05,$130.18,$271.76,$137.71,$130.18,$130.18,$156.60,$737.00,$284.24,$240.00,$583.70,$589.60,$394.92,$166.86,$194.49,$116.80,$270.71
31200459,EAP,CPT® 88305,,Needle Core Biopsy,$737.00,$32.05,$737.00,$90.56,$67.40,$47.44,$35.39,$67.40,$67.40,$77.40,$737.00,$49.62,$140.98,$583.70,$589.60,$68.93,$82.47,$32.05,$57.73,$47.25
31200460,EAP,CPT® 88300,,"Tissue, Gross Only",$263.00,$8.17,$263.00,$21.48,$18.95,$22.05,$8.17,$18.95,$18.95,$16.80,$263.00,$23.06,$38.76,$208.30,$210.40,$32.04,$17.90,$11.16,$12.53,$21.96
31200461,EAP,CPT® 88329,,Intra-operative Pathology Consult,$298.00,$0.00,$298.00,$0.00,$33.40,$0.00,$0.00,$33.40,$33.40,$0.00,$298.00,$0.00,$101.94,$236.02,$238.40,$0.00,$0.00,$0.00,$0.00,$0.00
31200462,EAP,CPT® 88331,,First Tissue Block W Fs (single Spec),$533.00,$29.37,$533.00,$128.36,$29.37,$137.60,$49.90,$29.37,$29.37,$87.82,$533.00,$143.92,$57.46,$422.14,$426.40,$199.96,$93.58,$34.94,$65.50,$137.07
31200463,EAP,CPT® 88332,,Each Add Tissue Block W Frozen Section(s),$257.00,$0.00,$257.00,$69.54,$10.48,$0.00,$27.40,$10.48,$10.48,$44.09,$257.00,$0.00,$20.46,$203.54,$205.60,$0.00,$46.98,$23.05,$32.88,$0.00
31200464,EAP,CPT® 88360,,ER/PR QUANTITIATIVE IHC,$995.00,$65.32,$995.00,$184.86,$65.70,$137.60,$65.32,$65.70,$65.70,$114.71,$995.00,$143.92,$121.34,$788.04,$796.00,$199.96,$122.23,$83.20,$85.56,$137.07
31200466,EAP,CPT® 88342,,"Human Herpesvirus , Type 8(hhv-8)",$510.00,$54.62,$510.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$510.00,$143.92,$106.46,$403.92,$408.00,$199.96,$89.59,$70.23,$62.72,$137.07
31200467,EAP,CPT® 88342,,"Neuron Specific Enolase (nse), Ihc",$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200468,EAP,CPT® 88342,,"Cd20, L26, Ihc",$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200469,EAP,CPT® 88307,,Salivary Gland,$774.00,$116.80,$774.00,$351.05,$130.18,$271.76,$137.71,$130.18,$130.18,$156.60,$774.00,$284.24,$240.00,$613.01,$619.20,$394.92,$166.86,$194.49,$116.80,$270.71
31200470,EAP,CPT® 88307,,"Urinary Bladder, Tur",$774.00,$116.80,$774.00,$351.05,$130.18,$271.76,$137.71,$130.18,$130.18,$156.60,$774.00,$284.24,$240.00,$613.01,$619.20,$394.92,$166.86,$194.49,$116.80,$270.71
31200471,EAP,CPT® 88333,,Intraoperative Cytologic Examination (touch Prep) Initial Site,$600.00,$0.00,$600.00,$0.00,$31.56,$0.00,$0.00,$31.56,$31.56,$0.00,$600.00,$0.00,$57.46,$475.20,$480.00,$0.00,$0.00,$0.00,$0.00,$0.00
31200472,EAP,CPT® 88334,,Intraoperative Cytologic Examination (touch Prep) Add Site,$257.00,$0.00,$257.00,$0.00,$19.25,$0.00,$0.00,$19.25,$19.25,$0.00,$257.00,$0.00,$34.52,$203.54,$205.60,$0.00,$0.00,$0.00,$0.00,$0.00
31200473,EAP,CPT® 88341,,Ihc Stain - Additional,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200474,EAP,CPT® 88341,,*stain: Melan A (mart-1),$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200475,EAP,CPT® 88341,,*stain: P10,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200476,EAP,CPT® 88341,,*stain: P63,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200477,EAP,CPT® 88341,,*stain: Treponema,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200478,EAP,CPT® 88341,,*stain: Wt-1,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200479,EAP,CPT® 88341,,*stain: Pin Cocktail(p63=p504s),$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200480,EAP,CPT® 88341,,*stain: Sma(smooth Muscle Actin,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200481,EAP,CPT® 88341,,Stain: Cd56,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200482,EAP,CPT® 88341,,Stain: Cd99,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200483,EAP,CPT® 88341,,Stain: Glypican-3,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200484,EAP,CPT® 88341,,Stain: Moc-1,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200485,EAP,CPT® 88341,,Immunohisto Chemistry,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200486,EAP,CPT® 88341,,Ihc Marker (stain Only) (so),$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200487,EAP,CPT® 88341,,Ercc1 Ihc With Interp (so),$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200488,EAP,CPT® 88341,,"P40 Protein, Ihc",$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200489,EAP,CPT® 88341,,"Napsin-a,ihc",$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200490,EAP,CPT® 88341,,"Neuron Specific Enolase (nse), Ihc",$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200491,EAP,CPT® 88341,,"Cd20, L26, Ihc",$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200492,EAP,CPT® 88341,,Placental Lactogen,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200493,EAP,CPT® 88341,,Prolactin,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200494,EAP,CPT® 88341,,Prostate Acid Phos,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200495,EAP,CPT® 88341,,Prostate Spec Ag,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200496,EAP,CPT® 88341,,S-100 Neural Ag,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200497,EAP,CPT® 88341,,Serotonin,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200498,EAP,CPT® 88341,,Synatophysin,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200499,EAP,CPT® 88341,,Thyroglobulin,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200500,EAP,CPT® 88341,,Uchl-1,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200501,EAP,CPT® 88341,,Vimentin,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200502,EAP,CPT® 88341,,Em:kappa,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200503,EAP,CPT® 88341,,Em:lambda,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200504,EAP,CPT® 88341,,*stain: Ber Ep4,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200505,EAP,CPT® 88341,,*stain: Cd117 (c-kit),$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200506,EAP,CPT® 88341,,*stain: Cdx2,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200507,EAP,CPT® 88341,,*stain: Cdx2,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200508,EAP,CPT® 88341,,*stain: Cea (monoclonal),$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200509,EAP,CPT® 88341,,*stain: Cyclin D1,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200510,EAP,CPT® 88341,,*stain: Cyclin D1,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200511,EAP,CPT® 88341,,*stain: Cytokeratin 19,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200512,EAP,CPT® 88341,,*stain: Cytokeratin 5,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200513,EAP,CPT® 88341,,*stain: Cytokeratin 5/6,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200514,EAP,CPT® 88341,,*stain: Cytokeratin 6,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200515,EAP,CPT® 88341,,*stain: E-cadherin,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200516,EAP,CPT® 88341,,*stain: Egfr,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200517,EAP,CPT® 88341,,*stain: Galectin-3,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200518,EAP,CPT® 88341,,*stain: Gcdfp-15,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200519,EAP,CPT® 88341,,*stain: Hbme-1,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200520,EAP,CPT® 88341,,*stain: Helicobacter Pylori,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200521,EAP,CPT® 88341,,*stain: Hhv-8 (human Herpes-8),$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200522,EAP,CPT® 88341,,*stain: Cd79,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200523,EAP,CPT® 88341,,*stain: Cytokeratin 7,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200524,EAP,CPT® 88341,,*stain: Hepatocyte,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200525,EAP,CPT® 88341,,*stain: Hi Mol Wt Keratin,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200526,EAP,CPT® 88341,,*stain: Inhibin Alpha,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200527,EAP,CPT® 88341,,*stain: Myeloperoxidase,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200528,EAP,CPT® 88341,,*stain: P16,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200529,EAP,CPT® 88341,,*stain: P53,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200530,EAP,CPT® 88341,,*stain: Tdt,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200531,EAP,CPT® 88341,,*stain: Ttf-1,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200532,EAP,CPT® 88341,,*stain: Villin,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200533,EAP,CPT® 88341,,Immunoperoxidase,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200534,EAP,CPT® 88341,,Glial Fibrillary Ap,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200535,EAP,CPT® 88341,,Glucagon,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200536,EAP,CPT® 88341,,Hepatitis B Core,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200537,EAP,CPT® 88341,,Hepatitis B Surface,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200538,EAP,CPT® 88341,,Herpes Simplex Prob,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200539,EAP,CPT® 88341,,Human Chorionic Gon,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200540,EAP,CPT® 88341,,Human Growth Hormon,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200541,EAP,CPT® 88341,,Insulin,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200542,EAP,CPT® 88341,,Kappa,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200543,EAP,CPT® 88341,,L-26 B Cell Marker,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200544,EAP,CPT® 88341,,Lambda,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200545,EAP,CPT® 88341,,Leu M1,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200546,EAP,CPT® 88341,,Leukocyte Common Ag,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200547,EAP,CPT® 88341,,Leuteinizing Hormon,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200548,EAP,CPT® 88341,,Macrophage-ham-56,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200549,EAP,CPT® 88341,,Melanoma-hmb-45,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200550,EAP,CPT® 88341,,Neuron Spec Enolase,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200551,EAP,CPT® 88341,,Placental Alk Phos,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200552,EAP,CPT® 88341,,A-1 Antitrypsin,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200553,EAP,CPT® 88341,,"Actin,muscle Spec.",$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200554,EAP,CPT® 88341,,Alpha-fetoprotein,$586.00,$0.00,$586.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$586.00,$0.00,$293.00,$464.11,$468.80,$0.00,$71.83,$64.47,$50.28,$0.00
31200555,EAP,CPT® 88341,,B72.3-breast,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200556,EAP,CPT® 88341,,Ca 125-ovarian Ca,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200557,EAP,CPT® 88341,,Ca-19-9-carbohydrat,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200558,EAP,CPT® 88341,,Calcitonin,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200559,EAP,CPT® 88341,,Cea-p,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200560,EAP,CPT® 88341,,Chromogranin,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200561,EAP,CPT® 88341,,Cytokeratin-ae1/ae3,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200562,EAP,CPT® 88341,,Cytokeratin-cam5.2,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200563,EAP,CPT® 88341,,Cytomegalovirus,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200564,EAP,CPT® 88341,,Desmin,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200565,EAP,CPT® 88341,,Ema,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200566,EAP,CPT® 88341,,Factor Viii,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200567,EAP,CPT® 88341,,*stain:oncoprotein (bcl2),$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200568,EAP,CPT® 88341,,*stain: Cd30/ber H2 (ki-1),$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200569,EAP,CPT® 88341,,*stain: B-1 Glyco,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200570,EAP,CPT® 88341,,*stain: Calponin,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200571,EAP,CPT® 88341,,*stain: Calretinin,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200572,EAP,CPT® 88341,,*stain: A-1 Antichymotryps,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200573,EAP,CPT® 88341,,*stain: Cytokeratin 20,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200574,EAP,CPT® 88341,,*stain: Cd10,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200575,EAP,CPT® 88341,,*stain: Cd138,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200576,EAP,CPT® 88341,,*stain: Cd23,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200577,EAP,CPT® 88341,,*stain: Cd3,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200578,EAP,CPT® 88341,,*stain: Cd31,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200579,EAP,CPT® 88341,,*stain: Cd34,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200580,EAP,CPT® 88341,,*stain: Cd43,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200581,EAP,CPT® 88341,,*stain: Cd5,$773.00,$0.00,$773.00,$119.97,$67.79,$0.00,$47.54,$67.79,$67.79,$67.41,$773.00,$0.00,$386.50,$612.22,$618.40,$0.00,$71.83,$64.47,$50.28,$0.00
31200582,EAP,CPT® 88342,,Stain:cd45(lca),$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200583,EAP,CPT® 88342,,Stain:cd15,$369.00,$54.62,$369.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$369.00,$143.92,$106.46,$292.25,$295.20,$199.96,$89.59,$70.23,$62.72,$137.07
31200584,EAP,CPT® 88360,,Er/pr Paraffin (so),$523.00,$65.32,$523.00,$184.86,$65.70,$137.60,$65.32,$65.70,$65.70,$114.71,$523.00,$143.92,$121.34,$414.22,$418.40,$199.96,$122.23,$83.20,$85.56,$137.07
31200585,EAP,CPT® 88360,,Her2 Ihc W/interpret (so),$427.00,$65.32,$427.00,$184.86,$65.70,$137.60,$65.32,$65.70,$65.70,$114.71,$427.00,$143.92,$121.34,$338.18,$341.60,$199.96,$122.23,$83.20,$85.56,$137.07
31200586,EAP,CPT® 88309,,Surg Path Fetus And Placenta,"$1,051.00",$164.53,"$1,051.00",$538.24,$178.45,$602.38,$209.20,$178.45,$178.45,$220.59,"$1,051.00",$630.05,$328.48,$832.39,$840.80,$875.37,$235.05,$274.45,$164.53,$600.04
31200600,EAP,CPT® 88342,,Ihc Stain - First,$549.00,$54.62,$549.00,$141.00,$57.65,$137.60,$54.62,$57.65,$57.65,$84.08,$549.00,$143.92,$106.46,$434.81,$439.20,$199.96,$89.59,$70.23,$62.72,$137.07
31900001,EAP,CPT® 88348,,Em Processing Only,"$3,841.00",$0.00,"$3,841.00",$0.00,$550.68,$0.00,$0.00,$550.68,$550.68,$0.00,"$3,841.00",$0.00,$906.38,"$3,042.07","$3,072.80",$0.00,$0.00,$0.00,$0.00,$0.00
31900002,EAP,CPT® 88348,,Em: Non Kidney,"$3,841.00",$0.00,"$3,841.00",$0.00,$550.68,$0.00,$0.00,$550.68,$550.68,$0.00,"$3,841.00",$0.00,$906.38,"$3,042.07","$3,072.80",$0.00,$0.00,$0.00,$0.00,$0.00
31900003,EAP,CPT® 88348,,Em:kidney,"$3,841.00",$0.00,"$3,841.00",$0.00,$550.68,$0.00,$0.00,$550.68,$550.68,$0.00,"$3,841.00",$0.00,$906.38,"$3,042.07","$3,072.80",$0.00,$0.00,$0.00,$0.00,$0.00
31900004,EAP,CPT® 81229,,Chromosomal Microarray  Postnatal (so),"$1,384.00",$246.35,"$2,903.98",$697.68,$987.76,$246.35,$584.01,$987.76,$987.76,"$2,725.40","$1,384.00","$1,218.00",$692.00,"$1,096.13","$1,107.20","$1,384.00","$2,903.98","$1,160.00","$2,032.79","$1,160.00"
31900005,EAP,CPT® 81263,,Cll-igvh Mutation Status  (so),"$1,294.00",$86.22,"$1,294.00",$525.04,$401.79,$400.79,$164.75,$401.79,$401.79,$115.59,"$1,294.00",$309.25,$647.00,"$1,024.85","$1,035.20",$427.05,$123.17,$294.52,$86.22,$294.52
31900007,EAP,CPT® 81301,,Microsatelite Instability (msi) (so),"$1,546.00",$0.00,"$1,546.00",$0.00,$395.04,$0.00,$0.00,$395.04,$395.04,$0.00,"$1,546.00",$0.00,$773.00,"$1,224.43","$1,236.80",$0.00,$0.00,$0.00,$0.00,$0.00
31900009,EAP,CPT® 81206,,P210 Bcr-abl1 (so),$622.00,$86.22,$622.00,$292.30,$223.69,$223.13,$91.72,$223.69,$223.69,$115.59,$622.00,$172.16,$311.00,$492.62,$497.60,$237.74,$123.17,$163.96,$86.22,$163.96
31900011,EAP,CPT® 81235,,Egfr Mutation Analysis  (so),"$1,338.00",$86.22,"$1,338.00",$431.24,$330.01,$329.18,$163.41,$330.01,$330.01,$115.59,"$1,338.00",$340.81,$669.00,"$1,059.70","$1,070.40",$470.64,$123.17,$324.58,$86.22,$324.58
31900013,EAP,Custom 31900013,,Bcr-abl1 Gene Rear Quant Pcr (so),$622.00,$0.00,$622.00,$0.00,$443.92,$0.00,$0.00,$443.92,$443.92,$0.00,$622.00,$0.00,$311.00,$492.62,$497.60,$0.00,$0.00,$0.00,$0.00,$0.00
31900014,EAP,CPT® 81207,,P190 Bcr-abl1 (so),$549.00,$81.02,$549.00,$258.21,$197.59,$197.10,$81.02,$197.59,$197.59,$115.59,$549.00,$152.08,$274.50,$434.81,$439.20,$210.02,$123.17,$144.84,$86.22,$144.84
31900015,EAP,CPT® 88271,,"Fish Dna Probe, Each (so)",$555.00,$11.98,$555.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$555.00,$22.49,$59.86,$439.56,$444.00,$31.06,$33.72,$21.42,$23.60,$21.42
31900016,EAP,CPT® 88275,,Interphase In Situ Hybridization (so),$555.00,$25.78,$555.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$555.00,$53.75,$112.22,$439.56,$444.00,$74.23,$63.21,$51.19,$44.25,$51.19
31900017,EAP,CPT® 88271,,"Fish Dna Probe, Each (so)",$555.00,$11.98,$555.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$555.00,$22.49,$59.86,$439.56,$444.00,$31.06,$33.72,$21.42,$23.60,$21.42
31900018,EAP,CPT® 88275,,Interphase In Situ Hybridization (so),$555.00,$25.78,$555.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$555.00,$53.75,$112.22,$439.56,$444.00,$74.23,$63.21,$51.19,$44.25,$51.19
31900019,EAP,CPT® 88271,,"Fish Dna Probe, Each (so)",$411.00,$11.98,$411.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$411.00,$22.49,$59.86,$325.51,$328.80,$31.06,$33.72,$21.42,$23.60,$21.42
31900020,EAP,CPT® 88275,,Interphase In Situ Hybridization (so),$411.00,$25.78,$411.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$411.00,$53.75,$112.22,$325.51,$328.80,$74.23,$63.21,$51.19,$44.25,$51.19
31900021,EAP,CPT® 88271,,"Fish Dna Probe, Each (so)",$411.00,$11.98,$411.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$411.00,$22.49,$59.86,$325.51,$328.80,$31.06,$33.72,$21.42,$23.60,$21.42
31900022,EAP,CPT® 88275,,Interphase In Situ Hybridization (so),$411.00,$25.78,$411.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$411.00,$53.75,$112.22,$325.51,$328.80,$74.23,$63.21,$51.19,$44.25,$51.19
31900023,EAP,CPT® 88271,,"Fish Dna Probe, Each (so)","$1,098.00",$11.98,"$1,098.00",$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,"$1,098.00",$22.49,$59.86,$869.62,$878.40,$31.06,$33.72,$21.42,$23.60,$21.42
31900024,EAP,CPT® 88275,,Interphase In Situ Hybridization (so),"$1,098.00",$25.78,"$1,098.00",$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,"$1,098.00",$53.75,$112.22,$869.62,$878.40,$74.23,$63.21,$51.19,$44.25,$51.19
31900025,EAP,CPT® 88271,,"Fish, Dna Probe Each (so)",$555.00,$11.98,$555.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$555.00,$22.49,$59.86,$439.56,$444.00,$31.06,$33.72,$21.42,$23.60,$21.42
31900026,EAP,CPT® 88275,,Interphase In Situ Hybridization (so),$555.00,$25.78,$555.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$555.00,$53.75,$112.22,$439.56,$444.00,$74.23,$63.21,$51.19,$44.25,$51.19
31900027,EAP,CPT® 88271,,"Fish, Dna Probe Each (so)",$690.00,$11.98,$690.00,$38.19,$31.27,$19.70,$11.98,$31.27,$31.27,$31.65,$690.00,$22.49,$59.86,$546.48,$552.00,$31.06,$33.72,$21.42,$23.60,$21.42
31900028,EAP,CPT® 88275,,Interphase In Situ Hybridization (so),$690.00,$25.78,$690.00,$71.59,$58.64,$54.65,$25.78,$58.64,$58.64,$59.33,$690.00,$53.75,$112.22,$546.48,$552.00,$74.23,$63.21,$51.19,$44.25,$51.19
31900030,EAP,CPT® 81404,,Pancreatitis Press (so),"$1,736.00",$138.36,"$1,736.00",$399.00,"$1,238.98",$309.01,$138.36,"$1,238.98","$1,238.98",$286.64,"$1,736.00",$288.57,$868.00,"$1,374.91","$1,388.80",$398.50,$305.42,$274.83,$213.79,$274.83
31900031,EAP,CPT® 81404,,Pancreatitis Spink-1 (so),"$1,736.00",$138.36,"$1,736.00",$399.00,"$1,238.98",$309.01,$138.36,"$1,238.98","$1,238.98",$286.64,"$1,736.00",$288.57,$868.00,"$1,374.91","$1,388.80",$398.50,$305.42,$274.83,$213.79,$274.83
31900032,EAP,CPT® 81479,,Pancreatitis Ctrc (so),$895.00,$0.00,"$1,114.12",$0.00,$638.76,$159.31,$154.20,$638.76,$638.76,"$1,045.61",$895.00,$0.00,$447.50,$708.84,$716.00,$537.00,"$1,114.12",$0.00,$779.89,$0.00
32000001,EAP,CPT® 77085,,"Dual-energy X-ray Absorptiometry(dxa),bone Density Study",$668.00,$0.00,$668.00,$0.00,$98.56,$0.00,$0.00,$98.56,$98.56,$0.00,$668.00,$0.00,$160.32,$529.06,$534.40,$0.00,$0.00,$0.00,$0.00,$0.00
32000003,EAP,CPT® 70015,,Cisternography,"$1,032.00",$0.00,"$1,032.00",$0.00,$192.50,$0.00,$0.00,$192.50,$192.50,$0.00,"$1,032.00",$0.00,$247.68,$817.34,$825.60,$0.00,$0.00,$0.00,$0.00,$0.00
32000005,EAP,CPT® 70100,,MANDIBLE 1-3 VIEW RDG,$262.00,$0.00,$262.00,$0.00,$50.30,$0.00,$0.00,$50.30,$50.30,$0.00,$262.00,$0.00,$62.88,$207.50,$209.60,$0.00,$0.00,$0.00,$0.00,$0.00
32000007,EAP,CPT® 70110,,MANDIBLE COMPL 4+ VIEW RDG,$306.00,$29.89,$306.00,$74.49,$63.09,$107.47,$52.72,$63.09,$63.09,$53.58,$306.00,$112.41,$73.44,$242.35,$244.80,$156.18,$36.22,$29.89,$48.72,$107.06
32000013,EAP,CPT® 70160,,NASAL BONES COMPL 3+VIEW RDG,$460.00,$0.00,$460.00,$0.00,$54.67,$0.00,$0.00,$54.67,$54.67,$0.00,$460.00,$0.00,$110.40,$364.32,$368.00,$0.00,$0.00,$0.00,$0.00,$0.00
32000020,EAP,CPT® 70250,,SKULL 1-3VIEW W/WO STEREO RDG,$807.00,$25.57,$807.00,$71.02,$56.99,$107.47,$139.04,$56.99,$56.99,$141.30,$807.00,$112.41,$193.68,$639.14,$645.60,$156.18,$35.86,$25.57,$128.47,$107.06
32000022,EAP,CPT® 70300,,Periapical X-ray,$371.00,$0.00,$371.00,$0.00,$20.64,$0.00,$0.00,$20.64,$20.64,$0.00,$371.00,$0.00,$89.04,$293.83,$296.80,$0.00,$0.00,$0.00,$0.00,$0.00
32000023,EAP,CPT® 70320,,X-ray Complete,$520.00,$0.00,$520.00,$0.00,$85.62,$0.00,$0.00,$85.62,$85.62,$0.00,$520.00,$0.00,$124.80,$411.84,$416.00,$0.00,$0.00,$0.00,$0.00,$0.00
32000024,EAP,CPT® 70355,,X-ray Panorex,$520.00,$8.64,$520.00,$41.09,$29.94,$76.53,$89.59,$29.94,$29.94,$91.05,$520.00,$80.04,$124.80,$411.84,$416.00,$111.21,$31.96,$8.64,$82.78,$76.23
32000026,EAP,CPT® 70328,,TMJ UNILAT OPEN & CLOSED RDG,$252.00,$0.00,$252.00,$0.00,$48.57,$0.00,$0.00,$48.57,$48.57,$0.00,$252.00,$0.00,$60.48,$199.58,$201.60,$0.00,$0.00,$0.00,$0.00,$0.00
32000028,EAP,CPT® 70330,,TMJ BILAT OPEN & CLOSED RDG,$667.00,$0.00,$667.00,$0.00,$82.14,$0.00,$0.00,$82.14,$82.14,$0.00,$667.00,$0.00,$160.08,$528.26,$533.60,$0.00,$0.00,$0.00,$0.00,$0.00
32000031,EAP,CPT® 70360,,NECK SOFT TISSUE RDG,$681.00,$21.61,$681.00,$55.02,$43.33,$76.53,$117.33,$43.33,$43.33,$119.24,$681.00,$80.04,$163.44,$539.35,$544.80,$111.21,$24.86,$21.61,$108.42,$76.23
32000033,EAP,CPT® 70370,,Pharyn/larynx Fluo &/magn Rdg,"$1,360.00",$0.00,"$1,360.00",$0.00,$137.70,$0.00,$0.00,$137.70,$137.70,$0.00,"$1,360.00",$0.00,$326.40,"$1,077.12","$1,088.00",$0.00,$0.00,$0.00,$0.00,$0.00
32000035,EAP,CPT® 70390,,SIALOGRAPHY S&I RDG,"$2,317.00",$0.00,"$2,317.00",$0.00,$189.43,$0.00,$0.00,$189.43,$189.43,$0.00,"$2,317.00",$0.00,$556.08,"$1,835.06","$1,853.60",$0.00,$0.00,$0.00,$0.00,$0.00
32000051,EAP,CPT® 71046,,Employee Health 2 View Chest,$665.00,$21.97,$665.00,$59.99,$47.17,$76.53,$114.58,$47.17,$47.17,$116.44,$665.00,$80.04,$159.60,$526.68,$532.00,$111.21,$29.30,$21.97,$105.87,$76.23
32000058,EAP,CPT® 71110,,RIBS BILAT X-RAY 3VIEW RDG,$724.00,$28.45,$724.00,$73.80,$64.69,$107.47,$124.74,$64.69,$64.69,$126.77,$724.00,$112.41,$173.76,$573.41,$579.20,$156.18,$43.70,$28.45,$115.26,$107.06
32000060,EAP,CPT® 71111,,RIBS BILAT X-RAY 4+VIEW RDG,"$1,246.00",$35.30,"$1,246.00",$94.69,$85.48,$107.47,$214.68,$85.48,$85.48,$218.16,"$1,246.00",$112.41,$299.04,$986.83,$996.80,$156.18,$50.44,$35.30,$198.36,$107.06
32000062,EAP,CPT® 71120,,STERNUM X-RAY 2+VIEW RDG,$513.00,$22.69,$513.00,$57.80,$53.49,$76.53,$88.39,$53.49,$53.49,$89.82,$513.00,$80.04,$123.12,$406.30,$410.40,$111.21,$34.82,$22.69,$81.67,$76.23
32000064,EAP,CPT® 71130,,STERNOCLAVICU JNTS 3+VIEW RDG,$375.00,$0.00,$375.00,$0.00,$62.22,$0.00,$0.00,$62.22,$62.22,$0.00,$375.00,$0.00,$90.00,$297.00,$300.00,$0.00,$0.00,$0.00,$0.00,$0.00
32000065,EAP,CPT® 73020,,SHOULDER 1 VIEW RDG,"$1,295.00",$13.69,"$1,295.00",$45.26,$37.22,$76.53,$223.12,$37.22,$37.22,$226.74,"$1,295.00",$80.04,$310.80,"$1,025.64","$1,036.00",$111.21,$25.94,$13.69,$206.16,$76.23
32000071,EAP,CPT® 72020,,CERVICAL SPINE 1 VIEW RDG,$992.00,$16.21,$992.00,$43.18,$37.22,$76.53,$170.92,$37.22,$37.22,$173.69,$992.00,$80.04,$238.08,$785.66,$793.60,$111.21,$23.80,$16.21,$157.93,$76.23
32000073,EAP,CPT® 72020,,LUMBAR SPINE 1 VIEW RDG,$992.00,$16.21,$992.00,$43.18,$37.22,$76.53,$170.92,$37.22,$37.22,$173.69,$992.00,$80.04,$238.08,$785.66,$793.60,$111.21,$23.80,$16.21,$157.93,$76.23
32000075,EAP,CPT® 72020,,THORACIC SPINE 1 VIEW RDG,$992.00,$16.21,$992.00,$43.18,$37.22,$76.53,$170.92,$37.22,$37.22,$173.69,$992.00,$80.04,$238.08,$785.66,$793.60,$111.21,$23.80,$16.21,$157.93,$76.23
32000078,EAP,CPT® 72040,,Rad Exam Spine 2 Or 3 Views,$960.00,$27.01,$960.00,$64.75,$60.47,$76.53,$165.40,$60.47,$60.47,$168.09,$960.00,$80.04,$230.40,$760.32,$768.00,$111.21,$34.09,$27.01,$152.83,$76.23
32000080,EAP,CPT® 72050,,CERVICAL SPINE 4+VIEW RDG,"$1,685.00",$37.10,"$1,685.00",$89.13,$86.36,$107.47,$290.32,$86.36,$86.36,$295.03,"$1,685.00",$112.41,$404.40,"$1,334.52","$1,348.00",$156.18,$49.72,$37.10,$268.25,$107.06
32000081,EAP,CPT® 72052,,CERVICAL SPINE COMPLETE W/ FLEX/EXT RDG,"$1,696.00",$44.66,"$1,696.00",$110.01,$110.79,$107.47,$292.21,$110.79,$110.79,$296.96,"$1,696.00",$112.41,$407.04,"$1,343.23","$1,356.80",$156.18,$61.14,$44.66,$270.00,$107.06
32000084,EAP,CPT® 72070,,THORACIC SPINE 2 VIEW RDG,"$1,060.00",$21.61,"$1,060.00",$66.85,$53.49,$107.47,$182.63,$53.49,$53.49,$185.60,"$1,060.00",$112.41,$254.40,$839.52,$848.00,$156.18,$35.88,$21.61,$168.75,$107.06
32000088,EAP,CPT® 72080,,THORACOLUMBAR 2VIEW RDG,"$1,073.00",$23.41,"$1,073.00",$59.87,$56.99,$76.53,$184.87,$56.99,$56.99,$187.87,"$1,073.00",$80.04,$257.52,$849.82,$858.40,$111.21,$36.61,$23.41,$170.82,$76.23
32000092,EAP,CPT® 72100,,LUMBOSACRAL SPINE 2-3VIEW RDG,$989.00,$27.01,$989.00,$68.92,$64.85,$107.47,$170.40,$64.85,$64.85,$173.17,$989.00,$112.41,$237.36,$783.29,$791.20,$156.18,$36.61,$27.01,$157.45,$107.06
32000095,EAP,CPT® 72110,,LUMBOSACRAL SPINE 4+VIEW RDG,"$1,733.00",$35.66,"$1,733.00",$96.08,$90.72,$107.47,$298.59,$90.72,$90.72,$303.43,"$1,733.00",$112.41,$415.92,"$1,372.54","$1,386.40",$156.18,$50.44,$35.66,$275.89,$107.06
32000097,EAP,CPT® 72114,,Lumbosac Com + Bending 6 Views,"$1,480.00",$44.66,"$1,480.00",$121.84,$123.00,$107.47,$255.00,$123.00,$123.00,$259.14,"$1,480.00",$112.41,$355.20,"$1,172.16","$1,184.00",$156.18,$63.63,$44.66,$235.62,$107.06
32000099,EAP,CPT® 72120,,Lumbosac Bending 2 Or 3 Views,$852.00,$0.00,$852.00,$0.00,$88.10,$0.00,$0.00,$88.10,$88.10,$0.00,$852.00,$0.00,$204.48,$674.78,$681.60,$0.00,$0.00,$0.00,$0.00,$0.00
32000109,EAP,CPT® 72170,,PELVIS X-RAY 1-2 VIEW RDG,$724.00,$19.81,$724.00,$62.68,$40.71,$107.47,$124.74,$40.71,$40.71,$126.77,$724.00,$112.41,$173.76,$573.41,$579.20,$156.18,$28.43,$19.81,$115.26,$107.06
32000111,EAP,CPT® 72190,,PELVIS X-RAY COMPL 3+VIEW RDG,$732.00,$28.09,$732.00,$74.51,$67.46,$107.47,$126.12,$67.46,$67.46,$128.17,$732.00,$112.41,$175.68,$579.74,$585.60,$156.18,$36.26,$28.09,$116.53,$107.06
32000117,EAP,CPT® 72200,,Sacroiliac Jnt 1-2 View Rdg,$375.00,$0.00,$375.00,$0.00,$47.70,$0.00,$0.00,$47.70,$47.70,$0.00,$375.00,$0.00,$90.00,$297.00,$300.00,$0.00,$0.00,$0.00,$0.00,$0.00
32000119,EAP,CPT® 72202,,SACROILIAC JNT 3+VIEW RDG,$320.00,$26.65,$320.00,$64.75,$59.59,$107.47,$55.13,$59.59,$59.59,$56.03,$320.00,$112.41,$76.80,$253.44,$256.00,$156.18,$33.41,$26.65,$50.94,$107.06
32000122,EAP,CPT® 72220,,SACRUM&COCCYX 2+VIEW RDG,$610.00,$22.69,$610.00,$55.02,$49.14,$76.53,$105.10,$49.14,$49.14,$106.81,$610.00,$80.04,$146.40,$483.12,$488.00,$111.21,$30.55,$22.69,$97.11,$76.23
32000123,EAP,CPT® 72240,,MYELOGRAPHY CERVICAL S&I RDG,"$1,386.00",$0.00,"$1,386.00",$0.00,$267.58,$0.00,$0.00,$267.58,$267.58,$0.00,"$1,386.00",$0.00,$332.64,"$1,097.71","$1,108.80",$0.00,$0.00,$0.00,$0.00,$0.00
32000124,EAP,CPT® 72255,,MYELOGRAPHY THORACIC S&I RDG,"$1,330.00",$0.00,"$1,330.00",$0.00,$237.50,$0.00,$0.00,$237.50,$237.50,$0.00,"$1,330.00",$0.00,$319.20,"$1,053.36","$1,064.00",$0.00,$0.00,$0.00,$0.00,$0.00
32000125,EAP,CPT® 72265,,MYELOGRAPHY LUMBAR S&I RDG,"$1,386.00",$0.00,"$1,386.00",$0.00,$250.57,$0.00,$0.00,$250.57,$250.57,$0.00,"$1,386.00",$0.00,$332.64,"$1,097.71","$1,108.80",$0.00,$0.00,$0.00,$0.00,$0.00
32000126,EAP,CPT® 72270,,MYELOGRAPHY COMPLETE S&I RDG,"$1,278.00",$75.28,"$1,278.00",$250.64,$385.91,$663.32,$220.19,$385.91,$385.91,$223.77,"$1,278.00",$693.78,$306.72,"$1,012.18","$1,022.40",$963.92,$298.54,$75.28,$203.46,$660.75
32000127,EAP,CPT® 72285,,Diskography Cervicl/thorac Spn,"$3,367.00",$0.00,"$3,367.00",$0.00,$289.24,$0.00,$0.00,$289.24,$289.24,$0.00,"$3,367.00",$0.00,$808.08,"$2,666.66","$2,693.60",$0.00,$0.00,$0.00,$0.00,$0.00
32000128,EAP,CPT® 72295,,Diskography Lumbar Spn,"$3,838.00",$0.00,"$3,838.00",$0.00,$279.24,$0.00,$0.00,$279.24,$279.24,$0.00,"$3,838.00",$0.00,$921.12,"$3,039.70","$3,070.40",$0.00,$0.00,$0.00,$0.00,$0.00
32000129,EAP,CPT® 73000,,Clavicle Complete Rdg,$840.00,$23.05,$840.00,$54.31,$45.08,$76.53,$144.73,$45.08,$45.08,$147.08,$840.00,$80.04,$201.60,$665.28,$672.00,$111.21,$27.72,$23.05,$133.73,$76.23
32000131,EAP,CPT® 73000,,CLAVICLE COMPLETE LT RDG,$840.00,$23.05,$840.00,$54.31,$45.08,$76.53,$144.73,$45.08,$45.08,$147.08,$840.00,$80.04,$201.60,$665.28,$672.00,$111.21,$27.72,$23.05,$133.73,$76.23
32000133,EAP,CPT® 73000,,CLAVICLE COMPLETE RT RDG,$840.00,$23.05,$840.00,$54.31,$45.08,$76.53,$144.73,$45.08,$45.08,$147.08,$840.00,$80.04,$201.60,$665.28,$672.00,$111.21,$27.72,$23.05,$133.73,$76.23
32000135,EAP,CPT® 73000,,CLAVICLES COMPLETE BILAT RDG,"$1,686.00",$23.05,"$1,686.00",$54.31,$45.08,$76.53,$290.49,$45.08,$45.08,$295.21,"$1,686.00",$80.04,$404.64,"$1,335.31","$1,348.80",$111.21,$27.72,$23.05,$268.41,$76.23
32000137,EAP,CPT® 73010,,Scapula Complete Rdg,$650.00,$18.73,$650.00,$59.19,$45.95,$107.47,$111.99,$45.95,$45.95,$113.81,$650.00,$112.41,$156.00,$514.80,$520.00,$156.18,$28.43,$18.73,$103.48,$107.06
32000139,EAP,CPT® 73010,,SCAPULA COMPLETE LT RDG,$650.00,$18.73,$650.00,$59.19,$45.95,$107.47,$111.99,$45.95,$45.95,$113.81,$650.00,$112.41,$156.00,$514.80,$520.00,$156.18,$28.43,$18.73,$103.48,$107.06
32000141,EAP,CPT® 73010,,SCAPULA COMPLETE RT RDG,$650.00,$18.73,$650.00,$59.19,$45.95,$107.47,$111.99,$45.95,$45.95,$113.81,$650.00,$112.41,$156.00,$514.80,$520.00,$156.18,$28.43,$18.73,$103.48,$107.06
32000143,EAP,CPT® 73010,,SCAPULAS COMPLETE BILAT RDG,"$1,295.00",$18.73,"$1,295.00",$59.19,$45.95,$107.47,$223.12,$45.95,$45.95,$226.74,"$1,295.00",$112.41,$310.80,"$1,025.64","$1,036.00",$156.18,$28.43,$18.73,$206.16,$107.06
32000153,EAP,CPT® 73030,,Shoulder 2+views Rdg,"$1,295.00",$22.88,"$1,295.00",$57.09,$48.26,$76.53,$22.88,$48.26,$48.26,$226.74,"$1,295.00",$80.04,$310.80,"$1,025.64","$1,036.00",$111.21,$30.90,$23.77,$206.16,$76.23
32000154,EAP,CPT® 73030,,Shoulder Compl 2+view Exr,"$1,295.00",$22.88,"$1,295.00",$57.09,$48.26,$76.53,$22.88,$48.26,$48.26,$226.74,"$1,295.00",$80.04,$310.80,"$1,025.64","$1,036.00",$111.21,$30.90,$23.77,$206.16,$76.23
32000156,EAP,CPT® 73030,,SHOULDER COMPL 2+VIEWS LT RDG,"$1,295.00",$22.88,"$1,295.00",$57.09,$48.26,$76.53,$22.88,$48.26,$48.26,$226.74,"$1,295.00",$80.04,$310.80,"$1,025.64","$1,036.00",$111.21,$30.90,$23.77,$206.16,$76.23
32000158,EAP,CPT® 73030,,SHOULDER COMPL 2+VIEWS RT RDG,"$1,295.00",$22.88,"$1,295.00",$57.09,$48.26,$76.53,$22.88,$48.26,$48.26,$226.74,"$1,295.00",$80.04,$310.80,"$1,025.64","$1,036.00",$111.21,$30.90,$23.77,$206.16,$76.23
32000161,EAP,CPT® 73030,,SHOULDERS 2+VIEW ECH BILAT RDG,"$1,307.00",$22.88,"$1,307.00",$57.09,$48.26,$76.53,$22.88,$48.26,$48.26,$228.85,"$1,307.00",$80.04,$313.68,"$1,035.14","$1,045.60",$111.21,$30.90,$23.77,$208.07,$76.23
32000163,EAP,CPT® 73040,,SHOULDER ARTHROGRAPHY RT RDG,"$1,220.00",$94.00,"$1,220.00",$196.33,$187.52,$370.02,$210.20,$187.52,$187.52,$213.61,"$1,220.00",$387.01,$292.80,$966.24,$976.00,$537.70,$107.06,$94.00,$194.22,$368.58
32000164,EAP,CPT® 73040,,SHOULDER ARTHROGRAPHY LT RDG,"$1,220.00",$94.00,"$1,220.00",$196.33,$187.52,$370.02,$210.20,$187.52,$187.52,$213.61,"$1,220.00",$387.01,$292.80,$966.24,$976.00,$537.70,$107.06,$94.00,$194.22,$368.58
32000165,EAP,CPT® 73040,,Shoulder Arthrograph Bi Rdg,"$2,440.00",$94.00,"$2,440.00",$196.33,$187.52,$370.02,$420.40,$187.52,$187.52,$427.22,"$2,440.00",$387.01,$585.60,"$1,932.48","$1,952.00",$537.70,$107.06,$94.00,$388.45,$368.58
32000167,EAP,CPT® 73050,,ACROMICLAVICULAR JNTS BI DRG,$873.00,$0.00,$873.00,$0.00,$59.59,$0.00,$0.00,$59.59,$59.59,$0.00,$873.00,$0.00,$209.52,$691.42,$698.40,$0.00,$0.00,$0.00,$0.00,$0.00
32000169,EAP,CPT® 73060,,HUMERI 2+VIEW EACH BILAT RDG,"$2,240.00",$23.05,"$2,240.00",$57.09,$48.26,$76.53,$385.94,$48.26,$48.26,$392.21,"$2,240.00",$80.04,$537.60,"$1,774.08","$1,792.00",$111.21,$30.55,$23.05,$356.61,$76.23
32000171,EAP,CPT® 73060,,Humerus 2+view Rdg,"$1,122.00",$23.05,"$1,122.00",$57.09,$48.26,$76.53,$193.31,$48.26,$48.26,$196.45,"$1,122.00",$80.04,$269.28,$888.62,$897.60,$111.21,$30.55,$23.05,$178.62,$76.23
32000173,EAP,CPT® 73060,,HUMERUS 2+VIEW LT RDG,"$1,122.00",$23.05,"$1,122.00",$57.09,$48.26,$76.53,$193.31,$48.26,$48.26,$196.45,"$1,122.00",$80.04,$269.28,$888.62,$897.60,$111.21,$30.55,$23.05,$178.62,$76.23
32000175,EAP,CPT® 73060,,HUMERUS 2+VIEW RT RDG,"$1,122.00",$23.05,"$1,122.00",$57.09,$48.26,$76.53,$193.31,$48.26,$48.26,$196.45,"$1,122.00",$80.04,$269.28,$888.62,$897.60,$111.21,$30.55,$23.05,$178.62,$76.23
32000177,EAP,CPT® 73070,,Elbow 2 View Rdg,$727.00,$20.17,$727.00,$53.63,$45.08,$76.53,$125.26,$45.08,$45.08,$127.29,$727.00,$80.04,$174.48,$575.78,$581.60,$111.21,$27.38,$20.17,$115.74,$76.23
32000179,EAP,CPT® 73070,,ELBOW 2 VIEW LT RDG,$727.00,$20.17,$727.00,$53.63,$45.08,$76.53,$125.26,$45.08,$45.08,$127.29,$727.00,$80.04,$174.48,$575.78,$581.60,$111.21,$27.38,$20.17,$115.74,$76.23
32000181,EAP,CPT® 73070,,ELBOW 2 VIEW RT RDG,$727.00,$20.17,$727.00,$53.63,$45.08,$76.53,$125.26,$45.08,$45.08,$127.29,$727.00,$80.04,$174.48,$575.78,$581.60,$111.21,$27.38,$20.17,$115.74,$76.23
32000183,EAP,CPT® 73070,,ELBOWS 2 VIEW EACH BILAT RDG,"$1,456.00",$20.17,"$1,456.00",$53.63,$45.08,$76.53,$250.86,$45.08,$45.08,$254.93,"$1,456.00",$80.04,$349.44,"$1,153.15","$1,164.80",$111.21,$27.38,$20.17,$231.80,$76.23
32000185,EAP,CPT® 73080,,Elbow 3+view Nwr,$774.00,$22.33,$774.00,$61.29,$60.47,$76.53,$133.36,$60.47,$60.47,$135.52,$774.00,$80.04,$185.76,$613.01,$619.20,$111.21,$30.55,$22.33,$123.22,$76.23
32000186,EAP,CPT® 73080,,Elbow Compl 3+view Rdg,$774.00,$22.33,$774.00,$61.29,$60.47,$76.53,$133.36,$60.47,$60.47,$135.52,$774.00,$80.04,$185.76,$613.01,$619.20,$111.21,$30.55,$22.33,$123.22,$76.23
32000188,EAP,CPT® 73080,,ELBOW COMPL 3+VIEW LT RDG,$774.00,$22.33,$774.00,$61.29,$60.47,$76.53,$133.36,$60.47,$60.47,$135.52,$774.00,$80.04,$185.76,$613.01,$619.20,$111.21,$30.55,$22.33,$123.22,$76.23
32000190,EAP,CPT® 73080,,ELBOW COMPL 3+VIEW RT RDG,$774.00,$22.33,$774.00,$61.29,$60.47,$76.53,$133.36,$60.47,$60.47,$135.52,$774.00,$80.04,$185.76,$613.01,$619.20,$111.21,$30.55,$22.33,$123.22,$76.23
32000192,EAP,CPT® 73080,,ELBOWS 3+VIEW EACH BILAT RDG,"$1,545.00",$22.33,"$1,545.00",$61.29,$60.47,$76.53,$266.20,$60.47,$60.47,$270.52,"$1,545.00",$80.04,$370.80,"$1,223.64","$1,236.00",$111.21,$30.55,$22.33,$245.96,$76.23
32000195,EAP,CPT® 73085,,ELBOW ARTHROGRAPHY RT RDG,"$2,731.00",$0.00,"$2,731.00",$0.00,$163.96,$0.00,$0.00,$163.96,$163.96,$0.00,"$2,731.00",$0.00,$655.44,"$2,162.95","$2,184.80",$0.00,$0.00,$0.00,$0.00,$0.00
32000196,EAP,CPT® 73085,,ELBOW ARTHROGRAPHY LT RDG,"$2,731.00",$0.00,"$2,731.00",$0.00,$163.96,$0.00,$0.00,$163.96,$163.96,$0.00,"$2,731.00",$0.00,$655.44,"$2,162.95","$2,184.80",$0.00,$0.00,$0.00,$0.00,$0.00
32000197,EAP,CPT® 73085,,Elbow Arthrography Bilat Rdg,"$5,466.00",$0.00,"$5,466.00",$0.00,$163.96,$0.00,$0.00,$163.96,$163.96,$0.00,"$5,466.00",$0.00,"$1,311.84","$4,329.07","$4,372.80",$0.00,$0.00,$0.00,$0.00,$0.00
32000198,EAP,CPT® 73090,,FOREARM X-RAY 2 VIEW RDG,$781.00,$20.53,$781.00,$50.84,$45.08,$76.53,$134.56,$45.08,$45.08,$136.75,$781.00,$80.04,$187.44,$618.55,$624.80,$111.21,$27.72,$20.53,$124.34,$76.23
32000200,EAP,CPT® 73090,,FOREARM X-RAY 2 VIEW LT RDG,$781.00,$20.53,$781.00,$50.84,$45.08,$76.53,$134.56,$45.08,$45.08,$136.75,$781.00,$80.04,$187.44,$618.55,$624.80,$111.21,$27.72,$20.53,$124.34,$76.23
32000202,EAP,CPT® 73090,,FOREARM X-RAY 2 VIEW RT RDG,$781.00,$20.53,$781.00,$50.84,$45.08,$76.53,$134.56,$45.08,$45.08,$136.75,$781.00,$80.04,$187.44,$618.55,$624.80,$111.21,$27.72,$20.53,$124.34,$76.23
32000205,EAP,CPT® 73090,,FOREARMS 2 VIEW EACH BILAT RDG,"$1,565.00",$20.53,"$1,565.00",$50.84,$45.08,$76.53,$269.64,$45.08,$45.08,$274.02,"$1,565.00",$80.04,$375.60,"$1,239.48","$1,252.00",$111.21,$27.72,$20.53,$249.15,$76.23
32000206,EAP,CPT® 73092,,Upp Ext Infant 2+view Rdg,$523.00,$0.00,$523.00,$0.00,$46.81,$0.00,$0.00,$46.81,$46.81,$0.00,$523.00,$0.00,$125.52,$414.22,$418.40,$0.00,$0.00,$0.00,$0.00,$0.00
32000207,EAP,CPT® 73092,,UPP EXT INFANT 2+VIEW BI RDG,"$1,040.00",$0.00,"$1,040.00",$0.00,$46.81,$0.00,$0.00,$46.81,$46.81,$0.00,"$1,040.00",$0.00,$249.60,$823.68,$832.00,$0.00,$0.00,$0.00,$0.00,$0.00
32000210,EAP,CPT® 73092,,UPP EXT INFANT 2+VIEW LT RDG,$523.00,$0.00,$523.00,$0.00,$46.81,$0.00,$0.00,$46.81,$46.81,$0.00,$523.00,$0.00,$125.52,$414.22,$418.40,$0.00,$0.00,$0.00,$0.00,$0.00
32000212,EAP,CPT® 73092,,UPP EXT INFANT 2+VIEW RT RDG,$523.00,$0.00,$523.00,$0.00,$46.81,$0.00,$0.00,$46.81,$46.81,$0.00,$523.00,$0.00,$125.52,$414.22,$418.40,$0.00,$0.00,$0.00,$0.00,$0.00
32000214,EAP,CPT® 73100,,Wrist 2 View  Rdg,$660.00,$24.49,$660.00,$57.09,$46.81,$76.53,$113.71,$46.81,$46.81,$115.56,$660.00,$80.04,$158.40,$522.72,$528.00,$111.21,$27.37,$24.49,$105.07,$76.23
32000216,EAP,CPT® 73100,,WRIST 2 VIEW  LT RDG,$660.00,$24.49,$660.00,$57.09,$46.81,$76.53,$113.71,$46.81,$46.81,$115.56,$660.00,$80.04,$158.40,$522.72,$528.00,$111.21,$27.37,$24.49,$105.07,$76.23
32000218,EAP,CPT® 73100,,WRIST 2 VIEW  RT RDG,$660.00,$24.49,$660.00,$57.09,$46.81,$76.53,$113.71,$46.81,$46.81,$115.56,$660.00,$80.04,$158.40,$522.72,$528.00,$111.21,$27.37,$24.49,$105.07,$76.23
32000220,EAP,CPT® 73100,,WRISTS 2 VIEW  BILAT RDG,"$1,317.00",$24.49,"$1,317.00",$57.09,$46.81,$76.53,$226.91,$46.81,$46.81,$230.60,"$1,317.00",$80.04,$316.08,"$1,043.06","$1,053.60",$111.21,$27.37,$24.49,$209.67,$76.23
32000223,EAP,CPT® 73110,,WRIST 3+VIEW RDG,$710.00,$28.79,$710.00,$69.63,$59.03,$76.53,$122.33,$59.03,$59.03,$124.32,$710.00,$80.04,$170.40,$562.32,$568.00,$111.21,$28.79,$30.25,$113.03,$76.23
32000225,EAP,CPT® 73110,,WRIST 3+VIEW LT RDG,$710.00,$28.79,$710.00,$69.63,$59.03,$76.53,$122.33,$59.03,$59.03,$124.32,$710.00,$80.04,$170.40,$562.32,$568.00,$111.21,$28.79,$30.25,$113.03,$76.23
32000227,EAP,CPT® 73110,,WRIST 3+VIEW RT RDG,$710.00,$28.79,$710.00,$69.63,$59.03,$76.53,$122.33,$59.03,$59.03,$124.32,$710.00,$80.04,$170.40,$562.32,$568.00,$111.21,$28.79,$30.25,$113.03,$76.23
32000229,EAP,CPT® 73110,,WRISTS 3+VIEW EACH BILAT RDG,"$1,421.00",$28.79,"$1,421.00",$69.63,$59.03,$76.53,$244.83,$59.03,$59.03,$248.81,"$1,421.00",$80.04,$341.04,"$1,125.43","$1,136.80",$111.21,$28.79,$30.25,$226.22,$76.23
32000231,EAP,CPT® 73115,,Wrist Arthrography Bilat Rdg,"$4,671.00",$0.00,"$4,671.00",$0.00,$176.51,$0.00,$0.00,$176.51,$176.51,$0.00,"$4,671.00",$0.00,"$1,121.04","$3,699.43","$3,736.80",$0.00,$0.00,$0.00,$0.00,$0.00
32000232,EAP,CPT® 73115,,WRIST ARTHROGRAPHY RT/LT RDG,"$2,333.00",$0.00,"$2,333.00",$0.00,$176.51,$0.00,$0.00,$176.51,$176.51,$0.00,"$2,333.00",$0.00,$559.92,"$1,847.74","$1,866.40",$0.00,$0.00,$0.00,$0.00,$0.00
32000233,EAP,CPT® 73120,,Hand 2 View Rdg,$682.00,$21.97,$682.00,$51.53,$44.19,$107.47,$117.51,$44.19,$44.19,$119.41,$682.00,$112.41,$163.68,$540.14,$545.60,$156.18,$27.37,$21.97,$108.57,$107.06
32000235,EAP,CPT® 73120,,HAND 2 VIEW LT RDG,$682.00,$21.97,$682.00,$51.53,$44.19,$107.47,$117.51,$44.19,$44.19,$119.41,$682.00,$112.41,$163.68,$540.14,$545.60,$156.18,$27.37,$21.97,$108.57,$107.06
32000237,EAP,CPT® 73120,,HAND 2 VIEW RT RDG,$682.00,$21.97,$682.00,$51.53,$44.19,$107.47,$117.51,$44.19,$44.19,$119.41,$682.00,$112.41,$163.68,$540.14,$545.60,$156.18,$27.37,$21.97,$108.57,$107.06
32000239,EAP,CPT® 73130,,HAND 3+VIEW RDG,$737.00,$21.03,$737.00,$60.58,$52.06,$76.53,$21.03,$52.06,$52.06,$129.04,$737.00,$80.04,$176.88,$583.70,$589.60,$111.21,$28.79,$26.29,$117.33,$76.23
32000241,EAP,CPT® 73130,,HAND 3+VIEW LT RDG,$737.00,$21.03,$737.00,$60.58,$52.06,$76.53,$21.03,$52.06,$52.06,$129.04,$737.00,$80.04,$176.88,$583.70,$589.60,$111.21,$28.79,$26.29,$117.33,$76.23
32000243,EAP,CPT® 73130,,HAND 3+VIEW RT RDG,$737.00,$21.03,$737.00,$60.58,$52.06,$76.53,$21.03,$52.06,$52.06,$129.04,$737.00,$80.04,$176.88,$583.70,$589.60,$111.21,$28.79,$26.29,$117.33,$76.23
32000244,EAP,CPT® 73120,,HANDS 2 VIEW EACH BILAT RDG,"$1,364.00",$21.97,"$1,364.00",$51.53,$44.19,$107.47,$235.01,$44.19,$44.19,$238.83,"$1,364.00",$112.41,$327.36,"$1,080.29","$1,091.20",$156.18,$27.37,$21.97,$217.15,$107.06
32000246,EAP,CPT® 73130,,HANDS 3+VIEW EACH BILAT RDG,"$1,478.00",$21.03,"$1,478.00",$60.58,$52.06,$76.53,$21.03,$52.06,$52.06,$258.79,"$1,478.00",$80.04,$354.72,"$1,170.58","$1,182.40",$111.21,$28.79,$26.29,$235.30,$76.23
32000248,EAP,CPT® 73140,,Finger  3 Views,$689.00,$23.09,$689.00,$61.97,$51.19,$76.53,$118.71,$51.19,$51.19,$120.64,$689.00,$80.04,$165.36,$545.69,$551.20,$111.21,$23.09,$28.81,$109.69,$76.23
32000249,EAP,CPT® 73140,,Finger X-ray,$689.00,$23.09,$689.00,$61.97,$51.19,$76.53,$118.71,$51.19,$51.19,$120.64,$689.00,$80.04,$165.36,$545.69,$551.20,$111.21,$23.09,$28.81,$109.69,$76.23
32000250,EAP,CPT® 73140,,FINGER(S) 2+VIEW RDG,$689.00,$23.09,$689.00,$61.97,$51.19,$76.53,$118.71,$51.19,$51.19,$120.64,$689.00,$80.04,$165.36,$545.69,$551.20,$111.21,$23.09,$28.81,$109.69,$76.23
32000252,EAP,CPT® 73140,,FINGER(S) 2+VIEW EACH BILAT RD,"$1,378.00",$23.09,"$1,378.00",$61.97,$51.19,$76.53,$237.42,$51.19,$51.19,$241.28,"$1,378.00",$80.04,$330.72,"$1,091.38","$1,102.40",$111.21,$23.09,$28.81,$219.38,$76.23
32000254,EAP,CPT® 73140,,FINGER(S) 2+VIEW LT RDG,$689.00,$23.09,$689.00,$61.97,$51.19,$76.53,$118.71,$51.19,$51.19,$120.64,$689.00,$80.04,$165.36,$545.69,$551.20,$111.21,$23.09,$28.81,$109.69,$76.23
32000256,EAP,CPT® 73140,,FINGER(S) 2+VIEW RT RDG,$689.00,$23.09,$689.00,$61.97,$51.19,$76.53,$118.71,$51.19,$51.19,$120.64,$689.00,$80.04,$165.36,$545.69,$551.20,$111.21,$23.09,$28.81,$109.69,$76.23
32000258,EAP,CPT® 36299,,Inject Vascular Unlstd Proc,"$3,921.00",$0.00,"$3,478.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,478.00",$0.00,"$2,255.00","$2,754.58","$2,782.40",$0.00,$0.00,$0.00,$0.00,$0.00
32000285,EAP,CPT® 73525,,HIP ARTHROGRAPHY RT RDG,"$1,181.00",$94.73,"$1,181.00",$199.82,$162.23,$370.02,$203.48,$162.23,$162.23,$206.78,"$1,181.00",$387.01,$283.44,$935.35,$944.80,$537.70,$107.06,$94.73,$188.02,$368.58
32000286,EAP,CPT® 73525,,HIP ARTHROGRAPHY LT RDG,"$1,181.00",$94.73,"$1,181.00",$199.82,$162.23,$370.02,$203.48,$162.23,$162.23,$206.78,"$1,181.00",$387.01,$283.44,$935.35,$944.80,$537.70,$107.06,$94.73,$188.02,$368.58
32000287,EAP,CPT® 73525,,Hips Arthrography Bilat Rdg,"$2,361.00",$94.73,"$2,361.00",$199.82,$162.23,$370.02,$406.79,$162.23,$162.23,$413.39,"$2,361.00",$387.01,$566.64,"$1,869.91","$1,888.80",$537.70,$107.06,$94.73,$375.87,$368.58
32000303,EAP,CPT® 73560,,KNEE 1-2 VIEW RDG,$766.00,$25.21,$766.00,$60.58,$45.95,$76.53,$131.98,$45.95,$45.95,$134.12,$766.00,$80.04,$183.84,$606.67,$612.80,$111.21,$28.43,$25.21,$121.95,$76.23
32000305,EAP,CPT® 73560,,KNEE 1-2 VIEW LT RDG,$766.00,$25.21,$766.00,$60.58,$45.95,$76.53,$131.98,$45.95,$45.95,$134.12,$766.00,$80.04,$183.84,$606.67,$612.80,$111.21,$28.43,$25.21,$121.95,$76.23
32000307,EAP,CPT® 73560,,KNEE 1-2 VIEW RT RDG,$766.00,$25.21,$766.00,$60.58,$45.95,$76.53,$131.98,$45.95,$45.95,$134.12,$766.00,$80.04,$183.84,$606.67,$612.80,$111.21,$28.43,$25.21,$121.95,$76.23
32000309,EAP,CPT® 73560,,KNEES 1-2 VIEW EACH BILAT RDG,"$1,528.00",$25.21,"$1,528.00",$60.58,$45.95,$76.53,$263.27,$45.95,$45.95,$267.54,"$1,528.00",$80.04,$366.72,"$1,210.18","$1,222.40",$111.21,$28.43,$25.21,$243.26,$76.23
32000311,EAP,CPT® 73562,,Knee 3 View Rdg,$826.00,$29.89,$826.00,$70.32,$57.87,$76.53,$142.32,$57.87,$57.87,$144.63,$826.00,$80.04,$198.24,$654.19,$660.80,$111.21,$31.26,$29.89,$131.50,$76.23
32000313,EAP,CPT® 73562,,KNEE 3 VIEW LT RDG,$826.00,$29.89,$826.00,$70.32,$57.87,$76.53,$142.32,$57.87,$57.87,$144.63,$826.00,$80.04,$198.24,$654.19,$660.80,$111.21,$31.26,$29.89,$131.50,$76.23
32000315,EAP,CPT® 73562,,KNEE 3 VIEW RT RDG,$826.00,$29.89,$826.00,$70.32,$57.87,$76.53,$142.32,$57.87,$57.87,$144.63,$826.00,$80.04,$198.24,$654.19,$660.80,$111.21,$31.26,$29.89,$131.50,$76.23
32000317,EAP,CPT® 73562,,KNEES 3 VIEW EACH BILAT RDG,"$1,649.00",$29.89,"$1,649.00",$70.32,$57.87,$76.53,$284.11,$57.87,$57.87,$288.73,"$1,649.00",$80.04,$395.76,"$1,306.01","$1,319.20",$111.21,$31.26,$29.89,$262.52,$76.23
32000319,EAP,CPT® 73564,,KNEE 4+VIEW EXR,$771.00,$32.78,$771.00,$77.98,$66.59,$107.47,$132.84,$66.59,$66.59,$135.00,$771.00,$112.41,$185.04,$610.63,$616.80,$156.18,$34.81,$32.78,$122.74,$107.06
32000320,EAP,CPT® 73564,,KNEE 4+VIEW LT RDG,$771.00,$32.78,$771.00,$77.98,$66.59,$107.47,$132.84,$66.59,$66.59,$135.00,$771.00,$112.41,$185.04,$610.63,$616.80,$156.18,$34.81,$32.78,$122.74,$107.06
32000322,EAP,CPT® 73564,,KNEE 4+VIEW RT RDG,$771.00,$32.78,$771.00,$77.98,$66.59,$107.47,$132.84,$66.59,$66.59,$135.00,$771.00,$112.41,$185.04,$610.63,$616.80,$156.18,$34.81,$32.78,$122.74,$107.06
32000324,EAP,CPT® 73564,,KNEES 4+VIEW BILAT RDG,"$1,539.00",$32.78,"$1,539.00",$77.98,$66.59,$107.47,$265.16,$66.59,$66.59,$269.47,"$1,539.00",$112.41,$369.36,"$1,218.89","$1,231.20",$156.18,$34.81,$32.78,$245.01,$107.06
32000327,EAP,CPT® 73565,,KNEES BOTH STANDING AP RDG,$911.00,$0.00,$911.00,$0.00,$49.43,$0.00,$0.00,$49.43,$49.43,$0.00,$911.00,$0.00,$218.64,$721.51,$728.80,$0.00,$0.00,$0.00,$0.00,$0.00
32000329,EAP,CPT® 73580,,KNEE ARTHROGRAPHY RT RDG,"$2,720.00",$0.00,"$2,720.00",$0.00,$218.63,$0.00,$0.00,$218.63,$218.63,$0.00,"$2,720.00",$0.00,$652.80,"$2,154.24","$2,176.00",$0.00,$0.00,$0.00,$0.00,$0.00
32000330,EAP,CPT® 73580,,KNEE ARTHROGRAPHY LT RDG,"$2,720.00",$0.00,"$2,720.00",$0.00,$218.63,$0.00,$0.00,$218.63,$218.63,$0.00,"$2,720.00",$0.00,$652.80,"$2,154.24","$2,176.00",$0.00,$0.00,$0.00,$0.00,$0.00
32000331,EAP,CPT® 73580,,Knees Arthrography Bilat Rdg,"$2,720.00",$0.00,"$2,720.00",$0.00,$218.63,$0.00,$0.00,$218.63,$218.63,$0.00,"$2,720.00",$0.00,$652.80,"$2,154.24","$2,176.00",$0.00,$0.00,$0.00,$0.00,$0.00
32000332,EAP,CPT® 73590,,TIBIA&FIBULA 2 VIEW RDG,$799.00,$22.69,$799.00,$56.41,$43.33,$76.53,$137.66,$43.33,$43.33,$139.90,$799.00,$80.04,$191.76,$632.81,$639.20,$111.21,$28.43,$22.69,$127.20,$76.23
32000334,EAP,CPT® 73590,,TIBIA&FIBULA 2 VIEW LT RDG,$799.00,$22.69,$799.00,$56.41,$43.33,$76.53,$137.66,$43.33,$43.33,$139.90,$799.00,$80.04,$191.76,$632.81,$639.20,$111.21,$28.43,$22.69,$127.20,$76.23
32000336,EAP,CPT® 73590,,TIBIA&FIBULA 2 VIEW RT RDG,$799.00,$22.69,$799.00,$56.41,$43.33,$76.53,$137.66,$43.33,$43.33,$139.90,$799.00,$80.04,$191.76,$632.81,$639.20,$111.21,$28.43,$22.69,$127.20,$76.23
32000338,EAP,CPT® 73590,,TIBIA&FIBULA 2VW ECH BILAT RDG,$799.00,$22.69,$799.00,$56.41,$43.33,$76.53,$137.66,$43.33,$43.33,$139.90,$799.00,$80.04,$191.76,$632.81,$639.20,$111.21,$28.43,$22.69,$127.20,$76.23
32000339,EAP,CPT® 73592,,Low Ext Infant 2+view Rdg,$376.00,$0.00,$376.00,$0.00,$46.81,$0.00,$0.00,$46.81,$46.81,$0.00,$376.00,$0.00,$90.24,$297.79,$300.80,$0.00,$0.00,$0.00,$0.00,$0.00
32000340,EAP,CPT® 73592,,LOW EXT INFANT 2+VIEW BI RDG,$376.00,$0.00,$376.00,$0.00,$46.81,$0.00,$0.00,$46.81,$46.81,$0.00,$376.00,$0.00,$90.24,$297.79,$300.80,$0.00,$0.00,$0.00,$0.00,$0.00
32000343,EAP,CPT® 73592,,LOW EXT INFANT 2+VIEW LT RDG,$376.00,$0.00,$376.00,$0.00,$46.81,$0.00,$0.00,$46.81,$46.81,$0.00,$376.00,$0.00,$90.24,$297.79,$300.80,$0.00,$0.00,$0.00,$0.00,$0.00
32000345,EAP,CPT® 73592,,LOW EXT INFANT 2+VIEW RT RDG,$376.00,$0.00,$376.00,$0.00,$46.81,$0.00,$0.00,$46.81,$46.81,$0.00,$376.00,$0.00,$90.24,$297.79,$300.80,$0.00,$0.00,$0.00,$0.00,$0.00
32000347,EAP,CPT® 73600,,Ankle 2 View Rdg,$892.00,$23.41,$892.00,$58.48,$44.19,$76.53,$153.69,$44.19,$44.19,$156.18,$892.00,$80.04,$214.08,$706.46,$713.60,$111.21,$27.37,$23.41,$142.01,$76.23
32000349,EAP,CPT® 73600,,ANKLE 2 VIEW LT RDG,$892.00,$23.41,$892.00,$58.48,$44.19,$76.53,$153.69,$44.19,$44.19,$156.18,$892.00,$80.04,$214.08,$706.46,$713.60,$111.21,$27.37,$23.41,$142.01,$76.23
32000351,EAP,CPT® 73600,,ANKLE 2 VIEW RT RDG,$892.00,$23.41,$892.00,$58.48,$44.19,$76.53,$153.69,$44.19,$44.19,$156.18,$892.00,$80.04,$214.08,$706.46,$713.60,$111.21,$27.37,$23.41,$142.01,$76.23
32000353,EAP,CPT® 73600,,ANKLES 2 VIEW EACH BILAT RDG,"$1,782.00",$23.41,"$1,782.00",$58.48,$44.19,$76.53,$307.03,$44.19,$44.19,$312.01,"$1,782.00",$80.04,$427.68,"$1,411.34","$1,425.60",$111.21,$27.37,$23.41,$283.69,$76.23
32000357,EAP,CPT® 73610,,ANKLE 3+VIEW LT RDG,$965.00,$26.29,$965.00,$61.97,$52.06,$76.53,$166.26,$52.06,$52.06,$168.96,$965.00,$80.04,$231.60,$764.28,$772.00,$111.21,$28.79,$26.29,$153.63,$76.23
32000359,EAP,CPT® 73610,,ANKLE 3+VIEW RT RDG,$965.00,$26.29,$965.00,$61.97,$52.06,$76.53,$166.26,$52.06,$52.06,$168.96,$965.00,$80.04,$231.60,$764.28,$772.00,$111.21,$28.79,$26.29,$153.63,$76.23
32000362,EAP,CPT® 73615,,ANKLE ARTHROGRAPHY LT RDG,"$3,153.00",$0.00,"$3,153.00",$0.00,$169.21,$0.00,$0.00,$169.21,$169.21,$0.00,"$3,153.00",$0.00,$756.72,"$2,497.18","$2,522.40",$0.00,$0.00,$0.00,$0.00,$0.00
32000363,EAP,CPT® 73615,,ANKLE ARTHROGRAPHY RT RDG,"$3,153.00",$0.00,"$3,153.00",$0.00,$169.21,$0.00,$0.00,$169.21,$169.21,$0.00,"$3,153.00",$0.00,$756.72,"$2,497.18","$2,522.40",$0.00,$0.00,$0.00,$0.00,$0.00
32000364,EAP,CPT® 73610,,ANKLES 3+VIEW EACH BILAT RDG,"$1,925.00",$26.29,"$1,925.00",$61.97,$52.06,$76.53,$331.67,$52.06,$52.06,$337.05,"$1,925.00",$80.04,$462.00,"$1,524.60","$1,540.00",$111.21,$28.79,$26.29,$306.46,$76.23
32000366,EAP,CPT® 73615,,Ankles Arthrography Bilat Rdg,"$6,309.00",$0.00,"$6,309.00",$0.00,$169.21,$0.00,$0.00,$169.21,$169.21,$0.00,"$6,309.00",$0.00,"$1,514.16","$4,996.73","$5,047.20",$0.00,$0.00,$0.00,$0.00,$0.00
32000367,EAP,CPT® 73620,,FEET 2 VIEW EACH BILAT RDG,"$1,461.00",$20.17,"$1,461.00",$50.84,$42.45,$76.53,$251.72,$42.45,$42.45,$255.81,"$1,461.00",$80.04,$350.64,"$1,157.11","$1,168.80",$111.21,$27.37,$20.17,$232.59,$76.23
32000369,EAP,CPT® 73620,,FOOT 2 VIEW LT RDG,$732.00,$20.17,$732.00,$50.84,$42.45,$76.53,$126.12,$42.45,$42.45,$128.17,$732.00,$80.04,$175.68,$579.74,$585.60,$111.21,$27.37,$20.17,$116.53,$76.23
32000371,EAP,CPT® 73620,,FOOT 2 VIEW RT RDG,$732.00,$20.17,$732.00,$50.84,$42.45,$76.53,$126.12,$42.45,$42.45,$128.17,$732.00,$80.04,$175.68,$579.74,$585.60,$111.21,$27.37,$20.17,$116.53,$76.23
32000373,EAP,CPT® 73620,,Foot 2 Views Rdg,$732.00,$20.17,$732.00,$50.84,$42.45,$76.53,$126.12,$42.45,$42.45,$128.17,$732.00,$80.04,$175.68,$579.74,$585.60,$111.21,$27.37,$20.17,$116.53,$76.23
32000375,EAP,CPT® 73630,,FEET 3+VIEW EACH BILAT RDG,"$1,580.00",$24.49,"$1,580.00",$57.09,$51.19,$76.53,$272.23,$51.19,$51.19,$276.65,"$1,580.00",$80.04,$379.20,"$1,251.36","$1,264.00",$111.21,$28.79,$24.49,$251.54,$76.23
32000377,EAP,CPT® 73630,,FOOT 3+VIEW RDG,$788.00,$24.49,$788.00,$57.09,$51.19,$76.53,$135.77,$51.19,$51.19,$137.97,$788.00,$80.04,$189.12,$624.10,$630.40,$111.21,$28.79,$24.49,$125.45,$76.23
32000379,EAP,CPT® 73630,,FOOT 3+VIEW LT RDG,$788.00,$24.49,$788.00,$57.09,$51.19,$76.53,$135.77,$51.19,$51.19,$137.97,$788.00,$80.04,$189.12,$624.10,$630.40,$111.21,$28.79,$24.49,$125.45,$76.23
32000381,EAP,CPT® 73630,,FOOT 3+VIEW RT RDG,$788.00,$24.49,$788.00,$57.09,$51.19,$76.53,$135.77,$51.19,$51.19,$137.97,$788.00,$80.04,$189.12,$624.10,$630.40,$111.21,$28.79,$24.49,$125.45,$76.23
32000383,EAP,CPT® 73650,,CALCANEI 2+VIEW EACH BILAT RDG,"$1,458.00",$20.17,"$1,458.00",$52.92,$43.33,$76.53,$251.21,$43.33,$43.33,$255.28,"$1,458.00",$80.04,$349.92,"$1,154.74","$1,166.40",$111.21,$26.66,$20.17,$232.11,$76.23
32000385,EAP,CPT® 73650,,CALCANEUS 2+VIEW RDG,$730.00,$20.17,$730.00,$52.92,$43.33,$76.53,$125.78,$43.33,$43.33,$127.82,$730.00,$80.04,$175.20,$578.16,$584.00,$111.21,$26.66,$20.17,$116.22,$76.23
32000387,EAP,CPT® 73650,,CALCANEUS 2+VIEW LT RDG,$730.00,$20.17,$730.00,$52.92,$43.33,$76.53,$125.78,$43.33,$43.33,$127.82,$730.00,$80.04,$175.20,$578.16,$584.00,$111.21,$26.66,$20.17,$116.22,$76.23
32000389,EAP,CPT® 73650,,CALCANEUS 2+VIEW RT RDG,$730.00,$20.17,$730.00,$52.92,$43.33,$76.53,$125.78,$43.33,$43.33,$127.82,$730.00,$80.04,$175.20,$578.16,$584.00,$111.21,$26.66,$20.17,$116.22,$76.23
32000391,EAP,CPT® 73660,,Toe X-ray,$863.00,$21.61,$863.00,$55.02,$48.57,$76.53,$148.69,$48.57,$48.57,$151.10,$863.00,$80.04,$207.12,$683.50,$690.40,$111.21,$23.09,$21.61,$137.39,$76.23
32000392,EAP,CPT® 73660,,TOE(S) 2+VIEW EACH BILAT RDG,"$1,733.00",$21.61,"$1,733.00",$55.02,$48.57,$76.53,$298.59,$48.57,$48.57,$303.43,"$1,733.00",$80.04,$415.92,"$1,372.54","$1,386.40",$111.21,$23.09,$21.61,$275.89,$76.23
32000394,EAP,CPT® 73660,,TOE(S) X-RAY 2+VIEW RDG,$863.00,$21.61,$863.00,$55.02,$48.57,$76.53,$148.69,$48.57,$48.57,$151.10,$863.00,$80.04,$207.12,$683.50,$690.40,$111.21,$23.09,$21.61,$137.39,$76.23
32000396,EAP,CPT® 73660,,TOE(S) X-RAY 2+VIEW LT RDG,$863.00,$21.61,$863.00,$55.02,$48.57,$76.53,$148.69,$48.57,$48.57,$151.10,$863.00,$80.04,$207.12,$683.50,$690.40,$111.21,$23.09,$21.61,$137.39,$76.23
32000398,EAP,CPT® 73660,,TOE(S) X-RAY 2+VIEW RT RDG,$863.00,$21.61,$863.00,$55.02,$48.57,$76.53,$148.69,$48.57,$48.57,$151.10,$863.00,$80.04,$207.12,$683.50,$690.40,$111.21,$23.09,$21.61,$137.39,$76.23
32000412,EAP,CPT® 74018,,"KUB-KIDNEY,URETER,BLADDER RDG",$727.00,$20.17,$727.00,$53.72,$43.76,$76.53,$125.26,$43.76,$43.76,$127.29,$727.00,$80.04,$174.48,$575.78,$581.60,$111.21,$26.25,$20.17,$115.74,$76.23
32000417,EAP,CPT® 74019,,ABDOMEN AP OBLIQ&CONE RDG,$723.00,$24.49,$723.00,$65.55,$52.33,$107.47,$124.57,$52.33,$52.33,$126.59,$723.00,$112.41,$173.52,$572.62,$578.40,$156.18,$32.02,$24.49,$115.10,$107.06
32000419,EAP,CPT® 74019,,ABDOMEN W/DECUB&/ERECT RDG,$742.00,$24.49,$742.00,$65.55,$52.33,$107.47,$127.84,$52.33,$52.33,$129.92,$742.00,$112.41,$178.08,$587.66,$593.60,$156.18,$32.02,$24.49,$118.13,$107.06
32000421,EAP,CPT® 74022,,Xr 2 Vw Abd W/ Single View Chest,"$1,090.00",$0.00,"$1,090.00",$87.73,$76.04,$107.47,$187.80,$76.04,$76.04,$190.85,"$1,090.00",$112.41,$261.60,$863.28,$872.00,$156.18,$44.36,$32.78,$0.00,$107.06
32000430,EAP,CPT® 74210,,Xr Pharynx/cerv Esoph Single Contrast,$665.00,$0.00,$665.00,$0.00,$136.97,$0.00,$0.00,$136.97,$136.97,$0.00,$665.00,$0.00,$159.60,$526.68,$532.00,$0.00,$0.00,$0.00,$0.00,$0.00
32000432,EAP,CPT® 74220,,Xr Esophagus Single Contrast,"$1,188.00",$66.99,"$1,188.00",$173.37,$150.06,$193.45,$204.69,$150.06,$150.06,$208.01,"$1,188.00",$202.33,$285.12,$940.90,$950.40,$281.11,$68.55,$66.99,$189.13,$192.70
32000434,EAP,CPT® 74230,,Xr Swallow Function Single Contrast,$988.00,$0.00,$988.00,$0.00,$147.27,$0.00,$0.00,$147.27,$147.27,$0.00,$988.00,$0.00,$237.12,$782.50,$790.40,$0.00,$0.00,$0.00,$0.00,$0.00
32000435,EAP,CPT® 74230,,Barium Swallow,$988.00,$0.00,$988.00,$0.00,$147.27,$0.00,$0.00,$147.27,$147.27,$0.00,$988.00,$0.00,$237.12,$782.50,$790.40,$0.00,$0.00,$0.00,$0.00,$0.00
32000436,EAP,CPT® 74235,,ESOPHAGEAL FB REMOVAL  S&I SPV,"$1,342.00",$0.00,"$1,342.00",$0.00,$286.87,$0.00,$0.00,$286.87,$286.87,$0.00,"$1,342.00",$0.00,$322.08,"$1,062.86","$1,073.60",$0.00,$0.00,$0.00,$0.00,$0.00
32000437,EAP,CPT® 74235,,FB REMOVAL ESOPHAGEAL S&I EXR,"$1,342.00",$0.00,"$1,342.00",$0.00,$286.87,$0.00,$0.00,$286.87,$286.87,$0.00,"$1,342.00",$0.00,$322.08,"$1,062.86","$1,073.60",$0.00,$0.00,$0.00,$0.00,$0.00
32000439,EAP,CPT® 74235,,Rem. F.b. Esoph Xray Super/int,"$1,342.00",$0.00,"$1,342.00",$0.00,$286.87,$0.00,$0.00,$286.87,$286.87,$0.00,"$1,342.00",$0.00,$322.08,"$1,062.86","$1,073.60",$0.00,$0.00,$0.00,$0.00,$0.00
32000441,EAP,CPT® 74240,,UGI W/O KUB RDG,"$1,361.00",$80.68,"$1,361.00",$221.41,$170.71,$193.45,$234.49,$170.71,$170.71,$238.30,"$1,361.00",$202.33,$326.64,"$1,077.91","$1,088.80",$281.11,$90.47,$80.68,$216.67,$192.70
32000448,EAP,CPT® 74246,,UGI W/ AIR CON W/O KUB RDG,"$1,289.00",$94.36,"$1,289.00",$249.25,$207.91,$193.45,$222.09,$207.91,$207.91,$225.69,"$1,289.00",$202.33,$309.36,"$1,020.89","$1,031.20",$281.11,$97.60,$94.36,$205.21,$192.70
32000449,EAP,CPT® 74246,,Ugi W/air Contrast,"$1,289.00",$94.36,"$1,289.00",$249.25,$207.91,$193.45,$222.09,$207.91,$207.91,$225.69,"$1,289.00",$202.33,$309.36,"$1,020.89","$1,031.20",$281.11,$97.60,$94.36,$205.21,$192.70
32000457,EAP,CPT® 74250,,Xr Small Bowel Single Contrast,$613.00,$0.00,$613.00,$0.00,$183.05,$0.00,$0.00,$183.05,$183.05,$0.00,$613.00,$0.00,$147.12,$485.50,$490.40,$0.00,$0.00,$0.00,$0.00,$0.00
32000462,EAP,CPT® 74270,,Xr Colon Single Contrast,"$1,733.00",$100.09,"$1,733.00",$287.55,$260.12,$193.45,$298.59,$260.12,$260.12,$303.43,"$1,733.00",$202.33,$415.92,"$1,372.54","$1,386.40",$281.11,$100.09,$103.37,$275.89,$192.70
32000463,EAP,CPT® 74270,,Be (barium Enema) Routi,"$1,733.00",$100.09,"$1,733.00",$287.55,$260.12,$193.45,$298.59,$260.12,$260.12,$303.43,"$1,733.00",$202.33,$415.92,"$1,372.54","$1,386.40",$281.11,$100.09,$103.37,$275.89,$192.70
32000465,EAP,CPT® 74280,,Xr Colon Double Contrast,"$2,721.00",$134.85,"$2,721.00",$317.49,$355.81,$193.45,$468.81,$355.81,$355.81,$476.43,"$2,721.00",$202.33,$653.04,"$2,155.03","$2,176.80",$281.11,$134.85,$160.64,$433.18,$192.70
32000467,EAP,CPT® 74283,,THERAPEUTIC ENEMA CON/AIR RDG,"$1,478.00",$0.00,"$1,478.00",$0.00,$246.57,$0.00,$0.00,$246.57,$246.57,$0.00,"$1,478.00",$0.00,$354.72,"$1,170.58","$1,182.40",$0.00,$0.00,$0.00,$0.00,$0.00
32000468,EAP,CPT® 74290,,Cholecystography W/dye Rdg,"$1,294.00",$0.00,"$1,294.00",$0.00,$114.42,$0.00,$0.00,$114.42,$114.42,$0.00,"$1,294.00",$0.00,$310.56,"$1,024.85","$1,035.20",$0.00,$0.00,$0.00,$0.00,$0.00
32000470,EAP,CPT® 74300,,CHOLANGIO INTRAOPERATIVE RDG,"$1,122.00",$0.00,"$1,122.00",$0.00,$85.40,$0.00,$0.00,$85.40,$85.40,$0.00,"$1,122.00",$0.00,$269.28,$888.62,$897.60,$0.00,$0.00,$0.00,$0.00,$0.00
32000471,EAP,CPT® 74300,,Xray Bile Ducts/pancreas,"$1,122.00",$0.00,"$1,122.00",$0.00,$85.40,$0.00,$0.00,$85.40,$85.40,$0.00,"$1,122.00",$0.00,$269.28,$888.62,$897.60,$0.00,$0.00,$0.00,$0.00,$0.00
32000477,EAP,CPT® 74328,,Radiological;biliary Ductal,$934.00,$0.00,$934.00,$0.00,$331.28,$0.00,$0.00,$331.28,$331.28,$0.00,$934.00,$0.00,$224.16,$739.73,$747.20,$0.00,$0.00,$0.00,$0.00,$0.00
32000478,EAP,CPT® 74329,,Radiological;pancreatic Ductal,$934.00,$0.00,$934.00,$0.00,$167.32,$0.00,$0.00,$167.32,$167.32,$0.00,$934.00,$0.00,$224.16,$739.73,$747.20,$0.00,$0.00,$0.00,$0.00,$0.00
32000479,EAP,CPT® 74330,,Radiological;biliary & Pancrea,$934.00,$0.00,$934.00,$0.00,$331.28,$0.00,$160.92,$331.28,$331.28,$163.54,$934.00,$0.00,$224.16,$739.73,$747.20,$0.00,$163.52,$0.00,$0.00,$0.00
32000481,EAP,CPT® 74340,,INTRO OF LONG GI TUBE S&I RDG,$461.00,$0.00,$461.00,$0.00,$275.61,$0.00,$0.00,$275.61,$275.61,$0.00,$461.00,$0.00,$110.64,$365.11,$368.80,$0.00,$0.00,$0.00,$0.00,$0.00
32000482,EAP,CPT® 74340,,X-ray Guide For Gi Tube,$461.00,$0.00,$461.00,$0.00,$275.61,$0.00,$0.00,$275.61,$275.61,$0.00,$461.00,$0.00,$110.64,$365.11,$368.80,$0.00,$0.00,$0.00,$0.00,$0.00
32000484,EAP,CPT® 74355,,Pl Enteroclysis Tube Perc Spv,$844.00,$0.00,$844.00,$0.00,$275.61,$0.00,$0.00,$275.61,$275.61,$0.00,$844.00,$0.00,$202.56,$668.45,$675.20,$0.00,$0.00,$0.00,$0.00,$0.00
32000485,EAP,CPT® 74360,,Eso-dil Intralu Dil Stric Xray,$976.00,$0.00,$976.00,$0.00,$331.28,$0.00,$0.00,$331.28,$331.28,$0.00,$976.00,$0.00,$234.24,$772.99,$780.80,$0.00,$0.00,$0.00,$0.00,$0.00
32000486,EAP,CPT® 74360,,INTRALUMINAL DILAT STRICTU SPV,$976.00,$0.00,$976.00,$0.00,$331.28,$0.00,$0.00,$331.28,$331.28,$0.00,$976.00,$0.00,$234.24,$772.99,$780.80,$0.00,$0.00,$0.00,$0.00,$0.00
32000487,EAP,CPT® 74363,,BILIARY STRICTURE SPV,"$2,534.00",$0.00,"$2,534.00",$0.00,$210.40,$0.00,$0.00,$210.40,$210.40,$0.00,"$2,534.00",$0.00,$608.16,"$2,006.93","$2,027.20",$0.00,$0.00,$0.00,$0.00,$0.00
32000488,EAP,CPT® 74400,,Urography Hypertensive,$888.00,$0.00,$888.00,$0.00,$200.78,$0.00,$0.00,$200.78,$200.78,$0.00,$888.00,$0.00,$213.12,$703.30,$710.40,$0.00,$0.00,$0.00,$0.00,$0.00
32000490,EAP,CPT® 74400,,Urography W/wo Kub/tomog Rdg,$888.00,$0.00,$888.00,$0.00,$200.78,$0.00,$0.00,$200.78,$200.78,$0.00,$888.00,$0.00,$213.12,$703.30,$710.40,$0.00,$0.00,$0.00,$0.00,$0.00
32000493,EAP,CPT® 74410,,Urography Drip Infusion Rdg,$868.00,$0.00,$868.00,$0.00,$213.85,$0.00,$0.00,$213.85,$213.85,$0.00,$868.00,$0.00,$208.32,$687.46,$694.40,$0.00,$0.00,$0.00,$0.00,$0.00
32000495,EAP,CPT® 74415,,Urography With Nephro Exr,$868.00,$0.00,$868.00,$0.00,$254.73,$0.00,$0.00,$254.73,$254.73,$0.00,$868.00,$0.00,$208.32,$687.46,$694.40,$0.00,$0.00,$0.00,$0.00,$0.00
32000496,EAP,CPT® 74420,,Retrograde Urography,$888.00,$0.00,$888.00,$0.00,$275.61,$0.00,$0.00,$275.61,$275.61,$0.00,$888.00,$0.00,$213.12,$703.30,$710.40,$0.00,$0.00,$0.00,$0.00,$0.00
32000497,EAP,CPT® 74420,,Urogra Retro W/wo Kub Rdg,$888.00,$0.00,$888.00,$0.00,$275.61,$0.00,$0.00,$275.61,$275.61,$0.00,$888.00,$0.00,$213.12,$703.30,$710.40,$0.00,$0.00,$0.00,$0.00,$0.00
32000500,EAP,CPT® 74425,,Nephrostogram,"$1,039.00",$67.58,"$1,039.00",$882.13,$137.30,$370.02,$179.01,$137.30,$137.30,$181.92,"$1,039.00",$387.01,$249.36,$822.89,$831.20,$537.70,$67.58,$106.25,$165.41,$368.58
32000501,EAP,CPT® 74425,,Loopogram/pouchogram,"$1,039.00",$67.58,"$1,039.00",$882.13,$137.30,$370.02,$179.01,$137.30,$137.30,$181.92,"$1,039.00",$387.01,$249.36,$822.89,$831.20,$537.70,$67.58,$106.25,$165.41,$368.58
32000502,EAP,CPT® 74425,,UROGRAPHY ANTEGRADE EXR,"$1,039.00",$67.58,"$1,039.00",$882.13,$137.30,$370.02,$179.01,$137.30,$137.30,$181.92,"$1,039.00",$387.01,$249.36,$822.89,$831.20,$537.70,$67.58,$106.25,$165.41,$368.58
32000503,EAP,CPT® 74430,,CYSTOGRAPHY 3+VIEW S&I RDG,"$1,247.00",$24.49,"$1,247.00",$74.51,$146.57,$370.02,$214.85,$146.57,$146.57,$218.34,"$1,247.00",$387.01,$299.28,$987.62,$997.60,$537.70,$56.52,$24.49,$198.52,$368.58
32000504,EAP,CPT® 74430,,Contrast Xray Bladder,"$1,247.00",$24.49,"$1,247.00",$74.51,$146.57,$370.02,$214.85,$146.57,$146.57,$218.34,"$1,247.00",$387.01,$299.28,$987.62,$997.60,$537.70,$56.52,$24.49,$198.52,$368.58
32000505,EAP,CPT® 74440,,Vasography Vesicu'graphy Spv,"$1,078.00",$0.00,"$1,078.00",$0.00,$153.55,$0.00,$0.00,$153.55,$153.55,$0.00,"$1,078.00",$0.00,$258.72,$853.78,$862.40,$0.00,$0.00,$0.00,$0.00,$0.00
32000506,EAP,CPT® 74445,,CORPORA CAVERNO'GRAM S&I SPV,"$1,078.00",$0.00,"$1,078.00",$0.00,$118.38,$0.00,$0.00,$118.38,$118.38,$0.00,"$1,078.00",$0.00,$258.72,$853.78,$862.40,$0.00,$0.00,$0.00,$0.00,$0.00
32000508,EAP,CPT® 74450,,Retro Urethrocystography,"$2,632.00",$0.00,"$2,632.00",$447.70,$153.20,$223.46,$453.48,$153.20,$153.20,$460.84,"$2,632.00",$233.72,$631.68,"$2,084.54","$2,105.60",$324.73,$72.23,$0.00,$419.01,$222.60
32000509,EAP,CPT® 74450,,RETROGRADE URETHROGRAM RDG,"$2,632.00",$0.00,"$2,632.00",$447.70,$153.20,$223.46,$453.48,$153.20,$153.20,$460.84,"$2,632.00",$233.72,$631.68,"$2,084.54","$2,105.60",$324.73,$72.23,$0.00,$419.01,$222.60
32000511,EAP,CPT® 74455,,URETHROCYSTOGRAPHY VOID RDG,"$2,015.00",$76.86,"$2,015.00",$160.83,$174.74,$223.46,$347.17,$174.74,$174.74,$352.81,"$2,015.00",$233.72,$483.60,"$1,595.88","$1,612.00",$324.73,$76.86,$82.12,$320.79,$222.60
32000514,EAP,CPT® 74485,,NEPHRSTOMY/URETERAL DILAT SPV,"$2,682.00",$0.00,"$2,682.00",$0.00,$215.57,$0.00,$0.00,$215.57,$215.57,$0.00,"$2,682.00",$0.00,$643.68,"$2,124.14","$2,145.60",$0.00,$0.00,$0.00,$0.00,$0.00
32000516,EAP,CPT® 74740,,HYSTEROSALPINGOGRAPHY RDG,$874.00,$68.95,$874.00,$146.90,$138.56,$223.46,$150.59,$138.56,$138.56,$153.03,$874.00,$233.72,$209.76,$692.21,$699.20,$324.73,$68.95,$72.03,$139.14,$222.60
32000517,EAP,CPT® 74742,,TRANSCERVIC CATH FALLOPIAN SPV,$623.00,$0.00,$623.00,$0.00,$143.89,$0.00,$0.00,$143.89,$143.89,$0.00,$623.00,$0.00,$149.52,$493.42,$498.40,$0.00,$0.00,$0.00,$0.00,$0.00
32000547,EAP,CPT® 75726,,ANGIO MESENTERIC SPV,"$8,171.00",$87.16,"$8,171.00",$293.82,$538.95,"$4,407.29","$1,407.82",$538.95,$538.95,"$1,430.68","$8,171.00","$4,609.70","$1,961.04","$6,471.43","$6,536.80","$6,404.56",$535.99,$87.16,"$1,300.82","$4,390.19"
32000548,EAP,CPT® 75726,,ANGIO HEPATIC SPV,"$8,171.00",$87.16,"$8,171.00",$293.82,$538.95,"$4,407.29","$1,407.82",$538.95,$538.95,"$1,430.68","$8,171.00","$4,609.70","$1,961.04","$6,471.43","$6,536.80","$6,404.56",$535.99,$87.16,"$1,300.82","$4,390.19"
32000555,EAP,CPT® 75746,,ANGIO PULMONARY NONSELE SPV,"$2,989.00",$0.00,"$2,989.00",$0.00,$524.99,$0.00,$0.00,$524.99,$524.99,$0.00,"$2,989.00",$0.00,$717.36,"$2,367.29","$2,391.20",$0.00,$0.00,$0.00,$0.00,$0.00
32000556,EAP,CPT® 75756,,"Artery Xray, Chest","$3,649.00",$0.00,"$3,649.00",$0.00,$555.53,$0.00,$0.00,$555.53,$555.53,$0.00,"$3,649.00",$0.00,$875.76,"$2,890.01","$2,919.20",$0.00,$0.00,$0.00,$0.00,$0.00
32000560,EAP,CPT® 75809,,Shuntogram Rdg,$862.00,$53.15,$862.00,$194.26,$150.20,$107.47,$148.52,$150.20,$150.20,$150.93,$862.00,$112.41,$206.88,$682.70,$689.60,$156.18,$53.15,$68.43,$137.23,$107.06
32000561,EAP,CPT® 75810,,SPLENOPORTOGRAPHY SPV,"$11,121.00",$0.00,"$11,121.00",$0.00,"$1,322.48",$0.00,$0.00,"$1,322.48","$1,322.48",$0.00,"$11,121.00",$0.00,"$2,669.04","$8,807.83","$8,896.80",$0.00,$0.00,$0.00,$0.00,$0.00
32000562,EAP,CPT® 75820,,EXTREMITY UNI VENOGRAM SPV,"$1,498.00",$71.50,"$1,498.00",$227.00,$197.19,$604.60,$258.10,$197.19,$197.19,$262.29,"$1,498.00",$632.36,$359.52,"$1,186.42","$1,198.40",$878.58,$71.50,$74.20,$238.48,$602.25
32000563,EAP,CPT® 75822,,EXTREMITY BI VENOGRAM SPV,"$1,632.00",$75.28,"$1,635.92",$269.47,$218.68,"$1,564.09",$271.71,$218.68,$218.68,$276.12,"$1,577.00","$1,635.92",$378.48,"$1,248.98","$1,261.60","$1,577.00",$109.07,$75.28,$251.06,"$1,558.02"
32000564,EAP,CPT® 75825,,INFERIOR VENO CAVAGRAM SPV,"$8,435.00",$0.00,"$8,435.00",$0.00,$487.46,$0.00,$0.00,$487.46,$487.46,$0.00,"$8,435.00",$0.00,"$2,024.40","$6,680.52","$6,748.00",$0.00,$0.00,$0.00,$0.00,$0.00
32000565,EAP,CPT® 75827,,SUPERIOR VENO CAVAGRAM SPV,"$2,516.00",$0.00,"$2,516.00",$0.00,$489.22,$0.00,$0.00,$489.22,$489.22,$0.00,"$2,516.00",$0.00,$603.84,"$1,992.67","$2,012.80",$0.00,$0.00,$0.00,$0.00,$0.00
32000566,EAP,CPT® 75831,,RENAL VENOGRAPH UNI SELEC SPV,"$7,799.00",$0.00,"$7,799.00",$0.00,$494.46,$0.00,$0.00,$494.46,$494.46,$0.00,"$7,799.00",$0.00,"$1,871.76","$6,176.81","$6,239.20",$0.00,$0.00,$0.00,$0.00,$0.00
32000567,EAP,CPT® 75833,,RENAL VENOGRAM BI SELECT SPV,"$8,009.00",$0.00,"$8,009.00",$0.00,$525.86,$0.00,$0.00,$525.86,$525.86,$0.00,"$8,009.00",$0.00,"$1,922.16","$6,343.13","$6,407.20",$0.00,$0.00,$0.00,$0.00,$0.00
32000568,EAP,CPT® 75840,,ADRENAL VENO UNILAT SEL SPV,"$5,415.00",$0.00,"$5,415.00",$0.00,$490.95,$0.00,$0.00,$490.95,$490.95,$0.00,"$5,415.00",$0.00,"$1,299.60","$4,288.68","$4,332.00",$0.00,$0.00,$0.00,$0.00,$0.00
32000569,EAP,CPT® 75842,,ADRENAL VENOGRPHY BI SELCT SPV,"$5,630.00",$0.00,"$5,630.00",$0.00,$527.60,$0.00,$0.00,$527.60,$527.60,$0.00,"$5,630.00",$0.00,"$1,351.20","$4,458.96","$4,504.00",$0.00,$0.00,$0.00,$0.00,$0.00
32000570,EAP,CPT® 75860,,SINUS/JUGULAR VENOGRAM SPN,"$3,300.00",$0.00,"$3,300.00",$0.00,$504.04,$0.00,$0.00,$504.04,$504.04,$0.00,"$3,300.00",$0.00,$792.00,"$2,613.60","$2,640.00",$0.00,$0.00,$0.00,$0.00,$0.00
32000571,EAP,CPT® 75870,,SUPER SAGG SINUS VENOGRAM SPN,"$2,716.00",$0.00,"$2,716.00",$0.00,$502.30,$0.00,$0.00,$502.30,$502.30,$0.00,"$2,716.00",$0.00,$651.84,"$2,151.07","$2,172.80",$0.00,$0.00,$0.00,$0.00,$0.00
32000572,EAP,CPT® 75872,,EPIDURAL VENOGRAM SPN,"$1,855.00",$0.00,"$1,855.00",$0.00,$552.05,$0.00,$0.00,$552.05,$552.05,$0.00,"$1,855.00",$0.00,$445.20,"$1,469.16","$1,484.00",$0.00,$0.00,$0.00,$0.00,$0.00
32000573,EAP,CPT® 75880,,ORBITAL VENOGRAM SPN,"$1,855.00",$0.00,"$1,855.00",$0.00,$203.29,$0.00,$0.00,$203.29,$203.29,$0.00,"$1,855.00",$0.00,$445.20,"$1,469.16","$1,484.00",$0.00,$0.00,$0.00,$0.00,$0.00
32000574,EAP,CPT® 75885,,TRANS-HEP PORT W/HEMODYNAM SPV,"$7,702.00",$0.00,"$7,702.00",$0.00,$496.19,$0.00,$0.00,$496.19,$496.19,$0.00,"$7,702.00",$0.00,"$1,848.48","$6,099.98","$6,161.60",$0.00,$0.00,$0.00,$0.00,$0.00
32000575,EAP,CPT® 75887,,TRANS-HEP PORT W/O HEMODYN SPV,"$4,043.00",$0.00,"$4,043.00",$0.00,$501.43,$0.00,$0.00,$501.43,$501.43,$0.00,"$4,043.00",$0.00,$970.32,"$3,202.06","$3,234.40",$0.00,$0.00,$0.00,$0.00,$0.00
32000576,EAP,CPT® 75889,,HEPATIC WEDGE VENO W/EVAL SPV,"$7,702.00",$0.00,"$7,702.00",$0.00,$495.32,$0.00,$0.00,$495.32,$495.32,$0.00,"$7,702.00",$0.00,"$1,848.48","$6,099.98","$6,161.60",$0.00,$0.00,$0.00,$0.00,$0.00
32000577,EAP,CPT® 75891,,HEPATIC WEDG VENO W/O EVAL SPV,"$8,009.00",$0.00,"$8,009.00",$0.00,$495.32,$0.00,$0.00,$495.32,$495.32,$0.00,"$8,009.00",$0.00,"$1,922.16","$6,343.13","$6,407.20",$0.00,$0.00,$0.00,$0.00,$0.00
32000578,EAP,CPT® 75893,,VENOUS SAMPLING W/WO ANGI SPV,"$5,000.00",$0.00,"$5,000.00",$0.00,$494.46,$0.00,$0.00,$494.46,$494.46,$0.00,"$5,000.00",$0.00,"$1,200.00","$3,960.00","$4,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
32000579,EAP,CPT® 75894,,Transcath Embolization,"$10,671.00",$0.00,"$10,671.00",$0.00,"$2,534.24",$0.00,$0.00,"$2,534.24","$2,534.24",$0.00,"$10,671.00",$0.00,"$2,561.04","$8,451.43","$8,536.80",$0.00,$0.00,$0.00,$0.00,$0.00
32000580,EAP,CPT® 75894,,"Transcath Embolization, S&i","$10,671.00",$0.00,"$10,671.00",$0.00,"$2,534.24",$0.00,$0.00,"$2,534.24","$2,534.24",$0.00,"$10,671.00",$0.00,"$2,561.04","$8,451.43","$8,536.80",$0.00,$0.00,$0.00,$0.00,$0.00
32000585,EAP,CPT® 75901,,Remove Cva Device Obstruct,$591.00,$0.00,$591.00,$0.00,$347.69,$0.00,$0.00,$347.69,$347.69,$0.00,$591.00,$0.00,$141.84,$468.07,$472.80,$0.00,$0.00,$0.00,$0.00,$0.00
32000592,EAP,CPT® 75956,,Endovasc Thor Ao Repr,"$2,118.00",$0.00,"$2,118.00",$0.00,"$1,511.62",$0.00,$0.00,"$1,511.62","$1,511.62",$0.00,"$2,118.00",$0.00,$508.32,"$1,677.46","$1,694.40",$0.00,$0.00,$0.00,$0.00,$0.00
32000593,EAP,CPT® 75957,,Endovasc Thor Aor Repr,"$2,287.00",$0.00,"$2,287.00",$0.00,"$1,632.23",$0.00,$0.00,"$1,632.23","$1,632.23",$0.00,"$2,287.00",$0.00,$548.88,"$1,811.30","$1,829.60",$0.00,$0.00,$0.00,$0.00,$0.00
32000594,EAP,CPT® 75958,,Place Prox Ext Thor Ao,"$1,761.00",$0.00,"$1,761.00",$0.00,"$1,256.83",$0.00,$0.00,"$1,256.83","$1,256.83",$0.00,"$1,761.00",$0.00,$422.64,"$1,394.71","$1,408.80",$0.00,$0.00,$0.00,$0.00,$0.00
32000595,EAP,CPT® 75959,,Place Dist Ext Thor Ao,"$1,693.00",$0.00,"$1,693.00",$0.00,"$1,208.29",$0.00,$0.00,"$1,208.29","$1,208.29",$0.00,"$1,693.00",$0.00,$406.32,"$1,340.86","$1,354.40",$0.00,$0.00,$0.00,$0.00,$0.00
32000607,EAP,CPT® 75984,,CHNG DRN TUBE CATH W DYE SPV,"$2,270.00",$0.00,"$2,270.00",$0.00,$184.19,$0.00,$0.00,$184.19,$184.19,$0.00,"$2,270.00",$0.00,$544.80,"$1,797.84","$1,816.00",$0.00,$0.00,$0.00,$0.00,$0.00
32000608,EAP,CPT® 75989,,Us Drain Percut S&i,"$3,905.00",$0.00,"$3,905.00",$0.00,$755.50,$0.00,$0.00,$755.50,$755.50,$0.00,"$3,905.00",$0.00,$937.20,"$3,092.76","$3,124.00",$0.00,$0.00,$0.00,$0.00,$0.00
32000609,EAP,CPT® 75989,,Drain Of Abscess Perc S&i,"$3,905.00",$0.00,"$3,905.00",$0.00,$755.50,$0.00,$0.00,$755.50,$755.50,$0.00,"$3,905.00",$0.00,$937.20,"$3,092.76","$3,124.00",$0.00,$0.00,$0.00,$0.00,$0.00
32000612,EAP,CPT® 76000,,Fluoro Modified Barium Swallow,"$1,440.00",$26.65,"$1,440.00",$93.32,$208.35,$223.46,$248.10,$208.35,$208.35,$252.13,"$1,440.00",$233.72,$345.60,"$1,140.48","$1,152.00",$324.73,$58.43,$26.65,$229.25,$222.60
32000613,EAP,CPT® 76000,,FLUOROSCOPY MAX 1 HOUR RDG,"$1,440.00",$26.65,"$1,440.00",$93.32,$208.35,$223.46,$248.10,$208.35,$208.35,$252.13,"$1,440.00",$233.72,$345.60,"$1,140.48","$1,152.00",$324.73,$58.43,$26.65,$229.25,$222.60
32000614,EAP,CPT® 76000,,Fluoro Time Up To 1 Hr,"$1,440.00",$26.65,"$1,440.00",$93.32,$208.35,$223.46,$248.10,$208.35,$208.35,$252.13,"$1,440.00",$233.72,$345.60,"$1,140.48","$1,152.00",$324.73,$58.43,$26.65,$229.25,$222.60
32000615,EAP,CPT® 76000,,Prosthetic Valve Cine Fluoro,"$1,440.00",$26.65,"$1,440.00",$93.32,$208.35,$223.46,$248.10,$208.35,$208.35,$252.13,"$1,440.00",$233.72,$345.60,"$1,140.48","$1,152.00",$324.73,$58.43,$26.65,$229.25,$222.60
32000619,EAP,CPT® 76010,,NOSE TO RECTUM FBODY CHILD RDG,$370.00,$0.00,$370.00,$0.00,$44.19,$0.00,$0.00,$44.19,$44.19,$0.00,$370.00,$0.00,$88.80,$293.04,$296.00,$0.00,$0.00,$0.00,$0.00,$0.00
32000621,EAP,CPT® 76080,,ABSCESS/FISTULA/SINUS S&I BCT,$874.00,$0.00,$874.00,$0.00,$85.48,$0.00,$0.00,$85.48,$85.48,$0.00,$874.00,$0.00,$209.76,$692.21,$699.20,$0.00,$0.00,$0.00,$0.00,$0.00
32000624,EAP,CPT® 76098,,RAD EXAM SURGICAL SPECMEN BIC,"$1,409.00",$27.37,"$1,409.00",$32.74,$27.63,$461.79,$242.76,$27.63,$27.63,$246.70,"$1,409.00",$483.00,$338.16,"$1,115.93","$1,127.20",$671.06,$220.51,$27.37,$224.31,$460.00
32000625,EAP,CPT® 76098,,Rad Exam Surgical Specmen Cbc,"$1,409.00",$27.37,"$1,409.00",$32.74,$27.63,$461.79,$242.76,$27.63,$27.63,$246.70,"$1,409.00",$483.00,$338.16,"$1,115.93","$1,127.20",$671.06,$220.51,$27.37,$224.31,$460.00
32000733,EAP,CPT® 77001,,FLUORO GUIDE CV ACCESS DEV SPV,"$1,070.00",$0.00,"$1,070.00",$165.71,$203.54,$0.00,$184.36,$203.54,$203.54,$187.35,"$1,070.00",$0.00,$256.80,$847.44,$856.00,$0.00,$79.65,$78.52,$170.34,$0.00
32000734,EAP,CPT® 77002,,Fluoro Guide Needle Place Rdg,$724.00,$0.00,$724.00,$183.13,$105.40,$0.00,$124.74,$105.40,$105.40,$126.77,$724.00,$0.00,$173.76,$573.41,$579.20,$0.00,$71.68,$81.40,$115.26,$0.00
32000735,EAP,CPT® 77002,,FLUORO GUIDED BX/ASPIRAT  SPN,$724.00,$0.00,$724.00,$183.13,$105.40,$0.00,$124.74,$105.40,$105.40,$126.77,$724.00,$0.00,$173.76,$573.41,$579.20,$0.00,$71.68,$81.40,$115.26,$0.00
32000736,EAP,CPT® 77002,,Fluoro Guidance For Needle Pla,$724.00,$0.00,$724.00,$183.13,$105.40,$0.00,$124.74,$105.40,$105.40,$126.77,$724.00,$0.00,$173.76,$573.41,$579.20,$0.00,$71.68,$81.40,$115.26,$0.00
32000738,EAP,CPT® 77003,,Fluoroscopy For Spine Procedur,$933.00,$0.00,$933.00,$185.20,$73.98,$0.00,$160.75,$73.98,$73.98,$163.36,$933.00,$0.00,$223.92,$738.94,$746.40,$0.00,$69.40,$72.03,$148.53,$0.00
32000739,EAP,CPT® 77003,,FLOURO GUIDE FOR SPINE RDG,$933.00,$0.00,$933.00,$185.20,$73.98,$0.00,$160.75,$73.98,$73.98,$163.36,$933.00,$0.00,$223.92,$738.94,$746.40,$0.00,$69.40,$72.03,$148.53,$0.00
32000740,EAP,CPT® 77003,,Fluoroguide For Spine Inject,$933.00,$0.00,$933.00,$185.20,$73.98,$0.00,$160.75,$73.98,$73.98,$163.36,$933.00,$0.00,$223.92,$738.94,$746.40,$0.00,$69.40,$72.03,$148.53,$0.00
32000751,EAP,CPT® 77053,,Galactogram Single Duct Bic,"$1,329.00",$0.00,"$1,329.00",$0.00,$139.22,$0.00,$0.00,$139.22,$139.22,$0.00,"$1,329.00",$0.00,$318.96,"$1,052.57","$1,063.20",$0.00,$0.00,$0.00,$0.00,$0.00
32000752,EAP,CPT® 77054,,Galactogram Multi Duct Bic,"$1,546.00",$0.00,"$1,546.00",$0.00,$191.70,$0.00,$0.00,$191.70,$191.70,$0.00,"$1,546.00",$0.00,$371.04,"$1,224.43","$1,236.80",$0.00,$0.00,$0.00,$0.00,$0.00
32000764,EAP,CPT® 77072,,BONE AGE STUDIES X-RAY RDG,$515.00,$15.85,$515.00,$45.26,$32.85,$107.47,$88.73,$32.85,$32.85,$90.17,$515.00,$112.41,$123.60,$407.88,$412.00,$156.18,$21.36,$15.85,$81.99,$107.06
32000766,EAP,CPT® 77073,,BONE LENGTH STUDIES RDG,$635.00,$30.61,$635.00,$70.34,$56.85,$107.47,$109.41,$56.85,$56.85,$111.18,$635.00,$112.41,$152.40,$502.92,$508.00,$156.18,$40.42,$30.61,$101.09,$107.06
32000768,EAP,CPT® 77074,,BONE SURVEY OSSEOUS LIMIT RDG,$432.00,$0.00,$432.00,$0.00,$109.04,$0.00,$0.00,$109.04,$109.04,$0.00,$432.00,$0.00,$103.68,$342.14,$345.60,$0.00,$0.00,$0.00,$0.00,$0.00
32000770,EAP,CPT® 77075,,BONE SURVEY OSSEOUS COMPL RDG,$455.00,$68.07,$455.00,$171.27,$172.43,$107.47,$78.39,$172.43,$172.43,$79.67,$455.00,$112.41,$109.20,$360.36,$364.00,$156.18,$85.39,$68.07,$72.44,$107.06
32000772,EAP,CPT® 77076,,BONE SURVEY OSSEOUS INFANT RDG,$291.00,$0.00,$291.00,$0.00,$139.74,$0.00,$0.00,$139.74,$139.74,$0.00,$291.00,$0.00,$69.84,$230.47,$232.80,$0.00,$0.00,$0.00,$0.00,$0.00
32000773,EAP,CPT® 77080,,Bone Density Scan Axial,$875.00,$29.89,$875.00,$80.76,$146.62,$107.47,$103.40,$146.62,$146.62,$153.21,$875.00,$112.41,$210.00,$693.00,$700.00,$156.18,$108.31,$29.89,$139.30,$107.06
32000774,EAP,CPT® 77081,,BONE DENSISTY SCAN PERIPH NUC,$164.00,$22.33,$164.00,$55.02,$46.36,$76.53,$28.26,$46.36,$46.36,$28.72,$164.00,$80.04,$39.36,$129.89,$131.20,$111.21,$38.50,$22.33,$26.11,$76.23
32000784,EAP,CPT® 75860,,Sinus/jugular Venogram Nir,"$3,300.00",$0.00,"$3,300.00",$0.00,$504.04,$0.00,$0.00,$504.04,$504.04,$0.00,"$3,300.00",$0.00,$792.00,"$2,613.60","$2,640.00",$0.00,$0.00,$0.00,$0.00,$0.00
32000785,EAP,CPT® 75870,,Super Sagg Sinus Venogram Nir,"$2,716.00",$0.00,"$2,716.00",$0.00,$502.30,$0.00,$0.00,$502.30,$502.30,$0.00,"$2,716.00",$0.00,$651.84,"$2,151.07","$2,172.80",$0.00,$0.00,$0.00,$0.00,$0.00
32000786,EAP,CPT® 75872,,Epidural Venogram Nir,"$1,855.00",$0.00,"$1,855.00",$0.00,$552.05,$0.00,$0.00,$552.05,$552.05,$0.00,"$1,855.00",$0.00,$445.20,"$1,469.16","$1,484.00",$0.00,$0.00,$0.00,$0.00,$0.00
32000787,EAP,CPT® 75894,,Transcath Embolization Nir,"$10,671.00",$0.00,"$10,671.00",$0.00,"$2,534.24",$0.00,$0.00,"$2,534.24","$2,534.24",$0.00,"$10,671.00",$0.00,"$2,561.04","$8,451.43","$8,536.80",$0.00,$0.00,$0.00,$0.00,$0.00
32000790,EAP,CPT® 76000,,Fluoroscopy Max 1 Hour Nir,"$1,440.00",$26.65,"$1,440.00",$93.32,$208.35,$223.46,$248.10,$208.35,$208.35,$252.13,"$1,440.00",$233.72,$345.60,"$1,140.48","$1,152.00",$324.73,$58.43,$26.65,$229.25,$222.60
32000796,EAP,CPT® 74263,,"Ct Colonography, Screen","$1,621.00",$0.00,"$1,621.00","$1,273.65",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,621.00",$0.00,$389.04,"$1,283.83","$1,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
32000797,EAP,CPT® 74261,,"Ct Colonography, W/o Dye","$1,621.00",$0.00,"$1,621.00","$1,273.65",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,621.00",$0.00,$389.04,"$1,283.83","$1,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
32000798,EAP,CPT® 74262,,"Ct Colonography, W/dye","$1,621.00",$0.00,"$1,621.00","$1,273.65",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,621.00",$0.00,$389.04,"$1,283.83","$1,296.80",$0.00,$0.00,$0.00,$0.00,$0.00
32000800,EAP,CPT® 76000,,Fluoroscopy 1st Hour,"$1,440.00",$26.65,"$1,440.00",$93.32,$208.35,$223.46,$248.10,$208.35,$208.35,$252.13,"$1,440.00",$233.72,$345.60,"$1,140.48","$1,152.00",$324.73,$58.43,$26.65,$229.25,$222.60
32000801,EAP,CPT® 72072,,Throacic Spine 4 View Rdg,"$1,196.00",$0.00,"$1,196.00",$0.00,$64.69,$0.00,$0.00,$64.69,$64.69,$0.00,"$1,196.00",$0.00,$287.04,$947.23,$956.80,$0.00,$0.00,$0.00,$0.00,$0.00
32000802,EAP,CPT® 77071,,Manual Appl Stress Pfrmd Phys/qhp Joint Films,$437.00,$26.91,$437.00,$95.42,$311.89,$76.53,$75.29,$311.89,$311.89,$76.52,$437.00,$80.04,$104.88,$346.10,$349.60,$111.21,$26.91,$54.05,$69.57,$76.23
32000810,EAP,CPT® 74190,,"Peritoneogram, Radiological Supervision And Interpretation",$911.00,$0.00,$911.00,$0.00,$137.30,$0.00,$0.00,$137.30,$137.30,$0.00,$911.00,$0.00,$218.64,$721.51,$728.80,$0.00,$0.00,$0.00,$0.00,$0.00
32000812,EAP,CPT® 74450,,"Urethrocystography, Retrograde, Radiological Supervision","$2,632.00",$0.00,"$2,632.00",$447.70,$153.20,$223.46,$453.48,$153.20,$153.20,$460.84,"$2,632.00",$233.72,$631.68,"$2,084.54","$2,105.60",$324.73,$72.23,$0.00,$419.01,$222.60
32000813,EAP,CPT® 74455,,"Urethrocystography, Voiding, Radiological Supervision","$2,015.00",$76.86,"$2,015.00",$160.83,$174.74,$223.46,$347.17,$174.74,$174.74,$352.81,"$2,015.00",$233.72,$483.60,"$1,595.88","$1,612.00",$324.73,$76.86,$82.12,$320.79,$222.60
32000814,EAP,CPT® 74470,,"Radiologic Examination, Renal Cyst Study","$1,135.00",$0.00,"$1,135.00",$0.00,$131.29,$0.00,$0.00,$131.29,$131.29,$0.00,"$1,135.00",$0.00,$272.40,$898.92,$908.00,$0.00,$0.00,$0.00,$0.00,$0.00
32000815,EAP,CPT® 75733,,"Adrenal, Bilateral","$4,471.00",$0.00,"$4,471.00",$0.00,$622.72,$0.00,$0.00,$622.72,$622.72,$0.00,"$4,471.00",$0.00,"$1,073.04","$3,541.03","$3,576.80",$0.00,$0.00,$0.00,$0.00,$0.00
32000820,EAP,CPT® 75809,,Shuntogram For Investigation,$862.00,$53.15,$862.00,$194.26,$150.20,$107.47,$148.52,$150.20,$150.20,$150.93,$862.00,$112.41,$206.88,$682.70,$689.60,$156.18,$53.15,$68.43,$137.23,$107.06
32000821,EAP,CPT® 75902,,Mechanical Removal Of Intraluminal (intracatheter) Frome,"$1,027.00",$0.00,"$1,027.00",$0.00,$185.38,$0.00,$0.00,$185.38,$185.38,$0.00,"$1,027.00",$0.00,$246.48,$813.38,$821.60,$0.00,$0.00,$0.00,$0.00,$0.00
32000822,EAP,CPT® 75970,,"Transcatheter Biopsy, Radiological Supervision And Interpretation","$3,058.00",$0.00,"$3,058.00",$0.00,"$1,210.95",$0.00,$0.00,"$1,210.95","$1,210.95",$0.00,"$3,058.00",$0.00,$733.92,"$2,421.94","$2,446.40",$0.00,$0.00,$0.00,$0.00,$0.00
32000823,EAP,CPT® 75984,,Change Of Percutaneous Tube Or Drainage Catheter With Contrast,"$2,270.00",$0.00,"$2,270.00",$0.00,$184.19,$0.00,$0.00,$184.19,$184.19,$0.00,"$2,270.00",$0.00,$544.80,"$1,797.84","$1,816.00",$0.00,$0.00,$0.00,$0.00,$0.00
32000824,EAP,CPT® 75989,,Radiological Guidance For Percutaneous Drainage,"$3,905.00",$0.00,"$3,905.00",$0.00,$755.50,$0.00,$0.00,$755.50,$755.50,$0.00,"$3,905.00",$0.00,$937.20,"$3,092.76","$3,124.00",$0.00,$0.00,$0.00,$0.00,$0.00
32000825,EAP,CPT® 76080,,"Abscess, Fistula, Sinus Tract Study",$874.00,$0.00,$874.00,$0.00,$85.48,$0.00,$0.00,$85.48,$85.48,$0.00,$874.00,$0.00,$209.76,$692.21,$699.20,$0.00,$0.00,$0.00,$0.00,$0.00
32000826,EAP,CPT® 76940,,"Ultrasound Guidance For, And Monitoring Of, Parenchymaln","$1,139.00",$0.00,"$1,139.00",$0.00,$177.84,$0.00,$0.00,$177.84,$177.84,$0.00,"$1,139.00",$0.00,$273.36,$902.09,$911.20,$0.00,$0.00,$0.00,$0.00,$0.00
32000828,EAP,CPT® 0075T,,"Intravascular Stent, Perc, Initial Vessel","$13,594.00",$0.00,"$13,594.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$13,594.00",$0.00,"$6,797.00","$10,766.45","$10,875.20",$0.00,$0.00,$0.00,$0.00,$0.00
32000829,EAP,CPT® 0076T,,"Intravascular Stent, Perc, Ea Add'l Vessel","$12,953.00",$0.00,"$12,953.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$12,953.00",$0.00,"$6,476.50","$10,258.78","$10,362.40",$0.00,$0.00,$0.00,$0.00,$0.00
32000840,EAP,CPT® 76496,,Fluroscopy Procedure,$524.00,$0.00,$524.00,$0.00,$202.34,$0.00,$90.28,$202.34,$202.34,$91.75,$524.00,$0.00,$125.76,$415.01,$419.20,$0.00,$82.01,$0.00,$0.00,$0.00
32000843,EAP,CPT® 49422,,Removal Of Tunneled Intraperitoneal Catheter,"$3,415.00",$0.00,"$3,415.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,415.00",$0.00,"$2,255.00","$2,704.68","$2,732.00",$0.00,$0.00,$0.00,$0.00,$0.00
32000854,EAP,CPT® 72081,,Xr T-l Spine Incl Skull 1 View,$388.00,$28.45,$388.00,$76.61,$60.94,$76.53,$66.85,$60.94,$60.94,$67.94,$388.00,$80.04,$93.12,$307.30,$310.40,$111.21,$37.03,$28.45,$61.77,$76.23
32000855,EAP,CPT® 72083,,Xr T-l Spine 4 Or 5 Views,"$1,228.00",$0.00,"$1,228.00",$0.00,$120.24,$0.00,$0.00,$120.24,$120.24,$0.00,"$1,228.00",$0.00,$294.72,$972.58,$982.40,$0.00,$0.00,$0.00,$0.00,$0.00
32000856,EAP,CPT® 72084,,Xr T-l Spine Incl Skll 6+ View,"$1,228.00",$0.00,"$1,228.00",$0.00,$144.30,$0.00,$0.00,$144.30,$144.30,$0.00,"$1,228.00",$0.00,$294.72,$972.58,$982.40,$0.00,$0.00,$0.00,$0.00,$0.00
32000857,EAP,CPT® 73501,,Xr Hip Unilat W/pelvis 1 View,$350.00,$22.33,$350.00,$58.48,$48.93,$76.53,$60.30,$48.93,$48.93,$61.28,$350.00,$80.04,$84.00,$277.20,$280.00,$111.21,$28.22,$22.33,$55.72,$76.23
32000858,EAP,CPT® 73502,,Xr Hip Unilat W/pelvis 2-3 Vw,$350.00,$34.22,$350.00,$81.46,$72.12,$76.53,$60.30,$72.12,$72.12,$61.28,$350.00,$80.04,$84.00,$277.20,$280.00,$111.21,$39.45,$34.22,$55.72,$76.23
32000859,EAP,CPT® 73503,,Xr Hip Unilat W/pelvis 4+ Vw,$581.00,$42.50,$581.00,$101.67,$89.32,$107.47,$100.10,$89.32,$89.32,$101.73,$581.00,$112.41,$139.44,$460.15,$464.80,$156.18,$49.31,$42.50,$92.50,$107.06
32000860,EAP,CPT® 73521,,Xr Hip Bilat W/pelvis 2 Views,$581.00,$28.81,$581.00,$77.98,$67.83,$107.47,$100.10,$67.83,$67.83,$101.73,$581.00,$112.41,$139.44,$460.15,$464.80,$156.18,$37.75,$28.81,$92.50,$107.06
32000861,EAP,CPT® 73522,,Xr Hip Bilat W/pelvis 3-4 View,$581.00,$37.46,$581.00,$96.08,$80.69,$107.47,$100.10,$80.69,$80.69,$101.73,$581.00,$112.41,$139.44,$460.15,$464.80,$156.18,$46.58,$37.46,$92.50,$107.06
32000862,EAP,CPT® 73523,,Xr Hip Bilat W/pelvis 5+ Views,"$1,106.00",$0.00,"$1,106.00",$0.00,$97.04,$0.00,$0.00,$97.04,$97.04,$0.00,"$1,106.00",$0.00,$265.44,$875.95,$884.80,$0.00,$0.00,$0.00,$0.00,$0.00
32000863,EAP,CPT® 73551,,Xr Femur 1 View,$331.00,$20.89,$331.00,$55.02,$46.35,$76.53,$57.03,$46.35,$46.35,$57.96,$331.00,$80.04,$79.44,$262.15,$264.80,$111.21,$26.17,$20.89,$52.70,$76.23
32000864,EAP,CPT® 73552,,Xr Femur Min 2 Views,$331.00,$25.57,$331.00,$64.07,$54.94,$76.53,$57.03,$54.94,$54.94,$57.96,$331.00,$80.04,$79.44,$262.15,$264.80,$111.21,$30.93,$25.57,$52.70,$76.23
32000865,EAP,CPT® 76499,,Radiographic Procedure,$149.00,$0.00,$149.00,$0.00,$106.34,$0.00,$0.00,$106.34,$106.34,$0.00,$149.00,$0.00,$35.76,$118.01,$119.20,$0.00,$0.00,$0.00,$0.00,$0.00
32000866,EAP,CPT® 77077,,Joint Survey Single View,$275.00,$0.00,$275.00,$0.00,$63.66,$0.00,$0.00,$63.66,$63.66,$0.00,$275.00,$0.00,$66.00,$217.80,$220.00,$0.00,$0.00,$0.00,$0.00,$0.00
32000867,EAP,CPT® 76000,,Fluoro Additional Hour,"$1,440.00",$26.65,"$1,440.00",$93.32,$208.35,$223.46,$248.10,$208.35,$208.35,$252.13,"$1,440.00",$233.72,$345.60,"$1,140.48","$1,152.00",$324.73,$58.43,$26.65,$229.25,$222.60
32000868,EAP,CPT® 75807,,Lymph Vessel X-ray Trunk,"$3,710.00",$0.00,"$3,710.00",$0.00,$600.80,$0.00,$0.00,$600.80,$600.80,$0.00,"$3,710.00",$0.00,$890.40,"$2,938.32","$2,968.00",$0.00,$0.00,$0.00,$0.00,$0.00
32000869,EAP,CPT® 74248,,Xr Small Bowel Follow-through Add On,"$2,100.00",$0.00,"$2,100.00",$0.00,$106.02,$0.00,$0.00,$106.02,$106.02,$0.00,"$2,100.00",$0.00,$504.00,"$1,663.20","$1,680.00",$0.00,$0.00,$0.00,$0.00,$0.00
32000870,EAP,CPT® 72275,,Epidurography,"$1,334.00",$0.00,"$1,334.00",$226.97,$161.56,$0.00,$229.84,$161.56,$161.56,$233.57,"$1,334.00",$0.00,$320.16,"$1,056.53","$1,067.20",$0.00,$107.42,$92.56,$212.37,$0.00
32200006,EAP,CPT® 73040,,Shoulder Arthrography Rdg,"$1,220.00",$94.00,"$1,220.00",$196.33,$870.71,$370.02,$210.20,$870.71,$870.71,$213.61,"$1,220.00",$387.01,$292.80,$966.24,$976.00,$537.70,$107.06,$94.00,$194.22,$368.58
32300001,EAP,CPT® 75605,,THORACIC ARCH ANGIO SPN,"$5,669.00",$0.00,"$5,669.00",$0.00,"$4,045.97",$0.00,$0.00,"$4,045.97","$4,045.97",$0.00,"$5,669.00",$0.00,"$1,360.56","$4,489.85","$4,535.20",$0.00,$0.00,$0.00,$0.00,$0.00
32300002,EAP,CPT® 75625,,AORTOGRAM ABD CATHETER SPV,"$5,623.00",$69.51,"$5,623.00",$270.20,"$4,013.14","$2,657.38",$968.81,"$4,013.14","$4,013.14",$984.54,"$5,623.00","$2,779.42","$1,349.52","$4,453.42","$4,498.40","$3,861.64",$536.35,$69.51,$895.18,"$2,647.07"
32300003,EAP,CPT® 75630,,Aortography Bilat Lower,"$6,944.00",$0.00,"$6,944.00",$0.00,"$4,955.93",$0.00,$0.00,"$4,955.93","$4,955.93",$0.00,"$6,944.00",$0.00,"$1,666.56","$5,499.65","$5,555.20",$0.00,$0.00,$0.00,$0.00,$0.00
32300013,EAP,CPT® 75705,,ANGIO SPINAL SELECTIVE SPN,"$9,955.00",$0.00,"$9,955.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$9,955.00",$0.00,"$2,389.20","$7,884.36","$7,964.00",$0.00,$0.00,$0.00,$0.00,$0.00
32300014,EAP,CPT® 75710,,ANGIO EXTREMITY UNILAT SPV,"$7,558.00",$78.52,"$7,558.00",$318.95,"$5,158.80","$2,657.38","$1,302.21","$5,158.80","$5,158.80","$1,323.35","$7,558.00","$2,779.42","$1,813.92","$5,985.94","$6,046.40","$3,861.64",$536.72,$78.52,"$1,203.23","$2,647.07"
32300015,EAP,CPT® 75716,,ANGIO EXTREMITY BILAT SPV,"$7,936.00",$80.32,"$7,936.00",$366.99,"$5,158.80","$2,657.38","$1,367.33","$5,158.80","$5,158.80","$1,389.53","$7,936.00","$2,779.42","$1,904.64","$6,285.31","$6,348.80","$3,861.64",$544.44,$80.32,"$1,263.41","$2,647.07"
32300018,EAP,CPT® 75726,,Angio Visceral,"$8,171.00",$87.16,"$8,171.00",$293.82,"$5,158.80","$4,407.29","$1,407.82","$5,158.80","$5,158.80","$1,430.68","$8,171.00","$4,609.70","$1,961.04","$6,471.43","$6,536.80","$6,404.56",$535.99,$87.16,"$1,300.82","$4,390.19"
32300019,EAP,CPT® 75731,,ANGIO ADRENAL UNILAT SPV,"$4,204.00",$0.00,"$4,204.00",$0.00,"$3,000.39",$0.00,$0.00,"$3,000.39","$3,000.39",$0.00,"$4,204.00",$0.00,"$1,008.96","$3,329.57","$3,363.20",$0.00,$0.00,$0.00,$0.00,$0.00
32300021,EAP,CPT® 75736,,ANGIO PELVIC SELECTIVE SPV,"$8,004.00",$97.61,"$8,004.00",$314.73,"$5,158.80","$4,407.29","$1,379.05","$5,158.80","$5,158.80","$1,401.44","$8,004.00","$4,609.70","$1,920.96","$6,339.17","$6,403.20","$6,404.56",$535.99,$97.61,"$1,274.24","$4,390.19"
32300022,EAP,CPT® 75741,,ANGIO PULMONARY UNILAT SPV,"$5,460.00",$0.00,"$5,460.00",$0.00,"$3,896.80",$0.00,$0.00,"$3,896.80","$3,896.80",$0.00,"$5,460.00",$0.00,"$1,310.40","$4,324.32","$4,368.00",$0.00,$0.00,$0.00,$0.00,$0.00
32300023,EAP,CPT® 75743,,ANGIO PULMONARY BILATERAL SPV,"$5,521.00",$0.00,"$5,521.00",$0.00,"$3,940.34",$0.00,$0.00,"$3,940.34","$3,940.34",$0.00,"$5,521.00",$0.00,"$1,325.04","$4,372.63","$4,416.80",$0.00,$0.00,$0.00,$0.00,$0.00
32300024,EAP,CPT® 75774,,ANGIO SELECTIVE ADD'L VESS SPV,"$3,834.00",$0.00,"$3,834.00",$169.88,"$2,736.33",$0.00,$660.58,"$2,736.33","$2,736.33",$671.30,"$3,834.00",$0.00,$920.16,"$3,036.53","$3,067.20",$0.00,$497.07,$59.79,$610.37,$0.00
32300026,EAP,CPT® 75898,,ANGIO W/EXIST CATH FU STDY SPV,"$2,531.00",$0.00,"$2,531.00",$0.00,"$1,806.37",$0.00,$0.00,"$1,806.37","$1,806.37",$0.00,"$2,531.00",$0.00,$607.44,"$2,004.55","$2,024.80",$0.00,$0.00,$0.00,$0.00,$0.00
32300066,EAP,CPT® 75705,,Angio Spinal Selective Nir,"$9,955.00",$0.00,"$9,955.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$9,955.00",$0.00,"$2,389.20","$7,884.36","$7,964.00",$0.00,$0.00,$0.00,$0.00,$0.00
32300071,EAP,CPT® 75716,,Inject: Illiac Angio,"$7,936.00",$80.32,"$7,936.00",$366.99,"$5,158.80","$2,657.38","$1,367.33","$5,158.80","$5,158.80","$1,389.53","$7,936.00","$2,779.42","$1,904.64","$6,285.31","$6,348.80","$3,861.64",$544.44,$80.32,"$1,263.41","$2,647.07"
32300072,EAP,CPT® 37197,,"Transcatheter Retrieval,percutaneous Of Intravas Fb Inci","$32,988.00",$0.00,"$32,988.00","$2,706.90","$5,158.80","$2,657.38",$0.00,"$5,158.80","$5,158.80",$0.00,"$32,988.00","$2,779.42","$2,858.00","$26,126.50","$26,390.40","$3,861.64",$0.00,$315.16,"$5,251.69","$2,647.07"
32400001,EAP,CPT® 71045,,Chest X-ray,$635.00,$16.57,$635.00,$39.12,$25.77,$76.53,$109.41,$25.77,$25.77,$111.18,$635.00,$80.04,$152.40,$502.92,$508.00,$111.21,$19.10,$16.57,$101.09,$76.23
32400002,EAP,CPT® 71045,,CHEST X-RAY 1 VIEW RDG,$635.00,$16.57,$635.00,$39.12,$25.77,$76.53,$109.41,$25.77,$25.77,$111.18,$635.00,$80.04,$152.40,$502.92,$508.00,$111.21,$19.10,$16.57,$101.09,$76.23
32400003,EAP,CPT® 71045,,Line Placement-chest,$635.00,$16.57,$635.00,$39.12,$25.77,$76.53,$109.41,$25.77,$25.77,$111.18,$635.00,$80.04,$152.40,$502.92,$508.00,$111.21,$19.10,$16.57,$101.09,$76.23
32400006,EAP,CPT® 71046,,CHEST 2 VIEW(PA & LATERAL) RDG,$665.00,$21.97,$665.00,$59.99,$47.17,$76.53,$114.58,$47.17,$47.17,$116.44,$665.00,$80.04,$159.60,$526.68,$532.00,$111.21,$29.30,$21.97,$105.87,$76.23
32400008,EAP,CPT® 71047,,CHEST 2VIEW W/APICAL LORDO RDG,$685.00,$27.73,$685.00,$76.70,$60.04,$76.53,$118.02,$60.04,$60.04,$119.94,$685.00,$80.04,$164.40,$542.52,$548.00,$111.21,$37.47,$27.73,$109.05,$76.23
32400010,EAP,CPT® 71048,,CHEST X-RAY 4+VIEW RDG,$737.00,$28.81,$737.00,$82.26,$61.73,$107.47,$126.98,$61.73,$61.73,$129.04,$737.00,$112.41,$176.88,$583.70,$589.60,$156.18,$40.18,$28.81,$117.33,$107.06
32400012,EAP,CPT® 71046,,CHEST X-RAY 3VW DECUBITUS RDG,$702.00,$21.97,$702.00,$59.99,$47.17,$76.53,$120.95,$47.17,$47.17,$122.91,$702.00,$80.04,$168.48,$555.98,$561.60,$111.21,$29.30,$21.97,$111.76,$76.23
33100001,EAP,CPT® 96411,,Iv Chemo Push-ea Addtl Med,$482.00,$55.87,$357.00,$158.62,$254.79,$57.98,$72.44,$254.79,$254.79,$62.51,$357.00,$60.65,$178.50,$282.74,$285.60,$84.26,$55.87,$59.80,$56.83,$57.76
33100002,EAP,CPT® 96409,,Iv Chemo Push-1st Med Initl1vs,$837.00,$97.03,$620.00,$282.08,$442.49,$176.19,$125.62,$442.49,$442.49,$108.56,$620.00,$184.28,$310.00,$491.04,$496.00,$256.03,$97.03,$109.86,$98.70,$175.50
33100004,EAP,CPT® 96411,,Iv Chemo Push1st Med Dur Infus,$482.00,$55.87,$357.00,$158.62,$254.79,$57.98,$72.44,$254.79,$254.79,$62.51,$357.00,$60.65,$178.50,$282.74,$285.60,$84.26,$55.87,$59.80,$56.83,$57.76
33100006,EAP,CPT® 96411,,Iv Chemo Push-1 Med Dur Infus,$482.00,$55.87,$357.00,$158.62,$254.79,$57.98,$72.44,$254.79,$254.79,$62.51,$357.00,$60.65,$178.50,$282.74,$285.60,$84.26,$55.87,$59.80,$56.83,$57.76
33100007,EAP,CPT® 96401,,Inject Chemo-im/sq Non Hormona,$500.00,$57.76,$370.00,$189.26,$264.07,$57.98,$67.93,$264.07,$264.07,$64.78,$370.00,$60.65,$185.00,$293.04,$296.00,$84.26,$57.91,$79.97,$58.90,$57.76
33100008,EAP,CPT® 96402,,Inject Chemo-im/sq Hormonal,$624.00,$32.07,$462.00,$82.90,$329.73,$57.98,$36.25,$329.73,$329.73,$80.89,$462.00,$60.65,$231.00,$365.90,$369.60,$84.26,$72.30,$32.07,$73.55,$57.76
33300001,EAP,CPT® 77280,,Simulation-simple,"$1,901.00",$120.92,"$1,408.00",$540.95,"$1,004.89",$121.39,$242.59,"$1,004.89","$1,004.89",$246.53,"$1,408.00",$126.96,$337.92,"$1,115.14","$1,126.40",$176.40,$220.35,$244.20,$224.15,$120.92
33300002,EAP,CPT® 77285,,Simulation-intermediat,"$2,557.00",$296.41,"$1,894.00",$861.91,"$1,351.75",$321.38,$326.33,"$1,351.75","$1,351.75",$331.62,"$1,894.00",$336.15,$454.56,"$1,500.05","$1,515.20",$467.03,$296.41,$414.20,$301.52,$320.14
33300003,EAP,CPT® 77290,,Simulation-complex,"$3,437.00",$320.14,"$2,546.00","$1,019.23","$1,817.08",$321.38,$438.66,"$1,817.08","$1,817.08",$445.78,"$2,546.00",$336.15,$611.04,"$2,016.43","$2,036.80",$467.03,$398.45,$422.12,$405.32,$320.14
33300004,EAP,CPT® 77295,,3d Radiotherapy Plan W/ Vol Histo,"$12,489.00",$265.08,"$9,251.00",$969.07,"$5,158.80","$1,194.16","$1,593.90","$5,158.80","$5,158.80","$1,619.78","$9,251.00","$1,249.00","$2,220.24","$7,326.79","$7,400.80","$1,735.32","$1,447.78",$265.08,"$1,472.76","$1,189.52"
33300007,EAP,CPT® 77300,,Central Axis Calculation,$925.00,$34.22,$685.00,$131.58,$488.88,$121.39,$118.02,$488.88,$488.88,$119.94,$685.00,$126.96,$164.40,$542.52,$548.00,$176.40,$107.20,$34.22,$109.05,$120.92
33300008,EAP,CPT® 77301,,Imrt,"$7,119.00",$825.22,"$5,273.00","$3,859.88","$3,763.34","$1,194.16",$908.51,"$3,763.34","$3,763.34",$923.26,"$5,273.00","$1,249.00","$1,265.52","$4,176.22","$4,218.40","$1,735.32",$825.22,"$1,513.43",$839.46,"$1,189.52"
33300012,EAP,CPT® 77321,,Telether Plan Special,"$1,970.00",$44.30,"$1,459.00",$183.79,"$1,041.29",$321.38,$251.38,"$1,041.29","$1,041.29",$255.46,"$1,459.00",$336.15,$350.16,"$1,155.53","$1,167.20",$467.03,$228.33,$44.30,$232.27,$320.14
33300014,EAP,CPT® 77331,,Tld/microdosimetry,$898.00,$0.00,$665.00,$0.00,$474.61,$0.00,$0.00,$474.61,$474.61,$0.00,$665.00,$0.00,$159.60,$526.68,$532.00,$0.00,$0.00,$0.00,$0.00,$0.00
33300015,EAP,CPT® 77332,,Block Simple,"$1,033.00",$23.77,$765.00,$132.97,$545.98,$121.39,$131.81,$545.98,$545.98,$133.95,$765.00,$126.96,$183.60,$605.88,$612.00,$176.40,$119.72,$23.77,$121.79,$120.92
33300016,EAP,CPT® 77332,,Bolus Simple,"$1,033.00",$23.77,$765.00,$132.97,$545.98,$121.39,$131.81,$545.98,$545.98,$133.95,$765.00,$126.96,$183.60,$605.88,$612.00,$176.40,$119.72,$23.77,$121.79,$120.92
33300017,EAP,CPT® 77333,,Block Intermed,"$1,426.00",$0.00,"$1,056.00",$0.00,$753.67,$0.00,$0.00,$753.67,$753.67,$0.00,"$1,056.00",$0.00,$253.44,$836.35,$844.80,$0.00,$0.00,$0.00,$0.00,$0.00
33300018,EAP,CPT® 77333,,Bolus Inter.,"$1,426.00",$0.00,"$1,056.00",$0.00,$753.67,$0.00,$0.00,$753.67,$753.67,$0.00,"$1,056.00",$0.00,$253.44,$836.35,$844.80,$0.00,$0.00,$0.00,$0.00,$0.00
33300019,EAP,CPT® 77334,,Device Complex,"$1,503.00",$67.35,"$1,113.00",$258.28,$794.35,$321.38,$191.76,$794.35,$794.35,$194.88,"$1,113.00",$336.15,$267.12,$881.50,$890.40,$467.03,$174.18,$67.35,$177.19,$320.14
33300020,EAP,CPT® 77334,,Compensator Filter,"$1,503.00",$67.35,"$1,113.00",$258.28,$794.35,$321.38,$191.76,$794.35,$794.35,$194.88,"$1,113.00",$336.15,$267.12,$881.50,$890.40,$467.03,$174.18,$67.35,$177.19,$320.14
33300021,EAP,CPT® 77334,,Positioning Mold,"$1,503.00",$67.35,"$1,113.00",$258.28,$794.35,$321.38,$191.76,$794.35,$794.35,$194.88,"$1,113.00",$336.15,$267.12,$881.50,$890.40,$467.03,$174.18,$67.35,$177.19,$320.14
33300022,EAP,CPT® 77336,,Continuing Physics/wk,$972.00,$81.03,$720.00,$156.73,$513.86,$121.39,$124.05,$513.86,$513.86,$126.07,$720.00,$126.96,$172.80,$570.24,$576.00,$176.40,$112.68,$81.03,$114.62,$120.92
33300023,EAP,CPT® 77370,,Spec Medical Physics Consult,"$1,154.00",$120.92,$855.00,$241.02,$610.21,$121.39,$147.31,$610.21,$610.21,$149.70,$855.00,$126.96,$205.20,$677.16,$684.00,$176.40,$133.81,$126.41,$136.12,$120.92
33300024,EAP,CPT® 77401,,"Rad Delivery, Superf &/or Orthovolt, Per Day","$1,214.00",$0.00,$899.00,$0.00,$641.62,$0.00,$0.00,$641.62,$641.62,$0.00,$899.00,$0.00,$215.76,$712.01,$719.20,$0.00,$0.00,$0.00,$0.00,$0.00
33300026,EAP,CPT® 77306,,Telether Plan Simple,"$1,204.00",$76.36,$892.00,$295.19,$636.62,$321.38,$153.69,$636.62,$636.62,$156.18,$892.00,$336.15,$214.08,$706.46,$713.60,$467.03,$139.60,$76.36,$142.01,$320.14
33300028,EAP,CPT® 77307,,Telether Plan Complex,"$2,018.00",$138.30,"$1,495.00",$570.84,"$1,066.98",$321.38,$257.58,"$1,066.98","$1,066.98",$261.76,"$1,495.00",$336.15,$358.80,"$1,184.04","$1,196.00",$467.03,$233.97,$138.30,$238.00,$320.14
33300030,EAP,CPT® 77318,,Brachyther Plan Complex,"$2,122.00",$0.00,"$1,572.00",$0.00,"$1,121.94",$0.00,$0.00,"$1,121.94","$1,121.94",$0.00,"$1,572.00",$0.00,$377.28,"$1,245.02","$1,257.60",$0.00,$0.00,$0.00,$0.00,$0.00
33300031,EAP,CPT® 77407,,"Rad Tx Del >= 1 Mev, Intermed","$1,639.00",$0.00,"$1,214.00",$0.00,$866.43,$0.00,$0.00,$866.43,$866.43,$0.00,"$1,214.00",$0.00,$291.36,$961.49,$971.20,$0.00,$0.00,$0.00,$0.00,$0.00
33300033,EAP,CPT® 77412,,"Rad Tx Del >= 1 Mev, Complex","$1,789.00",$0.00,"$1,325.00",$531.92,$945.65,$226.65,$228.29,$945.65,$945.65,$232.00,"$1,325.00",$237.05,$318.00,"$1,049.40","$1,060.00",$329.36,$207.36,$0.00,$210.94,$225.77
33300035,EAP,CPT® 77385,,Imrt Tx Delivery Simple,"$4,512.00",$0.00,"$3,342.00",$676.73,"$2,385.19",$516.68,$575.81,"$2,385.19","$2,385.19",$585.16,"$3,342.00",$540.41,$802.08,"$2,646.86","$2,673.60",$750.83,$523.02,$0.00,$532.05,$514.68
33300037,EAP,CPT® 77386,,Imrt Tx Delivery Complex,"$4,512.00",$0.00,"$3,342.00",$678.85,"$2,385.19",$516.68,$575.81,"$2,385.19","$2,385.19",$585.16,"$3,342.00",$540.41,$802.08,"$2,646.86","$2,673.60",$750.83,$523.02,$0.00,$532.05,$514.68
33300040,EAP,CPT® 77387,,Guidance For Radiation Tx Dlvr,"$1,015.00",$0.00,$752.00,$126.70,$536.70,$0.00,$129.57,$536.70,$536.70,$131.67,$752.00,$0.00,$180.48,$595.58,$601.60,$0.00,$117.69,$0.00,$119.72,$0.00
33300047,EAP,CPT® 77417,,Port Image(s),$637.00,$0.00,$472.00,$21.59,$336.87,$0.00,$81.32,$336.87,$336.87,$82.64,$472.00,$0.00,$113.28,$373.82,$377.60,$0.00,$73.87,$11.52,$75.14,$0.00
33300049,EAP,CPT® 77402,,"Rad Tx Del >= 1 Mev, Simple","$1,214.00",$0.00,$899.00,$284.07,$641.62,$117.67,$154.89,$641.62,$641.62,$157.41,$899.00,$123.07,$215.76,$712.01,$719.20,$170.99,$140.69,$0.00,$143.12,$117.21
33300050,EAP,CPT® 77470,,Special Treatment,"$6,687.00",$25.93,"$4,953.00",$284.73,"$3,534.96",$516.68,$853.38,"$3,534.96","$3,534.96",$867.23,"$4,953.00",$540.41,"$1,188.72","$3,922.78","$3,962.40",$750.83,$775.14,$25.93,$788.52,$514.68
33300052,EAP,CPT® 77763,,Intracavitary Complex,"$3,825.00",$0.00,"$2,833.00",$0.00,"$2,021.91",$0.00,$0.00,"$2,021.91","$2,021.91",$0.00,"$2,833.00",$0.00,$679.92,"$2,243.74","$2,266.40",$0.00,$0.00,$0.00,$0.00,$0.00
33300053,EAP,CPT® 77338,,Imrt Treatment Device,"$1,485.00",$172.15,"$1,100.00","$1,002.52",$785.07,$321.38,$189.52,$785.07,$785.07,$192.60,"$1,100.00",$336.15,$264.00,$871.20,$880.00,$467.03,$172.15,$264.36,$175.12,$320.14
33300055,EAP,CPT® 77372,,Cranial Only X 1,"$10,800.00","$1,067.19","$8,000.00","$2,120.15","$5,158.80","$7,615.98","$1,378.36","$5,158.80","$5,158.80","$1,400.74","$8,000.00","$7,965.75","$1,920.00","$6,336.00","$6,400.00","$8,000.00","$1,252.00","$1,067.19","$1,273.60","$7,586.43"
33300057,EAP,CPT® 77373,,Robt Lin-radsurg Fract 1-5,"$7,143.00",$828.04,"$5,291.00","$2,691.08","$3,776.19","$1,695.77",$911.61,"$3,776.19","$3,776.19",$926.41,"$5,291.00","$1,773.65","$1,269.84","$4,190.47","$4,232.80","$2,464.25",$828.04,"$1,228.18",$842.33,"$1,689.19"
33300067,EAP,CPT® 77014,,Cbct Infusion Radioactive Mat,"$1,477.00",$0.00,"$1,094.00","$1,094.00",$780.79,$0.00,$188.49,$780.79,$780.79,$191.55,"$1,094.00",$0.00,$262.56,$866.45,$875.20,$0.00,$171.21,$78.16,$174.16,$0.00
33300073,EAP,CPT® 57156,,Ins Vag Brachytx Device,"$1,400.00",$0.00,"$1,138.00",$0.00,$812.19,$0.00,$0.00,$812.19,$812.19,$0.00,"$1,138.00",$0.00,"$1,138.00",$901.30,$910.40,$0.00,$0.00,$0.00,$0.00,$0.00
33300088,EAP,CPT® 77293,,Resp Motion Mgmt Sim,"$1,283.00",$0.00,$950.00,$921.07,$678.02,$0.00,$163.68,$678.02,$678.02,$166.34,$950.00,$0.00,$228.00,$752.40,$760.00,$0.00,$148.68,$350.81,$151.24,$0.00
33500001,EAP,CPT® 96450,,Iv Chemo Into Cns W/spinal Pun,"$1,357.00",$0.00,"$1,005.00",$0.00,$717.27,$0.00,$0.00,$717.27,$717.27,$0.00,"$1,005.00",$0.00,$502.50,$795.96,$804.00,$0.00,$0.00,$0.00,$0.00,$0.00
33500002,EAP,CPT® 96413,,"Chemo Tx Admn Iv Nfs Tq Up 1 Hr, Sng Or 1st Sbst/drug","$1,223.00",$141.79,$906.00,$350.57,$646.61,$296.88,$177.52,$646.61,$646.61,$158.63,$906.00,$310.51,$453.00,$717.55,$724.80,$431.41,$141.79,$142.28,$144.24,$295.72
33500003,EAP,CPT® 96416,,Iv Chemo Inf Prolonged Gtr8hrs,"$1,357.00",$142.28,"$1,005.00",$354.18,$717.27,$296.88,$191.04,$717.27,$717.27,$175.97,"$1,005.00",$310.51,$502.50,$795.96,$804.00,$431.41,$157.28,$142.28,$160.00,$295.72
33500004,EAP,CPT® 96415,,Iv Chemo Inf Med Ea Addtl Hr,$340.00,$30.63,$252.00,$72.09,$179.85,$57.98,$39.50,$179.85,$179.85,$44.12,$252.00,$60.65,$126.00,$199.58,$201.60,$84.26,$39.44,$30.63,$40.12,$57.76
33500005,EAP,CPT® 96417,,Iv Chemo Inf Ea New Med 16-90,$533.00,$57.76,$395.00,$165.82,$281.91,$57.98,$86.47,$281.91,$281.91,$69.16,$395.00,$60.65,$197.50,$312.84,$316.00,$84.26,$61.82,$69.16,$62.88,$57.76
33500007,EAP,CPT® 96416,,Iv Chem Inf Prolong Gtr 8hr Pu,"$1,357.00",$142.28,"$1,005.00",$354.18,$717.27,$296.88,$191.04,$717.27,$717.27,$175.97,"$1,005.00",$310.51,$502.50,$795.96,$804.00,$431.41,$157.28,$142.28,$160.00,$295.72
34000004,EAP,CPT® 79440,,Nuclearrx Intra-articular Nuc,"$1,139.00",$0.00,"$1,139.00",$0.00,$143.59,$0.00,$0.00,$143.59,$143.59,$0.00,"$1,139.00",$0.00,$273.36,$902.09,$911.20,$0.00,$0.00,$0.00,$0.00,$0.00
34000005,EAP,CPT® 78265,,Nm Gastric Emptying Img Std,$832.00,$0.00,$878.69,$0.00,$878.69,$0.00,$0.00,$878.69,$878.69,$0.00,$832.00,$0.00,$199.68,$658.94,$665.60,$0.00,$0.00,$0.00,$0.00,$0.00
34100005,EAP,CPT® 78018,,THYROID CA/METS IMAGE WHOL NUC,"$1,645.00",$250.40,"$1,645.00",$637.76,$636.98,$436.80,$283.43,$636.98,$636.98,$288.03,"$1,645.00",$456.86,$394.80,"$1,302.84","$1,316.00",$634.74,$250.40,$280.57,$261.88,$435.10
34100006,EAP,CPT® 78020,,Thyroid Carcinoma Metatases Up,"$1,093.00",$0.00,"$1,093.00",$0.00,$143.59,$0.00,$0.00,$143.59,$143.59,$0.00,"$1,093.00",$0.00,$262.32,$865.66,$874.40,$0.00,$0.00,$0.00,$0.00,$0.00
34100007,EAP,CPT® 78070,,PARATHYROID SCAN NUC,"$1,953.00",$107.84,"$1,953.00",$611.29,$308.97,$338.96,$336.49,$308.97,$308.97,$341.95,"$1,953.00",$354.53,$468.72,"$1,546.78","$1,562.40",$492.57,$107.84,$265.80,$310.92,$337.65
34100008,EAP,CPT® 78075,,ADRENAL SCAN CORTX&/MEDU NUC,"$12,363.00",$0.00,"$12,363.00",$0.00,$873.47,$0.00,$0.00,$873.47,$873.47,$0.00,"$12,363.00",$0.00,"$2,967.12","$9,791.50","$9,890.40",$0.00,$0.00,$0.00,$0.00,$0.00
34100009,EAP,CPT® 78102,,BONE MARROW LIMITED NUC,"$1,469.00",$0.00,"$1,469.00",$0.00,$313.20,$0.00,$0.00,$313.20,$313.20,$0.00,"$1,469.00",$0.00,$352.56,"$1,163.45","$1,175.20",$0.00,$0.00,$0.00,$0.00,$0.00
34100010,EAP,CPT® 78104,,BONE MARROW WHOLE BODY NUC,"$1,469.00",$0.00,"$1,469.00",$0.00,$487.96,$0.00,$0.00,$487.96,$487.96,$0.00,"$1,469.00",$0.00,$352.56,"$1,163.45","$1,175.20",$0.00,$0.00,$0.00,$0.00,$0.00
34100011,EAP,CPT® 78140,,RBC LABELED SEQ LIVER NUC,"$1,312.00",$0.00,"$1,312.00",$0.00,$277.78,$0.00,$0.00,$277.78,$277.78,$0.00,"$1,312.00",$0.00,$314.88,"$1,039.10","$1,049.60",$0.00,$0.00,$0.00,$0.00,$0.00
34100012,EAP,CPT® 78185,,SPLEEN SCAN W/ W/O FLOW NUC,"$1,410.00",$0.00,"$1,410.00",$0.00,$392.47,$0.00,$0.00,$392.47,$392.47,$0.00,"$1,410.00",$0.00,$338.40,"$1,116.72","$1,128.00",$0.00,$0.00,$0.00,$0.00,$0.00
34100013,EAP,CPT® 78195,,LYMPHOSCINTIGRAPHY NUC,"$1,645.00",$211.12,"$1,645.00",$725.50,$641.52,$436.80,$283.43,$641.52,$641.52,$288.03,"$1,645.00",$456.86,$394.80,"$1,302.84","$1,316.00",$634.74,$211.12,$306.14,$261.88,$435.10
34100015,EAP,CPT® 78215,,Liver & Spleen Imaging Static,"$1,469.00",$0.00,"$1,469.00",$0.00,$375.72,$0.00,$253.10,$375.72,$375.72,$0.00,"$1,469.00",$0.00,$352.56,"$1,163.45","$1,175.20",$0.00,$136.08,$0.00,$0.00,$0.00
34100016,EAP,CPT® 78216,,LIVER/SPLEEN W/VASCU FLOW NUC,"$1,469.00",$0.00,"$1,469.00",$0.00,$260.79,$0.00,$0.00,$260.79,$260.79,$0.00,"$1,469.00",$0.00,$352.56,"$1,163.45","$1,175.20",$0.00,$0.00,$0.00,$0.00,$0.00
34100019,EAP,CPT® 78262,,GI REFLUX NUC,"$2,128.00",$0.00,"$2,128.00",$0.00,$480.95,$0.00,$0.00,$480.95,$480.95,$0.00,"$2,128.00",$0.00,$510.72,"$1,685.38","$1,702.40",$0.00,$0.00,$0.00,$0.00,$0.00
34100020,EAP,CPT® 78264,,GASTRIC EMPTYING NUC,"$2,869.00",$196.51,"$2,869.00",$685.12,$552.52,$338.96,$494.31,$552.52,$552.52,$502.34,"$2,869.00",$354.53,$688.56,"$2,272.25","$2,295.20",$492.57,$196.51,$303.26,$456.74,$337.65
34100021,EAP,CPT® 78278,,ACUTE GI BLEEDING IMAGING NUC,"$2,301.00",$0.00,"$2,301.00",$0.00,$659.40,$0.00,$0.00,$659.40,$659.40,$0.00,"$2,301.00",$0.00,$552.24,"$1,822.39","$1,840.80",$0.00,$0.00,$0.00,$0.00,$0.00
34100022,EAP,CPT® 78290,,BOWEL IMAGING MECKLES SCAN NUC,"$2,213.00",$0.00,"$2,213.00",$0.00,$613.67,$0.00,$0.00,$613.67,$613.67,$0.00,"$2,213.00",$0.00,$531.12,"$1,752.70","$1,770.40",$0.00,$0.00,$0.00,$0.00,$0.00
34100023,EAP,CPT® 78291,,SHUNT PATENCY LEVEEN/DENV  NUC,"$2,255.00",$0.00,"$2,255.00",$0.00,$460.07,$0.00,$0.00,$460.07,$460.07,$0.00,"$2,255.00",$0.00,$541.20,"$1,785.96","$1,804.00",$0.00,$0.00,$0.00,$0.00,$0.00
34100024,EAP,CPT® 78300,,BONE IMAGING LIMITED NUC,"$1,496.00",$0.00,"$1,496.00",$0.00,$323.37,$0.00,$0.00,$323.37,$323.37,$0.00,"$1,496.00",$0.00,$359.04,"$1,184.83","$1,196.80",$0.00,$0.00,$0.00,$0.00,$0.00
34100025,EAP,CPT® 78306,,Nm Bone Imaging Whole Body,"$2,765.00",$205.40,"$2,765.00",$511.72,$482.71,$338.96,$476.40,$482.71,$482.71,$484.13,"$2,765.00",$354.53,$663.60,"$2,189.88","$2,212.00",$492.57,$205.40,$266.89,$440.19,$337.65
34100026,EAP,CPT® 78315,,Nm Bone Imaging 3 Phase Study,"$2,765.00",$232.73,"$2,765.00",$704.59,$656.78,$338.96,$476.40,$656.78,$656.78,$484.13,"$2,765.00",$354.53,$663.60,"$2,189.88","$2,212.00",$492.57,$232.73,$305.42,$440.19,$337.65
34100028,EAP,CPT® 78445,,Ceretec Vascular Flow Imaging,"$1,584.00",$0.00,"$1,584.00",$0.00,$329.06,$0.00,$0.00,$329.06,$329.06,$0.00,"$1,584.00",$0.00,$380.16,"$1,254.53","$1,267.20",$0.00,$0.00,$0.00,$0.00,$0.00
34100029,EAP,CPT® 78453,,Cardiac Scan Thallium (planar),"$5,827.00",$0.00,"$5,827.00",$0.00,$546.60,$0.00,$0.00,$546.60,$546.60,$0.00,"$5,827.00",$0.00,"$1,398.48","$4,614.98","$4,661.60",$0.00,$0.00,$0.00,$0.00,$0.00
34100030,EAP,CPT® 78451,,CARDIAC PERFUSION SINGLE NUC,"$7,015.00",$167.51,"$7,015.00",$690.66,$609.93,"$1,178.85","$1,208.65",$609.93,$609.93,"$1,228.27","$7,015.00","$1,232.99","$1,683.60","$5,555.88","$5,612.00","$1,713.08",$167.51,$278.41,"$1,116.79","$1,174.28"
34100031,EAP,CPT® 78452,,Cardiac Scan,"$9,506.00",$286.29,"$9,506.00",$959.40,$892.62,"$1,178.85","$1,637.84",$892.62,$892.62,"$1,664.42","$9,506.00","$1,232.99","$2,281.44","$7,528.75","$7,604.80","$1,713.08",$286.29,$403.03,"$1,513.36","$1,174.28"
34100032,EAP,CPT® 78472,,CARDIAC SCAN GATED NUC,"$3,660.00",$185.13,"$3,660.00",$465.10,$499.80,$338.96,$630.60,$499.80,$499.80,$640.84,"$3,660.00",$354.53,$878.40,"$2,898.72","$2,928.00",$492.57,$259.91,$185.13,$582.67,$337.65
34100034,EAP,CPT® 78580,,Pulm (lung) Perfusion Imag,"$2,912.00",$167.63,"$2,912.00",$486.69,$402.17,$338.96,$501.72,$402.17,$402.17,$509.87,"$2,912.00",$354.53,$698.88,"$2,306.30","$2,329.60",$492.57,$167.63,$206.74,$463.59,$337.65
34100038,EAP,CPT® 78606,,BRAIN SCAN W/VASCULAR FLO NUC,"$2,283.00",$0.00,"$2,283.00",$0.00,$634.70,$0.00,$0.00,$634.70,$634.70,$0.00,"$2,283.00",$0.00,$547.92,"$1,808.14","$1,826.40",$0.00,$0.00,$0.00,$0.00,$0.00
34100040,EAP,CPT® 78630,,CISTERNOGRAPHY NUC,"$1,521.00",$0.00,"$1,521.00",$0.00,$673.93,$0.00,$0.00,$673.93,$673.93,$0.00,"$1,521.00",$0.00,$365.04,"$1,204.63","$1,216.80",$0.00,$0.00,$0.00,$0.00,$0.00
34100041,EAP,CPT® 78701,,Kidney Imag W/vascul Flo Nuc,"$4,099.00",$0.00,"$4,099.00",$0.00,$426.60,$0.00,$0.00,$426.60,$426.60,$0.00,"$4,099.00",$0.00,$983.76,"$3,246.41","$3,279.20",$0.00,$0.00,$0.00,$0.00,$0.00
34100042,EAP,CPT® 78707,,Kid.img.mor.w/vas.singlew/o Ph,"$3,444.00",$191.97,"$3,444.00",$473.44,$448.52,$436.80,$593.38,$448.52,$448.52,$603.02,"$3,444.00",$456.86,$826.56,"$2,727.65","$2,755.20",$634.74,$218.15,$191.97,$548.28,$435.10
34100043,EAP,CPT® 78708,,Kid.img.mor.w/vas.singlew/phar,"$3,715.00",$122.10,"$3,715.00",$357.18,$312.40,$436.80,$640.08,$312.40,$312.40,$650.47,"$3,715.00",$456.86,$891.60,"$2,942.28","$2,972.00",$634.74,$228.29,$122.10,$591.43,$435.10
34100044,EAP,CPT® 78709,,Kid.img.mor.w/vas.multi W&w/o,"$3,716.00",$0.00,"$3,716.00",$0.00,$659.70,$0.00,$0.00,$659.70,$659.70,$0.00,"$3,716.00",$0.00,$891.84,"$2,943.07","$2,972.80",$0.00,$0.00,$0.00,$0.00,$0.00
34100045,EAP,CPT® 78740,,Voiding Cystogram Nuc,"$3,569.00",$0.00,"$3,569.00",$0.00,$411.81,$0.00,$0.00,$411.81,$411.81,$0.00,"$3,569.00",$0.00,$856.56,"$2,826.65","$2,855.20",$0.00,$0.00,$0.00,$0.00,$0.00
34100046,EAP,CPT® 78800,,Nm Rp Loclzj Tum Plnr 1 Area Single Day Imaging,"$1,370.00",$162.68,"$1,370.00",$392.02,$353.30,$338.96,$236.04,$353.30,$353.30,$239.88,"$1,370.00",$354.53,$328.80,"$1,085.04","$1,096.00",$492.57,$162.68,$233.75,$218.10,$337.65
34100047,EAP,CPT® 78801,,Nm Rp Loclzj Tum Plnr 2+ Areas Or 2+ Days,"$1,295.00",$0.00,"$1,295.00",$0.00,$482.71,$0.00,$0.00,$482.71,$482.71,$0.00,"$1,295.00",$0.00,$310.80,"$1,025.64","$1,036.00",$0.00,$0.00,$0.00,$0.00,$0.00
34100048,EAP,CPT® 78802,,TUMOR SINGLE DAY,"$1,385.00",$0.00,"$1,385.00",$0.00,$654.28,$0.00,$0.00,$654.28,$654.28,$0.00,"$1,385.00",$0.00,$332.40,"$1,096.92","$1,108.00",$0.00,$0.00,$0.00,$0.00,$0.00
34100049,EAP,CPT® 78803,,NM TUMOR LOCALALIZATION SPECT,"$4,831.00",$0.00,"$4,831.00",$695.54,$703.26,"$1,178.85",$0.00,$703.26,$703.26,$0.00,"$4,831.00","$1,232.99","$1,159.44","$3,826.15","$3,864.80","$1,713.08",$0.00,$346.84,$769.10,"$1,174.28"
34100057,EAP,CPT® 78451,,Myocardial Ejection Fraction,"$7,015.00",$167.51,"$7,015.00",$690.66,$609.93,"$1,178.85","$1,208.65",$609.93,$609.93,"$1,228.27","$7,015.00","$1,232.99","$1,683.60","$5,555.88","$5,612.00","$1,713.08",$167.51,$278.41,"$1,116.79","$1,174.28"
34100060,EAP,CPT® 78804,,TUMOR IMAGING WHOLE BODY NUC,"$2,525.00",$395.16,"$2,525.00","$1,153.00","$1,204.94","$1,178.85",$435.04,"$1,204.94","$1,204.94",$442.11,"$2,525.00","$1,232.99",$606.00,"$1,999.80","$2,020.00","$1,713.08",$395.16,$629.22,$401.98,"$1,174.28"
34100062,EAP,CPT® 78226,,Hepatobiliary Imag W Glbldr,"$2,615.00",$300.74,"$2,615.00",$673.97,$710.47,$338.96,$450.55,$710.47,$710.47,$457.87,"$2,615.00",$354.53,$627.60,"$2,071.08","$2,092.00",$492.57,$315.27,$300.74,$416.31,$337.65
34100063,EAP,CPT® 78227,,Hepatobil Imag Pharma W Glbldr,"$2,615.00",$0.00,"$2,615.00",$0.00,$986.60,$0.00,$0.00,$986.60,$986.60,$0.00,"$2,615.00",$0.00,$627.60,"$2,071.08","$2,092.00",$0.00,$0.00,$0.00,$0.00,$0.00
34100064,EAP,CPT® 78579,,Pulmonary Ventilation Imaging,"$1,089.00",$0.00,"$1,089.00",$0.00,$366.73,$0.00,$0.00,$366.73,$366.73,$0.00,"$1,089.00",$0.00,$261.36,$862.49,$871.20,$0.00,$0.00,$0.00,$0.00,$0.00
34100065,EAP,CPT® 78582,,Pulmon Vent Imag W Perfus,"$1,700.00",$270.64,"$1,700.00",$681.63,$658.52,$436.80,$292.90,$658.52,$658.52,$297.66,"$1,700.00",$456.86,$408.00,"$1,346.40","$1,360.00",$634.74,$308.89,$289.94,$270.64,$435.10
34100066,EAP,CPT® 78598,,Quant Diff Pulm Perfu + Vent,"$1,700.00",$0.00,"$1,700.00",$0.00,$637.10,$0.00,$0.00,$637.10,$637.10,$0.00,"$1,700.00",$0.00,$408.00,"$1,346.40","$1,360.00",$0.00,$0.00,$0.00,$0.00,$0.00
34100067,EAP,CPT® 78597,,Quant Diff Pulm Perfusion,"$1,089.00",$0.00,"$1,089.00",$0.00,$393.13,$0.00,$0.00,$393.13,$393.13,$0.00,"$1,089.00",$0.00,$261.36,$862.49,$871.20,$0.00,$0.00,$0.00,$0.00,$0.00
34100070,EAP,CPT® 78645,,Shunt Evaluation,$922.00,$0.00,$922.00,$0.00,$627.32,$0.00,$0.00,$627.32,$627.32,$0.00,$922.00,$0.00,$221.28,$730.22,$737.60,$0.00,$0.00,$0.00,$0.00,$0.00
34100072,EAP,CPT® 78012,,Thyroid Uptake Sing/multi Inc Supres Disch,"$4,645.00",$0.00,"$4,645.00",$0.00,$178.75,$0.00,$0.00,$178.75,$178.75,$0.00,"$4,645.00",$0.00,"$1,114.80","$3,678.84","$3,716.00",$0.00,$0.00,$0.00,$0.00,$0.00
34100073,EAP,CPT® 78013,,Thyroid Imaging,"$2,303.00",$0.00,"$2,303.00",$0.00,$465.43,$0.00,$0.00,$465.43,$465.43,$0.00,"$2,303.00",$0.00,$552.72,"$1,823.98","$1,842.40",$0.00,$0.00,$0.00,$0.00,$0.00
34100074,EAP,CPT® 78014,,Thyroid Imaging W/multi Determ Inc Suprs/dc,"$5,069.00",$222.22,"$5,069.00",$492.25,$529.70,$338.96,$873.36,$529.70,$529.70,$887.54,"$5,069.00",$354.53,"$1,216.56","$4,014.65","$4,055.20",$492.57,$232.84,$222.22,$806.98,$337.65
34100075,EAP,CPT® 78071,,Parathyrd Planar W/wo Subtrj,"$1,173.00",$0.00,"$1,173.00",$0.00,$739.03,$0.00,$0.00,$739.03,$739.03,$0.00,"$1,173.00",$0.00,$281.52,$929.02,$938.40,$0.00,$0.00,$0.00,$0.00,$0.00
34100076,EAP,CPT® 78072,,Parathyrd Planar W/spect&ct,"$3,126.00",$74.44,"$3,126.00",$627.00,$755.50,$436.80,$538.59,$755.50,$755.50,$547.34,"$3,126.00",$456.86,$750.24,"$2,475.79","$2,500.80",$634.74,$74.44,$381.06,$497.66,$435.10
34100077,EAP,CPT® 78831,,Nm Rp Loclzj Tum Spect 2 Area/1 Day Or 1 Area/2+ Day,"$2,021.00",$0.00,"$2,021.00",$0.00,"$1,423.76",$0.00,$0.00,"$1,423.76","$1,423.76",$0.00,"$2,021.00",$0.00,$485.04,"$1,600.63","$1,616.80",$0.00,$0.00,$0.00,$0.00,$0.00
34200013,EAP,CPT® 79005,,INIT HYPERTHYROID THERAPY NUC,"$2,988.00",$51.14,"$2,988.00",$271.50,$149.70,$227.64,$514.82,$149.70,$149.70,$523.17,"$2,988.00",$238.10,$717.12,"$2,366.50","$2,390.40",$330.81,$196.86,$51.14,$475.69,$226.76
34200014,EAP,CPT® 77316,,Brachyther Plan Simple,$913.00,$145.35,$913.00,$372.48,$274.23,$321.38,$157.31,$274.23,$274.23,$159.86,$913.00,$336.15,$219.12,$723.10,$730.40,$467.03,$177.21,$146.23,$145.35,$320.14
34200015,EAP,CPT® 77317,,Brachyther Plan Inter,"$1,208.00",$191.61,"$1,208.00",$485.25,$357.34,$321.38,$208.13,$357.34,$357.34,$211.51,"$1,208.00",$336.15,$289.92,$956.74,$966.40,$467.03,$231.84,$191.61,$192.31,$320.14
34200016,EAP,CPT® 79445,,Nuclear Rx Intra-arterial,"$1,324.00",$0.00,"$1,324.00",$0.00,$252.71,$0.00,$0.00,$252.71,$252.71,$0.00,"$1,324.00",$0.00,$317.76,"$1,048.61","$1,059.20",$0.00,$0.00,$0.00,$0.00,$0.00
34200017,EAP,CPT® 77770,,Hdr Brachytx 1 Channel,"$4,567.00",$236.63,"$4,567.00",$633.54,$533.35,$710.08,$786.87,$533.35,$533.35,$799.65,"$4,567.00",$742.70,"$1,096.08","$3,617.06","$3,653.60","$1,031.88",$308.15,$236.63,$727.07,$707.33
34200018,EAP,CPT® 77771,,Hdr Brachytx 2-12 Channel,"$5,579.00",$405.91,"$5,579.00","$1,180.06",$971.39,$710.08,$961.23,$971.39,$971.39,$976.84,"$5,579.00",$742.70,"$1,338.96","$4,418.57","$4,463.20","$1,031.88",$573.41,$405.91,$888.18,$707.33
34200019,EAP,CPT® 77772,,Hdr Brachytx Over 12 Chan,"$6,946.00",$0.00,"$6,946.00",$0.00,"$1,533.05",$0.00,$0.00,"$1,533.05","$1,533.05",$0.00,"$6,946.00",$0.00,"$1,667.04","$5,501.23","$5,556.80",$0.00,$0.00,$0.00,$0.00,$0.00
34300001,EAP,HCPCS A9500,,Tc-99m Sestambi/cardiolite Nu,$516.00,$0.00,$516.00,$0.00,$368.27,$0.00,$88.90,$368.27,$368.27,$90.35,$516.00,$0.00,$258.00,$408.67,$412.80,$0.00,$106.29,$0.00,$82.15,$0.00
34300002,EAP,HCPCS A9502,,Tetrofosmin Myoview Nuc,$812.00,$0.00,$812.00,$0.00,$579.52,$0.00,$155.45,$579.52,$579.52,$131.76,$812.00,$0.00,$406.00,$643.10,$649.60,$0.00,$125.46,$0.00,$129.27,$0.00
34300003,EAP,HCPCS A9503,,99mtc Mdp Nuc,$312.00,$0.00,$312.00,$0.00,$222.67,$0.00,$53.76,$222.67,$222.67,$54.63,$312.00,$0.00,$156.00,$247.10,$249.60,$0.00,$48.83,$0.00,$49.67,$0.00
34300004,EAP,HCPCS A9505,,Ti-201 Thallous Chloride Nuc,$131.00,$0.00,$131.00,$0.00,$93.49,$0.00,$0.00,$93.49,$93.49,$0.00,$131.00,$0.00,$65.50,$103.75,$104.80,$0.00,$0.00,$0.00,$0.00,$0.00
34300005,EAP,HCPCS A9516,,I-123 Iodine Capsule Nuc,"$2,008.00",$0.00,"$2,008.00",$0.00,"$1,433.11",$0.00,$80.43,"$1,433.11","$1,433.11",$351.58,"$2,008.00",$0.00,"$1,004.00","$1,590.34","$1,606.40",$0.00,$314.25,$0.00,$319.67,$0.00
34300006,EAP,HCPCS A9521,,99mtc Ceretec-labld - Wbc,"$1,888.00",$0.00,"$1,888.00",$0.00,"$1,347.47",$0.00,$0.00,"$1,347.47","$1,347.47",$0.00,"$1,888.00",$0.00,$944.00,"$1,495.30","$1,510.40",$0.00,$0.00,$0.00,$0.00,$0.00
34300007,EAP,HCPCS A9537,,99mtc Hepat-biliary-unprep Nu,$335.00,$0.00,$335.00,$0.00,$239.09,$0.00,$57.72,$239.09,$239.09,$58.66,$335.00,$0.00,$167.50,$265.32,$268.00,$0.00,$52.00,$0.00,$53.33,$0.00
34300008,EAP,HCPCS A9539,,99mtc Dtpa,$335.00,$0.00,$335.00,$0.00,$239.09,$0.00,$57.72,$239.09,$239.09,$58.66,$335.00,$0.00,$167.50,$265.32,$268.00,$0.00,$52.43,$0.00,$53.33,$0.00
34300009,EAP,HCPCS A9540,,99mtc Maauc,$425.00,$0.00,$425.00,$0.00,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
34300010,EAP,HCPCS A9541,,Tc-99m S Colloid Nuc,$335.00,$0.00,$335.00,$0.00,$239.09,$0.00,$57.72,$239.09,$239.09,$58.66,$335.00,$0.00,$167.50,$265.32,$268.00,$0.00,$48.79,$0.00,$53.33,$0.00
34300011,EAP,HCPCS A9521,,99mtc Ceretec-bd,$809.00,$0.00,$809.00,$0.00,$577.38,$0.00,$0.00,$577.38,$577.38,$0.00,$809.00,$0.00,$404.50,$640.73,$647.20,$0.00,$0.00,$0.00,$0.00,$0.00
34300016,EAP,HCPCS A9582,,"I123-mibg,10 Mci","$8,951.00",$0.00,"$8,951.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$8,951.00",$0.00,"$4,475.50","$7,089.19","$7,160.80",$0.00,$0.00,$0.00,$0.00,$0.00
34300020,EAP,HCPCS A9572,,Indium In-111 Pentetreotide,"$4,304.00",$0.00,"$4,304.00",$0.00,"$3,071.76",$0.00,$741.56,"$3,071.76","$3,071.76",$753.60,"$4,304.00",$0.00,"$2,152.00","$3,408.77","$3,443.20",$0.00,$673.58,$0.00,$685.20,$0.00
34300021,EAP,HCPCS A9512,,Technetiumtc-99m Pertechnetate,$227.00,$0.00,$227.00,$0.00,$162.01,$0.00,$39.11,$162.01,$162.01,$39.75,$227.00,$0.00,$113.50,$179.78,$181.60,$0.00,$35.53,$0.00,$36.14,$0.00
34300024,EAP,CPT® A9520,,"Lymphoseek, Diag, Up To 0.5mci",$828.00,$0.00,$828.00,$0.00,$590.94,$0.00,$142.66,$590.94,$590.94,$144.98,$828.00,$0.00,$414.00,$655.78,$662.40,$0.00,$129.58,$0.00,$131.82,$0.00
34300025,EAP,HCPCS A9580,,"Sodium Fluoride F-18, Diagnostic",$312.00,$0.00,$312.00,$0.00,$222.67,$0.00,$53.76,$222.67,$222.67,$54.63,$312.00,$0.00,$156.00,$247.10,$249.60,$0.00,$48.83,$0.00,$49.67,$0.00
34300026,EAP,HCPCS A9587,,"Gallium Ga-68, Dotatate, Diagnostic","$8,000.00",$0.00,"$8,000.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$8,000.00",$0.00,"$4,000.00","$6,336.00","$6,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
34300027,EAP,HCPCS A9588,,"Fluciclovine F-18, Diagnostic","$11,015.00",$0.00,"$11,015.00","$5,981.15","$5,158.80",$0.00,"$1,897.83","$5,158.80","$5,158.80","$1,928.64","$11,015.00",$0.00,"$5,507.50","$8,723.88","$8,812.00",$0.00,"$1,723.85",$0.00,"$1,753.59",$0.00
34300028,EAP,HCPCS A9584,,"Iodine 1-123 Ioflupane, Diagnostic","$6,000.00",$0.00,"$6,000.00",$0.00,"$4,282.20",$0.00,$0.00,"$4,282.20","$4,282.20",$0.00,"$6,000.00",$0.00,"$3,000.00","$4,752.00","$4,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
34300029,EAP,HCPCS A9587,,"Gallium Ga-68, Dotatate, Diagnostic, 0.1 Millicurie",$167.00,$0.00,$167.00,$0.00,$119.19,$0.00,$0.00,$119.19,$119.19,$0.00,$167.00,$0.00,$83.50,$132.26,$133.60,$0.00,$0.00,$0.00,$0.00,$0.00
34400001,EAP,HCPCS A9527,,"Iodine I-125, Sodium Iodide, Per Millicurie",$207.00,$0.00,$207.00,$112.40,$147.74,$31.27,$35.67,$147.74,$147.74,$36.24,$207.00,$32.83,$103.50,$163.94,$165.60,$45.34,$32.40,$0.00,$32.95,$31.27
35000001,EAP,CPT® 73200,,Upp Ext Ct W/o Dye Bilat Ect,"$8,046.00",$107.06,"$8,046.00","$1,273.65",$755.50,$107.47,"$1,386.29",$755.50,$755.50,"$1,408.79","$8,046.00",$112.41,"$1,608.00","$6,372.43","$6,436.80",$156.18,"$1,259.20",$130.02,"$1,280.92",$107.06
35000002,EAP,CPT® 73201,,Upp Ext Ct W/dye Bilat Ect,"$8,963.00",$166.40,"$8,963.00","$1,273.65",$755.50,$370.02,"$1,544.28",$755.50,$755.50,"$1,569.35","$8,963.00",$387.01,$774.00,"$7,098.70","$7,170.40",$537.70,"$1,402.71",$166.40,"$1,426.91",$368.58
35000003,EAP,CPT® 73202,,Upp Ext Ct W&wo Dye Bilat Ect,"$9,943.00",$0.00,"$9,943.00","$1,273.65",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$9,943.00",$0.00,$923.00,"$7,874.86","$7,954.40",$0.00,$0.00,$0.00,$0.00,$0.00
35000005,EAP,CPT® 73700,,LOW EXT CT W/O DYE RT ECT,"$3,488.00",$105.89,"$3,488.00","$1,273.65",$755.50,$107.47,$600.96,$755.50,$755.50,$610.72,"$3,488.00",$112.41,$566.00,"$2,762.50","$2,790.40",$156.18,$545.87,$105.89,$555.29,$107.06
35000006,EAP,CPT® 73701,,LOW EXT CT W/DYE RT ECT,"$4,789.00",$137.23,"$4,789.00","$1,273.65",$755.50,$193.45,$825.12,$755.50,$755.50,$838.52,"$4,789.00",$202.33,"$1,149.36","$3,792.89","$3,831.20",$281.11,$749.48,$137.23,$762.41,$192.70
35000007,EAP,CPT® 73702,,LOW EXT CT W&WO DYE LT ECT,"$5,577.00",$174.32,"$5,577.00","$1,273.65",$755.50,$193.45,$375.07,$755.50,$755.50,$976.49,"$5,577.00",$202.33,$923.00,"$4,416.98","$4,461.60",$281.11,$872.80,$174.32,$887.86,$192.70
35000009,EAP,CPT® 75635,,ABD AORTA&ILLIOFEMORAL CTA ECT,"$6,159.00",$192.70,"$6,159.00","$1,273.65",$755.50,$193.45,"$1,061.16",$755.50,$755.50,"$1,078.39","$6,159.00",$202.33,"$1,048.00","$4,877.93","$4,927.20",$281.11,$963.88,$329.20,$980.51,$192.70
35000010,EAP,CPT® 76376,,3drendering W/o Postprocess,"$2,033.00",$0.00,"$2,033.00","$1,869.00",$755.50,$0.00,$147.89,$755.50,$755.50,$355.96,"$2,033.00",$0.00,$487.92,"$1,610.14","$1,626.40",$0.00,$318.16,$13.33,$323.65,$0.00
35000011,EAP,CPT® 76377,,3d Rendering W/postprocess,"$3,820.00",$0.00,"$3,820.00","$1,869.00",$755.50,$0.00,$187.24,$755.50,$755.50,$668.85,"$3,820.00",$0.00,$916.80,"$3,025.44","$3,056.00",$0.00,$597.83,$32.41,$608.14,$0.00
35000013,EAP,CPT® 77011,,CT GUIDED STEREOTAT LOC NCT,"$1,725.00",$0.00,"$1,725.00","$1,273.65",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,725.00",$0.00,$414.00,"$1,366.20","$1,380.00",$0.00,$0.00,$0.00,$0.00,$0.00
35000014,EAP,CPT® 77012,,CT GUIDANCE NEEDLE PLC BCT,"$2,389.00",$0.00,"$2,389.00","$1,273.65",$755.50,$0.00,$411.61,$755.50,$755.50,$418.29,"$2,389.00",$0.00,$573.36,"$1,892.09","$1,911.20",$0.00,$373.88,$77.80,$380.33,$0.00
35000015,EAP,CPT® 77013,,"Ct, Visceral Tissue Ablation","$2,762.00",$0.00,"$2,762.00","$1,273.65",$755.50,$0.00,$475.88,$755.50,$755.50,$483.60,"$2,762.00",$0.00,$662.88,"$2,187.50","$2,209.60",$0.00,$432.25,$0.00,$439.71,$0.00
35000104,EAP,CPT® 73206,,Upp Ext Cta W&wo Dye Rt Ect,"$3,537.00",$192.70,"$3,537.00","$1,273.65",$755.50,$193.45,$437.32,$755.50,$755.50,$619.30,"$3,537.00",$202.33,"$1,048.00","$2,801.30","$2,829.60",$281.11,$553.54,$241.31,$563.09,$192.70
35000108,EAP,CPT® 20982,,Ablation Bone Tumor Perc W/img,"$12,445.00",$0.00,"$12,445.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$12,445.00",$0.00,"$5,452.00","$9,856.44","$9,956.00",$0.00,$0.00,$0.00,$0.00,$0.00
35000202,EAP,CPT® 73201,,Upp Ext Ct W/dye Lt/rt Ect,"$4,482.00",$166.40,"$4,482.00","$1,273.65",$755.50,$370.02,$772.23,$755.50,$755.50,$784.76,"$4,482.00",$387.01,$774.00,"$3,549.74","$3,585.60",$537.70,$701.43,$166.40,$713.53,$368.58
35000303,EAP,CPT® 73202,,Upp Ext Ct W&wo Dye Lt/rt Ect,"$4,973.00",$0.00,"$4,973.00","$1,273.65",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,973.00",$0.00,$923.00,"$3,938.62","$3,978.40",$0.00,$0.00,$0.00,$0.00,$0.00
35000305,EAP,CPT® 75571,,Ct Hrt W/o Dye W/ca Test,$375.00,$19.72,$126.00,$126.00,$126.00,$76.53,$21.71,$126.00,$126.00,$22.06,$126.00,$80.04,$30.24,$99.79,$100.80,$111.21,$19.72,$76.72,$20.06,$76.23
35000306,EAP,CPT® 75572,,Ct Hrt W/3d Image,"$1,550.00",$0.00,"$1,550.00","$1,273.65",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,550.00",$0.00,$372.00,"$1,227.60","$1,240.00",$0.00,$0.00,$0.00,$0.00,$0.00
35000307,EAP,CPT® 75573,,"Ct Hrt W/3d Image, Congen","$1,281.00",$0.00,"$1,281.00","$1,273.65",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,281.00",$0.00,$307.44,"$1,014.55","$1,024.80",$0.00,$0.00,$0.00,$0.00,$0.00
35000308,EAP,CPT® 75574,,Ct Angio Hrt W/3d Image,"$2,127.00",$192.70,"$2,127.00","$1,273.65",$755.50,$193.45,$366.47,$755.50,$755.50,$372.42,"$2,127.00",$202.33,$510.48,"$1,684.58","$1,701.60",$281.11,$332.88,$244.20,$338.62,$192.70
35000309,EAP,CPT® 75571,,Ct Heart W/o Dye;qual Calc Oct,$375.00,$19.72,$126.00,$126.00,$126.00,$76.53,$21.71,$126.00,$126.00,$22.06,$126.00,$80.04,$30.24,$99.79,$100.80,$111.21,$19.72,$76.72,$20.06,$76.23
35000311,EAP,CPT® 73700,,Low Ext Ct W/o Dye Bilat Ect,"$6,983.00",$105.89,"$6,983.00","$1,273.65",$755.50,$107.47,"$1,203.14",$755.50,$755.50,"$1,222.67","$6,983.00",$112.41,$566.00,"$5,530.54","$5,586.40",$156.18,"$1,092.84",$105.89,"$1,111.69",$107.06
35000312,EAP,CPT® 73701,,Low Ext Ct W/dye Bilat Ect,"$9,578.00",$137.23,"$9,578.00","$1,273.65",$755.50,$193.45,"$1,650.24",$755.50,$755.50,"$1,677.03","$9,578.00",$202.33,"$2,298.72","$7,585.78","$7,662.40",$281.11,"$1,498.96",$137.23,"$1,524.82",$192.70
35000313,EAP,CPT® 73702,,Low Ext Ct W&wo Dye Bilat Ect,"$11,163.00",$174.32,"$11,163.00","$1,273.65",$755.50,$193.45,$375.07,$755.50,$755.50,"$1,954.55","$11,163.00",$202.33,$923.00,"$8,841.10","$8,930.40",$281.11,"$1,747.01",$174.32,"$1,777.15",$192.70
35000314,EAP,CPT® 73706,,Low Ext Cta W&wo Dye Bilat Ect,"$12,088.00",$192.70,"$12,088.00",$627.00,$755.50,$193.45,"$2,082.70",$755.50,$755.50,"$2,116.51","$12,088.00",$202.33,"$1,048.00","$9,573.70","$9,670.40",$281.11,"$1,891.77",$264.37,"$1,924.41",$192.70
35000315,EAP,CPT® 73206,,Upp Ext Cta W&wo Dye Bilat Ect,"$7,080.00",$192.70,"$7,080.00","$1,273.65",$755.50,$193.45,$437.32,$755.50,$755.50,"$1,239.65","$7,080.00",$202.33,"$1,048.00","$5,607.36","$5,664.00",$281.11,"$1,108.02",$241.31,"$1,127.14",$192.70
35000352,EAP,CPT® 74176,,"Ct, Abd And Pelvis W/o Contrast","$6,885.00",$113.81,"$6,885.00","$1,273.65",$755.50,$223.46,$131.86,$755.50,$755.50,"$1,205.51","$6,885.00",$233.72,"$1,652.40","$5,452.92","$5,508.00",$324.73,"$1,077.50",$113.81,"$1,096.09",$222.60
35000353,EAP,CPT® 74177,,"Ct, Abd And Pelvis W/contrast","$9,444.00",$238.43,"$9,444.00","$1,273.65",$755.50,$370.02,$251.52,$755.50,$755.50,"$1,653.57","$9,444.00",$387.01,"$2,266.56","$7,479.65","$7,555.20",$537.70,"$1,477.99",$238.43,"$1,503.48",$368.58
35000354,EAP,CPT® 37220,,Iliac Revasc,"$10,622.00",$0.00,"$10,622.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$10,622.00",$0.00,"$4,975.00","$8,412.62","$8,497.60",$0.00,$0.00,$0.00,$0.00,$0.00
35000355,EAP,CPT® 37221,,Iliac Revasc W/stent,"$31,279.00",$0.00,"$31,279.00",$0.00,$0.00,$0.00,"$5,389.22",$0.00,$0.00,"$5,476.70","$31,279.00",$0.00,"$6,105.00","$24,772.97","$25,023.20",$0.00,"$4,457.60",$0.00,$0.00,$0.00
35000356,EAP,CPT® 37222,,Iliac Revasc Add-on,"$31,279.00",$0.00,"$31,279.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$31,279.00",$0.00,"$15,639.50","$24,772.97","$25,023.20",$0.00,$0.00,$0.00,$0.00,$0.00
35000357,EAP,CPT® 37223,,Iliac Revasc W/stent Add-on,"$31,279.00",$0.00,"$31,279.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$31,279.00",$0.00,"$15,639.50","$24,772.97","$25,023.20",$0.00,$0.00,$0.00,$0.00,$0.00
35000358,EAP,CPT® 37224,,Fem/popl Revas W/tla,"$21,504.00",$466.92,"$21,504.00","$3,389.40","$15,347.40","$4,750.30","$3,705.03","$15,347.40","$5,416.74","$3,765.18","$21,504.00","$4,968.47","$4,975.00","$17,031.17","$17,203.20","$6,903.03","$3,623.42",$466.92,"$3,423.44","$4,731.88"
35000359,EAP,CPT® 37225,,Fem/popl Revas W/ather,"$45,644.00",$0.00,"$45,644.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$45,644.00",$0.00,"$6,105.00","$36,150.05","$36,515.20",$0.00,$0.00,$0.00,$0.00,$0.00
35000360,EAP,CPT® 37226,,Fem/popl Revasc W/stent,"$45,644.00",$545.88,"$45,644.00","$3,389.40","$32,576.12","$9,501.24","$7,864.23","$32,576.12","$5,416.74","$7,991.90","$45,644.00","$9,937.60","$6,105.00","$36,150.05","$36,515.20","$13,806.97","$7,751.33",$545.88,"$7,266.52","$9,464.38"
35000361,EAP,CPT® 37227,,Fem/popl Revasc Stnt & Ather,"$79,053.00",$0.00,"$79,053.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$79,053.00",$0.00,"$6,105.00","$62,609.98","$63,242.40",$0.00,$0.00,$0.00,$0.00,$0.00
35000362,EAP,CPT® 37228,,Tib/per Revasc W/tla,"$21,504.00",$0.00,"$21,504.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$21,504.00",$0.00,"$6,105.00","$17,031.17","$17,203.20",$0.00,$0.00,$0.00,$0.00,$0.00
35000363,EAP,CPT® 37229,,Tib/per Revasc W/ather,"$45,644.00",$0.00,"$45,644.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$45,644.00",$0.00,"$6,105.00","$36,150.05","$36,515.20",$0.00,$0.00,$0.00,$0.00,$0.00
35000364,EAP,CPT® 37230,,Tib/per Revasc W/stent,"$45,644.00",$0.00,"$45,644.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$45,644.00",$0.00,"$6,105.00","$36,150.05","$36,515.20",$0.00,$0.00,$0.00,$0.00,$0.00
35000365,EAP,CPT® 37231,,Tib/per Revasc Stent & Ather,"$61,472.00",$0.00,"$61,472.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$61,472.00",$0.00,"$6,105.00","$48,685.82","$49,177.60",$0.00,$0.00,$0.00,$0.00,$0.00
35000366,EAP,CPT® 37232,,Tib/per Revasc Add-on,"$21,504.00",$0.00,"$21,504.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$21,504.00",$0.00,"$10,752.00","$17,031.17","$17,203.20",$0.00,$0.00,$0.00,$0.00,$0.00
35000367,EAP,CPT® 37233,,Tibper Revasc W/ather Add-on,"$45,644.00",$0.00,"$45,644.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$45,644.00",$0.00,"$22,822.00","$36,150.05","$36,515.20",$0.00,$0.00,$0.00,$0.00,$0.00
35000368,EAP,CPT® 37234,,Revsc Opn/prq Tib/pero Stent,"$21,504.00",$0.00,"$21,504.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$21,504.00",$0.00,"$10,752.00","$17,031.17","$17,203.20",$0.00,$0.00,$0.00,$0.00,$0.00
35000369,EAP,CPT® 37235,,Tib/per Revasc Stnt & Ather,"$21,504.00",$0.00,"$21,504.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$21,504.00",$0.00,"$10,752.00","$17,031.17","$17,203.20",$0.00,$0.00,$0.00,$0.00,$0.00
35000381,EAP,CPT® 74178,,"Ct, Abd And Pelvis W&w/o Contrast","$11,006.00",$270.49,"$11,006.00","$1,273.65",$755.50,$370.02,$332.43,$755.50,$755.50,"$1,927.06","$11,006.00",$387.01,"$2,641.44","$8,716.75","$8,804.80",$537.70,"$1,722.44",$270.49,"$1,752.16",$368.58
35100001,EAP,CPT® 70450,,HEAD/BRAIN CT W/O DYE ECT,"$3,714.00",$73.47,"$3,714.00","$1,273.65",$755.50,$107.47,$639.90,$755.50,$755.50,$650.29,"$3,714.00",$112.41,$566.00,"$2,941.49","$2,971.20",$156.18,$581.24,$73.47,$591.27,$107.06
35100002,EAP,CPT® 70460,,HEAD/BRAIN CT W/ DYE ECT,"$5,094.00",$107.69,"$5,094.00","$1,273.65",$755.50,$193.45,$877.67,$755.50,$755.50,$891.92,"$5,094.00",$202.33,$774.00,"$4,034.45","$4,075.20",$281.11,$797.21,$107.69,$810.96,$192.70
35100003,EAP,CPT® 70470,,HEAD/BRAIN CT W&WO DYE ECT,"$5,933.00",$128.94,"$5,933.00","$1,273.65",$755.50,$193.45,"$1,022.23",$755.50,$755.50,"$1,038.82","$5,933.00",$202.33,$923.00,"$4,698.94","$4,746.40",$281.11,$928.51,$128.94,$944.53,$192.70
35100004,EAP,CPT® 70480,,ORBIT/SELLA/EAR W/O DYE ECT,"$4,362.00",$107.06,"$4,362.00","$1,273.65",$755.50,$107.47,$751.55,$755.50,$755.50,$763.75,"$4,362.00",$112.41,$566.00,"$3,454.70","$3,489.60",$156.18,$682.65,$137.95,$694.43,$107.06
35100005,EAP,CPT® 70481,,ORBIT/SELLA/EAR W/DYE ECT,"$5,982.00",$168.92,"$5,982.00","$1,273.65",$755.50,$193.45,"$1,030.67",$755.50,$755.50,"$1,047.40","$5,982.00",$202.33,$774.00,"$4,737.74","$4,785.60",$281.11,$936.18,$168.92,$952.33,$192.70
35100006,EAP,CPT® 70482,,ORB/SELLA/EAR W&WO DYE ECT,"$6,967.00",$0.00,"$6,967.00","$1,273.65",$755.50,$193.45,$0.00,$755.50,$755.50,$0.00,"$6,967.00",$202.33,$923.00,"$5,517.86","$5,573.60",$281.11,$0.00,$186.57,"$1,109.15",$192.70
35100007,EAP,CPT® 70486,,MAXILLOFAC CT W/O DYE ECT,"$4,362.00",$97.25,"$4,362.00","$1,273.65",$755.50,$107.47,$751.55,$755.50,$755.50,$763.75,"$4,362.00",$112.41,$566.00,"$3,454.70","$3,489.60",$156.18,$682.65,$97.25,$694.43,$107.06
35100008,EAP,CPT® 70487,,MAXILLOFAC CT W/DYE ECT,"$5,982.00",$111.65,"$5,982.00","$1,273.65",$755.50,$193.45,"$1,030.67",$755.50,$755.50,"$1,047.40","$5,982.00",$202.33,$774.00,"$4,737.74","$4,785.60",$281.11,$936.18,$111.65,$952.33,$192.70
35100009,EAP,CPT® 70488,,MAXILLOFAC CT W&WO DYE ECT,"$6,967.00",$141.55,"$6,967.00","$1,273.65",$755.50,$193.45,"$1,200.38",$755.50,$755.50,"$1,219.87","$6,967.00",$202.33,$923.00,"$5,517.86","$5,573.60",$281.11,"$1,090.34",$141.55,"$1,109.15",$192.70
35100010,EAP,CPT® 70490,,SOFT TISS NECK CT W/O DYE ECT,"$3,597.00",$101.21,"$3,597.00","$1,273.65",$755.50,$107.47,$619.75,$755.50,$755.50,$629.81,"$3,597.00",$112.41,$566.00,"$2,848.82","$2,877.60",$156.18,$562.93,$101.21,$572.64,$107.06
35100011,EAP,CPT® 70491,,SOFT TISS NECK CT W/DYE ECT,"$4,933.00",$134.70,"$4,933.00","$1,273.65",$755.50,$193.45,$849.93,$755.50,$755.50,$863.73,"$4,933.00",$202.33,$774.00,"$3,906.94","$3,946.40",$281.11,$772.01,$134.70,$785.33,$192.70
35100012,EAP,CPT® 70492,,SOFT TISS NECK CT W&WO DYE ECT,"$5,747.00",$164.96,"$5,747.00","$1,273.65",$755.50,$193.45,$990.18,$755.50,$755.50,"$1,006.25","$5,747.00",$202.33,$923.00,"$4,551.62","$4,597.60",$281.11,$899.41,$164.96,$914.92,$192.70
35100013,EAP,CPT® 70496,,HEAD CTA W & W/O DYE ECT,"$6,229.00",$192.70,"$6,229.00","$1,273.65",$755.50,$193.45,"$1,073.23",$755.50,$755.50,"$1,090.65","$6,229.00",$202.33,"$1,048.00","$4,933.37","$4,983.20",$281.11,$974.84,$211.42,$991.66,$192.70
35100014,EAP,CPT® 70498,,NECK CTA W & W/O DYE ECT,"$6,229.00",$192.70,"$6,229.00","$1,273.65",$755.50,$193.45,"$1,073.23",$755.50,$755.50,"$1,090.65","$6,229.00",$202.33,"$1,048.00","$4,933.37","$4,983.20",$281.11,$974.84,$211.06,$991.66,$192.70
35100015,EAP,CPT® 0042T,,"BRAIN PERFUSION W/CONT CT, ECT","$5,548.00",$0.00,"$5,548.00","$1,273.65",$755.50,$0.00,$955.89,$755.50,$755.50,$971.41,"$5,548.00",$0.00,"$2,774.00","$4,394.02","$4,438.40",$0.00,$868.26,$0.00,$883.24,$0.00
35200001,EAP,CPT® 71250,,THORAX CT W/O DYE BCT,"$3,404.00",$101.21,"$3,404.00","$1,273.65",$755.50,$107.47,$586.49,$755.50,$755.50,$596.01,"$3,404.00",$112.41,$816.96,"$2,695.97","$2,723.20",$156.18,$532.73,$101.21,$541.92,$107.06
35200002,EAP,CPT® 71260,,THORAX CT W/DYE BCT,"$4,672.00",$135.06,"$4,672.00","$1,273.65",$755.50,$193.45,$804.96,$755.50,$755.50,$818.03,"$4,672.00",$202.33,"$1,121.28","$3,700.22","$3,737.60",$281.11,$731.17,$135.06,$743.78,$192.70
35200003,EAP,CPT® 71270,,THORAX CT W&WO DYE BCT,"$5,441.00",$0.00,"$5,441.00","$1,273.65",$755.50,$193.45,$0.00,$755.50,$755.50,$952.68,"$5,441.00",$202.33,"$1,305.84","$4,309.27","$4,352.80",$281.11,$0.00,$164.96,$866.21,$192.70
35200004,EAP,CPT® 71275,,THORAX CTA W&WO DYE BCT,"$5,898.00",$192.70,"$5,898.00","$1,273.65",$755.50,$193.45,$442.66,$755.50,$755.50,"$1,032.69","$5,898.00",$202.33,"$1,415.52","$4,671.22","$4,718.40",$281.11,$923.04,$214.30,$938.96,$192.70
35200005,EAP,CPT® 72125,,CERVICAL SPINE CT W/O DYE ECT,"$6,480.00",$106.61,"$6,480.00","$1,273.65",$755.50,$107.47,"$1,116.47",$755.50,$755.50,"$1,134.60","$6,480.00",$112.41,$566.00,"$5,132.16","$5,184.00",$156.18,"$1,014.12",$106.61,"$1,031.62",$107.06
35200006,EAP,CPT® 72126,,CERVICAL SPINE CT W/DYE ECT,"$8,883.00",$0.00,"$8,883.00","$1,273.65",$755.50,$370.02,$0.00,$755.50,$755.50,"$1,555.34","$8,883.00",$387.01,$774.00,"$7,035.34","$7,106.40",$537.70,$0.00,$135.78,"$1,414.17",$368.58
35200007,EAP,CPT® 72127,,CERVICAL SPINE CT W&WO DYE ECT,"$9,976.00",$0.00,"$9,976.00","$1,273.65",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$9,976.00",$0.00,$923.00,"$7,900.99","$7,980.80",$0.00,$0.00,$0.00,$0.00,$0.00
35200008,EAP,CPT® 72128,,THORACIC SPINE CT W/O DYE ECT,"$4,276.00",$106.61,"$4,276.00","$1,273.65",$755.50,$107.47,$736.73,$755.50,$755.50,$748.69,"$4,276.00",$112.41,$566.00,"$3,386.59","$3,420.80",$156.18,$669.19,$106.61,$680.74,$107.06
35200009,EAP,CPT® 72129,,THORACIC SPINE CT W/DYE ECT,"$5,863.00",$137.23,"$5,863.00","$1,273.65",$755.50,$193.45,"$1,010.17",$755.50,$755.50,"$1,026.56","$5,863.00",$202.33,$774.00,"$4,643.50","$4,690.40",$281.11,$917.56,$137.23,$933.39,$192.70
35200010,EAP,CPT® 72130,,THORACIC SPINE CT W&WO DYE ECT,"$6,584.00",$0.00,"$6,584.00","$1,273.65",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,584.00",$0.00,$923.00,"$5,214.53","$5,267.20",$0.00,$0.00,$0.00,$0.00,$0.00
35200011,EAP,CPT® 72131,,LUMBAR SPINE CT W/O DYE ECT,"$3,580.00",$105.89,"$3,580.00","$1,273.65",$755.50,$107.47,$616.82,$755.50,$755.50,$626.83,"$3,580.00",$112.41,$566.00,"$2,835.36","$2,864.00",$156.18,$560.27,$105.89,$569.94,$107.06
35200012,EAP,CPT® 72132,,LUMBAR SPINE CT W/DYE ECT,"$4,910.00",$0.00,"$4,910.00","$1,273.65",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,910.00",$0.00,$774.00,"$3,888.72","$3,928.00",$0.00,$0.00,$0.00,$0.00,$0.00
35200013,EAP,CPT® 72133,,LUMBAR SPINE CT W&WO DYE ECT,"$5,514.00",$0.00,"$5,514.00","$1,273.65",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,514.00",$0.00,$923.00,"$4,367.09","$4,411.20",$0.00,$0.00,$0.00,$0.00,$0.00
35200014,EAP,CPT® 72191,,PELVIS CTA W&WO DYE BCT,"$6,199.00",$0.00,"$6,199.00","$1,273.65",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,199.00",$0.00,"$1,048.00","$4,909.61","$4,959.20",$0.00,$0.00,$0.00,$0.00,$0.00
35200015,EAP,CPT® 72192,,ORTHO PELVIS CT W/O DYE BCT,"$3,889.00",$91.84,"$3,889.00","$1,273.65",$755.50,$107.47,$670.06,$755.50,$755.50,$680.93,"$3,889.00",$112.41,$566.00,"$3,080.09","$3,111.20",$156.18,$608.63,$91.84,$619.13,$107.06
35200016,EAP,CPT® 72192,,PELVIS CT W/O DYE BCT,"$3,889.00",$91.84,"$3,889.00","$1,273.65",$755.50,$107.47,$670.06,$755.50,$755.50,$680.93,"$3,889.00",$112.41,$566.00,"$3,080.09","$3,111.20",$156.18,$608.63,$91.84,$619.13,$107.06
35200017,EAP,CPT® 72193,,PELVIS CT W/DYE BCT,"$5,337.00",$186.21,"$5,337.00","$1,273.65",$755.50,$193.45,$919.54,$755.50,$755.50,$934.47,"$5,337.00",$202.33,$774.00,"$4,226.90","$4,269.60",$281.11,$835.24,$186.21,$849.65,$192.70
35200018,EAP,CPT® 72194,,PELVIS CT W&WO DYE BCT,"$6,213.00",$192.70,"$6,213.00","$1,273.65",$755.50,$193.45,$370.31,$755.50,$755.50,"$1,087.85","$6,213.00",$202.33,$923.00,"$4,920.70","$4,970.40",$281.11,$972.33,$213.58,$989.11,$192.70
35200019,EAP,CPT® 73200,,Upp Ext Ct W/o Dye Bilat Bct,"$8,046.00",$107.06,"$8,046.00","$1,273.65",$755.50,$107.47,"$1,386.29",$755.50,$755.50,"$1,408.79","$8,046.00",$112.41,"$1,608.00","$6,372.43","$6,436.80",$156.18,"$1,259.20",$130.02,"$1,280.92",$107.06
35200020,EAP,CPT® 73200,,UPP EXT CT W/O DYE LT BCT,"$4,022.00",$107.06,"$4,022.00","$1,273.65",$755.50,$107.47,$692.97,$755.50,$755.50,$704.22,"$4,022.00",$112.41,"$1,608.00","$3,185.42","$3,217.60",$156.18,$629.44,$130.02,$640.30,$107.06
35200021,EAP,CPT® 73200,,UPP EXT CT W/O DYE RT BCT,"$4,022.00",$107.06,"$4,022.00","$1,273.65",$755.50,$107.47,$692.97,$755.50,$755.50,$704.22,"$4,022.00",$112.41,"$1,608.00","$3,185.42","$3,217.60",$156.18,$629.44,$130.02,$640.30,$107.06
35200022,EAP,CPT® 73201,,Upp Ext Ct W/dye Bilat Bct,"$8,963.00",$166.40,"$8,963.00","$1,273.65",$755.50,$370.02,"$1,544.28",$755.50,$755.50,"$1,569.35","$8,963.00",$387.01,$774.00,"$7,098.70","$7,170.40",$537.70,"$1,402.71",$166.40,"$1,426.91",$368.58
35200023,EAP,CPT® 73201,,Upp Ext Ct W/dye Lt,"$4,482.00",$166.40,"$4,482.00","$1,273.65",$755.50,$370.02,$772.23,$755.50,$755.50,$784.76,"$4,482.00",$387.01,$774.00,"$3,549.74","$3,585.60",$537.70,$701.43,$166.40,$713.53,$368.58
35200024,EAP,CPT® 73201,,UPP EXT CT W/DYE RT BCT,"$4,482.00",$166.40,"$4,482.00","$1,273.65",$755.50,$370.02,$772.23,$755.50,$755.50,$784.76,"$4,482.00",$387.01,$774.00,"$3,549.74","$3,585.60",$537.70,$701.43,$166.40,$713.53,$368.58
35200025,EAP,CPT® 73202,,Upp Ext Ct W&wo Dye Bilat Bct,"$9,943.00",$0.00,"$9,943.00","$1,273.65",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$9,943.00",$0.00,$923.00,"$7,874.86","$7,954.40",$0.00,$0.00,$0.00,$0.00,$0.00
35200026,EAP,CPT® 73202,,UPP EXT CT W&WO DYE LT BCT,"$4,973.00",$0.00,"$4,973.00","$1,273.65",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,973.00",$0.00,$923.00,"$3,938.62","$3,978.40",$0.00,$0.00,$0.00,$0.00,$0.00
35200027,EAP,CPT® 73202,,UPP EXT CT W&WO DYE RT BCT,"$4,973.00",$0.00,"$4,973.00","$1,273.65",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,973.00",$0.00,$923.00,"$3,938.62","$3,978.40",$0.00,$0.00,$0.00,$0.00,$0.00
35200028,EAP,CPT® 73206,,UPP EXT CTA W&WO DYE BILAT BCT,"$7,080.00",$192.70,"$7,080.00","$1,273.65",$755.50,$193.45,$437.32,$755.50,$755.50,"$1,239.65","$7,080.00",$202.33,"$1,048.00","$5,607.36","$5,664.00",$281.11,"$1,108.02",$241.31,"$1,127.14",$192.70
35200029,EAP,CPT® 73206,,UPP EXT CTA W&WO DYE LT BCT,"$3,537.00",$192.70,"$3,537.00","$1,273.65",$755.50,$193.45,$437.32,$755.50,$755.50,$619.30,"$3,537.00",$202.33,"$1,048.00","$2,801.30","$2,829.60",$281.11,$553.54,$241.31,$563.09,$192.70
35200030,EAP,CPT® 73206,,UPP EXT CTA W&WO DYE RT BCT,"$3,537.00",$192.70,"$3,537.00","$1,273.65",$755.50,$193.45,$437.32,$755.50,$755.50,$619.30,"$3,537.00",$202.33,"$1,048.00","$2,801.30","$2,829.60",$281.11,$553.54,$241.31,$563.09,$192.70
35200031,EAP,CPT® 73700,,Low Ext Ct W/o Dye Bilat Bct,"$6,983.00",$105.89,"$6,983.00","$1,273.65",$755.50,$107.47,"$1,203.14",$755.50,$755.50,"$1,222.67","$6,983.00",$112.41,$566.00,"$5,530.54","$5,586.40",$156.18,"$1,092.84",$105.89,"$1,111.69",$107.06
35200032,EAP,CPT® 73700,,LOW EXT CT W/O DYE LT BCT,"$3,488.00",$105.89,"$3,488.00","$1,273.65",$755.50,$107.47,$600.96,$755.50,$755.50,$610.72,"$3,488.00",$112.41,$566.00,"$2,762.50","$2,790.40",$156.18,$545.87,$105.89,$555.29,$107.06
35200033,EAP,CPT® 73700,,LOW EXT CT W/O DYE RT BCT,"$3,488.00",$105.89,"$3,488.00","$1,273.65",$755.50,$107.47,$600.96,$755.50,$755.50,$610.72,"$3,488.00",$112.41,$566.00,"$2,762.50","$2,790.40",$156.18,$545.87,$105.89,$555.29,$107.06
35200034,EAP,CPT® 73701,,Low Ext Ct W/dye Bilat Bct,"$9,578.00",$137.23,"$9,578.00","$1,273.65",$755.50,$193.45,"$1,650.24",$755.50,$755.50,"$1,677.03","$9,578.00",$202.33,"$2,298.72","$7,585.78","$7,662.40",$281.11,"$1,498.96",$137.23,"$1,524.82",$192.70
35200035,EAP,CPT® 73701,,LOW EXT CT W/DYE LT BCT,"$4,789.00",$137.23,"$4,789.00","$1,273.65",$755.50,$193.45,$825.12,$755.50,$755.50,$838.52,"$4,789.00",$202.33,"$1,149.36","$3,792.89","$3,831.20",$281.11,$749.48,$137.23,$762.41,$192.70
35200036,EAP,CPT® 73701,,LOW EXT CT W/DYE RT BCT,"$4,789.00",$137.23,"$4,789.00","$1,273.65",$755.50,$193.45,$825.12,$755.50,$755.50,$838.52,"$4,789.00",$202.33,"$1,149.36","$3,792.89","$3,831.20",$281.11,$749.48,$137.23,$762.41,$192.70
35200037,EAP,CPT® 73702,,Low Ext Ct W&wo Dye Bilat Bct,"$11,163.00",$174.32,"$11,163.00","$1,273.65",$755.50,$193.45,$375.07,$755.50,$755.50,"$1,954.55","$11,163.00",$202.33,$923.00,"$8,841.10","$8,930.40",$281.11,"$1,747.01",$174.32,"$1,777.15",$192.70
35200038,EAP,CPT® 73702,,LOW EXT CT W&WO DYE LT BCT,"$5,577.00",$174.32,"$5,577.00","$1,273.65",$755.50,$193.45,$375.07,$755.50,$755.50,$976.49,"$5,577.00",$202.33,$923.00,"$4,416.98","$4,461.60",$281.11,$872.80,$174.32,$887.86,$192.70
35200039,EAP,CPT® 73702,,LOW EXT CT W&WO DYE RT BCT,"$5,577.00",$174.32,"$5,577.00","$1,273.65",$755.50,$193.45,$375.07,$755.50,$755.50,$976.49,"$5,577.00",$202.33,$923.00,"$4,416.98","$4,461.60",$281.11,$872.80,$174.32,$887.86,$192.70
35200040,EAP,CPT® 73706,,Low Ext Cta W&wo Dye Bilat Bct,"$12,088.00",$192.70,"$12,088.00",$627.00,$755.50,$193.45,"$2,082.70",$755.50,$755.50,"$2,116.51","$12,088.00",$202.33,"$1,048.00","$9,573.70","$9,670.40",$281.11,"$1,891.77",$264.37,"$1,924.41",$192.70
35200041,EAP,CPT® 73706,,LOW EXT CTA W&WO DYE LT BCT,"$6,042.00",$192.70,"$6,042.00",$627.00,$755.50,$193.45,"$1,041.01",$755.50,$755.50,"$1,057.91","$6,042.00",$202.33,"$1,048.00","$4,785.26","$4,833.60",$281.11,$945.57,$264.37,$961.89,$192.70
35200042,EAP,CPT® 73706,,LOW EXT CTA W&WO DYE RT BCT,"$6,042.00",$192.70,"$6,042.00",$627.00,$755.50,$193.45,"$1,041.01",$755.50,$755.50,"$1,057.91","$6,042.00",$202.33,"$1,048.00","$4,785.26","$4,833.60",$281.11,$945.57,$264.37,$961.89,$192.70
35200043,EAP,CPT® 74150,,ABDOMEN CT W/O DYE BCT,"$3,698.00",$90.40,"$3,698.00","$1,273.65",$755.50,$107.47,$637.15,$755.50,$755.50,$647.49,"$3,698.00",$112.41,$566.00,"$2,928.82","$2,958.40",$156.18,$578.74,$90.40,$588.72,$107.06
35200044,EAP,CPT® 74150,,ABDOMEN CT W/O DYE LIMITED BCT,"$3,698.00",$90.40,"$3,698.00","$1,273.65",$755.50,$107.47,$637.15,$755.50,$755.50,$647.49,"$3,698.00",$112.41,$566.00,"$2,928.82","$2,958.40",$156.18,$578.74,$90.40,$588.72,$107.06
35200045,EAP,CPT® 74150,,"Stone Protocol, Bct","$3,698.00",$90.40,"$3,698.00","$1,273.65",$755.50,$107.47,$637.15,$755.50,$755.50,$647.49,"$3,698.00",$112.41,$566.00,"$2,928.82","$2,958.40",$156.18,$578.74,$90.40,$588.72,$107.06
35200046,EAP,CPT® 74160,,ABDOMEN CT W/DYE BCT,"$5,076.00",$185.49,"$5,076.00","$1,273.65",$755.50,$193.45,$874.57,$755.50,$755.50,$888.77,"$5,076.00",$202.33,$774.00,"$4,020.19","$4,060.80",$281.11,$794.39,$185.49,$808.10,$192.70
35200047,EAP,CPT® 74160,,ABDOMEN CT W/DYE LIMITED BCT,"$5,076.00",$185.49,"$5,076.00","$1,273.65",$755.50,$193.45,$874.57,$755.50,$755.50,$888.77,"$5,076.00",$202.33,$774.00,"$4,020.19","$4,060.80",$281.11,$794.39,$185.49,$808.10,$192.70
35200048,EAP,CPT® 74170,,ABDOMEN CT W&WO DYE BCT,"$5,911.00",$192.70,"$5,911.00","$1,273.65",$755.50,$193.45,$408.96,$755.50,$755.50,"$1,034.97","$5,911.00",$202.33,$923.00,"$4,681.51","$4,728.80",$281.11,$925.07,$211.06,$941.03,$192.70
35200049,EAP,CPT® 74175,,ABDOMEN CTA W&WO DYE BCT,"$6,406.00",$192.70,"$6,406.00","$1,273.65",$755.50,$193.45,"$1,103.72",$755.50,$755.50,"$1,121.64","$6,406.00",$202.33,"$1,048.00","$5,073.55","$5,124.80",$281.11,"$1,002.54",$235.19,"$1,019.84",$192.70
35200058,EAP,CPT® 75635,,Abd Aorta&illiofemor Cta Bct,"$6,159.00",$192.70,"$6,159.00","$1,273.65",$755.50,$193.45,"$1,061.16",$755.50,$755.50,"$1,078.39","$6,159.00",$202.33,"$1,048.00","$4,877.93","$4,927.20",$281.11,$963.88,$329.20,$980.51,$192.70
35200059,EAP,CPT® 76380,,FOLLOW UP STUDY CT LIMITED BCT,"$1,494.00",$0.00,"$1,494.00","$1,273.65",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,494.00",$0.00,$358.56,"$1,183.25","$1,195.20",$0.00,$0.00,$0.00,$0.00,$0.00
35200060,EAP,CPT® 74174,,"Cta, Abdomen And Pelvis, W Dye","$7,836.00",$298.94,"$7,836.00","$1,273.65",$755.50,$370.02,"$1,350.10",$755.50,$755.50,"$1,372.02","$7,836.00",$387.01,"$1,880.64","$6,206.11","$6,268.80",$537.70,"$1,226.33",$298.94,"$1,247.49",$368.58
35200063,EAP,HCPCS G0297,,Low Dose Ct Scan For Lung,$627.00,$76.23,$627.00,$627.00,$627.00,$76.53,$108.03,$627.00,$627.00,$109.78,$627.00,$80.04,$313.50,$496.58,$501.60,$111.21,$98.13,$189.09,$99.82,$76.23
36000003,EAP,CPT® 58611,,Ligate Oviduct(s) Add-on,$475.00,$0.00,$475.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$475.00,$0.00,$475.00,$376.20,$380.00,$0.00,$0.00,$0.00,$0.00,$0.00
36000027,EAP,CPT® 19499,,Breast Surgery Procedure Cbc,"$6,124.00",$0.00,"$6,124.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,124.00",$0.00,"$2,255.00","$4,850.21","$4,899.20",$0.00,$0.00,$0.00,$0.00,$0.00
36000028,EAP,Custom 36000028,,L&d Level 1 1st 30 Min,"$1,632.00",$0.00,"$1,470.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,470.00",$0.00,$735.00,"$1,164.24","$1,176.00",$0.00,$0.00,$0.00,$0.00,$0.00
36000029,EAP,Custom 36000029,,L&d Level 2 1st 30 Min,"$1,983.00",$0.00,"$1,786.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,786.00",$0.00,$893.00,"$1,414.51","$1,428.80",$0.00,$0.00,$0.00,$0.00,$0.00
36000038,EAP,Custom 36000038,,L&d Level 3 1st 30 Min,"$2,216.00",$0.00,"$1,996.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,996.00",$0.00,$998.00,"$1,580.83","$1,596.80",$0.00,$0.00,$0.00,$0.00,$0.00
36000039,EAP,Custom 36000039,,L&d Level 4 1st 30 Min,"$2,449.00",$0.00,"$2,206.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,206.00",$0.00,"$1,103.00","$1,747.15","$1,764.80",$0.00,$0.00,$0.00,$0.00,$0.00
36000040,EAP,Custom 36000040,,L&d Level 5 1st 30 Min,"$2,682.00",$0.00,"$2,416.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,416.00",$0.00,"$1,208.00","$1,913.47","$1,932.80",$0.00,$0.00,$0.00,$0.00,$0.00
36000042,EAP,Custom 36000042,,L&d Level 6 1st 30 Min,"$2,915.00",$0.00,"$2,626.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,626.00",$0.00,"$1,313.00","$2,079.79","$2,100.80",$0.00,$0.00,$0.00,$0.00,$0.00
36000043,EAP,Custom 36000043,,L&d Level 1 Add 15 Min,$735.00,$0.00,$662.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$662.00,$0.00,$331.00,$524.30,$529.60,$0.00,$0.00,$0.00,$0.00,$0.00
36000044,EAP,Custom 36000044,,L&d Level 2 Add 15 Min,$893.00,$0.00,$804.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$804.00,$0.00,$402.00,$636.77,$643.20,$0.00,$0.00,$0.00,$0.00,$0.00
36000045,EAP,Custom 36000045,,L&d Level 3 Add 15 Min,$996.00,$0.00,$897.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$897.00,$0.00,$448.50,$710.42,$717.60,$0.00,$0.00,$0.00,$0.00,$0.00
36000046,EAP,Custom 36000046,,L&d Level 4 Add 15 Min,"$1,101.00",$0.00,$992.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$992.00,$0.00,$496.00,$785.66,$793.60,$0.00,$0.00,$0.00,$0.00,$0.00
36000047,EAP,Custom 36000047,,L&d Level 5 Add 15 Min,"$1,088.00",$0.00,"$1,088.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,088.00",$0.00,$544.00,$861.70,$870.40,$0.00,$0.00,$0.00,$0.00,$0.00
36000048,EAP,Custom 36000048,,L&d Level 6 Add 15 Min,"$1,311.00",$0.00,"$1,181.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,181.00",$0.00,$590.50,$935.35,$944.80,$0.00,$0.00,$0.00,$0.00,$0.00
36000110,EAP,Custom 36000110,,Perfusionist,"$3,589.00",$0.00,"$3,589.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,589.00",$0.00,"$1,794.50","$2,842.49","$2,871.20",$0.00,$0.00,$0.00,$0.00,$0.00
36000116,EAP,CPT® 36680,,Placement Of A Needle For Intraosseous Infusion,$643.00,$0.00,$582.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$582.00,$0.00,$582.00,$460.94,$465.60,$0.00,$0.00,$0.00,$0.00,$0.00
36000117,EAP,Custom 36000117,,Level 1 1st 30 Min,"$10,164.00",$0.00,"$9,157.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$9,157.00",$0.00,"$4,578.50","$7,252.34","$7,325.60",$0.00,$0.00,$0.00,$0.00,$0.00
36000118,EAP,Custom 36000118,,Level 2 1st 30 Min,"$12,343.00",$0.00,"$11,120.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$11,120.00",$0.00,"$5,560.00","$8,807.04","$8,896.00",$0.00,$0.00,$0.00,$0.00,$0.00
36000119,EAP,Custom 36000119,,Level 3 1st 30 Min,"$13,795.00",$0.00,"$12,428.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$12,428.00",$0.00,"$6,214.00","$9,842.98","$9,942.40",$0.00,$0.00,$0.00,$0.00,$0.00
36000120,EAP,Custom 36000120,,Level 4 1st 30 Min,"$15,249.00",$0.00,"$13,738.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$13,738.00",$0.00,"$6,869.00","$10,880.50","$10,990.40",$0.00,$0.00,$0.00,$0.00,$0.00
36000121,EAP,Custom 36000121,,Level 5 1st 30 Min,"$16,698.00",$0.00,"$15,043.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$15,043.00",$0.00,"$7,521.50","$11,914.06","$12,034.40",$0.00,$0.00,$0.00,$0.00,$0.00
36000122,EAP,Custom 36000122,,Level 6 1st 30 Min,"$18,151.00",$0.00,"$16,352.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$16,352.00",$0.00,"$8,176.00","$12,950.78","$13,081.60",$0.00,$0.00,$0.00,$0.00,$0.00
36000123,EAP,Custom 36000123,,Level 1 Add 15 Min,"$4,575.00",$0.00,"$4,122.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,122.00",$0.00,"$2,061.00","$3,264.62","$3,297.60",$0.00,$0.00,$0.00,$0.00,$0.00
36000124,EAP,Custom 36000124,,Level 2 Add 15 Min,"$5,558.00",$0.00,"$5,007.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,007.00",$0.00,"$2,503.50","$3,965.54","$4,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
36000125,EAP,Custom 36000125,,Level 3 Add 15 Min,"$6,212.00",$0.00,"$5,596.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,596.00",$0.00,"$2,798.00","$4,432.03","$4,476.80",$0.00,$0.00,$0.00,$0.00,$0.00
36000126,EAP,Custom 36000126,,Level 4 Add 15 Min,"$6,862.00",$0.00,"$6,182.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,182.00",$0.00,"$3,091.00","$4,896.14","$4,945.60",$0.00,$0.00,$0.00,$0.00,$0.00
36000127,EAP,Custom 36000127,,Level 5 Add 15 Min,"$7,354.00",$0.00,"$6,625.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,625.00",$0.00,"$3,312.50","$5,247.00","$5,300.00",$0.00,$0.00,$0.00,$0.00,$0.00
36000128,EAP,Custom 36000128,,Level 6 Add 15 Min,"$8,170.00",$0.00,"$7,360.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$7,360.00",$0.00,"$3,680.00","$5,829.12","$5,888.00",$0.00,$0.00,$0.00,$0.00,$0.00
36100001,EAP,CPT® 10021,,Fna Bx W/o Img Gdn 1st Les,"$1,317.00",$0.00,"$1,317.00","$1,317.00",$0.00,$306.38,$226.91,$0.00,$0.00,$230.60,"$1,317.00",$320.45,"$1,317.00","$1,043.06","$1,053.60",$445.22,$93.38,$57.69,$209.67,$305.19
36100002,EAP,CPT® 69100,,Biopsy Of External Ear,"$2,074.00",$0.00,"$2,074.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,074.00",$0.00,"$2,074.00","$1,642.61","$1,659.20",$0.00,$0.00,$0.00,$0.00,$0.00
36100003,EAP,CPT® 22510,,Percut Vertebroplasty Thor,"$7,794.00",$0.00,"$7,794.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$7,794.00",$0.00,"$6,105.00","$6,172.85","$6,235.20",$0.00,$0.00,$0.00,$0.00,$0.00
36100005,EAP,CPT® 22511,,Percut Vertebroplasty Lumb,"$7,794.00",$0.00,"$7,794.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$7,794.00",$0.00,"$6,105.00","$6,172.85","$6,235.20",$0.00,$0.00,$0.00,$0.00,$0.00
36100006,EAP,CPT® 22512,,Percut Vertebroplasty Add'l,"$7,794.00",$0.00,"$7,794.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$7,794.00",$0.00,"$6,105.00","$6,172.85","$6,235.20",$0.00,$0.00,$0.00,$0.00,$0.00
36100007,EAP,CPT® 22513,,"Percut Kyphoplasty, Thor","$21,747.00",$0.00,"$21,747.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$21,747.00",$0.00,"$6,105.00","$17,223.62","$17,397.60",$0.00,$0.00,$0.00,$0.00,$0.00
36100008,EAP,CPT® 10040,,Acne Surgery,$562.00,$0.00,$562.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$562.00,$0.00,$562.00,$445.10,$449.60,$0.00,$0.00,$0.00,$0.00,$0.00
36100009,EAP,CPT® 10060,,Drainage Abscess Simple/single,"$1,320.00",$74.65,"$1,320.00","$1,320.00","$1,208.73",$167.55,$227.43,"$1,208.73","$1,208.73",$231.12,"$1,320.00",$175.24,"$1,320.00","$1,045.44","$1,056.00",$243.48,$74.65,$103.45,$210.14,$166.90
36100010,EAP,CPT® 99291,,Hypothermia (critical Care) 1st 30-74 Min,"$4,850.00",$182.90,"$4,315.00","$4,315.00","$3,136.01",$639.26,$743.45,"$3,136.01","$3,079.62",$755.52,"$4,315.00",$668.62,"$2,157.50","$3,417.48","$3,452.00",$928.96,$182.90,$226.49,$686.95,$636.78
36100012,EAP,CPT® 99292,,Hypothermia (critical Care) Addl 30 Min,"$1,325.00",$0.00,"$1,185.00","$1,185.00","$1,185.00",$0.00,$0.00,"$1,185.00",$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$113.96,$188.65,$0.00
36100013,EAP,CPT® 22514,,"Percut Kyphoplasty, Lumb","$21,747.00",$0.00,"$21,747.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$21,747.00",$0.00,"$6,105.00","$17,223.62","$17,397.60",$0.00,$0.00,$0.00,$0.00,$0.00
36100014,EAP,CPT® 22515,,"Percut Kyphoplasty, Add-on","$21,747.00",$0.00,"$21,747.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$21,747.00",$0.00,"$10,873.50","$17,223.62","$17,397.60",$0.00,$0.00,$0.00,$0.00,$0.00
36100016,EAP,CPT® 62302,,Myelography Via Lumbar Injection;cervical;including S&i,$764.00,$0.00,$764.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$764.00,$0.00,$382.00,$605.09,$611.20,$0.00,$0.00,$0.00,$0.00,$0.00
36100017,EAP,CPT® 62303,,Myelography Via Lumbar Injection;thoracic;including S&i,$764.00,$0.00,$764.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$764.00,$0.00,$382.00,$605.09,$611.20,$0.00,$0.00,$0.00,$0.00,$0.00
36100018,EAP,CPT® 62304,,Myelography Via Lumbar Injection;lumbosacral;including S&i,"$1,643.00",$0.00,"$1,643.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,643.00",$0.00,$821.50,"$1,301.26","$1,314.40",$0.00,$0.00,$0.00,$0.00,$0.00
36100019,EAP,CPT® 62305,,Myelography Via Lumbar Injection' 2or More Regions;including S&i,"$3,720.00",$0.00,"$3,720.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,720.00",$0.00,"$1,860.00","$2,946.24","$2,976.00",$0.00,$0.00,$0.00,$0.00,$0.00
36100020,EAP,CPT® 10061,,Drainage Abscess Complex/multiple,"$1,380.00",$0.00,"$1,380.00","$1,380.00","$1,208.73",$306.38,$0.00,"$1,208.73","$1,208.73",$0.00,"$1,380.00",$320.45,"$1,380.00","$1,092.96","$1,104.00",$445.22,$0.00,$187.80,$219.70,$305.19
36100022,EAP,CPT® 20604,,Drain /inject-finger/toe With Us Guidance,$936.00,$0.00,$936.00,$936.00,$0.00,$251.01,$161.27,$0.00,$0.00,$163.89,$936.00,$262.54,$936.00,$741.31,$748.80,$364.76,$69.40,$47.60,$149.01,$250.04
36100023,EAP,CPT® 20606,,Drain/inject-wrist Elbow Ankle With Us Guidance,$936.00,$0.00,$936.00,$936.00,$0.00,$599.36,$161.27,$0.00,$0.00,$163.89,$936.00,$626.89,$936.00,$741.31,$748.80,$870.98,$76.82,$54.81,$149.01,$597.04
36100024,EAP,CPT® 20611,,Drain/inject-shoulder Hip Knee With Us Guidance,"$2,200.00",$62.38,"$2,200.00","$2,106.30","$1,570.14",$251.01,$379.05,"$1,570.14","$1,570.14",$385.20,"$2,200.00",$262.54,"$2,200.00","$1,742.40","$1,760.00",$364.76,$88.61,$62.38,$350.24,$250.04
36100025,EAP,CPT® 20983,,Ablation Therapy Bone Tumor(s) Perq,"$6,299.00",$0.00,"$6,299.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,299.00",$0.00,"$5,452.00","$4,988.81","$5,039.20",$0.00,$0.00,$0.00,$0.00,$0.00
36100026,EAP,CPT® 64566,,Percutaneous Tibial Nerve Stimulation,$617.00,$0.00,$617.00,$617.00,$0.00,$251.01,$106.31,$0.00,$0.00,$108.03,$617.00,$262.54,$617.00,$488.66,$493.60,$364.76,$122.82,$32.45,$98.23,$250.04
36100027,EAP,CPT® 46607,,Anoscopy Hra W/biopsy,"$3,335.00",$0.00,"$3,335.00","$2,106.30","$2,380.19",$962.95,$0.00,"$2,380.19","$2,380.19",$583.93,"$3,335.00","$1,007.17","$2,255.00","$2,641.32","$2,668.00","$1,399.33",$0.00,$131.60,$530.93,$959.21
36100028,EAP,CPT® 10080,,Drainage Of Pilonidal Cyst,$705.00,$0.00,$705.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$705.00,$0.00,$705.00,$558.36,$564.00,$0.00,$0.00,$0.00,$0.00,$0.00
36100030,EAP,CPT® 10120,,Remove Foreign Body Sq Simple,$760.00,$0.00,$760.00,$0.00,$0.00,$0.00,$130.94,$0.00,$0.00,$0.00,$760.00,$0.00,$760.00,$601.92,$608.00,$0.00,$85.66,$0.00,$0.00,$0.00
36100034,EAP,CPT® 10121,,"Removal Of Fb, Sc Tissue Compl","$7,095.00",$0.00,"$7,095.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$7,095.00",$0.00,"$2,327.00","$5,619.24","$5,676.00",$0.00,$0.00,$0.00,$0.00,$0.00
36100035,EAP,CPT® 10140,,Drainage Of Hematoma/fluid,"$6,448.00",$0.00,"$6,448.00",$0.00,$0.00,$0.00,"$1,110.96",$0.00,$0.00,$0.00,"$6,448.00",$0.00,"$2,255.00","$5,106.82","$5,158.40",$0.00,$89.99,$0.00,$0.00,$0.00
36100036,EAP,CPT® 52204,,Cystoscopy W/diopsy (s),"$13,103.00",$0.00,"$13,103.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$13,103.00",$0.00,"$2,327.00","$10,377.58","$10,482.40",$0.00,$0.00,$0.00,$0.00,$0.00
36100037,EAP,CPT® 52354,,Cystouretero W/diopsy,"$6,074.00",$0.00,"$6,074.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,074.00",$0.00,"$3,606.00","$4,810.61","$4,859.20",$0.00,$0.00,$0.00,$0.00,$0.00
36100041,EAP,CPT® 10160,,Aspiration Abscess Hematoma Bulla/cyst,$638.00,$0.00,$638.00,$638.00,$0.00,$306.38,$109.92,$0.00,$0.00,$111.71,$638.00,$320.45,$638.00,$505.30,$510.40,$445.22,$78.53,$97.69,$101.57,$305.19
36100042,EAP,CPT® 31600,,"Tracheostomy, Planned","$4,879.00",$0.00,"$4,879.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,879.00",$0.00,"$2,327.00","$3,864.17","$3,903.20",$0.00,$0.00,$0.00,$0.00,$0.00
36100044,EAP,CPT® 36473,,Endoven Abltj Incmptnt Vein Mchnchem 1st Vein,"$8,793.00",$186.78,"$7,034.00","$2,706.90","$5,020.17","$2,657.38","$1,211.92","$5,020.17","$5,020.17","$1,231.60","$7,034.00","$2,779.42","$2,858.00","$5,570.93","$5,627.20","$3,861.64","$1,443.33",$186.78,"$1,119.81","$2,647.07"
36100045,EAP,CPT® 36474,,Endoven Abltj Incmptnt Vein Mchn Sbsq Veins-add On,"$2,199.00",$0.00,"$1,759.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,759.00",$0.00,$879.50,"$1,393.13","$1,407.20",$0.00,$0.00,$0.00,$0.00,$0.00
36100046,EAP,CPT® 64611,,Chemodenerv Parotid/subm Salivary Glands Bilateral,$472.00,$0.00,$472.00,$472.00,$0.00,$251.01,$81.32,$0.00,$0.00,$82.64,$472.00,$262.54,$472.00,$373.82,$377.60,$364.76,$94.40,$108.82,$75.14,$250.04
36100049,EAP,CPT® 10180,,I&d Complex Post Op Wound Inf,"$6,199.00",$0.00,"$6,199.00",$0.00,$0.00,$0.00,"$1,068.06",$0.00,$0.00,"$1,085.40","$6,199.00",$0.00,"$2,327.00","$4,909.61","$4,959.20",$0.00,$130.53,$0.00,$0.00,$0.00
36100050,EAP,CPT® 52315,,Cystoscopy And Treatment,"$8,143.00",$285.23,"$8,143.00","$2,496.90","$5,811.66","$1,698.74","$1,403.00","$5,811.66","$5,416.74","$1,425.77","$8,143.00","$1,776.76","$2,327.00","$6,449.26","$6,514.40","$2,468.57",$535.80,$285.23,"$1,296.37","$1,692.15"
36100051,EAP,CPT® 11000,,Debridement Of Skin,"$2,938.00",$0.00,"$2,938.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,938.00",$0.00,"$2,255.00","$2,326.90","$2,350.40",$0.00,$0.00,$0.00,$0.00,$0.00
36100057,EAP,CPT® 11001,,"Debride, Each Add 10% Of Body","$1,671.00",$0.00,"$1,671.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,671.00",$0.00,"$1,671.00","$1,323.43","$1,336.80",$0.00,$0.00,$0.00,$0.00,$0.00
36100058,EAP,CPT® 97597,,Debridement First 20 Sq Cm Or Less,$674.00,$0.00,$674.00,$674.00,$0.00,$167.55,$116.13,$0.00,$0.00,$118.01,$674.00,$175.24,$674.00,$533.81,$539.20,$243.48,$48.15,$37.87,$107.30,$166.90
36100060,EAP,CPT® 49418,,Insertion Of Tunneled Intraperitoneal Catheter,"$8,234.00",$0.00,"$8,234.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$8,234.00",$0.00,"$2,858.00","$6,521.33","$6,587.20",$0.00,$0.00,$0.00,$0.00,$0.00
36100061,EAP,CPT® 97598,,Debridement Open Wound Ea Addl 20 Sq Cm,$561.00,$0.00,$561.00,$561.00,$0.00,$0.00,$96.66,$0.00,$0.00,$98.23,$561.00,$0.00,$280.50,$444.31,$448.80,$0.00,$61.13,$26.68,$89.31,$0.00
36100063,EAP,CPT® 11042,,"Debridement Skin,and Subcutane","$2,065.00",$63.09,"$2,065.00","$2,065.00","$1,482.64",$306.38,$355.79,"$1,482.64","$1,482.64",$361.56,"$2,065.00",$320.45,"$2,065.00","$1,635.48","$1,652.00",$445.22,$70.00,$63.09,$328.75,$305.19
36100065,EAP,CPT® 11043,,Debridement Skin/sq/muscle,"$4,133.00",$161.16,"$4,133.00","$2,496.90","$2,949.72",$476.59,$712.10,"$2,949.72","$2,949.72",$723.66,"$4,133.00",$498.48,"$2,327.00","$3,273.34","$3,306.40",$692.57,$168.42,$161.16,$657.97,$474.74
36100067,EAP,CPT® 11044,,"Debridement, Bone","$5,080.00",$0.00,"$5,080.00","$2,496.90","$3,625.60","$1,316.19",$0.00,"$3,625.60","$3,625.60",$889.47,"$5,080.00","$1,376.63","$2,327.00","$4,023.36","$4,064.00","$1,912.65",$0.00,$236.52,$808.74,"$1,311.08"
36100070,EAP,CPT® 11055,,"Pare Wart/callus/hyperkaratotic Lesion, Single",$365.00,$0.00,$365.00,$365.00,$0.00,$167.55,$62.89,$0.00,$0.00,$63.91,$365.00,$175.24,$365.00,$289.08,$292.00,$243.48,$21.20,$16.59,$58.11,$166.90
36100073,EAP,CPT® 11056,,"Pare Wart/callus, 2-4 Lesions",$365.00,$0.00,$365.00,$365.00,$0.00,$167.55,$62.89,$0.00,$0.00,$63.91,$365.00,$175.24,$365.00,$289.08,$292.00,$243.48,$28.23,$24.16,$58.11,$166.90
36100074,EAP,CPT® 11057,,"Pare Wart/callus, >4 Lesions",$926.00,$0.00,$926.00,$926.00,$0.00,$167.55,$159.55,$0.00,$0.00,$162.14,$926.00,$175.24,$926.00,$733.39,$740.80,$243.48,$31.34,$30.66,$147.42,$166.90
36100078,EAP,CPT® 11200,,Removal Of Skin Tags (1-15),$711.00,$55.43,$711.00,$711.00,$711.00,$167.55,$122.50,$711.00,$711.00,$124.49,$711.00,$175.24,$711.00,$563.11,$568.80,$243.48,$55.43,$75.69,$113.19,$166.90
36100081,EAP,CPT® 11201,,Removal Of Skin Tags;ea Add 10,"$1,015.00",$0.00,"$1,015.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,015.00",$0.00,"$1,015.00",$803.88,$812.00,$0.00,$0.00,$0.00,$0.00,$0.00
36100082,EAP,CPT® 11300,,Shave Les Trunk Arm Leg <0.5cm,$365.00,$0.00,$365.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$365.00,$0.00,$365.00,$289.08,$292.00,$0.00,$0.00,$0.00,$0.00,$0.00
36100083,EAP,CPT® 11301,,Shave Trunk Arm Leg 0.6-1.0cm,$365.00,$0.00,$365.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$365.00,$0.00,$365.00,$289.08,$292.00,$0.00,$0.00,$0.00,$0.00,$0.00
36100084,EAP,CPT® 11302,,Shave Trunk Arm Leg 1.1-2.0cm,$752.00,$0.00,$752.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$752.00,$0.00,$752.00,$595.58,$601.60,$0.00,$0.00,$0.00,$0.00,$0.00
36100085,EAP,CPT® 11303,,Shave Trunk Arm Leg >2.0cm,"$1,135.00",$0.00,"$1,135.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,135.00",$0.00,"$1,135.00",$898.92,$908.00,$0.00,$0.00,$0.00,$0.00,$0.00
36100086,EAP,CPT® 11305,,Shave Skin Lesion 0.5 Cm/<,$752.00,$0.00,$752.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$752.00,$0.00,$752.00,$595.58,$601.60,$0.00,$0.00,$0.00,$0.00,$0.00
36100088,EAP,CPT® 11306,,Shave Scalp/neck/hnd/ft 0.6-1.,$752.00,$0.00,$752.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$752.00,$0.00,$752.00,$595.58,$601.60,$0.00,$0.00,$0.00,$0.00,$0.00
36100089,EAP,CPT® 11307,,Shave Scalp/neck/hnd/ft 1.1-2.,$670.00,$0.00,$670.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$670.00,$0.00,$670.00,$530.64,$536.00,$0.00,$0.00,$0.00,$0.00,$0.00
36100090,EAP,CPT® 11308,,Shave Scalp/neck/hnd/feet >2.0,$720.00,$0.00,$720.00,$390.96,$0.00,$306.38,$124.05,$0.00,$0.00,$126.07,$720.00,$320.45,$720.00,$570.24,$576.00,$445.22,$100.61,$76.09,$114.62,$305.19
36100091,EAP,CPT® 11310,,Shaving Fac Ear Nos Lip <.5cm,$720.00,$0.00,$720.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$720.00,$0.00,$720.00,$570.24,$576.00,$0.00,$0.00,$0.00,$0.00,$0.00
36100092,EAP,CPT® 27570,,Manipulation Knee Joint Under General Anes,"$4,221.00",$0.00,"$4,221.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,221.00",$0.00,"$2,255.00","$3,343.03","$3,376.80",$0.00,$0.00,$0.00,$0.00,$0.00
36100094,EAP,CPT® 11311,,Shav Fac/ear/eye/nos/lip 0.6-1,$752.00,$0.00,$752.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$752.00,$0.00,$752.00,$595.58,$601.60,$0.00,$0.00,$0.00,$0.00,$0.00
36100096,EAP,CPT® 11312,,Shav Fac/ear/eye/nos/lip 1.1-2,$752.00,$0.00,$752.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$752.00,$0.00,$752.00,$595.58,$601.60,$0.00,$0.00,$0.00,$0.00,$0.00
36100098,EAP,CPT® 11313,,Shav Face/ear/eye/nose/lip >2.,"$1,483.00",$0.00,"$1,483.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,483.00",$0.00,"$1,483.00","$1,174.54","$1,186.40",$0.00,$0.00,$0.00,$0.00,$0.00
36100099,EAP,CPT® 11400,,Exc Benign Lesion T/a/l  0.5 Cm/<,"$2,071.00",$0.00,"$2,071.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,071.00",$0.00,"$2,071.00","$1,640.23","$1,656.80",$0.00,$0.00,$0.00,$0.00,$0.00
36100100,EAP,CPT® 64999,,Quadratus Lumborum-anes,"$4,438.00",$0.00,"$4,438.00","$2,106.30","$3,167.40",$251.01,$764.65,"$3,167.40","$3,167.40",$777.06,"$4,438.00",$262.54,"$2,255.00","$3,514.90","$3,550.40",$364.76,$694.55,$0.00,$706.53,$250.04
36100101,EAP,CPT® 11401,,Exc Benign Lesion  T/a/l 0.6-1.0 Cm,"$2,324.00",$0.00,"$2,324.00",$0.00,$0.00,$0.00,$400.41,$0.00,$0.00,$0.00,"$2,324.00",$0.00,"$2,255.00","$1,840.61","$1,859.20",$0.00,$105.27,$0.00,$0.00,$0.00
36100103,EAP,CPT® 11402,,Exc Benign Lesion  T/a/l 1.1-2.0 Cm,"$2,324.00",$117.87,"$2,324.00","$2,106.30","$1,658.64",$584.94,$400.41,"$1,658.64","$1,658.64",$406.91,"$2,324.00",$611.80,"$2,255.00","$1,840.61","$1,859.20",$850.02,$121.81,$117.87,$369.98,$582.67
36100105,EAP,CPT® 11403,,Exc Benign Lesion  T/a/l 2.1-3.0 Cm,"$6,022.00",$142.90,"$6,022.00","$2,106.30","$4,297.90",$584.94,"$1,037.56","$4,297.90","$4,297.90","$1,054.40","$6,022.00",$611.80,"$2,255.00","$4,769.42","$4,817.60",$850.02,$142.90,$152.47,$958.70,$582.67
36100107,EAP,CPT® 11404,,Exc Benign Lesion T/a/l 3.1-4.0 Cm,"$10,492.00",$0.00,"$10,492.00","$2,106.30","$7,488.14","$1,316.19",$0.00,"$7,488.14","$5,416.74",$0.00,"$10,492.00","$1,376.63","$2,255.00","$8,309.66","$8,393.60","$1,912.65",$0.00,$167.97,"$1,670.33","$1,311.08"
36100109,EAP,CPT® 11406,,"Exc, Benign,>4.0 Cm, T/a/l","$11,757.00",$197.38,"$11,757.00","$2,496.90","$8,390.97","$1,316.19","$2,025.67","$8,390.97","$5,416.74","$2,058.56","$11,757.00","$1,376.63","$2,327.00","$9,311.54","$9,405.60","$1,912.65",$197.38,$255.57,"$1,871.71","$1,311.08"
36100110,EAP,CPT® 64505,,N Block Spenopalatine Gangl,"$2,571.00",$0.00,"$2,571.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,571.00",$0.00,"$2,255.00","$2,036.23","$2,056.80",$0.00,$0.00,$0.00,$0.00,$0.00
36100111,EAP,CPT® 11420,,Exc Benign Scalp Genit Hand Ft,"$6,022.00",$0.00,"$6,022.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,022.00",$0.00,"$2,255.00","$4,769.42","$4,817.60",$0.00,$0.00,$0.00,$0.00,$0.00
36100112,EAP,CPT® 30140,,Resect Inferior Turbinate Submucous Bilateral,"$5,043.00",$0.00,"$5,043.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,043.00",$0.00,"$2,327.00","$3,994.06","$4,034.40",$0.00,$0.00,$0.00,$0.00,$0.00
36100115,EAP,CPT® 11421,,Exc Benign Scalp Genit Hnd Ft,"$6,022.00",$111.86,"$6,022.00","$2,496.90","$4,297.90",$584.94,"$1,037.56","$4,297.90","$4,297.90","$1,054.40","$6,022.00",$611.80,"$2,255.00","$4,769.42","$4,817.60",$850.02,$111.86,$112.83,$958.70,$582.67
36100118,EAP,CPT® 11422,,Exc Ben Scal Gent Hd Ft Neck,"$5,534.00",$127.73,"$5,534.00","$2,106.30","$3,949.62","$1,316.19",$953.48,"$3,949.62","$3,949.62",$968.96,"$5,534.00","$1,376.63","$2,255.00","$4,382.93","$4,427.20","$1,912.65",$127.73,$139.85,$881.01,"$1,311.08"
36100120,EAP,CPT® 11423,,Exc Beng Scp Gent Hd Ft Nk,"$6,022.00",$0.00,"$6,022.00",$0.00,$0.00,$0.00,"$1,037.56",$0.00,$0.00,$0.00,"$6,022.00",$0.00,"$2,255.00","$4,769.42","$4,817.60",$0.00,$156.22,$0.00,$0.00,$0.00
36100121,EAP,CPT® 31295,,Sinus Endo W/balloon Dil,"$6,390.00",$0.00,"$6,390.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,390.00",$0.00,"$3,902.00","$5,060.88","$5,112.00",$0.00,$0.00,$0.00,$0.00,$0.00
36100122,EAP,CPT® 11424,,"Exc Beng Sc, Genit Hd Ft Neck","$4,845.00",$0.00,"$4,845.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,845.00",$0.00,"$2,327.00","$3,837.24","$3,876.00",$0.00,$0.00,$0.00,$0.00,$0.00
36100123,EAP,CPT® 31513,,Injection Into Vocal Cord,"$6,511.00",$0.00,"$6,511.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,511.00",$0.00,"$2,327.00","$5,156.71","$5,208.80",$0.00,$0.00,$0.00,$0.00,$0.00
36100124,EAP,CPT® 11426,,"Exc,benign,>4.0 Cm,sclp/h/f","$6,400.00",$0.00,"$6,400.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,400.00",$0.00,"$2,327.00","$5,068.80","$5,120.00",$0.00,$0.00,$0.00,$0.00,$0.00
36100126,EAP,CPT® 11440,,Exc Benign Face Ear Nose Muc,"$1,774.00",$101.18,"$1,774.00","$1,774.00","$1,266.10",$584.94,$305.65,"$1,266.10","$1,266.10",$310.61,"$1,774.00",$611.80,"$1,774.00","$1,405.01","$1,419.20",$850.02,$101.18,$105.96,$282.42,$582.67
36100130,EAP,CPT® 11441,,Exc Benign Face Ear Nose Muc,"$3,289.00",$0.00,"$3,289.00","$2,496.90","$2,347.36",$584.94,$0.00,"$2,347.36","$2,347.36",$0.00,"$3,289.00",$611.80,"$2,255.00","$2,604.89","$2,631.20",$850.02,$0.00,$134.44,$523.61,$582.67
36100132,EAP,CPT® 11442,,"Exc, Beng Fc, Er,nos,muc 1.1-2","$3,242.00",$139.44,"$3,242.00","$2,106.30","$2,313.82",$584.94,$558.58,"$2,313.82","$2,313.82",$567.65,"$3,242.00",$611.80,"$2,255.00","$2,567.66","$2,593.60",$850.02,$139.44,$149.22,$516.13,$582.67
36100135,EAP,CPT® 11443,,Exc Benign Lesion  F/e/e/n/l/m 2.1-3.0cm,"$6,022.00",$177.41,"$6,022.00","$2,106.30","$4,297.90","$1,316.19","$1,037.56","$4,297.90","$4,297.90","$1,054.40","$6,022.00","$1,376.63","$2,255.00","$4,769.42","$4,817.60","$1,912.65",$177.41,$183.11,$958.70,"$1,311.08"
36100138,EAP,CPT® 11444,,Exc Benign Lesion  F/e/e/n/l/m 3.1-4.0cm,"$2,481.00",$0.00,"$2,481.00",$0.00,$0.00,$0.00,$427.46,$0.00,$0.00,$0.00,"$2,481.00",$0.00,"$2,255.00","$1,964.95","$1,984.80",$0.00,$220.76,$0.00,$0.00,$0.00
36100141,EAP,CPT® 11446,,"Exc Benign,>4.0 Cm,f/e/mem","$15,291.00",$0.00,"$15,291.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$15,291.00",$0.00,"$2,327.00","$12,110.47","$12,232.80",$0.00,$0.00,$0.00,$0.00,$0.00
36100142,EAP,CPT® 11601,,"Exc.malig,tr/a/l,0.6-1.0cm","$2,232.00",$0.00,"$2,232.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,232.00",$0.00,"$2,232.00","$1,767.74","$1,785.60",$0.00,$0.00,$0.00,$0.00,$0.00
36100143,EAP,CPT® 11602,,"Exc.malig,tr/a/l,1.1-2.0cm","$2,324.00",$0.00,"$2,324.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,324.00",$0.00,"$2,255.00","$1,840.61","$1,859.20",$0.00,$0.00,$0.00,$0.00,$0.00
36100144,EAP,CPT® 11603,,"Exc.malig Tr/a/l,2.1-3.0cm","$5,169.00",$0.00,"$5,169.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,169.00",$0.00,"$2,255.00","$4,093.85","$4,135.20",$0.00,$0.00,$0.00,$0.00,$0.00
36100145,EAP,CPT® 11604,,Exc Malign Tr Arm Leg 3.1-4.0,"$5,169.00",$0.00,"$5,169.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,169.00",$0.00,"$2,327.00","$4,093.85","$4,135.20",$0.00,$0.00,$0.00,$0.00,$0.00
36100146,EAP,CPT® 11606,,"Exc Malig>4.0 Cm,trnk/a/l","$10,492.00",$252.57,"$10,492.00","$2,496.90","$7,488.14","$1,316.19","$1,807.72","$7,488.14","$5,416.74","$1,837.07","$10,492.00","$1,376.63","$2,327.00","$8,309.66","$8,393.60","$1,912.65",$252.57,$329.86,"$1,670.33","$1,311.08"
36100147,EAP,CPT® 11621,,"Exc Malign Scap Gent Hd,ft Nk","$3,289.00",$0.00,"$3,289.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,289.00",$0.00,"$2,255.00","$2,604.89","$2,631.20",$0.00,$0.00,$0.00,$0.00,$0.00
36100148,EAP,CPT® 11622,,Exc Malignant Lesion  S/n/h/f/g 1.1-2.0 Cm,"$6,022.00",$0.00,"$6,022.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,022.00",$0.00,"$2,255.00","$4,769.42","$4,817.60",$0.00,$0.00,$0.00,$0.00,$0.00
36100150,EAP,CPT® 11623,,Exc Malignant Lesion  S/n/h/f/g 2.1-3.0 Cm,"$11,307.00",$0.00,"$11,307.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$11,307.00",$0.00,"$2,255.00","$8,955.14","$9,045.60",$0.00,$0.00,$0.00,$0.00,$0.00
36100152,EAP,CPT® 11624,,Exc Malign Scp Gent Hd Ft Nk,"$10,091.00",$0.00,"$10,091.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$10,091.00",$0.00,"$2,327.00","$7,992.07","$8,072.80",$0.00,$0.00,$0.00,$0.00,$0.00
36100153,EAP,CPT® 11626,,"Excis Malig,>4.0 Cm,scp/h/ft","$13,133.00",$0.00,"$13,133.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$13,133.00",$0.00,"$2,327.00","$10,401.34","$10,506.40",$0.00,$0.00,$0.00,$0.00,$0.00
36100154,EAP,CPT® 11640,,Exc Malignant Lesion  F/e/e/n/l 0.5 Cm/<,"$3,164.00",$0.00,"$3,164.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,164.00",$0.00,"$2,255.00","$2,505.89","$2,531.20",$0.00,$0.00,$0.00,$0.00,$0.00
36100156,EAP,CPT® 11641,,Exc Malignant Lesion  F/e/e/n/l 0.6-1.0 Cm,"$3,044.00",$0.00,"$3,044.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,044.00",$0.00,"$2,255.00","$2,410.85","$2,435.20",$0.00,$0.00,$0.00,$0.00,$0.00
36100159,EAP,CPT® 11642,,Exc Malignant Lesion  F/e/e/n/l 1.1-2.0 Cm,"$6,022.00",$0.00,"$6,022.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,022.00",$0.00,"$2,255.00","$4,769.42","$4,817.60",$0.00,$0.00,$0.00,$0.00,$0.00
36100161,EAP,CPT® 11643,,Exc Malign Fc Ear Nose Mus Mem,"$5,789.00",$0.00,"$5,789.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,789.00",$0.00,"$2,255.00","$4,584.89","$4,631.20",$0.00,$0.00,$0.00,$0.00,$0.00
36100162,EAP,CPT® 11644,,Exc Malign Fc Ear Nose Muc Mem,"$10,091.00",$0.00,"$10,091.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$10,091.00",$0.00,"$2,327.00","$7,992.07","$8,072.80",$0.00,$0.00,$0.00,$0.00,$0.00
36100163,EAP,CPT® 11646,,"Exc,malig,>4.0 Cm,f/e/mem","$13,656.00",$0.00,"$13,656.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$13,656.00",$0.00,"$2,327.00","$10,815.55","$10,924.80",$0.00,$0.00,$0.00,$0.00,$0.00
36100165,EAP,CPT® 11719,,Trim Of Nondystrophic Nail(s) Any,$288.00,$0.00,$288.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$288.00,$0.00,$288.00,$228.10,$230.40,$0.00,$0.00,$0.00,$0.00,$0.00
36100166,EAP,CPT® 11720,,Debridement Nail Any Method 1-5,$201.00,$0.00,$201.00,$201.00,$0.00,$52.75,$34.63,$0.00,$0.00,$35.19,$201.00,$55.17,$201.00,$159.19,$160.80,$76.65,$25.44,$15.15,$32.00,$52.54
36100169,EAP,CPT® 11721,,Debridement Nail Any Method 6/>,$201.00,$0.00,$201.00,$201.00,$0.00,$52.75,$34.63,$0.00,$0.00,$35.19,$201.00,$55.17,$201.00,$159.19,$160.80,$76.65,$39.87,$25.97,$32.00,$52.54
36100173,EAP,CPT® 11730,,Avulsion Nail Plate Partial/complete Simple 1st,$431.00,$56.62,$431.00,$431.00,$431.00,$167.55,$74.26,$431.00,$431.00,$75.46,$431.00,$175.24,$431.00,$341.35,$344.80,$243.48,$63.22,$56.62,$68.62,$166.90
36100176,EAP,CPT® 11732,,Avulsion Nail Plate Partial/complete Simple Ea Addl,$209.00,$0.00,$209.00,$209.00,$0.00,$0.00,$36.01,$0.00,$0.00,$36.59,$209.00,$0.00,$209.00,$165.53,$167.20,$0.00,$31.24,$18.03,$33.27,$0.00
36100178,EAP,CPT® 11740,,Evacuation Subungual Hematoma,$250.00,$0.00,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$250.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
36100180,EAP,CPT® 11750,,Excision Nail Matrix Permanent Removal,"$1,410.00",$0.00,"$1,410.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,410.00",$0.00,"$1,410.00","$1,116.72","$1,128.00",$0.00,$0.00,$0.00,$0.00,$0.00
36100183,EAP,CPT® 11765,,Wedge Excision Skin Nail Fold,$559.00,$52.25,$559.00,$559.00,$559.00,$306.38,$96.31,$559.00,$559.00,$97.88,$559.00,$320.45,$559.00,$442.73,$447.20,$445.22,$52.25,$95.17,$88.99,$305.19
36100186,EAP,CPT® 11900,,Intralesional Inj Up To 7 Les,$341.00,$0.00,$341.00,$341.00,$0.00,$167.55,$58.75,$0.00,$0.00,$59.71,$341.00,$175.24,$341.00,$270.07,$272.80,$243.48,$36.36,$31.37,$54.29,$166.90
36100188,EAP,CPT® 11901,,Injection Intralesional >7 Lesions,$279.00,$0.00,$279.00,$279.00,$0.00,$167.55,$48.07,$0.00,$0.00,$48.85,$279.00,$175.24,$279.00,$220.97,$223.20,$243.48,$51.85,$49.03,$44.42,$166.90
36100190,EAP,CPT® 11952,,Saline Injection < 10.0cc,$562.00,$0.00,$562.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$562.00,$0.00,$562.00,$445.10,$449.60,$0.00,$0.00,$0.00,$0.00,$0.00
36100191,EAP,CPT® 11954,,Saline Injection > 10.0cc,$562.00,$0.00,$562.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$562.00,$0.00,$562.00,$445.10,$449.60,$0.00,$0.00,$0.00,$0.00,$0.00
36100192,EAP,CPT® 11960,,Insert Tissue Expander(s),"$5,416.00",$0.00,"$5,416.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,416.00",$0.00,"$2,327.00","$4,289.47","$4,332.80",$0.00,$0.00,$0.00,$0.00,$0.00
36100193,EAP,CPT® 11981,,"Insert,implant Contraceptive",$285.00,$0.00,$285.00,$285.00,$0.00,$104.55,$49.10,$0.00,$0.00,$49.90,$285.00,$109.35,$285.00,$225.72,$228.00,$151.93,$112.89,$67.06,$45.37,$104.14
36100196,EAP,CPT® 12001,,"Lac Repair, S,n,h,f <2.5cm",$704.00,$46.87,$704.00,$704.00,$704.00,$167.55,$121.30,$704.00,$704.00,$123.26,$704.00,$175.24,$704.00,$557.57,$563.20,$243.48,$116.22,$46.87,$112.08,$166.90
36100197,EAP,CPT® 12001,,Lac Repr Sclp Nck Hnd Ft <2.6c,$704.00,$46.87,$704.00,$704.00,$704.00,$167.55,$121.30,$704.00,$704.00,$123.26,$704.00,$175.24,$704.00,$557.57,$563.20,$243.48,$116.22,$46.87,$112.08,$166.90
36100198,EAP,CPT® 12001,,Lac Repr Sclp Nck Hnd Ft<2.6cm,$704.00,$46.87,$704.00,$704.00,$704.00,$167.55,$121.30,$704.00,$704.00,$123.26,$704.00,$175.24,$704.00,$557.57,$563.20,$243.48,$116.22,$46.87,$112.08,$166.90
36100199,EAP,CPT® 12002,,"Lac Repair, S,n,h,f 2.6-7.5cm",$879.00,$62.38,$879.00,$477.30,$879.00,$167.55,$151.45,$879.00,$879.00,$153.91,$879.00,$175.24,$879.00,$696.17,$703.20,$243.48,$127.88,$62.38,$139.94,$166.90
36100200,EAP,CPT® 12002,,Lac Repr Fce Ear Lp 2.6-5.0,$879.00,$62.38,$879.00,$477.30,$879.00,$167.55,$151.45,$879.00,$879.00,$153.91,$879.00,$175.24,$879.00,$696.17,$703.20,$243.48,$127.88,$62.38,$139.94,$166.90
36100201,EAP,CPT® 12002,,Lac Repr Sclp Nck Hnd Ft 2.6-7,$879.00,$62.38,$879.00,$477.30,$879.00,$167.55,$151.45,$879.00,$879.00,$153.91,$879.00,$175.24,$879.00,$696.17,$703.20,$243.48,$127.88,$62.38,$139.94,$166.90
36100202,EAP,CPT® 12004,,Rep Sc/nk/ax/gen/tk 7.6-12.5,$970.00,$77.52,$970.00,$970.00,$970.00,$167.55,$167.13,$970.00,$970.00,$169.84,$970.00,$175.24,$970.00,$768.24,$776.00,$243.48,$152.49,$77.52,$154.42,$166.90
36100203,EAP,CPT® 12011,,Lac Repr Fce Ear Eye Lp <2.6cm,$729.00,$58.77,$729.00,$395.85,$729.00,$167.55,$125.60,$729.00,$729.00,$127.64,$729.00,$175.24,$729.00,$577.37,$583.20,$243.48,$123.67,$58.77,$116.06,$166.90
36100206,EAP,CPT® 20552,,Bilat Inject Trigger Point 1-2 Musc,$962.00,$0.00,$962.00,$962.00,$0.00,$251.01,$165.75,$0.00,$0.00,$168.44,$962.00,$262.54,$962.00,$761.90,$769.60,$364.76,$66.56,$40.02,$153.15,$250.04
36100207,EAP,CPT® 12013,,Lac Repr Fce Ear Eye Lp 2.6-5.,$894.00,$62.02,$894.00,$485.44,$894.00,$167.55,$154.03,$894.00,$894.00,$156.53,$894.00,$175.24,$894.00,$708.05,$715.20,$243.48,$140.24,$62.02,$142.32,$166.90
36100208,EAP,CPT® 16036,,Escharotomy Each Addl Incision,"$1,198.00",$0.00,"$1,198.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,198.00",$0.00,"$1,198.00",$948.82,$958.40,$0.00,$0.00,$0.00,$0.00,$0.00
36100209,EAP,CPT® 16035,,Escharotomy First Incision,$732.00,$0.00,$732.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$732.00,$0.00,$732.00,$579.74,$585.60,$0.00,$0.00,$0.00,$0.00,$0.00
36100211,EAP,CPT® 12014,,Rp Si Fa Ear Nos Lip 5.1cm-7.5,$970.00,$79.33,$970.00,$970.00,$970.00,$167.55,$167.13,$970.00,$970.00,$169.84,$970.00,$175.24,$970.00,$768.24,$776.00,$243.48,$166.21,$79.33,$154.42,$166.90
36100214,EAP,CPT® 12015,,Smpl Rpr Sprfsl Face 7.6-12.5c,$970.00,$0.00,$970.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$970.00,$0.00,$970.00,$768.24,$776.00,$0.00,$0.00,$0.00,$0.00,$0.00
36100215,EAP,CPT® 12016,,Smpl Rpr Sprfsl Face 12.6-20cm,$970.00,$0.00,$970.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$970.00,$0.00,$970.00,$768.24,$776.00,$0.00,$0.00,$0.00,$0.00,$0.00
36100216,EAP,CPT® 12017,,Smpl Rpr Sprfsl Face 20.1-30.0,"$1,580.00",$0.00,"$1,580.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,580.00",$0.00,"$1,580.00","$1,251.36","$1,264.00",$0.00,$0.00,$0.00,$0.00,$0.00
36100217,EAP,CPT® 12020,,Wound Dehiscence Simple Closur,"$2,778.00",$0.00,"$2,778.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,778.00",$0.00,"$2,255.00","$2,200.18","$2,222.40",$0.00,$0.00,$0.00,$0.00,$0.00
36100219,EAP,CPT® 12021,,Packing Of Wound Dehisience,"$3,676.00",$117.17,"$3,676.00","$2,106.30","$2,623.56",$306.38,$633.36,"$2,623.56","$2,623.56",$643.64,"$3,676.00",$320.45,"$2,255.00","$2,911.39","$2,940.80",$445.22,$117.17,$144.54,$585.22,$305.19
36100221,EAP,CPT® 12031,,Int Rep Sclp Trnk Extrm <2.5cm,$970.00,$0.00,$970.00,$970.00,$0.00,$306.38,$167.13,$0.00,$0.00,$169.84,$970.00,$320.45,$970.00,$768.24,$776.00,$445.22,$141.63,$157.16,$154.42,$305.19
36100222,EAP,CPT® 12032,,Int Rep Sclp Trk Ext 2.6-7.5cm,$970.00,$0.00,$970.00,$970.00,$0.00,$306.38,$167.13,$0.00,$0.00,$169.84,$970.00,$320.45,$970.00,$768.24,$776.00,$445.22,$161.36,$196.82,$154.42,$305.19
36100223,EAP,CPT® 12034,,Int Rep Sclp Trk Ext7.6-12.5cm,$465.00,$0.00,$465.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$465.00,$0.00,$465.00,$368.28,$372.00,$0.00,$0.00,$0.00,$0.00,$0.00
36100224,EAP,CPT® 12041,,Int Repr N-hf/genit <2.6cm,$970.00,$152.13,$970.00,$970.00,$970.00,$306.38,$167.13,$970.00,$970.00,$169.84,$970.00,$320.45,$970.00,$768.24,$776.00,$445.22,$157.82,$152.13,$154.42,$305.19
36100225,EAP,CPT® 12042,,Int Repr Nck Hnd Ft 2.6-7.5 Cm,$465.00,$0.00,$465.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$465.00,$0.00,$465.00,$368.28,$372.00,$0.00,$0.00,$0.00,$0.00,$0.00
36100226,EAP,CPT® 12044,,Int Repr Nck Hnd Ft 7.6-12.5cm,$948.00,$0.00,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$948.00,$0.00,$948.00,$750.82,$758.40,$0.00,$0.00,$0.00,$0.00,$0.00
36100227,EAP,CPT® 12051,,Int Repr Fce Ear Eye Lp<2.5cm,$970.00,$0.00,$970.00,$970.00,$0.00,$306.38,$0.00,$0.00,$0.00,$169.84,$970.00,$320.45,$970.00,$768.24,$776.00,$445.22,$0.00,$174.83,$154.42,$305.19
36100228,EAP,CPT® 12052,,Int Repr F/e/l/mm 2.6-5.0cm,$970.00,$0.00,$970.00,$970.00,$0.00,$306.38,$167.13,$0.00,$0.00,$169.84,$970.00,$320.45,$970.00,$768.24,$776.00,$445.22,$183.25,$206.92,$154.42,$305.19
36100229,EAP,CPT® 12053,,Int Wnd Repr Face/mm 5.1-7.5cm,"$1,610.00",$0.00,"$1,610.00","$1,610.00",$0.00,$306.38,$277.39,$0.00,$0.00,$281.90,"$1,610.00",$320.45,"$1,610.00","$1,275.12","$1,288.00",$445.22,$204.98,$223.51,$256.31,$305.19
36100230,EAP,CPT® 12054,,Int Rep Fce Ear Lp 7.6-12.5 Cm,$970.00,$0.00,$970.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$970.00,$0.00,$970.00,$768.24,$776.00,$0.00,$0.00,$0.00,$0.00,$0.00
36100231,EAP,CPT® 12055,,Rep Int Fce Ear Lp 12.6-20.0cm,$970.00,$0.00,$970.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$970.00,$0.00,$970.00,$768.24,$776.00,$0.00,$0.00,$0.00,$0.00,$0.00
36100232,EAP,CPT® 12056,,Rep Int Fce Ear Lp 20.1-30.0cm,"$1,580.00",$0.00,"$1,580.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,580.00",$0.00,"$1,580.00","$1,251.36","$1,264.00",$0.00,$0.00,$0.00,$0.00,$0.00
36100233,EAP,CPT® 12057,,Lac Rep Inter Over 30.0cm,"$4,935.00",$0.00,"$4,935.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,935.00",$0.00,"$2,327.00","$3,908.52","$3,948.00",$0.00,$0.00,$0.00,$0.00,$0.00
36100234,EAP,CPT® 13100,,"Repr Complex,1.1 To 2.5 Cm","$2,338.00",$0.00,"$2,338.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,338.00",$0.00,"$2,327.00","$1,851.70","$1,870.40",$0.00,$0.00,$0.00,$0.00,$0.00
36100235,EAP,CPT® 13101,,Repr Complex Trk 2.6-7.5cm,"$2,438.00",$0.00,"$2,438.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,438.00",$0.00,"$2,438.00","$1,930.90","$1,950.40",$0.00,$0.00,$0.00,$0.00,$0.00
36100236,EAP,CPT® 13120,,Repr Comp Scalp Arms Lgs 1.1,"$1,337.00",$0.00,"$1,337.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,337.00",$0.00,"$1,337.00","$1,058.90","$1,069.60",$0.00,$0.00,$0.00,$0.00,$0.00
36100237,EAP,CPT® 13121,,Repr Comp Scalp Arms Lgs 2.5-7,"$1,442.00",$0.00,"$1,442.00","$1,442.00","$1,442.00",$476.59,$0.00,"$1,442.00","$1,442.00",$252.48,"$1,442.00",$498.48,"$1,442.00","$1,142.06","$1,153.60",$692.57,$0.00,$270.39,$229.57,$474.74
36100238,EAP,CPT® 13131,,"Repr Complex Mouth Neck Hds,ft","$1,337.00",$0.00,"$1,337.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,337.00",$0.00,"$1,337.00","$1,058.90","$1,069.60",$0.00,$0.00,$0.00,$0.00,$0.00
36100239,EAP,CPT® 13132,,"Repr Comp Mouth,neck,hds,ft2.6","$1,337.00",$0.00,"$1,337.00","$1,337.00","$1,337.00",$476.59,$0.00,"$1,337.00","$1,337.00",$234.10,"$1,337.00",$498.48,"$1,337.00","$1,058.90","$1,069.60",$692.57,$0.00,$317.62,$212.85,$474.74
36100241,EAP,CPT® 13151,,Repr Comp Eye Nose Ears Lips,"$2,338.00",$0.00,"$2,338.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,338.00",$0.00,"$2,338.00","$1,851.70","$1,870.40",$0.00,$0.00,$0.00,$0.00,$0.00
36100242,EAP,CPT® 13151,,Rpr Complx Eyelid Etc.1.1-2.5c,"$2,338.00",$0.00,"$2,338.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,338.00",$0.00,"$2,338.00","$1,851.70","$1,870.40",$0.00,$0.00,$0.00,$0.00,$0.00
36100243,EAP,CPT® 13152,,"Repr Comp Eyel, Nose,ears Lips","$2,533.00",$0.00,"$2,533.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,533.00",$0.00,"$2,533.00","$2,006.14","$2,026.40",$0.00,$0.00,$0.00,$0.00,$0.00
36100244,EAP,CPT® 14000,,"Tiss Tran,trnk,<10 Sq Cm","$8,323.00",$0.00,"$8,323.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$8,323.00",$0.00,"$2,327.00","$6,591.82","$6,658.40",$0.00,$0.00,$0.00,$0.00,$0.00
36100245,EAP,CPT® 14020,,"Tiss Trans,s/a/l/<10 Sq Cm","$8,323.00",$0.00,"$8,323.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$8,323.00",$0.00,"$2,858.00","$6,591.82","$6,658.40",$0.00,$0.00,$0.00,$0.00,$0.00
36100246,EAP,CPT® 14040,,Tiss Xfr Head Mouth Chk Hnd <1,"$8,323.00",$0.00,"$8,323.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$8,323.00",$0.00,"$2,327.00","$6,591.82","$6,658.40",$0.00,$0.00,$0.00,$0.00,$0.00
36100247,EAP,CPT® 14060,,Tiss Trans E/n/e/l <10 Sq Cm,"$9,690.00",$0.00,"$9,690.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$9,690.00",$0.00,"$2,858.00","$7,674.48","$7,752.00",$0.00,$0.00,$0.00,$0.00,$0.00
36100248,EAP,CPT® 15788,,Chem Peel Face Epidermal,$496.00,$0.00,$496.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$496.00,$0.00,$496.00,$392.83,$396.80,$0.00,$0.00,$0.00,$0.00,$0.00
36100249,EAP,CPT® 15820,,Blepharoplasty Lower Eyelid,"$15,114.00",$0.00,"$15,114.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$15,114.00",$0.00,"$2,858.00","$11,970.29","$12,091.20",$0.00,$0.00,$0.00,$0.00,$0.00
36100250,EAP,CPT® 15822,,Blepharoplasty Upper Eyelid,"$15,114.00",$0.00,"$15,114.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$15,114.00",$0.00,"$2,858.00","$11,970.29","$12,091.20",$0.00,$0.00,$0.00,$0.00,$0.00
36100251,EAP,CPT® 16000,,Init Trmnt Burn 1st Degree,"$1,607.00",$0.00,"$1,607.00",$872.60,$0.00,$167.55,$0.00,$0.00,$0.00,$281.37,"$1,607.00",$175.24,"$1,607.00","$1,272.74","$1,285.60",$243.48,$0.00,$47.96,$255.83,$166.90
36100252,EAP,CPT® 16000,,Init. Treatment 1st Degree Bur,"$1,607.00",$0.00,"$1,607.00",$872.60,$0.00,$167.55,$0.00,$0.00,$0.00,$281.37,"$1,607.00",$175.24,"$1,607.00","$1,272.74","$1,285.60",$243.48,$0.00,$47.96,$255.83,$166.90
36100253,EAP,CPT® 16000,,"Inital Treatment, 1% Burn","$1,607.00",$0.00,"$1,607.00",$872.60,$0.00,$167.55,$0.00,$0.00,$0.00,$281.37,"$1,607.00",$175.24,"$1,607.00","$1,272.74","$1,285.60",$243.48,$0.00,$47.96,$255.83,$166.90
36100254,EAP,CPT® 16020,,PART THICK BURN DRESS/DEBRD;SM,"$1,607.00",$0.00,"$1,607.00","$1,607.00",$0.00,$167.55,$276.88,$0.00,$0.00,$281.37,"$1,607.00",$175.24,"$1,607.00","$1,272.74","$1,285.60",$243.48,$54.62,$56.23,$255.83,$166.90
36100255,EAP,CPT® 16025,,Part Thick Burn Dress/debrd;md (tbsa 5%-10%),"$3,252.00",$107.09,"$3,252.00","$2,496.90","$2,320.95",$167.55,$560.30,"$2,320.95","$2,320.95",$569.40,"$3,252.00",$175.24,"$2,255.00","$2,575.58","$2,601.60",$243.48,$107.09,$114.64,$517.72,$166.90
36100256,EAP,CPT® 16030,,Part Thick Burn Dress/debrd;lg (tbsa >10%),"$4,348.00",$134.39,"$4,348.00","$2,496.90","$3,103.17",$306.38,$749.14,"$3,103.17","$3,103.17",$761.30,"$4,348.00",$320.45,"$2,255.00","$3,443.62","$3,478.40",$445.22,$134.39,$138.43,$692.20,$305.19
36100257,EAP,CPT® 17000,,"Dest, Premalignant Lesion 1st",$389.00,$48.44,$389.00,$389.00,$389.00,$167.55,$67.02,$389.00,$389.00,$68.11,$389.00,$175.24,$389.00,$308.09,$311.20,$243.48,$48.44,$55.15,$61.93,$166.90
36100258,EAP,CPT® 17000,,"Destruc Lesion Benign, 1st",$389.00,$48.44,$389.00,$389.00,$389.00,$167.55,$67.02,$389.00,$389.00,$68.11,$389.00,$175.24,$389.00,$308.09,$311.20,$243.48,$48.44,$55.15,$61.93,$166.90
36100259,EAP,CPT® 17003,,"Dest, Premalignant Lesion 2-14",$389.00,$0.00,$389.00,$389.00,$0.00,$0.00,$67.02,$0.00,$0.00,$68.11,$389.00,$0.00,$389.00,$308.09,$311.20,$0.00,$12.73,$2.16,$61.93,$0.00
36100260,EAP,CPT® 17004,,"Les Dest, Benign Premal > 15",$806.00,$0.00,$806.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$806.00,$0.00,$806.00,$638.35,$644.80,$0.00,$0.00,$0.00,$0.00,$0.00
36100261,EAP,CPT® 17004,,Lesion Destr Benign >15,$806.00,$0.00,$806.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$806.00,$0.00,$806.00,$638.35,$644.80,$0.00,$0.00,$0.00,$0.00,$0.00
36100262,EAP,CPT® 17110,,"Dest Flat Warts Mollu,milla",$365.00,$0.00,$365.00,$365.00,$0.00,$167.55,$62.89,$0.00,$0.00,$63.91,$365.00,$175.24,$365.00,$289.08,$292.00,$243.48,$49.09,$68.84,$58.11,$166.90
36100263,EAP,CPT® 17110,,"Dest Flat Warts, Up To 14 Les",$365.00,$0.00,$365.00,$365.00,$0.00,$167.55,$62.89,$0.00,$0.00,$63.91,$365.00,$175.24,$365.00,$289.08,$292.00,$243.48,$49.09,$68.84,$58.11,$166.90
36100264,EAP,CPT® 17110,,Destr Flat Wart Mollu Milia <1,$365.00,$0.00,$365.00,$365.00,$0.00,$167.55,$62.89,$0.00,$0.00,$63.91,$365.00,$175.24,$365.00,$289.08,$292.00,$243.48,$49.09,$68.84,$58.11,$166.90
36100266,EAP,CPT® 17111,,"Dest. Flat Warts, >15 Lesions",$806.00,$0.00,$806.00,$806.00,$0.00,$167.55,$138.87,$0.00,$0.00,$141.12,$806.00,$175.24,$806.00,$638.35,$644.80,$243.48,$66.36,$84.34,$128.32,$166.90
36100268,EAP,CPT® 17250,,"Cauterization, Medical",$752.00,$0.00,$752.00,$752.00,$0.00,$167.55,$129.57,$0.00,$0.00,$131.67,$752.00,$175.24,$752.00,$595.58,$601.60,$243.48,$37.05,$38.57,$119.72,$166.90
36100269,EAP,CPT® 17250,,Chemical Cautery Tissue,$752.00,$0.00,$752.00,$752.00,$0.00,$167.55,$129.57,$0.00,$0.00,$131.67,$752.00,$175.24,$752.00,$595.58,$601.60,$243.48,$37.05,$38.57,$119.72,$166.90
36100270,EAP,CPT® 36569,,Mid Line Insertion,"$6,120.00",$98.45,"$5,429.00","$2,106.30","$3,874.68","$1,564.09",$935.39,"$3,874.68","$3,874.68",$950.57,"$5,429.00","$1,635.92","$2,255.00","$4,299.77","$4,343.20","$2,272.90",$346.84,$98.45,$864.30,"$1,558.02"
36100272,EAP,CPT® 17260,,Lesion Dstr Malig Trnk Arm <.5,$670.00,$0.00,$670.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$670.00,$0.00,$670.00,$530.64,$536.00,$0.00,$0.00,$0.00,$0.00,$0.00
36100273,EAP,CPT® 17261,,Les Dstr Malig Trnk Arm 0.6-1.,$752.00,$0.00,$752.00,$752.00,$0.00,$167.55,$129.57,$0.00,$0.00,$131.67,$752.00,$175.24,$752.00,$595.58,$601.60,$243.48,$94.09,$89.76,$119.72,$166.90
36100274,EAP,CPT® 17262,,Les Dstr Malig Trnk Arm 1.1-2.,$752.00,$0.00,$752.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$752.00,$0.00,$752.00,$595.58,$601.60,$0.00,$0.00,$0.00,$0.00,$0.00
36100275,EAP,CPT® 17263,,Les Dstr Malig Trnk Arm 2.1-3.,$645.00,$0.00,$645.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$645.00,$0.00,$645.00,$510.84,$516.00,$0.00,$0.00,$0.00,$0.00,$0.00
36100276,EAP,CPT® 17264,,Les Dstr Malig Trnk Arm 3.1-4.,$645.00,$0.00,$645.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$645.00,$0.00,$645.00,$510.84,$516.00,$0.00,$0.00,$0.00,$0.00,$0.00
36100277,EAP,CPT® 17266,,Les Dstr Malig Trnk Arm >4.0,"$1,428.00",$0.00,"$1,428.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,428.00",$0.00,"$1,428.00","$1,130.98","$1,142.40",$0.00,$0.00,$0.00,$0.00,$0.00
36100278,EAP,CPT® 17271,,Les Dstr Malig Sclp Nck 0.6-1.,$945.00,$0.00,$945.00,$945.00,$0.00,$167.55,$162.82,$0.00,$0.00,$165.46,$945.00,$175.24,$945.00,$748.44,$756.00,$243.48,$115.27,$108.87,$150.44,$166.90
36100279,EAP,CPT® 17272,,Les Dstr Malig Sclp Nck 1.1-2.,$645.00,$0.00,$645.00,$645.00,$0.00,$167.55,$111.13,$0.00,$0.00,$112.93,$645.00,$175.24,$645.00,$510.84,$516.00,$243.48,$136.47,$126.90,$102.68,$166.90
36100280,EAP,CPT® 17273,,Les Dstr Malig Sclp Nck 2.1-3.,$974.00,$0.00,$974.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$974.00,$0.00,$974.00,$771.41,$779.20,$0.00,$0.00,$0.00,$0.00,$0.00
36100281,EAP,CPT® 17274,,Les Dstr Malig Sclp Nck 3.1-4.,"$1,428.00",$0.00,"$1,428.00","$1,428.00",$0.00,$306.38,$246.04,$0.00,$0.00,$250.03,"$1,428.00",$320.45,"$1,428.00","$1,130.98","$1,142.40",$445.22,$192.94,$175.94,$227.34,$305.19
36100282,EAP,CPT® 17280,,Lesion Dstr Malig Face Ear <.5,$645.00,$0.00,$645.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$645.00,$0.00,$645.00,$510.84,$516.00,$0.00,$0.00,$0.00,$0.00,$0.00
36100283,EAP,CPT® 17281,,Les Dstr Malig Face Ear 0.6-1.,"$1,724.00",$0.00,"$1,724.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,724.00",$0.00,"$1,724.00","$1,365.41","$1,379.20",$0.00,$0.00,$0.00,$0.00,$0.00
36100284,EAP,CPT® 17282,,Les Dstr Malig Face Ear 1.1-2.,$974.00,$0.00,$974.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$974.00,$0.00,$974.00,$771.41,$779.20,$0.00,$0.00,$0.00,$0.00,$0.00
36100285,EAP,CPT® 19000,,"Punc Asp Cyst, Breast","$1,141.00",$45.43,"$1,141.00","$1,141.00","$1,141.00",$584.94,$196.59,"$1,141.00","$1,141.00",$199.78,"$1,141.00",$611.80,"$1,141.00",$903.67,$912.80,$850.02,$59.58,$45.43,$181.65,$582.67
36100288,EAP,CPT® 19000,,Puncture Aspiration Of Breast,"$1,141.00",$45.43,"$1,141.00","$1,141.00","$1,141.00",$584.94,$196.59,"$1,141.00","$1,141.00",$199.78,"$1,141.00",$611.80,"$1,141.00",$903.67,$912.80,$850.02,$59.58,$45.43,$181.65,$582.67
36100289,EAP,CPT® 19001,,Each Additiona Cyst-breast,"$1,141.00",$0.00,"$1,141.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,141.00",$0.00,"$1,141.00",$903.67,$912.80,$0.00,$0.00,$0.00,$0.00,$0.00
36100297,EAP,CPT® 19000,,Punc Aspiration Cyst Of Breast,"$1,141.00",$45.43,"$1,141.00","$1,141.00","$1,141.00",$584.94,$196.59,"$1,141.00","$1,141.00",$199.78,"$1,141.00",$611.80,"$1,141.00",$903.67,$912.80,$850.02,$59.58,$45.43,$181.65,$582.67
36100298,EAP,CPT® 19000,,PUNCT ASPIR CYST BREAST BIC,"$1,141.00",$45.43,"$1,141.00","$1,141.00","$1,141.00",$584.94,$196.59,"$1,141.00","$1,141.00",$199.78,"$1,141.00",$611.80,"$1,141.00",$903.67,$912.80,$850.02,$59.58,$45.43,$181.65,$582.67
36100299,EAP,CPT® 54065,,Destruction Penis Lesion(s),"$7,265.00",$0.00,"$7,265.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$7,265.00",$0.00,"$2,255.00","$5,753.88","$5,812.00",$0.00,$0.00,$0.00,$0.00,$0.00
36100300,EAP,CPT® 19001,,Punc Aspir Ea Add'l Cyst Breas,"$1,141.00",$0.00,"$1,141.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,141.00",$0.00,"$1,141.00",$903.67,$912.80,$0.00,$0.00,$0.00,$0.00,$0.00
36100301,EAP,CPT® 19001,,PUNCT ASPIR EA ADDT CYST BIC,"$1,141.00",$0.00,"$1,141.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,141.00",$0.00,"$1,141.00",$903.67,$912.80,$0.00,$0.00,$0.00,$0.00,$0.00
36100303,EAP,CPT® 19020,,Incision Of Breast Lesion Rt,"$7,102.00",$0.00,"$7,102.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$7,102.00",$0.00,"$2,327.00","$5,624.78","$5,681.60",$0.00,$0.00,$0.00,$0.00,$0.00
36100304,EAP,CPT® 19030,,GALACTOGRAM INJECTION BIC,$946.00,$0.00,$946.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$946.00,$0.00,$946.00,$749.23,$756.80,$0.00,$0.00,$0.00,$0.00,$0.00
36100306,EAP,CPT® 19100,,Breast Bx Needle W/0 Imaging,"$1,946.00",$0.00,"$1,946.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,946.00",$0.00,"$1,946.00","$1,541.23","$1,556.80",$0.00,$0.00,$0.00,$0.00,$0.00
36100307,EAP,CPT® 19100,,"Breast Bx, Needle","$1,946.00",$0.00,"$1,946.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,946.00",$0.00,"$1,946.00","$1,541.23","$1,556.80",$0.00,$0.00,$0.00,$0.00,$0.00
36100318,EAP,CPT® 19296,,Place Po Breast Cath For Rad,"$21,736.00",$0.00,"$21,736.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$21,736.00",$0.00,"$6,105.00","$17,214.91","$17,388.80",$0.00,$0.00,$0.00,$0.00,$0.00
36100319,EAP,CPT® 19297,,Br Cath For Rad Concur W/pt Ma,"$21,736.00",$0.00,"$21,736.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$21,736.00",$0.00,"$6,105.00","$17,214.91","$17,388.80",$0.00,$0.00,$0.00,$0.00,$0.00
36100320,EAP,CPT® 19357,,Breast Reconst Tiss Expander,"$16,260.00",$0.00,"$14,782.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$14,782.00",$0.00,"$3,902.00","$11,707.34","$11,825.60",$0.00,$0.00,$0.00,$0.00,$0.00
36100321,EAP,CPT® 19499,,Duct Lav Aspiration,"$6,124.00",$0.00,"$6,124.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,124.00",$0.00,"$2,255.00","$4,850.21","$4,899.20",$0.00,$0.00,$0.00,$0.00,$0.00
36100322,EAP,CPT® 20103,,"Explore Wound, Extremity","$3,502.00",$323.52,"$3,502.00","$2,106.30","$2,499.38",$584.94,$603.38,"$2,499.38","$2,499.38",$613.17,"$3,502.00",$611.80,"$2,255.00","$2,773.58","$2,801.60",$850.02,$323.52,$360.85,$557.52,$582.67
36100323,EAP,CPT® 20206,,BX MUSCLE NEEDLE PERCUT BCT,"$1,500.00",$60.21,"$1,500.00","$1,500.00","$1,208.73","$1,316.19",$258.44,"$1,208.73","$1,208.73",$262.64,"$1,500.00","$1,376.63","$1,500.00","$1,188.00","$1,200.00","$1,500.00",$104.27,$60.21,$238.80,"$1,311.08"
36100324,EAP,CPT® 20206,,Bx Muscle Needle Us,"$1,500.00",$60.21,"$1,500.00","$1,500.00","$1,208.73","$1,316.19",$258.44,"$1,208.73","$1,208.73",$262.64,"$1,500.00","$1,376.63","$1,500.00","$1,188.00","$1,200.00","$1,500.00",$104.27,$60.21,$238.80,"$1,311.08"
36100325,EAP,CPT® 20220,,Biopsy Bone Trcar/needl Sprfcl,"$2,013.00",$0.00,"$2,013.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,013.00",$0.00,"$2,013.00","$1,594.30","$1,610.40",$0.00,$0.00,$0.00,$0.00,$0.00
36100326,EAP,CPT® 20220,,BX BONE TROCAR/NDLE SUPF BCT,"$2,013.00",$0.00,"$2,013.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,013.00",$0.00,"$2,013.00","$1,594.30","$1,610.40",$0.00,$0.00,$0.00,$0.00,$0.00
36100327,EAP,CPT® 20225,,Biopsy Bone Trocar/needle Deep,"$3,050.00",$126.60,"$3,050.00","$2,496.90","$2,176.79","$1,316.19",$525.50,"$2,176.79","$2,176.79",$534.03,"$3,050.00","$1,376.63","$2,327.00","$2,415.60","$2,440.00","$1,912.65",$126.60,$137.03,$485.56,"$1,311.08"
36100328,EAP,CPT® 20225,,BX BONE TROCAR/NDLE DEEP BCT,"$3,050.00",$126.60,"$3,050.00","$2,496.90","$2,176.79","$1,316.19",$525.50,"$2,176.79","$2,176.79",$534.03,"$3,050.00","$1,376.63","$2,327.00","$2,415.60","$2,440.00","$1,912.65",$126.60,$137.03,$485.56,"$1,311.08"
36100329,EAP,CPT® 20501,,Inject Sinus Tract Diagnostic,"$1,238.00",$0.00,"$1,238.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,238.00",$0.00,"$1,238.00",$980.50,$990.40,$0.00,$0.00,$0.00,$0.00,$0.00
36100330,EAP,CPT® 20520,,Remove Foreign Body (simple),"$1,550.00",$0.00,"$1,550.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,550.00",$0.00,"$1,550.00","$1,227.60","$1,240.00",$0.00,$0.00,$0.00,$0.00,$0.00
36100331,EAP,CPT® 20525,,Remove Foreign Body (compl.),"$2,741.00",$0.00,"$2,741.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,741.00",$0.00,"$2,741.00","$2,170.87","$2,192.80",$0.00,$0.00,$0.00,$0.00,$0.00
36100332,EAP,CPT® 20526,,Carpal Tunnel Injection,$904.00,$0.00,$904.00,$904.00,$0.00,$251.01,$155.75,$0.00,$0.00,$158.28,$904.00,$262.54,$904.00,$715.97,$723.20,$364.76,$141.48,$59.49,$143.92,$250.04
36100333,EAP,CPT® 20550,,Inject Tendon Sheath Ligament,$720.00,$40.75,$720.00,$720.00,$720.00,$251.01,$124.05,$720.00,$720.00,$126.07,$720.00,$262.54,$720.00,$570.24,$576.00,$364.76,$70.34,$40.75,$114.62,$250.04
36100336,EAP,CPT® 20551,,Inj Tendon Origin/insertion,$904.00,$0.00,$904.00,$904.00,$0.00,$251.01,$155.75,$0.00,$0.00,$158.28,$904.00,$262.54,$904.00,$715.97,$723.20,$364.76,$66.56,$41.47,$143.92,$250.04
36100337,EAP,CPT® 20552,,Inject Trigger Point 1-2 Musc,$641.00,$0.00,$641.00,$641.00,$0.00,$251.01,$110.44,$0.00,$0.00,$112.23,$641.00,$262.54,$641.00,$507.67,$512.80,$364.76,$66.56,$40.02,$102.05,$250.04
36100338,EAP,CPT® 20553,,Trigger Point Injections: Three Or More Muscles,$904.00,$0.00,$904.00,$904.00,$0.00,$251.01,$155.75,$0.00,$0.00,$158.28,$904.00,$262.54,$904.00,$715.97,$723.20,$364.76,$66.56,$45.07,$143.92,$250.04
36100339,EAP,CPT® 20600,,Drain/inject-finger/toe Wo Us Guidance,$936.00,$37.50,$936.00,$936.00,$936.00,$251.01,$161.27,$936.00,$936.00,$163.89,$936.00,$262.54,$936.00,$741.31,$748.80,$364.76,$54.79,$37.50,$149.01,$250.04
36100340,EAP,CPT® 50561,,Kindey Endoscopy & Treatment,"$6,215.00",$0.00,"$6,215.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,215.00",$0.00,"$2,255.00","$4,922.28","$4,972.00",$0.00,$0.00,$0.00,$0.00,$0.00
36100345,EAP,CPT® 20605,,Drain/inject-wrist Elbow Ankle Wo Us Guidance,$936.00,$0.00,$936.00,$936.00,$0.00,$251.01,$161.27,$0.00,$0.00,$163.89,$936.00,$262.54,$936.00,$741.31,$748.80,$364.76,$60.50,$38.94,$149.01,$250.04
36100348,EAP,CPT® 20610,,Drain/inject-shoulder Hip Knee Wo Us Guidance,"$2,200.00",$47.59,"$2,200.00","$2,106.30","$1,570.14",$251.01,$379.05,"$1,570.14","$1,570.14",$385.20,"$2,200.00",$262.54,"$2,200.00","$1,742.40","$1,760.00",$364.76,$70.76,$47.59,$350.24,$250.04
36100349,EAP,CPT® 41009,,Drainage Of Mouth Lesion,"$8,195.00",$0.00,"$8,195.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$8,195.00",$0.00,"$2,255.00","$6,490.44","$6,556.00",$0.00,$0.00,$0.00,$0.00,$0.00
36100354,EAP,CPT® 20612,,"Aspiration/inj.,gangion Cyst","$1,051.00",$0.00,"$1,051.00","$1,051.00",$0.00,$251.01,$181.08,$0.00,$0.00,$184.02,"$1,051.00",$262.54,"$1,051.00",$832.39,$840.80,$364.76,$54.88,$42.90,$167.32,$250.04
36100355,EAP,CPT® 20670,,Arch Bar Removal,"$6,755.00",$150.66,"$6,755.00","$2,106.30","$4,821.04","$1,316.19","$1,163.85","$4,821.04","$4,821.04","$1,182.75","$6,755.00","$1,376.63","$2,255.00","$5,349.96","$5,404.00","$1,912.65",$166.32,$150.66,"$1,075.40","$1,311.08"
36100356,EAP,CPT® 20670,,Removal Implant; Superficial,"$6,755.00",$150.66,"$6,755.00","$2,106.30","$4,821.04","$1,316.19","$1,163.85","$4,821.04","$4,821.04","$1,182.75","$6,755.00","$1,376.63","$2,255.00","$5,349.96","$5,404.00","$1,912.65",$166.32,$150.66,"$1,075.40","$1,311.08"
36100357,EAP,CPT® 21025,,"Sequestrectomy, Mandible","$12,260.00",$0.00,"$12,260.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$12,260.00",$0.00,"$2,327.00","$9,709.92","$9,808.00",$0.00,$0.00,$0.00,$0.00,$0.00
36100358,EAP,CPT® 21026,,"Sequestrectomy, Maxilla","$8,448.00",$0.00,"$8,448.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$8,448.00",$0.00,"$2,327.00","$6,690.82","$6,758.40",$0.00,$0.00,$0.00,$0.00,$0.00
36100359,EAP,CPT® 21031,,Excision Of Torus Mandibularis,"$3,080.00",$0.00,"$3,080.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,080.00",$0.00,"$2,327.00","$2,439.36","$2,464.00",$0.00,$0.00,$0.00,$0.00,$0.00
36100360,EAP,CPT® 21032,,Excision Of Maxillary Torus,"$4,910.00",$0.00,"$4,910.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,910.00",$0.00,"$2,327.00","$3,888.72","$3,928.00",$0.00,$0.00,$0.00,$0.00,$0.00
36100361,EAP,CPT® 21208,,"Osteoplasty, Facial Bones","$7,747.00",$0.00,"$7,747.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$7,747.00",$0.00,"$4,975.00","$6,135.62","$6,197.60",$0.00,$0.00,$0.00,$0.00,$0.00
36100362,EAP,CPT® 21320,,Closed Nasal Bone W/stabiliza,"$4,482.00",$0.00,"$4,482.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,482.00",$0.00,"$2,327.00","$3,549.74","$3,585.60",$0.00,$0.00,$0.00,$0.00,$0.00
36100364,EAP,CPT® 21440,,Reduce Alveolar Ridge Fracture,"$2,543.00",$0.00,"$2,543.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,543.00",$0.00,"$2,327.00","$2,014.06","$2,034.40",$0.00,$0.00,$0.00,$0.00,$0.00
36100365,EAP,CPT® 21453,,Reduce Mandibular Interdental,"$8,776.00",$0.00,"$8,776.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$8,776.00",$0.00,"$2,858.00","$6,950.59","$7,020.80",$0.00,$0.00,$0.00,$0.00,$0.00
36100366,EAP,CPT® 21480,,"Reduce Tmj Disloca, Ix Or Sub",$257.00,$0.00,$257.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$257.00,$0.00,$257.00,$203.54,$205.60,$0.00,$0.00,$0.00,$0.00,$0.00
36100368,EAP,CPT® 21550,,Biopsy Neck,"$4,399.00",$132.10,"$4,399.00","$2,106.30","$3,139.57","$1,316.19",$757.93,"$3,139.57","$3,139.57",$770.23,"$4,399.00","$1,376.63","$2,255.00","$3,484.01","$3,519.20","$1,912.65",$132.10,$161.13,$700.32,"$1,311.08"
36100369,EAP,CPT® 21550,,"Biopsy, Neck/thorax","$4,399.00",$132.10,"$4,399.00","$2,106.30","$3,139.57","$1,316.19",$757.93,"$3,139.57","$3,139.57",$770.23,"$4,399.00","$1,376.63","$2,255.00","$3,484.01","$3,519.20","$1,912.65",$132.10,$161.13,$700.32,"$1,311.08"
36100376,EAP,CPT® 23350,,Injection Shoulder Arthrograph,"$1,486.00",$0.00,"$1,486.00","$1,486.00",$0.00,$0.00,$256.03,$0.00,$0.00,$260.19,"$1,486.00",$0.00,"$1,486.00","$1,176.91","$1,188.80",$0.00,$202.19,$53.01,$236.57,$0.00
36100379,EAP,CPT® 24220,,Injection Elbow Arthrography,"$2,200.00",$0.00,"$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$2,200.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
36100380,EAP,CPT® 25246,,Injection Wrist Arthrography,"$1,487.00",$0.00,"$1,487.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,487.00",$0.00,"$1,487.00","$1,177.70","$1,189.60",$0.00,$0.00,$0.00,$0.00,$0.00
36100382,EAP,CPT® 26010,,"I&d Finger Abscess, Simple","$1,407.00",$0.00,"$1,407.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,407.00",$0.00,"$1,407.00","$1,114.34","$1,125.60",$0.00,$0.00,$0.00,$0.00,$0.00
36100383,EAP,CPT® 26011,,Abscess Finger Complicated,"$4,877.00",$0.00,"$4,877.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,877.00",$0.00,"$2,255.00","$3,862.58","$3,901.60",$0.00,$0.00,$0.00,$0.00,$0.00
36100384,EAP,CPT® 26035,,"Decompression Fingers, Hand","$3,512.00",$0.00,"$3,512.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,512.00",$0.00,"$2,255.00","$2,781.50","$2,809.60",$0.00,$0.00,$0.00,$0.00,$0.00
36100386,EAP,CPT® 27093,,Injection  Hip Arthro W/o Anes,"$1,674.00",$0.00,"$1,674.00","$1,674.00",$0.00,$0.00,$288.42,$0.00,$0.00,$293.10,"$1,674.00",$0.00,"$1,674.00","$1,325.81","$1,339.20",$0.00,$243.74,$72.12,$266.50,$0.00
36100388,EAP,CPT® 27095,,Injection Hip Arthro W Anes,"$2,101.00",$0.00,"$2,101.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,101.00",$0.00,"$2,101.00","$1,663.99","$1,680.80",$0.00,$0.00,$0.00,$0.00,$0.00
36100389,EAP,CPT® 27096,,Sacroiliac Jt Inj With Arthrography,"$2,131.00",$0.00,"$2,131.00","$2,106.30","$1,520.89",$0.00,$367.16,"$1,520.89","$1,520.89",$373.12,"$2,131.00",$0.00,"$2,131.00","$1,687.75","$1,704.80",$86.18,$398.44,$86.18,$339.26,$0.00
36100391,EAP,CPT® 27630,,"Excision, Les Ankle/lower Leg","$7,251.00",$0.00,"$7,251.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$7,251.00",$0.00,"$2,858.00","$5,742.79","$5,800.80",$0.00,$0.00,$0.00,$0.00,$0.00
36100392,EAP,CPT® 27648,,Injection Ankle Arthrography,"$1,892.00",$0.00,"$1,892.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,892.00",$0.00,"$1,892.00","$1,498.46","$1,513.60",$0.00,$0.00,$0.00,$0.00,$0.00
36100393,EAP,CPT® 28080,,"Excision,les. Interdigital Leg","$5,159.00",$0.00,"$5,159.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,159.00",$0.00,"$2,858.00","$4,085.93","$4,127.20",$0.00,$0.00,$0.00,$0.00,$0.00
36100394,EAP,CPT® 28090,,"Excision, Cyst Foot","$5,159.00",$0.00,"$5,159.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,159.00",$0.00,"$2,858.00","$4,085.93","$4,127.20",$0.00,$0.00,$0.00,$0.00,$0.00
36100395,EAP,CPT® 28092,,"Excision, Lesion, Toe(s) Each","$5,159.00",$0.00,"$5,159.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,159.00",$0.00,"$2,858.00","$4,085.93","$4,127.20",$0.00,$0.00,$0.00,$0.00,$0.00
36100396,EAP,CPT® 28190,,"Removal Fb, Foot Sc","$1,304.00",$138.80,"$1,304.00","$1,304.00","$1,208.73",$584.94,$224.67,"$1,208.73","$1,208.73",$228.32,"$1,304.00",$611.80,"$1,304.00","$1,032.77","$1,043.20",$850.02,$173.39,$138.80,$207.60,$582.67
36100397,EAP,CPT® 28192,,"Removal Fb, Foot Deep","$5,468.00",$0.00,"$5,468.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,468.00",$0.00,"$2,327.00","$4,330.66","$4,374.40",$0.00,$0.00,$0.00,$0.00,$0.00
36100398,EAP,CPT® 28193,,"Removal Fb, Foot, Complicated","$5,468.00",$0.00,"$5,468.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,468.00",$0.00,"$3,606.00","$4,330.66","$4,374.40",$0.00,$0.00,$0.00,$0.00,$0.00
36100399,EAP,CPT® 29130,,"Splinting, Finger",$859.00,$0.00,$859.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$859.00,$0.00,$859.00,$680.33,$687.20,$0.00,$0.00,$0.00,$0.00,$0.00
36100402,EAP,CPT® 29260,,"Splint Application, Wrist","$1,018.00",$0.00,"$1,018.00",$552.77,$0.00,$32.06,$175.40,$0.00,$0.00,$178.24,"$1,018.00",$33.53,"$1,018.00",$806.26,$814.40,$46.58,$44.15,$20.20,$162.07,$31.93
36100403,EAP,CPT® 29515,,Splint Application Ankle,$888.00,$0.00,$888.00,$482.18,$0.00,$128.24,$153.00,$0.00,$0.00,$155.48,$888.00,$134.13,$888.00,$703.30,$710.40,$186.36,$80.51,$51.19,$141.37,$127.75
36100404,EAP,CPT® 29515,,"Splint Application, Ankle",$888.00,$0.00,$888.00,$482.18,$0.00,$128.24,$153.00,$0.00,$0.00,$155.48,$888.00,$134.13,$888.00,$703.30,$710.40,$186.36,$80.51,$51.19,$141.37,$127.75
36100405,EAP,CPT® 29530,,"Wrapping, Knee",$762.00,$0.00,$762.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$762.00,$0.00,$762.00,$603.50,$609.60,$0.00,$0.00,$0.00,$0.00,$0.00
36100406,EAP,CPT® 29540,,Strapping Of Ankle And/or Ft,$345.00,$0.00,$345.00,$0.00,$0.00,$0.00,$59.44,$0.00,$0.00,$60.41,$345.00,$0.00,$345.00,$273.24,$276.00,$0.00,$33.83,$0.00,$0.00,$0.00
36100407,EAP,CPT® 29540,,"Wrapping, Ankle",$345.00,$0.00,$345.00,$0.00,$0.00,$0.00,$59.44,$0.00,$0.00,$60.41,$345.00,$0.00,$345.00,$273.24,$276.00,$0.00,$33.83,$0.00,$0.00,$0.00
36100408,EAP,CPT® 29550,,"Splinting, Toes",$707.00,$0.00,$707.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$707.00,$0.00,$707.00,$559.94,$565.60,$0.00,$0.00,$0.00,$0.00,$0.00
36100409,EAP,CPT® 29580,,Unna Boot,$780.00,$0.00,$780.00,$423.54,$0.00,$128.24,$134.39,$0.00,$0.00,$136.57,$780.00,$134.13,$780.00,$617.76,$624.00,$186.36,$54.52,$28.49,$124.18,$127.75
36100411,EAP,CPT® 30100,,"Biopsy, Intranasal","$1,833.00",$68.81,"$1,833.00","$1,833.00","$1,308.21","$1,293.88",$315.82,"$1,308.21","$1,308.21",$320.94,"$1,833.00","$1,353.31","$1,833.00","$1,451.74","$1,466.40","$1,833.00",$68.81,$68.85,$291.81,"$1,288.86"
36100412,EAP,CPT® 30300,,Remove Fb Intranasal,$272.00,$0.00,$272.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$272.00,$0.00,$272.00,$215.42,$217.60,$0.00,$0.00,$0.00,$0.00,$0.00
36100414,EAP,CPT® 30901,,Control Nasal Hemorr Ant Simpl,$348.00,$0.00,$348.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$348.00,$0.00,$348.00,$275.62,$278.40,$0.00,$0.00,$0.00,$0.00,$0.00
36100416,EAP,CPT® 30903,,Control Nasal Hemorr Ant Compl,$358.00,$0.00,$358.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$358.00,$0.00,$358.00,$283.54,$286.40,$0.00,$0.00,$0.00,$0.00,$0.00
36100418,EAP,CPT® 30905,,Control Nasal Hemorr Post Init,$518.00,$0.00,$518.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$518.00,$0.00,$518.00,$410.26,$414.40,$0.00,$0.00,$0.00,$0.00,$0.00
36100420,EAP,CPT® 31000,,Maxillary Sinus Irrigation,$605.00,$0.00,$605.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$605.00,$0.00,$605.00,$479.16,$484.00,$0.00,$0.00,$0.00,$0.00,$0.00
36100422,EAP,CPT® 31231,,Nasal Endoscopy Dx Uni/bilat,$822.00,$65.62,$822.00,$822.00,$822.00,$150.12,$141.63,$822.00,$822.00,$143.93,$822.00,$157.01,$822.00,$651.02,$657.60,$218.14,$98.38,$65.62,$130.86,$149.53
36100423,EAP,CPT® 31500,,Endotracheal Intubation,"$2,656.00",$0.00,"$2,656.00","$2,106.30","$1,895.59",$195.27,$0.00,"$1,895.59","$1,895.59",$0.00,"$2,656.00",$204.24,"$2,255.00","$2,103.55","$2,124.80",$283.76,$0.00,$149.30,$422.84,$194.51
36100428,EAP,CPT® 31502,,Et/trach Change,"$1,442.00",$36.42,"$1,442.00","$1,442.00","$1,029.16",$195.27,$248.45,"$1,029.16","$1,029.16",$252.48,"$1,442.00",$204.24,"$1,442.00","$1,142.06","$1,153.60",$283.76,$63.79,$36.42,$229.57,$194.51
36100429,EAP,CPT® 31502,,Trach Set Change,"$1,442.00",$0.00,"$1,442.00","$1,442.00",$0.00,$195.27,$248.45,$0.00,$0.00,$252.48,"$1,442.00",$204.24,"$1,442.00","$1,142.06","$1,153.60",$283.76,$63.79,$36.42,$229.57,$194.51
36100430,EAP,CPT® 31502,,Tracheotomy Tube Change,"$1,442.00",$0.00,"$1,442.00","$1,442.00",$0.00,$195.27,$248.45,$0.00,$0.00,$252.48,"$1,442.00",$204.24,"$1,442.00","$1,142.06","$1,153.60",$283.76,$63.79,$36.42,$229.57,$194.51
36100432,EAP,CPT® 31505,,"Laryngoscopy, Indirect, Dx",$648.00,$0.00,$648.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$648.00,$0.00,$648.00,$513.22,$518.40,$0.00,$0.00,$0.00,$0.00,$0.00
36100434,EAP,CPT® 31510,,"Laryngoscopy, Indir, W Bx","$4,755.00",$0.00,"$4,755.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,755.00",$0.00,"$2,327.00","$3,765.96","$3,804.00",$0.00,$0.00,$0.00,$0.00,$0.00
36100435,EAP,CPT® 31528,,Laryngoscopy And Dilation,"$10,101.00",$0.00,"$10,101.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$10,101.00",$0.00,"$2,327.00","$7,999.99","$8,080.80",$0.00,$0.00,$0.00,$0.00,$0.00
36100437,EAP,CPT® 31575,,"Laryngoscopy, Fiberoptic, Dx",$684.00,$0.00,$684.00,$684.00,$0.00,$150.12,$117.85,$0.00,$0.00,$119.76,$684.00,$157.01,$684.00,$541.73,$547.20,$218.14,$103.39,$68.49,$108.89,$149.53
36100438,EAP,CPT® 31605,,Tracheostomy-crico,"$1,598.00",$0.00,"$1,598.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,598.00",$0.00,"$1,598.00","$1,265.62","$1,278.40",$0.00,$0.00,$0.00,$0.00,$0.00
36100442,EAP,CPT® 31612,,Trach Punc Percut  Aspir,"$9,989.00",$0.00,"$9,989.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$9,989.00",$0.00,"$2,255.00","$7,911.29","$7,991.20",$0.00,$0.00,$0.00,$0.00,$0.00
36100444,EAP,CPT® 31615,,Tracheobronchoscopy,"$2,980.00",$0.00,"$2,980.00","$2,106.30","$2,126.83",$423.57,$0.00,"$2,126.83","$2,126.83",$521.77,"$2,980.00",$443.02,"$2,255.00","$2,360.16","$2,384.00",$615.51,$0.00,$118.25,$474.42,$421.92
36100446,EAP,CPT® 31622,,Bronchoscopy W Or W/o Washing,"$4,121.00",$0.00,"$3,746.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,746.00",$0.00,"$2,255.00","$2,966.83","$2,996.80",$0.00,$0.00,$0.00,$0.00,$0.00
36100448,EAP,CPT® 31623,,Bronchoscopy W/brushing,"$3,857.00",$137.76,"$3,104.00","$2,496.90","$2,215.32","$1,371.81",$534.80,"$2,215.32","$2,215.32",$543.49,"$3,104.00","$1,434.81","$2,327.00","$2,458.37","$2,483.20","$1,993.48",$224.43,$137.76,$494.16,"$1,366.49"
36100449,EAP,CPT® 31624,,Bronchoscopy W/bal,"$3,857.00",$139.56,"$3,857.00","$2,496.90","$2,752.74","$1,371.81",$664.54,"$2,752.74","$2,752.74",$675.33,"$3,857.00","$1,434.81","$2,327.00","$3,054.74","$3,085.60","$1,993.48",$217.26,$139.56,$614.03,"$1,366.49"
36100450,EAP,CPT® 31625,,BRONCH DX /ENDOBRONCHIAL BX  SINGLE/MULTIPLE LOBE,"$3,857.00",$162.28,"$3,857.00","$2,496.90","$2,752.74","$1,371.81",$664.54,"$2,752.74","$2,752.74",$675.33,"$3,857.00","$1,434.81","$2,327.00","$3,054.74","$3,085.60","$1,993.48",$246.87,$162.28,$614.03,"$1,366.49"
36100452,EAP,CPT® 31628,,Transbronch Bx W&w/o Fluo,"$3,505.00",$182.48,"$3,505.00","$2,496.90","$2,501.52","$2,816.20",$603.89,"$2,501.52","$2,501.52",$613.70,"$3,505.00","$2,945.54","$2,327.00","$2,775.96","$2,804.00","$3,505.00",$278.79,$182.48,$558.00,"$2,805.28"
36100453,EAP,CPT® 31629,,Bron W/trans Needl Aspir,"$4,003.00",$193.66,"$4,003.00","$2,496.90","$2,856.94","$2,816.20",$689.70,"$2,856.94","$2,856.94",$700.89,"$4,003.00","$2,945.54","$2,327.00","$3,170.38","$3,202.40","$4,003.00",$211.89,$193.66,$637.28,"$2,805.28"
36100454,EAP,CPT® 31630,,Bronchoscopy Dilate/fx Repr,"$10,620.00",$0.00,"$10,620.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$10,620.00",$0.00,"$2,327.00","$8,411.04","$8,496.00",$0.00,$0.00,$0.00,$0.00,$0.00
36100455,EAP,CPT® 31631,,Tracheal Broncial W&w/o Stent,"$9,733.00",$0.00,"$9,733.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$9,733.00",$0.00,"$2,327.00","$7,708.54","$7,786.40",$0.00,$0.00,$0.00,$0.00,$0.00
36100456,EAP,CPT® 31635,,"Bronch Tx, Fb Removal","$10,620.00",$0.00,"$10,620.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$10,620.00",$0.00,"$2,327.00","$8,411.04","$8,496.00",$0.00,$0.00,$0.00,$0.00,$0.00
36100457,EAP,CPT® 31635,,Bronchoscopy W/fb Removal,"$10,620.00",$0.00,"$10,620.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$10,620.00",$0.00,"$2,327.00","$8,411.04","$8,496.00",$0.00,$0.00,$0.00,$0.00,$0.00
36100458,EAP,CPT® 31640,,Bronchoscopy W/ Tumor,"$12,256.00",$260.01,"$12,256.00","$2,496.90","$8,747.11","$2,816.20","$2,111.65","$8,747.11","$5,416.74","$2,145.93","$12,256.00","$2,945.54","$2,327.00","$9,706.75","$9,804.80","$4,092.44",$319.32,$260.01,"$1,951.16","$2,805.28"
36100459,EAP,CPT® 31643,,Bronchoscopy Intracav Rad Addl,"$9,835.00",$0.00,"$9,835.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$9,835.00",$0.00,"$2,327.00","$7,789.32","$7,868.00",$0.00,$0.00,$0.00,$0.00,$0.00
36100460,EAP,CPT® 31645,,Bron W/aspir Trachbron Int,"$11,900.00",$152.54,"$11,900.00","$2,496.90","$8,493.03","$1,371.81","$2,050.31","$8,493.03","$5,416.74","$2,083.59","$11,900.00","$1,434.81","$2,255.00","$9,424.80","$9,520.00","$1,993.48",$199.84,$152.54,"$1,894.48","$1,366.49"
36100461,EAP,CPT® 31645,,"Bronchoscopy, Clear Airways","$11,900.00",$152.54,"$11,900.00","$2,496.90","$8,493.03","$1,371.81","$2,050.31","$8,493.03","$5,416.74","$2,083.59","$11,900.00","$1,434.81","$2,255.00","$9,424.80","$9,520.00","$1,993.48",$199.84,$152.54,"$1,894.48","$1,366.49"
36100462,EAP,CPT® 31646,,Bron W/asp Trachbron Sub,"$11,900.00",$0.00,"$11,900.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$11,900.00",$0.00,"$2,255.00","$9,424.80","$9,520.00",$0.00,$0.00,$0.00,$0.00,$0.00
36100463,EAP,CPT® 31646,,"Bronchoscopy, Reclear Airway","$11,900.00",$0.00,"$11,900.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$11,900.00",$0.00,"$2,255.00","$9,424.80","$9,520.00",$0.00,$0.00,$0.00,$0.00,$0.00
36100464,EAP,CPT® 31720,,Cath Aspir Nasotracbronch,$250.00,$0.00,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$250.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
36100467,EAP,CPT® 31720,,Nasotreacheal Suction,$250.00,$0.00,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$250.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
36100468,EAP,CPT® 31720,,Suctioning Nasotracheal,$250.00,$0.00,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$250.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
36100469,EAP,CPT® 31899,,Bronchi Medication Injection,"$5,372.00",$0.00,"$5,372.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,372.00",$0.00,"$2,255.00","$4,254.62","$4,297.60",$0.00,$0.00,$0.00,$0.00,$0.00
36100470,EAP,CPT® 32400,,Biopsy Pleura Perc Needle,"$4,094.00",$89.44,"$4,094.00","$2,106.30","$2,921.89","$1,316.19",$705.38,"$2,921.89","$2,921.89",$716.83,"$4,094.00","$1,376.63","$2,255.00","$3,242.45","$3,275.20","$1,912.65",$123.21,$89.44,$651.76,"$1,311.08"
36100471,EAP,CPT® 32400,,Pleural Biopsy,"$4,094.00",$89.44,"$4,094.00","$2,106.30","$2,921.89","$1,316.19",$705.38,"$2,921.89","$2,921.89",$716.83,"$4,094.00","$1,376.63","$2,255.00","$3,242.45","$3,275.20","$1,912.65",$123.21,$89.44,$651.76,"$1,311.08"
36100472,EAP,CPT® 32405,,BX LUNG/MEDIAST PERCUT NDL BCT,"$2,601.00",$93.40,"$2,601.00","$2,106.30","$1,856.33","$1,316.19",$448.14,"$1,856.33","$1,856.33",$455.41,"$2,601.00","$1,376.63","$2,255.00","$2,059.99","$2,080.80","$1,912.65",$151.70,$93.40,$414.08,"$1,311.08"
36100473,EAP,CPT® 32405,,Bx Lung/mediastinum Us,"$2,601.00",$93.40,"$2,601.00","$2,106.30","$1,856.33","$1,316.19",$448.14,"$1,856.33","$1,856.33",$455.41,"$2,601.00","$1,376.63","$2,255.00","$2,059.99","$2,080.80","$1,912.65",$151.70,$93.40,$414.08,"$1,311.08"
36100474,EAP,CPT® 32405,,Lung/mediastinum Bx,"$2,601.00",$93.40,"$2,601.00","$2,106.30","$1,856.33","$1,316.19",$448.14,"$1,856.33","$1,856.33",$455.41,"$2,601.00","$1,376.63","$2,255.00","$2,059.99","$2,080.80","$1,912.65",$151.70,$93.40,$414.08,"$1,311.08"
36100480,EAP,CPT® 32550,,Insert Indwelling Cath,"$19,618.00",$0.00,"$19,618.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$19,618.00",$0.00,"$2,858.00","$15,537.46","$15,694.40",$0.00,$0.00,$0.00,$0.00,$0.00
36100481,EAP,CPT® 32550,,Insert/indwelling Tun Pleural,"$19,618.00",$0.00,"$19,618.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$19,618.00",$0.00,"$2,858.00","$15,537.46","$15,694.40",$0.00,$0.00,$0.00,$0.00,$0.00
36100482,EAP,CPT® 32551,,Chest Tube Insertion,"$2,738.00",$0.00,"$2,489.00","$2,489.00","$1,776.40","$1,564.09",$0.00,"$1,776.40","$1,776.40",$0.00,"$2,489.00","$1,635.92","$2,255.00","$1,971.29","$1,991.20","$2,272.90",$0.00,$164.42,$396.25,"$1,558.02"
36100485,EAP,CPT® 32560,,Chemical Pleurodesis,"$2,053.00",$0.00,"$2,053.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,053.00",$0.00,"$2,053.00","$1,625.98","$1,642.40",$0.00,$0.00,$0.00,$0.00,$0.00
36100486,EAP,CPT® 32999,,Removal Of Pleural Catheter,"$1,373.00",$0.00,"$1,373.00",$745.54,$0.00,$604.60,$236.56,$0.00,$0.00,$240.40,"$1,373.00",$632.36,"$1,373.00","$1,087.42","$1,098.40",$878.58,$214.87,$0.00,$218.58,$602.25
36100488,EAP,CPT® 33206,,Insrt New/repl Pcmkr/ld-atrial,"$30,541.00",$0.00,"$30,541.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$30,541.00",$0.00,"$6,105.00","$24,188.47","$24,432.80",$0.00,$0.00,$0.00,$0.00,$0.00
36100489,EAP,CPT® 33207,,Insrt New/repl Pcmkr/ld-vent,"$30,541.00",$0.00,"$30,541.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$30,541.00",$0.00,"$6,105.00","$24,188.47","$24,432.80",$0.00,$0.00,$0.00,$0.00,$0.00
36100490,EAP,CPT® 33208,,Insrt New/repl Pcmkr/ld- A / V,"$13,127.00",$545.42,"$13,127.00","$5,163.90","$9,368.74","$9,830.59","$2,261.72","$9,368.74","$5,416.74","$2,298.43","$13,127.00","$10,282.07","$6,105.00","$10,396.58","$10,501.60","$13,127.00",$611.79,$545.42,"$2,089.82","$9,792.45"
36100491,EAP,CPT® 33210,,Temp Pacemaker Wire,"$24,539.00",$0.00,"$24,539.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$24,539.00",$0.00,"$3,606.00","$19,434.89","$19,631.20",$0.00,$0.00,$0.00,$0.00,$0.00
36100492,EAP,CPT® 33212,,Insrt Pcmkr W Exist Sngl Ld,"$19,394.00",$0.00,"$19,394.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$19,394.00",$0.00,"$2,858.00","$15,360.05","$15,515.20",$0.00,$0.00,$0.00,$0.00,$0.00
36100493,EAP,CPT® 33213,,Insrt Pcmkr W Exist Dual Lds,"$22,410.00",$0.00,"$22,410.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$22,410.00",$0.00,"$2,858.00","$17,748.72","$17,928.00",$0.00,$0.00,$0.00,$0.00,$0.00
36100494,EAP,CPT® 33214,,Upgrade Pacemaker System,"$13,204.00",$0.00,"$13,204.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$13,204.00",$0.00,"$6,105.00","$10,457.57","$10,563.20",$0.00,$0.00,$0.00,$0.00,$0.00
36100495,EAP,CPT® 33215,,Reposition Icd Lead,"$14,094.00",$0.00,"$14,094.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$14,094.00",$0.00,"$2,255.00","$11,162.45","$11,275.20",$0.00,$0.00,$0.00,$0.00,$0.00
36100496,EAP,CPT® 33216,,Insrt Sngl Icd Lead Transveno,"$15,415.00",$0.00,"$15,415.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$15,415.00",$0.00,"$6,105.00","$12,208.68","$12,332.00",$0.00,$0.00,$0.00,$0.00,$0.00
36100497,EAP,CPT® 33217,,Insrt Dual Icd Lead Transveno,"$29,638.00",$0.00,"$29,638.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$29,638.00",$0.00,"$6,105.00","$23,473.30","$23,710.40",$0.00,$0.00,$0.00,$0.00,$0.00
36100498,EAP,CPT® 33218,,Repair Sngl Lead Pcmkr / Icd,"$29,638.00",$0.00,"$29,638.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$29,638.00",$0.00,"$3,902.00","$23,473.30","$23,710.40",$0.00,$0.00,$0.00,$0.00,$0.00
36100499,EAP,CPT® 33220,,Repair Dual Leads Pcmkr / Icd,"$15,415.00",$0.00,"$15,415.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$15,415.00",$0.00,"$3,902.00","$12,208.68","$12,332.00",$0.00,$0.00,$0.00,$0.00,$0.00
36100500,EAP,CPT® 33223,,Relocation Skin  Pkt Cardiovert-defib,"$6,049.00",$0.00,"$6,049.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,049.00",$0.00,"$2,327.00","$4,790.81","$4,839.20",$0.00,$0.00,$0.00,$0.00,$0.00
36100501,EAP,CPT® 33224,,Insert Lead To Prev Pcmkr / Icd,"$13,204.00",$0.00,"$13,204.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$13,204.00",$0.00,"$6,105.00","$10,457.57","$10,563.20",$0.00,$0.00,$0.00,$0.00,$0.00
36100502,EAP,CPT® 33225,,L Ventr Pacing Lead Add +pock,"$49,623.00",$0.00,"$49,623.00",$0.00,$0.00,$0.00,"$8,138.89",$0.00,$0.00,$0.00,"$49,623.00",$0.00,"$24,811.50","$39,301.42","$39,698.40",$0.00,$418.74,$0.00,$0.00,$0.00
36100503,EAP,CPT® 33226,,Reposition Lv Pcmkr Lead,"$7,930.00",$0.00,"$7,930.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$7,930.00",$0.00,"$2,255.00","$6,280.56","$6,344.00",$0.00,$0.00,$0.00,$0.00,$0.00
36100504,EAP,CPT® 33233,,Remove Pcmkr Only,"$13,359.00",$0.00,"$13,359.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$13,359.00",$0.00,"$6,105.00","$10,580.33","$10,687.20",$0.00,$0.00,$0.00,$0.00,$0.00
36100505,EAP,CPT® 33234,,Remove Pcmkr Electrode,"$7,174.00",$0.00,"$7,174.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$7,174.00",$0.00,"$2,255.00","$5,681.81","$5,739.20",$0.00,$0.00,$0.00,$0.00,$0.00
36100506,EAP,CPT® 33241,,Remove Icd Generator Only,"$6,785.00",$0.00,"$6,785.00",$0.00,$0.00,$0.00,"$1,169.02",$0.00,$0.00,$0.00,"$6,785.00",$0.00,"$2,255.00","$5,373.72","$5,428.00",$0.00,$240.47,$0.00,$0.00,$0.00
36100507,EAP,CPT® 33244,,Transvenous Removal Icd Lead,"$11,649.00",$0.00,"$11,649.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$11,649.00",$0.00,"$2,327.00","$9,226.01","$9,319.20",$0.00,$0.00,$0.00,$0.00,$0.00
36100508,EAP,CPT® 33249,,Insrt/repl Sgl/dual Icd Ld/gen,"$39,613.00",$959.62,"$39,613.00","$5,163.90","$28,271.80","$30,955.82","$6,825.12","$28,271.80","$5,416.74","$6,935.92","$39,613.00","$32,377.52","$6,105.00","$31,373.50","$31,690.40","$39,613.00","$1,016.82",$959.62,"$6,306.39","$30,835.73"
36100518,EAP,CPT® 33968,,Remove Intra-aortic Balloon,"$1,959.00",$0.00,"$1,959.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,959.00",$0.00,"$1,959.00","$1,551.53","$1,567.20",$0.00,$0.00,$0.00,$0.00,$0.00
36100519,EAP,CPT® 34201,,Emb. Or Thromb; Femoropop,"$13,033.00",$0.00,"$13,033.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$13,033.00",$0.00,"$3,902.00","$10,322.14","$10,426.40",$0.00,$0.00,$0.00,$0.00,$0.00
36100520,EAP,CPT® 34203,,Emb. Or Thromb;popliteal-tibio,"$13,033.00",$0.00,"$13,033.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$13,033.00",$0.00,"$3,902.00","$10,322.14","$10,426.40",$0.00,$0.00,$0.00,$0.00,$0.00
36100535,EAP,CPT® 35286,,Repair Blood Vessel With Graft Other Than Vein Lower Exteremity,"$13,185.00",$0.00,"$13,185.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$13,185.00",$0.00,"$2,255.00","$10,442.52","$10,548.00",$0.00,$0.00,$0.00,$0.00,$0.00
36100536,EAP,CPT® 35355,,"Thromb., Iliofemoral","$6,828.00",$0.00,"$6,828.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,828.00",$0.00,"$2,255.00","$5,407.78","$5,462.40",$0.00,$0.00,$0.00,$0.00,$0.00
36100537,EAP,CPT® 35371,,"Thromb., Common Femoral","$5,569.00",$0.00,"$5,569.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,569.00",$0.00,"$2,255.00","$4,410.65","$4,455.20",$0.00,$0.00,$0.00,$0.00,$0.00
36100538,EAP,CPT® 35372,,"Thromb., Deep Femoral","$6,697.00",$0.00,"$6,697.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,697.00",$0.00,"$2,255.00","$5,304.02","$5,357.60",$0.00,$0.00,$0.00,$0.00,$0.00
36100556,EAP,CPT® 36002,,Pseudoaneurysm Inject/treat,"$2,313.00",$0.00,"$2,313.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,313.00",$0.00,"$2,255.00","$1,831.90","$1,850.40",$0.00,$0.00,$0.00,$0.00,$0.00
36100557,EAP,CPT® 36005,,Injection Contrast Venography,"$3,191.00",$0.00,"$3,191.00","$2,106.30","$2,277.42",$0.00,$549.79,"$2,277.42","$2,277.42",$558.72,"$3,191.00",$0.00,"$2,255.00","$2,527.27","$2,552.80",$0.00,$315.51,$49.76,$508.01,$0.00
36100558,EAP,CPT® 36010,,"Intro Cath, Sup/inf Vena Cava","$7,200.00",$0.00,"$7,200.00","$2,106.30","$5,138.64",$0.00,$0.00,"$5,138.64","$5,138.64",$0.00,"$7,200.00",$0.00,"$2,255.00","$5,702.40","$5,760.00",$0.00,$0.00,$115.03,"$1,146.24",$0.00
36100559,EAP,CPT® 36011,,Select Cath Venous 1st Order,"$2,630.00",$0.00,"$2,630.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,630.00",$0.00,"$2,630.00","$2,082.96","$2,104.00",$0.00,$0.00,$0.00,$0.00,$0.00
36100560,EAP,CPT® 36012,,Select Cath Venous 2nd Order,"$15,433.00",$0.00,"$15,433.00",$0.00,$0.00,$0.00,"$2,659.03",$0.00,$0.00,$0.00,"$15,433.00",$0.00,"$2,255.00","$12,222.94","$12,346.40",$0.00,$197.99,$0.00,$0.00,$0.00
36100561,EAP,CPT® 36013,,Intro Cath Rt Heart/main Pulm,"$14,682.00",$0.00,"$14,682.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$14,682.00",$0.00,"$2,255.00","$11,628.14","$11,745.60",$0.00,$0.00,$0.00,$0.00,$0.00
36100562,EAP,CPT® 36014,,Select Cath Lt/rt Pulm Artery,"$14,187.00",$0.00,"$14,187.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$14,187.00",$0.00,"$2,255.00","$11,236.10","$11,349.60",$0.00,$0.00,$0.00,$0.00,$0.00
36100563,EAP,CPT® 36015,,Select Cath Segmental Pulm Art,"$2,178.00",$0.00,"$2,178.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,178.00",$0.00,"$2,178.00","$1,724.98","$1,742.40",$0.00,$0.00,$0.00,$0.00,$0.00
36100565,EAP,CPT® 36140,,Intro Needle Extremity Artery,"$4,898.00",$0.00,"$4,898.00","$2,106.30","$3,495.70",$0.00,$843.90,"$3,495.70","$3,495.70",$857.60,"$4,898.00",$0.00,"$2,255.00","$3,879.22","$3,918.40",$0.00,$113.12,$93.75,$779.76,$0.00
36100567,EAP,CPT® 36160,,Intro Needle Aortic/translumba,"$9,128.00",$0.00,"$9,128.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$9,128.00",$0.00,"$2,255.00","$7,229.38","$7,302.40",$0.00,$0.00,$0.00,$0.00,$0.00
36100568,EAP,CPT® 36200,,Intro Catheter Aorta,"$8,070.00",$0.00,"$8,070.00","$2,496.90","$5,759.56",$0.00,$0.00,"$5,759.56","$5,416.74","$1,412.99","$8,070.00",$0.00,"$2,255.00","$6,391.44","$6,456.00",$0.00,$0.00,$146.39,"$1,284.74",$0.00
36100569,EAP,CPT® 36215,,Selct Art 1st Ord Thor/brach,"$3,718.00",$0.00,"$3,298.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,298.00",$0.00,"$2,255.00","$2,612.02","$2,638.40",$0.00,$0.00,$0.00,$0.00,$0.00
36100570,EAP,CPT® 36216,,Selct Art 2nd Ord Thor/brach,"$3,718.00",$0.00,"$3,298.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,298.00",$0.00,"$2,255.00","$2,612.02","$2,638.40",$0.00,$0.00,$0.00,$0.00,$0.00
36100571,EAP,CPT® 36217,,Selct Art 3rd Ord Thor/brach,"$3,718.00",$0.00,"$3,298.00","$2,496.90","$2,353.78",$0.00,$568.23,"$2,353.78","$2,353.78",$577.45,"$3,298.00",$0.00,"$2,255.00","$2,612.02","$2,638.40",$0.00,$342.41,$343.25,$525.04,$0.00
36100572,EAP,CPT® 36218,,Selct Art Add'l 2nd/3rd Th/br,"$1,790.00",$0.00,"$1,588.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,588.00",$0.00,"$1,588.00","$1,257.70","$1,270.40",$0.00,$0.00,$0.00,$0.00,$0.00
36100573,EAP,Custom 36100573,,Selct Art 1st Ord Abd/pelv,"$4,099.00",$0.00,"$4,099.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,099.00",$0.00,"$2,049.50","$3,246.41","$3,279.20",$0.00,$0.00,$0.00,$0.00,$0.00
36100574,EAP,CPT® 36245,,Selct Art 1st Ord Abd/pelv/le,"$3,718.00",$0.00,"$3,298.00","$2,496.90","$2,353.78",$0.00,$568.23,"$2,353.78","$2,353.78",$577.45,"$3,298.00",$0.00,"$2,255.00","$2,612.02","$2,638.40",$0.00,$264.78,$248.44,$525.04,$0.00
36100575,EAP,CPT® 36246,,Selct Art 2nd Ord Abd/pelv/le,"$3,850.00",$0.00,"$3,415.00","$2,496.90","$2,437.29",$0.00,$588.39,"$2,437.29","$2,437.29",$597.94,"$3,415.00",$0.00,"$2,255.00","$2,704.68","$2,732.00",$0.00,$288.99,$265.02,$543.67,$0.00
36100576,EAP,CPT® 36247,,Selct Art 3rd Ord Abd/pelv/le,"$4,115.00",$0.00,"$3,650.00","$2,496.90","$2,605.01",$0.00,$628.88,"$2,605.01","$2,605.01",$639.09,"$3,650.00",$0.00,"$2,255.00","$2,890.80","$2,920.00",$0.00,$341.72,$315.51,$581.08,$0.00
36100577,EAP,CPT® 36248,,"Selct Art, Addt'l, Abd/pelv/le","$3,850.00",$0.00,"$3,415.00","$2,496.90","$2,437.29",$0.00,$588.39,"$2,437.29","$2,437.29",$597.94,"$3,415.00",$0.00,"$2,255.00","$2,704.68","$2,732.00",$0.00,$56.19,$50.85,$543.67,$0.00
36100582,EAP,CPT® 36406,,"Phelb, Micro-10bopc",$139.00,$0.00,$111.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$111.00,$0.00,$111.00,$87.91,$88.80,$0.00,$0.00,$0.00,$0.00,$0.00
36100583,EAP,CPT® 36406,,"Phelb,micro-ward 12 Midnight",$139.00,$0.00,$111.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$111.00,$0.00,$111.00,$87.91,$88.80,$0.00,$0.00,$0.00,$0.00,$0.00
36100584,EAP,CPT® 36406,,"Phleb,cap-ward 12n",$139.00,$0.00,$111.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$111.00,$0.00,$111.00,$87.91,$88.80,$0.00,$0.00,$0.00,$0.00,$0.00
36100585,EAP,CPT® 36406,,"Phleb,cap-ward 6pm",$139.00,$0.00,$111.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$111.00,$0.00,$111.00,$87.91,$88.80,$0.00,$0.00,$0.00,$0.00,$0.00
36100586,EAP,CPT® 36406,,"Phleb,cap-ward 7am",$139.00,$0.00,$111.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$111.00,$0.00,$111.00,$87.91,$88.80,$0.00,$0.00,$0.00,$0.00,$0.00
36100587,EAP,CPT® 36406,,"Phleb,nursery 1pm",$139.00,$0.00,$111.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$111.00,$0.00,$111.00,$87.91,$88.80,$0.00,$0.00,$0.00,$0.00,$0.00
36100592,EAP,CPT® 36468,,"Injection(s), Spider Vein",$444.00,$0.00,$355.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$355.00,$0.00,$355.00,$281.16,$284.00,$0.00,$0.00,$0.00,$0.00,$0.00
36100594,EAP,CPT® 36470,,Injection Therapy Of Vein,$713.00,$0.00,$570.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$570.00,$0.00,$570.00,$451.44,$456.00,$0.00,$0.00,$0.00,$0.00,$0.00
36100596,EAP,CPT® 36475,,"Endovenous Rf, 1st Vein","$14,386.00",$0.00,"$14,386.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$14,386.00",$0.00,"$6,105.00","$11,393.71","$11,508.80",$0.00,$0.00,$0.00,$0.00,$0.00
36100597,EAP,CPT® 36476,,"Endovenous Rf, Vein Add On","$14,386.00",$0.00,"$14,386.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$14,386.00",$0.00,"$6,105.00","$11,393.71","$11,508.80",$0.00,$0.00,$0.00,$0.00,$0.00
36100598,EAP,CPT® 36478,,"Endovenous Laser, 1st Vein","$14,386.00",$0.00,"$14,386.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$14,386.00",$0.00,"$6,105.00","$11,393.71","$11,508.80",$0.00,$0.00,$0.00,$0.00,$0.00
36100599,EAP,CPT® 36479,,Endovenous Laser Vein Add-on,"$14,386.00",$0.00,"$14,386.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$14,386.00",$0.00,"$6,105.00","$11,393.71","$11,508.80",$0.00,$0.00,$0.00,$0.00,$0.00
36100600,EAP,CPT® 36481,,Percut Portal Vein Cath,"$6,911.00",$0.00,"$6,911.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,911.00",$0.00,"$2,255.00","$5,473.51","$5,528.80",$0.00,$0.00,$0.00,$0.00,$0.00
36100601,EAP,CPT® 36500,,Venous Cath Selct Org Bld Samp,"$2,857.00",$0.00,"$2,857.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,857.00",$0.00,"$2,255.00","$2,262.74","$2,285.60",$0.00,$0.00,$0.00,$0.00,$0.00
36100602,EAP,CPT® 36555,,INS NON-TUN CVC <5 SPV,"$5,883.00",$0.00,"$5,219.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,219.00",$0.00,"$2,255.00","$4,133.45","$4,175.20",$0.00,$0.00,$0.00,$0.00,$0.00
36100603,EAP,CPT® 36556,,Central Line Placement,"$6,201.00",$0.00,"$5,501.00",$0.00,$0.00,$0.00,$947.79,$0.00,$0.00,$963.18,"$5,501.00",$0.00,"$2,255.00","$4,356.79","$4,400.80",$0.00,$311.35,$0.00,$0.00,$0.00
36100607,EAP,CPT® 36557,,INS TUN CVC W/O PORT <5 SPV,"$9,762.00",$0.00,"$8,660.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$8,660.00",$0.00,"$2,327.00","$6,858.72","$6,928.00",$0.00,$0.00,$0.00,$0.00,$0.00
36100608,EAP,CPT® 36558,,INS TUN CVC W/O PORT >5 SPV,"$11,265.00",$272.22,"$9,993.00","$2,496.90","$7,132.00","$2,657.38","$1,721.74","$7,132.00","$5,416.74","$1,749.69","$9,993.00","$2,779.42","$2,327.00","$7,914.46","$7,994.40","$3,861.64",$693.87,$272.22,"$1,590.89","$2,647.07"
36100609,EAP,CPT® 36560,,INS TUN CVC W/PORT <5 SPV,"$20,843.00",$0.00,"$18,490.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$18,490.00",$0.00,"$2,858.00","$14,644.08","$14,792.00",$0.00,$0.00,$0.00,$0.00,$0.00
36100610,EAP,CPT® 36561,,INS TUN CVC W/PORT >5 SPV,"$22,512.00",$351.16,"$19,970.00","$2,706.90","$14,252.59","$2,657.38","$3,440.73","$14,252.59","$5,416.74","$3,496.59","$19,970.00","$2,779.42","$2,858.00","$15,816.24","$15,976.00","$3,861.64","$1,322.94",$351.16,"$3,179.22","$2,647.07"
36100611,EAP,CPT® 36563,,INS TUN CVC W/PUMP SPV,"$44,463.00",$0.00,"$39,443.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$39,443.00",$0.00,"$2,858.00","$31,238.86","$31,554.40",$0.00,$0.00,$0.00,$0.00,$0.00
36100612,EAP,CPT® 36565,,Insert Tunneled Cv Cath,"$21,320.00",$0.00,"$18,913.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$18,913.00",$0.00,"$2,858.00","$14,979.10","$15,130.40",$0.00,$0.00,$0.00,$0.00,$0.00
36100613,EAP,CPT® 36566,,Insert Tunneled Cv Cath W/port,"$11,012.00",$0.00,"$11,012.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$11,012.00",$0.00,"$2,858.00","$8,721.50","$8,809.60",$0.00,$0.00,$0.00,$0.00,$0.00
36100614,EAP,CPT® 36568,,INS PERH CVC W/O PORT <5 SPV,"$7,208.00",$0.00,"$6,394.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,394.00",$0.00,"$2,255.00","$5,064.05","$5,115.20",$0.00,$0.00,$0.00,$0.00,$0.00
36100615,EAP,CPT® 36568,,Insert/picc Catheter Discontin,"$7,208.00",$0.00,"$6,394.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,394.00",$0.00,"$2,255.00","$5,064.05","$5,115.20",$0.00,$0.00,$0.00,$0.00,$0.00
36100616,EAP,CPT® 36568,,Insertion Of Picc Catheter,"$7,208.00",$0.00,"$6,394.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,394.00",$0.00,"$2,255.00","$5,064.05","$5,115.20",$0.00,$0.00,$0.00,$0.00,$0.00
36100618,EAP,CPT® 36569,,Cvc/picc Line Place Exchange,"$6,120.00",$98.45,"$5,429.00","$2,106.30","$3,874.68","$1,564.09",$935.39,"$3,874.68","$3,874.68",$950.57,"$5,429.00","$1,635.92","$2,255.00","$4,299.77","$4,343.20","$2,272.90",$346.84,$98.45,$864.30,"$1,558.02"
36100619,EAP,CPT® 36569,,Insert Picc Wo Port/pump >5,"$6,120.00",$98.45,"$5,429.00","$2,106.30","$3,874.68","$1,564.09",$935.39,"$3,874.68","$3,874.68",$950.57,"$5,429.00","$1,635.92","$2,255.00","$4,299.77","$4,343.20","$2,272.90",$346.84,$98.45,$864.30,"$1,558.02"
36100620,EAP,CPT® 36570,,Ins Perh Cvc W/port <5spv,"$16,987.00",$0.00,"$16,987.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$16,987.00",$0.00,"$2,858.00","$13,453.70","$13,589.60",$0.00,$0.00,$0.00,$0.00,$0.00
36100621,EAP,CPT® 36571,,INS PERH CVC W/ PORT >5 SPV,"$9,538.00",$325.53,"$9,538.00","$2,706.90","$6,807.27","$2,657.38","$1,643.35","$6,807.27","$5,416.74","$1,670.03","$9,538.00","$2,779.42","$2,858.00","$7,554.10","$7,630.40","$3,861.64","$1,542.56",$325.53,"$1,518.45","$2,647.07"
36100622,EAP,CPT® 36575,,Repair Cv Cath Wo Port/pump,"$5,253.00",$0.00,"$5,253.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,253.00",$0.00,"$2,327.00","$4,160.38","$4,202.40",$0.00,$0.00,$0.00,$0.00,$0.00
36100623,EAP,CPT® 36575,,REPAIR TUN/N-TUN CVC WO PT SPV,"$5,253.00",$0.00,"$5,253.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,253.00",$0.00,"$2,327.00","$4,160.38","$4,202.40",$0.00,$0.00,$0.00,$0.00,$0.00
36100624,EAP,CPT® 36576,,REPAIR CVC W/PORT/PUMP SPV,"$5,253.00",$0.00,"$5,253.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,253.00",$0.00,"$2,327.00","$4,160.38","$4,202.40",$0.00,$0.00,$0.00,$0.00,$0.00
36100626,EAP,CPT® 36578,,Replce Cat Cvc W/port/pump Spv,"$14,611.00",$0.00,"$14,611.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$14,611.00",$0.00,"$2,327.00","$11,571.91","$11,688.80",$0.00,$0.00,$0.00,$0.00,$0.00
36100627,EAP,CPT® 36580,,Replace Cv Cath Non-tun Wo Por,"$7,816.00",$0.00,"$7,816.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$7,816.00",$0.00,"$2,255.00","$6,190.27","$6,252.80",$0.00,$0.00,$0.00,$0.00,$0.00
36100628,EAP,CPT® 36580,,REPLCE NON-TUN CVC WO PORT SPV,"$7,816.00",$0.00,"$7,816.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$7,816.00",$0.00,"$2,255.00","$6,190.27","$6,252.80",$0.00,$0.00,$0.00,$0.00,$0.00
36100629,EAP,CPT® 36581,,REPLCE TUN CVC W/O PORT SPV,"$5,285.00",$191.10,"$5,285.00","$2,496.90","$3,771.90","$2,657.38",$910.58,"$3,771.90","$3,771.90",$925.36,"$5,285.00","$2,779.42","$2,327.00","$4,185.72","$4,228.00","$3,861.64",$638.75,$191.10,$841.37,"$2,647.07"
36100630,EAP,CPT® 36582,,REPLCE TUN CVC W/ PORT SPV,"$20,909.00",$0.00,"$20,909.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$20,909.00",$0.00,"$2,858.00","$16,559.93","$16,727.20",$0.00,$0.00,$0.00,$0.00,$0.00
36100631,EAP,CPT® 36583,,Replce Tun Cvc W/pump Spv,"$39,443.00",$0.00,"$39,443.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$39,443.00",$0.00,"$2,858.00","$31,238.86","$31,554.40",$0.00,$0.00,$0.00,$0.00,$0.00
36100632,EAP,CPT® 36584,,Replace Picc Wo Port/pump,"$9,762.00",$0.00,"$9,762.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$9,762.00",$0.00,"$2,255.00","$7,731.50","$7,809.60",$0.00,$0.00,$0.00,$0.00,$0.00
36100633,EAP,CPT® 36584,,Replacement Of A Picc Catheter,"$9,762.00",$0.00,"$9,762.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$9,762.00",$0.00,"$2,255.00","$7,731.50","$7,809.60",$0.00,$0.00,$0.00,$0.00,$0.00
36100634,EAP,CPT® 36584,,REPLCE COMP PICC W/O PORT SPV,"$9,762.00",$0.00,"$9,762.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$9,762.00",$0.00,"$2,255.00","$7,731.50","$7,809.60",$0.00,$0.00,$0.00,$0.00,$0.00
36100635,EAP,CPT® 36585,,REPLCE COMP PICC W/PORT SPV,"$16,987.00",$283.37,"$16,987.00","$2,706.90","$12,123.62","$2,657.38","$2,926.78","$12,123.62","$5,416.74","$2,974.29","$16,987.00","$2,779.42","$2,858.00","$13,453.70","$13,589.60","$3,861.64","$1,518.02",$283.37,"$2,704.33","$2,647.07"
36100636,EAP,CPT® 36589,,REMOVAL TUN CVC W/O PORT SPV,"$4,657.00",$143.13,"$4,657.00","$2,106.30","$3,323.70",$604.60,$802.38,"$3,323.70","$3,323.70",$815.40,"$4,657.00",$632.36,"$2,255.00","$3,688.34","$3,725.60",$878.58,$171.53,$143.13,$741.39,$602.25
36100637,EAP,CPT® 36589,,Removal Venous Access Device,"$4,657.00",$143.13,"$4,657.00","$2,106.30","$3,323.70",$604.60,$802.38,"$3,323.70","$3,323.70",$815.40,"$4,657.00",$632.36,"$2,255.00","$3,688.34","$3,725.60",$878.58,$171.53,$143.13,$741.39,$602.25
36100638,EAP,CPT® 36590,,REMOVAL TUN CVC W/PORT SPV,"$4,657.00",$198.64,"$4,657.00","$2,106.30","$3,323.70",$604.60,$802.38,"$3,323.70","$3,323.70",$815.40,"$4,657.00",$632.36,"$2,255.00","$3,688.34","$3,725.60",$878.58,$371.18,$198.64,$741.39,$602.25
36100639,EAP,CPT® 36590,,Remove Cv Cath,"$4,657.00",$198.64,"$4,657.00","$2,106.30","$3,323.70",$604.60,$802.38,"$3,323.70","$3,323.70",$815.40,"$4,657.00",$632.36,"$2,255.00","$3,688.34","$3,725.60",$878.58,$371.18,$198.64,$741.39,$602.25
36100640,EAP,CPT® 36591,,Blood Draw Central Line,$295.00,$0.00,$262.00,$142.27,$0.00,$104.55,$0.00,$0.00,$0.00,$45.87,$262.00,$109.35,$262.00,$207.50,$209.60,$151.93,$0.00,$25.21,$41.71,$104.14
36100641,EAP,CPT® 36593,,Declot Vasc Cath By Thrombolyt,"$2,030.00",$0.00,"$1,624.00","$1,624.00",$0.00,$296.88,$279.81,$0.00,$0.00,$284.35,"$1,624.00",$310.51,"$1,624.00","$1,286.21","$1,299.20",$431.41,$30.97,$32.05,$258.54,$295.72
36100642,EAP,CPT® 36593,,Declot Vascular Access Device,"$2,030.00",$0.00,"$1,624.00","$1,624.00",$0.00,$296.88,$279.81,$0.00,$0.00,$284.35,"$1,624.00",$310.51,"$1,624.00","$1,286.21","$1,299.20",$431.41,$30.97,$32.05,$258.54,$295.72
36100645,EAP,CPT® 36595,,MECH REMOVAL OBSTR CVC SPV,"$15,541.00",$0.00,"$15,541.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$15,541.00",$0.00,"$2,858.00","$12,308.47","$12,432.80",$0.00,$0.00,$0.00,$0.00,$0.00
36100646,EAP,CPT® 36596,,MECH REMOVAL CATH OBST CVC SPV,"$6,465.00",$0.00,"$6,465.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,465.00",$0.00,"$2,255.00","$5,120.28","$5,172.00",$0.00,$0.00,$0.00,$0.00,$0.00
36100647,EAP,CPT® 36597,,REPOSIT CVC W/ FLUORO GUID SPV,"$7,648.00",$0.00,"$7,648.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$7,648.00",$0.00,"$2,255.00","$6,057.22","$6,118.40",$0.00,$0.00,$0.00,$0.00,$0.00
36100648,EAP,CPT® 36598,,"Inj W/fluro, Eval Cv Device","$1,100.00",$0.00,"$1,100.00","$1,100.00",$0.00,$176.19,$132.47,$0.00,$0.00,$192.60,"$1,100.00",$184.28,"$1,100.00",$871.20,$880.00,$256.03,$126.13,$38.59,$175.12,$175.50
36100649,EAP,CPT® 36600,,Arterial Puncture,$300.00,$16.23,$284.00,$284.00,$202.69,$104.55,$48.93,$202.69,$202.69,$49.73,$284.00,$109.35,$284.00,$224.93,$227.20,$151.93,$24.37,$16.23,$45.21,$104.14
36100650,EAP,CPT® 20610,,Bilateral Drain/inject-shoulder Hip Knee Wo Us Guidance,"$4,400.00",$47.59,"$4,400.00","$2,106.30","$3,140.28",$251.01,$758.10,"$3,140.28","$3,140.28",$770.40,"$4,400.00",$262.54,"$2,255.00","$3,484.80","$3,520.00",$364.76,$70.76,$47.59,$700.48,$250.04
36100652,EAP,CPT® 36620,,Arterial Line Insert,"$1,480.00",$0.00,"$1,339.00","$1,339.00",$0.00,$0.00,$230.70,$0.00,$0.00,$234.45,"$1,339.00",$0.00,"$1,339.00","$1,060.49","$1,071.20",$0.00,$59.97,$46.17,$213.17,$0.00
36100655,EAP,CPT® 36860,,Cannula Declot W/o Balloon,"$12,305.00",$0.00,"$10,916.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$10,916.00",$0.00,"$2,327.00","$8,645.47","$8,732.80",$0.00,$0.00,$0.00,$0.00,$0.00
36100657,EAP,CPT® 37182,,Insert Hepatic Shunt (tips),"$14,633.00",$0.00,"$14,633.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$14,633.00",$0.00,"$7,316.50","$11,589.34","$11,706.40",$0.00,$0.00,$0.00,$0.00,$0.00
36100658,EAP,CPT® 37183,,Remove Hepatic Shunt (tips),"$58,001.00",$0.00,"$58,001.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$58,001.00",$0.00,"$4,975.00","$45,936.79","$46,400.80",$0.00,$0.00,$0.00,$0.00,$0.00
36100659,EAP,CPT® 37184,,Prim Art Mech Thrombectomy,"$37,082.00",$0.00,"$37,082.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$37,082.00",$0.00,"$3,902.00","$29,368.94","$29,665.60",$0.00,$0.00,$0.00,$0.00,$0.00
36100660,EAP,CPT® 37185,,Prim Art M-thrombect Add-on,"$39,140.00",$0.00,"$39,140.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$39,140.00",$0.00,"$19,570.00","$30,998.88","$31,312.00",$0.00,$0.00,$0.00,$0.00,$0.00
36100661,EAP,CPT® 37186,,Sec Art Thrombect Add-on,"$36,236.00",$0.00,"$36,236.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$36,236.00",$0.00,"$18,118.00","$28,698.91","$28,988.80",$0.00,$0.00,$0.00,$0.00,$0.00
36100662,EAP,CPT® 37187,,Venous Mech Thrombectomy,"$19,361.00",$0.00,"$19,361.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$19,361.00",$0.00,"$3,902.00","$15,333.91","$15,488.80",$0.00,$0.00,$0.00,$0.00,$0.00
36100663,EAP,CPT® 37188,,Venous M-thrombectomy Add-on,"$16,010.00",$0.00,"$16,010.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$16,010.00",$0.00,"$3,902.00","$12,679.92","$12,808.00",$0.00,$0.00,$0.00,$0.00,$0.00
36100664,EAP,CPT® 37195,,"Thrombolytic Therapy, Stroke","$13,981.00",$0.00,"$13,981.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$13,981.00",$0.00,"$2,255.00","$11,072.95","$11,184.80",$0.00,$0.00,$0.00,$0.00,$0.00
36100665,EAP,CPT® 37200,,Transcatheter Biopsy,"$16,964.00",$0.00,"$16,964.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$16,964.00",$0.00,"$2,255.00","$13,435.49","$13,571.20",$0.00,$0.00,$0.00,$0.00,$0.00
36100681,EAP,CPT® 37215,,"Transcath Stent, Cca W/eps","$17,688.00","$1,046.93","$17,688.00","$2,706.90","$12,623.93","$3,148.46","$3,047.55","$12,623.93","$5,416.74","$3,097.03","$17,688.00","$1,114.70","$8,844.00","$14,008.90","$14,150.40","$1,046.93","$1,065.02","$1,046.93","$2,815.93","$1,046.93"
36100682,EAP,CPT® 37216,,"Transcath Stent, Cca W/o Eps","$20,303.00",$0.00,"$20,303.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$20,303.00",$0.00,"$10,151.50","$16,079.98","$16,242.40",$0.00,$0.00,$0.00,$0.00,$0.00
36100685,EAP,CPT® 37609,,Temporal Artery Biopsy,"$10,714.00",$214.12,"$10,714.00","$2,496.90","$7,646.58","$1,316.19","$1,845.97","$7,646.58","$5,416.74","$1,875.94","$10,714.00","$1,376.63","$2,327.00","$8,485.49","$8,571.20","$1,912.65",$242.02,$214.12,"$1,705.67","$1,311.08"
36100687,EAP,CPT® 37765,,Phleb Veins-extrem-up To 20,"$17,773.00",$0.00,"$17,773.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$17,773.00",$0.00,"$2,327.00","$14,076.22","$14,218.40",$0.00,$0.00,$0.00,$0.00,$0.00
36100688,EAP,CPT® 37766,,Phleb Veins-extrem-20+,"$17,537.00",$0.00,"$17,537.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$17,537.00",$0.00,"$2,327.00","$13,889.30","$14,029.60",$0.00,$0.00,$0.00,$0.00,$0.00
36100689,EAP,CPT® 37799,,Vascular Surgery Procedure,"$11,192.00",$0.00,"$11,192.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$11,192.00",$0.00,"$2,255.00","$8,864.06","$8,953.60",$0.00,$0.00,$0.00,$0.00,$0.00
36100690,EAP,CPT® 38200,,Splenoportography Inj,"$1,250.00",$0.00,"$1,250.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,"$1,250.00",$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
36100691,EAP,CPT® 38220,,Diagnostic Bone Marrow; Aspiration(s),"$1,500.00",$0.00,"$1,500.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,500.00",$0.00,"$1,500.00","$1,188.00","$1,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
36100692,EAP,CPT® 38220,,Diagnostic Bone Marrow; Aspiration(s),"$1,500.00",$0.00,"$1,500.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,500.00",$0.00,"$1,500.00","$1,188.00","$1,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
36100693,EAP,CPT® 38221,,Diagnostic Bone Marrow; Biopsy(ies),"$1,523.00",$0.00,"$1,523.00","$1,523.00",$0.00,"$1,316.19",$262.41,$0.00,$0.00,$266.67,"$1,523.00","$1,376.63","$1,523.00","$1,206.22","$1,218.40","$1,523.00",$245.12,$72.12,$242.46,"$1,311.08"
36100694,EAP,CPT® 38500,,Biopsy Lymph Nodes Sprfcl Open,"$4,110.00",$0.00,"$4,110.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,110.00",$0.00,"$2,327.00","$3,255.12","$3,288.00",$0.00,$0.00,$0.00,$0.00,$0.00
36100695,EAP,CPT® 38505,,BX LYMPH NODE(S) NDL BCT,"$1,801.00",$72.83,"$1,801.00","$1,801.00","$1,285.37","$1,316.19",$310.30,"$1,285.37","$1,285.37",$315.34,"$1,801.00","$1,376.63","$1,801.00","$1,426.39","$1,440.80","$1,801.00",$115.87,$72.83,$286.72,"$1,311.08"
36100696,EAP,CPT® 38525,,"Bx, Open Deep Ax Node","$5,701.00",$0.00,"$5,701.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,701.00",$0.00,"$2,327.00","$4,515.19","$4,560.80",$0.00,$0.00,$0.00,$0.00,$0.00
36100697,EAP,CPT® 38790,,Inj Lymphangiography,"$4,400.00",$0.00,"$4,400.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,400.00",$0.00,"$2,200.00","$3,484.80","$3,520.00",$0.00,$0.00,$0.00,$0.00,$0.00
36100698,EAP,CPT® 38792,,Identify Sentinel Node,$484.00,$0.00,$484.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$484.00,$0.00,$484.00,$383.33,$387.20,$0.00,$0.00,$0.00,$0.00,$0.00
36100699,EAP,CPT® 40490,,Biopsy Of Lip,$577.00,$0.00,$577.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$577.00,$0.00,$577.00,$456.98,$461.60,$0.00,$0.00,$0.00,$0.00,$0.00
36100701,EAP,CPT® 40800,,"I&d, Intra-oral, Simple",$705.00,$0.00,$705.00,$382.82,$0.00,$584.94,$121.47,$0.00,$0.00,$123.44,$705.00,$611.80,$705.00,$558.36,$564.00,$705.00,$87.87,$128.30,$112.24,$582.67
36100702,EAP,CPT® 40801,,"I&d Intra-oral, Complex","$1,582.00",$0.00,"$1,582.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,582.00",$0.00,"$1,582.00","$1,252.94","$1,265.60",$0.00,$0.00,$0.00,$0.00,$0.00
36100703,EAP,CPT® 40808,,Biopsy Vestibule Of Mouth,$872.00,$0.00,$872.00,$872.00,$0.00,$423.57,$150.24,$0.00,$0.00,$152.68,$872.00,$443.02,$872.00,$690.62,$697.60,$615.51,$81.68,$89.03,$138.82,$421.92
36100704,EAP,CPT® 36593,,Declot Vascular Access Device,"$2,030.00",$0.00,"$1,624.00","$1,624.00",$0.00,$296.88,$279.81,$0.00,$0.00,$284.35,"$1,624.00",$310.51,"$1,624.00","$1,286.21","$1,299.20",$431.41,$30.97,$32.05,$258.54,$295.72
36100705,EAP,CPT® 40812,,Exc/les/mouth W/simple Repair,"$6,726.00",$161.83,"$6,726.00","$2,106.30","$4,800.35","$1,293.88","$1,158.86","$4,800.35","$4,800.35","$1,177.67","$6,726.00","$1,353.31","$2,255.00","$5,326.99","$5,380.80","$1,880.24",$161.83,$196.45,"$1,070.78","$1,288.86"
36100706,EAP,CPT® 40814,,Exc/les/mouth W/complex Repair,"$5,221.00",$0.00,"$5,221.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,221.00",$0.00,"$2,327.00","$4,135.03","$4,176.80",$0.00,$0.00,$0.00,$0.00,$0.00
36100707,EAP,CPT® 40819,,Exc Frenum Libial Buccal,"$2,636.00",$0.00,"$2,636.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,636.00",$0.00,"$2,255.00","$2,087.71","$2,108.80",$0.00,$0.00,$0.00,$0.00,$0.00
36100708,EAP,CPT® 40820,,Dest/les Vestibule Mouth,"$6,081.00",$0.00,"$6,081.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,081.00",$0.00,"$2,255.00","$4,816.15","$4,864.80",$0.00,$0.00,$0.00,$0.00,$0.00
36100709,EAP,CPT® 41015,,I&d Extraoral Sublingual,$955.00,$0.00,$955.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$955.00,$0.00,$955.00,$756.36,$764.00,$0.00,$0.00,$0.00,$0.00,$0.00
36100710,EAP,CPT® 41016,,"I&d,floor Of Mouth-submental","$5,605.00",$0.00,"$5,605.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,605.00",$0.00,"$2,255.00","$4,439.16","$4,484.00",$0.00,$0.00,$0.00,$0.00,$0.00
36100711,EAP,CPT® 41017,,"I&d,floor/mouth-submandibular","$2,646.00",$0.00,"$2,646.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,646.00",$0.00,"$2,255.00","$2,095.63","$2,116.80",$0.00,$0.00,$0.00,$0.00,$0.00
36100712,EAP,CPT® 41018,,"I&d,floor Of Mouth-masticator","$2,344.00",$0.00,"$2,344.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,344.00",$0.00,"$2,255.00","$1,856.45","$1,875.20",$0.00,$0.00,$0.00,$0.00,$0.00
36100713,EAP,CPT® 41100,,Biopsy Anterior 2/3 Of Tongue,$989.00,$108.86,$989.00,$989.00,$989.00,$423.57,$170.40,$989.00,$989.00,$173.17,$989.00,$443.02,$989.00,$783.29,$791.20,$615.51,$116.06,$108.86,$157.45,$421.92
36100715,EAP,CPT® 41105,,Biopsy Posterior 1/3 Tongue,"$2,235.00",$0.00,"$2,235.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,235.00",$0.00,"$2,235.00","$1,770.12","$1,788.00",$0.00,$0.00,$0.00,$0.00,$0.00
36100717,EAP,CPT® 41108,,"Biopsy, Floor Of Mouth","$1,500.00",$0.00,"$1,500.00","$1,500.00",$0.00,"$1,316.19",$258.44,$0.00,$0.00,$262.64,"$1,500.00","$1,376.63","$1,500.00","$1,188.00","$1,200.00","$1,500.00",$90.18,$90.83,$238.80,"$1,311.08"
36100718,EAP,CPT® 41116,,Exc Lesion Floor Of Mouth,"$4,509.00",$0.00,"$4,509.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,509.00",$0.00,"$2,255.00","$3,571.13","$3,607.20",$0.00,$0.00,$0.00,$0.00,$0.00
36100719,EAP,CPT® 41822,,Excision Of Fibrous Tuberosity,"$4,493.00",$0.00,"$4,493.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,493.00",$0.00,"$2,255.00","$3,558.46","$3,594.40",$0.00,$0.00,$0.00,$0.00,$0.00
36100720,EAP,CPT® 41823,,Excision Of Osseoustuberosity,"$4,910.00",$0.00,"$4,910.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,910.00",$0.00,"$2,327.00","$3,888.72","$3,928.00",$0.00,$0.00,$0.00,$0.00,$0.00
36100721,EAP,CPT® 41826,,Exc W/simple Repair Dentoalveo,"$3,486.00",$0.00,"$3,486.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,486.00",$0.00,"$2,255.00","$2,760.91","$2,788.80",$0.00,$0.00,$0.00,$0.00,$0.00
36100722,EAP,CPT® 41850,,"Destruct Lesion, Dentoalveolar","$5,372.00",$0.00,"$5,372.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,372.00",$0.00,"$2,255.00","$4,254.62","$4,297.60",$0.00,$0.00,$0.00,$0.00,$0.00
36100723,EAP,CPT® 41874,,"Alveoloplasty, Each Quadrant","$3,080.00",$0.00,"$3,080.00","$2,106.30","$2,198.20","$2,511.64",$0.00,"$2,198.20","$2,198.20",$539.28,"$3,080.00","$2,626.99","$3,080.00","$2,439.36","$2,464.00","$3,080.00",$0.00,$259.89,$490.34,"$2,501.89"
36100724,EAP,CPT® 41899,,Completely Bony,"$1,880.00",$0.00,"$1,880.00","$1,880.00",$0.00,$195.27,$323.91,$0.00,$0.00,$329.17,"$1,880.00",$204.24,"$1,880.00","$1,488.96","$1,504.00",$283.76,$294.22,$0.00,$299.30,$194.51
36100725,EAP,CPT® 42100,,"Biopsy Palate, Uvula","$1,833.00",$0.00,"$1,833.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,833.00",$0.00,"$1,833.00","$1,451.74","$1,466.40",$0.00,$0.00,$0.00,$0.00,$0.00
36100727,EAP,CPT® 42104,,"Exc Palate, Uvula,w/o Closure","$3,466.00",$0.00,"$3,466.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,466.00",$0.00,"$2,255.00","$2,745.07","$2,772.80",$0.00,$0.00,$0.00,$0.00,$0.00
36100728,EAP,CPT® 42140,,Uvulectomy,"$3,002.00",$0.00,"$3,002.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,002.00",$0.00,"$2,327.00","$2,377.58","$2,401.60",$0.00,$0.00,$0.00,$0.00,$0.00
36100729,EAP,CPT® 42160,,"Dest Lesion, Palate Or Uvula","$7,507.00",$0.00,"$7,507.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$7,507.00",$0.00,"$2,255.00","$5,945.54","$6,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
36100730,EAP,CPT® 42400,,"Biopsy Of Salivary Gland,needl","$4,670.00",$0.00,"$4,670.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,670.00",$0.00,"$2,255.00","$3,698.64","$3,736.00",$0.00,$0.00,$0.00,$0.00,$0.00
36100732,EAP,CPT® 42700,,I&d Peritonsillar Abscess,$440.00,$70.05,$440.00,$440.00,$440.00,$195.27,$75.81,$440.00,$440.00,$77.04,$440.00,$204.24,$440.00,$348.48,$352.00,$283.76,$122.16,$139.13,$70.05,$194.51
36100733,EAP,CPT® 42405,,Biopsy Of Salivary Gland,"$9,551.00",$0.00,"$9,551.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$9,551.00",$0.00,"$2,327.00","$7,564.39","$7,640.80",$0.00,$0.00,$0.00,$0.00,$0.00
36100734,EAP,CPT® 42800,,"Biopsy, Oropharynx","$5,168.00",$0.00,"$5,168.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,168.00",$0.00,"$2,255.00","$4,093.06","$4,134.40",$0.00,$0.00,$0.00,$0.00,$0.00
36100735,EAP,CPT® 42804,,"Biopsy, Nasopharynx","$3,142.00",$0.00,"$3,142.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,142.00",$0.00,"$2,255.00","$2,488.46","$2,513.60",$0.00,$0.00,$0.00,$0.00,$0.00
36100738,EAP,CPT® 43246,,G-tube Insertion,"$5,711.00",$0.00,"$5,711.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,711.00",$0.00,"$2,327.00","$4,523.11","$4,568.80",$0.00,$0.00,$0.00,$0.00,$0.00
36100740,EAP,CPT® 43450,,Dil Eso/unguide Bougie 1>1 Pas,"$2,096.00",$0.00,"$2,096.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,096.00",$0.00,"$2,096.00","$1,660.03","$1,676.80",$0.00,$0.00,$0.00,$0.00,$0.00
36100742,EAP,CPT® 43752,,Naso Gastric Tube Place,"$2,052.00",$42.55,"$2,052.00","$2,052.00","$1,464.51",$348.65,$353.55,"$1,464.51","$1,464.51",$359.29,"$2,052.00",$364.66,"$2,052.00","$1,625.18","$1,641.60",$506.64,$321.14,$42.55,$326.68,$347.29
36100747,EAP,CPT® 43761,,Reposition Gastrostomy Tube,"$5,519.00",$0.00,"$5,519.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,519.00",$0.00,"$2,255.00","$4,371.05","$4,415.20",$0.00,$0.00,$0.00,$0.00,$0.00
36100748,EAP,CPT® 44015,,Jejunostomy Intra-op Ent Alime,"$6,567.00",$0.00,"$6,567.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,567.00",$0.00,"$2,255.00","$5,201.06","$5,253.60",$0.00,$0.00,$0.00,$0.00,$0.00
36100749,EAP,CPT® 44373,,Peg Conversion To Pej,"$4,055.00",$0.00,"$4,055.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,055.00",$0.00,"$2,327.00","$3,211.56","$3,244.00",$0.00,$0.00,$0.00,$0.00,$0.00
36100751,EAP,CPT® 44500,,Intro Of Long Gi Tube,"$1,304.00",$0.00,"$1,304.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,304.00",$0.00,"$1,304.00","$1,032.77","$1,043.20",$0.00,$0.00,$0.00,$0.00,$0.00
36100754,EAP,CPT® 45000,,Drain Pelvic Abscess Us,"$6,884.00",$0.00,"$6,884.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,884.00",$0.00,"$2,255.00","$5,452.13","$5,507.20",$0.00,$0.00,$0.00,$0.00,$0.00
36100757,EAP,CPT® 46040,,Perirectal Abscess,"$2,981.00",$0.00,"$2,981.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,981.00",$0.00,"$2,858.00","$2,360.95","$2,384.80",$0.00,$0.00,$0.00,$0.00,$0.00
36100758,EAP,CPT® 46600,,"Anoscopy, Diagnostic, Inc Spec Collect",$542.00,$0.00,$542.00,$542.00,$0.00,$104.55,$93.38,$0.00,$0.00,$94.90,$542.00,$109.35,$542.00,$429.26,$433.60,$151.93,$37.41,$42.17,$86.29,$104.14
36100759,EAP,CPT® 46606,,Anoscopy And Biopsy,"$2,137.00",$52.76,"$2,137.00","$2,106.30","$1,525.18",$962.95,$368.19,"$1,525.18","$1,525.18",$374.17,"$2,137.00","$1,007.17","$2,137.00","$1,692.50","$1,709.60","$1,399.33",$52.76,$78.23,$340.21,$959.21
36100760,EAP,CPT® 46900,,Destr Condyloma Anal - Chemic,$955.00,$0.00,$955.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$955.00,$0.00,$955.00,$756.36,$764.00,$0.00,$0.00,$0.00,$0.00,$0.00
36100763,EAP,CPT® 46916,,Anal Cryo Surgery,$433.00,$0.00,$433.00,$433.00,$0.00,$167.55,$74.60,$0.00,$0.00,$75.81,$433.00,$175.24,$433.00,$342.94,$346.40,$243.48,$138.83,$146.36,$68.93,$166.90
36100764,EAP,CPT® 47000,,"Liver Biopsy, Needle, Percut","$2,073.00",$92.31,"$2,073.00","$2,073.00","$1,479.50","$1,316.19",$357.17,"$1,479.50","$1,479.50",$362.97,"$2,073.00","$1,376.63","$2,073.00","$1,641.82","$1,658.40","$1,912.65",$233.09,$92.31,$330.02,"$1,311.08"
36100769,EAP,CPT® 47001,,BX LIVER ADDTL PROC PERCUT BCT,"$2,713.00",$0.00,"$2,713.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,713.00",$0.00,"$2,255.00","$2,148.70","$2,170.40",$0.00,$0.00,$0.00,$0.00,$0.00
36100770,EAP,CPT® 47015,,Exploratory Laparotomy,"$4,813.00",$0.00,"$4,813.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,813.00",$0.00,"$2,255.00","$3,811.90","$3,850.40",$0.00,$0.00,$0.00,$0.00,$0.00
36100771,EAP,CPT® 47380,,"Ablation, Open Liver Tumor, Rf","$6,657.00",$0.00,"$6,657.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,657.00",$0.00,"$2,255.00","$5,272.34","$5,325.60",$0.00,$0.00,$0.00,$0.00,$0.00
36100773,EAP,CPT® 47382,,"Ablation, Liver Tumor; Rf","$8,978.00",$637.15,"$8,978.00","$3,389.40","$6,407.60","$4,635.04","$1,546.86","$6,407.60","$5,416.74","$1,571.98","$8,978.00","$4,847.92","$5,452.00","$7,110.58","$7,182.40","$6,735.53",$637.15,$774.64,"$1,429.30","$4,617.06"
36100774,EAP,CPT® 47490,,DRAIN CHOLECYSTOSTOMY S&I BCT,"$5,903.00",$345.72,"$5,903.00","$3,205.33","$4,212.97","$2,981.55","$1,017.06","$4,212.97","$4,212.97","$1,033.57","$5,903.00","$3,118.48","$2,255.00","$4,675.18","$4,722.40","$4,332.71",$444.58,$345.72,$939.76,"$2,969.98"
36100781,EAP,CPT® 47555,,DILAT BIL STRICT W/O STENT SPV,"$4,136.00",$0.00,"$4,136.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,136.00",$0.00,"$2,858.00","$3,275.71","$3,308.80",$0.00,$0.00,$0.00,$0.00,$0.00
36100783,EAP,CPT® 47556,,Biliary Dil Strict W/stent,"$8,728.00",$0.00,"$8,728.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$8,728.00",$0.00,"$6,105.00","$6,912.58","$6,982.40",$0.00,$0.00,$0.00,$0.00,$0.00
36100786,EAP,CPT® 48000,,PANCREATITIS PLACE DRAIN BCT,"$9,260.00",$0.00,"$9,260.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$9,260.00",$0.00,"$2,327.00","$7,333.92","$7,408.00",$0.00,$0.00,$0.00,$0.00,$0.00
36100787,EAP,CPT® 48102,,BX PANCREAS PERCUT NDL BCT,"$2,114.00",$0.00,"$2,114.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,114.00",$0.00,"$2,114.00","$1,674.29","$1,691.20",$0.00,$0.00,$0.00,$0.00,$0.00
36100800,EAP,CPT® 37211,,Thrombolytic Art Therapy W/s/i Any Meth Init Day,"$24,394.00",$0.00,"$24,394.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$24,394.00",$0.00,"$2,255.00","$19,320.05","$19,515.20",$0.00,$0.00,$0.00,$0.00,$0.00
36100802,EAP,CPT® 37212,,Thrombolytic Venous Therapy  W S/i Any Meth Init Day,"$24,394.00",$0.00,"$24,394.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$24,394.00",$0.00,"$2,255.00","$19,320.05","$19,515.20",$0.00,$0.00,$0.00,$0.00,$0.00
36100804,EAP,CPT® 49180,,Ablation Abd Standard Bct,"$2,922.00",$87.64,"$2,922.00","$2,106.30","$2,085.43","$1,316.19",$503.45,"$2,085.43","$2,085.43",$511.62,"$2,922.00","$1,376.63","$2,255.00","$2,314.22","$2,337.60","$1,912.65",$203.88,$87.64,$465.18,"$1,311.08"
36100805,EAP,CPT® 49180,,Bx Abd/retroper Mass Us,"$2,922.00",$87.64,"$2,922.00","$2,106.30","$2,085.43","$1,316.19",$503.45,"$2,085.43","$2,085.43",$511.62,"$2,922.00","$1,376.63","$2,255.00","$2,314.22","$2,337.60","$1,912.65",$203.88,$87.64,$465.18,"$1,311.08"
36100806,EAP,CPT® 49180,,Bx Retroperitone Mass Perc Bct,"$2,922.00",$87.64,"$2,922.00","$2,106.30","$2,085.43","$1,316.19",$503.45,"$2,085.43","$2,085.43",$511.62,"$2,922.00","$1,376.63","$2,255.00","$2,314.22","$2,337.60","$1,912.65",$203.88,$87.64,$465.18,"$1,311.08"
36100807,EAP,CPT® 49419,,Insert. Of Intrperitoneal Cath,"$13,433.00",$0.00,"$13,433.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$13,433.00",$0.00,"$2,255.00","$10,638.94","$10,746.40",$0.00,$0.00,$0.00,$0.00,$0.00
36100808,EAP,CPT® 49421,,Peritoneal Dialysis Cat.placem,"$13,853.00",$0.00,"$13,853.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$13,853.00",$0.00,"$2,255.00","$10,971.58","$11,082.40",$0.00,$0.00,$0.00,$0.00,$0.00
36100809,EAP,CPT® 49423,,CATHETER EXCH RAD GUIDE BCT,"$4,076.00",$0.00,"$4,076.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,076.00",$0.00,"$3,606.00","$3,228.19","$3,260.80",$0.00,$0.00,$0.00,$0.00,$0.00
36100810,EAP,CPT® 37213,,Throm Art/ven Therapy  W S/i  Inc F/u Cath Subsq Day,"$41,496.00",$0.00,"$41,496.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$41,496.00",$0.00,"$2,858.00","$32,864.83","$33,196.80",$0.00,$0.00,$0.00,$0.00,$0.00
36100811,EAP,CPT® 49424,,Inj Dye Via Previous Drn Bct,"$4,076.00",$0.00,"$4,076.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,076.00",$0.00,"$2,255.00","$3,228.19","$3,260.80",$0.00,$0.00,$0.00,$0.00,$0.00
36100812,EAP,CPT® 49427,,"Injection, Abdominal Shunt",$436.00,$0.00,$436.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$436.00,$0.00,$436.00,$345.31,$348.80,$0.00,$0.00,$0.00,$0.00,$0.00
36100813,EAP,CPT® 49440,,Gastrostomy Tube Place S&i Spv,"$4,947.00",$213.84,"$4,947.00","$2,496.90","$3,530.67","$1,493.39",$852.34,"$3,530.67","$3,530.67",$866.18,"$4,947.00","$1,561.98","$2,255.00","$3,918.02","$3,957.60","$2,170.16",$774.21,$213.84,$787.56,"$1,487.60"
36100814,EAP,CPT® 49446,,G Tube Check,"$6,477.00",$0.00,"$6,477.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,477.00",$0.00,"$2,255.00","$5,129.78","$5,181.60",$0.00,$0.00,$0.00,$0.00,$0.00
36100815,EAP,CPT® 49450,,Replace G/c Tube Perc,"$3,319.00",$68.88,"$3,319.00","$2,106.30","$2,368.77",$753.62,$571.85,"$2,368.77","$2,368.77",$581.13,"$3,319.00",$788.23,"$2,255.00","$2,628.65","$2,655.20","$1,095.14",$685.21,$68.88,$528.38,$750.70
36100816,EAP,CPT® 49452,,Replace G-j Tube Perc,"$3,319.00",$144.98,"$3,319.00","$2,106.30","$2,368.77",$753.62,$571.85,"$2,368.77","$2,368.77",$581.13,"$3,319.00",$788.23,"$2,255.00","$2,628.65","$2,655.20","$1,095.14",$885.13,$144.98,$528.38,$750.70
36100818,EAP,CPT® 50200,,BX RENAL PERCUT TROCAR/NDL BCT,"$2,337.00",$133.42,"$2,337.00","$2,106.30","$1,667.92","$1,316.19",$402.65,"$1,667.92","$1,667.92",$409.19,"$2,337.00","$1,376.63","$2,255.00","$1,850.90","$1,869.60","$1,912.65",$161.61,$133.42,$372.05,"$1,311.08"
36100819,EAP,CPT® 50200,,Percutaneous Kidney Biopsy,"$2,337.00",$133.42,"$2,337.00","$2,106.30","$1,667.92","$1,316.19",$402.65,"$1,667.92","$1,667.92",$409.19,"$2,337.00","$1,376.63","$2,255.00","$1,850.90","$1,869.60","$1,912.65",$161.61,$133.42,$372.05,"$1,311.08"
36100821,EAP,CPT® 50382,,"Change Urter Stent, Percut","$7,360.00",$0.00,"$7,360.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$7,360.00",$0.00,"$2,327.00","$5,829.12","$5,888.00",$0.00,$0.00,$0.00,$0.00,$0.00
36100822,EAP,CPT® 50384,,"Remove Urter Stent, Percut","$6,573.00",$0.00,"$6,573.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,573.00",$0.00,"$2,255.00","$5,205.82","$5,258.40",$0.00,$0.00,$0.00,$0.00,$0.00
36100823,EAP,CPT® 50387,,Change Ext/int Ureter Stent,"$2,740.00",$87.64,"$2,740.00","$2,106.30","$1,955.54","$1,698.74",$108.01,"$1,955.54","$1,955.54",$479.75,"$2,740.00","$1,776.76","$2,255.00","$2,170.08","$2,192.00","$2,468.57",$790.32,$87.64,$436.21,"$1,692.15"
36100824,EAP,CPT® 50389,,Remove Renal Tube With Fluro,$997.00,$0.00,$997.00,$997.00,$0.00,$533.66,$59.62,$0.00,$0.00,$174.57,$997.00,$558.17,$997.00,$789.62,$797.60,$775.50,$541.78,$55.90,$158.72,$531.59
36100825,EAP,CPT® 50390,,Aspir/inject Renal Cyst/pelvis,"$4,210.00",$0.00,"$4,210.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,210.00",$0.00,"$2,255.00","$3,334.32","$3,368.00",$0.00,$0.00,$0.00,$0.00,$0.00
36100831,EAP,CPT® 50592,,"Ablation, Renal Tumor, Rf","$15,251.00",$357.73,"$15,251.00","$3,389.40","$10,884.64","$4,635.04",$395.35,"$10,884.64","$5,416.74","$2,670.33","$15,251.00","$4,847.92","$5,452.00","$12,078.79","$12,200.80","$6,735.53","$6,100.60",$357.73,"$2,427.96","$4,617.06"
36100832,EAP,CPT® 50684,,Injection For Ureter Xray,$774.00,$0.00,$774.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$774.00,$0.00,$387.00,$613.01,$619.20,$0.00,$0.00,$0.00,$0.00,$0.00
36100833,EAP,CPT® 50688,,Change Of Ureter Tube/stent,"$2,173.00",$0.00,"$2,173.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,173.00",$0.00,"$2,173.00","$1,721.02","$1,738.40",$0.00,$0.00,$0.00,$0.00,$0.00
36100834,EAP,CPT® 50690,,Inject For Ureter X-ray,$788.00,$0.00,$788.00,$788.00,$788.00,$0.00,$135.77,$788.00,$788.00,$137.97,$788.00,$0.00,$394.00,$624.10,$630.40,$0.00,$298.44,$72.83,$125.45,$0.00
36100835,EAP,CPT® 51080,,DRN PERIVESIC/PREVESIC ABS BCT,"$3,734.00",$0.00,"$3,734.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,734.00",$0.00,"$2,255.00","$2,957.33","$2,987.20",$0.00,$0.00,$0.00,$0.00,$0.00
36100836,EAP,CPT® 51100,,Drain Bladder By Needle,$647.00,$0.00,$647.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$647.00,$0.00,$647.00,$512.42,$517.60,$0.00,$0.00,$0.00,$0.00,$0.00
36100839,EAP,CPT® 51102,,Bladder Tap-suprapub W Cath In,"$5,564.00",$0.00,"$5,564.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,564.00",$0.00,"$2,255.00","$4,406.69","$4,451.20",$0.00,$0.00,$0.00,$0.00,$0.00
36100840,EAP,CPT® 51102,,Drain Bl W/cath Insertion,"$5,564.00",$0.00,"$5,564.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,564.00",$0.00,"$2,255.00","$4,406.69","$4,451.20",$0.00,$0.00,$0.00,$0.00,$0.00
36100841,EAP,CPT® 51102,,Drainage Of Bladder,"$5,564.00",$0.00,"$5,564.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,564.00",$0.00,"$2,255.00","$4,406.69","$4,451.20",$0.00,$0.00,$0.00,$0.00,$0.00
36100842,EAP,CPT® 51600,,Inject Cystography/voiding,"$1,274.00",$0.00,"$1,274.00",$691.78,"$1,208.73",$0.00,$219.50,"$1,208.73","$1,208.73",$223.07,"$1,274.00",$0.00,$637.00,"$1,009.01","$1,019.20",$0.00,$280.11,$46.16,$202.82,$0.00
36100844,EAP,CPT® 51610,,Inject Cystography/void Retro,"$2,404.00",$0.00,"$2,404.00","$1,305.37","$1,715.73",$0.00,$414.20,"$1,715.73","$1,715.73",$420.92,"$2,404.00",$0.00,"$1,202.00","$1,903.97","$1,923.20",$0.00,$301.43,$66.70,$382.72,$0.00
36100846,EAP,CPT® 51700,,Bladder Irrigation &/or Instil,$504.00,$0.00,$504.00,$0.00,$0.00,$0.00,$86.84,$0.00,$0.00,$88.25,$504.00,$0.00,$504.00,$399.17,$403.20,$0.00,$100.47,$0.00,$0.00,$0.00
36100848,EAP,CPT® 51701,,Insert Straight Cath In & Out,$864.00,$0.00,$864.00,$864.00,$0.00,$104.55,$148.86,$0.00,$0.00,$151.28,$864.00,$109.35,$864.00,$684.29,$691.20,$151.93,$57.62,$27.40,$137.55,$104.14
36100849,EAP,CPT® 51702,,Cath Insert Indwelling,"$1,069.00",$0.00,"$1,069.00","$1,069.00",$0.00,$104.55,$184.18,$0.00,$0.00,$187.17,"$1,069.00",$109.35,"$1,069.00",$846.65,$855.20,$151.93,$91.18,$26.68,$170.18,$104.14
36100850,EAP,CPT® 51702,,Insert Foley Cath,"$1,069.00",$0.00,"$1,069.00","$1,069.00",$0.00,$104.55,$184.18,$0.00,$0.00,$187.17,"$1,069.00",$109.35,"$1,069.00",$846.65,$855.20,$151.93,$91.18,$26.68,$170.18,$104.14
36100851,EAP,CPT® 51703,,Insert Complicated Cath,"$1,808.00",$80.41,"$1,808.00","$1,808.00","$1,290.37",$132.66,$311.51,"$1,290.37","$1,290.37",$316.57,"$1,808.00",$138.76,"$1,808.00","$1,431.94","$1,446.40",$192.78,$170.19,$80.41,$287.83,$132.15
36100852,EAP,CPT® 51705,,Change Cysto Tube Simple,$625.00,$0.00,$625.00,$625.00,$0.00,$225.25,$107.68,$0.00,$0.00,$109.43,$625.00,$235.59,$625.00,$495.00,$500.00,$327.32,$86.33,$54.08,$99.50,$224.37
36100853,EAP,CPT® 51710,,Change Cysto Tube Complicated,"$3,954.00",$0.00,"$3,954.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,954.00",$0.00,"$2,255.00","$3,131.57","$3,163.20",$0.00,$0.00,$0.00,$0.00,$0.00
36100854,EAP,CPT® 51720,,Instill Bladder Anticancer Age,"$1,028.00",$0.00,"$1,028.00","$1,028.00",$0.00,$225.25,$177.12,$0.00,$0.00,$179.99,"$1,028.00",$235.59,"$1,028.00",$814.18,$822.40,$327.32,$147.65,$45.44,$163.66,$224.37
36100855,EAP,CPT® 51726,,Cystometrogram,"$1,648.00",$0.00,"$1,648.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,648.00",$0.00,"$1,648.00","$1,305.22","$1,318.40",$0.00,$0.00,$0.00,$0.00,$0.00
36100858,EAP,CPT® 51798,,Residual Urine By Ultrasound,$207.00,$0.00,$207.00,$112.40,$0.00,$52.75,$35.67,$0.00,$0.00,$36.24,$207.00,$55.17,$207.00,$163.94,$165.60,$76.65,$19.99,$10.44,$32.95,$52.54
36100860,EAP,CPT® 52000,,Cystourethroscopy,"$3,100.00",$84.02,"$3,100.00","$2,106.30","$2,212.47",$533.66,$534.11,"$2,212.47","$2,212.47",$542.79,"$3,100.00",$558.17,"$2,255.00","$2,455.20","$2,480.00",$775.50,$152.62,$84.02,$493.52,$531.59
36100861,EAP,CPT® 52005,,Cystourethro W Ureteral Cath,"$5,962.00",$0.00,"$5,962.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,962.00",$0.00,"$2,327.00","$4,721.90","$4,769.60",$0.00,$0.00,$0.00,$0.00,$0.00
36100862,EAP,CPT® 52281,,Perc Dilate Ureter W Balloon,"$6,176.00",$157.57,"$6,176.00","$2,496.90","$4,407.81","$1,698.74","$1,064.09","$4,407.81","$4,407.81","$1,081.37","$6,176.00","$1,776.76","$2,327.00","$4,891.39","$4,940.80","$2,468.57",$208.00,$157.57,$983.22,"$1,692.15"
36100863,EAP,CPT® 52310,,Cysto W Stent Removal,"$5,783.00",$156.86,"$5,783.00","$2,496.90","$4,127.33","$1,698.74",$996.38,"$4,127.33","$4,127.33","$1,012.56","$5,783.00","$1,776.76","$2,327.00","$4,580.14","$4,626.40","$2,468.57",$409.12,$156.86,$920.65,"$1,692.15"
36100864,EAP,CPT® 52332,,Cysto W Ureter Stent Plcmnt,"$10,907.00",$0.00,"$10,907.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$10,907.00",$0.00,"$2,327.00","$8,638.34","$8,725.60",$0.00,$0.00,$0.00,$0.00,$0.00
36100865,EAP,CPT® 53600,,Dilate Urethra Strict Male Ini,$694.00,$0.00,$694.00,$694.00,$0.00,$225.25,$0.00,$0.00,$0.00,$0.00,$694.00,$235.59,$694.00,$549.65,$555.20,$327.32,$0.00,$65.99,$110.48,$224.37
36100866,EAP,CPT® 53601,,Dilate Stricture Male Subseq,$317.00,$0.00,$317.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$317.00,$0.00,$317.00,$251.06,$253.60,$0.00,$0.00,$0.00,$0.00,$0.00
36100867,EAP,CPT® 53620,,Dilate Strict Male Filiform Ix,"$4,447.00",$0.00,"$4,447.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,447.00",$0.00,"$2,255.00","$3,522.02","$3,557.60",$0.00,$0.00,$0.00,$0.00,$0.00
36100868,EAP,CPT® 53621,,Dilate Strict Male Filiform Su,$804.00,$0.00,$804.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$804.00,$0.00,$804.00,$636.77,$643.20,$0.00,$0.00,$0.00,$0.00,$0.00
36100869,EAP,CPT® 53660,,Dilate Urethra Strict Female I,$286.00,$0.00,$286.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$286.00,$0.00,$286.00,$226.51,$228.80,$0.00,$0.00,$0.00,$0.00,$0.00
36100870,EAP,CPT® 53661,,Dilate Urethra Strict Female S,$286.00,$0.00,$286.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$286.00,$0.00,$286.00,$226.51,$228.80,$0.00,$0.00,$0.00,$0.00,$0.00
36100871,EAP,CPT® 54001,,Dorsal Slit  Exc Newborn,"$6,453.00",$0.00,"$6,453.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,453.00",$0.00,"$2,327.00","$5,110.78","$5,162.40",$0.00,$0.00,$0.00,$0.00,$0.00
36100872,EAP,CPT® 54015,,"Incise And Drain Penis, Deep","$4,851.00",$0.00,"$4,851.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,851.00",$0.00,"$3,606.00","$3,841.99","$3,880.80",$0.00,$0.00,$0.00,$0.00,$0.00
36100873,EAP,CPT® 54050,,"Les, Dest, Chem Penis, Simple",$763.00,$0.00,$763.00,$414.31,$0.00,$306.38,$131.46,$0.00,$0.00,$133.60,$763.00,$320.45,$763.00,$604.30,$610.40,$445.22,$92.54,$107.78,$121.47,$305.19
36100875,EAP,CPT® 54056,,Cryosurg Penis Lesion(s) Simpl,$307.00,$0.00,$307.00,$166.70,$0.00,$167.55,$52.89,$0.00,$0.00,$53.75,$307.00,$175.24,$307.00,$243.14,$245.60,$243.48,$104.42,$112.46,$48.87,$166.90
36100876,EAP,CPT® 54100,,Biopsy Of Penis,"$6,140.00",$0.00,"$6,140.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,140.00",$0.00,"$2,255.00","$4,862.88","$4,912.00",$0.00,$0.00,$0.00,$0.00,$0.00
36100877,EAP,CPT® 54150,,Circumcision,"$2,287.00",$0.00,"$2,079.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,079.00",$0.00,"$2,079.00","$1,646.57","$1,663.20",$0.00,$0.00,$0.00,$0.00,$0.00
36100878,EAP,CPT® 54200,,Treatment Of Penis Lesion,$672.00,$0.00,$672.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$672.00,$0.00,$672.00,$532.22,$537.60,$0.00,$0.00,$0.00,$0.00,$0.00
36100879,EAP,CPT® 54230,,Inject Corpora Cavernosography,"$1,897.00",$0.00,"$1,897.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,897.00",$0.00,"$1,897.00","$1,502.42","$1,517.60",$0.00,$0.00,$0.00,$0.00,$0.00
36100880,EAP,CPT® 54450,,Paraphimosis Reduction,$624.00,$59.86,$624.00,$624.00,$624.00,$225.25,$107.51,$624.00,$624.00,$109.26,$624.00,$235.59,$624.00,$494.21,$499.20,$327.32,$70.76,$59.86,$99.34,$224.37
36100881,EAP,CPT® 54700,,"Incise And Drain, Testes","$3,277.00",$0.00,"$3,277.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,277.00",$0.00,"$2,327.00","$2,595.38","$2,621.60",$0.00,$0.00,$0.00,$0.00,$0.00
36100882,EAP,CPT® 54860,,Removal Of Epididymis,"$7,853.00",$0.00,"$7,853.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$7,853.00",$0.00,"$2,858.00","$6,219.58","$6,282.40",$0.00,$0.00,$0.00,$0.00,$0.00
36100883,EAP,CPT® 55000,,Aspiration Of Hydrocele,$998.00,$0.00,$998.00,$541.91,$0.00,$584.94,$171.95,$0.00,$0.00,$174.74,$998.00,$611.80,$998.00,$790.42,$798.40,$850.02,$92.61,$87.97,$158.88,$582.67
36100884,EAP,CPT® 55250,,Removal Of Sperm Duct(s),"$2,500.00",$236.13,"$2,500.00","$2,496.90","$1,784.25","$1,698.74",$430.74,"$1,784.25","$1,784.25",$437.73,"$2,500.00","$1,776.76","$2,327.00","$1,980.00","$2,000.00","$2,468.57",$321.77,$236.13,$398.00,"$1,692.15"
36100885,EAP,CPT® 55700,,Biopsy Prostate Needle/punch,"$4,494.00",$135.95,"$4,494.00","$2,496.90","$3,207.37","$1,698.74",$774.29,"$3,207.37","$3,207.37",$786.86,"$4,494.00","$1,776.76","$2,327.00","$3,559.25","$3,595.20","$2,468.57",$147.73,$135.95,$715.44,"$1,692.15"
36100887,EAP,CPT® 56405,,I And D Vulva Perineal Absces,$294.00,$0.00,$294.00,$0.00,$0.00,$0.00,$50.65,$0.00,$0.00,$51.48,$294.00,$0.00,$294.00,$232.85,$235.20,$0.00,$107.63,$0.00,$0.00,$0.00
36100898,EAP,CPT® 56420,,Bartholin Gland Abscess,$672.00,$0.00,$672.00,$672.00,$0.00,$159.23,$115.78,$0.00,$0.00,$117.66,$672.00,$166.54,$672.00,$532.22,$537.60,$231.38,$106.60,$107.06,$106.98,$158.61
36100902,EAP,CPT® 37214,,Cess Therapy Cath Removalw/ Vess Close,"$8,844.00",$0.00,"$8,844.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$8,844.00",$0.00,"$2,858.00","$7,004.45","$7,075.20",$0.00,$0.00,$0.00,$0.00,$0.00
36100903,EAP,CPT® 56501,,"Cryosurgery, Vulvar","$6,520.00",$0.00,"$6,520.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,520.00",$0.00,"$2,255.00","$5,163.84","$5,216.00",$0.00,$0.00,$0.00,$0.00,$0.00
36100904,EAP,CPT® 56501,,Destroy Lesion(s) Vulva Simple,"$6,520.00",$0.00,"$6,520.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,520.00",$0.00,"$2,255.00","$5,163.84","$5,216.00",$0.00,$0.00,$0.00,$0.00,$0.00
36100906,EAP,CPT® 56515,,Destroy Lesion(s) Vulva Extens,"$4,428.00",$0.00,"$4,428.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,428.00",$0.00,"$2,858.00","$3,506.98","$3,542.40",$0.00,$0.00,$0.00,$0.00,$0.00
36100909,EAP,CPT® 56605,,"Vulvar Biopsy, One Lesion",$639.00,$63.10,$640.34,$586.00,$586.00,$612.22,$100.96,$586.00,$586.00,$102.60,$586.00,$640.34,$586.00,$464.11,$468.80,$586.00,$84.36,$63.10,$93.29,$609.84
36100914,EAP,CPT® 56606,,"Vulvar Bx, Each Addl Lesion",$556.00,$0.00,$556.00,$556.00,$0.00,$0.00,$95.80,$0.00,$0.00,$97.35,$556.00,$0.00,$556.00,$440.35,$444.80,$0.00,$53.12,$31.01,$88.52,$0.00
36100920,EAP,CPT® 56820,,"Colposcopy, Vulva",$502.00,$0.00,$502.00,$502.00,$0.00,$159.23,$86.49,$0.00,$0.00,$87.90,$502.00,$166.54,$502.00,$397.58,$401.60,$231.38,$116.33,$89.05,$79.92,$158.61
36100921,EAP,CPT® 56821,,"Colposcopy, Vulva + Vulva Bx","$1,627.00",$0.00,"$1,627.00","$1,627.00",$0.00,$259.59,$280.32,$0.00,$0.00,$284.87,"$1,627.00",$271.52,"$1,627.00","$1,288.58","$1,301.60",$377.23,$150.61,$118.98,$259.02,$258.59
36100923,EAP,CPT® 57020,,Colpocentesis,"$3,290.00",$0.00,"$3,290.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,290.00",$0.00,"$2,327.00","$2,605.68","$2,632.00",$0.00,$0.00,$0.00,$0.00,$0.00
36100925,EAP,CPT® 57061,,Destroy Vaginal Lesion(s) Simp,"$4,240.00",$0.00,"$4,240.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,240.00",$0.00,"$2,327.00","$3,358.08","$3,392.00",$0.00,$0.00,$0.00,$0.00,$0.00
36100926,EAP,CPT® 57065,,Destroy Vaginal Lesion(s) Exte,"$4,256.00",$0.00,"$4,256.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,256.00",$0.00,"$2,255.00","$3,370.75","$3,404.80",$0.00,$0.00,$0.00,$0.00,$0.00
36100929,EAP,CPT® 57100,,Vaginal Biopsy Simple,"$3,440.00",$68.51,"$3,440.00","$2,106.30","$2,455.13",$612.22,$592.69,"$2,455.13","$2,455.13",$602.32,"$3,440.00",$640.34,"$3,440.00","$2,724.48","$2,752.00",$889.66,$71.96,$68.51,$547.65,$609.84
36100930,EAP,CPT® 27096,,Bil Sacroiliac Jt Inj With Arthrography,"$3,197.00",$0.00,"$3,197.00","$2,106.30","$2,281.70",$0.00,$550.83,"$2,281.70","$2,281.70",$559.77,"$3,197.00",$0.00,"$2,255.00","$2,532.02","$2,557.60",$86.18,$398.44,$86.18,$508.96,$0.00
36100933,EAP,CPT® 57150,,Vaginal Irrigation,$477.00,$0.00,$477.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$477.00,$0.00,$477.00,$377.78,$381.60,$0.00,$0.00,$0.00,$0.00,$0.00
36100934,EAP,CPT® 57155,,Insertion Of T&o,"$4,272.00",$0.00,"$2,500.00",$0.00,$0.00,$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$2,327.00","$1,980.00","$2,000.00",$0.00,$410.73,$0.00,$0.00,$0.00
36100935,EAP,CPT® 57160,,Pessary Insertion,$338.00,$0.00,$338.00,$183.53,$0.00,$159.23,$58.24,$0.00,$0.00,$59.18,$338.00,$166.54,$338.00,$267.70,$270.40,$231.38,$60.59,$48.68,$53.81,$158.61
36100936,EAP,CPT® 57170,,Diaphragm  Cervical Cap Fittin,$500.00,$0.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$500.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
36100938,EAP,CPT® 57170,,Diaphragm Fitting,$500.00,$0.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$500.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
36100939,EAP,CPT® 57210,,Colpoperineorrhaphy,"$10,423.00",$0.00,"$10,423.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$10,423.00",$0.00,"$2,327.00","$8,255.02","$8,338.40",$0.00,$0.00,$0.00,$0.00,$0.00
36100940,EAP,CPT® 57420,,Colposcopy Of Vagina,"$1,240.00",$0.00,"$1,240.00","$1,240.00",$0.00,$259.59,$213.65,$0.00,$0.00,$217.11,"$1,240.00",$271.52,"$1,240.00",$982.08,$992.00,$377.23,$121.31,$94.46,$197.41,$258.59
36100941,EAP,CPT® 57420,,"Colposcopy, Vagina With Cervix","$1,240.00",$0.00,"$1,240.00","$1,240.00",$0.00,$259.59,$213.65,$0.00,$0.00,$217.11,"$1,240.00",$271.52,"$1,240.00",$982.08,$992.00,$377.23,$121.31,$94.46,$197.41,$258.59
36100942,EAP,CPT® 57421,,Colposcopy Bx Of Vagina+cervix,"$1,042.00",$0.00,"$1,042.00","$1,042.00",$0.00,$612.22,$179.53,$0.00,$0.00,$182.45,"$1,042.00",$640.34,"$1,042.00",$825.26,$833.60,$889.66,$158.06,$128.00,$165.89,$609.84
36100943,EAP,CPT® 57421,,COLPOSCOPY OF VAGINA W/BX,"$1,042.00",$0.00,"$1,042.00","$1,042.00",$0.00,$612.22,$179.53,$0.00,$0.00,$182.45,"$1,042.00",$640.34,"$1,042.00",$825.26,$833.60,$889.66,$158.06,$128.00,$165.89,$609.84
36100944,EAP,CPT® 57421,,"COLPOSCOPY, VAGINA W/ BX","$1,042.00",$0.00,"$1,042.00","$1,042.00",$0.00,$612.22,$179.53,$0.00,$0.00,$182.45,"$1,042.00",$640.34,"$1,042.00",$825.26,$833.60,$889.66,$158.06,$128.00,$165.89,$609.84
36100945,EAP,CPT® 57452,,Colposcopy Without Biopsy,$557.00,$77.33,$557.00,$557.00,$557.00,$159.23,$95.97,$557.00,$557.00,$97.53,$557.00,$166.54,$557.00,$441.14,$445.60,$231.38,$77.33,$95.18,$88.67,$158.61
36100951,EAP,CPT® 57454,,Colposcopy W/bx & Ecc,"$1,188.00",$99.94,"$1,188.00","$1,188.00","$1,188.00",$259.59,$204.69,"$1,188.00","$1,188.00",$208.01,"$1,188.00",$271.52,"$1,188.00",$940.90,$950.40,$377.23,$99.94,$140.25,$189.13,$258.59
36100956,EAP,CPT® 57455,,Colposcopy + Cx Bx,"$1,221.00",$115.02,"$1,221.00","$1,221.00","$1,208.73",$259.59,$210.37,"$1,208.73","$1,208.73",$213.79,"$1,221.00",$271.52,"$1,221.00",$967.03,$976.80,$377.23,$145.54,$115.02,$194.38,$258.59
36100960,EAP,CPT® 57456,,Colposcopy + Ecc,"$1,221.00",$106.36,"$1,221.00","$1,221.00","$1,208.73",$259.59,$210.37,"$1,208.73","$1,208.73",$213.79,"$1,221.00",$271.52,"$1,221.00",$967.03,$976.80,$377.23,$137.69,$106.36,$194.38,$258.59
36100961,EAP,CPT® 57460,,Colposcopy W/leep Bx,"$4,743.00",$168.01,"$4,743.00","$2,496.90","$3,385.08","$2,395.43",$817.20,"$3,385.08","$3,385.08",$830.46,"$4,743.00","$2,505.44","$2,255.00","$3,756.46","$3,794.40","$3,480.98",$178.42,$168.01,$755.09,"$2,386.14"
36100963,EAP,CPT® 57461,,Colposcopy W/leep Cone,"$8,521.00",$194.34,"$8,521.00","$2,706.90","$6,081.44","$2,395.43","$1,468.13","$6,081.44","$5,416.74","$1,491.96","$8,521.00","$2,505.44","$2,255.00","$6,748.63","$6,816.80","$3,480.98",$325.94,$194.34,"$1,356.54","$2,386.14"
36100964,EAP,CPT® 57500,,Cervical Biopsy,"$3,354.00",$71.26,"$3,354.00","$2,106.30","$2,393.75",$612.22,$577.88,"$2,393.75","$2,393.75",$587.26,"$3,354.00",$640.34,"$2,255.00","$2,656.37","$2,683.20",$889.66,$71.26,$78.23,$533.96,$609.84
36100967,EAP,CPT® 57511,,"Cryosurgery, Cervix",$793.00,$0.00,$793.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$793.00,$0.00,$793.00,$628.06,$634.40,$0.00,$0.00,$0.00,$0.00,$0.00
36100968,EAP,CPT® 57522,,Leep + Ecc + Cone,"$8,739.00",$255.93,"$8,739.00","$2,496.90","$6,237.02","$2,395.43","$1,505.69","$6,237.02","$5,416.74","$1,530.13","$8,739.00","$2,505.44","$2,327.00","$6,921.29","$6,991.20","$3,480.98",$255.93,$259.91,"$1,391.25","$2,386.14"
36100969,EAP,CPT® 57720,,Revision Of Cervix,"$6,286.00",$0.00,"$6,286.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,286.00",$0.00,"$2,858.00","$4,978.51","$5,028.80",$0.00,$0.00,$0.00,$0.00,$0.00
36100970,EAP,CPT® 58100,,Endometrial Biopsy,$346.00,$55.08,$346.00,$346.00,$346.00,$159.23,$59.61,$346.00,$346.00,$60.58,$346.00,$166.54,$346.00,$274.03,$276.80,$231.38,$59.72,$67.07,$55.08,$158.61
36100971,EAP,CPT® 0237T,,"Atherectomy, Branchiocephalic Artery","$12,918.00",$0.00,"$12,918.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$12,918.00",$0.00,"$6,105.00","$10,231.06","$10,334.40",$0.00,$0.00,$0.00,$0.00,$0.00
36100972,EAP,CPT® 0236T,,"Atherectomy, Aorta","$24,595.00",$0.00,"$24,595.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$24,595.00",$0.00,"$6,105.00","$19,479.24","$19,676.00",$0.00,$0.00,$0.00,$0.00,$0.00
36100973,EAP,CPT® 0234T,,"Atherectomy, Renal Artery","$24,595.00",$0.00,"$24,595.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$24,595.00",$0.00,"$6,105.00","$19,479.24","$19,676.00",$0.00,$0.00,$0.00,$0.00,$0.00
36100974,EAP,CPT® 58110,,Endometrial Bx In Conj W/colp,$240.00,$0.00,$240.00,$240.00,$0.00,$0.00,$43.25,$0.00,$0.00,$42.02,$240.00,$0.00,$120.00,$190.08,$192.00,$0.00,$50.14,$42.91,$38.21,$0.00
36100975,EAP,CPT® 0238T,,"Atherectomy, Lilac Artery","$18,351.00",$0.00,"$18,351.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$18,351.00",$0.00,"$6,105.00","$14,533.99","$14,680.80",$0.00,$0.00,$0.00,$0.00,$0.00
36100978,EAP,CPT® 58300,,Insertion Iud,$675.00,$0.00,$675.00,$675.00,$0.00,$120.15,$116.30,$0.00,$0.00,$118.19,$675.00,$0.00,$675.00,$534.60,$540.00,$405.00,$69.90,$0.00,$107.46,$0.00
36100980,EAP,CPT® 37197,,Retrieve Fb Percut Intravascul W/ S And I,"$32,988.00",$0.00,"$32,988.00","$2,706.90","$23,543.54","$2,657.38",$0.00,"$23,543.54","$5,416.74",$0.00,"$32,988.00","$2,779.42","$2,858.00","$26,126.50","$26,390.40","$3,861.64",$0.00,$315.16,"$5,251.69","$2,647.07"
36100981,EAP,CPT® 36221,,Non Sel Cath Plac Aort W Angio  Inc S/i,"$63,838.00",$0.00,"$56,630.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$56,630.00",$0.00,"$2,858.00","$44,850.96","$45,304.00",$0.00,$0.00,$0.00,$0.00,$0.00
36100982,EAP,CPT® 36222,,Sel Cath Plac Ext Carotid Angio W S&i,"$18,460.00",$0.00,"$16,376.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$16,376.00",$0.00,"$2,858.00","$12,969.79","$13,100.80",$0.00,$0.00,$0.00,$0.00,$0.00
36100983,EAP,CPT® 58301,,"Iud, Removal",$280.00,$0.00,$280.00,$280.00,$0.00,$259.59,$48.24,$0.00,$0.00,$49.03,$280.00,$271.52,$280.00,$221.76,$224.00,$280.00,$81.66,$70.31,$44.58,$258.59
36100984,EAP,CPT® 36223,,Sel Cath Plac Common/inom Intracranial Carotid,"$17,755.00",$330.96,"$15,750.00","$2,496.90","$11,240.78","$4,407.29","$2,713.65","$11,240.78","$5,416.74","$2,757.70","$15,750.00","$4,609.70","$2,858.00","$12,474.00","$12,600.00","$6,404.56","$1,513.65",$330.96,"$2,507.40","$4,390.19"
36100985,EAP,CPT® 36224,,Sel Cath Plac Internalcarotid Intracranial Carotid,"$20,316.00",$376.00,"$18,022.00","$2,706.90","$12,862.30","$4,407.29","$3,105.10","$12,862.30","$5,416.74","$3,155.51","$18,022.00","$4,609.70","$4,975.00","$14,273.42","$14,417.60","$6,404.56","$1,644.17",$376.00,"$2,869.10","$4,390.19"
36100986,EAP,CPT® 36225,,"Sel Cath Plac Sub Clav,/innom Uni W/angio And S/i","$17,755.00",$0.00,"$15,750.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$15,750.00",$0.00,"$2,858.00","$12,474.00","$12,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
36100987,EAP,CPT® 36226,,"Sel Cath Plac Sub Clav,/vert  W/angio And S/i","$57,197.00",$370.60,"$50,739.00","$2,706.90","$36,212.42","$4,407.29","$8,138.89","$36,212.42","$5,416.74","$8,138.89","$50,739.00","$4,609.70","$4,975.00","$40,185.29","$40,591.20","$6,404.56","$1,676.21",$370.60,"$8,077.65","$4,390.19"
36100988,EAP,CPT® 36227,,Sel Cath Plac Ext Carotid Angio W S&i,"$17,755.00",$0.00,"$15,750.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$15,750.00",$0.00,"$7,875.00","$12,474.00","$12,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
36100989,EAP,CPT® 58340,,Inject Hysterosalpingography,"$1,055.00",$0.00,"$1,055.00","$1,055.00",$0.00,$0.00,$181.77,$0.00,$0.00,$184.72,"$1,055.00",$0.00,"$1,055.00",$835.56,$844.00,$0.00,$214.45,$59.48,$167.96,$0.00
36100990,EAP,CPT® 58345,,Transcervical Intro Of Cathete,"$6,236.00",$0.00,"$6,236.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,236.00",$0.00,"$2,255.00","$4,938.91","$4,988.80",$0.00,$0.00,$0.00,$0.00,$0.00
36100991,EAP,CPT® 58558,,"Hysteroscopy, Biopsy","$5,665.00",$0.00,"$5,665.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,665.00",$0.00,"$2,858.00","$4,486.68","$4,532.00",$0.00,$0.00,$0.00,$0.00,$0.00
36100993,EAP,CPT® 59000,,Amniocentesis Us,"$1,117.00",$83.99,"$1,117.00","$1,117.00","$1,117.00",$612.22,$192.45,"$1,117.00","$1,117.00",$195.58,"$1,117.00",$640.34,"$1,117.00",$884.66,$893.60,$889.66,$95.25,$83.99,$177.83,$609.84
36100999,EAP,CPT® 59200,,Insert Cervical Dilator,$768.00,$0.00,$768.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$768.00,$0.00,$768.00,$608.26,$614.40,$0.00,$0.00,$0.00,$0.00,$0.00
36101000,EAP,CPT® 59300,,Episitomy/vaginal Repair,"$9,291.00",$0.00,"$9,291.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$9,291.00",$0.00,"$2,327.00","$7,358.47","$7,432.80",$0.00,$0.00,$0.00,$0.00,$0.00
36101001,EAP,CPT® 59414,,Delivery Of Placenta,"$6,078.00",$0.00,"$6,078.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,078.00",$0.00,"$2,255.00","$4,813.78","$4,862.40",$0.00,$0.00,$0.00,$0.00,$0.00
36101002,EAP,CPT® 59525,,Remove Uterus After Cesarean,"$9,769.00",$0.00,"$8,801.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$8,801.00",$0.00,"$2,255.00","$6,970.39","$7,040.80",$0.00,$0.00,$0.00,$0.00,$0.00
36101003,EAP,CPT® 59812,,Trtmt Of Spontaneous Abortion,"$3,666.00",$267.54,"$3,666.00","$3,666.00","$2,616.42","$2,395.43",$631.63,"$2,616.42","$2,616.42",$641.89,"$3,666.00","$2,505.44","$3,666.00","$2,903.47","$2,932.80","$3,480.98",$267.54,$316.83,$583.63,"$2,386.14"
36101004,EAP,CPT® 59820,,Trmt Of Missed Abort.-1st Trim,"$3,807.00",$0.00,"$3,807.00",$0.00,$0.00,$0.00,$655.93,$0.00,$0.00,$0.00,"$3,807.00",$0.00,"$3,807.00","$3,015.14","$3,045.60",$0.00,$302.12,$0.00,$0.00,$0.00
36101005,EAP,CPT® 59840,,Ind/abortion/dilation&curettag,"$3,743.00",$0.00,"$3,743.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,743.00",$0.00,"$3,743.00","$2,964.46","$2,994.40",$0.00,$0.00,$0.00,$0.00,$0.00
36101007,EAP,CPT® 59855,,Abortion By Vag. Sup. Insert,"$1,825.00",$0.00,"$1,825.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,825.00",$0.00,"$1,825.00","$1,445.40","$1,460.00",$0.00,$0.00,$0.00,$0.00,$0.00
36101008,EAP,CPT® 59855,,Induced Abortion After 16 Wks,"$1,825.00",$0.00,"$1,825.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,825.00",$0.00,"$1,825.00","$1,445.40","$1,460.00",$0.00,$0.00,$0.00,$0.00,$0.00
36101009,EAP,CPT® 59871,,Removal Ceralage Suture,"$3,585.00",$0.00,"$3,585.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,585.00",$0.00,"$3,585.00","$2,839.32","$2,868.00",$0.00,$0.00,$0.00,$0.00,$0.00
36101010,EAP,CPT® 59871,,Remove Cerclage Suture,"$3,585.00",$0.00,"$3,585.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,585.00",$0.00,"$3,585.00","$2,839.32","$2,868.00",$0.00,$0.00,$0.00,$0.00,$0.00
36101011,EAP,CPT® 60100,,BX THYROID PERC NEEDLE BCT,$760.00,$81.14,$760.00,$760.00,$760.00,$584.94,$130.94,$760.00,$760.00,$133.07,$760.00,$611.80,$760.00,$601.92,$608.00,$760.00,$93.18,$81.14,$120.99,$582.67
36101012,EAP,CPT® 60100,,Bx Thyroid Us,$760.00,$81.14,$760.00,$760.00,$760.00,$584.94,$130.94,$760.00,$760.00,$133.07,$760.00,$611.80,$760.00,$601.92,$608.00,$760.00,$93.18,$81.14,$120.99,$582.67
36101013,EAP,CPT® 60100,,Thyroid Biopsy Perc Needle,$760.00,$81.14,$760.00,$760.00,$760.00,$584.94,$130.94,$760.00,$760.00,$133.07,$760.00,$611.80,$760.00,$601.92,$608.00,$760.00,$93.18,$81.14,$120.99,$582.67
36101015,EAP,CPT® 61070,,PUNCT SHUNT TUBE/RESERVO BCT,"$2,271.00",$0.00,"$2,271.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,271.00",$0.00,"$2,255.00","$1,798.63","$1,816.80",$0.00,$0.00,$0.00,$0.00,$0.00
36101016,EAP,CPT® 61624,,EMBOLIZA INTRACRAN/SP CORD SPN,"$11,291.00",$0.00,"$11,291.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$11,291.00",$0.00,"$2,255.00","$8,942.47","$9,032.80",$0.00,$0.00,$0.00,$0.00,$0.00
36101019,EAP,CPT® 61626,,Embolization Extracranial,"$25,787.00",$0.00,"$25,787.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$25,787.00",$0.00,"$6,105.00","$20,423.30","$20,629.60",$0.00,$0.00,$0.00,$0.00,$0.00
36101020,EAP,CPT® 61630,,Intracranial Angioplasty,"$18,533.00","$1,145.81","$18,533.00","$10,063.42","$13,227.00","$3,298.87","$1,145.81","$13,227.00","$5,416.74","$3,244.98","$18,533.00","$1,522.96","$9,266.50","$14,678.14","$14,826.40","$1,424.57","$2,900.41","$1,424.57","$2,950.45","$1,424.57"
36101021,EAP,CPT® 61635,,Intracran Angioplasty W/stent,"$29,529.00","$1,268.01","$29,529.00","$16,034.25","$21,074.85","$5,256.16","$1,309.00","$21,074.85","$5,416.74","$5,170.29","$29,529.00","$1,621.20","$14,764.50","$23,386.97","$23,623.20","$1,514.43","$1,268.01","$1,514.43","$4,701.02","$1,514.43"
36101022,EAP,CPT® 61640,,"Dilate Ic Vasospasm, Init","$27,795.00",$0.00,"$27,795.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$27,795.00",$0.00,"$13,897.50","$22,013.64","$22,236.00",$0.00,$0.00,$0.00,$0.00,$0.00
36101023,EAP,CPT® 61642,,Dilate Ic Vasospasm Add-on,"$24,321.00",$0.00,"$24,321.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$24,321.00",$0.00,"$12,160.50","$19,262.23","$19,456.80",$0.00,$0.00,$0.00,$0.00,$0.00
36101024,EAP,CPT® 61710,,Emblz Carotid Cavern Fistula,"$14,044.00",$0.00,"$14,044.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$14,044.00",$0.00,"$3,902.00","$11,122.85","$11,235.20",$0.00,$0.00,$0.00,$0.00,$0.00
36101025,EAP,CPT® 62268,,SPINAL CORD CYST PERC ASPI BCT,"$3,094.00",$0.00,"$3,094.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,094.00",$0.00,"$2,255.00","$2,450.45","$2,475.20",$0.00,$0.00,$0.00,$0.00,$0.00
36101026,EAP,CPT® 62269,,BX SPINAL CORD PERC NEEDLE BCT,"$3,386.00",$0.00,"$3,386.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,386.00",$0.00,"$2,255.00","$2,681.71","$2,708.80",$0.00,$0.00,$0.00,$0.00,$0.00
36101027,EAP,CPT® 62270,,Dx Lumbar Puncture W/o Imaging,$794.00,$64.55,$635.00,$635.00,$635.00,$599.36,$109.41,$635.00,$635.00,$111.18,$635.00,$626.89,$635.00,$502.92,$508.00,$635.00,$120.04,$64.55,$101.09,$597.04
36101032,EAP,CPT® 62272,,Therapeutic Lumbar Puncture W/o Imaging,$877.00,$0.00,$877.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$877.00,$0.00,$877.00,$694.58,$701.60,$0.00,$0.00,$0.00,$0.00,$0.00
36101033,EAP,CPT® 55876,,Placement Of Prostate Fiducial Markers,"$3,534.00",$104.92,"$3,534.00","$2,106.30","$2,522.22","$1,194.16",$608.89,"$2,522.22","$2,522.22",$618.78,"$3,534.00","$1,249.00","$2,255.00","$2,798.93","$2,827.20","$1,735.32",$138.46,$104.92,$562.61,"$1,189.52"
36101039,EAP,CPT® 62273,,Injection Epidural Blood Patch,"$1,596.00",$117.56,"$1,596.00","$1,596.00","$1,208.73",$599.36,$274.98,"$1,208.73","$1,208.73",$279.45,"$1,596.00",$626.89,"$1,596.00","$1,264.03","$1,276.80",$870.98,$123.36,$117.56,$254.08,$597.04
36101040,EAP,CPT® 62280,,Inject Subarachnoid Neurolytic,"$1,845.00",$0.00,"$1,845.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,845.00",$0.00,"$1,845.00","$1,461.24","$1,476.00",$0.00,$0.00,$0.00,$0.00,$0.00
36101041,EAP,CPT® 62282,,Epidur Lumbar Sacral Neurolyti,"$1,751.00",$0.00,"$1,751.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,751.00",$0.00,"$1,751.00","$1,386.79","$1,400.80",$0.00,$0.00,$0.00,$0.00,$0.00
36101042,EAP,CPT® 62284,,Injection Myelo/ct Spinal,"$1,494.00",$0.00,"$1,494.00","$1,494.00",$0.00,$0.00,$257.41,$0.00,$0.00,$261.59,"$1,494.00",$0.00,"$1,494.00","$1,183.25","$1,195.20",$0.00,$158.11,$90.14,$237.84,$0.00
36101043,EAP,CPT® 62287,,Aspir Perc Diskectomy,"$6,339.00",$0.00,"$6,339.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,339.00",$0.00,"$6,105.00","$5,020.49","$5,071.20",$0.00,$0.00,$0.00,$0.00,$0.00
36101044,EAP,CPT® 62290,,Inject Diskography Ea Lev Lumb,"$2,963.00",$0.00,"$2,963.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,963.00",$0.00,"$2,327.00","$2,346.70","$2,370.40",$0.00,$0.00,$0.00,$0.00,$0.00
36101045,EAP,CPT® 62291,,Inject Diskography Ea Lev Cerv,"$2,594.00",$0.00,"$2,594.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,594.00",$0.00,"$2,255.00","$2,054.45","$2,075.20",$0.00,$0.00,$0.00,$0.00,$0.00
36101048,EAP,CPT® 63650,,Implant Neuroelectrodes,"$16,380.00",$0.00,"$16,380.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$16,380.00",$0.00,"$2,327.00","$12,972.96","$13,104.00",$0.00,$0.00,$0.00,$0.00,$0.00
36101049,EAP,CPT® 64408,,Inj Anes/strd Cranial/vagus Nerve,"$2,005.00",$0.00,"$2,005.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,005.00",$0.00,"$2,005.00","$1,587.96","$1,604.00",$0.00,$0.00,$0.00,$0.00,$0.00
36101051,EAP,CPT® 64425,,Inj Anes/strd Ilioinguinal/iliohypogastric Nerve,"$3,441.00",$0.00,"$3,441.00","$2,106.30","$2,455.84",$599.36,$0.00,"$2,455.84","$2,455.84",$602.49,"$3,441.00",$626.89,"$2,255.00","$2,725.27","$2,752.80",$870.98,$0.00,$57.69,$547.81,$597.04
36101052,EAP,CPT® 64450,,Inj Anes/strd Other Peripheral Nerve,"$2,750.00",$44.35,"$2,750.00","$2,106.30","$1,962.68",$599.36,$473.81,"$1,962.68","$1,962.68",$481.50,"$2,750.00",$626.89,"$2,255.00","$2,178.00","$2,200.00",$870.98,$85.27,$44.35,$437.80,$597.04
36101059,EAP,CPT® 64483,,Inject Anest Txforamen L/s Sng,"$1,705.00",$115.74,"$1,705.00","$1,705.00","$1,216.86",$778.67,$293.76,"$1,216.86","$1,216.86",$298.53,"$1,705.00",$814.44,"$1,705.00","$1,350.36","$1,364.00","$1,131.55",$197.93,$115.74,$271.44,$775.65
36101061,EAP,CPT® 64484,,Transfor Inj Lum/sac Addt Spn,"$1,705.00",$0.00,"$1,705.00","$1,705.00","$1,216.86",$0.00,$293.76,"$1,216.86","$1,216.86",$298.53,"$1,705.00",$0.00,"$1,705.00","$1,350.36","$1,364.00",$0.00,$183.06,$54.09,$271.44,$0.00
36101062,EAP,CPT® 64520,,Inject Anest Lumbar Thoracic,"$5,245.00",$0.00,"$5,245.00",$0.00,$0.00,$0.00,$903.69,$0.00,$0.00,$918.36,"$5,245.00",$0.00,"$2,255.00","$4,154.04","$4,196.00",$0.00,$125.32,$0.00,$0.00,$0.00
36101064,EAP,CPT® 64530,,"N Block Inj, Celiac Pelus","$8,538.00",$0.00,"$8,538.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$8,538.00",$0.00,"$2,255.00","$6,762.10","$6,830.40",$0.00,$0.00,$0.00,$0.00,$0.00
36101065,EAP,CPT® 64612,,Chemodenerve Mus Inv Fac Nerve,$732.00,$0.00,$732.00,$732.00,$0.00,$251.01,$126.12,$0.00,$0.00,$128.17,$732.00,$262.54,$732.00,$579.74,$585.60,$364.76,$151.15,$120.74,$116.53,$250.04
36101070,EAP,CPT® 64640,,Destr Peripheral Nerve,"$2,501.00",$121.87,"$2,501.00","$2,106.30","$1,784.96",$778.67,$430.91,"$1,784.96","$1,784.96",$437.91,"$2,501.00",$814.44,"$2,255.00","$1,980.79","$2,000.80","$1,131.55",$198.96,$121.87,$398.16,$775.65
36101072,EAP,CPT® 64680,,Destr Neurolyitc Celiac Plexus,"$4,672.00",$0.00,"$4,672.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,672.00",$0.00,"$2,327.00","$3,700.22","$3,737.60",$0.00,$0.00,$0.00,$0.00,$0.00
36101075,EAP,CPT® 65205,,"Fb Removal, Eye",$382.00,$0.00,$382.00,$0.00,$0.00,$0.00,$65.82,$0.00,$0.00,$0.00,$382.00,$0.00,$382.00,$302.54,$305.60,$0.00,$132.91,$0.00,$0.00,$0.00
36101076,EAP,CPT® 65205,,Remove Fb Eye Conj Superficial,$382.00,$0.00,$382.00,$0.00,$0.00,$0.00,$65.82,$0.00,$0.00,$0.00,$382.00,$0.00,$382.00,$302.54,$305.60,$0.00,$132.91,$0.00,$0.00,$0.00
36101077,EAP,CPT® 65222,,Remove Fb Eye Corneal W/sl,$808.00,$0.00,$808.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$808.00,$0.00,$808.00,$639.94,$646.40,$0.00,$0.00,$0.00,$0.00,$0.00
36101078,EAP,CPT® 65270,,Repair Laceration Conjunctiva,"$4,226.00",$0.00,"$4,226.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,226.00",$0.00,"$2,327.00","$3,346.99","$3,380.80",$0.00,$0.00,$0.00,$0.00,$0.00
36101079,EAP,CPT® 65275,,Rpr Lacer Cornea Non-perfor,"$9,059.00",$0.00,"$9,059.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$9,059.00",$0.00,"$3,606.00","$7,174.73","$7,247.20",$0.00,$0.00,$0.00,$0.00,$0.00
36101080,EAP,CPT® 65286,,Cornea Sclera Wound Tissue Glu,"$3,307.00",$433.21,"$3,307.00","$2,496.90","$2,360.21","$1,938.76",$569.78,"$2,360.21","$2,360.21",$579.03,"$3,307.00","$2,027.80","$2,255.00","$2,619.14","$2,645.60","$2,817.36",$433.21,$506.49,$526.47,"$1,931.24"
36101081,EAP,CPT® 65290,,Repair Wound Extraocular Muscl,"$5,408.00",$0.00,"$5,408.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,408.00",$0.00,"$2,858.00","$4,283.14","$4,326.40",$0.00,$0.00,$0.00,$0.00,$0.00
36101082,EAP,CPT® 65400,,Excise Lesn Cornea Not Pterygm,"$6,055.00",$0.00,"$6,055.00",$0.00,$0.00,$0.00,"$1,043.25",$0.00,$0.00,$0.00,"$6,055.00",$0.00,"$2,255.00","$4,795.56","$4,844.00",$0.00,$484.61,$0.00,$0.00,$0.00
36101083,EAP,CPT® 65410,,Biopsy Of Cornea,"$3,307.00",$0.00,"$3,307.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,307.00",$0.00,"$2,327.00","$2,619.14","$2,645.60",$0.00,$0.00,$0.00,$0.00,$0.00
36101084,EAP,CPT® 65420,,Excise Pterygium W/o Graft,"$3,307.00",$0.00,"$3,307.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,307.00",$0.00,"$2,327.00","$2,619.14","$2,645.60",$0.00,$0.00,$0.00,$0.00,$0.00
36101085,EAP,CPT® 65430,,Scraping Cornea Diagnostic,$530.00,$0.00,$530.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$530.00,$0.00,$530.00,$419.76,$424.00,$0.00,$0.00,$0.00,$0.00,$0.00
36101086,EAP,CPT® 65772,,Relax Cornea Incision Astigmat,"$6,025.00",$0.00,"$6,025.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,025.00",$0.00,"$3,606.00","$4,771.80","$4,820.00",$0.00,$0.00,$0.00,$0.00,$0.00
36101087,EAP,CPT® 65800,,Paracentesis Ant Chamb Eye Wdx,"$4,717.00",$0.00,"$4,717.00","$2,106.30","$3,366.52","$1,938.76",$0.00,"$3,366.52","$3,366.52",$825.91,"$4,717.00","$2,027.80","$2,255.00","$3,735.86","$3,773.60","$2,817.36",$0.00,$93.03,$750.95,"$1,931.24"
36101089,EAP,CPT® 65815,,Eye Paracentesis Ant Blood Rem,"$9,011.00",$0.00,"$9,011.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$9,011.00",$0.00,"$2,327.00","$7,136.71","$7,208.80",$0.00,$0.00,$0.00,$0.00,$0.00
36101090,EAP,CPT® 65855,,Trabeculoplasty By Laser,"$2,960.00",$211.62,"$2,960.00","$2,496.90","$2,472.24",$486.10,$509.99,"$2,472.24","$2,472.24",$518.27,"$2,960.00",$508.42,"$2,255.00","$2,344.32","$2,368.00",$706.38,$354.58,$211.62,$471.23,$484.21
36101091,EAP,CPT® 65860,,Incise Inner Eye Adhesions,"$1,475.00",$0.00,"$1,475.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,475.00",$0.00,"$1,475.00","$1,168.20","$1,180.00",$0.00,$0.00,$0.00,$0.00,$0.00
36101092,EAP,CPT® 66250,,Repair Operative Wound Ant Eye,"$3,567.00",$0.00,"$3,567.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,567.00",$0.00,"$2,327.00","$2,825.06","$2,853.60",$0.00,$0.00,$0.00,$0.00,$0.00
36101093,EAP,CPT® 66710,,Destruction Ciliary Body,"$4,452.00",$399.78,"$4,452.00","$2,496.90","$3,177.39","$1,855.66",$767.06,"$3,177.39","$3,177.39",$779.51,"$4,452.00","$1,940.89","$2,327.00","$3,525.98","$3,561.60","$2,696.60",$412.49,$399.78,$708.76,"$1,848.46"
36101094,EAP,CPT® 66710,,Transscleral Cyclophotocoagula,"$4,452.00",$399.78,"$4,452.00","$2,496.90","$3,177.39","$1,855.66",$767.06,"$3,177.39","$3,177.39",$779.51,"$4,452.00","$1,940.89","$2,327.00","$3,525.98","$3,561.60","$2,696.60",$412.49,$399.78,$708.76,"$1,848.46"
36101095,EAP,CPT® 66720,,Destroy Ciliary Body Cryother,"$2,723.00",$0.00,"$2,723.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,723.00",$0.00,"$2,327.00","$2,156.62","$2,178.40",$0.00,$0.00,$0.00,$0.00,$0.00
36101096,EAP,CPT® 66761,,Iridotomy Laser Surgery,"$7,719.00",$240.80,"$7,719.00","$2,106.30","$5,509.05",$486.10,"$1,329.95","$5,509.05","$5,416.74","$1,351.54","$7,719.00",$508.42,"$2,255.00","$6,113.45","$6,175.20",$706.38,$315.03,$240.80,"$1,228.86",$484.21
36101097,EAP,CPT® 66762,,Iridoplasty Photocoagulation,"$1,057.00",$168.27,"$1,057.00","$1,057.00","$1,057.00",$486.10,$182.12,"$1,057.00","$1,057.00",$185.07,"$1,057.00",$508.42,"$1,057.00",$837.14,$845.60,$706.38,$348.17,$432.93,$168.27,$484.21
36101098,EAP,CPT® 66821,,Yag Laser Capsulotomy,"$2,146.00",$188.16,"$2,146.00","$2,146.00","$1,531.60",$486.10,$369.75,"$1,531.60","$1,531.60",$375.75,"$2,146.00",$508.42,"$2,146.00","$1,699.63","$1,716.80",$706.38,$188.16,$317.54,$341.64,$484.21
36101099,EAP,CPT® 67015,,Posterior Sclerotomy,"$15,938.00",$0.00,"$15,938.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$15,938.00",$0.00,"$2,255.00","$12,622.90","$12,750.40",$0.00,$0.00,$0.00,$0.00,$0.00
36101100,EAP,CPT® 67025,,Inject Vitreous Pars Pla/limbl,"$8,706.00",$643.81,"$8,706.00","$2,106.30","$6,213.47","$1,938.76","$1,500.00","$6,213.47","$5,416.74","$1,524.35","$8,706.00","$2,027.80","$2,255.00","$6,895.15","$6,964.80","$2,817.36",$651.56,$643.81,"$1,386.00","$1,931.24"
36101101,EAP,CPT® 67028,,Injection Intravitreal Drug,"$2,200.00",$100.58,"$2,200.00","$2,106.30","$1,570.14",$296.88,$379.05,"$1,570.14","$1,570.14",$385.20,"$2,200.00",$310.51,"$2,200.00","$1,742.40","$1,760.00",$431.41,$307.74,$100.58,$350.24,$295.72
36101102,EAP,CPT® 67031,,"Sever Vitreous, Laser","$2,310.00",$0.00,"$2,310.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,310.00",$0.00,"$2,310.00","$1,829.52","$1,848.00",$0.00,$0.00,$0.00,$0.00,$0.00
36101103,EAP,CPT® 67101,,Retinal Detach Rpr Cryo/diath,"$7,847.00",$0.00,"$7,847.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$7,847.00",$0.00,"$2,255.00","$6,214.82","$6,277.60",$0.00,$0.00,$0.00,$0.00,$0.00
36101104,EAP,CPT® 67105,,Repair Retinal Detach Laser,"$1,387.00",$0.00,"$1,387.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,387.00",$0.00,"$1,387.00","$1,098.50","$1,109.60",$0.00,$0.00,$0.00,$0.00,$0.00
36101105,EAP,CPT® 67141,,Cryotherapy Retinal Tear,"$1,917.00",$0.00,"$1,917.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,917.00",$0.00,"$1,917.00","$1,518.26","$1,533.60",$0.00,$0.00,$0.00,$0.00,$0.00
36101106,EAP,CPT® 67145,,Photocoagulation Retinal Tear,"$1,054.00",$0.00,"$1,054.00","$1,054.00",$0.00,$486.10,$181.60,$0.00,$0.00,$184.55,"$1,054.00",$508.42,"$1,054.00",$834.77,$843.20,$706.38,$412.94,$506.47,$167.80,$484.21
36101107,EAP,CPT® 67208,,Destroy Lesion Retina Cryo/dia,"$4,956.00",$0.00,"$4,956.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,956.00",$0.00,"$2,255.00","$3,925.15","$3,964.80",$0.00,$0.00,$0.00,$0.00,$0.00
36101108,EAP,CPT® 67210,,Destroy Lesion Retina Photocoa,"$1,019.00",$0.00,"$1,019.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,019.00",$0.00,"$1,019.00",$807.05,$815.20,$0.00,$0.00,$0.00,$0.00,$0.00
36101109,EAP,CPT® 67220,,Destr Choroid Lesion Phoptocoa,"$1,514.00",$0.00,"$1,514.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,514.00",$0.00,"$1,514.00","$1,199.09","$1,211.20",$0.00,$0.00,$0.00,$0.00,$0.00
36101110,EAP,CPT® 67227,,Destroy Retinopathy Cryo/diath,"$4,468.00",$0.00,"$4,468.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,468.00",$0.00,"$2,255.00","$3,538.66","$3,574.40",$0.00,$0.00,$0.00,$0.00,$0.00
36101111,EAP,CPT® 67228,,Destroy Retinopathy Photocoag,"$7,462.00",$311.48,"$7,462.00","$2,106.30","$5,325.63",$486.10,"$1,285.67","$5,325.63","$5,325.63","$1,306.54","$7,462.00",$508.42,"$2,255.00","$5,909.90","$5,969.60",$706.38,$821.55,$311.48,"$1,187.95",$484.21
36101112,EAP,CPT® 67335,,Place Adjust Suture Strabismus,"$6,484.00",$0.00,"$6,484.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,484.00",$0.00,"$3,606.00","$5,135.33","$5,187.20",$0.00,$0.00,$0.00,$0.00,$0.00
36101113,EAP,CPT® 67345,,Chemodenerv Extraocular Muscle,$851.00,$0.00,$851.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$851.00,$0.00,$851.00,$673.99,$680.80,$0.00,$0.00,$0.00,$0.00,$0.00
36101114,EAP,CPT® 67415,,Fna Orbital Contents,"$11,904.00",$0.00,"$11,904.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$11,904.00",$0.00,"$2,255.00","$9,427.97","$9,523.20",$0.00,$0.00,$0.00,$0.00,$0.00
36101115,EAP,CPT® 67500,,Inject Medication Retrobulbar,$639.00,$0.00,$639.00,$346.98,$0.00,$259.37,$110.10,$0.00,$0.00,$111.88,$639.00,$271.28,$639.00,$506.09,$511.20,$376.91,$179.43,$62.75,$101.73,$258.37
36101116,EAP,CPT® 67505,,Inject Alcohol Retrobulbar,$843.00,$0.00,$843.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$843.00,$0.00,$843.00,$667.66,$674.40,$0.00,$0.00,$0.00,$0.00,$0.00
36101117,EAP,CPT® 67515,,Inject Medication Tenon's Caps,"$1,820.00",$60.20,"$1,820.00","$1,820.00","$1,298.93",$259.37,$313.58,"$1,298.93","$1,298.93",$318.67,"$1,820.00",$271.28,"$1,820.00","$1,441.44","$1,456.00",$376.91,$137.37,$60.20,$289.74,$258.37
36101118,EAP,CPT® 67700,,Blepharotomy Eyelid,"$1,339.00",$0.00,"$1,339.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,339.00",$0.00,"$1,339.00","$1,060.49","$1,071.20",$0.00,$0.00,$0.00,$0.00,$0.00
36101119,EAP,CPT® 67710,,Severing Of Tarsorrhaphy,"$2,216.00",$0.00,"$2,216.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,216.00",$0.00,"$2,216.00","$1,755.07","$1,772.80",$0.00,$0.00,$0.00,$0.00,$0.00
36101120,EAP,CPT® 67715,,Canthotomy,"$9,546.00",$0.00,"$9,546.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$9,546.00",$0.00,"$2,255.00","$7,560.43","$7,636.80",$0.00,$0.00,$0.00,$0.00,$0.00
36101121,EAP,CPT® 67800,,Excise Chalazion Single,"$1,339.00",$0.00,"$1,339.00","$1,339.00",$0.00,$259.37,$230.70,$0.00,$0.00,$234.45,"$1,339.00",$271.28,"$1,339.00","$1,060.49","$1,071.20",$376.91,$174.52,$104.90,$213.17,$258.37
36101122,EAP,CPT® 67801,,Excise Chalazion Multiple,"$2,216.00",$0.00,"$2,216.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,216.00",$0.00,"$2,216.00","$1,755.07","$1,772.80",$0.00,$0.00,$0.00,$0.00,$0.00
36101123,EAP,CPT® 67805,,"Excise Chalazion,mult,diff Lid","$1,674.00",$0.00,"$1,674.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,674.00",$0.00,"$1,674.00","$1,325.81","$1,339.20",$0.00,$0.00,$0.00,$0.00,$0.00
36101124,EAP,CPT® 67810,,Biopsy Of Eyelid,"$1,154.00",$0.00,"$1,154.00","$1,154.00",$0.00,$259.37,$198.83,$0.00,$0.00,$202.06,"$1,154.00",$271.28,"$1,154.00",$913.97,$923.20,$376.91,$152.92,$72.11,$183.72,$258.37
36101125,EAP,CPT® 67825,,Correct Trichiasis Electrosurg,"$1,154.00",$0.00,"$1,154.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,154.00",$0.00,"$1,154.00",$913.97,$923.20,$0.00,$0.00,$0.00,$0.00,$0.00
36101126,EAP,CPT® 67840,,Excise Lesion Eyelid Smpl Clos,"$2,581.00",$160.78,"$2,581.00","$2,496.90","$1,842.06",$773.80,$444.69,"$1,842.06","$1,842.06",$451.91,"$2,581.00",$809.34,"$2,255.00","$2,044.15","$2,064.80","$1,124.47",$209.29,$160.78,$410.90,$770.80
36101127,EAP,CPT® 67875,,Temporary Tarsorraphy,"$3,750.00",$0.00,"$3,750.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$2,255.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
36101128,EAP,CPT® 67880,,Construct Intemar Adhes Etc.,"$7,570.00",$0.00,"$7,570.00",$0.00,$0.00,$0.00,"$1,304.27",$0.00,$0.00,$0.00,"$7,570.00",$0.00,"$2,858.00","$5,995.44","$6,056.00",$0.00,$389.90,$0.00,$0.00,$0.00
36101129,EAP,CPT® 67909,,Reduce Ptosis Overcorrection,"$9,164.00",$0.00,"$9,164.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$9,164.00",$0.00,"$3,606.00","$7,257.89","$7,331.20",$0.00,$0.00,$0.00,$0.00,$0.00
36101130,EAP,CPT® 67914,,Repair Ectropion By Suture,"$5,284.00",$0.00,"$5,284.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,284.00",$0.00,"$2,858.00","$4,184.93","$4,227.20",$0.00,$0.00,$0.00,$0.00,$0.00
36101131,EAP,CPT® 67916,,"Rpr Ectropion, Blephar Tarsal","$9,164.00",$0.00,"$9,164.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$9,164.00",$0.00,"$3,606.00","$7,257.89","$7,331.20",$0.00,$0.00,$0.00,$0.00,$0.00
36101132,EAP,CPT® 67921,,Repair Entropion By Suture,"$5,284.00",$0.00,"$5,284.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,284.00",$0.00,"$2,858.00","$4,184.93","$4,227.20",$0.00,$0.00,$0.00,$0.00,$0.00
36101133,EAP,CPT® 67923,,"Rpr Entropion, Blephar Tarsal","$9,164.00",$0.00,"$9,164.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$9,164.00",$0.00,"$3,606.00","$7,257.89","$7,331.20",$0.00,$0.00,$0.00,$0.00,$0.00
36101134,EAP,CPT® 67924,,"Rpr Entropion, Blephar Extnsv","$9,164.00",$0.00,"$9,164.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$9,164.00",$0.00,"$3,606.00","$7,257.89","$7,331.20",$0.00,$0.00,$0.00,$0.00,$0.00
36101135,EAP,CPT® 67930,,Suture Wound Eyelid Partial Th,"$5,496.00",$0.00,"$5,496.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,496.00",$0.00,"$2,255.00","$4,352.83","$4,396.80",$0.00,$0.00,$0.00,$0.00,$0.00
36101136,EAP,CPT® 67935,,Suture Wound Eyelid Full Thick,"$10,671.00",$0.00,"$10,671.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$10,671.00",$0.00,"$2,327.00","$8,451.43","$8,536.80",$0.00,$0.00,$0.00,$0.00,$0.00
36101138,EAP,CPT® 67938,,Remove Foreign Body Eyelid,"$1,208.00",$0.00,"$1,208.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,208.00",$0.00,"$1,208.00",$956.74,$966.40,$0.00,$0.00,$0.00,$0.00,$0.00
36101139,EAP,CPT® 67950,,Canthoplasty,"$9,427.00",$0.00,"$9,427.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$9,427.00",$0.00,"$2,327.00","$7,466.18","$7,541.60",$0.00,$0.00,$0.00,$0.00,$0.00
36101140,EAP,CPT® 68020,,I & D Conjunctiva Cyst,"$3,391.00",$0.00,"$3,391.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,391.00",$0.00,"$2,255.00","$2,685.67","$2,712.80",$0.00,$0.00,$0.00,$0.00,$0.00
36101141,EAP,CPT® 68100,,Biopsy Of Conjunctiva,"$2,371.00",$0.00,"$2,371.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,371.00",$0.00,"$2,255.00","$1,877.83","$1,896.80",$0.00,$0.00,$0.00,$0.00,$0.00
36101142,EAP,CPT® 68110,,Excise Lesion Conjunctiva <1 C,"$4,665.00",$0.00,"$4,665.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,665.00",$0.00,"$2,255.00","$3,694.68","$3,732.00",$0.00,$0.00,$0.00,$0.00,$0.00
36101143,EAP,CPT® 68110,,Incision Conjunctival Lesion,"$4,665.00",$0.00,"$4,665.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,665.00",$0.00,"$2,255.00","$3,694.68","$3,732.00",$0.00,$0.00,$0.00,$0.00,$0.00
36101144,EAP,CPT® 68115,,Excise Lesion Conjunctiva >1 C,"$5,304.00",$0.00,"$5,304.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,304.00",$0.00,"$2,327.00","$4,200.77","$4,243.20",$0.00,$0.00,$0.00,$0.00,$0.00
36101145,EAP,CPT® 68200,,Injection Subconjunctiva,$262.00,$0.00,$262.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$262.00,$0.00,$262.00,$207.50,$209.60,$0.00,$0.00,$0.00,$0.00,$0.00
36101146,EAP,CPT® 68400,,I & D Lacrimal Gland,$850.00,$0.00,$850.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$850.00,$0.00,$850.00,$673.20,$680.00,$0.00,$0.00,$0.00,$0.00,$0.00
36101147,EAP,CPT® 68420,,I & D Lacrimal Sac,"$3,029.00",$0.00,"$3,029.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,029.00",$0.00,"$2,255.00","$2,398.97","$2,423.20",$0.00,$0.00,$0.00,$0.00,$0.00
36101148,EAP,CPT® 68440,,Snip Incision Lacrimal Punctum,$661.00,$0.00,$661.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$661.00,$0.00,$661.00,$523.51,$528.80,$0.00,$0.00,$0.00,$0.00,$0.00
36101149,EAP,CPT® 68510,,Biopsy Of Lacrimal Gland,"$3,029.00",$0.00,"$3,029.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,029.00",$0.00,"$2,255.00","$2,398.97","$2,423.20",$0.00,$0.00,$0.00,$0.00,$0.00
36101150,EAP,CPT® 68705,,Correct Everted Punctum Cauter,$661.00,$0.00,$661.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$661.00,$0.00,$661.00,$523.51,$528.80,$0.00,$0.00,$0.00,$0.00,$0.00
36101151,EAP,CPT® 68760,,Close Lacri Punct Laser Ligate,$623.00,$0.00,$623.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$623.00,$0.00,$623.00,$493.42,$498.40,$0.00,$0.00,$0.00,$0.00,$0.00
36101152,EAP,CPT® 68761,,Close Tear Duct Opening,$579.00,$0.00,$579.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$579.00,$0.00,$579.00,$458.57,$463.20,$0.00,$0.00,$0.00,$0.00,$0.00
36101153,EAP,CPT® 68770,,Closure Lacrimal Fistula,"$5,253.00",$0.00,"$5,253.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,253.00",$0.00,"$3,606.00","$4,160.38","$4,202.40",$0.00,$0.00,$0.00,$0.00,$0.00
36101154,EAP,CPT® 68801,,Dilate Lacrimal Punctum,$519.00,$0.00,$519.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$519.00,$0.00,$519.00,$411.05,$415.20,$0.00,$0.00,$0.00,$0.00,$0.00
36101155,EAP,CPT® 68810,,Probe Nasolacrimal Duct,$670.00,$0.00,$670.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$670.00,$0.00,$670.00,$530.64,$536.00,$0.00,$0.00,$0.00,$0.00,$0.00
36101156,EAP,CPT® 68815,,Probe Nasolacrimal Duct W Tube,"$5,253.00",$0.00,"$5,253.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,253.00",$0.00,"$2,327.00","$4,160.38","$4,202.40",$0.00,$0.00,$0.00,$0.00,$0.00
36101157,EAP,CPT® 68840,,Probe Lacrimal Canaliculi,$670.00,$0.00,$670.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$670.00,$0.00,$670.00,$530.64,$536.00,$0.00,$0.00,$0.00,$0.00,$0.00
36101158,EAP,CPT® 69105,,Biopsy External Ear Canal,"$3,692.00",$64.16,"$3,692.00","$2,004.76","$2,634.98","$1,293.88",$636.11,"$2,634.98","$2,634.98",$646.44,"$3,692.00","$1,353.31","$2,255.00","$2,924.06","$2,953.60","$1,880.24",$69.63,$64.16,$587.77,"$1,288.86"
36101160,EAP,CPT® 69145,,Excision Aural Mass,"$14,215.00",$0.00,"$14,215.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$14,215.00",$0.00,"$2,327.00","$11,258.28","$11,372.00",$0.00,$0.00,$0.00,$0.00,$0.00
36101162,EAP,CPT® 69200,,Remove Fb Ear W/o Anes,$412.00,$0.00,$412.00,$223.72,$0.00,$104.55,$70.99,$0.00,$0.00,$72.14,$412.00,$109.35,$412.00,$326.30,$329.60,$151.93,$58.58,$48.67,$65.59,$104.14
36101165,EAP,CPT® 69220,,"Debridement,ear Wash Placement",$329.00,$0.00,$329.00,$178.65,$0.00,$167.55,$56.69,$0.00,$0.00,$57.61,$329.00,$175.24,$329.00,$260.57,$263.20,$243.48,$62.84,$52.64,$52.38,$166.90
36101171,EAP,CPT® 69420,,"Myringotomy W Aspir, E Tube In","$1,547.00",$96.31,"$1,547.00","$1,547.00","$1,482.64",$195.27,$266.54,"$1,482.64","$1,482.64",$270.87,"$1,547.00",$204.24,"$1,547.00","$1,225.22","$1,237.60",$283.76,$96.31,$122.18,$246.28,$194.51
36101173,EAP,CPT® 69424,,Remove Ventilating Tube W Anes,"$10,633.00",$0.00,"$10,633.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$10,633.00",$0.00,"$2,255.00","$8,421.34","$8,506.40",$0.00,$0.00,$0.00,$0.00,$0.00
36101176,EAP,CPT® 69433,,Tympanostomy Local Anes,"$1,470.00",$116.53,"$1,470.00","$1,470.00","$1,208.73",$423.57,$253.27,"$1,208.73","$1,208.73",$257.39,"$1,470.00",$443.02,"$1,470.00","$1,164.24","$1,176.00",$615.51,$116.53,$134.08,$234.02,$421.92
36101177,EAP,CPT® 69540,,Excision Of Aural Polyp,"$2,303.00",$0.00,"$2,303.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,303.00",$0.00,"$2,255.00","$1,823.98","$1,842.40",$0.00,$0.00,$0.00,$0.00,$0.00
36101179,EAP,CPT® 69610,,Tympanic Membrane Repair,"$3,245.00",$0.00,"$3,245.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,245.00",$0.00,"$2,255.00","$2,570.04","$2,596.00",$0.00,$0.00,$0.00,$0.00,$0.00
36101181,EAP,CPT® 92977,,Thrombolytic By Iv For Ami,"$4,227.00",$0.00,"$4,227.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,227.00",$0.00,"$2,113.50","$3,347.78","$3,381.60",$0.00,$0.00,$0.00,$0.00,$0.00
36101183,EAP,CPT® 92978,,Ivus Initial Vessel,"$7,459.00",$0.00,"$7,459.00","$4,050.24","$5,323.49",$0.00,"$1,285.15","$5,323.49","$5,323.49","$1,306.01","$7,459.00",$0.00,"$3,729.50","$5,907.53","$5,967.20",$0.00,$273.18,$0.00,"$1,187.47",$0.00
36101184,EAP,CPT® 92979,,Ivus - Addit Vessel,"$8,016.00",$0.00,"$7,459.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$7,459.00",$0.00,"$3,729.50","$5,907.53","$5,967.20",$0.00,$0.00,$0.00,$0.00,$0.00
36101185,EAP,CPT® 27096,,Inject Si Joint Arthrgrphy&/anes/steroid W/image,"$2,131.00",$86.18,"$2,131.00","$2,106.30","$1,520.89",$599.36,$367.16,"$1,520.89","$1,520.89",$373.12,"$2,131.00",$626.89,"$2,131.00","$1,687.75","$1,704.80",$86.18,$398.44,$86.18,$339.26,$597.04
36101186,EAP,CPT® 27096,,Bil Inject Si Joint Arthrgrphy&/anes/steroid W/image,"$3,197.00",$86.18,"$3,197.00","$2,106.30","$2,281.70",$599.36,$550.83,"$2,281.70","$2,281.70",$559.77,"$3,197.00",$626.89,"$2,255.00","$2,532.02","$2,557.60",$86.18,$398.44,$86.18,$508.96,$597.04
36101187,EAP,HCPCS G0269,,Closure Device Placement,"$2,845.00",$0.00,"$2,845.00","$1,544.84","$2,030.48",$0.00,$490.18,"$2,030.48","$2,030.48",$498.14,"$2,845.00",$0.00,"$1,422.50","$2,253.24","$2,276.00",$0.00,$445.24,$0.00,$452.92,$0.00
36101192,EAP,CPT® 41899,,Partially Bony,"$1,880.00",$0.00,"$1,880.00","$1,880.00",$0.00,$195.27,$323.91,$0.00,$0.00,$329.17,"$1,880.00",$204.24,"$1,880.00","$1,488.96","$1,504.00",$283.76,$294.22,$0.00,$299.30,$194.51
36101193,EAP,CPT® 41899,,Soft Tissue,"$1,880.00",$0.00,"$1,880.00","$1,880.00",$0.00,$195.27,$323.91,$0.00,$0.00,$329.17,"$1,880.00",$204.24,"$1,880.00","$1,488.96","$1,504.00",$283.76,$294.22,$0.00,$299.30,$194.51
36101198,EAP,CPT® 62320,,Njx Interlaminar Crv/thrc,"$1,316.00",$0.00,"$1,316.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,316.00",$0.00,"$1,316.00","$1,042.27","$1,052.80",$0.00,$0.00,$0.00,$0.00,$0.00
36101202,EAP,CPT® 15792,,Tca Peel,$990.00,$0.00,$990.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$990.00,$0.00,$990.00,$784.08,$792.00,$0.00,$0.00,$0.00,$0.00,$0.00
36101204,EAP,CPT® 17000,,"Destruc Lesion Benign, 1st",$389.00,$48.44,$389.00,$389.00,$389.00,$167.55,$67.02,$389.00,$389.00,$68.11,$389.00,$175.24,$389.00,$308.09,$311.20,$243.48,$48.44,$55.15,$61.93,$166.90
36101208,EAP,CPT® 36600,,Arterial Puncture,$300.00,$0.00,$284.00,$284.00,$0.00,$104.55,$48.93,$0.00,$0.00,$49.73,$284.00,$109.35,$284.00,$224.93,$227.20,$151.93,$24.37,$16.23,$45.21,$104.14
36101209,EAP,CPT® 46611,,Hr Anoscopy W/ Bx,"$2,898.00",$0.00,"$2,898.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,898.00",$0.00,"$2,255.00","$2,295.22","$2,318.40",$0.00,$0.00,$0.00,$0.00,$0.00
36101210,EAP,CPT® 46614,,Hr Ano/w Control Of Bleeding,"$1,516.00",$0.00,"$1,516.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,516.00",$0.00,"$1,516.00","$1,200.67","$1,212.80",$0.00,$0.00,$0.00,$0.00,$0.00
36101211,EAP,CPT® 46615,,Hr Ano W/ablation Of Tumor,"$5,989.00",$0.00,"$5,989.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,989.00",$0.00,"$2,327.00","$4,743.29","$4,791.20",$0.00,$0.00,$0.00,$0.00,$0.00
36101212,EAP,CPT® 51727,,Cystometrogram W/urethral Pres,$790.00,$0.00,$790.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$790.00,$0.00,$790.00,$625.68,$632.00,$0.00,$0.00,$0.00,$0.00,$0.00
36101213,EAP,CPT® 51728,,Cystometrogram W/voiding Press,$790.00,$0.00,$790.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$790.00,$0.00,$790.00,$625.68,$632.00,$0.00,$0.00,$0.00,$0.00,$0.00
36101214,EAP,CPT® 51729,,Cystometrogram W/vp&up,$790.00,$0.00,$790.00,$790.00,$0.00,$533.66,$136.11,$0.00,$0.00,$138.32,$790.00,$558.17,$790.00,$625.68,$632.00,$775.50,$235.63,$252.48,$125.77,$531.59
36101216,EAP,CPT® 49429,,Removal Of Peritoneal-venous Shunt,"$10,713.00",$0.00,"$10,713.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$10,713.00",$0.00,"$2,255.00","$8,484.70","$8,570.40",$0.00,$0.00,$0.00,$0.00,$0.00
36101217,EAP,CPT® 21040,,Excision Benign Tumor/cyst Mandible Encl & Curt,"$4,993.00",$0.00,"$4,993.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,993.00",$0.00,"$2,327.00","$3,954.46","$3,994.40",$0.00,$0.00,$0.00,$0.00,$0.00
36101219,EAP,CPT® 57800,,Insert Smit Sleeve,"$5,262.00",$0.00,"$5,262.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,262.00",$0.00,"$2,255.00","$4,167.50","$4,209.60",$0.00,$0.00,$0.00,$0.00,$0.00
36101225,EAP,CPT® 64415,,Inj Anes/strd Brachial Plexus,"$2,200.00",$66.00,"$1,890.00","$1,890.00","$1,348.89",$778.67,$325.64,"$1,348.89","$1,348.89",$330.92,"$1,890.00",$814.44,"$1,890.00","$1,496.88","$1,512.00","$1,131.55",$107.25,$66.00,$300.89,$775.65
36101226,EAP,CPT® 64417,,Inj Anes/strd Axillary Nerve,"$1,900.00",$63.11,"$1,890.00","$1,890.00","$1,348.89",$778.67,$325.64,"$1,348.89","$1,348.89",$330.92,"$1,890.00",$814.44,"$1,890.00","$1,496.88","$1,512.00","$1,131.55",$106.55,$63.11,$300.89,$775.65
36101227,EAP,CPT® 64420,,Inj Anes/strd Intercostal Nerve 1st Level,"$1,890.00",$62.02,"$1,890.00","$1,890.00","$1,348.89",$599.36,$325.64,"$1,348.89","$1,348.89",$330.92,"$1,890.00",$626.89,"$1,890.00","$1,496.88","$1,512.00",$870.98,$95.79,$62.02,$300.89,$597.04
36101228,EAP,CPT® 64421,,Inj Anes/strd Intercostal Nerve Addl Level,"$3,656.00",$26.33,"$3,656.00","$2,106.30","$2,609.29",$778.67,$629.91,"$2,609.29","$2,609.29",$640.14,"$3,656.00",$814.44,"$2,255.00","$2,895.55","$2,924.80","$1,131.55",$124.25,$26.33,$582.04,$775.65
36101229,EAP,CPT® 64445,,Inj Anes/strd Sciatic Nerve,"$3,656.00",$55.89,"$3,656.00","$2,106.30","$2,609.29",$599.36,$629.91,"$2,609.29","$2,609.29",$640.14,"$3,656.00",$626.89,"$2,255.00","$2,895.55","$2,924.80",$870.98,$117.68,$55.89,$582.04,$597.04
36101230,EAP,CPT® 64447,,Inj Anes/strd Femoral Nerve,"$2,300.00",$55.18,"$1,890.00","$1,026.27","$1,348.89",$599.36,$325.64,"$1,348.89","$1,348.89",$330.92,"$1,890.00",$626.89,"$1,890.00","$1,496.88","$1,512.00",$870.98,$74.36,$55.18,$300.89,$597.04
36101231,EAP,CPT® 64490,,Bilat_inj Paravert F Jnt C/t 1 Lev,"$5,484.00",$109.61,"$5,484.00","$2,106.30","$3,913.93",$778.67,$944.87,"$3,913.93","$3,913.93",$960.20,"$5,484.00",$814.44,"$2,255.00","$4,343.33","$4,387.20","$1,131.55",$122.58,$109.61,$873.05,$775.65
36101232,EAP,CPT® 64491,,Bilat_inj Paravert F Jnt C/t 2 Lev,"$2,644.00",$0.00,"$2,644.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,644.00",$0.00,"$1,322.00","$2,094.05","$2,115.20",$0.00,$0.00,$0.00,$0.00,$0.00
36101233,EAP,CPT® 64492,,Bilat_inj Paravert F Jnt C/t 3 Lev,"$2,355.00",$0.00,"$2,355.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,355.00",$0.00,"$1,177.50","$1,865.16","$1,884.00",$0.00,$0.00,$0.00,$0.00,$0.00
36101234,EAP,CPT® 64493,,Bilat_inj Paravert F Jnt L/s 1 Lev,"$5,484.00",$93.03,"$5,484.00","$2,106.30","$3,913.93",$778.67,$944.87,"$3,913.93","$3,913.93",$960.20,"$5,484.00",$814.44,"$2,255.00","$4,343.33","$4,387.20","$1,131.55",$111.04,$93.03,$873.05,$775.65
36101235,EAP,CPT® 64494,,Bilat_inj Paravert F Jnt L/s 2 Lev,"$2,492.00",$0.00,"$2,492.00","$2,106.30","$1,778.54",$0.00,$429.36,"$1,778.54","$1,778.54",$436.33,"$2,492.00",$0.00,"$1,246.00","$1,973.66","$1,993.60",$0.00,$54.06,$53.73,$396.73,$0.00
36101236,EAP,CPT® 64495,,Bilat_inj Paravert F Jnt L/s 3 Lev,"$2,391.00",$0.00,"$2,391.00","$2,106.30","$1,706.46",$0.00,$0.00,"$1,706.46","$1,706.46",$0.00,"$2,391.00",$0.00,"$1,195.50","$1,893.67","$1,912.80",$0.00,$0.00,$54.45,$380.65,$0.00
36101252,EAP,CPT® 19126,,Excision Addl Breast Lesion,$508.00,$0.00,$508.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$508.00,$0.00,$508.00,$402.34,$406.40,$0.00,$0.00,$0.00,$0.00,$0.00
36101253,EAP,CPT® 57520,,Conization Of Cervix,"$2,862.00",$0.00,"$2,862.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,862.00",$0.00,"$2,327.00","$2,266.70","$2,289.60",$0.00,$0.00,$0.00,$0.00,$0.00
36101264,EAP,CPT® 69210,,Removal Impacted Cerumen Instrument Unilat,$412.00,$0.00,$412.00,$412.00,$0.00,$52.75,$70.99,$0.00,$0.00,$72.14,$412.00,$55.17,$412.00,$326.30,$329.60,$76.65,$47.34,$34.61,$65.59,$52.54
36101266,EAP,CPT® 36569,,Picc W/o Port,"$6,120.00",$98.45,"$5,429.00","$2,106.30","$3,874.68","$1,564.09",$935.39,"$3,874.68","$3,874.68",$950.57,"$5,429.00","$1,635.92","$2,255.00","$4,299.77","$4,343.20","$2,272.90",$346.84,$98.45,$864.30,"$1,558.02"
36101267,EAP,CPT® 67820,,Revised Eye Lashes,$317.00,$0.00,$317.00,$172.13,$0.00,$104.55,$54.62,$0.00,$0.00,$55.50,$317.00,$109.35,$317.00,$251.06,$253.60,$151.93,$67.50,$28.84,$50.47,$104.14
36101270,EAP,CPT® 19000,,Drain Breast Cyst,"$1,141.00",$45.43,"$1,141.00","$1,141.00","$1,141.00",$584.94,$196.59,"$1,141.00","$1,141.00",$199.78,"$1,141.00",$611.80,"$1,141.00",$903.67,$912.80,$850.02,$59.58,$45.43,$181.65,$582.67
36101273,EAP,CPT® 21925,,Bx Soft Tissue Back/flank,"$5,368.00",$0.00,"$5,368.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,368.00",$0.00,"$2,327.00","$4,251.46","$4,294.40",$0.00,$0.00,$0.00,$0.00,$0.00
36101274,EAP,CPT® 31535,,Laryngoscopy W/biopsy,"$8,960.00",$0.00,"$8,960.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$8,960.00",$0.00,"$2,327.00","$7,096.32","$7,168.00",$0.00,$0.00,$0.00,$0.00,$0.00
36101275,EAP,CPT® 31577,,"Removal Foreign Body, Larynx","$1,826.00",$0.00,"$1,826.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,826.00",$0.00,"$1,826.00","$1,446.19","$1,460.80",$0.00,$0.00,$0.00,$0.00,$0.00
36101280,EAP,CPT® 44370,,"Small Bowel Endoscop/stent,spv","$7,753.00",$0.00,"$7,753.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$7,753.00",$0.00,"$6,105.00","$6,140.38","$6,202.40",$0.00,$0.00,$0.00,$0.00,$0.00
36101281,EAP,CPT® 49411,,Ins Mark Abd/pel For Rt Perq,"$3,183.00",$0.00,"$3,183.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,183.00",$0.00,"$2,255.00","$2,520.94","$2,546.40",$0.00,$0.00,$0.00,$0.00,$0.00
36101284,EAP,CPT® 54161,,Circum 28 Days Or Older,"$4,283.00",$0.00,"$4,283.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,283.00",$0.00,"$2,327.00","$3,392.14","$3,426.40",$0.00,$0.00,$0.00,$0.00,$0.00
36101285,EAP,CPT® 58999,,Female Genital System Procedur,$250.00,$0.00,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$250.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
36101286,EAP,CPT® 59412,,Antepartum Manipulation,"$4,901.00",$0.00,"$4,901.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,901.00",$0.00,"$2,255.00","$3,881.59","$3,920.80",$0.00,$0.00,$0.00,$0.00,$0.00
36101287,EAP,CPT® 59870,,Evacuate Mole Of Uterus,"$4,917.00",$0.00,"$4,917.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,917.00",$0.00,"$3,902.00","$3,894.26","$3,933.60",$0.00,$0.00,$0.00,$0.00,$0.00
36101288,EAP,CPT® 60300,,Aspir/inj Thyroid Cyst,"$1,741.00",$51.21,"$1,741.00","$1,741.00","$1,242.55",$584.94,$299.97,"$1,242.55","$1,242.55",$304.84,"$1,741.00",$611.80,"$1,741.00","$1,378.87","$1,392.80",$850.02,$86.36,$51.21,$277.17,$582.67
36101290,EAP,CPT® 61623,,Endovasc Tempry Vesel Ocl Nir,"$16,054.00",$0.00,"$16,054.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$16,054.00",$0.00,"$6,105.00","$12,714.77","$12,843.20",$0.00,$0.00,$0.00,$0.00,$0.00
36101292,EAP,CPT® 61641,,Dilate Ic Vasospasm Add-on,"$12,293.00",$0.00,"$12,293.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$12,293.00",$0.00,"$6,146.50","$9,736.06","$9,834.40",$0.00,$0.00,$0.00,$0.00,$0.00
36101295,EAP,CPT® 65210,,Remove Foreign Body From Eye,$611.00,$0.00,$611.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$611.00,$0.00,$611.00,$483.91,$488.80,$0.00,$0.00,$0.00,$0.00,$0.00
36101296,EAP,CPT® 69200,,Removal Fb Ear W/o Anesth,$412.00,$0.00,$412.00,$223.72,$0.00,$104.55,$70.99,$0.00,$0.00,$72.14,$412.00,$109.35,$412.00,$326.30,$329.60,$151.93,$58.58,$48.67,$65.59,$104.14
36101298,EAP,CPT® 74220,,"Contrast X-ray, Esophagus,spv","$1,188.00",$0.00,"$1,188.00",$173.37,$0.00,$193.45,$204.69,$0.00,$0.00,$208.01,"$1,188.00",$202.33,$285.12,$940.90,$950.40,$281.11,$68.55,$66.99,$189.13,$192.70
36101302,EAP,CPT® 92953,,Temp Transcut Pacing,"$2,499.00",$0.00,"$2,499.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,499.00",$0.00,"$1,249.50","$1,979.21","$1,999.20",$0.00,$0.00,$0.00,$0.00,$0.00
36101310,EAP,CPT® 31641,,Bronchoscopy Treat Blockage,"$9,697.00",$265.77,"$9,697.00","$2,496.90","$6,920.75","$2,816.20","$1,670.74","$6,920.75","$5,416.74","$1,697.87","$9,697.00","$2,945.54","$2,327.00","$7,680.02","$7,757.60","$4,092.44",$324.15,$265.77,"$1,543.76","$2,805.28"
36101311,EAP,CPT® 64416,,Inj Anes/strd Brachial Plexus By Cont Infusion,"$4,307.00",$0.00,"$4,307.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,307.00",$0.00,"$2,255.00","$3,411.14","$3,445.60",$0.00,$0.00,$0.00,$0.00,$0.00
36101312,EAP,CPT® 64446,,Inj Anes/strd Sicatic Nerve By Cont Infusion,"$4,699.00",$0.00,"$4,699.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,699.00",$0.00,"$2,255.00","$3,721.61","$3,759.20",$0.00,$0.00,$0.00,$0.00,$0.00
36101313,EAP,CPT® 64448,,Inj Anes/strd Femoral Nerve By Cont Infusion,"$3,811.00",$0.00,"$3,811.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,811.00",$0.00,"$2,255.00","$3,018.31","$3,048.80",$0.00,$0.00,$0.00,$0.00,$0.00
36101314,EAP,CPT® 64449,,Inj Anes/strd Lumbar Plexus By Cont Infusion,"$3,673.00",$0.00,"$3,673.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,673.00",$0.00,"$2,255.00","$2,909.02","$2,938.40",$0.00,$0.00,$0.00,$0.00,$0.00
36101315,EAP,CPT® 64486,,Tap Block Unil By Injection,"$1,705.00",$0.00,"$1,705.00","$1,705.00","$1,216.86",$0.00,$293.76,"$1,216.86","$1,216.86",$298.53,"$1,705.00",$0.00,$852.50,"$1,350.36","$1,364.00",$0.00,$119.70,$58.43,$271.44,$0.00
36101316,EAP,CPT® 64487,,Tap Block Uni By Infusion,"$1,705.00",$0.00,"$1,705.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,705.00",$0.00,$852.50,"$1,350.36","$1,364.00",$0.00,$0.00,$0.00,$0.00,$0.00
36101317,EAP,CPT® 64488,,Tap Block Bi Injection,"$1,705.00",$0.00,"$1,705.00","$1,705.00","$1,216.86",$0.00,$293.76,"$1,216.86","$1,216.86",$298.53,"$1,705.00",$0.00,$852.50,"$1,350.36","$1,364.00",$0.00,$147.17,$72.14,$271.44,$0.00
36101318,EAP,CPT® 64489,,Tap Block Bi By Infusion,"$1,705.00",$0.00,"$1,705.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,705.00",$0.00,$852.50,"$1,350.36","$1,364.00",$0.00,$0.00,$0.00,$0.00,$0.00
36101350,EAP,CPT® 31525,,"Dx Laryngoscopy, Except Nb","$6,412.00",$0.00,"$6,412.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,412.00",$0.00,"$2,255.00","$5,078.30","$5,129.60",$0.00,$0.00,$0.00,$0.00,$0.00
36101351,EAP,CPT® 49451,,"Replace Duod/jej Tube Perc,spv","$2,752.00",$0.00,"$2,752.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,752.00",$0.00,"$2,255.00","$2,179.58","$2,201.60",$0.00,$0.00,$0.00,$0.00,$0.00
36101355,EAP,CPT® 69000,,Drain External Ear Lesion,$700.00,$0.00,$700.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$700.00,$0.00,$700.00,$554.40,$560.00,$0.00,$0.00,$0.00,$0.00,$0.00
36101370,EAP,CPT® 92511,,Nasopharyngoscopy W/endoscope,$612.00,$0.00,$612.00,$612.00,$0.00,$150.12,$105.44,$0.00,$0.00,$107.16,$612.00,$157.01,$612.00,$484.70,$489.60,$218.14,$64.35,$38.94,$97.43,$149.53
36101371,EAP,CPT® 77002,,Fluoro Guidance For Needle Pla,$724.00,$0.00,$724.00,$183.13,$105.40,$0.00,$124.74,$105.40,$105.40,$126.77,$724.00,$0.00,$173.76,$573.41,$579.20,$0.00,$71.68,$81.40,$115.26,$0.00
36101375,EAP,CPT® 12021,,Wound Dehiscence With Packing,"$3,676.00",$117.17,"$3,676.00","$2,106.30","$2,623.56",$306.38,$633.36,"$2,623.56","$2,623.56",$643.64,"$3,676.00",$320.45,"$2,255.00","$2,911.39","$2,940.80",$445.22,$117.17,$144.54,$585.22,$305.19
36101390,EAP,CPT® 49180,,Ablation Abd Standa,"$2,922.00",$87.64,"$2,922.00","$2,106.30","$2,085.43","$1,316.19",$503.45,"$2,085.43","$2,085.43",$511.62,"$2,922.00","$1,376.63","$2,255.00","$2,314.22","$2,337.60","$1,912.65",$203.88,$87.64,$465.18,"$1,311.08"
36101396,EAP,CPT® 32555,,Aspirate Pleura W/ Imaging,"$3,461.00",$116.13,"$3,461.00","$2,106.30","$2,470.12",$604.60,$596.31,"$2,470.12","$2,470.12",$605.99,"$3,461.00",$632.36,"$2,255.00","$2,741.11","$2,768.80",$878.58,$626.46,$116.13,$550.99,$602.25
36101398,EAP,CPT® 31647,,Bronchial Valve Init Insert,"$5,148.00",$0.00,"$5,148.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,148.00",$0.00,"$2,858.00","$4,077.22","$4,118.40",$0.00,$0.00,$0.00,$0.00,$0.00
36101399,EAP,CPT® 31648,,Bronchial Valve Addl Insert,"$3,029.00",$0.00,"$3,029.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,029.00",$0.00,"$2,858.00","$2,398.97","$2,423.20",$0.00,$0.00,$0.00,$0.00,$0.00
36101400,EAP,CPT® 31649,,Bronchial Valve Remov Init,"$1,500.00",$0.00,"$1,500.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,500.00",$0.00,"$1,500.00","$1,188.00","$1,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
36101401,EAP,CPT® 31651,,Bronchial Valve Remov Addl,$947.00,$0.00,$947.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$947.00,$0.00,$473.50,$750.02,$757.60,$0.00,$0.00,$0.00,$0.00,$0.00
36101402,EAP,CPT® 32556,,Insert Cath Pleura W/o Image,"$3,536.00",$0.00,"$3,536.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,536.00",$0.00,"$2,255.00","$2,800.51","$2,828.80",$0.00,$0.00,$0.00,$0.00,$0.00
36101403,EAP,CPT® 32557,,Insert Cath Pleura W/ Image,"$2,627.00",$0.00,"$2,627.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,627.00",$0.00,"$2,255.00","$2,080.58","$2,101.60",$0.00,$0.00,$0.00,$0.00,$0.00
36101404,EAP,CPT® 31626,,Navigation Bronchoscopy W/markers,"$5,440.00",$205.55,"$5,456.35","$2,706.90","$3,777.61","$5,216.76",$911.96,"$3,777.61","$3,777.61",$926.76,"$5,293.00","$5,456.35","$2,858.00","$4,192.06","$4,234.40","$5,293.00",$317.84,$205.55,$842.65,"$5,196.52"
36101405,EAP,CPT® 61650,,Endovasc Intracran Adm Rx 1st,"$9,243.00",$0.00,"$9,243.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$9,243.00",$0.00,"$4,621.50","$7,320.46","$7,394.40",$0.00,$0.00,$0.00,$0.00,$0.00
36101406,EAP,CPT® 61651,,Endovasc Intracran Adm Rx Add,"$8,917.00",$0.00,"$8,917.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$8,917.00",$0.00,"$4,458.50","$7,062.26","$7,133.60",$0.00,$0.00,$0.00,$0.00,$0.00
36101407,EAP,CPT® 37252,,Us Vascular Non-coronary Init,"$15,114.00",$0.00,"$15,114.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$15,114.00",$0.00,"$3,902.00","$11,970.29","$12,091.20",$0.00,$0.00,$0.00,$0.00,$0.00
36101408,EAP,CPT® 37253,,Us Vascular Non-coron Add Ea,"$11,208.00",$0.00,"$11,208.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$11,208.00",$0.00,"$3,902.00","$8,876.74","$8,966.40",$0.00,$0.00,$0.00,$0.00,$0.00
36101409,EAP,CPT® 47532,,Xr Cholangiogram Transhepatic,"$3,257.00",$0.00,"$3,257.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,257.00",$0.00,"$2,858.00","$2,579.54","$2,605.60",$0.00,$0.00,$0.00,$0.00,$0.00
36101410,EAP,CPT® 47531,,Xr Cholangiogram Thru Cath,"$3,257.00",$73.56,"$3,257.00","$2,106.30","$2,324.52","$2,981.55",$561.16,"$2,324.52","$2,324.52",$570.27,"$3,257.00","$3,118.48","$2,255.00","$2,579.54","$2,605.60","$3,257.00",$360.21,$73.56,$518.51,"$2,969.98"
36101411,EAP,CPT® 47533,,Pl Bil Drn Cath Perc Ext Rad,"$5,443.00",$0.00,"$5,443.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,443.00",$0.00,"$2,255.00","$4,310.86","$4,354.40",$0.00,$0.00,$0.00,$0.00,$0.00
36101412,EAP,CPT® 47534,,Pl Bil Drn Cath Perc Int/ext R,"$6,205.00",$0.00,"$6,205.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,205.00",$0.00,"$2,255.00","$4,914.36","$4,964.00",$0.00,$0.00,$0.00,$0.00,$0.00
36101413,EAP,CPT® 47535,,Conv Ext Bil Drn Cath To Int/e,"$5,443.00",$0.00,"$5,443.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,443.00",$0.00,"$2,255.00","$4,310.86","$4,354.40",$0.00,$0.00,$0.00,$0.00,$0.00
36101414,EAP,CPT® 47536,,Exch Bil Drn Cath Perc Rad,"$6,205.00",$138.48,"$6,205.00","$2,496.90","$4,428.51","$2,981.55","$1,069.09","$4,428.51","$4,428.51","$1,086.45","$6,205.00","$3,118.48","$2,255.00","$4,914.36","$4,964.00","$4,332.71",$789.54,$138.48,$987.84,"$2,969.98"
36101415,EAP,CPT® 47537,,Rmvl Bil Drn Cath Perc Fluor G,"$1,207.00",$0.00,"$1,207.00","$1,207.00",$0.00,$753.62,$207.96,$0.00,$0.00,$211.34,"$1,207.00",$788.23,"$1,207.00",$955.94,$965.60,"$1,095.14",$390.05,$100.61,$192.15,$750.70
36101416,EAP,CPT® 47538,,PLMT STENT BILE DUCT PERC RAD EXIS ACCS,"$10,296.00",$0.00,"$10,296.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$10,296.00",$0.00,"$2,858.00","$8,154.43","$8,236.80",$0.00,$0.00,$0.00,$0.00,$0.00
36101417,EAP,CPT® 47539,,PLMT STENT BILE DUCT PERC RAD NEW ACCS W/O CATH,"$10,296.00",$0.00,"$10,296.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$10,296.00",$0.00,"$2,858.00","$8,154.43","$8,236.80",$0.00,$0.00,$0.00,$0.00,$0.00
36101418,EAP,CPT® 47540,,PLMT STENT BILE DUCT PERC RAD NEW ACCS W/ CATH,"$10,296.00",$0.00,"$10,296.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$10,296.00",$0.00,"$2,858.00","$8,154.43","$8,236.80",$0.00,$0.00,$0.00,$0.00,$0.00
36101419,EAP,CPT® 47541,,Place Access Biliary Sm Bowel,"$5,443.00",$0.00,"$5,443.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,443.00",$0.00,"$2,255.00","$4,310.86","$4,354.40",$0.00,$0.00,$0.00,$0.00,$0.00
36101420,EAP,CPT® 47542,,Dilation Biliary Duct/ampulla,"$5,443.00",$0.00,"$5,443.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,443.00",$0.00,"$2,721.50","$4,310.86","$4,354.40",$0.00,$0.00,$0.00,$0.00,$0.00
36101421,EAP,CPT® 47543,,Endolumin Bx Biliary Tree Perq,"$5,443.00",$0.00,"$5,443.00","$2,106.30","$3,884.67",$0.00,$937.80,"$3,884.67","$3,884.67",$953.03,"$5,443.00",$0.00,"$2,721.50","$4,310.86","$4,354.40",$0.00,"$1,282.63",$151.83,$866.53,$0.00
36101422,EAP,CPT® 47544,,Extract Stone Duct Biliary,"$2,246.00",$0.00,"$2,246.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,246.00",$0.00,"$2,246.00","$1,778.83","$1,796.80",$0.00,$0.00,$0.00,$0.00,$0.00
36101423,EAP,CPT® 49185,,Sclerotx Fluid Collection Perq,"$2,755.00",$0.00,"$2,755.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,755.00",$0.00,"$1,377.50","$2,181.96","$2,204.00",$0.00,$0.00,$0.00,$0.00,$0.00
36101424,EAP,CPT® 50432,,Ins Cath Drain Renal Pelvis,"$6,215.00",$214.93,"$6,215.00","$2,496.90","$4,435.65","$1,698.74","$1,070.81","$4,435.65","$4,435.65","$1,088.20","$6,215.00","$1,776.76","$2,255.00","$4,922.28","$4,972.00","$2,468.57",$817.36,$214.93,$989.43,"$1,692.15"
36101425,EAP,CPT® 50693,,PLMT URETERAL STENT PRQ NEPH/URETEROGRAM PRE-EXIST,"$5,609.00",$0.00,"$5,609.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,609.00",$0.00,"$2,255.00","$4,442.33","$4,487.20",$0.00,$0.00,$0.00,$0.00,$0.00
36101426,EAP,CPT® 50694,,PLMT URETERAL STENT PRQ NEPH/URETEROGRAM NEW ACCES,"$5,609.00",$0.00,"$5,609.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,609.00",$0.00,"$2,255.00","$4,442.33","$4,487.20",$0.00,$0.00,$0.00,$0.00,$0.00
36101427,EAP,CPT® 50695,,PLMT URETERAL STENT PRQ NEP/URT NEW ACCES SEP CATH,"$5,609.00",$0.00,"$5,609.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,609.00",$0.00,"$2,255.00","$4,442.33","$4,487.20",$0.00,$0.00,$0.00,$0.00,$0.00
36101428,EAP,CPT® 50430,,Inj Antegrade Neph/uret Comp,"$1,311.00",$0.00,"$1,311.00","$1,311.00",$0.00,$533.66,$225.88,$0.00,$0.00,$229.55,"$1,311.00",$558.17,"$1,311.00","$1,038.31","$1,048.80",$775.50,$503.90,$160.83,$208.71,$531.59
36101429,EAP,CPT® 50431,,Inj Antegrade Neph/uret Comp,"$1,311.00",$0.00,"$1,311.00","$1,311.00",$0.00,$533.66,$225.88,$0.00,$0.00,$229.55,"$1,311.00",$558.17,"$1,311.00","$1,038.31","$1,048.80",$775.50,$156.69,$67.79,$208.71,$531.59
36101430,EAP,CPT® 50433,,Place Nephroureteral Cath Prq,"$3,765.00",$0.00,"$3,765.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,765.00",$0.00,"$2,255.00","$2,981.88","$3,012.00",$0.00,$0.00,$0.00,$0.00,$0.00
36101431,EAP,CPT® 50434,,Convert Nephrostomy Cath,"$1,923.00",$200.50,"$1,923.00","$1,923.00","$1,372.45","$1,698.74",$331.32,"$1,372.45","$1,372.45",$336.70,"$1,923.00","$1,776.76","$1,923.00","$1,523.02","$1,538.40","$1,923.00",$870.58,$200.50,$306.14,"$1,692.15"
36101432,EAP,CPT® 50435,,Chg Tube Nephro/pyelo,"$2,163.00",$103.85,"$2,163.00","$2,106.30","$1,543.73","$1,698.74",$372.67,"$1,543.73","$1,543.73",$378.72,"$2,163.00","$1,776.76","$2,163.00","$1,713.10","$1,730.40","$2,163.00",$457.01,$103.85,$344.35,"$1,692.15"
36101433,EAP,CPT® 50606,,Endoluminal Bx Ureter Renal,"$5,609.00",$0.00,"$5,609.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,609.00",$0.00,"$2,804.50","$4,442.33","$4,487.20",$0.00,$0.00,$0.00,$0.00,$0.00
36101437,EAP,CPT® 50705,,Ureteral Embolization/occusion,"$5,609.00",$0.00,"$5,609.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,609.00",$0.00,"$2,804.50","$4,442.33","$4,487.20",$0.00,$0.00,$0.00,$0.00,$0.00
36101438,EAP,CPT® 50706,,Ball Dilat Ureteral Stricture,"$5,609.00",$0.00,"$5,609.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,609.00",$0.00,"$2,804.50","$4,442.33","$4,487.20",$0.00,$0.00,$0.00,$0.00,$0.00
36101439,EAP,CPT® 61645,,Perq Arterial Translum Thromec,"$23,168.00",$0.00,"$23,168.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$23,168.00",$0.00,"$11,584.00","$18,349.06","$18,534.40",$0.00,$0.00,$0.00,$0.00,$0.00
36101440,EAP,CPT® 62321,,Inj Of Sub Spinal Canal Upper/mid Back; W/image,"$1,316.00",$0.00,"$1,316.00","$1,316.00",$0.00,$599.36,$226.74,$0.00,$0.00,$230.42,"$1,316.00",$626.89,"$1,316.00","$1,042.27","$1,052.80",$870.98,$240.25,$111.42,$209.51,$597.04
36101441,EAP,CPT® 62323,,Inj Of Sub Spinal Canal Lower Back/sacrum; W/image,"$1,316.00",$0.00,"$1,316.00","$1,316.00",$0.00,$599.36,$226.74,$0.00,$0.00,$230.42,"$1,316.00",$626.89,"$1,316.00","$1,042.27","$1,052.80",$870.98,$235.81,$103.13,$209.51,$597.04
36101445,EAP,CPT® 31573,,Laryngoscopy Flexible Therapeutic Injection Uni,"$3,543.00",$0.00,"$3,543.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,543.00",$0.00,"$2,255.00","$2,806.06","$2,834.40",$0.00,$0.00,$0.00,$0.00,$0.00
36101501,EAP,CPT® 30020,,Drainage Of Nose Lesion,"$2,343.00",$0.00,"$2,343.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,343.00",$0.00,"$2,255.00","$1,855.66","$1,874.40",$0.00,$0.00,$0.00,$0.00,$0.00
36101502,EAP,CPT® 31654,,Bronchoscopy Rigid/flex Ebus Interven Peri Lesion,"$22,915.00",$0.00,"$22,915.00","$2,106.30","$16,354.44",$0.00,"$3,948.14","$16,354.44","$5,416.74","$4,012.23","$22,915.00",$0.00,"$11,457.50","$18,148.68","$18,332.00",$0.00,$139.20,$69.97,"$3,648.07",$0.00
36101503,EAP,CPT® 31652,,Bronchoscopy Rigid/flex Ebus Sampling 1 Or 2 Node,"$5,360.00",$230.08,"$5,360.00","$2,496.90","$3,825.43","$2,816.20",$923.50,"$3,825.43","$3,825.43",$938.49,"$5,360.00","$2,945.54","$2,255.00","$4,245.12","$4,288.00","$4,092.44",$874.40,$230.08,$853.31,"$2,805.28"
36101504,EAP,CPT® 31653,,Bronchoscopy Rigid/flex Ebus Sampling 3/> Node,"$4,729.00",$255.33,"$4,729.00","$2,496.90","$3,375.09","$2,816.20",$814.78,"$3,375.09","$3,375.09",$828.01,"$4,729.00","$2,945.54","$2,255.00","$3,745.37","$3,783.20","$4,092.44",$929.42,$255.33,$752.86,"$2,805.28"
36101520,EAP,CPT® 42330,,Removal Of Salivary Stone,"$6,417.00",$0.00,"$6,417.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,417.00",$0.00,"$2,255.00","$5,082.26","$5,133.60",$0.00,$0.00,$0.00,$0.00,$0.00
36101961,EAP,CPT® 57460,,Colposcopy W/leep Bx,"$4,743.00",$168.01,"$4,743.00","$2,496.90","$3,385.08","$2,395.43",$817.20,"$3,385.08","$3,385.08",$830.46,"$4,743.00","$2,505.44","$2,255.00","$3,756.46","$3,794.40","$3,480.98",$178.42,$168.01,$755.09,"$2,386.14"
36101970,EAP,CPT® 58100,,Endometrial Biopsy,$346.00,$55.08,$346.00,$346.00,$346.00,$159.23,$59.61,$346.00,$346.00,$60.58,$346.00,$166.54,$346.00,$274.03,$276.80,$231.38,$59.72,$67.07,$55.08,$158.61
36101985,EAP,CPT® 46999,,Anus Surgery Procedure,"$1,264.00",$0.00,"$1,264.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,264.00",$0.00,"$1,264.00","$1,001.09","$1,011.20",$0.00,$0.00,$0.00,$0.00,$0.00
36101987,EAP,CPT® 57456,,Colposcopy + Ecc,"$1,221.00",$106.36,"$1,221.00","$1,221.00","$1,208.73",$259.59,$210.37,"$1,208.73","$1,208.73",$213.79,"$1,221.00",$271.52,"$1,221.00",$967.03,$976.80,$377.23,$137.69,$106.36,$194.38,$258.59
36101989,EAP,CPT® 23931,,Drainage Of Arm Bursa,"$7,290.00",$0.00,"$7,290.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$7,290.00",$0.00,"$2,327.00","$5,773.68","$5,832.00",$0.00,$0.00,$0.00,$0.00,$0.00
36101990,EAP,CPT® 91111,,Esophageal Capsule Endoscopy,"$3,284.00",$513.95,"$3,284.00","$1,783.21","$2,343.79",$753.62,$565.82,"$2,343.79","$2,343.79",$575.00,"$3,284.00",$788.23,"$1,642.00","$2,600.93","$2,627.20","$1,095.14",$513.95,$828.40,$522.81,$750.70
36101991,EAP,CPT® 91110,,Gi Tract Capsule Endoscopy,"$4,068.00",$588.72,"$3,698.00","$2,008.01","$2,639.26",$753.62,$637.15,"$2,639.26","$2,639.26",$647.49,"$3,698.00",$788.23,"$1,849.00","$2,928.82","$2,958.40","$1,095.14",$923.73,$745.92,$588.72,$750.70
36101992,EAP,CPT® 56405,,"I & D, Vulva, Perineum",$294.00,$0.00,$294.00,$0.00,$0.00,$0.00,$50.65,$0.00,$0.00,$51.48,$294.00,$0.00,$294.00,$232.85,$235.20,$0.00,$107.63,$0.00,$0.00,$0.00
36101994,EAP,CPT® 64425,,Inject Anest Ilioin,"$3,441.00",$0.00,"$3,441.00","$2,106.30","$2,455.84",$599.36,$0.00,"$2,455.84","$2,455.84",$602.49,"$3,441.00",$626.89,"$2,255.00","$2,725.27","$2,752.80",$870.98,$0.00,$57.69,$547.81,$597.04
36101995,EAP,CPT® 41899,,Rem Imp Tooth W Mucoper Fip,"$1,880.00",$0.00,"$1,880.00","$1,880.00","$1,341.76",$195.27,$323.91,"$1,341.76","$1,341.76",$329.17,"$1,880.00",$204.24,"$1,880.00","$1,488.96","$1,504.00",$283.76,$294.22,$0.00,$299.30,$194.51
36101997,EAP,CPT® 12001,,Repair Superficial Wound(s),$704.00,$46.87,$704.00,$704.00,$704.00,$167.55,$121.30,$704.00,$704.00,$123.26,$704.00,$175.24,$704.00,$557.57,$563.20,$243.48,$116.22,$46.87,$112.08,$166.90
36101998,EAP,CPT® 36228,,Sel Cath Plc Intracrn Brnch Ic/vert Art W/angio,"$69,457.00",$0.00,"$61,615.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$61,615.00",$0.00,"$30,807.50","$48,799.08","$49,292.00",$0.00,$0.00,$0.00,$0.00,$0.00
36102010,EAP,CPT® 29580,,Unna Booth,$780.00,$0.00,$780.00,$423.54,$0.00,$128.24,$134.39,$0.00,$0.00,$136.57,$780.00,$134.13,$780.00,$617.76,$624.00,$186.36,$54.52,$28.49,$124.18,$127.75
36102050,EAP,CPT® 26010,,Abscess Finger Simple,"$1,407.00",$0.00,"$1,407.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,407.00",$0.00,"$1,407.00","$1,114.34","$1,125.60",$0.00,$0.00,$0.00,$0.00,$0.00
36102062,EAP,CPT® 29130,,Application Of Finger Splint,$859.00,$0.00,$859.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$859.00,$0.00,$859.00,$680.33,$687.20,$0.00,$0.00,$0.00,$0.00,$0.00
36102063,EAP,CPT® 38505,,Bx Lymph Node Ndl Bic,"$1,801.00",$72.83,"$1,801.00","$1,801.00","$1,285.37","$1,316.19",$310.30,"$1,285.37","$1,285.37",$315.34,"$1,801.00","$1,376.63","$1,801.00","$1,426.39","$1,440.80","$1,801.00",$115.87,$72.83,$286.72,"$1,311.08"
36102064,EAP,CPT® 45005,,Drainage Of Rectal Abscess Ult,"$5,625.00",$0.00,"$5,625.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,625.00",$0.00,"$2,327.00","$4,455.00","$4,500.00",$0.00,$0.00,$0.00,$0.00,$0.00
36102066,EAP,CPT® 49060,,Drain Open Retrop Abscess Ult,"$5,398.00",$0.00,"$5,398.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,398.00",$0.00,"$2,255.00","$4,275.22","$4,318.40",$0.00,$0.00,$0.00,$0.00,$0.00
36102068,EAP,CPT® 52341,,Cysto W/ureter Stricture Tx,"$9,599.00",$0.00,"$9,599.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$9,599.00",$0.00,"$2,858.00","$7,602.41","$7,679.20",$0.00,$0.00,$0.00,$0.00,$0.00
36102082,EAP,CPT® 57505,,Ecc Cervical Scrape,"$2,064.00",$86.47,"$2,064.00","$2,064.00","$1,473.08",$612.22,$355.62,"$1,473.08","$1,473.08",$361.39,"$2,064.00",$640.34,"$2,064.00","$1,634.69","$1,651.20",$889.66,$86.47,$104.52,$328.59,$609.84
36102090,EAP,CPT® 49421,,Perm Peritoneal Cath Insert,"$13,853.00",$0.00,"$13,853.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$13,853.00",$0.00,"$2,255.00","$10,971.58","$11,082.40",$0.00,$0.00,$0.00,$0.00,$0.00
36102091,EAP,CPT® 49402,,Techoff Cath. Removal,"$5,868.00",$0.00,"$5,868.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,868.00",$0.00,"$2,327.00","$4,647.46","$4,694.40",$0.00,$0.00,$0.00,$0.00,$0.00
36102095,EAP,CPT® 19120,,"Excision Of Cyst,fibro Adrenoma","$5,495.00",$0.00,"$5,495.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,495.00",$0.00,"$2,858.00","$4,352.04","$4,396.00",$0.00,$0.00,$0.00,$0.00,$0.00
36102100,EAP,CPT® 64400,,"Inj Anes/strd Trigeminal Nerve, Each Branch","$1,184.00",$0.00,"$1,184.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,184.00",$0.00,"$1,184.00",$937.73,$947.20,$0.00,$0.00,$0.00,$0.00,$0.00
36102101,EAP,CPT® 64455,,N Block Inj Plantar Digit,"$1,043.00",$0.00,"$1,043.00","$1,043.00",$0.00,$251.01,$179.70,$0.00,$0.00,$182.62,"$1,043.00",$262.54,"$1,043.00",$826.06,$834.40,$364.76,$46.42,$36.07,$166.05,$250.04
36102150,EAP,CPT® 19101,,"Breast Biopsy, Open, Incisional","$3,381.00",$0.00,"$3,381.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,381.00",$0.00,"$2,327.00","$2,677.75","$2,704.80",$0.00,$0.00,$0.00,$0.00,$0.00
36102151,EAP,CPT® 19125,,Excision Breast Lesion,"$3,030.00",$0.00,"$2,825.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,825.00",$0.00,"$2,825.00","$2,237.40","$2,260.00",$0.00,$0.00,$0.00,$0.00,$0.00
36102152,EAP,CPT® 66020,,Injection Treatment Of Eye,"$5,312.00",$0.00,"$5,312.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,312.00",$0.00,"$2,255.00","$4,207.10","$4,249.60",$0.00,$0.00,$0.00,$0.00,$0.00
36102153,EAP,CPT® 68530,,Clearance Of Tear Duct,$579.00,$0.00,$579.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$579.00,$0.00,$579.00,$458.57,$463.20,$0.00,$0.00,$0.00,$0.00,$0.00
36102155,EAP,CPT® 11600,,Exc Tr-emt Mlg+marg 0.5<cm,"$3,694.00",$0.00,"$3,694.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,694.00",$0.00,"$2,255.00","$2,925.65","$2,955.20",$0.00,$0.00,$0.00,$0.00,$0.00
36102156,EAP,CPT® 64530,,"INJECTION, ANESTHETIC AGENT,CELIAC","$8,538.00",$0.00,"$8,538.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$8,538.00",$0.00,"$2,255.00","$6,762.10","$6,830.40",$0.00,$0.00,$0.00,$0.00,$0.00
36102157,EAP,CPT® 77012,,Ct Quidance For Needle Placement,"$2,389.00",$0.00,"$2,039.00","$1,273.65","$1,455.23",$0.00,$351.31,"$1,455.23","$1,455.23",$357.01,"$2,039.00",$0.00,$489.36,"$1,614.89","$1,631.20",$0.00,$312.12,$77.80,$324.61,$0.00
36102161,EAP,CPT® 19120,,Excision Of Cyst Or Other Benign/malignant  Tumor 1 Or S,"$5,495.00",$0.00,"$5,495.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,495.00",$0.00,"$2,858.00","$4,352.04","$4,396.00",$0.00,$0.00,$0.00,$0.00,$0.00
36102172,EAP,CPT® 20500,,"Sinogram, Therapeutic","$1,414.00",$0.00,"$1,414.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,414.00",$0.00,"$1,414.00","$1,119.89","$1,131.20",$0.00,$0.00,$0.00,$0.00,$0.00
36102183,EAP,CPT® 32561,,"Fibrinolysis Via Chest Tube/catheter, Initial","$2,041.00",$0.00,"$2,041.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,041.00",$0.00,"$2,041.00","$1,616.47","$1,632.80",$0.00,$0.00,$0.00,$0.00,$0.00
36102184,EAP,CPT® 32562,,"Fibrinolysis Via Chest Tube/cath Catheter, Subseq","$2,041.00",$0.00,"$2,041.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,041.00",$0.00,"$2,041.00","$1,616.47","$1,632.80",$0.00,$0.00,$0.00,$0.00,$0.00
36102185,EAP,CPT® 32998,,Percutaneous Rfa Lung Tumor(s),"$12,982.00",$0.00,"$12,982.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$12,982.00",$0.00,"$5,452.00","$10,281.74","$10,385.60",$0.00,$0.00,$0.00,$0.00,$0.00
36102189,EAP,CPT® 35226,,Repair Of Blood  Vessel Direct Lower  Extremity,"$2,092.00",$0.00,"$1,812.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,812.00",$0.00,"$1,812.00","$1,435.10","$1,449.60",$0.00,$0.00,$0.00,$0.00,$0.00
36102190,EAP,CPT® 35256,,"Lower Extremity, Vein Graft","$7,768.00",$0.00,"$7,768.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$7,768.00",$0.00,"$2,255.00","$6,152.26","$6,214.40",$0.00,$0.00,$0.00,$0.00,$0.00
36102193,EAP,CPT® 35556,,"Bypass Graft, With Vein; Femoral-popliteal","$14,020.00",$0.00,"$14,020.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$14,020.00",$0.00,"$2,255.00","$11,103.84","$11,216.00",$0.00,$0.00,$0.00,$0.00,$0.00
36102194,EAP,CPT® 35565,,"Bypass Graft, With Vein; Iliofemoral","$14,154.00",$0.00,"$14,154.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$14,154.00",$0.00,"$2,255.00","$11,209.97","$11,323.20",$0.00,$0.00,$0.00,$0.00,$0.00
36102195,EAP,CPT® 36002,,Pseudoaneurysm Tx Injection (thrombin),"$2,313.00",$0.00,"$2,313.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,313.00",$0.00,"$2,255.00","$1,831.90","$1,850.40",$0.00,$0.00,$0.00,$0.00,$0.00
36102196,EAP,CPT® 36100,,"Introduction Of Needle Or Intracatheter, Carotid Or Vertebral Artery","$2,587.00",$0.00,"$2,587.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,587.00",$0.00,"$2,255.00","$2,048.90","$2,069.60",$0.00,$0.00,$0.00,$0.00,$0.00
36102197,EAP,CPT® 36471,,"Injection Of Sclerosing Solution; Multiple Veins, Same Leg",$781.00,$0.00,$625.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$625.00,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
36102198,EAP,CPT® 36620,,"Arterial Catheterization Or Cannulation For Sampling, Mn","$1,480.00",$0.00,"$1,339.00","$1,339.00",$0.00,$0.00,$230.70,$0.00,$0.00,$234.45,"$1,339.00",$0.00,"$1,339.00","$1,060.49","$1,071.20",$0.00,$59.97,$46.17,$213.17,$0.00
36102200,EAP,CPT® 38505,,"Lymph Nodes, Sup., Percut","$1,801.00",$72.83,"$1,801.00","$1,801.00","$1,285.37","$1,316.19",$310.30,"$1,285.37","$1,285.37",$315.34,"$1,801.00","$1,376.63","$1,801.00","$1,426.39","$1,440.80","$1,801.00",$115.87,$72.83,$286.72,"$1,311.08"
36102202,EAP,CPT® 43752,,Naso/oro Gastric Tube Placement,"$2,052.00",$42.55,"$2,052.00","$2,052.00","$1,464.51",$348.65,$353.55,"$1,464.51","$1,464.51",$359.29,"$2,052.00",$364.66,"$2,052.00","$1,625.18","$1,641.60",$506.64,$321.14,$42.55,$326.68,$347.29
36102205,EAP,CPT® 47380,,"Open Rfa, Liver Tumor(s) Using U/s Guidance","$6,657.00",$0.00,"$6,657.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,657.00",$0.00,"$2,255.00","$5,272.34","$5,325.60",$0.00,$0.00,$0.00,$0.00,$0.00
36102208,EAP,CPT® 47490,,Perc. Cholecystostomy,"$5,903.00",$345.72,"$5,903.00","$3,205.33","$4,212.97","$2,981.55","$1,017.06","$4,212.97","$4,212.97","$1,033.57","$5,903.00","$3,118.48","$2,255.00","$4,675.18","$4,722.40","$4,332.71",$444.58,$345.72,$939.76,"$2,969.98"
36102209,EAP,CPT® 47552,,"Cholangioscopy, Perc., W/ Or W/o Brushing Or Washing","$5,467.00",$0.00,"$5,467.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,467.00",$0.00,"$2,327.00","$4,329.86","$4,373.60",$0.00,$0.00,$0.00,$0.00,$0.00
36102210,EAP,CPT® 47553,,"Cholangioscopy, Perc., With Biopsy","$5,467.00",$0.00,"$5,467.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,467.00",$0.00,"$2,858.00","$4,329.86","$4,373.60",$0.00,$0.00,$0.00,$0.00,$0.00
36102211,EAP,CPT® 47554,,"Cholangioscopy, Perc., With Calculus/calculi Removal","$5,467.00",$0.00,"$5,467.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,467.00",$0.00,"$2,858.00","$4,329.86","$4,373.60",$0.00,$0.00,$0.00,$0.00,$0.00
36102212,EAP,CPT® 48102,,"Pancreas, Percutaneous","$2,114.00",$0.00,"$2,114.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,114.00",$0.00,"$2,114.00","$1,674.29","$1,691.20",$0.00,$0.00,$0.00,$0.00,$0.00
36102215,EAP,CPT® 49180,,"Abdomen/retrop., Percutaneous","$2,922.00",$87.64,"$2,922.00","$2,106.30","$2,085.43","$1,316.19",$503.45,"$2,085.43","$2,085.43",$511.62,"$2,922.00","$1,376.63","$2,255.00","$2,314.22","$2,337.60","$1,912.65",$203.88,$87.64,$465.18,"$1,311.08"
36102216,EAP,CPT® 49400,,Peritoneogram (air And/or Contrast),"$3,253.00",$0.00,"$3,253.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,253.00",$0.00,"$1,626.50","$2,576.38","$2,602.40",$0.00,$0.00,$0.00,$0.00,$0.00
36102217,EAP,CPT® 49423,,Change Of Abscess Drain (inc. Injection),"$4,076.00",$0.00,"$4,076.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,076.00",$0.00,"$3,606.00","$3,228.19","$3,260.80",$0.00,$0.00,$0.00,$0.00,$0.00
36102218,EAP,CPT® 49424,,Abscessogram (tube Check),"$4,076.00",$0.00,"$4,076.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,076.00",$0.00,"$2,255.00","$3,228.19","$3,260.80",$0.00,$0.00,$0.00,$0.00,$0.00
36102219,EAP,CPT® 49441,,J-tube Placement Under Fluoro Guidance,"$4,801.00",$0.00,"$4,801.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,801.00",$0.00,"$2,255.00","$3,802.39","$3,840.80",$0.00,$0.00,$0.00,$0.00,$0.00
36102220,EAP,CPT® 49442,,Duodenostomy Tube Placement Under Fluoro Guidance,"$8,612.00",$0.00,"$8,612.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$8,612.00",$0.00,"$2,255.00","$6,820.70","$6,889.60",$0.00,$0.00,$0.00,$0.00,$0.00
36102222,EAP,CPT® 49465,,"Contrast Injection For G-, J-, G-j, C Tube Radiological Evaluation",$455.00,$0.00,$455.00,$455.00,$0.00,$223.46,$78.39,$0.00,$0.00,$79.67,$455.00,$233.72,$455.00,$360.36,$364.00,$324.73,$150.79,$32.10,$72.44,$222.60
36102224,EAP,CPT® 50250,,"Open Cryo, Renal Tumor(s) Includes Us Guidance","$5,522.00",$0.00,"$5,522.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,522.00",$0.00,"$2,761.00","$4,373.42","$4,417.60",$0.00,$0.00,$0.00,$0.00,$0.00
36102225,EAP,CPT® 50385,,"Exchange, Transuretheral Approach Includes Imaging","$5,673.00",$0.00,"$5,673.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,673.00",$0.00,"$2,327.00","$4,493.02","$4,538.40",$0.00,$0.00,$0.00,$0.00,$0.00
36102226,EAP,CPT® 50386,,"Removal, Transuretheral Approach Includes Imaging","$1,772.00",$0.00,"$1,740.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,740.00",$0.00,"$1,740.00","$1,378.08","$1,392.00",$0.00,$0.00,$0.00,$0.00,$0.00
36102229,EAP,CPT® 50592,,"Percutaneous Rfa, Renal Tumor(s)","$15,251.00",$357.73,"$15,251.00","$3,389.40","$10,884.64","$4,635.04",$395.35,"$10,884.64","$5,416.74","$2,670.33","$15,251.00","$4,847.92","$5,452.00","$12,078.79","$12,200.80","$6,735.53","$6,100.60",$357.73,"$2,427.96","$4,617.06"
36102230,EAP,CPT® 50593,,"Percutaneous Cryoablation, Renal Tumor(s)","$10,581.00",$479.98,"$10,581.00","$5,409.60","$7,551.66","$8,067.33","$1,823.05","$7,551.66","$5,416.74","$1,852.65","$10,581.00","$8,437.84","$5,452.00","$8,380.15","$8,464.80","$10,581.00","$4,167.31",$479.98,"$1,684.50","$8,036.03"
36102231,EAP,CPT® 51101,,Aspirate Bladder (diagnostic) By Trocar/catheter,$950.00,$0.00,$950.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$950.00,$0.00,$950.00,$752.40,$760.00,$0.00,$0.00,$0.00,$0.00,$0.00
36102232,EAP,CPT® 51610,,"Urethrocystogram, Retrograde","$2,404.00",$0.00,"$2,404.00","$1,305.37","$1,715.73",$0.00,$414.20,"$1,715.73","$1,715.73",$420.92,"$2,404.00",$0.00,"$1,202.00","$1,903.97","$1,923.20",$0.00,$301.43,$66.70,$382.72,$0.00
36102233,EAP,CPT® 51705,,Change Bladder Tube,$625.00,$0.00,$625.00,$625.00,$0.00,$225.25,$107.68,$0.00,$0.00,$109.43,$625.00,$235.59,$625.00,$495.00,$500.00,$327.32,$86.33,$54.08,$99.50,$224.37
36102235,EAP,CPT® 55700,,"Biopsy, Prostate","$4,494.00",$135.95,"$4,494.00","$2,496.90","$3,207.37","$1,698.74",$774.29,"$3,207.37","$3,207.37",$786.86,"$4,494.00","$1,776.76","$2,327.00","$3,559.25","$3,595.20","$2,468.57",$147.73,$135.95,$715.44,"$1,692.15"
36102238,EAP,CPT® 61070,,puncture of shunt tubling injectio,"$2,271.00",$0.00,"$2,271.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,271.00",$0.00,"$2,255.00","$1,798.63","$1,816.80",$0.00,$0.00,$0.00,$0.00,$0.00
36102239,EAP,CPT® 62269,,"Biopsy, Spinal Cord","$3,386.00",$0.00,"$3,386.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,386.00",$0.00,"$2,255.00","$2,681.71","$2,708.80",$0.00,$0.00,$0.00,$0.00,$0.00
36102241,EAP,CPT® 62281,,Injection Cervical Or Thoracic Epidural,"$1,751.00",$0.00,"$1,751.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,751.00",$0.00,"$1,751.00","$1,386.79","$1,400.80",$0.00,$0.00,$0.00,$0.00,$0.00
36102244,EAP,CPT® 64479,,Injection Cervical/Thoracic sngl LEVel,"$3,387.00",$0.00,"$3,387.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,387.00",$0.00,"$2,255.00","$2,682.50","$2,709.60",$0.00,$0.00,$0.00,$0.00,$0.00
36102245,EAP,CPT® 64480,,"Injection Cervical/thoracic, Each Additional Level","$1,726.00",$0.00,"$1,726.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,726.00",$0.00,"$1,726.00","$1,366.99","$1,380.80",$0.00,$0.00,$0.00,$0.00,$0.00
36102249,EAP,CPT® 36593,,Declotting Vasc Device,"$2,030.00",$0.00,"$1,624.00","$1,624.00",$0.00,$296.88,$279.81,$0.00,$0.00,$284.35,"$1,624.00",$310.51,"$1,624.00","$1,286.21","$1,299.20",$431.41,$30.97,$32.05,$258.54,$295.72
36102255,EAP,CPT® 49460,,"Mechanical Removal Obstructive Material G-, J-, G-j, C O","$3,429.00",$50.85,"$3,429.00","$2,106.30","$2,447.28",$753.62,$590.80,"$2,447.28","$2,447.28",$600.39,"$3,429.00",$788.23,"$2,255.00","$2,715.77","$2,743.20","$1,095.14",$727.94,$50.85,$545.90,$750.70
36102260,EAP,CPT® 66030,,Injection Eye Treatment(medication),"$5,312.00",$0.00,"$5,312.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,312.00",$0.00,"$2,255.00","$4,207.10","$4,249.60",$0.00,$0.00,$0.00,$0.00,$0.00
36102262,EAP,CPT® 59830,,"Treatment Of Septic Abortion, Completed","$3,807.00",$0.00,"$3,807.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,807.00",$0.00,"$2,255.00","$3,015.14","$3,045.60",$0.00,$0.00,$0.00,$0.00,$0.00
36102280,EAP,CPT® 41825,,Exc. Of Gum Lesion,"$3,979.00",$0.00,"$3,979.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,979.00",$0.00,"$2,255.00","$3,151.37","$3,183.20",$0.00,$0.00,$0.00,$0.00,$0.00
36102281,EAP,CPT® 41899,,Simple Tooth Extraction,"$1,880.00",$0.00,"$1,880.00","$1,880.00","$1,341.76",$195.27,$323.91,"$1,341.76","$1,341.76",$329.17,"$1,880.00",$204.24,"$1,880.00","$1,488.96","$1,504.00",$283.76,$294.22,$0.00,$299.30,$194.51
36102284,EAP,CPT® 51728,,Cystometrogram W/vp,$790.00,$0.00,$790.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$790.00,$0.00,$790.00,$625.68,$632.00,$0.00,$0.00,$0.00,$0.00,$0.00
36102285,EAP,CPT® 36002,,Thrombin Injection For Percutaneours Pseudoaneurysm,"$2,313.00",$0.00,"$2,313.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,313.00",$0.00,"$2,255.00","$1,831.90","$1,850.40",$0.00,$0.00,$0.00,$0.00,$0.00
36102290,EAP,CPT® 41899,,Comp Bony W/surg.comp,"$1,880.00",$0.00,"$1,880.00","$1,880.00",$0.00,$195.27,$323.91,$0.00,$0.00,$329.17,"$1,880.00",$204.24,"$1,880.00","$1,488.96","$1,504.00",$283.76,$294.22,$0.00,$299.30,$194.51
36102310,EAP,CPT® 37191,,Ins Endovas Vena Cava Filter,"$23,839.00",$0.00,"$23,839.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$23,839.00",$0.00,"$2,858.00","$18,880.49","$19,071.20",$0.00,$0.00,$0.00,$0.00,$0.00
36102311,EAP,CPT® 37192,,Reposition Endov Vena Cava Fil,"$16,359.00",$0.00,"$16,359.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$16,359.00",$0.00,"$2,858.00","$12,956.33","$13,087.20",$0.00,$0.00,$0.00,$0.00,$0.00
36102312,EAP,CPT® 37193,,Replace Endovas Vena Cava Fil,"$16,359.00",$0.00,"$16,359.00","$2,706.90","$11,675.42","$2,657.38",$0.00,"$11,675.42","$5,416.74","$2,864.33","$16,359.00","$2,779.42","$2,858.00","$12,956.33","$13,087.20","$3,861.64",$0.00,$365.30,"$2,604.35","$2,647.07"
36102313,EAP,CPT® 36251,,Sel Cath Plmt Renal 1st Ord Uni,"$14,667.00",$0.00,"$13,011.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$13,011.00",$0.00,"$2,858.00","$10,304.71","$10,408.80",$0.00,$0.00,$0.00,$0.00,$0.00
36102314,EAP,CPT® 36252,,Sel Cath Plmt Renal 1st Ord Bil,"$14,667.00",$0.00,"$13,011.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$13,011.00",$0.00,"$2,858.00","$10,304.71","$10,408.80",$0.00,$0.00,$0.00,$0.00,$0.00
36102315,EAP,CPT® 36253,,Sprsel Cath Pl Rena 1st Ord Uni,"$14,667.00",$373.25,"$13,011.00","$2,496.90","$9,285.95","$4,407.29","$2,241.73","$9,285.95","$5,416.74","$2,278.12","$13,011.00","$4,609.70","$2,858.00","$10,304.71","$10,408.80","$6,404.56","$2,156.13",$373.25,"$2,071.35","$4,390.19"
36102316,EAP,CPT® 36254,,Sprsel Cath Pl Rena 1st Ord Bil,"$14,667.00",$0.00,"$13,011.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$13,011.00",$0.00,"$2,858.00","$10,304.71","$10,408.80",$0.00,$0.00,$0.00,$0.00,$0.00
36102317,EAP,CPT® 37619,,Ligate Inferior Vena Cava,"$15,783.00",$0.00,"$15,783.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$15,783.00",$0.00,"$2,327.00","$12,500.14","$12,626.40",$0.00,$0.00,$0.00,$0.00,$0.00
36102318,EAP,CPT® 64633,,Dstr Cerv/thor Paravet Sngl,"$1,751.00",$0.00,"$1,751.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,751.00",$0.00,"$1,751.00","$1,386.79","$1,400.80",$0.00,$0.00,$0.00,$0.00,$0.00
36102319,EAP,CPT® 64634,,Dstr Cerv/thor Paravet Ea Addl,$580.00,$0.00,$580.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$580.00,$0.00,$290.00,$459.36,$464.00,$0.00,$0.00,$0.00,$0.00,$0.00
36102320,EAP,CPT® 64635,,Unilateral Dstr Lumb/sac Paravet; Sngl,"$2,850.00",$229.68,"$2,850.00","$2,106.30","$2,034.05","$1,648.68",$491.04,"$2,034.05","$2,034.05",$499.01,"$2,850.00","$1,724.40","$2,255.00","$2,257.20","$2,280.00","$2,395.83",$425.03,$229.68,$453.72,"$1,642.29"
36102321,EAP,CPT® 64636,,Unilateral Dstr Lumb/sac Paravet; Ea Addl,"$1,662.00",$0.00,"$1,662.00","$1,662.00",$0.00,$0.00,$286.35,$0.00,$0.00,$291.00,"$1,662.00",$0.00,$831.00,"$1,316.30","$1,329.60",$0.00,$178.62,$62.03,$264.59,$0.00
36102322,EAP,CPT® 36222,,Ir Sel Cath Plac Ext Carotid Angio W/s&i,"$32,310.00",$0.00,"$28,662.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$28,662.00",$0.00,"$2,858.00","$22,700.30","$22,929.60",$0.00,$0.00,$0.00,$0.00,$0.00
36102323,EAP,CPT® 36223,,Ir Sel Cath Plac Common Inom Intracranial Carotid,"$31,070.00",$330.96,"$27,562.00","$2,496.90","$19,671.00","$4,407.29","$4,748.79","$19,671.00","$5,416.74","$4,825.89","$27,562.00","$4,609.70","$2,858.00","$21,829.10","$22,049.60","$6,404.56","$1,513.65",$330.96,"$4,387.87","$4,390.19"
36102324,EAP,CPT® 36224,,Ir Sel Cath Plac Internal Carotid Intracranial Carotid,"$35,554.00",$376.00,"$31,540.00","$2,706.90","$22,510.10","$4,407.29","$5,434.18","$22,510.10","$5,416.74","$5,522.40","$31,540.00","$4,609.70","$4,975.00","$24,979.68","$25,232.00","$6,404.56","$1,644.17",$376.00,"$5,021.17","$4,390.19"
36102325,EAP,CPT® 36225,,"Ir Sel Cath Plac Sub Clav, Innom, Bilat W/angio  S&i","$31,070.00",$0.00,"$27,562.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$27,562.00",$0.00,"$2,858.00","$21,829.10","$22,049.60",$0.00,$0.00,$0.00,$0.00,$0.00
36102326,EAP,CPT® 36226,,"Ir Sel Cath Plac Sub Calv, Vert W/angio S&i","$57,197.00",$370.60,"$50,739.00","$2,706.90","$36,212.42","$4,407.29","$8,138.89","$36,212.42","$5,416.74","$8,138.89","$50,739.00","$4,609.70","$4,975.00","$40,185.29","$40,591.20","$6,404.56","$1,676.21",$370.60,"$8,077.65","$4,390.19"
36102327,EAP,CPT® 36227,,Ir Sel Cath Plac Ext Carotid W/angio S&i,"$31,070.00",$0.00,"$27,562.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$27,562.00",$0.00,"$13,781.00","$21,829.10","$22,049.60",$0.00,$0.00,$0.00,$0.00,$0.00
36102328,EAP,CPT® 36228,,Ir Sel Cath Plac Intra Internal Carotid Or Vert W/angio S&i,"$69,457.00",$0.00,"$61,615.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$61,615.00",$0.00,"$30,807.50","$48,799.08","$49,292.00",$0.00,$0.00,$0.00,$0.00,$0.00
36102329,EAP,CPT® 10035,,Placement Of Soft Tissue Localization Device; 1st,"$1,641.00",$0.00,"$1,641.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,641.00",$0.00,$820.50,"$1,299.67","$1,312.80",$0.00,$0.00,$0.00,$0.00,$0.00
36102330,EAP,CPT® 11045,,Excl Debride- Subq > 20sq Cm,"$2,403.00",$0.00,"$2,403.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,403.00",$0.00,"$1,201.50","$1,903.18","$1,922.40",$0.00,$0.00,$0.00,$0.00,$0.00
36102331,EAP,CPT® 11046,,Excl Debride- Muscle > 20sq Cm,"$2,403.00",$0.00,"$2,403.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,403.00",$0.00,"$1,201.50","$1,903.18","$1,922.40",$0.00,$0.00,$0.00,$0.00,$0.00
36102332,EAP,CPT® 11047,,Excl Debride-bone > 20 Sq Cm,"$6,188.00",$0.00,"$6,188.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,188.00",$0.00,"$3,094.00","$4,900.90","$4,950.40",$0.00,$0.00,$0.00,$0.00,$0.00
36102333,EAP,CPT® 11755,,Biopsy Of Nail Unit,$987.00,$0.00,$987.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$987.00,$0.00,$987.00,$781.70,$789.60,$0.00,$0.00,$0.00,$0.00,$0.00
36102334,EAP,CPT® 15004,,"Site Prep-100 Sq Cm (hands, Feet)","$2,328.00",$0.00,"$2,328.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,328.00",$0.00,"$2,327.00","$1,843.78","$1,862.40",$0.00,$0.00,$0.00,$0.00,$0.00
36102341,EAP,CPT® 29581,,Apply Multlay Comprs Lwr Leg,$478.00,$0.00,$478.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$478.00,$0.00,$478.00,$378.58,$382.40,$0.00,$0.00,$0.00,$0.00,$0.00
36102342,EAP,CPT® 97602,,REM/DEBRIDE DEVITALIZED TISSUE W/O ANES,$352.00,$0.00,$352.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$352.00,$0.00,$176.00,$278.78,$281.60,$0.00,$0.00,$0.00,$0.00,$0.00
36102343,EAP,CPT® 10036,,Placement Of Soft Tissue Localization Device; Each,"$1,641.00",$0.00,"$1,641.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,641.00",$0.00,$820.50,"$1,299.67","$1,312.80",$0.00,$0.00,$0.00,$0.00,$0.00
36102344,EAP,CPT® 41110,,Exc. Of Tongue Lesion W/o  Closure,"$3,523.00",$0.00,"$3,523.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,523.00",$0.00,"$2,255.00","$2,790.22","$2,818.40",$0.00,$0.00,$0.00,$0.00,$0.00
36102345,EAP,CPT® 41820,,Exc. Gum Each Quad(gingivectomy),"$2,620.00",$0.00,"$2,300.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,300.00",$0.00,"$2,255.00","$1,821.60","$1,840.00",$0.00,$0.00,$0.00,$0.00,$0.00
36102346,EAP,CPT® 30580,,"Repair Upper Jaw Fistula,","$9,049.00",$0.00,"$9,049.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$9,049.00",$0.00,"$3,606.00","$7,166.81","$7,239.20",$0.00,$0.00,$0.00,$0.00,$0.00
36102347,EAP,CPT® 26605,,Treat Metacarpal Fx,$647.00,$0.00,$647.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$647.00,$0.00,$647.00,$512.42,$517.60,$0.00,$0.00,$0.00,$0.00,$0.00
36102360,EAP,CPT® 55100,,Drainage Of Scrotum Abcess,"$2,598.00",$0.00,"$2,598.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,598.00",$0.00,"$2,255.00","$2,057.62","$2,078.40",$0.00,$0.00,$0.00,$0.00,$0.00
36102362,EAP,CPT® 19081,,Breast Bx W/ Plce Local Dev And Imaging Of Spec 1st Lese,"$6,685.00",$173.82,"$6,685.00","$2,496.90","$4,771.08","$1,316.19","$1,151.79","$4,771.08","$4,771.08","$1,170.49","$6,685.00","$1,376.63","$2,255.00","$5,294.52","$5,348.00","$1,912.65",$649.79,$173.82,"$1,064.25","$1,311.08"
36102363,EAP,CPT® 19082,,Breast Bx W/ Plce Local Dev And Imaging Of Spec Ea Add'e,"$5,014.00",$0.00,"$5,014.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,014.00",$0.00,"$2,507.00","$3,971.09","$4,011.20",$0.00,$0.00,$0.00,$0.00,$0.00
36102364,EAP,CPT® 19083,,Breast Bx W/ Plce Local Dev And Imaging Of Spec 1st Lese,"$7,798.00",$164.44,"$7,798.00","$2,496.90","$5,565.43","$1,316.19","$1,343.56","$5,565.43","$5,416.74","$1,365.37","$7,798.00","$1,376.63","$2,255.00","$6,176.02","$6,238.40","$1,912.65",$645.55,$164.44,"$1,241.44","$1,311.08"
36102365,EAP,CPT® 19084,,Breast Bx W/ Plce Local Dev And Imaging Of Spec Ea Add'e,"$5,488.00",$0.00,"$5,488.00","$2,106.30","$3,916.79",$0.00,$945.55,"$3,916.79","$3,916.79",$960.90,"$5,488.00",$0.00,"$2,744.00","$4,346.50","$4,390.40",$0.00,$518.83,$81.14,$873.69,$0.00
36102366,EAP,CPT® 19085,,Breast Bx W/ Plce Local Dev And Imaging Of Spec 1st Lese,"$8,005.00",$0.00,"$8,005.00","$2,706.90","$5,713.17","$1,316.19",$0.00,"$5,713.17","$5,416.74","$1,401.61","$8,005.00","$1,376.63","$2,255.00","$6,339.96","$6,404.00","$1,912.65",$0.00,$190.41,"$1,274.40","$1,311.08"
36102367,EAP,CPT® 19086,,Breast Bx W/ Plce Local Dev And Imaging Of Spec Ea Add'l Lesion Inc Mri Guide,"$6,003.00",$0.00,"$6,003.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,003.00",$0.00,"$3,001.50","$4,754.38","$4,802.40",$0.00,$0.00,$0.00,$0.00,$0.00
36102368,EAP,CPT® 19281,,Plce Breast Local Dev Percut 1st Lesion Inc Mammo Guide,"$2,028.00",$104.58,"$2,028.00","$2,028.00","$1,447.38",$584.94,$349.41,"$1,447.38","$1,447.38",$355.09,"$2,028.00",$611.80,"$2,028.00","$1,606.18","$1,622.40",$850.02,$234.02,$104.58,$322.86,$582.67
36102369,EAP,CPT® 19282,,Plce Breast Local Dev Percut Ea Add'l Lesion Inc Mammo Guide,"$1,522.00",$0.00,"$1,522.00","$1,522.00",$0.00,$0.00,$262.23,$0.00,$0.00,$266.49,"$1,522.00",$0.00,$761.00,"$1,205.42","$1,217.60",$0.00,$162.73,$52.65,$242.30,$0.00
36102370,EAP,CPT® 19283,,Plce Breast Local Dev Percut 1st Lesion Inc Stereo Guide,"$3,496.00",$0.00,"$3,496.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,496.00",$0.00,"$2,255.00","$2,768.83","$2,796.80",$0.00,$0.00,$0.00,$0.00,$0.00
36102371,EAP,CPT® 19284,,Plce Breast Local Dev Percut Ea Add'l Lesion Inc Stereo Guide,"$2,623.00",$0.00,"$2,623.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,623.00",$0.00,"$1,311.50","$2,077.42","$2,098.40",$0.00,$0.00,$0.00,$0.00,$0.00
36102372,EAP,CPT® 19285,,Plce Breast Local Dev Percut 1st Lesion Inc Ultrsnd Guide,"$1,637.00",$0.00,"$1,637.00","$1,637.00",$0.00,$584.94,$282.05,$0.00,$0.00,$286.63,"$1,637.00",$611.80,"$1,637.00","$1,296.50","$1,309.60",$850.02,$450.73,$89.79,$260.61,$582.67
36102373,EAP,CPT® 19286,,Plce Breast Local Dev Percut Ea Add'l Lesion Inc Ultrsnd Guide,"$1,228.00",$0.00,"$1,228.00","$1,228.00",$0.00,$0.00,$211.58,$0.00,$0.00,$215.01,"$1,228.00",$0.00,$614.00,$972.58,$982.40,$0.00,$434.23,$45.44,$195.50,$0.00
36102374,EAP,CPT® 19287,,Plce Breast Local Dev Percut 1st Lesion Inc Stereo Guide,"$5,193.00",$0.00,"$5,193.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,193.00",$0.00,"$2,255.00","$4,112.86","$4,154.40",$0.00,$0.00,$0.00,$0.00,$0.00
36102375,EAP,CPT® 19288,,Plce Breast Local Dev Percut Ea Add'l Lesion Inc Mri Guide,"$3,894.00",$0.00,"$3,894.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,894.00",$0.00,"$1,947.00","$3,084.05","$3,115.20",$0.00,$0.00,$0.00,$0.00,$0.00
36102376,EAP,CPT® 10030,,Perq Image-guided Catheter Fluid Collection,"$1,221.00",$0.00,"$1,221.00","$1,221.00",$0.00,$584.94,$210.37,$0.00,$0.00,$213.79,"$1,221.00",$611.80,"$1,221.00",$967.03,$976.80,$850.02,$754.70,$143.53,$194.38,$582.67
36102380,EAP,CPT® 67028,,Injection Intravitreal Drug-both Eyes,"$3,300.00",$100.58,"$3,300.00","$2,106.30","$2,355.21",$296.88,$568.57,"$2,355.21","$2,355.21",$577.80,"$3,300.00",$310.51,"$2,255.00","$2,613.60","$2,640.00",$431.41,$307.74,$100.58,$525.36,$295.72
36103335,EAP,CPT® 57135,,Remove Vagina Lesion,"$3,706.00",$0.00,"$3,706.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,706.00",$0.00,"$2,327.00","$2,935.15","$2,964.80",$0.00,$0.00,$0.00,$0.00,$0.00
36103340,EAP,CPT® 64642,,Chemodenerv 1 Extermity 1-4,"$3,136.00",$111.39,"$3,136.00","$2,106.30","$2,238.16",$599.36,$540.32,"$2,238.16","$2,238.16",$549.09,"$3,136.00",$626.89,"$2,255.00","$2,483.71","$2,508.80",$870.98,$134.17,$111.39,$499.25,$597.04
36103341,EAP,CPT® 64643,,Chemodenerv 1 Exterm  1-4 Ea,"$2,352.00",$0.00,"$2,352.00","$2,106.30","$1,678.62",$0.00,$405.24,"$1,678.62","$1,678.62",$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$88.23,$74.27,$374.44,$0.00
36103342,EAP,CPT® 64644,,Chemodenerv 1 Exterm --5/>mus,"$3,721.00",$121.48,"$3,721.00","$2,106.30","$2,655.68",$599.36,$641.11,"$2,655.68","$2,655.68",$651.52,"$3,721.00",$626.89,"$2,255.00","$2,947.03","$2,976.80",$870.98,$153.25,$121.48,$592.38,$597.04
36103343,EAP,CPT® 64645,,Chemodenerv 1 Exterm --5/> Ea,"$2,790.00",$0.00,"$2,790.00","$2,106.30","$1,991.22",$0.00,$480.70,"$1,991.22","$1,991.22",$488.51,"$2,790.00",$0.00,"$1,395.00","$2,209.68","$2,232.00",$0.00,$107.96,$85.44,$444.17,$0.00
36103344,EAP,CPT® 64646,,Chemodenerv Trunk Musc 1-5,"$3,136.00",$119.68,"$3,136.00","$2,106.30","$2,238.16",$599.36,$540.32,"$2,238.16","$2,238.16",$549.09,"$3,136.00",$626.89,"$2,255.00","$2,483.71","$2,508.80",$870.98,$144.35,$119.68,$499.25,$597.04
36103345,EAP,CPT® 64647,,Chemodenerv Trunk Musc 6/>,"$3,721.00",$0.00,"$3,721.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,721.00",$0.00,"$2,255.00","$2,947.03","$2,976.80",$0.00,$0.00,$0.00,$0.00,$0.00
36103352,EAP,CPT® 37239,,Open/peq Place Stent Ea Add,"$20,079.00",$0.00,"$20,079.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$20,079.00",$0.00,"$10,039.50","$15,902.57","$16,063.20",$0.00,$0.00,$0.00,$0.00,$0.00
36103353,EAP,CPT® 37238,,Open/pero Place Stent Same,"$44,395.00",$0.00,"$44,395.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$44,395.00",$0.00,"$6,105.00","$35,160.84","$35,516.00",$0.00,$0.00,$0.00,$0.00,$0.00
36103354,EAP,CPT® 37236,,Open/perq Place Stent 1st,"$44,395.00",$0.00,"$44,395.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$44,395.00",$0.00,"$6,105.00","$35,160.84","$35,516.00",$0.00,$0.00,$0.00,$0.00,$0.00
36103355,EAP,CPT® 37237,,Open/perq Place Stent Ea Add,"$20,079.00",$0.00,"$20,079.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$20,079.00",$0.00,"$10,039.50","$15,902.57","$16,063.20",$0.00,$0.00,$0.00,$0.00,$0.00
36103358,EAP,CPT® 37242,,Vasc Embolize/occlude Artery,"$21,537.00",$499.45,"$21,537.00","$2,706.90","$15,370.96","$9,501.24","$3,710.72","$15,370.96","$5,416.74","$3,770.96","$21,537.00","$9,937.60","$6,105.00","$17,057.30","$17,229.60","$13,806.97","$7,460.11",$499.45,"$3,428.69","$9,464.38"
36103359,EAP,CPT® 37244,,Vasc Embolize/occlude Bleed,"$21,537.00",$0.00,"$21,537.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$21,537.00",$0.00,"$6,105.00","$17,057.30","$17,229.60",$0.00,$0.00,$0.00,$0.00,$0.00
36103361,EAP,CPT® 37241,,Vasc Embolize/occlude Venous,"$21,537.00",$0.00,"$21,537.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$21,537.00",$0.00,"$6,105.00","$17,057.30","$17,229.60",$0.00,$0.00,$0.00,$0.00,$0.00
36103374,EAP,CPT® 64616,,Chemodenerv  Musc Neck Dyston,$635.00,$0.00,$635.00,$635.00,$0.00,$251.01,$109.41,$0.00,$0.00,$111.18,$635.00,$262.54,$635.00,$502.92,$508.00,$364.76,$117.83,$113.17,$101.09,$250.04
36103376,EAP,CPT® 37243,,Vasc Embolize/occlude Organ,"$23,500.00",$587.86,"$23,500.00","$2,706.90","$16,771.95","$9,501.24","$4,048.93","$16,771.95","$5,416.74","$4,114.66","$23,500.00","$9,937.60","$6,105.00","$18,612.00","$18,800.00","$13,806.97","$7,751.33",$587.86,"$3,741.20","$9,464.38"
36103378,EAP,CPT® 34841,,"Endovas Rp Vis A Dep Viscl Aort End, S/i,angio One","$19,007.00",$0.00,"$19,007.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$19,007.00",$0.00,"$9,503.50","$15,053.54","$15,205.60",$0.00,$0.00,$0.00,$0.00,$0.00
36103379,EAP,CPT® 34842,,Endovas Rp Vis A Dep Viscl Aort End S/i Angio Two,"$20,567.00",$0.00,"$20,567.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$20,567.00",$0.00,"$10,283.50","$16,289.06","$16,453.60",$0.00,$0.00,$0.00,$0.00,$0.00
36103380,EAP,CPT® 34843,,Endovas Rp Vis A Dep Viscl Aort End S/i Angio Three,"$22,120.00",$0.00,"$22,120.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$22,120.00",$0.00,"$11,060.00","$17,519.04","$17,696.00",$0.00,$0.00,$0.00,$0.00,$0.00
36103381,EAP,CPT® 34844,,Endovas Rp Vis A Dep Viscl Aort End S/i Angio Four Or >,"$23,672.00",$0.00,"$23,672.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$23,672.00",$0.00,"$11,836.00","$18,748.22","$18,937.60",$0.00,$0.00,$0.00,$0.00,$0.00
36103382,EAP,CPT® 34845,,Endovas Rp Vis A Dep Viscl Aort End W/ Unibdy Or Mod Infrenl End  S/i Angio One,"$23,049.00",$0.00,"$23,049.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$23,049.00",$0.00,"$11,524.50","$18,254.81","$18,439.20",$0.00,$0.00,$0.00,$0.00,$0.00
36103383,EAP,CPT® 34846,,Endovas Rp Vis A Dep Viscl Aort End W/ Unibdy Or Mod Infrenl End  S/i Angio Two,"$24,602.00",$0.00,"$24,602.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$24,602.00",$0.00,"$12,301.00","$19,484.78","$19,681.60",$0.00,$0.00,$0.00,$0.00,$0.00
36103384,EAP,CPT® 34847,,Endovas Rp Vis A Dep Viscl Aort End W/ Unibdy Or Mod Infrenl End  S/i Angio Three,"$26,154.00",$0.00,"$26,154.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$26,154.00",$0.00,"$13,077.00","$20,713.97","$20,923.20",$0.00,$0.00,$0.00,$0.00,$0.00
36103385,EAP,CPT® 34848,,Endovas Rp Vis A Dep Viscl Aort End W/ Unibdy Or Mod Infrenl End  S/i Angio Four Or >,"$27,705.00",$0.00,"$27,705.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$27,705.00",$0.00,"$13,852.50","$21,942.36","$22,164.00",$0.00,$0.00,$0.00,$0.00,$0.00
36103388,EAP,CPT® 20694,,"Removal, Under Anesthesia, Of External Fix System","$5,087.00",$337.82,"$5,087.00","$2,106.30","$3,630.59","$1,299.68",$876.46,"$3,630.59","$3,630.59",$890.69,"$5,087.00","$1,359.37","$2,255.00","$4,028.90","$4,069.60","$1,888.67",$337.82,$350.34,$809.85,"$1,294.64"
36103390,EAP,CPT® 64617,,"Chemodenervation Of Muscle(s); Larynx, Unilateral, Percd",$855.00,$0.00,$855.00,$0.00,$0.00,$0.00,$147.31,$0.00,$0.00,$0.00,$855.00,$0.00,$855.00,$677.16,$684.00,$0.00,$183.94,$0.00,$0.00,$0.00
36103391,EAP,CPT® 66183,,"Insertion Of Anterior Segment Aqueous Drainage Device, H","$6,731.00",$0.00,"$6,731.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,731.00",$0.00,"$3,902.00","$5,330.95","$5,384.80",$0.00,$0.00,$0.00,$0.00,$0.00
36103392,EAP,CPT® 49406,,"Img-gde Fluid Collect Drain / Cath (eg, Abcss, Hema, Seu","$6,160.00",$0.00,"$6,160.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,160.00",$0.00,"$2,255.00","$4,878.72","$4,928.00",$0.00,$0.00,$0.00,$0.00,$0.00
36103394,EAP,CPT® 52356,,"Cysto, W/ Ureter And/or Pyelo; W/ Litho Inc Inst Of Ind ","$8,488.00",$0.00,"$8,488.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$8,488.00",$0.00,"$3,902.00","$6,722.50","$6,790.40",$0.00,$0.00,$0.00,$0.00,$0.00
36103395,EAP,CPT® 49405,,"Img-gde Fluid Collect Drain / Cath (eg, Abcss, Hema, Seu","$6,160.00",$0.00,"$6,160.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,160.00",$0.00,"$2,255.00","$4,878.72","$4,928.00",$0.00,$0.00,$0.00,$0.00,$0.00
36103396,EAP,CPT® 23333,,Removal Foreign Body Shoulder Deep Sub Fac/intra Musc,"$2,679.00",$0.00,"$2,679.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,679.00",$0.00,"$2,255.00","$2,121.77","$2,143.20",$0.00,$0.00,$0.00,$0.00,$0.00
36103397,EAP,CPT® 31633,,Tranbronchial Needle Aspiration Biospy Ea Addtl  Lobe,"$2,667.00",$0.00,"$2,667.00","$2,496.90","$1,903.44",$0.00,$459.51,"$1,903.44","$1,903.44",$466.97,"$2,667.00",$0.00,"$1,333.50","$2,112.26","$2,133.60",$0.00,$86.74,$65.64,$424.59,$0.00
36103398,EAP,CPT® 31627,,"Bronch With Computer-assisted, Image-guided Navigation","$3,500.00",$0.00,"$3,500.00","$2,106.30","$2,497.95",$0.00,$603.03,"$2,497.95","$2,497.95",$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$879.48,$100.26,$557.20,$0.00
36103399,EAP,HCPCS 64650,,Chemodenerv Eccrine Glands,$530.00,$0.00,$530.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$530.00,$0.00,$530.00,$419.76,$424.00,$0.00,$0.00,$0.00,$0.00,$0.00
36103400,EAP,HCPCS 64653,,"Chemodenerv Eccrine Other Scalp,face,neck",$561.00,$0.00,$561.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$561.00,$0.00,$561.00,$444.31,$448.80,$0.00,$0.00,$0.00,$0.00,$0.00
36103401,EAP,HCPCS 46221,,Ligation Of Hemorrhoid(s),"$2,252.00",$119.76,"$2,252.00","$2,106.30","$1,607.25",$732.48,$388.01,"$1,607.25","$1,607.25",$394.31,"$2,252.00",$766.13,"$2,252.00","$1,783.58","$1,801.60","$1,064.43",$119.76,$198.96,$358.52,$729.64
36103402,EAP,CPT® 64450,,Adductor Canal,"$2,750.00",$44.35,"$2,750.00","$2,106.30","$1,962.68",$599.36,$473.81,"$1,962.68","$1,962.68",$481.50,"$2,750.00",$626.89,"$2,255.00","$2,178.00","$2,200.00",$870.98,$85.27,$44.35,$437.80,$597.04
36103404,EAP,CPT® 24200,,Removal Of Arm Foreign Body,"$4,807.00",$0.00,"$4,807.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,807.00",$0.00,"$2,255.00","$3,807.14","$3,845.60",$0.00,$0.00,$0.00,$0.00,$0.00
36103405,EAP,CPT® 49425,,Insert Abdomen - Venous Drain,"$22,623.00",$0.00,"$22,623.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$22,623.00",$0.00,"$11,311.50","$17,917.42","$18,098.40",$0.00,$0.00,$0.00,$0.00,$0.00
36103406,EAP,CPT® 54220,,Treatment Of Penis Lesion,"$1,103.00",$139.18,"$1,103.00","$1,103.00","$1,103.00",$225.25,$190.04,"$1,103.00","$1,103.00",$193.13,"$1,103.00",$235.59,"$1,103.00",$873.58,$882.40,$327.32,$151.42,$139.18,$175.60,$224.37
36103407,EAP,CPT® 17106,,Destruction Of Skin Lesions,"$1,625.00",$0.00,"$1,625.00","$1,625.00",$0.00,$306.38,$0.00,$0.00,$0.00,$284.52,"$1,625.00",$320.45,"$1,625.00","$1,287.00","$1,300.00",$445.22,$0.00,$282.61,$258.70,$305.19
36103410,EAP,CPT® 54205,,Injection For Peyronie Disease; W/surg Exp Plaque,"$10,398.00",$0.00,"$10,398.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$10,398.00",$0.00,"$3,606.00","$8,235.22","$8,318.40",$0.00,$0.00,$0.00,$0.00,$0.00
36103411,EAP,CPT® 55874,,Tprnl Plmt Biodegradable Matrl Periprostatic,"$6,060.00",$0.00,"$6,060.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,060.00",$0.00,"$5,452.00","$4,799.52","$4,848.00",$0.00,$0.00,$0.00,$0.00,$0.00
36191374,EAP,CPT® 64615,,"Destroy Mucles Facial, Trigeminal, Cervical, Spinal ",$536.00,$0.00,$536.00,$536.00,$0.00,$251.01,$92.35,$0.00,$0.00,$93.85,$536.00,$262.54,$536.00,$424.51,$428.80,$364.76,$136.28,$127.95,$85.33,$250.04
36191375,EAP,CPT® 58145,,Myomectomy Vag Method,"$5,009.00",$0.00,"$5,009.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,009.00",$0.00,"$3,902.00","$3,967.13","$4,007.20",$0.00,$0.00,$0.00,$0.00,$0.00
36191376,EAP,CPT® 11982,,Remove Drug Implant Contraceptive,$500.00,$0.00,$500.00,$500.00,$0.00,$348.65,$86.15,$0.00,$0.00,$87.55,$500.00,$364.66,$500.00,$396.00,$400.00,$500.00,$128.55,$78.96,$79.60,$347.29
36191377,EAP,CPT® 11983,,Remove With Reinsertion Of Drug Implant,$501.00,$0.00,$501.00,$501.00,$0.00,$348.65,$86.32,$0.00,$0.00,$87.72,$501.00,$364.66,$501.00,$396.79,$400.80,$501.00,$207.60,$108.53,$79.76,$347.29
36191378,EAP,CPT® 64435,,Inj Anes/strd Paracervical Nerve,"$1,855.00",$0.00,"$1,855.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,855.00",$0.00,"$1,855.00","$1,469.16","$1,484.00",$0.00,$0.00,$0.00,$0.00,$0.00
36191379,EAP,CPT® 65800,,Anterior Chamber Tap,"$10,501.00",$0.00,"$10,501.00","$2,106.30","$7,494.56","$1,938.76",$0.00,"$7,494.56","$5,416.74","$1,838.64","$10,501.00","$2,027.80","$2,255.00","$8,316.79","$8,400.80","$2,817.36",$0.00,$93.03,"$1,671.76","$1,931.24"
36191381,EAP,CPT® 31632,,Transbronchial Bx W/addl Lobe,"$2,107.00",$0.00,"$2,107.00","$2,107.00","$1,503.77",$0.00,$363.03,"$1,503.77","$1,503.77",$368.92,"$2,107.00",$0.00,"$1,053.50","$1,668.74","$1,685.60",$0.00,$70.82,$51.57,$335.43,$0.00
36191382,EAP,CPT® 31633,,Transbronchial Needle Bx W/addl Lobe,"$2,667.00",$0.00,"$2,667.00","$2,496.90","$1,903.44",$0.00,$459.51,"$1,903.44","$1,903.44",$466.97,"$2,667.00",$0.00,"$1,333.50","$2,112.26","$2,133.60",$0.00,$86.74,$65.64,$424.59,$0.00
36191383,EAP,CPT® 20950,,Compartment Pressure Measurement,$664.00,$0.00,$664.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$664.00,$0.00,$664.00,$525.89,$531.20,$0.00,$0.00,$0.00,$0.00,$0.00
36191384,EAP,CPT® 23405,,"Tenotomy, Shoulder Area; Single Tendon","$5,700.00",$0.00,"$5,700.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,700.00",$0.00,"$2,327.00","$4,514.40","$4,560.00",$0.00,$0.00,$0.00,$0.00,$0.00
36191385,EAP,CPT® 59151,,Treat Ectopic Pregnancy,"$13,348.00",$0.00,"$13,348.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$13,348.00",$0.00,"$5,452.00","$10,571.62","$10,678.40",$0.00,$0.00,$0.00,$0.00,$0.00
36191386,EAP,CPT® 24357,,"Tenotomy, Elbow, Lateral Or Media; Percutaneous","$2,995.00",$0.00,"$2,995.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,995.00",$0.00,"$2,858.00","$2,372.04","$2,396.00",$0.00,$0.00,$0.00,$0.00,$0.00
36191387,EAP,CPT® 26055,,Tendon Sheath Incision,"$2,439.00",$0.00,"$2,439.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,439.00",$0.00,"$2,327.00","$1,931.69","$1,951.20",$0.00,$0.00,$0.00,$0.00,$0.00
36191389,EAP,CPT® 64491,,Inj Paravert F Jnt C/t 2 Lev,"$1,755.00",$0.00,"$1,755.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,755.00",$0.00,$877.50,"$1,389.96","$1,404.00",$0.00,$0.00,$0.00,$0.00,$0.00
36191391,EAP,CPT® 27000,,"Tenotomy, Adductor Of Hip, Percutaneous","$1,575.00",$0.00,"$1,575.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,575.00",$0.00,"$1,575.00","$1,247.40","$1,260.00",$0.00,$0.00,$0.00,$0.00,$0.00
36191392,EAP,CPT® 27005,,"Tenotomy, Hip Flexor(s), Open","$1,961.00",$0.00,"$1,961.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,961.00",$0.00,"$1,961.00","$1,553.11","$1,568.80",$0.00,$0.00,$0.00,$0.00,$0.00
36191393,EAP,CPT® 27006,,"Tenotomy, Abductors And/or Extensor(s) Of Hip,open","$2,650.00",$0.00,"$2,650.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,650.00",$0.00,"$2,255.00","$2,098.80","$2,120.00",$0.00,$0.00,$0.00,$0.00,$0.00
36191394,EAP,CPT® 27306,,"Tenotomy, Percutaneous, Or Hamstring, Single Tendon","$5,757.00",$0.00,"$5,757.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,757.00",$0.00,"$2,858.00","$4,559.54","$4,605.60",$0.00,$0.00,$0.00,$0.00,$0.00
36191395,EAP,CPT® 27307,,"Tenotomy, Percutaneous, Adductor Or Hamstring; Multiple Tendons","$8,511.00",$0.00,"$8,511.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$8,511.00",$0.00,"$2,858.00","$6,740.71","$6,808.80",$0.00,$0.00,$0.00,$0.00,$0.00
36191396,EAP,CPT® 27605,,"Tenotomy, Percutaneous, Achilles Tendon ; Local Anesthesia","$1,500.00",$0.00,"$1,500.00","$1,500.00","$1,208.73","$1,299.68",$0.00,"$1,208.73","$1,208.73",$262.64,"$1,500.00","$1,359.37","$1,500.00","$1,188.00","$1,200.00","$1,500.00",$0.00,$192.52,$238.80,"$1,294.64"
36191397,EAP,CPT® 28008,,"Fasciotomy, Foot And/or Toe","$3,083.00",$0.00,"$3,083.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,083.00",$0.00,"$2,858.00","$2,441.74","$2,466.40",$0.00,$0.00,$0.00,$0.00,$0.00
36191398,EAP,CPT® 28899,,"Unlisted Procedure, Foot Or Toes","$2,649.00",$0.00,"$2,649.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,649.00",$0.00,"$2,255.00","$2,098.01","$2,119.20",$0.00,$0.00,$0.00,$0.00,$0.00
36191399,EAP,CPT® 64430,,Inj Anes/strd Pudendal Nerve,$960.00,$0.00,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$960.00,$0.00,$960.00,$760.32,$768.00,$0.00,$0.00,$0.00,$0.00,$0.00
36191400,EAP,CPT® 12037,,Intmd Wnd Repair S/tr/ext,"$1,907.00",$0.00,"$1,907.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,907.00",$0.00,"$1,907.00","$1,510.34","$1,525.60",$0.00,$0.00,$0.00,$0.00,$0.00
36191401,EAP,CPT® 26070,,"Arthrotomy W/expl,drain,rmvl Of Loose/fb Carpometacarpal Jnt","$1,500.00",$0.00,"$1,500.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,500.00",$0.00,"$1,500.00","$1,188.00","$1,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
36191402,EAP,CPT® 26075,,"Arthrotomy W/expl,drain,rmvl Of Loose/fb Metacarpophalangeal Jnt Ea","$2,700.00",$0.00,"$2,700.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,700.00",$0.00,"$2,700.00","$2,138.40","$2,160.00",$0.00,$0.00,$0.00,$0.00,$0.00
36191403,EAP,CPT® 26080,,"Arthrotomy W/expl,drain,rmvl Of Loose/fb Interphalangeal Jnt Ea","$2,575.00",$0.00,"$2,575.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,575.00",$0.00,"$2,575.00","$2,039.40","$2,060.00",$0.00,$0.00,$0.00,$0.00,$0.00
36191404,EAP,Custom 26320,,Removal Of Implant From Finger Or Hand,"$1,581.00",$0.00,"$1,581.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,581.00",$0.00,"$1,581.00","$1,252.15","$1,264.80",$0.00,$0.00,$0.00,$0.00,$0.00
36191405,EAP,CPT® 26641,,"Closed Treatment Of Carpometacarpal Dislocation,thumb,w/manipulation","$1,104.00",$0.00,"$1,104.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,104.00",$0.00,"$1,104.00",$874.37,$883.20,$0.00,$0.00,$0.00,$0.00,$0.00
36191406,EAP,CPT® 26607,,"Clsd Tx Of Metacarpal Fx, W/ Manip,w/external Fix Ea Bone","$3,374.00",$0.00,"$3,374.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,374.00",$0.00,"$2,327.00","$2,672.21","$2,699.20",$0.00,$0.00,$0.00,$0.00,$0.00
36191407,EAP,CPT® 26645,,"Clsd Tx Of Carpometacarpal Fx Disloc, Thumb  W/manip","$1,593.00",$0.00,"$1,593.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,593.00",$0.00,"$1,593.00","$1,261.66","$1,274.40",$0.00,$0.00,$0.00,$0.00,$0.00
36191408,EAP,CPT® 26650,,Perc Skel Fix Of Carpometacarpal Fx Disloc Thumb W/ Manip,"$6,173.00",$0.00,"$6,173.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,173.00",$0.00,"$2,327.00","$4,889.02","$4,938.40",$0.00,$0.00,$0.00,$0.00,$0.00
36191409,EAP,CPT® 26670,,"Clsd Tx Of Carpometacarpal Disloc Not Thumb, W/manip Ea Jnt,w/o Anest","$1,099.00",$0.00,"$1,099.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,099.00",$0.00,"$1,099.00",$870.41,$879.20,$0.00,$0.00,$0.00,$0.00,$0.00
36191410,EAP,CPT® 26700,,"Clsd Tx Of Metacarpophalangeal Disloc Single W/manip, W/o Anest",$735.00,$0.00,$735.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$735.00,$0.00,$735.00,$582.12,$588.00,$0.00,$0.00,$0.00,$0.00,$0.00
36191450,EAP,CPT® 69209,,Remove Cerumen Impacted Irrig/lavage Unilat,$276.00,$0.00,$276.00,$276.00,$0.00,$52.75,$47.55,$0.00,$0.00,$48.33,$276.00,$55.17,$276.00,$218.59,$220.80,$76.65,$12.24,$14.41,$43.94,$52.54
36191451,EAP,CPT® 66761,,Iridotomy Laser Surgery-both Eyes,"$11,579.00",$240.80,"$11,579.00","$2,106.30","$8,263.93",$486.10,"$1,995.00","$8,263.93","$5,416.74","$2,027.39","$11,579.00",$508.42,"$2,255.00","$9,170.57","$9,263.20",$706.38,$315.03,$240.80,"$1,843.38",$484.21
36191452,EAP,CPT® 64405,,Inj Anes/strd Greater Occipital Nerve,"$3,197.00",$55.88,"$3,197.00","$2,106.30","$2,281.70",$251.01,$550.83,"$2,281.70","$2,281.70",$559.77,"$3,197.00",$262.54,"$2,255.00","$2,532.02","$2,557.60",$364.76,$102.34,$55.88,$508.96,$250.04
36191453,EAP,CPT® 64510,,Inject Stellate Ganglion,"$1,705.00",$0.00,"$1,705.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,705.00",$0.00,"$1,705.00","$1,350.36","$1,364.00",$0.00,$0.00,$0.00,$0.00,$0.00
36191454,EAP,CPT® 64620,,Destroy Intercostal Neurolytic,"$6,548.00",$176.30,"$6,548.00","$2,106.30","$4,673.31",$778.67,"$1,128.19","$4,673.31","$4,673.31","$1,146.50","$6,548.00",$814.44,"$2,255.00","$5,186.02","$5,238.40","$1,131.55",$176.30,$181.36,"$1,042.44",$775.65
36191455,EAP,CPT® 64494,,Inj Paravert F Jnt L/s 2 Lev,"$1,661.00",$0.00,"$1,661.00","$1,661.00",$0.00,$0.00,$286.18,$0.00,$0.00,$290.83,"$1,661.00",$0.00,$830.50,"$1,315.51","$1,328.80",$0.00,$54.06,$53.73,$264.43,$0.00
36191456,EAP,CPT® 64495,,Inj Paravert F Jnt L/s 3 Lev,"$1,594.00",$0.00,"$1,594.00","$1,594.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,594.00",$0.00,$797.00,"$1,262.45","$1,275.20",$0.00,$0.00,$54.45,$253.76,$0.00
36191457,EAP,CPT® 64492,,Inj Paravert F Jnt C/t 3 Lev,"$1,570.00",$0.00,"$1,570.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,570.00",$0.00,$785.00,"$1,243.44","$1,256.00",$0.00,$0.00,$0.00,$0.00,$0.00
36191458,EAP,CPT® 64493,,Inj Paravert F Jnt L/s 1 Lev,"$3,656.00",$93.03,"$3,656.00","$2,106.30","$2,609.29",$778.67,$629.91,"$2,609.29","$2,609.29",$640.14,"$3,656.00",$814.44,"$2,255.00","$2,895.55","$2,924.80","$1,131.55",$111.04,$93.03,$582.04,$775.65
36191459,EAP,CPT® 64490,,Inj Paravert F Jnt C/t 1 Lev,"$3,656.00",$109.61,"$3,656.00","$2,106.30","$2,609.29",$778.67,$629.91,"$2,609.29","$2,609.29",$640.14,"$3,656.00",$814.44,"$2,255.00","$2,895.55","$2,924.80","$1,131.55",$122.58,$109.61,$582.04,$775.65
36191460,EAP,CPT® 64517,,Nblock Inj Hypogas Plxs,"$3,370.00",$0.00,"$3,370.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,370.00",$0.00,"$2,327.00","$2,669.04","$2,696.00",$0.00,$0.00,$0.00,$0.00,$0.00
36191461,EAP,CPT® 64418,,Inj Anes/strd Suprascapular,"$3,062.00",$59.14,"$3,062.00","$2,106.30","$2,185.35",$599.36,$527.57,"$2,185.35","$2,185.35",$536.13,"$3,062.00",$626.89,"$2,255.00","$2,425.10","$2,449.60",$870.98,$104.21,$59.14,$487.47,$597.04
36191462,EAP,CPT® 38222,,Bone Marrow Biopsy(ies) & Aspiration(s),"$2,319.00",$80.78,"$2,325.71","$2,000.00","$1,427.40","$2,223.58",$344.59,"$1,427.40","$1,427.40",$350.18,"$2,000.00","$2,325.71","$2,000.00","$1,584.00","$1,600.00","$2,000.00",$164.87,$80.78,$318.40,"$2,214.96"
36191464,EAP,CPT® 65855,,"Argon Trabeculoplasty, Both Eyes","$4,441.00",$211.62,"$4,441.00","$2,496.90","$3,169.54",$486.10,$765.16,"$3,169.54","$3,169.54",$777.58,"$4,441.00",$508.42,"$2,255.00","$3,517.27","$3,552.80",$706.38,$354.58,$211.62,$707.01,$484.21
36191465,EAP,CPT® 67040,,"Pan Retinal Photocoagulation, Both Eyes","$16,125.00",$0.00,"$16,125.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$16,125.00",$0.00,"$4,975.00","$12,771.00","$12,900.00",$0.00,$0.00,$0.00,$0.00,$0.00
36191466,EAP,CPT® 66821,,"Yag Capsulotomy, Both Eyes","$3,213.00",$188.16,"$3,213.00","$2,496.90","$2,293.12",$486.10,$553.58,"$2,293.12","$2,293.12",$562.57,"$3,213.00",$508.42,"$2,327.00","$2,544.70","$2,570.40",$706.38,$188.16,$317.54,$511.51,$484.21
36191467,EAP,CPT® 65865,,"Argon Laser Gonioplasty, One Eye","$4,389.00",$0.00,"$4,389.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,389.00",$0.00,"$2,255.00","$3,476.09","$3,511.20",$0.00,$0.00,$0.00,$0.00,$0.00
36191468,EAP,CPT® 46230,,"Excision Of Multiple External Papillae Or Tags, Anus","$4,962.00",$0.00,"$4,962.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,962.00",$0.00,"$2,255.00","$3,929.90","$3,969.60",$0.00,$0.00,$0.00,$0.00,$0.00
36191469,EAP,CPT® 31574,,Laryngoscopy W/ Inj Augmentation Unilateral,"$3,310.00",$0.00,"$3,310.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,310.00",$0.00,"$2,255.00","$2,621.52","$2,648.00",$0.00,$0.00,$0.00,$0.00,$0.00
36191470,EAP,CPT® 31574,,Laryngoscopy W/ Inj Augmentation Bilateral,"$4,966.00",$0.00,"$4,966.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,966.00",$0.00,"$2,255.00","$3,933.07","$3,972.80",$0.00,$0.00,$0.00,$0.00,$0.00
36191471,EAP,CPT® 62355,,Remove Spinal Canal Catheter,"$7,880.00",$0.00,"$7,880.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$7,880.00",$0.00,"$2,327.00","$6,240.96","$6,304.00",$0.00,$0.00,$0.00,$0.00,$0.00
36191472,EAP,CPT® 64561,,Implant Neuroelectrodes Sacral Nerve,"$10,784.00",$0.00,"$10,784.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$10,784.00",$0.00,"$2,858.00","$8,540.93","$8,627.20",$0.00,$0.00,$0.00,$0.00,$0.00
36191473,EAP,CPT® 64461,,Pvb Thoracic Single Inj Site,"$4,161.00",$0.00,"$4,161.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,161.00",$0.00,"$2,255.00","$3,295.51","$3,328.80",$0.00,$0.00,$0.00,$0.00,$0.00
36191474,EAP,CPT® 64462,,Pvb Thoracic 2nd+ Inj Site,"$2,737.00",$0.00,"$2,737.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,737.00",$0.00,"$1,368.50","$2,167.70","$2,189.60",$0.00,$0.00,$0.00,$0.00,$0.00
36191475,EAP,CPT® 55920,,Place Needles Pelvic For Rt,"$10,001.00",$0.00,"$10,001.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$10,001.00",$0.00,"$2,858.00","$7,920.79","$8,000.80",$0.00,$0.00,$0.00,$0.00,$0.00
36191476,EAP,CPT® 36660,,Insertion Catheter Artery,$199.00,$0.00,$180.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$180.00,$0.00,$180.00,$142.56,$144.00,$0.00,$0.00,$0.00,$0.00,$0.00
36191477,EAP,CPT® 46910,,Destruction Anal Lesion(s),"$5,927.00",$138.42,"$5,927.00","$2,496.90","$4,230.10","$1,485.30","$1,021.19","$4,230.10","$4,230.10","$1,037.77","$5,927.00","$1,553.51","$2,255.00","$4,694.18","$4,741.60","$2,158.40",$144.75,$138.42,$943.58,"$1,479.54"
36191478,EAP,CPT® 66500,,Iridotomy By Stab Incision; Except Transfixion,"$4,119.00",$0.00,"$4,119.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,119.00",$0.00,"$2,255.00","$3,262.25","$3,295.20",$0.00,$0.00,$0.00,$0.00,$0.00
36191479,EAP,CPT® 65435,,Curette/treat Cornea,"$2,444.00",$0.00,"$2,444.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,444.00",$0.00,"$2,255.00","$1,935.65","$1,955.20",$0.00,$0.00,$0.00,$0.00,$0.00
36191480,EAP,CPT® 65810,,Paracentesis Ant Cham W/ Rmvl Vitreous W/wo Air Inj,"$6,110.00",$0.00,"$6,110.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,110.00",$0.00,"$2,858.00","$4,839.12","$4,888.00",$0.00,$0.00,$0.00,$0.00,$0.00
36191481,EAP,CPT® 27369,,Njx Px Cntrst Kne Arthg Cntrst Enhncd Ct/mri Kne,"$1,257.00",$0.00,"$1,257.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
36191482,EAP,CPT® 33285,,Insertion Subq Cardiac Rhythm Monitor W/prgrmg,"$12,600.00",$92.65,"$12,600.00","$2,106.30","$8,992.62","$7,327.77","$2,170.92","$8,992.62","$5,416.74","$2,206.16","$12,600.00","$7,664.31","$6,105.00","$9,979.20","$10,080.00","$10,648.54","$4,971.59",$92.65,"$2,005.92","$7,299.34"
36191483,EAP,CPT® 33286,,Removal Subcutaneous Cardiac Rhythm Monitor,"$13,167.00",$91.21,"$13,167.00","$2,106.30","$9,397.29",$584.94,"$2,268.61","$9,397.29","$5,416.74","$2,305.44","$13,167.00",$611.80,"$2,255.00","$10,428.26","$10,533.60",$850.02,$130.54,$91.21,"$2,096.19",$582.67
36191484,EAP,CPT® 10005,,Fna Bx W/ Us Guide 1st Lesion,"$1,546.00",$0.00,"$1,546.00","$1,546.00",$0.00,$584.94,$266.37,$0.00,$0.00,$270.69,"$1,546.00",$611.80,"$1,546.00","$1,224.43","$1,236.80",$850.02,$42.95,$74.65,$246.12,$582.67
36191485,EAP,CPT® 10006,,Fna Bx W/ Us Guide Ea Addtl,$528.00,$0.00,$528.00,$528.00,$0.00,$0.00,$90.97,$0.00,$0.00,$92.45,$528.00,$0.00,$264.00,$418.18,$422.40,$0.00,$58.60,$51.21,$84.06,$0.00
36191486,EAP,CPT® 10007,,Fna Bx W/ Fluoro Guide 1st Lesion,"$1,546.00",$0.00,"$1,546.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,546.00",$0.00,"$1,546.00","$1,224.43","$1,236.80",$0.00,$0.00,$0.00,$0.00,$0.00
36191487,EAP,CPT® 10008,,Fna Bx W/ Fluoro Guide Ea Addtl,$528.00,$0.00,$528.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$528.00,$0.00,$264.00,$418.18,$422.40,$0.00,$0.00,$0.00,$0.00,$0.00
36191488,EAP,CPT® 10009,,Fna Bx W/ Ct Guide 1st Lesion,"$1,546.00",$0.00,"$1,546.00","$1,546.00",$0.00,$584.94,$266.37,$0.00,$0.00,$270.69,"$1,546.00",$611.80,"$1,546.00","$1,224.43","$1,236.80",$850.02,$451.42,$118.28,$246.12,$582.67
36191489,EAP,CPT® 10010,,Fna Bx W/ Ct Guide Ea Addtl,$528.00,$0.00,$528.00,$528.00,$0.00,$0.00,$90.97,$0.00,$0.00,$92.45,$528.00,$0.00,$264.00,$418.18,$422.40,$0.00,$272.43,$85.83,$84.06,$0.00
36191490,EAP,CPT® 10011,,Fna Bx W/ Mr Guide 1st Lesion,"$1,546.00",$0.00,"$1,546.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,546.00",$0.00,"$1,546.00","$1,224.43","$1,236.80",$0.00,$0.00,$0.00,$0.00,$0.00
36191491,EAP,CPT® 10012,,Fna Bx W/ Mr Guide Ea Addtl,$528.00,$0.00,$528.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$528.00,$0.00,$264.00,$418.18,$422.40,$0.00,$0.00,$0.00,$0.00,$0.00
36191492,EAP,CPT® 11102,,Tangential (shave) Bx Skin; 1st Lesion,$313.00,$0.00,$313.00,$313.00,$0.00,$167.55,$53.93,$0.00,$0.00,$54.80,$313.00,$175.24,$313.00,$247.90,$250.40,$243.48,$95.62,$40.38,$49.83,$166.90
36191493,EAP,CPT® 11104,,Punch Bx Skin; 1st Lesion,$313.00,$0.00,$313.00,$313.00,$0.00,$167.55,$53.93,$0.00,$0.00,$54.80,$313.00,$175.24,$313.00,$247.90,$250.40,$243.48,$120.20,$50.48,$49.83,$166.90
36191494,EAP,CPT® 11106,,Incisional (wedge) Bx Skin; 1st Lesion,$375.00,$0.00,$375.00,$375.00,$0.00,$306.38,$64.61,$0.00,$0.00,$65.66,$375.00,$320.45,$375.00,$297.00,$300.00,$375.00,$145.49,$60.94,$59.70,$305.19
36191495,EAP,CPT® 11103,,Tangential (shave) Bx Skin; Ea Addtl,$300.00,$0.00,$300.00,$300.00,$0.00,$0.00,$51.69,$0.00,$0.00,$52.53,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$51.58,$23.44,$47.76,$0.00
36191496,EAP,CPT® 11105,,Punch Bx Skin; Ea Addtl,$300.00,$0.00,$300.00,$300.00,$0.00,$0.00,$51.69,$0.00,$0.00,$52.53,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$59.11,$27.40,$47.76,$0.00
36191497,EAP,CPT® 11107,,Incisional (wedge) Bx Skin; Ea Addtl,$300.00,$0.00,$300.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$0.00,$0.00,$0.00,$0.00
36191498,EAP,CPT® 43762,,Perq Replacement Gtube Not Req Rev Gastro Tract,"$1,604.00",$0.00,"$1,604.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,604.00",$0.00,"$1,604.00","$1,270.37","$1,283.20",$0.00,$0.00,$0.00,$0.00,$0.00
36191499,EAP,CPT® 43763,,Perq Replacement Gtube Requiring Rev Gastro Tract,"$1,604.00",$0.00,"$1,604.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,604.00",$0.00,"$1,604.00","$1,270.37","$1,283.20",$0.00,$0.00,$0.00,$0.00,$0.00
36191500,EAP,CPT® 50436,,Perq Dilation Xst Trc Endourologic Px W/img,"$9,134.00",$0.00,"$9,134.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$9,134.00",$0.00,"$2,255.00","$7,234.13","$7,307.20",$0.00,$0.00,$0.00,$0.00,$0.00
36191501,EAP,CPT® 50437,,Perq Dilation Xst Trc New Access Renal Coltj Sys,"$9,134.00",$0.00,"$9,134.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$9,134.00",$0.00,"$3,902.00","$7,234.13","$7,307.20",$0.00,$0.00,$0.00,$0.00,$0.00
36191502,EAP,CPT® 65436,,Curettage/treatment Cornea,"$5,499.00",$0.00,"$5,499.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,499.00",$0.00,"$2,255.00","$4,355.21","$4,399.20",$0.00,$0.00,$0.00,$0.00,$0.00
36191503,EAP,CPT® 10004,,Fna Bx W/o Img Gdn Ea Addl,$528.00,$0.00,$528.00,$528.00,$0.00,$0.00,$90.97,$0.00,$0.00,$92.45,$528.00,$0.00,$264.00,$418.18,$422.40,$0.00,$51.12,$45.07,$84.06,$0.00
36191504,EAP,CPT® 27369,,Ct/mr Contrast Enhanced Arthrg Knee Inj Px Bilateral,"$1,886.00",$0.00,"$1,886.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,886.00",$0.00,$943.00,"$1,493.71","$1,508.80",$0.00,$0.00,$0.00,$0.00,$0.00
36191505,EAP,CPT® 64635,,Bilateral Destr Lumb/sac Facet Jnt; Single,"$4,275.00",$229.68,"$4,275.00","$2,106.30","$3,051.07","$1,648.68",$736.56,"$3,051.07","$3,051.07",$748.52,"$4,275.00","$1,724.40","$2,255.00","$3,385.80","$3,420.00","$2,395.83",$425.03,$229.68,$680.58,"$1,642.29"
36191507,EAP,CPT® 69209,,Remove Impacted Ear Wax Irrig/lavage Bil,$414.00,$0.00,$414.00,$414.00,$0.00,$52.75,$71.33,$0.00,$0.00,$72.49,$414.00,$55.17,$414.00,$327.89,$331.20,$76.65,$12.24,$14.41,$65.91,$52.54
36191508,EAP,CPT® 36573,,Ins Picc W/ Imaging 5 Yr+,"$5,429.00",$88.35,"$5,429.00","$2,106.30","$3,874.68","$1,564.09",$935.39,"$3,874.68","$3,874.68",$950.57,"$5,429.00","$1,635.92","$2,255.00","$4,299.77","$4,343.20","$2,272.90",$849.64,$88.35,$864.30,"$1,558.02"
36191509,EAP,CPT® 27266,,Clsd Tx Post Hip Arthroplasty Disloc,"$4,326.00",$0.00,"$4,326.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,326.00",$0.00,"$2,327.00","$3,426.19","$3,460.80",$0.00,$0.00,$0.00,$0.00,$0.00
36191510,EAP,CPT® 15793,,Chemical Peel (tca) Nonfacial,"$1,188.00",$0.00,"$1,188.00",$645.08,$0.00,$306.38,$204.69,$0.00,$0.00,$208.01,"$1,188.00",$320.45,"$1,188.00",$940.90,$950.40,$445.22,$185.92,$362.58,$189.13,$305.19
36191511,EAP,CPT® 46922,,Simple Excision Of Anal Lesion(s),"$7,092.00",$0.00,"$7,092.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$7,092.00",$0.00,"$2,255.00","$5,616.86","$5,673.60",$0.00,$0.00,$0.00,$0.00,$0.00
36191512,EAP,CPT® 20526,,Bilateral Carpal Tunnel Inj,"$1,356.00",$0.00,"$1,356.00","$1,356.00",$0.00,$251.01,$233.63,$0.00,$0.00,$237.42,"$1,356.00",$262.54,"$1,356.00","$1,073.95","$1,084.80",$364.76,$212.21,$59.49,$215.88,$250.04
36191513,EAP,CPT® 64483,,Bil Inject Txforamen Epi L/s Sngl,"$2,558.00",$115.74,"$2,558.00","$2,106.30","$1,825.64",$778.67,$440.73,"$1,825.64","$1,825.64",$447.89,"$2,558.00",$814.44,"$2,255.00","$2,025.94","$2,046.40","$1,131.55",$197.93,$115.74,$407.23,$775.65
36191514,EAP,CPT® 67110,,Repair Retinal Detachment Inj Px,"$7,552.00",$0.00,"$7,552.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$7,552.00",$0.00,"$2,255.00","$5,981.18","$6,041.60",$0.00,$0.00,$0.00,$0.00,$0.00
36191515,EAP,CPT® 11450,,Removal Sweat Gland Lesion,"$8,549.00",$0.00,"$8,549.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$8,549.00",$0.00,"$2,327.00","$6,770.81","$6,839.20",$0.00,$0.00,$0.00,$0.00,$0.00
36191516,EAP,CPT® 69210,,Bil Removal Impacted Cerumen Instrument,$618.00,$0.00,$618.00,$618.00,$0.00,$52.75,$106.48,$0.00,$0.00,$108.21,$618.00,$55.17,$618.00,$489.46,$494.40,$76.65,$47.34,$34.61,$98.39,$52.54
36191517,EAP,CPT® 45100,,Biopsy Of Rectum,"$5,609.00",$0.00,"$5,609.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,609.00",$0.00,"$2,255.00","$4,442.33","$4,487.20",$0.00,$0.00,$0.00,$0.00,$0.00
36191518,EAP,CPT® 11462,,Excision Hidradenitis Inguinal Simple/interm,"$7,400.00",$0.00,"$7,400.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$7,400.00",$0.00,"$2,327.00","$5,860.80","$5,920.00",$0.00,$0.00,$0.00,$0.00,$0.00
36191519,EAP,CPT® 20611,,Bilateral Drain/inject-shoulder Hip Knee With Us Guidance,"$4,400.00",$62.38,"$4,400.00","$2,106.30","$3,140.28",$251.01,$758.10,"$3,140.28","$3,140.28",$770.40,"$4,400.00",$262.54,"$2,255.00","$3,484.80","$3,520.00",$364.76,$88.61,$62.38,$700.48,$250.04
36191520,EAP,CPT® 55899,,Genital Surgery Procedure Unlisted,"$5,214.00",$0.00,"$5,214.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,214.00",$0.00,"$2,255.00","$4,129.49","$4,171.20",$0.00,$0.00,$0.00,$0.00,$0.00
36191521,EAP,CPT® 53020,,Incision Of Urethra,"$6,781.00",$0.00,"$6,781.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,781.00",$0.00,"$2,255.00","$5,370.55","$5,424.80",$0.00,$0.00,$0.00,$0.00,$0.00
36191522,EAP,CPT® 31636,,Bronchoscopy Initial Bronch Stent,"$9,005.00",$0.00,"$9,005.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$9,005.00",$0.00,"$2,327.00","$7,131.96","$7,204.00",$0.00,$0.00,$0.00,$0.00,$0.00
36191523,EAP,CPT® 31637,,Bronchoscopy Addl Bronch Stent,"$4,558.00",$0.00,"$4,558.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,558.00",$0.00,"$2,255.00","$3,609.94","$3,646.40",$0.00,$0.00,$0.00,$0.00,$0.00
36191524,EAP,CPT® 31638,,Bronchoscopy Stent Revision Incl Dilation,"$8,711.00",$0.00,"$8,711.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$8,711.00",$0.00,"$2,327.00","$6,899.11","$6,968.80",$0.00,$0.00,$0.00,$0.00,$0.00
36191525,EAP,CPT® 64788,,Remove Nf Or Nl; Cutaneous Nerve,"$7,647.00",$0.00,"$7,647.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$7,647.00",$0.00,"$2,858.00","$6,056.42","$6,117.60",$0.00,$0.00,$0.00,$0.00,$0.00
36191526,EAP,CPT® 64999,,Unlisted Neuro Px,"$5,488.00",$0.00,"$5,488.00","$2,106.30","$3,916.79",$251.01,$945.55,"$3,916.79","$3,916.79",$960.90,"$5,488.00",$262.54,"$2,255.00","$4,346.50","$4,390.40",$364.76,$858.87,$0.00,$873.69,$250.04
36191527,EAP,CPT® 49999,,Unlisted Abdominal Px,"$8,000.00",$0.00,"$8,000.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$8,000.00",$0.00,"$2,255.00","$6,336.00","$6,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
36191528,EAP,CPT® 67911,,Bil Correction Of Lid Retraction,"$6,503.00",$0.00,"$6,503.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,503.00",$0.00,"$2,858.00","$5,150.38","$5,202.40",$0.00,$0.00,$0.00,$0.00,$0.00
36191529,EAP,CPT® 38794,,Access Thoracic Lymph Duct,"$2,000.00",$0.00,"$2,000.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,000.00",$0.00,"$2,000.00","$1,584.00","$1,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
36191530,EAP,CPT® 67025,,Bil Inj Substitute Pars Plana/limbl W/wo Asp Spx,"$13,059.00",$643.81,"$13,059.00","$2,106.30","$9,320.21","$1,938.76","$2,250.00","$9,320.21","$5,416.74","$2,286.53","$13,059.00","$2,027.80","$2,255.00","$10,342.73","$10,447.20","$2,817.36",$651.56,$643.81,"$2,078.99","$1,931.24"
36191531,EAP,CPT® 67505,,Bil Retrobulbar Injection Alcohol,"$1,265.00",$0.00,"$1,265.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,265.00",$0.00,"$1,265.00","$1,001.88","$1,012.00",$0.00,$0.00,$0.00,$0.00,$0.00
36191532,EAP,CPT® 68200,,Bil Subconjunctival Injection,$393.00,$0.00,$393.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$393.00,$0.00,$393.00,$311.26,$314.40,$0.00,$0.00,$0.00,$0.00,$0.00
36191533,EAP,CPT® 67515,,Bil Injection Medication/other Subst Tenon Capsule,"$2,730.00",$60.20,"$2,730.00","$2,106.30","$1,948.40",$259.37,$470.37,"$1,948.40","$1,948.40",$478.00,"$2,730.00",$271.28,"$2,255.00","$2,162.16","$2,184.00",$376.91,$137.37,$60.20,$434.62,$258.37
36191534,EAP,CPT® 36831,,Thrmbc Opn Arven Fstl W/o Revj Dial Grf,"$14,743.00",$0.00,"$14,743.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$14,743.00",$0.00,"$6,105.00","$11,676.46","$11,794.40",$0.00,$0.00,$0.00,$0.00,$0.00
36191535,EAP,CPT® 33016,,Pericardiocentesis W/imaging,"$1,385.00",$0.00,"$1,385.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,385.00",$0.00,"$1,385.00","$1,096.92","$1,108.00",$0.00,$0.00,$0.00,$0.00,$0.00
36191536,EAP,CPT® 33017,,Perq Prcrd Drg 6yr+ W/o Congenital Car Anomaly,$402.00,$0.00,$402.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$402.00,$0.00,$201.00,$318.38,$321.60,$0.00,$0.00,$0.00,$0.00,$0.00
36191537,EAP,CPT® 33018,,Perq Prcrd Drg 0-5yr/any Age W/cgen Car Anomaly,$402.00,$0.00,$402.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$402.00,$0.00,$201.00,$318.38,$321.60,$0.00,$0.00,$0.00,$0.00,$0.00
36191540,EAP,CPT® 62328,,Dx Lumbar Puncture W/fl Or Ct Guidance,"$1,493.00",$0.00,"$1,493.00","$1,493.00",$0.00,$599.36,$257.24,$0.00,$0.00,$261.41,"$1,493.00",$626.89,"$1,493.00","$1,182.46","$1,194.40",$870.98,$252.51,$93.39,$237.69,$597.04
36191541,EAP,CPT® 62329,,Therapeutic Lumbar Puncture W/fl Or Ct Guidance,"$1,493.00",$0.00,"$1,493.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,493.00",$0.00,"$1,493.00","$1,182.46","$1,194.40",$0.00,$0.00,$0.00,$0.00,$0.00
36191550,EAP,CPT® 64451,,Injection Aa&/strd Nerves Nrvtg Si Joint W/img,"$1,493.00",$0.00,"$1,493.00","$1,493.00",$0.00,$599.36,$257.24,$0.00,$0.00,$261.41,"$1,493.00",$626.89,"$1,493.00","$1,182.46","$1,194.40",$870.98,$204.40,$82.58,$237.69,$597.04
36191551,EAP,CPT® 64454,,Injection Aa&/strd Genicular Nrv Branches W/img,"$1,493.00",$0.00,"$1,493.00","$1,493.00",$0.00,$599.36,$257.24,$0.00,$0.00,$261.41,"$1,493.00",$626.89,"$1,493.00","$1,182.46","$1,194.40",$870.98,$206.45,$85.10,$237.69,$597.04
36191552,EAP,CPT® 64624,,Destruction Neurolytic Agt Genicular Nerve W/img,"$4,106.00",$0.00,"$4,106.00","$2,106.30","$2,930.45","$1,648.68",$0.00,"$2,930.45","$2,930.45",$718.93,"$4,106.00","$1,724.40","$2,255.00","$3,251.95","$3,284.80","$2,395.83",$0.00,$152.52,$653.68,"$1,642.29"
36191553,EAP,CPT® 64625,,Radiofrequency Abltj Nrv Nrvtg Si Jt W/img Gdn,"$4,106.00",$0.00,"$4,106.00","$3,389.40","$2,930.45","$1,648.68",$0.00,"$2,930.45","$2,930.45",$718.93,"$4,106.00","$1,724.40","$2,255.00","$3,251.95","$3,284.80","$2,395.83",$0.00,$201.56,$653.68,"$1,642.29"
36191555,EAP,CPT® 64405,,Bil Greater Occipital Nerve Inj,"$4,796.00",$55.88,"$4,796.00","$2,106.30","$3,422.91",$251.01,$826.33,"$3,422.91","$3,422.91",$839.74,"$4,796.00",$262.54,"$2,255.00","$3,798.43","$3,836.80",$364.76,$102.34,$55.88,$763.52,$250.04
36191556,EAP,CPT® 52224,,Cystourethroscopy W/ Fulguration <.5cm Lesn,"$3,964.00",$212.40,"$3,964.00","$2,496.90","$2,829.11","$1,698.74",$682.98,"$2,829.11","$2,829.11",$694.06,"$3,964.00","$1,776.76","$2,327.00","$3,139.49","$3,171.20","$2,468.57",$272.85,$212.40,$631.07,"$1,692.15"
36191560,EAP,CPT® 41008,,Submandibular Abscess,"$4,969.00",$0.00,"$4,969.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,969.00",$0.00,"$2,255.00","$3,935.45","$3,975.20",$0.00,$0.00,$0.00,$0.00,$0.00
36191561,EAP,CPT® 42000,,"I&d Abscess Plate, Uvula",$286.00,$45.53,$286.00,$286.00,$286.00,$195.27,$49.28,$286.00,$286.00,$50.08,$286.00,$204.24,$286.00,$226.51,$228.80,$283.76,$95.00,$107.41,$45.53,$194.51
36191562,EAP,CPT® 46050,,I & D Perianal Abcess,"$4,031.00",$0.00,"$4,031.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,031.00",$0.00,"$2,255.00","$3,192.55","$3,224.80",$0.00,$0.00,$0.00,$0.00,$0.00
36191563,EAP,CPT® 31233,,"Nasal/sinus Endoscopy, Dx",$661.00,$0.00,$661.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$661.00,$0.00,$661.00,$523.51,$528.80,$0.00,$0.00,$0.00,$0.00,$0.00
36191564,EAP,CPT® 45385,,Colonoscopy W/lesion Removal,"$3,214.00",$265.02,"$2,922.00","$2,496.90","$2,085.43",$962.95,$503.45,"$2,085.43","$2,085.43",$511.62,"$2,922.00","$1,007.17","$2,327.00","$2,314.22","$2,337.60","$1,399.33",$450.95,$265.02,$465.18,$959.21
36191565,EAP,CPT® 43235,,"Upper Gi Endoscopy, Diagnostic","$4,523.00",$0.00,"$4,112.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,112.00",$0.00,"$2,255.00","$3,256.70","$3,289.60",$0.00,$0.00,$0.00,$0.00,$0.00
36191566,EAP,CPT® 31515,,Laryngoscopy For Aspiration,"$7,040.00",$0.00,"$7,040.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$7,040.00",$0.00,"$2,255.00","$5,575.68","$5,632.00",$0.00,$0.00,$0.00,$0.00,$0.00
36191567,EAP,CPT® 45305,,Proctosigmoidoscopy W/bx Single/multiple,"$5,114.00",$0.00,"$5,114.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,114.00",$0.00,"$2,255.00","$4,050.29","$4,091.20",$0.00,$0.00,$0.00,$0.00,$0.00
36191568,EAP,CPT® 45300,,Proctosigmoidoscopy Dx,"$2,361.00",$0.00,"$2,361.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,361.00",$0.00,"$2,255.00","$1,869.91","$1,888.80",$0.00,$0.00,$0.00,$0.00,$0.00
36191569,EAP,CPT® 96373,,Iintra-arterial Injection,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$178.43,$178.43,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
36191570,EAP,CPT® 24201,,REMOVAL FOREIGN BODY UPPER ARM/ELBOW DEEP,"$9,504.00",$360.96,"$9,504.00","$2,496.90","$6,783.00","$2,223.58","$1,637.49","$6,783.00","$5,416.74","$1,664.07","$9,504.00","$2,325.71","$2,327.00","$7,527.17","$7,603.20","$3,231.26",$360.96,$376.65,"$1,513.04","$2,214.96"
36191571,EAP,CPT® 42809,,REMOVE PHARYNX FOREIGN BODY,$500.00,$0.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$500.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
36191573,EAP,CPT® 43247,,Egd Flexible Foreign Body Removal,"$4,263.00",$0.00,"$4,263.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,263.00",$0.00,"$2,327.00","$3,376.30","$3,410.40",$0.00,$0.00,$0.00,$0.00,$0.00
36191585,EAP,CPT® 26740,,Clsd Tx Artclr Fx Mtcrphlngl/iphal Jt W/o Manip,$795.00,$0.00,$795.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$795.00,$0.00,$795.00,$629.64,$636.00,$0.00,$0.00,$0.00,$0.00,$0.00
36191586,EAP,CPT® 10081,,I&d Pilonidal Cyst Complex,"$3,466.00",$0.00,"$3,466.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,466.00",$0.00,"$2,255.00","$2,745.07","$2,772.80",$0.00,$0.00,$0.00,$0.00,$0.00
37000023,EAP,Custom 37000023,,Level 1 1st 30 Min,"$1,066.00",$0.00,"$1,066.00",$0.00,$760.80,$0.00,$0.00,$760.80,$760.80,$0.00,"$1,066.00",$0.00,$533.00,$844.27,$852.80,$0.00,$0.00,$0.00,$0.00,$0.00
37000024,EAP,Custom 37000024,,Level 2 1st 30 Min,"$1,620.00",$0.00,"$1,473.00",$0.00,"$1,051.28",$0.00,$0.00,"$1,051.28","$1,051.28",$0.00,"$1,473.00",$0.00,$736.50,"$1,166.62","$1,178.40",$0.00,$0.00,$0.00,$0.00,$0.00
37000025,EAP,Custom 37000025,,Level 3 1st 30 Min,"$2,393.00",$0.00,"$2,175.00",$0.00,"$1,552.30",$0.00,$0.00,"$1,552.30","$1,552.30",$0.00,"$2,175.00",$0.00,"$1,087.50","$1,722.60","$1,740.00",$0.00,$0.00,$0.00,$0.00,$0.00
37000026,EAP,Custom 37000026,,Level 4 1st 30 Min,"$2,800.00",$0.00,"$2,545.00",$0.00,"$1,816.37",$0.00,$0.00,"$1,816.37","$1,816.37",$0.00,"$2,545.00",$0.00,"$1,272.50","$2,015.64","$2,036.00",$0.00,$0.00,$0.00,$0.00,$0.00
37000027,EAP,Custom 37000027,,Level 5 1st 30 Min,"$3,277.00",$0.00,"$2,979.00",$0.00,"$2,126.11",$0.00,$0.00,"$2,126.11","$2,126.11",$0.00,"$2,979.00",$0.00,"$1,489.50","$2,359.37","$2,383.20",$0.00,$0.00,$0.00,$0.00,$0.00
37000028,EAP,Custom 37000028,,Level 1 Add 15 Min,$434.00,$0.00,$434.00,$0.00,$309.75,$0.00,$0.00,$309.75,$309.75,$0.00,$434.00,$0.00,$217.00,$343.73,$347.20,$0.00,$0.00,$0.00,$0.00,$0.00
37000029,EAP,Custom 37000029,,Level 2 Add 15 Min,$612.00,$0.00,$556.00,$0.00,$396.82,$0.00,$0.00,$396.82,$396.82,$0.00,$556.00,$0.00,$278.00,$440.35,$444.80,$0.00,$0.00,$0.00,$0.00,$0.00
37000030,EAP,Custom 37000030,,Level 3 Add 15 Min,$995.00,$0.00,$853.00,$0.00,$608.79,$0.00,$0.00,$608.79,$608.79,$0.00,$853.00,$0.00,$426.50,$675.58,$682.40,$0.00,$0.00,$0.00,$0.00,$0.00
37000031,EAP,Custom 37000031,,Level 4 Add 15 Min,"$1,104.00",$0.00,"$1,004.00",$0.00,$716.55,$0.00,$0.00,$716.55,$716.55,$0.00,"$1,004.00",$0.00,$502.00,$795.17,$803.20,$0.00,$0.00,$0.00,$0.00,$0.00
37000032,EAP,Custom 37000032,,Level 5 Add 15 Min,"$1,262.00",$0.00,"$1,147.00",$0.00,$818.61,$0.00,$0.00,$818.61,$818.61,$0.00,"$1,147.00",$0.00,$573.50,$908.42,$917.60,$0.00,$0.00,$0.00,$0.00,$0.00
37000033,EAP,CPT® 99151,,Mod Sed Same Phys/qhp Initial 15 Mins; <5 Yrs,$462.00,$0.00,$420.00,$228.06,$299.75,$0.00,$72.36,$299.75,$299.75,$73.54,$420.00,$0.00,$210.00,$332.64,$336.00,$0.00,$74.17,$24.16,$66.86,$0.00
37000034,EAP,CPT® 99152,,Mod Sed Same Phys/qhp Initial 15 Mins 5/> Yrs,$462.00,$0.00,$420.00,$228.06,$299.75,$0.00,$72.36,$299.75,$299.75,$73.54,$420.00,$0.00,$210.00,$332.64,$336.00,$0.00,$49.33,$12.62,$66.86,$0.00
37000035,EAP,CPT® 99153,,Mod Sed Same Phys/qhp Each Addl 15 Mins,$127.00,$0.00,$115.00,$62.45,$82.08,$0.00,$19.81,$82.08,$82.08,$20.14,$115.00,$0.00,$57.50,$91.08,$92.00,$0.00,$10.55,$10.80,$18.31,$0.00
37000036,EAP,CPT® 99155,,Mod Sed Other Phys/qhp Initial 15 Mins; <5 Yrs,$462.00,$0.00,$420.00,$0.00,$299.75,$0.00,$0.00,$299.75,$299.75,$0.00,$420.00,$0.00,$210.00,$332.64,$336.00,$0.00,$0.00,$0.00,$0.00,$0.00
37000037,EAP,CPT® 99156,,Mod Sed Other Phys/qhp Initial 15 Mins 5/> Yrs,$462.00,$0.00,$420.00,$228.06,$299.75,$0.00,$72.36,$299.75,$299.75,$73.54,$420.00,$0.00,$210.00,$332.64,$336.00,$0.00,$73.17,$80.07,$66.86,$0.00
37000038,EAP,CPT® 99157,,Mod Sed Other Phys/qhp Each Addl 15 Mins,$127.00,$0.00,$115.00,$0.00,$82.08,$0.00,$0.00,$82.08,$82.08,$0.00,$115.00,$0.00,$57.50,$91.08,$92.00,$0.00,$0.00,$0.00,$0.00,$0.00
37000123,EAP,Custom 37000123,,Epidural Fee,"$2,125.00",$0.00,"$1,932.00",$0.00,"$1,378.87",$0.00,$0.00,"$1,378.87","$1,378.87",$0.00,"$1,932.00",$0.00,$966.00,"$1,530.14","$1,545.60",$0.00,$0.00,$0.00,$0.00,$0.00
37000124,EAP,,,Ea Add’l 60-90 Min,$477.00,$0.00,$434.00,$0.00,$309.75,$0.00,$0.00,$309.75,$309.75,$0.00,$434.00,$0.00,$217.00,$343.73,$347.20,$0.00,$0.00,$0.00,$0.00,$0.00
37825171,EAP,CPT® 36430,,"Transfusion, Blood","$2,915.00",$35.66,"$2,537.00","$2,106.30","$1,810.66",$372.09,$437.11,"$1,810.66","$1,810.66",$444.21,"$2,537.00",$389.18,"$2,255.00","$2,009.30","$2,029.60",$540.71,$38.59,$35.66,$403.89,$370.65
39000001,EAP,HCPCS P9010,,Whole Blood Unit,"$1,912.00",$0.00,"$1,912.00","$1,038.22","$1,364.59",$127.20,$329.43,"$1,364.59","$1,364.59",$334.78,"$1,912.00",$133.56,$956.00,"$1,514.30","$1,529.60",$184.44,$299.23,$0.00,$304.39,$127.20
39000002,EAP,HCPCS P9012,,Pooled Cryo,$824.00,$0.00,$824.00,$0.00,$588.09,$0.00,$0.00,$588.09,$588.09,$0.00,$824.00,$0.00,$412.00,$652.61,$659.20,$0.00,$0.00,$0.00,$0.00,$0.00
39000003,EAP,HCPCS P9016,,Rbc Leukored Unit,"$1,209.00",$0.00,"$1,209.00",$656.49,$862.86,$188.35,$208.30,$862.86,$862.86,$211.69,"$1,209.00",$197.77,$604.50,$957.53,$967.20,$273.11,$189.21,$0.00,$192.47,$188.35
39000004,EAP,HCPCS P9017,,Fresh Frozen Plasma Unit,$573.00,$0.00,$573.00,$0.00,$408.95,$0.00,$0.00,$408.95,$408.95,$0.00,$573.00,$0.00,$286.50,$453.82,$458.40,$0.00,$0.00,$0.00,$0.00,$0.00
39000012,EAP,HCPCS P9035,,Platelet Pheresis Leukored Unit,"$4,346.00",$0.00,"$4,346.00",$0.00,"$3,101.74",$0.00,$0.00,"$3,101.74","$3,101.74",$0.00,"$4,346.00",$0.00,"$2,173.00","$3,442.03","$3,476.80",$0.00,$0.00,$0.00,$0.00,$0.00
39000013,EAP,HCPCS P9037,,Platelet Pheresis Leukored Irr Unit,"$5,122.00",$0.00,"$5,122.00","$2,781.25","$3,655.57",$634.69,$882.49,"$3,655.57","$3,655.57",$896.82,"$5,122.00",$666.42,"$2,561.00","$4,056.62","$4,097.60",$920.30,$801.59,$0.00,$815.42,$634.69
39000016,EAP,HCPCS P9040,,Rbc Leukored Irr Unit,"$2,075.00",$0.00,"$2,075.00","$1,126.73","$1,480.93",$262.76,$357.51,"$1,480.93","$1,480.93",$363.32,"$2,075.00",$275.90,"$1,037.50","$1,643.40","$1,660.00",$381.00,$324.74,$0.00,$330.34,$262.76
39000017,EAP,HCPCS P9044,,Ffp-cryo Poor Plasma,$307.00,$0.00,$307.00,$0.00,$219.11,$0.00,$0.00,$219.11,$219.11,$0.00,$307.00,$0.00,$153.50,$243.14,$245.60,$0.00,$0.00,$0.00,$0.00,$0.00
39000021,EAP,HCPCS P9054,,Blood Leukored Deglyc Washed Unit,"$2,064.00",$0.00,"$2,064.00",$0.00,"$1,473.08",$0.00,$0.00,"$1,473.08","$1,473.08",$0.00,"$2,064.00",$0.00,"$1,032.00","$1,634.69","$1,651.20",$0.00,$0.00,$0.00,$0.00,$0.00
39000024,EAP,HCPCS P9057,,Blood Leukored Deglyc Washed Irr Unit,"$2,718.00",$0.00,"$2,718.00",$0.00,"$1,939.84",$0.00,$0.00,"$1,939.84","$1,939.84",$0.00,"$2,718.00",$0.00,"$1,359.00","$2,152.66","$2,174.40",$0.00,$0.00,$0.00,$0.00,$0.00
39000026,EAP,HCPCS P9059,,Ffp-frozen 24 Hour,$707.00,$0.00,$707.00,$0.00,$504.59,$0.00,$0.00,$504.59,$504.59,$0.00,$707.00,$0.00,$353.50,$559.94,$565.60,$0.00,$0.00,$0.00,$0.00,$0.00
39000040,EAP,HCPCS P9016,,Rbc-wbc Reduced,"$1,209.00",$0.00,"$1,209.00",$656.49,$862.86,$188.35,$208.30,$862.86,$862.86,$211.69,"$1,209.00",$197.77,$604.50,$957.53,$967.20,$273.11,$189.21,$0.00,$192.47,$188.35
39000052,EAP,CPT® 86891,,Non Cardiac Cell Saver,"$1,970.00",$0.00,"$1,970.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,970.00",$0.00,$234.84,"$1,560.24","$1,576.00",$0.00,$0.00,$0.00,$0.00,$0.00
39000060,EAP,HCPCS P9011,,Rbc Leukored Aliquot,$361.00,$0.00,$361.00,$196.02,$257.65,$134.48,$34.43,$257.65,$257.65,$63.21,$361.00,$141.20,$180.50,$285.91,$288.80,$195.00,$56.50,$0.00,$57.47,$134.48
39000061,EAP,HCPCS P9011,,Rbc Leukored Irr Aliquot,$361.00,$0.00,$361.00,$196.02,$257.65,$134.48,$34.43,$257.65,$257.65,$63.21,$361.00,$141.20,$180.50,$285.91,$288.80,$195.00,$56.50,$0.00,$57.47,$134.48
39000062,EAP,HCPCS P9011,,"Platelet Pheresis, Lr Aliquot",$729.00,$0.00,$729.00,$395.85,$520.29,$134.48,$34.43,$520.29,$520.29,$127.64,$729.00,$141.20,$364.50,$577.37,$583.20,$195.00,$114.09,$0.00,$116.06,$134.48
39000063,EAP,HCPCS P9011,,Platelet Pheresis Lr Irr Aliquot,$804.00,$0.00,$804.00,$436.57,$573.81,$134.48,$34.43,$573.81,$573.81,$140.77,$804.00,$141.20,$402.00,$636.77,$643.20,$195.00,$125.83,$0.00,$128.00,$134.48
39000064,EAP,HCPCS P9012,,Single Cryo,$361.00,$0.00,$361.00,$0.00,$257.65,$0.00,$0.00,$257.65,$257.65,$0.00,$361.00,$0.00,$180.50,$285.91,$288.80,$0.00,$0.00,$0.00,$0.00,$0.00
39000065,EAP,HCPCS P9011,,Thawed Ffp Aliquot,$361.00,$0.00,$361.00,$196.02,$257.65,$134.48,$34.43,$257.65,$257.65,$63.21,$361.00,$141.20,$180.50,$285.91,$288.80,$195.00,$56.50,$0.00,$57.47,$134.48
39100001,EAP,CPT® 36430,,"TRANSFUSION, BLOOD","$2,915.00",$35.66,"$2,537.00","$2,106.30","$1,810.66",$372.09,$437.11,"$1,810.66","$1,810.66",$444.21,"$2,537.00",$389.18,"$2,255.00","$2,009.30","$2,029.60",$540.71,$38.59,$35.66,$403.89,$370.65
39100005,EAP,CPT® 36430,,"Transfusion, Blood Or Bld Comp","$2,537.00",$35.66,"$2,537.00","$2,106.30","$1,810.66",$372.09,$437.11,"$1,810.66","$1,810.66",$444.21,"$2,537.00",$389.18,"$2,255.00","$2,009.30","$2,029.60",$540.71,$38.59,$35.66,$403.89,$370.65
40000002,EAP,CPT® 76376,,3d Rendering W/o Postproce Nir,"$3,864.00",$0.00,"$3,864.00","$1,869.00","$2,757.74",$0.00,$147.89,"$2,757.74","$2,757.74",$676.56,"$3,864.00",$0.00,$927.36,"$3,060.29","$3,091.20",$0.00,$140.81,$13.33,$615.15,$0.00
40000003,EAP,CPT® 76377,,3d Rendering W/postprocess Nir,"$3,864.00",$0.00,"$3,864.00","$1,869.00","$2,757.74",$0.00,$187.24,"$2,757.74","$2,757.74",$676.56,"$3,864.00",$0.00,$927.36,"$3,060.29","$3,091.20",$0.00,$186.77,$32.41,$615.15,$0.00
40100003,EAP,CPT® 77061,,Dx Digital Breast Tomosynthesis; Unilateral,$150.00,$0.00,$287.19,$150.00,$287.19,$26.70,$25.84,$287.19,$287.19,$26.26,$150.00,$26.75,$36.00,$118.80,$120.00,$90.00,$23.48,$0.00,$23.88,$25.21
40100008,EAP,CPT® 77062,,Dx Digital Breast Tomosynthesis; Bilateral,$235.00,$0.00,$225.45,$150.00,$225.45,$26.70,$25.84,$225.45,$225.45,$26.26,$150.00,$26.75,$36.00,$118.80,$120.00,$90.00,$23.48,$0.00,$23.88,$25.21
40100012,EAP,CPT® 77065,,Dx Mammo Incl Cad Uni,$340.00,$54.13,$340.00,$261.79,$227.19,$60.52,$58.58,$227.19,$227.19,$59.53,$340.00,$100.65,$81.60,$269.28,$272.00,$94.36,$130.40,$94.36,$54.13,$94.36
40100013,EAP,CPT® 77066,,Dx Mammo Incl Cad Bi,$420.00,$66.86,$420.00,$332.10,$290.61,$74.76,$72.36,$290.61,$290.61,$73.54,$420.00,$128.54,$100.80,$332.64,$336.00,$120.30,$163.40,$120.30,$66.86,$120.30
40200001,EAP,CPT® 76506,,Ultrasound Cranial,$621.00,$0.00,$621.00,$0.00,$197.74,$0.00,$0.00,$197.74,$197.74,$0.00,$621.00,$0.00,$149.04,$491.83,$496.80,$0.00,$0.00,$0.00,$0.00,$0.00
40200002,EAP,CPT® 76641,,"Ultrasound, Breast,unilateal,complete","$1,227.00",$0.00,"$1,227.00",$0.00,$172.27,$0.00,$0.00,$172.27,$172.27,$0.00,"$1,227.00",$0.00,$294.48,$971.78,$981.60,$0.00,$0.00,$0.00,$0.00,$0.00
40200003,EAP,CPT® 76506,,Us Cranial Complete,$621.00,$0.00,$621.00,$0.00,$197.74,$0.00,$0.00,$197.74,$197.74,$0.00,$621.00,$0.00,$149.04,$491.83,$496.80,$0.00,$0.00,$0.00,$0.00,$0.00
40200005,EAP,CPT® 76512,,"Ophth Us, B W/non-quant A",$767.00,$21.61,$767.00,$182.35,$100.56,$107.47,$132.15,$100.56,$100.56,$134.30,$767.00,$112.41,$184.08,$607.46,$613.60,$156.18,$93.72,$21.61,$122.11,$107.06
40200006,EAP,CPT® 76514,,"Echo Exam Of Eye, Thickness",$280.00,$3.96,$280.00,$29.94,$8.57,$22.05,$48.24,$8.57,$8.57,$49.03,$280.00,$23.06,$67.20,$221.76,$224.00,$32.04,$11.96,$3.96,$44.58,$21.96
40200007,EAP,CPT® 76519,,Ultrasonography,$767.00,$36.02,$767.00,$166.37,$104.53,$107.47,$132.15,$104.53,$104.53,$134.30,$767.00,$112.41,$184.08,$607.46,$613.60,$156.18,$76.68,$36.02,$122.11,$107.06
40200008,EAP,CPT® 76642,,"Ultrasound, Breast,unilateal,limited","$1,155.00",$54.39,"$1,155.00",$174.76,$132.02,$76.53,$199.00,$132.02,$132.02,$202.23,"$1,155.00",$80.04,$277.20,$914.76,$924.00,$111.21,$85.51,$54.39,$183.88,$76.23
40200009,EAP,CPT® 76536,,Soft Tiss/head&neck W/realtime,"$1,111.00",$82.37,"$1,111.00",$230.46,$196.88,$107.47,$191.42,$196.88,$196.88,$194.53,"$1,111.00",$112.41,$266.64,$879.91,$888.80,$156.18,$82.37,$88.96,$176.87,$107.06
40200011,EAP,CPT® 76536,,Us Thyroid,"$1,111.00",$82.37,"$1,111.00",$230.46,$196.88,$107.47,$191.42,$196.88,$196.88,$194.53,"$1,111.00",$112.41,$266.64,$879.91,$888.80,$156.18,$82.37,$88.96,$176.87,$107.06
40200012,EAP,CPT® 76604,,"Ultrasound Exam, Chest","$1,101.00",$50.78,"$1,101.00",$174.76,$139.42,$107.47,$189.70,$139.42,$139.42,$192.78,"$1,101.00",$112.41,$264.24,$871.99,$880.80,$156.18,$77.40,$50.78,$175.28,$107.06
40200014,EAP,CPT® 76604,,"Us Chest, Rt W/image","$1,101.00",$50.78,"$1,101.00",$174.76,$139.42,$107.47,$189.70,$139.42,$139.42,$192.78,"$1,101.00",$112.41,$264.24,$871.99,$880.80,$156.18,$77.40,$50.78,$175.28,$107.06
40200018,EAP,CPT® 76700,,"Us Abd, Rt W/image","$1,486.00",$83.20,"$1,486.00",$242.27,$227.84,$107.47,$256.03,$227.84,$227.84,$260.19,"$1,486.00",$112.41,$356.64,"$1,176.91","$1,188.80",$156.18,$115.39,$83.20,$236.57,$107.06
40200020,EAP,CPT® 76705,,Bladder Ultrasound,"$1,412.00",$62.67,"$1,412.00",$181.01,$175.05,$107.47,$243.28,$175.05,$175.05,$247.23,"$1,412.00",$112.41,$338.88,"$1,118.30","$1,129.60",$156.18,$83.78,$62.67,$224.79,$107.06
40200021,EAP,CPT® 76705,,"Us Abdominal, Ltd","$1,412.00",$62.67,"$1,412.00",$181.01,$175.05,$107.47,$243.28,$175.05,$175.05,$247.23,"$1,412.00",$112.41,$338.88,"$1,118.30","$1,129.60",$156.18,$83.78,$62.67,$224.79,$107.06
40200022,EAP,CPT® 76641,,Ultrasound Breast Rt Complete,"$1,227.00",$0.00,"$1,227.00",$0.00,$172.27,$0.00,$0.00,$172.27,$172.27,$0.00,"$1,227.00",$0.00,$294.48,$971.78,$981.60,$0.00,$0.00,$0.00,$0.00,$0.00
40200023,EAP,CPT® 76770,,"Us Retroperit, Rt W/image; Complete","$1,431.00",$77.44,"$1,431.00",$224.19,$222.59,$107.47,$246.55,$222.59,$222.59,$250.56,"$1,431.00",$112.41,$343.44,"$1,133.35","$1,144.80",$156.18,$112.23,$77.44,$227.82,$107.06
40200025,EAP,CPT® 76775,,"Us Retroper, Rt W/image Ltd","$1,315.00",$30.25,"$1,315.00",$115.57,$194.25,$107.47,$226.57,$194.25,$194.25,$230.25,"$1,315.00",$112.41,$315.60,"$1,041.48","$1,052.00",$156.18,$83.43,$30.25,$209.35,$107.06
40200027,EAP,CPT® 76800,,Us Spine,"$1,019.00",$0.00,"$1,019.00",$0.00,$163.73,$0.00,$0.00,$163.73,$163.73,$0.00,"$1,019.00",$0.00,$244.56,$807.05,$815.20,$0.00,$0.00,$0.00,$0.00,$0.00
40200028,EAP,CPT® 76642,,Ultrasound Breast Rt Limited,$988.00,$54.39,$988.00,$174.76,$132.02,$76.53,$170.23,$132.02,$132.02,$172.99,$988.00,$80.04,$237.12,$782.50,$790.40,$111.21,$85.51,$54.39,$157.29,$76.23
40200029,EAP,CPT® 76641,,Ultrasound Breast Rt Complete,"$1,227.00",$0.00,"$1,227.00",$0.00,$172.27,$0.00,$0.00,$172.27,$172.27,$0.00,"$1,227.00",$0.00,$294.48,$971.78,$981.60,$0.00,$0.00,$0.00,$0.00,$0.00
40200030,EAP,CPT® 76642,,Ultrasound Breast Rt Limited,$988.00,$54.39,$988.00,$174.76,$132.02,$76.53,$170.23,$132.02,$132.02,$172.99,$988.00,$80.04,$237.12,$782.50,$790.40,$111.21,$85.51,$54.39,$157.29,$76.23
40200031,EAP,CPT® 76941,,Cordocentesis Us Guidance,"$1,015.00",$0.00,"$1,015.00",$0.00,$142.08,$0.00,$0.00,$142.08,$142.08,$0.00,"$1,015.00",$0.00,$243.60,$803.88,$812.00,$0.00,$0.00,$0.00,$0.00,$0.00
40200034,EAP,CPT® 76801,,"Ob Us <14 Wks, Single Fetus",$555.00,$73.47,$555.00,$245.08,$193.63,$107.47,$95.62,$193.63,$193.63,$97.18,$555.00,$112.41,$133.20,$439.56,$444.00,$156.18,$90.90,$73.47,$88.36,$107.06
40200035,EAP,CPT® 76885,,Us Infant Hips Dynamic,"$2,232.00",$0.00,"$2,232.00",$0.00,$234.97,$0.00,$0.00,$234.97,$234.97,$0.00,"$2,232.00",$0.00,$535.68,"$1,767.74","$1,785.60",$0.00,$0.00,$0.00,$0.00,$0.00
40200036,EAP,CPT® 76870,,Us Scrotum,"$1,556.00",$74.20,"$1,556.00",$135.07,$207.04,$107.47,$268.09,$207.04,$207.04,$272.44,"$1,556.00",$112.41,$373.44,"$1,232.35","$1,244.80",$156.18,$90.49,$74.20,$247.72,$107.06
40200037,EAP,CPT® 76872,,"Ultrasound,transrectal",$621.00,$93.31,$621.00,$187.96,$253.30,$107.47,$107.00,$253.30,$253.30,$108.73,$621.00,$112.41,$149.04,$491.83,$496.80,$156.18,$93.31,$125.34,$98.86,$107.06
40200038,EAP,CPT® 76881,,"US EXTREMITY, NON-VASC RT W/IM COM","$1,010.00",$46.82,"$1,010.00",$233.93,$207.08,$107.47,$174.02,$207.08,$207.08,$176.84,"$1,010.00",$112.41,$242.40,$799.92,$808.00,$156.18,$109.54,$46.82,$160.79,$107.06
40200039,EAP,CPT® 76805,,Ob Us >/= 14 Wks Sngl Fetus,$681.00,$91.48,$681.00,$282.67,$230.29,$107.47,$117.33,$230.29,$230.29,$119.24,$681.00,$112.41,$163.44,$539.35,$544.80,$156.18,$130.22,$91.48,$108.42,$107.06
40200040,EAP,CPT® 76886,,Us Infant Hips Static,"$2,156.00",$0.00,"$2,156.00",$0.00,$165.47,$0.00,$0.00,$165.47,$165.47,$0.00,"$2,156.00",$0.00,$517.44,"$1,707.55","$1,724.80",$0.00,$0.00,$0.00,$0.00,$0.00
40200042,EAP,CPT® 76937,,Us Guidance For Vascular Acess,"$1,514.00",$0.00,"$1,514.00",$61.97,$49.08,$0.00,$260.85,$49.08,$49.08,$265.09,"$1,514.00",$0.00,$363.36,"$1,199.09","$1,211.20",$0.00,$33.32,$22.33,$241.03,$0.00
40200043,EAP,CPT® 76940,,Ult Guide For Mon. Par.tis.abl,"$1,139.00",$0.00,"$1,139.00",$0.00,$177.84,$0.00,$0.00,$177.84,$177.84,$0.00,"$1,139.00",$0.00,$273.36,$902.09,$911.20,$0.00,$0.00,$0.00,$0.00,$0.00
40200044,EAP,CPT® 76810,,Ob Us >/= 14 Wks Additional Fetus,$667.00,$0.00,$667.00,$185.20,$124.92,$0.00,$114.92,$124.92,$124.92,$116.79,$667.00,$0.00,$160.08,$528.26,$533.60,$0.00,$258.70,$42.86,$106.19,$0.00
40200045,EAP,CPT® 76942,,NEEDLE PLACEMENT US GUIDE BIC,"$1,094.00",$0.00,"$1,094.00",$119.04,$360.62,$0.00,$61.14,$360.62,$360.62,$191.55,"$1,094.00",$0.00,$262.56,$866.45,$875.20,$0.00,$92.25,$25.93,$174.16,$0.00
40200047,EAP,CPT® 76946,,Echo Guide Amniocentesis,$752.00,$0.00,$752.00,$0.00,$62.17,$0.00,$129.57,$62.17,$62.17,$131.67,$752.00,$0.00,$180.48,$595.58,$601.60,$0.00,$77.52,$0.00,$0.00,$0.00
40200048,EAP,CPT® 76810,,Ob Us >/= 14 Wks Additional Fetus,$667.00,$0.00,$667.00,$185.20,$124.92,$0.00,$114.92,$124.92,$124.92,$116.79,$667.00,$0.00,$160.08,$528.26,$533.60,$0.00,$258.70,$42.86,$106.19,$0.00
40200049,EAP,CPT® 76998,,Us Guidance Intraoperative,$864.00,$0.00,$864.00,$126.15,$275.61,$0.00,$148.86,$275.61,$275.61,$151.28,$864.00,$0.00,$207.36,$684.29,$691.20,$0.00,$135.22,$0.00,$137.55,$0.00
40200052,EAP,CPT® 76811,,Us Preg Uterus 1st Gest,"$1,417.00",$83.92,"$1,417.00",$364.87,$268.30,$223.46,$244.14,$268.30,$268.30,$248.11,"$1,417.00",$233.72,$340.08,"$1,122.26","$1,133.60",$324.73,$237.77,$83.92,$225.59,$222.60
40200054,EAP,CPT® 76813,,"Ob Us Nuchal Meas, 1 Gest",$929.00,$63.03,$929.00,$243.00,$168.03,$107.47,$160.06,$168.03,$168.03,$162.66,$929.00,$112.41,$222.96,$735.77,$743.20,$156.18,$118.66,$63.03,$147.90,$107.06
40200055,EAP,CPT® 76814,,"Ob Us Nuchal Meas, Add-on",$555.00,$0.00,$555.00,$0.00,$83.38,$0.00,$0.00,$83.38,$83.38,$0.00,$555.00,$0.00,$133.20,$439.56,$444.00,$0.00,$0.00,$0.00,$0.00,$0.00
40200056,EAP,CPT® 76815,,"Ob Us, Limited, Fetus(s)",$555.00,$52.22,$555.00,$168.49,$139.29,$107.47,$57.02,$139.29,$139.29,$97.18,$555.00,$112.41,$133.20,$439.56,$444.00,$156.18,$87.30,$52.22,$88.36,$107.06
40200062,EAP,CPT® 76816,,Us Preg Uterus F/u,$555.00,$71.66,$555.00,$230.46,$164.87,$107.47,$95.62,$164.87,$164.87,$97.18,$555.00,$112.41,$133.20,$439.56,$444.00,$156.18,$71.66,$71.67,$88.36,$107.06
40200064,EAP,CPT® 76817,,Transvaginal U/s Pregnant,$594.00,$59.07,$594.00,$193.55,$152.67,$107.47,$102.34,$152.67,$152.67,$104.00,$594.00,$112.41,$142.56,$470.45,$475.20,$156.18,$94.59,$59.07,$94.56,$107.06
40200065,EAP,CPT® 76882,,"Ultrasound, Extremity, Nonvascular, Limited",$656.00,$0.00,$656.00,$71.02,$24.38,$107.47,$10.15,$24.38,$24.38,$114.86,$656.00,$112.41,$157.44,$519.55,$524.80,$156.18,$28.65,$33.14,$0.00,$107.06
40200067,EAP,CPT® 76818,,Biophysical Profile W/nst,"$1,319.00",$66.63,"$1,319.00",$245.81,$164.27,$107.47,$227.26,$164.27,$164.27,$230.95,"$1,319.00",$112.41,$316.56,"$1,044.65","$1,055.20",$156.18,$101.11,$66.63,$209.98,$107.06
40200069,EAP,CPT® 76819,,Biophysical Profile W/o Nst,$981.00,$48.98,$981.00,$179.64,$131.99,$107.47,$66.55,$131.99,$131.99,$171.77,$981.00,$112.41,$235.44,$776.95,$784.80,$156.18,$96.45,$48.98,$156.18,$107.06
40200071,EAP,CPT® 76820,,Fetal Dopp Velocimetry Umb Art,"$1,460.00",$21.97,"$1,460.00",$96.10,$70.59,$107.47,$251.55,$70.59,$70.59,$255.63,"$1,460.00",$112.41,$350.40,"$1,156.32","$1,168.00",$156.18,$92.68,$21.97,$232.43,$107.06
40200072,EAP,CPT® 76821,,Fetal Dopp Velocimetry Mid Cer,"$1,460.00",$56.55,"$1,460.00",$185.23,$150.00,$107.47,$251.55,$150.00,$150.00,$255.63,"$1,460.00",$112.41,$350.40,"$1,156.32","$1,168.00",$156.18,$102.99,$56.55,$232.43,$107.06
40200073,EAP,CPT® 76825,,Fetal Echo (2d),"$2,678.00",$153.19,"$2,678.00",$552.10,$299.39,$461.79,$461.41,$299.39,$299.39,$468.90,"$2,678.00",$483.00,$642.72,"$2,120.98","$2,142.40",$671.06,$153.19,$193.77,$426.34,$460.00
40200074,EAP,CPT® 76826,,"Fetal Echo, F/u, Repeat","$1,629.00",$0.00,"$1,629.00",$0.00,$177.26,$0.00,$0.00,$177.26,$177.26,$0.00,"$1,629.00",$0.00,$390.96,"$1,290.17","$1,303.20",$0.00,$0.00,$0.00,$0.00,$0.00
40200075,EAP,CPT® 76827,,Fetal Doppler Echo,"$2,678.00",$0.00,"$2,678.00",$150.39,$103.76,$107.47,$0.00,$103.76,$103.76,$468.90,"$2,678.00",$112.41,$642.72,"$2,120.98","$2,142.40",$156.18,$0.00,$45.38,$426.34,$107.06
40200077,EAP,CPT® 76828,,"Fetal Dopp Echo,repeat","$1,148.00",$0.00,"$1,148.00",$0.00,$60.75,$0.00,$0.00,$60.75,$60.75,$0.00,"$1,148.00",$0.00,$275.52,$909.22,$918.40,$0.00,$0.00,$0.00,$0.00,$0.00
40200078,EAP,CPT® 76812,,Ob Us Detailed Addl Fetus,$290.00,$0.00,$272.00,$272.00,$0.00,$0.00,$46.86,$0.00,$0.00,$47.63,$272.00,$0.00,$65.28,$215.42,$217.60,$0.00,$139.72,$111.65,$43.30,$0.00
40200079,EAP,CPT® 76830,,US TRANSVAGINAL,"$1,628.00",$61.14,"$1,628.00",$242.30,$203.54,$107.47,$61.14,$203.54,$203.54,$285.05,"$1,628.00",$112.41,$390.72,"$1,289.38","$1,302.40",$156.18,$92.96,$89.68,$259.18,$107.06
40200083,EAP,CPT® 76831,,Us Hysterosono W/wo Doppler,"$2,561.00",$84.28,"$2,561.00",$237.42,$201.80,$223.46,$441.25,$201.80,$201.80,$448.41,"$2,561.00",$233.72,$614.64,"$2,028.31","$2,048.80",$324.73,$94.72,$84.28,$407.71,$222.60
40200085,EAP,CPT® 76856,,Us Pelvis(non-ob)comp W/rt Img,"$1,609.00",$61.14,"$1,609.00",$218.61,$204.41,$107.47,$61.14,$204.41,$204.41,$281.72,"$1,609.00",$112.41,$386.16,"$1,274.33","$1,287.20",$156.18,$92.96,$76.36,$256.15,$107.06
40200087,EAP,CPT® 76857,,Us Pelvis Ltd/fu Non-ob,"$1,028.00",$24.13,"$1,028.00",$95.40,$192.80,$107.47,$177.12,$192.80,$192.80,$179.99,"$1,028.00",$112.41,$246.72,$814.18,$822.40,$156.18,$59.67,$24.13,$163.66,$107.06
40200092,EAP,CPT® 76516,,Echo Exam Of Eye,$243.00,$25.57,$243.00,$154.54,$94.06,$107.47,$41.87,$94.06,$94.06,$42.55,$243.00,$112.41,$58.32,$192.46,$194.40,$156.18,$76.68,$25.57,$38.69,$107.06
40200097,EAP,CPT® 76510,,Opth Us B & Quant A,$636.00,$0.00,$636.00,$0.00,$162.11,$0.00,$0.00,$162.11,$162.11,$0.00,$636.00,$0.00,$152.64,$503.71,$508.80,$0.00,$0.00,$0.00,$0.00,$0.00
40200125,EAP,CPT® 76802,,Us Preg Uterus Ea Addl Gest,$488.00,$0.00,$488.00,$128.11,$77.56,$0.00,$84.08,$77.56,$77.56,$85.44,$488.00,$0.00,$117.12,$386.50,$390.40,$0.00,$70.91,$21.97,$77.69,$0.00
40200126,EAP,CPT® 93990,,Duplex Scan Of Hemodialysis Access,"$1,004.00",$107.06,"$1,004.00",$259.62,$432.81,$107.47,$172.98,$432.81,$432.81,$175.79,"$1,004.00",$112.41,$502.00,$795.17,$803.20,$156.18,$112.81,$132.54,$159.84,$107.06
40200127,EAP,CPT® 76529,,Ophthalmic Ultrasonic Foreign Body Localization,$220.00,$0.00,$220.00,$0.00,$92.16,$0.00,$0.00,$92.16,$92.16,$0.00,$220.00,$0.00,$52.80,$174.24,$176.00,$0.00,$0.00,$0.00,$0.00,$0.00
40200128,EAP,CPT® 76932,,"Us Guidance Endomyocardial Biopsy, Imaging S & I",$454.00,$0.00,$454.00,$0.00,$160.94,$0.00,$0.00,$160.94,$160.94,$0.00,$454.00,$0.00,$108.96,$359.57,$363.20,$0.00,$0.00,$0.00,$0.00,$0.00
40200132,EAP,CPT® 76706,,Us Abdl Aorta Screen Aaa,$379.00,$60.34,$379.00,$185.20,$160.30,$107.47,$65.30,$160.30,$160.30,$66.36,$379.00,$112.41,$90.96,$300.17,$303.20,$156.18,$90.50,$87.52,$60.34,$107.06
40200133,EAP,CPT® 76516,,Quantitative A-scan Us Both Eyes,$365.00,$25.57,$365.00,$154.54,$94.06,$107.47,$62.89,$94.06,$94.06,$63.91,$365.00,$112.41,$87.60,$289.08,$292.00,$156.18,$76.68,$25.57,$58.11,$107.06
40200134,EAP,CPT® 76513,,B-scan Us High Resolution One Eye,$544.00,$64.47,$544.00,$187.26,$120.63,$107.47,$93.73,$120.63,$120.63,$95.25,$544.00,$112.41,$130.56,$430.85,$435.20,$156.18,$93.36,$64.47,$86.60,$107.06
40200135,EAP,CPT® 76513,,"B-scan Us, High Resolution Both Eyes",$816.00,$64.47,$816.00,$187.26,$120.63,$107.47,$140.59,$120.63,$120.63,$142.88,$816.00,$112.41,$195.84,$646.27,$652.80,$156.18,$93.36,$64.47,$129.91,$107.06
40300003,EAP,CPT® 77063,,"Scr Digital Breast Tomosynthesis, Bil",$150.00,$23.88,$150.00,$109.30,$61.68,$26.70,$25.84,$61.68,$61.68,$26.26,$150.00,$26.75,$36.00,$118.80,$120.00,$25.21,$53.24,$25.21,$23.88,$25.21
40300004,EAP,CPT® 77063,,"Scr Digital Breast Tomosynthesis, Uni",$150.00,$23.88,$150.00,$109.30,$61.68,$26.70,$25.84,$61.68,$61.68,$26.26,$150.00,$26.75,$36.00,$118.80,$120.00,$25.21,$53.24,$25.21,$23.88,$25.21
40300010,EAP,CPT® 77067,,Scr Mammo Bi Incl Cad,$370.00,$58.90,$370.00,$268.04,$240.02,$65.86,$63.75,$240.02,$240.02,$64.78,$370.00,$106.31,$88.80,$293.04,$296.00,$99.77,$132.75,$99.77,$58.90,$99.77
40300011,EAP,CPT® 77067,,Scr Mammo Unilateral Incl Cad,$370.00,$58.90,$370.00,$268.04,$240.02,$65.86,$63.75,$240.02,$240.02,$64.78,$370.00,$106.31,$88.80,$293.04,$296.00,$99.77,$132.75,$99.77,$58.90,$99.77
40400005,EAP,CPT® 78814,,PET IMG RESTG THYROID CA PET,"$10,583.00",$0.00,"$10,583.00",$0.00,"$2,071.14",$0.00,$0.00,"$2,071.14","$2,071.14",$0.00,"$10,583.00",$0.00,"$2,539.92","$8,381.74","$8,466.40",$0.00,$0.00,$0.00,$0.00,$0.00
40400008,EAP,CPT® 78815,,Pet/ct Skull Base Mid-thigh,"$10,583.00",$0.00,"$10,583.00","$3,420.00","$2,288.79","$1,319.01","$2,369.07","$2,288.79","$2,288.79","$1,853.00","$10,583.00","$1,379.58","$2,539.92","$8,381.74","$8,466.40","$1,916.75","$2,380.22",$0.00,"$1,684.81","$1,313.89"
40400055,EAP,CPT® 78816,,Pet/ct Whole Body,"$10,583.00",$0.00,"$10,583.00","$3,420.00","$2,348.04","$1,319.01","$1,823.40","$2,348.04","$2,348.04","$1,853.00","$10,583.00","$1,379.58","$2,539.92","$8,381.74","$8,466.40","$1,916.75","$1,656.24",$0.00,"$1,684.81","$1,313.89"
40400056,EAP,CPT® 78608,,"Brain Imaging, Positron Emission Tomo (pet); Metabolic Eval","$6,905.00",$0.00,"$6,905.00","$3,420.00",$571.95,"$1,319.01",$143.74,$571.95,$571.95,"$1,209.01","$6,905.00","$1,379.58","$1,657.20","$5,468.76","$5,524.00","$1,916.75","$1,080.63",$0.00,"$1,099.28","$1,313.89"
40400057,EAP,CPT® 78459,,"Myocardial Imaging, Positron Emission Tomography (pet), Metabolic Eval","$6,000.00",$0.00,"$6,000.00","$3,420.00",$461.30,"$1,178.85","$1,033.77",$461.30,$461.30,"$1,050.55","$6,000.00","$1,232.99","$1,440.00","$4,752.00","$4,800.00","$1,713.08",$939.00,$0.00,$955.20,"$1,174.28"
40400058,EAP,CPT® 78429,,Pet/ct Cardiac Metabolic Eval,"$6,000.00",$0.00,"$6,000.00","$3,420.00","$4,282.20","$1,319.01","$1,033.77","$4,282.20","$4,282.20","$1,050.55","$6,000.00","$1,379.58","$1,440.00","$4,752.00","$4,800.00","$1,916.75",$939.00,$0.00,$955.20,"$1,313.89"
41000001,EAP,CPT® 94002,,Ventilation Assist/mgt Initial,"$6,240.00",$77.15,"$6,240.00","$3,388.32","$4,453.49",$445.44,"$1,075.12","$4,453.49","$4,453.49","$1,092.57","$6,240.00",$465.90,"$3,120.00","$4,942.08","$4,992.00",$647.30,$77.15,$94.86,$993.41,$443.71
41000009,EAP,CPT® 94003,,"Mech Vent, Ea Subseq Day","$5,684.00",$56.62,"$5,684.00","$3,086.41","$4,056.67",$445.44,$979.32,"$4,056.67","$4,056.67",$995.22,"$5,684.00",$465.90,"$2,842.00","$4,501.73","$4,547.20",$647.30,$56.62,$68.52,$904.89,$443.71
41000017,EAP,CPT® 94640,,Aerosal Rx Sub Admin (o2),$535.00,$18.01,$414.00,$224.80,$295.47,$176.40,$71.33,$295.47,$295.47,$72.49,$414.00,$184.50,$207.00,$327.89,$331.20,$256.34,$19.30,$18.01,$65.91,$175.71
41000020,EAP,Custom 94640,,Aerosol Continuous Subsequent,$535.00,$18.01,$414.00,$224.80,$295.47,$176.40,$71.33,$295.47,$295.47,$72.49,$414.00,$184.50,$207.00,$327.89,$331.20,$256.34,$19.30,$18.01,$65.91,$175.71
41000021,EAP,CPT® 94640,,Aerosol Treatment Initial,$535.00,$18.01,$414.00,$224.80,$295.47,$176.40,$71.33,$295.47,$295.47,$72.49,$414.00,$184.50,$207.00,$327.89,$331.20,$256.34,$19.30,$18.01,$65.91,$175.71
41000022,EAP,CPT® 94640,,Aersol Treatment Subsequent,$535.00,$18.01,$414.00,$224.80,$295.47,$176.40,$71.33,$295.47,$295.47,$72.49,$414.00,$184.50,$207.00,$327.89,$331.20,$256.34,$19.30,$18.01,$65.91,$175.71
41000027,EAP,CPT® 94640,,Delivery Assist,$535.00,$18.01,$414.00,$224.80,$295.47,$176.40,$71.33,$295.47,$295.47,$72.49,$414.00,$184.50,$207.00,$327.89,$331.20,$256.34,$19.30,$18.01,$65.91,$175.71
41000028,EAP,CPT® 94640,,High Humidity Aerosol Initial,$535.00,$18.01,$414.00,$224.80,$295.47,$176.40,$71.33,$295.47,$295.47,$72.49,$414.00,$184.50,$207.00,$327.89,$331.20,$256.34,$19.30,$18.01,$65.91,$175.71
41000029,EAP,CPT® 94640,,High Humidity Aerosol Subseq,$535.00,$18.01,$414.00,$224.80,$295.47,$176.40,$71.33,$295.47,$295.47,$72.49,$414.00,$184.50,$207.00,$327.89,$331.20,$256.34,$19.30,$18.01,$65.91,$175.71
41000031,EAP,CPT® 94640,,Incentive Spirometer Subsequen,$535.00,$18.01,$414.00,$224.80,$295.47,$176.40,$71.33,$295.47,$295.47,$72.49,$414.00,$184.50,$207.00,$327.89,$331.20,$256.34,$19.30,$18.01,$65.91,$175.71
41000034,EAP,CPT® 94640,,Init Inhala Trtmnt Airway Obs,$535.00,$18.01,$414.00,$224.80,$295.47,$176.40,$71.33,$295.47,$295.47,$72.49,$414.00,$184.50,$207.00,$327.89,$331.20,$256.34,$19.30,$18.01,$65.91,$175.71
41000040,EAP,CPT® 94640,,"Mdi, Initial Rx",$535.00,$18.01,$414.00,$224.80,$295.47,$176.40,$71.33,$295.47,$295.47,$72.49,$414.00,$184.50,$207.00,$327.89,$331.20,$256.34,$19.30,$18.01,$65.91,$175.71
41000041,EAP,CPT® 94640,,"Mdi, Subsequent Rx",$535.00,$18.01,$414.00,$224.80,$295.47,$176.40,$71.33,$295.47,$295.47,$72.49,$414.00,$184.50,$207.00,$327.89,$331.20,$256.34,$19.30,$18.01,$65.91,$175.71
41000042,EAP,CPT® 94640,,Micro Neb Subsequent,$535.00,$18.01,$414.00,$224.80,$295.47,$176.40,$71.33,$295.47,$295.47,$72.49,$414.00,$184.50,$207.00,$327.89,$331.20,$256.34,$19.30,$18.01,$65.91,$175.71
41000043,EAP,CPT® 94640,,"Micro Neb, Setup",$535.00,$18.01,$414.00,$224.80,$295.47,$176.40,$71.33,$295.47,$295.47,$72.49,$414.00,$184.50,$207.00,$327.89,$331.20,$256.34,$19.30,$18.01,$65.91,$175.71
41000045,EAP,CPT® 94640,,Neo Micro Subsquent,$535.00,$18.01,$414.00,$224.80,$295.47,$176.40,$71.33,$295.47,$295.47,$72.49,$414.00,$184.50,$207.00,$327.89,$331.20,$256.34,$19.30,$18.01,$65.91,$175.71
41000050,EAP,CPT® 94640,,Sputum Induction Initial,$535.00,$18.01,$414.00,$224.80,$295.47,$176.40,$71.33,$295.47,$295.47,$72.49,$414.00,$184.50,$207.00,$327.89,$331.20,$256.34,$19.30,$18.01,$65.91,$175.71
41000055,EAP,CPT® 94644,,"Micro Nebulizer, Cont; Initial",$983.00,$0.00,$983.00,$533.77,$701.57,$104.55,$0.00,$701.57,$701.57,$0.00,$983.00,$0.00,$491.50,$778.54,$786.40,$0.00,$0.00,$54.39,$0.00,$0.00
41000059,EAP,CPT® 94645,,Repeat Neb Treatment,$524.00,$0.00,$422.00,$0.00,$301.18,$0.00,$0.00,$301.18,$301.18,$0.00,$422.00,$0.00,$211.00,$334.22,$337.60,$0.00,$0.00,$0.00,$0.00,$0.00
41000062,EAP,CPT® 94660,,Sleep Apnea/bipap,"$2,100.00",$39.31,"$2,001.00","$1,086.54","$1,428.11",$176.40,$344.76,"$1,428.11","$1,428.11",$350.36,"$2,001.00",$184.50,"$1,000.50","$1,584.79","$1,600.80",$256.34,$52.24,$39.31,$318.56,$175.71
41000063,EAP,CPT® 94660,,Neo Cpap,"$2,100.00",$39.31,"$2,001.00","$1,086.54","$1,428.11",$176.40,$344.76,"$1,428.11","$1,428.11",$350.36,"$2,001.00",$184.50,"$1,000.50","$1,584.79","$1,600.80",$256.34,$52.24,$39.31,$318.56,$175.71
41000064,EAP,CPT® 94660,,Cpap Prescription,"$2,100.00",$39.31,"$2,001.00","$1,086.54","$1,428.11",$176.40,$344.76,"$1,428.11","$1,428.11",$350.36,"$2,001.00",$184.50,"$1,000.50","$1,584.79","$1,600.80",$256.34,$52.24,$39.31,$318.56,$175.71
41000065,EAP,CPT® 94664,,Patient Assessment/education,$269.00,$16.93,$220.00,$119.46,$157.01,$176.40,$37.90,$157.01,$157.01,$38.52,$220.00,$184.50,$110.00,$174.24,$176.00,$220.00,$18.91,$16.93,$35.02,$175.71
41000067,EAP,CPT® 94667,,"Chest Pt, Inital Rx",$465.00,$0.00,$465.00,$252.50,$331.87,$104.55,$0.00,$331.87,$331.87,$81.42,$465.00,$109.35,$232.50,$368.28,$372.00,$151.93,$0.00,$25.21,$74.03,$104.14
41000069,EAP,CPT® 94667,,Cpt/vest,$465.00,$0.00,$465.00,$252.50,$331.87,$104.55,$0.00,$331.87,$331.87,$81.42,$465.00,$109.35,$232.50,$368.28,$372.00,$151.93,$0.00,$25.21,$74.03,$104.14
41000070,EAP,CPT® 94667,,Initial Chest Therapy,$465.00,$0.00,$465.00,$252.50,$331.87,$104.55,$0.00,$331.87,$331.87,$81.42,$465.00,$109.35,$232.50,$368.28,$372.00,$151.93,$0.00,$25.21,$74.03,$104.14
41000072,EAP,CPT® 94667,,Pep/acpella Therapy,$465.00,$0.00,$465.00,$252.50,$331.87,$104.55,$0.00,$331.87,$331.87,$81.42,$465.00,$109.35,$232.50,$368.28,$372.00,$151.93,$0.00,$25.21,$74.03,$104.14
41000073,EAP,CPT® 94667,,Sipap Setup,$465.00,$0.00,$465.00,$252.50,$331.87,$104.55,$0.00,$331.87,$331.87,$81.42,$465.00,$109.35,$232.50,$368.28,$372.00,$151.93,$0.00,$25.21,$74.03,$104.14
41000074,EAP,CPT® 94668,,"Chest Pt, Subsequent Rx",$346.00,$0.00,$283.00,$0.00,$201.98,$0.00,$0.00,$201.98,$201.98,$0.00,$283.00,$0.00,$141.50,$224.14,$226.40,$0.00,$0.00,$0.00,$0.00,$0.00
41000076,EAP,CPT® 94668,,Cpt/vest Sub,$346.00,$0.00,$283.00,$0.00,$201.98,$0.00,$0.00,$201.98,$201.98,$0.00,$283.00,$0.00,$141.50,$224.14,$226.40,$0.00,$0.00,$0.00,$0.00,$0.00
41000077,EAP,CPT® 94668,,Sipap Ea Shift,$346.00,$0.00,$283.00,$0.00,$201.98,$0.00,$0.00,$201.98,$201.98,$0.00,$283.00,$0.00,$141.50,$224.14,$226.40,$0.00,$0.00,$0.00,$0.00,$0.00
41000078,EAP,CPT® 94668,,Subsequent Chest Therapy,$346.00,$0.00,$283.00,$0.00,$201.98,$0.00,$0.00,$201.98,$201.98,$0.00,$283.00,$0.00,$141.50,$224.14,$226.40,$0.00,$0.00,$0.00,$0.00,$0.00
41000080,EAP,CPT® 94003,,"Mech Vent, Ea Subseq Day","$5,684.00",$56.62,"$5,684.00","$3,086.41","$4,056.67",$445.44,$979.32,"$4,056.67","$4,056.67",$995.22,"$5,684.00",$465.90,"$2,842.00","$4,501.73","$4,547.20",$647.30,$56.62,$68.52,$904.89,$443.71
41000081,EAP,CPT® 94664,,Asthma Teaching-nebulizer &mdi,$269.00,$16.93,$220.00,$119.46,$157.01,$176.40,$37.90,$157.01,$157.01,$38.52,$220.00,$184.50,$110.00,$174.24,$176.00,$220.00,$18.91,$16.93,$35.02,$175.71
41000090,EAP,CPT® 94003,,"Mech Vent, Ea Subseq Day","$5,684.00",$56.62,"$5,684.00","$3,086.41","$4,056.67",$445.44,$979.32,"$4,056.67","$4,056.67",$995.22,"$5,684.00",$465.90,"$2,842.00","$4,501.73","$4,547.20",$647.30,$56.62,$68.52,$904.89,$443.71
41000110,EAP,CPT® 94002,,Spec Vent Initial,"$6,240.00",$77.15,"$6,240.00","$3,388.32","$4,453.49",$445.44,"$1,075.12","$4,453.49","$4,453.49","$1,092.57","$6,240.00",$465.90,"$3,120.00","$4,942.08","$4,992.00",$647.30,$77.15,$94.86,$993.41,$443.71
41000111,EAP,CPT® 94002,,Neo Mech Vent Initial,"$6,240.00",$77.15,"$6,240.00","$3,388.32","$4,453.49",$445.44,"$1,075.12","$4,453.49","$4,453.49","$1,092.57","$6,240.00",$465.90,"$3,120.00","$4,942.08","$4,992.00",$647.30,$77.15,$94.86,$993.41,$443.71
41000112,EAP,CPT® 94002,,Mech Vent Initial,"$6,240.00",$77.15,"$6,240.00","$3,388.32","$4,453.49",$445.44,"$1,075.12","$4,453.49","$4,453.49","$1,092.57","$6,240.00",$465.90,"$3,120.00","$4,942.08","$4,992.00",$647.30,$77.15,$94.86,$993.41,$443.71
41000119,EAP,CPT® 94003,,"Spec Vent, Ea Subseq Day","$5,684.00",$56.62,"$5,684.00","$3,086.41","$4,056.67",$445.44,$979.32,"$4,056.67","$4,056.67",$995.22,"$5,684.00",$465.90,"$2,842.00","$4,501.73","$4,547.20",$647.30,$56.62,$68.52,$904.89,$443.71
41000120,EAP,CPT® 94003,,Neo Mech Vent Subseq,"$5,684.00",$56.62,"$5,684.00","$3,086.41","$4,056.67",$445.44,$979.32,"$4,056.67","$4,056.67",$995.22,"$5,684.00",$465.90,"$2,842.00","$4,501.73","$4,547.20",$647.30,$56.62,$68.52,$904.89,$443.71
41000121,EAP,CPT® 94640,,"Neo Micro Neb, Setup",$535.00,$18.01,$414.00,$224.80,$295.47,$176.40,$71.33,$295.47,$295.47,$72.49,$414.00,$184.50,$207.00,$327.89,$331.20,$256.34,$19.30,$18.01,$65.91,$175.71
41000150,EAP,CPT® 94640,,Sputum Induction Subseq,$535.00,$18.01,$414.00,$224.80,$295.47,$176.40,$71.33,$295.47,$295.47,$72.49,$414.00,$184.50,$207.00,$327.89,$331.20,$256.34,$19.30,$18.01,$65.91,$175.71
41000190,EAP,CPT® 94003,,Neo Ventilation Subseq,"$5,684.00",$56.62,"$5,684.00","$3,086.41","$4,056.67",$445.44,$979.32,"$4,056.67","$4,056.67",$995.22,"$5,684.00",$465.90,"$2,842.00","$4,501.73","$4,547.20",$647.30,$56.62,$68.52,$904.89,$443.71
41000191,EAP,CPT® 94669,,Chest Vest  Mechanical Oscillat,"$1,866.00",$0.00,"$1,866.00",$0.00,"$1,331.76",$0.00,$0.00,"$1,331.76","$1,331.76",$0.00,"$1,866.00",$0.00,$933.00,"$1,477.87","$1,492.80",$0.00,$0.00,$0.00,$0.00,$0.00
41200001,EAP,CPT® 94642,,Aerosol Inhal. Of Pentamidine,$353.00,$0.00,$284.00,$154.21,$202.69,$176.40,$48.93,$202.69,$202.69,$49.73,$284.00,$184.50,$142.00,$224.93,$227.20,$256.34,$31.57,$0.00,$45.21,$175.71
42000002,EAP,CPT® 92526,,Pediatric Feeding,$728.00,$0.00,$728.00,$395.30,$427.63,$84.61,$125.43,$427.63,$427.63,$127.47,$728.00,$88.84,$364.00,$576.58,$582.40,$122.68,$113.93,$84.61,$0.00,$84.61
42000006,EAP,CPT® 97012,,"Traction, Mechanical",$206.00,$0.00,$427.63,$0.00,$427.63,$0.00,$0.00,$427.63,$427.63,$0.00,$206.00,$0.00,$103.00,$163.15,$164.80,$0.00,$0.00,$0.00,$0.00,$0.00
42000007,EAP,CPT® 97014,,Electrical Stim Unsupervised,$301.00,$0.00,$427.63,$23.39,$427.63,$13.17,$51.86,$427.63,$427.63,$52.70,$301.00,$13.83,$150.50,$238.39,$240.80,$180.60,$14.50,$0.00,$0.00,$13.17
42000009,EAP,CPT® 97018,,Paraffin Bath,$253.00,$0.00,$427.63,$16.12,$427.63,$5.63,$43.59,$427.63,$427.63,$44.30,$253.00,$5.91,$126.50,$200.38,$202.40,$8.16,$10.67,$5.63,$0.00,$5.63
42000010,EAP,CPT® 97022,,Whirlpool,$300.00,$0.00,$427.63,$34.84,$427.63,$16.98,$51.69,$427.63,$427.63,$52.53,$300.00,$17.83,$150.00,$237.60,$240.00,$24.62,$14.51,$16.98,$0.00,$16.98
42000011,EAP,CPT® 97032,,Elec Stim Cons Atten Ea 15 Min,$301.00,$0.00,$427.63,$28.09,$427.63,$14.41,$51.86,$427.63,$427.63,$52.70,$301.00,$15.13,$150.50,$238.39,$240.80,$20.89,$16.22,$14.41,$0.00,$14.41
42000012,EAP,CPT® 97035,,Ultrasound Ea 15 Min,$164.00,$0.00,$427.63,$18.72,$427.63,$13.93,$28.26,$427.63,$427.63,$28.72,$164.00,$14.63,$82.00,$129.89,$131.20,$20.20,$11.96,$13.93,$0.00,$13.93
42000013,EAP,CPT® 97036,,Hubbard Tank Ea 15 Min,$200.00,$0.00,$427.63,$0.00,$427.63,$0.00,$0.00,$427.63,$427.63,$0.00,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$0.00,$0.00,$0.00,$0.00
42000015,EAP,CPT® 97110,,Exercise Each 15 Minutes,$319.00,$0.00,$427.63,$47.83,$427.63,$29.58,$54.96,$427.63,$427.63,$55.85,$319.00,$31.06,$159.50,$252.65,$255.20,$42.89,$22.45,$29.58,$0.00,$29.58
42000016,EAP,CPT® 97112,,Neuro-musc Re-ed Ea 15 Min,$302.00,$0.00,$427.63,$49.93,$427.63,$33.96,$52.03,$427.63,$427.63,$52.88,$302.00,$35.66,$151.00,$239.18,$241.60,$49.24,$23.53,$33.96,$0.00,$33.96
42000017,EAP,CPT® 97116,,Gait Training Ea 15 Min,$302.00,$0.00,$427.63,$41.59,$427.63,$29.26,$52.03,$427.63,$427.63,$52.88,$302.00,$30.72,$151.00,$239.18,$241.60,$42.43,$21.09,$29.26,$0.00,$29.26
42000018,EAP,CPT® 97139,,Tilt Table - Each 15 Min,$180.00,$0.00,$427.63,$33.99,$427.63,$32.04,$31.01,$427.63,$427.63,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$108.00,$28.17,$0.00,$0.00,$0.00
42000019,EAP,CPT® 97140,,Joint Mobilization Ea 15 Min,$439.00,$0.00,$439.00,$44.19,$427.63,$27.26,$75.64,$427.63,$427.63,$76.87,$439.00,$28.62,$219.50,$347.69,$351.20,$39.53,$25.71,$27.26,$0.00,$27.26
42000020,EAP,CPT® 97150,,Group Activity/exercise,$143.00,$0.00,$427.63,$25.47,$427.63,$17.78,$24.64,$427.63,$427.63,$25.04,$143.00,$18.67,$71.50,$113.26,$114.40,$25.78,$18.34,$17.78,$0.00,$17.78
42000021,EAP,CPT® 97530,,Functional Activities Ea 15 Mi,$301.00,$0.00,$427.63,$51.48,$427.63,$37.56,$51.86,$427.63,$427.63,$52.70,$301.00,$39.44,$150.50,$238.39,$240.80,$54.46,$21.84,$37.56,$0.00,$37.56
42000023,EAP,CPT® 97542,,W/c Management Training Ea 15m,$264.00,$0.00,$427.63,$45.24,$427.63,$31.95,$45.49,$427.63,$427.63,$46.22,$264.00,$33.55,$132.00,$209.09,$211.20,$46.33,$15.60,$31.95,$0.00,$31.95
42000026,EAP,CPT® 97760,,Orthotic Fit/train Init Ea 15,$313.00,$0.00,$427.63,$169.96,$427.63,$46.79,$24.71,$427.63,$427.63,$54.80,$313.00,$49.13,$156.50,$247.90,$250.40,$67.85,$48.98,$46.79,$0.00,$46.79
42000027,EAP,CPT® 97761,,Prosthetic Training Ea 15 Min,$149.00,$0.00,$427.63,$80.91,$427.63,$40.05,$22.54,$427.63,$427.63,$26.09,$149.00,$42.05,$74.50,$118.01,$119.20,$58.07,$23.32,$40.05,$0.00,$40.05
42000028,EAP,CPT® 97763,,Orthotics/prosth Mgmt &/trainj Sbsq Enctr 15 Min,$313.00,$0.00,$427.63,$169.96,$427.63,$49.92,$53.93,$427.63,$427.63,$54.80,$313.00,$52.42,$156.50,$247.90,$250.40,$72.38,$46.64,$49.92,$0.00,$49.92
42000034,EAP,CPT® 97545,,Work Hardening-pt,$207.00,$0.00,$427.63,$0.00,$427.63,$0.00,$0.00,$427.63,$427.63,$0.00,$207.00,$0.00,$103.50,$163.94,$165.60,$0.00,$0.00,$0.00,$0.00,$0.00
42000045,EAP,CPT® 97139,,Scar Management Ea 15 Min,$180.00,$0.00,$427.63,$33.99,$427.63,$32.04,$31.01,$427.63,$427.63,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$108.00,$28.17,$0.00,$0.00,$0.00
42000050,EAP,CPT® 97546,,Work Hardening Add-on,$102.00,$0.00,$427.63,$0.00,$427.63,$0.00,$0.00,$427.63,$427.63,$0.00,$102.00,$0.00,$51.00,$80.78,$81.60,$0.00,$0.00,$0.00,$0.00,$0.00
42000060,EAP,CPT® 29581,,Apply Multlay Comprs Lwr Leg-lt,$478.00,$0.00,$478.00,$0.00,$427.63,$0.00,$0.00,$427.63,$427.63,$0.00,$478.00,$0.00,$478.00,$378.58,$382.40,$0.00,$0.00,$0.00,$0.00,$0.00
42000068,EAP,CPT® 29584,,Apply Multlay Comprs  Arm/hand-lt,$478.00,$0.00,$478.00,$0.00,$427.63,$0.00,$0.00,$427.63,$427.63,$0.00,$478.00,$0.00,$478.00,$378.58,$382.40,$0.00,$0.00,$0.00,$0.00,$0.00
42000088,EAP,CPT® 97022,,FLUIDIOTHERAPY-GP,$300.00,$0.00,$427.63,$34.84,$427.63,$16.98,$51.69,$427.63,$427.63,$52.53,$300.00,$17.83,$150.00,$237.60,$240.00,$24.62,$14.51,$16.98,$0.00,$16.98
42000090,EAP,CPT® 29581,,Apply Multlay Comprs Lwr Leg-rt,$478.00,$0.00,$478.00,$0.00,$427.63,$0.00,$0.00,$427.63,$427.63,$0.00,$478.00,$0.00,$478.00,$378.58,$382.40,$0.00,$0.00,$0.00,$0.00,$0.00
42000093,EAP,CPT® 29584,,Apply Multlay Comprs Arm/hand-rt,$478.00,$0.00,$478.00,$0.00,$427.63,$0.00,$0.00,$427.63,$427.63,$0.00,$478.00,$0.00,$478.00,$378.58,$382.40,$0.00,$0.00,$0.00,$0.00,$0.00
42000100,EAP,HCPCS G8978,,Mobility Current Status,$0.01,$0.00,$427.63,$0.00,$427.63,$0.00,$0.00,$427.63,$427.63,$0.00,$0.01,$0.00,$0.01,$0.01,$0.01,$0.00,$0.00,$0.00,$0.00,$0.00
42000101,EAP,HCPCS G8979,,Mobility Goal Status,$0.01,$0.00,$427.63,$0.00,$427.63,$0.00,$0.00,$427.63,$427.63,$0.00,$0.01,$0.00,$0.01,$0.01,$0.01,$0.00,$0.00,$0.00,$0.00,$0.00
42000102,EAP,HCPCS G8980,,Mobility D/c Status,$0.01,$0.00,$427.63,$0.00,$427.63,$0.00,$0.00,$427.63,$427.63,$0.00,$0.01,$0.00,$0.01,$0.01,$0.01,$0.00,$0.00,$0.00,$0.00,$0.00
42000103,EAP,HCPCS G8981,,Body Pos Current Status,$0.01,$0.00,$427.63,$0.00,$427.63,$0.00,$0.00,$427.63,$427.63,$0.00,$0.01,$0.00,$0.01,$0.01,$0.01,$0.00,$0.00,$0.00,$0.00,$0.00
42000104,EAP,HCPCS G8982,,Body Pos Goal Status,$0.01,$0.00,$427.63,$0.00,$427.63,$0.00,$0.00,$427.63,$427.63,$0.00,$0.01,$0.00,$0.01,$0.01,$0.01,$0.00,$0.00,$0.00,$0.00,$0.00
42000105,EAP,HCPCS G8983,,Body Pos D/c Status,$0.01,$0.00,$427.63,$0.00,$427.63,$0.00,$0.00,$427.63,$427.63,$0.00,$0.01,$0.00,$0.01,$0.01,$0.01,$0.00,$0.00,$0.00,$0.00,$0.00
42000106,EAP,HCPCS G8984,,Carry Current Status,$0.01,$0.00,$427.63,$0.00,$427.63,$0.00,$0.00,$427.63,$427.63,$0.00,$0.01,$0.00,$0.01,$0.01,$0.01,$0.00,$0.00,$0.00,$0.00,$0.00
42000107,EAP,HCPCS G8985,,Carry Goal Status,$0.01,$0.00,$427.63,$0.00,$427.63,$0.00,$0.00,$427.63,$427.63,$0.00,$0.01,$0.00,$0.01,$0.01,$0.01,$0.00,$0.00,$0.00,$0.00,$0.00
42000108,EAP,HCPCS G8986,,Carry D/c  Status,$0.01,$0.00,$427.63,$0.00,$427.63,$0.00,$0.00,$427.63,$427.63,$0.00,$0.01,$0.00,$0.01,$0.01,$0.01,$0.00,$0.00,$0.00,$0.00,$0.00
42000109,EAP,HCPCS G8987,,Self-care Current Status,$0.01,$0.00,$427.63,$0.00,$427.63,$0.00,$0.00,$427.63,$427.63,$0.00,$0.01,$0.00,$0.01,$0.01,$0.01,$0.00,$0.00,$0.00,$0.00,$0.00
42000110,EAP,HCPCS G8988,,Self-care Goal Status,$0.01,$0.00,$427.63,$0.00,$427.63,$0.00,$0.00,$427.63,$427.63,$0.00,$0.01,$0.00,$0.01,$0.01,$0.01,$0.00,$0.00,$0.00,$0.00,$0.00
42000111,EAP,HCPCS G8989,,Self-care D/c Status,$0.01,$0.00,$427.63,$0.00,$427.63,$0.00,$0.00,$427.63,$427.63,$0.00,$0.01,$0.00,$0.01,$0.01,$0.01,$0.00,$0.00,$0.00,$0.00,$0.00
42000112,EAP,HCPCS G8990,,Other Pt/ot Current Status,$0.01,$0.00,$427.63,$0.00,$427.63,$0.00,$0.00,$427.63,$427.63,$0.00,$0.01,$0.00,$0.01,$0.01,$0.01,$0.00,$0.00,$0.00,$0.00,$0.00
42000113,EAP,HCPCS G8991,,Other Pt/ot Goal Status,$0.01,$0.00,$427.63,$0.00,$427.63,$0.00,$0.00,$427.63,$427.63,$0.00,$0.01,$0.00,$0.01,$0.01,$0.01,$0.00,$0.00,$0.00,$0.00,$0.00
42000114,EAP,HCPCS G8992,,Other Pt/ot D/c Status,$0.01,$0.00,$427.63,$0.00,$427.63,$0.00,$0.00,$427.63,$427.63,$0.00,$0.01,$0.00,$0.01,$0.01,$0.01,$0.00,$0.00,$0.00,$0.00,$0.00
42000115,EAP,HCPCS G8993,,Sub Pt/ot Current Status,$0.01,$0.00,$427.63,$0.00,$427.63,$0.00,$0.00,$427.63,$427.63,$0.00,$0.01,$0.00,$0.01,$0.01,$0.01,$0.00,$0.00,$0.00,$0.00,$0.00
42000116,EAP,HCPCS G8994,,Sub Pt/ot Goal Status,$0.01,$0.00,$427.63,$0.00,$427.63,$0.00,$0.00,$427.63,$427.63,$0.00,$0.01,$0.00,$0.01,$0.01,$0.01,$0.00,$0.00,$0.00,$0.00,$0.00
42000117,EAP,HCPCS G8995,,Sub Pt/ot D/c Status,$0.01,$0.00,$427.63,$0.00,$427.63,$0.00,$0.00,$427.63,$427.63,$0.00,$0.01,$0.00,$0.01,$0.01,$0.01,$0.00,$0.00,$0.00,$0.00,$0.00
42000125,EAP,CPT® 97597,,Debridement First 20 Sq Cm Or Less,$674.00,$0.00,$674.00,$674.00,$427.63,$167.55,$116.13,$427.63,$427.63,$118.01,$674.00,$175.24,$674.00,$533.81,$539.20,$243.48,$48.15,$37.87,$0.00,$166.90
42000126,EAP,CPT® 97610,,Pt Low Frequency Non Contrast/thermal Per Day,$514.00,$0.00,$514.00,$0.00,$427.63,$0.00,$0.00,$427.63,$427.63,$0.00,$514.00,$0.00,$257.00,$407.09,$411.20,$0.00,$0.00,$0.00,$0.00,$0.00
42000226,EAP,CPT® 97598,,Debridement Open Wound Ea Addl 20 Sq Cm,$561.00,$0.00,$561.00,$561.00,$427.63,$0.00,$96.66,$427.63,$427.63,$98.23,$561.00,$0.00,$280.50,$444.31,$448.80,$0.00,$61.13,$26.68,$0.00,$0.00
42000227,EAP,CPT® 97014,,Pt Electric Stim Ther Unsupervised Wound,$301.00,$0.00,$427.63,$23.39,$427.63,$53.58,$51.86,$427.63,$427.63,$52.70,$301.00,$0.00,$150.50,$238.39,$240.80,$180.60,$14.50,$0.00,$0.00,$0.00
42000228,EAP,CPT® 97014,,Pt Electric Stim Ther Unsupervised Non-wound,$301.00,$0.00,$427.63,$23.39,$427.63,$13.17,$51.86,$427.63,$427.63,$52.70,$301.00,$13.83,$150.50,$238.39,$240.80,$180.60,$14.50,$0.00,$0.00,$13.17
42400010,EAP,CPT® 97161,,Pt Eval Low Complex,$660.00,$0.00,$660.00,$119.63,$427.63,$82.44,$113.71,$427.63,$427.63,$115.56,$660.00,$86.56,$330.00,$522.72,$528.00,$119.54,$77.58,$82.44,$0.00,$82.44
42400011,EAP,CPT® 97162,,Pt Eval Mod Complex,$675.00,$0.00,$675.00,$119.63,$427.63,$82.44,$116.30,$427.63,$427.63,$118.19,$675.00,$86.56,$337.50,$534.60,$540.00,$119.54,$77.58,$82.44,$0.00,$82.44
42400012,EAP,CPT® 97163,,Pt Eval High Complex,$690.00,$0.00,$690.00,$119.63,$427.63,$82.44,$118.88,$427.63,$427.63,$120.81,$690.00,$86.56,$345.00,$546.48,$552.00,$119.54,$77.58,$82.44,$0.00,$82.44
42400013,EAP,CPT® 97164,,Pt Re-eval,$480.00,$0.00,$480.00,$80.64,$427.63,$56.39,$82.70,$427.63,$427.63,$84.04,$480.00,$59.21,$240.00,$380.16,$384.00,$81.77,$52.74,$56.39,$0.00,$56.39
43000002,EAP,CPT® 92526,,Dysphagia Treatment,$728.00,$0.00,$728.00,$395.30,$427.63,$84.61,$125.43,$427.63,$427.63,$127.47,$728.00,$88.84,$364.00,$576.58,$582.40,$122.68,$113.93,$84.61,$0.00,$84.61
43000005,EAP,CPT® 95851,,Range Of Motion Measurement,$36.00,$0.00,$427.63,$0.00,$427.63,$0.00,$0.00,$427.63,$427.63,$0.00,$36.00,$0.00,$18.00,$28.51,$28.80,$0.00,$0.00,$0.00,$0.00,$0.00
43000008,EAP,CPT® 97014,,Electrical Stim Unsupervised,$301.00,$0.00,$427.63,$23.39,$427.63,$13.17,$51.86,$427.63,$427.63,$52.70,$301.00,$13.83,$150.50,$238.39,$240.80,$180.60,$14.50,$0.00,$0.00,$13.17
43000010,EAP,CPT® 97018,,Paraffin Bath,$253.00,$0.00,$427.63,$16.12,$427.63,$5.63,$43.59,$427.63,$427.63,$44.30,$253.00,$5.91,$126.50,$200.38,$202.40,$8.16,$10.67,$5.63,$0.00,$5.63
43000011,EAP,CPT® 97022,,Whirlpool,$300.00,$0.00,$427.63,$34.84,$427.63,$16.98,$51.69,$427.63,$427.63,$52.53,$300.00,$17.83,$150.00,$237.60,$240.00,$24.62,$14.51,$16.98,$0.00,$16.98
43000012,EAP,CPT® 97032,,Elec Stim Cons Atten Ea 15 Min,$301.00,$0.00,$427.63,$28.09,$427.63,$14.41,$51.86,$427.63,$427.63,$52.70,$301.00,$15.13,$150.50,$238.39,$240.80,$20.89,$16.22,$14.41,$0.00,$14.41
43000013,EAP,CPT® 97035,,Ultrasound Heat Ea 15 Min,$164.00,$0.00,$427.63,$18.72,$427.63,$13.93,$28.26,$427.63,$427.63,$28.72,$164.00,$14.63,$82.00,$129.89,$131.20,$20.20,$11.96,$13.93,$0.00,$13.93
43000014,EAP,CPT® 97022,,Fluidiotherapy,$300.00,$0.00,$427.63,$34.84,$427.63,$16.98,$51.69,$427.63,$427.63,$52.53,$300.00,$17.83,$150.00,$237.60,$240.00,$24.62,$14.51,$16.98,$0.00,$16.98
43000015,EAP,CPT® 97110,,Therapeutic Exercise Ea 15min,$319.00,$0.00,$427.63,$47.83,$427.63,$29.58,$54.96,$427.63,$427.63,$55.85,$319.00,$31.06,$159.50,$252.65,$255.20,$42.89,$22.45,$29.58,$0.00,$29.58
43000016,EAP,CPT® 97112,,Neuromuscular Re-ed Ea. 15 Min,$302.00,$0.00,$427.63,$49.93,$427.63,$33.96,$52.03,$427.63,$427.63,$52.88,$302.00,$35.66,$151.00,$239.18,$241.60,$49.24,$23.53,$33.96,$0.00,$33.96
43000018,EAP,CPT® 97139,,Scar Management Ea 15 Min,$180.00,$0.00,$427.63,$33.99,$427.63,$32.04,$31.01,$427.63,$427.63,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$108.00,$28.17,$0.00,$0.00,$0.00
43000019,EAP,CPT® 97140,,Joint Mobilization Ea 15 Min,$439.00,$0.00,$439.00,$44.19,$427.63,$27.26,$75.64,$427.63,$427.63,$76.87,$439.00,$28.62,$219.50,$347.69,$351.20,$39.53,$25.71,$27.26,$0.00,$27.26
43000020,EAP,CPT® 97150,,Group Activity/exercise,$143.00,$0.00,$427.63,$25.47,$427.63,$17.78,$24.64,$427.63,$427.63,$25.04,$143.00,$18.67,$71.50,$113.26,$114.40,$25.78,$18.34,$17.78,$0.00,$17.78
43000021,EAP,CPT® 97530,,Activ.to Increase Func.ea 15mi,$301.00,$0.00,$427.63,$51.48,$427.63,$37.56,$51.86,$427.63,$427.63,$52.70,$301.00,$39.44,$150.50,$238.39,$240.80,$54.46,$21.84,$37.56,$0.00,$37.56
43000023,EAP,CPT® 97533,,Sensory Integrat Tech Ea 15min,$174.00,$0.00,$427.63,$0.00,$427.63,$0.00,$0.00,$427.63,$427.63,$0.00,$174.00,$0.00,$87.00,$137.81,$139.20,$0.00,$0.00,$0.00,$0.00,$0.00
43000024,EAP,CPT® 97535,,Adl Training Each 15 Mins,$253.00,$0.00,$427.63,$51.48,$427.63,$32.79,$43.59,$427.63,$427.63,$44.30,$253.00,$34.43,$126.50,$200.38,$202.40,$47.55,$23.39,$32.79,$0.00,$32.79
43000028,EAP,CPT® 97760,,"Splint/ort-fab,fit/tra/q 15min",$313.00,$0.00,$427.63,$169.96,$427.63,$46.79,$24.71,$427.63,$427.63,$54.80,$313.00,$49.13,$156.50,$247.90,$250.40,$67.85,$48.98,$46.79,$0.00,$46.79
43000029,EAP,CPT® 97761,,Prosth/training Ea 15 Min,$149.00,$0.00,$427.63,$80.91,$427.63,$40.05,$22.54,$427.63,$427.63,$26.09,$149.00,$42.05,$74.50,$118.01,$119.20,$58.07,$23.32,$40.05,$0.00,$40.05
43000030,EAP,CPT® 97763,,Orthotics/prosth Mgmt &/trainj Sbsq Enctr 15 Min,$313.00,$0.00,$427.63,$169.96,$427.63,$49.92,$53.93,$427.63,$427.63,$54.80,$313.00,$52.42,$156.50,$247.90,$250.40,$72.38,$46.64,$49.92,$0.00,$49.92
43000044,EAP,CPT® 97545,,Work Hardening-ot,$207.00,$0.00,$427.63,$0.00,$427.63,$0.00,$0.00,$427.63,$427.63,$0.00,$207.00,$0.00,$103.50,$163.94,$165.60,$0.00,$0.00,$0.00,$0.00,$0.00
43000051,EAP,CPT® 97598,,"WOUND CARE,EACH ADDITIONAL 20 SQ CEMENT &PULSED LAVAGE)",$561.00,$0.00,$561.00,$561.00,$427.63,$0.00,$96.66,$427.63,$427.63,$98.23,$561.00,$0.00,$280.50,$444.31,$448.80,$0.00,$61.13,$26.68,$0.00,$0.00
43000060,EAP,CPT® 97546,,Work Hardening Add-on-ot,$102.00,$0.00,$427.63,$0.00,$427.63,$0.00,$0.00,$427.63,$427.63,$0.00,$102.00,$0.00,$51.00,$80.78,$81.60,$0.00,$0.00,$0.00,$0.00,$0.00
43000062,EAP,CPT® 29581,,Apply Multlay Comprs Lwr Leg-lt,$478.00,$0.00,$478.00,$0.00,$427.63,$0.00,$0.00,$427.63,$427.63,$0.00,$478.00,$0.00,$478.00,$378.58,$382.40,$0.00,$0.00,$0.00,$0.00,$0.00
43000065,EAP,CPT® 29584,,Apply Multlay Comprs  Arm/hand-lt,$478.00,$0.00,$478.00,$0.00,$427.63,$0.00,$0.00,$427.63,$427.63,$0.00,$478.00,$0.00,$478.00,$378.58,$382.40,$0.00,$0.00,$0.00,$0.00,$0.00
43000070,EAP,CPT® 29581,,Apply Multlay Comprs Lwr Leg-rt,$478.00,$0.00,$478.00,$0.00,$427.63,$0.00,$0.00,$427.63,$427.63,$0.00,$478.00,$0.00,$478.00,$378.58,$382.40,$0.00,$0.00,$0.00,$0.00,$0.00
43000080,EAP,CPT® 97129,,Occ Ther Ivntj Cog Funcj Cntct 1st 15 Minutes,$345.00,$0.00,$427.63,$35.50,$427.63,$61.41,$59.44,$427.63,$427.63,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$24.17,$23.23,$24.17,$0.00,$24.17
43000081,EAP,CPT® 97130,,Occ Ther Ivntj Cog Funcj Cntct Ea Addl 15 Minutes,$345.00,$0.00,$427.63,$33.93,$427.63,$61.41,$59.44,$427.63,$427.63,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$23.44,$22.20,$23.44,$0.00,$23.44
43000093,EAP,CPT® 29584,,Apply Multlay Comprs  Arm/hand-rt,$478.00,$0.00,$478.00,$0.00,$427.63,$0.00,$0.00,$427.63,$427.63,$0.00,$478.00,$0.00,$478.00,$378.58,$382.40,$0.00,$0.00,$0.00,$0.00,$0.00
43000100,EAP,HCPCS G8978,,Mobility Current Status,$0.01,$0.00,$427.63,$0.00,$427.63,$0.00,$0.00,$427.63,$427.63,$0.00,$0.01,$0.00,$0.01,$0.01,$0.01,$0.00,$0.00,$0.00,$0.00,$0.00
43000101,EAP,HCPCS G8979,,Mobility Goal Status,$0.01,$0.00,$427.63,$0.00,$427.63,$0.00,$0.00,$427.63,$427.63,$0.00,$0.01,$0.00,$0.01,$0.01,$0.01,$0.00,$0.00,$0.00,$0.00,$0.00
43000102,EAP,HCPCS G8980,,Mobility D/c Status,$0.01,$0.00,$427.63,$0.00,$427.63,$0.00,$0.00,$427.63,$427.63,$0.00,$0.01,$0.00,$0.01,$0.01,$0.01,$0.00,$0.00,$0.00,$0.00,$0.00
43000103,EAP,HCPCS G8981,,Body Pos Current Status,$0.01,$0.00,$427.63,$0.00,$427.63,$0.00,$0.00,$427.63,$427.63,$0.00,$0.01,$0.00,$0.01,$0.01,$0.01,$0.00,$0.00,$0.00,$0.00,$0.00
43000104,EAP,HCPCS G8982,,Body Pos Goal Status,$0.01,$0.00,$427.63,$0.00,$427.63,$0.00,$0.00,$427.63,$427.63,$0.00,$0.01,$0.00,$0.01,$0.01,$0.01,$0.00,$0.00,$0.00,$0.00,$0.00
43000106,EAP,HCPCS G8984,,Carry Current Status,$0.01,$0.00,$427.63,$0.00,$427.63,$0.00,$0.00,$427.63,$427.63,$0.00,$0.01,$0.00,$0.01,$0.01,$0.01,$0.00,$0.00,$0.00,$0.00,$0.00
43000107,EAP,HCPCS G8985,,Carry Goal Status,$0.01,$0.00,$427.63,$0.00,$427.63,$0.00,$0.00,$427.63,$427.63,$0.00,$0.01,$0.00,$0.01,$0.01,$0.01,$0.00,$0.00,$0.00,$0.00,$0.00
43000108,EAP,HCPCS G8986,,Carry D/c  Status,$0.01,$0.00,$427.63,$0.00,$427.63,$0.00,$0.00,$427.63,$427.63,$0.00,$0.01,$0.00,$0.01,$0.01,$0.01,$0.00,$0.00,$0.00,$0.00,$0.00
43000109,EAP,HCPCS G8987,,Self-care Current Status,$0.01,$0.00,$427.63,$0.00,$427.63,$0.00,$0.00,$427.63,$427.63,$0.00,$0.01,$0.00,$0.01,$0.01,$0.01,$0.00,$0.00,$0.00,$0.00,$0.00
43000110,EAP,HCPCS G8988,,Self-care Goal Status,$0.01,$0.00,$427.63,$0.00,$427.63,$0.00,$0.00,$427.63,$427.63,$0.00,$0.01,$0.00,$0.01,$0.01,$0.01,$0.00,$0.00,$0.00,$0.00,$0.00
43000111,EAP,HCPCS G8989,,Self-care D/c Status,$0.01,$0.00,$427.63,$0.00,$427.63,$0.00,$0.00,$427.63,$427.63,$0.00,$0.01,$0.00,$0.01,$0.01,$0.01,$0.00,$0.00,$0.00,$0.00,$0.00
43000112,EAP,HCPCS G8990,,Other Pt/ot Current Status,$0.01,$0.00,$427.63,$0.00,$427.63,$0.00,$0.00,$427.63,$427.63,$0.00,$0.01,$0.00,$0.01,$0.01,$0.01,$0.00,$0.00,$0.00,$0.00,$0.00
43000113,EAP,HCPCS G8991,,Other Pt/ot Goal Status,$0.01,$0.00,$427.63,$0.00,$427.63,$0.00,$0.00,$427.63,$427.63,$0.00,$0.01,$0.00,$0.01,$0.01,$0.01,$0.00,$0.00,$0.00,$0.00,$0.00
43000114,EAP,HCPCS G8992,,Other Pt/ot D/c Status,$0.01,$0.00,$427.63,$0.00,$427.63,$0.00,$0.00,$427.63,$427.63,$0.00,$0.01,$0.00,$0.01,$0.01,$0.01,$0.00,$0.00,$0.00,$0.00,$0.00
43000115,EAP,HCPCS G8993,,Sub Pt/ot Current Status,$0.01,$0.00,$427.63,$0.00,$427.63,$0.00,$0.00,$427.63,$427.63,$0.00,$0.01,$0.00,$0.01,$0.01,$0.01,$0.00,$0.00,$0.00,$0.00,$0.00
43000116,EAP,HCPCS G8994,,Sub Pt/ot Goal Status,$0.01,$0.00,$427.63,$0.00,$427.63,$0.00,$0.00,$427.63,$427.63,$0.00,$0.01,$0.00,$0.01,$0.01,$0.01,$0.00,$0.00,$0.00,$0.00,$0.00
43000117,EAP,HCPCS G8995,,Sub Pt/ot D/c Status,$0.01,$0.00,$427.63,$0.00,$427.63,$0.00,$0.00,$427.63,$427.63,$0.00,$0.01,$0.00,$0.01,$0.01,$0.01,$0.00,$0.00,$0.00,$0.00,$0.00
43000118,EAP,CPT® 97014,,Ot Electric Stim Ther Unsupervised Wound,$301.00,$0.00,$427.63,$23.39,$427.63,$53.58,$51.86,$427.63,$427.63,$52.70,$301.00,$0.00,$150.50,$238.39,$240.80,$180.60,$14.50,$0.00,$0.00,$0.00
43000119,EAP,CPT® 97014,,Ot Electric Stim Ther Unsupervised Non-wound,$301.00,$0.00,$427.63,$23.39,$427.63,$13.17,$51.86,$427.63,$427.63,$52.70,$301.00,$13.83,$150.50,$238.39,$240.80,$180.60,$14.50,$0.00,$0.00,$13.17
43400001,EAP,CPT® 92610,,Nicu/ped/swallowing Evaluation,"$1,185.00",$0.00,"$1,185.00",$643.46,$427.63,$210.93,$204.17,$427.63,$427.63,$207.48,"$1,185.00",$77.89,$592.50,$938.52,$948.00,$74.65,$42.12,$74.65,$0.00,$74.65
43400060,EAP,CPT® 97165,,Ot Eval Low Complex,$660.00,$0.00,$660.00,$136.28,$427.63,$87.25,$113.71,$427.63,$427.63,$115.56,$660.00,$91.61,$330.00,$522.72,$528.00,$126.51,$75.19,$87.25,$0.00,$87.25
43400061,EAP,CPT® 97166,,Ot Eval Mod Complex,$675.00,$0.00,$675.00,$136.28,$427.63,$86.93,$116.30,$427.63,$427.63,$118.19,$675.00,$91.28,$337.50,$534.60,$540.00,$126.05,$75.19,$86.93,$0.00,$86.93
43400062,EAP,CPT® 97167,,Ot Eval High Complex,$690.00,$0.00,$690.00,$136.28,$427.63,$86.93,$118.88,$427.63,$427.63,$120.81,$690.00,$91.28,$345.00,$546.48,$552.00,$126.05,$75.19,$86.93,$0.00,$86.93
43400063,EAP,CPT® 97168,,Ot Re-eval,$480.00,$0.00,$480.00,$90.52,$427.63,$59.92,$82.70,$427.63,$427.63,$84.04,$480.00,$62.92,$240.00,$380.16,$384.00,$86.88,$49.67,$59.92,$0.00,$59.92
44000001,EAP,CPT® 92507,,Individual Speech Therapy,$572.00,$44.25,$572.00,$127.82,$427.63,$77.07,$98.55,$427.63,$427.63,$100.15,$572.00,$80.92,$286.00,$453.02,$457.60,$111.75,$44.25,$77.07,$91.06,$77.07
44000004,EAP,CPT® 92526,,Treatmet Of Swallow & Oral Fun,$728.00,$84.61,$728.00,$395.30,$427.63,$84.61,$125.43,$427.63,$427.63,$127.47,$728.00,$88.84,$364.00,$576.58,$582.40,$122.68,$113.93,$84.61,$115.90,$84.61
44000007,EAP,CPT® 92609,,Ther Ser/speech-generating Dev,$509.00,$0.00,$509.00,$0.00,$427.63,$0.00,$0.00,$427.63,$427.63,$0.00,$509.00,$0.00,$254.50,$403.13,$407.20,$0.00,$0.00,$0.00,$0.00,$0.00
44000044,EAP,CPT® 92524,,Behavioral And Qualitative Analysis Of Voice And Resonae,$846.00,$87.62,$846.00,$143.89,$427.63,$87.62,$145.76,$427.63,$427.63,$148.13,$846.00,$92.00,$423.00,$670.03,$676.80,$127.05,$91.88,$87.62,$134.68,$87.62
44000050,EAP,CPT® 97129,,Speech Ther Ivntj Cog Funcj Cntct 1st 15 Minutes,$345.00,$0.00,$427.63,$35.50,$427.63,$61.41,$59.44,$427.63,$427.63,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$24.17,$23.23,$24.17,$54.92,$24.17
44000051,EAP,CPT® 97130,,Speech Ther Ivntj Cog Funcj Cntct Ea Addl 15 Minutes,$345.00,$0.00,$427.63,$33.93,$427.63,$61.41,$59.44,$427.63,$427.63,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$23.44,$22.20,$23.44,$54.92,$23.44
44300005,EAP,CPT® 92508,,Group Speech Ther Each 15min,$188.00,$0.00,$427.63,$0.00,$427.63,$0.00,$0.00,$427.63,$427.63,$0.00,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$0.00,$0.00,$0.00,$0.00
44400003,EAP,CPT® 92597,,Evaluation For Voice Prosthesi,"$1,082.00",$71.39,"$1,082.00",$587.53,$427.63,$71.39,$186.42,$427.63,$427.63,$189.45,"$1,082.00",$74.96,$541.00,$856.94,$865.60,$103.52,$169.33,$71.39,$172.25,$71.39
44400005,EAP,CPT® 92607,,Eval Speech Device First Hour,$553.00,$0.00,$553.00,$0.00,$427.63,$0.00,$0.00,$427.63,$427.63,$0.00,$553.00,$0.00,$276.50,$437.98,$442.40,$0.00,$0.00,$0.00,$0.00,$0.00
44400007,EAP,CPT® 92608,,Eval/speech Dvc (add'l 30 Min),$200.00,$0.00,$427.63,$0.00,$427.63,$0.00,$0.00,$427.63,$427.63,$0.00,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$0.00,$0.00,$0.00,$0.00
44400009,EAP,CPT® 92610,,Eval.of Swallow & Oral Func.,"$1,185.00",$42.12,"$1,185.00",$643.46,$427.63,$210.93,$204.17,$427.63,$427.63,$207.48,"$1,185.00",$77.89,$592.50,$938.52,$948.00,$74.65,$42.12,$74.65,$188.65,$74.65
44400012,EAP,CPT® 92611,,Motion Fluo Eval Of Swallowing,"$1,185.00",$45.81,"$1,185.00",$643.46,$427.63,$210.93,$204.17,$427.63,$427.63,$207.48,"$1,185.00",$93.79,$592.50,$938.52,$948.00,$94.46,$45.81,$94.46,$188.65,$94.46
44400014,EAP,CPT® 92612,,Flex Fib Endo Eval/swallowing,"$1,970.00",$0.00,"$1,970.00",$0.00,$427.63,$0.00,$0.00,$427.63,$427.63,$0.00,"$1,970.00",$0.00,$985.00,"$1,560.24","$1,576.00",$0.00,$0.00,$0.00,$0.00,$0.00
44400017,EAP,CPT® 96105,,Assessment Of Aphasia,$607.00,$0.00,$607.00,$0.00,$427.63,$0.00,$0.00,$427.63,$427.63,$0.00,$607.00,$0.00,$303.50,$480.74,$485.60,$0.00,$0.00,$0.00,$0.00,$0.00
44400020,EAP,CPT® 92540,,Basic Vestibular Exam,$838.00,$0.00,$838.00,$0.00,$427.63,$0.00,$0.00,$427.63,$427.63,$0.00,$838.00,$0.00,$419.00,$663.70,$670.40,$0.00,$0.00,$0.00,$0.00,$0.00
44400030,EAP,CPT® 92570,,Acoustic Immittance Testing,$276.00,$0.00,$427.63,$0.00,$427.63,$0.00,$47.55,$427.63,$427.63,$0.00,$276.00,$0.00,$138.00,$218.59,$220.80,$0.00,$23.55,$0.00,$0.00,$0.00
44400031,EAP,CPT® 92550,,Tympanometry And Reflex Thresh,$158.00,$15.45,$427.63,$85.79,$427.63,$132.66,$27.22,$427.63,$427.63,$27.66,$158.00,$138.76,$79.00,$125.14,$126.40,$158.00,$15.45,$22.71,$25.15,$132.15
44400033,EAP,CPT® 92618,,Ex For Non-speech Dev Rx Add,$150.00,$0.00,$427.63,$0.00,$427.63,$0.00,$0.00,$427.63,$427.63,$0.00,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$0.00,$0.00,$0.00,$0.00
44400034,EAP,CPT® 92522,,"Eval Of Only Speech Snd Prod (motor Speech, Artic, Etc)",$710.00,$88.23,$710.00,$149.04,$427.63,$89.54,$122.33,$427.63,$427.63,$124.32,$710.00,$94.02,$355.00,$562.32,$568.00,$129.83,$88.23,$89.54,$113.03,$89.54
44400035,EAP,CPT® 92521,,"Evaluation Of Speech Fluency (eg, Stuttering, Clutterin)",$746.00,$108.68,$746.00,$180.01,$427.63,$109.47,$128.53,$427.63,$427.63,$130.62,$746.00,$114.94,$373.00,$590.83,$596.80,$158.73,$108.68,$109.47,$118.76,$109.47
44400036,EAP,CPT® 92523,,"Eval Of Speech, Language & Cognition-communication","$1,093.00",$174.01,"$1,093.00",$318.15,$427.63,$187.76,$188.32,$427.63,$427.63,$191.38,"$1,093.00",$197.15,$546.50,$865.66,$874.40,$272.25,$183.27,$187.76,$174.01,$187.76
44400056,EAP,CPT® 92523,,"EVAL OF SPEECH, LANGUAGE & COGNITION-COMM","$1,093.00",$174.01,"$1,093.00",$318.15,$427.63,$187.76,$188.32,$427.63,$427.63,$191.38,"$1,093.00",$197.15,$546.50,$865.66,$874.40,$272.25,$183.27,$187.76,$174.01,$187.76
45000003,EAP,CPT® 52310,,Cystoscopy And Treatament,"$5,783.00",$156.86,"$5,783.00","$2,496.90","$1,482.64","$1,698.74",$996.38,"$1,482.64","$1,482.64","$1,012.56","$5,783.00","$1,776.76","$2,327.00","$4,580.14","$4,626.40","$2,468.57",$409.12,$156.86,$920.65,"$1,692.15"
45000005,EAP,CPT® 45300,,Proctosigmidoscopy Dx,"$2,361.00",$0.00,"$2,361.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,361.00",$0.00,"$2,255.00","$1,869.91","$1,888.80",$0.00,$0.00,$0.00,$0.00,$0.00
45000006,EAP,CPT® 24675,,Closed Tratment Of Proximal Ulna/w Manipulation,"$1,550.00",$0.00,"$1,550.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,550.00",$0.00,"$1,550.00","$1,227.60","$1,240.00",$0.00,$0.00,$0.00,$0.00,$0.00
45000009,EAP,CPT® 29126,,Applyfore Arm Splint,$689.00,$0.00,$689.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$689.00,$0.00,$689.00,$545.69,$551.20,$0.00,$0.00,$0.00,$0.00,$0.00
45000018,EAP,CPT® 11760,,Repair Of Nail Bed,$759.00,$0.00,$759.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$759.00,$0.00,$759.00,$601.13,$607.20,$0.00,$0.00,$0.00,$0.00,$0.00
45000020,EAP,CPT® 12001,,Lac Repr Sclp Nck Hnd Ft <2.6c,$704.00,$46.87,$704.00,$704.00,$704.00,$167.55,$121.30,$704.00,$704.00,$123.26,$704.00,$175.24,$704.00,$557.57,$563.20,$243.48,$116.22,$46.87,$112.08,$166.90
45000021,EAP,CPT® 27550,,"Treat Knee Dislocation,w/o Anesthesia",$857.00,$0.00,$857.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$857.00,$0.00,$857.00,$678.74,$685.60,$0.00,$0.00,$0.00,$0.00,$0.00
45000022,EAP,CPT® 12002,,Lac Repr Sclp Nck Hnd Ft 2.6-7,$879.00,$62.38,$879.00,$477.30,$879.00,$167.55,$151.45,$879.00,$879.00,$153.91,$879.00,$175.24,$879.00,$696.17,$703.20,$243.48,$127.88,$62.38,$139.94,$166.90
45000023,EAP,CPT® 12004,,Rep Sc/nk/ax/gen/tk 7.6-12.5cm,$970.00,$77.52,$970.00,$970.00,$970.00,$167.55,$167.13,$970.00,$970.00,$169.84,$970.00,$175.24,$970.00,$768.24,$776.00,$243.48,$152.49,$77.52,$154.42,$166.90
45000025,EAP,CPT® 12005,,Rep Sc/nk/ax/gen/ 12.6-20.0 Cm,$909.00,$0.00,$909.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$909.00,$0.00,$909.00,$719.93,$727.20,$0.00,$0.00,$0.00,$0.00,$0.00
45000027,EAP,CPT® 12006,,Rep Sc/nk/ax/gen/ 20.1-30.0 Cm,$436.00,$0.00,$436.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$436.00,$0.00,$436.00,$345.31,$348.80,$0.00,$0.00,$0.00,$0.00,$0.00
45000029,EAP,CPT® 12007,,Rep Sc/nk/ax/gen/tk > 30.0 Cm,$909.00,$0.00,$909.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$909.00,$0.00,$909.00,$719.93,$727.20,$0.00,$0.00,$0.00,$0.00,$0.00
45000030,EAP,CPT® 12011,,Lac Rep.fac/ear/lid/nose<2.5cm,$729.00,$58.77,$729.00,$395.85,$729.00,$167.55,$125.60,$729.00,$729.00,$127.64,$729.00,$175.24,$729.00,$577.37,$583.20,$243.48,$123.67,$58.77,$116.06,$166.90
45000031,EAP,CPT® 12013,,Lac Repr Fce Ear Eye Lp 2.6-5.,$894.00,$62.02,$894.00,$485.44,$894.00,$167.55,$154.03,$894.00,$894.00,$156.53,$894.00,$175.24,$894.00,$708.05,$715.20,$243.48,$140.24,$62.02,$142.32,$166.90
45000032,EAP,CPT® 12014,,Lac Repr Fce Ear Eye Lp 5.1-7.,$970.00,$79.33,$970.00,$970.00,$970.00,$167.55,$167.13,$970.00,$970.00,$169.84,$970.00,$175.24,$970.00,$768.24,$776.00,$243.48,$166.21,$79.33,$154.42,$166.90
45000034,EAP,CPT® 12015,,Lac Rep Fce Ear Eye Lp 7.6-12.,$970.00,$0.00,$970.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$970.00,$0.00,$970.00,$768.24,$776.00,$0.00,$0.00,$0.00,$0.00,$0.00
45000035,EAP,CPT® 27510,,"Treatment Of Thigh Fracture,w Manipulation","$1,589.00",$0.00,"$1,589.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,589.00",$0.00,"$1,589.00","$1,258.49","$1,271.20",$0.00,$0.00,$0.00,$0.00,$0.00
45000036,EAP,CPT® 12016,,Lac Rep Fce Ear Eye Lp12.6-20.,$970.00,$0.00,$970.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$970.00,$0.00,$970.00,$768.24,$776.00,$0.00,$0.00,$0.00,$0.00,$0.00
45000038,EAP,CPT® 12017,,Rp Si Fa Ear Nos Lip 20.1-30.0,"$1,580.00",$0.00,"$1,580.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,580.00",$0.00,"$1,580.00","$1,251.36","$1,264.00",$0.00,$0.00,$0.00,$0.00,$0.00
45000041,EAP,CPT® 12031,,Int Rep Sclp Trnk Extrm <2.5cm,$970.00,$0.00,$970.00,$970.00,$0.00,$306.38,$167.13,$0.00,$0.00,$169.84,$970.00,$320.45,$970.00,$768.24,$776.00,$445.22,$141.63,$157.16,$154.42,$305.19
45000042,EAP,CPT® 12032,,Int Rep Sclp Trk Ext 2.6-7.5cm,$970.00,$0.00,$970.00,$970.00,$0.00,$306.38,$167.13,$0.00,$0.00,$169.84,$970.00,$320.45,$970.00,$768.24,$776.00,$445.22,$161.36,$196.82,$154.42,$305.19
45000043,EAP,CPT® 12034,,Int Rep Sclp Trk Ext7.6-12.5cm,$465.00,$0.00,$465.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$465.00,$0.00,$465.00,$368.28,$372.00,$0.00,$0.00,$0.00,$0.00,$0.00
45000044,EAP,CPT® 12035,,Int Rep Sclp Trk Extrm12.6-20.,$909.00,$0.00,$909.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$909.00,$0.00,$909.00,$719.93,$727.20,$0.00,$0.00,$0.00,$0.00,$0.00
45000045,EAP,CPT® 28455,,Treatment Of Tarsal Bone Fracture,"$1,500.00",$0.00,"$1,500.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,500.00",$0.00,"$1,500.00","$1,188.00","$1,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
45000046,EAP,CPT® 12036,,Int Rep S/tr/ext/20.1-30.0cm,$838.00,$0.00,$838.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$838.00,$0.00,$838.00,$663.70,$670.40,$0.00,$0.00,$0.00,$0.00,$0.00
45000047,EAP,CPT® 56440,,Marsupialization Of Bartholin Cyst,"$7,879.00",$0.00,"$7,879.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$7,879.00",$0.00,"$2,327.00","$6,240.17","$6,303.20",$0.00,$0.00,$0.00,$0.00,$0.00
45000048,EAP,CPT® 12037,,Intmd Wnd Repair S/tr/ext,"$1,907.00",$0.00,"$1,907.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,907.00",$0.00,"$1,907.00","$1,510.34","$1,525.60",$0.00,$0.00,$0.00,$0.00,$0.00
45000049,EAP,CPT® 12041,,Int Repr N-hf/genit <2.6cm,$970.00,$152.13,$970.00,$970.00,$970.00,$306.38,$167.13,$970.00,$970.00,$169.84,$970.00,$320.45,$970.00,$768.24,$776.00,$445.22,$157.82,$152.13,$154.42,$305.19
45000051,EAP,CPT® 12042,,Int Repr Nck Hnd Ft 2.6-7.5 Cm,$576.00,$0.00,$465.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$465.00,$0.00,$465.00,$368.28,$372.00,$0.00,$0.00,$0.00,$0.00,$0.00
45000052,EAP,CPT® 12044,,Int Repr Nck Hnd Ft 7.6-12.5cm,$948.00,$0.00,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$948.00,$0.00,$948.00,$750.82,$758.40,$0.00,$0.00,$0.00,$0.00,$0.00
45000053,EAP,CPT® 12045,,Int Rep Nck Hnd Ft 12.6-20.0cm,"$2,058.00",$0.00,"$2,058.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,058.00",$0.00,"$2,058.00","$1,629.94","$1,646.40",$0.00,$0.00,$0.00,$0.00,$0.00
45000054,EAP,CPT® 12046,,Int Rep Nck Hnd Ft 20.1-30.0cm,"$1,332.00",$0.00,"$1,332.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,332.00",$0.00,"$1,332.00","$1,054.94","$1,065.60",$0.00,$0.00,$0.00,$0.00,$0.00
45000055,EAP,CPT® 12051,,Int Repr Fce Ear Eye Lp<2.5cm,$970.00,$0.00,$970.00,$970.00,$0.00,$306.38,$0.00,$0.00,$0.00,$169.84,$970.00,$320.45,$970.00,$768.24,$776.00,$445.22,$0.00,$174.83,$154.42,$305.19
45000056,EAP,CPT® 12052,,Int Repr F/e/l/mm 2.6-5.0cm,$970.00,$0.00,$970.00,$970.00,$0.00,$306.38,$167.13,$0.00,$0.00,$169.84,$970.00,$320.45,$970.00,$768.24,$776.00,$445.22,$183.25,$206.92,$154.42,$305.19
45000057,EAP,CPT® 12053,,Int Wnd Repr Face/mm 5.1-7.5cm,"$1,610.00",$0.00,"$1,610.00","$1,610.00",$0.00,$306.38,$277.39,$0.00,$0.00,$281.90,"$1,610.00",$320.45,"$1,610.00","$1,275.12","$1,288.00",$445.22,$204.98,$223.51,$256.31,$305.19
45000058,EAP,CPT® 12054,,Int Rep Fce Ear Lp 7.6-12.5 Cm,$970.00,$0.00,$970.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$970.00,$0.00,$970.00,$768.24,$776.00,$0.00,$0.00,$0.00,$0.00,$0.00
45000059,EAP,CPT® 12055,,Rep Int Fce Ear Lp 12.6-20.0cm,$970.00,$0.00,$970.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$970.00,$0.00,$970.00,$768.24,$776.00,$0.00,$0.00,$0.00,$0.00,$0.00
45000060,EAP,CPT® 16000,,Init Trmnt Burn 1st Degree,"$1,607.00",$0.00,"$1,607.00",$872.60,$0.00,$167.55,$0.00,$0.00,$0.00,$281.37,"$1,607.00",$175.24,"$1,607.00","$1,272.74","$1,285.60",$243.48,$0.00,$47.96,$255.83,$166.90
45000061,EAP,CPT® 16020,,Part Thick Burn Dress/debrd;sm (tbsa<5%),"$1,607.00",$0.00,"$1,607.00","$1,607.00",$0.00,$167.55,$276.88,$0.00,$0.00,$281.37,"$1,607.00",$175.24,"$1,607.00","$1,272.74","$1,285.60",$243.48,$54.62,$56.23,$255.83,$166.90
45000062,EAP,CPT® 16030,,Part Thick Burn Dress/debrd;lg (tbsa >10%),"$4,348.00",$134.39,"$4,348.00","$2,496.90","$1,482.64",$306.38,$749.14,"$1,482.64","$1,482.64",$761.30,"$4,348.00",$320.45,"$2,255.00","$3,443.62","$3,478.40",$445.22,$134.39,$138.43,$692.20,$305.19
45000063,EAP,CPT® 19020,,Incision Of Breast Lesion,"$7,102.00",$0.00,"$7,102.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$7,102.00",$0.00,"$2,327.00","$5,624.78","$5,681.60",$0.00,$0.00,$0.00,$0.00,$0.00
45000067,EAP,CPT® 24565,,Treat Humerus Fracture,"$1,550.00",$0.00,"$1,550.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,550.00",$0.00,"$1,550.00","$1,227.60","$1,240.00",$0.00,$0.00,$0.00,$0.00,$0.00
45000069,EAP,CPT® 25535,,Clsd Fracture Ulna W Manip,$625.00,$0.00,$625.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$625.00,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
45000070,EAP,CPT® 25600,,Treat Fracture Radius/ulna,"$1,180.00",$0.00,"$1,180.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,180.00",$0.00,"$1,180.00",$934.56,$944.00,$0.00,$0.00,$0.00,$0.00,$0.00
45000071,EAP,CPT® 26010,,"I&d Finger Abscess, Simple","$1,407.00",$0.00,"$1,407.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,407.00",$0.00,"$1,407.00","$1,114.34","$1,125.60",$0.00,$0.00,$0.00,$0.00,$0.00
45000072,EAP,CPT® 27760,,Clsd Tx Medial Malleolus Fx,$720.00,$0.00,$720.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$720.00,$0.00,$720.00,$570.24,$576.00,$0.00,$0.00,$0.00,$0.00,$0.00
45000073,EAP,CPT® 27780,,Clsd Fracture Fibula W/o Manip,"$1,119.00",$0.00,"$1,119.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,119.00",$0.00,"$1,119.00",$886.25,$895.20,$0.00,$0.00,$0.00,$0.00,$0.00
45000075,EAP,CPT® 27786,,Clsd Tx Distal Fibular Fx,"$1,153.00",$0.00,"$1,153.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,153.00",$0.00,"$1,153.00",$913.18,$922.40,$0.00,$0.00,$0.00,$0.00,$0.00
45000077,EAP,CPT® 28400,,Clsd Fracture Heel W/o Manip,$811.00,$0.00,$811.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$811.00,$0.00,$811.00,$642.31,$648.80,$0.00,$0.00,$0.00,$0.00,$0.00
45000078,EAP,CPT® 28430,,Treatment Of Ankle Fracture,$811.00,$0.00,$811.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$811.00,$0.00,$811.00,$642.31,$648.80,$0.00,$0.00,$0.00,$0.00,$0.00
45000079,EAP,CPT® 28515,,Clsd Fracture Toe W Manip,$541.00,$0.00,$541.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$541.00,$0.00,$541.00,$428.47,$432.80,$0.00,$0.00,$0.00,$0.00,$0.00
45000080,EAP,CPT® 28540,,Treat Foot Dislocation,$398.00,$0.00,$398.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$398.00,$0.00,$398.00,$315.22,$318.40,$0.00,$0.00,$0.00,$0.00,$0.00
45000081,EAP,CPT® 28630,,Closed Tx Metatarsophal Jt Dis,$541.00,$0.00,$541.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$541.00,$0.00,$541.00,$428.47,$432.80,$0.00,$0.00,$0.00,$0.00,$0.00
45000082,EAP,CPT® 29105,,App'l Long Arm Splint,$859.00,$0.00,$859.00,$466.44,$0.00,$128.24,$148.00,$0.00,$0.00,$150.40,$859.00,$134.13,$859.00,$680.33,$687.20,$186.36,$94.27,$43.63,$136.75,$127.75
45000083,EAP,CPT® 29240,,Strapping Of Shoulder,$813.00,$0.00,$813.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$813.00,$0.00,$813.00,$643.90,$650.40,$0.00,$0.00,$0.00,$0.00,$0.00
45000084,EAP,CPT® 29240,,Apply Shoulder Immobilizer,$813.00,$0.00,$813.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$813.00,$0.00,$813.00,$643.90,$650.40,$0.00,$0.00,$0.00,$0.00,$0.00
45000087,EAP,CPT® 36600,,Arterial Puncture,$300.00,$0.00,$284.00,$284.00,$0.00,$104.55,$48.93,$0.00,$0.00,$49.73,$284.00,$109.35,$284.00,$224.93,$227.20,$151.93,$24.37,$16.23,$45.21,$104.14
45000088,EAP,CPT® 41250,,Repair Tongue Laceration,$802.00,$0.00,$802.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$802.00,$0.00,$802.00,$635.18,$641.60,$0.00,$0.00,$0.00,$0.00,$0.00
45000089,EAP,CPT® 41800,,Drainage Of Gum Lesion,$640.00,$87.50,$640.00,$640.00,$640.00,$104.55,$110.27,$640.00,$640.00,$112.06,$640.00,$109.35,$640.00,$506.88,$512.00,$151.93,$87.50,$157.47,$101.89,$104.14
45000090,EAP,CPT® 42700,,I&d Peritonsillar Abscess,$440.00,$70.05,$440.00,$440.00,$440.00,$195.27,$75.81,$440.00,$440.00,$77.04,$440.00,$204.24,$440.00,$348.48,$352.00,$283.76,$122.16,$139.13,$70.05,$194.51
45000093,EAP,CPT® 46050,,I & D Perianal Abcess,"$4,031.00",$0.00,"$4,031.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,031.00",$0.00,"$2,255.00","$3,192.55","$3,224.80",$0.00,$0.00,$0.00,$0.00,$0.00
45000094,EAP,CPT® 56420,,I & D Bartholin Abscess,$672.00,$0.00,$672.00,$672.00,$0.00,$159.23,$115.78,$0.00,$0.00,$117.66,$672.00,$166.54,$672.00,$532.22,$537.60,$231.38,$106.60,$107.06,$106.98,$158.61
45000096,EAP,CPT® 69000,,Drain External Ear Lesion,$700.00,$0.00,$700.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$700.00,$0.00,$700.00,$554.40,$560.00,$0.00,$0.00,$0.00,$0.00,$0.00
45000112,EAP,CPT® 12056,,Rep Int Fce Ear Lp 20.1-30.0cm,"$1,580.00",$0.00,"$1,580.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,580.00",$0.00,"$1,580.00","$1,251.36","$1,264.00",$0.00,$0.00,$0.00,$0.00,$0.00
45000113,EAP,CPT® 13120,,Cmplx Rpr Sclp Arm Lgs 1.1-2.5,"$1,337.00",$0.00,"$1,337.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,337.00",$0.00,"$1,337.00","$1,058.90","$1,069.60",$0.00,$0.00,$0.00,$0.00,$0.00
45000114,EAP,CPT® 13121,,Repr Comp Scalp Arms Lgs 2.5-7,"$1,442.00",$0.00,"$1,442.00","$1,442.00","$1,442.00",$476.59,$0.00,"$1,442.00","$1,442.00",$252.48,"$1,442.00",$498.48,"$1,442.00","$1,142.06","$1,153.60",$692.57,$0.00,$270.39,$229.57,$474.74
45000115,EAP,CPT® 13122,,Cmplx Rpr Sclp Arm Lgs Ea Add,"$1,291.00",$0.00,"$1,291.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,291.00",$0.00,"$1,291.00","$1,022.47","$1,032.80",$0.00,$0.00,$0.00,$0.00,$0.00
45000116,EAP,CPT® 13131,,"Repr Complex Mouth Neck Hds,ft","$1,337.00",$0.00,"$1,337.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,337.00",$0.00,"$1,337.00","$1,058.90","$1,069.60",$0.00,$0.00,$0.00,$0.00,$0.00
45000117,EAP,CPT® 13132,,"Repr Comp Mouth,neck,hds,ft2.6","$1,337.00",$0.00,"$1,337.00","$1,337.00","$1,337.00",$476.59,$0.00,"$1,337.00","$1,337.00",$234.10,"$1,337.00",$498.48,"$1,337.00","$1,058.90","$1,069.60",$692.57,$0.00,$317.62,$212.85,$474.74
45000118,EAP,CPT® 13133,,Repair Wound/lesion Add-on,"$1,252.00",$0.00,"$1,252.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,252.00",$0.00,"$1,252.00",$991.58,"$1,001.60",$0.00,$0.00,$0.00,$0.00,$0.00
45000120,EAP,CPT® 13151,,Cmplx Rpr Eye Nose Ear 1.1-2.5,"$2,338.00",$0.00,"$2,338.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,338.00",$0.00,"$2,338.00","$1,851.70","$1,870.40",$0.00,$0.00,$0.00,$0.00,$0.00
45000121,EAP,CPT® 13152,,"Repr Comp Eyel, Nose,ears Lips","$2,533.00",$0.00,"$2,533.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,533.00",$0.00,"$2,533.00","$2,006.14","$2,026.40",$0.00,$0.00,$0.00,$0.00,$0.00
45000122,EAP,CPT® 13153,,Cmplx Rpr Eye Nose Ear Add-on,"$1,291.00",$0.00,"$1,291.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,291.00",$0.00,"$1,291.00","$1,022.47","$1,032.80",$0.00,$0.00,$0.00,$0.00,$0.00
45000123,EAP,CPT® 13160,,Second Closr Surg Wound; Comp,"$10,343.00",$0.00,"$10,343.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$10,343.00",$0.00,"$2,327.00","$8,191.66","$8,274.40",$0.00,$0.00,$0.00,$0.00,$0.00
45000124,EAP,CPT® 16025,,Part Thick Burn Dress/debrd;md (tbsa 5%-10%),"$3,252.00",$107.09,"$3,252.00","$2,496.90","$1,482.64",$167.55,$560.30,"$1,482.64","$1,482.64",$569.40,"$3,252.00",$175.24,"$2,255.00","$2,575.58","$2,601.60",$243.48,$107.09,$114.64,$517.72,$166.90
45000125,EAP,CPT® 26675,,Treat Hand Dislocation,"$4,148.00",$0.00,"$4,148.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,148.00",$0.00,"$2,327.00","$3,285.22","$3,318.40",$0.00,$0.00,$0.00,$0.00,$0.00
45000126,EAP,CPT® 19000,,Punc Aspiration Cyst Of Breast,"$1,141.00",$45.43,"$1,141.00","$1,141.00","$1,141.00",$584.94,$196.59,"$1,141.00","$1,141.00",$199.78,"$1,141.00",$611.80,"$1,141.00",$903.67,$912.80,$850.02,$59.58,$45.43,$181.65,$582.67
45000128,EAP,CPT® 20102,,"Explore Wound, Abdomen","$4,018.00",$0.00,"$4,018.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,018.00",$0.00,"$2,255.00","$3,182.26","$3,214.40",$0.00,$0.00,$0.00,$0.00,$0.00
45000129,EAP,CPT® 20103,,"Explore Wound, Extremity","$3,502.00",$0.00,"$3,502.00","$2,106.30",$0.00,$584.94,$603.38,$0.00,$0.00,$613.17,"$3,502.00",$611.80,"$2,255.00","$2,773.58","$2,801.60",$850.02,$323.52,$360.85,$557.52,$582.67
45000133,EAP,CPT® 20612,,"Aspiration/inj.,gangion Cyst","$1,051.00",$0.00,"$1,051.00","$1,051.00",$0.00,$251.01,$181.08,$0.00,$0.00,$184.02,"$1,051.00",$262.54,"$1,051.00",$832.39,$840.80,$364.76,$54.88,$42.90,$167.32,$250.04
45000134,EAP,CPT® 20822,,"Replantation Digit, Complete","$9,548.00",$0.00,"$9,548.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$9,548.00",$0.00,"$2,327.00","$7,562.02","$7,638.40",$0.00,$0.00,$0.00,$0.00,$0.00
45000135,EAP,CPT® 21110,,Interdental Fixation,"$1,389.00",$0.00,"$1,389.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,389.00",$0.00,"$1,389.00","$1,100.09","$1,111.20",$0.00,$0.00,$0.00,$0.00,$0.00
45000136,EAP,CPT® 21310,,Nasal Bone Fx Wo Manip,$506.00,$0.00,$506.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$506.00,$0.00,$506.00,$400.75,$404.80,$0.00,$0.00,$0.00,$0.00,$0.00
45000138,EAP,CPT® 21315,,Treatment Of Nose Fracture,"$4,328.00",$0.00,"$4,328.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,328.00",$0.00,"$2,327.00","$3,427.78","$3,462.40",$0.00,$0.00,$0.00,$0.00,$0.00
45000140,EAP,CPT® 21421,,Maxillary Fracture,"$9,628.00",$0.00,"$9,628.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$9,628.00",$0.00,"$3,606.00","$7,625.38","$7,702.40",$0.00,$0.00,$0.00,$0.00,$0.00
45000141,EAP,CPT® 21450,,Mandibular Fx Wo Manip,$818.00,$0.00,$818.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$818.00,$0.00,$818.00,$647.86,$654.40,$0.00,$0.00,$0.00,$0.00,$0.00
45000142,EAP,CPT® 21480,,Reset Dislocated Jaw,$257.00,$0.00,$257.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$257.00,$0.00,$257.00,$203.54,$205.60,$0.00,$0.00,$0.00,$0.00,$0.00
45000148,EAP,CPT® 23500,,Clavicular Fx Wo Manip,"$1,037.00",$0.00,"$1,037.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,037.00",$0.00,"$1,037.00",$821.30,$829.60,$0.00,$0.00,$0.00,$0.00,$0.00
45000150,EAP,CPT® 23540,,Acromioclavicular Disloca,$815.00,$0.00,$815.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$815.00,$0.00,$815.00,$645.48,$652.00,$0.00,$0.00,$0.00,$0.00,$0.00
45000154,EAP,CPT® 23605,,CLSD TXT PROXIMAL HUMERUS W/MANIPU,"$6,017.00",$0.00,"$6,017.00",$0.00,$0.00,$0.00,"$1,036.70",$0.00,$0.00,$0.00,"$6,017.00",$0.00,"$2,327.00","$4,765.46","$4,813.60",$0.00,$410.41,$0.00,$0.00,$0.00
45000156,EAP,CPT® 23615,,Treat Humerus Fracture,"$35,756.00",$0.00,"$35,756.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$35,756.00",$0.00,"$3,606.00","$28,318.75","$28,604.80",$0.00,$0.00,$0.00,$0.00,$0.00
45000158,EAP,CPT® 23650,,Shoulder Disloca W Manip,"$1,100.00",$175.12,"$1,100.00","$1,100.00","$1,100.00",$206.78,$189.52,"$1,100.00","$1,100.00",$192.60,"$1,100.00",$216.27,"$1,100.00",$871.20,$880.00,$300.48,$251.06,$301.31,$175.12,$205.98
45000160,EAP,CPT® 23655,,Shoulder Disloca W Humeral,"$5,444.00",$0.00,"$5,444.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,444.00",$0.00,"$2,255.00","$4,311.65","$4,355.20",$0.00,$0.00,$0.00,$0.00,$0.00
45000162,EAP,CPT® 23675,,Shoulder Disloca W Neck Fx,"$1,550.00",$0.00,"$1,550.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,550.00",$0.00,"$1,550.00","$1,227.60","$1,240.00",$0.00,$0.00,$0.00,$0.00,$0.00
45000163,EAP,CPT® 24201,,Removal Of Arm Foreign Body,"$9,504.00",$360.96,"$9,504.00","$2,496.90","$1,482.64","$2,223.58","$1,637.49","$1,482.64","$1,482.64","$1,664.07","$9,504.00","$2,325.71","$2,327.00","$7,527.17","$7,603.20","$3,231.26",$360.96,$376.65,"$1,513.04","$2,214.96"
45000164,EAP,CPT® 24341,,Repair Tendon/muscle Upper Arm,"$17,941.00",$0.00,"$17,941.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$17,941.00",$0.00,"$2,858.00","$14,209.27","$14,352.80",$0.00,$0.00,$0.00,$0.00,$0.00
45000165,EAP,CPT® 24500,,Clsd Txt Humeral Shaft Fx W/out Manip,$712.00,$0.00,$712.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$712.00,$0.00,$712.00,$563.90,$569.60,$0.00,$0.00,$0.00,$0.00,$0.00
45000167,EAP,CPT® 24500,,Apply Humeral Splint,$712.00,$0.00,$712.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$712.00,$0.00,$712.00,$563.90,$569.60,$0.00,$0.00,$0.00,$0.00,$0.00
45000168,EAP,CPT® 24505,,Clsd Txt Humeral Shaft W/manipulation,"$1,550.00",$0.00,"$1,550.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,550.00",$0.00,"$1,550.00","$1,227.60","$1,240.00",$0.00,$0.00,$0.00,$0.00,$0.00
45000174,EAP,CPT® 24577,,Treat Humerus Fracture,"$2,462.00",$0.00,"$2,462.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,462.00",$0.00,"$2,255.00","$1,949.90","$1,969.60",$0.00,$0.00,$0.00,$0.00,$0.00
45000175,EAP,CPT® 24600,,Elbow Disloca Wo Anes,$855.00,$0.00,$855.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$855.00,$0.00,$855.00,$677.16,$684.00,$0.00,$0.00,$0.00,$0.00,$0.00
45000176,EAP,CPT® 24605,,Treat Elbow Dislocation,"$8,918.00",$330.49,"$8,918.00","$2,496.90","$1,482.64","$1,299.68","$1,536.53","$1,482.64","$1,482.64","$1,561.47","$8,918.00","$1,359.37","$2,327.00","$7,063.06","$7,134.40","$1,888.67",$330.49,$491.61,"$1,419.75","$1,294.64"
45000177,EAP,CPT® 24620,,Treat Elbow Fracture,"$7,964.00",$0.00,"$7,964.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$7,964.00",$0.00,"$2,327.00","$6,307.49","$6,371.20",$0.00,$0.00,$0.00,$0.00,$0.00
45000179,EAP,CPT® 24650,,Radial Hd/neck Fx Wo Manip,"$1,097.00",$0.00,"$1,097.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,097.00",$0.00,"$1,097.00",$868.82,$877.60,$0.00,$0.00,$0.00,$0.00,$0.00
45000181,EAP,CPT® 24655,,CLSD TXT RADIAL HD/NECK FX W/OUT M,"$2,462.00",$0.00,"$2,462.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,462.00",$0.00,"$2,255.00","$1,949.90","$1,969.60",$0.00,$0.00,$0.00,$0.00,$0.00
45000184,EAP,CPT® 25500,,Radial Shaft Fx Wo Manip,"$1,061.00",$0.00,"$1,061.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,061.00",$0.00,"$1,061.00",$840.31,$848.80,$0.00,$0.00,$0.00,$0.00,$0.00
45000186,EAP,CPT® 25505,,CLSD TXT RADIAL SHAFT FX W/MANIPUL,"$2,315.00",$0.00,"$2,315.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,315.00",$0.00,"$2,255.00","$1,833.48","$1,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
45000189,EAP,CPT® 25520,,Treat Fracture Of Radius,"$2,345.00",$0.00,"$2,345.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,345.00",$0.00,"$2,255.00","$1,857.24","$1,876.00",$0.00,$0.00,$0.00,$0.00,$0.00
45000190,EAP,CPT® 25530,,Ulnar Shaft Fx Wo Manip,"$1,203.00",$0.00,"$1,203.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,203.00",$0.00,"$1,203.00",$952.78,$962.40,$0.00,$0.00,$0.00,$0.00,$0.00
45000192,EAP,CPT® 25560,,Radial/ulner Fx Wo Manip,$903.00,$0.00,$903.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$903.00,$0.00,$903.00,$715.18,$722.40,$0.00,$0.00,$0.00,$0.00,$0.00
45000194,EAP,CPT® 25565,,Treat Fracture Radius & Ulna,"$2,345.00",$373.32,"$2,345.00","$2,345.00","$1,482.64","$1,299.68",$404.03,"$1,482.64","$1,482.64",$410.59,"$2,345.00","$1,359.37","$2,327.00","$1,857.24","$1,876.00","$1,888.67",$473.67,$482.25,$373.32,"$1,294.64"
45000196,EAP,CPT® 25605,,Treat Fracture Radius/ulna,"$2,345.00",$373.32,"$2,345.00","$2,345.00","$1,756.53","$1,299.68",$404.03,"$1,756.53","$1,756.53",$410.59,"$2,345.00","$1,359.37","$2,345.00","$1,857.24","$1,876.00","$1,888.67",$469.11,$530.90,$373.32,"$1,294.64"
45000200,EAP,CPT® 25635,,Treat Wrist Bone Fracture,"$2,345.00",$0.00,"$2,345.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,345.00",$0.00,"$2,255.00","$1,857.24","$1,876.00",$0.00,$0.00,$0.00,$0.00,$0.00
45000203,EAP,CPT® 25650,,Treat Wrist Bone Fracture,$937.00,$0.00,$937.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$937.00,$0.00,$937.00,$742.10,$749.60,$0.00,$0.00,$0.00,$0.00,$0.00
45000205,EAP,CPT® 25675,,Treat Wrist Dislocation,$487.00,$0.00,$487.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$487.00,$0.00,$487.00,$385.70,$389.60,$0.00,$0.00,$0.00,$0.00,$0.00
45000206,EAP,CPT® 25680,,Trans-scapoperilunar Fx Disloc,"$1,099.00",$0.00,"$1,099.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,099.00",$0.00,"$1,099.00",$870.41,$879.20,$0.00,$0.00,$0.00,$0.00,$0.00
45000207,EAP,CPT® 25690,,Treat Wrist Dislocation,"$7,586.00",$0.00,"$7,586.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$7,586.00",$0.00,"$2,255.00","$6,008.11","$6,068.80",$0.00,$0.00,$0.00,$0.00,$0.00
45000209,EAP,CPT® 26410,,Repair Hand Tendon,"$3,717.00",$0.00,"$3,717.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,717.00",$0.00,"$2,858.00","$2,943.86","$2,973.60",$0.00,$0.00,$0.00,$0.00,$0.00
45000210,EAP,CPT® 26418,,Repair Finger Tendon,"$4,564.00",$0.00,"$4,564.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,564.00",$0.00,"$3,606.00","$3,614.69","$3,651.20",$0.00,$0.00,$0.00,$0.00,$0.00
45000211,EAP,CPT® 26600,,"Metacarpal Fx, Single,wo Manip","$1,078.00",$0.00,"$1,078.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,078.00",$0.00,"$1,078.00",$853.78,$862.40,$0.00,$0.00,$0.00,$0.00,$0.00
45000213,EAP,CPT® 26605,,Treat Metacarpal Fracture,$647.00,$0.00,$647.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$647.00,$0.00,$647.00,$512.42,$517.60,$0.00,$0.00,$0.00,$0.00,$0.00
45000215,EAP,CPT® 26641,,Treat Thumb Disolcation,"$1,104.00",$0.00,"$1,104.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,104.00",$0.00,"$1,104.00",$874.37,$883.20,$0.00,$0.00,$0.00,$0.00,$0.00
45000216,EAP,CPT® 26645,,Treat Thumb Fracture,"$1,593.00",$0.00,"$1,593.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,593.00",$0.00,"$1,593.00","$1,261.66","$1,274.40",$0.00,$0.00,$0.00,$0.00,$0.00
45000217,EAP,CPT® 26670,,Treat Hand Dislocation,"$1,099.00",$0.00,"$1,099.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,099.00",$0.00,"$1,099.00",$870.41,$879.20,$0.00,$0.00,$0.00,$0.00,$0.00
45000218,EAP,CPT® 26700,,"Metacarpophlangeal Disloc,sing",$735.00,$0.00,$735.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$735.00,$0.00,$735.00,$582.12,$588.00,$0.00,$0.00,$0.00,$0.00,$0.00
45000219,EAP,CPT® 26705,,Treat Knuckle Dislocation,"$1,593.00",$0.00,"$1,593.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,593.00",$0.00,"$1,593.00","$1,261.66","$1,274.40",$0.00,$0.00,$0.00,$0.00,$0.00
45000220,EAP,CPT® 26720,,"Phalangeal Shaft Fx, Wo Manip",$678.00,$0.00,$678.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$678.00,$0.00,$678.00,$536.98,$542.40,$0.00,$0.00,$0.00,$0.00,$0.00
45000223,EAP,CPT® 26725,,Closd Fracture Finger W Manip,"$1,116.00",$0.00,"$1,116.00",$0.00,$0.00,$0.00,$192.28,$0.00,$0.00,$0.00,"$1,116.00",$0.00,"$1,116.00",$883.87,$892.80,$0.00,$234.57,$0.00,$0.00,$0.00
45000224,EAP,CPT® 26746,,"Treat Finger Fracture, Each","$7,418.00",$0.00,"$7,418.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$7,418.00",$0.00,"$3,902.00","$5,875.06","$5,934.40",$0.00,$0.00,$0.00,$0.00,$0.00
45000227,EAP,CPT® 26755,,"Treat Finger Fracture, Each",$649.00,$0.00,$649.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$649.00,$0.00,$649.00,$514.01,$519.20,$0.00,$0.00,$0.00,$0.00,$0.00
45000229,EAP,CPT® 26756,,"Pin Finger Fracture, Each","$7,418.00",$0.00,"$7,418.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$7,418.00",$0.00,"$2,327.00","$5,875.06","$5,934.40",$0.00,$0.00,$0.00,$0.00,$0.00
45000230,EAP,CPT® 26765,,"Treat Finger Fracture, Each","$7,320.00",$0.00,"$7,320.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$7,320.00",$0.00,"$3,606.00","$5,797.44","$5,856.00",$0.00,$0.00,$0.00,$0.00,$0.00
45000231,EAP,CPT® 26770,,Interphalan Jt Disloca W Manip,$650.00,$0.00,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$650.00,$0.00,$650.00,$514.80,$520.00,$0.00,$0.00,$0.00,$0.00,$0.00
45000233,EAP,CPT® 26775,,Treat Finger Dislocation,"$5,028.00",$0.00,"$5,028.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,028.00",$0.00,"$2,255.00","$3,982.18","$4,022.40",$0.00,$0.00,$0.00,$0.00,$0.00
45000235,EAP,CPT® 26785,,Dislocation Of Finger,"$16,290.00",$0.00,"$16,290.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$16,290.00",$0.00,"$2,327.00","$12,901.68","$13,032.00",$0.00,$0.00,$0.00,$0.00,$0.00
45000236,EAP,CPT® 26951,,Amputation Of Finger/thumb,"$7,113.00",$0.00,"$7,113.00",$0.00,$0.00,$0.00,"$1,225.53",$0.00,$0.00,$0.00,"$7,113.00",$0.00,"$2,327.00","$5,633.50","$5,690.40",$0.00,$412.92,$0.00,$0.00,$0.00
45000238,EAP,CPT® 27230,,Femoral Fx Neck Wo Manip,$612.00,$0.00,$612.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$612.00,$0.00,$612.00,$484.70,$489.60,$0.00,$0.00,$0.00,$0.00,$0.00
45000239,EAP,CPT® 27232,,Treat Thigh Fracture,"$3,641.00",$0.00,"$3,641.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,641.00",$0.00,"$2,255.00","$2,883.67","$2,912.80",$0.00,$0.00,$0.00,$0.00,$0.00
45000240,EAP,CPT® 27246,,Trochanteric Fx Wo Manip,$612.00,$0.00,$612.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$612.00,$0.00,$612.00,$484.70,$489.60,$0.00,$0.00,$0.00,$0.00,$0.00
45000241,EAP,CPT® 27250,,Hip Disloca Wo Anes,$578.00,$0.00,$578.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$578.00,$0.00,$578.00,$457.78,$462.40,$0.00,$0.00,$0.00,$0.00,$0.00
45000244,EAP,CPT® 27256,,Treat Hip Dislocation,$950.00,$0.00,$568.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$568.00,$0.00,$568.00,$449.86,$454.40,$0.00,$0.00,$0.00,$0.00,$0.00
45000245,EAP,CPT® 69020,,Er Drain Absc Ext Auditory Can,$600.00,$0.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$600.00,$0.00,$600.00,$475.20,$480.00,$0.00,$0.00,$0.00,$0.00,$0.00
45000246,EAP,CPT® 27500,,Femoral Shaft Fx Wo Manip,"$1,560.00",$0.00,"$1,560.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,560.00",$0.00,"$1,560.00","$1,235.52","$1,248.00",$0.00,$0.00,$0.00,$0.00,$0.00
45000248,EAP,CPT® 27508,,"Femoral Fx,distal End,wo Manip","$1,091.00",$0.00,"$1,091.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,091.00",$0.00,"$1,091.00",$864.07,$872.80,$0.00,$0.00,$0.00,$0.00,$0.00
45000250,EAP,CPT® 27520,,Patellar Fx Wo Manip,"$1,494.00",$0.00,"$1,494.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,494.00",$0.00,"$1,494.00","$1,183.25","$1,195.20",$0.00,$0.00,$0.00,$0.00,$0.00
45000252,EAP,CPT® 27530,,Tibial Fx Wo Manip,"$1,494.00",$0.00,"$1,494.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,494.00",$0.00,"$1,494.00","$1,183.25","$1,195.20",$0.00,$0.00,$0.00,$0.00,$0.00
45000254,EAP,CPT® 27535,,Treat Knee Fracture,"$5,367.00",$0.00,"$5,367.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,367.00",$0.00,"$2,683.50","$4,250.66","$4,293.60",$0.00,$0.00,$0.00,$0.00,$0.00
45000255,EAP,CPT® 27560,,Treat Kneecap Dislocation,$995.00,$0.00,$995.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$995.00,$0.00,$995.00,$788.04,$796.00,$0.00,$0.00,$0.00,$0.00,$0.00
45000259,EAP,CPT® 27750,,Tibial Shaft Fx Wo Manip,"$1,133.00",$0.00,"$1,133.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,133.00",$0.00,"$1,133.00",$897.34,$906.40,$0.00,$0.00,$0.00,$0.00,$0.00
45000261,EAP,CPT® 27752,,Treatment Of Tibia Fracture,"$7,275.00",$0.00,"$7,275.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$7,275.00",$0.00,"$2,255.00","$5,761.80","$5,820.00",$0.00,$0.00,$0.00,$0.00,$0.00
45000264,EAP,CPT® 27762,,Treatment Of Ankle Fracture,"$7,275.00",$0.00,"$7,275.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$7,275.00",$0.00,"$2,255.00","$5,761.80","$5,820.00",$0.00,$0.00,$0.00,$0.00,$0.00
45000267,EAP,CPT® 27788,,Treatment Of Ankle Fracture,$985.00,$0.00,$275.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$275.00,$0.00,$275.00,$217.80,$220.00,$0.00,$0.00,$0.00,$0.00,$0.00
45000269,EAP,CPT® 29125,,App'l Short Arm Splint,$952.00,$0.00,$952.00,$516.94,$0.00,$104.55,$164.02,$0.00,$0.00,$166.69,$952.00,$109.35,$952.00,$753.98,$761.60,$151.93,$72.40,$40.73,$151.56,$104.14
45000270,EAP,CPT® 27808,,Clsd Frac Bimall Ankle Wo Mani,"$1,087.00",$0.00,"$1,087.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,087.00",$0.00,"$1,087.00",$860.90,$869.60,$0.00,$0.00,$0.00,$0.00,$0.00
45000272,EAP,CPT® 27810,,Closed Tx Bimal Ankle Fx W/man,"$2,249.00",$0.00,"$2,249.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,249.00",$0.00,"$2,249.00","$1,781.21","$1,799.20",$0.00,$0.00,$0.00,$0.00,$0.00
45000273,EAP,CPT® 27816,,Clsd Fx Trimall Ankle Wo Mani,$955.00,$0.00,$955.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$955.00,$0.00,$955.00,$756.36,$764.00,$0.00,$0.00,$0.00,$0.00,$0.00
45000275,EAP,CPT® 27818,,Trimalleolar Ankle Fx With Man,"$2,249.00",$358.04,"$2,249.00","$2,106.30","$1,208.73","$1,299.68",$387.49,"$1,208.73","$1,208.73",$393.78,"$2,249.00","$1,359.37","$2,249.00","$1,781.21","$1,799.20","$1,888.67",$492.83,$451.99,$358.04,"$1,294.64"
45000277,EAP,CPT® 27825,,Treat Lower Leg Fracture,"$7,275.00",$0.00,"$7,275.00","$2,496.90",$0.00,"$1,299.68",$0.00,"$1,482.64","$1,482.64",$0.00,"$7,275.00","$1,359.37","$2,327.00","$5,761.80","$5,820.00","$1,888.67",$0.00,$0.00,$0.00,$0.00
45000278,EAP,CPT® 27840,,Ankle Disloca Wo Anes,"$2,249.00",$0.00,"$2,249.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,249.00",$0.00,"$2,249.00","$1,781.21","$1,799.20",$0.00,$0.00,$0.00,$0.00,$0.00
45000283,EAP,CPT® 28470,,Clsd Tx Metatar Fx Wo Manip Ea,$981.00,$0.00,$981.00,$981.00,$0.00,$206.78,$169.02,$0.00,$0.00,$171.77,$981.00,$216.27,$981.00,$776.95,$784.80,$300.48,$214.80,$210.83,$0.00,$205.98
45000285,EAP,CPT® 28475,,Clsd Tx Metatar Fx W/manip,$415.00,$0.00,$415.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$415.00,$0.00,$415.00,$328.68,$332.00,$0.00,$0.00,$0.00,$0.00,$0.00
45000286,EAP,CPT® 28490,,"Clsd Tx Fx Grt Toe,phal/phalan",$898.00,$0.00,$898.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$898.00,$0.00,$898.00,$711.22,$718.40,$0.00,$0.00,$0.00,$0.00,$0.00
45000289,EAP,CPT® 28510,,Clsd Fx Toe W/o Manipulation,$981.00,$0.00,$981.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$981.00,$0.00,$981.00,$776.95,$784.80,$0.00,$0.00,$0.00,$0.00,$0.00
45000291,EAP,CPT® 28600,,Treat Foot Dislocation,$832.00,$0.00,$832.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$832.00,$0.00,$832.00,$658.94,$665.60,$0.00,$0.00,$0.00,$0.00,$0.00
45000292,EAP,CPT® 28660,,Treat Toe Dislocation,$230.00,$0.00,$230.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$230.00,$0.00,$230.00,$182.16,$184.00,$0.00,$0.00,$0.00,$0.00,$0.00
45000296,EAP,CPT® 29130,,App'l Finger Splint,$859.00,$0.00,$859.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$859.00,$0.00,$859.00,$680.33,$687.20,$0.00,$0.00,$0.00,$0.00,$0.00
45000298,EAP,CPT® 29200,,Apply Clavicle Strap,$545.00,$0.00,$545.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$545.00,$0.00,$545.00,$431.64,$436.00,$0.00,$0.00,$0.00,$0.00,$0.00
45000299,EAP,CPT® 29280,,Strapping Hand Or Finger,$481.00,$0.00,$481.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$481.00,$0.00,$481.00,$380.95,$384.80,$0.00,$0.00,$0.00,$0.00,$0.00
45000300,EAP,CPT® 29345,,Apply Long Leg Cast,$789.00,$0.00,$789.00,$0.00,$0.00,$0.00,$135.94,$0.00,$0.00,$0.00,$789.00,$0.00,$789.00,$624.89,$631.20,$0.00,$170.33,$0.00,$0.00,$0.00
45000301,EAP,CPT® 29358,,Long Leg Application,"$1,188.00",$0.00,"$1,188.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,188.00",$0.00,"$1,188.00",$940.90,$950.40,$0.00,$0.00,$0.00,$0.00,$0.00
45000302,EAP,CPT® 29515,,Apply Short Leg Splint,$888.00,$0.00,$888.00,$482.18,$0.00,$128.24,$153.00,$0.00,$0.00,$155.48,$888.00,$134.13,$888.00,$703.30,$710.40,$186.36,$80.51,$51.19,$141.37,$127.75
45000304,EAP,CPT® 29505,,App'l Long Leg Splint,"$1,535.00",$0.00,"$1,535.00",$833.51,$0.00,$128.24,$264.47,$0.00,$0.00,$268.77,"$1,535.00",$134.13,"$1,535.00","$1,215.72","$1,228.00",$186.36,$94.49,$52.27,$244.37,$127.75
45000310,EAP,CPT® 29530,,Apply Knee Immobilizer,$762.00,$0.00,$762.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$762.00,$0.00,$762.00,$603.50,$609.60,$0.00,$0.00,$0.00,$0.00,$0.00
45000313,EAP,CPT® 29580,,Strapping; Unna Boot,$780.00,$0.00,$780.00,$423.54,$0.00,$128.24,$134.39,$0.00,$0.00,$136.57,$780.00,$134.13,$780.00,$617.76,$624.00,$186.36,$54.52,$28.49,$124.18,$127.75
45000315,EAP,CPT® 30300,,"Remove Fb, Intranasal",$272.00,$0.00,$272.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$272.00,$0.00,$272.00,$215.42,$217.60,$0.00,$0.00,$0.00,$0.00,$0.00
45000317,EAP,CPT® 30901,,Control Nasal Hemorr Ant Simpl,$348.00,$0.00,$348.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$348.00,$0.00,$348.00,$275.62,$278.40,$0.00,$0.00,$0.00,$0.00,$0.00
45000319,EAP,CPT® 30903,,Control Nasal Hemorr Ant Compl,$358.00,$0.00,$358.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$358.00,$0.00,$358.00,$283.54,$286.40,$0.00,$0.00,$0.00,$0.00,$0.00
45000320,EAP,CPT® 30905,,Control Nasal Hemorr Post Init,$518.00,$0.00,$518.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$518.00,$0.00,$518.00,$410.26,$414.40,$0.00,$0.00,$0.00,$0.00,$0.00
45000322,EAP,CPT® 31233,,"Nasal/sinus Endoscopy, Dx",$661.00,$0.00,$661.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$661.00,$0.00,$661.00,$523.51,$528.80,$0.00,$0.00,$0.00,$0.00,$0.00
45000323,EAP,CPT® 31500,,Endotracheal Intubation,"$2,656.00",$0.00,"$2,656.00","$2,106.30",$0.00,$195.27,$0.00,$0.00,$0.00,$0.00,"$2,656.00",$204.24,"$2,255.00","$2,103.55","$2,124.80",$283.76,$0.00,$149.30,$422.84,$194.51
45000326,EAP,CPT® 31515,,Laryngoscopy For Aspiration,"$7,040.00",$0.00,"$7,040.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$7,040.00",$0.00,"$2,255.00","$5,575.68","$5,632.00",$0.00,$0.00,$0.00,$0.00,$0.00
45000327,EAP,CPT® 31525,,"Dx Laryngoscopy, Except Nb","$6,412.00",$0.00,"$6,412.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,412.00",$0.00,"$2,255.00","$5,078.30","$5,129.60",$0.00,$0.00,$0.00,$0.00,$0.00
45000328,EAP,CPT® 31575,,"Laryngoscopy, Fiberoptic, Dx",$684.00,$0.00,$684.00,$684.00,$0.00,$150.12,$117.85,$0.00,$0.00,$119.76,$684.00,$157.01,$684.00,$541.73,$547.20,$218.14,$103.39,$68.49,$108.89,$149.53
45000330,EAP,CPT® 31605,,"Tracheostomy, Cricothyroid","$1,598.00",$0.00,"$1,598.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,598.00",$0.00,"$1,598.00","$1,265.62","$1,278.40",$0.00,$0.00,$0.00,$0.00,$0.00
45000332,EAP,CPT® 31720,,Nasotreacheal Suction,$250.00,$0.00,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$250.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
45000333,EAP,CPT® 32160,,Thoracotomy W/cardiac Massage,"$5,167.00",$0.00,"$5,167.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,167.00",$0.00,"$2,255.00","$4,092.26","$4,133.60",$0.00,$0.00,$0.00,$0.00,$0.00
45000337,EAP,CPT® 35206,,Repair Blood Vessel Lesion,"$8,157.00",$0.00,"$8,157.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$8,157.00",$0.00,"$2,255.00","$6,460.34","$6,525.60",$0.00,$0.00,$0.00,$0.00,$0.00
45000347,EAP,CPT® 36589,,Removal Venous Access Device,"$4,657.00",$143.13,"$4,657.00","$2,106.30","$1,208.73",$604.60,$802.38,"$1,208.73","$1,208.73",$815.40,"$4,657.00",$632.36,"$2,255.00","$3,688.34","$3,725.60",$878.58,$171.53,$143.13,$741.39,$602.25
45000348,EAP,CPT® 36593,,Declot Vascular Access Device,"$1,624.00",$0.00,"$1,624.00","$1,624.00",$0.00,$296.88,$279.81,$0.00,$0.00,$284.35,"$1,624.00",$310.51,"$1,624.00","$1,286.21","$1,299.20",$431.41,$30.97,$32.05,$258.54,$295.72
45000352,EAP,CPT® 40800,,I & D Of Abscess Of Mouth,$705.00,$0.00,$705.00,$382.82,$0.00,$584.94,$121.47,$0.00,$0.00,$123.44,$705.00,$611.80,$705.00,$558.36,$564.00,$705.00,$87.87,$128.30,$112.24,$582.67
45000353,EAP,CPT® 40801,,Drainage Of Mouth Lesion,"$1,582.00",$0.00,"$1,582.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,582.00",$0.00,"$1,582.00","$1,252.94","$1,265.60",$0.00,$0.00,$0.00,$0.00,$0.00
45000355,EAP,CPT® 41008,,Submandibular Abscess,"$4,969.00",$0.00,"$4,969.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,969.00",$0.00,"$2,255.00","$3,935.45","$3,975.20",$0.00,$0.00,$0.00,$0.00,$0.00
45000356,EAP,CPT® 41252,,Repair Tongue Laceration 2.6cm,"$2,811.00",$0.00,"$2,811.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,811.00",$0.00,"$2,327.00","$2,226.31","$2,248.80",$0.00,$0.00,$0.00,$0.00,$0.00
45000357,EAP,CPT® 42000,,"I&d Abscess Plate, Uvula",$286.00,$45.53,$286.00,$286.00,$286.00,$195.27,$49.28,$286.00,$286.00,$50.08,$286.00,$204.24,$286.00,$226.51,$228.80,$283.76,$95.00,$107.41,$45.53,$194.51
45000358,EAP,CPT® 42809,,Remove Fb Pharynx,$500.00,$0.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$500.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
45000359,EAP,CPT® 43247,,Ugi Endo-rem Of Foreign Body,"$4,263.00",$0.00,"$4,263.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,263.00",$0.00,"$2,327.00","$3,376.30","$3,410.40",$0.00,$0.00,$0.00,$0.00,$0.00
45000360,EAP,CPT® 43752,,N/g Tube Placement,"$2,052.00",$0.00,"$2,052.00","$2,052.00",$0.00,$348.65,$353.55,$0.00,$0.00,$359.29,"$2,052.00",$364.66,"$2,052.00","$1,625.18","$1,641.60",$506.64,$321.14,$42.55,$326.68,$347.29
45000361,EAP,CPT® 44500,,Intro Of Long Gi Tube,"$1,304.00",$0.00,"$1,304.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,304.00",$0.00,"$1,304.00","$1,032.77","$1,043.20",$0.00,$0.00,$0.00,$0.00,$0.00
45000362,EAP,CPT® 45300,,Proctosigmoidoscopy,"$2,361.00",$0.00,"$2,361.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,361.00",$0.00,"$2,255.00","$1,869.91","$1,888.80",$0.00,$0.00,$0.00,$0.00,$0.00
45000363,EAP,CPT® 45305,,Proctosigmoidoscopy W/bx,"$5,114.00",$0.00,"$5,114.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,114.00",$0.00,"$2,255.00","$4,050.29","$4,091.20",$0.00,$0.00,$0.00,$0.00,$0.00
45000364,EAP,CPT® 45385,,Lesion Removal Colonoscopy,"$3,214.00",$265.02,"$2,922.00","$2,496.90","$2,085.43",$962.95,$503.45,"$2,085.43","$2,085.43",$511.62,"$2,922.00","$1,007.17","$2,327.00","$2,314.22","$2,337.60","$1,399.33",$450.95,$265.02,$465.18,$959.21
45000366,EAP,CPT® 46040,,Incision Of Rectal Abscess,"$2,981.00",$0.00,"$2,981.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,981.00",$0.00,"$2,858.00","$2,360.95","$2,384.80",$0.00,$0.00,$0.00,$0.00,$0.00
45000367,EAP,CPT® 46083,,Incise External Hemorrhoid,"$1,110.00",$0.00,"$1,110.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,110.00",$0.00,"$1,110.00",$879.12,$888.00,$0.00,$0.00,$0.00,$0.00,$0.00
45000371,EAP,CPT® 51701,,"Urinary Cath, Straight",$864.00,$0.00,$864.00,$864.00,$0.00,$104.55,$148.86,$0.00,$0.00,$151.28,$864.00,$109.35,$864.00,$684.29,$691.20,$151.93,$57.62,$27.40,$137.55,$104.14
45000372,EAP,CPT® 51701,,Insert Straight Cath,$864.00,$0.00,$864.00,$864.00,$0.00,$104.55,$148.86,$0.00,$0.00,$151.28,$864.00,$109.35,$864.00,$684.29,$691.20,$151.93,$57.62,$27.40,$137.55,$104.14
45000374,EAP,CPT® 51702,,Cath Insert Indwelling,"$1,069.00",$0.00,"$1,069.00","$1,069.00",$0.00,$104.55,$184.18,$0.00,$0.00,$187.17,"$1,069.00",$109.35,"$1,069.00",$846.65,$855.20,$151.93,$91.18,$26.68,$170.18,$104.14
45000375,EAP,CPT® 51703,,"Insert Bladder Cath, Complex","$1,808.00",$0.00,"$1,808.00","$1,808.00",$0.00,$132.66,$311.51,$0.00,$0.00,$316.57,"$1,808.00",$138.76,"$1,808.00","$1,431.94","$1,446.40",$192.78,$170.19,$80.41,$287.83,$132.15
45000376,EAP,CPT® 51705,,Cystostomy Tube,$625.00,$0.00,$625.00,$625.00,$0.00,$225.25,$107.68,$0.00,$0.00,$109.43,$625.00,$235.59,$625.00,$495.00,$500.00,$327.32,$86.33,$54.08,$99.50,$224.37
45000377,EAP,CPT® 52000,,Cystoscopy,"$3,100.00",$84.02,"$3,100.00","$2,106.30","$1,208.73",$533.66,$534.11,"$1,208.73","$1,208.73",$542.79,"$3,100.00",$558.17,"$2,255.00","$2,455.20","$2,480.00",$775.50,$152.62,$84.02,$493.52,$531.59
45000378,EAP,CPT® 54220,,Treatment Of Penis Lesion,"$1,103.00",$139.18,"$1,103.00","$1,103.00","$1,103.00",$225.25,$190.04,"$1,103.00","$1,103.00",$193.13,"$1,103.00",$235.59,"$1,103.00",$873.58,$882.40,$327.32,$151.42,$139.18,$175.60,$224.37
45000380,EAP,CPT® 54700,,I & D Scrotum,"$3,277.00",$0.00,"$3,277.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,277.00",$0.00,"$2,327.00","$2,595.38","$2,621.60",$0.00,$0.00,$0.00,$0.00,$0.00
45000381,EAP,CPT® 55100,,Drainage Of Scrotum Abscess,"$2,598.00",$0.00,"$2,598.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,598.00",$0.00,"$2,255.00","$2,057.62","$2,078.40",$0.00,$0.00,$0.00,$0.00,$0.00
45000383,EAP,CPT® 56405,,I & D Of Vulva/perineum,$294.00,$0.00,$294.00,$0.00,$0.00,$0.00,$50.65,$0.00,$0.00,$51.48,$294.00,$0.00,$294.00,$232.85,$235.20,$0.00,$107.63,$0.00,$0.00,$0.00
45000384,EAP,CPT® 57180,,Vag. Exam With Packing,$382.00,$0.00,$382.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$382.00,$0.00,$382.00,$302.54,$305.60,$0.00,$0.00,$0.00,$0.00,$0.00
45000385,EAP,CPT® 57415,,Remove Vaginal Fb W/anesthesia,"$8,500.00",$0.00,"$8,500.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$8,500.00",$0.00,"$2,327.00","$6,732.00","$6,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
45000391,EAP,CPT® 62273,,Injection Epidural Blood Patch,"$1,596.00",$117.56,"$1,596.00","$1,596.00","$1,208.73",$599.36,$274.98,"$1,208.73","$1,208.73",$279.45,"$1,596.00",$626.89,"$1,596.00","$1,264.03","$1,276.80",$870.98,$123.36,$117.56,$254.08,$597.04
45000394,EAP,CPT® 64450,,Inject Anest Peripheral Nerve,"$2,750.00",$44.35,"$2,750.00","$2,106.30","$1,208.73",$599.36,$473.81,"$1,208.73","$1,208.73",$481.50,"$2,750.00",$626.89,"$2,255.00","$2,178.00","$2,200.00",$870.98,$85.27,$44.35,$437.80,$597.04
45000395,EAP,CPT® 65205,,Remove Fb Eye Conj Superficial,$382.00,$0.00,$382.00,$0.00,$0.00,$0.00,$65.82,$0.00,$0.00,$0.00,$382.00,$0.00,$382.00,$302.54,$305.60,$0.00,$132.91,$0.00,$0.00,$0.00
45000398,EAP,CPT® 65220,,Eye Exam W/o Slit Lamp,"$1,578.00",$0.00,"$1,578.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,578.00",$0.00,"$1,578.00","$1,249.78","$1,262.40",$0.00,$0.00,$0.00,$0.00,$0.00
45000399,EAP,CPT® 65222,,Eye Exam Slit Lamp,$808.00,$0.00,$808.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$808.00,$0.00,$808.00,$639.94,$646.40,$0.00,$0.00,$0.00,$0.00,$0.00
45000400,EAP,CPT® 65800,,Paracentesis Ant Chamb Eye Wdx,"$4,717.00",$0.00,"$4,717.00","$2,106.30","$1,208.73","$1,938.76",$0.00,"$1,208.73","$1,208.73",$825.91,"$4,717.00","$2,027.80","$2,255.00","$3,735.86","$3,773.60","$2,817.36",$0.00,$93.03,$750.95,"$1,931.24"
45000402,EAP,CPT® 66999,,Irrigation Eye,"$2,000.00",$0.00,"$2,000.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,000.00",$0.00,"$2,000.00","$1,584.00","$1,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
45000403,EAP,CPT® 67228,,Destroy Retinopathy Photocoag,"$7,462.00",$311.48,"$7,462.00","$2,106.30","$1,208.73",$486.10,"$1,285.67","$1,208.73","$1,208.73","$1,306.54","$7,462.00",$508.42,"$2,255.00","$5,909.90","$5,969.60",$706.38,$821.55,$311.48,"$1,187.95",$484.21
45000404,EAP,CPT® 67700,,Drainage Of Eyelid Abscess,"$1,339.00",$0.00,"$1,339.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,339.00",$0.00,"$1,339.00","$1,060.49","$1,071.20",$0.00,$0.00,$0.00,$0.00,$0.00
45000405,EAP,CPT® 67715,,Incision Of Eye Lid Fold,"$9,546.00",$0.00,"$9,546.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$9,546.00",$0.00,"$2,255.00","$7,560.43","$7,636.80",$0.00,$0.00,$0.00,$0.00,$0.00
45000406,EAP,CPT® 67840,,Excise Lesion Eyelid Smpl Clos,"$2,581.00",$160.78,"$2,581.00","$2,496.90","$1,208.73",$773.80,$444.69,"$1,208.73","$1,208.73",$451.91,"$2,581.00",$809.34,"$2,255.00","$2,044.15","$2,064.80","$1,124.47",$209.29,$160.78,$410.90,$770.80
45000407,EAP,CPT® 69005,,Drain External Ear Lesion,"$9,524.00",$0.00,"$9,524.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$9,524.00",$0.00,"$2,255.00","$7,543.01","$7,619.20",$0.00,$0.00,$0.00,$0.00,$0.00
45000409,EAP,CPT® 69200,,Removal Fb Ear,$412.00,$0.00,$412.00,$223.72,$0.00,$104.55,$70.99,$0.00,$0.00,$72.14,$412.00,$109.35,$412.00,$326.30,$329.60,$151.93,$58.58,$48.67,$65.59,$104.14
45000412,EAP,CPT® 90945,,Peritoneal Dialysis,"$1,724.00",$0.00,"$1,724.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,724.00",$0.00,$862.00,"$1,365.41","$1,379.20",$0.00,$0.00,$0.00,$0.00,$0.00
45000413,EAP,CPT® 92511,,Nasopharyngoscopy W/endoscope,$612.00,$0.00,$612.00,$612.00,$0.00,$150.12,$105.44,$0.00,$0.00,$107.16,$612.00,$157.01,$612.00,$484.70,$489.60,$218.14,$64.35,$38.94,$97.43,$149.53
45000426,EAP,CPT® 96373,,Inject-intra-arterial Only,$250.00,$0.00,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
45000443,EAP,CPT® 99281,,Minimal Care,$550.00,$0.00,$390.00,$0.00,$0.00,$0.00,$67.13,$0.00,$0.00,$68.29,$390.00,$0.00,$195.00,$308.88,$312.00,$0.00,$19.33,$0.00,$0.00,$0.00
45000445,EAP,CPT® 99281,,Acute Visit Level 1,$550.00,$0.00,$390.00,$0.00,$0.00,$0.00,$67.13,$0.00,$0.00,$68.29,$390.00,$0.00,$195.00,$308.88,$312.00,$0.00,$19.33,$0.00,$0.00,$0.00
45000447,EAP,CPT® 99282,,Limited Care,$950.00,$30.21,$841.00,$841.00,$570.18,$122.70,$144.90,$570.18,$570.18,$147.25,$841.00,$128.34,$420.50,$666.07,$672.80,$178.31,$30.21,$44.36,$133.89,$122.22
45000449,EAP,CPT® 99282,,Acute Visit Level 2,$841.00,$30.21,$841.00,$841.00,$570.18,$122.70,$144.90,$570.18,$570.18,$147.25,$841.00,$128.34,$420.50,$666.07,$672.80,$178.31,$30.21,$44.36,$133.89,$122.22
45000451,EAP,CPT® 99283,,Moderate Care,"$1,540.00",$61.31,"$1,382.00","$1,273.65",$712.73,$214.16,$238.11,$712.73,$712.73,$241.98,"$1,382.00",$224.00,$691.00,"$1,094.54","$1,105.60",$311.21,$61.31,$66.37,$220.01,$213.33
45000453,EAP,CPT® 99283,,Acute Visit Level 3,"$1,540.00",$61.31,"$1,382.00","$1,273.65",$712.73,$214.16,$238.11,$712.73,$712.73,$241.98,"$1,382.00",$224.00,$691.00,"$1,094.54","$1,105.60",$311.21,$61.31,$66.37,$220.01,$213.33
45000455,EAP,CPT® 99284,,Extended Care,"$2,415.00",$94.21,"$2,161.00","$2,161.00","$2,161.00",$337.33,$372.33,"$2,161.00","$2,161.00",$378.37,"$2,161.00",$352.82,"$1,080.50","$1,711.51","$1,728.80",$490.20,$94.21,$121.91,$344.03,$336.02
45000457,EAP,CPT® 99284,,Acute Visit Level 4,"$2,415.00",$94.21,"$2,161.00","$2,161.00","$2,161.00",$337.33,$372.33,"$2,161.00","$2,161.00",$378.37,"$2,161.00",$352.82,"$1,080.50","$1,711.51","$1,728.80",$490.20,$94.21,$121.91,$344.03,$336.02
45000459,EAP,CPT® 99285,,Comprehensive Care,"$3,415.00",$148.14,"$3,060.00","$3,060.00","$3,060.00",$483.77,$527.22,"$3,060.00","$3,060.00",$535.78,"$3,060.00",$505.99,"$1,530.00","$2,423.52","$2,448.00",$703.01,$148.14,$177.09,$487.15,$481.90
45000461,EAP,CPT® 99285,,Acute Visit Level 5,"$3,415.00",$148.14,"$3,060.00","$3,060.00","$3,060.00",$483.77,$527.22,"$3,060.00","$3,060.00",$535.78,"$3,060.00",$505.99,"$1,530.00","$2,423.52","$2,448.00",$703.01,$148.14,$177.09,$487.15,$481.90
45000462,EAP,CPT® 99291,,Critical Care 1st Hr,"$4,850.00",$182.90,"$4,315.00","$4,315.00","$3,136.01",$639.26,$743.45,"$3,136.01","$3,136.01",$755.52,"$4,315.00",$668.62,"$2,157.50","$3,417.48","$3,452.00",$928.96,$182.90,$226.49,$686.95,$636.78
45000464,EAP,CPT® 99292,,Critical Care Add'l 0.5 Hr,"$1,325.00",$0.00,"$1,185.00","$1,185.00","$1,185.00",$0.00,$0.00,"$1,185.00","$1,185.00",$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$113.96,$188.65,$0.00
45000468,EAP,CPT® 99465,,Newborn Resuscitation,"$1,530.00",$0.00,"$1,530.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,530.00",$0.00,$765.00,"$1,211.76","$1,224.00",$0.00,$0.00,$0.00,$0.00,$0.00
45000471,EAP,Custom 45000471,,Strapping,$68.00,$0.00,$68.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$68.00,$0.00,$34.00,$53.86,$54.40,$0.00,$0.00,$0.00,$0.00,$0.00
45000473,EAP,CPT® 29131,,Application Finger Splint Dynamic,$487.00,$0.00,$487.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$487.00,$0.00,$487.00,$385.70,$389.60,$0.00,$0.00,$0.00,$0.00,$0.00
45000476,EAP,CPT® 40830,,Repair Mouth Laceration,"$1,110.00",$0.00,"$1,110.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,110.00",$0.00,"$1,110.00",$879.12,$888.00,$0.00,$0.00,$0.00,$0.00,$0.00
45000477,EAP,CPT® 26775,,Treat Finger Dislocation,"$5,028.00",$0.00,"$5,028.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,028.00",$0.00,"$2,255.00","$3,982.18","$4,022.40",$0.00,$0.00,$0.00,$0.00,$0.00
45000479,EAP,CPT® 28665,,Txt Toe Dislocation W/anesth,"$4,482.00",$0.00,"$4,482.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,482.00",$0.00,"$2,255.00","$3,549.74","$3,585.60",$0.00,$0.00,$0.00,$0.00,$0.00
45000480,EAP,CPT® 27784,,Treatment Of Fibula Fracture,"$15,668.00",$0.00,"$15,668.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$15,668.00",$0.00,"$2,858.00","$12,409.06","$12,534.40",$0.00,$0.00,$0.00,$0.00,$0.00
45000481,EAP,CPT® 43235,,"Upper Gi Endoscopy, Diagnosis","$4,523.00",$0.00,"$4,112.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,112.00",$0.00,"$2,255.00","$3,256.70","$3,289.60",$0.00,$0.00,$0.00,$0.00,$0.00
45000491,EAP,CPT® 12020,,Wound Dehiscence Simple Closur,"$2,778.00",$0.00,"$2,778.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,778.00",$0.00,"$2,255.00","$2,200.18","$2,222.40",$0.00,$0.00,$0.00,$0.00,$0.00
45000492,EAP,CPT® 26011,,Abscess Finger Complicated,"$4,877.00",$0.00,"$4,877.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,877.00",$0.00,"$2,255.00","$3,862.58","$3,901.60",$0.00,$0.00,$0.00,$0.00,$0.00
45000493,EAP,CPT® 29260,,"Splint Application, Wrist","$1,018.00",$0.00,"$1,018.00",$552.77,$0.00,$32.06,$175.40,$0.00,$0.00,$178.24,"$1,018.00",$33.53,"$1,018.00",$806.26,$814.40,$46.58,$44.15,$20.20,$162.07,$31.93
45000494,EAP,CPT® 53600,,Dilate Urethra Strict Male Ini,$694.00,$0.00,$694.00,$694.00,$0.00,$225.25,$0.00,$0.00,$0.00,$0.00,$694.00,$235.59,$694.00,$549.65,$555.20,$327.32,$0.00,$65.99,$110.48,$224.37
45000495,EAP,CPT® 54001,,Dorsal Slit Except Newborn,"$6,453.00",$0.00,"$6,453.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,453.00",$0.00,"$2,327.00","$5,110.78","$5,162.40",$0.00,$0.00,$0.00,$0.00,$0.00
45000496,EAP,CPT® 58301,,Removal Iud,$280.00,$0.00,$280.00,$280.00,$0.00,$259.59,$48.24,$0.00,$0.00,$49.03,$280.00,$271.52,$280.00,$221.76,$224.00,$280.00,$81.66,$70.31,$44.58,$258.59
45000498,EAP,CPT® 27781,,Clsd Fracture Fibular,"$6,322.00",$0.00,"$6,322.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,322.00",$0.00,"$2,255.00","$5,007.02","$5,057.60",$0.00,$0.00,$0.00,$0.00,$0.00
45000499,EAP,CPT® 69000,,Drain External Ear Lesion,$700.00,$0.00,$700.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$700.00,$0.00,$700.00,$554.40,$560.00,$0.00,$0.00,$0.00,$0.00,$0.00
45000501,EAP,CPT® 28190,,Removal Of Foot Foreign Body,"$1,304.00",$138.80,"$1,304.00","$1,304.00","$1,208.73",$584.94,$224.67,"$1,208.73","$1,208.73",$228.32,"$1,304.00",$611.80,"$1,304.00","$1,032.77","$1,043.20",$850.02,$173.39,$138.80,$207.60,$582.67
45000502,EAP,CPT® 49451,,Replace Duod/jej Tube Perc,"$2,752.00",$0.00,"$2,752.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,752.00",$0.00,"$2,255.00","$2,179.58","$2,201.60",$0.00,$0.00,$0.00,$0.00,$0.00
45000505,EAP,CPT® 25260,,Repair Forearm Tendon/muscle,"$6,859.00",$0.00,"$6,859.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,859.00",$0.00,"$3,606.00","$5,432.33","$5,487.20",$0.00,$0.00,$0.00,$0.00,$0.00
45000506,EAP,CPT® 42960,,Control Throat Bleeding,"$5,082.00",$0.00,"$5,082.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,082.00",$0.00,"$2,255.00","$4,024.94","$4,065.60",$0.00,$0.00,$0.00,$0.00,$0.00
45000508,EAP,CPT® 25270,,Repair Forearm Tendon/muscle,"$6,139.00",$0.00,"$6,139.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,139.00",$0.00,"$3,606.00","$4,862.09","$4,911.20",$0.00,$0.00,$0.00,$0.00,$0.00
45000512,EAP,CPT® 36425,,Vein Access Cutdown > 1 Yr,$499.00,$0.00,$499.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$499.00,$0.00,$499.00,$395.21,$399.20,$0.00,$0.00,$0.00,$0.00,$0.00
45000520,EAP,Custom 45000520,,Screened To Clinic,$0.01,$0.00,$0.01,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.01,$0.00,$0.01,$0.01,$0.01,$0.00,$0.00,$0.00,$0.00,$0.00
45000525,EAP,CPT® 64420,,Intercostal Nerve Block,"$1,890.00",$62.02,"$1,890.00","$1,890.00","$1,208.73",$599.36,$325.64,"$1,208.73","$1,208.73",$330.92,"$1,890.00",$626.89,"$1,890.00","$1,496.88","$1,512.00",$870.98,$95.79,$62.02,$300.89,$597.04
45000526,EAP,CPT® 64421,,Intercostal Nerve Block/multi,"$3,656.00",$26.33,"$3,656.00","$2,106.30","$1,208.73",$778.67,$629.91,"$1,208.73","$1,208.73",$640.14,"$3,656.00",$814.44,"$2,255.00","$2,895.55","$2,924.80","$1,131.55",$124.25,$26.33,$582.04,$775.65
45000529,EAP,CPT® 64400,,Trigeminal Nerve Block,"$1,184.00",$0.00,"$1,184.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,184.00",$0.00,"$1,184.00",$937.73,$947.20,$0.00,$0.00,$0.00,$0.00,$0.00
45000535,EAP,CPT® 36569,,Insert Picc Cath,"$6,120.00",$98.45,"$5,429.00","$2,106.30","$1,208.73","$1,564.09",$935.39,"$1,208.73","$1,208.73",$950.57,"$5,429.00","$1,635.92","$2,255.00","$4,299.77","$4,343.20","$2,272.90",$346.84,$98.45,$864.30,"$1,558.02"
45000536,EAP,CPT® 54235,,Penile Injection,$907.00,$0.00,$907.00,$492.50,$0.00,$225.25,$156.27,$0.00,$0.00,$158.81,$907.00,$235.59,$907.00,$718.34,$725.60,$327.32,$70.35,$75.71,$144.39,$224.37
45000537,EAP,CPT® 46320,,Rem. Of Hemorrhoid Clot,"$6,695.00",$0.00,"$6,695.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,695.00",$0.00,"$2,255.00","$5,302.44","$5,356.00",$0.00,$0.00,$0.00,$0.00,$0.00
45000538,EAP,CPT® 26735,,Open Tx Of Phalangeal Shaft Fx,"$8,712.00",$0.00,"$8,712.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$8,712.00",$0.00,"$3,606.00","$6,899.90","$6,969.60",$0.00,$0.00,$0.00,$0.00,$0.00
45000541,EAP,CPT® 23665,,Treat Dislocation /fx,"$1,697.00",$0.00,"$1,697.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,697.00",$0.00,"$1,697.00","$1,344.02","$1,357.60",$0.00,$0.00,$0.00,$0.00,$0.00
45000542,EAP,CPT® 40654,,Repair Lip/complex,"$1,426.00",$0.00,"$1,426.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,426.00",$0.00,"$1,426.00","$1,129.39","$1,140.80",$0.00,$0.00,$0.00,$0.00,$0.00
45000543,EAP,CPT® 31530,,Laryngoscopy W/fb Rem,"$7,261.00",$0.00,"$7,261.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$7,261.00",$0.00,"$2,327.00","$5,750.71","$5,808.80",$0.00,$0.00,$0.00,$0.00,$0.00
45000544,EAP,CPT® 28435,,Treatment Of Ankle Fx,"$1,500.00",$0.00,"$1,500.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,500.00",$0.00,"$1,500.00","$1,188.00","$1,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
45000545,EAP,CPT® 23625,,Treat Humerus Fx,"$6,821.00",$0.00,"$6,821.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,821.00",$0.00,"$2,327.00","$5,402.23","$5,456.80",$0.00,$0.00,$0.00,$0.00,$0.00
45000546,EAP,CPT® 23545,,Treat Clavicle Dislocation,"$1,245.00",$0.00,"$1,245.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,245.00",$0.00,"$1,245.00",$986.04,$996.00,$0.00,$0.00,$0.00,$0.00,$0.00
45000550,EAP,CPT® 52332,,Cysto W Ureter Stent Plcmnt,"$10,907.00",$0.00,"$10,907.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$10,907.00",$0.00,"$2,327.00","$8,638.34","$8,725.60",$0.00,$0.00,$0.00,$0.00,$0.00
45000560,EAP,CPT® 24535,,Treat Humerus Fx,"$1,697.00",$0.00,"$1,697.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,697.00",$0.00,"$1,697.00","$1,344.02","$1,357.60",$0.00,$0.00,$0.00,$0.00,$0.00
45000561,EAP,CPT® 24640,,Treat Elbow Dis/nursemaid,$499.00,$0.00,$499.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$499.00,$0.00,$499.00,$395.21,$399.20,$0.00,$0.00,$0.00,$0.00,$0.00
45000562,EAP,CPT® 28405,,Treat Heel Fx,"$4,960.00",$0.00,"$4,960.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,960.00",$0.00,"$2,327.00","$3,928.32","$3,968.00",$0.00,$0.00,$0.00,$0.00,$0.00
45000563,EAP,CPT® 40831,,Repair Mouth Lacerations,"$2,136.00",$0.00,"$2,136.00",$0.00,$0.00,$0.00,$368.02,$0.00,$0.00,$0.00,"$2,136.00",$0.00,"$2,136.00","$1,691.71","$1,708.80",$0.00,$170.53,$0.00,$0.00,$0.00
45000564,EAP,CPT® 23675,,Treat Dislocation/fracture,"$1,550.00",$0.00,"$1,550.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,550.00",$0.00,"$1,550.00","$1,227.60","$1,240.00",$0.00,$0.00,$0.00,$0.00,$0.00
45000565,EAP,CPT® 20101,,Exploration Of Penetrating Wound (chest),"$2,635.00",$0.00,"$2,635.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,635.00",$0.00,"$2,255.00","$2,086.92","$2,108.00",$0.00,$0.00,$0.00,$0.00,$0.00
45000571,EAP,CPT® 90792,,Psych Diag Eval W/med Srvcs,$572.00,$0.00,$572.00,$310.60,$0.00,$125.96,$139.01,$0.00,$0.00,$100.15,$572.00,$131.75,$286.00,$453.02,$457.60,$183.04,$117.89,$142.86,$91.06,$125.47
45000572,EAP,CPT® 90863,,Pharma Mgmt Inc Prescpt/med Review W Psytx (add-on),$331.00,$0.00,$331.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$331.00,$0.00,$165.50,$262.15,$264.80,$0.00,$0.00,$0.00,$0.00,$0.00
45000574,EAP,CPT® 32555,,Aspirate Pleura W/ Imaging,"$3,461.00",$0.00,"$3,461.00","$2,106.30",$0.00,$604.60,$596.31,$0.00,$0.00,$605.99,"$3,461.00",$632.36,"$2,255.00","$2,741.11","$2,768.80",$878.58,$626.46,$116.13,$550.99,$602.25
45000575,EAP,CPT® 27781,,Treatment Fibula Fracture,"$6,322.00",$0.00,"$6,322.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,322.00",$0.00,"$2,255.00","$5,007.02","$5,057.60",$0.00,$0.00,$0.00,$0.00,$0.00
45000576,EAP,CPT® 45900,,Reduction Of Rectal Prolapse,"$1,534.00",$0.00,"$1,534.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,534.00",$0.00,"$1,534.00","$1,214.93","$1,227.20",$0.00,$0.00,$0.00,$0.00,$0.00
45000580,EAP,Custom 45000580,,I & D Complex Post Op Wound Inf,"$8,153.00",$0.00,"$8,153.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$8,153.00",$0.00,"$4,076.50","$6,457.18","$6,522.40",$0.00,$0.00,$0.00,$0.00,$0.00
45000581,EAP,CPT® 21451,,Treata Lower Jaw Fracture,"$5,400.00",$0.00,"$5,400.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,400.00",$0.00,"$3,606.00","$4,276.80","$4,320.00",$0.00,$0.00,$0.00,$0.00,$0.00
45000584,EAP,Custom 45000584,,I & D Floor Mouth Sub Mandibular,"$1,441.00",$0.00,"$1,441.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,441.00",$0.00,$720.50,"$1,141.27","$1,152.80",$0.00,$0.00,$0.00,$0.00,$0.00
45000585,EAP,CPT® 13102,,"Repair,complex,trunk,each Additional 5cm Or Less","$3,141.00",$0.00,"$3,141.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,141.00",$0.00,"$2,255.00","$2,487.67","$2,512.80",$0.00,$0.00,$0.00,$0.00,$0.00
45000589,EAP,CPT® 41016,,"I&d Mouth Floor Les, Abcess,cyst, Hemat","$5,605.00",$0.00,"$5,605.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,605.00",$0.00,"$2,255.00","$4,439.16","$4,484.00",$0.00,$0.00,$0.00,$0.00,$0.00
45000590,EAP,CPT® 27265,,Treat Hip Dislocation,$891.00,$0.00,$891.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$891.00,$0.00,$891.00,$705.67,$712.80,$0.00,$0.00,$0.00,$0.00,$0.00
45000592,EAP,CPT® 41016,,"I&d,floor Of Mouth-submental","$5,605.00",$0.00,"$5,605.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,605.00",$0.00,"$2,255.00","$4,439.16","$4,484.00",$0.00,$0.00,$0.00,$0.00,$0.00
45000593,EAP,CPT® 21320,,Closed Tx Nose Fx W/stabj,"$4,482.00",$0.00,"$4,482.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,482.00",$0.00,"$2,327.00","$3,549.74","$3,585.60",$0.00,$0.00,$0.00,$0.00,$0.00
45000594,EAP,CPT® 21453,,Reduce Mandibular Interdental,"$8,776.00",$0.00,"$8,776.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$8,776.00",$0.00,"$2,858.00","$6,950.59","$7,020.80",$0.00,$0.00,$0.00,$0.00,$0.00
45000595,EAP,CPT® 11012,,Deb Skin Bone At Fx Site,"$7,850.00",$0.00,"$7,850.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$7,850.00",$0.00,"$2,327.00","$6,217.20","$6,280.00",$0.00,$0.00,$0.00,$0.00,$0.00
45000598,EAP,CPT® 25624,,Closed Treatment Of Carpal Scaphoid Fracture With Manipulation,"$2,295.00",$0.00,"$2,295.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,295.00",$0.00,"$2,295.00","$1,817.64","$1,836.00",$0.00,$0.00,$0.00,$0.00,$0.00
45000599,EAP,CPT® 28825,,"Amputation Toe, Interphalangeal Joint","$5,378.00",$0.00,"$5,378.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,378.00",$0.00,"$2,327.00","$4,259.38","$4,302.40",$0.00,$0.00,$0.00,$0.00,$0.00
45000600,EAP,CPT® 28495,,Closed Fracture Treatment Of Great Toe Or Phalanx,$582.00,$0.00,$582.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$582.00,$0.00,$582.00,$460.94,$465.60,$0.00,$0.00,$0.00,$0.00,$0.00
45000606,EAP,CPT® 28505,,"Open Tx, Internal Fixation Grt Toe Fx","$6,418.00",$0.00,"$6,418.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,418.00",$0.00,"$2,858.00","$5,083.06","$5,134.40",$0.00,$0.00,$0.00,$0.00,$0.00
45000607,EAP,CPT® 40652,,Repair Lip,"$2,051.00",$0.00,"$2,051.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,051.00",$0.00,"$2,051.00","$1,624.39","$1,640.80",$0.00,$0.00,$0.00,$0.00,$0.00
45000608,EAP,CPT® 26952,,Amputation Of Finger/thumb,"$5,908.00",$0.00,"$5,908.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,908.00",$0.00,"$3,606.00","$4,679.14","$4,726.40",$0.00,$0.00,$0.00,$0.00,$0.00
45000609,EAP,CPT® 51102,,Drain Bl W/cath Insertion,"$5,564.00",$0.00,"$5,564.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,564.00",$0.00,"$2,255.00","$4,406.69","$4,451.20",$0.00,$0.00,$0.00,$0.00,$0.00
45000610,EAP,CPT® 57200,,Repair Of Vagina,"$5,461.00",$0.00,"$5,461.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,461.00",$0.00,"$2,255.00","$4,325.11","$4,368.80",$0.00,$0.00,$0.00,$0.00,$0.00
45000611,EAP,CPT® 27532,,Tx Fx Tibial Prox W/ Or W/o Manip W/tract Closed,"$5,978.00",$0.00,"$5,978.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,978.00",$0.00,"$2,255.00","$4,734.58","$4,782.40",$0.00,$0.00,$0.00,$0.00,$0.00
45000612,EAP,Custom 45000612,,Level 3 Partial Trauma Activation W/o Prenotificat,"$5,159.00",$0.00,"$4,690.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,690.00",$0.00,"$2,345.00","$3,714.48","$3,752.00",$0.00,$0.00,$0.00,$0.00,$0.00
45000613,EAP,CPT® 41007,,Drainage Of Mouth Lesion,"$2,936.00",$0.00,"$2,936.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,936.00",$0.00,"$2,255.00","$2,325.31","$2,348.80",$0.00,$0.00,$0.00,$0.00,$0.00
45000620,EAP,CPT® 20650,,Insert And Remove Bone Pin,"$6,356.00",$0.00,"$6,356.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,356.00",$0.00,"$2,858.00","$5,033.95","$5,084.80",$0.00,$0.00,$0.00,$0.00,$0.00
45000634,EAP,CPT® 61107,,Twist Drill Hole Implt Ventricular Cath/device,"$3,871.00",$0.00,"$3,871.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,871.00",$0.00,"$2,255.00","$3,065.83","$3,096.80",$0.00,$0.00,$0.00,$0.00,$0.00
46000001,EAP,CPT® 94010,,Spiro Lung Vol/pf,$665.00,$27.37,$532.00,$288.88,$379.69,$132.66,$91.66,$379.69,$379.69,$93.15,$532.00,$138.76,$266.00,$421.34,$425.60,$192.78,$28.79,$27.37,$84.69,$132.15
46000006,EAP,CPT® 94060,,Bronchospasm Eval Pre And Post,$761.00,$46.82,$609.00,$330.69,$434.64,$241.94,$104.93,$434.64,$434.64,$106.63,$609.00,$253.05,$304.50,$482.33,$487.20,$351.58,$55.45,$46.82,$96.95,$241.00
46000007,EAP,CPT® 94060,,Spirometry Pre & Post,$761.00,$46.82,$609.00,$330.69,$434.64,$241.94,$104.93,$434.64,$434.64,$106.63,$609.00,$253.05,$304.50,$482.33,$487.20,$351.58,$55.45,$46.82,$96.95,$241.00
46000010,EAP,CPT® 94070,,Bronchoprovocation,"$1,399.00",$0.00,"$1,399.00",$0.00,$998.47,$0.00,$0.00,$998.47,$998.47,$0.00,"$1,399.00",$0.00,$699.50,"$1,108.01","$1,119.20",$0.00,$0.00,$0.00,$0.00,$0.00
46000012,EAP,CPT® 94150,,Peak Flow Determination,$267.00,$0.00,$267.00,$0.00,$190.56,$0.00,$0.00,$190.56,$190.56,$0.00,$267.00,$0.00,$133.50,$211.46,$213.60,$0.00,$0.00,$0.00,$0.00,$0.00
46000015,EAP,CPT® 94200,,Max Volume Ventilation (mvv),$110.00,$0.00,$110.00,$0.00,$78.51,$0.00,$0.00,$78.51,$78.51,$0.00,$110.00,$0.00,$55.00,$87.12,$88.00,$0.00,$0.00,$0.00,$0.00,$0.00
46000019,EAP,CPT® 94250,,Expired Gas Analysis,$175.00,$0.00,$175.00,$0.00,$124.90,$0.00,$0.00,$124.90,$124.90,$0.00,$175.00,$0.00,$87.50,$138.60,$140.00,$0.00,$0.00,$0.00,$0.00,$0.00
46000027,EAP,CPT® 94375,,"Maxflw-vol Curves, I+r",$268.00,$24.49,$268.00,$145.52,$191.27,$241.94,$46.18,$191.27,$191.27,$46.92,$268.00,$253.05,$134.00,$212.26,$214.40,$268.00,$35.48,$24.49,$42.67,$241.00
46000028,EAP,CPT® 94400,,Breathing Response To Co2,$275.00,$0.00,$275.00,$0.00,$196.27,$0.00,$0.00,$196.27,$196.27,$0.00,$275.00,$0.00,$137.50,$217.80,$220.00,$0.00,$0.00,$0.00,$0.00,$0.00
46000029,EAP,CPT® 94400,,Co2 Response Curve,$275.00,$0.00,$275.00,$0.00,$196.27,$0.00,$0.00,$196.27,$196.27,$0.00,$275.00,$0.00,$137.50,$217.80,$220.00,$0.00,$0.00,$0.00,$0.00,$0.00
46000030,EAP,CPT® 94450,,Hypoxic Response Curve,$219.00,$0.00,$219.00,$0.00,$156.30,$0.00,$0.00,$156.30,$156.30,$0.00,$219.00,$0.00,$109.50,$173.45,$175.20,$0.00,$0.00,$0.00,$0.00,$0.00
46000031,EAP,CPT® 94618,,Six Minute Walk(pulm Stress Simple),$314.00,$10.80,$314.00,$170.50,$224.10,$104.55,$54.10,$224.10,$224.10,$54.98,$314.00,$109.35,$157.00,$248.69,$251.20,$151.93,$33.08,$10.80,$49.99,$104.14
46000033,EAP,CPT® 94680,,02 Anal,$150.00,$0.00,$150.00,$0.00,$107.06,$0.00,$0.00,$107.06,$107.06,$0.00,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$0.00,$0.00,$0.00,$0.00
46000035,EAP,CPT® 94681,,Et/co2 Oxygen Uptake,"$1,390.00",$43.22,"$1,390.00",$754.77,$992.04,$241.94,$239.49,$992.04,$992.04,$243.38,"$1,390.00",$253.05,$695.00,"$1,100.88","$1,112.00",$351.58,$66.54,$43.22,$221.29,$241.00
46000037,EAP,CPT® 94681,,Met Cart V02,"$1,390.00",$43.22,"$1,390.00",$754.77,$992.04,$241.94,$239.49,$992.04,$992.04,$243.38,"$1,390.00",$253.05,$695.00,"$1,100.88","$1,112.00",$351.58,$66.54,$43.22,$221.29,$241.00
46000039,EAP,CPT® 94681,,O2 Uptake Incl Co2 Output,$279.00,$43.22,$279.00,$151.50,$199.12,$241.94,$48.07,$199.12,$199.12,$48.85,$279.00,$253.05,$139.50,$220.97,$223.20,$279.00,$66.54,$43.22,$44.42,$241.00
46000042,EAP,CPT® 94750,,Pulmonary Compliance,"$1,179.00",$36.60,"$1,179.00",$640.20,$841.45,$132.66,$203.14,$841.45,$841.45,$206.43,"$1,179.00",$138.76,$589.50,$933.77,$943.20,$192.78,$36.60,$78.16,$187.70,$132.15
46000044,EAP,CPT® 94760,,Neo Pulse Oximetry Single,$443.00,$0.00,$443.00,$240.55,$316.17,$0.00,$76.33,$316.17,$316.17,$77.57,$443.00,$0.00,$221.50,$350.86,$354.40,$0.00,$10.16,$2.52,$70.53,$0.00
46000046,EAP,CPT® 94760,,Pulse Oximetry,$443.00,$0.00,$443.00,$240.55,$316.17,$0.00,$76.33,$316.17,$316.17,$77.57,$443.00,$0.00,$221.50,$350.86,$354.40,$0.00,$10.16,$2.52,$70.53,$0.00
46000049,EAP,CPT® 94761,,Adult Pulse Ox Multiple,$711.00,$0.00,$711.00,$0.00,$507.44,$0.00,$0.00,$507.44,$507.44,$0.00,$711.00,$0.00,$355.50,$563.11,$568.80,$0.00,$0.00,$0.00,$0.00,$0.00
46000050,EAP,CPT® 94761,,Neo Pulse Ox Multiple,$711.00,$0.00,$711.00,$0.00,$507.44,$0.00,$0.00,$507.44,$507.44,$0.00,$711.00,$0.00,$355.50,$563.11,$568.80,$0.00,$0.00,$0.00,$0.00,$0.00
46000051,EAP,CPT® 94761,,"Oximetry, Multiple",$711.00,$0.00,$711.00,$0.00,$507.44,$0.00,$0.00,$507.44,$507.44,$0.00,$711.00,$0.00,$355.50,$563.11,$568.80,$0.00,$0.00,$0.00,$0.00,$0.00
46000055,EAP,CPT® 94762,,Oximetry Continuous,$764.00,$25.94,$764.00,$414.85,$545.27,$132.66,$131.63,$545.27,$545.27,$133.77,$764.00,$138.76,$382.00,$605.09,$611.20,$192.78,$25.94,$26.65,$121.63,$132.15
46000056,EAP,CPT® 94762,,Pulse Ox-overnight,$679.00,$25.94,$679.00,$368.70,$484.60,$132.66,$116.99,$484.60,$484.60,$118.89,$679.00,$138.76,$339.50,$537.77,$543.20,$192.78,$25.94,$26.65,$108.10,$132.15
46000059,EAP,CPT® 94770,,Transcut Co2 Monitor,$711.00,$0.00,$711.00,$0.00,$507.44,$0.00,$0.00,$507.44,$507.44,$0.00,$711.00,$0.00,$355.50,$563.11,$568.80,$0.00,$0.00,$0.00,$0.00,$0.00
46000060,EAP,CPT® 94799,,Breathing Exercise,"$1,327.00",$0.00,"$1,327.00",$0.00,$947.08,$0.00,$0.00,$947.08,$947.08,$0.00,"$1,327.00",$0.00,$663.50,"$1,050.98","$1,061.60",$0.00,$0.00,$0.00,$0.00,$0.00
46000061,EAP,CPT® 94799,,Mini Bal Lavage,"$1,327.00",$0.00,"$1,327.00",$0.00,$947.08,$0.00,$0.00,$947.08,$947.08,$0.00,"$1,327.00",$0.00,$663.50,"$1,050.98","$1,061.60",$0.00,$0.00,$0.00,$0.00,$0.00
46000066,EAP,CPT® 94610,,Surfactant Administration,$397.00,$0.00,$397.00,$0.00,$283.34,$0.00,$0.00,$283.34,$283.34,$0.00,$397.00,$0.00,$198.50,$314.42,$317.60,$0.00,$0.00,$0.00,$0.00,$0.00
46000070,EAP,CPT® 94681,,Met Cart Vco2,"$1,390.00",$43.22,"$1,390.00",$754.77,$992.04,$241.94,$239.49,$992.04,$992.04,$243.38,"$1,390.00",$253.05,$695.00,"$1,100.88","$1,112.00",$351.58,$66.54,$43.22,$221.29,$241.00
46000071,EAP,CPT® 94726,,Plethysmo Lung Vol / Air Resist,$317.00,$40.44,$254.00,$137.92,$181.28,$241.94,$43.76,$181.28,$181.28,$44.47,$254.00,$253.05,$127.00,$201.17,$203.20,$254.00,$51.52,$41.78,$40.44,$241.00
46000072,EAP,CPT® 94728,,Pul Func Oscillometry,$317.00,$0.00,$254.00,$0.00,$181.28,$0.00,$0.00,$181.28,$181.28,$0.00,$254.00,$0.00,$127.00,$201.17,$203.20,$0.00,$0.00,$0.00,$0.00,$0.00
46000075,EAP,CPT® 94726,,Pulm Func Test Plethysmogr,$317.00,$40.44,$254.00,$137.92,$181.28,$241.94,$43.76,$181.28,$181.28,$44.47,$254.00,$253.05,$127.00,$201.17,$203.20,$254.00,$51.52,$41.78,$40.44,$241.00
46000076,EAP,CPT® 94727,,Pulm Func Test By Gas,$317.00,$0.00,$254.00,$137.92,$181.28,$132.66,$0.00,$181.28,$181.28,$44.47,$254.00,$138.76,$127.00,$201.17,$203.20,$192.78,$0.00,$31.69,$40.44,$132.15
46000077,EAP,CPT® 94728,,Pulm Func Test Oscillometry,$317.00,$0.00,$254.00,$0.00,$181.28,$0.00,$0.00,$181.28,$181.28,$0.00,$254.00,$0.00,$127.00,$201.17,$203.20,$0.00,$0.00,$0.00,$0.00,$0.00
46000078,EAP,CPT® 94729,,C02/membrane Diffuse Capac,$383.00,$0.00,$307.00,$166.70,$219.11,$0.00,$52.89,$219.11,$219.11,$53.75,$307.00,$0.00,$153.50,$243.14,$245.60,$0.00,$51.25,$47.90,$48.87,$0.00
46000082,EAP,CPT® 32554,,Aspirate Pleura W/o Imaging,"$2,489.00",$93.40,"$2,489.00","$2,106.30","$1,776.40",$604.60,$428.84,"$1,776.40","$1,776.40",$435.80,"$2,489.00",$632.36,"$2,255.00","$1,971.29","$1,991.20",$878.58,$543.38,$93.40,$396.25,$602.25
46000083,EAP,CPT® 32555,,Aspirate Pleura W/ Imaging,"$3,461.00",$116.13,"$3,461.00","$2,106.30","$2,470.12",$604.60,$596.31,"$2,470.12","$2,470.12",$605.99,"$3,461.00",$632.36,"$2,255.00","$2,741.11","$2,768.80",$878.58,$626.46,$116.13,$550.99,$602.25
46000084,EAP,CPT® 31647,,Bronchial Valve Init Insert,"$5,148.00",$0.00,"$5,148.00",$0.00,"$3,674.13",$0.00,$0.00,"$3,674.13","$3,674.13",$0.00,"$5,148.00",$0.00,"$2,858.00","$4,077.22","$4,118.40",$0.00,$0.00,$0.00,$0.00,$0.00
46000085,EAP,CPT® 31648,,Bronchial Valve Addl Insert,"$3,029.00",$0.00,"$3,029.00",$0.00,"$2,161.80",$0.00,$0.00,"$2,161.80","$2,161.80",$0.00,"$3,029.00",$0.00,"$2,858.00","$2,398.97","$2,423.20",$0.00,$0.00,$0.00,$0.00,$0.00
46000086,EAP,CPT® 31649,,Bronchial Valve Remov Init,"$1,500.00",$0.00,"$1,500.00",$0.00,"$1,070.55",$0.00,$0.00,"$1,070.55","$1,070.55",$0.00,"$1,500.00",$0.00,"$1,500.00","$1,188.00","$1,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
46000087,EAP,CPT® 31651,,Bronchial Valve Remov Addl,$947.00,$0.00,$947.00,$0.00,$675.87,$0.00,$0.00,$675.87,$675.87,$0.00,$947.00,$0.00,$473.50,$750.02,$757.60,$0.00,$0.00,$0.00,$0.00,$0.00
46000088,EAP,CPT® 32556,,Insert Cath Pleura W/o Image,"$3,536.00",$0.00,"$3,536.00",$0.00,"$2,523.64",$0.00,$0.00,"$2,523.64","$2,523.64",$0.00,"$3,536.00",$0.00,"$2,255.00","$2,800.51","$2,828.80",$0.00,$0.00,$0.00,$0.00,$0.00
46000089,EAP,CPT® 32557,,Insert Cath Pleura W/ Image,"$2,627.00",$0.00,"$2,627.00",$0.00,"$1,874.89",$0.00,$0.00,"$1,874.89","$1,874.89",$0.00,"$2,627.00",$0.00,"$2,255.00","$2,080.58","$2,101.60",$0.00,$0.00,$0.00,$0.00,$0.00
46000090,EAP,CPT® 94452,,High Altitude Simulation Testing(hast),$447.00,$0.00,$447.00,$0.00,$319.02,$0.00,$0.00,$319.02,$319.02,$0.00,$447.00,$0.00,$223.50,$354.02,$357.60,$0.00,$0.00,$0.00,$0.00,$0.00
46000091,EAP,CPT® 94453,,High Altitude Simulation Testing(hast) O2 Titration,$500.00,$53.67,$500.00,$271.50,$356.85,$104.55,$86.15,$356.85,$356.85,$87.55,$500.00,$109.35,$250.00,$396.00,$400.00,$151.93,$74.05,$53.67,$79.60,$104.14
47000001,EAP,CPT® 92551,,"Ipv Scr, 2 Ears, Pure Tone,air",$30.00,$0.00,$30.00,$16.29,$21.41,$5.34,$5.17,$21.41,$21.41,$5.25,$30.00,$0.00,$15.00,$23.76,$24.00,$18.00,$9.01,$0.00,$4.78,$0.00
47000006,EAP,CPT® 92592,,"Hearing Aid Check, Monaural",$147.00,$0.00,$147.00,$79.82,$104.91,$26.17,$25.33,$104.91,$104.91,$25.74,$147.00,$0.00,$73.50,$116.42,$117.60,$88.20,$23.01,$0.00,$23.40,$0.00
47000007,EAP,CPT® 92593,,"Hearing Aid Check, Binaural",$291.00,$0.00,$291.00,$158.01,$207.69,$51.80,$50.14,$207.69,$207.69,$50.95,$291.00,$0.00,$145.50,$230.47,$232.80,$174.60,$45.54,$0.00,$46.33,$0.00
47000022,EAP,CPT® 95992,,Canalith Repositioning Proc,$103.00,$16.12,$103.00,$55.93,$73.51,$18.33,$17.75,$73.51,$73.51,$18.03,$103.00,$40.49,$51.50,$81.58,$82.40,$38.95,$16.12,$38.95,$16.40,$38.95
47000023,EAP,CPT® 92626,,Eval Aud Funcj Cand/po Surg Implt Dev 1st Hr,$508.00,$0.00,$508.00,$0.00,$362.56,$0.00,$0.00,$362.56,$362.56,$0.00,$508.00,$0.00,$254.00,$402.34,$406.40,$0.00,$0.00,$0.00,$0.00,$0.00
47000024,EAP,CPT® 92591,,Hearing Aid Examination & Selection Binaural,$348.00,$0.00,$348.00,$188.96,$248.37,$61.94,$59.96,$248.37,$248.37,$60.93,$348.00,$0.00,$174.00,$275.62,$278.40,$208.80,$54.46,$0.00,$55.40,$0.00
47000025,EAP,,,Electroacous Eval Hearing Aid Binaural,$224.00,$0.00,$224.00,$0.00,$159.87,$0.00,$0.00,$159.87,$159.87,$0.00,$224.00,$0.00,$112.00,$177.41,$179.20,$0.00,$0.00,$0.00,$0.00,$0.00
47100001,EAP,CPT® 92511,,"Nasal Pharyngoscopy, Simple",$612.00,$38.94,$612.00,$612.00,$436.78,$150.12,$105.44,$436.78,$436.78,$107.16,$612.00,$157.01,$612.00,$484.70,$489.60,$218.14,$64.35,$38.94,$97.43,$149.53
47100002,EAP,CPT® 92541,,Spontaneous Nystagmus Test,$654.00,$4.32,$654.00,$355.12,$466.76,$104.55,$112.68,$466.76,$466.76,$114.51,$654.00,$109.35,$327.00,$517.97,$523.20,$151.93,$36.09,$4.32,$104.12,$104.14
47100003,EAP,CPT® 92542,,POSITIONAL NYSTAGMUS TEST,$908.00,$0.00,$908.00,$0.00,$648.04,$0.00,$0.00,$648.04,$648.04,$0.00,$908.00,$0.00,$454.00,$719.14,$726.40,$0.00,$0.00,$0.00,$0.00,$0.00
47100005,EAP,CPT® 92544,,Optokinetic Nystagmus Test,$654.00,$0.00,$654.00,$0.00,$466.76,$0.00,$0.00,$466.76,$466.76,$0.00,$654.00,$0.00,$327.00,$517.97,$523.20,$0.00,$0.00,$0.00,$0.00,$0.00
47100006,EAP,CPT® 92545,,Oscillating Tracking Test,$575.00,$0.00,$575.00,$0.00,$410.38,$0.00,$0.00,$410.38,$410.38,$0.00,$575.00,$0.00,$287.50,$455.40,$460.00,$0.00,$0.00,$0.00,$0.00,$0.00
47100007,EAP,CPT® 92551,,Hearing Screening,$165.00,$0.00,$165.00,$89.60,$117.76,$29.37,$28.43,$117.76,$117.76,$28.89,$165.00,$0.00,$82.50,$130.68,$132.00,$99.00,$9.01,$0.00,$26.27,$0.00
47100011,EAP,CPT® 92552,,Air Conduction (both),$276.00,$17.48,$276.00,$149.87,$196.98,$104.55,$47.55,$196.98,$196.98,$48.33,$276.00,$109.35,$138.00,$218.59,$220.80,$151.93,$17.48,$32.05,$43.94,$104.14
47100012,EAP,CPT® 92552,,Air Conduction (one),$276.00,$17.48,$276.00,$149.87,$196.98,$104.55,$47.55,$196.98,$196.98,$48.33,$276.00,$109.35,$138.00,$218.59,$220.80,$151.93,$17.48,$32.05,$43.94,$104.14
47100013,EAP,CPT® 92552,,Audiometry,$276.00,$17.48,$276.00,$149.87,$196.98,$104.55,$47.55,$196.98,$196.98,$48.33,$276.00,$109.35,$138.00,$218.59,$220.80,$151.93,$17.48,$32.05,$43.94,$104.14
47100014,EAP,CPT® 92552,,Audiometry - Air Only,$276.00,$17.48,$276.00,$149.87,$196.98,$104.55,$47.55,$196.98,$196.98,$48.33,$276.00,$109.35,$138.00,$218.59,$220.80,$151.93,$17.48,$32.05,$43.94,$104.14
47100015,EAP,CPT® 92552,,Audiometry-air Conduction,$276.00,$17.48,$276.00,$149.87,$196.98,$104.55,$47.55,$196.98,$196.98,$48.33,$276.00,$109.35,$138.00,$218.59,$220.80,$151.93,$17.48,$32.05,$43.94,$104.14
47100017,EAP,CPT® 92553,,Air & Bone Conduction (both),$622.00,$25.68,$622.00,$337.75,$443.92,$132.66,$107.17,$443.92,$443.92,$108.91,$622.00,$138.76,$311.00,$492.62,$497.60,$192.78,$25.68,$38.90,$99.02,$132.15
47100018,EAP,CPT® 92592,,Air And Bone Conduction (one),$298.00,$0.00,$298.00,$161.81,$212.68,$53.04,$51.34,$212.68,$212.68,$52.18,$298.00,$0.00,$149.00,$236.02,$238.40,$178.80,$46.64,$0.00,$47.44,$0.00
47100019,EAP,CPT® 92553,,Audiometry - Air And Bone,$622.00,$25.68,$622.00,$337.75,$443.92,$132.66,$107.17,$443.92,$443.92,$108.91,$622.00,$138.76,$311.00,$492.62,$497.60,$192.78,$25.68,$38.90,$99.02,$132.15
47100020,EAP,CPT® 92555,,Speech Audiometry Threshold,$220.00,$14.98,$220.00,$119.46,$157.01,$32.06,$37.90,$157.01,$157.01,$38.52,$220.00,$33.53,$110.00,$174.24,$176.00,$46.58,$14.98,$24.13,$35.02,$31.93
47100023,EAP,CPT® 92556,,"Speech Audiometry, Complete",$160.00,$0.00,$160.00,$0.00,$114.19,$0.00,$0.00,$114.19,$114.19,$0.00,$160.00,$0.00,$80.00,$126.72,$128.00,$0.00,$0.00,$0.00,$0.00,$0.00
47100026,EAP,CPT® 92557,,Audiometric Battery,$743.00,$33.54,$743.00,$403.45,$530.28,$132.66,$128.02,$530.28,$530.28,$130.09,$743.00,$138.76,$371.50,$588.46,$594.40,$192.78,$47.03,$33.54,$118.29,$132.15
47100028,EAP,CPT® 92557,,Compre Audiometric Battery,$743.00,$33.54,$743.00,$403.45,$530.28,$132.66,$128.02,$530.28,$530.28,$130.09,$743.00,$138.76,$371.50,$588.46,$594.40,$192.78,$47.03,$33.54,$118.29,$132.15
47100029,EAP,CPT® 92562,,Loudness Balance Test,$227.00,$0.00,$227.00,$0.00,$162.01,$0.00,$0.00,$162.01,$162.01,$0.00,$227.00,$0.00,$113.50,$179.78,$181.60,$0.00,$0.00,$0.00,$0.00,$0.00
47100032,EAP,CPT® 92565,,"Stenger Test, Pure Tone",$281.00,$0.00,$281.00,$0.00,$200.55,$0.00,$0.00,$200.55,$200.55,$0.00,$281.00,$0.00,$140.50,$222.55,$224.80,$0.00,$0.00,$0.00,$0.00,$0.00
47100033,EAP,CPT® 92567,,Tympanometry,$160.00,$11.18,$160.00,$86.88,$114.19,$32.06,$27.57,$114.19,$114.19,$28.01,$160.00,$33.53,$80.00,$126.72,$128.00,$46.58,$20.66,$11.18,$25.47,$31.93
47100034,EAP,CPT® 92567,,"Tympanometry, Binaural",$160.00,$11.18,$160.00,$86.88,$114.19,$32.06,$27.57,$114.19,$114.19,$28.01,$160.00,$33.53,$80.00,$126.72,$128.00,$46.58,$20.66,$11.18,$25.47,$31.93
47100036,EAP,CPT® 92568,,Acoustic Reflex Testing,$276.00,$0.00,$276.00,$0.00,$196.98,$0.00,$0.00,$196.98,$196.98,$0.00,$276.00,$0.00,$138.00,$218.59,$220.80,$0.00,$0.00,$0.00,$0.00,$0.00
47100038,EAP,CPT® 92568,,Acoustic Reflex Testing (bt),$276.00,$0.00,$276.00,$0.00,$196.98,$0.00,$0.00,$196.98,$196.98,$0.00,$276.00,$0.00,$138.00,$218.59,$220.80,$0.00,$0.00,$0.00,$0.00,$0.00
47100040,EAP,CPT® 92568,,Acoustic Reflex(one),$276.00,$0.00,$276.00,$0.00,$196.98,$0.00,$0.00,$196.98,$196.98,$0.00,$276.00,$0.00,$138.00,$218.59,$220.80,$0.00,$0.00,$0.00,$0.00,$0.00
47100044,EAP,CPT® 92570,,"Acoustic Reflex Testing, Both",$276.00,$0.00,$276.00,$0.00,$196.98,$0.00,$47.55,$196.98,$196.98,$0.00,$276.00,$0.00,$138.00,$218.59,$220.80,$0.00,$23.55,$0.00,$0.00,$0.00
47100045,EAP,CPT® 92570,,"Acoustic Reflex Testing, One",$276.00,$0.00,$276.00,$0.00,$196.98,$0.00,$47.55,$196.98,$196.98,$0.00,$276.00,$0.00,$138.00,$218.59,$220.80,$0.00,$23.55,$0.00,$0.00,$0.00
47100049,EAP,CPT® 92577,,"Stenger Test, Speech",$500.00,$14.05,$500.00,$271.50,$356.85,$465.65,$86.15,$356.85,$356.85,$87.55,$500.00,$487.04,$250.00,$396.00,$400.00,$500.00,$28.15,$14.05,$79.60,$463.84
47100052,EAP,CPT® 92579,,Visual Reinforcement Audiometr,$329.00,$0.00,$329.00,$0.00,$234.81,$0.00,$0.00,$234.81,$234.81,$0.00,$329.00,$0.00,$164.50,$260.57,$263.20,$0.00,$0.00,$0.00,$0.00,$0.00
47100053,EAP,CPT® 92582,,Conditioning Play Audiometry,$414.00,$0.00,$414.00,$0.00,$295.47,$0.00,$0.00,$295.47,$295.47,$0.00,$414.00,$0.00,$207.00,$327.89,$331.20,$0.00,$0.00,$0.00,$0.00,$0.00
47100057,EAP,CPT® 92585,,Auditory Brainstern Response,$727.00,$0.00,$727.00,$0.00,$518.86,$0.00,$0.00,$518.86,$518.86,$0.00,$727.00,$0.00,$363.50,$575.78,$581.60,$0.00,$0.00,$0.00,$0.00,$0.00
47100059,EAP,CPT® 92585,,"Auditory Evok Potent, Compre",$727.00,$0.00,$727.00,$0.00,$518.86,$0.00,$0.00,$518.86,$518.86,$0.00,$727.00,$0.00,$363.50,$575.78,$581.60,$0.00,$0.00,$0.00,$0.00,$0.00
47100061,EAP,CPT® 92587,,Evoke Otoacoustic Emission Ltd,$434.00,$0.00,$434.00,$0.00,$309.75,$0.00,$0.00,$309.75,$309.75,$0.00,$434.00,$0.00,$217.00,$343.73,$347.20,$0.00,$0.00,$0.00,$0.00,$0.00
47100064,EAP,CPT® 92588,,Evoke Otoacoustic Dx/compre,$445.00,$0.00,$445.00,$0.00,$317.60,$0.00,$76.67,$317.60,$317.60,$77.92,$445.00,$0.00,$222.50,$352.44,$356.00,$0.00,$40.93,$0.00,$0.00,$0.00
47100066,EAP,CPT® 92567,,"Tympanometry, Monoaural",$160.00,$11.18,$160.00,$86.88,$114.19,$32.06,$27.57,$114.19,$114.19,$28.01,$160.00,$33.53,$80.00,$126.72,$128.00,$46.58,$20.66,$11.18,$25.47,$31.93
47100067,EAP,CPT® 92590,,Hearing Aid Eval 75 Min,$291.00,$0.00,$291.00,$158.01,$207.69,$51.80,$50.14,$207.69,$207.69,$50.95,$291.00,$0.00,$145.50,$230.47,$232.80,$174.60,$45.54,$0.00,$46.33,$0.00
47100072,EAP,CPT® 92594,,Electroacoustic Eval Monaural,$158.00,$0.00,$158.00,$0.00,$112.76,$0.00,$0.00,$112.76,$112.76,$0.00,$158.00,$0.00,$79.00,$125.14,$126.40,$0.00,$0.00,$0.00,$0.00,$0.00
47100073,EAP,CPT® 92596,,Ear Protector Attenuation Meas,$245.00,$0.00,$245.00,$0.00,$174.86,$0.00,$0.00,$174.86,$174.86,$0.00,$245.00,$0.00,$122.50,$194.04,$196.00,$0.00,$0.00,$0.00,$0.00,$0.00
47100086,EAP,CPT® 92551,,"Hearing Test, Diagnostic",$165.00,$0.00,$165.00,$89.60,$117.76,$29.37,$28.43,$117.76,$117.76,$28.89,$165.00,$0.00,$82.50,$130.68,$132.00,$99.00,$9.01,$0.00,$26.27,$0.00
47100088,EAP,CPT® 95885,,Ncs/emg <=4 Limb,$236.00,$0.00,$236.00,$128.15,$168.43,$0.00,$40.66,$168.43,$168.43,$41.32,$236.00,$0.00,$118.00,$186.91,$188.80,$0.00,$53.47,$44.66,$37.57,$0.00
47100089,EAP,CPT® 95886,,Ncs/emg 5+limb,$236.00,$0.00,$236.00,$128.15,$168.43,$0.00,$40.66,$168.43,$168.43,$41.32,$236.00,$0.00,$118.00,$186.91,$188.80,$0.00,$83.61,$51.87,$37.57,$0.00
47100098,EAP,CPT® 95887,,Muscl Test W/n Test Non-extr,$125.00,$0.00,$125.00,$0.00,$89.21,$0.00,$0.00,$89.21,$89.21,$0.00,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$0.00,$0.00,$0.00,$0.00
47100099,EAP,CPT® 95938,,Somatosensory Testing,$701.00,$0.00,$575.00,$0.00,$410.38,$0.00,$0.00,$410.38,$410.38,$0.00,$575.00,$0.00,$287.50,$455.40,$460.00,$0.00,$0.00,$0.00,$0.00,$0.00
47100110,EAP,CPT® 92547,,Vertical Electrodes,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$178.43,$178.43,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
47100132,EAP,CPT® 92537,,"Caloric Vstblar Test W/rec,bilat","$1,180.00",$10.08,"$1,180.00",$640.74,$842.17,$132.66,$203.31,$842.17,$842.17,$206.61,"$1,180.00",$138.76,$590.00,$934.56,$944.00,$192.78,$38.69,$10.08,$187.86,$132.15
47100133,EAP,CPT® 92538,,"Caloric Vstblar Test W/rec,bilat;monothermal","$1,180.00",$6.48,"$1,180.00",$640.74,$842.17,$132.66,$203.31,$842.17,$842.17,$206.61,"$1,180.00",$138.76,$590.00,$934.56,$944.00,$192.78,$19.67,$6.48,$187.86,$132.15
47100134,EAP,CPT® 92567,,"Tympanometry, Monaural",$160.00,$11.18,$160.00,$86.88,$114.19,$32.06,$27.57,$114.19,$114.19,$28.01,$160.00,$33.53,$80.00,$126.72,$128.00,$46.58,$20.66,$11.18,$25.47,$31.93
47100135,EAP,CPT® 92602,,Reprogram Cochlear Implt <7,$676.00,$0.00,$676.00,$0.00,$482.46,$0.00,$0.00,$482.46,$482.46,$0.00,$676.00,$0.00,$338.00,$535.39,$540.80,$0.00,$0.00,$0.00,$0.00,$0.00
47100137,EAP,,,Gll Fitting Visit,$215.00,$0.00,$215.00,$0.00,$153.45,$0.00,$0.00,$153.45,$153.45,$0.00,$215.00,$0.00,$107.50,$170.28,$172.00,$0.00,$0.00,$0.00,$0.00,$0.00
47100138,EAP,,,Gll Visit - Post 4th Visit,$25.00,$0.00,$25.00,$0.00,$17.84,$0.00,$0.00,$17.84,$17.84,$0.00,$25.00,$0.00,$12.50,$19.80,$20.00,$0.00,$0.00,$0.00,$0.00,$0.00
47200002,EAP,CPT® 92603,,Cochlear Implt Exam 7 > Yrs,$270.00,$42.98,$270.00,$146.61,$192.70,$132.66,$46.52,$192.70,$192.70,$47.27,$270.00,$138.76,$135.00,$213.84,$216.00,$192.78,$88.28,$125.50,$42.98,$132.15
47200003,EAP,CPT® 92604,,Reprogram Codhlear Implt 7 > Yrs,$637.00,$0.00,$637.00,$0.00,$454.63,$0.00,$0.00,$454.63,$454.63,$0.00,$637.00,$0.00,$318.50,$504.50,$509.60,$0.00,$0.00,$0.00,$0.00,$0.00
47200010,EAP,HCPCS C1887,,Maxc Catheter Reperfusion 4max,"$4,108.00",$0.00,"$4,108.00","$2,230.64","$2,931.88",$0.00,$707.79,"$2,931.88","$2,931.88",$719.28,"$4,108.00",$0.00,"$2,054.00","$3,253.54","$3,286.40",$0.00,$642.90,$0.00,$653.99,$0.00
47200011,EAP,HCPCS C1757,,Psc041 Catheter Thrmb 141cm 4.1fr .041in Reperfusion,"$3,813.00",$0.00,"$3,813.00",$0.00,"$2,721.34",$0.00,$0.00,"$2,721.34","$2,721.34",$0.00,"$3,813.00",$0.00,"$1,906.50","$3,019.90","$3,050.40",$0.00,$0.00,$0.00,$0.00,$0.00
47900001,EAP,CPT® 92586,,Hearing Screening (aabr),$439.00,$0.00,$439.00,$0.00,$313.31,$0.00,$0.00,$313.31,$313.31,$0.00,$439.00,$0.00,$219.50,$347.69,$351.20,$0.00,$0.00,$0.00,$0.00,$0.00
47900003,EAP,CPT® 92587,,Hearing Screening (oae),$434.00,$0.00,$434.00,$0.00,$309.75,$0.00,$0.00,$309.75,$309.75,$0.00,$434.00,$0.00,$217.00,$343.73,$347.20,$0.00,$0.00,$0.00,$0.00,$0.00
48000001,EAP,CPT® 33967,,Perc Insertion Intraaortic Bal,"$5,376.00",$0.00,"$4,891.00",$0.00,"$3,490.71",$0.00,$0.00,"$3,490.71","$3,490.71",$0.00,"$4,891.00",$0.00,"$2,255.00","$3,873.67","$3,912.80",$0.00,$0.00,$0.00,$0.00,$0.00
48000002,EAP,CPT® 92950,,Cardio Res - Cpr,"$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,"$1,516.61","$1,516.61",$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
48000003,EAP,CPT® 92953,,Temp Transcut Pacing,"$2,499.00",$0.00,"$2,499.00",$0.00,"$1,783.54",$0.00,$0.00,"$1,783.54","$1,783.54",$0.00,"$2,499.00",$0.00,"$1,249.50","$1,979.21","$1,999.20",$0.00,$0.00,$0.00,$0.00,$0.00
48000004,EAP,CPT® 92960,,Cardioversion,"$2,706.00",$112.51,"$2,165.00","$1,175.60","$1,545.16",$514.41,$373.02,"$1,545.16","$1,545.16",$379.07,"$2,165.00",$538.04,"$1,082.50","$1,714.68","$1,732.00",$747.53,$154.62,$112.51,$344.67,$512.42
48000005,EAP,CPT® 92971,,Circulatory Assist - External,"$1,227.00",$0.00,"$1,227.00",$0.00,$875.71,$0.00,$0.00,$875.71,$875.71,$0.00,"$1,227.00",$0.00,$613.50,$971.78,$981.60,$0.00,$0.00,$0.00,$0.00,$0.00
48000011,EAP,CPT® 92986,,"Perc Balloon Vplasty, Aortic","$20,704.00",$0.00,"$20,704.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$20,704.00",$0.00,"$2,255.00","$16,397.57","$16,563.20",$0.00,$0.00,$0.00,$0.00,$0.00
48000012,EAP,CPT® 92987,,"Perc Balloon Vplasty, Mitral","$20,704.00",$0.00,"$20,704.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$20,704.00",$0.00,"$2,255.00","$16,397.57","$16,563.20",$0.00,$0.00,$0.00,$0.00,$0.00
48000013,EAP,CPT® 92990,,"Perc Balloon Vplasty, Pulm","$20,704.00",$0.00,"$20,704.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$20,704.00",$0.00,"$2,255.00","$16,397.57","$16,563.20",$0.00,$0.00,$0.00,$0.00,$0.00
48000014,EAP,CPT® 93282,,Single Lead Icd Programming / Evaluation In Person,$330.00,$30.97,$264.00,$120.98,$188.42,$34.76,$45.49,$188.42,$188.42,$46.22,$264.00,$36.36,$132.00,$209.09,$211.20,$50.51,$68.00,$30.97,$42.03,$34.63
48000015,EAP,CPT® 93283,,Dual Lead Icd Program/ Eval In Person,$330.00,$33.86,$264.00,$156.11,$188.42,$34.76,$45.49,$188.42,$188.42,$46.22,$264.00,$36.36,$132.00,$209.09,$211.20,$50.51,$82.80,$33.86,$42.03,$34.63
48000016,EAP,CPT® 93285,,Sq-cardiac Rhythm Monitor / Loop Recorder  Program / Eval In Person,$205.00,$26.11,$164.00,$80.44,$117.05,$34.76,$28.26,$117.05,$117.05,$28.72,$164.00,$36.36,$82.00,$129.89,$131.20,$50.51,$45.96,$27.73,$26.11,$34.63
48000017,EAP,CPT® 93289,,Pacemaker Interrog / Eval In Person,$330.00,$28.81,$264.00,$125.70,$188.42,$34.76,$45.49,$188.42,$188.42,$46.22,$264.00,$36.36,$132.00,$209.09,$211.20,$50.51,$63.29,$28.81,$42.03,$34.63
48000019,EAP,CPT® 93307,,2d Echo,"$3,621.00",$0.00,"$3,621.00",$0.00,$304.53,$0.00,$0.00,$304.53,$304.53,$0.00,"$3,621.00",$0.00,"$1,810.50","$2,867.83","$2,896.80",$0.00,$0.00,$0.00,$0.00,$0.00
48000020,EAP,CPT® 93312,,Transesophageal Echo,"$4,788.00",$138.31,"$4,353.00",$470.39,$502.59,$461.79,$750.00,$502.59,$502.59,$762.18,"$4,353.00",$483.00,"$2,176.50","$3,447.58","$3,482.40",$671.06,$268.29,$138.31,$693.00,$460.00
48000021,EAP,CPT® 93320,,Echo Doppler Complete,"$2,728.00",$0.00,"$2,480.00",$103.40,$137.78,$0.00,$427.29,$137.78,$137.78,$434.23,"$2,480.00",$0.00,"$1,240.00","$1,964.16","$1,984.00",$0.00,$90.75,$35.66,$394.82,$0.00
48000022,EAP,CPT® 93325,,Color Flow Mapping,"$1,669.00",$0.00,"$1,669.00",$48.66,$118.09,$0.00,$287.56,$118.09,$118.09,$292.23,"$1,669.00",$0.00,$834.50,"$1,321.85","$1,335.20",$0.00,$116.25,$21.97,$265.70,$0.00
48000023,EAP,CPT® 93350,,Transthoracic Echo,"$3,694.00",$118.63,"$3,694.00",$459.58,$315.67,$461.79,$636.46,$315.67,$315.67,$646.79,"$3,694.00",$483.00,"$1,847.00","$2,925.65","$2,955.20",$671.06,$118.63,$120.30,$588.08,$460.00
48000024,EAP,CPT® 93503,,Insertion Swan Ganz,"$8,613.00",$0.00,"$8,613.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$8,613.00",$0.00,"$2,255.00","$6,821.50","$6,890.40",$0.00,$0.00,$0.00,$0.00,$0.00
48000025,EAP,CPT® 93580,,Perc Closure Atrial Septal Def,"$19,670.00",$0.00,"$18,649.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$18,649.00",$0.00,"$6,105.00","$14,770.01","$14,919.20",$0.00,$0.00,$0.00,$0.00,$0.00
48000026,EAP,CPT® 33222,,Relocation Skin  Pkt For Pacemaker,"$27,133.00",$0.00,"$27,133.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$27,133.00",$0.00,"$2,327.00","$21,489.34","$21,706.40",$0.00,$0.00,$0.00,$0.00,$0.00
48000027,EAP,CPT® 93640,,Ep Eval Icd Leads Init Implant,"$5,142.00",$0.00,"$5,142.00",$0.00,"$3,669.85",$0.00,$0.00,"$3,669.85","$3,669.85",$0.00,"$5,142.00",$0.00,"$2,571.00","$4,072.46","$4,113.60",$0.00,$0.00,$0.00,$0.00,$0.00
48000028,EAP,CPT® 93641,,Test Icd Gen Initial Implant,"$4,957.00",$0.00,"$4,957.00",$0.00,"$3,537.81",$0.00,$0.00,"$3,537.81","$3,537.81",$0.00,"$4,957.00",$0.00,"$2,478.50","$3,925.94","$3,965.60",$0.00,$0.00,$0.00,$0.00,$0.00
48000029,EAP,CPT® 93642,,Ep Eval Icd Gen & Programming,"$5,142.00",$83.20,"$5,142.00","$5,142.00","$3,669.85",$946.97,$885.94,"$3,669.85","$3,669.85",$900.32,"$5,142.00",$990.46,"$2,571.00","$4,072.46","$4,113.60","$1,376.12",$590.04,$83.20,$818.61,$943.30
48000030,EAP,CPT® 93660,,Tilt Table Evaluation,"$1,437.00",$0.00,"$1,437.00",$0.00,"$1,025.59",$0.00,$247.59,"$1,025.59","$1,025.59",$0.00,"$1,437.00",$0.00,$718.50,"$1,138.10","$1,149.60",$0.00,$173.19,$0.00,$0.00,$0.00
48000040,EAP,CPT® 93788,,Ambulatory Bp Analysis,$212.00,$0.00,$212.00,$0.00,$151.30,$0.00,$0.00,$151.30,$151.30,$0.00,$212.00,$0.00,$106.00,$167.90,$169.60,$0.00,$0.00,$0.00,$0.00,$0.00
48000045,EAP,CPT® 93458,,Lt Heart Cath Including V Gram,"$20,836.00",$786.98,"$18,092.00","$9,334.50","$5,345.48","$2,732.82","$3,117.16","$5,345.48","$5,345.48","$3,167.76","$18,092.00","$2,858.33","$2,858.00","$14,328.86","$14,473.60","$3,971.26","$1,000.10",$786.98,"$2,880.25","$2,722.22"
48000046,EAP,CPT® 93459,,Lhc W/ V Gram And Grafts,"$20,836.00",$842.80,"$18,092.00","$9,334.50","$5,345.48","$2,732.82","$3,117.16","$5,345.48","$5,345.48","$3,167.76","$18,092.00","$2,858.33","$2,858.00","$14,328.86","$14,473.60","$3,971.26","$1,104.45",$842.80,"$2,880.25","$2,722.22"
48000047,EAP,CPT® 93460,,R&lhc W/v Gram,"$20,836.00",$0.00,"$18,092.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$18,092.00",$0.00,"$2,858.00","$14,328.86","$14,473.60",$0.00,$0.00,$0.00,$0.00,$0.00
48000048,EAP,CPT® 93461,,R&lhc W/v Gram And Grafts,"$20,836.00",$0.00,"$18,092.00",$0.00,$0.00,$0.00,"$3,117.16",$0.00,$0.00,$0.00,"$18,092.00",$0.00,"$2,858.00","$14,328.86","$14,473.60",$0.00,"$1,354.33",$0.00,$0.00,$0.00
48000050,EAP,CPT® 33235,,Removal Pacemaker Electrodes,"$10,017.00",$0.00,"$10,017.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$10,017.00",$0.00,"$2,255.00","$7,933.46","$8,013.60",$0.00,$0.00,$0.00,$0.00,$0.00
48000053,EAP,CPT® 94621,,Pulm Exer Stress Test; Complex,"$1,369.00",$0.00,"$1,097.00",$0.00,$782.93,$0.00,$0.00,$782.93,$782.93,$0.00,"$1,097.00",$0.00,$548.50,$868.82,$877.60,$0.00,$0.00,$0.00,$0.00,$0.00
48000054,EAP,Custom 48000054,,Cpet Patient Interface Kit,$424.00,$0.00,$424.00,$0.00,$302.61,$0.00,$0.00,$302.61,$302.61,$0.00,$424.00,$0.00,$212.00,$335.81,$339.20,$0.00,$0.00,$0.00,$0.00,$0.00
48000055,EAP,Custom 48000055,,Analyze/ind/term Tachycardia,$254.00,$0.00,$254.00,$0.00,$181.28,$0.00,$0.00,$181.28,$181.28,$0.00,$254.00,$0.00,$127.00,$201.17,$203.20,$0.00,$0.00,$0.00,$0.00,$0.00
48000057,EAP,CPT® 92920,,Prq Cardiac Angioplast 1 Art,"$17,039.00",$0.00,"$17,039.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$17,039.00",$0.00,"$4,975.00","$13,494.89","$13,631.20",$0.00,$0.00,$0.00,$0.00,$0.00
48000058,EAP,CPT® 92921,,Prq Cardiac Angio Addl Art,"$27,233.00",$0.00,"$27,233.00",$0.00,"$5,158.80",$0.00,"$4,692.11","$5,158.80","$5,158.80","$4,768.28","$27,233.00",$0.00,"$13,616.50","$21,568.54","$21,786.40",$0.00,"$4,261.96",$0.00,$0.00,$0.00
48000059,EAP,CPT® 92928,,Prq Card Stent W/angio 1 Vsl,"$31,304.00",$0.00,"$31,304.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$31,304.00",$0.00,"$6,105.00","$24,792.77","$25,043.20",$0.00,$0.00,$0.00,$0.00,$0.00
48000060,EAP,CPT® 92929,,Prq Card Stent W/angio Addl,"$43,340.00",$0.00,"$43,340.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$43,340.00",$0.00,"$21,670.00","$34,325.28","$34,672.00",$0.00,$0.00,$0.00,$0.00,$0.00
48000061,EAP,CPT® 92937,,Prq Revasc Byp Graft 1 Vsl,"$13,838.00",$0.00,"$13,838.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$13,838.00",$0.00,"$6,105.00","$10,959.70","$11,070.40",$0.00,$0.00,$0.00,$0.00,$0.00
48000062,EAP,CPT® 92938,,Prq Revasc Byp Graft Addl,"$12,348.00",$0.00,"$12,348.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$12,348.00",$0.00,"$6,174.00","$9,779.62","$9,878.40",$0.00,$0.00,$0.00,$0.00,$0.00
48000063,EAP,CPT® 92941,,Prq Card Revasc Mi 1 Vsl,"$37,849.00",$0.00,"$37,849.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$37,849.00",$0.00,"$18,924.50","$29,976.41","$30,279.20",$0.00,$0.00,$0.00,$0.00,$0.00
48000064,EAP,CPT® 92943,,Prq Card Revasc Chronic 1vsl,"$28,322.00",$0.00,"$28,322.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$28,322.00",$0.00,"$6,105.00","$22,431.02","$22,657.60",$0.00,$0.00,$0.00,$0.00,$0.00
48000065,EAP,CPT® 92944,,Prq Card Revasc Chronic Addl,"$19,590.00",$0.00,"$19,590.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$19,590.00",$0.00,"$9,795.00","$15,515.28","$15,672.00",$0.00,$0.00,$0.00,$0.00,$0.00
48000066,EAP,CPT® 33223,,Relocation Skin  Pkt Cardiovert-defib,"$6,049.00",$0.00,"$6,049.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,049.00",$0.00,"$2,327.00","$4,790.81","$4,839.20",$0.00,$0.00,$0.00,$0.00,$0.00
48000067,EAP,CPT® 93261,,S-icd Interrog / Eval In Person,$209.00,$26.59,$167.00,$114.23,$119.19,$34.76,$28.77,$119.19,$119.19,$29.24,$167.00,$36.36,$83.50,$132.26,$133.60,$50.51,$58.66,$29.17,$26.59,$34.63
48000070,EAP,CPT® 92933,,Prq Trluml Coronary Angio/athe,"$20,271.00",$0.00,"$20,271.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$20,271.00",$0.00,"$6,105.00","$16,054.63","$16,216.80",$0.00,$0.00,$0.00,$0.00,$0.00
48000071,EAP,CPT® 33999,,Insertion Of Impella Device - Rp,"$13,507.00",$0.00,"$13,507.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$13,507.00",$0.00,"$2,255.00","$10,697.54","$10,805.60",$0.00,$0.00,$0.00,$0.00,$0.00
48000072,EAP,CPT® 93621,,Comp Ep Exam W/lt Atrial Pacing/record,"$12,625.00",$0.00,"$11,071.00","$5,163.90","$5,158.80",$0.00,"$1,907.48","$5,158.80","$5,158.80","$1,938.44","$11,071.00",$0.00,"$5,535.50","$8,768.23","$8,856.80",$0.00,"$1,732.61",$0.00,"$1,762.50",$0.00
48000110,EAP,CPT® 93297,,Icm Interrog / Eval Remote Up To 30 Days,$333.00,$0.00,$266.00,$0.00,$189.84,$0.00,$0.00,$189.84,$189.84,$0.00,$266.00,$0.00,$133.00,$210.67,$212.80,$0.00,$0.00,$0.00,$0.00,$0.00
48000111,EAP,CPT® 93298,,S-icd/loop Recorder Interrog / Eval Remote Up To 30 Days,$333.00,$28.13,$266.00,$51.37,$189.84,$34.76,$45.83,$189.84,$189.84,$46.57,$266.00,$36.36,$133.00,$210.67,$212.80,$28.13,$28.19,$28.13,$42.35,$34.63
48100001,EAP,CPT® 33240,,Insrt Icd Pulse Gen W Sngl Lead,"$29,050.00",$381.75,"$29,050.00","$5,163.90","$2,108.20","$21,779.39","$5,005.17","$2,108.20","$2,108.20","$5,086.42","$29,050.00","$22,779.64","$6,105.00","$23,007.60","$23,240.00","$29,050.00",$517.77,$381.75,"$4,624.76","$21,694.90"
48100003,EAP,CPT® 33249,,Insrt/repl Sgl/dual Icd Ld/gen,"$39,613.00",$959.62,"$39,613.00","$5,163.90","$5,158.80","$30,955.82","$6,825.12","$5,158.80","$5,158.80","$6,935.92","$39,613.00","$32,377.52","$6,105.00","$31,373.50","$31,690.40","$39,613.00","$1,016.82",$959.62,"$6,306.39","$30,835.73"
48100004,EAP,CPT® 92973,,Perc Coronary Thrombectomy,"$8,673.00",$0.00,"$8,673.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$8,673.00",$0.00,"$4,336.50","$6,869.02","$6,938.40",$0.00,$0.00,$0.00,$0.00,$0.00
48100006,EAP,CPT® 93505,,Endomyocardial Biopsy,"$3,323.00",$0.00,"$3,323.00",$0.00,"$2,371.63",$0.00,$572.54,"$2,371.63","$2,371.63",$581.83,"$3,323.00",$0.00,"$2,255.00","$2,631.82","$2,658.40",$0.00,$339.35,$0.00,$0.00,$0.00
48100020,EAP,CPT® 93561,,Therm Dilu Stdy Cardoutput Se,$261.00,$0.00,$246.00,$0.00,$175.57,$0.00,$0.00,$175.57,$175.57,$0.00,$246.00,$0.00,$246.00,$194.83,$196.80,$0.00,$0.00,$0.00,$0.00,$0.00
48100021,EAP,CPT® 93562,,Measure Card Output,$88.00,$0.00,$83.00,$0.00,$59.24,$0.00,$0.00,$59.24,$59.24,$0.00,$83.00,$0.00,$83.00,$65.74,$66.40,$0.00,$0.00,$0.00,$0.00,$0.00
48100022,EAP,CPT® 93571,,Intravasc Cornary Flow Measure,"$5,704.00",$0.00,"$5,408.00","$2,936.54","$3,859.69",$0.00,$931.77,"$3,859.69","$3,859.69",$946.90,"$5,408.00",$0.00,"$2,704.00","$4,283.14","$4,326.40",$0.00,$261.34,$0.00,$860.95,$0.00
48100023,EAP,CPT® 93572,,Intravasc Cor. Flow Addit Vess,"$5,637.00",$0.00,"$5,344.00","$2,901.79","$3,814.01",$0.00,$920.74,"$3,814.01","$3,814.01",$935.69,"$5,344.00",$0.00,"$2,672.00","$4,232.45","$4,275.20",$0.00,$239.81,$0.00,$850.76,$0.00
48100026,EAP,CPT® 33270,,Insert Subcutaneous Aicd,"$126,900.00",$574.64,"$126,900.00","$2,706.90","$5,158.80","$30,955.82","$8,138.89","$5,158.80","$5,158.80","$8,138.89","$126,900.00","$32,377.52","$6,105.00","$100,504.80","$101,520.00","$44,984.24",$574.64,$592.28,"$8,138.89","$30,835.73"
48100029,EAP,CPT® 93462,,Left Heart Cath By Transeptal Puncture,"$11,471.00",$0.00,"$9,960.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$9,960.00",$0.00,"$4,980.00","$7,888.32","$7,968.00",$0.00,$0.00,$0.00,$0.00,$0.00
48100030,EAP,CPT® 93451,,Right Heart Cath,"$20,836.00",$725.02,"$18,092.00","$9,334.50","$5,345.48","$2,732.82","$3,117.16","$5,345.48","$5,345.48","$3,167.76","$18,092.00","$2,858.33","$2,858.00","$14,328.86","$14,473.60","$3,971.26",$725.02,$725.39,"$2,880.25","$2,722.22"
48100031,EAP,CPT® 93452,,Lhc W/v Gram,"$20,836.00",$686.49,"$18,092.00","$9,334.50","$5,345.48","$2,732.82","$3,117.16","$5,345.48","$5,345.48","$3,167.76","$18,092.00","$2,858.33","$2,858.00","$14,328.86","$14,473.60","$3,971.26",$803.53,$686.49,"$2,880.25","$2,722.22"
48100032,EAP,CPT® 93453,,R/lhc W/v Gram (s&i),"$20,836.00",$0.00,"$18,092.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$18,092.00",$0.00,"$2,858.00","$14,328.86","$14,473.60",$0.00,$0.00,$0.00,$0.00,$0.00
48100033,EAP,CPT® 93454,,Coronary Angio W/o Lhc,"$20,836.00",$685.77,"$18,092.00","$9,334.50","$5,345.48","$2,732.82","$3,117.16","$5,345.48","$5,345.48","$3,167.76","$18,092.00","$2,858.33","$2,255.00","$14,328.86","$14,473.60","$3,971.26",$828.78,$685.77,"$2,880.25","$2,722.22"
48100034,EAP,CPT® 93455,,Coronary Angio W/o Lhc W/graft Inj,"$20,836.00",$0.00,"$18,092.00",$0.00,$0.00,$0.00,"$3,117.16",$0.00,$0.00,$0.00,"$18,092.00",$0.00,"$2,255.00","$14,328.86","$14,473.60",$0.00,$967.05,$0.00,$0.00,$0.00
48100035,EAP,CPT® 93456,,Rhc/coronary Angio W/o Lhc,"$20,836.00",$0.00,"$18,092.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$18,092.00",$0.00,"$2,858.00","$14,328.86","$14,473.60",$0.00,$0.00,$0.00,$0.00,$0.00
48100036,EAP,CPT® 93457,,Rhc/coronary Angio W/o Lhc W/graft Inj,"$20,836.00",$0.00,"$18,092.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$18,092.00",$0.00,"$2,858.00","$14,328.86","$14,473.60",$0.00,$0.00,$0.00,$0.00,$0.00
48100037,EAP,CPT® 33991,,Insert Vad Art&vein Access,"$34,511.00",$0.00,"$34,511.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$34,511.00",$0.00,"$17,255.50","$27,332.71","$27,608.80",$0.00,$0.00,$0.00,$0.00,$0.00
48100040,EAP,CPT® 93567,,Inj. Supravalvular Aortography,$187.00,$0.00,$177.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$177.00,$0.00,$88.50,$140.18,$141.60,$0.00,$0.00,$0.00,$0.00,$0.00
48100042,EAP,HCPCS G0278,,Iliac/fem Angio W/cardiac Cath,"$2,733.00",$0.00,"$2,733.00",$0.00,"$1,950.54",$0.00,$0.00,"$1,950.54","$1,950.54",$0.00,"$2,733.00",$0.00,"$1,366.50","$2,164.54","$2,186.40",$0.00,$0.00,$0.00,$0.00,$0.00
48100050,EAP,CPT® 33227,,Remove/repl Pcmkr W Sngl Ld,"$39,256.00",$0.00,"$39,256.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$39,256.00",$0.00,"$6,105.00","$31,090.75","$31,404.80",$0.00,$0.00,$0.00,$0.00,$0.00
48100051,EAP,CPT® 33229,,Remove/replac Pcmkr W Dual Ld,"$43,053.00",$0.00,"$43,053.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$43,053.00",$0.00,"$6,105.00","$34,097.98","$34,442.40",$0.00,$0.00,$0.00,$0.00,$0.00
48100052,EAP,CPT® 33229,,Remove/replac Pcmkr W Multi Ld,"$43,053.00",$0.00,"$43,053.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$43,053.00",$0.00,"$6,105.00","$34,097.98","$34,442.40",$0.00,$0.00,$0.00,$0.00,$0.00
48100053,EAP,CPT® 33230,,Insrt Icd W Exist Dual Lds,"$85,392.00",$0.00,"$85,392.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$85,392.00",$0.00,"$6,105.00","$67,630.46","$68,313.60",$0.00,$0.00,$0.00,$0.00,$0.00
48100054,EAP,CPT® 33231,,Insrt Icd W Exist Multi Lds,"$85,392.00",$0.00,"$85,392.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$85,392.00",$0.00,"$6,105.00","$67,630.46","$68,313.60",$0.00,$0.00,$0.00,$0.00,$0.00
48100055,EAP,CPT® 33262,,Remove/repl Icd W Sngl Ld,"$85,392.00",$351.54,"$85,392.00","$2,706.90","$5,158.80","$21,779.39","$8,138.89","$5,158.80","$5,158.80","$8,138.89","$85,392.00","$22,779.64","$6,105.00","$67,630.46","$68,313.60","$31,649.28",$351.54,$390.40,"$8,138.89","$21,694.90"
48100056,EAP,CPT® 33263,,Remove/repl Icd W Dual Lds,"$85,392.00",$365.37,"$85,392.00","$2,706.90","$5,158.80","$21,779.39","$8,138.89","$5,158.80","$5,158.80","$8,138.89","$85,392.00","$22,779.64","$6,105.00","$67,630.46","$68,313.60","$31,649.28",$365.37,$405.90,"$8,138.89","$21,694.90"
48100057,EAP,CPT® 33264,,Remove/repl Icd W Multi Lds,"$85,392.00",$0.00,"$85,392.00","$2,706.90","$5,158.80","$30,955.82",$0.00,"$5,158.80","$5,158.80",$0.00,"$85,392.00","$32,377.52","$6,105.00","$67,630.46","$68,313.60","$44,984.24",$0.00,$424.28,"$8,138.89","$30,835.73"
48100058,EAP,CPT® 33221,,Insrt Pcmkr Gen Only Exist Multi,"$43,053.00",$0.00,"$43,053.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$43,053.00",$0.00,"$6,105.00","$34,097.98","$34,442.40",$0.00,$0.00,$0.00,$0.00,$0.00
48100059,EAP,CPT® 33228,,Remv & Replc Pm Gen Dual Lead,"$41,752.00",$0.00,"$41,752.00","$2,706.90","$5,158.80","$9,830.59",$0.00,"$5,158.80","$5,158.80","$7,310.44","$41,752.00","$10,282.07","$6,105.00","$33,067.58","$33,401.60","$14,285.57",$0.00,$370.57,"$6,646.92","$9,792.45"
48100060,EAP,CPT® 93600,,Bundle Of Hils Recording,"$5,320.00",$0.00,"$5,320.00",$0.00,"$3,796.88",$0.00,$0.00,"$3,796.88","$3,796.88",$0.00,"$5,320.00",$0.00,"$2,660.00","$4,213.44","$4,256.00",$0.00,$0.00,$0.00,$0.00,$0.00
48100061,EAP,CPT® 93602,,Intra-atrial Recording,"$6,000.00",$0.00,"$6,000.00",$0.00,"$4,282.20",$0.00,$0.00,"$4,282.20","$4,282.20",$0.00,"$6,000.00",$0.00,"$3,000.00","$4,752.00","$4,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
48100062,EAP,CPT® 93603,,Right Ventricular Recording,"$9,546.00",$0.00,"$9,546.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$9,546.00",$0.00,"$4,773.00","$7,560.43","$7,636.80",$0.00,$0.00,$0.00,$0.00,$0.00
48100063,EAP,CPT® 93610,,Intra-atrial Pacing,"$6,000.00",$0.00,"$6,000.00",$0.00,"$4,282.20",$0.00,$0.00,"$4,282.20","$4,282.20",$0.00,"$6,000.00",$0.00,"$3,000.00","$4,752.00","$4,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
48100064,EAP,CPT® 93612,,Intra-ventricular Pacing,"$6,000.00",$0.00,"$6,000.00",$0.00,"$4,282.20",$0.00,$0.00,"$4,282.20","$4,282.20",$0.00,"$6,000.00",$0.00,"$3,000.00","$4,752.00","$4,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
48100065,EAP,CPT® 93618,,Induction Of Arrythmia By Electrial Pacing,"$4,835.00",$0.00,"$4,835.00",$0.00,"$3,450.74",$0.00,$0.00,"$3,450.74","$3,450.74",$0.00,"$4,835.00",$0.00,"$2,417.50","$3,829.32","$3,868.00",$0.00,$0.00,$0.00,$0.00,$0.00
48100066,EAP,CPT® 93624,,Follow-up Ep Study W/pacing & Recording,"$10,198.00",$0.00,"$10,198.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$10,198.00",$0.00,"$5,099.00","$8,076.82","$8,158.40",$0.00,$0.00,$0.00,$0.00,$0.00
48100067,EAP,CPT® 93619,,Complete Eps W/oinduction Of Arrhythmia,"$13,999.00",$0.00,"$13,999.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$13,999.00",$0.00,"$6,999.50","$11,087.21","$11,199.20",$0.00,$0.00,$0.00,$0.00,$0.00
48100068,EAP,CPT® 93620,,Complete Eps With Induction Arrhythmia,"$15,925.00",$0.00,"$15,925.00","$5,163.90","$5,158.80","$5,643.81","$2,743.80","$5,158.80","$5,158.80","$2,788.34","$15,925.00","$5,903.01","$7,962.50","$12,612.60","$12,740.00","$8,201.44","$1,092.52",$0.00,"$2,535.26","$5,621.91"
48100069,EAP,CPT® 93621,,Left Atrial Or Coronary Sinus Pacing & Recording,"$12,625.00",$0.00,"$12,625.00","$5,163.90","$5,158.80",$0.00,"$2,175.22","$5,158.80","$5,158.80","$2,210.54","$12,625.00",$0.00,"$6,312.50","$9,999.00","$10,100.00",$0.00,"$1,975.81",$0.00,"$2,009.90",$0.00
48100070,EAP,CPT® 93622,,Left Ventricular Pacing & Recording,"$12,007.00",$0.00,"$12,007.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$12,007.00",$0.00,"$6,003.50","$9,509.54","$9,605.60",$0.00,$0.00,$0.00,$0.00,$0.00
48100071,EAP,CPT® 93609,,Catheter Mapping Of Tachycardia,"$7,163.00",$0.00,"$7,163.00",$0.00,"$5,112.23",$0.00,$0.00,"$5,112.23","$5,112.23",$0.00,"$7,163.00",$0.00,"$3,581.50","$5,673.10","$5,730.40",$0.00,$0.00,$0.00,$0.00,$0.00
48100072,EAP,CPT® 93613,,Electrophys Map 3d,"$12,002.00",$0.00,"$12,002.00","$6,517.09","$5,158.80",$0.00,"$2,067.88","$5,158.80","$5,158.80","$2,101.45","$12,002.00",$0.00,"$6,001.00","$9,505.58","$9,601.60",$0.00,$373.18,$311.12,"$1,910.72",$0.00
48100073,EAP,CPT® 93623,,Program Stimulation And Pacing After Drug Infusion,"$7,071.00",$0.00,"$7,071.00","$3,839.55","$5,046.57",$0.00,"$1,218.30","$5,046.57","$5,046.57","$1,238.08","$7,071.00",$0.00,"$3,535.50","$5,600.23","$5,656.80",$0.00,$223.88,$0.00,"$1,125.70",$0.00
48100074,EAP,CPT® 93650,,Av Node Ablation,"$11,950.00",$0.00,"$11,950.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$11,950.00",$0.00,"$5,975.00","$9,464.40","$9,560.00",$0.00,$0.00,$0.00,$0.00,$0.00
48100077,EAP,CPT® 93662,,Intracardiac Echocardiography,"$5,568.00",$0.00,"$5,062.00",$0.00,"$3,612.75",$0.00,$0.00,"$3,612.75","$3,612.75",$0.00,"$5,062.00",$0.00,"$2,531.00","$4,009.10","$4,049.60",$0.00,$0.00,$0.00,$0.00,$0.00
48100078,EAP,CPT® 93631,,Heart Pacing Mapping,"$5,080.00",$0.00,"$5,080.00",$0.00,"$3,625.60",$0.00,$0.00,"$3,625.60","$3,625.60",$0.00,"$5,080.00",$0.00,"$2,540.00","$4,023.36","$4,064.00",$0.00,$0.00,$0.00,$0.00,$0.00
48100079,EAP,CPT® 37197,,Trans Cath Retrval Fb Inc S/i,"$32,988.00",$0.00,"$32,988.00","$2,706.90","$5,158.80","$2,657.38",$0.00,"$5,158.80","$5,158.80",$0.00,"$32,988.00","$2,779.42","$2,858.00","$26,126.50","$26,390.40","$3,861.64",$0.00,$315.16,"$5,251.69","$2,647.07"
48100080,EAP,CPT® 93653,,"Comp Ep Eval Inc Arrhyth Ind Ventric Pac, His Rec,  Cath Ablat","$37,635.00",$777.53,"$37,635.00","$5,163.90","$5,158.80","$19,595.38","$6,484.32","$5,158.80","$5,158.80","$6,589.59","$37,635.00","$20,495.33","$18,817.50","$29,806.92","$30,108.00","$28,475.53",$777.53,$875.69,"$5,991.49","$19,519.36"
48100081,EAP,CPT® 93654,,"Comp Ep Eval Inc Arrhyth Ind Ventric Pac, His Rec,  Cath Ablat W/tx Ve","$37,635.00",$0.00,"$37,635.00","$5,163.90","$5,158.80","$19,595.38",$0.00,"$5,158.80","$5,158.80","$6,589.59","$37,635.00","$20,495.33","$18,817.50","$29,806.92","$30,108.00","$28,475.53",$0.00,"$1,172.76","$5,991.49","$19,519.36"
48100082,EAP,CPT® 93655,,Ablatae Arrhythmia - Add On,"$37,635.00",$0.00,"$37,635.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$37,635.00",$0.00,"$18,817.50","$29,806.92","$30,108.00",$0.00,$0.00,$0.00,$0.00,$0.00
48100083,EAP,CPT® 93656,,"Comp Ep Eval Inc  Trans Sept Cath, Insert Elect Cath, Induct Arrhyth,","$37,635.00",$0.00,"$37,635.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$37,635.00",$0.00,"$18,817.50","$29,806.92","$30,108.00",$0.00,$0.00,$0.00,$0.00,$0.00
48100084,EAP,CPT® 93657,,Tx L/r Atrial Fib Addl,"$37,635.00",$0.00,"$37,635.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$37,635.00",$0.00,"$18,817.50","$29,806.92","$30,108.00",$0.00,$0.00,$0.00,$0.00,$0.00
48100085,EAP,CPT® 93530,,Rt Hearat Cath Congenital,"$20,015.00",$0.00,"$20,015.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$20,015.00",$0.00,"$2,255.00","$15,851.88","$16,012.00",$0.00,$0.00,$0.00,$0.00,$0.00
48100086,EAP,CPT® 93463,,MED ADMIN & HEMODYNAMIC MEASURMENT (W/NITRIC OXIDE),"$3,205.00",$0.00,"$3,205.00","$1,740.32","$3,205.00",$0.00,$552.21,"$3,205.00","$3,205.00",$561.17,"$3,205.00",$0.00,"$1,602.50","$2,538.36","$2,564.00",$0.00,$101.49,$101.70,$510.24,$0.00
48100090,EAP,CPT® 93581,,Percut Trans Cath Close Congent Ventric Sept Defect W/ T,"$20,314.00",$0.00,"$19,260.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$19,260.00",$0.00,"$6,105.00","$15,253.92","$15,408.00",$0.00,$0.00,$0.00,$0.00,$0.00
48100091,EAP,CPT® 93582,,Percut Trans Cath Close Patent Duct Arteriosus,"$23,055.00",$0.00,"$21,858.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$21,858.00",$0.00,"$6,105.00","$17,311.54","$17,486.40",$0.00,$0.00,$0.00,$0.00,$0.00
48100092,EAP,CPT® 93583,,Percut Trans Cath Septal Reduct Therpy (alcohol Sept Ab,"$32,354.00",$0.00,"$32,354.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$32,354.00",$0.00,"$16,177.00","$25,624.37","$25,883.20",$0.00,$0.00,$0.00,$0.00,$0.00
48100095,EAP,CPT® 93566,,Inject R Ventr/atrial Angio,"$3,664.00",$0.00,"$3,664.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,664.00",$0.00,"$1,832.00","$2,901.89","$2,931.20",$0.00,$0.00,$0.00,$0.00,$0.00
48100096,EAP,CPT® 93568,,Inject Pulm Art Hrt Cath,"$3,476.00",$0.00,"$3,281.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,281.00",$0.00,"$1,640.50","$2,598.55","$2,624.80",$0.00,$0.00,$0.00,$0.00,$0.00
48100097,EAP,CPT® 92998,,Pulmonary Artery Pta Add'l Vessel,"$13,019.00",$0.00,"$13,019.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$13,019.00",$0.00,"$2,255.00","$10,311.05","$10,415.20",$0.00,$0.00,$0.00,$0.00,$0.00
48100098,EAP,CPT® 92924,,Coronary Atherectomy,"$24,330.00",$0.00,"$24,330.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$24,330.00",$0.00,"$6,105.00","$19,269.36","$19,464.00",$0.00,$0.00,$0.00,$0.00,$0.00
48100099,EAP,CPT® 92925,,Atherectomy Add'l Vessel,"$24,330.00",$0.00,"$24,330.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$24,330.00",$0.00,"$12,165.00","$19,269.36","$19,464.00",$0.00,$0.00,$0.00,$0.00,$0.00
48100100,EAP,CPT® 93568,,Inj. Proc During Cath Pulmonary Angiography,"$3,476.00",$0.00,"$3,281.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,281.00",$0.00,"$1,640.50","$2,598.55","$2,624.80",$0.00,$0.00,$0.00,$0.00,$0.00
48100101,EAP,CPT® 93566,,Inject Pro. During Cath/rv/ra./s&i,"$3,664.00",$0.00,"$3,664.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,664.00",$0.00,"$1,832.00","$2,901.89","$2,931.20",$0.00,$0.00,$0.00,$0.00,$0.00
48100102,EAP,CPT® 93565,,Inj. Pro During Cath/lv/la/s&i,"$2,686.00",$0.00,"$2,686.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,686.00",$0.00,"$1,343.00","$2,127.31","$2,148.80",$0.00,$0.00,$0.00,$0.00,$0.00
48100103,EAP,CPT® 33990,,Insertion Of Impella Device - Cp,"$34,511.00",$0.00,"$34,511.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$34,511.00",$0.00,"$17,255.50","$27,332.71","$27,608.80",$0.00,$0.00,$0.00,$0.00,$0.00
48100104,EAP,CPT® 33992,,Removal Of Impella,"$12,639.00",$0.00,"$12,639.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$12,639.00",$0.00,"$6,319.50","$10,010.09","$10,111.20",$0.00,$0.00,$0.00,$0.00,$0.00
48100105,EAP,CPT® 33993,,Respositioning Of Impella,"$18,959.00",$0.00,"$18,959.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$18,959.00",$0.00,"$9,479.50","$15,015.53","$15,167.20",$0.00,$0.00,$0.00,$0.00,$0.00
48100106,EAP,CPT® 34812,,Open Of Femoral Artery,"$8,696.00",$0.00,"$8,696.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$8,696.00",$0.00,"$2,255.00","$6,887.23","$6,956.80",$0.00,$0.00,$0.00,$0.00,$0.00
48100107,EAP,HCPCS 93531,,R & L Heart Cath Congenital,"$29,098.00",$0.00,"$29,098.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$29,098.00",$0.00,"$2,858.00","$23,045.62","$23,278.40",$0.00,$0.00,$0.00,$0.00,$0.00
48100108,EAP,HCPCS 93563,,Inject Congenital Card Cath,"$4,037.00",$0.00,"$3,811.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,811.00",$0.00,"$1,905.50","$3,018.31","$3,048.80",$0.00,$0.00,$0.00,$0.00,$0.00
48100109,EAP,CPT® 33947,,Ecmo/ecls Initiation Artery,"$7,557.00",$0.00,"$4,571.00",$0.00,"$3,262.32",$0.00,$0.00,"$3,262.32","$3,262.32",$0.00,"$4,571.00",$0.00,"$2,255.00","$3,620.23","$3,656.80",$0.00,$0.00,$0.00,$0.00,$0.00
48100110,EAP,CPT® 33947,,Ecmo/ecls Insj Prph Cannula,"$7,557.00",$0.00,"$6,875.00",$0.00,"$4,906.69",$0.00,$0.00,"$4,906.69","$4,906.69",$0.00,"$6,875.00",$0.00,"$2,255.00","$5,445.00","$5,500.00",$0.00,$0.00,$0.00,$0.00,$0.00
48100111,EAP,CPT® 36901,,Intro Cath Dialysis Circuit,"$3,480.00",$0.00,"$3,087.00",$0.00,"$2,203.19",$0.00,$531.87,"$2,203.19","$2,203.19",$0.00,"$3,087.00",$0.00,"$2,255.00","$2,444.90","$2,469.60",$0.00,$550.60,$0.00,$0.00,$0.00
48100112,EAP,CPT® 36902,,Intro Cath Dialysis Circuit; W Angio,"$17,224.00",$0.00,"$15,279.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$15,279.00",$0.00,"$4,975.00","$12,100.97","$12,223.20",$0.00,$0.00,$0.00,$0.00,$0.00
48100113,EAP,CPT® 36903,,Intro Cath Dialysis Circuit; W Trans Intra Stent,"$34,811.00",$0.00,"$30,881.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$30,881.00",$0.00,"$6,105.00","$24,457.75","$24,704.80",$0.00,$0.00,$0.00,$0.00,$0.00
48100114,EAP,CPT® 36904,,Thrmbc/nfs Dialysis Circuit,"$17,224.00",$0.00,"$15,279.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$15,279.00",$0.00,"$4,975.00","$12,100.97","$12,223.20",$0.00,$0.00,$0.00,$0.00,$0.00
48100115,EAP,CPT® 36905,,Thrmbc/nfs Dialysis Circuit; W Angio,"$34,811.00",$0.00,"$30,881.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$30,881.00",$0.00,"$6,105.00","$24,457.75","$24,704.80",$0.00,$0.00,$0.00,$0.00,$0.00
48100116,EAP,CPT® 36906,,Thrmbc/nfs Dialysis Circuit; W Trans Intra Stent,"$52,765.00",$0.00,"$46,807.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$46,807.00",$0.00,"$6,105.00","$37,071.14","$37,445.60",$0.00,$0.00,$0.00,$0.00,$0.00
48100117,EAP,CPT® 36907,,Balo Angiop Ctr Dialysis Seg,"$3,480.00",$0.00,"$3,087.00",$0.00,"$2,203.19",$0.00,$0.00,"$2,203.19","$2,203.19",$0.00,"$3,087.00",$0.00,"$1,543.50","$2,444.90","$2,469.60",$0.00,$0.00,$0.00,$0.00,$0.00
48100118,EAP,CPT® 37246,,Trluml Balo Angiop 1st Art,"$15,178.00",$0.00,"$15,178.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$15,178.00",$0.00,"$4,975.00","$12,020.98","$12,142.40",$0.00,$0.00,$0.00,$0.00,$0.00
48100119,EAP,CPT® 37247,,Trluml Balo Angiop Addl Art,"$7,590.00",$0.00,"$7,590.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$7,590.00",$0.00,"$3,795.00","$6,011.28","$6,072.00",$0.00,$0.00,$0.00,$0.00,$0.00
48100120,EAP,CPT® 37248,,Trluml Balo Angiop 1st Vein,"$15,178.00",$0.00,"$15,178.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$15,178.00",$0.00,"$4,975.00","$12,020.98","$12,142.40",$0.00,$0.00,$0.00,$0.00,$0.00
48100121,EAP,CPT® 37249,,Trluml Balo Angiop Addl Vein,"$7,590.00",$0.00,"$7,590.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$7,590.00",$0.00,"$3,795.00","$6,011.28","$6,072.00",$0.00,$0.00,$0.00,$0.00,$0.00
48100122,EAP,CPT® 36908,,Tcat Plmt Iv Stent Ctr Dialysis Seg W/img S&i,"$3,096.00",$0.00,"$2,746.00",$0.00,"$1,959.82",$0.00,$0.00,"$1,959.82","$1,959.82",$0.00,"$2,746.00",$0.00,"$1,373.00","$2,174.83","$2,196.80",$0.00,$0.00,$0.00,$0.00,$0.00
48100123,EAP,CPT® 36909,,Dialyis Circuit Vasc Emboli Occls Evasc Img S&i,"$3,096.00",$0.00,"$2,746.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,746.00",$0.00,"$1,373.00","$2,174.83","$2,196.80",$0.00,$0.00,$0.00,$0.00,$0.00
48100124,EAP,CPT® 62321,,Njx Dx/ther Sbst Intrlmnr Crv/thrc W/img Gdn,"$1,316.00",$111.42,"$1,316.00","$1,316.00",$939.23,$599.36,$226.74,$939.23,$939.23,$230.42,"$1,316.00",$626.89,"$1,316.00","$1,042.27","$1,052.80",$870.98,$240.25,$111.42,$209.51,$597.04
48100125,EAP,CPT® 62323,,Njx Dx/ther Sbst Intrlmnr Lmbr/sac W/img Gdn,"$1,316.00",$103.13,"$1,316.00","$1,316.00",$939.23,$599.36,$226.74,$939.23,$939.23,$230.42,"$1,316.00",$626.89,"$1,316.00","$1,042.27","$1,052.80",$870.98,$235.81,$103.13,$209.51,$597.04
48100126,EAP,HCPCS C9600,,Perc Drug-eluting Cor Stent; Single Vessel,"$28,988.00",$0.00,"$23,352.00","$12,680.14","$5,158.80","$9,501.24","$4,023.43","$5,158.80","$5,158.80","$4,088.75","$23,352.00","$9,937.60","$11,676.00","$18,494.78","$18,681.60","$13,806.97","$3,654.59",$0.00,"$3,717.64","$9,464.38"
48100127,EAP,HCPCS C9601,,Perc Drug-eluting Cor Stent; Ea Addl Branch,"$24,606.00",$0.00,"$19,822.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$19,822.00",$0.00,"$9,911.00","$15,699.02","$15,857.60",$0.00,$0.00,$0.00,$0.00,$0.00
48100128,EAP,HCPCS C9602,,Perc Drug-eluting Cor Stent & Atherect; Singl Vess,"$24,606.00",$0.00,"$19,822.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$19,822.00",$0.00,"$9,911.00","$15,699.02","$15,857.60",$0.00,$0.00,$0.00,$0.00,$0.00
48100129,EAP,HCPCS C9603,,Perc Drug-eluting Cor Stent & Atherect; Ea Addl Br,"$26,843.00",$0.00,"$21,624.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$21,624.00",$0.00,"$10,812.00","$17,126.21","$17,299.20",$0.00,$0.00,$0.00,$0.00,$0.00
48100130,EAP,HCPCS C9604,,Perc Drug-eluting Cor Revasc Of Or Thro Cabg;sing,"$25,334.00",$0.00,"$20,408.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$20,408.00",$0.00,"$10,204.00","$16,163.14","$16,326.40",$0.00,$0.00,$0.00,$0.00,$0.00
48100131,EAP,HCPCS C9605,,Perc Drug-eluting Cor Revasc Of Or Thr Cabg; Ea Ad,"$24,606.00",$0.00,"$19,822.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$19,822.00",$0.00,"$9,911.00","$15,699.02","$15,857.60",$0.00,$0.00,$0.00,$0.00,$0.00
48100132,EAP,HCPCS C9606,,Perc Drug-eluting Cor W/ Ami;single Ves,"$26,871.00",$0.00,"$21,646.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$21,646.00",$0.00,"$10,823.00","$17,143.63","$17,316.80",$0.00,$0.00,$0.00,$0.00,$0.00
48100133,EAP,HCPCS C9607,,Perc Drug-eluting Cor Revasc Cto;single Vess,"$24,606.00",$0.00,"$19,822.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$19,822.00",$0.00,"$9,911.00","$15,699.02","$15,857.60",$0.00,$0.00,$0.00,$0.00,$0.00
48100134,EAP,HCPCS C9608,,Perc Drug-eluting Cor Revasc Cto; Ea Addl Vessel,"$25,448.00",$0.00,"$20,500.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$20,500.00",$0.00,"$10,250.00","$16,236.00","$16,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
48100136,EAP,CPT® 33272,,Removal Sq Implant Defib Electrode,"$10,938.00",$0.00,"$10,938.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$10,938.00",$0.00,"$2,858.00","$8,662.90","$8,750.40",$0.00,$0.00,$0.00,$0.00,$0.00
48100140,EAP,CPT® 33274,,Transcath Insj/rpl Perm Leadless Pm Rv W/img,"$42,434.00",$0.00,"$42,434.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$42,434.00",$0.00,"$6,105.00","$33,607.73","$33,947.20",$0.00,$0.00,$0.00,$0.00,$0.00
48200001,EAP,CPT® 93017,,STRESS ECHO,"$3,621.00",$34.22,"$3,621.00",$75.03,"$2,584.31",$241.94,$623.88,"$2,584.31","$2,584.31",$634.01,"$3,621.00",$253.05,"$1,810.50","$2,867.83","$2,896.80",$351.58,$64.64,$34.22,$576.46,$241.00
48200002,EAP,CPT® 93017,,Cardiac Stress Test,"$3,621.00",$34.22,"$3,621.00",$75.03,"$2,584.31",$241.94,$623.88,"$2,584.31","$2,584.31",$634.01,"$3,621.00",$253.05,"$1,810.50","$2,867.83","$2,896.80",$351.58,$64.64,$34.22,$576.46,$241.00
48300001,EAP,CPT® 93306,,"Tte, Complete","$4,351.00",$136.14,"$3,955.00",$435.94,"$2,822.68",$461.79,$195.39,"$2,822.68","$2,822.68",$692.49,"$3,955.00",$483.00,"$1,977.50","$3,132.36","$3,164.00",$671.06,$254.50,$136.14,$629.64,$460.00
48300003,EAP,CPT® 93308,,Tte. Limited,"$2,576.00",$74.20,"$2,342.00",$238.58,$197.85,$223.46,$403.51,$197.85,$197.85,$410.07,"$2,342.00",$233.72,"$1,171.00","$1,854.86","$1,873.60",$324.73,$108.83,$74.20,$372.85,$222.60
48300004,EAP,CPT® 93350,,Echo W/stress Test,"$3,694.00",$118.63,"$3,694.00",$459.58,$315.67,$461.79,$636.46,$315.67,$315.67,$646.79,"$3,694.00",$483.00,"$1,847.00","$2,925.65","$2,955.20",$671.06,$118.63,$120.30,$588.08,$460.00
48300005,EAP,CPT® 93303,,Transthoracic Echo For Congenital Anomalies,"$2,707.00",$0.00,"$2,461.00",$0.00,$357.76,$0.00,$0.00,$357.76,$357.76,$0.00,"$2,461.00",$0.00,"$1,230.50","$1,949.11","$1,968.80",$0.00,$0.00,$0.00,$0.00,$0.00
48300006,EAP,CPT® 93304,,Transthoracic Echo Follow-up Limited Study,"$1,694.00",$0.00,"$1,540.00",$0.00,$230.14,$0.00,$0.00,$230.14,$230.14,$0.00,"$1,540.00",$0.00,$770.00,"$1,219.68","$1,232.00",$0.00,$0.00,$0.00,$0.00,$0.00
48300007,EAP,HCPCS C8924,,Tte 2d W Or W/o Fol W/contrast; Follow-up Or Ltd,"$2,857.00",$0.00,"$2,597.00","$1,410.17","$1,853.48",$370.02,$447.45,"$1,853.48","$1,853.48",$454.71,"$2,597.00",$387.01,"$1,298.50","$2,056.82","$2,077.60",$537.70,$406.43,$0.00,$413.44,$368.58
48300008,EAP,HCPCS C8929,,Tte 2d W Or W/o Fol W/contrast; Doppler,"$4,630.00",$0.00,"$4,209.00","$2,285.49","$3,003.96",$663.32,$725.19,"$3,003.96","$3,003.96",$736.96,"$4,209.00",$693.78,"$2,104.50","$3,333.53","$3,367.20",$963.92,$658.71,$0.00,$670.07,$660.75
48300009,EAP,CPT® 93321,,Doppler Echo Exam Heart (add-on),$660.00,$0.00,$600.00,$0.00,$63.36,$0.00,$0.00,$63.36,$63.36,$0.00,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$0.00,$0.00,$0.00,$0.00
49000001,EAP,CPT® 59821,,Trmt Of Missed Abort.-2nd Trim,"$3,666.00",$0.00,"$3,666.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,666.00",$0.00,"$3,666.00","$2,903.47","$2,932.80",$0.00,$0.00,$0.00,$0.00,$0.00
51000003,EAP,CPT® 19499,,"Duct Lav Ea Brst, Sing Duct","$6,124.00",$0.00,"$6,124.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,124.00",$0.00,"$2,255.00","$4,850.21","$4,899.20",$0.00,$0.00,$0.00,$0.00,$0.00
51000004,EAP,CPT® 23500,,Shoulder-clavicular,"$1,037.00",$0.00,"$1,037.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,037.00",$0.00,"$1,037.00",$821.30,$829.60,$0.00,$0.00,$0.00,$0.00,$0.00
51000005,EAP,CPT® 23540,,Treat Clavicle Dislocation,$815.00,$0.00,$815.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$815.00,$0.00,$815.00,$645.48,$652.00,$0.00,$0.00,$0.00,$0.00,$0.00
51000006,EAP,CPT® 23620,,Humerus-proximal,"$1,069.00",$0.00,"$1,069.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,069.00",$0.00,"$1,069.00",$846.65,$855.20,$0.00,$0.00,$0.00,$0.00,$0.00
51000007,EAP,CPT® 23675,,Humerus-neck,"$1,550.00",$0.00,"$1,550.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,550.00",$0.00,"$1,550.00","$1,227.60","$1,240.00",$0.00,$0.00,$0.00,$0.00,$0.00
51000008,EAP,CPT® 24500,,Humerus-shaft,$712.00,$0.00,$712.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$712.00,$0.00,$712.00,$563.90,$569.60,$0.00,$0.00,$0.00,$0.00,$0.00
51000009,EAP,CPT® 24530,,Humerus-condyle-supra,"$1,069.00",$0.00,"$1,069.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,069.00",$0.00,"$1,069.00",$846.65,$855.20,$0.00,$0.00,$0.00,$0.00,$0.00
51000010,EAP,CPT® 24560,,Humerus-distal Closed,"$1,010.00",$0.00,"$1,010.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,010.00",$0.00,"$1,010.00",$799.92,$808.00,$0.00,$0.00,$0.00,$0.00,$0.00
51000011,EAP,CPT® 24576,,Humerus-condyle-medial,"$1,088.00",$0.00,"$1,088.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,088.00",$0.00,"$1,088.00",$861.70,$870.40,$0.00,$0.00,$0.00,$0.00,$0.00
51000012,EAP,CPT® 24650,,Elbow-radial Head,"$1,097.00",$0.00,"$1,097.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,097.00",$0.00,"$1,097.00",$868.82,$877.60,$0.00,$0.00,$0.00,$0.00,$0.00
51000013,EAP,CPT® 24670,,Elbow-olecranon,"$1,010.00",$0.00,"$1,010.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,010.00",$0.00,"$1,010.00",$799.92,$808.00,$0.00,$0.00,$0.00,$0.00,$0.00
51000014,EAP,CPT® 25530,,Forearm-ulnar Shaft,"$1,203.00",$0.00,"$1,203.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,203.00",$0.00,"$1,203.00",$952.78,$962.40,$0.00,$0.00,$0.00,$0.00,$0.00
51000015,EAP,CPT® 25560,,Forearm-both Bones,$903.00,$0.00,$903.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$903.00,$0.00,$903.00,$715.18,$722.40,$0.00,$0.00,$0.00,$0.00,$0.00
51000016,EAP,CPT® 25600,,Wrist-colles,"$1,180.00",$0.00,"$1,180.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,180.00",$0.00,"$1,180.00",$934.56,$944.00,$0.00,$0.00,$0.00,$0.00,$0.00
51000017,EAP,CPT® 25622,,Wrist-scaphoid,"$1,091.00",$0.00,"$1,091.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,091.00",$0.00,"$1,091.00",$864.07,$872.80,$0.00,$0.00,$0.00,$0.00,$0.00
51000018,EAP,CPT® 25630,,Wrist-capitate,"$1,155.00",$0.00,"$1,155.00","$1,155.00",$0.00,$206.78,$199.00,$0.00,$0.00,$202.23,"$1,155.00",$216.27,"$1,155.00",$914.76,$924.00,$300.48,$266.34,$293.00,$183.88,$205.98
51000019,EAP,CPT® 26600,,Hand-metacarpal Bone,"$1,078.00",$0.00,"$1,078.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,078.00",$0.00,"$1,078.00",$853.78,$862.40,$0.00,$0.00,$0.00,$0.00,$0.00
51000020,EAP,CPT® 26750,,Hand-phallax,"$1,035.00",$0.00,"$1,035.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,035.00",$0.00,"$1,035.00",$819.72,$828.00,$0.00,$0.00,$0.00,$0.00,$0.00
51000021,EAP,CPT® 27750,,Tibia-proximal,"$1,133.00",$0.00,"$1,133.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,133.00",$0.00,"$1,133.00",$897.34,$906.40,$0.00,$0.00,$0.00,$0.00,$0.00
51000022,EAP,CPT® 27760,,Ankle-medical Malleolus,$720.00,$0.00,$720.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$720.00,$0.00,$720.00,$570.24,$576.00,$0.00,$0.00,$0.00,$0.00,$0.00
51000023,EAP,CPT® 27780,,Tiba-distal,"$1,119.00",$0.00,"$1,119.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,119.00",$0.00,"$1,119.00",$886.25,$895.20,$0.00,$0.00,$0.00,$0.00,$0.00
51000024,EAP,CPT® 27786,,Ankle-lateral Malleolus,"$1,153.00",$0.00,"$1,153.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,153.00",$0.00,"$1,153.00",$913.18,$922.40,$0.00,$0.00,$0.00,$0.00,$0.00
51000025,EAP,CPT® 27808,,Treatment Of Ankle Fracture,"$1,087.00",$0.00,"$1,087.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,087.00",$0.00,"$1,087.00",$860.90,$869.60,$0.00,$0.00,$0.00,$0.00,$0.00
51000026,EAP,CPT® 28470,,Foot-metatarsal,$981.00,$0.00,$981.00,$981.00,$0.00,$206.78,$169.02,$0.00,$0.00,$171.77,$981.00,$216.27,$981.00,$776.95,$784.80,$300.48,$214.80,$210.83,$156.18,$205.98
51000027,EAP,CPT® 28510,,Treatment Of Toe Fracture,$981.00,$0.00,$981.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$981.00,$0.00,$981.00,$776.95,$784.80,$0.00,$0.00,$0.00,$0.00,$0.00
51000028,EAP,CPT® 29105,,Long Arm Splint,$859.00,$0.00,$859.00,$466.44,$0.00,$128.24,$148.00,$0.00,$0.00,$150.40,$859.00,$134.13,$859.00,$680.33,$687.20,$186.36,$94.27,$43.63,$136.75,$127.75
51000029,EAP,CPT® 29125,,"Splint, Short Arm",$952.00,$0.00,$952.00,$516.94,$0.00,$104.55,$164.02,$0.00,$0.00,$166.69,$952.00,$109.35,$952.00,$753.98,$761.60,$151.93,$72.40,$40.73,$151.56,$104.14
51000030,EAP,CPT® 29130,,"Splint, Finger",$859.00,$0.00,$859.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$859.00,$0.00,$859.00,$680.33,$687.20,$0.00,$0.00,$0.00,$0.00,$0.00
51000031,EAP,CPT® 29505,,Long Leg Splint,"$1,535.00",$0.00,"$1,535.00",$833.51,$0.00,$128.24,$264.47,$0.00,$0.00,$268.77,"$1,535.00",$134.13,"$1,535.00","$1,215.72","$1,228.00",$186.36,$94.49,$52.27,$244.37,$127.75
51000032,EAP,CPT® 29515,,"Splint, Short Leg",$888.00,$0.00,$888.00,$482.18,$0.00,$128.24,$153.00,$0.00,$0.00,$155.48,$888.00,$134.13,$888.00,$703.30,$710.40,$186.36,$80.51,$51.19,$141.37,$127.75
51000036,EAP,CPT® 51702,,Cath Insert Indwelling,"$1,069.00",$0.00,"$1,069.00","$1,069.00",$0.00,$104.55,$184.18,$0.00,$0.00,$187.17,"$1,069.00",$109.35,"$1,069.00",$846.65,$855.20,$151.93,$91.18,$26.68,$170.18,$104.14
51000038,EAP,CPT® 59070,,Amnio Infusion (adb),$443.00,$0.00,$443.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$443.00,$0.00,$443.00,$350.86,$354.40,$0.00,$0.00,$0.00,$0.00,$0.00
51000039,EAP,CPT® 59899,,Maternity Care Procedure,$183.00,$0.00,$183.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$183.00,$0.00,$183.00,$144.94,$146.40,$0.00,$0.00,$0.00,$0.00,$0.00
51000041,EAP,CPT® 92002,,"Ophalmol Exam, Inter, Np",$245.00,$0.00,$299.34,$0.00,$299.34,$111.17,$67.13,$299.34,$299.34,$42.90,$245.00,$116.27,$122.50,$194.04,$196.00,$161.54,$60.73,$48.33,$39.00,$110.73
51000042,EAP,CPT® 92004,,"Opthalmol Exam, Compre, Np",$404.00,$0.00,$404.00,$0.00,$299.34,$111.17,$67.13,$299.34,$299.34,$70.74,$404.00,$116.27,$202.00,$319.97,$323.20,$161.54,$101.46,$99.90,$64.32,$110.73
51000043,EAP,CPT® 92012,,"Opthalmol Exam, Inter, Ep",$222.00,$0.00,$299.34,$0.00,$299.34,$111.17,$67.13,$299.34,$299.34,$38.87,$222.00,$116.27,$111.00,$175.82,$177.60,$161.54,$51.64,$53.01,$35.34,$110.73
51000044,EAP,CPT® 92014,,"Opthalmol Exam, Compre, Ep",$374.00,$0.00,$374.00,$0.00,$299.34,$111.17,$67.13,$299.34,$299.34,$65.48,$374.00,$116.27,$187.00,$296.21,$299.20,$161.54,$74.47,$80.42,$59.54,$110.73
51000046,EAP,CPT® 92020,,Gonioscopy Exam,$268.00,$0.00,$299.34,$0.00,$299.34,$104.55,$67.13,$299.34,$299.34,$46.92,$268.00,$109.35,$134.00,$212.26,$214.40,$151.93,$33.89,$21.28,$42.67,$104.14
51000050,EAP,CPT® 96372,,Inject-im/sq Only,$245.00,$14.42,$223.00,$121.09,$159.16,$57.98,$38.42,$159.16,$159.16,$39.05,$223.00,$60.65,$111.50,$176.62,$178.40,$84.26,$20.00,$14.42,$35.50,$57.76
51000057,EAP,CPT® 99201,,Visit Level 1 - Np,$329.00,$0.00,$329.00,$0.00,$299.34,$111.17,$67.13,$299.34,$299.34,$57.61,$329.00,$116.27,$164.50,$260.57,$263.20,$27.04,$108.52,$0.00,$99.16,$110.73
51000058,EAP,CPT® 99202,,Visit Level 2 - Np,$378.00,$0.00,$378.00,$0.00,$299.34,$111.17,$67.13,$299.34,$299.34,$66.18,$378.00,$116.27,$189.00,$299.38,$302.40,$51.57,$108.52,$0.00,$99.16,$110.73
51000059,EAP,CPT® 99203,,Visit Level 3 - Np,$442.00,$0.00,$442.00,$0.00,$299.34,$111.17,$67.13,$299.34,$299.34,$77.39,$442.00,$116.27,$221.00,$350.06,$353.60,$77.17,$108.52,$0.00,$99.16,$110.73
51000060,EAP,CPT® 99204,,Visit Level 4 - Np,$569.00,$0.00,$569.00,$0.00,$299.34,$111.17,$67.13,$299.34,$299.34,$99.63,$569.00,$116.27,$284.50,$450.65,$455.20,$131.98,$108.52,$0.00,$99.16,$110.73
51000061,EAP,CPT® 99205,,Visit Level 5-np,$686.00,$0.00,$686.00,$0.00,$299.34,$111.17,$67.13,$299.34,$299.34,$120.11,$686.00,$116.27,$343.00,$543.31,$548.80,$172.37,$108.52,$0.00,$99.16,$110.73
51000062,EAP,CPT® 99211,,Visit Level 1 - Ep,$290.00,$0.00,$299.34,$0.00,$299.34,$111.17,$67.13,$299.34,$299.34,$50.78,$290.00,$116.27,$145.00,$229.68,$232.00,$9.38,$108.52,$0.00,$99.16,$110.73
51000063,EAP,CPT® 99212,,Visit Level 2-ep,$313.00,$0.00,$313.00,$0.00,$299.34,$111.17,$67.13,$299.34,$299.34,$54.80,$313.00,$116.27,$156.50,$247.90,$250.40,$26.32,$108.52,$0.00,$99.16,$110.73
51000064,EAP,CPT® 99213,,Visit Level 3-ep,$399.00,$0.00,$399.00,$0.00,$299.34,$111.17,$67.13,$299.34,$299.34,$69.86,$399.00,$116.27,$199.50,$316.01,$319.20,$52.29,$108.52,$0.00,$99.16,$110.73
51000065,EAP,CPT® 99214,,Visit Level 4-ep,$491.00,$0.00,$491.00,$0.00,$299.34,$111.17,$67.13,$299.34,$299.34,$85.97,$491.00,$116.27,$245.50,$388.87,$392.80,$80.42,$108.52,$0.00,$99.16,$110.73
51000066,EAP,CPT® 99215,,Visit Level 5-ep,$541.00,$0.00,$541.00,$0.00,$299.34,$111.17,$67.13,$299.34,$299.34,$94.72,$541.00,$116.27,$270.50,$428.47,$432.80,$113.60,$108.52,$0.00,$99.16,$110.73
51000086,EAP,HCPCS G0127,,Trim Of Dystrophic Nail(s),$122.00,$0.00,$122.00,$66.25,$0.00,$52.75,$21.02,$0.00,$0.00,$21.36,$122.00,$55.17,$122.00,$96.62,$97.60,$76.65,$19.09,$7.94,$19.42,$52.54
51000087,EAP,HCPCS G0402,,New Medicare Phys Exam,$369.00,$0.00,$369.00,$0.00,$299.34,$111.17,$67.13,$299.34,$299.34,$64.61,$369.00,$116.27,$184.50,$292.25,$295.20,$161.54,$57.75,$129.11,$58.74,$110.73
51000090,EAP,Custom 51000090,,Annual Health Screen,$168.00,$0.00,$299.34,$0.00,$299.34,$0.00,$0.00,$299.34,$299.34,$0.00,$168.00,$0.00,$84.00,$133.06,$134.40,$0.00,$0.00,$0.00,$0.00,$0.00
51000157,EAP,CPT® 99201,,Visit Level Bccp 1 - Np,$329.00,$0.00,$329.00,$0.00,$299.34,$111.17,$67.13,$299.34,$299.34,$57.61,$329.00,$116.27,$164.50,$260.57,$263.20,$27.04,$108.52,$27.04,$99.16,$110.73
51000158,EAP,CPT® 99202,,Visit Level Bccp 2 - Np,$378.00,$0.00,$378.00,$0.00,$299.34,$111.17,$67.13,$299.34,$299.34,$66.18,$378.00,$116.27,$189.00,$299.38,$302.40,$51.57,$108.52,$51.57,$99.16,$110.73
51000159,EAP,CPT® 99203,,Visit Level Bccp 3 - Np,$442.00,$0.00,$442.00,$0.00,$299.34,$111.17,$67.13,$299.34,$299.34,$77.39,$442.00,$116.27,$221.00,$350.06,$353.60,$77.17,$108.52,$77.17,$99.16,$110.73
51000161,EAP,CPT® 99205,,Visit Level Bccp 5-np,$686.00,$0.00,$686.00,$0.00,$299.34,$111.17,$67.13,$299.34,$299.34,$120.11,$686.00,$116.27,$343.00,$543.31,$548.80,$172.37,$108.52,$172.37,$99.16,$110.73
51000162,EAP,CPT® 99211,,Visit Level Bccp 1 - Ep,$290.00,$0.00,$299.34,$0.00,$299.34,$111.17,$67.13,$299.34,$299.34,$50.78,$290.00,$116.27,$145.00,$229.68,$232.00,$9.38,$108.52,$9.38,$99.16,$110.73
51000163,EAP,CPT® 99212,,Visit Level Bccp 2 - Ep,$313.00,$0.00,$313.00,$0.00,$299.34,$111.17,$67.13,$299.34,$299.34,$54.80,$313.00,$116.27,$156.50,$247.90,$250.40,$26.32,$108.52,$26.32,$99.16,$110.73
51000164,EAP,CPT® 99213,,Visit Level Bccp 3 - Ep,$399.00,$0.00,$399.00,$0.00,$299.34,$111.17,$67.13,$299.34,$299.34,$69.86,$399.00,$116.27,$199.50,$316.01,$319.20,$52.29,$108.52,$52.29,$99.16,$110.73
51000166,EAP,CPT® 99215,,Visit Level Bccp 5-ep,$541.00,$0.00,$541.00,$0.00,$299.34,$111.17,$67.13,$299.34,$299.34,$94.72,$541.00,$116.27,$270.50,$428.47,$432.80,$113.60,$108.52,$113.60,$99.16,$110.73
51000190,EAP,CPT® 92133,,Cmptr Ophth Img Optic Nerve,$336.00,$0.00,$336.00,$0.00,$299.34,$52.75,$67.13,$299.34,$299.34,$58.83,$336.00,$55.17,$168.00,$266.11,$268.80,$76.65,$42.26,$15.13,$53.49,$52.54
51000191,EAP,CPT® 92134,,Cptr Ophth Dx Img Post Segmt,$336.00,$0.00,$336.00,$0.00,$299.34,$52.75,$67.13,$299.34,$299.34,$58.83,$336.00,$55.17,$168.00,$266.11,$268.80,$76.65,$42.26,$15.49,$53.49,$52.54
51000211,EAP,CPT® 99497,,Advance Care Planning First 30 Mins,$170.00,$0.00,$299.34,$0.00,$299.34,$75.31,$67.13,$299.34,$299.34,$29.77,$170.00,$78.77,$85.00,$134.64,$136.00,$109.44,$26.61,$80.42,$27.06,$75.02
51000212,EAP,CPT® 99498,,Advance Care Planning Ea Addl 30 Mins (add-on),$155.00,$0.00,$299.34,$0.00,$299.34,$0.00,$0.00,$299.34,$299.34,$0.00,$155.00,$0.00,$77.50,$122.76,$124.00,$0.00,$0.00,$0.00,$0.00,$0.00
51000260,EAP,CPT® 99204,,Visit Level Bccp 4 - Np,$569.00,$0.00,$569.00,$0.00,$299.34,$111.17,$67.13,$299.34,$299.34,$99.63,$569.00,$116.27,$284.50,$450.65,$455.20,$131.98,$108.52,$131.98,$99.16,$110.73
51000265,EAP,CPT® 99214,,Visit Level Bccp 4-ep,$491.00,$0.00,$491.00,$0.00,$299.34,$111.17,$67.13,$299.34,$299.34,$85.97,$491.00,$116.27,$245.50,$388.87,$392.80,$80.42,$108.52,$80.42,$99.16,$110.73
51000313,EAP,CPT® 99495,,DISCHARGE PHONE CALL AND F/U APPT WITHIN 14  DAYS,$280.00,$0.00,$299.34,$0.00,$299.34,$111.17,$67.13,$299.34,$299.34,$49.03,$280.00,$116.27,$140.00,$221.76,$224.00,$161.54,$43.82,$125.50,$44.58,$110.73
51000314,EAP,CPT® 99496,,DISCHARGE PHONE CALL AND F/U APPT WITHIN 7  DAYS,$410.00,$0.00,$410.00,$0.00,$299.34,$111.17,$67.13,$299.34,$299.34,$71.79,$410.00,$116.27,$205.00,$324.72,$328.00,$161.54,$64.17,$165.53,$65.27,$110.73
51000315,EAP,CPT® 99205,,Isolation Evaluation - Np,"$1,700.00",$0.00,"$1,700.00",$0.00,$299.34,$302.60,$67.13,$299.34,$299.34,$297.66,"$1,700.00",$181.26,$850.00,"$1,346.40","$1,360.00",$172.37,$108.52,$172.37,$99.16,$172.37
51000316,EAP,CPT® 99215,,Isolation Evaluation - Ep,"$1,320.00",$0.00,"$1,320.00",$0.00,$299.34,$234.96,$67.13,$299.34,$299.34,$231.12,"$1,320.00",$118.93,$660.00,"$1,045.44","$1,056.00",$113.60,$108.52,$113.60,$99.16,$113.60
51000320,EAP,CPT® 97605,,Neg Press Wd Tx - 50 Sq Cm Or Less,$308.00,$0.00,$308.00,$167.24,$0.00,$167.55,$53.07,$0.00,$0.00,$53.93,$308.00,$175.24,$154.00,$243.94,$246.40,$243.48,$33.92,$26.69,$49.03,$166.90
51000321,EAP,CPT® 97606,,Neg Press Wd Tx-> Than 50 Sq Cm,$509.00,$0.00,$509.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$509.00,$0.00,$254.50,$403.13,$407.20,$0.00,$0.00,$0.00,$0.00,$0.00
51000322,EAP,CPT® G0438,,"Annual Wellness Visit, Initial Visit",$402.00,$0.00,$402.00,$0.00,$299.34,$111.17,$67.13,$299.34,$299.34,$70.39,$402.00,$116.27,$201.00,$318.38,$321.60,$172.69,$62.91,$172.69,$64.00,$110.73
51000323,EAP,CPT® G0439,,"Annual Wellness Visit, Subseq Visit",$286.00,$0.00,$299.34,$0.00,$299.34,$111.17,$67.13,$299.34,$299.34,$50.08,$286.00,$116.27,$143.00,$226.51,$228.80,$117.16,$44.76,$117.16,$45.53,$110.73
51000324,EAP,CPT® 99487,,Complex Chronic Care Mgmt - 1st Hr Per Month,$172.00,$0.00,$299.34,$0.00,$299.34,$75.31,$67.13,$299.34,$299.34,$30.12,$172.00,$78.77,$86.00,$136.22,$137.60,$109.44,$26.92,$53.37,$27.38,$75.02
51000325,EAP,CPT® 99490,,Chronic Care Mgmt - 20 Min. Per Month,$172.00,$0.00,$299.34,$0.00,$299.34,$75.31,$67.13,$299.34,$299.34,$30.12,$172.00,$78.77,$86.00,$136.22,$137.60,$109.44,$26.92,$32.82,$27.38,$75.02
51000326,EAP,CPT® 99489,,Complex Chronic Care Mgmt – Ea Addl 30 Min Per Month,$86.00,$0.00,$299.34,$0.00,$299.34,$0.00,$67.13,$299.34,$299.34,$15.06,$86.00,$0.00,$43.00,$68.11,$68.80,$0.00,$13.46,$26.33,$13.69,$0.00
51000327,EAP,CPT® 92230,,Eye Exam With Photos,$700.00,$0.00,$700.00,$0.00,$299.34,$0.00,$0.00,$299.34,$299.34,$0.00,$700.00,$0.00,$350.00,$554.40,$560.00,$0.00,$0.00,$0.00,$0.00,$0.00
51000328,EAP,CPT® 92326,,Replacement Of Contact Lens,$150.00,$0.00,$299.34,$0.00,$299.34,$0.00,$0.00,$299.34,$299.34,$0.00,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$0.00,$0.00,$0.00,$0.00
51100021,EAP,CPT® 64640,,Destr Peripheral Nerve,"$2,501.00",$121.87,"$2,501.00","$2,106.30","$1,784.96",$778.67,$430.91,"$1,784.96","$1,784.96",$437.91,"$2,501.00",$814.44,"$2,255.00","$1,980.79","$2,000.80","$1,131.55",$198.96,$121.87,$398.16,$775.65
61000001,EAP,CPT® 70336,,Mri Tmj Mri,"$4,165.00",$222.60,"$4,165.00","$1,869.00","$1,126.11",$223.46,$717.61,"$1,126.11","$1,126.11",$729.26,"$4,165.00",$233.72,"$1,043.00","$3,298.68","$3,332.00",$324.73,$651.82,$236.99,$663.07,$222.60
61000002,EAP,CPT® 70540,,Mri:orbit/face/neckw/o Contr.,"$5,287.00",$195.93,"$5,287.00","$1,869.00","$1,126.11",$223.46,$422.49,"$1,126.11","$1,126.11",$925.71,"$5,287.00",$233.72,"$1,043.00","$4,187.30","$4,229.60",$324.73,$827.42,$195.93,$841.69,$222.60
61000003,EAP,CPT® 70542,,Mri Orbit/face/neck/w/dye Mri,"$5,670.00",$230.87,"$5,670.00","$1,869.00","$1,126.11",$370.02,$976.91,"$1,126.11","$1,126.11",$992.77,"$5,670.00",$387.01,"$1,162.00","$4,490.64","$4,536.00",$537.70,$887.36,$230.87,$902.66,$368.58
61000004,EAP,CPT® 70543,,Mri Orb/face/neck W&wo Dye Mri,"$7,615.00",$285.62,"$7,615.00","$1,869.00","$1,126.11",$370.02,$651.22,"$1,126.11","$1,126.11","$1,333.33","$7,615.00",$387.01,"$1,608.00","$6,031.08","$6,092.00",$537.70,"$1,191.75",$285.62,"$1,212.31",$368.58
61000005,EAP,CPT® 70544,,Mra Head W/o Dye,"$5,287.00",$187.29,"$5,287.00","$1,869.00","$1,126.11",$223.46,$910.92,"$1,126.11","$1,126.11",$925.71,"$5,287.00",$233.72,"$1,043.00","$4,187.30","$4,229.60",$324.73,$827.42,$187.29,$841.69,$222.60
61000006,EAP,CPT® 70545,,Mra Head W/ Dye,"$5,670.00",$198.45,"$5,670.00","$1,869.00","$1,126.11",$370.02,$976.91,"$1,126.11","$1,126.11",$992.77,"$5,670.00",$387.01,"$1,162.00","$4,490.64","$4,536.00",$537.70,$887.36,$198.45,$902.66,$368.58
61000007,EAP,CPT® 70546,,Mra Head W & W/o Dye,"$7,615.00",$300.74,"$7,615.00","$1,869.00","$1,126.11",$370.02,"$1,312.03","$1,126.11","$1,126.11","$1,333.33","$7,615.00",$387.01,"$1,608.00","$6,031.08","$6,092.00",$537.70,"$1,191.75",$300.74,"$1,212.31",$368.58
61000008,EAP,CPT® 70547,,Mra Neck W/o Dye,"$5,287.00",$188.01,"$5,287.00","$1,869.00","$1,126.11",$223.46,$910.92,"$1,126.11","$1,126.11",$925.71,"$5,287.00",$233.72,"$1,043.00","$4,187.30","$4,229.60",$324.73,$827.42,$188.01,$841.69,$222.60
61000009,EAP,CPT® 70548,,Mra Neck W/ Dye,"$5,888.00",$202.06,"$5,888.00","$1,869.00","$1,126.11",$370.02,"$1,014.47","$1,126.11","$1,126.11","$1,030.94","$5,888.00",$387.01,"$1,162.00","$4,663.30","$4,710.40",$537.70,$921.47,$202.06,$937.37,$368.58
61000010,EAP,CPT® 70549,,Mra Neck W&wo Dye,"$7,615.00",$302.90,"$7,615.00","$1,869.00","$1,126.11",$370.02,"$1,312.03","$1,126.11","$1,126.11","$1,333.33","$7,615.00",$387.01,"$1,608.00","$6,031.08","$6,092.00",$537.70,"$1,191.75",$302.90,"$1,212.31",$368.58
61000011,EAP,CPT® 71550,,Mri Chest W/o Dye,"$4,991.00",$0.00,"$4,991.00","$1,869.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,991.00",$0.00,"$1,043.00","$3,952.87","$3,992.80",$0.00,$0.00,$0.00,$0.00,$0.00
61000012,EAP,CPT® 71551,,Mri Chest W/dye,"$3,546.00",$355.13,"$3,546.00","$1,869.00","$1,126.11",$663.32,$610.96,"$1,126.11","$1,126.11",$620.88,"$3,546.00",$693.78,"$1,162.00","$2,808.43","$2,836.80",$963.92,$554.95,$355.13,$564.52,$660.75
61000013,EAP,CPT® 71552,,Mri Chest W&wo Dye,"$6,245.00",$368.58,"$6,245.00","$1,869.00","$1,126.11",$370.02,"$1,075.98","$1,126.11","$1,126.11","$1,093.45","$6,245.00",$387.01,"$1,608.00","$4,946.04","$4,996.00",$537.70,$977.34,$446.61,$994.20,$368.58
61000014,EAP,CPT® 71555,,Mra Chest W&wo Dye,"$5,197.00",$0.00,"$5,197.00","$1,869.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,197.00",$0.00,"$1,247.28","$4,116.02","$4,157.60",$0.00,$0.00,$0.00,$0.00,$0.00
61000015,EAP,CPT® 72159,,Mra Spinal Canal W/wo Dye,"$8,498.00",$0.00,"$8,498.00","$1,869.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$8,498.00",$0.00,"$2,039.52","$6,730.42","$6,798.40",$0.00,$0.00,$0.00,$0.00,$0.00
61000016,EAP,CPT® 72198,,Mra  Pelvis W/wo Dye,"$6,414.00",$0.00,"$6,414.00","$1,869.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,414.00",$0.00,"$1,539.36","$5,079.89","$5,131.20",$0.00,$0.00,$0.00,$0.00,$0.00
61000017,EAP,CPT® 73218,,Mri Upp Ext Nt Jt Wo Dye B Mri,"$10,051.00",$222.60,"$10,051.00","$1,869.00","$1,126.11",$223.46,$422.12,"$1,126.11","$1,126.11","$1,759.85","$10,051.00",$233.72,"$1,043.00","$7,960.39","$8,040.80",$324.73,"$1,572.98",$288.50,"$1,600.12",$222.60
61000018,EAP,CPT® 73218,,Mri Upp Ext Nt Jt Wo Dye L Mri,"$5,026.00",$222.60,"$5,026.00","$1,869.00","$1,126.11",$223.46,$422.12,"$1,126.11","$1,126.11",$880.01,"$5,026.00",$233.72,"$1,043.00","$3,980.59","$4,020.80",$324.73,$786.57,$288.50,$800.14,$222.60
61000019,EAP,CPT® 73218,,Mri Upp Ext Nt Jt Wo Dye R Mri,"$5,026.00",$222.60,"$5,026.00","$1,869.00","$1,126.11",$223.46,$422.12,"$1,126.11","$1,126.11",$880.01,"$5,026.00",$233.72,"$1,043.00","$3,980.59","$4,020.80",$324.73,$786.57,$288.50,$800.14,$222.60
61000020,EAP,CPT® 73219,,Mri Upp Ext Not Jt W/dye B Mri,"$10,778.00",$0.00,"$10,778.00","$1,869.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$10,778.00",$0.00,"$1,162.00","$8,536.18","$8,622.40",$0.00,$0.00,$0.00,$0.00,$0.00
61000021,EAP,CPT® 73219,,Mri Upp Ext Not Jt W/dye L Mri,"$5,393.00",$0.00,"$5,393.00","$1,869.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,393.00",$0.00,"$1,162.00","$4,271.26","$4,314.40",$0.00,$0.00,$0.00,$0.00,$0.00
61000022,EAP,CPT® 73219,,Mri Upp Ext Not Jt W/dye R Mri,"$5,393.00",$0.00,"$5,393.00","$1,869.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,393.00",$0.00,"$1,162.00","$4,271.26","$4,314.40",$0.00,$0.00,$0.00,$0.00,$0.00
61000023,EAP,CPT® 73220,,Mri Upp Ext Nt Jt W&wo Bi Mri,"$13,949.00",$368.58,"$13,949.00","$1,869.00","$1,126.11",$370.02,$651.58,"$1,126.11","$1,126.11","$2,442.36","$13,949.00",$387.01,"$1,608.00","$11,047.61","$11,159.20",$537.70,"$2,183.02",$376.02,"$2,220.68",$368.58
61000024,EAP,CPT® 73220,,Mri Upp Ext Nt Jt W&wo Lt Mri,"$6,976.00",$368.58,"$6,976.00","$1,869.00","$1,126.11",$370.02,$651.58,"$1,126.11","$1,126.11","$1,221.44","$6,976.00",$387.01,"$1,608.00","$5,524.99","$5,580.80",$537.70,"$1,091.74",$376.02,"$1,110.58",$368.58
61000025,EAP,CPT® 73220,,Mri Upp Ext Nt Jt W&wo Rt Mri,"$6,976.00",$368.58,"$6,976.00","$1,869.00","$1,126.11",$370.02,$651.58,"$1,126.11","$1,126.11","$1,221.44","$6,976.00",$387.01,"$1,608.00","$5,524.99","$5,580.80",$537.70,"$1,091.74",$376.02,"$1,110.58",$368.58
61000026,EAP,CPT® 73221,,Mri Upp Ext Jnt W/o Dye Bi Mri,"$10,051.00",$162.80,"$10,051.00","$1,869.00","$1,126.11",$223.46,$354.05,"$1,126.11","$1,126.11","$1,759.85","$10,051.00",$233.72,"$1,043.00","$7,960.39","$8,040.80",$324.73,"$1,572.98",$162.80,"$1,600.12",$222.60
61000027,EAP,CPT® 73221,,Mri Upp Ext Jnt W/o Dye Lt Mri,"$5,026.00",$162.80,"$5,026.00","$1,869.00","$1,126.11",$223.46,$354.05,"$1,126.11","$1,126.11",$880.01,"$5,026.00",$233.72,"$1,043.00","$3,980.59","$4,020.80",$324.73,$786.57,$162.80,$800.14,$222.60
61000028,EAP,CPT® 73221,,Mri Upp Ext Jnt W/o Dye Rt Mri,"$5,026.00",$162.80,"$5,026.00","$1,869.00","$1,126.11",$223.46,$354.05,"$1,126.11","$1,126.11",$880.01,"$5,026.00",$233.72,"$1,043.00","$3,980.59","$4,020.80",$324.73,$786.57,$162.80,$800.14,$222.60
61000030,EAP,CPT® 73222,,Mri Upp Ext Jnt W/dye Bi Mri,"$11,196.00",$287.06,"$11,196.00","$1,869.00","$1,126.11",$663.32,$511.84,"$1,126.11","$1,126.11","$1,960.33","$11,196.00",$693.78,"$1,162.00","$8,867.23","$8,956.80",$963.92,"$1,752.17",$287.06,"$1,782.40",$660.75
61000031,EAP,CPT® 73222,,Mri Upp Ext Jnt W/dye Lt Mri,"$5,597.00",$287.06,"$5,597.00","$1,869.00","$1,126.11",$663.32,$511.84,"$1,126.11","$1,126.11",$979.99,"$5,597.00",$693.78,"$1,162.00","$4,432.82","$4,477.60",$963.92,$875.93,$287.06,$891.04,$660.75
61000032,EAP,CPT® 73222,,Mri Upp Ext Jnt W/dye Rt Mri,"$5,597.00",$287.06,"$5,597.00","$1,869.00","$1,126.11",$663.32,$511.84,"$1,126.11","$1,126.11",$979.99,"$5,597.00",$693.78,"$1,162.00","$4,432.82","$4,477.60",$963.92,$875.93,$287.06,$891.04,$660.75
61000033,EAP,CPT® 73223,,Mri Upp Ext Jnt W&wo Dye B Mri,"$13,949.00",$348.65,"$13,949.00","$1,869.00","$1,126.11",$370.02,"$2,403.34","$1,126.11","$1,126.11","$2,442.36","$13,949.00",$387.01,"$1,608.00","$11,047.61","$11,159.20",$537.70,"$2,183.02",$348.65,"$2,220.68",$368.58
61000034,EAP,CPT® 73223,,Mri Uppr Ext Jnt W&wo Dye Lt,"$6,976.00",$348.65,"$6,976.00","$1,869.00","$1,126.11",$370.02,"$1,201.93","$1,126.11","$1,126.11","$1,221.44","$6,976.00",$387.01,"$1,608.00","$5,524.99","$5,580.80",$537.70,"$1,091.74",$348.65,"$1,110.58",$368.58
61000035,EAP,CPT® 73223,,Mri Uppr Ext Jnt W&wo Dye Rt,"$6,976.00",$348.65,"$6,976.00","$1,869.00","$1,126.11",$370.02,"$1,201.93","$1,126.11","$1,126.11","$1,221.44","$6,976.00",$387.01,"$1,608.00","$5,524.99","$5,580.80",$537.70,"$1,091.74",$348.65,"$1,110.58",$368.58
61000036,EAP,CPT® 73225,,Mra Upp Ext W/wo Dye Bilat,"$27,844.00",$0.00,"$27,844.00","$1,869.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$27,844.00",$0.00,"$6,682.56","$22,052.45","$22,275.20",$0.00,$0.00,$0.00,$0.00,$0.00
61000037,EAP,CPT® 73225,,Mra Upp Ext W/wo Dye Lt,"$13,918.00",$0.00,"$13,918.00","$1,869.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$13,918.00",$0.00,"$3,340.32","$11,023.06","$11,134.40",$0.00,$0.00,$0.00,$0.00,$0.00
61000038,EAP,CPT® 73225,,Mra Upp Ext W/wo Dye Rt,"$13,918.00",$0.00,"$13,918.00","$1,869.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$13,918.00",$0.00,"$3,340.32","$11,023.06","$11,134.40",$0.00,$0.00,$0.00,$0.00,$0.00
61000040,EAP,CPT® 73718,,Mri Low Ext Nt Jt Wo Dye B Mri,"$11,745.00",$192.33,"$11,745.00","$1,869.00","$1,126.11",$223.46,$422.79,"$1,126.11","$1,126.11","$2,056.46","$11,745.00",$233.72,"$1,043.00","$9,302.04","$9,396.00",$324.73,"$1,838.09",$192.33,"$1,869.80",$222.60
61000041,EAP,CPT® 73718,,Mri Low Ext Nt Jt Wo Dye L Mri,"$4,151.00",$192.33,"$4,151.00","$1,869.00","$1,126.11",$223.46,$422.79,"$1,126.11","$1,126.11",$726.81,"$4,151.00",$233.72,"$1,043.00","$3,287.59","$3,320.80",$324.73,$649.63,$192.33,$660.84,$222.60
61000042,EAP,CPT® 73718,,Mri Low Ext Nt Jt Wo Dye R Mri,"$4,151.00",$192.33,"$4,151.00","$1,869.00","$1,126.11",$223.46,$422.79,"$1,126.11","$1,126.11",$726.81,"$4,151.00",$233.72,"$1,043.00","$3,287.59","$3,320.80",$324.73,$649.63,$192.33,$660.84,$222.60
61000043,EAP,CPT® 73719,,Mri Low Ext Nt Jt W/dye B Mri,"$9,248.00",$0.00,"$9,248.00","$1,869.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$9,248.00",$0.00,"$1,162.00","$7,324.42","$7,398.40",$0.00,$0.00,$0.00,$0.00,$0.00
61000044,EAP,CPT® 73719,,Mri Low Ext Nt Jt W/dye L Mri,"$4,631.00",$0.00,"$4,631.00","$1,869.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,631.00",$0.00,"$1,162.00","$3,667.75","$3,704.80",$0.00,$0.00,$0.00,$0.00,$0.00
61000045,EAP,CPT® 73719,,Mri Low Ext Nt Jt W/dye R Mri,"$4,631.00",$0.00,"$4,631.00","$1,869.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,631.00",$0.00,"$1,162.00","$3,667.75","$3,704.80",$0.00,$0.00,$0.00,$0.00,$0.00
61000046,EAP,CPT® 73720,,Mri Low Ext Not Jnt W&wo B Mri,"$11,957.00",$286.34,"$11,957.00","$1,869.00","$1,126.11",$370.02,$651.58,"$1,126.11","$1,126.11","$2,093.58","$11,957.00",$387.01,"$1,608.00","$9,469.94","$9,565.60",$537.70,"$1,871.27",$286.34,"$1,903.55",$368.58
61000047,EAP,CPT® 73720,,Mri Low Ext Not Jnt W&wo L Mri,"$5,981.00",$286.34,"$5,981.00","$1,869.00","$1,126.11",$370.02,$651.58,"$1,126.11","$1,126.11","$1,047.23","$5,981.00",$387.01,"$1,608.00","$4,736.95","$4,784.80",$537.70,$936.03,$286.34,$952.18,$368.58
61000048,EAP,CPT® 73720,,Mri Low Ext Not Jnt W&wo R Mri,"$5,981.00",$286.34,"$5,981.00","$1,869.00","$1,126.11",$370.02,$651.58,"$1,126.11","$1,126.11","$1,047.23","$5,981.00",$387.01,"$1,608.00","$4,736.95","$4,784.80",$537.70,$936.03,$286.34,$952.18,$368.58
61000050,EAP,CPT® 73721,,Mri Low Ext Jnt W/o Dye Bi Mri,"$8,302.00",$162.80,"$8,302.00","$1,869.00","$1,126.11",$223.46,$354.05,"$1,126.11","$1,126.11","$1,453.61","$8,302.00",$233.72,"$1,992.48","$6,575.18","$6,641.60",$324.73,"$1,299.26",$162.80,"$1,321.68",$222.60
61000051,EAP,CPT® 73721,,Mri Low Ext Jnt W/o Dye Lt Mri,"$4,151.00",$162.80,"$4,151.00","$1,869.00","$1,126.11",$223.46,$354.05,"$1,126.11","$1,126.11",$726.81,"$4,151.00",$233.72,$996.24,"$3,287.59","$3,320.80",$324.73,$649.63,$162.80,$660.84,$222.60
61000052,EAP,CPT® 73721,,Mri Low Ext Jnt W/o Dye Rt Mri,"$4,151.00",$162.80,"$4,151.00","$1,869.00","$1,126.11",$223.46,$354.05,"$1,126.11","$1,126.11",$726.81,"$4,151.00",$233.72,$996.24,"$3,287.59","$3,320.80",$324.73,$649.63,$162.80,$660.84,$222.60
61000053,EAP,CPT® 73722,,Mri Low Ext Jnt W/dye Bi Mri,"$8,903.00",$287.78,"$8,903.00","$1,869.00","$1,126.11",$663.32,$512.51,"$1,126.11","$1,126.11","$1,558.84","$8,903.00",$693.78,"$1,162.00","$7,051.18","$7,122.40",$963.92,"$1,393.32",$287.78,"$1,417.36",$660.75
61000054,EAP,CPT® 73722,,Mri Low Ext Jnt W/dye Lt Mri,"$4,455.00",$287.78,"$4,455.00","$1,869.00","$1,126.11",$663.32,$512.51,"$1,126.11","$1,126.11",$780.03,"$4,455.00",$693.78,"$1,162.00","$3,528.36","$3,564.00",$963.92,$697.21,$287.78,$709.24,$660.75
61000055,EAP,CPT® 73722,,Mri Low Ext Jnt W/dye Rt Mri,"$4,455.00",$287.78,"$4,455.00","$1,869.00","$1,126.11",$663.32,$512.51,"$1,126.11","$1,126.11",$780.03,"$4,455.00",$693.78,"$1,162.00","$3,528.36","$3,564.00",$963.92,$697.21,$287.78,$709.24,$660.75
61000056,EAP,CPT® 73723,,Mri Low Ext Jnt W&wo Dye B Mri,"$11,957.00",$347.93,"$11,957.00","$1,869.00","$1,126.11",$370.02,$651.58,"$1,126.11","$1,126.11","$2,093.58","$11,957.00",$387.01,"$1,608.00","$9,469.94","$9,565.60",$537.70,"$1,871.27",$347.93,"$1,903.55",$368.58
61000057,EAP,CPT® 73723,,Mri Low Ext Jnt W&wo Dye L Mri,"$5,981.00",$347.93,"$5,981.00","$1,869.00","$1,126.11",$370.02,$651.58,"$1,126.11","$1,126.11","$1,047.23","$5,981.00",$387.01,"$1,608.00","$4,736.95","$4,784.80",$537.70,$936.03,$347.93,$952.18,$368.58
61000058,EAP,CPT® 73723,,Mri Low Ext Jnt W&wo Dye R Mri,"$5,981.00",$347.93,"$5,981.00","$1,869.00","$1,126.11",$370.02,$651.58,"$1,126.11","$1,126.11","$1,047.23","$5,981.00",$387.01,"$1,608.00","$4,736.95","$4,784.80",$537.70,$936.03,$347.93,$952.18,$368.58
61000059,EAP,CPT® 74181,,Mri Abdomen W/o Dye,"$5,593.00",$153.43,"$5,593.00","$1,869.00","$1,126.11",$223.46,$427.96,"$1,126.11","$1,126.11",$979.29,"$5,593.00",$233.72,"$1,043.00","$4,429.66","$4,474.40",$324.73,$875.30,$153.43,$890.41,$222.60
61000060,EAP,CPT® 74182,,Mri Abdomen W/ Dye,"$5,532.00",$267.97,"$5,532.00","$1,869.00","$1,126.11",$370.02,$953.14,"$1,126.11","$1,126.11",$968.61,"$5,532.00",$387.01,"$1,162.00","$4,381.34","$4,425.60",$537.70,$865.76,$267.97,$880.69,$368.58
61000062,EAP,CPT® 74183,,Mri Abdomen W&wo Dye,"$6,118.00",$284.90,"$6,118.00","$1,869.00","$1,126.11",$370.02,$657.05,"$1,126.11","$1,126.11","$1,071.21","$6,118.00",$387.01,"$1,608.00","$4,845.46","$4,894.40",$537.70,$957.47,$284.90,$973.99,$368.58
61000063,EAP,CPT® 74185,,Mra Abdomen Wo Cont,"$3,394.00",$0.00,"$3,394.00","$1,869.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,394.00",$0.00,$814.56,"$2,688.05","$2,715.20",$0.00,$0.00,$0.00,$0.00,$0.00
61000064,EAP,CPT® 75557,,Mri Card Morph W/o Cont,"$3,962.00",$0.00,"$3,962.00","$1,869.00",$0.00,$0.00,$682.63,$0.00,$0.00,$0.00,"$3,962.00",$0.00,$950.88,"$3,137.90","$3,169.60",$0.00,$620.05,$0.00,$0.00,$0.00
61000065,EAP,CPT® 75559,,Mri Card Morph W/o W/stress,"$3,112.00",$0.00,"$3,112.00","$1,869.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,112.00",$0.00,$746.88,"$2,464.70","$2,489.60",$0.00,$0.00,$0.00,$0.00,$0.00
61000066,EAP,CPT® 75561,,Mri Card Morph W&w/o,"$4,756.00",$295.70,"$4,756.00","$1,869.00","$1,126.11",$370.02,$819.44,"$1,126.11","$1,126.11",$832.74,"$4,756.00",$387.01,"$1,141.44","$3,766.75","$3,804.80",$537.70,$744.31,$295.70,$757.16,$368.58
61000067,EAP,CPT® 75563,,Mri Card Morph W&w/o W/stress,"$5,552.00",$0.00,"$5,552.00","$1,869.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,552.00",$0.00,"$1,332.48","$4,397.18","$4,441.60",$0.00,$0.00,$0.00,$0.00,$0.00
61000068,EAP,CPT® 76390,,Mri Spectroscopy,"$4,612.00",$0.00,"$4,612.00","$1,869.00","$1,126.11",$820.94,$794.62,"$1,126.11","$1,126.11",$807.52,"$4,612.00",$0.00,"$1,106.88","$3,652.70","$3,689.60","$2,767.20",$721.78,$0.00,$734.23,$0.00
61000069,EAP,HCPCS C8900,,Mra Abdomen W Dye,"$4,351.00",$0.00,"$4,351.00","$2,362.59","$1,126.11",$370.02,$749.66,"$1,126.11","$1,126.11",$761.83,"$4,351.00",$387.01,"$2,175.50","$3,445.99","$3,480.80",$537.70,$680.93,$0.00,$692.68,$368.58
61000070,EAP,HCPCS C8901,,Mra Abdomen W/o Dye,"$2,308.00",$0.00,"$2,308.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,308.00",$0.00,"$1,154.00","$1,827.94","$1,846.40",$0.00,$0.00,$0.00,$0.00,$0.00
61000071,EAP,HCPCS C8909,,Mra Chest W Dye,"$4,696.00",$0.00,"$4,696.00","$2,549.93","$1,126.11",$370.02,$0.00,"$1,126.11","$1,126.11",$822.23,"$4,696.00",$387.01,"$2,348.00","$3,719.23","$3,756.80",$537.70,$0.00,$0.00,$747.60,$368.58
61000072,EAP,HCPCS C8910,,Mra Chest W/o Dye,"$5,464.00",$0.00,"$5,464.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,464.00",$0.00,"$2,732.00","$4,327.49","$4,371.20",$0.00,$0.00,$0.00,$0.00,$0.00
61000073,EAP,HCPCS C8914,,Mra Low Ext W&wo Dye Bi Mri,"$4,133.00",$0.00,"$4,133.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,133.00",$0.00,"$2,066.50","$3,273.34","$3,306.40",$0.00,$0.00,$0.00,$0.00,$0.00
61000074,EAP,HCPCS C8914,,Mra Low Ext W&wo Dye Lt,"$2,898.00",$0.00,"$2,898.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,898.00",$0.00,"$1,449.00","$2,295.22","$2,318.40",$0.00,$0.00,$0.00,$0.00,$0.00
61000075,EAP,HCPCS C8914,,Mra Low Ext W/wo Dye Rt,"$2,898.00",$0.00,"$2,898.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,898.00",$0.00,"$1,449.00","$2,295.22","$2,318.40",$0.00,$0.00,$0.00,$0.00,$0.00
61000077,EAP,HCPCS C8903,,"Mri W/cont, Brst, Uni, Mri","$1,736.00",$0.00,"$1,736.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,736.00",$0.00,$868.00,"$1,374.91","$1,388.80",$0.00,$0.00,$0.00,$0.00,$0.00
61000081,EAP,HCPCS C8905,,"Mri W/ofol W/con,brst,uni,mri","$2,191.00",$0.00,"$2,191.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,191.00",$0.00,"$1,095.50","$1,735.27","$1,752.80",$0.00,$0.00,$0.00,$0.00,$0.00
61000082,EAP,HCPCS C8906,,"Mri W/con, Brst, Bi,mri","$1,736.00",$0.00,"$1,736.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,736.00",$0.00,$868.00,"$1,374.91","$1,388.80",$0.00,$0.00,$0.00,$0.00,$0.00
61000087,EAP,HCPCS C8908,,"Mri W/ofol W/con, Brst, Bi,mri","$4,383.00",$0.00,"$4,383.00","$2,379.97","$1,126.11",$370.02,$755.17,"$1,126.11","$1,126.11",$767.43,"$4,383.00",$387.01,"$2,191.50","$3,471.34","$3,506.40",$537.70,$685.94,$0.00,$697.77,$368.58
61000090,EAP,CPT® 72220,,Cervical Spine Flex Ext Nir,$610.00,$22.69,$610.00,$55.02,$610.00,$76.53,$105.10,$610.00,$610.00,$106.81,$610.00,$80.04,$146.40,$483.12,$488.00,$111.21,$95.47,$22.69,$97.11,$76.23
61000098,EAP,CPT® 76376,,3d Rendering W/o Postproce Mri,"$2,033.00",$0.00,"$2,033.00","$1,869.00","$1,126.11",$0.00,$147.89,"$1,126.11","$1,126.11",$355.96,"$2,033.00",$0.00,$487.92,"$1,610.14","$1,626.40",$0.00,$318.16,$13.33,$323.65,$0.00
61000099,EAP,CPT® 76377,,3d Rendering W/postprocess Mri,"$2,033.00",$0.00,"$2,033.00","$1,869.00","$1,126.11",$0.00,$187.24,"$1,126.11","$1,126.11",$355.96,"$2,033.00",$0.00,$487.92,"$1,610.14","$1,626.40",$0.00,$318.16,$32.41,$323.65,$0.00
61000110,EAP,CPT® 77021,,"Mri Guide Needle Place, Cbc","$3,150.00",$0.00,"$3,150.00","$1,869.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,150.00",$0.00,$756.00,"$2,494.80","$2,520.00",$0.00,$0.00,$0.00,$0.00,$0.00
61000116,EAP,HCPCS C8932,,"Mra, W/o Dye, Spinal Canal","$4,243.00",$0.00,"$4,243.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,243.00",$0.00,"$2,121.50","$3,360.46","$3,394.40",$0.00,$0.00,$0.00,$0.00,$0.00
61000117,EAP,HCPCS C8933,,"Mra, W/o&w/dye, Spinal Canal","$3,605.00",$0.00,"$3,605.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,605.00",$0.00,"$1,802.50","$2,855.16","$2,884.00",$0.00,$0.00,$0.00,$0.00,$0.00
61000118,EAP,HCPCS C8934,,"Mra, W/dye, Upper Extremity","$4,210.00",$0.00,"$4,210.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,210.00",$0.00,"$2,105.00","$3,334.32","$3,368.00",$0.00,$0.00,$0.00,$0.00,$0.00
61000119,EAP,HCPCS C8935,,"Mra, W/odye, Upper Extremity","$4,210.00",$0.00,"$4,210.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,210.00",$0.00,"$2,105.00","$3,334.32","$3,368.00",$0.00,$0.00,$0.00,$0.00,$0.00
61000120,EAP,HCPCS C8936,,"Mra, W/o&w/dye, Upper Extremity","$4,210.00",$0.00,"$4,210.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,210.00",$0.00,"$2,105.00","$3,334.32","$3,368.00",$0.00,$0.00,$0.00,$0.00,$0.00
61000121,EAP,CPT® 73725,,Mri Ang Lwr Ext W Or W/o Dye,"$3,816.00",$0.00,"$3,816.00","$1,869.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,816.00",$0.00,$915.84,"$3,022.27","$3,052.80",$0.00,$0.00,$0.00,$0.00,$0.00
61000122,EAP,CPT® 77021,,Mri Guidance For Needle Placement,"$3,150.00",$0.00,"$3,150.00","$1,869.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,150.00",$0.00,$756.00,"$2,494.80","$2,520.00",$0.00,$0.00,$0.00,$0.00,$0.00
61000124,EAP,CPT® 77048,,Mri Breast W And/or Wo Cont Incl Cad Uni,$491.00,$0.00,$491.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$491.00,$0.00,$117.84,$388.87,$392.80,$0.00,$0.00,$0.00,$0.00,$0.00
61000125,EAP,CPT® 77049,,Mri Breast W And/or Wo Cont Incl Cad Bil,$491.00,$0.00,$491.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$491.00,$0.00,$117.84,$388.87,$392.80,$0.00,$0.00,$0.00,$0.00,$0.00
61000126,EAP,CPT® 77047,,Mri Breast Without Contrast Material Bilateral,"$2,874.00",$173.24,"$2,874.00",$969.00,"$1,126.11",$223.46,$495.18,"$1,126.11","$1,126.11",$503.21,"$2,874.00",$233.72,$689.76,"$2,276.21","$2,299.20",$324.73,$449.78,$173.24,$457.54,$222.60
61000127,EAP,CPT® 77046,,MRI BREAST WO CONTRAST UNI,$554.00,$0.00,$554.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$554.00,$0.00,$132.96,$438.77,$443.20,$0.00,$0.00,$0.00,$0.00,$0.00
61100001,EAP,CPT® 70551,,Mri Brain W/o Dye,"$5,287.00",$150.19,"$5,287.00","$1,869.00","$1,126.11",$223.46,$354.05,"$1,126.11","$1,126.11",$925.71,"$5,287.00",$233.72,"$1,043.00","$4,187.30","$4,229.60",$324.73,$827.42,$150.19,$841.69,$222.60
61100003,EAP,CPT® 70552,,Mri Brain W/dye,"$5,888.00",$221.87,"$5,888.00","$1,869.00","$1,126.11",$370.02,$519.86,"$1,126.11","$1,126.11","$1,030.94","$5,888.00",$387.01,"$1,162.00","$4,663.30","$4,710.40",$537.70,$921.47,$221.87,$937.37,$368.58
61100005,EAP,CPT® 70553,,Mri Brain W&wo Dye,"$7,615.00",$252.84,"$7,615.00","$1,869.00","$1,126.11",$370.02,$542.25,"$1,126.11","$1,126.11","$1,333.33","$7,615.00",$387.01,"$1,608.00","$6,031.08","$6,092.00",$537.70,"$1,191.75",$252.84,"$1,212.31",$368.58
61200001,EAP,CPT® 72141,,Mri Cervical Spine W/o Dye,"$5,319.00",$144.07,"$5,319.00","$1,869.00","$1,126.11",$223.46,$354.05,"$1,126.11","$1,126.11",$931.31,"$5,319.00",$233.72,"$1,043.00","$4,212.65","$4,255.20",$324.73,$832.42,$144.07,$846.78,$222.60
61200004,EAP,CPT® 72142,,Mri Cervical Spine W Contrast,"$5,924.00",$0.00,"$5,924.00","$1,869.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,924.00",$0.00,"$1,162.00","$4,691.81","$4,739.20",$0.00,$0.00,$0.00,$0.00,$0.00
61200005,EAP,CPT® 72146,,Mri Thoracic Spine W/o Dye,"$4,325.00",$144.07,"$4,325.00","$1,869.00","$1,126.11",$223.46,$354.05,"$1,126.11","$1,126.11",$757.27,"$4,325.00",$233.72,"$1,038.00","$3,425.40","$3,460.00",$324.73,$676.86,$144.07,$688.54,$222.60
61200006,EAP,CPT® 72147,,Mri Thoracic Spine W/dye,"$4,817.00",$226.55,"$4,817.00","$1,869.00","$1,126.11",$370.02,$521.23,"$1,126.11","$1,126.11",$843.42,"$4,817.00",$387.01,"$1,162.00","$3,815.06","$3,853.60",$537.70,$753.86,$226.55,$766.87,$368.58
61200007,EAP,CPT® 72148,,Mri Lumbar Spine W/o Dye,"$4,307.00",$144.43,"$4,307.00","$1,869.00","$1,126.11",$223.46,$354.05,"$1,126.11","$1,126.11",$754.12,"$4,307.00",$233.72,"$1,043.00","$3,411.14","$3,445.60",$324.73,$674.05,$144.43,$685.67,$222.60
61200008,EAP,CPT® 72149,,Mri Lumbar Spine W/ Dye,"$4,633.00",$223.67,"$4,633.00","$1,869.00","$1,126.11",$370.02,$520.16,"$1,126.11","$1,126.11",$811.20,"$4,633.00",$387.01,"$1,162.00","$3,669.34","$3,706.40",$537.70,$725.06,$223.67,$737.57,$368.58
61200009,EAP,CPT® 72156,,Mri Cervical Spine W&wo Dye,"$7,662.00",$255.72,"$7,662.00","$1,869.00","$1,126.11",$370.02,$542.25,"$1,126.11","$1,126.11","$1,341.55","$7,662.00",$387.01,"$1,608.00","$6,068.30","$6,129.60",$537.70,"$1,199.10",$255.72,"$1,219.79",$368.58
61200010,EAP,CPT® 72157,,Mri Thoracic Spine W&wo Dye,"$6,232.00",$256.44,"$6,232.00","$1,869.00","$1,126.11",$370.02,$672.93,"$1,126.11","$1,126.11","$1,091.17","$6,232.00",$387.01,"$1,495.68","$4,935.74","$4,985.60",$537.70,$975.31,$256.44,$992.13,$368.58
61200011,EAP,CPT® 72158,,Mri Lumbar Spine W&wo Dye,"$6,206.00",$255.00,"$6,206.00","$1,869.00","$1,126.11",$370.02,$542.25,"$1,126.11","$1,126.11","$1,086.62","$6,206.00",$387.01,"$1,608.00","$4,915.15","$4,964.80",$537.70,$971.24,$255.00,$988.00,$368.58
61200012,EAP,CPT® 72195,,Mri Pelvis W/o Dye,"$4,087.00",$194.85,"$4,087.00","$1,869.00","$1,126.11",$223.46,$428.25,"$1,126.11","$1,126.11",$715.60,"$4,087.00",$233.72,"$1,043.00","$3,236.90","$3,269.60",$324.73,$639.62,$194.85,$650.65,$222.60
61200013,EAP,CPT® 72196,,Mri Pelvis W/ Dye,"$4,631.00",$226.19,"$4,631.00","$1,869.00","$1,126.11",$370.02,$797.90,"$1,126.11","$1,126.11",$810.85,"$4,631.00",$387.01,"$1,162.00","$3,667.75","$3,704.80",$537.70,$724.75,$226.19,$737.26,$368.58
61200014,EAP,CPT® 72197,,Mri Pelvis W&wo Dye,"$5,025.00",$284.18,"$5,025.00","$1,869.00","$1,126.11",$370.02,$657.05,"$1,126.11","$1,126.11",$879.84,"$5,025.00",$387.01,"$1,608.00","$3,979.80","$4,020.00",$537.70,$786.41,$284.18,$799.98,$368.58
61400000,EAP,CPT® 75565,,Mr Cardiac Mri For Velocity Flow Mapping,"$2,506.00",$0.00,"$2,506.00","$1,869.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,506.00",$0.00,$601.44,"$1,984.75","$2,004.80",$0.00,$0.00,$0.00,$0.00,$0.00
61800010,EAP,HCPCS C8902,,"Mra W/o Fol W/cont, Abd, Cbc","$1,744.00",$0.00,"$1,744.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,744.00",$0.00,$872.00,"$1,381.25","$1,395.20",$0.00,$0.00,$0.00,$0.00,$0.00
62200001,EAP,Custom 62200001,,Intro Aortic Balloons,"$5,547.00",$0.00,"$5,547.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,547.00",$0.00,"$2,773.50","$4,393.22","$4,437.60",$0.00,$0.00,$0.00,$0.00,$0.00
62300002,EAP,HCPCS A6234,,Hydrocolloid Dsg 16 Sq In Or Less,$43.00,$0.00,$43.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$43.00,$0.00,$21.50,$34.06,$34.40,$0.00,$0.00,$0.00,$0.00,$0.00
62300003,EAP,HCPCS A6235,,Hydrocolloid Dsg more than 16sq in,$131.00,$0.00,$131.00,$71.13,$0.00,$0.00,$15.82,$0.00,$0.00,$22.94,$131.00,$0.00,$65.50,$103.75,$104.80,$0.00,$20.50,$0.00,$20.86,$0.00
62300006,EAP,HCPCS A6196,,Alginate Dressing <= 16 Sq In,$44.00,$0.00,$44.00,$23.89,$0.00,$0.00,$6.91,$0.00,$0.00,$7.70,$44.00,$0.00,$22.00,$34.85,$35.20,$0.00,$6.89,$0.00,$7.00,$0.00
62400002,EAP,Custom 62400002,,Trevo Retriever-ide#g100056,"$4,937.00",$0.00,"$4,937.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,937.00",$0.00,"$2,468.50","$3,910.10","$3,949.60",$0.00,$0.00,$0.00,$0.00,$0.00
62400003,EAP,Custom 62400003,,Trevo 18 Microcatheter-ide#g100056,$199.00,$0.00,$199.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$199.00,$0.00,$99.50,$157.61,$159.20,$0.00,$0.00,$0.00,$0.00,$0.00
63600011,EAP,CPT® 90670,,PNEUMONIA VACCINE PREVNAR,$30.00,$4.38,$252.18,$13.50,$21.41,$7.80,$5.17,$21.41,$21.41,$252.18,$30.00,$4.38,$15.00,$23.76,$24.00,$4.38,$252.18,$7.80,$240.12,$7.80
63600012,EAP,CPT® 90732,,PNEUMONIA VACCINE PNEUMOVAX,$30.00,$4.38,$134.20,$13.50,$21.41,$7.80,$9.40,$21.41,$21.41,$134.20,$30.00,$4.38,$15.00,$23.76,$24.00,$4.38,$134.20,$7.80,$127.78,$7.80
63600022,EAP,CPT® 90651,,GARDASIL-9 VACCINE,$493.00,$0.00,$493.00,$221.85,$351.85,$87.75,$84.94,$351.85,$351.85,$267.82,$493.00,$0.00,$246.50,$390.46,$394.40,$295.80,$267.82,$0.00,$255.01,$0.00
63600025,EAP,HCPCS J2182,,Rx Eap Nucala Charge,"$7,432.00",$0.00,"$7,432.00","$3,344.40","$5,158.80",$29.72,"$1,280.50","$5,158.80","$5,304.22",$34.42,"$7,432.00",$31.21,"$3,716.00","$5,886.14","$5,945.60",$43.09,$34.42,$0.00,$32.77,$29.72
63600101,EAP,HCPCS A9562,,Rad-99mtc Mag 3(ren)-pr,$350.00,$0.00,$350.00,$0.00,$249.80,$0.00,$60.30,$249.80,$249.80,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
63600104,EAP,HCPCS J7197,,Anti-thrombin Iii,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$4.28,$4.28,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
63600112,EAP,HCPCS J0881,,Darbepoetin Alfa 1,$16.00,$0.00,$16.00,$7.20,$11.42,$3.85,$3.60,$11.42,$11.42,$4.49,$16.00,$4.04,$8.00,$12.67,$12.80,$5.59,$4.49,$0.00,$4.27,$3.79
63600116,EAP,HCPCS J7189,,Factor 7a Novoseven,$5.00,$0.00,$5.00,$0.00,$3.57,$0.00,$0.00,$3.57,$3.57,$0.00,$5.00,$0.00,$2.50,$3.96,$4.00,$0.00,$0.00,$0.00,$0.00,$0.00
63600119,EAP,HCPCS A9552,,Fdg Unit Dose (supp,"$1,722.00",$0.00,"$1,722.00",$0.00,"$1,228.99",$0.00,$296.69,"$1,228.99","$1,228.99",$301.51,"$1,722.00",$0.00,$861.00,"$1,363.82","$1,377.60",$0.00,$227.28,$0.00,$274.14,$0.00
63600120,EAP,HCPCS A9556,,Ga-67 Gallium Citra,$49.00,$0.00,$49.00,$0.00,$34.97,$0.00,$0.00,$34.97,$34.97,$0.00,$49.00,$0.00,$24.50,$38.81,$39.20,$0.00,$0.00,$0.00,$0.00,$0.00
63600122,EAP,HCPCS A9517,,"I131 Therapy, 1mci",$60.00,$0.00,$60.00,$32.58,$42.82,$20.76,$10.34,$42.82,$42.82,$10.51,$60.00,$21.80,$30.00,$47.52,$48.00,$30.10,$9.39,$0.00,$9.55,$20.69
63600133,EAP,HCPCS J1885,,Ketorolac 15mg Inj,$34.00,$0.00,$34.00,$15.30,$24.27,$0.00,$0.32,$24.27,$24.27,$0.61,$34.00,$0.00,$17.00,$26.93,$27.20,$0.00,$0.61,$0.00,$0.58,$0.00
63600134,EAP,HCPCS J1885,,Ketorolac 30mg,$34.00,$0.00,$34.00,$15.30,$24.27,$0.00,$0.32,$24.27,$24.27,$0.61,$34.00,$0.00,$17.00,$26.93,$27.20,$0.00,$0.61,$0.00,$0.58,$0.00
63600138,EAP,HCPCS J0561,,Penicillin G Benzathine Inj,$30.00,$0.00,$30.00,$13.50,$21.41,$13.82,$5.17,$21.41,$21.41,$16.17,$30.00,$14.51,$15.00,$23.76,$24.00,$20.04,$16.17,$0.00,$15.39,$13.82
63600146,EAP,HCPCS Q9967,,Locm 300-349mg/ml I,$2.00,$0.00,$2.00,$0.90,$1.43,$0.00,$0.34,$1.43,$1.43,$0.14,$2.00,$0.00,$1.00,$1.58,$1.60,$0.00,$0.13,$0.00,$0.32,$0.00
63600170,EAP,HCPCS J0561,,Penicillin G Benz L,$158.00,$0.00,$158.00,$71.10,$112.76,$13.82,$27.22,$112.76,$112.76,$16.17,$158.00,$14.51,$79.00,$125.14,$126.40,$20.04,$16.17,$0.00,$15.39,$13.82
63600174,EAP,HCPCS J0561,,Penicillin G Benz L,$159.00,$0.00,$159.00,$71.55,$113.48,$13.82,$27.39,$113.48,$113.48,$16.17,$159.00,$14.51,$79.50,$125.93,$127.20,$20.04,$16.17,$0.00,$15.39,$13.82
63600182,EAP,HCPCS J2820,,Sargramostim 50mcg,$174.00,$0.00,$174.00,$0.00,$124.18,$0.00,$0.00,$124.18,$124.18,$0.00,$174.00,$0.00,$87.00,$137.81,$139.20,$0.00,$0.00,$0.00,$0.00,$0.00
63600209,EAP,HCPCS A9551,,Tc-99m Dmsa Nuc,$615.00,$0.00,$615.00,$0.00,$438.93,$0.00,$0.00,$438.93,$438.93,$0.00,$615.00,$0.00,$307.50,$487.08,$492.00,$0.00,$0.00,$0.00,$0.00,$0.00
63600210,EAP,HCPCS A9600,,Sr-89 Therapy Radio,"$3,784.00",$0.00,"$3,784.00",$0.00,"$2,700.64",$0.00,$0.00,"$2,700.64","$2,700.64",$0.00,"$3,784.00",$0.00,"$1,892.00","$2,996.93","$3,027.20",$0.00,$0.00,$0.00,$0.00,$0.00
63600211,EAP,HCPCS A9604,,Sm 153 Lexidronam 5,"$13,509.00",$0.00,"$13,509.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$13,509.00",$0.00,"$6,754.50","$10,699.13","$10,807.20",$0.00,$0.00,$0.00,$0.00,$0.00
63600212,EAP,HCPCS A9548,,In 111pentetate Dtp,"$3,094.00",$0.00,"$3,094.00",$0.00,"$2,208.19",$0.00,$0.00,"$2,208.19","$2,208.19",$0.00,"$3,094.00",$0.00,"$1,547.00","$2,450.45","$2,475.20",$0.00,$0.00,$0.00,$0.00,$0.00
63600324,EAP,CPT® 90632,,HEP A VACCINE,$72.00,$0.00,$72.00,$32.40,$51.39,$0.00,$56.67,$51.39,$51.39,$70.39,$72.00,$0.00,$36.00,$57.02,$57.60,$0.00,$70.39,$0.00,$67.03,$0.00
63600325,EAP,CPT® 90633,,HEPA VACCINE PED/ADOL 2 DOSE IM,$72.00,$0.00,$72.00,$32.40,$51.39,$0.00,$9.40,$51.39,$51.39,$12.61,$72.00,$0.00,$36.00,$57.02,$57.60,$0.00,$11.27,$0.00,$11.46,$0.00
63600326,EAP,CPT® 90636,,HEP A/B TWINRX VACCINE,$98.00,$0.00,$122.20,$44.10,$69.94,$0.00,$107.88,$69.94,$69.94,$122.20,$98.00,$0.00,$49.00,$77.62,$78.40,$0.00,$122.20,$0.00,$116.36,$0.00
63600327,EAP,CPT® 90647,,PEDVAXHIB VACCINE,$38.00,$0.00,$38.00,$17.10,$27.12,$0.00,$6.55,$27.12,$27.12,$6.65,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$5.95,$0.00,$6.05,$0.00
63600335,EAP,CPT® 90675,,RABIES VACCINE,"$1,011.00",$0.00,"$1,011.00",$454.95,$721.55,$297.59,$174.76,$721.55,$721.55,$326.44,"$1,011.00",$312.47,$505.50,$800.71,$808.80,$431.50,$326.44,$0.00,$310.83,$294.72
63600336,EAP,CPT® 90680,,ROTAVIRUS 3 DOSE VACCINE,$108.00,$0.00,$108.00,$48.60,$77.08,$0.00,$18.61,$77.08,$77.08,$18.91,$108.00,$0.00,$54.00,$85.54,$86.40,$0.00,$16.90,$0.00,$17.19,$0.00
63600337,EAP,CPT® 90698,,PENTACEL VACCINE,$130.00,$0.00,$130.00,$58.50,$92.78,$0.00,$22.40,$92.78,$92.78,$22.76,$130.00,$0.00,$65.00,$102.96,$104.00,$0.00,$20.35,$0.00,$20.70,$0.00
63600338,EAP,CPT® 90700,,DTAP VACCINE,$38.00,$0.00,$38.00,$17.10,$27.12,$0.00,$6.55,$27.12,$27.12,$6.65,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$5.95,$0.00,$6.05,$0.00
63600344,EAP,CPT® 90707,,MMR VACCINE,$83.00,$0.00,$92.45,$37.35,$59.24,$0.00,$11.75,$59.24,$59.24,$92.45,$83.00,$0.00,$41.50,$65.74,$66.40,$0.00,$92.45,$0.00,$88.03,$0.00
63600346,EAP,CPT® 90710,,MMRV VACCINE,$19.00,$0.00,$19.00,$8.55,$13.56,$0.00,$3.27,$13.56,$13.56,$3.33,$19.00,$0.00,$9.50,$15.05,$15.20,$0.00,$2.97,$0.00,$3.02,$0.00
63600348,EAP,CPT® 90713,,POLIO VACCINE,$32.00,$0.00,$32.00,$0.00,$22.84,$0.00,$0.00,$22.84,$22.84,$0.00,$32.00,$0.00,$16.00,$25.34,$25.60,$0.00,$0.00,$0.00,$0.00,$0.00
63600349,EAP,CPT® 90714,,TENIVAC VACCINE,$30.00,$0.00,$30.00,$13.50,$21.41,$0.00,$11.75,$21.41,$21.41,$29.50,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$29.50,$0.00,$28.09,$0.00
63600350,EAP,CPT® 90715,,TDAP VACCINE,$54.00,$0.00,$54.00,$24.30,$38.54,$0.00,$9.30,$38.54,$38.54,$39.53,$54.00,$0.00,$27.00,$42.77,$43.20,$0.00,$39.53,$0.00,$37.64,$0.00
63600351,EAP,CPT® 90716,,VARICELLA VACCINE,$414.00,$0.00,$414.00,$186.30,$295.47,$73.69,$9.40,$295.47,$295.47,$159.48,$414.00,$0.00,$207.00,$327.89,$331.20,$248.40,$159.48,$0.00,$151.85,$0.00
63600355,EAP,CPT® 90723,,DTAP HEPB VACCINE,$108.00,$0.00,$108.00,$48.60,$77.08,$19.22,$18.61,$77.08,$77.08,$18.91,$108.00,$0.00,$54.00,$85.54,$86.40,$64.80,$16.90,$0.00,$17.19,$0.00
63600360,EAP,CPT® 90746,,HEP B VACCINE ADULT 3 DOSE,$230.00,$0.00,$230.00,$103.50,$164.15,$59.80,$70.16,$164.15,$164.15,$78.80,$230.00,$0.00,$115.00,$182.16,$184.00,$138.00,$78.80,$59.80,$75.03,$59.80
63600374,EAP,HCPCS J0561,,Penicillin G Benz La 1.2 Mu,$159.00,$0.00,$159.00,$71.55,$113.48,$13.82,$27.39,$113.48,$113.48,$16.17,$159.00,$14.51,$79.50,$125.93,$127.20,$20.04,$16.17,$0.00,$15.39,$13.82
63600380,EAP,HCPCS J0131,,"Acetaminophen, Iv 1000mg/100 Ml",$58.00,$0.00,$58.00,$0.00,$41.39,$0.00,$0.00,$41.39,$41.39,$0.00,$58.00,$0.00,$29.00,$45.94,$46.40,$0.00,$0.00,$0.00,$0.00,$0.00
63600381,EAP,HCPCS J0461,,"Atropine 0.4mg/ml,20 Ml",$124.00,$0.00,$124.00,$55.80,$88.50,$0.00,$21.36,$88.50,$88.50,$0.09,$124.00,$0.00,$62.00,$98.21,$99.20,$0.00,$0.09,$0.00,$0.09,$0.00
63600382,EAP,HCPCS J0690,,"Cefazolin Sodium, 1 Gm Vial",$16.00,$0.00,$16.00,$7.20,$11.42,$0.00,$0.69,$11.42,$11.42,$0.96,$16.00,$0.00,$8.00,$12.67,$12.80,$0.00,$0.96,$0.00,$0.92,$0.00
63600383,EAP,HCPCS S0077,,"Clindamycin Phosphate, 300 Mg",$39.00,$0.00,$39.00,$17.55,$27.83,$6.94,$3.54,$27.83,$27.83,$1.65,$39.00,$0.00,$19.50,$30.89,$31.20,$23.40,$1.65,$0.00,$1.57,$0.00
63600384,EAP,HCPCS J1100,,"Dexamethasone,4mg/ml 5ml",$16.00,$0.00,$16.00,$7.20,$11.42,$0.00,$0.11,$11.42,$11.42,$0.14,$16.00,$0.00,$8.00,$12.67,$12.80,$0.00,$0.14,$0.00,$0.13,$0.00
63600385,EAP,HCPCS J1200,,Diphenhydramine  Hci  Up To 50 Mg,$16.00,$0.00,$16.00,$7.20,$11.42,$0.00,$0.86,$11.42,$11.42,$1.06,$16.00,$0.00,$8.00,$12.67,$12.80,$0.00,$1.06,$0.00,$1.01,$0.00
63600386,EAP,HCPCS J0171,,"Epinephrine1 Mg/1 Ml, 30 Ml",$27.00,$0.00,$27.00,$12.15,$19.27,$0.00,$4.65,$19.27,$19.27,$0.96,$27.00,$0.00,$13.50,$21.38,$21.60,$0.00,$0.96,$0.00,$0.92,$0.00
63600387,EAP,HCPCS J1940,,"Furosemide, Up To 20 Mg",$16.00,$0.00,$16.00,$7.20,$11.42,$0.00,$0.25,$11.42,$11.42,$0.69,$16.00,$0.00,$8.00,$12.67,$12.80,$0.00,$0.69,$0.00,$0.66,$0.00
63600388,EAP,HCPCS J1644,,"Heparin Sodium, Per 1000 Units/ml, 10 Ml",$16.00,$0.00,$16.00,$7.20,$11.42,$0.00,$0.24,$11.42,$11.42,$0.28,$16.00,$0.00,$8.00,$12.67,$12.80,$0.00,$0.28,$0.00,$0.27,$0.00
63600389,EAP,HCPCS J0360,,"Hydralazine  Hci, Up To 20 Mg",$47.00,$0.00,$47.00,$21.15,$33.54,$0.00,$5.77,$33.54,$33.54,$4.41,$47.00,$0.00,$23.50,$37.22,$37.60,$0.00,$4.41,$0.00,$4.20,$0.00
63600390,EAP,HCPCS J1720,,"Hydrocortisone Sod Succ Up, To 100",$19.00,$0.00,$19.00,$8.55,$13.56,$0.00,$3.27,$13.56,$13.56,$15.33,$19.00,$0.00,$9.50,$15.05,$15.20,$0.00,$15.33,$0.00,$14.60,$0.00
63600391,EAP,HCPCS J1885,,Ketorolac 60mg/2ml,$16.00,$0.00,$16.00,$7.20,$11.42,$0.00,$0.32,$11.42,$11.42,$0.61,$16.00,$0.00,$8.00,$12.67,$12.80,$0.00,$0.61,$0.00,$0.58,$0.00
63600392,EAP,HCPCS J2405,,"Ondansetron Hci, Per 1mg",$16.00,$0.00,$16.00,$7.20,$11.42,$0.00,$0.25,$11.42,$11.42,$0.11,$16.00,$0.00,$8.00,$12.67,$12.80,$0.00,$0.11,$0.00,$0.10,$0.00
63600393,EAP,HCPCS J2590,,"Oxytocin, Up To 10 Units",$16.00,$0.00,$16.00,$7.20,$11.42,$0.00,$1.47,$11.42,$11.42,$2.80,$16.00,$0.00,$8.00,$12.67,$12.80,$0.00,$2.50,$0.00,$2.55,$0.00
63600394,EAP,HCPCS J2370,,"Phenylephrine 10mg/ml, 1ml",$47.00,$0.00,$47.00,$21.15,$33.54,$0.00,$0.96,$33.54,$33.54,$4.31,$47.00,$0.00,$23.50,$37.22,$37.60,$0.00,$4.31,$0.00,$4.11,$0.00
63600395,EAP,HCPCS J0330,,"Succinylcholine Chloride, Up To 20 Mg/ml,10 Ml",$33.00,$0.00,$33.00,$14.85,$23.55,$0.00,$5.69,$23.55,$23.55,$5.78,$33.00,$0.00,$16.50,$26.14,$26.40,$0.00,$5.16,$0.00,$5.25,$0.00
63600396,EAP,HCPCS J3370,,Vancomycin 1gm Vial,$24.00,$0.00,$24.00,$10.80,$17.13,$0.00,$3.62,$17.13,$17.13,$3.98,$24.00,$0.00,$12.00,$19.01,$19.20,$0.00,$3.98,$0.00,$3.79,$0.00
63600402,EAP,HCPCS J2791,,"Njx, Rho(d) Immune Globulin (human), (rhophylac)",$534.00,$0.00,$534.00,$240.30,$381.12,$0.00,$0.00,$381.12,$381.12,$5.59,$534.00,$0.00,$267.00,$422.93,$427.20,$0.00,$0.00,$0.00,$5.33,$0.00
63600404,EAP,HCPCS J7194,,Factor 9,$2.00,$0.00,$2.00,$0.00,$1.43,$0.00,$0.00,$1.43,$1.43,$0.00,$2.00,$0.00,$1.00,$1.58,$1.60,$0.00,$0.00,$0.00,$0.00,$0.00
63600405,EAP,HCPCS J2790,,Rh Immune Globulin- 300 Mcg,$131.00,$0.00,$131.00,$58.95,$93.49,$0.00,$101.36,$93.49,$93.49,$87.71,$131.00,$0.00,$65.50,$103.75,$104.80,$0.00,$87.71,$0.00,$83.52,$0.00
63600460,EAP,HCPCS J7189,,Novoseven F7 1.0,"$5,380.00",$0.00,"$5,380.00",$0.00,"$3,839.71",$0.00,$0.00,"$3,839.71","$3,839.71",$0.00,"$5,380.00",$0.00,"$2,690.00","$4,260.96","$4,304.00",$0.00,$0.00,$0.00,$0.00,$0.00
63600461,EAP,HCPCS J7189,,Novoseven F7 2.0,"$10,222.00",$0.00,"$10,222.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$7,295.44",$0.00,"$10,222.00",$0.00,"$5,111.00","$8,095.82","$8,177.60",$0.00,$0.00,$0.00,$0.00,$0.00
63600462,EAP,CPT® 90734,,MENVEO VACCINE,$410.00,$0.00,$410.00,$184.50,$292.62,$72.98,$9.40,$292.62,$292.62,$143.71,$410.00,$0.00,$205.00,$324.72,$328.00,$246.00,$143.71,$0.00,$136.84,$0.00
63600467,EAP,CPT® 90620,,MENINGITIS VACCINE,$569.62,$0.00,$569.62,$256.33,$406.54,$101.39,$98.14,$406.54,$406.54,$200.63,$569.62,$0.00,$284.81,$451.14,$455.70,$341.77,$200.63,$0.00,$191.04,$0.00
63600526,EAP,HCPCS C9250,,Kit Tiss Clsr 4ml Artiss Frzn Slnt,$811.00,$0.00,$811.00,$364.95,$578.81,$164.85,$139.73,$578.81,$578.81,$142.00,$811.00,$173.09,$405.50,$642.31,$648.80,$239.03,$126.92,$0.00,$129.11,$164.85
63600527,EAP,HCPCS C9250,,Kit Tiss Clsr 10ml Artiss Frzn Slnt,"$1,814.00",$0.00,"$1,814.00",$816.30,"$1,294.65",$164.85,$312.54,"$1,294.65","$1,294.65",$317.62,"$1,814.00",$173.09,$907.00,"$1,436.69","$1,451.20",$239.03,$283.89,$0.00,$288.79,$164.85
63600528,EAP,HCPCS C9250,,Kit Tiss Clsr 2ml Artiss Frzn Slnt,$475.00,$0.00,$475.00,$213.75,$339.01,$164.85,$81.84,$339.01,$339.01,$83.17,$475.00,$173.09,$237.50,$376.20,$380.00,$239.03,$74.34,$0.00,$75.62,$164.85
63603027,EAP,HCPCS J1610,,Glucagon 1 Mg,$415.00,$0.00,$415.00,$186.75,$296.19,$199.27,$88.07,$296.19,$296.19,$255.63,$415.00,$209.24,$207.50,$328.68,$332.00,$288.94,$255.63,$0.00,$243.41,$199.13
63603176,EAP,HCPCS J2792,,"Rho(d) Immune Globulin H, Sd  Winrho","$1,482.00",$0.00,"$1,482.00",$0.00,"$1,057.70",$0.00,$0.00,"$1,057.70","$1,057.70",$0.00,"$1,482.00",$0.00,$741.00,"$1,173.74","$1,185.60",$0.00,$0.00,$0.00,$0.00,$0.00
63603287,EAP,CPT® 90634,,HEPA VACCINE PED/ADOL-3 DOSE-IM,$34.00,$0.00,$34.00,$0.00,$24.27,$0.00,$0.00,$24.27,$24.27,$0.00,$34.00,$0.00,$17.00,$26.93,$27.20,$0.00,$0.00,$0.00,$0.00,$0.00
63603296,EAP,CPT® 90696,,DTAP IPV VACCINE,$185.00,$0.00,$185.00,$83.25,$132.03,$0.00,$31.87,$132.03,$132.03,$32.39,$185.00,$0.00,$92.50,$146.52,$148.00,$0.00,$28.95,$0.00,$29.45,$0.00
63603300,EAP,CPT® 90747,,HEP B VACCINE IMMUNOSUPRESSED,$100.00,$0.00,$157.59,$45.00,$71.37,$26.00,$140.32,$71.37,$71.37,$157.59,$100.00,$0.00,$50.00,$79.20,$80.00,$60.00,$157.59,$26.00,$150.05,$26.00
63603301,EAP,CPT® 90744,,HEP B VACCINE PED/ADULT 3 DOSE,$100.00,$0.00,$100.00,$45.00,$71.37,$26.00,$17.23,$71.37,$71.37,$17.51,$100.00,$0.00,$50.00,$79.20,$80.00,$60.00,$15.65,$26.00,$0.00,$26.00
63604091,EAP,HCPCS C9250,,Kit Tiss Clsr Frzn Slnt Artiss 4ml,$836.00,$0.00,$836.00,$376.20,$596.65,$164.85,$144.04,$596.65,$596.65,$146.38,$836.00,$173.09,$418.00,$662.11,$668.80,$239.03,$130.83,$0.00,$133.09,$164.85
63604093,EAP,CPT® 90648,,HIBERIX VACCINE,$87.19,$0.00,$87.19,$39.24,$62.23,$0.00,$15.02,$62.23,$62.23,$15.27,$87.19,$0.00,$43.60,$69.05,$69.75,$0.00,$13.65,$0.00,$13.88,$0.00
63690324,EAP,HCPCS J1050,,Depo Provera Inject 1mg,$50.00,$0.00,$50.00,$22.50,$35.69,$0.00,$8.61,$35.69,$35.69,$0.66,$50.00,$0.00,$25.00,$39.60,$40.00,$0.00,$0.66,$0.00,$0.63,$0.00
63690325,EAP,HCPCS J0696,,Ceftriaxone Per 250 Mg,$35.00,$0.00,$35.00,$15.75,$24.98,$0.00,$1.41,$24.98,$24.98,$0.71,$35.00,$0.00,$17.50,$27.72,$28.00,$0.00,$0.71,$0.00,$0.67,$0.00
63690332,EAP,HCPCS J0694,,Cefoxitin 1gm Vial,$25.00,$0.00,$25.00,$11.25,$17.84,$0.00,$8.06,$17.84,$17.84,$6.22,$25.00,$0.00,$12.50,$19.80,$20.00,$0.00,$6.22,$0.00,$5.92,$0.00
63690333,EAP,HCPCS J1200,,Diphenhydramine 50 Mg/ml,$16.00,$0.00,$16.00,$7.20,$11.42,$0.00,$0.86,$11.42,$11.42,$1.06,$16.00,$0.00,$8.00,$12.67,$12.80,$0.00,$1.06,$0.00,$1.01,$0.00
63690334,EAP,HCPCS J0360,,Hydralazine 20mg/1ml,$47.00,$0.00,$47.00,$21.15,$33.54,$0.00,$5.77,$33.54,$33.54,$4.41,$47.00,$0.00,$23.50,$37.22,$37.60,$0.00,$4.41,$0.00,$4.20,$0.00
63690335,EAP,HCPCS J1720,,Hydrocortisone Sod Succ 100mg Vial,$19.00,$0.00,$19.00,$8.55,$13.56,$0.00,$3.27,$13.56,$13.56,$15.33,$19.00,$0.00,$9.50,$15.05,$15.20,$0.00,$15.33,$0.00,$14.60,$0.00
63690336,EAP,HCPCS J1885,,Ketorolac 60 Mg/2ml,$16.00,$0.00,$16.00,$7.20,$11.42,$0.00,$0.32,$11.42,$11.42,$0.61,$16.00,$0.00,$8.00,$12.67,$12.80,$0.00,$0.61,$0.00,$0.58,$0.00
63690337,EAP,HCPCS J2590,,Oxytocin 10unit/1ml,$16.00,$0.00,$16.00,$7.20,$11.42,$0.00,$1.47,$11.42,$11.42,$2.80,$16.00,$0.00,$8.00,$12.67,$12.80,$0.00,$2.50,$0.00,$2.55,$0.00
63690341,EAP,CPT® 90656,,Flu Vaccine Pf > 18 Yrs 2018-2019,$25.00,$3.65,$25.00,$11.25,$17.84,$6.50,$4.31,$17.84,$17.84,$4.38,$25.00,$3.65,$12.50,$19.80,$20.00,$3.65,$3.91,$6.50,$3.98,$6.50
63690342,EAP,CPT® 90685,,Flu Vaccine Pf 6-35 Months 2018-2019,$25.00,$3.65,$25.00,$11.25,$17.84,$6.50,$4.31,$17.84,$17.84,$4.38,$25.00,$3.65,$12.50,$19.80,$20.00,$3.65,$3.91,$6.50,$3.98,$6.50
63690347,EAP,CPT® 90688,,Flu Iiv4 Vaccine Splt 0.5ml Im (2018-2019),$25.00,$0.00,$25.00,$11.25,$17.84,$6.50,$0.00,$17.84,$17.84,$0.00,$25.00,$3.65,$12.50,$19.80,$20.00,$3.65,$0.00,$6.50,$19.96,$6.50
63690350,EAP,CPT® 90685,,Flu Vaccine Pf 6m - 35m 2019-2020,$25.00,$3.65,$25.00,$11.25,$17.84,$6.50,$4.31,$17.84,$17.84,$4.38,$25.00,$3.65,$12.50,$19.80,$20.00,$3.65,$3.91,$6.50,$3.98,$6.50
63690351,EAP,CPT® 90686,,Flu Vaccine Pf 3 & Up 2019-2020,$25.00,$3.65,$25.00,$11.25,$17.84,$6.50,$4.31,$17.84,$17.84,$22.36,$25.00,$3.65,$12.50,$19.80,$20.00,$3.65,$22.36,$6.50,$21.29,$6.50
63690355,EAP,CPT® 90674,,2020-2021 FLU VACCINE,$25.00,$3.65,$33.05,$11.25,$17.84,$6.50,$4.31,$17.84,$17.84,$33.05,$25.00,$3.65,$12.50,$19.80,$20.00,$3.65,$33.05,$6.50,$31.47,$6.50
63690358,EAP,CPT® 90686,,2020-2021 FLU VACCINE,$25.00,$3.65,$25.00,$11.25,$17.84,$6.50,$4.31,$17.84,$17.84,$22.36,$25.00,$3.65,$12.50,$19.80,$20.00,$3.65,$22.36,$6.50,$21.29,$6.50
63690360,EAP,CPT® 90681,,ROTAVIRUS 2 DOSE VACCINE,$108.00,$0.00,$108.00,$48.60,$77.08,$19.22,$0.00,$77.08,$77.08,$18.91,$108.00,$0.00,$54.00,$85.54,$86.40,$64.80,$0.00,$0.00,$17.19,$0.00
63690370,EAP,CPT® 90648,,ACTHIB VACCINE,$71.00,$0.00,$71.00,$31.95,$50.67,$0.00,$12.23,$50.67,$50.67,$12.43,$71.00,$0.00,$35.50,$56.23,$56.80,$0.00,$11.11,$0.00,$11.30,$0.00
68000010,EAP,Custom 68000010,,Level 2 Partial Trauma Activation W/o Prenotificat,"$13,599.00",$0.00,"$12,363.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$12,363.00",$0.00,"$6,181.50","$9,791.50","$9,890.40",$0.00,$0.00,$0.00,$0.00,$0.00
68000065,EAP,Custom 68000065,,Level 1 Full Trauma Activation W/o Prenotification,"$25,440.00",$0.00,"$23,127.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$23,127.00",$0.00,"$11,563.50","$18,316.58","$18,501.60",$0.00,$0.00,$0.00,$0.00,$0.00
68100003,EAP,Custom 68100003,,Level 1 Full Trauma Activation,"$25,440.00",$0.00,"$23,127.00","$5,107.20","$4,276.38",$0.00,$0.00,"$4,276.38","$4,276.38",$0.00,"$23,127.00",$0.00,"$11,563.50","$18,316.58","$18,501.60",$0.00,$0.00,$0.00,$0.00,$0.00
68100004,EAP,Custom 68100004,,Level 2 Partial Trauma Activation,"$13,599.00",$0.00,"$12,363.00","$5,107.20","$4,276.38",$0.00,$0.00,"$4,276.38","$4,276.38",$0.00,"$12,363.00",$0.00,"$6,181.50","$9,791.50","$9,890.40",$0.00,$0.00,$0.00,$0.00,$0.00
68100005,EAP,Custom 68100005,,Level 3 Partial Trauma Activation,"$6,825.00",$0.00,"$6,204.00","$5,107.20","$4,276.38",$0.00,$0.00,"$4,276.38","$4,276.38",$0.00,"$6,204.00",$0.00,"$3,102.00","$4,913.57","$4,963.20",$0.00,$0.00,$0.00,$0.00,$0.00
70000001,EAP,CPT® 29035,,"Apply Body Cast, Shldr To Hips","$1,578.00",$0.00,"$1,578.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,578.00",$0.00,"$1,578.00","$1,249.78","$1,262.40",$0.00,$0.00,$0.00,$0.00,$0.00
70000002,EAP,CPT® 29040,,Apply Body Cast Risser/minerva,"$1,188.00",$0.00,"$1,188.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,188.00",$0.00,"$1,188.00",$940.90,$950.40,$0.00,$0.00,$0.00,$0.00,$0.00
70000003,EAP,CPT® 29065,,Apply Long Arm Cast,"$1,380.00",$0.00,"$1,380.00",$749.34,$0.00,$220.37,$237.77,$0.00,$0.00,$241.63,"$1,380.00",$230.50,"$1,380.00","$1,092.96","$1,104.00",$320.24,$126.54,$70.29,$219.70,$219.52
70000004,EAP,CPT® 29075,,Apply Short Arm Cast,$888.00,$0.00,$888.00,$482.18,$0.00,$220.37,$153.00,$0.00,$0.00,$155.48,$888.00,$230.50,$888.00,$703.30,$710.40,$320.24,$110.88,$63.44,$141.37,$219.52
70000005,EAP,CPT® 29105,,Apply Long Arm Splint,$859.00,$0.00,$859.00,$466.44,$0.00,$128.24,$148.00,$0.00,$0.00,$150.40,$859.00,$134.13,$859.00,$680.33,$687.20,$186.36,$94.27,$43.63,$136.75,$127.75
70000006,EAP,CPT® 29125,,Apply Short Arm Splint Static,$952.00,$0.00,$952.00,$516.94,$0.00,$104.55,$164.02,$0.00,$0.00,$166.69,$952.00,$109.35,$952.00,$753.98,$761.60,$151.93,$72.40,$40.73,$151.56,$104.14
70000007,EAP,CPT® 29305,,"Apply Hip Spica Cast, One Leg",$685.00,$0.00,$685.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$685.00,$0.00,$685.00,$542.52,$548.00,$0.00,$0.00,$0.00,$0.00,$0.00
70000008,EAP,CPT® 29325,,Apply Hip Spica Cast Both Legs,"$1,235.00",$0.00,"$1,235.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,235.00",$0.00,"$1,235.00",$978.12,$988.00,$0.00,$0.00,$0.00,$0.00,$0.00
70000009,EAP,CPT® 29345,,Apply Long Leg Cast,$789.00,$0.00,$789.00,$0.00,$0.00,$0.00,$135.94,$0.00,$0.00,$0.00,$789.00,$0.00,$789.00,$624.89,$631.20,$0.00,$170.33,$0.00,$0.00,$0.00
70000010,EAP,CPT® 29358,,Apply Long Leg Cast Brace,"$1,188.00",$0.00,"$1,188.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,188.00",$0.00,"$1,188.00",$940.90,$950.40,$0.00,$0.00,$0.00,$0.00,$0.00
70000011,EAP,CPT® 29365,,Apply Cylinder Cast,"$1,235.00",$0.00,"$1,235.00",$670.61,$0.00,$220.37,$212.78,$0.00,$0.00,$216.24,"$1,235.00",$230.50,"$1,235.00",$978.12,$988.00,$320.24,$144.43,$90.11,$196.61,$219.52
70000012,EAP,CPT® 29405,,Apply Short Leg Cast,$888.00,$0.00,$888.00,$482.18,$0.00,$220.37,$153.00,$0.00,$0.00,$155.48,$888.00,$230.50,$888.00,$703.30,$710.40,$320.24,$118.65,$60.92,$141.37,$219.52
70000013,EAP,CPT® 29425,,Apply Short Leg Cast Walking,"$1,321.00",$0.00,"$1,321.00",$717.30,$0.00,$220.37,$227.60,$0.00,$0.00,$231.30,"$1,321.00",$230.50,"$1,321.00","$1,046.23","$1,056.80",$320.24,$123.49,$57.32,$210.30,$219.52
70000014,EAP,CPT® 29435,,Apply Short Leg Cast Ptb,$888.00,$0.00,$888.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$888.00,$0.00,$888.00,$703.30,$710.40,$0.00,$0.00,$0.00,$0.00,$0.00
70000015,EAP,CPT® 29445,,"Long Leg Cast, Rigid","$1,822.00",$106.00,"$1,822.00",$989.35,"$1,300.36",$220.37,$313.92,"$1,300.36","$1,300.36",$319.02,"$1,822.00",$230.50,"$1,822.00","$1,443.02","$1,457.60",$320.24,$206.12,$106.00,$290.06,$219.52
70000016,EAP,CPT® 29505,,Apply Long Leg Splint,"$1,535.00",$0.00,"$1,535.00",$833.51,$0.00,$128.24,$264.47,$0.00,$0.00,$268.77,"$1,535.00",$134.13,"$1,535.00","$1,215.72","$1,228.00",$186.36,$94.49,$52.27,$244.37,$127.75
70000017,EAP,CPT® 29515,,Apply Short Leg Splint,$888.00,$0.00,$888.00,$482.18,$0.00,$128.24,$153.00,$0.00,$0.00,$155.48,$888.00,$134.13,$888.00,$703.30,$710.40,$186.36,$80.51,$51.19,$141.37,$127.75
70000018,EAP,CPT® 29705,,Removal Full Arm/leg Cast,$888.00,$0.00,$888.00,$482.18,$0.00,$220.37,$153.00,$0.00,$0.00,$155.48,$888.00,$230.50,$888.00,$703.30,$710.40,$320.24,$51.73,$47.23,$141.37,$219.52
70000019,EAP,CPT® 29730,,Windowing Of Cast,$685.00,$0.00,$685.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$685.00,$0.00,$685.00,$542.52,$548.00,$0.00,$0.00,$0.00,$0.00,$0.00
70000200,EAP,HCPCS C1725,,Catheter Angio 100cm 4fr Sfvu Pgtl Curve Brd Strl,$175.00,$0.00,$175.00,$95.03,$124.90,$0.00,$30.15,$124.90,$124.90,$30.64,$175.00,$0.00,$87.50,$138.60,$140.00,$0.00,$27.39,$0.00,$27.86,$0.00
70000217,EAP,HCPCS C1725,,Catheter Angio Cbr 2 Curve 5fr 65cm Vscr Radiopq,$175.00,$0.00,$175.00,$95.03,$124.90,$0.00,$30.15,$124.90,$124.90,$30.64,$175.00,$0.00,$87.50,$138.60,$140.00,$0.00,$27.39,$0.00,$27.86,$0.00
70000219,EAP,HCPCS C1757,,Catheter Thrmb 135cm 5fr Unfs Flw-thru Hub Infus,$438.00,$0.00,$438.00,$0.00,$312.60,$0.00,$0.00,$312.60,$312.60,$0.00,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$0.00,$0.00,$0.00,$0.00
70000220,EAP,HCPCS C1757,,Catheter Thrmb 135cm 5fr Unfs Flw-thru Hub Infus,$438.00,$0.00,$438.00,$0.00,$312.60,$0.00,$0.00,$312.60,$312.60,$0.00,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$0.00,$0.00,$0.00,$0.00
70000224,EAP,HCPCS C1725,,Catheter Angio Ang Brnstn Curve 5fr 100cm 10cm,$175.00,$0.00,$175.00,$95.03,$124.90,$0.00,$30.15,$124.90,$124.90,$30.64,$175.00,$0.00,$87.50,$138.60,$140.00,$0.00,$27.39,$0.00,$27.86,$0.00
70000225,EAP,HCPCS C1725,,Catheter Angio Sos O2 Curve 5fr 80cm Vscr Radiopq,$175.00,$0.00,$175.00,$95.03,$124.90,$0.00,$30.15,$124.90,$124.90,$30.64,$175.00,$0.00,$87.50,$138.60,$140.00,$0.00,$27.39,$0.00,$27.86,$0.00
70000226,EAP,HCPCS C1725,,Catheter Angio Cbr 2 Curve 4fr 65cm Vscr Radiopq,$175.00,$0.00,$175.00,$95.03,$124.90,$0.00,$30.15,$124.90,$124.90,$30.64,$175.00,$0.00,$87.50,$138.60,$140.00,$0.00,$27.39,$0.00,$27.86,$0.00
70000584,EAP,HCPCS C1876,,Stent Endoprsth Trchbr 90mm 16mm 9fr Mtl Wlstnt,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,"$1,605.83","$1,605.83",$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
70000587,EAP,HCPCS C1769,,Guidewire Vasc 260cm .035in Flxb Flpy Tip Fltwr,"$2,653.00",$0.00,"$2,653.00","$1,440.58","$1,893.45",$0.00,$457.10,"$1,893.45","$1,893.45",$464.52,"$2,653.00",$0.00,"$1,326.50","$2,101.18","$2,122.40",$0.00,$415.19,$0.00,$422.36,$0.00
70000602,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in Intmd Tip Radiopq X,"$1,075.00",$0.00,"$1,075.00",$583.73,$767.23,$0.00,$185.22,$767.23,$767.23,$188.22,"$1,075.00",$0.00,$537.50,$851.40,$860.00,$0.00,$168.24,$0.00,$171.14,$0.00
70000603,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in Flpy Intmd Tip Radiopq,"$1,075.00",$0.00,"$1,075.00",$583.73,$767.23,$0.00,$185.22,$767.23,$767.23,$188.22,"$1,075.00",$0.00,$537.50,$851.40,$860.00,$0.00,$168.24,$0.00,$171.14,$0.00
70000626,EAP,HCPCS C1769,,Guidewire Vasc 145cm .035in Flxb Flpy Tip Fltwr,$331.00,$0.00,$331.00,$179.73,$236.23,$0.00,$57.03,$236.23,$236.23,$57.96,$331.00,$0.00,$165.50,$262.15,$264.80,$0.00,$51.80,$0.00,$52.70,$0.00
70000720,EAP,HCPCS C1769,,Guidewire Vasc 260cm .035in Fix Core Flx Tp Hvdty,$74.00,$0.00,$74.00,$40.18,$52.81,$0.00,$12.75,$52.81,$52.81,$12.96,$74.00,$0.00,$37.00,$58.61,$59.20,$0.00,$11.58,$0.00,$11.78,$0.00
70000762,EAP,HCPCS C1725,,Catheter Angio 100cm 5fr Trnb Ad Bcn Jb1 Curve Ss,$63.00,$0.00,$63.00,$34.21,$44.96,$0.00,$10.85,$44.96,$44.96,$11.03,$63.00,$0.00,$31.50,$49.90,$50.40,$0.00,$9.86,$0.00,$10.03,$0.00
70000764,EAP,HCPCS C1725,,Catheter Angio 100cm 5fr Trnb Ad Bcn Sim2 Curve Ss,$313.00,$0.00,$313.00,$169.96,$223.39,$0.00,$53.93,$223.39,$223.39,$54.80,$313.00,$0.00,$156.50,$247.90,$250.40,$0.00,$48.98,$0.00,$49.83,$0.00
70000820,EAP,HCPCS C1773,,Set Rtrvl 80cm 6.3fr 11fr Gnth Tlp Coons Vc 3w,$625.00,$0.00,$625.00,$339.38,$446.06,$0.00,$107.68,$446.06,$446.06,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
70000823,EAP,HCPCS C1769,,Guidewire Vasc 60cm .018in Flpy Sftp Ang Tpr 7cm,$95.00,$0.00,$95.00,$51.59,$67.80,$0.00,$16.37,$67.80,$67.80,$16.63,$95.00,$0.00,$47.50,$75.24,$76.00,$0.00,$14.87,$0.00,$15.12,$0.00
70000977,EAP,HCPCS C1887,,Catheter Guid Blue Ylw 100cm 6fr Crds Vsbr Ar2,$93.00,$0.00,$93.00,$50.50,$66.37,$0.00,$16.02,$66.37,$66.37,$16.28,$93.00,$0.00,$46.50,$73.66,$74.40,$0.00,$14.55,$0.00,$14.81,$0.00
70000983,EAP,HCPCS C1887,,Catheter Guid 100cm 6fr Shr Nx Act Mp1 Curve Peri,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
70000997,EAP,HCPCS C1887,,Catheter Guid Blue Ylw 100cm 6fr Crds Vsbr Jr4st,$93.00,$0.00,$93.00,$50.50,$66.37,$0.00,$16.02,$66.37,$66.37,$16.28,$93.00,$0.00,$46.50,$73.66,$74.40,$0.00,$14.55,$0.00,$14.81,$0.00
70000998,EAP,HCPCS C1887,,Catheter Guid 100cm 7fr Shr Nx Bal Ar1 Curve Coron,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
70001000,EAP,HCPCS C1887,,Catheter Guid 100cm 7fr Shr Nx Bal Std Jl3.5 Curve,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
70001001,EAP,HCPCS C1887,,Catheter Guid 7fr Shr Nx Bal Std Jr3.5 Curve Coron,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
70001003,EAP,HCPCS C1887,,Catheter Guid 100cm 7fr Shr Nx Bal Std Jl5 Curve,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
70001005,EAP,HCPCS C1887,,Catheter Guid 100cm 7fr Shr Nx Bal Std Jr5 Curve,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
70001006,EAP,HCPCS C1887,,Catheter Guid 100cm 7fr Shr Nx Bal Mp1 Curve Peri,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
70001013,EAP,HCPCS C1887,,Catheter Guid 7fr Shr Nx Bal Std Jr4 Curve Coron,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
70001014,EAP,HCPCS C1887,,Catheter Guid 100cm 7fr Shr Nx Bal Ima Curve Peri,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
70001028,EAP,HCPCS C1887,,Catheter Guid 100cm 6fr Shr Nx Bal Ar1 Curve Coron,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
70001029,EAP,HCPCS C1887,,Catheter Guid 100cm 6fr Shr Nx Bal Std Jl4 Curve,$118.00,$0.00,$118.00,$64.07,$84.22,$0.00,$20.33,$84.22,$84.22,$20.66,$118.00,$0.00,$59.00,$93.46,$94.40,$0.00,$18.47,$0.00,$18.79,$0.00
70001030,EAP,HCPCS C1887,,Catheter Guid 100cm 6fr Shr Nx Bal Std Jr4 Curve,$118.00,$0.00,$118.00,$64.07,$84.22,$0.00,$20.33,$84.22,$84.22,$20.66,$118.00,$0.00,$59.00,$93.46,$94.40,$0.00,$18.47,$0.00,$18.79,$0.00
70001041,EAP,HCPCS C1887,,Catheter Guid 100cm 7fr Shr Nx Bal Std Jl4 Curve,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
70001043,EAP,HCPCS C1887,,Catheter Guid 100cm 7fr Shr Nx Bal Std Jr4 Curve,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
70001045,EAP,HCPCS C1887,,Catheter Guid 100cm 6fr Shr Nx Bal Al1 Curve Coron,$118.00,$0.00,$118.00,$64.07,$84.22,$0.00,$20.33,$84.22,$84.22,$20.66,$118.00,$0.00,$59.00,$93.46,$94.40,$0.00,$18.47,$0.00,$18.79,$0.00
70001047,EAP,HCPCS C1887,,Catheter Guid 100cm 7fr Shr Nx Bal Al1 Curve Coron,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
70001048,EAP,HCPCS C1887,,Catheter Guid 100cm 6fr Shr Nx Bal Std Jl4 Curve,$118.00,$0.00,$118.00,$64.07,$84.22,$0.00,$20.33,$84.22,$84.22,$20.66,$118.00,$0.00,$59.00,$93.46,$94.40,$0.00,$18.47,$0.00,$18.79,$0.00
70001049,EAP,HCPCS C1887,,Catheter Guid 100cm 6fr Shr Nx Bal Std Jr4 Curve,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
70001050,EAP,HCPCS C1887,,Catheter Guid Blue Ylw 100cm 6fr Crds Vsbr Xb3,$93.00,$0.00,$93.00,$50.50,$66.37,$0.00,$16.02,$66.37,$66.37,$16.28,$93.00,$0.00,$46.50,$73.66,$74.40,$0.00,$14.55,$0.00,$14.81,$0.00
70001051,EAP,HCPCS C1887,,Catheter Guid Blue Ylw 100cm 6fr Crds Vsbr Xb3.5,$93.00,$0.00,$93.00,$50.50,$66.37,$0.00,$16.02,$66.37,$66.37,$16.28,$93.00,$0.00,$46.50,$73.66,$74.40,$0.00,$14.55,$0.00,$14.81,$0.00
70001053,EAP,HCPCS C1887,,Catheter Guid 100cm 6fr Shr Nx Bal Std Jl3.5 Curve,$118.00,$0.00,$118.00,$64.07,$84.22,$0.00,$20.33,$84.22,$84.22,$20.66,$118.00,$0.00,$59.00,$93.46,$94.40,$0.00,$18.47,$0.00,$18.79,$0.00
70001054,EAP,HCPCS C1887,,Catheter Guid 100cm 6fr Shr Nx Bal Al2 Curve Coron,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
70001055,EAP,HCPCS C1887,,Catheter Guid 100cm 6fr Shr Nx Bal Std Jr3.5 Curve,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
70001056,EAP,HCPCS C1887,,Catheter Guid 100cm 6fr Shr Nx Bal Al.75 Curve,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
70001057,EAP,HCPCS C1887,,Catheter Guid 100cm 7fr Shr Nx Bal Al.75 Curve,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
70001234,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in Sft Rbn Tip Kink Rst,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
70001408,EAP,HCPCS C1757,,Snare Vasc 120cm 9-15mm 6fr Ensnr Std 3 Prefrm,$828.00,$0.00,$828.00,$0.00,$590.94,$0.00,$0.00,$590.94,$590.94,$0.00,$828.00,$0.00,$414.00,$655.78,$662.40,$0.00,$0.00,$0.00,$0.00,$0.00
70001510,EAP,HCPCS L0625,,Support Orthopedic Universal Binder Velcro Closure Yellow,$538.00,$0.00,$538.00,$0.00,$383.97,$0.00,$0.00,$383.97,$383.97,$0.00,$538.00,$0.00,$269.00,$426.10,$430.40,$0.00,$0.00,$0.00,$0.00,$0.00
71000014,EAP,Custom 71000014,,PHASE II RECOVERY < 6HRS,"$2,740.00",$0.00,"$2,491.00",$0.00,"$1,777.83",$0.00,$0.00,"$1,777.83","$1,777.83",$0.00,"$2,491.00",$0.00,"$1,245.50","$1,972.87","$1,992.80",$0.00,$0.00,$0.00,$0.00,$0.00
71000033,EAP,Custom 71000033,,Phase Ii Recovery > 6hrs,"$4,106.00",$0.00,"$3,733.00",$0.00,"$2,664.24",$0.00,$0.00,"$2,664.24","$2,664.24",$0.00,"$3,733.00",$0.00,"$1,866.50","$2,956.54","$2,986.40",$0.00,$0.00,$0.00,$0.00,$0.00
71000040,EAP,Custom 71000040,,Level 1 1st 30 Min,"$1,943.00",$0.00,"$1,766.00",$0.00,"$1,260.39",$0.00,$0.00,"$1,260.39","$1,260.39",$0.00,"$1,766.00",$0.00,$883.00,"$1,398.67","$1,412.80",$0.00,$0.00,$0.00,$0.00,$0.00
71000041,EAP,Custom 71000041,,Level 2 1st 30 Min,"$2,333.00",$0.00,"$2,121.00",$0.00,"$1,513.76",$0.00,$0.00,"$1,513.76","$1,513.76",$0.00,"$2,121.00",$0.00,"$1,060.50","$1,679.83","$1,696.80",$0.00,$0.00,$0.00,$0.00,$0.00
71000042,EAP,Custom 71000042,,Level 3 1st 30 Min,"$3,108.00",$0.00,"$2,825.00",$0.00,"$2,016.20",$0.00,$0.00,"$2,016.20","$2,016.20",$0.00,"$2,825.00",$0.00,"$1,412.50","$2,237.40","$2,260.00",$0.00,$0.00,$0.00,$0.00,$0.00
71000043,EAP,Custom 71000043,,Level 4 1st 30 Min,"$3,366.00",$0.00,"$3,060.00",$0.00,"$2,183.92",$0.00,$0.00,"$2,183.92","$2,183.92",$0.00,"$3,060.00",$0.00,"$1,530.00","$2,423.52","$2,448.00",$0.00,$0.00,$0.00,$0.00,$0.00
71000044,EAP,Custom 71000044,,Level 5 1st 30 Min,"$4,661.00",$0.00,"$4,237.00",$0.00,"$3,023.95",$0.00,$0.00,"$3,023.95","$3,023.95",$0.00,"$4,237.00",$0.00,"$2,118.50","$3,355.70","$3,389.60",$0.00,$0.00,$0.00,$0.00,$0.00
71000045,EAP,Custom 71000045,,Level 1 Add 15 Min,"$1,018.00",$0.00,$925.00,$0.00,$660.17,$0.00,$0.00,$660.17,$660.17,$0.00,$925.00,$0.00,$462.50,$732.60,$740.00,$0.00,$0.00,$0.00,$0.00,$0.00
71000046,EAP,Custom 71000046,,Level 2 Add 15 Min,"$1,224.00",$0.00,"$1,113.00",$0.00,$794.35,$0.00,$0.00,$794.35,$794.35,$0.00,"$1,113.00",$0.00,$556.50,$881.50,$890.40,$0.00,$0.00,$0.00,$0.00,$0.00
71000047,EAP,Custom 71000047,,Level 3 Add 15 Min,"$1,629.00",$0.00,"$1,481.00",$0.00,"$1,056.99",$0.00,$0.00,"$1,056.99","$1,056.99",$0.00,"$1,481.00",$0.00,$740.50,"$1,172.95","$1,184.80",$0.00,$0.00,$0.00,$0.00,$0.00
71000048,EAP,Custom 71000048,,Level 4 Add 15 Min,"$1,770.00",$0.00,"$1,609.00",$0.00,"$1,148.34",$0.00,$0.00,"$1,148.34","$1,148.34",$0.00,"$1,609.00",$0.00,$804.50,"$1,274.33","$1,287.20",$0.00,$0.00,$0.00,$0.00,$0.00
71000049,EAP,Custom 71000049,,Level 5 Add 15 Min,"$2,448.00",$0.00,"$2,225.00",$0.00,"$1,587.98",$0.00,$0.00,"$1,587.98","$1,587.98",$0.00,"$2,225.00",$0.00,"$1,112.50","$1,762.20","$1,780.00",$0.00,$0.00,$0.00,$0.00,$0.00
71000050,EAP,,,Gi Procedure Recovery,$617.00,$0.00,$561.00,$0.00,$400.39,$0.00,$0.00,$400.39,$400.39,$0.00,$561.00,$0.00,$280.50,$444.31,$448.80,$0.00,$0.00,$0.00,$0.00,$0.00
71000051,EAP,,,Cardiology Recovery,$617.00,$0.00,$561.00,$0.00,$400.39,$0.00,$0.00,$400.39,$400.39,$0.00,$561.00,$0.00,$280.50,$444.31,$448.80,$0.00,$0.00,$0.00,$0.00,$0.00
71000133,EAP,Custom 71000133,,Phase Ii Recovery > 6hrs,"$4,236.00",$0.00,"$3,851.00",$0.00,"$2,748.46",$0.00,$0.00,"$2,748.46","$2,748.46",$0.00,"$3,851.00",$0.00,"$1,925.50","$3,049.99","$3,080.80",$0.00,$0.00,$0.00,$0.00,$0.00
71000134,EAP,,,Ir Recovery,$550.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$356.85,$356.85,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
71900020,EAP,Custom 71900020,,Extended Recovery 1st 30 Mins,"$1,613.00",$0.00,"$1,466.00",$0.00,"$1,046.28",$0.00,$0.00,"$1,046.28","$1,046.28",$0.00,"$1,466.00",$0.00,$733.00,"$1,161.07","$1,172.80",$0.00,$0.00,$0.00,$0.00,$0.00
71900021,EAP,Custom 71900021,,Extended Recovery Ea Addtl 15 Mins,$911.00,$0.00,$828.00,$0.00,$590.94,$0.00,$0.00,$590.94,$590.94,$0.00,$828.00,$0.00,$414.00,$655.78,$662.40,$0.00,$0.00,$0.00,$0.00,$0.00
72000001,EAP,CPT® 59030,,Fetal Scalp Blood,"$1,115.00",$0.00,"$1,115.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,115.00",$0.00,"$1,115.00",$883.08,$892.00,$0.00,$0.00,$0.00,$0.00,$0.00
72000006,EAP,CPT® 59612,,Vaginal Delivery After Prior Cesarean Delivery,"$8,307.00",$0.00,"$8,307.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$8,307.00",$0.00,"$2,255.00","$6,579.14","$6,645.60",$0.00,$0.00,$0.00,$0.00,$0.00
72200001,EAP,CPT® 59409,,Vaginal Delivery Only Complica,"$6,681.00",$0.00,"$5,316.00",$0.00,$0.00,$0.00,$915.92,$0.00,$0.00,$0.00,"$5,316.00",$0.00,"$2,255.00","$4,210.27","$4,252.80",$0.00,$892.16,$0.00,$0.00,$0.00
72200002,EAP,CPT® 59409,,Vaginal Delivery Only Uncompl.,"$6,500.00",$0.00,"$4,261.00",$0.00,$0.00,$0.00,$734.15,$0.00,$0.00,$0.00,"$4,261.00",$0.00,"$2,255.00","$3,374.71","$3,408.80",$0.00,$892.16,$0.00,$0.00,$0.00
73000001,EAP,CPT® 93005,,Ekg,$610.00,$8.64,$490.00,$16.23,$349.71,$52.75,$84.42,$349.71,$349.71,$85.80,$490.00,$55.17,$245.00,$388.08,$392.00,$76.65,$17.51,$8.64,$78.01,$52.54
73000007,EAP,CPT® 93041,,"Rhythm Ecg, Tracing",$71.00,$0.00,$57.00,$0.00,$40.68,$0.00,$0.00,$40.68,$40.68,$0.00,$57.00,$0.00,$28.50,$45.14,$45.60,$0.00,$0.00,$0.00,$0.00,$0.00
73000010,EAP,CPT® 93041,,Ekg Rhythm Strip 3 Lead,$71.00,$0.00,$57.00,$0.00,$40.68,$0.00,$0.00,$40.68,$40.68,$0.00,$57.00,$0.00,$28.50,$45.14,$45.60,$0.00,$0.00,$0.00,$0.00,$0.00
73000011,EAP,CPT® 93017,,Cardiac Stress Test,"$3,621.00",$34.22,"$3,621.00",$75.03,"$2,584.31",$241.94,$623.88,"$2,584.31","$2,584.31",$634.01,"$3,621.00",$253.05,"$1,810.50","$2,867.83","$2,896.80",$351.58,$64.64,$34.22,$576.46,$241.00
73100001,EAP,CPT® 93225,,"Ecg Monitoring, Continuous","$1,026.00",$25.93,"$1,026.00",$50.71,$732.26,$104.55,$176.77,$732.26,$732.26,$179.64,"$1,026.00",$109.35,$513.00,$812.59,$820.80,$151.93,$47.49,$25.93,$163.34,$104.14
73100002,EAP,CPT® 93226,,Ecg Monitoring Analysis&report,"$1,644.00",$0.00,"$1,644.00",$0.00,"$1,173.32",$0.00,$0.00,"$1,173.32","$1,173.32",$0.00,"$1,644.00",$0.00,$822.00,"$1,302.05","$1,315.20",$0.00,$0.00,$0.00,$0.00,$0.00
73100003,EAP,CPT® 93270,,Cardiac Event Recording,$716.00,$9.00,$716.00,$17.58,$511.01,$34.76,$123.36,$511.01,$511.01,$125.37,$716.00,$36.36,$358.00,$567.07,$572.80,$50.51,$47.49,$9.00,$113.99,$34.63
73100004,EAP,CPT® 93271,,Cardiac Event Analysis,$716.00,$0.00,$716.00,$0.00,$511.01,$0.00,$0.00,$511.01,$511.01,$0.00,$716.00,$0.00,$358.00,$567.07,$572.80,$0.00,$0.00,$0.00,$0.00,$0.00
73100005,EAP,CPT® 0296T,,Ext Ecg > 48hr To 21 Day Rcrd W/conect Intl Rcrd,$681.00,$0.00,$656.00,$0.00,$468.19,$0.00,$0.00,$468.19,$468.19,$0.00,$656.00,$0.00,$656.00,$519.55,$524.80,$0.00,$0.00,$0.00,$0.00,$0.00
74000001,EAP,CPT® 95812,,Eeg Up To 1 Hour,$762.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$446.06,$446.06,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
74000002,EAP,CPT® 95813,,Eeg Extended Monitoring 61-119 Minutes,"$1,709.00",$0.00,"$1,709.00",$0.00,"$1,219.71",$0.00,$294.45,"$1,219.71","$1,219.71",$299.23,"$1,709.00",$0.00,$854.50,"$1,353.53","$1,367.20",$0.00,$183.21,$0.00,$0.00,$0.00
74000003,EAP,CPT® 95816,,"Eeg, Awake And Drowsy",$958.00,$124.97,$785.00,$426.26,$560.25,$241.94,$135.25,$560.25,$560.25,$137.45,$785.00,$253.05,$392.50,$621.72,$628.00,$351.58,$128.39,$311.91,$124.97,$241.00
74000004,EAP,CPT® 95819,,"Eeg, W/awake & Asleep Record","$1,637.00",$56.24,"$1,637.00",$888.89,"$1,168.33",$241.94,$56.24,"$1,168.33","$1,168.33",$286.63,"$1,637.00",$253.05,$818.50,"$1,296.50","$1,309.60",$351.58,$110.11,$381.06,$260.61,$241.00
74000005,EAP,CPT® 95822,,"Eeg, Sleep Only","$1,599.00",$0.00,"$1,311.00",$0.00,$935.66,$0.00,$0.00,$935.66,$935.66,$0.00,"$1,311.00",$0.00,$655.50,"$1,038.31","$1,048.80",$0.00,$0.00,$0.00,$0.00,$0.00
74000009,EAP,CPT® 92585,,Ssep Ue,"$1,264.00",$0.00,"$1,264.00",$0.00,$902.12,$0.00,$0.00,$902.12,$902.12,$0.00,"$1,264.00",$0.00,$632.00,"$1,001.09","$1,011.20",$0.00,$0.00,$0.00,$0.00,$0.00
74000011,EAP,CPT® 95930,,Vep,"$1,460.00",$0.00,"$1,197.00",$0.00,$854.30,$0.00,$0.00,$854.30,$854.30,$0.00,"$1,197.00",$0.00,$598.50,$948.02,$957.60,$0.00,$0.00,$0.00,$0.00,$0.00
74000012,EAP,CPT® 95938,,Ssep 4 Ext,$701.00,$0.00,$575.00,$0.00,$410.38,$0.00,$0.00,$410.38,$410.38,$0.00,$575.00,$0.00,$287.50,$455.40,$460.00,$0.00,$0.00,$0.00,$0.00,$0.00
74000013,EAP,CPT® 95929,,Cmep Lower Limbs,"$1,237.00",$0.00,"$1,014.00",$0.00,$723.69,$0.00,$0.00,$723.69,$723.69,$0.00,"$1,014.00",$0.00,$507.00,$803.09,$811.20,$0.00,$0.00,$0.00,$0.00,$0.00
74000014,EAP,CPT® 95939,,Cmep Upper Limbs,"$1,233.00",$0.00,"$1,011.00",$0.00,$721.55,$0.00,$0.00,$721.55,$721.55,$0.00,"$1,011.00",$0.00,$505.50,$800.71,$808.80,$0.00,$0.00,$0.00,$0.00,$0.00
74000015,EAP,CPT® 95940,,Intraoperative Monitoring Neuro In Or Ea 15 Min,"$3,870.00",$0.00,"$3,870.00",$0.00,"$2,762.02",$0.00,$0.00,"$2,762.02","$2,762.02",$0.00,"$3,870.00",$0.00,"$1,935.00","$3,065.04","$3,096.00",$0.00,$0.00,$0.00,$0.00,$0.00
74000017,EAP,CPT® 95961,,Functional Cortical Mapping By Intra Operative Stimulation Initial Hr,$964.00,$0.00,$964.00,$0.00,$688.01,$0.00,$0.00,$688.01,$688.01,$0.00,$964.00,$0.00,$482.00,$763.49,$771.20,$0.00,$0.00,$0.00,$0.00,$0.00
74000018,EAP,CPT® 95962,,Functional Monitor By Stimulation Ea Add'l Hour,$704.00,$0.00,$704.00,$0.00,$502.44,$0.00,$0.00,$502.44,$502.44,$0.00,$704.00,$0.00,$352.00,$557.57,$563.20,$0.00,$0.00,$0.00,$0.00,$0.00
74000019,EAP,CPT® 92585,,Baer Auditory Evoked Potentials For Evoked Response Ans Or Testing Cns,$967.00,$0.00,$967.00,$0.00,$690.15,$0.00,$0.00,$690.15,$690.15,$0.00,$967.00,$0.00,$483.50,$765.86,$773.60,$0.00,$0.00,$0.00,$0.00,$0.00
74000020,EAP,CPT® 95958,,Eeg Monitoring/function Test,"$2,009.00",$0.00,"$2,009.00",$0.00,"$1,433.82",$0.00,$0.00,"$1,433.82","$1,433.82",$0.00,"$2,009.00",$0.00,"$1,004.50","$1,591.13","$1,607.20",$0.00,$0.00,$0.00,$0.00,$0.00
74000021,EAP,CPT® 95958,,Eeg Hemisphere Function (wada),"$2,009.00",$0.00,"$2,009.00",$0.00,"$1,433.82",$0.00,$0.00,"$1,433.82","$1,433.82",$0.00,"$2,009.00",$0.00,"$1,004.50","$1,591.13","$1,607.20",$0.00,$0.00,$0.00,$0.00,$0.00
74000030,EAP,CPT® 95941,,Ionm Remote/nearby/>1 Patient In Or Per Hour,"$3,358.00",$0.00,"$3,358.00",$0.00,"$2,396.60",$0.00,$0.00,"$2,396.60","$2,396.60",$0.00,"$3,358.00",$0.00,"$1,679.00","$2,659.54","$2,686.40",$0.00,$0.00,$0.00,$0.00,$0.00
74000050,EAP,CPT® 95700,,EEG CONT REC W/VIDEO BY TECH MIN 8 CHANNELS,"$3,870.00",$0.00,"$3,870.00","$2,101.41","$2,762.02",$241.94,$666.78,"$2,762.02","$2,762.02",$677.61,"$3,870.00",$253.05,"$1,935.00","$3,065.04","$3,096.00",$351.58,$605.66,$0.00,$616.10,$241.00
74000052,EAP,CPT® 95706,,Eeg W/o Video (ceribell) 2-12 Hr Intermittent Mntr,"$3,870.00",$0.00,"$3,870.00",$0.00,"$2,762.02",$0.00,$0.00,"$2,762.02","$2,762.02",$0.00,"$3,870.00",$0.00,"$1,935.00","$3,065.04","$3,096.00",$0.00,$0.00,$0.00,$0.00,$0.00
74000054,EAP,CPT® 95708,,Eeg W/o Vid By Tech Ea Incr 12-26hr Unmonitored,"$6,300.00",$0.00,"$6,300.00","$3,420.90","$4,496.31",$465.65,"$1,085.46","$4,496.31","$4,496.31","$1,103.08","$6,300.00",$487.04,"$3,150.00","$4,989.60","$5,040.00",$676.67,$985.95,$0.00,"$1,002.96",$463.84
74000055,EAP,CPT® 95709,,Eeg W/o Video (ceribell) Ea Incr 12-26 Hr Intmt Mntr,"$9,445.00",$0.00,"$9,445.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$9,445.00",$0.00,"$4,722.50","$7,480.44","$7,556.00",$0.00,$0.00,$0.00,$0.00,$0.00
74000057,EAP,CPT® 95711,,Veeg By Tech 2-12 Hours Unmonitored,"$3,870.00",$0.00,"$3,870.00",$0.00,"$2,762.02",$0.00,$0.00,"$2,762.02","$2,762.02",$0.00,"$3,870.00",$0.00,"$1,935.00","$3,065.04","$3,096.00",$0.00,$0.00,$0.00,$0.00,$0.00
74000058,EAP,CPT® 95712,,Veeg By Tech 2-12 Hr Intermittent Monitoring,"$3,870.00",$0.00,"$3,870.00","$2,101.41","$2,762.02",$241.94,$0.00,"$2,762.02","$2,762.02",$677.61,"$3,870.00",$253.05,"$1,935.00","$3,065.04","$3,096.00",$351.58,$0.00,$0.00,$616.10,$241.00
74000060,EAP,CPT® 95714,,Veeg By Tech Ea Incr 12-26 Hr Unmonitored,"$6,300.00",$0.00,"$6,300.00","$3,420.90","$4,496.31",$465.65,"$1,085.46","$4,496.31","$4,496.31","$1,103.08","$6,300.00",$487.04,"$3,150.00","$4,989.60","$5,040.00",$676.67,$985.95,$0.00,"$1,002.96",$463.84
74000061,EAP,CPT® 95715,,Veeg By Tech Ea Incr 12-26 Hr Intermittent Mntr,"$9,445.00",$0.00,"$9,445.00","$5,128.64","$5,158.80",$465.65,$0.00,"$5,158.80","$5,158.80","$1,653.74","$9,445.00",$487.04,"$4,722.50","$7,480.44","$7,556.00",$676.67,$0.00,$0.00,"$1,503.64",$463.84
74000065,EAP,CPT® 95955,,Eeg During (carotid) Surgery,"$1,000.00",$0.00,"$1,000.00",$0.00,$713.70,$0.00,$0.00,$713.70,$713.70,$0.00,"$1,000.00",$0.00,$500.00,$792.00,$800.00,$0.00,$0.00,$0.00,$0.00,$0.00
75000001,EAP,CPT® 31622,,Bronchoscopy,"$4,121.00",$0.00,"$3,746.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,746.00",$0.00,"$2,255.00","$2,966.83","$2,996.80",$0.00,$0.00,$0.00,$0.00,$0.00
75000029,EAP,CPT® 43260,,Ercp-w/wo Biopsy,"$6,432.00",$0.00,"$6,432.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,432.00",$0.00,"$2,327.00","$5,094.14","$5,145.60",$0.00,$0.00,$0.00,$0.00,$0.00
75000046,EAP,CPT® 44360,,Sb Endoscop Excluding Ileum Dx,"$3,412.00",$0.00,"$3,412.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,412.00",$0.00,"$2,327.00","$2,702.30","$2,729.60",$0.00,$0.00,$0.00,$0.00,$0.00
75000047,EAP,CPT® 44361,,Sb Endo-bx Single Multiple,"$2,751.00",$0.00,"$2,501.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,501.00",$0.00,"$2,327.00","$1,980.79","$2,000.80",$0.00,$0.00,$0.00,$0.00,$0.00
75000050,EAP,CPT® 44366,,Sb Endo-ctrl Of Bleed Any Meth,"$3,055.00",$0.00,"$2,777.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,777.00",$0.00,"$2,327.00","$2,199.38","$2,221.60",$0.00,$0.00,$0.00,$0.00,$0.00
75000051,EAP,CPT® 44369,,"Sb Endo-ablat Of Tum,les Other","$3,055.00",$256.01,"$2,777.00","$2,496.90","$1,981.94","$1,493.39",$478.46,"$1,981.94","$1,981.94",$486.23,"$2,777.00","$1,561.98","$2,327.00","$2,199.38","$2,221.60","$2,170.16",$328.65,$256.01,$442.10,"$1,487.60"
75000076,EAP,CPT® 45334,,"Sigmoid, Flex W Control Bleedi","$3,671.00",$0.00,"$3,337.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,337.00",$0.00,"$2,255.00","$2,642.90","$2,669.60",$0.00,$0.00,$0.00,$0.00,$0.00
75000089,EAP,CPT® 46600,,"Anoscopy, Diagnostic, Inc Spec Collect",$542.00,$0.00,$542.00,$542.00,$0.00,$104.55,$93.38,$0.00,$0.00,$94.90,$542.00,$109.35,$542.00,$429.26,$433.60,$151.93,$37.41,$42.17,$86.29,$104.14
75000091,EAP,CPT® 46606,,Anoscopy With Biopsy,"$2,137.00",$52.76,"$2,137.00","$2,106.30","$1,525.18",$962.95,$368.19,"$1,525.18","$1,525.18",$374.17,"$2,137.00","$1,007.17","$2,137.00","$1,692.50","$1,709.60","$1,399.33",$52.76,$78.23,$340.21,$959.21
75000100,EAP,HCPCS G0121,,Colon Ca Scrn Not Hi Rsk Ind,"$4,021.00",$193.26,"$4,021.00","$2,496.90","$2,869.79",$732.48,$692.80,"$2,869.79","$2,869.79",$704.04,"$4,021.00",$766.13,"$2,327.00","$3,184.63","$3,216.80","$1,064.43",$629.29,$193.26,$640.14,$729.64
75000101,EAP,CPT® 45391,,"Colonoscopy, Endoscopic Ultrasound Examination","$3,076.00",$0.00,"$2,796.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,796.00",$0.00,"$2,327.00","$2,214.43","$2,236.80",$0.00,$0.00,$0.00,$0.00,$0.00
75000102,EAP,CPT® 45341,,Sigmoidscopy W/ultrasound,"$4,385.00",$128.72,"$3,986.00","$2,106.30","$2,844.81",$732.48,$686.77,"$2,844.81","$2,844.81",$697.92,"$3,986.00",$766.13,"$2,255.00","$3,156.91","$3,188.80","$1,064.43",$219.13,$128.72,$634.57,$729.64
75000110,EAP,CPT® 45335,,Sigmoidoscopy W/submuc Inj,"$2,597.00",$0.00,"$2,361.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,361.00",$0.00,"$2,255.00","$1,869.91","$1,888.80",$0.00,$0.00,$0.00,$0.00,$0.00
75000120,EAP,CPT® 43238,,Upper Gi Endoscopy W/us Fn Bx,"$2,866.00",$0.00,"$2,605.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,605.00",$0.00,"$2,327.00","$2,063.16","$2,084.00",$0.00,$0.00,$0.00,$0.00,$0.00
75000125,EAP,CPT® 43242,,Upper Gi Endoscopy W/us Fn Bx,"$5,382.00",$0.00,"$4,893.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,893.00",$0.00,"$2,327.00","$3,875.26","$3,914.40",$0.00,$0.00,$0.00,$0.00,$0.00
75000127,EAP,CPT® 43242,,Transendoscopic Us W/ Fn Bx,"$5,382.00",$0.00,"$4,893.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,893.00",$0.00,"$2,327.00","$3,875.26","$3,914.40",$0.00,$0.00,$0.00,$0.00,$0.00
75000128,EAP,CPT® 45327,,Proctosigmoidoscopy W/stent,"$12,356.00",$0.00,"$11,233.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$11,233.00",$0.00,"$2,255.00","$8,896.54","$8,986.40",$0.00,$0.00,$0.00,$0.00,$0.00
75000130,EAP,CPT® 45335,,Sigmoidoscopy W/submuc Inj,"$2,597.00",$0.00,"$2,361.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,361.00",$0.00,"$2,255.00","$1,869.91","$1,888.80",$0.00,$0.00,$0.00,$0.00,$0.00
75000132,EAP,CPT® 45340,,Sig W/balloon Dilation,"$6,541.00",$0.00,"$5,946.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,946.00",$0.00,"$2,255.00","$4,709.23","$4,756.80",$0.00,$0.00,$0.00,$0.00,$0.00
75000136,EAP,CPT® 91034,,"Esoph, Gastroesoph Reflux Test W/rec, Anlys,rpt ","$3,414.00",$0.00,"$3,104.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,104.00",$0.00,"$1,552.00","$2,458.37","$2,483.20",$0.00,$0.00,$0.00,$0.00,$0.00
75000137,EAP,CPT® 91038,,"Esoph Gastro Reflux Test, Prolonged 1-24 Hrs.","$2,720.00",$0.00,"$2,473.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,473.00",$0.00,"$1,236.50","$1,958.62","$1,978.40",$0.00,$0.00,$0.00,$0.00,$0.00
75000138,EAP,CPT® 91010,,Esophageal Motility Study W/ Interp & Report,"$3,361.00",$111.47,"$3,055.00","$2,106.30","$2,180.35",$465.65,$526.36,"$2,180.35","$2,180.35",$534.91,"$3,055.00",$487.04,"$1,527.50","$2,419.56","$2,444.00",$676.67,$111.47,$137.22,$486.36,$463.84
75000139,EAP,CPT® 91037,,"Esoph  Gastroesoph Reflux Test Funct W/rec, Anlys,rpt  ","$2,277.00",$0.00,"$2,070.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,070.00",$0.00,"$1,035.00","$1,639.44","$1,656.00",$0.00,$0.00,$0.00,$0.00,$0.00
75000140,EAP,CPT® 91120,,Rectal Sensation Tone & Comply Balloon Distention,"$1,387.00",$0.00,"$1,261.00",$684.72,$0.00,$132.66,$217.26,$0.00,$0.00,$220.79,"$1,261.00",$138.76,$630.50,$998.71,"$1,008.80",$192.78,$462.13,$445.89,$200.75,$132.15
75000141,EAP,CPT® 91122,,Anorectal Manometry,"$1,387.00",$0.00,"$1,261.00",$684.72,$0.00,$225.25,$217.26,$0.00,$0.00,$220.79,"$1,261.00",$235.59,$630.50,$998.71,"$1,008.80",$327.32,$125.40,$164.96,$200.75,$224.37
75000142,EAP,CPT® 51784,,"Emg Anal Or Urethral Sphincter, Other Than Needle",$212.00,$0.00,$212.00,$115.12,$0.00,$132.66,$36.53,$0.00,$0.00,$37.12,$212.00,$138.76,$212.00,$167.90,$169.60,$192.78,$94.94,$29.53,$33.75,$132.15
75000146,EAP,CPT® 91022,,Duodenal Motility Study,"$1,551.00",$0.00,"$1,410.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,410.00",$0.00,$705.00,"$1,116.72","$1,128.00",$0.00,$0.00,$0.00,$0.00,$0.00
75000147,EAP,CPT® 91117,,Colon Motility 6hrs Or >inc Provoc Test W/ Interp& Repot,$952.00,$0.00,$865.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$865.00,$0.00,$432.50,$685.08,$692.00,$0.00,$0.00,$0.00,$0.00,$0.00
75000182,EAP,CPT® 46601,,Diagnostic Anoscopy,$616.00,$0.00,$560.00,$560.00,$0.00,$104.55,$96.49,$0.00,$0.00,$98.05,$560.00,$109.35,$560.00,$443.52,$448.00,$151.93,$87.64,$97.71,$89.15,$104.14
75000200,EAP,Custom 75000200,,Colonscopy Dx,"$3,894.00",$0.00,"$3,540.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,540.00",$0.00,"$1,770.00","$2,803.68","$2,832.00",$0.00,$0.00,$0.00,$0.00,$0.00
75000201,EAP,Custom 75000201,,Colonscopy Thera 1 Intervention,"$4,286.00",$0.00,"$3,896.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,896.00",$0.00,"$1,948.00","$3,085.63","$3,116.80",$0.00,$0.00,$0.00,$0.00,$0.00
75000202,EAP,Custom 75000202,,Colonscopy Thera 2 Intervention,"$4,712.00",$0.00,"$4,284.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,284.00",$0.00,"$2,142.00","$3,392.93","$3,427.20",$0.00,$0.00,$0.00,$0.00,$0.00
75000203,EAP,Custom 75000203,,Colonscopy Thera 3 Intervention,"$5,184.00",$0.00,"$4,713.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,713.00",$0.00,"$2,356.50","$3,732.70","$3,770.40",$0.00,$0.00,$0.00,$0.00,$0.00
75000204,EAP,Custom 75000204,,Egd Dx,"$3,314.00",$0.00,"$3,013.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,013.00",$0.00,"$1,506.50","$2,386.30","$2,410.40",$0.00,$0.00,$0.00,$0.00,$0.00
75000205,EAP,Custom 75000205,,Egd Thera 1 Intervention,"$3,645.00",$0.00,"$3,314.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,314.00",$0.00,"$1,657.00","$2,624.69","$2,651.20",$0.00,$0.00,$0.00,$0.00,$0.00
75000206,EAP,Custom 75000206,,Egd Thera 2 Intervention,"$4,010.00",$0.00,"$3,645.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,645.00",$0.00,"$1,822.50","$2,886.84","$2,916.00",$0.00,$0.00,$0.00,$0.00,$0.00
75000207,EAP,Custom 75000207,,Egd Thera 3 Intervention,"$4,411.00",$0.00,"$4,010.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,010.00",$0.00,"$2,005.00","$3,175.92","$3,208.00",$0.00,$0.00,$0.00,$0.00,$0.00
75000208,EAP,Custom 75000208,,Ercp Dx,"$6,256.00",$0.00,"$5,687.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,687.00",$0.00,"$2,843.50","$4,504.10","$4,549.60",$0.00,$0.00,$0.00,$0.00,$0.00
75000209,EAP,Custom 75000209,,Ercp Thera 1 Intervention,"$6,879.00",$0.00,"$6,254.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,254.00",$0.00,"$3,127.00","$4,953.17","$5,003.20",$0.00,$0.00,$0.00,$0.00,$0.00
75000210,EAP,Custom 75000210,,Ercp Thera 2 Intervention,"$7,569.00",$0.00,"$6,881.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,881.00",$0.00,"$3,440.50","$5,449.75","$5,504.80",$0.00,$0.00,$0.00,$0.00,$0.00
75000211,EAP,Custom 75000211,,Ercp Thera 3 Intervention,"$8,325.00",$0.00,"$7,568.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$7,568.00",$0.00,"$3,784.00","$5,993.86","$6,054.40",$0.00,$0.00,$0.00,$0.00,$0.00
75000212,EAP,Custom 75000212,,Sigmoidoscopy Dx,"$3,959.00",$0.00,"$3,599.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,599.00",$0.00,"$1,799.50","$2,850.41","$2,879.20",$0.00,$0.00,$0.00,$0.00,$0.00
75000213,EAP,Custom 75000213,,Sigmoidoscopy Thera 1 Intervention,"$4,355.00",$0.00,"$3,959.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,959.00",$0.00,"$1,979.50","$3,135.53","$3,167.20",$0.00,$0.00,$0.00,$0.00,$0.00
75000214,EAP,Custom 75000214,,Sigmoidoscopy Thera 2 Intervention,"$4,789.00",$0.00,"$4,354.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,354.00",$0.00,"$2,177.00","$3,448.37","$3,483.20",$0.00,$0.00,$0.00,$0.00,$0.00
75000215,EAP,Custom 75000215,,Sigmoidoscopy Thera 3 Intervention,"$5,270.00",$0.00,"$4,791.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,791.00",$0.00,"$2,395.50","$3,794.47","$3,832.80",$0.00,$0.00,$0.00,$0.00,$0.00
75000216,EAP,Custom 75000216,,Colonscopy Via Stoma Dx,"$3,112.00",$0.00,"$2,829.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,829.00",$0.00,"$1,414.50","$2,240.57","$2,263.20",$0.00,$0.00,$0.00,$0.00,$0.00
75000217,EAP,Custom 75000217,,Colonscopy Via Stoma 1 Intervention,"$3,423.00",$0.00,"$3,112.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,112.00",$0.00,"$1,556.00","$2,464.70","$2,489.60",$0.00,$0.00,$0.00,$0.00,$0.00
75000218,EAP,Custom 75000218,,Colonscopy Via Stoma 2 Intervention,"$3,765.00",$0.00,"$3,423.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,423.00",$0.00,"$1,711.50","$2,711.02","$2,738.40",$0.00,$0.00,$0.00,$0.00,$0.00
75000219,EAP,Custom 75000219,,Colonscopy Via Stoma 3 Intervention,"$4,142.00",$0.00,"$3,765.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,765.00",$0.00,"$1,882.50","$2,981.88","$3,012.00",$0.00,$0.00,$0.00,$0.00,$0.00
75000220,EAP,CPT® 91112,,Gi Wireless Capsule Measure,"$4,228.00",$0.00,"$3,844.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,844.00",$0.00,"$1,922.00","$3,044.45","$3,075.20",$0.00,$0.00,$0.00,$0.00,$0.00
75000221,EAP,HCPCS 91299,,Patency Pill Placement,"$1,189.00",$0.00,"$1,081.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,081.00",$0.00,$540.50,$856.15,$864.80,$0.00,$0.00,$0.00,$0.00,$0.00
75000222,EAP,,,Egd Transoral Biopsy Single/multi-ip Bedside,"$3,416.00",$0.00,"$3,105.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,105.00",$0.00,"$1,552.50","$2,459.16","$2,484.00",$0.00,$0.00,$0.00,$0.00,$0.00
76100002,EAP,CPT® 36511,,Leukopheresis,"$7,382.00",$0.00,"$7,382.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$7,382.00",$0.00,"$2,255.00","$5,846.54","$5,905.60",$0.00,$0.00,$0.00,$0.00,$0.00
76100003,EAP,CPT® 36512,,THERAPEUTIC APHERESIS RED BLOOD CELLS,"$7,654.00",$0.00,"$7,654.00","$2,496.90",$0.00,"$1,269.22","$1,318.75",$0.00,$0.00,"$1,340.15","$7,654.00","$1,327.51","$2,255.00","$6,061.97","$6,123.20","$1,844.40",$88.77,$112.51,"$1,218.52","$1,264.30"
76100004,EAP,CPT® 36513,,Plateletpheresis,"$7,654.00",$0.00,"$7,654.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$7,654.00",$0.00,"$2,255.00","$6,061.97","$6,123.20",$0.00,$0.00,$0.00,$0.00,$0.00
76100005,EAP,CPT® 36514,,Plasmapheresis,"$9,380.00",$0.00,"$8,933.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$8,933.00",$0.00,"$2,255.00","$7,074.94","$7,146.40",$0.00,$0.00,$0.00,$0.00,$0.00
76100006,EAP,CPT® 51700,,Bladder Irrig/instill Simple,$504.00,$0.00,$504.00,$0.00,$0.00,$0.00,$86.84,$0.00,$0.00,$88.25,$504.00,$0.00,$504.00,$399.17,$403.20,$0.00,$100.47,$0.00,$0.00,$0.00
76100007,EAP,CPT® 51700,,Badder Irrig/instill Simple,$504.00,$0.00,$504.00,$0.00,$0.00,$0.00,$86.84,$0.00,$0.00,$88.25,$504.00,$0.00,$504.00,$399.17,$403.20,$0.00,$100.47,$0.00,$0.00,$0.00
76100009,EAP,CPT® 92136,,Iol Calculations (ophthalmic Biometry),$420.00,$0.00,$420.00,$228.06,$0.00,$104.55,$72.36,$0.00,$0.00,$73.54,$420.00,$109.35,$210.00,$332.64,$336.00,$151.93,$90.57,$31.69,$66.86,$104.14
76100011,EAP,CPT® 51701,,Insert Straight Cath,$864.00,$0.00,$864.00,$864.00,$0.00,$104.55,$148.86,$0.00,$0.00,$151.28,$864.00,$109.35,$864.00,$684.29,$691.20,$151.93,$57.62,$27.40,$137.55,$104.14
76100013,EAP,CPT® 51703,,"Urinary Cath, Indwelling","$1,808.00",$0.00,"$1,808.00","$1,808.00",$0.00,$132.66,$311.51,$0.00,$0.00,$316.57,"$1,808.00",$138.76,"$1,808.00","$1,431.94","$1,446.40",$192.78,$170.19,$80.41,$287.83,$132.15
76100014,EAP,CPT® 51702,,Cath Insert Indwelling,"$1,069.00",$0.00,"$1,069.00","$1,069.00",$0.00,$104.55,$184.18,$0.00,$0.00,$187.17,"$1,069.00",$109.35,"$1,069.00",$846.65,$855.20,$151.93,$91.18,$26.68,$170.18,$104.14
76100016,EAP,CPT® 51703,,Cath Insertion Complicated,"$1,808.00",$0.00,"$1,808.00","$1,808.00",$0.00,$132.66,$311.51,$0.00,$0.00,$316.57,"$1,808.00",$138.76,"$1,808.00","$1,431.94","$1,446.40",$192.78,$170.19,$80.41,$287.83,$132.15
76100017,EAP,CPT® 51703,,"Insert Bladder Cath, Complex","$1,808.00",$0.00,"$1,808.00","$1,808.00",$0.00,$132.66,$311.51,$0.00,$0.00,$316.57,"$1,808.00",$138.76,"$1,808.00","$1,431.94","$1,446.40",$192.78,$170.19,$80.41,$287.83,$132.15
76100020,EAP,CPT® 51701,,Bladder Irrig/instill Simple,$864.00,$0.00,$864.00,$864.00,$0.00,$104.55,$148.86,$0.00,$0.00,$151.28,$864.00,$109.35,$864.00,$684.29,$691.20,$151.93,$57.62,$27.40,$137.55,$104.14
76100028,EAP,CPT® 40810,,Exc. Lesion Mucosa&sub W/o Repair,"$5,257.00",$0.00,"$5,257.00","$2,106.30",$0.00,"$2,511.64",$905.75,$0.00,$0.00,$920.46,"$5,257.00","$2,626.99","$2,255.00","$4,163.54","$4,205.60","$3,649.85",$822.72,$127.59,$836.91,"$2,501.89"
76100029,EAP,CPT® 40804,,"Rem Embedded Fb, Mouth Simple",$939.00,$0.00,$939.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$939.00,$0.00,$939.00,$743.69,$751.20,$0.00,$0.00,$0.00,$0.00,$0.00
76100030,EAP,CPT® 54520,,Orchiectomy Simple,"$4,807.00",$0.00,"$4,807.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,807.00",$0.00,"$2,858.00","$3,807.14","$3,845.60",$0.00,$0.00,$0.00,$0.00,$0.00
76100031,EAP,CPT® 54535,,Orchiectomy Radical/tumor,"$7,279.00",$0.00,"$7,279.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$7,279.00",$0.00,"$2,255.00","$5,764.97","$5,823.20",$0.00,$0.00,$0.00,$0.00,$0.00
76100032,EAP,CPT® 40799,,Lip Surgery Procedure,$230.00,$0.00,$230.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$230.00,$0.00,$230.00,$182.16,$184.00,$0.00,$0.00,$0.00,$0.00,$0.00
76100034,EAP,CPT® 53040,,Drainage Of Urethra Abscess,"$6,768.00",$0.00,"$6,768.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$6,768.00",$0.00,"$2,327.00","$5,360.26","$5,414.40",$0.00,$0.00,$0.00,$0.00,$0.00
76100035,EAP,CPT® 42106,,Exc. Lesion Mouth Roof(palate),"$2,709.00",$0.00,"$2,709.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,709.00",$0.00,"$2,255.00","$2,145.53","$2,167.20",$0.00,$0.00,$0.00,$0.00,$0.00
76100040,EAP,CPT® 21497,,Indental Wiring,"$4,642.00",$0.00,"$4,642.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,642.00",$0.00,"$2,327.00","$3,676.46","$3,713.60",$0.00,$0.00,$0.00,$0.00,$0.00
76100041,EAP,CPT® 41800,,Drainage Of Gum Lesion,$640.00,$87.50,$640.00,$640.00,$640.00,$104.55,$110.27,$640.00,$640.00,$112.06,$640.00,$109.35,$640.00,$506.88,$512.00,$151.93,$87.50,$157.47,$101.89,$104.14
76100042,EAP,CPT® 29799,,Casting/strapping Procedure,$198.00,$0.00,$198.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$198.00,$0.00,$198.00,$156.82,$158.40,$0.00,$0.00,$0.00,$0.00,$0.00
76100043,EAP,CPT® 31820,,Closure Of Windpipe Lesion,"$7,950.00",$0.00,"$7,950.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$7,950.00",$0.00,"$2,255.00","$6,296.40","$6,360.00",$0.00,$0.00,$0.00,$0.00,$0.00
76100044,EAP,CPT® 40650,,Lip Repair,"$1,604.00",$0.00,"$1,604.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,604.00",$0.00,"$1,604.00","$1,270.37","$1,283.20",$0.00,$0.00,$0.00,$0.00,$0.00
76100045,EAP,CPT® 41000,,Drainage Of Mouth Lesion,"$3,465.00",$98.48,"$3,465.00","$2,106.30","$1,208.73",$423.57,$597.00,"$1,208.73","$1,208.73",$606.69,"$3,465.00",$443.02,"$2,255.00","$2,744.28","$2,772.00",$615.51,$98.48,$112.82,$551.63,$421.92
76100046,EAP,CPT® 36511,,Leukopheresis,"$7,382.00",$0.00,"$7,382.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$7,382.00",$0.00,"$2,255.00","$5,846.54","$5,905.60",$0.00,$0.00,$0.00,$0.00,$0.00
76100047,EAP,CPT® 36513,,Plateletpheresis,"$7,654.00",$0.00,"$7,654.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$7,654.00",$0.00,"$2,255.00","$6,061.97","$6,123.20",$0.00,$0.00,$0.00,$0.00,$0.00
76100048,EAP,CPT® 36514,,Plasmapheresis,"$9,380.00",$0.00,"$8,933.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$8,933.00",$0.00,"$2,255.00","$7,074.94","$7,146.40",$0.00,$0.00,$0.00,$0.00,$0.00
76100055,EAP,CPT® 65778,,Cover Eye W/ Membrane,"$3,197.00",$0.00,"$3,197.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,197.00",$0.00,"$2,255.00","$2,532.02","$2,557.60",$0.00,$0.00,$0.00,$0.00,$0.00
76100060,EAP,CPT® 54235,,Penile Injection,$907.00,$0.00,$907.00,$492.50,$0.00,$225.25,$156.27,$0.00,$0.00,$158.81,$907.00,$235.59,$907.00,$718.34,$725.60,$327.32,$70.35,$75.71,$144.39,$224.37
76100061,EAP,CPT® 20240,,Bone Bx Exc.,"$2,380.00",$0.00,"$2,380.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,380.00",$0.00,"$2,327.00","$1,884.96","$1,904.00",$0.00,$0.00,$0.00,$0.00,$0.00
76100062,EAP,CPT® 21337,,Treat Nasa Septal Fx,"$2,300.00",$0.00,"$2,300.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,300.00",$0.00,"$2,300.00","$1,821.60","$1,840.00",$0.00,$0.00,$0.00,$0.00,$0.00
76100063,EAP,CPT® 31579,,Direct Laryngoscopy,"$1,524.00",$0.00,"$1,524.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,524.00",$0.00,"$1,524.00","$1,207.01","$1,219.20",$0.00,$0.00,$0.00,$0.00,$0.00
76100064,EAP,CPT® 31237,,Nasal/sinus Endoscopy,"$6,558.00",$163.68,"$6,558.00","$2,496.90","$1,482.64","$1,371.81","$1,129.91","$1,482.64","$1,482.64","$1,148.25","$6,558.00","$1,434.81","$2,327.00","$5,193.94","$5,246.40","$1,993.48",$226.31,$163.68,"$1,044.03","$1,366.49"
76100070,EAP,CPT® 20615,,Treatment Of Bone Cyst,$919.00,$0.00,$919.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$919.00,$0.00,$919.00,$727.85,$735.20,$0.00,$0.00,$0.00,$0.00,$0.00
76100071,EAP,CPT® 41830,,Removal Of Gum Tissue,"$3,511.00",$0.00,"$3,511.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,511.00",$0.00,"$2,255.00","$2,780.71","$2,808.80",$0.00,$0.00,$0.00,$0.00,$0.00
76100072,EAP,CPT® 31237,,Nasal/sinus Endoscopy,"$6,558.00",$163.68,"$6,558.00","$2,496.90","$1,482.64","$1,371.81","$1,129.91","$1,482.64","$1,482.64","$1,148.25","$6,558.00","$1,434.81","$2,327.00","$5,193.94","$5,246.40","$1,993.48",$226.31,$163.68,"$1,044.03","$1,366.49"
76100073,EAP,CPT® 42310,,Drainage Of Salivary Gland,"$1,571.00",$0.00,"$1,571.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,571.00",$0.00,"$1,571.00","$1,244.23","$1,256.80",$0.00,$0.00,$0.00,$0.00,$0.00
76100076,EAP,CPT® 53852,,Prostatic Rf Thermotx (tuna),"$15,721.00",$0.00,"$15,721.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$15,721.00",$0.00,"$3,902.00","$12,451.03","$12,576.80",$0.00,$0.00,$0.00,$0.00,$0.00
76100077,EAP,CPT® 53850,,Prostatic Microwave Thermotx (tumt),"$15,721.00",$0.00,"$15,721.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$15,721.00",$0.00,"$2,255.00","$12,451.03","$12,576.80",$0.00,$0.00,$0.00,$0.00,$0.00
76100078,EAP,CPT® 31571,,Laryngoscopy W/vc Inj+scope,"$11,149.00",$0.00,"$11,149.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$11,149.00",$0.00,"$2,327.00","$8,830.01","$8,919.20",$0.00,$0.00,$0.00,$0.00,$0.00
76100086,EAP,CPT® 36512,,Therapetic Phlebotomy,"$7,654.00",$0.00,"$7,654.00","$2,496.90",$0.00,"$1,269.22","$1,318.75",$0.00,$0.00,"$1,340.15","$7,654.00","$1,327.51","$2,255.00","$6,061.97","$6,123.20","$1,844.40",$88.77,$112.51,"$1,218.52","$1,264.30"
76100087,EAP,CPT® 21299,,Cranio/maxillofacial Proc.,$272.00,$0.00,$272.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$272.00,$0.00,$272.00,$215.42,$217.60,$0.00,$0.00,$0.00,$0.00,$0.00
76100088,EAP,CPT® 20527,,Inj Dupuytren Cord W Enzyme,$514.00,$0.00,$514.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$514.00,$0.00,$514.00,$407.09,$411.20,$0.00,$0.00,$0.00,$0.00,$0.00
76100089,EAP,CPT® 20615,,Nasal Surgery Proc,$919.00,$0.00,$919.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$919.00,$0.00,$919.00,$727.85,$735.20,$0.00,$0.00,$0.00,$0.00,$0.00
76100090,EAP,CPT® 15271,,Skin Sub Graft Trnk/arm/leg 25,"$1,997.00",$0.00,"$1,997.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,997.00",$0.00,"$1,997.00","$1,581.62","$1,597.60",$0.00,$0.00,$0.00,$0.00,$0.00
76100091,EAP,CPT® 15272,,Skin Sub Graft T/a/l Addl 25,$583.00,$0.00,$583.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$583.00,$0.00,$291.50,$461.74,$466.40,$0.00,$0.00,$0.00,$0.00,$0.00
76100092,EAP,CPT® 15273,,Skin Sub Grft T/a/lg Child 100,"$3,292.00",$0.00,"$3,292.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,292.00",$0.00,"$2,858.00","$2,607.26","$2,633.60",$0.00,$0.00,$0.00,$0.00,$0.00
76100093,EAP,CPT® 15274,,Skin Sub Grft T/a/lg Ch Addl 100,"$1,578.00",$0.00,"$1,578.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,578.00",$0.00,$789.00,"$1,249.78","$1,262.40",$0.00,$0.00,$0.00,$0.00,$0.00
76100094,EAP,CPT® 15275,,Skin Sub Grft Face/nk/hf/g 25,"$2,179.00",$0.00,"$2,179.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,179.00",$0.00,"$2,179.00","$1,725.77","$1,743.20",$0.00,$0.00,$0.00,$0.00,$0.00
76100095,EAP,CPT® 15276,,Skin Sub Grft F/n/hf/g Addl 25,$583.00,$0.00,$583.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$583.00,$0.00,$291.50,$461.74,$466.40,$0.00,$0.00,$0.00,$0.00,$0.00
76100096,EAP,CPT® 15277,,Skin Sub Grft F/n/hf/g Child 100,"$2,408.00",$0.00,"$2,408.00",$0.00,$0.00,$0.00,$414.89,$0.00,$0.00,$0.00,"$2,408.00",$0.00,"$2,255.00","$1,907.14","$1,926.40",$0.00,$283.67,$0.00,$0.00,$0.00
76100097,EAP,CPT® 15278,,Skin Sub Grft F/n/hf/g Ch Add 100,"$1,578.00",$0.00,"$1,578.00",$0.00,$0.00,$0.00,$271.88,$0.00,$0.00,$0.00,"$1,578.00",$0.00,$789.00,"$1,249.78","$1,262.40",$0.00,$81.00,$0.00,$0.00,$0.00
76100098,EAP,CPT® 29581,,Apply Multlay Comprs Lwr Leg,$478.00,$0.00,$478.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$478.00,$0.00,$478.00,$378.58,$382.40,$0.00,$0.00,$0.00,$0.00,$0.00
76100102,EAP,CPT® 29584,,Apply Multlay Comprs  Arm/hand,$478.00,$0.00,$478.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$478.00,$0.00,$478.00,$378.58,$382.40,$0.00,$0.00,$0.00,$0.00,$0.00
76100103,EAP,CPT® 46220,,Exc. Anal Ext. Tag/papilla,"$4,354.00",$0.00,"$4,354.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,354.00",$0.00,"$2,255.00","$3,448.37","$3,483.20",$0.00,$0.00,$0.00,$0.00,$0.00
76100104,EAP,CPT® 17999,,Skin Tissue Procedure,$250.00,$0.00,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$250.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
76100105,EAP,CPT® 31570,,Laryngoscope W/vc Inj,"$7,354.00",$235.43,"$7,354.00","$2,496.90","$1,482.64","$2,816.20","$1,267.06","$1,482.64","$1,482.64","$1,287.63","$7,354.00","$2,945.54","$2,327.00","$5,824.37","$5,883.20","$4,092.44",$296.20,$235.43,"$1,170.76","$2,805.28"
76100106,EAP,CPT® 41899,,Bx Of Gum Mass,"$1,880.00",$0.00,"$1,880.00","$1,880.00",$0.00,$195.27,$323.91,$0.00,$0.00,$329.17,"$1,880.00",$204.24,"$1,880.00","$1,488.96","$1,504.00",$283.76,$294.22,$0.00,$299.30,$194.51
76100107,EAP,CPT® 40899,,Vestibule Of Mouth (unlisted),$308.00,$0.00,$308.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$308.00,$0.00,$308.00,$243.94,$246.40,$0.00,$0.00,$0.00,$0.00,$0.00
76100110,EAP,CPT® 49082,,Abdom Paracentesis W/o Imag,"$1,857.00",$0.00,"$1,769.00","$1,769.00",$0.00,$753.62,$0.00,$0.00,$0.00,$309.74,"$1,769.00",$788.23,"$1,769.00","$1,401.05","$1,415.20","$1,095.14",$0.00,$77.15,$281.62,$750.70
76100112,EAP,CPT® 49083,,Abdom Paracentesis W Imag,"$1,857.00",$0.00,"$1,769.00","$1,769.00",$0.00,$753.62,$304.79,$0.00,$0.00,$309.74,"$1,769.00",$788.23,"$1,769.00","$1,401.05","$1,415.20","$1,095.14",$296.18,$112.15,$281.62,$750.70
76100113,EAP,CPT® 49084,,Peritoneal Lavage W Imag,"$1,857.00",$0.00,"$1,769.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,769.00",$0.00,"$1,769.00","$1,401.05","$1,415.20",$0.00,$0.00,$0.00,$0.00,$0.00
76100114,EAP,CPT® 20680,,Removal Of Support Implant,"$5,087.00",$0.00,"$5,087.00","$2,706.90","$3,630.59","$2,223.58",$0.00,"$3,630.59","$3,630.59",$0.00,"$5,087.00","$2,325.71","$2,858.00","$4,028.90","$4,069.60","$3,231.26",$0.00,$437.25,$809.85,"$2,214.96"
76100115,EAP,CPT® 25605,,Treat Fracture Radius Ulna,"$2,345.00",$373.32,"$2,345.00","$2,345.00","$1,756.53","$1,299.68",$404.03,"$1,756.53","$1,756.53",$410.59,"$2,345.00","$1,359.37","$2,345.00","$1,857.24","$1,876.00","$1,888.67",$469.11,$530.90,$373.32,"$1,294.64"
76100116,EAP,CPT® 27825,,Treat Lower Leg Fracture,"$7,275.00",$0.00,"$7,275.00","$2,496.90",$0.00,"$1,299.68",$0.00,"$1,482.64","$1,482.64",$0.00,"$7,275.00","$1,359.37","$2,327.00","$5,761.80","$5,820.00","$1,888.67",$0.00,$0.00,$0.00,$0.00
76100117,EAP,CPT® 41899,,Alveoplasty W/extractions,"$2,391.00",$0.00,"$2,391.00","$2,106.30",$0.00,$195.27,$411.96,$0.00,$0.00,$418.64,"$2,391.00",$204.24,"$2,327.00","$1,893.67","$1,912.80",$283.76,$374.19,$0.00,$380.65,$194.51
76100118,EAP,CPT® 26705,,Treat Knuckle Dislocation,"$1,593.00",$0.00,"$1,593.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,593.00",$0.00,"$1,593.00","$1,261.66","$1,274.40",$0.00,$0.00,$0.00,$0.00,$0.00
76100119,EAP,CPT® 51784,,Anal/urinary Muscle Study,$212.00,$0.00,$212.00,$115.12,$0.00,$132.66,$36.53,$0.00,$0.00,$37.12,$212.00,$138.76,$212.00,$167.90,$169.60,$192.78,$94.94,$29.53,$33.75,$132.15
76100120,EAP,CPT® 26951,,Amputation Of Finger Thumb,"$7,113.00",$0.00,"$7,113.00",$0.00,$0.00,$0.00,"$1,225.53",$0.00,$0.00,$0.00,"$7,113.00",$0.00,"$2,327.00","$5,633.50","$5,690.40",$0.00,$412.92,$0.00,$0.00,$0.00
76100121,EAP,CPT® 26705,,Treat Knuckle Dislocation,"$1,593.00",$0.00,"$1,593.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,593.00",$0.00,"$1,593.00","$1,261.66","$1,274.40",$0.00,$0.00,$0.00,$0.00,$0.00
76100122,EAP,CPT® 62273,,Injection Epidural Blood Patch,"$1,596.00",$117.56,"$1,596.00","$1,596.00","$1,208.73",$599.36,$274.98,"$1,208.73","$1,208.73",$279.45,"$1,596.00",$626.89,"$1,596.00","$1,264.03","$1,276.80",$870.98,$123.36,$117.56,$254.08,$597.04
76100123,EAP,CPT® 67904,,Blepharoptosis,"$5,067.00",$0.00,"$5,067.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,067.00",$0.00,"$3,606.00","$4,013.06","$4,053.60",$0.00,$0.00,$0.00,$0.00,$0.00
76100124,EAP,CPT® 11760,,Repair Nail Bed,$759.00,$0.00,$759.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$759.00,$0.00,$759.00,$601.13,$607.20,$0.00,$0.00,$0.00,$0.00,$0.00
76100125,EAP,CPT® 17270,,Destruction Malignant Lesion 0.5cm Or Less,$477.00,$0.00,$477.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$477.00,$0.00,$477.00,$377.78,$381.60,$0.00,$0.00,$0.00,$0.00,$0.00
76100126,EAP,CPT® 41599,,Tongue/mouth Unlisted Proc.,$271.00,$0.00,$271.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$271.00,$0.00,$271.00,$214.63,$216.80,$0.00,$0.00,$0.00,$0.00,$0.00
76100129,EAP,CPT® 28405,,Treat Heel Fx,"$4,960.00",$0.00,"$4,960.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,960.00",$0.00,"$2,327.00","$3,928.32","$3,968.00",$0.00,$0.00,$0.00,$0.00,$0.00
76100130,EAP,CPT® 31576,,"Laryngoscopy, Fiberoptic W/bx","$7,261.00",$121.86,"$7,261.00","$2,496.90","$5,182.18","$1,371.81","$1,251.03","$5,182.18","$5,182.18","$1,271.34","$7,261.00","$1,434.81","$2,327.00","$5,750.71","$5,808.80","$1,993.48",$149.37,$121.86,"$1,155.95","$1,366.49"
76100131,EAP,CPT® 42999,,Throat Proc. ( Phary/ Aden/tons),$225.00,$0.00,$225.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$225.00,$0.00,$225.00,$178.20,$180.00,$0.00,$0.00,$0.00,$0.00,$0.00
76100132,EAP,CPT® 59150,,Treat Ectopic Pregnancy,"$21,864.00",$0.00,"$21,864.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$21,864.00",$0.00,"$5,452.00","$17,316.29","$17,491.20",$0.00,$0.00,$0.00,$0.00,$0.00
76100133,EAP,CPT® 24999,,Upper Arm/elbow Surg,$483.00,$0.00,$483.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$483.00,$0.00,$483.00,$382.54,$386.40,$0.00,$0.00,$0.00,$0.00,$0.00
76100134,EAP,CPT® 52001,,Cysto Rem Of Clots,"$5,150.00",$0.00,"$5,150.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$5,150.00",$0.00,"$2,255.00","$4,078.80","$4,120.00",$0.00,$0.00,$0.00,$0.00,$0.00
76100135,EAP,CPT® 92025,,Topography,$291.00,$0.00,$291.00,$158.01,$0.00,$52.75,$50.14,$0.00,$0.00,$50.95,$291.00,$55.17,$145.50,$230.47,$232.80,$76.65,$45.54,$17.29,$46.33,$52.54
76100136,EAP,CPT® 59001,,Amniocentesis Therapeutic,"$2,089.00",$0.00,"$2,089.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,089.00",$0.00,"$2,089.00","$1,654.49","$1,671.20",$0.00,$0.00,$0.00,$0.00,$0.00
76100138,EAP,CPT® 25111,,Removal Of Ganglion Cyst,"$4,220.00",$0.00,"$4,220.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$4,220.00",$0.00,"$2,858.00","$3,342.24","$3,376.00",$0.00,$0.00,$0.00,$0.00,$0.00
76100139,EAP,CPT® 92025,,Corneal Topography,$291.00,$0.00,$291.00,$158.01,$0.00,$52.75,$50.14,$0.00,$0.00,$50.95,$291.00,$55.17,$145.50,$230.47,$232.80,$76.65,$45.54,$17.29,$46.33,$52.54
76100140,EAP,CPT® 27509,,Treatment Of Thigh Fracture,"$16,329.00",$0.00,"$16,329.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$16,329.00",$0.00,"$2,858.00","$12,932.57","$13,063.20",$0.00,$0.00,$0.00,$0.00,$0.00
76100141,EAP,CPT® 92504,,Ear Microscopy Examination,$90.00,$0.00,$90.00,$48.87,$0.00,$0.00,$15.51,$0.00,$0.00,$15.76,$90.00,$0.00,$45.00,$71.28,$72.00,$0.00,$25.24,$9.74,$14.33,$0.00
76200002,EAP,HCPCS G0378,,Observation Room,$132.00,$0.00,$124.00,$124.00,$88.50,$0.00,$21.36,$88.50,$88.50,$21.71,$124.00,$0.00,$80.60,$98.21,$99.20,$0.00,$19.41,$0.00,$19.74,$0.00
76200028,EAP,HCPCS G0378,,Obs. Rm. Ecc,$132.00,$0.00,$124.00,$124.00,$88.50,$0.00,$21.36,$88.50,$88.50,$21.71,$124.00,$0.00,$80.60,$98.21,$99.20,$0.00,$19.41,$0.00,$19.74,$0.00
76200077,EAP,HCPCS G0378,,Observation Room Carveout,$132.00,$0.00,$124.00,$124.00,$88.50,$0.00,$21.36,$88.50,$88.50,$21.71,$124.00,$0.00,$80.60,$98.21,$99.20,$0.00,$19.41,$0.00,$19.74,$0.00
77000001,EAP,HCPCS G0101,,Pelvic/breast Exam,$264.00,$29.20,$264.00,$143.35,$188.42,$75.31,$45.49,$188.42,$188.42,$46.22,$264.00,$78.77,$132.00,$209.09,$211.20,$109.44,$41.32,$29.20,$42.03,$75.02
77100006,EAP,CPT® 90471,,Immunization Admin 1st,$62.00,$9.08,$60.65,$31.49,$41.39,$57.98,$9.99,$41.39,$41.39,$10.16,$58.00,$60.65,$29.00,$45.94,$46.40,$58.00,$9.08,$14.42,$9.23,$57.76
77100007,EAP,CPT® 90471,,Administration Pneumo Vaccine,$62.00,$9.08,$58.00,$31.49,$41.39,$36.54,$9.99,$41.39,$41.39,$10.16,$58.00,$38.22,$29.00,$45.94,$46.40,$58.00,$9.08,$14.42,$9.23,$36.40
77100011,EAP,CPT® 90472,,Immunization Each Additional,$62.00,$0.00,$58.00,$31.49,$41.39,$0.00,$9.99,$41.39,$41.39,$10.16,$58.00,$0.00,$29.00,$45.94,$46.40,$0.00,$9.08,$12.98,$9.23,$0.00
77100018,EAP,HCPCS 90471,,Administration Flu Vaccine,$62.00,$9.08,$58.00,$31.49,$41.39,$36.54,$9.99,$41.39,$41.39,$10.16,$58.00,$38.22,$29.00,$45.94,$46.40,$58.00,$9.08,$14.42,$9.23,$36.40
77100035,EAP,CPT® 90471,,Immunization Admin. (ped),$62.00,$9.08,$60.65,$31.49,$41.39,$57.98,$9.99,$41.39,$41.39,$10.16,$58.00,$60.65,$29.00,$45.94,$46.40,$58.00,$9.08,$14.42,$9.23,$57.76
77100040,EAP,CPT® 90471,,Administration Of Hepatitis B Vaccine,$62.00,$9.08,$58.00,$31.49,$41.39,$36.54,$9.99,$41.39,$41.39,$10.16,$58.00,$38.22,$29.00,$45.94,$46.40,$58.00,$9.08,$14.42,$9.23,$36.40
77100044,EAP,CPT® 90471,,R-immunization Administration-24,$62.00,$9.08,$60.65,$31.49,$41.39,$57.98,$9.99,$41.39,$41.39,$10.16,$58.00,$60.65,$29.00,$45.94,$46.40,$58.00,$9.08,$14.42,$9.23,$57.76
78000010,EAP,HCPCS Q3014,,Telehealth Facility Fee,$65.00,$0.00,$65.00,$35.30,$0.00,$11.57,$11.20,$0.00,$0.00,$11.38,$65.00,$0.00,$32.50,$51.48,$52.00,$39.00,$22.96,$0.00,$10.35,$0.00
80000611,EAP,HCPCS C1769,,Guidewire Vasc 150cm .035in Fix Core Flxb 3mm Rad,$325.00,$0.00,$325.00,$176.48,$231.95,$0.00,$56.00,$231.95,$231.95,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
80000635,EAP,HCPCS C1894,,Sheath Introd 10cm 6fr Pncl Peri Snpon Dilat Lock,$219.00,$0.00,$219.00,$118.92,$156.30,$0.00,$37.73,$156.30,$156.30,$38.35,$219.00,$0.00,$109.50,$173.45,$175.20,$0.00,$34.27,$0.00,$34.86,$0.00
80002673,EAP,HCPCS C1729,,Catheter Xtrn Drn 80cm Strl Edm Cls Tip Ba Imprg Sil Lmbr,$566.00,$0.00,$566.00,$307.34,$403.95,$0.00,$97.52,$403.95,$403.95,$99.10,$566.00,$0.00,$283.00,$448.27,$452.80,$0.00,$88.58,$0.00,$90.11,$0.00
80003182,EAP,HCPCS C1751,,Catheter Art Ln 110cm 7fr Std Fem Vn 4 Lum S Tip,$145.00,$0.00,$145.00,$78.74,$103.49,$0.00,$24.98,$103.49,$103.49,$25.39,$145.00,$0.00,$72.50,$114.84,$116.00,$0.00,$22.69,$0.00,$23.08,$0.00
80003186,EAP,HCPCS C1887,,Catheter Guid Blue Ylw 100cm 7fr Crds Vsbr Jl4st,$93.00,$0.00,$93.00,$50.50,$66.37,$0.00,$16.02,$66.37,$66.37,$16.28,$93.00,$0.00,$46.50,$73.66,$74.40,$0.00,$14.55,$0.00,$14.81,$0.00
80003206,EAP,HCPCS C1725,,Catheter Pa 110cm 7fr 10mm Arw 1 Lum Bln Wdg Prss,$168.00,$0.00,$168.00,$91.22,$119.90,$0.00,$28.95,$119.90,$119.90,$29.42,$168.00,$0.00,$84.00,$133.06,$134.40,$0.00,$26.29,$0.00,$26.75,$0.00
80003226,EAP,HCPCS C1884,,System Embl Prtc 300cm .014in 110um 3.2fr Crtd,"$4,188.00",$0.00,"$4,188.00","$2,274.08","$2,988.98",$0.00,$721.57,"$2,988.98","$2,988.98",$733.29,"$4,188.00",$0.00,"$2,094.00","$3,316.90","$3,350.40",$0.00,$655.42,$0.00,$666.73,$0.00
80003239,EAP,HCPCS C1757,,Catheter Thrmb 140cm 6fr .07in Xprt Ap Aspirat,"$1,238.00",$0.00,"$1,238.00",$0.00,$883.56,$0.00,$0.00,$883.56,$883.56,$0.00,"$1,238.00",$0.00,$619.00,$980.50,$990.40,$0.00,$0.00,$0.00,$0.00,$0.00
80006190,EAP,HCPCS C1769,,Guidewire Vasc 145cm .035in Fix Core Flpy Flx Tp,$49.00,$0.00,$49.00,$26.61,$34.97,$0.00,$8.44,$34.97,$34.97,$8.58,$49.00,$0.00,$24.50,$38.81,$39.20,$0.00,$7.67,$0.00,$7.80,$0.00
80006520,EAP,HCPCS C1876,,System Coron Stent 8mm 3.5mm Mtlnk Vsn Cocr Rapex,"$1,188.00",$0.00,"$1,188.00",$534.60,$847.88,$0.00,$204.69,$847.88,$847.88,$208.01,"$1,188.00",$0.00,$594.00,$940.90,$950.40,$0.00,$185.92,$0.00,$189.13,$0.00
80006521,EAP,HCPCS C1876,,System Coron Stent 8mm 4mm Mtlnk Vsn Cocr Rapex Lp,"$1,188.00",$0.00,"$1,188.00",$534.60,$847.88,$0.00,$204.69,$847.88,$847.88,$208.01,"$1,188.00",$0.00,$594.00,$940.90,$950.40,$0.00,$185.92,$0.00,$189.13,$0.00
80006522,EAP,HCPCS C1876,,System Coron Stent 12mm 3mm Mtlnk Vsn Cocr Rapex,"$1,188.00",$0.00,"$1,188.00",$534.60,$847.88,$0.00,$204.69,$847.88,$847.88,$208.01,"$1,188.00",$0.00,$594.00,$940.90,$950.40,$0.00,$185.92,$0.00,$189.13,$0.00
80006523,EAP,HCPCS C1874,,System Coron Stent 12mm 3.5mm Mtlnk Vsn Cocr Rapex,"$1,188.00",$0.00,"$1,188.00",$534.60,$847.88,$0.00,$204.69,$847.88,$847.88,$208.01,"$1,188.00",$0.00,$594.00,$940.90,$950.40,$0.00,$185.92,$0.00,$189.13,$0.00
80006524,EAP,HCPCS C1876,,System Coron Stent 12mm 4mm Mtlnk Vsn Cocr Rapex,"$1,188.00",$0.00,"$1,188.00",$534.60,$847.88,$0.00,$204.69,$847.88,$847.88,$208.01,"$1,188.00",$0.00,$594.00,$940.90,$950.40,$0.00,$185.92,$0.00,$189.13,$0.00
80006526,EAP,HCPCS C1876,,System Coron Stent 15mm 3.5mm Mtlnk Vsn Cocr Rapex,"$1,188.00",$0.00,"$1,188.00",$534.60,$847.88,$0.00,$204.69,$847.88,$847.88,$208.01,"$1,188.00",$0.00,$594.00,$940.90,$950.40,$0.00,$185.92,$0.00,$189.13,$0.00
80006531,EAP,HCPCS C1876,,System Coron Stent 23mm 3mm Mtlnk Vsn Cocr Rapex,"$1,188.00",$0.00,"$1,188.00",$534.60,$847.88,$0.00,$204.69,$847.88,$847.88,$208.01,"$1,188.00",$0.00,$594.00,$940.90,$950.40,$0.00,$185.92,$0.00,$189.13,$0.00
80006535,EAP,HCPCS C1874,,System Coron Stent 28mm 3.5mm Mtlnk Vsn Cocr Rapex,"$1,188.00",$0.00,"$1,188.00",$534.60,$847.88,$0.00,$204.69,$847.88,$847.88,$208.01,"$1,188.00",$0.00,$594.00,$940.90,$950.40,$0.00,$185.92,$0.00,$189.13,$0.00
80006536,EAP,HCPCS C1876,,System Coron Stent 28mm 4mm Mtlnk Vsn Cocr Rapex,"$1,188.00",$0.00,"$1,188.00",$534.60,$847.88,$0.00,$204.69,$847.88,$847.88,$208.01,"$1,188.00",$0.00,$594.00,$940.90,$950.40,$0.00,$185.92,$0.00,$189.13,$0.00
80006635,EAP,HCPCS C1769,,Guidewire Vasc 145cm .038in Atrm Flpy Flx Tp Xstif,$65.00,$0.00,$65.00,$35.30,$46.39,$0.00,$11.20,$46.39,$46.39,$11.38,$65.00,$0.00,$32.50,$51.48,$52.00,$0.00,$10.17,$0.00,$10.35,$0.00
80006680,EAP,HCPCS C1894,,Sheath Introd 10cm 7fr Pncl Peri Ss Hydphi Ptfe,$219.00,$0.00,$219.00,$118.92,$156.30,$0.00,$37.73,$156.30,$156.30,$38.35,$219.00,$0.00,$109.50,$173.45,$175.20,$0.00,$34.27,$0.00,$34.86,$0.00
80006701,EAP,HCPCS C1773,,Kit Snr 120cm 15mm 6fr Agn Ntnl Cath Preform Loop,$800.00,$0.00,$800.00,$434.40,$570.96,$0.00,$137.84,$570.96,$570.96,$140.07,$800.00,$0.00,$400.00,$633.60,$640.00,$0.00,$125.20,$0.00,$127.36,$0.00
80008328,EAP,HCPCS C1876,,System Coron Stent 8mm 2.5mm Mtlnk Mvsn Cocr Rapex,"$1,188.00",$0.00,"$1,188.00",$534.60,$847.88,$0.00,$204.69,$847.88,$847.88,$208.01,"$1,188.00",$0.00,$594.00,$940.90,$950.40,$0.00,$185.92,$0.00,$189.13,$0.00
80008330,EAP,HCPCS C1876,,System Coron Stent 15mm 2.5mm Mtlnk Mvsn Cocr,"$1,188.00",$0.00,"$1,188.00",$534.60,$847.88,$0.00,$204.69,$847.88,$847.88,$208.01,"$1,188.00",$0.00,$594.00,$940.90,$950.40,$0.00,$185.92,$0.00,$189.13,$0.00
80008333,EAP,HCPCS C1876,,System Coron Stent 28mm 2.5mm Mtlnk Mvsn Cocr,"$1,188.00",$0.00,"$1,188.00",$534.60,$847.88,$0.00,$204.69,$847.88,$847.88,$208.01,"$1,188.00",$0.00,$594.00,$940.90,$950.40,$0.00,$185.92,$0.00,$189.13,$0.00
80008338,EAP,HCPCS A6198,,Dressing Brn 16x16in Strl Lf Actct Anbctrl Fst Act Brr Cntrl,$185.00,$0.00,$185.00,$0.00,$132.03,$0.00,$0.00,$132.03,$132.03,$0.00,$185.00,$0.00,$92.50,$146.52,$148.00,$0.00,$0.00,$0.00,$0.00,$0.00
80008439,EAP,HCPCS C1894,,Sheath Guid 45cm 6fr Pn Dstn Hs Curve Ss Nyl,$205.00,$0.00,$205.00,$111.32,$146.31,$0.00,$35.32,$146.31,$146.31,$35.89,$205.00,$0.00,$102.50,$162.36,$164.00,$0.00,$32.08,$0.00,$32.64,$0.00
80008456,EAP,HCPCS C1894,,Introd Shth 6fr 4cm Radiopq Lg Bore Stpck Pinch,$213.00,$0.00,$213.00,$115.66,$152.02,$0.00,$36.70,$152.02,$152.02,$37.29,$213.00,$0.00,$106.50,$168.70,$170.40,$0.00,$33.33,$0.00,$33.91,$0.00
80008503,EAP,HCPCS C1725,,Catheter Angiographic Chuang C Curve 5fr 80cm Torcon Nb,$63.00,$0.00,$63.00,$34.21,$44.96,$0.00,$10.85,$44.96,$44.96,$11.03,$63.00,$0.00,$31.50,$49.90,$50.40,$0.00,$9.86,$0.00,$10.03,$0.00
80008556,EAP,HCPCS C1894,,Introd Shth 10fr 2.5cm 25cm Dilat Kink Rst Pncl,$499.00,$0.00,$499.00,$270.96,$356.14,$0.00,$85.98,$356.14,$356.14,$87.37,$499.00,$0.00,$249.50,$395.21,$399.20,$0.00,$78.09,$0.00,$79.44,$0.00
80008561,EAP,HCPCS C1894,,Sheath Introd 25cm 5fr Pncl Peri Ss Hydphi Ptfe,$499.00,$0.00,$499.00,$270.96,$356.14,$0.00,$85.98,$356.14,$356.14,$87.37,$499.00,$0.00,$249.50,$395.21,$399.20,$0.00,$78.09,$0.00,$79.44,$0.00
80008562,EAP,HCPCS C1757,,Catheter Thrmb 135cm 5fr Unfs Flw-thru Hub Infus,$425.00,$0.00,$425.00,$0.00,$303.32,$0.00,$0.00,$303.32,$303.32,$0.00,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$0.00,$0.00,$0.00,$0.00
80008565,EAP,HCPCS C1894,,Sheath Introd 25cm 6fr Pncl Peri Ss Hydphi Ptfe,$499.00,$0.00,$499.00,$270.96,$356.14,$0.00,$85.98,$356.14,$356.14,$87.37,$499.00,$0.00,$249.50,$395.21,$399.20,$0.00,$78.09,$0.00,$79.44,$0.00
80008566,EAP,HCPCS C1894,,Introd Shth 8fr 2.5cm 25cm Dilat Mini Gwire Kink,$499.00,$0.00,$499.00,$270.96,$356.14,$0.00,$85.98,$356.14,$356.14,$87.37,$499.00,$0.00,$249.50,$395.21,$399.20,$0.00,$78.09,$0.00,$79.44,$0.00
80008570,EAP,HCPCS C1894,,Sheath Introd 25cm 7fr Pncl Peri Ss Hydphi Ptfe,$499.00,$0.00,$499.00,$270.96,$356.14,$0.00,$85.98,$356.14,$356.14,$87.37,$499.00,$0.00,$249.50,$395.21,$399.20,$0.00,$78.09,$0.00,$79.44,$0.00
80008625,EAP,HCPCS C1894,,Sheath Introd 10cm 10fr Pncl Peri Ss Hydphi Ptfe,$219.00,$0.00,$219.00,$118.92,$156.30,$0.00,$37.73,$156.30,$156.30,$38.35,$219.00,$0.00,$109.50,$173.45,$175.20,$0.00,$34.27,$0.00,$34.86,$0.00
80008715,EAP,HCPCS C1887,,Catheter Guid 100cm 7fr Shr Nx Bal Lcb Curve Coron,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
80008870,EAP,HCPCS C1887,,Catheter Guid Blue Ylw 100cm 7fr Crds Vsbr Mpa1,$120.00,$0.00,$120.00,$65.16,$85.64,$0.00,$20.68,$85.64,$85.64,$21.01,$120.00,$0.00,$60.00,$95.04,$96.00,$0.00,$18.78,$0.00,$19.10,$0.00
80008873,EAP,HCPCS C1887,,Catheter Guid Blue Ylw 100cm 7fr Crds Vsbr Jr3.5,$93.00,$0.00,$93.00,$50.50,$66.37,$0.00,$16.02,$66.37,$66.37,$16.28,$93.00,$0.00,$46.50,$73.66,$74.40,$0.00,$14.55,$0.00,$14.81,$0.00
80008874,EAP,HCPCS C1887,,Catheter Guid 100cm 7fr Shr Nx Bal Ima Curve Peri,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
80008930,EAP,HCPCS C1760,,Device Clsr 70cm 6fr Angsl Vip .035in Vasc Clgn,"$8,000.00",$0.00,"$8,000.00","$4,344.00","$5,158.80",$0.00,"$1,378.36","$5,158.80","$5,158.80","$1,400.74","$8,000.00",$0.00,"$4,000.00","$6,336.00","$6,400.00",$0.00,"$1,252.00",$0.00,"$1,273.60",$0.00
80009063,EAP,HCPCS C1725,,Catheter Angio 100cm 5fr Gldcath Radifocus Ang,$607.00,$0.00,$607.00,$329.60,$433.22,$0.00,$104.58,$433.22,$433.22,$106.28,$607.00,$0.00,$303.50,$480.74,$485.60,$0.00,$95.00,$0.00,$96.63,$0.00
80009071,EAP,HCPCS C1725,,Catheter Angio 65cm 5fr Gldcath Radifocus C2 Curve,$607.00,$0.00,$607.00,$329.60,$433.22,$0.00,$104.58,$433.22,$433.22,$106.28,$607.00,$0.00,$303.50,$480.74,$485.60,$0.00,$95.00,$0.00,$96.63,$0.00
80009072,EAP,HCPCS C1769,,Guidewire Vasc Std Ang .035in 260cm 3cm Gldwr Gld Tch Flxb,$555.00,$0.00,$555.00,$301.37,$396.10,$0.00,$95.62,$396.10,$396.10,$97.18,$555.00,$0.00,$277.50,$439.56,$444.00,$0.00,$86.86,$0.00,$88.36,$0.00
80009076,EAP,HCPCS C1769,,Guidewire Vasc 150cm .035in Radiopq Std Shft Flxb,$363.00,$0.00,$363.00,$197.11,$259.07,$0.00,$62.54,$259.07,$259.07,$63.56,$363.00,$0.00,$181.50,$287.50,$290.40,$0.00,$56.81,$0.00,$57.79,$0.00
80009079,EAP,HCPCS C1894,,Sheath Introd 10cm 5fr Pncl Peri Ss Hydphi Ptfe,$219.00,$0.00,$219.00,$118.92,$156.30,$0.00,$37.73,$156.30,$156.30,$38.35,$219.00,$0.00,$109.50,$173.45,$175.20,$0.00,$34.27,$0.00,$34.86,$0.00
80009081,EAP,HCPCS C1894,,Sheath Introd 10cm 8fr Pncl Peri Ss Hydphi Ptfe,$219.00,$0.00,$219.00,$118.92,$156.30,$0.00,$37.73,$156.30,$156.30,$38.35,$219.00,$0.00,$109.50,$173.45,$175.20,$0.00,$34.27,$0.00,$34.86,$0.00
80009082,EAP,HCPCS C1894,,Sheath Introd 10cm 9fr Pncl Peri Ss Hydphi Ptfe,$219.00,$0.00,$219.00,$118.92,$156.30,$0.00,$37.73,$156.30,$156.30,$38.35,$219.00,$0.00,$109.50,$173.45,$175.20,$0.00,$34.27,$0.00,$34.86,$0.00
80009106,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in Sft Rbn Tip Kink Rst,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
80009617,EAP,HCPCS B4087,,Tube Jjnstm 12fr 2-3ml Strl Lf Mc Slk Med Port Radopq Strp,$337.00,$0.00,$337.00,$0.00,$240.52,$0.00,$0.00,$240.52,$240.52,$0.00,$337.00,$0.00,$168.50,$266.90,$269.60,$0.00,$0.00,$0.00,$0.00,$0.00
80009798,EAP,HCPCS C1760,,Device Clsr 5-7fr Cardiva Ctlst Ii Fem Art Prtmn,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,"$2,676.38","$2,676.38",$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
80009995,EAP,HCPCS C1894,,Sheath Guid 45cm 6fr Pn Dstn Str Ss Nyl Hydphi,$207.00,$0.00,$207.00,$112.40,$147.74,$0.00,$35.67,$147.74,$147.74,$36.24,$207.00,$0.00,$103.50,$163.94,$165.60,$0.00,$32.40,$0.00,$32.95,$0.00
80010072,EAP,HCPCS C1887,,Catheter Guid 100cm 6fr Shr Nx Bal Al1 Curve Coron,$118.00,$0.00,$118.00,$64.07,$84.22,$0.00,$20.33,$84.22,$84.22,$20.66,$118.00,$0.00,$59.00,$93.46,$94.40,$0.00,$18.47,$0.00,$18.79,$0.00
80010120,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in Core To Tip Radiopq,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
80010121,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in Core To Tip Radiopq,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
80010122,EAP,HCPCS C1769,,Extension Gwire 145cm .014in Doc,$225.00,$0.00,$225.00,$122.18,$160.58,$0.00,$38.77,$160.58,$160.58,$39.40,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$35.21,$0.00,$35.82,$0.00
80010594,EAP,HCPCS C1725,,Catheter Angio 100cm 5fr Prfm Pgtl Curve Peri,$226.00,$0.00,$226.00,$122.72,$161.30,$0.00,$38.94,$161.30,$161.30,$39.57,$226.00,$0.00,$113.00,$178.99,$180.80,$0.00,$35.37,$0.00,$35.98,$0.00
80010631,EAP,HCPCS C1874,,Stent Trchbr 5mm 6fr 22mm 120cm Cover Cath Introd,"$6,288.00",$0.00,"$6,288.00","$2,829.60","$4,487.75",$0.00,"$1,083.39","$4,487.75","$4,487.75","$1,100.98","$6,288.00",$0.00,"$3,144.00","$4,980.10","$5,030.40",$0.00,$984.07,$0.00,"$1,001.05",$0.00
80010639,EAP,HCPCS C1876,,System Coron Stent 13mm 4.5mm Mtlnk Ul Xcelon,"$1,188.00",$0.00,"$1,188.00",$534.60,$847.88,$0.00,$204.69,$847.88,$847.88,$208.01,"$1,188.00",$0.00,$594.00,$940.90,$950.40,$0.00,$185.92,$0.00,$189.13,$0.00
80016126,EAP,HCPCS C1887,,Catheter Guid 100cm 6fr Lnchr Ebu3 Curve Coron Nyl,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
80016128,EAP,HCPCS C1887,,Catheter Guid 100cm 6fr Lnchr Ebu4 Curve Coron Nyl,$113.00,$0.00,$113.00,$61.36,$80.65,$0.00,$19.47,$80.65,$80.65,$19.79,$113.00,$0.00,$56.50,$89.50,$90.40,$0.00,$17.68,$0.00,$17.99,$0.00
80016129,EAP,HCPCS C1887,,Catheter Guid 100cm 7fr Shr Nx Bal Ebu3 Curve,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
80016130,EAP,HCPCS C1887,,Catheter Guid 100cm 7fr Shr Nx Bal Ebu3.5 Curve,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
80016131,EAP,HCPCS C1887,,Catheter Guid 100cm 7fr Shr Nx Bal Ebu4 Curve,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
80016135,EAP,HCPCS C1757,,Catheter Thrmb 145cm 7fr .080in Xprt Ap Aspirat,"$1,238.00",$0.00,"$1,238.00",$0.00,$883.56,$0.00,$0.00,$883.56,$883.56,$0.00,"$1,238.00",$0.00,$619.00,$980.50,$990.40,$0.00,$0.00,$0.00,$0.00,$0.00
80016142,EAP,HCPCS C1753,,Catheter Us 150cm 3.3-2.9fr 20mm Ee Pltn 20mhz,"$1,813.00",$0.00,"$1,813.00",$984.46,"$1,293.94",$0.00,$312.37,"$1,293.94","$1,293.94",$317.44,"$1,813.00",$0.00,$906.50,"$1,435.90","$1,450.40",$0.00,$283.73,$0.00,$288.63,$0.00
80016144,EAP,HCPCS C1773,,Kit Snr Agn 90d Mic 175cm 2.3-3fr 2mm Cath Loop,"$1,400.00",$0.00,"$1,400.00",$760.20,$999.18,$0.00,$241.21,$999.18,$999.18,$245.13,"$1,400.00",$0.00,$700.00,"$1,108.80","$1,120.00",$0.00,$219.10,$0.00,$222.88,$0.00
80017153,EAP,HCPCS C1752,,Catheter Sct Kt 2 Lum Coil Xtd Lgth,$200.00,$0.00,$200.00,$0.00,$142.74,$0.00,$0.00,$142.74,$142.74,$0.00,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$0.00,$0.00,$0.00,$0.00
80017258,EAP,HCPCS C1725,,Catheter Baldilat 2.5mm 12mm Coron Rapex Radiopq,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80017262,EAP,HCPCS C1725,,Catheter Baldilat 2.5mm 15mm Coron Rapex Radiopq,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80017266,EAP,HCPCS C1725,,Catheter Baldilat 2.5mm 20mm Coron Rapex Radiopq,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80017278,EAP,HCPCS C1725,,Catheter Baldilat 2.5mm 25mm Coron Rapex Radiopq,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80017284,EAP,HCPCS C1725,,Catheter Baldilat 3.5mm 25mm Coron Rapex Radiopq,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80017293,EAP,HCPCS C1725,,Catheter Baldilat 2.75mm 12mm Coron Rapex Radiopq,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80017362,EAP,Custom 80017362,,Envelope Abs 2.7x2.5in Tyrx Polyarylate,"$1,738.00",$0.00,"$1,738.00",$0.00,"$1,240.41",$0.00,$0.00,"$1,240.41","$1,240.41",$0.00,"$1,738.00",$0.00,$869.00,"$1,376.50","$1,390.40",$0.00,$0.00,$0.00,$0.00,$0.00
80017977,EAP,Custom 80017977,,Envelope Abs 3.3x2.9in Anbctrl Tyrx Polyarylate,"$2,238.00",$0.00,"$2,238.00",$0.00,"$1,597.26",$0.00,$0.00,"$1,597.26","$1,597.26",$0.00,"$2,238.00",$0.00,"$1,119.00","$1,772.50","$1,790.40",$0.00,$0.00,$0.00,$0.00,$0.00
80018159,EAP,HCPCS C1894,,Tray Cath Lf A Neos 2 Tier Dsgn Fn Tip Fcp Ins Deph Fr Mgln,$127.00,$0.00,$127.00,$68.96,$90.64,$0.00,$21.88,$90.64,$90.64,$22.24,$127.00,$0.00,$63.50,$100.58,$101.60,$0.00,$19.88,$0.00,$20.22,$0.00
80018208,EAP,HCPCS C1752,,Set Catheter .035in 24cm 70cm Sidehole Removable S,$375.00,$0.00,$375.00,$0.00,$267.64,$0.00,$0.00,$267.64,$267.64,$0.00,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$0.00,$0.00,$0.00,$0.00
80018623,EAP,HCPCS C1725,,Catheter Baldilat 1.5mm 145cm 12mm Otw 2 Lum Ult,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80018626,EAP,HCPCS C1725,,Catheter Baldilat 2mm 145cm 12mm Otw 2 Lum Ult Lp,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80018627,EAP,HCPCS C1725,,Catheter Baldilat 2mm 145cm 15mm Otw 2 Lum Ult Lp,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80018653,EAP,,,Dressing Foam 20x8in Gentle Adherence Polyurethane Foam Pad,$167.00,$0.00,$167.00,$0.00,$119.19,$0.00,$0.00,$119.19,$119.19,$0.00,$167.00,$0.00,$83.50,$132.26,$133.60,$0.00,$0.00,$0.00,$0.00,$0.00
80018673,EAP,HCPCS C1725,,Catheter Baldilat 2.75mm 20mm Coron Rapex Radiopq,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80018676,EAP,HCPCS C1725,,Catheter Baldilat 3mm 12mm Coron Rapex Radiopq,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80018677,EAP,HCPCS C1725,,Catheter Baldilat 3mm 15mm Coron Rapex Radiopq,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80018678,EAP,HCPCS C1725,,Catheter Baldilat 3mm 20mm Coron Rapex Radiopq,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80018679,EAP,HCPCS C1725,,Catheter Baldilat 3mm 25mm Coron Rapex Radiopq,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80018680,EAP,HCPCS C1725,,Catheter Baldilat 3.25mm 12mm Coron Rapex Radiopq,$488.00,$0.00,$488.00,$264.98,$348.29,$0.00,$84.08,$348.29,$348.29,$85.44,$488.00,$0.00,$244.00,$386.50,$390.40,$0.00,$76.37,$0.00,$77.69,$0.00
80018683,EAP,HCPCS C1725,,Catheter Baldilat 3.5mm 8mm Coron Rapex Radiopq,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80018684,EAP,HCPCS C1725,,Catheter Baldilat 3.5mm 12mm Coron Rapex Radiopq,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80018685,EAP,HCPCS C1725,,Catheter Baldilat 3.5mm 15mm Coron Rapex Radiopq,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80018686,EAP,HCPCS C1725,,Catheter Baldilat 3.5mm 20mm Coron Rapex Radiopq,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80018689,EAP,HCPCS C1725,,Catheter Baldilat 3.75mm 15mm Coron Rapex Radiopq,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80018690,EAP,HCPCS C1725,,Catheter Baldilat 3.75mm 20mm Coron Rapex Radiopq,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80018691,EAP,HCPCS C1725,,Catheter Baldilat 4mm 8mm Coron Rapex Radiopq Smth,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80018692,EAP,HCPCS C1725,,Catheter Baldilat 4mm 12mm Coron Rapex Radiopq,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80018693,EAP,HCPCS C1725,,Catheter Baldilat 4mm 15mm Coron Rapex Radiopq,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80018694,EAP,HCPCS C1725,,Catheter Baldilat 4mm 20mm Coron Rapex Radiopq,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80018696,EAP,HCPCS C1725,,Catheter Baldilat 5mm 12mm Coron Rapex Radiopq,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80074158,EAP,HCPCS C1898,,Lead Pacing 10mm Space Small Str 6.2fr 2mm 52cm 20,"$1,013.00",$0.00,"$1,013.00",$455.85,$722.98,$0.00,$174.53,$722.98,$722.98,$177.37,"$1,013.00",$0.00,$506.50,$802.30,$810.40,$0.00,$158.53,$0.00,$161.27,$0.00
80074159,EAP,HCPCS C1898,,Lead Pacing 10mm Space Small Str 6.2fr 2mm 58cm 20,"$1,013.00",$0.00,"$1,013.00",$455.85,$722.98,$0.00,$174.53,$722.98,$722.98,$177.37,"$1,013.00",$0.00,$506.50,$802.30,$810.40,$0.00,$158.53,$0.00,$161.27,$0.00
80078368,EAP,HCPCS C1884,,System Embl Prtc 320cm Crtd Lwr Xtrmt Cptr Wire,"$3,488.00",$0.00,"$3,488.00","$1,893.98","$2,489.39",$0.00,$600.96,"$2,489.39","$2,489.39",$610.72,"$3,488.00",$0.00,"$1,744.00","$2,762.50","$2,790.40",$0.00,$545.87,$0.00,$555.29,$0.00
80078369,EAP,HCPCS C1884,,System Embl Prtc 320cm Crtd Lwr Xtrmt Cptr Wire,"$3,488.00",$0.00,"$3,488.00","$1,893.98","$2,489.39",$0.00,$600.96,"$2,489.39","$2,489.39",$610.72,"$3,488.00",$0.00,"$1,744.00","$2,762.50","$2,790.40",$0.00,$545.87,$0.00,$555.29,$0.00
80078384,EAP,HCPCS C1769,,Guidewire Vasc 260cm .035in Radiopq Flxb Core To,$623.00,$0.00,$623.00,$338.29,$444.64,$0.00,$107.34,$444.64,$444.64,$109.08,$623.00,$0.00,$311.50,$493.42,$498.40,$0.00,$97.50,$0.00,$99.18,$0.00
80079016,EAP,HCPCS C1894,,Sheath Guid 80cm 6fr 2.2mm Flxr Sh Aq Radiopq Stf,$378.00,$0.00,$378.00,$205.25,$269.78,$0.00,$65.13,$269.78,$269.78,$66.18,$378.00,$0.00,$189.00,$299.38,$302.40,$0.00,$59.16,$0.00,$60.18,$0.00
80079147,EAP,HCPCS C1760,,Device Clsr 6fr Prgld Prcls Vasc Suture Mediate,$650.00,$0.00,$650.00,$292.50,$463.91,$0.00,$111.99,$463.91,$463.91,$113.81,$650.00,$0.00,$325.00,$514.80,$520.00,$0.00,$101.73,$0.00,$103.48,$0.00
80079222,EAP,HCPCS C1894,,Introducer Sheath Short 7fr 21ga 4cm Orange Hub Tubing,$43.00,$0.00,$43.00,$23.35,$30.69,$0.00,$7.41,$30.69,$30.69,$7.53,$43.00,$0.00,$21.50,$34.06,$34.40,$0.00,$6.73,$0.00,$6.85,$0.00
80079510,EAP,HCPCS C1769,,Guidewire Vasc 180cm .016in Str Tip Strbl,$744.00,$0.00,$744.00,$403.99,$530.99,$0.00,$128.19,$530.99,$530.99,$130.27,$744.00,$0.00,$372.00,$589.25,$595.20,$0.00,$116.44,$0.00,$118.44,$0.00
80079568,EAP,Custom 80079568,,Coil Embl 15cm 4mm Intlk Fbr Idc 18 Coil 2d Std,$943.00,$0.00,$943.00,$0.00,$673.02,$0.00,$0.00,$673.02,$673.02,$0.00,$943.00,$0.00,$471.50,$746.86,$754.40,$0.00,$0.00,$0.00,$0.00,$0.00
80079570,EAP,Custom 80079570,,Coil Embl 15cm 5mm Intlk Fbr Idc 18 Coil 2d Std,$943.00,$0.00,$943.00,$0.00,$673.02,$0.00,$0.00,$673.02,$673.02,$0.00,$943.00,$0.00,$471.50,$746.86,$754.40,$0.00,$0.00,$0.00,$0.00,$0.00
80097224,EAP,HCPCS C1725,,Catheter Angio 100cm 5fr Imprs Sim2 Curve Crbrl Ss,$30.00,$0.00,$30.00,$16.29,$21.41,$0.00,$5.17,$21.41,$21.41,$5.25,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$4.70,$0.00,$4.78,$0.00
80097225,EAP,HCPCS C1725,,Catheter Angio 100cm 5fr Crds Tmp Vert Curve Crbrl,$37.00,$0.00,$37.00,$20.09,$26.41,$0.00,$6.37,$26.41,$26.41,$6.48,$37.00,$0.00,$18.50,$29.30,$29.60,$0.00,$5.79,$0.00,$5.89,$0.00
80097341,EAP,Custom C1751,,Axium Coil Detacher,$135.00,$0.00,$135.00,$73.31,$96.35,$0.00,$23.26,$96.35,$96.35,$23.64,$135.00,$0.00,$67.50,$106.92,$108.00,$0.00,$21.13,$0.00,$21.49,$0.00
80097344,EAP,HCPCS C1769,,Guidewire Vascular Taper .018in 300cm 8cm Radiopq Str Tip,$197.00,$0.00,$197.00,$106.97,$140.60,$0.00,$33.94,$140.60,$140.60,$34.49,$197.00,$0.00,$98.50,$156.02,$157.60,$0.00,$30.83,$0.00,$31.36,$0.00
80097387,EAP,HCPCS C1876,,System Cor Stnt 2.25mm 12mm Intgr Microtrac Rx 1 Strn Intgr,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,"$1,248.98","$1,248.98",$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
80097412,EAP,HCPCS C1876,,System Cor Stnt 3mm 9mm Intgr Microtrac Rx 1 Strn Intgr Tip,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,"$1,248.98","$1,248.98",$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
80097421,EAP,HCPCS C1876,,System Cor Stnt 4mm 12mm Intgr Microtrac Rx 1 Strn Intgr Tip,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,"$1,248.98","$1,248.98",$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
80097435,EAP,HCPCS C1757,,System Thrmb 135cm 4fr 2mm Angjt Ult Cx-strm,"$4,488.00",$0.00,"$4,488.00",$0.00,"$3,203.09",$0.00,$0.00,"$3,203.09","$3,203.09",$0.00,"$4,488.00",$0.00,"$2,244.00","$3,554.50","$3,590.40",$0.00,$0.00,$0.00,$0.00,$0.00
80097440,EAP,Custom 80097440,,Pad Thrp Lg Arcticgel,"$4,960.00",$0.00,"$4,960.00",$0.00,"$3,539.95",$0.00,$0.00,"$3,539.95","$3,539.95",$0.00,"$4,960.00",$0.00,"$2,480.00","$3,928.32","$3,968.00",$0.00,$0.00,$0.00,$0.00,$0.00
80097469,EAP,HCPCS C1725,,Catheter Baldilat 2mm 12mm Coron Rapex Ult Lp,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80097470,EAP,HCPCS C1725,,Catheter Baldilat 2mm 15mm Coron Rapex Ult Lp,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80097471,EAP,HCPCS C1725,,Catheter Baldilat 2.5mm 12mm Coron Rapex Ult Lp,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80097472,EAP,HCPCS C1725,,Catheter Baldilat 2.5mm 15mm Coron Rapex Ult Lp,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80097473,EAP,HCPCS C1725,,Catheter Baldilat 3mm 12mm Coron Rapex Ult Lp,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80097474,EAP,HCPCS C1725,,Catheter Baldilat 3mm 15mm Coron Rapex Ult Lp,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80097475,EAP,HCPCS C1725,,Catheter Baldilat 3.5mm 12mm Coron Rapex Ult Lp,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80097476,EAP,HCPCS C1725,,Catheter Baldilat 3.5mm 15mm Coron Rapex Ult Lp,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80097477,EAP,Custom 80097477,,Catheter Baldilat 4mm 15mm Coron Rapex Ult Lp,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$178.43,$178.43,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
80100003,EAP,Custom 80100003,,Hemodialysis-acute-i/p,"$3,300.00",$0.00,"$2,388.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,388.00",$0.00,"$1,194.00","$1,891.30","$1,910.40",$0.00,$0.00,$0.00,$0.00,$0.00
80100234,EAP,HCPCS C1894,,Sheath Guid 70cm 6fr 2.2mm Flxr Chk-flo Str Tip Hi,$225.00,$0.00,$225.00,$122.18,$160.58,$0.00,$38.77,$160.58,$160.58,$39.40,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$35.21,$0.00,$35.82,$0.00
80100235,EAP,HCPCS C1894,,Sheath Guid 70cm 6fr 2.2mm Flxr Chk-flo Curve,$225.00,$0.00,$225.00,$122.18,$160.58,$0.00,$38.77,$160.58,$160.58,$39.40,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$35.21,$0.00,$35.82,$0.00
80100236,EAP,HCPCS C1894,,Introd Shth 8.8fr 7fr 110cm Gw Radiopq Band Hi Flx,$503.00,$0.00,$503.00,$273.13,$358.99,$0.00,$86.66,$358.99,$358.99,$88.07,$503.00,$0.00,$251.50,$398.38,$402.40,$0.00,$78.72,$0.00,$80.08,$0.00
80100237,EAP,HCPCS C1894,,Sheath Guid 70cm 7fr 2.5mm Flxr Introd / Flxr Guid,$225.00,$0.00,$225.00,$122.18,$160.58,$0.00,$38.77,$160.58,$160.58,$39.40,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$35.21,$0.00,$35.82,$0.00
80100239,EAP,HCPCS C1894,,Sheath Guid 70cm 8fr 2.9mm Flxr Chk-flo Curve,$225.00,$0.00,$225.00,$122.18,$160.58,$0.00,$38.77,$160.58,$160.58,$39.40,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$35.21,$0.00,$35.82,$0.00
80100242,EAP,HCPCS C1894,,Sheath Guid 45cm 6fr .087in Flxr Chk-flo Anl0,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
80100243,EAP,HCPCS C1894,,Sheath Guid 45cm 6fr 2.2mm Flxr Chk-flo Multpur,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
80100244,EAP,HCPCS C1894,,Sheath Guid 45cm 6fr 2.2in Flxr Chk-flo Anl2 Curve,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
80100245,EAP,HCPCS C1894,,Sheath Guid 45cm 7fr .1in Flxr Chk-flo Anl0 Curve,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
80100246,EAP,HCPCS C1894,,Sheath Guid 45cm 7fr 2.5mm Flxr Chk-flo Anl3 Curve,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
80100247,EAP,HCPCS C1894,,Sheath Guid .018/.038in Anl0 Curve 8fr .113in 45cm Radiopq,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
80100254,EAP,HCPCS C1769,,Guidewire Vasc 180cm .035in Flx Tp Fix Core Exch,$43.00,$0.00,$43.00,$23.35,$30.69,$0.00,$7.41,$30.69,$30.69,$7.53,$43.00,$0.00,$21.50,$34.06,$34.40,$0.00,$6.73,$0.00,$6.85,$0.00
80100273,EAP,HCPCS C1725,,Catheter Angio 100cm 5fr Trnb Ad Bcn Kmp Curve Ss,$63.00,$0.00,$63.00,$34.21,$44.96,$0.00,$10.85,$44.96,$44.96,$11.03,$63.00,$0.00,$31.50,$49.90,$50.40,$0.00,$9.86,$0.00,$10.03,$0.00
80100275,EAP,HCPCS C1725,,Catheter Angio 65cm 5fr Trnb Ad Bcn Kmp Curve Ss,$313.00,$0.00,$313.00,$169.96,$223.39,$0.00,$53.93,$223.39,$223.39,$54.80,$313.00,$0.00,$156.50,$247.90,$250.40,$0.00,$48.98,$0.00,$49.83,$0.00
80100322,EAP,HCPCS C1876,,Stent Bil 5mm 19mm 150cm Prmnt Bln Xpd Cath,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,"$1,070.55","$1,070.55",$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
80100329,EAP,HCPCS C1876,,Stent Bil 6mm 17mm 135cm 20mm Otw Radiopq Nc Bln,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,"$1,070.55","$1,070.55",$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
80100330,EAP,HCPCS C1876,,Stent Bil 6mm 37mm 135cm 40mm Radiopq Otw Nc Bln,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,"$1,070.55","$1,070.55",$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
80100331,EAP,HCPCS C1876,,Stent Bil 7mm 17mm 135cm 20mm Otw Radiopq Nc Bln,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,"$1,070.55","$1,070.55",$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
80100332,EAP,HCPCS C1876,,Stent Bil 7mm 37mm 135cm 40mm Otw Radiopq Nc Bln,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,"$1,070.55","$1,070.55",$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
80100333,EAP,HCPCS C1876,,Stent Bil 8mm 17mm 135cm 20mm Otw Radiopq Nc Bln,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,"$1,070.55","$1,070.55",$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
80100334,EAP,HCPCS C1876,,Stent Bil 8mm 37mm 135cm 40mm Otw Prmnt Bln Xpd,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,"$1,070.55","$1,070.55",$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
80100335,EAP,HCPCS C1876,,Stent Bil 9mm 25mm 135cm 30mm Otw Radiopq Nc Bln,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,"$1,070.55","$1,070.55",$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
80100336,EAP,HCPCS C1876,,Stent Bil 9mm 57mm 135cm 60mm Otw Radiopq Nc Bln,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,"$1,070.55","$1,070.55",$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
80100337,EAP,HCPCS C1725,,Catheter Baldilat 4mm 135cm 20mm Otw Inflat Port,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80100340,EAP,HCPCS C1725,,Catheter Baldilat 5mm 135cm 40mm Peri Otw Tpr Tip,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80100343,EAP,HCPCS C1725,,Catheter Baldilat 6mm 135cm 80mm Peri Otw Tpr Tip,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80100350,EAP,HCPCS C1725,,Catheter Baldilat 2mm 144cm 40mm Otw Ult Lp Nybax,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80100353,EAP,HCPCS C1725,,Catheter Baldilat 4mm 143cm 20mm Otw Ult Lp Nybax,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80100355,EAP,HCPCS C1725,,Catheter Baldilat 2mm 150cm 100mm Otw Inflat Port,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80100356,EAP,HCPCS C1725,,Catheter Baldilat 2mm 150cm 120mm Otw Inflat Port,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80100357,EAP,HCPCS C1725,,Catheter Baldilat 2mm 150cm 150mm Otw Inflat Port,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80100358,EAP,HCPCS C1725,,Catheter Baldilat 2mm 150cm 80mm Peri Otw Tpr Tip,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80100359,EAP,HCPCS C1725,,Catheter Baldilat 3mm 150cm 100mm Otw Inflat Port,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80100361,EAP,HCPCS C1725,,Catheter Baldilat 3mm 150cm 150mm Otw Inflat Port,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80100362,EAP,HCPCS C1725,,Catheter Baldilat 3mm 150cm 80mm Peri Otw Tpr Tip,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80100363,EAP,HCPCS C1725,,Catheter Baldilat 4mm 150cm 150mm Otw Infl Port Lp,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80100364,EAP,HCPCS C1725,,Catheter Baldilat 4mm 150cm 80mm Otw Inflat Port,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80100366,EAP,HCPCS C1725,,Catheter Baldilat 4mm 135cm 200mm Hi-prs Nybax,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80100371,EAP,HCPCS C1725,,Catheter Baldilat 5mm 135cm 200mm Hi-prs Nybax,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80100374,EAP,HCPCS C1725,,Catheter Baldilat 6mm 135cm 200mm Hi-prs Nybax,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80100377,EAP,HCPCS C1725,,Catheter Baldilat 8mm 75cm 100mm Hi-prs Nybax,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80100381,EAP,HCPCS C1726,,Catheter Baldilat 2mm 150cm 150mm Otw Ult Lp Nybax,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80100382,EAP,HCPCS C1726,,Catheter Baldilat 2mm 150cm 220mm Otw Ult Lp Nybax,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80100383,EAP,HCPCS C1726,,Catheter Baldilat 3mm 150cm 100mm Otw Ult Lp Nybax,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80100385,EAP,HCPCS C1725,,Catheter Baldilat 3mm 150cm 220mm Otw Ult Lp Nybax,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80100386,EAP,HCPCS C1726,,Catheter Baldilat 4mm 150cm 100mm Otw Ult Lp Nybax,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80100392,EAP,HCPCS C1876,,Stent Bil 10mm 37mm 75cm 40mm Otw Radiopq Nc Bln,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,"$1,070.55","$1,070.55",$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
80100413,EAP,HCPCS C1725,,Catheter Baldilat 4mm 135cm 40mm Peri Otw Tpr Tip,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80100416,EAP,HCPCS C1725,,Catheter Baldilat 6mm 20mm 135cm Otw Tpr Tip Lp,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80100418,EAP,HCPCS C1725,,Catheter Baldilat 6mm 135cm 40mm Peri Otw Tpr Tip,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80100420,EAP,HCPCS C1725,,Catheter Baldilat 6mm 135cm 60mm Otw Inflat Port,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80100425,EAP,HCPCS C1725,,Catheter Baldilat 7mm 135cm 60mm Otw Inflat Port,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80100428,EAP,HCPCS C1725,,Catheter Baldilat 8mm 135cm 20mm Peri Otw Tpr Tip,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80100430,EAP,HCPCS C1725,,Catheter Baldilat 8mm 135cm 40mm Peri Otw Tpr Tip,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80100432,EAP,HCPCS C1725,,Catheter Baldilat 8mm 135cm 40mm Otw Inflat Port,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80100433,EAP,HCPCS C1725,,Catheter Baldilat 4mm 75cm 20mm Hi-prs Nybax,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80100434,EAP,HCPCS C1725,,Catheter Baldilat 4mm 135cm 40mm Hi-prs Nybax,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80100435,EAP,HCPCS C1726,,Catheter Baldilat 4mm 75cm 40mm Hi-prs Nybax,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80100436,EAP,HCPCS C1725,,Catheter Baldilat 4mm 135cm 120mm Hi-prs Nybax,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80100437,EAP,HCPCS C1725,,Catheter Baldilat 5mm 75cm 20mm Hi-prs Nybax,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80100438,EAP,HCPCS C1725,,Catheter Baldilat 5mm 135cm 40mm Hi-prs Nybax,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80100439,EAP,HCPCS C1725,,Catheter Baldilat 5mm 75cm 40mm Hi-prs Nybax,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80100440,EAP,HCPCS C1725,,Catheter Baldilat 5mm 135cm 100mm Hi-prs Nybax,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80100441,EAP,HCPCS C1725,,Catheter Baldilat 5mm 135cm 150mm Hi-prs Nybax,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80100443,EAP,HCPCS C1725,,Catheter Baldilat 6mm 75cm 20mm Hi-prs Nybax,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80100444,EAP,HCPCS C1725,,Catheter Baldilat 6mm 135cm 40mm Hi-prs Nybax,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80100445,EAP,HCPCS C1725,,Catheter Baldilat 6mm 75cm 40mm Hi-prs Nybax,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80100446,EAP,HCPCS C1725,,Catheter Baldilat 6mm 135cm 100mm Hi-prs Nybax,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80100447,EAP,HCPCS C1725,,Catheter Baldilat 6mm 135cm 150mm Hi-prs Nybax,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80100448,EAP,HCPCS C1725,,Catheter Baldilat 7mm 75cm 20mm Hi-prs Nybax,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80100449,EAP,HCPCS C1725,,Catheter Baldilat 7mm 135cm 40mm Hi-prs Nybax,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80100450,EAP,HCPCS C1725,,Catheter Baldilat 7mm 75cm 40mm Hi-prs Nybax,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80100451,EAP,HCPCS C1725,,Catheter Baldilat 8mm 75cm 20mm Hi-prs Nybax,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80100453,EAP,HCPCS C1725,,Catheter Baldilat 8mm 75cm 40mm Hi-prs Nybax,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80100454,EAP,HCPCS C1725,,Catheter Baldilat 8mm 75cm 80mm Hi-prs Nybax,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80100456,EAP,HCPCS C1725,,Catheter Baldilat 10mm 75cm 20mm Hi-prs Nybax,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80100470,EAP,HCPCS C1757,,SET THROMBECTOMY 6FR 3MM 120CM 15MM OTW CONTRAST INJEC PORT,"$4,225.00",$0.00,"$4,225.00",$0.00,"$3,015.38",$0.00,$0.00,"$3,015.38","$3,015.38",$0.00,"$4,225.00",$0.00,"$2,112.50","$3,346.20","$3,380.00",$0.00,$0.00,$0.00,$0.00,$0.00
80100527,EAP,HCPCS C1768,,Graft Vascular Gore Heparin Propaten Ptfe Standard Wall,"$3,148.00",$0.00,"$3,148.00","$1,416.60","$2,246.73",$0.00,$542.38,"$2,246.73","$2,246.73",$551.19,"$3,148.00",$0.00,"$1,574.00","$2,493.22","$2,518.40",$0.00,$492.66,$0.00,$501.16,$0.00
80100552,EAP,HCPCS C1894,,Set Introd 30cm 14fr 4.6mm Chk-flo 41cm Acpt .038,$318.00,$0.00,$318.00,$172.67,$226.96,$0.00,$54.79,$226.96,$226.96,$55.68,$318.00,$0.00,$159.00,$251.86,$254.40,$0.00,$49.77,$0.00,$50.63,$0.00
80100555,EAP,HCPCS C1726,,CATHETER BLNDIL 5MM 135CM 20MM PR CTBLN OTW TPR TIP INFL,"$1,750.00",$0.00,"$1,750.00",$950.25,"$1,248.98",$0.00,$301.52,"$1,248.98","$1,248.98",$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
80100582,EAP,HCPCS C1769,,GUIDEWIRE VASCULAR ANGLED .035IN 260CM 25CM GLIDEW,$450.00,$0.00,$450.00,$244.35,$321.17,$0.00,$77.53,$321.17,$321.17,$78.79,$450.00,$0.00,$225.00,$356.40,$360.00,$0.00,$70.43,$0.00,$71.64,$0.00
80100584,EAP,HCPCS C1887,,Catheter Angiographic Angle 4fr .041in 100cm 15cm 2 Braid,$121.00,$0.00,$121.00,$65.70,$86.36,$0.00,$20.85,$86.36,$86.36,$21.19,$121.00,$0.00,$60.50,$95.83,$96.80,$0.00,$18.94,$0.00,$19.26,$0.00
80100610,EAP,HCPCS C1726,,Catheter Baldilat 2.5mm 150cm 120mm Otw Ult Lp,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80100611,EAP,HCPCS C1726,,Catheter Baldilat 2.5mm 150cm 220mm Otw Ult Lp,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80100614,EAP,HCPCS C1725,,Catheter Baldilat 4mm 150cm 220mm Otw Ult Lp Nybax,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80200001,EAP,Custom 80200001,,Peritoneal Dialysis-inpat,"$1,724.00",$0.00,$917.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$917.00,$0.00,$458.50,$726.26,$733.60,$0.00,$0.00,$0.00,$0.00,$0.00
80200005,EAP,HCPCS C1751,,Catheter Cen Ven .032in 9.3fr 38cm 75cm 3 Infus Lumen Extn,"$1,955.00",$0.00,"$1,955.00","$1,061.57","$1,395.28",$0.00,$336.84,"$1,395.28","$1,395.28",$342.30,"$1,955.00",$0.00,$977.50,"$1,548.36","$1,564.00",$0.00,$305.96,$0.00,$311.24,$0.00
80200008,EAP,HCPCS C1769,,Guidewire Vasc 180cm .014in Atrm X Flpy Tip,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$142.74,$142.74,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
80200010,EAP,HCPCS C1725,,Catheter Angio 100cm 5fr Optitorque Jacky Radl 3.5,$88.00,$0.00,$88.00,$47.78,$62.81,$0.00,$15.16,$62.81,$62.81,$15.41,$88.00,$0.00,$44.00,$69.70,$70.40,$0.00,$13.77,$0.00,$14.01,$0.00
80200013,EAP,HCPCS C1894,,Set Acces 10cm 5fr 21ga Mpnch Slht .018in Ss,$100.00,$0.00,$100.00,$54.30,$71.37,$0.00,$17.23,$71.37,$71.37,$17.51,$100.00,$0.00,$50.00,$79.20,$80.00,$0.00,$15.65,$0.00,$15.92,$0.00
80200098,EAP,HCPCS C1769,,Guidewire Vasc 260cm .018in Flpy Tip Radiopq Shrt,$203.00,$0.00,$203.00,$110.23,$144.88,$0.00,$34.98,$144.88,$144.88,$35.54,$203.00,$0.00,$101.50,$160.78,$162.40,$0.00,$31.77,$0.00,$32.32,$0.00
80200103,EAP,HCPCS C1887,,Catheter Intvn 6fr 5.1fr .056in 150cm 25cm Rapex,"$1,183.00",$0.00,"$1,183.00",$642.37,$844.31,$0.00,$203.82,$844.31,$844.31,$207.13,"$1,183.00",$0.00,$591.50,$936.94,$946.40,$0.00,$185.14,$0.00,$188.33,$0.00
80200104,EAP,HCPCS C1725,,Catheter Guid 100cm 7fr Lnchr Ebu3.75 Curve Coron,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
80200105,EAP,HCPCS C1725,,Catheter Angio 100cm 5fr Optitorque Radl Tig 4.5,$88.00,$0.00,$88.00,$47.78,$62.81,$0.00,$15.16,$62.81,$62.81,$15.41,$88.00,$0.00,$44.00,$69.70,$70.40,$0.00,$13.77,$0.00,$14.01,$0.00
80200129,EAP,HCPCS C1725,,Catheter Baldilat 9mm 75cm 60mm Hi-prs Nybax,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80200207,EAP,HCPCS C1725,,Catheter Baldilat 8mm 135cm 100mm Hi-prs Nybax,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80200262,EAP,HCPCS C1753,,Catheter Us .018in 3.4fr 135cm Intvasc Exch Vsn Pv,"$1,688.00",$0.00,"$1,688.00",$916.58,"$1,204.73",$0.00,$290.83,"$1,204.73","$1,204.73",$295.56,"$1,688.00",$0.00,$844.00,"$1,336.90","$1,350.40",$0.00,$264.17,$0.00,$268.73,$0.00
80202089,EAP,Custom 80202089,,SET TUBING 2.6MR 2 WAY COMMUNICATION IRRIGATION PUMP,$125.00,$0.00,$125.00,$0.00,$89.21,$0.00,$0.00,$89.21,$89.21,$0.00,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$0.00,$0.00,$0.00,$0.00
80202090,EAP,HCPCS C1733,,Catheter Ep 110cm 7fr Safire Tx 2-5-2mm Spc 1mm,"$2,125.00",$0.00,"$2,125.00","$1,153.88","$1,516.61",$0.00,$366.13,"$1,516.61","$1,516.61",$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
80202091,EAP,HCPCS C1733,,Safire Tx Catheter 8mm Large Curl,"$1,500.00",$0.00,"$1,500.00",$814.50,"$1,070.55",$0.00,$258.44,"$1,070.55","$1,070.55",$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
80202094,EAP,HCPCS C1733,,Catheter Ep 115cm 7fr Safire Comfortgrip 2-5-2mm,"$1,625.00",$0.00,"$1,625.00",$882.38,"$1,159.76",$0.00,$279.98,"$1,159.76","$1,159.76",$284.52,"$1,625.00",$0.00,$812.50,"$1,287.00","$1,300.00",$0.00,$254.31,$0.00,$258.70,$0.00
80202112,EAP,HCPCS C1893,,Introd Shth 8.5fr 180cm 63cm Hmsts Vlv Sdprt Dilat,$363.00,$0.00,$363.00,$197.11,$259.07,$0.00,$62.54,$259.07,$259.07,$63.56,$363.00,$0.00,$181.50,$287.50,$290.40,$0.00,$56.81,$0.00,$57.79,$0.00
80202116,EAP,HCPCS C1894,,Introd Shth 8fr 50cm 12cm 2 Distal Gwire Hmsts Vlv,$28.00,$0.00,$28.00,$15.20,$19.98,$0.00,$4.82,$19.98,$19.98,$4.90,$28.00,$0.00,$14.00,$22.18,$22.40,$0.00,$4.38,$0.00,$4.46,$0.00
80202118,EAP,HCPCS C1894,,Introd Shth 6fr 50cm 12cm 2 Distal Gwire Hmsts Vlv,$28.00,$0.00,$28.00,$15.20,$19.98,$0.00,$4.82,$19.98,$19.98,$4.90,$28.00,$0.00,$14.00,$22.18,$22.40,$0.00,$4.38,$0.00,$4.46,$0.00
80202121,EAP,HCPCS C1893,,Introd Shth 8fr 60cm Fstcth Strl Latex Free Disp,$313.00,$0.00,$313.00,$169.96,$223.39,$0.00,$53.93,$223.39,$223.39,$54.80,$313.00,$0.00,$156.50,$247.90,$250.40,$0.00,$48.98,$0.00,$49.83,$0.00
80202130,EAP,HCPCS C1766,,Introd Cath 40cm 8.5fr 17ga Epicardium Rspn Agilis,"$2,638.00",$0.00,"$2,638.00","$1,432.43","$1,882.74",$0.00,$454.51,"$1,882.74","$1,882.74",$461.89,"$2,638.00",$0.00,"$1,319.00","$2,089.30","$2,110.40",$0.00,$412.85,$0.00,$419.97,$0.00
80202131,EAP,HCPCS C1730,,Catheter Ep 120cm 5fr Rspn 5mm Spc Crnnd Curve,$213.00,$0.00,$213.00,$115.66,$152.02,$0.00,$36.70,$152.02,$152.02,$37.29,$213.00,$0.00,$106.50,$168.70,$170.40,$0.00,$33.33,$0.00,$33.91,$0.00
80202133,EAP,HCPCS C1730,,Catheter Ep 120cm 5fr Rspn 5mm Spc Jsphsn Curve,$213.00,$0.00,$213.00,$115.66,$152.02,$0.00,$36.70,$152.02,$152.02,$37.29,$213.00,$0.00,$106.50,$168.70,$170.40,$0.00,$33.33,$0.00,$33.91,$0.00
80202150,EAP,HCPCS C1731,,Catheter Ep 95cm 7fr Lvwr 2-10-2mm Spc Sup Lg Curl,"$1,938.00",$0.00,"$1,938.00","$1,052.33","$1,383.15",$0.00,$333.91,"$1,383.15","$1,383.15",$339.33,"$1,938.00",$0.00,$969.00,"$1,534.90","$1,550.40",$0.00,$303.30,$0.00,$308.53,$0.00
80202158,EAP,,,Kit Eltrd Ns Lf Ensite Navx Srfc Disp,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,"$1,605.83","$1,605.83",$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
80202163,EAP,HCPCS C1898,,Lead Packing Tendril Sts Steroid Silicone Helix L46cm Od6fr,"$1,125.00",$0.00,"$1,125.00",$506.25,$802.91,$0.00,$193.83,$802.91,$802.91,$196.98,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$176.06,$0.00,$179.10,$0.00
80202164,EAP,HCPCS C1898,,Lead Pacing Tendril Sts Optim Steroid L52 Cm Od6 Fr Endocard Is-1 Bipolar Con,"$1,125.00",$0.00,"$1,125.00",$506.25,$802.91,$0.00,$193.83,$802.91,$802.91,$196.98,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$176.06,$0.00,$179.10,$0.00
80202165,EAP,HCPCS C1898,,Lead Pacing Tendril Sts Steroid Silicone Helix L58 Od6 Fr Endocard,"$1,125.00",$0.00,"$1,125.00",$506.25,$802.91,$0.00,$193.83,$802.91,$802.91,$196.98,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$176.06,$0.00,$179.10,$0.00
80202189,EAP,HCPCS C1751,,Kit Cath .032in 8.5fr 18ga 16cm Lf 2.5in Blu Flxtp Arwg+ard,$349.00,$0.00,$349.00,$189.51,$249.08,$0.00,$60.13,$249.08,$249.08,$61.11,$349.00,$0.00,$174.50,$276.41,$279.20,$0.00,$54.62,$0.00,$55.56,$0.00
80202203,EAP,HCPCS C1729,,Tray Catheterization 16fr 2 Conctr Temperature Sense,$69.00,$0.00,$69.00,$37.47,$49.25,$0.00,$11.89,$49.25,$49.25,$12.08,$69.00,$0.00,$34.50,$54.65,$55.20,$0.00,$10.80,$0.00,$10.98,$0.00
80202219,EAP,HCPCS C1726,,Catheter Blndil 11 Atm 8mm 180cm 4cm Hrcn Rx Loprfl Radopq,$603.00,$0.00,$603.00,$327.43,$430.36,$0.00,$103.89,$430.36,$430.36,$105.58,$603.00,$0.00,$301.50,$477.58,$482.40,$0.00,$94.37,$0.00,$96.00,$0.00
80202586,EAP,,,Coil Embolization .02in Complex 14mm 40cm Soft The Penumbra,"$6,188.00",$0.00,"$6,188.00",$0.00,"$4,416.38",$0.00,$0.00,"$4,416.38","$4,416.38",$0.00,"$6,188.00",$0.00,"$3,094.00","$4,900.90","$4,950.40",$0.00,$0.00,$0.00,$0.00,$0.00
80202609,EAP,,,Coil Embl .02in Cmplx 5mm 9cm The Penumbra Coil 400 Sft,"$5,490.00",$0.00,"$5,490.00",$0.00,"$3,918.21",$0.00,$0.00,"$3,918.21","$3,918.21",$0.00,"$5,490.00",$0.00,"$2,745.00","$4,348.08","$4,392.00",$0.00,$0.00,$0.00,$0.00,$0.00
80202611,EAP,,,Coil Embolization .02in Standard Complex 10mm 30cm Complex,"$5,513.00",$0.00,"$5,513.00",$0.00,"$3,934.63",$0.00,$0.00,"$3,934.63","$3,934.63",$0.00,"$5,513.00",$0.00,"$2,756.50","$4,366.30","$4,410.40",$0.00,$0.00,$0.00,$0.00,$0.00
80202615,EAP,,,Coil Embolization .02in Standard Complex 12mm 35cm Complex,"$5,570.00",$0.00,"$5,570.00",$0.00,"$3,975.31",$0.00,$0.00,"$3,975.31","$3,975.31",$0.00,"$5,570.00",$0.00,"$2,785.00","$4,411.44","$4,456.00",$0.00,$0.00,$0.00,$0.00,$0.00
80202624,EAP,,,Coil Embl .02in Cmplx 7mm 15cm The Penumbra Coil 400 Sft,"$5,625.00",$0.00,"$5,625.00",$0.00,"$4,014.56",$0.00,$0.00,"$4,014.56","$4,014.56",$0.00,"$5,625.00",$0.00,"$2,812.50","$4,455.00","$4,500.00",$0.00,$0.00,$0.00,$0.00,$0.00
80202641,EAP,,,Coil Embolization .02in Complex 10mm 30cm Soft The Penumbra,"$5,963.00",$0.00,"$5,963.00",$0.00,"$4,255.79",$0.00,$0.00,"$4,255.79","$4,255.79",$0.00,"$5,963.00",$0.00,"$2,981.50","$4,722.70","$4,770.40",$0.00,$0.00,$0.00,$0.00,$0.00
80202926,EAP,HCPCS C1887,,Set Interventional .038in 10fr 40cm 62.5cm Catheter Cannu,"$1,131.00",$0.00,"$1,131.00",$614.13,$807.19,$0.00,$194.87,$807.19,$807.19,$198.03,"$1,131.00",$0.00,$565.50,$895.75,$904.80,$0.00,$177.00,$0.00,$180.06,$0.00
80202933,EAP,HCPCS C1894,,Introd Cath 80cm 10fr 3.4mm Chk-flo Flxr Lg Vlv,$265.00,$0.00,$265.00,$143.90,$189.13,$0.00,$45.66,$189.13,$189.13,$46.40,$265.00,$0.00,$132.50,$209.88,$212.00,$0.00,$41.47,$0.00,$42.19,$0.00
80202945,EAP,HCPCS C1894,,Sheath Guid 45cm 7fr 2.5mm Flxr Chk-flo Anl2 Curve,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
80202946,EAP,HCPCS C1894,,Sheath Guid 90cm 6fr 2.2mm Flxr Chk-flo Anl1 Curve,$378.00,$0.00,$378.00,$205.25,$269.78,$0.00,$65.13,$269.78,$269.78,$66.18,$378.00,$0.00,$189.00,$299.38,$302.40,$0.00,$59.16,$0.00,$60.18,$0.00
80202963,EAP,HCPCS C1894,,Sheath Guid 45cm 8fr 2.9mm Flxr Chk-flo Anl1 Curve,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
80203000,EAP,HCPCS C1751,,Kit Catheter 8.5fr 16cm 3 Lumen Expand Chloraprep Safety,$825.00,$0.00,$825.00,$447.98,$588.80,$0.00,$142.14,$588.80,$588.80,$144.45,$825.00,$0.00,$412.50,$653.40,$660.00,$0.00,$129.11,$0.00,$131.34,$0.00
80206800,EAP,,,Kit Ndl Gd 21ga 96in Strt Us,$54.00,$0.00,$54.00,$0.00,$38.54,$0.00,$0.00,$38.54,$38.54,$0.00,$54.00,$0.00,$27.00,$42.77,$43.20,$0.00,$0.00,$0.00,$0.00,$0.00
80206851,EAP,Custom 27220128,,Dressing Gel 144x10in Effective Protection Knit Roll,$118.00,$0.00,$118.00,$0.00,$84.22,$0.00,$0.00,$84.22,$84.22,$0.00,$118.00,$0.00,$59.00,$93.46,$94.40,$0.00,$0.00,$0.00,$0.00,$0.00
80206898,EAP,HCPCS C1725,,Catheter Baldilat 5mm 135cm 120mm Hi-prs Nybax,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80206901,EAP,HCPCS C1725,,Catheter Baldilat 6mm 135cm 120mm Hi-prs Nybax,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80206904,EAP,HCPCS C1725,,Catheter Baldilat 7mm 135cm 120mm Hi-prs Nybax,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80206906,EAP,HCPCS C1725,,Catheter Baldilat 8mm 135cm 120mm Hi-prs Nybax,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80206908,EAP,HCPCS C1725,,Catheter Baldilat 3mm 135cm 150mm Hi-prs Nybax,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80206910,EAP,HCPCS C1725,,Catheter Baldilat 4mm 135cm 150mm Hi-prs Nybax,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80206916,EAP,HCPCS C1725,,Catheter Baldilat 8mm 135cm 150mm Hi-prs Nybax,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80206930,EAP,HCPCS C1725,,Catheter Baldilat 3mm 135cm 200mm Hi-prs Nybax,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80206935,EAP,HCPCS C1725,,Catheter Baldilat 7mm 135cm 200mm Hi-prs Nybax,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80206937,EAP,HCPCS C1725,,Catheter Baldilat 8mm 135cm 200mm Hi-prs Nybax,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80206941,EAP,HCPCS C1726,,Catheter Baldilat 3mm 75cm 20mm Hi-prs Nybax,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80206949,EAP,HCPCS C1725,,Catheter Baldilat 9mm 135cm 20mm Hi-prs Nybax,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80206952,EAP,HCPCS C1725,,CAT BALD LP 5.8FR 10MM 135CM 20MM HIGH PRE,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80206954,EAP,HCPCS C1725,,CAT BALD LP 5.8FR 12MM 135CM 20MM HIGH PRES,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80206956,EAP,HCPCS C1725,,Catheter Baldilat 12mm 75cm 20mm Hi-prs Nybax,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80206984,EAP,HCPCS C1725,,Catheter Baldilat 3mm 135cm 40mm Hi-prs Nybax,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80206986,EAP,HCPCS C1725,,Catheter Baldilat 3mm 75cm 40mm Hi-prs Nybax,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80206988,EAP,HCPCS C1725,,Catheter Baldilat 9mm 135cm 40mm Hi-prs Nybax,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80206990,EAP,HCPCS C1725,,Catheter Baldilat 10mm 135cm 40mm Hi-prs Nybax,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80206992,EAP,HCPCS C1725,,Catheter Baldilat 12mm 135cm 40mm Hi-prs Nybax,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80206997,EAP,HCPCS C1753,,CATHETER BALDILAT LP 5.3FR 4MM 135CM 60MM HIGH PRESSURE,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80206999,EAP,HCPCS C1725,,CATHETER BALDILAT LP 5.3FR 4MM 75CM 60MM HIGH PRESSURE,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80207000,EAP,HCPCS C1725,,Catheter Baldilat 5mm 135cm 60mm Hi-prs Nybax,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80207002,EAP,HCPCS C1725,,Catheter Baldilat 5mm 75cm 60mm Hi-prs Nybax,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80207003,EAP,HCPCS C1725,,CAT BALD LP 5.3FR 6MM 135CM 60MM HIGH PRES,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80207005,EAP,HCPCS C1725,,CAT BALD .035IN 6MM 75CM 60MM HIGH PRES LP,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80207009,EAP,HCPCS C1725,,Catheter Baldilat 8mm 135cm 60mm Hi-prs Nybax,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80207011,EAP,HCPCS C1725,,CAT BALD .035IN 8MM 75CM 60MM HIGH PRE LP,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80207012,EAP,HCPCS C1725,,CAT BALD LP 5.8FR 9MM 135CM 60MM HIGH PRES,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80207014,EAP,HCPCS C1725,,Catheter Baldilat 10mm 135cm 60mm Hi-prs Nybax,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80207016,EAP,HCPCS C1725,,"MUSTANG 7FR 12.0MM X 60MM, 135CM",$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80207018,EAP,HCPCS C1725,,CAT BALD LP 5.8FR 12MM 75CM 60MM HIGH PRES,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80207019,EAP,HCPCS C1725,,Catheter Baldilat 3mm 135cm 80mm Hi-prs Nybax,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80207021,EAP,HCPCS C1725,,Catheter Baldilat 3mm 75cm 80mm Hi-prs Nybax,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80207022,EAP,HCPCS C1725,,Catheter Baldilat 4mm 135cm 80mm Hi-prs Nybax,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80207024,EAP,HCPCS C1725,,Catheter Baldilat 4mm 75cm 80mm Hi-prs Nybax,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80207025,EAP,HCPCS C1725,,Catheter Balloon Dilatation Mustang Nybax L135cm L80mm Od5.3fr,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80207027,EAP,HCPCS C1725,,Catheter Baldilat 5mm 75cm 80mm Hi-prs Nybax,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80207028,EAP,HCPCS C1725,,Catheter Baldilat 6mm 135cm 80mm Hi-prs Nybax,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80207030,EAP,HCPCS C1725,,Catheter Baldilat 6mm 75cm 80mm Hi-prs Nybax,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80207031,EAP,HCPCS C1725,,Catheter Baldilat 7mm 135cm 80mm Hi-prs Nybax,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80207033,EAP,HCPCS C1725,,Catheter Baldilat 7mm 75cm 80mm Hi-prs Nybax,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80207039,EAP,HCPCS C1725,,Catheter Baldilat 10mm 135cm 80mm Hi-prs Nybax,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80207041,EAP,HCPCS C1725,,Catheter Baldilat 10mm 75cm 80mm Hi-prs Nybax,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80207044,EAP,HCPCS C1725,,Catheter Baldilat 12mm 75cm 80mm Hi-prs Nybax,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80207045,EAP,HCPCS C1725,,Catheter Baldilat 3mm 135cm 100mm Hi-prs Nybax,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80207048,EAP,HCPCS C1725,,Catheter Baldilat 4mm 135cm 100mm Hi-prs Nybax,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80207050,EAP,HCPCS C1725,,Catheter Blndil 4mm 75cm 100mm Mustang,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80207054,EAP,HCPCS C1725,,CAT BALD LP 5.3FR 7MM 135CM 100MM HIGH PRES,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80207066,EAP,HCPCS C1725,,Catheter Baldilat 4mm 30mm 135cm Otw Tpr Tip Lp,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80207067,EAP,Custom 80207067,,STERLING OTW 4MM X 60MM X 135CM,$425.00,$0.00,$425.00,$0.00,$303.32,$0.00,$0.00,$303.32,$303.32,$0.00,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$0.00,$0.00,$0.00,$0.00
80207074,EAP,HCPCS C1725,,Catheter Baldilat 5mm 135cm 30mm Peri Otw Tpr Tip,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80207075,EAP,HCPCS C1725,,Catheter Baldilat 5mm 135cm 60mm Otw Inflat Port,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80207077,EAP,HCPCS C1725,,STERLING OTW 5MM X 100MM X 135CM,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80207083,EAP,HCPCS C1725,,Catheter Baldilat 6mm 135cm 30mm Peri Otw Tpr Tip,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80207084,EAP,HCPCS C1725,,STERLING OTW 6MM X 100MM X 135CM,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80207089,EAP,HCPCS C1725,,Catheter Baldilat 7mm 135cm 30mm Peri Otw Tpr Tip,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80207090,EAP,HCPCS C1725,,Catheter Baldilat 7mm 135cm 80mm Otw Inflat Port,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80207091,EAP,HCPCS C1725,,Catheter Baldilat 7mm 135cm 100mm Peri Otw Tpr Tip,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80207096,EAP,HCPCS C1725,,Catheter Baldilat 8mm 135cm 30mm Peri Otw Tpr Tip,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80207101,EAP,HCPCS C1725,,Catheter Baldilat 9mm 135cm 20mm Peri Otw Tpr Tip,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80207102,EAP,HCPCS C1725,,Catheter Baldilat 9mm 135cm 30mm Peri Otw Tpr Tip,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80207103,EAP,HCPCS C1725,,Catheter Baldilat 9mm 135cm 60mm Peri Otw Tpr Tip,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80207104,EAP,HCPCS C1725,,Catheter Baldilat 9mm 135cm 80mm Peri Otw Tpr Tip,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80207111,EAP,HCPCS C1725,,Catheter Baldilat 10mm 135cm 30mm Peri Otw Tpr Tip,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80207113,EAP,HCPCS C1725,,Catheter Baldilat 10mm 135cm 60mm Peri Otw Tpr Tip,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80207114,EAP,HCPCS C1725,,Catheter Baldilat 10mm 135cm 80mm Peri Otw Tpr Tip,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80207119,EAP,HCPCS C1725,,Catheter Baldilat 2.5mm 150cm 80mm Otw Inflat Port,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80207125,EAP,HCPCS C1725,,Catheter Baldilat 3.5mm 150cm 80mm Otw Infl Port,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80207145,EAP,HCPCS C1725,,CAT BALD 14 ATM ULT LP 6FR 2.5MM 143CM 20MM,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80207168,EAP,HCPCS C1753,,Catheter Baldilat 2mm 150cm 60mm Otw Ult Lp Nybax,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80207169,EAP,HCPCS C1753,,Catheter Baldilat 2.5mm 150cm 60mm Otw Ult Lp,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80207170,EAP,HCPCS C1753,,Catheter Baldilat 3mm 150cm 60mm Otw Ult Lp Nybax,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80207171,EAP,HCPCS C1753,,Catheter Baldilat 3.5mm 150cm 60mm Otw Ult Lp,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80207172,EAP,HCPCS C1753,,Catheter Baldilat 4mm 150cm 60mm Otw Ult Lp Nybax,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80207173,EAP,HCPCS C1753,,Catheter Baldilat 2mm 150cm 80mm Otw Ult Lp Nybax,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80207174,EAP,HCPCS C1753,,Catheter Baldilat 2.5mm 150cm 80mm Otw Ult Lp,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80207177,EAP,HCPCS C1753,,Catheter Baldilat 4mm 150cm 80mm Otw Ult Lp Nybax,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80207178,EAP,HCPCS C1725,,CAT BALD ULT LP TAP 6FR 2.5MM 150CM 100MM OTW,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80207190,EAP,HCPCS C1753,,Catheter Baldilat 3.5mm 150cm 120mm Otw Ult Lp,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80207191,EAP,HCPCS C1753,,Catheter Baldilat 2.5mm 150cm 150mm Otw Ult Lp,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80207192,EAP,HCPCS C1725,,Catheter Baldilat 3.5mm 150cm 150mm Otw Ult Lp,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80207193,EAP,HCPCS C1753,,Catheter Baldilat 4mm 150cm 150mm Otw Ult Lp Nybax,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80207199,EAP,HCPCS C1725,,COYOTE 3.5MM X 220MM X 150CM,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80207206,EAP,HCPCS C1725,,Catheter Baldilat 14mm 75cm 60mm Peri Lv Scrch Rst,$513.00,$0.00,$513.00,$278.56,$366.13,$0.00,$88.39,$366.13,$366.13,$89.82,$513.00,$0.00,$256.50,$406.30,$410.40,$0.00,$80.28,$0.00,$81.67,$0.00
80207210,EAP,HCPCS C1725,,Catheter Baldilat 16mm 75cm 60mm Peri Lv Scrch Rst,$513.00,$0.00,$513.00,$278.56,$366.13,$0.00,$88.39,$366.13,$366.13,$89.82,$513.00,$0.00,$256.50,$406.30,$410.40,$0.00,$80.28,$0.00,$81.67,$0.00
80207214,EAP,HCPCS C1725,,Catheter Baldilat 18mm 75cm 60mm Peri Lv Scrch Rst,$513.00,$0.00,$513.00,$278.56,$366.13,$0.00,$88.39,$366.13,$366.13,$89.82,$513.00,$0.00,$256.50,$406.30,$410.40,$0.00,$80.28,$0.00,$81.67,$0.00
80207556,EAP,HCPCS C1725,,Catheter Baldilat 8mm 135cm 20mm Otw Inflat Port,"$1,750.00",$0.00,"$1,750.00",$950.25,"$1,248.98",$0.00,$301.52,"$1,248.98","$1,248.98",$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
80207580,EAP,HCPCS C1876,,Stent Bil 7mm 27mm 135cm 30mm Otw Radiopq Bln Xpd,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,"$1,070.55","$1,070.55",$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
80207581,EAP,HCPCS C1876,,Stent Bil 8mm 27mm 135cm 30mm Otw Radiopq Nc Bln,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,"$1,070.55","$1,070.55",$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
80207585,EAP,HCPCS C1876,,Stent Bil 7mm 57mm 135cm 60mm Otw Radiopq Nc Bln,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,"$1,070.55","$1,070.55",$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
80207586,EAP,HCPCS C1876,,Stent Bil 8mm 57mm 135cm 60mm Otw Radiopq Nc Bln,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,"$1,070.55","$1,070.55",$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
80207662,EAP,HCPCS C1876,,STENT ENDO 100CM 14MM 40MM 75CM UNCONSTRAIN FLEX,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,"$1,605.83","$1,605.83",$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
80207663,EAP,HCPCS C1876,,Stent Endoprsth Trchbr 60mm 14mm 9fr Mtl Wlstnt,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,"$1,605.83","$1,605.83",$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
80207665,EAP,HCPCS C1876,,Stent Endoprsth Trchbr Vns 40mm 16mm Elgiloy,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,"$1,605.83","$1,605.83",$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
80207666,EAP,HCPCS C1876,,Stent Endoprsth Trchbr 60mm 16mm 9fr Mtl Wlstnt,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,"$1,605.83","$1,605.83",$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
80207668,EAP,HCPCS C1876,,Stent Endoprsth Trchbr 60mm 18mm 9fr Mtl Wlstnt,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,"$1,605.83","$1,605.83",$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
80207678,EAP,HCPCS C1876,,Stent Endoprsth Trchbr 90mm 14mm 9fr Mtl Wlstnt,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,"$1,605.83","$1,605.83",$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
80207773,EAP,HCPCS C1725,,Catheter Angio 100cm 5fr Imgr2 Bern Curve Crbrl,$30.00,$0.00,$30.00,$16.29,$21.41,$0.00,$5.17,$21.41,$21.41,$5.25,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$4.70,$0.00,$4.78,$0.00
80207912,EAP,HCPCS C1726,,Device Athrcm 165cm .018in Truepath .017in Peri,"$3,920.00",$0.00,"$3,920.00","$2,128.56","$2,797.70",$0.00,$675.40,"$2,797.70","$2,797.70",$686.36,"$3,920.00",$0.00,"$1,960.00","$3,104.64","$3,136.00",$0.00,$613.48,$0.00,$624.06,$0.00
80207913,EAP,HCPCS C1769,,Wire Cath Extn Truepath Chrnc Tot Ocl Dev,$210.00,$0.00,$210.00,$114.03,$149.88,$0.00,$36.18,$149.88,$149.88,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
80207925,EAP,HCPCS C1769,,GUI VAS ST STR .035IN 260CM FLEXIBLE TIP,$100.00,$0.00,$100.00,$54.30,$71.37,$0.00,$17.23,$71.37,$71.37,$17.51,$100.00,$0.00,$50.00,$79.20,$80.00,$0.00,$15.65,$0.00,$15.92,$0.00
80207926,EAP,HCPCS C1769,,Guidewire Vasc 260cm .038in Flpy Tip Fltwr Coil,$100.00,$0.00,$100.00,$54.30,$71.37,$0.00,$17.23,$71.37,$71.37,$17.51,$100.00,$0.00,$50.00,$79.20,$80.00,$0.00,$15.65,$0.00,$15.92,$0.00
80207935,EAP,HCPCS C1769,,Guidewire Vasc 260cm .035in Flpy Tip Fltwr Coil 3,$104.00,$0.00,$104.00,$56.47,$74.22,$0.00,$17.92,$74.22,$74.22,$18.21,$104.00,$0.00,$52.00,$82.37,$83.20,$0.00,$16.28,$0.00,$16.56,$0.00
80207943,EAP,HCPCS C1769,,Guidewire Vasc 260cm .018in Flpy Tip Radiopq Lng,$203.00,$0.00,$203.00,$110.23,$144.88,$0.00,$34.98,$144.88,$144.88,$35.54,$203.00,$0.00,$101.50,$160.78,$162.40,$0.00,$31.77,$0.00,$32.32,$0.00
80207946,EAP,HCPCS C1769,,Guidewire Vasc 260cm .025in Flpy Tip Radiopq Shrt,$202.00,$0.00,$202.00,$109.69,$144.17,$0.00,$34.80,$144.17,$144.17,$35.37,$202.00,$0.00,$101.00,$159.98,$161.60,$0.00,$31.61,$0.00,$32.16,$0.00
80207949,EAP,HCPCS C1769,,GUIDEWIRE VASCULAR STR SHORT TAPER .014IN 300CM 8CM ROBUST,$319.00,$0.00,$319.00,$173.22,$227.67,$0.00,$54.96,$227.67,$227.67,$55.85,$319.00,$0.00,$159.50,$252.65,$255.20,$0.00,$49.92,$0.00,$50.78,$0.00
80208087,EAP,HCPCS C1887,,Mcth Infus 150cm 3-2.8fr .027in Rngd Hfl Hydphi,$721.00,$0.00,$721.00,$391.50,$514.58,$0.00,$124.22,$514.58,$514.58,$126.24,$721.00,$0.00,$360.50,$571.03,$576.80,$0.00,$112.84,$0.00,$114.78,$0.00
80208096,EAP,HCPCS C1887,,Mcth Infus 130cm 3-2.4fr Rngd Stc 18 90d Peri Hdr,"$1,055.00",$0.00,"$1,055.00",$572.87,$752.95,$0.00,$181.77,$752.95,$752.95,$184.72,"$1,055.00",$0.00,$527.50,$835.56,$844.00,$0.00,$165.11,$0.00,$167.96,$0.00
80208101,EAP,HCPCS C1769,,Guidewire Vasc 180cm .016in Strbl Microfabricate,$744.00,$0.00,$744.00,$403.99,$530.99,$0.00,$128.19,$530.99,$530.99,$130.27,$744.00,$0.00,$372.00,$589.25,$595.20,$0.00,$116.44,$0.00,$118.44,$0.00
80215246,EAP,HCPCS C1725,,Catheter Angio 100cm 5fr Optitorque Radl Tig 4,$88.00,$0.00,$88.00,$47.78,$62.81,$0.00,$15.16,$62.81,$62.81,$15.41,$88.00,$0.00,$44.00,$69.70,$70.40,$0.00,$13.77,$0.00,$14.01,$0.00
80284625,EAP,HCPCS C1887,,Catheter Guid 100cm 6fr Lnchr Ebu3.75 Curve Coron,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
80298657,EAP,HCPCS C1894,,Set Introd 25 5/8in 6fr 8fr S Arwflx Perc 3w Stpck,$257.00,$0.00,$257.00,$139.55,$183.42,$0.00,$44.28,$183.42,$183.42,$45.00,$257.00,$0.00,$128.50,$203.54,$205.60,$0.00,$40.22,$0.00,$40.91,$0.00
80307573,EAP,HCPCS C1729,,Tray Surg 14fr 18ga 29cm 5cm 19 Sideport Catheter Echogenic,$417.00,$0.00,$417.00,$226.43,$297.61,$0.00,$71.85,$297.61,$297.61,$73.01,$417.00,$0.00,$208.50,$330.26,$333.60,$0.00,$65.26,$0.00,$66.39,$0.00
80307582,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in Core To Tip Radiopq,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$142.74,$142.74,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
80307684,EAP,HCPCS C1766,,Introd Shth 8.5fr Strbl Cath Agilis Nxt 22.4mm,"$2,000.00",$0.00,"$2,000.00","$1,086.00","$1,427.40",$0.00,$344.59,"$1,427.40","$1,427.40",$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
80307685,EAP,HCPCS C1766,,Introd Shth 8.5fr 71cm 50mm Gwire Strbl Radiopq,"$2,000.00",$0.00,"$2,000.00","$1,086.00","$1,427.40",$0.00,$344.59,"$1,427.40","$1,427.40",$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
80307691,EAP,HCPCS C1730,,Catheter Ep 115cm 5fr Lvwr Crnnd-2 5mm Spc 1mm,"$1,125.00",$0.00,"$1,125.00",$610.88,$802.91,$0.00,$193.83,$802.91,$802.91,$196.98,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$176.06,$0.00,$179.10,$0.00
80307719,EAP,HCPCS C1894,,Sheath Guid 55cm 6fr 2.2mm Flxr Chk-flo Str,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$142.74,$142.74,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
80307720,EAP,HCPCS C1894,,Sheath Guid 55cm 6fr 2.2mm Flxr Hi-flx Chk-flo,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$142.74,$142.74,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
80307775,EAP,Custom 80307775,,Coil Embolization 360d 5mm 10cm Detachable Soft Target,"$4,755.00",$0.00,"$4,755.00",$0.00,"$3,393.64",$0.00,$0.00,"$3,393.64","$3,393.64",$0.00,"$4,755.00",$0.00,"$2,377.50","$3,765.96","$3,804.00",$0.00,$0.00,$0.00,$0.00,$0.00
80307945,EAP,HCPCS C1725,,Catheter Baldilat 2.5mm 20mm Coron Rapex Ult Lp,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80307951,EAP,HCPCS C1725,,Catheter Baldilat 3.5mm 20mm Coron Rapex Ult Lp,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80307953,EAP,HCPCS C1725,,Catheter Baldilat 4mm 8mm Coron Rapex Ult Lp,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80307954,EAP,HCPCS C1725,,Catheter Baldilat 4mm 12mm Coron Rapex Ult Lp,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80307956,EAP,HCPCS C1725,,Catheter Baldilat 2mm 8mm Coron Rapex Radiopq Smth,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80307957,EAP,HCPCS C1725,,Catheter Baldilat 2.25mm 8mm Coron Rapex Radiopq,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80307959,EAP,HCPCS C1725,,Catheter Baldilat 2.25mm 15mm Coron Rapex Radiopq,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80307960,EAP,HCPCS C1725,,Catheter Baldilat 2.25mm 20mm Coron Rapex Radiopq,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80307961,EAP,HCPCS C1725,,Catheter Baldilat 2.75mm 8mm Coron Rapex Radiopq,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80307962,EAP,HCPCS C1725,,Catheter Baldilat 3.25mm 8mm Coron Rapex Radiopq,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80307963,EAP,HCPCS C1725,,Catheter Baldilat 3.25mm 20mm Coron Rapex Radiopq,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80307964,EAP,HCPCS C1725,,Catheter Baldilat 3.75mm 8mm Coron Rapex Radiopq,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80307965,EAP,HCPCS C1725,,Catheter Baldilat 4.5mm 8mm Coron Rapex Radiopq,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80307966,EAP,HCPCS C1725,,Catheter Baldilat 4.5mm 15mm Coron Rapex Radiopq,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80307967,EAP,HCPCS C1725,,Catheter Baldilat 5mm 15mm Coron Rapex Radiopq,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80308041,EAP,HCPCS C1724,,Catheter Athrcm 135cm 7fr 2.1mm Navitus Jetstream,"$8,500.00",$0.00,"$8,500.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$8,500.00",$0.00,"$4,250.00","$6,732.00","$6,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
80308043,EAP,HCPCS C1724,,Catheter Athrcm Jetstream Navitus Rot,"$8,500.00",$0.00,"$8,500.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$8,500.00",$0.00,"$4,250.00","$6,732.00","$6,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
80308065,EAP,HCPCS C1724,,Catheter Athrcm 120cm 7fr 2.4/3.4mm Jetstream,"$8,500.00",$0.00,"$8,500.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$8,500.00",$0.00,"$4,250.00","$6,732.00","$6,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
80308067,EAP,HCPCS C1894,,Introducer Sheath 6fr 25cm 2.5cm Dilat Kink Resistant,$42.00,$0.00,$42.00,$22.81,$29.98,$0.00,$7.24,$29.98,$29.98,$7.35,$42.00,$0.00,$21.00,$33.26,$33.60,$0.00,$6.57,$0.00,$6.69,$0.00
80308097,EAP,HCPCS C1725,,Kit Cath Ins 8fr Sns Plus Stlk Fo Bln Iab Dev 50cc,"$2,614.00",$0.00,"$2,614.00","$1,419.40","$1,865.61",$0.00,$450.38,"$1,865.61","$1,865.61",$457.69,"$2,614.00",$0.00,"$1,307.00","$2,070.29","$2,091.20",$0.00,$409.09,$0.00,$416.15,$0.00
80308098,EAP,HCPCS C1725,,Catheter Iab 6in 7.5fr 16mm Sns Plus .025in 2 Stlk,"$2,725.00",$0.00,"$2,725.00","$1,479.68","$1,944.83",$0.00,$469.50,"$1,944.83","$1,944.83",$477.13,"$2,725.00",$0.00,"$1,362.50","$2,158.20","$2,180.00",$0.00,$426.46,$0.00,$433.82,$0.00
80308211,EAP,HCPCS C1894,,Kit Introd 10cm 6fr 21ga Glidesheath Slndr .021in,$138.00,$0.00,$138.00,$74.93,$98.49,$0.00,$23.78,$98.49,$98.49,$24.16,$138.00,$0.00,$69.00,$109.30,$110.40,$0.00,$21.60,$0.00,$21.97,$0.00
80308259,EAP,HCPCS C1817,,Occluder Cardio 4mm 22mm 32-36mm Spt 2 Disc Slf,"$15,163.00",$0.00,"$15,163.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$10,821.83",$0.00,"$15,163.00",$0.00,"$7,581.50","$12,009.10","$12,130.40",$0.00,$0.00,$0.00,$0.00,$0.00
80308260,EAP,HCPCS C1817,,Occluder Cardio 4mm 24mm 34-38mm Spt 2 Disc Slf,"$15,163.00",$0.00,"$15,163.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$10,821.83",$0.00,"$15,163.00",$0.00,"$7,581.50","$12,009.10","$12,130.40",$0.00,$0.00,$0.00,$0.00,$0.00
80308262,EAP,Custom 80308262,,Catheter Dlv Sys 45d 10fr 80cm Lfric Radiopq Tip,"$1,630.00",$0.00,"$1,630.00",$0.00,"$1,163.33",$0.00,$0.00,"$1,163.33","$1,163.33",$0.00,"$1,630.00",$0.00,$815.00,"$1,290.96","$1,304.00",$0.00,$0.00,$0.00,$0.00,$0.00
80308264,EAP,Custom 80308264,,Balloon Sz 70cm 40mm Amplzr 3 Lum Radiopq Sft,$690.00,$0.00,$690.00,$0.00,$492.45,$0.00,$0.00,$492.45,$492.45,$0.00,$690.00,$0.00,$345.00,$546.48,$552.00,$0.00,$0.00,$0.00,$0.00,$0.00
80308265,EAP,HCPCS C1759,,Catheter Us Cnsl Viewflexxice Viewmate,"$7,000.00",$0.00,"$7,000.00",$0.00,"$4,995.90",$0.00,$0.00,"$4,995.90","$4,995.90",$0.00,"$7,000.00",$0.00,"$3,500.00","$5,544.00","$5,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
80308295,EAP,HCPCS C1753,,Catheter Us 20mhz Shrt Tpr 5fr 2.9fr 150cm 24cm,"$1,813.00",$0.00,"$1,813.00",$984.46,"$1,293.94",$0.00,$312.37,"$1,293.94","$1,293.94",$317.44,"$1,813.00",$0.00,$906.50,"$1,435.90","$1,450.40",$0.00,$283.73,$0.00,$288.63,$0.00
80308611,EAP,HCPCS C1760,,Device Clsr 5fr Vascade Fem Art,$525.00,$0.00,$525.00,$236.25,$374.69,$0.00,$90.45,$374.69,$374.69,$91.92,$525.00,$0.00,$262.50,$415.80,$420.00,$0.00,$82.16,$0.00,$83.58,$0.00
80308612,EAP,HCPCS C1760,,System Cmpr 6/7fr Vascade Vasc Clgn Babsr,$525.00,$0.00,$525.00,$236.25,$374.69,$0.00,$90.45,$374.69,$374.69,$91.92,$525.00,$0.00,$262.50,$415.80,$420.00,$0.00,$82.16,$0.00,$83.58,$0.00
80308880,EAP,HCPCS C1887,,Catheter Sprt 150cm 1.5fr .026-.039in Qkcrs 15mm,$430.00,$0.00,$430.00,$233.49,$306.89,$0.00,$74.09,$306.89,$306.89,$75.29,$430.00,$0.00,$215.00,$340.56,$344.00,$0.00,$67.30,$0.00,$68.46,$0.00
80308883,EAP,Custom 80308883,,QUICK CROSS 4F .018IN X 150CM,$430.00,$0.00,$430.00,$0.00,$306.89,$0.00,$0.00,$306.89,$306.89,$0.00,$430.00,$0.00,$215.00,$340.56,$344.00,$0.00,$0.00,$0.00,$0.00,$0.00
80308885,EAP,HCPCS C1887,,CATHETER GUID .035IN 4.8-3.7FR 90CM LOW CROSSING P,$418.00,$0.00,$418.00,$226.97,$298.33,$0.00,$72.02,$298.33,$298.33,$73.19,$418.00,$0.00,$209.00,$331.06,$334.40,$0.00,$65.42,$0.00,$66.55,$0.00
80308887,EAP,HCPCS C1887,,Catheter Sprt 150cm 3.1fr .05-.063in Qkcrs 50mm,$418.00,$0.00,$418.00,$226.97,$298.33,$0.00,$72.02,$298.33,$298.33,$73.19,$418.00,$0.00,$209.00,$331.06,$334.40,$0.00,$65.42,$0.00,$66.55,$0.00
80308888,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in Core To Tip Radiopq,$300.00,$0.00,$300.00,$162.90,$214.11,$0.00,$51.69,$214.11,$214.11,$52.53,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$46.95,$0.00,$47.76,$0.00
80308889,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in Core To Tip Radiopq,$300.00,$0.00,$300.00,$162.90,$214.11,$0.00,$51.69,$214.11,$214.11,$52.53,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$46.95,$0.00,$47.76,$0.00
80308892,EAP,HCPCS C1729,,Kit Pressure Monitr 38cm Transducer Catheter Tunneling,"$2,028.00",$0.00,"$2,028.00","$1,101.20","$1,447.38",$0.00,$349.41,"$1,447.38","$1,447.38",$355.09,"$2,028.00",$0.00,"$1,014.00","$1,606.18","$1,622.40",$0.00,$317.38,$0.00,$322.86,$0.00
80308949,EAP,HCPCS C1724,,System Athrcm 135cm 1.25mm Rtbl Rtl+ Dmd Precnct,"$3,092.00",$0.00,"$3,092.00",$0.00,"$2,206.76",$0.00,$0.00,"$2,206.76","$2,206.76",$0.00,"$3,092.00",$0.00,"$1,546.00","$2,448.86","$2,473.60",$0.00,$0.00,$0.00,$0.00,$0.00
80308950,EAP,HCPCS C1724,,System Athrcm 135cm 1.5mm Rtbl Rtl+ Dmd Precnct,"$2,988.00",$0.00,"$2,988.00",$0.00,"$2,132.54",$0.00,$0.00,"$2,132.54","$2,132.54",$0.00,"$2,988.00",$0.00,"$1,494.00","$2,366.50","$2,390.40",$0.00,$0.00,$0.00,$0.00,$0.00
80308951,EAP,HCPCS C1724,,System Athrcm 135cm 1.75mm Rtbl Rtl+ Dmd Precnct,"$3,092.00",$0.00,"$3,092.00",$0.00,"$2,206.76",$0.00,$0.00,"$2,206.76","$2,206.76",$0.00,"$3,092.00",$0.00,"$1,546.00","$2,448.86","$2,473.60",$0.00,$0.00,$0.00,$0.00,$0.00
80308954,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in Atrm X Flpy Tip,$213.00,$0.00,$213.00,$115.66,$152.02,$0.00,$36.70,$152.02,$152.02,$37.29,$213.00,$0.00,$106.50,$168.70,$170.40,$0.00,$33.33,$0.00,$33.91,$0.00
80308956,EAP,HCPCS C1887,,Catheter Guid 150cm 1.8-2.6fr Finecross Mg Coron,"$1,063.00",$0.00,"$1,063.00",$577.21,$758.66,$0.00,$183.15,$758.66,$758.66,$186.12,"$1,063.00",$0.00,$531.50,$841.90,$850.40,$0.00,$166.36,$0.00,$169.23,$0.00
80308957,EAP,HCPCS C1769,,Guidewire Vasc 330cm .014in Sprg Tip X Sprt Stf,"$2,070.00",$0.00,"$2,070.00","$1,124.01","$1,477.36",$0.00,$356.65,"$1,477.36","$1,477.36",$362.44,"$2,070.00",$0.00,"$1,035.00","$1,639.44","$1,656.00",$0.00,$323.96,$0.00,$329.54,$0.00
80308958,EAP,HCPCS C1769,,Guidewire Vasc 330cm .014in Flpy Flxb Sprg Tip 2.2,$414.00,$0.00,$414.00,$224.80,$295.47,$0.00,$71.33,$295.47,$295.47,$72.49,$414.00,$0.00,$207.00,$327.89,$331.20,$0.00,$64.79,$0.00,$65.91,$0.00
80308964,EAP,HCPCS C1769,,Guidewire Vasc 180cm .035in Flxb Core To Tip,$496.00,$0.00,$496.00,$269.33,$354.00,$0.00,$85.46,$354.00,$354.00,$86.85,$496.00,$0.00,$248.00,$392.83,$396.80,$0.00,$77.62,$0.00,$78.96,$0.00
80308966,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in Kink Rst Radiopq Strbl,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
80308967,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in Core To Tip Radiopq,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
80308968,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in Core To Tip Radiopq,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
80308971,EAP,HCPCS C1730,,Catheter Ep 65cm 6fr Rspn 5-5-5mm Spc Csl Curve Mp,$875.00,$0.00,$875.00,$475.13,$624.49,$0.00,$150.76,$624.49,$624.49,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
80308973,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in Core To Tip Radiopq,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
80309134,EAP,HCPCS C1725,,Catheter Baldilat 1.5mm 145cm 6mm Otw 2 Lum Ult Lp,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80309137,EAP,HCPCS C1725,,Catheter Baldilat 2mm 145cm 20mm Otw 2 Lum Ult Lp,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80309140,EAP,HCPCS C1725,,Catheter Baldilat 1.2mm 12mm Coron Rapex Ult Lp,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80309141,EAP,HCPCS C1725,,Catheter Baldilat 1.2mm 15mm Coron Rapex Ult Lp,$313.00,$0.00,$313.00,$169.96,$223.39,$0.00,$53.93,$223.39,$223.39,$54.80,$313.00,$0.00,$156.50,$247.90,$250.40,$0.00,$48.98,$0.00,$49.83,$0.00
80309142,EAP,HCPCS C1725,,Catheter Baldilat 1.2mm 20mm Coron Rapex Ult Lp,$313.00,$0.00,$313.00,$169.96,$223.39,$0.00,$53.93,$223.39,$223.39,$54.80,$313.00,$0.00,$156.50,$247.90,$250.40,$0.00,$48.98,$0.00,$49.83,$0.00
80309152,EAP,HCPCS C1725,,Catheter Baldilat 2.25mm 12mm Coron Rapex Ult Lp,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80309153,EAP,HCPCS C1725,,Catheter Baldilat 2.25mm 15mm Coron Rapex Ult Lp,$313.00,$0.00,$313.00,$169.96,$223.39,$0.00,$53.93,$223.39,$223.39,$54.80,$313.00,$0.00,$156.50,$247.90,$250.40,$0.00,$48.98,$0.00,$49.83,$0.00
80309166,EAP,HCPCS C1725,,Catheter Baldilat 3mm 6mm Coron Rapex Ult Lp,$313.00,$0.00,$313.00,$169.96,$223.39,$0.00,$53.93,$223.39,$223.39,$54.80,$313.00,$0.00,$156.50,$247.90,$250.40,$0.00,$48.98,$0.00,$49.83,$0.00
80309172,EAP,HCPCS C1725,,Catheter Baldilat 3.25mm 20mm Coron Rapex Ult Lp,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80309175,EAP,HCPCS C1725,,Catheter Baldilat 3.5mm 6mm Coron Rapex Ult Lp,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80309176,EAP,HCPCS C1725,,Catheter Baldilat 3.5mm 30mm Coron Rapex Ult Lp,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80309185,EAP,HCPCS C1725,,Catheter Baldilat 4mm 20mm Coron Rapex Ult Lp,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80309186,EAP,HCPCS C1725,,Catheter Baldilat 4mm 25mm Coron Rapex Ult Lp,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80309187,EAP,HCPCS C1725,,Catheter Baldilat 4mm 30mm Coron Rapex Ult Lp,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80309188,EAP,HCPCS C1725,,Catheter Baldilat 1.5mm 6mm Coron Rapex Radiopq,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80309192,EAP,HCPCS C1725,,Catheter Baldilat 1.5mm 20mm Coron Rapex Radiopq,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80309193,EAP,HCPCS C1725,,Catheter Baldilat 2mm 15mm Coron Rapex Radiopq,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80309197,EAP,HCPCS C1725,,Catheter Baldilat 4.5mm 20mm Coron Rapex Radiopq,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80309198,EAP,HCPCS C1725,,Catheter Baldilat 5mm 20mm Coron Rapex Radiopq,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80309200,EAP,HCPCS C1876,,System Coron Stent 12mm 2.75mm Mtlnk Vsn Cocr,"$1,188.00",$0.00,"$1,188.00",$534.60,$847.88,$0.00,$204.69,$847.88,$847.88,$208.01,"$1,188.00",$0.00,$594.00,$940.90,$950.40,$0.00,$185.92,$0.00,$189.13,$0.00
80309201,EAP,HCPCS C1876,,System Coron Stent 15mm 2.75mm Mtlnk Vsn Cocr,"$1,188.00",$0.00,"$1,188.00",$534.60,$847.88,$0.00,$204.69,$847.88,$847.88,$208.01,"$1,188.00",$0.00,$594.00,$940.90,$950.40,$0.00,$185.92,$0.00,$189.13,$0.00
80309203,EAP,HCPCS C1876,,System Coron Stent 23mm 2.75mm Mtlnk Vsn Cocr,"$1,188.00",$0.00,"$1,188.00",$534.60,$847.88,$0.00,$204.69,$847.88,$847.88,$208.01,"$1,188.00",$0.00,$594.00,$940.90,$950.40,$0.00,$185.92,$0.00,$189.13,$0.00
80309206,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in Core To Tip Radiopq,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
80309208,EAP,Custom 80309208,,Catheter Pcng Eltrd Bipol Distal Tip Bln Flw Ast,"$1,950.00",$0.00,"$1,950.00",$0.00,"$1,391.72",$0.00,$0.00,"$1,391.72","$1,391.72",$0.00,"$1,950.00",$0.00,$975.00,"$1,544.40","$1,560.00",$0.00,$0.00,$0.00,$0.00,$0.00
80309257,EAP,HCPCS C1887,,Catheter Guid 100cm 6fr Lnchr Std Jr5 Curve Coron,$113.00,$0.00,$113.00,$61.36,$80.65,$0.00,$19.47,$80.65,$80.65,$19.79,$113.00,$0.00,$56.50,$89.50,$90.40,$0.00,$17.68,$0.00,$17.99,$0.00
80309258,EAP,HCPCS C1887,,Catheter Guid 100cm 6fr Lnchr Lcb Curve Coron Nyl,$113.00,$0.00,$113.00,$61.36,$80.65,$0.00,$19.47,$80.65,$80.65,$19.79,$113.00,$0.00,$56.50,$89.50,$90.40,$0.00,$17.68,$0.00,$17.99,$0.00
80309261,EAP,HCPCS C1887,,Catheter Guid 100cm 7fr Lnchr Al1 Curve Coron Peri,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
80309262,EAP,HCPCS C1887,,Catheter Guid 100cm 6fr Lnchr Radl Curve Peri Nyl,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
80309263,EAP,HCPCS C1887,,Catheter Guid 100cm 6fr Lnchr Lara Curve Coron Nyl,$113.00,$0.00,$113.00,$61.36,$80.65,$0.00,$19.47,$80.65,$80.65,$19.79,$113.00,$0.00,$56.50,$89.50,$90.40,$0.00,$17.68,$0.00,$17.99,$0.00
80309264,EAP,HCPCS C1887,,Catheter Guid 100cm 6fr Lnchr 30d Mac3 Curve Coron,$113.00,$0.00,$113.00,$61.36,$80.65,$0.00,$19.47,$80.65,$80.65,$19.79,$113.00,$0.00,$56.50,$89.50,$90.40,$0.00,$17.68,$0.00,$17.99,$0.00
80309265,EAP,HCPCS C1887,,Catheter Guid 100cm 6fr Lnchr Std Ima Curve Coron,$113.00,$0.00,$113.00,$61.36,$80.65,$0.00,$19.47,$80.65,$80.65,$19.79,$113.00,$0.00,$56.50,$89.50,$90.40,$0.00,$17.68,$0.00,$17.99,$0.00
80309266,EAP,HCPCS C1725,,Catheter Angio 125cm 5fr Stsr Jr4 Curve Peri Pebax,$175.00,$0.00,$175.00,$95.03,$124.90,$0.00,$30.15,$124.90,$124.90,$30.64,$175.00,$0.00,$87.50,$138.60,$140.00,$0.00,$27.39,$0.00,$27.86,$0.00
80309276,EAP,HCPCS C1769,,"GUIDEWIRE HI-TORQUE COMM ES .014"" 300CM",$988.00,$0.00,$988.00,$536.48,$705.14,$0.00,$170.23,$705.14,$705.14,$172.99,$988.00,$0.00,$494.00,$782.50,$790.40,$0.00,$154.62,$0.00,$157.29,$0.00
80309278,EAP,HCPCS C1725,,Catheter Baldilat 6mm 150cm 200mm Peri Otw Tpr Tip,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80309279,EAP,HCPCS C1725,,Catheter Angio 110cm 6fr Langston 145d Pgtl Curve,$57.00,$0.00,$57.00,$30.95,$40.68,$0.00,$9.82,$40.68,$40.68,$9.98,$57.00,$0.00,$28.50,$45.14,$45.60,$0.00,$8.92,$0.00,$9.07,$0.00
80309287,EAP,HCPCS C1725,,Catheter Baldilat 3mm 8mm Coron Rapex Radiopq Smth,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80309335,EAP,HCPCS C1725,,Catheter Baldilat 4.5mm 15mm Coron Rapex Ult Lp,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80309338,EAP,HCPCS C1725,,Catheter Baldilat 4.5mm 12mm Coron Rapex Radiopq,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80309343,EAP,HCPCS C1880,,Filter Embl 49mm 65cm Vc Radiopq Preld Flsh Sdprt,"$2,313.00",$0.00,"$2,313.00","$1,040.85","$1,650.79",$0.00,$398.52,"$1,650.79","$1,650.79",$404.99,"$2,313.00",$0.00,"$1,156.50","$1,831.90","$1,850.40",$0.00,$361.98,$0.00,$368.23,$0.00
80309345,EAP,HCPCS C1880,,Filter Embl Navalign Dlv Uniset Strl Disp Pltn,"$2,313.00",$0.00,"$2,313.00","$1,040.85","$1,650.79",$0.00,$398.52,"$1,650.79","$1,650.79",$404.99,"$2,313.00",$0.00,"$1,156.50","$1,831.90","$1,850.40",$0.00,$361.98,$0.00,$368.23,$0.00
80309346,EAP,HCPCS C1725,,Catheter Baldilat 2mm 12mm Coron Rapex Radiopq,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80309407,EAP,HCPCS C1876,,System Coron Stent 8mm 2mm Mtlnk Mvsn Cocr Rapex,"$1,188.00",$0.00,"$1,188.00",$534.60,$847.88,$0.00,$204.69,$847.88,$847.88,$208.01,"$1,188.00",$0.00,$594.00,$940.90,$950.40,$0.00,$185.92,$0.00,$189.13,$0.00
80309409,EAP,HCPCS C1876,,System Coron Stent 15mm 2mm Mtlnk Mvsn Cocr Rapex,"$1,188.00",$0.00,"$1,188.00",$534.60,$847.88,$0.00,$204.69,$847.88,$847.88,$208.01,"$1,188.00",$0.00,$594.00,$940.90,$950.40,$0.00,$185.92,$0.00,$189.13,$0.00
80309410,EAP,HCPCS C1876,,System Coron Stent 18mm 2mm Mtlnk Mvsn Cocr Rapex,"$1,188.00",$0.00,"$1,188.00",$534.60,$847.88,$0.00,$204.69,$847.88,$847.88,$208.01,"$1,188.00",$0.00,$594.00,$940.90,$950.40,$0.00,$185.92,$0.00,$189.13,$0.00
80309411,EAP,HCPCS C1876,,System Coron Stent 23mm 2mm Mtlnk Mvsn Cocr Rapex,"$1,188.00",$0.00,"$1,188.00",$534.60,$847.88,$0.00,$204.69,$847.88,$847.88,$208.01,"$1,188.00",$0.00,$594.00,$940.90,$950.40,$0.00,$185.92,$0.00,$189.13,$0.00
80309438,EAP,HCPCS C1900,,Lead Pcng Lv Atn Starfix,"$4,125.00",$0.00,"$4,125.00",$0.00,"$2,944.01",$0.00,$710.72,"$2,944.01","$2,944.01",$0.00,"$4,125.00",$0.00,"$2,062.50","$3,267.00","$3,300.00",$0.00,$645.56,$0.00,$0.00,$0.00
80309448,EAP,HCPCS C1725,,Catheter Pa 110cm 5fr 8mm Arw 1 Lum Bln Wdg Prss,$300.00,$0.00,$300.00,$162.90,$214.11,$0.00,$51.69,$214.11,$214.11,$52.53,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$46.95,$0.00,$47.76,$0.00
80309457,EAP,Custom 80309457,,System Drg Dlv Ekosonic Mach 4 Microsonic Tx Zn,"$6,738.00",$0.00,"$6,738.00",$0.00,"$4,808.91",$0.00,$0.00,"$4,808.91","$4,808.91",$0.00,"$6,738.00",$0.00,"$3,369.00","$5,336.50","$5,390.40",$0.00,$0.00,$0.00,$0.00,$0.00
80309459,EAP,Custom 80309459,,Device Thrmb 135cm 5.4fr Ekosonic Mach 4 Evas,"$6,738.00",$0.00,"$6,738.00",$0.00,"$4,808.91",$0.00,$0.00,"$4,808.91","$4,808.91",$0.00,"$6,738.00",$0.00,"$3,369.00","$5,336.50","$5,390.40",$0.00,$0.00,$0.00,$0.00,$0.00
80309461,EAP,Custom 80309461,,Device Drg Dlv Ekosonic Mach 4 Infus Cath Us Core,"$6,738.00",$0.00,"$6,738.00",$0.00,"$4,808.91",$0.00,$0.00,"$4,808.91","$4,808.91",$0.00,"$6,738.00",$0.00,"$3,369.00","$5,336.50","$5,390.40",$0.00,$0.00,$0.00,$0.00,$0.00
80309462,EAP,Custom 80309462,,Device Drg Dlv Ekosonic Mach 4 Infus Cath Us Core,"$6,738.00",$0.00,"$6,738.00",$0.00,"$4,808.91",$0.00,$0.00,"$4,808.91","$4,808.91",$0.00,"$6,738.00",$0.00,"$3,369.00","$5,336.50","$5,390.40",$0.00,$0.00,$0.00,$0.00,$0.00
80309492,EAP,HCPCS A6212,,Dressing 6x3.5in Anmc Wtprf Flxb N Linr Strp Ionic,$64.00,$0.00,$64.00,$34.75,$45.68,$0.00,$9.12,$45.68,$45.68,$11.21,$64.00,$0.00,$32.00,$50.69,$51.20,$0.00,$10.02,$0.00,$10.19,$0.00
80309550,EAP,Custom 80309550,,Set Vntrc Ast 17.4x13.8in Impella Cp 9.3in 10-40c,"$62,500.00",$0.00,"$62,500.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$62,500.00",$0.00,"$31,250.00","$49,500.00","$50,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
80309582,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in Sft Rbn Tip Kink Rst,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
80309672,EAP,HCPCS C1757,,Catheter Thrmb 10mm Flowtriever Strl Latex Free,"$11,625.00",$0.00,"$11,625.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$11,625.00",$0.00,"$5,812.50","$9,207.00","$9,300.00",$0.00,$0.00,$0.00,$0.00,$0.00
80309673,EAP,HCPCS C1757,,Catheter Thrmb 14mm Flowtriever Strl Latex Free,"$11,625.00",$0.00,"$11,625.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$11,625.00",$0.00,"$5,812.50","$9,207.00","$9,300.00",$0.00,$0.00,$0.00,$0.00,$0.00
80309674,EAP,HCPCS C1757,,Catheter Thrmb 18mm Flowtriever Strl Latex Free,"$11,625.00",$0.00,"$11,625.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$11,625.00",$0.00,"$5,812.50","$9,207.00","$9,300.00",$0.00,$0.00,$0.00,$0.00,$0.00
80309675,EAP,HCPCS C1757,,Catheter Guid 6.7mm Flowtriever 1 Ins Aspirate,"$6,875.00",$0.00,"$6,875.00",$0.00,"$4,906.69",$0.00,$0.00,"$4,906.69","$4,906.69",$0.00,"$6,875.00",$0.00,"$3,437.50","$5,445.00","$5,500.00",$0.00,$0.00,$0.00,$0.00,$0.00
80309676,EAP,Custom 80309676,,FT RETRACTION ASPIRATOR DEVICE SE,"$3,125.00",$0.00,"$3,125.00",$0.00,"$2,230.31",$0.00,$0.00,"$2,230.31","$2,230.31",$0.00,"$3,125.00",$0.00,"$1,562.50","$2,475.00","$2,500.00",$0.00,$0.00,$0.00,$0.00,$0.00
80309726,EAP,HCPCS C1887,,Catheter Vasc 135cm 2.6-2.9fr 1.6fr Turnpike Ml Lr,"$1,313.00",$0.00,"$1,313.00",$712.96,$937.09,$0.00,$226.22,$937.09,$937.09,$229.90,"$1,313.00",$0.00,$656.50,"$1,039.90","$1,050.40",$0.00,$205.48,$0.00,$209.03,$0.00
80309727,EAP,HCPCS C1887,,Catheter Vasc 150cm 2.6-3.1fr 1.6fr Turnpike Ml Lr,"$1,488.00",$0.00,"$1,488.00",$807.98,"$1,061.99",$0.00,$256.37,"$1,061.99","$1,061.99",$260.54,"$1,488.00",$0.00,$744.00,"$1,178.50","$1,190.40",$0.00,$232.87,$0.00,$236.89,$0.00
80309751,EAP,HCPCS C1874,,System Coron Stent 12mm 4mm Promus Prmr Mnrl,"$4,250.00",$0.00,"$4,250.00","$1,912.50","$3,033.23",$0.00,$732.25,"$3,033.23","$3,033.23",$744.14,"$4,250.00",$0.00,"$2,125.00","$3,366.00","$3,400.00",$0.00,$665.13,$0.00,$676.60,$0.00
80309753,EAP,HCPCS C1874,,System Coron Stent 20mm 4mm Promus Prmr Mnrl,"$4,250.00",$0.00,"$4,250.00","$1,912.50","$3,033.23",$0.00,$732.25,"$3,033.23","$3,033.23",$744.14,"$4,250.00",$0.00,"$2,125.00","$3,366.00","$3,400.00",$0.00,$665.13,$0.00,$676.60,$0.00
80309754,EAP,HCPCS C1874,,System Coron Stent 24mm 4mm Promus Prmr Mnrl,"$4,250.00",$0.00,"$4,250.00","$1,912.50","$3,033.23",$0.00,$732.25,"$3,033.23","$3,033.23",$744.14,"$4,250.00",$0.00,"$2,125.00","$3,366.00","$3,400.00",$0.00,$665.13,$0.00,$676.60,$0.00
80310083,EAP,HCPCS C1884,,System Embl Prtc 190cm .014in 110um Crtd Gwire,"$3,738.00",$0.00,"$3,738.00","$2,029.73","$2,667.81",$0.00,$644.04,"$2,667.81","$2,667.81",$654.49,"$3,738.00",$0.00,"$1,869.00","$2,960.50","$2,990.40",$0.00,$585.00,$0.00,$595.09,$0.00
80310085,EAP,HCPCS C1894,,Introd Shth Ped 5fr 21ga 40cm 7cm Gry Hub Dilat,$103.00,$0.00,$103.00,$55.93,$73.51,$0.00,$17.75,$73.51,$73.51,$18.03,$103.00,$0.00,$51.50,$81.58,$82.40,$0.00,$16.12,$0.00,$16.40,$0.00
80310086,EAP,HCPCS C1894,,Introd Shth Ped 6fr 21ga 40cm 7cm Grn Hub Dilat,$102.00,$0.00,$102.00,$55.39,$72.80,$0.00,$17.57,$72.80,$72.80,$17.86,$102.00,$0.00,$51.00,$80.78,$81.60,$0.00,$15.96,$0.00,$16.24,$0.00
80310399,EAP,HCPCS C1876,,Stent Vasc Epic Nitinol L60mm L120cm Od9mm Iliac,"$1,463.00",$0.00,"$1,463.00",$658.35,"$1,044.14",$0.00,$252.07,"$1,044.14","$1,044.14",$256.16,"$1,463.00",$0.00,$731.50,"$1,158.70","$1,170.40",$0.00,$228.96,$0.00,$232.91,$0.00
80310402,EAP,HCPCS C1876,,Stent Vasc 9mm 80mm 159cm 120cm Slf Xpd Ilc Art Ep,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,"$1,070.55","$1,070.55",$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
80310534,EAP,HCPCS C1769,,Guidewire Vasc 260cm .035in Flxb Sprg Coil Tip Std,$251.00,$0.00,$251.00,$136.29,$179.14,$0.00,$43.25,$179.14,$179.14,$43.95,$251.00,$0.00,$125.50,$198.79,$200.80,$0.00,$39.28,$0.00,$39.96,$0.00
80310535,EAP,HCPCS C1769,,Guidewire Vasc 180cm .035in Flxb Sprg Coil Tip Std,$130.00,$0.00,$130.00,$70.59,$92.78,$0.00,$22.40,$92.78,$92.78,$22.76,$130.00,$0.00,$65.00,$102.96,$104.00,$0.00,$20.35,$0.00,$20.70,$0.00
80310536,EAP,HCPCS C1769,,Guidewire Vasc 260cm .035in Flxb Sprg Coil Tip Std,"$1,045.00",$0.00,"$1,045.00",$567.44,$745.82,$0.00,$180.05,$745.82,$745.82,$182.97,"$1,045.00",$0.00,$522.50,$827.64,$836.00,$0.00,$163.54,$0.00,$166.36,$0.00
80310824,EAP,HCPCS C1733,,Catheter Ablt 115cm 8fr 4mm 1-4-1mm Spc F-j Curve,"$4,125.00",$0.00,"$4,125.00","$2,239.88","$2,944.01",$0.00,$710.72,"$2,944.01","$2,944.01",$722.25,"$4,125.00",$0.00,"$2,062.50","$3,267.00","$3,300.00",$0.00,$645.56,$0.00,$656.70,$0.00
80315167,EAP,HCPCS C1894,,Sheath Introd 28cm 9.8mm 26fr Gore Dryseal Hydphi,$863.00,$0.00,$863.00,$468.61,$615.92,$0.00,$148.69,$615.92,$615.92,$151.10,$863.00,$0.00,$431.50,$683.50,$690.40,$0.00,$135.06,$0.00,$137.39,$0.00
80315263,EAP,HCPCS C1725,,CATR BALD 14 ATM LP TAER 7FR 5MM 150CM 150MM,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80315264,EAP,HCPCS C1725,,Catheter Baldilat 5mm 150cm 200mm Peri Otw Tpr Tip,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80315265,EAP,HCPCS C1725,,Catheter Baldilat 6mm 150cm 150mm Peri Otw Tpr Tip,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80315266,EAP,HCPCS C1725,,Catheter Baldilat 6mm 150cm 220mm Peri Otw Tpr Tip,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80315267,EAP,HCPCS C1725,,Catheter Baldilat 7mm 150cm 120mm Otw Inflat Port,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80315268,EAP,HCPCS C1725,,Catheter Baldilat 7mm 150cm 150mm Peri Otw Tpr Tip,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80316943,EAP,HCPCS C1757,,Set Thrmb 145cm 3-4fr 1.5mm Angjt Ult Solent Dista,"$5,000.00",$0.00,"$5,000.00",$0.00,"$3,568.50",$0.00,$0.00,"$3,568.50","$3,568.50",$0.00,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
80317120,EAP,HCPCS C1760,,Device Clsr 6fr Strcls Se Vasc Ntnl Clip Strl Disp,$788.00,$0.00,$788.00,$354.60,$562.40,$0.00,$135.77,$562.40,$562.40,$137.97,$788.00,$0.00,$394.00,$624.10,$630.40,$0.00,$123.32,$0.00,$125.45,$0.00
80318107,EAP,HCPCS C1894,,Introd Cath 90cm 6fr Chk-flo Flxr Raabe,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
80318555,EAP,HCPCS C1725,,Catheter Guid 135cm 3.2fr Stingray Lp Hydphi Strl,"$4,738.00",$0.00,"$4,738.00","$2,572.73","$3,381.51",$0.00,$816.33,"$3,381.51","$3,381.51",$829.59,"$4,738.00",$0.00,"$2,369.00","$3,752.50","$3,790.40",$0.00,$741.50,$0.00,$754.29,$0.00
80318556,EAP,HCPCS C1769,,Guidewire Vasc 185cm .014in 20cm Stingray Hydphi,"$1,228.00",$0.00,"$1,228.00",$666.80,$876.42,$0.00,$211.58,$876.42,$876.42,$215.01,"$1,228.00",$0.00,$614.00,$972.58,$982.40,$0.00,$192.18,$0.00,$195.50,$0.00
80318557,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in 20cm Stingray Hydphi,"$1,228.00",$0.00,"$1,228.00",$666.80,$876.42,$0.00,$211.58,$876.42,$876.42,$215.01,"$1,228.00",$0.00,$614.00,$972.58,$982.40,$0.00,$192.18,$0.00,$195.50,$0.00
80318677,EAP,HCPCS C1764,,System Crd Monitr Rvl Linq Mycarelink Ins Loop,"$11,613.00",$0.00,"$11,613.00","$5,225.85","$5,158.80",$0.00,"$2,000.86","$5,158.80","$8,288.20","$2,033.34","$11,613.00",$0.00,"$5,806.50","$9,197.50","$9,290.40",$0.00,"$1,817.43",$0.00,"$1,848.79",$0.00
80320653,EAP,HCPCS C1894,,Kit Introd 10cm 7fr 21ga Glidesheath Slndr .021in,$138.00,$0.00,$138.00,$74.93,$98.49,$0.00,$23.78,$98.49,$98.49,$24.16,$138.00,$0.00,$69.00,$109.30,$110.40,$0.00,$21.60,$0.00,$21.97,$0.00
80320723,EAP,HCPCS C1769,,Guidewire Vasc 80cm .035in Flxb Core To Tip,$73.00,$0.00,$73.00,$39.64,$52.10,$0.00,$12.58,$52.10,$52.10,$12.78,$73.00,$0.00,$36.50,$57.82,$58.40,$0.00,$11.42,$0.00,$11.62,$0.00
80320735,EAP,HCPCS C1725,,CHOCOLATE PTCA BALLOON CATHETER 2.0X10 MM 5F,"$1,875.00",$0.00,"$1,875.00","$1,018.13","$1,338.19",$0.00,$323.05,"$1,338.19","$1,338.19",$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
80320736,EAP,HCPCS C1725,,CHOCOLATE PTCA BALLOON CATHETER 2.0X15 MM 5F,"$1,875.00",$0.00,"$1,875.00","$1,018.13","$1,338.19",$0.00,$323.05,"$1,338.19","$1,338.19",$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
80320737,EAP,HCPCS C1725,,CHOCOLATE PTCA BALLOON CATHETER 2.0X20 MM 5F,"$1,875.00",$0.00,"$1,875.00","$1,018.13","$1,338.19",$0.00,$323.05,"$1,338.19","$1,338.19",$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
80320738,EAP,HCPCS C1725,,CHOCOLATE PTCA BALLOON CATHETER 2.5X10 MM 5F,"$1,875.00",$0.00,"$1,875.00","$1,018.13","$1,338.19",$0.00,$323.05,"$1,338.19","$1,338.19",$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
80320739,EAP,HCPCS C1725,,CHOCOLATE PTCA BALLOON CATHETER 2.5X15 MM 5F,"$1,875.00",$0.00,"$1,875.00","$1,018.13","$1,338.19",$0.00,$323.05,"$1,338.19","$1,338.19",$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
80320740,EAP,HCPCS C1725,,CHOCOLATE PTCA BALLOON CATHETER 2.5X20 MM 5F,"$1,875.00",$0.00,"$1,875.00","$1,018.13","$1,338.19",$0.00,$323.05,"$1,338.19","$1,338.19",$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
80320741,EAP,HCPCS C1725,,CHOCOLATE PTCA BALLOON CATHETER 3.0X10 MM 6F,"$1,875.00",$0.00,"$1,875.00","$1,018.13","$1,338.19",$0.00,$323.05,"$1,338.19","$1,338.19",$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
80320742,EAP,HCPCS C1725,,Catheter Baldilat 3mm 140cm 15mm Rapex Ntnl Latex,"$1,875.00",$0.00,"$1,875.00","$1,018.13","$1,338.19",$0.00,$323.05,"$1,338.19","$1,338.19",$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
80320743,EAP,HCPCS C1725,,CHOCOLATE PTCA BALLOON CATHETER 3.0X20 MM 6F,"$1,875.00",$0.00,"$1,875.00","$1,018.13","$1,338.19",$0.00,$323.05,"$1,338.19","$1,338.19",$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
80320744,EAP,HCPCS C1725,,CHOCOLATE PTCA BALLOON CATHETER 3.5X10 MM 6F,"$1,875.00",$0.00,"$1,875.00","$1,018.13","$1,338.19",$0.00,$323.05,"$1,338.19","$1,338.19",$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
80320745,EAP,HCPCS C1725,,CHOCOLATE PTCA BALLOON CATHETER 3.5X15 MM 6F,"$1,875.00",$0.00,"$1,875.00","$1,018.13","$1,338.19",$0.00,$323.05,"$1,338.19","$1,338.19",$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
80320746,EAP,HCPCS C1725,,CHOCOLATE PTCA BALLOON CATHETER 3.5X20 MM 6F,"$1,875.00",$0.00,"$1,875.00","$1,018.13","$1,338.19",$0.00,$323.05,"$1,338.19","$1,338.19",$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
80320748,EAP,HCPCS C1887,,CATHETER GUID EBU3.75 CURVE 8FR .09IN 90CM LEFT,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
80320749,EAP,HCPCS C1887,,CATHETER GUID JR4 CURVE 8FR .088IN 90CM CORON SHR,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
80320750,EAP,HCPCS C1887,,CATHETER GUID JL4 CURVE 8FR 90CM CORON SHR NX BAL,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
80320781,EAP,,,Dressing 8x8in Anbctrl Latex Hydrofera Foam Blue,$34.00,$0.00,$34.00,$0.00,$24.27,$0.00,$0.00,$24.27,$24.27,$0.00,$34.00,$0.00,$17.00,$26.93,$27.20,$0.00,$0.00,$0.00,$0.00,$0.00
80320787,EAP,HCPCS C1729,,Set Drain .038in 18fr L 40cm 32 Side Port Luer Lock Lock,$280.00,$0.00,$280.00,$152.04,$199.84,$0.00,$48.24,$199.84,$199.84,$49.03,$280.00,$0.00,$140.00,$221.76,$224.00,$0.00,$43.82,$0.00,$44.58,$0.00
80320793,EAP,HCPCS C1894,,Introducer Sheath 9fr 25cm 2.5cm Dilat Kink Resistant,$424.00,$0.00,$424.00,$230.23,$302.61,$0.00,$73.05,$302.61,$302.61,$74.24,$424.00,$0.00,$212.00,$335.81,$339.20,$0.00,$66.36,$0.00,$67.50,$0.00
80320799,EAP,HCPCS C1896,,Electrode Dfbr 45cm Trplr Eblm S-icd 11.5fr Sbq,"$10,000.00",$0.00,"$10,000.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$7,137.00",$0.00,"$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
80320811,EAP,HCPCS C1769,,Guidewire Vasc 300cm .035in Core To Tip Radiopq,$225.00,$0.00,$225.00,$122.18,$160.58,$0.00,$38.77,$160.58,$160.58,$39.40,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$35.21,$0.00,$35.82,$0.00
80320812,EAP,HCPCS C1725,,Catheter Angio 100cm 5fr Crds Infnt Jl3.5 Curve,$97.00,$0.00,$97.00,$52.67,$69.23,$0.00,$16.71,$69.23,$69.23,$16.98,$97.00,$0.00,$48.50,$76.82,$77.60,$0.00,$15.18,$0.00,$15.44,$0.00
80320813,EAP,HCPCS C1887,,CATHETER ANGIO JL 4 CRV 5FR .047IN 100CM INFNT THRLMN RADOPQ,$97.00,$0.00,$97.00,$52.67,$69.23,$0.00,$16.71,$69.23,$69.23,$16.98,$97.00,$0.00,$48.50,$76.82,$77.60,$0.00,$15.18,$0.00,$15.44,$0.00
80320814,EAP,HCPCS C1725,,Catheter Angio 100cm 5fr Crds Infnt Jr4 Curve,$97.00,$0.00,$97.00,$52.67,$69.23,$0.00,$16.71,$69.23,$69.23,$16.98,$97.00,$0.00,$48.50,$76.82,$77.60,$0.00,$15.18,$0.00,$15.44,$0.00
80320817,EAP,HCPCS C1894,,SET INTROD 6FR 8FR 17.75IN 3 W,$249.00,$0.00,$249.00,$135.21,$177.71,$0.00,$42.90,$177.71,$177.71,$43.60,$249.00,$0.00,$124.50,$197.21,$199.20,$0.00,$38.97,$0.00,$39.64,$0.00
80320820,EAP,HCPCS C1893,,Introd Shth 10fr 67cm 63cm Gwire Hmsts Vlv Sh,$638.00,$0.00,$638.00,$346.43,$455.34,$0.00,$109.92,$455.34,$455.34,$111.71,$638.00,$0.00,$319.00,$505.30,$510.40,$0.00,$99.85,$0.00,$101.57,$0.00
80320821,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in Sft Rbn Tip Kink Rst,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
80320844,EAP,HCPCS C1876,,System Coron Stent 28mm 5mm Mtlnk Ul Xcelon Mcgld,"$1,188.00",$0.00,"$1,188.00",$534.60,$847.88,$0.00,$204.69,$847.88,$847.88,$208.01,"$1,188.00",$0.00,$594.00,$940.90,$950.40,$0.00,$185.92,$0.00,$189.13,$0.00
80320846,EAP,HCPCS C1725,,Catheter Baldilat 2mm 150cm 220mm Otw Inflat Port,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80320847,EAP,HCPCS C1725,,Catheter Baldilat 2mm 150cm 40mm Peri Otw Tpr Tip,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80320848,EAP,HCPCS C1725,,Catheter Baldilat 3mm 150cm 220mm Otw Inflat Port,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80320849,EAP,HCPCS C1725,,Catheter Baldilat 3mm 150cm 40mm Peri Otw Tpr Tip,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80320850,EAP,HCPCS C1725,,Catheter Baldilat 4mm 150cm 220mm Otw Inflat Port,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80320851,EAP,HCPCS C1725,,Catheter Baldilat 7mm 150cm 200mm Otw Inflat Port,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80320852,EAP,HCPCS C1725,,Catheter Baldilat 7mm 150cm 220mm Otw Inflat Port,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80320854,EAP,HCPCS C1757,,Catheter Thrmb 135cm 4fr Unfs Flw-thru Hub Infus,$438.00,$0.00,$438.00,$0.00,$312.60,$0.00,$0.00,$312.60,$312.60,$0.00,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$0.00,$0.00,$0.00,$0.00
80320860,EAP,HCPCS C1725,,Catheter Baldilat 26mm 100cm 4cm Flxb Distal Tip,"$1,712.00",$0.00,"$1,712.00",$929.62,"$1,221.85",$0.00,$294.97,"$1,221.85","$1,221.85",$299.76,"$1,712.00",$0.00,$856.00,"$1,355.90","$1,369.60",$0.00,$267.93,$0.00,$272.55,$0.00
80320864,EAP,HCPCS C1876,,System Coron Stent 13mm 5mm Mtlnk Ul Xcelon Mcgld,"$1,188.00",$0.00,"$1,188.00",$534.60,$847.88,$0.00,$204.69,$847.88,$847.88,$208.01,"$1,188.00",$0.00,$594.00,$940.90,$950.40,$0.00,$185.92,$0.00,$189.13,$0.00
80320865,EAP,Custom 80320865,,Balloon Sz 70cm 27mm Amplzr 3 Lum Sft Distal Tip,$815.00,$0.00,$815.00,$0.00,$581.67,$0.00,$0.00,$581.67,$581.67,$0.00,$815.00,$0.00,$407.50,$645.48,$652.00,$0.00,$0.00,$0.00,$0.00,$0.00
80320866,EAP,HCPCS C1887,,Catheter Guid 90cm 6fr Lnchr Ima Curve Peri Nyl Lg,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
80320868,EAP,HCPCS C1887,,Catheter Guid 100cm 5fr Lnchr Ebu5 Curve Coron Nyl,$120.00,$0.00,$120.00,$65.16,$85.64,$0.00,$20.68,$85.64,$85.64,$21.01,$120.00,$0.00,$60.00,$95.04,$96.00,$0.00,$18.78,$0.00,$19.10,$0.00
80320869,EAP,HCPCS C1887,,Catheter Guid 100cm 6fr Lnchr Ebu3.5 Curve Peri,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
80320870,EAP,HCPCS C1769,,CATHETER GUID EXTRA BACKUP 4.5 LEFT CURVE 6FR .071,$120.00,$0.00,$120.00,$65.16,$85.64,$0.00,$20.68,$85.64,$85.64,$21.01,$120.00,$0.00,$60.00,$95.04,$96.00,$0.00,$18.78,$0.00,$19.10,$0.00
80321053,EAP,HCPCS C2617,,Zimmon Pancreatic Stent 7fr 12cm,$178.00,$0.00,$178.00,$80.10,$127.04,$0.00,$30.67,$127.04,$127.04,$31.17,$178.00,$0.00,$89.00,$140.98,$142.40,$0.00,$27.86,$0.00,$28.34,$0.00
80321087,EAP,HCPCS C1757,,"INDIGO CATHETER 8, XTORQ TIP 115CM","$7,225.00",$0.00,"$7,225.00",$0.00,"$5,156.48",$0.00,$0.00,"$5,156.48","$5,156.48",$0.00,"$7,225.00",$0.00,"$3,612.50","$5,722.20","$5,780.00",$0.00,$0.00,$0.00,$0.00,$0.00
80321088,EAP,Custom 80321088,,INDIGO SEPARATOR 8,"$4,700.00",$0.00,"$4,700.00",$0.00,"$3,354.39",$0.00,$0.00,"$3,354.39","$3,354.39",$0.00,"$4,700.00",$0.00,"$2,350.00","$3,722.40","$3,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
80321095,EAP,HCPCS C1773,,Kit Snr Agn 90d 200cm 2.3-3fr 7mm Mcth Loop Coil,"$1,625.00",$0.00,"$1,625.00",$882.38,"$1,159.76",$0.00,$279.98,"$1,159.76","$1,159.76",$284.52,"$1,625.00",$0.00,$812.50,"$1,287.00","$1,300.00",$0.00,$254.31,$0.00,$258.70,$0.00
80321110,EAP,HCPCS C1769,,Guidewire Vasc 175cm .014in Radiopq Prox Conctr,"$1,500.00",$0.00,"$1,500.00",$814.50,"$1,070.55",$0.00,$258.44,"$1,070.55","$1,070.55",$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
80321111,EAP,Custom 80321111,,Kit Cath 135cm 2.7fr Img 1 Syr Rapex Tip Radiopq,"$1,875.00",$0.00,"$1,875.00",$0.00,"$1,338.19",$0.00,$0.00,"$1,338.19","$1,338.19",$0.00,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$0.00,$0.00,$0.00,$0.00
80321115,EAP,HCPCS C1887,,Catheter Intvn 5fr .056in .046in 150cm 25cm Rapex,"$1,023.00",$0.00,"$1,023.00",$555.49,$730.12,$0.00,$176.26,$730.12,$730.12,$179.12,"$1,023.00",$0.00,$511.50,$810.22,$818.40,$0.00,$160.10,$0.00,$162.86,$0.00
80321116,EAP,HCPCS C1887,,CATHETER INTVN 7FR .078IN .062IN 150CM 25CM RAPEX,"$1,023.00",$0.00,"$1,023.00",$555.49,$730.12,$0.00,$176.26,$730.12,$730.12,$179.12,"$1,023.00",$0.00,$511.50,$810.22,$818.40,$0.00,$160.10,$0.00,$162.86,$0.00
80321117,EAP,HCPCS C1887,,Catheter Intvn 8fr .088in .071in 150cm 25cm Rapex,"$1,023.00",$0.00,"$1,023.00",$555.49,$730.12,$0.00,$176.26,$730.12,$730.12,$179.12,"$1,023.00",$0.00,$511.50,$810.22,$818.40,$0.00,$160.10,$0.00,$162.86,$0.00
80321162,EAP,HCPCS C1887,,SHEATH GUID 65CM 8FR PN DSTN .038IN STR HYDPHI,$224.00,$0.00,$224.00,$121.63,$159.87,$0.00,$38.59,$159.87,$159.87,$39.22,$224.00,$0.00,$112.00,$177.41,$179.20,$0.00,$35.06,$0.00,$35.66,$0.00
80321939,EAP,HCPCS C1773,,SEPARATOR THRMB INDG 6 LATEX FREE,"$2,700.00",$0.00,"$2,700.00","$1,466.10","$1,926.99",$0.00,$465.20,"$1,926.99","$1,926.99",$472.75,"$2,700.00",$0.00,"$1,350.00","$2,138.40","$2,160.00",$0.00,$422.55,$0.00,$429.84,$0.00
80321943,EAP,HCPCS C1757,,CATHETER THRMB 6FR INDG ASPIRAT LATEX FREE,"$4,725.00",$0.00,"$4,725.00",$0.00,"$3,372.23",$0.00,$0.00,"$3,372.23","$3,372.23",$0.00,"$4,725.00",$0.00,"$2,362.50","$3,742.20","$3,780.00",$0.00,$0.00,$0.00,$0.00,$0.00
80321958,EAP,,,Coloplast Fistula Wound Mgr.-small 14021,$29.00,$0.00,$29.00,$0.00,$20.70,$0.00,$0.00,$20.70,$20.70,$0.00,$29.00,$0.00,$14.50,$22.97,$23.20,$0.00,$0.00,$0.00,$0.00,$0.00
80321959,EAP,,,System 156-228mm Ost Midi Ctf 2 Spout Drain Port,$127.00,$0.00,$127.00,$0.00,$90.64,$0.00,$0.00,$90.64,$90.64,$0.00,$127.00,$0.00,$63.50,$100.58,$101.60,$0.00,$0.00,$0.00,$0.00,$0.00
80321960,EAP,,,Coloplast Fistula Wound Mgr.-large 14041,$130.00,$0.00,$130.00,$0.00,$92.78,$0.00,$0.00,$92.78,$92.78,$0.00,$130.00,$0.00,$65.00,$102.96,$104.00,$0.00,$0.00,$0.00,$0.00,$0.00
80322020,EAP,HCPCS C1753,,CATHETER ULTRASOUND .035IN 8.5FR 90CM 100CM OTW RADIOPQ,"$2,500.00",$0.00,"$2,500.00","$1,357.50","$1,784.25",$0.00,$430.74,"$1,784.25","$1,784.25",$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
80322156,EAP,HCPCS C1725,,Catheter Baldilat 2.5mm 30mm Coron Rapex Ult Lp,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80322157,EAP,HCPCS C1725,,Catheter Baldilat 2mm 25mm Coron Rapex Ult Lp,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80322159,EAP,HCPCS C1725,,CATHETER BALDILAT ULTRA LP 5FR 1.5MM 12MM 2 LUMEN,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80322160,EAP,HCPCS C1874,,Catheter Baldilat 1.5mm 8mm Coron Rapex Ult Lp,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80322163,EAP,HCPCS C1725,,Catheter Baldilat 3mm 25mm Coron Rapex Ult Lp,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80322164,EAP,HCPCS C1725,,Catheter Baldilat 3mm 20mm Coron Rapex Ult Lp,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80322165,EAP,HCPCS C1725,,Catheter Baldilat 3mm 8mm Coron Rapex Ult Lp,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80322166,EAP,HCPCS C1725,,Catheter Baldilat 2.5mm 25mm Coron Rapex Ult Lp,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80322167,EAP,HCPCS C1725,,Trek Coronary Dilatation Catheter 2.50 Mm X 8 Mm / Rapid-exchange,$213.00,$0.00,$213.00,$115.66,$152.02,$0.00,$36.70,$152.02,$152.02,$37.29,$213.00,$0.00,$106.50,$168.70,$170.40,$0.00,$33.33,$0.00,$33.91,$0.00
80322168,EAP,HCPCS C1725,,Catheter Baldilat 2mm 20mm Coron Rapex Ult Lp,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80322169,EAP,HCPCS C1725,,Catheter Baldilat 2mm 8mm Coron Rapex Ult Lp,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80322170,EAP,HCPCS C1725,,CATHETER BALDILAT ULTRA LP 5FR 1.5MM 15MM 2 LUMEN,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80322173,EAP,HCPCS C1769,,Guidewire Vasc 190cm .014in Jointless Sprg Coil,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
80322174,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in Core To Tip Radiopq,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
80322178,EAP,HCPCS C1769,,Guidewire Vasc 300cm .014in Jointless Sprg Coil,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
80322247,EAP,HCPCS A6213,,Dressing 6x6in Adh Hydrofera Foam Blue,$336.00,$0.00,$336.00,$0.00,$239.80,$0.00,$0.00,$239.80,$239.80,$0.00,$336.00,$0.00,$168.00,$266.11,$268.80,$0.00,$0.00,$0.00,$0.00,$0.00
80322311,EAP,HCPCS C1769,,GUIDEWIRE VASC 180CM ASAHI PTCA SION BLUE,$375.00,$0.00,$375.00,$203.63,$267.64,$0.00,$64.61,$267.64,$267.64,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
80322312,EAP,HCPCS C1769,,GUIDEWIRE VASC 180CM .014IN STR 3CM SION ASAHI SS,$375.00,$0.00,$375.00,$203.63,$267.64,$0.00,$64.61,$267.64,$267.64,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
80322313,EAP,HCPCS C1769,,GUIDEWIRE VASC 300CM .014IN 3 RADIOPQ SEG STR 3CM,$375.00,$0.00,$375.00,$203.63,$267.64,$0.00,$64.61,$267.64,$267.64,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
80322314,EAP,HCPCS C1769,,GUIDEWIRE VASC RG3,$575.00,$0.00,$575.00,$312.23,$410.38,$0.00,$99.07,$410.38,$410.38,$100.68,$575.00,$0.00,$287.50,$455.40,$460.00,$0.00,$89.99,$0.00,$91.54,$0.00
80322339,EAP,HCPCS C1887,,CATHETER GUID AL1 CURVE 8FR 90CM CORON SH LNCHR,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
80322340,EAP,HCPCS C1887,,CATHETER GUID 3DRC CURVE 8FR 90CM CORON LNCHR,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
80322342,EAP,HCPCS C1887,,CATHETER GUID AL1.5 CURVE 8FR .09IN 90CM CORON,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
80322343,EAP,HCPCS C1887,,CATHETER GUID AL1.5 CURVE 8FR 90CM CORON SH LNCHR,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
80322347,EAP,HCPCS C1887,,CATHETER GUID XB3.5 CURVE 8FR 90CM CORON SH LNCHR,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
80322349,EAP,HCPCS C1887,,CATHETER GUID XB4 CURVE 8FR 90CM CORON SH LNCHR,$163.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$129.10,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
80322411,EAP,Custom 80322411,,OMNI FLUSH (VCF) 5FR 100CM,$35.00,$0.00,$35.00,$0.00,$24.98,$0.00,$0.00,$24.98,$24.98,$0.00,$35.00,$0.00,$17.50,$27.72,$28.00,$0.00,$0.00,$0.00,$0.00,$0.00
80322620,EAP,HCPCS C1750,,Kit Cath 61cm Palindrome Prcs Smtr Tip 44cm Chrnc,"$1,445.00",$0.00,"$1,445.00",$784.64,"$1,031.30",$0.00,$248.97,"$1,031.30","$1,031.30",$253.01,"$1,445.00",$0.00,$722.50,"$1,144.44","$1,156.00",$0.00,$226.14,$0.00,$230.04,$0.00
80322779,EAP,Custom 80322779,,Set Ndl 15ga 45mm Strl Lf Ezio Ez-cnct Wrst Band Std Ll Cath,$340.00,$0.00,$340.00,$0.00,$242.66,$0.00,$0.00,$242.66,$242.66,$0.00,$340.00,$0.00,$170.00,$269.28,$272.00,$0.00,$0.00,$0.00,$0.00,$0.00
80323591,EAP,,,Stabilit First Fracture Kit With Powercurve,"$7,000.00",$0.00,"$7,000.00",$0.00,"$4,995.90",$0.00,$0.00,"$4,995.90","$4,995.90",$0.00,"$7,000.00",$0.00,"$3,500.00","$5,544.00","$5,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
80323627,EAP,HCPCS C1874,,Stent Vascular  Zilver Ptx 125cm 80mm 100mm Od6 Fr,"$4,488.00",$0.00,"$4,488.00","$2,436.98","$3,203.09",$0.00,$773.26,"$3,203.09","$3,203.09",$785.81,"$4,488.00",$0.00,"$2,244.00","$3,554.50","$3,590.40",$0.00,$702.37,$0.00,$714.49,$0.00
80323828,EAP,HCPCS C1769,,GUIDEWIRE VASC 190CM .014IN STRBL RADIOPQ KINK RST,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
80323833,EAP,Custom 80323833,,IMPELLA RP US HDE PUMP SET,"$62,500.00",$0.00,"$62,500.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$62,500.00",$0.00,"$31,250.00","$49,500.00","$50,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
80324729,EAP,Custom 80324729,,TURNPIKE CATHETER LP 135CM,"$1,313.00",$0.00,"$1,313.00",$0.00,$937.09,$0.00,$0.00,$937.09,$937.09,$0.00,"$1,313.00",$0.00,$656.50,"$1,039.90","$1,050.40",$0.00,$0.00,$0.00,$0.00,$0.00
80324730,EAP,Custom 80324730,,TURNPIKE CATHETER LP 150CM,"$1,488.00",$0.00,"$1,488.00",$0.00,"$1,061.99",$0.00,$0.00,"$1,061.99","$1,061.99",$0.00,"$1,488.00",$0.00,$744.00,"$1,178.50","$1,190.40",$0.00,$0.00,$0.00,$0.00,$0.00
80324863,EAP,HCPCS C1874,,Stent Endoprsth Sprfc Fem Art Ilium 10cm 7mm 7fr,"$8,950.00",$0.00,"$8,950.00","$4,027.50","$5,158.80",$0.00,"$1,542.04","$5,158.80","$6,387.62","$1,567.07","$8,950.00",$0.00,"$4,475.00","$7,088.40","$7,160.00",$0.00,"$1,400.68",$0.00,"$1,424.84",$0.00
80324866,EAP,HCPCS C1892,,Introd Shth 9fr 13cm Optiseal,$130.00,$0.00,$130.00,$70.59,$92.78,$0.00,$22.40,$92.78,$92.78,$22.76,$130.00,$0.00,$65.00,$102.96,$104.00,$0.00,$20.35,$0.00,$20.70,$0.00
80325074,EAP,HCPCS C1773,,Snare Vasc 47in .71-1.18in .055in .074in Ensnr,$828.00,$0.00,$828.00,$449.60,$590.94,$0.00,$142.66,$590.94,$590.94,$144.98,$828.00,$0.00,$414.00,$655.78,$662.40,$0.00,$129.58,$0.00,$131.82,$0.00
80325086,EAP,HCPCS C1817,,Occluder Cardio 25mm Spt Sft Wire Frm Flrscp Img,"$19,778.00",$0.00,"$19,778.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$14,115.56",$0.00,"$19,778.00",$0.00,"$9,889.00","$15,664.18","$15,822.40",$0.00,$0.00,$0.00,$0.00,$0.00
80325087,EAP,HCPCS C1817,,Occluder Cardio 30mm Spt Sft Wire Frm Flrscp Img,"$19,778.00",$0.00,"$19,778.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$14,115.56",$0.00,"$19,778.00",$0.00,"$9,889.00","$15,664.18","$15,822.40",$0.00,$0.00,$0.00,$0.00,$0.00
80325319,EAP,,,Spinestar Ablation Instr 17.5 Cm L15 Mm L10 Mm Od11 Ga Therm,"$7,250.00",$0.00,"$7,250.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$7,250.00",$0.00,"$3,625.00","$5,742.00","$5,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
80325443,EAP,HCPCS C1887,,Sheath Guid 65cm 6fr .109in .087in Pn Dstn Str Ss,$225.00,$0.00,$225.00,$122.18,$160.58,$0.00,$38.77,$160.58,$160.58,$39.40,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$35.21,$0.00,$35.82,$0.00
80325494,EAP,HCPCS C1725,,Catheter Angio 125cm 6fr Crds St+ Jr4 Curve Coron,$84.00,$0.00,$84.00,$45.61,$59.95,$0.00,$14.47,$59.95,$59.95,$14.71,$84.00,$0.00,$42.00,$66.53,$67.20,$0.00,$13.15,$0.00,$13.37,$0.00
80325495,EAP,HCPCS C1725,,Catheter Angio 125cm 6fr Crds St+ Jl4 Curve Coron,$84.00,$0.00,$84.00,$45.61,$59.95,$0.00,$14.47,$59.95,$59.95,$14.71,$84.00,$0.00,$42.00,$66.53,$67.20,$0.00,$13.15,$0.00,$13.37,$0.00
80325526,EAP,HCPCS C1876,,INNOVA 5MM X 60MM X 75CM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,"$1,516.61","$1,516.61",$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
80325555,EAP,HCPCS C1876,,STENT VASC BLUE 40MM 6MM INNOVA SPRFC FEM ART SLF,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,"$1,516.61","$1,516.61",$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
80325566,EAP,HCPCS C1876,,INNOVA 8MM X 20MM X 130CM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,"$1,516.61","$1,516.61",$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
80325567,EAP,HCPCS C1876,,INNOVA 8MM X 40MM X 130CM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,"$1,516.61","$1,516.61",$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
80325568,EAP,HCPCS C1876,,INNOVA 8MM X 60MM X 130CM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,"$1,516.61","$1,516.61",$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
80325569,EAP,HCPCS C1876,,INNOVA 8MM X 80MM X 130CM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,"$1,516.61","$1,516.61",$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
80325650,EAP,HCPCS C1757,,SYSTEM THRMB ZELANTEDVT,"$7,313.00",$0.00,"$7,313.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$7,313.00",$0.00,"$3,656.50","$5,791.90","$5,850.40",$0.00,$0.00,$0.00,$0.00,$0.00
80325671,EAP,HCPCS C1874,,STENT VASC 60MM 6MM GORE TIGRIS CBAS NTNL FLPLMR,"$3,738.00",$0.00,"$3,738.00","$1,682.10","$2,667.81",$0.00,$644.04,"$2,667.81","$2,667.81",$654.49,"$3,738.00",$0.00,"$1,869.00","$2,960.50","$2,990.40",$0.00,$585.00,$0.00,$595.09,$0.00
80325673,EAP,HCPCS C1874,,STENT VASC 100MM 6MM GORE TIGRIS CBAS NTNL FLPLMR,"$3,738.00",$0.00,"$3,738.00","$1,682.10","$2,667.81",$0.00,$644.04,"$2,667.81","$2,667.81",$654.49,"$3,738.00",$0.00,"$1,869.00","$2,960.50","$2,990.40",$0.00,$585.00,$0.00,$595.09,$0.00
80325675,EAP,HCPCS C1874,,STENT VASC 60MM 7MM GORE TIGRIS CBAS NTNL FLPLMR,"$3,738.00",$0.00,"$3,738.00","$1,682.10","$2,667.81",$0.00,$644.04,"$2,667.81","$2,667.81",$654.49,"$3,738.00",$0.00,"$1,869.00","$2,960.50","$2,990.40",$0.00,$585.00,$0.00,$595.09,$0.00
80325676,EAP,HCPCS C1874,,STENT VASC 100MM 7MM GORE TIGRIS CBAS NTNL FLPLMR,"$3,738.00",$0.00,"$3,738.00","$1,682.10","$2,667.81",$0.00,$644.04,"$2,667.81","$2,667.81",$654.49,"$3,738.00",$0.00,"$1,869.00","$2,960.50","$2,990.40",$0.00,$585.00,$0.00,$595.09,$0.00
80326084,EAP,HCPCS C1887,,CATHETER ANGIO RADIALTIGER CURVE 6FR 4MM 110CM,$88.00,$0.00,$88.00,$47.78,$62.81,$0.00,$15.16,$62.81,$62.81,$15.41,$88.00,$0.00,$44.00,$69.70,$70.40,$0.00,$13.77,$0.00,$14.01,$0.00
80326288,EAP,HCPCS C1769,,Guidewire Vasc 325cm .012in Viperwire Adv Coron,$488.00,$0.00,$488.00,$264.98,$348.29,$0.00,$84.08,$348.29,$348.29,$85.44,$488.00,$0.00,$244.00,$386.50,$390.40,$0.00,$76.37,$0.00,$77.69,$0.00
80326302,EAP,HCPCS C1724,,CATHETER ATHRCM 145CM STLTH 360 1.25MM ORBTL CLS,"$9,488.00",$0.00,"$9,488.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$9,488.00",$0.00,"$4,744.00","$7,514.50","$7,590.40",$0.00,$0.00,$0.00,$0.00,$0.00
80326668,EAP,HCPCS C1722,,Generator Pcmkr 83.1x69.1mm Eblm S-icd 12.7mm 59.5,"$42,500.00",$0.00,"$42,500.00","$19,125.00","$5,158.80",$0.00,"$7,322.54","$5,158.80","$30,332.25","$7,441.41","$42,500.00",$0.00,"$21,250.00","$33,660.00","$34,000.00",$0.00,"$6,651.25",$0.00,"$6,766.00",$0.00
80332586,EAP,HCPCS C1751,,Catheter Angel,"$5,625.00",$0.00,"$5,625.00","$3,054.38","$4,014.56",$0.00,$969.16,"$4,014.56","$4,014.56",$984.89,"$5,625.00",$0.00,"$2,812.50","$4,455.00","$4,500.00",$0.00,$880.31,$0.00,$895.50,$0.00
80332596,EAP,HCPCS C1757,,Retriever Escp 3mm 20mm Trevo Xp Provue,"$13,118.00",$0.00,"$13,118.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$13,118.00",$0.00,"$6,559.00","$10,389.46","$10,494.40",$0.00,$0.00,$0.00,$0.00,$0.00
80333053,EAP,HCPCS C1769,,GUIDEWIRE VASC 185CM STRL LF VERRATA + PRSS DISP,"$1,688.00",$0.00,"$1,688.00",$916.58,"$1,204.73",$0.00,$290.83,"$1,204.73","$1,204.73",$295.56,"$1,688.00",$0.00,$844.00,"$1,336.90","$1,350.40",$0.00,$264.17,$0.00,$268.73,$0.00
80338397,EAP,HCPCS C1769,,Guidewire Vasc 180cm .035in Flx Tp Ang 25cm 5cm,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$285.48,$285.48,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
80339398,EAP,HCPCS C1874,,Stent Eprsth .035in 9mm 13mm 8,"$6,725.00",$0.00,"$6,725.00","$3,026.25","$4,799.63",$0.00,"$1,158.68","$4,799.63","$4,799.63","$1,177.49","$6,725.00",$0.00,"$3,362.50","$5,326.20","$5,380.00",$0.00,"$1,052.46",$0.00,"$1,070.62",$0.00
80339402,EAP,HCPCS C1874,,Stent Endoprsth 29mm 11mm 16sq Mm 8fr Gore Vbhn,"$8,548.00",$0.00,"$8,548.00","$3,846.60","$5,158.80",$0.00,"$1,472.78","$5,158.80","$6,100.71","$1,496.69","$8,548.00",$0.00,"$4,274.00","$6,770.02","$6,838.40",$0.00,"$1,337.76",$0.00,"$1,360.84",$0.00
80339410,EAP,HCPCS C1874,,Stent Endoprsth 39mm 7mm 11mm 7fr Gore Vbhn 135cm,"$8,548.00",$0.00,"$8,548.00","$3,846.60","$5,158.80",$0.00,"$1,472.78","$5,158.80","$6,100.71","$1,496.69","$8,548.00",$0.00,"$4,274.00","$6,770.02","$6,838.40",$0.00,"$1,337.76",$0.00,"$1,360.84",$0.00
80339412,EAP,HCPCS C1874,,Stent Endoprsth 39mm 8mm 11mm 7fr Gore Vbhn 135cm,"$8,548.00",$0.00,"$8,548.00","$3,846.60","$5,158.80",$0.00,"$1,472.78","$5,158.80","$6,100.71","$1,496.69","$8,548.00",$0.00,"$4,274.00","$6,770.02","$6,838.40",$0.00,"$1,337.76",$0.00,"$1,360.84",$0.00
80339426,EAP,HCPCS C1874,,Stent Endoprsth 59mm 7mm 11mm 7fr Gore Vbhn 135cm,"$8,548.00",$0.00,"$8,548.00","$3,846.60","$5,158.80",$0.00,"$1,472.78","$5,158.80","$6,100.71","$1,496.69","$8,548.00",$0.00,"$4,274.00","$6,770.02","$6,838.40",$0.00,"$1,337.76",$0.00,"$1,360.84",$0.00
80339428,EAP,HCPCS C1874,,Stent Endoprsth 59mm 8mm 11mm 7fr Gore Vbhn 135cm,"$8,138.00",$0.00,"$8,138.00","$3,662.10","$5,158.80",$0.00,"$1,402.14","$5,158.80","$5,808.09","$1,424.90","$8,138.00",$0.00,"$4,069.00","$6,445.30","$6,510.40",$0.00,"$1,273.60",$0.00,"$1,295.57",$0.00
80339456,EAP,HCPCS C1887,,Catheter Guid Blue Ylw 100cm 6fr Crds Vsbr 3drc,$93.00,$0.00,$93.00,$50.50,$66.37,$0.00,$16.02,$66.37,$66.37,$16.28,$93.00,$0.00,$46.50,$73.66,$74.40,$0.00,$14.55,$0.00,$14.81,$0.00
80339903,EAP,,,Catheter Angio Tpr Loprfl Rc2 Crv 5fr 65cm Strl Trnb Ad,$313.00,$0.00,$313.00,$0.00,$223.39,$0.00,$0.00,$223.39,$223.39,$0.00,$313.00,$0.00,$156.50,$247.90,$250.40,$0.00,$0.00,$0.00,$0.00,$0.00
80340523,EAP,HCPCS C1894,,Sheath Guid 90cm 2.5fr Chk-flo Flxr Raabe,$188.00,$0.00,$188.00,$102.08,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
80341173,EAP,HCPCS C1769,,Guidewire Vasc 260cm .035in Radiopq Flpy Flx Tp,$551.00,$0.00,$551.00,$299.19,$393.25,$0.00,$94.93,$393.25,$393.25,$96.48,$551.00,$0.00,$275.50,$436.39,$440.80,$0.00,$86.23,$0.00,$87.72,$0.00
80341288,EAP,HCPCS C1769,,Guidewire Vasc Ang Shrt Tpr .018in 60cm 7cm Cp Mdrl Dist Tip,$106.00,$0.00,$106.00,$57.56,$75.65,$0.00,$18.26,$75.65,$75.65,$18.56,$106.00,$0.00,$53.00,$83.95,$84.80,$0.00,$16.59,$0.00,$16.88,$0.00
80341936,EAP,HCPCS C1769,,Guidewire Vasc 15cm Strg 2 Crv Tpr .035in 180cm 7cm Lndrqs,$753.00,$0.00,$753.00,$408.88,$537.42,$0.00,$129.74,$537.42,$537.42,$131.84,$753.00,$0.00,$376.50,$596.38,$602.40,$0.00,$117.84,$0.00,$119.88,$0.00
80349650,EAP,,,KIT MCTRDCR .018IN TPR 5FR 40CM 7CM VSI SMTH NDL GW REG DIL,$474.00,$0.00,$474.00,$0.00,$338.29,$0.00,$0.00,$338.29,$338.29,$0.00,$474.00,$0.00,$237.00,$375.41,$379.20,$0.00,$0.00,$0.00,$0.00,$0.00
80359050,EAP,HCPCS C1753,,Catheter Us Kodama,$300.00,$0.00,$300.00,$162.90,$214.11,$0.00,$51.69,$214.11,$214.11,$52.53,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$46.95,$0.00,$47.76,$0.00
80359064,EAP,HCPCS A6198,,Dressing Brn 48x4in Strl Lf Actct Flx 3 Anmc Brr 1 Lyr Knit,$211.00,$0.00,$211.00,$0.00,$150.59,$0.00,$0.00,$150.59,$150.59,$0.00,$211.00,$0.00,$105.50,$167.11,$168.80,$0.00,$0.00,$0.00,$0.00,$0.00
80370959,EAP,HCPCS C1874,,System Coron Stent 24mm 2.75mm Cbr Pzf Polyzene-f,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,"$1,516.61","$1,516.61",$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
80370960,EAP,HCPCS C1874,,System Coron Stent 30mm 2.75mm Cbr Pzf Polyzene-f,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,"$1,516.61","$1,516.61",$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
80370964,EAP,HCPCS C1874,,System Cor Stnt 3mm 18mm Cbr Pzf Rx Dlv Sys Polyzene-f Cocr,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,"$1,516.61","$1,516.61",$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
80370965,EAP,HCPCS C1874,,System Coron Stent 24mm 3mm Cbr Pzf Polyzene-f,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,"$1,516.61","$1,516.61",$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
80370966,EAP,HCPCS C1874,,System Coron Stent 30mm 3mm Cbr Pzf Cocr Hydphi,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,"$1,516.61","$1,516.61",$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
80370969,EAP,HCPCS C1876,,System Coronary Stent Cobra Pzf Polyzene-f L15mm,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,"$1,516.61","$1,516.61",$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
80370970,EAP,HCPCS C1876,,System Cor Stnt 3.5mm 18mm Cbr Pzf Rx Dlv Sys Polyzene-f,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,"$1,516.61","$1,516.61",$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
80370972,EAP,HCPCS C1876,,System Coronary Stent Cobra L30mm Id3.5mm Rapid Exchange,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,"$1,516.61","$1,516.61",$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
80370976,EAP,HCPCS C1876,,System Coronary Stent Cobra L18mm Id4mm Rapid Exchange,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,"$1,516.61","$1,516.61",$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
80370978,EAP,HCPCS C1876,,System Coronary Stent Cobra L30 Mm Id4 Mm Rapid Exchange,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,"$1,516.61","$1,516.61",$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
80371591,EAP,HCPCS C1874,,STENT EPRSTH 8MM 7FR 10CM 120CM VBHN DLV SYS HEP SPRFC FEM,"$8,738.00",$0.00,"$8,738.00","$3,932.10","$5,158.80",$0.00,"$1,505.51","$5,158.80","$6,236.31","$1,529.95","$8,738.00",$0.00,"$4,369.00","$6,920.50","$6,990.40",$0.00,"$1,367.50",$0.00,"$1,391.09",$0.00
80379042,EAP,HCPCS C1752,,Kit Cath 13fr 20cm Strl Pwr-trialysis 3 Lum Shrt Term Dlys,$596.00,$0.00,$596.00,$0.00,$425.37,$0.00,$0.00,$425.37,$425.37,$0.00,$596.00,$0.00,$298.00,$472.03,$476.80,$0.00,$0.00,$0.00,$0.00,$0.00
80379099,EAP,HCPCS C2621,,Percepta Quad Crtp Mri Surescan,"$16,500.00",$0.00,"$16,500.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$11,776.05",$0.00,"$16,500.00",$0.00,"$8,250.00","$13,068.00","$13,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
80379103,EAP,HCPCS C1729,,Catheter Primafit Sage,$27.00,$0.00,$27.00,$14.66,$19.27,$0.00,$4.65,$19.27,$19.27,$4.73,$27.00,$0.00,$13.50,$21.38,$21.60,$0.00,$4.23,$0.00,$4.30,$0.00
80379488,EAP,HCPCS C1726,,Rigiflex Ii Single Use Achalasia Balloon Dilator,"$1,690.00",$0.00,"$1,690.00",$917.67,"$1,206.15",$0.00,$291.18,"$1,206.15","$1,206.15",$295.91,"$1,690.00",$0.00,$845.00,"$1,338.48","$1,352.00",$0.00,$264.49,$0.00,$269.05,$0.00
80379641,EAP,HCPCS C1786,,SYSTEM DLV 3.2V 120MAH 6.7MM 25.9MM MICRA SURESCAN HBRD,"$26,875.00",$0.00,"$26,875.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$19,180.69",$0.00,"$26,875.00",$0.00,"$13,437.50","$21,285.00","$21,500.00",$0.00,$0.00,$0.00,$0.00,$0.00
80379642,EAP,HCPCS C1894,,INTRODUCER SHTH 23FR 55.7CM 69.9CM MICRA STPCK RADOPQ DIL,"$1,500.00",$0.00,"$1,500.00",$814.50,"$1,070.55",$0.00,$258.44,"$1,070.55","$1,070.55",$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
80379742,EAP,Custom 80379742,,Set Hmdial 27x22x9cm 165ml Strl Lf Prismaflex Hmfltr Bg,$400.00,$0.00,$400.00,$0.00,$285.48,$0.00,$0.00,$285.48,$285.48,$0.00,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$0.00,$0.00,$0.00,$0.00
80379801,EAP,HCPCS C2623,,CATHETER BLNDIL 7MM 75CM 60MM LUTONIX DRG COAT ACPT .035IN,"$3,500.00",$0.00,"$3,500.00","$1,900.50","$2,497.95",$0.00,$603.03,"$2,497.95","$2,497.95",$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
80379803,EAP,HCPCS C2623,,CATHETER BLNDIL 8MM 75CM 60MM LUTONIX DRG COAT ACPT .035IN,"$4,250.00",$0.00,"$4,250.00","$2,307.75","$3,033.23",$0.00,$732.25,"$3,033.23","$3,033.23",$744.14,"$4,250.00",$0.00,"$2,125.00","$3,366.00","$3,400.00",$0.00,$665.13,$0.00,$676.60,$0.00
80379806,EAP,HCPCS C2623,,CATHETER BLNDIL 10MM 75CM 40MM LUTONIX DRG COAT ACPT .035IN,"$4,250.00",$0.00,"$4,250.00","$2,307.75","$3,033.23",$0.00,$732.25,"$3,033.23","$3,033.23",$744.14,"$4,250.00",$0.00,"$2,125.00","$3,366.00","$3,400.00",$0.00,$665.13,$0.00,$676.60,$0.00
80390076,EAP,HCPCS C2623,,Catheter Baldilat 4mm 130cm 100mm Pcltxl Latex,"$3,500.00",$0.00,"$3,500.00","$1,900.50","$2,497.95",$0.00,$603.03,"$2,497.95","$2,497.95",$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
80390081,EAP,HCPCS C2623,,Catheter Baldilat 4mm 130cm 60mm Pcltxl Latex Free,"$3,500.00",$0.00,"$3,500.00","$1,900.50","$2,497.95",$0.00,$603.03,"$2,497.95","$2,497.95",$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
80390085,EAP,HCPCS C2623,,Catheter Baldilat 5mm 130cm 100mm Pcltxl Latex,"$3,500.00",$0.00,"$3,500.00","$1,900.50","$2,497.95",$0.00,$603.03,"$2,497.95","$2,497.95",$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
80390093,EAP,HCPCS C2623,,Catheter Baldilat 5mm 130cm 60mm Pcltxl Latex Free,"$3,500.00",$0.00,"$3,500.00","$1,900.50","$2,497.95",$0.00,$603.03,"$2,497.95","$2,497.95",$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
80390101,EAP,HCPCS C2623,,Catheter Blndil 5f 6mm 130cm 150mm Lutonix,"$4,250.00",$0.00,"$4,250.00","$2,307.75","$3,033.23",$0.00,$732.25,"$3,033.23","$3,033.23",$744.14,"$4,250.00",$0.00,"$2,125.00","$3,366.00","$3,400.00",$0.00,$665.13,$0.00,$676.60,$0.00
80397351,EAP,HCPCS C1898,,Lead Pacing Capsure Sense Steroid Eluting L52 Cm Atrium Right Vent,"$1,013.00",$0.00,"$1,013.00",$455.85,$722.98,$0.00,$174.53,$722.98,$722.98,$177.37,"$1,013.00",$0.00,$506.50,$802.30,$810.40,$0.00,$158.53,$0.00,$161.27,$0.00
80397520,EAP,HCPCS C1887,,Catheter Gd 9fr 7.2fr 45cm Atn Cmnd Surevalve Lh,$588.00,$0.00,$588.00,$319.28,$419.66,$0.00,$101.31,$419.66,$419.66,$102.95,$588.00,$0.00,$294.00,$465.70,$470.40,$0.00,$92.02,$0.00,$93.61,$0.00
80397527,EAP,HCPCS C1887,,Catheter Gd .035in Mp Rt Crv 9fr 7.2fr 45cm Atn Cmnd,$588.00,$0.00,$588.00,$319.28,$419.66,$0.00,$101.31,$419.66,$419.66,$102.95,$588.00,$0.00,$294.00,$465.70,$470.40,$0.00,$92.02,$0.00,$93.61,$0.00
80397542,EAP,HCPCS C1777,,Lead Pacing Sprint Quattro Secure L58 Cm 1 Coil Defib,"$7,875.00",$0.00,"$7,875.00","$3,543.75","$5,158.80",$0.00,"$1,356.82","$5,158.80","$5,620.39","$1,378.85","$7,875.00",$0.00,"$3,937.50","$6,237.00","$6,300.00",$0.00,"$1,232.44",$0.00,"$1,253.70",$0.00
80397543,EAP,HCPCS C1777,,Lead Pacing Sprint Quattro Secure Steroid Eluting Silicone Helix L65,"$7,875.00",$0.00,"$7,875.00","$3,543.75","$5,158.80",$0.00,"$1,356.82","$5,158.80","$5,620.39","$1,378.85","$7,875.00",$0.00,"$3,937.50","$6,237.00","$6,300.00",$0.00,"$1,232.44",$0.00,"$1,253.70",$0.00
80398493,EAP,HCPCS C1769,,GUIDEWIRE VASC 300CM .014IN RADIOPQ KINK RST STR 3,$187.50,$0.00,$187.50,$101.81,$133.82,$0.00,$32.31,$133.82,$133.82,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
80398507,EAP,HCPCS C1769,,GUIDEWIRE VASC 300CM .014IN STR 3CM HTORQ WHSPR LS,$187.50,$0.00,$187.50,$101.81,$133.82,$0.00,$32.31,$133.82,$133.82,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
80398619,EAP,HCPCS C1874,,System Coron Stent 38mm 4mm Xience Srr Everolimus,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
80398620,EAP,HCPCS C1874,,System Coron Stent 33mm 4mm Xience Srr Everolimus,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
80398621,EAP,HCPCS C1874,,System Coron Stent 28mm 4mm Xience Srr Everolimus,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
80398622,EAP,HCPCS C1874,,System Coron Stent 23mm 4mm Xience Srr Everolimus,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
80398629,EAP,HCPCS C1874,,System Coron Stent 18mm 4mm Xience Srr Everolimus,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
80398631,EAP,HCPCS C1874,,System Coron Stent 15mm 4mm Xience Srr Everolimus,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
80398632,EAP,HCPCS C1874,,System Coron Stent 12mm 4mm Xience Srr Everolimus,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
80398634,EAP,HCPCS C1874,,System Coron Stent 8mm 4mm Xience Srr Everolimus,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
80398635,EAP,HCPCS C1874,,System Coron Stent 38mm 3.5mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
80398636,EAP,HCPCS C1874,,System Coron Stent 33mm 3.5mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
80398638,EAP,HCPCS C1874,,System Coron Stent 28mm 3.5mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
80398639,EAP,HCPCS C1874,,System Coron Stent 23mm 3.5mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
80398640,EAP,HCPCS C1874,,System Coron Stent 18mm 3.5mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
80398647,EAP,HCPCS C1874,,System Coron Stent 15mm 3.5mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
80398650,EAP,HCPCS C1874,,System Coron Stent 12mm 3.5mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
80398655,EAP,HCPCS C1874,,System Coron Stent 8mm 3.5mm Xience Srr Everolimus,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
80398661,EAP,HCPCS C1874,,System Coron Stent 38mm 3.25mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
80398666,EAP,HCPCS C1874,,System Coron Stent 33mm 3.25mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
80398672,EAP,HCPCS C1874,,System Coron Stent 28mm 3.25mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
80398673,EAP,HCPCS C1874,,System Coron Stent 23mm 3.25mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
80398679,EAP,HCPCS C1874,,System Coron Stent 18mm 3.25mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
80398680,EAP,HCPCS C1874,,System Coron Stent 15mm 3.25mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
80398682,EAP,HCPCS C1874,,System Coron Stent 12mm 3.25mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
80398683,EAP,HCPCS C1874,,System Coron Stent 8mm 3.25mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
80398684,EAP,HCPCS C1874,,System Coron Stent 38mm 3mm Xience Srr Everolimus,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
80398685,EAP,HCPCS C1874,,System Coron Stent 33mm 3mm Xience Srr Everolimus,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
80398686,EAP,HCPCS C1874,,System Coron Stent 28mm 3mm Xience Srr Everolimus,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
80398687,EAP,HCPCS C1874,,System Coron Stent 23mm 3mm Xience Srr Everolimus,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
80398688,EAP,HCPCS C1874,,System Coron Stent 18mm 3mm Xience Srr Everolimus,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
80398689,EAP,HCPCS C1874,,System Coron Stent 15mm 3mm Xience Srr Everolimus,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
80398690,EAP,HCPCS C1874,,System Coron Stent 12mm 3mm Xience Srr Everolimus,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
80398691,EAP,HCPCS C1874,,System Coron Stent 8mm 3mm Xience Srr Everolimus,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
80398692,EAP,HCPCS C1874,,System Coron Stent 38mm 2.75mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
80398693,EAP,HCPCS C1874,,System Coron Stent 33mm 2.75mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
80398699,EAP,HCPCS C1874,,System Coron Stent 28mm 2.75mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
80398700,EAP,HCPCS C1874,,System Coron Stent 23mm 2.75mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
80398701,EAP,HCPCS C1874,,System Coron Stent 18mm 2.75mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
80398702,EAP,HCPCS C1874,,System Coron Stent 15mm 2.75mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
80398703,EAP,HCPCS C1874,,System Coron Stent 12mm 2.75mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
80398704,EAP,HCPCS C1874,,System Coron Stent 8mm 2.75mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
80398705,EAP,HCPCS C1874,,System Coron Stent 38mm 2.5mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
80398706,EAP,HCPCS C1874,,System Coron Stent 33mm 2.5mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
80398707,EAP,HCPCS C1874,,System Coron Stent 28mm 2.5mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
80398708,EAP,HCPCS C1874,,System Coron Stent 23mm 2.5mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
80398709,EAP,HCPCS C1874,,System Coron Stent 18mm 2.5mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
80398710,EAP,HCPCS C1874,,System Coron Stent 15mm 2.5mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
80398770,EAP,HCPCS C1874,,System Coron Stent 12mm 2.5mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
80398771,EAP,HCPCS C1874,,System Coron Stent 8mm 2.25mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
80398772,EAP,HCPCS C1874,,System Coron Stent 12mm 2.25mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
80398773,EAP,HCPCS C1874,,System Coron Stent 15mm 2.25mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
80398774,EAP,HCPCS C1874,,System Coron Stent 18mm 2.25mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
80398775,EAP,HCPCS C1874,,System Coron Stent 23mm 2.25mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
80398776,EAP,HCPCS C1874,,System Coron Stent 28mm 2.25mm Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
80398777,EAP,HCPCS C1874,,Stent Coron 33mm 2.25mm Everolimus Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
80398778,EAP,HCPCS C1874,,Stent Coron 38mm 2.25mm Everolimus Xience Srr,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
80398779,EAP,HCPCS C1874,,System Coron Stent 8mm 2.5mm Xience Srr Everolimus,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,"$2,141.10","$2,141.10",$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
80398790,EAP,HCPCS C1769,,GUIDEWIRE VASC 300CM .014IN RADIOPQ CORE TO TIP,$375.00,$0.00,$375.00,$203.63,$267.64,$0.00,$64.61,$267.64,$267.64,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
80399090,EAP,,,Advance Capsule Endoscopy Delivery Device,$413.00,$0.00,$413.00,$0.00,$294.76,$0.00,$0.00,$294.76,$294.76,$0.00,$413.00,$0.00,$206.50,$327.10,$330.40,$0.00,$0.00,$0.00,$0.00,$0.00
80399207,EAP,HCPCS C1887,,Catheter Infus 10d 3.5fr 135cm Otw 2 Lum Brd Trq,"$1,068.00",$0.00,"$1,068.00",$579.92,$762.23,$0.00,$184.01,$762.23,$762.23,$187.00,"$1,068.00",$0.00,$534.00,$845.86,$854.40,$0.00,$167.14,$0.00,$170.03,$0.00
80399275,EAP,HCPCS C1887,,CATHETER INTVN 5.1FR 150CM 13CM TRAPLINER RX GD XTN RADOPQ,"$1,625.00",$0.00,"$1,625.00",$882.38,"$1,159.76",$0.00,$279.98,"$1,159.76","$1,159.76",$284.52,"$1,625.00",$0.00,$812.50,"$1,287.00","$1,300.00",$0.00,$254.31,$0.00,$258.70,$0.00
80399276,EAP,HCPCS C1887,,CATHETER INTVN 5.7FR 150CM 13CM TRAPLINER RX GD XTN RADOPQ,"$1,625.00",$0.00,"$1,625.00",$882.38,"$1,159.76",$0.00,$279.98,"$1,159.76","$1,159.76",$284.52,"$1,625.00",$0.00,$812.50,"$1,287.00","$1,300.00",$0.00,$254.31,$0.00,$258.70,$0.00
80399277,EAP,HCPCS C1887,,CATHETER INTVN 6.5FR 150CM 13CM TRAPLINER RX GD XTN RADOPQ,"$1,625.00",$0.00,"$1,625.00",$882.38,"$1,159.76",$0.00,$279.98,"$1,159.76","$1,159.76",$284.52,"$1,625.00",$0.00,$812.50,"$1,287.00","$1,300.00",$0.00,$254.31,$0.00,$258.70,$0.00
80405583,EAP,HCPCS C1757,,CATHETER THRMB .044IN 140CM STRL LF INDG SYS ASP KT COR,"$4,850.00",$0.00,"$4,850.00",$0.00,"$3,461.45",$0.00,$0.00,"$3,461.45","$3,461.45",$0.00,"$4,850.00",$0.00,"$2,425.00","$3,841.20","$3,880.00",$0.00,$0.00,$0.00,$0.00,$0.00
80405584,EAP,Custom 80405584,,SEPARATOR THRMB STRL LF INDG SYS 4 DISP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,"$1,570.14","$1,570.14",$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
80405589,EAP,HCPCS C1874,,SYSTEM COR STNT 2MM 8MM 140CM RSLT ONYX RX DLV SYS RADOPQ 1,"$3,425.00",$0.00,"$3,425.00","$1,541.25","$2,444.42",$0.00,$590.11,"$2,444.42","$2,444.42",$599.69,"$3,425.00",$0.00,"$1,712.50","$2,712.60","$2,740.00",$0.00,$536.01,$0.00,$545.26,$0.00
80405590,EAP,HCPCS C1874,,SYSTEM COR STNT 2MM 12MM 140CM RSLT ONYX RX DLV SYS RADOPQ 1,"$3,425.00",$0.00,"$3,425.00","$1,541.25","$2,444.42",$0.00,$590.11,"$2,444.42","$2,444.42",$599.69,"$3,425.00",$0.00,"$1,712.50","$2,712.60","$2,740.00",$0.00,$536.01,$0.00,$545.26,$0.00
80405591,EAP,HCPCS C1874,,SYSTEM COR STNT 2MM 15MM 140CM RSLT ONYX RX DLV SYS RADOPQ 1,"$3,425.00",$0.00,"$3,425.00","$1,541.25","$2,444.42",$0.00,$590.11,"$2,444.42","$2,444.42",$599.69,"$3,425.00",$0.00,"$1,712.50","$2,712.60","$2,740.00",$0.00,$536.01,$0.00,$545.26,$0.00
80405592,EAP,HCPCS C1874,,SYSTEM COR STNT 2MM 18MM 140CM RSLT ONYX RX DLV SYS RADOPQ 1,"$3,425.00",$0.00,"$3,425.00","$1,541.25","$2,444.42",$0.00,$590.11,"$2,444.42","$2,444.42",$599.69,"$3,425.00",$0.00,"$1,712.50","$2,712.60","$2,740.00",$0.00,$536.01,$0.00,$545.26,$0.00
80405593,EAP,HCPCS C1874,,SYSTEM COR STNT 2MM 22MM 140CM RSLT ONYX RX DLV SYS RADOPQ 1,"$3,425.00",$0.00,"$3,425.00","$1,541.25","$2,444.42",$0.00,$590.11,"$2,444.42","$2,444.42",$599.69,"$3,425.00",$0.00,"$1,712.50","$2,712.60","$2,740.00",$0.00,$536.01,$0.00,$545.26,$0.00
80405594,EAP,HCPCS C1874,,SYSTEM COR STNT 2MM 26MM 140CM RSLT ONYX RX DLV SYS RADOPQ 1,"$3,425.00",$0.00,"$3,425.00","$1,541.25","$2,444.42",$0.00,$590.11,"$2,444.42","$2,444.42",$599.69,"$3,425.00",$0.00,"$1,712.50","$2,712.60","$2,740.00",$0.00,$536.01,$0.00,$545.26,$0.00
80405595,EAP,HCPCS C1874,,SYSTEM COR STNT 2MM 30MM 140CM RSLT ONYX RX DLV SYS RADOPQ 1,"$3,425.00",$0.00,"$3,425.00","$1,541.25","$2,444.42",$0.00,$590.11,"$2,444.42","$2,444.42",$599.69,"$3,425.00",$0.00,"$1,712.50","$2,712.60","$2,740.00",$0.00,$536.01,$0.00,$545.26,$0.00
80406242,EAP,Custom 80406242,,PLUG OCL 3MM 12X5.3MM MVP MECH DTCH FULL RESHEATHABLE NTNL,"$3,738.00",$0.00,"$3,738.00",$0.00,"$2,667.81",$0.00,$0.00,"$2,667.81","$2,667.81",$0.00,"$3,738.00",$0.00,"$1,869.00","$2,960.50","$2,990.40",$0.00,$0.00,$0.00,$0.00,$0.00
80406243,EAP,Custom 80406243,,PLUG OCL 5MM 12X6.5MM STRL LF MVP MECH DTCH FULL,"$3,738.00",$0.00,"$3,738.00",$0.00,"$2,667.81",$0.00,$0.00,"$2,667.81","$2,667.81",$0.00,"$3,738.00",$0.00,"$1,869.00","$2,960.50","$2,990.40",$0.00,$0.00,$0.00,$0.00,$0.00
80406244,EAP,Custom 80406244,,PLUG OCL MIC 7MM STRL LF MVP MECH VASC DISP V03,"$3,738.00",$0.00,"$3,738.00",$0.00,"$2,667.81",$0.00,$0.00,"$2,667.81","$2,667.81",$0.00,"$3,738.00",$0.00,"$1,869.00","$2,960.50","$2,990.40",$0.00,$0.00,$0.00,$0.00,$0.00
80406245,EAP,Custom 80406245,,PLUG OCL 9MM STRL LF MVP V03,"$3,738.00",$0.00,"$3,738.00",$0.00,"$2,667.81",$0.00,$0.00,"$2,667.81","$2,667.81",$0.00,"$3,738.00",$0.00,"$1,869.00","$2,960.50","$2,990.40",$0.00,$0.00,$0.00,$0.00,$0.00
80406248,EAP,HCPCS C1769,,GUIDEWIRE VASC .014IN 180CM STRL LF CNFNZ PRO 12 DISP,$333.00,$0.00,$333.00,$180.82,$237.66,$0.00,$57.37,$237.66,$237.66,$58.31,$333.00,$0.00,$166.50,$263.74,$266.40,$0.00,$52.11,$0.00,$53.01,$0.00
80406249,EAP,HCPCS C1769,,GUIDEWIRE VASC .014IN 300CM STRL LF FIELDER FC DISP,$198.00,$0.00,$198.00,$107.51,$141.31,$0.00,$34.11,$141.31,$141.31,$34.67,$198.00,$0.00,$99.00,$156.82,$158.40,$0.00,$30.99,$0.00,$31.52,$0.00
80406250,EAP,HCPCS C1769,,GUIDEWIRE VASC .014IN 180CM STRL LF FIELDER FC DISP,$198.00,$0.00,$198.00,$107.51,$141.31,$0.00,$34.11,$141.31,$141.31,$34.67,$198.00,$0.00,$99.00,$156.82,$158.40,$0.00,$30.99,$0.00,$31.52,$0.00
80406251,EAP,HCPCS C1769,,GUIDEWIRE VASC .014IN 300CM STRL LF GRAND SLAM DISP,$288.00,$0.00,$288.00,$156.38,$205.55,$0.00,$49.62,$205.55,$205.55,$50.43,$288.00,$0.00,$144.00,$228.10,$230.40,$0.00,$45.07,$0.00,$45.85,$0.00
80406252,EAP,HCPCS C1769,,GUIDEWIRE VASC .014IN 180CM STRL LF MRCLBRS 6 DISP,$333.00,$0.00,$333.00,$180.82,$237.66,$0.00,$57.37,$237.66,$237.66,$58.31,$333.00,$0.00,$166.50,$263.74,$266.40,$0.00,$52.11,$0.00,$53.01,$0.00
80406253,EAP,HCPCS C1769,,GUIDEWIRE VASC .014IN 300CM STRL LF MRCLBRS 6 DISP,$333.00,$0.00,$333.00,$180.82,$237.66,$0.00,$57.37,$237.66,$237.66,$58.31,$333.00,$0.00,$166.50,$263.74,$266.40,$0.00,$52.11,$0.00,$53.01,$0.00
80406254,EAP,HCPCS C1769,,GUIDEWIRE VASC .014IN 300CM STRL LF MRCLBRS 3 DISP,$333.00,$0.00,$333.00,$180.82,$237.66,$0.00,$57.37,$237.66,$237.66,$58.31,$333.00,$0.00,$166.50,$263.74,$266.40,$0.00,$52.11,$0.00,$53.01,$0.00
80406255,EAP,HCPCS C1769,,GUIDEWIRE VASC .014IN 180CM STRL LF P-H2O DISP,$198.00,$0.00,$198.00,$107.51,$141.31,$0.00,$34.11,$141.31,$141.31,$34.67,$198.00,$0.00,$99.00,$156.82,$158.40,$0.00,$30.99,$0.00,$31.52,$0.00
80406256,EAP,HCPCS C1769,,GUIDEWIRE VASC .014IN 300CM STRL LF P-H2O DISP,$198.00,$0.00,$198.00,$107.51,$141.31,$0.00,$34.11,$141.31,$141.31,$34.67,$198.00,$0.00,$99.00,$156.82,$158.40,$0.00,$30.99,$0.00,$31.52,$0.00
80406275,EAP,HCPCS C1894,,Vascular Vein Kit,$353.00,$0.00,$353.00,$191.68,$251.94,$0.00,$60.82,$251.94,$251.94,$61.81,$353.00,$0.00,$176.50,$279.58,$282.40,$0.00,$55.24,$0.00,$56.20,$0.00
80406279,EAP,HCPCS C1785,,Pacemaker Assurity Mri 6mm X 50mm X 47mm 10.44 Cc 2 Chmbr  Is-1 Con,"$12,225.00",$0.00,"$12,225.00","$5,501.25","$5,158.80",$0.00,"$2,106.31","$5,158.80","$8,724.98","$2,140.50","$12,225.00",$0.00,"$6,112.50","$9,682.20","$9,780.00",$0.00,"$1,913.21",$0.00,"$1,946.22",$0.00
80406478,EAP,,,Dressing Gel Strl Lf Isrb Abs Tube Nadh Cdxmr Iod 10gm,$36.00,$0.00,$36.00,$0.00,$25.69,$0.00,$0.00,$25.69,$25.69,$0.00,$36.00,$0.00,$18.00,$28.51,$28.80,$0.00,$0.00,$0.00,$0.00,$0.00
80406479,EAP,,,Dressing Gel Strl Iodoflex 3 In 1 Mode Abs Pd Nadh Cdxmr Iod,$30.00,$0.00,$30.00,$0.00,$21.41,$0.00,$0.00,$21.41,$21.41,$0.00,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$0.00,$0.00,$0.00,$0.00
80406513,EAP,,,Marker Endoscopic Spot Ex Tattoo Prefill Perm Syringe,$950.00,$0.00,$950.00,$0.00,$678.02,$0.00,$0.00,$678.02,$678.02,$0.00,$950.00,$0.00,$475.00,$752.40,$760.00,$0.00,$0.00,$0.00,$0.00,$0.00
80406525,EAP,HCPCS C1894,,"Kit Triple Lumen Cvc,  Agb+ 7 French, Pressure Rated, 20cm",$360.00,$0.00,$360.00,$195.48,$256.93,$0.00,$62.03,$256.93,$256.93,$63.03,$360.00,$0.00,$180.00,$285.12,$288.00,$0.00,$56.34,$0.00,$57.31,$0.00
80411625,EAP,HCPCS C1725,,Catheter Baldilat 2mm 150cm 20mm Otw Inflat Port,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80411627,EAP,HCPCS C1725,,Catheter Baldilat 2mm 150cm 30mm Otw Inflat Port,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80411630,EAP,HCPCS C1725,,Catheter Baldilat 2mm 150cm 60mm Otw Inflat Port,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80411635,EAP,HCPCS C1725,,Catheter Baldilat 2.5mm 150cm 30mm Otw Inflat Port,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80411637,EAP,HCPCS C1725,,Catheter Baldilat 2.5mm 150cm 40mm Otw Inflat Port,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80411639,EAP,HCPCS C1725,,Catheter Baldilat 2.5mm 150cm 60mm Otw Inflat Port,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80411641,EAP,HCPCS C1725,,Catheter Baldilat 2.5mm 150cm 220mm Otw Inflat,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80411645,EAP,HCPCS C1725,,Catheter Baldilat 3mm 150cm 30mm Otw Inflat Port,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80411648,EAP,HCPCS C1725,,Catheter Baldilat 3mm 150cm 60mm Otw Inflat Port,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80411651,EAP,HCPCS C1725,,Catheter Baldilat 3.5mm 150cm 20mm Otw Inflat Port,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80411653,EAP,HCPCS C1725,,Catheter Baldilat 3.5mm 150cm 30mm Otw Inflat Port,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80411655,EAP,HCPCS C1725,,Catheter Baldilat 3.5mm 150cm 40mm Otw Inflat Port,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80411657,EAP,HCPCS C1725,,Catheter Baldilat 3.5mm 150cm 60mm Otw Inflat Port,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80411659,EAP,HCPCS C1725,,Catheter Baldilat 3.5mm 150cm 220mm Otw Inflat,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80411662,EAP,HCPCS C1725,,Catheter Baldilat 5mm 150cm 120mm Peri Otw Tpr Tip,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80411666,EAP,HCPCS C1725,,Catheter Baldilat 5mm 150cm 220mm Peri Otw Tpr Tip,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80411668,EAP,HCPCS C1725,,Catheter Baldilat 6mm 120mm 150cm Otw Tpr Tip Lp,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$303.32,$303.32,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
80412733,EAP,HCPCS C2630,,Catheter Ablation Tacticath 2-2-2 Mm Space Damato Type,"$6,750.00",$0.00,"$6,750.00",$0.00,"$4,817.48",$0.00,$0.00,"$4,817.48","$4,817.48",$0.00,"$6,750.00",$0.00,"$3,375.00","$5,346.00","$5,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
80416033,EAP,HCPCS C1895,,"Lead Defibrillator Reliance 4-front, Dual Coil 59cm","$6,500.00",$0.00,"$6,500.00","$2,925.00","$4,639.05",$0.00,"$1,119.92","$4,639.05","$4,639.05","$1,138.10","$6,500.00",$0.00,"$3,250.00","$5,148.00","$5,200.00",$0.00,"$1,017.25",$0.00,"$1,034.80",$0.00
80416166,EAP,HCPCS C1722,,Dfbr Crd .99cm 5.37x7.79cm Momentum Heartlogic,"$22,643.00",$0.00,"$22,643.00","$10,189.35","$5,158.80",$0.00,"$3,901.28","$5,158.80","$16,160.31","$3,964.61","$22,643.00",$0.00,"$11,321.50","$17,933.26","$18,114.40",$0.00,"$3,543.63",$0.00,"$3,604.77",$0.00
80416179,EAP,HCPCS C1721,,Resonate El Aicd Dual Chamber 5.37cm 7.68cm 0.99cm,"$28,250.00",$0.00,"$28,250.00","$12,712.50","$5,158.80",$0.00,"$4,867.33","$5,158.80","$20,162.03","$4,946.35","$28,250.00",$0.00,"$14,125.00","$22,374.00","$22,600.00",$0.00,"$4,421.13",$0.00,"$4,497.40",$0.00
80416197,EAP,HCPCS C1786,,Pacemaker Crd .75cm 4.45x4.81cm Acld Pacesafe Ltd,"$6,680.00",$0.00,"$6,680.00",$0.00,"$4,767.52",$0.00,$0.00,"$4,767.52","$4,767.52",$0.00,"$6,680.00",$0.00,"$3,340.00","$5,290.56","$5,344.00",$0.00,$0.00,$0.00,$0.00,$0.00
80416198,EAP,HCPCS C1785,,Pacemaker Crd .75cm 4.45x5.02cm Acld Pacesafe Ltd,"$7,625.00",$0.00,"$7,625.00","$3,431.25","$5,158.80",$0.00,"$1,313.75","$5,158.80","$5,441.96","$1,335.08","$7,625.00",$0.00,"$3,812.50","$6,039.00","$6,100.00",$0.00,"$1,193.31",$0.00,"$1,213.90",$0.00
80435214,EAP,HCPCS C1887,,Kit Catheter Gd 9fr 80cm Strl Lf Mrc Bln Sil With Axs Catalyst,"$7,979.00",$0.00,"$7,979.00","$4,332.60","$5,158.80",$0.00,"$1,374.74","$5,158.80","$5,158.80","$1,397.06","$7,979.00",$0.00,"$3,989.50","$6,319.37","$6,383.20",$0.00,"$1,248.71",$0.00,"$1,270.26",$0.00
80435215,EAP,HCPCS C1887,,Kit Catheter Gd 9fr 95cm Strl Lf Mrc Bln Sil With Axs Catalyst,"$7,979.00",$0.00,"$7,979.00","$4,332.60","$5,158.80",$0.00,"$1,374.74","$5,158.80","$5,158.80","$1,397.06","$7,979.00",$0.00,"$3,989.50","$6,319.37","$6,383.20",$0.00,"$1,248.71",$0.00,"$1,270.26",$0.00
80436768,EAP,HCPCS C1817,,Plug Cardio 11mm 6mm 4fr Amplzr .038in Lp Ntnl,"$2,375.00",$0.00,"$2,375.00",$0.00,"$1,695.04",$0.00,$0.00,"$1,695.04","$1,695.04",$0.00,"$2,375.00",$0.00,"$1,187.50","$1,881.00","$1,900.00",$0.00,$0.00,$0.00,$0.00,$0.00
80436769,EAP,HCPCS C1817,,Plug Cardio 13.5mm 8mm 4fr Amplzr .038in Lp Ntnl,"$2,375.00",$0.00,"$2,375.00",$0.00,"$1,695.04",$0.00,$0.00,"$1,695.04","$1,695.04",$0.00,"$2,375.00",$0.00,"$1,187.50","$1,881.00","$1,900.00",$0.00,$0.00,$0.00,$0.00,$0.00
80436770,EAP,HCPCS C1769,,Kit Trevo 3x20 Packaged With Synchro2 Std Custom Grady,"$14,432.00",$0.00,"$14,432.00","$7,836.58","$5,158.80",$0.00,"$2,486.56","$5,158.80","$5,158.80","$2,526.93","$14,432.00",$0.00,"$7,216.00","$11,430.14","$11,545.60",$0.00,"$2,258.61",$0.00,"$2,297.57",$0.00
80436771,EAP,HCPCS C1769,,Kit Trevo 4x20 Packaged With Synchro2 Std Custom Grady,"$14,432.00",$0.00,"$14,432.00","$7,836.58","$5,158.80",$0.00,"$2,486.56","$5,158.80","$5,158.80","$2,526.93","$14,432.00",$0.00,"$7,216.00","$11,430.14","$11,545.60",$0.00,"$2,258.61",$0.00,"$2,297.57",$0.00
80436772,EAP,HCPCS C1769,,Kit Trevo 4x30 Packaged With Synchro2 Std Custom Grady,"$14,432.00",$0.00,"$14,432.00","$7,836.58","$5,158.80",$0.00,"$2,486.56","$5,158.80","$5,158.80","$2,526.93","$14,432.00",$0.00,"$7,216.00","$11,430.14","$11,545.60",$0.00,"$2,258.61",$0.00,"$2,297.57",$0.00
80436773,EAP,HCPCS C1769,,Kit Trevo 6x25 Packaged With Synchro2 Std Custom Grady,"$14,432.00",$0.00,"$14,432.00","$7,836.58","$5,158.80",$0.00,"$2,486.56","$5,158.80","$5,158.80","$2,526.93","$14,432.00",$0.00,"$7,216.00","$11,430.14","$11,545.60",$0.00,"$2,258.61",$0.00,"$2,297.57",$0.00
80436775,EAP,HCPCS C1884,,Kit Intvn Enroute Neuroprotection Transcarotid,"$8,875.00",$0.00,"$8,875.00","$4,819.13","$5,158.80",$0.00,"$1,529.12","$5,158.80","$5,158.80","$1,553.94","$8,875.00",$0.00,"$4,437.50","$7,029.00","$7,100.00",$0.00,"$1,388.94",$0.00,"$1,412.90",$0.00
80436776,EAP,HCPCS C1894,,Kit Mctrdcr 21ga 7cm Ndl,"$4,375.00",$0.00,"$4,375.00","$2,375.63","$3,122.44",$0.00,$753.79,"$3,122.44","$3,122.44",$766.03,"$4,375.00",$0.00,"$2,187.50","$3,465.00","$3,500.00",$0.00,$684.69,$0.00,$696.50,$0.00
80436777,EAP,HCPCS C1769,,Guidewire Vasc 5cm .014in 95cm 15cm Enroute Radopq Ptfe,"$2,375.00",$0.00,"$2,375.00","$1,289.63","$1,695.04",$0.00,$409.20,"$1,695.04","$1,695.04",$415.84,"$2,375.00",$0.00,"$1,187.50","$1,881.00","$1,900.00",$0.00,$371.69,$0.00,$378.10,$0.00
80436779,EAP,HCPCS C1729,,Tray Cath 14fr 60in 350ml Ltx Bdx Lbr Adv Urmtr Drn Tube,$51.00,$0.00,$51.00,$27.69,$36.40,$0.00,$8.79,$36.40,$36.40,$8.93,$51.00,$0.00,$25.50,$40.39,$40.80,$0.00,$7.98,$0.00,$8.12,$0.00
80436780,EAP,HCPCS C1729,,Tray Cath 16fr 60in 350ml Strl Ltx Lbrcth Urmtr Drn Tube,$51.00,$0.00,$51.00,$27.69,$36.40,$0.00,$8.79,$36.40,$36.40,$8.93,$51.00,$0.00,$25.50,$40.39,$40.80,$0.00,$7.98,$0.00,$8.12,$0.00
80436781,EAP,HCPCS C1729,,Tray Cath 18fr 60in 350ml Ltx Bdx Lbr Adv Urmtr Drn Tube,$51.00,$0.00,$51.00,$27.69,$36.40,$0.00,$8.79,$36.40,$36.40,$8.93,$51.00,$0.00,$25.50,$40.39,$40.80,$0.00,$7.98,$0.00,$8.12,$0.00
80436783,EAP,HCPCS C1757,,Catheter Asp .074in 125cm Strl Lf Axs Vecta 74 Lum Disp,"$7,375.00",$0.00,"$7,375.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$7,375.00",$0.00,"$3,687.50","$5,841.00","$5,900.00",$0.00,$0.00,$0.00,$0.00,$0.00
80436784,EAP,HCPCS C1757,,Catheter Asp .074in 132cm Strl Lf Axs Vecta 74 Lum Disp,"$7,375.00",$0.00,"$7,375.00",$0.00,"$5,158.80",$0.00,$0.00,"$5,158.80","$5,158.80",$0.00,"$7,375.00",$0.00,"$3,687.50","$5,841.00","$5,900.00",$0.00,$0.00,$0.00,$0.00,$0.00
80436791,EAP,HCPCS C1894,,Kit Intro .021in 80cm 6fr 21ga 25cm Strl 1.5in Glidesheath,$120.00,$0.00,$120.00,$65.16,$85.64,$0.00,$20.68,$85.64,$85.64,$21.01,$120.00,$0.00,$60.00,$95.04,$96.00,$0.00,$18.78,$0.00,$19.10,$0.00
80436798,EAP,HCPCS C1894,,Sheath Intro 8.2mm 22fr 33cm Gore Dryseal Flx Hdrph,"$1,585.00",$0.00,"$1,585.00",$860.66,"$1,131.21",$0.00,$273.09,"$1,131.21","$1,131.21",$277.52,"$1,585.00",$0.00,$792.50,"$1,255.32","$1,268.00",$0.00,$248.05,$0.00,$252.33,$0.00
80436802,EAP,HCPCS C1894,,Sheath Introducer Gore Dryseal Flex Hydro L33 Cm Od9.5 Mm Id26 Fr,"$1,585.00",$0.00,"$1,585.00",$860.66,"$1,131.21",$0.00,$273.09,"$1,131.21","$1,131.21",$277.52,"$1,585.00",$0.00,$792.50,"$1,255.32","$1,268.00",$0.00,$248.05,$0.00,$252.33,$0.00
80436934,EAP,HCPCS C1876,,Stent Eprsth 14mm 90mm 100mm Vici Vns Stnt Cath Ntnl Acpt,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,"$3,746.93","$3,746.93",$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
80438566,EAP,HCPCS C1760,,Device Clsr 18fr Manta Vasc,"$3,125.00",$0.00,"$3,125.00","$1,406.25","$2,230.31",$0.00,$538.42,"$2,230.31","$2,230.31",$547.16,"$3,125.00",$0.00,"$1,562.50","$2,475.00","$2,500.00",$0.00,$489.06,$0.00,$497.50,$0.00
80438567,EAP,HCPCS C1760,,Device Clsr 14fr Manta Vasc,"$3,125.00",$0.00,"$3,125.00","$1,406.25","$2,230.31",$0.00,$538.42,"$2,230.31","$2,230.31",$547.16,"$3,125.00",$0.00,"$1,562.50","$2,475.00","$2,500.00",$0.00,$489.06,$0.00,$497.50,$0.00
80438594,EAP,HCPCS C1894,,Kit Intro .018in Mic 5fr 21ga 3fr 45cm Strl 15cm,$250.00,$0.00,$250.00,$135.75,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
80438603,EAP,Custom 80438603,,Sheath Gd Strg 6fr 119cm Strl Lf R2p Destination Slndr Disp,$754.00,$0.00,$754.00,$0.00,$538.13,$0.00,$0.00,$538.13,$538.13,$0.00,$754.00,$0.00,$377.00,$597.17,$603.20,$0.00,$0.00,$0.00,$0.00,$0.00
80438604,EAP,HCPCS C1887,,Catheter Intvn 45d .014in Mic 2.1-2.5fr .017in .021in 150cm,"$1,210.00",$0.00,"$1,210.00",$657.03,$863.58,$0.00,$208.48,$863.58,$863.58,$211.86,"$1,210.00",$0.00,$605.00,$958.32,$968.00,$0.00,$189.37,$0.00,$192.63,$0.00
80438605,EAP,HCPCS C1887,,Catheter Intvn 90d Mic 2.4fr .017in .018in 130cm 40cm,"$1,210.00",$0.00,"$1,210.00",$657.03,$863.58,$0.00,$208.48,$863.58,$863.58,$211.86,"$1,210.00",$0.00,$605.00,$958.32,$968.00,$0.00,$189.37,$0.00,$192.63,$0.00
80438606,EAP,HCPCS C1887,,Catheter Intvn 90d .014in Mic 2.1-2.5fr .017in .021in 150cm,"$1,210.00",$0.00,"$1,210.00",$657.03,$863.58,$0.00,$208.48,$863.58,$863.58,$211.86,"$1,210.00",$0.00,$605.00,$958.32,$968.00,$0.00,$189.37,$0.00,$192.63,$0.00
80438607,EAP,HCPCS C1887,,Catheter Intvn 120d Mic 2.4-3.2fr .017-.018in 130cm 80cm,"$1,210.00",$0.00,"$1,210.00",$657.03,$863.58,$0.00,$208.48,$863.58,$863.58,$211.86,"$1,210.00",$0.00,$605.00,$958.32,$968.00,$0.00,$189.37,$0.00,$192.63,$0.00
80438608,EAP,HCPCS C1887,,Catheter Intvn 120d .014in Mic 2.1-2.5fr .017in .021in 150cm,"$1,210.00",$0.00,"$1,210.00",$657.03,$863.58,$0.00,$208.48,$863.58,$863.58,$211.86,"$1,210.00",$0.00,$605.00,$958.32,$968.00,$0.00,$189.37,$0.00,$192.63,$0.00
80438609,EAP,HCPCS C1887,,Catheter Intvn 90d Mic 2.4fr .017in .018in 130cm 80cm,"$1,210.00",$0.00,"$1,210.00",$657.03,$863.58,$0.00,$208.48,$863.58,$863.58,$211.86,"$1,210.00",$0.00,$605.00,$958.32,$968.00,$0.00,$189.37,$0.00,$192.63,$0.00
80438610,EAP,HCPCS C1887,,Catheter Intvn 45d .014in Mic 2.1-2.5fr .017in .021in 130cm,"$1,210.00",$0.00,"$1,210.00",$657.03,$863.58,$0.00,$208.48,$863.58,$863.58,$211.86,"$1,210.00",$0.00,$605.00,$958.32,$968.00,$0.00,$189.37,$0.00,$192.63,$0.00
80438611,EAP,HCPCS C1887,,Catheter Intvn 120d Mic 3.2-2.4fr .018-.017in 150cm 80cm,"$1,210.00",$0.00,"$1,210.00",$657.03,$863.58,$0.00,$208.48,$863.58,$863.58,$211.86,"$1,210.00",$0.00,$605.00,$958.32,$968.00,$0.00,$189.37,$0.00,$192.63,$0.00
80438621,EAP,,,Bronchoscope Glidescope,$37.00,$0.00,$37.00,$0.00,$26.41,$0.00,$0.00,$26.41,$26.41,$0.00,$37.00,$0.00,$18.50,$29.30,$29.60,$0.00,$0.00,$0.00,$0.00,$0.00
80463074,EAP,HCPCS C1887,,Catheter Gd Mp1 Crv 6fr 100cm Strl Lf Lnchr Lg Lum Radopq,$120.00,$0.00,$120.00,$65.16,$85.64,$0.00,$20.68,$85.64,$85.64,$21.01,$120.00,$0.00,$60.00,$95.04,$96.00,$0.00,$18.78,$0.00,$19.10,$0.00
80467372,EAP,HCPCS C1769,,Guidewire Vasc 220cm .007-.012in Distal Tip,"$1,425.00",$0.00,"$1,425.00",$773.78,"$1,017.02",$0.00,$245.52,"$1,017.02","$1,017.02",$249.51,"$1,425.00",$0.00,$712.50,"$1,128.60","$1,140.00",$0.00,$223.01,$0.00,$226.86,$0.00
80467373,EAP,HCPCS C1769,,Guidewire Vasc 220cm .007-.012in Distal Tip,"$1,495.00",$0.00,"$1,495.00",$811.79,"$1,066.98",$0.00,$257.58,"$1,066.98","$1,066.98",$261.76,"$1,495.00",$0.00,$747.50,"$1,184.04","$1,196.00",$0.00,$233.97,$0.00,$238.00,$0.00
80467374,EAP,HCPCS C1769,,Guidewire Vasc 220cm .008-.012in Hbrd Radiopq Str,"$1,425.00",$0.00,"$1,425.00",$773.78,"$1,017.02",$0.00,$245.52,"$1,017.02","$1,017.02",$249.51,"$1,425.00",$0.00,$712.50,"$1,128.60","$1,140.00",$0.00,$223.01,$0.00,$226.86,$0.00
80467375,EAP,HCPCS C1769,,Guidewire Vasc 220cm .008-.012in Distal Tip,"$1,495.00",$0.00,"$1,495.00",$811.79,"$1,066.98",$0.00,$257.58,"$1,066.98","$1,066.98",$261.76,"$1,495.00",$0.00,$747.50,"$1,184.04","$1,196.00",$0.00,$233.97,$0.00,$238.00,$0.00
80467376,EAP,HCPCS C1769,,Guidewire Vasc 200cm .012-.014in Hbrd Radiopq Str,"$1,035.00",$0.00,"$1,035.00",$562.01,$738.68,$0.00,$178.33,$738.68,$738.68,$181.22,"$1,035.00",$0.00,$517.50,$819.72,$828.00,$0.00,$161.98,$0.00,$164.77,$0.00
80467377,EAP,HCPCS C1769,,Guidewire Vasc 2 Ang .012-.014,"$1,093.00",$0.00,"$1,093.00",$593.50,$780.07,$0.00,$188.32,$780.07,$780.07,$191.38,"$1,093.00",$0.00,$546.50,$865.66,$874.40,$0.00,$171.05,$0.00,$174.01,$0.00
80467378,EAP,HCPCS C1769,,Guidewire Vasc 310cm .010in Radiopq Atrm Tip Str,"$1,598.00",$0.00,"$1,598.00",$867.71,"$1,140.49",$0.00,$275.33,"$1,140.49","$1,140.49",$279.80,"$1,598.00",$0.00,$799.00,"$1,265.62","$1,278.40",$0.00,$250.09,$0.00,$254.40,$0.00
80467379,EAP,HCPCS C1769,,Guidewire Vasc 310cm .012in Radiopq Atrm Tip Str,"$1,598.00",$0.00,"$1,598.00",$867.71,"$1,140.49",$0.00,$275.33,"$1,140.49","$1,140.49",$279.80,"$1,598.00",$0.00,$799.00,"$1,265.62","$1,278.40",$0.00,$250.09,$0.00,$254.40,$0.00
80467381,EAP,HCPCS C1894,,Introducer Sheath 088 80 Cm,"$1,100.00",$0.00,"$1,100.00",$597.30,$785.07,$0.00,$189.52,$785.07,$785.07,$192.60,"$1,100.00",$0.00,$550.00,$871.20,$880.00,$0.00,$172.15,$0.00,$175.12,$0.00
80467382,EAP,HCPCS C1894,,Introducer Sheath 088 90 Cm,"$1,100.00",$0.00,"$1,100.00",$597.30,$785.07,$0.00,$189.52,$785.07,$785.07,$192.60,"$1,100.00",$0.00,$550.00,$871.20,$880.00,$0.00,$172.15,$0.00,$175.12,$0.00
80467383,EAP,HCPCS C1894,,Introducer Sheath 088 100 Cm,"$1,100.00",$0.00,"$1,100.00",$597.30,$785.07,$0.00,$189.52,$785.07,$785.07,$192.60,"$1,100.00",$0.00,$550.00,$871.20,$880.00,$0.00,$172.15,$0.00,$175.12,$0.00
80467384,EAP,HCPCS C1769,,Guidewire Vasc 180cm .035in Std Tip Radiopq Strbl,$175.00,$0.00,$175.00,$95.03,$124.90,$0.00,$30.15,$124.90,$124.90,$30.64,$175.00,$0.00,$87.50,$138.60,$140.00,$0.00,$27.39,$0.00,$27.86,$0.00
80467385,EAP,HCPCS C1769,,Guidewire Vasc 300cm .035in Std Tip Radiopq Strbl,$175.00,$0.00,$175.00,$95.03,$124.90,$0.00,$30.15,$124.90,$124.90,$30.64,$175.00,$0.00,$87.50,$138.60,$140.00,$0.00,$27.39,$0.00,$27.86,$0.00
80467387,EAP,HCPCS C1751,,Kit Cath 6fr 60cm Prln 2 Lum Basic Gwire Mini Scpl,$438.00,$0.00,$438.00,$237.83,$312.60,$0.00,$75.47,$312.60,$312.60,$76.69,$438.00,$0.00,$219.00,$346.90,$350.40,$0.00,$68.55,$0.00,$69.73,$0.00
80467396,EAP,HCPCS C2628,,Catheter Blnocc Thk.9mm 3cm 7mm 1.1in 6- Mm 2fr,"$4,488.00",$0.00,"$4,488.00",$0.00,"$3,203.09",$0.00,$0.00,"$3,203.09","$3,203.09",$0.00,"$4,488.00",$0.00,"$2,244.00","$3,554.50","$3,590.40",$0.00,$0.00,$0.00,$0.00,$0.00
80467397,EAP,HCPCS C2628,,Catheter Blnocc Thk.9mm 3cm 7mm 1.1in 6- Mm 2fr,"$4,488.00",$0.00,"$4,488.00",$0.00,"$3,203.09",$0.00,$0.00,"$3,203.09","$3,203.09",$0.00,"$4,488.00",$0.00,"$2,244.00","$3,554.50","$3,590.40",$0.00,$0.00,$0.00,$0.00,$0.00
80467398,EAP,HCPCS C2628,,Catheter Blnocc Thk.9mm 3cm 7mm 1.1in 6- Mm 2fr,"$4,488.00",$0.00,"$4,488.00",$0.00,"$3,203.09",$0.00,$0.00,"$3,203.09","$3,203.09",$0.00,"$4,488.00",$0.00,"$2,244.00","$3,554.50","$3,590.40",$0.00,$0.00,$0.00,$0.00,$0.00
80467399,EAP,HCPCS C2628,,Catheter Blnocc Thk.9mm 3cm 7mm 1.1in 6- Mm 2fr,"$4,488.00",$0.00,"$4,488.00",$0.00,"$3,203.09",$0.00,$0.00,"$3,203.09","$3,203.09",$0.00,"$4,488.00",$0.00,"$2,244.00","$3,554.50","$3,590.40",$0.00,$0.00,$0.00,$0.00,$0.00
80467400,EAP,HCPCS C2628,,Catheter Blnocc Thk.9mm 3cm 3mm 1.1in 6- Mm 2fr,"$5,238.00",$0.00,"$5,238.00",$0.00,"$3,738.36",$0.00,$0.00,"$3,738.36","$3,738.36",$0.00,"$5,238.00",$0.00,"$2,619.00","$4,148.50","$4,190.40",$0.00,$0.00,$0.00,$0.00,$0.00
80469324,EAP,HCPCS C1895,,Lead Dfbr 64cm 7.3fr Rlnc 4-frn Rv Mp35n Irox Strd,"$6,500.00",$0.00,"$6,500.00","$2,925.00","$4,639.05",$0.00,"$1,119.92","$4,639.05","$4,639.05","$1,138.10","$6,500.00",$0.00,"$3,250.00","$5,148.00","$5,200.00",$0.00,"$1,017.25",$0.00,"$1,034.80",$0.00
80469325,EAP,HCPCS C1777,,Lead Dfbr 64cm 7.3fr Rlnc 4-frn Rv Mp35n Irox Strd 1 Coil,"$6,500.00",$0.00,"$6,500.00","$2,925.00","$4,639.05",$0.00,"$1,119.92","$4,639.05","$4,639.05","$1,138.10","$6,500.00",$0.00,"$3,250.00","$5,148.00","$5,200.00",$0.00,"$1,017.25",$0.00,"$1,034.80",$0.00
80469326,EAP,HCPCS C1895,,Lead Dfbr 59cm 7.3fr Rlnc 4-frn Rv Mp35n Irox Strd 2 Coil,"$6,500.00",$0.00,"$6,500.00","$2,925.00","$4,639.05",$0.00,"$1,119.92","$4,639.05","$4,639.05","$1,138.10","$6,500.00",$0.00,"$3,250.00","$5,148.00","$5,200.00",$0.00,"$1,017.25",$0.00,"$1,034.80",$0.00
80472492,EAP,HCPCS C1887,,Catheter Dlv Sys 45d Mic .025in 135cm Lntrn Hflo,"$1,625.00",$0.00,"$1,625.00",$882.38,"$1,159.76",$0.00,$279.98,"$1,159.76","$1,159.76",$284.52,"$1,625.00",$0.00,$812.50,"$1,287.00","$1,300.00",$0.00,$254.31,$0.00,$258.70,$0.00
80472499,EAP,,,Coil Embl Std .02in 3mm 20cm Penumbra Coil 400 Ruby Cmplx Lg,"$2,475.00",$0.00,"$2,475.00",$0.00,"$1,766.41",$0.00,$0.00,"$1,766.41","$1,766.41",$0.00,"$2,475.00",$0.00,"$1,237.50","$1,960.20","$1,980.00",$0.00,$0.00,$0.00,$0.00,$0.00
80472510,EAP,,,Coil Embl Std .02in 7mm 25cm Penumbra Coil 400 Ruby Cmplx Lg,"$2,475.00",$0.00,"$2,475.00",$0.00,"$1,766.41",$0.00,$0.00,"$1,766.41","$1,766.41",$0.00,"$2,475.00",$0.00,"$1,237.50","$1,960.20","$1,980.00",$0.00,$0.00,$0.00,$0.00,$0.00
80472512,EAP,,,COIL EMBL STD .02IN 8MM 25CM PENUMBRA COIL 400 RUBY CMPLX LG,"$2,475.00",$0.00,"$2,475.00",$0.00,"$1,766.41",$0.00,$0.00,"$1,766.41","$1,766.41",$0.00,"$2,475.00",$0.00,"$1,237.50","$1,960.20","$1,980.00",$0.00,$0.00,$0.00,$0.00,$0.00
80472530,EAP,,,Coil Embl .02in 2mm 4cm Penumbra Coil 400 Ruby Cmplx Lg,"$1,975.00",$0.00,"$1,975.00",$0.00,"$1,409.56",$0.00,$0.00,"$1,409.56","$1,409.56",$0.00,"$1,975.00",$0.00,$987.50,"$1,564.20","$1,580.00",$0.00,$0.00,$0.00,$0.00,$0.00
80472552,EAP,,,Coil Embl J-sft 30cm Strl Lf Pod Pk,"$3,225.00",$0.00,"$3,225.00",$0.00,"$2,301.68",$0.00,$0.00,"$2,301.68","$2,301.68",$0.00,"$3,225.00",$0.00,"$1,612.50","$2,554.20","$2,580.00",$0.00,$0.00,$0.00,$0.00,$0.00
80472555,EAP,,,COIL EMBL J-SFT 60CM STRL LF POD PK,"$3,225.00",$0.00,"$3,225.00",$0.00,"$2,301.68",$0.00,$0.00,"$2,301.68","$2,301.68",$0.00,"$3,225.00",$0.00,"$1,612.50","$2,554.20","$2,580.00",$0.00,$0.00,$0.00,$0.00,$0.00
80472556,EAP,,,Handle Inst Ruby Dtch Coil,$595.00,$0.00,$595.00,$0.00,$424.65,$0.00,$0.00,$424.65,$424.65,$0.00,$595.00,$0.00,$297.50,$471.24,$476.00,$0.00,$0.00,$0.00,$0.00,$0.00
80488974,EAP,HCPCS C1882,,Cobalt Hf Quad Crt-d Mri Surescan,"$44,750.00",$0.00,"$44,750.00","$20,137.50","$5,158.80",$0.00,$0.00,"$5,158.80","$31,938.08","$7,835.37","$44,750.00",$0.00,"$22,375.00","$35,442.00","$35,800.00",$0.00,$0.00,$0.00,"$7,124.20",$0.00
82000002,EAP,CPT® G0257,,Emergency Dialysis,"$3,300.00",$0.00,"$2,388.00","$1,296.68",$0.00,$613.72,$411.44,$0.00,$0.00,$418.12,"$2,388.00",$641.91,"$1,194.00","$1,891.30","$1,910.40",$891.85,$373.72,$0.00,$380.17,$611.34
83100001,EAP,CPT® 90947,,Intpatient Dialysis Crrt,"$3,300.00",$0.00,"$2,388.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$2,388.00",$0.00,"$1,194.00","$1,891.30","$1,910.40",$0.00,$0.00,$0.00,$0.00,$0.00
83100005,EAP,CPT® 90945,,Peritoneal Dialysis Op,"$1,724.00",$0.00,"$1,724.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,724.00",$0.00,$862.00,"$1,365.41","$1,379.20",$0.00,$0.00,$0.00,$0.00,$0.00
90000011,EAP,CPT® 90882,,Brief Evaluation Management,$62.00,$0.00,$62.00,$0.00,$44.25,$0.00,$0.00,$44.25,$44.25,$0.00,$62.00,$0.00,$31.00,$49.10,$49.60,$0.00,$0.00,$0.00,$0.00,$0.00
90000012,EAP,CPT® 90885,,Psych Eval Of Records,$400.00,$0.00,$400.00,$0.00,$285.48,$0.00,$0.00,$285.48,$285.48,$0.00,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$0.00,$0.00,$0.00,$0.00
90000013,EAP,CPT® 90887,,Consultation With Family,$240.00,$0.00,$240.00,$0.00,$171.29,$0.00,$0.00,$171.29,$171.29,$0.00,$240.00,$0.00,$120.00,$190.08,$192.00,$0.00,$0.00,$0.00,$0.00,$0.00
90000014,EAP,CPT® 90889,,Preparation Of Reports,$240.00,$0.00,$240.00,$0.00,$171.29,$0.00,$0.00,$171.29,$171.29,$0.00,$240.00,$0.00,$120.00,$190.08,$192.00,$0.00,$0.00,$0.00,$0.00,$0.00
90000017,EAP,HCPCS H0004,,Group Outpatient Services,$19.00,$0.00,$24.42,$10.32,$13.56,$3.38,$24.42,$13.56,$13.56,$3.33,$19.00,$0.00,$9.50,$15.05,$15.20,$11.40,$2.97,$0.00,$0.00,$0.00
90000020,EAP,HCPCS H0004,,Group Outpatient Services,$85.00,$0.00,$85.00,$46.16,$60.66,$15.13,$24.42,$60.66,$60.66,$14.88,$85.00,$0.00,$42.50,$67.32,$68.00,$51.00,$13.30,$0.00,$0.00,$0.00
90000022,EAP,HCPCS H0004,,Group Outpatient Services,$85.00,$0.00,$85.00,$46.16,$60.66,$15.13,$24.42,$60.66,$60.66,$14.88,$85.00,$0.00,$42.50,$67.32,$68.00,$51.00,$13.30,$0.00,$0.00,$0.00
90000023,EAP,HCPCS H0020,,Methadone Administration,$131.00,$0.00,$131.00,$0.00,$93.49,$0.00,$0.00,$93.49,$93.49,$0.00,$131.00,$0.00,$65.50,$103.75,$104.80,$0.00,$0.00,$0.00,$0.00,$0.00
90000024,EAP,HCPCS H0031,,Mh Assessment By A Non-physician,$167.00,$0.00,$167.00,$90.68,$119.19,$29.73,$27.68,$119.19,$119.19,$29.24,$167.00,$0.00,$83.50,$132.26,$133.60,$100.20,$26.14,$0.00,$0.00,$0.00
90000026,EAP,HCPCS H0032,,Service Plan Development,$85.00,$0.00,$85.00,$46.16,$60.66,$15.13,$27.68,$60.66,$60.66,$14.88,$85.00,$0.00,$42.50,$67.32,$68.00,$51.00,$13.30,$0.00,$0.00,$0.00
90000027,EAP,HCPCS H0038,,Peer Support,$28.00,$0.00,$28.00,$15.20,$19.98,$4.98,$1.80,$19.98,$19.98,$4.90,$28.00,$0.00,$14.00,$22.18,$22.40,$16.80,$4.38,$0.00,$0.00,$0.00
90000028,EAP,HCPCS H0039,,Assertive Community Treatment,$93.00,$0.00,$93.00,$50.50,$66.37,$16.55,$28.95,$66.37,$66.37,$16.28,$93.00,$0.00,$46.50,$73.66,$74.40,$55.80,$14.55,$0.00,$0.00,$0.00
90000030,EAP,HCPCS H2010,,Medication Administ Comp,$85.00,$0.00,$85.00,$46.16,$60.66,$15.13,$28.99,$60.66,$60.66,$14.88,$85.00,$0.00,$42.50,$67.32,$68.00,$51.00,$13.30,$0.00,$0.00,$0.00
90000035,EAP,HCPCS H2014,,Group Skills Train/devl 15 Min,$15.00,$0.00,$16.80,$8.15,$10.71,$2.67,$16.80,$10.71,$10.71,$2.63,$15.00,$0.00,$7.50,$11.88,$12.00,$9.00,$2.35,$0.00,$0.00,$0.00
90000045,EAP,HCPCS H2011,,Crisis Intervention,$136.00,$0.00,$136.00,$73.85,$97.06,$24.21,$28.15,$97.06,$97.06,$23.81,$136.00,$0.00,$68.00,$107.71,$108.80,$81.60,$21.28,$0.00,$0.00,$0.00
90000048,EAP,HCPCS H2017,,Psychosocial Rehabilitation,$28.00,$0.00,$28.00,$15.20,$19.98,$4.98,$4.82,$19.98,$19.98,$4.90,$28.00,$0.00,$14.00,$22.18,$22.40,$16.80,$4.38,$0.00,$0.00,$0.00
90000049,EAP,HCPCS H2014,,Grp/fam Skill Train W/pat15min,$17.00,$0.00,$17.00,$9.23,$12.13,$3.03,$16.80,$12.13,$12.13,$2.98,$17.00,$0.00,$8.50,$13.46,$13.60,$10.20,$2.66,$0.00,$0.00,$0.00
90000051,EAP,HCPCS H2014,,Group Skills Training 15mins,$17.00,$0.00,$17.00,$9.23,$12.13,$3.03,$16.80,$12.13,$12.13,$2.98,$17.00,$0.00,$8.50,$13.46,$13.60,$10.20,$2.66,$0.00,$0.00,$0.00
90000052,EAP,HCPCS H2014,,Family Training W/pat 15mins,$72.00,$0.00,$72.00,$39.10,$51.39,$12.82,$16.80,$51.39,$51.39,$12.61,$72.00,$0.00,$36.00,$57.02,$57.60,$43.20,$11.27,$0.00,$0.00,$0.00
90000053,EAP,HCPCS H2014,,Family Training W/o Pat 15mins,$72.00,$0.00,$72.00,$39.10,$51.39,$12.82,$16.80,$51.39,$51.39,$12.61,$72.00,$0.00,$36.00,$57.02,$57.60,$43.20,$11.27,$0.00,$0.00,$0.00
90000054,EAP,HCPCS T1001,,Nursing Assessment,$98.00,$0.00,$98.00,$53.21,$69.94,$17.44,$16.88,$69.94,$69.94,$17.16,$98.00,$0.00,$49.00,$77.62,$78.40,$58.80,$15.34,$0.00,$0.00,$0.00
90000055,EAP,HCPCS T1001,,Nursing Assessment,$98.00,$0.00,$98.00,$53.21,$69.94,$17.44,$16.88,$69.94,$69.94,$17.16,$98.00,$0.00,$49.00,$77.62,$78.40,$58.80,$15.34,$0.00,$0.00,$0.00
90000056,EAP,HCPCS T1002,,Rn Services 15mins,$98.00,$0.00,$98.00,$53.21,$69.94,$17.44,$16.88,$69.94,$69.94,$17.16,$98.00,$0.00,$49.00,$77.62,$78.40,$58.80,$15.34,$0.00,$0.00,$0.00
90000057,EAP,HCPCS T1003,,Lpn Services 15mins,$74.00,$0.00,$74.00,$40.18,$52.81,$13.17,$12.75,$52.81,$52.81,$12.96,$74.00,$0.00,$37.00,$58.61,$59.20,$44.40,$11.58,$0.00,$0.00,$0.00
90000058,EAP,HCPCS T2038,,Community Transitional Planning,$69.00,$0.00,$69.00,$37.47,$49.25,$12.28,$11.89,$49.25,$49.25,$12.08,$69.00,$0.00,$34.50,$54.65,$55.20,$41.40,$10.80,$0.00,$0.00,$0.00
90000060,EAP,HCPCS H0004,,Multi-group Family Couns 15min,$19.00,$0.00,$24.42,$10.32,$13.56,$3.38,$24.42,$13.56,$13.56,$3.33,$19.00,$0.00,$9.50,$15.05,$15.20,$11.40,$2.97,$0.00,$0.00,$0.00
90000067,EAP,CPT® 90791,,Psych Dx Eval (no Med Service),$572.00,$91.06,$572.00,$310.60,$408.24,$125.96,$140.01,$408.24,$408.24,$100.15,$572.00,$131.75,$286.00,$453.02,$457.60,$183.04,$143.47,$127.71,$91.06,$125.47
90000068,EAP,CPT® 90792,,Psych Dx Eval (with Med Service),$572.00,$91.06,$572.00,$310.60,$408.24,$125.96,$139.01,$408.24,$408.24,$100.15,$572.00,$131.75,$286.00,$453.02,$457.60,$183.04,$117.89,$142.86,$91.06,$125.47
90000069,EAP,CPT® 90785,,Interactive Complexity,$319.00,$0.00,$319.00,$173.22,$227.67,$0.00,$54.96,$227.67,$227.67,$55.85,$319.00,$0.00,$159.50,$252.65,$255.20,$0.00,$49.92,$14.07,$50.78,$0.00
90000070,EAP,HCPCS T1016,,Case Management,$45.00,$0.00,$45.00,$24.44,$32.12,$8.01,$7.75,$32.12,$32.12,$7.88,$45.00,$0.00,$22.50,$35.64,$36.00,$27.00,$7.04,$0.00,$0.00,$0.00
90000071,EAP,HCPCS T1016,,"Case Management - Practitioner Level 5,",$45.00,$0.00,$45.00,$24.44,$32.12,$8.01,$7.75,$32.12,$32.12,$7.88,$45.00,$0.00,$22.50,$35.64,$36.00,$27.00,$7.04,$0.00,$0.00,$0.00
90000072,EAP,HCPCS T1016,,"Case Management - Practitioner Level 4,",$45.00,$0.00,$45.00,$24.44,$32.12,$8.01,$7.75,$32.12,$32.12,$7.88,$45.00,$0.00,$22.50,$35.64,$36.00,$27.00,$7.04,$0.00,$0.00,$0.00
90000073,EAP,HCPCS T1016,,"Case Management - Practitioner Level 5,",$45.00,$0.00,$45.00,$24.44,$32.12,$8.01,$7.75,$32.12,$32.12,$7.88,$45.00,$0.00,$22.50,$35.64,$36.00,$27.00,$7.04,$0.00,$0.00,$0.00
90000074,EAP,HCPCS T1016,,"CASE MANAGEMENT-PRACTITIONER LEVEL 4, COLLATERAL CONTACT",$45.00,$0.00,$45.00,$24.44,$32.12,$8.01,$7.75,$32.12,$32.12,$7.88,$45.00,$0.00,$22.50,$35.64,$36.00,$27.00,$7.04,$0.00,$0.00,$0.00
90000075,EAP,HCPCS T1016,,"Case Management-practitioner Level 5, Collateral Contact",$45.00,$0.00,$45.00,$24.44,$32.12,$8.01,$7.75,$32.12,$32.12,$7.88,$45.00,$0.00,$22.50,$35.64,$36.00,$27.00,$7.04,$0.00,$0.00,$0.00
90000076,EAP,HCPCS T1016,,"CASE MANAGEMENT-PRACTITIONER LEVEL 4,COLLATERAL CONTACT",$45.00,$0.00,$45.00,$24.44,$32.12,$8.01,$7.75,$32.12,$32.12,$7.88,$45.00,$0.00,$22.50,$35.64,$36.00,$27.00,$7.04,$0.00,$0.00,$0.00
90000077,EAP,HCPCS T1016,,"CASE MANAGEMENT-PREACTITIONER LEVEL 5,OUT-COLLATERAL",$45.00,$0.00,$45.00,$24.44,$32.12,$8.01,$7.75,$32.12,$32.12,$7.88,$45.00,$0.00,$22.50,$35.64,$36.00,$27.00,$7.04,$0.00,$0.00,$0.00
90000078,EAP,HCPCS H0025,,Peer Support Whole Health & Wellness,$34.00,$0.00,$34.00,$18.46,$24.27,$6.05,$5.86,$24.27,$24.27,$5.95,$34.00,$0.00,$17.00,$26.93,$27.20,$20.40,$5.32,$0.00,$0.00,$0.00
90000080,EAP,CPT® G0447,,Behavior Counsel Obesity 15m,$100.00,$15.65,$100.00,$54.30,$71.37,$75.31,$17.23,$71.37,$71.37,$17.51,$100.00,$78.77,$50.00,$79.20,$80.00,$100.00,$15.65,$24.16,$15.92,$75.02
90000081,EAP,HCPCS G0444,,"Annual Depression Screening, 15 Minutes",$70.00,$9.74,$70.00,$38.01,$49.96,$26.20,$12.06,$49.96,$49.96,$12.26,$70.00,$27.40,$35.00,$55.44,$56.00,$38.07,$10.96,$9.74,$11.14,$26.10
91400004,EAP,CPT® 90832,,Individual Psychotherapy 30 Mins,$537.00,$59.54,$537.00,$291.59,$383.26,$125.96,$62.31,$383.26,$383.26,$94.02,$537.00,$131.75,$268.50,$425.30,$429.60,$183.04,$59.54,$63.85,$85.49,$125.47
91400006,EAP,CPT® 90837,,Individual Psychotherapy 60 Min,$653.00,$103.96,$653.00,$354.58,$466.05,$125.96,$144.55,$466.05,$466.05,$114.34,$653.00,$131.75,$326.50,$517.18,$522.40,$183.04,$124.37,$127.35,$103.96,$125.47
91400024,EAP,CPT® 90834,,Individual Psychotherapy 45 Min,$537.00,$84.04,$537.00,$291.59,$383.26,$125.96,$124.62,$383.26,$383.26,$94.02,$537.00,$131.75,$268.50,$425.30,$429.60,$183.04,$84.04,$85.14,$85.49,$125.47
91400061,EAP,CPT® 90833,,Psychotherapy W/pat W/e&m Srvcs 30 Min (add-on),$379.00,$0.00,$379.00,$205.80,$270.49,$0.00,$69.65,$270.49,$270.49,$66.36,$379.00,$0.00,$189.50,$300.17,$303.20,$0.00,$39.40,$66.38,$0.00,$0.00
91400062,EAP,CPT® 90836,,INDIVIDUAL COUNSELING 45 MIN ADD ON,$537.00,$0.00,$537.00,$291.59,$383.26,$0.00,$139.31,$383.26,$383.26,$94.02,$537.00,$0.00,$268.50,$425.30,$429.60,$0.00,$84.04,$84.05,$85.49,$0.00
91400063,EAP,CPT® 90838,,"Psychotherapy, 60min W/pat And Or Fam W  E/m(add-on)",$653.00,$0.00,$653.00,$354.58,$466.05,$0.00,$150.01,$466.05,$466.05,$114.34,$653.00,$0.00,$326.50,$517.18,$522.40,$0.00,$102.19,$110.39,$103.96,$0.00
91400071,EAP,CPT® 90839,,Psychotherapy For Crisis First 60 Minutes,$677.00,$105.95,$677.00,$367.61,$483.17,$125.96,$116.64,$483.17,$483.17,$118.54,$677.00,$131.75,$338.50,$536.18,$541.60,$183.04,$105.95,$133.12,$107.78,$125.47
91400072,EAP,CPT® 90840,,PSYCHOTHERAPY ADDITIONAL 30  MINUTES,$216.00,$0.00,$216.00,$0.00,$154.16,$0.00,$0.00,$154.16,$154.16,$0.00,$216.00,$0.00,$108.00,$171.07,$172.80,$0.00,$0.00,$0.00,$0.00,$0.00
91500001,EAP,CPT® 90853,,Psy Group Therapy,$247.00,$25.25,$247.00,$134.12,$176.28,$75.31,$33.98,$176.28,$176.28,$43.25,$247.00,$78.77,$123.50,$195.62,$197.60,$109.44,$34.39,$25.25,$39.32,$75.02
91500006,EAP,HCPCS H2014,,Group Skills Training 15mins,$17.00,$0.00,$17.00,$9.23,$12.13,$3.03,$16.80,$12.13,$12.13,$2.98,$17.00,$0.00,$8.50,$13.46,$13.60,$10.20,$2.66,$0.00,$0.00,$0.00
91600001,EAP,CPT® 90846,,Family Psychotherapy W/o Patient Present 50 Min,"$1,046.00",$93.25,"$1,046.00",$567.98,$746.53,$125.96,$93.25,$746.53,$746.53,$183.15,"$1,046.00",$131.75,$523.00,$828.43,$836.80,$183.04,$163.70,$102.82,$166.52,$125.47
91600009,EAP,CPT® 90847,,Psy Family Therapy W Pt,"$1,046.00",$105.59,"$1,046.00",$567.98,$746.53,$125.96,$110.90,$746.53,$746.53,$183.15,"$1,046.00",$131.75,$523.00,$828.43,$836.80,$183.04,$105.59,$106.79,$166.52,$125.47
91600010,EAP,CPT® 90849,,Multiple Family Group Therapy,$258.00,$0.00,$258.00,$0.00,$184.13,$0.00,$0.00,$184.13,$184.13,$0.00,$258.00,$0.00,$129.00,$204.34,$206.40,$0.00,$0.00,$0.00,$0.00,$0.00
91600012,EAP,HCPCS H2014,,Group Outpatient Services,$72.00,$0.00,$72.00,$39.10,$51.39,$12.82,$16.80,$51.39,$51.39,$12.61,$72.00,$0.00,$36.00,$57.02,$57.60,$43.20,$11.27,$0.00,$0.00,$0.00
91600013,EAP,HCPCS H2014,,Group Outpatient Services,$72.00,$0.00,$72.00,$39.10,$51.39,$12.82,$16.80,$51.39,$51.39,$12.61,$72.00,$0.00,$36.00,$57.02,$57.60,$43.20,$11.27,$0.00,$0.00,$0.00
91800005,EAP,CPT® 96110,,"NICU/PED/DEVELOP.TESTING,LIMI",$192.00,$0.00,$192.00,$0.00,$137.03,$0.00,$0.00,$137.03,$137.03,$0.00,$192.00,$0.00,$96.00,$152.06,$153.60,$0.00,$0.00,$0.00,$0.00,$0.00
91800013,EAP,CPT® 96125,,Cognitive Testing,$702.00,$0.00,$702.00,$0.00,$427.63,$0.00,$0.00,$427.63,$427.63,$0.00,$702.00,$0.00,$351.00,$555.98,$561.60,$0.00,$0.00,$0.00,$0.00,$0.00
91800017,EAP,CPT® 96125,,Cognitive Testing_52,$353.00,$0.00,$427.63,$0.00,$427.63,$0.00,$0.00,$427.63,$427.63,$0.00,$353.00,$0.00,$176.50,$279.58,$282.40,$0.00,$0.00,$0.00,$0.00,$0.00
91800019,EAP,CPT® 96130,,Psychological Tst Eval Svc Phys/qhp First Hour,$564.00,$89.79,$564.00,$306.25,$402.53,$132.66,$97.17,$402.53,$402.53,$98.75,$564.00,$138.76,$282.00,$446.69,$451.20,$192.78,$112.86,$111.11,$89.79,$132.15
91800020,EAP,CPT® 96131,,Psychological Tst Eval Svc Phys/qhp Ea Addl Hour,$300.00,$0.00,$300.00,$0.00,$214.11,$0.00,$0.00,$214.11,$214.11,$0.00,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$0.00,$0.00,$0.00,$0.00
91800021,EAP,CPT® 96112,,Developmental Tst Admin Phys/qhp 1st Hour,$699.00,$0.00,$699.00,$0.00,$498.88,$0.00,$0.00,$498.88,$498.88,$0.00,$699.00,$0.00,$349.50,$553.61,$559.20,$0.00,$0.00,$0.00,$0.00,$0.00
91800022,EAP,CPT® 96113,,Developmental Tst Admin Phys/qhp Ea Addl 30 Min,$300.00,$0.00,$300.00,$0.00,$214.11,$0.00,$0.00,$214.11,$214.11,$0.00,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$0.00,$0.00,$0.00,$0.00
91800023,EAP,CPT® 96116,,Neurobehavioral Status Xm Phys/qhp 1st Hour,$605.00,$86.57,$605.00,$328.52,$431.79,$228.85,$98.94,$431.79,$431.79,$105.93,$605.00,$239.36,$302.50,$479.16,$484.00,$332.56,$101.28,$86.57,$96.32,$227.96
91800024,EAP,CPT® 96121,,Neurobehavioral Status Xm Phys/qhp Ea Addl Hour,$300.00,$0.00,$300.00,$0.00,$214.11,$0.00,$0.00,$214.11,$214.11,$0.00,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$0.00,$0.00,$0.00,$0.00
91800025,EAP,CPT® 96132,,Neuropsychol Tst Eval Phys/qhp 1st Hour,$327.00,$52.06,$327.00,$177.56,$233.38,$132.66,$56.34,$233.38,$233.38,$57.26,$327.00,$138.76,$163.50,$258.98,$261.60,$192.78,$126.78,$109.67,$52.06,$132.15
91800026,EAP,CPT® 96133,,Neuropsychol Tst Eval Physl/qph Ea Addl Hr,$164.00,$0.00,$164.00,$89.05,$117.05,$0.00,$28.26,$117.05,$117.05,$28.72,$164.00,$0.00,$82.00,$129.89,$131.20,$0.00,$79.70,$84.42,$26.11,$0.00
91800027,EAP,CPT® 96138,,Psycl/nrpsycl Tst Tech 2+ Tst 1st 30 Min,$41.00,$6.53,$41.00,$22.26,$29.26,$22.05,$7.06,$29.26,$29.26,$7.18,$41.00,$23.06,$20.50,$32.47,$32.80,$32.04,$36.79,$38.54,$6.53,$21.96
91800028,EAP,CPT® 96139,,Psycl/nrpsyc Tst Tech 2+ Tst Ea Addl 30 Min,$20.00,$0.00,$38.54,$10.86,$14.27,$0.00,$3.45,$14.27,$14.27,$3.50,$20.00,$0.00,$10.00,$15.84,$16.00,$0.00,$36.79,$38.54,$3.18,$0.00
91800029,EAP,CPT® 96136,,Psycl/nrpsycl Tst Phy/qhp Tst 1st 30 Min,$55.00,$8.76,$55.00,$29.87,$39.25,$22.05,$9.48,$39.25,$39.25,$9.63,$55.00,$23.06,$27.50,$43.56,$44.00,$32.04,$45.41,$25.25,$8.76,$21.96
91800030,EAP,CPT® 96137,,Psycl/nrpsycl Tst Phy/qhp Tst Addl 30 Min,$21.00,$0.00,$41.97,$11.40,$14.99,$0.00,$3.62,$14.99,$14.99,$3.68,$21.00,$0.00,$10.50,$16.63,$16.80,$0.00,$41.97,$19.84,$3.34,$0.00
91800031,EAP,CPT® 96156,,Health Behavior Assessment/re-assessment,$188.00,$29.93,$188.00,$102.08,$134.18,$75.31,$32.39,$134.18,$134.18,$32.92,$188.00,$78.77,$94.00,$148.90,$150.40,$109.44,$94.62,$90.55,$29.93,$75.02
91800032,EAP,CPT® 96158,,Health Behavior Ivntj Indiv F2f 1st 30 Min,$188.00,$0.00,$188.00,$0.00,$134.18,$0.00,$0.00,$134.18,$134.18,$0.00,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$0.00,$0.00,$0.00,$0.00
91800033,EAP,CPT® 96159,,Health Behavior Ivntj Indiv F2f Ea Addl 15 Min,$94.00,$0.00,$94.00,$0.00,$67.09,$0.00,$0.00,$67.09,$67.09,$0.00,$94.00,$0.00,$47.00,$74.45,$75.20,$0.00,$0.00,$0.00,$0.00,$0.00
91800034,EAP,CPT® 96164,,Health Behavior Ivntj Group F2f 1st 30 Min,$107.00,$0.00,$107.00,$0.00,$76.37,$0.00,$0.00,$76.37,$76.37,$0.00,$107.00,$0.00,$53.50,$84.74,$85.60,$0.00,$0.00,$0.00,$0.00,$0.00
91800035,EAP,CPT® 96165,,Health Behavior Ivntj Group F2f Ea Addl 15 Min,$107.00,$0.00,$107.00,$0.00,$76.37,$0.00,$0.00,$76.37,$76.37,$0.00,$107.00,$0.00,$53.50,$84.74,$85.60,$0.00,$0.00,$0.00,$0.00,$0.00
91800036,EAP,CPT® 96167,,Health Behavior Invtj Fam W/pt F2f 1st 30 Min,$107.00,$0.00,$107.00,$0.00,$76.37,$0.00,$0.00,$76.37,$76.37,$0.00,$107.00,$0.00,$53.50,$84.74,$85.60,$0.00,$0.00,$0.00,$0.00,$0.00
91800037,EAP,CPT® 96168,,Health Behavior Ivntj Fam W/pt F2f Ea Add 15 Min,$107.00,$0.00,$107.00,$0.00,$76.37,$0.00,$0.00,$76.37,$76.37,$0.00,$107.00,$0.00,$53.50,$84.74,$85.60,$0.00,$0.00,$0.00,$0.00,$0.00
92000001,EAP,CPT® 51725,,"Cystometrogram, Simple","$1,682.00",$92.84,"$1,682.00","$1,682.00","$1,208.73",$225.25,$289.80,"$1,208.73","$1,208.73",$294.50,"$1,682.00",$235.59,"$1,682.00","$1,332.14","$1,345.60",$327.32,$92.84,$139.03,$267.77,$224.37
92000002,EAP,CPT® 51726,,"Cystometrogram, Complex","$1,648.00",$0.00,"$1,648.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,648.00",$0.00,"$1,648.00","$1,305.22","$1,318.40",$0.00,$0.00,$0.00,$0.00,$0.00
92000003,EAP,CPT® 51736,,Uroflowmetry Simple,$293.00,$0.00,$293.00,$0.00,$209.11,$0.00,$0.00,$209.11,$209.11,$0.00,$293.00,$0.00,$293.00,$232.06,$234.40,$0.00,$0.00,$0.00,$0.00,$0.00
92000004,EAP,CPT® 51741,,"Uroflowmetry, Complex",$280.00,$5.76,$280.00,$152.04,$199.84,$132.66,$48.24,$199.84,$199.84,$49.03,$280.00,$138.76,$280.00,$221.76,$224.00,$192.78,$64.97,$5.76,$44.58,$132.15
92000007,EAP,CPT® 51797,,Intra-abdominal Pressure Test,$465.00,$0.00,$465.00,$465.00,$331.87,$0.00,$80.12,$331.87,$331.87,$81.42,$465.00,$0.00,$465.00,$368.28,$372.00,$0.00,$97.70,$124.26,$74.03,$0.00
92000009,EAP,CPT® 59020,,Fetal Contraction Stress Test,"$2,629.00",$0.00,"$2,629.00",$0.00,"$1,876.32",$0.00,$452.96,"$1,876.32","$1,876.32",$0.00,"$2,629.00",$0.00,"$2,255.00","$2,082.17","$2,103.20",$0.00,$65.30,$0.00,$0.00,$0.00
92000010,EAP,CPT® 59025,,Fetal Non Stress Test,$431.00,$19.09,$431.00,$234.03,$307.60,$159.23,$74.26,$307.60,$307.60,$75.46,$431.00,$166.54,$431.00,$341.35,$344.80,$231.38,$40.51,$19.09,$68.62,$158.61
92000011,EAP,CPT® 92081,,Vision Screen,$269.00,$17.65,$269.00,$146.07,$191.99,$52.75,$46.35,$191.99,$191.99,$47.10,$269.00,$55.17,$134.50,$213.05,$215.20,$76.65,$46.21,$17.65,$42.82,$52.54
92000012,EAP,CPT® 92081,,"Vision Test, Routine",$269.00,$17.65,$269.00,$146.07,$191.99,$52.75,$46.35,$191.99,$191.99,$47.10,$269.00,$55.17,$134.50,$213.05,$215.20,$76.65,$46.21,$17.65,$42.82,$52.54
92000013,EAP,CPT® 92081,,Visual Exam Limited-lt,$269.00,$17.65,$269.00,$146.07,$191.99,$52.75,$46.35,$191.99,$191.99,$47.10,$269.00,$55.17,$134.50,$213.05,$215.20,$76.65,$46.21,$17.65,$42.82,$52.54
92000014,EAP,CPT® 92081,,Visual Field Exam Unilat/bilat,$534.00,$17.65,$534.00,$289.96,$381.12,$52.75,$92.01,$381.12,$381.12,$93.50,$534.00,$55.17,$267.00,$422.93,$427.20,$76.65,$46.21,$17.65,$85.01,$52.54
92000016,EAP,CPT® 92081,,Visual Field Exam Limited-lt,$269.00,$17.65,$269.00,$146.07,$191.99,$52.75,$46.35,$191.99,$191.99,$47.10,$269.00,$55.17,$134.50,$213.05,$215.20,$76.65,$46.21,$17.65,$42.82,$52.54
92000017,EAP,CPT® 92081,,Visual Field Exam Limited-rt,$269.00,$17.65,$269.00,$146.07,$191.99,$52.75,$46.35,$191.99,$191.99,$47.10,$269.00,$55.17,$134.50,$213.05,$215.20,$76.65,$46.21,$17.65,$42.82,$52.54
92000020,EAP,CPT® 92082,,Visual Field Exam Uni/bil Intermed,$575.00,$0.00,$575.00,$0.00,$410.38,$0.00,$0.00,$410.38,$410.38,$0.00,$575.00,$0.00,$287.50,$455.40,$460.00,$0.00,$0.00,$0.00,$0.00,$0.00
92000028,EAP,CPT® 92083,,Visual Field Exam Uni/bil Extended,$583.00,$36.02,$583.00,$316.57,$416.09,$104.55,$100.45,$416.09,$416.09,$102.08,$583.00,$109.35,$291.50,$461.74,$466.40,$151.93,$56.79,$36.02,$92.81,$104.14
92000032,EAP,CPT® 92235,,Flourescein Angioscopy W Photo,$960.00,$61.59,$960.00,$521.28,$685.15,$241.94,$165.40,$685.15,$685.15,$168.09,$960.00,$253.05,$480.00,$760.32,$768.00,$351.58,$100.45,$61.59,$152.83,$241.00
92000033,EAP,CPT® 92235,,Flourescein Photo W Photo Both,$960.00,$61.59,$960.00,$521.28,$685.15,$241.94,$165.40,$685.15,$685.15,$168.09,$960.00,$253.05,$480.00,$760.32,$768.00,$351.58,$100.45,$61.59,$152.83,$241.00
92000035,EAP,CPT® 92250,,Ophthalmoscopy W/ Fundus Photo,$408.00,$23.77,$408.00,$221.54,$291.19,$104.55,$70.30,$291.19,$291.19,$71.44,$408.00,$109.35,$204.00,$323.14,$326.40,$151.93,$59.03,$23.77,$64.95,$104.14
92000036,EAP,CPT® 92285,,Slit Lamp Photography,$161.00,$0.00,$161.00,$0.00,$114.91,$0.00,$0.00,$114.91,$114.91,$0.00,$161.00,$0.00,$80.50,$127.51,$128.80,$0.00,$0.00,$0.00,$0.00,$0.00
92000037,EAP,CPT® 95810,,Polysomnography,"$6,027.00",$419.12,"$6,027.00","$1,387.11","$3,242.91",$871.59,$419.12,"$3,242.91","$3,242.91","$1,055.28","$6,027.00",$911.62,"$3,013.50","$4,773.38","$4,821.60","$1,266.58",$594.31,$495.59,$959.50,$868.21
92000038,EAP,CPT® 95811,,Polysomnography W/cpap,"$7,232.00",$518.64,"$7,232.00","$1,457.31","$2,779.64",$871.59,"$1,246.04","$2,779.64","$2,779.64","$1,266.27","$7,232.00",$911.62,"$3,616.00","$5,727.74","$5,785.60","$1,266.58",$618.03,$518.64,"$1,151.33",$868.21
92000039,EAP,CPT® 95857,,Tensilon Test,$257.00,$0.00,$257.00,$0.00,$183.42,$0.00,$0.00,$183.42,$183.42,$0.00,$257.00,$0.00,$128.50,$203.54,$205.60,$0.00,$0.00,$0.00,$0.00,$0.00
92000041,EAP,CPT® 95970,,Analyze Neurostim No Prog,$368.00,$0.00,$368.00,$0.00,$262.64,$0.00,$0.00,$262.64,$262.64,$0.00,$368.00,$0.00,$184.00,$291.46,$294.40,$0.00,$0.00,$0.00,$0.00,$0.00
92000050,EAP,CPT® 95972,,"Complex Programming, Up To 1 Hr",$472.00,$0.00,$472.00,$0.00,$336.87,$0.00,$0.00,$336.87,$336.87,$0.00,$472.00,$0.00,$236.00,$373.82,$377.60,$0.00,$0.00,$0.00,$0.00,$0.00
92000054,EAP,CPT® 51728,,Cystometrogram W/vp,$790.00,$0.00,$790.00,$0.00,$563.82,$0.00,$0.00,$563.82,$563.82,$0.00,$790.00,$0.00,$790.00,$625.68,$632.00,$0.00,$0.00,$0.00,$0.00,$0.00
92000055,EAP,CPT® 95873,,Guide Nerv Destr Elec Stim,$165.00,$0.00,$165.00,$89.60,$117.76,$0.00,$8.53,$117.76,$117.76,$28.89,$165.00,$0.00,$82.50,$130.68,$132.00,$0.00,$27.56,$57.63,$26.27,$0.00
92000056,EAP,CPT® 95874,,Guide Nerv Destr Needle Emg,$194.00,$0.00,$194.00,$105.34,$138.46,$0.00,$8.53,$138.46,$138.46,$33.97,$194.00,$0.00,$97.00,$153.65,$155.20,$0.00,$27.93,$60.15,$30.88,$0.00
92000057,EAP,CPT® 95971,,Analyze Neurostim Simple,$400.00,$0.00,$400.00,$0.00,$285.48,$0.00,$0.00,$285.48,$285.48,$0.00,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$0.00,$0.00,$0.00,$0.00
92000058,EAP,CPT® 91200,,Liver Elastography,$303.00,$23.41,$303.00,$164.53,$216.25,$132.66,$52.21,$216.25,$216.25,$53.05,$303.00,$138.76,$151.50,$239.98,$242.40,$192.78,$34.27,$23.41,$48.24,$132.15
92000059,EAP,CPT® 92132,,Cmptr Ophthalmic Dx Img Ant Segmt W/i&r Uni/bi,$210.00,$15.13,$210.00,$114.03,$149.88,$52.75,$36.18,$149.88,$149.88,$36.77,$210.00,$55.17,$105.00,$166.32,$168.00,$76.65,$34.49,$15.13,$33.43,$52.54
92000060,EAP,CPT® 92240,,Icg Angiography - One Eye,$940.00,$0.00,$940.00,$0.00,$670.88,$0.00,$0.00,$670.88,$670.88,$0.00,$940.00,$0.00,$470.00,$744.48,$752.00,$0.00,$0.00,$0.00,$0.00,$0.00
92000061,EAP,CPT® 92240,,Icg Angiography - Both Eyes,"$1,410.00",$0.00,"$1,410.00",$0.00,"$1,006.32",$0.00,$0.00,"$1,006.32","$1,006.32",$0.00,"$1,410.00",$0.00,$705.00,"$1,116.72","$1,128.00",$0.00,$0.00,$0.00,$0.00,$0.00
92000062,EAP,CPT® 92060,,Sensormotor Xm W/mlt Meas Ocular Devij W/i&r Spx,$200.00,$0.00,$200.00,$0.00,$142.74,$0.00,$0.00,$142.74,$142.74,$0.00,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$0.00,$0.00,$0.00,$0.00
92000065,EAP,CPT® 92283,,Color Vision Examination,$200.00,$0.00,$200.00,$0.00,$142.74,$0.00,$0.00,$142.74,$142.74,$0.00,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$0.00,$0.00,$0.00,$0.00
92000066,EAP,CPT® 95976,,Elec Alys Implt Smpl Cn Npgt Prgrmg,$590.00,$0.00,$590.00,$0.00,$421.08,$0.00,$0.00,$421.08,$421.08,$0.00,$590.00,$0.00,$295.00,$467.28,$472.00,$0.00,$0.00,$0.00,$0.00,$0.00
92000067,EAP,CPT® 95977,,Elec Alys Implt Cplx Cn Npgt Prgrmg,$590.00,$0.00,$590.00,$0.00,$421.08,$0.00,$0.00,$421.08,$421.08,$0.00,$590.00,$0.00,$295.00,$467.28,$472.00,$0.00,$0.00,$0.00,$0.00,$0.00
92000068,EAP,CPT® 0509T,,Electroretinography (erg) W/i&r Pattern (perg),$327.00,$0.00,$327.00,$0.00,$233.38,$0.00,$0.00,$233.38,$233.38,$0.00,$327.00,$0.00,$163.50,$258.98,$261.60,$0.00,$0.00,$0.00,$0.00,$0.00
92000069,EAP,CPT® 92273,,"Electroretinography (erg), W/i&r; Full Field",$606.00,$0.00,$606.00,$0.00,$432.50,$0.00,$0.00,$432.50,$432.50,$0.00,$606.00,$0.00,$606.00,$479.95,$484.80,$0.00,$0.00,$0.00,$0.00,$0.00
92000070,EAP,CPT® 92274,,"Electroretinography (erg), W/i&r; Multifocal (mferg)",$327.00,$0.00,$327.00,$0.00,$233.38,$0.00,$0.00,$233.38,$233.38,$0.00,$327.00,$0.00,$163.50,$258.98,$261.60,$0.00,$0.00,$0.00,$0.00,$0.00
92000071,EAP,CPT® 95249,,Cont Gluc Mntr Pt Prov Eqp,$155.00,$0.00,$155.00,$0.00,$110.62,$0.00,$0.00,$110.62,$110.62,$0.00,$155.00,$0.00,$155.00,$122.76,$124.00,$0.00,$0.00,$0.00,$0.00,$0.00
92000072,EAP,CPT® 95250,,Cont Gluc Mntr Phys/qhp Prov Eqp,$300.00,$0.00,$300.00,$0.00,$214.11,$0.00,$0.00,$214.11,$214.11,$0.00,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$0.00,$0.00,$0.00,$0.00
92000073,EAP,HCPCS G0399,,HOME SLEEP STUDY,$780.00,$0.00,$780.00,$0.00,$556.69,$0.00,$0.00,$556.69,$556.69,$0.00,$780.00,$0.00,$390.00,$617.76,$624.00,$0.00,$0.00,$0.00,$0.00,$0.00
92000074,EAP,CPT® 92201,,Ophthalmoscopy Ext Retinal Drawing Uni Or Bil,$175.00,$0.00,$175.00,$0.00,$124.90,$0.00,$0.00,$124.90,$124.90,$0.00,$175.00,$0.00,$87.50,$138.60,$140.00,$0.00,$0.00,$0.00,$0.00,$0.00
92000075,EAP,CPT® 92202,,Ophthalmoscopy Ext Optic Nerve Drawing Uni Or Bil,$175.00,$15.15,$175.00,$95.03,$124.90,$52.75,$30.15,$124.90,$124.90,$30.64,$175.00,$55.17,$87.50,$138.60,$140.00,$76.65,$15.37,$15.15,$27.86,$52.54
92000080,EAP,CPT® 95800,,Slp Stdy Unattended W/hrt Rate/o2 Sat/resp/slp Time,$780.00,$0.00,$780.00,$0.00,$556.69,$0.00,$0.00,$556.69,$556.69,$0.00,$780.00,$0.00,$390.00,$617.76,$624.00,$0.00,$0.00,$0.00,$0.00,$0.00
92000081,EAP,CPT® 95801,,Slp Stdy Unatnd W/min Hrt Rate/o2 Sat/resp Analysis,$650.00,$0.00,$650.00,$0.00,$463.91,$0.00,$0.00,$463.91,$463.91,$0.00,$650.00,$0.00,$325.00,$514.80,$520.00,$0.00,$0.00,$0.00,$0.00,$0.00
92000085,EAP,CPT® 99453,,Rem Mntr Physiol Param 1st Set Up Pt Educaj Eqp,$277.00,$18.73,$277.00,$150.41,$197.69,$111.17,$47.73,$197.69,$197.69,$48.50,$277.00,$116.27,$138.50,$219.38,$221.60,$161.54,$43.35,$18.73,$44.10,$110.73
92000086,EAP,CPT® 99454,,Rem Mntr Physiol Param 1st Dev Supply Ea 30 D,$87.00,$13.62,$87.00,$47.24,$62.09,$34.76,$14.99,$62.09,$62.09,$15.23,$87.00,$36.36,$43.50,$68.90,$69.60,$50.51,$13.62,$62.31,$13.85,$34.63
92100001,EAP,CPT® 93279,,Single Lead Pacemaker Program / Eval In Person,$205.00,$26.11,$164.00,$95.97,$117.05,$34.76,$28.26,$117.05,$117.05,$28.72,$164.00,$36.36,$82.00,$129.89,$131.20,$50.51,$53.20,$28.81,$26.11,$34.63
92100002,EAP,CPT® 93280,,Dual Lead Pacemaker Program / Eval In Person,$205.00,$26.11,$164.00,$111.51,$117.05,$34.76,$28.26,$117.05,$117.05,$28.72,$164.00,$36.36,$82.00,$129.89,$131.20,$50.51,$62.94,$33.50,$26.11,$34.63
92100003,EAP,CPT® 93288,,Pacemaker Sngl/dual/multi Interrog / Eval In Person,$205.00,$0.00,$164.00,$0.00,$117.05,$0.00,$28.26,$117.05,$117.05,$28.72,$164.00,$0.00,$82.00,$129.89,$131.20,$0.00,$41.18,$0.00,$0.00,$0.00
92100005,EAP,CPT® 93880,,US DUPLEX CA,"$2,836.00",$162.44,"$2,836.00",$387.33,$520.86,$223.46,$488.63,$520.86,$520.86,$496.56,"$2,836.00",$233.72,"$1,418.00","$2,246.11","$2,268.80",$324.73,$179.50,$162.44,$451.49,$222.60
92100007,EAP,CPT® 93882,,US DUPLEX CA,"$2,411.00",$105.17,"$2,411.00",$246.74,$343.08,$107.47,$415.40,$343.08,$343.08,$422.15,"$2,411.00",$112.41,"$1,205.50","$1,909.51","$1,928.80",$156.18,$119.45,$105.17,$383.83,$107.06
92100009,EAP,CPT® 93886,,Us Transcran Intracran Complete,"$2,693.00",$214.18,"$2,693.00",$516.42,$600.55,$223.46,$463.99,$600.55,$600.55,$471.52,"$2,693.00",$233.72,"$1,346.50","$2,132.86","$2,154.40",$324.73,$214.18,$228.71,$428.73,$222.60
92100011,EAP,CPT® 93888,,Us Transcran Intracran Limited,"$2,693.00",$0.00,"$2,693.00",$0.00,$409.52,$0.00,$0.00,$409.52,$409.52,$0.00,"$2,693.00",$0.00,"$1,346.50","$2,132.86","$2,154.40",$0.00,$0.00,$0.00,$0.00,$0.00
92100013,EAP,Custom 92100013,,Ankle/brachial Indices (abi),$768.00,$0.00,$768.00,$0.00,$548.12,$0.00,$0.00,$548.12,$548.12,$0.00,$768.00,$0.00,$384.00,$608.26,$614.40,$0.00,$0.00,$0.00,$0.00,$0.00
92100014,EAP,CPT® 93922,,Abi -non-inv Doppler Test,"$1,085.00",$0.00,"$1,085.00",$0.00,$258.93,$0.00,$0.00,$258.93,$258.93,$0.00,"$1,085.00",$0.00,$542.50,$859.32,$868.00,$0.00,$0.00,$0.00,$0.00,$0.00
92100015,EAP,CPT® 93923,,Ext Arterial Pvr Study,"$1,369.00",$112.01,"$1,369.00",$263.64,$391.08,$132.66,$235.87,$391.08,$391.08,$239.70,"$1,369.00",$138.76,$684.50,"$1,084.25","$1,095.20",$192.78,$115.78,$112.01,$217.94,$132.15
92100017,EAP,CPT® 93925,,Us Low Ext Arteries Comp,"$2,325.00",$179.51,"$2,325.00",$495.47,$669.22,$223.46,$400.59,$669.22,$669.22,$407.09,"$2,325.00",$233.72,"$1,162.50","$1,841.40","$1,860.00",$324.73,$179.51,$218.26,$370.14,$222.60
92100018,EAP,CPT® 93926,,Low Ext Arteries Ltd,"$1,263.00",$107.06,"$1,263.00",$258.92,$424.07,$107.47,$217.61,$424.07,$424.07,$221.14,"$1,263.00",$112.41,$631.50,"$1,000.30","$1,010.40",$156.18,$120.13,$127.86,$201.07,$107.06
92100020,EAP,CPT® 93930,,Upper Ext Arteries Comp,"$2,150.00",$168.92,"$2,150.00",$398.16,$527.55,$223.46,$370.43,$527.55,$527.55,$376.45,"$2,150.00",$233.72,"$1,075.00","$1,702.80","$1,720.00",$324.73,$183.19,$168.92,$342.28,$222.60
92100022,EAP,CPT® 93931,,Upper Ext Arteries Ltd,"$1,263.00",$105.89,"$1,263.00",$246.06,$353.26,$107.47,$217.61,$353.26,$353.26,$221.14,"$1,263.00",$112.41,$631.50,"$1,000.30","$1,010.40",$156.18,$121.65,$105.89,$201.07,$107.06
92100025,EAP,CPT® 93970,,Us Ext Veins Doppler Comp,"$2,667.00",$163.16,"$2,667.00",$377.18,$523.58,$223.46,$459.51,$523.58,$523.58,$466.97,"$2,667.00",$233.72,"$1,333.50","$2,112.26","$2,133.60",$324.73,$199.35,$163.16,$424.59,$222.60
92100026,EAP,CPT® 93970,,Periph.vas. Bil. W/mapping,"$2,667.00",$163.16,"$2,667.00",$377.18,$523.58,$223.46,$459.51,$523.58,$523.58,$466.97,"$2,667.00",$233.72,"$1,333.50","$2,112.26","$2,133.60",$324.73,$199.35,$163.16,$424.59,$222.60
92100028,EAP,CPT® 93971,,Us Ext Veins Doppler Ltd,"$1,956.00",$101.21,"$1,956.00",$229.82,$346.68,$107.47,$113.40,$346.68,$346.68,$342.48,"$1,956.00",$112.41,$978.00,"$1,549.15","$1,564.80",$156.18,$132.53,$101.21,$311.40,$107.06
92100029,EAP,CPT® 93971,,Periph.vas. Uni. & Ext Non-vas,"$1,956.00",$101.21,"$1,956.00",$229.82,$346.68,$107.47,$113.40,$346.68,$346.68,$342.48,"$1,956.00",$112.41,$978.00,"$1,549.15","$1,564.80",$156.18,$132.53,$101.21,$311.40,$107.06
92100030,EAP,CPT® 93971,,Periph.vas. Uni. W/mapping,"$1,956.00",$101.21,"$1,956.00",$229.82,$346.68,$107.47,$113.40,$346.68,$346.68,$342.48,"$1,956.00",$112.41,$978.00,"$1,549.15","$1,564.80",$156.18,$132.53,$101.21,$311.40,$107.06
92100032,EAP,CPT® 93975,,Abd/retroper Doppler Comp Us,"$3,326.00",$222.60,"$3,326.00",$536.71,$683.69,$223.46,$573.05,$683.69,$683.69,$582.36,"$3,326.00",$233.72,"$1,663.00","$2,634.19","$2,660.80",$324.73,$268.31,$223.31,$529.50,$222.60
92100033,EAP,CPT® 93976,,Abd/retroper Doppler Ltd Us,"$1,809.00",$107.06,"$1,809.00",$289.29,$375.03,$107.47,$311.68,$375.03,$375.03,$316.74,"$1,809.00",$112.41,$904.50,"$1,432.73","$1,447.20",$156.18,$179.32,$126.42,$287.99,$107.06
92100034,EAP,Custom 92100034,,Sngl Lead Pm Program Eval,$204.00,$0.00,$204.00,$0.00,$145.59,$0.00,$0.00,$145.59,$145.59,$0.00,$204.00,$0.00,$102.00,$161.57,$163.20,$0.00,$0.00,$0.00,$0.00,$0.00
92100035,EAP,Custom 92100035,,Sngl Lead Icd Program Eval,$264.00,$0.00,$264.00,$0.00,$188.42,$0.00,$0.00,$188.42,$188.42,$0.00,$264.00,$0.00,$132.00,$209.09,$211.20,$0.00,$0.00,$0.00,$0.00,$0.00
92100036,EAP,CPT® 93286,,Pacemaker Sngl/dual/multi  Peri-procedure Eval In Person,$235.00,$0.00,$188.00,$52.05,$134.18,$0.00,$32.39,$134.18,$134.18,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$25.21,$29.93,$0.00
92100037,EAP,CPT® 93287,,Icd Sngl/dual/multi Peri-procedure Eval In Person,$313.00,$0.00,$250.00,$70.29,$178.43,$0.00,$43.07,$178.43,$178.43,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$34.26,$25.21,$39.80,$0.00
92100038,EAP,CPT® 93296,,Pacemaker/icd Interrog / Eval Remote Up To 90 Days,$255.00,$0.00,$204.00,$50.02,$145.59,$34.76,$0.00,$145.59,$145.59,$0.00,$204.00,$36.36,$102.00,$161.57,$163.20,$50.51,$0.00,$25.93,$32.48,$34.63
92100039,EAP,Custom 92100039,,Mult Lead Pm Program Eval,$164.00,$0.00,$164.00,$0.00,$117.05,$0.00,$0.00,$117.05,$117.05,$0.00,$164.00,$0.00,$82.00,$129.89,$131.20,$0.00,$0.00,$0.00,$0.00,$0.00
92100040,EAP,CPT® 93284,,Multi-lead Icd  Program / Eval In Person,$330.00,$34.63,$264.00,$173.01,$188.42,$34.76,$45.49,$188.42,$188.42,$46.22,$264.00,$36.36,$132.00,$209.09,$211.20,$50.51,$96.97,$36.38,$42.03,$34.63
92100041,EAP,CPT® 93291,,Interrog / Eval Scrms Or Loop Recorder In Clinic,$204.00,$21.96,$204.00,$70.29,$145.59,$22.05,$35.15,$145.59,$145.59,$35.72,$204.00,$23.06,$102.00,$161.57,$163.20,$32.04,$39.45,$24.85,$32.48,$21.96
92100043,EAP,Custom 92100043,,Icd Interrogation,$264.00,$0.00,$264.00,$0.00,$188.42,$0.00,$0.00,$188.42,$188.42,$0.00,$264.00,$0.00,$132.00,$209.09,$211.20,$0.00,$0.00,$0.00,$0.00,$0.00
92100044,EAP,Custom 92100044,,Dual Lead Pm Program Eval,$204.00,$0.00,$204.00,$0.00,$145.59,$0.00,$0.00,$145.59,$145.59,$0.00,$204.00,$0.00,$102.00,$161.57,$163.20,$0.00,$0.00,$0.00,$0.00,$0.00
92100045,EAP,Custom 92100045,,Dual Lead Icd Program Eval,$264.00,$0.00,$264.00,$0.00,$188.42,$0.00,$0.00,$188.42,$188.42,$0.00,$264.00,$0.00,$132.00,$209.09,$211.20,$0.00,$0.00,$0.00,$0.00,$0.00
92100050,EAP,CPT® 93978,,Aorta Duplex,"$1,685.00",$151.27,"$1,685.00",$365.05,$490.90,$223.46,$290.32,$490.90,$490.90,$295.03,"$1,685.00",$233.72,$842.50,"$1,334.52","$1,348.00",$324.73,$187.25,$151.27,$268.25,$222.60
92100052,EAP,CPT® 93880,,Carotid Duplex,"$2,836.00",$162.44,"$2,836.00",$387.33,$520.86,$223.46,$488.63,$520.86,$520.86,$496.56,"$2,836.00",$233.72,"$1,418.00","$2,246.11","$2,268.80",$324.73,$179.50,$162.44,$451.49,$222.60
92100063,EAP,CPT® 93978,,Vascular Study Ult,"$1,685.00",$151.27,"$1,685.00",$365.05,$490.90,$223.46,$290.32,$490.90,$490.90,$295.03,"$1,685.00",$233.72,$842.50,"$1,334.52","$1,348.00",$324.73,$187.25,$151.27,$268.25,$222.60
92100065,EAP,CPT® 93979,,Vascular Study Limited Ult,"$1,057.00",$0.00,"$1,057.00",$0.00,$341.04,$0.00,$0.00,$341.04,$341.04,$0.00,"$1,057.00",$0.00,$528.50,$837.14,$845.60,$0.00,$0.00,$0.00,$0.00,$0.00
92100072,EAP,CPT® 93281,,Multi-lead Pacemaker Program / Eval In Person,$205.00,$26.11,$164.00,$131.10,$117.05,$34.76,$28.26,$117.05,$117.05,$28.72,$164.00,$36.36,$82.00,$129.89,$131.20,$50.51,$73.61,$34.22,$26.11,$34.63
92100080,EAP,CPT® 93886,,Transcran Doppler Comp Us,"$2,693.00",$214.18,"$2,693.00",$516.42,$600.55,$223.46,$463.99,$600.55,$600.55,$471.52,"$2,693.00",$233.72,"$1,346.50","$2,132.86","$2,154.40",$324.73,$214.18,$228.71,$428.73,$222.60
92100081,EAP,CPT® 93888,,Transcran Doppler Ltd Us,"$2,693.00",$0.00,"$2,693.00",$0.00,$409.52,$0.00,$0.00,$409.52,$409.52,$0.00,"$2,693.00",$0.00,"$1,346.50","$2,132.86","$2,154.40",$0.00,$0.00,$0.00,$0.00,$0.00
92100082,EAP,CPT® 93890,,Tcd. Vasoreactivity Study,"$1,845.00",$0.00,"$1,845.00",$0.00,$506.27,$0.00,$0.00,$506.27,$506.27,$0.00,"$1,845.00",$0.00,$922.50,"$1,461.24","$1,476.00",$0.00,$0.00,$0.00,$0.00,$0.00
92100083,EAP,CPT® 93892,,Tcd. Emboli Detct W/o Inj,$897.00,$107.06,$897.00,$327.84,$549.93,$107.47,$154.55,$549.93,$549.93,$157.06,$897.00,$112.41,$448.50,$710.42,$717.60,$156.18,$256.10,$255.72,$142.80,$107.06
92100084,EAP,CPT® 93893,,Tcd. Emboli Detect W/inj,$897.00,$0.00,$897.00,$327.13,$547.32,$107.47,$0.00,$547.32,$547.32,$157.06,$897.00,$112.41,$448.50,$710.42,$717.60,$156.18,$0.00,$302.18,$142.80,$107.06
92100086,EAP,CPT® 93922,,Abi -non-inv Doppler Test,"$1,085.00",$0.00,"$1,085.00",$0.00,$258.93,$0.00,$0.00,$258.93,$258.93,$0.00,"$1,085.00",$0.00,$542.50,$859.32,$868.00,$0.00,$0.00,$0.00,$0.00,$0.00
92100088,EAP,CPT® 93922,,Limited Bilateral Pvr Exam,"$1,085.00",$0.00,"$1,085.00",$0.00,$258.93,$0.00,$0.00,$258.93,$258.93,$0.00,"$1,085.00",$0.00,$542.50,$859.32,$868.00,$0.00,$0.00,$0.00,$0.00,$0.00
92100089,EAP,CPT® 93980,,Penile Vascular Study,"$1,524.00",$0.00,"$1,524.00",$0.00,$283.66,$0.00,$0.00,$283.66,$283.66,$0.00,"$1,524.00",$0.00,$762.00,"$1,207.01","$1,219.20",$0.00,$0.00,$0.00,$0.00,$0.00
92100090,EAP,CPT® 93924,,Vas Lab Pvr Lower Ext With Exercise,"$1,200.00",$127.08,"$1,200.00",$328.53,$486.60,$132.66,$206.75,$486.60,$486.60,$210.11,"$1,200.00",$138.76,$600.00,$950.40,$960.00,$192.78,$127.08,$141.19,$191.04,$132.15
92100091,EAP,CPT® 93985,,Vessel Mapping For Hd Access Bilateral,$557.00,$88.67,$557.00,$510.24,$397.53,$223.46,$95.97,$397.53,$397.53,$97.53,$557.00,$233.72,$278.50,$441.14,$445.60,$324.73,$256.89,$231.59,$88.67,$222.60
92100092,EAP,CPT® 93986,,Vessel Mapping For Hd Access Unilateral,$268.00,$42.67,$268.00,$258.85,$191.27,$107.47,$46.18,$191.27,$191.27,$46.92,$268.00,$112.41,$134.00,$212.26,$214.40,$156.18,$130.33,$131.82,$42.67,$107.06
92200001,EAP,CPT® 95860,,Electromyogram - 1 Extermity,$432.00,$68.77,$432.00,$234.58,$308.32,$104.55,$74.43,$308.32,$308.32,$75.64,$432.00,$109.35,$216.00,$342.14,$345.60,$151.93,$70.97,$68.79,$68.77,$104.14
92200002,EAP,CPT® 95861,,Electromyorgam - 2 Extermities,$421.00,$0.00,$421.00,$0.00,$300.47,$0.00,$0.00,$300.47,$300.47,$0.00,$421.00,$0.00,$210.50,$333.43,$336.80,$0.00,$0.00,$0.00,$0.00,$0.00
92200003,EAP,CPT® 95869,,Emg Limited (thoracic Psp),$183.00,$0.00,$183.00,$0.00,$130.61,$0.00,$0.00,$130.61,$130.61,$0.00,$183.00,$0.00,$91.50,$144.94,$146.40,$0.00,$0.00,$0.00,$0.00,$0.00
92200004,EAP,CPT® 95870,,Emg Limited Ext,$311.00,$0.00,$311.00,$0.00,$221.96,$0.00,$0.00,$221.96,$221.96,$0.00,$311.00,$0.00,$155.50,$246.31,$248.80,$0.00,$0.00,$0.00,$0.00,$0.00
92200010,EAP,CPT® 95937,,Rns,$175.00,$27.86,$175.00,$95.03,$124.90,$132.66,$30.15,$124.90,$124.90,$30.64,$175.00,$138.76,$87.50,$138.60,$140.00,$175.00,$50.14,$60.15,$27.86,$132.15
92200011,EAP,CPT® 95907,,Nvr Cndj Tst 1-2 Studies,$679.00,$42.14,$679.00,$368.70,$484.60,$132.66,$116.99,$484.60,$484.60,$118.89,$679.00,$138.76,$339.50,$537.77,$543.20,$192.78,$90.38,$42.14,$108.10,$132.15
92200012,EAP,CPT® 95908,,Nrv Cndj Tst 3-4 Studies,"$1,001.00",$54.75,"$1,001.00",$543.54,$714.41,$241.94,$172.47,$714.41,$714.41,$175.27,"$1,001.00",$253.05,$500.50,$792.79,$800.80,$351.58,$111.50,$54.75,$159.36,$241.00
92200013,EAP,CPT® 95909,,Nrv Cndj Tst 5-6 Studies,"$1,322.00",$65.55,"$1,322.00",$717.85,$943.51,$241.94,$227.77,$943.51,$943.51,$231.47,"$1,322.00",$253.05,$661.00,"$1,047.02","$1,057.60",$351.58,$133.60,$65.55,$210.46,$241.00
92200014,EAP,CPT® 95910,,Nrv Cndj Test 7-8 Studies,"$1,646.00",$84.28,"$1,646.00",$893.78,"$1,174.75",$241.94,$283.60,"$1,174.75","$1,174.75",$288.20,"$1,646.00",$253.05,$823.00,"$1,303.63","$1,316.80",$351.58,$175.83,$84.28,$262.04,$241.00
92200015,EAP,CPT® 95911,,Nrv Cndj Test 9-10 Studies,"$1,968.00",$96.53,"$1,968.00","$1,068.62","$1,404.56",$465.65,$339.08,"$1,404.56","$1,404.56",$344.58,"$1,968.00",$487.04,$984.00,"$1,558.66","$1,574.40",$676.67,$212.84,$96.53,$313.31,$463.84
92200016,EAP,CPT® 95912,,Nvr Cndj Tst 11-12 Studies,"$2,290.00",$104.09,"$2,290.00","$1,243.47","$1,634.37",$465.65,$394.56,"$1,634.37","$1,634.37",$400.96,"$2,290.00",$487.04,"$1,145.00","$1,813.68","$1,832.00",$676.67,$249.19,$104.09,$364.57,$463.84
92200017,EAP,CPT® 95913,,Nrv Cndj Tst 13- Or More Studies,"$2,612.00",$115.61,"$2,612.00","$1,418.32","$1,864.18",$465.65,$450.03,"$1,864.18","$1,864.18",$457.34,"$2,612.00",$487.04,"$1,306.00","$2,068.70","$2,089.60",$676.67,$288.80,$115.61,$415.83,$463.84
92200018,EAP,CPT® 95872,,Needle Emg W/1 Fiber Electrode Quan Meas Jitter,$636.00,$47.18,$636.00,$345.35,$453.91,$132.66,$109.58,$453.91,$453.91,$111.36,$636.00,$138.76,$318.00,$503.71,$508.80,$192.78,$101.87,$47.18,$101.25,$132.15
92200040,EAP,CPT® 95933,,Orbicularis Oculi Reflex,$421.00,$51.50,$421.00,$228.60,$300.47,$52.75,$72.54,$300.47,$300.47,$73.71,$421.00,$55.17,$210.50,$333.43,$336.80,$76.65,$65.19,$51.50,$67.02,$52.54
92200041,EAP,CPT® 95925,,Short-latency Somatosens Ep Std Upr Limbs,"$1,372.00",$0.00,"$1,372.00",$0.00,$979.20,$0.00,$0.00,$979.20,$979.20,$0.00,"$1,372.00",$0.00,$686.00,"$1,086.62","$1,097.60",$0.00,$0.00,$0.00,$0.00,$0.00
92200042,EAP,CPT® 95926,,Short-latency Somatosens Ep Std Lwr Limbs,"$1,372.00",$0.00,"$1,372.00",$0.00,$979.20,$0.00,$0.00,$979.20,$979.20,$0.00,"$1,372.00",$0.00,$686.00,"$1,086.62","$1,097.60",$0.00,$0.00,$0.00,$0.00,$0.00
92200043,EAP,CPT® 95867,,Emg Cranial Nerve Unilateral,$614.00,$65.91,$614.00,$333.40,$438.21,$132.66,$105.79,$438.21,$438.21,$107.51,$614.00,$138.76,$307.00,$486.29,$491.20,$192.78,$68.25,$65.91,$97.75,$132.15
92200044,EAP,CPT® 95868,,Emg Cranial Nerve Bilateral,$836.00,$0.00,$836.00,$0.00,$596.65,$0.00,$0.00,$596.65,$596.65,$0.00,$836.00,$0.00,$418.00,$662.11,$668.80,$0.00,$0.00,$0.00,$0.00,$0.00
92400001,EAP,CPT® 95004,,"Perc. Allergy Test, Immed. Rea","$1,009.00",$0.00,"$1,009.00",$0.00,$720.12,$0.00,$0.00,$720.12,$720.12,$0.00,"$1,009.00",$0.00,$504.50,$799.13,$807.20,$0.00,$0.00,$0.00,$0.00,$0.00
92400002,EAP,CPT® 95004,,"Allergy Testing, Extracts",$950.00,$0.00,$950.00,$0.00,$678.02,$0.00,$0.00,$678.02,$678.02,$0.00,$950.00,$0.00,$475.00,$752.40,$760.00,$0.00,$0.00,$0.00,$0.00,$0.00
92400011,EAP,CPT® 95028,,Intradermal Test #,$165.00,$8.93,$165.00,$89.60,$117.76,$32.06,$28.43,$117.76,$117.76,$28.89,$165.00,$33.53,$82.50,$130.68,$132.00,$46.58,$8.93,$12.97,$26.27,$31.93
92400012,EAP,CPT® 95044,,Patch Tests - Each,$913.00,$5.40,$913.00,$495.76,$651.61,$871.59,$157.31,$651.61,$651.61,$159.86,$913.00,$911.62,$456.50,$723.10,$730.40,$913.00,$7.85,$5.40,$145.35,$868.21
92400030,EAP,CPT® 95180,,Rapid Desensitization,$385.00,$0.00,$385.00,$0.00,$274.77,$0.00,$0.00,$274.77,$274.77,$0.00,$385.00,$0.00,$192.50,$304.92,$308.00,$0.00,$0.00,$0.00,$0.00,$0.00
92400034,EAP,CPT® 95076,,Ingest Challenge Ini 120 Min,$702.00,$0.00,$702.00,$0.00,$501.02,$0.00,$0.00,$501.02,$501.02,$0.00,$702.00,$0.00,$351.00,$555.98,$561.60,$0.00,$0.00,$0.00,$0.00,$0.00
92900002,EAP,CPT® 93293,,"Transtelephonic Rhythm Strip Pm Eval / Sngl, Dual, Multi-lead",$330.00,$0.00,$264.00,$0.00,$188.42,$0.00,$0.00,$188.42,$188.42,$0.00,$264.00,$0.00,$132.00,$209.09,$211.20,$0.00,$0.00,$0.00,$0.00,$0.00
94000002,EAP,CPT® 95115,,Allergy Injection,$40.00,$0.00,$40.00,$0.00,$28.55,$0.00,$0.00,$28.55,$28.55,$0.00,$40.00,$0.00,$20.00,$31.68,$32.00,$0.00,$0.00,$0.00,$0.00,$0.00
94000003,EAP,CPT® 95117,,"Allergy Injections, 2 Or More",$63.00,$0.00,$63.00,$0.00,$44.96,$0.00,$0.00,$44.96,$44.96,$0.00,$63.00,$0.00,$31.50,$49.90,$50.40,$0.00,$0.00,$0.00,$0.00,$0.00
94000005,EAP,CPT® 96900,,"Actinotherapy, Uvl",$215.00,$0.00,$215.00,$0.00,$153.45,$0.00,$0.00,$153.45,$153.45,$0.00,$215.00,$0.00,$107.50,$170.28,$172.00,$0.00,$0.00,$0.00,$0.00,$0.00
94000006,EAP,CPT® 96910,,"Photochemotherapy,uvb",$127.00,$20.22,$127.00,$68.96,$90.64,$52.75,$21.88,$90.64,$90.64,$22.24,$127.00,$55.17,$63.50,$100.58,$101.60,$76.65,$22.14,$118.14,$20.22,$52.54
94000007,EAP,CPT® 96912,,"Photochemotherapy, Puva",$206.00,$0.00,$206.00,$0.00,$147.02,$0.00,$0.00,$147.02,$147.02,$0.00,$206.00,$0.00,$103.00,$163.15,$164.80,$0.00,$0.00,$0.00,$0.00,$0.00
94000021,EAP,CPT® 99195,,Phlebotomy,$188.00,$17.15,$188.00,$102.08,$134.18,$104.55,$32.39,$134.18,$134.18,$32.92,$188.00,$109.35,$94.00,$148.90,$150.40,$151.93,$17.15,$102.65,$29.93,$104.14
94000022,EAP,CPT® 99195,,Therapeutic Phlebotomy,$188.00,$17.15,$188.00,$102.08,$134.18,$104.55,$32.39,$134.18,$134.18,$32.92,$188.00,$109.35,$94.00,$148.90,$150.40,$151.93,$17.15,$102.65,$29.93,$104.14
94000031,EAP,CPT® 95907,,Nerve conductionstudies 1-2 studie,$679.00,$42.14,$679.00,$368.70,$484.60,$132.66,$116.99,$484.60,$484.60,$118.89,$679.00,$138.76,$339.50,$537.77,$543.20,$192.78,$90.38,$42.14,$108.10,$132.15
94200001,EAP,CPT® 97802,,"Mnt - Individual, Initial Per 15 Min",$97.00,$15.18,$97.00,$52.67,$69.23,$17.27,$16.71,$69.23,$69.23,$16.98,$97.00,$29.55,$48.50,$76.82,$77.60,$34.61,$15.18,$34.61,$15.44,$34.61
94200002,EAP,CPT® 97803,,"Mnt - Individual, Follow-up Per 15 Min",$84.00,$13.15,$84.00,$45.61,$59.95,$14.95,$14.47,$59.95,$59.95,$14.71,$84.00,$25.06,$42.00,$66.53,$67.20,$29.21,$13.15,$29.21,$13.37,$29.21
94200003,EAP,CPT® 97804,,"Mnt - Group, Initial Or Follow-up Per 30 Min",$46.00,$7.20,$46.00,$24.98,$32.83,$8.19,$7.93,$32.83,$32.83,$8.05,$46.00,$13.82,$23.00,$36.43,$36.80,$16.23,$7.20,$16.23,$7.32,$16.23
94200004,EAP,HCPCS G0108,,"Dsmt - Individual, Initial Or Follow-up Per 30 Min",$154.00,$24.10,$154.00,$83.62,$109.91,$27.41,$26.53,$109.91,$109.91,$26.96,$154.00,$57.08,$77.00,$121.97,$123.20,$56.97,$24.10,$56.97,$24.52,$56.97
94200005,EAP,HCPCS G0109,,"Dsmt - Group, Initial Or Follow-up Per 30 Min",$117.00,$15.50,$117.00,$63.53,$83.50,$20.83,$20.16,$83.50,$83.50,$20.49,$117.00,$15.50,$58.50,$92.66,$93.60,$15.86,$18.31,$15.86,$18.63,$15.86
94200012,EAP,HCPCS G0270,,Mnt - Individual (beyond Initial 3hrs Or Beyond 2hrs In Subq Yrs) - Per 15 Min,$107.00,$16.75,$107.00,$58.10,$76.37,$19.05,$18.44,$76.37,$76.37,$18.73,$107.00,$25.06,$53.50,$84.74,$85.60,$29.21,$16.75,$29.21,$17.03,$29.21
94200013,EAP,HCPCS G0271,,Mnt - Group (beyond Initial 3hrs Or Beyond 2hrs In Sebq Yrs) - Per 30 Min,$59.00,$0.00,$59.00,$32.04,$42.11,$10.50,$10.17,$42.11,$42.11,$10.33,$59.00,$13.82,$29.50,$46.73,$47.20,$16.23,$9.23,$16.23,$0.00,$16.23
94200014,EAP,CPT® 99412,,Childbirth Education Class,$35.00,$0.00,$35.00,$19.01,$24.98,$6.23,$6.03,$24.98,$24.98,$6.13,$35.00,$0.00,$17.50,$27.72,$28.00,$21.00,$5.48,$0.00,$5.57,$0.00
94200015,EAP,CPT® 99078,,Centering Preg Group Session,$125.00,$0.00,$125.00,$67.88,$89.21,$0.00,$21.54,$89.21,$89.21,$21.89,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$19.56,$0.00,$19.90,$0.00
94300001,EAP,CPT® 93797,,Cardiac Rehab - Regular,$143.00,$0.00,$143.00,$0.00,$102.06,$0.00,$0.00,$102.06,$102.06,$0.00,$143.00,$0.00,$71.50,$113.26,$114.40,$0.00,$0.00,$0.00,$0.00,$0.00
94600011,EAP,Custom 94600011,,Kinair Iii W/o Scale,$178.00,$0.00,$178.00,$0.00,$127.04,$0.00,$0.00,$127.04,$127.04,$0.00,$178.00,$0.00,$89.00,$140.98,$142.40,$0.00,$0.00,$0.00,$0.00,$0.00
99900120,EAP,HCPCS G1004,,"Cdsm National Decision Support Company, Medicare Auc Program",$0.01,$0.00,$0.01,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.01,$0.00,$0.00,$0.01,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
99900132,EAP,Custom 99900132,,"Trauma Protocol, Ect","$25,279.00",$0.00,"$25,279.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$25,279.00",$0.00,"$12,639.50","$20,020.97","$20,223.20",$0.00,$0.00,$0.00,$0.00,$0.00
99900529,EAP,Custom 99900529,,"Head/neck Cta W&w/o Dye,nct","$12,458.00",$0.00,"$12,458.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$12,458.00",$0.00,"$6,229.00","$9,866.74","$9,966.40",$0.00,$0.00,$0.00,$0.00,$0.00
0159T,EAP,CPT® 0159T,,Computer Aided Breast Mri,$118.00,$0.00,$118.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$118.00,$0.00,$0.00,$93.46,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
C9803,EAP,HCPCS C9803,,Hopd Covid-19 Spec Collect,$57.00,$0.00,$57.00,$30.95,$40.68,$22.05,$9.82,$40.68,$40.68,$9.98,$57.00,$23.06,$28.50,$45.14,$45.60,$32.04,$8.92,$0.00,$9.07,$21.96
CMPR7501,EAP,,,Colonoscopy Procedure,"$1,413.00",$0.00,"$1,413.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,413.00",$0.00,$706.50,"$1,119.10","$1,130.40",$0.00,$0.00,$0.00,$0.00,$0.00
CMPR7502,EAP,,,Sigmoidoscopy Procedure,$761.00,$0.00,$761.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$761.00,$0.00,$380.50,$602.71,$608.80,$0.00,$0.00,$0.00,$0.00,$0.00
CMPR7504,EAP,,,Dilation Of Esophagus Procedure,"$3,267.00",$0.00,"$3,267.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$3,267.00",$0.00,"$1,633.50","$2,587.46","$2,613.60",$0.00,$0.00,$0.00,$0.00,$0.00
CMPR7505,EAP,,,Endoscopic Cannulation Procedure,$445.00,$0.00,$445.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$445.00,$0.00,$222.50,$352.44,$356.00,$0.00,$0.00,$0.00,$0.00,$0.00
G0008,EAP,HCPCS G0008,,ADMIN INFLUENZA VIRUS VAC,$73.00,$0.00,$73.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$73.00,$0.00,$0.00,$57.82,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
G0009,EAP,HCPCS G0009,,ADMIN PNEUMOCOCCAL VACCINE,$73.00,$0.00,$73.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$73.00,$0.00,$0.00,$57.82,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
G0010,EAP,HCPCS G0010,,ADMIN HEPATITIS B VACCINE,$73.00,$0.00,$73.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$73.00,$0.00,$0.00,$57.82,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
G0105,EAP,HCPCS G0105,,COLORECTAL SCRN; HI RISK IND,"$1,187.00",$0.00,"$1,187.00",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,187.00",$0.00,"$1,187.00",$940.10,$949.60,$0.00,$0.00,$0.00,$0.00,$0.00
G0121,EAP,HCPCS G0121,,COLON CA SCRN NOT HI RSK IND,"$1,189.00",$186.08,"$1,189.00","$1,189.00","$1,189.00",$732.48,$204.86,"$1,189.00","$1,189.00",$208.18,"$1,189.00",$766.13,"$1,189.00",$941.69,$951.20,"$1,064.43",$186.08,$193.26,$189.29,$729.64
G0297,EAP,HCPCS G0297,,Ldct for lung ca screen,$662.00,$76.23,$662.00,$662.00,$662.00,$76.53,$114.06,$662.00,$662.00,$115.91,$662.00,$80.04,$331.00,$524.30,$529.60,$111.21,$103.60,$189.09,$105.39,$76.23
G0438,EAP,HCPCS G0438,,FIRST ANNUAL WELLNESS VISIT,$604.00,$0.00,$604.00,$0.00,$299.34,$107.51,$0.00,$299.34,$299.34,$105.76,$604.00,$184.17,$302.00,$478.37,$483.20,$172.69,$0.00,$172.69,$96.16,$172.69
G0447,EAP,HCPCS G0447,,"Face-to-face Behavioral Counseling For Obesity, 15 Minus",$93.00,$14.55,$93.00,$50.50,$66.37,$75.31,$16.02,$66.37,$66.37,$16.28,$93.00,$78.77,$46.50,$73.66,$74.40,$93.00,$14.55,$24.16,$14.81,$75.02
G2012,EAP,HCPCS G2012,,PR BRIEF CHECK IN BY MD/QHP BY TELEPHONE,$52.00,$0.00,$52.00,$28.24,$0.00,$0.00,$8.96,$0.00,$0.00,$9.10,$52.00,$0.00,$26.00,$41.18,$41.60,$13.34,$8.14,$13.34,$0.00,$0.00
101,ERX,HCPCS 25000001,00904-6719-60,ACETAMINOPHEN 325 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
101,ERX,HCPCS 25000001,00904-6773-61,ACETAMINOPHEN 325 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
101,ERX,HCPCS 25000001,49348-0973-10,ACETAMINOPHEN 325 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
101,ERX,HCPCS 25000001,50580-0600-02,ACETAMINOPHEN 325 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
101,ERX,HCPCS 25000001,57896-0102-10,ACETAMINOPHEN 325 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
101,ERX,HCPCS 25000001,63739-0440-01,ACETAMINOPHEN 325 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
101,ERX,HCPCS 25000001,69618-0010-01,ACETAMINOPHEN 325 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
102,ERX,HCPCS 25000001,00904-6730-61,ACETAMINOPHEN 500 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
102,ERX,HCPCS 25000001,49348-0042-14,ACETAMINOPHEN 500 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
102,ERX,HCPCS 25000001,50580-0412-01,ACETAMINOPHEN 500 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
102,ERX,HCPCS 25000001,50580-0412-02,ACETAMINOPHEN 500 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
102,ERX,HCPCS 25000001,57896-0204-01,ACETAMINOPHEN 500 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
103,ERX,HCPCS 25000001,45802-0732-00,ACETAMINOPHEN 120 MG RECTAL SUPP,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
103,ERX,HCPCS 25000001,45802-0732-30,ACETAMINOPHEN 120 MG RECTAL SUPP,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
104,ERX,HCPCS 25000001,,ACETAMINOPHEN 325 MG RECTAL SUPP,$6.00,$0.00,$64.95,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$64.95,$0.00
104,ERX,HCPCS 25000001,51672-2116-02,ACETAMINOPHEN 325 MG RECTAL SUPP,$6.00,$0.00,$64.95,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$64.95,$0.00
105,ERX,HCPCS 25000001,45802-0730-00,ACETAMINOPHEN 650 MG RECTAL SUPP,$6.00,$0.00,$64.95,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$64.95,$0.00
105,ERX,HCPCS 25000001,45802-0730-30,ACETAMINOPHEN 650 MG RECTAL SUPP,$6.00,$0.00,$64.95,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$64.95,$0.00
105,ERX,HCPCS 25000001,45802-0730-32,ACETAMINOPHEN 650 MG RECTAL SUPP,$6.00,$0.00,$64.95,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$64.95,$0.00
113,ERX,HCPCS 63700001,00527-1050-01,ACETAZOLAMIDE 250 MG PO TABS,$10.96,$0.00,$10.96,$0.00,$7.82,$0.00,$0.00,$0.00,$0.00,$0.00,$10.96,$0.00,$5.48,$8.68,$8.77,$0.00,$0.00,$0.00,$0.00,$0.00
113,ERX,HCPCS 63700001,51672-4023-01,ACETAZOLAMIDE 250 MG PO TABS,$10.96,$0.00,$10.96,$0.00,$7.82,$0.00,$0.00,$0.00,$0.00,$0.00,$10.96,$0.00,$5.48,$8.68,$8.77,$0.00,$0.00,$0.00,$0.00,$0.00
114,ERX,HCPCS J1120,00143-9503-01,ACETAZOLAMIDE SODIUM 500 MG IJ SOLR,$92.32,$0.00,$92.32,$41.54,$65.89,$0.00,$41.60,$0.00,$0.00,$16.61,$92.32,$0.00,$46.16,$73.12,$73.86,$0.00,$16.61,$0.00,$15.82,$0.00
114,ERX,HCPCS J1120,39822-0190-01,ACETAZOLAMIDE SODIUM 500 MG IJ SOLR,$92.32,$0.00,$92.32,$41.54,$65.89,$0.00,$41.60,$0.00,$0.00,$16.61,$92.32,$0.00,$46.16,$73.12,$73.86,$0.00,$16.61,$0.00,$15.82,$0.00
114,ERX,HCPCS J1120,39822-0190-07,ACETAZOLAMIDE SODIUM 500 MG IJ SOLR,$92.32,$0.00,$92.32,$41.54,$65.89,$0.00,$41.60,$0.00,$0.00,$16.61,$92.32,$0.00,$46.16,$73.12,$73.86,$0.00,$16.61,$0.00,$15.82,$0.00
114,ERX,HCPCS J1120,67457-0853-50,ACETAZOLAMIDE SODIUM 500 MG IJ SOLR,$92.32,$0.00,$92.32,$41.54,$65.89,$0.00,$41.60,$0.00,$0.00,$16.61,$92.32,$0.00,$46.16,$73.12,$73.86,$0.00,$16.61,$0.00,$15.82,$0.00
123,ERX,HCPCS J7608,00409-3308-03,ACETYLCYSTEINE 20 % IN SOLN,$42.65,$0.00,$42.65,$0.00,$30.44,$0.00,$7.35,$0.00,$0.00,$0.00,$42.65,$0.00,$21.33,$33.78,$34.12,$0.00,$6.67,$0.00,$0.00,$0.00
123,ERX,HCPCS J7608,00517-7604-01,ACETYLCYSTEINE 20 % IN SOLN,$42.65,$0.00,$42.65,$0.00,$30.44,$0.00,$7.35,$0.00,$0.00,$0.00,$42.65,$0.00,$21.33,$33.78,$34.12,$0.00,$6.67,$0.00,$0.00,$0.00
123,ERX,HCPCS J7608,00517-7604-25,ACETYLCYSTEINE 20 % IN SOLN,$42.65,$0.00,$42.65,$0.00,$30.44,$0.00,$7.35,$0.00,$0.00,$0.00,$42.65,$0.00,$21.33,$33.78,$34.12,$0.00,$6.67,$0.00,$0.00,$0.00
123,ERX,HCPCS J7608,63323-0690-30,ACETYLCYSTEINE 20 % IN SOLN,$42.65,$0.00,$42.65,$0.00,$30.44,$0.00,$7.35,$0.00,$0.00,$0.00,$42.65,$0.00,$21.33,$33.78,$34.12,$0.00,$6.67,$0.00,$0.00,$0.00
123,ERX,HCPCS J7608,63323-0694-04,ACETYLCYSTEINE 20 % IN SOLN,$42.65,$0.00,$42.65,$0.00,$30.44,$0.00,$7.35,$0.00,$0.00,$0.00,$42.65,$0.00,$21.33,$33.78,$34.12,$0.00,$6.67,$0.00,$0.00,$0.00
123,ERX,HCPCS J7608,99999-6005-92,ACETYLCYSTEINE 20 % IN SOLN,$42.65,$0.00,$42.65,$0.00,$30.44,$0.00,$7.35,$0.00,$0.00,$0.00,$42.65,$0.00,$21.33,$33.78,$34.12,$0.00,$6.67,$0.00,$0.00,$0.00
250,ERX,HCPCS 25000001,00378-6990-31,ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
250,ERX,HCPCS 25000001,00487-9501-01,ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
250,ERX,HCPCS 25000001,00487-9501-03,ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
250,ERX,HCPCS 25000001,00487-9501-25,ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
250,ERX,HCPCS 25000001,00591-3797-83,ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
250,ERX,HCPCS 25000001,76204-0200-01,ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
252,ERX,HCPCS 25000001,99999-6010-97,ALBUTEROL SULFATE 2 MG/5ML PO SYRP,$19.38,$0.00,$71.40,$0.00,$50.96,$0.00,$0.00,$0.00,$0.00,$0.00,$71.40,$0.00,$35.70,$15.35,$57.12,$0.00,$0.00,$0.00,$0.00,$0.00
252,ERX,HCPCS 25000001,99999-6004-59,ALBUTEROL SULFATE 2 MG/5ML PO SYRP,$71.40,$0.00,$71.40,$0.00,$50.96,$0.00,$0.00,$0.00,$0.00,$0.00,$71.40,$0.00,$35.70,$56.55,$57.12,$0.00,$0.00,$0.00,$0.00,$0.00
252,ERX,HCPCS 25000001,00472-0825-16,ALBUTEROL SULFATE 2 MG/5ML PO SYRP,$107.61,$0.00,$85.23,$0.00,$50.96,$0.00,$0.00,$0.00,$0.00,$0.00,$71.40,$0.00,$35.70,$85.23,$57.12,$0.00,$0.00,$0.00,$0.00,$0.00
253,ERX,HCPCS 63700001,51079-0657-20,ALBUTEROL SULFATE 2 MG PO TABS,$26.79,$0.00,$26.79,$0.00,$19.12,$0.00,$0.00,$0.00,$0.00,$0.00,$26.79,$0.00,$13.40,$21.22,$21.43,$0.00,$0.00,$0.00,$0.00,$0.00
253,ERX,HCPCS 63700001,68084-0949-95,ALBUTEROL SULFATE 2 MG PO TABS,$26.79,$0.00,$26.79,$0.00,$19.12,$0.00,$0.00,$0.00,$0.00,$0.00,$26.79,$0.00,$13.40,$21.22,$21.43,$0.00,$0.00,$0.00,$0.00,$0.00
254,ERX,HCPCS 63700001,00378-0572-01,ALBUTEROL SULFATE 4 MG PO TABS,$26.79,$0.00,$26.79,$0.00,$19.12,$0.00,$0.00,$0.00,$0.00,$0.00,$26.79,$0.00,$13.40,$21.22,$21.43,$0.00,$0.00,$0.00,$0.00,$0.00
254,ERX,HCPCS 63700001,53489-0177-01,ALBUTEROL SULFATE 4 MG PO TABS,$26.79,$0.00,$26.79,$0.00,$19.12,$0.00,$0.00,$0.00,$0.00,$0.00,$26.79,$0.00,$13.40,$21.22,$21.43,$0.00,$0.00,$0.00,$0.00,$0.00
254,ERX,HCPCS 63700001,69543-0291-10,ALBUTEROL SULFATE 4 MG PO TABS,$26.79,$0.00,$26.79,$0.00,$19.12,$0.00,$0.00,$0.00,$0.00,$0.00,$26.79,$0.00,$13.40,$21.22,$21.43,$0.00,$0.00,$0.00,$0.00,$0.00
310,ERX,HCPCS 63700001,00904-6571-61,ALLOPURINOL 100 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
310,ERX,HCPCS 63700001,16714-0041-10,ALLOPURINOL 100 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
310,ERX,HCPCS 63700001,16714-0041-12,ALLOPURINOL 100 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
310,ERX,HCPCS 63700001,51079-0205-20,ALLOPURINOL 100 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
310,ERX,HCPCS 63700001,62584-0988-01,ALLOPURINOL 100 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
310,ERX,HCPCS 63700001,62584-0988-11,ALLOPURINOL 100 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
310,ERX,HCPCS 63700001,63739-0410-10,ALLOPURINOL 100 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
311,ERX,HCPCS 63700001,00591-5544-01,ALLOPURINOL 300 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
311,ERX,HCPCS 63700001,00904-6572-61,ALLOPURINOL 300 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
311,ERX,HCPCS 63700001,50268-0064-11,ALLOPURINOL 300 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
311,ERX,HCPCS 63700001,50268-0064-15,ALLOPURINOL 300 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
311,ERX,HCPCS 63700001,51079-0206-01,ALLOPURINOL 300 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
311,ERX,HCPCS 63700001,51079-0206-20,ALLOPURINOL 300 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
311,ERX,HCPCS 63700001,62584-0713-01,ALLOPURINOL 300 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
324,ERX,HCPCS 25000001,00228-2027-10,ALPRAZOLAM 0.25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
324,ERX,HCPCS 25000001,59762-3719-01,ALPRAZOLAM 0.25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
326,ERX,HCPCS 25000001,00904-5860-61,ALPRAZOLAM 1 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
345,ERX,HCPCS 25000001,00395-0049-96,ALUM AMMONIUM POWD,$30.78,$0.00,$30.78,$0.00,$21.97,$0.00,$0.00,$0.00,$0.00,$0.00,$30.78,$0.00,$15.39,$24.38,$24.62,$0.00,$0.00,$0.00,$0.00,$0.00
346,ERX,HCPCS 25000001,51927-1692-00,ALUM POTASSIUM POWD,$6.00,$0.00,$31.16,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$31.16,$0.00,$15.58,$4.75,$24.93,$0.00,$0.00,$0.00,$0.00,$0.00
346,ERX,HCPCS 25000001,49452-0370-01,ALUM POTASSIUM POWD,$384.30,$0.00,$304.37,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$31.16,$0.00,$15.58,$304.37,$24.93,$0.00,$0.00,$0.00,$0.00,$0.00
353,ERX,HCPCS 63700001,99999-6009-93,ALUMINUM HYDROXIDE GEL 320 MG/5ML PO SUSP,$11.00,$0.00,$11.00,$0.00,$7.85,$0.00,$0.00,$0.00,$0.00,$0.00,$11.00,$0.00,$5.50,$8.71,$8.80,$0.00,$0.00,$0.00,$0.00,$0.00
353,ERX,HCPCS 63700001,00536-0091-85,ALUMINUM HYDROXIDE GEL 320 MG/5ML PO SUSP,$23.37,$0.00,$18.51,$0.00,$7.85,$0.00,$0.00,$0.00,$0.00,$0.00,$11.00,$0.00,$5.50,$18.51,$8.80,$0.00,$0.00,$0.00,$0.00,$0.00
364,ERX,HCPCS 63700001,00904-6630-61,AMANTADINE HCL 100 MG PO CAPS,$7.37,$0.00,$7.37,$0.00,$5.26,$0.00,$0.00,$0.00,$0.00,$0.00,$7.37,$0.00,$3.69,$5.84,$5.90,$0.00,$0.00,$0.00,$0.00,$0.00
364,ERX,HCPCS 63700001,42543-0493-01,AMANTADINE HCL 100 MG PO CAPS,$7.37,$0.00,$7.37,$0.00,$5.26,$0.00,$0.00,$0.00,$0.00,$0.00,$7.37,$0.00,$3.69,$5.84,$5.90,$0.00,$0.00,$0.00,$0.00,$0.00
364,ERX,HCPCS 63700001,62332-0246-31,AMANTADINE HCL 100 MG PO CAPS,$7.37,$0.00,$7.37,$0.00,$5.26,$0.00,$0.00,$0.00,$0.00,$0.00,$7.37,$0.00,$3.69,$5.84,$5.90,$0.00,$0.00,$0.00,$0.00,$0.00
365,ERX,HCPCS 63700001,00121-0646-16,AMANTADINE HCL 50 MG/5ML PO SYRP,$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
365,ERX,HCPCS 63700001,50383-0807-16,AMANTADINE HCL 50 MG/5ML PO SYRP,$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
365,ERX,HCPCS 63700001,60432-0093-16,AMANTADINE HCL 50 MG/5ML PO SYRP,$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
365,ERX,HCPCS 63700001,99999-6008-86,AMANTADINE HCL 50 MG/5ML PO SYRP,$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
391,ERX,HCPCS 63700001,00574-0292-01,AMILORIDE HCL 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
391,ERX,HCPCS 63700001,49884-0117-01,AMILORIDE HCL 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
391,ERX,HCPCS 63700001,50268-0071-15,AMILORIDE HCL 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
403,ERX,HCPCS 25000001,00409-4346-16,AMINOCAPROIC ACID 250 MG/ML IV SOLN,$32.68,$0.00,$32.68,$0.00,$23.32,$0.00,$0.00,$0.00,$0.00,$0.00,$32.68,$0.00,$16.34,$25.88,$26.14,$0.00,$0.00,$0.00,$0.00,$0.00
403,ERX,HCPCS 25000001,00409-4346-73,AMINOCAPROIC ACID 250 MG/ML IV SOLN,$32.68,$0.00,$32.68,$0.00,$23.32,$0.00,$0.00,$0.00,$0.00,$0.00,$32.68,$0.00,$16.34,$25.88,$26.14,$0.00,$0.00,$0.00,$0.00,$0.00
403,ERX,HCPCS 25000001,00517-9120-25,AMINOCAPROIC ACID 250 MG/ML IV SOLN,$32.68,$0.00,$32.68,$0.00,$23.32,$0.00,$0.00,$0.00,$0.00,$0.00,$32.68,$0.00,$16.34,$25.88,$26.14,$0.00,$0.00,$0.00,$0.00,$0.00
407,ERX,HCPCS J0280,00409-5921-01,AMINOPHYLLINE 25 MG/ML IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
407,ERX,HCPCS J0280,00409-5922-01,AMINOPHYLLINE 25 MG/ML IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
407,ERX,HCPCS J0280,00409-5922-16,AMINOPHYLLINE 25 MG/ML IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
432,ERX,HCPCS 63700001,16714-0446-01,AMITRIPTYLINE HCL 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
432,ERX,HCPCS 63700001,51079-0131-01,AMITRIPTYLINE HCL 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
432,ERX,HCPCS 63700001,51079-0131-20,AMITRIPTYLINE HCL 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
435,ERX,HCPCS 63700001,16714-0447-01,AMITRIPTYLINE HCL 25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
435,ERX,HCPCS 63700001,51079-0107-20,AMITRIPTYLINE HCL 25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
436,ERX,HCPCS 63700001,51079-0133-01,AMITRIPTYLINE HCL 50 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
436,ERX,HCPCS 63700001,51079-0133-20,AMITRIPTYLINE HCL 50 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
437,ERX,HCPCS 63700001,16714-0449-01,AMITRIPTYLINE HCL 75 MG PO TABS,$6.90,$0.00,$6.90,$0.00,$4.92,$0.00,$0.00,$0.00,$0.00,$0.00,$6.90,$0.00,$3.45,$5.46,$5.52,$0.00,$0.00,$0.00,$0.00,$0.00
449,ERX,HCPCS 63700001,00591-5714-01,AMOXAPINE 50 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
450,ERX,HCPCS 63700001,00781-2020-01,AMOXICILLIN 250 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
450,ERX,HCPCS 63700001,00781-2020-05,AMOXICILLIN 250 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
450,ERX,HCPCS 63700001,16714-0298-02,AMOXICILLIN 250 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
451,ERX,HCPCS 63700001,00781-2613-05,AMOXICILLIN 500 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
451,ERX,HCPCS 63700001,16714-0299-03,AMOXICILLIN 500 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
451,ERX,HCPCS 63700001,16714-0299-04,AMOXICILLIN 500 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
451,ERX,HCPCS 63700001,65862-0017-05,AMOXICILLIN 500 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
452,ERX,HCPCS 63700001,00093-2268-01,AMOXICILLIN 250 MG PO CHEW,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
453,ERX,HCPCS 25000001,00143-9888-80,AMOXICILLIN 125 MG/5ML PO SUSR,$11.86,$0.00,$11.86,$0.00,$8.46,$0.00,$0.00,$0.00,$0.00,$0.00,$11.86,$0.00,$5.93,$9.39,$9.49,$0.00,$0.00,$0.00,$0.00,$0.00
453,ERX,HCPCS 25000001,00781-6039-58,AMOXICILLIN 125 MG/5ML PO SUSR,$11.86,$0.00,$11.86,$0.00,$8.46,$0.00,$0.00,$0.00,$0.00,$0.00,$11.86,$0.00,$5.93,$9.39,$9.49,$0.00,$0.00,$0.00,$0.00,$0.00
454,ERX,HCPCS 63700001,00093-4155-79,AMOXICILLIN 250 MG/5ML PO SUSR,$20.07,$0.00,$26.79,$0.00,$19.12,$0.00,$0.00,$0.00,$0.00,$0.00,$26.79,$0.00,$13.40,$15.90,$21.43,$0.00,$0.00,$0.00,$0.00,$0.00
454,ERX,HCPCS 63700001,00781-6041-58,AMOXICILLIN 250 MG/5ML PO SUSR,$20.07,$0.00,$26.79,$0.00,$19.12,$0.00,$0.00,$0.00,$0.00,$0.00,$26.79,$0.00,$13.40,$15.90,$21.43,$0.00,$0.00,$0.00,$0.00,$0.00
454,ERX,HCPCS 63700001,00093-4155-80,AMOXICILLIN 250 MG/5ML PO SUSR,$26.79,$0.00,$26.79,$0.00,$19.12,$0.00,$0.00,$0.00,$0.00,$0.00,$26.79,$0.00,$13.40,$21.22,$21.43,$0.00,$0.00,$0.00,$0.00,$0.00
454,ERX,HCPCS 63700001,00143-9889-15,AMOXICILLIN 250 MG/5ML PO SUSR,$26.79,$0.00,$26.79,$0.00,$19.12,$0.00,$0.00,$0.00,$0.00,$0.00,$26.79,$0.00,$13.40,$21.22,$21.43,$0.00,$0.00,$0.00,$0.00,$0.00
454,ERX,HCPCS 63700001,00781-6041-55,AMOXICILLIN 250 MG/5ML PO SUSR,$26.79,$0.00,$26.79,$0.00,$19.12,$0.00,$0.00,$0.00,$0.00,$0.00,$26.79,$0.00,$13.40,$21.22,$21.43,$0.00,$0.00,$0.00,$0.00,$0.00
464,ERX,HCPCS J0285,39822-1055-05,AMPHOTERICIN B 50 MG IV SOLR,$166.25,$0.00,$166.25,$0.00,$122.82,$0.00,$0.00,$0.00,$0.00,$0.00,$166.25,$0.00,$83.13,$131.67,$133.00,$0.00,$0.00,$0.00,$0.00,$0.00
466,ERX,HCPCS 63700001,00781-2145-01,AMPICILLIN 500 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
469,ERX,HCPCS J0290,00781-3404-85,AMPICILLIN SODIUM 1 G IJ SOLR,$32.82,$0.00,$32.82,$14.77,$23.42,$0.00,$5.22,$0.00,$0.00,$2.30,$32.82,$0.00,$16.41,$25.99,$26.26,$0.00,$2.30,$0.00,$2.19,$0.00
469,ERX,HCPCS J0290,00781-3404-95,AMPICILLIN SODIUM 1 G IJ SOLR,$32.82,$0.00,$32.82,$14.77,$23.42,$0.00,$5.22,$0.00,$0.00,$2.30,$32.82,$0.00,$16.41,$25.99,$26.26,$0.00,$2.30,$0.00,$2.19,$0.00
469,ERX,HCPCS J0290,00781-9404-95,AMPICILLIN SODIUM 1 G IJ SOLR,$32.82,$0.00,$32.82,$14.77,$23.42,$0.00,$5.22,$0.00,$0.00,$2.30,$32.82,$0.00,$16.41,$25.99,$26.26,$0.00,$2.30,$0.00,$2.19,$0.00
469,ERX,HCPCS J0290,25021-0136-10,AMPICILLIN SODIUM 1 G IJ SOLR,$32.82,$0.00,$32.82,$14.77,$23.42,$0.00,$5.22,$0.00,$0.00,$2.30,$32.82,$0.00,$16.41,$25.99,$26.26,$0.00,$2.30,$0.00,$2.19,$0.00
469,ERX,HCPCS J0290,44567-0102-10,AMPICILLIN SODIUM 1 G IJ SOLR,$32.82,$0.00,$32.82,$14.77,$23.42,$0.00,$5.22,$0.00,$0.00,$2.30,$32.82,$0.00,$16.41,$25.99,$26.26,$0.00,$2.30,$0.00,$2.19,$0.00
469,ERX,HCPCS J0290,55150-0113-10,AMPICILLIN SODIUM 1 G IJ SOLR,$32.82,$0.00,$32.82,$14.77,$23.42,$0.00,$5.22,$0.00,$0.00,$2.30,$32.82,$0.00,$16.41,$25.99,$26.26,$0.00,$2.30,$0.00,$2.19,$0.00
469,ERX,HCPCS J0290,67457-0351-01,AMPICILLIN SODIUM 1 G IJ SOLR,$32.82,$0.00,$32.82,$14.77,$23.42,$0.00,$5.22,$0.00,$0.00,$2.30,$32.82,$0.00,$16.41,$25.99,$26.26,$0.00,$2.30,$0.00,$2.19,$0.00
469,ERX,HCPCS J0290,67457-0351-10,AMPICILLIN SODIUM 1 G IJ SOLR,$32.82,$0.00,$32.82,$14.77,$23.42,$0.00,$5.22,$0.00,$0.00,$2.30,$32.82,$0.00,$16.41,$25.99,$26.26,$0.00,$2.30,$0.00,$2.19,$0.00
471,ERX,HCPCS 25000001,00781-3400-78,AMPICILLIN SODIUM 125 MG IJ SOLR,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
471,ERX,HCPCS 25000001,00781-3400-95,AMPICILLIN SODIUM 125 MG IJ SOLR,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
472,ERX,HCPCS J0290,00781-3408-95,AMPICILLIN SODIUM 2 G IJ SOLR,$63.67,$0.00,$63.67,$28.65,$45.44,$0.00,$10.43,$0.00,$0.00,$4.61,$63.67,$0.00,$31.84,$50.43,$50.94,$0.00,$4.61,$0.00,$4.39,$0.00
472,ERX,HCPCS J0290,00781-9408-95,AMPICILLIN SODIUM 2 G IJ SOLR,$63.67,$0.00,$63.67,$28.65,$45.44,$0.00,$10.43,$0.00,$0.00,$4.61,$63.67,$0.00,$31.84,$50.43,$50.94,$0.00,$4.61,$0.00,$4.39,$0.00
472,ERX,HCPCS J0290,25021-0137-20,AMPICILLIN SODIUM 2 G IJ SOLR,$63.67,$0.00,$63.67,$28.65,$45.44,$0.00,$10.43,$0.00,$0.00,$4.61,$63.67,$0.00,$31.84,$50.43,$50.94,$0.00,$4.61,$0.00,$4.39,$0.00
472,ERX,HCPCS J0290,44567-0103-10,AMPICILLIN SODIUM 2 G IJ SOLR,$63.67,$0.00,$63.67,$28.65,$45.44,$0.00,$10.43,$0.00,$0.00,$4.61,$63.67,$0.00,$31.84,$50.43,$50.94,$0.00,$4.61,$0.00,$4.39,$0.00
472,ERX,HCPCS J0290,55150-0114-20,AMPICILLIN SODIUM 2 G IJ SOLR,$63.67,$0.00,$63.67,$28.65,$45.44,$0.00,$10.43,$0.00,$0.00,$4.61,$63.67,$0.00,$31.84,$50.43,$50.94,$0.00,$4.61,$0.00,$4.39,$0.00
474,ERX,HCPCS J0290,00781-3407-78,AMPICILLIN SODIUM 500 MG IJ SOLR,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$2.61,$0.00,$0.00,$1.15,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.15,$0.00,$1.10,$0.00
474,ERX,HCPCS J0290,00781-3407-95,AMPICILLIN SODIUM 500 MG IJ SOLR,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$2.61,$0.00,$0.00,$1.15,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.15,$0.00,$1.10,$0.00
474,ERX,HCPCS J0290,00781-9407-78,AMPICILLIN SODIUM 500 MG IJ SOLR,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$2.61,$0.00,$0.00,$1.15,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.15,$0.00,$1.10,$0.00
474,ERX,HCPCS J0290,00781-9407-95,AMPICILLIN SODIUM 500 MG IJ SOLR,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$2.61,$0.00,$0.00,$1.15,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.15,$0.00,$1.10,$0.00
474,ERX,HCPCS J0290,44567-0101-10,AMPICILLIN SODIUM 500 MG IJ SOLR,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$2.61,$0.00,$0.00,$1.15,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.15,$0.00,$1.10,$0.00
474,ERX,HCPCS J0290,55150-0112-10,AMPICILLIN SODIUM 500 MG IJ SOLR,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$2.61,$0.00,$0.00,$1.15,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.15,$0.00,$1.10,$0.00
612,ERX,HCPCS 63700001,72140-0452-31,AQUAPHOR EX OINT,$20.90,$0.00,$154.00,$0.00,$109.91,$0.00,$0.00,$0.00,$0.00,$0.00,$154.00,$0.00,$77.00,$16.55,$123.20,$0.00,$0.00,$0.00,$0.00,$0.00
612,ERX,HCPCS 63700001,72140-0031-47,AQUAPHOR EX OINT,$154.00,$0.00,$154.00,$0.00,$109.91,$0.00,$0.00,$0.00,$0.00,$0.00,$154.00,$0.00,$77.00,$121.97,$123.20,$0.00,$0.00,$0.00,$0.00,$0.00
654,ERX,HCPCS 25000001,67457-0118-50,ASCORBIC ACID 500 MG/ML IJ SOLN,$331.23,$0.00,$331.23,$0.00,$236.40,$0.00,$0.00,$0.00,$0.00,$0.00,$331.23,$0.00,$165.62,$262.33,$264.98,$0.00,$0.00,$0.00,$0.00,$0.00
680,ERX,HCPCS 25000001,00536-1008-36,ASPIRIN 81 MG PO CHEW,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
680,ERX,HCPCS 25000001,00904-4040-73,ASPIRIN 81 MG PO CHEW,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
680,ERX,HCPCS 25000001,00904-6794-80,ASPIRIN 81 MG PO CHEW,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
680,ERX,HCPCS 25000001,63739-0434-01,ASPIRIN 81 MG PO CHEW,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
680,ERX,HCPCS 25000001,66553-0002-01,ASPIRIN 81 MG PO CHEW,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
681,ERX,HCPCS 25000001,66553-0001-01,ASPIRIN 325 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
693,ERX,HCPCS 25000001,00574-7034-12,ASPIRIN 300 MG RECTAL SUPP,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
716,ERX,HCPCS 63700001,00781-1507-01,ATENOLOL 100 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
716,ERX,HCPCS 63700001,51079-0685-01,ATENOLOL 100 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
716,ERX,HCPCS 63700001,51079-0685-20,ATENOLOL 100 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
716,ERX,HCPCS 63700001,68382-0024-01,ATENOLOL 100 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
717,ERX,HCPCS 63700001,00093-0787-01,ATENOLOL 25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
717,ERX,HCPCS 63700001,00781-1078-01,ATENOLOL 25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
717,ERX,HCPCS 63700001,51079-0759-01,ATENOLOL 25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
717,ERX,HCPCS 63700001,51079-0759-20,ATENOLOL 25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
718,ERX,HCPCS 63700001,00781-1506-01,ATENOLOL 50 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
718,ERX,HCPCS 63700001,51079-0684-20,ATENOLOL 50 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
718,ERX,HCPCS 63700001,68382-0023-01,ATENOLOL 50 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
731,ERX,HCPCS J0461,00517-0401-25,ATROPINE SULFATE 0.4 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$1.88,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.88,$0.00,$1.79,$0.00
731,ERX,HCPCS J0461,99999-6008-06,ATROPINE SULFATE 0.4 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$1.88,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.88,$0.00,$1.79,$0.00
734,ERX,HCPCS J0461,00517-1010-25,ATROPINE SULFATE 1 MG/ML IJ SOLN,$55.09,$0.00,$55.09,$24.79,$40.88,$0.00,$9.49,$0.00,$0.00,$9.40,$55.09,$0.00,$27.55,$43.63,$44.07,$0.00,$9.40,$0.00,$8.95,$0.00
735,ERX,HCPCS 25000001,24208-0825-55,ATROPINE SULFATE 1 % OP OINT,$73.54,$0.00,$73.54,$0.00,$52.49,$0.00,$0.00,$0.00,$0.00,$0.00,$73.54,$0.00,$36.77,$58.24,$58.83,$0.00,$0.00,$0.00,$0.00,$0.00
736,ERX,HCPCS 25000001,17478-0215-02,ATROPINE SULFATE 1 % OP SOLN,$156.10,$0.00,$156.10,$0.00,$111.41,$0.00,$0.00,$0.00,$0.00,$0.00,$156.10,$0.00,$78.05,$123.63,$124.88,$0.00,$0.00,$0.00,$0.00,$0.00
736,ERX,HCPCS 25000001,00065-0303-55,ATROPINE SULFATE 1 % OP SOLN,$183.90,$0.00,$156.10,$0.00,$111.41,$0.00,$0.00,$0.00,$0.00,$0.00,$156.10,$0.00,$78.05,$145.65,$124.88,$0.00,$0.00,$0.00,$0.00,$0.00
736,ERX,HCPCS 25000001,17478-0215-05,ATROPINE SULFATE 1 % OP SOLN,$183.90,$0.00,$156.10,$0.00,$111.41,$0.00,$0.00,$0.00,$0.00,$0.00,$156.10,$0.00,$78.05,$145.65,$124.88,$0.00,$0.00,$0.00,$0.00,$0.00
850,ERX,HCPCS 25000001,45802-0060-70,BACITRACIN 500 UNIT/GM EX OINT,$13.17,$0.00,$13.17,$0.00,$9.40,$0.00,$0.00,$0.00,$0.00,$0.00,$13.17,$0.00,$6.59,$10.43,$10.54,$0.00,$0.00,$0.00,$0.00,$0.00
850,ERX,HCPCS 25000001,00713-0280-31,BACITRACIN 500 UNIT/GM EX OINT,$13.17,$0.00,$13.17,$0.00,$9.40,$0.00,$0.00,$0.00,$0.00,$0.00,$13.17,$0.00,$6.59,$10.43,$10.54,$0.00,$0.00,$0.00,$0.00,$0.00
851,ERX,HCPCS 25000001,00009-0233-01,BACITRACIN 50000 UNITS IM SOLR,$41.04,$0.00,$41.04,$0.00,$29.29,$0.00,$0.00,$0.00,$0.00,$0.00,$41.04,$0.00,$20.52,$32.50,$32.83,$0.00,$0.00,$0.00,$0.00,$0.00
851,ERX,HCPCS 25000001,00009-0233-03,BACITRACIN 50000 UNITS IM SOLR,$41.04,$0.00,$41.04,$0.00,$29.29,$0.00,$0.00,$0.00,$0.00,$0.00,$41.04,$0.00,$20.52,$32.50,$32.83,$0.00,$0.00,$0.00,$0.00,$0.00
851,ERX,HCPCS 25000001,63323-0329-31,BACITRACIN 50000 UNITS IM SOLR,$41.04,$0.00,$41.04,$0.00,$29.29,$0.00,$0.00,$0.00,$0.00,$0.00,$41.04,$0.00,$20.52,$32.50,$32.83,$0.00,$0.00,$0.00,$0.00,$0.00
851,ERX,HCPCS 25000001,70594-0026-01,BACITRACIN 50000 UNITS IM SOLR,$41.04,$0.00,$41.04,$0.00,$29.29,$0.00,$0.00,$0.00,$0.00,$0.00,$41.04,$0.00,$20.52,$32.50,$32.83,$0.00,$0.00,$0.00,$0.00,$0.00
851,ERX,HCPCS 25000001,70594-0026-02,BACITRACIN 50000 UNITS IM SOLR,$41.04,$0.00,$41.04,$0.00,$29.29,$0.00,$0.00,$0.00,$0.00,$0.00,$41.04,$0.00,$20.52,$32.50,$32.83,$0.00,$0.00,$0.00,$0.00,$0.00
852,ERX,HCPCS 25000001,00574-4022-35,BACITRACIN 500 UNIT/GM OP OINT,$361.25,$0.00,$361.25,$0.00,$257.82,$0.00,$0.00,$0.00,$0.00,$0.00,$361.25,$0.00,$180.63,$286.11,$289.00,$0.00,$0.00,$0.00,$0.00,$0.00
854,ERX,HCPCS 25000001,45802-0143-03,BACITRACIN-NEOMYCIN-POLYMYXIN 400-5-5000 EX OINT,$23.41,$0.00,$23.41,$0.00,$16.71,$0.00,$0.00,$0.00,$0.00,$0.00,$23.41,$0.00,$11.71,$18.54,$18.73,$0.00,$0.00,$0.00,$0.00,$0.00
856,ERX,HCPCS 25000001,24208-0555-55,BACITRACIN-POLYMYXIN B 500-10000 UNIT/GM OP OINT,$100.28,$0.00,$100.28,$0.00,$71.57,$0.00,$0.00,$0.00,$0.00,$0.00,$100.28,$0.00,$50.14,$79.42,$80.22,$0.00,$0.00,$0.00,$0.00,$0.00
860,ERX,HCPCS 63700001,00904-6475-61,BACLOFEN 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
860,ERX,HCPCS 63700001,16714-0071-04,BACLOFEN 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
860,ERX,HCPCS 63700001,63739-0479-10,BACLOFEN 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
860,ERX,HCPCS 63700001,68084-0855-01,BACLOFEN 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
987,ERX,HCPCS 25000001,54162-0100-01,BENZOIN COMPOUND EX TINC,$14.00,$0.00,$36.03,$0.00,$25.71,$0.00,$0.00,$0.00,$0.00,$0.00,$36.03,$0.00,$18.02,$11.09,$28.82,$0.00,$0.00,$0.00,$0.00,$0.00
987,ERX,HCPCS 25000001,54162-0100-02,BENZOIN COMPOUND EX TINC,$20.28,$0.00,$36.03,$0.00,$25.71,$0.00,$0.00,$0.00,$0.00,$0.00,$36.03,$0.00,$18.02,$16.06,$28.82,$0.00,$0.00,$0.00,$0.00,$0.00
987,ERX,HCPCS 25000001,54162-0100-04,BENZOIN COMPOUND EX TINC,$35.88,$0.00,$36.03,$0.00,$25.71,$0.00,$0.00,$0.00,$0.00,$0.00,$36.03,$0.00,$18.02,$28.42,$28.82,$0.00,$0.00,$0.00,$0.00,$0.00
987,ERX,HCPCS 25000001,00395-0243-92,BENZOIN COMPOUND EX TINC,$36.03,$0.00,$36.03,$0.00,$25.71,$0.00,$0.00,$0.00,$0.00,$0.00,$36.03,$0.00,$18.02,$28.54,$28.82,$0.00,$0.00,$0.00,$0.00,$0.00
988,ERX,HCPCS 63700001,00904-6564-60,BENZONATATE 100 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
988,ERX,HCPCS 63700001,00904-6564-61,BENZONATATE 100 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
988,ERX,HCPCS 63700001,42291-0164-01,BENZONATATE 100 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
988,ERX,HCPCS 63700001,42291-0164-50,BENZONATATE 100 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
988,ERX,HCPCS 63700001,60687-0346-01,BENZONATATE 100 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
988,ERX,HCPCS 63700001,60687-0346-11,BENZONATATE 100 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
988,ERX,HCPCS 63700001,63739-0029-10,BENZONATATE 100 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
988,ERX,HCPCS 63700001,67877-0573-01,BENZONATATE 100 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
988,ERX,HCPCS 63700001,68382-0247-01,BENZONATATE 100 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
989,ERX,HCPCS 25000001,00536-1056-56,BENZOYL PEROXIDE 10 % EX GEL,$26.33,$0.00,$26.33,$0.00,$18.79,$0.00,$0.00,$0.00,$0.00,$0.00,$26.33,$0.00,$13.17,$20.85,$21.06,$0.00,$0.00,$0.00,$0.00,$0.00
991,ERX,HCPCS 25000001,00536-1055-56,BENZOYL PEROXIDE 5 % EX GEL,$21.65,$0.00,$21.65,$0.00,$15.45,$0.00,$0.00,$0.00,$0.00,$0.00,$21.65,$0.00,$10.83,$17.15,$17.32,$0.00,$0.00,$0.00,$0.00,$0.00
998,ERX,HCPCS 63700001,00603-2437-21,BENZTROPINE MESYLATE 0.5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
998,ERX,HCPCS 63700001,60687-0356-01,BENZTROPINE MESYLATE 0.5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
998,ERX,HCPCS 63700001,60687-0356-11,BENZTROPINE MESYLATE 0.5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
998,ERX,HCPCS 63700001,69315-0136-01,BENZTROPINE MESYLATE 0.5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
999,ERX,HCPCS 63700001,00603-2438-21,BENZTROPINE MESYLATE 1 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
999,ERX,HCPCS 63700001,10135-0607-01,BENZTROPINE MESYLATE 1 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
999,ERX,HCPCS 63700001,60687-0368-01,BENZTROPINE MESYLATE 1 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
999,ERX,HCPCS 63700001,60687-0368-11,BENZTROPINE MESYLATE 1 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
999,ERX,HCPCS 63700001,76385-0104-01,BENZTROPINE MESYLATE 1 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
1000,ERX,HCPCS 63700001,00603-2439-21,BENZTROPINE MESYLATE 2 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
1000,ERX,HCPCS 63700001,69315-0138-01,BENZTROPINE MESYLATE 2 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
1029,ERX,HCPCS 63700001,00168-0056-15,BETAMETHASONE DIPROPIONATE 0.05 % EX OINT,$193.68,$0.00,$193.68,$0.00,$138.23,$0.00,$0.00,$0.00,$0.00,$0.00,$193.68,$0.00,$96.84,$153.39,$154.94,$0.00,$0.00,$0.00,$0.00,$0.00
1029,ERX,HCPCS 63700001,00472-0381-15,BETAMETHASONE DIPROPIONATE 0.05 % EX OINT,$193.68,$0.00,$193.68,$0.00,$138.23,$0.00,$0.00,$0.00,$0.00,$0.00,$193.68,$0.00,$96.84,$153.39,$154.94,$0.00,$0.00,$0.00,$0.00,$0.00
1044,ERX,HCPCS 63700001,00832-0512-01,BETHANECHOL CHLORIDE 25 MG PO TABS,$8.14,$0.00,$8.14,$0.00,$5.81,$0.00,$0.00,$0.00,$0.00,$0.00,$8.14,$0.00,$4.07,$6.45,$6.51,$0.00,$0.00,$0.00,$0.00,$0.00
1044,ERX,HCPCS 63700001,00832-0512-89,BETHANECHOL CHLORIDE 25 MG PO TABS,$8.14,$0.00,$8.14,$0.00,$5.81,$0.00,$0.00,$0.00,$0.00,$0.00,$8.14,$0.00,$4.07,$6.45,$6.51,$0.00,$0.00,$0.00,$0.00,$0.00
1044,ERX,HCPCS 63700001,65162-0573-10,BETHANECHOL CHLORIDE 25 MG PO TABS,$8.14,$0.00,$8.14,$0.00,$5.81,$0.00,$0.00,$0.00,$0.00,$0.00,$8.14,$0.00,$4.07,$6.45,$6.51,$0.00,$0.00,$0.00,$0.00,$0.00
1079,ERX,HCPCS 63700001,00904-6407-61,BISACODYL 5 MG PO TBEC,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
1079,ERX,HCPCS 63700001,00904-7927-60,BISACODYL 5 MG PO TBEC,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
1079,ERX,HCPCS 63700001,49483-0003-01,BISACODYL 5 MG PO TBEC,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
1080,ERX,HCPCS 63700001,00574-7050-12,BISACODYL 10 MG RECTAL SUPP,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
1080,ERX,HCPCS 63700001,00574-7050-50,BISACODYL 10 MG RECTAL SUPP,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
1080,ERX,HCPCS 63700001,57896-0443-05,BISACODYL 10 MG RECTAL SUPP,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
1080,ERX,HCPCS 63700001,57896-0444-05,BISACODYL 10 MG RECTAL SUPP,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
1080,ERX,HCPCS 63700001,68784-0102-12,BISACODYL 10 MG RECTAL SUPP,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
1080,ERX,HCPCS 63700001,81421-0021-01,BISACODYL 10 MG RECTAL SUPP,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
1090,ERX,HCPCS 25000001,37000-0032-01,BISMUTH SUBSALICYLATE 262 MG/15ML PO SUSP,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
1259,ERX,HCPCS 25000001,46017-0018-16,CAFFEINE 200 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
1259,ERX,HCPCS 25000001,70677-0021-01,CAFFEINE 200 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
1262,ERX,HCPCS 25000001,00517-2502-10,CAFFEINE-SODIUM BENZOATE 125-125 MG/ML IJ SOLN,$47.95,$0.00,$47.95,$0.00,$34.22,$0.00,$0.00,$0.00,$0.00,$0.00,$47.95,$0.00,$23.98,$37.98,$38.36,$0.00,$0.00,$0.00,$0.00,$0.00
1306,ERX,HCPCS 25000001,00409-1631-10,CALCIUM CHLORIDE 10 % IV SOLN,$81.17,$0.00,$81.17,$0.00,$57.93,$0.00,$0.00,$0.00,$0.00,$0.00,$81.17,$0.00,$40.59,$64.29,$64.94,$0.00,$0.00,$0.00,$0.00,$0.00
1306,ERX,HCPCS 25000001,00409-4928-34,CALCIUM CHLORIDE 10 % IV SOLN,$81.17,$0.00,$81.17,$0.00,$57.93,$0.00,$0.00,$0.00,$0.00,$0.00,$81.17,$0.00,$40.59,$64.29,$64.94,$0.00,$0.00,$0.00,$0.00,$0.00
1306,ERX,HCPCS 25000001,00517-2710-25,CALCIUM CHLORIDE 10 % IV SOLN,$81.17,$0.00,$81.17,$0.00,$57.93,$0.00,$0.00,$0.00,$0.00,$0.00,$81.17,$0.00,$40.59,$64.29,$64.94,$0.00,$0.00,$0.00,$0.00,$0.00
1306,ERX,HCPCS 25000001,00517-6710-01,CALCIUM CHLORIDE 10 % IV SOLN,$81.17,$0.00,$81.17,$0.00,$57.93,$0.00,$0.00,$0.00,$0.00,$0.00,$81.17,$0.00,$40.59,$64.29,$64.94,$0.00,$0.00,$0.00,$0.00,$0.00
1306,ERX,HCPCS 25000001,00517-6710-10,CALCIUM CHLORIDE 10 % IV SOLN,$81.17,$0.00,$81.17,$0.00,$57.93,$0.00,$0.00,$0.00,$0.00,$0.00,$81.17,$0.00,$40.59,$64.29,$64.94,$0.00,$0.00,$0.00,$0.00,$0.00
1306,ERX,HCPCS 25000001,76329-3304-01,CALCIUM CHLORIDE 10 % IV SOLN,$81.17,$0.00,$81.17,$0.00,$57.93,$0.00,$0.00,$0.00,$0.00,$0.00,$81.17,$0.00,$40.59,$64.29,$64.94,$0.00,$0.00,$0.00,$0.00,$0.00
1308,ERX,HCPCS 63700001,00904-5062-60,CALCIUM CITRATE 950 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
1312,ERX,HCPCS J0610,63323-0360-19,CALCIUM GLUCONATE 10 % IV SOLN,$32.00,$0.00,$32.00,$14.40,$22.84,$0.00,$0.34,$0.00,$0.00,$4.04,$32.00,$0.00,$16.00,$25.34,$25.60,$0.00,$4.04,$0.00,$0.00,$0.00
1350,ERX,HCPCS 63700001,00536-2525-25,CAPSAICIN 0.025 % EX CREA,$37.85,$0.00,$37.85,$0.00,$27.01,$0.00,$0.00,$0.00,$0.00,$0.00,$37.85,$0.00,$18.93,$29.98,$30.28,$0.00,$0.00,$0.00,$0.00,$0.00
1355,ERX,HCPCS 63700001,00904-3854-61,CARBAMAZEPINE 100 MG PO CHEW,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
1356,ERX,HCPCS 25000001,99999-6004-61,CARBAMAZEPINE 100 MG/5ML PO SUSP,$97.02,$0.00,$97.02,$0.00,$69.24,$0.00,$0.00,$0.00,$0.00,$0.00,$97.02,$0.00,$48.51,$76.84,$77.62,$0.00,$0.00,$0.00,$0.00,$0.00
1356,ERX,HCPCS 25000001,00078-0508-83,CARBAMAZEPINE 100 MG/5ML PO SUSP,$597.04,$0.00,$472.86,$0.00,$69.24,$0.00,$0.00,$0.00,$0.00,$0.00,$97.02,$0.00,$48.51,$472.86,$77.62,$0.00,$0.00,$0.00,$0.00,$0.00
1356,ERX,HCPCS 25000001,60432-0129-16,CARBAMAZEPINE 100 MG/5ML PO SUSP,$597.04,$0.00,$472.86,$0.00,$69.24,$0.00,$0.00,$0.00,$0.00,$0.00,$97.02,$0.00,$48.51,$472.86,$77.62,$0.00,$0.00,$0.00,$0.00,$0.00
1357,ERX,HCPCS 63700001,00904-6172-61,CARBAMAZEPINE 200 MG PO TABS,$6.08,$0.00,$6.08,$0.00,$4.34,$0.00,$0.00,$0.00,$0.00,$0.00,$6.08,$0.00,$3.04,$4.82,$4.86,$0.00,$0.00,$0.00,$0.00,$0.00
1357,ERX,HCPCS 63700001,51079-0385-20,CARBAMAZEPINE 200 MG PO TABS,$6.08,$0.00,$6.08,$0.00,$4.34,$0.00,$0.00,$0.00,$0.00,$0.00,$6.08,$0.00,$3.04,$4.82,$4.86,$0.00,$0.00,$0.00,$0.00,$0.00
1395,ERX,HCPCS 63700001,42543-0700-01,CARISOPRODOL 350 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
1445,ERX,HCPCS J0690,00143-9262-25,CEFAZOLIN SODIUM 1 G IJ SOLR,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.39,$0.00,$0.00,$1.93,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.93,$0.00,$0.00,$0.00
1445,ERX,HCPCS J0690,00143-9924-90,CEFAZOLIN SODIUM 1 G IJ SOLR,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.39,$0.00,$0.00,$1.93,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.93,$0.00,$0.00,$0.00
1445,ERX,HCPCS J0690,00781-3451-96,CEFAZOLIN SODIUM 1 G IJ SOLR,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.39,$0.00,$0.00,$1.93,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.93,$0.00,$0.00,$0.00
1445,ERX,HCPCS J0690,25021-0101-10,CEFAZOLIN SODIUM 1 G IJ SOLR,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.39,$0.00,$0.00,$1.93,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.93,$0.00,$0.00,$0.00
1445,ERX,HCPCS J0690,44567-0707-25,CEFAZOLIN SODIUM 1 G IJ SOLR,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.39,$0.00,$0.00,$1.93,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.93,$0.00,$0.00,$0.00
1445,ERX,HCPCS J0690,60505-6142-05,CEFAZOLIN SODIUM 1 G IJ SOLR,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.39,$0.00,$0.00,$1.93,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.93,$0.00,$0.00,$0.00
1445,ERX,HCPCS J0690,63323-0237-10,CEFAZOLIN SODIUM 1 G IJ SOLR,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.39,$0.00,$0.00,$1.93,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.93,$0.00,$0.00,$0.00
1446,ERX,HCPCS J0690,00143-9261-01,CEFAZOLIN SODIUM 10 G IJ SOLR,$54.72,$0.00,$54.72,$24.62,$39.05,$0.00,$13.87,$0.00,$0.00,$19.27,$54.72,$0.00,$27.36,$43.34,$43.78,$0.00,$19.27,$0.00,$18.35,$0.00
1446,ERX,HCPCS J0690,00143-9261-10,CEFAZOLIN SODIUM 10 G IJ SOLR,$54.72,$0.00,$54.72,$24.62,$39.05,$0.00,$13.87,$0.00,$0.00,$19.27,$54.72,$0.00,$27.36,$43.34,$43.78,$0.00,$19.27,$0.00,$18.35,$0.00
1446,ERX,HCPCS J0690,00143-9983-03,CEFAZOLIN SODIUM 10 G IJ SOLR,$54.72,$0.00,$54.72,$24.62,$39.05,$0.00,$13.87,$0.00,$0.00,$19.27,$54.72,$0.00,$27.36,$43.34,$43.78,$0.00,$19.27,$0.00,$18.35,$0.00
1446,ERX,HCPCS J0690,00781-3452-95,CEFAZOLIN SODIUM 10 G IJ SOLR,$54.72,$0.00,$54.72,$24.62,$39.05,$0.00,$13.87,$0.00,$0.00,$19.27,$54.72,$0.00,$27.36,$43.34,$43.78,$0.00,$19.27,$0.00,$18.35,$0.00
1446,ERX,HCPCS J0690,25021-0102-99,CEFAZOLIN SODIUM 10 G IJ SOLR,$54.72,$0.00,$54.72,$24.62,$39.05,$0.00,$13.87,$0.00,$0.00,$19.27,$54.72,$0.00,$27.36,$43.34,$43.78,$0.00,$19.27,$0.00,$18.35,$0.00
1446,ERX,HCPCS J0690,44567-0708-10,CEFAZOLIN SODIUM 10 G IJ SOLR,$54.72,$0.00,$54.72,$24.62,$39.05,$0.00,$13.87,$0.00,$0.00,$19.27,$54.72,$0.00,$27.36,$43.34,$43.78,$0.00,$19.27,$0.00,$18.35,$0.00
1446,ERX,HCPCS J0690,63323-0238-61,CEFAZOLIN SODIUM 10 G IJ SOLR,$54.72,$0.00,$54.72,$24.62,$39.05,$0.00,$13.87,$0.00,$0.00,$19.27,$54.72,$0.00,$27.36,$43.34,$43.78,$0.00,$19.27,$0.00,$18.35,$0.00
1448,ERX,HCPCS J0690,00143-9923-90,CEFAZOLIN SODIUM 500 MG IJ SOLR,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.69,$0.00,$0.00,$0.96,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.96,$0.00,$0.92,$0.00
1448,ERX,HCPCS J0690,00781-3450-95,CEFAZOLIN SODIUM 500 MG IJ SOLR,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.69,$0.00,$0.00,$0.96,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.96,$0.00,$0.92,$0.00
1448,ERX,HCPCS J0690,25021-0100-10,CEFAZOLIN SODIUM 500 MG IJ SOLR,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.69,$0.00,$0.00,$0.96,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.96,$0.00,$0.92,$0.00
1448,ERX,HCPCS J0690,63323-0236-10,CEFAZOLIN SODIUM 500 MG IJ SOLR,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.69,$0.00,$0.00,$0.96,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.96,$0.00,$0.92,$0.00
1465,ERX,HCPCS J0697,00143-9979-22,CEFUROXIME SODIUM 750 MG IJ SOLR,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
1465,ERX,HCPCS J0697,25021-0118-10,CEFUROXIME SODIUM 750 MG IJ SOLR,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
1622,ERX,HCPCS 25000001,00555-0033-02,CHLORDIAZEPOXIDE HCL 10 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
1622,ERX,HCPCS 25000001,51079-0375-01,CHLORDIAZEPOXIDE HCL 10 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
1622,ERX,HCPCS 25000001,51079-0375-20,CHLORDIAZEPOXIDE HCL 10 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
1623,ERX,HCPCS 25000001,51079-0141-01,CHLORDIAZEPOXIDE HCL 25 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
1623,ERX,HCPCS 25000001,51079-0141-20,CHLORDIAZEPOXIDE HCL 25 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
1624,ERX,HCPCS 25000001,00555-0158-02,CHLORDIAZEPOXIDE HCL 5 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
1624,ERX,HCPCS 25000001,51079-0374-01,CHLORDIAZEPOXIDE HCL 5 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
1624,ERX,HCPCS 25000001,51079-0374-20,CHLORDIAZEPOXIDE HCL 5 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
1637,ERX,HCPCS 63700001,64980-0177-50,CHLOROQUINE PHOSPHATE 250 MG PO TABS,$34.94,$0.00,$34.94,$0.00,$24.94,$0.00,$0.00,$0.00,$0.00,$0.00,$34.94,$0.00,$17.47,$27.67,$27.95,$0.00,$0.00,$0.00,$0.00,$0.00
1645,ERX,HCPCS 63700001,00904-0012-59,CHLORPHENIRAMINE MALEATE 4 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
1645,ERX,HCPCS 63700001,10135-0133-01,CHLORPHENIRAMINE MALEATE 4 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
1649,ERX,HCPCS J3230,00641-1397-31,CHLORPROMAZINE HCL 25 MG/ML IJ SOLN,$121.34,$0.00,$121.34,$54.60,$86.60,$0.00,$9.35,$0.00,$0.00,$37.08,$121.34,$0.00,$60.67,$96.10,$97.07,$0.00,$37.08,$0.00,$35.31,$0.00
1649,ERX,HCPCS J3230,00641-1397-35,CHLORPROMAZINE HCL 25 MG/ML IJ SOLN,$121.34,$0.00,$121.34,$54.60,$86.60,$0.00,$9.35,$0.00,$0.00,$37.08,$121.34,$0.00,$60.67,$96.10,$97.07,$0.00,$37.08,$0.00,$35.31,$0.00
1653,ERX,HCPCS Q0161,00781-5913-01,CHLORPROMAZINE HCL 10 MG PO TABS,$25.20,$0.00,$25.20,$11.34,$17.99,$0.00,$4.34,$0.00,$0.00,$4.41,$25.20,$0.00,$12.60,$19.96,$20.16,$0.00,$3.94,$0.00,$4.01,$0.00
1653,ERX,HCPCS Q0161,00832-0300-00,CHLORPROMAZINE HCL 10 MG PO TABS,$25.20,$0.00,$25.20,$11.34,$17.99,$0.00,$4.34,$0.00,$0.00,$4.41,$25.20,$0.00,$12.60,$19.96,$20.16,$0.00,$3.94,$0.00,$4.01,$0.00
1653,ERX,HCPCS Q0161,51079-0518-01,CHLORPROMAZINE HCL 10 MG PO TABS,$25.20,$0.00,$25.20,$11.34,$17.99,$0.00,$4.34,$0.00,$0.00,$4.41,$25.20,$0.00,$12.60,$19.96,$20.16,$0.00,$3.94,$0.00,$4.01,$0.00
1653,ERX,HCPCS Q0161,51079-0518-20,CHLORPROMAZINE HCL 10 MG PO TABS,$25.20,$0.00,$25.20,$11.34,$17.99,$0.00,$4.34,$0.00,$0.00,$4.41,$25.20,$0.00,$12.60,$19.96,$20.16,$0.00,$3.94,$0.00,$4.01,$0.00
1654,ERX,HCPCS Q0161,00832-0303-00,CHLORPROMAZINE HCL 100 MG PO TABS,$77.83,$0.00,$77.83,$35.02,$55.55,$0.00,$13.41,$0.00,$0.00,$13.63,$77.83,$0.00,$38.92,$61.64,$62.26,$0.00,$12.18,$0.00,$0.00,$0.00
1654,ERX,HCPCS Q0161,51079-0516-01,CHLORPROMAZINE HCL 100 MG PO TABS,$77.83,$0.00,$77.83,$35.02,$55.55,$0.00,$13.41,$0.00,$0.00,$13.63,$77.83,$0.00,$38.92,$61.64,$62.26,$0.00,$12.18,$0.00,$0.00,$0.00
1654,ERX,HCPCS Q0161,51079-0516-20,CHLORPROMAZINE HCL 100 MG PO TABS,$77.83,$0.00,$77.83,$35.02,$55.55,$0.00,$13.41,$0.00,$0.00,$13.63,$77.83,$0.00,$38.92,$61.64,$62.26,$0.00,$12.18,$0.00,$0.00,$0.00
1655,ERX,HCPCS Q0161,00781-5917-01,CHLORPROMAZINE HCL 200 MG PO TABS,$92.82,$0.00,$92.82,$41.77,$66.25,$0.00,$15.99,$0.00,$0.00,$16.25,$92.82,$0.00,$46.41,$73.51,$74.26,$0.00,$14.53,$0.00,$14.78,$0.00
1655,ERX,HCPCS Q0161,00832-0304-00,CHLORPROMAZINE HCL 200 MG PO TABS,$92.82,$0.00,$92.82,$41.77,$66.25,$0.00,$15.99,$0.00,$0.00,$16.25,$92.82,$0.00,$46.41,$73.51,$74.26,$0.00,$14.53,$0.00,$14.78,$0.00
1655,ERX,HCPCS Q0161,51079-0517-01,CHLORPROMAZINE HCL 200 MG PO TABS,$92.82,$0.00,$92.82,$41.77,$66.25,$0.00,$15.99,$0.00,$0.00,$16.25,$92.82,$0.00,$46.41,$73.51,$74.26,$0.00,$14.53,$0.00,$14.78,$0.00
1655,ERX,HCPCS Q0161,51079-0517-20,CHLORPROMAZINE HCL 200 MG PO TABS,$92.82,$0.00,$92.82,$41.77,$66.25,$0.00,$15.99,$0.00,$0.00,$16.25,$92.82,$0.00,$46.41,$73.51,$74.26,$0.00,$14.53,$0.00,$14.78,$0.00
1656,ERX,HCPCS Q0161,00781-5914-01,CHLORPROMAZINE HCL 25 MG PO TABS,$36.34,$0.00,$36.34,$16.35,$25.94,$0.00,$6.26,$0.00,$0.00,$6.36,$36.34,$0.00,$18.17,$28.78,$29.07,$0.00,$5.69,$0.00,$5.79,$0.00
1656,ERX,HCPCS Q0161,00832-0301-00,CHLORPROMAZINE HCL 25 MG PO TABS,$36.34,$0.00,$36.34,$16.35,$25.94,$0.00,$6.26,$0.00,$0.00,$6.36,$36.34,$0.00,$18.17,$28.78,$29.07,$0.00,$5.69,$0.00,$5.79,$0.00
1656,ERX,HCPCS Q0161,51079-0519-01,CHLORPROMAZINE HCL 25 MG PO TABS,$36.34,$0.00,$36.34,$16.35,$25.94,$0.00,$6.26,$0.00,$0.00,$6.36,$36.34,$0.00,$18.17,$28.78,$29.07,$0.00,$5.69,$0.00,$5.79,$0.00
1656,ERX,HCPCS Q0161,51079-0519-20,CHLORPROMAZINE HCL 25 MG PO TABS,$36.34,$0.00,$36.34,$16.35,$25.94,$0.00,$6.26,$0.00,$0.00,$6.36,$36.34,$0.00,$18.17,$28.78,$29.07,$0.00,$5.69,$0.00,$5.79,$0.00
1657,ERX,HCPCS Q0161,00781-5915-01,CHLORPROMAZINE HCL 50 MG PO TABS,$39.43,$0.00,$39.43,$17.74,$28.14,$0.00,$6.79,$0.00,$0.00,$6.90,$39.43,$0.00,$19.72,$31.23,$31.54,$0.00,$6.17,$0.00,$6.28,$0.00
1657,ERX,HCPCS Q0161,00832-0302-00,CHLORPROMAZINE HCL 50 MG PO TABS,$39.43,$0.00,$39.43,$17.74,$28.14,$0.00,$6.79,$0.00,$0.00,$6.90,$39.43,$0.00,$19.72,$31.23,$31.54,$0.00,$6.17,$0.00,$6.28,$0.00
1657,ERX,HCPCS Q0161,00832-0302-89,CHLORPROMAZINE HCL 50 MG PO TABS,$39.43,$0.00,$39.43,$17.74,$28.14,$0.00,$6.79,$0.00,$0.00,$6.90,$39.43,$0.00,$19.72,$31.23,$31.54,$0.00,$6.17,$0.00,$6.28,$0.00
1657,ERX,HCPCS Q0161,51079-0130-01,CHLORPROMAZINE HCL 50 MG PO TABS,$39.43,$0.00,$39.43,$17.74,$28.14,$0.00,$6.79,$0.00,$0.00,$6.90,$39.43,$0.00,$19.72,$31.23,$31.54,$0.00,$6.17,$0.00,$6.28,$0.00
1657,ERX,HCPCS Q0161,51079-0130-20,CHLORPROMAZINE HCL 50 MG PO TABS,$39.43,$0.00,$39.43,$17.74,$28.14,$0.00,$6.79,$0.00,$0.00,$6.90,$39.43,$0.00,$19.72,$31.23,$31.54,$0.00,$6.17,$0.00,$6.28,$0.00
1661,ERX,HCPCS 63700001,00378-0222-01,CHLORTHALIDONE 25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
1661,ERX,HCPCS 63700001,16714-0800-01,CHLORTHALIDONE 25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
1661,ERX,HCPCS 63700001,43598-0719-01,CHLORTHALIDONE 25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
1661,ERX,HCPCS 63700001,57664-0648-88,CHLORTHALIDONE 25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
1661,ERX,HCPCS 63700001,68382-0970-01,CHLORTHALIDONE 25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
1662,ERX,HCPCS 63700001,00378-0213-01,CHLORTHALIDONE 50 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
1662,ERX,HCPCS 63700001,57664-0649-88,CHLORTHALIDONE 50 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
1662,ERX,HCPCS 63700001,64980-0304-01,CHLORTHALIDONE 50 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
1662,ERX,HCPCS 63700001,66689-0346-99,CHLORTHALIDONE 50 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
1664,ERX,HCPCS 63700001,00591-2520-01,CHLORZOXAZONE 500 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
1676,ERX,HCPCS J0725,55566-1501-01,CHORIONIC GONADOTROPIN 10000 UNITS IM SOLR,$65.80,$0.00,$65.80,$0.00,$46.96,$0.00,$0.00,$0.00,$0.00,$0.00,$65.80,$0.00,$32.90,$52.11,$52.64,$0.00,$0.00,$0.00,$0.00,$0.00
1683,ERX,HCPCS 63700001,00904-4314-60,CHROMIUM 200 MCG PO TABS,$6.00,$0.00,$4.75,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$4.75,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
1740,ERX,HCPCS 63700001,00904-5959-61,CLINDAMYCIN HCL 150 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
1740,ERX,HCPCS 63700001,63739-0059-10,CLINDAMYCIN HCL 150 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
1742,ERX,HCPCS 25000001,00168-0201-30,CLINDAMYCIN PHOSPHATE 1 % EX SOLN,$142.80,$0.00,$142.80,$0.00,$101.92,$0.00,$0.00,$0.00,$0.00,$0.00,$142.80,$0.00,$71.40,$113.10,$114.24,$0.00,$0.00,$0.00,$0.00,$0.00
1742,ERX,HCPCS 25000001,45802-0562-01,CLINDAMYCIN PHOSPHATE 1 % EX SOLN,$142.80,$0.00,$142.80,$0.00,$101.92,$0.00,$0.00,$0.00,$0.00,$0.00,$142.80,$0.00,$71.40,$113.10,$114.24,$0.00,$0.00,$0.00,$0.00,$0.00
1753,ERX,HCPCS 63700001,49884-0701-55,CLOMIPHENE CITRATE 50 MG PO TABS,$26.30,$0.00,$26.30,$0.00,$18.77,$0.00,$0.00,$0.00,$0.00,$0.00,$26.30,$0.00,$13.15,$20.83,$21.04,$0.00,$0.00,$0.00,$0.00,$0.00
1754,ERX,HCPCS 63700001,00406-8807-01,CLOMIPRAMINE HCL 50 MG PO CAPS,$42.72,$0.00,$42.72,$0.00,$30.49,$0.00,$0.00,$0.00,$0.00,$0.00,$42.72,$0.00,$21.36,$33.83,$34.18,$0.00,$0.00,$0.00,$0.00,$0.00
1754,ERX,HCPCS 63700001,00781-2037-01,CLOMIPRAMINE HCL 50 MG PO CAPS,$42.72,$0.00,$42.72,$0.00,$30.49,$0.00,$0.00,$0.00,$0.00,$0.00,$42.72,$0.00,$21.36,$33.83,$34.18,$0.00,$0.00,$0.00,$0.00,$0.00
1754,ERX,HCPCS 63700001,51672-4012-06,CLOMIPRAMINE HCL 50 MG PO CAPS,$42.72,$0.00,$42.72,$0.00,$30.49,$0.00,$0.00,$0.00,$0.00,$0.00,$42.72,$0.00,$21.36,$33.83,$34.18,$0.00,$0.00,$0.00,$0.00,$0.00
1755,ERX,HCPCS 25000001,00597-0006-01,CLONIDINE HCL 0.1 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
1755,ERX,HCPCS 25000001,29300-0135-01,CLONIDINE HCL 0.1 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
1755,ERX,HCPCS 25000001,51079-0299-01,CLONIDINE HCL 0.1 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
1755,ERX,HCPCS 25000001,51079-0299-20,CLONIDINE HCL 0.1 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
1755,ERX,HCPCS 25000001,62332-0054-91,CLONIDINE HCL 0.1 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
1755,ERX,HCPCS 25000001,63739-0060-10,CLONIDINE HCL 0.1 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
1756,ERX,HCPCS 25000001,29300-0136-01,CLONIDINE HCL 0.2 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
1756,ERX,HCPCS 25000001,51079-0300-01,CLONIDINE HCL 0.2 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
1756,ERX,HCPCS 25000001,51079-0300-20,CLONIDINE HCL 0.2 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
1756,ERX,HCPCS 25000001,62332-0055-31,CLONIDINE HCL 0.2 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
1767,ERX,HCPCS 25000001,00904-7822-31,CLOTRIMAZOLE 1 % EX CREA,$32.61,$0.00,$32.61,$0.00,$23.27,$0.00,$0.00,$0.00,$0.00,$0.00,$32.61,$0.00,$16.31,$25.83,$26.09,$0.00,$0.00,$0.00,$0.00,$0.00
1767,ERX,HCPCS 25000001,45802-0434-11,CLOTRIMAZOLE 1 % EX CREA,$32.61,$0.00,$32.61,$0.00,$23.27,$0.00,$0.00,$0.00,$0.00,$0.00,$32.61,$0.00,$16.31,$25.83,$26.09,$0.00,$0.00,$0.00,$0.00,$0.00
1768,ERX,HCPCS 25000001,51672-1260-03,CLOTRIMAZOLE 1 % EX SOLN,$235.40,$0.00,$235.40,$0.00,$168.00,$0.00,$0.00,$0.00,$0.00,$0.00,$235.40,$0.00,$117.70,$186.44,$188.32,$0.00,$0.00,$0.00,$0.00,$0.00
1768,ERX,HCPCS 25000001,70954-0036-20,CLOTRIMAZOLE 1 % EX SOLN,$235.40,$0.00,$235.40,$0.00,$168.00,$0.00,$0.00,$0.00,$0.00,$0.00,$235.40,$0.00,$117.70,$186.44,$188.32,$0.00,$0.00,$0.00,$0.00,$0.00
1770,ERX,HCPCS 25000001,00395-1949-88,CLOVE OIL OIL,$23.72,$0.00,$23.72,$0.00,$16.93,$0.00,$0.00,$0.00,$0.00,$0.00,$23.72,$0.00,$11.86,$18.79,$18.98,$0.00,$0.00,$0.00,$0.00,$0.00
1802,ERX,HCPCS 25000001,00054-0244-24,CODEINE SULFATE 30 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
1821,ERX,HCPCS 63700001,00254-2008-01,COLCHICINE 0.6 MG PO TABS,$25.60,$0.00,$25.60,$0.00,$18.27,$0.00,$0.00,$0.00,$0.00,$0.00,$25.60,$0.00,$12.80,$20.28,$20.48,$0.00,$0.00,$0.00,$0.00,$0.00
1821,ERX,HCPCS 63700001,64764-0119-01,COLCHICINE 0.6 MG PO TABS,$25.60,$0.00,$25.60,$0.00,$18.27,$0.00,$0.00,$0.00,$0.00,$0.00,$25.60,$0.00,$12.80,$20.28,$20.48,$0.00,$0.00,$0.00,$0.00,$0.00
1821,ERX,HCPCS 63700001,65162-0710-09,COLCHICINE 0.6 MG PO TABS,$25.60,$0.00,$25.60,$0.00,$18.27,$0.00,$0.00,$0.00,$0.00,$0.00,$25.60,$0.00,$12.80,$20.28,$20.48,$0.00,$0.00,$0.00,$0.00,$0.00
1821,ERX,HCPCS 63700001,66993-0165-02,COLCHICINE 0.6 MG PO TABS,$25.60,$0.00,$25.60,$0.00,$18.27,$0.00,$0.00,$0.00,$0.00,$0.00,$25.60,$0.00,$12.80,$20.28,$20.48,$0.00,$0.00,$0.00,$0.00,$0.00
1985,ERX,HCPCS 25000001,00409-4092-01,CUPRIC CHLORIDE 0.4 MG/ML IV SOLN,$82.08,$0.00,$82.08,$0.00,$58.58,$0.00,$0.00,$0.00,$0.00,$0.00,$82.08,$0.00,$41.04,$65.01,$65.66,$0.00,$0.00,$0.00,$0.00,$0.00
2007,ERX,HCPCS J3420,00143-9621-01,CYANOCOBALAMIN 1000 MCG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.31,$0.00,$0.00,$2.60,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$2.60,$0.00,$2.47,$0.00
2007,ERX,HCPCS J3420,00143-9621-25,CYANOCOBALAMIN 1000 MCG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.31,$0.00,$0.00,$2.60,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$2.60,$0.00,$2.47,$0.00
2007,ERX,HCPCS J3420,00517-0031-25,CYANOCOBALAMIN 1000 MCG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.31,$0.00,$0.00,$2.60,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$2.60,$0.00,$2.47,$0.00
2007,ERX,HCPCS J3420,63323-0044-00,CYANOCOBALAMIN 1000 MCG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.31,$0.00,$0.00,$2.60,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$2.60,$0.00,$2.47,$0.00
2007,ERX,HCPCS J3420,63323-0044-01,CYANOCOBALAMIN 1000 MCG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.31,$0.00,$0.00,$2.60,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$2.60,$0.00,$2.47,$0.00
2007,ERX,HCPCS J3420,70069-0005-10,CYANOCOBALAMIN 1000 MCG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.31,$0.00,$0.00,$2.60,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$2.60,$0.00,$2.47,$0.00
2017,ERX,HCPCS 63700001,52817-0332-10,CYCLOBENZAPRINE HCL 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
2017,ERX,HCPCS 63700001,52817-0332-50,CYCLOBENZAPRINE HCL 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
2017,ERX,HCPCS 63700001,63739-0531-10,CYCLOBENZAPRINE HCL 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
2017,ERX,HCPCS 63700001,69097-0846-07,CYCLOBENZAPRINE HCL 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
2025,ERX,HCPCS 25000001,17478-0100-02,CYCLOPENTOLATE HCL 1 % OP SOLN,$63.84,$0.00,$133.93,$0.00,$95.59,$0.00,$0.00,$0.00,$0.00,$0.00,$133.93,$0.00,$66.97,$50.56,$107.14,$0.00,$0.00,$0.00,$0.00,$0.00
2025,ERX,HCPCS 25000001,24208-0735-01,CYCLOPENTOLATE HCL 1 % OP SOLN,$63.84,$0.00,$133.93,$0.00,$95.59,$0.00,$0.00,$0.00,$0.00,$0.00,$133.93,$0.00,$66.97,$50.56,$107.14,$0.00,$0.00,$0.00,$0.00,$0.00
2025,ERX,HCPCS 25000001,61314-0396-01,CYCLOPENTOLATE HCL 1 % OP SOLN,$63.84,$0.00,$133.93,$0.00,$95.59,$0.00,$0.00,$0.00,$0.00,$0.00,$133.93,$0.00,$66.97,$50.56,$107.14,$0.00,$0.00,$0.00,$0.00,$0.00
2025,ERX,HCPCS 25000001,17478-0100-12,CYCLOPENTOLATE HCL 1 % OP SOLN,$133.93,$0.00,$133.93,$0.00,$95.59,$0.00,$0.00,$0.00,$0.00,$0.00,$133.93,$0.00,$66.97,$106.07,$107.14,$0.00,$0.00,$0.00,$0.00,$0.00
2025,ERX,HCPCS 25000001,24208-0735-06,CYCLOPENTOLATE HCL 1 % OP SOLN,$133.93,$0.00,$133.93,$0.00,$95.59,$0.00,$0.00,$0.00,$0.00,$0.00,$133.93,$0.00,$66.97,$106.07,$107.14,$0.00,$0.00,$0.00,$0.00,$0.00
2025,ERX,HCPCS 25000001,61314-0396-03,CYCLOPENTOLATE HCL 1 % OP SOLN,$133.93,$0.00,$133.93,$0.00,$95.59,$0.00,$0.00,$0.00,$0.00,$0.00,$133.93,$0.00,$66.97,$106.07,$107.14,$0.00,$0.00,$0.00,$0.00,$0.00
2025,ERX,HCPCS 25000001,00065-0396-05,CYCLOPENTOLATE HCL 1 % OP SOLN,$187.30,$0.00,$148.34,$0.00,$95.59,$0.00,$0.00,$0.00,$0.00,$0.00,$133.93,$0.00,$66.97,$148.34,$107.14,$0.00,$0.00,$0.00,$0.00,$0.00
2033,ERX,HCPCS 63700001,51991-0838-01,CYPROHEPTADINE HCL 4 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
2091,ERX,HCPCS J9130,00703-5075-01,DACARBAZINE 200 MG IV SOLR,$137.97,$0.00,$137.97,$62.09,$98.47,$0.00,$10.32,$0.00,$0.00,$9.56,$137.97,$0.00,$68.99,$109.27,$110.38,$0.00,$9.56,$0.00,$0.00,$0.00
2091,ERX,HCPCS J9130,61703-0327-22,DACARBAZINE 200 MG IV SOLR,$137.97,$0.00,$137.97,$62.09,$98.47,$0.00,$10.32,$0.00,$0.00,$9.56,$137.97,$0.00,$68.99,$109.27,$110.38,$0.00,$9.56,$0.00,$0.00,$0.00
2091,ERX,HCPCS J9130,63323-0128-20,DACARBAZINE 200 MG IV SOLR,$137.97,$0.00,$137.97,$62.09,$98.47,$0.00,$10.32,$0.00,$0.00,$9.56,$137.97,$0.00,$68.99,$109.27,$110.38,$0.00,$9.56,$0.00,$0.00,$0.00
2120,ERX,HCPCS 25000001,00527-1369-01,DANAZOL 200 MG PO CAPS,$34.47,$0.00,$34.47,$0.00,$24.60,$0.00,$0.00,$0.00,$0.00,$0.00,$34.47,$0.00,$17.24,$27.30,$27.58,$0.00,$0.00,$0.00,$0.00,$0.00
2120,ERX,HCPCS 25000001,00527-1369-06,DANAZOL 200 MG PO CAPS,$34.47,$0.00,$34.47,$0.00,$24.60,$0.00,$0.00,$0.00,$0.00,$0.00,$34.47,$0.00,$17.24,$27.30,$27.58,$0.00,$0.00,$0.00,$0.00,$0.00
2120,ERX,HCPCS 25000001,00555-0635-02,DANAZOL 200 MG PO CAPS,$34.47,$0.00,$34.47,$0.00,$24.60,$0.00,$0.00,$0.00,$0.00,$0.00,$34.47,$0.00,$17.24,$27.30,$27.58,$0.00,$0.00,$0.00,$0.00,$0.00
2120,ERX,HCPCS 25000001,00555-0635-09,DANAZOL 200 MG PO CAPS,$34.47,$0.00,$34.47,$0.00,$24.60,$0.00,$0.00,$0.00,$0.00,$0.00,$34.47,$0.00,$17.24,$27.30,$27.58,$0.00,$0.00,$0.00,$0.00,$0.00
2131,ERX,HCPCS 63700001,47781-0334-31,DAPSONE 100 MG PO TABS,$10.26,$0.00,$10.26,$0.00,$7.32,$0.00,$0.00,$0.00,$0.00,$0.00,$10.26,$0.00,$5.13,$8.13,$8.21,$0.00,$0.00,$0.00,$0.00,$0.00
2131,ERX,HCPCS 63700001,69543-0151-30,DAPSONE 100 MG PO TABS,$10.26,$0.00,$10.26,$0.00,$7.32,$0.00,$0.00,$0.00,$0.00,$0.00,$10.26,$0.00,$5.13,$8.13,$8.21,$0.00,$0.00,$0.00,$0.00,$0.00
2131,ERX,HCPCS 63700001,70954-0136-10,DAPSONE 100 MG PO TABS,$10.26,$0.00,$10.26,$0.00,$7.32,$0.00,$0.00,$0.00,$0.00,$0.00,$10.26,$0.00,$5.13,$8.13,$8.21,$0.00,$0.00,$0.00,$0.00,$0.00
2131,ERX,HCPCS 63700001,70954-0136-20,DAPSONE 100 MG PO TABS,$10.26,$0.00,$10.26,$0.00,$7.32,$0.00,$0.00,$0.00,$0.00,$0.00,$10.26,$0.00,$5.13,$8.13,$8.21,$0.00,$0.00,$0.00,$0.00,$0.00
2132,ERX,HCPCS 63700001,47781-0333-31,DAPSONE 25 MG PO TABS,$10.41,$0.00,$10.41,$0.00,$7.43,$0.00,$0.00,$0.00,$0.00,$0.00,$10.41,$0.00,$5.21,$8.24,$8.33,$0.00,$0.00,$0.00,$0.00,$0.00
2132,ERX,HCPCS 63700001,49938-0102-30,DAPSONE 25 MG PO TABS,$10.41,$0.00,$10.41,$0.00,$7.43,$0.00,$0.00,$0.00,$0.00,$0.00,$10.41,$0.00,$5.21,$8.24,$8.33,$0.00,$0.00,$0.00,$0.00,$0.00
2132,ERX,HCPCS 63700001,70954-0135-20,DAPSONE 25 MG PO TABS,$10.41,$0.00,$10.41,$0.00,$7.43,$0.00,$0.00,$0.00,$0.00,$0.00,$10.41,$0.00,$5.21,$8.24,$8.33,$0.00,$0.00,$0.00,$0.00,$0.00
2286,ERX,HCPCS 63700001,50742-0113-01,DESIPRAMINE HCL 25 MG PO TABS,$6.93,$0.00,$6.93,$0.00,$4.95,$0.00,$0.00,$0.00,$0.00,$0.00,$6.93,$0.00,$3.47,$5.49,$5.54,$0.00,$0.00,$0.00,$0.00,$0.00
2286,ERX,HCPCS 63700001,69238-1055-01,DESIPRAMINE HCL 25 MG PO TABS,$6.93,$0.00,$6.93,$0.00,$4.95,$0.00,$0.00,$0.00,$0.00,$0.00,$6.93,$0.00,$3.47,$5.49,$5.54,$0.00,$0.00,$0.00,$0.00,$0.00
2287,ERX,HCPCS 63700001,45963-0343-02,DESIPRAMINE HCL 50 MG PO TABS,$10.18,$0.00,$10.18,$0.00,$7.27,$0.00,$0.00,$0.00,$0.00,$0.00,$10.18,$0.00,$5.09,$8.06,$8.14,$0.00,$0.00,$0.00,$0.00,$0.00
2287,ERX,HCPCS 63700001,50742-0114-01,DESIPRAMINE HCL 50 MG PO TABS,$10.18,$0.00,$10.18,$0.00,$7.27,$0.00,$0.00,$0.00,$0.00,$0.00,$10.18,$0.00,$5.09,$8.06,$8.14,$0.00,$0.00,$0.00,$0.00,$0.00
2291,ERX,HCPCS 25000001,45802-0422-37,DESONIDE 0.05 % EX CREA,$272.16,$0.00,$272.16,$0.00,$194.24,$0.00,$0.00,$0.00,$0.00,$0.00,$272.16,$0.00,$136.08,$215.55,$217.73,$0.00,$0.00,$0.00,$0.00,$0.00
2291,ERX,HCPCS 25000001,51672-1280-03,DESONIDE 0.05 % EX CREA,$272.16,$0.00,$272.16,$0.00,$194.24,$0.00,$0.00,$0.00,$0.00,$0.00,$272.16,$0.00,$136.08,$215.55,$217.73,$0.00,$0.00,$0.00,$0.00,$0.00
2319,ERX,HCPCS J8540,54879-0003-08,DEXAMETHASONE 0.5 MG/5ML PO ELIX,$200.83,$0.00,$162.75,$73.24,$116.15,$0.00,$6.63,$0.00,$0.00,$28.50,$162.75,$0.00,$81.38,$159.06,$130.20,$0.00,$31.43,$0.00,$25.91,$0.00
2319,ERX,HCPCS J8540,60432-0466-08,DEXAMETHASONE 0.5 MG/5ML PO ELIX,$200.83,$0.00,$162.75,$73.24,$116.15,$0.00,$6.63,$0.00,$0.00,$28.50,$162.75,$0.00,$81.38,$159.06,$130.20,$0.00,$31.43,$0.00,$25.91,$0.00
2322,ERX,HCPCS J8540,00054-4179-25,DEXAMETHASONE 0.5 MG PO TABS,$6.00,$0.00,$6.00,$2.70,$4.28,$0.00,$0.14,$0.00,$0.00,$1.05,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.94,$0.00,$0.96,$0.00
2322,ERX,HCPCS J8540,00054-8179-25,DEXAMETHASONE 0.5 MG PO TABS,$6.00,$0.00,$6.00,$2.70,$4.28,$0.00,$0.14,$0.00,$0.00,$1.05,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.94,$0.00,$0.96,$0.00
2327,ERX,HCPCS 25000001,00054-4184-25,DEXAMETHASONE 4 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
2327,ERX,HCPCS 25000001,00054-8175-25,DEXAMETHASONE 4 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
2332,ERX,HCPCS J1100,00641-6145-25,DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.42,$0.00,$0.00,$0.56,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.56,$0.00,$0.54,$0.00
2332,ERX,HCPCS J1100,55150-0237-01,DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.42,$0.00,$0.00,$0.56,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.56,$0.00,$0.54,$0.00
2332,ERX,HCPCS J1100,63323-0165-01,DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.42,$0.00,$0.00,$0.56,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.56,$0.00,$0.54,$0.00
2332,ERX,HCPCS J1100,63323-0165-02,DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.42,$0.00,$0.00,$0.56,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.56,$0.00,$0.54,$0.00
2332,ERX,HCPCS J1100,67457-0423-12,DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.42,$0.00,$0.00,$0.56,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.56,$0.00,$0.54,$0.00
2335,ERX,HCPCS 25000001,24208-0720-02,DEXAMETHASONE SODIUM PHOSPHATE 0.1 % OP SOLN,$203.75,$0.00,$203.75,$0.00,$145.42,$0.00,$0.00,$0.00,$0.00,$0.00,$203.75,$0.00,$101.88,$161.37,$163.00,$0.00,$0.00,$0.00,$0.00,$0.00
2354,ERX,HCPCS 63700001,00406-8958-01,DEXTROAMPHETAMINE SULFATE 5 MG PO TABS,$11.02,$0.00,$11.02,$0.00,$7.86,$0.00,$0.00,$0.00,$0.00,$0.00,$11.02,$0.00,$5.51,$8.73,$8.82,$0.00,$0.00,$0.00,$0.00,$0.00
2354,ERX,HCPCS 63700001,00555-0952-02,DEXTROAMPHETAMINE SULFATE 5 MG PO TABS,$11.02,$0.00,$11.02,$0.00,$7.86,$0.00,$0.00,$0.00,$0.00,$0.00,$11.02,$0.00,$5.51,$8.73,$8.82,$0.00,$0.00,$0.00,$0.00,$0.00
2354,ERX,HCPCS 63700001,13107-0035-01,DEXTROAMPHETAMINE SULFATE 5 MG PO TABS,$11.02,$0.00,$11.02,$0.00,$7.86,$0.00,$0.00,$0.00,$0.00,$0.00,$11.02,$0.00,$5.51,$8.73,$8.82,$0.00,$0.00,$0.00,$0.00,$0.00
2357,ERX,HCPCS 25000001,00264-7520-20,DEXTROSE 10 % IV SOLN,$22.00,$0.00,$30.40,$0.00,$21.70,$0.00,$0.00,$0.00,$0.00,$0.00,$30.40,$0.00,$15.20,$17.42,$24.32,$0.00,$0.00,$0.00,$0.00,$0.00
2357,ERX,HCPCS 25000001,00338-0023-02,DEXTROSE 10 % IV SOLN,$22.00,$0.00,$30.40,$0.00,$21.70,$0.00,$0.00,$0.00,$0.00,$0.00,$30.40,$0.00,$15.20,$17.42,$24.32,$0.00,$0.00,$0.00,$0.00,$0.00
2357,ERX,HCPCS 25000001,00264-7520-10,DEXTROSE 10 % IV SOLN,$22.80,$0.00,$30.40,$0.00,$21.70,$0.00,$0.00,$0.00,$0.00,$0.00,$30.40,$0.00,$15.20,$18.06,$24.32,$0.00,$0.00,$0.00,$0.00,$0.00
2357,ERX,HCPCS 25000001,00338-0023-03,DEXTROSE 10 % IV SOLN,$22.80,$0.00,$30.40,$0.00,$21.70,$0.00,$0.00,$0.00,$0.00,$0.00,$30.40,$0.00,$15.20,$18.06,$24.32,$0.00,$0.00,$0.00,$0.00,$0.00
2357,ERX,HCPCS 25000001,00409-7930-03,DEXTROSE 10 % IV SOLN,$22.80,$0.00,$30.40,$0.00,$21.70,$0.00,$0.00,$0.00,$0.00,$0.00,$30.40,$0.00,$15.20,$18.06,$24.32,$0.00,$0.00,$0.00,$0.00,$0.00
2357,ERX,HCPCS 25000001,00338-0023-04,DEXTROSE 10 % IV SOLN,$30.40,$0.00,$30.40,$0.00,$21.70,$0.00,$0.00,$0.00,$0.00,$0.00,$30.40,$0.00,$15.20,$24.08,$24.32,$0.00,$0.00,$0.00,$0.00,$0.00
2357,ERX,HCPCS 25000001,00409-7930-09,DEXTROSE 10 % IV SOLN,$30.40,$0.00,$30.40,$0.00,$21.70,$0.00,$0.00,$0.00,$0.00,$0.00,$30.40,$0.00,$15.20,$24.08,$24.32,$0.00,$0.00,$0.00,$0.00,$0.00
2359,ERX,HCPCS 25000001,00990-7935-19,DEXTROSE 20 % IV SOLN,$53.20,$0.00,$53.20,$0.00,$37.97,$0.00,$0.00,$0.00,$0.00,$0.00,$53.20,$0.00,$26.60,$42.13,$42.56,$0.00,$0.00,$0.00,$0.00,$0.00
2361,ERX,HCPCS 25000001,00409-1775-10,DEXTROSE 250 MG/ML IV SOLN,$41.73,$0.00,$41.73,$0.00,$29.78,$0.00,$0.00,$0.00,$0.00,$0.00,$41.73,$0.00,$20.87,$33.05,$33.38,$0.00,$0.00,$0.00,$0.00,$0.00
2364,ERX,HCPCS J7060,00264-7510-20,DEXTROSE 5 % IV SOLN,$22.00,$0.00,$22.80,$10.26,$16.27,$0.00,$2.56,$0.00,$0.00,$4.28,$22.80,$0.00,$11.40,$17.42,$18.24,$0.00,$4.28,$0.00,$2.04,$0.00
2364,ERX,HCPCS J7060,00338-0017-02,DEXTROSE 5 % IV SOLN,$22.00,$0.00,$22.80,$10.26,$16.27,$0.00,$2.56,$0.00,$0.00,$4.28,$22.80,$0.00,$11.40,$17.42,$18.24,$0.00,$4.28,$0.00,$2.04,$0.00
2364,ERX,HCPCS J7060,00264-1510-31,DEXTROSE 5 % IV SOLN,$22.00,$0.00,$22.80,$10.26,$16.27,$0.00,$2.56,$0.00,$0.00,$4.28,$22.80,$0.00,$11.40,$17.42,$18.24,$0.00,$4.28,$0.00,$2.04,$0.00
2364,ERX,HCPCS J7060,00338-0017-11,DEXTROSE 5 % IV SOLN,$22.00,$0.00,$22.80,$10.26,$16.27,$0.00,$2.56,$0.00,$0.00,$4.28,$22.80,$0.00,$11.40,$17.42,$18.24,$0.00,$4.28,$0.00,$2.04,$0.00
2364,ERX,HCPCS J7060,00338-0017-31,DEXTROSE 5 % IV SOLN,$22.00,$0.00,$22.80,$10.26,$16.27,$0.00,$2.56,$0.00,$0.00,$4.28,$22.80,$0.00,$11.40,$17.42,$18.24,$0.00,$4.28,$0.00,$2.04,$0.00
2364,ERX,HCPCS J7060,00338-0017-41,DEXTROSE 5 % IV SOLN,$22.00,$0.00,$22.80,$10.26,$16.27,$0.00,$2.56,$0.00,$0.00,$4.28,$22.80,$0.00,$11.40,$17.42,$18.24,$0.00,$4.28,$0.00,$2.04,$0.00
2364,ERX,HCPCS J7060,00338-0551-11,DEXTROSE 5 % IV SOLN,$22.00,$0.00,$22.80,$10.26,$16.27,$0.00,$2.56,$0.00,$0.00,$4.28,$22.80,$0.00,$11.40,$17.42,$18.24,$0.00,$4.28,$0.00,$2.04,$0.00
2364,ERX,HCPCS J7060,00264-7510-10,DEXTROSE 5 % IV SOLN,$22.00,$0.00,$22.80,$10.26,$16.27,$0.00,$2.56,$0.00,$0.00,$4.28,$22.80,$0.00,$11.40,$17.42,$18.24,$0.00,$4.28,$0.00,$2.04,$0.00
2364,ERX,HCPCS J7060,00338-0017-03,DEXTROSE 5 % IV SOLN,$22.00,$0.00,$22.80,$10.26,$16.27,$0.00,$2.56,$0.00,$0.00,$4.28,$22.80,$0.00,$11.40,$17.42,$18.24,$0.00,$4.28,$0.00,$2.04,$0.00
2364,ERX,HCPCS J7060,63323-0624-75,DEXTROSE 5 % IV SOLN,$22.00,$0.00,$22.80,$10.26,$16.27,$0.00,$2.56,$0.00,$0.00,$4.28,$22.80,$0.00,$11.40,$17.42,$18.24,$0.00,$4.28,$0.00,$2.04,$0.00
2364,ERX,HCPCS J7060,00338-0017-04,DEXTROSE 5 % IV SOLN,$22.80,$0.00,$22.80,$10.26,$16.27,$0.00,$2.56,$0.00,$0.00,$4.28,$22.80,$0.00,$11.40,$18.06,$18.24,$0.00,$4.28,$0.00,$2.04,$0.00
2364,ERX,HCPCS J7060,00338-0017-18,DEXTROSE 5 % IV SOLN,$22.80,$0.00,$22.80,$10.26,$16.27,$0.00,$2.56,$0.00,$0.00,$4.28,$22.80,$0.00,$11.40,$18.06,$18.24,$0.00,$4.28,$0.00,$2.04,$0.00
2364,ERX,HCPCS J7060,00338-0017-38,DEXTROSE 5 % IV SOLN,$22.80,$0.00,$22.80,$10.26,$16.27,$0.00,$2.56,$0.00,$0.00,$4.28,$22.80,$0.00,$11.40,$18.06,$18.24,$0.00,$4.28,$0.00,$2.04,$0.00
2364,ERX,HCPCS J7060,00338-0017-48,DEXTROSE 5 % IV SOLN,$22.80,$0.00,$22.80,$10.26,$16.27,$0.00,$2.56,$0.00,$0.00,$4.28,$22.80,$0.00,$11.40,$18.06,$18.24,$0.00,$4.28,$0.00,$2.04,$0.00
2364,ERX,HCPCS J7060,00338-0551-18,DEXTROSE 5 % IV SOLN,$22.80,$0.00,$22.80,$10.26,$16.27,$0.00,$2.56,$0.00,$0.00,$4.28,$22.80,$0.00,$11.40,$18.06,$18.24,$0.00,$4.28,$0.00,$2.04,$0.00
2365,ERX,HCPCS 25000001,00409-6648-02,DEXTROSE 50 % IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
2365,ERX,HCPCS 25000001,00409-6648-16,DEXTROSE 50 % IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
2365,ERX,HCPCS 25000001,00409-7517-16,DEXTROSE 50 % IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
2365,ERX,HCPCS 25000001,00409-7936-19,DEXTROSE 50 % IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
2365,ERX,HCPCS 25000001,69374-0953-50,DEXTROSE 50 % IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
2365,ERX,HCPCS 25000001,76329-3301-01,DEXTROSE 50 % IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
2365,ERX,HCPCS 25000001,99999-6007-48,DEXTROSE 50 % IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
2367,ERX,HCPCS 25000001,00264-7387-50,DEXTROSE 70 % IV SOLN,$68.40,$0.00,$68.40,$0.00,$48.82,$0.00,$0.00,$0.00,$0.00,$0.00,$68.40,$0.00,$34.20,$54.17,$54.72,$0.00,$0.00,$0.00,$0.00,$0.00
2367,ERX,HCPCS 25000001,00338-0719-06,DEXTROSE 70 % IV SOLN,$68.40,$0.00,$68.40,$0.00,$48.82,$0.00,$0.00,$0.00,$0.00,$0.00,$68.40,$0.00,$34.20,$54.17,$54.72,$0.00,$0.00,$0.00,$0.00,$0.00
2401,ERX,HCPCS J3360,00409-1273-32,DIAZEPAM 5 MG/ML IJ SOLN,$31.18,$0.00,$31.18,$0.00,$22.25,$0.00,$0.00,$0.00,$0.00,$0.00,$31.18,$0.00,$15.59,$24.69,$24.94,$0.00,$0.00,$0.00,$0.00,$0.00
2401,ERX,HCPCS J3360,69339-0136-02,DIAZEPAM 5 MG/ML IJ SOLN,$31.18,$0.00,$31.18,$0.00,$22.25,$0.00,$0.00,$0.00,$0.00,$0.00,$31.18,$0.00,$15.59,$24.69,$24.94,$0.00,$0.00,$0.00,$0.00,$0.00
2401,ERX,HCPCS J3360,69339-0136-32,DIAZEPAM 5 MG/ML IJ SOLN,$31.18,$0.00,$31.18,$0.00,$22.25,$0.00,$0.00,$0.00,$0.00,$0.00,$31.18,$0.00,$15.59,$24.69,$24.94,$0.00,$0.00,$0.00,$0.00,$0.00
2405,ERX,HCPCS 25000001,00172-3926-60,DIAZEPAM 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
2405,ERX,HCPCS 25000001,00904-5880-61,DIAZEPAM 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
2405,ERX,HCPCS 25000001,51079-0285-20,DIAZEPAM 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
2405,ERX,HCPCS 25000001,63739-0073-10,DIAZEPAM 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
2412,ERX,HCPCS 25000001,00536-1211-95,DIBUCAINE 1 % EX OINT,$30.12,$0.00,$30.12,$0.00,$21.50,$0.00,$0.00,$0.00,$0.00,$0.00,$30.12,$0.00,$15.06,$23.86,$24.10,$0.00,$0.00,$0.00,$0.00,$0.00
2412,ERX,HCPCS 25000001,54162-0011-01,DIBUCAINE 1 % EX OINT,$30.12,$0.00,$30.12,$0.00,$21.50,$0.00,$0.00,$0.00,$0.00,$0.00,$30.12,$0.00,$15.06,$23.86,$24.10,$0.00,$0.00,$0.00,$0.00,$0.00
2412,ERX,HCPCS 25000001,55741-0402-02,DIBUCAINE 1 % EX OINT,$83.21,$0.00,$65.90,$0.00,$21.50,$0.00,$0.00,$0.00,$0.00,$0.00,$30.12,$0.00,$15.06,$65.90,$24.10,$0.00,$0.00,$0.00,$0.00,$0.00
2414,ERX,HCPCS 63700001,00093-3123-01,DICLOXACILLIN SODIUM 250 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
2414,ERX,HCPCS 63700001,00781-2248-01,DICLOXACILLIN SODIUM 250 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
2418,ERX,HCPCS 63700001,00378-1610-01,DICYCLOMINE HCL 10 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
2418,ERX,HCPCS 63700001,00378-1610-05,DICYCLOMINE HCL 10 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
2418,ERX,HCPCS 63700001,00527-0586-01,DICYCLOMINE HCL 10 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
2418,ERX,HCPCS 63700001,00591-0794-01,DICYCLOMINE HCL 10 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
2420,ERX,HCPCS J0500,00378-1620-01,DICYCLOMINE HCL 20 MG PO TABS,$6.00,$0.00,$59.65,$3.26,$4.28,$0.00,$21.83,$0.00,$0.00,$1.05,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$59.65,$0.00
2420,ERX,HCPCS J0500,00527-1282-01,DICYCLOMINE HCL 20 MG PO TABS,$6.00,$0.00,$59.65,$3.26,$4.28,$0.00,$21.83,$0.00,$0.00,$1.05,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$59.65,$0.00
2420,ERX,HCPCS J0500,00591-0795-01,DICYCLOMINE HCL 20 MG PO TABS,$6.00,$0.00,$59.65,$3.26,$4.28,$0.00,$21.83,$0.00,$0.00,$1.05,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$59.65,$0.00
2420,ERX,HCPCS J0500,51079-0119-20,DICYCLOMINE HCL 20 MG PO TABS,$6.00,$0.00,$59.65,$3.26,$4.28,$0.00,$21.83,$0.00,$0.00,$1.05,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$59.65,$0.00
2442,ERX,HCPCS J1160,00641-1410-31,DIGOXIN 0.25 MG/ML IJ SOLN,$25.08,$0.00,$25.08,$0.00,$17.90,$0.00,$0.00,$0.00,$0.00,$0.00,$25.08,$0.00,$12.54,$19.86,$20.06,$0.00,$0.00,$0.00,$0.00,$0.00
2442,ERX,HCPCS J1160,00641-1410-35,DIGOXIN 0.25 MG/ML IJ SOLN,$25.08,$0.00,$25.08,$0.00,$17.90,$0.00,$0.00,$0.00,$0.00,$0.00,$25.08,$0.00,$12.54,$19.86,$20.06,$0.00,$0.00,$0.00,$0.00,$0.00
2442,ERX,HCPCS J1160,00641-6184-01,DIGOXIN 0.25 MG/ML IJ SOLN,$25.08,$0.00,$25.08,$0.00,$17.90,$0.00,$0.00,$0.00,$0.00,$0.00,$25.08,$0.00,$12.54,$19.86,$20.06,$0.00,$0.00,$0.00,$0.00,$0.00
2442,ERX,HCPCS J1160,00641-6184-25,DIGOXIN 0.25 MG/ML IJ SOLN,$25.08,$0.00,$25.08,$0.00,$17.90,$0.00,$0.00,$0.00,$0.00,$0.00,$25.08,$0.00,$12.54,$19.86,$20.06,$0.00,$0.00,$0.00,$0.00,$0.00
2442,ERX,HCPCS J1160,00781-3059-72,DIGOXIN 0.25 MG/ML IJ SOLN,$25.08,$0.00,$25.08,$0.00,$17.90,$0.00,$0.00,$0.00,$0.00,$0.00,$25.08,$0.00,$12.54,$19.86,$20.06,$0.00,$0.00,$0.00,$0.00,$0.00
2442,ERX,HCPCS J1160,00781-3059-95,DIGOXIN 0.25 MG/ML IJ SOLN,$25.08,$0.00,$25.08,$0.00,$17.90,$0.00,$0.00,$0.00,$0.00,$0.00,$25.08,$0.00,$12.54,$19.86,$20.06,$0.00,$0.00,$0.00,$0.00,$0.00
2444,ERX,HCPCS 63700001,00143-1240-01,DIGOXIN 0.125 MG PO TABS,$8.01,$0.00,$8.01,$0.00,$5.72,$0.00,$0.00,$0.00,$0.00,$0.00,$8.01,$0.00,$4.01,$6.34,$6.41,$0.00,$0.00,$0.00,$0.00,$0.00
2444,ERX,HCPCS 63700001,16714-0590-01,DIGOXIN 0.125 MG PO TABS,$8.01,$0.00,$8.01,$0.00,$5.72,$0.00,$0.00,$0.00,$0.00,$0.00,$8.01,$0.00,$4.01,$6.34,$6.41,$0.00,$0.00,$0.00,$0.00,$0.00
2445,ERX,HCPCS 63700001,00527-1325-01,DIGOXIN 0.25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
2445,ERX,HCPCS 63700001,00904-5922-61,DIGOXIN 0.25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
2445,ERX,HCPCS 63700001,16714-0591-01,DIGOXIN 0.25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
2474,ERX,HCPCS 63700001,00093-0321-01,DILTIAZEM HCL 120 MG PO TABS,$10.96,$0.00,$10.96,$0.00,$7.82,$0.00,$0.00,$0.00,$0.00,$0.00,$10.96,$0.00,$5.48,$8.68,$8.77,$0.00,$0.00,$0.00,$0.00,$0.00
2475,ERX,HCPCS 63700001,00093-0318-01,DILTIAZEM HCL 30 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
2475,ERX,HCPCS 63700001,63739-0079-10,DILTIAZEM HCL 30 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
2475,ERX,HCPCS 63700001,68682-0006-10,DILTIAZEM HCL 30 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
2476,ERX,HCPCS 63700001,00378-0045-05,DILTIAZEM HCL 60 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
2476,ERX,HCPCS 63700001,51079-0746-20,DILTIAZEM HCL 60 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
2476,ERX,HCPCS 63700001,63739-0080-10,DILTIAZEM HCL 60 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
2476,ERX,HCPCS 63700001,68682-0007-10,DILTIAZEM HCL 60 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
2477,ERX,HCPCS 63700001,00093-0320-01,DILTIAZEM HCL 90 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
2508,ERX,HCPCS J1200,00641-0376-21,DIPHENHYDRAMINE HCL 50 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.86,$0.00,$0.00,$1.06,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.06,$0.00,$1.01,$0.00
2508,ERX,HCPCS J1200,00641-0376-25,DIPHENHYDRAMINE HCL 50 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.86,$0.00,$0.00,$1.06,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.06,$0.00,$1.01,$0.00
2508,ERX,HCPCS J1200,63323-0664-01,DIPHENHYDRAMINE HCL 50 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.86,$0.00,$0.00,$1.06,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.06,$0.00,$1.01,$0.00
2509,ERX,HCPCS J3490,00904-5306-61,DIPHENHYDRAMINE HCL 25 MG PO CAPS,$6.00,$0.00,$6.00,$3.26,$4.28,$0.00,$1.03,$0.00,$0.00,$1.05,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.96,$0.00
2510,ERX,HCPCS Q0163,00904-2056-61,DIPHENHYDRAMINE HCL 50 MG PO CAPS,$6.00,$0.00,$6.00,$3.26,$4.28,$0.00,$1.03,$0.00,$0.00,$1.05,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.96,$0.00
2511,ERX,HCPCS Q0163,00121-0489-00,DIPHENHYDRAMINE HCL 12.5 MG/5ML PO ELIX,$8.17,$0.00,$8.17,$3.68,$5.83,$0.00,$1.41,$0.00,$0.00,$1.43,$8.17,$0.00,$4.09,$6.47,$6.54,$0.00,$1.28,$0.00,$1.30,$0.00
2511,ERX,HCPCS Q0163,00121-0489-05,DIPHENHYDRAMINE HCL 12.5 MG/5ML PO ELIX,$8.17,$0.00,$8.17,$3.68,$5.83,$0.00,$1.41,$0.00,$0.00,$1.43,$8.17,$0.00,$4.09,$6.47,$6.54,$0.00,$1.28,$0.00,$1.30,$0.00
2515,ERX,HCPCS 63700001,99999-6009-38,DIPHENOXYLATE-ATROPINE 2.5-0.025 MG/5ML PO LIQD,$11.00,$0.00,$11.00,$0.00,$7.85,$0.00,$0.00,$0.00,$0.00,$0.00,$11.00,$0.00,$5.50,$8.71,$8.80,$0.00,$0.00,$0.00,$0.00,$0.00
2516,ERX,HCPCS 63700001,00378-0415-01,DIPHENOXYLATE-ATROPINE 2.5-0.025 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
2516,ERX,HCPCS 63700001,59762-1061-01,DIPHENOXYLATE-ATROPINE 2.5-0.025 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
2528,ERX,HCPCS 63700001,64980-0133-01,DIPYRIDAMOLE 25 MG PO TABS,$10.80,$0.00,$10.80,$0.00,$7.71,$0.00,$0.00,$0.00,$0.00,$0.00,$10.80,$0.00,$5.40,$8.55,$8.64,$0.00,$0.00,$0.00,$0.00,$0.00
2537,ERX,HCPCS 63700001,00025-2732-31,DISOPYRAMIDE PHOSPHATE ER 100 MG PO CP12,$18.29,$0.00,$18.29,$0.00,$13.05,$0.00,$0.00,$0.00,$0.00,$0.00,$18.29,$0.00,$9.15,$14.49,$14.63,$0.00,$0.00,$0.00,$0.00,$0.00
2551,ERX,HCPCS 63700001,00074-6212-13,DIVALPROEX SODIUM 125 MG PO TBEC,$8.10,$0.00,$8.10,$0.00,$5.78,$0.00,$0.00,$0.00,$0.00,$0.00,$8.10,$0.00,$4.05,$6.42,$6.48,$0.00,$0.00,$0.00,$0.00,$0.00
2551,ERX,HCPCS 63700001,00832-7122-11,DIVALPROEX SODIUM 125 MG PO TBEC,$8.10,$0.00,$8.10,$0.00,$5.78,$0.00,$0.00,$0.00,$0.00,$0.00,$8.10,$0.00,$4.05,$6.42,$6.48,$0.00,$0.00,$0.00,$0.00,$0.00
2552,ERX,HCPCS 63700001,00832-7123-15,DIVALPROEX SODIUM 250 MG PO TBEC,$8.23,$0.00,$8.23,$0.00,$5.87,$0.00,$0.00,$0.00,$0.00,$0.00,$8.23,$0.00,$4.12,$6.52,$6.58,$0.00,$0.00,$0.00,$0.00,$0.00
2552,ERX,HCPCS 63700001,68084-0776-01,DIVALPROEX SODIUM 250 MG PO TBEC,$8.23,$0.00,$8.23,$0.00,$5.87,$0.00,$0.00,$0.00,$0.00,$0.00,$8.23,$0.00,$4.12,$6.52,$6.58,$0.00,$0.00,$0.00,$0.00,$0.00
2553,ERX,HCPCS 63700001,00832-7124-01,DIVALPROEX SODIUM 500 MG PO TBEC,$12.35,$0.00,$12.35,$0.00,$8.81,$0.00,$0.00,$0.00,$0.00,$0.00,$12.35,$0.00,$6.18,$9.78,$9.88,$0.00,$0.00,$0.00,$0.00,$0.00
2553,ERX,HCPCS 63700001,00832-7124-11,DIVALPROEX SODIUM 500 MG PO TBEC,$12.35,$0.00,$12.35,$0.00,$8.81,$0.00,$0.00,$0.00,$0.00,$0.00,$12.35,$0.00,$6.18,$9.78,$9.88,$0.00,$0.00,$0.00,$0.00,$0.00
2553,ERX,HCPCS 63700001,62756-0798-13,DIVALPROEX SODIUM 500 MG PO TBEC,$12.35,$0.00,$12.35,$0.00,$8.81,$0.00,$0.00,$0.00,$0.00,$0.00,$12.35,$0.00,$6.18,$9.78,$9.88,$0.00,$0.00,$0.00,$0.00,$0.00
2553,ERX,HCPCS 63700001,62756-0798-88,DIVALPROEX SODIUM 500 MG PO TBEC,$12.35,$0.00,$12.35,$0.00,$8.81,$0.00,$0.00,$0.00,$0.00,$0.00,$12.35,$0.00,$6.18,$9.78,$9.88,$0.00,$0.00,$0.00,$0.00,$0.00
2553,ERX,HCPCS 63700001,68084-0782-61,DIVALPROEX SODIUM 500 MG PO TBEC,$12.35,$0.00,$12.35,$0.00,$8.81,$0.00,$0.00,$0.00,$0.00,$0.00,$12.35,$0.00,$6.18,$9.78,$9.88,$0.00,$0.00,$0.00,$0.00,$0.00
2565,ERX,HCPCS 63700001,00904-6459-59,DOCUSATE CALCIUM 240 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
2565,ERX,HCPCS 63700001,49348-0280-10,DOCUSATE CALCIUM 240 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
2566,ERX,HCPCS 63700001,00904-6455-61,DOCUSATE SODIUM 100 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
2566,ERX,HCPCS 63700001,00904-6457-60,DOCUSATE SODIUM 100 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
2566,ERX,HCPCS 63700001,00904-6457-80,DOCUSATE SODIUM 100 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
2566,ERX,HCPCS 63700001,69618-0044-10,DOCUSATE SODIUM 100 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
2569,ERX,HCPCS 63700001,50383-0771-10,DOCUSATE SODIUM 150 MG/15ML PO LIQD,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
2569,ERX,HCPCS 63700001,50383-0771-11,DOCUSATE SODIUM 150 MG/15ML PO LIQD,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
2569,ERX,HCPCS 63700001,50383-0771-16,DOCUSATE SODIUM 150 MG/15ML PO LIQD,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
2595,ERX,HCPCS J1265,00409-9104-20,DOPAMINE HCL 40 MG/ML IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
2595,ERX,HCPCS J1265,00409-5820-01,DOPAMINE HCL 40 MG/ML IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
2607,ERX,HCPCS 25000001,00641-6018-06,DOXAPRAM HCL 20 MG/ML IV SOLN,$183.02,$0.00,$183.02,$0.00,$130.62,$0.00,$0.00,$0.00,$0.00,$0.00,$183.02,$0.00,$91.51,$144.95,$146.42,$0.00,$0.00,$0.00,$0.00,$0.00
2608,ERX,HCPCS 63700001,00378-1049-01,DOXEPIN HCL 10 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
2608,ERX,HCPCS 63700001,51079-0436-01,DOXEPIN HCL 10 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
2608,ERX,HCPCS 63700001,51079-0436-20,DOXEPIN HCL 10 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
2609,ERX,HCPCS 63700001,51079-0651-01,DOXEPIN HCL 100 MG PO CAPS,$7.59,$0.00,$7.59,$0.00,$5.42,$0.00,$0.00,$0.00,$0.00,$0.00,$7.59,$0.00,$3.80,$6.01,$6.07,$0.00,$0.00,$0.00,$0.00,$0.00
2609,ERX,HCPCS 63700001,51079-0651-20,DOXEPIN HCL 100 MG PO CAPS,$7.59,$0.00,$7.59,$0.00,$5.42,$0.00,$0.00,$0.00,$0.00,$0.00,$7.59,$0.00,$3.80,$6.01,$6.07,$0.00,$0.00,$0.00,$0.00,$0.00
2610,ERX,HCPCS 63700001,49884-0222-01,DOXEPIN HCL 150 MG PO CAPS,$12.65,$0.00,$12.65,$0.00,$9.03,$0.00,$0.00,$0.00,$0.00,$0.00,$12.65,$0.00,$6.33,$10.02,$10.12,$0.00,$0.00,$0.00,$0.00,$0.00
2611,ERX,HCPCS 63700001,51079-0437-01,DOXEPIN HCL 25 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
2611,ERX,HCPCS 63700001,51079-0437-20,DOXEPIN HCL 25 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
2612,ERX,HCPCS 63700001,51079-0438-01,DOXEPIN HCL 50 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
2612,ERX,HCPCS 63700001,51079-0438-20,DOXEPIN HCL 50 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
2613,ERX,HCPCS 63700001,00378-5375-01,DOXEPIN HCL 75 MG PO CAPS,$6.88,$0.00,$6.88,$0.00,$4.91,$0.00,$0.00,$0.00,$0.00,$0.00,$6.88,$0.00,$3.44,$5.45,$5.50,$0.00,$0.00,$0.00,$0.00,$0.00
2614,ERX,HCPCS 63700001,54838-0512-40,DOXEPIN HCL 10 MG/ML PO CONC,$83.16,$0.00,$157.36,$0.00,$112.31,$0.00,$0.00,$0.00,$0.00,$0.00,$157.36,$0.00,$78.68,$65.86,$125.89,$0.00,$0.00,$0.00,$0.00,$0.00
2614,ERX,HCPCS 63700001,60432-0651-04,DOXEPIN HCL 10 MG/ML PO CONC,$157.36,$0.00,$157.36,$0.00,$112.31,$0.00,$0.00,$0.00,$0.00,$0.00,$157.36,$0.00,$78.68,$124.63,$125.89,$0.00,$0.00,$0.00,$0.00,$0.00
2616,ERX,HCPCS J9000,00069-3034-20,DOXORUBICIN HCL 2 MG/ML IV SOLN,$512.40,$0.00,$512.40,$230.58,$365.70,$0.00,$89.07,$0.00,$0.00,$67.45,$512.40,$0.00,$256.20,$405.82,$409.92,$0.00,$67.45,$0.00,$64.22,$0.00
2616,ERX,HCPCS J9000,00069-4034-01,DOXORUBICIN HCL 2 MG/ML IV SOLN,$512.40,$0.00,$512.40,$230.58,$365.70,$0.00,$89.07,$0.00,$0.00,$67.45,$512.40,$0.00,$256.20,$405.82,$409.92,$0.00,$67.45,$0.00,$64.22,$0.00
2616,ERX,HCPCS J9000,00143-9546-01,DOXORUBICIN HCL 2 MG/ML IV SOLN,$512.40,$0.00,$512.40,$230.58,$365.70,$0.00,$89.07,$0.00,$0.00,$67.45,$512.40,$0.00,$256.20,$405.82,$409.92,$0.00,$67.45,$0.00,$64.22,$0.00
2616,ERX,HCPCS J9000,45963-0733-60,DOXORUBICIN HCL 2 MG/ML IV SOLN,$512.40,$0.00,$512.40,$230.58,$365.70,$0.00,$89.07,$0.00,$0.00,$67.45,$512.40,$0.00,$256.20,$405.82,$409.92,$0.00,$67.45,$0.00,$64.22,$0.00
2616,ERX,HCPCS J9000,70860-0208-51,DOXORUBICIN HCL 2 MG/ML IV SOLN,$512.40,$0.00,$512.40,$230.58,$365.70,$0.00,$89.07,$0.00,$0.00,$67.45,$512.40,$0.00,$256.20,$405.82,$409.92,$0.00,$67.45,$0.00,$64.22,$0.00
2622,ERX,HCPCS 25000001,63323-0130-11,DOXYCYCLINE HYCLATE 100 MG IV SOLR,$88.20,$0.00,$88.20,$0.00,$62.95,$0.00,$0.00,$0.00,$0.00,$0.00,$88.20,$0.00,$44.10,$69.85,$70.56,$0.00,$0.00,$0.00,$0.00,$0.00
2622,ERX,HCPCS 25000001,63323-0130-13,DOXYCYCLINE HYCLATE 100 MG IV SOLR,$88.20,$0.00,$88.20,$0.00,$62.95,$0.00,$0.00,$0.00,$0.00,$0.00,$88.20,$0.00,$44.10,$69.85,$70.56,$0.00,$0.00,$0.00,$0.00,$0.00
2622,ERX,HCPCS 25000001,68382-0910-01,DOXYCYCLINE HYCLATE 100 MG IV SOLR,$88.20,$0.00,$88.20,$0.00,$62.95,$0.00,$0.00,$0.00,$0.00,$0.00,$88.20,$0.00,$44.10,$69.85,$70.56,$0.00,$0.00,$0.00,$0.00,$0.00
2622,ERX,HCPCS 25000001,68382-0910-10,DOXYCYCLINE HYCLATE 100 MG IV SOLR,$88.20,$0.00,$88.20,$0.00,$62.95,$0.00,$0.00,$0.00,$0.00,$0.00,$88.20,$0.00,$44.10,$69.85,$70.56,$0.00,$0.00,$0.00,$0.00,$0.00
2654,ERX,HCPCS J1790,00517-9702-01,DROPERIDOL 2.5 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$5.16,$0.00
2654,ERX,HCPCS J1790,00517-9702-25,DROPERIDOL 2.5 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$5.16,$0.00
2805,ERX,HCPCS 25000001,00536-7415-51,ENEMA 7-19 GM/133ML RECTAL ENEM,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
2887,ERX,HCPCS 25000001,45802-0038-46,ERYTHROMYCIN 2 % EX SOLN,$166.74,$0.00,$166.74,$0.00,$119.00,$0.00,$0.00,$0.00,$0.00,$0.00,$166.74,$0.00,$83.37,$132.06,$133.39,$0.00,$0.00,$0.00,$0.00,$0.00
2887,ERX,HCPCS 25000001,60432-0671-60,ERYTHROMYCIN 2 % EX SOLN,$166.74,$0.00,$166.74,$0.00,$119.00,$0.00,$0.00,$0.00,$0.00,$0.00,$166.74,$0.00,$83.37,$132.06,$133.39,$0.00,$0.00,$0.00,$0.00,$0.00
2888,ERX,HCPCS 25000001,00574-4024-11,ERYTHROMYCIN 5 MG/GM OP OINT,$72.21,$0.00,$72.21,$0.00,$51.54,$0.00,$0.00,$0.00,$0.00,$0.00,$72.21,$0.00,$36.11,$57.19,$57.77,$0.00,$0.00,$0.00,$0.00,$0.00
2888,ERX,HCPCS 25000001,00574-4024-50,ERYTHROMYCIN 5 MG/GM OP OINT,$72.21,$0.00,$72.21,$0.00,$51.54,$0.00,$0.00,$0.00,$0.00,$0.00,$72.21,$0.00,$36.11,$57.19,$57.77,$0.00,$0.00,$0.00,$0.00,$0.00
2888,ERX,HCPCS 25000001,17478-0070-31,ERYTHROMYCIN 5 MG/GM OP OINT,$72.21,$0.00,$72.21,$0.00,$51.54,$0.00,$0.00,$0.00,$0.00,$0.00,$72.21,$0.00,$36.11,$57.19,$57.77,$0.00,$0.00,$0.00,$0.00,$0.00
2888,ERX,HCPCS 25000001,24208-0910-19,ERYTHROMYCIN 5 MG/GM OP OINT,$72.21,$0.00,$72.21,$0.00,$51.54,$0.00,$0.00,$0.00,$0.00,$0.00,$72.21,$0.00,$36.11,$57.19,$57.77,$0.00,$0.00,$0.00,$0.00,$0.00
2888,ERX,HCPCS 25000001,00574-4024-35,ERYTHROMYCIN 5 MG/GM OP OINT,$133.02,$0.00,$105.35,$0.00,$51.54,$0.00,$0.00,$0.00,$0.00,$0.00,$72.21,$0.00,$36.11,$105.35,$57.77,$0.00,$0.00,$0.00,$0.00,$0.00
2888,ERX,HCPCS 25000001,17478-0070-35,ERYTHROMYCIN 5 MG/GM OP OINT,$133.02,$0.00,$105.35,$0.00,$51.54,$0.00,$0.00,$0.00,$0.00,$0.00,$72.21,$0.00,$36.11,$105.35,$57.77,$0.00,$0.00,$0.00,$0.00,$0.00
2888,ERX,HCPCS 25000001,24208-0910-55,ERYTHROMYCIN 5 MG/GM OP OINT,$133.02,$0.00,$105.35,$0.00,$51.54,$0.00,$0.00,$0.00,$0.00,$0.00,$72.21,$0.00,$36.11,$105.35,$57.77,$0.00,$0.00,$0.00,$0.00,$0.00
2899,ERX,HCPCS 63700001,24338-0132-13,ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5ML PO SUSR,"$1,196.48",$0.00,"$1,196.48",$0.00,$853.93,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,196.48",$0.00,$598.24,$947.61,$957.18,$0.00,$0.00,$0.00,$0.00,$0.00
2899,ERX,HCPCS 63700001,24338-0134-02,ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5ML PO SUSR,"$1,196.48",$0.00,"$1,196.48",$0.00,$853.93,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,196.48",$0.00,$598.24,$947.61,$957.18,$0.00,$0.00,$0.00,$0.00,$0.00
2899,ERX,HCPCS 63700001,62559-0630-01,ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5ML PO SUSR,"$1,196.48",$0.00,"$1,196.48",$0.00,$853.93,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,196.48",$0.00,$598.24,$947.61,$957.18,$0.00,$0.00,$0.00,$0.00,$0.00
2899,ERX,HCPCS 63700001,69238-1503-01,ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5ML PO SUSR,"$1,196.48",$0.00,"$1,196.48",$0.00,$853.93,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,196.48",$0.00,$598.24,$947.61,$957.18,$0.00,$0.00,$0.00,$0.00,$0.00
2903,ERX,HCPCS J1364,00409-6476-44,ERYTHROMYCIN LACTOBIONATE 500 MG IV SOLR,$307.68,$0.00,$307.68,$0.00,$219.59,$0.00,$0.00,$0.00,$0.00,$0.00,$307.68,$0.00,$153.84,$243.68,$246.14,$0.00,$0.00,$0.00,$0.00,$0.00
2903,ERX,HCPCS J1364,00409-6482-01,ERYTHROMYCIN LACTOBIONATE 500 MG IV SOLR,$307.68,$0.00,$307.68,$0.00,$219.59,$0.00,$0.00,$0.00,$0.00,$0.00,$307.68,$0.00,$153.84,$243.68,$246.14,$0.00,$0.00,$0.00,$0.00,$0.00
2931,ERX,HCPCS J1380,00574-0870-05,ESTRADIOL VALERATE 20 MG/ML IM OIL,$42.66,$0.00,$42.66,$0.00,$30.45,$0.00,$0.00,$0.00,$0.00,$0.00,$42.66,$0.00,$21.33,$33.79,$34.13,$0.00,$0.00,$0.00,$0.00,$0.00
2931,ERX,HCPCS J1380,42023-0111-01,ESTRADIOL VALERATE 20 MG/ML IM OIL,$42.66,$0.00,$42.66,$0.00,$30.45,$0.00,$0.00,$0.00,$0.00,$0.00,$42.66,$0.00,$21.33,$33.79,$34.13,$0.00,$0.00,$0.00,$0.00,$0.00
2938,ERX,HCPCS 63700001,00046-1104-81,ESTROGENS CONJUGATED 1.25 MG PO TABS,$26.93,$0.00,$26.93,$0.00,$19.22,$0.00,$0.00,$0.00,$0.00,$0.00,$26.93,$0.00,$13.47,$21.33,$21.54,$0.00,$0.00,$0.00,$0.00,$0.00
3000,ERX,HCPCS 25000001,10119-0002-52,EYE WASH OP SOLN,$11.00,$0.00,$11.00,$0.00,$7.85,$0.00,$0.00,$0.00,$0.00,$0.00,$11.00,$0.00,$5.50,$8.71,$8.80,$0.00,$0.00,$0.00,$0.00,$0.00
3059,ERX,HCPCS 63700001,48783-0112-08,FERRIC SUBSULFATE PASTE,$57.00,$0.00,$57.00,$0.00,$40.68,$0.00,$0.00,$0.00,$0.00,$0.00,$57.00,$0.00,$28.50,$45.14,$45.60,$0.00,$0.00,$0.00,$0.00,$0.00
3069,ERX,HCPCS 63700001,99999-6004-65,FERROUS SULFATE 220 (44 FE) MG/5ML PO ELIX,$11.00,$0.00,$11.00,$0.00,$7.85,$0.00,$0.00,$0.00,$0.00,$0.00,$11.00,$0.00,$5.50,$8.71,$8.80,$0.00,$0.00,$0.00,$0.00,$0.00
3069,ERX,HCPCS 63700001,99999-6010-60,FERROUS SULFATE 220 (44 FE) MG/5ML PO ELIX,$11.00,$0.00,$11.00,$0.00,$7.85,$0.00,$0.00,$0.00,$0.00,$0.00,$11.00,$0.00,$5.50,$8.71,$8.80,$0.00,$0.00,$0.00,$0.00,$0.00
3069,ERX,HCPCS 63700001,50383-0778-16,FERROUS SULFATE 220 (44 FE) MG/5ML PO ELIX,$64.71,$0.00,$51.25,$0.00,$7.85,$0.00,$0.00,$0.00,$0.00,$0.00,$11.00,$0.00,$5.50,$51.25,$8.80,$0.00,$0.00,$0.00,$0.00,$0.00
3069,ERX,HCPCS 63700001,54838-0001-80,FERROUS SULFATE 220 (44 FE) MG/5ML PO ELIX,$64.71,$0.00,$51.25,$0.00,$7.85,$0.00,$0.00,$0.00,$0.00,$0.00,$11.00,$0.00,$5.50,$51.25,$8.80,$0.00,$0.00,$0.00,$0.00,$0.00
3074,ERX,HCPCS 63700001,00904-7590-60,FERROUS SULFATE 325 (65 FE) MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3074,ERX,HCPCS 63700001,00904-7591-60,FERROUS SULFATE 325 (65 FE) MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3074,ERX,HCPCS 63700001,00904-7591-61,FERROUS SULFATE 325 (65 FE) MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3128,ERX,HCPCS 25000001,00132-0202-20,FLEET PEDIATRIC 3.5-9.5 GM/66ML RECTAL ENEM,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3177,ERX,HCPCS J9200,00143-9270-01,FLOXURIDINE 0.5 G IJ SOLR,$435.54,$0.00,$435.54,$0.00,$310.84,$0.00,$0.00,$0.00,$0.00,$0.00,$435.54,$0.00,$217.77,$344.95,$348.43,$0.00,$0.00,$0.00,$0.00,$0.00
3177,ERX,HCPCS J9200,63323-0145-07,FLOXURIDINE 0.5 G IJ SOLR,$435.54,$0.00,$435.54,$0.00,$310.84,$0.00,$0.00,$0.00,$0.00,$0.00,$435.54,$0.00,$217.77,$344.95,$348.43,$0.00,$0.00,$0.00,$0.00,$0.00
3184,ERX,HCPCS 25000001,00168-0060-15,FLUOCINOLONE ACETONIDE 0.025 % EX CREA,$118.18,$0.00,$118.18,$0.00,$84.35,$0.00,$0.00,$0.00,$0.00,$0.00,$118.18,$0.00,$59.09,$93.60,$94.54,$0.00,$0.00,$0.00,$0.00,$0.00
3184,ERX,HCPCS 25000001,52565-0020-15,FLUOCINOLONE ACETONIDE 0.025 % EX CREA,$118.18,$0.00,$118.18,$0.00,$84.35,$0.00,$0.00,$0.00,$0.00,$0.00,$118.18,$0.00,$59.09,$93.60,$94.54,$0.00,$0.00,$0.00,$0.00,$0.00
3185,ERX,HCPCS 25000001,00168-0064-15,FLUOCINOLONE ACETONIDE 0.025 % EX OINT,$118.18,$0.00,$118.18,$0.00,$84.35,$0.00,$0.00,$0.00,$0.00,$0.00,$118.18,$0.00,$59.09,$93.60,$94.54,$0.00,$0.00,$0.00,$0.00,$0.00
3185,ERX,HCPCS 25000001,00713-0224-15,FLUOCINOLONE ACETONIDE 0.025 % EX OINT,$118.18,$0.00,$118.18,$0.00,$84.35,$0.00,$0.00,$0.00,$0.00,$0.00,$118.18,$0.00,$59.09,$93.60,$94.54,$0.00,$0.00,$0.00,$0.00,$0.00
3186,ERX,HCPCS 25000001,00168-0059-60,FLUOCINOLONE ACETONIDE 0.01 % EX SOLN,$549.00,$0.00,$549.00,$0.00,$391.82,$0.00,$0.00,$0.00,$0.00,$0.00,$549.00,$0.00,$274.50,$434.81,$439.20,$0.00,$0.00,$0.00,$0.00,$0.00
3186,ERX,HCPCS 25000001,51672-1365-04,FLUOCINOLONE ACETONIDE 0.01 % EX SOLN,$549.00,$0.00,$549.00,$0.00,$391.82,$0.00,$0.00,$0.00,$0.00,$0.00,$549.00,$0.00,$274.50,$434.81,$439.20,$0.00,$0.00,$0.00,$0.00,$0.00
3186,ERX,HCPCS 25000001,52565-0012-59,FLUOCINOLONE ACETONIDE 0.01 % EX SOLN,$549.00,$0.00,$549.00,$0.00,$391.82,$0.00,$0.00,$0.00,$0.00,$0.00,$549.00,$0.00,$274.50,$434.81,$439.20,$0.00,$0.00,$0.00,$0.00,$0.00
3187,ERX,HCPCS 25000001,00093-0262-15,FLUOCINONIDE 0.05 % EX CREA,$159.45,$0.00,$159.45,$0.00,$113.80,$0.00,$0.00,$0.00,$0.00,$0.00,$159.45,$0.00,$79.73,$126.28,$127.56,$0.00,$0.00,$0.00,$0.00,$0.00
3187,ERX,HCPCS 25000001,51672-1253-01,FLUOCINONIDE 0.05 % EX CREA,$159.45,$0.00,$159.45,$0.00,$113.80,$0.00,$0.00,$0.00,$0.00,$0.00,$159.45,$0.00,$79.73,$126.28,$127.56,$0.00,$0.00,$0.00,$0.00,$0.00
3187,ERX,HCPCS 25000001,51672-1386-01,FLUOCINONIDE 0.05 % EX CREA,$159.45,$0.00,$159.45,$0.00,$113.80,$0.00,$0.00,$0.00,$0.00,$0.00,$159.45,$0.00,$79.73,$126.28,$127.56,$0.00,$0.00,$0.00,$0.00,$0.00
3187,ERX,HCPCS 25000001,00093-0262-30,FLUOCINONIDE 0.05 % EX CREA,$287.00,$0.00,$227.30,$0.00,$113.80,$0.00,$0.00,$0.00,$0.00,$0.00,$159.45,$0.00,$79.73,$227.30,$127.56,$0.00,$0.00,$0.00,$0.00,$0.00
3187,ERX,HCPCS 25000001,51672-1253-02,FLUOCINONIDE 0.05 % EX CREA,$287.00,$0.00,$227.30,$0.00,$113.80,$0.00,$0.00,$0.00,$0.00,$0.00,$159.45,$0.00,$79.73,$227.30,$127.56,$0.00,$0.00,$0.00,$0.00,$0.00
3187,ERX,HCPCS 25000001,51672-1386-02,FLUOCINONIDE 0.05 % EX CREA,$287.00,$0.00,$227.30,$0.00,$113.80,$0.00,$0.00,$0.00,$0.00,$0.00,$159.45,$0.00,$79.73,$227.30,$127.56,$0.00,$0.00,$0.00,$0.00,$0.00
3188,ERX,HCPCS 25000001,51672-1279-01,FLUOCINONIDE 0.05 % EX GEL,$631.23,$0.00,$631.23,$0.00,$450.51,$0.00,$0.00,$0.00,$0.00,$0.00,$631.23,$0.00,$315.62,$499.93,$504.98,$0.00,$0.00,$0.00,$0.00,$0.00
3188,ERX,HCPCS 25000001,51672-1279-02,FLUOCINONIDE 0.05 % EX GEL,$631.23,$0.00,$631.23,$0.00,$450.51,$0.00,$0.00,$0.00,$0.00,$0.00,$631.23,$0.00,$315.62,$499.93,$504.98,$0.00,$0.00,$0.00,$0.00,$0.00
3188,ERX,HCPCS 25000001,00168-0135-60,FLUOCINONIDE 0.05 % EX GEL,$631.23,$0.00,$631.23,$0.00,$450.51,$0.00,$0.00,$0.00,$0.00,$0.00,$631.23,$0.00,$315.62,$499.93,$504.98,$0.00,$0.00,$0.00,$0.00,$0.00
3188,ERX,HCPCS 25000001,51672-1279-03,FLUOCINONIDE 0.05 % EX GEL,$631.23,$0.00,$631.23,$0.00,$450.51,$0.00,$0.00,$0.00,$0.00,$0.00,$631.23,$0.00,$315.62,$499.93,$504.98,$0.00,$0.00,$0.00,$0.00,$0.00
3189,ERX,HCPCS 25000001,00093-0264-15,FLUOCINONIDE 0.05 % EX OINT,$222.88,$0.00,$222.88,$0.00,$159.07,$0.00,$0.00,$0.00,$0.00,$0.00,$222.88,$0.00,$111.44,$176.52,$178.30,$0.00,$0.00,$0.00,$0.00,$0.00
3189,ERX,HCPCS 25000001,16714-0502-01,FLUOCINONIDE 0.05 % EX OINT,$222.88,$0.00,$222.88,$0.00,$159.07,$0.00,$0.00,$0.00,$0.00,$0.00,$222.88,$0.00,$111.44,$176.52,$178.30,$0.00,$0.00,$0.00,$0.00,$0.00
3189,ERX,HCPCS 25000001,51672-1264-01,FLUOCINONIDE 0.05 % EX OINT,$222.88,$0.00,$222.88,$0.00,$159.07,$0.00,$0.00,$0.00,$0.00,$0.00,$222.88,$0.00,$111.44,$176.52,$178.30,$0.00,$0.00,$0.00,$0.00,$0.00
3190,ERX,HCPCS 25000001,00168-0134-60,FLUOCINONIDE 0.05 % EX SOLN,$306.18,$0.00,$306.18,$0.00,$218.52,$0.00,$0.00,$0.00,$0.00,$0.00,$306.18,$0.00,$153.09,$242.49,$244.94,$0.00,$0.00,$0.00,$0.00,$0.00
3215,ERX,HCPCS J2680,00143-9529-01,FLUPHENAZINE DECANOATE 25 MG/ML IJ SOLN,$70.67,$0.00,$70.67,$31.80,$50.44,$0.00,$4.27,$0.00,$0.00,$11.73,$70.67,$0.00,$35.34,$55.97,$56.54,$0.00,$11.73,$0.00,$11.17,$0.00
3215,ERX,HCPCS J2680,42023-0129-01,FLUPHENAZINE DECANOATE 25 MG/ML IJ SOLN,$70.67,$0.00,$70.67,$31.80,$50.44,$0.00,$4.27,$0.00,$0.00,$11.73,$70.67,$0.00,$35.34,$55.97,$56.54,$0.00,$11.73,$0.00,$11.17,$0.00
3215,ERX,HCPCS J2680,55150-0267-05,FLUPHENAZINE DECANOATE 25 MG/ML IJ SOLN,$70.67,$0.00,$70.67,$31.80,$50.44,$0.00,$4.27,$0.00,$0.00,$11.73,$70.67,$0.00,$35.34,$55.97,$56.54,$0.00,$11.73,$0.00,$11.17,$0.00
3215,ERX,HCPCS J2680,63323-0272-05,FLUPHENAZINE DECANOATE 25 MG/ML IJ SOLN,$70.67,$0.00,$70.67,$31.80,$50.44,$0.00,$4.27,$0.00,$0.00,$11.73,$70.67,$0.00,$35.34,$55.97,$56.54,$0.00,$11.73,$0.00,$11.17,$0.00
3216,ERX,HCPCS 25000001,63323-0281-10,FLUPHENAZINE HCL 2.5 MG/ML IJ SOLN,$581.68,$0.00,$581.68,$0.00,$415.15,$0.00,$0.00,$0.00,$0.00,$0.00,$581.68,$0.00,$290.84,$460.69,$465.34,$0.00,$0.00,$0.00,$0.00,$0.00
3218,ERX,HCPCS 63700001,00527-1788-01,FLUPHENAZINE HCL 1 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3219,ERX,HCPCS 63700001,00527-1791-01,FLUPHENAZINE HCL 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3220,ERX,HCPCS 63700001,00527-1789-01,FLUPHENAZINE HCL 2.5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3221,ERX,HCPCS 63700001,00527-1790-01,FLUPHENAZINE HCL 5 MG PO TABS,$34.96,$0.00,$34.96,$0.00,$24.95,$0.00,$0.00,$0.00,$0.00,$0.00,$34.96,$0.00,$17.48,$27.69,$27.97,$0.00,$0.00,$0.00,$0.00,$0.00
3232,ERX,HCPCS 25000001,63323-0184-10,FOLIC ACID 5 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
3232,ERX,HCPCS 25000001,99999-6005-63,FOLIC ACID 5 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
3233,ERX,HCPCS 63700001,62584-0897-01,FOLIC ACID 1 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3233,ERX,HCPCS 63700001,62584-0897-11,FOLIC ACID 1 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3233,ERX,HCPCS 63700001,63739-0537-10,FOLIC ACID 1 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3233,ERX,HCPCS 63700001,65162-0361-10,FOLIC ACID 1 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3233,ERX,HCPCS 63700001,65162-0361-11,FOLIC ACID 1 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3264,ERX,HCPCS 25000001,00264-9341-55,FREAMINE III 10 % IV SOLN,$148.75,$0.00,$148.75,$0.00,$106.16,$0.00,$0.00,$0.00,$0.00,$0.00,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$0.00,$0.00,$0.00,$0.00
3291,ERX,HCPCS J1940,00409-6102-02,FUROSEMIDE 10 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.25,$0.00,$0.00,$0.69,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.69,$0.00,$0.66,$0.00
3291,ERX,HCPCS J1940,00409-6102-04,FUROSEMIDE 10 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.25,$0.00,$0.00,$0.69,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.69,$0.00,$0.66,$0.00
3291,ERX,HCPCS J1940,00409-6102-10,FUROSEMIDE 10 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.25,$0.00,$0.00,$0.69,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.69,$0.00,$0.66,$0.00
3291,ERX,HCPCS J1940,00409-6102-18,FUROSEMIDE 10 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.25,$0.00,$0.00,$0.69,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.69,$0.00,$0.66,$0.00
3291,ERX,HCPCS J1940,00409-6102-25,FUROSEMIDE 10 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.25,$0.00,$0.00,$0.69,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.69,$0.00,$0.66,$0.00
3291,ERX,HCPCS J1940,00409-6102-26,FUROSEMIDE 10 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.25,$0.00,$0.00,$0.69,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.69,$0.00,$0.66,$0.00
3291,ERX,HCPCS J1940,00409-6102-27,FUROSEMIDE 10 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.25,$0.00,$0.00,$0.69,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.69,$0.00,$0.66,$0.00
3291,ERX,HCPCS J1940,00409-6102-35,FUROSEMIDE 10 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.25,$0.00,$0.00,$0.69,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.69,$0.00,$0.66,$0.00
3291,ERX,HCPCS J1940,00409-6102-36,FUROSEMIDE 10 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.25,$0.00,$0.00,$0.69,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.69,$0.00,$0.66,$0.00
3291,ERX,HCPCS J1940,00409-6102-37,FUROSEMIDE 10 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.25,$0.00,$0.00,$0.69,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.69,$0.00,$0.66,$0.00
3291,ERX,HCPCS J1940,23155-0473-32,FUROSEMIDE 10 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.25,$0.00,$0.00,$0.69,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.69,$0.00,$0.66,$0.00
3291,ERX,HCPCS J1940,23155-0473-42,FUROSEMIDE 10 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.25,$0.00,$0.00,$0.69,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.69,$0.00,$0.66,$0.00
3291,ERX,HCPCS J1940,23155-0473-44,FUROSEMIDE 10 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.25,$0.00,$0.00,$0.69,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.69,$0.00,$0.66,$0.00
3291,ERX,HCPCS J1940,36000-0282-25,FUROSEMIDE 10 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.25,$0.00,$0.00,$0.69,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.69,$0.00,$0.66,$0.00
3291,ERX,HCPCS J1940,36000-0283-25,FUROSEMIDE 10 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.25,$0.00,$0.00,$0.69,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.69,$0.00,$0.66,$0.00
3291,ERX,HCPCS J1940,36000-0284-25,FUROSEMIDE 10 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.25,$0.00,$0.00,$0.69,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.69,$0.00,$0.66,$0.00
3291,ERX,HCPCS J1940,63323-0280-01,FUROSEMIDE 10 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.25,$0.00,$0.00,$0.69,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.69,$0.00,$0.66,$0.00
3291,ERX,HCPCS J1940,63323-0280-02,FUROSEMIDE 10 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.25,$0.00,$0.00,$0.69,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.69,$0.00,$0.66,$0.00
3291,ERX,HCPCS J1940,63323-0280-03,FUROSEMIDE 10 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.25,$0.00,$0.00,$0.69,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.69,$0.00,$0.66,$0.00
3291,ERX,HCPCS J1940,63323-0280-04,FUROSEMIDE 10 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.25,$0.00,$0.00,$0.69,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.69,$0.00,$0.66,$0.00
3291,ERX,HCPCS J1940,63323-0280-10,FUROSEMIDE 10 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.25,$0.00,$0.00,$0.69,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.69,$0.00,$0.66,$0.00
3292,ERX,HCPCS 25000001,00054-3294-46,FUROSEMIDE 10 MG/ML PO SOLN,$39.45,$0.00,$70.56,$0.00,$50.36,$0.00,$0.00,$0.00,$0.00,$0.00,$70.56,$0.00,$35.28,$31.24,$56.45,$0.00,$0.00,$0.00,$0.00,$0.00
3292,ERX,HCPCS 25000001,60432-0613-60,FUROSEMIDE 10 MG/ML PO SOLN,$39.45,$0.00,$70.56,$0.00,$50.36,$0.00,$0.00,$0.00,$0.00,$0.00,$70.56,$0.00,$35.28,$31.24,$56.45,$0.00,$0.00,$0.00,$0.00,$0.00
3292,ERX,HCPCS 25000001,99999-6004-66,FUROSEMIDE 10 MG/ML PO SOLN,$39.45,$0.00,$70.56,$0.00,$50.36,$0.00,$0.00,$0.00,$0.00,$0.00,$70.56,$0.00,$35.28,$31.24,$56.45,$0.00,$0.00,$0.00,$0.00,$0.00
3292,ERX,HCPCS 25000001,00054-3294-50,FUROSEMIDE 10 MG/ML PO SOLN,$70.56,$0.00,$70.56,$0.00,$50.36,$0.00,$0.00,$0.00,$0.00,$0.00,$70.56,$0.00,$35.28,$55.88,$56.45,$0.00,$0.00,$0.00,$0.00,$0.00
3294,ERX,HCPCS 63700001,00054-8297-25,FUROSEMIDE 20 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3294,ERX,HCPCS 63700001,00378-0208-01,FUROSEMIDE 20 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3294,ERX,HCPCS 63700001,51079-0072-20,FUROSEMIDE 20 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3295,ERX,HCPCS 63700001,00054-8299-25,FUROSEMIDE 40 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3295,ERX,HCPCS 63700001,00378-0216-01,FUROSEMIDE 40 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3295,ERX,HCPCS 63700001,00781-1966-10,FUROSEMIDE 40 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3295,ERX,HCPCS 63700001,51079-0073-01,FUROSEMIDE 40 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3295,ERX,HCPCS 63700001,51079-0073-20,FUROSEMIDE 40 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3296,ERX,HCPCS 63700001,00054-4301-25,FUROSEMIDE 80 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3296,ERX,HCPCS 63700001,00054-8301-25,FUROSEMIDE 80 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3296,ERX,HCPCS 63700001,51079-0527-01,FUROSEMIDE 80 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3296,ERX,HCPCS 63700001,51079-0527-20,FUROSEMIDE 80 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3378,ERX,HCPCS 63700001,16714-0101-05,GEMFIBROZIL 600 MG PO TABS,$9.24,$0.00,$9.24,$0.00,$6.59,$0.00,$0.00,$0.00,$0.00,$0.00,$9.24,$0.00,$4.62,$7.32,$7.39,$0.00,$0.00,$0.00,$0.00,$0.00
3378,ERX,HCPCS 63700001,60687-0224-01,GEMFIBROZIL 600 MG PO TABS,$9.24,$0.00,$9.24,$0.00,$6.59,$0.00,$0.00,$0.00,$0.00,$0.00,$9.24,$0.00,$4.62,$7.32,$7.39,$0.00,$0.00,$0.00,$0.00,$0.00
3423,ERX,HCPCS 25000001,45802-0056-35,GENTAMICIN SULFATE 0.1 % EX CREA,$311.10,$0.00,$311.10,$0.00,$222.03,$0.00,$0.00,$0.00,$0.00,$0.00,$311.10,$0.00,$155.55,$246.39,$248.88,$0.00,$0.00,$0.00,$0.00,$0.00
3423,ERX,HCPCS 25000001,45802-0056-11,GENTAMICIN SULFATE 0.1 % EX CREA,$311.10,$0.00,$311.10,$0.00,$222.03,$0.00,$0.00,$0.00,$0.00,$0.00,$311.10,$0.00,$155.55,$246.39,$248.88,$0.00,$0.00,$0.00,$0.00,$0.00
3424,ERX,HCPCS 25000001,45802-0046-35,GENTAMICIN SULFATE 0.1 % EX OINT,$311.10,$0.00,$311.10,$0.00,$222.03,$0.00,$0.00,$0.00,$0.00,$0.00,$311.10,$0.00,$155.55,$246.39,$248.88,$0.00,$0.00,$0.00,$0.00,$0.00
3424,ERX,HCPCS 25000001,45802-0046-11,GENTAMICIN SULFATE 0.1 % EX OINT,$311.10,$0.00,$311.10,$0.00,$222.03,$0.00,$0.00,$0.00,$0.00,$0.00,$311.10,$0.00,$155.55,$246.39,$248.88,$0.00,$0.00,$0.00,$0.00,$0.00
3424,ERX,HCPCS 25000001,52565-0090-30,GENTAMICIN SULFATE 0.1 % EX OINT,$311.10,$0.00,$311.10,$0.00,$222.03,$0.00,$0.00,$0.00,$0.00,$0.00,$311.10,$0.00,$155.55,$246.39,$248.88,$0.00,$0.00,$0.00,$0.00,$0.00
3425,ERX,HCPCS J1580,63323-0173-02,GENTAMICIN SULFATE 10 MG/ML (NICU) IM INJ,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.02,$0.00,$0.00,$2.31,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$2.31,$0.00,$2.20,$0.00
3426,ERX,HCPCS J1580,00409-1207-03,GENTAMICIN SULFATE 40 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.02,$0.00,$0.00,$2.31,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$2.31,$0.00,$2.20,$0.00
3426,ERX,HCPCS J1580,00409-1207-25,GENTAMICIN SULFATE 40 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.02,$0.00,$0.00,$2.31,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$2.31,$0.00,$2.20,$0.00
3426,ERX,HCPCS J1580,63323-0010-02,GENTAMICIN SULFATE 40 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.02,$0.00,$0.00,$2.31,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$2.31,$0.00,$2.20,$0.00
3426,ERX,HCPCS J1580,63323-0010-20,GENTAMICIN SULFATE 40 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.02,$0.00,$0.00,$2.31,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$2.31,$0.00,$2.20,$0.00
3427,ERX,HCPCS 63700001,17478-0284-35,GENTAMICIN SULFATE 0.3 % OP OINT,$124.05,$0.00,$124.05,$0.00,$88.53,$0.00,$0.00,$0.00,$0.00,$0.00,$124.05,$0.00,$62.03,$98.25,$99.24,$0.00,$0.00,$0.00,$0.00,$0.00
3428,ERX,HCPCS 25000001,17478-0283-10,GENTAMICIN SULFATE 0.3 % OP SOLN,$75.95,$0.00,$75.95,$0.00,$54.21,$0.00,$0.00,$0.00,$0.00,$0.00,$75.95,$0.00,$37.98,$60.15,$60.76,$0.00,$0.00,$0.00,$0.00,$0.00
3428,ERX,HCPCS 25000001,24208-0580-60,GENTAMICIN SULFATE 0.3 % OP SOLN,$75.95,$0.00,$75.95,$0.00,$54.21,$0.00,$0.00,$0.00,$0.00,$0.00,$75.95,$0.00,$37.98,$60.15,$60.76,$0.00,$0.00,$0.00,$0.00,$0.00
3428,ERX,HCPCS 25000001,60758-0188-05,GENTAMICIN SULFATE 0.3 % OP SOLN,$75.95,$0.00,$75.95,$0.00,$54.21,$0.00,$0.00,$0.00,$0.00,$0.00,$75.95,$0.00,$37.98,$60.15,$60.76,$0.00,$0.00,$0.00,$0.00,$0.00
3428,ERX,HCPCS 25000001,61314-0633-05,GENTAMICIN SULFATE 0.3 % OP SOLN,$75.95,$0.00,$75.95,$0.00,$54.21,$0.00,$0.00,$0.00,$0.00,$0.00,$75.95,$0.00,$37.98,$60.15,$60.76,$0.00,$0.00,$0.00,$0.00,$0.00
3430,ERX,HCPCS 25000001,00395-1003-92,GENTIAN VIOLET 1 % EX SOLN,$30.50,$0.00,$30.50,$0.00,$21.77,$0.00,$0.00,$0.00,$0.00,$0.00,$30.50,$0.00,$15.25,$24.16,$24.40,$0.00,$0.00,$0.00,$0.00,$0.00
3489,ERX,HCPCS 63700001,00093-8344-01,GLYBURIDE 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3489,ERX,HCPCS 63700001,63739-0119-10,GLYBURIDE 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3497,ERX,HCPCS 25000001,00143-9587-25,GLYCOPYRROLATE 0.2 MG/ML IJ SOLN,$32.14,$0.00,$32.14,$0.00,$22.94,$0.00,$0.00,$0.00,$0.00,$0.00,$32.14,$0.00,$16.07,$25.45,$25.71,$0.00,$0.00,$0.00,$0.00,$0.00
3497,ERX,HCPCS 25000001,00143-9682-01,GLYCOPYRROLATE 0.2 MG/ML IJ SOLN,$32.14,$0.00,$32.14,$0.00,$22.94,$0.00,$0.00,$0.00,$0.00,$0.00,$32.14,$0.00,$16.07,$25.45,$25.71,$0.00,$0.00,$0.00,$0.00,$0.00
3497,ERX,HCPCS 25000001,00143-9682-25,GLYCOPYRROLATE 0.2 MG/ML IJ SOLN,$32.14,$0.00,$32.14,$0.00,$22.94,$0.00,$0.00,$0.00,$0.00,$0.00,$32.14,$0.00,$16.07,$25.45,$25.71,$0.00,$0.00,$0.00,$0.00,$0.00
3497,ERX,HCPCS 25000001,00517-4601-25,GLYCOPYRROLATE 0.2 MG/ML IJ SOLN,$32.14,$0.00,$32.14,$0.00,$22.94,$0.00,$0.00,$0.00,$0.00,$0.00,$32.14,$0.00,$16.07,$25.45,$25.71,$0.00,$0.00,$0.00,$0.00,$0.00
3497,ERX,HCPCS 25000001,00781-3825-71,GLYCOPYRROLATE 0.2 MG/ML IJ SOLN,$32.14,$0.00,$32.14,$0.00,$22.94,$0.00,$0.00,$0.00,$0.00,$0.00,$32.14,$0.00,$16.07,$25.45,$25.71,$0.00,$0.00,$0.00,$0.00,$0.00
3497,ERX,HCPCS 25000001,00781-3825-96,GLYCOPYRROLATE 0.2 MG/ML IJ SOLN,$32.14,$0.00,$32.14,$0.00,$22.94,$0.00,$0.00,$0.00,$0.00,$0.00,$32.14,$0.00,$16.07,$25.45,$25.71,$0.00,$0.00,$0.00,$0.00,$0.00
3497,ERX,HCPCS 25000001,66794-0202-42,GLYCOPYRROLATE 0.2 MG/ML IJ SOLN,$32.14,$0.00,$32.14,$0.00,$22.94,$0.00,$0.00,$0.00,$0.00,$0.00,$32.14,$0.00,$16.07,$25.45,$25.71,$0.00,$0.00,$0.00,$0.00,$0.00
3497,ERX,HCPCS 25000001,70069-0011-25,GLYCOPYRROLATE 0.2 MG/ML IJ SOLN,$32.14,$0.00,$32.14,$0.00,$22.94,$0.00,$0.00,$0.00,$0.00,$0.00,$32.14,$0.00,$16.07,$25.45,$25.71,$0.00,$0.00,$0.00,$0.00,$0.00
3497,ERX,HCPCS 25000001,70121-1394-05,GLYCOPYRROLATE 0.2 MG/ML IJ SOLN,$32.14,$0.00,$32.14,$0.00,$22.94,$0.00,$0.00,$0.00,$0.00,$0.00,$32.14,$0.00,$16.07,$25.45,$25.71,$0.00,$0.00,$0.00,$0.00,$0.00
3578,ERX,HCPCS 25000001,00378-0351-01,HALOPERIDOL 0.5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3578,ERX,HCPCS 25000001,00781-1391-01,HALOPERIDOL 0.5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3578,ERX,HCPCS 25000001,51079-0733-01,HALOPERIDOL 0.5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3578,ERX,HCPCS 25000001,51079-0733-20,HALOPERIDOL 0.5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3579,ERX,HCPCS 25000001,51079-0734-20,HALOPERIDOL 1 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3580,ERX,HCPCS 63700001,51079-0431-20,HALOPERIDOL 10 MG PO TABS,$6.82,$0.00,$6.82,$0.00,$4.87,$0.00,$0.00,$0.00,$0.00,$0.00,$6.82,$0.00,$3.41,$5.40,$5.46,$0.00,$0.00,$0.00,$0.00,$0.00
3580,ERX,HCPCS 63700001,68382-0080-01,HALOPERIDOL 10 MG PO TABS,$6.82,$0.00,$6.82,$0.00,$4.87,$0.00,$0.00,$0.00,$0.00,$0.00,$6.82,$0.00,$3.41,$5.40,$5.46,$0.00,$0.00,$0.00,$0.00,$0.00
3581,ERX,HCPCS 63700001,00378-0214-01,HALOPERIDOL 2 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3582,ERX,HCPCS 63700001,00378-0335-01,HALOPERIDOL 20 MG PO TABS,$13.76,$0.00,$13.76,$0.00,$9.82,$0.00,$0.00,$0.00,$0.00,$0.00,$13.76,$0.00,$6.88,$10.90,$11.01,$0.00,$0.00,$0.00,$0.00,$0.00
3582,ERX,HCPCS 63700001,00781-1398-01,HALOPERIDOL 20 MG PO TABS,$13.76,$0.00,$13.76,$0.00,$9.82,$0.00,$0.00,$0.00,$0.00,$0.00,$13.76,$0.00,$6.88,$10.90,$11.01,$0.00,$0.00,$0.00,$0.00,$0.00
3582,ERX,HCPCS 63700001,68382-0081-01,HALOPERIDOL 20 MG PO TABS,$13.76,$0.00,$13.76,$0.00,$9.82,$0.00,$0.00,$0.00,$0.00,$0.00,$13.76,$0.00,$6.88,$10.90,$11.01,$0.00,$0.00,$0.00,$0.00,$0.00
3583,ERX,HCPCS 63700001,00378-0327-01,HALOPERIDOL 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3583,ERX,HCPCS 63700001,00781-1396-01,HALOPERIDOL 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3583,ERX,HCPCS 63700001,51079-0736-20,HALOPERIDOL 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3583,ERX,HCPCS 63700001,68382-0079-01,HALOPERIDOL 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3584,ERX,HCPCS J1630,00143-9501-25,HALOPERIDOL LACTATE 5 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.80,$0.00,$0.00,$1.42,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.42,$0.00,$1.35,$0.00
3584,ERX,HCPCS J1630,25021-0806-01,HALOPERIDOL LACTATE 5 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.80,$0.00,$0.00,$1.42,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.42,$0.00,$1.35,$0.00
3584,ERX,HCPCS J1630,63323-0474-00,HALOPERIDOL LACTATE 5 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.80,$0.00,$0.00,$1.42,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.42,$0.00,$1.35,$0.00
3584,ERX,HCPCS J1630,63323-0474-01,HALOPERIDOL LACTATE 5 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.80,$0.00,$0.00,$1.42,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.42,$0.00,$1.35,$0.00
3584,ERX,HCPCS J1630,67457-0426-00,HALOPERIDOL LACTATE 5 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.80,$0.00,$0.00,$1.42,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.42,$0.00,$1.35,$0.00
3584,ERX,HCPCS J1630,67457-0426-12,HALOPERIDOL LACTATE 5 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.80,$0.00,$0.00,$1.42,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.42,$0.00,$1.35,$0.00
3585,ERX,HCPCS 25000001,00121-0581-04,HALOPERIDOL LACTATE 2 MG/ML PO CONC,$8.61,$0.00,$8.61,$0.00,$6.14,$0.00,$0.00,$0.00,$0.00,$0.00,$8.61,$0.00,$4.31,$6.82,$6.89,$0.00,$0.00,$0.00,$0.00,$0.00
3585,ERX,HCPCS 25000001,00121-0581-05,HALOPERIDOL LACTATE 2 MG/ML PO CONC,$8.61,$0.00,$8.61,$0.00,$6.14,$0.00,$0.00,$0.00,$0.00,$0.00,$8.61,$0.00,$4.31,$6.82,$6.89,$0.00,$0.00,$0.00,$0.00,$0.00
3585,ERX,HCPCS 25000001,99999-6007-06,HALOPERIDOL LACTATE 2 MG/ML PO CONC,$8.61,$0.00,$8.61,$0.00,$6.14,$0.00,$0.00,$0.00,$0.00,$0.00,$8.61,$0.00,$4.31,$6.82,$6.89,$0.00,$0.00,$0.00,$0.00,$0.00
3697,ERX,HCPCS J0360,63323-0614-00,HYDRALAZINE HCL 20 MG/ML IJ SOLN,$59.65,$0.00,$59.65,$26.84,$42.57,$0.00,$5.77,$0.00,$0.00,$4.41,$59.65,$0.00,$29.83,$47.24,$47.72,$0.00,$4.41,$0.00,$4.20,$0.00
3697,ERX,HCPCS J0360,63323-0614-01,HYDRALAZINE HCL 20 MG/ML IJ SOLN,$59.65,$0.00,$59.65,$26.84,$42.57,$0.00,$5.77,$0.00,$0.00,$4.41,$59.65,$0.00,$29.83,$47.24,$47.72,$0.00,$4.41,$0.00,$4.20,$0.00
3697,ERX,HCPCS J0360,63323-0614-55,HYDRALAZINE HCL 20 MG/ML IJ SOLN,$59.65,$0.00,$59.65,$26.84,$42.57,$0.00,$5.77,$0.00,$0.00,$4.41,$59.65,$0.00,$29.83,$47.24,$47.72,$0.00,$4.41,$0.00,$4.20,$0.00
3697,ERX,HCPCS J0360,67457-0291-01,HYDRALAZINE HCL 20 MG/ML IJ SOLN,$59.65,$0.00,$59.65,$26.84,$42.57,$0.00,$5.77,$0.00,$0.00,$4.41,$59.65,$0.00,$29.83,$47.24,$47.72,$0.00,$4.41,$0.00,$4.20,$0.00
3698,ERX,HCPCS 63700001,00904-6440-61,HYDRALAZINE HCL 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3698,ERX,HCPCS 63700001,50111-0398-01,HYDRALAZINE HCL 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3698,ERX,HCPCS 63700001,51079-0074-01,HYDRALAZINE HCL 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3698,ERX,HCPCS 63700001,51079-0074-20,HYDRALAZINE HCL 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3698,ERX,HCPCS 63700001,68084-0447-01,HYDRALAZINE HCL 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3699,ERX,HCPCS 63700001,00904-6443-61,HYDRALAZINE HCL 100 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3699,ERX,HCPCS 63700001,31722-0522-01,HYDRALAZINE HCL 100 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3699,ERX,HCPCS 63700001,50111-0397-01,HYDRALAZINE HCL 100 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3700,ERX,HCPCS 63700001,00904-6441-61,HYDRALAZINE HCL 25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3700,ERX,HCPCS 63700001,50111-0327-01,HYDRALAZINE HCL 25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3700,ERX,HCPCS 63700001,51079-0075-01,HYDRALAZINE HCL 25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3700,ERX,HCPCS 63700001,51079-0075-20,HYDRALAZINE HCL 25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3700,ERX,HCPCS 63700001,62584-0733-01,HYDRALAZINE HCL 25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3700,ERX,HCPCS 63700001,62584-0733-11,HYDRALAZINE HCL 25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3700,ERX,HCPCS 63700001,63739-0126-10,HYDRALAZINE HCL 25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3700,ERX,HCPCS 63700001,63739-0327-10,HYDRALAZINE HCL 25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3701,ERX,HCPCS 63700001,00904-6442-61,HYDRALAZINE HCL 50 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3701,ERX,HCPCS 63700001,50111-0328-01,HYDRALAZINE HCL 50 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3701,ERX,HCPCS 63700001,51079-0076-01,HYDRALAZINE HCL 50 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3701,ERX,HCPCS 63700001,62584-0734-01,HYDRALAZINE HCL 50 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3701,ERX,HCPCS 63700001,62584-0734-11,HYDRALAZINE HCL 50 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3701,ERX,HCPCS 63700001,63739-0328-10,HYDRALAZINE HCL 50 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3701,ERX,HCPCS 63700001,76282-0311-01,HYDRALAZINE HCL 50 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3720,ERX,HCPCS 63700001,16729-0183-01,HYDROCHLOROTHIAZIDE 25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3720,ERX,HCPCS 63700001,16729-0183-17,HYDROCHLOROTHIAZIDE 25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3720,ERX,HCPCS 63700001,29300-0128-10,HYDROCHLOROTHIAZIDE 25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3720,ERX,HCPCS 63700001,63739-0128-10,HYDROCHLOROTHIAZIDE 25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3721,ERX,HCPCS 63700001,16729-0184-01,HYDROCHLOROTHIAZIDE 50 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3721,ERX,HCPCS 63700001,43547-0398-10,HYDROCHLOROTHIAZIDE 50 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3726,ERX,HCPCS 63700001,45802-0438-03,HYDROCORTISONE 1 % EX CREA,$11.00,$0.00,$11.00,$0.00,$7.85,$0.00,$0.00,$0.00,$0.00,$0.00,$11.00,$0.00,$5.50,$8.71,$8.80,$0.00,$0.00,$0.00,$0.00,$0.00
3726,ERX,HCPCS 63700001,00168-0015-31,HYDROCORTISONE 1 % EX CREA,$11.00,$0.00,$11.00,$0.00,$7.85,$0.00,$0.00,$0.00,$0.00,$0.00,$11.00,$0.00,$5.50,$8.71,$8.80,$0.00,$0.00,$0.00,$0.00,$0.00
3726,ERX,HCPCS 63700001,00168-0154-31,HYDROCORTISONE 1 % EX CREA,$11.00,$0.00,$11.00,$0.00,$7.85,$0.00,$0.00,$0.00,$0.00,$0.00,$11.00,$0.00,$5.50,$8.71,$8.80,$0.00,$0.00,$0.00,$0.00,$0.00
3726,ERX,HCPCS 63700001,51672-2069-02,HYDROCORTISONE 1 % EX CREA,$11.00,$0.00,$11.00,$0.00,$7.85,$0.00,$0.00,$0.00,$0.00,$0.00,$11.00,$0.00,$5.50,$8.71,$8.80,$0.00,$0.00,$0.00,$0.00,$0.00
3727,ERX,HCPCS 63700001,45802-0004-03,HYDROCORTISONE 2.5 % EX CREA,$41.84,$0.00,$41.84,$0.00,$29.86,$0.00,$0.00,$0.00,$0.00,$0.00,$41.84,$0.00,$20.92,$33.14,$33.47,$0.00,$0.00,$0.00,$0.00,$0.00
3727,ERX,HCPCS 63700001,00168-0080-31,HYDROCORTISONE 2.5 % EX CREA,$41.84,$0.00,$41.84,$0.00,$29.86,$0.00,$0.00,$0.00,$0.00,$0.00,$41.84,$0.00,$20.92,$33.14,$33.47,$0.00,$0.00,$0.00,$0.00,$0.00
3727,ERX,HCPCS 63700001,00472-0337-30,HYDROCORTISONE 2.5 % EX CREA,$41.84,$0.00,$41.84,$0.00,$29.86,$0.00,$0.00,$0.00,$0.00,$0.00,$41.84,$0.00,$20.92,$33.14,$33.47,$0.00,$0.00,$0.00,$0.00,$0.00
3728,ERX,HCPCS 63700001,00394-0859-32,HYDROCORTISONE 1 % EX LOTN,$25.13,$0.00,$25.13,$0.00,$17.94,$0.00,$0.00,$0.00,$0.00,$0.00,$25.13,$0.00,$12.57,$19.90,$20.10,$0.00,$0.00,$0.00,$0.00,$0.00
3731,ERX,HCPCS 63700001,00472-0345-56,HYDROCORTISONE 1 % EX OINT,$13.20,$0.00,$13.20,$0.00,$9.42,$0.00,$0.00,$0.00,$0.00,$0.00,$13.20,$0.00,$6.60,$10.45,$10.56,$0.00,$0.00,$0.00,$0.00,$0.00
3731,ERX,HCPCS 63700001,45802-0276-03,HYDROCORTISONE 1 % EX OINT,$13.20,$0.00,$13.20,$0.00,$9.42,$0.00,$0.00,$0.00,$0.00,$0.00,$13.20,$0.00,$6.60,$10.45,$10.56,$0.00,$0.00,$0.00,$0.00,$0.00
3731,ERX,HCPCS 63700001,00168-0020-16,HYDROCORTISONE 1 % EX OINT,$185.93,$0.00,$147.26,$0.00,$9.42,$0.00,$0.00,$0.00,$0.00,$0.00,$13.20,$0.00,$6.60,$147.26,$10.56,$0.00,$0.00,$0.00,$0.00,$0.00
3732,ERX,HCPCS 63700001,45802-0014-02,HYDROCORTISONE 2.5 % EX OINT,$41.80,$0.00,$41.80,$0.00,$29.83,$0.00,$0.00,$0.00,$0.00,$0.00,$41.80,$0.00,$20.90,$33.11,$33.44,$0.00,$0.00,$0.00,$0.00,$0.00
3732,ERX,HCPCS 63700001,00168-0146-30,HYDROCORTISONE 2.5 % EX OINT,$41.80,$0.00,$41.80,$0.00,$29.83,$0.00,$0.00,$0.00,$0.00,$0.00,$41.80,$0.00,$20.90,$33.11,$33.44,$0.00,$0.00,$0.00,$0.00,$0.00
3733,ERX,HCPCS 63700001,59762-0074-01,HYDROCORTISONE 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3734,ERX,HCPCS 63700001,00009-0044-01,HYDROCORTISONE 20 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3734,ERX,HCPCS 63700001,42543-0142-01,HYDROCORTISONE 20 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3734,ERX,HCPCS 63700001,59762-0075-01,HYDROCORTISONE 20 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3734,ERX,HCPCS 63700001,72789-0062-01,HYDROCORTISONE 20 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3738,ERX,HCPCS 25000001,00574-7090-12,HYDROCORTISONE ACETATE 25 MG RECTAL SUPP,$198.20,$0.00,$198.20,$0.00,$141.46,$0.00,$0.00,$0.00,$0.00,$0.00,$198.20,$0.00,$99.10,$156.97,$158.56,$0.00,$0.00,$0.00,$0.00,$0.00
3738,ERX,HCPCS 25000001,00713-0503-12,HYDROCORTISONE ACETATE 25 MG RECTAL SUPP,$198.20,$0.00,$198.20,$0.00,$141.46,$0.00,$0.00,$0.00,$0.00,$0.00,$198.20,$0.00,$99.10,$156.97,$158.56,$0.00,$0.00,$0.00,$0.00,$0.00
3738,ERX,HCPCS 25000001,00713-0503-24,HYDROCORTISONE ACETATE 25 MG RECTAL SUPP,$198.20,$0.00,$198.20,$0.00,$141.46,$0.00,$0.00,$0.00,$0.00,$0.00,$198.20,$0.00,$99.10,$156.97,$158.56,$0.00,$0.00,$0.00,$0.00,$0.00
3738,ERX,HCPCS 25000001,16477-0201-24,HYDROCORTISONE ACETATE 25 MG RECTAL SUPP,$198.20,$0.00,$198.20,$0.00,$141.46,$0.00,$0.00,$0.00,$0.00,$0.00,$198.20,$0.00,$99.10,$156.97,$158.56,$0.00,$0.00,$0.00,$0.00,$0.00
3738,ERX,HCPCS 25000001,65649-0411-12,HYDROCORTISONE ACETATE 25 MG RECTAL SUPP,$198.20,$0.00,$198.20,$0.00,$141.46,$0.00,$0.00,$0.00,$0.00,$0.00,$198.20,$0.00,$99.10,$156.97,$158.56,$0.00,$0.00,$0.00,$0.00,$0.00
3738,ERX,HCPCS 25000001,65649-0411-24,HYDROCORTISONE ACETATE 25 MG RECTAL SUPP,$198.20,$0.00,$198.20,$0.00,$141.46,$0.00,$0.00,$0.00,$0.00,$0.00,$198.20,$0.00,$99.10,$156.97,$158.56,$0.00,$0.00,$0.00,$0.00,$0.00
3747,ERX,HCPCS 25000001,51672-2010-02,HYDROCORTISONE-ALOE 0.5 % EX CREA,$20.94,$0.00,$20.94,$0.00,$14.94,$0.00,$0.00,$0.00,$0.00,$0.00,$20.94,$0.00,$10.47,$16.58,$16.75,$0.00,$0.00,$0.00,$0.00,$0.00
3757,ERX,HCPCS J1170,00409-1283-03,HYDROMORPHONE HCL 1 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.56,$0.00,$0.00,$3.64,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.64,$0.00,$3.47,$0.00
3757,ERX,HCPCS J1170,00409-1283-31,HYDROMORPHONE HCL 1 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.56,$0.00,$0.00,$3.64,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.64,$0.00,$3.47,$0.00
3757,ERX,HCPCS J1170,00409-2552-01,HYDROMORPHONE HCL 1 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.56,$0.00,$0.00,$3.64,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.64,$0.00,$3.47,$0.00
3757,ERX,HCPCS J1170,76045-0009-01,HYDROMORPHONE HCL 1 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.56,$0.00,$0.00,$3.64,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.64,$0.00,$3.47,$0.00
3757,ERX,HCPCS J1170,76045-0009-10,HYDROMORPHONE HCL 1 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.56,$0.00,$0.00,$3.64,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.64,$0.00,$3.47,$0.00
3757,ERX,HCPCS J1170,76045-0009-11,HYDROMORPHONE HCL 1 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.56,$0.00,$0.00,$3.64,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.64,$0.00,$3.47,$0.00
3757,ERX,HCPCS J1170,99999-6010-70,HYDROMORPHONE HCL 1 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.56,$0.00,$0.00,$3.64,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.64,$0.00,$3.47,$0.00
3758,ERX,HCPCS J1170,00409-1312-30,HYDROMORPHONE HCL 2 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.56,$0.00,$0.00,$3.64,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.64,$0.00,$3.47,$0.00
3758,ERX,HCPCS J1170,00409-3365-01,HYDROMORPHONE HCL 2 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.56,$0.00,$0.00,$3.64,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.64,$0.00,$3.47,$0.00
3758,ERX,HCPCS J1170,00409-3365-11,HYDROMORPHONE HCL 2 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.56,$0.00,$0.00,$3.64,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.64,$0.00,$3.47,$0.00
3758,ERX,HCPCS J1170,00641-0121-25,HYDROMORPHONE HCL 2 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.56,$0.00,$0.00,$3.64,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.64,$0.00,$3.47,$0.00
3758,ERX,HCPCS J1170,00641-6151-01,HYDROMORPHONE HCL 2 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.56,$0.00,$0.00,$3.64,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.64,$0.00,$3.47,$0.00
3758,ERX,HCPCS J1170,00641-6151-25,HYDROMORPHONE HCL 2 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.56,$0.00,$0.00,$3.64,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.64,$0.00,$3.47,$0.00
3760,ERX,HCPCS 25000001,42858-0301-25,HYDROMORPHONE HCL 2 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3760,ERX,HCPCS 25000001,68084-0423-01,HYDROMORPHONE HCL 2 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3760,ERX,HCPCS 25000001,68084-0423-11,HYDROMORPHONE HCL 2 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3761,ERX,HCPCS 25000001,00054-0264-24,HYDROMORPHONE HCL 4 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3761,ERX,HCPCS 25000001,42858-0302-25,HYDROMORPHONE HCL 4 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3770,ERX,HCPCS J3410,00517-5602-25,HYDROXYZINE HCL 50 MG/ML IM SOLN,$74.23,$0.00,$74.23,$33.40,$52.98,$0.00,$0.59,$0.00,$0.00,$16.50,$74.23,$0.00,$37.12,$58.79,$59.38,$0.00,$16.50,$0.00,$15.71,$0.00
3771,ERX,HCPCS 63700001,99999-6010-58,HYDROXYZINE HCL 10 MG/5ML PO SYRP,$19.16,$0.00,$38.31,$0.00,$27.34,$0.00,$0.00,$0.00,$0.00,$0.00,$38.31,$0.00,$19.16,$15.17,$30.65,$0.00,$0.00,$0.00,$0.00,$0.00
3771,ERX,HCPCS 63700001,60432-0150-04,HYDROXYZINE HCL 10 MG/5ML PO SYRP,$38.31,$0.00,$38.31,$0.00,$27.34,$0.00,$0.00,$0.00,$0.00,$0.00,$38.31,$0.00,$19.16,$30.34,$30.65,$0.00,$0.00,$0.00,$0.00,$0.00
3771,ERX,HCPCS 63700001,99999-6004-67,HYDROXYZINE HCL 10 MG/5ML PO SYRP,$38.31,$0.00,$38.31,$0.00,$27.34,$0.00,$0.00,$0.00,$0.00,$0.00,$38.31,$0.00,$19.16,$30.34,$30.65,$0.00,$0.00,$0.00,$0.00,$0.00
3771,ERX,HCPCS 63700001,60432-0150-16,HYDROXYZINE HCL 10 MG/5ML PO SYRP,$139.07,$0.00,$110.14,$0.00,$27.34,$0.00,$0.00,$0.00,$0.00,$0.00,$38.31,$0.00,$19.16,$110.14,$30.65,$0.00,$0.00,$0.00,$0.00,$0.00
3772,ERX,HCPCS 63700001,16714-0081-10,HYDROXYZINE HCL 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3772,ERX,HCPCS 63700001,68084-0253-01,HYDROXYZINE HCL 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3772,ERX,HCPCS 63700001,68084-0253-11,HYDROXYZINE HCL 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3774,ERX,HCPCS 63700001,16714-0082-10,HYDROXYZINE HCL 25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3774,ERX,HCPCS 63700001,63739-0486-10,HYDROXYZINE HCL 25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3774,ERX,HCPCS 63700001,68084-0254-01,HYDROXYZINE HCL 25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3778,ERX,HCPCS Q0177,00185-0615-01,HYDROXYZINE PAMOATE 50 MG PO CAPS,$6.00,$0.00,$6.00,$2.70,$4.28,$0.00,$1.03,$0.00,$0.00,$1.05,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.94,$0.00,$0.96,$0.00
3778,ERX,HCPCS Q0177,00185-0615-05,HYDROXYZINE PAMOATE 50 MG PO CAPS,$6.00,$0.00,$6.00,$2.70,$4.28,$0.00,$1.03,$0.00,$0.00,$1.05,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.94,$0.00,$0.96,$0.00
3778,ERX,HCPCS Q0177,51079-0078-20,HYDROXYZINE PAMOATE 50 MG PO CAPS,$6.00,$0.00,$6.00,$2.70,$4.28,$0.00,$1.03,$0.00,$0.00,$1.05,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.94,$0.00,$0.96,$0.00
3781,ERX,HCPCS 25000001,39328-0048-16,HYOSCYAMINE SULFATE 0.125 MG/5ML PO ELIX,$51.99,$0.00,$51.99,$0.00,$37.11,$0.00,$0.00,$0.00,$0.00,$0.00,$51.99,$0.00,$26.00,$41.18,$41.59,$0.00,$0.00,$0.00,$0.00,$0.00
3781,ERX,HCPCS 25000001,54838-0511-80,HYOSCYAMINE SULFATE 0.125 MG/5ML PO ELIX,$51.99,$0.00,$51.99,$0.00,$37.11,$0.00,$0.00,$0.00,$0.00,$0.00,$51.99,$0.00,$26.00,$41.18,$41.59,$0.00,$0.00,$0.00,$0.00,$0.00
3781,ERX,HCPCS 25000001,58657-0427-16,HYOSCYAMINE SULFATE 0.125 MG/5ML PO ELIX,$51.99,$0.00,$51.99,$0.00,$37.11,$0.00,$0.00,$0.00,$0.00,$0.00,$51.99,$0.00,$26.00,$41.18,$41.59,$0.00,$0.00,$0.00,$0.00,$0.00
3781,ERX,HCPCS 25000001,99999-6008-10,HYOSCYAMINE SULFATE 0.125 MG/5ML PO ELIX,$51.99,$0.00,$51.99,$0.00,$37.11,$0.00,$0.00,$0.00,$0.00,$0.00,$51.99,$0.00,$26.00,$41.18,$41.59,$0.00,$0.00,$0.00,$0.00,$0.00
3783,ERX,HCPCS 63700001,42192-0340-01,HYOSCYAMINE SULFATE 0.125 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3841,ERX,HCPCS 25000001,00904-7914-59,IBUPROFEN 200 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3841,ERX,HCPCS 25000001,00904-7914-61,IBUPROFEN 200 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3841,ERX,HCPCS 25000001,63739-0134-01,IBUPROFEN 200 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3843,ERX,HCPCS 25000001,00904-5853-60,IBUPROFEN 400 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3843,ERX,HCPCS 25000001,00904-5853-61,IBUPROFEN 400 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3843,ERX,HCPCS 25000001,49483-0602-01,IBUPROFEN 400 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3843,ERX,HCPCS 25000001,60687-0446-01,IBUPROFEN 400 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3843,ERX,HCPCS 25000001,63739-0672-01,IBUPROFEN 400 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3843,ERX,HCPCS 25000001,63739-0672-10,IBUPROFEN 400 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3844,ERX,HCPCS 25000001,00904-5854-61,IBUPROFEN 600 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3844,ERX,HCPCS 25000001,11788-0009-05,IBUPROFEN 600 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3844,ERX,HCPCS 25000001,63739-0684-01,IBUPROFEN 600 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3844,ERX,HCPCS 25000001,63739-0684-10,IBUPROFEN 600 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3845,ERX,HCPCS 25000001,49483-0604-50,IBUPROFEN 800 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3845,ERX,HCPCS 25000001,63739-0691-01,IBUPROFEN 800 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3845,ERX,HCPCS 25000001,63739-0691-10,IBUPROFEN 800 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3860,ERX,HCPCS 63700001,00781-1762-01,IMIPRAMINE HCL 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3860,ERX,HCPCS 63700001,49884-0054-01,IMIPRAMINE HCL 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3860,ERX,HCPCS 63700001,53489-0330-01,IMIPRAMINE HCL 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3861,ERX,HCPCS 63700001,00781-1764-01,IMIPRAMINE HCL 25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3861,ERX,HCPCS 63700001,00781-1764-13,IMIPRAMINE HCL 25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3862,ERX,HCPCS 63700001,00781-1766-01,IMIPRAMINE HCL 50 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3862,ERX,HCPCS 63700001,00781-1766-13,IMIPRAMINE HCL 50 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3862,ERX,HCPCS 63700001,49884-0056-01,IMIPRAMINE HCL 50 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3879,ERX,HCPCS 63700001,00378-0080-01,INDAPAMIDE 2.5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3897,ERX,HCPCS 63700001,31722-0542-01,INDOMETHACIN 25 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3897,ERX,HCPCS 63700001,50268-0430-11,INDOMETHACIN 25 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3897,ERX,HCPCS 63700001,50268-0430-15,INDOMETHACIN 25 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3897,ERX,HCPCS 63700001,68462-0406-01,INDOMETHACIN 25 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
3900,ERX,HCPCS 25000001,69344-0101-01,INDOMETHACIN 25 MG/5ML PO SUSP,$173.73,$0.00,$173.73,$0.00,$123.99,$0.00,$0.00,$0.00,$0.00,$0.00,$173.73,$0.00,$86.87,$137.59,$138.98,$0.00,$0.00,$0.00,$0.00,$0.00
3900,ERX,HCPCS 25000001,99999-6012-44,INDOMETHACIN 25 MG/5ML PO SUSP,$173.73,$0.00,$173.73,$0.00,$123.99,$0.00,$0.00,$0.00,$0.00,$0.00,$173.73,$0.00,$86.87,$137.59,$138.98,$0.00,$0.00,$0.00,$0.00,$0.00
3901,ERX,HCPCS 63700001,69344-0102-33,INDOMETHACIN 50 MG RECTAL SUPP,$594.12,$0.00,$594.12,$0.00,$424.02,$0.00,$0.00,$0.00,$0.00,$0.00,$594.12,$0.00,$297.06,$470.54,$475.30,$0.00,$0.00,$0.00,$0.00,$0.00
3961,ERX,HCPCS 25000001,48433-0230-15,IODINE STRONG 5 % SOLN,$120.74,$0.00,$120.74,$0.00,$86.17,$0.00,$0.00,$0.00,$0.00,$0.00,$120.74,$0.00,$60.37,$95.63,$96.59,$0.00,$0.00,$0.00,$0.00,$0.00
3961,ERX,HCPCS 25000001,00395-2775-16,IODINE STRONG 5 % SOLN,$254.79,$0.00,$201.79,$0.00,$86.17,$0.00,$0.00,$0.00,$0.00,$0.00,$120.74,$0.00,$60.37,$201.79,$96.59,$0.00,$0.00,$0.00,$0.00,$0.00
3990,ERX,HCPCS J1750,00023-6082-01,IRON DEXTRAN 50 MG/ML IJ SOLN,$33.31,$0.00,$33.31,$14.99,$23.77,$0.00,$5.74,$0.00,$0.00,$16.90,$33.31,$15.13,$16.66,$26.38,$26.65,$20.89,$16.90,$0.00,$0.00,$0.00
3990,ERX,HCPCS J1750,00023-6082-10,IRON DEXTRAN 50 MG/ML IJ SOLN,$33.31,$0.00,$33.31,$14.99,$23.77,$0.00,$5.74,$0.00,$0.00,$16.90,$33.31,$15.13,$16.66,$26.38,$26.65,$20.89,$16.90,$0.00,$0.00,$0.00
4008,ERX,HCPCS 25000001,10019-0360-40,ISOFLURANE IN SOLN,$100.80,$0.00,$100.80,$0.00,$71.94,$0.00,$0.00,$0.00,$0.00,$0.00,$100.80,$0.00,$50.40,$79.83,$80.64,$0.00,$0.00,$0.00,$0.00,$0.00
4008,ERX,HCPCS 25000001,66794-0017-10,ISOFLURANE IN SOLN,$100.80,$0.00,$100.80,$0.00,$71.94,$0.00,$0.00,$0.00,$0.00,$0.00,$100.80,$0.00,$50.40,$79.83,$80.64,$0.00,$0.00,$0.00,$0.00,$0.00
4008,ERX,HCPCS 25000001,66794-0017-25,ISOFLURANE IN SOLN,$131.25,$0.00,$103.95,$0.00,$71.94,$0.00,$0.00,$0.00,$0.00,$0.00,$100.80,$0.00,$50.40,$103.95,$80.64,$0.00,$0.00,$0.00,$0.00,$0.00
4024,ERX,HCPCS 25000001,00781-3056-70,ISONIAZID 100 MG/ML IJ SOLN,$322.14,$0.00,$322.14,$0.00,$229.91,$0.00,$0.00,$0.00,$0.00,$0.00,$322.14,$0.00,$161.07,$255.13,$257.71,$0.00,$0.00,$0.00,$0.00,$0.00
4025,ERX,HCPCS 63700001,99999-6004-68,ISONIAZID 50 MG/5ML PO SYRP,$62.93,$0.00,$62.93,$0.00,$44.91,$0.00,$0.00,$0.00,$0.00,$0.00,$62.93,$0.00,$31.47,$49.84,$50.34,$0.00,$0.00,$0.00,$0.00,$0.00
4025,ERX,HCPCS 63700001,46287-0009-01,ISONIAZID 50 MG/5ML PO SYRP,"$1,082.99",$0.00,$857.73,$0.00,$44.91,$0.00,$0.00,$0.00,$0.00,$0.00,$62.93,$0.00,$31.47,$857.73,$50.34,$0.00,$0.00,$0.00,$0.00,$0.00
4026,ERX,HCPCS 63700001,00555-0066-02,ISONIAZID 100 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4027,ERX,HCPCS 63700001,00555-0071-01,ISONIAZID 300 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4027,ERX,HCPCS 63700001,00555-0071-02,ISONIAZID 300 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4027,ERX,HCPCS 63700001,51079-0083-01,ISONIAZID 300 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4027,ERX,HCPCS 63700001,51079-0083-20,ISONIAZID 300 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4030,ERX,HCPCS 25000001,00574-0067-16,ISOPROPYL ALCOHOL 70 % SOLN,$11.00,$0.00,$11.00,$0.00,$7.85,$0.00,$0.00,$0.00,$0.00,$0.00,$11.00,$0.00,$5.50,$8.71,$8.80,$0.00,$0.00,$0.00,$0.00,$0.00
4030,ERX,HCPCS 25000001,49348-0030-38,ISOPROPYL ALCOHOL 70 % SOLN,$11.00,$0.00,$11.00,$0.00,$7.85,$0.00,$0.00,$0.00,$0.00,$0.00,$11.00,$0.00,$5.50,$8.71,$8.80,$0.00,$0.00,$0.00,$0.00,$0.00
4034,ERX,HCPCS 25000001,00187-4330-01,ISOPROTERENOL HCL 0.2 MG/ML IJ SOLN,"$2,250.90",$0.00,"$2,250.90",$0.00,"$1,606.47",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.90",$0.00,"$1,125.45","$1,782.71","$1,800.72",$0.00,$0.00,$0.00,$0.00,$0.00
4034,ERX,HCPCS 25000001,00187-4330-05,ISOPROTERENOL HCL 0.2 MG/ML IJ SOLN,"$2,250.90",$0.00,"$2,250.90",$0.00,"$1,606.47",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.90",$0.00,"$1,125.45","$1,782.71","$1,800.72",$0.00,$0.00,$0.00,$0.00,$0.00
4034,ERX,HCPCS 25000001,00548-9501-00,ISOPROTERENOL HCL 0.2 MG/ML IJ SOLN,"$2,250.90",$0.00,"$2,250.90",$0.00,"$1,606.47",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.90",$0.00,"$1,125.45","$1,782.71","$1,800.72",$0.00,$0.00,$0.00,$0.00,$0.00
4034,ERX,HCPCS 25000001,00548-9502-00,ISOPROTERENOL HCL 0.2 MG/ML IJ SOLN,"$2,250.90",$0.00,"$2,250.90",$0.00,"$1,606.47",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.90",$0.00,"$1,125.45","$1,782.71","$1,800.72",$0.00,$0.00,$0.00,$0.00,$0.00
4034,ERX,HCPCS 25000001,14789-0015-05,ISOPROTERENOL HCL 0.2 MG/ML IJ SOLN,"$2,250.90",$0.00,"$2,250.90",$0.00,"$1,606.47",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.90",$0.00,"$1,125.45","$1,782.71","$1,800.72",$0.00,$0.00,$0.00,$0.00,$0.00
4034,ERX,HCPCS 25000001,14789-0015-07,ISOPROTERENOL HCL 0.2 MG/ML IJ SOLN,"$2,250.90",$0.00,"$2,250.90",$0.00,"$1,606.47",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.90",$0.00,"$1,125.45","$1,782.71","$1,800.72",$0.00,$0.00,$0.00,$0.00,$0.00
4034,ERX,HCPCS 25000001,70121-1604-01,ISOPROTERENOL HCL 0.2 MG/ML IJ SOLN,"$2,250.90",$0.00,"$2,250.90",$0.00,"$1,606.47",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.90",$0.00,"$1,125.45","$1,782.71","$1,800.72",$0.00,$0.00,$0.00,$0.00,$0.00
4034,ERX,HCPCS 25000001,70121-1604-07,ISOPROTERENOL HCL 0.2 MG/ML IJ SOLN,"$2,250.90",$0.00,"$2,250.90",$0.00,"$1,606.47",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.90",$0.00,"$1,125.45","$1,782.71","$1,800.72",$0.00,$0.00,$0.00,$0.00,$0.00
4034,ERX,HCPCS 25000001,70121-1605-01,ISOPROTERENOL HCL 0.2 MG/ML IJ SOLN,"$2,250.90",$0.00,"$2,250.90",$0.00,"$1,606.47",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.90",$0.00,"$1,125.45","$1,782.71","$1,800.72",$0.00,$0.00,$0.00,$0.00,$0.00
4034,ERX,HCPCS 25000001,70121-1605-07,ISOPROTERENOL HCL 0.2 MG/ML IJ SOLN,"$2,250.90",$0.00,"$2,250.90",$0.00,"$1,606.47",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.90",$0.00,"$1,125.45","$1,782.71","$1,800.72",$0.00,$0.00,$0.00,$0.00,$0.00
4064,ERX,HCPCS 63700001,00143-1771-01,ISOSORBIDE DINITRATE 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4064,ERX,HCPCS 63700001,00781-1556-01,ISOSORBIDE DINITRATE 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4064,ERX,HCPCS 63700001,00904-6619-61,ISOSORBIDE DINITRATE 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4064,ERX,HCPCS 63700001,50268-0448-15,ISOSORBIDE DINITRATE 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4064,ERX,HCPCS 63700001,63739-0569-10,ISOSORBIDE DINITRATE 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4064,ERX,HCPCS 63700001,68084-0082-01,ISOSORBIDE DINITRATE 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4065,ERX,HCPCS 63700001,00781-1695-01,ISOSORBIDE DINITRATE 20 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4065,ERX,HCPCS 63700001,00904-6620-61,ISOSORBIDE DINITRATE 20 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4065,ERX,HCPCS 63700001,63739-0367-10,ISOSORBIDE DINITRATE 20 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4065,ERX,HCPCS 63700001,68084-0083-01,ISOSORBIDE DINITRATE 20 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4068,ERX,HCPCS 63700001,00143-1769-01,ISOSORBIDE DINITRATE 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4068,ERX,HCPCS 63700001,00781-1635-01,ISOSORBIDE DINITRATE 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4201,ERX,HCPCS 25000001,99999-6005-50,KAYEXALATE PO POWD,$28.50,$0.00,$28.50,$0.00,$20.34,$0.00,$0.00,$0.00,$0.00,$0.00,$28.50,$0.00,$14.25,$22.57,$22.80,$0.00,$0.00,$0.00,$0.00,$0.00
4236,ERX,HCPCS J3490,42023-0113-10,KETAMINE HCL 10 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$3.85,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.44,$0.00,$3.50,$0.00
4236,ERX,HCPCS J3490,67457-0181-20,KETAMINE HCL 10 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$3.85,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.44,$0.00,$3.50,$0.00
4237,ERX,HCPCS 25000001,00143-9509-10,KETAMINE HCL 100 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
4238,ERX,HCPCS J3490,00143-9508-10,KETAMINE HCL 50 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$3.85,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.44,$0.00,$3.50,$0.00
4238,ERX,HCPCS J3490,00409-2053-10,KETAMINE HCL 50 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$3.85,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.44,$0.00,$3.50,$0.00
4238,ERX,HCPCS J3490,42023-0114-10,KETAMINE HCL 50 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$3.85,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.44,$0.00,$3.50,$0.00
4238,ERX,HCPCS J3490,67457-0001-00,KETAMINE HCL 50 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$3.85,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.44,$0.00,$3.50,$0.00
4238,ERX,HCPCS J3490,67457-0001-10,KETAMINE HCL 50 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$3.85,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.44,$0.00,$3.50,$0.00
4318,ERX,HCPCS J7120,00264-7750-00,LACTATED RINGERS IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.13,$0.00,$0.00,$2.77,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$2.77,$0.00,$2.64,$0.00
4318,ERX,HCPCS J7120,00338-0117-04,LACTATED RINGERS IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.13,$0.00,$0.00,$2.77,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$2.77,$0.00,$2.64,$0.00
4318,ERX,HCPCS J7120,00990-7953-09,LACTATED RINGERS IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.13,$0.00,$0.00,$2.77,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$2.77,$0.00,$2.64,$0.00
4318,ERX,HCPCS J7120,00264-7750-20,LACTATED RINGERS IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.13,$0.00,$0.00,$2.77,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$2.77,$0.00,$2.64,$0.00
4318,ERX,HCPCS J7120,00338-0117-03,LACTATED RINGERS IV SOLN,$24.70,$0.00,$22.00,$9.90,$15.70,$0.00,$1.13,$0.00,$0.00,$2.77,$22.00,$0.00,$11.00,$19.56,$17.60,$0.00,$2.77,$0.00,$2.64,$0.00
4318,ERX,HCPCS J7120,00409-7953-03,LACTATED RINGERS IV SOLN,$24.70,$0.00,$22.00,$9.90,$15.70,$0.00,$1.13,$0.00,$0.00,$2.77,$22.00,$0.00,$11.00,$19.56,$17.60,$0.00,$2.77,$0.00,$2.64,$0.00
4323,ERX,HCPCS 63700001,08290-2367-12,LACTINEX PO PACK,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4393,ERX,HCPCS J0640,00143-9552-01,LEUCOVORIN CALCIUM 350 MG IJ SOLR,$109.20,$0.00,$109.20,$49.14,$77.94,$0.00,$7.32,$0.00,$0.00,$27.39,$109.20,$0.00,$54.60,$86.49,$87.36,$0.00,$27.39,$0.00,$26.08,$0.00
4393,ERX,HCPCS J0640,00703-5145-01,LEUCOVORIN CALCIUM 350 MG IJ SOLR,$109.20,$0.00,$109.20,$49.14,$77.94,$0.00,$7.32,$0.00,$0.00,$27.39,$109.20,$0.00,$54.60,$86.49,$87.36,$0.00,$27.39,$0.00,$26.08,$0.00
4393,ERX,HCPCS J0640,67457-0530-35,LEUCOVORIN CALCIUM 350 MG IJ SOLR,$109.20,$0.00,$109.20,$49.14,$77.94,$0.00,$7.32,$0.00,$0.00,$27.39,$109.20,$0.00,$54.60,$86.49,$87.36,$0.00,$27.39,$0.00,$26.08,$0.00
4394,ERX,HCPCS J0640,00143-9555-01,LEUCOVORIN CALCIUM 50 MG IJ SOLR,$45.60,$0.00,$45.60,$20.52,$32.54,$0.00,$1.05,$0.00,$0.00,$3.91,$45.60,$0.00,$22.80,$36.12,$36.48,$0.00,$3.91,$0.00,$3.73,$0.00
4394,ERX,HCPCS J0640,25021-0813-10,LEUCOVORIN CALCIUM 50 MG IJ SOLR,$45.60,$0.00,$45.60,$20.52,$32.54,$0.00,$1.05,$0.00,$0.00,$3.91,$45.60,$0.00,$22.80,$36.12,$36.48,$0.00,$3.91,$0.00,$3.73,$0.00
4397,ERX,HCPCS 63700001,51079-0582-01,LEUCOVORIN CALCIUM 25 MG PO TABS,$52.02,$0.00,$52.02,$0.00,$37.13,$0.00,$0.00,$0.00,$0.00,$0.00,$52.02,$0.00,$26.01,$41.20,$41.62,$0.00,$0.00,$0.00,$0.00,$0.00
4397,ERX,HCPCS 63700001,51079-0582-05,LEUCOVORIN CALCIUM 25 MG PO TABS,$52.02,$0.00,$52.02,$0.00,$37.13,$0.00,$0.00,$0.00,$0.00,$0.00,$52.02,$0.00,$26.01,$41.20,$41.62,$0.00,$0.00,$0.00,$0.00,$0.00
4397,ERX,HCPCS 63700001,60687-0227-94,LEUCOVORIN CALCIUM 25 MG PO TABS,$52.02,$0.00,$52.02,$0.00,$37.13,$0.00,$0.00,$0.00,$0.00,$0.00,$52.02,$0.00,$26.01,$41.20,$41.62,$0.00,$0.00,$0.00,$0.00,$0.00
4398,ERX,HCPCS 63700001,00054-8496-19,LEUCOVORIN CALCIUM 5 MG PO TABS,$12.35,$0.00,$12.35,$0.00,$8.81,$0.00,$0.00,$0.00,$0.00,$0.00,$12.35,$0.00,$6.18,$9.78,$9.88,$0.00,$0.00,$0.00,$0.00,$0.00
4398,ERX,HCPCS 63700001,00555-0484-01,LEUCOVORIN CALCIUM 5 MG PO TABS,$12.35,$0.00,$12.35,$0.00,$8.81,$0.00,$0.00,$0.00,$0.00,$0.00,$12.35,$0.00,$6.18,$9.78,$9.88,$0.00,$0.00,$0.00,$0.00,$0.00
4398,ERX,HCPCS 63700001,51079-0581-01,LEUCOVORIN CALCIUM 5 MG PO TABS,$12.35,$0.00,$12.35,$0.00,$8.81,$0.00,$0.00,$0.00,$0.00,$0.00,$12.35,$0.00,$6.18,$9.78,$9.88,$0.00,$0.00,$0.00,$0.00,$0.00
4398,ERX,HCPCS 63700001,51079-0581-06,LEUCOVORIN CALCIUM 5 MG PO TABS,$12.35,$0.00,$12.35,$0.00,$8.81,$0.00,$0.00,$0.00,$0.00,$0.00,$12.35,$0.00,$6.18,$9.78,$9.88,$0.00,$0.00,$0.00,$0.00,$0.00
4420,ERX,HCPCS 63700001,00378-1800-77,LEVOTHYROXINE SODIUM 25 MCG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4420,ERX,HCPCS 63700001,00781-5180-92,LEVOTHYROXINE SODIUM 25 MCG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4420,ERX,HCPCS 63700001,51079-0444-20,LEVOTHYROXINE SODIUM 25 MCG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4421,ERX,HCPCS 63700001,00378-1803-77,LEVOTHYROXINE SODIUM 50 MCG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4421,ERX,HCPCS 63700001,00781-5181-92,LEVOTHYROXINE SODIUM 50 MCG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4421,ERX,HCPCS 63700001,51079-0440-20,LEVOTHYROXINE SODIUM 50 MCG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4422,ERX,HCPCS 63700001,00378-1805-77,LEVOTHYROXINE SODIUM 75 MCG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4422,ERX,HCPCS 63700001,00781-5182-92,LEVOTHYROXINE SODIUM 75 MCG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4422,ERX,HCPCS 63700001,51079-0441-20,LEVOTHYROXINE SODIUM 75 MCG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4423,ERX,HCPCS 63700001,00781-5184-92,LEVOTHYROXINE SODIUM 100 MCG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4423,ERX,HCPCS 63700001,51079-0442-20,LEVOTHYROXINE SODIUM 100 MCG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4424,ERX,HCPCS 63700001,00781-5186-92,LEVOTHYROXINE SODIUM 125 MCG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4424,ERX,HCPCS 63700001,51079-0443-20,LEVOTHYROXINE SODIUM 125 MCG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4425,ERX,HCPCS 63700001,00378-1815-77,LEVOTHYROXINE SODIUM 150 MCG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4425,ERX,HCPCS 63700001,00781-5187-92,LEVOTHYROXINE SODIUM 150 MCG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4426,ERX,HCPCS 63700001,00781-5189-92,LEVOTHYROXINE SODIUM 200 MCG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4450,ERX,HCPCS 25000001,00054-3505-47,LIDOCAINE HCL 4 % EX SOLN,$168.00,$0.00,$168.00,$0.00,$119.90,$0.00,$0.00,$0.00,$0.00,$0.00,$168.00,$0.00,$84.00,$133.06,$134.40,$0.00,$0.00,$0.00,$0.00,$0.00
4451,ERX,HCPCS 25000001,00409-4275-01,LIDOCAINE HCL 0.5 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
4451,ERX,HCPCS 25000001,63323-0484-57,LIDOCAINE HCL 0.5 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
4452,ERX,HCPCS 25000001,00409-4276-01,LIDOCAINE HCL 1 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
4452,ERX,HCPCS 25000001,00409-4276-16,LIDOCAINE HCL 1 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
4452,ERX,HCPCS 25000001,55150-0252-20,LIDOCAINE HCL 1 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
4452,ERX,HCPCS 25000001,63323-0485-27,LIDOCAINE HCL 1 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
4454,ERX,HCPCS 25000001,00409-4277-01,LIDOCAINE HCL 2 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
4454,ERX,HCPCS 25000001,00409-4277-16,LIDOCAINE HCL 2 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
4454,ERX,HCPCS 25000001,55150-0254-10,LIDOCAINE HCL 2 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
4454,ERX,HCPCS 25000001,55150-0255-20,LIDOCAINE HCL 2 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
4454,ERX,HCPCS 25000001,63323-0202-02,LIDOCAINE HCL 2 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
4454,ERX,HCPCS 25000001,63323-0486-17,LIDOCAINE HCL 2 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
4454,ERX,HCPCS 25000001,63323-0486-27,LIDOCAINE HCL 2 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
4498,ERX,HCPCS 25000001,60432-0834-60,LINDANE 1 % EX SHAM,$417.43,$0.00,$417.43,$0.00,$297.92,$0.00,$0.00,$0.00,$0.00,$0.00,$417.43,$0.00,$208.72,$330.60,$333.94,$0.00,$0.00,$0.00,$0.00,$0.00
4504,ERX,HCPCS 63700001,59762-1207-01,LIOTHYRONINE SODIUM 25 MCG PO TABS,$11.49,$0.00,$11.49,$0.00,$8.20,$0.00,$0.00,$0.00,$0.00,$0.00,$11.49,$0.00,$5.75,$9.10,$9.19,$0.00,$0.00,$0.00,$0.00,$0.00
4504,ERX,HCPCS 63700001,60793-0116-01,LIOTHYRONINE SODIUM 25 MCG PO TABS,$11.49,$0.00,$11.49,$0.00,$8.20,$0.00,$0.00,$0.00,$0.00,$0.00,$11.49,$0.00,$5.75,$9.10,$9.19,$0.00,$0.00,$0.00,$0.00,$0.00
4526,ERX,HCPCS 63700001,00904-6799-61,LISINOPRIL 20 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4526,ERX,HCPCS 63700001,43547-0354-10,LISINOPRIL 20 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4526,ERX,HCPCS 63700001,60687-0333-01,LISINOPRIL 20 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4526,ERX,HCPCS 63700001,63739-0350-10,LISINOPRIL 20 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4529,ERX,HCPCS 63700001,00054-2527-25,LITHIUM CARBONATE 300 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4529,ERX,HCPCS 63700001,00054-8527-25,LITHIUM CARBONATE 300 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4560,ERX,HCPCS 63700001,00093-0311-01,LOPERAMIDE HCL 2 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4560,ERX,HCPCS 63700001,51079-0690-01,LOPERAMIDE HCL 2 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4560,ERX,HCPCS 63700001,51079-0690-20,LOPERAMIDE HCL 2 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4560,ERX,HCPCS 63700001,60687-0229-01,LOPERAMIDE HCL 2 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4571,ERX,HCPCS 25000001,00054-3532-44,LORAZEPAM 2 MG/ML PO CONC,$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
4571,ERX,HCPCS 25000001,00121-0770-01,LORAZEPAM 2 MG/ML PO CONC,$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
4571,ERX,HCPCS 25000001,50383-0705-30,LORAZEPAM 2 MG/ML PO CONC,$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
4571,ERX,HCPCS 25000001,99999-6007-84,LORAZEPAM 2 MG/ML PO CONC,$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
4572,ERX,HCPCS 25000001,69315-0904-01,LORAZEPAM 0.5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4573,ERX,HCPCS 25000001,00591-0241-01,LORAZEPAM 1 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4573,ERX,HCPCS 25000001,00904-6008-60,LORAZEPAM 1 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4573,ERX,HCPCS 25000001,00904-6008-61,LORAZEPAM 1 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4573,ERX,HCPCS 25000001,69315-0905-01,LORAZEPAM 1 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4574,ERX,HCPCS 25000001,00591-0242-01,LORAZEPAM 2 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4574,ERX,HCPCS 25000001,00591-0242-05,LORAZEPAM 2 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4574,ERX,HCPCS 25000001,00904-6009-61,LORAZEPAM 2 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4574,ERX,HCPCS 25000001,60687-0367-01,LORAZEPAM 2 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4574,ERX,HCPCS 25000001,60687-0367-11,LORAZEPAM 2 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4599,ERX,HCPCS 63700001,00527-1395-01,LOXAPINE SUCCINATE 10 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4600,ERX,HCPCS 63700001,00591-0371-01,LOXAPINE SUCCINATE 25 MG PO CAPS,$7.32,$0.00,$7.32,$0.00,$5.22,$0.00,$0.00,$0.00,$0.00,$0.00,$7.32,$0.00,$3.66,$5.80,$5.86,$0.00,$0.00,$0.00,$0.00,$0.00
4602,ERX,HCPCS 63700001,00378-7050-01,LOXAPINE SUCCINATE 50 MG PO CAPS,$9.78,$0.00,$9.78,$0.00,$6.98,$0.00,$0.00,$0.00,$0.00,$0.00,$9.78,$0.00,$4.89,$7.75,$7.82,$0.00,$0.00,$0.00,$0.00,$0.00
4602,ERX,HCPCS 63700001,00591-0372-01,LOXAPINE SUCCINATE 50 MG PO CAPS,$9.78,$0.00,$9.78,$0.00,$6.98,$0.00,$0.00,$0.00,$0.00,$0.00,$9.78,$0.00,$4.89,$7.75,$7.82,$0.00,$0.00,$0.00,$0.00,$0.00
4711,ERX,HCPCS 63700001,00869-0686-38,MAGNESIUM CITRATE 58 MG/ML PO SOLN,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4711,ERX,HCPCS 63700001,00904-6787-44,MAGNESIUM CITRATE 58 MG/ML PO SOLN,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4711,ERX,HCPCS 63700001,49348-0504-49,MAGNESIUM CITRATE 58 MG/ML PO SOLN,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4711,ERX,HCPCS 63700001,49348-0696-49,MAGNESIUM CITRATE 58 MG/ML PO SOLN,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4711,ERX,HCPCS 63700001,70677-0051-01,MAGNESIUM CITRATE 58 MG/ML PO SOLN,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4711,ERX,HCPCS 63700001,70677-0053-01,MAGNESIUM CITRATE 58 MG/ML PO SOLN,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4715,ERX,HCPCS 63700001,59016-0420-17,MAGNESIUM LACTATE 84 MG (7MEQ) PO TBCR,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4720,ERX,HCPCS J3475,51754-1000-04,MAGNESIUM SULFATE 50 % IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.12,$0.00,$0.00,$1.48,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.48,$0.00,$1.41,$0.00
4720,ERX,HCPCS J3475,63323-0064-03,MAGNESIUM SULFATE 50 % IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.12,$0.00,$0.00,$1.48,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.48,$0.00,$1.41,$0.00
4720,ERX,HCPCS J3475,63323-0064-11,MAGNESIUM SULFATE 50 % IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.12,$0.00,$0.00,$1.48,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.48,$0.00,$1.41,$0.00
4720,ERX,HCPCS J3475,63323-0642-20,MAGNESIUM SULFATE 50 % IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.12,$0.00,$0.00,$1.48,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.48,$0.00,$1.41,$0.00
4720,ERX,HCPCS J3475,63323-0642-50,MAGNESIUM SULFATE 50 % IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.12,$0.00,$0.00,$1.48,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.48,$0.00,$1.41,$0.00
4744,ERX,HCPCS 25000001,00409-4091-01,MANGANESE CHLORIDE 0.1 MG/ML IV SOLN,$96.46,$0.00,$96.46,$0.00,$68.84,$0.00,$0.00,$0.00,$0.00,$0.00,$96.46,$0.00,$48.23,$76.40,$77.17,$0.00,$0.00,$0.00,$0.00,$0.00
4749,ERX,HCPCS 25000001,00264-7578-10,MANNITOL 20 % IV SOLN,$91.88,$0.00,$91.88,$0.00,$65.57,$0.00,$0.00,$0.00,$0.00,$0.00,$91.88,$0.00,$45.94,$72.77,$73.50,$0.00,$0.00,$0.00,$0.00,$0.00
4749,ERX,HCPCS 25000001,00338-0357-02,MANNITOL 20 % IV SOLN,$91.88,$0.00,$91.88,$0.00,$65.57,$0.00,$0.00,$0.00,$0.00,$0.00,$91.88,$0.00,$45.94,$72.77,$73.50,$0.00,$0.00,$0.00,$0.00,$0.00
4749,ERX,HCPCS 25000001,00338-0357-03,MANNITOL 20 % IV SOLN,$91.88,$0.00,$91.88,$0.00,$65.57,$0.00,$0.00,$0.00,$0.00,$0.00,$91.88,$0.00,$45.94,$72.77,$73.50,$0.00,$0.00,$0.00,$0.00,$0.00
4750,ERX,HCPCS J2150,00409-4031-01,MANNITOL 25 % IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
4750,ERX,HCPCS J2150,63323-0024-25,MANNITOL 25 % IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
4759,ERX,HCPCS 63700001,00378-0060-01,MAPROTILINE HCL 25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4760,ERX,HCPCS 63700001,00378-0087-01,MAPROTILINE HCL 50 MG PO TABS,$6.50,$0.00,$6.50,$0.00,$4.64,$0.00,$0.00,$0.00,$0.00,$0.00,$6.50,$0.00,$3.25,$5.15,$5.20,$0.00,$0.00,$0.00,$0.00,$0.00
4822,ERX,HCPCS 63700001,00536-1018-01,MECLIZINE HCL 25 MG PO CHEW,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4854,ERX,HCPCS 63700001,00555-0779-02,MEDROXYPROGESTERONE ACETATE 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4855,ERX,HCPCS 63700001,00555-0872-02,MEDROXYPROGESTERONE ACETATE 2.5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4856,ERX,HCPCS 63700001,00555-0873-02,MEDROXYPROGESTERONE ACETATE 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4871,ERX,HCPCS 63700001,00904-3571-61,MEGESTROL ACETATE 40 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4871,ERX,HCPCS 63700001,49884-0290-01,MEGESTROL ACETATE 40 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4871,ERX,HCPCS 63700001,63739-0165-10,MEGESTROL ACETATE 40 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4903,ERX,HCPCS J2175,00409-1176-03,MEPERIDINE HCL 25 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.67,$0.00,$0.00,$5.55,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$5.55,$0.00,$5.28,$0.00
4903,ERX,HCPCS J2175,00409-1176-30,MEPERIDINE HCL 25 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.67,$0.00,$0.00,$5.55,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$5.55,$0.00,$5.28,$0.00
4903,ERX,HCPCS J2175,00641-6052-25,MEPERIDINE HCL 25 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.67,$0.00,$0.00,$5.55,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$5.55,$0.00,$5.28,$0.00
4904,ERX,HCPCS J2175,00641-6053-25,MEPERIDINE HCL 50 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.67,$0.00,$0.00,$5.55,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$5.55,$0.00,$5.28,$0.00
4905,ERX,HCPCS J2175,00409-1179-03,MEPERIDINE HCL 75 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.67,$0.00,$0.00,$5.55,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$5.55,$0.00,$5.28,$0.00
4905,ERX,HCPCS J2175,00409-1179-30,MEPERIDINE HCL 75 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.67,$0.00,$0.00,$5.55,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$5.55,$0.00,$5.28,$0.00
4914,ERX,HCPCS J0670,00409-1038-50,MEPIVACAINE HCL 1 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
4915,ERX,HCPCS J0670,00409-2047-50,MEPIVACAINE HCL 2 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
4952,ERX,HCPCS 63700001,00054-3555-63,METHADONE HCL 5 MG/5ML PO SOLN,$35.91,$0.00,$35.91,$0.00,$25.63,$0.00,$0.00,$0.00,$0.00,$0.00,$35.91,$0.00,$17.96,$28.44,$28.73,$0.00,$0.00,$0.00,$0.00,$0.00
4952,ERX,HCPCS 63700001,66689-0711-16,METHADONE HCL 5 MG/5ML PO SOLN,$35.91,$0.00,$35.91,$0.00,$25.63,$0.00,$0.00,$0.00,$0.00,$0.00,$35.91,$0.00,$17.96,$28.44,$28.73,$0.00,$0.00,$0.00,$0.00,$0.00
4952,ERX,HCPCS 63700001,99999-6011-43,METHADONE HCL 5 MG/5ML PO SOLN,$35.91,$0.00,$35.91,$0.00,$25.63,$0.00,$0.00,$0.00,$0.00,$0.00,$35.91,$0.00,$17.96,$28.44,$28.73,$0.00,$0.00,$0.00,$0.00,$0.00
4953,ERX,HCPCS 63700001,00054-8554-24,METHADONE HCL 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4953,ERX,HCPCS 63700001,00406-5771-62,METHADONE HCL 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4954,ERX,HCPCS 63700001,00054-4570-25,METHADONE HCL 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4954,ERX,HCPCS 63700001,00054-8553-24,METHADONE HCL 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4954,ERX,HCPCS 63700001,00406-5755-23,METHADONE HCL 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4954,ERX,HCPCS 63700001,00406-5755-62,METHADONE HCL 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4962,ERX,HCPCS 63700001,00574-0791-01,METHAZOLAMIDE 50 MG PO TABS,$29.12,$0.00,$29.12,$0.00,$20.78,$0.00,$0.00,$0.00,$0.00,$0.00,$29.12,$0.00,$14.56,$23.06,$23.30,$0.00,$0.00,$0.00,$0.00,$0.00
4962,ERX,HCPCS 63700001,00781-1071-01,METHAZOLAMIDE 50 MG PO TABS,$29.12,$0.00,$29.12,$0.00,$20.78,$0.00,$0.00,$0.00,$0.00,$0.00,$29.12,$0.00,$14.56,$23.06,$23.30,$0.00,$0.00,$0.00,$0.00,$0.00
4962,ERX,HCPCS 63700001,62559-0241-01,METHAZOLAMIDE 50 MG PO TABS,$29.12,$0.00,$29.12,$0.00,$20.78,$0.00,$0.00,$0.00,$0.00,$0.00,$29.12,$0.00,$14.56,$23.06,$23.30,$0.00,$0.00,$0.00,$0.00,$0.00
4966,ERX,HCPCS 63700001,13925-0107-01,METHENAMINE MANDELATE 1 G PO TABS,$9.01,$0.00,$9.01,$0.00,$6.43,$0.00,$0.00,$0.00,$0.00,$0.00,$9.01,$0.00,$4.51,$7.14,$7.21,$0.00,$0.00,$0.00,$0.00,$0.00
4971,ERX,HCPCS 63700001,76385-0123-50,METHOCARBAMOL 500 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4972,ERX,HCPCS 63700001,31722-0534-01,METHOCARBAMOL 750 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4973,ERX,HCPCS J8610,00054-4550-25,METHOTREXATE 2.5 MG PO TABS,$71.14,$0.00,$71.14,$0.00,$50.77,$0.00,$12.26,$0.00,$0.00,$12.46,$71.14,$0.00,$35.57,$56.34,$56.91,$0.00,$11.13,$0.00,$0.00,$0.00
4973,ERX,HCPCS J8610,00054-8550-25,METHOTREXATE 2.5 MG PO TABS,$71.14,$0.00,$71.14,$0.00,$50.77,$0.00,$12.26,$0.00,$0.00,$12.46,$71.14,$0.00,$35.57,$56.34,$56.91,$0.00,$11.13,$0.00,$0.00,$0.00
4973,ERX,HCPCS J8610,00378-0014-01,METHOTREXATE 2.5 MG PO TABS,$71.14,$0.00,$71.14,$0.00,$50.77,$0.00,$12.26,$0.00,$0.00,$12.46,$71.14,$0.00,$35.57,$56.34,$56.91,$0.00,$11.13,$0.00,$0.00,$0.00
4973,ERX,HCPCS J8610,00555-0572-02,METHOTREXATE 2.5 MG PO TABS,$71.14,$0.00,$71.14,$0.00,$50.77,$0.00,$12.26,$0.00,$0.00,$12.46,$71.14,$0.00,$35.57,$56.34,$56.91,$0.00,$11.13,$0.00,$0.00,$0.00
4973,ERX,HCPCS J8610,51079-0670-01,METHOTREXATE 2.5 MG PO TABS,$71.14,$0.00,$71.14,$0.00,$50.77,$0.00,$12.26,$0.00,$0.00,$12.46,$71.14,$0.00,$35.57,$56.34,$56.91,$0.00,$11.13,$0.00,$0.00,$0.00
4973,ERX,HCPCS J8610,51079-0670-05,METHOTREXATE 2.5 MG PO TABS,$71.14,$0.00,$71.14,$0.00,$50.77,$0.00,$12.26,$0.00,$0.00,$12.46,$71.14,$0.00,$35.57,$56.34,$56.91,$0.00,$11.13,$0.00,$0.00,$0.00
4986,ERX,HCPCS 63700001,00406-1144-01,METHYLPHENIDATE HCL 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4986,ERX,HCPCS 63700001,10702-0101-01,METHYLPHENIDATE HCL 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4986,ERX,HCPCS 63700001,65580-0530-01,METHYLPHENIDATE HCL 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4988,ERX,HCPCS 63700001,00406-1142-01,METHYLPHENIDATE HCL 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4988,ERX,HCPCS 63700001,00781-5748-01,METHYLPHENIDATE HCL 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4988,ERX,HCPCS 63700001,16714-0821-01,METHYLPHENIDATE HCL 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
4991,ERX,HCPCS J7509,00781-5022-07,METHYLPREDNISOLONE 4 MG PO TBPK,$105.11,$0.00,$105.11,$47.30,$75.02,$0.00,$18.11,$0.00,$0.00,$18.40,$105.11,$0.00,$52.56,$83.25,$84.09,$0.00,$16.45,$0.00,$16.73,$0.00
4992,ERX,HCPCS J7509,00009-0073-01,METHYLPREDNISOLONE 16 MG PO TABS,$12.92,$0.00,$12.92,$5.81,$9.22,$0.00,$2.23,$0.00,$0.00,$2.26,$12.92,$0.00,$6.46,$10.23,$10.34,$0.00,$2.02,$0.00,$2.06,$0.00
4992,ERX,HCPCS J7509,59746-0003-14,METHYLPREDNISOLONE 16 MG PO TABS,$12.92,$0.00,$12.92,$5.81,$9.22,$0.00,$2.23,$0.00,$0.00,$2.26,$12.92,$0.00,$6.46,$10.23,$10.34,$0.00,$2.02,$0.00,$2.06,$0.00
4992,ERX,HCPCS J7509,59762-0050-01,METHYLPREDNISOLONE 16 MG PO TABS,$12.92,$0.00,$12.92,$5.81,$9.22,$0.00,$2.23,$0.00,$0.00,$2.26,$12.92,$0.00,$6.46,$10.23,$10.34,$0.00,$2.02,$0.00,$2.06,$0.00
4993,ERX,HCPCS J7509,00781-5022-01,METHYLPREDNISOLONE 4 MG PO TABS,$6.27,$0.00,$6.27,$2.82,$4.47,$0.00,$1.08,$0.00,$0.00,$1.10,$6.27,$0.00,$3.14,$4.97,$5.02,$0.00,$0.98,$0.00,$1.00,$0.00
4993,ERX,HCPCS J7509,59746-0001-06,METHYLPREDNISOLONE 4 MG PO TABS,$6.27,$0.00,$6.27,$2.82,$4.47,$0.00,$1.08,$0.00,$0.00,$1.10,$6.27,$0.00,$3.14,$4.97,$5.02,$0.00,$0.98,$0.00,$1.00,$0.00
4993,ERX,HCPCS J7509,68084-0149-01,METHYLPREDNISOLONE 4 MG PO TABS,$6.27,$0.00,$6.27,$2.82,$4.47,$0.00,$1.08,$0.00,$0.00,$1.10,$6.27,$0.00,$3.14,$4.97,$5.02,$0.00,$0.98,$0.00,$1.00,$0.00
4993,ERX,HCPCS J7509,68084-0149-11,METHYLPREDNISOLONE 4 MG PO TABS,$6.27,$0.00,$6.27,$2.82,$4.47,$0.00,$1.08,$0.00,$0.00,$1.10,$6.27,$0.00,$3.14,$4.97,$5.02,$0.00,$0.98,$0.00,$1.00,$0.00
4995,ERX,HCPCS J1030,00009-3073-01,METHYLPREDNISOLONE ACETATE 40 MG/ML IJ SUSP,$24.10,$0.00,$24.10,$10.85,$17.20,$0.00,$4.86,$0.00,$0.00,$7.39,$24.10,$0.00,$12.05,$19.09,$19.28,$0.00,$7.39,$0.00,$7.04,$0.00
4995,ERX,HCPCS J1030,00009-3073-03,METHYLPREDNISOLONE ACETATE 40 MG/ML IJ SUSP,$24.10,$0.00,$24.10,$10.85,$17.20,$0.00,$4.86,$0.00,$0.00,$7.39,$24.10,$0.00,$12.05,$19.09,$19.28,$0.00,$7.39,$0.00,$7.04,$0.00
5002,ERX,HCPCS J2765,00409-3414-01,METOCLOPRAMIDE HCL 5 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$1.41,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.41,$0.00,$1.34,$0.00
5002,ERX,HCPCS J2765,00409-3414-18,METOCLOPRAMIDE HCL 5 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$1.41,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.41,$0.00,$1.34,$0.00
5002,ERX,HCPCS J2765,00703-4502-04,METOCLOPRAMIDE HCL 5 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$1.41,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.41,$0.00,$1.34,$0.00
5005,ERX,HCPCS 25000001,00093-2203-01,METOCLOPRAMIDE HCL 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5005,ERX,HCPCS 25000001,00093-2203-05,METOCLOPRAMIDE HCL 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5005,ERX,HCPCS 25000001,51079-0888-20,METOCLOPRAMIDE HCL 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5005,ERX,HCPCS 25000001,63739-0293-10,METOCLOPRAMIDE HCL 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5005,ERX,HCPCS 25000001,68084-0676-01,METOCLOPRAMIDE HCL 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5005,ERX,HCPCS 25000001,68084-0676-11,METOCLOPRAMIDE HCL 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5009,ERX,HCPCS 63700001,51079-0801-01,METOPROLOL TARTRATE 50 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5009,ERX,HCPCS 63700001,51079-0801-20,METOPROLOL TARTRATE 50 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5009,ERX,HCPCS 63700001,57664-0477-52,METOPROLOL TARTRATE 50 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5009,ERX,HCPCS 63700001,62584-0266-01,METOPROLOL TARTRATE 50 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5009,ERX,HCPCS 63700001,62584-0266-11,METOPROLOL TARTRATE 50 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5009,ERX,HCPCS 63700001,65862-0063-01,METOPROLOL TARTRATE 50 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5015,ERX,HCPCS 63700001,00904-1453-61,METRONIDAZOLE 250 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5015,ERX,HCPCS 63700001,50111-0333-01,METRONIDAZOLE 250 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5015,ERX,HCPCS 63700001,50111-0333-02,METRONIDAZOLE 250 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5016,ERX,HCPCS 63700001,29300-0227-01,METRONIDAZOLE 500 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5016,ERX,HCPCS 63700001,29300-0227-05,METRONIDAZOLE 500 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5016,ERX,HCPCS 63700001,29300-0227-46,METRONIDAZOLE 500 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5016,ERX,HCPCS 63700001,50111-0334-01,METRONIDAZOLE 500 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5016,ERX,HCPCS 63700001,50268-0535-11,METRONIDAZOLE 500 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5016,ERX,HCPCS 63700001,50268-0535-15,METRONIDAZOLE 500 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5016,ERX,HCPCS 63700001,60687-0550-01,METRONIDAZOLE 500 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5018,ERX,HCPCS 25000001,00338-1055-48,METRONIDAZOLE IN NACL 5-0.79 MG/ML-% IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
5018,ERX,HCPCS 25000001,00409-7811-24,METRONIDAZOLE IN NACL 5-0.79 MG/ML-% IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
5018,ERX,HCPCS 25000001,00409-7811-37,METRONIDAZOLE IN NACL 5-0.79 MG/ML-% IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
5039,ERX,HCPCS 63700001,00472-0735-56,MICONAZOLE NITRATE 2 % EX CREA,$20.07,$0.00,$20.07,$0.00,$14.32,$0.00,$0.00,$0.00,$0.00,$0.00,$20.07,$0.00,$10.04,$15.90,$16.06,$0.00,$0.00,$0.00,$0.00,$0.00
5039,ERX,HCPCS 63700001,49348-0689-72,MICONAZOLE NITRATE 2 % EX CREA,$20.07,$0.00,$20.07,$0.00,$14.32,$0.00,$0.00,$0.00,$0.00,$0.00,$20.07,$0.00,$10.04,$15.90,$16.06,$0.00,$0.00,$0.00,$0.00,$0.00
5039,ERX,HCPCS 63700001,51672-2001-02,MICONAZOLE NITRATE 2 % EX CREA,$20.07,$0.00,$20.07,$0.00,$14.32,$0.00,$0.00,$0.00,$0.00,$0.00,$20.07,$0.00,$10.04,$15.90,$16.06,$0.00,$0.00,$0.00,$0.00,$0.00
5086,ERX,HCPCS 25000001,00869-0831-43,MINERAL OIL PO OIL,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5086,ERX,HCPCS 25000001,00869-4206-10,MINERAL OIL PO OIL,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5086,ERX,HCPCS 25000001,48433-0202-30,MINERAL OIL PO OIL,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5086,ERX,HCPCS 25000001,54162-0190-16,MINERAL OIL PO OIL,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5086,ERX,HCPCS 25000001,99999-6007-83,MINERAL OIL PO OIL,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5110,ERX,HCPCS 63700001,00591-5695-50,MINOCYCLINE HCL 100 MG PO CAPS,$12.91,$0.00,$12.91,$0.00,$9.21,$0.00,$0.00,$0.00,$0.00,$0.00,$12.91,$0.00,$6.46,$10.22,$10.33,$0.00,$0.00,$0.00,$0.00,$0.00
5110,ERX,HCPCS 63700001,65862-0211-50,MINOCYCLINE HCL 100 MG PO CAPS,$12.91,$0.00,$12.91,$0.00,$9.21,$0.00,$0.00,$0.00,$0.00,$0.00,$12.91,$0.00,$6.46,$10.22,$10.33,$0.00,$0.00,$0.00,$0.00,$0.00
5111,ERX,HCPCS 63700001,00591-5694-01,MINOCYCLINE HCL 50 MG PO CAPS,$6.46,$0.00,$6.46,$0.00,$4.61,$0.00,$0.00,$0.00,$0.00,$0.00,$6.46,$0.00,$3.23,$5.12,$5.17,$0.00,$0.00,$0.00,$0.00,$0.00
5111,ERX,HCPCS 63700001,63304-0694-01,MINOCYCLINE HCL 50 MG PO CAPS,$6.46,$0.00,$6.46,$0.00,$4.61,$0.00,$0.00,$0.00,$0.00,$0.00,$6.46,$0.00,$3.23,$5.12,$5.17,$0.00,$0.00,$0.00,$0.00,$0.00
5111,ERX,HCPCS 63700001,65862-0209-01,MINOCYCLINE HCL 50 MG PO CAPS,$6.46,$0.00,$6.46,$0.00,$4.61,$0.00,$0.00,$0.00,$0.00,$0.00,$6.46,$0.00,$3.23,$5.12,$5.17,$0.00,$0.00,$0.00,$0.00,$0.00
5114,ERX,HCPCS 63700001,68084-0205-01,MINOXIDIL 10 MG PO TABS,$8.06,$0.00,$8.06,$0.00,$5.75,$0.00,$0.00,$0.00,$0.00,$0.00,$8.06,$0.00,$4.03,$6.38,$6.45,$0.00,$0.00,$0.00,$0.00,$0.00
5114,ERX,HCPCS 63700001,68084-0205-11,MINOXIDIL 10 MG PO TABS,$8.06,$0.00,$8.06,$0.00,$5.75,$0.00,$0.00,$0.00,$0.00,$0.00,$8.06,$0.00,$4.03,$6.38,$6.45,$0.00,$0.00,$0.00,$0.00,$0.00
5115,ERX,HCPCS 63700001,00591-5642-01,MINOXIDIL 2.5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5115,ERX,HCPCS 63700001,49884-0256-01,MINOXIDIL 2.5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5115,ERX,HCPCS 63700001,68084-0204-01,MINOXIDIL 2.5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5115,ERX,HCPCS 63700001,68084-0204-11,MINOXIDIL 2.5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5170,ERX,HCPCS J2270,76045-0004-10,MORPHINE SULFATE 2 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$2.39,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$2.39,$0.00,$2.27,$0.00
5172,ERX,HCPCS J2270,76045-0005-10,MORPHINE SULFATE 4 MG/ML IJ SOLN,$22.00,$0.00,$17.42,$0.00,$0.00,$0.00,$3.79,$0.00,$0.00,$2.39,$0.00,$0.00,$0.00,$17.42,$0.00,$0.00,$2.39,$0.00,$0.00,$0.00
5176,ERX,HCPCS 25000001,00054-0237-63,MORPHINE SULFATE 10 MG/5ML PO SOLN,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5176,ERX,HCPCS 25000001,66689-0032-50,MORPHINE SULFATE 10 MG/5ML PO SOLN,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5176,ERX,HCPCS 25000001,68094-0001-62,MORPHINE SULFATE 10 MG/5ML PO SOLN,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5176,ERX,HCPCS 25000001,99999-6007-18,MORPHINE SULFATE 10 MG/5ML PO SOLN,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5178,ERX,HCPCS 25000001,00054-0235-24,MORPHINE SULFATE 15 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5178,ERX,HCPCS 25000001,00054-0235-25,MORPHINE SULFATE 15 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5179,ERX,HCPCS 25000001,00054-0236-25,MORPHINE SULFATE 30 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5180,ERX,HCPCS 25000001,00574-7112-12,MORPHINE SULFATE 10 MG RECTAL SUPP,$23.75,$0.00,$23.75,$0.00,$16.95,$0.00,$0.00,$0.00,$0.00,$0.00,$23.75,$0.00,$11.88,$18.81,$19.00,$0.00,$0.00,$0.00,$0.00,$0.00
5330,ERX,HCPCS 63700001,51079-0812-20,NADOLOL 20 MG PO TABS,$17.71,$0.00,$17.71,$0.00,$12.64,$0.00,$0.00,$0.00,$0.00,$0.00,$17.71,$0.00,$8.86,$14.03,$14.17,$0.00,$0.00,$0.00,$0.00,$0.00
5330,ERX,HCPCS 63700001,69238-1123-09,NADOLOL 20 MG PO TABS,$17.71,$0.00,$17.71,$0.00,$12.64,$0.00,$0.00,$0.00,$0.00,$0.00,$17.71,$0.00,$8.86,$14.03,$14.17,$0.00,$0.00,$0.00,$0.00,$0.00
5331,ERX,HCPCS 63700001,51079-0813-01,NADOLOL 40 MG PO TABS,$27.48,$0.00,$27.48,$0.00,$19.61,$0.00,$0.00,$0.00,$0.00,$0.00,$27.48,$0.00,$13.74,$21.76,$21.98,$0.00,$0.00,$0.00,$0.00,$0.00
5331,ERX,HCPCS 63700001,51079-0813-20,NADOLOL 40 MG PO TABS,$27.48,$0.00,$27.48,$0.00,$19.61,$0.00,$0.00,$0.00,$0.00,$0.00,$27.48,$0.00,$13.74,$21.76,$21.98,$0.00,$0.00,$0.00,$0.00,$0.00
5331,ERX,HCPCS 63700001,59762-0811-01,NADOLOL 40 MG PO TABS,$27.48,$0.00,$27.48,$0.00,$19.61,$0.00,$0.00,$0.00,$0.00,$0.00,$27.48,$0.00,$13.74,$21.76,$21.98,$0.00,$0.00,$0.00,$0.00,$0.00
5331,ERX,HCPCS 63700001,69097-0868-07,NADOLOL 40 MG PO TABS,$27.48,$0.00,$27.48,$0.00,$19.61,$0.00,$0.00,$0.00,$0.00,$0.00,$27.48,$0.00,$13.74,$21.76,$21.98,$0.00,$0.00,$0.00,$0.00,$0.00
5331,ERX,HCPCS 63700001,69238-1124-09,NADOLOL 40 MG PO TABS,$27.48,$0.00,$27.48,$0.00,$19.61,$0.00,$0.00,$0.00,$0.00,$0.00,$27.48,$0.00,$13.74,$21.76,$21.98,$0.00,$0.00,$0.00,$0.00,$0.00
5332,ERX,HCPCS 63700001,69097-0869-07,NADOLOL 80 MG PO TABS,$28.47,$0.00,$28.47,$0.00,$20.32,$0.00,$0.00,$0.00,$0.00,$0.00,$28.47,$0.00,$14.24,$22.55,$22.78,$0.00,$0.00,$0.00,$0.00,$0.00
5332,ERX,HCPCS 63700001,69238-1125-09,NADOLOL 80 MG PO TABS,$28.47,$0.00,$28.47,$0.00,$20.32,$0.00,$0.00,$0.00,$0.00,$0.00,$28.47,$0.00,$14.24,$22.55,$22.78,$0.00,$0.00,$0.00,$0.00,$0.00
5333,ERX,HCPCS 25000001,00781-3124-85,NAFCILLIN SODIUM 1 G IJ SOLR,$55.10,$0.00,$55.10,$0.00,$39.32,$0.00,$0.00,$0.00,$0.00,$0.00,$55.10,$0.00,$27.55,$43.64,$44.08,$0.00,$0.00,$0.00,$0.00,$0.00
5333,ERX,HCPCS 25000001,00781-3124-95,NAFCILLIN SODIUM 1 G IJ SOLR,$55.10,$0.00,$55.10,$0.00,$39.32,$0.00,$0.00,$0.00,$0.00,$0.00,$55.10,$0.00,$27.55,$43.64,$44.08,$0.00,$0.00,$0.00,$0.00,$0.00
5333,ERX,HCPCS 25000001,25021-0139-10,NAFCILLIN SODIUM 1 G IJ SOLR,$55.10,$0.00,$55.10,$0.00,$39.32,$0.00,$0.00,$0.00,$0.00,$0.00,$55.10,$0.00,$27.55,$43.64,$44.08,$0.00,$0.00,$0.00,$0.00,$0.00
5333,ERX,HCPCS 25000001,44567-0221-10,NAFCILLIN SODIUM 1 G IJ SOLR,$55.10,$0.00,$55.10,$0.00,$39.32,$0.00,$0.00,$0.00,$0.00,$0.00,$55.10,$0.00,$27.55,$43.64,$44.08,$0.00,$0.00,$0.00,$0.00,$0.00
5333,ERX,HCPCS 25000001,55150-0122-15,NAFCILLIN SODIUM 1 G IJ SOLR,$55.10,$0.00,$55.10,$0.00,$39.32,$0.00,$0.00,$0.00,$0.00,$0.00,$55.10,$0.00,$27.55,$43.64,$44.08,$0.00,$0.00,$0.00,$0.00,$0.00
5333,ERX,HCPCS 25000001,63323-0327-10,NAFCILLIN SODIUM 1 G IJ SOLR,$55.10,$0.00,$55.10,$0.00,$39.32,$0.00,$0.00,$0.00,$0.00,$0.00,$55.10,$0.00,$27.55,$43.64,$44.08,$0.00,$0.00,$0.00,$0.00,$0.00
5333,ERX,HCPCS 25000001,70860-0116-26,NAFCILLIN SODIUM 1 G IJ SOLR,$55.10,$0.00,$55.10,$0.00,$39.32,$0.00,$0.00,$0.00,$0.00,$0.00,$55.10,$0.00,$27.55,$43.64,$44.08,$0.00,$0.00,$0.00,$0.00,$0.00
5333,ERX,HCPCS 25000001,70860-0116-41,NAFCILLIN SODIUM 1 G IJ SOLR,$55.10,$0.00,$55.10,$0.00,$39.32,$0.00,$0.00,$0.00,$0.00,$0.00,$55.10,$0.00,$27.55,$43.64,$44.08,$0.00,$0.00,$0.00,$0.00,$0.00
5335,ERX,HCPCS 25000001,25021-0140-10,NAFCILLIN SODIUM 2 G IJ SOLR,$98.97,$0.00,$98.97,$0.00,$70.63,$0.00,$0.00,$0.00,$0.00,$0.00,$98.97,$0.00,$49.49,$78.38,$79.18,$0.00,$0.00,$0.00,$0.00,$0.00
5335,ERX,HCPCS 25000001,44567-0222-10,NAFCILLIN SODIUM 2 G IJ SOLR,$98.97,$0.00,$98.97,$0.00,$70.63,$0.00,$0.00,$0.00,$0.00,$0.00,$98.97,$0.00,$49.49,$78.38,$79.18,$0.00,$0.00,$0.00,$0.00,$0.00
5335,ERX,HCPCS 25000001,55150-0123-15,NAFCILLIN SODIUM 2 G IJ SOLR,$98.97,$0.00,$98.97,$0.00,$70.63,$0.00,$0.00,$0.00,$0.00,$0.00,$98.97,$0.00,$49.49,$78.38,$79.18,$0.00,$0.00,$0.00,$0.00,$0.00
5335,ERX,HCPCS 25000001,55150-0123-16,NAFCILLIN SODIUM 2 G IJ SOLR,$98.97,$0.00,$98.97,$0.00,$70.63,$0.00,$0.00,$0.00,$0.00,$0.00,$98.97,$0.00,$49.49,$78.38,$79.18,$0.00,$0.00,$0.00,$0.00,$0.00
5335,ERX,HCPCS 25000001,63323-0328-20,NAFCILLIN SODIUM 2 G IJ SOLR,$98.97,$0.00,$98.97,$0.00,$70.63,$0.00,$0.00,$0.00,$0.00,$0.00,$98.97,$0.00,$49.49,$78.38,$79.18,$0.00,$0.00,$0.00,$0.00,$0.00
5335,ERX,HCPCS 25000001,70860-0117-26,NAFCILLIN SODIUM 2 G IJ SOLR,$98.97,$0.00,$98.97,$0.00,$70.63,$0.00,$0.00,$0.00,$0.00,$0.00,$98.97,$0.00,$49.49,$78.38,$79.18,$0.00,$0.00,$0.00,$0.00,$0.00
5335,ERX,HCPCS 25000001,70860-0117-41,NAFCILLIN SODIUM 2 G IJ SOLR,$98.97,$0.00,$98.97,$0.00,$70.63,$0.00,$0.00,$0.00,$0.00,$0.00,$98.97,$0.00,$49.49,$78.38,$79.18,$0.00,$0.00,$0.00,$0.00,$0.00
5339,ERX,HCPCS J2300,00409-1463-01,NALBUPHINE HCL 10 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.22,$0.00,$0.00,$3.70,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.70,$0.00,$3.52,$0.00
5339,ERX,HCPCS J2300,00409-1463-49,NALBUPHINE HCL 10 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.22,$0.00,$0.00,$3.70,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.70,$0.00,$3.52,$0.00
5339,ERX,HCPCS J2300,00409-1464-01,NALBUPHINE HCL 10 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.22,$0.00,$0.00,$3.70,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.70,$0.00,$3.52,$0.00
5339,ERX,HCPCS J2300,99999-6005-73,NALBUPHINE HCL 10 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.22,$0.00,$0.00,$3.70,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.70,$0.00,$3.52,$0.00
5340,ERX,HCPCS J2300,00409-1465-01,NALBUPHINE HCL 20 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.22,$0.00,$0.00,$3.70,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.70,$0.00,$3.52,$0.00
5340,ERX,HCPCS J2300,00409-1467-01,NALBUPHINE HCL 20 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.22,$0.00,$0.00,$3.70,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.70,$0.00,$3.52,$0.00
5373,ERX,HCPCS J2310,00409-1215-01,NALOXONE HCL 0.4 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$4.37,$0.00,$0.00,$15.60,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$15.60,$0.00,$14.86,$0.00
5373,ERX,HCPCS J2310,00409-1215-21,NALOXONE HCL 0.4 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$4.37,$0.00,$0.00,$15.60,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$15.60,$0.00,$14.86,$0.00
5373,ERX,HCPCS J2310,00641-6132-25,NALOXONE HCL 0.4 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$4.37,$0.00,$0.00,$15.60,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$15.60,$0.00,$14.86,$0.00
5373,ERX,HCPCS J2310,67457-0292-00,NALOXONE HCL 0.4 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$4.37,$0.00,$0.00,$15.60,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$15.60,$0.00,$14.86,$0.00
5373,ERX,HCPCS J2310,67457-0292-02,NALOXONE HCL 0.4 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$4.37,$0.00,$0.00,$15.60,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$15.60,$0.00,$14.86,$0.00
5384,ERX,HCPCS 25000001,00065-0085-15,NAPHAZOLINE-PHENIRAMINE 0.025-0.3 % OP SOLN,$57.00,$0.00,$57.00,$0.00,$40.68,$0.00,$0.00,$0.00,$0.00,$0.00,$57.00,$0.00,$28.50,$45.14,$45.60,$0.00,$0.00,$0.00,$0.00,$0.00
5384,ERX,HCPCS 25000001,12547-0493-78,NAPHAZOLINE-PHENIRAMINE 0.025-0.3 % OP SOLN,$57.00,$0.00,$57.00,$0.00,$40.68,$0.00,$0.00,$0.00,$0.00,$0.00,$57.00,$0.00,$28.50,$45.14,$45.60,$0.00,$0.00,$0.00,$0.00,$0.00
5384,ERX,HCPCS 25000001,69968-0063-01,NAPHAZOLINE-PHENIRAMINE 0.025-0.3 % OP SOLN,$57.00,$0.00,$57.00,$0.00,$40.68,$0.00,$0.00,$0.00,$0.00,$0.00,$57.00,$0.00,$28.50,$45.14,$45.60,$0.00,$0.00,$0.00,$0.00,$0.00
5391,ERX,HCPCS 63700001,50268-0594-15,NAPROXEN 250 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5391,ERX,HCPCS 63700001,51079-0793-01,NAPROXEN 250 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5391,ERX,HCPCS 63700001,51079-0793-20,NAPROXEN 250 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5391,ERX,HCPCS 63700001,65162-0188-10,NAPROXEN 250 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5392,ERX,HCPCS 63700001,65162-0189-50,NAPROXEN 375 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5392,ERX,HCPCS 63700001,76282-0341-01,NAPROXEN 375 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5393,ERX,HCPCS 63700001,51079-0795-01,NAPROXEN 500 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5393,ERX,HCPCS 63700001,51079-0795-20,NAPROXEN 500 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5393,ERX,HCPCS 63700001,60687-0491-01,NAPROXEN 500 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5393,ERX,HCPCS 63700001,60687-0491-11,NAPROXEN 500 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5393,ERX,HCPCS 63700001,63739-0403-10,NAPROXEN 500 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5393,ERX,HCPCS 63700001,68462-0190-01,NAPROXEN 500 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5472,ERX,HCPCS 63700001,00093-1177-01,NEOMYCIN SULFATE 500 MG PO TABS,$7.51,$0.00,$7.51,$0.00,$5.36,$0.00,$0.00,$0.00,$0.00,$0.00,$7.51,$0.00,$3.76,$5.95,$6.01,$0.00,$0.00,$0.00,$0.00,$0.00
5472,ERX,HCPCS 63700001,39822-0310-05,NEOMYCIN SULFATE 500 MG PO TABS,$7.51,$0.00,$7.51,$0.00,$5.36,$0.00,$0.00,$0.00,$0.00,$0.00,$7.51,$0.00,$3.76,$5.95,$6.01,$0.00,$0.00,$0.00,$0.00,$0.00
5472,ERX,HCPCS 63700001,50383-0565-10,NEOMYCIN SULFATE 500 MG PO TABS,$7.51,$0.00,$7.51,$0.00,$5.36,$0.00,$0.00,$0.00,$0.00,$0.00,$7.51,$0.00,$3.76,$5.95,$6.01,$0.00,$0.00,$0.00,$0.00,$0.00
5472,ERX,HCPCS 63700001,51079-0015-01,NEOMYCIN SULFATE 500 MG PO TABS,$7.51,$0.00,$7.51,$0.00,$5.36,$0.00,$0.00,$0.00,$0.00,$0.00,$7.51,$0.00,$3.76,$5.95,$6.01,$0.00,$0.00,$0.00,$0.00,$0.00
5472,ERX,HCPCS 63700001,51079-0015-20,NEOMYCIN SULFATE 500 MG PO TABS,$7.51,$0.00,$7.51,$0.00,$5.36,$0.00,$0.00,$0.00,$0.00,$0.00,$7.51,$0.00,$3.76,$5.95,$6.01,$0.00,$0.00,$0.00,$0.00,$0.00
5474,ERX,HCPCS 25000001,24208-0790-62,NEOMYCIN-POLYMYXIN-GRAMICIDIN 1.75-10000-.025 OP SOLN,$192.97,$0.00,$192.97,$0.00,$137.72,$0.00,$0.00,$0.00,$0.00,$0.00,$192.97,$0.00,$96.49,$152.83,$154.38,$0.00,$0.00,$0.00,$0.00,$0.00
5539,ERX,HCPCS 63700001,54629-0071-01,NIACIN 100 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5542,ERX,HCPCS 63700001,00536-4078-10,NIACIN 500 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5558,ERX,HCPCS 63700001,00228-2497-10,NIFEDIPINE 10 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5558,ERX,HCPCS 63700001,43386-0440-24,NIFEDIPINE 10 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5558,ERX,HCPCS 63700001,69315-0211-01,NIFEDIPINE 10 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5559,ERX,HCPCS 63700001,00228-2530-10,NIFEDIPINE 20 MG PO CAPS,$8.76,$0.00,$8.76,$0.00,$6.25,$0.00,$0.00,$0.00,$0.00,$0.00,$8.76,$0.00,$4.38,$6.94,$7.01,$0.00,$0.00,$0.00,$0.00,$0.00
5559,ERX,HCPCS 63700001,23155-0195-01,NIFEDIPINE 20 MG PO CAPS,$8.76,$0.00,$8.76,$0.00,$6.25,$0.00,$0.00,$0.00,$0.00,$0.00,$8.76,$0.00,$4.38,$6.94,$7.01,$0.00,$0.00,$0.00,$0.00,$0.00
5595,ERX,HCPCS 63700001,47781-0307-01,NITROFURANTOIN MACROCRYSTAL 50 MG PO CAPS,$8.64,$0.00,$8.64,$0.00,$6.17,$0.00,$0.00,$0.00,$0.00,$0.00,$8.64,$0.00,$4.32,$6.84,$6.91,$0.00,$0.00,$0.00,$0.00,$0.00
5599,ERX,HCPCS 25000001,00517-4810-25,NITROGLYCERIN 5 MG/ML IV SOLN,$65.06,$0.00,$65.06,$0.00,$46.43,$0.00,$0.00,$0.00,$0.00,$0.00,$65.06,$0.00,$32.53,$51.53,$52.05,$0.00,$0.00,$0.00,$0.00,$0.00
5603,ERX,HCPCS 25000001,00071-0417-24,NITROGLYCERIN 0.3 MG SL SUBL,$226.49,$0.00,$226.49,$0.00,$161.65,$0.00,$0.00,$0.00,$0.00,$0.00,$226.49,$0.00,$113.25,$179.38,$181.19,$0.00,$0.00,$0.00,$0.00,$0.00
5603,ERX,HCPCS 25000001,59762-4921-01,NITROGLYCERIN 0.3 MG SL SUBL,$226.49,$0.00,$226.49,$0.00,$161.65,$0.00,$0.00,$0.00,$0.00,$0.00,$226.49,$0.00,$113.25,$179.38,$181.19,$0.00,$0.00,$0.00,$0.00,$0.00
5604,ERX,HCPCS 25000001,00071-0418-13,NITROGLYCERIN 0.4 MG SL SUBL,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5604,ERX,HCPCS 25000001,43598-0436-11,NITROGLYCERIN 0.4 MG SL SUBL,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5604,ERX,HCPCS 25000001,43598-0436-35,NITROGLYCERIN 0.4 MG SL SUBL,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5604,ERX,HCPCS 25000001,59762-3304-03,NITROGLYCERIN 0.4 MG SL SUBL,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5604,ERX,HCPCS 25000001,68462-0639-45,NITROGLYCERIN 0.4 MG SL SUBL,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5605,ERX,HCPCS 25000001,00071-0419-24,NITROGLYCERIN 0.6 MG SL SUBL,$226.49,$0.00,$226.49,$0.00,$161.65,$0.00,$0.00,$0.00,$0.00,$0.00,$226.49,$0.00,$113.25,$179.38,$181.19,$0.00,$0.00,$0.00,$0.00,$0.00
5605,ERX,HCPCS 25000001,59762-0489-01,NITROGLYCERIN 0.6 MG SL SUBL,$226.49,$0.00,$226.49,$0.00,$161.65,$0.00,$0.00,$0.00,$0.00,$0.00,$226.49,$0.00,$113.25,$179.38,$181.19,$0.00,$0.00,$0.00,$0.00,$0.00
5606,ERX,HCPCS 25000001,00281-0326-08,NITROGLYCERIN 2 % TD OINT,$10.47,$0.00,$10.47,$0.00,$7.47,$0.00,$0.00,$0.00,$0.00,$0.00,$10.47,$0.00,$5.24,$8.29,$8.38,$0.00,$0.00,$0.00,$0.00,$0.00
5674,ERX,HCPCS 63700001,50268-0603-15,NORTRIPTYLINE HCL 10 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5674,ERX,HCPCS 63700001,60687-0281-01,NORTRIPTYLINE HCL 10 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5675,ERX,HCPCS 63700001,51672-4002-01,NORTRIPTYLINE HCL 25 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5677,ERX,HCPCS 63700001,00093-0813-01,NORTRIPTYLINE HCL 75 MG PO CAPS,$16.03,$0.00,$16.03,$0.00,$11.44,$0.00,$0.00,$0.00,$0.00,$0.00,$16.03,$0.00,$8.02,$12.70,$12.82,$0.00,$0.00,$0.00,$0.00,$0.00
5677,ERX,HCPCS 63700001,51672-4004-01,NORTRIPTYLINE HCL 75 MG PO CAPS,$16.03,$0.00,$16.03,$0.00,$11.44,$0.00,$0.00,$0.00,$0.00,$0.00,$16.03,$0.00,$8.02,$12.70,$12.82,$0.00,$0.00,$0.00,$0.00,$0.00
5749,ERX,HCPCS 25000001,00168-0054-15,NYSTATIN 100000 UNIT/GM EX CREA,$92.19,$0.00,$92.19,$0.00,$65.80,$0.00,$0.00,$0.00,$0.00,$0.00,$92.19,$0.00,$46.10,$73.01,$73.75,$0.00,$0.00,$0.00,$0.00,$0.00
5749,ERX,HCPCS 25000001,45802-0059-35,NYSTATIN 100000 UNIT/GM EX CREA,$92.19,$0.00,$92.19,$0.00,$65.80,$0.00,$0.00,$0.00,$0.00,$0.00,$92.19,$0.00,$46.10,$73.01,$73.75,$0.00,$0.00,$0.00,$0.00,$0.00
5749,ERX,HCPCS 25000001,51672-1289-01,NYSTATIN 100000 UNIT/GM EX CREA,$92.19,$0.00,$92.19,$0.00,$65.80,$0.00,$0.00,$0.00,$0.00,$0.00,$92.19,$0.00,$46.10,$73.01,$73.75,$0.00,$0.00,$0.00,$0.00,$0.00
5749,ERX,HCPCS 25000001,00168-0054-30,NYSTATIN 100000 UNIT/GM EX CREA,$92.19,$0.00,$92.19,$0.00,$65.80,$0.00,$0.00,$0.00,$0.00,$0.00,$92.19,$0.00,$46.10,$73.01,$73.75,$0.00,$0.00,$0.00,$0.00,$0.00
5749,ERX,HCPCS 25000001,45802-0059-11,NYSTATIN 100000 UNIT/GM EX CREA,$92.19,$0.00,$92.19,$0.00,$65.80,$0.00,$0.00,$0.00,$0.00,$0.00,$92.19,$0.00,$46.10,$73.01,$73.75,$0.00,$0.00,$0.00,$0.00,$0.00
5749,ERX,HCPCS 25000001,51672-1289-02,NYSTATIN 100000 UNIT/GM EX CREA,$92.19,$0.00,$92.19,$0.00,$65.80,$0.00,$0.00,$0.00,$0.00,$0.00,$92.19,$0.00,$46.10,$73.01,$73.75,$0.00,$0.00,$0.00,$0.00,$0.00
5750,ERX,HCPCS 25000001,00168-0007-15,NYSTATIN 100000 UNIT/GM EX OINT,$88.20,$0.00,$88.20,$0.00,$62.95,$0.00,$0.00,$0.00,$0.00,$0.00,$88.20,$0.00,$44.10,$69.85,$70.56,$0.00,$0.00,$0.00,$0.00,$0.00
5750,ERX,HCPCS 25000001,45802-0048-35,NYSTATIN 100000 UNIT/GM EX OINT,$88.20,$0.00,$88.20,$0.00,$62.95,$0.00,$0.00,$0.00,$0.00,$0.00,$88.20,$0.00,$44.10,$69.85,$70.56,$0.00,$0.00,$0.00,$0.00,$0.00
5750,ERX,HCPCS 25000001,00168-0007-30,NYSTATIN 100000 UNIT/GM EX OINT,$88.20,$0.00,$88.20,$0.00,$62.95,$0.00,$0.00,$0.00,$0.00,$0.00,$88.20,$0.00,$44.10,$69.85,$70.56,$0.00,$0.00,$0.00,$0.00,$0.00
5750,ERX,HCPCS 25000001,00472-0166-30,NYSTATIN 100000 UNIT/GM EX OINT,$88.20,$0.00,$88.20,$0.00,$62.95,$0.00,$0.00,$0.00,$0.00,$0.00,$88.20,$0.00,$44.10,$69.85,$70.56,$0.00,$0.00,$0.00,$0.00,$0.00
5750,ERX,HCPCS 25000001,45802-0048-11,NYSTATIN 100000 UNIT/GM EX OINT,$88.20,$0.00,$88.20,$0.00,$62.95,$0.00,$0.00,$0.00,$0.00,$0.00,$88.20,$0.00,$44.10,$69.85,$70.56,$0.00,$0.00,$0.00,$0.00,$0.00
5751,ERX,HCPCS 25000001,50383-0587-66,NYSTATIN 100000 UNIT/ML MT SUSP,$64.30,$0.00,$353.45,$0.00,$252.26,$0.00,$0.00,$0.00,$0.00,$0.00,$353.45,$0.00,$176.73,$50.93,$282.76,$0.00,$0.00,$0.00,$0.00,$0.00
5751,ERX,HCPCS 25000001,51672-4117-04,NYSTATIN 100000 UNIT/ML MT SUSP,$64.30,$0.00,$353.45,$0.00,$252.26,$0.00,$0.00,$0.00,$0.00,$0.00,$353.45,$0.00,$176.73,$50.93,$282.76,$0.00,$0.00,$0.00,$0.00,$0.00
5751,ERX,HCPCS 25000001,60432-0537-60,NYSTATIN 100000 UNIT/ML MT SUSP,$64.30,$0.00,$353.45,$0.00,$252.26,$0.00,$0.00,$0.00,$0.00,$0.00,$353.45,$0.00,$176.73,$50.93,$282.76,$0.00,$0.00,$0.00,$0.00,$0.00
5751,ERX,HCPCS 25000001,50383-0587-16,NYSTATIN 100000 UNIT/ML MT SUSP,$353.45,$0.00,$353.45,$0.00,$252.26,$0.00,$0.00,$0.00,$0.00,$0.00,$353.45,$0.00,$176.73,$279.93,$282.76,$0.00,$0.00,$0.00,$0.00,$0.00
5751,ERX,HCPCS 25000001,51672-4117-09,NYSTATIN 100000 UNIT/ML MT SUSP,$353.45,$0.00,$353.45,$0.00,$252.26,$0.00,$0.00,$0.00,$0.00,$0.00,$353.45,$0.00,$176.73,$279.93,$282.76,$0.00,$0.00,$0.00,$0.00,$0.00
5751,ERX,HCPCS 25000001,60432-0537-16,NYSTATIN 100000 UNIT/ML MT SUSP,$353.45,$0.00,$353.45,$0.00,$252.26,$0.00,$0.00,$0.00,$0.00,$0.00,$353.45,$0.00,$176.73,$279.93,$282.76,$0.00,$0.00,$0.00,$0.00,$0.00
5755,ERX,HCPCS 25000001,51672-1272-01,NYSTATIN-TRIAMCINOLONE 100000-0.1 UNIT/GM-% EX OINT,$341.44,$0.00,$341.44,$0.00,$243.69,$0.00,$0.00,$0.00,$0.00,$0.00,$341.44,$0.00,$170.72,$270.42,$273.15,$0.00,$0.00,$0.00,$0.00,$0.00
5851,ERX,HCPCS 25000001,99999-6006-21,ORA-PLUS PO LIQD,$19.16,$0.00,$19.16,$0.00,$13.67,$0.00,$0.00,$0.00,$0.00,$0.00,$19.16,$0.00,$9.58,$15.17,$15.33,$0.00,$0.00,$0.00,$0.00,$0.00
5851,ERX,HCPCS 25000001,00574-0303-16,ORA-PLUS PO LIQD,$77.81,$0.00,$61.63,$0.00,$13.67,$0.00,$0.00,$0.00,$0.00,$0.00,$19.16,$0.00,$9.58,$61.63,$15.33,$0.00,$0.00,$0.00,$0.00,$0.00
5852,ERX,HCPCS 25000001,00574-0304-16,ORA-SWEET PO SYRP,$77.81,$0.00,$77.81,$0.00,$55.53,$0.00,$0.00,$0.00,$0.00,$0.00,$77.81,$0.00,$38.91,$61.63,$62.25,$0.00,$0.00,$0.00,$0.00,$0.00
5853,ERX,HCPCS 25000001,00574-0302-16,ORA-SWEET SF PO SYRP,$77.81,$0.00,$77.81,$0.00,$55.53,$0.00,$0.00,$0.00,$0.00,$0.00,$77.81,$0.00,$38.91,$61.63,$62.25,$0.00,$0.00,$0.00,$0.00,$0.00
5924,ERX,HCPCS J2700,25021-0146-10,OXACILLIN SODIUM 1 G IJ SOLR,$25.65,$0.00,$25.65,$0.00,$18.31,$0.00,$0.00,$0.00,$0.00,$0.00,$25.65,$0.00,$12.83,$20.31,$20.52,$0.00,$0.00,$0.00,$0.00,$0.00
5924,ERX,HCPCS J2700,55150-0127-15,OXACILLIN SODIUM 1 G IJ SOLR,$25.65,$0.00,$25.65,$0.00,$18.31,$0.00,$0.00,$0.00,$0.00,$0.00,$25.65,$0.00,$12.83,$20.31,$20.52,$0.00,$0.00,$0.00,$0.00,$0.00
5938,ERX,HCPCS 63700001,00603-4975-21,OXYBUTYNIN CHLORIDE 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5938,ERX,HCPCS 63700001,00832-0038-00,OXYBUTYNIN CHLORIDE 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5938,ERX,HCPCS 63700001,00832-0038-01,OXYBUTYNIN CHLORIDE 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5938,ERX,HCPCS 63700001,00832-0038-50,OXYBUTYNIN CHLORIDE 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5938,ERX,HCPCS 63700001,00904-2821-61,OXYBUTYNIN CHLORIDE 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5938,ERX,HCPCS 63700001,50111-0456-01,OXYBUTYNIN CHLORIDE 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5938,ERX,HCPCS 63700001,68084-0400-01,OXYBUTYNIN CHLORIDE 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5940,ERX,HCPCS 25000001,00054-0551-25,OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5940,ERX,HCPCS 25000001,00406-0512-01,OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5940,ERX,HCPCS 25000001,00406-0512-05,OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5940,ERX,HCPCS 25000001,00406-0512-23,OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5940,ERX,HCPCS 25000001,00406-0512-62,OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5940,ERX,HCPCS 25000001,00904-6437-61,OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5940,ERX,HCPCS 25000001,13107-0044-01,OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5940,ERX,HCPCS 25000001,68084-0355-01,OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5940,ERX,HCPCS 25000001,68084-0355-11,OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5940,ERX,HCPCS 25000001,99999-6006-78,OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5943,ERX,HCPCS 25000001,00904-6761-30,OXYMETAZOLINE HCL 0.05 % NA SOLN,$11.00,$0.00,$11.00,$0.00,$7.85,$0.00,$0.00,$0.00,$0.00,$0.00,$11.00,$0.00,$5.50,$8.71,$8.80,$0.00,$0.00,$0.00,$0.00,$0.00
5944,ERX,HCPCS J2590,42023-0116-02,OXYTOCIN 10 UNIT/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.47,$0.00,$0.00,$3.85,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.44,$0.00,$0.00,$0.00
5944,ERX,HCPCS J2590,42023-0116-25,OXYTOCIN 10 UNIT/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.47,$0.00,$0.00,$3.85,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.44,$0.00,$0.00,$0.00
5944,ERX,HCPCS J2590,63323-0012-03,OXYTOCIN 10 UNIT/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.47,$0.00,$0.00,$3.85,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.44,$0.00,$0.00,$0.00
5944,ERX,HCPCS J2590,63323-0012-10,OXYTOCIN 10 UNIT/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.47,$0.00,$0.00,$3.85,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.44,$0.00,$0.00,$0.00
5944,ERX,HCPCS J2590,63323-0012-11,OXYTOCIN 10 UNIT/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.47,$0.00,$0.00,$3.85,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.44,$0.00,$0.00,$0.00
5944,ERX,HCPCS J2590,63323-0012-12,OXYTOCIN 10 UNIT/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.47,$0.00,$0.00,$3.85,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.44,$0.00,$0.00,$0.00
5955,ERX,HCPCS 63700001,00904-1883-61,OYSTER CALCIUM 500 (1250 CA CARB) MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5955,ERX,HCPCS 63700001,00904-1883-72,OYSTER CALCIUM 500 (1250 CA CARB) MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
5955,ERX,HCPCS 63700001,51645-0827-99,OYSTER CALCIUM 500 (1250 CA CARB) MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6013,ERX,HCPCS 25000001,00409-4646-01,PANCURONIUM BROMIDE 1 MG/ML IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
6030,ERX,HCPCS J2440,00517-4002-25,PAPAVERINE HCL 30 MG/ML IJ SOLN,$86.97,$0.00,$86.97,$39.14,$62.07,$0.00,$14.98,$0.00,$0.00,$15.23,$86.97,$0.00,$43.49,$68.88,$69.58,$0.00,$13.61,$0.00,$13.85,$0.00
6040,ERX,HCPCS J7300,51285-0204-01,PARAGARD INTRAUTERINE COPPER IU IUD,"$2,175.87",$0.00,"$2,175.87",$979.14,"$1,552.92",$387.30,$750.43,$0.00,$0.00,"$1,039.29","$2,175.87",$0.00,"$1,087.94","$1,723.29","$1,740.70","$1,305.52","$1,039.29",$0.00,$989.58,$0.00
6040,ERX,HCPCS J7300,59365-5128-01,PARAGARD INTRAUTERINE COPPER IU IUD,"$2,175.87",$0.00,"$2,175.87",$979.14,"$1,552.92",$387.30,$750.43,$0.00,$0.00,"$1,039.29","$2,175.87",$0.00,"$1,087.94","$1,723.29","$1,740.70","$1,305.52","$1,039.29",$0.00,$989.58,$0.00
6085,ERX,HCPCS J2540,00049-0530-22,PENICILLIN G POTASSIUM 20000000 UNITS IJ SOLR,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
6085,ERX,HCPCS J2540,00049-0530-28,PENICILLIN G POTASSIUM 20000000 UNITS IJ SOLR,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
6085,ERX,HCPCS J2540,70860-0127-51,PENICILLIN G POTASSIUM 20000000 UNITS IJ SOLR,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
6086,ERX,HCPCS J2540,00049-0520-83,PENICILLIN G POTASSIUM 5000000 UNITS IJ SOLR,$57.73,$0.00,$57.73,$0.00,$41.20,$0.00,$0.00,$0.00,$0.00,$0.00,$57.73,$0.00,$28.87,$45.72,$46.18,$0.00,$0.00,$0.00,$0.00,$0.00
6087,ERX,HCPCS 25000001,00781-6153-94,PENICILLIN G SODIUM 5000000 UNITS IJ SOLR,$26.27,$0.00,$26.27,$0.00,$18.75,$0.00,$0.00,$0.00,$0.00,$0.00,$26.27,$0.00,$13.14,$20.81,$21.02,$0.00,$0.00,$0.00,$0.00,$0.00
6087,ERX,HCPCS 25000001,00781-6153-95,PENICILLIN G SODIUM 5000000 UNITS IJ SOLR,$26.27,$0.00,$26.27,$0.00,$18.75,$0.00,$0.00,$0.00,$0.00,$0.00,$26.27,$0.00,$13.14,$20.81,$21.02,$0.00,$0.00,$0.00,$0.00,$0.00
6090,ERX,HCPCS 63700001,00093-4125-73,PENICILLIN V POTASSIUM 125 MG/5ML PO SOLR,$34.58,$0.00,$34.58,$0.00,$24.68,$0.00,$0.00,$0.00,$0.00,$0.00,$34.58,$0.00,$17.29,$27.39,$27.66,$0.00,$0.00,$0.00,$0.00,$0.00
6090,ERX,HCPCS 63700001,00093-4125-74,PENICILLIN V POTASSIUM 125 MG/5ML PO SOLR,$50.92,$0.00,$40.33,$0.00,$24.68,$0.00,$0.00,$0.00,$0.00,$0.00,$34.58,$0.00,$17.29,$40.33,$27.66,$0.00,$0.00,$0.00,$0.00,$0.00
6091,ERX,HCPCS 25000001,00093-4127-73,PENICILLIN V POTASSIUM 250 MG/5ML PO SOLR,$38.76,$0.00,$38.76,$0.00,$27.66,$0.00,$0.00,$0.00,$0.00,$0.00,$38.76,$0.00,$19.38,$30.70,$31.01,$0.00,$0.00,$0.00,$0.00,$0.00
6091,ERX,HCPCS 25000001,00093-4127-74,PENICILLIN V POTASSIUM 250 MG/5ML PO SOLR,$56.24,$0.00,$44.54,$0.00,$27.66,$0.00,$0.00,$0.00,$0.00,$0.00,$38.76,$0.00,$19.38,$44.54,$31.01,$0.00,$0.00,$0.00,$0.00,$0.00
6092,ERX,HCPCS 63700001,00093-1172-10,PENICILLIN V POTASSIUM 250 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6092,ERX,HCPCS 63700001,16714-0234-01,PENICILLIN V POTASSIUM 250 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6092,ERX,HCPCS 63700001,57237-0040-01,PENICILLIN V POTASSIUM 250 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6093,ERX,HCPCS 63700001,16714-0235-01,PENICILLIN V POTASSIUM 500 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6097,ERX,HCPCS J2515,25021-0676-20,PENTOBARBITAL SODIUM 50 MG/ML IJ SOLN,"$3,444.00",$0.00,"$3,444.00",$0.00,"$2,457.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,444.00",$0.00,"$1,722.00","$2,727.65","$2,755.20",$0.00,$0.00,$0.00,$0.00,$0.00
6097,ERX,HCPCS J2515,76478-0501-20,PENTOBARBITAL SODIUM 50 MG/ML IJ SOLN,"$3,444.00",$0.00,"$3,444.00",$0.00,"$2,457.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,444.00",$0.00,"$1,722.00","$2,727.65","$2,755.20",$0.00,$0.00,$0.00,$0.00,$0.00
6116,ERX,HCPCS 25000001,00395-2015-91,PEPPERMINT OIL OIL,$86.10,$0.00,$86.10,$0.00,$61.45,$0.00,$0.00,$0.00,$0.00,$0.00,$86.10,$0.00,$43.05,$68.19,$68.88,$0.00,$0.00,$0.00,$0.00,$0.00
6157,ERX,HCPCS Q0175,00781-1046-13,PERPHENAZINE 2 MG PO TABS,$7.47,$0.00,$7.47,$0.00,$5.33,$0.00,$0.00,$0.00,$0.00,$0.00,$7.47,$0.00,$3.74,$5.92,$5.98,$0.00,$0.00,$0.00,$0.00,$0.00
6157,ERX,HCPCS Q0175,52536-0162-01,PERPHENAZINE 2 MG PO TABS,$7.47,$0.00,$7.47,$0.00,$5.33,$0.00,$0.00,$0.00,$0.00,$0.00,$7.47,$0.00,$3.74,$5.92,$5.98,$0.00,$0.00,$0.00,$0.00,$0.00
6158,ERX,HCPCS Q0175,00603-5061-21,PERPHENAZINE 4 MG PO TABS,$10.22,$0.00,$10.22,$0.00,$7.29,$0.00,$0.00,$0.00,$0.00,$0.00,$10.22,$0.00,$5.11,$8.09,$8.18,$0.00,$0.00,$0.00,$0.00,$0.00
6158,ERX,HCPCS Q0175,00781-1047-01,PERPHENAZINE 4 MG PO TABS,$10.22,$0.00,$10.22,$0.00,$7.29,$0.00,$0.00,$0.00,$0.00,$0.00,$10.22,$0.00,$5.11,$8.09,$8.18,$0.00,$0.00,$0.00,$0.00,$0.00
6158,ERX,HCPCS Q0175,00781-1047-13,PERPHENAZINE 4 MG PO TABS,$10.22,$0.00,$10.22,$0.00,$7.29,$0.00,$0.00,$0.00,$0.00,$0.00,$10.22,$0.00,$5.11,$8.09,$8.18,$0.00,$0.00,$0.00,$0.00,$0.00
6158,ERX,HCPCS Q0175,00781-8047-01,PERPHENAZINE 4 MG PO TABS,$10.22,$0.00,$10.22,$0.00,$7.29,$0.00,$0.00,$0.00,$0.00,$0.00,$10.22,$0.00,$5.11,$8.09,$8.18,$0.00,$0.00,$0.00,$0.00,$0.00
6159,ERX,HCPCS Q0175,00378-5352-01,PERPHENAZINE 8 MG PO TABS,$12.40,$0.00,$12.40,$0.00,$8.85,$0.00,$0.00,$0.00,$0.00,$0.00,$12.40,$0.00,$6.20,$9.82,$9.92,$0.00,$0.00,$0.00,$0.00,$0.00
6159,ERX,HCPCS Q0175,00603-5062-21,PERPHENAZINE 8 MG PO TABS,$12.40,$0.00,$12.40,$0.00,$8.85,$0.00,$0.00,$0.00,$0.00,$0.00,$12.40,$0.00,$6.20,$9.82,$9.92,$0.00,$0.00,$0.00,$0.00,$0.00
6159,ERX,HCPCS Q0175,00781-1048-13,PERPHENAZINE 8 MG PO TABS,$12.40,$0.00,$12.40,$0.00,$8.85,$0.00,$0.00,$0.00,$0.00,$0.00,$12.40,$0.00,$6.20,$9.82,$9.92,$0.00,$0.00,$0.00,$0.00,$0.00
6159,ERX,HCPCS Q0175,00781-8048-01,PERPHENAZINE 8 MG PO TABS,$12.40,$0.00,$12.40,$0.00,$8.85,$0.00,$0.00,$0.00,$0.00,$0.00,$12.40,$0.00,$6.20,$9.82,$9.92,$0.00,$0.00,$0.00,$0.00,$0.00
6159,ERX,HCPCS Q0175,68084-0607-01,PERPHENAZINE 8 MG PO TABS,$12.40,$0.00,$12.40,$0.00,$8.85,$0.00,$0.00,$0.00,$0.00,$0.00,$12.40,$0.00,$6.20,$9.82,$9.92,$0.00,$0.00,$0.00,$0.00,$0.00
6193,ERX,HCPCS 63700001,10135-0620-01,PHENAZOPYRIDINE HCL 100 MG PO TABS,$6.05,$0.00,$6.05,$0.00,$4.32,$0.00,$0.00,$0.00,$0.00,$0.00,$6.05,$0.00,$3.03,$4.79,$4.84,$0.00,$0.00,$0.00,$0.00,$0.00
6193,ERX,HCPCS 63700001,42937-0701-10,PHENAZOPYRIDINE HCL 100 MG PO TABS,$6.05,$0.00,$6.05,$0.00,$4.32,$0.00,$0.00,$0.00,$0.00,$0.00,$6.05,$0.00,$3.03,$4.79,$4.84,$0.00,$0.00,$0.00,$0.00,$0.00
6193,ERX,HCPCS 63700001,51293-0801-01,PHENAZOPYRIDINE HCL 100 MG PO TABS,$6.05,$0.00,$6.05,$0.00,$4.32,$0.00,$0.00,$0.00,$0.00,$0.00,$6.05,$0.00,$3.03,$4.79,$4.84,$0.00,$0.00,$0.00,$0.00,$0.00
6212,ERX,HCPCS 63700001,00603-1508-58,PHENOBARBITAL 20 MG/5ML PO ELIX,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6212,ERX,HCPCS 63700001,13517-0107-16,PHENOBARBITAL 20 MG/5ML PO ELIX,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6212,ERX,HCPCS 63700001,99999-6006-84,PHENOBARBITAL 20 MG/5ML PO ELIX,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6217,ERX,HCPCS 63700001,00904-6575-61,PHENOBARBITAL 32.4 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6220,ERX,HCPCS 63700001,00603-5168-21,PHENOBARBITAL 97.2 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6220,ERX,HCPCS 63700001,13517-0113-01,PHENOBARBITAL 97.2 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6221,ERX,HCPCS J2560,00641-0477-21,PHENOBARBITAL SODIUM 130 MG/ML IJ SOLN,$181.17,$0.00,$181.17,$81.53,$129.30,$0.00,$3.81,$0.00,$0.00,$49.81,$181.17,$0.00,$90.59,$143.49,$144.94,$0.00,$49.81,$0.00,$47.43,$0.00
6221,ERX,HCPCS J2560,00641-0477-25,PHENOBARBITAL SODIUM 130 MG/ML IJ SOLN,$181.17,$0.00,$181.17,$81.53,$129.30,$0.00,$3.81,$0.00,$0.00,$49.81,$181.17,$0.00,$90.59,$143.49,$144.94,$0.00,$49.81,$0.00,$47.43,$0.00
6224,ERX,HCPCS J2560,00641-0476-25,PHENOBARBITAL SODIUM 65 MG/ML IJ SOLN,$100.72,$0.00,$100.72,$45.32,$71.88,$0.00,$3.81,$0.00,$0.00,$49.81,$100.72,$0.00,$50.36,$79.77,$80.58,$0.00,$49.81,$0.00,$47.43,$0.00
6227,ERX,HCPCS 25000001,49452-5220-02,PHENOL EX LIQD,"$1,269.60",$0.00,"$1,269.60",$0.00,$906.11,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,269.60",$0.00,$634.80,"$1,005.52","$1,015.68",$0.00,$0.00,$0.00,$0.00,$0.00
6243,ERX,HCPCS 25000001,00225-0800-47,PHENYLEPHRINE HCL 0.25 % NA SOLN,$14.43,$0.00,$14.43,$0.00,$10.30,$0.00,$0.00,$0.00,$0.00,$0.00,$14.43,$0.00,$7.22,$11.43,$11.54,$0.00,$0.00,$0.00,$0.00,$0.00
6244,ERX,HCPCS 25000001,00225-0805-47,PHENYLEPHRINE HCL 0.5 % NA SOLN,$14.43,$0.00,$14.43,$0.00,$10.30,$0.00,$0.00,$0.00,$0.00,$0.00,$14.43,$0.00,$7.22,$11.43,$11.54,$0.00,$0.00,$0.00,$0.00,$0.00
6246,ERX,HCPCS 25000001,17478-0201-02,PHENYLEPHRINE HCL 2.5 % OP SOLN,$142.21,$0.00,$343.13,$0.00,$244.89,$0.00,$0.00,$0.00,$0.00,$0.00,$343.13,$0.00,$171.57,$112.63,$274.50,$0.00,$0.00,$0.00,$0.00,$0.00
6246,ERX,HCPCS 25000001,17478-0201-15,PHENYLEPHRINE HCL 2.5 % OP SOLN,$343.13,$0.00,$343.13,$0.00,$244.89,$0.00,$0.00,$0.00,$0.00,$0.00,$343.13,$0.00,$171.57,$271.76,$274.50,$0.00,$0.00,$0.00,$0.00,$0.00
6246,ERX,HCPCS 25000001,42702-0102-15,PHENYLEPHRINE HCL 2.5 % OP SOLN,$343.13,$0.00,$343.13,$0.00,$244.89,$0.00,$0.00,$0.00,$0.00,$0.00,$343.13,$0.00,$171.57,$271.76,$274.50,$0.00,$0.00,$0.00,$0.00,$0.00
6255,ERX,HCPCS 63700001,99999-6010-65,PHENYTOIN 125 MG/5ML PO SUSP,$75.02,$0.00,$138.18,$0.00,$98.62,$0.00,$0.00,$0.00,$0.00,$0.00,$138.18,$0.00,$69.09,$59.42,$110.54,$0.00,$0.00,$0.00,$0.00,$0.00
6255,ERX,HCPCS 63700001,99999-6004-70,PHENYTOIN 125 MG/5ML PO SUSP,$138.18,$0.00,$138.18,$0.00,$98.62,$0.00,$0.00,$0.00,$0.00,$0.00,$138.18,$0.00,$69.09,$109.44,$110.54,$0.00,$0.00,$0.00,$0.00,$0.00
6255,ERX,HCPCS 63700001,00071-2214-20,PHENYTOIN 125 MG/5ML PO SUSP,$539.50,$0.00,$427.28,$0.00,$98.62,$0.00,$0.00,$0.00,$0.00,$0.00,$138.18,$0.00,$69.09,$427.28,$110.54,$0.00,$0.00,$0.00,$0.00,$0.00
6255,ERX,HCPCS 63700001,59762-0531-02,PHENYTOIN 125 MG/5ML PO SUSP,$539.50,$0.00,$427.28,$0.00,$98.62,$0.00,$0.00,$0.00,$0.00,$0.00,$138.18,$0.00,$69.09,$427.28,$110.54,$0.00,$0.00,$0.00,$0.00,$0.00
6256,ERX,HCPCS J1165,00641-0493-25,PHENYTOIN SODIUM 50 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
6256,ERX,HCPCS J1165,00641-2555-41,PHENYTOIN SODIUM 50 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
6256,ERX,HCPCS J1165,00641-2555-45,PHENYTOIN SODIUM 50 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
6256,ERX,HCPCS J1165,00641-6138-25,PHENYTOIN SODIUM 50 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
6256,ERX,HCPCS J1165,00641-6139-25,PHENYTOIN SODIUM 50 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
6257,ERX,HCPCS 63700001,00071-0369-40,PHENYTOIN SODIUM EXTENDED 100 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6257,ERX,HCPCS 63700001,00904-6187-61,PHENYTOIN SODIUM EXTENDED 100 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6257,ERX,HCPCS 63700001,51079-0905-20,PHENYTOIN SODIUM EXTENDED 100 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6257,ERX,HCPCS 63700001,51672-4111-01,PHENYTOIN SODIUM EXTENDED 100 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6257,ERX,HCPCS 63700001,51672-4111-03,PHENYTOIN SODIUM EXTENDED 100 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6257,ERX,HCPCS 63700001,68084-0376-01,PHENYTOIN SODIUM EXTENDED 100 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6270,ERX,HCPCS 25000001,17478-0510-02,PHYSOSTIGMINE SALICYLATE 1 MG/ML IJ SOLN,$164.41,$0.00,$164.41,$0.00,$117.34,$0.00,$0.00,$0.00,$0.00,$0.00,$164.41,$0.00,$82.21,$130.21,$131.53,$0.00,$0.00,$0.00,$0.00,$0.00
6279,ERX,HCPCS 25000001,00998-0203-15,PILOCARPINE HCL 1 % OP SOLN,$310.48,$0.00,$310.48,$0.00,$221.59,$0.00,$0.00,$0.00,$0.00,$0.00,$310.48,$0.00,$155.24,$245.90,$248.38,$0.00,$0.00,$0.00,$0.00,$0.00
6279,ERX,HCPCS 25000001,61314-0203-15,PILOCARPINE HCL 1 % OP SOLN,$310.48,$0.00,$310.48,$0.00,$221.59,$0.00,$0.00,$0.00,$0.00,$0.00,$310.48,$0.00,$155.24,$245.90,$248.38,$0.00,$0.00,$0.00,$0.00,$0.00
6279,ERX,HCPCS 25000001,70069-0181-01,PILOCARPINE HCL 1 % OP SOLN,$310.48,$0.00,$310.48,$0.00,$221.59,$0.00,$0.00,$0.00,$0.00,$0.00,$310.48,$0.00,$155.24,$245.90,$248.38,$0.00,$0.00,$0.00,$0.00,$0.00
6280,ERX,HCPCS 25000001,00998-0204-15,PILOCARPINE HCL 2 % OP SOLN,$307.49,$0.00,$307.49,$0.00,$219.46,$0.00,$0.00,$0.00,$0.00,$0.00,$307.49,$0.00,$153.75,$243.53,$245.99,$0.00,$0.00,$0.00,$0.00,$0.00
6280,ERX,HCPCS 25000001,17478-0224-12,PILOCARPINE HCL 2 % OP SOLN,$307.49,$0.00,$307.49,$0.00,$219.46,$0.00,$0.00,$0.00,$0.00,$0.00,$307.49,$0.00,$153.75,$243.53,$245.99,$0.00,$0.00,$0.00,$0.00,$0.00
6280,ERX,HCPCS 25000001,61314-0204-15,PILOCARPINE HCL 2 % OP SOLN,$307.49,$0.00,$307.49,$0.00,$219.46,$0.00,$0.00,$0.00,$0.00,$0.00,$307.49,$0.00,$153.75,$243.53,$245.99,$0.00,$0.00,$0.00,$0.00,$0.00
6282,ERX,HCPCS 25000001,00998-0206-15,PILOCARPINE HCL 4 % OP SOLN,$322.36,$0.00,$322.36,$0.00,$230.07,$0.00,$0.00,$0.00,$0.00,$0.00,$322.36,$0.00,$161.18,$255.31,$257.89,$0.00,$0.00,$0.00,$0.00,$0.00
6282,ERX,HCPCS 25000001,61314-0206-15,PILOCARPINE HCL 4 % OP SOLN,$322.36,$0.00,$322.36,$0.00,$230.07,$0.00,$0.00,$0.00,$0.00,$0.00,$322.36,$0.00,$161.18,$255.31,$257.89,$0.00,$0.00,$0.00,$0.00,$0.00
6296,ERX,HCPCS 63700001,00378-0127-01,PINDOLOL 10 MG PO TABS,$6.84,$0.00,$6.84,$0.00,$4.88,$0.00,$0.00,$0.00,$0.00,$0.00,$6.84,$0.00,$3.42,$5.42,$5.47,$0.00,$0.00,$0.00,$0.00,$0.00
6296,ERX,HCPCS 63700001,57664-0656-88,PINDOLOL 10 MG PO TABS,$6.84,$0.00,$6.84,$0.00,$4.88,$0.00,$0.00,$0.00,$0.00,$0.00,$6.84,$0.00,$3.42,$5.42,$5.47,$0.00,$0.00,$0.00,$0.00,$0.00
6297,ERX,HCPCS 63700001,00378-0052-01,PINDOLOL 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6297,ERX,HCPCS 63700001,57664-0655-88,PINDOLOL 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6331,ERX,HCPCS 25000001,00338-0221-04,PLASMA-LYTE A IV SOLN,$57.00,$0.00,$57.00,$0.00,$40.68,$0.00,$0.00,$0.00,$0.00,$0.00,$57.00,$0.00,$28.50,$45.14,$45.60,$0.00,$0.00,$0.00,$0.00,$0.00
6393,ERX,HCPCS 25000001,55150-0234-10,POLYMYXIN B SULFATE 500000 UNITS IJ SOLR,$51.30,$0.00,$51.30,$0.00,$36.61,$0.00,$0.00,$0.00,$0.00,$0.00,$51.30,$0.00,$25.65,$40.63,$41.04,$0.00,$0.00,$0.00,$0.00,$0.00
6393,ERX,HCPCS 25000001,63323-0367-01,POLYMYXIN B SULFATE 500000 UNITS IJ SOLR,$51.30,$0.00,$51.30,$0.00,$36.61,$0.00,$0.00,$0.00,$0.00,$0.00,$51.30,$0.00,$25.65,$40.63,$41.04,$0.00,$0.00,$0.00,$0.00,$0.00
6393,ERX,HCPCS 25000001,63323-0367-11,POLYMYXIN B SULFATE 500000 UNITS IJ SOLR,$51.30,$0.00,$51.30,$0.00,$36.61,$0.00,$0.00,$0.00,$0.00,$0.00,$51.30,$0.00,$25.65,$40.63,$41.04,$0.00,$0.00,$0.00,$0.00,$0.00
6393,ERX,HCPCS 25000001,70860-0103-10,POLYMYXIN B SULFATE 500000 UNITS IJ SOLR,$51.30,$0.00,$51.30,$0.00,$36.61,$0.00,$0.00,$0.00,$0.00,$0.00,$51.30,$0.00,$25.65,$40.63,$41.04,$0.00,$0.00,$0.00,$0.00,$0.00
6393,ERX,HCPCS 25000001,70860-0103-41,POLYMYXIN B SULFATE 500000 UNITS IJ SOLR,$51.30,$0.00,$51.30,$0.00,$36.61,$0.00,$0.00,$0.00,$0.00,$0.00,$51.30,$0.00,$25.65,$40.63,$41.04,$0.00,$0.00,$0.00,$0.00,$0.00
6420,ERX,HCPCS 25000001,00409-8183-01,POTASSIUM ACETATE 2 MEQ/ML IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
6429,ERX,HCPCS J3480,00264-1940-20,KCL 2 MEQ/ML IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.24,$0.00,$0.00,$1.65,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.65,$0.00,$1.57,$0.00
6429,ERX,HCPCS J3480,00409-6651-06,KCL 2 MEQ/ML IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.24,$0.00,$0.00,$1.65,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.65,$0.00,$1.57,$0.00
6429,ERX,HCPCS J3480,63323-0965-03,KCL 2 MEQ/ML IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.24,$0.00,$0.00,$1.65,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.65,$0.00,$1.57,$0.00
6429,ERX,HCPCS J3480,63323-0965-10,KCL 2 MEQ/ML IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.24,$0.00,$0.00,$1.65,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.65,$0.00,$1.57,$0.00
6429,ERX,HCPCS J3480,63323-0965-20,KCL 2 MEQ/ML IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.24,$0.00,$0.00,$1.65,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.65,$0.00,$1.57,$0.00
6458,ERX,HCPCS 25000001,49348-0622-37,POVIDONE-IODINE 10 % EX SOLN,$24.32,$0.00,$24.32,$0.00,$17.36,$0.00,$0.00,$0.00,$0.00,$0.00,$24.32,$0.00,$12.16,$19.26,$19.46,$0.00,$0.00,$0.00,$0.00,$0.00
6462,ERX,HCPCS J2730,60977-0141-01,PRALIDOXIME CHLORIDE 1 G IV SOLR,$91.04,$0.00,$91.04,$0.00,$64.98,$0.00,$0.00,$0.00,$0.00,$0.00,$91.04,$0.00,$45.52,$72.10,$72.83,$0.00,$0.00,$0.00,$0.00,$0.00
6462,ERX,HCPCS J2730,60977-0141-27,PRALIDOXIME CHLORIDE 1 G IV SOLR,$91.04,$0.00,$91.04,$0.00,$64.98,$0.00,$0.00,$0.00,$0.00,$0.00,$91.04,$0.00,$45.52,$72.10,$72.83,$0.00,$0.00,$0.00,$0.00,$0.00
6468,ERX,HCPCS 63700001,00378-1101-01,PRAZOSIN HCL 1 MG PO CAPS,$6.89,$0.00,$6.89,$0.00,$4.92,$0.00,$0.00,$0.00,$0.00,$0.00,$6.89,$0.00,$3.45,$5.46,$5.51,$0.00,$0.00,$0.00,$0.00,$0.00
6468,ERX,HCPCS 63700001,51079-0630-20,PRAZOSIN HCL 1 MG PO CAPS,$6.89,$0.00,$6.89,$0.00,$4.92,$0.00,$0.00,$0.00,$0.00,$0.00,$6.89,$0.00,$3.45,$5.46,$5.51,$0.00,$0.00,$0.00,$0.00,$0.00
6469,ERX,HCPCS 63700001,00093-4068-01,PRAZOSIN HCL 2 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6469,ERX,HCPCS 63700001,00378-2302-01,PRAZOSIN HCL 2 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6469,ERX,HCPCS 63700001,51079-0631-20,PRAZOSIN HCL 2 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6469,ERX,HCPCS 63700001,59762-5320-01,PRAZOSIN HCL 2 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6470,ERX,HCPCS 63700001,00093-4069-01,PRAZOSIN HCL 5 MG PO CAPS,$16.38,$0.00,$16.38,$0.00,$11.69,$0.00,$0.00,$0.00,$0.00,$0.00,$16.38,$0.00,$8.19,$12.97,$13.10,$0.00,$0.00,$0.00,$0.00,$0.00
6470,ERX,HCPCS 63700001,51079-0632-20,PRAZOSIN HCL 5 MG PO CAPS,$16.38,$0.00,$16.38,$0.00,$11.69,$0.00,$0.00,$0.00,$0.00,$0.00,$16.38,$0.00,$8.19,$12.97,$13.10,$0.00,$0.00,$0.00,$0.00,$0.00
6470,ERX,HCPCS 63700001,70954-0021-10,PRAZOSIN HCL 5 MG PO CAPS,$16.38,$0.00,$16.38,$0.00,$11.69,$0.00,$0.00,$0.00,$0.00,$0.00,$16.38,$0.00,$8.19,$12.97,$13.10,$0.00,$0.00,$0.00,$0.00,$0.00
6487,ERX,HCPCS 25000001,60758-0119-10,PREDNISOLONE ACETATE 1 % OP SUSP,$322.08,$0.00,$322.08,$0.00,$229.87,$0.00,$0.00,$0.00,$0.00,$0.00,$322.08,$0.00,$161.04,$255.09,$257.66,$0.00,$0.00,$0.00,$0.00,$0.00
6487,ERX,HCPCS 25000001,61314-0637-10,PREDNISOLONE ACETATE 1 % OP SUSP,$322.08,$0.00,$322.08,$0.00,$229.87,$0.00,$0.00,$0.00,$0.00,$0.00,$322.08,$0.00,$161.04,$255.09,$257.66,$0.00,$0.00,$0.00,$0.00,$0.00
6487,ERX,HCPCS 25000001,11980-0180-05,PREDNISOLONE ACETATE 1 % OP SUSP,$559.10,$0.00,$442.81,$0.00,$229.87,$0.00,$0.00,$0.00,$0.00,$0.00,$322.08,$0.00,$161.04,$442.81,$257.66,$0.00,$0.00,$0.00,$0.00,$0.00
6487,ERX,HCPCS 25000001,60758-0119-05,PREDNISOLONE ACETATE 1 % OP SUSP,$559.10,$0.00,$442.81,$0.00,$229.87,$0.00,$0.00,$0.00,$0.00,$0.00,$322.08,$0.00,$161.04,$442.81,$257.66,$0.00,$0.00,$0.00,$0.00,$0.00
6487,ERX,HCPCS 25000001,61314-0637-05,PREDNISOLONE ACETATE 1 % OP SUSP,$559.10,$0.00,$442.81,$0.00,$229.87,$0.00,$0.00,$0.00,$0.00,$0.00,$322.08,$0.00,$161.04,$442.81,$257.66,$0.00,$0.00,$0.00,$0.00,$0.00
6493,ERX,HCPCS 25000001,00054-4741-25,PREDNISONE 1 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6493,ERX,HCPCS 25000001,00054-8739-25,PREDNISONE 1 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6493,ERX,HCPCS 25000001,59746-0171-06,PREDNISONE 1 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6494,ERX,HCPCS 25000001,00054-0017-20,PREDNISONE 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6494,ERX,HCPCS 25000001,00054-0017-29,PREDNISONE 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6494,ERX,HCPCS 25000001,00603-5338-21,PREDNISONE 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6494,ERX,HCPCS 25000001,00603-5338-28,PREDNISONE 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6494,ERX,HCPCS 25000001,00603-5338-32,PREDNISONE 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6494,ERX,HCPCS 25000001,59746-0173-06,PREDNISONE 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6494,ERX,HCPCS 25000001,60687-0134-01,PREDNISONE 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6494,ERX,HCPCS 25000001,63739-0519-10,PREDNISONE 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6496,ERX,HCPCS 25000001,00054-0018-20,PREDNISONE 20 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6496,ERX,HCPCS 25000001,59746-0175-06,PREDNISONE 20 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6497,ERX,HCPCS 25000001,00054-8724-25,PREDNISONE 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6497,ERX,HCPCS 25000001,00603-5337-21,PREDNISONE 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6497,ERX,HCPCS 25000001,59746-0172-06,PREDNISONE 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6497,ERX,HCPCS 25000001,60687-0122-01,PREDNISONE 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6497,ERX,HCPCS 25000001,60687-0122-11,PREDNISONE 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6497,ERX,HCPCS 25000001,63739-0518-10,PREDNISONE 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6498,ERX,HCPCS 25000001,00054-0019-20,PREDNISONE 50 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6498,ERX,HCPCS 25000001,00054-0019-25,PREDNISONE 50 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6541,ERX,HCPCS 63700001,00024-1596-01,PRIMAQUINE PHOSPHATE 26.3 MG PO TABS,$8.10,$0.00,$8.10,$0.00,$5.78,$0.00,$0.00,$0.00,$0.00,$0.00,$8.10,$0.00,$4.05,$6.42,$6.48,$0.00,$0.00,$0.00,$0.00,$0.00
6541,ERX,HCPCS 63700001,76385-0102-01,PRIMAQUINE PHOSPHATE 26.3 MG PO TABS,$8.10,$0.00,$8.10,$0.00,$5.78,$0.00,$0.00,$0.00,$0.00,$0.00,$8.10,$0.00,$4.05,$6.42,$6.48,$0.00,$0.00,$0.00,$0.00,$0.00
6544,ERX,HCPCS 63700001,00591-5321-01,PRIMIDONE 250 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6544,ERX,HCPCS 63700001,68084-0203-01,PRIMIDONE 250 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6561,ERX,HCPCS 63700001,00378-0156-01,PROBENECID 500 MG PO TABS,$7.48,$0.00,$7.48,$0.00,$5.34,$0.00,$0.00,$0.00,$0.00,$0.00,$7.48,$0.00,$3.74,$5.92,$5.98,$0.00,$0.00,$0.00,$0.00,$0.00
6561,ERX,HCPCS 63700001,00591-5347-01,PROBENECID 500 MG PO TABS,$7.48,$0.00,$7.48,$0.00,$5.34,$0.00,$0.00,$0.00,$0.00,$0.00,$7.48,$0.00,$3.74,$5.92,$5.98,$0.00,$0.00,$0.00,$0.00,$0.00
6562,ERX,HCPCS J2690,14789-0901-10,PROCAINAMIDE HCL 100 MG/ML IJ SOLN,$458.97,$0.00,$458.97,$0.00,$327.57,$0.00,$0.00,$0.00,$0.00,$0.00,$458.97,$0.00,$229.49,$363.50,$367.18,$0.00,$0.00,$0.00,$0.00,$0.00
6582,ERX,HCPCS S0183,59746-0115-06,PROCHLORPERAZINE MALEATE 10 MG PO TABS,$6.00,$0.00,$6.00,$2.70,$4.28,$0.00,$1.41,$0.00,$0.00,$1.05,$6.00,$0.00,$3.00,$4.75,$4.80,$3.60,$0.94,$0.00,$0.00,$0.00
6583,ERX,HCPCS S0183,00378-5105-01,PROCHLORPERAZINE MALEATE 5 MG PO TABS,$6.00,$0.00,$6.00,$2.70,$4.28,$0.00,$0.71,$0.00,$0.00,$1.05,$6.00,$0.00,$3.00,$4.75,$4.80,$3.60,$0.94,$0.00,$0.00,$0.00
6583,ERX,HCPCS S0183,59746-0113-06,PROCHLORPERAZINE MALEATE 5 MG PO TABS,$6.00,$0.00,$6.00,$2.70,$4.28,$0.00,$0.71,$0.00,$0.00,$1.05,$6.00,$0.00,$3.00,$4.75,$4.80,$3.60,$0.94,$0.00,$0.00,$0.00
6597,ERX,HCPCS J2675,00591-3128-79,PROGESTERONE 50 MG/ML IM OIL,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
6618,ERX,HCPCS J2550,00641-0928-21,PROMETHAZINE HCL 25 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.93,$0.00,$0.00,$2.42,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$2.42,$0.00,$2.30,$0.00
6618,ERX,HCPCS J2550,00641-0928-25,PROMETHAZINE HCL 25 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.93,$0.00,$0.00,$2.42,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$2.42,$0.00,$2.30,$0.00
6618,ERX,HCPCS J2550,00641-0955-25,PROMETHAZINE HCL 25 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.93,$0.00,$0.00,$2.42,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$2.42,$0.00,$2.30,$0.00
6618,ERX,HCPCS J2550,00641-1495-31,PROMETHAZINE HCL 25 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.93,$0.00,$0.00,$2.42,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$2.42,$0.00,$2.30,$0.00
6618,ERX,HCPCS J2550,00641-1495-35,PROMETHAZINE HCL 25 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.93,$0.00,$0.00,$2.42,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$2.42,$0.00,$2.30,$0.00
6618,ERX,HCPCS J2550,00641-6084-25,PROMETHAZINE HCL 25 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.93,$0.00,$0.00,$2.42,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$2.42,$0.00,$2.30,$0.00
6618,ERX,HCPCS J2550,39822-5525-03,PROMETHAZINE HCL 25 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.93,$0.00,$0.00,$2.42,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$2.42,$0.00,$2.30,$0.00
6622,ERX,HCPCS Q0169,00904-6461-61,PROMETHAZINE HCL 25 MG PO TABS,$6.00,$0.00,$6.00,$2.70,$4.28,$0.00,$1.03,$0.00,$0.00,$1.05,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.94,$0.00,$0.96,$0.00
6622,ERX,HCPCS Q0169,10702-0003-01,PROMETHAZINE HCL 25 MG PO TABS,$6.00,$0.00,$6.00,$2.70,$4.28,$0.00,$1.03,$0.00,$0.00,$1.05,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.94,$0.00,$0.96,$0.00
6622,ERX,HCPCS Q0169,68084-0155-01,PROMETHAZINE HCL 25 MG PO TABS,$6.00,$0.00,$6.00,$2.70,$4.28,$0.00,$1.03,$0.00,$0.00,$1.05,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.94,$0.00,$0.96,$0.00
6643,ERX,HCPCS 63700001,00054-4721-25,PROPANTHELINE BROMIDE 15 MG PO TABS,$11.40,$0.00,$11.40,$0.00,$8.14,$0.00,$0.00,$0.00,$0.00,$0.00,$11.40,$0.00,$5.70,$9.03,$9.12,$0.00,$0.00,$0.00,$0.00,$0.00
6644,ERX,HCPCS 25000001,24208-0730-06,PROPARACAINE HCL 0.5 % OP SOLN,$153.57,$0.00,$153.57,$0.00,$109.60,$0.00,$0.00,$0.00,$0.00,$0.00,$153.57,$0.00,$76.79,$121.63,$122.86,$0.00,$0.00,$0.00,$0.00,$0.00
6644,ERX,HCPCS 25000001,61314-0016-01,PROPARACAINE HCL 0.5 % OP SOLN,$153.57,$0.00,$153.57,$0.00,$109.60,$0.00,$0.00,$0.00,$0.00,$0.00,$153.57,$0.00,$76.79,$121.63,$122.86,$0.00,$0.00,$0.00,$0.00,$0.00
6654,ERX,HCPCS 25000001,99999-6010-68,PROPRANOLOL HCL 20 MG/5ML PO SOLN,$18.24,$0.00,$36.48,$0.00,$26.04,$0.00,$0.00,$0.00,$0.00,$0.00,$36.48,$0.00,$18.24,$14.45,$29.18,$0.00,$0.00,$0.00,$0.00,$0.00
6654,ERX,HCPCS 25000001,99999-6004-71,PROPRANOLOL HCL 20 MG/5ML PO SOLN,$36.48,$0.00,$36.48,$0.00,$26.04,$0.00,$0.00,$0.00,$0.00,$0.00,$36.48,$0.00,$18.24,$28.89,$29.18,$0.00,$0.00,$0.00,$0.00,$0.00
6654,ERX,HCPCS 25000001,00054-3727-63,PROPRANOLOL HCL 20 MG/5ML PO SOLN,$207.90,$0.00,$164.66,$0.00,$26.04,$0.00,$0.00,$0.00,$0.00,$0.00,$36.48,$0.00,$18.24,$164.66,$29.18,$0.00,$0.00,$0.00,$0.00,$0.00
6656,ERX,HCPCS 63700001,00378-0182-01,PROPRANOLOL HCL 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6656,ERX,HCPCS 63700001,00378-0182-10,PROPRANOLOL HCL 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6656,ERX,HCPCS 63700001,00591-5554-01,PROPRANOLOL HCL 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6656,ERX,HCPCS 63700001,00603-5482-21,PROPRANOLOL HCL 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6656,ERX,HCPCS 63700001,00603-5482-32,PROPRANOLOL HCL 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6656,ERX,HCPCS 63700001,00904-6550-61,PROPRANOLOL HCL 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6658,ERX,HCPCS 63700001,00115-1661-01,PROPRANOLOL HCL 40 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6658,ERX,HCPCS 63700001,00378-0184-01,PROPRANOLOL HCL 40 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6658,ERX,HCPCS 63700001,00591-5556-01,PROPRANOLOL HCL 40 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6658,ERX,HCPCS 63700001,00603-5484-21,PROPRANOLOL HCL 40 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6659,ERX,HCPCS 63700001,00378-0187-01,PROPRANOLOL HCL 60 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6659,ERX,HCPCS 63700001,00603-5485-21,PROPRANOLOL HCL 60 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6660,ERX,HCPCS 63700001,00378-0185-01,PROPRANOLOL HCL 80 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6660,ERX,HCPCS 63700001,00603-5486-21,PROPRANOLOL HCL 80 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6662,ERX,HCPCS 63700001,00228-2348-10,PROPYLTHIOURACIL 50 MG PO TABS,$6.00,$0.00,$12.77,$0.00,$9.11,$0.00,$0.00,$0.00,$0.00,$0.00,$12.77,$0.00,$6.39,$4.75,$10.22,$0.00,$0.00,$0.00,$0.00,$0.00
6662,ERX,HCPCS 63700001,67253-0651-10,PROPYLTHIOURACIL 50 MG PO TABS,$6.00,$0.00,$12.77,$0.00,$9.11,$0.00,$0.00,$0.00,$0.00,$0.00,$12.77,$0.00,$6.39,$4.75,$10.22,$0.00,$0.00,$0.00,$0.00,$0.00
6662,ERX,HCPCS 63700001,67253-0651-11,PROPYLTHIOURACIL 50 MG PO TABS,$6.00,$0.00,$12.77,$0.00,$9.11,$0.00,$0.00,$0.00,$0.00,$0.00,$12.77,$0.00,$6.39,$4.75,$10.22,$0.00,$0.00,$0.00,$0.00,$0.00
6662,ERX,HCPCS 63700001,68084-0964-25,PROPYLTHIOURACIL 50 MG PO TABS,$6.00,$0.00,$12.77,$0.00,$9.11,$0.00,$0.00,$0.00,$0.00,$0.00,$12.77,$0.00,$6.39,$4.75,$10.22,$0.00,$0.00,$0.00,$0.00,$0.00
6677,ERX,HCPCS J2720,63323-0229-05,PROTAMINE SULFATE 10 MG/ML IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.60,$0.00,$0.00,$1.28,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.28,$0.00,$1.22,$0.00
6677,ERX,HCPCS J2720,63323-0229-15,PROTAMINE SULFATE 10 MG/ML IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.60,$0.00,$0.00,$1.28,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.28,$0.00,$1.22,$0.00
6677,ERX,HCPCS J2720,63323-0229-30,PROTAMINE SULFATE 10 MG/ML IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.60,$0.00,$0.00,$1.28,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.28,$0.00,$1.22,$0.00
6714,ERX,HCPCS 63700001,00904-5053-24,PSEUDOEPHEDRINE HCL 30 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6714,ERX,HCPCS 63700001,00904-5053-59,PSEUDOEPHEDRINE HCL 30 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6714,ERX,HCPCS 63700001,45802-0432-62,PSEUDOEPHEDRINE HCL 30 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6715,ERX,HCPCS 63700001,00904-5125-59,PSEUDOEPHEDRINE HCL 60 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6715,ERX,HCPCS 63700001,00904-6728-52,PSEUDOEPHEDRINE HCL 60 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6738,ERX,HCPCS 63700001,61748-0012-01,PYRAZINAMIDE 500 MG PO TABS,$46.78,$0.00,$46.78,$0.00,$33.39,$0.00,$0.00,$0.00,$0.00,$0.00,$46.78,$0.00,$23.39,$37.05,$37.42,$0.00,$0.00,$0.00,$0.00,$0.00
6738,ERX,HCPCS 63700001,61748-0012-11,PYRAZINAMIDE 500 MG PO TABS,$46.78,$0.00,$46.78,$0.00,$33.39,$0.00,$0.00,$0.00,$0.00,$0.00,$46.78,$0.00,$23.39,$37.05,$37.42,$0.00,$0.00,$0.00,$0.00,$0.00
6744,ERX,HCPCS J3415,63323-0180-01,PYRIDOXINE HCL 100 MG/ML IJ SOLN,$34.66,$0.00,$34.66,$0.00,$24.74,$0.00,$0.00,$0.00,$0.00,$0.00,$34.66,$0.00,$17.33,$27.45,$27.73,$0.00,$0.00,$0.00,$0.00,$0.00
6777,ERX,HCPCS 63700001,00185-4346-01,QUINIDINE SULFATE 200 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6781,ERX,HCPCS 63700001,00093-3002-56,QUININE SULFATE 324 MG PO CAPS,$26.85,$0.00,$26.85,$0.00,$19.16,$0.00,$0.00,$0.00,$0.00,$0.00,$26.85,$0.00,$13.43,$21.27,$21.48,$0.00,$0.00,$0.00,$0.00,$0.00
6781,ERX,HCPCS 63700001,13310-0153-07,QUININE SULFATE 324 MG PO CAPS,$26.85,$0.00,$26.85,$0.00,$19.16,$0.00,$0.00,$0.00,$0.00,$0.00,$26.85,$0.00,$13.43,$21.27,$21.48,$0.00,$0.00,$0.00,$0.00,$0.00
6781,ERX,HCPCS 63700001,53489-0700-07,QUININE SULFATE 324 MG PO CAPS,$26.85,$0.00,$26.85,$0.00,$19.16,$0.00,$0.00,$0.00,$0.00,$0.00,$26.85,$0.00,$13.43,$21.27,$21.48,$0.00,$0.00,$0.00,$0.00,$0.00
6839,ERX,HCPCS 25000001,00327-0012-30,RENACIDIN IR SOLN,$26.22,$0.00,$26.22,$0.00,$18.71,$0.00,$0.00,$0.00,$0.00,$0.00,$26.22,$0.00,$13.11,$20.77,$20.98,$0.00,$0.00,$0.00,$0.00,$0.00
6969,ERX,HCPCS 25000001,51801-0004-40,ROSE BENGAL 1.3 MG OP STRP,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
7030,ERX,HCPCS 25000001,00904-3865-75,SALINE NASAL SPRAY 0.65 % NA SOLN,$11.00,$0.00,$11.00,$0.00,$7.85,$0.00,$0.00,$0.00,$0.00,$0.00,$11.00,$0.00,$5.50,$8.71,$8.80,$0.00,$0.00,$0.00,$0.00,$0.00
7030,ERX,HCPCS 25000001,45802-0357-58,SALINE NASAL SPRAY 0.65 % NA SOLN,$11.00,$0.00,$11.00,$0.00,$7.85,$0.00,$0.00,$0.00,$0.00,$0.00,$11.00,$0.00,$5.50,$8.71,$8.80,$0.00,$0.00,$0.00,$0.00,$0.00
7034,ERX,HCPCS 63700001,51293-0803-01,SALSALATE 500 MG PO TABS,$7.22,$0.00,$7.22,$0.00,$5.15,$0.00,$0.00,$0.00,$0.00,$0.00,$7.22,$0.00,$3.61,$5.72,$5.78,$0.00,$0.00,$0.00,$0.00,$0.00
7035,ERX,HCPCS 63700001,10135-0493-01,SALSALATE 750 MG PO TABS,$7.71,$0.00,$7.71,$0.00,$5.50,$0.00,$0.00,$0.00,$0.00,$0.00,$7.71,$0.00,$3.86,$6.11,$6.17,$0.00,$0.00,$0.00,$0.00,$0.00
7035,ERX,HCPCS 63700001,51293-0804-01,SALSALATE 750 MG PO TABS,$7.71,$0.00,$7.71,$0.00,$5.50,$0.00,$0.00,$0.00,$0.00,$0.00,$7.71,$0.00,$3.86,$6.11,$6.17,$0.00,$0.00,$0.00,$0.00,$0.00
7222,ERX,HCPCS 25000001,62991-2927-03,SILVER NITRATE CRYS,"$1,053.38",$0.00,"$1,053.38",$0.00,$751.80,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,053.38",$0.00,$526.69,$834.28,$842.70,$0.00,$0.00,$0.00,$0.00,$0.00
7224,ERX,HCPCS 25000001,43598-0210-50,SILVER SULFADIAZINE 1 % EX CREA,$57.38,$0.00,$368.44,$0.00,$262.96,$0.00,$0.00,$0.00,$0.00,$0.00,$368.44,$0.00,$184.22,$45.44,$294.75,$0.00,$0.00,$0.00,$0.00,$0.00
7224,ERX,HCPCS 25000001,43598-0210-55,SILVER SULFADIAZINE 1 % EX CREA,$57.38,$0.00,$368.44,$0.00,$262.96,$0.00,$0.00,$0.00,$0.00,$0.00,$368.44,$0.00,$184.22,$45.44,$294.75,$0.00,$0.00,$0.00,$0.00,$0.00
7224,ERX,HCPCS 25000001,61570-0131-50,SILVER SULFADIAZINE 1 % EX CREA,$57.38,$0.00,$368.44,$0.00,$262.96,$0.00,$0.00,$0.00,$0.00,$0.00,$368.44,$0.00,$184.22,$45.44,$294.75,$0.00,$0.00,$0.00,$0.00,$0.00
7224,ERX,HCPCS 25000001,67877-0124-05,SILVER SULFADIAZINE 1 % EX CREA,$57.38,$0.00,$368.44,$0.00,$262.96,$0.00,$0.00,$0.00,$0.00,$0.00,$368.44,$0.00,$184.22,$45.44,$294.75,$0.00,$0.00,$0.00,$0.00,$0.00
7224,ERX,HCPCS 25000001,67877-0124-50,SILVER SULFADIAZINE 1 % EX CREA,$57.38,$0.00,$368.44,$0.00,$262.96,$0.00,$0.00,$0.00,$0.00,$0.00,$368.44,$0.00,$184.22,$45.44,$294.75,$0.00,$0.00,$0.00,$0.00,$0.00
7224,ERX,HCPCS 25000001,43598-0210-40,SILVER SULFADIAZINE 1 % EX CREA,$368.44,$0.00,$368.44,$0.00,$262.96,$0.00,$0.00,$0.00,$0.00,$0.00,$368.44,$0.00,$184.22,$291.80,$294.75,$0.00,$0.00,$0.00,$0.00,$0.00
7224,ERX,HCPCS 25000001,61570-0131-40,SILVER SULFADIAZINE 1 % EX CREA,$368.44,$0.00,$368.44,$0.00,$262.96,$0.00,$0.00,$0.00,$0.00,$0.00,$368.44,$0.00,$184.22,$291.80,$294.75,$0.00,$0.00,$0.00,$0.00,$0.00
7224,ERX,HCPCS 25000001,67877-0124-40,SILVER SULFADIAZINE 1 % EX CREA,$368.44,$0.00,$368.44,$0.00,$262.96,$0.00,$0.00,$0.00,$0.00,$0.00,$368.44,$0.00,$184.22,$291.80,$294.75,$0.00,$0.00,$0.00,$0.00,$0.00
7227,ERX,HCPCS 63700001,00904-5068-60,SIMETHICONE 80 MG PO CHEW,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
7227,ERX,HCPCS 63700001,63739-0225-10,SIMETHICONE 80 MG PO CHEW,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
7227,ERX,HCPCS 63700001,69618-0033-01,SIMETHICONE 80 MG PO CHEW,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
7228,ERX,HCPCS 63700001,00536-2220-75,SIMETHICONE 40 MG/0.6ML PO SUSP,$22.58,$0.00,$17.88,$0.00,$9.52,$0.00,$0.00,$0.00,$0.00,$0.00,$13.34,$0.00,$6.67,$17.88,$10.67,$0.00,$0.00,$0.00,$0.00,$0.00
7228,ERX,HCPCS 63700001,00904-5894-30,SIMETHICONE 40 MG/0.6ML PO SUSP,$22.58,$0.00,$17.88,$0.00,$9.52,$0.00,$0.00,$0.00,$0.00,$0.00,$13.34,$0.00,$6.67,$17.88,$10.67,$0.00,$0.00,$0.00,$0.00,$0.00
7228,ERX,HCPCS 63700001,49348-0740-27,SIMETHICONE 40 MG/0.6ML PO SUSP,$22.58,$0.00,$17.88,$0.00,$9.52,$0.00,$0.00,$0.00,$0.00,$0.00,$13.34,$0.00,$6.67,$17.88,$10.67,$0.00,$0.00,$0.00,$0.00,$0.00
7228,ERX,HCPCS 63700001,56184-0120-41,SIMETHICONE 40 MG/0.6ML PO SUSP,$22.58,$0.00,$17.88,$0.00,$9.52,$0.00,$0.00,$0.00,$0.00,$0.00,$13.34,$0.00,$6.67,$17.88,$10.67,$0.00,$0.00,$0.00,$0.00,$0.00
7242,ERX,HCPCS 25000001,00395-2661-16,SIMPLE SYRUP PO SYRP,$72.85,$0.00,$72.85,$0.00,$51.99,$0.00,$0.00,$0.00,$0.00,$0.00,$72.85,$0.00,$36.43,$57.70,$58.28,$0.00,$0.00,$0.00,$0.00,$0.00
7242,ERX,HCPCS 25000001,00802-3920-16,SIMPLE SYRUP PO SYRP,$72.85,$0.00,$72.85,$0.00,$51.99,$0.00,$0.00,$0.00,$0.00,$0.00,$72.85,$0.00,$36.43,$57.70,$58.28,$0.00,$0.00,$0.00,$0.00,$0.00
7301,ERX,HCPCS 25000001,00409-3299-06,SODIUM ACETATE 2 MEQ/ML IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
7301,ERX,HCPCS 25000001,00409-3299-15,SODIUM ACETATE 2 MEQ/ML IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
7301,ERX,HCPCS 25000001,00409-3299-25,SODIUM ACETATE 2 MEQ/ML IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
7301,ERX,HCPCS 25000001,00409-3299-45,SODIUM ACETATE 2 MEQ/ML IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
7301,ERX,HCPCS 25000001,00409-7299-25,SODIUM ACETATE 2 MEQ/ML IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
7301,ERX,HCPCS 25000001,00409-7299-73,SODIUM ACETATE 2 MEQ/ML IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
7306,ERX,HCPCS 25000001,00409-5555-02,SODIUM BICARBONATE 4.2 % IV SOLN,$22.00,$0.00,$49.29,$0.00,$35.18,$0.00,$0.00,$0.00,$0.00,$0.00,$49.29,$0.00,$24.65,$17.42,$39.43,$0.00,$0.00,$0.00,$0.00,$0.00
7306,ERX,HCPCS 25000001,00409-5555-12,SODIUM BICARBONATE 4.2 % IV SOLN,$22.00,$0.00,$49.29,$0.00,$35.18,$0.00,$0.00,$0.00,$0.00,$0.00,$49.29,$0.00,$24.65,$17.42,$39.43,$0.00,$0.00,$0.00,$0.00,$0.00
7306,ERX,HCPCS 25000001,63323-0083-05,SODIUM BICARBONATE 4.2 % IV SOLN,$22.00,$0.00,$49.29,$0.00,$35.18,$0.00,$0.00,$0.00,$0.00,$0.00,$49.29,$0.00,$24.65,$17.42,$39.43,$0.00,$0.00,$0.00,$0.00,$0.00
7306,ERX,HCPCS 25000001,00409-5534-34,SODIUM BICARBONATE 4.2 % IV SOLN,$49.29,$0.00,$49.29,$0.00,$35.18,$0.00,$0.00,$0.00,$0.00,$0.00,$49.29,$0.00,$24.65,$39.04,$39.43,$0.00,$0.00,$0.00,$0.00,$0.00
7308,ERX,HCPCS 25000001,00409-4916-34,SODIUM BICARBONATE 7.5 % IV SOLN,$70.03,$0.00,$70.03,$0.00,$49.98,$0.00,$0.00,$0.00,$0.00,$0.00,$70.03,$0.00,$35.02,$55.46,$56.02,$0.00,$0.00,$0.00,$0.00,$0.00
7309,ERX,HCPCS 25000001,00409-6625-02,SODIUM BICARBONATE 8.4 % IV SOLN,$22.14,$0.00,$22.14,$0.00,$15.80,$0.00,$0.00,$0.00,$0.00,$0.00,$22.14,$0.00,$11.07,$17.53,$17.71,$0.00,$0.00,$0.00,$0.00,$0.00
7309,ERX,HCPCS 25000001,00409-6625-25,SODIUM BICARBONATE 8.4 % IV SOLN,$22.14,$0.00,$22.14,$0.00,$15.80,$0.00,$0.00,$0.00,$0.00,$0.00,$22.14,$0.00,$11.07,$17.53,$17.71,$0.00,$0.00,$0.00,$0.00,$0.00
7309,ERX,HCPCS 25000001,00409-6637-34,SODIUM BICARBONATE 8.4 % IV SOLN,$22.14,$0.00,$22.14,$0.00,$15.80,$0.00,$0.00,$0.00,$0.00,$0.00,$22.14,$0.00,$11.07,$17.53,$17.71,$0.00,$0.00,$0.00,$0.00,$0.00
7309,ERX,HCPCS 25000001,51754-5001-05,SODIUM BICARBONATE 8.4 % IV SOLN,$22.14,$0.00,$22.14,$0.00,$15.80,$0.00,$0.00,$0.00,$0.00,$0.00,$22.14,$0.00,$11.07,$17.53,$17.71,$0.00,$0.00,$0.00,$0.00,$0.00
7309,ERX,HCPCS 25000001,63323-0089-50,SODIUM BICARBONATE 8.4 % IV SOLN,$22.14,$0.00,$22.14,$0.00,$15.80,$0.00,$0.00,$0.00,$0.00,$0.00,$22.14,$0.00,$11.07,$17.53,$17.71,$0.00,$0.00,$0.00,$0.00,$0.00
7309,ERX,HCPCS 25000001,76329-3352-01,SODIUM BICARBONATE 8.4 % IV SOLN,$22.14,$0.00,$22.14,$0.00,$15.80,$0.00,$0.00,$0.00,$0.00,$0.00,$22.14,$0.00,$11.07,$17.53,$17.71,$0.00,$0.00,$0.00,$0.00,$0.00
7313,ERX,HCPCS 63700001,64980-0294-10,SODIUM BICARBONATE 650 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
7313,ERX,HCPCS 63700001,66553-0008-01,SODIUM BICARBONATE 650 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
7313,ERX,HCPCS 63700001,77333-0831-10,SODIUM BICARBONATE 650 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
7318,ERX,HCPCS 25000001,00990-7730-37,SODIUM CHLORIDE 0.45 % IV SOLN,$22.00,$0.00,$22.80,$0.00,$16.27,$0.00,$0.00,$0.00,$0.00,$0.00,$22.80,$0.00,$11.40,$17.42,$18.24,$0.00,$0.00,$0.00,$0.00,$0.00
7318,ERX,HCPCS 25000001,00264-7802-10,SODIUM CHLORIDE 0.45 % IV SOLN,$22.00,$0.00,$22.80,$0.00,$16.27,$0.00,$0.00,$0.00,$0.00,$0.00,$22.80,$0.00,$11.40,$17.42,$18.24,$0.00,$0.00,$0.00,$0.00,$0.00
7318,ERX,HCPCS 25000001,00338-0043-03,SODIUM CHLORIDE 0.45 % IV SOLN,$22.00,$0.00,$22.80,$0.00,$16.27,$0.00,$0.00,$0.00,$0.00,$0.00,$22.80,$0.00,$11.40,$17.42,$18.24,$0.00,$0.00,$0.00,$0.00,$0.00
7318,ERX,HCPCS 25000001,00409-7985-03,SODIUM CHLORIDE 0.45 % IV SOLN,$22.00,$0.00,$22.80,$0.00,$16.27,$0.00,$0.00,$0.00,$0.00,$0.00,$22.80,$0.00,$11.40,$17.42,$18.24,$0.00,$0.00,$0.00,$0.00,$0.00
7318,ERX,HCPCS 25000001,00264-7802-00,SODIUM CHLORIDE 0.45 % IV SOLN,$22.80,$0.00,$22.80,$0.00,$16.27,$0.00,$0.00,$0.00,$0.00,$0.00,$22.80,$0.00,$11.40,$18.06,$18.24,$0.00,$0.00,$0.00,$0.00,$0.00
7318,ERX,HCPCS 25000001,00338-0043-04,SODIUM CHLORIDE 0.45 % IV SOLN,$22.80,$0.00,$22.80,$0.00,$16.27,$0.00,$0.00,$0.00,$0.00,$0.00,$22.80,$0.00,$11.40,$18.06,$18.24,$0.00,$0.00,$0.00,$0.00,$0.00
7320,ERX,HCPCS J7131,00409-6660-75,SODIUM CHLORIDE 2.5 MEQ/ML IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
7321,ERX,HCPCS 25000001,00264-7805-10,SODIUM CHLORIDE 3 % IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
7321,ERX,HCPCS 25000001,00338-0054-03,SODIUM CHLORIDE 3 % IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
7322,ERX,HCPCS 25000001,00409-1141-02,SODIUM CHLORIDE 4 MEQ/ML IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
7322,ERX,HCPCS 25000001,63323-0088-61,SODIUM CHLORIDE 4 MEQ/ML IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
7322,ERX,HCPCS 25000001,63323-0088-63,SODIUM CHLORIDE 4 MEQ/ML IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
7322,ERX,HCPCS 25000001,63323-0187-30,SODIUM CHLORIDE 4 MEQ/ML IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
7323,ERX,HCPCS 25000001,00264-7806-10,SODIUM CHLORIDE 5 % IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
7323,ERX,HCPCS 25000001,00338-0056-03,SODIUM CHLORIDE 5 % IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
7325,ERX,HCPCS 25000001,00378-6985-01,SODIUM CHLORIDE 0.9 % IN NEBU,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
7325,ERX,HCPCS 25000001,00487-9301-03,SODIUM CHLORIDE 0.9 % IN NEBU,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
7325,ERX,HCPCS 25000001,00487-9301-33,SODIUM CHLORIDE 0.9 % IN NEBU,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
7327,ERX,HCPCS 25000001,00378-6997-89,SODIUM CHLORIDE 3 % IN NEBU,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
7328,ERX,HCPCS 63700001,00223-1760-02,SODIUM CHLORIDE 1000 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
7331,ERX,HCPCS 25000001,17478-0622-35,SODIUM CHLORIDE (HYPERTONIC) 5 % OP OINT,$72.89,$0.00,$72.89,$0.00,$52.02,$0.00,$0.00,$0.00,$0.00,$0.00,$72.89,$0.00,$36.45,$57.73,$58.31,$0.00,$0.00,$0.00,$0.00,$0.00
7331,ERX,HCPCS 25000001,24208-0385-55,SODIUM CHLORIDE (HYPERTONIC) 5 % OP OINT,$72.89,$0.00,$72.89,$0.00,$52.02,$0.00,$0.00,$0.00,$0.00,$0.00,$72.89,$0.00,$36.45,$57.73,$58.31,$0.00,$0.00,$0.00,$0.00,$0.00
7332,ERX,HCPCS 25000001,17478-0623-12,SODIUM CHLORIDE (HYPERTONIC) 5 % OP SOLN,$46.00,$0.00,$46.00,$0.00,$32.83,$0.00,$0.00,$0.00,$0.00,$0.00,$46.00,$0.00,$23.00,$36.43,$36.80,$0.00,$0.00,$0.00,$0.00,$0.00
7356,ERX,HCPCS 25000001,10135-0146-17,SODIUM POLYSTYRENE SULFONATE PO POWD,$25.37,$0.00,$25.37,$0.00,$18.11,$0.00,$0.00,$0.00,$0.00,$0.00,$25.37,$0.00,$12.69,$20.09,$20.30,$0.00,$0.00,$0.00,$0.00,$0.00
7356,ERX,HCPCS 25000001,10702-0036-45,SODIUM POLYSTYRENE SULFONATE PO POWD,$25.37,$0.00,$25.37,$0.00,$18.11,$0.00,$0.00,$0.00,$0.00,$0.00,$25.37,$0.00,$12.69,$20.09,$20.30,$0.00,$0.00,$0.00,$0.00,$0.00
7356,ERX,HCPCS 25000001,11534-0166-15,SODIUM POLYSTYRENE SULFONATE PO POWD,$25.37,$0.00,$25.37,$0.00,$18.11,$0.00,$0.00,$0.00,$0.00,$0.00,$25.37,$0.00,$12.69,$20.09,$20.30,$0.00,$0.00,$0.00,$0.00,$0.00
7356,ERX,HCPCS 25000001,24658-0760-16,SODIUM POLYSTYRENE SULFONATE PO POWD,$25.37,$0.00,$25.37,$0.00,$18.11,$0.00,$0.00,$0.00,$0.00,$0.00,$25.37,$0.00,$12.69,$20.09,$20.30,$0.00,$0.00,$0.00,$0.00,$0.00
7356,ERX,HCPCS 25000001,99999-6007-33,SODIUM POLYSTYRENE SULFONATE PO POWD,$25.37,$0.00,$25.37,$0.00,$18.11,$0.00,$0.00,$0.00,$0.00,$0.00,$25.37,$0.00,$12.69,$20.09,$20.30,$0.00,$0.00,$0.00,$0.00,$0.00
7359,ERX,HCPCS 25000001,24208-0670-04,SULFACETAMIDE SODIUM 10 % OP SOLN,$192.17,$0.00,$192.17,$0.00,$137.15,$0.00,$0.00,$0.00,$0.00,$0.00,$192.17,$0.00,$96.09,$152.20,$153.74,$0.00,$0.00,$0.00,$0.00,$0.00
7359,ERX,HCPCS 25000001,61314-0701-01,SULFACETAMIDE SODIUM 10 % OP SOLN,$192.17,$0.00,$192.17,$0.00,$137.15,$0.00,$0.00,$0.00,$0.00,$0.00,$192.17,$0.00,$96.09,$152.20,$153.74,$0.00,$0.00,$0.00,$0.00,$0.00
7359,ERX,HCPCS 25000001,11980-0011-05,SULFACETAMIDE SODIUM 10 % OP SOLN,$486.75,$0.00,$385.51,$0.00,$137.15,$0.00,$0.00,$0.00,$0.00,$0.00,$192.17,$0.00,$96.09,$385.51,$153.74,$0.00,$0.00,$0.00,$0.00,$0.00
7364,ERX,HCPCS 25000001,60267-0705-50,SODIUM THIOSULFATE 25 % IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
7413,ERX,HCPCS 25000001,54162-0700-16,SORBITOL 70 % PO SOLN,$18.02,$0.00,$14.27,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$14.27,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
7437,ERX,HCPCS 63700001,00378-2146-01,SPIRONOLACTONE 25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
7437,ERX,HCPCS 63700001,00904-6927-61,SPIRONOLACTONE 25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
7437,ERX,HCPCS 63700001,51079-0103-01,SPIRONOLACTONE 25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
7437,ERX,HCPCS 63700001,51079-0103-20,SPIRONOLACTONE 25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
7437,ERX,HCPCS 63700001,59746-0216-01,SPIRONOLACTONE 25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
7437,ERX,HCPCS 63700001,63739-0544-10,SPIRONOLACTONE 25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
7484,ERX,HCPCS 25000001,00409-4887-20,STERILE WATER FOR INJECTION IJ SOLN,$22.00,$0.00,$23.75,$0.00,$16.95,$0.00,$0.00,$0.00,$0.00,$0.00,$23.75,$0.00,$11.88,$17.42,$19.00,$0.00,$0.00,$0.00,$0.00,$0.00
7484,ERX,HCPCS 25000001,00517-3020-25,STERILE WATER FOR INJECTION IJ SOLN,$22.00,$0.00,$23.75,$0.00,$16.95,$0.00,$0.00,$0.00,$0.00,$0.00,$23.75,$0.00,$11.88,$17.42,$19.00,$0.00,$0.00,$0.00,$0.00,$0.00
7484,ERX,HCPCS 25000001,00409-4887-50,STERILE WATER FOR INJECTION IJ SOLN,$22.00,$0.00,$23.75,$0.00,$16.95,$0.00,$0.00,$0.00,$0.00,$0.00,$23.75,$0.00,$11.88,$17.42,$19.00,$0.00,$0.00,$0.00,$0.00,$0.00
7484,ERX,HCPCS 25000001,63323-0185-50,STERILE WATER FOR INJECTION IJ SOLN,$22.00,$0.00,$23.75,$0.00,$16.95,$0.00,$0.00,$0.00,$0.00,$0.00,$23.75,$0.00,$11.88,$17.42,$19.00,$0.00,$0.00,$0.00,$0.00,$0.00
7484,ERX,HCPCS 25000001,00990-7990-09,STERILE WATER FOR INJECTION IJ SOLN,$22.80,$0.00,$23.75,$0.00,$16.95,$0.00,$0.00,$0.00,$0.00,$0.00,$23.75,$0.00,$11.88,$18.06,$19.00,$0.00,$0.00,$0.00,$0.00,$0.00
7484,ERX,HCPCS 25000001,00409-4887-10,STERILE WATER FOR INJECTION IJ SOLN,$23.75,$0.00,$23.75,$0.00,$16.95,$0.00,$0.00,$0.00,$0.00,$0.00,$23.75,$0.00,$11.88,$18.81,$19.00,$0.00,$0.00,$0.00,$0.00,$0.00
7484,ERX,HCPCS 25000001,00641-6147-01,STERILE WATER FOR INJECTION IJ SOLN,$23.75,$0.00,$23.75,$0.00,$16.95,$0.00,$0.00,$0.00,$0.00,$0.00,$23.75,$0.00,$11.88,$18.81,$19.00,$0.00,$0.00,$0.00,$0.00,$0.00
7484,ERX,HCPCS 25000001,00641-6147-10,STERILE WATER FOR INJECTION IJ SOLN,$23.75,$0.00,$23.75,$0.00,$16.95,$0.00,$0.00,$0.00,$0.00,$0.00,$23.75,$0.00,$11.88,$18.81,$19.00,$0.00,$0.00,$0.00,$0.00,$0.00
7484,ERX,HCPCS 25000001,00641-6147-25,STERILE WATER FOR INJECTION IJ SOLN,$23.75,$0.00,$23.75,$0.00,$16.95,$0.00,$0.00,$0.00,$0.00,$0.00,$23.75,$0.00,$11.88,$18.81,$19.00,$0.00,$0.00,$0.00,$0.00,$0.00
7484,ERX,HCPCS 25000001,63323-0185-10,STERILE WATER FOR INJECTION IJ SOLN,$23.75,$0.00,$23.75,$0.00,$16.95,$0.00,$0.00,$0.00,$0.00,$0.00,$23.75,$0.00,$11.88,$18.81,$19.00,$0.00,$0.00,$0.00,$0.00,$0.00
7485,ERX,HCPCS 25000001,00338-0004-04,STERILE WATER FOR IRRIGATION IR SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
7508,ERX,HCPCS J3000,39822-0706-02,STREPTOMYCIN SULFATE 1 G IM SOLR,$295.32,$0.00,$295.32,$0.00,$210.77,$0.00,$0.00,$0.00,$0.00,$0.00,$295.32,$0.00,$147.66,$233.89,$236.26,$0.00,$0.00,$0.00,$0.00,$0.00
7536,ERX,HCPCS J0330,00409-6629-02,SUCCINYLCHOLINE CHLORIDE 20 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$3.85,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.44,$0.00,$0.00,$0.00
7536,ERX,HCPCS J0330,00781-3411-70,SUCCINYLCHOLINE CHLORIDE 20 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$3.85,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.44,$0.00,$0.00,$0.00
7536,ERX,HCPCS J0330,00781-3411-95,SUCCINYLCHOLINE CHLORIDE 20 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$3.85,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.44,$0.00,$0.00,$0.00
7536,ERX,HCPCS J0330,70069-0301-25,SUCCINYLCHOLINE CHLORIDE 20 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$3.85,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.44,$0.00,$0.00,$0.00
7536,ERX,HCPCS J0330,70121-1581-01,SUCCINYLCHOLINE CHLORIDE 20 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$3.85,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.44,$0.00,$0.00,$0.00
7536,ERX,HCPCS J0330,70121-1581-05,SUCCINYLCHOLINE CHLORIDE 20 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$3.85,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.44,$0.00,$0.00,$0.00
7554,ERX,HCPCS 63700001,00185-0757-01,SULFADIAZINE 500 MG PO TABS,$19.18,$0.00,$19.18,$0.00,$13.69,$0.00,$0.00,$0.00,$0.00,$0.00,$19.18,$0.00,$9.59,$15.19,$15.34,$0.00,$0.00,$0.00,$0.00,$0.00
7556,ERX,HCPCS 25000001,00703-9514-01,SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5ML IV SOLN,$57.19,$0.00,$57.19,$0.00,$40.82,$0.00,$0.00,$0.00,$0.00,$0.00,$57.19,$0.00,$28.60,$45.29,$45.75,$0.00,$0.00,$0.00,$0.00,$0.00
7556,ERX,HCPCS 25000001,00703-9514-03,SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5ML IV SOLN,$57.19,$0.00,$57.19,$0.00,$40.82,$0.00,$0.00,$0.00,$0.00,$0.00,$57.19,$0.00,$28.60,$45.29,$45.75,$0.00,$0.00,$0.00,$0.00,$0.00
7557,ERX,HCPCS 63700001,57237-0232-01,SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
7557,ERX,HCPCS 63700001,65862-0419-01,SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
7562,ERX,HCPCS 63700001,00591-0796-01,SULFASALAZINE 500 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
7562,ERX,HCPCS 63700001,50268-0730-11,SULFASALAZINE 500 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
7562,ERX,HCPCS 63700001,50268-0730-15,SULFASALAZINE 500 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
7579,ERX,HCPCS 63700001,00591-5660-01,SULINDAC 200 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
7579,ERX,HCPCS 63700001,00591-5660-05,SULINDAC 200 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
7579,ERX,HCPCS 63700001,42806-0011-01,SULINDAC 200 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
7579,ERX,HCPCS 63700001,51079-0667-20,SULINDAC 200 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
7711,ERX,HCPCS 63700001,00591-2472-60,TAMOXIFEN CITRATE 10 MG PO TABS,$7.20,$0.00,$7.20,$0.00,$5.14,$0.00,$0.00,$0.00,$0.00,$0.00,$7.20,$0.00,$3.60,$5.70,$5.76,$0.00,$0.00,$0.00,$0.00,$0.00
7753,ERX,HCPCS 63700001,00378-4010-01,TEMAZEPAM 15 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
7753,ERX,HCPCS 63700001,63739-0231-10,TEMAZEPAM 15 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
7753,ERX,HCPCS 63700001,63739-0877-10,TEMAZEPAM 15 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
7753,ERX,HCPCS 63700001,67877-0146-01,TEMAZEPAM 15 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
7784,ERX,HCPCS J1071,00009-0417-01,TESTOSTERONE CYPIONATE 200 MG/ML IM SOLN,$22.80,$0.00,$22.80,$10.26,$16.27,$0.00,$3.93,$0.00,$0.00,$1.76,$22.80,$0.00,$11.40,$18.06,$18.24,$0.00,$1.76,$0.00,$1.68,$0.00
7784,ERX,HCPCS J1071,00143-9659-01,TESTOSTERONE CYPIONATE 200 MG/ML IM SOLN,$22.80,$0.00,$22.80,$10.26,$16.27,$0.00,$3.93,$0.00,$0.00,$1.76,$22.80,$0.00,$11.40,$18.06,$18.24,$0.00,$1.76,$0.00,$1.68,$0.00
7784,ERX,HCPCS J1071,00574-0820-10,TESTOSTERONE CYPIONATE 200 MG/ML IM SOLN,$22.80,$0.00,$22.80,$10.26,$16.27,$0.00,$3.93,$0.00,$0.00,$1.76,$22.80,$0.00,$11.40,$18.06,$18.24,$0.00,$1.76,$0.00,$1.68,$0.00
7784,ERX,HCPCS J1071,62756-0015-40,TESTOSTERONE CYPIONATE 200 MG/ML IM SOLN,$22.80,$0.00,$22.80,$10.26,$16.27,$0.00,$3.93,$0.00,$0.00,$1.76,$22.80,$0.00,$11.40,$18.06,$18.24,$0.00,$1.76,$0.00,$1.68,$0.00
7785,ERX,HCPCS J3121,00143-9750-01,TESTOSTERONE ENANTHATE 200 MG/ML IM SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$2.94,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$2.94,$0.00,$2.80,$0.00
7785,ERX,HCPCS J3121,99999-6005-75,TESTOSTERONE ENANTHATE 200 MG/ML IM SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$2.94,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$2.94,$0.00,$2.80,$0.00
7789,ERX,HCPCS J1670,13533-0634-02,TETANUS IMMUNE GLOBULIN 250 UNIT/ML IM INJ,"$1,602.44",$0.00,"$1,602.44",$0.00,"$1,143.66",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,602.44",$0.00,$801.22,"$1,269.13","$1,281.95",$0.00,$0.00,$0.00,$0.00,$0.00
7795,ERX,HCPCS 25000001,00065-0741-14,TETRACAINE HCL 0.5 % OP SOLN,$48.30,$0.00,$48.30,$0.00,$34.47,$0.00,$0.00,$0.00,$0.00,$0.00,$48.30,$0.00,$24.15,$38.25,$38.64,$0.00,$0.00,$0.00,$0.00,$0.00
7796,ERX,HCPCS 63700001,23155-0017-01,TETRACYCLINE HCL 250 MG PO CAPS,$29.93,$0.00,$29.93,$0.00,$21.36,$0.00,$0.00,$0.00,$0.00,$0.00,$29.93,$0.00,$14.97,$23.70,$23.94,$0.00,$0.00,$0.00,$0.00,$0.00
7821,ERX,HCPCS 63700001,00121-4794-15,THEOPHYLLINE 80 MG/15ML PO SOLN,$47.60,$0.00,$47.60,$0.00,$33.97,$0.00,$0.00,$0.00,$0.00,$0.00,$47.60,$0.00,$23.80,$37.70,$38.08,$0.00,$0.00,$0.00,$0.00,$0.00
7821,ERX,HCPCS 63700001,00121-4820-40,THEOPHYLLINE 80 MG/15ML PO SOLN,$47.60,$0.00,$47.60,$0.00,$33.97,$0.00,$0.00,$0.00,$0.00,$0.00,$47.60,$0.00,$23.80,$37.70,$38.08,$0.00,$0.00,$0.00,$0.00,$0.00
7821,ERX,HCPCS 63700001,27808-0033-01,THEOPHYLLINE 80 MG/15ML PO SOLN,$47.60,$0.00,$47.60,$0.00,$33.97,$0.00,$0.00,$0.00,$0.00,$0.00,$47.60,$0.00,$23.80,$37.70,$38.08,$0.00,$0.00,$0.00,$0.00,$0.00
7825,ERX,HCPCS 63700001,00904-0539-61,THERA PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
7876,ERX,HCPCS J3411,63323-0013-01,THIAMINE HCL 100 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$3.85,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.44,$0.00,$3.50,$0.00
7876,ERX,HCPCS J3411,63323-0013-02,THIAMINE HCL 100 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$3.85,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.44,$0.00,$3.50,$0.00
7876,ERX,HCPCS J3411,63323-0013-09,THIAMINE HCL 100 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$3.85,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.44,$0.00,$3.50,$0.00
7876,ERX,HCPCS J3411,63323-0013-21,THIAMINE HCL 100 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$3.85,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.44,$0.00,$3.50,$0.00
7876,ERX,HCPCS J3411,67457-0196-00,THIAMINE HCL 100 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$3.85,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.44,$0.00,$3.50,$0.00
7876,ERX,HCPCS J3411,67457-0196-02,THIAMINE HCL 100 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$3.85,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.44,$0.00,$3.50,$0.00
7886,ERX,HCPCS 63700001,76388-0880-25,THIOGUANINE 40 MG PO TABS,$106.17,$0.00,$106.17,$0.00,$75.77,$0.00,$0.00,$0.00,$0.00,$0.00,$106.17,$0.00,$53.09,$84.09,$84.94,$0.00,$0.00,$0.00,$0.00,$0.00
7894,ERX,HCPCS 63700001,51079-0565-01,THIORIDAZINE HCL 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
7894,ERX,HCPCS 63700001,51079-0565-20,THIORIDAZINE HCL 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
7894,ERX,HCPCS 63700001,53489-0148-01,THIORIDAZINE HCL 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
7895,ERX,HCPCS 63700001,51079-0580-20,THIORIDAZINE HCL 100 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
7899,ERX,HCPCS 63700001,51079-0566-01,THIORIDAZINE HCL 25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
7899,ERX,HCPCS 63700001,51079-0566-20,THIORIDAZINE HCL 25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
7900,ERX,HCPCS 63700001,00378-0616-01,THIORIDAZINE HCL 50 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
7900,ERX,HCPCS 63700001,51079-0567-01,THIORIDAZINE HCL 50 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
7900,ERX,HCPCS 63700001,53489-0150-01,THIORIDAZINE HCL 50 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
7902,ERX,HCPCS 63700001,00378-1001-01,THIOTHIXENE 1 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
7903,ERX,HCPCS 63700001,00378-5010-01,THIOTHIXENE 10 MG PO CAPS,$12.76,$0.00,$12.76,$0.00,$9.11,$0.00,$0.00,$0.00,$0.00,$0.00,$12.76,$0.00,$6.38,$10.11,$10.21,$0.00,$0.00,$0.00,$0.00,$0.00
7906,ERX,HCPCS 63700001,00378-3005-01,THIOTHIXENE 5 MG PO CAPS,$13.76,$0.00,$13.76,$0.00,$9.82,$0.00,$0.00,$0.00,$0.00,$0.00,$13.76,$0.00,$6.88,$10.90,$11.01,$0.00,$0.00,$0.00,$0.00,$0.00
7906,ERX,HCPCS 63700001,51079-0588-01,THIOTHIXENE 5 MG PO CAPS,$13.76,$0.00,$13.76,$0.00,$9.82,$0.00,$0.00,$0.00,$0.00,$0.00,$13.76,$0.00,$6.88,$10.90,$11.01,$0.00,$0.00,$0.00,$0.00,$0.00
7906,ERX,HCPCS 63700001,51079-0588-20,THIOTHIXENE 5 MG PO CAPS,$13.76,$0.00,$13.76,$0.00,$9.82,$0.00,$0.00,$0.00,$0.00,$0.00,$13.76,$0.00,$6.88,$10.90,$11.01,$0.00,$0.00,$0.00,$0.00,$0.00
7906,ERX,HCPCS 63700001,70954-0016-10,THIOTHIXENE 5 MG PO CAPS,$13.76,$0.00,$13.76,$0.00,$9.82,$0.00,$0.00,$0.00,$0.00,$0.00,$13.76,$0.00,$6.88,$10.90,$11.01,$0.00,$0.00,$0.00,$0.00,$0.00
7940,ERX,HCPCS 63700001,00456-0457-01,THYROID 15 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
7947,ERX,HCPCS 63700001,00456-0459-01,THYROID 60 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
7993,ERX,HCPCS 25000001,63323-0305-02,TOBRAMYCIN SULFATE 10 MG/ML IJ SOLN,$24.08,$0.00,$24.08,$0.00,$17.19,$0.00,$0.00,$0.00,$0.00,$0.00,$24.08,$0.00,$12.04,$19.07,$19.26,$0.00,$0.00,$0.00,$0.00,$0.00
7995,ERX,HCPCS 25000001,17478-0290-10,TOBRAMYCIN 0.3 % OP SOLN,$52.67,$0.00,$52.67,$0.00,$16.95,$0.00,$0.00,$0.00,$0.00,$0.00,$52.67,$0.00,$26.34,$41.71,$42.14,$0.00,$0.00,$0.00,$0.00,$0.00
7995,ERX,HCPCS 25000001,24208-0290-05,TOBRAMYCIN 0.3 % OP SOLN,$52.67,$0.00,$52.67,$0.00,$16.95,$0.00,$0.00,$0.00,$0.00,$0.00,$52.67,$0.00,$26.34,$41.71,$42.14,$0.00,$0.00,$0.00,$0.00,$0.00
7995,ERX,HCPCS 25000001,61314-0643-05,TOBRAMYCIN 0.3 % OP SOLN,$52.67,$0.00,$52.67,$0.00,$16.95,$0.00,$0.00,$0.00,$0.00,$0.00,$52.67,$0.00,$26.34,$41.71,$42.14,$0.00,$0.00,$0.00,$0.00,$0.00
7995,ERX,HCPCS 25000001,70069-0131-01,TOBRAMYCIN 0.3 % OP SOLN,$52.67,$0.00,$52.67,$0.00,$16.95,$0.00,$0.00,$0.00,$0.00,$0.00,$52.67,$0.00,$26.34,$41.71,$42.14,$0.00,$0.00,$0.00,$0.00,$0.00
8083,ERX,HCPCS 63700001,00904-6869-61,TRAZODONE HCL 100 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
8083,ERX,HCPCS 63700001,50111-0434-01,TRAZODONE HCL 100 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
8085,ERX,HCPCS 63700001,00904-6868-61,TRAZODONE HCL 50 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
8085,ERX,HCPCS 63700001,50111-0433-01,TRAZODONE HCL 50 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
8085,ERX,HCPCS 63700001,50111-0433-02,TRAZODONE HCL 50 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
8112,ERX,HCPCS 63700001,45802-0063-35,TRIAMCINOLONE ACETONIDE 0.025 % EX CREA,$16.93,$0.00,$16.93,$0.00,$12.08,$0.00,$0.00,$0.00,$0.00,$0.00,$16.93,$0.00,$8.47,$13.41,$13.54,$0.00,$0.00,$0.00,$0.00,$0.00
8113,ERX,HCPCS 63700001,00168-0004-15,TRIAMCINOLONE ACETONIDE 0.1 % EX CREA,$21.21,$0.00,$21.21,$0.00,$15.14,$0.00,$0.00,$0.00,$0.00,$0.00,$21.21,$0.00,$10.61,$16.80,$16.97,$0.00,$0.00,$0.00,$0.00,$0.00
8113,ERX,HCPCS 63700001,52565-0056-15,TRIAMCINOLONE ACETONIDE 0.1 % EX CREA,$21.21,$0.00,$21.21,$0.00,$15.14,$0.00,$0.00,$0.00,$0.00,$0.00,$21.21,$0.00,$10.61,$16.80,$16.97,$0.00,$0.00,$0.00,$0.00,$0.00
8113,ERX,HCPCS 63700001,00168-0004-80,TRIAMCINOLONE ACETONIDE 0.1 % EX CREA,$117.18,$0.00,$92.81,$0.00,$15.14,$0.00,$0.00,$0.00,$0.00,$0.00,$21.21,$0.00,$10.61,$92.81,$16.97,$0.00,$0.00,$0.00,$0.00,$0.00
8113,ERX,HCPCS 63700001,45802-0064-36,TRIAMCINOLONE ACETONIDE 0.1 % EX CREA,$117.18,$0.00,$92.81,$0.00,$15.14,$0.00,$0.00,$0.00,$0.00,$0.00,$21.21,$0.00,$10.61,$92.81,$16.97,$0.00,$0.00,$0.00,$0.00,$0.00
8114,ERX,HCPCS 63700001,00168-0002-15,TRIAMCINOLONE ACETONIDE 0.5 % EX CREA,$42.18,$0.00,$42.18,$0.00,$30.10,$0.00,$0.00,$0.00,$0.00,$0.00,$42.18,$0.00,$21.09,$33.41,$33.74,$0.00,$0.00,$0.00,$0.00,$0.00
8114,ERX,HCPCS 63700001,45802-0065-35,TRIAMCINOLONE ACETONIDE 0.5 % EX CREA,$42.18,$0.00,$42.18,$0.00,$30.10,$0.00,$0.00,$0.00,$0.00,$0.00,$42.18,$0.00,$21.09,$33.41,$33.74,$0.00,$0.00,$0.00,$0.00,$0.00
8117,ERX,HCPCS 25000001,45802-0054-35,TRIAMCINOLONE ACETONIDE 0.025 % EX OINT,$23.26,$0.00,$23.26,$0.00,$16.60,$0.00,$0.00,$0.00,$0.00,$0.00,$23.26,$0.00,$11.63,$18.42,$18.61,$0.00,$0.00,$0.00,$0.00,$0.00
8118,ERX,HCPCS 63700001,45802-0055-35,TRIAMCINOLONE ACETONIDE 0.1 % EX OINT,$144.60,$0.00,$144.60,$0.00,$103.20,$0.00,$0.00,$0.00,$0.00,$0.00,$144.60,$0.00,$72.30,$114.52,$115.68,$0.00,$0.00,$0.00,$0.00,$0.00
8118,ERX,HCPCS 63700001,45802-0055-05,TRIAMCINOLONE ACETONIDE 0.1 % EX OINT,$144.60,$0.00,$144.60,$0.00,$103.20,$0.00,$0.00,$0.00,$0.00,$0.00,$144.60,$0.00,$72.30,$114.52,$115.68,$0.00,$0.00,$0.00,$0.00,$0.00
8118,ERX,HCPCS 63700001,52565-0014-26,TRIAMCINOLONE ACETONIDE 0.1 % EX OINT,$144.60,$0.00,$144.60,$0.00,$103.20,$0.00,$0.00,$0.00,$0.00,$0.00,$144.60,$0.00,$72.30,$114.52,$115.68,$0.00,$0.00,$0.00,$0.00,$0.00
8118,ERX,HCPCS 63700001,00168-0006-80,TRIAMCINOLONE ACETONIDE 0.1 % EX OINT,$144.60,$0.00,$144.60,$0.00,$103.20,$0.00,$0.00,$0.00,$0.00,$0.00,$144.60,$0.00,$72.30,$114.52,$115.68,$0.00,$0.00,$0.00,$0.00,$0.00
8118,ERX,HCPCS 63700001,45802-0055-36,TRIAMCINOLONE ACETONIDE 0.1 % EX OINT,$144.60,$0.00,$144.60,$0.00,$103.20,$0.00,$0.00,$0.00,$0.00,$0.00,$144.60,$0.00,$72.30,$114.52,$115.68,$0.00,$0.00,$0.00,$0.00,$0.00
8118,ERX,HCPCS 63700001,51672-1284-08,TRIAMCINOLONE ACETONIDE 0.1 % EX OINT,$144.60,$0.00,$144.60,$0.00,$103.20,$0.00,$0.00,$0.00,$0.00,$0.00,$144.60,$0.00,$72.30,$114.52,$115.68,$0.00,$0.00,$0.00,$0.00,$0.00
8118,ERX,HCPCS 63700001,52565-0014-80,TRIAMCINOLONE ACETONIDE 0.1 % EX OINT,$144.60,$0.00,$144.60,$0.00,$103.20,$0.00,$0.00,$0.00,$0.00,$0.00,$144.60,$0.00,$72.30,$114.52,$115.68,$0.00,$0.00,$0.00,$0.00,$0.00
8120,ERX,HCPCS J3301,00003-0293-05,TRIAMCINOLONE ACETONIDE 40 MG/ML IJ SUSP,$42.68,$0.00,$42.68,$19.21,$27.66,$0.00,$7.10,$0.00,$0.00,$7.33,$42.68,$0.00,$21.34,$33.80,$34.14,$0.00,$7.33,$0.00,$6.98,$0.00
8120,ERX,HCPCS J3301,00703-0241-01,TRIAMCINOLONE ACETONIDE 40 MG/ML IJ SUSP,$42.68,$0.00,$42.68,$19.21,$27.66,$0.00,$7.10,$0.00,$0.00,$7.33,$42.68,$0.00,$21.34,$33.80,$34.14,$0.00,$7.33,$0.00,$6.98,$0.00
8120,ERX,HCPCS J3301,70121-1049-01,TRIAMCINOLONE ACETONIDE 40 MG/ML IJ SUSP,$42.68,$0.00,$42.68,$19.21,$27.66,$0.00,$7.10,$0.00,$0.00,$7.33,$42.68,$0.00,$21.34,$33.80,$34.14,$0.00,$7.33,$0.00,$6.98,$0.00
8120,ERX,HCPCS J3301,70121-1049-05,TRIAMCINOLONE ACETONIDE 40 MG/ML IJ SUSP,$42.68,$0.00,$42.68,$19.21,$27.66,$0.00,$7.10,$0.00,$0.00,$7.33,$42.68,$0.00,$21.34,$33.80,$34.14,$0.00,$7.33,$0.00,$6.98,$0.00
8121,ERX,HCPCS 25000001,00713-0655-40,TRIAMCINOLONE ACETONIDE 0.1 % MT PSTE,$253.86,$0.00,$253.86,$0.00,$181.18,$0.00,$0.00,$0.00,$0.00,$0.00,$253.86,$0.00,$126.93,$201.06,$203.09,$0.00,$0.00,$0.00,$0.00,$0.00
8121,ERX,HCPCS 25000001,51672-1267-05,TRIAMCINOLONE ACETONIDE 0.1 % MT PSTE,$253.86,$0.00,$253.86,$0.00,$181.18,$0.00,$0.00,$0.00,$0.00,$0.00,$253.86,$0.00,$126.93,$201.06,$203.09,$0.00,$0.00,$0.00,$0.00,$0.00
8121,ERX,HCPCS 25000001,64980-0320-05,TRIAMCINOLONE ACETONIDE 0.1 % MT PSTE,$253.86,$0.00,$253.86,$0.00,$181.18,$0.00,$0.00,$0.00,$0.00,$0.00,$253.86,$0.00,$126.93,$201.06,$203.09,$0.00,$0.00,$0.00,$0.00,$0.00
8132,ERX,HCPCS 63700001,00378-1352-01,TRIAMTERENE-HCTZ 37.5-25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
8132,ERX,HCPCS 63700001,00591-0424-01,TRIAMTERENE-HCTZ 37.5-25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
8132,ERX,HCPCS 63700001,00591-0424-05,TRIAMTERENE-HCTZ 37.5-25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
8132,ERX,HCPCS 63700001,00781-1123-01,TRIAMTERENE-HCTZ 37.5-25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
8132,ERX,HCPCS 63700001,60505-2656-01,TRIAMTERENE-HCTZ 37.5-25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
8134,ERX,HCPCS 63700001,51079-0433-01,TRIAMTERENE-HCTZ 75-50 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
8134,ERX,HCPCS 63700001,51079-0433-20,TRIAMTERENE-HCTZ 75-50 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
8134,ERX,HCPCS 63700001,60505-2657-01,TRIAMTERENE-HCTZ 75-50 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
8162,ERX,HCPCS 63700001,00378-2410-01,TRIFLUOPERAZINE HCL 10 MG PO TABS,$9.30,$0.00,$9.30,$0.00,$6.64,$0.00,$0.00,$0.00,$0.00,$0.00,$9.30,$0.00,$4.65,$7.37,$7.44,$0.00,$0.00,$0.00,$0.00,$0.00
8163,ERX,HCPCS 63700001,00378-2402-01,TRIFLUOPERAZINE HCL 2 MG PO TABS,$7.60,$0.00,$7.60,$0.00,$5.42,$0.00,$0.00,$0.00,$0.00,$0.00,$7.60,$0.00,$3.80,$6.02,$6.08,$0.00,$0.00,$0.00,$0.00,$0.00
8163,ERX,HCPCS 63700001,51079-0573-01,TRIFLUOPERAZINE HCL 2 MG PO TABS,$7.60,$0.00,$7.60,$0.00,$5.42,$0.00,$0.00,$0.00,$0.00,$0.00,$7.60,$0.00,$3.80,$6.02,$6.08,$0.00,$0.00,$0.00,$0.00,$0.00
8163,ERX,HCPCS 63700001,51079-0573-20,TRIFLUOPERAZINE HCL 2 MG PO TABS,$7.60,$0.00,$7.60,$0.00,$5.42,$0.00,$0.00,$0.00,$0.00,$0.00,$7.60,$0.00,$3.80,$6.02,$6.08,$0.00,$0.00,$0.00,$0.00,$0.00
8164,ERX,HCPCS 63700001,00781-8034-01,TRIFLUOPERAZINE HCL 5 MG PO TABS,$6.17,$0.00,$6.17,$0.00,$4.40,$0.00,$0.00,$0.00,$0.00,$0.00,$6.17,$0.00,$3.09,$4.89,$4.94,$0.00,$0.00,$0.00,$0.00,$0.00
8166,ERX,HCPCS 63700001,00591-5335-01,TRIHEXYPHENIDYL HCL 2 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
8167,ERX,HCPCS 63700001,00591-5337-01,TRIHEXYPHENIDYL HCL 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
8167,ERX,HCPCS 63700001,16571-0161-10,TRIHEXYPHENIDYL HCL 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
8182,ERX,HCPCS 63700001,43386-0330-01,TRIMETHOPRIM 100 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
8249,ERX,HCPCS 25000001,17478-0101-12,TROPICAMIDE 0.5 % OP SOLN,$87.52,$0.00,$87.52,$0.00,$62.46,$0.00,$0.00,$0.00,$0.00,$0.00,$87.52,$0.00,$43.76,$69.32,$70.02,$0.00,$0.00,$0.00,$0.00,$0.00
8249,ERX,HCPCS 25000001,24208-0590-64,TROPICAMIDE 0.5 % OP SOLN,$87.52,$0.00,$87.52,$0.00,$62.46,$0.00,$0.00,$0.00,$0.00,$0.00,$87.52,$0.00,$43.76,$69.32,$70.02,$0.00,$0.00,$0.00,$0.00,$0.00
8249,ERX,HCPCS 25000001,61314-0354-01,TROPICAMIDE 0.5 % OP SOLN,$87.52,$0.00,$87.52,$0.00,$62.46,$0.00,$0.00,$0.00,$0.00,$0.00,$87.52,$0.00,$43.76,$69.32,$70.02,$0.00,$0.00,$0.00,$0.00,$0.00
8250,ERX,HCPCS 25000001,17478-0102-12,TROPICAMIDE 1 % OP SOLN,$40.47,$0.00,$40.47,$0.00,$28.88,$0.00,$0.00,$0.00,$0.00,$0.00,$40.47,$0.00,$20.24,$32.05,$32.38,$0.00,$0.00,$0.00,$0.00,$0.00
8250,ERX,HCPCS 25000001,61314-0355-02,TROPICAMIDE 1 % OP SOLN,$40.47,$0.00,$40.47,$0.00,$28.88,$0.00,$0.00,$0.00,$0.00,$0.00,$40.47,$0.00,$20.24,$32.05,$32.38,$0.00,$0.00,$0.00,$0.00,$0.00
8250,ERX,HCPCS 25000001,24208-0585-59,TROPICAMIDE 1 % OP SOLN,$40.47,$0.00,$40.47,$0.00,$28.88,$0.00,$0.00,$0.00,$0.00,$0.00,$40.47,$0.00,$20.24,$32.05,$32.38,$0.00,$0.00,$0.00,$0.00,$0.00
8250,ERX,HCPCS 25000001,61314-0355-01,TROPICAMIDE 1 % OP SOLN,$40.47,$0.00,$40.47,$0.00,$28.88,$0.00,$0.00,$0.00,$0.00,$0.00,$40.47,$0.00,$20.24,$32.05,$32.38,$0.00,$0.00,$0.00,$0.00,$0.00
8259,ERX,HCPCS 25000001,42023-0104-01,TUBERCULIN PPD 5 UNIT/0.1ML ID SOLN,$27.00,$0.00,$27.00,$0.00,$19.27,$0.00,$0.00,$0.00,$0.00,$0.00,$27.00,$0.00,$13.50,$21.38,$21.60,$0.00,$0.00,$0.00,$0.00,$0.00
8259,ERX,HCPCS 25000001,49281-0752-21,TUBERCULIN PPD 5 UNIT/0.1ML ID SOLN,$27.00,$0.00,$27.00,$0.00,$19.27,$0.00,$0.00,$0.00,$0.00,$0.00,$27.00,$0.00,$13.50,$21.38,$21.60,$0.00,$0.00,$0.00,$0.00,$0.00
8259,ERX,HCPCS 25000001,49281-0752-22,TUBERCULIN PPD 5 UNIT/0.1ML ID SOLN,$27.00,$0.00,$27.00,$0.00,$19.27,$0.00,$0.00,$0.00,$0.00,$0.00,$27.00,$0.00,$13.50,$21.38,$21.60,$0.00,$0.00,$0.00,$0.00,$0.00
8259,ERX,HCPCS 25000001,99999-6005-54,TUBERCULIN PPD 5 UNIT/0.1ML ID SOLN,$27.00,$0.00,$27.00,$0.00,$19.27,$0.00,$0.00,$0.00,$0.00,$0.00,$27.00,$0.00,$13.50,$21.38,$21.60,$0.00,$0.00,$0.00,$0.00,$0.00
8443,ERX,HCPCS J3370,00409-4332-01,VANCOMYCIN HCL 500 MG IV SOLR,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.62,$0.00,$0.00,$3.98,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.98,$0.00,$3.79,$0.00
8443,ERX,HCPCS J3370,00409-6534-01,VANCOMYCIN HCL 500 MG IV SOLR,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.62,$0.00,$0.00,$3.98,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.98,$0.00,$3.79,$0.00
8443,ERX,HCPCS J3370,47781-0598-07,VANCOMYCIN HCL 500 MG IV SOLR,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.62,$0.00,$0.00,$3.98,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.98,$0.00,$3.79,$0.00
8443,ERX,HCPCS J3370,47781-0598-91,VANCOMYCIN HCL 500 MG IV SOLR,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.62,$0.00,$0.00,$3.98,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.98,$0.00,$3.79,$0.00
8443,ERX,HCPCS J3370,67457-0339-50,VANCOMYCIN HCL 500 MG IV SOLR,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.62,$0.00,$0.00,$3.98,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.98,$0.00,$3.79,$0.00
8443,ERX,HCPCS J3370,70860-0104-10,VANCOMYCIN HCL 500 MG IV SOLR,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.62,$0.00,$0.00,$3.98,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.98,$0.00,$3.79,$0.00
8527,ERX,HCPCS 25000001,00409-1144-05,VERAPAMIL HCL 2.5 MG/ML IV SOLN,$73.31,$0.00,$73.31,$0.00,$52.32,$0.00,$0.00,$0.00,$0.00,$0.00,$73.31,$0.00,$36.66,$58.06,$58.65,$0.00,$0.00,$0.00,$0.00,$0.00
8527,ERX,HCPCS 25000001,42571-0313-75,VERAPAMIL HCL 2.5 MG/ML IV SOLN,$73.31,$0.00,$73.31,$0.00,$52.32,$0.00,$0.00,$0.00,$0.00,$0.00,$73.31,$0.00,$36.66,$58.06,$58.65,$0.00,$0.00,$0.00,$0.00,$0.00
8527,ERX,HCPCS 25000001,42571-0313-87,VERAPAMIL HCL 2.5 MG/ML IV SOLN,$73.31,$0.00,$73.31,$0.00,$52.32,$0.00,$0.00,$0.00,$0.00,$0.00,$73.31,$0.00,$36.66,$58.06,$58.65,$0.00,$0.00,$0.00,$0.00,$0.00
8527,ERX,HCPCS 25000001,42571-0313-97,VERAPAMIL HCL 2.5 MG/ML IV SOLN,$73.31,$0.00,$73.31,$0.00,$52.32,$0.00,$0.00,$0.00,$0.00,$0.00,$73.31,$0.00,$36.66,$58.06,$58.65,$0.00,$0.00,$0.00,$0.00,$0.00
8527,ERX,HCPCS 25000001,51754-0203-04,VERAPAMIL HCL 2.5 MG/ML IV SOLN,$73.31,$0.00,$73.31,$0.00,$52.32,$0.00,$0.00,$0.00,$0.00,$0.00,$73.31,$0.00,$36.66,$58.06,$58.65,$0.00,$0.00,$0.00,$0.00,$0.00
8527,ERX,HCPCS 25000001,70121-1585-05,VERAPAMIL HCL 2.5 MG/ML IV SOLN,$73.31,$0.00,$73.31,$0.00,$52.32,$0.00,$0.00,$0.00,$0.00,$0.00,$73.31,$0.00,$36.66,$58.06,$58.65,$0.00,$0.00,$0.00,$0.00,$0.00
8527,ERX,HCPCS 25000001,72485-0108-05,VERAPAMIL HCL 2.5 MG/ML IV SOLN,$73.31,$0.00,$73.31,$0.00,$52.32,$0.00,$0.00,$0.00,$0.00,$0.00,$73.31,$0.00,$36.66,$58.06,$58.65,$0.00,$0.00,$0.00,$0.00,$0.00
8527,ERX,HCPCS 25000001,72485-0108-25,VERAPAMIL HCL 2.5 MG/ML IV SOLN,$73.31,$0.00,$73.31,$0.00,$52.32,$0.00,$0.00,$0.00,$0.00,$0.00,$73.31,$0.00,$36.66,$58.06,$58.65,$0.00,$0.00,$0.00,$0.00,$0.00
8528,ERX,HCPCS 63700001,00904-2924-61,VERAPAMIL HCL 120 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
8530,ERX,HCPCS 63700001,00591-0343-01,VERAPAMIL HCL 80 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
8530,ERX,HCPCS 63700001,00904-2920-61,VERAPAMIL HCL 80 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
8594,ERX,HCPCS J9360,63323-0278-10,VINBLASTINE SULFATE 1 MG/ML IV SOLN,$162.80,$0.00,$162.80,$73.26,$116.19,$0.00,$28.05,$0.00,$0.00,$45.71,$162.80,$0.00,$81.40,$128.94,$130.24,$0.00,$45.71,$0.00,$43.52,$0.00
8597,ERX,HCPCS J9370,61703-0309-06,VINCRISTINE SULFATE 1 MG/ML IV SOLN,$57.00,$0.00,$57.00,$25.65,$40.68,$0.00,$15.09,$0.00,$0.00,$11.47,$57.00,$0.00,$28.50,$45.14,$45.60,$0.00,$11.47,$0.00,$0.00,$0.00
8597,ERX,HCPCS J9370,61703-0309-16,VINCRISTINE SULFATE 1 MG/ML IV SOLN,$57.00,$0.00,$57.00,$25.65,$40.68,$0.00,$15.09,$0.00,$0.00,$11.47,$57.00,$0.00,$28.50,$45.14,$45.60,$0.00,$11.47,$0.00,$0.00,$0.00
8597,ERX,HCPCS J9370,61703-0309-25,VINCRISTINE SULFATE 1 MG/ML IV SOLN,$57.00,$0.00,$57.00,$25.65,$40.68,$0.00,$15.09,$0.00,$0.00,$11.47,$57.00,$0.00,$28.50,$45.14,$45.60,$0.00,$11.47,$0.00,$0.00,$0.00
8597,ERX,HCPCS J9370,61703-0309-26,VINCRISTINE SULFATE 1 MG/ML IV SOLN,$57.00,$0.00,$57.00,$25.65,$40.68,$0.00,$15.09,$0.00,$0.00,$11.47,$57.00,$0.00,$28.50,$45.14,$45.60,$0.00,$11.47,$0.00,$0.00,$0.00
8639,ERX,HCPCS 63700001,00904-2085-60,VITAMIN A 3 MG (10000 UT) PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
8647,ERX,HCPCS 63700001,31604-0012-81,VITAMIN B-1 100 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
8647,ERX,HCPCS 63700001,37864-0905-99,VITAMIN B-1 100 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
8647,ERX,HCPCS 63700001,48433-0108-01,VITAMIN B-1 100 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
8647,ERX,HCPCS 63700001,51645-0905-99,VITAMIN B-1 100 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
8647,ERX,HCPCS 63700001,54629-0057-01,VITAMIN B-1 100 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
8647,ERX,HCPCS 63700001,77333-0934-10,VITAMIN B-1 100 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
8647,ERX,HCPCS 63700001,77333-0934-25,VITAMIN B-1 100 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
8654,ERX,HCPCS 63700001,10006-0730-43,VITAMIN B-12 1000 MCG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
8654,ERX,HCPCS 63700001,74312-0013-80,VITAMIN B-12 1000 MCG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
8654,ERX,HCPCS 63700001,77333-0938-10,VITAMIN B-12 1000 MCG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
8654,ERX,HCPCS 63700001,77333-0938-25,VITAMIN B-12 1000 MCG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
8661,ERX,HCPCS 63700001,43292-0555-38,VITAMIN B-2 25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
8667,ERX,HCPCS 63700001,00904-0520-60,VITAMIN B-6 50 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
8667,ERX,HCPCS 63700001,77333-0940-10,VITAMIN B-6 50 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
8667,ERX,HCPCS 63700001,77333-0940-25,VITAMIN B-6 50 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
8680,ERX,HCPCS 63700001,00904-0523-61,VITAMIN C 500 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
8680,ERX,HCPCS 63700001,00904-0523-72,VITAMIN C 500 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
8680,ERX,HCPCS 63700001,00904-0523-80,VITAMIN C 500 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
8680,ERX,HCPCS 63700001,57896-0841-01,VITAMIN C 500 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
8698,ERX,HCPCS 63700001,00904-0270-60,VITAMIN E 100 UNITS PO CAPS,$6.00,$0.00,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
8701,ERX,HCPCS 63700001,00904-0274-60,VITAMIN E 400 UNITS PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
8701,ERX,HCPCS 63700001,10006-0700-34,VITAMIN E 400 UNITS PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
8718,ERX,HCPCS J3430,00409-9158-01,VITAMIN K1 10 MG/ML IJ SOLN,$44.00,$0.00,$44.00,$0.00,$31.40,$0.00,$0.00,$0.00,$0.00,$0.00,$44.00,$0.00,$22.00,$34.85,$35.20,$0.00,$0.00,$0.00,$0.00,$0.00
8718,ERX,HCPCS J3430,00409-9158-31,VITAMIN K1 10 MG/ML IJ SOLN,$44.00,$0.00,$44.00,$0.00,$31.40,$0.00,$0.00,$0.00,$0.00,$0.00,$44.00,$0.00,$22.00,$34.85,$35.20,$0.00,$0.00,$0.00,$0.00,$0.00
8718,ERX,HCPCS J3430,43598-0405-16,VITAMIN K1 10 MG/ML IJ SOLN,$44.00,$0.00,$44.00,$0.00,$31.40,$0.00,$0.00,$0.00,$0.00,$0.00,$44.00,$0.00,$22.00,$34.85,$35.20,$0.00,$0.00,$0.00,$0.00,$0.00
8748,ERX,HCPCS 63700001,00832-1219-01,WARFARIN SODIUM 10 MG PO TABS,$14.59,$0.00,$14.59,$0.00,$10.41,$0.00,$0.00,$0.00,$0.00,$0.00,$14.59,$0.00,$7.30,$11.56,$11.67,$0.00,$0.00,$0.00,$0.00,$0.00
8749,ERX,HCPCS 63700001,00832-1212-01,WARFARIN SODIUM 2 MG PO TABS,$9.81,$0.00,$9.81,$0.00,$7.00,$0.00,$0.00,$0.00,$0.00,$0.00,$9.81,$0.00,$4.91,$7.77,$7.85,$0.00,$0.00,$0.00,$0.00,$0.00
8749,ERX,HCPCS 63700001,00832-1212-89,WARFARIN SODIUM 2 MG PO TABS,$9.81,$0.00,$9.81,$0.00,$7.00,$0.00,$0.00,$0.00,$0.00,$0.00,$9.81,$0.00,$4.91,$7.77,$7.85,$0.00,$0.00,$0.00,$0.00,$0.00
8749,ERX,HCPCS 63700001,51672-4028-01,WARFARIN SODIUM 2 MG PO TABS,$9.81,$0.00,$9.81,$0.00,$7.00,$0.00,$0.00,$0.00,$0.00,$0.00,$9.81,$0.00,$4.91,$7.77,$7.85,$0.00,$0.00,$0.00,$0.00,$0.00
8750,ERX,HCPCS 63700001,00832-1213-01,WARFARIN SODIUM 2.5 MG PO TABS,$10.13,$0.00,$10.13,$0.00,$7.23,$0.00,$0.00,$0.00,$0.00,$0.00,$10.13,$0.00,$5.07,$8.02,$8.10,$0.00,$0.00,$0.00,$0.00,$0.00
8750,ERX,HCPCS 63700001,57237-0121-01,WARFARIN SODIUM 2.5 MG PO TABS,$10.13,$0.00,$10.13,$0.00,$7.23,$0.00,$0.00,$0.00,$0.00,$0.00,$10.13,$0.00,$5.07,$8.02,$8.10,$0.00,$0.00,$0.00,$0.00,$0.00
8750,ERX,HCPCS 63700001,68084-0027-01,WARFARIN SODIUM 2.5 MG PO TABS,$10.13,$0.00,$10.13,$0.00,$7.23,$0.00,$0.00,$0.00,$0.00,$0.00,$10.13,$0.00,$5.07,$8.02,$8.10,$0.00,$0.00,$0.00,$0.00,$0.00
8751,ERX,HCPCS 63700001,00832-1216-01,WARFARIN SODIUM 5 MG PO TABS,$10.55,$0.00,$10.55,$0.00,$7.53,$0.00,$0.00,$0.00,$0.00,$0.00,$10.55,$0.00,$5.28,$8.36,$8.44,$0.00,$0.00,$0.00,$0.00,$0.00
8751,ERX,HCPCS 63700001,57237-0124-01,WARFARIN SODIUM 5 MG PO TABS,$10.55,$0.00,$10.55,$0.00,$7.53,$0.00,$0.00,$0.00,$0.00,$0.00,$10.55,$0.00,$5.28,$8.36,$8.44,$0.00,$0.00,$0.00,$0.00,$0.00
8752,ERX,HCPCS 63700001,00832-1218-01,WARFARIN SODIUM 7.5 MG PO TABS,$14.06,$0.00,$14.06,$0.00,$10.03,$0.00,$0.00,$0.00,$0.00,$0.00,$14.06,$0.00,$7.03,$11.14,$11.25,$0.00,$0.00,$0.00,$0.00,$0.00
8752,ERX,HCPCS 63700001,51672-4034-01,WARFARIN SODIUM 7.5 MG PO TABS,$14.06,$0.00,$14.06,$0.00,$10.03,$0.00,$0.00,$0.00,$0.00,$0.00,$14.06,$0.00,$7.03,$11.14,$11.25,$0.00,$0.00,$0.00,$0.00,$0.00
8752,ERX,HCPCS 63700001,57237-0126-01,WARFARIN SODIUM 7.5 MG PO TABS,$14.06,$0.00,$14.06,$0.00,$10.03,$0.00,$0.00,$0.00,$0.00,$0.00,$14.06,$0.00,$7.03,$11.14,$11.25,$0.00,$0.00,$0.00,$0.00,$0.00
8780,ERX,HCPCS 63700001,00168-0053-21,WHITE PETROLATUM EX OINT,$84.15,$0.00,$84.15,$0.00,$60.06,$0.00,$0.00,$0.00,$0.00,$0.00,$84.15,$0.00,$42.08,$66.65,$67.32,$0.00,$0.00,$0.00,$0.00,$0.00
8780,ERX,HCPCS 63700001,00168-0053-16,WHITE PETROLATUM EX OINT,$84.15,$0.00,$84.15,$0.00,$60.06,$0.00,$0.00,$0.00,$0.00,$0.00,$84.15,$0.00,$42.08,$66.65,$67.32,$0.00,$0.00,$0.00,$0.00,$0.00
8865,ERX,HCPCS 25000001,00409-4090-01,ZINC CHLORIDE 1 MG/ML IV SOLN,$81.62,$0.00,$81.62,$0.00,$58.25,$0.00,$0.00,$0.00,$0.00,$0.00,$81.62,$0.00,$40.81,$64.64,$65.30,$0.00,$0.00,$0.00,$0.00,$0.00
8874,ERX,HCPCS 63700001,00168-0062-31,ZINC OXIDE 20 % EX OINT,$11.00,$0.00,$11.00,$0.00,$7.85,$0.00,$0.00,$0.00,$0.00,$0.00,$11.00,$0.00,$5.50,$8.71,$8.80,$0.00,$0.00,$0.00,$0.00,$0.00
8874,ERX,HCPCS 63700001,75834-0170-01,ZINC OXIDE 20 % EX OINT,$11.00,$0.00,$11.00,$0.00,$7.85,$0.00,$0.00,$0.00,$0.00,$0.00,$11.00,$0.00,$5.50,$8.71,$8.80,$0.00,$0.00,$0.00,$0.00,$0.00
8874,ERX,HCPCS 63700001,00536-5700-28,ZINC OXIDE 20 % EX OINT,$11.00,$0.00,$11.00,$0.00,$7.85,$0.00,$0.00,$0.00,$0.00,$0.00,$11.00,$0.00,$5.50,$8.71,$8.80,$0.00,$0.00,$0.00,$0.00,$0.00
8874,ERX,HCPCS 63700001,00536-5700-98,ZINC OXIDE 20 % EX OINT,$137.76,$0.00,$109.11,$0.00,$7.85,$0.00,$0.00,$0.00,$0.00,$0.00,$11.00,$0.00,$5.50,$109.11,$8.80,$0.00,$0.00,$0.00,$0.00,$0.00
8878,ERX,HCPCS 25000001,00517-6110-25,ZINC SULFATE 1 MG/ML IV SOLN,$111.65,$0.00,$111.65,$0.00,$79.68,$0.00,$0.00,$0.00,$0.00,$0.00,$111.65,$0.00,$55.83,$88.43,$89.32,$0.00,$0.00,$0.00,$0.00,$0.00
8880,ERX,HCPCS 63700001,37864-0991-01,ZINC SULFATE 220 (50 ZN) MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
8880,ERX,HCPCS 63700001,77333-0983-10,ZINC SULFATE 220 (50 ZN) MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
8946,ERX,HCPCS 25000001,51672-2114-00,ACETAMINOPHEN 80 MG RECTAL SUPP,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
8946,ERX,HCPCS 25000001,51672-2114-02,ACETAMINOPHEN 80 MG RECTAL SUPP,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
8958,ERX,HCPCS 63700001,00591-3369-01,BUTALBITAL-APAP-CAFFEINE 50-325-40 MG PO TABS,$6.42,$0.00,$6.42,$0.00,$4.58,$0.00,$0.00,$0.00,$0.00,$0.00,$6.42,$0.00,$3.21,$5.08,$5.14,$0.00,$0.00,$0.00,$0.00,$0.00
8958,ERX,HCPCS 63700001,00603-2544-21,BUTALBITAL-APAP-CAFFEINE 50-325-40 MG PO TABS,$6.42,$0.00,$6.42,$0.00,$4.58,$0.00,$0.00,$0.00,$0.00,$0.00,$6.42,$0.00,$3.21,$5.08,$5.14,$0.00,$0.00,$0.00,$0.00,$0.00
8958,ERX,HCPCS 63700001,10702-0253-01,BUTALBITAL-APAP-CAFFEINE 50-325-40 MG PO TABS,$6.42,$0.00,$6.42,$0.00,$4.58,$0.00,$0.00,$0.00,$0.00,$0.00,$6.42,$0.00,$3.21,$5.08,$5.14,$0.00,$0.00,$0.00,$0.00,$0.00
8958,ERX,HCPCS 63700001,68084-0396-65,BUTALBITAL-APAP-CAFFEINE 50-325-40 MG PO TABS,$6.42,$0.00,$6.42,$0.00,$4.58,$0.00,$0.00,$0.00,$0.00,$0.00,$6.42,$0.00,$3.21,$5.08,$5.14,$0.00,$0.00,$0.00,$0.00,$0.00
8962,ERX,HCPCS 63700001,29033-0030-01,ACETAZOLAMIDE ER 500 MG PO CP12,$16.32,$0.00,$16.32,$0.00,$11.65,$0.00,$0.00,$0.00,$0.00,$0.00,$16.32,$0.00,$8.16,$12.93,$13.06,$0.00,$0.00,$0.00,$0.00,$0.00
8962,ERX,HCPCS 63700001,50742-0233-01,ACETAZOLAMIDE ER 500 MG PO CP12,$16.32,$0.00,$16.32,$0.00,$11.65,$0.00,$0.00,$0.00,$0.00,$0.00,$16.32,$0.00,$8.16,$12.93,$13.06,$0.00,$0.00,$0.00,$0.00,$0.00
8963,ERX,HCPCS 25000001,00338-0656-04,ACETIC ACID 0.25 % IR SOLN,$26.60,$0.00,$26.60,$0.00,$18.98,$0.00,$0.00,$0.00,$0.00,$0.00,$26.60,$0.00,$13.30,$21.07,$21.28,$0.00,$0.00,$0.00,$0.00,$0.00
8968,ERX,HCPCS 63700001,00378-8700-06,ACYCLOVIR 5 % EX OINT,"$1,056.84",$0.00,"$1,056.84",$0.00,$754.27,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,056.84",$0.00,$528.42,$837.02,$845.47,$0.00,$0.00,$0.00,$0.00,$0.00
8968,ERX,HCPCS 63700001,13668-0515-01,ACYCLOVIR 5 % EX OINT,"$1,056.84",$0.00,"$1,056.84",$0.00,$754.27,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,056.84",$0.00,$528.42,$837.02,$845.47,$0.00,$0.00,$0.00,$0.00,$0.00
8968,ERX,HCPCS 63700001,00187-0993-95,ACYCLOVIR 5 % EX OINT,"$1,914.27",$0.00,"$1,516.10",$0.00,$754.27,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,056.84",$0.00,$528.42,"$1,516.10",$845.47,$0.00,$0.00,$0.00,$0.00,$0.00
8969,ERX,HCPCS 63700001,00904-5789-61,ACYCLOVIR 200 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
8969,ERX,HCPCS 63700001,68084-0107-01,ACYCLOVIR 200 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
8970,ERX,HCPCS 63700001,99999-6004-74,ACYCLOVIR 200 MG/5ML PO SUSP,$165.00,$0.00,$165.00,$0.00,$117.76,$0.00,$0.00,$0.00,$0.00,$0.00,$165.00,$0.00,$82.50,$130.68,$132.00,$0.00,$0.00,$0.00,$0.00,$0.00
8970,ERX,HCPCS 63700001,00378-8712-73,ACYCLOVIR 200 MG/5ML PO SUSP,"$1,179.50",$0.00,$934.16,$0.00,$117.76,$0.00,$0.00,$0.00,$0.00,$0.00,$165.00,$0.00,$82.50,$934.16,$132.00,$0.00,$0.00,$0.00,$0.00,$0.00
8970,ERX,HCPCS 63700001,00472-0082-16,ACYCLOVIR 200 MG/5ML PO SUSP,"$1,179.50",$0.00,$934.16,$0.00,$117.76,$0.00,$0.00,$0.00,$0.00,$0.00,$165.00,$0.00,$82.50,$934.16,$132.00,$0.00,$0.00,$0.00,$0.00,$0.00
8970,ERX,HCPCS 63700001,50383-0810-16,ACYCLOVIR 200 MG/5ML PO SUSP,"$1,179.50",$0.00,$934.16,$0.00,$117.76,$0.00,$0.00,$0.00,$0.00,$0.00,$165.00,$0.00,$82.50,$934.16,$132.00,$0.00,$0.00,$0.00,$0.00,$0.00
8971,ERX,HCPCS 63700001,00904-5790-61,ACYCLOVIR 400 MG PO TABS,$7.17,$0.00,$7.17,$0.00,$5.12,$0.00,$0.00,$0.00,$0.00,$0.00,$7.17,$0.00,$3.59,$5.68,$5.74,$0.00,$0.00,$0.00,$0.00,$0.00
8971,ERX,HCPCS 63700001,31722-0777-01,ACYCLOVIR 400 MG PO TABS,$7.17,$0.00,$7.17,$0.00,$5.12,$0.00,$0.00,$0.00,$0.00,$0.00,$7.17,$0.00,$3.59,$5.68,$5.74,$0.00,$0.00,$0.00,$0.00,$0.00
8971,ERX,HCPCS 63700001,31722-0777-05,ACYCLOVIR 400 MG PO TABS,$7.17,$0.00,$7.17,$0.00,$5.12,$0.00,$0.00,$0.00,$0.00,$0.00,$7.17,$0.00,$3.59,$5.68,$5.74,$0.00,$0.00,$0.00,$0.00,$0.00
8971,ERX,HCPCS 63700001,50268-0061-15,ACYCLOVIR 400 MG PO TABS,$7.17,$0.00,$7.17,$0.00,$5.12,$0.00,$0.00,$0.00,$0.00,$0.00,$7.17,$0.00,$3.59,$5.68,$5.74,$0.00,$0.00,$0.00,$0.00,$0.00
8971,ERX,HCPCS 63700001,60505-5306-01,ACYCLOVIR 400 MG PO TABS,$7.17,$0.00,$7.17,$0.00,$5.12,$0.00,$0.00,$0.00,$0.00,$0.00,$7.17,$0.00,$3.59,$5.68,$5.74,$0.00,$0.00,$0.00,$0.00,$0.00
8971,ERX,HCPCS 63700001,60505-5306-08,ACYCLOVIR 400 MG PO TABS,$7.17,$0.00,$7.17,$0.00,$5.12,$0.00,$0.00,$0.00,$0.00,$0.00,$7.17,$0.00,$3.59,$5.68,$5.74,$0.00,$0.00,$0.00,$0.00,$0.00
8971,ERX,HCPCS 63700001,61442-0112-05,ACYCLOVIR 400 MG PO TABS,$7.17,$0.00,$7.17,$0.00,$5.12,$0.00,$0.00,$0.00,$0.00,$0.00,$7.17,$0.00,$3.59,$5.68,$5.74,$0.00,$0.00,$0.00,$0.00,$0.00
8971,ERX,HCPCS 63700001,63304-0504-01,ACYCLOVIR 400 MG PO TABS,$7.17,$0.00,$7.17,$0.00,$5.12,$0.00,$0.00,$0.00,$0.00,$0.00,$7.17,$0.00,$3.59,$5.68,$5.74,$0.00,$0.00,$0.00,$0.00,$0.00
8971,ERX,HCPCS 63700001,63739-0682-10,ACYCLOVIR 400 MG PO TABS,$7.17,$0.00,$7.17,$0.00,$5.12,$0.00,$0.00,$0.00,$0.00,$0.00,$7.17,$0.00,$3.59,$5.68,$5.74,$0.00,$0.00,$0.00,$0.00,$0.00
8971,ERX,HCPCS 63700001,68084-0108-01,ACYCLOVIR 400 MG PO TABS,$7.17,$0.00,$7.17,$0.00,$5.12,$0.00,$0.00,$0.00,$0.00,$0.00,$7.17,$0.00,$3.59,$5.68,$5.74,$0.00,$0.00,$0.00,$0.00,$0.00
8972,ERX,HCPCS 63700001,31722-0778-01,ACYCLOVIR 800 MG PO TABS,$13.31,$0.00,$13.31,$0.00,$9.50,$0.00,$0.00,$0.00,$0.00,$0.00,$13.31,$0.00,$6.66,$10.54,$10.65,$0.00,$0.00,$0.00,$0.00,$0.00
8972,ERX,HCPCS 63700001,60505-5307-01,ACYCLOVIR 800 MG PO TABS,$13.31,$0.00,$13.31,$0.00,$9.50,$0.00,$0.00,$0.00,$0.00,$0.00,$13.31,$0.00,$6.66,$10.54,$10.65,$0.00,$0.00,$0.00,$0.00,$0.00
8972,ERX,HCPCS 63700001,68084-0109-01,ACYCLOVIR 800 MG PO TABS,$13.31,$0.00,$13.31,$0.00,$9.50,$0.00,$0.00,$0.00,$0.00,$0.00,$13.31,$0.00,$6.66,$10.54,$10.65,$0.00,$0.00,$0.00,$0.00,$0.00
8979,ERX,HCPCS 63700001,00591-2712-02,ALBENDAZOLE 200 MG PO TABS,$373.28,$0.00,$373.28,$0.00,$266.41,$0.00,$0.00,$0.00,$0.00,$0.00,$373.28,$0.00,$186.64,$295.64,$298.62,$0.00,$0.00,$0.00,$0.00,$0.00
8979,ERX,HCPCS 63700001,52054-0550-22,ALBENDAZOLE 200 MG PO TABS,$373.28,$0.00,$373.28,$0.00,$266.41,$0.00,$0.00,$0.00,$0.00,$0.00,$373.28,$0.00,$186.64,$295.64,$298.62,$0.00,$0.00,$0.00,$0.00,$0.00
8979,ERX,HCPCS 63700001,69097-0237-72,ALBENDAZOLE 200 MG PO TABS,$373.28,$0.00,$373.28,$0.00,$266.41,$0.00,$0.00,$0.00,$0.00,$0.00,$373.28,$0.00,$186.64,$295.64,$298.62,$0.00,$0.00,$0.00,$0.00,$0.00
8979,ERX,HCPCS 63700001,70710-1021-08,ALBENDAZOLE 200 MG PO TABS,$373.28,$0.00,$373.28,$0.00,$266.41,$0.00,$0.00,$0.00,$0.00,$0.00,$373.28,$0.00,$186.64,$295.64,$298.62,$0.00,$0.00,$0.00,$0.00,$0.00
8981,ERX,HCPCS P9047,00944-0493-01,ALBUMIN HUMAN 25 % IV SOLN,$181.44,$0.00,$181.44,$81.65,$129.49,$52.45,$60.16,$0.00,$0.00,$61.63,$181.44,$55.07,$90.72,$143.70,$145.15,$76.05,$61.63,$0.00,$58.68,$52.45
8981,ERX,HCPCS P9047,76125-0792-25,ALBUMIN HUMAN 25 % IV SOLN,$181.44,$0.00,$181.44,$81.65,$129.49,$52.45,$60.16,$0.00,$0.00,$61.63,$181.44,$55.07,$90.72,$143.70,$145.15,$76.05,$61.63,$0.00,$58.68,$52.45
8982,ERX,HCPCS P9045,00944-0495-05,ALBUMIN HUMAN 5 % IV SOLN,$181.13,$0.00,$181.13,$81.51,$129.27,$52.45,$27.86,$0.00,$0.00,$31.71,$181.13,$55.07,$90.57,$143.45,$144.90,$76.05,$28.35,$0.00,$28.84,$52.45
8982,ERX,HCPCS P9045,44206-0310-25,ALBUMIN HUMAN 5 % IV SOLN,$181.13,$0.00,$181.13,$81.51,$129.27,$52.45,$27.86,$0.00,$0.00,$31.71,$181.13,$55.07,$90.57,$143.45,$144.90,$76.05,$28.35,$0.00,$28.84,$52.45
8982,ERX,HCPCS P9045,44206-0310-50,ALBUMIN HUMAN 5 % IV SOLN,$181.13,$0.00,$181.13,$81.51,$129.27,$52.45,$27.86,$0.00,$0.00,$31.71,$181.13,$55.07,$90.57,$143.45,$144.90,$76.05,$28.35,$0.00,$28.84,$52.45
8982,ERX,HCPCS P9045,68516-5214-02,ALBUMIN HUMAN 5 % IV SOLN,$181.13,$0.00,$181.13,$81.51,$129.27,$52.45,$27.86,$0.00,$0.00,$31.71,$181.13,$55.07,$90.57,$143.45,$144.90,$76.05,$28.35,$0.00,$28.84,$52.45
8982,ERX,HCPCS P9045,76125-0790-26,ALBUMIN HUMAN 5 % IV SOLN,$181.13,$0.00,$181.13,$81.51,$129.27,$52.45,$27.86,$0.00,$0.00,$31.71,$181.13,$55.07,$90.57,$143.45,$144.90,$76.05,$28.35,$0.00,$28.84,$52.45
8982,ERX,HCPCS P9045,99999-6006-39,ALBUMIN HUMAN 5 % IV SOLN,$181.13,$0.00,$181.13,$81.51,$129.27,$52.45,$27.86,$0.00,$0.00,$31.71,$181.13,$55.07,$90.57,$143.45,$144.90,$76.05,$28.35,$0.00,$28.84,$52.45
8985,ERX,HCPCS 25000001,00168-0263-15,ALCLOMETASONE DIPROPIONATE 0.05 % EX CREA,$168.27,$0.00,$168.27,$0.00,$120.09,$0.00,$0.00,$0.00,$0.00,$0.00,$168.27,$0.00,$84.14,$133.27,$134.62,$0.00,$0.00,$0.00,$0.00,$0.00
8985,ERX,HCPCS 25000001,51672-1306-01,ALCLOMETASONE DIPROPIONATE 0.05 % EX CREA,$168.27,$0.00,$168.27,$0.00,$120.09,$0.00,$0.00,$0.00,$0.00,$0.00,$168.27,$0.00,$84.14,$133.27,$134.62,$0.00,$0.00,$0.00,$0.00,$0.00
8985,ERX,HCPCS 25000001,68462-0300-17,ALCLOMETASONE DIPROPIONATE 0.05 % EX CREA,$168.27,$0.00,$168.27,$0.00,$120.09,$0.00,$0.00,$0.00,$0.00,$0.00,$168.27,$0.00,$84.14,$133.27,$134.62,$0.00,$0.00,$0.00,$0.00,$0.00
8985,ERX,HCPCS 25000001,51672-1306-06,ALCLOMETASONE DIPROPIONATE 0.05 % EX CREA,$439.89,$0.00,$348.39,$0.00,$120.09,$0.00,$0.00,$0.00,$0.00,$0.00,$168.27,$0.00,$84.14,$348.39,$134.62,$0.00,$0.00,$0.00,$0.00,$0.00
8985,ERX,HCPCS 25000001,51672-1306-03,ALCLOMETASONE DIPROPIONATE 0.05 % EX CREA,$586.52,$0.00,$464.52,$0.00,$120.09,$0.00,$0.00,$0.00,$0.00,$0.00,$168.27,$0.00,$84.14,$464.52,$134.62,$0.00,$0.00,$0.00,$0.00,$0.00
8985,ERX,HCPCS 25000001,68462-0300-65,ALCLOMETASONE DIPROPIONATE 0.05 % EX CREA,$586.52,$0.00,$464.52,$0.00,$120.09,$0.00,$0.00,$0.00,$0.00,$0.00,$168.27,$0.00,$84.14,$464.52,$134.62,$0.00,$0.00,$0.00,$0.00,$0.00
8986,ERX,HCPCS 25000001,00168-0264-15,ALCLOMETASONE DIPROPIONATE 0.05 % EX OINT,$75.99,$0.00,$75.99,$0.00,$54.23,$0.00,$0.00,$0.00,$0.00,$0.00,$75.99,$0.00,$38.00,$60.18,$60.79,$0.00,$0.00,$0.00,$0.00,$0.00
8986,ERX,HCPCS 25000001,51672-1316-01,ALCLOMETASONE DIPROPIONATE 0.05 % EX OINT,$75.99,$0.00,$75.99,$0.00,$54.23,$0.00,$0.00,$0.00,$0.00,$0.00,$75.99,$0.00,$38.00,$60.18,$60.79,$0.00,$0.00,$0.00,$0.00,$0.00
8986,ERX,HCPCS 25000001,68462-0299-17,ALCLOMETASONE DIPROPIONATE 0.05 % EX OINT,$75.99,$0.00,$75.99,$0.00,$54.23,$0.00,$0.00,$0.00,$0.00,$0.00,$75.99,$0.00,$38.00,$60.18,$60.79,$0.00,$0.00,$0.00,$0.00,$0.00
8986,ERX,HCPCS 25000001,00168-0264-45,ALCLOMETASONE DIPROPIONATE 0.05 % EX OINT,$188.96,$0.00,$149.66,$0.00,$54.23,$0.00,$0.00,$0.00,$0.00,$0.00,$75.99,$0.00,$38.00,$149.66,$60.79,$0.00,$0.00,$0.00,$0.00,$0.00
8986,ERX,HCPCS 25000001,00168-0264-60,ALCLOMETASONE DIPROPIONATE 0.05 % EX OINT,$251.94,$0.00,$199.54,$0.00,$54.23,$0.00,$0.00,$0.00,$0.00,$0.00,$75.99,$0.00,$38.00,$199.54,$60.79,$0.00,$0.00,$0.00,$0.00,$0.00
9001,ERX,HCPCS J0270,00009-3169-06,ALPROSTADIL 500 MCG/ML IJ SOLN,$396.54,$0.00,$396.54,$0.00,$283.01,$0.00,$0.00,$0.00,$0.00,$0.00,$396.54,$0.00,$198.27,$314.06,$317.23,$0.00,$0.00,$0.00,$0.00,$0.00
9001,ERX,HCPCS J0270,00703-1501-01,ALPROSTADIL 500 MCG/ML IJ SOLN,$396.54,$0.00,$396.54,$0.00,$283.01,$0.00,$0.00,$0.00,$0.00,$0.00,$396.54,$0.00,$198.27,$314.06,$317.23,$0.00,$0.00,$0.00,$0.00,$0.00
9002,ERX,HCPCS J2997,50242-0085-27,ALTEPLASE 100 MG IV SOLR,"$2,164.89",$0.00,"$2,164.89",$974.20,"$1,545.08",$876.38,$373.00,$0.00,$0.00,$379.05,"$2,164.89",$920.20,"$1,082.45","$1,714.59","$1,731.91","$1,270.75",$338.81,$0.00,$344.65,$878.85
9003,ERX,HCPCS J2997,50242-0044-13,ALTEPLASE 50 MG IV SOLR,"$10,824.46",$0.00,"$10,824.46","$4,871.01","$5,158.80","$4,381.90","$1,865.00",$0.00,$0.00,"$1,895.28","$10,824.46","$4,601.00","$5,412.23","$8,572.97","$8,659.57","$6,353.76","$1,694.03",$0.00,"$1,723.25","$4,394.25"
9009,ERX,HCPCS 25000001,00121-1761-30,ALUM & MAG HYDROXIDE-SIMETH 200-200-20 MG/5ML PO SUSP,$7.19,$0.00,$7.19,$0.00,$5.13,$0.00,$0.00,$0.00,$0.00,$0.00,$7.19,$0.00,$3.60,$5.69,$5.75,$0.00,$0.00,$0.00,$0.00,$0.00
9009,ERX,HCPCS 25000001,00904-6833-14,ALUM & MAG HYDROXIDE-SIMETH 200-200-20 MG/5ML PO SUSP,$7.19,$0.00,$7.19,$0.00,$5.13,$0.00,$0.00,$0.00,$0.00,$0.00,$7.19,$0.00,$3.60,$5.69,$5.75,$0.00,$0.00,$0.00,$0.00,$0.00
9009,ERX,HCPCS 25000001,49348-0019-39,ALUM & MAG HYDROXIDE-SIMETH 200-200-20 MG/5ML PO SUSP,$7.19,$0.00,$7.19,$0.00,$5.13,$0.00,$0.00,$0.00,$0.00,$0.00,$7.19,$0.00,$3.60,$5.69,$5.75,$0.00,$0.00,$0.00,$0.00,$0.00
9009,ERX,HCPCS 25000001,57896-0629-12,ALUM & MAG HYDROXIDE-SIMETH 200-200-20 MG/5ML PO SUSP,$7.19,$0.00,$7.19,$0.00,$5.13,$0.00,$0.00,$0.00,$0.00,$0.00,$7.19,$0.00,$3.60,$5.69,$5.75,$0.00,$0.00,$0.00,$0.00,$0.00
9020,ERX,HCPCS 25000001,51224-0162-12,ALUM SULFATE-CA ACETATE EX PACK,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9028,ERX,HCPCS 25000001,00096-0707-37,ALUMINUM CHLORIDE 20 % EX SOLN,$29.64,$0.00,$29.64,$0.00,$21.15,$0.00,$0.00,$0.00,$0.00,$0.00,$29.64,$0.00,$14.82,$23.47,$23.71,$0.00,$0.00,$0.00,$0.00,$0.00
9028,ERX,HCPCS 25000001,00096-0707-60,ALUMINUM CHLORIDE 20 % EX SOLN,$44.24,$0.00,$35.04,$0.00,$21.15,$0.00,$0.00,$0.00,$0.00,$0.00,$29.64,$0.00,$14.82,$35.04,$23.71,$0.00,$0.00,$0.00,$0.00,$0.00
9063,ERX,HCPCS 63700001,49411-0050-30,AMINOCAPROIC ACID 500 MG PO TABS,$85.51,$0.00,$85.51,$0.00,$61.03,$0.00,$0.00,$0.00,$0.00,$0.00,$85.51,$0.00,$42.76,$67.72,$68.41,$0.00,$0.00,$0.00,$0.00,$0.00
9063,ERX,HCPCS 63700001,69680-0115-30,AMINOCAPROIC ACID 500 MG PO TABS,$85.51,$0.00,$85.51,$0.00,$61.03,$0.00,$0.00,$0.00,$0.00,$0.00,$85.51,$0.00,$42.76,$67.72,$68.41,$0.00,$0.00,$0.00,$0.00,$0.00
9066,ERX,HCPCS 63700001,00245-0147-01,AMIODARONE HCL 200 MG PO TABS,$12.85,$0.00,$12.85,$0.00,$9.17,$0.00,$0.00,$0.00,$0.00,$0.00,$12.85,$0.00,$6.43,$10.18,$10.28,$0.00,$0.00,$0.00,$0.00,$0.00
9066,ERX,HCPCS 63700001,00245-0147-89,AMIODARONE HCL 200 MG PO TABS,$12.85,$0.00,$12.85,$0.00,$9.17,$0.00,$0.00,$0.00,$0.00,$0.00,$12.85,$0.00,$6.43,$10.18,$10.28,$0.00,$0.00,$0.00,$0.00,$0.00
9066,ERX,HCPCS 63700001,16714-0844-01,AMIODARONE HCL 200 MG PO TABS,$12.85,$0.00,$12.85,$0.00,$9.17,$0.00,$0.00,$0.00,$0.00,$0.00,$12.85,$0.00,$6.43,$10.18,$10.28,$0.00,$0.00,$0.00,$0.00,$0.00
9066,ERX,HCPCS 63700001,51672-4025-04,AMIODARONE HCL 200 MG PO TABS,$12.85,$0.00,$12.85,$0.00,$9.17,$0.00,$0.00,$0.00,$0.00,$0.00,$12.85,$0.00,$6.43,$10.18,$10.28,$0.00,$0.00,$0.00,$0.00,$0.00
9066,ERX,HCPCS 63700001,63739-0387-10,AMIODARONE HCL 200 MG PO TABS,$12.85,$0.00,$12.85,$0.00,$9.17,$0.00,$0.00,$0.00,$0.00,$0.00,$12.85,$0.00,$6.43,$10.18,$10.28,$0.00,$0.00,$0.00,$0.00,$0.00
9066,ERX,HCPCS 63700001,68382-0227-14,AMIODARONE HCL 200 MG PO TABS,$12.85,$0.00,$12.85,$0.00,$9.17,$0.00,$0.00,$0.00,$0.00,$0.00,$12.85,$0.00,$6.43,$10.18,$10.28,$0.00,$0.00,$0.00,$0.00,$0.00
9069,ERX,HCPCS 63700001,00904-6371-61,AMLODIPINE BESYLATE 10 MG PO TABS,$9.02,$0.00,$9.02,$0.00,$6.44,$0.00,$0.00,$0.00,$0.00,$0.00,$9.02,$0.00,$4.51,$7.14,$7.22,$0.00,$0.00,$0.00,$0.00,$0.00
9069,ERX,HCPCS 63700001,10135-0526-05,AMLODIPINE BESYLATE 10 MG PO TABS,$9.02,$0.00,$9.02,$0.00,$6.44,$0.00,$0.00,$0.00,$0.00,$0.00,$9.02,$0.00,$4.51,$7.14,$7.22,$0.00,$0.00,$0.00,$0.00,$0.00
9069,ERX,HCPCS 63700001,63739-0631-10,AMLODIPINE BESYLATE 10 MG PO TABS,$9.02,$0.00,$9.02,$0.00,$6.44,$0.00,$0.00,$0.00,$0.00,$0.00,$9.02,$0.00,$4.51,$7.14,$7.22,$0.00,$0.00,$0.00,$0.00,$0.00
9069,ERX,HCPCS 63700001,67877-0199-05,AMLODIPINE BESYLATE 10 MG PO TABS,$9.02,$0.00,$9.02,$0.00,$6.44,$0.00,$0.00,$0.00,$0.00,$0.00,$9.02,$0.00,$4.51,$7.14,$7.22,$0.00,$0.00,$0.00,$0.00,$0.00
9069,ERX,HCPCS 63700001,68382-0123-16,AMLODIPINE BESYLATE 10 MG PO TABS,$9.02,$0.00,$9.02,$0.00,$6.44,$0.00,$0.00,$0.00,$0.00,$0.00,$9.02,$0.00,$4.51,$7.14,$7.22,$0.00,$0.00,$0.00,$0.00,$0.00
9069,ERX,HCPCS 63700001,69097-0128-05,AMLODIPINE BESYLATE 10 MG PO TABS,$9.02,$0.00,$9.02,$0.00,$6.44,$0.00,$0.00,$0.00,$0.00,$0.00,$9.02,$0.00,$4.51,$7.14,$7.22,$0.00,$0.00,$0.00,$0.00,$0.00
9070,ERX,HCPCS 63700001,00904-6369-61,AMLODIPINE BESYLATE 2.5 MG PO TABS,$6.58,$0.00,$6.58,$0.00,$4.70,$0.00,$0.00,$0.00,$0.00,$0.00,$6.58,$0.00,$3.29,$5.21,$5.26,$0.00,$0.00,$0.00,$0.00,$0.00
9070,ERX,HCPCS 63700001,68382-0121-16,AMLODIPINE BESYLATE 2.5 MG PO TABS,$6.58,$0.00,$6.58,$0.00,$4.70,$0.00,$0.00,$0.00,$0.00,$0.00,$6.58,$0.00,$3.29,$5.21,$5.26,$0.00,$0.00,$0.00,$0.00,$0.00
9071,ERX,HCPCS 63700001,00904-6370-61,AMLODIPINE BESYLATE 5 MG PO TABS,$6.58,$0.00,$6.58,$0.00,$4.70,$0.00,$0.00,$0.00,$0.00,$0.00,$6.58,$0.00,$3.29,$5.21,$5.26,$0.00,$0.00,$0.00,$0.00,$0.00
9071,ERX,HCPCS 63700001,50268-0084-11,AMLODIPINE BESYLATE 5 MG PO TABS,$6.58,$0.00,$6.58,$0.00,$4.70,$0.00,$0.00,$0.00,$0.00,$0.00,$6.58,$0.00,$3.29,$5.21,$5.26,$0.00,$0.00,$0.00,$0.00,$0.00
9071,ERX,HCPCS 63700001,50268-0084-15,AMLODIPINE BESYLATE 5 MG PO TABS,$6.58,$0.00,$6.58,$0.00,$4.70,$0.00,$0.00,$0.00,$0.00,$0.00,$6.58,$0.00,$3.29,$5.21,$5.26,$0.00,$0.00,$0.00,$0.00,$0.00
9081,ERX,HCPCS 63700001,00555-0972-02,AMPHETAMINE-DEXTROAMPHETAMINE 10 MG PO TABS,$6.52,$0.00,$6.52,$0.00,$4.65,$0.00,$0.00,$0.00,$0.00,$0.00,$6.52,$0.00,$3.26,$5.16,$5.22,$0.00,$0.00,$0.00,$0.00,$0.00
9083,ERX,HCPCS J0295,00049-0013-83,AMPICILLIN-SULBACTAM SODIUM 1.5 (1-0.5) G IJ SOLR,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$4.24,$0.00,$0.00,$3.03,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.03,$0.00,$0.00,$0.00
9083,ERX,HCPCS J0295,00641-6116-10,AMPICILLIN-SULBACTAM SODIUM 1.5 (1-0.5) G IJ SOLR,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$4.24,$0.00,$0.00,$3.03,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.03,$0.00,$0.00,$0.00
9083,ERX,HCPCS J0295,25021-0142-20,AMPICILLIN-SULBACTAM SODIUM 1.5 (1-0.5) G IJ SOLR,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$4.24,$0.00,$0.00,$3.03,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.03,$0.00,$0.00,$0.00
9083,ERX,HCPCS J0295,44567-0210-10,AMPICILLIN-SULBACTAM SODIUM 1.5 (1-0.5) G IJ SOLR,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$4.24,$0.00,$0.00,$3.03,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.03,$0.00,$0.00,$0.00
9083,ERX,HCPCS J0295,55150-0116-20,AMPICILLIN-SULBACTAM SODIUM 1.5 (1-0.5) G IJ SOLR,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$4.24,$0.00,$0.00,$3.03,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.03,$0.00,$0.00,$0.00
9083,ERX,HCPCS J0295,66794-0206-41,AMPICILLIN-SULBACTAM SODIUM 1.5 (1-0.5) G IJ SOLR,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$4.24,$0.00,$0.00,$3.03,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.03,$0.00,$0.00,$0.00
9083,ERX,HCPCS J0295,67457-0348-10,AMPICILLIN-SULBACTAM SODIUM 1.5 (1-0.5) G IJ SOLR,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$4.24,$0.00,$0.00,$3.03,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.03,$0.00,$0.00,$0.00
9084,ERX,HCPCS J0295,00049-0014-83,AMPICILLIN-SULBACTAM SODIUM 3 (2-1) G IJ SOLR,$72.74,$0.00,$72.74,$32.73,$51.91,$0.00,$8.48,$0.00,$0.00,$6.06,$72.74,$0.00,$36.37,$57.61,$58.19,$0.00,$6.06,$0.00,$5.77,$0.00
9084,ERX,HCPCS J0295,00641-6117-10,AMPICILLIN-SULBACTAM SODIUM 3 (2-1) G IJ SOLR,$72.74,$0.00,$72.74,$32.73,$51.91,$0.00,$8.48,$0.00,$0.00,$6.06,$72.74,$0.00,$36.37,$57.61,$58.19,$0.00,$6.06,$0.00,$5.77,$0.00
9084,ERX,HCPCS J0295,44567-0211-10,AMPICILLIN-SULBACTAM SODIUM 3 (2-1) G IJ SOLR,$72.74,$0.00,$72.74,$32.73,$51.91,$0.00,$8.48,$0.00,$0.00,$6.06,$72.74,$0.00,$36.37,$57.61,$58.19,$0.00,$6.06,$0.00,$5.77,$0.00
9084,ERX,HCPCS J0295,55150-0117-20,AMPICILLIN-SULBACTAM SODIUM 3 (2-1) G IJ SOLR,$72.74,$0.00,$72.74,$32.73,$51.91,$0.00,$8.48,$0.00,$0.00,$6.06,$72.74,$0.00,$36.37,$57.61,$58.19,$0.00,$6.06,$0.00,$5.77,$0.00
9084,ERX,HCPCS J0295,67457-0349-10,AMPICILLIN-SULBACTAM SODIUM 3 (2-1) G IJ SOLR,$72.74,$0.00,$72.74,$32.73,$51.91,$0.00,$8.48,$0.00,$0.00,$6.06,$72.74,$0.00,$36.37,$57.61,$58.19,$0.00,$6.06,$0.00,$5.77,$0.00
9096,ERX,HCPCS 63700001,11086-0037-01,ANTHRALIN 1 % EX CREA,"$1,113.00",$0.00,"$1,113.00",$0.00,$794.35,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,113.00",$0.00,$556.50,$881.50,$890.40,$0.00,$0.00,$0.00,$0.00,$0.00
9119,ERX,HCPCS 25000001,61314-0665-05,APRACLONIDINE HCL 0.5 % OP SOLN,$530.56,$0.00,$530.56,$0.00,$378.66,$0.00,$0.00,$0.00,$0.00,$0.00,$530.56,$0.00,$265.28,$420.20,$424.45,$0.00,$0.00,$0.00,$0.00,$0.00
9120,ERX,HCPCS 25000001,00065-0660-10,APRACLONIDINE HCL 1 % OP SOLN,"$1,916.53",$0.00,"$1,916.53",$0.00,"$1,367.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,916.53",$0.00,$958.27,"$1,517.89","$1,533.22",$0.00,$0.00,$0.00,$0.00,$0.00
9123,ERX,HCPCS 25000001,00009-0436-01,ARGININE HCL (DIAGNOSTIC) 10 % IV SOLN,$133.88,$0.00,$133.88,$0.00,$95.55,$0.00,$0.00,$0.00,$0.00,$0.00,$133.88,$0.00,$66.94,$106.03,$107.10,$0.00,$0.00,$0.00,$0.00,$0.00
9183,ERX,HCPCS J7500,60219-1076-01,AZATHIOPRINE 50 MG PO TABS,$6.00,$0.00,$6.00,$2.70,$4.28,$0.00,$1.03,$0.00,$0.00,$1.05,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.94,$0.00,$0.96,$0.00
9183,ERX,HCPCS J7500,68084-0229-01,AZATHIOPRINE 50 MG PO TABS,$6.00,$0.00,$6.00,$2.70,$4.28,$0.00,$1.03,$0.00,$0.00,$1.05,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.94,$0.00,$0.96,$0.00
9183,ERX,HCPCS J7500,68462-0502-01,AZATHIOPRINE 50 MG PO TABS,$6.00,$0.00,$6.00,$2.70,$4.28,$0.00,$1.03,$0.00,$0.00,$1.05,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.94,$0.00,$0.96,$0.00
9185,ERX,HCPCS 25000001,63323-0401-20,AZTREONAM 1 G IJ SOLR,$75.13,$0.00,$75.13,$0.00,$53.62,$0.00,$0.00,$0.00,$0.00,$0.00,$75.13,$0.00,$37.57,$59.50,$60.10,$0.00,$0.00,$0.00,$0.00,$0.00
9185,ERX,HCPCS 25000001,63323-0401-26,AZTREONAM 1 G IJ SOLR,$75.13,$0.00,$75.13,$0.00,$53.62,$0.00,$0.00,$0.00,$0.00,$0.00,$75.13,$0.00,$37.57,$59.50,$60.10,$0.00,$0.00,$0.00,$0.00,$0.00
9186,ERX,HCPCS 25000001,00003-2570-16,AZTREONAM 2 G IJ SOLR,$70.30,$0.00,$70.30,$0.00,$50.17,$0.00,$0.00,$0.00,$0.00,$0.00,$70.30,$0.00,$35.15,$55.68,$56.24,$0.00,$0.00,$0.00,$0.00,$0.00
9186,ERX,HCPCS 25000001,63323-0402-20,AZTREONAM 2 G IJ SOLR,$70.30,$0.00,$70.30,$0.00,$50.17,$0.00,$0.00,$0.00,$0.00,$0.00,$70.30,$0.00,$35.15,$55.68,$56.24,$0.00,$0.00,$0.00,$0.00,$0.00
9186,ERX,HCPCS 25000001,63323-0402-30,AZTREONAM 2 G IJ SOLR,$70.30,$0.00,$70.30,$0.00,$50.17,$0.00,$0.00,$0.00,$0.00,$0.00,$70.30,$0.00,$35.15,$55.68,$56.24,$0.00,$0.00,$0.00,$0.00,$0.00
9219,ERX,HCPCS 25000001,00574-7045-12,BELLADONNA ALKALOIDS-OPIUM 16.2-30 MG RECTAL SUPP,$96.32,$0.00,$96.32,$0.00,$68.74,$0.00,$0.00,$0.00,$0.00,$0.00,$96.32,$0.00,$48.16,$76.29,$77.06,$0.00,$0.00,$0.00,$0.00,$0.00
9254,ERX,HCPCS 25000001,00781-7054-49,BENZOYL PEROXIDE-ERYTHROMYCIN 5-3 % EX GEL,$549.60,$0.00,$549.60,$0.00,$392.25,$0.00,$0.00,$0.00,$0.00,$0.00,$549.60,$0.00,$274.80,$435.28,$439.68,$0.00,$0.00,$0.00,$0.00,$0.00
9259,ERX,HCPCS J0515,00143-9729-01,BENZTROPINE MESYLATE 1 MG/ML IJ SOLN,$62.70,$0.00,$62.70,$28.22,$44.75,$0.00,$0.00,$0.00,$0.00,$20.83,$62.70,$0.00,$31.35,$49.66,$50.16,$0.00,$0.00,$0.00,$19.84,$0.00
9259,ERX,HCPCS J0515,00143-9729-05,BENZTROPINE MESYLATE 1 MG/ML IJ SOLN,$62.70,$0.00,$62.70,$28.22,$44.75,$0.00,$0.00,$0.00,$0.00,$20.83,$62.70,$0.00,$31.35,$49.66,$50.16,$0.00,$0.00,$0.00,$19.84,$0.00
9259,ERX,HCPCS J0515,63323-0970-02,BENZTROPINE MESYLATE 1 MG/ML IJ SOLN,$62.70,$0.00,$62.70,$28.22,$44.75,$0.00,$0.00,$0.00,$0.00,$20.83,$62.70,$0.00,$31.35,$49.66,$50.16,$0.00,$0.00,$0.00,$19.84,$0.00
9259,ERX,HCPCS J0515,68382-0860-02,BENZTROPINE MESYLATE 1 MG/ML IJ SOLN,$62.70,$0.00,$62.70,$28.22,$44.75,$0.00,$0.00,$0.00,$0.00,$20.83,$62.70,$0.00,$31.35,$49.66,$50.16,$0.00,$0.00,$0.00,$19.84,$0.00
9259,ERX,HCPCS J0515,68382-0860-10,BENZTROPINE MESYLATE 1 MG/ML IJ SOLN,$62.70,$0.00,$62.70,$28.22,$44.75,$0.00,$0.00,$0.00,$0.00,$20.83,$62.70,$0.00,$31.35,$49.66,$50.16,$0.00,$0.00,$0.00,$19.84,$0.00
9260,ERX,HCPCS 25000001,49471-0001-05,BENZYLPENICILLOYL POLYLYSINE 0.25 ML ID SOLN,$505.08,$0.00,$505.08,$0.00,$378.76,$0.00,$0.00,$0.00,$0.00,$0.00,$505.08,$0.00,$252.54,$400.02,$404.06,$0.00,$0.00,$0.00,$0.00,$0.00
9266,ERX,HCPCS J0702,00085-4320-01,BETAMETHASONE SOD PHOS & ACET 6 (3-3) MG/ML IJ SUSP,$46.97,$0.00,$46.97,$21.14,$33.52,$0.00,$7.14,$0.00,$0.00,$8.31,$46.97,$0.00,$23.49,$37.20,$37.58,$0.00,$8.31,$0.00,$7.91,$0.00
9266,ERX,HCPCS J0702,00517-0720-01,BETAMETHASONE SOD PHOS & ACET 6 (3-3) MG/ML IJ SUSP,$46.97,$0.00,$46.97,$21.14,$33.52,$0.00,$7.14,$0.00,$0.00,$8.31,$46.97,$0.00,$23.49,$37.20,$37.58,$0.00,$8.31,$0.00,$7.91,$0.00
9266,ERX,HCPCS J0702,51754-5060-01,BETAMETHASONE SOD PHOS & ACET 6 (3-3) MG/ML IJ SUSP,$46.97,$0.00,$46.97,$21.14,$33.52,$0.00,$7.14,$0.00,$0.00,$8.31,$46.97,$0.00,$23.49,$37.20,$37.58,$0.00,$8.31,$0.00,$7.91,$0.00
9284,ERX,HCPCS 63700001,00904-1315-46,BISMUTH SUBSALICYLATE 262 MG PO CHEW,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9289,ERX,HCPCS J9040,00703-3154-01,BLEOMYCIN SULFATE 15 UNITS IJ SOLR,$144.90,$0.00,$144.90,$65.21,$103.42,$0.00,$37.40,$0.00,$0.00,$26.64,$144.90,$0.00,$72.45,$114.76,$115.92,$0.00,$26.64,$0.00,$25.36,$0.00
9289,ERX,HCPCS J9040,61703-0332-18,BLEOMYCIN SULFATE 15 UNITS IJ SOLR,$144.90,$0.00,$144.90,$65.21,$103.42,$0.00,$37.40,$0.00,$0.00,$26.64,$144.90,$0.00,$72.45,$114.76,$115.92,$0.00,$26.64,$0.00,$25.36,$0.00
9289,ERX,HCPCS J9040,63323-0136-10,BLEOMYCIN SULFATE 15 UNITS IJ SOLR,$144.90,$0.00,$144.90,$65.21,$103.42,$0.00,$37.40,$0.00,$0.00,$26.64,$144.90,$0.00,$72.45,$114.76,$115.92,$0.00,$26.64,$0.00,$25.36,$0.00
9297,ERX,HCPCS 63700001,00574-0106-01,BROMOCRIPTINE MESYLATE 2.5 MG PO TABS,$15.73,$0.00,$15.73,$0.00,$11.23,$0.00,$0.00,$0.00,$0.00,$0.00,$15.73,$0.00,$7.87,$12.46,$12.58,$0.00,$0.00,$0.00,$0.00,$0.00
9297,ERX,HCPCS 63700001,00574-0106-03,BROMOCRIPTINE MESYLATE 2.5 MG PO TABS,$15.73,$0.00,$15.73,$0.00,$11.23,$0.00,$0.00,$0.00,$0.00,$0.00,$15.73,$0.00,$7.87,$12.46,$12.58,$0.00,$0.00,$0.00,$0.00,$0.00
9297,ERX,HCPCS 63700001,00781-5325-01,BROMOCRIPTINE MESYLATE 2.5 MG PO TABS,$15.73,$0.00,$15.73,$0.00,$11.23,$0.00,$0.00,$0.00,$0.00,$0.00,$15.73,$0.00,$7.87,$12.46,$12.58,$0.00,$0.00,$0.00,$0.00,$0.00
9297,ERX,HCPCS 63700001,00781-5325-31,BROMOCRIPTINE MESYLATE 2.5 MG PO TABS,$15.73,$0.00,$15.73,$0.00,$11.23,$0.00,$0.00,$0.00,$0.00,$0.00,$15.73,$0.00,$7.87,$12.46,$12.58,$0.00,$0.00,$0.00,$0.00,$0.00
9297,ERX,HCPCS 63700001,63304-0962-01,BROMOCRIPTINE MESYLATE 2.5 MG PO TABS,$15.73,$0.00,$15.73,$0.00,$11.23,$0.00,$0.00,$0.00,$0.00,$0.00,$15.73,$0.00,$7.87,$12.46,$12.58,$0.00,$0.00,$0.00,$0.00,$0.00
9297,ERX,HCPCS 63700001,63304-0962-30,BROMOCRIPTINE MESYLATE 2.5 MG PO TABS,$15.73,$0.00,$15.73,$0.00,$11.23,$0.00,$0.00,$0.00,$0.00,$0.00,$15.73,$0.00,$7.87,$12.46,$12.58,$0.00,$0.00,$0.00,$0.00,$0.00
9308,ERX,HCPCS S0171,00409-1412-10,BUMETANIDE 0.25 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$3.92,$1.21,$0.00,$0.00,$3.85,$22.00,$0.00,$11.00,$17.42,$17.60,$13.20,$3.44,$0.00,$3.50,$0.00
9308,ERX,HCPCS S0171,00641-6007-10,BUMETANIDE 0.25 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$3.92,$1.21,$0.00,$0.00,$3.85,$22.00,$0.00,$11.00,$17.42,$17.60,$13.20,$3.44,$0.00,$3.50,$0.00
9308,ERX,HCPCS S0171,00641-6008-01,BUMETANIDE 0.25 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$3.92,$1.21,$0.00,$0.00,$3.85,$22.00,$0.00,$11.00,$17.42,$17.60,$13.20,$3.44,$0.00,$3.50,$0.00
9308,ERX,HCPCS S0171,00641-6008-10,BUMETANIDE 0.25 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$3.92,$1.21,$0.00,$0.00,$3.85,$22.00,$0.00,$11.00,$17.42,$17.60,$13.20,$3.44,$0.00,$3.50,$0.00
9308,ERX,HCPCS S0171,00641-6161-10,BUMETANIDE 0.25 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$3.92,$1.21,$0.00,$0.00,$3.85,$22.00,$0.00,$11.00,$17.42,$17.60,$13.20,$3.44,$0.00,$3.50,$0.00
9309,ERX,HCPCS 63700001,42799-0119-01,BUMETANIDE 0.5 MG PO TABS,$9.14,$0.00,$9.14,$0.00,$6.52,$0.00,$0.00,$0.00,$0.00,$0.00,$9.14,$0.00,$4.57,$7.24,$7.31,$0.00,$0.00,$0.00,$0.00,$0.00
9310,ERX,HCPCS 63700001,16714-0832-01,BUMETANIDE 1 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9310,ERX,HCPCS 63700001,42799-0120-01,BUMETANIDE 1 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9316,ERX,HCPCS 25000001,00409-1761-02,BUPIVACAINE IN DEXTROSE 0.75-8.25 % IT SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
9316,ERX,HCPCS 25000001,00409-3613-01,BUPIVACAINE IN DEXTROSE 0.75-8.25 % IT SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
9320,ERX,HCPCS J0592,00143-9246-05,BUPRENORPHINE HCL 0.3 MG/ML IJ SOLN,$69.18,$0.00,$69.18,$0.00,$49.37,$0.00,$0.00,$0.00,$0.00,$0.00,$69.18,$0.00,$34.59,$54.79,$55.34,$0.00,$0.00,$0.00,$0.00,$0.00
9320,ERX,HCPCS J0592,00409-2012-32,BUPRENORPHINE HCL 0.3 MG/ML IJ SOLN,$69.18,$0.00,$69.18,$0.00,$49.37,$0.00,$0.00,$0.00,$0.00,$0.00,$69.18,$0.00,$34.59,$54.79,$55.34,$0.00,$0.00,$0.00,$0.00,$0.00
9321,ERX,HCPCS 63700001,23155-0192-01,BUPROPION HCL 100 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9321,ERX,HCPCS 63700001,60505-0157-01,BUPROPION HCL 100 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9322,ERX,HCPCS 63700001,23155-0191-01,BUPROPION HCL 75 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9323,ERX,HCPCS 63700001,00093-0054-01,BUSPIRONE HCL 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9323,ERX,HCPCS 63700001,00378-1150-01,BUSPIRONE HCL 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9323,ERX,HCPCS 63700001,51079-0986-01,BUSPIRONE HCL 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9323,ERX,HCPCS 63700001,51079-0986-20,BUSPIRONE HCL 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9323,ERX,HCPCS 63700001,64380-0742-06,BUSPIRONE HCL 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9324,ERX,HCPCS 63700001,00093-0053-01,BUSPIRONE HCL 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9324,ERX,HCPCS 63700001,51079-0985-01,BUSPIRONE HCL 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9324,ERX,HCPCS 63700001,51079-0985-20,BUSPIRONE HCL 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9324,ERX,HCPCS 63700001,64380-0741-06,BUSPIRONE HCL 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9324,ERX,HCPCS 63700001,64380-0741-08,BUSPIRONE HCL 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9325,ERX,HCPCS J8510,76388-0713-25,BUSULFAN 2 MG PO TABS,$98.38,$0.00,$98.38,$0.00,$70.21,$0.00,$0.00,$0.00,$0.00,$0.00,$98.38,$0.00,$49.19,$77.92,$78.70,$0.00,$0.00,$0.00,$0.00,$0.00
9333,ERX,HCPCS J0595,00409-1623-01,BUTORPHANOL TARTRATE 1 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
9347,ERX,HCPCS J0630,67457-0675-02,CALCITONIN (SALMON) 200 UNIT/ML IJ SOLN,"$6,649.55",$0.00,"$6,649.55",$0.00,"$4,745.78",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,649.55",$0.00,"$3,324.78","$5,266.44","$5,319.64",$0.00,$0.00,$0.00,$0.00,$0.00
9348,ERX,HCPCS J0636,17478-0931-01,CALCITRIOL 1 MCG/ML IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
9350,ERX,HCPCS 63700001,00054-0007-13,CALCITRIOL 0.25 MCG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9350,ERX,HCPCS 63700001,00054-0007-25,CALCITRIOL 0.25 MCG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9350,ERX,HCPCS 63700001,23155-0118-01,CALCITRIOL 0.25 MCG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9350,ERX,HCPCS 63700001,23155-0662-01,CALCITRIOL 0.25 MCG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9350,ERX,HCPCS 63700001,23155-0662-03,CALCITRIOL 0.25 MCG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9394,ERX,HCPCS 25000001,17478-0080-50,CAPREOMYCIN SULFATE 1 G IJ SOLR,$685.14,$0.00,$685.14,$0.00,$488.98,$0.00,$0.00,$0.00,$0.00,$0.00,$685.14,$0.00,$342.57,$542.63,$548.11,$0.00,$0.00,$0.00,$0.00,$0.00
9400,ERX,HCPCS 63700001,00143-1174-01,CAPTOPRIL 100 MG PO TABS,$14.47,$0.00,$14.47,$0.00,$10.33,$0.00,$0.00,$0.00,$0.00,$0.00,$14.47,$0.00,$7.24,$11.46,$11.58,$0.00,$0.00,$0.00,$0.00,$0.00
9400,ERX,HCPCS 63700001,00378-3022-01,CAPTOPRIL 100 MG PO TABS,$14.47,$0.00,$14.47,$0.00,$10.33,$0.00,$0.00,$0.00,$0.00,$0.00,$14.47,$0.00,$7.24,$11.46,$11.58,$0.00,$0.00,$0.00,$0.00,$0.00
9400,ERX,HCPCS 63700001,00781-8080-01,CAPTOPRIL 100 MG PO TABS,$14.47,$0.00,$14.47,$0.00,$10.33,$0.00,$0.00,$0.00,$0.00,$0.00,$14.47,$0.00,$7.24,$11.46,$11.58,$0.00,$0.00,$0.00,$0.00,$0.00
9401,ERX,HCPCS 63700001,00143-1171-01,CAPTOPRIL 12.5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9401,ERX,HCPCS 63700001,00378-3007-01,CAPTOPRIL 12.5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9401,ERX,HCPCS 63700001,00781-8052-01,CAPTOPRIL 12.5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9401,ERX,HCPCS 63700001,51079-0863-20,CAPTOPRIL 12.5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9402,ERX,HCPCS 63700001,00143-1172-01,CAPTOPRIL 25 MG PO TABS,$7.07,$0.00,$7.07,$0.00,$5.05,$0.00,$0.00,$0.00,$0.00,$0.00,$7.07,$0.00,$3.54,$5.60,$5.66,$0.00,$0.00,$0.00,$0.00,$0.00
9402,ERX,HCPCS 63700001,00378-3012-01,CAPTOPRIL 25 MG PO TABS,$7.07,$0.00,$7.07,$0.00,$5.05,$0.00,$0.00,$0.00,$0.00,$0.00,$7.07,$0.00,$3.54,$5.60,$5.66,$0.00,$0.00,$0.00,$0.00,$0.00
9402,ERX,HCPCS 63700001,00781-8061-01,CAPTOPRIL 25 MG PO TABS,$7.07,$0.00,$7.07,$0.00,$5.05,$0.00,$0.00,$0.00,$0.00,$0.00,$7.07,$0.00,$3.54,$5.60,$5.66,$0.00,$0.00,$0.00,$0.00,$0.00
9402,ERX,HCPCS 63700001,00904-5046-61,CAPTOPRIL 25 MG PO TABS,$7.07,$0.00,$7.07,$0.00,$5.05,$0.00,$0.00,$0.00,$0.00,$0.00,$7.07,$0.00,$3.54,$5.60,$5.66,$0.00,$0.00,$0.00,$0.00,$0.00
9402,ERX,HCPCS 63700001,51079-0864-01,CAPTOPRIL 25 MG PO TABS,$7.07,$0.00,$7.07,$0.00,$5.05,$0.00,$0.00,$0.00,$0.00,$0.00,$7.07,$0.00,$3.54,$5.60,$5.66,$0.00,$0.00,$0.00,$0.00,$0.00
9402,ERX,HCPCS 63700001,51079-0864-20,CAPTOPRIL 25 MG PO TABS,$7.07,$0.00,$7.07,$0.00,$5.05,$0.00,$0.00,$0.00,$0.00,$0.00,$7.07,$0.00,$3.54,$5.60,$5.66,$0.00,$0.00,$0.00,$0.00,$0.00
9403,ERX,HCPCS 63700001,00143-1173-01,CAPTOPRIL 50 MG PO TABS,$8.95,$0.00,$8.95,$0.00,$6.39,$0.00,$0.00,$0.00,$0.00,$0.00,$8.95,$0.00,$4.48,$7.09,$7.16,$0.00,$0.00,$0.00,$0.00,$0.00
9403,ERX,HCPCS 63700001,00781-8075-01,CAPTOPRIL 50 MG PO TABS,$8.95,$0.00,$8.95,$0.00,$6.39,$0.00,$0.00,$0.00,$0.00,$0.00,$8.95,$0.00,$4.48,$7.09,$7.16,$0.00,$0.00,$0.00,$0.00,$0.00
9406,ERX,HCPCS 63700001,63739-0107-10,CARBIDOPA-LEVODOPA 10-100 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9407,ERX,HCPCS 63700001,00228-2539-10,CARBIDOPA-LEVODOPA 25-100 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9407,ERX,HCPCS 63700001,00228-2539-50,CARBIDOPA-LEVODOPA 25-100 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9407,ERX,HCPCS 63700001,51079-0884-20,CARBIDOPA-LEVODOPA 25-100 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9407,ERX,HCPCS 63700001,68084-0093-01,CARBIDOPA-LEVODOPA 25-100 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9408,ERX,HCPCS 63700001,00904-6238-61,CARBIDOPA-LEVODOPA 25-250 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9413,ERX,HCPCS 25000001,00009-0856-08,CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN,"$1,014.39",$0.00,"$1,014.39",$0.00,$723.97,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,014.39",$0.00,$507.20,$803.40,$811.51,$0.00,$0.00,$0.00,$0.00,$0.00
9413,ERX,HCPCS 25000001,43598-0698-11,CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN,"$1,014.39",$0.00,"$1,014.39",$0.00,$723.97,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,014.39",$0.00,$507.20,$803.40,$811.51,$0.00,$0.00,$0.00,$0.00,$0.00
9413,ERX,HCPCS 25000001,43598-0698-58,CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN,"$1,014.39",$0.00,"$1,014.39",$0.00,$723.97,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,014.39",$0.00,$507.20,$803.40,$811.51,$0.00,$0.00,$0.00,$0.00,$0.00
9430,ERX,HCPCS 63700001,00143-9985-01,CEFACLOR 250 MG PO CAPS,$7.57,$0.00,$7.57,$0.00,$5.40,$0.00,$0.00,$0.00,$0.00,$0.00,$7.57,$0.00,$3.79,$6.00,$6.06,$0.00,$0.00,$0.00,$0.00,$0.00
9430,ERX,HCPCS 63700001,61442-0171-30,CEFACLOR 250 MG PO CAPS,$7.57,$0.00,$7.57,$0.00,$5.40,$0.00,$0.00,$0.00,$0.00,$0.00,$7.57,$0.00,$3.79,$6.00,$6.06,$0.00,$0.00,$0.00,$0.00,$0.00
9431,ERX,HCPCS 63700001,00143-9986-01,CEFACLOR 500 MG PO CAPS,$14.81,$0.00,$14.81,$0.00,$10.57,$0.00,$0.00,$0.00,$0.00,$0.00,$14.81,$0.00,$7.41,$11.73,$11.85,$0.00,$0.00,$0.00,$0.00,$0.00
9431,ERX,HCPCS 63700001,61442-0172-30,CEFACLOR 500 MG PO CAPS,$14.81,$0.00,$14.81,$0.00,$10.57,$0.00,$0.00,$0.00,$0.00,$0.00,$14.81,$0.00,$7.41,$11.73,$11.85,$0.00,$0.00,$0.00,$0.00,$0.00
9446,ERX,HCPCS 63700001,65862-0751-50,CEFIXIME 100 MG/5ML PO SUSR,$721.33,$0.00,$721.33,$0.00,$514.81,$0.00,$0.00,$0.00,$0.00,$0.00,$721.33,$0.00,$360.67,$571.29,$577.06,$0.00,$0.00,$0.00,$0.00,$0.00
9446,ERX,HCPCS 63700001,68180-0202-03,CEFIXIME 100 MG/5ML PO SUSR,$721.33,$0.00,$721.33,$0.00,$514.81,$0.00,$0.00,$0.00,$0.00,$0.00,$721.33,$0.00,$360.67,$571.29,$577.06,$0.00,$0.00,$0.00,$0.00,$0.00
9452,ERX,HCPCS J0698,,CEFOTAXIME SODIUM 1 G IJ SOLR,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
9452,ERX,HCPCS J0698,00143-9931-25,CEFOTAXIME SODIUM 1 G IJ SOLR,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
9455,ERX,HCPCS 25000001,,CEFOTAXIME SODIUM 500 MG IJ SOLR,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
9455,ERX,HCPCS 25000001,00143-9930-10,CEFOTAXIME SODIUM 500 MG IJ SOLR,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
9461,ERX,HCPCS J0694,25021-0109-10,CEFOXITIN SODIUM 1 G IV SOLR,$27.36,$0.00,$27.36,$12.31,$19.53,$0.00,$8.06,$0.00,$0.00,$6.22,$27.36,$0.00,$13.68,$21.67,$21.89,$0.00,$6.22,$0.00,$5.92,$0.00
9461,ERX,HCPCS J0694,44567-0245-25,CEFOXITIN SODIUM 1 G IV SOLR,$27.36,$0.00,$27.36,$12.31,$19.53,$0.00,$8.06,$0.00,$0.00,$6.22,$27.36,$0.00,$13.68,$21.67,$21.89,$0.00,$6.22,$0.00,$5.92,$0.00
9461,ERX,HCPCS J0694,44567-0245-85,CEFOXITIN SODIUM 1 G IV SOLR,$27.36,$0.00,$27.36,$12.31,$19.53,$0.00,$8.06,$0.00,$0.00,$6.22,$27.36,$0.00,$13.68,$21.67,$21.89,$0.00,$6.22,$0.00,$5.92,$0.00
9461,ERX,HCPCS J0694,63323-0341-25,CEFOXITIN SODIUM 1 G IV SOLR,$27.36,$0.00,$27.36,$12.31,$19.53,$0.00,$8.06,$0.00,$0.00,$6.22,$27.36,$0.00,$13.68,$21.67,$21.89,$0.00,$6.22,$0.00,$5.92,$0.00
9463,ERX,HCPCS J0694,25021-0110-20,CEFOXITIN SODIUM 2 G IV SOLR,$83.79,$0.00,$83.79,$37.71,$59.80,$0.00,$16.12,$0.00,$0.00,$12.43,$83.79,$0.00,$41.90,$66.36,$67.03,$0.00,$12.43,$0.00,$11.84,$0.00
9463,ERX,HCPCS J0694,44567-0246-25,CEFOXITIN SODIUM 2 G IV SOLR,$83.79,$0.00,$83.79,$37.71,$59.80,$0.00,$16.12,$0.00,$0.00,$12.43,$83.79,$0.00,$41.90,$66.36,$67.03,$0.00,$12.43,$0.00,$11.84,$0.00
9463,ERX,HCPCS J0694,44567-0246-85,CEFOXITIN SODIUM 2 G IV SOLR,$83.79,$0.00,$83.79,$37.71,$59.80,$0.00,$16.12,$0.00,$0.00,$12.43,$83.79,$0.00,$41.90,$66.36,$67.03,$0.00,$12.43,$0.00,$11.84,$0.00
9463,ERX,HCPCS J0694,63323-0342-25,CEFOXITIN SODIUM 2 G IV SOLR,$83.79,$0.00,$83.79,$37.71,$59.80,$0.00,$16.12,$0.00,$0.00,$12.43,$83.79,$0.00,$41.90,$66.36,$67.03,$0.00,$12.43,$0.00,$11.84,$0.00
9468,ERX,HCPCS 63700001,16714-0394-01,CEFPODOXIME PROXETIL 100 MG PO TABS,$25.61,$0.00,$25.61,$0.00,$18.28,$0.00,$0.00,$0.00,$0.00,$0.00,$25.61,$0.00,$12.81,$20.28,$20.49,$0.00,$0.00,$0.00,$0.00,$0.00
9469,ERX,HCPCS 63700001,65862-0096-20,CEFPODOXIME PROXETIL 200 MG PO TABS,$32.14,$0.00,$32.14,$0.00,$22.94,$0.00,$0.00,$0.00,$0.00,$0.00,$32.14,$0.00,$16.07,$25.45,$25.71,$0.00,$0.00,$0.00,$0.00,$0.00
9474,ERX,HCPCS J0713,00409-5082-16,CEFTAZIDIME 1 G IJ SOLR,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$3.85,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.44,$0.00,$3.50,$0.00
9474,ERX,HCPCS J0713,25021-0127-20,CEFTAZIDIME 1 G IJ SOLR,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$3.85,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.44,$0.00,$3.50,$0.00
9474,ERX,HCPCS J0713,44567-0235-25,CEFTAZIDIME 1 G IJ SOLR,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$3.85,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.44,$0.00,$3.50,$0.00
9476,ERX,HCPCS J0713,00409-5084-11,CEFTAZIDIME 2 G IJ SOLR,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$3.85,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.44,$0.00,$3.50,$0.00
9476,ERX,HCPCS J0713,25021-0128-50,CEFTAZIDIME 2 G IJ SOLR,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$3.85,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.44,$0.00,$3.50,$0.00
9476,ERX,HCPCS J0713,44567-0236-10,CEFTAZIDIME 2 G IJ SOLR,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$3.85,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.44,$0.00,$3.50,$0.00
9487,ERX,HCPCS J0696,00409-7332-01,CEFTRIAXONE SODIUM 1 G IJ SOLR,$161.00,$0.00,$161.00,$72.45,$114.91,$0.00,$5.64,$0.00,$0.00,$2.82,$161.00,$0.00,$80.50,$127.51,$128.80,$0.00,$2.82,$0.00,$2.69,$0.00
9487,ERX,HCPCS J0696,00409-7332-11,CEFTRIAXONE SODIUM 1 G IJ SOLR,$161.00,$0.00,$161.00,$72.45,$114.91,$0.00,$5.64,$0.00,$0.00,$2.82,$161.00,$0.00,$80.50,$127.51,$128.80,$0.00,$2.82,$0.00,$2.69,$0.00
9487,ERX,HCPCS J0696,00781-3208-95,CEFTRIAXONE SODIUM 1 G IJ SOLR,$161.00,$0.00,$161.00,$72.45,$114.91,$0.00,$5.64,$0.00,$0.00,$2.82,$161.00,$0.00,$80.50,$127.51,$128.80,$0.00,$2.82,$0.00,$2.69,$0.00
9487,ERX,HCPCS J0696,25021-0106-10,CEFTRIAXONE SODIUM 1 G IJ SOLR,$161.00,$0.00,$161.00,$72.45,$114.91,$0.00,$5.64,$0.00,$0.00,$2.82,$161.00,$0.00,$80.50,$127.51,$128.80,$0.00,$2.82,$0.00,$2.69,$0.00
9487,ERX,HCPCS J0696,44567-0701-25,CEFTRIAXONE SODIUM 1 G IJ SOLR,$161.00,$0.00,$161.00,$72.45,$114.91,$0.00,$5.64,$0.00,$0.00,$2.82,$161.00,$0.00,$80.50,$127.51,$128.80,$0.00,$2.82,$0.00,$2.69,$0.00
9488,ERX,HCPCS J0696,00143-9856-25,CEFTRIAXONE SODIUM 2 G IJ SOLR,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$11.28,$0.00,$0.00,$5.64,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$5.64,$0.00,$5.37,$0.00
9488,ERX,HCPCS J0696,00409-7335-03,CEFTRIAXONE SODIUM 2 G IJ SOLR,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$11.28,$0.00,$0.00,$5.64,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$5.64,$0.00,$5.37,$0.00
9488,ERX,HCPCS J0696,00409-7335-20,CEFTRIAXONE SODIUM 2 G IJ SOLR,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$11.28,$0.00,$0.00,$5.64,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$5.64,$0.00,$5.37,$0.00
9488,ERX,HCPCS J0696,00409-7335-21,CEFTRIAXONE SODIUM 2 G IJ SOLR,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$11.28,$0.00,$0.00,$5.64,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$5.64,$0.00,$5.37,$0.00
9488,ERX,HCPCS J0696,44567-0702-25,CEFTRIAXONE SODIUM 2 G IJ SOLR,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$11.28,$0.00,$0.00,$5.64,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$5.64,$0.00,$5.37,$0.00
9489,ERX,HCPCS J0696,00409-7337-01,CEFTRIAXONE SODIUM 250 MG IJ SOLR,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.41,$0.00,$0.00,$0.71,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.71,$0.00,$0.67,$0.00
9489,ERX,HCPCS J0696,00409-7337-11,CEFTRIAXONE SODIUM 250 MG IJ SOLR,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.41,$0.00,$0.00,$0.71,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.71,$0.00,$0.67,$0.00
9490,ERX,HCPCS J0696,00143-9858-25,CEFTRIAXONE SODIUM 500 MG IJ SOLR,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$2.82,$0.00,$0.00,$1.41,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.41,$0.00,$0.00,$0.00
9490,ERX,HCPCS J0696,00409-7338-01,CEFTRIAXONE SODIUM 500 MG IJ SOLR,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$2.82,$0.00,$0.00,$1.41,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.41,$0.00,$0.00,$0.00
9490,ERX,HCPCS J0696,00409-7338-11,CEFTRIAXONE SODIUM 500 MG IJ SOLR,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$2.82,$0.00,$0.00,$1.41,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.41,$0.00,$0.00,$0.00
9491,ERX,HCPCS J0696,00409-7334-10,CEFTRIAXONE SODIUM 10 G IV SOLR,$71.65,$0.00,$71.65,$32.24,$51.14,$0.00,$56.40,$0.00,$0.00,$28.20,$71.65,$0.00,$35.83,$56.75,$57.32,$0.00,$28.20,$0.00,$26.85,$0.00
9491,ERX,HCPCS J0696,00781-3210-46,CEFTRIAXONE SODIUM 10 G IV SOLR,$71.65,$0.00,$71.65,$32.24,$51.14,$0.00,$56.40,$0.00,$0.00,$28.20,$71.65,$0.00,$35.83,$56.75,$57.32,$0.00,$28.20,$0.00,$26.85,$0.00
9491,ERX,HCPCS J0696,25021-0108-99,CEFTRIAXONE SODIUM 10 G IV SOLR,$71.65,$0.00,$71.65,$32.24,$51.14,$0.00,$56.40,$0.00,$0.00,$28.20,$71.65,$0.00,$35.83,$56.75,$57.32,$0.00,$28.20,$0.00,$26.85,$0.00
9495,ERX,HCPCS 63700001,16714-0400-01,CEFUROXIME AXETIL 250 MG PO TABS,$16.72,$0.00,$16.72,$0.00,$11.93,$0.00,$0.00,$0.00,$0.00,$0.00,$16.72,$0.00,$8.36,$13.24,$13.38,$0.00,$0.00,$0.00,$0.00,$0.00
9495,ERX,HCPCS 63700001,57237-0058-20,CEFUROXIME AXETIL 250 MG PO TABS,$16.72,$0.00,$16.72,$0.00,$11.93,$0.00,$0.00,$0.00,$0.00,$0.00,$16.72,$0.00,$8.36,$13.24,$13.38,$0.00,$0.00,$0.00,$0.00,$0.00
9495,ERX,HCPCS 63700001,64679-0921-01,CEFUROXIME AXETIL 250 MG PO TABS,$16.72,$0.00,$16.72,$0.00,$11.93,$0.00,$0.00,$0.00,$0.00,$0.00,$16.72,$0.00,$8.36,$13.24,$13.38,$0.00,$0.00,$0.00,$0.00,$0.00
9495,ERX,HCPCS 63700001,64679-0921-02,CEFUROXIME AXETIL 250 MG PO TABS,$16.72,$0.00,$16.72,$0.00,$11.93,$0.00,$0.00,$0.00,$0.00,$0.00,$16.72,$0.00,$8.36,$13.24,$13.38,$0.00,$0.00,$0.00,$0.00,$0.00
9495,ERX,HCPCS 63700001,68180-0302-20,CEFUROXIME AXETIL 250 MG PO TABS,$16.72,$0.00,$16.72,$0.00,$11.93,$0.00,$0.00,$0.00,$0.00,$0.00,$16.72,$0.00,$8.36,$13.24,$13.38,$0.00,$0.00,$0.00,$0.00,$0.00
9499,ERX,HCPCS 63700001,50268-0151-11,CEPHALEXIN 250 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9499,ERX,HCPCS 63700001,50268-0151-15,CEPHALEXIN 250 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9499,ERX,HCPCS 63700001,60687-0152-01,CEPHALEXIN 250 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9499,ERX,HCPCS 63700001,67877-0220-01,CEPHALEXIN 250 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9500,ERX,HCPCS 63700001,00093-3147-05,CEPHALEXIN 500 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9500,ERX,HCPCS 63700001,60687-0163-01,CEPHALEXIN 500 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9500,ERX,HCPCS 63700001,60687-0163-11,CEPHALEXIN 500 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9500,ERX,HCPCS 63700001,65862-0019-05,CEPHALEXIN 500 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9500,ERX,HCPCS 63700001,68180-0122-02,CEPHALEXIN 500 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9501,ERX,HCPCS 63700001,00093-4175-73,CEPHALEXIN 125 MG/5ML PO SUSR,$83.30,$0.00,$83.30,$0.00,$59.45,$0.00,$0.00,$0.00,$0.00,$0.00,$83.30,$0.00,$41.65,$65.97,$66.64,$0.00,$0.00,$0.00,$0.00,$0.00
9501,ERX,HCPCS 63700001,68180-0440-01,CEPHALEXIN 125 MG/5ML PO SUSR,$83.30,$0.00,$83.30,$0.00,$59.45,$0.00,$0.00,$0.00,$0.00,$0.00,$83.30,$0.00,$41.65,$65.97,$66.64,$0.00,$0.00,$0.00,$0.00,$0.00
9502,ERX,HCPCS 63700001,00093-4177-73,CEPHALEXIN 250 MG/5ML PO SUSR,$100.80,$0.00,$100.80,$0.00,$71.94,$0.00,$0.00,$0.00,$0.00,$0.00,$100.80,$0.00,$50.40,$79.83,$80.64,$0.00,$0.00,$0.00,$0.00,$0.00
9502,ERX,HCPCS 63700001,68180-0441-01,CEPHALEXIN 250 MG/5ML PO SUSR,$100.80,$0.00,$100.80,$0.00,$71.94,$0.00,$0.00,$0.00,$0.00,$0.00,$100.80,$0.00,$50.40,$79.83,$80.64,$0.00,$0.00,$0.00,$0.00,$0.00
9502,ERX,HCPCS 63700001,00093-4177-74,CEPHALEXIN 250 MG/5ML PO SUSR,$161.28,$0.00,$127.73,$0.00,$71.94,$0.00,$0.00,$0.00,$0.00,$0.00,$100.80,$0.00,$50.40,$127.73,$80.64,$0.00,$0.00,$0.00,$0.00,$0.00
9506,ERX,HCPCS 63700001,00378-3637-01,CETIRIZINE HCL 10 MG PO TABS,$9.48,$0.00,$9.48,$0.00,$6.77,$0.00,$0.00,$0.00,$0.00,$0.00,$9.48,$0.00,$4.74,$7.51,$7.58,$0.00,$0.00,$0.00,$0.00,$0.00
9506,ERX,HCPCS 63700001,00904-6717-61,CETIRIZINE HCL 10 MG PO TABS,$9.48,$0.00,$9.48,$0.00,$6.77,$0.00,$0.00,$0.00,$0.00,$0.00,$9.48,$0.00,$4.74,$7.51,$7.58,$0.00,$0.00,$0.00,$0.00,$0.00
9506,ERX,HCPCS 63700001,16571-0402-10,CETIRIZINE HCL 10 MG PO TABS,$9.48,$0.00,$9.48,$0.00,$6.77,$0.00,$0.00,$0.00,$0.00,$0.00,$9.48,$0.00,$4.74,$7.51,$7.58,$0.00,$0.00,$0.00,$0.00,$0.00
9506,ERX,HCPCS 63700001,16714-0799-04,CETIRIZINE HCL 10 MG PO TABS,$9.48,$0.00,$9.48,$0.00,$6.77,$0.00,$0.00,$0.00,$0.00,$0.00,$9.48,$0.00,$4.74,$7.51,$7.58,$0.00,$0.00,$0.00,$0.00,$0.00
9506,ERX,HCPCS 63700001,45802-0919-39,CETIRIZINE HCL 10 MG PO TABS,$9.48,$0.00,$9.48,$0.00,$6.77,$0.00,$0.00,$0.00,$0.00,$0.00,$9.48,$0.00,$4.74,$7.51,$7.58,$0.00,$0.00,$0.00,$0.00,$0.00
9506,ERX,HCPCS 63700001,51079-0597-01,CETIRIZINE HCL 10 MG PO TABS,$9.48,$0.00,$9.48,$0.00,$6.77,$0.00,$0.00,$0.00,$0.00,$0.00,$9.48,$0.00,$4.74,$7.51,$7.58,$0.00,$0.00,$0.00,$0.00,$0.00
9506,ERX,HCPCS 63700001,51079-0597-20,CETIRIZINE HCL 10 MG PO TABS,$9.48,$0.00,$9.48,$0.00,$6.77,$0.00,$0.00,$0.00,$0.00,$0.00,$9.48,$0.00,$4.74,$7.51,$7.58,$0.00,$0.00,$0.00,$0.00,$0.00
9513,ERX,HCPCS 63700001,76388-0635-25,CHLORAMBUCIL 2 MG PO TABS,$445.20,$0.00,$445.20,$0.00,$317.74,$0.00,$0.00,$0.00,$0.00,$0.00,$445.20,$0.00,$222.60,$352.60,$356.16,$0.00,$0.00,$0.00,$0.00,$0.00
9516,ERX,HCPCS 25000001,00116-2001-16,CHLORHEXIDINE GLUCONATE 0.12 % MT SOLN,$8.10,$0.00,$8.10,$0.00,$5.78,$0.00,$0.00,$0.00,$0.00,$0.00,$8.10,$0.00,$4.05,$6.42,$6.48,$0.00,$0.00,$0.00,$0.00,$0.00
9516,ERX,HCPCS 25000001,69339-0138-15,CHLORHEXIDINE GLUCONATE 0.12 % MT SOLN,$8.10,$0.00,$8.10,$0.00,$5.78,$0.00,$0.00,$0.00,$0.00,$0.00,$8.10,$0.00,$4.05,$6.42,$6.48,$0.00,$0.00,$0.00,$0.00,$0.00
9516,ERX,HCPCS 25000001,69339-0138-17,CHLORHEXIDINE GLUCONATE 0.12 % MT SOLN,$8.10,$0.00,$8.10,$0.00,$5.78,$0.00,$0.00,$0.00,$0.00,$0.00,$8.10,$0.00,$4.05,$6.42,$6.48,$0.00,$0.00,$0.00,$0.00,$0.00
9516,ERX,HCPCS 25000001,69339-0138-19,CHLORHEXIDINE GLUCONATE 0.12 % MT SOLN,$8.10,$0.00,$8.10,$0.00,$5.78,$0.00,$0.00,$0.00,$0.00,$0.00,$8.10,$0.00,$4.05,$6.42,$6.48,$0.00,$0.00,$0.00,$0.00,$0.00
9516,ERX,HCPCS 25000001,99999-6004-28,CHLORHEXIDINE GLUCONATE 0.12 % MT SOLN,$8.10,$0.00,$8.10,$0.00,$5.78,$0.00,$0.00,$0.00,$0.00,$0.00,$8.10,$0.00,$4.05,$6.42,$6.48,$0.00,$0.00,$0.00,$0.00,$0.00
9523,ERX,HCPCS J2400,63323-0475-37,CHLOROPROCAINE HCL 1 % IJ SOLN,$75.81,$0.00,$75.81,$0.00,$54.11,$0.00,$0.00,$0.00,$0.00,$0.00,$75.81,$0.00,$37.91,$60.04,$60.65,$0.00,$0.00,$0.00,$0.00,$0.00
9525,ERX,HCPCS 25000001,65649-0311-12,CHLOROTHIAZIDE 250 MG/5ML PO SUSP,$6.64,$0.00,$88.62,$0.00,$63.25,$0.00,$0.00,$0.00,$0.00,$0.00,$88.62,$0.00,$44.31,$5.26,$70.90,$0.00,$0.00,$0.00,$0.00,$0.00
9525,ERX,HCPCS 25000001,99999-6008-62,CHLOROTHIAZIDE 250 MG/5ML PO SUSP,$6.64,$0.00,$88.62,$0.00,$63.25,$0.00,$0.00,$0.00,$0.00,$0.00,$88.62,$0.00,$44.31,$5.26,$70.90,$0.00,$0.00,$0.00,$0.00,$0.00
9525,ERX,HCPCS 25000001,99999-6012-04,CHLOROTHIAZIDE 250 MG/5ML PO SUSP,$6.64,$0.00,$88.62,$0.00,$63.25,$0.00,$0.00,$0.00,$0.00,$0.00,$88.62,$0.00,$44.31,$5.26,$70.90,$0.00,$0.00,$0.00,$0.00,$0.00
9525,ERX,HCPCS 25000001,99999-6004-75,CHLOROTHIAZIDE 250 MG/5ML PO SUSP,$88.62,$0.00,$88.62,$0.00,$63.25,$0.00,$0.00,$0.00,$0.00,$0.00,$88.62,$0.00,$44.31,$70.19,$70.90,$0.00,$0.00,$0.00,$0.00,$0.00
9526,ERX,HCPCS J1205,00517-1820-01,CHLOROTHIAZIDE SODIUM 500 MG IV SOLR,$126.00,$0.00,$126.00,$0.00,$89.93,$0.00,$0.00,$0.00,$0.00,$0.00,$126.00,$0.00,$63.00,$99.79,$100.80,$0.00,$0.00,$0.00,$0.00,$0.00
9526,ERX,HCPCS J1205,17478-0419-40,CHLOROTHIAZIDE SODIUM 500 MG IV SOLR,$126.00,$0.00,$126.00,$0.00,$89.93,$0.00,$0.00,$0.00,$0.00,$0.00,$126.00,$0.00,$63.00,$99.79,$100.80,$0.00,$0.00,$0.00,$0.00,$0.00
9526,ERX,HCPCS J1205,25021-0305-20,CHLOROTHIAZIDE SODIUM 500 MG IV SOLR,$126.00,$0.00,$126.00,$0.00,$89.93,$0.00,$0.00,$0.00,$0.00,$0.00,$126.00,$0.00,$63.00,$99.79,$100.80,$0.00,$0.00,$0.00,$0.00,$0.00
9526,ERX,HCPCS J1205,25021-0305-66,CHLOROTHIAZIDE SODIUM 500 MG IV SOLR,$126.00,$0.00,$126.00,$0.00,$89.93,$0.00,$0.00,$0.00,$0.00,$0.00,$126.00,$0.00,$63.00,$99.79,$100.80,$0.00,$0.00,$0.00,$0.00,$0.00
9526,ERX,HCPCS J1205,47335-0330-40,CHLOROTHIAZIDE SODIUM 500 MG IV SOLR,$126.00,$0.00,$126.00,$0.00,$89.93,$0.00,$0.00,$0.00,$0.00,$0.00,$126.00,$0.00,$63.00,$99.79,$100.80,$0.00,$0.00,$0.00,$0.00,$0.00
9526,ERX,HCPCS J1205,63323-0658-20,CHLOROTHIAZIDE SODIUM 500 MG IV SOLR,$126.00,$0.00,$126.00,$0.00,$89.93,$0.00,$0.00,$0.00,$0.00,$0.00,$126.00,$0.00,$63.00,$99.79,$100.80,$0.00,$0.00,$0.00,$0.00,$0.00
9526,ERX,HCPCS J1205,63323-0658-27,CHLOROTHIAZIDE SODIUM 500 MG IV SOLR,$126.00,$0.00,$126.00,$0.00,$89.93,$0.00,$0.00,$0.00,$0.00,$0.00,$126.00,$0.00,$63.00,$99.79,$100.80,$0.00,$0.00,$0.00,$0.00,$0.00
9526,ERX,HCPCS J1205,67457-0263-30,CHLOROTHIAZIDE SODIUM 500 MG IV SOLR,$126.00,$0.00,$126.00,$0.00,$89.93,$0.00,$0.00,$0.00,$0.00,$0.00,$126.00,$0.00,$63.00,$99.79,$100.80,$0.00,$0.00,$0.00,$0.00,$0.00
9526,ERX,HCPCS J1205,76478-0711-40,CHLOROTHIAZIDE SODIUM 500 MG IV SOLR,$126.00,$0.00,$126.00,$0.00,$89.93,$0.00,$0.00,$0.00,$0.00,$0.00,$126.00,$0.00,$63.00,$99.79,$100.80,$0.00,$0.00,$0.00,$0.00,$0.00
9578,ERX,HCPCS 63700001,00904-5351-24,CHLORPHENIRAMINE-PSEUDOEPH 4-60 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9578,ERX,HCPCS 63700001,00904-5351-96,CHLORPHENIRAMINE-PSEUDOEPH 4-60 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9598,ERX,HCPCS 25000001,45802-0138-35,CICLOPIROX OLAMINE 0.77 % EX CREA,$110.62,$0.00,$110.62,$0.00,$78.95,$0.00,$0.00,$0.00,$0.00,$0.00,$110.62,$0.00,$55.31,$87.61,$88.50,$0.00,$0.00,$0.00,$0.00,$0.00
9598,ERX,HCPCS 25000001,51672-1318-01,CICLOPIROX OLAMINE 0.77 % EX CREA,$110.62,$0.00,$110.62,$0.00,$78.95,$0.00,$0.00,$0.00,$0.00,$0.00,$110.62,$0.00,$55.31,$87.61,$88.50,$0.00,$0.00,$0.00,$0.00,$0.00
9598,ERX,HCPCS 25000001,68462-0297-17,CICLOPIROX OLAMINE 0.77 % EX CREA,$110.62,$0.00,$110.62,$0.00,$78.95,$0.00,$0.00,$0.00,$0.00,$0.00,$110.62,$0.00,$55.31,$87.61,$88.50,$0.00,$0.00,$0.00,$0.00,$0.00
9603,ERX,HCPCS J0743,00006-3516-59,IMIPENEM-CILASTATIN 500 MG IV SOLR,$137.14,$0.00,$137.14,$0.00,$97.88,$0.00,$0.00,$0.00,$0.00,$0.00,$137.14,$0.00,$68.57,$108.61,$109.71,$0.00,$0.00,$0.00,$0.00,$0.00
9603,ERX,HCPCS J0743,63323-0322-93,IMIPENEM-CILASTATIN 500 MG IV SOLR,$137.14,$0.00,$137.14,$0.00,$97.88,$0.00,$0.00,$0.00,$0.00,$0.00,$137.14,$0.00,$68.57,$108.61,$109.71,$0.00,$0.00,$0.00,$0.00,$0.00
9607,ERX,HCPCS 63700001,00378-0541-01,CIMETIDINE 800 MG PO TABS,$19.07,$0.00,$19.07,$0.00,$13.61,$0.00,$0.00,$0.00,$0.00,$0.00,$19.07,$0.00,$9.54,$15.10,$15.26,$0.00,$0.00,$0.00,$0.00,$0.00
9610,ERX,HCPCS 25000001,61314-0656-25,CIPROFLOXACIN HCL 0.3 % OP SOLN,$47.88,$0.00,$47.88,$0.00,$34.17,$0.00,$0.00,$0.00,$0.00,$0.00,$47.88,$0.00,$23.94,$37.92,$38.30,$0.00,$0.00,$0.00,$0.00,$0.00
9610,ERX,HCPCS 25000001,69315-0308-02,CIPROFLOXACIN HCL 0.3 % OP SOLN,$47.88,$0.00,$47.88,$0.00,$34.17,$0.00,$0.00,$0.00,$0.00,$0.00,$47.88,$0.00,$23.94,$37.92,$38.30,$0.00,$0.00,$0.00,$0.00,$0.00
9610,ERX,HCPCS 25000001,61314-0656-05,CIPROFLOXACIN HCL 0.3 % OP SOLN,$63.84,$0.00,$50.56,$0.00,$34.17,$0.00,$0.00,$0.00,$0.00,$0.00,$47.88,$0.00,$23.94,$50.56,$38.30,$0.00,$0.00,$0.00,$0.00,$0.00
9610,ERX,HCPCS 25000001,69315-0308-05,CIPROFLOXACIN HCL 0.3 % OP SOLN,$63.84,$0.00,$50.56,$0.00,$34.17,$0.00,$0.00,$0.00,$0.00,$0.00,$47.88,$0.00,$23.94,$50.56,$38.30,$0.00,$0.00,$0.00,$0.00,$0.00
9616,ERX,HCPCS 63700001,65862-0225-60,CLARITHROMYCIN 250 MG PO TABS,$17.18,$0.00,$17.18,$0.00,$16.32,$0.00,$0.00,$0.00,$0.00,$0.00,$17.18,$0.00,$8.59,$13.61,$13.74,$0.00,$0.00,$0.00,$0.00,$0.00
9617,ERX,HCPCS 63700001,00527-1932-06,CLARITHROMYCIN 500 MG PO TABS,$22.86,$0.00,$22.86,$0.00,$16.32,$0.00,$0.00,$0.00,$0.00,$0.00,$22.86,$0.00,$11.43,$18.11,$18.29,$0.00,$0.00,$0.00,$0.00,$0.00
9617,ERX,HCPCS 63700001,00781-1962-60,CLARITHROMYCIN 500 MG PO TABS,$22.86,$0.00,$22.86,$0.00,$16.32,$0.00,$0.00,$0.00,$0.00,$0.00,$22.86,$0.00,$11.43,$18.11,$18.29,$0.00,$0.00,$0.00,$0.00,$0.00
9617,ERX,HCPCS 63700001,57237-0045-60,CLARITHROMYCIN 500 MG PO TABS,$22.86,$0.00,$22.86,$0.00,$16.32,$0.00,$0.00,$0.00,$0.00,$0.00,$22.86,$0.00,$11.43,$18.11,$18.29,$0.00,$0.00,$0.00,$0.00,$0.00
9617,ERX,HCPCS 63700001,65862-0226-60,CLARITHROMYCIN 500 MG PO TABS,$22.86,$0.00,$22.86,$0.00,$16.32,$0.00,$0.00,$0.00,$0.00,$0.00,$22.86,$0.00,$11.43,$18.11,$18.29,$0.00,$0.00,$0.00,$0.00,$0.00
9623,ERX,HCPCS 25000001,00168-0202-30,CLINDAMYCIN PHOSPHATE 1 % EX GEL,$316.14,$0.00,$316.14,$0.00,$225.63,$0.00,$0.00,$0.00,$0.00,$0.00,$316.14,$0.00,$158.07,$250.38,$252.91,$0.00,$0.00,$0.00,$0.00,$0.00
9623,ERX,HCPCS 25000001,59762-3743-01,CLINDAMYCIN PHOSPHATE 1 % EX GEL,$316.14,$0.00,$316.14,$0.00,$225.63,$0.00,$0.00,$0.00,$0.00,$0.00,$316.14,$0.00,$158.07,$250.38,$252.91,$0.00,$0.00,$0.00,$0.00,$0.00
9624,ERX,HCPCS 25000001,00009-3448-01,CLINDAMYCIN PHOSPHATE 2 % VA CREA,$397.48,$0.00,$397.48,$0.00,$283.68,$0.00,$0.00,$0.00,$0.00,$0.00,$397.48,$0.00,$198.74,$314.80,$317.98,$0.00,$0.00,$0.00,$0.00,$0.00
9624,ERX,HCPCS 25000001,00168-0277-40,CLINDAMYCIN PHOSPHATE 2 % VA CREA,$397.48,$0.00,$397.48,$0.00,$283.68,$0.00,$0.00,$0.00,$0.00,$0.00,$397.48,$0.00,$198.74,$314.80,$317.98,$0.00,$0.00,$0.00,$0.00,$0.00
9624,ERX,HCPCS 25000001,59762-5009-01,CLINDAMYCIN PHOSPHATE 2 % VA CREA,$397.48,$0.00,$397.48,$0.00,$283.68,$0.00,$0.00,$0.00,$0.00,$0.00,$397.48,$0.00,$198.74,$314.80,$317.98,$0.00,$0.00,$0.00,$0.00,$0.00
9626,ERX,HCPCS S0077,00781-3289-09,CLINDAMYCIN PHOSPHATE IN D5W 600 MG/50ML IV SOLN,$56.43,$0.00,$56.43,$25.39,$40.27,$10.04,$7.07,$0.00,$0.00,$3.29,$56.43,$0.00,$28.22,$44.69,$45.14,$33.86,$3.29,$0.00,$3.13,$0.00
9626,ERX,HCPCS S0077,00781-9221-09,CLINDAMYCIN PHOSPHATE IN D5W 600 MG/50ML IV SOLN,$56.43,$0.00,$56.43,$25.39,$40.27,$10.04,$7.07,$0.00,$0.00,$3.29,$56.43,$0.00,$28.22,$44.69,$45.14,$33.86,$3.29,$0.00,$3.13,$0.00
9626,ERX,HCPCS S0077,00781-9221-91,CLINDAMYCIN PHOSPHATE IN D5W 600 MG/50ML IV SOLN,$56.43,$0.00,$56.43,$25.39,$40.27,$10.04,$7.07,$0.00,$0.00,$3.29,$56.43,$0.00,$28.22,$44.69,$45.14,$33.86,$3.29,$0.00,$3.13,$0.00
9627,ERX,HCPCS S0077,00781-3290-09,CLINDAMYCIN PHOSPHATE IN D5W 900 MG/50ML IV SOLN,$68.78,$0.00,$68.78,$30.95,$49.09,$12.24,$10.61,$0.00,$0.00,$4.94,$68.78,$0.00,$34.39,$54.47,$55.02,$41.27,$4.94,$0.00,$4.70,$0.00
9627,ERX,HCPCS S0077,00781-9222-09,CLINDAMYCIN PHOSPHATE IN D5W 900 MG/50ML IV SOLN,$68.78,$0.00,$68.78,$30.95,$49.09,$12.24,$10.61,$0.00,$0.00,$4.94,$68.78,$0.00,$34.39,$54.47,$55.02,$41.27,$4.94,$0.00,$4.70,$0.00
9627,ERX,HCPCS S0077,00781-9222-91,CLINDAMYCIN PHOSPHATE IN D5W 900 MG/50ML IV SOLN,$68.78,$0.00,$68.78,$30.95,$49.09,$12.24,$10.61,$0.00,$0.00,$4.94,$68.78,$0.00,$34.39,$54.47,$55.02,$41.27,$4.94,$0.00,$4.70,$0.00
9630,ERX,HCPCS 25000001,00168-0163-15,CLOBETASOL PROPIONATE 0.05 % EX CREA,$391.12,$0.00,$391.12,$0.00,$279.14,$0.00,$0.00,$0.00,$0.00,$0.00,$391.12,$0.00,$195.56,$309.77,$312.90,$0.00,$0.00,$0.00,$0.00,$0.00
9630,ERX,HCPCS 25000001,00472-0400-15,CLOBETASOL PROPIONATE 0.05 % EX CREA,$391.12,$0.00,$391.12,$0.00,$279.14,$0.00,$0.00,$0.00,$0.00,$0.00,$391.12,$0.00,$195.56,$309.77,$312.90,$0.00,$0.00,$0.00,$0.00,$0.00
9630,ERX,HCPCS 25000001,50383-0267-15,CLOBETASOL PROPIONATE 0.05 % EX CREA,$391.12,$0.00,$391.12,$0.00,$279.14,$0.00,$0.00,$0.00,$0.00,$0.00,$391.12,$0.00,$195.56,$309.77,$312.90,$0.00,$0.00,$0.00,$0.00,$0.00
9630,ERX,HCPCS 25000001,51672-1258-01,CLOBETASOL PROPIONATE 0.05 % EX CREA,$391.12,$0.00,$391.12,$0.00,$279.14,$0.00,$0.00,$0.00,$0.00,$0.00,$391.12,$0.00,$195.56,$309.77,$312.90,$0.00,$0.00,$0.00,$0.00,$0.00
9630,ERX,HCPCS 25000001,52565-0051-15,CLOBETASOL PROPIONATE 0.05 % EX CREA,$391.12,$0.00,$391.12,$0.00,$279.14,$0.00,$0.00,$0.00,$0.00,$0.00,$391.12,$0.00,$195.56,$309.77,$312.90,$0.00,$0.00,$0.00,$0.00,$0.00
9630,ERX,HCPCS 25000001,00472-0400-30,CLOBETASOL PROPIONATE 0.05 % EX CREA,$679.65,$0.00,$538.28,$0.00,$279.14,$0.00,$0.00,$0.00,$0.00,$0.00,$391.12,$0.00,$195.56,$538.28,$312.90,$0.00,$0.00,$0.00,$0.00,$0.00
9630,ERX,HCPCS 25000001,10337-0163-30,CLOBETASOL PROPIONATE 0.05 % EX CREA,$679.65,$0.00,$538.28,$0.00,$279.14,$0.00,$0.00,$0.00,$0.00,$0.00,$391.12,$0.00,$195.56,$538.28,$312.90,$0.00,$0.00,$0.00,$0.00,$0.00
9630,ERX,HCPCS 25000001,00472-0400-60,CLOBETASOL PROPIONATE 0.05 % EX CREA,"$1,231.06",$0.00,$975.00,$0.00,$279.14,$0.00,$0.00,$0.00,$0.00,$0.00,$391.12,$0.00,$195.56,$975.00,$312.90,$0.00,$0.00,$0.00,$0.00,$0.00
9630,ERX,HCPCS 25000001,52565-0051-60,CLOBETASOL PROPIONATE 0.05 % EX CREA,"$1,231.06",$0.00,$975.00,$0.00,$279.14,$0.00,$0.00,$0.00,$0.00,$0.00,$391.12,$0.00,$195.56,$975.00,$312.90,$0.00,$0.00,$0.00,$0.00,$0.00
9631,ERX,HCPCS 25000001,00168-0162-15,CLOBETASOL PROPIONATE 0.05 % EX OINT,$474.11,$0.00,$474.11,$0.00,$338.37,$0.00,$0.00,$0.00,$0.00,$0.00,$474.11,$0.00,$237.06,$375.50,$379.29,$0.00,$0.00,$0.00,$0.00,$0.00
9631,ERX,HCPCS 25000001,10337-0162-15,CLOBETASOL PROPIONATE 0.05 % EX OINT,$474.11,$0.00,$474.11,$0.00,$338.37,$0.00,$0.00,$0.00,$0.00,$0.00,$474.11,$0.00,$237.06,$375.50,$379.29,$0.00,$0.00,$0.00,$0.00,$0.00
9631,ERX,HCPCS 25000001,43386-0096-60,CLOBETASOL PROPIONATE 0.05 % EX OINT,$474.11,$0.00,$474.11,$0.00,$338.37,$0.00,$0.00,$0.00,$0.00,$0.00,$474.11,$0.00,$237.06,$375.50,$379.29,$0.00,$0.00,$0.00,$0.00,$0.00
9631,ERX,HCPCS 25000001,50383-0268-15,CLOBETASOL PROPIONATE 0.05 % EX OINT,$474.11,$0.00,$474.11,$0.00,$338.37,$0.00,$0.00,$0.00,$0.00,$0.00,$474.11,$0.00,$237.06,$375.50,$379.29,$0.00,$0.00,$0.00,$0.00,$0.00
9631,ERX,HCPCS 25000001,51672-1259-01,CLOBETASOL PROPIONATE 0.05 % EX OINT,$474.11,$0.00,$474.11,$0.00,$338.37,$0.00,$0.00,$0.00,$0.00,$0.00,$474.11,$0.00,$237.06,$375.50,$379.29,$0.00,$0.00,$0.00,$0.00,$0.00
9631,ERX,HCPCS 25000001,52565-0039-15,CLOBETASOL PROPIONATE 0.05 % EX OINT,$474.11,$0.00,$474.11,$0.00,$338.37,$0.00,$0.00,$0.00,$0.00,$0.00,$474.11,$0.00,$237.06,$375.50,$379.29,$0.00,$0.00,$0.00,$0.00,$0.00
9631,ERX,HCPCS 25000001,51672-1259-02,CLOBETASOL PROPIONATE 0.05 % EX OINT,$823.86,$0.00,$652.50,$0.00,$338.37,$0.00,$0.00,$0.00,$0.00,$0.00,$474.11,$0.00,$237.06,$652.50,$379.29,$0.00,$0.00,$0.00,$0.00,$0.00
9631,ERX,HCPCS 25000001,00168-0162-46,CLOBETASOL PROPIONATE 0.05 % EX OINT,"$1,235.79",$0.00,$978.75,$0.00,$338.37,$0.00,$0.00,$0.00,$0.00,$0.00,$474.11,$0.00,$237.06,$978.75,$379.29,$0.00,$0.00,$0.00,$0.00,$0.00
9632,ERX,HCPCS 25000001,00472-0402-25,CLOBETASOL PROPIONATE 0.05 % EX SOLN,$314.61,$0.00,$314.61,$0.00,$224.54,$0.00,$0.00,$0.00,$0.00,$0.00,$314.61,$0.00,$157.31,$249.17,$251.69,$0.00,$0.00,$0.00,$0.00,$0.00
9632,ERX,HCPCS 25000001,50383-0266-25,CLOBETASOL PROPIONATE 0.05 % EX SOLN,$314.61,$0.00,$314.61,$0.00,$224.54,$0.00,$0.00,$0.00,$0.00,$0.00,$314.61,$0.00,$157.31,$249.17,$251.69,$0.00,$0.00,$0.00,$0.00,$0.00
9632,ERX,HCPCS 25000001,51672-1293-02,CLOBETASOL PROPIONATE 0.05 % EX SOLN,$314.61,$0.00,$314.61,$0.00,$224.54,$0.00,$0.00,$0.00,$0.00,$0.00,$314.61,$0.00,$157.31,$249.17,$251.69,$0.00,$0.00,$0.00,$0.00,$0.00
9632,ERX,HCPCS 25000001,60432-0133-25,CLOBETASOL PROPIONATE 0.05 % EX SOLN,$314.61,$0.00,$314.61,$0.00,$224.54,$0.00,$0.00,$0.00,$0.00,$0.00,$314.61,$0.00,$157.31,$249.17,$251.69,$0.00,$0.00,$0.00,$0.00,$0.00
9632,ERX,HCPCS 25000001,00168-0269-50,CLOBETASOL PROPIONATE 0.05 % EX SOLN,$546.70,$0.00,$432.99,$0.00,$224.54,$0.00,$0.00,$0.00,$0.00,$0.00,$314.61,$0.00,$157.31,$432.99,$251.69,$0.00,$0.00,$0.00,$0.00,$0.00
9632,ERX,HCPCS 25000001,51672-1293-03,CLOBETASOL PROPIONATE 0.05 % EX SOLN,$546.70,$0.00,$432.99,$0.00,$224.54,$0.00,$0.00,$0.00,$0.00,$0.00,$314.61,$0.00,$157.31,$432.99,$251.69,$0.00,$0.00,$0.00,$0.00,$0.00
9632,ERX,HCPCS 25000001,60432-0133-50,CLOBETASOL PROPIONATE 0.05 % EX SOLN,$546.70,$0.00,$432.99,$0.00,$224.54,$0.00,$0.00,$0.00,$0.00,$0.00,$314.61,$0.00,$157.31,$432.99,$251.69,$0.00,$0.00,$0.00,$0.00,$0.00
9635,ERX,HCPCS 63700001,00378-3025-01,CLOMIPRAMINE HCL 25 MG PO CAPS,$42.72,$0.00,$42.72,$0.00,$30.49,$0.00,$0.00,$0.00,$0.00,$0.00,$42.72,$0.00,$21.36,$33.83,$34.18,$0.00,$0.00,$0.00,$0.00,$0.00
9635,ERX,HCPCS 63700001,00781-2027-01,CLOMIPRAMINE HCL 25 MG PO CAPS,$42.72,$0.00,$42.72,$0.00,$30.49,$0.00,$0.00,$0.00,$0.00,$0.00,$42.72,$0.00,$21.36,$33.83,$34.18,$0.00,$0.00,$0.00,$0.00,$0.00
9635,ERX,HCPCS 63700001,51672-4011-05,CLOMIPRAMINE HCL 25 MG PO CAPS,$42.72,$0.00,$42.72,$0.00,$30.49,$0.00,$0.00,$0.00,$0.00,$0.00,$42.72,$0.00,$21.36,$33.83,$34.18,$0.00,$0.00,$0.00,$0.00,$0.00
9636,ERX,HCPCS 63700001,00406-9908-03,CLOMIPRAMINE HCL 75 MG PO CAPS,$42.72,$0.00,$42.72,$0.00,$30.49,$0.00,$0.00,$0.00,$0.00,$0.00,$42.72,$0.00,$21.36,$33.83,$34.18,$0.00,$0.00,$0.00,$0.00,$0.00
9636,ERX,HCPCS 63700001,51672-4013-05,CLOMIPRAMINE HCL 75 MG PO CAPS,$42.72,$0.00,$42.72,$0.00,$30.49,$0.00,$0.00,$0.00,$0.00,$0.00,$42.72,$0.00,$21.36,$33.83,$34.18,$0.00,$0.00,$0.00,$0.00,$0.00
9637,ERX,HCPCS 25000001,00093-0832-01,CLONAZEPAM 0.5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9637,ERX,HCPCS 25000001,00228-3003-11,CLONAZEPAM 0.5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9637,ERX,HCPCS 25000001,16714-0752-01,CLONAZEPAM 0.5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9637,ERX,HCPCS 25000001,16729-0136-00,CLONAZEPAM 0.5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9637,ERX,HCPCS 25000001,63739-0263-10,CLONAZEPAM 0.5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9638,ERX,HCPCS 25000001,00093-3212-01,CLONAZEPAM 1 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9638,ERX,HCPCS 25000001,00228-3004-11,CLONAZEPAM 1 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9638,ERX,HCPCS 25000001,16714-0750-01,CLONAZEPAM 1 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9638,ERX,HCPCS 25000001,16729-0137-00,CLONAZEPAM 1 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9644,ERX,HCPCS 63700001,00054-4146-22,CLOTRIMAZOLE 10 MG MT TROC,$12.22,$0.00,$12.22,$0.00,$8.72,$0.00,$0.00,$0.00,$0.00,$0.00,$12.22,$0.00,$6.11,$9.68,$9.78,$0.00,$0.00,$0.00,$0.00,$0.00
9644,ERX,HCPCS 63700001,00574-0107-77,CLOTRIMAZOLE 10 MG MT TROC,$12.22,$0.00,$12.22,$0.00,$8.72,$0.00,$0.00,$0.00,$0.00,$0.00,$12.22,$0.00,$6.11,$9.68,$9.78,$0.00,$0.00,$0.00,$0.00,$0.00
9647,ERX,HCPCS 63700001,00093-7772-93,CLOZAPINE 100 MG PO TABS,$13.00,$0.00,$13.00,$0.00,$9.28,$0.00,$0.00,$0.00,$0.00,$0.00,$13.00,$0.00,$6.50,$10.30,$10.40,$0.00,$0.00,$0.00,$0.00,$0.00
9647,ERX,HCPCS 63700001,00378-0860-01,CLOZAPINE 100 MG PO TABS,$13.00,$0.00,$13.00,$0.00,$9.28,$0.00,$0.00,$0.00,$0.00,$0.00,$13.00,$0.00,$6.50,$10.30,$10.40,$0.00,$0.00,$0.00,$0.00,$0.00
9647,ERX,HCPCS 63700001,51079-0922-20,CLOZAPINE 100 MG PO TABS,$13.00,$0.00,$13.00,$0.00,$9.28,$0.00,$0.00,$0.00,$0.00,$0.00,$13.00,$0.00,$6.50,$10.30,$10.40,$0.00,$0.00,$0.00,$0.00,$0.00
9648,ERX,HCPCS 63700001,00093-4359-93,CLOZAPINE 25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9648,ERX,HCPCS 63700001,00378-0825-01,CLOZAPINE 25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9648,ERX,HCPCS 63700001,51079-0921-20,CLOZAPINE 25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9682,ERX,HCPCS 25000001,50484-0010-30,COLLAGENASE 250 UNIT/GM EX OINT,$791.19,$0.00,$791.19,$0.00,$564.67,$0.00,$0.00,$0.00,$0.00,$0.00,$791.19,$0.00,$395.60,$626.62,$632.95,$0.00,$0.00,$0.00,$0.00,$0.00
9686,ERX,HCPCS J0834,00548-5900-00,COSYNTROPIN 0.25 MG IJ SOLR,$322.72,$0.00,$322.72,$145.22,$230.33,$0.00,$55.60,$0.00,$0.00,$44.56,$322.72,$0.00,$161.36,$255.59,$258.18,$0.00,$44.56,$0.00,$42.42,$0.00
9686,ERX,HCPCS J0834,67457-0227-02,COSYNTROPIN 0.25 MG IJ SOLR,$322.72,$0.00,$322.72,$145.22,$230.33,$0.00,$55.60,$0.00,$0.00,$44.56,$322.72,$0.00,$161.36,$255.59,$258.18,$0.00,$44.56,$0.00,$42.42,$0.00
9690,ERX,HCPCS J7631,00172-6406-49,CROMOLYN SODIUM 20 MG/2ML IN NEBU,$25.84,$0.00,$25.84,$0.00,$18.44,$0.00,$0.00,$0.00,$0.00,$0.00,$25.84,$0.00,$12.92,$20.47,$20.67,$0.00,$0.00,$0.00,$0.00,$0.00
9691,ERX,HCPCS 25000001,17478-0291-11,CROMOLYN SODIUM 4 % OP SOLN,$130.20,$0.00,$130.20,$0.00,$92.92,$0.00,$0.00,$0.00,$0.00,$0.00,$130.20,$0.00,$65.10,$103.12,$104.16,$0.00,$0.00,$0.00,$0.00,$0.00
9691,ERX,HCPCS 25000001,61314-0237-10,CROMOLYN SODIUM 4 % OP SOLN,$130.20,$0.00,$130.20,$0.00,$92.92,$0.00,$0.00,$0.00,$0.00,$0.00,$130.20,$0.00,$65.10,$103.12,$104.16,$0.00,$0.00,$0.00,$0.00,$0.00
9699,ERX,HCPCS 25000001,00065-0395-15,CYCLOPENTOLATE HCL 0.5 % OP SOLN,$297.68,$0.00,$297.68,$0.00,$212.45,$0.00,$0.00,$0.00,$0.00,$0.00,$297.68,$0.00,$148.84,$235.76,$238.14,$0.00,$0.00,$0.00,$0.00,$0.00
9699,ERX,HCPCS 25000001,17478-0096-15,CYCLOPENTOLATE HCL 0.5 % OP SOLN,$297.68,$0.00,$297.68,$0.00,$212.45,$0.00,$0.00,$0.00,$0.00,$0.00,$297.68,$0.00,$148.84,$235.76,$238.14,$0.00,$0.00,$0.00,$0.00,$0.00
9700,ERX,HCPCS 25000001,00065-0397-02,CYCLOPENTOLATE HCL 2 % OP SOLN,$151.48,$0.00,$151.48,$0.00,$108.11,$0.00,$0.00,$0.00,$0.00,$0.00,$151.48,$0.00,$75.74,$119.97,$121.18,$0.00,$0.00,$0.00,$0.00,$0.00
9700,ERX,HCPCS 25000001,17478-0097-02,CYCLOPENTOLATE HCL 2 % OP SOLN,$151.48,$0.00,$151.48,$0.00,$108.11,$0.00,$0.00,$0.00,$0.00,$0.00,$151.48,$0.00,$75.74,$119.97,$121.18,$0.00,$0.00,$0.00,$0.00,$0.00
9700,ERX,HCPCS 25000001,17478-0097-10,CYCLOPENTOLATE HCL 2 % OP SOLN,$170.80,$0.00,$151.48,$0.00,$108.11,$0.00,$0.00,$0.00,$0.00,$0.00,$151.48,$0.00,$75.74,$135.27,$121.18,$0.00,$0.00,$0.00,$0.00,$0.00
9701,ERX,HCPCS 25000001,00065-0359-02,CYCLOPENTOLATE-PHENYLEPHRINE 0.2-1 % OP SOLN,$120.96,$0.00,$120.96,$0.00,$86.33,$0.00,$0.00,$0.00,$0.00,$0.00,$120.96,$0.00,$60.48,$95.80,$96.77,$0.00,$0.00,$0.00,$0.00,$0.00
9701,ERX,HCPCS 25000001,00065-0359-05,CYCLOPENTOLATE-PHENYLEPHRINE 0.2-1 % OP SOLN,$191.24,$0.00,$151.46,$0.00,$86.33,$0.00,$0.00,$0.00,$0.00,$0.00,$120.96,$0.00,$60.48,$151.46,$96.77,$0.00,$0.00,$0.00,$0.00,$0.00
9704,ERX,HCPCS 63700001,13845-1202-02,CYCLOSERINE 250 MG PO CAPS,$263.34,$0.00,$263.34,$0.00,$187.95,$0.00,$0.00,$0.00,$0.00,$0.00,$263.34,$0.00,$131.67,$208.57,$210.67,$0.00,$0.00,$0.00,$0.00,$0.00
9705,ERX,HCPCS j7516,00078-0109-01,CYCLOSPORINE 50 MG/ML IV SOLN,$164.24,$0.00,$164.24,$0.00,$117.22,$0.00,$0.00,$0.00,$0.00,$0.00,$164.24,$0.00,$82.12,$130.08,$131.39,$0.00,$0.00,$0.00,$0.00,$0.00
9705,ERX,HCPCS j7516,00574-0866-10,CYCLOSPORINE 50 MG/ML IV SOLN,$164.24,$0.00,$164.24,$0.00,$117.22,$0.00,$0.00,$0.00,$0.00,$0.00,$164.24,$0.00,$82.12,$130.08,$131.39,$0.00,$0.00,$0.00,$0.00,$0.00
9706,ERX,HCPCS J7502,00078-0241-15,CYCLOSPORINE 100 MG PO CAPS,$53.09,$0.00,$53.09,$23.89,$37.89,$0.00,$9.15,$0.00,$0.00,$9.30,$53.09,$0.00,$26.55,$42.05,$42.47,$0.00,$8.31,$0.00,$8.45,$0.00
9706,ERX,HCPCS J7502,00078-0241-61,CYCLOSPORINE 100 MG PO CAPS,$53.09,$0.00,$53.09,$23.89,$37.89,$0.00,$9.15,$0.00,$0.00,$9.30,$53.09,$0.00,$26.55,$42.05,$42.47,$0.00,$8.31,$0.00,$8.45,$0.00
9706,ERX,HCPCS J7502,60505-0134-00,CYCLOSPORINE 100 MG PO CAPS,$53.09,$0.00,$53.09,$23.89,$37.89,$0.00,$9.15,$0.00,$0.00,$9.30,$53.09,$0.00,$26.55,$42.05,$42.47,$0.00,$8.31,$0.00,$8.45,$0.00
9707,ERX,HCPCS J7515,00078-0240-15,CYCLOSPORINE (SANDIMMUNE) 25 MG PO CAPS,$26.60,$0.00,$26.60,$0.00,$18.98,$0.00,$0.00,$0.00,$0.00,$0.00,$26.60,$0.00,$13.30,$21.07,$21.28,$0.00,$0.00,$0.00,$0.00,$0.00
9707,ERX,HCPCS J7515,00078-0240-61,CYCLOSPORINE (SANDIMMUNE) 25 MG PO CAPS,$26.60,$0.00,$26.60,$0.00,$18.98,$0.00,$0.00,$0.00,$0.00,$0.00,$26.60,$0.00,$13.30,$21.07,$21.28,$0.00,$0.00,$0.00,$0.00,$0.00
9707,ERX,HCPCS J7515,60505-0133-00,CYCLOSPORINE (SANDIMMUNE) 25 MG PO CAPS,$26.60,$0.00,$26.60,$0.00,$18.98,$0.00,$0.00,$0.00,$0.00,$0.00,$26.60,$0.00,$13.30,$21.07,$21.28,$0.00,$0.00,$0.00,$0.00,$0.00
9708,ERX,HCPCS J7502,00078-0110-22,CYCLOSPORINE 100 MG/ML PO SOLN,"$2,159.52",$0.00,"$2,159.52",$971.78,"$1,541.25",$0.00,$372.07,$0.00,$0.00,$378.11,"$2,159.52",$0.00,"$1,079.76","$1,710.34","$1,727.62",$0.00,$337.96,$0.00,$343.80,$0.00
9715,ERX,HCPCS 63700001,00555-0633-02,DANAZOL 50 MG PO CAPS,$13.79,$0.00,$13.79,$0.00,$9.84,$0.00,$0.00,$0.00,$0.00,$0.00,$13.79,$0.00,$6.90,$10.92,$11.03,$0.00,$0.00,$0.00,$0.00,$0.00
9716,ERX,HCPCS 25000001,00143-9297-01,DANTROLENE SODIUM 20 MG IV SOLR,$268.04,$0.00,$268.04,$0.00,$191.30,$0.00,$0.00,$0.00,$0.00,$0.00,$268.04,$0.00,$134.02,$212.29,$214.43,$0.00,$0.00,$0.00,$0.00,$0.00
9716,ERX,HCPCS 25000001,27505-0003-67,DANTROLENE SODIUM 20 MG IV SOLR,$268.04,$0.00,$268.04,$0.00,$191.30,$0.00,$0.00,$0.00,$0.00,$0.00,$268.04,$0.00,$134.02,$212.29,$214.43,$0.00,$0.00,$0.00,$0.00,$0.00
9716,ERX,HCPCS 25000001,42023-0123-06,DANTROLENE SODIUM 20 MG IV SOLR,$268.04,$0.00,$268.04,$0.00,$191.30,$0.00,$0.00,$0.00,$0.00,$0.00,$268.04,$0.00,$134.02,$212.29,$214.43,$0.00,$0.00,$0.00,$0.00,$0.00
9717,ERX,HCPCS 63700001,00115-4433-01,DANTROLENE SODIUM 100 MG PO CAPS,$8.24,$0.00,$8.24,$0.00,$5.88,$0.00,$0.00,$0.00,$0.00,$0.00,$8.24,$0.00,$4.12,$6.53,$6.59,$0.00,$0.00,$0.00,$0.00,$0.00
9718,ERX,HCPCS 63700001,00115-4411-01,DANTROLENE SODIUM 25 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9718,ERX,HCPCS 63700001,68084-0300-21,DANTROLENE SODIUM 25 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9719,ERX,HCPCS 63700001,00115-4422-01,DANTROLENE SODIUM 50 MG PO CAPS,$6.58,$0.00,$6.58,$0.00,$4.70,$0.00,$0.00,$0.00,$0.00,$0.00,$6.58,$0.00,$3.29,$5.21,$5.26,$0.00,$0.00,$0.00,$0.00,$0.00
9719,ERX,HCPCS 63700001,42023-0125-01,DANTROLENE SODIUM 50 MG PO CAPS,$6.58,$0.00,$6.58,$0.00,$4.70,$0.00,$0.00,$0.00,$0.00,$0.00,$6.58,$0.00,$3.29,$5.21,$5.26,$0.00,$0.00,$0.00,$0.00,$0.00
9722,ERX,HCPCS J0895,00409-2337-25,DEFEROXAMINE MESYLATE 2 G IJ SOLR,$132.64,$0.00,$132.64,$0.00,$94.67,$0.00,$0.00,$0.00,$0.00,$0.00,$132.64,$0.00,$66.32,$105.05,$106.11,$0.00,$0.00,$0.00,$0.00,$0.00
9722,ERX,HCPCS J0895,63323-0599-30,DEFEROXAMINE MESYLATE 2 G IJ SOLR,$132.64,$0.00,$132.64,$0.00,$94.67,$0.00,$0.00,$0.00,$0.00,$0.00,$132.64,$0.00,$66.32,$105.05,$106.11,$0.00,$0.00,$0.00,$0.00,$0.00
9723,ERX,HCPCS J0895,00078-0467-61,DEFEROXAMINE MESYLATE 500 MG IJ SOLR,$42.92,$0.00,$42.92,$0.00,$30.63,$0.00,$0.00,$0.00,$0.00,$0.00,$42.92,$0.00,$21.46,$33.99,$34.34,$0.00,$0.00,$0.00,$0.00,$0.00
9723,ERX,HCPCS J0895,00409-2336-10,DEFEROXAMINE MESYLATE 500 MG IJ SOLR,$42.92,$0.00,$42.92,$0.00,$30.63,$0.00,$0.00,$0.00,$0.00,$0.00,$42.92,$0.00,$21.46,$33.99,$34.34,$0.00,$0.00,$0.00,$0.00,$0.00
9723,ERX,HCPCS J0895,63323-0597-10,DEFEROXAMINE MESYLATE 500 MG IJ SOLR,$42.92,$0.00,$42.92,$0.00,$30.63,$0.00,$0.00,$0.00,$0.00,$0.00,$42.92,$0.00,$21.46,$33.99,$34.34,$0.00,$0.00,$0.00,$0.00,$0.00
9726,ERX,HCPCS 63700001,62584-0159-01,DEMECLOCYCLINE HCL 150 MG PO TABS,$40.41,$0.00,$40.41,$0.00,$28.84,$0.00,$0.00,$0.00,$0.00,$0.00,$40.41,$0.00,$20.21,$32.00,$32.33,$0.00,$0.00,$0.00,$0.00,$0.00
9726,ERX,HCPCS 63700001,65162-0554-10,DEMECLOCYCLINE HCL 150 MG PO TABS,$40.41,$0.00,$40.41,$0.00,$28.84,$0.00,$0.00,$0.00,$0.00,$0.00,$40.41,$0.00,$20.21,$32.00,$32.33,$0.00,$0.00,$0.00,$0.00,$0.00
9727,ERX,HCPCS 63700001,42806-0144-48,DEMECLOCYCLINE HCL 300 MG PO TABS,$119.48,$0.00,$119.48,$0.00,$85.27,$0.00,$0.00,$0.00,$0.00,$0.00,$119.48,$0.00,$59.74,$94.63,$95.58,$0.00,$0.00,$0.00,$0.00,$0.00
9727,ERX,HCPCS 63700001,65162-0555-48,DEMECLOCYCLINE HCL 300 MG PO TABS,$119.48,$0.00,$119.48,$0.00,$85.27,$0.00,$0.00,$0.00,$0.00,$0.00,$119.48,$0.00,$59.74,$94.63,$95.58,$0.00,$0.00,$0.00,$0.00,$0.00
9748,ERX,HCPCS J2597,00703-5054-01,DESMOPRESSIN ACETATE 4 MCG/ML IJ SOLN,$85.20,$0.00,$85.20,$0.00,$60.81,$0.00,$0.00,$0.00,$0.00,$0.00,$85.20,$0.00,$42.60,$67.48,$68.16,$0.00,$0.00,$0.00,$0.00,$0.00
9748,ERX,HCPCS J2597,43598-0931-09,DESMOPRESSIN ACETATE 4 MCG/ML IJ SOLN,$85.20,$0.00,$85.20,$0.00,$60.81,$0.00,$0.00,$0.00,$0.00,$0.00,$85.20,$0.00,$42.60,$67.48,$68.16,$0.00,$0.00,$0.00,$0.00,$0.00
9748,ERX,HCPCS J2597,55566-2200-00,DESMOPRESSIN ACETATE 4 MCG/ML IJ SOLN,$85.20,$0.00,$85.20,$0.00,$60.81,$0.00,$0.00,$0.00,$0.00,$0.00,$85.20,$0.00,$42.60,$67.48,$68.16,$0.00,$0.00,$0.00,$0.00,$0.00
9748,ERX,HCPCS J2597,55566-2300-00,DESMOPRESSIN ACETATE 4 MCG/ML IJ SOLN,$85.20,$0.00,$85.20,$0.00,$60.81,$0.00,$0.00,$0.00,$0.00,$0.00,$85.20,$0.00,$42.60,$67.48,$68.16,$0.00,$0.00,$0.00,$0.00,$0.00
9748,ERX,HCPCS J2597,62756-0529-40,DESMOPRESSIN ACETATE 4 MCG/ML IJ SOLN,$85.20,$0.00,$85.20,$0.00,$60.81,$0.00,$0.00,$0.00,$0.00,$0.00,$85.20,$0.00,$42.60,$67.48,$68.16,$0.00,$0.00,$0.00,$0.00,$0.00
9748,ERX,HCPCS J2597,69918-0899-10,DESMOPRESSIN ACETATE 4 MCG/ML IJ SOLN,$85.20,$0.00,$85.20,$0.00,$60.81,$0.00,$0.00,$0.00,$0.00,$0.00,$85.20,$0.00,$42.60,$67.48,$68.16,$0.00,$0.00,$0.00,$0.00,$0.00
9748,ERX,HCPCS J2597,69918-0901-10,DESMOPRESSIN ACETATE 4 MCG/ML IJ SOLN,$85.20,$0.00,$85.20,$0.00,$60.81,$0.00,$0.00,$0.00,$0.00,$0.00,$85.20,$0.00,$42.60,$67.48,$68.16,$0.00,$0.00,$0.00,$0.00,$0.00
9759,ERX,HCPCS 25000001,00409-7418-03,DEXTRAN 40 IN D5W 10 % IV SOLN,$112.00,$0.00,$112.00,$0.00,$79.93,$0.00,$0.00,$0.00,$0.00,$0.00,$112.00,$0.00,$56.00,$88.70,$89.60,$0.00,$0.00,$0.00,$0.00,$0.00
9788,ERX,HCPCS J7120,00264-7751-10,DEXTROSE IN LACTATED RINGERS 5 % IV SOLN,$22.00,$0.00,$22.80,$10.26,$16.27,$0.00,$1.13,$0.00,$0.00,$2.77,$22.80,$0.00,$11.40,$17.42,$18.24,$0.00,$2.77,$0.00,$2.64,$0.00
9788,ERX,HCPCS J7120,00338-0125-03,DEXTROSE IN LACTATED RINGERS 5 % IV SOLN,$22.00,$0.00,$22.80,$10.26,$16.27,$0.00,$1.13,$0.00,$0.00,$2.77,$22.80,$0.00,$11.40,$17.42,$18.24,$0.00,$2.77,$0.00,$2.64,$0.00
9788,ERX,HCPCS J7120,00264-7751-00,DEXTROSE IN LACTATED RINGERS 5 % IV SOLN,$22.80,$0.00,$22.80,$10.26,$16.27,$0.00,$1.13,$0.00,$0.00,$2.77,$22.80,$0.00,$11.40,$18.06,$18.24,$0.00,$2.77,$0.00,$2.64,$0.00
9788,ERX,HCPCS J7120,00338-0125-04,DEXTROSE IN LACTATED RINGERS 5 % IV SOLN,$22.80,$0.00,$22.80,$10.26,$16.27,$0.00,$1.13,$0.00,$0.00,$2.77,$22.80,$0.00,$11.40,$18.06,$18.24,$0.00,$2.77,$0.00,$2.64,$0.00
9823,ERX,HCPCS Q9958,00270-1410-30,DIATRIZOATE MEGLUMINE 18 % UR SOLN,$135.45,$0.00,$135.45,$0.00,$96.67,$0.00,$0.00,$0.00,$0.00,$0.00,$135.45,$0.00,$67.73,$107.28,$108.36,$0.00,$0.00,$0.00,$0.00,$0.00
9828,ERX,HCPCS Q9963,00270-0445-40,DIATRIZOATE MEGLUMINE & SODIUM 66-10 % (37% IODINE) SOLN,$263.47,$0.00,$263.47,$118.56,$188.04,$0.00,$45.39,$0.00,$0.00,$23.97,$263.47,$0.00,$131.74,$208.67,$210.78,$0.00,$22.82,$0.00,$41.94,$0.00
9859,ERX,HCPCS J1110,00574-0850-05,DIHYDROERGOTAMINE MESYLATE 1 MG/ML IJ SOLN,$248.26,$0.00,$248.26,$0.00,$177.18,$0.00,$0.00,$0.00,$0.00,$0.00,$248.26,$0.00,$124.13,$196.62,$198.61,$0.00,$0.00,$0.00,$0.00,$0.00
9859,ERX,HCPCS J1110,00574-0850-10,DIHYDROERGOTAMINE MESYLATE 1 MG/ML IJ SOLN,$248.26,$0.00,$248.26,$0.00,$177.18,$0.00,$0.00,$0.00,$0.00,$0.00,$248.26,$0.00,$124.13,$196.62,$198.61,$0.00,$0.00,$0.00,$0.00,$0.00
9872,ERX,HCPCS J0470,17478-0526-03,DIMERCAPROL 100 MG/ML IM SOLN,$587.22,$0.00,$587.22,$0.00,$419.10,$0.00,$0.00,$0.00,$0.00,$0.00,$587.22,$0.00,$293.61,$465.08,$469.78,$0.00,$0.00,$0.00,$0.00,$0.00
9875,ERX,HCPCS 25000001,00009-0827-03,DINOPROSTONE 20 MG VA SUPP,"$5,432.10",$0.00,"$5,432.10",$0.00,"$3,876.89",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,432.10",$0.00,"$2,716.05","$4,302.22","$4,345.68",$0.00,$0.00,$0.00,$0.00,$0.00
9891,ERX,HCPCS J1245,00641-2569-41,DIPYRIDAMOLE 5 MG/ML IV SOLN,$83.16,$0.00,$83.16,$0.00,$59.35,$0.00,$0.00,$0.00,$0.00,$0.00,$83.16,$0.00,$41.58,$65.86,$66.53,$0.00,$0.00,$0.00,$0.00,$0.00
9891,ERX,HCPCS J1245,00641-2569-44,DIPYRIDAMOLE 5 MG/ML IV SOLN,$83.16,$0.00,$83.16,$0.00,$59.35,$0.00,$0.00,$0.00,$0.00,$0.00,$83.16,$0.00,$41.58,$65.86,$66.53,$0.00,$0.00,$0.00,$0.00,$0.00
9894,ERX,HCPCS 63700001,00904-5522-61,DOXAZOSIN MESYLATE 1 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9894,ERX,HCPCS 63700001,16729-0211-01,DOXAZOSIN MESYLATE 1 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9894,ERX,HCPCS 63700001,68084-0836-25,DOXAZOSIN MESYLATE 1 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9894,ERX,HCPCS 63700001,68084-0836-95,DOXAZOSIN MESYLATE 1 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9895,ERX,HCPCS 63700001,00378-4022-01,DOXAZOSIN MESYLATE 2 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9895,ERX,HCPCS 63700001,51079-0958-01,DOXAZOSIN MESYLATE 2 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9895,ERX,HCPCS 63700001,51079-0958-20,DOXAZOSIN MESYLATE 2 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9896,ERX,HCPCS 63700001,00904-5524-61,DOXAZOSIN MESYLATE 4 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9896,ERX,HCPCS 63700001,16729-0213-01,DOXAZOSIN MESYLATE 4 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9897,ERX,HCPCS 63700001,16729-0415-01,DOXAZOSIN MESYLATE 8 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9897,ERX,HCPCS 63700001,68382-0786-01,DOXAZOSIN MESYLATE 8 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9900,ERX,HCPCS 63700001,49884-0727-03,DOXYCYCLINE MONOHYDRATE 100 MG PO CAPS,$9.01,$0.00,$9.01,$0.00,$6.43,$0.00,$0.00,$0.00,$0.00,$0.00,$9.01,$0.00,$4.51,$7.14,$7.21,$0.00,$0.00,$0.00,$0.00,$0.00
9900,ERX,HCPCS 63700001,63304-0616-50,DOXYCYCLINE MONOHYDRATE 100 MG PO CAPS,$9.01,$0.00,$9.01,$0.00,$6.43,$0.00,$0.00,$0.00,$0.00,$0.00,$9.01,$0.00,$4.51,$7.14,$7.21,$0.00,$0.00,$0.00,$0.00,$0.00
9902,ERX,HCPCS 25000001,69097-0228-43,DOXYCYCLINE MONOHYDRATE 25 MG/5ML PO SUSR,$92.82,$0.00,$92.82,$0.00,$66.25,$0.00,$0.00,$0.00,$0.00,$0.00,$92.82,$0.00,$46.41,$73.51,$74.26,$0.00,$0.00,$0.00,$0.00,$0.00
9904,ERX,HCPCS Q0167,00527-1450-06,DRONABINOL 2.5 MG PO CAPS,$22.40,$0.00,$22.40,$0.00,$15.99,$0.00,$0.00,$0.00,$0.00,$0.00,$22.40,$0.00,$11.20,$17.74,$17.92,$0.00,$0.00,$0.00,$0.00,$0.00
9904,ERX,HCPCS Q0167,17478-0761-06,DRONABINOL 2.5 MG PO CAPS,$22.40,$0.00,$22.40,$0.00,$15.99,$0.00,$0.00,$0.00,$0.00,$0.00,$22.40,$0.00,$11.20,$17.74,$17.92,$0.00,$0.00,$0.00,$0.00,$0.00
9904,ERX,HCPCS Q0167,42858-0867-06,DRONABINOL 2.5 MG PO CAPS,$22.40,$0.00,$22.40,$0.00,$15.99,$0.00,$0.00,$0.00,$0.00,$0.00,$22.40,$0.00,$11.20,$17.74,$17.92,$0.00,$0.00,$0.00,$0.00,$0.00
9914,ERX,HCPCS 25000001,00046-1065-05,ECHOTHIOPHATE IODIDE 0.125 % OP SOLR,$324.52,$0.00,$324.52,$0.00,$231.61,$0.00,$0.00,$0.00,$0.00,$0.00,$324.52,$0.00,$162.26,$257.02,$259.62,$0.00,$0.00,$0.00,$0.00,$0.00
9915,ERX,HCPCS 63700001,45802-0466-35,ECONAZOLE NITRATE 1 % EX CREA,$331.69,$0.00,$331.69,$0.00,$236.73,$0.00,$0.00,$0.00,$0.00,$0.00,$331.69,$0.00,$165.85,$262.70,$265.35,$0.00,$0.00,$0.00,$0.00,$0.00
9915,ERX,HCPCS 63700001,52565-0022-15,ECONAZOLE NITRATE 1 % EX CREA,$331.69,$0.00,$331.69,$0.00,$236.73,$0.00,$0.00,$0.00,$0.00,$0.00,$331.69,$0.00,$165.85,$262.70,$265.35,$0.00,$0.00,$0.00,$0.00,$0.00
9927,ERX,HCPCS 63700001,16714-0443-01,ENALAPRIL MALEATE 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9927,ERX,HCPCS 63700001,64679-0924-02,ENALAPRIL MALEATE 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9929,ERX,HCPCS 25000001,00143-9786-01,ENALAPRILAT 1.25 MG/ML IV INJ,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
9929,ERX,HCPCS 25000001,00143-9786-10,ENALAPRILAT 1.25 MG/ML IV INJ,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
9929,ERX,HCPCS 25000001,00409-2122-02,ENALAPRILAT 1.25 MG/ML IV INJ,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
9938,ERX,HCPCS J0885,59676-0310-00,EPOETIN ALFA 10000 UNIT/ML IJ SOLN,$849.83,$0.00,$849.83,$461.46,$0.00,$0.00,$146.42,$0.00,$0.00,$148.80,$849.83,$0.00,$424.92,$673.07,$679.86,$0.00,$133.00,$0.00,$118.59,$0.00
9938,ERX,HCPCS J0885,59676-0310-01,EPOETIN ALFA 10000 UNIT/ML IJ SOLN,$849.83,$0.00,$849.83,$461.46,$0.00,$0.00,$146.42,$0.00,$0.00,$148.80,$849.83,$0.00,$424.92,$673.07,$679.86,$0.00,$133.00,$0.00,$118.59,$0.00
9938,ERX,HCPCS J0885,59676-0310-02,EPOETIN ALFA 10000 UNIT/ML IJ SOLN,$849.83,$0.00,$849.83,$461.46,$0.00,$0.00,$146.42,$0.00,$0.00,$148.80,$849.83,$0.00,$424.92,$673.07,$679.86,$0.00,$133.00,$0.00,$118.59,$0.00
9939,ERX,HCPCS J0885,55513-0126-01,EPOETIN ALFA (EPOGEN) 2000 UNIT/ML IJ SOLN,$139.27,$0.00,$139.27,$75.62,$0.00,$0.00,$24.00,$0.00,$0.00,$24.39,$139.27,$0.00,$69.64,$110.30,$111.42,$0.00,$21.80,$0.00,$23.72,$0.00
9939,ERX,HCPCS J0885,55513-0126-10,EPOETIN ALFA (EPOGEN) 2000 UNIT/ML IJ SOLN,$139.27,$0.00,$139.27,$75.62,$0.00,$0.00,$24.00,$0.00,$0.00,$24.39,$139.27,$0.00,$69.64,$110.30,$111.42,$0.00,$21.80,$0.00,$23.72,$0.00
9941,ERX,HCPCS J0885,55513-0148-10,EPOETIN ALFA (EPOGEN) 4000 UNIT/ML IJ SOLN,$139.28,$0.00,$139.28,$75.63,$0.00,$0.00,$24.00,$0.00,$0.00,$24.39,$139.28,$0.00,$69.64,$110.31,$111.42,$0.00,$21.80,$0.00,$23.72,$0.00
9949,ERX,HCPCS 63700001,00781-5405-01,ERGOTAMINE-CAFFEINE 1-100 MG PO TABS,$58.67,$0.00,$58.67,$0.00,$41.87,$0.00,$0.00,$0.00,$0.00,$0.00,$58.67,$0.00,$29.34,$46.47,$46.94,$0.00,$0.00,$0.00,$0.00,$0.00
9963,ERX,HCPCS 63700001,61570-0072-01,ESTERIFIED ESTROGENS 0.3 MG PO TABS,$8.01,$0.00,$8.01,$0.00,$5.72,$0.00,$0.00,$0.00,$0.00,$0.00,$8.01,$0.00,$4.01,$6.34,$6.41,$0.00,$0.00,$0.00,$0.00,$0.00
9964,ERX,HCPCS 63700001,61570-0073-01,ESTERIFIED ESTROGENS 0.625 MG PO TABS,$11.38,$0.00,$11.38,$0.00,$8.12,$0.00,$0.00,$0.00,$0.00,$0.00,$11.38,$0.00,$5.69,$9.01,$9.10,$0.00,$0.00,$0.00,$0.00,$0.00
9965,ERX,HCPCS 63700001,61570-0074-01,ESTERIFIED ESTROGENS 1.25 MG PO TABS,$15.88,$0.00,$15.88,$0.00,$11.33,$0.00,$0.00,$0.00,$0.00,$0.00,$15.88,$0.00,$7.94,$12.58,$12.70,$0.00,$0.00,$0.00,$0.00,$0.00
9967,ERX,HCPCS 63700001,00378-1454-01,ESTRADIOL 1 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9967,ERX,HCPCS 63700001,00555-0886-02,ESTRADIOL 1 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9968,ERX,HCPCS 63700001,00378-1458-01,ESTRADIOL 2 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9968,ERX,HCPCS 63700001,00555-0887-02,ESTRADIOL 2 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9968,ERX,HCPCS 63700001,00555-0887-04,ESTRADIOL 2 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9969,ERX,HCPCS 25000001,00430-3754-14,ESTRADIOL 0.1 MG/GM VA CREA,$73.99,$0.00,$73.99,$0.00,$52.81,$0.00,$0.00,$0.00,$0.00,$0.00,$73.99,$0.00,$37.00,$58.60,$59.19,$0.00,$0.00,$0.00,$0.00,$0.00
9971,ERX,HCPCS 63700001,00013-0132-02,ESTRAMUSTINE PHOSPHATE SODIUM 140 MG PO CAPS,$73.12,$0.00,$73.12,$0.00,$52.19,$0.00,$0.00,$0.00,$0.00,$0.00,$73.12,$0.00,$36.56,$57.91,$58.50,$0.00,$0.00,$0.00,$0.00,$0.00
9972,ERX,HCPCS J1410,00046-0749-05,ESTROGENS CONJUGATED 25 MG IJ SOLR,$991.03,$0.00,$991.03,$0.00,$707.30,$0.00,$92.23,$0.00,$0.00,$0.00,$991.03,$0.00,$495.52,$784.90,$792.82,$0.00,$362.72,$0.00,$0.00,$0.00
9973,ERX,HCPCS 63700001,00046-1100-81,ESTROGENS CONJUGATED 0.3 MG PO TABS,$26.93,$0.00,$26.93,$0.00,$19.22,$0.00,$0.00,$0.00,$0.00,$0.00,$26.93,$0.00,$13.47,$21.33,$21.54,$0.00,$0.00,$0.00,$0.00,$0.00
9974,ERX,HCPCS 63700001,00046-1102-81,ESTROGENS CONJUGATED 0.625 MG PO TABS,$26.93,$0.00,$26.93,$0.00,$19.22,$0.00,$0.00,$0.00,$0.00,$0.00,$26.93,$0.00,$13.47,$21.33,$21.54,$0.00,$0.00,$0.00,$0.00,$0.00
9977,ERX,HCPCS 63700001,00046-0872-21,"ESTROGENS, CONJUGATED 0.625 MG/GM VA CREA","$1,247.36",$0.00,"$1,247.36",$0.00,$890.24,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,247.36",$0.00,$623.68,$987.91,$997.89,$0.00,$0.00,$0.00,$0.00,$0.00
9979,ERX,HCPCS 25000001,25010-0210-27,ETHACRYNATE SODIUM 50 MG IV SOLR,"$12,336.06",$0.00,"$12,336.06",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$12,336.06",$0.00,"$6,168.03","$9,770.16","$9,868.85",$0.00,$0.00,$0.00,$0.00,$0.00
9980,ERX,HCPCS 63700001,25010-0215-15,ETHACRYNIC ACID 25 MG PO TABS,$102.67,$0.00,$102.67,$0.00,$73.28,$0.00,$0.00,$0.00,$0.00,$0.00,$102.67,$0.00,$51.34,$81.31,$82.14,$0.00,$0.00,$0.00,$0.00,$0.00
9982,ERX,HCPCS 63700001,54879-0001-01,ETHAMBUTOL HCL 100 MG PO TABS,$17.52,$0.00,$17.52,$0.00,$12.50,$0.00,$0.00,$0.00,$0.00,$0.00,$17.52,$0.00,$8.76,$13.88,$14.02,$0.00,$0.00,$0.00,$0.00,$0.00
9982,ERX,HCPCS 63700001,68180-0280-01,ETHAMBUTOL HCL 100 MG PO TABS,$17.52,$0.00,$17.52,$0.00,$12.50,$0.00,$0.00,$0.00,$0.00,$0.00,$17.52,$0.00,$8.76,$13.88,$14.02,$0.00,$0.00,$0.00,$0.00,$0.00
9983,ERX,HCPCS 63700001,54879-0002-01,ETHAMBUTOL HCL 400 MG PO TABS,$11.27,$0.00,$11.27,$0.00,$8.04,$0.00,$0.00,$0.00,$0.00,$0.00,$11.27,$0.00,$5.64,$8.93,$9.02,$0.00,$0.00,$0.00,$0.00,$0.00
9983,ERX,HCPCS 63700001,68850-0012-02,ETHAMBUTOL HCL 400 MG PO TABS,$11.27,$0.00,$11.27,$0.00,$8.04,$0.00,$0.00,$0.00,$0.00,$0.00,$11.27,$0.00,$5.64,$8.93,$9.02,$0.00,$0.00,$0.00,$0.00,$0.00
9988,ERX,HCPCS 25000001,00008-4117-01,ETHIONAMIDE 250 MG PO TABS,$25.18,$0.00,$25.18,$0.00,$17.97,$0.00,$0.00,$0.00,$0.00,$0.00,$25.18,$0.00,$12.59,$19.94,$20.14,$0.00,$0.00,$0.00,$0.00,$0.00
9989,ERX,HCPCS 63700001,00071-0237-24,ETHOSUXIMIDE 250 MG PO CAPS,$16.87,$0.00,$16.87,$0.00,$12.04,$0.00,$0.00,$0.00,$0.00,$0.00,$16.87,$0.00,$8.44,$13.36,$13.50,$0.00,$0.00,$0.00,$0.00,$0.00
9989,ERX,HCPCS 63700001,23155-0532-01,ETHOSUXIMIDE 250 MG PO CAPS,$16.87,$0.00,$16.87,$0.00,$12.04,$0.00,$0.00,$0.00,$0.00,$0.00,$16.87,$0.00,$8.44,$13.36,$13.50,$0.00,$0.00,$0.00,$0.00,$0.00
9989,ERX,HCPCS 63700001,61748-0025-01,ETHOSUXIMIDE 250 MG PO CAPS,$16.87,$0.00,$16.87,$0.00,$12.04,$0.00,$0.00,$0.00,$0.00,$0.00,$16.87,$0.00,$8.44,$13.36,$13.50,$0.00,$0.00,$0.00,$0.00,$0.00
10001,ERX,HCPCS J8560,00378-3266-94,ETOPOSIDE 50 MG PO CAPS,$306.34,$0.00,$306.34,$0.00,$218.63,$0.00,$0.00,$0.00,$0.00,$0.00,$306.34,$0.00,$153.17,$242.62,$245.07,$0.00,$0.00,$0.00,$0.00,$0.00
10010,ERX,HCPCS 63700001,68180-0150-01,FAMOTIDINE 40 MG/5ML PO SUSR,$539.70,$0.00,$539.70,$0.00,$385.18,$0.00,$0.00,$0.00,$0.00,$0.00,$539.70,$0.00,$269.85,$427.44,$431.76,$0.00,$0.00,$0.00,$0.00,$0.00
10011,ERX,HCPCS 63700001,00172-5728-60,FAMOTIDINE 20 MG PO TABS,$9.21,$0.00,$9.21,$0.00,$6.57,$0.00,$0.00,$0.00,$0.00,$0.00,$9.21,$0.00,$4.61,$7.29,$7.37,$0.00,$0.00,$0.00,$0.00,$0.00
10011,ERX,HCPCS 63700001,42291-0281-10,FAMOTIDINE 20 MG PO TABS,$9.21,$0.00,$9.21,$0.00,$6.57,$0.00,$0.00,$0.00,$0.00,$0.00,$9.21,$0.00,$4.61,$7.29,$7.37,$0.00,$0.00,$0.00,$0.00,$0.00
10011,ERX,HCPCS 63700001,62332-0001-31,FAMOTIDINE 20 MG PO TABS,$9.21,$0.00,$9.21,$0.00,$6.57,$0.00,$0.00,$0.00,$0.00,$0.00,$9.21,$0.00,$4.61,$7.29,$7.37,$0.00,$0.00,$0.00,$0.00,$0.00
10014,ERX,HCPCS 25000001,00338-0519-09,FAT EMULSION PLANT BASED 20 % IV EMUL,$173.25,$0.00,$173.25,$0.00,$123.65,$0.00,$0.00,$0.00,$0.00,$0.00,$173.25,$0.00,$86.63,$137.21,$138.60,$0.00,$0.00,$0.00,$78.15,$0.00
10023,ERX,HCPCS 25000001,99999-6004-76,FELBAMATE 600 MG/5ML PO SUSP,$284.64,$0.00,"$3,821.70",$0.00,"$2,727.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,821.70",$0.00,"$1,910.85",$225.43,"$3,057.36",$0.00,$0.00,$0.00,$0.00,$0.00
10023,ERX,HCPCS 25000001,00037-0442-67,FELBAMATE 600 MG/5ML PO SUSP,"$3,821.70",$0.00,"$3,821.70",$0.00,"$2,727.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,821.70",$0.00,"$1,910.85","$3,026.79","$3,057.36",$0.00,$0.00,$0.00,$0.00,$0.00
10025,ERX,HCPCS 63700001,00037-0431-01,FELBAMATE 600 MG PO TABS,$22.74,$0.00,$22.74,$0.00,$16.23,$0.00,$0.00,$0.00,$0.00,$0.00,$22.74,$0.00,$11.37,$18.01,$18.19,$0.00,$0.00,$0.00,$0.00,$0.00
10025,ERX,HCPCS 63700001,51525-0431-01,FELBAMATE 600 MG PO TABS,$22.74,$0.00,$22.74,$0.00,$16.23,$0.00,$0.00,$0.00,$0.00,$0.00,$22.74,$0.00,$11.37,$18.01,$18.19,$0.00,$0.00,$0.00,$0.00,$0.00
10037,ERX,HCPCS 63700001,00093-7355-56,FINASTERIDE 5 MG PO TABS,$11.90,$0.00,$11.90,$0.00,$8.49,$0.00,$0.00,$0.00,$0.00,$0.00,$11.90,$0.00,$5.95,$9.42,$9.52,$0.00,$0.00,$0.00,$0.00,$0.00
10037,ERX,HCPCS 63700001,00093-7355-98,FINASTERIDE 5 MG PO TABS,$11.90,$0.00,$11.90,$0.00,$8.49,$0.00,$0.00,$0.00,$0.00,$0.00,$11.90,$0.00,$5.95,$9.42,$9.52,$0.00,$0.00,$0.00,$0.00,$0.00
10037,ERX,HCPCS 63700001,16729-0090-01,FINASTERIDE 5 MG PO TABS,$11.90,$0.00,$11.90,$0.00,$8.49,$0.00,$0.00,$0.00,$0.00,$0.00,$11.90,$0.00,$5.95,$9.42,$9.52,$0.00,$0.00,$0.00,$0.00,$0.00
10037,ERX,HCPCS 63700001,50268-0323-15,FINASTERIDE 5 MG PO TABS,$11.90,$0.00,$11.90,$0.00,$8.49,$0.00,$0.00,$0.00,$0.00,$0.00,$11.90,$0.00,$5.95,$9.42,$9.52,$0.00,$0.00,$0.00,$0.00,$0.00
10037,ERX,HCPCS 63700001,57237-0062-30,FINASTERIDE 5 MG PO TABS,$11.90,$0.00,$11.90,$0.00,$8.49,$0.00,$0.00,$0.00,$0.00,$0.00,$11.90,$0.00,$5.95,$9.42,$9.52,$0.00,$0.00,$0.00,$0.00,$0.00
10037,ERX,HCPCS 63700001,65862-0149-90,FINASTERIDE 5 MG PO TABS,$11.90,$0.00,$11.90,$0.00,$8.49,$0.00,$0.00,$0.00,$0.00,$0.00,$11.90,$0.00,$5.95,$9.42,$9.52,$0.00,$0.00,$0.00,$0.00,$0.00
10037,ERX,HCPCS 63700001,76282-0412-90,FINASTERIDE 5 MG PO TABS,$11.90,$0.00,$11.90,$0.00,$8.49,$0.00,$0.00,$0.00,$0.00,$0.00,$11.90,$0.00,$5.95,$9.42,$9.52,$0.00,$0.00,$0.00,$0.00,$0.00
10041,ERX,HCPCS 63700001,00054-0011-21,FLECAINIDE ACETATE 100 MG PO TABS,$13.61,$0.00,$13.61,$0.00,$9.71,$0.00,$0.00,$0.00,$0.00,$0.00,$13.61,$0.00,$6.81,$10.78,$10.89,$0.00,$0.00,$0.00,$0.00,$0.00
10041,ERX,HCPCS 63700001,00054-0011-25,FLECAINIDE ACETATE 100 MG PO TABS,$13.61,$0.00,$13.61,$0.00,$9.71,$0.00,$0.00,$0.00,$0.00,$0.00,$13.61,$0.00,$6.81,$10.78,$10.89,$0.00,$0.00,$0.00,$0.00,$0.00
10041,ERX,HCPCS 63700001,50268-0321-11,FLECAINIDE ACETATE 100 MG PO TABS,$13.61,$0.00,$13.61,$0.00,$9.71,$0.00,$0.00,$0.00,$0.00,$0.00,$13.61,$0.00,$6.81,$10.78,$10.89,$0.00,$0.00,$0.00,$0.00,$0.00
10041,ERX,HCPCS 63700001,50268-0321-15,FLECAINIDE ACETATE 100 MG PO TABS,$13.61,$0.00,$13.61,$0.00,$9.71,$0.00,$0.00,$0.00,$0.00,$0.00,$13.61,$0.00,$6.81,$10.78,$10.89,$0.00,$0.00,$0.00,$0.00,$0.00
10041,ERX,HCPCS 63700001,65162-0642-10,FLECAINIDE ACETATE 100 MG PO TABS,$13.61,$0.00,$13.61,$0.00,$9.71,$0.00,$0.00,$0.00,$0.00,$0.00,$13.61,$0.00,$6.81,$10.78,$10.89,$0.00,$0.00,$0.00,$0.00,$0.00
10042,ERX,HCPCS 63700001,00054-0012-21,FLECAINIDE ACETATE 150 MG PO TABS,$16.51,$0.00,$16.51,$0.00,$11.78,$0.00,$0.00,$0.00,$0.00,$0.00,$16.51,$0.00,$8.26,$13.08,$13.21,$0.00,$0.00,$0.00,$0.00,$0.00
10042,ERX,HCPCS 63700001,00054-0012-25,FLECAINIDE ACETATE 150 MG PO TABS,$16.51,$0.00,$16.51,$0.00,$11.78,$0.00,$0.00,$0.00,$0.00,$0.00,$16.51,$0.00,$8.26,$13.08,$13.21,$0.00,$0.00,$0.00,$0.00,$0.00
10042,ERX,HCPCS 63700001,53746-0643-01,FLECAINIDE ACETATE 150 MG PO TABS,$16.51,$0.00,$16.51,$0.00,$11.78,$0.00,$0.00,$0.00,$0.00,$0.00,$16.51,$0.00,$8.26,$13.08,$13.21,$0.00,$0.00,$0.00,$0.00,$0.00
10042,ERX,HCPCS 63700001,65162-0643-10,FLECAINIDE ACETATE 150 MG PO TABS,$16.51,$0.00,$16.51,$0.00,$11.78,$0.00,$0.00,$0.00,$0.00,$0.00,$16.51,$0.00,$8.26,$13.08,$13.21,$0.00,$0.00,$0.00,$0.00,$0.00
10043,ERX,HCPCS 63700001,00054-0010-20,FLECAINIDE ACETATE 50 MG PO TABS,$7.68,$0.00,$7.68,$0.00,$5.48,$0.00,$0.00,$0.00,$0.00,$0.00,$7.68,$0.00,$3.84,$6.08,$6.14,$0.00,$0.00,$0.00,$0.00,$0.00
10043,ERX,HCPCS 63700001,00054-0010-21,FLECAINIDE ACETATE 50 MG PO TABS,$7.68,$0.00,$7.68,$0.00,$5.48,$0.00,$0.00,$0.00,$0.00,$0.00,$7.68,$0.00,$3.84,$6.08,$6.14,$0.00,$0.00,$0.00,$0.00,$0.00
10043,ERX,HCPCS 63700001,00054-0010-25,FLECAINIDE ACETATE 50 MG PO TABS,$7.68,$0.00,$7.68,$0.00,$5.48,$0.00,$0.00,$0.00,$0.00,$0.00,$7.68,$0.00,$3.84,$6.08,$6.14,$0.00,$0.00,$0.00,$0.00,$0.00
10043,ERX,HCPCS 63700001,65162-0641-10,FLECAINIDE ACETATE 50 MG PO TABS,$7.68,$0.00,$7.68,$0.00,$5.48,$0.00,$0.00,$0.00,$0.00,$0.00,$7.68,$0.00,$3.84,$6.08,$6.14,$0.00,$0.00,$0.00,$0.00,$0.00
10044,ERX,HCPCS 63700001,00172-5411-46,FLUCONAZOLE 100 MG PO TABS,$33.46,$0.00,$33.46,$0.00,$23.88,$0.00,$0.00,$0.00,$0.00,$0.00,$33.46,$0.00,$16.73,$26.50,$26.77,$0.00,$0.00,$0.00,$0.00,$0.00
10044,ERX,HCPCS 63700001,16714-0691-01,FLUCONAZOLE 100 MG PO TABS,$33.46,$0.00,$33.46,$0.00,$23.88,$0.00,$0.00,$0.00,$0.00,$0.00,$33.46,$0.00,$16.73,$26.50,$26.77,$0.00,$0.00,$0.00,$0.00,$0.00
10044,ERX,HCPCS 63700001,16714-0691-02,FLUCONAZOLE 100 MG PO TABS,$33.46,$0.00,$33.46,$0.00,$23.88,$0.00,$0.00,$0.00,$0.00,$0.00,$33.46,$0.00,$16.73,$26.50,$26.77,$0.00,$0.00,$0.00,$0.00,$0.00
10044,ERX,HCPCS 63700001,55111-0144-01,FLUCONAZOLE 100 MG PO TABS,$33.46,$0.00,$33.46,$0.00,$23.88,$0.00,$0.00,$0.00,$0.00,$0.00,$33.46,$0.00,$16.73,$26.50,$26.77,$0.00,$0.00,$0.00,$0.00,$0.00
10044,ERX,HCPCS 63700001,55111-0144-30,FLUCONAZOLE 100 MG PO TABS,$33.46,$0.00,$33.46,$0.00,$23.88,$0.00,$0.00,$0.00,$0.00,$0.00,$33.46,$0.00,$16.73,$26.50,$26.77,$0.00,$0.00,$0.00,$0.00,$0.00
10044,ERX,HCPCS 63700001,68462-0102-30,FLUCONAZOLE 100 MG PO TABS,$33.46,$0.00,$33.46,$0.00,$23.88,$0.00,$0.00,$0.00,$0.00,$0.00,$33.46,$0.00,$16.73,$26.50,$26.77,$0.00,$0.00,$0.00,$0.00,$0.00
10045,ERX,HCPCS 63700001,00172-5413-46,FLUCONAZOLE 200 MG PO TABS,$62.12,$0.00,$62.12,$0.00,$44.34,$0.00,$0.00,$0.00,$0.00,$0.00,$62.12,$0.00,$31.06,$49.20,$49.70,$0.00,$0.00,$0.00,$0.00,$0.00
10045,ERX,HCPCS 63700001,00904-6501-61,FLUCONAZOLE 200 MG PO TABS,$62.12,$0.00,$62.12,$0.00,$44.34,$0.00,$0.00,$0.00,$0.00,$0.00,$62.12,$0.00,$31.06,$49.20,$49.70,$0.00,$0.00,$0.00,$0.00,$0.00
10045,ERX,HCPCS 63700001,16714-0693-01,FLUCONAZOLE 200 MG PO TABS,$62.12,$0.00,$62.12,$0.00,$44.34,$0.00,$0.00,$0.00,$0.00,$0.00,$62.12,$0.00,$31.06,$49.20,$49.70,$0.00,$0.00,$0.00,$0.00,$0.00
10045,ERX,HCPCS 63700001,68084-0735-01,FLUCONAZOLE 200 MG PO TABS,$62.12,$0.00,$62.12,$0.00,$44.34,$0.00,$0.00,$0.00,$0.00,$0.00,$62.12,$0.00,$31.06,$49.20,$49.70,$0.00,$0.00,$0.00,$0.00,$0.00
10049,ERX,HCPCS j1450,00338-6046-48,FLUCONAZOLE IN SODIUM CHLORIDE 200-0.9 MG/100ML-% IV SOLN,$41.04,$0.00,$41.04,$0.00,$29.29,$0.00,$7.07,$0.00,$0.00,$7.19,$41.04,$0.00,$20.52,$32.50,$32.83,$0.00,$6.42,$0.00,$0.00,$0.00
10049,ERX,HCPCS j1450,00409-4688-18,FLUCONAZOLE IN SODIUM CHLORIDE 200-0.9 MG/100ML-% IV SOLN,$41.04,$0.00,$41.04,$0.00,$29.29,$0.00,$7.07,$0.00,$0.00,$7.19,$41.04,$0.00,$20.52,$32.50,$32.83,$0.00,$6.42,$0.00,$0.00,$0.00
10049,ERX,HCPCS j1450,25021-0113-82,FLUCONAZOLE IN SODIUM CHLORIDE 200-0.9 MG/100ML-% IV SOLN,$41.04,$0.00,$41.04,$0.00,$29.29,$0.00,$7.07,$0.00,$0.00,$7.19,$41.04,$0.00,$20.52,$32.50,$32.83,$0.00,$6.42,$0.00,$0.00,$0.00
10049,ERX,HCPCS j1450,25021-0184-66,FLUCONAZOLE IN SODIUM CHLORIDE 200-0.9 MG/100ML-% IV SOLN,$41.04,$0.00,$41.04,$0.00,$29.29,$0.00,$7.07,$0.00,$0.00,$7.19,$41.04,$0.00,$20.52,$32.50,$32.83,$0.00,$6.42,$0.00,$0.00,$0.00
10049,ERX,HCPCS j1450,25021-0184-82,FLUCONAZOLE IN SODIUM CHLORIDE 200-0.9 MG/100ML-% IV SOLN,$41.04,$0.00,$41.04,$0.00,$29.29,$0.00,$7.07,$0.00,$0.00,$7.19,$41.04,$0.00,$20.52,$32.50,$32.83,$0.00,$6.42,$0.00,$0.00,$0.00
10049,ERX,HCPCS j1450,70655-0002-06,FLUCONAZOLE IN SODIUM CHLORIDE 200-0.9 MG/100ML-% IV SOLN,$41.04,$0.00,$41.04,$0.00,$29.29,$0.00,$7.07,$0.00,$0.00,$7.19,$41.04,$0.00,$20.52,$32.50,$32.83,$0.00,$6.42,$0.00,$0.00,$0.00
10049,ERX,HCPCS j1450,70655-0002-10,FLUCONAZOLE IN SODIUM CHLORIDE 200-0.9 MG/100ML-% IV SOLN,$41.04,$0.00,$41.04,$0.00,$29.29,$0.00,$7.07,$0.00,$0.00,$7.19,$41.04,$0.00,$20.52,$32.50,$32.83,$0.00,$6.42,$0.00,$0.00,$0.00
10050,ERX,HCPCS J1450,00338-6045-37,FLUCONAZOLE IN SODIUM CHLORIDE 400-0.9 MG/200ML-% IV SOLN,$63.84,$0.00,$63.84,$0.00,$45.56,$0.00,$0.00,$0.00,$0.00,$0.00,$63.84,$0.00,$31.92,$50.56,$51.07,$0.00,$0.00,$0.00,$0.00,$0.00
10050,ERX,HCPCS J1450,00409-4688-12,FLUCONAZOLE IN SODIUM CHLORIDE 400-0.9 MG/200ML-% IV SOLN,$63.84,$0.00,$63.84,$0.00,$45.56,$0.00,$0.00,$0.00,$0.00,$0.00,$63.84,$0.00,$31.92,$50.56,$51.07,$0.00,$0.00,$0.00,$0.00,$0.00
10050,ERX,HCPCS J1450,00409-4688-16,FLUCONAZOLE IN SODIUM CHLORIDE 400-0.9 MG/200ML-% IV SOLN,$63.84,$0.00,$63.84,$0.00,$45.56,$0.00,$0.00,$0.00,$0.00,$0.00,$63.84,$0.00,$31.92,$50.56,$51.07,$0.00,$0.00,$0.00,$0.00,$0.00
10050,ERX,HCPCS J1450,25021-0113-87,FLUCONAZOLE IN SODIUM CHLORIDE 400-0.9 MG/200ML-% IV SOLN,$63.84,$0.00,$63.84,$0.00,$45.56,$0.00,$0.00,$0.00,$0.00,$0.00,$63.84,$0.00,$31.92,$50.56,$51.07,$0.00,$0.00,$0.00,$0.00,$0.00
10050,ERX,HCPCS J1450,25021-0184-87,FLUCONAZOLE IN SODIUM CHLORIDE 400-0.9 MG/200ML-% IV SOLN,$63.84,$0.00,$63.84,$0.00,$45.56,$0.00,$0.00,$0.00,$0.00,$0.00,$63.84,$0.00,$31.92,$50.56,$51.07,$0.00,$0.00,$0.00,$0.00,$0.00
10050,ERX,HCPCS J1450,70655-0088-06,FLUCONAZOLE IN SODIUM CHLORIDE 400-0.9 MG/200ML-% IV SOLN,$63.84,$0.00,$63.84,$0.00,$45.56,$0.00,$0.00,$0.00,$0.00,$0.00,$63.84,$0.00,$31.92,$50.56,$51.07,$0.00,$0.00,$0.00,$0.00,$0.00
10050,ERX,HCPCS J1450,70655-0088-10,FLUCONAZOLE IN SODIUM CHLORIDE 400-0.9 MG/200ML-% IV SOLN,$63.84,$0.00,$63.84,$0.00,$45.56,$0.00,$0.00,$0.00,$0.00,$0.00,$63.84,$0.00,$31.92,$50.56,$51.07,$0.00,$0.00,$0.00,$0.00,$0.00
10051,ERX,HCPCS 63700001,00054-0427-25,FLUCYTOSINE 250 MG PO CAPS,$131.25,$0.00,$131.25,$0.00,$93.67,$0.00,$0.00,$0.00,$0.00,$0.00,$131.25,$0.00,$65.63,$103.95,$105.00,$0.00,$0.00,$0.00,$0.00,$0.00
10051,ERX,HCPCS 63700001,42794-0009-08,FLUCYTOSINE 250 MG PO CAPS,$131.25,$0.00,$131.25,$0.00,$93.67,$0.00,$0.00,$0.00,$0.00,$0.00,$131.25,$0.00,$65.63,$103.95,$105.00,$0.00,$0.00,$0.00,$0.00,$0.00
10052,ERX,HCPCS 63700001,00054-0428-25,FLUCYTOSINE 500 MG PO CAPS,$223.13,$0.00,$223.13,$0.00,$159.25,$0.00,$0.00,$0.00,$0.00,$0.00,$223.13,$0.00,$111.57,$176.72,$178.50,$0.00,$0.00,$0.00,$0.00,$0.00
10052,ERX,HCPCS 63700001,42494-0340-01,FLUCYTOSINE 500 MG PO CAPS,$223.13,$0.00,$223.13,$0.00,$159.25,$0.00,$0.00,$0.00,$0.00,$0.00,$223.13,$0.00,$111.57,$176.72,$178.50,$0.00,$0.00,$0.00,$0.00,$0.00
10052,ERX,HCPCS 63700001,42794-0010-08,FLUCYTOSINE 500 MG PO CAPS,$223.13,$0.00,$223.13,$0.00,$159.25,$0.00,$0.00,$0.00,$0.00,$0.00,$223.13,$0.00,$111.57,$176.72,$178.50,$0.00,$0.00,$0.00,$0.00,$0.00
10052,ERX,HCPCS 63700001,43386-0770-01,FLUCYTOSINE 500 MG PO CAPS,$223.13,$0.00,$223.13,$0.00,$159.25,$0.00,$0.00,$0.00,$0.00,$0.00,$223.13,$0.00,$111.57,$176.72,$178.50,$0.00,$0.00,$0.00,$0.00,$0.00
10054,ERX,HCPCS 63700001,00115-7033-01,FLUDROCORTISONE ACETATE 0.1 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10054,ERX,HCPCS 63700001,00555-0997-02,FLUDROCORTISONE ACETATE 0.1 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10054,ERX,HCPCS 63700001,68084-0288-01,FLUDROCORTISONE ACETATE 0.1 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10054,ERX,HCPCS 63700001,68084-0288-11,FLUDROCORTISONE ACETATE 0.1 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10061,ERX,HCPCS 25000001,59390-0218-05,FLUORESCEIN-BENOXINATE 0.25-0.4 % OP SOLN,$134.40,$0.00,$134.40,$0.00,$95.92,$0.00,$0.00,$0.00,$0.00,$0.00,$134.40,$0.00,$67.20,$106.44,$107.52,$0.00,$0.00,$0.00,$0.00,$0.00
10063,ERX,HCPCS 25000001,00065-0096-05,FLUOROMETHOLONE ACETATE 0.1 % OP SUSP,$329.25,$0.00,$329.25,$0.00,$234.99,$0.00,$0.00,$0.00,$0.00,$0.00,$329.25,$0.00,$164.63,$260.77,$263.40,$0.00,$0.00,$0.00,$0.00,$0.00
10065,ERX,HCPCS 25000001,66530-0249-40,FLUOROURACIL 5 % EX CREA,$682.11,$0.00,$682.11,$0.00,$486.82,$0.00,$0.00,$0.00,$0.00,$0.00,$682.11,$0.00,$341.06,$540.23,$545.69,$0.00,$0.00,$0.00,$0.00,$0.00
10069,ERX,HCPCS 63700001,00904-5784-61,FLUOXETINE HCL 10 MG PO CAPS,$9.88,$0.00,$9.88,$0.00,$7.05,$0.00,$0.00,$0.00,$0.00,$0.00,$9.88,$0.00,$4.94,$7.82,$7.90,$0.00,$0.00,$0.00,$0.00,$0.00
10069,ERX,HCPCS 63700001,65862-0192-01,FLUOXETINE HCL 10 MG PO CAPS,$9.88,$0.00,$9.88,$0.00,$7.05,$0.00,$0.00,$0.00,$0.00,$0.00,$9.88,$0.00,$4.94,$7.82,$7.90,$0.00,$0.00,$0.00,$0.00,$0.00
10069,ERX,HCPCS 63700001,65862-0192-99,FLUOXETINE HCL 10 MG PO CAPS,$9.88,$0.00,$9.88,$0.00,$7.05,$0.00,$0.00,$0.00,$0.00,$0.00,$9.88,$0.00,$4.94,$7.82,$7.90,$0.00,$0.00,$0.00,$0.00,$0.00
10070,ERX,HCPCS 63700001,00904-5785-61,FLUOXETINE HCL 20 MG PO CAPS,$9.44,$0.00,$9.44,$0.00,$6.74,$0.00,$0.00,$0.00,$0.00,$0.00,$9.44,$0.00,$4.72,$7.48,$7.55,$0.00,$0.00,$0.00,$0.00,$0.00
10070,ERX,HCPCS 63700001,68084-0605-01,FLUOXETINE HCL 20 MG PO CAPS,$9.44,$0.00,$9.44,$0.00,$6.74,$0.00,$0.00,$0.00,$0.00,$0.00,$9.44,$0.00,$4.72,$7.48,$7.55,$0.00,$0.00,$0.00,$0.00,$0.00
10072,ERX,HCPCS 63700001,00121-0654-02,FLUPHENAZINE HCL 2.5 MG/5ML PO ELIX,$99.75,$0.00,$99.75,$0.00,$71.19,$0.00,$0.00,$0.00,$0.00,$0.00,$99.75,$0.00,$49.88,$79.00,$79.80,$0.00,$0.00,$0.00,$0.00,$0.00
10078,ERX,HCPCS 63700001,00093-0711-01,FLURBIPROFEN 100 MG PO TABS,$7.20,$0.00,$7.20,$0.00,$5.14,$0.00,$0.00,$0.00,$0.00,$0.00,$7.20,$0.00,$3.60,$5.70,$5.76,$0.00,$0.00,$0.00,$0.00,$0.00
10078,ERX,HCPCS 63700001,00378-0093-01,FLURBIPROFEN 100 MG PO TABS,$7.20,$0.00,$7.20,$0.00,$5.14,$0.00,$0.00,$0.00,$0.00,$0.00,$7.20,$0.00,$3.60,$5.70,$5.76,$0.00,$0.00,$0.00,$0.00,$0.00
10082,ERX,HCPCS 25000001,45802-0222-11,FLUTICASONE PROPIONATE 0.05 % EX CREA,$120.02,$0.00,$120.02,$0.00,$85.66,$0.00,$0.00,$0.00,$0.00,$0.00,$120.02,$0.00,$60.01,$95.06,$96.02,$0.00,$0.00,$0.00,$0.00,$0.00
10083,ERX,HCPCS 25000001,00713-0632-31,FLUTICASONE PROPIONATE 0.005 % EX OINT,$120.02,$0.00,$120.02,$0.00,$85.66,$0.00,$0.00,$0.00,$0.00,$0.00,$120.02,$0.00,$60.01,$95.06,$96.02,$0.00,$0.00,$0.00,$0.00,$0.00
10083,ERX,HCPCS 25000001,45802-0221-11,FLUTICASONE PROPIONATE 0.005 % EX OINT,$120.02,$0.00,$120.02,$0.00,$85.66,$0.00,$0.00,$0.00,$0.00,$0.00,$120.02,$0.00,$60.01,$95.06,$96.02,$0.00,$0.00,$0.00,$0.00,$0.00
10084,ERX,HCPCS 63700001,60505-0166-01,FLUVOXAMINE MALEATE 100 MG PO TABS,$10.04,$0.00,$10.04,$0.00,$7.17,$0.00,$0.00,$0.00,$0.00,$0.00,$10.04,$0.00,$5.02,$7.95,$8.03,$0.00,$0.00,$0.00,$0.00,$0.00
10085,ERX,HCPCS 63700001,62559-0159-01,FLUVOXAMINE MALEATE 50 MG PO TABS,$9.79,$0.00,$9.79,$0.00,$6.99,$0.00,$0.00,$0.00,$0.00,$0.00,$9.79,$0.00,$4.90,$7.75,$7.83,$0.00,$0.00,$0.00,$0.00,$0.00
10100,ERX,HCPCS A9579,00270-1111-01,GADOTERIDOL 279.3 MG/ML IV SOLN,$219.87,$0.00,$219.87,$98.94,$156.92,$0.00,$37.88,$0.00,$0.00,$38.50,$219.87,$0.00,$109.94,$174.14,$175.90,$0.00,$34.41,$0.00,$35.00,$0.00
10100,ERX,HCPCS A9579,00270-1111-02,GADOTERIDOL 279.3 MG/ML IV SOLN,$219.87,$0.00,$219.87,$98.94,$156.92,$0.00,$37.88,$0.00,$0.00,$38.50,$219.87,$0.00,$109.94,$174.14,$175.90,$0.00,$34.41,$0.00,$35.00,$0.00
10100,ERX,HCPCS A9579,00270-1111-03,GADOTERIDOL 279.3 MG/ML IV SOLN,$219.87,$0.00,$219.87,$98.94,$156.92,$0.00,$37.88,$0.00,$0.00,$38.50,$219.87,$0.00,$109.94,$174.14,$175.90,$0.00,$34.41,$0.00,$35.00,$0.00
10101,ERX,HCPCS J1570,42023-0173-25,GANCICLOVIR SODIUM 500 MG IV SOLR,$356.01,$0.00,$356.01,$0.00,$254.08,$0.00,$0.00,$0.00,$0.00,$0.00,$356.01,$0.00,$178.01,$281.96,$284.81,$0.00,$0.00,$0.00,$0.00,$0.00
10101,ERX,HCPCS J1570,63323-0315-10,GANCICLOVIR SODIUM 500 MG IV SOLR,$356.01,$0.00,$356.01,$0.00,$254.08,$0.00,$0.00,$0.00,$0.00,$0.00,$356.01,$0.00,$178.01,$281.96,$284.81,$0.00,$0.00,$0.00,$0.00,$0.00
10116,ERX,HCPCS 63700001,51079-0811-01,GLIPIZIDE 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10116,ERX,HCPCS 63700001,51079-0811-20,GLIPIZIDE 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10117,ERX,HCPCS 63700001,00904-6637-61,GLIPIZIDE 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10117,ERX,HCPCS 63700001,51079-0810-20,GLIPIZIDE 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10126,ERX,HCPCS 63700001,00093-8343-01,GLYBURIDE 2.5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10126,ERX,HCPCS 63700001,00093-9433-01,GLYBURIDE 2.5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10126,ERX,HCPCS 63700001,51079-0872-01,GLYBURIDE 2.5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10126,ERX,HCPCS 63700001,51079-0872-20,GLYBURIDE 2.5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10126,ERX,HCPCS 63700001,65862-0029-01,GLYBURIDE 2.5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10130,ERX,HCPCS 25000001,13107-0014-01,GLYCOPYRROLATE 1 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10130,ERX,HCPCS 25000001,42291-0303-90,GLYCOPYRROLATE 1 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10130,ERX,HCPCS 25000001,49884-0065-01,GLYCOPYRROLATE 1 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10130,ERX,HCPCS 25000001,64980-0272-01,GLYCOPYRROLATE 1 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10137,ERX,HCPCS J9202,70720-0950-36,GOSERELIN ACETATE 3.6 MG SC IMPL,"$1,829.52",$0.00,"$2,010.65",$0.00,"$1,435.00",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,010.65",$0.00,"$1,005.33","$1,448.98","$1,608.52",$0.00,$0.00,$0.00,$0.00,$0.00
10149,ERX,HCPCS 63700001,00378-1160-01,GUANFACINE HCL 1 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10149,ERX,HCPCS 63700001,00591-0444-01,GUANFACINE HCL 1 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10162,ERX,HCPCS J1631,00143-9295-01,HALOPERIDOL DECANOATE 100 MG/ML IM SOLN,$50.43,$0.00,$50.43,$22.69,$35.99,$0.00,$3.87,$0.00,$0.00,$19.36,$50.43,$0.00,$25.22,$39.94,$40.34,$0.00,$19.36,$0.00,$18.44,$0.00
10162,ERX,HCPCS J1631,10147-0922-05,HALOPERIDOL DECANOATE 100 MG/ML IM SOLN,$50.43,$0.00,$50.43,$22.69,$35.99,$0.00,$3.87,$0.00,$0.00,$19.36,$50.43,$0.00,$25.22,$39.94,$40.34,$0.00,$19.36,$0.00,$18.44,$0.00
10162,ERX,HCPCS J1631,25021-0833-01,HALOPERIDOL DECANOATE 100 MG/ML IM SOLN,$50.43,$0.00,$50.43,$22.69,$35.99,$0.00,$3.87,$0.00,$0.00,$19.36,$50.43,$0.00,$25.22,$39.94,$40.34,$0.00,$19.36,$0.00,$18.44,$0.00
10176,ERX,HCPCS J1644,00069-0058-01,HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.24,$0.00,$0.00,$0.28,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.28,$0.00,$0.27,$0.00
10176,ERX,HCPCS J1644,00069-0137-01,HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.24,$0.00,$0.00,$0.28,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.28,$0.00,$0.27,$0.00
10176,ERX,HCPCS J1644,00069-0137-03,HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.24,$0.00,$0.00,$0.28,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.28,$0.00,$0.27,$0.00
10176,ERX,HCPCS J1644,00409-2720-03,HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.24,$0.00,$0.00,$0.28,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.28,$0.00,$0.27,$0.00
10176,ERX,HCPCS J1644,00409-2720-31,HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.24,$0.00,$0.00,$0.28,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.28,$0.00,$0.27,$0.00
10176,ERX,HCPCS J1644,00409-2720-32,HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.24,$0.00,$0.00,$0.28,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.28,$0.00,$0.27,$0.00
10176,ERX,HCPCS J1644,00641-2450-55,HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.24,$0.00,$0.00,$0.28,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.28,$0.00,$0.27,$0.00
10176,ERX,HCPCS J1644,25021-0400-10,HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.24,$0.00,$0.00,$0.28,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.28,$0.00,$0.27,$0.00
10176,ERX,HCPCS J1644,25021-0400-30,HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.24,$0.00,$0.00,$0.28,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.28,$0.00,$0.27,$0.00
10176,ERX,HCPCS J1644,63323-0540-01,HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.24,$0.00,$0.00,$0.28,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.28,$0.00,$0.27,$0.00
10176,ERX,HCPCS J1644,63323-0540-11,HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.24,$0.00,$0.00,$0.28,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.28,$0.00,$0.27,$0.00
10176,ERX,HCPCS J1644,63323-0540-15,HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.24,$0.00,$0.00,$0.28,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.28,$0.00,$0.27,$0.00
10176,ERX,HCPCS J1644,63323-0540-31,HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.24,$0.00,$0.00,$0.28,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.28,$0.00,$0.27,$0.00
10176,ERX,HCPCS J1644,63323-0540-36,HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.24,$0.00,$0.00,$0.28,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.28,$0.00,$0.27,$0.00
10176,ERX,HCPCS J1644,63323-0540-67,HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.24,$0.00,$0.00,$0.28,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.28,$0.00,$0.27,$0.00
10176,ERX,HCPCS J1644,67457-0384-99,HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.24,$0.00,$0.00,$0.28,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.28,$0.00,$0.27,$0.00
10176,ERX,HCPCS J1644,67457-0385-10,HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.24,$0.00,$0.00,$0.28,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.28,$0.00,$0.27,$0.00
10176,ERX,HCPCS J1644,67457-0385-99,HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.24,$0.00,$0.00,$0.28,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.28,$0.00,$0.27,$0.00
10177,ERX,HCPCS J1644,25021-0403-04,HEPARIN SODIUM (PORCINE) 10000 UNIT/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$2.35,$0.00,$0.00,$2.82,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$2.82,$0.00,$2.69,$0.00
10177,ERX,HCPCS J1644,67457-0603-05,HEPARIN SODIUM (PORCINE) 10000 UNIT/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$2.35,$0.00,$0.00,$2.82,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$2.82,$0.00,$2.69,$0.00
10177,ERX,HCPCS J1644,67457-0603-99,HEPARIN SODIUM (PORCINE) 10000 UNIT/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$2.35,$0.00,$0.00,$2.82,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$2.82,$0.00,$2.69,$0.00
10181,ERX,HCPCS J1644,00069-0059-03,HEPARIN SODIUM (PORCINE) 5000 UNIT/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.18,$0.00,$0.00,$1.41,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.41,$0.00,$0.00,$0.00
10181,ERX,HCPCS J1644,00641-0400-12,HEPARIN SODIUM (PORCINE) 5000 UNIT/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.18,$0.00,$0.00,$1.41,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.41,$0.00,$0.00,$0.00
10181,ERX,HCPCS J1644,25021-0402-01,HEPARIN SODIUM (PORCINE) 5000 UNIT/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.18,$0.00,$0.00,$1.41,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.41,$0.00,$0.00,$0.00
10181,ERX,HCPCS J1644,63323-0262-01,HEPARIN SODIUM (PORCINE) 5000 UNIT/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.18,$0.00,$0.00,$1.41,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.41,$0.00,$0.00,$0.00
10181,ERX,HCPCS J1644,63739-0953-25,HEPARIN SODIUM (PORCINE) 5000 UNIT/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.18,$0.00,$0.00,$1.41,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.41,$0.00,$0.00,$0.00
10203,ERX,HCPCS 25000001,51927-1647-00,HYDROCHLORIC ACID 37 % LIQD,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
10209,ERX,HCPCS 63700001,00009-0012-01,HYDROCORTISONE 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10209,ERX,HCPCS 63700001,42543-0140-50,HYDROCORTISONE 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10209,ERX,HCPCS 63700001,59762-0073-01,HYDROCORTISONE 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10209,ERX,HCPCS 63700001,72789-0095-50,HYDROCORTISONE 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10210,ERX,HCPCS 25000001,62559-0138-07,HYDROCORTISONE 100 MG/60ML RECTAL ENEM,$46.06,$0.00,$46.06,$0.00,$32.87,$0.00,$0.00,$0.00,$0.00,$0.00,$46.06,$0.00,$23.03,$36.48,$36.85,$0.00,$0.00,$0.00,$0.00,$0.00
10217,ERX,HCPCS 25000001,00574-0420-25,HYDROCORTISONE MICRONIZED POWD,$283.50,$0.00,$283.50,$0.00,$202.33,$0.00,$0.00,$0.00,$0.00,$0.00,$283.50,$0.00,$141.75,$224.53,$226.80,$0.00,$0.00,$0.00,$0.00,$0.00
10230,ERX,HCPCS 25000001,42192-0151-01,HYDROQUINONE 4 % EX CREA,$325.99,$0.00,$325.99,$0.00,$232.66,$0.00,$0.00,$0.00,$0.00,$0.00,$325.99,$0.00,$163.00,$258.18,$260.79,$0.00,$0.00,$0.00,$0.00,$0.00
10235,ERX,HCPCS 63700001,00378-0373-01,HYDROXYCHLOROQUINE SULFATE 200 MG PO TABS,$10.79,$0.00,$10.79,$0.00,$7.70,$0.00,$0.00,$0.00,$0.00,$0.00,$10.79,$0.00,$5.40,$8.55,$8.63,$0.00,$0.00,$0.00,$0.00,$0.00
10235,ERX,HCPCS 63700001,00591-3041-01,HYDROXYCHLOROQUINE SULFATE 200 MG PO TABS,$10.79,$0.00,$10.79,$0.00,$7.70,$0.00,$0.00,$0.00,$0.00,$0.00,$10.79,$0.00,$5.40,$8.55,$8.63,$0.00,$0.00,$0.00,$0.00,$0.00
10235,ERX,HCPCS 63700001,00781-5994-01,HYDROXYCHLOROQUINE SULFATE 200 MG PO TABS,$10.79,$0.00,$10.79,$0.00,$7.70,$0.00,$0.00,$0.00,$0.00,$0.00,$10.79,$0.00,$5.40,$8.55,$8.63,$0.00,$0.00,$0.00,$0.00,$0.00
10235,ERX,HCPCS 63700001,43598-0721-01,HYDROXYCHLOROQUINE SULFATE 200 MG PO TABS,$10.79,$0.00,$10.79,$0.00,$7.70,$0.00,$0.00,$0.00,$0.00,$0.00,$10.79,$0.00,$5.40,$8.55,$8.63,$0.00,$0.00,$0.00,$0.00,$0.00
10235,ERX,HCPCS 63700001,63739-0777-10,HYDROXYCHLOROQUINE SULFATE 200 MG PO TABS,$10.79,$0.00,$10.79,$0.00,$7.70,$0.00,$0.00,$0.00,$0.00,$0.00,$10.79,$0.00,$5.40,$8.55,$8.63,$0.00,$0.00,$0.00,$0.00,$0.00
10235,ERX,HCPCS 63700001,66993-0057-02,HYDROXYCHLOROQUINE SULFATE 200 MG PO TABS,$10.79,$0.00,$10.79,$0.00,$7.70,$0.00,$0.00,$0.00,$0.00,$0.00,$10.79,$0.00,$5.40,$8.55,$8.63,$0.00,$0.00,$0.00,$0.00,$0.00
10235,ERX,HCPCS 63700001,68084-0269-01,HYDROXYCHLOROQUINE SULFATE 200 MG PO TABS,$10.79,$0.00,$10.79,$0.00,$7.70,$0.00,$0.00,$0.00,$0.00,$0.00,$10.79,$0.00,$5.40,$8.55,$8.63,$0.00,$0.00,$0.00,$0.00,$0.00
10235,ERX,HCPCS 63700001,68084-0269-11,HYDROXYCHLOROQUINE SULFATE 200 MG PO TABS,$10.79,$0.00,$10.79,$0.00,$7.70,$0.00,$0.00,$0.00,$0.00,$0.00,$10.79,$0.00,$5.40,$8.55,$8.63,$0.00,$0.00,$0.00,$0.00,$0.00
10236,ERX,HCPCS 63700001,00555-0882-02,HYDROXYUREA 500 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10236,ERX,HCPCS 63700001,49884-0724-01,HYDROXYUREA 500 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10236,ERX,HCPCS 63700001,68084-0284-01,HYDROXYUREA 500 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10236,ERX,HCPCS 63700001,68084-0284-11,HYDROXYUREA 500 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10246,ERX,HCPCS 25000001,00121-1836-05,IBUPROFEN 100 MG/5ML PO SUSP,$6.00,$0.00,$18.39,$0.00,$13.12,$0.00,$0.00,$0.00,$0.00,$0.00,$18.39,$0.00,$9.20,$4.75,$14.71,$0.00,$0.00,$0.00,$0.00,$0.00
10246,ERX,HCPCS 25000001,00121-4774-40,IBUPROFEN 100 MG/5ML PO SUSP,$6.00,$0.00,$18.39,$0.00,$13.12,$0.00,$0.00,$0.00,$0.00,$0.00,$18.39,$0.00,$9.20,$4.75,$14.71,$0.00,$0.00,$0.00,$0.00,$0.00
10246,ERX,HCPCS 25000001,68094-0494-61,IBUPROFEN 100 MG/5ML PO SUSP,$6.00,$0.00,$18.39,$0.00,$13.12,$0.00,$0.00,$0.00,$0.00,$0.00,$18.39,$0.00,$9.20,$4.75,$14.71,$0.00,$0.00,$0.00,$0.00,$0.00
10246,ERX,HCPCS 25000001,49348-0229-34,IBUPROFEN 100 MG/5ML PO SUSP,$14.14,$0.00,$18.39,$0.00,$13.12,$0.00,$0.00,$0.00,$0.00,$0.00,$18.39,$0.00,$9.20,$11.20,$14.71,$0.00,$0.00,$0.00,$0.00,$0.00
10246,ERX,HCPCS 25000001,51672-2130-08,IBUPROFEN 100 MG/5ML PO SUSP,$14.14,$0.00,$18.39,$0.00,$13.12,$0.00,$0.00,$0.00,$0.00,$0.00,$18.39,$0.00,$9.20,$11.20,$14.71,$0.00,$0.00,$0.00,$0.00,$0.00
10246,ERX,HCPCS 25000001,45802-0140-26,IBUPROFEN 100 MG/5ML PO SUSP,$18.39,$0.00,$18.39,$0.00,$13.12,$0.00,$0.00,$0.00,$0.00,$0.00,$18.39,$0.00,$9.20,$14.56,$14.71,$0.00,$0.00,$0.00,$0.00,$0.00
10248,ERX,HCPCS J9208,10019-0925-01,IFOSFAMIDE 1 G IV SOLR,$219.43,$0.00,$219.43,$0.00,$156.61,$0.00,$0.00,$0.00,$0.00,$0.00,$219.43,$0.00,$109.72,$173.79,$175.54,$0.00,$0.00,$0.00,$0.00,$0.00
10248,ERX,HCPCS J9208,10019-0925-82,IFOSFAMIDE 1 G IV SOLR,$219.43,$0.00,$219.43,$0.00,$156.61,$0.00,$0.00,$0.00,$0.00,$0.00,$219.43,$0.00,$109.72,$173.79,$175.54,$0.00,$0.00,$0.00,$0.00,$0.00
10248,ERX,HCPCS J9208,63323-0142-10,IFOSFAMIDE 1 G IV SOLR,$219.43,$0.00,$219.43,$0.00,$156.61,$0.00,$0.00,$0.00,$0.00,$0.00,$219.43,$0.00,$109.72,$173.79,$175.54,$0.00,$0.00,$0.00,$0.00,$0.00
10266,ERX,HCPCS 25000001,17238-0424-06,INDOCYANINE GREEN 25 MG IV SOLR,$31.18,$0.00,$31.18,$0.00,$22.25,$0.00,$0.00,$0.00,$0.00,$0.00,$31.18,$0.00,$15.59,$24.69,$24.94,$0.00,$0.00,$0.00,$0.00,$0.00
10266,ERX,HCPCS 25000001,17478-0701-02,INDOCYANINE GREEN 25 MG IV SOLR,$31.18,$0.00,$31.18,$0.00,$22.25,$0.00,$0.00,$0.00,$0.00,$0.00,$31.18,$0.00,$15.59,$24.69,$24.94,$0.00,$0.00,$0.00,$0.00,$0.00
10266,ERX,HCPCS 25000001,66259-0701-25,INDOCYANINE GREEN 25 MG IV SOLR,$31.18,$0.00,$31.18,$0.00,$22.25,$0.00,$0.00,$0.00,$0.00,$0.00,$31.18,$0.00,$15.59,$24.69,$24.94,$0.00,$0.00,$0.00,$0.00,$0.00
10266,ERX,HCPCS 25000001,70100-0424-02,INDOCYANINE GREEN 25 MG IV SOLR,$31.18,$0.00,$31.18,$0.00,$22.25,$0.00,$0.00,$0.00,$0.00,$0.00,$31.18,$0.00,$15.59,$24.69,$24.94,$0.00,$0.00,$0.00,$0.00,$0.00
10267,ERX,HCPCS 25000001,00409-1113-01,INDOMETHACIN SODIUM 1 MG IV SOLR,"$1,259.28",$0.00,"$1,259.28",$0.00,$898.75,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,259.28",$0.00,$629.64,$997.35,"$1,007.42",$0.00,$0.00,$0.00,$0.00,$0.00
10267,ERX,HCPCS 25000001,63323-0659-03,INDOMETHACIN SODIUM 1 MG IV SOLR,"$1,259.28",$0.00,"$1,259.28",$0.00,$898.75,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,259.28",$0.00,$629.64,$997.35,"$1,007.42",$0.00,$0.00,$0.00,$0.00,$0.00
10267,ERX,HCPCS 25000001,63323-0659-09,INDOMETHACIN SODIUM 1 MG IV SOLR,"$1,259.28",$0.00,"$1,259.28",$0.00,$898.75,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,259.28",$0.00,$629.64,$997.35,"$1,007.42",$0.00,$0.00,$0.00,$0.00,$0.00
10267,ERX,HCPCS 25000001,68382-0470-01,INDOMETHACIN SODIUM 1 MG IV SOLR,"$1,259.28",$0.00,"$1,259.28",$0.00,$898.75,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,259.28",$0.00,$629.64,$997.35,"$1,007.42",$0.00,$0.00,$0.00,$0.00,$0.00
10284,ERX,HCPCS J1815,00002-8315-01,INSULIN NOVOLIN NPH 100 UNIT/ML SC SUSP,$10.00,$0.00,$201.38,$5.43,$7.14,$0.00,$72.85,$0.00,$0.00,$1.75,$10.00,$0.00,$5.00,$7.92,$8.00,$0.00,$0.00,$0.00,$201.38,$0.00
10284,ERX,HCPCS J1815,00169-1834-11,INSULIN NOVOLIN NPH 100 UNIT/ML SC SUSP,$10.00,$0.00,$201.38,$5.43,$7.14,$0.00,$72.85,$0.00,$0.00,$1.75,$10.00,$0.00,$5.00,$7.92,$8.00,$0.00,$0.00,$0.00,$201.38,$0.00
10289,ERX,HCPCS J1815,00002-8215-01,INSULIN NOVOLIN REGULAR 100 UNIT/ML IJ SOLN,$10.00,$0.00,$10.00,$5.43,$7.14,$0.00,$0.36,$0.00,$0.00,$1.75,$10.00,$0.00,$5.00,$7.92,$8.00,$0.00,$0.00,$0.00,$1.01,$0.00
10289,ERX,HCPCS J1815,00169-1833-11,INSULIN NOVOLIN REGULAR 100 UNIT/ML IJ SOLN,$10.00,$0.00,$10.00,$5.43,$7.14,$0.00,$0.36,$0.00,$0.00,$1.75,$10.00,$0.00,$5.00,$7.92,$8.00,$0.00,$0.00,$0.00,$1.01,$0.00
10321,ERX,HCPCS Q9966,00407-1412-30,IOHEXOL 240 MG/ML IJ SOLN,$221.61,$0.00,$221.61,$99.72,$158.16,$0.00,$38.18,$0.00,$0.00,$40.54,$221.61,$0.00,$110.81,$175.52,$177.29,$0.00,$38.60,$0.00,$35.28,$0.00
10322,ERX,HCPCS Q9967,00407-1413-10,IOHEXOL 300 MG/ML IJ SOLN,$116.45,$0.00,$116.45,$52.40,$83.11,$0.00,$20.06,$0.00,$0.00,$4.23,$116.45,$0.00,$58.23,$92.23,$93.16,$0.00,$4.03,$0.00,$18.54,$0.00
10322,ERX,HCPCS Q9967,00407-1413-61,IOHEXOL 300 MG/ML IJ SOLN,$116.45,$0.00,$116.45,$52.40,$83.11,$0.00,$20.06,$0.00,$0.00,$4.23,$116.45,$0.00,$58.23,$92.23,$93.16,$0.00,$4.03,$0.00,$18.54,$0.00
10322,ERX,HCPCS Q9967,00407-1413-63,IOHEXOL 300 MG/ML IJ SOLN,$116.45,$0.00,$116.45,$52.40,$83.11,$0.00,$20.06,$0.00,$0.00,$4.23,$116.45,$0.00,$58.23,$92.23,$93.16,$0.00,$4.03,$0.00,$18.54,$0.00
10322,ERX,HCPCS Q9967,00407-1413-65,IOHEXOL 300 MG/ML IJ SOLN,$116.45,$0.00,$116.45,$52.40,$83.11,$0.00,$20.06,$0.00,$0.00,$4.23,$116.45,$0.00,$58.23,$92.23,$93.16,$0.00,$4.03,$0.00,$18.54,$0.00
10322,ERX,HCPCS Q9967,00407-1413-87,IOHEXOL 300 MG/ML IJ SOLN,$116.45,$0.00,$116.45,$52.40,$83.11,$0.00,$20.06,$0.00,$0.00,$4.23,$116.45,$0.00,$58.23,$92.23,$93.16,$0.00,$4.03,$0.00,$18.54,$0.00
10322,ERX,HCPCS Q9967,00407-1413-88,IOHEXOL 300 MG/ML IJ SOLN,$116.45,$0.00,$116.45,$52.40,$83.11,$0.00,$20.06,$0.00,$0.00,$4.23,$116.45,$0.00,$58.23,$92.23,$93.16,$0.00,$4.03,$0.00,$18.54,$0.00
10323,ERX,HCPCS Q9967,00407-1414-84,IOHEXOL 350 MG/ML IV SOLN,$285.39,$0.00,$285.39,$128.43,$203.68,$0.00,$49.17,$0.00,$0.00,$10.58,$285.39,$0.00,$142.70,$226.03,$228.31,$0.00,$10.07,$0.00,$45.43,$0.00
10323,ERX,HCPCS Q9967,00407-1414-86,IOHEXOL 350 MG/ML IV SOLN,$285.39,$0.00,$285.39,$128.43,$203.68,$0.00,$49.17,$0.00,$0.00,$10.58,$285.39,$0.00,$142.70,$226.03,$228.31,$0.00,$10.07,$0.00,$45.43,$0.00
10323,ERX,HCPCS Q9967,00407-1414-89,IOHEXOL 350 MG/ML IV SOLN,$285.39,$0.00,$285.39,$128.43,$203.68,$0.00,$49.17,$0.00,$0.00,$10.58,$285.39,$0.00,$142.70,$226.03,$228.31,$0.00,$10.07,$0.00,$45.43,$0.00
10323,ERX,HCPCS Q9967,00407-1414-91,IOHEXOL 350 MG/ML IV SOLN,$285.39,$0.00,$285.39,$128.43,$203.68,$0.00,$49.17,$0.00,$0.00,$10.58,$285.39,$0.00,$142.70,$226.03,$228.31,$0.00,$10.07,$0.00,$45.43,$0.00
10323,ERX,HCPCS Q9967,00407-1414-93,IOHEXOL 350 MG/ML IV SOLN,$285.39,$0.00,$285.39,$128.43,$203.68,$0.00,$49.17,$0.00,$0.00,$10.58,$285.39,$0.00,$142.70,$226.03,$228.31,$0.00,$10.07,$0.00,$45.43,$0.00
10328,ERX,HCPCS Q9967,00270-1316-37,IOPAMIDOL 76 % IV SOLN,$151.48,$0.00,$151.48,$68.17,$108.11,$0.00,$26.10,$0.00,$0.00,$5.64,$151.48,$0.00,$75.74,$119.97,$121.18,$0.00,$5.37,$0.00,$24.12,$0.00
10358,ERX,HCPCS Q9968,55150-0240-05,ISOSULFAN BLUE 1 % SC SOLN,"$1,764.00",$0.00,"$1,764.00",$793.80,"$1,258.97",$192.03,$303.93,$0.00,$0.00,$308.86,"$1,764.00",$201.63,$882.00,"$1,397.09","$1,411.20",$278.44,$276.07,$0.00,$280.83,$217.98
10358,ERX,HCPCS Q9968,67457-0220-05,ISOSULFAN BLUE 1 % SC SOLN,"$1,764.00",$0.00,"$1,764.00",$793.80,"$1,258.97",$192.03,$303.93,$0.00,$0.00,$308.86,"$1,764.00",$201.63,$882.00,"$1,397.09","$1,411.20",$278.44,$276.07,$0.00,$280.83,$217.98
10359,ERX,HCPCS 63700001,00555-1054-86,ISOTRETINOIN 10 MG PO CAPS,$71.77,$0.00,$71.77,$0.00,$51.22,$0.00,$0.00,$0.00,$0.00,$0.00,$71.77,$0.00,$35.89,$56.84,$57.42,$0.00,$0.00,$0.00,$0.00,$0.00
10360,ERX,HCPCS 63700001,00555-1055-86,ISOTRETINOIN 20 MG PO CAPS,$85.10,$0.00,$85.10,$0.00,$60.74,$0.00,$0.00,$0.00,$0.00,$0.00,$85.10,$0.00,$42.55,$67.40,$68.08,$0.00,$0.00,$0.00,$0.00,$0.00
10361,ERX,HCPCS 63700001,55111-0137-81,ISOTRETINOIN 40 MG PO CAPS,$86.91,$0.00,$86.91,$0.00,$62.03,$0.00,$0.00,$0.00,$0.00,$0.00,$86.91,$0.00,$43.46,$68.83,$69.53,$0.00,$0.00,$0.00,$0.00,$0.00
10364,ERX,HCPCS 63700001,10147-1700-07,ITRACONAZOLE 100 MG PO CAPS,$84.51,$0.00,$84.51,$0.00,$60.31,$0.00,$0.00,$0.00,$0.00,$0.00,$84.51,$0.00,$42.26,$66.93,$67.61,$0.00,$0.00,$0.00,$0.00,$0.00
10364,ERX,HCPCS 63700001,67877-0454-30,ITRACONAZOLE 100 MG PO CAPS,$84.51,$0.00,$84.51,$0.00,$60.31,$0.00,$0.00,$0.00,$0.00,$0.00,$84.51,$0.00,$42.26,$66.93,$67.61,$0.00,$0.00,$0.00,$0.00,$0.00
10368,ERX,HCPCS 63700001,00168-0099-15,KETOCONAZOLE 2 % EX CREA,$108.15,$0.00,$108.15,$0.00,$77.19,$0.00,$0.00,$0.00,$0.00,$0.00,$108.15,$0.00,$54.08,$85.65,$86.52,$0.00,$0.00,$0.00,$0.00,$0.00
10368,ERX,HCPCS 63700001,51672-1298-01,KETOCONAZOLE 2 % EX CREA,$108.15,$0.00,$108.15,$0.00,$77.19,$0.00,$0.00,$0.00,$0.00,$0.00,$108.15,$0.00,$54.08,$85.65,$86.52,$0.00,$0.00,$0.00,$0.00,$0.00
10368,ERX,HCPCS 63700001,51672-1298-02,KETOCONAZOLE 2 % EX CREA,$194.67,$0.00,$154.18,$0.00,$77.19,$0.00,$0.00,$0.00,$0.00,$0.00,$108.15,$0.00,$54.08,$154.18,$86.52,$0.00,$0.00,$0.00,$0.00,$0.00
10369,ERX,HCPCS 63700001,00378-0261-01,KETOCONAZOLE 200 MG PO TABS,$14.41,$0.00,$14.41,$0.00,$10.28,$0.00,$0.00,$0.00,$0.00,$0.00,$14.41,$0.00,$7.21,$11.41,$11.53,$0.00,$0.00,$0.00,$0.00,$0.00
10369,ERX,HCPCS 63700001,51672-4026-01,KETOCONAZOLE 200 MG PO TABS,$14.41,$0.00,$14.41,$0.00,$10.28,$0.00,$0.00,$0.00,$0.00,$0.00,$14.41,$0.00,$7.21,$11.41,$11.53,$0.00,$0.00,$0.00,$0.00,$0.00
10369,ERX,HCPCS 63700001,51672-4026-06,KETOCONAZOLE 200 MG PO TABS,$14.41,$0.00,$14.41,$0.00,$10.28,$0.00,$0.00,$0.00,$0.00,$0.00,$14.41,$0.00,$7.21,$11.41,$11.53,$0.00,$0.00,$0.00,$0.00,$0.00
10371,ERX,HCPCS 63700001,00093-0314-01,KETOROLAC TROMETHAMINE 10 MG PO TABS,$8.61,$0.00,$8.61,$0.00,$6.14,$0.00,$0.00,$0.00,$0.00,$0.00,$8.61,$0.00,$4.31,$6.82,$6.89,$0.00,$0.00,$0.00,$0.00,$0.00
10371,ERX,HCPCS 63700001,00378-1134-01,KETOROLAC TROMETHAMINE 10 MG PO TABS,$8.61,$0.00,$8.61,$0.00,$6.14,$0.00,$0.00,$0.00,$0.00,$0.00,$8.61,$0.00,$4.31,$6.82,$6.89,$0.00,$0.00,$0.00,$0.00,$0.00
10371,ERX,HCPCS 63700001,69543-0388-10,KETOROLAC TROMETHAMINE 10 MG PO TABS,$8.61,$0.00,$8.61,$0.00,$6.14,$0.00,$0.00,$0.00,$0.00,$0.00,$8.61,$0.00,$4.31,$6.82,$6.89,$0.00,$0.00,$0.00,$0.00,$0.00
10372,ERX,HCPCS 25000001,00143-9622-01,LABETALOL HCL 5 MG/ML IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
10372,ERX,HCPCS 25000001,00409-2267-20,LABETALOL HCL 5 MG/ML IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
10372,ERX,HCPCS 25000001,00409-2267-54,LABETALOL HCL 5 MG/ML IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
10372,ERX,HCPCS 25000001,00409-2339-34,LABETALOL HCL 5 MG/ML IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
10372,ERX,HCPCS 25000001,17478-0420-40,LABETALOL HCL 5 MG/ML IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
10372,ERX,HCPCS 25000001,47781-0586-29,LABETALOL HCL 5 MG/ML IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
10372,ERX,HCPCS 25000001,47781-0586-56,LABETALOL HCL 5 MG/ML IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
10372,ERX,HCPCS 25000001,72266-0102-01,LABETALOL HCL 5 MG/ML IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
10372,ERX,HCPCS 25000001,72266-0103-01,LABETALOL HCL 5 MG/ML IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
10372,ERX,HCPCS 25000001,99999-6007-13,LABETALOL HCL 5 MG/ML IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
10372,ERX,HCPCS 25000001,99999-6011-99,LABETALOL HCL 5 MG/ML IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
10373,ERX,HCPCS 63700001,00185-0010-01,LABETALOL HCL 100 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10373,ERX,HCPCS 63700001,00591-0605-01,LABETALOL HCL 100 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10373,ERX,HCPCS 63700001,00904-5928-61,LABETALOL HCL 100 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10373,ERX,HCPCS 63700001,10135-0641-01,LABETALOL HCL 100 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10374,ERX,HCPCS 63700001,00185-0117-05,LABETALOL HCL 200 MG PO TABS,$13.26,$0.00,$13.26,$0.00,$9.46,$0.00,$0.00,$0.00,$0.00,$0.00,$13.26,$0.00,$6.63,$10.50,$10.61,$0.00,$0.00,$0.00,$0.00,$0.00
10374,ERX,HCPCS 63700001,00904-5929-61,LABETALOL HCL 200 MG PO TABS,$13.26,$0.00,$13.26,$0.00,$9.46,$0.00,$0.00,$0.00,$0.00,$0.00,$13.26,$0.00,$6.63,$10.50,$10.61,$0.00,$0.00,$0.00,$0.00,$0.00
10374,ERX,HCPCS 63700001,10135-0642-01,LABETALOL HCL 200 MG PO TABS,$13.26,$0.00,$13.26,$0.00,$9.46,$0.00,$0.00,$0.00,$0.00,$0.00,$13.26,$0.00,$6.63,$10.50,$10.61,$0.00,$0.00,$0.00,$0.00,$0.00
10375,ERX,HCPCS 63700001,00185-0118-01,LABETALOL HCL 300 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10375,ERX,HCPCS 63700001,00185-0118-05,LABETALOL HCL 300 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10375,ERX,HCPCS 63700001,00591-0607-01,LABETALOL HCL 300 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10375,ERX,HCPCS 63700001,00904-5930-61,LABETALOL HCL 300 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10375,ERX,HCPCS 63700001,49884-0124-01,LABETALOL HCL 300 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10375,ERX,HCPCS 63700001,49884-0124-05,LABETALOL HCL 300 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10380,ERX,HCPCS 63700001,92771-0612-08,AMMONIUM LACTATE 12 % EX LOTN,$28.69,$0.00,$115.77,$0.00,$82.63,$0.00,$0.00,$0.00,$0.00,$0.00,$115.77,$0.00,$57.89,$22.72,$92.62,$0.00,$0.00,$0.00,$0.00,$0.00
10380,ERX,HCPCS 63700001,45802-0419-54,AMMONIUM LACTATE 12 % EX LOTN,$115.77,$0.00,$115.77,$0.00,$82.63,$0.00,$0.00,$0.00,$0.00,$0.00,$115.77,$0.00,$57.89,$91.69,$92.62,$0.00,$0.00,$0.00,$0.00,$0.00
10380,ERX,HCPCS 63700001,00904-5984-26,AMMONIUM LACTATE 12 % EX LOTN,$208.38,$0.00,$165.04,$0.00,$82.63,$0.00,$0.00,$0.00,$0.00,$0.00,$115.77,$0.00,$57.89,$165.04,$92.62,$0.00,$0.00,$0.00,$0.00,$0.00
10380,ERX,HCPCS 63700001,45802-0525-55,AMMONIUM LACTATE 12 % EX LOTN,$208.38,$0.00,$165.04,$0.00,$82.63,$0.00,$0.00,$0.00,$0.00,$0.00,$115.77,$0.00,$57.89,$165.04,$92.62,$0.00,$0.00,$0.00,$0.00,$0.00
10392,ERX,HCPCS J9217,00074-3642-03,LEUPROLIDE ACETATE 7.5 MG IM KIT,"$4,094.10",$0.00,"$4,094.10","$1,842.35","$2,921.96",$224.70,$246.83,$0.00,$0.00,$270.33,"$4,094.10",$235.93,"$2,047.05","$3,242.53","$3,275.28",$325.81,$270.33,$0.00,$257.40,$205.89
10394,ERX,HCPCS 25000001,24208-0505-05,LEVOBUNOLOL HCL 0.5 % OP SOLN,$84.63,$0.00,$84.63,$0.00,$60.40,$0.00,$0.00,$0.00,$0.00,$0.00,$84.63,$0.00,$42.32,$67.03,$67.70,$0.00,$0.00,$0.00,$0.00,$0.00
10403,ERX,HCPCS 63700001,00781-5183-92,LEVOTHYROXINE SODIUM 88 MCG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10404,ERX,HCPCS 63700001,00781-5185-92,LEVOTHYROXINE SODIUM 112 MCG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10405,ERX,HCPCS 63700001,00378-1823-77,LEVOTHYROXINE SODIUM 137 MCG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10405,ERX,HCPCS 63700001,00781-5191-92,LEVOTHYROXINE SODIUM 137 MCG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10406,ERX,HCPCS 63700001,00781-5188-92,LEVOTHYROXINE SODIUM 175 MCG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10426,ERX,HCPCS 25000001,00409-3177-01,LIDOCAINE-EPINEPHRINE 0.5 %-1:200000 IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
10427,ERX,HCPCS 25000001,00409-3178-01,LIDOCAINE-EPINEPHRINE 1 %-1:100000 IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
10427,ERX,HCPCS 25000001,00409-3178-02,LIDOCAINE-EPINEPHRINE 1 %-1:100000 IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
10427,ERX,HCPCS 25000001,00409-3178-16,LIDOCAINE-EPINEPHRINE 1 %-1:100000 IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
10427,ERX,HCPCS 25000001,63323-0482-03,LIDOCAINE-EPINEPHRINE 1 %-1:100000 IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
10427,ERX,HCPCS 25000001,63323-0482-17,LIDOCAINE-EPINEPHRINE 1 %-1:100000 IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
10427,ERX,HCPCS 25000001,63323-0482-27,LIDOCAINE-EPINEPHRINE 1 %-1:100000 IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
10428,ERX,HCPCS 25000001,63323-0487-17,LIDOCAINE-EPINEPHRINE 1 %-1:200000 IJ SOLN MPF,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
10428,ERX,HCPCS 25000001,63323-0487-31,LIDOCAINE-EPINEPHRINE 1 %-1:200000 IJ SOLN MPF,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
10428,ERX,HCPCS 25000001,63323-0487-37,LIDOCAINE-EPINEPHRINE 1 %-1:200000 IJ SOLN MPF,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
10429,ERX,HCPCS 25000001,00409-1209-01,LIDOCAINE-EPINEPHRINE 1.5 %-1:200000 IJ SOLN MPF,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
10429,ERX,HCPCS 25000001,00409-1209-65,LIDOCAINE-EPINEPHRINE 1.5 %-1:200000 IJ SOLN MPF,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
10430,ERX,HCPCS 25000001,00362-1095-60,LIDOCAINE-EPINEPHRINE 2 %-1:100000 IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
10430,ERX,HCPCS 25000001,51004-1095-06,LIDOCAINE-EPINEPHRINE 2 %-1:100000 IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
10430,ERX,HCPCS 25000001,00409-3182-01,LIDOCAINE-EPINEPHRINE 2 %-1:100000 IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
10430,ERX,HCPCS 25000001,63323-0483-27,LIDOCAINE-EPINEPHRINE 2 %-1:100000 IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
10431,ERX,HCPCS 25000001,00409-3183-01,LIDOCAINE-EPINEPHRINE 2 %-1:200000 IJ SOLN MPF,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
10431,ERX,HCPCS 25000001,63323-0489-02,LIDOCAINE-EPINEPHRINE 2 %-1:200000 IJ SOLN MPF,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
10431,ERX,HCPCS 25000001,63323-0489-17,LIDOCAINE-EPINEPHRINE 2 %-1:200000 IJ SOLN MPF,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
10431,ERX,HCPCS 25000001,63323-0489-21,LIDOCAINE-EPINEPHRINE 2 %-1:200000 IJ SOLN MPF,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
10431,ERX,HCPCS 25000001,63323-0489-27,LIDOCAINE-EPINEPHRINE 2 %-1:200000 IJ SOLN MPF,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
10434,ERX,HCPCS 25000001,00115-1468-53,LIDOCAINE-PRILOCAINE 2.5-2.5 % EX CREA,$30.56,$0.00,$168.84,$0.00,$120.50,$0.00,$0.00,$0.00,$0.00,$0.00,$168.84,$0.00,$84.42,$24.20,$135.07,$0.00,$0.00,$0.00,$0.00,$0.00
10434,ERX,HCPCS 25000001,00115-1468-60,LIDOCAINE-PRILOCAINE 2.5-2.5 % EX CREA,$30.56,$0.00,$168.84,$0.00,$120.50,$0.00,$0.00,$0.00,$0.00,$0.00,$168.84,$0.00,$84.42,$24.20,$135.07,$0.00,$0.00,$0.00,$0.00,$0.00
10434,ERX,HCPCS 25000001,00168-0357-55,LIDOCAINE-PRILOCAINE 2.5-2.5 % EX CREA,$30.56,$0.00,$168.84,$0.00,$120.50,$0.00,$0.00,$0.00,$0.00,$0.00,$168.84,$0.00,$84.42,$24.20,$135.07,$0.00,$0.00,$0.00,$0.00,$0.00
10434,ERX,HCPCS 25000001,00115-1468-45,LIDOCAINE-PRILOCAINE 2.5-2.5 % EX CREA,$168.84,$0.00,$168.84,$0.00,$120.50,$0.00,$0.00,$0.00,$0.00,$0.00,$168.84,$0.00,$84.42,$133.72,$135.07,$0.00,$0.00,$0.00,$0.00,$0.00
10443,ERX,HCPCS 63700001,42794-0018-02,LIOTHYRONINE SODIUM 5 MCG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10443,ERX,HCPCS 63700001,51862-0320-01,LIOTHYRONINE SODIUM 5 MCG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10443,ERX,HCPCS 63700001,59762-1206-01,LIOTHYRONINE SODIUM 5 MCG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10449,ERX,HCPCS 63700001,00904-6798-61,LISINOPRIL 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10449,ERX,HCPCS 63700001,43547-0353-10,LISINOPRIL 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10449,ERX,HCPCS 63700001,60687-0325-01,LISINOPRIL 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10449,ERX,HCPCS 63700001,60687-0325-11,LISINOPRIL 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10449,ERX,HCPCS 63700001,68180-0980-01,LISINOPRIL 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10450,ERX,HCPCS 63700001,00904-6800-61,LISINOPRIL 40 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10450,ERX,HCPCS 63700001,68084-0199-01,LISINOPRIL 40 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10451,ERX,HCPCS 63700001,00904-6797-61,LISINOPRIL 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10451,ERX,HCPCS 63700001,43547-0352-10,LISINOPRIL 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10451,ERX,HCPCS 63700001,68180-0513-01,LISINOPRIL 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10452,ERX,HCPCS 63700001,00591-0861-01,LISINOPRIL-HCTZ 20-12.5 MG TABLET,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10452,ERX,HCPCS 63700001,68180-0519-01,LISINOPRIL-HCTZ 20-12.5 MG TABLET,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10453,ERX,HCPCS 63700001,68180-0520-01,LISINOPRIL-HCTZ 20-25 MG TABLET,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10454,ERX,HCPCS 63700001,00054-0021-25,LITHIUM CARBONATE ER 300 MG PO TBCR,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10454,ERX,HCPCS 63700001,68462-0223-01,LITHIUM CARBONATE ER 300 MG PO TBCR,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10455,ERX,HCPCS 63700001,00054-0020-25,LITHIUM CARBONATE ER 450 MG PO TBCR,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10455,ERX,HCPCS 63700001,51079-0142-01,LITHIUM CARBONATE ER 450 MG PO TBCR,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10455,ERX,HCPCS 63700001,51079-0142-20,LITHIUM CARBONATE ER 450 MG PO TBCR,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10455,ERX,HCPCS 63700001,68462-0224-01,LITHIUM CARBONATE ER 450 MG PO TBCR,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10460,ERX,HCPCS 63700001,58181-3042-05,LOMUSTINE 100 MG PO CAPS,"$2,471.12",$0.00,"$2,471.12",$0.00,"$1,763.64",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,471.12",$0.00,"$1,235.56","$1,957.13","$1,976.90",$0.00,$0.00,$0.00,$0.00,$0.00
10461,ERX,HCPCS 63700001,58181-3041-05,LOMUSTINE 40 MG PO CAPS,"$1,157.18",$0.00,"$1,157.18",$0.00,$825.88,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,157.18",$0.00,$578.59,$916.49,$925.74,$0.00,$0.00,$0.00,$0.00,$0.00
10466,ERX,HCPCS 63700001,00904-6852-61,LORATADINE 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10466,ERX,HCPCS 63700001,45802-0650-87,LORATADINE 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10466,ERX,HCPCS 63700001,51079-0246-20,LORATADINE 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10466,ERX,HCPCS 63700001,68084-0248-01,LORATADINE 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10466,ERX,HCPCS 63700001,68084-0248-11,LORATADINE 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10467,ERX,HCPCS J2060,00409-1985-30,LORAZEPAM 2 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$3.85,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.44,$0.00,$3.50,$0.00
10467,ERX,HCPCS J2060,00409-6778-02,LORAZEPAM 2 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$3.85,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.44,$0.00,$3.50,$0.00
10467,ERX,HCPCS J2060,00409-6778-11,LORAZEPAM 2 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$3.85,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.44,$0.00,$3.50,$0.00
10467,ERX,HCPCS J2060,00641-6044-01,LORAZEPAM 2 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$3.85,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.44,$0.00,$3.50,$0.00
10467,ERX,HCPCS J2060,00641-6044-25,LORAZEPAM 2 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$3.85,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.44,$0.00,$3.50,$0.00
10467,ERX,HCPCS J2060,00641-6046-10,LORAZEPAM 2 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$3.85,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.44,$0.00,$3.50,$0.00
10467,ERX,HCPCS J2060,00641-6048-25,LORAZEPAM 2 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$3.85,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.44,$0.00,$3.50,$0.00
10467,ERX,HCPCS J2060,00641-6050-10,LORAZEPAM 2 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$3.85,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.44,$0.00,$3.50,$0.00
10467,ERX,HCPCS J2060,76329-8261-00,LORAZEPAM 2 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$3.85,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.44,$0.00,$3.50,$0.00
10467,ERX,HCPCS J2060,76329-8261-01,LORAZEPAM 2 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$3.85,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.44,$0.00,$3.50,$0.00
10475,ERX,HCPCS J7504,00009-7224-01,"LYMPHOCYTE,ANTI-THYMO IMM GLOB 50 MG/ML IV INJ","$5,365.88",$0.00,"$5,365.88",$0.00,"$3,829.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,365.88",$0.00,"$2,682.94","$4,249.78","$4,292.70",$0.00,$0.00,$0.00,$0.00,$0.00
10475,ERX,HCPCS J7504,00009-7224-02,"LYMPHOCYTE,ANTI-THYMO IMM GLOB 50 MG/ML IV INJ","$5,365.88",$0.00,"$5,365.88",$0.00,"$3,829.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,365.88",$0.00,"$2,682.94","$4,249.78","$4,292.70",$0.00,$0.00,$0.00,$0.00,$0.00
10478,ERX,HCPCS 25000001,51079-0623-81,MAFENIDE ACETATE 85 MG/GM EX CREA,$443.06,$0.00,$577.43,$0.00,$412.11,$0.00,$0.00,$0.00,$0.00,$0.00,$577.43,$0.00,$288.72,$350.90,$461.94,$0.00,$0.00,$0.00,$0.00,$0.00
10478,ERX,HCPCS 25000001,51079-0623-82,MAFENIDE ACETATE 85 MG/GM EX CREA,$577.43,$0.00,$577.43,$0.00,$412.11,$0.00,$0.00,$0.00,$0.00,$0.00,$577.43,$0.00,$288.72,$457.32,$461.94,$0.00,$0.00,$0.00,$0.00,$0.00
10521,ERX,HCPCS 63700001,99999-6005-55,MEGESTROL ACETATE 40 MG/ML PO SUSP,$126.00,$0.00,$439.20,$0.00,$313.46,$0.00,$0.00,$0.00,$0.00,$0.00,$439.20,$0.00,$219.60,$99.79,$351.36,$0.00,$0.00,$0.00,$0.00,$0.00
10521,ERX,HCPCS 63700001,00054-3542-58,MEGESTROL ACETATE 40 MG/ML PO SUSP,$439.20,$0.00,$439.20,$0.00,$313.46,$0.00,$0.00,$0.00,$0.00,$0.00,$439.20,$0.00,$219.60,$347.85,$351.36,$0.00,$0.00,$0.00,$0.00,$0.00
10521,ERX,HCPCS 63700001,49884-0907-38,MEGESTROL ACETATE 40 MG/ML PO SUSP,$439.20,$0.00,$439.20,$0.00,$313.46,$0.00,$0.00,$0.00,$0.00,$0.00,$439.20,$0.00,$219.60,$347.85,$351.36,$0.00,$0.00,$0.00,$0.00,$0.00
10521,ERX,HCPCS 63700001,50383-0859-24,MEGESTROL ACETATE 40 MG/ML PO SUSP,$439.20,$0.00,$439.20,$0.00,$313.46,$0.00,$0.00,$0.00,$0.00,$0.00,$439.20,$0.00,$219.60,$347.85,$351.36,$0.00,$0.00,$0.00,$0.00,$0.00
10521,ERX,HCPCS 63700001,60432-0126-08,MEGESTROL ACETATE 40 MG/ML PO SUSP,$439.20,$0.00,$439.20,$0.00,$313.46,$0.00,$0.00,$0.00,$0.00,$0.00,$439.20,$0.00,$219.60,$347.85,$351.36,$0.00,$0.00,$0.00,$0.00,$0.00
10521,ERX,HCPCS 63700001,60432-0126-16,MEGESTROL ACETATE 40 MG/ML PO SUSP,$759.39,$0.00,$601.44,$0.00,$313.46,$0.00,$0.00,$0.00,$0.00,$0.00,$439.20,$0.00,$219.60,$601.44,$351.36,$0.00,$0.00,$0.00,$0.00,$0.00
10523,ERX,HCPCS J8600,52609-0001-05,MELPHALAN 2 MG PO TABS,$57.00,$0.00,$57.00,$0.00,$40.68,$0.00,$0.00,$0.00,$0.00,$0.00,$57.00,$0.00,$28.50,$45.14,$45.60,$0.00,$0.00,$0.00,$0.00,$0.00
10531,ERX,HCPCS 63700001,00054-4581-11,MERCAPTOPURINE 50 MG PO TABS,$15.55,$0.00,$15.55,$0.00,$11.10,$0.00,$0.00,$0.00,$0.00,$0.00,$15.55,$0.00,$7.78,$12.32,$12.44,$0.00,$0.00,$0.00,$0.00,$0.00
10531,ERX,HCPCS 63700001,00378-3547-52,MERCAPTOPURINE 50 MG PO TABS,$15.55,$0.00,$15.55,$0.00,$11.10,$0.00,$0.00,$0.00,$0.00,$0.00,$15.55,$0.00,$7.78,$12.32,$12.44,$0.00,$0.00,$0.00,$0.00,$0.00
10533,ERX,HCPCS 63700001,54092-0189-81,MESALAMINE ER 250 MG PO CPCR,$27.69,$0.00,$27.69,$0.00,$19.76,$0.00,$0.00,$0.00,$0.00,$0.00,$27.69,$0.00,$13.85,$21.93,$22.15,$0.00,$0.00,$0.00,$0.00,$0.00
10535,ERX,HCPCS 25000001,45802-0098-28,MESALAMINE 4 G RECTAL ENEM,$85.05,$0.00,$85.05,$0.00,$60.70,$0.00,$0.00,$0.00,$0.00,$0.00,$85.05,$0.00,$42.53,$67.36,$68.04,$0.00,$0.00,$0.00,$0.00,$0.00
10535,ERX,HCPCS 25000001,45802-0098-51,MESALAMINE 4 G RECTAL ENEM,$85.05,$0.00,$85.05,$0.00,$60.70,$0.00,$0.00,$0.00,$0.00,$0.00,$85.05,$0.00,$42.53,$67.36,$68.04,$0.00,$0.00,$0.00,$0.00,$0.00
10535,ERX,HCPCS 25000001,62559-0420-07,MESALAMINE 4 G RECTAL ENEM,$85.05,$0.00,$85.05,$0.00,$60.70,$0.00,$0.00,$0.00,$0.00,$0.00,$85.05,$0.00,$42.53,$67.36,$68.04,$0.00,$0.00,$0.00,$0.00,$0.00
10537,ERX,HCPCS J9209,00338-1305-01,MESNA 100 MG/ML IV SOLN,$84.00,$0.00,$84.00,$0.00,$59.95,$0.00,$0.00,$0.00,$0.00,$0.00,$84.00,$0.00,$42.00,$66.53,$67.20,$0.00,$0.00,$0.00,$0.00,$0.00
10537,ERX,HCPCS J9209,10019-0953-01,MESNA 100 MG/ML IV SOLN,$84.00,$0.00,$84.00,$0.00,$59.95,$0.00,$0.00,$0.00,$0.00,$0.00,$84.00,$0.00,$42.00,$66.53,$67.20,$0.00,$0.00,$0.00,$0.00,$0.00
10537,ERX,HCPCS J9209,25021-0201-10,MESNA 100 MG/ML IV SOLN,$84.00,$0.00,$84.00,$0.00,$59.95,$0.00,$0.00,$0.00,$0.00,$0.00,$84.00,$0.00,$42.00,$66.53,$67.20,$0.00,$0.00,$0.00,$0.00,$0.00
10537,ERX,HCPCS J9209,25021-0201-11,MESNA 100 MG/ML IV SOLN,$84.00,$0.00,$84.00,$0.00,$59.95,$0.00,$0.00,$0.00,$0.00,$0.00,$84.00,$0.00,$42.00,$66.53,$67.20,$0.00,$0.00,$0.00,$0.00,$0.00
10537,ERX,HCPCS J9209,63323-0733-10,MESNA 100 MG/ML IV SOLN,$84.00,$0.00,$84.00,$0.00,$59.95,$0.00,$0.00,$0.00,$0.00,$0.00,$84.00,$0.00,$42.00,$66.53,$67.20,$0.00,$0.00,$0.00,$0.00,$0.00
10537,ERX,HCPCS J9209,63323-0733-11,MESNA 100 MG/ML IV SOLN,$84.00,$0.00,$84.00,$0.00,$59.95,$0.00,$0.00,$0.00,$0.00,$0.00,$84.00,$0.00,$42.00,$66.53,$67.20,$0.00,$0.00,$0.00,$0.00,$0.00
10544,ERX,HCPCS 63700001,00904-6689-61,METFORMIN HCL 500 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10544,ERX,HCPCS 63700001,60687-0155-01,METFORMIN HCL 500 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10544,ERX,HCPCS 63700001,63739-0640-10,METFORMIN HCL 500 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10546,ERX,HCPCS J1230,17478-0380-20,METHADONE HCL 10 MG/ML IJ SOLN,$29.60,$0.00,$29.60,$0.00,$21.13,$0.00,$0.00,$0.00,$0.00,$0.00,$29.60,$0.00,$14.80,$23.44,$23.68,$0.00,$0.00,$0.00,$0.00,$0.00
10546,ERX,HCPCS J1230,67457-0217-20,METHADONE HCL 10 MG/ML IJ SOLN,$29.60,$0.00,$29.60,$0.00,$21.13,$0.00,$0.00,$0.00,$0.00,$0.00,$29.60,$0.00,$14.80,$23.44,$23.68,$0.00,$0.00,$0.00,$0.00,$0.00
10546,ERX,HCPCS J1230,99999-6005-49,METHADONE HCL 10 MG/ML IJ SOLN,$29.60,$0.00,$29.60,$0.00,$21.13,$0.00,$0.00,$0.00,$0.00,$0.00,$29.60,$0.00,$14.80,$23.44,$23.68,$0.00,$0.00,$0.00,$0.00,$0.00
10552,ERX,HCPCS 63700001,49884-0641-01,METHIMAZOLE 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10552,ERX,HCPCS 63700001,51293-0821-01,METHIMAZOLE 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10552,ERX,HCPCS 63700001,60687-0370-01,METHIMAZOLE 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10552,ERX,HCPCS 63700001,60687-0370-11,METHIMAZOLE 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10552,ERX,HCPCS 63700001,64980-0261-01,METHIMAZOLE 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10553,ERX,HCPCS 63700001,00185-0205-01,METHIMAZOLE 5 MG PO TABS,$9.33,$0.00,$9.33,$0.00,$6.66,$0.00,$0.00,$0.00,$0.00,$0.00,$9.33,$0.00,$4.67,$7.39,$7.46,$0.00,$0.00,$0.00,$0.00,$0.00
10553,ERX,HCPCS 63700001,49884-0640-01,METHIMAZOLE 5 MG PO TABS,$9.33,$0.00,$9.33,$0.00,$6.66,$0.00,$0.00,$0.00,$0.00,$0.00,$9.33,$0.00,$4.67,$7.39,$7.46,$0.00,$0.00,$0.00,$0.00,$0.00
10553,ERX,HCPCS 63700001,51293-0820-01,METHIMAZOLE 5 MG PO TABS,$9.33,$0.00,$9.33,$0.00,$6.66,$0.00,$0.00,$0.00,$0.00,$0.00,$9.33,$0.00,$4.67,$7.39,$7.46,$0.00,$0.00,$0.00,$0.00,$0.00
10553,ERX,HCPCS 63700001,60687-0357-01,METHIMAZOLE 5 MG PO TABS,$9.33,$0.00,$9.33,$0.00,$6.66,$0.00,$0.00,$0.00,$0.00,$0.00,$9.33,$0.00,$4.67,$7.39,$7.46,$0.00,$0.00,$0.00,$0.00,$0.00
10553,ERX,HCPCS 63700001,60687-0357-11,METHIMAZOLE 5 MG PO TABS,$9.33,$0.00,$9.33,$0.00,$6.66,$0.00,$0.00,$0.00,$0.00,$0.00,$9.33,$0.00,$4.67,$7.39,$7.46,$0.00,$0.00,$0.00,$0.00,$0.00
10553,ERX,HCPCS 63700001,60793-0104-01,METHIMAZOLE 5 MG PO TABS,$9.33,$0.00,$9.33,$0.00,$6.66,$0.00,$0.00,$0.00,$0.00,$0.00,$9.33,$0.00,$4.67,$7.39,$7.46,$0.00,$0.00,$0.00,$0.00,$0.00
10571,ERX,HCPCS J2210,00517-0740-01,METHYLERGONOVINE MALEATE 0.2 MG/ML IJ SOLN,$113.89,$0.00,$113.89,$51.25,$81.28,$0.00,$6.51,$0.00,$0.00,$21.20,$113.89,$0.00,$56.95,$90.20,$91.11,$0.00,$21.20,$0.00,$20.18,$0.00
10571,ERX,HCPCS J2210,00517-0740-20,METHYLERGONOVINE MALEATE 0.2 MG/ML IJ SOLN,$113.89,$0.00,$113.89,$51.25,$81.28,$0.00,$6.51,$0.00,$0.00,$21.20,$113.89,$0.00,$56.95,$90.20,$91.11,$0.00,$21.20,$0.00,$20.18,$0.00
10571,ERX,HCPCS J2210,51991-0144-17,METHYLERGONOVINE MALEATE 0.2 MG/ML IJ SOLN,$113.89,$0.00,$113.89,$51.25,$81.28,$0.00,$6.51,$0.00,$0.00,$21.20,$113.89,$0.00,$56.95,$90.20,$91.11,$0.00,$21.20,$0.00,$20.18,$0.00
10571,ERX,HCPCS J2210,51991-0144-99,METHYLERGONOVINE MALEATE 0.2 MG/ML IJ SOLN,$113.89,$0.00,$113.89,$51.25,$81.28,$0.00,$6.51,$0.00,$0.00,$21.20,$113.89,$0.00,$56.95,$90.20,$91.11,$0.00,$21.20,$0.00,$20.18,$0.00
10572,ERX,HCPCS 63700001,27437-0050-56,METHYLERGONOVINE MALEATE 0.2 MG PO TABS,$235.17,$0.00,$235.17,$0.00,$167.84,$0.00,$0.00,$0.00,$0.00,$0.00,$235.17,$0.00,$117.59,$186.25,$188.14,$0.00,$0.00,$0.00,$0.00,$0.00
10572,ERX,HCPCS 63700001,43386-0140-28,METHYLERGONOVINE MALEATE 0.2 MG PO TABS,$235.17,$0.00,$235.17,$0.00,$167.84,$0.00,$0.00,$0.00,$0.00,$0.00,$235.17,$0.00,$117.59,$186.25,$188.14,$0.00,$0.00,$0.00,$0.00,$0.00
10572,ERX,HCPCS 63700001,69238-1605-08,METHYLERGONOVINE MALEATE 0.2 MG PO TABS,$235.17,$0.00,$235.17,$0.00,$167.84,$0.00,$0.00,$0.00,$0.00,$0.00,$235.17,$0.00,$117.59,$186.25,$188.14,$0.00,$0.00,$0.00,$0.00,$0.00
10573,ERX,HCPCS 63700001,00009-0020-01,METHYLPREDNISOLONE 2 MG PO TABS,$7.38,$0.00,$7.38,$0.00,$5.27,$0.00,$0.00,$0.00,$0.00,$0.00,$7.38,$0.00,$3.69,$5.84,$5.90,$0.00,$0.00,$0.00,$0.00,$0.00
10576,ERX,HCPCS J7509,00009-0022-01,METHYLPREDNISOLONE 8 MG PO TABS,$8.03,$0.00,$8.03,$3.61,$5.73,$0.00,$1.38,$0.00,$0.00,$1.41,$8.03,$0.00,$4.02,$6.36,$6.42,$0.00,$1.26,$0.00,$1.28,$0.00
10576,ERX,HCPCS J7509,59746-0002-04,METHYLPREDNISOLONE 8 MG PO TABS,$8.03,$0.00,$8.03,$3.61,$5.73,$0.00,$1.38,$0.00,$0.00,$1.41,$8.03,$0.00,$4.02,$6.36,$6.42,$0.00,$1.26,$0.00,$1.28,$0.00
10576,ERX,HCPCS J7509,59762-0049-01,METHYLPREDNISOLONE 8 MG PO TABS,$8.03,$0.00,$8.03,$3.61,$5.73,$0.00,$1.38,$0.00,$0.00,$1.41,$8.03,$0.00,$4.02,$6.36,$6.42,$0.00,$1.26,$0.00,$1.28,$0.00
10577,ERX,HCPCS J2930,00009-0698-01,METHYLPREDNISOLONE SODIUM SUCC 1000 MG IJ SOLR,$126.00,$0.00,$126.00,$56.70,$89.93,$0.00,$29.70,$0.00,$0.00,$59.41,$126.00,$0.00,$63.00,$99.79,$100.80,$0.00,$59.41,$0.00,$0.00,$0.00
10577,ERX,HCPCS J2930,25021-0810-30,METHYLPREDNISOLONE SODIUM SUCC 1000 MG IJ SOLR,$126.00,$0.00,$126.00,$56.70,$89.93,$0.00,$29.70,$0.00,$0.00,$59.41,$126.00,$0.00,$63.00,$99.79,$100.80,$0.00,$59.41,$0.00,$0.00,$0.00
10577,ERX,HCPCS J2930,63323-0265-30,METHYLPREDNISOLONE SODIUM SUCC 1000 MG IJ SOLR,$126.00,$0.00,$126.00,$56.70,$89.93,$0.00,$29.70,$0.00,$0.00,$59.41,$126.00,$0.00,$63.00,$99.79,$100.80,$0.00,$59.41,$0.00,$0.00,$0.00
10578,ERX,HCPCS J2930,00009-0047-22,METHYLPREDNISOLONE SODIUM SUCC 125 MG IJ SOLR,$28.28,$0.00,$28.28,$12.73,$20.18,$0.00,$3.71,$0.00,$0.00,$7.43,$28.28,$0.00,$14.14,$22.40,$22.62,$0.00,$7.43,$0.00,$7.07,$0.00
10578,ERX,HCPCS J2930,00009-0047-26,METHYLPREDNISOLONE SODIUM SUCC 125 MG IJ SOLR,$28.28,$0.00,$28.28,$12.73,$20.18,$0.00,$3.71,$0.00,$0.00,$7.43,$28.28,$0.00,$14.14,$22.40,$22.62,$0.00,$7.43,$0.00,$7.07,$0.00
10578,ERX,HCPCS J2930,00009-0047-27,METHYLPREDNISOLONE SODIUM SUCC 125 MG IJ SOLR,$28.28,$0.00,$28.28,$12.73,$20.18,$0.00,$3.71,$0.00,$0.00,$7.43,$28.28,$0.00,$14.14,$22.40,$22.62,$0.00,$7.43,$0.00,$7.07,$0.00
10580,ERX,HCPCS J2920,00009-0039-28,METHYLPREDNISOLONE SODIUM SUCC 40 MG IJ SOLR,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$2.64,$0.00,$0.00,$5.38,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$5.38,$0.00,$5.12,$0.00
10580,ERX,HCPCS J2920,00009-0039-32,METHYLPREDNISOLONE SODIUM SUCC 40 MG IJ SOLR,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$2.64,$0.00,$0.00,$5.38,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$5.38,$0.00,$5.12,$0.00
10580,ERX,HCPCS J2920,00009-0039-33,METHYLPREDNISOLONE SODIUM SUCC 40 MG IJ SOLR,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$2.64,$0.00,$0.00,$5.38,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$5.38,$0.00,$5.12,$0.00
10581,ERX,HCPCS J2930,00009-0003-02,METHYLPREDNISOLONE SODIUM SUCC 500 MG IJ SOLR,$97.09,$0.00,$97.09,$43.69,$69.29,$0.00,$14.85,$0.00,$0.00,$29.70,$97.09,$0.00,$48.55,$76.90,$77.67,$0.00,$29.70,$0.00,$28.28,$0.00
10581,ERX,HCPCS J2930,00009-0758-01,METHYLPREDNISOLONE SODIUM SUCC 500 MG IJ SOLR,$97.09,$0.00,$97.09,$43.69,$69.29,$0.00,$14.85,$0.00,$0.00,$29.70,$97.09,$0.00,$48.55,$76.90,$77.67,$0.00,$29.70,$0.00,$28.28,$0.00
10586,ERX,HCPCS 63700001,00185-5600-01,METOLAZONE 10 MG PO TABS,$10.72,$0.00,$10.72,$0.00,$7.65,$0.00,$0.00,$0.00,$0.00,$0.00,$10.72,$0.00,$5.36,$8.49,$8.58,$0.00,$0.00,$0.00,$0.00,$0.00
10586,ERX,HCPCS 63700001,00378-6174-01,METOLAZONE 10 MG PO TABS,$10.72,$0.00,$10.72,$0.00,$7.65,$0.00,$0.00,$0.00,$0.00,$0.00,$10.72,$0.00,$5.36,$8.49,$8.58,$0.00,$0.00,$0.00,$0.00,$0.00
10586,ERX,HCPCS 63700001,00527-2217-37,METOLAZONE 10 MG PO TABS,$10.72,$0.00,$10.72,$0.00,$7.65,$0.00,$0.00,$0.00,$0.00,$0.00,$10.72,$0.00,$5.36,$8.49,$8.58,$0.00,$0.00,$0.00,$0.00,$0.00
10586,ERX,HCPCS 63700001,65580-0645-71,METOLAZONE 10 MG PO TABS,$10.72,$0.00,$10.72,$0.00,$7.65,$0.00,$0.00,$0.00,$0.00,$0.00,$10.72,$0.00,$5.36,$8.49,$8.58,$0.00,$0.00,$0.00,$0.00,$0.00
10587,ERX,HCPCS 63700001,00185-5050-01,METOLAZONE 2.5 MG PO TABS,$9.31,$0.00,$9.31,$0.00,$6.64,$0.00,$0.00,$0.00,$0.00,$0.00,$9.31,$0.00,$4.66,$7.37,$7.45,$0.00,$0.00,$0.00,$0.00,$0.00
10587,ERX,HCPCS 63700001,00378-6172-01,METOLAZONE 2.5 MG PO TABS,$9.31,$0.00,$9.31,$0.00,$6.64,$0.00,$0.00,$0.00,$0.00,$0.00,$9.31,$0.00,$4.66,$7.37,$7.45,$0.00,$0.00,$0.00,$0.00,$0.00
10587,ERX,HCPCS 63700001,00527-2215-37,METOLAZONE 2.5 MG PO TABS,$9.31,$0.00,$9.31,$0.00,$6.64,$0.00,$0.00,$0.00,$0.00,$0.00,$9.31,$0.00,$4.66,$7.37,$7.45,$0.00,$0.00,$0.00,$0.00,$0.00
10588,ERX,HCPCS 63700001,00185-0055-01,METOLAZONE 5 MG PO TABS,$10.58,$0.00,$10.58,$0.00,$7.55,$0.00,$0.00,$0.00,$0.00,$0.00,$10.58,$0.00,$5.29,$8.38,$8.46,$0.00,$0.00,$0.00,$0.00,$0.00
10588,ERX,HCPCS 63700001,00378-6173-01,METOLAZONE 5 MG PO TABS,$10.58,$0.00,$10.58,$0.00,$7.55,$0.00,$0.00,$0.00,$0.00,$0.00,$10.58,$0.00,$5.29,$8.38,$8.46,$0.00,$0.00,$0.00,$0.00,$0.00
10588,ERX,HCPCS 63700001,00527-2216-37,METOLAZONE 5 MG PO TABS,$10.58,$0.00,$10.58,$0.00,$7.55,$0.00,$0.00,$0.00,$0.00,$0.00,$10.58,$0.00,$5.29,$8.38,$8.46,$0.00,$0.00,$0.00,$0.00,$0.00
10592,ERX,HCPCS 63700001,00245-0860-70,METRONIDAZOLE 0.75 % VA GEL,$497.25,$0.00,$497.25,$0.00,$354.89,$0.00,$0.00,$0.00,$0.00,$0.00,$497.25,$0.00,$248.63,$393.82,$397.80,$0.00,$0.00,$0.00,$0.00,$0.00
10592,ERX,HCPCS 63700001,00781-7077-87,METRONIDAZOLE 0.75 % VA GEL,$497.25,$0.00,$497.25,$0.00,$354.89,$0.00,$0.00,$0.00,$0.00,$0.00,$497.25,$0.00,$248.63,$393.82,$397.80,$0.00,$0.00,$0.00,$0.00,$0.00
10594,ERX,HCPCS 63700001,25010-0305-15,METYROSINE 250 MG PO CAPS,"$1,171.76",$0.00,"$1,171.76",$0.00,$836.29,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,171.76",$0.00,$585.88,$928.03,$937.41,$0.00,$0.00,$0.00,$0.00,$0.00
10595,ERX,HCPCS 63700001,00093-8739-01,MEXILETINE HCL 150 MG PO CAPS,$9.64,$0.00,$9.64,$0.00,$6.88,$0.00,$0.00,$0.00,$0.00,$0.00,$9.64,$0.00,$4.82,$7.63,$7.71,$0.00,$0.00,$0.00,$0.00,$0.00
10595,ERX,HCPCS 63700001,62559-0820-01,MEXILETINE HCL 150 MG PO CAPS,$9.64,$0.00,$9.64,$0.00,$6.88,$0.00,$0.00,$0.00,$0.00,$0.00,$9.64,$0.00,$4.82,$7.63,$7.71,$0.00,$0.00,$0.00,$0.00,$0.00
10596,ERX,HCPCS 63700001,00093-8740-01,MEXILETINE HCL 200 MG PO CAPS,$11.51,$0.00,$11.51,$0.00,$8.21,$0.00,$0.00,$0.00,$0.00,$0.00,$11.51,$0.00,$5.76,$9.12,$9.21,$0.00,$0.00,$0.00,$0.00,$0.00
10608,ERX,HCPCS J2250,00409-2308-49,MIDAZOLAM HCL 5 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.94,$0.00,$0.00,$0.71,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.71,$0.00,$0.67,$0.00
10608,ERX,HCPCS J2250,00641-6061-25,MIDAZOLAM HCL 5 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.94,$0.00,$0.00,$0.71,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.71,$0.00,$0.67,$0.00
10609,ERX,HCPCS 63700001,00245-0211-11,MIDODRINE HCL 2.5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10609,ERX,HCPCS 63700001,42291-0560-90,MIDODRINE HCL 2.5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10610,ERX,HCPCS 63700001,00245-0212-01,MIDODRINE HCL 5 MG PO TABS,$15.80,$0.00,$15.80,$0.00,$11.28,$0.00,$0.00,$0.00,$0.00,$0.00,$15.80,$0.00,$7.90,$12.51,$12.64,$0.00,$0.00,$0.00,$0.00,$0.00
10610,ERX,HCPCS 63700001,00245-0212-11,MIDODRINE HCL 5 MG PO TABS,$15.80,$0.00,$15.80,$0.00,$11.28,$0.00,$0.00,$0.00,$0.00,$0.00,$15.80,$0.00,$7.90,$12.51,$12.64,$0.00,$0.00,$0.00,$0.00,$0.00
10610,ERX,HCPCS 63700001,00378-1902-01,MIDODRINE HCL 5 MG PO TABS,$15.80,$0.00,$15.80,$0.00,$11.28,$0.00,$0.00,$0.00,$0.00,$0.00,$15.80,$0.00,$7.90,$12.51,$12.64,$0.00,$0.00,$0.00,$0.00,$0.00
10610,ERX,HCPCS 63700001,42291-0561-90,MIDODRINE HCL 5 MG PO TABS,$15.80,$0.00,$15.80,$0.00,$11.28,$0.00,$0.00,$0.00,$0.00,$0.00,$15.80,$0.00,$7.90,$12.51,$12.64,$0.00,$0.00,$0.00,$0.00,$0.00
10610,ERX,HCPCS 63700001,51079-0453-20,MIDODRINE HCL 5 MG PO TABS,$15.80,$0.00,$15.80,$0.00,$11.28,$0.00,$0.00,$0.00,$0.00,$0.00,$15.80,$0.00,$7.90,$12.51,$12.64,$0.00,$0.00,$0.00,$0.00,$0.00
10610,ERX,HCPCS 63700001,60505-1321-01,MIDODRINE HCL 5 MG PO TABS,$15.80,$0.00,$15.80,$0.00,$11.28,$0.00,$0.00,$0.00,$0.00,$0.00,$15.80,$0.00,$7.90,$12.51,$12.64,$0.00,$0.00,$0.00,$0.00,$0.00
10612,ERX,HCPCS J2265,70842-0160-01,MINOCYCLINE HCL 100 MG IV SOLR,$564.56,$0.00,$564.56,$0.00,$402.93,$0.00,$0.00,$0.00,$0.00,$0.00,$564.56,$0.00,$282.28,$447.13,$451.65,$0.00,$0.00,$0.00,$0.00,$0.00
10612,ERX,HCPCS J2265,70842-0160-10,MINOCYCLINE HCL 100 MG IV SOLR,$564.56,$0.00,$564.56,$0.00,$402.93,$0.00,$0.00,$0.00,$0.00,$0.00,$564.56,$0.00,$282.28,$447.13,$451.65,$0.00,$0.00,$0.00,$0.00,$0.00
10628,ERX,HCPCS 63700001,00025-1451-34,MISOPROSTOL 100 MCG PO TABS,$9.43,$0.00,$9.43,$0.00,$6.73,$0.00,$0.00,$0.00,$0.00,$0.00,$9.43,$0.00,$4.72,$7.47,$7.54,$0.00,$0.00,$0.00,$0.00,$0.00
10628,ERX,HCPCS 63700001,43386-0160-06,MISOPROSTOL 100 MCG PO TABS,$9.43,$0.00,$9.43,$0.00,$6.73,$0.00,$0.00,$0.00,$0.00,$0.00,$9.43,$0.00,$4.72,$7.47,$7.54,$0.00,$0.00,$0.00,$0.00,$0.00
10628,ERX,HCPCS 63700001,59762-5007-01,MISOPROSTOL 100 MCG PO TABS,$9.43,$0.00,$9.43,$0.00,$6.73,$0.00,$0.00,$0.00,$0.00,$0.00,$9.43,$0.00,$4.72,$7.47,$7.54,$0.00,$0.00,$0.00,$0.00,$0.00
10628,ERX,HCPCS 63700001,68084-0040-01,MISOPROSTOL 100 MCG PO TABS,$9.43,$0.00,$9.43,$0.00,$6.73,$0.00,$0.00,$0.00,$0.00,$0.00,$9.43,$0.00,$4.72,$7.47,$7.54,$0.00,$0.00,$0.00,$0.00,$0.00
10629,ERX,HCPCS 63700001,00025-1461-60,MISOPROSTOL 200 MCG PO TABS,$26.38,$0.00,$26.38,$0.00,$18.83,$0.00,$0.00,$0.00,$0.00,$0.00,$26.38,$0.00,$13.19,$20.89,$21.10,$0.00,$0.00,$0.00,$0.00,$0.00
10629,ERX,HCPCS 63700001,43386-0161-01,MISOPROSTOL 200 MCG PO TABS,$26.38,$0.00,$26.38,$0.00,$18.83,$0.00,$0.00,$0.00,$0.00,$0.00,$26.38,$0.00,$13.19,$20.89,$21.10,$0.00,$0.00,$0.00,$0.00,$0.00
10629,ERX,HCPCS 63700001,59762-5008-01,MISOPROSTOL 200 MCG PO TABS,$26.38,$0.00,$26.38,$0.00,$18.83,$0.00,$0.00,$0.00,$0.00,$0.00,$26.38,$0.00,$13.19,$20.89,$21.10,$0.00,$0.00,$0.00,$0.00,$0.00
10629,ERX,HCPCS 63700001,59762-5008-02,MISOPROSTOL 200 MCG PO TABS,$26.38,$0.00,$26.38,$0.00,$18.83,$0.00,$0.00,$0.00,$0.00,$0.00,$26.38,$0.00,$13.19,$20.89,$21.10,$0.00,$0.00,$0.00,$0.00,$0.00
10629,ERX,HCPCS 63700001,68084-0041-01,MISOPROSTOL 200 MCG PO TABS,$26.38,$0.00,$26.38,$0.00,$18.83,$0.00,$0.00,$0.00,$0.00,$0.00,$26.38,$0.00,$13.19,$20.89,$21.10,$0.00,$0.00,$0.00,$0.00,$0.00
10630,ERX,HCPCS J9280,16729-0108-11,MITOMYCIN 20 MG IV SOLR,$937.87,$0.00,$937.87,$422.04,$669.36,$175.50,$35.96,$0.00,$0.00,$187.74,$937.87,$184.27,$468.94,$742.79,$750.30,$254.47,$187.74,$0.00,$178.76,$114.42
10631,ERX,HCPCS J9280,16729-0116-38,MITOMYCIN 40 MG IV SOLR,$937.87,$0.00,$937.87,$422.04,$669.36,$175.50,$35.96,$0.00,$0.00,$187.74,$937.87,$184.27,$468.94,$742.79,$750.30,$254.47,$187.74,$0.00,$178.76,$114.42
10632,ERX,HCPCS J9280,16729-0115-05,MITOMYCIN 5 MG IV SOLR,"$1,307.81",$0.00,"$1,307.81",$588.51,$933.38,$175.50,$35.96,$0.00,$0.00,$187.74,"$1,307.81",$184.27,$653.91,"$1,035.79","$1,046.25",$254.47,$187.74,$0.00,$178.76,$114.42
10646,ERX,HCPCS 25000001,45802-0257-42,MOMETASONE FUROATE 0.1 % EX CREA,$166.70,$0.00,$166.70,$0.00,$118.97,$0.00,$0.00,$0.00,$0.00,$0.00,$166.70,$0.00,$83.35,$132.03,$133.36,$0.00,$0.00,$0.00,$0.00,$0.00
10648,ERX,HCPCS 25000001,45802-0119-42,MOMETASONE FUROATE 0.1 % EX OINT,$156.09,$0.00,$156.09,$0.00,$111.40,$0.00,$0.00,$0.00,$0.00,$0.00,$156.09,$0.00,$78.05,$123.62,$124.87,$0.00,$0.00,$0.00,$0.00,$0.00
10674,ERX,HCPCS 25000001,00093-1010-42,MUPIROCIN 2 % EX OINT,$42.72,$0.00,$42.72,$0.00,$30.49,$0.00,$0.00,$0.00,$0.00,$0.00,$42.72,$0.00,$21.36,$33.83,$34.18,$0.00,$0.00,$0.00,$0.00,$0.00
10674,ERX,HCPCS 25000001,45802-0112-22,MUPIROCIN 2 % EX OINT,$42.72,$0.00,$42.72,$0.00,$30.49,$0.00,$0.00,$0.00,$0.00,$0.00,$42.72,$0.00,$21.36,$33.83,$34.18,$0.00,$0.00,$0.00,$0.00,$0.00
10674,ERX,HCPCS 25000001,51672-1312-00,MUPIROCIN 2 % EX OINT,$42.72,$0.00,$42.72,$0.00,$30.49,$0.00,$0.00,$0.00,$0.00,$0.00,$42.72,$0.00,$21.36,$33.83,$34.18,$0.00,$0.00,$0.00,$0.00,$0.00
10674,ERX,HCPCS 25000001,68462-0180-22,MUPIROCIN 2 % EX OINT,$42.72,$0.00,$42.72,$0.00,$30.49,$0.00,$0.00,$0.00,$0.00,$0.00,$42.72,$0.00,$21.36,$33.83,$34.18,$0.00,$0.00,$0.00,$0.00,$0.00
10676,ERX,HCPCS 63700001,68462-0358-01,NABUMETONE 500 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10685,ERX,HCPCS 63700001,00406-1170-03,DEPADE: NALTREXONE HCL 50 MG PO TABS,$16.25,$0.00,$16.25,$0.00,$11.60,$0.00,$0.00,$0.00,$0.00,$0.00,$16.25,$0.00,$8.13,$12.87,$13.00,$0.00,$0.00,$0.00,$0.00,$0.00
10685,ERX,HCPCS 63700001,51224-0206-30,DEPADE: NALTREXONE HCL 50 MG PO TABS,$16.25,$0.00,$16.25,$0.00,$11.60,$0.00,$0.00,$0.00,$0.00,$0.00,$16.25,$0.00,$8.13,$12.87,$13.00,$0.00,$0.00,$0.00,$0.00,$0.00
10692,ERX,HCPCS 25000001,00065-0645-15,NATAMYCIN 5 % OP SUSP,"$1,046.74",$0.00,"$1,046.74",$0.00,$813.62,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,046.74",$0.00,$523.37,$829.02,$837.39,$0.00,$0.00,$0.00,$0.00,$0.00
10712,ERX,HCPCS 63700001,42806-0501-09,NICARDIPINE HCL 20 MG PO CAPS,$58.88,$0.00,$58.88,$0.00,$42.02,$0.00,$0.00,$0.00,$0.00,$0.00,$58.88,$0.00,$29.44,$46.63,$47.10,$0.00,$0.00,$0.00,$0.00,$0.00
10722,ERX,HCPCS 63700001,23155-0512-00,NIMODIPINE 30 MG PO CAPS,$26.21,$0.00,$26.21,$0.00,$18.71,$0.00,$0.00,$0.00,$0.00,$0.00,$26.21,$0.00,$13.11,$20.76,$20.97,$0.00,$0.00,$0.00,$0.00,$0.00
10722,ERX,HCPCS 63700001,23155-0512-11,NIMODIPINE 30 MG PO CAPS,$26.21,$0.00,$26.21,$0.00,$18.71,$0.00,$0.00,$0.00,$0.00,$0.00,$26.21,$0.00,$13.11,$20.76,$20.97,$0.00,$0.00,$0.00,$0.00,$0.00
10722,ERX,HCPCS 63700001,23155-0512-30,NIMODIPINE 30 MG PO CAPS,$26.21,$0.00,$26.21,$0.00,$18.71,$0.00,$0.00,$0.00,$0.00,$0.00,$26.21,$0.00,$13.11,$20.76,$20.97,$0.00,$0.00,$0.00,$0.00,$0.00
10722,ERX,HCPCS 63700001,63739-0797-33,NIMODIPINE 30 MG PO CAPS,$26.21,$0.00,$26.21,$0.00,$18.71,$0.00,$0.00,$0.00,$0.00,$0.00,$26.21,$0.00,$13.11,$20.76,$20.97,$0.00,$0.00,$0.00,$0.00,$0.00
10724,ERX,HCPCS 63700001,00185-0122-01,NITROFURANTOIN MONOHYD MACRO 100 MG PO CAPS,$13.44,$0.00,$13.44,$0.00,$9.59,$0.00,$0.00,$0.00,$0.00,$0.00,$13.44,$0.00,$6.72,$10.64,$10.75,$0.00,$0.00,$0.00,$0.00,$0.00
10724,ERX,HCPCS 63700001,16714-0439-01,NITROFURANTOIN MONOHYD MACRO 100 MG PO CAPS,$13.44,$0.00,$13.44,$0.00,$9.59,$0.00,$0.00,$0.00,$0.00,$0.00,$13.44,$0.00,$6.72,$10.64,$10.75,$0.00,$0.00,$0.00,$0.00,$0.00
10724,ERX,HCPCS 63700001,68084-0446-01,NITROFURANTOIN MONOHYD MACRO 100 MG PO CAPS,$13.44,$0.00,$13.44,$0.00,$9.59,$0.00,$0.00,$0.00,$0.00,$0.00,$13.44,$0.00,$6.72,$10.64,$10.75,$0.00,$0.00,$0.00,$0.00,$0.00
10747,ERX,HCPCS 63700001,00555-0211-10,NORETHINDRONE ACETATE 5 MG PO TABS,$10.07,$0.00,$10.07,$0.00,$7.19,$0.00,$0.00,$0.00,$0.00,$0.00,$10.07,$0.00,$5.04,$7.98,$8.06,$0.00,$0.00,$0.00,$0.00,$0.00
10747,ERX,HCPCS 63700001,51285-0424-10,NORETHINDRONE ACETATE 5 MG PO TABS,$10.07,$0.00,$10.07,$0.00,$7.19,$0.00,$0.00,$0.00,$0.00,$0.00,$10.07,$0.00,$5.04,$7.98,$8.06,$0.00,$0.00,$0.00,$0.00,$0.00
10747,ERX,HCPCS 63700001,65162-0475-05,NORETHINDRONE ACETATE 5 MG PO TABS,$10.07,$0.00,$10.07,$0.00,$7.19,$0.00,$0.00,$0.00,$0.00,$0.00,$10.07,$0.00,$5.04,$7.98,$8.06,$0.00,$0.00,$0.00,$0.00,$0.00
10749,ERX,HCPCS 63700001,16714-0360-01,NORGESTIMATE-ETH ESTRADIOL 0.25-35 MG-MCG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10749,ERX,HCPCS 63700001,16714-0360-04,NORGESTIMATE-ETH ESTRADIOL 0.25-35 MG-MCG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10749,ERX,HCPCS 63700001,99999-6009-94,NORGESTIMATE-ETH ESTRADIOL 0.25-35 MG-MCG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10752,ERX,HCPCS 63700001,16714-0365-04,NORGESTREL-ETHINYL ESTRADIOL 0.3-30 MG-MCG PO TABS,$106.82,$0.00,$106.82,$0.00,$76.24,$0.00,$0.00,$0.00,$0.00,$0.00,$106.82,$0.00,$53.41,$84.60,$85.46,$0.00,$0.00,$0.00,$0.00,$0.00
10778,ERX,HCPCS Q0162,00904-6551-61,ONDANSETRON HCL 4 MG PO TABS,$86.73,$0.00,$86.73,$47.09,$61.90,$0.00,$14.94,$0.00,$0.00,$15.19,$86.73,$0.00,$43.37,$68.69,$69.38,$0.00,$0.00,$0.00,$0.00,$0.00
10778,ERX,HCPCS Q0162,55111-0153-30,ONDANSETRON HCL 4 MG PO TABS,$86.73,$0.00,$86.73,$47.09,$61.90,$0.00,$14.94,$0.00,$0.00,$15.19,$86.73,$0.00,$43.37,$68.69,$69.38,$0.00,$0.00,$0.00,$0.00,$0.00
10778,ERX,HCPCS Q0162,68084-0220-01,ONDANSETRON HCL 4 MG PO TABS,$86.73,$0.00,$86.73,$47.09,$61.90,$0.00,$14.94,$0.00,$0.00,$15.19,$86.73,$0.00,$43.37,$68.69,$69.38,$0.00,$0.00,$0.00,$0.00,$0.00
10778,ERX,HCPCS Q0162,68084-0220-11,ONDANSETRON HCL 4 MG PO TABS,$86.73,$0.00,$86.73,$47.09,$61.90,$0.00,$14.94,$0.00,$0.00,$15.19,$86.73,$0.00,$43.37,$68.69,$69.38,$0.00,$0.00,$0.00,$0.00,$0.00
10779,ERX,HCPCS Q0162,00904-6552-61,ONDANSETRON HCL 8 MG PO TABS,$144.41,$0.00,$144.41,$78.41,$103.07,$0.00,$24.88,$0.00,$0.00,$25.29,$144.41,$0.00,$72.21,$114.37,$115.53,$0.00,$0.00,$0.00,$0.00,$0.00
10779,ERX,HCPCS Q0162,55111-0154-30,ONDANSETRON HCL 8 MG PO TABS,$144.41,$0.00,$144.41,$78.41,$103.07,$0.00,$24.88,$0.00,$0.00,$25.29,$144.41,$0.00,$72.21,$114.37,$115.53,$0.00,$0.00,$0.00,$0.00,$0.00
10779,ERX,HCPCS Q0162,62756-0131-01,ONDANSETRON HCL 8 MG PO TABS,$144.41,$0.00,$144.41,$78.41,$103.07,$0.00,$24.88,$0.00,$0.00,$25.29,$144.41,$0.00,$72.21,$114.37,$115.53,$0.00,$0.00,$0.00,$0.00,$0.00
10779,ERX,HCPCS Q0162,63304-0459-30,ONDANSETRON HCL 8 MG PO TABS,$144.41,$0.00,$144.41,$78.41,$103.07,$0.00,$24.88,$0.00,$0.00,$25.29,$144.41,$0.00,$72.21,$114.37,$115.53,$0.00,$0.00,$0.00,$0.00,$0.00
10779,ERX,HCPCS Q0162,63739-0333-10,ONDANSETRON HCL 8 MG PO TABS,$144.41,$0.00,$144.41,$78.41,$103.07,$0.00,$24.88,$0.00,$0.00,$25.29,$144.41,$0.00,$72.21,$114.37,$115.53,$0.00,$0.00,$0.00,$0.00,$0.00
10779,ERX,HCPCS Q0162,68084-0221-01,ONDANSETRON HCL 8 MG PO TABS,$144.41,$0.00,$144.41,$78.41,$103.07,$0.00,$24.88,$0.00,$0.00,$25.29,$144.41,$0.00,$72.21,$114.37,$115.53,$0.00,$0.00,$0.00,$0.00,$0.00
10803,ERX,HCPCS 63700001,00245-0271-11,OXANDROLONE 2.5 MG PO TABS,$21.02,$0.00,$21.02,$0.00,$15.00,$0.00,$0.00,$0.00,$0.00,$0.00,$21.02,$0.00,$10.51,$16.65,$16.82,$0.00,$0.00,$0.00,$0.00,$0.00
10803,ERX,HCPCS 63700001,49884-0301-01,OXANDROLONE 2.5 MG PO TABS,$21.02,$0.00,$21.02,$0.00,$15.00,$0.00,$0.00,$0.00,$0.00,$0.00,$21.02,$0.00,$10.51,$16.65,$16.82,$0.00,$0.00,$0.00,$0.00,$0.00
10810,ERX,HCPCS 63700001,99999-6004-78,OXYBUTYNIN CHLORIDE 5 MG/5ML PO SYRP,$47.88,$0.00,$163.90,$0.00,$116.98,$0.00,$0.00,$0.00,$0.00,$0.00,$163.90,$0.00,$81.95,$37.92,$131.12,$0.00,$0.00,$0.00,$0.00,$0.00
10810,ERX,HCPCS 63700001,54838-0510-80,OXYBUTYNIN CHLORIDE 5 MG/5ML PO SYRP,$163.90,$0.00,$163.90,$0.00,$116.98,$0.00,$0.00,$0.00,$0.00,$0.00,$163.90,$0.00,$81.95,$129.81,$131.12,$0.00,$0.00,$0.00,$0.00,$0.00
10810,ERX,HCPCS 63700001,60432-0092-16,OXYBUTYNIN CHLORIDE 5 MG/5ML PO SYRP,$163.90,$0.00,$163.90,$0.00,$116.98,$0.00,$0.00,$0.00,$0.00,$0.00,$163.90,$0.00,$81.95,$129.81,$131.12,$0.00,$0.00,$0.00,$0.00,$0.00
10811,ERX,HCPCS 25000001,00327-0001-10,OXYCHLOROSENE SODIUM POWD,$23.56,$0.00,$23.56,$0.00,$16.81,$0.00,$0.00,$0.00,$0.00,$0.00,$23.56,$0.00,$11.78,$18.66,$18.85,$0.00,$0.00,$0.00,$0.00,$0.00
10812,ERX,HCPCS 25000001,00406-8557-30,OXYCODONE HCL 100 MG/5ML PO CONC,$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
10812,ERX,HCPCS 25000001,66689-0025-30,OXYCODONE HCL 100 MG/5ML PO CONC,$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
10812,ERX,HCPCS 25000001,68308-0020-03,OXYCODONE HCL 100 MG/5ML PO CONC,$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
10812,ERX,HCPCS 25000001,99999-6005-57,OXYCODONE HCL 100 MG/5ML PO CONC,$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
10813,ERX,HCPCS 25000001,00054-0390-63,OXYCODONE HCL 5 MG/5ML PO SOLN,$32.78,$0.00,$32.78,$0.00,$23.40,$0.00,$0.00,$0.00,$0.00,$0.00,$32.78,$0.00,$16.39,$25.96,$26.22,$0.00,$0.00,$0.00,$0.00,$0.00
10813,ERX,HCPCS 25000001,66689-0401-01,OXYCODONE HCL 5 MG/5ML PO SOLN,$32.78,$0.00,$32.78,$0.00,$23.40,$0.00,$0.00,$0.00,$0.00,$0.00,$32.78,$0.00,$16.39,$25.96,$26.22,$0.00,$0.00,$0.00,$0.00,$0.00
10813,ERX,HCPCS 25000001,66689-0401-50,OXYCODONE HCL 5 MG/5ML PO SOLN,$32.78,$0.00,$32.78,$0.00,$23.40,$0.00,$0.00,$0.00,$0.00,$0.00,$32.78,$0.00,$16.39,$25.96,$26.22,$0.00,$0.00,$0.00,$0.00,$0.00
10813,ERX,HCPCS 25000001,66689-0403-16,OXYCODONE HCL 5 MG/5ML PO SOLN,$32.78,$0.00,$32.78,$0.00,$23.40,$0.00,$0.00,$0.00,$0.00,$0.00,$32.78,$0.00,$16.39,$25.96,$26.22,$0.00,$0.00,$0.00,$0.00,$0.00
10813,ERX,HCPCS 25000001,99999-6004-35,OXYCODONE HCL 5 MG/5ML PO SOLN,$32.78,$0.00,$32.78,$0.00,$23.40,$0.00,$0.00,$0.00,$0.00,$0.00,$32.78,$0.00,$16.39,$25.96,$26.22,$0.00,$0.00,$0.00,$0.00,$0.00
10814,ERX,HCPCS 25000001,00406-0552-23,OXYCODONE HCL 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10814,ERX,HCPCS 25000001,00406-0552-62,OXYCODONE HCL 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10814,ERX,HCPCS 25000001,42858-0001-10,OXYCODONE HCL 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10814,ERX,HCPCS 25000001,57664-0223-88,OXYCODONE HCL 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10814,ERX,HCPCS 25000001,68084-0354-01,OXYCODONE HCL 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10814,ERX,HCPCS 25000001,68084-0354-11,OXYCODONE HCL 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10839,ERX,HCPCS 63700001,52268-0100-01,PEG 3350-KCL-NABCB-NACL-NASULF 236 G PO SOLR,$60.80,$0.00,$76.00,$0.00,$54.24,$0.00,$0.00,$0.00,$0.00,$0.00,$76.00,$0.00,$38.00,$48.15,$60.80,$0.00,$0.00,$0.00,$0.00,$0.00
10839,ERX,HCPCS 63700001,52268-0101-01,PEG 3350-KCL-NABCB-NACL-NASULF 236 G PO SOLR,$60.80,$0.00,$76.00,$0.00,$54.24,$0.00,$0.00,$0.00,$0.00,$0.00,$76.00,$0.00,$38.00,$48.15,$60.80,$0.00,$0.00,$0.00,$0.00,$0.00
10845,ERX,HCPCS J2430,59923-0601-10,PAMIDRONATE DISODIUM 30 MG IV SOLR,$78.93,$0.00,$78.93,$35.52,$56.33,$0.00,$36.23,$0.00,$0.00,$13.82,$78.93,$0.00,$39.47,$62.51,$63.14,$0.00,$12.35,$0.00,$12.57,$0.00
10854,ERX,HCPCS 63700001,23155-0038-01,PAROMOMYCIN SULFATE 250 MG PO CAPS,$21.55,$0.00,$21.55,$0.00,$15.38,$0.00,$0.00,$0.00,$0.00,$0.00,$21.55,$0.00,$10.78,$17.07,$17.24,$0.00,$0.00,$0.00,$0.00,$0.00
10855,ERX,HCPCS 63700001,00904-5677-61,PAROXETINE HCL 20 MG PO TABS,$10.37,$0.00,$10.37,$0.00,$7.40,$0.00,$0.00,$0.00,$0.00,$0.00,$10.37,$0.00,$5.19,$8.21,$8.30,$0.00,$0.00,$0.00,$0.00,$0.00
10855,ERX,HCPCS 63700001,13107-0155-30,PAROXETINE HCL 20 MG PO TABS,$10.37,$0.00,$10.37,$0.00,$7.40,$0.00,$0.00,$0.00,$0.00,$0.00,$10.37,$0.00,$5.19,$8.21,$8.30,$0.00,$0.00,$0.00,$0.00,$0.00
10855,ERX,HCPCS 63700001,51079-0774-01,PAROXETINE HCL 20 MG PO TABS,$10.37,$0.00,$10.37,$0.00,$7.40,$0.00,$0.00,$0.00,$0.00,$0.00,$10.37,$0.00,$5.19,$8.21,$8.30,$0.00,$0.00,$0.00,$0.00,$0.00
10855,ERX,HCPCS 63700001,51079-0774-20,PAROXETINE HCL 20 MG PO TABS,$10.37,$0.00,$10.37,$0.00,$7.40,$0.00,$0.00,$0.00,$0.00,$0.00,$10.37,$0.00,$5.19,$8.21,$8.30,$0.00,$0.00,$0.00,$0.00,$0.00
10855,ERX,HCPCS 63700001,63739-0963-10,PAROXETINE HCL 20 MG PO TABS,$10.37,$0.00,$10.37,$0.00,$7.40,$0.00,$0.00,$0.00,$0.00,$0.00,$10.37,$0.00,$5.19,$8.21,$8.30,$0.00,$0.00,$0.00,$0.00,$0.00
10855,ERX,HCPCS 63700001,63874-0538-10,PAROXETINE HCL 20 MG PO TABS,$10.37,$0.00,$10.37,$0.00,$7.40,$0.00,$0.00,$0.00,$0.00,$0.00,$10.37,$0.00,$5.19,$8.21,$8.30,$0.00,$0.00,$0.00,$0.00,$0.00
10855,ERX,HCPCS 63700001,68084-0045-01,PAROXETINE HCL 20 MG PO TABS,$10.37,$0.00,$10.37,$0.00,$7.40,$0.00,$0.00,$0.00,$0.00,$0.00,$10.37,$0.00,$5.19,$8.21,$8.30,$0.00,$0.00,$0.00,$0.00,$0.00
10855,ERX,HCPCS 63700001,68084-0045-11,PAROXETINE HCL 20 MG PO TABS,$10.37,$0.00,$10.37,$0.00,$7.40,$0.00,$0.00,$0.00,$0.00,$0.00,$10.37,$0.00,$5.19,$8.21,$8.30,$0.00,$0.00,$0.00,$0.00,$0.00
10855,ERX,HCPCS 63700001,68382-0098-06,PAROXETINE HCL 20 MG PO TABS,$10.37,$0.00,$10.37,$0.00,$7.40,$0.00,$0.00,$0.00,$0.00,$0.00,$10.37,$0.00,$5.19,$8.21,$8.30,$0.00,$0.00,$0.00,$0.00,$0.00
10856,ERX,HCPCS 63700001,13107-0156-30,PAROXETINE HCL 30 MG PO TABS,$10.38,$0.00,$10.38,$0.00,$7.41,$0.00,$0.00,$0.00,$0.00,$0.00,$10.38,$0.00,$5.19,$8.22,$8.30,$0.00,$0.00,$0.00,$0.00,$0.00
10897,ERX,HCPCS J0561,60793-0700-10,PENICILLIN G BENZATHINE 600000 UNIT/ML IM SUSP,$363.81,$0.00,$363.81,$163.71,$259.65,$82.92,$62.68,$0.00,$0.00,$97.01,$363.81,$87.07,$181.91,$288.14,$291.05,$120.23,$97.01,$0.00,$92.37,$82.92
10910,ERX,HCPCS J9268,00409-0801-01,PENTOSTATIN 10 MG IV SOLR,"$5,427.52",$0.00,"$5,427.52",$0.00,"$3,873.62",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,427.52",$0.00,"$2,713.76","$4,298.60","$4,342.02",$0.00,$0.00,$0.00,$0.00,$0.00
10917,ERX,HCPCS 25000001,00472-0242-60,PERMETHRIN 5 % EX CREA,$377.53,$0.00,$377.53,$0.00,$269.44,$0.00,$0.00,$0.00,$0.00,$0.00,$377.53,$0.00,$188.77,$299.00,$302.02,$0.00,$0.00,$0.00,$0.00,$0.00
10917,ERX,HCPCS 25000001,16714-0897-01,PERMETHRIN 5 % EX CREA,$377.53,$0.00,$377.53,$0.00,$269.44,$0.00,$0.00,$0.00,$0.00,$0.00,$377.53,$0.00,$188.77,$299.00,$302.02,$0.00,$0.00,$0.00,$0.00,$0.00
10917,ERX,HCPCS 25000001,45802-0269-37,PERMETHRIN 5 % EX CREA,$377.53,$0.00,$377.53,$0.00,$269.44,$0.00,$0.00,$0.00,$0.00,$0.00,$377.53,$0.00,$188.77,$299.00,$302.02,$0.00,$0.00,$0.00,$0.00,$0.00
10918,ERX,HCPCS 25000001,63736-0120-03,PERMETHRIN 1 % EX LIQD,$30.72,$0.00,$38.34,$0.00,$27.36,$0.00,$0.00,$0.00,$0.00,$0.00,$38.34,$0.00,$19.17,$24.33,$30.67,$0.00,$0.00,$0.00,$0.00,$0.00
10933,ERX,HCPCS 63700001,59762-0119-01,PHENELZINE SULFATE 15 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
10945,ERX,HCPCS 63700001,49884-0038-01,PHENOXYBENZAMINE HCL 10 MG PO CAPS,$394.81,$0.00,$394.81,$0.00,$281.78,$0.00,$0.00,$0.00,$0.00,$0.00,$394.81,$0.00,$197.41,$312.69,$315.85,$0.00,$0.00,$0.00,$0.00,$0.00
10945,ERX,HCPCS 63700001,59212-0001-01,PHENOXYBENZAMINE HCL 10 MG PO CAPS,$394.81,$0.00,$394.81,$0.00,$281.78,$0.00,$0.00,$0.00,$0.00,$0.00,$394.81,$0.00,$197.41,$312.69,$315.85,$0.00,$0.00,$0.00,$0.00,$0.00
10947,ERX,HCPCS J2760,00143-9564-01,PHENTOLAMINE MESYLATE 5 MG IJ SOLR,"$1,283.96",$0.00,"$1,283.96",$0.00,$916.36,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,283.96",$0.00,$641.98,"$1,016.90","$1,027.17",$0.00,$0.00,$0.00,$0.00,$0.00
10947,ERX,HCPCS J2760,00143-9564-10,PHENTOLAMINE MESYLATE 5 MG IJ SOLR,"$1,283.96",$0.00,"$1,283.96",$0.00,$916.36,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,283.96",$0.00,$641.98,"$1,016.90","$1,027.17",$0.00,$0.00,$0.00,$0.00,$0.00
11018,ERX,HCPCS 63700001,00071-0007-40,PHENYTOIN 50 MG PO CHEW,$8.25,$0.00,$8.25,$0.00,$5.89,$0.00,$0.00,$0.00,$0.00,$0.00,$8.25,$0.00,$4.13,$6.53,$6.60,$0.00,$0.00,$0.00,$0.00,$0.00
11018,ERX,HCPCS 63700001,51672-4146-01,PHENYTOIN 50 MG PO CHEW,$8.25,$0.00,$8.25,$0.00,$5.89,$0.00,$0.00,$0.00,$0.00,$0.00,$8.25,$0.00,$4.13,$6.53,$6.60,$0.00,$0.00,$0.00,$0.00,$0.00
11019,ERX,HCPCS 63700001,00071-3740-66,PHENYTOIN SODIUM EXTENDED 30 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
11024,ERX,HCPCS 63700001,00187-1704-05,PHYTONADIONE 5 MG PO TABS,$222.12,$0.00,$222.12,$0.00,$158.53,$0.00,$0.00,$0.00,$0.00,$0.00,$222.12,$0.00,$111.06,$175.92,$177.70,$0.00,$0.00,$0.00,$0.00,$0.00
11024,ERX,HCPCS 63700001,68682-0170-30,PHYTONADIONE 5 MG PO TABS,$222.12,$0.00,$222.12,$0.00,$158.53,$0.00,$0.00,$0.00,$0.00,$0.00,$222.12,$0.00,$111.06,$175.92,$177.70,$0.00,$0.00,$0.00,$0.00,$0.00
11037,ERX,HCPCS 90732,00006-4837-01,PNEUMOCOCCAL VAC POLYVALENT 25 MCG/0.5ML IJ INJ,$385.01,$0.00,$385.01,$173.25,$288.53,$105.11,$9.40,$0.00,$0.00,$134.20,$385.01,$56.21,$192.51,$304.93,$308.01,$56.21,$134.20,$105.11,$127.78,$105.11
11037,ERX,HCPCS 90732,00006-4837-03,PNEUMOCOCCAL VAC POLYVALENT 25 MCG/0.5ML IJ INJ,$385.01,$0.00,$385.01,$173.25,$288.53,$105.11,$9.40,$0.00,$0.00,$134.20,$385.01,$56.21,$192.51,$304.93,$308.01,$56.21,$134.20,$105.11,$127.78,$105.11
11038,ERX,HCPCS 25000001,00574-0611-05,PODOFILOX 0.5 % EX SOLN,$329.86,$0.00,$329.86,$0.00,$235.42,$0.00,$0.00,$0.00,$0.00,$0.00,$329.86,$0.00,$164.93,$261.25,$263.89,$0.00,$0.00,$0.00,$0.00,$0.00
11038,ERX,HCPCS 25000001,00591-3204-13,PODOFILOX 0.5 % EX SOLN,$329.86,$0.00,$329.86,$0.00,$235.42,$0.00,$0.00,$0.00,$0.00,$0.00,$329.86,$0.00,$164.93,$261.25,$263.89,$0.00,$0.00,$0.00,$0.00,$0.00
11058,ERX,HCPCS 25000001,60258-0002-16,K & NA CIT-CIT AC 550-500-334 MG/5ML PO SYRP,$11.00,$0.00,$11.00,$0.00,$7.85,$0.00,$0.00,$0.00,$0.00,$0.00,$11.00,$0.00,$5.50,$8.71,$8.80,$0.00,$0.00,$0.00,$0.00,$0.00
11074,ERX,HCPCS J3480,00338-0709-48,POTASSIUM CHLORIDE 10 MEQ/100ML IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.12,$0.00,$0.00,$0.82,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.82,$0.00,$0.78,$0.00
11076,ERX,HCPCS J3480,00338-0705-48,POTASSIUM CHLORIDE 20 MEQ/100ML IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.24,$0.00,$0.00,$1.65,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.65,$0.00,$1.57,$0.00
11076,ERX,HCPCS J3480,00990-7075-26,POTASSIUM CHLORIDE 20 MEQ/100ML IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.24,$0.00,$0.00,$1.65,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.65,$0.00,$1.57,$0.00
11083,ERX,HCPCS 63700001,00245-0071-11,POTASSIUM CITRATE ER 10 MEQ (1080 MG) PO TBCR,$10.49,$0.00,$10.49,$0.00,$7.49,$0.00,$0.00,$0.00,$0.00,$0.00,$10.49,$0.00,$5.25,$8.31,$8.39,$0.00,$0.00,$0.00,$0.00,$0.00
11087,ERX,HCPCS 25000001,00486-1111-01,POTASSIUM PHOSPHATE MONOBASIC 500 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
11110,ERX,HCPCS 63700001,00093-0771-98,PRAVASTATIN SODIUM 10 MG PO TABS,$12.22,$0.00,$12.22,$0.00,$8.72,$0.00,$0.00,$0.00,$0.00,$0.00,$12.22,$0.00,$6.11,$9.68,$9.78,$0.00,$0.00,$0.00,$0.00,$0.00
11110,ERX,HCPCS 63700001,00904-5891-61,PRAVASTATIN SODIUM 10 MG PO TABS,$12.22,$0.00,$12.22,$0.00,$8.72,$0.00,$0.00,$0.00,$0.00,$0.00,$12.22,$0.00,$6.11,$9.68,$9.78,$0.00,$0.00,$0.00,$0.00,$0.00
11110,ERX,HCPCS 63700001,60505-0168-09,PRAVASTATIN SODIUM 10 MG PO TABS,$12.22,$0.00,$12.22,$0.00,$8.72,$0.00,$0.00,$0.00,$0.00,$0.00,$12.22,$0.00,$6.11,$9.68,$9.78,$0.00,$0.00,$0.00,$0.00,$0.00
11110,ERX,HCPCS 63700001,68462-0195-90,PRAVASTATIN SODIUM 10 MG PO TABS,$12.22,$0.00,$12.22,$0.00,$8.72,$0.00,$0.00,$0.00,$0.00,$0.00,$12.22,$0.00,$6.11,$9.68,$9.78,$0.00,$0.00,$0.00,$0.00,$0.00
11111,ERX,HCPCS 63700001,00093-7201-98,PRAVASTATIN SODIUM 20 MG PO TABS,$9.49,$0.00,$9.49,$0.00,$6.77,$0.00,$0.00,$0.00,$0.00,$0.00,$9.49,$0.00,$4.75,$7.52,$7.59,$0.00,$0.00,$0.00,$0.00,$0.00
11111,ERX,HCPCS 63700001,00904-5892-61,PRAVASTATIN SODIUM 20 MG PO TABS,$9.49,$0.00,$9.49,$0.00,$6.77,$0.00,$0.00,$0.00,$0.00,$0.00,$9.49,$0.00,$4.75,$7.52,$7.59,$0.00,$0.00,$0.00,$0.00,$0.00
11111,ERX,HCPCS 63700001,16729-0009-15,PRAVASTATIN SODIUM 20 MG PO TABS,$9.49,$0.00,$9.49,$0.00,$6.77,$0.00,$0.00,$0.00,$0.00,$0.00,$9.49,$0.00,$4.75,$7.52,$7.59,$0.00,$0.00,$0.00,$0.00,$0.00
11111,ERX,HCPCS 63700001,51079-0458-01,PRAVASTATIN SODIUM 20 MG PO TABS,$9.49,$0.00,$9.49,$0.00,$6.77,$0.00,$0.00,$0.00,$0.00,$0.00,$9.49,$0.00,$4.75,$7.52,$7.59,$0.00,$0.00,$0.00,$0.00,$0.00
11111,ERX,HCPCS 63700001,51079-0458-20,PRAVASTATIN SODIUM 20 MG PO TABS,$9.49,$0.00,$9.49,$0.00,$6.77,$0.00,$0.00,$0.00,$0.00,$0.00,$9.49,$0.00,$4.75,$7.52,$7.59,$0.00,$0.00,$0.00,$0.00,$0.00
11111,ERX,HCPCS 63700001,63739-0649-10,PRAVASTATIN SODIUM 20 MG PO TABS,$9.49,$0.00,$9.49,$0.00,$6.77,$0.00,$0.00,$0.00,$0.00,$0.00,$9.49,$0.00,$4.75,$7.52,$7.59,$0.00,$0.00,$0.00,$0.00,$0.00
11112,ERX,HCPCS 63700001,00904-5893-61,PRAVASTATIN SODIUM 40 MG PO TABS,$16.32,$0.00,$16.32,$0.00,$11.65,$0.00,$0.00,$0.00,$0.00,$0.00,$16.32,$0.00,$8.16,$12.93,$13.06,$0.00,$0.00,$0.00,$0.00,$0.00
11112,ERX,HCPCS 63700001,55111-0231-05,PRAVASTATIN SODIUM 40 MG PO TABS,$16.32,$0.00,$16.32,$0.00,$11.65,$0.00,$0.00,$0.00,$0.00,$0.00,$16.32,$0.00,$8.16,$12.93,$13.06,$0.00,$0.00,$0.00,$0.00,$0.00
11112,ERX,HCPCS 63700001,68462-0197-90,PRAVASTATIN SODIUM 40 MG PO TABS,$16.32,$0.00,$16.32,$0.00,$11.65,$0.00,$0.00,$0.00,$0.00,$0.00,$16.32,$0.00,$8.16,$12.93,$13.06,$0.00,$0.00,$0.00,$0.00,$0.00
11113,ERX,HCPCS 63700001,50419-0747-01,PRAZIQUANTEL 600 MG PO TABS,$313.89,$0.00,$313.89,$0.00,$224.02,$0.00,$0.00,$0.00,$0.00,$0.00,$313.89,$0.00,$156.95,$248.60,$251.11,$0.00,$0.00,$0.00,$0.00,$0.00
11129,ERX,HCPCS 63700001,53746-0544-01,PRIMIDONE 50 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
11129,ERX,HCPCS 63700001,68084-0202-01,PRIMIDONE 50 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
11129,ERX,HCPCS 63700001,68084-0202-11,PRIMIDONE 50 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
11138,ERX,HCPCS 25000001,00574-7226-12,PROCHLORPERAZINE 25 MG RECTAL SUPP,$47.82,$0.00,$47.82,$0.00,$34.13,$0.00,$0.00,$0.00,$0.00,$0.00,$47.82,$0.00,$23.91,$37.87,$38.26,$0.00,$0.00,$0.00,$0.00,$0.00
11143,ERX,HCPCS 25000001,00713-0536-06,PROMETHAZINE HCL 12.5 MG RECTAL SUPP,$67.28,$0.00,$67.28,$0.00,$48.02,$0.00,$0.00,$0.00,$0.00,$0.00,$67.28,$0.00,$33.64,$53.29,$53.82,$0.00,$0.00,$0.00,$0.00,$0.00
11143,ERX,HCPCS 25000001,00713-0536-12,PROMETHAZINE HCL 12.5 MG RECTAL SUPP,$67.28,$0.00,$67.28,$0.00,$48.02,$0.00,$0.00,$0.00,$0.00,$0.00,$67.28,$0.00,$33.64,$53.29,$53.82,$0.00,$0.00,$0.00,$0.00,$0.00
11143,ERX,HCPCS 25000001,45802-0758-30,PROMETHAZINE HCL 12.5 MG RECTAL SUPP,$67.28,$0.00,$67.28,$0.00,$48.02,$0.00,$0.00,$0.00,$0.00,$0.00,$67.28,$0.00,$33.64,$53.29,$53.82,$0.00,$0.00,$0.00,$0.00,$0.00
11144,ERX,HCPCS 25000001,00713-0526-12,PROMETHAZINE HCL 25 MG RECTAL SUPP,$67.28,$0.00,$67.28,$0.00,$48.02,$0.00,$0.00,$0.00,$0.00,$0.00,$67.28,$0.00,$33.64,$53.29,$53.82,$0.00,$0.00,$0.00,$0.00,$0.00
11144,ERX,HCPCS 25000001,45802-0759-30,PROMETHAZINE HCL 25 MG RECTAL SUPP,$67.28,$0.00,$67.28,$0.00,$48.02,$0.00,$0.00,$0.00,$0.00,$0.00,$67.28,$0.00,$33.64,$53.29,$53.82,$0.00,$0.00,$0.00,$0.00,$0.00
11144,ERX,HCPCS 25000001,51672-5297-01,PROMETHAZINE HCL 25 MG RECTAL SUPP,$67.28,$0.00,$67.28,$0.00,$48.02,$0.00,$0.00,$0.00,$0.00,$0.00,$67.28,$0.00,$33.64,$53.29,$53.82,$0.00,$0.00,$0.00,$0.00,$0.00
11146,ERX,HCPCS 63700001,00591-0582-01,PROPAFENONE HCL 150 MG PO TABS,$6.40,$0.00,$6.40,$0.00,$4.57,$0.00,$0.00,$0.00,$0.00,$0.00,$6.40,$0.00,$3.20,$5.07,$5.12,$0.00,$0.00,$0.00,$0.00,$0.00
11146,ERX,HCPCS 63700001,53489-0551-01,PROPAFENONE HCL 150 MG PO TABS,$6.40,$0.00,$6.40,$0.00,$4.57,$0.00,$0.00,$0.00,$0.00,$0.00,$6.40,$0.00,$3.20,$5.07,$5.12,$0.00,$0.00,$0.00,$0.00,$0.00
11146,ERX,HCPCS 63700001,62559-0230-01,PROPAFENONE HCL 150 MG PO TABS,$6.40,$0.00,$6.40,$0.00,$4.57,$0.00,$0.00,$0.00,$0.00,$0.00,$6.40,$0.00,$3.20,$5.07,$5.12,$0.00,$0.00,$0.00,$0.00,$0.00
11146,ERX,HCPCS 63700001,63739-0509-10,PROPAFENONE HCL 150 MG PO TABS,$6.40,$0.00,$6.40,$0.00,$4.57,$0.00,$0.00,$0.00,$0.00,$0.00,$6.40,$0.00,$3.20,$5.07,$5.12,$0.00,$0.00,$0.00,$0.00,$0.00
11147,ERX,HCPCS 63700001,00591-0583-01,PROPAFENONE HCL 225 MG PO TABS,$8.86,$0.00,$8.86,$0.00,$6.32,$0.00,$0.00,$0.00,$0.00,$0.00,$8.86,$0.00,$4.43,$7.02,$7.09,$0.00,$0.00,$0.00,$0.00,$0.00
11147,ERX,HCPCS 63700001,00603-5449-21,PROPAFENONE HCL 225 MG PO TABS,$8.86,$0.00,$8.86,$0.00,$6.32,$0.00,$0.00,$0.00,$0.00,$0.00,$8.86,$0.00,$4.43,$7.02,$7.09,$0.00,$0.00,$0.00,$0.00,$0.00
11147,ERX,HCPCS 63700001,53489-0552-01,PROPAFENONE HCL 225 MG PO TABS,$8.86,$0.00,$8.86,$0.00,$6.32,$0.00,$0.00,$0.00,$0.00,$0.00,$8.86,$0.00,$4.43,$7.02,$7.09,$0.00,$0.00,$0.00,$0.00,$0.00
11164,ERX,HCPCS 63700001,00054-0210-25,PROTRIPTYLINE HCL 5 MG PO TABS,$21.79,$0.00,$21.79,$0.00,$15.55,$0.00,$0.00,$0.00,$0.00,$0.00,$21.79,$0.00,$10.90,$17.26,$17.43,$0.00,$0.00,$0.00,$0.00,$0.00
11164,ERX,HCPCS 63700001,64980-0158-01,PROTRIPTYLINE HCL 5 MG PO TABS,$21.79,$0.00,$21.79,$0.00,$15.55,$0.00,$0.00,$0.00,$0.00,$0.00,$21.79,$0.00,$10.90,$17.26,$17.43,$0.00,$0.00,$0.00,$0.00,$0.00
11217,ERX,HCPCS 63700001,37000-0023-04,PSYLLIUM 28 % PO PACK,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
11217,ERX,HCPCS 63700001,37000-0740-87,PSYLLIUM 28 % PO PACK,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
11239,ERX,HCPCS 63700001,00115-3511-01,PYRIDOSTIGMINE BROMIDE 60 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
11239,ERX,HCPCS 63700001,68682-0302-10,PYRIDOSTIGMINE BROMIDE 60 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
11240,ERX,HCPCS 63700001,00115-1404-08,PYRIDOSTIGMINE BROMIDE ER 180 MG PO TBCR,$86.83,$0.00,$86.83,$0.00,$61.97,$0.00,$0.00,$0.00,$0.00,$0.00,$86.83,$0.00,$43.42,$68.77,$69.46,$0.00,$0.00,$0.00,$0.00,$0.00
11240,ERX,HCPCS 63700001,00187-3013-30,PYRIDOSTIGMINE BROMIDE ER 180 MG PO TBCR,$86.83,$0.00,$86.83,$0.00,$61.97,$0.00,$0.00,$0.00,$0.00,$0.00,$86.83,$0.00,$43.42,$68.77,$69.46,$0.00,$0.00,$0.00,$0.00,$0.00
11240,ERX,HCPCS 63700001,47781-0335-30,PYRIDOSTIGMINE BROMIDE ER 180 MG PO TBCR,$86.83,$0.00,$86.83,$0.00,$61.97,$0.00,$0.00,$0.00,$0.00,$0.00,$86.83,$0.00,$43.42,$68.77,$69.46,$0.00,$0.00,$0.00,$0.00,$0.00
11240,ERX,HCPCS 63700001,64980-0220-03,PYRIDOSTIGMINE BROMIDE ER 180 MG PO TBCR,$86.83,$0.00,$86.83,$0.00,$61.97,$0.00,$0.00,$0.00,$0.00,$0.00,$86.83,$0.00,$43.42,$68.77,$69.46,$0.00,$0.00,$0.00,$0.00,$0.00
11246,ERX,HCPCS 63700001,69413-0330-10,PYRIMETHAMINE 25 MG PO TABS,"$3,690.00",$0.00,"$3,690.00",$0.00,"$2,633.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,690.00",$0.00,"$1,845.00","$2,922.48","$2,952.00",$0.00,$0.00,$0.00,$0.00,$0.00
11246,ERX,HCPCS 63700001,69413-0330-30,PYRIMETHAMINE 25 MG PO TABS,"$3,690.00",$0.00,"$3,690.00",$0.00,"$2,633.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,690.00",$0.00,"$1,845.00","$2,922.48","$2,952.00",$0.00,$0.00,$0.00,$0.00,$0.00
11257,ERX,HCPCS 90675,49281-0250-51,"RABIES VIRUS VACCINE, HDC IM INJ","$1,189.85",$0.00,"$1,189.85",$535.43,$849.20,$297.59,$174.76,$0.00,$0.00,$326.44,"$1,189.85",$312.47,$594.93,$942.36,$951.88,$431.50,$326.44,$0.00,$310.83,$294.72
11259,ERX,HCPCS 63700001,68180-0591-01,RAMIPRIL 10 MG PO CAPS,$9.01,$0.00,$9.01,$0.00,$6.43,$0.00,$0.00,$0.00,$0.00,$0.00,$9.01,$0.00,$4.51,$7.14,$7.21,$0.00,$0.00,$0.00,$0.00,$0.00
11286,ERX,HCPCS 63700001,65862-0290-84,RIBAVIRIN 200 MG PO CAPS,$37.75,$0.00,$37.75,$0.00,$26.94,$0.00,$0.00,$0.00,$0.00,$0.00,$37.75,$0.00,$18.88,$29.90,$30.20,$0.00,$0.00,$0.00,$0.00,$0.00
11286,ERX,HCPCS 63700001,68382-0260-12,RIBAVIRIN 200 MG PO CAPS,$37.75,$0.00,$37.75,$0.00,$26.94,$0.00,$0.00,$0.00,$0.00,$0.00,$37.75,$0.00,$18.88,$29.90,$30.20,$0.00,$0.00,$0.00,$0.00,$0.00
11290,ERX,HCPCS 63700001,00013-5301-17,RIFABUTIN 150 MG PO CAPS,$80.50,$0.00,$80.50,$0.00,$57.45,$0.00,$0.00,$0.00,$0.00,$0.00,$80.50,$0.00,$40.25,$63.76,$64.40,$0.00,$0.00,$0.00,$0.00,$0.00
11290,ERX,HCPCS 63700001,59762-1350-01,RIFABUTIN 150 MG PO CAPS,$80.50,$0.00,$80.50,$0.00,$57.45,$0.00,$0.00,$0.00,$0.00,$0.00,$80.50,$0.00,$40.25,$63.76,$64.40,$0.00,$0.00,$0.00,$0.00,$0.00
11291,ERX,HCPCS 25000001,00068-0597-01,RIFAMPIN 600 MG IV SOLR,$326.77,$0.00,$326.77,$0.00,$233.22,$0.00,$0.00,$0.00,$0.00,$0.00,$326.77,$0.00,$163.39,$258.80,$261.42,$0.00,$0.00,$0.00,$0.00,$0.00
11291,ERX,HCPCS 25000001,00068-0599-01,RIFAMPIN 600 MG IV SOLR,$326.77,$0.00,$326.77,$0.00,$233.22,$0.00,$0.00,$0.00,$0.00,$0.00,$326.77,$0.00,$163.39,$258.80,$261.42,$0.00,$0.00,$0.00,$0.00,$0.00
11291,ERX,HCPCS 25000001,63323-0351-20,RIFAMPIN 600 MG IV SOLR,$326.77,$0.00,$326.77,$0.00,$233.22,$0.00,$0.00,$0.00,$0.00,$0.00,$326.77,$0.00,$163.39,$258.80,$261.42,$0.00,$0.00,$0.00,$0.00,$0.00
11291,ERX,HCPCS 25000001,67457-0445-60,RIFAMPIN 600 MG IV SOLR,$326.77,$0.00,$326.77,$0.00,$233.22,$0.00,$0.00,$0.00,$0.00,$0.00,$326.77,$0.00,$163.39,$258.80,$261.42,$0.00,$0.00,$0.00,$0.00,$0.00
11293,ERX,HCPCS 63700001,00527-1315-01,RIFAMPIN 300 MG PO CAPS,$7.23,$0.00,$7.23,$0.00,$5.16,$0.00,$0.00,$0.00,$0.00,$0.00,$7.23,$0.00,$3.62,$5.73,$5.78,$0.00,$0.00,$0.00,$0.00,$0.00
11293,ERX,HCPCS 63700001,00527-1315-06,RIFAMPIN 300 MG PO CAPS,$7.23,$0.00,$7.23,$0.00,$5.16,$0.00,$0.00,$0.00,$0.00,$0.00,$7.23,$0.00,$3.62,$5.73,$5.78,$0.00,$0.00,$0.00,$0.00,$0.00
11293,ERX,HCPCS 63700001,61748-0018-01,RIFAMPIN 300 MG PO CAPS,$7.23,$0.00,$7.23,$0.00,$5.16,$0.00,$0.00,$0.00,$0.00,$0.00,$7.23,$0.00,$3.62,$5.73,$5.78,$0.00,$0.00,$0.00,$0.00,$0.00
11293,ERX,HCPCS 63700001,63739-0415-10,RIFAMPIN 300 MG PO CAPS,$7.23,$0.00,$7.23,$0.00,$5.16,$0.00,$0.00,$0.00,$0.00,$0.00,$7.23,$0.00,$3.62,$5.73,$5.78,$0.00,$0.00,$0.00,$0.00,$0.00
11308,ERX,HCPCS 25000001,11086-0030-10,SALICYLIC ACID 6 % EX GEL,$193.41,$0.00,$193.41,$0.00,$138.04,$0.00,$0.00,$0.00,$0.00,$0.00,$193.41,$0.00,$96.71,$153.18,$154.73,$0.00,$0.00,$0.00,$0.00,$0.00
11323,ERX,HCPCS 25000001,11017-0252-20,SALICYLIC ACID 17 % EX SOLN,$23.06,$0.00,$23.06,$0.00,$16.46,$0.00,$0.00,$0.00,$0.00,$0.00,$23.06,$0.00,$11.53,$18.26,$18.45,$0.00,$0.00,$0.00,$0.00,$0.00
11340,ERX,HCPCS 63700001,60505-3438-03,SELEGILINE HCL 5 MG PO TABS,$7.99,$0.00,$7.99,$0.00,$5.70,$0.00,$0.00,$0.00,$0.00,$0.00,$7.99,$0.00,$4.00,$6.33,$6.39,$0.00,$0.00,$0.00,$0.00,$0.00
11349,ERX,HCPCS 63700001,00904-6522-61,SENNOSIDES 8.6 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
11349,ERX,HCPCS 63700001,57896-0451-01,SENNOSIDES 8.6 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
11349,ERX,HCPCS 63700001,70677-0041-01,SENNOSIDES 8.6 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
11349,ERX,HCPCS 63700001,70677-0058-01,SENNOSIDES 8.6 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
11350,ERX,HCPCS 63700001,16714-0613-04,SERTRALINE HCL 100 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
11350,ERX,HCPCS 63700001,16714-0613-06,SERTRALINE HCL 100 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
11350,ERX,HCPCS 63700001,60687-0253-01,SERTRALINE HCL 100 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
11351,ERX,HCPCS 63700001,60687-0242-01,SERTRALINE HCL 50 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
11351,ERX,HCPCS 63700001,60687-0242-11,SERTRALINE HCL 50 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
11351,ERX,HCPCS 63700001,69097-0834-02,SERTRALINE HCL 50 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
11351,ERX,HCPCS 63700001,76282-0213-60,SERTRALINE HCL 50 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
11351,ERX,HCPCS 63700001,76282-0213-90,SERTRALINE HCL 50 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
11359,ERX,HCPCS 25000001,12870-0001-01,SILVER NITRATE-POT NITRATE 75-25 % EX MISC,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
11359,ERX,HCPCS 25000001,12870-0001-02,SILVER NITRATE-POT NITRATE 75-25 % EX MISC,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
11364,ERX,HCPCS 63700001,16714-0682-02,SIMVASTATIN 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
11364,ERX,HCPCS 63700001,63739-0571-10,SIMVASTATIN 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
11365,ERX,HCPCS 63700001,16714-0683-01,SIMVASTATIN 20 MG PO TABS,$18.70,$0.00,$18.70,$0.00,$13.35,$0.00,$0.00,$0.00,$0.00,$0.00,$18.70,$0.00,$9.35,$14.81,$14.96,$0.00,$0.00,$0.00,$0.00,$0.00
11365,ERX,HCPCS 63700001,63739-0572-10,SIMVASTATIN 20 MG PO TABS,$18.70,$0.00,$18.70,$0.00,$13.35,$0.00,$0.00,$0.00,$0.00,$0.00,$18.70,$0.00,$9.35,$14.81,$14.96,$0.00,$0.00,$0.00,$0.00,$0.00
11365,ERX,HCPCS 63700001,68084-0512-01,SIMVASTATIN 20 MG PO TABS,$18.70,$0.00,$18.70,$0.00,$13.35,$0.00,$0.00,$0.00,$0.00,$0.00,$18.70,$0.00,$9.35,$14.81,$14.96,$0.00,$0.00,$0.00,$0.00,$0.00
11366,ERX,HCPCS 63700001,60687-0210-01,SIMVASTATIN 40 MG PO TABS,$18.70,$0.00,$18.70,$0.00,$13.35,$0.00,$0.00,$0.00,$0.00,$0.00,$18.70,$0.00,$9.35,$14.81,$14.96,$0.00,$0.00,$0.00,$0.00,$0.00
11366,ERX,HCPCS 63700001,60687-0210-11,SIMVASTATIN 40 MG PO TABS,$18.70,$0.00,$18.70,$0.00,$13.35,$0.00,$0.00,$0.00,$0.00,$0.00,$18.70,$0.00,$9.35,$14.81,$14.96,$0.00,$0.00,$0.00,$0.00,$0.00
11366,ERX,HCPCS 63700001,63739-0573-10,SIMVASTATIN 40 MG PO TABS,$18.70,$0.00,$18.70,$0.00,$13.35,$0.00,$0.00,$0.00,$0.00,$0.00,$18.70,$0.00,$9.35,$14.81,$14.96,$0.00,$0.00,$0.00,$0.00,$0.00
11366,ERX,HCPCS 63700001,68180-0464-09,SIMVASTATIN 40 MG PO TABS,$18.70,$0.00,$18.70,$0.00,$13.35,$0.00,$0.00,$0.00,$0.00,$0.00,$18.70,$0.00,$9.35,$14.81,$14.96,$0.00,$0.00,$0.00,$0.00,$0.00
11367,ERX,HCPCS 63700001,63739-0570-10,SIMVASTATIN 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
11394,ERX,HCPCS 25000001,00121-0595-16,SOD CITRATE-CITRIC ACID 500-334 MG/5ML PO SOLN,$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
11394,ERX,HCPCS 25000001,00121-1190-00,SOD CITRATE-CITRIC ACID 500-334 MG/5ML PO SOLN,$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
11400,ERX,HCPCS 25000001,00409-6609-25,SODIUM BICARBONATE 4 % IV SOLN,$34.79,$0.00,$34.79,$0.00,$24.83,$0.00,$0.00,$0.00,$0.00,$0.00,$34.79,$0.00,$17.40,$27.55,$27.83,$0.00,$0.00,$0.00,$0.00,$0.00
11403,ERX,HCPCS 25000001,00338-0048-04,SODIUM CHLORIDE 0.9 % IR SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
11403,ERX,HCPCS 25000001,00264-2201-10,SODIUM CHLORIDE 0.9 % IR SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
11403,ERX,HCPCS 25000001,00338-0048-03,SODIUM CHLORIDE 0.9 % IR SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
11403,ERX,HCPCS 25000001,99999-6011-64,SODIUM CHLORIDE 0.9 % IR SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
11418,ERX,HCPCS J2941,00002-7335-11,SOMATROPIN (HUMATROPE) 5 MG IJ SOLR,"$1,929.32",$0.00,"$1,929.32",$0.00,"$1,376.96",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,929.32",$0.00,$964.66,"$1,528.02","$1,543.46",$0.00,$0.00,$0.00,$0.00,$0.00
11420,ERX,HCPCS 63700001,00093-1063-01,SOTALOL HCL 240 MG PO TABS,$19.35,$0.00,$19.35,$0.00,$13.81,$0.00,$0.00,$0.00,$0.00,$0.00,$19.35,$0.00,$9.68,$15.33,$15.48,$0.00,$0.00,$0.00,$0.00,$0.00
11420,ERX,HCPCS 63700001,60505-0082-00,SOTALOL HCL 240 MG PO TABS,$19.35,$0.00,$19.35,$0.00,$13.81,$0.00,$0.00,$0.00,$0.00,$0.00,$19.35,$0.00,$9.68,$15.33,$15.48,$0.00,$0.00,$0.00,$0.00,$0.00
11421,ERX,HCPCS 63700001,60505-0080-00,SOTALOL HCL 80 MG PO TABS,$8.82,$0.00,$8.82,$0.00,$6.29,$0.00,$0.00,$0.00,$0.00,$0.00,$8.82,$0.00,$4.41,$6.99,$7.06,$0.00,$0.00,$0.00,$0.00,$0.00
11421,ERX,HCPCS 63700001,68084-0654-01,SOTALOL HCL 80 MG PO TABS,$8.82,$0.00,$8.82,$0.00,$6.29,$0.00,$0.00,$0.00,$0.00,$0.00,$8.82,$0.00,$4.41,$6.99,$7.06,$0.00,$0.00,$0.00,$0.00,$0.00
11425,ERX,HCPCS 63700001,53746-0515-01,SPIRONOLACTONE 100 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
11425,ERX,HCPCS 63700001,59746-0218-01,SPIRONOLACTONE 100 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
11425,ERX,HCPCS 63700001,60687-0487-01,SPIRONOLACTONE 100 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
11425,ERX,HCPCS 63700001,60687-0487-11,SPIRONOLACTONE 100 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
11436,ERX,HCPCS J9320,00703-4636-01,STREPTOZOCIN 1 G IV SOLR,"$1,110.57",$0.00,"$1,110.57",$0.00,$792.61,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,110.57",$0.00,$555.29,$879.57,$888.46,$0.00,$0.00,$0.00,$0.00,$0.00
11438,ERX,HCPCS 63700001,55292-0201-11,SUCCIMER 100 MG PO CAPS,$80.16,$0.00,$80.16,$0.00,$57.21,$0.00,$0.00,$0.00,$0.00,$0.00,$80.16,$0.00,$40.08,$63.49,$64.13,$0.00,$0.00,$0.00,$0.00,$0.00
11441,ERX,HCPCS 63700001,00121-0747-10,SUCRALFATE 1 GM/10ML PO SUSP,$53.24,$0.00,$53.24,$0.00,$38.00,$0.00,$0.00,$0.00,$0.00,$0.00,$53.24,$0.00,$26.62,$42.17,$42.59,$0.00,$0.00,$0.00,$0.00,$0.00
11441,ERX,HCPCS 63700001,00121-0747-40,SUCRALFATE 1 GM/10ML PO SUSP,$53.24,$0.00,$53.24,$0.00,$38.00,$0.00,$0.00,$0.00,$0.00,$0.00,$53.24,$0.00,$26.62,$42.17,$42.59,$0.00,$0.00,$0.00,$0.00,$0.00
11441,ERX,HCPCS 63700001,58914-0170-14,SUCRALFATE 1 GM/10ML PO SUSP,$53.24,$0.00,$53.24,$0.00,$38.00,$0.00,$0.00,$0.00,$0.00,$0.00,$53.24,$0.00,$26.62,$42.17,$42.59,$0.00,$0.00,$0.00,$0.00,$0.00
11441,ERX,HCPCS 63700001,66689-0790-01,SUCRALFATE 1 GM/10ML PO SUSP,$53.24,$0.00,$53.24,$0.00,$38.00,$0.00,$0.00,$0.00,$0.00,$0.00,$53.24,$0.00,$26.62,$42.17,$42.59,$0.00,$0.00,$0.00,$0.00,$0.00
11441,ERX,HCPCS 63700001,66689-0790-50,SUCRALFATE 1 GM/10ML PO SUSP,$53.24,$0.00,$53.24,$0.00,$38.00,$0.00,$0.00,$0.00,$0.00,$0.00,$53.24,$0.00,$26.62,$42.17,$42.59,$0.00,$0.00,$0.00,$0.00,$0.00
11442,ERX,HCPCS 63700001,00093-2210-01,SUCRALFATE 1 G PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
11442,ERX,HCPCS 63700001,00093-2210-05,SUCRALFATE 1 G PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
11442,ERX,HCPCS 63700001,00093-2210-98,SUCRALFATE 1 G PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
11442,ERX,HCPCS 63700001,51079-0753-20,SUCRALFATE 1 G PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
11442,ERX,HCPCS 63700001,59762-0401-01,SUCRALFATE 1 G PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
11442,ERX,HCPCS 63700001,63739-0943-10,SUCRALFATE 1 G PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
11498,ERX,HCPCS 25000001,00591-2473-19,TAMOXIFEN CITRATE 20 MG PO TABS,$57.00,$0.00,$57.00,$0.00,$40.68,$0.00,$0.00,$0.00,$0.00,$0.00,$57.00,$0.00,$28.50,$45.14,$45.60,$0.00,$0.00,$0.00,$0.00,$0.00
11498,ERX,HCPCS 25000001,51862-0446-01,TAMOXIFEN CITRATE 20 MG PO TABS,$57.00,$0.00,$57.00,$0.00,$40.68,$0.00,$0.00,$0.00,$0.00,$0.00,$57.00,$0.00,$28.50,$45.14,$45.60,$0.00,$0.00,$0.00,$0.00,$0.00
11498,ERX,HCPCS 25000001,51862-0446-30,TAMOXIFEN CITRATE 20 MG PO TABS,$57.00,$0.00,$57.00,$0.00,$40.68,$0.00,$0.00,$0.00,$0.00,$0.00,$57.00,$0.00,$28.50,$45.14,$45.60,$0.00,$0.00,$0.00,$0.00,$0.00
11498,ERX,HCPCS 25000001,68382-0827-01,TAMOXIFEN CITRATE 20 MG PO TABS,$57.00,$0.00,$57.00,$0.00,$40.68,$0.00,$0.00,$0.00,$0.00,$0.00,$57.00,$0.00,$28.50,$45.14,$45.60,$0.00,$0.00,$0.00,$0.00,$0.00
11501,ERX,HCPCS Q2017,44567-0507-01,TENIPOSIDE 10 MG/ML IV SOLN,"$6,140.04",$0.00,"$6,140.04",$0.00,"$4,382.15",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,140.04",$0.00,"$3,070.02","$4,862.91","$4,912.03",$0.00,$0.00,$0.00,$0.00,$0.00
11507,ERX,HCPCS J3105,00143-9746-01,TERBUTALINE SULFATE 1 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$2.94,$0.00,$0.00,$2.49,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$2.49,$0.00,$2.37,$0.00
11507,ERX,HCPCS J3105,00143-9746-10,TERBUTALINE SULFATE 1 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$2.94,$0.00,$0.00,$2.49,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$2.49,$0.00,$2.37,$0.00
11507,ERX,HCPCS J3105,63323-0665-01,TERBUTALINE SULFATE 1 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$2.94,$0.00,$0.00,$2.49,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$2.49,$0.00,$2.37,$0.00
11507,ERX,HCPCS J3105,70860-0801-01,TERBUTALINE SULFATE 1 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$2.94,$0.00,$0.00,$2.49,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$2.49,$0.00,$2.37,$0.00
11508,ERX,HCPCS 63700001,00115-2611-01,TERBUTALINE SULFATE 2.5 MG PO TABS,$52.18,$0.00,$52.18,$0.00,$37.24,$0.00,$0.00,$0.00,$0.00,$0.00,$52.18,$0.00,$26.09,$41.33,$41.74,$0.00,$0.00,$0.00,$0.00,$0.00
11508,ERX,HCPCS 63700001,00527-1318-01,TERBUTALINE SULFATE 2.5 MG PO TABS,$52.18,$0.00,$52.18,$0.00,$37.24,$0.00,$0.00,$0.00,$0.00,$0.00,$52.18,$0.00,$26.09,$41.33,$41.74,$0.00,$0.00,$0.00,$0.00,$0.00
11508,ERX,HCPCS 63700001,10135-0579-01,TERBUTALINE SULFATE 2.5 MG PO TABS,$52.18,$0.00,$52.18,$0.00,$37.24,$0.00,$0.00,$0.00,$0.00,$0.00,$52.18,$0.00,$26.09,$41.33,$41.74,$0.00,$0.00,$0.00,$0.00,$0.00
11508,ERX,HCPCS 63700001,62559-0721-01,TERBUTALINE SULFATE 2.5 MG PO TABS,$52.18,$0.00,$52.18,$0.00,$37.24,$0.00,$0.00,$0.00,$0.00,$0.00,$52.18,$0.00,$26.09,$41.33,$41.74,$0.00,$0.00,$0.00,$0.00,$0.00
11509,ERX,HCPCS 63700001,00115-2622-01,TERBUTALINE SULFATE 5 MG PO TABS,$63.72,$0.00,$63.72,$0.00,$45.48,$0.00,$0.00,$0.00,$0.00,$0.00,$63.72,$0.00,$31.86,$50.47,$50.98,$0.00,$0.00,$0.00,$0.00,$0.00
11509,ERX,HCPCS 63700001,00527-1311-01,TERBUTALINE SULFATE 5 MG PO TABS,$63.72,$0.00,$63.72,$0.00,$45.48,$0.00,$0.00,$0.00,$0.00,$0.00,$63.72,$0.00,$31.86,$50.47,$50.98,$0.00,$0.00,$0.00,$0.00,$0.00
11509,ERX,HCPCS 63700001,10135-0580-01,TERBUTALINE SULFATE 5 MG PO TABS,$63.72,$0.00,$63.72,$0.00,$45.48,$0.00,$0.00,$0.00,$0.00,$0.00,$63.72,$0.00,$31.86,$50.47,$50.98,$0.00,$0.00,$0.00,$0.00,$0.00
11509,ERX,HCPCS 63700001,62559-0722-01,TERBUTALINE SULFATE 5 MG PO TABS,$63.72,$0.00,$63.72,$0.00,$45.48,$0.00,$0.00,$0.00,$0.00,$0.00,$63.72,$0.00,$31.86,$50.47,$50.98,$0.00,$0.00,$0.00,$0.00,$0.00
11510,ERX,HCPCS 63700001,00168-0346-46,TERCONAZOLE 0.4 % VA CREA,$155.93,$0.00,$155.93,$0.00,$111.29,$0.00,$0.00,$0.00,$0.00,$0.00,$155.93,$0.00,$77.97,$123.50,$124.74,$0.00,$0.00,$0.00,$0.00,$0.00
11510,ERX,HCPCS 63700001,51672-1304-06,TERCONAZOLE 0.4 % VA CREA,$155.93,$0.00,$155.93,$0.00,$111.29,$0.00,$0.00,$0.00,$0.00,$0.00,$155.93,$0.00,$77.97,$123.50,$124.74,$0.00,$0.00,$0.00,$0.00,$0.00
11511,ERX,HCPCS 63700001,51672-1302-00,TERCONAZOLE 0.8 % VA CREA,$143.29,$0.00,$143.29,$0.00,$102.27,$0.00,$0.00,$0.00,$0.00,$0.00,$143.29,$0.00,$71.65,$113.49,$114.63,$0.00,$0.00,$0.00,$0.00,$0.00
11512,ERX,HCPCS 63700001,45802-0717-08,TERCONAZOLE 80 MG VA SUPP,$114.20,$0.00,$114.20,$0.00,$81.50,$0.00,$0.00,$0.00,$0.00,$0.00,$114.20,$0.00,$57.10,$90.45,$91.36,$0.00,$0.00,$0.00,$0.00,$0.00
11517,ERX,HCPCS 25000001,17478-0045-32,TETRACAINE HCL 1 % IJ SOLN,$159.48,$0.00,$159.48,$0.00,$113.82,$0.00,$0.00,$0.00,$0.00,$0.00,$159.48,$0.00,$79.74,$126.31,$127.58,$0.00,$0.00,$0.00,$0.00,$0.00
11562,ERX,HCPCS 25000001,17478-0288-10,TIMOLOL MALEATE 0.5 % OP SOLN,$64.60,$0.00,$64.60,$0.00,$46.11,$0.00,$0.00,$0.00,$0.00,$0.00,$64.60,$0.00,$32.30,$51.16,$51.68,$0.00,$0.00,$0.00,$0.00,$0.00
11562,ERX,HCPCS 25000001,61314-0227-05,TIMOLOL MALEATE 0.5 % OP SOLN,$64.60,$0.00,$64.60,$0.00,$46.11,$0.00,$0.00,$0.00,$0.00,$0.00,$64.60,$0.00,$32.30,$51.16,$51.68,$0.00,$0.00,$0.00,$0.00,$0.00
11562,ERX,HCPCS 25000001,64980-0514-05,TIMOLOL MALEATE 0.5 % OP SOLN,$64.60,$0.00,$64.60,$0.00,$46.11,$0.00,$0.00,$0.00,$0.00,$0.00,$64.60,$0.00,$32.30,$51.16,$51.68,$0.00,$0.00,$0.00,$0.00,$0.00
11565,ERX,HCPCS J3260,39822-0412-01,TOBRAMYCIN SULFATE 1.2 G IJ SOLR,$579.69,$0.00,$579.69,$260.86,$413.72,$0.00,$38.42,$0.00,$0.00,$65.04,$579.69,$0.00,$289.85,$459.11,$463.75,$0.00,$65.04,$0.00,$61.93,$0.00
11565,ERX,HCPCS J3260,39822-0412-06,TOBRAMYCIN SULFATE 1.2 G IJ SOLR,$579.69,$0.00,$579.69,$260.86,$413.72,$0.00,$38.42,$0.00,$0.00,$65.04,$579.69,$0.00,$289.85,$459.11,$463.75,$0.00,$65.04,$0.00,$61.93,$0.00
11565,ERX,HCPCS J3260,63323-0303-51,TOBRAMYCIN SULFATE 1.2 G IJ SOLR,$579.69,$0.00,$579.69,$260.86,$413.72,$0.00,$38.42,$0.00,$0.00,$65.04,$579.69,$0.00,$289.85,$459.11,$463.75,$0.00,$65.04,$0.00,$61.93,$0.00
11565,ERX,HCPCS J3260,63323-0303-55,TOBRAMYCIN SULFATE 1.2 G IJ SOLR,$579.69,$0.00,$579.69,$260.86,$413.72,$0.00,$38.42,$0.00,$0.00,$65.04,$579.69,$0.00,$289.85,$459.11,$463.75,$0.00,$65.04,$0.00,$61.93,$0.00
11566,ERX,HCPCS 25000001,00065-0648-35,TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OP OINT,$725.71,$0.00,$725.71,$0.00,$517.94,$0.00,$0.00,$0.00,$0.00,$0.00,$725.71,$0.00,$362.86,$574.76,$580.57,$0.00,$0.00,$0.00,$0.00,$0.00
11567,ERX,HCPCS 25000001,00065-0647-25,TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OP SUSP,$299.32,$0.00,$299.32,$0.00,$213.62,$0.00,$0.00,$0.00,$0.00,$0.00,$299.32,$0.00,$149.66,$237.06,$239.46,$0.00,$0.00,$0.00,$0.00,$0.00
11567,ERX,HCPCS 25000001,61314-0647-25,TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OP SUSP,$299.32,$0.00,$299.32,$0.00,$213.62,$0.00,$0.00,$0.00,$0.00,$0.00,$299.32,$0.00,$149.66,$237.06,$239.46,$0.00,$0.00,$0.00,$0.00,$0.00
11576,ERX,HCPCS 25000001,00472-0117-20,TRETINOIN 0.025 % EX CREA,$389.12,$0.00,$389.12,$0.00,$277.71,$0.00,$0.00,$0.00,$0.00,$0.00,$389.12,$0.00,$194.56,$308.18,$311.30,$0.00,$0.00,$0.00,$0.00,$0.00
11577,ERX,HCPCS 25000001,00187-5162-20,TRETINOIN 0.05 % EX CREA,$299.25,$0.00,$299.25,$0.00,$213.57,$0.00,$0.00,$0.00,$0.00,$0.00,$299.25,$0.00,$149.63,$237.01,$239.40,$0.00,$0.00,$0.00,$0.00,$0.00
11577,ERX,HCPCS 25000001,00574-2205-20,TRETINOIN 0.05 % EX CREA,$299.25,$0.00,$299.25,$0.00,$213.57,$0.00,$0.00,$0.00,$0.00,$0.00,$299.25,$0.00,$149.63,$237.01,$239.40,$0.00,$0.00,$0.00,$0.00,$0.00
11578,ERX,HCPCS 25000001,00187-5164-20,TRETINOIN 0.1 % EX CREA,$299.25,$0.00,$299.25,$0.00,$213.57,$0.00,$0.00,$0.00,$0.00,$0.00,$299.25,$0.00,$149.63,$237.01,$239.40,$0.00,$0.00,$0.00,$0.00,$0.00
11584,ERX,HCPCS J3301,00003-0494-20,TRIAMCINOLONE ACETONIDE 10 MG/ML IJ SUSP,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.77,$0.00,$0.00,$1.83,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.83,$0.00,$1.75,$0.00
11589,ERX,HCPCS 25000001,10481-3008-01,TRICHLOROACETIC ACID 80 % EX LIQD,$244.15,$0.00,$244.15,$0.00,$174.25,$0.00,$0.00,$0.00,$0.00,$0.00,$244.15,$0.00,$122.08,$193.37,$195.32,$0.00,$0.00,$0.00,$0.00,$0.00
11595,ERX,HCPCS 25000001,61314-0044-75,TRIFLURIDINE 1 % OP SOLN,$590.79,$0.00,$590.79,$0.00,$421.65,$0.00,$0.00,$0.00,$0.00,$0.00,$590.79,$0.00,$295.40,$467.91,$472.63,$0.00,$0.00,$0.00,$0.00,$0.00
11596,ERX,HCPCS 25000001,17478-0703-11,POLYMYXIN B-TRIMETHOPRIM 10000-0.1 UNIT/ML-% OP SOLN,$51.08,$0.00,$51.08,$0.00,$36.46,$0.00,$0.00,$0.00,$0.00,$0.00,$51.08,$0.00,$25.54,$40.46,$40.86,$0.00,$0.00,$0.00,$0.00,$0.00
11596,ERX,HCPCS 25000001,24208-0315-10,POLYMYXIN B-TRIMETHOPRIM 10000-0.1 UNIT/ML-% OP SOLN,$51.08,$0.00,$51.08,$0.00,$36.46,$0.00,$0.00,$0.00,$0.00,$0.00,$51.08,$0.00,$25.54,$40.46,$40.86,$0.00,$0.00,$0.00,$0.00,$0.00
11596,ERX,HCPCS 25000001,60758-0908-10,POLYMYXIN B-TRIMETHOPRIM 10000-0.1 UNIT/ML-% OP SOLN,$51.08,$0.00,$51.08,$0.00,$36.46,$0.00,$0.00,$0.00,$0.00,$0.00,$51.08,$0.00,$25.54,$40.46,$40.86,$0.00,$0.00,$0.00,$0.00,$0.00
11596,ERX,HCPCS 25000001,61314-0628-10,POLYMYXIN B-TRIMETHOPRIM 10000-0.1 UNIT/ML-% OP SOLN,$51.08,$0.00,$51.08,$0.00,$36.46,$0.00,$0.00,$0.00,$0.00,$0.00,$51.08,$0.00,$25.54,$40.46,$40.86,$0.00,$0.00,$0.00,$0.00,$0.00
11599,ERX,HCPCS 63700001,00904-2725-61,SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
11599,ERX,HCPCS 63700001,57237-0233-05,SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
11599,ERX,HCPCS 63700001,63739-0228-10,SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
11624,ERX,HCPCS 63700001,00591-3159-01,URSODIOL 300 MG PO CAPS,$29.04,$0.00,$29.04,$0.00,$20.73,$0.00,$0.00,$0.00,$0.00,$0.00,$29.04,$0.00,$14.52,$23.00,$23.23,$0.00,$0.00,$0.00,$0.00,$0.00
11624,ERX,HCPCS 63700001,42806-0503-01,URSODIOL 300 MG PO CAPS,$29.04,$0.00,$29.04,$0.00,$20.73,$0.00,$0.00,$0.00,$0.00,$0.00,$29.04,$0.00,$14.52,$23.00,$23.23,$0.00,$0.00,$0.00,$0.00,$0.00
11624,ERX,HCPCS 63700001,51079-0383-01,URSODIOL 300 MG PO CAPS,$29.04,$0.00,$29.04,$0.00,$20.73,$0.00,$0.00,$0.00,$0.00,$0.00,$29.04,$0.00,$14.52,$23.00,$23.23,$0.00,$0.00,$0.00,$0.00,$0.00
11627,ERX,HCPCS J3370,00143-9359-01,VANCOMYCIN HCL 10 G IV SOLR,$680.55,$0.00,$680.55,$306.25,$485.71,$0.00,$72.38,$0.00,$0.00,$79.67,$680.55,$0.00,$340.28,$539.00,$544.44,$0.00,$79.67,$0.00,$75.85,$0.00
11627,ERX,HCPCS J3370,00409-6510-01,VANCOMYCIN HCL 10 G IV SOLR,$680.55,$0.00,$680.55,$306.25,$485.71,$0.00,$72.38,$0.00,$0.00,$79.67,$680.55,$0.00,$340.28,$539.00,$544.44,$0.00,$79.67,$0.00,$75.85,$0.00
11627,ERX,HCPCS J3370,25021-0158-99,VANCOMYCIN HCL 10 G IV SOLR,$680.55,$0.00,$680.55,$306.25,$485.71,$0.00,$72.38,$0.00,$0.00,$79.67,$680.55,$0.00,$340.28,$539.00,$544.44,$0.00,$79.67,$0.00,$75.85,$0.00
11627,ERX,HCPCS J3370,63323-0314-61,VANCOMYCIN HCL 10 G IV SOLR,$680.55,$0.00,$680.55,$306.25,$485.71,$0.00,$72.38,$0.00,$0.00,$79.67,$680.55,$0.00,$340.28,$539.00,$544.44,$0.00,$79.67,$0.00,$75.85,$0.00
11627,ERX,HCPCS J3370,67457-0342-10,VANCOMYCIN HCL 10 G IV SOLR,$680.55,$0.00,$680.55,$306.25,$485.71,$0.00,$72.38,$0.00,$0.00,$79.67,$680.55,$0.00,$340.28,$539.00,$544.44,$0.00,$79.67,$0.00,$75.85,$0.00
11628,ERX,HCPCS 63700001,47781-0729-02,VANCOMYCIN HCL 125 MG PO CAPS,$109.64,$0.00,$109.64,$0.00,$78.25,$0.00,$0.00,$0.00,$0.00,$0.00,$109.64,$0.00,$54.82,$86.83,$87.71,$0.00,$0.00,$0.00,$0.00,$0.00
11634,ERX,HCPCS 25000001,00409-1632-01,VECURONIUM BROMIDE 10 MG IV SOLR,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
11634,ERX,HCPCS 25000001,00409-1632-21,VECURONIUM BROMIDE 10 MG IV SOLR,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
11634,ERX,HCPCS 25000001,00703-2914-01,VECURONIUM BROMIDE 10 MG IV SOLR,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
11634,ERX,HCPCS 25000001,00703-2914-03,VECURONIUM BROMIDE 10 MG IV SOLR,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
11634,ERX,HCPCS 25000001,47335-0931-40,VECURONIUM BROMIDE 10 MG IV SOLR,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
11634,ERX,HCPCS 25000001,47335-0931-44,VECURONIUM BROMIDE 10 MG IV SOLR,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
11634,ERX,HCPCS 25000001,63323-0781-10,VECURONIUM BROMIDE 10 MG IV SOLR,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
11634,ERX,HCPCS 25000001,67457-0438-00,VECURONIUM BROMIDE 10 MG IV SOLR,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
11634,ERX,HCPCS 25000001,67457-0438-10,VECURONIUM BROMIDE 10 MG IV SOLR,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
11641,ERX,HCPCS 25000001,61703-0418-18,VITAMIN A 15 MG/ML IM SOLN,$422.73,$0.00,$422.73,$0.00,$301.70,$0.00,$0.00,$0.00,$0.00,$0.00,$422.73,$0.00,$211.37,$334.80,$338.18,$0.00,$0.00,$0.00,$0.00,$0.00
11664,ERX,HCPCS 63700001,00832-1211-01,WARFARIN SODIUM 1 MG PO TABS,$28.16,$0.00,$28.16,$0.00,$20.10,$0.00,$0.00,$0.00,$0.00,$0.00,$28.16,$0.00,$14.08,$22.30,$22.53,$0.00,$0.00,$0.00,$0.00,$0.00
11664,ERX,HCPCS 63700001,00832-1211-89,WARFARIN SODIUM 1 MG PO TABS,$28.16,$0.00,$28.16,$0.00,$20.10,$0.00,$0.00,$0.00,$0.00,$0.00,$28.16,$0.00,$14.08,$22.30,$22.53,$0.00,$0.00,$0.00,$0.00,$0.00
11691,ERX,HCPCS J3485,49702-0213-26,ZIDOVUDINE 10 MG/ML IV SOLN,$122.57,$0.00,$122.57,$0.00,$87.48,$0.00,$0.00,$0.00,$0.00,$0.00,$122.57,$0.00,$61.29,$97.08,$98.06,$0.00,$0.00,$0.00,$0.00,$0.00
11692,ERX,HCPCS 63700001,65862-0107-01,ZIDOVUDINE 100 MG PO CAPS,$7.68,$0.00,$7.68,$0.00,$5.48,$0.00,$0.00,$0.00,$0.00,$0.00,$7.68,$0.00,$3.84,$6.08,$6.14,$0.00,$0.00,$0.00,$0.00,$0.00
11700,ERX,HCPCS 63700001,63739-0526-10,ZOLPIDEM TARTRATE 10 MG PO TABS,$17.66,$0.00,$17.66,$0.00,$12.60,$0.00,$0.00,$0.00,$0.00,$0.00,$17.66,$0.00,$8.83,$13.99,$14.13,$0.00,$0.00,$0.00,$0.00,$0.00
11701,ERX,HCPCS 63700001,00904-6082-61,ZOLPIDEM TARTRATE 5 MG PO TABS,$17.56,$0.00,$17.56,$0.00,$12.53,$0.00,$0.00,$0.00,$0.00,$0.00,$17.56,$0.00,$8.78,$13.91,$14.05,$0.00,$0.00,$0.00,$0.00,$0.00
11701,ERX,HCPCS 63700001,16714-0621-01,ZOLPIDEM TARTRATE 5 MG PO TABS,$17.56,$0.00,$17.56,$0.00,$12.53,$0.00,$0.00,$0.00,$0.00,$0.00,$17.56,$0.00,$8.78,$13.91,$14.05,$0.00,$0.00,$0.00,$0.00,$0.00
11701,ERX,HCPCS 63700001,68084-0189-01,ZOLPIDEM TARTRATE 5 MG PO TABS,$17.56,$0.00,$17.56,$0.00,$12.53,$0.00,$0.00,$0.00,$0.00,$0.00,$17.56,$0.00,$8.78,$13.91,$14.05,$0.00,$0.00,$0.00,$0.00,$0.00
11701,ERX,HCPCS 63700001,68084-0189-11,ZOLPIDEM TARTRATE 5 MG PO TABS,$17.56,$0.00,$17.56,$0.00,$12.53,$0.00,$0.00,$0.00,$0.00,$0.00,$17.56,$0.00,$8.78,$13.91,$14.05,$0.00,$0.00,$0.00,$0.00,$0.00
11930,ERX,HCPCS 25000001,00065-0345-10,LODOXAMIDE TROMETHAMINE 0.1 % OP SOLN,$544.00,$0.00,$544.00,$0.00,$388.25,$0.00,$0.00,$0.00,$0.00,$0.00,$544.00,$0.00,$272.00,$430.85,$435.20,$0.00,$0.00,$0.00,$0.00,$0.00
11931,ERX,HCPCS 90648,49281-0545-03,HAEMOPHILUS B POLYSAC CONJ VAC IM SOLR,$71.47,$0.00,$71.47,$32.16,$51.01,$0.00,$12.31,$0.00,$0.00,$12.51,$71.47,$0.00,$35.74,$56.60,$57.18,$0.00,$11.19,$0.00,$11.38,$0.00
11934,ERX,HCPCS 25000001,00168-0357-56,LIDOCAINE-PRILOCAINE 2.5-2.5 % EX KIT,$173.53,$0.00,$173.53,$0.00,$123.85,$0.00,$0.00,$0.00,$0.00,$0.00,$173.53,$0.00,$86.77,$137.44,$138.82,$0.00,$0.00,$0.00,$0.00,$0.00
12025,ERX,HCPCS 63700001,50268-0523-15,MECLIZINE HCL 25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
12025,ERX,HCPCS 63700001,68084-0491-01,MECLIZINE HCL 25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
12025,ERX,HCPCS 63700001,68084-0491-11,MECLIZINE HCL 25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
12203,ERX,HCPCS 63700001,16714-0311-01,VENLAFAXINE HCL 25 MG PO TABS,$7.39,$0.00,$7.39,$0.00,$5.27,$0.00,$0.00,$0.00,$0.00,$0.00,$7.39,$0.00,$3.70,$5.85,$5.91,$0.00,$0.00,$0.00,$0.00,$0.00
12203,ERX,HCPCS 63700001,50268-0798-15,VENLAFAXINE HCL 25 MG PO TABS,$7.39,$0.00,$7.39,$0.00,$5.27,$0.00,$0.00,$0.00,$0.00,$0.00,$7.39,$0.00,$3.70,$5.85,$5.91,$0.00,$0.00,$0.00,$0.00,$0.00
12203,ERX,HCPCS 63700001,68084-0896-25,VENLAFAXINE HCL 25 MG PO TABS,$7.39,$0.00,$7.39,$0.00,$5.27,$0.00,$0.00,$0.00,$0.00,$0.00,$7.39,$0.00,$3.70,$5.85,$5.91,$0.00,$0.00,$0.00,$0.00,$0.00
12206,ERX,HCPCS 63700001,16714-0314-01,VENLAFAXINE HCL 75 MG PO TABS,$8.31,$0.00,$8.31,$0.00,$5.93,$0.00,$0.00,$0.00,$0.00,$0.00,$8.31,$0.00,$4.16,$6.58,$6.65,$0.00,$0.00,$0.00,$0.00,$0.00
12207,ERX,HCPCS 63700001,16714-0656-01,VENLAFAXINE HCL 37.5 MG PO TABS,$7.60,$0.00,$7.60,$0.00,$5.42,$0.00,$0.00,$0.00,$0.00,$0.00,$7.60,$0.00,$3.80,$6.02,$6.08,$0.00,$0.00,$0.00,$0.00,$0.00
12207,ERX,HCPCS 63700001,68084-0844-01,VENLAFAXINE HCL 37.5 MG PO TABS,$7.60,$0.00,$7.60,$0.00,$5.42,$0.00,$0.00,$0.00,$0.00,$0.00,$7.60,$0.00,$3.80,$6.02,$6.08,$0.00,$0.00,$0.00,$0.00,$0.00
12207,ERX,HCPCS 63700001,68084-0844-11,VENLAFAXINE HCL 37.5 MG PO TABS,$7.60,$0.00,$7.60,$0.00,$5.42,$0.00,$0.00,$0.00,$0.00,$0.00,$7.60,$0.00,$3.80,$6.02,$6.08,$0.00,$0.00,$0.00,$0.00,$0.00
12211,ERX,HCPCS J7639,50242-0100-39,DORNASE ALFA 1 MG/ML IN SOLN,$420.60,$0.00,$420.60,$0.00,$300.18,$0.00,$0.00,$0.00,$0.00,$0.00,$420.60,$0.00,$210.30,$333.12,$336.48,$0.00,$0.00,$0.00,$0.00,$0.00
12211,ERX,HCPCS J7639,50242-0100-40,DORNASE ALFA 1 MG/ML IN SOLN,$420.60,$0.00,$420.60,$0.00,$300.18,$0.00,$0.00,$0.00,$0.00,$0.00,$420.60,$0.00,$210.30,$333.12,$336.48,$0.00,$0.00,$0.00,$0.00,$0.00
12244,ERX,HCPCS 63700001,51672-4154-03,CALCIPOTRIENE 0.005 % EX OINT,"$1,014.90",$0.00,"$1,014.90",$0.00,$724.33,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,014.90",$0.00,$507.45,$803.80,$811.92,$0.00,$0.00,$0.00,$0.00,$0.00
12244,ERX,HCPCS 63700001,51672-5278-03,CALCIPOTRIENE 0.005 % EX OINT,"$1,014.90",$0.00,"$1,014.90",$0.00,$724.33,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,014.90",$0.00,$507.45,$803.80,$811.92,$0.00,$0.00,$0.00,$0.00,$0.00
12370,ERX,HCPCS 25000001,00143-9593-01,NICARDIPINE HCL 2.5 MG/ML IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
12370,ERX,HCPCS 25000001,00143-9593-10,NICARDIPINE HCL 2.5 MG/ML IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
12370,ERX,HCPCS 25000001,00143-9689-01,NICARDIPINE HCL 2.5 MG/ML IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
12370,ERX,HCPCS 25000001,00143-9689-10,NICARDIPINE HCL 2.5 MG/ML IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
12370,ERX,HCPCS 25000001,00517-0735-01,NICARDIPINE HCL 2.5 MG/ML IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
12411,ERX,HCPCS 63700001,00378-8020-93,FLUVASTATIN SODIUM 20 MG PO CAPS,$19.03,$0.00,$19.03,$0.00,$13.58,$0.00,$0.00,$0.00,$0.00,$0.00,$19.03,$0.00,$9.52,$15.07,$15.22,$0.00,$0.00,$0.00,$0.00,$0.00
12412,ERX,HCPCS 63700001,00093-7443-01,FLUVASTATIN SODIUM 40 MG PO CAPS,$18.99,$0.00,$18.99,$0.00,$13.55,$0.00,$0.00,$0.00,$0.00,$0.00,$18.99,$0.00,$9.50,$15.04,$15.19,$0.00,$0.00,$0.00,$0.00,$0.00
12556,ERX,HCPCS Q0163,49348-0045-34,DIPHENHYDRAMINE HCL 12.5 MG/5ML PO LIQD,$11.00,$0.00,$11.00,$4.95,$7.85,$0.00,$1.90,$0.00,$0.00,$1.93,$11.00,$0.00,$5.50,$8.71,$8.80,$0.00,$1.72,$0.00,$0.00,$0.00
12556,ERX,HCPCS Q0163,58602-0022-24,DIPHENHYDRAMINE HCL 12.5 MG/5ML PO LIQD,$11.00,$0.00,$11.00,$4.95,$7.85,$0.00,$1.90,$0.00,$0.00,$1.93,$11.00,$0.00,$5.50,$8.71,$8.80,$0.00,$1.72,$0.00,$0.00,$0.00
12556,ERX,HCPCS Q0163,49348-0045-37,DIPHENHYDRAMINE HCL 12.5 MG/5ML PO LIQD,$26.12,$0.00,$20.69,$4.95,$7.85,$0.00,$1.90,$0.00,$0.00,$1.93,$11.00,$0.00,$5.50,$20.69,$8.80,$0.00,$1.72,$0.00,$0.00,$0.00
12556,ERX,HCPCS Q0163,54838-0135-70,DIPHENHYDRAMINE HCL 12.5 MG/5ML PO LIQD,$26.12,$0.00,$20.69,$4.95,$7.85,$0.00,$1.90,$0.00,$0.00,$1.93,$11.00,$0.00,$5.50,$20.69,$8.80,$0.00,$1.72,$0.00,$0.00,$0.00
12580,ERX,HCPCS 25000001,00487-9801-01,IPRATROPIUM BROMIDE 0.02 % IN SOLN,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
12580,ERX,HCPCS 25000001,00487-9801-25,IPRATROPIUM BROMIDE 0.02 % IN SOLN,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
12580,ERX,HCPCS 25000001,00781-7157-86,IPRATROPIUM BROMIDE 0.02 % IN SOLN,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
12580,ERX,HCPCS 25000001,76204-0100-01,IPRATROPIUM BROMIDE 0.02 % IN SOLN,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
12580,ERX,HCPCS 25000001,76204-0100-25,IPRATROPIUM BROMIDE 0.02 % IN SOLN,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
12587,ERX,HCPCS J2543,63323-0304-74,PIPERACILLIN SOD-TAZOBACTAM SO 40.5 (36-4.5) G IV SOLR,$537.17,$0.00,$537.17,$291.68,$383.38,$0.00,$235.61,$0.00,$0.00,$94.05,$537.17,$0.00,$268.59,$425.44,$429.74,$0.00,$84.07,$0.00,$74.51,$0.00
12587,ERX,HCPCS J2543,63323-0304-78,PIPERACILLIN SOD-TAZOBACTAM SO 40.5 (36-4.5) G IV SOLR,$537.17,$0.00,$537.17,$291.68,$383.38,$0.00,$235.61,$0.00,$0.00,$94.05,$537.17,$0.00,$268.59,$425.44,$429.74,$0.00,$84.07,$0.00,$74.51,$0.00
12724,ERX,HCPCS 63700001,16714-0501-01,TERBINAFINE HCL 250 MG PO TABS,$48.15,$0.00,$48.15,$0.00,$34.36,$0.00,$0.00,$0.00,$0.00,$0.00,$48.15,$0.00,$24.08,$38.13,$38.52,$0.00,$0.00,$0.00,$0.00,$0.00
12724,ERX,HCPCS 63700001,16714-0501-02,TERBINAFINE HCL 250 MG PO TABS,$48.15,$0.00,$48.15,$0.00,$34.36,$0.00,$0.00,$0.00,$0.00,$0.00,$48.15,$0.00,$24.08,$38.13,$38.52,$0.00,$0.00,$0.00,$0.00,$0.00
12724,ERX,HCPCS 63700001,16714-0795-02,TERBINAFINE HCL 250 MG PO TABS,$48.15,$0.00,$48.15,$0.00,$34.36,$0.00,$0.00,$0.00,$0.00,$0.00,$48.15,$0.00,$24.08,$38.13,$38.52,$0.00,$0.00,$0.00,$0.00,$0.00
12724,ERX,HCPCS 63700001,51991-0526-01,TERBINAFINE HCL 250 MG PO TABS,$48.15,$0.00,$48.15,$0.00,$34.36,$0.00,$0.00,$0.00,$0.00,$0.00,$48.15,$0.00,$24.08,$38.13,$38.52,$0.00,$0.00,$0.00,$0.00,$0.00
12729,ERX,HCPCS 63700001,00007-3650-22,TRIAMTERENE-HCTZ 37.5-25 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
12729,ERX,HCPCS 63700001,00781-2074-10,TRIAMTERENE-HCTZ 37.5-25 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
12729,ERX,HCPCS 63700001,51079-0935-01,TRIAMTERENE-HCTZ 37.5-25 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
12729,ERX,HCPCS 63700001,51079-0935-20,TRIAMTERENE-HCTZ 37.5-25 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
12803,ERX,HCPCS 63700001,00527-1313-01,PILOCARPINE HCL 5 MG PO TABS,$6.90,$0.00,$6.90,$0.00,$4.92,$0.00,$0.00,$0.00,$0.00,$0.00,$6.90,$0.00,$3.45,$5.46,$5.52,$0.00,$0.00,$0.00,$0.00,$0.00
12885,ERX,HCPCS 63700001,00781-6022-52,CLARITHROMYCIN 125 MG/5ML PO SUSR,$231.84,$0.00,$231.84,$0.00,$165.46,$0.00,$0.00,$0.00,$0.00,$0.00,$231.84,$0.00,$115.92,$183.62,$185.47,$0.00,$0.00,$0.00,$0.00,$0.00
12886,ERX,HCPCS 63700001,00781-6023-52,CLARITHROMYCIN 250 MG/5ML PO SUSR,$326.81,$0.00,$605.43,$0.00,$432.10,$0.00,$0.00,$0.00,$0.00,$0.00,$605.43,$0.00,$302.72,$258.83,$484.34,$0.00,$0.00,$0.00,$0.00,$0.00
12886,ERX,HCPCS 63700001,00781-6023-46,CLARITHROMYCIN 250 MG/5ML PO SUSR,$605.43,$0.00,$605.43,$0.00,$432.10,$0.00,$0.00,$0.00,$0.00,$0.00,$605.43,$0.00,$302.72,$479.50,$484.34,$0.00,$0.00,$0.00,$0.00,$0.00
12933,ERX,HCPCS J7507,00378-2046-01,TACROLIMUS 1 MG PO CAPS,$16.95,$0.00,$16.95,$9.20,$12.10,$0.00,$2.92,$0.00,$0.00,$2.97,$16.95,$0.00,$8.48,$13.42,$13.56,$0.00,$0.00,$0.00,$2.70,$0.00
12933,ERX,HCPCS J7507,00469-0617-73,TACROLIMUS 1 MG PO CAPS,$16.95,$0.00,$16.95,$9.20,$12.10,$0.00,$2.92,$0.00,$0.00,$2.97,$16.95,$0.00,$8.48,$13.42,$13.56,$0.00,$0.00,$0.00,$2.70,$0.00
12933,ERX,HCPCS J7507,00781-2103-01,TACROLIMUS 1 MG PO CAPS,$16.95,$0.00,$16.95,$9.20,$12.10,$0.00,$2.92,$0.00,$0.00,$2.97,$16.95,$0.00,$8.48,$13.42,$13.56,$0.00,$0.00,$0.00,$2.70,$0.00
12933,ERX,HCPCS J7507,16729-0042-01,TACROLIMUS 1 MG PO CAPS,$16.95,$0.00,$16.95,$9.20,$12.10,$0.00,$2.92,$0.00,$0.00,$2.97,$16.95,$0.00,$8.48,$13.42,$13.56,$0.00,$0.00,$0.00,$2.70,$0.00
12933,ERX,HCPCS J7507,55111-0526-01,TACROLIMUS 1 MG PO CAPS,$16.95,$0.00,$16.95,$9.20,$12.10,$0.00,$2.92,$0.00,$0.00,$2.97,$16.95,$0.00,$8.48,$13.42,$13.56,$0.00,$0.00,$0.00,$2.70,$0.00
12933,ERX,HCPCS J7507,68084-0450-01,TACROLIMUS 1 MG PO CAPS,$16.95,$0.00,$16.95,$9.20,$12.10,$0.00,$2.92,$0.00,$0.00,$2.97,$16.95,$0.00,$8.48,$13.42,$13.56,$0.00,$0.00,$0.00,$2.70,$0.00
12934,ERX,HCPCS J7507,16729-0043-01,TACROLIMUS 5 MG PO CAPS,$126.69,$0.00,$126.69,$68.79,$90.42,$0.00,$21.83,$0.00,$0.00,$22.18,$126.69,$0.00,$63.35,$100.34,$101.35,$0.00,$0.00,$0.00,$0.00,$0.00
12934,ERX,HCPCS J7507,55111-0527-01,TACROLIMUS 5 MG PO CAPS,$126.69,$0.00,$126.69,$68.79,$90.42,$0.00,$21.83,$0.00,$0.00,$22.18,$126.69,$0.00,$63.35,$100.34,$101.35,$0.00,$0.00,$0.00,$0.00,$0.00
12934,ERX,HCPCS J7507,69452-0155-20,TACROLIMUS 5 MG PO CAPS,$126.69,$0.00,$126.69,$68.79,$90.42,$0.00,$21.83,$0.00,$0.00,$22.18,$126.69,$0.00,$63.35,$100.34,$101.35,$0.00,$0.00,$0.00,$0.00,$0.00
12935,ERX,HCPCS J7525,00469-3016-01,TACROLIMUS 5 MG/ML IV SOLN,$661.16,$0.00,$661.16,$0.00,$471.87,$0.00,$0.00,$0.00,$0.00,$0.00,$661.16,$0.00,$330.58,$523.64,$528.93,$0.00,$0.00,$0.00,$0.00,$0.00
13073,ERX,HCPCS 63700001,68462-0260-01,VERAPAMIL HCL CR 240 MG PO TBCR,$9.62,$0.00,$9.62,$0.00,$6.87,$0.00,$0.00,$0.00,$0.00,$0.00,$9.62,$0.00,$4.81,$7.62,$7.70,$0.00,$0.00,$0.00,$0.00,$0.00
13132,ERX,HCPCS 63700001,16714-0697-01,VALACYCLOVIR HCL 1 G PO TABS,$48.04,$0.00,$48.04,$0.00,$34.29,$0.00,$0.00,$0.00,$0.00,$0.00,$48.04,$0.00,$24.02,$38.05,$38.43,$0.00,$0.00,$0.00,$0.00,$0.00
13132,ERX,HCPCS 63700001,57237-0043-30,VALACYCLOVIR HCL 1 G PO TABS,$48.04,$0.00,$48.04,$0.00,$34.29,$0.00,$0.00,$0.00,$0.00,$0.00,$48.04,$0.00,$24.02,$38.05,$38.43,$0.00,$0.00,$0.00,$0.00,$0.00
13133,ERX,HCPCS 63700001,00378-4275-77,VALACYCLOVIR HCL 500 MG PO TABS,$27.46,$0.00,$27.46,$0.00,$19.60,$0.00,$0.00,$0.00,$0.00,$0.00,$27.46,$0.00,$13.73,$21.75,$21.97,$0.00,$0.00,$0.00,$0.00,$0.00
13133,ERX,HCPCS 63700001,00781-5208-92,VALACYCLOVIR HCL 500 MG PO TABS,$27.46,$0.00,$27.46,$0.00,$19.60,$0.00,$0.00,$0.00,$0.00,$0.00,$27.46,$0.00,$13.73,$21.75,$21.97,$0.00,$0.00,$0.00,$0.00,$0.00
13133,ERX,HCPCS 63700001,16714-0698-03,VALACYCLOVIR HCL 500 MG PO TABS,$27.46,$0.00,$27.46,$0.00,$19.60,$0.00,$0.00,$0.00,$0.00,$0.00,$27.46,$0.00,$13.73,$21.75,$21.97,$0.00,$0.00,$0.00,$0.00,$0.00
13133,ERX,HCPCS 63700001,57237-0042-90,VALACYCLOVIR HCL 500 MG PO TABS,$27.46,$0.00,$27.46,$0.00,$19.60,$0.00,$0.00,$0.00,$0.00,$0.00,$27.46,$0.00,$13.73,$21.75,$21.97,$0.00,$0.00,$0.00,$0.00,$0.00
13178,ERX,HCPCS 25000001,00019-1333-06,IOVERSOL 74 % IJ SOLN,$79.80,$0.00,$255.15,$0.00,$182.10,$0.00,$0.00,$0.00,$0.00,$0.00,$255.15,$0.00,$127.58,$63.20,$204.12,$0.00,$0.00,$0.00,$0.00,$0.00
13178,ERX,HCPCS 25000001,00019-1333-21,IOVERSOL 74 % IJ SOLN,$255.15,$0.00,$255.15,$0.00,$182.10,$0.00,$0.00,$0.00,$0.00,$0.00,$255.15,$0.00,$127.58,$202.08,$204.12,$0.00,$0.00,$0.00,$0.00,$0.00
13184,ERX,HCPCS 63700001,00378-2120-01,VERAPAMIL HCL ER 120 MG PO TBCR,$8.11,$0.00,$8.11,$0.00,$5.79,$0.00,$0.00,$0.00,$0.00,$0.00,$8.11,$0.00,$4.06,$6.42,$6.49,$0.00,$0.00,$0.00,$0.00,$0.00
13184,ERX,HCPCS 63700001,68462-0292-01,VERAPAMIL HCL ER 120 MG PO TBCR,$8.11,$0.00,$8.11,$0.00,$5.79,$0.00,$0.00,$0.00,$0.00,$0.00,$8.11,$0.00,$4.06,$6.42,$6.49,$0.00,$0.00,$0.00,$0.00,$0.00
13309,ERX,HCPCS 63700001,31722-0516-60,STAVUDINE 20 MG PO CAPS,$24.05,$0.00,$24.05,$0.00,$17.16,$0.00,$0.00,$0.00,$0.00,$0.00,$24.05,$0.00,$12.03,$19.05,$19.24,$0.00,$0.00,$0.00,$0.00,$0.00
13309,ERX,HCPCS 63700001,65862-0112-60,STAVUDINE 20 MG PO CAPS,$24.05,$0.00,$24.05,$0.00,$17.16,$0.00,$0.00,$0.00,$0.00,$0.00,$24.05,$0.00,$12.03,$19.05,$19.24,$0.00,$0.00,$0.00,$0.00,$0.00
13310,ERX,HCPCS 63700001,31722-0517-60,STAVUDINE 30 MG PO CAPS,$25.54,$0.00,$25.54,$0.00,$18.23,$0.00,$0.00,$0.00,$0.00,$0.00,$25.54,$0.00,$12.77,$20.23,$20.43,$0.00,$0.00,$0.00,$0.00,$0.00
13310,ERX,HCPCS 63700001,65862-0046-60,STAVUDINE 30 MG PO CAPS,$25.54,$0.00,$25.54,$0.00,$18.23,$0.00,$0.00,$0.00,$0.00,$0.00,$25.54,$0.00,$12.77,$20.23,$20.43,$0.00,$0.00,$0.00,$0.00,$0.00
13311,ERX,HCPCS 63700001,31722-0518-60,STAVUDINE 40 MG PO CAPS,$26.02,$0.00,$26.02,$0.00,$18.57,$0.00,$0.00,$0.00,$0.00,$0.00,$26.02,$0.00,$13.01,$20.61,$20.82,$0.00,$0.00,$0.00,$0.00,$0.00
13311,ERX,HCPCS 63700001,65862-0047-60,STAVUDINE 40 MG PO CAPS,$26.02,$0.00,$26.02,$0.00,$18.57,$0.00,$0.00,$0.00,$0.00,$0.00,$26.02,$0.00,$13.01,$20.61,$20.82,$0.00,$0.00,$0.00,$0.00,$0.00
13369,ERX,HCPCS 63700001,,SUMATRIPTAN SUCCINATE 100 MG PO TABS,$87.99,$0.00,$87.99,$0.00,$62.80,$0.00,$0.00,$0.00,$0.00,$0.00,$87.99,$0.00,$44.00,$69.69,$70.39,$0.00,$0.00,$0.00,$0.00,$0.00
13369,ERX,HCPCS 63700001,16714-0533-11,SUMATRIPTAN SUCCINATE 100 MG PO TABS,$87.99,$0.00,$87.99,$0.00,$62.80,$0.00,$0.00,$0.00,$0.00,$0.00,$87.99,$0.00,$44.00,$69.69,$70.39,$0.00,$0.00,$0.00,$0.00,$0.00
13369,ERX,HCPCS 63700001,62756-0522-69,SUMATRIPTAN SUCCINATE 100 MG PO TABS,$87.99,$0.00,$87.99,$0.00,$62.80,$0.00,$0.00,$0.00,$0.00,$0.00,$87.99,$0.00,$44.00,$69.69,$70.39,$0.00,$0.00,$0.00,$0.00,$0.00
13369,ERX,HCPCS 63700001,63304-0099-19,SUMATRIPTAN SUCCINATE 100 MG PO TABS,$87.99,$0.00,$87.99,$0.00,$62.80,$0.00,$0.00,$0.00,$0.00,$0.00,$87.99,$0.00,$44.00,$69.69,$70.39,$0.00,$0.00,$0.00,$0.00,$0.00
13393,ERX,HCPCS 25000001,00338-0520-13,FAT EMULSION PLANT BASED 30 % IV EMUL,$204.75,$0.00,$204.75,$0.00,$146.13,$0.00,$0.00,$0.00,$0.00,$0.00,$204.75,$0.00,$102.38,$162.16,$163.80,$0.00,$0.00,$0.00,$0.00,$0.00
13444,ERX,HCPCS 63700001,00093-1024-06,NEFAZODONE HCL 100 MG PO TABS,$18.24,$0.00,$18.24,$0.00,$13.02,$0.00,$0.00,$0.00,$0.00,$0.00,$18.24,$0.00,$9.12,$14.45,$14.59,$0.00,$0.00,$0.00,$0.00,$0.00
13445,ERX,HCPCS 63700001,00093-7113-06,NEFAZODONE HCL 150 MG PO TABS,$18.59,$0.00,$18.59,$0.00,$13.27,$0.00,$0.00,$0.00,$0.00,$0.00,$18.59,$0.00,$9.30,$14.72,$14.87,$0.00,$0.00,$0.00,$0.00,$0.00
13577,ERX,HCPCS 63700001,,FLUCONAZOLE 150 MG PO TABS,$51.66,$0.00,$51.66,$0.00,$36.87,$0.00,$0.00,$0.00,$0.00,$0.00,$51.66,$0.00,$25.83,$40.91,$41.33,$0.00,$0.00,$0.00,$0.00,$0.00
13577,ERX,HCPCS 63700001,00049-3500-79,FLUCONAZOLE 150 MG PO TABS,$51.66,$0.00,$51.66,$0.00,$36.87,$0.00,$0.00,$0.00,$0.00,$0.00,$51.66,$0.00,$25.83,$40.91,$41.33,$0.00,$0.00,$0.00,$0.00,$0.00
13577,ERX,HCPCS 63700001,00172-5412-11,FLUCONAZOLE 150 MG PO TABS,$51.66,$0.00,$51.66,$0.00,$36.87,$0.00,$0.00,$0.00,$0.00,$0.00,$51.66,$0.00,$25.83,$40.91,$41.33,$0.00,$0.00,$0.00,$0.00,$0.00
13577,ERX,HCPCS 63700001,00172-5412-79,FLUCONAZOLE 150 MG PO TABS,$51.66,$0.00,$51.66,$0.00,$36.87,$0.00,$0.00,$0.00,$0.00,$0.00,$51.66,$0.00,$25.83,$40.91,$41.33,$0.00,$0.00,$0.00,$0.00,$0.00
13577,ERX,HCPCS 63700001,16714-0692-10,FLUCONAZOLE 150 MG PO TABS,$51.66,$0.00,$51.66,$0.00,$36.87,$0.00,$0.00,$0.00,$0.00,$0.00,$51.66,$0.00,$25.83,$40.91,$41.33,$0.00,$0.00,$0.00,$0.00,$0.00
13577,ERX,HCPCS 63700001,16714-0692-11,FLUCONAZOLE 150 MG PO TABS,$51.66,$0.00,$51.66,$0.00,$36.87,$0.00,$0.00,$0.00,$0.00,$0.00,$51.66,$0.00,$25.83,$40.91,$41.33,$0.00,$0.00,$0.00,$0.00,$0.00
13577,ERX,HCPCS 63700001,55111-0145-12,FLUCONAZOLE 150 MG PO TABS,$51.66,$0.00,$51.66,$0.00,$36.87,$0.00,$0.00,$0.00,$0.00,$0.00,$51.66,$0.00,$25.83,$40.91,$41.33,$0.00,$0.00,$0.00,$0.00,$0.00
13577,ERX,HCPCS 63700001,59762-5017-01,FLUCONAZOLE 150 MG PO TABS,$51.66,$0.00,$51.66,$0.00,$36.87,$0.00,$0.00,$0.00,$0.00,$0.00,$51.66,$0.00,$25.83,$40.91,$41.33,$0.00,$0.00,$0.00,$0.00,$0.00
13577,ERX,HCPCS 63700001,68462-0103-40,FLUCONAZOLE 150 MG PO TABS,$51.66,$0.00,$51.66,$0.00,$36.87,$0.00,$0.00,$0.00,$0.00,$0.00,$51.66,$0.00,$25.83,$40.91,$41.33,$0.00,$0.00,$0.00,$0.00,$0.00
13654,ERX,HCPCS 25000001,00904-6784-80,ASPIRIN EC 325 MG PO TBEC,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
13654,ERX,HCPCS 25000001,57896-0921-10,ASPIRIN EC 325 MG PO TBEC,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
13654,ERX,HCPCS 25000001,63739-0523-01,ASPIRIN EC 325 MG PO TBEC,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
13691,ERX,HCPCS J1950,00074-3641-03,LEUPROLIDE ACETATE 3.75 MG IM KIT,"$3,435.64",$0.00,"$3,435.64","$1,546.04","$2,452.02","$1,269.23",$549.12,$0.00,$0.00,"$1,493.54","$3,435.64","$1,332.69","$1,717.82","$2,721.03","$2,748.51","$1,840.38","$1,493.54",$0.00,"$1,422.11","$1,244.34"
13691,ERX,HCPCS J1950,00074-3641-04,LEUPROLIDE ACETATE 3.75 MG IM KIT,"$3,435.64",$0.00,"$3,435.64","$1,546.04","$2,452.02","$1,269.23",$549.12,$0.00,$0.00,"$1,493.54","$3,435.64","$1,332.69","$1,717.82","$2,721.03","$2,748.51","$1,840.38","$1,493.54",$0.00,"$1,422.11","$1,244.34"
13748,ERX,HCPCS 63700001,49348-0135-34,GUAIFENESIN 100 MG/5ML PO LIQD,$11.00,$0.00,$11.00,$0.00,$7.85,$0.00,$0.00,$0.00,$0.00,$0.00,$11.00,$0.00,$5.50,$8.71,$8.80,$0.00,$0.00,$0.00,$0.00,$0.00
13748,ERX,HCPCS 63700001,61787-0063-04,GUAIFENESIN 100 MG/5ML PO LIQD,$11.00,$0.00,$11.00,$0.00,$7.85,$0.00,$0.00,$0.00,$0.00,$0.00,$11.00,$0.00,$5.50,$8.71,$8.80,$0.00,$0.00,$0.00,$0.00,$0.00
13818,ERX,HCPCS 25000001,54162-0017-09,BACITRACIN ZINC 500 UNIT/GM EX OINT,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
13884,ERX,HCPCS 63700001,59762-0450-01,COLESTIPOL HCL 1 G PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
13979,ERX,HCPCS 63700001,00093-1136-56,ACITRETIN 25 MG PO CAPS,$134.46,$0.00,$134.46,$0.00,$95.96,$0.00,$0.00,$0.00,$0.00,$0.00,$134.46,$0.00,$67.23,$106.49,$107.57,$0.00,$0.00,$0.00,$0.00,$0.00
13979,ERX,HCPCS 63700001,00145-0091-25,ACITRETIN 25 MG PO CAPS,$134.46,$0.00,$134.46,$0.00,$95.96,$0.00,$0.00,$0.00,$0.00,$0.00,$134.46,$0.00,$67.23,$106.49,$107.57,$0.00,$0.00,$0.00,$0.00,$0.00
13979,ERX,HCPCS 63700001,42291-0088-30,ACITRETIN 25 MG PO CAPS,$134.46,$0.00,$134.46,$0.00,$95.96,$0.00,$0.00,$0.00,$0.00,$0.00,$134.46,$0.00,$67.23,$106.49,$107.57,$0.00,$0.00,$0.00,$0.00,$0.00
13979,ERX,HCPCS 63700001,66993-0896-30,ACITRETIN 25 MG PO CAPS,$134.46,$0.00,$134.46,$0.00,$95.96,$0.00,$0.00,$0.00,$0.00,$0.00,$134.46,$0.00,$67.23,$106.49,$107.57,$0.00,$0.00,$0.00,$0.00,$0.00
13980,ERX,HCPCS 63700001,00115-1750-08,ACITRETIN 10 MG PO CAPS,$109.21,$0.00,$109.21,$0.00,$77.94,$0.00,$0.00,$0.00,$0.00,$0.00,$109.21,$0.00,$54.61,$86.49,$87.37,$0.00,$0.00,$0.00,$0.00,$0.00
13980,ERX,HCPCS 63700001,42291-0086-30,ACITRETIN 10 MG PO CAPS,$109.21,$0.00,$109.21,$0.00,$77.94,$0.00,$0.00,$0.00,$0.00,$0.00,$109.21,$0.00,$54.61,$86.49,$87.37,$0.00,$0.00,$0.00,$0.00,$0.00
13981,ERX,HCPCS 63700001,16714-0700-01,LAMOTRIGINE 25 MG PO TABS,$15.81,$0.00,$15.81,$0.00,$11.28,$0.00,$0.00,$0.00,$0.00,$0.00,$15.81,$0.00,$7.91,$12.52,$12.65,$0.00,$0.00,$0.00,$0.00,$0.00
13981,ERX,HCPCS 63700001,63739-0670-10,LAMOTRIGINE 25 MG PO TABS,$15.81,$0.00,$15.81,$0.00,$11.28,$0.00,$0.00,$0.00,$0.00,$0.00,$15.81,$0.00,$7.91,$12.52,$12.65,$0.00,$0.00,$0.00,$0.00,$0.00
13981,ERX,HCPCS 63700001,68084-0318-01,LAMOTRIGINE 25 MG PO TABS,$15.81,$0.00,$15.81,$0.00,$11.28,$0.00,$0.00,$0.00,$0.00,$0.00,$15.81,$0.00,$7.91,$12.52,$12.65,$0.00,$0.00,$0.00,$0.00,$0.00
13982,ERX,HCPCS 63700001,13668-0047-01,LAMOTRIGINE 100 MG PO TABS,$18.05,$0.00,$18.05,$0.00,$12.88,$0.00,$0.00,$0.00,$0.00,$0.00,$18.05,$0.00,$9.03,$14.30,$14.44,$0.00,$0.00,$0.00,$0.00,$0.00
13982,ERX,HCPCS 63700001,16714-0701-01,LAMOTRIGINE 100 MG PO TABS,$18.05,$0.00,$18.05,$0.00,$12.88,$0.00,$0.00,$0.00,$0.00,$0.00,$18.05,$0.00,$9.03,$14.30,$14.44,$0.00,$0.00,$0.00,$0.00,$0.00
13982,ERX,HCPCS 63700001,68084-0319-01,LAMOTRIGINE 100 MG PO TABS,$18.05,$0.00,$18.05,$0.00,$12.88,$0.00,$0.00,$0.00,$0.00,$0.00,$18.05,$0.00,$9.03,$14.30,$14.44,$0.00,$0.00,$0.00,$0.00,$0.00
13983,ERX,HCPCS 63700001,00173-0644-60,LAMOTRIGINE 200 MG PO TABS,$23.32,$0.00,$23.32,$0.00,$16.64,$0.00,$0.00,$0.00,$0.00,$0.00,$23.32,$0.00,$11.66,$18.47,$18.66,$0.00,$0.00,$0.00,$0.00,$0.00
13983,ERX,HCPCS 63700001,16714-0703-01,LAMOTRIGINE 200 MG PO TABS,$23.32,$0.00,$23.32,$0.00,$16.64,$0.00,$0.00,$0.00,$0.00,$0.00,$23.32,$0.00,$11.66,$18.47,$18.66,$0.00,$0.00,$0.00,$0.00,$0.00
13983,ERX,HCPCS 63700001,51672-4133-04,LAMOTRIGINE 200 MG PO TABS,$23.32,$0.00,$23.32,$0.00,$16.64,$0.00,$0.00,$0.00,$0.00,$0.00,$23.32,$0.00,$11.66,$18.47,$18.66,$0.00,$0.00,$0.00,$0.00,$0.00
13983,ERX,HCPCS 63700001,68382-0010-14,LAMOTRIGINE 200 MG PO TABS,$23.32,$0.00,$23.32,$0.00,$16.64,$0.00,$0.00,$0.00,$0.00,$0.00,$23.32,$0.00,$11.66,$18.47,$18.66,$0.00,$0.00,$0.00,$0.00,$0.00
14087,ERX,HCPCS 25000001,00093-0150-01,ACETAMINOPHEN-CODEINE #3 300-30 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
14087,ERX,HCPCS 25000001,00406-0484-62,ACETAMINOPHEN-CODEINE #3 300-30 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
14087,ERX,HCPCS 25000001,00603-2338-21,ACETAMINOPHEN-CODEINE #3 300-30 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
14087,ERX,HCPCS 25000001,65162-0033-10,ACETAMINOPHEN-CODEINE #3 300-30 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
14087,ERX,HCPCS 25000001,68084-0372-01,ACETAMINOPHEN-CODEINE #3 300-30 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
14113,ERX,HCPCS 63700001,10939-0441-44,ASPIRIN EC 81 MG PO TBEC,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
14113,ERX,HCPCS 63700001,63739-0212-01,ASPIRIN EC 81 MG PO TBEC,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
14113,ERX,HCPCS 63700001,63739-0522-01,ASPIRIN EC 81 MG PO TBEC,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
14113,ERX,HCPCS 63700001,63739-0522-10,ASPIRIN EC 81 MG PO TBEC,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
14132,ERX,HCPCS 63700001,45802-0465-64,KETOCONAZOLE 2 % EX SHAM,$97.44,$0.00,$97.44,$0.00,$69.54,$0.00,$0.00,$0.00,$0.00,$0.00,$97.44,$0.00,$48.72,$77.17,$77.95,$0.00,$0.00,$0.00,$0.00,$0.00
14190,ERX,HCPCS 25000001,00472-0339-56,HYDROCORTISONE-ALOE 1 % EX CREA,$13.20,$0.00,$13.20,$0.00,$9.42,$0.00,$0.00,$0.00,$0.00,$0.00,$13.20,$0.00,$6.60,$10.45,$10.56,$0.00,$0.00,$0.00,$0.00,$0.00
14196,ERX,HCPCS 63700001,00046-1107-11,CONJ ESTROG-MEDROXYPROGEST ACE 0.625-2.5 MG PO TABS,$33.03,$0.00,$33.03,$0.00,$23.57,$0.00,$0.00,$0.00,$0.00,$0.00,$33.03,$0.00,$16.52,$26.16,$26.42,$0.00,$0.00,$0.00,$0.00,$0.00
14232,ERX,HCPCS 63700001,16714-0695-01,FLUCONAZOLE 10 MG/ML PO SUSR,$120.91,$0.00,$120.91,$0.00,$86.29,$0.00,$0.00,$0.00,$0.00,$0.00,$120.91,$0.00,$60.46,$95.76,$96.73,$0.00,$0.00,$0.00,$0.00,$0.00
14232,ERX,HCPCS 63700001,59762-5029-01,FLUCONAZOLE 10 MG/ML PO SUSR,$120.91,$0.00,$120.91,$0.00,$86.29,$0.00,$0.00,$0.00,$0.00,$0.00,$120.91,$0.00,$60.46,$95.76,$96.73,$0.00,$0.00,$0.00,$0.00,$0.00
14232,ERX,HCPCS 63700001,99999-6004-82,FLUCONAZOLE 10 MG/ML PO SUSR,$120.91,$0.00,$120.91,$0.00,$86.29,$0.00,$0.00,$0.00,$0.00,$0.00,$120.91,$0.00,$60.46,$95.76,$96.73,$0.00,$0.00,$0.00,$0.00,$0.00
14233,ERX,HCPCS 63700001,00049-3450-19,FLUCONAZOLE 40 MG/ML PO SUSR,$116.26,$0.00,$116.26,$0.00,$82.97,$0.00,$0.00,$0.00,$0.00,$0.00,$116.26,$0.00,$58.13,$92.08,$93.01,$0.00,$0.00,$0.00,$0.00,$0.00
14233,ERX,HCPCS 63700001,00054-0003-85,FLUCONAZOLE 40 MG/ML PO SUSR,$116.26,$0.00,$116.26,$0.00,$82.97,$0.00,$0.00,$0.00,$0.00,$0.00,$116.26,$0.00,$58.13,$92.08,$93.01,$0.00,$0.00,$0.00,$0.00,$0.00
14233,ERX,HCPCS 63700001,16714-0696-01,FLUCONAZOLE 40 MG/ML PO SUSR,$116.26,$0.00,$116.26,$0.00,$82.97,$0.00,$0.00,$0.00,$0.00,$0.00,$116.26,$0.00,$58.13,$92.08,$93.01,$0.00,$0.00,$0.00,$0.00,$0.00
14233,ERX,HCPCS 63700001,59762-5030-01,FLUCONAZOLE 40 MG/ML PO SUSR,$116.26,$0.00,$116.26,$0.00,$82.97,$0.00,$0.00,$0.00,$0.00,$0.00,$116.26,$0.00,$58.13,$92.08,$93.01,$0.00,$0.00,$0.00,$0.00,$0.00
14266,ERX,HCPCS 63700001,16714-0702-01,LAMOTRIGINE 150 MG PO TABS,$19.79,$0.00,$19.79,$0.00,$14.12,$0.00,$0.00,$0.00,$0.00,$0.00,$19.79,$0.00,$9.90,$15.67,$15.83,$0.00,$0.00,$0.00,$0.00,$0.00
14266,ERX,HCPCS 63700001,29300-0113-16,LAMOTRIGINE 150 MG PO TABS,$19.79,$0.00,$19.79,$0.00,$14.12,$0.00,$0.00,$0.00,$0.00,$0.00,$19.79,$0.00,$9.90,$15.67,$15.83,$0.00,$0.00,$0.00,$0.00,$0.00
14266,ERX,HCPCS 63700001,51672-4132-04,LAMOTRIGINE 150 MG PO TABS,$19.79,$0.00,$19.79,$0.00,$14.12,$0.00,$0.00,$0.00,$0.00,$0.00,$19.79,$0.00,$9.90,$15.67,$15.83,$0.00,$0.00,$0.00,$0.00,$0.00
14468,ERX,HCPCS 25000001,99999-6007-11,ACETAMINOPHEN-CODEINE 120-12 MG/5ML PO SOLN,$6.00,$0.00,$71.90,$0.00,$51.32,$0.00,$0.00,$0.00,$0.00,$0.00,$71.90,$0.00,$35.95,$4.75,$57.52,$0.00,$0.00,$0.00,$0.00,$0.00
14468,ERX,HCPCS 25000001,00121-0504-16,ACETAMINOPHEN-CODEINE 120-12 MG/5ML PO SOLN,$71.90,$0.00,$71.90,$0.00,$51.32,$0.00,$0.00,$0.00,$0.00,$0.00,$71.90,$0.00,$35.95,$56.94,$57.52,$0.00,$0.00,$0.00,$0.00,$0.00
14468,ERX,HCPCS 25000001,50383-0079-16,ACETAMINOPHEN-CODEINE 120-12 MG/5ML PO SOLN,$71.90,$0.00,$71.90,$0.00,$51.32,$0.00,$0.00,$0.00,$0.00,$0.00,$71.90,$0.00,$35.95,$56.94,$57.52,$0.00,$0.00,$0.00,$0.00,$0.00
14471,ERX,HCPCS 63700001,00006-3519-36,DORZOLAMIDE HCL 2 % OP SOLN,$216.03,$0.00,$216.03,$0.00,$154.18,$0.00,$0.00,$0.00,$0.00,$0.00,$216.03,$0.00,$108.02,$171.10,$172.82,$0.00,$0.00,$0.00,$0.00,$0.00
14471,ERX,HCPCS 63700001,24208-0485-10,DORZOLAMIDE HCL 2 % OP SOLN,$216.03,$0.00,$216.03,$0.00,$154.18,$0.00,$0.00,$0.00,$0.00,$0.00,$216.03,$0.00,$108.02,$171.10,$172.82,$0.00,$0.00,$0.00,$0.00,$0.00
14471,ERX,HCPCS 63700001,42571-0141-26,DORZOLAMIDE HCL 2 % OP SOLN,$216.03,$0.00,$216.03,$0.00,$154.18,$0.00,$0.00,$0.00,$0.00,$0.00,$216.03,$0.00,$108.02,$171.10,$172.82,$0.00,$0.00,$0.00,$0.00,$0.00
14471,ERX,HCPCS 63700001,50383-0232-10,DORZOLAMIDE HCL 2 % OP SOLN,$216.03,$0.00,$216.03,$0.00,$154.18,$0.00,$0.00,$0.00,$0.00,$0.00,$216.03,$0.00,$108.02,$171.10,$172.82,$0.00,$0.00,$0.00,$0.00,$0.00
14471,ERX,HCPCS 63700001,61314-0019-10,DORZOLAMIDE HCL 2 % OP SOLN,$216.03,$0.00,$216.03,$0.00,$154.18,$0.00,$0.00,$0.00,$0.00,$0.00,$216.03,$0.00,$108.02,$171.10,$172.82,$0.00,$0.00,$0.00,$0.00,$0.00
14553,ERX,HCPCS 63700001,59746-0385-06,TERAZOSIN HCL 5 MG PO CAPS,$6.10,$0.00,$6.10,$0.00,$4.35,$0.00,$0.00,$0.00,$0.00,$0.00,$6.10,$0.00,$3.05,$4.83,$4.88,$0.00,$0.00,$0.00,$0.00,$0.00
14626,ERX,HCPCS 63700001,68462-0293-01,VERAPAMIL HCL ER 180 MG PO TBCR,$9.47,$0.00,$9.47,$0.00,$6.76,$0.00,$0.00,$0.00,$0.00,$0.00,$9.47,$0.00,$4.74,$7.50,$7.58,$0.00,$0.00,$0.00,$0.00,$0.00
14632,ERX,HCPCS 63700001,00378-4151-01,TRAMADOL HCL 50 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
14632,ERX,HCPCS 63700001,00378-4151-05,TRAMADOL HCL 50 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
14632,ERX,HCPCS 63700001,00904-6365-61,TRAMADOL HCL 50 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
14632,ERX,HCPCS 63700001,51079-0991-01,TRAMADOL HCL 50 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
14632,ERX,HCPCS 63700001,51079-0991-20,TRAMADOL HCL 50 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
14632,ERX,HCPCS 63700001,57664-0377-08,TRAMADOL HCL 50 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
14632,ERX,HCPCS 63700001,65162-0627-10,TRAMADOL HCL 50 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
14632,ERX,HCPCS 63700001,68084-0808-01,TRAMADOL HCL 50 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
14633,ERX,HCPCS J9214,00085-1168-01,INTERFERON ALFA-2B 6000000 UNIT/ML IJ SOLN,"$2,050.80",$0.00,"$2,050.80",$0.00,"$1,463.66",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,050.80",$0.00,"$1,025.40","$1,624.23","$1,640.64",$0.00,$0.00,$0.00,$0.00,$0.00
14643,ERX,HCPCS J0885,59676-0320-04,EPOETIN ALFA 20000 UNIT/ML IJ SOLN,"$1,539.36",$0.00,"$1,539.36",$835.87,$0.00,$0.00,$265.22,$0.00,$0.00,$269.53,"$1,539.36",$0.00,$769.68,"$1,219.17","$1,231.49",$0.00,$240.91,$0.00,$237.19,$0.00
14678,ERX,HCPCS 25000001,49281-0790-51,TYPHOID VI POLYSACCHARIDE VACC 25 MCG/0.5ML IM SOLN,$385.59,$0.00,$385.59,$0.00,$275.20,$0.00,$0.00,$0.00,$0.00,$0.00,$385.59,$0.00,$192.80,$305.39,$308.47,$0.00,$0.00,$0.00,$0.00,$0.00
14719,ERX,HCPCS 63700001,23155-0103-05,METFORMIN HCL 850 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
14719,ERX,HCPCS 63700001,57664-0435-51,METFORMIN HCL 850 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
14719,ERX,HCPCS 63700001,60687-0143-01,METFORMIN HCL 850 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
14719,ERX,HCPCS 63700001,60687-0143-11,METFORMIN HCL 850 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
14719,ERX,HCPCS 63700001,63739-0702-10,METFORMIN HCL 850 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
14792,ERX,HCPCS 63700001,00185-0034-51,TIZANIDINE HCL 2 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
14792,ERX,HCPCS 63700001,42291-0808-15,TIZANIDINE HCL 2 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
14792,ERX,HCPCS 63700001,55111-0179-15,TIZANIDINE HCL 2 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
14792,ERX,HCPCS 63700001,57664-0502-89,TIZANIDINE HCL 2 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
14792,ERX,HCPCS 63700001,60505-0251-03,TIZANIDINE HCL 2 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
14793,ERX,HCPCS 63700001,00185-4400-51,TIZANIDINE HCL 4 MG PO TABS,$9.69,$0.00,$9.69,$0.00,$6.92,$0.00,$0.00,$0.00,$0.00,$0.00,$9.69,$0.00,$4.85,$7.67,$7.75,$0.00,$0.00,$0.00,$0.00,$0.00
14793,ERX,HCPCS 63700001,55111-0180-15,TIZANIDINE HCL 4 MG PO TABS,$9.69,$0.00,$9.69,$0.00,$6.92,$0.00,$0.00,$0.00,$0.00,$0.00,$9.69,$0.00,$4.85,$7.67,$7.75,$0.00,$0.00,$0.00,$0.00,$0.00
14793,ERX,HCPCS 63700001,60505-0252-03,TIZANIDINE HCL 4 MG PO TABS,$9.69,$0.00,$9.69,$0.00,$6.92,$0.00,$0.00,$0.00,$0.00,$0.00,$9.69,$0.00,$4.85,$7.67,$7.75,$0.00,$0.00,$0.00,$0.00,$0.00
14820,ERX,HCPCS 63700001,55111-0338-01,AMLODIPINE-BENAZEPRIL HCL 2.5-10 MG PO CAPS,$10.09,$0.00,$10.09,$0.00,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00,$10.09,$0.00,$5.05,$7.99,$8.07,$0.00,$0.00,$0.00,$0.00,$0.00
14820,ERX,HCPCS 63700001,65862-0582-01,AMLODIPINE-BENAZEPRIL HCL 2.5-10 MG PO CAPS,$10.09,$0.00,$10.09,$0.00,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00,$10.09,$0.00,$5.05,$7.99,$8.07,$0.00,$0.00,$0.00,$0.00,$0.00
14821,ERX,HCPCS 63700001,55111-0339-01,AMLODIPINE-BENAZEPRIL HCL 5-10 MG PO CAPS,$10.29,$0.00,$10.29,$0.00,$7.34,$0.00,$0.00,$0.00,$0.00,$0.00,$10.29,$0.00,$5.15,$8.15,$8.23,$0.00,$0.00,$0.00,$0.00,$0.00
14822,ERX,HCPCS 63700001,55111-0340-01,AMLODIPINE-BENAZEPRIL HCL 5-20 MG PO CAPS,$10.87,$0.00,$10.87,$0.00,$7.76,$0.00,$0.00,$0.00,$0.00,$0.00,$10.87,$0.00,$5.44,$8.61,$8.70,$0.00,$0.00,$0.00,$0.00,$0.00
14822,ERX,HCPCS 63700001,57237-0144-01,AMLODIPINE-BENAZEPRIL HCL 5-20 MG PO CAPS,$10.87,$0.00,$10.87,$0.00,$7.76,$0.00,$0.00,$0.00,$0.00,$0.00,$10.87,$0.00,$5.44,$8.61,$8.70,$0.00,$0.00,$0.00,$0.00,$0.00
14823,ERX,HCPCS 63700001,31722-0700-90,LOSARTAN POTASSIUM 25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
14823,ERX,HCPCS 63700001,63739-0673-10,LOSARTAN POTASSIUM 25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
14823,ERX,HCPCS 63700001,68084-0346-01,LOSARTAN POTASSIUM 25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
14823,ERX,HCPCS 63700001,68180-0376-09,LOSARTAN POTASSIUM 25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
14824,ERX,HCPCS 63700001,00006-0952-31,LOSARTAN POTASSIUM 50 MG PO TABS,$8.55,$0.00,$8.55,$0.00,$6.10,$0.00,$0.00,$0.00,$0.00,$0.00,$8.55,$0.00,$4.28,$6.77,$6.84,$0.00,$0.00,$0.00,$0.00,$0.00
14824,ERX,HCPCS 63700001,31722-0701-30,LOSARTAN POTASSIUM 50 MG PO TABS,$8.55,$0.00,$8.55,$0.00,$6.10,$0.00,$0.00,$0.00,$0.00,$0.00,$8.55,$0.00,$4.28,$6.77,$6.84,$0.00,$0.00,$0.00,$0.00,$0.00
14824,ERX,HCPCS 63700001,31722-0701-90,LOSARTAN POTASSIUM 50 MG PO TABS,$8.55,$0.00,$8.55,$0.00,$6.10,$0.00,$0.00,$0.00,$0.00,$0.00,$8.55,$0.00,$4.28,$6.77,$6.84,$0.00,$0.00,$0.00,$0.00,$0.00
14824,ERX,HCPCS 63700001,50268-0517-11,LOSARTAN POTASSIUM 50 MG PO TABS,$8.55,$0.00,$8.55,$0.00,$6.10,$0.00,$0.00,$0.00,$0.00,$0.00,$8.55,$0.00,$4.28,$6.77,$6.84,$0.00,$0.00,$0.00,$0.00,$0.00
14824,ERX,HCPCS 63700001,50268-0517-15,LOSARTAN POTASSIUM 50 MG PO TABS,$8.55,$0.00,$8.55,$0.00,$6.10,$0.00,$0.00,$0.00,$0.00,$0.00,$8.55,$0.00,$4.28,$6.77,$6.84,$0.00,$0.00,$0.00,$0.00,$0.00
14824,ERX,HCPCS 63700001,65862-0202-30,LOSARTAN POTASSIUM 50 MG PO TABS,$8.55,$0.00,$8.55,$0.00,$6.10,$0.00,$0.00,$0.00,$0.00,$0.00,$8.55,$0.00,$4.28,$6.77,$6.84,$0.00,$0.00,$0.00,$0.00,$0.00
14824,ERX,HCPCS 63700001,65862-0202-90,LOSARTAN POTASSIUM 50 MG PO TABS,$8.55,$0.00,$8.55,$0.00,$6.10,$0.00,$0.00,$0.00,$0.00,$0.00,$8.55,$0.00,$4.28,$6.77,$6.84,$0.00,$0.00,$0.00,$0.00,$0.00
14824,ERX,HCPCS 63700001,68084-0347-01,LOSARTAN POTASSIUM 50 MG PO TABS,$8.55,$0.00,$8.55,$0.00,$6.10,$0.00,$0.00,$0.00,$0.00,$0.00,$8.55,$0.00,$4.28,$6.77,$6.84,$0.00,$0.00,$0.00,$0.00,$0.00
14824,ERX,HCPCS 63700001,68180-0377-09,LOSARTAN POTASSIUM 50 MG PO TABS,$8.55,$0.00,$8.55,$0.00,$6.10,$0.00,$0.00,$0.00,$0.00,$0.00,$8.55,$0.00,$4.28,$6.77,$6.84,$0.00,$0.00,$0.00,$0.00,$0.00
14825,ERX,HCPCS 63700001,00456-4300-01,FOSFOMYCIN TROMETHAMINE 3 G PO PACK,$334.04,$0.00,$334.04,$0.00,$238.40,$0.00,$0.00,$0.00,$0.00,$0.00,$334.04,$0.00,$167.02,$264.56,$267.23,$0.00,$0.00,$0.00,$0.00,$0.00
14845,ERX,HCPCS J1265,00338-1007-03,DOPAMINE IN D5W 1.6-5 MG/ML-% IV SOLN,$75.25,$0.00,$75.25,$0.00,$53.71,$0.00,$0.00,$0.00,$0.00,$0.00,$75.25,$0.00,$37.63,$59.60,$60.20,$0.00,$0.00,$0.00,$0.00,$0.00
14845,ERX,HCPCS J1265,00409-7809-24,DOPAMINE IN D5W 1.6-5 MG/ML-% IV SOLN,$75.25,$0.00,$75.25,$0.00,$53.71,$0.00,$0.00,$0.00,$0.00,$0.00,$75.25,$0.00,$37.63,$59.60,$60.20,$0.00,$0.00,$0.00,$0.00,$0.00
14868,ERX,HCPCS J2001,00264-9594-20,LIDOCAINE IN D5W 4-5 MG/ML-% IV SOLN,$25.65,$0.00,$25.65,$11.54,$18.31,$0.00,$2.35,$0.00,$0.00,$3.53,$25.65,$0.00,$12.83,$20.31,$20.52,$0.00,$3.53,$0.00,$3.36,$0.00
14923,ERX,HCPCS 25000001,00409-1966-07,SODIUM CHLORIDE BACTERIOSTATIC 0.9 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
14952,ERX,HCPCS 63700001,80681-0104-00,CO-ENZYME Q-10 30 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
14953,ERX,HCPCS 63700001,00173-0547-00,ATOVAQUONE 750 MG/5ML PO SUSP,$127.75,$0.00,$127.75,$0.00,$91.18,$0.00,$0.00,$0.00,$0.00,$0.00,$127.75,$0.00,$63.88,$101.18,$102.20,$0.00,$0.00,$0.00,$0.00,$0.00
14953,ERX,HCPCS 63700001,16714-0900-01,ATOVAQUONE 750 MG/5ML PO SUSP,$127.75,$0.00,$127.75,$0.00,$91.18,$0.00,$0.00,$0.00,$0.00,$0.00,$127.75,$0.00,$63.88,$101.18,$102.20,$0.00,$0.00,$0.00,$0.00,$0.00
14953,ERX,HCPCS 63700001,31722-0629-21,ATOVAQUONE 750 MG/5ML PO SUSP,$127.75,$0.00,$127.75,$0.00,$91.18,$0.00,$0.00,$0.00,$0.00,$0.00,$127.75,$0.00,$63.88,$101.18,$102.20,$0.00,$0.00,$0.00,$0.00,$0.00
14953,ERX,HCPCS 63700001,66993-0062-72,ATOVAQUONE 750 MG/5ML PO SUSP,$127.75,$0.00,$127.75,$0.00,$91.18,$0.00,$0.00,$0.00,$0.00,$0.00,$127.75,$0.00,$63.88,$101.18,$102.20,$0.00,$0.00,$0.00,$0.00,$0.00
14953,ERX,HCPCS 63700001,68180-0282-01,ATOVAQUONE 750 MG/5ML PO SUSP,$127.75,$0.00,$127.75,$0.00,$91.18,$0.00,$0.00,$0.00,$0.00,$0.00,$127.75,$0.00,$63.88,$101.18,$102.20,$0.00,$0.00,$0.00,$0.00,$0.00
14953,ERX,HCPCS 63700001,99999-6008-29,ATOVAQUONE 750 MG/5ML PO SUSP,$127.75,$0.00,$127.75,$0.00,$91.18,$0.00,$0.00,$0.00,$0.00,$0.00,$127.75,$0.00,$63.88,$101.18,$102.20,$0.00,$0.00,$0.00,$0.00,$0.00
14958,ERX,HCPCS 63700001,00006-0717-31,LOSARTAN-HCTZ 50-12.5 MG PO TABS,$9.46,$0.00,$9.46,$0.00,$6.75,$0.00,$0.00,$0.00,$0.00,$0.00,$9.46,$0.00,$4.73,$7.49,$7.57,$0.00,$0.00,$0.00,$0.00,$0.00
14958,ERX,HCPCS 63700001,00006-0717-54,LOSARTAN-HCTZ 50-12.5 MG PO TABS,$9.46,$0.00,$9.46,$0.00,$6.75,$0.00,$0.00,$0.00,$0.00,$0.00,$9.46,$0.00,$4.73,$7.49,$7.57,$0.00,$0.00,$0.00,$0.00,$0.00
14958,ERX,HCPCS 63700001,00093-7367-98,LOSARTAN-HCTZ 50-12.5 MG PO TABS,$9.46,$0.00,$9.46,$0.00,$6.75,$0.00,$0.00,$0.00,$0.00,$0.00,$9.46,$0.00,$4.73,$7.49,$7.57,$0.00,$0.00,$0.00,$0.00,$0.00
14958,ERX,HCPCS 63700001,16714-0226-01,LOSARTAN-HCTZ 50-12.5 MG PO TABS,$9.46,$0.00,$9.46,$0.00,$6.75,$0.00,$0.00,$0.00,$0.00,$0.00,$9.46,$0.00,$4.73,$7.49,$7.57,$0.00,$0.00,$0.00,$0.00,$0.00
14958,ERX,HCPCS 63700001,16714-0226-02,LOSARTAN-HCTZ 50-12.5 MG PO TABS,$9.46,$0.00,$9.46,$0.00,$6.75,$0.00,$0.00,$0.00,$0.00,$0.00,$9.46,$0.00,$4.73,$7.49,$7.57,$0.00,$0.00,$0.00,$0.00,$0.00
14958,ERX,HCPCS 63700001,62332-0048-90,LOSARTAN-HCTZ 50-12.5 MG PO TABS,$9.46,$0.00,$9.46,$0.00,$6.75,$0.00,$0.00,$0.00,$0.00,$0.00,$9.46,$0.00,$4.73,$7.49,$7.57,$0.00,$0.00,$0.00,$0.00,$0.00
14958,ERX,HCPCS 63700001,65862-0468-90,LOSARTAN-HCTZ 50-12.5 MG PO TABS,$9.46,$0.00,$9.46,$0.00,$6.75,$0.00,$0.00,$0.00,$0.00,$0.00,$9.46,$0.00,$4.73,$7.49,$7.57,$0.00,$0.00,$0.00,$0.00,$0.00
14958,ERX,HCPCS 63700001,68180-0215-09,LOSARTAN-HCTZ 50-12.5 MG PO TABS,$9.46,$0.00,$9.46,$0.00,$6.75,$0.00,$0.00,$0.00,$0.00,$0.00,$9.46,$0.00,$4.73,$7.49,$7.57,$0.00,$0.00,$0.00,$0.00,$0.00
14979,ERX,HCPCS 25000001,00409-3977-03,BACTERIOSTATIC WATER(BENZ ALC) IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
15113,ERX,HCPCS J7517,00093-7334-01,MYCOPHENOLATE MOFETIL 250 MG PO CAPS,$15.08,$0.00,$15.08,$6.79,$10.76,$0.00,$2.60,$0.00,$0.00,$2.64,$15.08,$0.00,$7.54,$11.94,$12.06,$0.00,$2.36,$0.00,$2.40,$0.00
15113,ERX,HCPCS J7517,00093-7334-05,MYCOPHENOLATE MOFETIL 250 MG PO CAPS,$15.08,$0.00,$15.08,$6.79,$10.76,$0.00,$2.60,$0.00,$0.00,$2.64,$15.08,$0.00,$7.54,$11.94,$12.06,$0.00,$2.36,$0.00,$2.40,$0.00
15113,ERX,HCPCS J7517,51079-0721-20,MYCOPHENOLATE MOFETIL 250 MG PO CAPS,$15.08,$0.00,$15.08,$6.79,$10.76,$0.00,$2.60,$0.00,$0.00,$2.64,$15.08,$0.00,$7.54,$11.94,$12.06,$0.00,$2.36,$0.00,$2.40,$0.00
15119,ERX,HCPCS 25000001,00074-4456-04,SEVOFLURANE IN SOLN,$597.58,$0.00,$597.58,$0.00,$426.49,$0.00,$0.00,$0.00,$0.00,$0.00,$597.58,$0.00,$298.79,$473.28,$478.06,$0.00,$0.00,$0.00,$0.00,$0.00
15168,ERX,HCPCS 63700001,99999-6009-06,SENNOSIDES 8.8 MG/5ML PO SYRP,$11.00,$0.00,$11.00,$0.00,$7.85,$0.00,$0.00,$0.00,$0.00,$0.00,$11.00,$0.00,$5.50,$8.71,$8.80,$0.00,$0.00,$0.00,$0.00,$0.00
15168,ERX,HCPCS 63700001,54162-0007-08,SENNOSIDES 8.8 MG/5ML PO SYRP,$48.43,$0.00,$38.36,$0.00,$7.85,$0.00,$0.00,$0.00,$0.00,$0.00,$11.00,$0.00,$5.50,$38.36,$8.80,$0.00,$0.00,$0.00,$0.00,$0.00
15235,ERX,HCPCS J1642,64253-0333-35,HEPARIN SODIUM LOCK FLUSH 100 UNIT/ML IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$5.29,$0.00,$0.00,$18.80,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$18.80,$0.00,$17.90,$0.00
15255,ERX,HCPCS 25000001,10956-0618-01,PYRANTEL PAMOATE 144 (50 BASE) MG/ML PO SUSP,$27.82,$0.00,$27.82,$0.00,$19.86,$0.00,$0.00,$0.00,$0.00,$0.00,$27.82,$0.00,$13.91,$22.03,$22.26,$0.00,$0.00,$0.00,$0.00,$0.00
15327,ERX,HCPCS 63700001,16714-0531-11,SUMATRIPTAN SUCCINATE 25 MG PO TABS,$94.69,$0.00,$94.69,$0.00,$67.58,$0.00,$0.00,$0.00,$0.00,$0.00,$94.69,$0.00,$47.35,$74.99,$75.75,$0.00,$0.00,$0.00,$0.00,$0.00
15327,ERX,HCPCS 63700001,55111-0291-09,SUMATRIPTAN SUCCINATE 25 MG PO TABS,$94.69,$0.00,$94.69,$0.00,$67.58,$0.00,$0.00,$0.00,$0.00,$0.00,$94.69,$0.00,$47.35,$74.99,$75.75,$0.00,$0.00,$0.00,$0.00,$0.00
15328,ERX,HCPCS 63700001,00378-5631-59,SUMATRIPTAN SUCCINATE 50 MG PO TABS,$87.99,$0.00,$87.99,$0.00,$62.80,$0.00,$0.00,$0.00,$0.00,$0.00,$87.99,$0.00,$44.00,$69.69,$70.39,$0.00,$0.00,$0.00,$0.00,$0.00
15328,ERX,HCPCS 63700001,16714-0532-11,SUMATRIPTAN SUCCINATE 50 MG PO TABS,$87.99,$0.00,$87.99,$0.00,$62.80,$0.00,$0.00,$0.00,$0.00,$0.00,$87.99,$0.00,$44.00,$69.69,$70.39,$0.00,$0.00,$0.00,$0.00,$0.00
15330,ERX,HCPCS J0153,00409-1932-02,ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN,$467.20,$0.00,$467.20,$210.24,$333.44,$0.00,$80.50,$0.00,$0.00,$65.57,$467.20,$0.00,$233.60,$370.02,$373.76,$0.00,$65.57,$0.00,$62.43,$0.00
15330,ERX,HCPCS J0153,00703-8777-01,ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN,$467.20,$0.00,$467.20,$210.24,$333.44,$0.00,$80.50,$0.00,$0.00,$65.57,$467.20,$0.00,$233.60,$370.02,$373.76,$0.00,$65.57,$0.00,$62.43,$0.00
15330,ERX,HCPCS J0153,55150-0193-30,ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN,$467.20,$0.00,$467.20,$210.24,$333.44,$0.00,$80.50,$0.00,$0.00,$65.57,$467.20,$0.00,$233.60,$370.02,$373.76,$0.00,$65.57,$0.00,$62.43,$0.00
15330,ERX,HCPCS J0153,67457-0857-30,ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN,$467.20,$0.00,$467.20,$210.24,$333.44,$0.00,$80.50,$0.00,$0.00,$65.57,$467.20,$0.00,$233.60,$370.02,$373.76,$0.00,$65.57,$0.00,$62.43,$0.00
15340,ERX,HCPCS 63700001,00228-2550-11,DICLOFENAC SODIUM 50 MG PO TBEC,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
15340,ERX,HCPCS 63700001,61442-0102-01,DICLOFENAC SODIUM 50 MG PO TBEC,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
15341,ERX,HCPCS 63700001,00228-2551-06,DICLOFENAC SODIUM 75 MG PO TBEC,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
15341,ERX,HCPCS 63700001,00228-2551-11,DICLOFENAC SODIUM 75 MG PO TBEC,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
15341,ERX,HCPCS 63700001,68084-0333-01,DICLOFENAC SODIUM 75 MG PO TBEC,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
15341,ERX,HCPCS 63700001,68084-0333-11,DICLOFENAC SODIUM 75 MG PO TBEC,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
15349,ERX,HCPCS 63700001,00378-3635-01,CETIRIZINE HCL 5 MG PO TABS,$9.49,$0.00,$9.49,$0.00,$6.77,$0.00,$0.00,$0.00,$0.00,$0.00,$9.49,$0.00,$4.75,$7.52,$7.59,$0.00,$0.00,$0.00,$0.00,$0.00
15349,ERX,HCPCS 63700001,16571-0401-10,CETIRIZINE HCL 5 MG PO TABS,$9.49,$0.00,$9.49,$0.00,$6.77,$0.00,$0.00,$0.00,$0.00,$0.00,$9.49,$0.00,$4.75,$7.52,$7.59,$0.00,$0.00,$0.00,$0.00,$0.00
15349,ERX,HCPCS 63700001,60505-2632-01,CETIRIZINE HCL 5 MG PO TABS,$9.49,$0.00,$9.49,$0.00,$6.77,$0.00,$0.00,$0.00,$0.00,$0.00,$9.49,$0.00,$4.75,$7.52,$7.59,$0.00,$0.00,$0.00,$0.00,$0.00
15372,ERX,HCPCS 63700001,00225-0525-47,AYR SALINE NASAL NA GEL,$11.69,$0.00,$11.69,$0.00,$8.34,$0.00,$0.00,$0.00,$0.00,$0.00,$11.69,$0.00,$5.85,$9.26,$9.35,$0.00,$0.00,$0.00,$0.00,$0.00
15661,ERX,HCPCS 63700001,16714-0631-01,ALENDRONATE SODIUM 10 MG PO TABS,$11.11,$0.00,$11.11,$0.00,$7.93,$0.00,$0.00,$0.00,$0.00,$0.00,$11.11,$0.00,$5.56,$8.80,$8.89,$0.00,$0.00,$0.00,$0.00,$0.00
15661,ERX,HCPCS 63700001,16714-0631-02,ALENDRONATE SODIUM 10 MG PO TABS,$11.11,$0.00,$11.11,$0.00,$7.93,$0.00,$0.00,$0.00,$0.00,$0.00,$11.11,$0.00,$5.56,$8.80,$8.89,$0.00,$0.00,$0.00,$0.00,$0.00
15661,ERX,HCPCS 63700001,64980-0340-01,ALENDRONATE SODIUM 10 MG PO TABS,$11.11,$0.00,$11.11,$0.00,$7.93,$0.00,$0.00,$0.00,$0.00,$0.00,$11.11,$0.00,$5.56,$8.80,$8.89,$0.00,$0.00,$0.00,$0.00,$0.00
15738,ERX,HCPCS 63700001,60505-0823-06,CALCITONIN (SALMON) 200 UNIT/ACT NA SOLN,$955.54,$0.00,$955.54,$0.00,$681.97,$0.00,$0.00,$0.00,$0.00,$0.00,$955.54,$0.00,$477.77,$756.79,$764.43,$0.00,$0.00,$0.00,$0.00,$0.00
15746,ERX,HCPCS 63700001,16714-0816-01,BICALUTAMIDE 50 MG PO TABS,$80.79,$0.00,$80.79,$0.00,$57.66,$0.00,$0.00,$0.00,$0.00,$0.00,$80.79,$0.00,$40.40,$63.99,$64.63,$0.00,$0.00,$0.00,$0.00,$0.00
15746,ERX,HCPCS 63700001,16714-0816-02,BICALUTAMIDE 50 MG PO TABS,$80.79,$0.00,$80.79,$0.00,$57.66,$0.00,$0.00,$0.00,$0.00,$0.00,$80.79,$0.00,$40.40,$63.99,$64.63,$0.00,$0.00,$0.00,$0.00,$0.00
15746,ERX,HCPCS 63700001,60429-0177-01,BICALUTAMIDE 50 MG PO TABS,$80.79,$0.00,$80.79,$0.00,$57.66,$0.00,$0.00,$0.00,$0.00,$0.00,$80.79,$0.00,$40.40,$63.99,$64.63,$0.00,$0.00,$0.00,$0.00,$0.00
15747,ERX,HCPCS 63700001,00378-3632-01,CARVEDILOL 6.25 MG PO TABS,$8.11,$0.00,$8.11,$0.00,$5.79,$0.00,$0.00,$0.00,$0.00,$0.00,$8.11,$0.00,$4.06,$6.42,$6.49,$0.00,$0.00,$0.00,$0.00,$0.00
15747,ERX,HCPCS 63700001,00904-6301-61,CARVEDILOL 6.25 MG PO TABS,$8.11,$0.00,$8.11,$0.00,$5.79,$0.00,$0.00,$0.00,$0.00,$0.00,$8.11,$0.00,$4.06,$6.42,$6.49,$0.00,$0.00,$0.00,$0.00,$0.00
15747,ERX,HCPCS 63700001,51079-0930-01,CARVEDILOL 6.25 MG PO TABS,$8.11,$0.00,$8.11,$0.00,$5.79,$0.00,$0.00,$0.00,$0.00,$0.00,$8.11,$0.00,$4.06,$6.42,$6.49,$0.00,$0.00,$0.00,$0.00,$0.00
15747,ERX,HCPCS 63700001,51079-0930-20,CARVEDILOL 6.25 MG PO TABS,$8.11,$0.00,$8.11,$0.00,$5.79,$0.00,$0.00,$0.00,$0.00,$0.00,$8.11,$0.00,$4.06,$6.42,$6.49,$0.00,$0.00,$0.00,$0.00,$0.00
15747,ERX,HCPCS 63700001,68084-0854-01,CARVEDILOL 6.25 MG PO TABS,$8.11,$0.00,$8.11,$0.00,$5.79,$0.00,$0.00,$0.00,$0.00,$0.00,$8.11,$0.00,$4.06,$6.42,$6.49,$0.00,$0.00,$0.00,$0.00,$0.00
15748,ERX,HCPCS 63700001,00093-7296-01,CARVEDILOL 25 MG PO TABS,$8.11,$0.00,$8.11,$0.00,$5.79,$0.00,$0.00,$0.00,$0.00,$0.00,$8.11,$0.00,$4.06,$6.42,$6.49,$0.00,$0.00,$0.00,$0.00,$0.00
15748,ERX,HCPCS 63700001,00378-3634-01,CARVEDILOL 25 MG PO TABS,$8.11,$0.00,$8.11,$0.00,$5.79,$0.00,$0.00,$0.00,$0.00,$0.00,$8.11,$0.00,$4.06,$6.42,$6.49,$0.00,$0.00,$0.00,$0.00,$0.00
15748,ERX,HCPCS 63700001,00904-6303-61,CARVEDILOL 25 MG PO TABS,$8.11,$0.00,$8.11,$0.00,$5.79,$0.00,$0.00,$0.00,$0.00,$0.00,$8.11,$0.00,$4.06,$6.42,$6.49,$0.00,$0.00,$0.00,$0.00,$0.00
15748,ERX,HCPCS 63700001,51079-0932-01,CARVEDILOL 25 MG PO TABS,$8.11,$0.00,$8.11,$0.00,$5.79,$0.00,$0.00,$0.00,$0.00,$0.00,$8.11,$0.00,$4.06,$6.42,$6.49,$0.00,$0.00,$0.00,$0.00,$0.00
15748,ERX,HCPCS 63700001,51079-0932-20,CARVEDILOL 25 MG PO TABS,$8.11,$0.00,$8.11,$0.00,$5.79,$0.00,$0.00,$0.00,$0.00,$0.00,$8.11,$0.00,$4.06,$6.42,$6.49,$0.00,$0.00,$0.00,$0.00,$0.00
15749,ERX,HCPCS 63700001,00093-7295-01,CARVEDILOL 12.5 MG PO TABS,$8.11,$0.00,$8.11,$0.00,$5.79,$0.00,$0.00,$0.00,$0.00,$0.00,$8.11,$0.00,$4.06,$6.42,$6.49,$0.00,$0.00,$0.00,$0.00,$0.00
15749,ERX,HCPCS 63700001,00781-5223-01,CARVEDILOL 12.5 MG PO TABS,$8.11,$0.00,$8.11,$0.00,$5.79,$0.00,$0.00,$0.00,$0.00,$0.00,$8.11,$0.00,$4.06,$6.42,$6.49,$0.00,$0.00,$0.00,$0.00,$0.00
15749,ERX,HCPCS 63700001,00904-6302-61,CARVEDILOL 12.5 MG PO TABS,$8.11,$0.00,$8.11,$0.00,$5.79,$0.00,$0.00,$0.00,$0.00,$0.00,$8.11,$0.00,$4.06,$6.42,$6.49,$0.00,$0.00,$0.00,$0.00,$0.00
15749,ERX,HCPCS 63700001,51079-0931-01,CARVEDILOL 12.5 MG PO TABS,$8.11,$0.00,$8.11,$0.00,$5.79,$0.00,$0.00,$0.00,$0.00,$0.00,$8.11,$0.00,$4.06,$6.42,$6.49,$0.00,$0.00,$0.00,$0.00,$0.00
15749,ERX,HCPCS 63700001,51079-0931-20,CARVEDILOL 12.5 MG PO TABS,$8.11,$0.00,$8.11,$0.00,$5.79,$0.00,$0.00,$0.00,$0.00,$0.00,$8.11,$0.00,$4.06,$6.42,$6.49,$0.00,$0.00,$0.00,$0.00,$0.00
15749,ERX,HCPCS 63700001,68382-0094-01,CARVEDILOL 12.5 MG PO TABS,$8.11,$0.00,$8.11,$0.00,$5.79,$0.00,$0.00,$0.00,$0.00,$0.00,$8.11,$0.00,$4.06,$6.42,$6.49,$0.00,$0.00,$0.00,$0.00,$0.00
15796,ERX,HCPCS 63700001,00069-3110-19,AZITHROMYCIN 100 MG/5ML PO SUSR,$109.89,$0.00,$109.89,$0.00,$78.43,$0.00,$0.00,$0.00,$0.00,$0.00,$109.89,$0.00,$54.95,$87.03,$87.91,$0.00,$0.00,$0.00,$0.00,$0.00
15796,ERX,HCPCS 63700001,59762-3110-01,AZITHROMYCIN 100 MG/5ML PO SUSR,$109.89,$0.00,$109.89,$0.00,$78.43,$0.00,$0.00,$0.00,$0.00,$0.00,$109.89,$0.00,$54.95,$87.03,$87.91,$0.00,$0.00,$0.00,$0.00,$0.00
15797,ERX,HCPCS 63700001,00093-2026-23,AZITHROMYCIN 200 MG/5ML PO SUSR,$122.07,$0.00,$122.07,$0.00,$87.12,$0.00,$0.00,$0.00,$0.00,$0.00,$122.07,$0.00,$61.04,$96.68,$97.66,$0.00,$0.00,$0.00,$0.00,$0.00
15797,ERX,HCPCS 63700001,59762-3120-01,AZITHROMYCIN 200 MG/5ML PO SUSR,$122.07,$0.00,$122.07,$0.00,$87.12,$0.00,$0.00,$0.00,$0.00,$0.00,$122.07,$0.00,$61.04,$96.68,$97.66,$0.00,$0.00,$0.00,$0.00,$0.00
15797,ERX,HCPCS 63700001,59762-3140-01,AZITHROMYCIN 200 MG/5ML PO SUSR,$122.12,$0.00,$122.07,$0.00,$87.12,$0.00,$0.00,$0.00,$0.00,$0.00,$122.07,$0.00,$61.04,$96.72,$97.66,$0.00,$0.00,$0.00,$0.00,$0.00
15816,ERX,HCPCS 63700001,00121-1276-00,GUAIFENESIN-DM 100-10 MG/5ML PO SYRP,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
15852,ERX,HCPCS J2274,00409-3815-12,MORPHINE SULFATE (PF) 1 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
15852,ERX,HCPCS J2274,00641-6019-01,MORPHINE SULFATE (PF) 1 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
15852,ERX,HCPCS J2274,00641-6019-10,MORPHINE SULFATE (PF) 1 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
15852,ERX,HCPCS J2274,99999-6012-28,MORPHINE SULFATE (PF) 1 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
15859,ERX,HCPCS 25000001,00338-1049-02,NITROGLYCERIN IN D5W 200-5 MCG/ML-% IV SOLN,$29.45,$0.00,$29.45,$0.00,$21.02,$0.00,$0.00,$0.00,$0.00,$0.00,$29.45,$0.00,$14.73,$23.32,$23.56,$0.00,$0.00,$0.00,$0.00,$0.00
15861,ERX,HCPCS J7042,00338-0085-03,DEXTROSE-NACL 5-0.45 % IV SOLN,$22.00,$0.00,$22.80,$10.26,$16.27,$0.00,$0.73,$0.00,$0.00,$2.19,$22.80,$0.00,$11.40,$17.42,$18.24,$0.00,$2.19,$0.00,$2.08,$0.00
15861,ERX,HCPCS J7042,00409-7926-03,DEXTROSE-NACL 5-0.45 % IV SOLN,$22.00,$0.00,$22.80,$10.26,$16.27,$0.00,$0.73,$0.00,$0.00,$2.19,$22.80,$0.00,$11.40,$17.42,$18.24,$0.00,$2.19,$0.00,$2.08,$0.00
15861,ERX,HCPCS J7042,00264-7612-00,DEXTROSE-NACL 5-0.45 % IV SOLN,$22.80,$0.00,$22.80,$10.26,$16.27,$0.00,$0.73,$0.00,$0.00,$2.19,$22.80,$0.00,$11.40,$18.06,$18.24,$0.00,$2.19,$0.00,$2.08,$0.00
15861,ERX,HCPCS J7042,00338-0085-04,DEXTROSE-NACL 5-0.45 % IV SOLN,$22.80,$0.00,$22.80,$10.26,$16.27,$0.00,$0.73,$0.00,$0.00,$2.19,$22.80,$0.00,$11.40,$18.06,$18.24,$0.00,$2.19,$0.00,$2.08,$0.00
15863,ERX,HCPCS J7042,00338-0077-03,DEXTROSE-NACL 5-0.2 % IV SOLN,$22.00,$0.00,$22.80,$10.26,$16.27,$0.00,$0.73,$0.00,$0.00,$2.19,$22.80,$0.00,$11.40,$17.42,$18.24,$0.00,$2.19,$0.00,$2.08,$0.00
15863,ERX,HCPCS J7042,00264-7616-00,DEXTROSE-NACL 5-0.2 % IV SOLN,$22.80,$0.00,$22.80,$10.26,$16.27,$0.00,$0.73,$0.00,$0.00,$2.19,$22.80,$0.00,$11.40,$18.06,$18.24,$0.00,$2.19,$0.00,$2.08,$0.00
15863,ERX,HCPCS J7042,00338-0077-04,DEXTROSE-NACL 5-0.2 % IV SOLN,$22.80,$0.00,$22.80,$10.26,$16.27,$0.00,$0.73,$0.00,$0.00,$2.19,$22.80,$0.00,$11.40,$18.06,$18.24,$0.00,$2.19,$0.00,$2.08,$0.00
15865,ERX,HCPCS J7042,00264-7623-20,DEXTROSE-NACL 10-0.2 % IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.36,$0.00,$0.00,$1.09,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.09,$0.00,$1.04,$0.00
15880,ERX,HCPCS 63700001,50742-0623-60,LAMIVUDINE 150 MG PO TABS,$27.19,$0.00,$27.19,$0.00,$19.41,$0.00,$0.00,$0.00,$0.00,$0.00,$27.19,$0.00,$13.60,$21.53,$21.75,$0.00,$0.00,$0.00,$0.00,$0.00
15880,ERX,HCPCS 63700001,60505-3251-06,LAMIVUDINE 150 MG PO TABS,$27.19,$0.00,$27.19,$0.00,$19.41,$0.00,$0.00,$0.00,$0.00,$0.00,$27.19,$0.00,$13.60,$21.53,$21.75,$0.00,$0.00,$0.00,$0.00,$0.00
15880,ERX,HCPCS 63700001,64380-0710-03,LAMIVUDINE 150 MG PO TABS,$27.19,$0.00,$27.19,$0.00,$19.41,$0.00,$0.00,$0.00,$0.00,$0.00,$27.19,$0.00,$13.60,$21.53,$21.75,$0.00,$0.00,$0.00,$0.00,$0.00
15880,ERX,HCPCS 63700001,65862-0025-60,LAMIVUDINE 150 MG PO TABS,$27.19,$0.00,$27.19,$0.00,$19.41,$0.00,$0.00,$0.00,$0.00,$0.00,$27.19,$0.00,$13.60,$21.53,$21.75,$0.00,$0.00,$0.00,$0.00,$0.00
15881,ERX,HCPCS 63700001,99999-6010-41,LAMIVUDINE 10 MG/ML PO SOLN,$56.89,$0.00,$192.41,$0.00,$137.32,$0.00,$0.00,$0.00,$0.00,$0.00,$192.41,$0.00,$96.21,$45.06,$153.93,$0.00,$0.00,$0.00,$0.00,$0.00
15881,ERX,HCPCS 63700001,99999-6004-86,LAMIVUDINE 10 MG/ML PO SOLN,$192.41,$0.00,$192.41,$0.00,$137.32,$0.00,$0.00,$0.00,$0.00,$0.00,$192.41,$0.00,$96.21,$152.39,$153.93,$0.00,$0.00,$0.00,$0.00,$0.00
15881,ERX,HCPCS 63700001,49702-0205-48,LAMIVUDINE 10 MG/ML PO SOLN,$405.53,$0.00,$321.18,$0.00,$137.32,$0.00,$0.00,$0.00,$0.00,$0.00,$192.41,$0.00,$96.21,$321.18,$153.93,$0.00,$0.00,$0.00,$0.00,$0.00
15881,ERX,HCPCS 63700001,54838-0566-70,LAMIVUDINE 10 MG/ML PO SOLN,$405.53,$0.00,$321.18,$0.00,$137.32,$0.00,$0.00,$0.00,$0.00,$0.00,$192.41,$0.00,$96.21,$321.18,$153.93,$0.00,$0.00,$0.00,$0.00,$0.00
15882,ERX,HCPCS J7042,00338-0089-04,DEXTROSE-NACL 5-0.9 % IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.73,$0.00,$0.00,$2.19,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$2.19,$0.00,$2.08,$0.00
15882,ERX,HCPCS J7042,00338-0089-03,DEXTROSE-NACL 5-0.9 % IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.73,$0.00,$0.00,$2.19,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$2.19,$0.00,$2.08,$0.00
15898,ERX,HCPCS J1325,66215-0402-01,EPOPROSTENOL SODIUM 1.5 MG IV SOLR,$177.07,$0.00,$177.07,$0.00,$126.37,$0.00,$0.00,$0.00,$0.00,$0.00,$177.07,$0.00,$88.54,$140.24,$141.66,$0.00,$0.00,$0.00,$0.00,$0.00
15906,ERX,HCPCS J1580,00338-0503-48,GENTAMICIN IN SALINE 0.8-0.9 MG/ML-% IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.02,$0.00,$0.00,$2.31,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$2.31,$0.00,$2.20,$0.00
15908,ERX,HCPCS J1580,00338-0505-48,GENTAMICIN IN SALINE 1-0.9 MG/ML-% IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.02,$0.00,$0.00,$2.31,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$2.31,$0.00,$2.20,$0.00
15911,ERX,HCPCS J1580,00338-0509-41,GENTAMICIN IN SALINE 1.6-0.9 MG/ML-% IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.02,$0.00,$0.00,$2.31,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$2.31,$0.00,$2.20,$0.00
16005,ERX,HCPCS 63700001,00555-0808-02,TRETINOIN 10 MG PO CAPS,$569.62,$0.00,$569.62,$0.00,$406.54,$0.00,$0.00,$0.00,$0.00,$0.00,$569.62,$0.00,$284.81,$451.14,$455.70,$0.00,$0.00,$0.00,$0.00,$0.00
16005,ERX,HCPCS 63700001,10370-0268-01,TRETINOIN 10 MG PO CAPS,$569.62,$0.00,$569.62,$0.00,$406.54,$0.00,$0.00,$0.00,$0.00,$0.00,$569.62,$0.00,$284.81,$451.14,$455.70,$0.00,$0.00,$0.00,$0.00,$0.00
16005,ERX,HCPCS 63700001,68084-0075-21,TRETINOIN 10 MG PO CAPS,$569.62,$0.00,$569.62,$0.00,$406.54,$0.00,$0.00,$0.00,$0.00,$0.00,$569.62,$0.00,$284.81,$451.14,$455.70,$0.00,$0.00,$0.00,$0.00,$0.00
16032,ERX,HCPCS 63700001,00046-2575-12,CONJ ESTROG-MEDROXYPROGEST ACE PO TABS,$33.03,$0.00,$33.03,$0.00,$23.57,$0.00,$0.00,$0.00,$0.00,$0.00,$33.03,$0.00,$16.52,$26.16,$26.42,$0.00,$0.00,$0.00,$0.00,$0.00
16050,ERX,HCPCS 25000001,00904-6710-15,GLUCOSE 4 G PO CHEW,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
16052,ERX,HCPCS 63700001,00591-2464-01,DESMOPRESSIN ACETATE 0.1 MG PO TABS,$20.09,$0.00,$20.09,$0.00,$14.34,$0.00,$0.00,$0.00,$0.00,$0.00,$20.09,$0.00,$10.05,$15.91,$16.07,$0.00,$0.00,$0.00,$0.00,$0.00
16052,ERX,HCPCS 63700001,10702-0169-01,DESMOPRESSIN ACETATE 0.1 MG PO TABS,$20.09,$0.00,$20.09,$0.00,$14.34,$0.00,$0.00,$0.00,$0.00,$0.00,$20.09,$0.00,$10.05,$15.91,$16.07,$0.00,$0.00,$0.00,$0.00,$0.00
16052,ERX,HCPCS 63700001,68084-0606-11,DESMOPRESSIN ACETATE 0.1 MG PO TABS,$20.09,$0.00,$20.09,$0.00,$14.34,$0.00,$0.00,$0.00,$0.00,$0.00,$20.09,$0.00,$10.05,$15.91,$16.07,$0.00,$0.00,$0.00,$0.00,$0.00
16052,ERX,HCPCS 63700001,68084-0606-21,DESMOPRESSIN ACETATE 0.1 MG PO TABS,$20.09,$0.00,$20.09,$0.00,$14.34,$0.00,$0.00,$0.00,$0.00,$0.00,$20.09,$0.00,$10.05,$15.91,$16.07,$0.00,$0.00,$0.00,$0.00,$0.00
16052,ERX,HCPCS 63700001,68462-0275-01,DESMOPRESSIN ACETATE 0.1 MG PO TABS,$20.09,$0.00,$20.09,$0.00,$14.34,$0.00,$0.00,$0.00,$0.00,$0.00,$20.09,$0.00,$10.05,$15.91,$16.07,$0.00,$0.00,$0.00,$0.00,$0.00
16052,ERX,HCPCS 63700001,69918-0101-01,DESMOPRESSIN ACETATE 0.1 MG PO TABS,$20.09,$0.00,$20.09,$0.00,$14.34,$0.00,$0.00,$0.00,$0.00,$0.00,$20.09,$0.00,$10.05,$15.91,$16.07,$0.00,$0.00,$0.00,$0.00,$0.00
16124,ERX,HCPCS 63700001,67877-0286-60,(RILUTEK) RILUZOLE 50 MG PO TABS,$114.44,$0.00,$114.44,$0.00,$81.68,$0.00,$0.00,$0.00,$0.00,$0.00,$114.44,$0.00,$57.22,$90.64,$91.55,$0.00,$0.00,$0.00,$0.00,$0.00
16124,ERX,HCPCS 63700001,68462-0381-60,(RILUTEK) RILUZOLE 50 MG PO TABS,$114.44,$0.00,$114.44,$0.00,$81.68,$0.00,$0.00,$0.00,$0.00,$0.00,$114.44,$0.00,$57.22,$90.64,$91.55,$0.00,$0.00,$0.00,$0.00,$0.00
16205,ERX,HCPCS 63700001,00093-7536-56,ANASTROZOLE 1 MG PO TABS,$73.45,$0.00,$73.45,$0.00,$52.42,$0.00,$0.00,$0.00,$0.00,$0.00,$73.45,$0.00,$36.73,$58.17,$58.76,$0.00,$0.00,$0.00,$0.00,$0.00
16205,ERX,HCPCS 63700001,00904-6195-46,ANASTROZOLE 1 MG PO TABS,$73.45,$0.00,$73.45,$0.00,$52.42,$0.00,$0.00,$0.00,$0.00,$0.00,$73.45,$0.00,$36.73,$58.17,$58.76,$0.00,$0.00,$0.00,$0.00,$0.00
16205,ERX,HCPCS 63700001,16729-0035-10,ANASTROZOLE 1 MG PO TABS,$73.45,$0.00,$73.45,$0.00,$52.42,$0.00,$0.00,$0.00,$0.00,$0.00,$73.45,$0.00,$36.73,$58.17,$58.76,$0.00,$0.00,$0.00,$0.00,$0.00
16205,ERX,HCPCS 63700001,60505-2985-03,ANASTROZOLE 1 MG PO TABS,$73.45,$0.00,$73.45,$0.00,$52.42,$0.00,$0.00,$0.00,$0.00,$0.00,$73.45,$0.00,$36.73,$58.17,$58.76,$0.00,$0.00,$0.00,$0.00,$0.00
16205,ERX,HCPCS 63700001,68382-0209-06,ANASTROZOLE 1 MG PO TABS,$73.45,$0.00,$73.45,$0.00,$52.42,$0.00,$0.00,$0.00,$0.00,$0.00,$73.45,$0.00,$36.73,$58.17,$58.76,$0.00,$0.00,$0.00,$0.00,$0.00
16208,ERX,HCPCS 25000001,60258-0001-16,CYTRA-2 500-334 MG/5ML PO SOLN,$11.00,$0.00,$11.00,$0.00,$7.85,$0.00,$0.00,$0.00,$0.00,$0.00,$11.00,$0.00,$5.50,$8.71,$8.80,$0.00,$0.00,$0.00,$0.00,$0.00
16218,ERX,HCPCS 63700001,00054-3120-41,CALCITRIOL 1 MCG/ML PO SOLN,$545.94,$0.00,$545.94,$0.00,$389.64,$0.00,$0.00,$0.00,$0.00,$0.00,$545.94,$0.00,$272.97,$432.38,$436.75,$0.00,$0.00,$0.00,$0.00,$0.00
16218,ERX,HCPCS 63700001,30698-0911-15,CALCITRIOL 1 MCG/ML PO SOLN,$545.94,$0.00,$545.94,$0.00,$389.64,$0.00,$0.00,$0.00,$0.00,$0.00,$545.94,$0.00,$272.97,$432.38,$436.75,$0.00,$0.00,$0.00,$0.00,$0.00
16218,ERX,HCPCS 63700001,63304-0241-59,CALCITRIOL 1 MCG/ML PO SOLN,$545.94,$0.00,$545.94,$0.00,$389.64,$0.00,$0.00,$0.00,$0.00,$0.00,$545.94,$0.00,$272.97,$432.38,$436.75,$0.00,$0.00,$0.00,$0.00,$0.00
16355,ERX,HCPCS 63700001,55111-0320-01,GLIMEPIRIDE 1 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
16356,ERX,HCPCS 63700001,68084-0326-01,GLIMEPIRIDE 2 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
16356,ERX,HCPCS 63700001,68084-0326-11,GLIMEPIRIDE 2 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
16357,ERX,HCPCS 63700001,55111-0322-01,GLIMEPIRIDE 4 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
16369,ERX,HCPCS J0692,25021-0121-20,CEFEPIME HCL 1 G IJ SOLR,$71.17,$0.00,$71.17,$32.03,$50.79,$0.00,$12.26,$0.00,$0.00,$12.46,$71.17,$0.00,$35.59,$56.37,$56.94,$0.00,$11.14,$0.00,$11.33,$0.00
16369,ERX,HCPCS J0692,44567-0240-10,CEFEPIME HCL 1 G IJ SOLR,$71.17,$0.00,$71.17,$32.03,$50.79,$0.00,$12.26,$0.00,$0.00,$12.46,$71.17,$0.00,$35.59,$56.37,$56.94,$0.00,$11.14,$0.00,$11.33,$0.00
16369,ERX,HCPCS J0692,60505-6144-04,CEFEPIME HCL 1 G IJ SOLR,$71.17,$0.00,$71.17,$32.03,$50.79,$0.00,$12.26,$0.00,$0.00,$12.46,$71.17,$0.00,$35.59,$56.37,$56.94,$0.00,$11.14,$0.00,$11.33,$0.00
16369,ERX,HCPCS J0692,60505-6146-04,CEFEPIME HCL 1 G IJ SOLR,$71.17,$0.00,$71.17,$32.03,$50.79,$0.00,$12.26,$0.00,$0.00,$12.46,$71.17,$0.00,$35.59,$56.37,$56.94,$0.00,$11.14,$0.00,$11.33,$0.00
16369,ERX,HCPCS J0692,63323-0326-20,CEFEPIME HCL 1 G IJ SOLR,$71.17,$0.00,$71.17,$32.03,$50.79,$0.00,$12.26,$0.00,$0.00,$12.46,$71.17,$0.00,$35.59,$56.37,$56.94,$0.00,$11.14,$0.00,$11.33,$0.00
16371,ERX,HCPCS J0692,44567-0241-10,CEFEPIME HCL 2 G IJ SOLR,$141.26,$0.00,$141.26,$63.57,$100.82,$0.00,$24.34,$0.00,$0.00,$24.73,$141.26,$0.00,$70.63,$111.88,$113.01,$0.00,$22.11,$0.00,$22.49,$0.00
16371,ERX,HCPCS J0692,60505-6145-04,CEFEPIME HCL 2 G IJ SOLR,$141.26,$0.00,$141.26,$63.57,$100.82,$0.00,$24.34,$0.00,$0.00,$24.73,$141.26,$0.00,$70.63,$111.88,$113.01,$0.00,$22.11,$0.00,$22.49,$0.00
16371,ERX,HCPCS J0692,60505-6147-00,CEFEPIME HCL 2 G IJ SOLR,$141.26,$0.00,$141.26,$63.57,$100.82,$0.00,$24.34,$0.00,$0.00,$24.73,$141.26,$0.00,$70.63,$111.88,$113.01,$0.00,$22.11,$0.00,$22.49,$0.00
16371,ERX,HCPCS J0692,60505-6147-04,CEFEPIME HCL 2 G IJ SOLR,$141.26,$0.00,$141.26,$63.57,$100.82,$0.00,$24.34,$0.00,$0.00,$24.73,$141.26,$0.00,$70.63,$111.88,$113.01,$0.00,$22.11,$0.00,$22.49,$0.00
16440,ERX,HCPCS 63700001,99999-6004-87,RITONAVIR 80 MG/ML PO SOLN,$572.48,$0.00,"$3,542.90",$0.00,"$2,528.57",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,542.90",$0.00,"$1,771.45",$453.40,"$2,834.32",$0.00,$0.00,$0.00,$0.00,$0.00
16440,ERX,HCPCS 63700001,00074-1940-63,RITONAVIR 80 MG/ML PO SOLN,"$3,542.90",$0.00,"$3,542.90",$0.00,"$2,528.57",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,542.90",$0.00,"$1,771.45","$2,805.98","$2,834.32",$0.00,$0.00,$0.00,$0.00,$0.00
16632,ERX,HCPCS 63700001,00904-5676-61,PAROXETINE HCL 10 MG PO TABS,$10.70,$0.00,$10.70,$0.00,$7.64,$0.00,$0.00,$0.00,$0.00,$0.00,$10.70,$0.00,$5.35,$8.47,$8.56,$0.00,$0.00,$0.00,$0.00,$0.00
16632,ERX,HCPCS 63700001,13107-0154-30,PAROXETINE HCL 10 MG PO TABS,$10.70,$0.00,$10.70,$0.00,$7.64,$0.00,$0.00,$0.00,$0.00,$0.00,$10.70,$0.00,$5.35,$8.47,$8.56,$0.00,$0.00,$0.00,$0.00,$0.00
16633,ERX,HCPCS 63700001,60505-0101-02,PAROXETINE HCL 40 MG PO TABS,$11.53,$0.00,$11.53,$0.00,$8.23,$0.00,$0.00,$0.00,$0.00,$0.00,$11.53,$0.00,$5.77,$9.13,$9.22,$0.00,$0.00,$0.00,$0.00,$0.00
16633,ERX,HCPCS 63700001,68084-0047-01,PAROXETINE HCL 40 MG PO TABS,$11.53,$0.00,$11.53,$0.00,$8.23,$0.00,$0.00,$0.00,$0.00,$0.00,$11.53,$0.00,$5.77,$9.13,$9.22,$0.00,$0.00,$0.00,$0.00,$0.00
16633,ERX,HCPCS 63700001,68382-0001-16,PAROXETINE HCL 40 MG PO TABS,$11.53,$0.00,$11.53,$0.00,$8.23,$0.00,$0.00,$0.00,$0.00,$0.00,$11.53,$0.00,$5.77,$9.13,$9.22,$0.00,$0.00,$0.00,$0.00,$0.00
16639,ERX,HCPCS 25000001,00703-9258-09,GLYCINE DILUENT IV SOLN,$64.22,$0.00,$64.22,$0.00,$45.83,$0.00,$0.00,$0.00,$0.00,$0.00,$64.22,$0.00,$32.11,$50.86,$51.38,$0.00,$0.00,$0.00,$0.00,$0.00
16644,ERX,HCPCS 63700001,00006-0571-43,INDINAVIR SULFATE 200 MG PO CAPS,$11.58,$0.00,$11.58,$0.00,$8.26,$0.00,$0.00,$0.00,$0.00,$0.00,$11.58,$0.00,$5.79,$9.17,$9.26,$0.00,$0.00,$0.00,$0.00,$0.00
16645,ERX,HCPCS 63700001,00006-0573-62,INDINAVIR SULFATE 400 MG PO CAPS,$11.58,$0.00,$11.58,$0.00,$8.26,$0.00,$0.00,$0.00,$0.00,$0.00,$11.58,$0.00,$5.79,$9.17,$9.26,$0.00,$0.00,$0.00,$0.00,$0.00
16825,ERX,HCPCS 25000001,00942-0641-03,ACD FORMULA A 0.73-2.45-2.2 GM/100ML VI SOLN,$26.60,$0.00,$26.60,$0.00,$18.98,$0.00,$0.00,$0.00,$0.00,$0.00,$26.60,$0.00,$13.30,$21.07,$21.28,$0.00,$0.00,$0.00,$0.00,$0.00
16825,ERX,HCPCS 25000001,00942-0641-04,ACD FORMULA A 0.73-2.45-2.2 GM/100ML VI SOLN,$26.60,$0.00,$26.60,$0.00,$18.98,$0.00,$0.00,$0.00,$0.00,$0.00,$26.60,$0.00,$13.30,$21.07,$21.28,$0.00,$0.00,$0.00,$0.00,$0.00
16830,ERX,HCPCS 63700001,07610-0226-40,MELATONIN 3 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
16830,ERX,HCPCS 63700001,20555-0036-01,MELATONIN 3 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
16830,ERX,HCPCS 63700001,31604-0027-41,MELATONIN 3 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
16830,ERX,HCPCS 63700001,50268-0524-11,MELATONIN 3 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
16830,ERX,HCPCS 63700001,50268-0524-15,MELATONIN 3 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
16830,ERX,HCPCS 63700001,77333-0516-10,MELATONIN 3 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
17010,ERX,HCPCS 63700001,43199-0014-01,HYOSCYAMINE SULFATE ER 0.375 MG PO TB12,$6.08,$0.00,$6.08,$0.00,$4.34,$0.00,$0.00,$0.00,$0.00,$0.00,$6.08,$0.00,$3.04,$4.82,$4.86,$0.00,$0.00,$0.00,$0.00,$0.00
17010,ERX,HCPCS 63700001,51525-0115-01,HYOSCYAMINE SULFATE ER 0.375 MG PO TB12,$6.08,$0.00,$6.08,$0.00,$4.34,$0.00,$0.00,$0.00,$0.00,$0.00,$6.08,$0.00,$3.04,$4.82,$4.86,$0.00,$0.00,$0.00,$0.00,$0.00
17010,ERX,HCPCS 63700001,68047-0255-01,HYOSCYAMINE SULFATE ER 0.375 MG PO TB12,$6.08,$0.00,$6.08,$0.00,$4.34,$0.00,$0.00,$0.00,$0.00,$0.00,$6.08,$0.00,$3.04,$4.82,$4.86,$0.00,$0.00,$0.00,$0.00,$0.00
17012,ERX,HCPCS J9040,00703-3155-01,BLEOMYCIN SULFATE 30 UNITS IJ SOLR,$337.58,$0.00,$337.58,$151.91,$240.93,$0.00,$74.80,$0.00,$0.00,$53.27,$337.58,$0.00,$168.79,$267.36,$270.06,$0.00,$53.27,$0.00,$50.73,$0.00
17012,ERX,HCPCS J9040,61703-0323-22,BLEOMYCIN SULFATE 30 UNITS IJ SOLR,$337.58,$0.00,$337.58,$151.91,$240.93,$0.00,$74.80,$0.00,$0.00,$53.27,$337.58,$0.00,$168.79,$267.36,$270.06,$0.00,$53.27,$0.00,$50.73,$0.00
17023,ERX,HCPCS 63700001,43199-0011-01,HYOSCYAMINE SULFATE 0.125 MG SL SUBL,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
17023,ERX,HCPCS 63700001,70156-0105-01,HYOSCYAMINE SULFATE 0.125 MG SL SUBL,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
17122,ERX,HCPCS J9201,25021-0235-50,GEMCITABINE HCL 1 G IV SOLR,$187.68,$0.00,$811.87,$84.46,$133.95,$0.00,$811.87,$0.00,$0.00,$24.44,$187.68,$0.00,$93.84,$148.64,$150.14,$0.00,$24.44,$0.00,$23.27,$0.00
17122,ERX,HCPCS J9201,63323-0125-53,GEMCITABINE HCL 1 G IV SOLR,$187.68,$0.00,$811.87,$84.46,$133.95,$0.00,$811.87,$0.00,$0.00,$24.44,$187.68,$0.00,$93.84,$148.64,$150.14,$0.00,$24.44,$0.00,$23.27,$0.00
17280,ERX,HCPCS 63700001,60505-0055-01,SELEGILINE HCL 5 MG PO CAPS,$8.76,$0.00,$8.76,$0.00,$6.25,$0.00,$0.00,$0.00,$0.00,$0.00,$8.76,$0.00,$4.38,$6.94,$7.01,$0.00,$0.00,$0.00,$0.00,$0.00
17285,ERX,HCPCS J9351,16729-0151-31,TOPOTECAN HCL 4 MG IV SOLR,$949.37,$0.00,$949.37,$427.22,$677.57,$0.00,$163.57,$0.00,$0.00,$46.06,$949.37,$0.00,$474.69,$751.90,$759.50,$0.00,$46.06,$0.00,$43.86,$0.00
17377,ERX,HCPCS 25000001,13668-0589-06,RISPERIDONE 1 MG/ML PO SOLN,$465.28,$0.00,$465.28,$0.00,$332.07,$0.00,$0.00,$0.00,$0.00,$0.00,$465.28,$0.00,$232.64,$368.50,$372.22,$0.00,$0.00,$0.00,$0.00,$0.00
17377,ERX,HCPCS 25000001,51991-0716-41,RISPERIDONE 1 MG/ML PO SOLN,$465.28,$0.00,$465.28,$0.00,$332.07,$0.00,$0.00,$0.00,$0.00,$0.00,$465.28,$0.00,$232.64,$368.50,$372.22,$0.00,$0.00,$0.00,$0.00,$0.00
17377,ERX,HCPCS 25000001,65162-0673-84,RISPERIDONE 1 MG/ML PO SOLN,$465.28,$0.00,$465.28,$0.00,$332.07,$0.00,$0.00,$0.00,$0.00,$0.00,$465.28,$0.00,$232.64,$368.50,$372.22,$0.00,$0.00,$0.00,$0.00,$0.00
17378,ERX,HCPCS J0740,23155-0216-31,CIDOFOVIR 75 MG/ML IV SOLN,"$2,131.20",$0.00,"$2,131.20",$0.00,"$1,521.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,131.20",$0.00,"$1,065.60","$1,687.91","$1,704.96",$0.00,$0.00,$0.00,$0.00,$0.00
17379,ERX,HCPCS J2185,00781-3000-95,MEROPENEM 500 MG IV SOLR,$91.00,$0.00,$91.00,$0.00,$64.95,$0.00,$0.00,$0.00,$0.00,$0.00,$91.00,$0.00,$45.50,$72.07,$72.80,$0.00,$0.00,$0.00,$0.00,$0.00
17379,ERX,HCPCS J2185,55150-0207-20,MEROPENEM 500 MG IV SOLR,$91.00,$0.00,$91.00,$0.00,$64.95,$0.00,$0.00,$0.00,$0.00,$0.00,$91.00,$0.00,$45.50,$72.07,$72.80,$0.00,$0.00,$0.00,$0.00,$0.00
17379,ERX,HCPCS J2185,63323-0507-20,MEROPENEM 500 MG IV SOLR,$91.00,$0.00,$91.00,$0.00,$64.95,$0.00,$0.00,$0.00,$0.00,$0.00,$91.00,$0.00,$45.50,$72.07,$72.80,$0.00,$0.00,$0.00,$0.00,$0.00
17379,ERX,HCPCS J2185,63323-0507-21,MEROPENEM 500 MG IV SOLR,$91.00,$0.00,$91.00,$0.00,$64.95,$0.00,$0.00,$0.00,$0.00,$0.00,$91.00,$0.00,$45.50,$72.07,$72.80,$0.00,$0.00,$0.00,$0.00,$0.00
17379,ERX,HCPCS J2185,70121-1454-01,MEROPENEM 500 MG IV SOLR,$91.00,$0.00,$91.00,$0.00,$64.95,$0.00,$0.00,$0.00,$0.00,$0.00,$91.00,$0.00,$45.50,$72.07,$72.80,$0.00,$0.00,$0.00,$0.00,$0.00
17379,ERX,HCPCS J2185,70121-1454-07,MEROPENEM 500 MG IV SOLR,$91.00,$0.00,$91.00,$0.00,$64.95,$0.00,$0.00,$0.00,$0.00,$0.00,$91.00,$0.00,$45.50,$72.07,$72.80,$0.00,$0.00,$0.00,$0.00,$0.00
17380,ERX,HCPCS J2185,00069-0314-01,MEROPENEM 1 G IV SOLR,$163.80,$0.00,$163.80,$0.00,$116.90,$0.00,$0.00,$0.00,$0.00,$0.00,$163.80,$0.00,$81.90,$129.73,$131.04,$0.00,$0.00,$0.00,$0.00,$0.00
17380,ERX,HCPCS J2185,00069-0314-10,MEROPENEM 1 G IV SOLR,$163.80,$0.00,$163.80,$0.00,$116.90,$0.00,$0.00,$0.00,$0.00,$0.00,$163.80,$0.00,$81.90,$129.73,$131.04,$0.00,$0.00,$0.00,$0.00,$0.00
17380,ERX,HCPCS J2185,00781-3098-95,MEROPENEM 1 G IV SOLR,$163.80,$0.00,$163.80,$0.00,$116.90,$0.00,$0.00,$0.00,$0.00,$0.00,$163.80,$0.00,$81.90,$129.73,$131.04,$0.00,$0.00,$0.00,$0.00,$0.00
17380,ERX,HCPCS J2185,55150-0208-30,MEROPENEM 1 G IV SOLR,$163.80,$0.00,$163.80,$0.00,$116.90,$0.00,$0.00,$0.00,$0.00,$0.00,$163.80,$0.00,$81.90,$129.73,$131.04,$0.00,$0.00,$0.00,$0.00,$0.00
17380,ERX,HCPCS J2185,63323-0508-30,MEROPENEM 1 G IV SOLR,$163.80,$0.00,$163.80,$0.00,$116.90,$0.00,$0.00,$0.00,$0.00,$0.00,$163.80,$0.00,$81.90,$129.73,$131.04,$0.00,$0.00,$0.00,$0.00,$0.00
17380,ERX,HCPCS J2185,70121-1453-01,MEROPENEM 1 G IV SOLR,$163.80,$0.00,$163.80,$0.00,$116.90,$0.00,$0.00,$0.00,$0.00,$0.00,$163.80,$0.00,$81.90,$129.73,$131.04,$0.00,$0.00,$0.00,$0.00,$0.00
17380,ERX,HCPCS J2185,70121-1453-07,MEROPENEM 1 G IV SOLR,$163.80,$0.00,$163.80,$0.00,$116.90,$0.00,$0.00,$0.00,$0.00,$0.00,$163.80,$0.00,$81.90,$129.73,$131.04,$0.00,$0.00,$0.00,$0.00,$0.00
17387,ERX,HCPCS 63700001,50111-0789-10,AZITHROMYCIN 600 MG PO TABS,$70.92,$0.00,$70.92,$0.00,$50.62,$0.00,$0.00,$0.00,$0.00,$0.00,$70.92,$0.00,$35.46,$56.17,$56.74,$0.00,$0.00,$0.00,$0.00,$0.00
17387,ERX,HCPCS 63700001,60687-0314-25,AZITHROMYCIN 600 MG PO TABS,$70.92,$0.00,$70.92,$0.00,$50.62,$0.00,$0.00,$0.00,$0.00,$0.00,$70.92,$0.00,$35.46,$56.17,$56.74,$0.00,$0.00,$0.00,$0.00,$0.00
17387,ERX,HCPCS 63700001,69452-0173-13,AZITHROMYCIN 600 MG PO TABS,$70.92,$0.00,$70.92,$0.00,$50.62,$0.00,$0.00,$0.00,$0.00,$0.00,$70.92,$0.00,$35.46,$56.17,$56.74,$0.00,$0.00,$0.00,$0.00,$0.00
17403,ERX,HCPCS 63700001,00597-0046-60,NEVIRAPINE 200 MG PO TABS,$68.86,$0.00,$68.86,$0.00,$49.15,$0.00,$0.00,$0.00,$0.00,$0.00,$68.86,$0.00,$34.43,$54.54,$55.09,$0.00,$0.00,$0.00,$0.00,$0.00
17403,ERX,HCPCS 63700001,31722-0505-60,NEVIRAPINE 200 MG PO TABS,$68.86,$0.00,$68.86,$0.00,$49.15,$0.00,$0.00,$0.00,$0.00,$0.00,$68.86,$0.00,$34.43,$54.54,$55.09,$0.00,$0.00,$0.00,$0.00,$0.00
17405,ERX,HCPCS J1815,00002-7510-01,INSULIN LISPRO 100 UNIT/ML SC SOLN,$15.00,$0.00,$15.00,$8.15,$10.71,$0.00,$0.36,$0.00,$0.00,$2.63,$15.00,$0.00,$7.50,$11.88,$12.00,$0.00,$0.00,$0.00,$1.01,$0.00
17464,ERX,HCPCS 63700001,00093-1003-01,BUSPIRONE HCL 15 MG PO TABS,$7.68,$0.00,$7.68,$0.00,$5.48,$0.00,$0.00,$0.00,$0.00,$0.00,$7.68,$0.00,$3.84,$6.08,$6.14,$0.00,$0.00,$0.00,$0.00,$0.00
17464,ERX,HCPCS 63700001,68382-0182-01,BUSPIRONE HCL 15 MG PO TABS,$7.68,$0.00,$7.68,$0.00,$5.48,$0.00,$0.00,$0.00,$0.00,$0.00,$7.68,$0.00,$3.84,$6.08,$6.14,$0.00,$0.00,$0.00,$0.00,$0.00
17465,ERX,HCPCS 63700001,00052-0107-30,MIRTAZAPINE 30 MG PO TABS,$25.08,$0.00,$25.08,$0.00,$17.90,$0.00,$0.00,$0.00,$0.00,$0.00,$25.08,$0.00,$12.54,$19.86,$20.06,$0.00,$0.00,$0.00,$0.00,$0.00
17465,ERX,HCPCS 63700001,51079-0087-20,MIRTAZAPINE 30 MG PO TABS,$25.08,$0.00,$25.08,$0.00,$17.90,$0.00,$0.00,$0.00,$0.00,$0.00,$25.08,$0.00,$12.54,$19.86,$20.06,$0.00,$0.00,$0.00,$0.00,$0.00
17465,ERX,HCPCS 63700001,68084-0120-01,MIRTAZAPINE 30 MG PO TABS,$25.08,$0.00,$25.08,$0.00,$17.90,$0.00,$0.00,$0.00,$0.00,$0.00,$25.08,$0.00,$12.54,$19.86,$20.06,$0.00,$0.00,$0.00,$0.00,$0.00
17465,ERX,HCPCS 63700001,68084-0120-11,MIRTAZAPINE 30 MG PO TABS,$25.08,$0.00,$25.08,$0.00,$17.90,$0.00,$0.00,$0.00,$0.00,$0.00,$25.08,$0.00,$12.54,$19.86,$20.06,$0.00,$0.00,$0.00,$0.00,$0.00
17466,ERX,HCPCS 63700001,00904-6519-61,MIRTAZAPINE 15 MG PO TABS,$12.90,$0.00,$12.90,$0.00,$9.21,$0.00,$0.00,$0.00,$0.00,$0.00,$12.90,$0.00,$6.45,$10.22,$10.32,$0.00,$0.00,$0.00,$0.00,$0.00
17466,ERX,HCPCS 63700001,51079-0086-20,MIRTAZAPINE 15 MG PO TABS,$12.90,$0.00,$12.90,$0.00,$9.21,$0.00,$0.00,$0.00,$0.00,$0.00,$12.90,$0.00,$6.45,$10.22,$10.32,$0.00,$0.00,$0.00,$0.00,$0.00
17500,ERX,HCPCS 25000001,62991-2015-01,CAFFEINE ANHYDROUS POWD,$273.11,$0.00,$273.11,$0.00,$194.92,$0.00,$0.00,$0.00,$0.00,$0.00,$273.11,$0.00,$136.56,$216.30,$218.49,$0.00,$0.00,$0.00,$0.00,$0.00
17524,ERX,HCPCS 25000001,59584-0138-01,CANDIDA ALBICANS SKN TST ANTGN ID SOLN,$94.50,$0.00,$94.50,$0.00,$67.44,$0.00,$0.00,$0.00,$0.00,$0.00,$94.50,$0.00,$47.25,$74.84,$75.60,$0.00,$0.00,$0.00,$0.00,$0.00
17594,ERX,HCPCS Q9966,00407-2222-19,IODIXANOL 270 MG/ML IV SOLN,$189.63,$0.00,$189.63,$85.33,$135.34,$0.00,$32.67,$0.00,$0.00,$27.03,$189.63,$0.00,$94.82,$150.19,$151.70,$0.00,$25.73,$0.00,$30.19,$0.00
17801,ERX,HCPCS 25000001,50383-0889-15,ACETIC ACID 2 % OT SOLN,$140.02,$0.00,$140.02,$0.00,$99.93,$0.00,$0.00,$0.00,$0.00,$0.00,$140.02,$0.00,$70.01,$110.90,$112.02,$0.00,$0.00,$0.00,$0.00,$0.00
17837,ERX,HCPCS 25000001,00085-1132-04,ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT IN AERS,$252.81,$0.00,$252.81,$0.00,$180.43,$0.00,$0.00,$0.00,$0.00,$0.00,$252.81,$0.00,$126.41,$200.23,$202.25,$0.00,$0.00,$0.00,$0.00,$0.00
17837,ERX,HCPCS 25000001,00173-0682-24,ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT IN AERS,$252.81,$0.00,$252.81,$0.00,$180.43,$0.00,$0.00,$0.00,$0.00,$0.00,$252.81,$0.00,$126.41,$200.23,$202.25,$0.00,$0.00,$0.00,$0.00,$0.00
17837,ERX,HCPCS 25000001,59310-0579-22,ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT IN AERS,$489.57,$0.00,$387.74,$0.00,$180.43,$0.00,$0.00,$0.00,$0.00,$0.00,$252.81,$0.00,$126.41,$387.74,$202.25,$0.00,$0.00,$0.00,$0.00,$0.00
17881,ERX,HCPCS 63700001,17478-0715-10,BRIMONIDINE TARTRATE 0.2 % OP SOLN,$47.50,$0.00,$47.50,$0.00,$33.90,$0.00,$0.00,$0.00,$0.00,$0.00,$47.50,$0.00,$23.75,$37.62,$38.00,$0.00,$0.00,$0.00,$0.00,$0.00
17881,ERX,HCPCS 63700001,24208-0411-05,BRIMONIDINE TARTRATE 0.2 % OP SOLN,$47.50,$0.00,$47.50,$0.00,$33.90,$0.00,$0.00,$0.00,$0.00,$0.00,$47.50,$0.00,$23.75,$37.62,$38.00,$0.00,$0.00,$0.00,$0.00,$0.00
17881,ERX,HCPCS 63700001,61314-0143-05,BRIMONIDINE TARTRATE 0.2 % OP SOLN,$47.50,$0.00,$47.50,$0.00,$33.90,$0.00,$0.00,$0.00,$0.00,$0.00,$47.50,$0.00,$23.75,$37.62,$38.00,$0.00,$0.00,$0.00,$0.00,$0.00
17881,ERX,HCPCS 63700001,70069-0231-01,BRIMONIDINE TARTRATE 0.2 % OP SOLN,$47.50,$0.00,$47.50,$0.00,$33.90,$0.00,$0.00,$0.00,$0.00,$0.00,$47.50,$0.00,$23.75,$37.62,$38.00,$0.00,$0.00,$0.00,$0.00,$0.00
17936,ERX,HCPCS 63700001,00904-6377-61,OLANZAPINE 5 MG PO TABS,$50.16,$0.00,$50.16,$0.00,$35.80,$0.00,$0.00,$0.00,$0.00,$0.00,$50.16,$0.00,$25.08,$39.73,$40.13,$0.00,$0.00,$0.00,$0.00,$0.00
17936,ERX,HCPCS 63700001,43598-0164-30,OLANZAPINE 5 MG PO TABS,$50.16,$0.00,$50.16,$0.00,$35.80,$0.00,$0.00,$0.00,$0.00,$0.00,$50.16,$0.00,$25.08,$39.73,$40.13,$0.00,$0.00,$0.00,$0.00,$0.00
17936,ERX,HCPCS 63700001,60505-3111-00,OLANZAPINE 5 MG PO TABS,$50.16,$0.00,$50.16,$0.00,$35.80,$0.00,$0.00,$0.00,$0.00,$0.00,$50.16,$0.00,$25.08,$39.73,$40.13,$0.00,$0.00,$0.00,$0.00,$0.00
17936,ERX,HCPCS 63700001,66993-0681-30,OLANZAPINE 5 MG PO TABS,$50.16,$0.00,$50.16,$0.00,$35.80,$0.00,$0.00,$0.00,$0.00,$0.00,$50.16,$0.00,$25.08,$39.73,$40.13,$0.00,$0.00,$0.00,$0.00,$0.00
17936,ERX,HCPCS 63700001,68084-0723-01,OLANZAPINE 5 MG PO TABS,$50.16,$0.00,$50.16,$0.00,$35.80,$0.00,$0.00,$0.00,$0.00,$0.00,$50.16,$0.00,$25.08,$39.73,$40.13,$0.00,$0.00,$0.00,$0.00,$0.00
17937,ERX,HCPCS 63700001,00904-6376-61,OLANZAPINE 10 MG PO TABS,$75.68,$0.00,$75.68,$0.00,$54.01,$0.00,$0.00,$0.00,$0.00,$0.00,$75.68,$0.00,$37.84,$59.94,$60.54,$0.00,$0.00,$0.00,$0.00,$0.00
17937,ERX,HCPCS 63700001,33342-0070-07,OLANZAPINE 10 MG PO TABS,$75.68,$0.00,$75.68,$0.00,$54.01,$0.00,$0.00,$0.00,$0.00,$0.00,$75.68,$0.00,$37.84,$59.94,$60.54,$0.00,$0.00,$0.00,$0.00,$0.00
17937,ERX,HCPCS 63700001,43598-0166-30,OLANZAPINE 10 MG PO TABS,$75.68,$0.00,$75.68,$0.00,$54.01,$0.00,$0.00,$0.00,$0.00,$0.00,$75.68,$0.00,$37.84,$59.94,$60.54,$0.00,$0.00,$0.00,$0.00,$0.00
17937,ERX,HCPCS 63700001,60505-3113-00,OLANZAPINE 10 MG PO TABS,$75.68,$0.00,$75.68,$0.00,$54.01,$0.00,$0.00,$0.00,$0.00,$0.00,$75.68,$0.00,$37.84,$59.94,$60.54,$0.00,$0.00,$0.00,$0.00,$0.00
17937,ERX,HCPCS 63700001,68084-0740-01,OLANZAPINE 10 MG PO TABS,$75.68,$0.00,$75.68,$0.00,$54.01,$0.00,$0.00,$0.00,$0.00,$0.00,$75.68,$0.00,$37.84,$59.94,$60.54,$0.00,$0.00,$0.00,$0.00,$0.00
17937,ERX,HCPCS 63700001,69543-0383-30,OLANZAPINE 10 MG PO TABS,$75.68,$0.00,$75.68,$0.00,$54.01,$0.00,$0.00,$0.00,$0.00,$0.00,$75.68,$0.00,$37.84,$59.94,$60.54,$0.00,$0.00,$0.00,$0.00,$0.00
17938,ERX,HCPCS 63700001,60505-3112-00,OLANZAPINE 7.5 MG PO TABS,$61.12,$0.00,$61.12,$0.00,$43.62,$0.00,$0.00,$0.00,$0.00,$0.00,$61.12,$0.00,$30.56,$48.41,$48.90,$0.00,$0.00,$0.00,$0.00,$0.00
17946,ERX,HCPCS J8540,00054-3176-44,DEXAMETHASONE 1 MG/ML PO CONC,$112.56,$0.00,$112.56,$50.65,$80.33,$0.00,$8.46,$0.00,$0.00,$19.71,$112.56,$0.00,$56.28,$89.15,$90.05,$0.00,$17.62,$0.00,$17.92,$0.00
17961,ERX,HCPCS 63700001,31722-0509-60,ZIDOVUDINE 300 MG PO TABS,$22.87,$0.00,$22.87,$0.00,$16.32,$0.00,$0.00,$0.00,$0.00,$0.00,$22.87,$0.00,$11.44,$18.11,$18.30,$0.00,$0.00,$0.00,$0.00,$0.00
17961,ERX,HCPCS 63700001,65862-0024-60,ZIDOVUDINE 300 MG PO TABS,$22.87,$0.00,$22.87,$0.00,$16.32,$0.00,$0.00,$0.00,$0.00,$0.00,$22.87,$0.00,$11.44,$18.11,$18.30,$0.00,$0.00,$0.00,$0.00,$0.00
18031,ERX,HCPCS 25000001,00187-0245-03,DIHYDROERGOTAMINE MESYLATE 4 MG/ML NA SOLN,"$1,376.26",$0.00,"$1,376.26",$0.00,$982.24,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,376.26",$0.00,$688.13,"$1,090.00","$1,101.01",$0.00,$0.00,$0.00,$0.00,$0.00
18192,ERX,HCPCS J2795,00409-9300-20,ROPIVACAINE HCL 2 MG/ML IJ SOLN,$22.08,$0.00,$22.08,$9.94,$15.76,$0.00,$3.80,$0.00,$0.00,$3.87,$22.08,$0.00,$11.04,$17.49,$17.66,$0.00,$3.46,$0.00,$3.52,$0.00
18192,ERX,HCPCS J2795,00409-9300-21,ROPIVACAINE HCL 2 MG/ML IJ SOLN,$22.08,$0.00,$22.08,$9.94,$15.76,$0.00,$3.80,$0.00,$0.00,$3.87,$22.08,$0.00,$11.04,$17.49,$17.66,$0.00,$3.46,$0.00,$3.52,$0.00
18192,ERX,HCPCS J2795,55150-0195-20,ROPIVACAINE HCL 2 MG/ML IJ SOLN,$22.08,$0.00,$22.08,$9.94,$15.76,$0.00,$3.80,$0.00,$0.00,$3.87,$22.08,$0.00,$11.04,$17.49,$17.66,$0.00,$3.46,$0.00,$3.52,$0.00
18192,ERX,HCPCS J2795,63323-0285-07,ROPIVACAINE HCL 2 MG/ML IJ SOLN,$22.08,$0.00,$22.08,$9.94,$15.76,$0.00,$3.80,$0.00,$0.00,$3.87,$22.08,$0.00,$11.04,$17.49,$17.66,$0.00,$3.46,$0.00,$3.52,$0.00
18192,ERX,HCPCS J2795,63323-0285-13,ROPIVACAINE HCL 2 MG/ML IJ SOLN,$22.08,$0.00,$22.08,$9.94,$15.76,$0.00,$3.80,$0.00,$0.00,$3.87,$22.08,$0.00,$11.04,$17.49,$17.66,$0.00,$3.46,$0.00,$3.52,$0.00
18192,ERX,HCPCS J2795,63323-0285-23,ROPIVACAINE HCL 2 MG/ML IJ SOLN,$22.08,$0.00,$22.08,$9.94,$15.76,$0.00,$3.80,$0.00,$0.00,$3.87,$22.08,$0.00,$11.04,$17.49,$17.66,$0.00,$3.46,$0.00,$3.52,$0.00
18193,ERX,HCPCS J2795,63323-0287-20,ROPIVACAINE HCL 7.5 MG/ML IJ SOLN,$64.64,$0.00,$64.64,$29.09,$46.13,$0.00,$11.14,$0.00,$0.00,$11.32,$64.64,$0.00,$32.32,$51.19,$51.71,$0.00,$10.12,$0.00,$10.29,$0.00
18195,ERX,HCPCS J2795,55150-0197-20,ROPIVACAINE HCL 5 MG/ML IJ SOLN,$47.88,$0.00,$47.88,$21.55,$34.17,$0.00,$8.25,$0.00,$0.00,$8.38,$47.88,$0.00,$23.94,$37.92,$38.30,$0.00,$7.49,$0.00,$7.62,$0.00
18195,ERX,HCPCS J2795,55150-0198-30,ROPIVACAINE HCL 5 MG/ML IJ SOLN,$47.88,$0.00,$47.88,$21.55,$34.17,$0.00,$8.25,$0.00,$0.00,$8.38,$47.88,$0.00,$23.94,$37.92,$38.30,$0.00,$7.49,$0.00,$7.62,$0.00
18195,ERX,HCPCS J2795,63323-0286-23,ROPIVACAINE HCL 5 MG/ML IJ SOLN,$47.88,$0.00,$47.88,$21.55,$34.17,$0.00,$8.25,$0.00,$0.00,$8.38,$47.88,$0.00,$23.94,$37.92,$38.30,$0.00,$7.49,$0.00,$7.62,$0.00
18195,ERX,HCPCS J2795,63323-0286-31,ROPIVACAINE HCL 5 MG/ML IJ SOLN,$47.88,$0.00,$47.88,$21.55,$34.17,$0.00,$8.25,$0.00,$0.00,$8.38,$47.88,$0.00,$23.94,$37.92,$38.30,$0.00,$7.49,$0.00,$7.62,$0.00
18195,ERX,HCPCS J2795,63323-0286-35,ROPIVACAINE HCL 5 MG/ML IJ SOLN,$47.88,$0.00,$47.88,$21.55,$34.17,$0.00,$8.25,$0.00,$0.00,$8.38,$47.88,$0.00,$23.94,$37.92,$38.30,$0.00,$7.49,$0.00,$7.62,$0.00
18265,ERX,HCPCS 25000001,00517-9310-25,TRACE MINERALS CR-CU-MN-ZN 1-100-30-500 MCG/ML IV SOLN,$33.25,$0.00,$33.25,$0.00,$23.73,$0.00,$0.00,$0.00,$0.00,$0.00,$33.25,$0.00,$16.63,$26.33,$26.60,$0.00,$0.00,$0.00,$0.00,$0.00
18266,ERX,HCPCS 2500003,00517-9203-25,TRACE MINERALS CR-CU-MN-ZN 1-100-25-1000 MCG/ML IV SOLN,$51.07,$0.00,$51.07,$0.00,$36.45,$0.00,$0.00,$0.00,$0.00,$0.00,$51.07,$0.00,$25.54,$40.45,$40.86,$0.00,$0.00,$0.00,$0.00,$0.00
18287,ERX,HCPCS 63700001,29300-0127-13,BISOPROLOL FUMARATE 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
18288,ERX,HCPCS 63700001,00185-0771-01,BISOPROLOL FUMARATE 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
18292,ERX,HCPCS 63700001,50111-0916-01,TORSEMIDE 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
18292,ERX,HCPCS 63700001,50268-0755-11,TORSEMIDE 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
18292,ERX,HCPCS 63700001,50268-0755-15,TORSEMIDE 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
18293,ERX,HCPCS 63700001,00054-0077-25,TORSEMIDE 20 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
18293,ERX,HCPCS 63700001,00054-0077-29,TORSEMIDE 20 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
18293,ERX,HCPCS 63700001,31722-0531-01,TORSEMIDE 20 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
18293,ERX,HCPCS 63700001,50111-0917-01,TORSEMIDE 20 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
18293,ERX,HCPCS 63700001,50268-0756-15,TORSEMIDE 20 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
18293,ERX,HCPCS 63700001,68084-0539-01,TORSEMIDE 20 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
18293,ERX,HCPCS 63700001,68084-0539-11,TORSEMIDE 20 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
18294,ERX,HCPCS 63700001,31722-0532-01,TORSEMIDE 100 MG PO TABS,$11.56,$0.00,$11.56,$0.00,$8.25,$0.00,$0.00,$0.00,$0.00,$0.00,$11.56,$0.00,$5.78,$9.16,$9.25,$0.00,$0.00,$0.00,$0.00,$0.00
18294,ERX,HCPCS 63700001,50111-0918-01,TORSEMIDE 100 MG PO TABS,$11.56,$0.00,$11.56,$0.00,$8.25,$0.00,$0.00,$0.00,$0.00,$0.00,$11.56,$0.00,$5.78,$9.16,$9.25,$0.00,$0.00,$0.00,$0.00,$0.00
18295,ERX,HCPCS 63700001,31722-0529-01,TORSEMIDE 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
18295,ERX,HCPCS 63700001,50111-0915-01,TORSEMIDE 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
18302,ERX,HCPCS J2543,00781-3114-91,PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR,$81.85,$0.00,$81.85,$36.83,$58.42,$0.00,$26.18,$0.00,$0.00,$8.70,$81.85,$0.00,$40.93,$64.83,$65.48,$0.00,$8.70,$0.00,$8.28,$0.00
18302,ERX,HCPCS J2543,00781-3114-95,PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR,$81.85,$0.00,$81.85,$36.83,$58.42,$0.00,$26.18,$0.00,$0.00,$8.70,$81.85,$0.00,$40.93,$64.83,$65.48,$0.00,$8.70,$0.00,$8.28,$0.00
18302,ERX,HCPCS J2543,44567-0803-10,PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR,$81.85,$0.00,$81.85,$36.83,$58.42,$0.00,$26.18,$0.00,$0.00,$8.70,$81.85,$0.00,$40.93,$64.83,$65.48,$0.00,$8.70,$0.00,$8.28,$0.00
18302,ERX,HCPCS J2543,55150-0121-50,PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR,$81.85,$0.00,$81.85,$36.83,$58.42,$0.00,$26.18,$0.00,$0.00,$8.70,$81.85,$0.00,$40.93,$64.83,$65.48,$0.00,$8.70,$0.00,$8.28,$0.00
18302,ERX,HCPCS J2543,67457-0523-00,PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR,$81.85,$0.00,$81.85,$36.83,$58.42,$0.00,$26.18,$0.00,$0.00,$8.70,$81.85,$0.00,$40.93,$64.83,$65.48,$0.00,$8.70,$0.00,$8.28,$0.00
18302,ERX,HCPCS J2543,67457-0523-45,PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR,$81.85,$0.00,$81.85,$36.83,$58.42,$0.00,$26.18,$0.00,$0.00,$8.70,$81.85,$0.00,$40.93,$64.83,$65.48,$0.00,$8.70,$0.00,$8.28,$0.00
18303,ERX,HCPCS J2543,00409-3385-13,PIPERACILLIN SOD-TAZOBACTAM SO 3.375 (3-0.375) G IV SOLR,$46.98,$0.00,$46.98,$21.14,$33.53,$0.00,$19.63,$0.00,$0.00,$6.52,$46.98,$0.00,$23.49,$37.21,$37.58,$0.00,$6.52,$0.00,$6.21,$0.00
18303,ERX,HCPCS J2543,00781-3113-95,PIPERACILLIN SOD-TAZOBACTAM SO 3.375 (3-0.375) G IV SOLR,$46.98,$0.00,$46.98,$21.14,$33.53,$0.00,$19.63,$0.00,$0.00,$6.52,$46.98,$0.00,$23.49,$37.21,$37.58,$0.00,$6.52,$0.00,$6.21,$0.00
18303,ERX,HCPCS J2543,55150-0120-30,PIPERACILLIN SOD-TAZOBACTAM SO 3.375 (3-0.375) G IV SOLR,$46.98,$0.00,$46.98,$21.14,$33.53,$0.00,$19.63,$0.00,$0.00,$6.52,$46.98,$0.00,$23.49,$37.21,$37.58,$0.00,$6.52,$0.00,$6.21,$0.00
18304,ERX,HCPCS J2543,00409-3383-02,PIPERACILLIN SOD-TAZOBACTAM SO 2.25 (2-0.25) G IV SOLR,$31.32,$0.00,$31.32,$14.09,$22.35,$0.00,$13.09,$0.00,$0.00,$4.35,$31.32,$0.00,$15.66,$24.81,$25.06,$0.00,$4.35,$0.00,$4.14,$0.00
18304,ERX,HCPCS J2543,00781-3110-95,PIPERACILLIN SOD-TAZOBACTAM SO 2.25 (2-0.25) G IV SOLR,$31.32,$0.00,$31.32,$14.09,$22.35,$0.00,$13.09,$0.00,$0.00,$4.35,$31.32,$0.00,$15.66,$24.81,$25.06,$0.00,$4.35,$0.00,$4.14,$0.00
18304,ERX,HCPCS J2543,44567-0801-10,PIPERACILLIN SOD-TAZOBACTAM SO 2.25 (2-0.25) G IV SOLR,$31.32,$0.00,$31.32,$14.09,$22.35,$0.00,$13.09,$0.00,$0.00,$4.35,$31.32,$0.00,$15.66,$24.81,$25.06,$0.00,$4.35,$0.00,$4.14,$0.00
18304,ERX,HCPCS J2543,55150-0119-30,PIPERACILLIN SOD-TAZOBACTAM SO 2.25 (2-0.25) G IV SOLR,$31.32,$0.00,$31.32,$14.09,$22.35,$0.00,$13.09,$0.00,$0.00,$4.35,$31.32,$0.00,$15.66,$24.81,$25.06,$0.00,$4.35,$0.00,$4.14,$0.00
18307,ERX,HCPCS 63700001,00904-6667-61,GABAPENTIN 400 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
18307,ERX,HCPCS 63700001,16714-0505-02,GABAPENTIN 400 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
18307,ERX,HCPCS 63700001,63739-0984-10,GABAPENTIN 400 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
18307,ERX,HCPCS 63700001,68084-0774-01,GABAPENTIN 400 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
18307,ERX,HCPCS 63700001,68084-0774-11,GABAPENTIN 400 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
18308,ERX,HCPCS 63700001,00904-6666-61,GABAPENTIN 300 MG PO CAPS,$6.31,$0.00,$6.31,$0.00,$4.50,$0.00,$0.00,$0.00,$0.00,$0.00,$6.31,$0.00,$3.16,$5.00,$5.05,$0.00,$0.00,$0.00,$0.00,$0.00
18308,ERX,HCPCS 63700001,16714-0662-01,GABAPENTIN 300 MG PO CAPS,$6.31,$0.00,$6.31,$0.00,$4.50,$0.00,$0.00,$0.00,$0.00,$0.00,$6.31,$0.00,$3.16,$5.00,$5.05,$0.00,$0.00,$0.00,$0.00,$0.00
18308,ERX,HCPCS 63700001,49483-0606-50,GABAPENTIN 300 MG PO CAPS,$6.31,$0.00,$6.31,$0.00,$4.50,$0.00,$0.00,$0.00,$0.00,$0.00,$6.31,$0.00,$3.16,$5.00,$5.05,$0.00,$0.00,$0.00,$0.00,$0.00
18308,ERX,HCPCS 63700001,50228-0180-05,GABAPENTIN 300 MG PO CAPS,$6.31,$0.00,$6.31,$0.00,$4.50,$0.00,$0.00,$0.00,$0.00,$0.00,$6.31,$0.00,$3.16,$5.00,$5.05,$0.00,$0.00,$0.00,$0.00,$0.00
18308,ERX,HCPCS 63700001,63739-0236-10,GABAPENTIN 300 MG PO CAPS,$6.31,$0.00,$6.31,$0.00,$4.50,$0.00,$0.00,$0.00,$0.00,$0.00,$6.31,$0.00,$3.16,$5.00,$5.05,$0.00,$0.00,$0.00,$0.00,$0.00
18308,ERX,HCPCS 63700001,63739-0689-10,GABAPENTIN 300 MG PO CAPS,$6.31,$0.00,$6.31,$0.00,$4.50,$0.00,$0.00,$0.00,$0.00,$0.00,$6.31,$0.00,$3.16,$5.00,$5.05,$0.00,$0.00,$0.00,$0.00,$0.00
18308,ERX,HCPCS 63700001,65862-0199-01,GABAPENTIN 300 MG PO CAPS,$6.31,$0.00,$6.31,$0.00,$4.50,$0.00,$0.00,$0.00,$0.00,$0.00,$6.31,$0.00,$3.16,$5.00,$5.05,$0.00,$0.00,$0.00,$0.00,$0.00
18308,ERX,HCPCS 63700001,67877-0223-01,GABAPENTIN 300 MG PO CAPS,$6.31,$0.00,$6.31,$0.00,$4.50,$0.00,$0.00,$0.00,$0.00,$0.00,$6.31,$0.00,$3.16,$5.00,$5.05,$0.00,$0.00,$0.00,$0.00,$0.00
18308,ERX,HCPCS 63700001,68084-0762-01,GABAPENTIN 300 MG PO CAPS,$6.31,$0.00,$6.31,$0.00,$4.50,$0.00,$0.00,$0.00,$0.00,$0.00,$6.31,$0.00,$3.16,$5.00,$5.05,$0.00,$0.00,$0.00,$0.00,$0.00
18309,ERX,HCPCS 63700001,00904-6665-61,GABAPENTIN 100 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
18309,ERX,HCPCS 63700001,16714-0503-01,GABAPENTIN 100 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
18309,ERX,HCPCS 63700001,16714-0661-01,GABAPENTIN 100 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
18309,ERX,HCPCS 63700001,63739-0591-10,GABAPENTIN 100 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
18309,ERX,HCPCS 63700001,68084-0783-01,GABAPENTIN 100 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
18309,ERX,HCPCS 63700001,69097-0813-07,GABAPENTIN 100 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
18310,ERX,HCPCS 63700001,00904-6362-61,RISPERIDONE 4 MG PO TABS,$23.59,$0.00,$23.59,$0.00,$16.84,$0.00,$0.00,$0.00,$0.00,$0.00,$23.59,$0.00,$11.80,$18.68,$18.87,$0.00,$0.00,$0.00,$0.00,$0.00
18310,ERX,HCPCS 63700001,50458-0595-60,RISPERIDONE 4 MG PO TABS,$23.59,$0.00,$23.59,$0.00,$16.84,$0.00,$0.00,$0.00,$0.00,$0.00,$23.59,$0.00,$11.80,$18.68,$18.87,$0.00,$0.00,$0.00,$0.00,$0.00
18310,ERX,HCPCS 63700001,51079-0465-01,RISPERIDONE 4 MG PO TABS,$23.59,$0.00,$23.59,$0.00,$16.84,$0.00,$0.00,$0.00,$0.00,$0.00,$23.59,$0.00,$11.80,$18.68,$18.87,$0.00,$0.00,$0.00,$0.00,$0.00
18310,ERX,HCPCS 63700001,51079-0465-20,RISPERIDONE 4 MG PO TABS,$23.59,$0.00,$23.59,$0.00,$16.84,$0.00,$0.00,$0.00,$0.00,$0.00,$23.59,$0.00,$11.80,$18.68,$18.87,$0.00,$0.00,$0.00,$0.00,$0.00
18311,ERX,HCPCS 63700001,00904-6360-61,RISPERIDONE 2 MG PO TABS,$14.95,$0.00,$14.95,$0.00,$10.67,$0.00,$0.00,$0.00,$0.00,$0.00,$14.95,$0.00,$7.48,$11.84,$11.96,$0.00,$0.00,$0.00,$0.00,$0.00
18311,ERX,HCPCS 63700001,51079-0463-01,RISPERIDONE 2 MG PO TABS,$14.95,$0.00,$14.95,$0.00,$10.67,$0.00,$0.00,$0.00,$0.00,$0.00,$14.95,$0.00,$7.48,$11.84,$11.96,$0.00,$0.00,$0.00,$0.00,$0.00
18311,ERX,HCPCS 63700001,51079-0463-20,RISPERIDONE 2 MG PO TABS,$14.95,$0.00,$14.95,$0.00,$10.67,$0.00,$0.00,$0.00,$0.00,$0.00,$14.95,$0.00,$7.48,$11.84,$11.96,$0.00,$0.00,$0.00,$0.00,$0.00
18312,ERX,HCPCS 63700001,00904-6361-61,RISPERIDONE 3 MG PO TABS,$17.56,$0.00,$17.56,$0.00,$12.53,$0.00,$0.00,$0.00,$0.00,$0.00,$17.56,$0.00,$8.78,$13.91,$14.05,$0.00,$0.00,$0.00,$0.00,$0.00
18312,ERX,HCPCS 63700001,68084-0274-01,RISPERIDONE 3 MG PO TABS,$17.56,$0.00,$17.56,$0.00,$12.53,$0.00,$0.00,$0.00,$0.00,$0.00,$17.56,$0.00,$8.78,$13.91,$14.05,$0.00,$0.00,$0.00,$0.00,$0.00
18312,ERX,HCPCS 63700001,68084-0274-11,RISPERIDONE 3 MG PO TABS,$17.56,$0.00,$17.56,$0.00,$12.53,$0.00,$0.00,$0.00,$0.00,$0.00,$17.56,$0.00,$8.78,$13.91,$14.05,$0.00,$0.00,$0.00,$0.00,$0.00
18313,ERX,HCPCS 63700001,00904-6359-61,RISPERIDONE 1 MG PO TABS,$8.95,$0.00,$8.95,$0.00,$6.39,$0.00,$0.00,$0.00,$0.00,$0.00,$8.95,$0.00,$4.48,$7.09,$7.16,$0.00,$0.00,$0.00,$0.00,$0.00
18315,ERX,HCPCS J1250,00338-1075-02,DOBUTAMINE IN D5W 2 MG/ML IV SOLN,$146.13,$0.00,$146.13,$65.76,$104.29,$0.00,$13.16,$0.00,$0.00,$14.29,$146.13,$0.00,$73.07,$115.73,$116.90,$0.00,$14.29,$0.00,$13.60,$0.00
18315,ERX,HCPCS J1250,00409-2347-32,DOBUTAMINE IN D5W 2 MG/ML IV SOLN,$146.13,$0.00,$146.13,$65.76,$104.29,$0.00,$13.16,$0.00,$0.00,$14.29,$146.13,$0.00,$73.07,$115.73,$116.90,$0.00,$14.29,$0.00,$13.60,$0.00
18385,ERX,HCPCS 63700001,00591-3540-60,BUPROPION HCL ER (SR) 100 MG PO TB12,$6.33,$0.00,$6.33,$0.00,$4.52,$0.00,$0.00,$0.00,$0.00,$0.00,$6.33,$0.00,$3.17,$5.01,$5.06,$0.00,$0.00,$0.00,$0.00,$0.00
18385,ERX,HCPCS 63700001,43547-0288-10,BUPROPION HCL ER (SR) 100 MG PO TB12,$6.33,$0.00,$6.33,$0.00,$4.52,$0.00,$0.00,$0.00,$0.00,$0.00,$6.33,$0.00,$3.17,$5.01,$5.06,$0.00,$0.00,$0.00,$0.00,$0.00
18385,ERX,HCPCS 63700001,43598-0751-01,BUPROPION HCL ER (SR) 100 MG PO TB12,$6.33,$0.00,$6.33,$0.00,$4.52,$0.00,$0.00,$0.00,$0.00,$0.00,$6.33,$0.00,$3.17,$5.01,$5.06,$0.00,$0.00,$0.00,$0.00,$0.00
18385,ERX,HCPCS 63700001,68084-0697-01,BUPROPION HCL ER (SR) 100 MG PO TB12,$6.33,$0.00,$6.33,$0.00,$4.52,$0.00,$0.00,$0.00,$0.00,$0.00,$6.33,$0.00,$3.17,$5.01,$5.06,$0.00,$0.00,$0.00,$0.00,$0.00
18386,ERX,HCPCS 63700001,00173-0135-55,BUPROPION HCL ER (SR) 150 MG PO TB12,$33.84,$0.00,$33.84,$0.00,$24.15,$0.00,$0.00,$0.00,$0.00,$0.00,$33.84,$0.00,$16.92,$26.80,$27.07,$0.00,$0.00,$0.00,$0.00,$0.00
18386,ERX,HCPCS 63700001,00185-0415-05,BUPROPION HCL ER (SR) 150 MG PO TB12,$33.84,$0.00,$33.84,$0.00,$24.15,$0.00,$0.00,$0.00,$0.00,$0.00,$33.84,$0.00,$16.92,$26.80,$27.07,$0.00,$0.00,$0.00,$0.00,$0.00
18386,ERX,HCPCS 63700001,00185-0415-60,BUPROPION HCL ER (SR) 150 MG PO TB12,$33.84,$0.00,$33.84,$0.00,$24.15,$0.00,$0.00,$0.00,$0.00,$0.00,$33.84,$0.00,$16.92,$26.80,$27.07,$0.00,$0.00,$0.00,$0.00,$0.00
18386,ERX,HCPCS 63700001,00591-3541-60,BUPROPION HCL ER (SR) 150 MG PO TB12,$33.84,$0.00,$33.84,$0.00,$24.15,$0.00,$0.00,$0.00,$0.00,$0.00,$33.84,$0.00,$16.92,$26.80,$27.07,$0.00,$0.00,$0.00,$0.00,$0.00
18386,ERX,HCPCS 63700001,00904-6585-61,BUPROPION HCL ER (SR) 150 MG PO TB12,$33.84,$0.00,$33.84,$0.00,$24.15,$0.00,$0.00,$0.00,$0.00,$0.00,$33.84,$0.00,$16.92,$26.80,$27.07,$0.00,$0.00,$0.00,$0.00,$0.00
18386,ERX,HCPCS 63700001,63739-0714-10,BUPROPION HCL ER (SR) 150 MG PO TB12,$33.84,$0.00,$33.84,$0.00,$24.15,$0.00,$0.00,$0.00,$0.00,$0.00,$33.84,$0.00,$16.92,$26.80,$27.07,$0.00,$0.00,$0.00,$0.00,$0.00
18386,ERX,HCPCS 63700001,68084-0708-25,BUPROPION HCL ER (SR) 150 MG PO TB12,$33.84,$0.00,$33.84,$0.00,$24.15,$0.00,$0.00,$0.00,$0.00,$0.00,$33.84,$0.00,$16.92,$26.80,$27.07,$0.00,$0.00,$0.00,$0.00,$0.00
18400,ERX,HCPCS 25000001,63323-0724-05,REMIFENTANIL HCL 2 MG IV SOLR,$448.65,$0.00,$448.65,$0.00,$320.20,$0.00,$0.00,$0.00,$0.00,$0.00,$448.65,$0.00,$224.33,$355.33,$358.92,$0.00,$0.00,$0.00,$0.00,$0.00
18400,ERX,HCPCS 25000001,67457-0198-05,REMIFENTANIL HCL 2 MG IV SOLR,$448.65,$0.00,$448.65,$0.00,$320.20,$0.00,$0.00,$0.00,$0.00,$0.00,$448.65,$0.00,$224.33,$355.33,$358.92,$0.00,$0.00,$0.00,$0.00,$0.00
18400,ERX,HCPCS 25000001,67457-0198-99,REMIFENTANIL HCL 2 MG IV SOLR,$448.65,$0.00,$448.65,$0.00,$320.20,$0.00,$0.00,$0.00,$0.00,$0.00,$448.65,$0.00,$224.33,$355.33,$358.92,$0.00,$0.00,$0.00,$0.00,$0.00
18551,ERX,HCPCS 63700001,00093-0051-01,CARVEDILOL 3.125 MG PO TABS,$8.11,$0.00,$8.11,$0.00,$5.79,$0.00,$0.00,$0.00,$0.00,$0.00,$8.11,$0.00,$4.06,$6.42,$6.49,$0.00,$0.00,$0.00,$0.00,$0.00
18551,ERX,HCPCS 63700001,00904-6300-61,CARVEDILOL 3.125 MG PO TABS,$8.11,$0.00,$8.11,$0.00,$5.79,$0.00,$0.00,$0.00,$0.00,$0.00,$8.11,$0.00,$4.06,$6.42,$6.49,$0.00,$0.00,$0.00,$0.00,$0.00
18551,ERX,HCPCS 63700001,51079-0771-01,CARVEDILOL 3.125 MG PO TABS,$8.11,$0.00,$8.11,$0.00,$5.79,$0.00,$0.00,$0.00,$0.00,$0.00,$8.11,$0.00,$4.06,$6.42,$6.49,$0.00,$0.00,$0.00,$0.00,$0.00
18551,ERX,HCPCS 63700001,51079-0771-20,CARVEDILOL 3.125 MG PO TABS,$8.11,$0.00,$8.11,$0.00,$5.79,$0.00,$0.00,$0.00,$0.00,$0.00,$8.11,$0.00,$4.06,$6.42,$6.49,$0.00,$0.00,$0.00,$0.00,$0.00
18551,ERX,HCPCS 63700001,55111-0252-01,CARVEDILOL 3.125 MG PO TABS,$8.11,$0.00,$8.11,$0.00,$5.79,$0.00,$0.00,$0.00,$0.00,$0.00,$8.11,$0.00,$4.06,$6.42,$6.49,$0.00,$0.00,$0.00,$0.00,$0.00
18551,ERX,HCPCS 63700001,68382-0092-01,CARVEDILOL 3.125 MG PO TABS,$8.11,$0.00,$8.11,$0.00,$5.79,$0.00,$0.00,$0.00,$0.00,$0.00,$8.11,$0.00,$4.06,$6.42,$6.49,$0.00,$0.00,$0.00,$0.00,$0.00
18621,ERX,HCPCS 25000001,00013-8303-04,LATANOPROST 0.005 % OP SOLN,$679.78,$0.00,$679.78,$0.00,$485.16,$0.00,$0.00,$0.00,$0.00,$0.00,$679.78,$0.00,$339.89,$538.39,$543.82,$0.00,$0.00,$0.00,$0.00,$0.00
18621,ERX,HCPCS 25000001,17478-0625-12,LATANOPROST 0.005 % OP SOLN,$679.78,$0.00,$679.78,$0.00,$485.16,$0.00,$0.00,$0.00,$0.00,$0.00,$679.78,$0.00,$339.89,$538.39,$543.82,$0.00,$0.00,$0.00,$0.00,$0.00
18621,ERX,HCPCS 25000001,24208-0463-25,LATANOPROST 0.005 % OP SOLN,$679.78,$0.00,$679.78,$0.00,$485.16,$0.00,$0.00,$0.00,$0.00,$0.00,$679.78,$0.00,$339.89,$538.39,$543.82,$0.00,$0.00,$0.00,$0.00,$0.00
18621,ERX,HCPCS 25000001,59762-0333-02,LATANOPROST 0.005 % OP SOLN,$679.78,$0.00,$679.78,$0.00,$485.16,$0.00,$0.00,$0.00,$0.00,$0.00,$679.78,$0.00,$339.89,$538.39,$543.82,$0.00,$0.00,$0.00,$0.00,$0.00
18621,ERX,HCPCS 25000001,61314-0547-01,LATANOPROST 0.005 % OP SOLN,$679.78,$0.00,$679.78,$0.00,$485.16,$0.00,$0.00,$0.00,$0.00,$0.00,$679.78,$0.00,$339.89,$538.39,$543.82,$0.00,$0.00,$0.00,$0.00,$0.00
18786,ERX,HCPCS 63700001,00904-6477-61,DONEPEZIL HCL 5 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
18787,ERX,HCPCS 63700001,00904-6478-61,DONEPEZIL HCL 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
18787,ERX,HCPCS 63700001,60687-0303-01,DONEPEZIL HCL 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
18908,ERX,HCPCS 25000001,00187-4302-02,NITROPRUSSIDE SODIUM 25 MG/ML IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
18908,ERX,HCPCS 25000001,25021-0310-02,NITROPRUSSIDE SODIUM 25 MG/ML IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
18918,ERX,HCPCS 63700001,00904-6351-61,LEVOFLOXACIN 250 MG PO TABS,$63.89,$0.00,$63.89,$0.00,$45.60,$0.00,$0.00,$0.00,$0.00,$0.00,$63.89,$0.00,$31.95,$50.60,$51.11,$0.00,$0.00,$0.00,$0.00,$0.00
18918,ERX,HCPCS 63700001,65862-0536-50,LEVOFLOXACIN 250 MG PO TABS,$63.89,$0.00,$63.89,$0.00,$45.60,$0.00,$0.00,$0.00,$0.00,$0.00,$63.89,$0.00,$31.95,$50.60,$51.11,$0.00,$0.00,$0.00,$0.00,$0.00
18918,ERX,HCPCS 63700001,68180-0240-01,LEVOFLOXACIN 250 MG PO TABS,$63.89,$0.00,$63.89,$0.00,$45.60,$0.00,$0.00,$0.00,$0.00,$0.00,$63.89,$0.00,$31.95,$50.60,$51.11,$0.00,$0.00,$0.00,$0.00,$0.00
18919,ERX,HCPCS 63700001,00904-6352-61,LEVOFLOXACIN 500 MG PO TABS,$71.83,$0.00,$71.83,$0.00,$51.27,$0.00,$0.00,$0.00,$0.00,$0.00,$71.83,$0.00,$35.92,$56.89,$57.46,$0.00,$0.00,$0.00,$0.00,$0.00
18919,ERX,HCPCS 63700001,65862-0537-50,LEVOFLOXACIN 500 MG PO TABS,$71.83,$0.00,$71.83,$0.00,$51.27,$0.00,$0.00,$0.00,$0.00,$0.00,$71.83,$0.00,$35.92,$56.89,$57.46,$0.00,$0.00,$0.00,$0.00,$0.00
18920,ERX,HCPCS 63700001,68084-0342-01,TOPIRAMATE 25 MG PO TABS,$7.71,$0.00,$7.71,$0.00,$5.50,$0.00,$0.00,$0.00,$0.00,$0.00,$7.71,$0.00,$3.86,$6.11,$6.17,$0.00,$0.00,$0.00,$0.00,$0.00
18921,ERX,HCPCS 63700001,47335-0712-86,TOPIRAMATE 200 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
18921,ERX,HCPCS 63700001,62756-0712-86,TOPIRAMATE 200 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
18921,ERX,HCPCS 63700001,68084-0345-11,TOPIRAMATE 200 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
18921,ERX,HCPCS 63700001,68084-0345-21,TOPIRAMATE 200 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
18921,ERX,HCPCS 63700001,68382-0141-14,TOPIRAMATE 200 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
18921,ERX,HCPCS 63700001,69097-0125-03,TOPIRAMATE 200 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
18922,ERX,HCPCS 63700001,62756-0711-86,TOPIRAMATE 100 MG PO TABS,$26.41,$0.00,$26.41,$0.00,$18.85,$0.00,$0.00,$0.00,$0.00,$0.00,$26.41,$0.00,$13.21,$20.92,$21.13,$0.00,$0.00,$0.00,$0.00,$0.00
18922,ERX,HCPCS 63700001,68084-0344-01,TOPIRAMATE 100 MG PO TABS,$26.41,$0.00,$26.41,$0.00,$18.85,$0.00,$0.00,$0.00,$0.00,$0.00,$26.41,$0.00,$13.21,$20.92,$21.13,$0.00,$0.00,$0.00,$0.00,$0.00
18925,ERX,HCPCS J1956,17478-0107-20,LEVOFLOXACIN 25 MG/ML IV SOLN,$77.00,$0.00,$77.00,$34.65,$54.95,$0.00,$13.27,$0.00,$0.00,$13.48,$77.00,$0.00,$38.50,$60.98,$61.60,$0.00,$12.05,$0.00,$12.26,$0.00
18925,ERX,HCPCS J1956,17478-0107-30,LEVOFLOXACIN 25 MG/ML IV SOLN,$77.00,$0.00,$77.00,$34.65,$54.95,$0.00,$13.27,$0.00,$0.00,$13.48,$77.00,$0.00,$38.50,$60.98,$61.60,$0.00,$12.05,$0.00,$12.26,$0.00
18925,ERX,HCPCS J1956,55150-0156-20,LEVOFLOXACIN 25 MG/ML IV SOLN,$77.00,$0.00,$77.00,$34.65,$54.95,$0.00,$13.27,$0.00,$0.00,$13.48,$77.00,$0.00,$38.50,$60.98,$61.60,$0.00,$12.05,$0.00,$12.26,$0.00
19176,ERX,HCPCS 63700001,00904-6290-61,ATORVASTATIN CALCIUM 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
19176,ERX,HCPCS 63700001,50268-0093-11,ATORVASTATIN CALCIUM 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
19176,ERX,HCPCS 63700001,50268-0093-15,ATORVASTATIN CALCIUM 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
19176,ERX,HCPCS 63700001,60505-2578-09,ATORVASTATIN CALCIUM 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
19176,ERX,HCPCS 63700001,62175-0890-46,ATORVASTATIN CALCIUM 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
19177,ERX,HCPCS 63700001,00378-3952-77,ATORVASTATIN CALCIUM 40 MG PO TABS,$21.95,$0.00,$21.95,$0.00,$15.67,$0.00,$0.00,$0.00,$0.00,$0.00,$21.95,$0.00,$10.98,$17.38,$17.56,$0.00,$0.00,$0.00,$0.00,$0.00
19177,ERX,HCPCS 63700001,00904-6292-61,ATORVASTATIN CALCIUM 40 MG PO TABS,$21.95,$0.00,$21.95,$0.00,$15.67,$0.00,$0.00,$0.00,$0.00,$0.00,$21.95,$0.00,$10.98,$17.38,$17.56,$0.00,$0.00,$0.00,$0.00,$0.00
19177,ERX,HCPCS 63700001,51079-0210-01,ATORVASTATIN CALCIUM 40 MG PO TABS,$21.95,$0.00,$21.95,$0.00,$15.67,$0.00,$0.00,$0.00,$0.00,$0.00,$21.95,$0.00,$10.98,$17.38,$17.56,$0.00,$0.00,$0.00,$0.00,$0.00
19177,ERX,HCPCS 63700001,51079-0210-20,ATORVASTATIN CALCIUM 40 MG PO TABS,$21.95,$0.00,$21.95,$0.00,$15.67,$0.00,$0.00,$0.00,$0.00,$0.00,$21.95,$0.00,$10.98,$17.38,$17.56,$0.00,$0.00,$0.00,$0.00,$0.00
19177,ERX,HCPCS 63700001,55111-0123-90,ATORVASTATIN CALCIUM 40 MG PO TABS,$21.95,$0.00,$21.95,$0.00,$15.67,$0.00,$0.00,$0.00,$0.00,$0.00,$21.95,$0.00,$10.98,$17.38,$17.56,$0.00,$0.00,$0.00,$0.00,$0.00
19177,ERX,HCPCS 63700001,60505-2580-09,ATORVASTATIN CALCIUM 40 MG PO TABS,$21.95,$0.00,$21.95,$0.00,$15.67,$0.00,$0.00,$0.00,$0.00,$0.00,$21.95,$0.00,$10.98,$17.38,$17.56,$0.00,$0.00,$0.00,$0.00,$0.00
19177,ERX,HCPCS 63700001,68084-0099-01,ATORVASTATIN CALCIUM 40 MG PO TABS,$21.95,$0.00,$21.95,$0.00,$15.67,$0.00,$0.00,$0.00,$0.00,$0.00,$21.95,$0.00,$10.98,$17.38,$17.56,$0.00,$0.00,$0.00,$0.00,$0.00
19178,ERX,HCPCS 63700001,00904-6291-61,ATORVASTATIN CALCIUM 20 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
19178,ERX,HCPCS 63700001,55111-0122-90,ATORVASTATIN CALCIUM 20 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
19178,ERX,HCPCS 63700001,60505-2579-09,ATORVASTATIN CALCIUM 20 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
19178,ERX,HCPCS 63700001,68084-0098-01,ATORVASTATIN CALCIUM 20 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
19179,ERX,HCPCS 25000001,42291-0153-30,AZELASTINE HCL 0.1 % NA SOLN,$320.99,$0.00,$320.99,$0.00,$229.09,$0.00,$0.00,$0.00,$0.00,$0.00,$320.99,$0.00,$160.50,$254.22,$256.79,$0.00,$0.00,$0.00,$0.00,$0.00
19179,ERX,HCPCS 25000001,60505-0833-05,AZELASTINE HCL 0.1 % NA SOLN,$320.99,$0.00,$320.99,$0.00,$229.09,$0.00,$0.00,$0.00,$0.00,$0.00,$320.99,$0.00,$160.50,$254.22,$256.79,$0.00,$0.00,$0.00,$0.00,$0.00
19226,ERX,HCPCS 63700001,00093-5420-88,CABERGOLINE 0.5 MG PO TABS,$128.31,$0.00,$128.31,$0.00,$91.57,$0.00,$0.00,$0.00,$0.00,$0.00,$128.31,$0.00,$64.16,$101.62,$102.65,$0.00,$0.00,$0.00,$0.00,$0.00
19226,ERX,HCPCS 63700001,49884-0673-14,CABERGOLINE 0.5 MG PO TABS,$128.31,$0.00,$128.31,$0.00,$91.57,$0.00,$0.00,$0.00,$0.00,$0.00,$128.31,$0.00,$64.16,$101.62,$102.65,$0.00,$0.00,$0.00,$0.00,$0.00
19226,ERX,HCPCS 63700001,50742-0118-08,CABERGOLINE 0.5 MG PO TABS,$128.31,$0.00,$128.31,$0.00,$91.57,$0.00,$0.00,$0.00,$0.00,$0.00,$128.31,$0.00,$64.16,$101.62,$102.65,$0.00,$0.00,$0.00,$0.00,$0.00
19226,ERX,HCPCS 63700001,59762-1005-01,CABERGOLINE 0.5 MG PO TABS,$128.31,$0.00,$128.31,$0.00,$91.57,$0.00,$0.00,$0.00,$0.00,$0.00,$128.31,$0.00,$64.16,$101.62,$102.65,$0.00,$0.00,$0.00,$0.00,$0.00
19333,ERX,HCPCS J0735,00143-9724-01,CLONIDINE HCL (ANALGESIA) 100 MCG/ML EP SOLN,$39.90,$0.00,$39.90,$0.00,$28.48,$0.00,$0.00,$0.00,$0.00,$0.00,$39.90,$0.00,$19.95,$31.60,$31.92,$0.00,$0.00,$0.00,$0.00,$0.00
19333,ERX,HCPCS J0735,39822-2000-01,CLONIDINE HCL (ANALGESIA) 100 MCG/ML EP SOLN,$39.90,$0.00,$39.90,$0.00,$28.48,$0.00,$0.00,$0.00,$0.00,$0.00,$39.90,$0.00,$19.95,$31.60,$31.92,$0.00,$0.00,$0.00,$0.00,$0.00
19333,ERX,HCPCS J0735,67457-0218-10,CLONIDINE HCL (ANALGESIA) 100 MCG/ML EP SOLN,$39.90,$0.00,$39.90,$0.00,$28.48,$0.00,$0.00,$0.00,$0.00,$0.00,$39.90,$0.00,$19.95,$31.60,$31.92,$0.00,$0.00,$0.00,$0.00,$0.00
19451,ERX,HCPCS 90700,58160-0810-11,DIPHTH-ACELL PERTUSSIS-TETANUS 25-58-10 LF-MCG/0.5 IM SUSP,$105.04,$0.00,$105.04,$47.27,$74.97,$0.00,$18.10,$0.00,$0.00,$18.39,$105.04,$0.00,$52.52,$83.19,$84.03,$0.00,$16.44,$0.00,$16.72,$0.00
19451,ERX,HCPCS 90700,58160-0810-52,DIPHTH-ACELL PERTUSSIS-TETANUS 25-58-10 LF-MCG/0.5 IM SUSP,$105.04,$0.00,$105.04,$47.27,$74.97,$0.00,$18.10,$0.00,$0.00,$18.39,$105.04,$0.00,$52.52,$83.19,$84.03,$0.00,$16.44,$0.00,$16.72,$0.00
19452,ERX,HCPCS 25000001,17478-0105-05,OLOPATADINE HCL 0.1 % OP SOLN,$924.14,$0.00,$924.14,$0.00,$659.56,$0.00,$0.00,$0.00,$0.00,$0.00,$924.14,$0.00,$462.07,$731.92,$739.31,$0.00,$0.00,$0.00,$0.00,$0.00
19452,ERX,HCPCS 25000001,61314-0271-05,OLOPATADINE HCL 0.1 % OP SOLN,$924.14,$0.00,$924.14,$0.00,$659.56,$0.00,$0.00,$0.00,$0.00,$0.00,$924.14,$0.00,$462.07,$731.92,$739.31,$0.00,$0.00,$0.00,$0.00,$0.00
19452,ERX,HCPCS 25000001,65862-0757-05,OLOPATADINE HCL 0.1 % OP SOLN,$924.14,$0.00,$924.14,$0.00,$659.56,$0.00,$0.00,$0.00,$0.00,$0.00,$924.14,$0.00,$462.07,$731.92,$739.31,$0.00,$0.00,$0.00,$0.00,$0.00
19452,ERX,HCPCS 25000001,70069-0007-01,OLOPATADINE HCL 0.1 % OP SOLN,$924.14,$0.00,$924.14,$0.00,$659.56,$0.00,$0.00,$0.00,$0.00,$0.00,$924.14,$0.00,$462.07,$731.92,$739.31,$0.00,$0.00,$0.00,$0.00,$0.00
19527,ERX,HCPCS 63700001,00904-5460-52,OYSTER SHELL CALCIUM/D 500-200 MG-UNIT PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
19527,ERX,HCPCS 63700001,00904-5460-72,OYSTER SHELL CALCIUM/D 500-200 MG-UNIT PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
19527,ERX,HCPCS 63700001,00904-5460-92,OYSTER SHELL CALCIUM/D 500-200 MG-UNIT PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
19691,ERX,HCPCS 25000001,61010-8100-01,BENZOCAINE 20 % MT GEL,$32.84,$0.00,$32.84,$0.00,$23.44,$0.00,$0.00,$0.00,$0.00,$0.00,$32.84,$0.00,$16.42,$26.01,$26.27,$0.00,$0.00,$0.00,$0.00,$0.00
19691,ERX,HCPCS 25000001,00283-0293-31,BENZOCAINE 20 % MT GEL,$32.84,$0.00,$32.84,$0.00,$23.44,$0.00,$0.00,$0.00,$0.00,$0.00,$32.84,$0.00,$16.42,$26.01,$26.27,$0.00,$0.00,$0.00,$0.00,$0.00
19691,ERX,HCPCS 25000001,00283-0871-31,BENZOCAINE 20 % MT GEL,$32.84,$0.00,$32.84,$0.00,$23.44,$0.00,$0.00,$0.00,$0.00,$0.00,$32.84,$0.00,$16.42,$26.01,$26.27,$0.00,$0.00,$0.00,$0.00,$0.00
19703,ERX,HCPCS 63700001,00065-0246-10,BETAXOLOL HCL 0.25 % OP SUSP,$987.50,$0.00,$987.50,$0.00,$704.78,$0.00,$0.00,$0.00,$0.00,$0.00,$987.50,$0.00,$493.75,$782.10,$790.00,$0.00,$0.00,$0.00,$0.00,$0.00
19704,ERX,HCPCS 25000001,00065-0023-15,CARBACHOL 0.01 % IO SOLN,$152.97,$0.00,$152.97,$0.00,$9.88,$0.00,$0.00,$0.00,$0.00,$0.00,$152.97,$0.00,$76.49,$121.15,$122.38,$0.00,$0.00,$0.00,$0.00,$0.00
19711,ERX,HCPCS 25000001,00168-0203-60,CLINDAMYCIN PHOSPHATE 1 % EX LOTN,$366.55,$0.00,$366.55,$0.00,$261.61,$0.00,$0.00,$0.00,$0.00,$0.00,$366.55,$0.00,$183.28,$290.31,$293.24,$0.00,$0.00,$0.00,$0.00,$0.00
19711,ERX,HCPCS 25000001,59762-3744-01,CLINDAMYCIN PHOSPHATE 1 % EX LOTN,$366.55,$0.00,$366.55,$0.00,$261.61,$0.00,$0.00,$0.00,$0.00,$0.00,$366.55,$0.00,$183.28,$290.31,$293.24,$0.00,$0.00,$0.00,$0.00,$0.00
19713,ERX,HCPCS j1730,00575-6200-30,DIAZOXIDE 50 MG/ML PO SUSP,"$1,095.20",$0.00,"$1,095.20",$0.00,$781.64,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,095.20",$0.00,$547.60,$867.40,$876.16,$0.00,$0.00,$0.00,$0.00,$0.00
19714,ERX,HCPCS 25000001,17478-0892-25,DICLOFENAC SODIUM 0.1 % OP SOLN,$156.70,$0.00,$156.70,$0.00,$111.84,$0.00,$0.00,$0.00,$0.00,$0.00,$156.70,$0.00,$78.35,$124.11,$125.36,$0.00,$0.00,$0.00,$0.00,$0.00
19714,ERX,HCPCS 25000001,61314-0014-25,DICLOFENAC SODIUM 0.1 % OP SOLN,$156.70,$0.00,$156.70,$0.00,$111.84,$0.00,$0.00,$0.00,$0.00,$0.00,$156.70,$0.00,$78.35,$124.11,$125.36,$0.00,$0.00,$0.00,$0.00,$0.00
19714,ERX,HCPCS 25000001,61314-0014-05,DICLOFENAC SODIUM 0.1 % OP SOLN,$230.05,$0.00,$182.20,$0.00,$111.84,$0.00,$0.00,$0.00,$0.00,$0.00,$156.70,$0.00,$78.35,$182.20,$125.36,$0.00,$0.00,$0.00,$0.00,$0.00
19732,ERX,HCPCS 25000001,00037-6830-15,HYDROCORTISONE ACETATE 10 % EX FOAM,"$1,266.28",$0.00,"$1,266.28",$0.00,$903.74,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,266.28",$0.00,$633.14,"$1,002.89","$1,013.02",$0.00,$0.00,$0.00,$0.00,$0.00
19733,ERX,HCPCS 25000001,17478-0209-10,KETOROLAC TROMETHAMINE 0.5 % OP SOLN,$325.96,$0.00,$556.50,$0.00,$397.17,$0.00,$0.00,$0.00,$0.00,$0.00,$556.50,$0.00,$278.25,$258.16,$445.20,$0.00,$0.00,$0.00,$0.00,$0.00
19733,ERX,HCPCS 25000001,60505-1003-01,KETOROLAC TROMETHAMINE 0.5 % OP SOLN,$325.96,$0.00,$556.50,$0.00,$397.17,$0.00,$0.00,$0.00,$0.00,$0.00,$556.50,$0.00,$278.25,$258.16,$445.20,$0.00,$0.00,$0.00,$0.00,$0.00
19733,ERX,HCPCS 25000001,61314-0126-05,KETOROLAC TROMETHAMINE 0.5 % OP SOLN,$325.96,$0.00,$556.50,$0.00,$397.17,$0.00,$0.00,$0.00,$0.00,$0.00,$556.50,$0.00,$278.25,$258.16,$445.20,$0.00,$0.00,$0.00,$0.00,$0.00
19733,ERX,HCPCS 25000001,61314-0126-10,KETOROLAC TROMETHAMINE 0.5 % OP SOLN,$556.50,$0.00,$556.50,$0.00,$397.17,$0.00,$0.00,$0.00,$0.00,$0.00,$556.50,$0.00,$278.25,$440.75,$445.20,$0.00,$0.00,$0.00,$0.00,$0.00
19736,ERX,HCPCS J1050,00009-0746-30,MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP,$308.23,$0.00,$308.23,$138.70,$219.98,$0.00,$53.11,$0.00,$0.00,$98.70,$308.23,$0.00,$154.12,$244.12,$246.58,$0.00,$98.70,$0.00,$93.98,$0.00
19736,ERX,HCPCS J1050,00009-0746-35,MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP,$308.23,$0.00,$308.23,$138.70,$219.98,$0.00,$53.11,$0.00,$0.00,$98.70,$308.23,$0.00,$154.12,$244.12,$246.58,$0.00,$98.70,$0.00,$93.98,$0.00
19736,ERX,HCPCS J1050,00548-5400-00,MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP,$308.23,$0.00,$308.23,$138.70,$219.98,$0.00,$53.11,$0.00,$0.00,$98.70,$308.23,$0.00,$154.12,$244.12,$246.58,$0.00,$98.70,$0.00,$93.98,$0.00
19736,ERX,HCPCS J1050,00703-6801-01,MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP,$308.23,$0.00,$308.23,$138.70,$219.98,$0.00,$53.11,$0.00,$0.00,$98.70,$308.23,$0.00,$154.12,$244.12,$246.58,$0.00,$98.70,$0.00,$93.98,$0.00
19736,ERX,HCPCS J1050,59762-4537-01,MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP,$308.23,$0.00,$308.23,$138.70,$219.98,$0.00,$53.11,$0.00,$0.00,$98.70,$308.23,$0.00,$154.12,$244.12,$246.58,$0.00,$98.70,$0.00,$93.98,$0.00
19736,ERX,HCPCS J1050,59762-4537-02,MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP,$308.23,$0.00,$308.23,$138.70,$219.98,$0.00,$53.11,$0.00,$0.00,$98.70,$308.23,$0.00,$154.12,$244.12,$246.58,$0.00,$98.70,$0.00,$93.98,$0.00
19736,ERX,HCPCS J1050,67457-0887-00,MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP,$308.23,$0.00,$308.23,$138.70,$219.98,$0.00,$53.11,$0.00,$0.00,$98.70,$308.23,$0.00,$154.12,$244.12,$246.58,$0.00,$98.70,$0.00,$93.98,$0.00
19736,ERX,HCPCS J1050,67457-0887-99,MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP,$308.23,$0.00,$308.23,$138.70,$219.98,$0.00,$53.11,$0.00,$0.00,$98.70,$308.23,$0.00,$154.12,$244.12,$246.58,$0.00,$98.70,$0.00,$93.98,$0.00
19741,ERX,HCPCS 63700001,00115-1474-46,METRONIDAZOLE 0.75 % EX GEL,$846.32,$0.00,$846.32,$0.00,$604.02,$0.00,$0.00,$0.00,$0.00,$0.00,$846.32,$0.00,$423.16,$670.29,$677.06,$0.00,$0.00,$0.00,$0.00,$0.00
19741,ERX,HCPCS 63700001,00168-0275-45,METRONIDAZOLE 0.75 % EX GEL,$846.32,$0.00,$846.32,$0.00,$604.02,$0.00,$0.00,$0.00,$0.00,$0.00,$846.32,$0.00,$423.16,$670.29,$677.06,$0.00,$0.00,$0.00,$0.00,$0.00
19741,ERX,HCPCS 63700001,51672-4116-06,METRONIDAZOLE 0.75 % EX GEL,$846.32,$0.00,$846.32,$0.00,$604.02,$0.00,$0.00,$0.00,$0.00,$0.00,$846.32,$0.00,$423.16,$670.29,$677.06,$0.00,$0.00,$0.00,$0.00,$0.00
19741,ERX,HCPCS 63700001,66993-0962-45,METRONIDAZOLE 0.75 % EX GEL,$846.32,$0.00,$846.32,$0.00,$604.02,$0.00,$0.00,$0.00,$0.00,$0.00,$846.32,$0.00,$423.16,$670.29,$677.06,$0.00,$0.00,$0.00,$0.00,$0.00
19743,ERX,HCPCS 63700001,00378-7272-53,"MICRONOR, JOLIVETTE, NORETHINDRONE 0.35 MG TAB PO",$206.48,$0.00,$206.48,$0.00,$147.36,$0.00,$0.00,$0.00,$0.00,$0.00,$206.48,$0.00,$103.24,$163.53,$165.18,$0.00,$0.00,$0.00,$0.00,$0.00
19743,ERX,HCPCS 63700001,00378-7272-85,"MICRONOR, JOLIVETTE, NORETHINDRONE 0.35 MG TAB PO",$206.48,$0.00,$206.48,$0.00,$147.36,$0.00,$0.00,$0.00,$0.00,$0.00,$206.48,$0.00,$103.24,$163.53,$165.18,$0.00,$0.00,$0.00,$0.00,$0.00
19743,ERX,HCPCS 63700001,50458-0194-06,"MICRONOR, JOLIVETTE, NORETHINDRONE 0.35 MG TAB PO",$206.48,$0.00,$206.48,$0.00,$147.36,$0.00,$0.00,$0.00,$0.00,$0.00,$206.48,$0.00,$103.24,$163.53,$165.18,$0.00,$0.00,$0.00,$0.00,$0.00
19769,ERX,HCPCS 25000001,00065-0644-35,TOBRAMYCIN 0.3 % OP OINT,$681.66,$0.00,$681.66,$0.00,$486.50,$0.00,$0.00,$0.00,$0.00,$0.00,$681.66,$0.00,$340.83,$539.87,$545.33,$0.00,$0.00,$0.00,$0.00,$0.00
19776,ERX,HCPCS 25000001,00536-1109-45,UREA 20 % EX CREA,$55.24,$0.00,$55.24,$0.00,$39.42,$0.00,$0.00,$0.00,$0.00,$0.00,$55.24,$0.00,$27.62,$43.75,$44.19,$0.00,$0.00,$0.00,$0.00,$0.00
19791,ERX,HCPCS 63700001,00065-0411-30,POVIDONE-IODINE 5 % OP SOLN,$63.50,$0.00,$63.50,$0.00,$45.32,$0.00,$0.00,$0.00,$0.00,$0.00,$63.50,$0.00,$31.75,$50.29,$50.80,$0.00,$0.00,$0.00,$0.00,$0.00
19805,ERX,HCPCS 63700001,00168-0323-46,METRONIDAZOLE 0.75 % EX CREA,"$1,801.12",$0.00,"$1,801.12",$0.00,"$1,285.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,801.12",$0.00,$900.56,"$1,426.49","$1,440.90",$0.00,$0.00,$0.00,$0.00,$0.00
19805,ERX,HCPCS 63700001,00299-3836-45,METRONIDAZOLE 0.75 % EX CREA,"$1,801.12",$0.00,"$1,801.12",$0.00,"$1,285.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,801.12",$0.00,$900.56,"$1,426.49","$1,440.90",$0.00,$0.00,$0.00,$0.00,$0.00
19805,ERX,HCPCS 63700001,00713-0633-37,METRONIDAZOLE 0.75 % EX CREA,"$1,801.12",$0.00,"$1,801.12",$0.00,"$1,285.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,801.12",$0.00,$900.56,"$1,426.49","$1,440.90",$0.00,$0.00,$0.00,$0.00,$0.00
19805,ERX,HCPCS 63700001,66993-0960-45,METRONIDAZOLE 0.75 % EX CREA,"$1,801.12",$0.00,"$1,801.12",$0.00,"$1,285.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,801.12",$0.00,$900.56,"$1,426.49","$1,440.90",$0.00,$0.00,$0.00,$0.00,$0.00
19813,ERX,HCPCS J7195,70504-0270-01,COAGULATION FACTOR IX (RECOMB IXINITY) 500 UNITS IV SOLR,"$2,162.75",$0.00,"$2,162.75",$0.00,"$1,543.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,162.75",$0.00,"$1,081.38","$1,712.90","$1,730.20",$0.00,$0.00,$0.00,$0.00,$0.00
19813,ERX,HCPCS J7195,70504-0282-05,COAGULATION FACTOR IX (RECOMB IXINITY) 500 UNITS IV SOLR,"$2,162.75",$0.00,"$2,162.75",$0.00,"$1,543.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,162.75",$0.00,"$1,081.38","$1,712.90","$1,730.20",$0.00,$0.00,$0.00,$0.00,$0.00
19814,ERX,HCPCS J7195,70504-0271-01,COAGULATION FACTOR IX (RECOMB IXINITY) 1000 UNITS IV SOLR,"$4,325.50",$0.00,"$4,325.50",$0.00,"$3,087.11",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,325.50",$0.00,"$2,162.75","$3,425.80","$3,460.40",$0.00,$0.00,$0.00,$0.00,$0.00
19814,ERX,HCPCS J7195,70504-0283-05,COAGULATION FACTOR IX (RECOMB IXINITY) 1000 UNITS IV SOLR,"$4,325.50",$0.00,"$4,325.50",$0.00,"$3,087.11",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,325.50",$0.00,"$2,162.75","$3,425.80","$3,460.40",$0.00,$0.00,$0.00,$0.00,$0.00
19882,ERX,HCPCS 63700001,16714-0611-01,SERTRALINE HCL 25 MG PO TABS,$10.83,$0.00,$10.83,$0.00,$7.73,$0.00,$0.00,$0.00,$0.00,$0.00,$10.83,$0.00,$5.42,$8.58,$8.66,$0.00,$0.00,$0.00,$0.00,$0.00
19882,ERX,HCPCS 63700001,16714-0611-04,SERTRALINE HCL 25 MG PO TABS,$10.83,$0.00,$10.83,$0.00,$7.73,$0.00,$0.00,$0.00,$0.00,$0.00,$10.83,$0.00,$5.42,$8.58,$8.66,$0.00,$0.00,$0.00,$0.00,$0.00
19882,ERX,HCPCS 63700001,60687-0231-01,SERTRALINE HCL 25 MG PO TABS,$10.83,$0.00,$10.83,$0.00,$7.73,$0.00,$0.00,$0.00,$0.00,$0.00,$10.83,$0.00,$5.42,$8.58,$8.66,$0.00,$0.00,$0.00,$0.00,$0.00
19882,ERX,HCPCS 63700001,60687-0231-11,SERTRALINE HCL 25 MG PO TABS,$10.83,$0.00,$10.83,$0.00,$7.73,$0.00,$0.00,$0.00,$0.00,$0.00,$10.83,$0.00,$5.42,$8.58,$8.66,$0.00,$0.00,$0.00,$0.00,$0.00
19882,ERX,HCPCS 63700001,76282-0212-18,SERTRALINE HCL 25 MG PO TABS,$10.83,$0.00,$10.83,$0.00,$7.73,$0.00,$0.00,$0.00,$0.00,$0.00,$10.83,$0.00,$5.42,$8.58,$8.66,$0.00,$0.00,$0.00,$0.00,$0.00
19898,ERX,HCPCS J9214,00085-1133-01,INTERFERON ALFA-2B 10000000 UNIT/ML IJ SOLN,$982.82,$0.00,$982.82,$0.00,$701.44,$0.00,$0.00,$0.00,$0.00,$0.00,$982.82,$0.00,$491.41,$778.39,$786.26,$0.00,$0.00,$0.00,$0.00,$0.00
19928,ERX,HCPCS 63700001,65162-0087-74,ITRACONAZOLE 10 MG/ML ORAL SOLUTION,$165.62,$0.00,$165.62,$0.00,$118.20,$0.00,$0.00,$0.00,$0.00,$0.00,$165.62,$0.00,$82.81,$131.17,$132.50,$0.00,$0.00,$0.00,$0.00,$0.00
19928,ERX,HCPCS 63700001,99999-6009-61,ITRACONAZOLE 10 MG/ML ORAL SOLUTION,$165.62,$0.00,$165.62,$0.00,$118.20,$0.00,$0.00,$0.00,$0.00,$0.00,$165.62,$0.00,$82.81,$131.17,$132.50,$0.00,$0.00,$0.00,$0.00,$0.00
20032,ERX,HCPCS 63700001,63010-0010-30,NELFINAVIR MESYLATE 250 MG PO TABS,$84.98,$0.00,$84.98,$0.00,$60.65,$0.00,$0.00,$0.00,$0.00,$0.00,$84.98,$0.00,$42.49,$67.30,$67.98,$0.00,$0.00,$0.00,$0.00,$0.00
20039,ERX,HCPCS 25000001,00173-0523-00,SUMATRIPTAN 20 MG/ACT NA SOLN,$307.32,$0.00,$307.32,$0.00,$219.33,$0.00,$0.00,$0.00,$0.00,$0.00,$307.32,$0.00,$153.66,$243.40,$245.86,$0.00,$0.00,$0.00,$0.00,$0.00
20077,ERX,HCPCS 63700001,67108-3565-09,MESNA 400 MG PO TABS,$575.29,$0.00,$575.29,$0.00,$410.58,$0.00,$0.00,$0.00,$0.00,$0.00,$575.29,$0.00,$287.65,$455.63,$460.23,$0.00,$0.00,$0.00,$0.00,$0.00
20103,ERX,HCPCS 25000001,92771-0810-08,LUBRISKIN EX LOTN,$11.00,$0.00,$8.71,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$8.71,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
20103,ERX,HCPCS 25000001,92771-0810-16,LUBRISKIN EX LOTN,$12.56,$0.00,$9.95,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$9.95,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
20140,ERX,HCPCS 63700001,54162-0500-02,HYDROPHOR EX OINT,$46.59,$0.00,$46.59,$0.00,$33.25,$0.00,$0.00,$0.00,$0.00,$0.00,$46.59,$0.00,$23.30,$36.90,$37.27,$0.00,$0.00,$0.00,$0.00,$0.00
20140,ERX,HCPCS 63700001,54162-0500-01,HYDROPHOR EX OINT,$46.59,$0.00,$46.59,$0.00,$33.25,$0.00,$0.00,$0.00,$0.00,$0.00,$46.59,$0.00,$23.30,$36.90,$37.27,$0.00,$0.00,$0.00,$0.00,$0.00
20140,ERX,HCPCS 63700001,10356-0101-10,HYDROPHOR EX OINT,$46.59,$0.00,$46.59,$0.00,$33.25,$0.00,$0.00,$0.00,$0.00,$0.00,$46.59,$0.00,$23.30,$36.90,$37.27,$0.00,$0.00,$0.00,$0.00,$0.00
20156,ERX,HCPCS J9100,61703-0319-22,CYTARABINE (PF) 100 MG/ML IJ SOLN,$87.78,$0.00,$87.78,$0.00,$62.65,$0.00,$0.00,$0.00,$0.00,$0.00,$87.78,$0.00,$43.89,$69.52,$70.22,$0.00,$0.00,$0.00,$0.00,$0.00
20156,ERX,HCPCS J9100,63323-0120-20,CYTARABINE (PF) 100 MG/ML IJ SOLN,$87.78,$0.00,$87.78,$0.00,$62.65,$0.00,$0.00,$0.00,$0.00,$0.00,$87.78,$0.00,$43.89,$69.52,$70.22,$0.00,$0.00,$0.00,$0.00,$0.00
20156,ERX,HCPCS J9100,67457-0452-20,CYTARABINE (PF) 100 MG/ML IJ SOLN,$87.78,$0.00,$87.78,$0.00,$62.65,$0.00,$0.00,$0.00,$0.00,$0.00,$87.78,$0.00,$43.89,$69.52,$70.22,$0.00,$0.00,$0.00,$0.00,$0.00
20330,ERX,HCPCS 25000001,00023-8335-03,TAZAROTENE 0.05 % EX GEL,"$1,205.14",$0.00,"$1,205.14",$0.00,$860.11,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,205.14",$0.00,$602.57,$954.47,$964.11,$0.00,$0.00,$0.00,$0.00,$0.00
20446,ERX,HCPCS 63700001,00172-5241-60,ANAGRELIDE HCL 0.5 MG PO CAPS,$37.71,$0.00,$37.71,$0.00,$26.91,$0.00,$0.00,$0.00,$0.00,$0.00,$37.71,$0.00,$18.86,$29.87,$30.17,$0.00,$0.00,$0.00,$0.00,$0.00
20446,ERX,HCPCS 63700001,54092-0063-01,ANAGRELIDE HCL 0.5 MG PO CAPS,$37.71,$0.00,$37.71,$0.00,$26.91,$0.00,$0.00,$0.00,$0.00,$0.00,$37.71,$0.00,$18.86,$29.87,$30.17,$0.00,$0.00,$0.00,$0.00,$0.00
20447,ERX,HCPCS 63700001,00172-5240-60,ANAGRELIDE HCL 1 MG PO CAPS,$84.25,$0.00,$84.25,$0.00,$60.13,$0.00,$0.00,$0.00,$0.00,$0.00,$84.25,$0.00,$42.13,$66.73,$67.40,$0.00,$0.00,$0.00,$0.00,$0.00
20472,ERX,HCPCS 25000001,00143-9310-10,ETOMIDATE 2 MG/ML IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
20472,ERX,HCPCS 25000001,00143-9506-10,ETOMIDATE 2 MG/ML IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
20472,ERX,HCPCS 25000001,55150-0221-10,ETOMIDATE 2 MG/ML IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
20472,ERX,HCPCS 25000001,55150-0222-20,ETOMIDATE 2 MG/ML IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
20472,ERX,HCPCS 25000001,68382-0545-07,ETOMIDATE 2 MG/ML IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
20472,ERX,HCPCS 25000001,72266-0146-10,ETOMIDATE 2 MG/ML IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
20566,ERX,HCPCS 63700001,50268-0525-15,MELOXICAM 7.5 MG PO TABS,$11.78,$0.00,$11.78,$0.00,$8.41,$0.00,$0.00,$0.00,$0.00,$0.00,$11.78,$0.00,$5.89,$9.33,$9.42,$0.00,$0.00,$0.00,$0.00,$0.00
20566,ERX,HCPCS 63700001,68382-0050-01,MELOXICAM 7.5 MG PO TABS,$11.78,$0.00,$11.78,$0.00,$8.41,$0.00,$0.00,$0.00,$0.00,$0.00,$11.78,$0.00,$5.89,$9.33,$9.42,$0.00,$0.00,$0.00,$0.00,$0.00
20580,ERX,HCPCS 63700001,50268-0526-15,MELOXICAM 15 MG PO TABS,$17.72,$0.00,$17.72,$0.00,$12.65,$0.00,$0.00,$0.00,$0.00,$0.00,$17.72,$0.00,$8.86,$14.03,$14.18,$0.00,$0.00,$0.00,$0.00,$0.00
20580,ERX,HCPCS 63700001,68382-0051-01,MELOXICAM 15 MG PO TABS,$17.72,$0.00,$17.72,$0.00,$12.65,$0.00,$0.00,$0.00,$0.00,$0.00,$17.72,$0.00,$8.86,$14.03,$14.18,$0.00,$0.00,$0.00,$0.00,$0.00
20638,ERX,HCPCS 63700001,00555-9045-58,"FALMINA,ORSYTHIA,LEVONORG-ETHINYL ESTRAD 0.1/0.02MG TAB",$123.09,$0.00,$123.09,$0.00,$87.85,$0.00,$0.00,$0.00,$0.00,$0.00,$123.09,$0.00,$61.55,$97.49,$98.47,$0.00,$0.00,$0.00,$0.00,$0.00
20638,ERX,HCPCS 63700001,16714-0359-04,"FALMINA,ORSYTHIA,LEVONORG-ETHINYL ESTRAD 0.1/0.02MG TAB",$123.09,$0.00,$123.09,$0.00,$87.85,$0.00,$0.00,$0.00,$0.00,$0.00,$123.09,$0.00,$61.55,$97.49,$98.47,$0.00,$0.00,$0.00,$0.00,$0.00
20718,ERX,HCPCS 63700001,68462-0536-70,IMIQUIMOD 5 % EX CREA,$127.12,$0.00,$127.12,$0.00,$90.73,$0.00,$0.00,$0.00,$0.00,$0.00,$127.12,$0.00,$63.56,$100.68,$101.70,$0.00,$0.00,$0.00,$0.00,$0.00
20943,ERX,HCPCS 63700001,00069-3060-75,AZITHROMYCIN 250 MG PO TABS,$16.02,$0.00,$16.02,$0.00,$11.43,$0.00,$0.00,$0.00,$0.00,$0.00,$16.02,$0.00,$8.01,$12.69,$12.82,$0.00,$0.00,$0.00,$0.00,$0.00
20943,ERX,HCPCS 63700001,00781-5776-69,AZITHROMYCIN 250 MG PO TABS,$16.02,$0.00,$16.02,$0.00,$11.43,$0.00,$0.00,$0.00,$0.00,$0.00,$16.02,$0.00,$8.01,$12.69,$12.82,$0.00,$0.00,$0.00,$0.00,$0.00
20943,ERX,HCPCS 63700001,00904-6708-06,AZITHROMYCIN 250 MG PO TABS,$16.02,$0.00,$16.02,$0.00,$11.43,$0.00,$0.00,$0.00,$0.00,$0.00,$16.02,$0.00,$8.01,$12.69,$12.82,$0.00,$0.00,$0.00,$0.00,$0.00
20943,ERX,HCPCS 63700001,50111-0787-10,AZITHROMYCIN 250 MG PO TABS,$16.02,$0.00,$16.02,$0.00,$11.43,$0.00,$0.00,$0.00,$0.00,$0.00,$16.02,$0.00,$8.01,$12.69,$12.82,$0.00,$0.00,$0.00,$0.00,$0.00
20943,ERX,HCPCS 63700001,50111-0787-51,AZITHROMYCIN 250 MG PO TABS,$16.02,$0.00,$16.02,$0.00,$11.43,$0.00,$0.00,$0.00,$0.00,$0.00,$16.02,$0.00,$8.01,$12.69,$12.82,$0.00,$0.00,$0.00,$0.00,$0.00
20943,ERX,HCPCS 63700001,50268-0098-15,AZITHROMYCIN 250 MG PO TABS,$16.02,$0.00,$16.02,$0.00,$11.43,$0.00,$0.00,$0.00,$0.00,$0.00,$16.02,$0.00,$8.01,$12.69,$12.82,$0.00,$0.00,$0.00,$0.00,$0.00
20943,ERX,HCPCS 63700001,51224-0022-30,AZITHROMYCIN 250 MG PO TABS,$16.02,$0.00,$16.02,$0.00,$11.43,$0.00,$0.00,$0.00,$0.00,$0.00,$16.02,$0.00,$8.01,$12.69,$12.82,$0.00,$0.00,$0.00,$0.00,$0.00
20943,ERX,HCPCS 63700001,59762-2198-01,AZITHROMYCIN 250 MG PO TABS,$16.02,$0.00,$16.02,$0.00,$11.43,$0.00,$0.00,$0.00,$0.00,$0.00,$16.02,$0.00,$8.01,$12.69,$12.82,$0.00,$0.00,$0.00,$0.00,$0.00
20943,ERX,HCPCS 63700001,59762-2198-03,AZITHROMYCIN 250 MG PO TABS,$16.02,$0.00,$16.02,$0.00,$11.43,$0.00,$0.00,$0.00,$0.00,$0.00,$16.02,$0.00,$8.01,$12.69,$12.82,$0.00,$0.00,$0.00,$0.00,$0.00
20943,ERX,HCPCS 63700001,59762-2198-07,AZITHROMYCIN 250 MG PO TABS,$16.02,$0.00,$16.02,$0.00,$11.43,$0.00,$0.00,$0.00,$0.00,$0.00,$16.02,$0.00,$8.01,$12.69,$12.82,$0.00,$0.00,$0.00,$0.00,$0.00
20943,ERX,HCPCS 63700001,60687-0282-01,AZITHROMYCIN 250 MG PO TABS,$16.02,$0.00,$16.02,$0.00,$11.43,$0.00,$0.00,$0.00,$0.00,$0.00,$16.02,$0.00,$8.01,$12.69,$12.82,$0.00,$0.00,$0.00,$0.00,$0.00
20943,ERX,HCPCS 63700001,65862-0641-63,AZITHROMYCIN 250 MG PO TABS,$16.02,$0.00,$16.02,$0.00,$11.43,$0.00,$0.00,$0.00,$0.00,$0.00,$16.02,$0.00,$8.01,$12.69,$12.82,$0.00,$0.00,$0.00,$0.00,$0.00
20943,ERX,HCPCS 63700001,65862-0641-69,AZITHROMYCIN 250 MG PO TABS,$16.02,$0.00,$16.02,$0.00,$11.43,$0.00,$0.00,$0.00,$0.00,$0.00,$16.02,$0.00,$8.01,$12.69,$12.82,$0.00,$0.00,$0.00,$0.00,$0.00
20954,ERX,HCPCS J1955,54482-0147-01,LEVOCARNITINE 200 MG/ML IV SOLN,$139.11,$0.00,$139.11,$0.00,$99.28,$0.00,$0.00,$0.00,$0.00,$0.00,$139.11,$0.00,$69.56,$110.18,$111.29,$0.00,$0.00,$0.00,$0.00,$0.00
21044,ERX,HCPCS J1950,00074-3663-03,LEUPROLIDE ACETATE (3 MONTH) 11.25 MG IM KIT,"$10,307.02",$0.00,"$10,307.02","$4,638.16","$5,158.80","$3,807.68","$1,647.37",$0.00,$0.00,"$4,480.63","$10,307.02","$3,998.07","$5,153.51","$8,163.16","$8,245.62","$5,521.14","$4,480.63",$0.00,"$4,266.32","$3,733.01"
21045,ERX,HCPCS J9217,00074-3346-03,LEUPROLIDE ACETATE (3 MONTH) 22.5 MG IM KIT,"$12,282.27",$0.00,"$12,282.27","$5,527.02","$5,158.80",$674.09,$740.50,$0.00,$0.00,$811.00,"$12,282.27",$707.80,"$6,141.14","$9,727.56","$9,825.82",$977.44,$811.00,$0.00,$772.21,$617.66
21057,ERX,HCPCS 63700001,00904-6283-61,OLANZAPINE 2.5 MG PO TABS,$42.55,$0.00,$42.55,$0.00,$30.37,$0.00,$0.00,$0.00,$0.00,$0.00,$42.55,$0.00,$21.28,$33.70,$34.04,$0.00,$0.00,$0.00,$0.00,$0.00
21057,ERX,HCPCS 63700001,60505-3110-00,OLANZAPINE 2.5 MG PO TABS,$42.55,$0.00,$42.55,$0.00,$30.37,$0.00,$0.00,$0.00,$0.00,$0.00,$42.55,$0.00,$21.28,$33.70,$34.04,$0.00,$0.00,$0.00,$0.00,$0.00
21057,ERX,HCPCS 63700001,68084-0525-01,OLANZAPINE 2.5 MG PO TABS,$42.55,$0.00,$42.55,$0.00,$30.37,$0.00,$0.00,$0.00,$0.00,$0.00,$42.55,$0.00,$21.28,$33.70,$34.04,$0.00,$0.00,$0.00,$0.00,$0.00
21061,ERX,HCPCS 63700001,62756-0184-13,OXCARBAZEPINE 300 MG PO TABS,$10.60,$0.00,$10.60,$0.00,$7.57,$0.00,$0.00,$0.00,$0.00,$0.00,$10.60,$0.00,$5.30,$8.40,$8.48,$0.00,$0.00,$0.00,$0.00,$0.00
21061,ERX,HCPCS 63700001,62756-0184-88,OXCARBAZEPINE 300 MG PO TABS,$10.60,$0.00,$10.60,$0.00,$7.57,$0.00,$0.00,$0.00,$0.00,$0.00,$10.60,$0.00,$5.30,$8.40,$8.48,$0.00,$0.00,$0.00,$0.00,$0.00
21061,ERX,HCPCS 63700001,68084-0853-01,OXCARBAZEPINE 300 MG PO TABS,$10.60,$0.00,$10.60,$0.00,$7.57,$0.00,$0.00,$0.00,$0.00,$0.00,$10.60,$0.00,$5.30,$8.40,$8.48,$0.00,$0.00,$0.00,$0.00,$0.00
21062,ERX,HCPCS 63700001,00904-6085-61,CITALOPRAM HYDROBROMIDE 20 MG PO TABS,$10.24,$0.00,$10.24,$0.00,$7.31,$0.00,$0.00,$0.00,$0.00,$0.00,$10.24,$0.00,$5.12,$8.11,$8.19,$0.00,$0.00,$0.00,$0.00,$0.00
21062,ERX,HCPCS 63700001,13668-0010-01,CITALOPRAM HYDROBROMIDE 20 MG PO TABS,$10.24,$0.00,$10.24,$0.00,$7.31,$0.00,$0.00,$0.00,$0.00,$0.00,$10.24,$0.00,$5.12,$8.11,$8.19,$0.00,$0.00,$0.00,$0.00,$0.00
21062,ERX,HCPCS 63700001,55111-0343-30,CITALOPRAM HYDROBROMIDE 20 MG PO TABS,$10.24,$0.00,$10.24,$0.00,$7.31,$0.00,$0.00,$0.00,$0.00,$0.00,$10.24,$0.00,$5.12,$8.11,$8.19,$0.00,$0.00,$0.00,$0.00,$0.00
21062,ERX,HCPCS 63700001,57664-0508-88,CITALOPRAM HYDROBROMIDE 20 MG PO TABS,$10.24,$0.00,$10.24,$0.00,$7.31,$0.00,$0.00,$0.00,$0.00,$0.00,$10.24,$0.00,$5.12,$8.11,$8.19,$0.00,$0.00,$0.00,$0.00,$0.00
21062,ERX,HCPCS 63700001,68084-0744-01,CITALOPRAM HYDROBROMIDE 20 MG PO TABS,$10.24,$0.00,$10.24,$0.00,$7.31,$0.00,$0.00,$0.00,$0.00,$0.00,$10.24,$0.00,$5.12,$8.11,$8.19,$0.00,$0.00,$0.00,$0.00,$0.00
21063,ERX,HCPCS J0456,00069-3150-83,AZITHROMYCIN 500 MG IV SOLR,$27.36,$0.00,$27.36,$12.31,$19.53,$0.00,$4.71,$0.00,$0.00,$4.79,$27.36,$0.00,$13.68,$21.67,$21.89,$0.00,$4.28,$0.00,$4.36,$0.00
21063,ERX,HCPCS J0456,55150-0174-10,AZITHROMYCIN 500 MG IV SOLR,$27.36,$0.00,$27.36,$12.31,$19.53,$0.00,$4.71,$0.00,$0.00,$4.79,$27.36,$0.00,$13.68,$21.67,$21.89,$0.00,$4.28,$0.00,$4.36,$0.00
21063,ERX,HCPCS J0456,63323-0398-10,AZITHROMYCIN 500 MG IV SOLR,$27.36,$0.00,$27.36,$12.31,$19.53,$0.00,$4.71,$0.00,$0.00,$4.79,$27.36,$0.00,$13.68,$21.67,$21.89,$0.00,$4.28,$0.00,$4.36,$0.00
21063,ERX,HCPCS J0456,63323-0398-12,AZITHROMYCIN 500 MG IV SOLR,$27.36,$0.00,$27.36,$12.31,$19.53,$0.00,$4.71,$0.00,$0.00,$4.79,$27.36,$0.00,$13.68,$21.67,$21.89,$0.00,$4.28,$0.00,$4.36,$0.00
21063,ERX,HCPCS J0456,67457-0860-50,AZITHROMYCIN 500 MG IV SOLR,$27.36,$0.00,$27.36,$12.31,$19.53,$0.00,$4.71,$0.00,$0.00,$4.79,$27.36,$0.00,$13.68,$21.67,$21.89,$0.00,$4.28,$0.00,$4.36,$0.00
21063,ERX,HCPCS J0456,70860-0100-10,AZITHROMYCIN 500 MG IV SOLR,$27.36,$0.00,$27.36,$12.31,$19.53,$0.00,$4.71,$0.00,$0.00,$4.79,$27.36,$0.00,$13.68,$21.67,$21.89,$0.00,$4.28,$0.00,$4.36,$0.00
21063,ERX,HCPCS J0456,70860-0100-41,AZITHROMYCIN 500 MG IV SOLR,$27.36,$0.00,$27.36,$12.31,$19.53,$0.00,$4.71,$0.00,$0.00,$4.79,$27.36,$0.00,$13.68,$21.67,$21.89,$0.00,$4.28,$0.00,$4.36,$0.00
21063,ERX,HCPCS J0456,70860-0125-66,AZITHROMYCIN 500 MG IV SOLR,$27.36,$0.00,$27.36,$12.31,$19.53,$0.00,$4.71,$0.00,$0.00,$4.79,$27.36,$0.00,$13.68,$21.67,$21.89,$0.00,$4.28,$0.00,$4.36,$0.00
21064,ERX,HCPCS 25000001,00904-6488-38,LUBRIFRESH P.M. OP OINT,$18.85,$0.00,$18.85,$0.00,$13.45,$0.00,$0.00,$0.00,$0.00,$0.00,$18.85,$0.00,$9.43,$14.93,$15.08,$0.00,$0.00,$0.00,$0.00,$0.00
21108,ERX,HCPCS J9217,00074-3683-03,LEUPROLIDE ACETATE (4 MONTH) 30 MG IM KIT,"$16,376.37",$0.00,"$16,376.37","$7,369.37","$5,158.80",$898.79,$987.33,$0.00,$0.00,"$1,081.33","$16,376.37",$943.73,"$8,188.19","$12,970.09","$13,101.10","$1,303.25","$1,081.33",$0.00,"$1,029.61",$823.54
21135,ERX,HCPCS 25000001,47335-0788-91,DESMOPRESSIN ACETATE SPRAY 0.01 % NA SOLN,$652.57,$0.00,$652.57,$0.00,$465.74,$0.00,$0.00,$0.00,$0.00,$0.00,$652.57,$0.00,$326.29,$516.84,$522.06,$0.00,$0.00,$0.00,$0.00,$0.00
21135,ERX,HCPCS 25000001,68382-0384-01,DESMOPRESSIN ACETATE SPRAY 0.01 % NA SOLN,$652.57,$0.00,$652.57,$0.00,$465.74,$0.00,$0.00,$0.00,$0.00,$0.00,$652.57,$0.00,$326.29,$516.84,$522.06,$0.00,$0.00,$0.00,$0.00,$0.00
21135,ERX,HCPCS 25000001,69918-0501-05,DESMOPRESSIN ACETATE SPRAY 0.01 % NA SOLN,$652.57,$0.00,$652.57,$0.00,$465.74,$0.00,$0.00,$0.00,$0.00,$0.00,$652.57,$0.00,$326.29,$516.84,$522.06,$0.00,$0.00,$0.00,$0.00,$0.00
21157,ERX,HCPCS 63700001,62756-0185-88,OXCARBAZEPINE 600 MG PO TABS,$19.24,$0.00,$19.24,$0.00,$13.73,$0.00,$0.00,$0.00,$0.00,$0.00,$19.24,$0.00,$9.62,$15.24,$15.39,$0.00,$0.00,$0.00,$0.00,$0.00
21157,ERX,HCPCS 63700001,68084-0867-01,OXCARBAZEPINE 600 MG PO TABS,$19.24,$0.00,$19.24,$0.00,$13.73,$0.00,$0.00,$0.00,$0.00,$0.00,$19.24,$0.00,$9.62,$15.24,$15.39,$0.00,$0.00,$0.00,$0.00,$0.00
21157,ERX,HCPCS 63700001,68084-0867-11,OXCARBAZEPINE 600 MG PO TABS,$19.24,$0.00,$19.24,$0.00,$13.73,$0.00,$0.00,$0.00,$0.00,$0.00,$19.24,$0.00,$9.62,$15.24,$15.39,$0.00,$0.00,$0.00,$0.00,$0.00
21284,ERX,HCPCS 63700001,13107-0068-01,AMPHETAMINE-DEXTROAMPHETAMINE 5 MG PO TABS,$6.52,$0.00,$6.52,$0.00,$4.65,$0.00,$0.00,$0.00,$0.00,$0.00,$6.52,$0.00,$3.26,$5.16,$5.22,$0.00,$0.00,$0.00,$0.00,$0.00
21284,ERX,HCPCS 63700001,42806-0339-01,AMPHETAMINE-DEXTROAMPHETAMINE 5 MG PO TABS,$6.52,$0.00,$6.52,$0.00,$4.65,$0.00,$0.00,$0.00,$0.00,$0.00,$6.52,$0.00,$3.26,$5.16,$5.22,$0.00,$0.00,$0.00,$0.00,$0.00
21285,ERX,HCPCS J0795,55566-0302-01,CORTICORELIN OVINE TRIFLUTATE 100 MCG IV SOLR,"$2,244.90",$0.00,"$2,244.90",$0.00,"$1,602.19",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,244.90",$0.00,"$1,122.45","$1,777.96","$1,795.92",$0.00,$0.00,$0.00,$0.00,$0.00
21287,ERX,HCPCS 63700001,00597-0183-90,PRAMIPEXOLE DIHYDROCHLORIDE 0.125 MG PO TABS,$32.02,$0.00,$32.02,$0.00,$22.85,$0.00,$0.00,$0.00,$0.00,$0.00,$32.02,$0.00,$16.01,$25.36,$25.62,$0.00,$0.00,$0.00,$0.00,$0.00
21287,ERX,HCPCS 63700001,33342-0031-10,PRAMIPEXOLE DIHYDROCHLORIDE 0.125 MG PO TABS,$32.02,$0.00,$32.02,$0.00,$22.85,$0.00,$0.00,$0.00,$0.00,$0.00,$32.02,$0.00,$16.01,$25.36,$25.62,$0.00,$0.00,$0.00,$0.00,$0.00
21287,ERX,HCPCS 63700001,68382-0196-16,PRAMIPEXOLE DIHYDROCHLORIDE 0.125 MG PO TABS,$32.02,$0.00,$32.02,$0.00,$22.85,$0.00,$0.00,$0.00,$0.00,$0.00,$32.02,$0.00,$16.01,$25.36,$25.62,$0.00,$0.00,$0.00,$0.00,$0.00
21287,ERX,HCPCS 63700001,68462-0330-90,PRAMIPEXOLE DIHYDROCHLORIDE 0.125 MG PO TABS,$32.02,$0.00,$32.02,$0.00,$22.85,$0.00,$0.00,$0.00,$0.00,$0.00,$32.02,$0.00,$16.01,$25.36,$25.62,$0.00,$0.00,$0.00,$0.00,$0.00
21288,ERX,HCPCS 63700001,33342-0034-10,PRAMIPEXOLE DIHYDROCHLORIDE 1 MG PO TABS,$33.62,$0.00,$33.62,$0.00,$23.99,$0.00,$0.00,$0.00,$0.00,$0.00,$33.62,$0.00,$16.81,$26.63,$26.90,$0.00,$0.00,$0.00,$0.00,$0.00
21288,ERX,HCPCS 63700001,68382-0199-16,PRAMIPEXOLE DIHYDROCHLORIDE 1 MG PO TABS,$33.62,$0.00,$33.62,$0.00,$23.99,$0.00,$0.00,$0.00,$0.00,$0.00,$33.62,$0.00,$16.81,$26.63,$26.90,$0.00,$0.00,$0.00,$0.00,$0.00
21288,ERX,HCPCS 63700001,68462-0333-90,PRAMIPEXOLE DIHYDROCHLORIDE 1 MG PO TABS,$33.62,$0.00,$33.62,$0.00,$23.99,$0.00,$0.00,$0.00,$0.00,$0.00,$33.62,$0.00,$16.81,$26.63,$26.90,$0.00,$0.00,$0.00,$0.00,$0.00
21289,ERX,HCPCS 63700001,00781-5252-92,PRAMIPEXOLE DIHYDROCHLORIDE 1.5 MG PO TABS,$11.21,$0.00,$11.21,$0.00,$8.00,$0.00,$0.00,$0.00,$0.00,$0.00,$11.21,$0.00,$5.61,$8.88,$8.97,$0.00,$0.00,$0.00,$0.00,$0.00
21289,ERX,HCPCS 63700001,33342-0035-10,PRAMIPEXOLE DIHYDROCHLORIDE 1.5 MG PO TABS,$11.21,$0.00,$11.21,$0.00,$8.00,$0.00,$0.00,$0.00,$0.00,$0.00,$11.21,$0.00,$5.61,$8.88,$8.97,$0.00,$0.00,$0.00,$0.00,$0.00
21289,ERX,HCPCS 63700001,68382-0200-16,PRAMIPEXOLE DIHYDROCHLORIDE 1.5 MG PO TABS,$11.21,$0.00,$11.21,$0.00,$8.00,$0.00,$0.00,$0.00,$0.00,$0.00,$11.21,$0.00,$5.61,$8.88,$8.97,$0.00,$0.00,$0.00,$0.00,$0.00
21289,ERX,HCPCS 63700001,68462-0334-90,PRAMIPEXOLE DIHYDROCHLORIDE 1.5 MG PO TABS,$11.21,$0.00,$11.21,$0.00,$8.00,$0.00,$0.00,$0.00,$0.00,$0.00,$11.21,$0.00,$5.61,$8.88,$8.97,$0.00,$0.00,$0.00,$0.00,$0.00
21290,ERX,HCPCS 63700001,13668-0092-90,PRAMIPEXOLE DIHYDROCHLORIDE 0.25 MG PO TABS,$12.32,$0.00,$12.32,$0.00,$8.79,$0.00,$0.00,$0.00,$0.00,$0.00,$12.32,$0.00,$6.16,$9.76,$9.86,$0.00,$0.00,$0.00,$0.00,$0.00
21290,ERX,HCPCS 63700001,33342-0032-10,PRAMIPEXOLE DIHYDROCHLORIDE 0.25 MG PO TABS,$12.32,$0.00,$12.32,$0.00,$8.79,$0.00,$0.00,$0.00,$0.00,$0.00,$12.32,$0.00,$6.16,$9.76,$9.86,$0.00,$0.00,$0.00,$0.00,$0.00
21290,ERX,HCPCS 63700001,68382-0197-16,PRAMIPEXOLE DIHYDROCHLORIDE 0.25 MG PO TABS,$12.32,$0.00,$12.32,$0.00,$8.79,$0.00,$0.00,$0.00,$0.00,$0.00,$12.32,$0.00,$6.16,$9.76,$9.86,$0.00,$0.00,$0.00,$0.00,$0.00
21290,ERX,HCPCS 63700001,68462-0331-90,PRAMIPEXOLE DIHYDROCHLORIDE 0.25 MG PO TABS,$12.32,$0.00,$12.32,$0.00,$8.79,$0.00,$0.00,$0.00,$0.00,$0.00,$12.32,$0.00,$6.16,$9.76,$9.86,$0.00,$0.00,$0.00,$0.00,$0.00
21300,ERX,HCPCS 63700001,00904-5448-61,PENTOXIFYLLINE ER 400 MG PO TBCR,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
21321,ERX,HCPCS 63700001,52544-0256-12,PROGESTERONE 8 % VA GEL,$10.91,$0.00,$10.91,$0.00,$7.79,$0.00,$0.00,$0.00,$0.00,$0.00,$10.91,$0.00,$5.46,$8.64,$8.73,$0.00,$0.00,$0.00,$0.00,$0.00
21321,ERX,HCPCS 63700001,52544-0256-54,PROGESTERONE 8 % VA GEL,$10.91,$0.00,$10.91,$0.00,$7.79,$0.00,$0.00,$0.00,$0.00,$0.00,$10.91,$0.00,$5.46,$8.64,$8.73,$0.00,$0.00,$0.00,$0.00,$0.00
21374,ERX,HCPCS J7517,00004-0260-01,MYCOPHENOLATE MOFETIL 500 MG PO TABS,$75.57,$0.00,$75.57,$34.01,$53.93,$0.00,$13.02,$0.00,$0.00,$13.23,$75.57,$0.00,$37.79,$59.85,$60.46,$0.00,$11.83,$0.00,$12.03,$0.00
21374,ERX,HCPCS J7517,00054-0166-25,MYCOPHENOLATE MOFETIL 500 MG PO TABS,$75.57,$0.00,$75.57,$34.01,$53.93,$0.00,$13.02,$0.00,$0.00,$13.23,$75.57,$0.00,$37.79,$59.85,$60.46,$0.00,$11.83,$0.00,$12.03,$0.00
21374,ERX,HCPCS J7517,16729-0019-01,MYCOPHENOLATE MOFETIL 500 MG PO TABS,$75.57,$0.00,$75.57,$34.01,$53.93,$0.00,$13.02,$0.00,$0.00,$13.23,$75.57,$0.00,$37.79,$59.85,$60.46,$0.00,$11.83,$0.00,$12.03,$0.00
21374,ERX,HCPCS J7517,51079-0379-01,MYCOPHENOLATE MOFETIL 500 MG PO TABS,$75.57,$0.00,$75.57,$34.01,$53.93,$0.00,$13.02,$0.00,$0.00,$13.23,$75.57,$0.00,$37.79,$59.85,$60.46,$0.00,$11.83,$0.00,$12.03,$0.00
21374,ERX,HCPCS J7517,51079-0379-20,MYCOPHENOLATE MOFETIL 500 MG PO TABS,$75.57,$0.00,$75.57,$34.01,$53.93,$0.00,$13.02,$0.00,$0.00,$13.23,$75.57,$0.00,$37.79,$59.85,$60.46,$0.00,$11.83,$0.00,$12.03,$0.00
21374,ERX,HCPCS J7517,60687-0438-01,MYCOPHENOLATE MOFETIL 500 MG PO TABS,$75.57,$0.00,$75.57,$34.01,$53.93,$0.00,$13.02,$0.00,$0.00,$13.23,$75.57,$0.00,$37.79,$59.85,$60.46,$0.00,$11.83,$0.00,$12.03,$0.00
21374,ERX,HCPCS J7517,60687-0438-11,MYCOPHENOLATE MOFETIL 500 MG PO TABS,$75.57,$0.00,$75.57,$34.01,$53.93,$0.00,$13.02,$0.00,$0.00,$13.23,$75.57,$0.00,$37.79,$59.85,$60.46,$0.00,$11.83,$0.00,$12.03,$0.00
21374,ERX,HCPCS J7517,64380-0725-06,MYCOPHENOLATE MOFETIL 500 MG PO TABS,$75.57,$0.00,$75.57,$34.01,$53.93,$0.00,$13.02,$0.00,$0.00,$13.23,$75.57,$0.00,$37.79,$59.85,$60.46,$0.00,$11.83,$0.00,$12.03,$0.00
21374,ERX,HCPCS J7517,67877-0225-01,MYCOPHENOLATE MOFETIL 500 MG PO TABS,$75.57,$0.00,$75.57,$34.01,$53.93,$0.00,$13.02,$0.00,$0.00,$13.23,$75.57,$0.00,$37.79,$59.85,$60.46,$0.00,$11.83,$0.00,$12.03,$0.00
21374,ERX,HCPCS J7517,67877-0225-05,MYCOPHENOLATE MOFETIL 500 MG PO TABS,$75.57,$0.00,$75.57,$34.01,$53.93,$0.00,$13.02,$0.00,$0.00,$13.23,$75.57,$0.00,$37.79,$59.85,$60.46,$0.00,$11.83,$0.00,$12.03,$0.00
21381,ERX,HCPCS 25000001,10858-0081-07,BARIUM SULFATE PO CAPS,$75.60,$0.00,$75.60,$0.00,$53.96,$0.00,$0.00,$0.00,$0.00,$0.00,$75.60,$0.00,$37.80,$59.88,$60.48,$0.00,$0.00,$0.00,$0.00,$0.00
21381,ERX,HCPCS 25000001,10858-0081-10,BARIUM SULFATE PO CAPS,$75.60,$0.00,$75.60,$0.00,$53.96,$0.00,$0.00,$0.00,$0.00,$0.00,$75.60,$0.00,$37.80,$59.88,$60.48,$0.00,$0.00,$0.00,$0.00,$0.00
21509,ERX,HCPCS 63700001,00078-0249-15,LETROZOLE 2.5 MG PO TABS,$98.30,$0.00,$98.30,$0.00,$70.16,$0.00,$0.00,$0.00,$0.00,$0.00,$98.30,$0.00,$49.15,$77.85,$78.64,$0.00,$0.00,$0.00,$0.00,$0.00
21509,ERX,HCPCS 63700001,00093-7620-56,LETROZOLE 2.5 MG PO TABS,$98.30,$0.00,$98.30,$0.00,$70.16,$0.00,$0.00,$0.00,$0.00,$0.00,$98.30,$0.00,$49.15,$77.85,$78.64,$0.00,$0.00,$0.00,$0.00,$0.00
21509,ERX,HCPCS 63700001,16729-0034-10,LETROZOLE 2.5 MG PO TABS,$98.30,$0.00,$98.30,$0.00,$70.16,$0.00,$0.00,$0.00,$0.00,$0.00,$98.30,$0.00,$49.15,$77.85,$78.64,$0.00,$0.00,$0.00,$0.00,$0.00
21509,ERX,HCPCS 63700001,50268-0476-15,LETROZOLE 2.5 MG PO TABS,$98.30,$0.00,$98.30,$0.00,$70.16,$0.00,$0.00,$0.00,$0.00,$0.00,$98.30,$0.00,$49.15,$77.85,$78.64,$0.00,$0.00,$0.00,$0.00,$0.00
21509,ERX,HCPCS 63700001,51991-0759-33,LETROZOLE 2.5 MG PO TABS,$98.30,$0.00,$98.30,$0.00,$70.16,$0.00,$0.00,$0.00,$0.00,$0.00,$98.30,$0.00,$49.15,$77.85,$78.64,$0.00,$0.00,$0.00,$0.00,$0.00
21509,ERX,HCPCS 63700001,60505-3255-03,LETROZOLE 2.5 MG PO TABS,$98.30,$0.00,$98.30,$0.00,$70.16,$0.00,$0.00,$0.00,$0.00,$0.00,$98.30,$0.00,$49.15,$77.85,$78.64,$0.00,$0.00,$0.00,$0.00,$0.00
21570,ERX,HCPCS J9030,00052-0602-02,BCG LIVE 50 MG IS SUSR,$574.87,$0.00,$574.87,$258.69,$410.28,$141.05,$99.05,$0.00,$0.00,$166.26,$574.87,$148.10,$287.44,$455.30,$459.90,$204.52,$166.26,$0.00,$158.31,$141.05
21688,ERX,HCPCS 63700001,00378-5525-01,ROPINIROLE HCL 0.25 MG PO TABS,$9.50,$0.00,$9.50,$0.00,$6.78,$0.00,$0.00,$0.00,$0.00,$0.00,$9.50,$0.00,$4.75,$7.52,$7.60,$0.00,$0.00,$0.00,$0.00,$0.00
21688,ERX,HCPCS 63700001,43547-0268-10,ROPINIROLE HCL 0.25 MG PO TABS,$9.50,$0.00,$9.50,$0.00,$6.78,$0.00,$0.00,$0.00,$0.00,$0.00,$9.50,$0.00,$4.75,$7.52,$7.60,$0.00,$0.00,$0.00,$0.00,$0.00
21688,ERX,HCPCS 63700001,62332-0030-31,ROPINIROLE HCL 0.25 MG PO TABS,$9.50,$0.00,$9.50,$0.00,$6.78,$0.00,$0.00,$0.00,$0.00,$0.00,$9.50,$0.00,$4.75,$7.52,$7.60,$0.00,$0.00,$0.00,$0.00,$0.00
21689,ERX,HCPCS 63700001,00904-6374-61,ROPINIROLE HCL 1 MG PO TABS,$9.52,$0.00,$9.52,$0.00,$6.79,$0.00,$0.00,$0.00,$0.00,$0.00,$9.52,$0.00,$4.76,$7.54,$7.62,$0.00,$0.00,$0.00,$0.00,$0.00
21689,ERX,HCPCS 63700001,43547-0270-10,ROPINIROLE HCL 1 MG PO TABS,$9.52,$0.00,$9.52,$0.00,$6.79,$0.00,$0.00,$0.00,$0.00,$0.00,$9.52,$0.00,$4.76,$7.54,$7.62,$0.00,$0.00,$0.00,$0.00,$0.00
21689,ERX,HCPCS 63700001,68462-0255-01,ROPINIROLE HCL 1 MG PO TABS,$9.52,$0.00,$9.52,$0.00,$6.79,$0.00,$0.00,$0.00,$0.00,$0.00,$9.52,$0.00,$4.76,$7.54,$7.62,$0.00,$0.00,$0.00,$0.00,$0.00
21690,ERX,HCPCS 63700001,43547-0271-10,ROPINIROLE HCL 2 MG PO TABS,$9.50,$0.00,$9.50,$0.00,$6.78,$0.00,$0.00,$0.00,$0.00,$0.00,$9.50,$0.00,$4.75,$7.52,$7.60,$0.00,$0.00,$0.00,$0.00,$0.00
21690,ERX,HCPCS 63700001,62332-0033-31,ROPINIROLE HCL 2 MG PO TABS,$9.50,$0.00,$9.50,$0.00,$6.78,$0.00,$0.00,$0.00,$0.00,$0.00,$9.50,$0.00,$4.75,$7.52,$7.60,$0.00,$0.00,$0.00,$0.00,$0.00
21690,ERX,HCPCS 63700001,68462-0256-01,ROPINIROLE HCL 2 MG PO TABS,$9.50,$0.00,$9.50,$0.00,$6.78,$0.00,$0.00,$0.00,$0.00,$0.00,$9.50,$0.00,$4.75,$7.52,$7.60,$0.00,$0.00,$0.00,$0.00,$0.00
21691,ERX,HCPCS 63700001,43547-0274-10,ROPINIROLE HCL 5 MG PO TABS,$9.88,$0.00,$9.88,$0.00,$7.05,$0.00,$0.00,$0.00,$0.00,$0.00,$9.88,$0.00,$4.94,$7.82,$7.90,$0.00,$0.00,$0.00,$0.00,$0.00
21800,ERX,HCPCS 63700001,43547-0269-10,ROPINIROLE HCL 0.5 MG PO TABS,$9.50,$0.00,$9.50,$0.00,$6.78,$0.00,$0.00,$0.00,$0.00,$0.00,$9.50,$0.00,$4.75,$7.52,$7.60,$0.00,$0.00,$0.00,$0.00,$0.00
21810,ERX,HCPCS 63700001,31722-0506-60,COMBIVIR: LAMIVUDINE-ZIDOVUDINE 150-300 MG PO TABS,$59.01,$0.00,$59.01,$0.00,$42.12,$0.00,$0.00,$0.00,$0.00,$0.00,$59.01,$0.00,$29.51,$46.74,$47.21,$0.00,$0.00,$0.00,$0.00,$0.00
21810,ERX,HCPCS 63700001,64380-0707-03,COMBIVIR: LAMIVUDINE-ZIDOVUDINE 150-300 MG PO TABS,$59.01,$0.00,$59.01,$0.00,$42.12,$0.00,$0.00,$0.00,$0.00,$0.00,$59.01,$0.00,$29.51,$46.74,$47.21,$0.00,$0.00,$0.00,$0.00,$0.00
21823,ERX,HCPCS 63700001,00054-0220-20,QUETIAPINE FUMARATE 25 MG PO TABS,$17.72,$0.00,$17.72,$0.00,$12.65,$0.00,$0.00,$0.00,$0.00,$0.00,$17.72,$0.00,$8.86,$14.03,$14.18,$0.00,$0.00,$0.00,$0.00,$0.00
21823,ERX,HCPCS 63700001,00310-0275-10,QUETIAPINE FUMARATE 25 MG PO TABS,$17.72,$0.00,$17.72,$0.00,$12.65,$0.00,$0.00,$0.00,$0.00,$0.00,$17.72,$0.00,$8.86,$14.03,$14.18,$0.00,$0.00,$0.00,$0.00,$0.00
21823,ERX,HCPCS 63700001,00904-6638-61,QUETIAPINE FUMARATE 25 MG PO TABS,$17.72,$0.00,$17.72,$0.00,$12.65,$0.00,$0.00,$0.00,$0.00,$0.00,$17.72,$0.00,$8.86,$14.03,$14.18,$0.00,$0.00,$0.00,$0.00,$0.00
21823,ERX,HCPCS 63700001,16729-0145-01,QUETIAPINE FUMARATE 25 MG PO TABS,$17.72,$0.00,$17.72,$0.00,$12.65,$0.00,$0.00,$0.00,$0.00,$0.00,$17.72,$0.00,$8.86,$14.03,$14.18,$0.00,$0.00,$0.00,$0.00,$0.00
21823,ERX,HCPCS 63700001,50268-0630-15,QUETIAPINE FUMARATE 25 MG PO TABS,$17.72,$0.00,$17.72,$0.00,$12.65,$0.00,$0.00,$0.00,$0.00,$0.00,$17.72,$0.00,$8.86,$14.03,$14.18,$0.00,$0.00,$0.00,$0.00,$0.00
21823,ERX,HCPCS 63700001,60687-0327-01,QUETIAPINE FUMARATE 25 MG PO TABS,$17.72,$0.00,$17.72,$0.00,$12.65,$0.00,$0.00,$0.00,$0.00,$0.00,$17.72,$0.00,$8.86,$14.03,$14.18,$0.00,$0.00,$0.00,$0.00,$0.00
21824,ERX,HCPCS 63700001,00054-0221-20,QUETIAPINE FUMARATE 100 MG PO TABS,$26.07,$0.00,$26.07,$0.00,$18.61,$0.00,$0.00,$0.00,$0.00,$0.00,$26.07,$0.00,$13.04,$20.65,$20.86,$0.00,$0.00,$0.00,$0.00,$0.00
21824,ERX,HCPCS 63700001,50268-0632-15,QUETIAPINE FUMARATE 100 MG PO TABS,$26.07,$0.00,$26.07,$0.00,$18.61,$0.00,$0.00,$0.00,$0.00,$0.00,$26.07,$0.00,$13.04,$20.65,$20.86,$0.00,$0.00,$0.00,$0.00,$0.00
21824,ERX,HCPCS 63700001,63739-0665-10,QUETIAPINE FUMARATE 100 MG PO TABS,$26.07,$0.00,$26.07,$0.00,$18.61,$0.00,$0.00,$0.00,$0.00,$0.00,$26.07,$0.00,$13.04,$20.65,$20.86,$0.00,$0.00,$0.00,$0.00,$0.00
21825,ERX,HCPCS 63700001,16714-0455-01,QUETIAPINE FUMARATE 200 MG PO TABS,$49.17,$0.00,$49.17,$0.00,$35.09,$0.00,$0.00,$0.00,$0.00,$0.00,$49.17,$0.00,$24.59,$38.94,$39.34,$0.00,$0.00,$0.00,$0.00,$0.00
21825,ERX,HCPCS 63700001,47335-0905-88,QUETIAPINE FUMARATE 200 MG PO TABS,$49.17,$0.00,$49.17,$0.00,$35.09,$0.00,$0.00,$0.00,$0.00,$0.00,$49.17,$0.00,$24.59,$38.94,$39.34,$0.00,$0.00,$0.00,$0.00,$0.00
21827,ERX,HCPCS 25000001,63459-0404-30,TIAGABINE HCL 4 MG PO TABS,$45.38,$0.00,$45.38,$0.00,$32.39,$0.00,$0.00,$0.00,$0.00,$0.00,$45.38,$0.00,$22.69,$35.94,$36.30,$0.00,$0.00,$0.00,$0.00,$0.00
21867,ERX,HCPCS 63700001,76336-0455-18,METYRAPONE 250 MG PO CAPS,$123.09,$0.00,$123.09,$0.00,$87.85,$0.00,$0.00,$0.00,$0.00,$0.00,$123.09,$0.00,$61.55,$97.49,$98.47,$0.00,$0.00,$0.00,$0.00,$0.00
21900,ERX,HCPCS J0289,00469-3051-30,AMPHOTERICIN B LIPOSOME 50 MG IV SUSR,$825.21,$0.00,$825.21,$0.00,$588.95,$0.00,$0.00,$0.00,$0.00,$0.00,$825.21,$0.00,$412.61,$653.57,$660.17,$0.00,$0.00,$0.00,$0.00,$0.00
21905,ERX,HCPCS 25000001,00085-1288-01,MOMETASONE FUROATE 50 MCG/ACT NA SUSP,$799.55,$0.00,$799.55,$0.00,$570.64,$0.00,$0.00,$0.00,$0.00,$0.00,$799.55,$0.00,$399.78,$633.24,$639.64,$0.00,$0.00,$0.00,$0.00,$0.00
22120,ERX,HCPCS 90675,58160-0964-12,"RABIES VACCINE, PCEC IM SUSR","$1,103.81",$0.00,"$1,103.81",$496.71,$787.79,$297.59,$174.76,$0.00,$0.00,$326.44,"$1,103.81",$312.47,$551.91,$874.22,$883.05,$431.50,$326.44,$0.00,$310.83,$294.72
22142,ERX,HCPCS 25000001,00904-6294-61,CLOPIDOGREL BISULFATE 75 MG PO TABS,$29.40,$0.00,$29.40,$0.00,$20.98,$0.00,$0.00,$0.00,$0.00,$0.00,$29.40,$0.00,$14.70,$23.28,$23.52,$0.00,$0.00,$0.00,$0.00,$0.00
22142,ERX,HCPCS 25000001,47335-0894-83,CLOPIDOGREL BISULFATE 75 MG PO TABS,$29.40,$0.00,$29.40,$0.00,$20.98,$0.00,$0.00,$0.00,$0.00,$0.00,$29.40,$0.00,$14.70,$23.28,$23.52,$0.00,$0.00,$0.00,$0.00,$0.00
22142,ERX,HCPCS 25000001,55111-0196-30,CLOPIDOGREL BISULFATE 75 MG PO TABS,$29.40,$0.00,$29.40,$0.00,$20.98,$0.00,$0.00,$0.00,$0.00,$0.00,$29.40,$0.00,$14.70,$23.28,$23.52,$0.00,$0.00,$0.00,$0.00,$0.00
22142,ERX,HCPCS 25000001,55111-0196-90,CLOPIDOGREL BISULFATE 75 MG PO TABS,$29.40,$0.00,$29.40,$0.00,$20.98,$0.00,$0.00,$0.00,$0.00,$0.00,$29.40,$0.00,$14.70,$23.28,$23.52,$0.00,$0.00,$0.00,$0.00,$0.00
22142,ERX,HCPCS 25000001,65862-0357-30,CLOPIDOGREL BISULFATE 75 MG PO TABS,$29.40,$0.00,$29.40,$0.00,$20.98,$0.00,$0.00,$0.00,$0.00,$0.00,$29.40,$0.00,$14.70,$23.28,$23.52,$0.00,$0.00,$0.00,$0.00,$0.00
22142,ERX,HCPCS 25000001,68084-0536-01,CLOPIDOGREL BISULFATE 75 MG PO TABS,$29.40,$0.00,$29.40,$0.00,$20.98,$0.00,$0.00,$0.00,$0.00,$0.00,$29.40,$0.00,$14.70,$23.28,$23.52,$0.00,$0.00,$0.00,$0.00,$0.00
22143,ERX,HCPCS 63700001,00093-7290-01,RALOXIFENE HCL 60 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
22143,ERX,HCPCS 63700001,00093-7290-56,RALOXIFENE HCL 60 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
22148,ERX,HCPCS 63700001,69543-0120-10,ACARBOSE 25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
22220,ERX,HCPCS 25000001,50484-0810-15,BECAPLERMIN 0.01 % EX GEL,"$2,889.52",$0.00,"$2,889.52",$0.00,"$2,062.25",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,889.52",$0.00,"$1,444.76","$2,288.50","$2,311.62",$0.00,$0.00,$0.00,$0.00,$0.00
22290,ERX,HCPCS 25000001,00093-4136-73,CEFDINIR 125 MG/5ML PO SUSR,$254.52,$0.00,$254.52,$0.00,$181.65,$0.00,$0.00,$0.00,$0.00,$0.00,$254.52,$0.00,$127.26,$201.58,$203.62,$0.00,$0.00,$0.00,$0.00,$0.00
22290,ERX,HCPCS 25000001,00781-6077-46,CEFDINIR 125 MG/5ML PO SUSR,$254.52,$0.00,$254.52,$0.00,$181.65,$0.00,$0.00,$0.00,$0.00,$0.00,$254.52,$0.00,$127.26,$201.58,$203.62,$0.00,$0.00,$0.00,$0.00,$0.00
22290,ERX,HCPCS 25000001,65862-0218-01,CEFDINIR 125 MG/5ML PO SUSR,$254.52,$0.00,$254.52,$0.00,$181.65,$0.00,$0.00,$0.00,$0.00,$0.00,$254.52,$0.00,$127.26,$201.58,$203.62,$0.00,$0.00,$0.00,$0.00,$0.00
22456,ERX,HCPCS 63700001,59528-0331-02,CALCIUM ACETATE (PHOS BINDER) 667 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
22456,ERX,HCPCS 63700001,71321-0803-20,CALCIUM ACETATE (PHOS BINDER) 667 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
22469,ERX,HCPCS 63700001,00904-5224-52,LACTASE 3000 UNITS PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
22472,ERX,HCPCS J1885,00338-0069-10,KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.32,$0.00,$0.00,$0.61,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.61,$0.00,$0.58,$0.00
22472,ERX,HCPCS J1885,00409-3793-01,KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.32,$0.00,$0.00,$0.61,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.61,$0.00,$0.58,$0.00
22472,ERX,HCPCS J1885,00641-6041-25,KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.32,$0.00,$0.00,$0.61,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.61,$0.00,$0.58,$0.00
22472,ERX,HCPCS J1885,25021-0700-01,KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.32,$0.00,$0.00,$0.61,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.61,$0.00,$0.58,$0.00
22472,ERX,HCPCS J1885,47781-0583-68,KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.32,$0.00,$0.00,$0.61,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.61,$0.00,$0.58,$0.00
22472,ERX,HCPCS J1885,63323-0161-01,KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.32,$0.00,$0.00,$0.61,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.61,$0.00,$0.58,$0.00
22472,ERX,HCPCS J1885,63323-0161-12,KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.32,$0.00,$0.00,$0.61,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.61,$0.00,$0.58,$0.00
22472,ERX,HCPCS J1885,70860-0700-02,KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.32,$0.00,$0.00,$0.61,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.61,$0.00,$0.58,$0.00
22472,ERX,HCPCS J1885,70860-0700-41,KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.32,$0.00,$0.00,$0.61,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.61,$0.00,$0.58,$0.00
22472,ERX,HCPCS J1885,72611-0719-25,KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.32,$0.00,$0.00,$0.61,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.61,$0.00,$0.58,$0.00
22473,ERX,HCPCS J1885,00338-0072-25,KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.32,$0.00,$0.00,$0.61,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.61,$0.00,$0.58,$0.00
22473,ERX,HCPCS J1885,00409-3795-01,KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.32,$0.00,$0.00,$0.61,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.61,$0.00,$0.58,$0.00
22473,ERX,HCPCS J1885,00641-6042-01,KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.32,$0.00,$0.00,$0.61,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.61,$0.00,$0.58,$0.00
22473,ERX,HCPCS J1885,00641-6042-25,KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.32,$0.00,$0.00,$0.61,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.61,$0.00,$0.58,$0.00
22473,ERX,HCPCS J1885,25021-0701-01,KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.32,$0.00,$0.00,$0.61,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.61,$0.00,$0.58,$0.00
22473,ERX,HCPCS J1885,47781-0584-68,KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.32,$0.00,$0.00,$0.61,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.61,$0.00,$0.58,$0.00
22473,ERX,HCPCS J1885,63323-0162-01,KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.32,$0.00,$0.00,$0.61,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.61,$0.00,$0.58,$0.00
22473,ERX,HCPCS J1885,63323-0162-12,KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.32,$0.00,$0.00,$0.61,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.61,$0.00,$0.58,$0.00
22473,ERX,HCPCS J1885,70860-0701-01,KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.32,$0.00,$0.00,$0.61,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.61,$0.00,$0.58,$0.00
22473,ERX,HCPCS J1885,70860-0701-03,KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.32,$0.00,$0.00,$0.61,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.61,$0.00,$0.58,$0.00
22473,ERX,HCPCS J1885,72611-0722-25,KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.32,$0.00,$0.00,$0.61,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.61,$0.00,$0.58,$0.00
22509,ERX,HCPCS 63700001,00904-6808-61,MONTELUKAST SODIUM 10 MG PO TABS,$20.93,$0.00,$20.93,$0.00,$14.94,$0.00,$0.00,$0.00,$0.00,$0.00,$20.93,$0.00,$10.47,$16.58,$16.74,$0.00,$0.00,$0.00,$0.00,$0.00
22509,ERX,HCPCS 63700001,50268-0575-15,MONTELUKAST SODIUM 10 MG PO TABS,$20.93,$0.00,$20.93,$0.00,$14.94,$0.00,$0.00,$0.00,$0.00,$0.00,$20.93,$0.00,$10.47,$16.58,$16.74,$0.00,$0.00,$0.00,$0.00,$0.00
22509,ERX,HCPCS 63700001,65862-0574-90,MONTELUKAST SODIUM 10 MG PO TABS,$20.93,$0.00,$20.93,$0.00,$14.94,$0.00,$0.00,$0.00,$0.00,$0.00,$20.93,$0.00,$10.47,$16.58,$16.74,$0.00,$0.00,$0.00,$0.00,$0.00
22509,ERX,HCPCS 63700001,68084-0875-01,MONTELUKAST SODIUM 10 MG PO TABS,$20.93,$0.00,$20.93,$0.00,$14.94,$0.00,$0.00,$0.00,$0.00,$0.00,$20.93,$0.00,$10.47,$16.58,$16.74,$0.00,$0.00,$0.00,$0.00,$0.00
22510,ERX,HCPCS 63700001,50268-0574-15,MONTELUKAST SODIUM 5 MG PO CHEW,$19.12,$0.00,$19.12,$0.00,$13.65,$0.00,$0.00,$0.00,$0.00,$0.00,$19.12,$0.00,$9.56,$15.14,$15.30,$0.00,$0.00,$0.00,$0.00,$0.00
22510,ERX,HCPCS 63700001,57237-0213-30,MONTELUKAST SODIUM 5 MG PO CHEW,$19.12,$0.00,$19.12,$0.00,$13.65,$0.00,$0.00,$0.00,$0.00,$0.00,$19.12,$0.00,$9.56,$15.14,$15.30,$0.00,$0.00,$0.00,$0.00,$0.00
22510,ERX,HCPCS 63700001,65862-0568-90,MONTELUKAST SODIUM 5 MG PO CHEW,$19.12,$0.00,$19.12,$0.00,$13.65,$0.00,$0.00,$0.00,$0.00,$0.00,$19.12,$0.00,$9.56,$15.14,$15.30,$0.00,$0.00,$0.00,$0.00,$0.00
22560,ERX,HCPCS 63700001,99999-6005-56,SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5ML PO SUSP,$77.49,$0.00,$77.49,$0.00,$55.30,$0.00,$0.00,$0.00,$0.00,$0.00,$77.49,$0.00,$38.75,$61.37,$61.99,$0.00,$0.00,$0.00,$0.00,$0.00
22560,ERX,HCPCS 63700001,00121-0854-16,SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5ML PO SUSP,$570.32,$0.00,$451.69,$0.00,$55.30,$0.00,$0.00,$0.00,$0.00,$0.00,$77.49,$0.00,$38.75,$451.69,$61.99,$0.00,$0.00,$0.00,$0.00,$0.00
22560,ERX,HCPCS 63700001,50383-0823-16,SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5ML PO SUSP,$570.32,$0.00,$451.69,$0.00,$55.30,$0.00,$0.00,$0.00,$0.00,$0.00,$77.49,$0.00,$38.75,$451.69,$61.99,$0.00,$0.00,$0.00,$0.00,$0.00
22560,ERX,HCPCS 63700001,50383-0824-16,SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5ML PO SUSP,$570.32,$0.00,$451.69,$0.00,$55.30,$0.00,$0.00,$0.00,$0.00,$0.00,$77.49,$0.00,$38.75,$451.69,$61.99,$0.00,$0.00,$0.00,$0.00,$0.00
22560,ERX,HCPCS 63700001,65862-0496-47,SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5ML PO SUSP,$570.32,$0.00,$451.69,$0.00,$55.30,$0.00,$0.00,$0.00,$0.00,$0.00,$77.49,$0.00,$38.75,$451.69,$61.99,$0.00,$0.00,$0.00,$0.00,$0.00
22588,ERX,HCPCS 63700001,00006-0960-31,LOSARTAN POTASSIUM 100 MG PO TABS,$23.08,$0.00,$23.08,$0.00,$16.47,$0.00,$0.00,$0.00,$0.00,$0.00,$23.08,$0.00,$11.54,$18.28,$18.46,$0.00,$0.00,$0.00,$0.00,$0.00
22588,ERX,HCPCS 63700001,00904-6389-61,LOSARTAN POTASSIUM 100 MG PO TABS,$23.08,$0.00,$23.08,$0.00,$16.47,$0.00,$0.00,$0.00,$0.00,$0.00,$23.08,$0.00,$11.54,$18.28,$18.46,$0.00,$0.00,$0.00,$0.00,$0.00
22588,ERX,HCPCS 63700001,13668-0115-90,LOSARTAN POTASSIUM 100 MG PO TABS,$23.08,$0.00,$23.08,$0.00,$16.47,$0.00,$0.00,$0.00,$0.00,$0.00,$23.08,$0.00,$11.54,$18.28,$18.46,$0.00,$0.00,$0.00,$0.00,$0.00
22588,ERX,HCPCS 63700001,31722-0702-30,LOSARTAN POTASSIUM 100 MG PO TABS,$23.08,$0.00,$23.08,$0.00,$16.47,$0.00,$0.00,$0.00,$0.00,$0.00,$23.08,$0.00,$11.54,$18.28,$18.46,$0.00,$0.00,$0.00,$0.00,$0.00
22588,ERX,HCPCS 63700001,31722-0702-90,LOSARTAN POTASSIUM 100 MG PO TABS,$23.08,$0.00,$23.08,$0.00,$16.47,$0.00,$0.00,$0.00,$0.00,$0.00,$23.08,$0.00,$11.54,$18.28,$18.46,$0.00,$0.00,$0.00,$0.00,$0.00
22588,ERX,HCPCS 63700001,50268-0518-15,LOSARTAN POTASSIUM 100 MG PO TABS,$23.08,$0.00,$23.08,$0.00,$16.47,$0.00,$0.00,$0.00,$0.00,$0.00,$23.08,$0.00,$11.54,$18.28,$18.46,$0.00,$0.00,$0.00,$0.00,$0.00
22588,ERX,HCPCS 63700001,63739-0698-10,LOSARTAN POTASSIUM 100 MG PO TABS,$23.08,$0.00,$23.08,$0.00,$16.47,$0.00,$0.00,$0.00,$0.00,$0.00,$23.08,$0.00,$11.54,$18.28,$18.46,$0.00,$0.00,$0.00,$0.00,$0.00
22588,ERX,HCPCS 63700001,65862-0203-30,LOSARTAN POTASSIUM 100 MG PO TABS,$23.08,$0.00,$23.08,$0.00,$16.47,$0.00,$0.00,$0.00,$0.00,$0.00,$23.08,$0.00,$11.54,$18.28,$18.46,$0.00,$0.00,$0.00,$0.00,$0.00
22588,ERX,HCPCS 63700001,65862-0203-99,LOSARTAN POTASSIUM 100 MG PO TABS,$23.08,$0.00,$23.08,$0.00,$16.47,$0.00,$0.00,$0.00,$0.00,$0.00,$23.08,$0.00,$11.54,$18.28,$18.46,$0.00,$0.00,$0.00,$0.00,$0.00
22588,ERX,HCPCS 63700001,68084-0348-01,LOSARTAN POTASSIUM 100 MG PO TABS,$23.08,$0.00,$23.08,$0.00,$16.47,$0.00,$0.00,$0.00,$0.00,$0.00,$23.08,$0.00,$11.54,$18.28,$18.46,$0.00,$0.00,$0.00,$0.00,$0.00
22953,ERX,HCPCS 63700001,00065-0275-10,BRINZOLAMIDE 1 % OP SUSP,"$1,034.59",$0.00,"$1,034.59",$0.00,$738.39,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,034.59",$0.00,$517.30,$819.40,$827.67,$0.00,$0.00,$0.00,$0.00,$0.00
22959,ERX,HCPCS 25000001,99999-6004-88,PAROXETINE HCL 10 MG/5ML PO SUSP,$238.90,$0.00,$238.90,$0.00,$170.50,$0.00,$0.00,$0.00,$0.00,$0.00,$238.90,$0.00,$119.45,$189.21,$191.12,$0.00,$0.00,$0.00,$0.00,$0.00
22959,ERX,HCPCS 25000001,60505-0402-05,PAROXETINE HCL 10 MG/5ML PO SUSP,"$1,167.99",$0.00,$925.05,$0.00,$170.50,$0.00,$0.00,$0.00,$0.00,$0.00,$238.90,$0.00,$119.45,$925.05,$191.12,$0.00,$0.00,$0.00,$0.00,$0.00
22981,ERX,HCPCS J0287,57665-0101-41,AMPHOTERICIN B LIPID 5 MG/ML IV SUSP,$366.00,$0.00,$366.00,$0.00,$261.21,$0.00,$0.00,$0.00,$0.00,$0.00,$366.00,$0.00,$183.00,$289.87,$292.80,$0.00,$0.00,$0.00,$0.00,$0.00
22993,ERX,HCPCS J8520,00004-1100-20,CAPECITABINE 150 MG PO TABS,$61.83,$0.00,$61.83,$0.00,$44.13,$0.00,$0.00,$0.00,$0.00,$0.00,$61.83,$0.00,$30.92,$48.97,$49.46,$0.00,$0.00,$0.00,$0.00,$0.00
22994,ERX,HCPCS J8521,00004-1101-50,CAPECITABINE 500 MG PO TABS,$170.81,$0.00,$170.81,$0.00,$121.91,$0.00,$0.00,$0.00,$0.00,$0.00,$170.81,$0.00,$85.41,$135.28,$136.65,$0.00,$0.00,$0.00,$0.00,$0.00
22994,ERX,HCPCS J8521,72485-0205-12,CAPECITABINE 500 MG PO TABS,$170.81,$0.00,$170.81,$0.00,$121.91,$0.00,$0.00,$0.00,$0.00,$0.00,$170.81,$0.00,$85.41,$135.28,$136.65,$0.00,$0.00,$0.00,$0.00,$0.00
23009,ERX,HCPCS 63700001,00003-6335-17,HYDROXYUREA 200 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
23010,ERX,HCPCS 63700001,00003-6336-17,HYDROXYUREA 300 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
23011,ERX,HCPCS 63700001,00003-6337-17,HYDROXYUREA 400 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
23036,ERX,HCPCS 25000001,51552-0071-05,POTASSIUM HYDROXIDE 10 % SOLN,$200.03,$0.00,$200.03,$0.00,$142.76,$0.00,$0.00,$0.00,$0.00,$0.00,$200.03,$0.00,$100.02,$158.42,$160.02,$0.00,$0.00,$0.00,$0.00,$0.00
23063,ERX,HCPCS 25000001,,CAMPHOR-MENTHOL 0.5-0.5 % EX LOTN,$18.56,$0.00,$18.56,$0.00,$13.25,$0.00,$0.00,$0.00,$0.00,$0.00,$18.56,$0.00,$9.28,$14.70,$14.85,$0.00,$0.00,$0.00,$0.00,$0.00
23063,ERX,HCPCS 25000001,00536-1268-12,CAMPHOR-MENTHOL 0.5-0.5 % EX LOTN,$18.56,$0.00,$18.56,$0.00,$13.25,$0.00,$0.00,$0.00,$0.00,$0.00,$18.56,$0.00,$9.28,$14.70,$14.85,$0.00,$0.00,$0.00,$0.00,$0.00
23063,ERX,HCPCS 25000001,54162-0550-07,CAMPHOR-MENTHOL 0.5-0.5 % EX LOTN,$18.56,$0.00,$18.56,$0.00,$13.25,$0.00,$0.00,$0.00,$0.00,$0.00,$18.56,$0.00,$9.28,$14.70,$14.85,$0.00,$0.00,$0.00,$0.00,$0.00
23063,ERX,HCPCS 25000001,54162-0550-09,CAMPHOR-MENTHOL 0.5-0.5 % EX LOTN,$18.56,$0.00,$18.56,$0.00,$13.25,$0.00,$0.00,$0.00,$0.00,$0.00,$18.56,$0.00,$9.28,$14.70,$14.85,$0.00,$0.00,$0.00,$0.00,$0.00
23065,ERX,HCPCS 63700001,19076-9022-00,ELTA EX CREA,$116.10,$0.00,$116.10,$0.00,$82.86,$0.00,$0.00,$0.00,$0.00,$0.00,$116.10,$0.00,$58.05,$91.95,$92.88,$0.00,$0.00,$0.00,$0.00,$0.00
23128,ERX,HCPCS J0133,55150-0154-10,ACYCLOVIR SODIUM 50 MG/ML IV SOLN,$60.80,$0.00,$60.80,$0.00,$43.39,$0.00,$0.00,$0.00,$0.00,$0.00,$60.80,$0.00,$30.40,$48.15,$48.64,$0.00,$0.00,$0.00,$0.00,$0.00
23128,ERX,HCPCS J0133,55150-0154-11,ACYCLOVIR SODIUM 50 MG/ML IV SOLN,$60.80,$0.00,$60.80,$0.00,$43.39,$0.00,$0.00,$0.00,$0.00,$0.00,$60.80,$0.00,$30.40,$48.15,$48.64,$0.00,$0.00,$0.00,$0.00,$0.00
23128,ERX,HCPCS J0133,63323-0325-10,ACYCLOVIR SODIUM 50 MG/ML IV SOLN,$60.80,$0.00,$60.80,$0.00,$43.39,$0.00,$0.00,$0.00,$0.00,$0.00,$60.80,$0.00,$30.40,$48.15,$48.64,$0.00,$0.00,$0.00,$0.00,$0.00
23128,ERX,HCPCS J0133,55150-0155-21,ACYCLOVIR SODIUM 50 MG/ML IV SOLN,$147.00,$0.00,$116.42,$0.00,$43.39,$0.00,$0.00,$0.00,$0.00,$0.00,$60.80,$0.00,$30.40,$116.42,$48.64,$0.00,$0.00,$0.00,$0.00,$0.00
23128,ERX,HCPCS J0133,63323-0325-20,ACYCLOVIR SODIUM 50 MG/ML IV SOLN,$147.00,$0.00,$116.42,$0.00,$43.39,$0.00,$0.00,$0.00,$0.00,$0.00,$60.80,$0.00,$30.40,$116.42,$48.64,$0.00,$0.00,$0.00,$0.00,$0.00
23233,ERX,HCPCS 25000001,49884-0902-78,MAFENIDE ACETATE 5 % EX PACK,$617.64,$0.00,$617.64,$0.00,$440.81,$0.00,$0.00,$0.00,$0.00,$0.00,$617.64,$0.00,$308.82,$489.17,$494.11,$0.00,$0.00,$0.00,$0.00,$0.00
23233,ERX,HCPCS 25000001,50742-0310-25,MAFENIDE ACETATE 5 % EX PACK,$617.64,$0.00,$617.64,$0.00,$440.81,$0.00,$0.00,$0.00,$0.00,$0.00,$617.64,$0.00,$308.82,$489.17,$494.11,$0.00,$0.00,$0.00,$0.00,$0.00
23233,ERX,HCPCS 25000001,50742-0310-50,MAFENIDE ACETATE 5 % EX PACK,$617.64,$0.00,$617.64,$0.00,$440.81,$0.00,$0.00,$0.00,$0.00,$0.00,$617.64,$0.00,$308.82,$489.17,$494.11,$0.00,$0.00,$0.00,$0.00,$0.00
23233,ERX,HCPCS 25000001,51079-0624-85,MAFENIDE ACETATE 5 % EX PACK,$617.64,$0.00,$617.64,$0.00,$440.81,$0.00,$0.00,$0.00,$0.00,$0.00,$617.64,$0.00,$308.82,$489.17,$494.11,$0.00,$0.00,$0.00,$0.00,$0.00
23365,ERX,HCPCS 63700001,00088-2102-01,RIFAPENTINE 150 MG PO TABS,$69.29,$0.00,$69.29,$0.00,$49.45,$0.00,$0.00,$0.00,$0.00,$0.00,$69.29,$0.00,$34.65,$54.88,$55.43,$0.00,$0.00,$0.00,$0.00,$0.00
23365,ERX,HCPCS 63700001,00088-2102-24,RIFAPENTINE 150 MG PO TABS,$69.29,$0.00,$69.29,$0.00,$49.45,$0.00,$0.00,$0.00,$0.00,$0.00,$69.29,$0.00,$34.65,$54.88,$55.43,$0.00,$0.00,$0.00,$0.00,$0.00
23449,ERX,HCPCS 63700001,16714-0685-01,SIMVASTATIN 80 MG PO TABS,$18.64,$0.00,$18.64,$0.00,$13.30,$0.00,$0.00,$0.00,$0.00,$0.00,$18.64,$0.00,$9.32,$14.76,$14.91,$0.00,$0.00,$0.00,$0.00,$0.00
23449,ERX,HCPCS 63700001,16714-0685-02,SIMVASTATIN 80 MG PO TABS,$18.64,$0.00,$18.64,$0.00,$13.30,$0.00,$0.00,$0.00,$0.00,$0.00,$18.64,$0.00,$9.32,$14.76,$14.91,$0.00,$0.00,$0.00,$0.00,$0.00
23449,ERX,HCPCS 63700001,65862-0054-30,SIMVASTATIN 80 MG PO TABS,$18.64,$0.00,$18.64,$0.00,$13.30,$0.00,$0.00,$0.00,$0.00,$0.00,$18.64,$0.00,$9.32,$14.76,$14.91,$0.00,$0.00,$0.00,$0.00,$0.00
23458,ERX,HCPCS 63700001,00143-9285-01,AMOXICILLIN 875 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
23458,ERX,HCPCS 63700001,57237-0029-01,AMOXICILLIN 875 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
23458,ERX,HCPCS 63700001,65862-0015-01,AMOXICILLIN 875 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
23461,ERX,HCPCS 25000001,00496-0882-05,LIDOCAINE 4 % EX CREA,$31.92,$0.00,$31.92,$0.00,$22.78,$0.00,$0.00,$0.00,$0.00,$0.00,$31.92,$0.00,$15.96,$25.28,$25.54,$0.00,$0.00,$0.00,$0.00,$0.00
23461,ERX,HCPCS 25000001,00496-0882-06,LIDOCAINE 4 % EX CREA,$31.92,$0.00,$31.92,$0.00,$22.78,$0.00,$0.00,$0.00,$0.00,$0.00,$31.92,$0.00,$15.96,$25.28,$25.54,$0.00,$0.00,$0.00,$0.00,$0.00
23461,ERX,HCPCS 25000001,52565-0122-07,LIDOCAINE 4 % EX CREA,$31.92,$0.00,$31.92,$0.00,$22.78,$0.00,$0.00,$0.00,$0.00,$0.00,$31.92,$0.00,$15.96,$25.28,$25.54,$0.00,$0.00,$0.00,$0.00,$0.00
23490,ERX,HCPCS 63700001,13668-0011-01,CITALOPRAM HYDROBROMIDE 40 MG PO TABS,$9.54,$0.00,$9.54,$0.00,$6.81,$0.00,$0.00,$0.00,$0.00,$0.00,$9.54,$0.00,$4.77,$7.56,$7.63,$0.00,$0.00,$0.00,$0.00,$0.00
23599,ERX,HCPCS 63700001,59572-0205-14,THALIDOMIDE 50 MG PO CAPS,$543.47,$0.00,$543.47,$0.00,$387.87,$0.00,$0.00,$0.00,$0.00,$0.00,$543.47,$0.00,$271.74,$430.43,$434.78,$0.00,$0.00,$0.00,$0.00,$0.00
23599,ERX,HCPCS 63700001,59572-0205-94,THALIDOMIDE 50 MG PO CAPS,$543.47,$0.00,$543.47,$0.00,$387.87,$0.00,$0.00,$0.00,$0.00,$0.00,$543.47,$0.00,$271.74,$430.43,$434.78,$0.00,$0.00,$0.00,$0.00,$0.00
23796,ERX,HCPCS J1745,57894-0030-01,INFLIXIMAB 100 MG IV SOLR,"$2,872.83",$0.00,"$2,872.83","$1,292.77","$2,050.34",$632.85,$668.93,$0.00,$0.00,$673.86,"$2,872.83",$664.49,"$1,436.42","$2,275.28","$2,298.26",$917.63,$673.86,$0.00,$641.63,$512.00
23814,ERX,HCPCS 63700001,00173-0675-02,ATOVAQUONE-PROGUANIL HCL 250-100 MG PO TABS,$31.32,$0.00,$31.32,$0.00,$22.35,$0.00,$0.00,$0.00,$0.00,$0.00,$31.32,$0.00,$15.66,$24.81,$25.06,$0.00,$0.00,$0.00,$0.00,$0.00
23814,ERX,HCPCS 63700001,00378-4162-01,ATOVAQUONE-PROGUANIL HCL 250-100 MG PO TABS,$31.32,$0.00,$31.32,$0.00,$22.35,$0.00,$0.00,$0.00,$0.00,$0.00,$31.32,$0.00,$15.66,$24.81,$25.06,$0.00,$0.00,$0.00,$0.00,$0.00
23814,ERX,HCPCS 63700001,68462-0404-01,ATOVAQUONE-PROGUANIL HCL 250-100 MG PO TABS,$31.32,$0.00,$31.32,$0.00,$22.35,$0.00,$0.00,$0.00,$0.00,$0.00,$31.32,$0.00,$15.66,$24.81,$25.06,$0.00,$0.00,$0.00,$0.00,$0.00
23814,ERX,HCPCS 63700001,68462-0404-67,ATOVAQUONE-PROGUANIL HCL 250-100 MG PO TABS,$31.32,$0.00,$31.32,$0.00,$22.35,$0.00,$0.00,$0.00,$0.00,$0.00,$31.32,$0.00,$15.66,$24.81,$25.06,$0.00,$0.00,$0.00,$0.00,$0.00
23872,ERX,HCPCS 63700001,00088-2160-30,LEFLUNOMIDE 10 MG PO TABS,$163.28,$0.00,$163.28,$0.00,$116.53,$0.00,$0.00,$0.00,$0.00,$0.00,$163.28,$0.00,$81.64,$129.32,$130.62,$0.00,$0.00,$0.00,$0.00,$0.00
23872,ERX,HCPCS 63700001,23155-0043-03,LEFLUNOMIDE 10 MG PO TABS,$163.28,$0.00,$163.28,$0.00,$116.53,$0.00,$0.00,$0.00,$0.00,$0.00,$163.28,$0.00,$81.64,$129.32,$130.62,$0.00,$0.00,$0.00,$0.00,$0.00
23872,ERX,HCPCS 63700001,62332-0061-30,LEFLUNOMIDE 10 MG PO TABS,$163.28,$0.00,$163.28,$0.00,$116.53,$0.00,$0.00,$0.00,$0.00,$0.00,$163.28,$0.00,$81.64,$129.32,$130.62,$0.00,$0.00,$0.00,$0.00,$0.00
23873,ERX,HCPCS 63700001,23155-0044-03,LEFLUNOMIDE 20 MG PO TABS,$62.35,$0.00,$62.35,$0.00,$44.50,$0.00,$0.00,$0.00,$0.00,$0.00,$62.35,$0.00,$31.18,$49.38,$49.88,$0.00,$0.00,$0.00,$0.00,$0.00
23873,ERX,HCPCS 63700001,60505-2503-01,LEFLUNOMIDE 20 MG PO TABS,$62.35,$0.00,$62.35,$0.00,$44.50,$0.00,$0.00,$0.00,$0.00,$0.00,$62.35,$0.00,$31.18,$49.38,$49.88,$0.00,$0.00,$0.00,$0.00,$0.00
23873,ERX,HCPCS 63700001,62332-0062-30,LEFLUNOMIDE 20 MG PO TABS,$62.35,$0.00,$62.35,$0.00,$44.50,$0.00,$0.00,$0.00,$0.00,$0.00,$62.35,$0.00,$31.18,$49.38,$49.88,$0.00,$0.00,$0.00,$0.00,$0.00
23876,ERX,HCPCS 25000001,00409-7419-03,DEXTRAN 40 IN SALINE 10-0.9 % IV SOLN,$115.50,$0.00,$115.50,$0.00,$82.43,$0.00,$0.00,$0.00,$0.00,$0.00,$115.50,$0.00,$57.75,$91.48,$92.40,$0.00,$0.00,$0.00,$0.00,$0.00
23898,ERX,HCPCS 63700001,00056-0470-30,EFAVIRENZ 50 MG PO CAPS,$49.72,$0.00,$49.72,$0.00,$35.49,$0.00,$0.00,$0.00,$0.00,$0.00,$49.72,$0.00,$24.86,$39.38,$39.78,$0.00,$0.00,$0.00,$0.00,$0.00
23900,ERX,HCPCS 63700001,00056-0474-92,EFAVIRENZ 200 MG PO CAPS,$49.69,$0.00,$49.69,$0.00,$35.46,$0.00,$0.00,$0.00,$0.00,$0.00,$49.69,$0.00,$24.85,$39.35,$39.75,$0.00,$0.00,$0.00,$0.00,$0.00
23968,ERX,HCPCS 25000001,00004-0298-09,MYCOPHENOLATE MOFETIL HCL 500 MG IV SOLR,$686.74,$0.00,$686.74,$0.00,$490.13,$0.00,$0.00,$0.00,$0.00,$0.00,$686.74,$0.00,$343.37,$543.90,$549.39,$0.00,$0.00,$0.00,$0.00,$0.00
23968,ERX,HCPCS 25000001,17478-0422-40,MYCOPHENOLATE MOFETIL HCL 500 MG IV SOLR,$686.74,$0.00,$686.74,$0.00,$490.13,$0.00,$0.00,$0.00,$0.00,$0.00,$686.74,$0.00,$343.37,$543.90,$549.39,$0.00,$0.00,$0.00,$0.00,$0.00
23968,ERX,HCPCS 25000001,42023-0172-04,MYCOPHENOLATE MOFETIL HCL 500 MG IV SOLR,$686.74,$0.00,$686.74,$0.00,$490.13,$0.00,$0.00,$0.00,$0.00,$0.00,$686.74,$0.00,$343.37,$543.90,$549.39,$0.00,$0.00,$0.00,$0.00,$0.00
24119,ERX,HCPCS 25000001,00597-0047-24,NEVIRAPINE 50 MG/5ML PO SUSP,$623.92,$0.00,$623.92,$0.00,$445.29,$0.00,$0.00,$0.00,$0.00,$0.00,$623.92,$0.00,$311.96,$494.14,$499.14,$0.00,$0.00,$0.00,$0.00,$0.00
24119,ERX,HCPCS 25000001,65862-0057-24,NEVIRAPINE 50 MG/5ML PO SUSP,$623.92,$0.00,$623.92,$0.00,$445.29,$0.00,$0.00,$0.00,$0.00,$0.00,$623.92,$0.00,$311.96,$494.14,$499.14,$0.00,$0.00,$0.00,$0.00,$0.00
24176,ERX,HCPCS 25000001,00054-3566-99,MIDAZOLAM HCL 2 MG/ML PO SYRP,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
24176,ERX,HCPCS 25000001,00574-0150-04,MIDAZOLAM HCL 2 MG/ML PO SYRP,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
24176,ERX,HCPCS 25000001,68094-0762-59,MIDAZOLAM HCL 2 MG/ML PO SYRP,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
24176,ERX,HCPCS 25000001,68094-0762-62,MIDAZOLAM HCL 2 MG/ML PO SYRP,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
24188,ERX,HCPCS 25000001,00006-5424-02,ANTIVENIN LATRODECTUS MACTANS IJ KIT,$116.38,$0.00,$116.38,$0.00,$83.06,$0.00,$0.00,$0.00,$0.00,$0.00,$116.38,$0.00,$58.19,$92.17,$93.10,$0.00,$0.00,$0.00,$0.00,$0.00
24190,ERX,HCPCS 63700001,00224-1801-84,PSYLLIUM 100 % PO PACK,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
24268,ERX,HCPCS 63700001,00143-2260-01,ISOSORBIDE MONONITRATE CR 60 MG PO TB24,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
24268,ERX,HCPCS 63700001,00904-6450-61,ISOSORBIDE MONONITRATE CR 60 MG PO TB24,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
24268,ERX,HCPCS 63700001,13668-0105-01,ISOSORBIDE MONONITRATE CR 60 MG PO TB24,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
24268,ERX,HCPCS 63700001,62175-0119-37,ISOSORBIDE MONONITRATE CR 60 MG PO TB24,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
24268,ERX,HCPCS 63700001,68084-0592-01,ISOSORBIDE MONONITRATE CR 60 MG PO TB24,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
24325,ERX,HCPCS 25000001,57782-0397-26,CROMOLYN SODIUM 5.2 MG/ACT NA AERS,$11.00,$0.00,$11.00,$0.00,$7.85,$0.00,$0.00,$0.00,$0.00,$0.00,$11.00,$0.00,$5.50,$8.71,$8.80,$0.00,$0.00,$0.00,$0.00,$0.00
24384,ERX,HCPCS 63700001,00006-0747-31,LOSARTAN-HCTZ 100-25 MG PO TABS,$25.54,$0.00,$25.54,$0.00,$18.23,$0.00,$0.00,$0.00,$0.00,$0.00,$25.54,$0.00,$12.77,$20.23,$20.43,$0.00,$0.00,$0.00,$0.00,$0.00
24384,ERX,HCPCS 63700001,00093-7368-98,LOSARTAN-HCTZ 100-25 MG PO TABS,$25.54,$0.00,$25.54,$0.00,$18.23,$0.00,$0.00,$0.00,$0.00,$0.00,$25.54,$0.00,$12.77,$20.23,$20.43,$0.00,$0.00,$0.00,$0.00,$0.00
24384,ERX,HCPCS 63700001,16714-0225-01,LOSARTAN-HCTZ 100-25 MG PO TABS,$25.54,$0.00,$25.54,$0.00,$18.23,$0.00,$0.00,$0.00,$0.00,$0.00,$25.54,$0.00,$12.77,$20.23,$20.43,$0.00,$0.00,$0.00,$0.00,$0.00
24384,ERX,HCPCS 63700001,16714-0225-02,LOSARTAN-HCTZ 100-25 MG PO TABS,$25.54,$0.00,$25.54,$0.00,$18.23,$0.00,$0.00,$0.00,$0.00,$0.00,$25.54,$0.00,$12.77,$20.23,$20.43,$0.00,$0.00,$0.00,$0.00,$0.00
24384,ERX,HCPCS 63700001,68180-0217-09,LOSARTAN-HCTZ 100-25 MG PO TABS,$25.54,$0.00,$25.54,$0.00,$18.23,$0.00,$0.00,$0.00,$0.00,$0.00,$25.54,$0.00,$12.77,$20.23,$20.43,$0.00,$0.00,$0.00,$0.00,$0.00
24385,ERX,HCPCS 25000001,50383-0901-10,HYDROCORTISONE-ACETIC ACID 1-2 % OT SOLN,$638.89,$0.00,$638.89,$0.00,$455.98,$0.00,$0.00,$0.00,$0.00,$0.00,$638.89,$0.00,$319.45,$506.00,$511.11,$0.00,$0.00,$0.00,$0.00,$0.00
24398,ERX,HCPCS 63700001,00904-6691-61,METFORMIN HCL 1000 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
24398,ERX,HCPCS 63700001,23155-0104-05,METFORMIN HCL 1000 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
24398,ERX,HCPCS 63700001,57664-0474-53,METFORMIN HCL 1000 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
24398,ERX,HCPCS 63700001,57664-0474-58,METFORMIN HCL 1000 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
24409,ERX,HCPCS J3240,58468-0030-02,THYROTROPIN ALFA 1.1 MG IM SOLR,"$3,657.89",$0.00,"$3,657.89","$1,646.05","$2,610.64",$0.00,"$1,135.46",$0.00,$0.00,"$1,997.98","$3,657.89","$1,779.87","$1,828.95","$2,897.05","$2,926.31","$2,457.92","$1,997.98",$0.00,$0.00,$0.00
24435,ERX,HCPCS J2353,00078-0818-81,OCTREOTIDE ACETATE 20 MG IM KIT,"$8,697.31",$0.00,"$8,697.31","$3,913.79","$5,158.80",$0.00,"$1,498.50",$0.00,$0.00,"$4,843.12","$8,697.31","$4,337.87","$4,348.66","$6,888.27","$6,957.85","$5,990.39","$4,843.12",$0.00,$0.00,$0.00
24438,ERX,HCPCS 63700001,00378-4105-91,ABACAVIR SULFATE 300 MG PO TABS,$38.18,$0.00,$38.18,$0.00,$27.25,$0.00,$0.00,$0.00,$0.00,$0.00,$38.18,$0.00,$19.09,$30.24,$30.54,$0.00,$0.00,$0.00,$0.00,$0.00
24438,ERX,HCPCS 63700001,31722-0557-60,ABACAVIR SULFATE 300 MG PO TABS,$38.18,$0.00,$38.18,$0.00,$27.25,$0.00,$0.00,$0.00,$0.00,$0.00,$38.18,$0.00,$19.09,$30.24,$30.54,$0.00,$0.00,$0.00,$0.00,$0.00
24438,ERX,HCPCS 63700001,60505-3583-06,ABACAVIR SULFATE 300 MG PO TABS,$38.18,$0.00,$38.18,$0.00,$27.25,$0.00,$0.00,$0.00,$0.00,$0.00,$38.18,$0.00,$19.09,$30.24,$30.54,$0.00,$0.00,$0.00,$0.00,$0.00
24438,ERX,HCPCS 63700001,64380-0717-03,ABACAVIR SULFATE 300 MG PO TABS,$38.18,$0.00,$38.18,$0.00,$27.25,$0.00,$0.00,$0.00,$0.00,$0.00,$38.18,$0.00,$19.09,$30.24,$30.54,$0.00,$0.00,$0.00,$0.00,$0.00
24438,ERX,HCPCS 63700001,65862-0073-60,ABACAVIR SULFATE 300 MG PO TABS,$38.18,$0.00,$38.18,$0.00,$27.25,$0.00,$0.00,$0.00,$0.00,$0.00,$38.18,$0.00,$19.09,$30.24,$30.54,$0.00,$0.00,$0.00,$0.00,$0.00
24438,ERX,HCPCS 63700001,69097-0514-03,ABACAVIR SULFATE 300 MG PO TABS,$38.18,$0.00,$38.18,$0.00,$27.25,$0.00,$0.00,$0.00,$0.00,$0.00,$38.18,$0.00,$19.09,$30.24,$30.54,$0.00,$0.00,$0.00,$0.00,$0.00
24439,ERX,HCPCS 63700001,99999-6005-00,ABACAVIR SULFATE 20 MG/ML PO SOLN,$277.46,$0.00,$277.46,$0.00,$198.02,$0.00,$0.00,$0.00,$0.00,$0.00,$277.46,$0.00,$138.73,$219.75,$221.97,$0.00,$0.00,$0.00,$0.00,$0.00
24439,ERX,HCPCS 63700001,31722-0562-24,ABACAVIR SULFATE 20 MG/ML PO SOLN,$537.29,$0.00,$425.53,$0.00,$198.02,$0.00,$0.00,$0.00,$0.00,$0.00,$277.46,$0.00,$138.73,$425.53,$221.97,$0.00,$0.00,$0.00,$0.00,$0.00
24439,ERX,HCPCS 63700001,49702-0222-48,ABACAVIR SULFATE 20 MG/ML PO SOLN,$537.29,$0.00,$425.53,$0.00,$198.02,$0.00,$0.00,$0.00,$0.00,$0.00,$277.46,$0.00,$138.73,$425.53,$221.97,$0.00,$0.00,$0.00,$0.00,$0.00
24467,ERX,HCPCS 25000001,99999-6007-34,VITAMIN E 15 UNIT/0.3ML PO SOLN,$61.56,$0.00,$61.56,$0.00,$43.94,$0.00,$0.00,$0.00,$0.00,$0.00,$61.56,$0.00,$30.78,$48.76,$49.25,$0.00,$0.00,$0.00,$0.00,$0.00
24467,ERX,HCPCS 25000001,54838-0005-30,VITAMIN E 15 UNIT/0.3ML PO SOLN,$141.75,$0.00,$112.27,$0.00,$43.94,$0.00,$0.00,$0.00,$0.00,$0.00,$61.56,$0.00,$30.78,$112.27,$49.25,$0.00,$0.00,$0.00,$0.00,$0.00
24473,ERX,HCPCS 63700001,00093-2065-06,CILOSTAZOL 50 MG PO TABS,$6.94,$0.00,$6.94,$0.00,$4.95,$0.00,$0.00,$0.00,$0.00,$0.00,$6.94,$0.00,$3.47,$5.50,$5.55,$0.00,$0.00,$0.00,$0.00,$0.00
24473,ERX,HCPCS 63700001,00185-0123-60,CILOSTAZOL 50 MG PO TABS,$6.94,$0.00,$6.94,$0.00,$4.95,$0.00,$0.00,$0.00,$0.00,$0.00,$6.94,$0.00,$3.47,$5.50,$5.55,$0.00,$0.00,$0.00,$0.00,$0.00
24474,ERX,HCPCS 63700001,00093-2064-06,CILOSTAZOL 100 MG PO TABS,$6.94,$0.00,$6.94,$0.00,$4.95,$0.00,$0.00,$0.00,$0.00,$0.00,$6.94,$0.00,$3.47,$5.50,$5.55,$0.00,$0.00,$0.00,$0.00,$0.00
24500,ERX,HCPCS 63700001,00025-1520-34,CELECOXIB 100 MG PO CAPS,$17.56,$0.00,$17.56,$0.00,$12.53,$0.00,$0.00,$0.00,$0.00,$0.00,$17.56,$0.00,$8.78,$13.91,$14.05,$0.00,$0.00,$0.00,$0.00,$0.00
24500,ERX,HCPCS 63700001,00904-6502-61,CELECOXIB 100 MG PO CAPS,$17.56,$0.00,$17.56,$0.00,$12.53,$0.00,$0.00,$0.00,$0.00,$0.00,$17.56,$0.00,$8.78,$13.91,$14.05,$0.00,$0.00,$0.00,$0.00,$0.00
24500,ERX,HCPCS 63700001,16714-0732-01,CELECOXIB 100 MG PO CAPS,$17.56,$0.00,$17.56,$0.00,$12.53,$0.00,$0.00,$0.00,$0.00,$0.00,$17.56,$0.00,$8.78,$13.91,$14.05,$0.00,$0.00,$0.00,$0.00,$0.00
24500,ERX,HCPCS 63700001,60687-0436-01,CELECOXIB 100 MG PO CAPS,$17.56,$0.00,$17.56,$0.00,$12.53,$0.00,$0.00,$0.00,$0.00,$0.00,$17.56,$0.00,$8.78,$13.91,$14.05,$0.00,$0.00,$0.00,$0.00,$0.00
24501,ERX,HCPCS 63700001,33342-0157-11,CELECOXIB 200 MG PO CAPS,$28.77,$0.00,$28.77,$0.00,$20.53,$0.00,$0.00,$0.00,$0.00,$0.00,$28.77,$0.00,$14.39,$22.79,$23.02,$0.00,$0.00,$0.00,$0.00,$0.00
24501,ERX,HCPCS 63700001,65862-0909-01,CELECOXIB 200 MG PO CAPS,$28.77,$0.00,$28.77,$0.00,$20.53,$0.00,$0.00,$0.00,$0.00,$0.00,$28.77,$0.00,$14.39,$22.79,$23.02,$0.00,$0.00,$0.00,$0.00,$0.00
24513,ERX,HCPCS J0885,59676-0340-01,EPOETIN ALFA 40000 UNIT/ML IJ SOLN,"$2,629.74",$0.00,"$2,629.74","$1,427.95",$0.00,$441.24,$432.40,$0.00,$0.00,$460.45,"$2,629.74",$463.30,"$1,314.87","$2,082.75","$2,103.79",$639.80,$411.55,$0.00,$472.58,$387.84
24521,ERX,HCPCS 63700001,00143-2230-01,ISOSORBIDE MONONITRATE ER 30 MG PO TB24,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
24521,ERX,HCPCS 63700001,00904-6449-61,ISOSORBIDE MONONITRATE ER 30 MG PO TB24,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
24521,ERX,HCPCS 63700001,13668-0104-01,ISOSORBIDE MONONITRATE ER 30 MG PO TB24,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
24521,ERX,HCPCS 63700001,62175-0128-37,ISOSORBIDE MONONITRATE ER 30 MG PO TB24,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
24521,ERX,HCPCS 63700001,68084-0591-01,ISOSORBIDE MONONITRATE ER 30 MG PO TB24,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
24521,ERX,HCPCS 63700001,68084-0591-11,ISOSORBIDE MONONITRATE ER 30 MG PO TB24,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
24585,ERX,HCPCS J7511,58468-0080-01,ANTI-THYMOCYTE GLOB (RABBIT) 25 MG IV SOLR,"$2,152.71",$0.00,"$2,152.71",$0.00,"$1,536.39",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,152.71",$0.00,"$1,076.36","$1,704.95","$1,722.17",$0.00,$0.00,$0.00,$0.00,$0.00
24702,ERX,HCPCS 63700001,49884-0534-11,MODAFINIL 100 MG PO TABS,$92.32,$0.00,$92.32,$0.00,$65.89,$0.00,$0.00,$0.00,$0.00,$0.00,$92.32,$0.00,$46.16,$73.12,$73.86,$0.00,$0.00,$0.00,$0.00,$0.00
24702,ERX,HCPCS 63700001,60505-2526-03,MODAFINIL 100 MG PO TABS,$92.32,$0.00,$92.32,$0.00,$65.89,$0.00,$0.00,$0.00,$0.00,$0.00,$92.32,$0.00,$46.16,$73.12,$73.86,$0.00,$0.00,$0.00,$0.00,$0.00
24702,ERX,HCPCS 63700001,65862-0601-30,MODAFINIL 100 MG PO TABS,$92.32,$0.00,$92.32,$0.00,$65.89,$0.00,$0.00,$0.00,$0.00,$0.00,$92.32,$0.00,$46.16,$73.12,$73.86,$0.00,$0.00,$0.00,$0.00,$0.00
24711,ERX,HCPCS 63700001,68180-0518-01,LISINOPRIL-HCTZ 10-12.5 MG TABLET,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
24711,ERX,HCPCS 63700001,68180-0518-02,LISINOPRIL-HCTZ 10-12.5 MG TABLET,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
24914,ERX,HCPCS 63700001,00781-2102-01,TACROLIMUS 0.5 MG PO CAPS,$8.48,$0.00,$8.48,$0.00,$6.05,$0.00,$0.00,$0.00,$0.00,$0.00,$8.48,$0.00,$4.24,$6.72,$6.78,$0.00,$0.00,$0.00,$0.00,$0.00
24914,ERX,HCPCS 63700001,16729-0041-01,TACROLIMUS 0.5 MG PO CAPS,$8.48,$0.00,$8.48,$0.00,$6.05,$0.00,$0.00,$0.00,$0.00,$0.00,$8.48,$0.00,$4.24,$6.72,$6.78,$0.00,$0.00,$0.00,$0.00,$0.00
24914,ERX,HCPCS 63700001,51079-0817-01,TACROLIMUS 0.5 MG PO CAPS,$8.48,$0.00,$8.48,$0.00,$6.05,$0.00,$0.00,$0.00,$0.00,$0.00,$8.48,$0.00,$4.24,$6.72,$6.78,$0.00,$0.00,$0.00,$0.00,$0.00
24914,ERX,HCPCS 63700001,51079-0817-20,TACROLIMUS 0.5 MG PO CAPS,$8.48,$0.00,$8.48,$0.00,$6.05,$0.00,$0.00,$0.00,$0.00,$0.00,$8.48,$0.00,$4.24,$6.72,$6.78,$0.00,$0.00,$0.00,$0.00,$0.00
24914,ERX,HCPCS 63700001,68084-0449-01,TACROLIMUS 0.5 MG PO CAPS,$8.48,$0.00,$8.48,$0.00,$6.05,$0.00,$0.00,$0.00,$0.00,$0.00,$8.48,$0.00,$4.24,$6.72,$6.78,$0.00,$0.00,$0.00,$0.00,$0.00
24915,ERX,HCPCS 25000001,00378-9691-52,LEVALBUTEROL HCL 0.63 MG/3ML IN NEBU,$7.61,$0.00,$7.61,$0.00,$5.43,$0.00,$0.00,$0.00,$0.00,$0.00,$7.61,$0.00,$3.81,$6.03,$6.09,$0.00,$0.00,$0.00,$0.00,$0.00
24915,ERX,HCPCS 25000001,00378-9691-62,LEVALBUTEROL HCL 0.63 MG/3ML IN NEBU,$7.61,$0.00,$7.61,$0.00,$5.43,$0.00,$0.00,$0.00,$0.00,$0.00,$7.61,$0.00,$3.81,$6.03,$6.09,$0.00,$0.00,$0.00,$0.00,$0.00
24915,ERX,HCPCS 25000001,43598-0410-25,LEVALBUTEROL HCL 0.63 MG/3ML IN NEBU,$7.61,$0.00,$7.61,$0.00,$5.43,$0.00,$0.00,$0.00,$0.00,$0.00,$7.61,$0.00,$3.81,$6.03,$6.09,$0.00,$0.00,$0.00,$0.00,$0.00
24915,ERX,HCPCS 25000001,66993-0022-27,LEVALBUTEROL HCL 0.63 MG/3ML IN NEBU,$7.61,$0.00,$7.61,$0.00,$5.43,$0.00,$0.00,$0.00,$0.00,$0.00,$7.61,$0.00,$3.81,$6.03,$6.09,$0.00,$0.00,$0.00,$0.00,$0.00
24915,ERX,HCPCS 25000001,76204-0800-01,LEVALBUTEROL HCL 0.63 MG/3ML IN NEBU,$7.61,$0.00,$7.61,$0.00,$5.43,$0.00,$0.00,$0.00,$0.00,$0.00,$7.61,$0.00,$3.81,$6.03,$6.09,$0.00,$0.00,$0.00,$0.00,$0.00
24915,ERX,HCPCS 25000001,76204-0800-11,LEVALBUTEROL HCL 0.63 MG/3ML IN NEBU,$7.61,$0.00,$7.61,$0.00,$5.43,$0.00,$0.00,$0.00,$0.00,$0.00,$7.61,$0.00,$3.81,$6.03,$6.09,$0.00,$0.00,$0.00,$0.00,$0.00
24916,ERX,HCPCS J7614,43598-0409-25,LEVALBUTEROL HCL 1.25 MG/3ML IN NEBU,$24.47,$0.00,$24.47,$0.00,$17.46,$0.00,$0.00,$0.00,$0.00,$0.00,$24.47,$0.00,$12.24,$19.38,$19.58,$0.00,$0.00,$0.00,$0.00,$0.00
24916,ERX,HCPCS J7614,76204-0900-01,LEVALBUTEROL HCL 1.25 MG/3ML IN NEBU,$24.47,$0.00,$24.47,$0.00,$17.46,$0.00,$0.00,$0.00,$0.00,$0.00,$24.47,$0.00,$12.24,$19.38,$19.58,$0.00,$0.00,$0.00,$0.00,$0.00
24932,ERX,HCPCS J2916,00024-2792-10,NA FERRIC GLUC CPLX IN SUCROSE 12.5 MG/ML IV SOLN,$133.56,$0.00,$133.56,$60.10,$95.32,$0.00,$27.85,$0.00,$0.00,$11.69,$133.56,$0.00,$66.78,$105.78,$106.85,$0.00,$11.69,$0.00,$11.13,$0.00
24932,ERX,HCPCS J2916,00143-9298-01,NA FERRIC GLUC CPLX IN SUCROSE 12.5 MG/ML IV SOLN,$133.56,$0.00,$133.56,$60.10,$95.32,$0.00,$27.85,$0.00,$0.00,$11.69,$133.56,$0.00,$66.78,$105.78,$106.85,$0.00,$11.69,$0.00,$11.13,$0.00
24932,ERX,HCPCS J2916,00143-9298-10,NA FERRIC GLUC CPLX IN SUCROSE 12.5 MG/ML IV SOLN,$133.56,$0.00,$133.56,$60.10,$95.32,$0.00,$27.85,$0.00,$0.00,$11.69,$133.56,$0.00,$66.78,$105.78,$106.85,$0.00,$11.69,$0.00,$11.13,$0.00
24932,ERX,HCPCS J2916,00143-9570-10,NA FERRIC GLUC CPLX IN SUCROSE 12.5 MG/ML IV SOLN,$133.56,$0.00,$133.56,$60.10,$95.32,$0.00,$27.85,$0.00,$0.00,$11.69,$133.56,$0.00,$66.78,$105.78,$106.85,$0.00,$11.69,$0.00,$11.13,$0.00
24945,ERX,HCPCS 63700001,13107-0032-34,MIRTAZAPINE 45 MG PO TABS,$10.83,$0.00,$10.83,$0.00,$7.73,$0.00,$0.00,$0.00,$0.00,$0.00,$10.83,$0.00,$5.42,$8.58,$8.66,$0.00,$0.00,$0.00,$0.00,$0.00
24945,ERX,HCPCS 63700001,51079-0088-01,MIRTAZAPINE 45 MG PO TABS,$10.83,$0.00,$10.83,$0.00,$7.73,$0.00,$0.00,$0.00,$0.00,$0.00,$10.83,$0.00,$5.42,$8.58,$8.66,$0.00,$0.00,$0.00,$0.00,$0.00
24945,ERX,HCPCS 63700001,51079-0088-20,MIRTAZAPINE 45 MG PO TABS,$10.83,$0.00,$10.83,$0.00,$7.73,$0.00,$0.00,$0.00,$0.00,$0.00,$10.83,$0.00,$5.42,$8.58,$8.66,$0.00,$0.00,$0.00,$0.00,$0.00
24945,ERX,HCPCS 63700001,60505-0249-01,MIRTAZAPINE 45 MG PO TABS,$10.83,$0.00,$10.83,$0.00,$7.73,$0.00,$0.00,$0.00,$0.00,$0.00,$10.83,$0.00,$5.42,$8.58,$8.66,$0.00,$0.00,$0.00,$0.00,$0.00
24945,ERX,HCPCS 63700001,68084-0121-01,MIRTAZAPINE 45 MG PO TABS,$10.83,$0.00,$10.83,$0.00,$7.73,$0.00,$0.00,$0.00,$0.00,$0.00,$10.83,$0.00,$5.42,$8.58,$8.66,$0.00,$0.00,$0.00,$0.00,$0.00
25005,ERX,HCPCS J7517,00004-0261-29,MYCOPHENOLATE MOFETIL 200 MG/ML PO SUSR,$43.04,$0.00,$43.04,$19.37,$30.72,$0.00,$7.42,$0.00,$0.00,$7.54,$43.04,$0.00,$21.52,$34.09,$34.43,$0.00,$6.74,$0.00,$6.85,$0.00
25005,ERX,HCPCS J7517,67877-0230-22,MYCOPHENOLATE MOFETIL 200 MG/ML PO SUSR,$43.04,$0.00,$43.04,$19.37,$30.72,$0.00,$7.42,$0.00,$0.00,$7.54,$43.04,$0.00,$21.52,$34.09,$34.43,$0.00,$6.74,$0.00,$6.85,$0.00
25118,ERX,HCPCS 63700001,00143-9927-01,CIPROFLOXACIN HCL 250 MG PO TABS,$17.23,$0.00,$17.23,$0.00,$12.30,$0.00,$0.00,$0.00,$0.00,$0.00,$17.23,$0.00,$8.62,$13.65,$13.78,$0.00,$0.00,$0.00,$0.00,$0.00
25118,ERX,HCPCS 63700001,16714-0651-02,CIPROFLOXACIN HCL 250 MG PO TABS,$17.23,$0.00,$17.23,$0.00,$12.30,$0.00,$0.00,$0.00,$0.00,$0.00,$17.23,$0.00,$8.62,$13.65,$13.78,$0.00,$0.00,$0.00,$0.00,$0.00
25118,ERX,HCPCS 63700001,55111-0126-01,CIPROFLOXACIN HCL 250 MG PO TABS,$17.23,$0.00,$17.23,$0.00,$12.30,$0.00,$0.00,$0.00,$0.00,$0.00,$17.23,$0.00,$8.62,$13.65,$13.78,$0.00,$0.00,$0.00,$0.00,$0.00
25118,ERX,HCPCS 63700001,63739-0700-10,CIPROFLOXACIN HCL 250 MG PO TABS,$17.23,$0.00,$17.23,$0.00,$12.30,$0.00,$0.00,$0.00,$0.00,$0.00,$17.23,$0.00,$8.62,$13.65,$13.78,$0.00,$0.00,$0.00,$0.00,$0.00
25119,ERX,HCPCS 63700001,16714-0652-02,CIPROFLOXACIN HCL 500 MG PO TABS,$12.08,$0.00,$12.08,$0.00,$8.62,$0.00,$0.00,$0.00,$0.00,$0.00,$12.08,$0.00,$6.04,$9.57,$9.66,$0.00,$0.00,$0.00,$0.00,$0.00
25119,ERX,HCPCS 63700001,63739-0559-10,CIPROFLOXACIN HCL 500 MG PO TABS,$12.08,$0.00,$12.08,$0.00,$8.62,$0.00,$0.00,$0.00,$0.00,$0.00,$12.08,$0.00,$6.04,$9.57,$9.66,$0.00,$0.00,$0.00,$0.00,$0.00
25119,ERX,HCPCS 63700001,68084-0070-01,CIPROFLOXACIN HCL 500 MG PO TABS,$12.08,$0.00,$12.08,$0.00,$8.62,$0.00,$0.00,$0.00,$0.00,$0.00,$12.08,$0.00,$6.04,$9.57,$9.66,$0.00,$0.00,$0.00,$0.00,$0.00
25119,ERX,HCPCS 63700001,68084-0070-11,CIPROFLOXACIN HCL 500 MG PO TABS,$12.08,$0.00,$12.08,$0.00,$8.62,$0.00,$0.00,$0.00,$0.00,$0.00,$12.08,$0.00,$6.04,$9.57,$9.66,$0.00,$0.00,$0.00,$0.00,$0.00
25120,ERX,HCPCS 63700001,16571-0413-05,CIPROFLOXACIN HCL 750 MG PO TABS,$29.11,$0.00,$29.11,$0.00,$20.78,$0.00,$0.00,$0.00,$0.00,$0.00,$29.11,$0.00,$14.56,$23.06,$23.29,$0.00,$0.00,$0.00,$0.00,$0.00
25120,ERX,HCPCS 63700001,16714-0653-01,CIPROFLOXACIN HCL 750 MG PO TABS,$29.11,$0.00,$29.11,$0.00,$20.78,$0.00,$0.00,$0.00,$0.00,$0.00,$29.11,$0.00,$14.56,$23.06,$23.29,$0.00,$0.00,$0.00,$0.00,$0.00
25120,ERX,HCPCS 63700001,68084-0071-01,CIPROFLOXACIN HCL 750 MG PO TABS,$29.11,$0.00,$29.11,$0.00,$20.78,$0.00,$0.00,$0.00,$0.00,$0.00,$29.11,$0.00,$14.56,$23.06,$23.29,$0.00,$0.00,$0.00,$0.00,$0.00
25174,ERX,HCPCS 25000001,00264-1965-10,HETASTARCH-NACL 6-0.9 % IV SOLN,$71.75,$0.00,$71.75,$0.00,$51.21,$0.00,$0.00,$0.00,$0.00,$0.00,$71.75,$0.00,$35.88,$56.83,$57.40,$0.00,$0.00,$0.00,$0.00,$0.00
25238,ERX,HCPCS 63700001,00378-6320-01,VERAPAMIL HCL CR 120 MG PO CP24,$6.64,$0.00,$6.64,$0.00,$4.74,$0.00,$0.00,$0.00,$0.00,$0.00,$6.64,$0.00,$3.32,$5.26,$5.31,$0.00,$0.00,$0.00,$0.00,$0.00
25238,ERX,HCPCS 63700001,00591-2880-01,VERAPAMIL HCL CR 120 MG PO CP24,$6.64,$0.00,$6.64,$0.00,$4.74,$0.00,$0.00,$0.00,$0.00,$0.00,$6.64,$0.00,$3.32,$5.26,$5.31,$0.00,$0.00,$0.00,$0.00,$0.00
25246,ERX,HCPCS 25000001,00143-9887-50,AMOXICILLIN 400 MG/5ML PO SUSR,$18.62,$0.00,$37.24,$0.00,$26.58,$0.00,$0.00,$0.00,$0.00,$0.00,$37.24,$0.00,$18.62,$14.75,$29.79,$0.00,$0.00,$0.00,$0.00,$0.00
25246,ERX,HCPCS 25000001,00781-6157-52,AMOXICILLIN 400 MG/5ML PO SUSR,$18.62,$0.00,$37.24,$0.00,$26.58,$0.00,$0.00,$0.00,$0.00,$0.00,$37.24,$0.00,$18.62,$14.75,$29.79,$0.00,$0.00,$0.00,$0.00,$0.00
25246,ERX,HCPCS 25000001,00093-4161-73,AMOXICILLIN 400 MG/5ML PO SUSR,$37.24,$0.00,$37.24,$0.00,$26.58,$0.00,$0.00,$0.00,$0.00,$0.00,$37.24,$0.00,$18.62,$29.49,$29.79,$0.00,$0.00,$0.00,$0.00,$0.00
25246,ERX,HCPCS 25000001,00143-9887-01,AMOXICILLIN 400 MG/5ML PO SUSR,$37.24,$0.00,$37.24,$0.00,$26.58,$0.00,$0.00,$0.00,$0.00,$0.00,$37.24,$0.00,$18.62,$29.49,$29.79,$0.00,$0.00,$0.00,$0.00,$0.00
25246,ERX,HCPCS 25000001,00781-6157-46,AMOXICILLIN 400 MG/5ML PO SUSR,$37.24,$0.00,$37.24,$0.00,$26.58,$0.00,$0.00,$0.00,$0.00,$0.00,$37.24,$0.00,$18.62,$29.49,$29.79,$0.00,$0.00,$0.00,$0.00,$0.00
25354,ERX,HCPCS 63700001,00955-1722-50,DOXERCALCIFEROL 2.5 MCG PO CAPS,$141.43,$0.00,$141.43,$0.00,$100.94,$0.00,$0.00,$0.00,$0.00,$0.00,$141.43,$0.00,$70.72,$112.01,$113.14,$0.00,$0.00,$0.00,$0.00,$0.00
25408,ERX,HCPCS 25000001,67457-0187-50,ALLOPURINOL SODIUM 500 MG IV SOLR,"$9,808.17",$0.00,"$9,808.17",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$9,808.17",$0.00,"$4,904.09","$7,768.07","$7,846.54",$0.00,$0.00,$0.00,$0.00,$0.00
25471,ERX,HCPCS 25000001,24208-0601-10,KETOTIFEN FUMARATE 0.025 % OP SOLN,$39.37,$0.00,$39.37,$0.00,$28.10,$0.00,$0.00,$0.00,$0.00,$0.00,$39.37,$0.00,$19.69,$31.18,$31.50,$0.00,$0.00,$0.00,$0.00,$0.00
25471,ERX,HCPCS 25000001,17478-0717-10,KETOTIFEN FUMARATE 0.025 % OP SOLN,$46.33,$0.00,$39.37,$0.00,$28.10,$0.00,$0.00,$0.00,$0.00,$0.00,$39.37,$0.00,$19.69,$36.69,$31.50,$0.00,$0.00,$0.00,$0.00,$0.00
25471,ERX,HCPCS 25000001,49348-0107-17,KETOTIFEN FUMARATE 0.025 % OP SOLN,$46.33,$0.00,$39.37,$0.00,$28.10,$0.00,$0.00,$0.00,$0.00,$0.00,$39.37,$0.00,$19.69,$36.69,$31.50,$0.00,$0.00,$0.00,$0.00,$0.00
25518,ERX,HCPCS 25000001,63323-0011-15,CHLORAMPHENICOL SOD SUCCINATE 1 G IV SOLR,$163.47,$0.00,$163.47,$0.00,$116.67,$0.00,$0.00,$0.00,$0.00,$0.00,$163.47,$0.00,$81.74,$129.47,$130.78,$0.00,$0.00,$0.00,$0.00,$0.00
25519,ERX,HCPCS 63700001,00904-6357-61,RISPERIDONE 0.25 MG PO TABS,$13.61,$0.00,$13.61,$0.00,$9.71,$0.00,$0.00,$0.00,$0.00,$0.00,$13.61,$0.00,$6.81,$10.78,$10.89,$0.00,$0.00,$0.00,$0.00,$0.00
25520,ERX,HCPCS 63700001,00904-6358-61,RISPERIDONE 0.5 MG PO TABS,$16.24,$0.00,$16.24,$0.00,$11.59,$0.00,$0.00,$0.00,$0.00,$0.00,$16.24,$0.00,$8.12,$12.86,$12.99,$0.00,$0.00,$0.00,$0.00,$0.00
25520,ERX,HCPCS 63700001,68084-0271-01,RISPERIDONE 0.5 MG PO TABS,$16.24,$0.00,$16.24,$0.00,$11.59,$0.00,$0.00,$0.00,$0.00,$0.00,$16.24,$0.00,$8.12,$12.86,$12.99,$0.00,$0.00,$0.00,$0.00,$0.00
25528,ERX,HCPCS 63700001,33342-0054-07,PIOGLITAZONE HCL 15 MG PO TABS,$59.07,$0.00,$59.07,$0.00,$42.16,$0.00,$0.00,$0.00,$0.00,$0.00,$59.07,$0.00,$29.54,$46.78,$47.26,$0.00,$0.00,$0.00,$0.00,$0.00
25528,ERX,HCPCS 63700001,33342-0054-10,PIOGLITAZONE HCL 15 MG PO TABS,$59.07,$0.00,$59.07,$0.00,$42.16,$0.00,$0.00,$0.00,$0.00,$0.00,$59.07,$0.00,$29.54,$46.78,$47.26,$0.00,$0.00,$0.00,$0.00,$0.00
25528,ERX,HCPCS 63700001,64764-0151-04,PIOGLITAZONE HCL 15 MG PO TABS,$59.07,$0.00,$59.07,$0.00,$42.16,$0.00,$0.00,$0.00,$0.00,$0.00,$59.07,$0.00,$29.54,$46.78,$47.26,$0.00,$0.00,$0.00,$0.00,$0.00
25528,ERX,HCPCS 63700001,65862-0512-90,PIOGLITAZONE HCL 15 MG PO TABS,$59.07,$0.00,$59.07,$0.00,$42.16,$0.00,$0.00,$0.00,$0.00,$0.00,$59.07,$0.00,$29.54,$46.78,$47.26,$0.00,$0.00,$0.00,$0.00,$0.00
25798,ERX,HCPCS 25000001,00264-9341-55,TROPHAMINE 10 % IV SOLN,$148.75,$0.00,$148.75,$0.00,$106.16,$0.00,$0.00,$0.00,$0.00,$0.00,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$0.00,$0.00,$0.00,$0.00
25820,ERX,HCPCS 63700001,00006-0032-20,IVERMECTIN 3 MG PO TABS,$21.22,$0.00,$21.22,$0.00,$15.14,$0.00,$0.00,$0.00,$0.00,$0.00,$21.22,$0.00,$10.61,$16.81,$16.98,$0.00,$0.00,$0.00,$0.00,$0.00
25820,ERX,HCPCS 63700001,42799-0806-01,IVERMECTIN 3 MG PO TABS,$21.22,$0.00,$21.22,$0.00,$15.14,$0.00,$0.00,$0.00,$0.00,$0.00,$21.22,$0.00,$10.61,$16.81,$16.98,$0.00,$0.00,$0.00,$0.00,$0.00
25855,ERX,HCPCS 63700001,50268-0351-15,GABAPENTIN 600 MG PO TABS,$9.58,$0.00,$9.58,$0.00,$6.84,$0.00,$0.00,$0.00,$0.00,$0.00,$9.58,$0.00,$4.79,$7.59,$7.66,$0.00,$0.00,$0.00,$0.00,$0.00
25855,ERX,HCPCS 63700001,58657-0623-01,GABAPENTIN 600 MG PO TABS,$9.58,$0.00,$9.58,$0.00,$6.84,$0.00,$0.00,$0.00,$0.00,$0.00,$9.58,$0.00,$4.79,$7.59,$7.66,$0.00,$0.00,$0.00,$0.00,$0.00
25855,ERX,HCPCS 63700001,63739-0560-10,GABAPENTIN 600 MG PO TABS,$9.58,$0.00,$9.58,$0.00,$6.84,$0.00,$0.00,$0.00,$0.00,$0.00,$9.58,$0.00,$4.79,$7.59,$7.66,$0.00,$0.00,$0.00,$0.00,$0.00
25856,ERX,HCPCS 63700001,00228-2637-11,GABAPENTIN 800 MG PO TABS,$11.56,$0.00,$11.56,$0.00,$8.25,$0.00,$0.00,$0.00,$0.00,$0.00,$11.56,$0.00,$5.78,$9.16,$9.25,$0.00,$0.00,$0.00,$0.00,$0.00
25856,ERX,HCPCS 63700001,00904-6586-61,GABAPENTIN 800 MG PO TABS,$11.56,$0.00,$11.56,$0.00,$8.25,$0.00,$0.00,$0.00,$0.00,$0.00,$11.56,$0.00,$5.78,$9.16,$9.25,$0.00,$0.00,$0.00,$0.00,$0.00
25856,ERX,HCPCS 63700001,16714-0332-01,GABAPENTIN 800 MG PO TABS,$11.56,$0.00,$11.56,$0.00,$8.25,$0.00,$0.00,$0.00,$0.00,$0.00,$11.56,$0.00,$5.78,$9.16,$9.25,$0.00,$0.00,$0.00,$0.00,$0.00
25856,ERX,HCPCS 63700001,16714-0332-02,GABAPENTIN 800 MG PO TABS,$11.56,$0.00,$11.56,$0.00,$8.25,$0.00,$0.00,$0.00,$0.00,$0.00,$11.56,$0.00,$5.78,$9.16,$9.25,$0.00,$0.00,$0.00,$0.00,$0.00
25892,ERX,HCPCS J8700,00085-3004-03,TEMOZOLOMIDE 5 MG PO CAPS,$95.68,$0.00,$95.68,$0.00,$68.29,$0.00,$0.00,$0.00,$0.00,$0.00,$95.68,$0.00,$47.84,$75.78,$76.54,$0.00,$0.00,$0.00,$0.00,$0.00
25892,ERX,HCPCS J8700,00085-3004-04,TEMOZOLOMIDE 5 MG PO CAPS,$95.68,$0.00,$95.68,$0.00,$68.29,$0.00,$0.00,$0.00,$0.00,$0.00,$95.68,$0.00,$47.84,$75.78,$76.54,$0.00,$0.00,$0.00,$0.00,$0.00
25893,ERX,HCPCS J8700,65162-0802-51,TEMOZOLOMIDE 20 MG PO CAPS,$181.33,$0.00,$181.33,$0.00,$129.42,$0.00,$0.00,$0.00,$0.00,$0.00,$181.33,$0.00,$90.67,$143.61,$145.06,$0.00,$0.00,$0.00,$0.00,$0.00
25894,ERX,HCPCS J8700,16729-0050-53,TEMOZOLOMIDE 100 MG PO CAPS,$762.57,$0.00,$762.57,$0.00,$544.25,$0.00,$0.00,$0.00,$0.00,$0.00,$762.57,$0.00,$381.29,$603.96,$610.06,$0.00,$0.00,$0.00,$0.00,$0.00
25895,ERX,HCPCS J8700,65162-0806-51,TEMOZOLOMIDE 250 MG PO CAPS,"$1,727.04",$0.00,"$1,727.04",$0.00,"$1,232.59",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,727.04",$0.00,$863.52,"$1,367.82","$1,381.63",$0.00,$0.00,$0.00,$0.00,$0.00
26224,ERX,HCPCS 63700001,50268-0636-15,PANTOPRAZOLE SODIUM 20 MG PO TBEC,$15.15,$0.00,$15.15,$0.00,$10.81,$0.00,$0.00,$0.00,$0.00,$0.00,$15.15,$0.00,$7.58,$12.00,$12.12,$0.00,$0.00,$0.00,$0.00,$0.00
26224,ERX,HCPCS 63700001,65862-0559-90,PANTOPRAZOLE SODIUM 20 MG PO TBEC,$15.15,$0.00,$15.15,$0.00,$10.81,$0.00,$0.00,$0.00,$0.00,$0.00,$15.15,$0.00,$7.58,$12.00,$12.12,$0.00,$0.00,$0.00,$0.00,$0.00
26224,ERX,HCPCS 63700001,68084-0643-01,PANTOPRAZOLE SODIUM 20 MG PO TBEC,$15.15,$0.00,$15.15,$0.00,$10.81,$0.00,$0.00,$0.00,$0.00,$0.00,$15.15,$0.00,$7.58,$12.00,$12.12,$0.00,$0.00,$0.00,$0.00,$0.00
26224,ERX,HCPCS 63700001,68084-0643-11,PANTOPRAZOLE SODIUM 20 MG PO TBEC,$15.15,$0.00,$15.15,$0.00,$10.81,$0.00,$0.00,$0.00,$0.00,$0.00,$15.15,$0.00,$7.58,$12.00,$12.12,$0.00,$0.00,$0.00,$0.00,$0.00
26225,ERX,HCPCS 63700001,55111-0333-90,PANTOPRAZOLE SODIUM 40 MG PO TBEC,$15.55,$0.00,$15.55,$0.00,$11.10,$0.00,$0.00,$0.00,$0.00,$0.00,$15.55,$0.00,$7.78,$12.32,$12.44,$0.00,$0.00,$0.00,$0.00,$0.00
26225,ERX,HCPCS 63700001,63739-0564-10,PANTOPRAZOLE SODIUM 40 MG PO TBEC,$15.55,$0.00,$15.55,$0.00,$11.10,$0.00,$0.00,$0.00,$0.00,$0.00,$15.55,$0.00,$7.78,$12.32,$12.44,$0.00,$0.00,$0.00,$0.00,$0.00
26225,ERX,HCPCS 63700001,66993-0068-80,PANTOPRAZOLE SODIUM 40 MG PO TBEC,$15.55,$0.00,$15.55,$0.00,$11.10,$0.00,$0.00,$0.00,$0.00,$0.00,$15.55,$0.00,$7.78,$12.32,$12.44,$0.00,$0.00,$0.00,$0.00,$0.00
26225,ERX,HCPCS 63700001,68084-0813-09,PANTOPRAZOLE SODIUM 40 MG PO TBEC,$15.55,$0.00,$15.55,$0.00,$11.10,$0.00,$0.00,$0.00,$0.00,$0.00,$15.55,$0.00,$7.78,$12.32,$12.44,$0.00,$0.00,$0.00,$0.00,$0.00
26226,ERX,HCPCS 25000001,00008-0923-55,PANTOPRAZOLE SODIUM 40 MG IV SOLR,$22.80,$0.00,$22.80,$0.00,$16.27,$0.00,$0.00,$0.00,$0.00,$0.00,$22.80,$0.00,$11.40,$18.06,$18.24,$0.00,$0.00,$0.00,$0.00,$0.00
26226,ERX,HCPCS 25000001,00008-0923-60,PANTOPRAZOLE SODIUM 40 MG IV SOLR,$22.80,$0.00,$22.80,$0.00,$16.27,$0.00,$0.00,$0.00,$0.00,$0.00,$22.80,$0.00,$11.40,$18.06,$18.24,$0.00,$0.00,$0.00,$0.00,$0.00
26226,ERX,HCPCS 25000001,00143-9284-10,PANTOPRAZOLE SODIUM 40 MG IV SOLR,$22.80,$0.00,$22.80,$0.00,$16.27,$0.00,$0.00,$0.00,$0.00,$0.00,$22.80,$0.00,$11.40,$18.06,$18.24,$0.00,$0.00,$0.00,$0.00,$0.00
26226,ERX,HCPCS 25000001,00143-9300-01,PANTOPRAZOLE SODIUM 40 MG IV SOLR,$22.80,$0.00,$22.80,$0.00,$16.27,$0.00,$0.00,$0.00,$0.00,$0.00,$22.80,$0.00,$11.40,$18.06,$18.24,$0.00,$0.00,$0.00,$0.00,$0.00
26226,ERX,HCPCS 25000001,00143-9300-10,PANTOPRAZOLE SODIUM 40 MG IV SOLR,$22.80,$0.00,$22.80,$0.00,$16.27,$0.00,$0.00,$0.00,$0.00,$0.00,$22.80,$0.00,$11.40,$18.06,$18.24,$0.00,$0.00,$0.00,$0.00,$0.00
26226,ERX,HCPCS 25000001,55150-0202-00,PANTOPRAZOLE SODIUM 40 MG IV SOLR,$22.80,$0.00,$22.80,$0.00,$16.27,$0.00,$0.00,$0.00,$0.00,$0.00,$22.80,$0.00,$11.40,$18.06,$18.24,$0.00,$0.00,$0.00,$0.00,$0.00
26226,ERX,HCPCS 25000001,55150-0202-10,PANTOPRAZOLE SODIUM 40 MG IV SOLR,$22.80,$0.00,$22.80,$0.00,$16.27,$0.00,$0.00,$0.00,$0.00,$0.00,$22.80,$0.00,$11.40,$18.06,$18.24,$0.00,$0.00,$0.00,$0.00,$0.00
26335,ERX,HCPCS J2770,61570-0260-01,QUINUPRISTIN-DALFOPRISTIN 500 MG IV SOLR,"$1,278.20",$0.00,"$1,278.20",$0.00,$912.25,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,278.20",$0.00,$639.10,"$1,012.33","$1,022.56",$0.00,$0.00,$0.00,$0.00,$0.00
26335,ERX,HCPCS J2770,61570-0260-10,QUINUPRISTIN-DALFOPRISTIN 500 MG IV SOLR,"$1,278.20",$0.00,"$1,278.20",$0.00,$912.25,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,278.20",$0.00,$639.10,"$1,012.33","$1,022.56",$0.00,$0.00,$0.00,$0.00,$0.00
26336,ERX,HCPCS J7520,00008-1030-06,SIROLIMUS 1 MG/ML PO SOLN,"$4,445.22",$0.00,"$4,445.22",$0.00,"$3,172.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,445.22",$0.00,"$2,222.61","$3,520.61","$3,556.18",$0.00,$0.00,$0.00,$0.00,$0.00
26371,ERX,HCPCS 63700001,51079-0923-01,CARBIDOPA-LEVODOPA ER 50-200 MG PO TBCR,$6.62,$0.00,$6.62,$0.00,$4.72,$0.00,$0.00,$0.00,$0.00,$0.00,$6.62,$0.00,$3.31,$5.24,$5.30,$0.00,$0.00,$0.00,$0.00,$0.00
26371,ERX,HCPCS 63700001,51079-0923-20,CARBIDOPA-LEVODOPA ER 50-200 MG PO TBCR,$6.62,$0.00,$6.62,$0.00,$4.72,$0.00,$0.00,$0.00,$0.00,$0.00,$6.62,$0.00,$3.31,$5.24,$5.30,$0.00,$0.00,$0.00,$0.00,$0.00
26371,ERX,HCPCS 63700001,68084-0282-01,CARBIDOPA-LEVODOPA ER 50-200 MG PO TBCR,$6.62,$0.00,$6.62,$0.00,$4.72,$0.00,$0.00,$0.00,$0.00,$0.00,$6.62,$0.00,$3.31,$5.24,$5.30,$0.00,$0.00,$0.00,$0.00,$0.00
26429,ERX,HCPCS 63700001,00378-5504-01,ROPINIROLE HCL 4 MG PO TABS,$9.87,$0.00,$9.87,$0.00,$7.04,$0.00,$0.00,$0.00,$0.00,$0.00,$9.87,$0.00,$4.94,$7.82,$7.90,$0.00,$0.00,$0.00,$0.00,$0.00
26429,ERX,HCPCS 63700001,43547-0273-10,ROPINIROLE HCL 4 MG PO TABS,$9.87,$0.00,$9.87,$0.00,$7.04,$0.00,$0.00,$0.00,$0.00,$0.00,$9.87,$0.00,$4.94,$7.82,$7.90,$0.00,$0.00,$0.00,$0.00,$0.00
26429,ERX,HCPCS 63700001,68462-0258-01,ROPINIROLE HCL 4 MG PO TABS,$9.87,$0.00,$9.87,$0.00,$7.04,$0.00,$0.00,$0.00,$0.00,$0.00,$9.87,$0.00,$4.94,$7.82,$7.90,$0.00,$0.00,$0.00,$0.00,$0.00
26546,ERX,HCPCS 63700001,16714-0819-01,OSELTAMIVIR PHOSPHATE 75 MG PO CAPS,$58.74,$0.00,$58.74,$0.00,$41.92,$0.00,$0.00,$0.00,$0.00,$0.00,$58.74,$0.00,$29.37,$46.52,$46.99,$0.00,$0.00,$0.00,$0.00,$0.00
26546,ERX,HCPCS 63700001,33342-0258-66,OSELTAMIVIR PHOSPHATE 75 MG PO CAPS,$58.74,$0.00,$58.74,$0.00,$41.92,$0.00,$0.00,$0.00,$0.00,$0.00,$58.74,$0.00,$29.37,$46.52,$46.99,$0.00,$0.00,$0.00,$0.00,$0.00
26546,ERX,HCPCS 63700001,42291-0664-10,OSELTAMIVIR PHOSPHATE 75 MG PO CAPS,$58.74,$0.00,$58.74,$0.00,$41.92,$0.00,$0.00,$0.00,$0.00,$0.00,$58.74,$0.00,$29.37,$46.52,$46.99,$0.00,$0.00,$0.00,$0.00,$0.00
26546,ERX,HCPCS 63700001,47781-0470-13,OSELTAMIVIR PHOSPHATE 75 MG PO CAPS,$58.74,$0.00,$58.74,$0.00,$41.92,$0.00,$0.00,$0.00,$0.00,$0.00,$58.74,$0.00,$29.37,$46.52,$46.99,$0.00,$0.00,$0.00,$0.00,$0.00
26546,ERX,HCPCS 63700001,64380-0799-01,OSELTAMIVIR PHOSPHATE 75 MG PO CAPS,$58.74,$0.00,$58.74,$0.00,$41.92,$0.00,$0.00,$0.00,$0.00,$0.00,$58.74,$0.00,$29.37,$46.52,$46.99,$0.00,$0.00,$0.00,$0.00,$0.00
26546,ERX,HCPCS 63700001,70710-1010-02,OSELTAMIVIR PHOSPHATE 75 MG PO CAPS,$58.74,$0.00,$58.74,$0.00,$41.92,$0.00,$0.00,$0.00,$0.00,$0.00,$58.74,$0.00,$29.37,$46.52,$46.99,$0.00,$0.00,$0.00,$0.00,$0.00
26547,ERX,HCPCS 63700001,33342-0260-11,ENTACAPONE 200 MG PO TABS,$15.01,$0.00,$15.01,$0.00,$10.71,$0.00,$0.00,$0.00,$0.00,$0.00,$15.01,$0.00,$7.51,$11.89,$12.01,$0.00,$0.00,$0.00,$0.00,$0.00
26547,ERX,HCPCS 63700001,64679-0781-02,ENTACAPONE 200 MG PO TABS,$15.01,$0.00,$15.01,$0.00,$10.71,$0.00,$0.00,$0.00,$0.00,$0.00,$15.01,$0.00,$7.51,$11.89,$12.01,$0.00,$0.00,$0.00,$0.00,$0.00
26551,ERX,HCPCS 63700001,00009-7663-04,EXEMESTANE 25 MG PO TABS,$70.81,$0.00,$70.81,$0.00,$50.54,$0.00,$0.00,$0.00,$0.00,$0.00,$70.81,$0.00,$35.41,$56.08,$56.65,$0.00,$0.00,$0.00,$0.00,$0.00
26551,ERX,HCPCS 63700001,00054-0080-13,EXEMESTANE 25 MG PO TABS,$70.81,$0.00,$70.81,$0.00,$50.54,$0.00,$0.00,$0.00,$0.00,$0.00,$70.81,$0.00,$35.41,$56.08,$56.65,$0.00,$0.00,$0.00,$0.00,$0.00
26551,ERX,HCPCS 63700001,00832-0595-30,EXEMESTANE 25 MG PO TABS,$70.81,$0.00,$70.81,$0.00,$50.54,$0.00,$0.00,$0.00,$0.00,$0.00,$70.81,$0.00,$35.41,$56.08,$56.65,$0.00,$0.00,$0.00,$0.00,$0.00
26551,ERX,HCPCS 63700001,47781-0108-30,EXEMESTANE 25 MG PO TABS,$70.81,$0.00,$70.81,$0.00,$50.54,$0.00,$0.00,$0.00,$0.00,$0.00,$70.81,$0.00,$35.41,$56.08,$56.65,$0.00,$0.00,$0.00,$0.00,$0.00
26688,ERX,HCPCS 63700001,60258-0161-01,RENA-VITE RX 1 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
26816,ERX,HCPCS 63700001,00904-6051-61,LEVETIRACETAM 250 MG PO TABS,$10.93,$0.00,$10.93,$0.00,$7.80,$0.00,$0.00,$0.00,$0.00,$0.00,$10.93,$0.00,$5.47,$8.66,$8.74,$0.00,$0.00,$0.00,$0.00,$0.00
26816,ERX,HCPCS 63700001,68084-0859-01,LEVETIRACETAM 250 MG PO TABS,$10.93,$0.00,$10.93,$0.00,$7.80,$0.00,$0.00,$0.00,$0.00,$0.00,$10.93,$0.00,$5.47,$8.66,$8.74,$0.00,$0.00,$0.00,$0.00,$0.00
26816,ERX,HCPCS 63700001,68180-0112-16,LEVETIRACETAM 250 MG PO TABS,$10.93,$0.00,$10.93,$0.00,$7.80,$0.00,$0.00,$0.00,$0.00,$0.00,$10.93,$0.00,$5.47,$8.66,$8.74,$0.00,$0.00,$0.00,$0.00,$0.00
26817,ERX,HCPCS 63700001,00904-6052-61,LEVETIRACETAM 500 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
26817,ERX,HCPCS 63700001,16714-0355-01,LEVETIRACETAM 500 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
26817,ERX,HCPCS 63700001,16714-0355-02,LEVETIRACETAM 500 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
26817,ERX,HCPCS 63700001,50268-0473-11,LEVETIRACETAM 500 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
26817,ERX,HCPCS 63700001,50268-0473-15,LEVETIRACETAM 500 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
26817,ERX,HCPCS 63700001,51079-0821-01,LEVETIRACETAM 500 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
26817,ERX,HCPCS 63700001,51079-0821-20,LEVETIRACETAM 500 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
26817,ERX,HCPCS 63700001,63739-0411-10,LEVETIRACETAM 500 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
26817,ERX,HCPCS 63700001,68084-0870-01,LEVETIRACETAM 500 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
26818,ERX,HCPCS 63700001,00378-5617-78,LEVETIRACETAM 750 MG PO TABS,$18.10,$0.00,$18.10,$0.00,$12.92,$0.00,$0.00,$0.00,$0.00,$0.00,$18.10,$0.00,$9.05,$14.34,$14.48,$0.00,$0.00,$0.00,$0.00,$0.00
26818,ERX,HCPCS 63700001,00904-6053-61,LEVETIRACETAM 750 MG PO TABS,$18.10,$0.00,$18.10,$0.00,$12.92,$0.00,$0.00,$0.00,$0.00,$0.00,$18.10,$0.00,$9.05,$14.34,$14.48,$0.00,$0.00,$0.00,$0.00,$0.00
26818,ERX,HCPCS 63700001,16714-0356-01,LEVETIRACETAM 750 MG PO TABS,$18.10,$0.00,$18.10,$0.00,$12.92,$0.00,$0.00,$0.00,$0.00,$0.00,$18.10,$0.00,$9.05,$14.34,$14.48,$0.00,$0.00,$0.00,$0.00,$0.00
26818,ERX,HCPCS 63700001,50268-0474-11,LEVETIRACETAM 750 MG PO TABS,$18.10,$0.00,$18.10,$0.00,$12.92,$0.00,$0.00,$0.00,$0.00,$0.00,$18.10,$0.00,$9.05,$14.34,$14.48,$0.00,$0.00,$0.00,$0.00,$0.00
26818,ERX,HCPCS 63700001,50474-0596-40,LEVETIRACETAM 750 MG PO TABS,$18.10,$0.00,$18.10,$0.00,$12.92,$0.00,$0.00,$0.00,$0.00,$0.00,$18.10,$0.00,$9.05,$14.34,$14.48,$0.00,$0.00,$0.00,$0.00,$0.00
26818,ERX,HCPCS 63700001,63739-0787-10,LEVETIRACETAM 750 MG PO TABS,$18.10,$0.00,$18.10,$0.00,$12.92,$0.00,$0.00,$0.00,$0.00,$0.00,$18.10,$0.00,$9.05,$14.34,$14.48,$0.00,$0.00,$0.00,$0.00,$0.00
26818,ERX,HCPCS 63700001,68084-0882-01,LEVETIRACETAM 750 MG PO TABS,$18.10,$0.00,$18.10,$0.00,$12.92,$0.00,$0.00,$0.00,$0.00,$0.00,$18.10,$0.00,$9.05,$14.34,$14.48,$0.00,$0.00,$0.00,$0.00,$0.00
26818,ERX,HCPCS 63700001,68084-0882-11,LEVETIRACETAM 750 MG PO TABS,$18.10,$0.00,$18.10,$0.00,$12.92,$0.00,$0.00,$0.00,$0.00,$0.00,$18.10,$0.00,$9.05,$14.34,$14.48,$0.00,$0.00,$0.00,$0.00,$0.00
26854,ERX,HCPCS 63700001,51991-0943-33,MOXIFLOXACIN HCL 400 MG PO TABS,$95.29,$0.00,$95.29,$0.00,$68.01,$0.00,$0.00,$0.00,$0.00,$0.00,$95.29,$0.00,$47.65,$75.47,$76.23,$0.00,$0.00,$0.00,$0.00,$0.00
26854,ERX,HCPCS 63700001,65862-0603-30,MOXIFLOXACIN HCL 400 MG PO TABS,$95.29,$0.00,$95.29,$0.00,$68.01,$0.00,$0.00,$0.00,$0.00,$0.00,$95.29,$0.00,$47.65,$75.47,$76.23,$0.00,$0.00,$0.00,$0.00,$0.00
26950,ERX,HCPCS 63700001,51285-0063-90,ESTRADIOL-NORGESTIMATE 1/1-0.09 MG (15/15) PO TABS,$22.76,$0.00,$22.76,$0.00,$16.24,$0.00,$0.00,$0.00,$0.00,$0.00,$22.76,$0.00,$11.38,$18.03,$18.21,$0.00,$0.00,$0.00,$0.00,$0.00
26952,ERX,HCPCS 63700001,00904-6286-06,OLANZAPINE 15 MG PO TABS,$104.56,$0.00,$104.56,$0.00,$74.62,$0.00,$0.00,$0.00,$0.00,$0.00,$104.56,$0.00,$52.28,$82.81,$83.65,$0.00,$0.00,$0.00,$0.00,$0.00
26952,ERX,HCPCS 63700001,55111-0167-30,OLANZAPINE 15 MG PO TABS,$104.56,$0.00,$104.56,$0.00,$74.62,$0.00,$0.00,$0.00,$0.00,$0.00,$104.56,$0.00,$52.28,$82.81,$83.65,$0.00,$0.00,$0.00,$0.00,$0.00
26952,ERX,HCPCS 63700001,68084-0528-01,OLANZAPINE 15 MG PO TABS,$104.56,$0.00,$104.56,$0.00,$74.62,$0.00,$0.00,$0.00,$0.00,$0.00,$104.56,$0.00,$52.28,$82.81,$83.65,$0.00,$0.00,$0.00,$0.00,$0.00
26965,ERX,HCPCS 63700001,00069-5800-43,DOFETILIDE 125 MCG PO CAPS,$47.40,$0.00,$47.40,$0.00,$33.83,$0.00,$0.00,$0.00,$0.00,$0.00,$47.40,$0.00,$23.70,$37.54,$37.92,$0.00,$0.00,$0.00,$0.00,$0.00
26965,ERX,HCPCS 63700001,00069-5800-60,DOFETILIDE 125 MCG PO CAPS,$47.40,$0.00,$47.40,$0.00,$33.83,$0.00,$0.00,$0.00,$0.00,$0.00,$47.40,$0.00,$23.70,$37.54,$37.92,$0.00,$0.00,$0.00,$0.00,$0.00
26965,ERX,HCPCS 63700001,42291-0411-60,DOFETILIDE 125 MCG PO CAPS,$47.40,$0.00,$47.40,$0.00,$33.83,$0.00,$0.00,$0.00,$0.00,$0.00,$47.40,$0.00,$23.70,$37.54,$37.92,$0.00,$0.00,$0.00,$0.00,$0.00
26965,ERX,HCPCS 63700001,51862-0125-60,DOFETILIDE 125 MCG PO CAPS,$47.40,$0.00,$47.40,$0.00,$33.83,$0.00,$0.00,$0.00,$0.00,$0.00,$47.40,$0.00,$23.70,$37.54,$37.92,$0.00,$0.00,$0.00,$0.00,$0.00
26965,ERX,HCPCS 63700001,69452-0131-17,DOFETILIDE 125 MCG PO CAPS,$47.40,$0.00,$47.40,$0.00,$33.83,$0.00,$0.00,$0.00,$0.00,$0.00,$47.40,$0.00,$23.70,$37.54,$37.92,$0.00,$0.00,$0.00,$0.00,$0.00
26966,ERX,HCPCS 63700001,00069-5810-60,DOFETILIDE 250 MCG PO CAPS,$32.54,$0.00,$32.54,$0.00,$23.22,$0.00,$0.00,$0.00,$0.00,$0.00,$32.54,$0.00,$16.27,$25.77,$26.03,$0.00,$0.00,$0.00,$0.00,$0.00
26966,ERX,HCPCS 63700001,59762-0038-02,DOFETILIDE 250 MCG PO CAPS,$32.54,$0.00,$32.54,$0.00,$23.22,$0.00,$0.00,$0.00,$0.00,$0.00,$32.54,$0.00,$16.27,$25.77,$26.03,$0.00,$0.00,$0.00,$0.00,$0.00
26967,ERX,HCPCS 25000001,00069-5820-43,DOFETILIDE 500 MCG PO CAPS,$32.51,$0.00,$32.51,$0.00,$23.20,$0.00,$0.00,$0.00,$0.00,$0.00,$32.51,$0.00,$16.26,$25.75,$26.01,$0.00,$0.00,$0.00,$0.00,$0.00
26967,ERX,HCPCS 25000001,00069-5820-60,DOFETILIDE 500 MCG PO CAPS,$32.51,$0.00,$32.51,$0.00,$23.20,$0.00,$0.00,$0.00,$0.00,$0.00,$32.51,$0.00,$16.26,$25.75,$26.01,$0.00,$0.00,$0.00,$0.00,$0.00
26967,ERX,HCPCS 25000001,51862-0005-60,DOFETILIDE 500 MCG PO CAPS,$32.51,$0.00,$32.51,$0.00,$23.20,$0.00,$0.00,$0.00,$0.00,$0.00,$32.51,$0.00,$16.26,$25.75,$26.01,$0.00,$0.00,$0.00,$0.00,$0.00
27022,ERX,HCPCS 25000001,00045-0646-12,BUDESONIDE 32 MCG/ACT NA SUSP,$72.59,$0.00,$72.59,$0.00,$51.81,$0.00,$0.00,$0.00,$0.00,$0.00,$72.59,$0.00,$36.30,$57.49,$58.07,$0.00,$0.00,$0.00,$0.00,$0.00
27023,ERX,HCPCS 63700001,00067-8100-12,TERBINAFINE HCL 1 % EX CREA,$32.61,$0.00,$32.61,$0.00,$23.27,$0.00,$0.00,$0.00,$0.00,$0.00,$32.61,$0.00,$16.31,$25.83,$26.09,$0.00,$0.00,$0.00,$0.00,$0.00
27023,ERX,HCPCS 63700001,51672-2080-01,TERBINAFINE HCL 1 % EX CREA,$65.21,$0.00,$51.65,$0.00,$23.27,$0.00,$0.00,$0.00,$0.00,$0.00,$32.61,$0.00,$16.31,$51.65,$26.09,$0.00,$0.00,$0.00,$0.00,$0.00
27023,ERX,HCPCS 63700001,51672-2080-02,TERBINAFINE HCL 1 % EX CREA,$90.09,$0.00,$71.35,$0.00,$23.27,$0.00,$0.00,$0.00,$0.00,$0.00,$32.61,$0.00,$16.31,$71.35,$26.09,$0.00,$0.00,$0.00,$0.00,$0.00
27027,ERX,HCPCS 63700001,00187-5526-75,BEXAROTENE 75 MG PO CAPS,$791.02,$0.00,$791.02,$0.00,$564.55,$0.00,$0.00,$0.00,$0.00,$0.00,$791.02,$0.00,$395.51,$626.49,$632.82,$0.00,$0.00,$0.00,$0.00,$0.00
27032,ERX,HCPCS J7674,64281-0100-00,METHACHOLINE CHLORIDE 100 MG IN SOLR,$283.50,$0.00,$283.50,$0.00,$202.33,$0.00,$0.00,$0.00,$0.00,$0.00,$283.50,$0.00,$141.75,$224.53,$226.80,$0.00,$0.00,$0.00,$0.00,$0.00
27032,ERX,HCPCS J7674,64281-0100-06,METHACHOLINE CHLORIDE 100 MG IN SOLR,$283.50,$0.00,$283.50,$0.00,$202.33,$0.00,$0.00,$0.00,$0.00,$0.00,$283.50,$0.00,$141.75,$224.53,$226.80,$0.00,$0.00,$0.00,$0.00,$0.00
27049,ERX,HCPCS 63700001,62756-0183-88,OXCARBAZEPINE 150 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
27049,ERX,HCPCS 63700001,68084-0845-01,OXCARBAZEPINE 150 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
27099,ERX,HCPCS 25000001,00574-0121-08,CHARCOAL ACTIVATED PO LIQD,$141.96,$0.00,$141.96,$0.00,$101.32,$0.00,$0.00,$0.00,$0.00,$0.00,$141.96,$0.00,$70.98,$112.43,$113.57,$0.00,$0.00,$0.00,$0.00,$0.00
27099,ERX,HCPCS 25000001,00574-0121-74,CHARCOAL ACTIVATED PO LIQD,$141.96,$0.00,$141.96,$0.00,$101.32,$0.00,$0.00,$0.00,$0.00,$0.00,$141.96,$0.00,$70.98,$112.43,$113.57,$0.00,$0.00,$0.00,$0.00,$0.00
27099,ERX,HCPCS 25000001,00574-0121-76,CHARCOAL ACTIVATED PO LIQD,$141.96,$0.00,$141.96,$0.00,$101.32,$0.00,$0.00,$0.00,$0.00,$0.00,$141.96,$0.00,$70.98,$112.43,$113.57,$0.00,$0.00,$0.00,$0.00,$0.00
27099,ERX,HCPCS 25000001,66689-0201-08,CHARCOAL ACTIVATED PO LIQD,$141.96,$0.00,$141.96,$0.00,$101.32,$0.00,$0.00,$0.00,$0.00,$0.00,$141.96,$0.00,$70.98,$112.43,$113.57,$0.00,$0.00,$0.00,$0.00,$0.00
27099,ERX,HCPCS 25000001,66689-0202-04,CHARCOAL ACTIVATED PO LIQD,$141.96,$0.00,$141.96,$0.00,$101.32,$0.00,$0.00,$0.00,$0.00,$0.00,$141.96,$0.00,$70.98,$112.43,$113.57,$0.00,$0.00,$0.00,$0.00,$0.00
27099,ERX,HCPCS 25000001,66689-0202-08,CHARCOAL ACTIVATED PO LIQD,$141.96,$0.00,$141.96,$0.00,$101.32,$0.00,$0.00,$0.00,$0.00,$0.00,$141.96,$0.00,$70.98,$112.43,$113.57,$0.00,$0.00,$0.00,$0.00,$0.00
27112,ERX,HCPCS 63700001,00093-3099-56,RISEDRONATE SODIUM 5 MG PO TABS,$33.66,$0.00,$33.66,$0.00,$24.02,$0.00,$0.00,$0.00,$0.00,$0.00,$33.66,$0.00,$16.83,$26.66,$26.93,$0.00,$0.00,$0.00,$0.00,$0.00
27181,ERX,HCPCS 63700001,62175-0320-46,NIACIN ER (ANTIHYPERLIPIDEMIC) 500 MG PO TBCR,$19.83,$0.00,$19.83,$0.00,$14.15,$0.00,$0.00,$0.00,$0.00,$0.00,$19.83,$0.00,$9.92,$15.71,$15.86,$0.00,$0.00,$0.00,$0.00,$0.00
27181,ERX,HCPCS 63700001,65162-0321-09,NIACIN ER (ANTIHYPERLIPIDEMIC) 500 MG PO TBCR,$19.83,$0.00,$19.83,$0.00,$14.15,$0.00,$0.00,$0.00,$0.00,$0.00,$19.83,$0.00,$9.92,$15.71,$15.86,$0.00,$0.00,$0.00,$0.00,$0.00
27182,ERX,HCPCS 63700001,47335-0614-81,NIACIN ER (ANTIHYPERLIPIDEMIC) 750 MG PO TBCR,$22.95,$0.00,$22.95,$0.00,$16.38,$0.00,$0.00,$0.00,$0.00,$0.00,$22.95,$0.00,$11.48,$18.18,$18.36,$0.00,$0.00,$0.00,$0.00,$0.00
27183,ERX,HCPCS 63700001,47335-0613-81,NIACIN ER (ANTIHYPERLIPIDEMIC) 1000 MG PO TBCR,$41.69,$0.00,$41.69,$0.00,$29.75,$0.00,$0.00,$0.00,$0.00,$0.00,$41.69,$0.00,$20.85,$33.02,$33.35,$0.00,$0.00,$0.00,$0.00,$0.00
27183,ERX,HCPCS 63700001,65162-0323-09,NIACIN ER (ANTIHYPERLIPIDEMIC) 1000 MG PO TBCR,$41.69,$0.00,$41.69,$0.00,$29.75,$0.00,$0.00,$0.00,$0.00,$0.00,$41.69,$0.00,$20.85,$33.02,$33.35,$0.00,$0.00,$0.00,$0.00,$0.00
27234,ERX,HCPCS 63700001,00781-5554-31,MONTELUKAST SODIUM 4 MG PO CHEW,$21.50,$0.00,$21.50,$0.00,$15.34,$0.00,$0.00,$0.00,$0.00,$0.00,$21.50,$0.00,$10.75,$17.03,$17.20,$0.00,$0.00,$0.00,$0.00,$0.00
27234,ERX,HCPCS 63700001,27241-0016-03,MONTELUKAST SODIUM 4 MG PO CHEW,$21.50,$0.00,$21.50,$0.00,$15.34,$0.00,$0.00,$0.00,$0.00,$0.00,$21.50,$0.00,$10.75,$17.03,$17.20,$0.00,$0.00,$0.00,$0.00,$0.00
27234,ERX,HCPCS 63700001,42291-0622-90,MONTELUKAST SODIUM 4 MG PO CHEW,$21.50,$0.00,$21.50,$0.00,$15.34,$0.00,$0.00,$0.00,$0.00,$0.00,$21.50,$0.00,$10.75,$17.03,$17.20,$0.00,$0.00,$0.00,$0.00,$0.00
27278,ERX,HCPCS 63700001,13668-0106-01,ISOSORBIDE MONONITRATE ER 120 MG PO TB24,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
27278,ERX,HCPCS 63700001,62175-0129-37,ISOSORBIDE MONONITRATE ER 120 MG PO TB24,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
27291,ERX,HCPCS J0713,00409-5093-11,CEFTAZIDIME 2 G IV SOLR,$27.17,$0.00,$27.17,$12.23,$19.39,$0.00,$4.68,$0.00,$0.00,$4.76,$27.17,$0.00,$13.59,$21.52,$21.74,$0.00,$4.25,$0.00,$4.33,$0.00
27299,ERX,HCPCS J0697,00143-9977-22,CEFUROXIME SODIUM 1.5 G IV SOLR,$26.66,$0.00,$26.66,$0.00,$19.03,$0.00,$0.00,$0.00,$0.00,$0.00,$26.66,$0.00,$13.33,$21.11,$21.33,$0.00,$0.00,$0.00,$0.00,$0.00
27314,ERX,HCPCS J2941,00013-2626-81,SOMATROPIN (ZOMACTON) 5 MG SC SOLR,$922.20,$0.00,$922.20,$0.00,$658.17,$0.00,$0.00,$0.00,$0.00,$0.00,$922.20,$0.00,$461.10,$730.38,$737.76,$0.00,$0.00,$0.00,$0.00,$0.00
27314,ERX,HCPCS J2941,55566-1801-01,SOMATROPIN (ZOMACTON) 5 MG SC SOLR,$922.20,$0.00,$922.20,$0.00,$658.17,$0.00,$0.00,$0.00,$0.00,$0.00,$922.20,$0.00,$461.10,$730.38,$737.76,$0.00,$0.00,$0.00,$0.00,$0.00
27325,ERX,HCPCS 90744,58160-0820-52,HEPATITIS B VAC RECOMBINANT 10 MCG/0.5ML IJ SUSP,$103.93,$0.00,$103.93,$46.77,$74.17,$27.02,$17.91,$0.00,$0.00,$18.20,$103.93,$0.00,$51.97,$82.31,$83.14,$62.36,$16.27,$27.02,$0.00,$27.02
27326,ERX,HCPCS 90746,58160-0821-11,HEPATITIS B VAC RECOMBINANT 20 MCG/ML IJ SUSP,$233.36,$0.00,$233.36,$105.01,$166.55,$60.67,$70.16,$0.00,$0.00,$78.80,$233.36,$0.00,$116.68,$184.82,$186.69,$140.02,$78.80,$60.67,$75.03,$60.67
27326,ERX,HCPCS 90746,58160-0821-43,HEPATITIS B VAC RECOMBINANT 20 MCG/ML IJ SUSP,$233.36,$0.00,$233.36,$105.01,$166.55,$60.67,$70.16,$0.00,$0.00,$78.80,$233.36,$0.00,$116.68,$184.82,$186.69,$140.02,$78.80,$60.67,$75.03,$60.67
27326,ERX,HCPCS 90746,58160-0821-52,HEPATITIS B VAC RECOMBINANT 20 MCG/ML IJ SUSP,$233.36,$0.00,$233.36,$105.01,$166.55,$60.67,$70.16,$0.00,$0.00,$78.80,$233.36,$0.00,$116.68,$184.82,$186.69,$140.02,$78.80,$60.67,$75.03,$60.67
27386,ERX,HCPCS 25000001,63323-0254-10,MINERAL OIL LIGHT OIL,$63.46,$0.00,$63.46,$0.00,$45.29,$0.00,$0.00,$0.00,$0.00,$0.00,$63.46,$0.00,$31.73,$50.26,$50.77,$0.00,$0.00,$0.00,$0.00,$0.00
27393,ERX,HCPCS 63600001,00409-1134-03,MORPHINE SULFATE 50 MG/ML IV SOLN,$57.76,$0.00,$57.76,$0.00,$41.22,$0.00,$0.00,$0.00,$0.00,$0.00,$57.76,$0.00,$28.88,$45.75,$46.21,$0.00,$0.00,$0.00,$0.00,$0.00
27393,ERX,HCPCS 63600001,00409-1134-05,MORPHINE SULFATE 50 MG/ML IV SOLN,$113.05,$0.00,$89.54,$0.00,$41.22,$0.00,$0.00,$0.00,$0.00,$0.00,$57.76,$0.00,$28.88,$89.54,$46.21,$0.00,$0.00,$0.00,$0.00,$0.00
27430,ERX,HCPCS 25000001,13925-0515-10,PENTAMIDINE ISETHIONATE 300 MG IJ SOLR,$530.72,$0.00,$530.72,$0.00,$378.77,$0.00,$0.00,$0.00,$0.00,$0.00,$530.72,$0.00,$265.36,$420.33,$424.58,$0.00,$0.00,$0.00,$0.00,$0.00
27430,ERX,HCPCS 25000001,63323-0113-10,PENTAMIDINE ISETHIONATE 300 MG IJ SOLR,$530.72,$0.00,$530.72,$0.00,$378.77,$0.00,$0.00,$0.00,$0.00,$0.00,$530.72,$0.00,$265.36,$420.33,$424.58,$0.00,$0.00,$0.00,$0.00,$0.00
27431,ERX,HCPCS Q2050,43598-0283-35,DOXORUBICIN HCL LIPOSOMAL 2 MG/ML IV INJ,"$2,383.74",$0.00,"$2,383.74","$1,072.68","$1,701.28",$710.14,$410.71,$0.00,$0.00,$694.47,"$2,383.74",$745.65,"$1,191.87","$1,887.92","$1,906.99","$1,029.70",$694.47,$0.00,$661.26,$635.41
27431,ERX,HCPCS Q2050,47335-0049-40,DOXORUBICIN HCL LIPOSOMAL 2 MG/ML IV INJ,"$2,383.74",$0.00,"$2,383.74","$1,072.68","$1,701.28",$710.14,$410.71,$0.00,$0.00,$694.47,"$2,383.74",$745.65,"$1,191.87","$1,887.92","$1,906.99","$1,029.70",$694.47,$0.00,$661.26,$635.41
27459,ERX,HCPCS 63700001,00378-4642-26,ESTRADIOL 0.05 MG/24HR TD PTTW,$43.08,$0.00,$43.08,$0.00,$30.75,$0.00,$0.00,$0.00,$0.00,$0.00,$43.08,$0.00,$21.54,$34.12,$34.46,$0.00,$0.00,$0.00,$0.00,$0.00
27461,ERX,HCPCS 25000001,00378-4640-16,ESTRADIOL 0.1 MG/24HR TD PTTW,$67.23,$0.00,$67.23,$0.00,$47.98,$0.00,$0.00,$0.00,$0.00,$0.00,$67.23,$0.00,$33.62,$53.25,$53.78,$0.00,$0.00,$0.00,$0.00,$0.00
27461,ERX,HCPCS 25000001,00378-4640-26,ESTRADIOL 0.1 MG/24HR TD PTTW,$67.23,$0.00,$67.23,$0.00,$47.98,$0.00,$0.00,$0.00,$0.00,$0.00,$67.23,$0.00,$33.62,$53.25,$53.78,$0.00,$0.00,$0.00,$0.00,$0.00
27471,ERX,HCPCS 25000001,,NITROGLYCERIN 0.1 MG/HR TD PT24,$7.07,$0.00,$7.07,$0.00,$5.05,$0.00,$0.00,$0.00,$0.00,$0.00,$7.07,$0.00,$3.54,$5.60,$5.66,$0.00,$0.00,$0.00,$0.00,$0.00
27471,ERX,HCPCS 25000001,00378-9102-93,NITROGLYCERIN 0.1 MG/HR TD PT24,$7.07,$0.00,$7.07,$0.00,$5.05,$0.00,$0.00,$0.00,$0.00,$0.00,$7.07,$0.00,$3.54,$5.60,$5.66,$0.00,$0.00,$0.00,$0.00,$0.00
27471,ERX,HCPCS 25000001,47781-0296-03,NITROGLYCERIN 0.1 MG/HR TD PT24,$7.07,$0.00,$7.07,$0.00,$5.05,$0.00,$0.00,$0.00,$0.00,$0.00,$7.07,$0.00,$3.54,$5.60,$5.66,$0.00,$0.00,$0.00,$0.00,$0.00
27472,ERX,HCPCS 25000001,00378-9104-93,NITROGLYCERIN 0.2 MG/HR TD PT24,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
27473,ERX,HCPCS 25000001,50742-0515-30,NITROGLYCERIN 0.3 MG/HR TD PT24,$131.89,$0.00,$131.89,$0.00,$94.13,$0.00,$0.00,$0.00,$0.00,$0.00,$131.89,$0.00,$65.95,$104.46,$105.51,$0.00,$0.00,$0.00,$0.00,$0.00
27474,ERX,HCPCS 25000001,,NITROGLYCERIN 0.4 MG/HR TD PT24,$7.02,$0.00,$7.02,$0.00,$5.01,$0.00,$0.00,$0.00,$0.00,$0.00,$7.02,$0.00,$3.51,$5.56,$5.62,$0.00,$0.00,$0.00,$0.00,$0.00
27474,ERX,HCPCS 25000001,00378-9112-93,NITROGLYCERIN 0.4 MG/HR TD PT24,$7.02,$0.00,$7.02,$0.00,$5.01,$0.00,$0.00,$0.00,$0.00,$0.00,$7.02,$0.00,$3.51,$5.56,$5.62,$0.00,$0.00,$0.00,$0.00,$0.00
27474,ERX,HCPCS 25000001,47781-0298-03,NITROGLYCERIN 0.4 MG/HR TD PT24,$7.02,$0.00,$7.02,$0.00,$5.01,$0.00,$0.00,$0.00,$0.00,$0.00,$7.02,$0.00,$3.51,$5.56,$5.62,$0.00,$0.00,$0.00,$0.00,$0.00
27475,ERX,HCPCS 25000001,,NITROGLYCERIN 0.6 MG/HR TD PT24,$9.11,$0.00,$9.11,$0.00,$6.50,$0.00,$0.00,$0.00,$0.00,$0.00,$9.11,$0.00,$4.56,$7.22,$7.29,$0.00,$0.00,$0.00,$0.00,$0.00
27475,ERX,HCPCS 25000001,00378-9116-93,NITROGLYCERIN 0.6 MG/HR TD PT24,$9.11,$0.00,$9.11,$0.00,$6.50,$0.00,$0.00,$0.00,$0.00,$0.00,$9.11,$0.00,$4.56,$7.22,$7.29,$0.00,$0.00,$0.00,$0.00,$0.00
27489,ERX,HCPCS 63700001,53489-0368-01,FELODIPINE ER 2.5 MG PO TB24,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
27490,ERX,HCPCS 63700001,00603-3582-21,FELODIPINE ER 5 MG PO TB24,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
27490,ERX,HCPCS 63700001,53489-0369-01,FELODIPINE ER 5 MG PO TB24,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
27491,ERX,HCPCS 63700001,53489-0370-01,FELODIPINE ER 10 MG PO TB24,$10.32,$0.00,$10.32,$0.00,$7.37,$0.00,$0.00,$0.00,$0.00,$0.00,$10.32,$0.00,$5.16,$8.17,$8.26,$0.00,$0.00,$0.00,$0.00,$0.00
27494,ERX,HCPCS 63700001,00378-2223-01,NISOLDIPINE ER 30 MG PO TB24,$68.18,$0.00,$68.18,$0.00,$48.66,$0.00,$0.00,$0.00,$0.00,$0.00,$68.18,$0.00,$34.09,$54.00,$54.54,$0.00,$0.00,$0.00,$0.00,$0.00
27495,ERX,HCPCS 63700001,00378-2224-01,NISOLDIPINE ER 40 MG PO TB24,$68.18,$0.00,$68.18,$0.00,$48.66,$0.00,$0.00,$0.00,$0.00,$0.00,$68.18,$0.00,$34.09,$54.00,$54.54,$0.00,$0.00,$0.00,$0.00,$0.00
27520,ERX,HCPCS 63700001,00573-2660-12,LORATADINE-PSEUDOEPHEDRINE ER 5-120 MG PO TB12,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
27520,ERX,HCPCS 63700001,00573-2660-24,LORATADINE-PSEUDOEPHEDRINE ER 5-120 MG PO TB12,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
27529,ERX,HCPCS 63700001,63824-0057-18,PSEUDOEPHEDRINE-GUAIFENESIN ER 60-600 MG PO TB12,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
27529,ERX,HCPCS 63700001,63824-0057-36,PSEUDOEPHEDRINE-GUAIFENESIN ER 60-600 MG PO TB12,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
27631,ERX,HCPCS 63700001,68084-0313-01,DIVALPROEX SODIUM 125 MG PO CSDR,$8.20,$0.00,$8.20,$0.00,$5.85,$0.00,$0.00,$0.00,$0.00,$0.00,$8.20,$0.00,$4.10,$6.49,$6.56,$0.00,$0.00,$0.00,$0.00,$0.00
27631,ERX,HCPCS 63700001,68084-0313-11,DIVALPROEX SODIUM 125 MG PO CSDR,$8.20,$0.00,$8.20,$0.00,$5.85,$0.00,$0.00,$0.00,$0.00,$0.00,$8.20,$0.00,$4.10,$6.49,$6.56,$0.00,$0.00,$0.00,$0.00,$0.00
27632,ERX,HCPCS 63700001,54092-0172-12,CARBAMAZEPINE ER 200 MG PO CP12,$8.09,$0.00,$8.09,$0.00,$5.77,$0.00,$0.00,$0.00,$0.00,$0.00,$8.09,$0.00,$4.05,$6.41,$6.47,$0.00,$0.00,$0.00,$0.00,$0.00
27633,ERX,HCPCS 63700001,54092-0173-12,CARBAMAZEPINE ER 300 MG PO CP12,$8.09,$0.00,$8.09,$0.00,$5.77,$0.00,$0.00,$0.00,$0.00,$0.00,$8.09,$0.00,$4.05,$6.41,$6.47,$0.00,$0.00,$0.00,$0.00,$0.00
27634,ERX,HCPCS 63700001,00078-0510-05,CARBAMAZEPINE ER 100 MG PO TB12,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
27634,ERX,HCPCS 63700001,00781-8016-01,CARBAMAZEPINE ER 100 MG PO TB12,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
27635,ERX,HCPCS 63700001,00078-0511-05,CARBAMAZEPINE ER 200 MG PO TB12,$7.91,$0.00,$7.91,$0.00,$5.65,$0.00,$0.00,$0.00,$0.00,$0.00,$7.91,$0.00,$3.96,$6.26,$6.33,$0.00,$0.00,$0.00,$0.00,$0.00
27635,ERX,HCPCS 63700001,00781-5987-01,CARBAMAZEPINE ER 200 MG PO TB12,$7.91,$0.00,$7.91,$0.00,$5.65,$0.00,$0.00,$0.00,$0.00,$0.00,$7.91,$0.00,$3.96,$6.26,$6.33,$0.00,$0.00,$0.00,$0.00,$0.00
27635,ERX,HCPCS 63700001,51672-4124-01,CARBAMAZEPINE ER 200 MG PO TB12,$7.91,$0.00,$7.91,$0.00,$5.65,$0.00,$0.00,$0.00,$0.00,$0.00,$7.91,$0.00,$3.96,$6.26,$6.33,$0.00,$0.00,$0.00,$0.00,$0.00
27636,ERX,HCPCS 63700001,00078-0512-05,CARBAMAZEPINE ER 400 MG PO TB12,$24.67,$0.00,$24.67,$0.00,$17.61,$0.00,$0.00,$0.00,$0.00,$0.00,$24.67,$0.00,$12.34,$19.54,$19.74,$0.00,$0.00,$0.00,$0.00,$0.00
27636,ERX,HCPCS 63700001,00781-5988-01,CARBAMAZEPINE ER 400 MG PO TB12,$24.67,$0.00,$24.67,$0.00,$17.61,$0.00,$0.00,$0.00,$0.00,$0.00,$24.67,$0.00,$12.34,$19.54,$19.74,$0.00,$0.00,$0.00,$0.00,$0.00
27636,ERX,HCPCS 63700001,51672-4125-01,CARBAMAZEPINE ER 400 MG PO TB12,$24.67,$0.00,$24.67,$0.00,$17.61,$0.00,$0.00,$0.00,$0.00,$0.00,$24.67,$0.00,$12.34,$19.54,$19.74,$0.00,$0.00,$0.00,$0.00,$0.00
27641,ERX,HCPCS 63700001,00093-7335-06,TOPIRAMATE 15 MG PO CPSP,$26.64,$0.00,$26.64,$0.00,$19.01,$0.00,$0.00,$0.00,$0.00,$0.00,$26.64,$0.00,$13.32,$21.10,$21.31,$0.00,$0.00,$0.00,$0.00,$0.00
27641,ERX,HCPCS 63700001,50458-0647-65,TOPIRAMATE 15 MG PO CPSP,$26.64,$0.00,$26.64,$0.00,$19.01,$0.00,$0.00,$0.00,$0.00,$0.00,$26.64,$0.00,$13.32,$21.10,$21.31,$0.00,$0.00,$0.00,$0.00,$0.00
27641,ERX,HCPCS 63700001,68382-0004-14,TOPIRAMATE 15 MG PO CPSP,$26.64,$0.00,$26.64,$0.00,$19.01,$0.00,$0.00,$0.00,$0.00,$0.00,$26.64,$0.00,$13.32,$21.10,$21.31,$0.00,$0.00,$0.00,$0.00,$0.00
27642,ERX,HCPCS 63700001,00093-7336-06,TOPIRAMATE 25 MG PO CPSP,$11.12,$0.00,$11.12,$0.00,$7.94,$0.00,$0.00,$0.00,$0.00,$0.00,$11.12,$0.00,$5.56,$8.81,$8.90,$0.00,$0.00,$0.00,$0.00,$0.00
27642,ERX,HCPCS 63700001,50458-0645-65,TOPIRAMATE 25 MG PO CPSP,$11.12,$0.00,$11.12,$0.00,$7.94,$0.00,$0.00,$0.00,$0.00,$0.00,$11.12,$0.00,$5.56,$8.81,$8.90,$0.00,$0.00,$0.00,$0.00,$0.00
27642,ERX,HCPCS 63700001,68382-0005-14,TOPIRAMATE 25 MG PO CPSP,$11.12,$0.00,$11.12,$0.00,$7.94,$0.00,$0.00,$0.00,$0.00,$0.00,$11.12,$0.00,$5.56,$8.81,$8.90,$0.00,$0.00,$0.00,$0.00,$0.00
27644,ERX,HCPCS 25000001,65162-0596-06,ASPIRIN-DIPYRIDAMOLE ER 25-200 MG PO CP12,$31.75,$0.00,$31.75,$0.00,$22.66,$0.00,$0.00,$0.00,$0.00,$0.00,$31.75,$0.00,$15.88,$25.15,$25.40,$0.00,$0.00,$0.00,$0.00,$0.00
27659,ERX,HCPCS 63700001,62175-0261-37,NIFEDIPINE ER OSMOTIC RELEASE 60 MG PO TB24,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
27659,ERX,HCPCS 63700001,71205-0964-00,NIFEDIPINE ER OSMOTIC RELEASE 60 MG PO TB24,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
27661,ERX,HCPCS 25000001,49938-0107-04,AMINOSALICYLIC ACID 4 G PO PACK,$30.40,$0.00,$30.40,$0.00,$21.70,$0.00,$0.00,$0.00,$0.00,$0.00,$30.40,$0.00,$15.20,$24.08,$24.32,$0.00,$0.00,$0.00,$0.00,$0.00
27662,ERX,HCPCS 25000001,17478-0403-03,FLUORESCEIN SODIUM 0.6 MG OP STRP,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
27663,ERX,HCPCS 25000001,17238-0900-11,FLUORESCEIN SODIUM 1 MG OP STRP,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
27663,ERX,HCPCS 25000001,17238-0900-30,FLUORESCEIN SODIUM 1 MG OP STRP,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
27663,ERX,HCPCS 25000001,17238-0900-99,FLUORESCEIN SODIUM 1 MG OP STRP,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
27663,ERX,HCPCS 25000001,17478-0404-01,FLUORESCEIN SODIUM 1 MG OP STRP,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
27667,ERX,HCPCS 25000001,45802-0050-03,DIBUCAINE (PERIANAL) 1 % EX OINT,$22.77,$0.00,$22.77,$0.00,$16.25,$0.00,$0.00,$0.00,$0.00,$0.00,$22.77,$0.00,$11.39,$18.03,$18.22,$0.00,$0.00,$0.00,$0.00,$0.00
27691,ERX,HCPCS 63700001,00781-2147-31,LANSOPRAZOLE 15 MG PO CPDR,$21.54,$0.00,$21.54,$0.00,$15.37,$0.00,$0.00,$0.00,$0.00,$0.00,$21.54,$0.00,$10.77,$17.06,$17.23,$0.00,$0.00,$0.00,$0.00,$0.00
27692,ERX,HCPCS 63700001,00093-7351-56,LANSOPRAZOLE 30 MG PO CPDR,$22.42,$0.00,$22.42,$0.00,$16.00,$0.00,$0.00,$0.00,$0.00,$0.00,$22.42,$0.00,$11.21,$17.76,$17.94,$0.00,$0.00,$0.00,$0.00,$0.00
27692,ERX,HCPCS 63700001,00378-8030-93,LANSOPRAZOLE 30 MG PO CPDR,$22.42,$0.00,$22.42,$0.00,$16.00,$0.00,$0.00,$0.00,$0.00,$0.00,$22.42,$0.00,$11.21,$17.76,$17.94,$0.00,$0.00,$0.00,$0.00,$0.00
27692,ERX,HCPCS 63700001,51079-0121-01,LANSOPRAZOLE 30 MG PO CPDR,$22.42,$0.00,$22.42,$0.00,$16.00,$0.00,$0.00,$0.00,$0.00,$0.00,$22.42,$0.00,$11.21,$17.76,$17.94,$0.00,$0.00,$0.00,$0.00,$0.00
27694,ERX,HCPCS 63700001,16714-0747-01,OMEPRAZOLE 20 MG PO CPDR,$16.52,$0.00,$16.52,$0.00,$11.79,$0.00,$0.00,$0.00,$0.00,$0.00,$16.52,$0.00,$8.26,$13.08,$13.22,$0.00,$0.00,$0.00,$0.00,$0.00
27694,ERX,HCPCS 63700001,16714-0747-02,OMEPRAZOLE 20 MG PO CPDR,$16.52,$0.00,$16.52,$0.00,$11.79,$0.00,$0.00,$0.00,$0.00,$0.00,$16.52,$0.00,$8.26,$13.08,$13.22,$0.00,$0.00,$0.00,$0.00,$0.00
27694,ERX,HCPCS 63700001,63739-0358-10,OMEPRAZOLE 20 MG PO CPDR,$16.52,$0.00,$16.52,$0.00,$11.79,$0.00,$0.00,$0.00,$0.00,$0.00,$16.52,$0.00,$8.26,$13.08,$13.22,$0.00,$0.00,$0.00,$0.00,$0.00
27695,ERX,HCPCS 63700001,00781-2234-31,OMEPRAZOLE 40 MG PO CPDR,$7.72,$0.00,$7.72,$0.00,$5.51,$0.00,$0.00,$0.00,$0.00,$0.00,$7.72,$0.00,$3.86,$6.11,$6.18,$0.00,$0.00,$0.00,$0.00,$0.00
27695,ERX,HCPCS 63700001,63739-0445-10,OMEPRAZOLE 40 MG PO CPDR,$7.72,$0.00,$7.72,$0.00,$5.51,$0.00,$0.00,$0.00,$0.00,$0.00,$7.72,$0.00,$3.86,$6.11,$6.18,$0.00,$0.00,$0.00,$0.00,$0.00
27697,ERX,HCPCS Q0162,00781-5238-64,ONDANSETRON 4 MG PO TBDP,$78.03,$0.00,$78.03,$42.37,$55.69,$0.00,$13.44,$0.00,$0.00,$13.66,$78.03,$0.00,$39.02,$61.80,$62.42,$0.00,$0.00,$0.00,$12.42,$0.00
27697,ERX,HCPCS Q0162,57237-0077-10,ONDANSETRON 4 MG PO TBDP,$78.03,$0.00,$78.03,$42.37,$55.69,$0.00,$13.44,$0.00,$0.00,$13.66,$78.03,$0.00,$39.02,$61.80,$62.42,$0.00,$0.00,$0.00,$12.42,$0.00
27697,ERX,HCPCS Q0162,65862-0390-10,ONDANSETRON 4 MG PO TBDP,$78.03,$0.00,$78.03,$42.37,$55.69,$0.00,$13.44,$0.00,$0.00,$13.66,$78.03,$0.00,$39.02,$61.80,$62.42,$0.00,$0.00,$0.00,$12.42,$0.00
27698,ERX,HCPCS Q0162,00781-5239-06,ONDANSETRON 8 MG PO TBDP,$129.97,$0.00,$129.97,$70.57,$92.76,$0.00,$22.39,$0.00,$0.00,$22.76,$129.97,$0.00,$64.99,$102.94,$103.98,$0.00,$0.00,$0.00,$20.69,$0.00
27698,ERX,HCPCS Q0162,65862-0391-10,ONDANSETRON 8 MG PO TBDP,$129.97,$0.00,$129.97,$70.57,$92.76,$0.00,$22.39,$0.00,$0.00,$22.76,$129.97,$0.00,$64.99,$102.94,$103.98,$0.00,$0.00,$0.00,$20.69,$0.00
27735,ERX,HCPCS Q9958,00270-0149-57,DIATRIZOATE MEGLUMINE 30 % UR SOLN,$208.85,$0.00,$208.85,$0.00,$149.06,$0.00,$0.00,$0.00,$0.00,$0.00,$208.85,$0.00,$104.43,$165.41,$167.08,$0.00,$0.00,$0.00,$0.00,$0.00
27770,ERX,HCPCS 25000001,24208-0342-05,DESMOPRESSIN ACE SPRAY REFRIG 0.01 % NA SOLN,$652.59,$0.00,$652.59,$0.00,$465.75,$0.00,$0.00,$0.00,$0.00,$0.00,$652.59,$0.00,$326.30,$516.85,$522.07,$0.00,$0.00,$0.00,$0.00,$0.00
27780,ERX,HCPCS 63700001,50268-0816-15,ZONISAMIDE 100 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
27780,ERX,HCPCS 63700001,60687-0230-01,ZONISAMIDE 100 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
27838,ERX,HCPCS J7040,00264-7800-00,SODIUM CHLORIDE 0.9 % IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.27,$0.00,$0.00,$3.03,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.03,$0.00,$2.89,$0.00
27838,ERX,HCPCS J7040,00338-0049-04,SODIUM CHLORIDE 0.9 % IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.27,$0.00,$0.00,$3.03,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.03,$0.00,$2.89,$0.00
27838,ERX,HCPCS J7040,99999-6008-99,SODIUM CHLORIDE 0.9 % IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.27,$0.00,$0.00,$3.03,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.03,$0.00,$2.89,$0.00
27838,ERX,HCPCS J7040,99999-6009-26,SODIUM CHLORIDE 0.9 % IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.27,$0.00,$0.00,$3.03,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.03,$0.00,$2.89,$0.00
27838,ERX,HCPCS J7040,99999-6008-17,SODIUM CHLORIDE 0.9 % IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.27,$0.00,$0.00,$3.03,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.03,$0.00,$2.89,$0.00
27838,ERX,HCPCS J7040,00264-1800-32,SODIUM CHLORIDE 0.9 % IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.27,$0.00,$0.00,$3.03,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.03,$0.00,$2.89,$0.00
27838,ERX,HCPCS J7040,00338-0049-18,SODIUM CHLORIDE 0.9 % IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.27,$0.00,$0.00,$3.03,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.03,$0.00,$2.89,$0.00
27838,ERX,HCPCS J7040,00338-0049-38,SODIUM CHLORIDE 0.9 % IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.27,$0.00,$0.00,$3.03,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.03,$0.00,$2.89,$0.00
27838,ERX,HCPCS J7040,00338-0049-48,SODIUM CHLORIDE 0.9 % IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.27,$0.00,$0.00,$3.03,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.03,$0.00,$2.89,$0.00
27838,ERX,HCPCS J7040,00338-0553-18,SODIUM CHLORIDE 0.9 % IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.27,$0.00,$0.00,$3.03,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.03,$0.00,$2.89,$0.00
27838,ERX,HCPCS J7040,00990-7984-37,SODIUM CHLORIDE 0.9 % IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.27,$0.00,$0.00,$3.03,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.03,$0.00,$2.89,$0.00
27838,ERX,HCPCS J7040,99999-6010-80,SODIUM CHLORIDE 0.9 % IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.27,$0.00,$0.00,$3.03,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.03,$0.00,$2.89,$0.00
27838,ERX,HCPCS J7040,00264-7800-20,SODIUM CHLORIDE 0.9 % IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.27,$0.00,$0.00,$3.03,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.03,$0.00,$2.89,$0.00
27838,ERX,HCPCS J7040,00338-0049-02,SODIUM CHLORIDE 0.9 % IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.27,$0.00,$0.00,$3.03,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.03,$0.00,$2.89,$0.00
27838,ERX,HCPCS J7040,00990-7983-02,SODIUM CHLORIDE 0.9 % IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.27,$0.00,$0.00,$3.03,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.03,$0.00,$2.89,$0.00
27838,ERX,HCPCS J7040,99999-6008-15,SODIUM CHLORIDE 0.9 % IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.27,$0.00,$0.00,$3.03,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.03,$0.00,$2.89,$0.00
27838,ERX,HCPCS J7040,00264-1800-31,SODIUM CHLORIDE 0.9 % IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.27,$0.00,$0.00,$3.03,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.03,$0.00,$2.89,$0.00
27838,ERX,HCPCS J7040,00338-0049-11,SODIUM CHLORIDE 0.9 % IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.27,$0.00,$0.00,$3.03,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.03,$0.00,$2.89,$0.00
27838,ERX,HCPCS J7040,00338-0049-31,SODIUM CHLORIDE 0.9 % IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.27,$0.00,$0.00,$3.03,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.03,$0.00,$2.89,$0.00
27838,ERX,HCPCS J7040,00338-0049-41,SODIUM CHLORIDE 0.9 % IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.27,$0.00,$0.00,$3.03,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.03,$0.00,$2.89,$0.00
27838,ERX,HCPCS J7040,00338-0553-11,SODIUM CHLORIDE 0.9 % IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.27,$0.00,$0.00,$3.03,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.03,$0.00,$2.89,$0.00
27838,ERX,HCPCS J7040,00990-7984-13,SODIUM CHLORIDE 0.9 % IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.27,$0.00,$0.00,$3.03,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.03,$0.00,$2.89,$0.00
27838,ERX,HCPCS J7040,00338-0049-03,SODIUM CHLORIDE 0.9 % IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.27,$0.00,$0.00,$3.03,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.03,$0.00,$2.89,$0.00
27838,ERX,HCPCS J7040,99999-6008-16,SODIUM CHLORIDE 0.9 % IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.27,$0.00,$0.00,$3.03,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.03,$0.00,$2.89,$0.00
27838,ERX,HCPCS J7040,99999-6010-79,SODIUM CHLORIDE 0.9 % IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.27,$0.00,$0.00,$3.03,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.03,$0.00,$2.89,$0.00
27855,ERX,HCPCS 25000001,00013-2150-36,ESTRADIOL 2 MG VA RING,"$1,369.61",$0.00,"$1,369.61",$0.00,$977.49,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,369.61",$0.00,$684.81,"$1,084.73","$1,095.69",$0.00,$0.00,$0.00,$0.00,$0.00
27857,ERX,HCPCS 63700001,00093-7384-98,VENLAFAXINE HCL ER 37.5 MG PO CP24,$15.83,$0.00,$15.83,$0.00,$11.30,$0.00,$0.00,$0.00,$0.00,$0.00,$15.83,$0.00,$7.92,$12.54,$12.66,$0.00,$0.00,$0.00,$0.00,$0.00
27857,ERX,HCPCS 63700001,65862-0527-30,VENLAFAXINE HCL ER 37.5 MG PO CP24,$15.83,$0.00,$15.83,$0.00,$11.30,$0.00,$0.00,$0.00,$0.00,$0.00,$15.83,$0.00,$7.92,$12.54,$12.66,$0.00,$0.00,$0.00,$0.00,$0.00
27857,ERX,HCPCS 63700001,68382-0034-06,VENLAFAXINE HCL ER 37.5 MG PO CP24,$15.83,$0.00,$15.83,$0.00,$11.30,$0.00,$0.00,$0.00,$0.00,$0.00,$15.83,$0.00,$7.92,$12.54,$12.66,$0.00,$0.00,$0.00,$0.00,$0.00
27857,ERX,HCPCS 63700001,68382-0034-16,VENLAFAXINE HCL ER 37.5 MG PO CP24,$15.83,$0.00,$15.83,$0.00,$11.30,$0.00,$0.00,$0.00,$0.00,$0.00,$15.83,$0.00,$7.92,$12.54,$12.66,$0.00,$0.00,$0.00,$0.00,$0.00
27858,ERX,HCPCS 63700001,00008-0833-21,VENLAFAXINE HCL ER 75 MG PO CP24,$64.15,$0.00,$64.15,$0.00,$45.78,$0.00,$0.00,$0.00,$0.00,$0.00,$64.15,$0.00,$32.08,$50.81,$51.32,$0.00,$0.00,$0.00,$0.00,$0.00
27858,ERX,HCPCS 63700001,00093-7385-56,VENLAFAXINE HCL ER 75 MG PO CP24,$64.15,$0.00,$64.15,$0.00,$45.78,$0.00,$0.00,$0.00,$0.00,$0.00,$64.15,$0.00,$32.08,$50.81,$51.32,$0.00,$0.00,$0.00,$0.00,$0.00
27858,ERX,HCPCS 63700001,00093-7385-98,VENLAFAXINE HCL ER 75 MG PO CP24,$64.15,$0.00,$64.15,$0.00,$45.78,$0.00,$0.00,$0.00,$0.00,$0.00,$64.15,$0.00,$32.08,$50.81,$51.32,$0.00,$0.00,$0.00,$0.00,$0.00
27858,ERX,HCPCS 63700001,65862-0528-90,VENLAFAXINE HCL ER 75 MG PO CP24,$64.15,$0.00,$64.15,$0.00,$45.78,$0.00,$0.00,$0.00,$0.00,$0.00,$64.15,$0.00,$32.08,$50.81,$51.32,$0.00,$0.00,$0.00,$0.00,$0.00
27859,ERX,HCPCS 63700001,00093-7386-56,VENLAFAXINE HCL ER 150 MG PO CP24,$19.32,$0.00,$19.32,$0.00,$13.79,$0.00,$0.00,$0.00,$0.00,$0.00,$19.32,$0.00,$9.66,$15.30,$15.46,$0.00,$0.00,$0.00,$0.00,$0.00
27859,ERX,HCPCS 63700001,00093-7386-98,VENLAFAXINE HCL ER 150 MG PO CP24,$19.32,$0.00,$19.32,$0.00,$13.79,$0.00,$0.00,$0.00,$0.00,$0.00,$19.32,$0.00,$9.66,$15.30,$15.46,$0.00,$0.00,$0.00,$0.00,$0.00
27859,ERX,HCPCS 63700001,63739-0512-10,VENLAFAXINE HCL ER 150 MG PO CP24,$19.32,$0.00,$19.32,$0.00,$13.79,$0.00,$0.00,$0.00,$0.00,$0.00,$19.32,$0.00,$9.66,$15.30,$15.46,$0.00,$0.00,$0.00,$0.00,$0.00
27860,ERX,HCPCS 63700001,00536-1106-88,NICOTINE 7 MG/24HR TD PT24,$7.19,$0.00,$7.19,$0.00,$5.13,$0.00,$0.00,$0.00,$0.00,$0.00,$7.19,$0.00,$3.60,$5.69,$5.75,$0.00,$0.00,$0.00,$0.00,$0.00
27860,ERX,HCPCS 63700001,70677-0030-01,NICOTINE 7 MG/24HR TD PT24,$7.19,$0.00,$7.19,$0.00,$5.13,$0.00,$0.00,$0.00,$0.00,$0.00,$7.19,$0.00,$3.60,$5.69,$5.75,$0.00,$0.00,$0.00,$0.00,$0.00
27862,ERX,HCPCS 63700001,,NICOTINE 14 MG/24HR TD PT24,$8.14,$0.00,$8.14,$0.00,$5.81,$0.00,$0.00,$0.00,$0.00,$0.00,$8.14,$0.00,$4.07,$6.45,$6.51,$0.00,$0.00,$0.00,$0.00,$0.00
27862,ERX,HCPCS 63700001,00536-5895-88,NICOTINE 14 MG/24HR TD PT24,$8.14,$0.00,$8.14,$0.00,$5.81,$0.00,$0.00,$0.00,$0.00,$0.00,$8.14,$0.00,$4.07,$6.45,$6.51,$0.00,$0.00,$0.00,$0.00,$0.00
27863,ERX,HCPCS 63700001,,NICOTINE 21 MG/24HR TD PT24,$7.19,$0.00,$7.19,$0.00,$5.13,$0.00,$0.00,$0.00,$0.00,$0.00,$7.19,$0.00,$3.60,$5.69,$5.75,$0.00,$0.00,$0.00,$0.00,$0.00
27863,ERX,HCPCS 63700001,00536-5896-71,NICOTINE 21 MG/24HR TD PT24,$7.19,$0.00,$7.19,$0.00,$5.13,$0.00,$0.00,$0.00,$0.00,$0.00,$7.19,$0.00,$3.60,$5.69,$5.75,$0.00,$0.00,$0.00,$0.00,$0.00
27863,ERX,HCPCS 63700001,00536-5896-88,NICOTINE 21 MG/24HR TD PT24,$7.19,$0.00,$7.19,$0.00,$5.13,$0.00,$0.00,$0.00,$0.00,$0.00,$7.19,$0.00,$3.60,$5.69,$5.75,$0.00,$0.00,$0.00,$0.00,$0.00
27863,ERX,HCPCS 63700001,43598-0448-71,NICOTINE 21 MG/24HR TD PT24,$7.19,$0.00,$7.19,$0.00,$5.13,$0.00,$0.00,$0.00,$0.00,$0.00,$7.19,$0.00,$3.60,$5.69,$5.75,$0.00,$0.00,$0.00,$0.00,$0.00
27863,ERX,HCPCS 63700001,49348-0144-46,NICOTINE 21 MG/24HR TD PT24,$7.19,$0.00,$7.19,$0.00,$5.13,$0.00,$0.00,$0.00,$0.00,$0.00,$7.19,$0.00,$3.60,$5.69,$5.75,$0.00,$0.00,$0.00,$0.00,$0.00
27863,ERX,HCPCS 63700001,70677-0032-01,NICOTINE 21 MG/24HR TD PT24,$7.19,$0.00,$7.19,$0.00,$5.13,$0.00,$0.00,$0.00,$0.00,$0.00,$7.19,$0.00,$3.60,$5.69,$5.75,$0.00,$0.00,$0.00,$0.00,$0.00
27898,ERX,HCPCS 25000001,00054-3500-49,LIDOCAINE VISCOUS HCL 2 % MT SOLN,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
27898,ERX,HCPCS 25000001,50383-0775-04,LIDOCAINE VISCOUS HCL 2 % MT SOLN,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
27898,ERX,HCPCS 25000001,50383-0775-17,LIDOCAINE VISCOUS HCL 2 % MT SOLN,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
27898,ERX,HCPCS 25000001,63739-0694-57,LIDOCAINE VISCOUS HCL 2 % MT SOLN,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
27898,ERX,HCPCS 25000001,99999-6007-04,LIDOCAINE VISCOUS HCL 2 % MT SOLN,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
27905,ERX,HCPCS 63700001,00378-9121-98,FENTANYL 25 MCG/HR TD PATCH 72 HR,$54.80,$0.00,$54.80,$0.00,$39.11,$0.00,$0.00,$0.00,$0.00,$0.00,$54.80,$0.00,$27.40,$43.40,$43.84,$0.00,$0.00,$0.00,$0.00,$0.00
27905,ERX,HCPCS 63700001,47781-0424-47,FENTANYL 25 MCG/HR TD PATCH 72 HR,$54.80,$0.00,$54.80,$0.00,$39.11,$0.00,$0.00,$0.00,$0.00,$0.00,$54.80,$0.00,$27.40,$43.40,$43.84,$0.00,$0.00,$0.00,$0.00,$0.00
27905,ERX,HCPCS 63700001,60505-7006-02,FENTANYL 25 MCG/HR TD PATCH 72 HR,$54.80,$0.00,$54.80,$0.00,$39.11,$0.00,$0.00,$0.00,$0.00,$0.00,$54.80,$0.00,$27.40,$43.40,$43.84,$0.00,$0.00,$0.00,$0.00,$0.00
27905,ERX,HCPCS 63700001,60505-7081-02,FENTANYL 25 MCG/HR TD PATCH 72 HR,$54.80,$0.00,$54.80,$0.00,$39.11,$0.00,$0.00,$0.00,$0.00,$0.00,$54.80,$0.00,$27.40,$43.40,$43.84,$0.00,$0.00,$0.00,$0.00,$0.00
27905,ERX,HCPCS 63700001,67767-0120-08,FENTANYL 25 MCG/HR TD PATCH 72 HR,$54.80,$0.00,$54.80,$0.00,$39.11,$0.00,$0.00,$0.00,$0.00,$0.00,$54.80,$0.00,$27.40,$43.40,$43.84,$0.00,$0.00,$0.00,$0.00,$0.00
27906,ERX,HCPCS 63700001,47781-0426-47,FENTANYL 50 MCG/HR TD PATCH 72 HR,$136.09,$0.00,$136.09,$0.00,$97.13,$0.00,$0.00,$0.00,$0.00,$0.00,$136.09,$0.00,$68.05,$107.78,$108.87,$0.00,$0.00,$0.00,$0.00,$0.00
27906,ERX,HCPCS 63700001,60505-7007-02,FENTANYL 50 MCG/HR TD PATCH 72 HR,$136.09,$0.00,$136.09,$0.00,$97.13,$0.00,$0.00,$0.00,$0.00,$0.00,$136.09,$0.00,$68.05,$107.78,$108.87,$0.00,$0.00,$0.00,$0.00,$0.00
27907,ERX,HCPCS 63700001,47781-0427-47,FENTANYL 75 MCG/HR TD PATCH 72 HR,$186.82,$0.00,$186.82,$0.00,$133.33,$0.00,$0.00,$0.00,$0.00,$0.00,$186.82,$0.00,$93.41,$147.96,$149.46,$0.00,$0.00,$0.00,$0.00,$0.00
27907,ERX,HCPCS 63700001,60505-7008-02,FENTANYL 75 MCG/HR TD PATCH 72 HR,$186.82,$0.00,$186.82,$0.00,$133.33,$0.00,$0.00,$0.00,$0.00,$0.00,$186.82,$0.00,$93.41,$147.96,$149.46,$0.00,$0.00,$0.00,$0.00,$0.00
27907,ERX,HCPCS 63700001,60505-7013-02,FENTANYL 75 MCG/HR TD PATCH 72 HR,$186.82,$0.00,$186.82,$0.00,$133.33,$0.00,$0.00,$0.00,$0.00,$0.00,$186.82,$0.00,$93.41,$147.96,$149.46,$0.00,$0.00,$0.00,$0.00,$0.00
27908,ERX,HCPCS 63700001,47781-0428-11,FENTANYL 100 MCG/HR TD PATCH 72 HR,$247.95,$0.00,$247.95,$0.00,$176.96,$0.00,$0.00,$0.00,$0.00,$0.00,$247.95,$0.00,$123.98,$196.38,$198.36,$0.00,$0.00,$0.00,$0.00,$0.00
27908,ERX,HCPCS 63700001,47781-0428-47,FENTANYL 100 MCG/HR TD PATCH 72 HR,$247.95,$0.00,$247.95,$0.00,$176.96,$0.00,$0.00,$0.00,$0.00,$0.00,$247.95,$0.00,$123.98,$196.38,$198.36,$0.00,$0.00,$0.00,$0.00,$0.00
27908,ERX,HCPCS 63700001,60505-7009-02,FENTANYL 100 MCG/HR TD PATCH 72 HR,$247.95,$0.00,$247.95,$0.00,$176.96,$0.00,$0.00,$0.00,$0.00,$0.00,$247.95,$0.00,$123.98,$196.38,$198.36,$0.00,$0.00,$0.00,$0.00,$0.00
27999,ERX,HCPCS 25000001,00574-2002-02,SODIUM POLYSTYRENE SULFONATE 15 GM/60ML PO SUSP,$42.87,$0.00,$42.87,$0.00,$30.60,$0.00,$0.00,$0.00,$0.00,$0.00,$42.87,$0.00,$21.44,$33.95,$34.30,$0.00,$0.00,$0.00,$0.00,$0.00
27999,ERX,HCPCS 25000001,00574-2002-16,SODIUM POLYSTYRENE SULFONATE 15 GM/60ML PO SUSP,$42.87,$0.00,$42.87,$0.00,$30.60,$0.00,$0.00,$0.00,$0.00,$0.00,$42.87,$0.00,$21.44,$33.95,$34.30,$0.00,$0.00,$0.00,$0.00,$0.00
27999,ERX,HCPCS 25000001,46287-0006-01,SODIUM POLYSTYRENE SULFONATE 15 GM/60ML PO SUSP,$42.87,$0.00,$42.87,$0.00,$30.60,$0.00,$0.00,$0.00,$0.00,$0.00,$42.87,$0.00,$21.44,$33.95,$34.30,$0.00,$0.00,$0.00,$0.00,$0.00
27999,ERX,HCPCS 25000001,46287-0006-60,SODIUM POLYSTYRENE SULFONATE 15 GM/60ML PO SUSP,$42.87,$0.00,$42.87,$0.00,$30.60,$0.00,$0.00,$0.00,$0.00,$0.00,$42.87,$0.00,$21.44,$33.95,$34.30,$0.00,$0.00,$0.00,$0.00,$0.00
27999,ERX,HCPCS 25000001,99999-6010-75,SODIUM POLYSTYRENE SULFONATE 15 GM/60ML PO SUSP,$42.87,$0.00,$42.87,$0.00,$30.60,$0.00,$0.00,$0.00,$0.00,$0.00,$42.87,$0.00,$21.44,$33.95,$34.30,$0.00,$0.00,$0.00,$0.00,$0.00
28001,ERX,HCPCS 25000001,00093-9614-13,SILVER NITRATE 0.5 % EX SOLN,$266.12,$0.00,$266.12,$0.00,$189.93,$0.00,$0.00,$0.00,$0.00,$0.00,$266.12,$0.00,$133.06,$210.77,$212.90,$0.00,$0.00,$0.00,$0.00,$0.00
28158,ERX,HCPCS 63700001,00904-6287-06,OLANZAPINE 20 MG PO TABS,$139.41,$0.00,$139.41,$0.00,$99.50,$0.00,$0.00,$0.00,$0.00,$0.00,$139.41,$0.00,$69.71,$110.41,$111.53,$0.00,$0.00,$0.00,$0.00,$0.00
28158,ERX,HCPCS 63700001,55111-0168-30,OLANZAPINE 20 MG PO TABS,$139.41,$0.00,$139.41,$0.00,$99.50,$0.00,$0.00,$0.00,$0.00,$0.00,$139.41,$0.00,$69.71,$110.41,$111.53,$0.00,$0.00,$0.00,$0.00,$0.00
28158,ERX,HCPCS 63700001,60505-3140-00,OLANZAPINE 20 MG PO TABS,$139.41,$0.00,$139.41,$0.00,$99.50,$0.00,$0.00,$0.00,$0.00,$0.00,$139.41,$0.00,$69.71,$110.41,$111.53,$0.00,$0.00,$0.00,$0.00,$0.00
28159,ERX,HCPCS 63700001,00002-4453-01,OLANZAPINE 5 MG PO TBDP,$53.20,$0.00,$53.20,$0.00,$37.97,$0.00,$0.00,$0.00,$0.00,$0.00,$53.20,$0.00,$26.60,$42.13,$42.56,$0.00,$0.00,$0.00,$0.00,$0.00
28159,ERX,HCPCS 63700001,00002-4453-85,OLANZAPINE 5 MG PO TBDP,$53.20,$0.00,$53.20,$0.00,$37.97,$0.00,$0.00,$0.00,$0.00,$0.00,$53.20,$0.00,$26.60,$42.13,$42.56,$0.00,$0.00,$0.00,$0.00,$0.00
28159,ERX,HCPCS 63700001,00093-5245-65,OLANZAPINE 5 MG PO TBDP,$53.20,$0.00,$53.20,$0.00,$37.97,$0.00,$0.00,$0.00,$0.00,$0.00,$53.20,$0.00,$26.60,$42.13,$42.56,$0.00,$0.00,$0.00,$0.00,$0.00
28159,ERX,HCPCS 63700001,13668-0086-30,OLANZAPINE 5 MG PO TBDP,$53.20,$0.00,$53.20,$0.00,$37.97,$0.00,$0.00,$0.00,$0.00,$0.00,$53.20,$0.00,$26.60,$42.13,$42.56,$0.00,$0.00,$0.00,$0.00,$0.00
28159,ERX,HCPCS 63700001,33342-0083-07,OLANZAPINE 5 MG PO TBDP,$53.20,$0.00,$53.20,$0.00,$37.97,$0.00,$0.00,$0.00,$0.00,$0.00,$53.20,$0.00,$26.60,$42.13,$42.56,$0.00,$0.00,$0.00,$0.00,$0.00
28159,ERX,HCPCS 63700001,49884-0320-55,OLANZAPINE 5 MG PO TBDP,$53.20,$0.00,$53.20,$0.00,$37.97,$0.00,$0.00,$0.00,$0.00,$0.00,$53.20,$0.00,$26.60,$42.13,$42.56,$0.00,$0.00,$0.00,$0.00,$0.00
28159,ERX,HCPCS 63700001,50268-0615-11,OLANZAPINE 5 MG PO TBDP,$53.20,$0.00,$53.20,$0.00,$37.97,$0.00,$0.00,$0.00,$0.00,$0.00,$53.20,$0.00,$26.60,$42.13,$42.56,$0.00,$0.00,$0.00,$0.00,$0.00
28159,ERX,HCPCS 63700001,50268-0615-13,OLANZAPINE 5 MG PO TBDP,$53.20,$0.00,$53.20,$0.00,$37.97,$0.00,$0.00,$0.00,$0.00,$0.00,$53.20,$0.00,$26.60,$42.13,$42.56,$0.00,$0.00,$0.00,$0.00,$0.00
28159,ERX,HCPCS 63700001,55111-0262-81,OLANZAPINE 5 MG PO TBDP,$53.20,$0.00,$53.20,$0.00,$37.97,$0.00,$0.00,$0.00,$0.00,$0.00,$53.20,$0.00,$26.60,$42.13,$42.56,$0.00,$0.00,$0.00,$0.00,$0.00
28159,ERX,HCPCS 63700001,60505-3275-00,OLANZAPINE 5 MG PO TBDP,$53.20,$0.00,$53.20,$0.00,$37.97,$0.00,$0.00,$0.00,$0.00,$0.00,$53.20,$0.00,$26.60,$42.13,$42.56,$0.00,$0.00,$0.00,$0.00,$0.00
28159,ERX,HCPCS 63700001,60505-3275-03,OLANZAPINE 5 MG PO TBDP,$53.20,$0.00,$53.20,$0.00,$37.97,$0.00,$0.00,$0.00,$0.00,$0.00,$53.20,$0.00,$26.60,$42.13,$42.56,$0.00,$0.00,$0.00,$0.00,$0.00
28160,ERX,HCPCS 63700001,00002-4454-01,OLANZAPINE 10 MG PO TBDP,$72.34,$0.00,$72.34,$0.00,$51.63,$0.00,$0.00,$0.00,$0.00,$0.00,$72.34,$0.00,$36.17,$57.29,$57.87,$0.00,$0.00,$0.00,$0.00,$0.00
28160,ERX,HCPCS 63700001,00002-4454-85,OLANZAPINE 10 MG PO TBDP,$72.34,$0.00,$72.34,$0.00,$51.63,$0.00,$0.00,$0.00,$0.00,$0.00,$72.34,$0.00,$36.17,$57.29,$57.87,$0.00,$0.00,$0.00,$0.00,$0.00
28160,ERX,HCPCS 63700001,13668-0088-30,OLANZAPINE 10 MG PO TBDP,$72.34,$0.00,$72.34,$0.00,$51.63,$0.00,$0.00,$0.00,$0.00,$0.00,$72.34,$0.00,$36.17,$57.29,$57.87,$0.00,$0.00,$0.00,$0.00,$0.00
28160,ERX,HCPCS 63700001,49884-0321-55,OLANZAPINE 10 MG PO TBDP,$72.34,$0.00,$72.34,$0.00,$51.63,$0.00,$0.00,$0.00,$0.00,$0.00,$72.34,$0.00,$36.17,$57.29,$57.87,$0.00,$0.00,$0.00,$0.00,$0.00
28160,ERX,HCPCS 63700001,50268-0616-13,OLANZAPINE 10 MG PO TBDP,$72.34,$0.00,$72.34,$0.00,$51.63,$0.00,$0.00,$0.00,$0.00,$0.00,$72.34,$0.00,$36.17,$57.29,$57.87,$0.00,$0.00,$0.00,$0.00,$0.00
28160,ERX,HCPCS 63700001,55111-0263-81,OLANZAPINE 10 MG PO TBDP,$72.34,$0.00,$72.34,$0.00,$51.63,$0.00,$0.00,$0.00,$0.00,$0.00,$72.34,$0.00,$36.17,$57.29,$57.87,$0.00,$0.00,$0.00,$0.00,$0.00
28160,ERX,HCPCS 63700001,59746-0307-32,OLANZAPINE 10 MG PO TBDP,$72.34,$0.00,$72.34,$0.00,$51.63,$0.00,$0.00,$0.00,$0.00,$0.00,$72.34,$0.00,$36.17,$57.29,$57.87,$0.00,$0.00,$0.00,$0.00,$0.00
28160,ERX,HCPCS 63700001,60505-3276-00,OLANZAPINE 10 MG PO TBDP,$72.34,$0.00,$72.34,$0.00,$51.63,$0.00,$0.00,$0.00,$0.00,$0.00,$72.34,$0.00,$36.17,$57.29,$57.87,$0.00,$0.00,$0.00,$0.00,$0.00
28160,ERX,HCPCS 63700001,60505-3276-03,OLANZAPINE 10 MG PO TBDP,$72.34,$0.00,$72.34,$0.00,$51.63,$0.00,$0.00,$0.00,$0.00,$0.00,$72.34,$0.00,$36.17,$57.29,$57.87,$0.00,$0.00,$0.00,$0.00,$0.00
28161,ERX,HCPCS 63700001,13668-0089-30,OLANZAPINE 15 MG PO TBDP,$106.17,$0.00,$106.17,$0.00,$75.77,$0.00,$0.00,$0.00,$0.00,$0.00,$106.17,$0.00,$53.09,$84.09,$84.94,$0.00,$0.00,$0.00,$0.00,$0.00
28161,ERX,HCPCS 63700001,33342-0085-07,OLANZAPINE 15 MG PO TBDP,$106.17,$0.00,$106.17,$0.00,$75.77,$0.00,$0.00,$0.00,$0.00,$0.00,$106.17,$0.00,$53.09,$84.09,$84.94,$0.00,$0.00,$0.00,$0.00,$0.00
28161,ERX,HCPCS 63700001,49884-0322-52,OLANZAPINE 15 MG PO TBDP,$106.17,$0.00,$106.17,$0.00,$75.77,$0.00,$0.00,$0.00,$0.00,$0.00,$106.17,$0.00,$53.09,$84.09,$84.94,$0.00,$0.00,$0.00,$0.00,$0.00
28162,ERX,HCPCS 63700001,00002-4456-01,OLANZAPINE 20 MG PO TBDP,$140.00,$0.00,$140.00,$0.00,$99.92,$0.00,$0.00,$0.00,$0.00,$0.00,$140.00,$0.00,$70.00,$110.88,$112.00,$0.00,$0.00,$0.00,$0.00,$0.00
28162,ERX,HCPCS 63700001,00002-4456-85,OLANZAPINE 20 MG PO TBDP,$140.00,$0.00,$140.00,$0.00,$99.92,$0.00,$0.00,$0.00,$0.00,$0.00,$140.00,$0.00,$70.00,$110.88,$112.00,$0.00,$0.00,$0.00,$0.00,$0.00
28162,ERX,HCPCS 63700001,00093-5248-65,OLANZAPINE 20 MG PO TBDP,$140.00,$0.00,$140.00,$0.00,$99.92,$0.00,$0.00,$0.00,$0.00,$0.00,$140.00,$0.00,$70.00,$110.88,$112.00,$0.00,$0.00,$0.00,$0.00,$0.00
28162,ERX,HCPCS 63700001,13668-0090-30,OLANZAPINE 20 MG PO TBDP,$140.00,$0.00,$140.00,$0.00,$99.92,$0.00,$0.00,$0.00,$0.00,$0.00,$140.00,$0.00,$70.00,$110.88,$112.00,$0.00,$0.00,$0.00,$0.00,$0.00
28162,ERX,HCPCS 63700001,55111-0265-81,OLANZAPINE 20 MG PO TBDP,$140.00,$0.00,$140.00,$0.00,$99.92,$0.00,$0.00,$0.00,$0.00,$0.00,$140.00,$0.00,$70.00,$110.88,$112.00,$0.00,$0.00,$0.00,$0.00,$0.00
28162,ERX,HCPCS 63700001,60505-3278-00,OLANZAPINE 20 MG PO TBDP,$140.00,$0.00,$140.00,$0.00,$99.92,$0.00,$0.00,$0.00,$0.00,$0.00,$140.00,$0.00,$70.00,$110.88,$112.00,$0.00,$0.00,$0.00,$0.00,$0.00
28162,ERX,HCPCS 63700001,60505-3278-03,OLANZAPINE 20 MG PO TBDP,$140.00,$0.00,$140.00,$0.00,$99.92,$0.00,$0.00,$0.00,$0.00,$0.00,$140.00,$0.00,$70.00,$110.88,$112.00,$0.00,$0.00,$0.00,$0.00,$0.00
28188,ERX,HCPCS 25000001,67618-0200-08,CHLORHEXIDINE GLUCONATE 4 % EX LIQD,$33.33,$0.00,$33.33,$0.00,$23.79,$0.00,$0.00,$0.00,$0.00,$0.00,$33.33,$0.00,$16.67,$26.40,$26.66,$0.00,$0.00,$0.00,$0.00,$0.00
28203,ERX,HCPCS 25000001,00378-9055-16,LIDOCAINE 5 % EX PTCH,$35.57,$0.00,$35.57,$0.00,$25.39,$0.00,$0.00,$0.00,$0.00,$0.00,$35.57,$0.00,$17.79,$28.17,$28.46,$0.00,$0.00,$0.00,$0.00,$0.00
28203,ERX,HCPCS 25000001,00591-2679-30,LIDOCAINE 5 % EX PTCH,$35.57,$0.00,$35.57,$0.00,$25.39,$0.00,$0.00,$0.00,$0.00,$0.00,$35.57,$0.00,$17.79,$28.17,$28.46,$0.00,$0.00,$0.00,$0.00,$0.00
28203,ERX,HCPCS 25000001,00591-3525-30,LIDOCAINE 5 % EX PTCH,$35.57,$0.00,$35.57,$0.00,$25.39,$0.00,$0.00,$0.00,$0.00,$0.00,$35.57,$0.00,$17.79,$28.17,$28.46,$0.00,$0.00,$0.00,$0.00,$0.00
28203,ERX,HCPCS 25000001,00603-1880-10,LIDOCAINE 5 % EX PTCH,$35.57,$0.00,$35.57,$0.00,$25.39,$0.00,$0.00,$0.00,$0.00,$0.00,$35.57,$0.00,$17.79,$28.17,$28.46,$0.00,$0.00,$0.00,$0.00,$0.00
28203,ERX,HCPCS 25000001,00603-1880-16,LIDOCAINE 5 % EX PTCH,$35.57,$0.00,$35.57,$0.00,$25.39,$0.00,$0.00,$0.00,$0.00,$0.00,$35.57,$0.00,$17.79,$28.17,$28.46,$0.00,$0.00,$0.00,$0.00,$0.00
28205,ERX,HCPCS 25000001,00295-1201-31,PEPPERMINT SPIRIT SPRT,$33.86,$0.00,$33.86,$0.00,$24.17,$0.00,$0.00,$0.00,$0.00,$0.00,$33.86,$0.00,$16.93,$26.82,$27.09,$0.00,$0.00,$0.00,$0.00,$0.00
28205,ERX,HCPCS 25000001,00395-2243-91,PEPPERMINT SPIRIT SPRT,$33.86,$0.00,$33.86,$0.00,$24.17,$0.00,$0.00,$0.00,$0.00,$0.00,$33.86,$0.00,$16.93,$26.82,$27.09,$0.00,$0.00,$0.00,$0.00,$0.00
28224,ERX,HCPCS 63700001,00904-6553-04,LINEZOLID 600 MG PO TABS,$540.82,$0.00,$540.82,$0.00,$385.98,$0.00,$0.00,$0.00,$0.00,$0.00,$540.82,$0.00,$270.41,$428.33,$432.66,$0.00,$0.00,$0.00,$0.00,$0.00
28224,ERX,HCPCS 63700001,59762-1307-02,LINEZOLID 600 MG PO TABS,$540.82,$0.00,$540.82,$0.00,$385.98,$0.00,$0.00,$0.00,$0.00,$0.00,$540.82,$0.00,$270.41,$428.33,$432.66,$0.00,$0.00,$0.00,$0.00,$0.00
28224,ERX,HCPCS 63700001,65162-0777-02,LINEZOLID 600 MG PO TABS,$540.82,$0.00,$540.82,$0.00,$385.98,$0.00,$0.00,$0.00,$0.00,$0.00,$540.82,$0.00,$270.41,$428.33,$432.66,$0.00,$0.00,$0.00,$0.00,$0.00
28224,ERX,HCPCS 63700001,67877-0419-20,LINEZOLID 600 MG PO TABS,$540.82,$0.00,$540.82,$0.00,$385.98,$0.00,$0.00,$0.00,$0.00,$0.00,$540.82,$0.00,$270.41,$428.33,$432.66,$0.00,$0.00,$0.00,$0.00,$0.00
28225,ERX,HCPCS 25000001,00009-5136-01,LINEZOLID 100 MG/5ML PO SUSR,"$1,934.64",$0.00,"$1,934.64",$0.00,"$1,380.75",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,934.64",$0.00,$967.32,"$1,532.23","$1,547.71",$0.00,$0.00,$0.00,$0.00,$0.00
28225,ERX,HCPCS 25000001,00054-0319-50,LINEZOLID 100 MG/5ML PO SUSR,"$1,934.64",$0.00,"$1,934.64",$0.00,"$1,380.75",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,934.64",$0.00,$967.32,"$1,532.23","$1,547.71",$0.00,$0.00,$0.00,$0.00,$0.00
28225,ERX,HCPCS 25000001,59762-1308-01,LINEZOLID 100 MG/5ML PO SUSR,"$1,934.64",$0.00,"$1,934.64",$0.00,"$1,380.75",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,934.64",$0.00,$967.32,"$1,532.23","$1,547.71",$0.00,$0.00,$0.00,$0.00,$0.00
28246,ERX,HCPCS 25000001,00173-0520-00,SALMETEROL XINAFOATE 50 MCG/DOSE IN AEPB,$38.38,$0.00,$38.38,$0.00,$27.39,$0.00,$0.00,$0.00,$0.00,$0.00,$38.38,$0.00,$19.19,$30.40,$30.70,$0.00,$0.00,$0.00,$0.00,$0.00
28252,ERX,HCPCS 63700001,00115-5522-10,FENOFIBRATE 160 MG PO TABS,$9.03,$0.00,$9.03,$0.00,$6.44,$0.00,$0.00,$0.00,$0.00,$0.00,$9.03,$0.00,$4.52,$7.15,$7.22,$0.00,$0.00,$0.00,$0.00,$0.00
28252,ERX,HCPCS 63700001,42858-0660-45,FENOFIBRATE 160 MG PO TABS,$9.03,$0.00,$9.03,$0.00,$6.44,$0.00,$0.00,$0.00,$0.00,$0.00,$9.03,$0.00,$4.52,$7.15,$7.22,$0.00,$0.00,$0.00,$0.00,$0.00
28252,ERX,HCPCS 63700001,68180-0363-09,FENOFIBRATE 160 MG PO TABS,$9.03,$0.00,$9.03,$0.00,$6.44,$0.00,$0.00,$0.00,$0.00,$0.00,$9.03,$0.00,$4.52,$7.15,$7.22,$0.00,$0.00,$0.00,$0.00,$0.00
28278,ERX,HCPCS 63700001,55111-0352-60,RIVASTIGMINE TARTRATE 1.5 MG PO CAPS,$16.13,$0.00,$16.13,$0.00,$11.51,$0.00,$0.00,$0.00,$0.00,$0.00,$16.13,$0.00,$8.07,$12.77,$12.90,$0.00,$0.00,$0.00,$0.00,$0.00
28278,ERX,HCPCS 63700001,63739-0576-10,RIVASTIGMINE TARTRATE 1.5 MG PO CAPS,$16.13,$0.00,$16.13,$0.00,$11.51,$0.00,$0.00,$0.00,$0.00,$0.00,$16.13,$0.00,$8.07,$12.77,$12.90,$0.00,$0.00,$0.00,$0.00,$0.00
28279,ERX,HCPCS 63700001,55111-0353-60,RIVASTIGMINE TARTRATE 3 MG PO CAPS,$15.33,$0.00,$15.33,$0.00,$10.94,$0.00,$0.00,$0.00,$0.00,$0.00,$15.33,$0.00,$7.67,$12.14,$12.26,$0.00,$0.00,$0.00,$0.00,$0.00
28279,ERX,HCPCS 63700001,63739-0577-10,RIVASTIGMINE TARTRATE 3 MG PO CAPS,$15.33,$0.00,$15.33,$0.00,$10.94,$0.00,$0.00,$0.00,$0.00,$0.00,$15.33,$0.00,$7.67,$12.14,$12.26,$0.00,$0.00,$0.00,$0.00,$0.00
28280,ERX,HCPCS 63700001,00781-2616-60,RIVASTIGMINE TARTRATE 4.5 MG PO CAPS,$16.04,$0.00,$16.04,$0.00,$11.45,$0.00,$0.00,$0.00,$0.00,$0.00,$16.04,$0.00,$8.02,$12.70,$12.83,$0.00,$0.00,$0.00,$0.00,$0.00
28280,ERX,HCPCS 63700001,62756-0147-86,RIVASTIGMINE TARTRATE 4.5 MG PO CAPS,$16.04,$0.00,$16.04,$0.00,$11.45,$0.00,$0.00,$0.00,$0.00,$0.00,$16.04,$0.00,$8.02,$12.70,$12.83,$0.00,$0.00,$0.00,$0.00,$0.00
28280,ERX,HCPCS 63700001,63739-0578-10,RIVASTIGMINE TARTRATE 4.5 MG PO CAPS,$16.04,$0.00,$16.04,$0.00,$11.45,$0.00,$0.00,$0.00,$0.00,$0.00,$16.04,$0.00,$8.02,$12.70,$12.83,$0.00,$0.00,$0.00,$0.00,$0.00
28281,ERX,HCPCS 63700001,00781-2617-60,RIVASTIGMINE TARTRATE 6 MG PO CAPS,$26.14,$0.00,$26.14,$0.00,$11.51,$0.00,$0.00,$0.00,$0.00,$0.00,$26.14,$0.00,$13.07,$20.70,$20.91,$0.00,$0.00,$0.00,$0.00,$0.00
28281,ERX,HCPCS 63700001,51991-0796-06,RIVASTIGMINE TARTRATE 6 MG PO CAPS,$26.14,$0.00,$26.14,$0.00,$11.51,$0.00,$0.00,$0.00,$0.00,$0.00,$26.14,$0.00,$13.07,$20.70,$20.91,$0.00,$0.00,$0.00,$0.00,$0.00
28281,ERX,HCPCS 63700001,55111-0355-60,RIVASTIGMINE TARTRATE 6 MG PO CAPS,$26.14,$0.00,$26.14,$0.00,$11.51,$0.00,$0.00,$0.00,$0.00,$0.00,$26.14,$0.00,$13.07,$20.70,$20.91,$0.00,$0.00,$0.00,$0.00,$0.00
28282,ERX,HCPCS J1815,00088-2220-33,INSULIN GLARGINE (LANTUS) 100 UNIT/ML SC SOLN,$12.50,$0.00,$201.38,$6.79,$8.92,$0.00,$72.85,$0.00,$0.00,$2.19,$12.50,$0.00,$6.25,$9.90,$10.00,$0.00,$0.00,$0.00,$201.38,$0.00
28372,ERX,HCPCS 25000001,65597-0701-18,COLESEVELAM HCL 625 MG PO TABS,$16.97,$0.00,$16.97,$0.00,$12.11,$0.00,$0.00,$0.00,$0.00,$0.00,$16.97,$0.00,$8.49,$13.44,$13.58,$0.00,$0.00,$0.00,$0.00,$0.00
28372,ERX,HCPCS 25000001,67877-0506-51,COLESEVELAM HCL 625 MG PO TABS,$16.97,$0.00,$16.97,$0.00,$12.11,$0.00,$0.00,$0.00,$0.00,$0.00,$16.97,$0.00,$8.49,$13.44,$13.58,$0.00,$0.00,$0.00,$0.00,$0.00
28400,ERX,HCPCS 25000001,52919-0006-05,STERILE WATER FOR INJECTION IV SOLN,$22.00,$0.00,$34.20,$0.00,$24.41,$0.00,$0.00,$0.00,$0.00,$0.00,$34.20,$0.00,$17.10,$17.42,$27.36,$0.00,$0.00,$0.00,$0.00,$0.00
28400,ERX,HCPCS 25000001,52919-0011-04,STERILE WATER FOR INJECTION IV SOLN,$22.00,$0.00,$34.20,$0.00,$24.41,$0.00,$0.00,$0.00,$0.00,$0.00,$34.20,$0.00,$17.10,$17.42,$27.36,$0.00,$0.00,$0.00,$0.00,$0.00
28400,ERX,HCPCS 25000001,00264-7850-10,STERILE WATER FOR INJECTION IV SOLN,$22.00,$0.00,$34.20,$0.00,$24.41,$0.00,$0.00,$0.00,$0.00,$0.00,$34.20,$0.00,$17.10,$17.42,$27.36,$0.00,$0.00,$0.00,$0.00,$0.00
28400,ERX,HCPCS 25000001,00264-7385-50,STERILE WATER FOR INJECTION IV SOLN,$22.80,$0.00,$34.20,$0.00,$24.41,$0.00,$0.00,$0.00,$0.00,$0.00,$34.20,$0.00,$17.10,$18.06,$27.36,$0.00,$0.00,$0.00,$0.00,$0.00
28400,ERX,HCPCS 25000001,00264-7850-00,STERILE WATER FOR INJECTION IV SOLN,$34.20,$0.00,$34.20,$0.00,$24.41,$0.00,$0.00,$0.00,$0.00,$0.00,$34.20,$0.00,$17.10,$27.09,$27.36,$0.00,$0.00,$0.00,$0.00,$0.00
28400,ERX,HCPCS 25000001,00338-0013-04,STERILE WATER FOR INJECTION IV SOLN,$34.20,$0.00,$34.20,$0.00,$24.41,$0.00,$0.00,$0.00,$0.00,$0.00,$34.20,$0.00,$17.10,$27.09,$27.36,$0.00,$0.00,$0.00,$0.00,$0.00
28558,ERX,HCPCS 25000001,00023-5902-04,TRIPTORELIN PAMOATE 3.75 MG IM SUSR,"$2,342.14",$0.00,"$2,342.14",$0.00,"$1,671.59",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,342.14",$0.00,"$1,171.07","$1,854.97","$1,873.71",$0.00,$0.00,$0.00,$0.00,$0.00
28643,ERX,HCPCS 63700001,50742-0260-01,NIFEDIPINE ER OSMOTIC RELEASE 30 MG PO TB24,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
28643,ERX,HCPCS 63700001,62175-0260-55,NIFEDIPINE ER OSMOTIC RELEASE 30 MG PO TB24,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
28643,ERX,HCPCS 63700001,71205-0963-00,NIFEDIPINE ER OSMOTIC RELEASE 30 MG PO TB24,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
28645,ERX,HCPCS 63700001,00378-3953-77,ATORVASTATIN CALCIUM 80 MG PO TABS,$7.38,$0.00,$7.38,$0.00,$5.27,$0.00,$0.00,$0.00,$0.00,$0.00,$7.38,$0.00,$3.69,$5.84,$5.90,$0.00,$0.00,$0.00,$0.00,$0.00
28645,ERX,HCPCS 63700001,00904-6293-04,ATORVASTATIN CALCIUM 80 MG PO TABS,$7.38,$0.00,$7.38,$0.00,$5.27,$0.00,$0.00,$0.00,$0.00,$0.00,$7.38,$0.00,$3.69,$5.84,$5.90,$0.00,$0.00,$0.00,$0.00,$0.00
28645,ERX,HCPCS 63700001,16714-0877-01,ATORVASTATIN CALCIUM 80 MG PO TABS,$7.38,$0.00,$7.38,$0.00,$5.27,$0.00,$0.00,$0.00,$0.00,$0.00,$7.38,$0.00,$3.69,$5.84,$5.90,$0.00,$0.00,$0.00,$0.00,$0.00
28645,ERX,HCPCS 63700001,51079-0211-01,ATORVASTATIN CALCIUM 80 MG PO TABS,$7.38,$0.00,$7.38,$0.00,$5.27,$0.00,$0.00,$0.00,$0.00,$0.00,$7.38,$0.00,$3.69,$5.84,$5.90,$0.00,$0.00,$0.00,$0.00,$0.00
28645,ERX,HCPCS 63700001,51079-0211-03,ATORVASTATIN CALCIUM 80 MG PO TABS,$7.38,$0.00,$7.38,$0.00,$5.27,$0.00,$0.00,$0.00,$0.00,$0.00,$7.38,$0.00,$3.69,$5.84,$5.90,$0.00,$0.00,$0.00,$0.00,$0.00
28686,ERX,HCPCS 63700001,68462-0402-01,ATOVAQUONE-PROGUANIL HCL 62.5-25 MG PO TABS,$20.41,$0.00,$20.41,$0.00,$14.57,$0.00,$0.00,$0.00,$0.00,$0.00,$20.41,$0.00,$10.21,$16.16,$16.33,$0.00,$0.00,$0.00,$0.00,$0.00
28774,ERX,HCPCS J7626,00487-9601-01,BUDESONIDE 0.25 MG/2ML IN SUSP,$22.61,$0.00,$22.61,$0.00,$16.14,$0.00,$0.00,$0.00,$0.00,$0.00,$22.61,$0.00,$11.31,$17.91,$18.09,$0.00,$0.00,$0.00,$0.00,$0.00
28774,ERX,HCPCS J7626,00487-9601-30,BUDESONIDE 0.25 MG/2ML IN SUSP,$22.61,$0.00,$22.61,$0.00,$16.14,$0.00,$0.00,$0.00,$0.00,$0.00,$22.61,$0.00,$11.31,$17.91,$18.09,$0.00,$0.00,$0.00,$0.00,$0.00
28774,ERX,HCPCS J7626,69097-0318-87,BUDESONIDE 0.25 MG/2ML IN SUSP,$22.61,$0.00,$22.61,$0.00,$16.14,$0.00,$0.00,$0.00,$0.00,$0.00,$22.61,$0.00,$11.31,$17.91,$18.09,$0.00,$0.00,$0.00,$0.00,$0.00
28775,ERX,HCPCS J7626,00093-6816-73,BUDESONIDE 0.5 MG/2ML IN SUSP,$46.78,$0.00,$46.78,$0.00,$33.39,$0.00,$0.00,$0.00,$0.00,$0.00,$46.78,$0.00,$23.39,$37.05,$37.42,$0.00,$0.00,$0.00,$0.00,$0.00
28775,ERX,HCPCS J7626,00186-1989-04,BUDESONIDE 0.5 MG/2ML IN SUSP,$46.78,$0.00,$46.78,$0.00,$33.39,$0.00,$0.00,$0.00,$0.00,$0.00,$46.78,$0.00,$23.39,$37.05,$37.42,$0.00,$0.00,$0.00,$0.00,$0.00
28775,ERX,HCPCS J7626,00487-9701-01,BUDESONIDE 0.5 MG/2ML IN SUSP,$46.78,$0.00,$46.78,$0.00,$33.39,$0.00,$0.00,$0.00,$0.00,$0.00,$46.78,$0.00,$23.39,$37.05,$37.42,$0.00,$0.00,$0.00,$0.00,$0.00
28775,ERX,HCPCS J7626,00487-9701-30,BUDESONIDE 0.5 MG/2ML IN SUSP,$46.78,$0.00,$46.78,$0.00,$33.39,$0.00,$0.00,$0.00,$0.00,$0.00,$46.78,$0.00,$23.39,$37.05,$37.42,$0.00,$0.00,$0.00,$0.00,$0.00
28775,ERX,HCPCS J7626,00781-7516-87,BUDESONIDE 0.5 MG/2ML IN SUSP,$46.78,$0.00,$46.78,$0.00,$33.39,$0.00,$0.00,$0.00,$0.00,$0.00,$46.78,$0.00,$23.39,$37.05,$37.42,$0.00,$0.00,$0.00,$0.00,$0.00
28775,ERX,HCPCS J7626,69097-0319-86,BUDESONIDE 0.5 MG/2ML IN SUSP,$46.78,$0.00,$46.78,$0.00,$33.39,$0.00,$0.00,$0.00,$0.00,$0.00,$46.78,$0.00,$23.39,$37.05,$37.42,$0.00,$0.00,$0.00,$0.00,$0.00
28775,ERX,HCPCS J7626,69097-0319-87,BUDESONIDE 0.5 MG/2ML IN SUSP,$46.78,$0.00,$46.78,$0.00,$33.39,$0.00,$0.00,$0.00,$0.00,$0.00,$46.78,$0.00,$23.39,$37.05,$37.42,$0.00,$0.00,$0.00,$0.00,$0.00
28810,ERX,HCPCS 25000001,24208-0635-62,NEOMYCIN-POLYMYXIN-HC 3.5-10000-1 OT SUSP,$307.08,$0.00,$307.08,$0.00,$219.16,$0.00,$0.00,$0.00,$0.00,$0.00,$307.08,$0.00,$153.54,$243.21,$245.66,$0.00,$0.00,$0.00,$0.00,$0.00
28810,ERX,HCPCS 25000001,61314-0645-11,NEOMYCIN-POLYMYXIN-HC 3.5-10000-1 OT SUSP,$307.08,$0.00,$307.08,$0.00,$219.16,$0.00,$0.00,$0.00,$0.00,$0.00,$307.08,$0.00,$153.54,$243.21,$245.66,$0.00,$0.00,$0.00,$0.00,$0.00
28824,ERX,HCPCS 25000001,10631-0407-01,HYDROCORTISONE (PERIANAL) 2.5 % EX CREA,$275.06,$0.00,$291.06,$0.00,$207.73,$0.00,$0.00,$0.00,$0.00,$0.00,$291.06,$0.00,$145.53,$217.85,$220.05,$0.00,$0.00,$0.00,$0.00,$0.00
28824,ERX,HCPCS 25000001,64980-0301-30,HYDROCORTISONE (PERIANAL) 2.5 % EX CREA,$291.06,$0.00,$291.06,$0.00,$207.73,$0.00,$0.00,$0.00,$0.00,$0.00,$291.06,$0.00,$145.53,$230.52,$220.05,$0.00,$0.00,$0.00,$0.00,$0.00
28836,ERX,HCPCS 63700001,00121-0431-30,MAGNESIUM HYDROXIDE 400 MG/5ML PO SUSP,$11.00,$0.00,$11.00,$0.00,$7.85,$0.00,$0.00,$0.00,$0.00,$0.00,$11.00,$0.00,$5.50,$8.71,$8.80,$0.00,$0.00,$0.00,$0.00,$0.00
28836,ERX,HCPCS 63700001,00536-2470-85,MAGNESIUM HYDROXIDE 400 MG/5ML PO SUSP,$11.00,$0.00,$11.00,$0.00,$7.85,$0.00,$0.00,$0.00,$0.00,$0.00,$11.00,$0.00,$5.50,$8.71,$8.80,$0.00,$0.00,$0.00,$0.00,$0.00
28836,ERX,HCPCS 63700001,99999-6006-91,MAGNESIUM HYDROXIDE 400 MG/5ML PO SUSP,$11.00,$0.00,$11.00,$0.00,$7.85,$0.00,$0.00,$0.00,$0.00,$0.00,$11.00,$0.00,$5.50,$8.71,$8.80,$0.00,$0.00,$0.00,$0.00,$0.00
28842,ERX,HCPCS J7515,00093-5740-65,CYCLOSPORINE MODIFIED (GENGRAF) 25 MG PO CAPS,$10.45,$0.00,$10.45,$0.00,$7.46,$0.00,$0.00,$0.00,$0.00,$0.00,$10.45,$0.00,$5.23,$8.28,$8.36,$0.00,$0.00,$0.00,$0.00,$0.00
28843,ERX,HCPCS J7502,00093-5742-19,CYCLOSPORINE MODIFIED 100 MG PO CAPS,$20.89,$0.00,$20.89,$9.40,$14.91,$0.00,$3.60,$0.00,$0.00,$3.66,$20.89,$0.00,$10.45,$16.54,$16.71,$0.00,$3.27,$0.00,$3.33,$0.00
28843,ERX,HCPCS J7502,00093-5742-65,CYCLOSPORINE MODIFIED 100 MG PO CAPS,$20.89,$0.00,$20.89,$9.40,$14.91,$0.00,$3.60,$0.00,$0.00,$3.66,$20.89,$0.00,$10.45,$16.54,$16.71,$0.00,$3.27,$0.00,$3.33,$0.00
28844,ERX,HCPCS J7502,00172-7313-20,CYCLOSPORINE MODIFIED (GENGRAF) 100 MG/ML PO SOLN,$793.81,$0.00,$793.81,$357.21,$566.54,$0.00,$136.77,$0.00,$0.00,$138.99,$793.81,$0.00,$396.91,$628.70,$635.05,$0.00,$124.23,$0.00,$126.37,$0.00
28849,ERX,HCPCS 25000001,00037-6822-10,HYDROCORT-PRAMOXINE (PERIANAL) 1-1 % EX FOAM,$547.51,$0.00,$547.51,$0.00,$390.76,$0.00,$0.00,$0.00,$0.00,$0.00,$547.51,$0.00,$273.76,$433.63,$438.01,$0.00,$0.00,$0.00,$0.00,$0.00
28899,ERX,HCPCS 25000001,00406-8515-23,OXYCODONE HCL 15 MG PO TABS,$7.11,$0.00,$7.11,$0.00,$5.07,$0.00,$0.00,$0.00,$0.00,$0.00,$7.11,$0.00,$3.56,$5.63,$5.69,$0.00,$0.00,$0.00,$0.00,$0.00
28899,ERX,HCPCS 25000001,00406-8515-62,OXYCODONE HCL 15 MG PO TABS,$7.11,$0.00,$7.11,$0.00,$5.07,$0.00,$0.00,$0.00,$0.00,$0.00,$7.11,$0.00,$3.56,$5.63,$5.69,$0.00,$0.00,$0.00,$0.00,$0.00
28899,ERX,HCPCS 25000001,57664-0187-88,OXYCODONE HCL 15 MG PO TABS,$7.11,$0.00,$7.11,$0.00,$5.07,$0.00,$0.00,$0.00,$0.00,$0.00,$7.11,$0.00,$3.56,$5.63,$5.69,$0.00,$0.00,$0.00,$0.00,$0.00
28899,ERX,HCPCS 25000001,68084-0184-01,OXYCODONE HCL 15 MG PO TABS,$7.11,$0.00,$7.11,$0.00,$5.07,$0.00,$0.00,$0.00,$0.00,$0.00,$7.11,$0.00,$3.56,$5.63,$5.69,$0.00,$0.00,$0.00,$0.00,$0.00
28899,ERX,HCPCS 25000001,68094-0005-59,OXYCODONE HCL 15 MG PO TABS,$7.11,$0.00,$7.11,$0.00,$5.07,$0.00,$0.00,$0.00,$0.00,$0.00,$7.11,$0.00,$3.56,$5.63,$5.69,$0.00,$0.00,$0.00,$0.00,$0.00
28899,ERX,HCPCS 25000001,68094-0005-61,OXYCODONE HCL 15 MG PO TABS,$7.11,$0.00,$7.11,$0.00,$5.07,$0.00,$0.00,$0.00,$0.00,$0.00,$7.11,$0.00,$3.56,$5.63,$5.69,$0.00,$0.00,$0.00,$0.00,$0.00
28900,ERX,HCPCS 25000001,00406-8530-62,OXYCODONE HCL 30 MG PO TABS,$13.54,$0.00,$13.54,$0.00,$9.66,$0.00,$0.00,$0.00,$0.00,$0.00,$13.54,$0.00,$6.77,$10.72,$10.83,$0.00,$0.00,$0.00,$0.00,$0.00
28900,ERX,HCPCS 25000001,68084-0185-01,OXYCODONE HCL 30 MG PO TABS,$13.54,$0.00,$13.54,$0.00,$9.66,$0.00,$0.00,$0.00,$0.00,$0.00,$13.54,$0.00,$6.77,$10.72,$10.83,$0.00,$0.00,$0.00,$0.00,$0.00
28912,ERX,HCPCS J9120,55292-0811-55,DACTINOMYCIN 0.5 MG IV SOLR,"$3,736.31",$0.00,"$3,736.31",$0.00,"$2,666.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,736.31",$0.00,"$1,868.16","$2,959.16","$2,989.05",$0.00,$0.00,$0.00,$0.00,$0.00
28912,ERX,HCPCS J9120,66993-0489-83,DACTINOMYCIN 0.5 MG IV SOLR,"$3,736.31",$0.00,"$3,736.31",$0.00,"$2,666.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,736.31",$0.00,"$1,868.16","$2,959.16","$2,989.05",$0.00,$0.00,$0.00,$0.00,$0.00
28912,ERX,HCPCS J9120,67457-0513-05,DACTINOMYCIN 0.5 MG IV SOLR,"$3,736.31",$0.00,"$3,736.31",$0.00,"$2,666.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,736.31",$0.00,"$1,868.16","$2,959.16","$2,989.05",$0.00,$0.00,$0.00,$0.00,$0.00
28913,ERX,HCPCS 25000001,08065-1830-85,SODIUM HYALURONATE 10 MG/ML IO SOLN,$611.62,$0.00,$611.62,$0.00,$436.51,$0.00,$0.00,$0.00,$0.00,$0.00,$611.62,$0.00,$305.81,$484.40,$489.30,$0.00,$0.00,$0.00,$0.00,$0.00
28917,ERX,HCPCS 25000001,08065-1831-50,NA HYALUR & NA CHOND-NA HYALUR 0.55-0.5 ML IO KIT,$687.02,$0.00,$687.02,$0.00,$490.33,$0.00,$0.00,$0.00,$0.00,$0.00,$687.02,$0.00,$343.51,$544.12,$549.62,$0.00,$0.00,$0.00,$0.00,$0.00
28923,ERX,HCPCS 25000001,08065-1839-05,NA CHONDROIT SULF-NA HYALURON 40-30 MG/ML IO SOLN,$568.80,$0.00,$568.80,$0.00,$405.97,$0.00,$0.00,$0.00,$0.00,$0.00,$568.80,$0.00,$284.40,$450.49,$455.04,$0.00,$0.00,$0.00,$0.00,$0.00
28929,ERX,HCPCS 63700001,99999-6004-92,KALETRA:LOPINAVIR-RITONAVIR 400-100 MG/5ML PO SOLN,$481.48,$0.00,"$1,474.95",$0.00,"$1,052.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,474.95",$0.00,$737.48,$381.33,"$1,179.96",$0.00,$0.00,$0.00,$0.00,$0.00
28929,ERX,HCPCS 63700001,00074-3956-46,KALETRA:LOPINAVIR-RITONAVIR 400-100 MG/5ML PO SOLN,"$1,474.95",$0.00,"$1,474.95",$0.00,"$1,052.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,474.95",$0.00,$737.48,"$1,168.16","$1,179.96",$0.00,$0.00,$0.00,$0.00,$0.00
28929,ERX,HCPCS 63700001,00527-1947-48,KALETRA:LOPINAVIR-RITONAVIR 400-100 MG/5ML PO SOLN,"$1,474.95",$0.00,"$1,474.95",$0.00,"$1,052.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,474.95",$0.00,$737.48,"$1,168.16","$1,179.96",$0.00,$0.00,$0.00,$0.00,$0.00
28947,ERX,HCPCS J0883,00143-9674-01,ARGATROBAN 250 MG/2.5ML IV SOLN,"$1,468.80",$0.00,"$1,468.80",$0.00,"$1,048.28",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,468.80",$0.00,$734.40,"$1,163.29","$1,175.04",$0.00,$0.00,$0.00,$0.00,$0.00
28947,ERX,HCPCS J0883,00409-1140-01,ARGATROBAN 250 MG/2.5ML IV SOLN,"$1,468.80",$0.00,"$1,468.80",$0.00,"$1,048.28",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,468.80",$0.00,$734.40,"$1,163.29","$1,175.04",$0.00,$0.00,$0.00,$0.00,$0.00
28947,ERX,HCPCS J0883,42023-0182-01,ARGATROBAN 250 MG/2.5ML IV SOLN,"$1,468.80",$0.00,"$1,468.80",$0.00,"$1,048.28",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,468.80",$0.00,$734.40,"$1,163.29","$1,175.04",$0.00,$0.00,$0.00,$0.00,$0.00
28947,ERX,HCPCS J0883,63323-0526-03,ARGATROBAN 250 MG/2.5ML IV SOLN,"$1,468.80",$0.00,"$1,468.80",$0.00,"$1,048.28",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,468.80",$0.00,$734.40,"$1,163.29","$1,175.04",$0.00,$0.00,$0.00,$0.00,$0.00
28947,ERX,HCPCS J0883,67457-0212-02,ARGATROBAN 250 MG/2.5ML IV SOLN,"$1,468.80",$0.00,"$1,468.80",$0.00,"$1,048.28",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,468.80",$0.00,$734.40,"$1,163.29","$1,175.04",$0.00,$0.00,$0.00,$0.00,$0.00
28958,ERX,HCPCS J7520,00008-1041-10,SIROLIMUS 1 MG PO TABS,$64.79,$0.00,$64.79,$0.00,$46.24,$0.00,$0.00,$0.00,$0.00,$0.00,$64.79,$0.00,$32.40,$51.31,$51.83,$0.00,$0.00,$0.00,$0.00,$0.00
28958,ERX,HCPCS J7520,55111-0653-01,SIROLIMUS 1 MG PO TABS,$64.79,$0.00,$64.79,$0.00,$46.24,$0.00,$0.00,$0.00,$0.00,$0.00,$64.79,$0.00,$32.40,$51.31,$51.83,$0.00,$0.00,$0.00,$0.00,$0.00
28964,ERX,HCPCS 63700001,00904-6353-61,LEVOFLOXACIN 750 MG PO TABS,$123.89,$0.00,$123.89,$0.00,$88.42,$0.00,$0.00,$0.00,$0.00,$0.00,$123.89,$0.00,$61.95,$98.12,$99.11,$0.00,$0.00,$0.00,$0.00,$0.00
28964,ERX,HCPCS 63700001,55111-0281-30,LEVOFLOXACIN 750 MG PO TABS,$123.89,$0.00,$123.89,$0.00,$88.42,$0.00,$0.00,$0.00,$0.00,$0.00,$123.89,$0.00,$61.95,$98.12,$99.11,$0.00,$0.00,$0.00,$0.00,$0.00
28975,ERX,HCPCS 63700001,64875-0001-03,MIFEPRISTONE 200 MG PO TABS,$549.00,$0.00,$549.00,$0.00,$391.82,$0.00,$0.00,$0.00,$0.00,$0.00,$549.00,$0.00,$274.50,$434.81,$439.20,$0.00,$0.00,$0.00,$0.00,$0.00
28995,ERX,HCPCS 63700001,67877-0159-01,METFORMIN HCL ER 500 MG PO TB24,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
28995,ERX,HCPCS 63700001,70010-0491-01,METFORMIN HCL ER 500 MG PO TB24,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
29048,ERX,HCPCS 63700001,16714-0633-01,ALENDRONATE SODIUM 70 MG PO TABS,$71.45,$0.00,$71.45,$0.00,$50.99,$0.00,$0.00,$0.00,$0.00,$0.00,$71.45,$0.00,$35.73,$56.59,$57.16,$0.00,$0.00,$0.00,$0.00,$0.00
29071,ERX,HCPCS J9017,,ARSENIC TRIOXIDE 10 MG/10ML IV SOLN,"$1,710.72",$0.00,"$1,710.72",$769.82,"$1,220.94",$443.14,$294.75,$0.00,$0.00,$517.82,"$1,710.72",$465.30,$855.36,"$1,354.89","$1,368.58",$642.55,$517.82,$0.00,$493.06,$286.69
29071,ERX,HCPCS J9017,50742-0438-10,ARSENIC TRIOXIDE 10 MG/10ML IV SOLN,"$1,710.72",$0.00,"$1,710.72",$769.82,"$1,220.94",$443.14,$294.75,$0.00,$0.00,$517.82,"$1,710.72",$465.30,$855.36,"$1,354.89","$1,368.58",$642.55,$517.82,$0.00,$493.06,$286.69
29071,ERX,HCPCS J9017,63323-0637-10,ARSENIC TRIOXIDE 10 MG/10ML IV SOLN,"$1,710.72",$0.00,"$1,710.72",$769.82,"$1,220.94",$443.14,$294.75,$0.00,$0.00,$517.82,"$1,710.72",$465.30,$855.36,"$1,354.89","$1,368.58",$642.55,$517.82,$0.00,$493.06,$286.69
29072,ERX,HCPCS 63700001,16714-0632-01,ALENDRONATE SODIUM 35 MG PO TABS,$71.63,$0.00,$71.63,$0.00,$51.12,$0.00,$0.00,$0.00,$0.00,$0.00,$71.63,$0.00,$35.82,$56.73,$57.30,$0.00,$0.00,$0.00,$0.00,$0.00
29109,ERX,HCPCS 63700001,65862-0312-30,DIDANOSINE 250 MG PO CPDR,$29.91,$0.00,$29.91,$0.00,$21.35,$0.00,$0.00,$0.00,$0.00,$0.00,$29.91,$0.00,$14.96,$23.69,$23.93,$0.00,$0.00,$0.00,$0.00,$0.00
29110,ERX,HCPCS 63700001,65862-0313-30,DIDANOSINE 400 MG PO CPDR,$46.71,$0.00,$46.71,$0.00,$33.34,$0.00,$0.00,$0.00,$0.00,$0.00,$46.71,$0.00,$23.36,$36.99,$37.37,$0.00,$0.00,$0.00,$0.00,$0.00
29132,ERX,HCPCS J1756,00517-2340-01,IRON SUCROSE 20 MG/ML IV SOLN,$189.00,$0.00,$189.00,$85.05,$134.89,$0.00,$43.48,$0.00,$0.00,$24.68,$189.00,$0.00,$94.50,$149.69,$151.20,$0.00,$24.68,$0.00,$23.49,$0.00
29132,ERX,HCPCS J1756,00517-2340-10,IRON SUCROSE 20 MG/ML IV SOLN,$189.00,$0.00,$189.00,$85.05,$134.89,$0.00,$43.48,$0.00,$0.00,$24.68,$189.00,$0.00,$94.50,$149.69,$151.20,$0.00,$24.68,$0.00,$23.49,$0.00
29132,ERX,HCPCS J1756,00517-2340-25,IRON SUCROSE 20 MG/ML IV SOLN,$189.00,$0.00,$189.00,$85.05,$134.89,$0.00,$43.48,$0.00,$0.00,$24.68,$189.00,$0.00,$94.50,$149.69,$151.20,$0.00,$24.68,$0.00,$23.49,$0.00
29167,ERX,HCPCS 63700001,49702-0217-18,TRIZIVIR:ABACAVIR-LAMIVUDINE-ZIDOVUDINE PO TAB,$101.41,$0.00,$101.41,$0.00,$72.38,$0.00,$0.00,$0.00,$0.00,$0.00,$101.41,$0.00,$50.71,$80.32,$81.13,$0.00,$0.00,$0.00,$0.00,$0.00
29167,ERX,HCPCS 63700001,68180-0286-07,TRIZIVIR:ABACAVIR-LAMIVUDINE-ZIDOVUDINE PO TAB,$101.41,$0.00,$101.41,$0.00,$72.38,$0.00,$0.00,$0.00,$0.00,$0.00,$101.41,$0.00,$50.71,$80.32,$81.13,$0.00,$0.00,$0.00,$0.00,$0.00
29169,ERX,HCPCS 63700001,42192-0608-16,GABAPENTIN 250 MG/5ML PO SOLN,$9.51,$0.00,$9.51,$0.00,$6.79,$0.00,$0.00,$0.00,$0.00,$0.00,$9.51,$0.00,$4.76,$7.53,$7.61,$0.00,$0.00,$0.00,$0.00,$0.00
29169,ERX,HCPCS 63700001,50383-0311-09,GABAPENTIN 250 MG/5ML PO SOLN,$9.51,$0.00,$9.51,$0.00,$6.79,$0.00,$0.00,$0.00,$0.00,$0.00,$9.51,$0.00,$4.76,$7.53,$7.61,$0.00,$0.00,$0.00,$0.00,$0.00
29169,ERX,HCPCS 63700001,59762-5050-01,GABAPENTIN 250 MG/5ML PO SOLN,$9.51,$0.00,$9.51,$0.00,$6.79,$0.00,$0.00,$0.00,$0.00,$0.00,$9.51,$0.00,$4.76,$7.53,$7.61,$0.00,$0.00,$0.00,$0.00,$0.00
29169,ERX,HCPCS 63700001,99999-6010-82,GABAPENTIN 250 MG/5ML PO SOLN,$9.51,$0.00,$9.51,$0.00,$6.79,$0.00,$0.00,$0.00,$0.00,$0.00,$9.51,$0.00,$4.76,$7.53,$7.61,$0.00,$0.00,$0.00,$0.00,$0.00
29169,ERX,HCPCS 63700001,99999-6012-40,GABAPENTIN 250 MG/5ML PO SOLN,$9.51,$0.00,$9.51,$0.00,$6.79,$0.00,$0.00,$0.00,$0.00,$0.00,$9.51,$0.00,$4.76,$7.53,$7.61,$0.00,$0.00,$0.00,$0.00,$0.00
29267,ERX,HCPCS 63700001,00904-6642-61,QUETIAPINE FUMARATE 300 MG PO TABS,$38.57,$0.00,$38.57,$0.00,$27.53,$0.00,$0.00,$0.00,$0.00,$0.00,$38.57,$0.00,$19.29,$30.55,$30.86,$0.00,$0.00,$0.00,$0.00,$0.00
29267,ERX,HCPCS 63700001,50268-0634-15,QUETIAPINE FUMARATE 300 MG PO TABS,$38.57,$0.00,$38.57,$0.00,$27.53,$0.00,$0.00,$0.00,$0.00,$0.00,$38.57,$0.00,$19.29,$30.55,$30.86,$0.00,$0.00,$0.00,$0.00,$0.00
29270,ERX,HCPCS 63700001,60687-0195-01,DILTIAZEM HCL ER COATED BEADS 120 MG PO CP24,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
29270,ERX,HCPCS 63700001,63739-0014-10,DILTIAZEM HCL ER COATED BEADS 120 MG PO CP24,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
29272,ERX,HCPCS 63700001,60687-0206-01,DILTIAZEM HCL ER COATED BEADS 180 MG PO CP24,$6.87,$0.00,$6.87,$0.00,$4.90,$0.00,$0.00,$0.00,$0.00,$0.00,$6.87,$0.00,$3.44,$5.44,$5.50,$0.00,$0.00,$0.00,$0.00,$0.00
29272,ERX,HCPCS 63700001,63739-0015-10,DILTIAZEM HCL ER COATED BEADS 180 MG PO CP24,$6.87,$0.00,$6.87,$0.00,$4.90,$0.00,$0.00,$0.00,$0.00,$0.00,$6.87,$0.00,$3.44,$5.44,$5.50,$0.00,$0.00,$0.00,$0.00,$0.00
29274,ERX,HCPCS 63700001,10370-0831-11,DILTIAZEM HCL ER COATED BEADS 240 MG PO CP24,$7.80,$0.00,$7.80,$0.00,$5.57,$0.00,$0.00,$0.00,$0.00,$0.00,$7.80,$0.00,$3.90,$6.18,$6.24,$0.00,$0.00,$0.00,$0.00,$0.00
29274,ERX,HCPCS 63700001,60687-0217-01,DILTIAZEM HCL ER COATED BEADS 240 MG PO CP24,$7.80,$0.00,$7.80,$0.00,$5.57,$0.00,$0.00,$0.00,$0.00,$0.00,$7.80,$0.00,$3.90,$6.18,$6.24,$0.00,$0.00,$0.00,$0.00,$0.00
29274,ERX,HCPCS 63700001,60687-0217-11,DILTIAZEM HCL ER COATED BEADS 240 MG PO CP24,$7.80,$0.00,$7.80,$0.00,$5.57,$0.00,$0.00,$0.00,$0.00,$0.00,$7.80,$0.00,$3.90,$6.18,$6.24,$0.00,$0.00,$0.00,$0.00,$0.00
29274,ERX,HCPCS 63700001,63739-0016-10,DILTIAZEM HCL ER COATED BEADS 240 MG PO CP24,$7.80,$0.00,$7.80,$0.00,$5.57,$0.00,$0.00,$0.00,$0.00,$0.00,$7.80,$0.00,$3.90,$6.18,$6.24,$0.00,$0.00,$0.00,$0.00,$0.00
29276,ERX,HCPCS 63700001,60687-0228-01,DILTIAZEM HCL ER COATED BEADS 300 MG PO CP24,$10.19,$0.00,$10.19,$0.00,$7.27,$0.00,$0.00,$0.00,$0.00,$0.00,$10.19,$0.00,$5.10,$8.07,$8.15,$0.00,$0.00,$0.00,$0.00,$0.00
29277,ERX,HCPCS 63700001,47335-0673-81,DILTIAZEM HCL ER BEADS 360 MG PO CP24,$8.92,$0.00,$8.92,$0.00,$6.37,$0.00,$0.00,$0.00,$0.00,$0.00,$8.92,$0.00,$4.46,$7.06,$7.14,$0.00,$0.00,$0.00,$0.00,$0.00
29277,ERX,HCPCS 63700001,68682-0371-90,DILTIAZEM HCL ER BEADS 360 MG PO CP24,$8.92,$0.00,$8.92,$0.00,$6.37,$0.00,$0.00,$0.00,$0.00,$0.00,$8.92,$0.00,$4.46,$7.06,$7.14,$0.00,$0.00,$0.00,$0.00,$0.00
29302,ERX,HCPCS J7510,99999-6005-14,PREDNISOLONE SODIUM PHOSPHATE 15 MG/5ML PO SOLN,$194.67,$0.00,$194.67,$0.00,$138.94,$0.00,$33.54,$0.00,$0.00,$0.00,$194.67,$0.00,$97.34,$154.18,$155.74,$0.00,$30.47,$0.00,$0.00,$0.00
29302,ERX,HCPCS J7510,00121-0759-08,PREDNISOLONE SODIUM PHOSPHATE 15 MG/5ML PO SOLN,$232.93,$0.00,$194.67,$0.00,$138.94,$0.00,$33.54,$0.00,$0.00,$0.00,$194.67,$0.00,$97.34,$184.48,$155.74,$0.00,$30.47,$0.00,$0.00,$0.00
29302,ERX,HCPCS J7510,60432-0212-08,PREDNISOLONE SODIUM PHOSPHATE 15 MG/5ML PO SOLN,$232.93,$0.00,$194.67,$0.00,$138.94,$0.00,$33.54,$0.00,$0.00,$0.00,$194.67,$0.00,$97.34,$184.48,$155.74,$0.00,$30.47,$0.00,$0.00,$0.00
29313,ERX,HCPCS J0840,50633-0110-11,CROTALIDAE POLYVAL IMMUNE FAB IV SOLR,"$15,734.16",$0.00,"$15,734.16",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$15,734.16",$0.00,"$7,867.08","$12,461.45","$12,587.33",$0.00,$0.00,$0.00,$0.00,$0.00
29335,ERX,HCPCS J1800,00143-9872-01,PROPRANOLOL HCL 1 MG/ML IV SOLN,$36.48,$0.00,$36.48,$0.00,$26.04,$0.00,$0.00,$0.00,$0.00,$0.00,$36.48,$0.00,$18.24,$28.89,$29.18,$0.00,$0.00,$0.00,$0.00,$0.00
29335,ERX,HCPCS J1800,00143-9872-10,PROPRANOLOL HCL 1 MG/ML IV SOLN,$36.48,$0.00,$36.48,$0.00,$26.04,$0.00,$0.00,$0.00,$0.00,$0.00,$36.48,$0.00,$18.24,$28.89,$29.18,$0.00,$0.00,$0.00,$0.00,$0.00
29434,ERX,HCPCS 63700001,00093-7163-56,TOLTERODINE TARTRATE ER 2 MG PO CP24,$30.54,$0.00,$30.54,$0.00,$21.80,$0.00,$0.00,$0.00,$0.00,$0.00,$30.54,$0.00,$15.27,$24.19,$24.43,$0.00,$0.00,$0.00,$0.00,$0.00
29434,ERX,HCPCS 63700001,00093-7163-98,TOLTERODINE TARTRATE ER 2 MG PO CP24,$30.54,$0.00,$30.54,$0.00,$21.80,$0.00,$0.00,$0.00,$0.00,$0.00,$30.54,$0.00,$15.27,$24.19,$24.43,$0.00,$0.00,$0.00,$0.00,$0.00
29434,ERX,HCPCS 63700001,13668-0189-30,TOLTERODINE TARTRATE ER 2 MG PO CP24,$30.54,$0.00,$30.54,$0.00,$21.80,$0.00,$0.00,$0.00,$0.00,$0.00,$30.54,$0.00,$15.27,$24.19,$24.43,$0.00,$0.00,$0.00,$0.00,$0.00
29434,ERX,HCPCS 63700001,31722-0607-30,TOLTERODINE TARTRATE ER 2 MG PO CP24,$30.54,$0.00,$30.54,$0.00,$21.80,$0.00,$0.00,$0.00,$0.00,$0.00,$30.54,$0.00,$15.27,$24.19,$24.43,$0.00,$0.00,$0.00,$0.00,$0.00
29434,ERX,HCPCS 63700001,59762-0047-01,TOLTERODINE TARTRATE ER 2 MG PO CP24,$30.54,$0.00,$30.54,$0.00,$21.80,$0.00,$0.00,$0.00,$0.00,$0.00,$30.54,$0.00,$15.27,$24.19,$24.43,$0.00,$0.00,$0.00,$0.00,$0.00
29435,ERX,HCPCS 63700001,00093-7164-05,TOLTERODINE TARTRATE ER 4 MG PO CP24,$36.28,$0.00,$36.28,$0.00,$25.89,$0.00,$0.00,$0.00,$0.00,$0.00,$36.28,$0.00,$18.14,$28.73,$29.02,$0.00,$0.00,$0.00,$0.00,$0.00
29435,ERX,HCPCS 63700001,00093-7164-56,TOLTERODINE TARTRATE ER 4 MG PO CP24,$36.28,$0.00,$36.28,$0.00,$25.89,$0.00,$0.00,$0.00,$0.00,$0.00,$36.28,$0.00,$18.14,$28.73,$29.02,$0.00,$0.00,$0.00,$0.00,$0.00
29435,ERX,HCPCS 63700001,31722-0608-30,TOLTERODINE TARTRATE ER 4 MG PO CP24,$36.28,$0.00,$36.28,$0.00,$25.89,$0.00,$0.00,$0.00,$0.00,$0.00,$36.28,$0.00,$18.14,$28.73,$29.02,$0.00,$0.00,$0.00,$0.00,$0.00
29435,ERX,HCPCS 63700001,59762-0048-01,TOLTERODINE TARTRATE ER 4 MG PO CP24,$36.28,$0.00,$36.28,$0.00,$25.89,$0.00,$0.00,$0.00,$0.00,$0.00,$36.28,$0.00,$18.14,$28.73,$29.02,$0.00,$0.00,$0.00,$0.00,$0.00
29437,ERX,HCPCS 63700001,00078-0351-05,NATEGLINIDE 60 MG PO TABS,$6.32,$0.00,$6.32,$0.00,$4.51,$0.00,$0.00,$0.00,$0.00,$0.00,$6.32,$0.00,$3.16,$5.01,$5.06,$0.00,$0.00,$0.00,$0.00,$0.00
29437,ERX,HCPCS 63700001,00591-3354-01,NATEGLINIDE 60 MG PO TABS,$6.32,$0.00,$6.32,$0.00,$4.51,$0.00,$0.00,$0.00,$0.00,$0.00,$6.32,$0.00,$3.16,$5.01,$5.06,$0.00,$0.00,$0.00,$0.00,$0.00
29437,ERX,HCPCS 63700001,49884-0984-01,NATEGLINIDE 60 MG PO TABS,$6.32,$0.00,$6.32,$0.00,$4.51,$0.00,$0.00,$0.00,$0.00,$0.00,$6.32,$0.00,$3.16,$5.01,$5.06,$0.00,$0.00,$0.00,$0.00,$0.00
29437,ERX,HCPCS 63700001,55111-0328-90,NATEGLINIDE 60 MG PO TABS,$6.32,$0.00,$6.32,$0.00,$4.51,$0.00,$0.00,$0.00,$0.00,$0.00,$6.32,$0.00,$3.16,$5.01,$5.06,$0.00,$0.00,$0.00,$0.00,$0.00
29438,ERX,HCPCS 63700001,00078-0352-05,NATEGLINIDE 120 MG PO TABS,$6.57,$0.00,$6.57,$0.00,$4.69,$0.00,$0.00,$0.00,$0.00,$0.00,$6.57,$0.00,$3.29,$5.20,$5.26,$0.00,$0.00,$0.00,$0.00,$0.00
29438,ERX,HCPCS 63700001,49884-0985-01,NATEGLINIDE 120 MG PO TABS,$6.57,$0.00,$6.57,$0.00,$4.69,$0.00,$0.00,$0.00,$0.00,$0.00,$6.57,$0.00,$3.29,$5.20,$5.26,$0.00,$0.00,$0.00,$0.00,$0.00
29438,ERX,HCPCS 63700001,55111-0329-90,NATEGLINIDE 120 MG PO TABS,$6.57,$0.00,$6.57,$0.00,$4.69,$0.00,$0.00,$0.00,$0.00,$0.00,$6.57,$0.00,$3.29,$5.20,$5.26,$0.00,$0.00,$0.00,$0.00,$0.00
29464,ERX,HCPCS J2274,00641-6020-10,MORPHINE SULFATE (PF) 0.5 MG/ML IJ SOLN,$44.08,$0.00,$44.08,$0.00,$31.46,$0.00,$0.00,$0.00,$0.00,$0.00,$44.08,$0.00,$22.04,$34.91,$35.26,$0.00,$0.00,$0.00,$0.00,$0.00
29464,ERX,HCPCS J2274,15082-0248-70,MORPHINE SULFATE (PF) 0.5 MG/ML IJ SOLN,$44.08,$0.00,$44.08,$0.00,$31.46,$0.00,$0.00,$0.00,$0.00,$0.00,$44.08,$0.00,$22.04,$34.91,$35.26,$0.00,$0.00,$0.00,$0.00,$0.00
29464,ERX,HCPCS J2274,42852-0248-70,MORPHINE SULFATE (PF) 0.5 MG/ML IJ SOLN,$44.08,$0.00,$44.08,$0.00,$31.46,$0.00,$0.00,$0.00,$0.00,$0.00,$44.08,$0.00,$22.04,$34.91,$35.26,$0.00,$0.00,$0.00,$0.00,$0.00
29531,ERX,HCPCS 63700001,65862-0021-06,MIRTAZAPINE 15 MG PO TBDP,$8.95,$0.00,$8.95,$0.00,$6.39,$0.00,$0.00,$0.00,$0.00,$0.00,$8.95,$0.00,$4.48,$7.09,$7.16,$0.00,$0.00,$0.00,$0.00,$0.00
29532,ERX,HCPCS 63700001,00052-0108-30,MIRTAZAPINE 30 MG PO TBDP,$9.22,$0.00,$9.22,$0.00,$6.58,$0.00,$0.00,$0.00,$0.00,$0.00,$9.22,$0.00,$4.61,$7.30,$7.38,$0.00,$0.00,$0.00,$0.00,$0.00
29532,ERX,HCPCS 63700001,65862-0022-06,MIRTAZAPINE 30 MG PO TBDP,$9.22,$0.00,$9.22,$0.00,$6.58,$0.00,$0.00,$0.00,$0.00,$0.00,$9.22,$0.00,$4.61,$7.30,$7.38,$0.00,$0.00,$0.00,$0.00,$0.00
29567,ERX,HCPCS J0637,00006-3822-10,CASPOFUNGIN ACETATE 50 MG IV SOLR,"$1,073.92",$0.00,"$1,073.92",$0.00,$766.46,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,073.92",$0.00,$536.96,$850.54,$859.14,$0.00,$0.00,$0.00,$0.00,$0.00
29568,ERX,HCPCS J0637,00006-3823-10,CASPOFUNGIN ACETATE 70 MG IV SOLR,"$1,115.81",$0.00,"$1,115.81",$0.00,$796.35,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,115.81",$0.00,$557.91,$883.72,$892.65,$0.00,$0.00,$0.00,$0.00,$0.00
29745,ERX,HCPCS 63700001,00093-6450-56,ESOMEPRAZOLE 20 MG PO CPDR,$34.30,$0.00,$34.30,$0.00,$24.48,$0.00,$0.00,$0.00,$0.00,$0.00,$34.30,$0.00,$17.15,$27.17,$27.44,$0.00,$0.00,$0.00,$0.00,$0.00
29745,ERX,HCPCS 63700001,00186-5020-31,ESOMEPRAZOLE 20 MG PO CPDR,$34.30,$0.00,$34.30,$0.00,$24.48,$0.00,$0.00,$0.00,$0.00,$0.00,$34.30,$0.00,$17.15,$27.17,$27.44,$0.00,$0.00,$0.00,$0.00,$0.00
29745,ERX,HCPCS 63700001,00378-2350-93,ESOMEPRAZOLE 20 MG PO CPDR,$34.30,$0.00,$34.30,$0.00,$24.48,$0.00,$0.00,$0.00,$0.00,$0.00,$34.30,$0.00,$17.15,$27.17,$27.44,$0.00,$0.00,$0.00,$0.00,$0.00
29745,ERX,HCPCS 63700001,31722-0572-30,ESOMEPRAZOLE 20 MG PO CPDR,$34.30,$0.00,$34.30,$0.00,$24.48,$0.00,$0.00,$0.00,$0.00,$0.00,$34.30,$0.00,$17.15,$27.17,$27.44,$0.00,$0.00,$0.00,$0.00,$0.00
29745,ERX,HCPCS 63700001,43598-0509-30,ESOMEPRAZOLE 20 MG PO CPDR,$34.30,$0.00,$34.30,$0.00,$24.48,$0.00,$0.00,$0.00,$0.00,$0.00,$34.30,$0.00,$17.15,$27.17,$27.44,$0.00,$0.00,$0.00,$0.00,$0.00
29745,ERX,HCPCS 63700001,65862-0783-30,ESOMEPRAZOLE 20 MG PO CPDR,$34.30,$0.00,$34.30,$0.00,$24.48,$0.00,$0.00,$0.00,$0.00,$0.00,$34.30,$0.00,$17.15,$27.17,$27.44,$0.00,$0.00,$0.00,$0.00,$0.00
29746,ERX,HCPCS 63700001,00093-6451-98,ESOMEPRAZOLE MAGNESIUM 40 MG PO CPDR,$33.61,$0.00,$33.61,$0.00,$23.99,$0.00,$0.00,$0.00,$0.00,$0.00,$33.61,$0.00,$16.81,$26.62,$26.89,$0.00,$0.00,$0.00,$0.00,$0.00
29746,ERX,HCPCS 63700001,00186-5040-31,ESOMEPRAZOLE MAGNESIUM 40 MG PO CPDR,$33.61,$0.00,$33.61,$0.00,$23.99,$0.00,$0.00,$0.00,$0.00,$0.00,$33.61,$0.00,$16.81,$26.62,$26.89,$0.00,$0.00,$0.00,$0.00,$0.00
29746,ERX,HCPCS 63700001,16714-0736-01,ESOMEPRAZOLE MAGNESIUM 40 MG PO CPDR,$33.61,$0.00,$33.61,$0.00,$23.99,$0.00,$0.00,$0.00,$0.00,$0.00,$33.61,$0.00,$16.81,$26.62,$26.89,$0.00,$0.00,$0.00,$0.00,$0.00
29746,ERX,HCPCS 63700001,43598-0510-10,ESOMEPRAZOLE MAGNESIUM 40 MG PO CPDR,$33.61,$0.00,$33.61,$0.00,$23.99,$0.00,$0.00,$0.00,$0.00,$0.00,$33.61,$0.00,$16.81,$26.62,$26.89,$0.00,$0.00,$0.00,$0.00,$0.00
29746,ERX,HCPCS 63700001,65862-0784-30,ESOMEPRAZOLE MAGNESIUM 40 MG PO CPDR,$33.61,$0.00,$33.61,$0.00,$23.99,$0.00,$0.00,$0.00,$0.00,$0.00,$33.61,$0.00,$16.81,$26.62,$26.89,$0.00,$0.00,$0.00,$0.00,$0.00
29778,ERX,HCPCS 63700001,00781-2164-60,ZIPRASIDONE HCL 20 MG PO CAPS,$32.18,$0.00,$32.18,$0.00,$22.97,$0.00,$0.00,$0.00,$0.00,$0.00,$32.18,$0.00,$16.09,$25.49,$25.74,$0.00,$0.00,$0.00,$0.00,$0.00
29778,ERX,HCPCS 63700001,00904-6269-08,ZIPRASIDONE HCL 20 MG PO CAPS,$32.18,$0.00,$32.18,$0.00,$22.97,$0.00,$0.00,$0.00,$0.00,$0.00,$32.18,$0.00,$16.09,$25.49,$25.74,$0.00,$0.00,$0.00,$0.00,$0.00
29778,ERX,HCPCS 63700001,00904-6269-45,ZIPRASIDONE HCL 20 MG PO CAPS,$32.18,$0.00,$32.18,$0.00,$22.97,$0.00,$0.00,$0.00,$0.00,$0.00,$32.18,$0.00,$16.09,$25.49,$25.74,$0.00,$0.00,$0.00,$0.00,$0.00
29778,ERX,HCPCS 63700001,33342-0144-09,ZIPRASIDONE HCL 20 MG PO CAPS,$32.18,$0.00,$32.18,$0.00,$22.97,$0.00,$0.00,$0.00,$0.00,$0.00,$32.18,$0.00,$16.09,$25.49,$25.74,$0.00,$0.00,$0.00,$0.00,$0.00
29778,ERX,HCPCS 63700001,65862-0702-60,ZIPRASIDONE HCL 20 MG PO CAPS,$32.18,$0.00,$32.18,$0.00,$22.97,$0.00,$0.00,$0.00,$0.00,$0.00,$32.18,$0.00,$16.09,$25.49,$25.74,$0.00,$0.00,$0.00,$0.00,$0.00
29778,ERX,HCPCS 63700001,68084-0103-09,ZIPRASIDONE HCL 20 MG PO CAPS,$32.18,$0.00,$32.18,$0.00,$22.97,$0.00,$0.00,$0.00,$0.00,$0.00,$32.18,$0.00,$16.09,$25.49,$25.74,$0.00,$0.00,$0.00,$0.00,$0.00
29779,ERX,HCPCS 63700001,16714-0836-01,ZIPRASIDONE HCL 40 MG PO CAPS,$34.06,$0.00,$34.06,$0.00,$24.31,$0.00,$0.00,$0.00,$0.00,$0.00,$34.06,$0.00,$17.03,$26.98,$27.25,$0.00,$0.00,$0.00,$0.00,$0.00
29779,ERX,HCPCS 63700001,60505-2529-06,ZIPRASIDONE HCL 40 MG PO CAPS,$34.06,$0.00,$34.06,$0.00,$24.31,$0.00,$0.00,$0.00,$0.00,$0.00,$34.06,$0.00,$17.03,$26.98,$27.25,$0.00,$0.00,$0.00,$0.00,$0.00
29779,ERX,HCPCS 63700001,65862-0703-60,ZIPRASIDONE HCL 40 MG PO CAPS,$34.06,$0.00,$34.06,$0.00,$24.31,$0.00,$0.00,$0.00,$0.00,$0.00,$34.06,$0.00,$17.03,$26.98,$27.25,$0.00,$0.00,$0.00,$0.00,$0.00
29779,ERX,HCPCS 63700001,68084-0104-09,ZIPRASIDONE HCL 40 MG PO CAPS,$34.06,$0.00,$34.06,$0.00,$24.31,$0.00,$0.00,$0.00,$0.00,$0.00,$34.06,$0.00,$17.03,$26.98,$27.25,$0.00,$0.00,$0.00,$0.00,$0.00
29780,ERX,HCPCS 63700001,00781-2167-60,ZIPRASIDONE HCL 60 MG PO CAPS,$41.34,$0.00,$41.34,$0.00,$29.50,$0.00,$0.00,$0.00,$0.00,$0.00,$41.34,$0.00,$20.67,$32.74,$33.07,$0.00,$0.00,$0.00,$0.00,$0.00
29780,ERX,HCPCS 63700001,00904-6271-08,ZIPRASIDONE HCL 60 MG PO CAPS,$41.34,$0.00,$41.34,$0.00,$29.50,$0.00,$0.00,$0.00,$0.00,$0.00,$41.34,$0.00,$20.67,$32.74,$33.07,$0.00,$0.00,$0.00,$0.00,$0.00
29780,ERX,HCPCS 63700001,33342-0146-09,ZIPRASIDONE HCL 60 MG PO CAPS,$41.34,$0.00,$41.34,$0.00,$29.50,$0.00,$0.00,$0.00,$0.00,$0.00,$41.34,$0.00,$20.67,$32.74,$33.07,$0.00,$0.00,$0.00,$0.00,$0.00
29780,ERX,HCPCS 63700001,55111-0258-60,ZIPRASIDONE HCL 60 MG PO CAPS,$41.34,$0.00,$41.34,$0.00,$29.50,$0.00,$0.00,$0.00,$0.00,$0.00,$41.34,$0.00,$20.67,$32.74,$33.07,$0.00,$0.00,$0.00,$0.00,$0.00
29780,ERX,HCPCS 63700001,59762-2003-01,ZIPRASIDONE HCL 60 MG PO CAPS,$41.34,$0.00,$41.34,$0.00,$29.50,$0.00,$0.00,$0.00,$0.00,$0.00,$41.34,$0.00,$20.67,$32.74,$33.07,$0.00,$0.00,$0.00,$0.00,$0.00
29780,ERX,HCPCS 63700001,65862-0704-60,ZIPRASIDONE HCL 60 MG PO CAPS,$41.34,$0.00,$41.34,$0.00,$29.50,$0.00,$0.00,$0.00,$0.00,$0.00,$41.34,$0.00,$20.67,$32.74,$33.07,$0.00,$0.00,$0.00,$0.00,$0.00
29780,ERX,HCPCS 63700001,68084-0105-09,ZIPRASIDONE HCL 60 MG PO CAPS,$41.34,$0.00,$41.34,$0.00,$29.50,$0.00,$0.00,$0.00,$0.00,$0.00,$41.34,$0.00,$20.67,$32.74,$33.07,$0.00,$0.00,$0.00,$0.00,$0.00
29780,ERX,HCPCS 63700001,68180-0333-07,ZIPRASIDONE HCL 60 MG PO CAPS,$41.34,$0.00,$41.34,$0.00,$29.50,$0.00,$0.00,$0.00,$0.00,$0.00,$41.34,$0.00,$20.67,$32.74,$33.07,$0.00,$0.00,$0.00,$0.00,$0.00
29781,ERX,HCPCS 63700001,00781-2168-60,ZIPRASIDONE HCL 80 MG PO CAPS,$41.34,$0.00,$41.34,$0.00,$29.50,$0.00,$0.00,$0.00,$0.00,$0.00,$41.34,$0.00,$20.67,$32.74,$33.07,$0.00,$0.00,$0.00,$0.00,$0.00
29781,ERX,HCPCS 63700001,00904-6272-08,ZIPRASIDONE HCL 80 MG PO CAPS,$41.34,$0.00,$41.34,$0.00,$29.50,$0.00,$0.00,$0.00,$0.00,$0.00,$41.34,$0.00,$20.67,$32.74,$33.07,$0.00,$0.00,$0.00,$0.00,$0.00
29781,ERX,HCPCS 63700001,68084-0106-09,ZIPRASIDONE HCL 80 MG PO CAPS,$41.34,$0.00,$41.34,$0.00,$29.50,$0.00,$0.00,$0.00,$0.00,$0.00,$41.34,$0.00,$20.67,$32.74,$33.07,$0.00,$0.00,$0.00,$0.00,$0.00
29805,ERX,HCPCS 25000001,10019-0055-61,ESMOLOL HCL-SODIUM CHLORIDE 2500 MG/250ML IV SOLN,"$1,347.00",$0.00,"$1,347.00",$0.00,$961.35,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,347.00",$0.00,$673.50,"$1,066.82","$1,077.60",$0.00,$0.00,$0.00,$0.00,$0.00
29805,ERX,HCPCS 25000001,10019-0672-10,ESMOLOL HCL-SODIUM CHLORIDE 2500 MG/250ML IV SOLN,"$1,347.00",$0.00,"$1,347.00",$0.00,$961.35,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,347.00",$0.00,$673.50,"$1,066.82","$1,077.60",$0.00,$0.00,$0.00,$0.00,$0.00
29805,ERX,HCPCS 25000001,25021-0308-84,ESMOLOL HCL-SODIUM CHLORIDE 2500 MG/250ML IV SOLN,"$1,347.00",$0.00,"$1,347.00",$0.00,$961.35,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,347.00",$0.00,$673.50,"$1,066.82","$1,077.60",$0.00,$0.00,$0.00,$0.00,$0.00
29822,ERX,HCPCS 63700001,00225-0295-15,HYOSCYAMINE SULFATE 0.125 MG PO TBDP,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
29858,ERX,HCPCS 63700001,00904-6322-61,METOPROLOL SUCCINATE ER 25 MG PO TB24,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
29858,ERX,HCPCS 63700001,50742-0615-01,METOPROLOL SUCCINATE ER 25 MG PO TB24,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
29858,ERX,HCPCS 63700001,51079-0169-20,METOPROLOL SUCCINATE ER 25 MG PO TB24,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
29858,ERX,HCPCS 63700001,55111-0466-01,METOPROLOL SUCCINATE ER 25 MG PO TB24,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
29904,ERX,HCPCS 63700001,68180-0429-01,BIMATOPROST 0.03 % OP SOLN,$410.63,$0.00,$410.63,$0.00,$293.07,$0.00,$0.00,$0.00,$0.00,$0.00,$410.63,$0.00,$205.32,$325.22,$328.50,$0.00,$0.00,$0.00,$0.00,$0.00
29967,ERX,HCPCS 63700001,24689-0785-01,BUSPIRONE HCL 7.5 MG PO TABS,$6.01,$0.00,$6.01,$0.00,$4.29,$0.00,$0.00,$0.00,$0.00,$0.00,$6.01,$0.00,$3.01,$4.76,$4.81,$0.00,$0.00,$0.00,$0.00,$0.00
29967,ERX,HCPCS 63700001,64380-0787-06,BUSPIRONE HCL 7.5 MG PO TABS,$6.01,$0.00,$6.01,$0.00,$4.29,$0.00,$0.00,$0.00,$0.00,$0.00,$6.01,$0.00,$3.01,$4.76,$4.81,$0.00,$0.00,$0.00,$0.00,$0.00
30070,ERX,HCPCS 63700001,00904-6323-61,METOPROLOL SUCCINATE ER 50 MG PO TB24,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
30070,ERX,HCPCS 63700001,50268-0541-11,METOPROLOL SUCCINATE ER 50 MG PO TB24,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
30070,ERX,HCPCS 63700001,50268-0541-15,METOPROLOL SUCCINATE ER 50 MG PO TB24,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
30070,ERX,HCPCS 63700001,50742-0616-01,METOPROLOL SUCCINATE ER 50 MG PO TB24,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
30070,ERX,HCPCS 63700001,55111-0467-01,METOPROLOL SUCCINATE ER 50 MG PO TB24,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
30070,ERX,HCPCS 63700001,55111-0467-05,METOPROLOL SUCCINATE ER 50 MG PO TB24,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
30070,ERX,HCPCS 63700001,62037-0831-01,METOPROLOL SUCCINATE ER 50 MG PO TB24,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
30071,ERX,HCPCS 63700001,00904-6324-61,METOPROLOL SUCCINATE ER 100 MG PO TB24,$7.78,$0.00,$7.78,$0.00,$5.55,$0.00,$0.00,$0.00,$0.00,$0.00,$7.78,$0.00,$3.89,$6.16,$6.22,$0.00,$0.00,$0.00,$0.00,$0.00
30071,ERX,HCPCS 63700001,50742-0617-01,METOPROLOL SUCCINATE ER 100 MG PO TB24,$7.78,$0.00,$7.78,$0.00,$5.55,$0.00,$0.00,$0.00,$0.00,$0.00,$7.78,$0.00,$3.89,$6.16,$6.22,$0.00,$0.00,$0.00,$0.00,$0.00
30071,ERX,HCPCS 63700001,55111-0468-01,METOPROLOL SUCCINATE ER 100 MG PO TB24,$7.78,$0.00,$7.78,$0.00,$5.55,$0.00,$0.00,$0.00,$0.00,$0.00,$7.78,$0.00,$3.89,$6.16,$6.22,$0.00,$0.00,$0.00,$0.00,$0.00
30071,ERX,HCPCS 63700001,63739-0454-10,METOPROLOL SUCCINATE ER 100 MG PO TB24,$7.78,$0.00,$7.78,$0.00,$5.55,$0.00,$0.00,$0.00,$0.00,$0.00,$7.78,$0.00,$3.89,$6.16,$6.22,$0.00,$0.00,$0.00,$0.00,$0.00
30072,ERX,HCPCS 63700001,00378-4598-77,METOPROLOL SUCCINATE ER 200 MG PO TB24,$9.58,$0.00,$9.58,$0.00,$6.84,$0.00,$0.00,$0.00,$0.00,$0.00,$9.58,$0.00,$4.79,$7.59,$7.66,$0.00,$0.00,$0.00,$0.00,$0.00
30072,ERX,HCPCS 63700001,50742-0618-01,METOPROLOL SUCCINATE ER 200 MG PO TB24,$9.58,$0.00,$9.58,$0.00,$6.84,$0.00,$0.00,$0.00,$0.00,$0.00,$9.58,$0.00,$4.79,$7.59,$7.66,$0.00,$0.00,$0.00,$0.00,$0.00
30072,ERX,HCPCS 63700001,55111-0469-01,METOPROLOL SUCCINATE ER 200 MG PO TB24,$9.58,$0.00,$9.58,$0.00,$6.84,$0.00,$0.00,$0.00,$0.00,$0.00,$9.58,$0.00,$4.79,$7.59,$7.66,$0.00,$0.00,$0.00,$0.00,$0.00
30072,ERX,HCPCS 63700001,55111-0469-05,METOPROLOL SUCCINATE ER 200 MG PO TB24,$9.58,$0.00,$9.58,$0.00,$6.84,$0.00,$0.00,$0.00,$0.00,$0.00,$9.58,$0.00,$4.79,$7.59,$7.66,$0.00,$0.00,$0.00,$0.00,$0.00
30148,ERX,HCPCS 63700001,00004-0038-22,VALGANCICLOVIR HCL 450 MG PO TABS,$202.86,$0.00,$202.86,$0.00,$144.78,$0.00,$0.00,$0.00,$0.00,$0.00,$202.86,$0.00,$101.43,$160.67,$162.29,$0.00,$0.00,$0.00,$0.00,$0.00
30148,ERX,HCPCS 63700001,00603-6330-20,VALGANCICLOVIR HCL 450 MG PO TABS,$202.86,$0.00,$202.86,$0.00,$144.78,$0.00,$0.00,$0.00,$0.00,$0.00,$202.86,$0.00,$101.43,$160.67,$162.29,$0.00,$0.00,$0.00,$0.00,$0.00
30148,ERX,HCPCS 63700001,16714-0765-01,VALGANCICLOVIR HCL 450 MG PO TABS,$202.86,$0.00,$202.86,$0.00,$144.78,$0.00,$0.00,$0.00,$0.00,$0.00,$202.86,$0.00,$101.43,$160.67,$162.29,$0.00,$0.00,$0.00,$0.00,$0.00
30148,ERX,HCPCS 63700001,55111-0762-60,VALGANCICLOVIR HCL 450 MG PO TABS,$202.86,$0.00,$202.86,$0.00,$144.78,$0.00,$0.00,$0.00,$0.00,$0.00,$202.86,$0.00,$101.43,$160.67,$162.29,$0.00,$0.00,$0.00,$0.00,$0.00
30148,ERX,HCPCS 63700001,63739-0357-33,VALGANCICLOVIR HCL 450 MG PO TABS,$202.86,$0.00,$202.86,$0.00,$144.78,$0.00,$0.00,$0.00,$0.00,$0.00,$202.86,$0.00,$101.43,$160.67,$162.29,$0.00,$0.00,$0.00,$0.00,$0.00
30148,ERX,HCPCS 63700001,65862-0753-60,VALGANCICLOVIR HCL 450 MG PO TABS,$202.86,$0.00,$202.86,$0.00,$144.78,$0.00,$0.00,$0.00,$0.00,$0.00,$202.86,$0.00,$101.43,$160.67,$162.29,$0.00,$0.00,$0.00,$0.00,$0.00
30183,ERX,HCPCS 25000001,47781-0570-89,LIDOCAINE-TRANSPARENT DRESSING 4 % EX KIT,$105.00,$0.00,$105.00,$0.00,$74.94,$0.00,$0.00,$0.00,$0.00,$0.00,$105.00,$0.00,$52.50,$83.16,$84.00,$0.00,$0.00,$0.00,$0.00,$0.00
30213,ERX,HCPCS 63700001,51285-0369-01,METHOTREXATE SODIUM 15 MG PO TABS,$182.60,$0.00,$182.60,$0.00,$130.32,$0.00,$0.00,$0.00,$0.00,$0.00,$182.60,$0.00,$91.30,$144.62,$146.08,$0.00,$0.00,$0.00,$0.00,$0.00
30264,ERX,HCPCS 63700001,00904-6084-61,CITALOPRAM HYDROBROMIDE 10 MG PO TABS,$9.23,$0.00,$9.23,$0.00,$6.59,$0.00,$0.00,$0.00,$0.00,$0.00,$9.23,$0.00,$4.62,$7.31,$7.38,$0.00,$0.00,$0.00,$0.00,$0.00
30264,ERX,HCPCS 63700001,13668-0009-01,CITALOPRAM HYDROBROMIDE 10 MG PO TABS,$9.23,$0.00,$9.23,$0.00,$6.59,$0.00,$0.00,$0.00,$0.00,$0.00,$9.23,$0.00,$4.62,$7.31,$7.38,$0.00,$0.00,$0.00,$0.00,$0.00
30264,ERX,HCPCS 63700001,68084-0737-01,CITALOPRAM HYDROBROMIDE 10 MG PO TABS,$9.23,$0.00,$9.23,$0.00,$6.59,$0.00,$0.00,$0.00,$0.00,$0.00,$9.23,$0.00,$4.62,$7.31,$7.38,$0.00,$0.00,$0.00,$0.00,$0.00
30264,ERX,HCPCS 63700001,68084-0737-11,CITALOPRAM HYDROBROMIDE 10 MG PO TABS,$9.23,$0.00,$9.23,$0.00,$6.59,$0.00,$0.00,$0.00,$0.00,$0.00,$9.23,$0.00,$4.62,$7.31,$7.38,$0.00,$0.00,$0.00,$0.00,$0.00
30433,ERX,HCPCS 63700001,50419-0402-03,DROSPIRENONE-ETHINYL ESTRADIOL 3-0.03 MG PO TABS,$457.66,$0.00,$457.66,$0.00,$326.63,$0.00,$0.00,$0.00,$0.00,$0.00,$457.66,$0.00,$228.83,$362.47,$366.13,$0.00,$0.00,$0.00,$0.00,$0.00
30479,ERX,HCPCS 63700001,00054-0199-59,OXCARBAZEPINE 300 MG/5ML PO SUSP,$10.05,$0.00,$10.05,$0.00,$7.17,$0.00,$0.00,$0.00,$0.00,$0.00,$10.05,$0.00,$5.03,$7.96,$8.04,$0.00,$0.00,$0.00,$0.00,$0.00
30479,ERX,HCPCS 63700001,00078-0357-52,OXCARBAZEPINE 300 MG/5ML PO SUSP,$10.05,$0.00,$10.05,$0.00,$7.17,$0.00,$0.00,$0.00,$0.00,$0.00,$10.05,$0.00,$5.03,$7.96,$8.04,$0.00,$0.00,$0.00,$0.00,$0.00
30479,ERX,HCPCS 63700001,00781-6270-43,OXCARBAZEPINE 300 MG/5ML PO SUSP,$10.05,$0.00,$10.05,$0.00,$7.17,$0.00,$0.00,$0.00,$0.00,$0.00,$10.05,$0.00,$5.03,$7.96,$8.04,$0.00,$0.00,$0.00,$0.00,$0.00
30479,ERX,HCPCS 63700001,65162-0649-78,OXCARBAZEPINE 300 MG/5ML PO SUSP,$10.05,$0.00,$10.05,$0.00,$7.17,$0.00,$0.00,$0.00,$0.00,$0.00,$10.05,$0.00,$5.03,$7.96,$8.04,$0.00,$0.00,$0.00,$0.00,$0.00
30479,ERX,HCPCS 63700001,99999-6007-93,OXCARBAZEPINE 300 MG/5ML PO SUSP,$10.05,$0.00,$10.05,$0.00,$7.17,$0.00,$0.00,$0.00,$0.00,$0.00,$10.05,$0.00,$5.03,$7.96,$8.04,$0.00,$0.00,$0.00,$0.00,$0.00
30699,ERX,HCPCS 63700001,43547-0272-10,ROPINIROLE HCL 3 MG PO TABS,$9.50,$0.00,$9.50,$0.00,$6.78,$0.00,$0.00,$0.00,$0.00,$0.00,$9.50,$0.00,$4.75,$7.52,$7.60,$0.00,$0.00,$0.00,$0.00,$0.00
31086,ERX,HCPCS J0690,66288-1100-01,CEFAZOLIN SODIUM 100 G IJ SOLR,$347.70,$0.00,$347.70,$156.47,$261.21,$0.00,$138.65,$0.00,$0.00,$192.70,$347.70,$0.00,$173.85,$275.38,$278.16,$0.00,$192.70,$0.00,$183.48,$0.00
31087,ERX,HCPCS J0690,66288-1300-01,CEFAZOLIN SODIUM 300 G IJ SOLR,$922.20,$0.00,$922.20,$414.99,$658.17,$0.00,$415.95,$0.00,$0.00,$578.10,$922.20,$0.00,$461.10,$730.38,$737.76,$0.00,$578.10,$0.00,$550.45,$0.00
31097,ERX,HCPCS J9267,44567-0506-01,PACLITAXEL 300 MG/50ML IV CONC,$207.90,$0.00,$207.90,$93.56,$148.38,$0.00,$35.82,$0.00,$0.00,$49.35,$207.90,$0.00,$103.95,$164.66,$166.32,$0.00,$49.35,$0.00,$46.99,$0.00
31097,ERX,HCPCS J9267,47781-0595-07,PACLITAXEL 300 MG/50ML IV CONC,$207.90,$0.00,$207.90,$93.56,$148.38,$0.00,$35.82,$0.00,$0.00,$49.35,$207.90,$0.00,$103.95,$164.66,$166.32,$0.00,$49.35,$0.00,$46.99,$0.00
31097,ERX,HCPCS J9267,61703-0342-50,PACLITAXEL 300 MG/50ML IV CONC,$207.90,$0.00,$207.90,$93.56,$148.38,$0.00,$35.82,$0.00,$0.00,$49.35,$207.90,$0.00,$103.95,$164.66,$166.32,$0.00,$49.35,$0.00,$46.99,$0.00
31097,ERX,HCPCS J9267,63323-0763-50,PACLITAXEL 300 MG/50ML IV CONC,$207.90,$0.00,$207.90,$93.56,$148.38,$0.00,$35.82,$0.00,$0.00,$49.35,$207.90,$0.00,$103.95,$164.66,$166.32,$0.00,$49.35,$0.00,$46.99,$0.00
31097,ERX,HCPCS J9267,67457-0434-51,PACLITAXEL 300 MG/50ML IV CONC,$207.90,$0.00,$207.90,$93.56,$148.38,$0.00,$35.82,$0.00,$0.00,$49.35,$207.90,$0.00,$103.95,$164.66,$166.32,$0.00,$49.35,$0.00,$46.99,$0.00
31097,ERX,HCPCS J9267,70860-0200-50,PACLITAXEL 300 MG/50ML IV CONC,$207.90,$0.00,$207.90,$93.56,$148.38,$0.00,$35.82,$0.00,$0.00,$49.35,$207.90,$0.00,$103.95,$164.66,$166.32,$0.00,$49.35,$0.00,$46.99,$0.00
31177,ERX,HCPCS 63700001,00093-8675-78,AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5ML PO SUSR,$134.40,$0.00,$253.97,$0.00,$181.26,$0.00,$0.00,$0.00,$0.00,$0.00,$253.97,$0.00,$126.99,$106.44,$203.18,$0.00,$0.00,$0.00,$0.00,$0.00
31177,ERX,HCPCS 63700001,16714-0294-01,AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5ML PO SUSR,$134.40,$0.00,$253.97,$0.00,$181.26,$0.00,$0.00,$0.00,$0.00,$0.00,$253.97,$0.00,$126.99,$106.44,$203.18,$0.00,$0.00,$0.00,$0.00,$0.00
31177,ERX,HCPCS 63700001,16714-0294-02,AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5ML PO SUSR,$253.97,$0.00,$253.97,$0.00,$181.26,$0.00,$0.00,$0.00,$0.00,$0.00,$253.97,$0.00,$126.99,$201.14,$203.18,$0.00,$0.00,$0.00,$0.00,$0.00
31209,ERX,HCPCS 63700001,00078-0358-34,VALSARTAN 80 MG PO TABS,$35.82,$0.00,$35.82,$0.00,$25.56,$0.00,$0.00,$0.00,$0.00,$0.00,$35.82,$0.00,$17.91,$28.37,$28.66,$0.00,$0.00,$0.00,$0.00,$0.00
31209,ERX,HCPCS 63700001,00378-5813-77,VALSARTAN 80 MG PO TABS,$35.82,$0.00,$35.82,$0.00,$25.56,$0.00,$0.00,$0.00,$0.00,$0.00,$35.82,$0.00,$17.91,$28.37,$28.66,$0.00,$0.00,$0.00,$0.00,$0.00
31209,ERX,HCPCS 63700001,33342-0063-10,VALSARTAN 80 MG PO TABS,$35.82,$0.00,$35.82,$0.00,$25.56,$0.00,$0.00,$0.00,$0.00,$0.00,$35.82,$0.00,$17.91,$28.37,$28.66,$0.00,$0.00,$0.00,$0.00,$0.00
31209,ERX,HCPCS 63700001,59746-0361-90,VALSARTAN 80 MG PO TABS,$35.82,$0.00,$35.82,$0.00,$25.56,$0.00,$0.00,$0.00,$0.00,$0.00,$35.82,$0.00,$17.91,$28.37,$28.66,$0.00,$0.00,$0.00,$0.00,$0.00
31210,ERX,HCPCS 63700001,00078-0359-34,VALSARTAN 160 MG PO TABS,$19.00,$0.00,$19.00,$0.00,$13.56,$0.00,$0.00,$0.00,$0.00,$0.00,$19.00,$0.00,$9.50,$15.05,$15.20,$0.00,$0.00,$0.00,$0.00,$0.00
31210,ERX,HCPCS 63700001,33342-0064-10,VALSARTAN 160 MG PO TABS,$19.00,$0.00,$19.00,$0.00,$13.56,$0.00,$0.00,$0.00,$0.00,$0.00,$19.00,$0.00,$9.50,$15.05,$15.20,$0.00,$0.00,$0.00,$0.00,$0.00
31210,ERX,HCPCS 63700001,59746-0362-90,VALSARTAN 160 MG PO TABS,$19.00,$0.00,$19.00,$0.00,$13.56,$0.00,$0.00,$0.00,$0.00,$0.00,$19.00,$0.00,$9.50,$15.05,$15.20,$0.00,$0.00,$0.00,$0.00,$0.00
31210,ERX,HCPCS 63700001,65862-0572-90,VALSARTAN 160 MG PO TABS,$19.00,$0.00,$19.00,$0.00,$13.56,$0.00,$0.00,$0.00,$0.00,$0.00,$19.00,$0.00,$9.50,$15.05,$15.20,$0.00,$0.00,$0.00,$0.00,$0.00
31211,ERX,HCPCS 63700001,00078-0360-34,VALSARTAN 320 MG PO TABS,$48.72,$0.00,$48.72,$0.00,$34.77,$0.00,$0.00,$0.00,$0.00,$0.00,$48.72,$0.00,$24.36,$38.59,$38.98,$0.00,$0.00,$0.00,$0.00,$0.00
31211,ERX,HCPCS 63700001,33342-0065-10,VALSARTAN 320 MG PO TABS,$48.72,$0.00,$48.72,$0.00,$34.77,$0.00,$0.00,$0.00,$0.00,$0.00,$48.72,$0.00,$24.36,$38.59,$38.98,$0.00,$0.00,$0.00,$0.00,$0.00
31239,ERX,HCPCS 63700001,50580-0728-24,CETIRIZINE-PSEUDOEPHEDRINE ER 5-120 MG PO TB12,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
31270,ERX,HCPCS Q9957,11994-0011-04,PERFLUTREN LIPID MICROSPHERE 6.52 MG/ML IV SUSP,$844.71,$0.00,$844.71,$0.00,$602.87,$0.00,$0.00,$0.00,$0.00,$0.00,$844.71,$0.00,$422.36,$669.01,$675.77,$0.00,$0.00,$0.00,$0.00,$0.00
31310,ERX,HCPCS J2997,50242-0041-64,ALTEPLASE 2 MG IJ SOLR,$560.20,$0.00,$560.20,$252.09,$399.81,$175.28,$96.52,$0.00,$0.00,$98.09,$560.20,$184.04,$280.10,$443.68,$448.16,$254.15,$87.67,$0.00,$89.18,$175.77
31336,ERX,HCPCS 63700001,00115-5511-10,FENOFIBRATE 54 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
31336,ERX,HCPCS 63700001,42858-0454-45,FENOFIBRATE 54 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
31415,ERX,HCPCS 63700001,00187-0650-42,METHOXSALEN RAPID 10 MG PO CAPS,$310.80,$0.00,$310.80,$0.00,$221.82,$0.00,$0.00,$0.00,$0.00,$0.00,$310.80,$0.00,$155.40,$246.15,$248.64,$0.00,$0.00,$0.00,$0.00,$0.00
31432,ERX,HCPCS J1162,50633-0120-11,DIGOXIN IMMUNE FAB 40 MG IV SOLR,"$93,996.60",$0.00,"$97,760.40",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$97,760.40",$0.00,"$48,880.20","$74,445.31","$78,208.32",$0.00,$0.00,$0.00,$0.00,$0.00
31530,ERX,HCPCS 25000001,00052-0273-01,ETONOGESTREL-ETHINYL ESTRADIOL 0.12-0.015 MG/24HR VA RING,$595.23,$0.00,$595.23,$0.00,$424.82,$0.00,$0.00,$0.00,$0.00,$0.00,$595.23,$0.00,$297.62,$471.42,$476.18,$0.00,$0.00,$0.00,$0.00,$0.00
31530,ERX,HCPCS 25000001,00052-0273-03,ETONOGESTREL-ETHINYL ESTRADIOL 0.12-0.015 MG/24HR VA RING,$595.23,$0.00,$595.23,$0.00,$424.82,$0.00,$0.00,$0.00,$0.00,$0.00,$595.23,$0.00,$297.62,$471.42,$476.18,$0.00,$0.00,$0.00,$0.00,$0.00
31576,ERX,HCPCS 63700001,00574-9850-10,BUDESONIDE 3 MG PO CPEP,$71.62,$0.00,$71.62,$0.00,$51.12,$0.00,$0.00,$0.00,$0.00,$0.00,$71.62,$0.00,$35.81,$56.72,$57.30,$0.00,$0.00,$0.00,$0.00,$0.00
31576,ERX,HCPCS 63700001,16714-0829-01,BUDESONIDE 3 MG PO CPEP,$71.62,$0.00,$71.62,$0.00,$51.12,$0.00,$0.00,$0.00,$0.00,$0.00,$71.62,$0.00,$35.81,$56.72,$57.30,$0.00,$0.00,$0.00,$0.00,$0.00
31684,ERX,HCPCS 63700001,42291-0800-30,TENOFOVIR DISOPROXIL FUMARATE 300 MG PO TABS,$21.18,$0.00,$21.18,$0.00,$15.12,$0.00,$0.00,$0.00,$0.00,$0.00,$21.18,$0.00,$10.59,$16.77,$16.94,$0.00,$0.00,$0.00,$0.00,$0.00
31684,ERX,HCPCS 63700001,61958-0401-01,TENOFOVIR DISOPROXIL FUMARATE 300 MG PO TABS,$21.18,$0.00,$21.18,$0.00,$15.12,$0.00,$0.00,$0.00,$0.00,$0.00,$21.18,$0.00,$10.59,$16.77,$16.94,$0.00,$0.00,$0.00,$0.00,$0.00
31684,ERX,HCPCS 63700001,64380-0714-04,TENOFOVIR DISOPROXIL FUMARATE 300 MG PO TABS,$21.18,$0.00,$21.18,$0.00,$15.12,$0.00,$0.00,$0.00,$0.00,$0.00,$21.18,$0.00,$10.59,$16.77,$16.94,$0.00,$0.00,$0.00,$0.00,$0.00
31684,ERX,HCPCS 63700001,65862-0421-30,TENOFOVIR DISOPROXIL FUMARATE 300 MG PO TABS,$21.18,$0.00,$21.18,$0.00,$15.12,$0.00,$0.00,$0.00,$0.00,$0.00,$21.18,$0.00,$10.59,$16.77,$16.94,$0.00,$0.00,$0.00,$0.00,$0.00
31688,ERX,HCPCS J2501,00074-4637-01,PARICALCITOL 2 MCG/ML IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$4.30,$0.00,$0.00,$0.90,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.90,$0.00,$0.86,$0.00
31688,ERX,HCPCS J2501,55150-0212-01,PARICALCITOL 2 MCG/ML IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$4.30,$0.00,$0.00,$0.90,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.90,$0.00,$0.86,$0.00
31688,ERX,HCPCS J2501,67457-0379-25,PARICALCITOL 2 MCG/ML IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$4.30,$0.00,$0.00,$0.90,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.90,$0.00,$0.86,$0.00
31784,ERX,HCPCS 25000001,66658-0234-01,ANAKINRA 100 MG/0.67ML SC SOSY,$567.34,$0.00,$567.34,$0.00,$404.91,$0.00,$0.00,$0.00,$0.00,$0.00,$567.34,$0.00,$283.67,$449.33,$453.87,$0.00,$0.00,$0.00,$0.00,$0.00
31784,ERX,HCPCS 25000001,66658-0234-07,ANAKINRA 100 MG/0.67ML SC SOSY,$567.34,$0.00,$567.34,$0.00,$404.91,$0.00,$0.00,$0.00,$0.00,$0.00,$567.34,$0.00,$283.67,$449.33,$453.87,$0.00,$0.00,$0.00,$0.00,$0.00
31876,ERX,HCPCS 63700001,66215-0102-06,BOSENTAN 125 MG PO TABS,$616.48,$0.00,$616.48,$0.00,$439.98,$0.00,$0.00,$0.00,$0.00,$0.00,$616.48,$0.00,$308.24,$488.25,$493.18,$0.00,$0.00,$0.00,$0.00,$0.00
31921,ERX,HCPCS J1650,00548-5607-00,ENOXAPARIN SODIUM 150 MG/ML SC SOLN,$372.01,$0.00,$372.01,$167.40,$265.50,$0.00,$64.10,$0.00,$0.00,$65.14,$372.01,$0.00,$186.01,$294.63,$297.61,$0.00,$58.22,$0.00,$59.22,$0.00
31921,ERX,HCPCS J1650,00781-3655-69,ENOXAPARIN SODIUM 150 MG/ML SC SOLN,$372.01,$0.00,$372.01,$167.40,$265.50,$0.00,$64.10,$0.00,$0.00,$65.14,$372.01,$0.00,$186.01,$294.63,$297.61,$0.00,$58.22,$0.00,$59.22,$0.00
31921,ERX,HCPCS J1650,00955-1015-10,ENOXAPARIN SODIUM 150 MG/ML SC SOLN,$372.01,$0.00,$372.01,$167.40,$265.50,$0.00,$64.10,$0.00,$0.00,$65.14,$372.01,$0.00,$186.01,$294.63,$297.61,$0.00,$58.22,$0.00,$59.22,$0.00
31921,ERX,HCPCS J1650,63323-0537-84,ENOXAPARIN SODIUM 150 MG/ML SC SOLN,$372.01,$0.00,$372.01,$167.40,$265.50,$0.00,$64.10,$0.00,$0.00,$65.14,$372.01,$0.00,$186.01,$294.63,$297.61,$0.00,$58.22,$0.00,$59.22,$0.00
31922,ERX,HCPCS J1335,00006-3843-71,ERTAPENEM SODIUM 1 G IJ SOLR,$221.27,$0.00,$221.27,$99.57,$157.92,$0.00,$38.12,$0.00,$0.00,$45.47,$221.27,$0.00,$110.64,$175.25,$177.02,$0.00,$45.47,$0.00,$43.30,$0.00
31922,ERX,HCPCS J1335,42023-0221-10,ERTAPENEM SODIUM 1 G IJ SOLR,$221.27,$0.00,$221.27,$99.57,$157.92,$0.00,$38.12,$0.00,$0.00,$45.47,$221.27,$0.00,$110.64,$175.25,$177.02,$0.00,$45.47,$0.00,$43.30,$0.00
31922,ERX,HCPCS J1335,55150-0282-20,ERTAPENEM SODIUM 1 G IJ SOLR,$221.27,$0.00,$221.27,$99.57,$157.92,$0.00,$38.12,$0.00,$0.00,$45.47,$221.27,$0.00,$110.64,$175.25,$177.02,$0.00,$45.47,$0.00,$43.30,$0.00
32052,ERX,HCPCS 25000001,00187-5100-01,PIMECROLIMUS 1 % EX CREA,$852.24,$0.00,$852.24,$0.00,$608.24,$0.00,$0.00,$0.00,$0.00,$0.00,$852.24,$0.00,$426.12,$674.97,$681.79,$0.00,$0.00,$0.00,$0.00,$0.00
32052,ERX,HCPCS 25000001,68462-0609-35,PIMECROLIMUS 1 % EX CREA,$852.24,$0.00,$852.24,$0.00,$608.24,$0.00,$0.00,$0.00,$0.00,$0.00,$852.24,$0.00,$426.12,$674.97,$681.79,$0.00,$0.00,$0.00,$0.00,$0.00
32052,ERX,HCPCS 25000001,68682-0110-01,PIMECROLIMUS 1 % EX CREA,$852.24,$0.00,$852.24,$0.00,$608.24,$0.00,$0.00,$0.00,$0.00,$0.00,$852.24,$0.00,$426.12,$674.97,$681.79,$0.00,$0.00,$0.00,$0.00,$0.00
32128,ERX,HCPCS 63700001,00093-7270-98,PRAVASTATIN SODIUM 80 MG PO TABS,$18.22,$0.00,$18.22,$0.00,$13.00,$0.00,$0.00,$0.00,$0.00,$0.00,$18.22,$0.00,$9.11,$14.43,$14.58,$0.00,$0.00,$0.00,$0.00,$0.00
32128,ERX,HCPCS 63700001,16729-0011-15,PRAVASTATIN SODIUM 80 MG PO TABS,$18.22,$0.00,$18.22,$0.00,$13.00,$0.00,$0.00,$0.00,$0.00,$0.00,$18.22,$0.00,$9.11,$14.43,$14.58,$0.00,$0.00,$0.00,$0.00,$0.00
32128,ERX,HCPCS 63700001,60505-1323-09,PRAVASTATIN SODIUM 80 MG PO TABS,$18.22,$0.00,$18.22,$0.00,$13.00,$0.00,$0.00,$0.00,$0.00,$0.00,$18.22,$0.00,$9.11,$14.43,$14.58,$0.00,$0.00,$0.00,$0.00,$0.00
32128,ERX,HCPCS 63700001,68462-0198-90,PRAVASTATIN SODIUM 80 MG PO TABS,$18.22,$0.00,$18.22,$0.00,$13.00,$0.00,$0.00,$0.00,$0.00,$0.00,$18.22,$0.00,$9.11,$14.43,$14.58,$0.00,$0.00,$0.00,$0.00,$0.00
32215,ERX,HCPCS J1652,55111-0678-02,FONDAPARINUX SODIUM 2.5 MG/0.5ML SC SOLN,$172.16,$0.00,$172.16,$0.00,$122.87,$0.00,$0.00,$0.00,$0.00,$0.00,$172.16,$0.00,$86.08,$136.35,$137.73,$0.00,$0.00,$0.00,$0.00,$0.00
32215,ERX,HCPCS J1652,55111-0678-10,FONDAPARINUX SODIUM 2.5 MG/0.5ML SC SOLN,$172.16,$0.00,$172.16,$0.00,$122.87,$0.00,$0.00,$0.00,$0.00,$0.00,$172.16,$0.00,$86.08,$136.35,$137.73,$0.00,$0.00,$0.00,$0.00,$0.00
32215,ERX,HCPCS J1652,55511-0678-11,FONDAPARINUX SODIUM 2.5 MG/0.5ML SC SOLN,$172.16,$0.00,$172.16,$0.00,$122.87,$0.00,$0.00,$0.00,$0.00,$0.00,$172.16,$0.00,$86.08,$136.35,$137.73,$0.00,$0.00,$0.00,$0.00,$0.00
32298,ERX,HCPCS 63700001,00056-0510-30,EFAVIRENZ 600 MG PO TABS,$137.29,$0.00,$137.29,$0.00,$97.98,$0.00,$0.00,$0.00,$0.00,$0.00,$137.29,$0.00,$68.65,$108.73,$109.83,$0.00,$0.00,$0.00,$0.00,$0.00
32298,ERX,HCPCS 63700001,69097-0301-02,EFAVIRENZ 600 MG PO TABS,$137.29,$0.00,$137.29,$0.00,$97.98,$0.00,$0.00,$0.00,$0.00,$0.00,$137.29,$0.00,$68.65,$108.73,$109.83,$0.00,$0.00,$0.00,$0.00,$0.00
32354,ERX,HCPCS 25000001,42192-0139-01,SULFACETAMIDE SODIUM-SULFUR 10-5 % EX CREA,$361.76,$0.00,$361.76,$0.00,$258.19,$0.00,$0.00,$0.00,$0.00,$0.00,$361.76,$0.00,$180.88,$286.51,$289.41,$0.00,$0.00,$0.00,$0.00,$0.00
32375,ERX,HCPCS 25000001,24208-0344-25,FLUNISOLIDE 25 MCG/ACT (0.025%) NA SOLN,$226.65,$0.00,$226.65,$0.00,$161.76,$0.00,$0.00,$0.00,$0.00,$0.00,$226.65,$0.00,$113.33,$179.51,$181.32,$0.00,$0.00,$0.00,$0.00,$0.00
32589,ERX,HCPCS J2430,61703-0324-18,PAMIDRONATE DISODIUM 30 MG/10ML IV SOLN,$62.97,$0.00,$62.97,$28.34,$44.94,$0.00,$36.23,$0.00,$0.00,$11.03,$62.97,$0.00,$31.49,$49.87,$50.38,$0.00,$9.85,$0.00,$10.02,$0.00
32589,ERX,HCPCS J2430,67457-0430-10,PAMIDRONATE DISODIUM 30 MG/10ML IV SOLN,$62.97,$0.00,$62.97,$28.34,$44.94,$0.00,$36.23,$0.00,$0.00,$11.03,$62.97,$0.00,$31.49,$49.87,$50.38,$0.00,$9.85,$0.00,$10.02,$0.00
32703,ERX,HCPCS 25000001,08212-4271-81,ILEX SKIN PROTECTANT 58.3 % EX PSTE,$23.72,$0.00,$23.72,$0.00,$16.93,$0.00,$0.00,$0.00,$0.00,$0.00,$23.72,$0.00,$11.86,$18.79,$18.98,$0.00,$0.00,$0.00,$0.00,$0.00
32810,ERX,HCPCS 25000001,89141-0456-02,GELCLAIR MT GEL,$171.14,$0.00,$171.14,$0.00,$122.14,$0.00,$0.00,$0.00,$0.00,$0.00,$171.14,$0.00,$85.57,$135.54,$136.91,$0.00,$0.00,$0.00,$0.00,$0.00
32810,ERX,HCPCS 25000001,89141-0456-03,GELCLAIR MT GEL,$171.14,$0.00,$171.14,$0.00,$122.14,$0.00,$0.00,$0.00,$0.00,$0.00,$171.14,$0.00,$85.57,$135.54,$136.91,$0.00,$0.00,$0.00,$0.00,$0.00
32893,ERX,HCPCS J9217,62935-0753-75,LEUPROLIDE ACETATE 7.5 MG SC KIT,"$1,300.88",$0.00,"$1,300.88",$585.40,$928.44,$224.70,$246.83,$0.00,$0.00,$270.33,"$1,300.88",$235.93,$650.44,"$1,030.30","$1,040.70",$325.81,$270.33,$0.00,$257.40,$205.89
32895,ERX,HCPCS 63700001,00430-0472-03,RISEDRONATE SODIUM 35 MG PO TABS,$312.00,$0.00,$312.00,$0.00,$222.67,$0.00,$0.00,$0.00,$0.00,$0.00,$312.00,$0.00,$156.00,$247.10,$249.60,$0.00,$0.00,$0.00,$0.00,$0.00
32960,ERX,HCPCS J7192,00026-3783-35,ANTIHEMOPHILIC FACTOR VIII RECOMB (KOGENATE FS) 500 UNITS IV KIT,"$2,364.00",$0.00,"$2,364.00",$0.00,"$1,687.19",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,364.00",$0.00,"$1,182.00","$1,872.29","$1,891.20",$0.00,$0.00,$0.00,$0.00,$0.00
32961,ERX,HCPCS J7192,00026-3785-55,ANTIHEMOPHILIC FACTOR VIII RECOMB (KOGENATE FS) 1000 UNITS IV KIT,"$4,038.50",$0.00,"$4,038.50",$0.00,"$2,882.28",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,038.50",$0.00,"$2,019.25","$3,198.49","$3,230.80",$0.00,$0.00,$0.00,$0.00,$0.00
32961,ERX,HCPCS J7192,00026-4785-01,ANTIHEMOPHILIC FACTOR VIII RECOMB (KOGENATE FS) 1000 UNITS IV KIT,"$4,038.50",$0.00,"$4,038.50",$0.00,"$2,882.28",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,038.50",$0.00,"$2,019.25","$3,198.49","$3,230.80",$0.00,$0.00,$0.00,$0.00,$0.00
32979,ERX,HCPCS 63700001,00078-0401-34,IMATINIB MESYLATE 100 MG PO TABS,"$1,191.08",$0.00,"$1,191.08",$0.00,$850.07,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,191.08",$0.00,$595.54,$943.34,$952.86,$0.00,$0.00,$0.00,$0.00,$0.00
33008,ERX,HCPCS 63700001,00049-3170-30,VORICONAZOLE 50 MG PO TABS,$13.38,$0.00,$13.38,$0.00,$9.55,$0.00,$0.00,$0.00,$0.00,$0.00,$13.38,$0.00,$6.69,$10.60,$10.70,$0.00,$0.00,$0.00,$0.00,$0.00
33008,ERX,HCPCS 63700001,00781-5667-31,VORICONAZOLE 50 MG PO TABS,$13.38,$0.00,$13.38,$0.00,$9.55,$0.00,$0.00,$0.00,$0.00,$0.00,$13.38,$0.00,$6.69,$10.60,$10.70,$0.00,$0.00,$0.00,$0.00,$0.00
33008,ERX,HCPCS 63700001,16714-0514-01,VORICONAZOLE 50 MG PO TABS,$13.38,$0.00,$13.38,$0.00,$9.55,$0.00,$0.00,$0.00,$0.00,$0.00,$13.38,$0.00,$6.69,$10.60,$10.70,$0.00,$0.00,$0.00,$0.00,$0.00
33009,ERX,HCPCS 63700001,00049-3180-30,VORICONAZOLE 200 MG PO TABS,$16.73,$0.00,$16.73,$0.00,$11.94,$0.00,$0.00,$0.00,$0.00,$0.00,$16.73,$0.00,$8.37,$13.25,$13.38,$0.00,$0.00,$0.00,$0.00,$0.00
33009,ERX,HCPCS 63700001,00781-5668-31,VORICONAZOLE 200 MG PO TABS,$16.73,$0.00,$16.73,$0.00,$11.94,$0.00,$0.00,$0.00,$0.00,$0.00,$16.73,$0.00,$8.37,$13.25,$13.38,$0.00,$0.00,$0.00,$0.00,$0.00
33009,ERX,HCPCS 63700001,16714-0515-01,VORICONAZOLE 200 MG PO TABS,$16.73,$0.00,$16.73,$0.00,$11.94,$0.00,$0.00,$0.00,$0.00,$0.00,$16.73,$0.00,$8.37,$13.25,$13.38,$0.00,$0.00,$0.00,$0.00,$0.00
33009,ERX,HCPCS 63700001,51079-0165-03,VORICONAZOLE 200 MG PO TABS,$16.73,$0.00,$16.73,$0.00,$11.94,$0.00,$0.00,$0.00,$0.00,$0.00,$16.73,$0.00,$8.37,$13.25,$13.38,$0.00,$0.00,$0.00,$0.00,$0.00
33010,ERX,HCPCS J3465,00049-3190-01,VORICONAZOLE 200 MG IV SOLR,$465.37,$0.00,$465.37,$0.00,$332.13,$0.00,$0.00,$0.00,$0.00,$0.00,$465.37,$0.00,$232.69,$368.57,$372.30,$0.00,$0.00,$0.00,$0.00,$0.00
33010,ERX,HCPCS J3465,00049-3190-28,VORICONAZOLE 200 MG IV SOLR,$465.37,$0.00,$465.37,$0.00,$332.13,$0.00,$0.00,$0.00,$0.00,$0.00,$465.37,$0.00,$232.69,$368.57,$372.30,$0.00,$0.00,$0.00,$0.00,$0.00
33010,ERX,HCPCS J3465,00781-3416-94,VORICONAZOLE 200 MG IV SOLR,$465.37,$0.00,$465.37,$0.00,$332.13,$0.00,$0.00,$0.00,$0.00,$0.00,$465.37,$0.00,$232.69,$368.57,$372.30,$0.00,$0.00,$0.00,$0.00,$0.00
33010,ERX,HCPCS J3465,47781-0466-71,VORICONAZOLE 200 MG IV SOLR,$465.37,$0.00,$465.37,$0.00,$332.13,$0.00,$0.00,$0.00,$0.00,$0.00,$465.37,$0.00,$232.69,$368.57,$372.30,$0.00,$0.00,$0.00,$0.00,$0.00
33083,ERX,HCPCS 63700001,00245-0213-11,MIDODRINE HCL 10 MG PO TABS,$16.55,$0.00,$16.55,$0.00,$11.81,$0.00,$0.00,$0.00,$0.00,$0.00,$16.55,$0.00,$8.28,$13.11,$13.24,$0.00,$0.00,$0.00,$0.00,$0.00
33083,ERX,HCPCS 63700001,00378-1903-01,MIDODRINE HCL 10 MG PO TABS,$16.55,$0.00,$16.55,$0.00,$11.81,$0.00,$0.00,$0.00,$0.00,$0.00,$16.55,$0.00,$8.28,$13.11,$13.24,$0.00,$0.00,$0.00,$0.00,$0.00
33083,ERX,HCPCS 63700001,42291-0562-90,MIDODRINE HCL 10 MG PO TABS,$16.55,$0.00,$16.55,$0.00,$11.81,$0.00,$0.00,$0.00,$0.00,$0.00,$16.55,$0.00,$8.28,$13.11,$13.24,$0.00,$0.00,$0.00,$0.00,$0.00
33111,ERX,HCPCS 63700001,55111-0341-01,AMLODIPINE-BENAZEPRIL HCL 10-20 MG PO CAPS,$12.62,$0.00,$12.62,$0.00,$9.01,$0.00,$0.00,$0.00,$0.00,$0.00,$12.62,$0.00,$6.31,$10.00,$10.10,$0.00,$0.00,$0.00,$0.00,$0.00
33111,ERX,HCPCS 63700001,65862-0586-01,AMLODIPINE-BENAZEPRIL HCL 10-20 MG PO CAPS,$12.62,$0.00,$12.62,$0.00,$9.01,$0.00,$0.00,$0.00,$0.00,$0.00,$12.62,$0.00,$6.31,$10.00,$10.10,$0.00,$0.00,$0.00,$0.00,$0.00
33175,ERX,HCPCS J3486,00049-3920-83,ZIPRASIDONE MESYLATE 20 MG IM SOLR,$74.77,$0.00,$74.77,$33.65,$53.36,$0.00,$12.88,$0.00,$0.00,$21.10,$74.77,$0.00,$37.39,$59.22,$59.82,$0.00,$21.10,$0.00,$20.09,$0.00
33175,ERX,HCPCS J3486,43598-0848-58,ZIPRASIDONE MESYLATE 20 MG IM SOLR,$74.77,$0.00,$74.77,$33.65,$53.36,$0.00,$12.88,$0.00,$0.00,$21.10,$74.77,$0.00,$37.39,$59.22,$59.82,$0.00,$21.10,$0.00,$20.09,$0.00
33175,ERX,HCPCS J3486,72266-0160-01,ZIPRASIDONE MESYLATE 20 MG IM SOLR,$74.77,$0.00,$74.77,$33.65,$53.36,$0.00,$12.88,$0.00,$0.00,$21.10,$74.77,$0.00,$37.39,$59.22,$59.82,$0.00,$21.10,$0.00,$20.09,$0.00
33175,ERX,HCPCS J3486,72266-0160-10,ZIPRASIDONE MESYLATE 20 MG IM SOLR,$74.77,$0.00,$74.77,$33.65,$53.36,$0.00,$12.88,$0.00,$0.00,$21.10,$74.77,$0.00,$37.39,$59.22,$59.82,$0.00,$21.10,$0.00,$20.09,$0.00
33226,ERX,HCPCS 63700001,00093-2272-34,AMOXICILLIN-POT CLAVULANATE 400-57 MG PO CHEW,$20.49,$0.00,$20.49,$0.00,$14.62,$0.00,$0.00,$0.00,$0.00,$0.00,$20.49,$0.00,$10.25,$16.23,$16.39,$0.00,$0.00,$0.00,$0.00,$0.00
33227,ERX,HCPCS 63700001,00093-2274-34,AMOXICILLIN-POT CLAVULANATE 500-125 MG PO TABS,$14.39,$0.00,$14.39,$0.00,$10.27,$0.00,$0.00,$0.00,$0.00,$0.00,$14.39,$0.00,$7.20,$11.40,$11.51,$0.00,$0.00,$0.00,$0.00,$0.00
33227,ERX,HCPCS 63700001,16714-0296-01,AMOXICILLIN-POT CLAVULANATE 500-125 MG PO TABS,$14.39,$0.00,$14.39,$0.00,$10.27,$0.00,$0.00,$0.00,$0.00,$0.00,$14.39,$0.00,$7.20,$11.40,$11.51,$0.00,$0.00,$0.00,$0.00,$0.00
33227,ERX,HCPCS 63700001,16714-0494-01,AMOXICILLIN-POT CLAVULANATE 500-125 MG PO TABS,$14.39,$0.00,$14.39,$0.00,$10.27,$0.00,$0.00,$0.00,$0.00,$0.00,$14.39,$0.00,$7.20,$11.40,$11.51,$0.00,$0.00,$0.00,$0.00,$0.00
33227,ERX,HCPCS 63700001,65862-0502-20,AMOXICILLIN-POT CLAVULANATE 500-125 MG PO TABS,$14.39,$0.00,$14.39,$0.00,$10.27,$0.00,$0.00,$0.00,$0.00,$0.00,$14.39,$0.00,$7.20,$11.40,$11.51,$0.00,$0.00,$0.00,$0.00,$0.00
33227,ERX,HCPCS 63700001,66685-1002-02,AMOXICILLIN-POT CLAVULANATE 500-125 MG PO TABS,$14.39,$0.00,$14.39,$0.00,$10.27,$0.00,$0.00,$0.00,$0.00,$0.00,$14.39,$0.00,$7.20,$11.40,$11.51,$0.00,$0.00,$0.00,$0.00,$0.00
33228,ERX,HCPCS 63700001,00093-2275-34,AMOXICILLIN-POT CLAVULANATE 875-125 MG PO TABS,$18.66,$0.00,$18.66,$0.00,$13.32,$0.00,$0.00,$0.00,$0.00,$0.00,$18.66,$0.00,$9.33,$14.78,$14.93,$0.00,$0.00,$0.00,$0.00,$0.00
33228,ERX,HCPCS 63700001,00781-1852-20,AMOXICILLIN-POT CLAVULANATE 875-125 MG PO TABS,$18.66,$0.00,$18.66,$0.00,$13.32,$0.00,$0.00,$0.00,$0.00,$0.00,$18.66,$0.00,$9.33,$14.78,$14.93,$0.00,$0.00,$0.00,$0.00,$0.00
33228,ERX,HCPCS 63700001,16714-0297-01,AMOXICILLIN-POT CLAVULANATE 875-125 MG PO TABS,$18.66,$0.00,$18.66,$0.00,$13.32,$0.00,$0.00,$0.00,$0.00,$0.00,$18.66,$0.00,$9.33,$14.78,$14.93,$0.00,$0.00,$0.00,$0.00,$0.00
33228,ERX,HCPCS 63700001,16714-0297-02,AMOXICILLIN-POT CLAVULANATE 875-125 MG PO TABS,$18.66,$0.00,$18.66,$0.00,$13.32,$0.00,$0.00,$0.00,$0.00,$0.00,$18.66,$0.00,$9.33,$14.78,$14.93,$0.00,$0.00,$0.00,$0.00,$0.00
33228,ERX,HCPCS 63700001,16714-0478-01,AMOXICILLIN-POT CLAVULANATE 875-125 MG PO TABS,$18.66,$0.00,$18.66,$0.00,$13.32,$0.00,$0.00,$0.00,$0.00,$0.00,$18.66,$0.00,$9.33,$14.78,$14.93,$0.00,$0.00,$0.00,$0.00,$0.00
33228,ERX,HCPCS 63700001,16714-0478-02,AMOXICILLIN-POT CLAVULANATE 875-125 MG PO TABS,$18.66,$0.00,$18.66,$0.00,$13.32,$0.00,$0.00,$0.00,$0.00,$0.00,$18.66,$0.00,$9.33,$14.78,$14.93,$0.00,$0.00,$0.00,$0.00,$0.00
33228,ERX,HCPCS 63700001,43598-0221-14,AMOXICILLIN-POT CLAVULANATE 875-125 MG PO TABS,$18.66,$0.00,$18.66,$0.00,$13.32,$0.00,$0.00,$0.00,$0.00,$0.00,$18.66,$0.00,$9.33,$14.78,$14.93,$0.00,$0.00,$0.00,$0.00,$0.00
33228,ERX,HCPCS 63700001,65862-0503-01,AMOXICILLIN-POT CLAVULANATE 875-125 MG PO TABS,$18.66,$0.00,$18.66,$0.00,$13.32,$0.00,$0.00,$0.00,$0.00,$0.00,$18.66,$0.00,$9.33,$14.78,$14.93,$0.00,$0.00,$0.00,$0.00,$0.00
33228,ERX,HCPCS 63700001,65862-0503-20,AMOXICILLIN-POT CLAVULANATE 875-125 MG PO TABS,$18.66,$0.00,$18.66,$0.00,$13.32,$0.00,$0.00,$0.00,$0.00,$0.00,$18.66,$0.00,$9.33,$14.78,$14.93,$0.00,$0.00,$0.00,$0.00,$0.00
33228,ERX,HCPCS 63700001,66685-1001-00,AMOXICILLIN-POT CLAVULANATE 875-125 MG PO TABS,$18.66,$0.00,$18.66,$0.00,$13.32,$0.00,$0.00,$0.00,$0.00,$0.00,$18.66,$0.00,$9.33,$14.78,$14.93,$0.00,$0.00,$0.00,$0.00,$0.00
33230,ERX,HCPCS 63700001,16714-0293-01,AMOXICILLIN-POT CLAVULANATE 400-57 MG/5ML PO SUSR,$123.03,$0.00,$123.03,$0.00,$87.81,$0.00,$0.00,$0.00,$0.00,$0.00,$123.03,$0.00,$61.52,$97.44,$98.42,$0.00,$0.00,$0.00,$0.00,$0.00
33230,ERX,HCPCS 63700001,66685-1012-00,AMOXICILLIN-POT CLAVULANATE 400-57 MG/5ML PO SUSR,$123.03,$0.00,$123.03,$0.00,$87.81,$0.00,$0.00,$0.00,$0.00,$0.00,$123.03,$0.00,$61.52,$97.44,$98.42,$0.00,$0.00,$0.00,$0.00,$0.00
33512,ERX,HCPCS 63700001,00093-5851-01,ESCITALOPRAM OXALATE 10 MG PO TABS,$16.46,$0.00,$16.46,$0.00,$11.75,$0.00,$0.00,$0.00,$0.00,$0.00,$16.46,$0.00,$8.23,$13.04,$13.17,$0.00,$0.00,$0.00,$0.00,$0.00
33512,ERX,HCPCS 63700001,00904-6426-61,ESCITALOPRAM OXALATE 10 MG PO TABS,$16.46,$0.00,$16.46,$0.00,$11.75,$0.00,$0.00,$0.00,$0.00,$0.00,$16.46,$0.00,$8.23,$13.04,$13.17,$0.00,$0.00,$0.00,$0.00,$0.00
33512,ERX,HCPCS 63700001,43547-0281-10,ESCITALOPRAM OXALATE 10 MG PO TABS,$16.46,$0.00,$16.46,$0.00,$11.75,$0.00,$0.00,$0.00,$0.00,$0.00,$16.46,$0.00,$8.23,$13.04,$13.17,$0.00,$0.00,$0.00,$0.00,$0.00
33512,ERX,HCPCS 63700001,76282-0250-90,ESCITALOPRAM OXALATE 10 MG PO TABS,$16.46,$0.00,$16.46,$0.00,$11.75,$0.00,$0.00,$0.00,$0.00,$0.00,$16.46,$0.00,$8.23,$13.04,$13.17,$0.00,$0.00,$0.00,$0.00,$0.00
33513,ERX,HCPCS 63700001,00456-2020-01,ESCITALOPRAM OXALATE 20 MG PO TABS,$17.18,$0.00,$17.18,$0.00,$12.26,$0.00,$0.00,$0.00,$0.00,$0.00,$17.18,$0.00,$8.59,$13.61,$13.74,$0.00,$0.00,$0.00,$0.00,$0.00
33513,ERX,HCPCS 63700001,00904-6427-61,ESCITALOPRAM OXALATE 20 MG PO TABS,$17.18,$0.00,$17.18,$0.00,$12.26,$0.00,$0.00,$0.00,$0.00,$0.00,$17.18,$0.00,$8.59,$13.61,$13.74,$0.00,$0.00,$0.00,$0.00,$0.00
33513,ERX,HCPCS 63700001,43547-0282-10,ESCITALOPRAM OXALATE 20 MG PO TABS,$17.18,$0.00,$17.18,$0.00,$12.26,$0.00,$0.00,$0.00,$0.00,$0.00,$17.18,$0.00,$8.59,$13.61,$13.74,$0.00,$0.00,$0.00,$0.00,$0.00
33513,ERX,HCPCS 63700001,65862-0375-01,ESCITALOPRAM OXALATE 20 MG PO TABS,$17.18,$0.00,$17.18,$0.00,$12.26,$0.00,$0.00,$0.00,$0.00,$0.00,$17.18,$0.00,$8.59,$13.61,$13.74,$0.00,$0.00,$0.00,$0.00,$0.00
33541,ERX,HCPCS 63700001,00378-5807-93,VALSARTAN 40 MG PO TABS,$15.41,$0.00,$15.41,$0.00,$11.00,$0.00,$0.00,$0.00,$0.00,$0.00,$15.41,$0.00,$7.71,$12.20,$12.33,$0.00,$0.00,$0.00,$0.00,$0.00
33541,ERX,HCPCS 63700001,33342-0062-07,VALSARTAN 40 MG PO TABS,$15.41,$0.00,$15.41,$0.00,$11.00,$0.00,$0.00,$0.00,$0.00,$0.00,$15.41,$0.00,$7.71,$12.20,$12.33,$0.00,$0.00,$0.00,$0.00,$0.00
33541,ERX,HCPCS 63700001,59746-0360-30,VALSARTAN 40 MG PO TABS,$15.41,$0.00,$15.41,$0.00,$11.00,$0.00,$0.00,$0.00,$0.00,$0.00,$15.41,$0.00,$7.71,$12.20,$12.33,$0.00,$0.00,$0.00,$0.00,$0.00
33591,ERX,HCPCS J2783,00024-5150-10,RASBURICASE 1.5 MG IV SOLR,"$2,243.20",$0.00,"$2,243.20",$0.00,"$1,600.97",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,243.20",$0.00,"$1,121.60","$1,776.61","$1,794.56",$0.00,$0.00,$0.00,$0.00,$0.00
33666,ERX,HCPCS J1815,00169-3685-12,INSULIN ASPART PROT & ASPART (70-30) 100 UNIT/ML SC SUSP,$954.38,$0.00,$954.38,$518.23,$681.14,$0.00,$72.85,$0.00,$0.00,$167.10,$954.38,$0.00,$477.19,$755.87,$763.50,$0.00,$0.00,$0.00,$201.38,$0.00
33669,ERX,HCPCS J9217,62935-0223-05,LEUPROLIDE ACETATE (3 MONTH) 22.5 MG SC KIT,"$3,333.47",$0.00,"$3,333.47","$1,500.06","$2,379.10",$674.09,$740.50,$0.00,$0.00,$811.00,"$3,333.47",$707.80,"$1,666.74","$2,640.11","$2,666.78",$977.44,$811.00,$0.00,$772.21,$617.66
33816,ERX,HCPCS 63700001,61958-0501-01,ADEFOVIR DIPIVOXIL 10 MG PO TABS,$196.01,$0.00,$196.01,$0.00,$139.89,$0.00,$0.00,$0.00,$0.00,$0.00,$196.01,$0.00,$98.01,$155.24,$156.81,$0.00,$0.00,$0.00,$0.00,$0.00
33826,ERX,HCPCS 63700001,00245-0272-06,OXANDROLONE 10 MG PO TABS,$71.26,$0.00,$71.26,$0.00,$50.86,$0.00,$0.00,$0.00,$0.00,$0.00,$71.26,$0.00,$35.63,$56.44,$57.01,$0.00,$0.00,$0.00,$0.00,$0.00
33826,ERX,HCPCS 63700001,49884-0302-02,OXANDROLONE 10 MG PO TABS,$71.26,$0.00,$71.26,$0.00,$50.86,$0.00,$0.00,$0.00,$0.00,$0.00,$71.26,$0.00,$35.63,$56.44,$57.01,$0.00,$0.00,$0.00,$0.00,$0.00
33863,ERX,HCPCS J7192,00026-3786-65,ANTIHEMOPHILIC FACTOR VIII RECOMB (KOGENATE FS) 2000 UNITS IV KIT,"$8,077.00",$0.00,"$8,077.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,077.00",$0.00,"$4,038.50","$6,396.98","$6,461.60",$0.00,$0.00,$0.00,$0.00,$0.00
33863,ERX,HCPCS J7192,00026-4786-01,ANTIHEMOPHILIC FACTOR VIII RECOMB (KOGENATE FS) 2000 UNITS IV KIT,"$8,077.00",$0.00,"$8,077.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,077.00",$0.00,"$4,038.50","$6,396.98","$6,461.60",$0.00,$0.00,$0.00,$0.00,$0.00
33937,ERX,HCPCS 63700001,31722-0754-30,LAMIVUDINE 300 MG PO TABS,$54.37,$0.00,$54.37,$0.00,$38.80,$0.00,$0.00,$0.00,$0.00,$0.00,$54.37,$0.00,$27.19,$43.06,$43.50,$0.00,$0.00,$0.00,$0.00,$0.00
33937,ERX,HCPCS 63700001,60505-3252-03,LAMIVUDINE 300 MG PO TABS,$54.37,$0.00,$54.37,$0.00,$38.80,$0.00,$0.00,$0.00,$0.00,$0.00,$54.37,$0.00,$27.19,$43.06,$43.50,$0.00,$0.00,$0.00,$0.00,$0.00
33937,ERX,HCPCS 63700001,64380-0711-04,LAMIVUDINE 300 MG PO TABS,$54.37,$0.00,$54.37,$0.00,$38.80,$0.00,$0.00,$0.00,$0.00,$0.00,$54.37,$0.00,$27.19,$43.06,$43.50,$0.00,$0.00,$0.00,$0.00,$0.00
33937,ERX,HCPCS 63700001,65862-0553-30,LAMIVUDINE 300 MG PO TABS,$54.37,$0.00,$54.37,$0.00,$38.80,$0.00,$0.00,$0.00,$0.00,$0.00,$54.37,$0.00,$27.19,$43.06,$43.50,$0.00,$0.00,$0.00,$0.00,$0.00
34153,ERX,HCPCS 63700001,00591-3713-19,EZETIMIBE 10 MG PO TABS,$9.94,$0.00,$9.94,$0.00,$7.09,$0.00,$0.00,$0.00,$0.00,$0.00,$9.94,$0.00,$4.97,$7.87,$7.95,$0.00,$0.00,$0.00,$0.00,$0.00
34153,ERX,HCPCS 63700001,00781-5690-92,EZETIMIBE 10 MG PO TABS,$9.94,$0.00,$9.94,$0.00,$7.09,$0.00,$0.00,$0.00,$0.00,$0.00,$9.94,$0.00,$4.97,$7.87,$7.95,$0.00,$0.00,$0.00,$0.00,$0.00
34153,ERX,HCPCS 63700001,59651-0052-90,EZETIMIBE 10 MG PO TABS,$9.94,$0.00,$9.94,$0.00,$7.09,$0.00,$0.00,$0.00,$0.00,$0.00,$9.94,$0.00,$4.97,$7.87,$7.95,$0.00,$0.00,$0.00,$0.00,$0.00
34153,ERX,HCPCS 63700001,66582-0414-31,EZETIMIBE 10 MG PO TABS,$9.94,$0.00,$9.94,$0.00,$7.09,$0.00,$0.00,$0.00,$0.00,$0.00,$9.94,$0.00,$4.97,$7.87,$7.95,$0.00,$0.00,$0.00,$0.00,$0.00
34153,ERX,HCPCS 63700001,68382-0773-16,EZETIMIBE 10 MG PO TABS,$9.94,$0.00,$9.94,$0.00,$7.09,$0.00,$0.00,$0.00,$0.00,$0.00,$9.94,$0.00,$4.97,$7.87,$7.95,$0.00,$0.00,$0.00,$0.00,$0.00
34153,ERX,HCPCS 63700001,69238-1154-03,EZETIMIBE 10 MG PO TABS,$9.94,$0.00,$9.94,$0.00,$7.09,$0.00,$0.00,$0.00,$0.00,$0.00,$9.94,$0.00,$4.97,$7.87,$7.95,$0.00,$0.00,$0.00,$0.00,$0.00
34369,ERX,HCPCS 63700001,16714-0785-01,ARIPIPRAZOLE 10 MG PO TABS,$111.56,$0.00,$111.56,$0.00,$79.62,$0.00,$0.00,$0.00,$0.00,$0.00,$111.56,$0.00,$55.78,$88.36,$89.25,$0.00,$0.00,$0.00,$0.00,$0.00
34369,ERX,HCPCS 63700001,27241-0053-03,ARIPIPRAZOLE 10 MG PO TABS,$111.56,$0.00,$111.56,$0.00,$79.62,$0.00,$0.00,$0.00,$0.00,$0.00,$111.56,$0.00,$55.78,$88.36,$89.25,$0.00,$0.00,$0.00,$0.00,$0.00
34369,ERX,HCPCS 63700001,43598-0556-30,ARIPIPRAZOLE 10 MG PO TABS,$111.56,$0.00,$111.56,$0.00,$79.62,$0.00,$0.00,$0.00,$0.00,$0.00,$111.56,$0.00,$55.78,$88.36,$89.25,$0.00,$0.00,$0.00,$0.00,$0.00
34369,ERX,HCPCS 63700001,65162-0898-03,ARIPIPRAZOLE 10 MG PO TABS,$111.56,$0.00,$111.56,$0.00,$79.62,$0.00,$0.00,$0.00,$0.00,$0.00,$111.56,$0.00,$55.78,$88.36,$89.25,$0.00,$0.00,$0.00,$0.00,$0.00
34369,ERX,HCPCS 63700001,65862-0663-30,ARIPIPRAZOLE 10 MG PO TABS,$111.56,$0.00,$111.56,$0.00,$79.62,$0.00,$0.00,$0.00,$0.00,$0.00,$111.56,$0.00,$55.78,$88.36,$89.25,$0.00,$0.00,$0.00,$0.00,$0.00
34370,ERX,HCPCS 63700001,27241-0054-03,ARIPIPRAZOLE 15 MG PO TABS,$112.02,$0.00,$112.02,$0.00,$79.95,$0.00,$0.00,$0.00,$0.00,$0.00,$112.02,$0.00,$56.01,$88.72,$89.62,$0.00,$0.00,$0.00,$0.00,$0.00
34370,ERX,HCPCS 63700001,31722-0828-30,ARIPIPRAZOLE 15 MG PO TABS,$112.02,$0.00,$112.02,$0.00,$79.95,$0.00,$0.00,$0.00,$0.00,$0.00,$112.02,$0.00,$56.01,$88.72,$89.62,$0.00,$0.00,$0.00,$0.00,$0.00
34370,ERX,HCPCS 63700001,43598-0557-30,ARIPIPRAZOLE 15 MG PO TABS,$112.02,$0.00,$112.02,$0.00,$79.95,$0.00,$0.00,$0.00,$0.00,$0.00,$112.02,$0.00,$56.01,$88.72,$89.62,$0.00,$0.00,$0.00,$0.00,$0.00
34370,ERX,HCPCS 63700001,65862-0664-30,ARIPIPRAZOLE 15 MG PO TABS,$112.02,$0.00,$112.02,$0.00,$79.95,$0.00,$0.00,$0.00,$0.00,$0.00,$112.02,$0.00,$56.01,$88.72,$89.62,$0.00,$0.00,$0.00,$0.00,$0.00
34370,ERX,HCPCS 63700001,67877-0433-03,ARIPIPRAZOLE 15 MG PO TABS,$112.02,$0.00,$112.02,$0.00,$79.95,$0.00,$0.00,$0.00,$0.00,$0.00,$112.02,$0.00,$56.01,$88.72,$89.62,$0.00,$0.00,$0.00,$0.00,$0.00
34371,ERX,HCPCS 63700001,16714-0787-01,ARIPIPRAZOLE 20 MG PO TABS,$157.96,$0.00,$157.96,$0.00,$112.74,$0.00,$0.00,$0.00,$0.00,$0.00,$157.96,$0.00,$78.98,$125.10,$126.37,$0.00,$0.00,$0.00,$0.00,$0.00
34371,ERX,HCPCS 63700001,31722-0829-30,ARIPIPRAZOLE 20 MG PO TABS,$157.96,$0.00,$157.96,$0.00,$112.74,$0.00,$0.00,$0.00,$0.00,$0.00,$157.96,$0.00,$78.98,$125.10,$126.37,$0.00,$0.00,$0.00,$0.00,$0.00
34371,ERX,HCPCS 63700001,43547-0306-03,ARIPIPRAZOLE 20 MG PO TABS,$157.96,$0.00,$157.96,$0.00,$112.74,$0.00,$0.00,$0.00,$0.00,$0.00,$157.96,$0.00,$78.98,$125.10,$126.37,$0.00,$0.00,$0.00,$0.00,$0.00
34371,ERX,HCPCS 63700001,67877-0434-03,ARIPIPRAZOLE 20 MG PO TABS,$157.96,$0.00,$157.96,$0.00,$112.74,$0.00,$0.00,$0.00,$0.00,$0.00,$157.96,$0.00,$78.98,$125.10,$126.37,$0.00,$0.00,$0.00,$0.00,$0.00
34372,ERX,HCPCS 63700001,65862-0666-30,ARIPIPRAZOLE 30 MG PO TABS,$158.94,$0.00,$158.94,$0.00,$113.44,$0.00,$0.00,$0.00,$0.00,$0.00,$158.94,$0.00,$79.47,$125.88,$127.15,$0.00,$0.00,$0.00,$0.00,$0.00
34418,ERX,HCPCS 63700001,16714-0484-01,DIVALPROEX SODIUM ER 250 MG PO TB24,$9.33,$0.00,$9.33,$0.00,$6.66,$0.00,$0.00,$0.00,$0.00,$0.00,$9.33,$0.00,$4.67,$7.39,$7.46,$0.00,$0.00,$0.00,$0.00,$0.00
34418,ERX,HCPCS 63700001,65862-0594-01,DIVALPROEX SODIUM ER 250 MG PO TB24,$9.33,$0.00,$9.33,$0.00,$6.66,$0.00,$0.00,$0.00,$0.00,$0.00,$9.33,$0.00,$4.67,$7.39,$7.46,$0.00,$0.00,$0.00,$0.00,$0.00
34447,ERX,HCPCS 63700001,00002-3229-30,ATOMOXETINE HCL 40 MG PO CAPS,$65.30,$0.00,$65.30,$0.00,$46.60,$0.00,$0.00,$0.00,$0.00,$0.00,$65.30,$0.00,$32.65,$51.72,$52.24,$0.00,$0.00,$0.00,$0.00,$0.00
34448,ERX,HCPCS 63700001,00002-3239-30,ATOMOXETINE HCL 60 MG PO CAPS,$65.30,$0.00,$65.30,$0.00,$46.60,$0.00,$0.00,$0.00,$0.00,$0.00,$65.30,$0.00,$32.65,$51.72,$52.24,$0.00,$0.00,$0.00,$0.00,$0.00
34505,ERX,HCPCS 63700001,00406-0123-23,HYDROCODONE-ACETAMINOPHEN 5-325 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
34505,ERX,HCPCS 63700001,00406-0123-62,HYDROCODONE-ACETAMINOPHEN 5-325 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
34505,ERX,HCPCS 63700001,13107-0019-01,HYDROCODONE-ACETAMINOPHEN 5-325 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
34505,ERX,HCPCS 63700001,51862-0585-01,HYDROCODONE-ACETAMINOPHEN 5-325 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
34505,ERX,HCPCS 63700001,53746-0109-01,HYDROCODONE-ACETAMINOPHEN 5-325 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
34505,ERX,HCPCS 63700001,57664-0126-13,HYDROCODONE-ACETAMINOPHEN 5-325 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
34505,ERX,HCPCS 63700001,57664-0126-88,HYDROCODONE-ACETAMINOPHEN 5-325 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
34505,ERX,HCPCS 63700001,63739-0704-10,HYDROCODONE-ACETAMINOPHEN 5-325 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
34505,ERX,HCPCS 63700001,68084-0895-11,HYDROCODONE-ACETAMINOPHEN 5-325 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
34524,ERX,HCPCS J2543,00206-8861-02,PIPERACILLIN-TAZOBACTAM IN DEX 3-0.375 GM/50ML IV SOLN,$99.00,$0.00,$99.00,$44.55,$70.66,$0.00,$19.63,$0.00,$0.00,$6.52,$99.00,$0.00,$49.50,$78.41,$79.20,$0.00,$6.52,$0.00,$6.21,$0.00
34550,ERX,HCPCS 90723,58160-0811-52,DTAP-HEPATITIS B RECOMB-IPV IM SUSP,$311.08,$0.00,$311.08,$139.99,$222.02,$55.37,$53.60,$0.00,$0.00,$54.47,$311.08,$0.00,$155.54,$246.38,$248.86,$186.65,$48.68,$0.00,$49.52,$0.00
34683,ERX,HCPCS 63700001,,ELETRIPTAN HYDROBROMIDE 20 MG PO TABS,$193.60,$0.00,$193.60,$0.00,$138.17,$0.00,$0.00,$0.00,$0.00,$0.00,$193.60,$0.00,$96.80,$153.33,$154.88,$0.00,$0.00,$0.00,$0.00,$0.00
34683,ERX,HCPCS 63700001,00049-2330-45,ELETRIPTAN HYDROBROMIDE 20 MG PO TABS,$193.60,$0.00,$193.60,$0.00,$138.17,$0.00,$0.00,$0.00,$0.00,$0.00,$193.60,$0.00,$96.80,$153.33,$154.88,$0.00,$0.00,$0.00,$0.00,$0.00
34683,ERX,HCPCS 63700001,00093-8310-18,ELETRIPTAN HYDROBROMIDE 20 MG PO TABS,$193.60,$0.00,$193.60,$0.00,$138.17,$0.00,$0.00,$0.00,$0.00,$0.00,$193.60,$0.00,$96.80,$153.33,$154.88,$0.00,$0.00,$0.00,$0.00,$0.00
34684,ERX,HCPCS 63700001,00049-2340-45,ELETRIPTAN HYDROBROMIDE 40 MG PO TABS,$246.96,$0.00,$246.96,$0.00,$176.26,$0.00,$0.00,$0.00,$0.00,$0.00,$246.96,$0.00,$123.48,$195.59,$197.57,$0.00,$0.00,$0.00,$0.00,$0.00
34684,ERX,HCPCS 63700001,00049-2340-79,ELETRIPTAN HYDROBROMIDE 40 MG PO TABS,$246.96,$0.00,$246.96,$0.00,$176.26,$0.00,$0.00,$0.00,$0.00,$0.00,$246.96,$0.00,$123.48,$195.59,$197.57,$0.00,$0.00,$0.00,$0.00,$0.00
34684,ERX,HCPCS 63700001,59762-2322-08,ELETRIPTAN HYDROBROMIDE 40 MG PO TABS,$246.96,$0.00,$246.96,$0.00,$176.26,$0.00,$0.00,$0.00,$0.00,$0.00,$246.96,$0.00,$123.48,$195.59,$197.57,$0.00,$0.00,$0.00,$0.00,$0.00
34708,ERX,HCPCS 25000001,67546-0212-21,NITAZOXANIDE 100 MG/5ML PO SUSR,"$1,503.36",$0.00,"$1,503.36",$0.00,"$1,072.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,503.36",$0.00,$751.68,"$1,190.66","$1,202.69",$0.00,$0.00,$0.00,$0.00,$0.00
34711,ERX,HCPCS 63700001,00054-0176-13,BUPRENORPHINE HCL 2 MG SL SUBL,$15.74,$0.00,$15.74,$0.00,$11.23,$0.00,$0.00,$0.00,$0.00,$0.00,$15.74,$0.00,$7.87,$12.47,$12.59,$0.00,$0.00,$0.00,$0.00,$0.00
34711,ERX,HCPCS 63700001,42858-0501-03,BUPRENORPHINE HCL 2 MG SL SUBL,$15.74,$0.00,$15.74,$0.00,$11.23,$0.00,$0.00,$0.00,$0.00,$0.00,$15.74,$0.00,$7.87,$12.47,$12.59,$0.00,$0.00,$0.00,$0.00,$0.00
34711,ERX,HCPCS 63700001,50383-0924-93,BUPRENORPHINE HCL 2 MG SL SUBL,$15.74,$0.00,$15.74,$0.00,$11.23,$0.00,$0.00,$0.00,$0.00,$0.00,$15.74,$0.00,$7.87,$12.47,$12.59,$0.00,$0.00,$0.00,$0.00,$0.00
34712,ERX,HCPCS 63700001,42858-0502-03,BUPRENORPHINE HCL 8 MG SL SUBL,$31.62,$0.00,$31.62,$0.00,$22.57,$0.00,$0.00,$0.00,$0.00,$0.00,$31.62,$0.00,$15.81,$25.04,$25.30,$0.00,$0.00,$0.00,$0.00,$0.00
34712,ERX,HCPCS 63700001,50383-0930-93,BUPRENORPHINE HCL 8 MG SL SUBL,$31.62,$0.00,$31.62,$0.00,$22.57,$0.00,$0.00,$0.00,$0.00,$0.00,$31.62,$0.00,$15.81,$25.04,$25.30,$0.00,$0.00,$0.00,$0.00,$0.00
34713,ERX,HCPCS 25000001,00054-0188-13,BUPRENORPHINE HCL-NALOXONE HCL 2-0.5 MG SL SUBL,$22.14,$0.00,$22.14,$0.00,$15.80,$0.00,$0.00,$0.00,$0.00,$0.00,$22.14,$0.00,$11.07,$17.53,$17.71,$0.00,$0.00,$0.00,$0.00,$0.00
34713,ERX,HCPCS 25000001,62175-0452-32,BUPRENORPHINE HCL-NALOXONE HCL 2-0.5 MG SL SUBL,$22.14,$0.00,$22.14,$0.00,$15.80,$0.00,$0.00,$0.00,$0.00,$0.00,$22.14,$0.00,$11.07,$17.53,$17.71,$0.00,$0.00,$0.00,$0.00,$0.00
34713,ERX,HCPCS 25000001,62756-0969-83,BUPRENORPHINE HCL-NALOXONE HCL 2-0.5 MG SL SUBL,$22.14,$0.00,$22.14,$0.00,$15.80,$0.00,$0.00,$0.00,$0.00,$0.00,$22.14,$0.00,$11.07,$17.53,$17.71,$0.00,$0.00,$0.00,$0.00,$0.00
34713,ERX,HCPCS 25000001,65162-0416-03,BUPRENORPHINE HCL-NALOXONE HCL 2-0.5 MG SL SUBL,$22.14,$0.00,$22.14,$0.00,$15.80,$0.00,$0.00,$0.00,$0.00,$0.00,$22.14,$0.00,$11.07,$17.53,$17.71,$0.00,$0.00,$0.00,$0.00,$0.00
34714,ERX,HCPCS 25000001,00054-0189-13,BUPRENORPHINE HCL-NALOXONE HCL 8-2 MG SL SUBL,$39.60,$0.00,$39.60,$0.00,$28.26,$0.00,$0.00,$0.00,$0.00,$0.00,$39.60,$0.00,$19.80,$31.36,$31.68,$0.00,$0.00,$0.00,$0.00,$0.00
34714,ERX,HCPCS 25000001,62175-0458-32,BUPRENORPHINE HCL-NALOXONE HCL 8-2 MG SL SUBL,$39.60,$0.00,$39.60,$0.00,$28.26,$0.00,$0.00,$0.00,$0.00,$0.00,$39.60,$0.00,$19.80,$31.36,$31.68,$0.00,$0.00,$0.00,$0.00,$0.00
34714,ERX,HCPCS 25000001,62756-0970-83,BUPRENORPHINE HCL-NALOXONE HCL 8-2 MG SL SUBL,$39.60,$0.00,$39.60,$0.00,$28.26,$0.00,$0.00,$0.00,$0.00,$0.00,$39.60,$0.00,$19.80,$31.36,$31.68,$0.00,$0.00,$0.00,$0.00,$0.00
34814,ERX,HCPCS 25000001,61314-0646-10,NEOMYCIN-POLYMYXIN-HC 3.5-10000-1 OT SOLN,$319.89,$0.00,$319.89,$0.00,$228.31,$0.00,$0.00,$0.00,$0.00,$0.00,$319.89,$0.00,$159.95,$253.35,$255.91,$0.00,$0.00,$0.00,$0.00,$0.00
35134,ERX,HCPCS 63700001,27808-0156-01,ROSUVASTATIN CALCIUM 10 MG PO TABS,$34.00,$0.00,$34.00,$0.00,$24.27,$0.00,$0.00,$0.00,$0.00,$0.00,$34.00,$0.00,$17.00,$26.93,$27.20,$0.00,$0.00,$0.00,$0.00,$0.00
35134,ERX,HCPCS 63700001,57237-0169-90,ROSUVASTATIN CALCIUM 10 MG PO TABS,$34.00,$0.00,$34.00,$0.00,$24.27,$0.00,$0.00,$0.00,$0.00,$0.00,$34.00,$0.00,$17.00,$26.93,$27.20,$0.00,$0.00,$0.00,$0.00,$0.00
35134,ERX,HCPCS 63700001,57237-0169-99,ROSUVASTATIN CALCIUM 10 MG PO TABS,$34.00,$0.00,$34.00,$0.00,$24.27,$0.00,$0.00,$0.00,$0.00,$0.00,$34.00,$0.00,$17.00,$26.93,$27.20,$0.00,$0.00,$0.00,$0.00,$0.00
35134,ERX,HCPCS 63700001,60505-4503-09,ROSUVASTATIN CALCIUM 10 MG PO TABS,$34.00,$0.00,$34.00,$0.00,$24.27,$0.00,$0.00,$0.00,$0.00,$0.00,$34.00,$0.00,$17.00,$26.93,$27.20,$0.00,$0.00,$0.00,$0.00,$0.00
35134,ERX,HCPCS 63700001,68462-0262-90,ROSUVASTATIN CALCIUM 10 MG PO TABS,$34.00,$0.00,$34.00,$0.00,$24.27,$0.00,$0.00,$0.00,$0.00,$0.00,$34.00,$0.00,$17.00,$26.93,$27.20,$0.00,$0.00,$0.00,$0.00,$0.00
35134,ERX,HCPCS 63700001,70377-0007-12,ROSUVASTATIN CALCIUM 10 MG PO TABS,$34.00,$0.00,$34.00,$0.00,$24.27,$0.00,$0.00,$0.00,$0.00,$0.00,$34.00,$0.00,$17.00,$26.93,$27.20,$0.00,$0.00,$0.00,$0.00,$0.00
35135,ERX,HCPCS 63700001,16729-0286-15,ROSUVASTATIN CALCIUM 20 MG PO TABS,$34.00,$0.00,$34.00,$0.00,$24.27,$0.00,$0.00,$0.00,$0.00,$0.00,$34.00,$0.00,$17.00,$26.93,$27.20,$0.00,$0.00,$0.00,$0.00,$0.00
35135,ERX,HCPCS 63700001,27808-0157-01,ROSUVASTATIN CALCIUM 20 MG PO TABS,$34.00,$0.00,$34.00,$0.00,$24.27,$0.00,$0.00,$0.00,$0.00,$0.00,$34.00,$0.00,$17.00,$26.93,$27.20,$0.00,$0.00,$0.00,$0.00,$0.00
35135,ERX,HCPCS 63700001,57237-0170-90,ROSUVASTATIN CALCIUM 20 MG PO TABS,$34.00,$0.00,$34.00,$0.00,$24.27,$0.00,$0.00,$0.00,$0.00,$0.00,$34.00,$0.00,$17.00,$26.93,$27.20,$0.00,$0.00,$0.00,$0.00,$0.00
35135,ERX,HCPCS 63700001,57237-0170-99,ROSUVASTATIN CALCIUM 20 MG PO TABS,$34.00,$0.00,$34.00,$0.00,$24.27,$0.00,$0.00,$0.00,$0.00,$0.00,$34.00,$0.00,$17.00,$26.93,$27.20,$0.00,$0.00,$0.00,$0.00,$0.00
35135,ERX,HCPCS 63700001,60505-4504-09,ROSUVASTATIN CALCIUM 20 MG PO TABS,$34.00,$0.00,$34.00,$0.00,$24.27,$0.00,$0.00,$0.00,$0.00,$0.00,$34.00,$0.00,$17.00,$26.93,$27.20,$0.00,$0.00,$0.00,$0.00,$0.00
35136,ERX,HCPCS 63700001,27808-0158-01,ROSUVASTATIN CALCIUM 40 MG PO TABS,$33.99,$0.00,$33.99,$0.00,$24.26,$0.00,$0.00,$0.00,$0.00,$0.00,$33.99,$0.00,$17.00,$26.92,$27.19,$0.00,$0.00,$0.00,$0.00,$0.00
35136,ERX,HCPCS 63700001,51407-0156-30,ROSUVASTATIN CALCIUM 40 MG PO TABS,$33.99,$0.00,$33.99,$0.00,$24.26,$0.00,$0.00,$0.00,$0.00,$0.00,$33.99,$0.00,$17.00,$26.92,$27.19,$0.00,$0.00,$0.00,$0.00,$0.00
35136,ERX,HCPCS 63700001,57237-0171-05,ROSUVASTATIN CALCIUM 40 MG PO TABS,$33.99,$0.00,$33.99,$0.00,$24.26,$0.00,$0.00,$0.00,$0.00,$0.00,$33.99,$0.00,$17.00,$26.92,$27.19,$0.00,$0.00,$0.00,$0.00,$0.00
35136,ERX,HCPCS 63700001,57237-0171-30,ROSUVASTATIN CALCIUM 40 MG PO TABS,$33.99,$0.00,$33.99,$0.00,$24.26,$0.00,$0.00,$0.00,$0.00,$0.00,$33.99,$0.00,$17.00,$26.92,$27.19,$0.00,$0.00,$0.00,$0.00,$0.00
35136,ERX,HCPCS 63700001,57237-0171-90,ROSUVASTATIN CALCIUM 40 MG PO TABS,$33.99,$0.00,$33.99,$0.00,$24.26,$0.00,$0.00,$0.00,$0.00,$0.00,$33.99,$0.00,$17.00,$26.92,$27.19,$0.00,$0.00,$0.00,$0.00,$0.00
35136,ERX,HCPCS 63700001,68462-0264-30,ROSUVASTATIN CALCIUM 40 MG PO TABS,$33.99,$0.00,$33.99,$0.00,$24.26,$0.00,$0.00,$0.00,$0.00,$0.00,$33.99,$0.00,$17.00,$26.92,$27.19,$0.00,$0.00,$0.00,$0.00,$0.00
35136,ERX,HCPCS 63700001,70377-0009-11,ROSUVASTATIN CALCIUM 40 MG PO TABS,$33.99,$0.00,$33.99,$0.00,$24.26,$0.00,$0.00,$0.00,$0.00,$0.00,$33.99,$0.00,$17.00,$26.92,$27.19,$0.00,$0.00,$0.00,$0.00,$0.00
35136,ERX,HCPCS 63700001,72205-0005-99,ROSUVASTATIN CALCIUM 40 MG PO TABS,$33.99,$0.00,$33.99,$0.00,$24.26,$0.00,$0.00,$0.00,$0.00,$0.00,$33.99,$0.00,$17.00,$26.92,$27.19,$0.00,$0.00,$0.00,$0.00,$0.00
35184,ERX,HCPCS 63700001,50268-0190-15,CYCLOBENZAPRINE HCL 5 MG PO TABS,$6.24,$0.00,$6.24,$0.00,$4.45,$0.00,$0.00,$0.00,$0.00,$0.00,$6.24,$0.00,$3.12,$4.94,$4.99,$0.00,$0.00,$0.00,$0.00,$0.00
35184,ERX,HCPCS 63700001,52817-0330-10,CYCLOBENZAPRINE HCL 5 MG PO TABS,$6.24,$0.00,$6.24,$0.00,$4.45,$0.00,$0.00,$0.00,$0.00,$0.00,$6.24,$0.00,$3.12,$4.94,$4.99,$0.00,$0.00,$0.00,$0.00,$0.00
35184,ERX,HCPCS 63700001,69097-0845-07,CYCLOBENZAPRINE HCL 5 MG PO TABS,$6.24,$0.00,$6.24,$0.00,$4.45,$0.00,$0.00,$0.00,$0.00,$0.00,$6.24,$0.00,$3.12,$4.94,$4.99,$0.00,$0.00,$0.00,$0.00,$0.00
35209,ERX,HCPCS 63700001,00023-9163-30,CYCLOSPORINE 0.05 % OP EMUL,$44.51,$0.00,$44.51,$0.00,$31.77,$0.00,$0.00,$0.00,$0.00,$0.00,$44.51,$0.00,$22.26,$35.25,$35.61,$0.00,$0.00,$0.00,$0.00,$0.00
35262,ERX,HCPCS J7520,00008-1042-05,SIROLIMUS 2 MG PO TABS,$239.07,$0.00,$239.07,$0.00,$170.62,$0.00,$0.00,$0.00,$0.00,$0.00,$239.07,$0.00,$119.54,$189.34,$191.26,$0.00,$0.00,$0.00,$0.00,$0.00
35263,ERX,HCPCS 63700001,59572-0210-15,THALIDOMIDE 100 MG PO CAPS,$882.16,$0.00,$882.16,$0.00,$629.60,$0.00,$0.00,$0.00,$0.00,$0.00,$882.16,$0.00,$441.08,$698.67,$705.73,$0.00,$0.00,$0.00,$0.00,$0.00
35264,ERX,HCPCS 63700001,59572-0220-16,THALIDOMIDE 200 MG PO CAPS,"$1,004.37",$0.00,"$1,004.37",$0.00,$716.82,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,004.37",$0.00,$502.19,$795.46,$803.50,$0.00,$0.00,$0.00,$0.00,$0.00
35264,ERX,HCPCS 63700001,59572-0220-96,THALIDOMIDE 200 MG PO CAPS,"$1,004.37",$0.00,"$1,004.37",$0.00,$716.82,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,004.37",$0.00,$502.19,$795.46,$803.50,$0.00,$0.00,$0.00,$0.00,$0.00
35439,ERX,HCPCS J2850,67066-0006-01,SECRETIN ACETATE 16 MCG IV SOLR,$24.23,$0.00,$24.23,$0.00,$17.29,$0.00,$0.00,$0.00,$0.00,$0.00,$24.23,$0.00,$12.12,$19.19,$19.38,$0.00,$0.00,$0.00,$0.00,$0.00
35488,ERX,HCPCS J8501,,APREPITANT 80 MG PO CAPS,$539.97,$0.00,$539.97,$242.99,$385.38,$0.00,$125.02,$0.00,$0.00,$94.54,$539.97,$0.00,$269.99,$427.66,$431.98,$0.00,$84.51,$0.00,$85.96,$0.00
35488,ERX,HCPCS J8501,68462-0584-76,APREPITANT 80 MG PO CAPS,$539.97,$0.00,$539.97,$242.99,$385.38,$0.00,$125.02,$0.00,$0.00,$94.54,$539.97,$0.00,$269.99,$427.66,$431.98,$0.00,$84.51,$0.00,$85.96,$0.00
35489,ERX,HCPCS J8501,,APREPITANT 125 MG PO CAPS,$531.22,$0.00,$531.22,$239.05,$379.13,$0.00,$195.34,$0.00,$0.00,$93.01,$531.22,$0.00,$265.61,$420.73,$424.98,$0.00,$83.14,$0.00,$84.57,$0.00
35489,ERX,HCPCS J8501,00781-2323-68,APREPITANT 125 MG PO CAPS,$531.22,$0.00,$531.22,$239.05,$379.13,$0.00,$195.34,$0.00,$0.00,$93.01,$531.22,$0.00,$265.61,$420.73,$424.98,$0.00,$83.14,$0.00,$84.57,$0.00
35489,ERX,HCPCS J8501,68462-0585-76,APREPITANT 125 MG PO CAPS,$531.22,$0.00,$531.22,$239.05,$379.13,$0.00,$195.34,$0.00,$0.00,$93.01,$531.22,$0.00,$265.61,$420.73,$424.98,$0.00,$83.14,$0.00,$84.57,$0.00
35490,ERX,HCPCS J8501,00006-3862-03,APREPITANT 80 & 125 MG PO MISC,$820.82,$0.00,$820.82,$369.37,$585.82,$0.00,$7.81,$0.00,$0.00,$143.72,$820.82,$0.00,$410.41,$650.09,$656.66,$0.00,$128.46,$0.00,$130.67,$0.00
35639,ERX,HCPCS 25000001,10019-0075-87,ESMOLOL HCL-SODIUM CHLORIDE 2000 MG/100ML IV SOLN,"$1,451.28",$0.00,"$1,451.28",$0.00,"$1,035.78",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,451.28",$0.00,$725.64,"$1,149.41","$1,161.02",$0.00,$0.00,$0.00,$0.00,$0.00
35639,ERX,HCPCS 25000001,25021-0309-82,ESMOLOL HCL-SODIUM CHLORIDE 2000 MG/100ML IV SOLN,"$1,451.28",$0.00,"$1,451.28",$0.00,"$1,035.78",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,451.28",$0.00,$725.64,"$1,149.41","$1,161.02",$0.00,$0.00,$0.00,$0.00,$0.00
35640,ERX,HCPCS J3489,00409-4215-01,ZOLEDRONIC ACID 4 MG/5ML IV CONC,$166.32,$0.00,$166.32,$74.84,$118.70,$0.00,$28.66,$0.00,$0.00,$51.14,$166.32,$0.00,$83.16,$131.73,$133.06,$0.00,$51.14,$0.00,$48.69,$0.00
35640,ERX,HCPCS J3489,25021-0801-66,ZOLEDRONIC ACID 4 MG/5ML IV CONC,$166.32,$0.00,$166.32,$74.84,$118.70,$0.00,$28.66,$0.00,$0.00,$51.14,$166.32,$0.00,$83.16,$131.73,$133.06,$0.00,$51.14,$0.00,$48.69,$0.00
35640,ERX,HCPCS J3489,55111-0685-07,ZOLEDRONIC ACID 4 MG/5ML IV CONC,$166.32,$0.00,$166.32,$74.84,$118.70,$0.00,$28.66,$0.00,$0.00,$51.14,$166.32,$0.00,$83.16,$131.73,$133.06,$0.00,$51.14,$0.00,$48.69,$0.00
35640,ERX,HCPCS J3489,63323-0961-98,ZOLEDRONIC ACID 4 MG/5ML IV CONC,$166.32,$0.00,$166.32,$74.84,$118.70,$0.00,$28.66,$0.00,$0.00,$51.14,$166.32,$0.00,$83.16,$131.73,$133.06,$0.00,$51.14,$0.00,$48.69,$0.00
35640,ERX,HCPCS J3489,67457-0390-54,ZOLEDRONIC ACID 4 MG/5ML IV CONC,$166.32,$0.00,$166.32,$74.84,$118.70,$0.00,$28.66,$0.00,$0.00,$51.14,$166.32,$0.00,$83.16,$131.73,$133.06,$0.00,$51.14,$0.00,$48.69,$0.00
35687,ERX,HCPCS 63700001,00781-5311-08,RISPERIDONE 1 MG PO TBDP,$56.09,$0.00,$56.09,$0.00,$40.03,$0.00,$0.00,$0.00,$0.00,$0.00,$56.09,$0.00,$28.05,$44.42,$44.87,$0.00,$0.00,$0.00,$0.00,$0.00
35687,ERX,HCPCS 63700001,49884-0315-91,RISPERIDONE 1 MG PO TBDP,$56.09,$0.00,$56.09,$0.00,$40.03,$0.00,$0.00,$0.00,$0.00,$0.00,$56.09,$0.00,$28.05,$44.42,$44.87,$0.00,$0.00,$0.00,$0.00,$0.00
35688,ERX,HCPCS 63700001,49884-0401-91,RISPERIDONE 2 MG PO TBDP,$84.00,$0.00,$84.00,$0.00,$59.95,$0.00,$0.00,$0.00,$0.00,$0.00,$84.00,$0.00,$42.00,$66.53,$67.20,$0.00,$0.00,$0.00,$0.00,$0.00
35699,ERX,HCPCS 25000001,00065-4013-03,MOXIFLOXACIN HCL 0.5 % OP SOLN,$531.71,$0.00,$531.71,$0.00,$379.48,$0.00,$0.00,$0.00,$0.00,$0.00,$531.71,$0.00,$265.86,$421.11,$425.37,$0.00,$0.00,$0.00,$0.00,$0.00
35699,ERX,HCPCS 25000001,00781-7135-93,MOXIFLOXACIN HCL 0.5 % OP SOLN,$531.71,$0.00,$531.71,$0.00,$379.48,$0.00,$0.00,$0.00,$0.00,$0.00,$531.71,$0.00,$265.86,$421.11,$425.37,$0.00,$0.00,$0.00,$0.00,$0.00
35699,ERX,HCPCS 25000001,60505-0582-04,MOXIFLOXACIN HCL 0.5 % OP SOLN,$531.71,$0.00,$531.71,$0.00,$379.48,$0.00,$0.00,$0.00,$0.00,$0.00,$531.71,$0.00,$265.86,$421.11,$425.37,$0.00,$0.00,$0.00,$0.00,$0.00
35699,ERX,HCPCS 25000001,65862-0840-03,MOXIFLOXACIN HCL 0.5 % OP SOLN,$531.71,$0.00,$531.71,$0.00,$379.48,$0.00,$0.00,$0.00,$0.00,$0.00,$531.71,$0.00,$265.86,$421.11,$425.37,$0.00,$0.00,$0.00,$0.00,$0.00
35780,ERX,HCPCS 63700001,00310-0482-30,GEFITINIB 250 MG PO TABS,$825.63,$0.00,$825.63,$0.00,$589.25,$0.00,$0.00,$0.00,$0.00,$0.00,$825.63,$0.00,$412.82,$653.90,$660.50,$0.00,$0.00,$0.00,$0.00,$0.00
35942,ERX,HCPCS 63700001,00245-5317-01,KCL CRYS ER 10 MEQ PO TBCR,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
35942,ERX,HCPCS 63700001,00245-5317-89,KCL CRYS ER 10 MEQ PO TBCR,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
35942,ERX,HCPCS 63700001,63739-0446-10,KCL CRYS ER 10 MEQ PO TBCR,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
35942,ERX,HCPCS 63700001,66758-0170-13,KCL CRYS ER 10 MEQ PO TBCR,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
35943,ERX,HCPCS 63700001,00245-5319-01,POTASSIUM CHLORIDE CRYS ER 20 MEQ PO TBCR,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
35943,ERX,HCPCS 63700001,00245-5319-89,POTASSIUM CHLORIDE CRYS ER 20 MEQ PO TBCR,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
35943,ERX,HCPCS 63700001,00781-5720-01,POTASSIUM CHLORIDE CRYS ER 20 MEQ PO TBCR,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
35943,ERX,HCPCS 63700001,00781-5720-10,POTASSIUM CHLORIDE CRYS ER 20 MEQ PO TBCR,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
35943,ERX,HCPCS 63700001,63739-0447-10,POTASSIUM CHLORIDE CRYS ER 20 MEQ PO TBCR,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
35943,ERX,HCPCS 63700001,66758-0190-13,POTASSIUM CHLORIDE CRYS ER 20 MEQ PO TBCR,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
35943,ERX,HCPCS 63700001,68084-0360-09,POTASSIUM CHLORIDE CRYS ER 20 MEQ PO TBCR,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
35957,ERX,HCPCS 63700001,00046-1106-11,CONJ ESTROG-MEDROXYPROGEST ACE 0.45-1.5 MG PO TABS,$33.03,$0.00,$33.03,$0.00,$23.57,$0.00,$0.00,$0.00,$0.00,$0.00,$33.03,$0.00,$16.52,$26.16,$26.42,$0.00,$0.00,$0.00,$0.00,$0.00
36046,ERX,HCPCS J3480,00338-0704-34,POTASSIUM CHLORIDE IN NACL 20-0.45 MEQ/L-% IV SOLN,$26.60,$0.00,$26.60,$11.97,$18.98,$0.00,$0.24,$0.00,$0.00,$1.65,$26.60,$0.00,$13.30,$21.07,$21.28,$0.00,$1.65,$0.00,$1.57,$0.00
36092,ERX,HCPCS 63700001,00078-0649-30,IMATINIB MESYLATE 400 MG PO TABS,"$1,072.98",$0.00,"$1,072.98",$0.00,$765.79,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,072.98",$0.00,$536.49,$849.80,$858.38,$0.00,$0.00,$0.00,$0.00,$0.00
36092,ERX,HCPCS 63700001,16714-0705-01,IMATINIB MESYLATE 400 MG PO TABS,"$1,072.98",$0.00,"$1,072.98",$0.00,$765.79,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,072.98",$0.00,$536.49,$849.80,$858.38,$0.00,$0.00,$0.00,$0.00,$0.00
36092,ERX,HCPCS 63700001,60505-2901-03,IMATINIB MESYLATE 400 MG PO TABS,"$1,072.98",$0.00,"$1,072.98",$0.00,$765.79,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,072.98",$0.00,$536.49,$849.80,$858.38,$0.00,$0.00,$0.00,$0.00,$0.00
36149,ERX,HCPCS 63700001,00003-3624-12,ATAZANAVIR SULFATE 150 MG PO CAPS,$184.37,$0.00,$184.37,$0.00,$131.58,$0.00,$0.00,$0.00,$0.00,$0.00,$184.37,$0.00,$92.19,$146.02,$147.50,$0.00,$0.00,$0.00,$0.00,$0.00
36149,ERX,HCPCS 63700001,16714-0860-01,ATAZANAVIR SULFATE 150 MG PO CAPS,$184.37,$0.00,$184.37,$0.00,$131.58,$0.00,$0.00,$0.00,$0.00,$0.00,$184.37,$0.00,$92.19,$146.02,$147.50,$0.00,$0.00,$0.00,$0.00,$0.00
36150,ERX,HCPCS 63700001,00003-3631-12,ATAZANAVIR SULFATE 200 MG PO CAPS,$184.37,$0.00,$184.37,$0.00,$131.58,$0.00,$0.00,$0.00,$0.00,$0.00,$184.37,$0.00,$92.19,$146.02,$147.50,$0.00,$0.00,$0.00,$0.00,$0.00
36150,ERX,HCPCS 63700001,16714-0861-01,ATAZANAVIR SULFATE 200 MG PO CAPS,$184.37,$0.00,$184.37,$0.00,$131.58,$0.00,$0.00,$0.00,$0.00,$0.00,$184.37,$0.00,$92.19,$146.02,$147.50,$0.00,$0.00,$0.00,$0.00,$0.00
36150,ERX,HCPCS 63700001,65862-0712-60,ATAZANAVIR SULFATE 200 MG PO CAPS,$184.37,$0.00,$184.37,$0.00,$131.58,$0.00,$0.00,$0.00,$0.00,$0.00,$184.37,$0.00,$92.19,$146.02,$147.50,$0.00,$0.00,$0.00,$0.00,$0.00
36198,ERX,HCPCS 63700001,00046-1101-81,ESTROGENS CONJUGATED 0.45 MG PO TABS,$26.93,$0.00,$26.93,$0.00,$19.22,$0.00,$0.00,$0.00,$0.00,$0.00,$26.93,$0.00,$13.47,$21.33,$21.54,$0.00,$0.00,$0.00,$0.00,$0.00
36252,ERX,HCPCS 63700001,61958-0601-01,EMTRICITABINE 200 MG PO CAPS,$73.38,$0.00,$73.39,$0.00,$52.38,$0.00,$0.00,$0.00,$0.00,$0.00,$73.39,$0.00,$36.70,$58.12,$58.71,$0.00,$0.00,$0.00,$0.00,$0.00
36252,ERX,HCPCS 63700001,69097-0642-02,EMTRICITABINE 200 MG PO CAPS,$73.38,$0.00,$73.39,$0.00,$52.38,$0.00,$0.00,$0.00,$0.00,$0.00,$73.39,$0.00,$36.70,$58.12,$58.71,$0.00,$0.00,$0.00,$0.00,$0.00
36438,ERX,HCPCS 63700001,00904-6656-40,ARIPIPRAZOLE 5 MG PO TABS,$111.39,$0.00,$111.39,$0.00,$79.50,$0.00,$0.00,$0.00,$0.00,$0.00,$111.39,$0.00,$55.70,$88.22,$89.11,$0.00,$0.00,$0.00,$0.00,$0.00
36438,ERX,HCPCS 63700001,16714-0784-01,ARIPIPRAZOLE 5 MG PO TABS,$111.39,$0.00,$111.39,$0.00,$79.50,$0.00,$0.00,$0.00,$0.00,$0.00,$111.39,$0.00,$55.70,$88.22,$89.11,$0.00,$0.00,$0.00,$0.00,$0.00
36438,ERX,HCPCS 63700001,33342-0123-07,ARIPIPRAZOLE 5 MG PO TABS,$111.39,$0.00,$111.39,$0.00,$79.50,$0.00,$0.00,$0.00,$0.00,$0.00,$111.39,$0.00,$55.70,$88.22,$89.11,$0.00,$0.00,$0.00,$0.00,$0.00
36438,ERX,HCPCS 63700001,43598-0555-30,ARIPIPRAZOLE 5 MG PO TABS,$111.39,$0.00,$111.39,$0.00,$79.50,$0.00,$0.00,$0.00,$0.00,$0.00,$111.39,$0.00,$55.70,$88.22,$89.11,$0.00,$0.00,$0.00,$0.00,$0.00
36438,ERX,HCPCS 63700001,65862-0662-30,ARIPIPRAZOLE 5 MG PO TABS,$111.39,$0.00,$111.39,$0.00,$79.50,$0.00,$0.00,$0.00,$0.00,$0.00,$111.39,$0.00,$55.70,$88.22,$89.11,$0.00,$0.00,$0.00,$0.00,$0.00
36576,ERX,HCPCS 25000001,00065-8533-02,CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OT SUSP,$712.90,$0.00,$712.90,$0.00,$508.80,$0.00,$0.00,$0.00,$0.00,$0.00,$712.90,$0.00,$356.45,$564.62,$570.32,$0.00,$0.00,$0.00,$0.00,$0.00
36576,ERX,HCPCS 25000001,00781-6186-67,CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OT SUSP,$712.90,$0.00,$712.90,$0.00,$508.80,$0.00,$0.00,$0.00,$0.00,$0.00,$712.90,$0.00,$356.45,$564.62,$570.32,$0.00,$0.00,$0.00,$0.00,$0.00
36576,ERX,HCPCS 25000001,43598-0326-75,CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OT SUSP,$712.90,$0.00,$712.90,$0.00,$508.80,$0.00,$0.00,$0.00,$0.00,$0.00,$712.90,$0.00,$356.45,$564.62,$570.32,$0.00,$0.00,$0.00,$0.00,$0.00
36590,ERX,HCPCS 25000001,00121-0799-16,LEVETIRACETAM 100 MG/ML PO SOLN,$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
36590,ERX,HCPCS 25000001,00472-0235-16,LEVETIRACETAM 100 MG/ML PO SOLN,$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
36590,ERX,HCPCS 25000001,16714-0358-01,LEVETIRACETAM 100 MG/ML PO SOLN,$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
36590,ERX,HCPCS 25000001,50383-0241-16,LEVETIRACETAM 100 MG/ML PO SOLN,$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
36590,ERX,HCPCS 25000001,50474-0001-48,LEVETIRACETAM 100 MG/ML PO SOLN,$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
36590,ERX,HCPCS 25000001,51991-0651-16,LEVETIRACETAM 100 MG/ML PO SOLN,$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
36590,ERX,HCPCS 25000001,99999-6012-25,LEVETIRACETAM 100 MG/ML PO SOLN,$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
36590,ERX,HCPCS 25000001,99999-6004-94,LEVETIRACETAM 100 MG/ML PO SOLN,$134.82,$0.00,$106.78,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$106.78,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
36612,ERX,HCPCS 63700001,00310-0755-90,ROSUVASTATIN CALCIUM 5 MG PO TABS,$42.04,$0.00,$42.04,$0.00,$30.00,$0.00,$0.00,$0.00,$0.00,$0.00,$42.04,$0.00,$21.02,$33.30,$33.63,$0.00,$0.00,$0.00,$0.00,$0.00
36612,ERX,HCPCS 63700001,16714-0988-01,ROSUVASTATIN CALCIUM 5 MG PO TABS,$42.04,$0.00,$42.04,$0.00,$30.00,$0.00,$0.00,$0.00,$0.00,$0.00,$42.04,$0.00,$21.02,$33.30,$33.63,$0.00,$0.00,$0.00,$0.00,$0.00
36612,ERX,HCPCS 63700001,27808-0155-01,ROSUVASTATIN CALCIUM 5 MG PO TABS,$42.04,$0.00,$42.04,$0.00,$30.00,$0.00,$0.00,$0.00,$0.00,$0.00,$42.04,$0.00,$21.02,$33.30,$33.63,$0.00,$0.00,$0.00,$0.00,$0.00
36612,ERX,HCPCS 63700001,60505-4502-09,ROSUVASTATIN CALCIUM 5 MG PO TABS,$42.04,$0.00,$42.04,$0.00,$30.00,$0.00,$0.00,$0.00,$0.00,$0.00,$42.04,$0.00,$21.02,$33.30,$33.63,$0.00,$0.00,$0.00,$0.00,$0.00
36612,ERX,HCPCS 63700001,68462-0261-90,ROSUVASTATIN CALCIUM 5 MG PO TABS,$42.04,$0.00,$42.04,$0.00,$30.00,$0.00,$0.00,$0.00,$0.00,$0.00,$42.04,$0.00,$21.02,$33.30,$33.63,$0.00,$0.00,$0.00,$0.00,$0.00
36612,ERX,HCPCS 63700001,70377-0006-12,ROSUVASTATIN CALCIUM 5 MG PO TABS,$42.04,$0.00,$42.04,$0.00,$30.00,$0.00,$0.00,$0.00,$0.00,$0.00,$42.04,$0.00,$21.02,$33.30,$33.63,$0.00,$0.00,$0.00,$0.00,$0.00
36631,ERX,HCPCS 25000001,00023-9277-05,KETOROLAC TROMETHAMINE 0.4 % OP SOLN,$857.54,$0.00,$857.54,$0.00,$612.03,$0.00,$0.00,$0.00,$0.00,$0.00,$857.54,$0.00,$428.77,$679.17,$686.03,$0.00,$0.00,$0.00,$0.00,$0.00
36631,ERX,HCPCS 25000001,60758-0773-05,KETOROLAC TROMETHAMINE 0.4 % OP SOLN,$857.54,$0.00,$857.54,$0.00,$612.03,$0.00,$0.00,$0.00,$0.00,$0.00,$857.54,$0.00,$428.77,$679.17,$686.03,$0.00,$0.00,$0.00,$0.00,$0.00
36775,ERX,HCPCS 63700001,00187-0730-90,BUPROPION HCL ER (XL) 150 MG PO TB24,$19.84,$0.00,$19.84,$0.00,$14.16,$0.00,$0.00,$0.00,$0.00,$0.00,$19.84,$0.00,$9.92,$15.71,$15.87,$0.00,$0.00,$0.00,$0.00,$0.00
36775,ERX,HCPCS 63700001,10370-0101-03,BUPROPION HCL ER (XL) 150 MG PO TB24,$19.84,$0.00,$19.84,$0.00,$14.16,$0.00,$0.00,$0.00,$0.00,$0.00,$19.84,$0.00,$9.92,$15.71,$15.87,$0.00,$0.00,$0.00,$0.00,$0.00
36775,ERX,HCPCS 63700001,16729-0443-15,BUPROPION HCL ER (XL) 150 MG PO TB24,$19.84,$0.00,$19.84,$0.00,$14.16,$0.00,$0.00,$0.00,$0.00,$0.00,$19.84,$0.00,$9.92,$15.71,$15.87,$0.00,$0.00,$0.00,$0.00,$0.00
36775,ERX,HCPCS 63700001,69097-0875-02,BUPROPION HCL ER (XL) 150 MG PO TB24,$19.84,$0.00,$19.84,$0.00,$14.16,$0.00,$0.00,$0.00,$0.00,$0.00,$19.84,$0.00,$9.92,$15.71,$15.87,$0.00,$0.00,$0.00,$0.00,$0.00
36776,ERX,HCPCS 63700001,10370-0102-03,BUPROPION HCL ER (XL) 300 MG PO TB24,$18.12,$0.00,$18.12,$0.00,$12.93,$0.00,$0.00,$0.00,$0.00,$0.00,$18.12,$0.00,$9.06,$14.35,$14.50,$0.00,$0.00,$0.00,$0.00,$0.00
36776,ERX,HCPCS 63700001,16729-0444-10,BUPROPION HCL ER (XL) 300 MG PO TB24,$18.12,$0.00,$18.12,$0.00,$12.93,$0.00,$0.00,$0.00,$0.00,$0.00,$18.12,$0.00,$9.06,$14.35,$14.50,$0.00,$0.00,$0.00,$0.00,$0.00
36776,ERX,HCPCS 63700001,68180-0320-09,BUPROPION HCL ER (XL) 300 MG PO TB24,$18.12,$0.00,$18.12,$0.00,$12.93,$0.00,$0.00,$0.00,$0.00,$0.00,$18.12,$0.00,$9.06,$14.35,$14.50,$0.00,$0.00,$0.00,$0.00,$0.00
36962,ERX,HCPCS 63700001,00121-0544-10,DOCUSATE SODIUM 50 MG/5ML PO LIQD,$11.00,$0.00,$11.00,$0.00,$7.85,$0.00,$0.00,$0.00,$0.00,$0.00,$11.00,$0.00,$5.50,$8.71,$8.80,$0.00,$0.00,$0.00,$0.00,$0.00
36962,ERX,HCPCS 63700001,50383-0771-16,DOCUSATE SODIUM 50 MG/5ML PO LIQD,$11.00,$0.00,$11.00,$0.00,$7.85,$0.00,$0.00,$0.00,$0.00,$0.00,$11.00,$0.00,$5.50,$8.71,$8.80,$0.00,$0.00,$0.00,$0.00,$0.00
36962,ERX,HCPCS 63700001,99999-6006-70,DOCUSATE SODIUM 50 MG/5ML PO LIQD,$11.00,$0.00,$11.00,$0.00,$7.85,$0.00,$0.00,$0.00,$0.00,$0.00,$11.00,$0.00,$5.50,$8.71,$8.80,$0.00,$0.00,$0.00,$0.00,$0.00
36966,ERX,HCPCS 63700001,00456-3210-63,MEMANTINE HCL 10 MG PO TABS,$33.80,$0.00,$33.80,$0.00,$24.12,$0.00,$0.00,$0.00,$0.00,$0.00,$33.80,$0.00,$16.90,$26.77,$27.04,$0.00,$0.00,$0.00,$0.00,$0.00
36966,ERX,HCPCS 63700001,00904-6506-61,MEMANTINE HCL 10 MG PO TABS,$33.80,$0.00,$33.80,$0.00,$24.12,$0.00,$0.00,$0.00,$0.00,$0.00,$33.80,$0.00,$16.90,$26.77,$27.04,$0.00,$0.00,$0.00,$0.00,$0.00
36966,ERX,HCPCS 63700001,55111-0597-60,MEMANTINE HCL 10 MG PO TABS,$33.80,$0.00,$33.80,$0.00,$24.12,$0.00,$0.00,$0.00,$0.00,$0.00,$33.80,$0.00,$16.90,$26.77,$27.04,$0.00,$0.00,$0.00,$0.00,$0.00
36976,ERX,HCPCS 25000001,00904-6305-21,PHENOL 1.4 % MT LIQD,$11.00,$0.00,$11.00,$0.00,$7.85,$0.00,$0.00,$0.00,$0.00,$0.00,$11.00,$0.00,$5.50,$8.71,$8.80,$0.00,$0.00,$0.00,$0.00,$0.00
36976,ERX,HCPCS 25000001,49348-0991-36,PHENOL 1.4 % MT LIQD,$11.00,$0.00,$11.00,$0.00,$7.85,$0.00,$0.00,$0.00,$0.00,$0.00,$11.00,$0.00,$5.50,$8.71,$8.80,$0.00,$0.00,$0.00,$0.00,$0.00
36982,ERX,HCPCS 25000001,47335-0956-88,ALFUZOSIN HCL ER 10 MG PO TB24,$16.02,$0.00,$16.02,$0.00,$11.43,$0.00,$0.00,$0.00,$0.00,$0.00,$16.02,$0.00,$8.01,$12.69,$12.82,$0.00,$0.00,$0.00,$0.00,$0.00
36983,ERX,HCPCS 63700001,00185-5368-30,EPLERENONE 25 MG PO TABS,$16.49,$0.00,$16.49,$0.00,$11.77,$0.00,$0.00,$0.00,$0.00,$0.00,$16.49,$0.00,$8.25,$13.06,$13.19,$0.00,$0.00,$0.00,$0.00,$0.00
36983,ERX,HCPCS 63700001,00378-1030-93,EPLERENONE 25 MG PO TABS,$16.49,$0.00,$16.49,$0.00,$11.77,$0.00,$0.00,$0.00,$0.00,$0.00,$16.49,$0.00,$8.25,$13.06,$13.19,$0.00,$0.00,$0.00,$0.00,$0.00
36984,ERX,HCPCS 63700001,00185-5369-30,EPLERENONE 50 MG PO TABS,$16.50,$0.00,$16.50,$0.00,$11.78,$0.00,$0.00,$0.00,$0.00,$0.00,$16.50,$0.00,$8.25,$13.07,$13.20,$0.00,$0.00,$0.00,$0.00,$0.00
36984,ERX,HCPCS 63700001,00378-1031-93,EPLERENONE 50 MG PO TABS,$16.50,$0.00,$16.50,$0.00,$11.78,$0.00,$0.00,$0.00,$0.00,$0.00,$16.50,$0.00,$8.25,$13.07,$13.20,$0.00,$0.00,$0.00,$0.00,$0.00
36986,ERX,HCPCS 63700001,00002-4464-30,TADALAFIL 20 MG PO TABS,$508.74,$0.00,$508.74,$0.00,$363.09,$0.00,$0.00,$0.00,$0.00,$0.00,$508.74,$0.00,$254.37,$402.92,$406.99,$0.00,$0.00,$0.00,$0.00,$0.00
36987,ERX,HCPCS 63700001,62756-0258-02,ZONISAMIDE 25 MG PO CAPS,$50.13,$0.00,$50.13,$0.00,$35.78,$0.00,$0.00,$0.00,$0.00,$0.00,$50.13,$0.00,$25.07,$39.70,$40.10,$0.00,$0.00,$0.00,$0.00,$0.00
36987,ERX,HCPCS 63700001,68462-0128-01,ZONISAMIDE 25 MG PO CAPS,$50.13,$0.00,$50.13,$0.00,$35.78,$0.00,$0.00,$0.00,$0.00,$0.00,$50.13,$0.00,$25.07,$39.70,$40.10,$0.00,$0.00,$0.00,$0.00,$0.00
36988,ERX,HCPCS 63700001,62756-0259-02,ZONISAMIDE 50 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
36988,ERX,HCPCS 63700001,68462-0129-01,ZONISAMIDE 50 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
36989,ERX,HCPCS J0878,00143-9378-01,DAPTOMYCIN 500 MG IV SOLR,$459.55,$0.00,$459.55,$206.80,$327.98,$165.00,$223.25,$0.00,$0.00,$170.38,$459.55,$173.25,$229.78,$363.96,$367.64,$239.25,$170.38,$0.00,$162.23,$68.00
36989,ERX,HCPCS J0878,25021-0174-15,DAPTOMYCIN 500 MG IV SOLR,$459.55,$0.00,$459.55,$206.80,$327.98,$165.00,$223.25,$0.00,$0.00,$170.38,$459.55,$173.25,$229.78,$363.96,$367.64,$239.25,$170.38,$0.00,$162.23,$68.00
36989,ERX,HCPCS J0878,63323-0371-10,DAPTOMYCIN 500 MG IV SOLR,$459.55,$0.00,$459.55,$206.80,$327.98,$165.00,$223.25,$0.00,$0.00,$170.38,$459.55,$173.25,$229.78,$363.96,$367.64,$239.25,$170.38,$0.00,$162.23,$68.00
36989,ERX,HCPCS J0878,63323-0371-19,DAPTOMYCIN 500 MG IV SOLR,$459.55,$0.00,$459.55,$206.80,$327.98,$165.00,$223.25,$0.00,$0.00,$170.38,$459.55,$173.25,$229.78,$363.96,$367.64,$239.25,$170.38,$0.00,$162.23,$68.00
36989,ERX,HCPCS J0878,63323-0871-15,DAPTOMYCIN 500 MG IV SOLR,$459.55,$0.00,$459.55,$206.80,$327.98,$165.00,$223.25,$0.00,$0.00,$170.38,$459.55,$173.25,$229.78,$363.96,$367.64,$239.25,$170.38,$0.00,$162.23,$68.00
36989,ERX,HCPCS J0878,67919-0011-01,DAPTOMYCIN 500 MG IV SOLR,$459.55,$0.00,$459.55,$206.80,$327.98,$165.00,$223.25,$0.00,$0.00,$170.38,$459.55,$173.25,$229.78,$363.96,$367.64,$239.25,$170.38,$0.00,$162.23,$68.00
37170,ERX,HCPCS 63700001,00456-3205-11,MEMANTINE HCL 5 MG PO TABS,$33.79,$0.00,$33.79,$0.00,$24.12,$0.00,$0.00,$0.00,$0.00,$0.00,$33.79,$0.00,$16.90,$26.76,$27.03,$0.00,$0.00,$0.00,$0.00,$0.00
37170,ERX,HCPCS 63700001,00456-3205-60,MEMANTINE HCL 5 MG PO TABS,$33.79,$0.00,$33.79,$0.00,$24.12,$0.00,$0.00,$0.00,$0.00,$0.00,$33.79,$0.00,$16.90,$26.76,$27.03,$0.00,$0.00,$0.00,$0.00,$0.00
37170,ERX,HCPCS 63700001,00456-3205-63,MEMANTINE HCL 5 MG PO TABS,$33.79,$0.00,$33.79,$0.00,$24.12,$0.00,$0.00,$0.00,$0.00,$0.00,$33.79,$0.00,$16.90,$26.76,$27.03,$0.00,$0.00,$0.00,$0.00,$0.00
37170,ERX,HCPCS 63700001,53746-0173-60,MEMANTINE HCL 5 MG PO TABS,$33.79,$0.00,$33.79,$0.00,$24.12,$0.00,$0.00,$0.00,$0.00,$0.00,$33.79,$0.00,$16.90,$26.76,$27.03,$0.00,$0.00,$0.00,$0.00,$0.00
37170,ERX,HCPCS 63700001,60687-0173-11,MEMANTINE HCL 5 MG PO TABS,$33.79,$0.00,$33.79,$0.00,$24.12,$0.00,$0.00,$0.00,$0.00,$0.00,$33.79,$0.00,$16.90,$26.76,$27.03,$0.00,$0.00,$0.00,$0.00,$0.00
37170,ERX,HCPCS 63700001,60687-0173-57,MEMANTINE HCL 5 MG PO TABS,$33.79,$0.00,$33.79,$0.00,$24.12,$0.00,$0.00,$0.00,$0.00,$0.00,$33.79,$0.00,$16.90,$26.76,$27.03,$0.00,$0.00,$0.00,$0.00,$0.00
37182,ERX,HCPCS 63700001,49702-0207-18,FOSAMPRENAVIR CALCIUM 700 MG PO TABS,$81.10,$0.00,$81.10,$0.00,$57.88,$0.00,$0.00,$0.00,$0.00,$0.00,$81.10,$0.00,$40.55,$64.23,$64.88,$0.00,$0.00,$0.00,$0.00,$0.00
37459,ERX,HCPCS 63700001,00046-1105-11,CONJ ESTROG-MEDROXYPROGEST ACE 0.3-1.5 MG PO TABS,$644.88,$0.00,$644.88,$0.00,$460.25,$0.00,$0.00,$0.00,$0.00,$0.00,$644.88,$0.00,$322.44,$510.74,$515.90,$0.00,$0.00,$0.00,$0.00,$0.00
37482,ERX,HCPCS 63700001,00245-0036-42,CHOLESTYRAMINE LIGHT 4 G PO PACK,$19.42,$0.00,$19.42,$0.00,$13.86,$0.00,$0.00,$0.00,$0.00,$0.00,$19.42,$0.00,$9.71,$15.38,$15.54,$0.00,$0.00,$0.00,$0.00,$0.00
37482,ERX,HCPCS 63700001,00245-0036-89,CHOLESTYRAMINE LIGHT 4 G PO PACK,$19.42,$0.00,$19.42,$0.00,$13.86,$0.00,$0.00,$0.00,$0.00,$0.00,$19.42,$0.00,$9.71,$15.38,$15.54,$0.00,$0.00,$0.00,$0.00,$0.00
37579,ERX,HCPCS 25000001,00065-0795-15,BSS IO SOLN,$45.21,$0.00,$45.21,$0.00,$32.27,$0.00,$0.00,$0.00,$0.00,$0.00,$45.21,$0.00,$22.61,$35.81,$36.17,$0.00,$0.00,$0.00,$0.00,$0.00
37616,ERX,HCPCS 63700001,29300-0116-16,TOPIRAMATE 50 MG PO TABS,$19.38,$0.00,$19.38,$0.00,$13.83,$0.00,$0.00,$0.00,$0.00,$0.00,$19.38,$0.00,$9.69,$15.35,$15.50,$0.00,$0.00,$0.00,$0.00,$0.00
37616,ERX,HCPCS 63700001,68382-0139-14,TOPIRAMATE 50 MG PO TABS,$19.38,$0.00,$19.38,$0.00,$13.83,$0.00,$0.00,$0.00,$0.00,$0.00,$19.38,$0.00,$9.69,$15.35,$15.50,$0.00,$0.00,$0.00,$0.00,$0.00
37616,ERX,HCPCS 63700001,69097-0123-03,TOPIRAMATE 50 MG PO TABS,$19.38,$0.00,$19.38,$0.00,$13.83,$0.00,$0.00,$0.00,$0.00,$0.00,$19.38,$0.00,$9.69,$15.35,$15.50,$0.00,$0.00,$0.00,$0.00,$0.00
37616,ERX,HCPCS 63700001,69097-0817-03,TOPIRAMATE 50 MG PO TABS,$19.38,$0.00,$19.38,$0.00,$13.83,$0.00,$0.00,$0.00,$0.00,$0.00,$19.38,$0.00,$9.69,$15.35,$15.50,$0.00,$0.00,$0.00,$0.00,$0.00
37630,ERX,HCPCS 63700001,45802-0040-64,SELENIUM SULFIDE 2.5 % EX LOTN,$75.24,$0.00,$75.34,$0.00,$53.77,$0.00,$0.00,$0.00,$0.00,$0.00,$75.34,$0.00,$37.67,$59.59,$60.27,$0.00,$0.00,$0.00,$0.00,$0.00
37630,ERX,HCPCS 63700001,60432-0528-04,SELENIUM SULFIDE 2.5 % EX LOTN,$75.34,$0.00,$75.34,$0.00,$53.77,$0.00,$0.00,$0.00,$0.00,$0.00,$75.34,$0.00,$37.67,$59.67,$60.27,$0.00,$0.00,$0.00,$0.00,$0.00
37630,ERX,HCPCS 63700001,60432-0528-05,SELENIUM SULFIDE 2.5 % EX LOTN,$75.34,$0.00,$75.34,$0.00,$53.77,$0.00,$0.00,$0.00,$0.00,$0.00,$75.34,$0.00,$37.67,$59.67,$60.27,$0.00,$0.00,$0.00,$0.00,$0.00
37635,ERX,HCPCS 63700001,43547-0280-10,ESCITALOPRAM OXALATE 5 MG PO TABS,$15.77,$0.00,$15.77,$0.00,$11.26,$0.00,$0.00,$0.00,$0.00,$0.00,$15.77,$0.00,$7.89,$12.49,$12.62,$0.00,$0.00,$0.00,$0.00,$0.00
37637,ERX,HCPCS 63700001,00378-0018-01,METOPROLOL TARTRATE 25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
37637,ERX,HCPCS 63700001,51079-0255-01,METOPROLOL TARTRATE 25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
37637,ERX,HCPCS 63700001,51079-0255-20,METOPROLOL TARTRATE 25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
37637,ERX,HCPCS 63700001,52817-0360-10,METOPROLOL TARTRATE 25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
37637,ERX,HCPCS 63700001,57664-0506-52,METOPROLOL TARTRATE 25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
37637,ERX,HCPCS 63700001,62332-0112-31,METOPROLOL TARTRATE 25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
37637,ERX,HCPCS 63700001,62584-0265-01,METOPROLOL TARTRATE 25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
37637,ERX,HCPCS 63700001,62584-0265-11,METOPROLOL TARTRATE 25 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
37642,ERX,HCPCS 63700001,00009-0760-04,CLINDAMYCIN PALMITATE HCL 75 MG/5ML PO SOLR,$128.10,$0.00,$128.10,$0.00,$91.42,$0.00,$0.00,$0.00,$0.00,$0.00,$128.10,$0.00,$64.05,$101.46,$102.48,$0.00,$0.00,$0.00,$0.00,$0.00
37642,ERX,HCPCS 63700001,00574-0129-01,CLINDAMYCIN PALMITATE HCL 75 MG/5ML PO SOLR,$128.10,$0.00,$128.10,$0.00,$91.42,$0.00,$0.00,$0.00,$0.00,$0.00,$128.10,$0.00,$64.05,$101.46,$102.48,$0.00,$0.00,$0.00,$0.00,$0.00
37642,ERX,HCPCS 63700001,16714-0483-01,CLINDAMYCIN PALMITATE HCL 75 MG/5ML PO SOLR,$128.10,$0.00,$128.10,$0.00,$91.42,$0.00,$0.00,$0.00,$0.00,$0.00,$128.10,$0.00,$64.05,$101.46,$102.48,$0.00,$0.00,$0.00,$0.00,$0.00
37642,ERX,HCPCS 63700001,59762-0016-01,CLINDAMYCIN PALMITATE HCL 75 MG/5ML PO SOLR,$128.10,$0.00,$128.10,$0.00,$91.42,$0.00,$0.00,$0.00,$0.00,$0.00,$128.10,$0.00,$64.05,$101.46,$102.48,$0.00,$0.00,$0.00,$0.00,$0.00
37642,ERX,HCPCS 63700001,64980-0511-10,CLINDAMYCIN PALMITATE HCL 75 MG/5ML PO SOLR,$128.10,$0.00,$128.10,$0.00,$91.42,$0.00,$0.00,$0.00,$0.00,$0.00,$128.10,$0.00,$64.05,$101.46,$102.48,$0.00,$0.00,$0.00,$0.00,$0.00
37642,ERX,HCPCS 63700001,65862-0596-01,CLINDAMYCIN PALMITATE HCL 75 MG/5ML PO SOLR,$128.10,$0.00,$128.10,$0.00,$91.42,$0.00,$0.00,$0.00,$0.00,$0.00,$128.10,$0.00,$64.05,$101.46,$102.48,$0.00,$0.00,$0.00,$0.00,$0.00
37643,ERX,HCPCS 63700001,00378-1258-91,PROPAFENONE HCL ER 225 MG PO CP12,$30.00,$0.00,$30.00,$0.00,$21.41,$0.00,$0.00,$0.00,$0.00,$0.00,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$0.00,$0.00,$0.00,$0.00
37643,ERX,HCPCS 63700001,49884-0113-02,PROPAFENONE HCL ER 225 MG PO CP12,$30.00,$0.00,$30.00,$0.00,$21.41,$0.00,$0.00,$0.00,$0.00,$0.00,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$0.00,$0.00,$0.00,$0.00
37644,ERX,HCPCS 63700001,49884-0210-02,PROPAFENONE HCL ER 325 MG PO CP12,$38.00,$0.00,$38.00,$0.00,$27.12,$0.00,$0.00,$0.00,$0.00,$0.00,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
37644,ERX,HCPCS 63700001,66993-0115-60,PROPAFENONE HCL ER 325 MG PO CP12,$38.00,$0.00,$38.00,$0.00,$27.12,$0.00,$0.00,$0.00,$0.00,$0.00,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
37644,ERX,HCPCS 63700001,68462-0409-60,PROPAFENONE HCL ER 325 MG PO CP12,$38.00,$0.00,$38.00,$0.00,$27.12,$0.00,$0.00,$0.00,$0.00,$0.00,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
37645,ERX,HCPCS 63700001,49884-0211-02,PROPAFENONE HCL ER 425 MG PO CP12,$38.00,$0.00,$38.00,$0.00,$27.12,$0.00,$0.00,$0.00,$0.00,$0.00,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
37645,ERX,HCPCS 63700001,66993-0116-60,PROPAFENONE HCL ER 425 MG PO CP12,$38.00,$0.00,$38.00,$0.00,$27.12,$0.00,$0.00,$0.00,$0.00,$0.00,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
37645,ERX,HCPCS 63700001,68462-0410-60,PROPAFENONE HCL ER 425 MG PO CP12,$38.00,$0.00,$38.00,$0.00,$27.12,$0.00,$0.00,$0.00,$0.00,$0.00,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
37648,ERX,HCPCS 63700001,00591-0900-30,GLIPIZIDE ER 2.5 MG PO TB24,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
37648,ERX,HCPCS 63700001,59762-0540-01,GLIPIZIDE ER 2.5 MG PO TB24,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
37648,ERX,HCPCS 63700001,68084-0295-21,GLIPIZIDE ER 2.5 MG PO TB24,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
37649,ERX,HCPCS 63700001,68084-0111-01,GLIPIZIDE ER 5 MG PO TB24,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
37649,ERX,HCPCS 63700001,68084-0111-11,GLIPIZIDE ER 5 MG PO TB24,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
37650,ERX,HCPCS 63700001,00591-0845-10,GLIPIZIDE ER 10 MG PO TB24,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
37650,ERX,HCPCS 63700001,68084-0112-01,GLIPIZIDE ER 10 MG PO TB24,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
37650,ERX,HCPCS 63700001,68084-0112-11,GLIPIZIDE ER 10 MG PO TB24,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
37651,ERX,HCPCS 63700001,63824-0008-15,GUAIFENESIN ER 600 MG PO TB12,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
37651,ERX,HCPCS 63700001,70677-0055-01,GUAIFENESIN ER 600 MG PO TB12,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
37662,ERX,HCPCS 63700001,50742-0622-01,NIFEDIPINE 90 MG PO TB24,$11.53,$0.00,$11.53,$0.00,$8.23,$0.00,$0.00,$0.00,$0.00,$0.00,$11.53,$0.00,$5.77,$9.13,$9.22,$0.00,$0.00,$0.00,$0.00,$0.00
37848,ERX,HCPCS 25000001,66689-0023-01,HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15ML PO SOLN,$12.32,$0.00,$12.32,$0.00,$8.79,$0.00,$0.00,$0.00,$0.00,$0.00,$12.32,$0.00,$6.16,$9.76,$9.86,$0.00,$0.00,$0.00,$0.00,$0.00
37848,ERX,HCPCS 25000001,66689-0023-50,HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15ML PO SOLN,$12.32,$0.00,$12.32,$0.00,$8.79,$0.00,$0.00,$0.00,$0.00,$0.00,$12.32,$0.00,$6.16,$9.76,$9.86,$0.00,$0.00,$0.00,$0.00,$0.00
37894,ERX,HCPCS J9305,00002-7623-01,PEMETREXED DISODIUM 500 MG IV SOLR,"$9,099.18",$0.00,"$9,099.18","$4,094.63","$5,158.80","$3,473.60","$2,832.93",$0.00,$0.00,"$4,158.91","$9,099.18","$3,647.28","$4,549.59","$7,206.55","$7,279.34","$5,036.72","$4,158.91",$0.00,"$3,959.99","$3,620.25"
37989,ERX,HCPCS J9055,66733-0948-23,CETUXIMAB 100 MG/50ML IV SOLN,"$1,919.52",$0.00,"$1,919.52",$863.78,"$1,369.96",$620.48,$584.45,$0.00,$0.00,$742.72,"$1,919.52",$651.50,$959.76,"$1,520.26","$1,535.62",$899.70,$742.72,$0.00,$707.19,$647.13
38062,ERX,HCPCS J7518,00078-0385-66,MYCOPHENOLATE SODIUM 180 MG PO TBEC,$17.37,$0.00,$17.37,$0.00,$12.40,$0.00,$0.00,$0.00,$0.00,$0.00,$17.37,$0.00,$8.69,$13.76,$13.90,$0.00,$0.00,$0.00,$0.00,$0.00
38062,ERX,HCPCS J7518,00378-4201-78,MYCOPHENOLATE SODIUM 180 MG PO TBEC,$17.37,$0.00,$17.37,$0.00,$12.40,$0.00,$0.00,$0.00,$0.00,$0.00,$17.37,$0.00,$8.69,$13.76,$13.90,$0.00,$0.00,$0.00,$0.00,$0.00
38062,ERX,HCPCS J7518,16729-0261-29,MYCOPHENOLATE SODIUM 180 MG PO TBEC,$17.37,$0.00,$17.37,$0.00,$12.40,$0.00,$0.00,$0.00,$0.00,$0.00,$17.37,$0.00,$8.69,$13.76,$13.90,$0.00,$0.00,$0.00,$0.00,$0.00
38063,ERX,HCPCS 63700001,16729-0189-29,MYCOPHENOLATE SODIUM 360 MG PO TBEC,$34.73,$0.00,$34.73,$0.00,$24.79,$0.00,$0.00,$0.00,$0.00,$0.00,$34.73,$0.00,$17.37,$27.51,$27.78,$0.00,$0.00,$0.00,$0.00,$0.00
38063,ERX,HCPCS 63700001,60505-2966-07,MYCOPHENOLATE SODIUM 360 MG PO TBEC,$34.73,$0.00,$34.73,$0.00,$24.79,$0.00,$0.00,$0.00,$0.00,$0.00,$34.73,$0.00,$17.37,$27.51,$27.78,$0.00,$0.00,$0.00,$0.00,$0.00
38063,ERX,HCPCS 63700001,68084-0918-25,MYCOPHENOLATE SODIUM 360 MG PO TBEC,$34.73,$0.00,$34.73,$0.00,$24.79,$0.00,$0.00,$0.00,$0.00,$0.00,$34.73,$0.00,$17.37,$27.51,$27.78,$0.00,$0.00,$0.00,$0.00,$0.00
38100,ERX,HCPCS 63700001,55513-0073-30,CINACALCET HCL 30 MG PO TABS,$107.28,$0.00,$107.28,$0.00,$76.57,$0.00,$0.00,$0.00,$0.00,$0.00,$107.28,$0.00,$53.64,$84.97,$85.82,$0.00,$0.00,$0.00,$0.00,$0.00
38100,ERX,HCPCS 63700001,67877-0503-30,CINACALCET HCL 30 MG PO TABS,$107.28,$0.00,$107.28,$0.00,$76.57,$0.00,$0.00,$0.00,$0.00,$0.00,$107.28,$0.00,$53.64,$84.97,$85.82,$0.00,$0.00,$0.00,$0.00,$0.00
38100,ERX,HCPCS 63700001,70436-0007-04,CINACALCET HCL 30 MG PO TABS,$107.28,$0.00,$107.28,$0.00,$76.57,$0.00,$0.00,$0.00,$0.00,$0.00,$107.28,$0.00,$53.64,$84.97,$85.82,$0.00,$0.00,$0.00,$0.00,$0.00
38101,ERX,HCPCS 63700001,47335-0380-83,CINACALCET HCL 60 MG PO TABS,$194.82,$0.00,$194.82,$0.00,$139.04,$0.00,$0.00,$0.00,$0.00,$0.00,$194.82,$0.00,$97.41,$154.30,$155.86,$0.00,$0.00,$0.00,$0.00,$0.00
38101,ERX,HCPCS 63700001,55513-0074-30,CINACALCET HCL 60 MG PO TABS,$194.82,$0.00,$194.82,$0.00,$139.04,$0.00,$0.00,$0.00,$0.00,$0.00,$194.82,$0.00,$97.41,$154.30,$155.86,$0.00,$0.00,$0.00,$0.00,$0.00
38101,ERX,HCPCS 63700001,70436-0008-04,CINACALCET HCL 60 MG PO TABS,$194.82,$0.00,$194.82,$0.00,$139.04,$0.00,$0.00,$0.00,$0.00,$0.00,$194.82,$0.00,$97.41,$154.30,$155.86,$0.00,$0.00,$0.00,$0.00,$0.00
38102,ERX,HCPCS 63700001,55513-0075-30,CINACALCET HCL 90 MG PO TABS,$304.94,$0.00,$304.94,$0.00,$217.64,$0.00,$0.00,$0.00,$0.00,$0.00,$304.94,$0.00,$152.47,$241.51,$243.95,$0.00,$0.00,$0.00,$0.00,$0.00
38102,ERX,HCPCS 63700001,69097-0412-02,CINACALCET HCL 90 MG PO TABS,$304.94,$0.00,$304.94,$0.00,$217.64,$0.00,$0.00,$0.00,$0.00,$0.00,$304.94,$0.00,$152.47,$241.51,$243.95,$0.00,$0.00,$0.00,$0.00,$0.00
38224,ERX,HCPCS 63700001,00228-2778-11,PROPRANOLOL HCL ER 60 MG PO CP24,$7.76,$0.00,$7.76,$0.00,$5.54,$0.00,$0.00,$0.00,$0.00,$0.00,$7.76,$0.00,$3.88,$6.15,$6.21,$0.00,$0.00,$0.00,$0.00,$0.00
38224,ERX,HCPCS 63700001,42291-0522-01,PROPRANOLOL HCL ER 60 MG PO CP24,$7.76,$0.00,$7.76,$0.00,$5.54,$0.00,$0.00,$0.00,$0.00,$0.00,$7.76,$0.00,$3.88,$6.15,$6.21,$0.00,$0.00,$0.00,$0.00,$0.00
38224,ERX,HCPCS 63700001,62559-0530-01,PROPRANOLOL HCL ER 60 MG PO CP24,$7.76,$0.00,$7.76,$0.00,$5.54,$0.00,$0.00,$0.00,$0.00,$0.00,$7.76,$0.00,$3.88,$6.15,$6.21,$0.00,$0.00,$0.00,$0.00,$0.00
38225,ERX,HCPCS 63700001,00228-2779-11,PROPRANOLOL HCL ER 80 MG PO CP24,$8.67,$0.00,$8.67,$0.00,$6.19,$0.00,$0.00,$0.00,$0.00,$0.00,$8.67,$0.00,$4.34,$6.87,$6.94,$0.00,$0.00,$0.00,$0.00,$0.00
38225,ERX,HCPCS 63700001,42291-0523-01,PROPRANOLOL HCL ER 80 MG PO CP24,$8.67,$0.00,$8.67,$0.00,$6.19,$0.00,$0.00,$0.00,$0.00,$0.00,$8.67,$0.00,$4.34,$6.87,$6.94,$0.00,$0.00,$0.00,$0.00,$0.00
38225,ERX,HCPCS 63700001,42291-0523-10,PROPRANOLOL HCL ER 80 MG PO CP24,$8.67,$0.00,$8.67,$0.00,$6.19,$0.00,$0.00,$0.00,$0.00,$0.00,$8.67,$0.00,$4.34,$6.87,$6.94,$0.00,$0.00,$0.00,$0.00,$0.00
38225,ERX,HCPCS 63700001,62559-0531-01,PROPRANOLOL HCL ER 80 MG PO CP24,$8.67,$0.00,$8.67,$0.00,$6.19,$0.00,$0.00,$0.00,$0.00,$0.00,$8.67,$0.00,$4.34,$6.87,$6.94,$0.00,$0.00,$0.00,$0.00,$0.00
38226,ERX,HCPCS 63700001,00228-2780-11,PROPRANOLOL HCL ER 120 MG PO CP24,$11.34,$0.00,$11.34,$0.00,$8.09,$0.00,$0.00,$0.00,$0.00,$0.00,$11.34,$0.00,$5.67,$8.98,$9.07,$0.00,$0.00,$0.00,$0.00,$0.00
38227,ERX,HCPCS 63700001,00228-2781-11,PROPRANOLOL HCL ER 160 MG PO CP24,$9.56,$0.00,$9.56,$0.00,$6.82,$0.00,$0.00,$0.00,$0.00,$0.00,$9.56,$0.00,$4.78,$7.57,$7.65,$0.00,$0.00,$0.00,$0.00,$0.00
38227,ERX,HCPCS 63700001,62559-0533-01,PROPRANOLOL HCL ER 160 MG PO CP24,$9.56,$0.00,$9.56,$0.00,$6.82,$0.00,$0.00,$0.00,$0.00,$0.00,$9.56,$0.00,$4.78,$7.57,$7.65,$0.00,$0.00,$0.00,$0.00,$0.00
38245,ERX,HCPCS 63700001,50383-0779-31,LACTULOSE 10 GM/15ML SOLN,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
38245,ERX,HCPCS 63700001,50383-0779-16,LACTULOSE 10 GM/15ML SOLN,$127.48,$0.00,$100.96,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$100.96,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
38263,ERX,HCPCS 25000001,00002-7597-01,OLANZAPINE 10 MG IM SOLR,$39.43,$0.00,$39.43,$0.00,$28.14,$0.00,$0.00,$0.00,$0.00,$0.00,$39.43,$0.00,$19.72,$31.23,$31.54,$0.00,$0.00,$0.00,$0.00,$0.00
38263,ERX,HCPCS 25000001,00517-0955-01,OLANZAPINE 10 MG IM SOLR,$39.43,$0.00,$39.43,$0.00,$28.14,$0.00,$0.00,$0.00,$0.00,$0.00,$39.43,$0.00,$19.72,$31.23,$31.54,$0.00,$0.00,$0.00,$0.00,$0.00
38263,ERX,HCPCS 25000001,00781-3159-72,OLANZAPINE 10 MG IM SOLR,$39.43,$0.00,$39.43,$0.00,$28.14,$0.00,$0.00,$0.00,$0.00,$0.00,$39.43,$0.00,$19.72,$31.23,$31.54,$0.00,$0.00,$0.00,$0.00,$0.00
38270,ERX,HCPCS J9070,00781-3244-94,CYCLOPHOSPHAMIDE 1 G IJ SOLR,"$2,109.60",$0.00,"$2,109.60",$949.32,"$1,505.62",$341.39,$363.47,$0.00,$0.00,$390.57,"$2,109.60",$358.46,"$1,054.80","$1,670.80","$1,687.68",$495.02,$390.57,$0.00,$371.89,$345.66
38270,ERX,HCPCS J9070,10019-0956-01,CYCLOPHOSPHAMIDE 1 G IJ SOLR,"$2,109.60",$0.00,"$2,109.60",$949.32,"$1,505.62",$341.39,$363.47,$0.00,$0.00,$390.57,"$2,109.60",$358.46,"$1,054.80","$1,670.80","$1,687.68",$495.02,$390.57,$0.00,$371.89,$345.66
38270,ERX,HCPCS J9070,16714-0857-01,CYCLOPHOSPHAMIDE 1 G IJ SOLR,"$2,109.60",$0.00,"$2,109.60",$949.32,"$1,505.62",$341.39,$363.47,$0.00,$0.00,$390.57,"$2,109.60",$358.46,"$1,054.80","$1,670.80","$1,687.68",$495.02,$390.57,$0.00,$371.89,$345.66
38270,ERX,HCPCS J9070,70121-1239-01,CYCLOPHOSPHAMIDE 1 G IJ SOLR,"$2,109.60",$0.00,"$2,109.60",$949.32,"$1,505.62",$341.39,$363.47,$0.00,$0.00,$390.57,"$2,109.60",$358.46,"$1,054.80","$1,670.80","$1,687.68",$495.02,$390.57,$0.00,$371.89,$345.66
38271,ERX,HCPCS J9070,00781-3233-94,CYCLOPHOSPHAMIDE 500 MG IJ SOLR,"$1,164.68",$0.00,"$1,164.68",$524.11,$831.23,$170.70,$200.67,$0.00,$0.00,$195.29,"$1,164.68",$179.23,$582.34,$922.43,$931.74,$247.51,$195.29,$0.00,$185.94,$172.83
38271,ERX,HCPCS J9070,10019-0955-01,CYCLOPHOSPHAMIDE 500 MG IJ SOLR,"$1,164.68",$0.00,"$1,164.68",$524.11,$831.23,$170.70,$200.67,$0.00,$0.00,$195.29,"$1,164.68",$179.23,$582.34,$922.43,$931.74,$247.51,$195.29,$0.00,$185.94,$172.83
38271,ERX,HCPCS J9070,16714-0859-01,CYCLOPHOSPHAMIDE 500 MG IJ SOLR,"$1,164.68",$0.00,"$1,164.68",$524.11,$831.23,$170.70,$200.67,$0.00,$0.00,$195.29,"$1,164.68",$179.23,$582.34,$922.43,$931.74,$247.51,$195.29,$0.00,$185.94,$172.83
38280,ERX,HCPCS J9070,00781-3255-94,CYCLOPHOSPHAMIDE 2 G IJ SOLR,"$3,603.90",$0.00,"$3,603.90","$1,621.76","$2,572.10",$682.78,$620.93,$0.00,$0.00,$781.14,"$3,603.90",$716.92,"$1,801.95","$2,854.29","$2,883.12",$990.03,$781.14,$0.00,$743.78,$691.32
38280,ERX,HCPCS J9070,10019-0957-01,CYCLOPHOSPHAMIDE 2 G IJ SOLR,"$3,603.90",$0.00,"$3,603.90","$1,621.76","$2,572.10",$682.78,$620.93,$0.00,$0.00,$781.14,"$3,603.90",$716.92,"$1,801.95","$2,854.29","$2,883.12",$990.03,$781.14,$0.00,$743.78,$691.32
38280,ERX,HCPCS J9070,10019-0957-11,CYCLOPHOSPHAMIDE 2 G IJ SOLR,"$3,603.90",$0.00,"$3,603.90","$1,621.76","$2,572.10",$682.78,$620.93,$0.00,$0.00,$781.14,"$3,603.90",$716.92,"$1,801.95","$2,854.29","$2,883.12",$990.03,$781.14,$0.00,$743.78,$691.32
38280,ERX,HCPCS J9070,70121-1240-01,CYCLOPHOSPHAMIDE 2 G IJ SOLR,"$3,603.90",$0.00,"$3,603.90","$1,621.76","$2,572.10",$682.78,$620.93,$0.00,$0.00,$781.14,"$3,603.90",$716.92,"$1,801.95","$2,854.29","$2,883.12",$990.03,$781.14,$0.00,$743.78,$691.32
38303,ERX,HCPCS J0132,00574-0805-30,ACETYLCYSTEINE 200 MG/ML IV SOLN,$685.69,$0.00,$685.69,$0.00,$489.38,$0.00,$0.00,$0.00,$0.00,$0.00,$685.69,$0.00,$342.85,$543.07,$548.55,$0.00,$0.00,$0.00,$0.00,$0.00
38303,ERX,HCPCS J0132,00574-0815-30,ACETYLCYSTEINE 200 MG/ML IV SOLN,$685.69,$0.00,$685.69,$0.00,$489.38,$0.00,$0.00,$0.00,$0.00,$0.00,$685.69,$0.00,$342.85,$543.07,$548.55,$0.00,$0.00,$0.00,$0.00,$0.00
38303,ERX,HCPCS J0132,17478-0660-30,ACETYLCYSTEINE 200 MG/ML IV SOLN,$685.69,$0.00,$685.69,$0.00,$489.38,$0.00,$0.00,$0.00,$0.00,$0.00,$685.69,$0.00,$342.85,$543.07,$548.55,$0.00,$0.00,$0.00,$0.00,$0.00
38303,ERX,HCPCS J0132,25021-0812-30,ACETYLCYSTEINE 200 MG/ML IV SOLN,$685.69,$0.00,$685.69,$0.00,$489.38,$0.00,$0.00,$0.00,$0.00,$0.00,$685.69,$0.00,$342.85,$543.07,$548.55,$0.00,$0.00,$0.00,$0.00,$0.00
38303,ERX,HCPCS J0132,63323-0963-30,ACETYLCYSTEINE 200 MG/ML IV SOLN,$685.69,$0.00,$685.69,$0.00,$489.38,$0.00,$0.00,$0.00,$0.00,$0.00,$685.69,$0.00,$342.85,$543.07,$548.55,$0.00,$0.00,$0.00,$0.00,$0.00
38303,ERX,HCPCS J0132,66220-0207-30,ACETYLCYSTEINE 200 MG/ML IV SOLN,$685.69,$0.00,$685.69,$0.00,$489.38,$0.00,$0.00,$0.00,$0.00,$0.00,$685.69,$0.00,$342.85,$543.07,$548.55,$0.00,$0.00,$0.00,$0.00,$0.00
38315,ERX,HCPCS 25000001,00597-0075-41,TIOTROPIUM BROMIDE MONOHYDRATE 18 MCG IN CAPS,"$1,311.12",$0.00,"$1,311.12",$0.00,$935.75,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,311.12",$0.00,$655.56,"$1,038.41","$1,048.90",$0.00,$0.00,$0.00,$0.00,$0.00
38315,ERX,HCPCS 25000001,00597-0075-75,TIOTROPIUM BROMIDE MONOHYDRATE 18 MCG IN CAPS,"$1,311.12",$0.00,"$1,311.12",$0.00,$935.75,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,311.12",$0.00,$655.56,"$1,038.41","$1,048.90",$0.00,$0.00,$0.00,$0.00,$0.00
38318,ERX,HCPCS 63700001,63010-0027-70,NELFINAVIR MESYLATE 625 MG PO TABS,$46.14,$0.00,$46.14,$0.00,$32.93,$0.00,$0.00,$0.00,$0.00,$0.00,$46.14,$0.00,$23.07,$36.54,$36.91,$0.00,$0.00,$0.00,$0.00,$0.00
38421,ERX,HCPCS 63700001,13107-0001-30,MIRTAZAPINE 7.5 MG PO TABS,$10.01,$0.00,$10.01,$0.00,$7.14,$0.00,$0.00,$0.00,$0.00,$0.00,$10.01,$0.00,$5.01,$7.93,$8.01,$0.00,$0.00,$0.00,$0.00,$0.00
38421,ERX,HCPCS 63700001,16714-0706-01,MIRTAZAPINE 7.5 MG PO TABS,$10.01,$0.00,$10.01,$0.00,$7.14,$0.00,$0.00,$0.00,$0.00,$0.00,$10.01,$0.00,$5.01,$7.93,$8.01,$0.00,$0.00,$0.00,$0.00,$0.00
38479,ERX,HCPCS 63700001,00093-5417-84,CLOZAPINE 25 MG PO TBDP,$11.40,$0.00,$11.40,$0.00,$8.14,$0.00,$0.00,$0.00,$0.00,$0.00,$11.40,$0.00,$5.70,$9.03,$9.12,$0.00,$0.00,$0.00,$0.00,$0.00
38480,ERX,HCPCS 63700001,00093-5419-19,CLOZAPINE 100 MG PO TBDP,$31.07,$0.00,$31.07,$0.00,$22.17,$0.00,$0.00,$0.00,$0.00,$0.00,$31.07,$0.00,$15.54,$24.61,$24.86,$0.00,$0.00,$0.00,$0.00,$0.00
38480,ERX,HCPCS 63700001,00093-5419-84,CLOZAPINE 100 MG PO TBDP,$31.07,$0.00,$31.07,$0.00,$22.17,$0.00,$0.00,$0.00,$0.00,$0.00,$31.07,$0.00,$15.54,$24.61,$24.86,$0.00,$0.00,$0.00,$0.00,$0.00
38488,ERX,HCPCS 63700001,00121-0721-04,FLUOXETINE HCL 20 MG/5ML PO SOLN,$13.00,$0.00,$13.00,$0.00,$9.28,$0.00,$0.00,$0.00,$0.00,$0.00,$13.00,$0.00,$6.50,$10.30,$10.40,$0.00,$0.00,$0.00,$0.00,$0.00
38488,ERX,HCPCS 63700001,00121-4721-05,FLUOXETINE HCL 20 MG/5ML PO SOLN,$13.00,$0.00,$13.00,$0.00,$9.28,$0.00,$0.00,$0.00,$0.00,$0.00,$13.00,$0.00,$6.50,$10.30,$10.40,$0.00,$0.00,$0.00,$0.00,$0.00
38488,ERX,HCPCS 63700001,54838-0523-40,FLUOXETINE HCL 20 MG/5ML PO SOLN,$13.00,$0.00,$13.00,$0.00,$9.28,$0.00,$0.00,$0.00,$0.00,$0.00,$13.00,$0.00,$6.50,$10.30,$10.40,$0.00,$0.00,$0.00,$0.00,$0.00
38489,ERX,HCPCS 63700001,99999-6005-07,ETHOSUXIMIDE 250 MG/5ML PO SOLN,$95.34,$0.00,$95.34,$0.00,$68.04,$0.00,$0.00,$0.00,$0.00,$0.00,$95.34,$0.00,$47.67,$75.51,$76.27,$0.00,$0.00,$0.00,$0.00,$0.00
38489,ERX,HCPCS 63700001,00121-0670-16,ETHOSUXIMIDE 250 MG/5ML PO SOLN,$621.72,$0.00,$492.40,$0.00,$68.04,$0.00,$0.00,$0.00,$0.00,$0.00,$95.34,$0.00,$47.67,$492.40,$76.27,$0.00,$0.00,$0.00,$0.00,$0.00
38703,ERX,HCPCS J0153,17478-0542-02,ADENOSINE 6 MG/2ML IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$2.19,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$2.19,$0.00,$2.08,$0.00
38703,ERX,HCPCS J0153,17478-0953-02,ADENOSINE 6 MG/2ML IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$2.19,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$2.19,$0.00,$2.08,$0.00
38703,ERX,HCPCS J0153,25021-0301-67,ADENOSINE 6 MG/2ML IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$2.19,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$2.19,$0.00,$2.08,$0.00
38703,ERX,HCPCS J0153,63323-0651-21,ADENOSINE 6 MG/2ML IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$2.19,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$2.19,$0.00,$2.08,$0.00
38703,ERX,HCPCS J0153,63323-0651-89,ADENOSINE 6 MG/2ML IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$2.19,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$2.19,$0.00,$2.08,$0.00
38703,ERX,HCPCS J0153,67457-0855-02,ADENOSINE 6 MG/2ML IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$2.19,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$2.19,$0.00,$2.08,$0.00
38907,ERX,HCPCS 63700001,43386-0551-02,TINIDAZOLE 500 MG PO TABS,$88.80,$0.00,$88.80,$0.00,$63.38,$0.00,$0.00,$0.00,$0.00,$0.00,$88.80,$0.00,$44.40,$70.33,$71.04,$0.00,$0.00,$0.00,$0.00,$0.00
39063,ERX,HCPCS 63700001,65649-0301-03,RIFAXIMIN 200 MG PO TABS,$253.40,$0.00,$253.40,$0.00,$180.85,$0.00,$0.00,$0.00,$0.00,$0.00,$253.40,$0.00,$126.70,$200.69,$202.72,$0.00,$0.00,$0.00,$0.00,$0.00
39136,ERX,HCPCS 63700001,00574-2008-15,NYSTATIN 100000 UNIT/GM EX POWD,$96.13,$0.00,$96.13,$0.00,$68.61,$0.00,$0.00,$0.00,$0.00,$0.00,$96.13,$0.00,$48.07,$76.13,$76.90,$0.00,$0.00,$0.00,$0.00,$0.00
39136,ERX,HCPCS 63700001,16714-0769-01,NYSTATIN 100000 UNIT/GM EX POWD,$96.13,$0.00,$96.13,$0.00,$68.61,$0.00,$0.00,$0.00,$0.00,$0.00,$96.13,$0.00,$48.07,$76.13,$76.90,$0.00,$0.00,$0.00,$0.00,$0.00
39136,ERX,HCPCS 63700001,43386-0530-01,NYSTATIN 100000 UNIT/GM EX POWD,$96.13,$0.00,$96.13,$0.00,$68.61,$0.00,$0.00,$0.00,$0.00,$0.00,$96.13,$0.00,$48.07,$76.13,$76.90,$0.00,$0.00,$0.00,$0.00,$0.00
39136,ERX,HCPCS 63700001,68308-0152-15,NYSTATIN 100000 UNIT/GM EX POWD,$96.13,$0.00,$96.13,$0.00,$68.61,$0.00,$0.00,$0.00,$0.00,$0.00,$96.13,$0.00,$48.07,$76.13,$76.90,$0.00,$0.00,$0.00,$0.00,$0.00
39254,ERX,HCPCS 63700001,67546-0111-12,NITAZOXANIDE 500 MG PO TABS,$492.76,$0.00,$492.76,$0.00,$351.68,$0.00,$0.00,$0.00,$0.00,$0.00,$492.76,$0.00,$246.38,$390.27,$394.21,$0.00,$0.00,$0.00,$0.00,$0.00
39255,ERX,HCPCS 63700001,61958-0701-01,TRUVADA:EMTRICITABINE-TENOFOVIR 200-300 MG TAB PO,$232.13,$0.00,$232.13,$0.00,$165.67,$0.00,$0.00,$0.00,$0.00,$0.00,$232.13,$0.00,$116.07,$183.85,$185.70,$0.00,$0.00,$0.00,$0.00,$0.00
39267,ERX,HCPCS J9045,00703-4248-01,CARBOPLATIN 450 MG/45ML IV SOLN,$245.66,$0.00,$245.66,$110.55,$175.33,$0.00,$60.81,$0.00,$0.00,$28.45,$245.66,$0.00,$122.83,$194.56,$196.53,$0.00,$28.45,$0.00,$27.09,$0.00
39267,ERX,HCPCS J9045,61703-0339-50,CARBOPLATIN 450 MG/45ML IV SOLN,$245.66,$0.00,$245.66,$110.55,$175.33,$0.00,$60.81,$0.00,$0.00,$28.45,$245.66,$0.00,$122.83,$194.56,$196.53,$0.00,$28.45,$0.00,$27.09,$0.00
39275,ERX,HCPCS 63700001,00002-3235-60,DULOXETINE HCL 20 MG PO CPEP,$34.80,$0.00,$34.80,$0.00,$24.84,$0.00,$0.00,$0.00,$0.00,$0.00,$34.80,$0.00,$17.40,$27.56,$27.84,$0.00,$0.00,$0.00,$0.00,$0.00
39275,ERX,HCPCS 63700001,13668-0109-60,DULOXETINE HCL 20 MG PO CPEP,$34.80,$0.00,$34.80,$0.00,$24.84,$0.00,$0.00,$0.00,$0.00,$0.00,$34.80,$0.00,$17.40,$27.56,$27.84,$0.00,$0.00,$0.00,$0.00,$0.00
39275,ERX,HCPCS 63700001,27241-0097-06,DULOXETINE HCL 20 MG PO CPEP,$34.80,$0.00,$34.80,$0.00,$24.84,$0.00,$0.00,$0.00,$0.00,$0.00,$34.80,$0.00,$17.40,$27.56,$27.84,$0.00,$0.00,$0.00,$0.00,$0.00
39275,ERX,HCPCS 63700001,57237-0017-60,DULOXETINE HCL 20 MG PO CPEP,$34.80,$0.00,$34.80,$0.00,$24.84,$0.00,$0.00,$0.00,$0.00,$0.00,$34.80,$0.00,$17.40,$27.56,$27.84,$0.00,$0.00,$0.00,$0.00,$0.00
39275,ERX,HCPCS 63700001,60505-2995-06,DULOXETINE HCL 20 MG PO CPEP,$34.80,$0.00,$34.80,$0.00,$24.84,$0.00,$0.00,$0.00,$0.00,$0.00,$34.80,$0.00,$17.40,$27.56,$27.84,$0.00,$0.00,$0.00,$0.00,$0.00
39275,ERX,HCPCS 63700001,69097-0297-03,DULOXETINE HCL 20 MG PO CPEP,$34.80,$0.00,$34.80,$0.00,$24.84,$0.00,$0.00,$0.00,$0.00,$0.00,$34.80,$0.00,$17.40,$27.56,$27.84,$0.00,$0.00,$0.00,$0.00,$0.00
39276,ERX,HCPCS 63700001,27241-0098-09,DULOXETINE HCL 30 MG PO CPEP,$29.84,$0.00,$29.84,$0.00,$21.30,$0.00,$0.00,$0.00,$0.00,$0.00,$29.84,$0.00,$14.92,$23.63,$23.87,$0.00,$0.00,$0.00,$0.00,$0.00
39276,ERX,HCPCS 63700001,57237-0018-30,DULOXETINE HCL 30 MG PO CPEP,$29.84,$0.00,$29.84,$0.00,$21.30,$0.00,$0.00,$0.00,$0.00,$0.00,$29.84,$0.00,$14.92,$23.63,$23.87,$0.00,$0.00,$0.00,$0.00,$0.00
39276,ERX,HCPCS 63700001,57237-0018-90,DULOXETINE HCL 30 MG PO CPEP,$29.84,$0.00,$29.84,$0.00,$21.30,$0.00,$0.00,$0.00,$0.00,$0.00,$29.84,$0.00,$14.92,$23.63,$23.87,$0.00,$0.00,$0.00,$0.00,$0.00
39277,ERX,HCPCS 63700001,00228-2892-03,DULOXETINE HCL 60 MG PO CPEP,$29.80,$0.00,$29.80,$0.00,$21.27,$0.00,$0.00,$0.00,$0.00,$0.00,$29.80,$0.00,$14.90,$23.60,$23.84,$0.00,$0.00,$0.00,$0.00,$0.00
39277,ERX,HCPCS 63700001,27241-0099-03,DULOXETINE HCL 60 MG PO CPEP,$29.80,$0.00,$29.80,$0.00,$21.27,$0.00,$0.00,$0.00,$0.00,$0.00,$29.80,$0.00,$14.90,$23.60,$23.84,$0.00,$0.00,$0.00,$0.00,$0.00
39277,ERX,HCPCS 63700001,47335-0383-83,DULOXETINE HCL 60 MG PO CPEP,$29.80,$0.00,$29.80,$0.00,$21.27,$0.00,$0.00,$0.00,$0.00,$0.00,$29.80,$0.00,$14.90,$23.60,$23.84,$0.00,$0.00,$0.00,$0.00,$0.00
39277,ERX,HCPCS 63700001,57237-0019-30,DULOXETINE HCL 60 MG PO CPEP,$29.80,$0.00,$29.80,$0.00,$21.27,$0.00,$0.00,$0.00,$0.00,$0.00,$29.80,$0.00,$14.90,$23.60,$23.84,$0.00,$0.00,$0.00,$0.00,$0.00
39277,ERX,HCPCS 63700001,57237-0019-99,DULOXETINE HCL 60 MG PO CPEP,$29.80,$0.00,$29.80,$0.00,$21.27,$0.00,$0.00,$0.00,$0.00,$0.00,$29.80,$0.00,$14.90,$23.60,$23.84,$0.00,$0.00,$0.00,$0.00,$0.00
39301,ERX,HCPCS 63700001,00093-5382-56,EPZICOM:ABACAVIR-LAMIVUDINE 600-300 MG PO TABS,$162.58,$0.00,$162.58,$0.00,$116.03,$0.00,$0.00,$0.00,$0.00,$0.00,$162.58,$0.00,$81.29,$128.76,$130.06,$0.00,$0.00,$0.00,$0.00,$0.00
39301,ERX,HCPCS 63700001,35573-0402-30,EPZICOM:ABACAVIR-LAMIVUDINE 600-300 MG PO TABS,$162.58,$0.00,$162.58,$0.00,$116.03,$0.00,$0.00,$0.00,$0.00,$0.00,$162.58,$0.00,$81.29,$128.76,$130.06,$0.00,$0.00,$0.00,$0.00,$0.00
39301,ERX,HCPCS 63700001,66993-0482-30,EPZICOM:ABACAVIR-LAMIVUDINE 600-300 MG PO TABS,$162.58,$0.00,$162.58,$0.00,$116.03,$0.00,$0.00,$0.00,$0.00,$0.00,$162.58,$0.00,$81.29,$128.76,$130.06,$0.00,$0.00,$0.00,$0.00,$0.00
39301,ERX,HCPCS 63700001,68180-0288-06,EPZICOM:ABACAVIR-LAMIVUDINE 600-300 MG PO TABS,$162.58,$0.00,$162.58,$0.00,$116.03,$0.00,$0.00,$0.00,$0.00,$0.00,$162.58,$0.00,$81.29,$128.76,$130.06,$0.00,$0.00,$0.00,$0.00,$0.00
39301,ERX,HCPCS 63700001,69097-0362-02,EPZICOM:ABACAVIR-LAMIVUDINE 600-300 MG PO TABS,$162.58,$0.00,$162.58,$0.00,$116.03,$0.00,$0.00,$0.00,$0.00,$0.00,$162.58,$0.00,$81.29,$128.76,$130.06,$0.00,$0.00,$0.00,$0.00,$0.00
39522,ERX,HCPCS 25000001,00781-6078-46,CEFDINIR 250 MG/5ML PO SUSR,$480.38,$0.00,$480.38,$0.00,$342.85,$0.00,$0.00,$0.00,$0.00,$0.00,$480.38,$0.00,$240.19,$380.46,$384.30,$0.00,$0.00,$0.00,$0.00,$0.00
39594,ERX,HCPCS 63700001,49411-0051-30,AMINOCAPROIC ACID 1000 MG PO TABS,$171.02,$0.00,$171.02,$0.00,$122.06,$0.00,$0.00,$0.00,$0.00,$0.00,$171.02,$0.00,$85.51,$135.45,$136.82,$0.00,$0.00,$0.00,$0.00,$0.00
39700,ERX,HCPCS 25000001,00019-1323-06,IOVERSOL 68 % IJ SOLN,$73.50,$0.00,$189.48,$0.00,$135.23,$0.00,$0.00,$0.00,$0.00,$0.00,$189.48,$0.00,$94.74,$58.21,$151.58,$0.00,$0.00,$0.00,$0.00,$0.00
39700,ERX,HCPCS 25000001,00019-1323-16,IOVERSOL 68 % IJ SOLN,$189.48,$0.00,$189.48,$0.00,$135.23,$0.00,$0.00,$0.00,$0.00,$0.00,$189.48,$0.00,$94.74,$150.07,$151.58,$0.00,$0.00,$0.00,$0.00,$0.00
39720,ERX,HCPCS 63700001,00093-5352-86,ACAMPROSATE CALCIUM 333 MG PO TBEC,$6.68,$0.00,$6.68,$0.00,$4.77,$0.00,$0.00,$0.00,$0.00,$0.00,$6.68,$0.00,$3.34,$5.29,$5.34,$0.00,$0.00,$0.00,$0.00,$0.00
39744,ERX,HCPCS 25000001,00143-9684-10,FLUMAZENIL 0.5 MG/5ML IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
39744,ERX,HCPCS 25000001,00143-9784-10,FLUMAZENIL 0.5 MG/5ML IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
39802,ERX,HCPCS 25000001,00386-0004-04,PENTAFLUOROPROP-TETRAFLUOROETH EX AERO,$115.31,$0.00,$115.31,$0.00,$82.30,$0.00,$0.00,$0.00,$0.00,$0.00,$115.31,$0.00,$57.66,$91.33,$92.25,$0.00,$0.00,$0.00,$0.00,$0.00
39802,ERX,HCPCS 25000001,00386-0008-02,PENTAFLUOROPROP-TETRAFLUOROETH EX AERO,$115.31,$0.00,$115.31,$0.00,$82.30,$0.00,$0.00,$0.00,$0.00,$0.00,$115.31,$0.00,$57.66,$91.33,$92.25,$0.00,$0.00,$0.00,$0.00,$0.00
39802,ERX,HCPCS 25000001,00386-0008-03,PENTAFLUOROPROP-TETRAFLUOROETH EX AERO,$115.31,$0.00,$115.31,$0.00,$82.30,$0.00,$0.00,$0.00,$0.00,$0.00,$115.31,$0.00,$57.66,$91.33,$92.25,$0.00,$0.00,$0.00,$0.00,$0.00
39918,ERX,HCPCS J3260,00409-3578-01,TOBRAMYCIN SULFATE 80 MG/2ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$2.56,$0.00,$0.00,$4.34,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$4.34,$0.00,$4.13,$0.00
39918,ERX,HCPCS J3260,36000-0244-01,TOBRAMYCIN SULFATE 80 MG/2ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$2.56,$0.00,$0.00,$4.34,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$4.34,$0.00,$4.13,$0.00
39918,ERX,HCPCS J3260,36000-0244-25,TOBRAMYCIN SULFATE 80 MG/2ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$2.56,$0.00,$0.00,$4.34,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$4.34,$0.00,$4.13,$0.00
39918,ERX,HCPCS J3260,63323-0306-02,TOBRAMYCIN SULFATE 80 MG/2ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$2.56,$0.00,$0.00,$4.34,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$4.34,$0.00,$4.13,$0.00
39918,ERX,HCPCS J3260,67457-0473-22,TOBRAMYCIN SULFATE 80 MG/2ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$2.56,$0.00,$0.00,$4.34,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$4.34,$0.00,$4.13,$0.00
39975,ERX,HCPCS 63700001,54092-0252-45,LANTHANUM CARBONATE 500 MG PO CHEW,$54.76,$0.00,$54.76,$0.00,$39.08,$0.00,$0.00,$0.00,$0.00,$0.00,$54.76,$0.00,$27.38,$43.37,$43.81,$0.00,$0.00,$0.00,$0.00,$0.00
39975,ERX,HCPCS 63700001,54092-0252-90,LANTHANUM CARBONATE 500 MG PO CHEW,$54.76,$0.00,$54.76,$0.00,$39.08,$0.00,$0.00,$0.00,$0.00,$0.00,$54.76,$0.00,$27.38,$43.37,$43.81,$0.00,$0.00,$0.00,$0.00,$0.00
40055,ERX,HCPCS J9045,00703-4239-01,CARBOPLATIN 600 MG/60ML IV SOLN,$166.32,$0.00,$166.32,$74.84,$118.70,$0.00,$81.08,$0.00,$0.00,$37.93,$166.32,$0.00,$83.16,$131.73,$133.06,$0.00,$37.93,$0.00,$36.11,$0.00
40055,ERX,HCPCS J9045,16729-0295-12,CARBOPLATIN 600 MG/60ML IV SOLN,$166.32,$0.00,$166.32,$74.84,$118.70,$0.00,$81.08,$0.00,$0.00,$37.93,$166.32,$0.00,$83.16,$131.73,$133.06,$0.00,$37.93,$0.00,$36.11,$0.00
40055,ERX,HCPCS J9045,25021-0202-51,CARBOPLATIN 600 MG/60ML IV SOLN,$166.32,$0.00,$166.32,$74.84,$118.70,$0.00,$81.08,$0.00,$0.00,$37.93,$166.32,$0.00,$83.16,$131.73,$133.06,$0.00,$37.93,$0.00,$36.11,$0.00
40055,ERX,HCPCS J9045,25021-0205-51,CARBOPLATIN 600 MG/60ML IV SOLN,$166.32,$0.00,$166.32,$74.84,$118.70,$0.00,$81.08,$0.00,$0.00,$37.93,$166.32,$0.00,$83.16,$131.73,$133.06,$0.00,$37.93,$0.00,$36.11,$0.00
40055,ERX,HCPCS J9045,61703-0339-56,CARBOPLATIN 600 MG/60ML IV SOLN,$166.32,$0.00,$166.32,$74.84,$118.70,$0.00,$81.08,$0.00,$0.00,$37.93,$166.32,$0.00,$83.16,$131.73,$133.06,$0.00,$37.93,$0.00,$36.11,$0.00
40055,ERX,HCPCS J9045,63323-0172-60,CARBOPLATIN 600 MG/60ML IV SOLN,$166.32,$0.00,$166.32,$74.84,$118.70,$0.00,$81.08,$0.00,$0.00,$37.93,$166.32,$0.00,$83.16,$131.73,$133.06,$0.00,$37.93,$0.00,$36.11,$0.00
40055,ERX,HCPCS J9045,71288-0100-51,CARBOPLATIN 600 MG/60ML IV SOLN,$166.32,$0.00,$166.32,$74.84,$118.70,$0.00,$81.08,$0.00,$0.00,$37.93,$166.32,$0.00,$83.16,$131.73,$133.06,$0.00,$37.93,$0.00,$36.11,$0.00
40089,ERX,HCPCS 63700001,50242-0062-01,ERLOTINIB HCL 25 MG PO TABS,$331.89,$0.00,$331.89,$0.00,$236.87,$0.00,$0.00,$0.00,$0.00,$0.00,$331.89,$0.00,$165.95,$262.86,$265.51,$0.00,$0.00,$0.00,$0.00,$0.00
40090,ERX,HCPCS 63700001,50242-0063-01,ERLOTINIB HCL 100 MG PO TABS,$792.04,$0.00,$792.04,$0.00,$565.28,$0.00,$0.00,$0.00,$0.00,$0.00,$792.04,$0.00,$396.02,$627.30,$633.63,$0.00,$0.00,$0.00,$0.00,$0.00
40091,ERX,HCPCS 63700001,50242-0064-01,ERLOTINIB HCL 150 MG PO TABS,$895.85,$0.00,$895.85,$0.00,$639.37,$0.00,$0.00,$0.00,$0.00,$0.00,$895.85,$0.00,$447.93,$709.51,$716.68,$0.00,$0.00,$0.00,$0.00,$0.00
40321,ERX,HCPCS 63700001,00378-5271-01,ESZOPICLONE 2 MG PO TABS,$44.32,$0.00,$44.32,$0.00,$31.63,$0.00,$0.00,$0.00,$0.00,$0.00,$44.32,$0.00,$22.16,$35.10,$35.46,$0.00,$0.00,$0.00,$0.00,$0.00
40369,ERX,HCPCS 25000001,69918-0560-30,MESALAMINE 1000 MG RECTAL SUPP,$70.64,$0.00,$70.64,$0.00,$50.42,$0.00,$0.00,$0.00,$0.00,$0.00,$70.64,$0.00,$35.32,$55.95,$56.51,$0.00,$0.00,$0.00,$0.00,$0.00
40401,ERX,HCPCS 63700001,00004-0244-51,SAQUINAVIR MESYLATE 500 MG PO TABS,$84.12,$0.00,$84.12,$0.00,$60.04,$0.00,$0.00,$0.00,$0.00,$0.00,$84.12,$0.00,$42.06,$66.62,$67.30,$0.00,$0.00,$0.00,$0.00,$0.00
40413,ERX,HCPCS 63600001,66215-0302-00,ILOPROST 10 MCG/ML IN SOLN,$141.44,$0.00,$141.44,$0.00,$100.95,$0.00,$0.00,$0.00,$0.00,$0.00,$141.44,$0.00,$70.72,$112.02,$113.15,$0.00,$0.00,$0.00,$0.00,$0.00
40413,ERX,HCPCS 63600001,66215-0302-30,ILOPROST 10 MCG/ML IN SOLN,$141.44,$0.00,$141.44,$0.00,$100.95,$0.00,$0.00,$0.00,$0.00,$0.00,$141.44,$0.00,$70.72,$112.02,$113.15,$0.00,$0.00,$0.00,$0.00,$0.00
40449,ERX,HCPCS J3471,24208-0002-02,HYALURONIDASE OVINE 200 UNIT/ML IJ SOLN,$244.27,$0.00,$244.27,$109.92,$174.34,$0.00,$17.63,$0.00,$0.00,$42.77,$244.27,$0.00,$122.14,$193.46,$195.42,$0.00,$38.23,$0.00,$38.89,$0.00
40475,ERX,HCPCS J9264,68817-0134-50,NAB-PACLITAXEL 100 MG IV SUSR,"$3,559.40",$0.00,"$3,559.40","$1,601.73","$2,540.34","$1,251.30","$1,065.73",$0.00,$0.00,"$1,474.63","$3,559.40","$1,313.87","$1,779.70","$2,819.04","$2,847.52","$1,814.39","$1,474.63",$0.00,"$1,404.09","$1,326.90"
40540,ERX,HCPCS 90734,49281-0589-05,MENINGOCOCCAL A C Y&W-135 CONJ IM INJ,$469.43,$0.00,$469.43,$211.24,$335.03,$83.56,$9.40,$0.00,$0.00,$143.71,$469.43,$0.00,$234.72,$371.79,$375.54,$281.66,$143.71,$0.00,$136.84,$0.00
40661,ERX,HCPCS J0202,58468-0357-01,ALEMTUZUMAB 30 MG/ML IV SOLN,"$4,341.90",$0.00,"$4,341.90",$0.00,"$3,098.81",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,341.90",$0.00,"$2,170.95","$3,438.78","$3,473.52",$0.00,$0.00,$0.00,$0.00,$0.00
40661,ERX,HCPCS J0202,58468-0357-03,ALEMTUZUMAB 30 MG/ML IV SOLN,"$4,341.90",$0.00,"$4,341.90",$0.00,"$3,098.81",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,341.90",$0.00,"$2,170.95","$3,438.78","$3,473.52",$0.00,$0.00,$0.00,$0.00,$0.00
40697,ERX,HCPCS 25000001,00173-0718-20,FLUTICASONE PROPIONATE HFA 44 MCG/ACT IN AERO,$613.10,$0.00,$613.10,$0.00,$437.57,$0.00,$0.00,$0.00,$0.00,$0.00,$613.10,$0.00,$306.55,$485.58,$490.48,$0.00,$0.00,$0.00,$0.00,$0.00
40698,ERX,HCPCS 25000001,00173-0719-20,FLUTICASONE PROPIONATE HFA 110 MCG/ACT IN AERO,$820.79,$0.00,$820.79,$0.00,$585.80,$0.00,$0.00,$0.00,$0.00,$0.00,$820.79,$0.00,$410.40,$650.07,$656.63,$0.00,$0.00,$0.00,$0.00,$0.00
40699,ERX,HCPCS 25000001,00173-0720-20,FLUTICASONE PROPIONATE HFA 220 MCG/ACT IN AERO,"$1,274.90",$0.00,"$1,274.90",$0.00,$909.90,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,274.90",$0.00,$637.45,"$1,009.72","$1,019.92",$0.00,$0.00,$0.00,$0.00,$0.00
40801,ERX,HCPCS J9217,62935-0453-45,LEUPROLIDE ACETATE (6 MONTH) 45 MG SC KIT,"$6,666.93",$0.00,"$6,666.93","$3,000.12","$4,758.19","$1,348.19","$1,480.99",$0.00,$0.00,"$1,621.99","$6,666.93","$1,415.60","$3,333.47","$5,280.21","$5,333.54","$1,954.87","$1,621.99",$0.00,"$1,544.41","$1,235.32"
40872,ERX,HCPCS J2250,00641-6057-25,MIDAZOLAM HCL 2 MG/2ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.38,$0.00,$0.00,$0.28,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.28,$0.00,$0.27,$0.00
40872,ERX,HCPCS J2250,23155-0600-31,MIDAZOLAM HCL 2 MG/2ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.38,$0.00,$0.00,$0.28,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.28,$0.00,$0.27,$0.00
40872,ERX,HCPCS J2250,23155-0600-41,MIDAZOLAM HCL 2 MG/2ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.38,$0.00,$0.00,$0.28,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.28,$0.00,$0.27,$0.00
40872,ERX,HCPCS J2250,47781-0588-46,MIDAZOLAM HCL 2 MG/2ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.38,$0.00,$0.00,$0.28,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.28,$0.00,$0.27,$0.00
40872,ERX,HCPCS J2250,47781-0588-68,MIDAZOLAM HCL 2 MG/2ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.38,$0.00,$0.00,$0.28,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.28,$0.00,$0.27,$0.00
40872,ERX,HCPCS J2250,70860-0600-02,MIDAZOLAM HCL 2 MG/2ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.38,$0.00,$0.00,$0.28,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.28,$0.00,$0.27,$0.00
40872,ERX,HCPCS J2250,70860-0600-41,MIDAZOLAM HCL 2 MG/2ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.38,$0.00,$0.00,$0.28,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.28,$0.00,$0.27,$0.00
40994,ERX,HCPCS 25000001,00132-0079-12,GLYCERIN (ADULT) 2 G RECTAL SUPP,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
40994,ERX,HCPCS 25000001,00132-0079-24,GLYCERIN (ADULT) 2 G RECTAL SUPP,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
41124,ERX,HCPCS 25000001,62991-2502-01,PHENOL LIQD,$874.50,$0.00,$874.50,$0.00,$624.13,$0.00,$0.00,$0.00,$0.00,$0.00,$874.50,$0.00,$437.25,$692.60,$699.60,$0.00,$0.00,$0.00,$0.00,$0.00
41137,ERX,HCPCS A9577,00270-5164-13,GADOBENATE DIMEGLUMINE 529 MG/ML IV SOLN,$219.87,$0.00,$219.87,$98.94,$156.92,$0.00,$37.88,$0.00,$0.00,$38.50,$219.87,$0.00,$109.94,$174.14,$175.90,$0.00,$34.41,$0.00,$35.00,$0.00
41137,ERX,HCPCS A9577,00270-5164-14,GADOBENATE DIMEGLUMINE 529 MG/ML IV SOLN,$219.87,$0.00,$219.87,$98.94,$156.92,$0.00,$37.88,$0.00,$0.00,$38.50,$219.87,$0.00,$109.94,$174.14,$175.90,$0.00,$34.41,$0.00,$35.00,$0.00
41137,ERX,HCPCS A9577,00270-5164-15,GADOBENATE DIMEGLUMINE 529 MG/ML IV SOLN,$219.87,$0.00,$219.87,$98.94,$156.92,$0.00,$37.88,$0.00,$0.00,$38.50,$219.87,$0.00,$109.94,$174.14,$175.90,$0.00,$34.41,$0.00,$35.00,$0.00
41139,ERX,HCPCS 63700001,10147-0892-03,GALANTAMINE HYDROBROMIDE ER 16 MG PO CP24,$23.20,$0.00,$23.20,$0.00,$16.56,$0.00,$0.00,$0.00,$0.00,$0.00,$23.20,$0.00,$11.60,$18.37,$18.56,$0.00,$0.00,$0.00,$0.00,$0.00
41142,ERX,HCPCS 25000001,00597-0087-17,IPRATROPIUM BROMIDE HFA 17 MCG/ACT IN AERS,"$2,369.62",$0.00,"$2,369.62",$0.00,"$1,691.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,369.62",$0.00,"$1,184.81","$1,876.74","$1,895.70",$0.00,$0.00,$0.00,$0.00,$0.00
41144,ERX,HCPCS J2248,00469-3250-10,MICAFUNGIN SODIUM 50 MG IV SOLR,$342.21,$0.00,$342.21,$0.00,$244.37,$0.00,$0.00,$0.00,$0.00,$0.00,$342.21,$0.00,$171.11,$271.03,$273.77,$0.00,$0.00,$0.00,$0.00,$0.00
41147,ERX,HCPCS 63700001,65162-0446-03,ENTECAVIR 0.5 MG PO TABS,$155.36,$0.00,$155.36,$0.00,$110.88,$0.00,$0.00,$0.00,$0.00,$0.00,$155.36,$0.00,$77.68,$123.05,$124.29,$0.00,$0.00,$0.00,$0.00,$0.00
41147,ERX,HCPCS 63700001,65862-0841-30,ENTECAVIR 0.5 MG PO TABS,$155.36,$0.00,$155.36,$0.00,$110.88,$0.00,$0.00,$0.00,$0.00,$0.00,$155.36,$0.00,$77.68,$123.05,$124.29,$0.00,$0.00,$0.00,$0.00,$0.00
41147,ERX,HCPCS 63700001,68382-0920-06,ENTECAVIR 0.5 MG PO TABS,$155.36,$0.00,$155.36,$0.00,$110.88,$0.00,$0.00,$0.00,$0.00,$0.00,$155.36,$0.00,$77.68,$123.05,$124.29,$0.00,$0.00,$0.00,$0.00,$0.00
41293,ERX,HCPCS 90715,58160-0842-52,TETANUS-DIPHTH-ACELL PERTUSSIS 5-2.5-18.5 LF-MCG/0.5 IM SUSP,$158.70,$0.00,$158.70,$71.42,$113.26,$0.00,$27.34,$0.00,$0.00,$39.53,$158.70,$0.00,$79.35,$125.69,$126.96,$0.00,$39.53,$0.00,$37.64,$0.00
41294,ERX,HCPCS J9185,25021-0242-02,FLUDARABINE PHOSPHATE 50 MG/2ML IV SOLN,$691.65,$0.00,$691.65,$311.24,$493.63,$0.00,$0.00,$0.00,$0.00,$56.27,$691.65,$0.00,$345.83,$547.79,$553.32,$0.00,$0.00,$0.00,$53.58,$0.00
41294,ERX,HCPCS J9185,63323-0192-02,FLUDARABINE PHOSPHATE 50 MG/2ML IV SOLN,$691.65,$0.00,$691.65,$311.24,$493.63,$0.00,$0.00,$0.00,$0.00,$56.27,$691.65,$0.00,$345.83,$547.79,$553.32,$0.00,$0.00,$0.00,$53.58,$0.00
41382,ERX,HCPCS 63700001,00378-9119-98,FENTANYL 12 MCG/HR TD PATCH 72 HR,$71.06,$0.00,$71.06,$0.00,$50.72,$0.00,$0.00,$0.00,$0.00,$0.00,$71.06,$0.00,$35.53,$56.28,$56.85,$0.00,$0.00,$0.00,$0.00,$0.00
41382,ERX,HCPCS 63700001,47781-0423-11,FENTANYL 12 MCG/HR TD PATCH 72 HR,$71.06,$0.00,$71.06,$0.00,$50.72,$0.00,$0.00,$0.00,$0.00,$0.00,$71.06,$0.00,$35.53,$56.28,$56.85,$0.00,$0.00,$0.00,$0.00,$0.00
41382,ERX,HCPCS 63700001,47781-0423-47,FENTANYL 12 MCG/HR TD PATCH 72 HR,$71.06,$0.00,$71.06,$0.00,$50.72,$0.00,$0.00,$0.00,$0.00,$0.00,$71.06,$0.00,$35.53,$56.28,$56.85,$0.00,$0.00,$0.00,$0.00,$0.00
41382,ERX,HCPCS 63700001,60505-7080-02,FENTANYL 12 MCG/HR TD PATCH 72 HR,$71.06,$0.00,$71.06,$0.00,$50.72,$0.00,$0.00,$0.00,$0.00,$0.00,$71.06,$0.00,$35.53,$56.28,$56.85,$0.00,$0.00,$0.00,$0.00,$0.00
41581,ERX,HCPCS J1610,00597-0053-45,GLUCAGON HCL RDNA (DIAGNOSTIC) 1 MG IJ SOLR,$314.03,$0.00,$314.03,$141.31,$224.12,$199.27,$88.07,$0.00,$0.00,$255.63,$314.03,$209.24,$157.02,$248.71,$251.22,$288.94,$255.63,$0.00,$243.41,$199.13
41581,ERX,HCPCS J1610,00597-0260-10,GLUCAGON HCL RDNA (DIAGNOSTIC) 1 MG IJ SOLR,$314.03,$0.00,$314.03,$141.31,$224.12,$199.27,$88.07,$0.00,$0.00,$255.63,$314.03,$209.24,$157.02,$248.71,$251.22,$288.94,$255.63,$0.00,$243.41,$199.13
41623,ERX,HCPCS 25000001,99999-6010-71,LEVOCARNITINE 1 GM/10ML PO SOLN,$44.69,$0.00,$161.90,$0.00,$115.55,$0.00,$0.00,$0.00,$0.00,$0.00,$161.90,$0.00,$80.95,$35.39,$129.52,$0.00,$0.00,$0.00,$0.00,$0.00
41623,ERX,HCPCS 25000001,50383-0171-04,LEVOCARNITINE 1 GM/10ML PO SOLN,$161.90,$0.00,$161.90,$0.00,$115.55,$0.00,$0.00,$0.00,$0.00,$0.00,$161.90,$0.00,$80.95,$128.22,$129.52,$0.00,$0.00,$0.00,$0.00,$0.00
41623,ERX,HCPCS 25000001,54482-0145-08,LEVOCARNITINE 1 GM/10ML PO SOLN,$161.90,$0.00,$161.90,$0.00,$115.55,$0.00,$0.00,$0.00,$0.00,$0.00,$161.90,$0.00,$80.95,$128.22,$129.52,$0.00,$0.00,$0.00,$0.00,$0.00
41623,ERX,HCPCS 25000001,64980-0503-12,LEVOCARNITINE 1 GM/10ML PO SOLN,$161.90,$0.00,$161.90,$0.00,$115.55,$0.00,$0.00,$0.00,$0.00,$0.00,$161.90,$0.00,$80.95,$128.22,$129.52,$0.00,$0.00,$0.00,$0.00,$0.00
41624,ERX,HCPCS J3430,00409-9157-01,VITAMIN K1 1 MG/0.5ML IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
41624,ERX,HCPCS J3430,00409-9157-31,VITAMIN K1 1 MG/0.5ML IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
41624,ERX,HCPCS J3430,00409-9157-50,VITAMIN K1 1 MG/0.5ML IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
41628,ERX,HCPCS 90715,49281-0400-10,TETANUS-DIPHTH-ACELL PERTUSSIS 5-2-15.5 LF-MCG/0.5 IM SUSP,$175.49,$0.00,$175.49,$78.97,$125.25,$0.00,$30.24,$0.00,$0.00,$39.53,$175.49,$0.00,$87.75,$138.99,$140.39,$0.00,$39.53,$0.00,$0.00,$0.00
41628,ERX,HCPCS 90715,49281-0400-58,TETANUS-DIPHTH-ACELL PERTUSSIS 5-2-15.5 LF-MCG/0.5 IM SUSP,$175.49,$0.00,$175.49,$78.97,$125.25,$0.00,$30.24,$0.00,$0.00,$39.53,$175.49,$0.00,$87.75,$138.99,$140.39,$0.00,$39.53,$0.00,$0.00,$0.00
41652,ERX,HCPCS J3243,00781-3481-70,TIGECYCLINE 50 MG IV SOLR,$477.33,$0.00,$477.33,$0.00,$340.67,$0.00,$0.00,$0.00,$0.00,$0.00,$477.33,$0.00,$238.67,$378.05,$381.86,$0.00,$0.00,$0.00,$0.00,$0.00
41652,ERX,HCPCS J3243,00781-3481-92,TIGECYCLINE 50 MG IV SOLR,$477.33,$0.00,$477.33,$0.00,$340.67,$0.00,$0.00,$0.00,$0.00,$0.00,$477.33,$0.00,$238.67,$378.05,$381.86,$0.00,$0.00,$0.00,$0.00,$0.00
41652,ERX,HCPCS J3243,63323-0960-10,TIGECYCLINE 50 MG IV SOLR,$477.33,$0.00,$477.33,$0.00,$340.67,$0.00,$0.00,$0.00,$0.00,$0.00,$477.33,$0.00,$238.67,$378.05,$381.86,$0.00,$0.00,$0.00,$0.00,$0.00
41673,ERX,HCPCS J9390,64370-0532-02,VINORELBINE TARTRATE 50 MG/5ML IV SOLN,$311.10,$0.00,$311.10,$0.00,$222.03,$0.00,$0.00,$0.00,$0.00,$0.00,$311.10,$0.00,$155.55,$246.39,$248.88,$0.00,$0.00,$0.00,$0.00,$0.00
41675,ERX,HCPCS 90378,60574-4113-01,PALIVIZUMAB 100 MG/ML IM SOLN,"$7,307.89",$0.00,"$7,307.89",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,307.89",$0.00,"$3,653.95","$5,787.85","$5,846.31",$0.00,$0.00,$0.00,$0.00,$0.00
41676,ERX,HCPCS 63700001,00597-0003-02,TIPRANAVIR 250 MG PO CAPS,$124.14,$0.00,$124.14,$0.00,$88.60,$0.00,$0.00,$0.00,$0.00,$0.00,$124.14,$0.00,$62.07,$98.32,$99.31,$0.00,$0.00,$0.00,$0.00,$0.00
41793,ERX,HCPCS 25000001,67457-0163-02,SODIUM TETRADECYL SULFATE 3 % IV SOLN,$82.04,$0.00,$80.85,$0.00,$57.70,$0.00,$0.00,$0.00,$0.00,$0.00,$80.85,$0.00,$40.43,$64.98,$64.68,$0.00,$0.00,$0.00,$0.00,$0.00
41822,ERX,HCPCS 63700001,00173-0884-08,OMEGA-3-ACID ETHYL ESTERS 1 G PO CAPS,$22.76,$0.00,$22.76,$0.00,$16.24,$0.00,$0.00,$0.00,$0.00,$0.00,$22.76,$0.00,$11.38,$18.03,$18.21,$0.00,$0.00,$0.00,$0.00,$0.00
41822,ERX,HCPCS 63700001,42291-0657-12,OMEGA-3-ACID ETHYL ESTERS 1 G PO CAPS,$22.76,$0.00,$22.76,$0.00,$16.24,$0.00,$0.00,$0.00,$0.00,$0.00,$22.76,$0.00,$11.38,$18.03,$18.21,$0.00,$0.00,$0.00,$0.00,$0.00
41822,ERX,HCPCS 63700001,60505-3170-07,OMEGA-3-ACID ETHYL ESTERS 1 G PO CAPS,$22.76,$0.00,$22.76,$0.00,$16.24,$0.00,$0.00,$0.00,$0.00,$0.00,$22.76,$0.00,$11.38,$18.03,$18.21,$0.00,$0.00,$0.00,$0.00,$0.00
41828,ERX,HCPCS 25000001,00085-1341-06,MOMETASONE FUROATE 220 MCG/INH IN AEPB,$279.57,$0.00,$279.57,$0.00,$199.53,$0.00,$0.00,$0.00,$0.00,$0.00,$279.57,$0.00,$139.79,$221.42,$223.66,$0.00,$0.00,$0.00,$0.00,$0.00
41828,ERX,HCPCS 25000001,00085-1341-07,MOMETASONE FUROATE 220 MCG/INH IN AEPB,$279.57,$0.00,$279.57,$0.00,$199.53,$0.00,$0.00,$0.00,$0.00,$0.00,$279.57,$0.00,$139.79,$221.42,$223.66,$0.00,$0.00,$0.00,$0.00,$0.00
41831,ERX,HCPCS 25000001,50383-0933-35,LIDOCAINE 5 % EX OINT,$795.00,$0.00,$795.00,$0.00,$567.39,$0.00,$0.00,$0.00,$0.00,$0.00,$795.00,$0.00,$397.50,$629.64,$636.00,$0.00,$0.00,$0.00,$0.00,$0.00
41831,ERX,HCPCS 25000001,52565-0008-14,LIDOCAINE 5 % EX OINT,$795.00,$0.00,$795.00,$0.00,$567.39,$0.00,$0.00,$0.00,$0.00,$0.00,$795.00,$0.00,$397.50,$629.64,$636.00,$0.00,$0.00,$0.00,$0.00,$0.00
41831,ERX,HCPCS 25000001,68462-0418-20,LIDOCAINE 5 % EX OINT,$795.00,$0.00,$795.00,$0.00,$567.39,$0.00,$0.00,$0.00,$0.00,$0.00,$795.00,$0.00,$397.50,$629.64,$636.00,$0.00,$0.00,$0.00,$0.00,$0.00
41832,ERX,HCPCS 63700001,00093-5517-98,SILDENAFIL CITRATE 20 MG PO TABS,$77.17,$0.00,$77.17,$0.00,$55.08,$0.00,$0.00,$0.00,$0.00,$0.00,$77.17,$0.00,$38.59,$61.12,$61.74,$0.00,$0.00,$0.00,$0.00,$0.00
41832,ERX,HCPCS 63700001,52817-0295-90,SILDENAFIL CITRATE 20 MG PO TABS,$77.17,$0.00,$77.17,$0.00,$55.08,$0.00,$0.00,$0.00,$0.00,$0.00,$77.17,$0.00,$38.59,$61.12,$61.74,$0.00,$0.00,$0.00,$0.00,$0.00
41893,ERX,HCPCS 63700001,24338-0010-18,ISOSORB DINITRATE-HYDRALAZINE 20-37.5 MG PO TABS,$16.98,$0.00,$16.98,$0.00,$12.12,$0.00,$0.00,$0.00,$0.00,$0.00,$16.98,$0.00,$8.49,$13.45,$13.58,$0.00,$0.00,$0.00,$0.00,$0.00
41938,ERX,HCPCS 63700001,00054-4538-25,METHADONE HCL 40 MG PO TBSO,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
42064,ERX,HCPCS 63700001,64764-0805-30,RAMELTEON 8 MG PO TABS,$59.14,$0.00,$59.14,$0.00,$42.21,$0.00,$0.00,$0.00,$0.00,$0.00,$59.14,$0.00,$29.57,$46.84,$47.31,$0.00,$0.00,$0.00,$0.00,$0.00
42162,ERX,HCPCS 63700001,00071-1012-68,PREGABALIN 25 MG PO CAPS,$37.33,$0.00,$37.33,$0.00,$26.64,$0.00,$0.00,$0.00,$0.00,$0.00,$37.33,$0.00,$18.67,$29.57,$29.86,$0.00,$0.00,$0.00,$0.00,$0.00
42162,ERX,HCPCS 63700001,50228-0350-90,PREGABALIN 25 MG PO CAPS,$37.33,$0.00,$37.33,$0.00,$26.64,$0.00,$0.00,$0.00,$0.00,$0.00,$37.33,$0.00,$18.67,$29.57,$29.86,$0.00,$0.00,$0.00,$0.00,$0.00
42162,ERX,HCPCS 63700001,62332-0119-90,PREGABALIN 25 MG PO CAPS,$37.33,$0.00,$37.33,$0.00,$26.64,$0.00,$0.00,$0.00,$0.00,$0.00,$37.33,$0.00,$18.67,$29.57,$29.86,$0.00,$0.00,$0.00,$0.00,$0.00
42162,ERX,HCPCS 63700001,76282-0568-90,PREGABALIN 25 MG PO CAPS,$37.33,$0.00,$37.33,$0.00,$26.64,$0.00,$0.00,$0.00,$0.00,$0.00,$37.33,$0.00,$18.67,$29.57,$29.86,$0.00,$0.00,$0.00,$0.00,$0.00
42163,ERX,HCPCS 63700001,00071-1013-41,PREGABALIN 50 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
42163,ERX,HCPCS 63700001,00071-1013-68,PREGABALIN 50 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
42163,ERX,HCPCS 63700001,50228-0351-90,PREGABALIN 50 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
42163,ERX,HCPCS 63700001,60687-0484-01,PREGABALIN 50 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
42163,ERX,HCPCS 63700001,62332-0120-90,PREGABALIN 50 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
42163,ERX,HCPCS 63700001,76282-0569-90,PREGABALIN 50 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
42164,ERX,HCPCS 63700001,00071-1014-41,PREGABALIN 75 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
42164,ERX,HCPCS 63700001,00071-1014-68,PREGABALIN 75 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
42164,ERX,HCPCS 63700001,50228-0352-90,PREGABALIN 75 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
42164,ERX,HCPCS 63700001,62332-0121-90,PREGABALIN 75 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
42164,ERX,HCPCS 63700001,76282-0570-90,PREGABALIN 75 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
42165,ERX,HCPCS 63700001,00071-1015-41,PREGABALIN 100 MG PO CAPS,$41.06,$0.00,$41.06,$0.00,$29.30,$0.00,$0.00,$0.00,$0.00,$0.00,$41.06,$0.00,$20.53,$32.52,$32.85,$0.00,$0.00,$0.00,$0.00,$0.00
42165,ERX,HCPCS 63700001,00904-7001-61,PREGABALIN 100 MG PO CAPS,$41.06,$0.00,$41.06,$0.00,$29.30,$0.00,$0.00,$0.00,$0.00,$0.00,$41.06,$0.00,$20.53,$32.52,$32.85,$0.00,$0.00,$0.00,$0.00,$0.00
42165,ERX,HCPCS 63700001,50228-0353-90,PREGABALIN 100 MG PO CAPS,$41.06,$0.00,$41.06,$0.00,$29.30,$0.00,$0.00,$0.00,$0.00,$0.00,$41.06,$0.00,$20.53,$32.52,$32.85,$0.00,$0.00,$0.00,$0.00,$0.00
42165,ERX,HCPCS 63700001,60687-0506-01,PREGABALIN 100 MG PO CAPS,$41.06,$0.00,$41.06,$0.00,$29.30,$0.00,$0.00,$0.00,$0.00,$0.00,$41.06,$0.00,$20.53,$32.52,$32.85,$0.00,$0.00,$0.00,$0.00,$0.00
42165,ERX,HCPCS 63700001,60687-0506-11,PREGABALIN 100 MG PO CAPS,$41.06,$0.00,$41.06,$0.00,$29.30,$0.00,$0.00,$0.00,$0.00,$0.00,$41.06,$0.00,$20.53,$32.52,$32.85,$0.00,$0.00,$0.00,$0.00,$0.00
42165,ERX,HCPCS 63700001,62332-0122-90,PREGABALIN 100 MG PO CAPS,$41.06,$0.00,$41.06,$0.00,$29.30,$0.00,$0.00,$0.00,$0.00,$0.00,$41.06,$0.00,$20.53,$32.52,$32.85,$0.00,$0.00,$0.00,$0.00,$0.00
42166,ERX,HCPCS 63700001,00071-1016-41,PREGABALIN 150 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
42166,ERX,HCPCS 63700001,00071-1016-68,PREGABALIN 150 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
42166,ERX,HCPCS 63700001,43598-0295-66,PREGABALIN 150 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
42166,ERX,HCPCS 63700001,43598-0295-79,PREGABALIN 150 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
42166,ERX,HCPCS 63700001,50228-0354-90,PREGABALIN 150 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
42166,ERX,HCPCS 63700001,60687-0517-01,PREGABALIN 150 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
42166,ERX,HCPCS 63700001,62332-0123-90,PREGABALIN 150 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
42166,ERX,HCPCS 63700001,72205-0015-90,PREGABALIN 150 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
42167,ERX,HCPCS 63700001,00071-1017-68,PREGABALIN 200 MG PO CAPS,$37.33,$0.00,$37.33,$0.00,$26.64,$0.00,$0.00,$0.00,$0.00,$0.00,$37.33,$0.00,$18.67,$29.57,$29.86,$0.00,$0.00,$0.00,$0.00,$0.00
42167,ERX,HCPCS 63700001,50228-0355-90,PREGABALIN 200 MG PO CAPS,$37.33,$0.00,$37.33,$0.00,$26.64,$0.00,$0.00,$0.00,$0.00,$0.00,$37.33,$0.00,$18.67,$29.57,$29.86,$0.00,$0.00,$0.00,$0.00,$0.00
42167,ERX,HCPCS 63700001,62332-0124-90,PREGABALIN 200 MG PO CAPS,$37.33,$0.00,$37.33,$0.00,$26.64,$0.00,$0.00,$0.00,$0.00,$0.00,$37.33,$0.00,$18.67,$29.57,$29.86,$0.00,$0.00,$0.00,$0.00,$0.00
42168,ERX,HCPCS 63700001,50228-0356-90,PREGABALIN 225 MG PO CAPS,$22.24,$0.00,$22.24,$0.00,$15.87,$0.00,$0.00,$0.00,$0.00,$0.00,$22.24,$0.00,$11.12,$17.61,$17.79,$0.00,$0.00,$0.00,$0.00,$0.00
42168,ERX,HCPCS 63700001,62332-0125-90,PREGABALIN 225 MG PO CAPS,$22.24,$0.00,$22.24,$0.00,$15.87,$0.00,$0.00,$0.00,$0.00,$0.00,$22.24,$0.00,$11.12,$17.61,$17.79,$0.00,$0.00,$0.00,$0.00,$0.00
42169,ERX,HCPCS 63700001,00071-1018-68,PREGABALIN 300 MG PO CAPS,$37.33,$0.00,$37.33,$0.00,$26.64,$0.00,$0.00,$0.00,$0.00,$0.00,$37.33,$0.00,$18.67,$29.57,$29.86,$0.00,$0.00,$0.00,$0.00,$0.00
42169,ERX,HCPCS 63700001,50228-0357-90,PREGABALIN 300 MG PO CAPS,$37.33,$0.00,$37.33,$0.00,$26.64,$0.00,$0.00,$0.00,$0.00,$0.00,$37.33,$0.00,$18.67,$29.57,$29.86,$0.00,$0.00,$0.00,$0.00,$0.00
42169,ERX,HCPCS 63700001,62332-0126-90,PREGABALIN 300 MG PO CAPS,$37.33,$0.00,$37.33,$0.00,$26.64,$0.00,$0.00,$0.00,$0.00,$0.00,$37.33,$0.00,$18.67,$29.57,$29.86,$0.00,$0.00,$0.00,$0.00,$0.00
42219,ERX,HCPCS 63700001,00904-6836-20,LOPERAMIDE HCL 1 MG/7.5ML PO LIQD,$11.00,$0.00,$11.00,$0.00,$7.85,$0.00,$0.00,$0.00,$0.00,$0.00,$11.00,$0.00,$5.50,$8.71,$8.80,$0.00,$0.00,$0.00,$0.00,$0.00
42219,ERX,HCPCS 63700001,70677-0054-01,LOPERAMIDE HCL 1 MG/7.5ML PO LIQD,$11.00,$0.00,$11.00,$0.00,$7.85,$0.00,$0.00,$0.00,$0.00,$0.00,$11.00,$0.00,$5.50,$8.71,$8.80,$0.00,$0.00,$0.00,$0.00,$0.00
42918,ERX,HCPCS 63700001,99999-6005-12,ZIDOVUDINE 50 MG/5ML PO SYRP,$101.22,$0.00,$101.22,$0.00,$72.24,$0.00,$0.00,$0.00,$0.00,$0.00,$101.22,$0.00,$50.61,$80.17,$80.98,$0.00,$0.00,$0.00,$0.00,$0.00
42918,ERX,HCPCS 63700001,65862-0048-24,ZIDOVUDINE 50 MG/5ML PO SYRP,$182.20,$0.00,$144.30,$0.00,$72.24,$0.00,$0.00,$0.00,$0.00,$0.00,$101.22,$0.00,$50.61,$144.30,$80.98,$0.00,$0.00,$0.00,$0.00,$0.00
42939,ERX,HCPCS 25000001,65628-0063-01,PROGESTERONE 200 MG VA SUPP,$25.84,$0.00,$25.84,$0.00,$18.44,$0.00,$0.00,$0.00,$0.00,$0.00,$25.84,$0.00,$12.92,$20.47,$20.67,$0.00,$0.00,$0.00,$0.00,$0.00
43010,ERX,HCPCS 63700001,00904-5313-46,PRENATAL 27-0.8 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
43010,ERX,HCPCS 63700001,00904-5313-60,PRENATAL 27-0.8 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
43230,ERX,HCPCS 63700001,13668-0117-30,LOSARTAN-HCTZ 100-12.5 MG PO TABS,$12.96,$0.00,$12.96,$0.00,$9.25,$0.00,$0.00,$0.00,$0.00,$0.00,$12.96,$0.00,$6.48,$10.26,$10.37,$0.00,$0.00,$0.00,$0.00,$0.00
43230,ERX,HCPCS 63700001,13668-0117-90,LOSARTAN-HCTZ 100-12.5 MG PO TABS,$12.96,$0.00,$12.96,$0.00,$9.25,$0.00,$0.00,$0.00,$0.00,$0.00,$12.96,$0.00,$6.48,$10.26,$10.37,$0.00,$0.00,$0.00,$0.00,$0.00
43230,ERX,HCPCS 63700001,16714-0224-01,LOSARTAN-HCTZ 100-12.5 MG PO TABS,$12.96,$0.00,$12.96,$0.00,$9.25,$0.00,$0.00,$0.00,$0.00,$0.00,$12.96,$0.00,$6.48,$10.26,$10.37,$0.00,$0.00,$0.00,$0.00,$0.00
43230,ERX,HCPCS 63700001,16714-0224-02,LOSARTAN-HCTZ 100-12.5 MG PO TABS,$12.96,$0.00,$12.96,$0.00,$9.25,$0.00,$0.00,$0.00,$0.00,$0.00,$12.96,$0.00,$6.48,$10.26,$10.37,$0.00,$0.00,$0.00,$0.00,$0.00
43230,ERX,HCPCS 63700001,62332-0049-90,LOSARTAN-HCTZ 100-12.5 MG PO TABS,$12.96,$0.00,$12.96,$0.00,$9.25,$0.00,$0.00,$0.00,$0.00,$0.00,$12.96,$0.00,$6.48,$10.26,$10.37,$0.00,$0.00,$0.00,$0.00,$0.00
43391,ERX,HCPCS 63700001,00074-6799-22,KALETRA:LOPINAVIR-RITONAVIR 200-50 MG PO TABS,$71.69,$0.00,$71.69,$0.00,$51.17,$0.00,$0.00,$0.00,$0.00,$0.00,$71.69,$0.00,$35.85,$56.78,$57.35,$0.00,$0.00,$0.00,$0.00,$0.00
43416,ERX,HCPCS 63700001,00078-0469-15,DEFERASIROX 250 MG PO TBSO,$309.11,$0.00,$309.11,$0.00,$220.61,$0.00,$0.00,$0.00,$0.00,$0.00,$309.11,$0.00,$154.56,$244.82,$247.29,$0.00,$0.00,$0.00,$0.00,$0.00
43417,ERX,HCPCS 63700001,00078-0470-15,DEFERASIROX 500 MG PO TBSO,$537.13,$0.00,$537.13,$0.00,$383.35,$0.00,$0.00,$0.00,$0.00,$0.00,$537.13,$0.00,$268.57,$425.41,$429.70,$0.00,$0.00,$0.00,$0.00,$0.00
43472,ERX,HCPCS 25000001,63402-0510-01,LEVALBUTEROL TARTRATE 45 MCG/ACT IN AERO,$257.94,$0.00,$257.94,$0.00,$184.09,$0.00,$0.00,$0.00,$0.00,$0.00,$257.94,$0.00,$128.97,$204.29,$206.35,$0.00,$0.00,$0.00,$0.00,$0.00
43548,ERX,HCPCS 63700001,54092-0254-10,LANTHANUM CARBONATE 1000 MG PO CHEW,$54.76,$0.00,$54.76,$0.00,$39.08,$0.00,$0.00,$0.00,$0.00,$0.00,$54.76,$0.00,$27.38,$43.37,$43.81,$0.00,$0.00,$0.00,$0.00,$0.00
43548,ERX,HCPCS 63700001,54092-0254-90,LANTHANUM CARBONATE 1000 MG PO CHEW,$54.76,$0.00,$54.76,$0.00,$39.08,$0.00,$0.00,$0.00,$0.00,$0.00,$54.76,$0.00,$27.38,$43.37,$43.81,$0.00,$0.00,$0.00,$0.00,$0.00
43556,ERX,HCPCS 63700001,00054-0057-46,DIGOXIN 0.05 MG/ML PO SOLN,$512.40,$0.00,$512.40,$0.00,$365.70,$0.00,$0.00,$0.00,$0.00,$0.00,$512.40,$0.00,$256.20,$405.82,$409.92,$0.00,$0.00,$0.00,$0.00,$0.00
43675,ERX,HCPCS 63700001,50419-0488-58,SORAFENIB TOSYLATE 200 MG PO TABS,"$1,059.01",$0.00,"$1,059.01",$0.00,$755.82,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,059.01",$0.00,$529.51,$838.74,$847.21,$0.00,$0.00,$0.00,$0.00,$0.00
43718,ERX,HCPCS 63700001,59572-0405-00,LENALIDOMIDE 5 MG PO CAPS,"$2,197.47",$0.00,"$2,197.47",$0.00,"$1,568.33",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,197.47",$0.00,"$1,098.74","$1,740.40","$1,757.98",$0.00,$0.00,$0.00,$0.00,$0.00
43718,ERX,HCPCS 63700001,59572-0405-28,LENALIDOMIDE 5 MG PO CAPS,"$2,197.47",$0.00,"$2,197.47",$0.00,"$1,568.33",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,197.47",$0.00,"$1,098.74","$1,740.40","$1,757.98",$0.00,$0.00,$0.00,$0.00,$0.00
43719,ERX,HCPCS 63700001,59572-0410-00,LENALIDOMIDE 10 MG PO CAPS,"$2,197.47",$0.00,"$2,197.47",$0.00,"$1,568.33",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,197.47",$0.00,"$1,098.74","$1,740.40","$1,757.98",$0.00,$0.00,$0.00,$0.00,$0.00
43719,ERX,HCPCS 63700001,59572-0410-28,LENALIDOMIDE 10 MG PO CAPS,"$2,197.47",$0.00,"$2,197.47",$0.00,"$1,568.33",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,197.47",$0.00,"$1,098.74","$1,740.40","$1,757.98",$0.00,$0.00,$0.00,$0.00,$0.00
70257,ERX,HCPCS 63700001,49884-0402-91,RISPERIDONE 3 MG PO TBDP,$44.77,$0.00,$44.77,$0.00,$31.95,$0.00,$0.00,$0.00,$0.00,$0.00,$44.77,$0.00,$22.39,$35.46,$35.82,$0.00,$0.00,$0.00,$0.00,$0.00
70261,ERX,HCPCS J1815,00169-3687-12,INSULIN DETEMIR (LEVEMIR) 100 UNIT/ML SC SOLN,$15.00,$0.00,$201.38,$8.15,$10.71,$0.00,$72.85,$0.00,$0.00,$2.63,$15.00,$0.00,$7.50,$11.88,$12.00,$0.00,$0.00,$0.00,$201.38,$0.00
70267,ERX,HCPCS J9261,00078-0683-06,NELARABINE 5 MG/ML IV SOLN,"$2,117.88",$0.00,"$2,117.88",$0.00,"$1,511.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,117.88",$0.00,"$1,058.94","$1,677.36","$1,694.30",$0.00,$0.00,$0.00,$0.00,$0.00
70284,ERX,HCPCS 63700001,60258-0006-01,K & NA PHOSPHATES 280-160-250 MG PO PACK,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
70306,ERX,HCPCS 63700001,13668-0216-30,ARIPIPRAZOLE 2 MG PO TABS,$111.06,$0.00,$111.06,$0.00,$79.26,$0.00,$0.00,$0.00,$0.00,$0.00,$111.06,$0.00,$55.53,$87.96,$88.85,$0.00,$0.00,$0.00,$0.00,$0.00
70306,ERX,HCPCS 63700001,16714-0783-01,ARIPIPRAZOLE 2 MG PO TABS,$111.06,$0.00,$111.06,$0.00,$79.26,$0.00,$0.00,$0.00,$0.00,$0.00,$111.06,$0.00,$55.53,$87.96,$88.85,$0.00,$0.00,$0.00,$0.00,$0.00
70306,ERX,HCPCS 63700001,65862-0661-30,ARIPIPRAZOLE 2 MG PO TABS,$111.06,$0.00,$111.06,$0.00,$79.26,$0.00,$0.00,$0.00,$0.00,$0.00,$111.06,$0.00,$55.53,$87.96,$88.85,$0.00,$0.00,$0.00,$0.00,$0.00
70324,ERX,HCPCS 63700001,00093-4405-93,CLOZAPINE 200 MG PO TABS,$24.75,$0.00,$24.75,$0.00,$17.66,$0.00,$0.00,$0.00,$0.00,$0.00,$24.75,$0.00,$12.38,$19.60,$19.80,$0.00,$0.00,$0.00,$0.00,$0.00
70397,ERX,HCPCS 63700001,00904-6639-61,QUETIAPINE FUMARATE 50 MG PO TABS,$23.52,$0.00,$23.52,$0.00,$16.79,$0.00,$0.00,$0.00,$0.00,$0.00,$23.52,$0.00,$11.76,$18.63,$18.82,$0.00,$0.00,$0.00,$0.00,$0.00
70397,ERX,HCPCS 63700001,50268-0631-15,QUETIAPINE FUMARATE 50 MG PO TABS,$23.52,$0.00,$23.52,$0.00,$16.79,$0.00,$0.00,$0.00,$0.00,$0.00,$23.52,$0.00,$11.76,$18.63,$18.82,$0.00,$0.00,$0.00,$0.00,$0.00
70397,ERX,HCPCS 63700001,60687-0338-01,QUETIAPINE FUMARATE 50 MG PO TABS,$23.52,$0.00,$23.52,$0.00,$16.79,$0.00,$0.00,$0.00,$0.00,$0.00,$23.52,$0.00,$11.76,$18.63,$18.82,$0.00,$0.00,$0.00,$0.00,$0.00
70398,ERX,HCPCS 63700001,16714-0457-01,QUETIAPINE FUMARATE 400 MG PO TABS,$75.76,$0.00,$75.76,$0.00,$54.07,$0.00,$0.00,$0.00,$0.00,$0.00,$75.76,$0.00,$37.88,$60.00,$60.61,$0.00,$0.00,$0.00,$0.00,$0.00
70405,ERX,HCPCS J7187,63833-0616-02,ANTIHEMOPHILIC FACTOR-VWF 500-1200 UNITS IV SOLR,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
70424,ERX,HCPCS 63700001,00069-0550-38,SUNITINIB MALATE 12.5 MG PO CAPS,$612.06,$0.00,$612.06,$0.00,$436.83,$0.00,$0.00,$0.00,$0.00,$0.00,$612.06,$0.00,$306.03,$484.75,$489.65,$0.00,$0.00,$0.00,$0.00,$0.00
70425,ERX,HCPCS 63700001,00069-0770-38,SUNITINIB MALATE 25 MG PO CAPS,"$1,224.12",$0.00,"$1,224.12",$0.00,$873.65,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,224.12",$0.00,$612.06,$969.50,$979.30,$0.00,$0.00,$0.00,$0.00,$0.00
70426,ERX,HCPCS 63700001,00069-0980-38,SUNITINIB MALATE 50 MG PO CAPS,"$1,929.98",$0.00,"$1,929.98",$0.00,"$1,377.43",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,929.98",$0.00,$964.99,"$1,528.54","$1,543.98",$0.00,$0.00,$0.00,$0.00,$0.00
70434,ERX,HCPCS 63700001,50228-0423-60,RANOLAZINE ER 500 MG PO TB12,$29.82,$0.00,$29.82,$0.00,$21.28,$0.00,$0.00,$0.00,$0.00,$0.00,$29.82,$0.00,$14.91,$23.62,$23.86,$0.00,$0.00,$0.00,$0.00,$0.00
70434,ERX,HCPCS 63700001,61958-1003-01,RANOLAZINE ER 500 MG PO TB12,$29.82,$0.00,$29.82,$0.00,$21.28,$0.00,$0.00,$0.00,$0.00,$0.00,$29.82,$0.00,$14.91,$23.62,$23.86,$0.00,$0.00,$0.00,$0.00,$0.00
70472,ERX,HCPCS 63700001,64764-0240-60,LUBIPROSTONE 24 MCG PO CAPS,$28.21,$0.00,$28.21,$0.00,$20.13,$0.00,$0.00,$0.00,$0.00,$0.00,$28.21,$0.00,$14.11,$22.34,$22.57,$0.00,$0.00,$0.00,$0.00,$0.00
70536,ERX,HCPCS 25000001,00054-3270-99,FLUTICASONE PROPIONATE 50 MCG/ACT NA SUSP,$268.59,$0.00,$268.59,$0.00,$191.69,$0.00,$0.00,$0.00,$0.00,$0.00,$268.59,$0.00,$134.30,$212.72,$214.87,$0.00,$0.00,$0.00,$0.00,$0.00
70536,ERX,HCPCS 25000001,50383-0700-16,FLUTICASONE PROPIONATE 50 MCG/ACT NA SUSP,$268.59,$0.00,$268.59,$0.00,$191.69,$0.00,$0.00,$0.00,$0.00,$0.00,$268.59,$0.00,$134.30,$212.72,$214.87,$0.00,$0.00,$0.00,$0.00,$0.00
70536,ERX,HCPCS 25000001,60432-0264-15,FLUTICASONE PROPIONATE 50 MCG/ACT NA SUSP,$268.59,$0.00,$268.59,$0.00,$191.69,$0.00,$0.00,$0.00,$0.00,$0.00,$268.59,$0.00,$134.30,$212.72,$214.87,$0.00,$0.00,$0.00,$0.00,$0.00
70536,ERX,HCPCS 25000001,60505-0829-01,FLUTICASONE PROPIONATE 50 MCG/ACT NA SUSP,$268.59,$0.00,$268.59,$0.00,$191.69,$0.00,$0.00,$0.00,$0.00,$0.00,$268.59,$0.00,$134.30,$212.72,$214.87,$0.00,$0.00,$0.00,$0.00,$0.00
70545,ERX,HCPCS 25000001,42023-0105-01,METHOHEXITAL SODIUM 0.5 G IJ SOLR,$294.59,$0.00,$294.59,$0.00,$210.25,$0.00,$0.00,$0.00,$0.00,$0.00,$294.59,$0.00,$147.30,$233.32,$235.67,$0.00,$0.00,$0.00,$0.00,$0.00
70678,ERX,HCPCS 25000001,39822-1201-02,NEOMYCIN-POLYMYXIN B GU 40-200000 IR SOLN,$167.36,$0.00,$167.36,$0.00,$119.44,$0.00,$0.00,$0.00,$0.00,$0.00,$167.36,$0.00,$83.68,$132.55,$133.89,$0.00,$0.00,$0.00,$0.00,$0.00
70693,ERX,HCPCS 25000001,00002-7511-01,HUMALOG MIX 75-25 VIAL,$905.35,$0.00,$905.35,$0.00,$646.15,$0.00,$0.00,$0.00,$0.00,$0.00,$905.35,$0.00,$452.68,$717.04,$724.28,$0.00,$0.00,$0.00,$0.00,$0.00
70773,ERX,HCPCS 63700001,16714-0357-01,LEVETIRACETAM 1000 MG PO TABS,$6.39,$0.00,$21.62,$0.00,$21.62,$0.00,$0.00,$0.00,$0.00,$0.00,$6.39,$0.00,$3.20,$5.06,$5.11,$0.00,$0.00,$0.00,$0.00,$0.00
70773,ERX,HCPCS 63700001,16729-0067-12,LEVETIRACETAM 1000 MG PO TABS,$6.39,$0.00,$21.62,$0.00,$21.62,$0.00,$0.00,$0.00,$0.00,$0.00,$6.39,$0.00,$3.20,$5.06,$5.11,$0.00,$0.00,$0.00,$0.00,$0.00
70773,ERX,HCPCS 63700001,31722-0539-60,LEVETIRACETAM 1000 MG PO TABS,$6.39,$0.00,$21.62,$0.00,$21.62,$0.00,$0.00,$0.00,$0.00,$0.00,$6.39,$0.00,$3.20,$5.06,$5.11,$0.00,$0.00,$0.00,$0.00,$0.00
70773,ERX,HCPCS 63700001,68084-0893-01,LEVETIRACETAM 1000 MG PO TABS,$6.39,$0.00,$21.62,$0.00,$21.62,$0.00,$0.00,$0.00,$0.00,$0.00,$6.39,$0.00,$3.20,$5.06,$5.11,$0.00,$0.00,$0.00,$0.00,$0.00
70773,ERX,HCPCS 63700001,68180-0115-07,LEVETIRACETAM 1000 MG PO TABS,$6.39,$0.00,$21.62,$0.00,$21.62,$0.00,$0.00,$0.00,$0.00,$0.00,$6.39,$0.00,$3.20,$5.06,$5.11,$0.00,$0.00,$0.00,$0.00,$0.00
70784,ERX,HCPCS 63700001,50419-0405-03,DROSPIRENONE-ETHINYL ESTRADIOL 3-0.02 MG PO TABS,$552.80,$0.00,$552.80,$0.00,$394.53,$0.00,$0.00,$0.00,$0.00,$0.00,$552.80,$0.00,$276.40,$437.82,$442.24,$0.00,$0.00,$0.00,$0.00,$0.00
76364,ERX,HCPCS J0894,16714-0749-01,DECITABINE 50 MG IV SOLR,"$2,976.60",$0.00,"$2,976.60","$1,339.47","$2,124.40",$374.25,$512.85,$0.00,$0.00,$252.63,"$2,976.60",$392.96,"$1,488.30","$2,357.47","$2,381.28",$542.66,$252.63,$0.00,$240.54,$214.05
76364,ERX,HCPCS J0894,16729-0224-05,DECITABINE 50 MG IV SOLR,"$2,976.60",$0.00,"$2,976.60","$1,339.47","$2,124.40",$374.25,$512.85,$0.00,$0.00,$252.63,"$2,976.60",$392.96,"$1,488.30","$2,357.47","$2,381.28",$542.66,$252.63,$0.00,$240.54,$214.05
76364,ERX,HCPCS J0894,25021-0231-20,DECITABINE 50 MG IV SOLR,"$2,976.60",$0.00,"$2,976.60","$1,339.47","$2,124.40",$374.25,$512.85,$0.00,$0.00,$252.63,"$2,976.60",$392.96,"$1,488.30","$2,357.47","$2,381.28",$542.66,$252.63,$0.00,$240.54,$214.05
76364,ERX,HCPCS J0894,47335-0361-41,DECITABINE 50 MG IV SOLR,"$2,976.60",$0.00,"$2,976.60","$1,339.47","$2,124.40",$374.25,$512.85,$0.00,$0.00,$252.63,"$2,976.60",$392.96,"$1,488.30","$2,357.47","$2,381.28",$542.66,$252.63,$0.00,$240.54,$214.05
76364,ERX,HCPCS J0894,55111-0556-10,DECITABINE 50 MG IV SOLR,"$2,976.60",$0.00,"$2,976.60","$1,339.47","$2,124.40",$374.25,$512.85,$0.00,$0.00,$252.63,"$2,976.60",$392.96,"$1,488.30","$2,357.47","$2,381.28",$542.66,$252.63,$0.00,$240.54,$214.05
76396,ERX,HCPCS 25000001,68968-5555-03,METHYLPHENIDATE 30 MG/9HR TD PTCH,$60.25,$0.00,$60.25,$0.00,$43.00,$0.00,$0.00,$0.00,$0.00,$0.00,$60.25,$0.00,$30.13,$47.72,$48.20,$0.00,$0.00,$0.00,$0.00,$0.00
76437,ERX,HCPCS 63700001,55111-0587-01,AMLODIPINE-BENAZEPRIL 5-40 MG PO CAPSULE,$15.24,$0.00,$15.24,$0.00,$10.88,$0.00,$0.00,$0.00,$0.00,$0.00,$15.24,$0.00,$7.62,$12.07,$12.19,$0.00,$0.00,$0.00,$0.00,$0.00
76437,ERX,HCPCS 63700001,65862-0585-01,AMLODIPINE-BENAZEPRIL 5-40 MG PO CAPSULE,$15.24,$0.00,$15.24,$0.00,$10.88,$0.00,$0.00,$0.00,$0.00,$0.00,$15.24,$0.00,$7.62,$12.07,$12.19,$0.00,$0.00,$0.00,$0.00,$0.00
76438,ERX,HCPCS 63700001,55111-0586-01,AMLODIPINE-BENAZEPRIL HCL 10-40 MG PO CAPS,$18.40,$0.00,$18.40,$0.00,$13.13,$0.00,$0.00,$0.00,$0.00,$0.00,$18.40,$0.00,$9.20,$14.57,$14.72,$0.00,$0.00,$0.00,$0.00,$0.00
76438,ERX,HCPCS 63700001,65862-0587-01,AMLODIPINE-BENAZEPRIL HCL 10-40 MG PO CAPS,$18.40,$0.00,$18.40,$0.00,$13.13,$0.00,$0.00,$0.00,$0.00,$0.00,$18.40,$0.00,$9.20,$14.57,$14.72,$0.00,$0.00,$0.00,$0.00,$0.00
76444,ERX,HCPCS 63700001,00069-0468-56,VARENICLINE TARTRATE 0.5 MG PO TABS,$36.03,$0.00,$36.03,$0.00,$25.71,$0.00,$0.00,$0.00,$0.00,$0.00,$36.03,$0.00,$18.02,$28.54,$28.82,$0.00,$0.00,$0.00,$0.00,$0.00
76445,ERX,HCPCS 63700001,00069-0469-56,VARENICLINE TARTRATE 1 MG PO TABS,$36.03,$0.00,$36.03,$0.00,$25.71,$0.00,$0.00,$0.00,$0.00,$0.00,$36.03,$0.00,$18.02,$28.54,$28.82,$0.00,$0.00,$0.00,$0.00,$0.00
76446,ERX,HCPCS 63700001,00069-0471-03,VARENICLINE STARTING 0.5 MG X 11 & 1 MG X 42 PO MISC,$38.07,$0.00,$38.07,$0.00,$27.17,$0.00,$0.00,$0.00,$0.00,$0.00,$38.07,$0.00,$19.04,$30.15,$30.46,$0.00,$0.00,$0.00,$0.00,$0.00
76472,ERX,HCPCS 25000001,49348-0636-34,LORATADINE 5 MG/5ML PO SYRP,$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
76472,ERX,HCPCS 25000001,51672-2073-08,LORATADINE 5 MG/5ML PO SYRP,$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
76618,ERX,HCPCS 25000001,00065-0356-10,OPTI-FREE REPLENISH SOLN,$36.48,$0.00,$36.48,$0.00,$26.04,$0.00,$0.00,$0.00,$0.00,$0.00,$36.48,$0.00,$18.24,$28.89,$29.18,$0.00,$0.00,$0.00,$0.00,$0.00
76641,ERX,HCPCS 25000001,24208-0539-20,ACETYLCHOLINE CHLORIDE 20 MG IO SOLR,$380.10,$0.00,$380.10,$0.00,$271.28,$0.00,$0.00,$0.00,$0.00,$0.00,$380.10,$0.00,$190.05,$301.04,$304.08,$0.00,$0.00,$0.00,$0.00,$0.00
76717,ERX,HCPCS 63700001,00003-0527-11,DASATINIB 20 MG PO TABS,"$1,545.53",$0.00,"$1,545.53",$0.00,"$1,103.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,545.53",$0.00,$772.77,"$1,224.06","$1,236.42",$0.00,$0.00,$0.00,$0.00,$0.00
76718,ERX,HCPCS 63700001,00003-0528-11,DASATINIB 50 MG PO TABS,"$1,545.52",$0.00,"$1,545.52",$0.00,"$1,103.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,545.52",$0.00,$772.76,"$1,224.05","$1,236.42",$0.00,$0.00,$0.00,$0.00,$0.00
76719,ERX,HCPCS 63700001,00003-0524-11,DASATINIB 70 MG PO TABS,$853.26,$0.00,$853.26,$0.00,$608.97,$0.00,$0.00,$0.00,$0.00,$0.00,$853.26,$0.00,$426.63,$675.78,$682.61,$0.00,$0.00,$0.00,$0.00,$0.00
76780,ERX,HCPCS 25000001,66993-0490-36,IBUPROFEN LYSINE 10 MG/ML IV SOLN,"$1,313.97",$0.00,"$1,313.97",$0.00,$937.78,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,313.97",$0.00,$656.99,"$1,040.66","$1,051.18",$0.00,$0.00,$0.00,$0.00,$0.00
76783,ERX,HCPCS 63700001,59572-0415-21,LENALIDOMIDE 15 MG PO CAPS,"$2,197.47",$0.00,"$2,197.47",$0.00,"$1,568.33",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,197.47",$0.00,"$1,098.74","$1,740.40","$1,757.98",$0.00,$0.00,$0.00,$0.00,$0.00
76784,ERX,HCPCS 63700001,59572-0425-00,LENALIDOMIDE 25 MG PO CAPS,"$2,197.47",$0.00,"$2,197.47",$0.00,"$1,568.33",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,197.47",$0.00,"$1,098.74","$1,740.40","$1,757.98",$0.00,$0.00,$0.00,$0.00,$0.00
76784,ERX,HCPCS 63700001,59572-0425-21,LENALIDOMIDE 25 MG PO CAPS,"$2,197.47",$0.00,"$2,197.47",$0.00,"$1,568.33",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,197.47",$0.00,"$1,098.74","$1,740.40","$1,757.98",$0.00,$0.00,$0.00,$0.00,$0.00
76829,ERX,HCPCS 63700001,00121-1744-00,GUAIFENESIN 100 MG/5ML PO SOLN,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
76829,ERX,HCPCS 63700001,00121-1744-05,GUAIFENESIN 100 MG/5ML PO SOLN,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
76829,ERX,HCPCS 63700001,99999-6007-12,GUAIFENESIN 100 MG/5ML PO SOLN,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
76835,ERX,HCPCS 63700001,15584-0101-01,ATRIPLA:EFAVIRENZ-EMTRICITAB-TENOFOV 600-200-300MGTAB,$365.36,$0.00,$365.36,$0.00,$260.76,$0.00,$0.00,$0.00,$0.00,$0.00,$365.36,$0.00,$182.68,$289.37,$292.29,$0.00,$0.00,$0.00,$0.00,$0.00
76843,ERX,HCPCS J8501,00006-0464-05,APREPITANT 40 MG PO CAPS,$432.04,$0.00,$432.04,$194.42,$308.35,$0.00,$62.51,$0.00,$0.00,$75.65,$432.04,$0.00,$216.02,$342.18,$345.63,$0.00,$67.61,$0.00,$0.00,$0.00
76843,ERX,HCPCS J8501,00781-2321-06,APREPITANT 40 MG PO CAPS,$432.04,$0.00,$432.04,$194.42,$308.35,$0.00,$62.51,$0.00,$0.00,$75.65,$432.04,$0.00,$216.02,$342.18,$345.63,$0.00,$67.61,$0.00,$0.00,$0.00
76843,ERX,HCPCS J8501,00781-2321-51,APREPITANT 40 MG PO CAPS,$432.04,$0.00,$432.04,$194.42,$308.35,$0.00,$62.51,$0.00,$0.00,$75.65,$432.04,$0.00,$216.02,$342.18,$345.63,$0.00,$67.61,$0.00,$0.00,$0.00
76843,ERX,HCPCS J8501,68462-0583-40,APREPITANT 40 MG PO CAPS,$432.04,$0.00,$432.04,$194.42,$308.35,$0.00,$62.51,$0.00,$0.00,$75.65,$432.04,$0.00,$216.02,$342.18,$345.63,$0.00,$67.61,$0.00,$0.00,$0.00
76843,ERX,HCPCS J8501,68462-0583-85,APREPITANT 40 MG PO CAPS,$432.04,$0.00,$432.04,$194.42,$308.35,$0.00,$62.51,$0.00,$0.00,$75.65,$432.04,$0.00,$216.02,$342.18,$345.63,$0.00,$67.61,$0.00,$0.00,$0.00
76913,ERX,HCPCS 25000001,00121-1680-16,KCL 20 MEQ/15ML (10%) PO SOLN,$6.00,$0.00,$70.68,$0.00,$50.44,$0.00,$0.00,$0.00,$0.00,$0.00,$70.68,$0.00,$35.34,$4.75,$56.54,$0.00,$0.00,$0.00,$0.00,$0.00
76913,ERX,HCPCS 25000001,00603-1542-58,KCL 20 MEQ/15ML (10%) PO SOLN,$6.00,$0.00,$70.68,$0.00,$50.44,$0.00,$0.00,$0.00,$0.00,$0.00,$70.68,$0.00,$35.34,$4.75,$56.54,$0.00,$0.00,$0.00,$0.00,$0.00
76913,ERX,HCPCS 25000001,43386-0168-01,KCL 20 MEQ/15ML (10%) PO SOLN,$6.00,$0.00,$70.68,$0.00,$50.44,$0.00,$0.00,$0.00,$0.00,$0.00,$70.68,$0.00,$35.34,$4.75,$56.54,$0.00,$0.00,$0.00,$0.00,$0.00
76913,ERX,HCPCS 25000001,66689-0047-50,KCL 20 MEQ/15ML (10%) PO SOLN,$6.00,$0.00,$70.68,$0.00,$50.44,$0.00,$0.00,$0.00,$0.00,$0.00,$70.68,$0.00,$35.34,$4.75,$56.54,$0.00,$0.00,$0.00,$0.00,$0.00
76913,ERX,HCPCS 25000001,99999-6006-99,KCL 20 MEQ/15ML (10%) PO SOLN,$6.00,$0.00,$70.68,$0.00,$50.44,$0.00,$0.00,$0.00,$0.00,$0.00,$70.68,$0.00,$35.34,$4.75,$56.54,$0.00,$0.00,$0.00,$0.00,$0.00
76974,ERX,HCPCS 25000001,00713-0102-06,GLYCERIN (LAXATIVE) 1.2 G RECTAL SUPP,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
76997,ERX,HCPCS 63700001,00904-5824-60,CHOLECALCIFEROL-D3 1000 UNITS PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
76997,ERX,HCPCS 63700001,00904-5824-93,CHOLECALCIFEROL-D3 1000 UNITS PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
76997,ERX,HCPCS 63700001,20555-0033-00,CHOLECALCIFEROL-D3 1000 UNITS PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
76997,ERX,HCPCS 63700001,80681-0169-00,CHOLECALCIFEROL-D3 1000 UNITS PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
77006,ERX,HCPCS J2270,99999-6011-51,MORPHINE SULFATE PCA 5 MG/ML IV SOLN,$275.63,$0.00,$275.63,$124.03,$196.72,$0.00,$47.49,$0.00,$0.00,$11.93,$275.63,$0.00,$137.82,$218.30,$220.50,$0.00,$11.93,$0.00,$11.36,$0.00
77006,ERX,HCPCS J2270,99999-6007-23,MORPHINE SULFATE PCA 5 MG/ML IV SOLN,$695.63,$0.00,$550.94,$124.03,$196.72,$0.00,$47.49,$0.00,$0.00,$11.93,$275.63,$0.00,$137.82,$550.94,$220.50,$0.00,$11.93,$0.00,$11.36,$0.00
77007,ERX,HCPCS J1050,00009-0626-01,MEDROXYPROGESTERONE ACETATE 400 MG/ML IM SUSP,$685.44,$0.00,$548.35,$308.45,$0.00,$0.00,$118.10,$0.00,$0.00,$263.20,$0.00,$0.00,$0.00,$542.87,$548.35,$0.00,$263.20,$0.00,$0.00,$0.00
77012,ERX,HCPCS J7307,00052-4330-01,ETONOGESTREL 68 MG SC IMPL,"$2,299.65",$0.00,"$2,414.64","$1,086.59","$1,723.33",$429.81,$827.51,$0.00,$0.00,"$1,098.41","$2,414.64",$0.00,"$1,207.32","$1,821.32","$1,931.71","$1,448.78","$1,098.41",$0.00,"$1,045.88",$0.00
77164,ERX,HCPCS 25000001,17238-0610-15,HYPROMELLOSE 2.5 % OP SOLN,$29.64,$0.00,$29.64,$0.00,$21.15,$0.00,$0.00,$0.00,$0.00,$0.00,$29.64,$0.00,$14.82,$23.47,$23.71,$0.00,$0.00,$0.00,$0.00,$0.00
77164,ERX,HCPCS 25000001,17478-0064-12,HYPROMELLOSE 2.5 % OP SOLN,$29.64,$0.00,$29.64,$0.00,$21.15,$0.00,$0.00,$0.00,$0.00,$0.00,$29.64,$0.00,$14.82,$23.47,$23.71,$0.00,$0.00,$0.00,$0.00,$0.00
77174,ERX,HCPCS 25000001,00173-0716-20,FLUTICASONE-SALMETEROL 115-21 MCG/ACT IN AERO,"$1,252.70",$0.00,"$1,252.70",$0.00,$894.05,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,252.70",$0.00,$626.35,$992.14,"$1,002.16",$0.00,$0.00,$0.00,$0.00,$0.00
77195,ERX,HCPCS J1953,00143-9574-25,LEVETIRACETAM 500 MG/5ML IV SOLN,$28.50,$0.00,$28.50,$12.83,$20.34,$0.00,$4.91,$0.00,$0.00,$4.99,$28.50,$0.00,$14.25,$22.57,$22.80,$0.00,$4.46,$0.00,$4.54,$0.00
77195,ERX,HCPCS J1953,00143-9673-25,LEVETIRACETAM 500 MG/5ML IV SOLN,$28.50,$0.00,$28.50,$12.83,$20.34,$0.00,$4.91,$0.00,$0.00,$4.99,$28.50,$0.00,$14.25,$22.57,$22.80,$0.00,$4.46,$0.00,$4.54,$0.00
77195,ERX,HCPCS J1953,00409-1886-02,LEVETIRACETAM 500 MG/5ML IV SOLN,$28.50,$0.00,$28.50,$12.83,$20.34,$0.00,$4.91,$0.00,$0.00,$4.99,$28.50,$0.00,$14.25,$22.57,$22.80,$0.00,$4.46,$0.00,$4.54,$0.00
77195,ERX,HCPCS J1953,25021-0780-05,LEVETIRACETAM 500 MG/5ML IV SOLN,$28.50,$0.00,$28.50,$12.83,$20.34,$0.00,$4.91,$0.00,$0.00,$4.99,$28.50,$0.00,$14.25,$22.57,$22.80,$0.00,$4.46,$0.00,$4.54,$0.00
77195,ERX,HCPCS J1953,50474-0002-63,LEVETIRACETAM 500 MG/5ML IV SOLN,$28.50,$0.00,$28.50,$12.83,$20.34,$0.00,$4.91,$0.00,$0.00,$4.99,$28.50,$0.00,$14.25,$22.57,$22.80,$0.00,$4.46,$0.00,$4.54,$0.00
77195,ERX,HCPCS J1953,55150-0177-05,LEVETIRACETAM 500 MG/5ML IV SOLN,$28.50,$0.00,$28.50,$12.83,$20.34,$0.00,$4.91,$0.00,$0.00,$4.99,$28.50,$0.00,$14.25,$22.57,$22.80,$0.00,$4.46,$0.00,$4.54,$0.00
77308,ERX,HCPCS 25000001,00517-6510-25,SELENIUM 40 MCG/ML IV SOLN,$77.56,$0.00,$77.56,$0.00,$55.35,$0.00,$0.00,$0.00,$0.00,$0.00,$77.56,$0.00,$38.78,$61.43,$62.05,$0.00,$0.00,$0.00,$0.00,$0.00
77318,ERX,HCPCS J1250,00409-2344-01,DOBUTAMINE HCL 250 MG/20ML IV SOLN,$25.31,$0.00,$25.31,$11.39,$18.06,$0.00,$6.58,$0.00,$0.00,$7.14,$25.31,$0.00,$12.66,$20.05,$20.25,$0.00,$7.14,$0.00,$6.80,$0.00
77318,ERX,HCPCS J1250,00409-2344-02,DOBUTAMINE HCL 250 MG/20ML IV SOLN,$25.31,$0.00,$25.31,$11.39,$18.06,$0.00,$6.58,$0.00,$0.00,$7.14,$25.31,$0.00,$12.66,$20.05,$20.25,$0.00,$7.14,$0.00,$6.80,$0.00
77318,ERX,HCPCS J1250,00409-2344-88,DOBUTAMINE HCL 250 MG/20ML IV SOLN,$25.31,$0.00,$25.31,$11.39,$18.06,$0.00,$6.58,$0.00,$0.00,$7.14,$25.31,$0.00,$12.66,$20.05,$20.25,$0.00,$7.14,$0.00,$6.80,$0.00
77371,ERX,HCPCS 25000001,00085-1328-01,POSACONAZOLE 40 MG/ML PO SUSP,"$3,541.30",$0.00,"$3,541.30",$0.00,"$2,527.43",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,541.30",$0.00,"$1,770.65","$2,804.71","$2,833.04",$0.00,$0.00,$0.00,$0.00,$0.00
77411,ERX,HCPCS 25000001,63323-0406-03,CAFFEINE CITRATE 20 MG/ML PO SOLN,$169.55,$0.00,$169.55,$0.00,$121.01,$0.00,$0.00,$0.00,$0.00,$0.00,$169.55,$0.00,$84.78,$134.28,$135.64,$0.00,$0.00,$0.00,$0.00,$0.00
77411,ERX,HCPCS 25000001,99999-6004-97,CAFFEINE CITRATE 20 MG/ML PO SOLN,"$1,283.69",$0.00,"$1,016.68",$0.00,$121.01,$0.00,$0.00,$0.00,$0.00,$0.00,$169.55,$0.00,$84.78,"$1,016.68",$135.64,$0.00,$0.00,$0.00,$0.00,$0.00
77412,ERX,HCPCS J0706,25021-0601-03,CAFFEINE CITRATE 60 MG/3ML IV SOLN,$140.00,$0.00,$140.00,$0.00,$99.92,$0.00,$0.00,$0.00,$0.00,$0.00,$140.00,$0.00,$70.00,$110.88,$112.00,$0.00,$0.00,$0.00,$0.00,$0.00
77412,ERX,HCPCS J0706,42571-0244-69,CAFFEINE CITRATE 60 MG/3ML IV SOLN,$140.00,$0.00,$140.00,$0.00,$99.92,$0.00,$0.00,$0.00,$0.00,$0.00,$140.00,$0.00,$70.00,$110.88,$112.00,$0.00,$0.00,$0.00,$0.00,$0.00
77412,ERX,HCPCS J0706,47335-0289-40,CAFFEINE CITRATE 60 MG/3ML IV SOLN,$140.00,$0.00,$140.00,$0.00,$99.92,$0.00,$0.00,$0.00,$0.00,$0.00,$140.00,$0.00,$70.00,$110.88,$112.00,$0.00,$0.00,$0.00,$0.00,$0.00
77412,ERX,HCPCS J0706,51754-0500-01,CAFFEINE CITRATE 60 MG/3ML IV SOLN,$140.00,$0.00,$140.00,$0.00,$99.92,$0.00,$0.00,$0.00,$0.00,$0.00,$140.00,$0.00,$70.00,$110.88,$112.00,$0.00,$0.00,$0.00,$0.00,$0.00
77412,ERX,HCPCS J0706,51754-0502-01,CAFFEINE CITRATE 60 MG/3ML IV SOLN,$140.00,$0.00,$140.00,$0.00,$99.92,$0.00,$0.00,$0.00,$0.00,$0.00,$140.00,$0.00,$70.00,$110.88,$112.00,$0.00,$0.00,$0.00,$0.00,$0.00
77412,ERX,HCPCS J0706,55150-0187-03,CAFFEINE CITRATE 60 MG/3ML IV SOLN,$140.00,$0.00,$140.00,$0.00,$99.92,$0.00,$0.00,$0.00,$0.00,$0.00,$140.00,$0.00,$70.00,$110.88,$112.00,$0.00,$0.00,$0.00,$0.00,$0.00
77412,ERX,HCPCS J0706,72485-0104-01,CAFFEINE CITRATE 60 MG/3ML IV SOLN,$140.00,$0.00,$140.00,$0.00,$99.92,$0.00,$0.00,$0.00,$0.00,$0.00,$140.00,$0.00,$70.00,$110.88,$112.00,$0.00,$0.00,$0.00,$0.00,$0.00
77539,ERX,HCPCS 63700001,00006-0568-40,VORINOSTAT 100 MG PO CAPS,"$1,193.27",$0.00,"$1,193.27",$0.00,$851.64,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,193.27",$0.00,$596.64,$945.07,$954.62,$0.00,$0.00,$0.00,$0.00,$0.00
77615,ERX,HCPCS 63700001,00006-0221-01,SITAGLIPTIN PHOSPHATE 25 MG PO TABS,$71.96,$0.00,$71.96,$0.00,$51.36,$0.00,$0.00,$0.00,$0.00,$0.00,$71.96,$0.00,$35.98,$56.99,$57.57,$0.00,$0.00,$0.00,$0.00,$0.00
77615,ERX,HCPCS 63700001,00006-0221-28,SITAGLIPTIN PHOSPHATE 25 MG PO TABS,$71.96,$0.00,$71.96,$0.00,$51.36,$0.00,$0.00,$0.00,$0.00,$0.00,$71.96,$0.00,$35.98,$56.99,$57.57,$0.00,$0.00,$0.00,$0.00,$0.00
77615,ERX,HCPCS 63700001,00006-0221-31,SITAGLIPTIN PHOSPHATE 25 MG PO TABS,$71.96,$0.00,$71.96,$0.00,$51.36,$0.00,$0.00,$0.00,$0.00,$0.00,$71.96,$0.00,$35.98,$56.99,$57.57,$0.00,$0.00,$0.00,$0.00,$0.00
77615,ERX,HCPCS 63700001,00006-0221-54,SITAGLIPTIN PHOSPHATE 25 MG PO TABS,$71.96,$0.00,$71.96,$0.00,$51.36,$0.00,$0.00,$0.00,$0.00,$0.00,$71.96,$0.00,$35.98,$56.99,$57.57,$0.00,$0.00,$0.00,$0.00,$0.00
77616,ERX,HCPCS 63700001,00006-0112-01,SITAGLIPTIN PHOSPHATE 50 MG PO TABS,$71.96,$0.00,$71.96,$0.00,$51.36,$0.00,$0.00,$0.00,$0.00,$0.00,$71.96,$0.00,$35.98,$56.99,$57.57,$0.00,$0.00,$0.00,$0.00,$0.00
77616,ERX,HCPCS 63700001,00006-0112-28,SITAGLIPTIN PHOSPHATE 50 MG PO TABS,$71.96,$0.00,$71.96,$0.00,$51.36,$0.00,$0.00,$0.00,$0.00,$0.00,$71.96,$0.00,$35.98,$56.99,$57.57,$0.00,$0.00,$0.00,$0.00,$0.00
77616,ERX,HCPCS 63700001,00006-0112-31,SITAGLIPTIN PHOSPHATE 50 MG PO TABS,$71.96,$0.00,$71.96,$0.00,$51.36,$0.00,$0.00,$0.00,$0.00,$0.00,$71.96,$0.00,$35.98,$56.99,$57.57,$0.00,$0.00,$0.00,$0.00,$0.00
77616,ERX,HCPCS 63700001,00006-0112-54,SITAGLIPTIN PHOSPHATE 50 MG PO TABS,$71.96,$0.00,$71.96,$0.00,$51.36,$0.00,$0.00,$0.00,$0.00,$0.00,$71.96,$0.00,$35.98,$56.99,$57.57,$0.00,$0.00,$0.00,$0.00,$0.00
77617,ERX,HCPCS 63700001,00006-0277-01,SITAGLIPTIN PHOSPHATE 100 MG PO TABS,$71.96,$0.00,$71.96,$0.00,$51.36,$0.00,$0.00,$0.00,$0.00,$0.00,$71.96,$0.00,$35.98,$56.99,$57.57,$0.00,$0.00,$0.00,$0.00,$0.00
77617,ERX,HCPCS 63700001,00006-0277-28,SITAGLIPTIN PHOSPHATE 100 MG PO TABS,$71.96,$0.00,$71.96,$0.00,$51.36,$0.00,$0.00,$0.00,$0.00,$0.00,$71.96,$0.00,$35.98,$56.99,$57.57,$0.00,$0.00,$0.00,$0.00,$0.00
77617,ERX,HCPCS 63700001,00006-0277-31,SITAGLIPTIN PHOSPHATE 100 MG PO TABS,$71.96,$0.00,$71.96,$0.00,$51.36,$0.00,$0.00,$0.00,$0.00,$0.00,$71.96,$0.00,$35.98,$56.99,$57.57,$0.00,$0.00,$0.00,$0.00,$0.00
77617,ERX,HCPCS 63700001,00006-0277-54,SITAGLIPTIN PHOSPHATE 100 MG PO TABS,$71.96,$0.00,$71.96,$0.00,$51.36,$0.00,$0.00,$0.00,$0.00,$0.00,$71.96,$0.00,$35.98,$56.99,$57.57,$0.00,$0.00,$0.00,$0.00,$0.00
77617,ERX,HCPCS 63700001,00006-0277-82,SITAGLIPTIN PHOSPHATE 100 MG PO TABS,$71.96,$0.00,$71.96,$0.00,$51.36,$0.00,$0.00,$0.00,$0.00,$0.00,$71.96,$0.00,$35.98,$56.99,$57.57,$0.00,$0.00,$0.00,$0.00,$0.00
77648,ERX,HCPCS 63700001,00003-3622-12,ATAZANAVIR SULFATE 300 MG PO CAPS,$173.50,$0.00,$173.50,$0.00,$123.83,$0.00,$0.00,$0.00,$0.00,$0.00,$173.50,$0.00,$86.75,$137.41,$138.80,$0.00,$0.00,$0.00,$0.00,$0.00
77648,ERX,HCPCS 63700001,00093-5528-56,ATAZANAVIR SULFATE 300 MG PO CAPS,$173.50,$0.00,$173.50,$0.00,$123.83,$0.00,$0.00,$0.00,$0.00,$0.00,$173.50,$0.00,$86.75,$137.41,$138.80,$0.00,$0.00,$0.00,$0.00,$0.00
77648,ERX,HCPCS 63700001,65862-0713-30,ATAZANAVIR SULFATE 300 MG PO CAPS,$173.50,$0.00,$173.50,$0.00,$123.83,$0.00,$0.00,$0.00,$0.00,$0.00,$173.50,$0.00,$86.75,$137.41,$138.80,$0.00,$0.00,$0.00,$0.00,$0.00
77685,ERX,HCPCS J2248,00469-3211-10,MICAFUNGIN SODIUM 100 MG IV SOLR,$594.66,$0.00,$594.66,$0.00,$424.41,$0.00,$0.00,$0.00,$0.00,$0.00,$594.66,$0.00,$297.33,$470.97,$475.73,$0.00,$0.00,$0.00,$0.00,$0.00
77710,ERX,HCPCS 25000001,00121-1576-10,METOCLOPRAMIDE HCL 10 MG/10ML PO SOLN,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
77822,ERX,HCPCS 63700001,00173-0388-79,BECLOMETHASONE DIPROP MONOHYD 42 MCG/SPRAY NA SUSP,$932.87,$0.00,$932.87,$0.00,$665.79,$0.00,$0.00,$0.00,$0.00,$0.00,$932.87,$0.00,$466.44,$738.83,$746.30,$0.00,$0.00,$0.00,$0.00,$0.00
78003,ERX,HCPCS 63700001,50383-0087-07,GUAIFENESIN-CODEINE 100-10 MG/5ML PO SYRP,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
78030,ERX,HCPCS 25000001,58914-0214-60,AQUADEKS PO LIQD,$87.78,$0.00,$87.78,$0.00,$62.65,$0.00,$0.00,$0.00,$0.00,$0.00,$87.78,$0.00,$43.89,$69.52,$70.22,$0.00,$0.00,$0.00,$0.00,$0.00
78064,ERX,HCPCS 63700001,10147-0952-03,PALIPERIDONE ER 3 MG PO TB24,$168.31,$0.00,$168.31,$0.00,$120.12,$0.00,$0.00,$0.00,$0.00,$0.00,$168.31,$0.00,$84.16,$133.30,$134.65,$0.00,$0.00,$0.00,$0.00,$0.00
78064,ERX,HCPCS 63700001,50458-0550-01,PALIPERIDONE ER 3 MG PO TB24,$168.31,$0.00,$168.31,$0.00,$120.12,$0.00,$0.00,$0.00,$0.00,$0.00,$168.31,$0.00,$84.16,$133.30,$134.65,$0.00,$0.00,$0.00,$0.00,$0.00
78065,ERX,HCPCS 63700001,00378-3980-93,PALIPERIDONE ER 6 MG PO TB24,$168.31,$0.00,$168.31,$0.00,$120.12,$0.00,$0.00,$0.00,$0.00,$0.00,$168.31,$0.00,$84.16,$133.30,$134.65,$0.00,$0.00,$0.00,$0.00,$0.00
78065,ERX,HCPCS 63700001,50458-0551-10,PALIPERIDONE ER 6 MG PO TB24,$168.31,$0.00,$168.31,$0.00,$120.12,$0.00,$0.00,$0.00,$0.00,$0.00,$168.31,$0.00,$84.16,$133.30,$134.65,$0.00,$0.00,$0.00,$0.00,$0.00
78066,ERX,HCPCS 63700001,00591-3695-30,PALIPERIDONE ER 9 MG PO TB24,$160.63,$0.00,$160.63,$0.00,$114.64,$0.00,$0.00,$0.00,$0.00,$0.00,$160.63,$0.00,$80.32,$127.22,$128.50,$0.00,$0.00,$0.00,$0.00,$0.00
78420,ERX,HCPCS J9025,59572-0102-01,AZACITIDINE 100 MG IJ SUSR,"$1,685.50",$0.00,"$1,685.50",$0.00,"$1,202.94",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,685.50",$0.00,$842.75,"$1,334.92","$1,348.40",$0.00,$0.00,$0.00,$0.00,$0.00
78615,ERX,HCPCS 63700001,00186-4020-01,ESOMEPRAZOLE 20 MG PO PACK,$43.67,$0.00,$43.67,$0.00,$31.17,$0.00,$0.00,$0.00,$0.00,$0.00,$43.67,$0.00,$21.84,$34.59,$34.94,$0.00,$0.00,$0.00,$0.00,$0.00
78616,ERX,HCPCS 63700001,00186-4040-01,ESOMEPRAZOLE 40 MG PO PACK,$43.67,$0.00,$43.67,$0.00,$31.17,$0.00,$0.00,$0.00,$0.00,$0.00,$43.67,$0.00,$21.84,$34.59,$34.94,$0.00,$0.00,$0.00,$0.00,$0.00
78879,ERX,HCPCS 63700001,00904-2533-21,CALAMINE 8-8 % EX LOTN,$11.00,$0.00,$11.00,$0.00,$7.85,$0.00,$0.00,$0.00,$0.00,$0.00,$11.00,$0.00,$5.50,$8.71,$8.80,$0.00,$0.00,$0.00,$0.00,$0.00
79088,ERX,HCPCS 63700001,00121-0775-16,GUAIFENESIN-CODEINE 100-10 MG/5ML PO SOLN,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
79088,ERX,HCPCS 63700001,00121-1775-00,GUAIFENESIN-CODEINE 100-10 MG/5ML PO SOLN,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
79088,ERX,HCPCS 63700001,00121-1775-05,GUAIFENESIN-CODEINE 100-10 MG/5ML PO SOLN,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
79088,ERX,HCPCS 63700001,50383-0087-07,GUAIFENESIN-CODEINE 100-10 MG/5ML PO SOLN,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
79088,ERX,HCPCS 63700001,69543-0276-16,GUAIFENESIN-CODEINE 100-10 MG/5ML PO SOLN,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
79088,ERX,HCPCS 63700001,99999-6006-93,GUAIFENESIN-CODEINE 100-10 MG/5ML PO SOLN,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
81426,ERX,HCPCS 63700001,00904-6364-61,DIVALPROEX SODIUM ER 500 MG PO TB24,$9.39,$0.00,$9.39,$0.00,$6.70,$0.00,$0.00,$0.00,$0.00,$0.00,$9.39,$0.00,$4.70,$7.44,$7.51,$0.00,$0.00,$0.00,$0.00,$0.00
81426,ERX,HCPCS 63700001,16714-0485-01,DIVALPROEX SODIUM ER 500 MG PO TB24,$9.39,$0.00,$9.39,$0.00,$6.70,$0.00,$0.00,$0.00,$0.00,$0.00,$9.39,$0.00,$4.70,$7.44,$7.51,$0.00,$0.00,$0.00,$0.00,$0.00
81426,ERX,HCPCS 63700001,16714-0485-02,DIVALPROEX SODIUM ER 500 MG PO TB24,$9.39,$0.00,$9.39,$0.00,$6.70,$0.00,$0.00,$0.00,$0.00,$0.00,$9.39,$0.00,$4.70,$7.44,$7.51,$0.00,$0.00,$0.00,$0.00,$0.00
81426,ERX,HCPCS 63700001,65862-0595-01,DIVALPROEX SODIUM ER 500 MG PO TB24,$9.39,$0.00,$9.39,$0.00,$6.70,$0.00,$0.00,$0.00,$0.00,$0.00,$9.39,$0.00,$4.70,$7.44,$7.51,$0.00,$0.00,$0.00,$0.00,$0.00
81453,ERX,HCPCS 63700001,00186-0372-20,BUDESONIDE-FORMOTEROL FUMARATE 80-4.5 MCG/ACT IN AERO,"$1,239.79",$0.00,"$1,239.79",$0.00,$884.84,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,239.79",$0.00,$619.90,$981.91,$991.83,$0.00,$0.00,$0.00,$0.00,$0.00
81453,ERX,HCPCS 63700001,00186-0372-28,BUDESONIDE-FORMOTEROL FUMARATE 80-4.5 MCG/ACT IN AERO,"$1,239.79",$0.00,"$1,239.79",$0.00,$884.84,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,239.79",$0.00,$619.90,$981.91,$991.83,$0.00,$0.00,$0.00,$0.00,$0.00
81454,ERX,HCPCS 63700001,00186-0370-28,BUDESONIDE-FORMOTEROL FUMARATE 160-4.5 MCG/ACT IN AERO,$787.37,$0.00,"$1,426.18",$0.00,"$1,017.86",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,426.18",$0.00,$713.09,$623.60,"$1,140.94",$0.00,$0.00,$0.00,$0.00,$0.00
81454,ERX,HCPCS 63700001,00186-0370-20,BUDESONIDE-FORMOTEROL FUMARATE 160-4.5 MCG/ACT IN AERO,"$1,426.18",$0.00,"$1,426.18",$0.00,"$1,017.86",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,426.18",$0.00,$713.09,"$1,129.53","$1,140.94",$0.00,$0.00,$0.00,$0.00,$0.00
81461,ERX,HCPCS J8700,00781-2694-75,TEMOZOLOMIDE 140 MG PO CAPS,$937.06,$0.00,$937.06,$0.00,$668.78,$0.00,$0.00,$0.00,$0.00,$0.00,$937.06,$0.00,$468.53,$742.15,$749.65,$0.00,$0.00,$0.00,$0.00,$0.00
81474,ERX,HCPCS 63700001,59417-0103-10,LISDEXAMFETAMINE DIMESYLATE 30 MG PO CAPS,$48.50,$0.00,$48.50,$0.00,$34.61,$0.00,$0.00,$0.00,$0.00,$0.00,$48.50,$0.00,$24.25,$38.41,$38.80,$0.00,$0.00,$0.00,$0.00,$0.00
81479,ERX,HCPCS 63700001,58914-0601-20,BIS SUBCIT-METRONID-TETRACYC 140-125-125 MG PO CAPS,$96.76,$0.00,$96.76,$0.00,$69.06,$0.00,$0.00,$0.00,$0.00,$0.00,$96.76,$0.00,$48.38,$76.63,$77.41,$0.00,$0.00,$0.00,$0.00,$0.00
81540,ERX,HCPCS 63700001,00006-0577-61,JANUMET 50-1000 MG (SITAGLIPTIN-METFORMIN) PO TABS,$35.98,$0.00,$35.98,$0.00,$25.68,$0.00,$0.00,$0.00,$0.00,$0.00,$35.98,$0.00,$17.99,$28.50,$28.78,$0.00,$0.00,$0.00,$0.00,$0.00
81541,ERX,HCPCS 63700001,00006-0575-61,JANUMET 50-500 MG (SITAGLIPTIN-METFORMIN) PO TABS,$35.98,$0.00,$35.98,$0.00,$25.68,$0.00,$0.00,$0.00,$0.00,$0.00,$35.98,$0.00,$17.99,$28.50,$28.78,$0.00,$0.00,$0.00,$0.00,$0.00
81696,ERX,HCPCS J1300,25682-0001-01,ECULIZUMAB 300 MG/30ML IV SOLN,"$16,046.58",$0.00,"$16,046.58","$7,220.96","$5,158.80","$6,914.37","$2,764.75",$0.00,$0.00,"$8,124.42","$16,046.58","$7,260.09","$8,023.29","$12,708.89","$12,837.26","$10,025.84","$8,124.42",$0.00,"$7,735.83","$6,914.37"
81725,ERX,HCPCS 25000001,99073-0708-22,FREESTYLE LITE TEST VI STRP,$274.37,$0.00,$274.37,$0.00,$195.82,$0.00,$0.00,$0.00,$0.00,$0.00,$274.37,$0.00,$137.19,$217.30,$219.50,$0.00,$0.00,$0.00,$0.00,$0.00
81823,ERX,HCPCS 25000001,00574-0069-15,GLUCOSE 40 % PO GEL,$15.01,$0.00,$15.01,$0.00,$10.71,$0.00,$0.00,$0.00,$0.00,$0.00,$15.01,$0.00,$7.51,$11.89,$12.01,$0.00,$0.00,$0.00,$0.00,$0.00
81823,ERX,HCPCS 25000001,00574-0069-30,GLUCOSE 40 % PO GEL,$15.01,$0.00,$15.01,$0.00,$10.71,$0.00,$0.00,$0.00,$0.00,$0.00,$15.01,$0.00,$7.51,$11.89,$12.01,$0.00,$0.00,$0.00,$0.00,$0.00
81823,ERX,HCPCS 25000001,00574-0070-30,GLUCOSE 40 % PO GEL,$15.01,$0.00,$15.01,$0.00,$10.71,$0.00,$0.00,$0.00,$0.00,$0.00,$15.01,$0.00,$7.51,$11.89,$12.01,$0.00,$0.00,$0.00,$0.00,$0.00
82021,ERX,HCPCS 25000001,00121-0677-16,TRICITRATES 550-500-334 MG/5ML PO SOLN,$187.74,$0.00,$187.74,$0.00,$133.99,$0.00,$0.00,$0.00,$0.00,$0.00,$187.74,$0.00,$93.87,$148.69,$150.19,$0.00,$0.00,$0.00,$0.00,$0.00
82085,ERX,HCPCS 25000001,10019-0120-01,ESMOLOL HCL 100 MG/10ML IV SOLN,$52.48,$0.00,$52.48,$0.00,$37.45,$0.00,$0.00,$0.00,$0.00,$0.00,$52.48,$0.00,$26.24,$41.56,$41.98,$0.00,$0.00,$0.00,$0.00,$0.00
82085,ERX,HCPCS 25000001,25021-0314-10,ESMOLOL HCL 100 MG/10ML IV SOLN,$52.48,$0.00,$52.48,$0.00,$37.45,$0.00,$0.00,$0.00,$0.00,$0.00,$52.48,$0.00,$26.24,$41.56,$41.98,$0.00,$0.00,$0.00,$0.00,$0.00
82085,ERX,HCPCS 25000001,55150-0194-10,ESMOLOL HCL 100 MG/10ML IV SOLN,$52.48,$0.00,$52.48,$0.00,$37.45,$0.00,$0.00,$0.00,$0.00,$0.00,$52.48,$0.00,$26.24,$41.56,$41.98,$0.00,$0.00,$0.00,$0.00,$0.00
82085,ERX,HCPCS 25000001,63323-0652-10,ESMOLOL HCL 100 MG/10ML IV SOLN,$52.48,$0.00,$52.48,$0.00,$37.45,$0.00,$0.00,$0.00,$0.00,$0.00,$52.48,$0.00,$26.24,$41.56,$41.98,$0.00,$0.00,$0.00,$0.00,$0.00
82085,ERX,HCPCS 25000001,67457-0182-00,ESMOLOL HCL 100 MG/10ML IV SOLN,$52.48,$0.00,$52.48,$0.00,$37.45,$0.00,$0.00,$0.00,$0.00,$0.00,$52.48,$0.00,$26.24,$41.56,$41.98,$0.00,$0.00,$0.00,$0.00,$0.00
82085,ERX,HCPCS 25000001,67457-0182-10,ESMOLOL HCL 100 MG/10ML IV SOLN,$52.48,$0.00,$52.48,$0.00,$37.45,$0.00,$0.00,$0.00,$0.00,$0.00,$52.48,$0.00,$26.24,$41.56,$41.98,$0.00,$0.00,$0.00,$0.00,$0.00
82100,ERX,HCPCS 63700001,50474-0802-03,ROTIGOTINE 2 MG/24HR TD PT24,$98.76,$0.00,$98.76,$0.00,$70.49,$0.00,$0.00,$0.00,$0.00,$0.00,$98.76,$0.00,$49.38,$78.22,$79.01,$0.00,$0.00,$0.00,$0.00,$0.00
82134,ERX,HCPCS 25000001,83490-0307-60,SODIUM CHLORIDE 7 % IN NEBU,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
82177,ERX,HCPCS Q9956,00407-2707-03,PERFLUTREN PROTEIN A MICROSPH IV SUSP,$98.28,$0.00,$98.28,$44.23,$70.14,$0.00,$16.93,$0.00,$0.00,$17.21,$98.28,$0.00,$49.14,$77.84,$78.62,$0.00,$15.38,$0.00,$15.65,$0.00
82228,ERX,HCPCS J9330,00008-1179-01,TEMSIROLIMUS 25 MG/ML IV SOLN,"$4,353.20",$0.00,"$4,353.20","$1,958.94","$3,106.88","$1,328.38",$750.03,$0.00,$0.00,"$1,407.94","$4,353.20","$1,394.79","$2,176.60","$3,447.73","$3,482.56","$1,926.14","$1,407.94",$0.00,"$1,340.60","$1,112.85"
82301,ERX,HCPCS S0077,00009-0775-26,CLINDAMYCIN PHOSPHATE 600 MG/4ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$3.92,$7.07,$0.00,$0.00,$3.29,$22.00,$0.00,$11.00,$17.42,$17.60,$13.20,$3.29,$0.00,$3.13,$0.00
82301,ERX,HCPCS S0077,63323-0282-04,CLINDAMYCIN PHOSPHATE 600 MG/4ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$3.92,$7.07,$0.00,$0.00,$3.29,$22.00,$0.00,$11.00,$17.42,$17.60,$13.20,$3.29,$0.00,$3.13,$0.00
82302,ERX,HCPCS S0077,00009-0902-18,CLINDAMYCIN PHOSPHATE 900 MG/6ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$3.92,$7.07,$0.00,$0.00,$3.29,$22.00,$0.00,$11.00,$17.42,$17.60,$13.20,$3.29,$0.00,$3.13,$0.00
82302,ERX,HCPCS S0077,25021-0115-06,CLINDAMYCIN PHOSPHATE 900 MG/6ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$3.92,$7.07,$0.00,$0.00,$3.29,$22.00,$0.00,$11.00,$17.42,$17.60,$13.20,$3.29,$0.00,$3.13,$0.00
82302,ERX,HCPCS S0077,67457-0816-06,CLINDAMYCIN PHOSPHATE 900 MG/6ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$3.92,$7.07,$0.00,$0.00,$3.29,$22.00,$0.00,$11.00,$17.42,$17.60,$13.20,$3.29,$0.00,$3.13,$0.00
82363,ERX,HCPCS 63700001,62332-0205-90,AMLODIPINE-VALSARTAN 5 MG-160 MG TABS,$20.78,$0.00,$20.78,$0.00,$14.83,$0.00,$0.00,$0.00,$0.00,$0.00,$20.78,$0.00,$10.39,$16.46,$16.62,$0.00,$0.00,$0.00,$0.00,$0.00
82363,ERX,HCPCS 63700001,65862-0737-30,AMLODIPINE-VALSARTAN 5 MG-160 MG TABS,$20.78,$0.00,$20.78,$0.00,$14.83,$0.00,$0.00,$0.00,$0.00,$0.00,$20.78,$0.00,$10.39,$16.46,$16.62,$0.00,$0.00,$0.00,$0.00,$0.00
82364,ERX,HCPCS 63700001,65862-0738-30,AMLODIPINE-VALSARTAN 5 MG-320 MG TABS,$26.36,$0.00,$26.36,$0.00,$18.81,$0.00,$0.00,$0.00,$0.00,$0.00,$26.36,$0.00,$13.18,$20.88,$21.09,$0.00,$0.00,$0.00,$0.00,$0.00
82365,ERX,HCPCS 63700001,00378-1722-93,AMLODIPINE-VALSARTAN 10-160 MG TABLET,$23.58,$0.00,$23.58,$0.00,$16.83,$0.00,$0.00,$0.00,$0.00,$0.00,$23.58,$0.00,$11.79,$18.68,$18.86,$0.00,$0.00,$0.00,$0.00,$0.00
82365,ERX,HCPCS 63700001,62332-0206-90,AMLODIPINE-VALSARTAN 10-160 MG TABLET,$23.58,$0.00,$23.58,$0.00,$16.83,$0.00,$0.00,$0.00,$0.00,$0.00,$23.58,$0.00,$11.79,$18.68,$18.86,$0.00,$0.00,$0.00,$0.00,$0.00
82365,ERX,HCPCS 63700001,65862-0739-30,AMLODIPINE-VALSARTAN 10-160 MG TABLET,$23.58,$0.00,$23.58,$0.00,$16.83,$0.00,$0.00,$0.00,$0.00,$0.00,$23.58,$0.00,$11.79,$18.68,$18.86,$0.00,$0.00,$0.00,$0.00,$0.00
82366,ERX,HCPCS 63700001,00078-0491-15,AMLODIPINE-VALSARTAN 10 MG-320 MG TABS,$29.93,$0.00,$29.93,$0.00,$21.36,$0.00,$0.00,$0.00,$0.00,$0.00,$29.93,$0.00,$14.97,$23.70,$23.94,$0.00,$0.00,$0.00,$0.00,$0.00
82366,ERX,HCPCS 63700001,00378-1724-93,AMLODIPINE-VALSARTAN 10 MG-320 MG TABS,$29.93,$0.00,$29.93,$0.00,$21.36,$0.00,$0.00,$0.00,$0.00,$0.00,$29.93,$0.00,$14.97,$23.70,$23.94,$0.00,$0.00,$0.00,$0.00,$0.00
82366,ERX,HCPCS 63700001,62332-0208-90,AMLODIPINE-VALSARTAN 10 MG-320 MG TABS,$29.93,$0.00,$29.93,$0.00,$21.36,$0.00,$0.00,$0.00,$0.00,$0.00,$29.93,$0.00,$14.97,$23.70,$23.94,$0.00,$0.00,$0.00,$0.00,$0.00
82366,ERX,HCPCS 63700001,65862-0740-30,AMLODIPINE-VALSARTAN 10 MG-320 MG TABS,$29.93,$0.00,$29.93,$0.00,$21.36,$0.00,$0.00,$0.00,$0.00,$0.00,$29.93,$0.00,$14.97,$23.70,$23.94,$0.00,$0.00,$0.00,$0.00,$0.00
82504,ERX,HCPCS 63700001,00078-0501-15,RIVASTIGMINE 4.6 MG/24HR TD PT24,$96.04,$0.00,$96.04,$0.00,$68.54,$0.00,$0.00,$0.00,$0.00,$0.00,$96.04,$0.00,$48.02,$76.06,$76.83,$0.00,$0.00,$0.00,$0.00,$0.00
82504,ERX,HCPCS 63700001,00078-0501-61,RIVASTIGMINE 4.6 MG/24HR TD PT24,$96.04,$0.00,$96.04,$0.00,$68.54,$0.00,$0.00,$0.00,$0.00,$0.00,$96.04,$0.00,$48.02,$76.06,$76.83,$0.00,$0.00,$0.00,$0.00,$0.00
87795,ERX,HCPCS 25000001,10702-0056-01,OXYCODONE HCL 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
87795,ERX,HCPCS 25000001,42858-0002-10,OXYCODONE HCL 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
87795,ERX,HCPCS 25000001,68084-0968-01,OXYCODONE HCL 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
87795,ERX,HCPCS 25000001,68084-0968-11,OXYCODONE HCL 10 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
87801,ERX,HCPCS 25000001,67768-3063-06,CALCIUM GLUCONATE (ANTIDOTE) 2.5 % EX GEL,$113.40,$0.00,$113.40,$0.00,$80.93,$0.00,$0.00,$0.00,$0.00,$0.00,$113.40,$0.00,$56.70,$89.81,$90.72,$0.00,$0.00,$0.00,$0.00,$0.00
87801,ERX,HCPCS 25000001,99999-6009-13,CALCIUM GLUCONATE (ANTIDOTE) 2.5 % EX GEL,$113.40,$0.00,$113.40,$0.00,$80.93,$0.00,$0.00,$0.00,$0.00,$0.00,$113.40,$0.00,$56.70,$89.81,$90.72,$0.00,$0.00,$0.00,$0.00,$0.00
87822,ERX,HCPCS 25000001,42858-0004-01,OXYCODONE HCL 20 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
87834,ERX,HCPCS 63700001,00023-9211-05,COMBIGAN: BRIMONIDINE-TIMOLOL 0.2-0.5 % OP SOLN,$588.78,$0.00,$588.78,$0.00,$420.21,$0.00,$0.00,$0.00,$0.00,$0.00,$588.78,$0.00,$294.39,$466.31,$471.02,$0.00,$0.00,$0.00,$0.00,$0.00
87861,ERX,HCPCS J1930,15054-1120-03,LANREOTIDE ACETATE 120 MG/0.5ML SC SOLN,"$21,539.76",$0.00,"$21,539.76","$9,692.89","$5,158.80","$7,478.88","$3,711.19",$0.00,$0.00,"$8,138.89","$21,539.76","$7,852.82","$10,769.88","$17,059.49","$17,231.81","$10,844.38","$8,138.89",$0.00,"$8,138.89","$8,450.04"
87861,ERX,HCPCS J1930,15054-1120-04,LANREOTIDE ACETATE 120 MG/0.5ML SC SOLN,"$21,539.76",$0.00,"$21,539.76","$9,692.89","$5,158.80","$7,478.88","$3,711.19",$0.00,$0.00,"$8,138.89","$21,539.76","$7,852.82","$10,769.88","$17,059.49","$17,231.81","$10,844.38","$8,138.89",$0.00,"$8,138.89","$8,450.04"
87865,ERX,HCPCS 25000001,66490-0650-20,DIAZEPAM 2.5 MG RECTAL GEL,"$1,128.33",$0.00,"$1,128.33",$0.00,$805.29,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,128.33",$0.00,$564.17,$893.64,$902.66,$0.00,$0.00,$0.00,$0.00,$0.00
87867,ERX,HCPCS 25000001,00187-0658-20,DIAZEPAM 10 MG RECTAL GEL,$557.70,$0.00,$557.70,$0.00,$398.03,$0.00,$0.00,$0.00,$0.00,$0.00,$557.70,$0.00,$278.85,$441.70,$446.16,$0.00,$0.00,$0.00,$0.00,$0.00
87869,ERX,HCPCS 25000001,00187-0659-20,DIAZEPAM 20 MG RECTAL GEL,$725.01,$0.00,$725.01,$0.00,$517.44,$0.00,$0.00,$0.00,$0.00,$0.00,$725.01,$0.00,$362.51,$574.21,$580.01,$0.00,$0.00,$0.00,$0.00,$0.00
87889,ERX,HCPCS 25000001,00088-2500-33,INSULIN GLULISINE 100 UNIT/ML IJ SOLN,$902.97,$0.00,$902.97,$0.00,$644.45,$0.00,$0.00,$0.00,$0.00,$0.00,$902.97,$0.00,$451.49,$715.15,$722.38,$0.00,$0.00,$0.00,$0.00,$0.00
87912,ERX,HCPCS 63700001,51801-0011-17,POTASSIUM BICARB-CITRIC ACID 20 MEQ PO TBEF,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
87912,ERX,HCPCS 63700001,51801-0011-30,POTASSIUM BICARB-CITRIC ACID 20 MEQ PO TBEF,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
87912,ERX,HCPCS 63700001,51801-0012-30,POTASSIUM BICARB-CITRIC ACID 20 MEQ PO TBEF,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
87998,ERX,HCPCS 63700001,49702-0223-18,MARAVIROC 150 MG PO TABS,$108.94,$0.00,$108.94,$0.00,$77.75,$0.00,$0.00,$0.00,$0.00,$0.00,$108.94,$0.00,$54.47,$86.28,$87.15,$0.00,$0.00,$0.00,$0.00,$0.00
87999,ERX,HCPCS 63700001,49702-0224-18,MARAVIROC 300 MG PO TABS,$108.94,$0.00,$108.94,$0.00,$77.75,$0.00,$0.00,$0.00,$0.00,$0.00,$108.94,$0.00,$54.47,$86.28,$87.15,$0.00,$0.00,$0.00,$0.00,$0.00
88007,ERX,HCPCS 63700001,50228-0424-60,RANOLAZINE ER 1000 MG PO TB12,$48.96,$0.00,$48.96,$0.00,$34.94,$0.00,$0.00,$0.00,$0.00,$0.00,$48.96,$0.00,$24.48,$38.78,$39.17,$0.00,$0.00,$0.00,$0.00,$0.00
88007,ERX,HCPCS 63700001,61958-1004-01,RANOLAZINE ER 1000 MG PO TB12,$48.96,$0.00,$48.96,$0.00,$34.94,$0.00,$0.00,$0.00,$0.00,$0.00,$48.96,$0.00,$24.48,$38.78,$39.17,$0.00,$0.00,$0.00,$0.00,$0.00
88008,ERX,HCPCS J9178,00009-5091-01,EPIRUBICIN HCL 50 MG/25ML IV SOLN,$172.03,$0.00,$172.03,$0.00,$122.78,$0.00,$0.00,$0.00,$0.00,$0.00,$172.03,$0.00,$86.02,$136.25,$137.62,$0.00,$0.00,$0.00,$0.00,$0.00
88010,ERX,HCPCS Q2009,00069-5474-02,FOSPHENYTOIN SODIUM 500 MG PE/10ML IJ SOLN,$179.55,$0.00,$179.55,$80.80,$128.14,$17.25,$30.94,$0.00,$0.00,$31.44,$179.55,$18.11,$89.78,$142.20,$143.64,$25.01,$28.10,$0.00,$28.58,$17.25
88010,ERX,HCPCS Q2009,00069-6001-21,FOSPHENYTOIN SODIUM 500 MG PE/10ML IJ SOLN,$179.55,$0.00,$179.55,$80.80,$128.14,$17.25,$30.94,$0.00,$0.00,$31.44,$179.55,$18.11,$89.78,$142.20,$143.64,$25.01,$28.10,$0.00,$28.58,$17.25
88010,ERX,HCPCS Q2009,00641-6137-01,FOSPHENYTOIN SODIUM 500 MG PE/10ML IJ SOLN,$179.55,$0.00,$179.55,$80.80,$128.14,$17.25,$30.94,$0.00,$0.00,$31.44,$179.55,$18.11,$89.78,$142.20,$143.64,$25.01,$28.10,$0.00,$28.58,$17.25
88010,ERX,HCPCS Q2009,00641-6137-10,FOSPHENYTOIN SODIUM 500 MG PE/10ML IJ SOLN,$179.55,$0.00,$179.55,$80.80,$128.14,$17.25,$30.94,$0.00,$0.00,$31.44,$179.55,$18.11,$89.78,$142.20,$143.64,$25.01,$28.10,$0.00,$28.58,$17.25
88010,ERX,HCPCS Q2009,63323-0403-10,FOSPHENYTOIN SODIUM 500 MG PE/10ML IJ SOLN,$179.55,$0.00,$179.55,$80.80,$128.14,$17.25,$30.94,$0.00,$0.00,$31.44,$179.55,$18.11,$89.78,$142.20,$143.64,$25.01,$28.10,$0.00,$28.58,$17.25
88010,ERX,HCPCS Q2009,67457-0517-00,FOSPHENYTOIN SODIUM 500 MG PE/10ML IJ SOLN,$179.55,$0.00,$179.55,$80.80,$128.14,$17.25,$30.94,$0.00,$0.00,$31.44,$179.55,$18.11,$89.78,$142.20,$143.64,$25.01,$28.10,$0.00,$28.58,$17.25
88010,ERX,HCPCS Q2009,67457-0517-01,FOSPHENYTOIN SODIUM 500 MG PE/10ML IJ SOLN,$179.55,$0.00,$179.55,$80.80,$128.14,$17.25,$30.94,$0.00,$0.00,$31.44,$179.55,$18.11,$89.78,$142.20,$143.64,$25.01,$28.10,$0.00,$28.58,$17.25
88010,ERX,HCPCS Q2009,70121-1390-07,FOSPHENYTOIN SODIUM 500 MG PE/10ML IJ SOLN,$179.55,$0.00,$179.55,$80.80,$128.14,$17.25,$30.94,$0.00,$0.00,$31.44,$179.55,$18.11,$89.78,$142.20,$143.64,$25.01,$28.10,$0.00,$28.58,$17.25
88011,ERX,HCPCS Q2009,00069-5471-02,FOSPHENYTOIN SODIUM 100 MG PE/2ML IJ SOLN,$68.40,$0.00,$68.40,$30.78,$48.82,$3.45,$11.78,$0.00,$0.00,$11.98,$68.40,$3.62,$34.20,$54.17,$54.72,$5.00,$10.70,$0.00,$10.89,$3.45
88011,ERX,HCPCS Q2009,00069-6001-25,FOSPHENYTOIN SODIUM 100 MG PE/2ML IJ SOLN,$68.40,$0.00,$68.40,$30.78,$48.82,$3.45,$11.78,$0.00,$0.00,$11.98,$68.40,$3.62,$34.20,$54.17,$54.72,$5.00,$10.70,$0.00,$10.89,$3.45
88011,ERX,HCPCS Q2009,00641-6136-25,FOSPHENYTOIN SODIUM 100 MG PE/2ML IJ SOLN,$68.40,$0.00,$68.40,$30.78,$48.82,$3.45,$11.78,$0.00,$0.00,$11.98,$68.40,$3.62,$34.20,$54.17,$54.72,$5.00,$10.70,$0.00,$10.89,$3.45
88011,ERX,HCPCS Q2009,70121-1381-05,FOSPHENYTOIN SODIUM 100 MG PE/2ML IJ SOLN,$68.40,$0.00,$68.40,$30.78,$48.82,$3.45,$11.78,$0.00,$0.00,$11.98,$68.40,$3.62,$34.20,$54.17,$54.72,$5.00,$10.70,$0.00,$10.89,$3.45
88093,ERX,HCPCS J0348,00049-0116-28,ANIDULAFUNGIN 100 MG IV SOLR,$572.40,$0.00,$572.40,$257.58,$408.52,$0.00,$98.62,$0.00,$0.00,$61.10,$572.40,$0.00,$286.20,$453.34,$457.92,$0.00,$61.10,$0.00,$58.18,$0.00
88241,ERX,HCPCS J9211,00703-4154-11,IDARUBICIN HCL 5 MG/5ML IV SOLN,$311.29,$0.00,$311.29,$0.00,$222.17,$0.00,$0.00,$0.00,$0.00,$0.00,$311.29,$0.00,$155.65,$246.54,$249.03,$0.00,$0.00,$0.00,$0.00,$0.00
88242,ERX,HCPCS J9211,00013-2586-91,IDARUBICIN HCL 10 MG/10ML IV SOLN,$388.64,$0.00,$388.64,$0.00,$277.37,$0.00,$0.00,$0.00,$0.00,$0.00,$388.64,$0.00,$194.32,$307.80,$310.91,$0.00,$0.00,$0.00,$0.00,$0.00
88242,ERX,HCPCS J9211,00703-4155-11,IDARUBICIN HCL 10 MG/10ML IV SOLN,$388.64,$0.00,$388.64,$0.00,$277.37,$0.00,$0.00,$0.00,$0.00,$0.00,$388.64,$0.00,$194.32,$307.80,$310.91,$0.00,$0.00,$0.00,$0.00,$0.00
88243,ERX,HCPCS J9211,00703-4156-11,IDARUBICIN HCL 20 MG/20ML IV SOLN,$730.45,$0.00,$730.45,$0.00,$521.32,$0.00,$0.00,$0.00,$0.00,$0.00,$730.45,$0.00,$365.23,$578.52,$584.36,$0.00,$0.00,$0.00,$0.00,$0.00
88317,ERX,HCPCS 25000001,68803-0612-10,TRYPAN BLUE 0.06 % OP SOLN,$263.85,$0.00,$263.85,$0.00,$188.31,$0.00,$0.00,$0.00,$0.00,$0.00,$263.85,$0.00,$131.93,$208.97,$211.08,$0.00,$0.00,$0.00,$0.00,$0.00
88376,ERX,HCPCS J9060,00703-5747-11,CISPLATIN 50 MG/50ML IV SOLN,$75.78,$0.00,$75.78,$34.10,$54.08,$0.00,$13.10,$0.00,$0.00,$11.34,$75.78,$0.00,$37.89,$60.02,$60.62,$0.00,$11.34,$0.00,$10.80,$0.00
88376,ERX,HCPCS J9060,63323-0103-51,CISPLATIN 50 MG/50ML IV SOLN,$75.78,$0.00,$75.78,$34.10,$54.08,$0.00,$13.10,$0.00,$0.00,$11.34,$75.78,$0.00,$37.89,$60.02,$60.62,$0.00,$11.34,$0.00,$10.80,$0.00
88377,ERX,HCPCS J9060,00703-5748-11,CISPLATIN 100 MG/100ML IV SOLN,$126.00,$0.00,$126.00,$56.70,$89.93,$0.00,$26.20,$0.00,$0.00,$22.68,$126.00,$0.00,$63.00,$99.79,$100.80,$0.00,$22.68,$0.00,$21.59,$0.00
88377,ERX,HCPCS J9060,16729-0288-38,CISPLATIN 100 MG/100ML IV SOLN,$126.00,$0.00,$126.00,$56.70,$89.93,$0.00,$26.20,$0.00,$0.00,$22.68,$126.00,$0.00,$63.00,$99.79,$100.80,$0.00,$22.68,$0.00,$21.59,$0.00
88377,ERX,HCPCS J9060,44567-0510-01,CISPLATIN 100 MG/100ML IV SOLN,$126.00,$0.00,$126.00,$56.70,$89.93,$0.00,$26.20,$0.00,$0.00,$22.68,$126.00,$0.00,$63.00,$99.79,$100.80,$0.00,$22.68,$0.00,$21.59,$0.00
88377,ERX,HCPCS J9060,63323-0103-65,CISPLATIN 100 MG/100ML IV SOLN,$126.00,$0.00,$126.00,$56.70,$89.93,$0.00,$26.20,$0.00,$0.00,$22.68,$126.00,$0.00,$63.00,$99.79,$100.80,$0.00,$22.68,$0.00,$21.59,$0.00
88378,ERX,HCPCS J9060,63323-0103-64,CISPLATIN 200 MG/200ML IV SOLN,$272.79,$0.00,$272.79,$122.76,$194.69,$0.00,$52.41,$0.00,$0.00,$45.36,$272.79,$0.00,$136.40,$216.05,$218.23,$0.00,$45.36,$0.00,$43.19,$0.00
88567,ERX,HCPCS 63700001,00597-0101-90,PRAMIPEXOLE DIHYDROCHLORIDE 0.75 MG PO TABS,$32.02,$0.00,$32.02,$0.00,$22.85,$0.00,$0.00,$0.00,$0.00,$0.00,$32.02,$0.00,$16.01,$25.36,$25.62,$0.00,$0.00,$0.00,$0.00,$0.00
88567,ERX,HCPCS 63700001,13668-0184-90,PRAMIPEXOLE DIHYDROCHLORIDE 0.75 MG PO TABS,$32.02,$0.00,$32.02,$0.00,$22.85,$0.00,$0.00,$0.00,$0.00,$0.00,$32.02,$0.00,$16.01,$25.36,$25.62,$0.00,$0.00,$0.00,$0.00,$0.00
88608,ERX,HCPCS 63700001,00006-0227-61,RALTEGRAVIR POTASSIUM 400 MG PO TABS,$115.72,$0.00,$115.72,$0.00,$82.59,$0.00,$0.00,$0.00,$0.00,$0.00,$115.72,$0.00,$57.86,$91.65,$92.58,$0.00,$0.00,$0.00,$0.00,$0.00
88704,ERX,HCPCS 63700001,00004-0802-85,OSELTAMIVIR PHOSPHATE 30 MG PO CAPS,$47.07,$0.00,$47.07,$0.00,$33.59,$0.00,$0.00,$0.00,$0.00,$0.00,$47.07,$0.00,$23.54,$37.28,$37.66,$0.00,$0.00,$0.00,$0.00,$0.00
88704,ERX,HCPCS 63700001,16714-0817-01,OSELTAMIVIR PHOSPHATE 30 MG PO CAPS,$47.07,$0.00,$47.07,$0.00,$33.59,$0.00,$0.00,$0.00,$0.00,$0.00,$47.07,$0.00,$23.54,$37.28,$37.66,$0.00,$0.00,$0.00,$0.00,$0.00
88704,ERX,HCPCS 63700001,31722-0630-31,OSELTAMIVIR PHOSPHATE 30 MG PO CAPS,$47.07,$0.00,$47.07,$0.00,$33.59,$0.00,$0.00,$0.00,$0.00,$0.00,$47.07,$0.00,$23.54,$37.28,$37.66,$0.00,$0.00,$0.00,$0.00,$0.00
88704,ERX,HCPCS 63700001,47781-0468-13,OSELTAMIVIR PHOSPHATE 30 MG PO CAPS,$47.07,$0.00,$47.07,$0.00,$33.59,$0.00,$0.00,$0.00,$0.00,$0.00,$47.07,$0.00,$23.54,$37.28,$37.66,$0.00,$0.00,$0.00,$0.00,$0.00
88704,ERX,HCPCS 63700001,63739-0038-07,OSELTAMIVIR PHOSPHATE 30 MG PO CAPS,$47.07,$0.00,$47.07,$0.00,$33.59,$0.00,$0.00,$0.00,$0.00,$0.00,$47.07,$0.00,$23.54,$37.28,$37.66,$0.00,$0.00,$0.00,$0.00,$0.00
88704,ERX,HCPCS 63700001,68180-0675-11,OSELTAMIVIR PHOSPHATE 30 MG PO CAPS,$47.07,$0.00,$47.07,$0.00,$33.59,$0.00,$0.00,$0.00,$0.00,$0.00,$47.07,$0.00,$23.54,$37.28,$37.66,$0.00,$0.00,$0.00,$0.00,$0.00
88705,ERX,HCPCS 63700001,00004-0801-85,OSELTAMIVIR PHOSPHATE 45 MG PO CAPS,$63.54,$0.00,$63.54,$0.00,$45.35,$0.00,$0.00,$0.00,$0.00,$0.00,$63.54,$0.00,$31.77,$50.32,$50.83,$0.00,$0.00,$0.00,$0.00,$0.00
88720,ERX,HCPCS 63700001,00078-0526-51,NILOTINIB HCL 200 MG PO CAPS,$480.90,$0.00,$480.90,$0.00,$343.22,$0.00,$0.00,$0.00,$0.00,$0.00,$480.90,$0.00,$240.45,$380.87,$384.72,$0.00,$0.00,$0.00,$0.00,$0.00
88806,ERX,HCPCS 63700001,00074-0522-60,KALETRA:LOPINAVIR-RITONAVIR 100-25 MG PO TABS,$19.46,$0.00,$19.46,$0.00,$13.89,$0.00,$0.00,$0.00,$0.00,$0.00,$19.46,$0.00,$9.73,$15.41,$15.57,$0.00,$0.00,$0.00,$0.00,$0.00
88945,ERX,HCPCS 63700001,53191-0362-01,CHOLECALCIFEROL-D3 50000 UNITS PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
89128,ERX,HCPCS J3300,00065-0543-01,TRIAMCINOLONE ACETONIDE 40 MG/ML IO SUSP,$68.59,$0.00,$68.59,$30.87,$48.95,$0.00,$11.82,$0.00,$0.00,$12.01,$68.59,$0.00,$34.30,$54.32,$54.87,$0.00,$10.73,$0.00,$10.92,$0.00
89201,ERX,HCPCS 63700001,00955-1050-27,SEVELAMER CARBONATE 800 MG PO TABS,$23.17,$0.00,$23.17,$0.00,$16.54,$0.00,$0.00,$0.00,$0.00,$0.00,$23.17,$0.00,$11.59,$18.35,$18.54,$0.00,$0.00,$0.00,$0.00,$0.00
89201,ERX,HCPCS 63700001,16714-0814-01,SEVELAMER CARBONATE 800 MG PO TABS,$23.17,$0.00,$23.17,$0.00,$16.54,$0.00,$0.00,$0.00,$0.00,$0.00,$23.17,$0.00,$11.59,$18.35,$18.54,$0.00,$0.00,$0.00,$0.00,$0.00
89201,ERX,HCPCS 63700001,65162-0058-27,SEVELAMER CARBONATE 800 MG PO TABS,$23.17,$0.00,$23.17,$0.00,$16.54,$0.00,$0.00,$0.00,$0.00,$0.00,$23.17,$0.00,$11.59,$18.35,$18.54,$0.00,$0.00,$0.00,$0.00,$0.00
89201,ERX,HCPCS 63700001,65862-0921-27,SEVELAMER CARBONATE 800 MG PO TABS,$23.17,$0.00,$23.17,$0.00,$16.54,$0.00,$0.00,$0.00,$0.00,$0.00,$23.17,$0.00,$11.59,$18.35,$18.54,$0.00,$0.00,$0.00,$0.00,$0.00
89284,ERX,HCPCS 63700001,00456-1405-30,NEBIVOLOL HCL 5 MG PO TABS,$22.87,$0.00,$22.87,$0.00,$16.32,$0.00,$0.00,$0.00,$0.00,$0.00,$22.87,$0.00,$11.44,$18.11,$18.30,$0.00,$0.00,$0.00,$0.00,$0.00
89286,ERX,HCPCS 63700001,00456-1410-30,NEBIVOLOL HCL 10 MG PO TABS,$22.87,$0.00,$22.87,$0.00,$16.32,$0.00,$0.00,$0.00,$0.00,$0.00,$22.87,$0.00,$11.44,$18.11,$18.30,$0.00,$0.00,$0.00,$0.00,$0.00
89346,ERX,HCPCS 25000001,00904-6467-07,CLOPIDOGREL BISULFATE 300 MG PO TABS,$108.29,$0.00,$108.29,$0.00,$77.29,$0.00,$0.00,$0.00,$0.00,$0.00,$108.29,$0.00,$54.15,$85.77,$86.63,$0.00,$0.00,$0.00,$0.00,$0.00
89346,ERX,HCPCS 25000001,55111-0671-06,CLOPIDOGREL BISULFATE 300 MG PO TABS,$108.29,$0.00,$108.29,$0.00,$77.29,$0.00,$0.00,$0.00,$0.00,$0.00,$108.29,$0.00,$54.15,$85.77,$86.63,$0.00,$0.00,$0.00,$0.00,$0.00
89346,ERX,HCPCS 25000001,55111-0671-31,CLOPIDOGREL BISULFATE 300 MG PO TABS,$108.29,$0.00,$108.29,$0.00,$77.29,$0.00,$0.00,$0.00,$0.00,$0.00,$108.29,$0.00,$54.15,$85.77,$86.63,$0.00,$0.00,$0.00,$0.00,$0.00
89346,ERX,HCPCS 25000001,68084-0752-25,CLOPIDOGREL BISULFATE 300 MG PO TABS,$108.29,$0.00,$108.29,$0.00,$77.29,$0.00,$0.00,$0.00,$0.00,$0.00,$108.29,$0.00,$54.15,$85.77,$86.63,$0.00,$0.00,$0.00,$0.00,$0.00
89346,ERX,HCPCS 25000001,68084-0752-95,CLOPIDOGREL BISULFATE 300 MG PO TABS,$108.29,$0.00,$108.29,$0.00,$77.29,$0.00,$0.00,$0.00,$0.00,$0.00,$108.29,$0.00,$54.15,$85.77,$86.63,$0.00,$0.00,$0.00,$0.00,$0.00
89350,ERX,HCPCS J9305,00002-7640-01,PEMETREXED DISODIUM 100 MG IV SOLR,"$2,130.53",$0.00,"$2,130.53",$958.74,"$1,520.56",$694.72,$566.59,$0.00,$0.00,$831.78,"$2,130.53",$729.46,"$1,065.27","$1,687.38","$1,704.42","$1,007.34",$831.78,$0.00,$792.00,$724.05
89432,ERX,HCPCS 63700001,59676-0570-01,ETRAVIRINE 100 MG PO TABS,$96.87,$0.00,$96.87,$0.00,$69.14,$0.00,$0.00,$0.00,$0.00,$0.00,$96.87,$0.00,$48.44,$76.72,$77.50,$0.00,$0.00,$0.00,$0.00,$0.00
89570,ERX,HCPCS 25000001,00338-0322-01,THROMBIN (RECOMBINANT) 5000 UNITS EX SOLR,$314.76,$0.00,$314.76,$0.00,$224.64,$0.00,$0.00,$0.00,$0.00,$0.00,$314.76,$0.00,$157.38,$249.29,$251.81,$0.00,$0.00,$0.00,$0.00,$0.00
89570,ERX,HCPCS 25000001,65293-0006-41,THROMBIN (RECOMBINANT) 5000 UNITS EX SOLR,$314.76,$0.00,$314.76,$0.00,$224.64,$0.00,$0.00,$0.00,$0.00,$0.00,$314.76,$0.00,$157.38,$249.29,$251.81,$0.00,$0.00,$0.00,$0.00,$0.00
89740,ERX,HCPCS 63700001,60258-0171-01,MAGNESIUM OXIDE 400 (241.3 MG) MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
89740,ERX,HCPCS 63700001,63739-0354-01,MAGNESIUM OXIDE 400 (241.3 MG) MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
89740,ERX,HCPCS 63700001,63739-0354-10,MAGNESIUM OXIDE 400 (241.3 MG) MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
89783,ERX,HCPCS 63700001,59417-0102-10,LISDEXAMFETAMINE DIMESYLATE 20 MG PO CAPS,$48.50,$0.00,$48.50,$0.00,$34.61,$0.00,$0.00,$0.00,$0.00,$0.00,$48.50,$0.00,$24.25,$38.41,$38.80,$0.00,$0.00,$0.00,$0.00,$0.00
89791,ERX,HCPCS 63700001,00008-0844-01,PANTOPRAZOLE SODIUM 40 MG PO PACK,$72.14,$0.00,$72.14,$0.00,$51.49,$0.00,$0.00,$0.00,$0.00,$0.00,$72.14,$0.00,$36.07,$57.13,$57.71,$0.00,$0.00,$0.00,$0.00,$0.00
89791,ERX,HCPCS 63700001,00008-0844-02,PANTOPRAZOLE SODIUM 40 MG PO PACK,$72.14,$0.00,$72.14,$0.00,$51.49,$0.00,$0.00,$0.00,$0.00,$0.00,$72.14,$0.00,$36.07,$57.13,$57.71,$0.00,$0.00,$0.00,$0.00,$0.00
90996,ERX,HCPCS 63600001,31382-0753-05,MEPIVACAINE HCL 3 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
91001,ERX,HCPCS 63700001,10122-0901-12,ZILEUTON 600 MG PO TABS,$131.57,$0.00,$131.57,$0.00,$93.90,$0.00,$0.00,$0.00,$0.00,$0.00,$131.57,$0.00,$65.79,$104.20,$105.26,$0.00,$0.00,$0.00,$0.00,$0.00
91018,ERX,HCPCS 25000001,00065-0474-01,HYPROMELLOSE 0.3 % OP GEL,$29.64,$0.00,$29.64,$0.00,$21.15,$0.00,$0.00,$0.00,$0.00,$0.00,$29.64,$0.00,$14.82,$23.47,$23.71,$0.00,$0.00,$0.00,$0.00,$0.00
91018,ERX,HCPCS 25000001,00065-8064-01,HYPROMELLOSE 0.3 % OP GEL,$29.64,$0.00,$29.64,$0.00,$21.15,$0.00,$0.00,$0.00,$0.00,$0.00,$29.64,$0.00,$14.82,$23.47,$23.71,$0.00,$0.00,$0.00,$0.00,$0.00
91018,ERX,HCPCS 25000001,00078-0429-47,HYPROMELLOSE 0.3 % OP GEL,$29.64,$0.00,$29.64,$0.00,$21.15,$0.00,$0.00,$0.00,$0.00,$0.00,$29.64,$0.00,$14.82,$23.47,$23.71,$0.00,$0.00,$0.00,$0.00,$0.00
91033,ERX,HCPCS 90633,58160-0825-52,HEPATITIS A VACCINE 720 EL U/0.5ML IM SUSP,$141.67,$0.00,$141.67,$63.75,$101.11,$0.00,$9.40,$0.00,$0.00,$24.81,$141.67,$0.00,$70.84,$112.20,$113.34,$0.00,$22.17,$0.00,$22.55,$0.00
91034,ERX,HCPCS 90632,58160-0826-52,HEPATITIS A VACCINE 1440 EL U/ML IM SUSP,$270.27,$0.00,$270.27,$121.62,$192.89,$0.00,$56.67,$0.00,$0.00,$70.39,$270.27,$0.00,$135.14,$214.05,$216.22,$0.00,$70.39,$0.00,$67.03,$0.00
91037,ERX,HCPCS J3470,00548-9090-10,HYALURONIDASE BOVINE 150 UNIT/ML IJ SOLN,$210.93,$0.00,$210.93,$94.92,$150.54,$0.00,$29.38,$0.00,$0.00,$36.93,$210.93,$0.00,$105.47,$167.06,$168.74,$0.00,$33.01,$0.00,$33.58,$0.00
91047,ERX,HCPCS 90371,13533-0636-03,HEPATITIS B IMMUNE GLOBULIN IM SOLN,$323.73,$0.00,$323.73,$0.00,$231.05,$0.00,$0.00,$0.00,$0.00,$0.00,$323.73,$0.00,$161.87,$256.39,$258.98,$0.00,$0.00,$0.00,$0.00,$0.00
91047,ERX,HCPCS 90371,13533-0636-05,HEPATITIS B IMMUNE GLOBULIN IM SOLN,$323.73,$0.00,$323.73,$0.00,$231.05,$0.00,$0.00,$0.00,$0.00,$0.00,$323.73,$0.00,$161.87,$256.39,$258.98,$0.00,$0.00,$0.00,$0.00,$0.00
91047,ERX,HCPCS 90371,59730-4202-01,HEPATITIS B IMMUNE GLOBULIN IM SOLN,$323.73,$0.00,$323.73,$0.00,$231.05,$0.00,$0.00,$0.00,$0.00,$0.00,$323.73,$0.00,$161.87,$256.39,$258.98,$0.00,$0.00,$0.00,$0.00,$0.00
91054,ERX,HCPCS J9206,00009-7529-03,IRINOTECAN HCL 100 MG/5ML IV SOLN,$142.80,$0.00,$142.80,$64.26,$101.92,$0.00,$127.61,$0.00,$0.00,$14.57,$142.80,$0.00,$71.40,$113.10,$114.24,$0.00,$14.57,$0.00,$13.87,$0.00
91054,ERX,HCPCS J9206,63323-0193-55,IRINOTECAN HCL 100 MG/5ML IV SOLN,$142.80,$0.00,$142.80,$64.26,$101.92,$0.00,$127.61,$0.00,$0.00,$14.57,$142.80,$0.00,$71.40,$113.10,$114.24,$0.00,$14.57,$0.00,$13.87,$0.00
91073,ERX,HCPCS 63700001,00008-1211-30,DESVENLAFAXINE SUCCINATE ER 50 MG PO TB24,$62.75,$0.00,$62.75,$0.00,$44.78,$0.00,$0.00,$0.00,$0.00,$0.00,$62.75,$0.00,$31.38,$49.70,$50.20,$0.00,$0.00,$0.00,$0.00,$0.00
91073,ERX,HCPCS 63700001,51991-0311-33,DESVENLAFAXINE SUCCINATE ER 50 MG PO TB24,$62.75,$0.00,$62.75,$0.00,$44.78,$0.00,$0.00,$0.00,$0.00,$0.00,$62.75,$0.00,$31.38,$49.70,$50.20,$0.00,$0.00,$0.00,$0.00,$0.00
91073,ERX,HCPCS 63700001,59762-1211-03,DESVENLAFAXINE SUCCINATE ER 50 MG PO TB24,$62.75,$0.00,$62.75,$0.00,$44.78,$0.00,$0.00,$0.00,$0.00,$0.00,$62.75,$0.00,$31.38,$49.70,$50.20,$0.00,$0.00,$0.00,$0.00,$0.00
91238,ERX,HCPCS J0744,00409-4777-02,CIPROFLOXACIN IN D5W 400 MG/200ML IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$3.85,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.44,$0.00,$3.50,$0.00
91238,ERX,HCPCS J0744,25021-0114-87,CIPROFLOXACIN IN D5W 400 MG/200ML IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$3.85,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.44,$0.00,$3.50,$0.00
91238,ERX,HCPCS J0744,36000-0009-24,CIPROFLOXACIN IN D5W 400 MG/200ML IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$3.85,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.44,$0.00,$3.50,$0.00
91278,ERX,HCPCS J2354,00641-6174-10,OCTREOTIDE ACETATE 50 MCG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.00,$0.00,$0.00,$1.10,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
91278,ERX,HCPCS J2354,00703-3301-04,OCTREOTIDE ACETATE 50 MCG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.00,$0.00,$0.00,$1.10,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
91278,ERX,HCPCS J2354,25021-0451-01,OCTREOTIDE ACETATE 50 MCG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.00,$0.00,$0.00,$1.10,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
91278,ERX,HCPCS J2354,67457-0239-01,OCTREOTIDE ACETATE 50 MCG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.00,$0.00,$0.00,$1.10,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
91279,ERX,HCPCS J2354,00078-0181-01,OCTREOTIDE ACETATE 100 MCG/ML IJ SOLN,$45.33,$0.00,$45.33,$20.40,$32.35,$0.00,$0.00,$0.00,$0.00,$4.42,$45.33,$0.00,$22.67,$35.90,$36.26,$0.00,$0.00,$0.00,$4.21,$0.00
91279,ERX,HCPCS J2354,00703-3311-01,OCTREOTIDE ACETATE 100 MCG/ML IJ SOLN,$45.33,$0.00,$45.33,$20.40,$32.35,$0.00,$0.00,$0.00,$0.00,$4.42,$45.33,$0.00,$22.67,$35.90,$36.26,$0.00,$0.00,$0.00,$4.21,$0.00
91279,ERX,HCPCS J2354,00703-3311-04,OCTREOTIDE ACETATE 100 MCG/ML IJ SOLN,$45.33,$0.00,$45.33,$20.40,$32.35,$0.00,$0.00,$0.00,$0.00,$4.42,$45.33,$0.00,$22.67,$35.90,$36.26,$0.00,$0.00,$0.00,$4.21,$0.00
91279,ERX,HCPCS J2354,25021-0452-01,OCTREOTIDE ACETATE 100 MCG/ML IJ SOLN,$45.33,$0.00,$45.33,$20.40,$32.35,$0.00,$0.00,$0.00,$0.00,$4.42,$45.33,$0.00,$22.67,$35.90,$36.26,$0.00,$0.00,$0.00,$4.21,$0.00
91279,ERX,HCPCS J2354,63323-0376-01,OCTREOTIDE ACETATE 100 MCG/ML IJ SOLN,$45.33,$0.00,$45.33,$20.40,$32.35,$0.00,$0.00,$0.00,$0.00,$4.42,$45.33,$0.00,$22.67,$35.90,$36.26,$0.00,$0.00,$0.00,$4.21,$0.00
91279,ERX,HCPCS J2354,67457-0245-01,OCTREOTIDE ACETATE 100 MCG/ML IJ SOLN,$45.33,$0.00,$45.33,$20.40,$32.35,$0.00,$0.00,$0.00,$0.00,$4.42,$45.33,$0.00,$22.67,$35.90,$36.26,$0.00,$0.00,$0.00,$4.21,$0.00
91281,ERX,HCPCS J2354,00641-6176-01,OCTREOTIDE ACETATE 500 MCG/ML IJ SOLN,$187.83,$0.00,$187.83,$84.52,$134.05,$0.00,$0.00,$0.00,$0.00,$22.09,$187.83,$0.00,$93.92,$148.76,$150.26,$0.00,$0.00,$0.00,$21.03,$0.00
91281,ERX,HCPCS J2354,00641-6176-10,OCTREOTIDE ACETATE 500 MCG/ML IJ SOLN,$187.83,$0.00,$187.83,$84.52,$134.05,$0.00,$0.00,$0.00,$0.00,$22.09,$187.83,$0.00,$93.92,$148.76,$150.26,$0.00,$0.00,$0.00,$21.03,$0.00
91281,ERX,HCPCS J2354,00703-3321-01,OCTREOTIDE ACETATE 500 MCG/ML IJ SOLN,$187.83,$0.00,$187.83,$84.52,$134.05,$0.00,$0.00,$0.00,$0.00,$22.09,$187.83,$0.00,$93.92,$148.76,$150.26,$0.00,$0.00,$0.00,$21.03,$0.00
91281,ERX,HCPCS J2354,00703-3321-04,OCTREOTIDE ACETATE 500 MCG/ML IJ SOLN,$187.83,$0.00,$187.83,$84.52,$134.05,$0.00,$0.00,$0.00,$0.00,$22.09,$187.83,$0.00,$93.92,$148.76,$150.26,$0.00,$0.00,$0.00,$21.03,$0.00
91281,ERX,HCPCS J2354,25021-0453-01,OCTREOTIDE ACETATE 500 MCG/ML IJ SOLN,$187.83,$0.00,$187.83,$84.52,$134.05,$0.00,$0.00,$0.00,$0.00,$22.09,$187.83,$0.00,$93.92,$148.76,$150.26,$0.00,$0.00,$0.00,$21.03,$0.00
91281,ERX,HCPCS J2354,63323-0377-01,OCTREOTIDE ACETATE 500 MCG/ML IJ SOLN,$187.83,$0.00,$187.83,$84.52,$134.05,$0.00,$0.00,$0.00,$0.00,$22.09,$187.83,$0.00,$93.92,$148.76,$150.26,$0.00,$0.00,$0.00,$21.03,$0.00
91281,ERX,HCPCS J2354,67457-0246-01,OCTREOTIDE ACETATE 500 MCG/ML IJ SOLN,$187.83,$0.00,$187.83,$84.52,$134.05,$0.00,$0.00,$0.00,$0.00,$22.09,$187.83,$0.00,$93.92,$148.76,$150.26,$0.00,$0.00,$0.00,$21.03,$0.00
91363,ERX,HCPCS J1451,00517-0710-01,FOMEPIZOLE 1.5 GM/1.5ML IV SOLN,"$2,644.50",$0.00,"$2,644.50",$0.00,"$1,887.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,644.50",$0.00,"$1,322.25","$2,094.44","$2,115.60",$0.00,$0.00,$0.00,$0.00,$0.00
91363,ERX,HCPCS J1451,67457-0211-02,FOMEPIZOLE 1.5 GM/1.5ML IV SOLN,"$2,644.50",$0.00,"$2,644.50",$0.00,"$1,887.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,644.50",$0.00,"$1,322.25","$2,094.44","$2,115.60",$0.00,$0.00,$0.00,$0.00,$0.00
91363,ERX,HCPCS J1451,70710-1478-01,FOMEPIZOLE 1.5 GM/1.5ML IV SOLN,"$2,644.50",$0.00,"$2,644.50",$0.00,"$1,887.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,644.50",$0.00,"$1,322.25","$2,094.44","$2,115.60",$0.00,$0.00,$0.00,$0.00,$0.00
91408,ERX,HCPCS J2785,00469-6501-89,REGADENOSON 0.4 MG/5ML IV SOLN,$772.61,$0.00,$772.61,$347.67,$551.41,$0.00,$133.12,$0.00,$0.00,$278.62,$772.61,$0.00,$386.31,$611.91,$618.09,$0.00,$278.62,$0.00,$265.29,$0.00
91534,ERX,HCPCS 63700001,64764-0080-60,LUBIPROSTONE 8 MCG PO CAPS,$28.21,$0.00,$28.21,$0.00,$20.13,$0.00,$0.00,$0.00,$0.00,$0.00,$28.21,$0.00,$14.11,$22.34,$22.57,$0.00,$0.00,$0.00,$0.00,$0.00
91651,ERX,HCPCS J2212,65649-0551-02,METHYLNALTREXONE BROMIDE 12 MG/0.6ML SC SOLN,$456.28,$0.00,$456.28,$0.00,$325.65,$0.00,$0.00,$0.00,$0.00,$0.00,$456.28,$0.00,$228.14,$361.37,$365.02,$0.00,$0.00,$0.00,$0.00,$0.00
91651,ERX,HCPCS J2212,65649-0551-07,METHYLNALTREXONE BROMIDE 12 MG/0.6ML SC SOLN,$456.28,$0.00,$456.28,$0.00,$325.65,$0.00,$0.00,$0.00,$0.00,$0.00,$456.28,$0.00,$228.14,$361.37,$365.02,$0.00,$0.00,$0.00,$0.00,$0.00
91870,ERX,HCPCS 63700001,67919-0020-10,ALVIMOPAN 12 MG PO CAPS,$550.72,$0.00,$550.72,$0.00,$393.05,$0.00,$0.00,$0.00,$0.00,$0.00,$550.72,$0.00,$275.36,$436.17,$440.58,$0.00,$0.00,$0.00,$0.00,$0.00
91877,ERX,HCPCS 25000001,00085-1461-02,MOMETASONE FUROATE 110 MCG/INH IN AEPB,$564.11,$0.00,$564.11,$0.00,$402.61,$0.00,$0.00,$0.00,$0.00,$0.00,$564.11,$0.00,$282.06,$446.78,$451.29,$0.00,$0.00,$0.00,$0.00,$0.00
92074,ERX,HCPCS 25000001,49281-0510-05,DTAP-IPV-HIB VACCINE IM SUSR,$363.11,$0.00,$363.11,$0.00,$259.15,$0.00,$0.00,$0.00,$0.00,$0.00,$363.11,$0.00,$181.56,$287.58,$290.49,$0.00,$0.00,$0.00,$0.00,$0.00
92079,ERX,HCPCS 25000001,00143-9660-10,METOPROLOL TARTRATE 5 MG/5ML IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
92079,ERX,HCPCS 25000001,00143-9873-25,METOPROLOL TARTRATE 5 MG/5ML IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
92079,ERX,HCPCS 25000001,36000-0033-10,METOPROLOL TARTRATE 5 MG/5ML IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
92079,ERX,HCPCS 25000001,47781-0587-17,METOPROLOL TARTRATE 5 MG/5ML IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
92079,ERX,HCPCS 25000001,70860-0300-05,METOPROLOL TARTRATE 5 MG/5ML IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
92079,ERX,HCPCS 25000001,70860-0300-41,METOPROLOL TARTRATE 5 MG/5ML IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
92788,ERX,HCPCS 90696,58160-0812-11,DTAP-IPV VACCINE IM SUSP,$200.78,$0.00,$200.78,$90.35,$143.30,$0.00,$34.59,$0.00,$0.00,$35.15,$200.78,$0.00,$100.39,$159.02,$160.62,$0.00,$31.42,$0.00,$31.96,$0.00
92851,ERX,HCPCS 63700001,59676-0562-01,DARUNAVIR ETHANOLATE 600 MG PO TABS,$123.61,$0.00,$123.61,$0.00,$88.22,$0.00,$0.00,$0.00,$0.00,$0.00,$123.61,$0.00,$61.81,$97.90,$98.89,$0.00,$0.00,$0.00,$0.00,$0.00
92854,ERX,HCPCS J7189,00169-7202-01,COAGULATION FACTOR VIIA RECOMB 2 MG IV SOLR,"$11,029.00",$0.00,"$11,029.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,029.00",$0.00,"$5,514.50","$8,734.97","$8,823.20",$0.00,$0.00,$0.00,$0.00,$0.00
92895,ERX,HCPCS J3370,00338-3552-48,VANCOMYCIN HCL IN DEXTROSE 1000 MG/200ML IV SOLN,$113.40,$0.00,$113.40,$51.03,$80.93,$0.00,$7.24,$0.00,$0.00,$7.97,$113.40,$0.00,$56.70,$89.81,$90.72,$0.00,$7.97,$0.00,$7.59,$0.00
92897,ERX,HCPCS 63700001,00003-0852-22,DASATINIB 100 MG PO TABS,"$1,392.77",$0.00,"$1,392.77",$0.00,$994.02,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,392.77",$0.00,$696.39,"$1,103.07","$1,114.22",$0.00,$0.00,$0.00,$0.00,$0.00
93084,ERX,HCPCS J0282,00143-9875-10,AMIODARONE HCL 150 MG/3ML IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$3.85,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.44,$0.00,$3.50,$0.00
93084,ERX,HCPCS J0282,00143-9875-25,AMIODARONE HCL 150 MG/3ML IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$3.85,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.44,$0.00,$3.50,$0.00
93084,ERX,HCPCS J0282,55150-0180-03,AMIODARONE HCL 150 MG/3ML IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$3.85,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.44,$0.00,$3.50,$0.00
93084,ERX,HCPCS J0282,63323-0616-03,AMIODARONE HCL 150 MG/3ML IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$3.85,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.44,$0.00,$3.50,$0.00
93084,ERX,HCPCS J0282,67457-0153-03,AMIODARONE HCL 150 MG/3ML IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$3.85,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.44,$0.00,$3.50,$0.00
93106,ERX,HCPCS J1170,17478-0540-50,HYDROMORPHONE HCL PF 500 MG/50ML IJ SOLN,$388.88,$0.00,$455.31,$175.00,$277.54,$0.00,$195.34,$0.00,$0.00,$455.31,$388.88,$0.00,$194.44,$307.99,$311.10,$0.00,$455.31,$0.00,$433.54,$0.00
93352,ERX,HCPCS 63700001,,FLORANEX PO PACK,$7.73,$0.00,$7.73,$0.00,$5.52,$0.00,$0.00,$0.00,$0.00,$0.00,$7.73,$0.00,$3.87,$6.12,$6.18,$0.00,$0.00,$0.00,$0.00,$0.00
93352,ERX,HCPCS 63700001,64980-0146-12,FLORANEX PO PACK,$7.73,$0.00,$7.73,$0.00,$5.52,$0.00,$0.00,$0.00,$0.00,$0.00,$7.73,$0.00,$3.87,$6.12,$6.18,$0.00,$0.00,$0.00,$0.00,$0.00
93523,ERX,HCPCS J2250,00409-2596-05,MIDAZOLAM HCL 50 MG/10ML IJ SOLN,$26.91,$0.00,$26.91,$12.11,$19.21,$0.00,$9.40,$0.00,$0.00,$7.05,$26.91,$0.00,$13.46,$21.31,$21.53,$0.00,$7.05,$0.00,$6.71,$0.00
93523,ERX,HCPCS J2250,00641-6060-01,MIDAZOLAM HCL 50 MG/10ML IJ SOLN,$26.91,$0.00,$26.91,$12.11,$19.21,$0.00,$9.40,$0.00,$0.00,$7.05,$26.91,$0.00,$13.46,$21.31,$21.53,$0.00,$7.05,$0.00,$6.71,$0.00
93523,ERX,HCPCS J2250,00641-6060-10,MIDAZOLAM HCL 50 MG/10ML IJ SOLN,$26.91,$0.00,$26.91,$12.11,$19.21,$0.00,$9.40,$0.00,$0.00,$7.05,$26.91,$0.00,$13.46,$21.31,$21.53,$0.00,$7.05,$0.00,$6.71,$0.00
93523,ERX,HCPCS J2250,00641-6190-10,MIDAZOLAM HCL 50 MG/10ML IJ SOLN,$26.91,$0.00,$26.91,$12.11,$19.21,$0.00,$9.40,$0.00,$0.00,$7.05,$26.91,$0.00,$13.46,$21.31,$21.53,$0.00,$7.05,$0.00,$6.71,$0.00
93523,ERX,HCPCS J2250,47781-0589-91,MIDAZOLAM HCL 50 MG/10ML IJ SOLN,$26.91,$0.00,$26.91,$12.11,$19.21,$0.00,$9.40,$0.00,$0.00,$7.05,$26.91,$0.00,$13.46,$21.31,$21.53,$0.00,$7.05,$0.00,$6.71,$0.00
93523,ERX,HCPCS J2250,70860-0601-10,MIDAZOLAM HCL 50 MG/10ML IJ SOLN,$26.91,$0.00,$26.91,$12.11,$19.21,$0.00,$9.40,$0.00,$0.00,$7.05,$26.91,$0.00,$13.46,$21.31,$21.53,$0.00,$7.05,$0.00,$6.71,$0.00
93566,ERX,HCPCS J2796,55513-0221-01,ROMIPLOSTIM 250 MCG SC SOLR,"$4,796.14",$0.00,"$4,796.14",$0.00,"$3,423.01",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,796.14",$0.00,"$2,398.07","$3,798.54","$3,836.91",$0.00,$0.00,$0.00,$0.00,$0.00
93574,ERX,HCPCS A9581,50419-0320-05,GADOXETATE DISODIUM 0.25 MOL/L IV SOLN,$519.57,$0.00,$519.57,$233.81,$370.82,$0.00,$89.52,$0.00,$0.00,$90.97,$519.57,$0.00,$259.79,$411.50,$415.66,$0.00,$81.31,$0.00,$82.72,$0.00
93748,ERX,HCPCS J9293,61703-0343-18,MITOXANTRONE HCL 20 MG/10ML IV CONC,$540.60,$0.00,$540.60,$0.00,$385.83,$0.00,$0.00,$0.00,$0.00,$0.00,$540.60,$0.00,$270.30,$428.16,$432.48,$0.00,$0.00,$0.00,$0.00,$0.00
93748,ERX,HCPCS J9293,63323-0132-10,MITOXANTRONE HCL 20 MG/10ML IV CONC,$540.60,$0.00,$540.60,$0.00,$385.83,$0.00,$0.00,$0.00,$0.00,$0.00,$540.60,$0.00,$270.30,$428.16,$432.48,$0.00,$0.00,$0.00,$0.00,$0.00
93823,ERX,HCPCS 63700001,00597-0002-01,TIPRANAVIR 100 MG/ML PO SOLN,"$1,702.25",$0.00,"$1,702.25",$0.00,"$1,214.90",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,702.25",$0.00,$851.13,"$1,348.18","$1,361.80",$0.00,$0.00,$0.00,$0.00,$0.00
93927,ERX,HCPCS 25000001,46287-0500-30,SORBITOL 70 % SOLN,$11.00,$0.00,$27.00,$0.00,$19.27,$0.00,$0.00,$0.00,$0.00,$0.00,$27.00,$0.00,$13.50,$8.71,$21.60,$0.00,$0.00,$0.00,$0.00,$0.00
93927,ERX,HCPCS 25000001,99999-6005-16,SORBITOL 70 % SOLN,$27.00,$0.00,$27.00,$0.00,$19.27,$0.00,$0.00,$0.00,$0.00,$0.00,$27.00,$0.00,$13.50,$21.38,$21.60,$0.00,$0.00,$0.00,$0.00,$0.00
93927,ERX,HCPCS 25000001,46287-0500-01,SORBITOL 70 % SOLN,$37.75,$0.00,$29.90,$0.00,$19.27,$0.00,$0.00,$0.00,$0.00,$0.00,$27.00,$0.00,$13.50,$29.90,$21.60,$0.00,$0.00,$0.00,$0.00,$0.00
93931,ERX,HCPCS 25000001,00487-0201-01,IPRATROPIUM-ALBUTEROL BASE 0.5-2.5 (3) MG/3ML IN SOLN,$8.40,$0.00,$6.65,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$6.65,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
93931,ERX,HCPCS 25000001,00487-0201-60,IPRATROPIUM-ALBUTEROL BASE 0.5-2.5 (3) MG/3ML IN SOLN,$8.40,$0.00,$6.65,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$6.65,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
93931,ERX,HCPCS 25000001,76204-0600-01,IPRATROPIUM-ALBUTEROL BASE 0.5-2.5 (3) MG/3ML IN SOLN,$8.40,$0.00,$6.65,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$6.65,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
94096,ERX,HCPCS J2405,00409-4755-03,ONDANSETRON HCL 4 MG/2ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.99,$0.00,$0.00,$0.42,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.42,$0.00,$0.40,$0.00
94096,ERX,HCPCS J2405,00641-6078-25,ONDANSETRON HCL 4 MG/2ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.99,$0.00,$0.00,$0.42,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.42,$0.00,$0.40,$0.00
94096,ERX,HCPCS J2405,00641-6080-25,ONDANSETRON HCL 4 MG/2ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.99,$0.00,$0.00,$0.42,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.42,$0.00,$0.40,$0.00
94096,ERX,HCPCS J2405,23155-0547-41,ONDANSETRON HCL 4 MG/2ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.99,$0.00,$0.00,$0.42,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.42,$0.00,$0.40,$0.00
94096,ERX,HCPCS J2405,23155-0547-42,ONDANSETRON HCL 4 MG/2ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.99,$0.00,$0.00,$0.42,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.42,$0.00,$0.40,$0.00
94096,ERX,HCPCS J2405,36000-0012-25,ONDANSETRON HCL 4 MG/2ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.99,$0.00,$0.00,$0.42,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.42,$0.00,$0.40,$0.00
94096,ERX,HCPCS J2405,55150-0125-02,ONDANSETRON HCL 4 MG/2ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.99,$0.00,$0.00,$0.42,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.42,$0.00,$0.40,$0.00
94096,ERX,HCPCS J2405,60505-6130-05,ONDANSETRON HCL 4 MG/2ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.99,$0.00,$0.00,$0.42,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.42,$0.00,$0.40,$0.00
94096,ERX,HCPCS J2405,70860-0776-02,ONDANSETRON HCL 4 MG/2ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.99,$0.00,$0.00,$0.42,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.42,$0.00,$0.40,$0.00
94097,ERX,HCPCS J2405,00143-9890-01,ONDANSETRON HCL 40 MG/20ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.99,$0.00,$0.00,$0.42,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.42,$0.00,$0.40,$0.00
94097,ERX,HCPCS J2405,63323-0374-20,ONDANSETRON HCL 40 MG/20ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.99,$0.00,$0.00,$0.42,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.42,$0.00,$0.40,$0.00
94141,ERX,HCPCS 25000001,63824-0713-16,BENZOCAINE-MENTHOL 15-3.6 MG MT LOZG,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
94141,ERX,HCPCS 25000001,63824-0715-16,BENZOCAINE-MENTHOL 15-3.6 MG MT LOZG,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
94141,ERX,HCPCS 25000001,99999-6009-97,BENZOCAINE-MENTHOL 15-3.6 MG MT LOZG,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
94219,ERX,HCPCS 25000001,10122-0313-10,NICARDIPINE HCL IN NACL 20-0.86 MG/200ML-% IV SOLN,$372.10,$0.00,$372.10,$0.00,$265.57,$0.00,$0.00,$0.00,$0.00,$0.00,$372.10,$0.00,$186.05,$294.70,$297.68,$0.00,$0.00,$0.00,$0.00,$0.00
94576,ERX,HCPCS 25000001,10122-0325-10,NICARDIPINE HCL IN NACL 40-0.83 MG/200ML-% IV SOLN,$646.60,$0.00,$646.60,$0.00,$461.48,$0.00,$0.00,$0.00,$0.00,$0.00,$646.60,$0.00,$323.30,$512.11,$517.28,$0.00,$0.00,$0.00,$0.00,$0.00
95687,ERX,HCPCS 63700001,65649-0103-02,MESALAMINE ER 0.375 G PO CP24,$71.45,$0.00,$71.45,$0.00,$50.99,$0.00,$0.00,$0.00,$0.00,$0.00,$71.45,$0.00,$35.73,$56.59,$57.16,$0.00,$0.00,$0.00,$0.00,$0.00
95693,ERX,HCPCS 63700001,39328-0057-50,FERROUS SULFATE 75 (15 FE) MG/ML PO SOLN,$33.25,$0.00,$33.25,$0.00,$23.73,$0.00,$0.00,$0.00,$0.00,$0.00,$33.25,$0.00,$16.63,$26.33,$26.60,$0.00,$0.00,$0.00,$0.00,$0.00
95693,ERX,HCPCS 63700001,50383-0627-50,FERROUS SULFATE 75 (15 FE) MG/ML PO SOLN,$33.25,$0.00,$33.25,$0.00,$23.73,$0.00,$0.00,$0.00,$0.00,$0.00,$33.25,$0.00,$16.63,$26.33,$26.60,$0.00,$0.00,$0.00,$0.00,$0.00
95693,ERX,HCPCS 63700001,54838-0011-50,FERROUS SULFATE 75 (15 FE) MG/ML PO SOLN,$33.25,$0.00,$33.25,$0.00,$23.73,$0.00,$0.00,$0.00,$0.00,$0.00,$33.25,$0.00,$16.63,$26.33,$26.60,$0.00,$0.00,$0.00,$0.00,$0.00
95811,ERX,HCPCS 25000001,00409-9558-05,ROCURONIUM BROMIDE 50 MG/5ML IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
95811,ERX,HCPCS 25000001,00781-3220-95,ROCURONIUM BROMIDE 50 MG/5ML IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
95811,ERX,HCPCS 25000001,25021-0662-05,ROCURONIUM BROMIDE 50 MG/5ML IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
95811,ERX,HCPCS 25000001,39822-4200-02,ROCURONIUM BROMIDE 50 MG/5ML IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
95811,ERX,HCPCS 25000001,63323-0426-05,ROCURONIUM BROMIDE 50 MG/5ML IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
95811,ERX,HCPCS 25000001,67457-0228-05,ROCURONIUM BROMIDE 50 MG/5ML IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
95812,ERX,HCPCS 25000001,00143-9251-01,ROCURONIUM BROMIDE 100 MG/10ML IV SOLN,$32.34,$0.00,$32.34,$0.00,$23.08,$0.00,$0.00,$0.00,$0.00,$0.00,$32.34,$0.00,$16.17,$25.61,$25.87,$0.00,$0.00,$0.00,$0.00,$0.00
95812,ERX,HCPCS 25000001,00143-9251-10,ROCURONIUM BROMIDE 100 MG/10ML IV SOLN,$32.34,$0.00,$32.34,$0.00,$23.08,$0.00,$0.00,$0.00,$0.00,$0.00,$32.34,$0.00,$16.17,$25.61,$25.87,$0.00,$0.00,$0.00,$0.00,$0.00
95812,ERX,HCPCS 25000001,00409-9558-10,ROCURONIUM BROMIDE 100 MG/10ML IV SOLN,$32.34,$0.00,$32.34,$0.00,$23.08,$0.00,$0.00,$0.00,$0.00,$0.00,$32.34,$0.00,$16.17,$25.61,$25.87,$0.00,$0.00,$0.00,$0.00,$0.00
95812,ERX,HCPCS 25000001,00409-9558-31,ROCURONIUM BROMIDE 100 MG/10ML IV SOLN,$32.34,$0.00,$32.34,$0.00,$23.08,$0.00,$0.00,$0.00,$0.00,$0.00,$32.34,$0.00,$16.17,$25.61,$25.87,$0.00,$0.00,$0.00,$0.00,$0.00
95812,ERX,HCPCS 25000001,00409-9558-50,ROCURONIUM BROMIDE 100 MG/10ML IV SOLN,$32.34,$0.00,$32.34,$0.00,$23.08,$0.00,$0.00,$0.00,$0.00,$0.00,$32.34,$0.00,$16.17,$25.61,$25.87,$0.00,$0.00,$0.00,$0.00,$0.00
95812,ERX,HCPCS 25000001,00409-9558-70,ROCURONIUM BROMIDE 100 MG/10ML IV SOLN,$32.34,$0.00,$32.34,$0.00,$23.08,$0.00,$0.00,$0.00,$0.00,$0.00,$32.34,$0.00,$16.17,$25.61,$25.87,$0.00,$0.00,$0.00,$0.00,$0.00
95812,ERX,HCPCS 25000001,00781-3220-70,ROCURONIUM BROMIDE 100 MG/10ML IV SOLN,$32.34,$0.00,$32.34,$0.00,$23.08,$0.00,$0.00,$0.00,$0.00,$0.00,$32.34,$0.00,$16.17,$25.61,$25.87,$0.00,$0.00,$0.00,$0.00,$0.00
95812,ERX,HCPCS 25000001,00781-3220-92,ROCURONIUM BROMIDE 100 MG/10ML IV SOLN,$32.34,$0.00,$32.34,$0.00,$23.08,$0.00,$0.00,$0.00,$0.00,$0.00,$32.34,$0.00,$16.17,$25.61,$25.87,$0.00,$0.00,$0.00,$0.00,$0.00
95812,ERX,HCPCS 25000001,25021-0662-10,ROCURONIUM BROMIDE 100 MG/10ML IV SOLN,$32.34,$0.00,$32.34,$0.00,$23.08,$0.00,$0.00,$0.00,$0.00,$0.00,$32.34,$0.00,$16.17,$25.61,$25.87,$0.00,$0.00,$0.00,$0.00,$0.00
95812,ERX,HCPCS 25000001,39822-4200-05,ROCURONIUM BROMIDE 100 MG/10ML IV SOLN,$32.34,$0.00,$32.34,$0.00,$23.08,$0.00,$0.00,$0.00,$0.00,$0.00,$32.34,$0.00,$16.17,$25.61,$25.87,$0.00,$0.00,$0.00,$0.00,$0.00
95812,ERX,HCPCS 25000001,39822-4200-06,ROCURONIUM BROMIDE 100 MG/10ML IV SOLN,$32.34,$0.00,$32.34,$0.00,$23.08,$0.00,$0.00,$0.00,$0.00,$0.00,$32.34,$0.00,$16.17,$25.61,$25.87,$0.00,$0.00,$0.00,$0.00,$0.00
95812,ERX,HCPCS 25000001,67457-0228-10,ROCURONIUM BROMIDE 100 MG/10ML IV SOLN,$32.34,$0.00,$32.34,$0.00,$23.08,$0.00,$0.00,$0.00,$0.00,$0.00,$32.34,$0.00,$16.17,$25.61,$25.87,$0.00,$0.00,$0.00,$0.00,$0.00
95812,ERX,HCPCS 25000001,70860-0651-10,ROCURONIUM BROMIDE 100 MG/10ML IV SOLN,$32.34,$0.00,$32.34,$0.00,$23.08,$0.00,$0.00,$0.00,$0.00,$0.00,$32.34,$0.00,$16.17,$25.61,$25.87,$0.00,$0.00,$0.00,$0.00,$0.00
96941,ERX,HCPCS 63700001,43598-0552-30,LAMOTRIGINE 100 MG PO TBDP,$38.83,$0.00,$38.83,$0.00,$27.71,$0.00,$0.00,$0.00,$0.00,$0.00,$38.83,$0.00,$19.42,$30.75,$31.06,$0.00,$0.00,$0.00,$0.00,$0.00
96968,ERX,HCPCS 63700001,00131-2477-35,LACOSAMIDE 50 MG PO TABS,$43.28,$0.00,$43.28,$0.00,$30.89,$0.00,$0.00,$0.00,$0.00,$0.00,$43.28,$0.00,$21.64,$34.28,$34.62,$0.00,$0.00,$0.00,$0.00,$0.00
96968,ERX,HCPCS 63700001,00131-2477-60,LACOSAMIDE 50 MG PO TABS,$43.28,$0.00,$43.28,$0.00,$30.89,$0.00,$0.00,$0.00,$0.00,$0.00,$43.28,$0.00,$21.64,$34.28,$34.62,$0.00,$0.00,$0.00,$0.00,$0.00
96969,ERX,HCPCS 63700001,00131-2478-60,LACOSAMIDE 100 MG PO TABS,$74.44,$0.00,$74.44,$0.00,$53.13,$0.00,$0.00,$0.00,$0.00,$0.00,$74.44,$0.00,$37.22,$58.96,$59.55,$0.00,$0.00,$0.00,$0.00,$0.00
96970,ERX,HCPCS 63700001,00131-2479-35,LACOSAMIDE 150 MG PO TABS,$71.66,$0.00,$71.66,$0.00,$51.14,$0.00,$0.00,$0.00,$0.00,$0.00,$71.66,$0.00,$35.83,$56.75,$57.33,$0.00,$0.00,$0.00,$0.00,$0.00
96970,ERX,HCPCS 63700001,00131-2479-60,LACOSAMIDE 150 MG PO TABS,$71.66,$0.00,$71.66,$0.00,$51.14,$0.00,$0.00,$0.00,$0.00,$0.00,$71.66,$0.00,$35.83,$56.75,$57.33,$0.00,$0.00,$0.00,$0.00,$0.00
96971,ERX,HCPCS 63700001,00131-2480-35,LACOSAMIDE 200 MG PO TABS,$71.68,$0.00,$71.68,$0.00,$51.16,$0.00,$0.00,$0.00,$0.00,$0.00,$71.68,$0.00,$35.84,$56.77,$57.34,$0.00,$0.00,$0.00,$0.00,$0.00
96971,ERX,HCPCS 63700001,00131-2480-60,LACOSAMIDE 200 MG PO TABS,$71.68,$0.00,$71.68,$0.00,$51.16,$0.00,$0.00,$0.00,$0.00,$0.00,$71.68,$0.00,$35.84,$56.77,$57.34,$0.00,$0.00,$0.00,$0.00,$0.00
96972,ERX,HCPCS C9254,00131-1810-67,LACOSAMIDE 200 MG/20ML IV SOLN,$81.80,$0.00,$81.80,$36.81,$58.38,$0.00,$14.09,$0.00,$0.00,$14.32,$81.80,$0.00,$40.90,$64.79,$65.44,$0.00,$12.80,$0.00,$13.02,$0.00
96976,ERX,HCPCS 25000001,00186-0917-06,BUDESONIDE 90 MCG/ACT IN AEPB,$589.44,$0.00,$589.44,$0.00,$420.68,$0.00,$0.00,$0.00,$0.00,$0.00,$589.44,$0.00,$294.72,$466.84,$471.55,$0.00,$0.00,$0.00,$0.00,$0.00
96977,ERX,HCPCS 25000001,00186-0916-12,BUDESONIDE 180 MCG/ACT IN AEPB,$789.28,$0.00,$789.28,$0.00,$563.31,$0.00,$0.00,$0.00,$0.00,$0.00,$789.28,$0.00,$394.64,$625.11,$631.42,$0.00,$0.00,$0.00,$0.00,$0.00
96982,ERX,HCPCS J9100,61703-0305-38,CYTARABINE (PF) 20 MG/ML IJ SOLN,$57.00,$0.00,$57.00,$0.00,$40.68,$0.00,$0.00,$0.00,$0.00,$0.00,$57.00,$0.00,$28.50,$45.14,$45.60,$0.00,$0.00,$0.00,$0.00,$0.00
96982,ERX,HCPCS J9100,61703-0303-46,CYTARABINE (PF) 20 MG/ML IJ SOLN,$113.75,$0.00,$90.09,$0.00,$40.68,$0.00,$0.00,$0.00,$0.00,$0.00,$57.00,$0.00,$28.50,$90.09,$45.60,$0.00,$0.00,$0.00,$0.00,$0.00
96986,ERX,HCPCS J9155,55566-8303-01,DEGARELIX ACETATE 80 MG SC SOLR,"$1,406.74",$0.00,"$1,406.74",$0.00,"$1,003.99",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,406.74",$0.00,$703.37,"$1,114.14","$1,125.39",$0.00,$0.00,$0.00,$0.00,$0.00
96988,ERX,HCPCS 25000001,66220-0160-10,CONIVAPTAN HCL IN DEXTROSE 20-5 MG/100ML-% IV SOLN,"$2,292.48",$0.00,"$2,292.48",$0.00,"$1,509.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,292.48",$0.00,"$1,146.24","$1,815.64","$1,833.98",$0.00,$0.00,$0.00,$0.00,$0.00
97005,ERX,HCPCS 63700001,30768-0003-48,MILK THISTLE XTRA PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
97053,ERX,HCPCS 63700001,59676-0563-01,DARUNAVIR ETHANOLATE 75 MG PO TABS,$123.60,$0.00,$123.60,$0.00,$88.21,$0.00,$0.00,$0.00,$0.00,$0.00,$123.60,$0.00,$61.80,$97.89,$98.88,$0.00,$0.00,$0.00,$0.00,$0.00
97133,ERX,HCPCS 63700001,64764-0918-30,FEBUXOSTAT 40 MG PO TABS,$50.17,$0.00,$50.17,$0.00,$35.81,$0.00,$0.00,$0.00,$0.00,$0.00,$50.17,$0.00,$25.09,$39.73,$40.14,$0.00,$0.00,$0.00,$0.00,$0.00
97134,ERX,HCPCS 63700001,64764-0677-30,FEBUXOSTAT 80 MG PO TABS,$50.17,$0.00,$50.17,$0.00,$35.81,$0.00,$0.00,$0.00,$0.00,$0.00,$50.17,$0.00,$25.09,$39.73,$40.14,$0.00,$0.00,$0.00,$0.00,$0.00
97252,ERX,HCPCS J3490,99999-6010-51,DILTIAZEM HCL 25 MG/5ML IV SOLN,$736.70,$0.00,$736.70,$331.52,$525.78,$0.00,$126.93,$0.00,$0.00,$128.99,$736.70,$0.00,$368.35,$583.47,$589.36,$0.00,$115.29,$0.00,$117.28,$0.00
97253,ERX,HCPCS 25000001,00641-6015-10,DILTIAZEM HCL 125 MG/25ML IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
97254,ERX,HCPCS 25000001,00409-1171-02,DILTIAZEM HCL 50 MG/10ML IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
97254,ERX,HCPCS 25000001,00641-6014-01,DILTIAZEM HCL 50 MG/10ML IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
97254,ERX,HCPCS 25000001,00641-6014-10,DILTIAZEM HCL 50 MG/10ML IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
97254,ERX,HCPCS 25000001,00641-9218-10,DILTIAZEM HCL 50 MG/10ML IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
97254,ERX,HCPCS 25000001,17478-0937-10,DILTIAZEM HCL 50 MG/10ML IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
97266,ERX,HCPCS 63700001,00456-1420-90,NEBIVOLOL HCL 20 MG PO TABS,$22.87,$0.00,$22.87,$0.00,$16.32,$0.00,$0.00,$0.00,$0.00,$0.00,$22.87,$0.00,$11.44,$18.11,$18.30,$0.00,$0.00,$0.00,$0.00,$0.00
97343,ERX,HCPCS 63700001,00781-3174-14,SUMATRIPTAN SUCCINATE 6 MG/0.5ML SC SOLN,$267.75,$0.00,$267.75,$0.00,$191.09,$0.00,$0.00,$0.00,$0.00,$0.00,$267.75,$0.00,$133.88,$212.06,$214.20,$0.00,$0.00,$0.00,$0.00,$0.00
97343,ERX,HCPCS 63700001,55150-0173-01,SUMATRIPTAN SUCCINATE 6 MG/0.5ML SC SOLN,$267.75,$0.00,$267.75,$0.00,$191.09,$0.00,$0.00,$0.00,$0.00,$0.00,$267.75,$0.00,$133.88,$212.06,$214.20,$0.00,$0.00,$0.00,$0.00,$0.00
97343,ERX,HCPCS 63700001,63323-0273-01,SUMATRIPTAN SUCCINATE 6 MG/0.5ML SC SOLN,$267.75,$0.00,$267.75,$0.00,$191.09,$0.00,$0.00,$0.00,$0.00,$0.00,$267.75,$0.00,$133.88,$212.06,$214.20,$0.00,$0.00,$0.00,$0.00,$0.00
97371,ERX,HCPCS J3370,00143-9355-10,VANCOMYCIN HCL 750 MG IV SOLR,$43.32,$0.00,$43.32,$19.49,$30.92,$0.00,$3.62,$0.00,$0.00,$3.98,$43.32,$0.00,$21.66,$34.31,$34.66,$0.00,$3.98,$0.00,$3.79,$0.00
97371,ERX,HCPCS J3370,00409-6531-02,VANCOMYCIN HCL 750 MG IV SOLR,$43.32,$0.00,$43.32,$19.49,$30.92,$0.00,$3.62,$0.00,$0.00,$3.98,$43.32,$0.00,$21.66,$34.31,$34.66,$0.00,$3.98,$0.00,$3.79,$0.00
97371,ERX,HCPCS J3370,63323-0203-20,VANCOMYCIN HCL 750 MG IV SOLR,$43.32,$0.00,$43.32,$19.49,$30.92,$0.00,$3.62,$0.00,$0.00,$3.98,$43.32,$0.00,$21.66,$34.31,$34.66,$0.00,$3.98,$0.00,$3.79,$0.00
97389,ERX,HCPCS J7527,00078-0566-51,EVEROLIMUS 5 MG PO TABS,"$1,615.55",$0.00,"$1,615.55",$0.00,"$1,153.02",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,615.55",$0.00,$807.78,"$1,279.52","$1,292.44",$0.00,$0.00,$0.00,$0.00,$0.00
97390,ERX,HCPCS J7527,00078-0567-51,EVEROLIMUS 10 MG PO TABS,"$1,615.55",$0.00,"$1,615.55",$0.00,"$1,153.02",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,615.55",$0.00,$807.78,"$1,279.52","$1,292.44",$0.00,$0.00,$0.00,$0.00,$0.00
97480,ERX,HCPCS J7510,99999-6010-77,PREDNISOLONE 15 MG/5ML PO SOLN,$108.15,$0.00,$182.20,$0.00,$130.04,$0.00,$31.39,$0.00,$0.00,$0.00,$182.20,$0.00,$91.10,$85.65,$145.76,$0.00,$28.51,$0.00,$0.00,$0.00
97480,ERX,HCPCS J7510,99999-6004-79,PREDNISOLONE 15 MG/5ML PO SOLN,$182.20,$0.00,$182.20,$0.00,$130.04,$0.00,$31.39,$0.00,$0.00,$0.00,$182.20,$0.00,$91.10,$144.30,$145.76,$0.00,$28.51,$0.00,$0.00,$0.00
97480,ERX,HCPCS J7510,50383-0042-24,PREDNISOLONE 15 MG/5ML PO SOLN,$352.83,$0.00,$279.44,$0.00,$130.04,$0.00,$31.39,$0.00,$0.00,$0.00,$182.20,$0.00,$91.10,$279.44,$145.76,$0.00,$28.51,$0.00,$0.00,$0.00
97480,ERX,HCPCS J7510,50383-0042-48,PREDNISOLONE 15 MG/5ML PO SOLN,$563.64,$0.00,$446.40,$0.00,$130.04,$0.00,$31.39,$0.00,$0.00,$0.00,$182.20,$0.00,$91.10,$446.40,$145.76,$0.00,$28.51,$0.00,$0.00,$0.00
97660,ERX,HCPCS 25000001,48582-0512-01,BIOTENE ORALBALANCE DRY MOUTH MT GEL,$21.55,$0.00,$21.55,$0.00,$15.38,$0.00,$0.00,$0.00,$0.00,$0.00,$21.55,$0.00,$10.78,$17.07,$17.24,$0.00,$0.00,$0.00,$0.00,$0.00
97716,ERX,HCPCS J1885,00409-3796-01,KETOROLAC TROMETHAMINE 60 MG/2ML IM SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.63,$0.00,$0.00,$1.22,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.22,$0.00,$1.16,$0.00
97716,ERX,HCPCS J1885,00641-6043-25,KETOROLAC TROMETHAMINE 60 MG/2ML IM SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.63,$0.00,$0.00,$1.22,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.22,$0.00,$1.16,$0.00
97716,ERX,HCPCS J1885,25021-0701-02,KETOROLAC TROMETHAMINE 60 MG/2ML IM SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.63,$0.00,$0.00,$1.22,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.22,$0.00,$1.16,$0.00
97716,ERX,HCPCS J1885,47781-0585-68,KETOROLAC TROMETHAMINE 60 MG/2ML IM SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.63,$0.00,$0.00,$1.22,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.22,$0.00,$1.16,$0.00
97716,ERX,HCPCS J1885,63323-0162-02,KETOROLAC TROMETHAMINE 60 MG/2ML IM SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.63,$0.00,$0.00,$1.22,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.22,$0.00,$1.16,$0.00
97716,ERX,HCPCS J1885,63323-0162-14,KETOROLAC TROMETHAMINE 60 MG/2ML IM SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.63,$0.00,$0.00,$1.22,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.22,$0.00,$1.16,$0.00
97744,ERX,HCPCS 63700001,68180-0771-06,AMLOD/VALSA/HCTZ 5-160-12.5 MG TAB,$21.65,$0.00,$21.65,$0.00,$15.45,$0.00,$0.00,$0.00,$0.00,$0.00,$21.65,$0.00,$10.83,$17.15,$17.32,$0.00,$0.00,$0.00,$0.00,$0.00
97745,ERX,HCPCS 63700001,68180-0773-06,AMLOD/VALSA/HCTZ 5-160-25 MG TAB,$21.65,$0.00,$21.65,$0.00,$15.45,$0.00,$0.00,$0.00,$0.00,$0.00,$21.65,$0.00,$10.83,$17.15,$17.32,$0.00,$0.00,$0.00,$0.00,$0.00
97747,ERX,HCPCS 63700001,68180-0774-06,AMLOD/VALSA/HCTZ 10-160-25 MG TABS,$24.56,$0.00,$24.56,$0.00,$17.53,$0.00,$0.00,$0.00,$0.00,$0.00,$24.56,$0.00,$12.28,$19.45,$19.65,$0.00,$0.00,$0.00,$0.00,$0.00
97748,ERX,HCPCS 63700001,68180-0775-06,AMLOD/VALSA/HCTZ 10-320-25 MG TABS,$31.17,$0.00,$31.17,$0.00,$22.25,$0.00,$0.00,$0.00,$0.00,$0.00,$31.17,$0.00,$15.59,$24.69,$24.94,$0.00,$0.00,$0.00,$0.00,$0.00
97790,ERX,HCPCS J3260,63323-0306-30,TOBRAMYCIN SULFATE 1.2 GM/30ML IJ SOLN,$92.40,$0.00,$92.40,$41.58,$65.95,$0.00,$38.42,$0.00,$0.00,$65.04,$92.40,$0.00,$46.20,$73.18,$73.92,$0.00,$65.04,$0.00,$61.93,$0.00
97790,ERX,HCPCS J3260,67457-0428-00,TOBRAMYCIN SULFATE 1.2 GM/30ML IJ SOLN,$92.40,$0.00,$92.40,$41.58,$65.95,$0.00,$38.42,$0.00,$0.00,$65.04,$92.40,$0.00,$46.20,$73.18,$73.92,$0.00,$65.04,$0.00,$61.93,$0.00
97790,ERX,HCPCS J3260,67457-0428-30,TOBRAMYCIN SULFATE 1.2 GM/30ML IJ SOLN,$92.40,$0.00,$92.40,$41.58,$65.95,$0.00,$38.42,$0.00,$0.00,$65.04,$92.40,$0.00,$46.20,$73.18,$73.92,$0.00,$65.04,$0.00,$61.93,$0.00
97830,ERX,HCPCS 63700001,00173-0772-02,LAMOTRIGINE 25 MG PO TBDP,$33.73,$0.00,$33.73,$0.00,$24.07,$0.00,$0.00,$0.00,$0.00,$0.00,$33.73,$0.00,$16.87,$26.71,$26.98,$0.00,$0.00,$0.00,$0.00,$0.00
97893,ERX,HCPCS 63700001,59148-0020-50,TOLVAPTAN 15 MG PO TABS,$743.57,$0.00,$743.57,$0.00,$530.69,$0.00,$0.00,$0.00,$0.00,$0.00,$743.57,$0.00,$371.79,$588.91,$594.86,$0.00,$0.00,$0.00,$0.00,$0.00
97893,ERX,HCPCS 63700001,99999-6011-58,TOLVAPTAN 15 MG PO TABS,$743.57,$0.00,$743.57,$0.00,$530.69,$0.00,$0.00,$0.00,$0.00,$0.00,$743.57,$0.00,$371.79,$588.91,$594.86,$0.00,$0.00,$0.00,$0.00,$0.00
97894,ERX,HCPCS 25000001,59148-0021-50,TOLVAPTAN 30 MG PO TABS,"$1,480.17",$0.00,"$1,480.17",$0.00,"$1,056.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,480.17",$0.00,$740.09,"$1,172.29","$1,184.14",$0.00,$0.00,$0.00,$0.00,$0.00
98035,ERX,HCPCS 63700001,00032-1212-01,PANCRELIPASE (LIP-PROT-AMYL) 12000 UNITS PO CPEP,$15.24,$0.00,$15.24,$0.00,$10.88,$0.00,$0.00,$0.00,$0.00,$0.00,$15.24,$0.00,$7.62,$12.07,$12.19,$0.00,$0.00,$0.00,$0.00,$0.00
98127,ERX,HCPCS 25000001,08271-0361-00,LANCETS ULTRA THIN MISC,$11.00,$0.00,$11.00,$0.00,$7.85,$0.00,$0.00,$0.00,$0.00,$0.00,$11.00,$0.00,$5.50,$8.71,$8.80,$0.00,$0.00,$0.00,$0.00,$0.00
98249,ERX,HCPCS J9190,16729-0276-38,FLUOROURACIL 5 GM/100ML IV SOLN,$57.00,$0.00,$57.00,$25.65,$40.68,$0.00,$1.82,$0.00,$0.00,$1.77,$57.00,$0.00,$28.50,$45.14,$45.60,$0.00,$1.77,$0.00,$0.00,$0.00
98249,ERX,HCPCS J9190,63323-0117-61,FLUOROURACIL 5 GM/100ML IV SOLN,$57.00,$0.00,$57.00,$25.65,$40.68,$0.00,$1.82,$0.00,$0.00,$1.77,$57.00,$0.00,$28.50,$45.14,$45.60,$0.00,$1.77,$0.00,$0.00,$0.00
98329,ERX,HCPCS 25000001,00024-4142-60,DRONEDARONE HCL 400 MG PO TABS,$50.04,$0.00,$50.04,$0.00,$35.71,$0.00,$0.00,$0.00,$0.00,$0.00,$50.04,$0.00,$25.02,$39.63,$40.03,$0.00,$0.00,$0.00,$0.00,$0.00
98372,ERX,HCPCS 63700001,60505-4642-03,PRASUGREL HCL 5 MG PO TABS,$62.73,$0.00,$62.73,$0.00,$44.77,$0.00,$0.00,$0.00,$0.00,$0.00,$62.73,$0.00,$31.37,$49.68,$50.18,$0.00,$0.00,$0.00,$0.00,$0.00
98373,ERX,HCPCS 63700001,00002-5123-30,PRASUGREL HCL 10 MG PO TABS,$62.73,$0.00,$62.73,$0.00,$44.77,$0.00,$0.00,$0.00,$0.00,$0.00,$62.73,$0.00,$31.37,$49.68,$50.18,$0.00,$0.00,$0.00,$0.00,$0.00
98373,ERX,HCPCS 63700001,00378-5186-93,PRASUGREL HCL 10 MG PO TABS,$62.73,$0.00,$62.73,$0.00,$44.77,$0.00,$0.00,$0.00,$0.00,$0.00,$62.73,$0.00,$31.37,$49.68,$50.18,$0.00,$0.00,$0.00,$0.00,$0.00
98373,ERX,HCPCS 63700001,16729-0273-10,PRASUGREL HCL 10 MG PO TABS,$62.73,$0.00,$62.73,$0.00,$44.77,$0.00,$0.00,$0.00,$0.00,$0.00,$62.73,$0.00,$31.37,$49.68,$50.18,$0.00,$0.00,$0.00,$0.00,$0.00
98373,ERX,HCPCS 63700001,60505-4643-03,PRASUGREL HCL 10 MG PO TABS,$62.73,$0.00,$62.73,$0.00,$44.77,$0.00,$0.00,$0.00,$0.00,$0.00,$62.73,$0.00,$31.37,$49.68,$50.18,$0.00,$0.00,$0.00,$0.00,$0.00
98373,ERX,HCPCS 63700001,65162-0002-03,PRASUGREL HCL 10 MG PO TABS,$62.73,$0.00,$62.73,$0.00,$44.77,$0.00,$0.00,$0.00,$0.00,$0.00,$62.73,$0.00,$31.37,$49.68,$50.18,$0.00,$0.00,$0.00,$0.00,$0.00
98373,ERX,HCPCS 63700001,65862-0830-30,PRASUGREL HCL 10 MG PO TABS,$62.73,$0.00,$62.73,$0.00,$44.77,$0.00,$0.00,$0.00,$0.00,$0.00,$62.73,$0.00,$31.37,$49.68,$50.18,$0.00,$0.00,$0.00,$0.00,$0.00
98373,ERX,HCPCS 63700001,67877-0605-30,PRASUGREL HCL 10 MG PO TABS,$62.73,$0.00,$62.73,$0.00,$44.77,$0.00,$0.00,$0.00,$0.00,$0.00,$62.73,$0.00,$31.37,$49.68,$50.18,$0.00,$0.00,$0.00,$0.00,$0.00
99404,ERX,HCPCS 25000001,42799-0217-01,OPIUM 10 MG/ML (1%) PO TINC,"$1,775.95",$0.00,"$1,775.95",$0.00,"$1,267.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,775.95",$0.00,$887.98,"$1,406.55","$1,420.76",$0.00,$0.00,$0.00,$0.00,$0.00
99404,ERX,HCPCS 25000001,62559-0153-04,OPIUM 10 MG/ML (1%) PO TINC,"$1,775.95",$0.00,"$1,775.95",$0.00,"$1,267.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,775.95",$0.00,$887.98,"$1,406.55","$1,420.76",$0.00,$0.00,$0.00,$0.00,$0.00
99438,ERX,HCPCS 63700001,16714-0809-01,LEVONORGESTREL 1.5 MG PO TABS,$136.50,$0.00,$136.50,$0.00,$97.42,$0.00,$0.00,$0.00,$0.00,$0.00,$136.50,$0.00,$68.25,$108.11,$109.20,$0.00,$0.00,$0.00,$0.00,$0.00
99438,ERX,HCPCS 63700001,51285-0146-19,LEVONORGESTREL 1.5 MG PO TABS,$136.50,$0.00,$136.50,$0.00,$97.42,$0.00,$0.00,$0.00,$0.00,$0.00,$136.50,$0.00,$68.25,$108.11,$109.20,$0.00,$0.00,$0.00,$0.00,$0.00
99438,ERX,HCPCS 63700001,51285-0162-88,LEVONORGESTREL 1.5 MG PO TABS,$136.50,$0.00,$136.50,$0.00,$97.42,$0.00,$0.00,$0.00,$0.00,$0.00,$136.50,$0.00,$68.25,$108.11,$109.20,$0.00,$0.00,$0.00,$0.00,$0.00
99438,ERX,HCPCS 63700001,62756-0720-60,LEVONORGESTREL 1.5 MG PO TABS,$136.50,$0.00,$136.50,$0.00,$97.42,$0.00,$0.00,$0.00,$0.00,$0.00,$136.50,$0.00,$68.25,$108.11,$109.20,$0.00,$0.00,$0.00,$0.00,$0.00
99438,ERX,HCPCS 63700001,68180-0852-11,LEVONORGESTREL 1.5 MG PO TABS,$136.50,$0.00,$136.50,$0.00,$97.42,$0.00,$0.00,$0.00,$0.00,$0.00,$136.50,$0.00,$68.25,$108.11,$109.20,$0.00,$0.00,$0.00,$0.00,$0.00
99438,ERX,HCPCS 63700001,69536-0146-19,LEVONORGESTREL 1.5 MG PO TABS,$136.50,$0.00,$136.50,$0.00,$97.42,$0.00,$0.00,$0.00,$0.00,$0.00,$136.50,$0.00,$68.25,$108.11,$109.20,$0.00,$0.00,$0.00,$0.00,$0.00
99452,ERX,HCPCS J7312,00023-3348-07,DEXAMETHASONE 0.7 MG INTRAVITREAL IMPL,"$3,279.18",$0.00,"$3,279.18","$1,475.63","$2,340.35","$1,400.18",$564.99,$0.00,$0.00,"$1,645.82","$3,279.18","$1,470.19","$1,639.59","$2,597.11","$2,623.34","$2,030.26","$1,645.82",$0.00,"$1,567.10","$1,400.55"
99602,ERX,HCPCS J9263,00703-3985-01,OXALIPLATIN 50 MG/10ML IV SOLN,$189.00,$0.00,"$1,124.48",$85.05,$134.89,$0.00,"$1,124.48",$0.00,$0.00,$17.63,$189.00,$0.00,$94.50,$149.69,$151.20,$0.00,$17.63,$0.00,$16.78,$0.00
99602,ERX,HCPCS J9263,00781-3315-70,OXALIPLATIN 50 MG/10ML IV SOLN,$189.00,$0.00,"$1,124.48",$85.05,$134.89,$0.00,"$1,124.48",$0.00,$0.00,$17.63,$189.00,$0.00,$94.50,$149.69,$151.20,$0.00,$17.63,$0.00,$16.78,$0.00
99602,ERX,HCPCS J9263,00781-9315-70,OXALIPLATIN 50 MG/10ML IV SOLN,$189.00,$0.00,"$1,124.48",$85.05,$134.89,$0.00,"$1,124.48",$0.00,$0.00,$17.63,$189.00,$0.00,$94.50,$149.69,$151.20,$0.00,$17.63,$0.00,$16.78,$0.00
99602,ERX,HCPCS J9263,25021-0233-10,OXALIPLATIN 50 MG/10ML IV SOLN,$189.00,$0.00,"$1,124.48",$85.05,$134.89,$0.00,"$1,124.48",$0.00,$0.00,$17.63,$189.00,$0.00,$94.50,$149.69,$151.20,$0.00,$17.63,$0.00,$16.78,$0.00
99602,ERX,HCPCS J9263,61703-0363-18,OXALIPLATIN 50 MG/10ML IV SOLN,$189.00,$0.00,"$1,124.48",$85.05,$134.89,$0.00,"$1,124.48",$0.00,$0.00,$17.63,$189.00,$0.00,$94.50,$149.69,$151.20,$0.00,$17.63,$0.00,$16.78,$0.00
99602,ERX,HCPCS J9263,67457-0469-10,OXALIPLATIN 50 MG/10ML IV SOLN,$189.00,$0.00,"$1,124.48",$85.05,$134.89,$0.00,"$1,124.48",$0.00,$0.00,$17.63,$189.00,$0.00,$94.50,$149.69,$151.20,$0.00,$17.63,$0.00,$16.78,$0.00
99604,ERX,HCPCS J9263,00703-3986-01,OXALIPLATIN 100 MG/20ML IV SOLN,$366.00,$0.00,"$2,248.95",$164.70,$261.21,$0.00,"$2,248.95",$0.00,$0.00,$35.25,$366.00,$0.00,$183.00,$289.87,$292.80,$0.00,$35.25,$0.00,$33.56,$0.00
99604,ERX,HCPCS J9263,00781-3317-80,OXALIPLATIN 100 MG/20ML IV SOLN,$366.00,$0.00,"$2,248.95",$164.70,$261.21,$0.00,"$2,248.95",$0.00,$0.00,$35.25,$366.00,$0.00,$183.00,$289.87,$292.80,$0.00,$35.25,$0.00,$33.56,$0.00
99604,ERX,HCPCS J9263,00955-1727-20,OXALIPLATIN 100 MG/20ML IV SOLN,$366.00,$0.00,"$2,248.95",$164.70,$261.21,$0.00,"$2,248.95",$0.00,$0.00,$35.25,$366.00,$0.00,$183.00,$289.87,$292.80,$0.00,$35.25,$0.00,$33.56,$0.00
99604,ERX,HCPCS J9263,25021-0233-20,OXALIPLATIN 100 MG/20ML IV SOLN,$366.00,$0.00,"$2,248.95",$164.70,$261.21,$0.00,"$2,248.95",$0.00,$0.00,$35.25,$366.00,$0.00,$183.00,$289.87,$292.80,$0.00,$35.25,$0.00,$33.56,$0.00
99604,ERX,HCPCS J9263,61703-0363-22,OXALIPLATIN 100 MG/20ML IV SOLN,$366.00,$0.00,"$2,248.95",$164.70,$261.21,$0.00,"$2,248.95",$0.00,$0.00,$35.25,$366.00,$0.00,$183.00,$289.87,$292.80,$0.00,$35.25,$0.00,$33.56,$0.00
99686,ERX,HCPCS 63700001,00955-1052-90,SEVELAMER CARBONATE 0.8 G PO PACK,$43.12,$0.00,$43.12,$0.00,$30.77,$0.00,$0.00,$0.00,$0.00,$0.00,$43.12,$0.00,$21.56,$34.15,$34.50,$0.00,$0.00,$0.00,$0.00,$0.00
99686,ERX,HCPCS 63700001,65862-0930-90,SEVELAMER CARBONATE 0.8 G PO PACK,$43.12,$0.00,$43.12,$0.00,$30.77,$0.00,$0.00,$0.00,$0.00,$0.00,$43.12,$0.00,$21.56,$34.15,$34.50,$0.00,$0.00,$0.00,$0.00,$0.00
99687,ERX,HCPCS 63700001,58468-0131-01,SEVELAMER CARBONATE 2.4 G PO PACK,$74.96,$0.00,$74.96,$0.00,$53.50,$0.00,$0.00,$0.00,$0.00,$0.00,$74.96,$0.00,$37.48,$59.37,$59.97,$0.00,$0.00,$0.00,$0.00,$0.00
99687,ERX,HCPCS 63700001,58468-0131-02,SEVELAMER CARBONATE 2.4 G PO PACK,$74.96,$0.00,$74.96,$0.00,$53.50,$0.00,$0.00,$0.00,$0.00,$0.00,$74.96,$0.00,$37.48,$59.37,$59.97,$0.00,$0.00,$0.00,$0.00,$0.00
99744,ERX,HCPCS 25000001,58160-0818-11,HAEMOPHILUS B POLYSAC CONJ VAC 10 MCG IJ SOLR,$50.29,$0.00,$50.29,$0.00,$35.89,$0.00,$0.00,$0.00,$0.00,$0.00,$50.29,$0.00,$25.15,$39.83,$40.23,$0.00,$0.00,$0.00,$0.00,$0.00
99746,ERX,HCPCS 63700001,00456-2405-60,ASENAPINE MALEATE 5 MG SL SUBL,$84.06,$0.00,$84.06,$0.00,$59.99,$0.00,$0.00,$0.00,$0.00,$0.00,$84.06,$0.00,$42.03,$66.58,$67.25,$0.00,$0.00,$0.00,$0.00,$0.00
99765,ERX,HCPCS Q4074,66215-0303-00,ILOPROST 20 MCG/ML IN SOLN,$73.55,$0.00,$73.55,$0.00,$52.49,$0.00,$0.00,$0.00,$0.00,$0.00,$73.55,$0.00,$36.78,$58.25,$58.84,$0.00,$0.00,$0.00,$0.00,$0.00
99765,ERX,HCPCS Q4074,66215-0303-30,ILOPROST 20 MCG/ML IN SOLN,$73.55,$0.00,$73.55,$0.00,$52.49,$0.00,$0.00,$0.00,$0.00,$0.00,$73.55,$0.00,$36.78,$58.25,$58.84,$0.00,$0.00,$0.00,$0.00,$0.00
100004,ERX,HCPCS 63700001,16714-0866-01,PALIPERIDONE ER 1.5 MG PO TB24,$106.85,$0.00,$106.85,$0.00,$76.26,$0.00,$0.00,$0.00,$0.00,$0.00,$106.85,$0.00,$53.43,$84.63,$85.48,$0.00,$0.00,$0.00,$0.00,$0.00
100004,ERX,HCPCS 63700001,50458-0554-01,PALIPERIDONE ER 1.5 MG PO TB24,$106.85,$0.00,$106.85,$0.00,$76.26,$0.00,$0.00,$0.00,$0.00,$0.00,$106.85,$0.00,$53.43,$84.63,$85.48,$0.00,$0.00,$0.00,$0.00,$0.00
100055,ERX,HCPCS 25000001,00904-6422-81,PEG 3350 17 G PO PACK,$7.11,$0.00,$7.11,$0.00,$5.07,$0.00,$0.00,$0.00,$0.00,$0.00,$7.11,$0.00,$3.56,$5.63,$5.69,$0.00,$0.00,$0.00,$0.00,$0.00
100055,ERX,HCPCS 25000001,00904-6422-86,PEG 3350 17 G PO PACK,$7.11,$0.00,$7.11,$0.00,$5.07,$0.00,$0.00,$0.00,$0.00,$0.00,$7.11,$0.00,$3.56,$5.63,$5.69,$0.00,$0.00,$0.00,$0.00,$0.00
100055,ERX,HCPCS 25000001,00904-6931-81,PEG 3350 17 G PO PACK,$7.11,$0.00,$7.11,$0.00,$5.07,$0.00,$0.00,$0.00,$0.00,$0.00,$7.11,$0.00,$3.56,$5.63,$5.69,$0.00,$0.00,$0.00,$0.00,$0.00
100055,ERX,HCPCS 25000001,00904-6931-86,PEG 3350 17 G PO PACK,$7.11,$0.00,$7.11,$0.00,$5.07,$0.00,$0.00,$0.00,$0.00,$0.00,$7.11,$0.00,$3.56,$5.63,$5.69,$0.00,$0.00,$0.00,$0.00,$0.00
100212,ERX,HCPCS 25000001,24571-0105-06,PRISMASOL BGK 4/2.5 32-4-2.5 MEQ/L IV SOLN,$252.00,$0.00,$252.00,$0.00,$179.85,$0.00,$0.00,$0.00,$0.00,$0.00,$252.00,$0.00,$126.00,$199.58,$201.60,$0.00,$0.00,$0.00,$0.00,$0.00
100215,ERX,HCPCS 25000001,24571-0103-06,PRISMASOL BGK 2/3.5 32-2-3.5 MEQ/L IV SOLN,$252.00,$0.00,$252.00,$0.00,$179.85,$0.00,$0.00,$0.00,$0.00,$0.00,$252.00,$0.00,$126.00,$199.58,$201.60,$0.00,$0.00,$0.00,$0.00,$0.00
100258,ERX,HCPCS J9302,00078-0669-13,OFATUMUMAB 100 MG/5ML IV CONC,"$1,737.71",$0.00,"$1,737.71",$0.00,"$1,240.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,737.71",$0.00,$868.86,"$1,376.27","$1,390.17",$0.00,$0.00,$0.00,$0.00,$0.00
100258,ERX,HCPCS J9302,00078-0669-61,OFATUMUMAB 100 MG/5ML IV CONC,"$1,737.71",$0.00,"$1,737.71",$0.00,"$1,240.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,737.71",$0.00,$868.86,"$1,376.27","$1,390.17",$0.00,$0.00,$0.00,$0.00,$0.00
100265,ERX,HCPCS J0597,63833-0825-02,C1 ESTERASE INHIBITOR (HUMAN) 500 UNITS IV KIT,"$3,813,000.00",$0.00,"$3,813,000.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,813,000.00",$0.00,"$1,906,500.00","$3,019,896.00","$3,050,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
100482,ERX,HCPCS 63700001,42291-0266-01,VITAMIN D (ERGOCALCIFEROL) 1.25 MG (50000 UT) PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
100482,ERX,HCPCS 63700001,64380-0737-06,VITAMIN D (ERGOCALCIFEROL) 1.25 MG (50000 UT) PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
100482,ERX,HCPCS 63700001,69452-0151-20,VITAMIN D (ERGOCALCIFEROL) 1.25 MG (50000 UT) PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
100597,ERX,HCPCS 25000001,63481-0684-47,DICLOFENAC SODIUM 1 % TD GEL,$172.62,$0.00,$172.62,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$172.62,$0.00,$86.31,$136.72,$138.10,$0.00,$0.00,$0.00,$0.00,$0.00
100597,ERX,HCPCS 25000001,65162-0833-66,DICLOFENAC SODIUM 1 % TD GEL,$172.62,$0.00,$172.62,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$172.62,$0.00,$86.31,$136.72,$138.10,$0.00,$0.00,$0.00,$0.00,$0.00
100597,ERX,HCPCS 25000001,76282-0663-39,DICLOFENAC SODIUM 1 % TD GEL,$172.62,$0.00,$172.62,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$172.62,$0.00,$86.31,$136.72,$138.10,$0.00,$0.00,$0.00,$0.00,$0.00
101313,ERX,HCPCS 25000001,00132-0081-12,GLYCERIN (LAXATIVE) 1 G RECTAL SUPP,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
101316,ERX,HCPCS 63700001,99999-6012-26,VALGANCICLOVIR HCL 50 MG/ML PO SOLR,$312.03,$0.00,"$2,050.61",$0.00,"$1,463.52",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,050.61",$0.00,"$1,025.31",$247.13,"$1,640.49",$0.00,$0.00,$0.00,$0.00,$0.00
101316,ERX,HCPCS 63700001,00591-2579-20,VALGANCICLOVIR HCL 50 MG/ML PO SOLR,"$2,050.61",$0.00,"$2,050.61",$0.00,"$1,463.52",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,050.61",$0.00,"$1,025.31","$1,624.08","$1,640.49",$0.00,$0.00,$0.00,$0.00,$0.00
101316,ERX,HCPCS 63700001,27241-0159-19,VALGANCICLOVIR HCL 50 MG/ML PO SOLR,"$2,050.61",$0.00,"$2,050.61",$0.00,"$1,463.52",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,050.61",$0.00,"$1,025.31","$1,624.08","$1,640.49",$0.00,$0.00,$0.00,$0.00,$0.00
101323,ERX,HCPCS J3490,55150-0166-13,SILDENAFIL CITRATE 10 MG/12.5ML IV SOLN,$583.00,$0.00,$583.00,$262.35,$416.09,$0.00,$100.45,$0.00,$0.00,$102.08,$583.00,$0.00,$291.50,$461.74,$466.40,$0.00,$91.24,$0.00,$92.81,$0.00
101445,ERX,HCPCS J1742,00009-3794-01,IBUTILIDE FUMARATE 1 MG/10ML IV SOLN,"$1,302.53",$0.00,"$1,302.53",$0.00,$929.62,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,302.53",$0.00,$651.27,"$1,031.60","$1,042.02",$0.00,$0.00,$0.00,$0.00,$0.00
101445,ERX,HCPCS J1742,00009-3794-22,IBUTILIDE FUMARATE 1 MG/10ML IV SOLN,"$1,302.53",$0.00,"$1,302.53",$0.00,$929.62,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,302.53",$0.00,$651.27,"$1,031.60","$1,042.02",$0.00,$0.00,$0.00,$0.00,$0.00
101445,ERX,HCPCS J1742,67457-0366-10,IBUTILIDE FUMARATE 1 MG/10ML IV SOLN,"$1,302.53",$0.00,"$1,302.53",$0.00,$929.62,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,302.53",$0.00,$651.27,"$1,031.60","$1,042.02",$0.00,$0.00,$0.00,$0.00,$0.00
101583,ERX,HCPCS 63700001,68462-0719-29,NORGESTIM-ETH ESTRAD TRIPHASIC 0.18/0.215/0.25 MG-25 MCG PO TABS,$491.14,$0.00,$491.14,$0.00,$350.53,$0.00,$0.00,$0.00,$0.00,$0.00,$491.14,$0.00,$245.57,$388.98,$392.91,$0.00,$0.00,$0.00,$0.00,$0.00
101584,ERX,HCPCS 63700001,16714-0363-04,"ORTHO TRI-CYCLEN,TRINESSA,0.18/0.215/0.25 MG-35 MCG PO TABS",$188.75,$0.00,$188.75,$0.00,$134.71,$0.00,$0.00,$0.00,$0.00,$0.00,$188.75,$0.00,$94.38,$149.49,$151.00,$0.00,$0.00,$0.00,$0.00,$0.00
101700,ERX,HCPCS 63700001,00054-0407-13,RITONAVIR 100 MG PO TABS,$35.19,$0.00,$35.19,$0.00,$25.12,$0.00,$0.00,$0.00,$0.00,$0.00,$35.19,$0.00,$17.60,$27.87,$28.15,$0.00,$0.00,$0.00,$0.00,$0.00
101700,ERX,HCPCS 63700001,00074-3333-30,RITONAVIR 100 MG PO TABS,$35.19,$0.00,$35.19,$0.00,$25.12,$0.00,$0.00,$0.00,$0.00,$0.00,$35.19,$0.00,$17.60,$27.87,$28.15,$0.00,$0.00,$0.00,$0.00,$0.00
101700,ERX,HCPCS 63700001,31722-0597-30,RITONAVIR 100 MG PO TABS,$35.19,$0.00,$35.19,$0.00,$25.12,$0.00,$0.00,$0.00,$0.00,$0.00,$35.19,$0.00,$17.60,$27.87,$28.15,$0.00,$0.00,$0.00,$0.00,$0.00
101700,ERX,HCPCS 63700001,65862-0687-30,RITONAVIR 100 MG PO TABS,$35.19,$0.00,$35.19,$0.00,$25.12,$0.00,$0.00,$0.00,$0.00,$0.00,$35.19,$0.00,$17.60,$27.87,$28.15,$0.00,$0.00,$0.00,$0.00,$0.00
101739,ERX,HCPCS 90734,58160-0955-09,MENVEO MENINGOCOCCAL A C Y&W-135 OLIG IM SOLR,$492.37,$0.00,$492.37,$221.57,$351.40,$87.64,$9.40,$0.00,$0.00,$143.71,$492.37,$0.00,$246.19,$389.96,$393.90,$295.42,$143.71,$0.00,$136.84,$0.00
101739,ERX,HCPCS 90734,58160-0958-01,MENVEO MENINGOCOCCAL A C Y&W-135 OLIG IM SOLR,$492.37,$0.00,$492.37,$221.57,$351.40,$87.64,$9.40,$0.00,$0.00,$143.71,$492.37,$0.00,$246.19,$389.96,$393.90,$295.42,$143.71,$0.00,$136.84,$0.00
102036,ERX,HCPCS 63700001,00173-0695-04,FLUTICASONE-SALMETEROL 100-50 MCG/DOSE IN AEPB,$555.36,$0.00,$555.36,$0.00,$396.36,$0.00,$0.00,$0.00,$0.00,$0.00,$555.36,$0.00,$277.68,$439.85,$444.29,$0.00,$0.00,$0.00,$0.00,$0.00
102037,ERX,HCPCS 25000001,00173-0696-04,FLUTICASONE-SALMETEROL 250-50 MCG/DOSE IN AEPB,$555.36,$0.00,$555.36,$0.00,$396.36,$0.00,$0.00,$0.00,$0.00,$0.00,$555.36,$0.00,$277.68,$439.85,$444.29,$0.00,$0.00,$0.00,$0.00,$0.00
102038,ERX,HCPCS 25000001,00173-0697-00,FLUTICASONE-SALMETEROL 500-50 MCG/DOSE IN AEPB,$786.41,$0.00,$786.41,$0.00,$561.26,$0.00,$0.00,$0.00,$0.00,$0.00,$786.41,$0.00,$393.21,$622.84,$629.13,$0.00,$0.00,$0.00,$0.00,$0.00
102038,ERX,HCPCS 25000001,00173-0697-04,FLUTICASONE-SALMETEROL 500-50 MCG/DOSE IN AEPB,$786.41,$0.00,$786.41,$0.00,$561.26,$0.00,$0.00,$0.00,$0.00,$0.00,$786.41,$0.00,$393.21,$622.84,$629.13,$0.00,$0.00,$0.00,$0.00,$0.00
102040,ERX,HCPCS 63700001,00173-0526-00,LAMOTRIGINE 5 MG PO CHEW,$58.05,$0.00,$58.05,$0.00,$41.43,$0.00,$0.00,$0.00,$0.00,$0.00,$58.05,$0.00,$29.03,$45.98,$46.44,$0.00,$0.00,$0.00,$0.00,$0.00
102040,ERX,HCPCS 63700001,68462-0228-01,LAMOTRIGINE 5 MG PO CHEW,$58.05,$0.00,$58.05,$0.00,$41.43,$0.00,$0.00,$0.00,$0.00,$0.00,$58.05,$0.00,$29.03,$45.98,$46.44,$0.00,$0.00,$0.00,$0.00,$0.00
102053,ERX,HCPCS 63700001,00228-2996-11,TAMSULOSIN HCL 0.4 MG PO CAPS,$38.39,$0.00,$38.39,$0.00,$27.40,$0.00,$0.00,$0.00,$0.00,$0.00,$38.39,$0.00,$19.20,$30.40,$30.71,$0.00,$0.00,$0.00,$0.00,$0.00
102053,ERX,HCPCS 63700001,00228-2996-50,TAMSULOSIN HCL 0.4 MG PO CAPS,$38.39,$0.00,$38.39,$0.00,$27.40,$0.00,$0.00,$0.00,$0.00,$0.00,$38.39,$0.00,$19.20,$30.40,$30.71,$0.00,$0.00,$0.00,$0.00,$0.00
102053,ERX,HCPCS 63700001,00597-0058-01,TAMSULOSIN HCL 0.4 MG PO CAPS,$38.39,$0.00,$38.39,$0.00,$27.40,$0.00,$0.00,$0.00,$0.00,$0.00,$38.39,$0.00,$19.20,$30.40,$30.71,$0.00,$0.00,$0.00,$0.00,$0.00
102053,ERX,HCPCS 63700001,00781-2076-01,TAMSULOSIN HCL 0.4 MG PO CAPS,$38.39,$0.00,$38.39,$0.00,$27.40,$0.00,$0.00,$0.00,$0.00,$0.00,$38.39,$0.00,$19.20,$30.40,$30.71,$0.00,$0.00,$0.00,$0.00,$0.00
102053,ERX,HCPCS 63700001,00904-6401-61,TAMSULOSIN HCL 0.4 MG PO CAPS,$38.39,$0.00,$38.39,$0.00,$27.40,$0.00,$0.00,$0.00,$0.00,$0.00,$38.39,$0.00,$19.20,$30.40,$30.71,$0.00,$0.00,$0.00,$0.00,$0.00
102053,ERX,HCPCS 63700001,50268-0740-11,TAMSULOSIN HCL 0.4 MG PO CAPS,$38.39,$0.00,$38.39,$0.00,$27.40,$0.00,$0.00,$0.00,$0.00,$0.00,$38.39,$0.00,$19.20,$30.40,$30.71,$0.00,$0.00,$0.00,$0.00,$0.00
102053,ERX,HCPCS 63700001,50268-0740-15,TAMSULOSIN HCL 0.4 MG PO CAPS,$38.39,$0.00,$38.39,$0.00,$27.40,$0.00,$0.00,$0.00,$0.00,$0.00,$38.39,$0.00,$19.20,$30.40,$30.71,$0.00,$0.00,$0.00,$0.00,$0.00
102053,ERX,HCPCS 63700001,57237-0014-01,TAMSULOSIN HCL 0.4 MG PO CAPS,$38.39,$0.00,$38.39,$0.00,$27.40,$0.00,$0.00,$0.00,$0.00,$0.00,$38.39,$0.00,$19.20,$30.40,$30.71,$0.00,$0.00,$0.00,$0.00,$0.00
102053,ERX,HCPCS 63700001,63739-0567-10,TAMSULOSIN HCL 0.4 MG PO CAPS,$38.39,$0.00,$38.39,$0.00,$27.40,$0.00,$0.00,$0.00,$0.00,$0.00,$38.39,$0.00,$19.20,$30.40,$30.71,$0.00,$0.00,$0.00,$0.00,$0.00
102053,ERX,HCPCS 63700001,65862-0598-01,TAMSULOSIN HCL 0.4 MG PO CAPS,$38.39,$0.00,$38.39,$0.00,$27.40,$0.00,$0.00,$0.00,$0.00,$0.00,$38.39,$0.00,$19.20,$30.40,$30.71,$0.00,$0.00,$0.00,$0.00,$0.00
102053,ERX,HCPCS 63700001,65862-0598-05,TAMSULOSIN HCL 0.4 MG PO CAPS,$38.39,$0.00,$38.39,$0.00,$27.40,$0.00,$0.00,$0.00,$0.00,$0.00,$38.39,$0.00,$19.20,$30.40,$30.71,$0.00,$0.00,$0.00,$0.00,$0.00
102053,ERX,HCPCS 63700001,68084-0299-01,TAMSULOSIN HCL 0.4 MG PO CAPS,$38.39,$0.00,$38.39,$0.00,$27.40,$0.00,$0.00,$0.00,$0.00,$0.00,$38.39,$0.00,$19.20,$30.40,$30.71,$0.00,$0.00,$0.00,$0.00,$0.00
102058,ERX,HCPCS 90670,00005-1971-02,PNEUMOCOCCAL 13-VAL CONJ VACC IM SUSP,$641.98,$0.00,$641.98,$288.89,$458.18,$166.91,$110.61,$0.00,$0.00,$252.18,$641.98,$93.73,$320.99,$508.45,$513.58,$93.73,$252.18,$166.91,$240.12,$166.91
102397,ERX,HCPCS 63700001,65649-0303-03,RIFAXIMIN 550 MG PO TABS,$161.01,$0.00,$161.01,$0.00,$114.91,$0.00,$0.00,$0.00,$0.00,$0.00,$161.01,$0.00,$80.51,$127.52,$128.81,$0.00,$0.00,$0.00,$0.00,$0.00
102404,ERX,HCPCS 63700001,00173-0696-04,ADVAIR DISKUS 250-50 MCG/DOSE IN AEPB,$555.36,$0.00,$555.36,$0.00,$396.36,$0.00,$0.00,$0.00,$0.00,$0.00,$555.36,$0.00,$277.68,$439.85,$444.29,$0.00,$0.00,$0.00,$0.00,$0.00
102415,ERX,HCPCS 25000001,00143-9595-01,LIDOCAINE HCL (PF) 1 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
102415,ERX,HCPCS 25000001,00143-9595-25,LIDOCAINE HCL (PF) 1 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
102415,ERX,HCPCS 25000001,00409-4279-02,LIDOCAINE HCL (PF) 1 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
102415,ERX,HCPCS 25000001,00409-4279-16,LIDOCAINE HCL (PF) 1 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
102415,ERX,HCPCS 25000001,00409-4713-25,LIDOCAINE HCL (PF) 1 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
102415,ERX,HCPCS 25000001,00409-4713-42,LIDOCAINE HCL (PF) 1 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
102415,ERX,HCPCS 25000001,55150-0161-02,LIDOCAINE HCL (PF) 1 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
102415,ERX,HCPCS 25000001,55150-0162-05,LIDOCAINE HCL (PF) 1 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
102415,ERX,HCPCS 25000001,63323-0492-09,LIDOCAINE HCL (PF) 1 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
102415,ERX,HCPCS 25000001,63323-0492-27,LIDOCAINE HCL (PF) 1 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
102415,ERX,HCPCS 25000001,63323-0492-57,LIDOCAINE HCL (PF) 1 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
102416,ERX,HCPCS 25000001,00143-9594-01,LIDOCAINE HCL (PF) 2 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
102416,ERX,HCPCS 25000001,00143-9594-25,LIDOCAINE HCL (PF) 2 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
102416,ERX,HCPCS 25000001,55150-0165-05,LIDOCAINE HCL (PF) 2 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
102416,ERX,HCPCS 25000001,63323-0495-07,LIDOCAINE HCL (PF) 2 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
102429,ERX,HCPCS J0585,00023-1145-01,ONABOTULINUMTOXINA 100 UNITS IJ SOLR,"$1,730.88",$0.00,"$1,730.88",$778.90,"$1,235.33",$612.30,$642.73,$0.00,$0.00,$719.10,"$1,730.88",$642.92,$865.44,"$1,370.86","$1,384.70",$887.84,$719.10,$0.00,$684.71,$609.50
102430,ERX,HCPCS J3480,00264-7865-00,KCL IN NACL 20-0.9 MEQ/L-% IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.24,$0.00,$0.00,$1.65,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.65,$0.00,$0.00,$0.00
102430,ERX,HCPCS J3480,00338-0691-04,KCL IN NACL 20-0.9 MEQ/L-% IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.24,$0.00,$0.00,$1.65,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.65,$0.00,$0.00,$0.00
102431,ERX,HCPCS J3480,00338-0695-04,KCL IN NACL 40-0.9 MEQ/L-% IV SOLN,$41.80,$0.00,$41.80,$18.81,$29.83,$0.00,$0.47,$0.00,$0.00,$3.29,$41.80,$0.00,$20.90,$33.11,$33.44,$0.00,$3.29,$0.00,$3.13,$0.00
102431,ERX,HCPCS J3480,00990-7116-09,KCL IN NACL 40-0.9 MEQ/L-% IV SOLN,$41.80,$0.00,$41.80,$18.81,$29.83,$0.00,$0.47,$0.00,$0.00,$3.29,$41.80,$0.00,$20.90,$33.11,$33.44,$0.00,$3.29,$0.00,$3.13,$0.00
102452,ERX,HCPCS 25000001,00264-7652-00,KCL IN DEXTROSE-NACL 20-5-0.9 MEQ/L-%-% IV SOLN,$38.00,$0.00,$38.00,$0.00,$27.12,$0.00,$0.00,$0.00,$0.00,$0.00,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
102452,ERX,HCPCS 25000001,00338-0803-04,KCL IN DEXTROSE-NACL 20-5-0.9 MEQ/L-%-% IV SOLN,$38.00,$0.00,$38.00,$0.00,$27.12,$0.00,$0.00,$0.00,$0.00,$0.00,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
102453,ERX,HCPCS 25000001,00338-0807-04,KCL IN DEXTROSE-NACL 40-5-0.9 MEQ/L-%-% IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
102456,ERX,HCPCS 25000001,00264-7634-00,KCL IN DEXTROSE-NACL 10-5-0.45 MEQ/L-%-% IV SOLN,$38.00,$0.00,$38.00,$0.00,$27.12,$0.00,$0.00,$0.00,$0.00,$0.00,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
102456,ERX,HCPCS 25000001,00338-0669-04,KCL IN DEXTROSE-NACL 10-5-0.45 MEQ/L-%-% IV SOLN,$38.00,$0.00,$38.00,$0.00,$27.12,$0.00,$0.00,$0.00,$0.00,$0.00,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
102456,ERX,HCPCS 25000001,00409-7993-09,KCL IN DEXTROSE-NACL 10-5-0.45 MEQ/L-%-% IV SOLN,$38.00,$0.00,$38.00,$0.00,$27.12,$0.00,$0.00,$0.00,$0.00,$0.00,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
102458,ERX,HCPCS 25000001,00338-0663-04,KCL IN DEXTROSE-NACL 20-5-0.2 MEQ/L-%-% IV SOLN,$38.00,$0.00,$38.00,$0.00,$27.12,$0.00,$0.00,$0.00,$0.00,$0.00,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
102459,ERX,HCPCS 25000001,00264-7635-00,KCL IN DEXTROSE-NACL 20-5-0.45 MEQ/L-%-% IV SOLN,$22.80,$0.00,$22.80,$0.00,$16.27,$0.00,$0.00,$0.00,$0.00,$0.00,$22.80,$0.00,$11.40,$18.06,$18.24,$0.00,$0.00,$0.00,$0.00,$0.00
102459,ERX,HCPCS 25000001,00338-0671-04,KCL IN DEXTROSE-NACL 20-5-0.45 MEQ/L-%-% IV SOLN,$22.80,$0.00,$22.80,$0.00,$16.27,$0.00,$0.00,$0.00,$0.00,$0.00,$22.80,$0.00,$11.40,$18.06,$18.24,$0.00,$0.00,$0.00,$0.00,$0.00
102464,ERX,HCPCS 25000001,00264-7638-00,KCL IN DEXTROSE-NACL 40-5-0.45 MEQ/L-%-% IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
102464,ERX,HCPCS 25000001,00338-0675-04,KCL IN DEXTROSE-NACL 40-5-0.45 MEQ/L-%-% IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
102609,ERX,HCPCS J3315,00023-5906-23,TRIPTORELIN PAMOATE 22.5 MG IM SUSR,"$12,003.43",$0.00,"$9,602.74",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$9,506.72","$9,602.74",$0.00,$0.00,$0.00,$0.00,$0.00
103164,ERX,HCPCS 63700001,00591-3720-30,TRANEXAMIC ACID 650 MG PO TABS,$39.63,$0.00,$39.63,$0.00,$28.28,$0.00,$0.00,$0.00,$0.00,$0.00,$39.63,$0.00,$19.82,$31.39,$31.70,$0.00,$0.00,$0.00,$0.00,$0.00
103164,ERX,HCPCS 63700001,60505-3638-03,TRANEXAMIC ACID 650 MG PO TABS,$39.63,$0.00,$39.63,$0.00,$28.28,$0.00,$0.00,$0.00,$0.00,$0.00,$39.63,$0.00,$19.82,$31.39,$31.70,$0.00,$0.00,$0.00,$0.00,$0.00
103164,ERX,HCPCS 63700001,69918-0301-30,TRANEXAMIC ACID 650 MG PO TABS,$39.63,$0.00,$39.63,$0.00,$28.28,$0.00,$0.00,$0.00,$0.00,$0.00,$39.63,$0.00,$19.82,$31.39,$31.70,$0.00,$0.00,$0.00,$0.00,$0.00
103332,ERX,HCPCS 25000001,54162-0185-16,MINERAL OIL LIGHT 100 % EX OIL,$14.35,$0.00,$11.37,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$11.37,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
103727,ERX,HCPCS 25000001,00143-9637-10,VALPROATE SODIUM 500 MG/5ML IV SOLN,$72.61,$0.00,$72.61,$0.00,$51.82,$0.00,$0.00,$0.00,$0.00,$0.00,$72.61,$0.00,$36.31,$57.51,$58.09,$0.00,$0.00,$0.00,$0.00,$0.00
103727,ERX,HCPCS 25000001,00143-9785-10,VALPROATE SODIUM 500 MG/5ML IV SOLN,$72.61,$0.00,$72.61,$0.00,$51.82,$0.00,$0.00,$0.00,$0.00,$0.00,$72.61,$0.00,$36.31,$57.51,$58.09,$0.00,$0.00,$0.00,$0.00,$0.00
103727,ERX,HCPCS 25000001,63323-0494-01,VALPROATE SODIUM 500 MG/5ML IV SOLN,$72.61,$0.00,$72.61,$0.00,$51.82,$0.00,$0.00,$0.00,$0.00,$0.00,$72.61,$0.00,$36.31,$57.51,$58.09,$0.00,$0.00,$0.00,$0.00,$0.00
103727,ERX,HCPCS 25000001,63323-0494-05,VALPROATE SODIUM 500 MG/5ML IV SOLN,$72.61,$0.00,$72.61,$0.00,$51.82,$0.00,$0.00,$0.00,$0.00,$0.00,$72.61,$0.00,$36.31,$57.51,$58.09,$0.00,$0.00,$0.00,$0.00,$0.00
103756,ERX,HCPCS 63700001,00078-0592-51,NILOTINIB HCL 150 MG PO CAPS,$480.90,$0.00,$480.90,$0.00,$343.22,$0.00,$0.00,$0.00,$0.00,$0.00,$480.90,$0.00,$240.45,$380.87,$384.72,$0.00,$0.00,$0.00,$0.00,$0.00
104015,ERX,HCPCS J9043,00024-5824-11,CABAZITAXEL 60 MG/1.5ML IV SOLN,"$28,392.12",$0.00,"$28,392.12","$12,776.45","$5,158.80","$10,419.96","$4,891.82",$0.00,$0.00,"$8,138.89","$28,392.12","$10,940.96","$14,196.06","$22,486.56","$22,713.70","$15,108.94","$8,138.89",$0.00,"$8,138.89","$10,888.38"
104022,ERX,HCPCS 63700001,67618-0107-60,MAGNESIUM CHLORIDE DELAY RELEASE 71.5 MG PO TAB,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
104100,ERX,HCPCS J7527,00078-0594-51,EVEROLIMUS 2.5 MG PO TABS,"$1,544.53",$0.00,"$1,544.53",$0.00,"$1,102.33",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,544.53",$0.00,$772.27,"$1,223.27","$1,235.62",$0.00,$0.00,$0.00,$0.00,$0.00
104174,ERX,HCPCS J1650,00075-0624-30,ENOXAPARIN SODIUM 30 MG/0.3ML SC SOLN,$27.23,$0.00,$27.23,$12.25,$19.43,$0.00,$4.69,$0.00,$0.00,$4.77,$27.23,$0.00,$13.62,$21.57,$21.78,$0.00,$4.26,$0.00,$4.34,$0.00
104174,ERX,HCPCS J1650,00548-5601-00,ENOXAPARIN SODIUM 30 MG/0.3ML SC SOLN,$27.23,$0.00,$27.23,$12.25,$19.43,$0.00,$4.69,$0.00,$0.00,$4.77,$27.23,$0.00,$13.62,$21.57,$21.78,$0.00,$4.26,$0.00,$4.34,$0.00
104174,ERX,HCPCS J1650,00548-5631-00,ENOXAPARIN SODIUM 30 MG/0.3ML SC SOLN,$27.23,$0.00,$27.23,$12.25,$19.43,$0.00,$4.69,$0.00,$0.00,$4.77,$27.23,$0.00,$13.62,$21.57,$21.78,$0.00,$4.26,$0.00,$4.34,$0.00
104174,ERX,HCPCS J1650,00703-8530-23,ENOXAPARIN SODIUM 30 MG/0.3ML SC SOLN,$27.23,$0.00,$27.23,$12.25,$19.43,$0.00,$4.69,$0.00,$0.00,$4.77,$27.23,$0.00,$13.62,$21.57,$21.78,$0.00,$4.26,$0.00,$4.34,$0.00
104174,ERX,HCPCS J1650,00781-3133-63,ENOXAPARIN SODIUM 30 MG/0.3ML SC SOLN,$27.23,$0.00,$27.23,$12.25,$19.43,$0.00,$4.69,$0.00,$0.00,$4.77,$27.23,$0.00,$13.62,$21.57,$21.78,$0.00,$4.26,$0.00,$4.34,$0.00
104174,ERX,HCPCS J1650,00955-1003-01,ENOXAPARIN SODIUM 30 MG/0.3ML SC SOLN,$27.23,$0.00,$27.23,$12.25,$19.43,$0.00,$4.69,$0.00,$0.00,$4.77,$27.23,$0.00,$13.62,$21.57,$21.78,$0.00,$4.26,$0.00,$4.34,$0.00
104174,ERX,HCPCS J1650,00955-1003-10,ENOXAPARIN SODIUM 30 MG/0.3ML SC SOLN,$27.23,$0.00,$27.23,$12.25,$19.43,$0.00,$4.69,$0.00,$0.00,$4.77,$27.23,$0.00,$13.62,$21.57,$21.78,$0.00,$4.26,$0.00,$4.34,$0.00
104174,ERX,HCPCS J1650,63323-0568-83,ENOXAPARIN SODIUM 30 MG/0.3ML SC SOLN,$27.23,$0.00,$27.23,$12.25,$19.43,$0.00,$4.69,$0.00,$0.00,$4.77,$27.23,$0.00,$13.62,$21.57,$21.78,$0.00,$4.26,$0.00,$4.34,$0.00
104175,ERX,HCPCS J1650,00548-5602-00,ENOXAPARIN SODIUM 40 MG/0.4ML SC SOLN,$124.89,$0.00,$98.91,$17.52,$27.79,$0.00,$21.52,$0.00,$0.00,$6.82,$38.94,$0.00,$19.47,$98.91,$31.15,$0.00,$19.55,$0.00,$6.20,$0.00
104175,ERX,HCPCS J1650,00703-8540-23,ENOXAPARIN SODIUM 40 MG/0.4ML SC SOLN,$124.89,$0.00,$98.91,$17.52,$27.79,$0.00,$21.52,$0.00,$0.00,$6.82,$38.94,$0.00,$19.47,$98.91,$31.15,$0.00,$19.55,$0.00,$6.20,$0.00
104175,ERX,HCPCS J1650,00781-3224-64,ENOXAPARIN SODIUM 40 MG/0.4ML SC SOLN,$124.89,$0.00,$98.91,$17.52,$27.79,$0.00,$21.52,$0.00,$0.00,$6.82,$38.94,$0.00,$19.47,$98.91,$31.15,$0.00,$19.55,$0.00,$6.20,$0.00
104175,ERX,HCPCS J1650,00955-1004-01,ENOXAPARIN SODIUM 40 MG/0.4ML SC SOLN,$124.89,$0.00,$98.91,$17.52,$27.79,$0.00,$21.52,$0.00,$0.00,$6.82,$38.94,$0.00,$19.47,$98.91,$31.15,$0.00,$19.55,$0.00,$6.20,$0.00
104175,ERX,HCPCS J1650,00955-1004-10,ENOXAPARIN SODIUM 40 MG/0.4ML SC SOLN,$124.89,$0.00,$98.91,$17.52,$27.79,$0.00,$21.52,$0.00,$0.00,$6.82,$38.94,$0.00,$19.47,$98.91,$31.15,$0.00,$19.55,$0.00,$6.20,$0.00
104176,ERX,HCPCS J1650,00548-5603-00,ENOXAPARIN SODIUM 60 MG/0.6ML SC SOLN,$22.88,$0.00,$22.88,$10.30,$16.33,$0.00,$3.94,$0.00,$0.00,$4.01,$22.88,$0.00,$11.44,$18.12,$18.30,$0.00,$3.58,$0.00,$0.00,$0.00
104176,ERX,HCPCS J1650,00781-3356-66,ENOXAPARIN SODIUM 60 MG/0.6ML SC SOLN,$22.88,$0.00,$22.88,$10.30,$16.33,$0.00,$3.94,$0.00,$0.00,$4.01,$22.88,$0.00,$11.44,$18.12,$18.30,$0.00,$3.58,$0.00,$0.00,$0.00
104176,ERX,HCPCS J1650,00955-1006-01,ENOXAPARIN SODIUM 60 MG/0.6ML SC SOLN,$22.88,$0.00,$22.88,$10.30,$16.33,$0.00,$3.94,$0.00,$0.00,$4.01,$22.88,$0.00,$11.44,$18.12,$18.30,$0.00,$3.58,$0.00,$0.00,$0.00
104176,ERX,HCPCS J1650,00955-1006-10,ENOXAPARIN SODIUM 60 MG/0.6ML SC SOLN,$22.88,$0.00,$22.88,$10.30,$16.33,$0.00,$3.94,$0.00,$0.00,$4.01,$22.88,$0.00,$11.44,$18.12,$18.30,$0.00,$3.58,$0.00,$0.00,$0.00
104176,ERX,HCPCS J1650,63323-0607-88,ENOXAPARIN SODIUM 60 MG/0.6ML SC SOLN,$22.88,$0.00,$22.88,$10.30,$16.33,$0.00,$3.94,$0.00,$0.00,$4.01,$22.88,$0.00,$11.44,$18.12,$18.30,$0.00,$3.58,$0.00,$0.00,$0.00
104177,ERX,HCPCS J1650,00548-5604-00,ENOXAPARIN SODIUM 80 MG/0.8ML SC SOLN,$63.45,$0.00,$63.45,$28.55,$45.28,$0.00,$10.93,$0.00,$0.00,$11.11,$63.45,$0.00,$31.73,$50.25,$50.76,$0.00,$9.93,$0.00,$0.00,$0.00
104177,ERX,HCPCS J1650,00781-3428-68,ENOXAPARIN SODIUM 80 MG/0.8ML SC SOLN,$63.45,$0.00,$63.45,$28.55,$45.28,$0.00,$10.93,$0.00,$0.00,$11.11,$63.45,$0.00,$31.73,$50.25,$50.76,$0.00,$9.93,$0.00,$0.00,$0.00
104177,ERX,HCPCS J1650,00955-1008-01,ENOXAPARIN SODIUM 80 MG/0.8ML SC SOLN,$63.45,$0.00,$63.45,$28.55,$45.28,$0.00,$10.93,$0.00,$0.00,$11.11,$63.45,$0.00,$31.73,$50.25,$50.76,$0.00,$9.93,$0.00,$0.00,$0.00
104177,ERX,HCPCS J1650,00955-1008-10,ENOXAPARIN SODIUM 80 MG/0.8ML SC SOLN,$63.45,$0.00,$63.45,$28.55,$45.28,$0.00,$10.93,$0.00,$0.00,$11.11,$63.45,$0.00,$31.73,$50.25,$50.76,$0.00,$9.93,$0.00,$0.00,$0.00
104177,ERX,HCPCS J1650,63323-0531-90,ENOXAPARIN SODIUM 80 MG/0.8ML SC SOLN,$63.45,$0.00,$63.45,$28.55,$45.28,$0.00,$10.93,$0.00,$0.00,$11.11,$63.45,$0.00,$31.73,$50.25,$50.76,$0.00,$9.93,$0.00,$0.00,$0.00
104178,ERX,HCPCS J1650,00955-1010-10,ENOXAPARIN SODIUM 100 MG/ML SC SOLN,$75.15,$0.00,$75.15,$33.82,$53.63,$0.00,$12.95,$0.00,$0.00,$13.16,$75.15,$0.00,$37.58,$59.52,$60.12,$0.00,$11.76,$0.00,$0.00,$0.00
104178,ERX,HCPCS J1650,63323-0605-84,ENOXAPARIN SODIUM 100 MG/ML SC SOLN,$75.15,$0.00,$75.15,$33.82,$53.63,$0.00,$12.95,$0.00,$0.00,$13.16,$75.15,$0.00,$37.58,$59.52,$60.12,$0.00,$11.76,$0.00,$0.00,$0.00
104179,ERX,HCPCS J1650,00548-5606-00,ENOXAPARIN SODIUM 120 MG/0.8ML SC SOLN,$100.17,$0.00,$100.17,$45.08,$71.49,$0.00,$17.26,$0.00,$0.00,$17.54,$100.17,$0.00,$50.09,$79.33,$80.14,$0.00,$15.68,$0.00,$0.00,$0.00
104179,ERX,HCPCS J1650,00781-3612-68,ENOXAPARIN SODIUM 120 MG/0.8ML SC SOLN,$100.17,$0.00,$100.17,$45.08,$71.49,$0.00,$17.26,$0.00,$0.00,$17.54,$100.17,$0.00,$50.09,$79.33,$80.14,$0.00,$15.68,$0.00,$0.00,$0.00
104179,ERX,HCPCS J1650,00955-1012-10,ENOXAPARIN SODIUM 120 MG/0.8ML SC SOLN,$100.17,$0.00,$100.17,$45.08,$71.49,$0.00,$17.26,$0.00,$0.00,$17.54,$100.17,$0.00,$50.09,$79.33,$80.14,$0.00,$15.68,$0.00,$0.00,$0.00
104179,ERX,HCPCS J1650,16714-0056-01,ENOXAPARIN SODIUM 120 MG/0.8ML SC SOLN,$100.17,$0.00,$100.17,$45.08,$71.49,$0.00,$17.26,$0.00,$0.00,$17.54,$100.17,$0.00,$50.09,$79.33,$80.14,$0.00,$15.68,$0.00,$0.00,$0.00
104179,ERX,HCPCS J1650,63323-0609-90,ENOXAPARIN SODIUM 120 MG/0.8ML SC SOLN,$100.17,$0.00,$100.17,$45.08,$71.49,$0.00,$17.26,$0.00,$0.00,$17.54,$100.17,$0.00,$50.09,$79.33,$80.14,$0.00,$15.68,$0.00,$0.00,$0.00
104407,ERX,HCPCS J0588,00259-1610-01,INCOBOTULINUMTOXINA 100 UNITS IM SOLR,"$1,388.16",$0.00,"$1,388.16",$0.00,$990.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,388.16",$0.00,$694.08,"$1,099.42","$1,110.53",$0.00,$0.00,$0.00,$0.00,$0.00
104804,ERX,HCPCS 63700001,00023-3205-03,BIMATOPROST 0.01 % OP SOLN,$657.68,$0.00,$657.68,$0.00,$469.39,$0.00,$0.00,$0.00,$0.00,$0.00,$657.68,$0.00,$328.84,$520.88,$526.14,$0.00,$0.00,$0.00,$0.00,$0.00
104817,ERX,HCPCS 25000001,00310-6512-01,EXENATIDE 5 MCG/0.02ML SC SOPN,$57.12,$0.00,$57.12,$0.00,$40.77,$0.00,$0.00,$0.00,$0.00,$0.00,$57.12,$0.00,$28.56,$45.24,$45.70,$0.00,$0.00,$0.00,$0.00,$0.00
104818,ERX,HCPCS 25000001,00310-6524-01,EXENATIDE 10 MCG/0.04ML SC SOPN,$57.12,$0.00,$57.12,$0.00,$40.77,$0.00,$0.00,$0.00,$0.00,$0.00,$57.12,$0.00,$28.56,$45.24,$45.70,$0.00,$0.00,$0.00,$0.00,$0.00
104822,ERX,HCPCS 25000001,00409-1746-10,BUPIVACAINE-EPINEPHRINE (PF) 0.25% -1:200000 IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
104822,ERX,HCPCS 25000001,00409-1746-30,BUPIVACAINE-EPINEPHRINE (PF) 0.25% -1:200000 IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
104822,ERX,HCPCS 25000001,00409-1746-71,BUPIVACAINE-EPINEPHRINE (PF) 0.25% -1:200000 IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
104822,ERX,HCPCS 25000001,00409-9042-01,BUPIVACAINE-EPINEPHRINE (PF) 0.25% -1:200000 IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
104822,ERX,HCPCS 25000001,00409-9042-17,BUPIVACAINE-EPINEPHRINE (PF) 0.25% -1:200000 IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
104822,ERX,HCPCS 25000001,63323-0468-01,BUPIVACAINE-EPINEPHRINE (PF) 0.25% -1:200000 IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
104822,ERX,HCPCS 25000001,63323-0468-02,BUPIVACAINE-EPINEPHRINE (PF) 0.25% -1:200000 IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
104822,ERX,HCPCS 25000001,63323-0468-17,BUPIVACAINE-EPINEPHRINE (PF) 0.25% -1:200000 IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
104822,ERX,HCPCS 25000001,63323-0468-37,BUPIVACAINE-EPINEPHRINE (PF) 0.25% -1:200000 IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
104823,ERX,HCPCS 25000001,00409-9045-01,BUPIVACAINE-EPINEPHRINE (PF) 0.5-1:200000 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
104823,ERX,HCPCS 25000001,00409-9045-17,BUPIVACAINE-EPINEPHRINE (PF) 0.5-1:200000 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
104823,ERX,HCPCS 25000001,31382-0557-05,BUPIVACAINE-EPINEPHRINE (PF) 0.5-1:200000 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
104823,ERX,HCPCS 25000001,63323-0462-01,BUPIVACAINE-EPINEPHRINE (PF) 0.5-1:200000 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
104823,ERX,HCPCS 25000001,63323-0462-17,BUPIVACAINE-EPINEPHRINE (PF) 0.5-1:200000 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
104823,ERX,HCPCS 25000001,63323-0462-31,BUPIVACAINE-EPINEPHRINE (PF) 0.5-1:200000 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
104823,ERX,HCPCS 25000001,63323-0462-37,BUPIVACAINE-EPINEPHRINE (PF) 0.5-1:200000 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
104825,ERX,HCPCS J0670,00409-1036-30,MEPIVACAINE HCL (PF) 1 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
104825,ERX,HCPCS J0670,63323-0260-37,MEPIVACAINE HCL (PF) 1 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
104826,ERX,HCPCS J0670,00409-1067-20,MEPIVACAINE HCL (PF) 2 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
104826,ERX,HCPCS J0670,63323-0294-27,MEPIVACAINE HCL (PF) 2 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
104827,ERX,HCPCS 25000001,00409-1159-02,BUPIVACAINE HCL (PF) 0.25 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
104827,ERX,HCPCS 25000001,00409-1559-10,BUPIVACAINE HCL (PF) 0.25 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
104827,ERX,HCPCS 25000001,00409-1559-30,BUPIVACAINE HCL (PF) 0.25 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
104827,ERX,HCPCS 25000001,55150-0167-10,BUPIVACAINE HCL (PF) 0.25 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
104827,ERX,HCPCS 25000001,55150-0168-30,BUPIVACAINE HCL (PF) 0.25 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
104827,ERX,HCPCS 25000001,63323-0464-01,BUPIVACAINE HCL (PF) 0.25 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
104827,ERX,HCPCS 25000001,63323-0464-17,BUPIVACAINE HCL (PF) 0.25 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
104827,ERX,HCPCS 25000001,63323-0464-31,BUPIVACAINE HCL (PF) 0.25 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
104827,ERX,HCPCS 25000001,63323-0464-37,BUPIVACAINE HCL (PF) 0.25 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
104828,ERX,HCPCS 25000001,00409-1162-01,BUPIVACAINE HCL (PF) 0.5 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
104828,ERX,HCPCS 25000001,00409-1162-02,BUPIVACAINE HCL (PF) 0.5 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
104828,ERX,HCPCS 25000001,00409-1162-09,BUPIVACAINE HCL (PF) 0.5 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
104828,ERX,HCPCS 25000001,00409-1162-10,BUPIVACAINE HCL (PF) 0.5 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
104828,ERX,HCPCS 25000001,55150-0169-10,BUPIVACAINE HCL (PF) 0.5 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
104828,ERX,HCPCS 25000001,55150-0170-30,BUPIVACAINE HCL (PF) 0.5 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
104828,ERX,HCPCS 25000001,63323-0466-17,BUPIVACAINE HCL (PF) 0.5 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
104828,ERX,HCPCS 25000001,63323-0466-37,BUPIVACAINE HCL (PF) 0.5 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
104858,ERX,HCPCS 25000001,12496-1202-01,SUBOXONE:BUPRENORPHINE HCL-NALOXONE HCL 2-0.5 MG SL FILM,$22.85,$0.00,$22.85,$0.00,$16.31,$0.00,$0.00,$0.00,$0.00,$0.00,$22.85,$0.00,$11.43,$18.10,$18.28,$0.00,$0.00,$0.00,$0.00,$0.00
104858,ERX,HCPCS 25000001,12496-1202-03,SUBOXONE:BUPRENORPHINE HCL-NALOXONE HCL 2-0.5 MG SL FILM,$22.85,$0.00,$22.85,$0.00,$16.31,$0.00,$0.00,$0.00,$0.00,$0.00,$22.85,$0.00,$11.43,$18.10,$18.28,$0.00,$0.00,$0.00,$0.00,$0.00
104859,ERX,HCPCS 25000001,12496-1208-01,SUBOXONE:BUPRENORPHINE HCL-NALOXONE HCL 8-2 MG SL FILM,$40.95,$0.00,$40.95,$0.00,$29.23,$0.00,$0.00,$0.00,$0.00,$0.00,$40.95,$0.00,$20.48,$32.43,$32.76,$0.00,$0.00,$0.00,$0.00,$0.00
104859,ERX,HCPCS 25000001,12496-1208-03,SUBOXONE:BUPRENORPHINE HCL-NALOXONE HCL 8-2 MG SL FILM,$40.95,$0.00,$40.95,$0.00,$29.23,$0.00,$0.00,$0.00,$0.00,$0.00,$40.95,$0.00,$20.48,$32.43,$32.76,$0.00,$0.00,$0.00,$0.00,$0.00
104955,ERX,HCPCS J0257,00944-2884-01,ALPHA1-PROTEINASE INHIBITOR 1000 MG/50ML IV SOLN,"$1,632.00",$0.00,"$1,632.00",$0.00,"$1,164.76",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,632.00",$0.00,$816.00,"$1,292.54","$1,305.60",$0.00,$0.00,$0.00,$0.00,$0.00
104955,ERX,HCPCS J0257,00944-2884-02,ALPHA1-PROTEINASE INHIBITOR 1000 MG/50ML IV SOLN,"$1,632.00",$0.00,"$1,632.00",$0.00,"$1,164.76",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,632.00",$0.00,$816.00,"$1,292.54","$1,305.60",$0.00,$0.00,$0.00,$0.00,$0.00
105032,ERX,HCPCS 25000001,00409-4278-01,LIDOCAINE HCL (PF) 0.5 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
105032,ERX,HCPCS 25000001,63323-0491-57,LIDOCAINE HCL (PF) 0.5 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
105342,ERX,HCPCS 63700001,00597-0360-82,DABIGATRAN ETEXILATE MESYLATE 150 MG PO CAPS,$34.86,$0.00,$34.86,$0.00,$24.88,$0.00,$0.00,$0.00,$0.00,$0.00,$34.86,$0.00,$17.43,$27.61,$27.89,$0.00,$0.00,$0.00,$0.00,$0.00
105514,ERX,HCPCS 63700001,00597-0355-09,DABIGATRAN ETEXILATE MESYLATE 75 MG PO CAPS,$30.45,$0.00,$30.45,$0.00,$21.73,$0.00,$0.00,$0.00,$0.00,$0.00,$30.45,$0.00,$15.23,$24.12,$24.36,$0.00,$0.00,$0.00,$0.00,$0.00
105737,ERX,HCPCS J9179,62856-0389-01,ERIBULIN MESYLATE 1 MG/2ML IV SOLN,"$2,902.80",$0.00,"$2,902.80","$1,306.26","$2,071.73","$1,142.74",$0.00,$0.00,$0.00,"$1,365.82","$2,902.80","$1,199.88","$1,451.40","$2,299.02","$2,322.24","$1,656.97",$0.00,$0.00,"$1,300.49","$1,174.22"
105747,ERX,HCPCS J1453,00006-3061-00,FOSAPREPITANT DIMEGLUMINE 150 MG IV SOLR,$956.65,$0.00,$956.65,$430.49,$682.76,$295.35,$164.83,$0.00,$0.00,$348.98,$956.65,$310.12,$478.33,$757.67,$765.32,$428.26,$348.98,$0.00,$332.28,$161.25
105747,ERX,HCPCS J1453,00006-3061-04,FOSAPREPITANT DIMEGLUMINE 150 MG IV SOLR,$956.65,$0.00,$956.65,$430.49,$682.76,$295.35,$164.83,$0.00,$0.00,$348.98,$956.65,$310.12,$478.33,$757.67,$765.32,$428.26,$348.98,$0.00,$332.28,$161.25
105747,ERX,HCPCS J1453,60505-6105-01,FOSAPREPITANT DIMEGLUMINE 150 MG IV SOLR,$956.65,$0.00,$956.65,$430.49,$682.76,$295.35,$164.83,$0.00,$0.00,$348.98,$956.65,$310.12,$478.33,$757.67,$765.32,$428.26,$348.98,$0.00,$332.28,$161.25
105747,ERX,HCPCS J1453,67457-0889-10,FOSAPREPITANT DIMEGLUMINE 150 MG IV SOLR,$956.65,$0.00,$956.65,$430.49,$682.76,$295.35,$164.83,$0.00,$0.00,$348.98,$956.65,$310.12,$478.33,$757.67,$765.32,$428.26,$348.98,$0.00,$332.28,$161.25
105747,ERX,HCPCS J1453,71288-0418-10,FOSAPREPITANT DIMEGLUMINE 150 MG IV SOLR,$956.65,$0.00,$956.65,$430.49,$682.76,$295.35,$164.83,$0.00,$0.00,$348.98,$956.65,$310.12,$478.33,$757.67,$765.32,$428.26,$348.98,$0.00,$332.28,$161.25
105747,ERX,HCPCS J1453,71839-0104-01,FOSAPREPITANT DIMEGLUMINE 150 MG IV SOLR,$956.65,$0.00,$956.65,$430.49,$682.76,$295.35,$164.83,$0.00,$0.00,$348.98,$956.65,$310.12,$478.33,$757.67,$765.32,$428.26,$348.98,$0.00,$332.28,$161.25
105768,ERX,HCPCS J0897,55513-0730-01,DENOSUMAB 120 MG/1.7ML SC SOLN,"$5,786.54",$0.00,"$5,786.54","$2,603.94","$4,129.85","$2,313.12",$996.99,$0.00,$0.00,"$2,718.48","$5,786.54","$2,428.78","$2,893.27","$4,582.94","$4,629.23","$3,354.02","$2,718.48",$0.00,"$2,588.46","$2,388.12"
106031,ERX,HCPCS 25000001,63402-0304-30,LURASIDONE HCL 40 MG PO TABS,$161.71,$0.00,$161.71,$0.00,$115.41,$0.00,$0.00,$0.00,$0.00,$0.00,$161.71,$0.00,$80.86,$128.07,$129.37,$0.00,$0.00,$0.00,$0.00,$0.00
106032,ERX,HCPCS 25000001,63402-0308-10,LURASIDONE HCL 80 MG PO TABS,$161.71,$0.00,$161.71,$0.00,$115.41,$0.00,$0.00,$0.00,$0.00,$0.00,$161.71,$0.00,$80.86,$128.07,$129.37,$0.00,$0.00,$0.00,$0.00,$0.00
106032,ERX,HCPCS 25000001,63402-0308-30,LURASIDONE HCL 80 MG PO TABS,$161.71,$0.00,$161.71,$0.00,$115.41,$0.00,$0.00,$0.00,$0.00,$0.00,$161.71,$0.00,$80.86,$128.07,$129.37,$0.00,$0.00,$0.00,$0.00,$0.00
106033,ERX,HCPCS J0712,00456-0400-01,CEFTAROLINE FOSAMIL 400 MG IV SOLR,$641.50,$0.00,$641.50,$0.00,$457.84,$0.00,$0.00,$0.00,$0.00,$0.00,$641.50,$0.00,$320.75,$508.07,$513.20,$0.00,$0.00,$0.00,$0.00,$0.00
106033,ERX,HCPCS J0712,00456-0400-10,CEFTAROLINE FOSAMIL 400 MG IV SOLR,$641.50,$0.00,$641.50,$0.00,$457.84,$0.00,$0.00,$0.00,$0.00,$0.00,$641.50,$0.00,$320.75,$508.07,$513.20,$0.00,$0.00,$0.00,$0.00,$0.00
106034,ERX,HCPCS J0712,00456-0600-01,CEFTAROLINE FOSAMIL 600 MG IV SOLR,$641.50,$0.00,$641.50,$0.00,$457.84,$0.00,$0.00,$0.00,$0.00,$0.00,$641.50,$0.00,$320.75,$508.07,$513.20,$0.00,$0.00,$0.00,$0.00,$0.00
106034,ERX,HCPCS J0712,00456-0600-10,CEFTAROLINE FOSAMIL 600 MG IV SOLR,$641.50,$0.00,$641.50,$0.00,$457.84,$0.00,$0.00,$0.00,$0.00,$0.00,$641.50,$0.00,$320.75,$508.07,$513.20,$0.00,$0.00,$0.00,$0.00,$0.00
106035,ERX,HCPCS 25000001,64597-0301-60,DEXTROMETHORPHAN-QUINIDINE 20-10 MG PO CAPS,$87.53,$0.00,$87.53,$0.00,$62.47,$0.00,$0.00,$0.00,$0.00,$0.00,$87.53,$0.00,$43.77,$69.32,$70.02,$0.00,$0.00,$0.00,$0.00,$0.00
106115,ERX,HCPCS J1561,13533-0800-20,IMMUNE GLOBULIN (HUMAN) 5 GM/50ML IJ SOLN,"$1,716.48",$0.00,"$1,759.44",$791.75,"$1,255.71",$391.40,$295.74,$0.00,$0.00,$474.11,"$1,759.44",$410.97,$879.72,"$1,359.45","$1,407.55",$567.53,$474.11,$0.00,$451.44,$416.91
106116,ERX,HCPCS J1561,13533-0800-71,IMMUNE GLOBULIN (HUMAN) 10 GM/100ML IJ SOLN,"$2,932.53",$0.00,"$3,005.71","$1,352.57","$2,145.18",$782.80,$505.26,$0.00,$0.00,$948.23,"$3,005.71",$821.94,"$1,502.86","$2,322.56","$2,404.57","$1,135.06",$948.23,$0.00,$902.87,$833.82
106117,ERX,HCPCS J1561,13533-0800-24,IMMUNE GLOBULIN (HUMAN) 20 GM/200ML IJ SOLN,"$5,865.05",$0.00,"$6,011.42","$2,705.14","$4,290.35","$1,565.60","$1,010.52",$0.00,$0.00,"$1,896.45","$6,011.42","$1,643.88","$3,005.71","$4,645.12","$4,809.14","$2,270.12","$1,896.45",$0.00,"$1,805.74","$1,667.64"
106117,ERX,HCPCS J1561,13533-0800-25,IMMUNE GLOBULIN (HUMAN) 20 GM/200ML IJ SOLN,"$5,865.05",$0.00,"$6,011.42","$2,705.14","$4,290.35","$1,565.60","$1,010.52",$0.00,$0.00,"$1,896.45","$6,011.42","$1,643.88","$3,005.71","$4,645.12","$4,809.14","$2,270.12","$1,896.45",$0.00,"$1,805.74","$1,667.64"
106201,ERX,HCPCS 63700001,00121-4675-00,VALPROIC ACID 250 MG/5ML PO SOLN,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
106201,ERX,HCPCS 63700001,00121-4675-05,VALPROIC ACID 250 MG/5ML PO SOLN,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
106201,ERX,HCPCS 63700001,00121-4675-40,VALPROIC ACID 250 MG/5ML PO SOLN,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
106201,ERX,HCPCS 63700001,50383-0792-07,VALPROIC ACID 250 MG/5ML PO SOLN,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
106201,ERX,HCPCS 63700001,68094-0193-61,VALPROIC ACID 250 MG/5ML PO SOLN,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
106201,ERX,HCPCS 63700001,68094-0193-62,VALPROIC ACID 250 MG/5ML PO SOLN,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
106621,ERX,HCPCS 63700001,00003-0857-22,DASATINIB 140 MG PO TABS,"$1,392.77",$0.00,"$1,392.77",$0.00,$994.02,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,392.77",$0.00,$696.39,"$1,103.07","$1,114.22",$0.00,$0.00,$0.00,$0.00,$0.00
106632,ERX,HCPCS 63700001,59676-0571-01,ETRAVIRINE 200 MG PO TABS,$96.87,$0.00,$96.87,$0.00,$69.14,$0.00,$0.00,$0.00,$0.00,$0.00,$96.87,$0.00,$48.44,$76.72,$77.50,$0.00,$0.00,$0.00,$0.00,$0.00
106862,ERX,HCPCS J9351,00409-0302-01,TOPOTECAN HCL 4 MG/4ML IV SOLN,$499.59,$0.00,$499.59,$224.82,$356.56,$0.00,$86.08,$0.00,$0.00,$46.06,$499.59,$0.00,$249.80,$395.68,$399.67,$0.00,$46.06,$0.00,$43.86,$0.00
106862,ERX,HCPCS J9351,67457-0662-05,TOPOTECAN HCL 4 MG/4ML IV SOLN,$499.59,$0.00,$499.59,$224.82,$356.56,$0.00,$86.08,$0.00,$0.00,$46.06,$499.59,$0.00,$249.80,$395.68,$399.67,$0.00,$46.06,$0.00,$43.86,$0.00
107058,ERX,HCPCS J1652,55111-0679-10,FONDAPARINUX SODIUM 5 MG/0.4ML SC SOLN,$392.27,$0.00,$392.27,$0.00,$279.96,$0.00,$0.00,$0.00,$0.00,$0.00,$392.27,$0.00,$196.14,$310.68,$313.82,$0.00,$0.00,$0.00,$0.00,$0.00
107058,ERX,HCPCS J1652,55111-0679-11,FONDAPARINUX SODIUM 5 MG/0.4ML SC SOLN,$392.27,$0.00,$392.27,$0.00,$279.96,$0.00,$0.00,$0.00,$0.00,$0.00,$392.27,$0.00,$196.14,$310.68,$313.82,$0.00,$0.00,$0.00,$0.00,$0.00
107059,ERX,HCPCS J1652,55111-0680-02,FONDAPARINUX SODIUM 7.5 MG/0.6ML SC SOLN,$392.27,$0.00,$392.27,$0.00,$279.96,$0.00,$0.00,$0.00,$0.00,$0.00,$392.27,$0.00,$196.14,$310.68,$313.82,$0.00,$0.00,$0.00,$0.00,$0.00
107059,ERX,HCPCS J1652,55111-0680-10,FONDAPARINUX SODIUM 7.5 MG/0.6ML SC SOLN,$392.27,$0.00,$392.27,$0.00,$279.96,$0.00,$0.00,$0.00,$0.00,$0.00,$392.27,$0.00,$196.14,$310.68,$313.82,$0.00,$0.00,$0.00,$0.00,$0.00
107059,ERX,HCPCS J1652,55150-0232-00,FONDAPARINUX SODIUM 7.5 MG/0.6ML SC SOLN,$392.27,$0.00,$392.27,$0.00,$279.96,$0.00,$0.00,$0.00,$0.00,$0.00,$392.27,$0.00,$196.14,$310.68,$313.82,$0.00,$0.00,$0.00,$0.00,$0.00
107059,ERX,HCPCS J1652,55150-0232-10,FONDAPARINUX SODIUM 7.5 MG/0.6ML SC SOLN,$392.27,$0.00,$392.27,$0.00,$279.96,$0.00,$0.00,$0.00,$0.00,$0.00,$392.27,$0.00,$196.14,$310.68,$313.82,$0.00,$0.00,$0.00,$0.00,$0.00
107059,ERX,HCPCS J1652,67457-0584-00,FONDAPARINUX SODIUM 7.5 MG/0.6ML SC SOLN,$392.27,$0.00,$392.27,$0.00,$279.96,$0.00,$0.00,$0.00,$0.00,$0.00,$392.27,$0.00,$196.14,$310.68,$313.82,$0.00,$0.00,$0.00,$0.00,$0.00
107060,ERX,HCPCS J1652,55111-0681-02,FONDAPARINUX SODIUM 10 MG/0.8ML SC SOLN,$479.01,$0.00,$392.27,$0.00,$279.96,$0.00,$0.00,$0.00,$0.00,$0.00,$392.27,$0.00,$196.14,$379.38,$313.82,$0.00,$0.00,$0.00,$0.00,$0.00
107060,ERX,HCPCS J1652,55111-0681-10,FONDAPARINUX SODIUM 10 MG/0.8ML SC SOLN,$479.01,$0.00,$392.27,$0.00,$279.96,$0.00,$0.00,$0.00,$0.00,$0.00,$392.27,$0.00,$196.14,$379.38,$313.82,$0.00,$0.00,$0.00,$0.00,$0.00
107060,ERX,HCPCS J1652,55111-0681-11,FONDAPARINUX SODIUM 10 MG/0.8ML SC SOLN,$479.01,$0.00,$392.27,$0.00,$279.96,$0.00,$0.00,$0.00,$0.00,$0.00,$392.27,$0.00,$196.14,$379.38,$313.82,$0.00,$0.00,$0.00,$0.00,$0.00
107068,ERX,HCPCS 25000001,00051-8450-30,TESTOSTERONE 50 MG/5GM (1%) TD GEL,$89.66,$0.00,$89.66,$0.00,$63.99,$0.00,$0.00,$0.00,$0.00,$0.00,$89.66,$0.00,$44.83,$71.01,$71.73,$0.00,$0.00,$0.00,$0.00,$0.00
107078,ERX,HCPCS J0561,60793-0701-10,PENICILLIN G BENZATHINE 1200000 UNIT/2ML IM SUSP,$315.05,$0.00,$315.05,$141.77,$224.85,$82.92,$54.28,$0.00,$0.00,$97.01,$315.05,$87.07,$157.53,$249.52,$252.04,$120.23,$97.01,$0.00,$92.37,$82.92
107084,ERX,HCPCS J9303,55513-0954-01,PANITUMUMAB 100 MG/5ML IV SOLN,"$3,156.16",$0.00,"$3,156.16","$1,420.27","$2,252.55","$1,190.71",$543.79,$0.00,$0.00,"$1,392.61","$3,156.16","$1,250.25","$1,578.08","$2,499.68","$2,524.93","$1,726.53","$1,392.61",$0.00,"$1,326.00","$1,228.01"
107086,ERX,HCPCS J9303,55513-0956-01,PANITUMUMAB 400 MG/20ML IV SOLN,"$12,624.64",$0.00,"$12,624.64","$5,681.09","$5,158.80","$4,762.84","$2,175.16",$0.00,$0.00,"$5,570.44","$12,624.64","$5,000.98","$6,312.32","$9,998.71","$10,099.71","$6,906.12","$5,570.44",$0.00,"$5,304.01","$4,912.04"
107089,ERX,HCPCS 90378,60574-4114-01,PALIVIZUMAB 50 MG/0.5ML IM SOLN,"$3,870.12",$0.00,"$3,870.12",$0.00,"$2,762.10",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,870.12",$0.00,"$1,935.06","$3,065.14","$3,096.10",$0.00,$0.00,$0.00,$0.00,$0.00
107090,ERX,HCPCS J3262,50242-0135-01,TOCILIZUMAB 80 MG/4ML IV SOLN,"$1,328.15",$0.00,"$1,328.15",$0.00,$947.90,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,328.15",$0.00,$664.08,"$1,051.89","$1,062.52",$0.00,$0.00,$0.00,$0.00,$0.00
107091,ERX,HCPCS J3262,50242-0136-01,TOCILIZUMAB 200 MG/10ML IV SOLN,"$2,836.14",$0.00,"$2,836.14",$0.00,"$2,024.15",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,836.14",$0.00,"$1,418.07","$2,246.22","$2,268.91",$0.00,$0.00,$0.00,$0.00,$0.00
107092,ERX,HCPCS J3262,50242-0137-01,TOCILIZUMAB 400 MG/20ML IV SOLN,"$5,672.27",$0.00,"$5,672.27",$0.00,"$4,048.30",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,672.27",$0.00,"$2,836.14","$4,492.44","$4,537.82",$0.00,$0.00,$0.00,$0.00,$0.00
107094,ERX,HCPCS J9035,50242-0060-01,BEVACIZUMAB 100 MG/4ML IV SOLN,"$2,295.20",$0.00,"$2,295.20","$1,032.84","$1,638.08",$811.82,$674.22,$0.00,$0.00,$947.52,"$2,295.20",$852.41,"$1,147.60","$1,817.80","$1,836.16","$1,177.14",$947.52,$0.00,$902.20,$783.99
107095,ERX,HCPCS J9035,50242-0061-01,BEVACIZUMAB 400 MG/16ML IV SOLN,"$7,841.89",$0.00,"$7,841.89","$3,528.85","$5,158.80","$3,247.28","$2,696.86",$0.00,$0.00,"$3,790.08","$7,841.89","$3,409.64","$3,920.95","$6,210.78","$6,273.51","$4,708.56","$3,790.08",$0.00,"$3,608.80","$3,135.96"
107101,ERX,HCPCS J9055,66733-0958-23,CETUXIMAB 200 MG/100ML IV SOLN,"$3,279.18",$0.00,"$3,279.18","$1,475.63","$2,340.35","$1,240.96","$1,168.89",$0.00,$0.00,"$1,485.44","$3,279.18","$1,303.01","$1,639.59","$2,597.11","$2,623.34","$1,799.39","$1,485.44",$0.00,"$1,414.39","$1,294.26"
107125,ERX,HCPCS J9395,00310-0720-10,FULVESTRANT 250 MG/5ML IM SOLN,"$2,385.04",$0.00,"$2,235.99","$1,006.20","$1,595.83",$948.74,$956.22,$0.00,$0.00,$998.28,"$2,235.99",$996.18,"$1,118.00","$1,888.95","$1,788.79","$1,375.67",$998.28,$0.00,$950.53,$494.81
107125,ERX,HCPCS J9395,00310-7720-10,FULVESTRANT 250 MG/5ML IM SOLN,"$2,385.04",$0.00,"$2,235.99","$1,006.20","$1,595.83",$948.74,$956.22,$0.00,$0.00,$998.28,"$2,235.99",$996.18,"$1,118.00","$1,888.95","$1,788.79","$1,375.67",$998.28,$0.00,$950.53,$494.81
107125,ERX,HCPCS J9395,00781-3079-12,FULVESTRANT 250 MG/5ML IM SOLN,"$2,385.04",$0.00,"$2,235.99","$1,006.20","$1,595.83",$948.74,$956.22,$0.00,$0.00,$998.28,"$2,235.99",$996.18,"$1,118.00","$1,888.95","$1,788.79","$1,375.67",$998.28,$0.00,$950.53,$494.81
107125,ERX,HCPCS J9395,25021-0462-74,FULVESTRANT 250 MG/5ML IM SOLN,"$2,385.04",$0.00,"$2,235.99","$1,006.20","$1,595.83",$948.74,$956.22,$0.00,$0.00,$998.28,"$2,235.99",$996.18,"$1,118.00","$1,888.95","$1,788.79","$1,375.67",$998.28,$0.00,$950.53,$494.81
107125,ERX,HCPCS J9395,67457-0311-05,FULVESTRANT 250 MG/5ML IM SOLN,"$2,385.04",$0.00,"$2,235.99","$1,006.20","$1,595.83",$948.74,$956.22,$0.00,$0.00,$998.28,"$2,235.99",$996.18,"$1,118.00","$1,888.95","$1,788.79","$1,375.67",$998.28,$0.00,$950.53,$494.81
107142,ERX,HCPCS 90744,00006-4093-02,HEPATITIS B VAC RECOMBINANT 5 MCG/0.5ML IJ SUSP,$100.07,$0.00,$100.07,$45.03,$74.20,$27.03,$17.24,$0.00,$0.00,$17.52,$100.07,$0.00,$50.04,$79.26,$80.06,$60.04,$15.66,$27.03,$0.00,$27.03
107142,ERX,HCPCS 90744,00006-4981-00,HEPATITIS B VAC RECOMBINANT 5 MCG/0.5ML IJ SUSP,$100.07,$0.00,$100.07,$45.03,$74.20,$27.03,$17.24,$0.00,$0.00,$17.52,$100.07,$0.00,$50.04,$79.26,$80.06,$60.04,$15.66,$27.03,$0.00,$27.03
107142,ERX,HCPCS 90744,00006-4981-01,HEPATITIS B VAC RECOMBINANT 5 MCG/0.5ML IJ SUSP,$100.07,$0.00,$100.07,$45.03,$74.20,$27.03,$17.24,$0.00,$0.00,$17.52,$100.07,$0.00,$50.04,$79.26,$80.06,$60.04,$15.66,$27.03,$0.00,$27.03
107147,ERX,HCPCS J1956,00143-9722-01,LEVOFLOXACIN IN D5W 250 MG/50ML IV SOLN,$27.36,$0.00,$27.36,$12.31,$19.53,$0.00,$4.71,$0.00,$0.00,$4.79,$27.36,$0.00,$13.68,$21.67,$21.89,$0.00,$4.28,$0.00,$4.36,$0.00
107147,ERX,HCPCS J1956,00143-9722-24,LEVOFLOXACIN IN D5W 250 MG/50ML IV SOLN,$27.36,$0.00,$27.36,$12.31,$19.53,$0.00,$4.71,$0.00,$0.00,$4.79,$27.36,$0.00,$13.68,$21.67,$21.89,$0.00,$4.28,$0.00,$4.36,$0.00
107147,ERX,HCPCS J1956,36000-0046-24,LEVOFLOXACIN IN D5W 250 MG/50ML IV SOLN,$27.36,$0.00,$27.36,$12.31,$19.53,$0.00,$4.71,$0.00,$0.00,$4.79,$27.36,$0.00,$13.68,$21.67,$21.89,$0.00,$4.28,$0.00,$4.36,$0.00
107148,ERX,HCPCS J1956,00143-9721-01,LEVOFLOXACIN IN D5W 500 MG/100ML IV SOLN,$27.74,$0.00,$27.74,$12.48,$19.80,$0.00,$4.78,$0.00,$0.00,$4.86,$27.74,$0.00,$13.87,$21.97,$22.19,$0.00,$4.34,$0.00,$4.42,$0.00
107148,ERX,HCPCS J1956,00143-9721-24,LEVOFLOXACIN IN D5W 500 MG/100ML IV SOLN,$27.74,$0.00,$27.74,$12.48,$19.80,$0.00,$4.78,$0.00,$0.00,$4.86,$27.74,$0.00,$13.87,$21.97,$22.19,$0.00,$4.34,$0.00,$4.42,$0.00
107148,ERX,HCPCS J1956,36000-0047-24,LEVOFLOXACIN IN D5W 500 MG/100ML IV SOLN,$27.74,$0.00,$27.74,$12.48,$19.80,$0.00,$4.78,$0.00,$0.00,$4.86,$27.74,$0.00,$13.87,$21.97,$22.19,$0.00,$4.34,$0.00,$4.42,$0.00
107149,ERX,HCPCS J1956,00143-9720-24,LEVOFLOXACIN IN D5W 750 MG/150ML IV SOLN,$50.16,$0.00,$50.16,$22.57,$35.80,$0.00,$8.64,$0.00,$0.00,$8.78,$50.16,$0.00,$25.08,$39.73,$40.13,$0.00,$7.85,$0.00,$7.99,$0.00
107149,ERX,HCPCS J1956,25021-0132-83,LEVOFLOXACIN IN D5W 750 MG/150ML IV SOLN,$50.16,$0.00,$50.16,$22.57,$35.80,$0.00,$8.64,$0.00,$0.00,$8.78,$50.16,$0.00,$25.08,$39.73,$40.13,$0.00,$7.85,$0.00,$7.99,$0.00
107150,ERX,HCPCS J2543,00206-8862-02,PIPERACILLIN-TAZOBACTAM IN DEX 4-0.5 GM/100ML IV SOLN FROZEN,$105.00,$0.00,$105.00,$47.25,$74.94,$0.00,$26.18,$0.00,$0.00,$8.70,$105.00,$0.00,$52.50,$83.16,$84.00,$0.00,$8.70,$0.00,$8.28,$0.00
107151,ERX,HCPCS J9171,00955-1021-04,DOCETAXEL 80 MG/4ML IV CONC,"$1,252.80",$0.00,"$2,304.00","$1,036.80","$1,644.36",$69.20,$215.85,$0.00,$0.00,$91.18,"$2,304.00",$72.66,"$1,152.00",$992.22,"$1,843.20",$100.34,$91.18,$0.00,$86.82,$69.44
107151,ERX,HCPCS J9171,16729-0267-64,DOCETAXEL 80 MG/4ML IV CONC,"$1,252.80",$0.00,"$2,304.00","$1,036.80","$1,644.36",$69.20,$215.85,$0.00,$0.00,$91.18,"$2,304.00",$72.66,"$1,152.00",$992.22,"$1,843.20",$100.34,$91.18,$0.00,$86.82,$69.44
107151,ERX,HCPCS J9171,43598-0259-40,DOCETAXEL 80 MG/4ML IV CONC,"$1,252.80",$0.00,"$2,304.00","$1,036.80","$1,644.36",$69.20,$215.85,$0.00,$0.00,$91.18,"$2,304.00",$72.66,"$1,152.00",$992.22,"$1,843.20",$100.34,$91.18,$0.00,$86.82,$69.44
107151,ERX,HCPCS J9171,45963-0765-52,DOCETAXEL 80 MG/4ML IV CONC,"$1,252.80",$0.00,"$2,304.00","$1,036.80","$1,644.36",$69.20,$215.85,$0.00,$0.00,$91.18,"$2,304.00",$72.66,"$1,152.00",$992.22,"$1,843.20",$100.34,$91.18,$0.00,$86.82,$69.44
107156,ERX,HCPCS 90713,49281-0860-10,POLIOVIRUS VACCINE INACTIVATED IJ INJ,$147.17,$0.00,$147.17,$0.00,$105.04,$0.00,$0.00,$0.00,$0.00,$0.00,$147.17,$0.00,$73.59,$116.56,$117.74,$0.00,$0.00,$0.00,$0.00,$0.00
107157,ERX,HCPCS J0744,00409-4777-23,CIPROFLOXACIN IN D5W 200 MG/100ML IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$3.85,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.44,$0.00,$0.00,$0.00
107158,ERX,HCPCS J0278,00641-6167-10,AMIKACIN SULFATE 500 MG/2ML IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
107158,ERX,HCPCS J0278,00703-9032-01,AMIKACIN SULFATE 500 MG/2ML IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
107158,ERX,HCPCS J0278,00703-9032-03,AMIKACIN SULFATE 500 MG/2ML IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
107158,ERX,HCPCS J0278,23155-0290-41,AMIKACIN SULFATE 500 MG/2ML IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
107158,ERX,HCPCS J0278,25021-0173-02,AMIKACIN SULFATE 500 MG/2ML IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
107159,ERX,HCPCS J0278,00703-9040-01,AMIKACIN SULFATE 1 GM/4ML IJ SOLN,$33.29,$0.00,$33.29,$0.00,$23.76,$0.00,$0.00,$0.00,$0.00,$0.00,$33.29,$0.00,$16.65,$26.37,$26.63,$0.00,$0.00,$0.00,$0.00,$0.00
107159,ERX,HCPCS J0278,00703-9040-03,AMIKACIN SULFATE 1 GM/4ML IJ SOLN,$33.29,$0.00,$33.29,$0.00,$23.76,$0.00,$0.00,$0.00,$0.00,$0.00,$33.29,$0.00,$16.65,$26.37,$26.63,$0.00,$0.00,$0.00,$0.00,$0.00
107159,ERX,HCPCS J0278,23155-0290-42,AMIKACIN SULFATE 1 GM/4ML IJ SOLN,$33.29,$0.00,$33.29,$0.00,$23.76,$0.00,$0.00,$0.00,$0.00,$0.00,$33.29,$0.00,$16.65,$26.37,$26.63,$0.00,$0.00,$0.00,$0.00,$0.00
107159,ERX,HCPCS J0278,63323-0815-04,AMIKACIN SULFATE 1 GM/4ML IJ SOLN,$33.29,$0.00,$33.29,$0.00,$23.76,$0.00,$0.00,$0.00,$0.00,$0.00,$33.29,$0.00,$16.65,$26.37,$26.63,$0.00,$0.00,$0.00,$0.00,$0.00
107160,ERX,HCPCS 25000001,63323-0282-60,CLINDAMYCIN PHOSPHATE 9 GM/60ML IJ SOLN,$98.49,$0.00,$98.49,$0.00,$70.29,$0.00,$0.00,$0.00,$0.00,$0.00,$98.49,$0.00,$49.25,$78.00,$78.79,$0.00,$0.00,$0.00,$0.00,$0.00
107378,ERX,HCPCS J0490,49401-0101-01,BELIMUMAB 120 MG IV SOLR,"$1,560.63",$0.00,"$1,560.63",$0.00,"$1,113.82",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,560.63",$0.00,$780.32,"$1,236.02","$1,248.50",$0.00,$0.00,$0.00,$0.00,$0.00
107379,ERX,HCPCS J0490,49401-0102-01,BELIMUMAB 400 MG IV SOLR,"$4,443.28",$0.00,"$4,443.28",$0.00,"$3,171.17",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,443.28",$0.00,"$2,221.64","$3,519.08","$3,554.62",$0.00,$0.00,$0.00,$0.00,$0.00
107443,ERX,HCPCS J9171,00409-0201-10,DOCETAXEL 80 MG/8ML IV SOLN,"$3,112.25",$0.00,"$3,112.25","$1,400.51","$2,221.21",$69.20,$536.23,$0.00,$0.00,$91.18,"$3,112.25",$72.66,"$1,556.13","$2,464.90","$2,489.80",$100.34,$91.18,$0.00,$86.82,$69.44
107443,ERX,HCPCS J9171,66758-0050-02,DOCETAXEL 80 MG/8ML IV SOLN,"$3,112.25",$0.00,"$3,112.25","$1,400.51","$2,221.21",$69.20,$536.23,$0.00,$0.00,$91.18,"$3,112.25",$72.66,"$1,556.13","$2,464.90","$2,489.80",$100.34,$91.18,$0.00,$86.82,$69.44
107443,ERX,HCPCS J9171,67457-0532-08,DOCETAXEL 80 MG/8ML IV SOLN,"$3,112.25",$0.00,"$3,112.25","$1,400.51","$2,221.21",$69.20,$536.23,$0.00,$0.00,$91.18,"$3,112.25",$72.66,"$1,556.13","$2,464.90","$2,489.80",$100.34,$91.18,$0.00,$86.82,$69.44
107446,ERX,HCPCS J9171,00409-0201-02,DOCETAXEL 20 MG/2ML IV SOLN,$259.88,$0.00,$259.88,$116.95,$185.48,$17.30,$44.78,$0.00,$0.00,$22.80,$259.88,$18.17,$129.94,$205.82,$207.90,$25.09,$22.80,$0.00,$21.70,$17.36
107491,ERX,HCPCS J9228,00003-2327-11,IPILIMUMAB 50 MG/10ML IV SOLN,"$18,453.47",$0.00,"$18,453.47","$8,304.06","$5,158.80","$7,656.40","$3,179.44",$0.00,$0.00,"$8,138.89","$18,453.47","$8,039.22","$9,226.74","$14,615.15","$14,762.78","$11,101.78","$8,138.89",$0.00,"$8,138.89","$7,864.60"
107492,ERX,HCPCS J9228,00003-2328-22,IPILIMUMAB 200 MG/40ML IV SOLN,"$73,813.70",$0.00,"$73,813.70","$33,216.17","$5,158.80","$30,625.60","$8,138.89",$0.00,$0.00,"$8,138.89","$73,813.70","$32,156.88","$36,906.85","$58,460.45","$59,050.96","$44,407.12","$8,138.89",$0.00,"$8,138.89","$31,458.40"
107815,ERX,HCPCS 63700001,00597-0123-30,NEVIRAPINE ER 400 MG PO TB24,$75.37,$0.00,$75.37,$0.00,$53.79,$0.00,$0.00,$0.00,$0.00,$0.00,$75.37,$0.00,$37.69,$59.69,$60.30,$0.00,$0.00,$0.00,$0.00,$0.00
107815,ERX,HCPCS 63700001,33342-0238-07,NEVIRAPINE ER 400 MG PO TB24,$75.37,$0.00,$75.37,$0.00,$53.79,$0.00,$0.00,$0.00,$0.00,$0.00,$75.37,$0.00,$37.69,$59.69,$60.30,$0.00,$0.00,$0.00,$0.00,$0.00
107815,ERX,HCPCS 63700001,47781-0317-30,NEVIRAPINE ER 400 MG PO TB24,$75.37,$0.00,$75.37,$0.00,$53.79,$0.00,$0.00,$0.00,$0.00,$0.00,$75.37,$0.00,$37.69,$59.69,$60.30,$0.00,$0.00,$0.00,$0.00,$0.00
107843,ERX,HCPCS 63700001,62103-0333-02,ZINC OXIDE 16 % EX OINT,$15.17,$0.00,$15.17,$0.00,$10.83,$0.00,$0.00,$0.00,$0.00,$0.00,$15.17,$0.00,$7.59,$12.01,$12.14,$0.00,$0.00,$0.00,$0.00,$0.00
108161,ERX,HCPCS 63700001,00456-1120-30,VILAZODONE HCL 20 MG PO TABS,$43.45,$0.00,$43.45,$0.00,$31.01,$0.00,$0.00,$0.00,$0.00,$0.00,$43.45,$0.00,$21.73,$34.41,$34.76,$0.00,$0.00,$0.00,$0.00,$0.00
108272,ERX,HCPCS 63600001,57894-0150-12,ABIRATERONE ACETATE 250 MG PO TABS,$973.99,$0.00,$973.99,$0.00,$695.14,$0.00,$0.00,$0.00,$0.00,$0.00,$973.99,$0.00,$487.00,$771.40,$779.19,$0.00,$0.00,$0.00,$0.00,$0.00
108272,ERX,HCPCS 63600001,57894-0155-12,ABIRATERONE ACETATE 250 MG PO TABS,$973.99,$0.00,$973.99,$0.00,$695.14,$0.00,$0.00,$0.00,$0.00,$0.00,$973.99,$0.00,$487.00,$771.40,$779.19,$0.00,$0.00,$0.00,$0.00,$0.00
108405,ERX,HCPCS 63700001,59676-0278-01,RILPIVIRINE HCL 25 MG PO TABS,$163.15,$0.00,$163.15,$0.00,$116.44,$0.00,$0.00,$0.00,$0.00,$0.00,$163.15,$0.00,$81.58,$129.21,$130.52,$0.00,$0.00,$0.00,$0.00,$0.00
108619,ERX,HCPCS J0282,43066-0150-10,AMIODARONE HCL IN DEXTROSE 150-4.21 MG/100ML-% IV SOLN,$145.60,$0.00,$145.60,$65.52,$103.91,$0.00,$25.09,$0.00,$0.00,$25.49,$145.60,$0.00,$72.80,$115.32,$116.48,$0.00,$22.79,$0.00,$23.18,$0.00
108620,ERX,HCPCS J0282,43066-0360-20,AMIODARONE HCL IN DEXTROSE 360-4.14 MG/200ML-% IV SOLN,$174.51,$0.00,$174.51,$78.53,$124.55,$0.00,$30.07,$0.00,$0.00,$30.56,$174.51,$0.00,$87.26,$138.21,$139.61,$0.00,$27.31,$0.00,$27.78,$0.00
108708,ERX,HCPCS 63700001,52015-0080-01,FIDAXOMICIN 200 MG PO TABS,$645.42,$0.00,$645.42,$0.00,$460.64,$0.00,$0.00,$0.00,$0.00,$0.00,$645.42,$0.00,$322.71,$511.17,$516.34,$0.00,$0.00,$0.00,$0.00,$0.00
109063,ERX,HCPCS J9217,00074-3473-03,LEUPROLIDE ACETATE (6 MONTH) 45 MG IM KIT,"$24,564.91",$0.00,"$24,564.91","$11,054.21","$5,158.80","$1,348.19","$1,480.99",$0.00,$0.00,"$1,621.99","$24,564.91","$1,415.60","$12,282.46","$19,455.41","$19,651.93","$1,954.87","$1,621.99",$0.00,"$1,544.41","$1,235.32"
109481,ERX,HCPCS 63700001,50458-0580-10,RIVAROXABAN 10 MG PO TABS,$71.44,$0.00,$71.44,$0.00,$50.99,$0.00,$0.00,$0.00,$0.00,$0.00,$71.44,$0.00,$35.72,$56.58,$57.15,$0.00,$0.00,$0.00,$0.00,$0.00
109481,ERX,HCPCS 63700001,50458-0580-30,RIVAROXABAN 10 MG PO TABS,$71.44,$0.00,$71.44,$0.00,$50.99,$0.00,$0.00,$0.00,$0.00,$0.00,$71.44,$0.00,$35.72,$56.58,$57.15,$0.00,$0.00,$0.00,$0.00,$0.00
109484,ERX,HCPCS 63700001,00186-0777-39,TICAGRELOR 90 MG PO TABS,$29.88,$0.00,$29.88,$0.00,$21.33,$0.00,$0.00,$0.00,$0.00,$0.00,$29.88,$0.00,$14.94,$23.66,$23.90,$0.00,$0.00,$0.00,$0.00,$0.00
109651,ERX,HCPCS 25000001,00004-0822-05,OSELTAMIVIR PHOSPHATE 6 MG/ML PO SUSR,$555.96,$0.00,$555.96,$0.00,$396.79,$0.00,$0.00,$0.00,$0.00,$0.00,$555.96,$0.00,$277.98,$440.32,$444.77,$0.00,$0.00,$0.00,$0.00,$0.00
109651,ERX,HCPCS 25000001,47781-0384-26,OSELTAMIVIR PHOSPHATE 6 MG/ML PO SUSR,$555.96,$0.00,$555.96,$0.00,$396.79,$0.00,$0.00,$0.00,$0.00,$0.00,$555.96,$0.00,$277.98,$440.32,$444.77,$0.00,$0.00,$0.00,$0.00,$0.00
110050,ERX,HCPCS 25000001,99999-6006-74,PENICILLIN G 100 UNITS/ML ID INJ,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
110052,ERX,HCPCS 25000001,99999-6006-75,PENICILLIN G 1000 UNITS/ML ID INJ,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
110156,ERX,HCPCS 63700001,00904-2137-61,FERROUS GLUCONATE 324 (37.5 FE) MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
110232,ERX,HCPCS 63700001,61958-1101-01,COMPLERA:EMTRICITAB-RILPIVIR-TENOFOVIR200-25-300MGTAB,$359.55,$0.00,$359.55,$0.00,$256.61,$0.00,$0.00,$0.00,$0.00,$0.00,$359.55,$0.00,$179.78,$284.76,$287.64,$0.00,$0.00,$0.00,$0.00,$0.00
110284,ERX,HCPCS 63700001,50242-0090-02,VEMURAFENIB 240 MG PO TABS,$575.10,$0.00,$575.10,$0.00,$410.45,$0.00,$0.00,$0.00,$0.00,$0.00,$575.10,$0.00,$287.55,$455.48,$460.08,$0.00,$0.00,$0.00,$0.00,$0.00
110289,ERX,HCPCS 63700001,27434-0010-17,COPPER GLUCONATE 2 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
110289,ERX,HCPCS 63700001,66536-0014-44,COPPER GLUCONATE 2 MG PO CAPS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
110307,ERX,HCPCS J9042,51144-0050-01,BRENTUXIMAB VEDOTIN 50 MG IV SOLR,"$21,136.32",$0.00,"$21,136.32","$9,511.34","$5,158.80","$8,121.85","$3,641.68",$0.00,$0.00,"$8,138.89","$21,136.32","$8,527.94","$10,568.16","$16,739.97","$16,909.06","$11,776.68","$8,138.89",$0.00,"$8,138.89","$8,793.05"
110346,ERX,HCPCS J1744,54092-0702-02,ICATIBANT ACETATE 30 MG/3ML SC SOLN,"$27,422.84",$0.00,"$27,422.84",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$27,422.84",$0.00,"$13,711.42","$21,718.89","$21,938.27",$0.00,$0.00,$0.00,$0.00,$0.00
110349,ERX,HCPCS 63700001,00069-8141-20,CRIZOTINIB 200 MG PO CAPS,$938.19,$0.00,$938.19,$0.00,$669.59,$0.00,$0.00,$0.00,$0.00,$0.00,$938.19,$0.00,$469.10,$743.05,$750.55,$0.00,$0.00,$0.00,$0.00,$0.00
110350,ERX,HCPCS 63700001,00069-8140-20,CRIZOTINIB 250 MG PO CAPS,$938.19,$0.00,$938.19,$0.00,$669.59,$0.00,$0.00,$0.00,$0.00,$0.00,$938.19,$0.00,$469.10,$743.05,$750.55,$0.00,$0.00,$0.00,$0.00,$0.00
110577,ERX,HCPCS 25000001,11704-0370-01,HYDROXOCOBALAMIN 5 G IV SOLR,"$2,365.40",$0.00,"$2,365.40",$0.00,"$1,688.19",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,365.40",$0.00,"$1,182.70","$1,873.40","$1,892.32",$0.00,$0.00,$0.00,$0.00,$0.00
110604,ERX,HCPCS J3489,25021-0826-82,ZOLEDRONIC ACID 4 MG/100ML IV SOLN,$572.40,$0.00,$572.40,$257.58,$408.52,$0.00,$98.62,$0.00,$0.00,$51.14,$572.40,$0.00,$286.20,$453.34,$457.92,$0.00,$51.14,$0.00,$48.69,$0.00
110863,ERX,HCPCS 25000001,00004-0357-30,PEGINTERFERON ALFA-2A 180 MCG/0.5ML SC SOLN,"$2,512.87",$0.00,"$2,512.87",$0.00,"$1,793.44",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,512.87",$0.00,"$1,256.44","$1,990.19","$2,010.30",$0.00,$0.00,$0.00,$0.00,$0.00
111020,ERX,HCPCS 25000001,65702-0407-10,ACCU-CHEK AVIVA PLUS VI STRP,$295.16,$0.00,$295.16,$0.00,$210.66,$0.00,$0.00,$0.00,$0.00,$0.00,$295.16,$0.00,$147.58,$233.77,$236.13,$0.00,$0.00,$0.00,$0.00,$0.00
111272,ERX,HCPCS 25000001,51991-0900-01,CLOBAZAM 10 MG PO TABS,$92.52,$0.00,$92.52,$0.00,$66.03,$0.00,$0.00,$0.00,$0.00,$0.00,$92.52,$0.00,$46.26,$73.28,$74.02,$0.00,$0.00,$0.00,$0.00,$0.00
111272,ERX,HCPCS 25000001,67386-0314-01,CLOBAZAM 10 MG PO TABS,$92.52,$0.00,$92.52,$0.00,$66.03,$0.00,$0.00,$0.00,$0.00,$0.00,$92.52,$0.00,$46.26,$73.28,$74.02,$0.00,$0.00,$0.00,$0.00,$0.00
111273,ERX,HCPCS 25000001,67386-0315-01,CLOBAZAM 20 MG PO TABS,$166.54,$0.00,$166.54,$0.00,$118.86,$0.00,$0.00,$0.00,$0.00,$0.00,$166.54,$0.00,$83.27,$131.90,$133.23,$0.00,$0.00,$0.00,$0.00,$0.00
111314,ERX,HCPCS C9290,65250-0133-09,BUPIVACAINE LIPOSOME 1.3 % IJ SUSP,$573.52,$0.00,$573.52,$258.08,$409.32,$0.00,$0.00,$0.00,$0.00,$100.42,$573.52,$0.00,$286.76,$454.23,$458.82,$0.00,$0.00,$0.00,$91.30,$0.00
111314,ERX,HCPCS C9290,65250-0133-10,BUPIVACAINE LIPOSOME 1.3 % IJ SUSP,$573.52,$0.00,$573.52,$258.08,$409.32,$0.00,$0.00,$0.00,$0.00,$100.42,$573.52,$0.00,$286.76,$454.23,$458.82,$0.00,$0.00,$0.00,$91.30,$0.00
111314,ERX,HCPCS C9290,65250-0266-09,BUPIVACAINE LIPOSOME 1.3 % IJ SUSP,$573.52,$0.00,$573.52,$258.08,$409.32,$0.00,$0.00,$0.00,$0.00,$100.42,$573.52,$0.00,$286.76,$454.23,$458.82,$0.00,$0.00,$0.00,$91.30,$0.00
111314,ERX,HCPCS C9290,65250-0266-20,BUPIVACAINE LIPOSOME 1.3 % IJ SUSP,$573.52,$0.00,$573.52,$258.08,$409.32,$0.00,$0.00,$0.00,$0.00,$100.42,$573.52,$0.00,$286.76,$454.23,$458.82,$0.00,$0.00,$0.00,$91.30,$0.00
111320,ERX,HCPCS J9201,00409-0181-01,GEMCITABINE HCL 1 GM/26.3ML IV SOLN,$168.76,$0.00,$811.87,$75.94,$120.44,$0.00,$811.87,$0.00,$0.00,$24.44,$168.76,$0.00,$84.38,$133.66,$135.01,$0.00,$24.44,$0.00,$23.27,$0.00
111320,ERX,HCPCS J9201,25021-0239-26,GEMCITABINE HCL 1 GM/26.3ML IV SOLN,$168.76,$0.00,$811.87,$75.94,$120.44,$0.00,$811.87,$0.00,$0.00,$24.44,$168.76,$0.00,$84.38,$133.66,$135.01,$0.00,$24.44,$0.00,$23.27,$0.00
111320,ERX,HCPCS J9201,60505-6114-00,GEMCITABINE HCL 1 GM/26.3ML IV SOLN,$168.76,$0.00,$811.87,$75.94,$120.44,$0.00,$811.87,$0.00,$0.00,$24.44,$168.76,$0.00,$84.38,$133.66,$135.01,$0.00,$24.44,$0.00,$23.27,$0.00
111367,ERX,HCPCS 63700001,50458-0578-10,RIVAROXABAN 15 MG PO TABS,$71.44,$0.00,$71.44,$0.00,$50.99,$0.00,$0.00,$0.00,$0.00,$0.00,$71.44,$0.00,$35.72,$56.58,$57.15,$0.00,$0.00,$0.00,$0.00,$0.00
111367,ERX,HCPCS 63700001,50458-0578-30,RIVAROXABAN 15 MG PO TABS,$71.44,$0.00,$71.44,$0.00,$50.99,$0.00,$0.00,$0.00,$0.00,$0.00,$71.44,$0.00,$35.72,$56.58,$57.15,$0.00,$0.00,$0.00,$0.00,$0.00
111368,ERX,HCPCS 63700001,50458-0579-01,RIVAROXABAN 20 MG PO TABS,$71.44,$0.00,$71.44,$0.00,$50.99,$0.00,$0.00,$0.00,$0.00,$0.00,$71.44,$0.00,$35.72,$56.58,$57.15,$0.00,$0.00,$0.00,$0.00,$0.00
111368,ERX,HCPCS 63700001,50458-0579-10,RIVAROXABAN 20 MG PO TABS,$71.44,$0.00,$71.44,$0.00,$50.99,$0.00,$0.00,$0.00,$0.00,$0.00,$71.44,$0.00,$35.72,$56.58,$57.15,$0.00,$0.00,$0.00,$0.00,$0.00
111368,ERX,HCPCS 63700001,50458-0579-90,RIVAROXABAN 20 MG PO TABS,$71.44,$0.00,$71.44,$0.00,$50.99,$0.00,$0.00,$0.00,$0.00,$0.00,$71.44,$0.00,$35.72,$56.58,$57.15,$0.00,$0.00,$0.00,$0.00,$0.00
111436,ERX,HCPCS 63700001,50881-0005-60,RUXOLITINIB PHOSPHATE 5 MG PO TABS,$730.03,$0.00,$730.03,$0.00,$536.65,$0.00,$0.00,$0.00,$0.00,$0.00,$730.03,$0.00,$365.02,$578.18,$584.02,$0.00,$0.00,$0.00,$0.00,$0.00
111437,ERX,HCPCS 63700001,50881-0010-60,RUXOLITINIB PHOSPHATE 10 MG PO TABS,$730.03,$0.00,$730.03,$0.00,$536.65,$0.00,$0.00,$0.00,$0.00,$0.00,$730.03,$0.00,$365.02,$578.18,$584.02,$0.00,$0.00,$0.00,$0.00,$0.00
111438,ERX,HCPCS 63700001,50881-0015-60,RUXOLITINIB PHOSPHATE 15 MG PO TABS,$730.03,$0.00,$730.03,$0.00,$536.65,$0.00,$0.00,$0.00,$0.00,$0.00,$730.03,$0.00,$365.02,$578.18,$584.02,$0.00,$0.00,$0.00,$0.00,$0.00
111439,ERX,HCPCS 63700001,50881-0020-60,RUXOLITINIB PHOSPHATE 20 MG PO TABS,$730.03,$0.00,$730.03,$0.00,$536.65,$0.00,$0.00,$0.00,$0.00,$0.00,$730.03,$0.00,$365.02,$578.18,$584.02,$0.00,$0.00,$0.00,$0.00,$0.00
111440,ERX,HCPCS 63700001,50881-0025-60,RUXOLITINIB PHOSPHATE 25 MG PO TABS,$730.03,$0.00,$730.03,$0.00,$536.65,$0.00,$0.00,$0.00,$0.00,$0.00,$730.03,$0.00,$365.02,$578.18,$584.02,$0.00,$0.00,$0.00,$0.00,$0.00
111479,ERX,HCPCS J0178,61755-0005-02,AFLIBERCEPT 2 MG/0.05ML INTRAVITREAL SOLN,"$4,551.00",$0.00,"$4,551.00","$2,047.95","$3,248.05","$1,904.95",$784.11,$0.00,$0.00,"$2,220.82","$4,551.00","$2,000.19","$2,275.50","$3,604.39","$3,640.80","$2,762.17","$2,220.82",$0.00,"$2,114.60","$1,863.53"
111525,ERX,HCPCS J3490,63323-0648-10,LEVOTHYROXINE SODIUM 500 MCG IV SOLR,$386.43,$0.00,$386.43,$173.89,$275.80,$0.00,$66.58,$0.00,$0.00,$67.66,$386.43,$0.00,$193.22,$306.05,$309.14,$0.00,$60.48,$0.00,$61.52,$0.00
111526,ERX,HCPCS 25000001,42023-0201-01,LEVOTHYROXINE SODIUM 100 MCG IV SOLR,$386.44,$0.00,$386.44,$0.00,$275.80,$0.00,$0.00,$0.00,$0.00,$0.00,$386.44,$0.00,$193.22,$306.06,$309.15,$0.00,$0.00,$0.00,$0.00,$0.00
111526,ERX,HCPCS 25000001,63323-0649-07,LEVOTHYROXINE SODIUM 100 MCG IV SOLR,$386.44,$0.00,$386.44,$0.00,$275.80,$0.00,$0.00,$0.00,$0.00,$0.00,$386.44,$0.00,$193.22,$306.06,$309.15,$0.00,$0.00,$0.00,$0.00,$0.00
111526,ERX,HCPCS 25000001,63323-0649-16,LEVOTHYROXINE SODIUM 100 MCG IV SOLR,$386.44,$0.00,$386.44,$0.00,$275.80,$0.00,$0.00,$0.00,$0.00,$0.00,$386.44,$0.00,$193.22,$306.06,$309.15,$0.00,$0.00,$0.00,$0.00,$0.00
111526,ERX,HCPCS 25000001,70860-0451-10,LEVOTHYROXINE SODIUM 100 MCG IV SOLR,$386.44,$0.00,$386.44,$0.00,$275.80,$0.00,$0.00,$0.00,$0.00,$0.00,$386.44,$0.00,$193.22,$306.06,$309.15,$0.00,$0.00,$0.00,$0.00,$0.00
111662,ERX,HCPCS 25000001,46783-0221-52,POLIDOCANOL 1 % IV SOLN,$92.40,$0.00,$92.40,$0.00,$65.95,$0.00,$0.00,$0.00,$0.00,$0.00,$92.40,$0.00,$46.20,$73.18,$73.92,$0.00,$0.00,$0.00,$0.00,$0.00
112303,ERX,HCPCS J1953,55150-0246-47,LEVETIRACETAM IN NACL 500 MG/100ML IV SOLN,$116.55,$0.00,$116.55,$52.45,$83.18,$0.00,$20.08,$0.00,$0.00,$20.41,$116.55,$0.00,$58.28,$92.31,$93.24,$0.00,$18.24,$0.00,$18.55,$0.00
112303,ERX,HCPCS J1953,67457-0255-10,LEVETIRACETAM IN NACL 500 MG/100ML IV SOLN,$116.55,$0.00,$116.55,$52.45,$83.18,$0.00,$20.08,$0.00,$0.00,$20.41,$116.55,$0.00,$58.28,$92.31,$93.24,$0.00,$18.24,$0.00,$18.55,$0.00
112304,ERX,HCPCS J1953,43598-0636-10,LEVETIRACETAM IN NACL 1000 MG/100ML IV SOLN,$187.43,$0.00,$187.43,$84.34,$133.77,$0.00,$32.29,$0.00,$0.00,$32.82,$187.43,$0.00,$93.72,$148.44,$149.94,$0.00,$29.33,$0.00,$29.84,$0.00
112304,ERX,HCPCS J1953,43598-0636-52,LEVETIRACETAM IN NACL 1000 MG/100ML IV SOLN,$187.43,$0.00,$187.43,$84.34,$133.77,$0.00,$32.29,$0.00,$0.00,$32.82,$187.43,$0.00,$93.72,$148.44,$149.94,$0.00,$29.33,$0.00,$29.84,$0.00
112304,ERX,HCPCS J1953,43598-0757-10,LEVETIRACETAM IN NACL 1000 MG/100ML IV SOLN,$187.43,$0.00,$187.43,$84.34,$133.77,$0.00,$32.29,$0.00,$0.00,$32.82,$187.43,$0.00,$93.72,$148.44,$149.94,$0.00,$29.33,$0.00,$29.84,$0.00
112304,ERX,HCPCS J1953,43598-0757-52,LEVETIRACETAM IN NACL 1000 MG/100ML IV SOLN,$187.43,$0.00,$187.43,$84.34,$133.77,$0.00,$32.29,$0.00,$0.00,$32.82,$187.43,$0.00,$93.72,$148.44,$149.94,$0.00,$29.33,$0.00,$29.84,$0.00
112304,ERX,HCPCS J1953,55150-0247-47,LEVETIRACETAM IN NACL 1000 MG/100ML IV SOLN,$187.43,$0.00,$187.43,$84.34,$133.77,$0.00,$32.29,$0.00,$0.00,$32.82,$187.43,$0.00,$93.72,$148.44,$149.94,$0.00,$29.33,$0.00,$29.84,$0.00
112304,ERX,HCPCS J1953,67457-0265-00,LEVETIRACETAM IN NACL 1000 MG/100ML IV SOLN,$187.43,$0.00,$187.43,$84.34,$133.77,$0.00,$32.29,$0.00,$0.00,$32.82,$187.43,$0.00,$93.72,$148.44,$149.94,$0.00,$29.33,$0.00,$29.84,$0.00
112304,ERX,HCPCS J1953,67457-0265-10,LEVETIRACETAM IN NACL 1000 MG/100ML IV SOLN,$187.43,$0.00,$187.43,$84.34,$133.77,$0.00,$32.29,$0.00,$0.00,$32.82,$187.43,$0.00,$93.72,$148.44,$149.94,$0.00,$29.33,$0.00,$29.84,$0.00
112304,ERX,HCPCS J1953,70860-0603-82,LEVETIRACETAM IN NACL 1000 MG/100ML IV SOLN,$187.43,$0.00,$187.43,$84.34,$133.77,$0.00,$32.29,$0.00,$0.00,$32.82,$187.43,$0.00,$93.72,$148.44,$149.94,$0.00,$29.33,$0.00,$29.84,$0.00
112305,ERX,HCPCS J1953,43598-0637-10,LEVETIRACETAM IN NACL 1500 MG/100ML IV SOLN,$168.00,$0.00,$168.00,$75.60,$119.90,$0.00,$28.95,$0.00,$0.00,$29.42,$168.00,$0.00,$84.00,$133.06,$134.40,$0.00,$26.29,$0.00,$26.75,$0.00
112305,ERX,HCPCS J1953,43598-0637-52,LEVETIRACETAM IN NACL 1500 MG/100ML IV SOLN,$168.00,$0.00,$168.00,$75.60,$119.90,$0.00,$28.95,$0.00,$0.00,$29.42,$168.00,$0.00,$84.00,$133.06,$134.40,$0.00,$26.29,$0.00,$26.75,$0.00
112305,ERX,HCPCS J1953,43598-0759-10,LEVETIRACETAM IN NACL 1500 MG/100ML IV SOLN,$168.00,$0.00,$168.00,$75.60,$119.90,$0.00,$28.95,$0.00,$0.00,$29.42,$168.00,$0.00,$84.00,$133.06,$134.40,$0.00,$26.29,$0.00,$26.75,$0.00
112305,ERX,HCPCS J1953,43598-0759-52,LEVETIRACETAM IN NACL 1500 MG/100ML IV SOLN,$168.00,$0.00,$168.00,$75.60,$119.90,$0.00,$28.95,$0.00,$0.00,$29.42,$168.00,$0.00,$84.00,$133.06,$134.40,$0.00,$26.29,$0.00,$26.75,$0.00
112305,ERX,HCPCS J1953,55150-0248-47,LEVETIRACETAM IN NACL 1500 MG/100ML IV SOLN,$168.00,$0.00,$168.00,$75.60,$119.90,$0.00,$28.95,$0.00,$0.00,$29.42,$168.00,$0.00,$84.00,$133.06,$134.40,$0.00,$26.29,$0.00,$26.75,$0.00
112305,ERX,HCPCS J1953,67457-0266-00,LEVETIRACETAM IN NACL 1500 MG/100ML IV SOLN,$168.00,$0.00,$168.00,$75.60,$119.90,$0.00,$28.95,$0.00,$0.00,$29.42,$168.00,$0.00,$84.00,$133.06,$134.40,$0.00,$26.29,$0.00,$26.75,$0.00
112305,ERX,HCPCS J1953,67457-0266-10,LEVETIRACETAM IN NACL 1500 MG/100ML IV SOLN,$168.00,$0.00,$168.00,$75.60,$119.90,$0.00,$28.95,$0.00,$0.00,$29.42,$168.00,$0.00,$84.00,$133.06,$134.40,$0.00,$26.29,$0.00,$26.75,$0.00
112380,ERX,HCPCS 25000001,63402-0302-30,LURASIDONE HCL 20 MG PO TABS,$161.71,$0.00,$161.71,$0.00,$115.41,$0.00,$0.00,$0.00,$0.00,$0.00,$161.71,$0.00,$80.86,$128.07,$129.37,$0.00,$0.00,$0.00,$0.00,$0.00
112618,ERX,HCPCS J2212,65649-0552-04,METHYLNALTREXONE BROMIDE 8 MG/0.4ML SC SOLN,$456.28,$0.00,$456.28,$0.00,$325.65,$0.00,$0.00,$0.00,$0.00,$0.00,$456.28,$0.00,$228.14,$361.37,$365.02,$0.00,$0.00,$0.00,$0.00,$0.00
112638,ERX,HCPCS 63600001,50242-0140-01,VISMODEGIB 150 MG PO CAPS,"$1,297.34",$0.00,"$1,297.34",$0.00,$925.91,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,297.34",$0.00,$648.67,"$1,027.49","$1,037.87",$0.00,$0.00,$0.00,$0.00,$0.00
112683,ERX,HCPCS 25000001,00006-0078-82,JANUMET XR 50-500 MG (SITAGLIPTIN-METFORMIN ER) PO TB24,$35.98,$0.00,$35.98,$0.00,$25.68,$0.00,$0.00,$0.00,$0.00,$0.00,$35.98,$0.00,$17.99,$28.50,$28.78,$0.00,$0.00,$0.00,$0.00,$0.00
112684,ERX,HCPCS 25000001,00006-0080-82,JANUMET XR 50-1000 MG (SITAGLIPTIN-METFORMIN ER) PO TB24,$35.98,$0.00,$35.98,$0.00,$25.68,$0.00,$0.00,$0.00,$0.00,$0.00,$35.98,$0.00,$17.99,$28.50,$28.78,$0.00,$0.00,$0.00,$0.00,$0.00
112685,ERX,HCPCS 25000001,00006-0081-31,JANUMET XR 100-1000 MG (SITAGLIPTIN-METFORMIN ER) PO TB24,$71.96,$0.00,$71.96,$0.00,$51.36,$0.00,$0.00,$0.00,$0.00,$0.00,$71.96,$0.00,$35.98,$56.99,$57.57,$0.00,$0.00,$0.00,$0.00,$0.00
112904,ERX,HCPCS 25000001,65702-0101-10,ACCU-CHEK AVIVA PLUS W/DEVICE KIT,$100.59,$0.00,$100.59,$0.00,$71.79,$0.00,$0.00,$0.00,$0.00,$0.00,$100.59,$0.00,$50.30,$79.67,$80.47,$0.00,$0.00,$0.00,$0.00,$0.00
112975,ERX,HCPCS J7527,00078-0620-51,EVEROLIMUS 7.5 MG PO TABS,"$1,615.55",$0.00,"$1,615.55",$0.00,"$1,153.02",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,615.55",$0.00,$807.78,"$1,279.52","$1,292.44",$0.00,$0.00,$0.00,$0.00,$0.00
113303,ERX,HCPCS 63700001,00487-2784-01,RACEPINEPHRINE HCL 2.25 % IN NEBU,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
113303,ERX,HCPCS 63700001,00487-5901-99,RACEPINEPHRINE HCL 2.25 % IN NEBU,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
113304,ERX,HCPCS 90716,00006-4827-00,VARICELLA VIRUS VACCINE LIVE 1350 PFU/0.5ML SC INJ,$496.30,$0.00,$496.30,$223.34,$371.84,$92.74,$9.40,$0.00,$0.00,$159.48,$496.30,$0.00,$248.15,$393.07,$397.04,$297.78,$159.48,$0.00,$151.85,$0.00
113363,ERX,HCPCS 25000001,00054-3188-63,DIAZEPAM 5 MG/5ML PO SOLN,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
113624,ERX,HCPCS J1324,00004-0380-01,ENFUVIRTIDE 90 MG SC SOLR,$225.89,$0.00,$225.89,$0.00,$161.22,$0.00,$0.00,$0.00,$0.00,$0.00,$225.89,$0.00,$112.95,$178.90,$180.71,$0.00,$0.00,$0.00,$0.00,$0.00
113624,ERX,HCPCS J1324,00004-0381-40,ENFUVIRTIDE 90 MG SC SOLR,$225.89,$0.00,$225.89,$0.00,$161.22,$0.00,$0.00,$0.00,$0.00,$0.00,$225.89,$0.00,$112.95,$178.90,$180.71,$0.00,$0.00,$0.00,$0.00,$0.00
114621,ERX,HCPCS 25000001,49100-0400-08,CULTURELLE KIDS PO PACK,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
115133,ERX,HCPCS 25000001,99999-6007-10,TRICHLOROACETIC ACID 40 % EX SOLN,$76.00,$0.00,$76.00,$0.00,$54.24,$0.00,$0.00,$0.00,$0.00,$0.00,$76.00,$0.00,$38.00,$60.19,$60.80,$0.00,$0.00,$0.00,$0.00,$0.00
115145,ERX,HCPCS J7315,49771-0002-01,MITOMYCIN 0.2 MG OP KIT,"$1,141.62",$0.00,"$1,141.62",$513.73,$878.32,$0.00,$196.70,$0.00,$0.00,$199.89,"$1,141.62",$0.00,$570.81,$904.16,$913.30,$0.00,$178.66,$0.00,$195.92,$0.00
115145,ERX,HCPCS J7315,49771-0002-03,MITOMYCIN 0.2 MG OP KIT,"$1,141.62",$0.00,"$1,141.62",$513.73,$878.32,$0.00,$196.70,$0.00,$0.00,$199.89,"$1,141.62",$0.00,$570.81,$904.16,$913.30,$0.00,$178.66,$0.00,$195.92,$0.00
115244,ERX,HCPCS J9306,50242-0145-01,PERTUZUMAB 420 MG/14ML IV SOLN,"$13,018.35",$0.00,"$13,018.35","$5,858.26","$5,158.80","$5,161.80","$2,243.00",$0.00,$0.00,"$6,227.97","$13,018.35","$5,419.89","$6,509.18","$10,310.53","$10,414.68","$7,484.61","$6,227.97",$0.00,"$5,930.09","$5,435.64"
115824,ERX,HCPCS J9250,00143-9519-01,METHOTREXATE SODIUM (PF) 50 MG/2ML IJ SOLN,$57.00,$0.00,$57.00,$25.65,$40.68,$0.00,$9.82,$0.00,$0.00,$2.94,$57.00,$0.00,$28.50,$45.14,$45.60,$0.00,$2.94,$0.00,$2.80,$0.00
115824,ERX,HCPCS J9250,00143-9519-10,METHOTREXATE SODIUM (PF) 50 MG/2ML IJ SOLN,$57.00,$0.00,$57.00,$25.65,$40.68,$0.00,$9.82,$0.00,$0.00,$2.94,$57.00,$0.00,$28.50,$45.14,$45.60,$0.00,$2.94,$0.00,$2.80,$0.00
115824,ERX,HCPCS J9250,00703-3671-01,METHOTREXATE SODIUM (PF) 50 MG/2ML IJ SOLN,$57.00,$0.00,$57.00,$25.65,$40.68,$0.00,$9.82,$0.00,$0.00,$2.94,$57.00,$0.00,$28.50,$45.14,$45.60,$0.00,$2.94,$0.00,$2.80,$0.00
115824,ERX,HCPCS J9250,16729-0277-30,METHOTREXATE SODIUM (PF) 50 MG/2ML IJ SOLN,$57.00,$0.00,$57.00,$25.65,$40.68,$0.00,$9.82,$0.00,$0.00,$2.94,$57.00,$0.00,$28.50,$45.14,$45.60,$0.00,$2.94,$0.00,$2.80,$0.00
115826,ERX,HCPCS J9260,00703-3678-01,METHOTREXATE SODIUM (PF) 1 GM/40ML IJ SOLN,$152.04,$0.00,$152.04,$68.42,$108.51,$0.00,$54.05,$0.00,$0.00,$58.52,$152.04,$0.00,$76.02,$120.42,$121.63,$0.00,$58.52,$0.00,$55.72,$0.00
115826,ERX,HCPCS J9260,61703-0408-41,METHOTREXATE SODIUM (PF) 1 GM/40ML IJ SOLN,$152.04,$0.00,$152.04,$68.42,$108.51,$0.00,$54.05,$0.00,$0.00,$58.52,$152.04,$0.00,$76.02,$120.42,$121.63,$0.00,$58.52,$0.00,$55.72,$0.00
115839,ERX,HCPCS J9047,76075-0101-01,CARFILZOMIB 60 MG IV SOLR,"$5,991.13",$0.00,"$5,991.13","$2,696.01","$4,275.87","$2,255.94","$1,032.24",$0.00,$0.00,"$2,646.57","$5,991.13","$2,368.74","$2,995.57","$4,744.97","$4,792.90","$3,271.11","$2,646.57",$0.00,"$2,519.99","$2,338.32"
116010,ERX,HCPCS J2300,99999-6011-83,NALBUPHINE (NUBAIN) 10 MG/0.5 ML IV SYRINGE,$27.00,$0.00,$27.00,$12.15,$19.27,$0.00,$1.22,$0.00,$0.00,$3.70,$27.00,$0.00,$13.50,$21.38,$21.60,$0.00,$3.70,$0.00,$3.52,$0.00
116012,ERX,HCPCS 63700001,61958-1201-01,STRIBILD:150-150-200-300 MG PO TABS,$414.44,$0.00,$414.44,$0.00,$295.79,$0.00,$0.00,$0.00,$0.00,$0.00,$414.44,$0.00,$207.22,$328.24,$331.55,$0.00,$0.00,$0.00,$0.00,$0.00
116047,ERX,HCPCS J9302,00078-0690-61,OFATUMUMAB 1000 MG/50ML IV CONC,"$14,842.93",$0.00,"$14,842.93",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$14,842.93",$0.00,"$7,421.47","$11,755.60","$11,874.34",$0.00,$0.00,$0.00,$0.00,$0.00
116049,ERX,HCPCS 63700001,00006-0473-61,RALTEGRAVIR POTASSIUM 25 MG PO CHEW,$7.86,$0.00,$7.86,$0.00,$5.61,$0.00,$0.00,$0.00,$0.00,$0.00,$7.86,$0.00,$3.93,$6.23,$6.29,$0.00,$0.00,$0.00,$0.00,$0.00
116050,ERX,HCPCS 63700001,00006-0477-61,RALTEGRAVIR POTASSIUM 100 MG PO CHEW,$31.42,$0.00,$31.42,$0.00,$22.42,$0.00,$0.00,$0.00,$0.00,$0.00,$31.42,$0.00,$15.71,$24.88,$25.14,$0.00,$0.00,$0.00,$0.00,$0.00
116053,ERX,HCPCS J1100,63323-0506-01,DEXAMETHASONE SOD PHOSPHATE PF 10 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.53,$0.00,$0.00,$0.71,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.71,$0.00,$0.67,$0.00
116053,ERX,HCPCS J1100,70069-0021-25,DEXAMETHASONE SOD PHOSPHATE PF 10 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.53,$0.00,$0.00,$0.71,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.71,$0.00,$0.67,$0.00
116158,ERX,HCPCS 63600001,49281-0225-10,DIPHTHERIA-TETANUS TOXOIDS DT 25-5 LFU/0.5ML IM SUSP,$215.46,$0.00,$215.46,$0.00,$153.77,$0.00,$0.00,$0.00,$0.00,$0.00,$215.46,$0.00,$107.73,$170.64,$172.37,$0.00,$0.00,$0.00,$0.00,$0.00
116294,ERX,HCPCS 25000001,63402-0312-30,LURASIDONE HCL 120 MG PO TABS,$241.40,$0.00,$241.40,$0.00,$172.29,$0.00,$0.00,$0.00,$0.00,$0.00,$241.40,$0.00,$120.70,$191.19,$193.12,$0.00,$0.00,$0.00,$0.00,$0.00
116340,ERX,HCPCS 25000001,00054-0404-44,MORPHINE SULFATE (CONCENTRATE) 100 MG/5ML PO SOLN,$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
116340,ERX,HCPCS 25000001,00054-0404-50,MORPHINE SULFATE (CONCENTRATE) 100 MG/5ML PO SOLN,$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
116340,ERX,HCPCS 25000001,00406-8003-12,MORPHINE SULFATE (CONCENTRATE) 100 MG/5ML PO SOLN,$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
116340,ERX,HCPCS 25000001,99999-6005-51,MORPHINE SULFATE (CONCENTRATE) 100 MG/5ML PO SOLN,$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
116365,ERX,HCPCS J2270,00409-1891-01,MORPHINE SULFATE (PF) 4 MG/ML IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$2.39,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$2.39,$0.00,$2.27,$0.00
116365,ERX,HCPCS J2270,00409-1891-03,MORPHINE SULFATE (PF) 4 MG/ML IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$2.39,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$2.39,$0.00,$2.27,$0.00
116365,ERX,HCPCS J2270,00641-6125-01,MORPHINE SULFATE (PF) 4 MG/ML IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$2.39,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$2.39,$0.00,$2.27,$0.00
116365,ERX,HCPCS J2270,00641-6125-25,MORPHINE SULFATE (PF) 4 MG/ML IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$2.39,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$2.39,$0.00,$2.27,$0.00
116374,ERX,HCPCS J2270,00409-1893-01,MORPHINE SULFATE (PF) 10 MG/ML IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$2.39,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$2.39,$0.00,$0.00,$0.00
116374,ERX,HCPCS J2270,00641-6127-01,MORPHINE SULFATE (PF) 10 MG/ML IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$2.39,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$2.39,$0.00,$0.00,$0.00
116374,ERX,HCPCS J2270,00641-6127-25,MORPHINE SULFATE (PF) 10 MG/ML IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$2.39,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$2.39,$0.00,$0.00,$0.00
116385,ERX,HCPCS 63700001,00469-0125-99,ENZALUTAMIDE 40 MG PO CAPS,$631.67,$0.00,$631.67,$0.00,$450.82,$0.00,$0.00,$0.00,$0.00,$0.00,$631.67,$0.00,$315.84,$500.28,$505.34,$0.00,$0.00,$0.00,$0.00,$0.00
116397,ERX,HCPCS J8999,00069-0135-01,BOSUTINIB 100 MG PO TABS,$478.03,$0.00,$478.03,$0.00,$341.17,$0.00,$0.00,$0.00,$0.00,$0.00,$478.03,$0.00,$239.02,$378.60,$382.42,$0.00,$0.00,$0.00,$0.00,$0.00
116398,ERX,HCPCS 63600001,00069-0136-01,BOSUTINIB 500 MG PO TABS,"$1,504.61",$0.00,"$1,504.61",$0.00,"$1,073.84",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,504.61",$0.00,$752.31,"$1,191.65","$1,203.69",$0.00,$0.00,$0.00,$0.00,$0.00
117006,ERX,HCPCS 25000001,12496-1204-01,SUBOXONE:BUPRENORPHINE HCL-NALOXONE HCL 4-1 MG SL FILM,$40.95,$0.00,$40.95,$0.00,$29.23,$0.00,$0.00,$0.00,$0.00,$0.00,$40.95,$0.00,$20.48,$32.43,$32.76,$0.00,$0.00,$0.00,$0.00,$0.00
117006,ERX,HCPCS 25000001,12496-1204-03,SUBOXONE:BUPRENORPHINE HCL-NALOXONE HCL 4-1 MG SL FILM,$40.95,$0.00,$40.95,$0.00,$29.23,$0.00,$0.00,$0.00,$0.00,$0.00,$40.95,$0.00,$20.48,$32.43,$32.76,$0.00,$0.00,$0.00,$0.00,$0.00
117007,ERX,HCPCS 25000001,12496-1212-01,SUBOXONE:BUPRENORPHINE HCL-NALOXONE HCL 12-3 MG SL FILM,$75.44,$0.00,$75.44,$0.00,$53.84,$0.00,$0.00,$0.00,$0.00,$0.00,$75.44,$0.00,$37.72,$59.75,$60.35,$0.00,$0.00,$0.00,$0.00,$0.00
117007,ERX,HCPCS 25000001,12496-1212-03,SUBOXONE:BUPRENORPHINE HCL-NALOXONE HCL 12-3 MG SL FILM,$75.44,$0.00,$75.44,$0.00,$53.84,$0.00,$0.00,$0.00,$0.00,$0.00,$75.44,$0.00,$37.72,$59.75,$60.35,$0.00,$0.00,$0.00,$0.00,$0.00
117011,ERX,HCPCS 63700001,00456-1201-30,LINACLOTIDE 145 MCG PO CAPS,$67.65,$0.00,$67.65,$0.00,$48.28,$0.00,$0.00,$0.00,$0.00,$0.00,$67.65,$0.00,$33.83,$53.58,$54.12,$0.00,$0.00,$0.00,$0.00,$0.00
117021,ERX,HCPCS 25000001,50419-0171-03,REGORAFENIB 40 MG PO TABS,"$1,237.25",$0.00,"$1,237.25",$0.00,$883.03,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,237.25",$0.00,$618.63,$979.90,$989.80,$0.00,$0.00,$0.00,$0.00,$0.00
117385,ERX,HCPCS 63700001,59676-0566-30,DARUNAVIR ETHANOLATE 800 MG PO TABS,$222.49,$0.00,$222.49,$0.00,$158.79,$0.00,$0.00,$0.00,$0.00,$0.00,$222.49,$0.00,$111.25,$176.21,$177.99,$0.00,$0.00,$0.00,$0.00,$0.00
117945,ERX,HCPCS 25000001,24208-0503-07,LOTEPREDNOL ETABONATE 0.5 % OP GEL,$642.89,$0.00,$642.89,$0.00,$458.83,$0.00,$0.00,$0.00,$0.00,$0.00,$642.89,$0.00,$321.45,$509.17,$514.31,$0.00,$0.00,$0.00,$0.00,$0.00
118046,ERX,HCPCS 63700001,42937-0705-18,PRENATAL PLUS IRON 29-1 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
118105,ERX,HCPCS 63600001,76189-0535-30,PONATINIB HCL 15 MG PO TABS,"$1,589.86",$0.00,"$1,589.86",$0.00,"$1,134.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,589.86",$0.00,$794.93,"$1,259.17","$1,271.89",$0.00,$0.00,$0.00,$0.00,$0.00
118189,ERX,HCPCS 25000001,54643-5649-01,INFUVITE ADULT IV INJ,$46.14,$0.00,$46.14,$0.00,$32.93,$0.00,$0.00,$0.00,$0.00,$0.00,$46.14,$0.00,$23.07,$36.54,$36.91,$0.00,$0.00,$0.00,$0.00,$0.00
118319,ERX,HCPCS 63700001,00003-0893-21,APIXABAN 2.5 MG PO TABS,$35.79,$0.00,$35.79,$0.00,$25.54,$0.00,$0.00,$0.00,$0.00,$0.00,$35.79,$0.00,$17.90,$28.35,$28.63,$0.00,$0.00,$0.00,$0.00,$0.00
118319,ERX,HCPCS 63700001,00003-0893-31,APIXABAN 2.5 MG PO TABS,$35.79,$0.00,$35.79,$0.00,$25.54,$0.00,$0.00,$0.00,$0.00,$0.00,$35.79,$0.00,$17.90,$28.35,$28.63,$0.00,$0.00,$0.00,$0.00,$0.00
118352,ERX,HCPCS 63700001,00003-0894-21,APIXABAN 5 MG PO TABS,$35.79,$0.00,$35.79,$0.00,$25.54,$0.00,$0.00,$0.00,$0.00,$0.00,$35.79,$0.00,$17.90,$28.35,$28.63,$0.00,$0.00,$0.00,$0.00,$0.00
118352,ERX,HCPCS 63700001,00003-0894-31,APIXABAN 5 MG PO TABS,$35.79,$0.00,$35.79,$0.00,$25.54,$0.00,$0.00,$0.00,$0.00,$0.00,$35.79,$0.00,$17.90,$28.35,$28.63,$0.00,$0.00,$0.00,$0.00,$0.00
118810,ERX,HCPCS 63700001,00536-4085-01,PRENATAL VITAMINS 28-0.8 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
118851,ERX,HCPCS 25000001,59572-0501-00,POMALIDOMIDE 1 MG PO CAPS,"$2,136.58",$0.00,"$2,136.58",$0.00,"$1,524.88",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,136.58",$0.00,"$1,068.29","$1,692.17","$1,709.26",$0.00,$0.00,$0.00,$0.00,$0.00
118851,ERX,HCPCS 25000001,59572-0501-21,POMALIDOMIDE 1 MG PO CAPS,"$2,136.58",$0.00,"$2,136.58",$0.00,"$1,524.88",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,136.58",$0.00,"$1,068.29","$1,692.17","$1,709.26",$0.00,$0.00,$0.00,$0.00,$0.00
118852,ERX,HCPCS 25000001,59572-0502-00,POMALIDOMIDE 2 MG PO CAPS,"$2,136.58",$0.00,"$2,136.58",$0.00,"$1,524.88",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,136.58",$0.00,"$1,068.29","$1,692.17","$1,709.26",$0.00,$0.00,$0.00,$0.00,$0.00
118852,ERX,HCPCS 25000001,59572-0502-21,POMALIDOMIDE 2 MG PO CAPS,"$2,136.58",$0.00,"$2,136.58",$0.00,"$1,524.88",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,136.58",$0.00,"$1,068.29","$1,692.17","$1,709.26",$0.00,$0.00,$0.00,$0.00,$0.00
118853,ERX,HCPCS 25000001,59572-0503-00,POMALIDOMIDE 3 MG PO CAPS,"$2,136.58",$0.00,"$2,136.58",$0.00,"$1,524.88",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,136.58",$0.00,"$1,068.29","$1,692.17","$1,709.26",$0.00,$0.00,$0.00,$0.00,$0.00
118853,ERX,HCPCS 25000001,59572-0503-21,POMALIDOMIDE 3 MG PO CAPS,"$2,136.58",$0.00,"$2,136.58",$0.00,"$1,524.88",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,136.58",$0.00,"$1,068.29","$1,692.17","$1,709.26",$0.00,$0.00,$0.00,$0.00,$0.00
118854,ERX,HCPCS 25000001,59572-0504-00,POMALIDOMIDE 4 MG PO CAPS,"$2,136.58",$0.00,"$2,136.58",$0.00,"$1,524.88",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,136.58",$0.00,"$1,068.29","$1,692.17","$1,709.26",$0.00,$0.00,$0.00,$0.00,$0.00
118854,ERX,HCPCS 25000001,59572-0504-21,POMALIDOMIDE 4 MG PO CAPS,"$2,136.58",$0.00,"$2,136.58",$0.00,"$1,524.88",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,136.58",$0.00,"$1,068.29","$1,692.17","$1,709.26",$0.00,$0.00,$0.00,$0.00,$0.00
118951,ERX,HCPCS J9354,50242-0087-01,ADO-TRASTUZUMAB EMTANSINE 160 MG IV SOLR,"$12,416.08",$0.00,"$12,416.08","$5,587.24","$5,158.80","$5,018.24","$2,139.23",$0.00,$0.00,"$6,036.68","$12,416.08","$5,269.15","$6,208.04","$9,833.54","$9,932.86","$7,276.45","$6,036.68",$0.00,"$5,747.95","$5,250.88"
119091,ERX,HCPCS 63700001,00406-8330-23,MORPHINE SULFATE CR 30 MG PO TB12,$12.85,$0.00,$12.85,$0.00,$9.17,$0.00,$0.00,$0.00,$0.00,$0.00,$12.85,$0.00,$6.43,$10.18,$10.28,$0.00,$0.00,$0.00,$0.00,$0.00
119091,ERX,HCPCS 63700001,00406-8330-62,MORPHINE SULFATE CR 30 MG PO TB12,$12.85,$0.00,$12.85,$0.00,$9.17,$0.00,$0.00,$0.00,$0.00,$0.00,$12.85,$0.00,$6.43,$10.18,$10.28,$0.00,$0.00,$0.00,$0.00,$0.00
119102,ERX,HCPCS 63700001,00456-3407-33,MEMANTINE HCL ER 7 MG PO CP24,$70.65,$0.00,$70.65,$0.00,$50.42,$0.00,$0.00,$0.00,$0.00,$0.00,$70.65,$0.00,$35.33,$55.95,$56.52,$0.00,$0.00,$0.00,$0.00,$0.00
119105,ERX,HCPCS 63700001,00456-3428-33,MEMANTINE HCL ER 28 MG PO CP24,$58.07,$0.00,$58.07,$0.00,$41.44,$0.00,$0.00,$0.00,$0.00,$0.00,$58.07,$0.00,$29.04,$45.99,$46.46,$0.00,$0.00,$0.00,$0.00,$0.00
119105,ERX,HCPCS 63700001,10370-0349-11,MEMANTINE HCL ER 28 MG PO CP24,$58.07,$0.00,$58.07,$0.00,$41.44,$0.00,$0.00,$0.00,$0.00,$0.00,$58.07,$0.00,$29.04,$45.99,$46.46,$0.00,$0.00,$0.00,$0.00,$0.00
119105,ERX,HCPCS 63700001,43975-0266-03,MEMANTINE HCL ER 28 MG PO CP24,$58.07,$0.00,$58.07,$0.00,$41.44,$0.00,$0.00,$0.00,$0.00,$0.00,$58.07,$0.00,$29.04,$45.99,$46.46,$0.00,$0.00,$0.00,$0.00,$0.00
119111,ERX,HCPCS 63700001,99999-6007-75,DARUNAVIR ETHANOLATE 100 MG/ML PO SUSP,$925.00,$0.00,$732.60,$0.00,$409.94,$0.00,$0.00,$0.00,$0.00,$0.00,$574.38,$0.00,$287.19,$732.60,$459.50,$0.00,$0.00,$0.00,$0.00,$0.00
119111,ERX,HCPCS 63700001,59676-0565-01,DARUNAVIR ETHANOLATE 100 MG/ML PO SUSP,"$2,412.85",$0.00,"$1,910.98",$0.00,$409.94,$0.00,$0.00,$0.00,$0.00,$0.00,$574.38,$0.00,$287.19,"$1,910.98",$459.50,$0.00,$0.00,$0.00,$0.00,$0.00
119120,ERX,HCPCS J2270,00409-1890-01,MORPHINE SULFATE (PF) 2 MG/ML IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$2.39,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$2.39,$0.00,$2.27,$0.00
119120,ERX,HCPCS J2270,00409-1890-03,MORPHINE SULFATE (PF) 2 MG/ML IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$2.39,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$2.39,$0.00,$2.27,$0.00
119123,ERX,HCPCS 25000001,00074-4380-10,CISATRACURIUM BESYLATE 20 MG/10ML IV SOLN,$96.60,$0.00,$96.60,$0.00,$68.94,$0.00,$0.00,$0.00,$0.00,$0.00,$96.60,$0.00,$48.30,$76.51,$77.28,$0.00,$0.00,$0.00,$0.00,$0.00
119123,ERX,HCPCS 25000001,00074-4380-81,CISATRACURIUM BESYLATE 20 MG/10ML IV SOLN,$96.60,$0.00,$96.60,$0.00,$68.94,$0.00,$0.00,$0.00,$0.00,$0.00,$96.60,$0.00,$48.30,$76.51,$77.28,$0.00,$0.00,$0.00,$0.00,$0.00
119123,ERX,HCPCS 25000001,00781-3152-95,CISATRACURIUM BESYLATE 20 MG/10ML IV SOLN,$96.60,$0.00,$96.60,$0.00,$68.94,$0.00,$0.00,$0.00,$0.00,$0.00,$96.60,$0.00,$48.30,$76.51,$77.28,$0.00,$0.00,$0.00,$0.00,$0.00
119123,ERX,HCPCS 25000001,00781-9038-70,CISATRACURIUM BESYLATE 20 MG/10ML IV SOLN,$96.60,$0.00,$96.60,$0.00,$68.94,$0.00,$0.00,$0.00,$0.00,$0.00,$96.60,$0.00,$48.30,$76.51,$77.28,$0.00,$0.00,$0.00,$0.00,$0.00
119123,ERX,HCPCS 25000001,00781-9038-95,CISATRACURIUM BESYLATE 20 MG/10ML IV SOLN,$96.60,$0.00,$96.60,$0.00,$68.94,$0.00,$0.00,$0.00,$0.00,$0.00,$96.60,$0.00,$48.30,$76.51,$77.28,$0.00,$0.00,$0.00,$0.00,$0.00
119123,ERX,HCPCS 25000001,63323-0417-10,CISATRACURIUM BESYLATE 20 MG/10ML IV SOLN,$96.60,$0.00,$96.60,$0.00,$68.94,$0.00,$0.00,$0.00,$0.00,$0.00,$96.60,$0.00,$48.30,$76.51,$77.28,$0.00,$0.00,$0.00,$0.00,$0.00
119129,ERX,HCPCS 63700001,00406-8315-01,MORPHINE SULFATE CR 15 MG PO TB12,$7.12,$0.00,$7.12,$0.00,$5.08,$0.00,$0.00,$0.00,$0.00,$0.00,$7.12,$0.00,$3.56,$5.64,$5.70,$0.00,$0.00,$0.00,$0.00,$0.00
119129,ERX,HCPCS 63700001,00406-8315-23,MORPHINE SULFATE CR 15 MG PO TB12,$7.12,$0.00,$7.12,$0.00,$5.08,$0.00,$0.00,$0.00,$0.00,$0.00,$7.12,$0.00,$3.56,$5.64,$5.70,$0.00,$0.00,$0.00,$0.00,$0.00
119129,ERX,HCPCS 63700001,00406-8315-62,MORPHINE SULFATE CR 15 MG PO TB12,$7.12,$0.00,$7.12,$0.00,$5.08,$0.00,$0.00,$0.00,$0.00,$0.00,$7.12,$0.00,$3.56,$5.64,$5.70,$0.00,$0.00,$0.00,$0.00,$0.00
119131,ERX,HCPCS 63700001,00406-8390-01,MORPHINE SULFATE CR 100 MG PO TB12,$29.02,$0.00,$29.02,$0.00,$20.71,$0.00,$0.00,$0.00,$0.00,$0.00,$29.02,$0.00,$14.51,$22.98,$23.22,$0.00,$0.00,$0.00,$0.00,$0.00
119131,ERX,HCPCS 63700001,00406-8390-62,MORPHINE SULFATE CR 100 MG PO TB12,$29.02,$0.00,$29.02,$0.00,$20.71,$0.00,$0.00,$0.00,$0.00,$0.00,$29.02,$0.00,$14.51,$22.98,$23.22,$0.00,$0.00,$0.00,$0.00,$0.00
119134,ERX,HCPCS 25000001,00143-9680-25,GLYCOPYRROLATE 1 MG/5ML IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
119134,ERX,HCPCS 25000001,62295-3325-05,GLYCOPYRROLATE 1 MG/5ML IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
119134,ERX,HCPCS 25000001,70121-1396-05,GLYCOPYRROLATE 1 MG/5ML IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
119650,ERX,HCPCS 63700001,00065-4147-27,(SIMBRINZA) BRINZOLAMIDE-BRIMONIDINE 1-0.2 % OP SUSP,$545.97,$0.00,$436.78,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$432.41,$436.78,$0.00,$0.00,$0.00,$0.00,$0.00
119955,ERX,HCPCS 63700001,50268-0851-15,VITAMIN B1 100 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
120301,ERX,HCPCS 25000001,00904-6488-38,ARTIFICIAL TEARS 83-15 % OP OINT,$14.02,$0.00,$14.02,$0.00,$10.01,$0.00,$0.00,$0.00,$0.00,$0.00,$14.02,$0.00,$7.01,$11.10,$11.22,$0.00,$0.00,$0.00,$0.00,$0.00
120319,ERX,HCPCS C9132,63833-0386-02,PROTHROMBIN COMPLEX CONC HUMAN 500 UNITS IV KIT,"$3,075.00",$0.00,"$3,218.50",$0.00,"$2,297.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,218.50",$0.00,"$1,609.25","$2,435.40","$2,574.80",$0.00,$0.00,$0.00,$0.00,$0.00
120319,ERX,HCPCS C9132,63833-0396-01,PROTHROMBIN COMPLEX CONC HUMAN 500 UNITS IV KIT,"$3,075.00",$0.00,"$3,218.50",$0.00,"$2,297.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,218.50",$0.00,"$1,609.25","$2,435.40","$2,574.80",$0.00,$0.00,$0.00,$0.00,$0.00
120606,ERX,HCPCS 63700001,00078-0681-66,DABRAFENIB MESYLATE 75 MG PO CAPS,$583.05,$0.00,$583.05,$0.00,$416.12,$0.00,$0.00,$0.00,$0.00,$0.00,$583.05,$0.00,$291.53,$461.78,$466.44,$0.00,$0.00,$0.00,$0.00,$0.00
120607,ERX,HCPCS 63700001,00078-0666-15,TRAMETINIB DIMETHYL SULFOXIDE 0.5 MG PO TABS,"$1,347.57",$0.00,"$1,347.57",$0.00,$961.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,347.57",$0.00,$673.79,"$1,067.28","$1,078.06",$0.00,$0.00,$0.00,$0.00,$0.00
120608,ERX,HCPCS 63700001,00078-0668-15,TRAMETINIB DIMETHYL SULFOXIDE 2 MG PO TABS,"$1,266.06",$0.00,"$1,266.06",$0.00,$903.59,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,266.06",$0.00,$633.03,"$1,002.72","$1,012.85",$0.00,$0.00,$0.00,$0.00,$0.00
120650,ERX,HCPCS J2710,00641-6149-10,NEOSTIGMINE METHYLSULFATE 10 MG/10ML IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.12,$0.00,$0.00,$2.03,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$2.03,$0.00,$1.94,$0.00
120650,ERX,HCPCS J2710,63323-0415-10,NEOSTIGMINE METHYLSULFATE 10 MG/10ML IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.12,$0.00,$0.00,$2.03,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$2.03,$0.00,$1.94,$0.00
120650,ERX,HCPCS J2710,76014-0003-10,NEOSTIGMINE METHYLSULFATE 10 MG/10ML IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.12,$0.00,$0.00,$2.03,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$2.03,$0.00,$1.94,$0.00
120650,ERX,HCPCS J2710,76014-0003-33,NEOSTIGMINE METHYLSULFATE 10 MG/10ML IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.12,$0.00,$0.00,$2.03,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$2.03,$0.00,$1.94,$0.00
120829,ERX,HCPCS 63700001,99999-6011-84,NIMODIPINE 60 MG/20ML PO SOLN,$171.64,$0.00,$171.64,$0.00,$122.50,$0.00,$0.00,$0.00,$0.00,$0.00,$171.64,$0.00,$85.82,$135.94,$137.31,$0.00,$0.00,$0.00,$0.00,$0.00
121069,ERX,HCPCS J1602,57894-0350-01,GOLIMUMAB 50 MG/4ML IV SOLN,"$4,692.74",$0.00,"$4,692.74",$0.00,"$3,349.21",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,692.74",$0.00,"$2,346.37","$3,716.65","$3,754.19",$0.00,$0.00,$0.00,$0.00,$0.00
121091,ERX,HCPCS J1439,00517-0650-01,FERRIC CARBOXYMALTOSE 750 MG/15ML IV SOLN,"$2,803.57",$0.00,"$2,803.57","$1,261.61","$2,000.91",$822.75,$483.04,$0.00,$0.00,$978.19,"$2,803.57",$863.89,"$1,401.79","$2,220.43","$2,242.86","$1,192.99",$978.19,$0.00,$931.40,$840.00
121434,ERX,HCPCS 63700001,49702-0228-13,DOLUTEGRAVIR SODIUM 50 MG PO TABS,$230.14,$0.00,$230.14,$0.00,$164.25,$0.00,$0.00,$0.00,$0.00,$0.00,$230.14,$0.00,$115.07,$182.27,$184.11,$0.00,$0.00,$0.00,$0.00,$0.00
121712,ERX,HCPCS 90680,00006-4047-41,ROTAVIRUS VAC LIVE PENTAVALENT PO SOLN,$308.93,$0.00,$308.93,$139.02,$229.24,$0.00,$53.23,$0.00,$0.00,$54.09,$308.93,$0.00,$154.47,$244.67,$247.14,$0.00,$48.35,$0.00,$51.14,$0.00
121715,ERX,HCPCS 25000001,00409-1165-01,BUPIVACAINE HCL (PF) 0.75 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
121715,ERX,HCPCS 25000001,00409-1582-10,BUPIVACAINE HCL (PF) 0.75 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
121715,ERX,HCPCS 25000001,55150-0171-10,BUPIVACAINE HCL (PF) 0.75 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
121715,ERX,HCPCS 25000001,63323-0472-17,BUPIVACAINE HCL (PF) 0.75 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
121718,ERX,HCPCS J2260,00143-9710-01,MILRINONE LACTATE 10 MG/10ML IV SOLN,$28.50,$0.00,$28.50,$12.83,$20.34,$0.00,$4.91,$0.00,$0.00,$3.60,$28.50,$0.00,$14.25,$22.57,$22.80,$0.00,$3.60,$0.00,$3.42,$0.00
121718,ERX,HCPCS J2260,00143-9710-10,MILRINONE LACTATE 10 MG/10ML IV SOLN,$28.50,$0.00,$28.50,$12.83,$20.34,$0.00,$4.91,$0.00,$0.00,$3.60,$28.50,$0.00,$14.25,$22.57,$22.80,$0.00,$3.60,$0.00,$3.42,$0.00
121718,ERX,HCPCS J2260,00409-0212-01,MILRINONE LACTATE 10 MG/10ML IV SOLN,$28.50,$0.00,$28.50,$12.83,$20.34,$0.00,$4.91,$0.00,$0.00,$3.60,$28.50,$0.00,$14.25,$22.57,$22.80,$0.00,$3.60,$0.00,$3.42,$0.00
121718,ERX,HCPCS J2260,63323-0617-10,MILRINONE LACTATE 10 MG/10ML IV SOLN,$28.50,$0.00,$28.50,$12.83,$20.34,$0.00,$4.91,$0.00,$0.00,$3.60,$28.50,$0.00,$14.25,$22.57,$22.80,$0.00,$3.60,$0.00,$3.42,$0.00
121722,ERX,HCPCS J9181,00143-9511-01,ETOPOSIDE 500 MG/25ML IV SOLN,$179.08,$0.00,$179.08,$80.59,$127.81,$0.00,$30.85,$0.00,$0.00,$36.43,$179.08,$0.00,$89.54,$141.83,$143.26,$0.00,$36.43,$0.00,$34.68,$0.00
121722,ERX,HCPCS J9181,16729-0114-08,ETOPOSIDE 500 MG/25ML IV SOLN,$179.08,$0.00,$179.08,$80.59,$127.81,$0.00,$30.85,$0.00,$0.00,$36.43,$179.08,$0.00,$89.54,$141.83,$143.26,$0.00,$36.43,$0.00,$34.68,$0.00
121723,ERX,HCPCS J9181,00703-5657-01,ETOPOSIDE 1 GM/50ML IV SOLN,$455.22,$0.00,$455.22,$204.85,$324.89,$0.00,$78.43,$0.00,$0.00,$72.85,$455.22,$0.00,$227.61,$360.53,$364.18,$0.00,$72.85,$0.00,$69.37,$0.00
121723,ERX,HCPCS J9181,63323-0104-50,ETOPOSIDE 1 GM/50ML IV SOLN,$455.22,$0.00,$455.22,$204.85,$324.89,$0.00,$78.43,$0.00,$0.00,$72.85,$455.22,$0.00,$227.61,$360.53,$364.18,$0.00,$72.85,$0.00,$69.37,$0.00
121727,ERX,HCPCS 63700001,60258-0172-01,MAGNESIUM GLUCONATE 500 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
121730,ERX,HCPCS 25000001,59011-0410-10,OXYCODONE HCL ER 10 MG PO T12A,$19.79,$0.00,$19.79,$0.00,$14.12,$0.00,$0.00,$0.00,$0.00,$0.00,$19.79,$0.00,$9.90,$15.67,$15.83,$0.00,$0.00,$0.00,$0.00,$0.00
121730,ERX,HCPCS 25000001,59011-0410-20,OXYCODONE HCL ER 10 MG PO T12A,$19.79,$0.00,$19.79,$0.00,$14.12,$0.00,$0.00,$0.00,$0.00,$0.00,$19.79,$0.00,$9.90,$15.67,$15.83,$0.00,$0.00,$0.00,$0.00,$0.00
121733,ERX,HCPCS 25000001,59011-0420-10,OXYCODONE HCL ER 20 MG PO T12A,$36.86,$0.00,$36.86,$0.00,$26.31,$0.00,$0.00,$0.00,$0.00,$0.00,$36.86,$0.00,$18.43,$29.19,$29.49,$0.00,$0.00,$0.00,$0.00,$0.00
121733,ERX,HCPCS 25000001,59011-0420-20,OXYCODONE HCL ER 20 MG PO T12A,$36.86,$0.00,$36.86,$0.00,$26.31,$0.00,$0.00,$0.00,$0.00,$0.00,$36.86,$0.00,$18.43,$29.19,$29.49,$0.00,$0.00,$0.00,$0.00,$0.00
121735,ERX,HCPCS 25000001,59011-0440-10,OXYCODONE HCL ER 40 MG PO T12A,$61.55,$0.00,$61.55,$0.00,$43.93,$0.00,$0.00,$0.00,$0.00,$0.00,$61.55,$0.00,$30.78,$48.75,$49.24,$0.00,$0.00,$0.00,$0.00,$0.00
121735,ERX,HCPCS 25000001,59011-0440-20,OXYCODONE HCL ER 40 MG PO T12A,$61.55,$0.00,$61.55,$0.00,$43.93,$0.00,$0.00,$0.00,$0.00,$0.00,$61.55,$0.00,$30.78,$48.75,$49.24,$0.00,$0.00,$0.00,$0.00,$0.00
121737,ERX,HCPCS 25000001,59011-0480-20,OXYCODONE HCL ER 80 MG PO T12A,$101.46,$0.00,$101.46,$0.00,$72.41,$0.00,$0.00,$0.00,$0.00,$0.00,$101.46,$0.00,$50.73,$80.36,$81.17,$0.00,$0.00,$0.00,$0.00,$0.00
121854,ERX,HCPCS 25000001,63402-0306-30,LURASIDONE HCL 60 MG PO TABS,$161.71,$0.00,$161.71,$0.00,$115.41,$0.00,$0.00,$0.00,$0.00,$0.00,$161.71,$0.00,$80.86,$128.07,$129.37,$0.00,$0.00,$0.00,$0.00,$0.00
121934,ERX,HCPCS 25000001,00143-9532-25,DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN,$166.32,$0.00,$166.32,$0.00,$118.70,$0.00,$0.00,$0.00,$0.00,$0.00,$166.32,$0.00,$83.16,$131.73,$133.06,$0.00,$0.00,$0.00,$0.00,$0.00
121934,ERX,HCPCS 25000001,16729-0239-30,DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN,$166.32,$0.00,$166.32,$0.00,$118.70,$0.00,$0.00,$0.00,$0.00,$0.00,$166.32,$0.00,$83.16,$131.73,$133.06,$0.00,$0.00,$0.00,$0.00,$0.00
121934,ERX,HCPCS 25000001,16729-0239-93,DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN,$166.32,$0.00,$166.32,$0.00,$118.70,$0.00,$0.00,$0.00,$0.00,$0.00,$166.32,$0.00,$83.16,$131.73,$133.06,$0.00,$0.00,$0.00,$0.00,$0.00
121934,ERX,HCPCS 25000001,16729-0432-30,DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN,$166.32,$0.00,$166.32,$0.00,$118.70,$0.00,$0.00,$0.00,$0.00,$0.00,$166.32,$0.00,$83.16,$131.73,$133.06,$0.00,$0.00,$0.00,$0.00,$0.00
121934,ERX,HCPCS 25000001,16729-0432-93,DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN,$166.32,$0.00,$166.32,$0.00,$118.70,$0.00,$0.00,$0.00,$0.00,$0.00,$166.32,$0.00,$83.16,$131.73,$133.06,$0.00,$0.00,$0.00,$0.00,$0.00
121934,ERX,HCPCS 25000001,42023-0146-25,DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN,$166.32,$0.00,$166.32,$0.00,$118.70,$0.00,$0.00,$0.00,$0.00,$0.00,$166.32,$0.00,$83.16,$131.73,$133.06,$0.00,$0.00,$0.00,$0.00,$0.00
121934,ERX,HCPCS 25000001,55150-0209-02,DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN,$166.32,$0.00,$166.32,$0.00,$118.70,$0.00,$0.00,$0.00,$0.00,$0.00,$166.32,$0.00,$83.16,$131.73,$133.06,$0.00,$0.00,$0.00,$0.00,$0.00
121934,ERX,HCPCS 25000001,57664-0596-50,DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN,$166.32,$0.00,$166.32,$0.00,$118.70,$0.00,$0.00,$0.00,$0.00,$0.00,$166.32,$0.00,$83.16,$131.73,$133.06,$0.00,$0.00,$0.00,$0.00,$0.00
121934,ERX,HCPCS 25000001,63323-0421-02,DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN,$166.32,$0.00,$166.32,$0.00,$118.70,$0.00,$0.00,$0.00,$0.00,$0.00,$166.32,$0.00,$83.16,$131.73,$133.06,$0.00,$0.00,$0.00,$0.00,$0.00
121934,ERX,HCPCS 25000001,70860-0605-03,DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN,$166.32,$0.00,$166.32,$0.00,$118.70,$0.00,$0.00,$0.00,$0.00,$0.00,$166.32,$0.00,$83.16,$131.73,$133.06,$0.00,$0.00,$0.00,$0.00,$0.00
121934,ERX,HCPCS 25000001,70860-0605-41,DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN,$166.32,$0.00,$166.32,$0.00,$118.70,$0.00,$0.00,$0.00,$0.00,$0.00,$166.32,$0.00,$83.16,$131.73,$133.06,$0.00,$0.00,$0.00,$0.00,$0.00
121955,ERX,HCPCS J9041,63020-0049-01,BORTEZOMIB 3.5 MG IJ SOLR,"$3,943.38",$0.00,"$3,943.38","$1,774.52","$2,814.39","$1,564.05","$1,491.60",$0.00,$0.00,"$1,844.87","$3,943.38","$1,642.25","$1,971.69","$3,123.16","$3,154.70","$2,267.87","$1,844.87",$0.00,"$1,756.63","$1,574.55"
122027,ERX,HCPCS 63700001,64764-0750-30,VORTIOXETINE HBR 20 MG PO TABS,$61.24,$0.00,$61.24,$0.00,$43.71,$0.00,$0.00,$0.00,$0.00,$0.00,$61.24,$0.00,$30.62,$48.50,$48.99,$0.00,$0.00,$0.00,$0.00,$0.00
122192,ERX,HCPCS J9301,50242-0070-01,OBINUTUZUMAB 1000 MG/40ML IV SOLN,"$16,357.20",$0.00,"$16,357.20",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$16,357.20",$0.00,"$8,178.60","$12,954.90","$13,085.76",$0.00,$0.00,$0.00,$0.00,$0.00
122260,ERX,HCPCS 63700001,57962-0140-09,IBRUTINIB 140 MG PO CAPS,$981.72,$0.00,$981.72,$0.00,$700.65,$0.00,$0.00,$0.00,$0.00,$0.00,$981.72,$0.00,$490.86,$777.52,$785.38,$0.00,$0.00,$0.00,$0.00,$0.00
122260,ERX,HCPCS 63700001,57962-0140-12,IBRUTINIB 140 MG PO CAPS,$981.72,$0.00,$981.72,$0.00,$700.65,$0.00,$0.00,$0.00,$0.00,$0.00,$981.72,$0.00,$490.86,$777.52,$785.38,$0.00,$0.00,$0.00,$0.00,$0.00
122312,ERX,HCPCS 25000001,00085-4324-02,POSACONAZOLE 100 MG PO TBEC,$653.78,$0.00,$653.78,$0.00,$466.60,$0.00,$0.00,$0.00,$0.00,$0.00,$653.78,$0.00,$326.89,$517.79,$523.02,$0.00,$0.00,$0.00,$0.00,$0.00
122959,ERX,HCPCS 63700001,00310-6205-30,DAPAGLIFLOZIN PROPANEDIOL 5 MG PO TABS,$72.43,$0.00,$72.43,$0.00,$51.69,$0.00,$0.00,$0.00,$0.00,$0.00,$72.43,$0.00,$36.22,$57.36,$57.94,$0.00,$0.00,$0.00,$0.00,$0.00
122960,ERX,HCPCS 63700001,00310-6210-30,DAPAGLIFLOZIN PROPANEDIOL 10 MG PO TABS,$72.43,$0.00,$72.43,$0.00,$51.69,$0.00,$0.00,$0.00,$0.00,$0.00,$72.43,$0.00,$36.22,$57.36,$57.94,$0.00,$0.00,$0.00,$0.00,$0.00
123430,ERX,HCPCS J9181,00703-5653-01,ETOPOSIDE 100 MG/5ML IV SOLN,$57.00,$0.00,$57.00,$25.65,$40.68,$0.00,$9.82,$0.00,$0.00,$7.29,$57.00,$0.00,$28.50,$45.14,$45.60,$0.00,$7.29,$0.00,$6.94,$0.00
123430,ERX,HCPCS J9181,16729-0114-31,ETOPOSIDE 100 MG/5ML IV SOLN,$57.00,$0.00,$57.00,$25.65,$40.68,$0.00,$9.82,$0.00,$0.00,$7.29,$57.00,$0.00,$28.50,$45.14,$45.60,$0.00,$7.29,$0.00,$6.94,$0.00
123430,ERX,HCPCS J9181,63323-0104-05,ETOPOSIDE 100 MG/5ML IV SOLN,$57.00,$0.00,$57.00,$25.65,$40.68,$0.00,$9.82,$0.00,$0.00,$7.29,$57.00,$0.00,$28.50,$45.14,$45.60,$0.00,$7.29,$0.00,$6.94,$0.00
123462,ERX,HCPCS 25000001,00169-4060-13,(VICTOZA) LIRAGLUTIDE 18 MG/3ML SC SOPN,$393.60,$0.00,$393.60,$0.00,$280.91,$0.00,$0.00,$0.00,$0.00,$0.00,$393.60,$0.00,$196.80,$311.73,$314.88,$0.00,$0.00,$0.00,$0.00,$0.00
123464,ERX,HCPCS J1720,00009-0011-03,HYDROCORTISONE NA SUCCINATE PF 100 MG IJ SOLR,$24.78,$0.00,$24.78,$11.15,$17.69,$0.00,$4.27,$0.00,$0.00,$15.33,$24.78,$0.00,$12.39,$19.63,$19.82,$0.00,$15.33,$0.00,$14.60,$0.00
123464,ERX,HCPCS J1720,00009-0825-01,HYDROCORTISONE NA SUCCINATE PF 100 MG IJ SOLR,$24.78,$0.00,$24.78,$11.15,$17.69,$0.00,$4.27,$0.00,$0.00,$15.33,$24.78,$0.00,$12.39,$19.63,$19.82,$0.00,$15.33,$0.00,$14.60,$0.00
123468,ERX,HCPCS 25000001,00641-6022-25,FAMOTIDINE 20 MG/2ML IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
123468,ERX,HCPCS 25000001,63323-0739-11,FAMOTIDINE 20 MG/2ML IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
123468,ERX,HCPCS 25000001,63323-0739-12,FAMOTIDINE 20 MG/2ML IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
123468,ERX,HCPCS 25000001,67457-0433-22,FAMOTIDINE 20 MG/2ML IV SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
123472,ERX,HCPCS J1100,55150-0238-05,DEXAMETHASONE SODIUM PHOSPHATE 20 MG/5ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.06,$0.00,$0.00,$1.41,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.41,$0.00,$1.34,$0.00
123472,ERX,HCPCS J1100,63323-0165-05,DEXAMETHASONE SODIUM PHOSPHATE 20 MG/5ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.06,$0.00,$0.00,$1.41,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.41,$0.00,$1.34,$0.00
123472,ERX,HCPCS J1100,67457-0422-00,DEXAMETHASONE SODIUM PHOSPHATE 20 MG/5ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.06,$0.00,$0.00,$1.41,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.41,$0.00,$1.34,$0.00
123472,ERX,HCPCS J1100,67457-0422-54,DEXAMETHASONE SODIUM PHOSPHATE 20 MG/5ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.06,$0.00,$0.00,$1.41,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.41,$0.00,$1.34,$0.00
123476,ERX,HCPCS J0171,49502-0102-02,EPINEPHRINE 0.3 MG/0.3ML IJ SOAJ,$967.69,$0.00,$967.69,$435.46,$690.64,$0.00,$166.73,$0.00,$0.00,$2.89,$967.69,$0.00,$483.85,$766.41,$774.15,$0.00,$2.89,$0.00,$2.75,$0.00
123476,ERX,HCPCS J0171,49502-0500-02,EPINEPHRINE 0.3 MG/0.3ML IJ SOAJ,$967.69,$0.00,$967.69,$435.46,$690.64,$0.00,$166.73,$0.00,$0.00,$2.89,$967.69,$0.00,$483.85,$766.41,$774.15,$0.00,$2.89,$0.00,$2.75,$0.00
123622,ERX,HCPCS 25000001,00085-4331-01,POSACONAZOLE 300 MG/16.7ML IV SOLN,"$1,527.69",$0.00,"$1,527.69",$0.00,"$1,090.31",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,527.69",$0.00,$763.85,"$1,209.93","$1,222.15",$0.00,$0.00,$0.00,$0.00,$0.00
123623,ERX,HCPCS C9132,63833-0387-02,PROTHROMBIN COMPLEX CONC HUMAN 1000 UNITS/40 ML IV KIT,"$6,150.00",$0.00,"$6,437.00",$0.00,"$4,594.09",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,437.00",$0.00,"$3,218.50","$4,870.80","$5,149.60",$0.00,$0.00,$0.00,$0.00,$0.00
123623,ERX,HCPCS C9132,63833-0397-01,PROTHROMBIN COMPLEX CONC HUMAN 1000 UNITS/40 ML IV KIT,"$6,150.00",$0.00,"$6,437.00",$0.00,"$4,594.09",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,437.00",$0.00,"$3,218.50","$4,870.80","$5,149.60",$0.00,$0.00,$0.00,$0.00,$0.00
123656,ERX,HCPCS 63700001,59572-0631-06,APREMILAST 30 MG PO TABS,$226.28,$0.00,$226.28,$0.00,$161.50,$0.00,$0.00,$0.00,$0.00,$0.00,$226.28,$0.00,$113.14,$179.21,$181.02,$0.00,$0.00,$0.00,$0.00,$0.00
123657,ERX,HCPCS 25000001,59572-0632-55,APREMILAST 10 & 20 & 30 MG PO TBPK,$246.85,$0.00,$246.85,$0.00,$176.18,$0.00,$0.00,$0.00,$0.00,$0.00,$246.85,$0.00,$123.43,$195.51,$197.48,$0.00,$0.00,$0.00,$0.00,$0.00
123886,ERX,HCPCS J0171,76329-9060-00,EPINEPHRINE 30 MG/30ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$0.00,$0.00,$3.79,$0.00,$0.00,$2.89,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$2.89,$0.00,$0.00,$0.00
123899,ERX,HCPCS 25000001,41167-0058-20,LIDOCAINE 4 % EX CREAM- LARGE TUBE,$45.94,$0.00,$45.94,$0.00,$32.79,$0.00,$0.00,$0.00,$0.00,$0.00,$45.94,$0.00,$22.97,$36.38,$36.75,$0.00,$0.00,$0.00,$0.00,$0.00
123951,ERX,HCPCS J7327,59676-0820-01,HYALURONAN 88 MG/4ML I-ARTICULAR SOSY,"$3,690.00",$0.00,"$3,690.00","$1,660.50","$2,633.55",$769.51,$635.77,$0.00,$0.00,$646.09,"$3,690.00",$807.98,"$1,845.00","$2,922.48","$2,952.00","$1,115.78",$577.49,$0.00,$587.45,$766.34
123968,ERX,HCPCS J9308,00002-7669-01,RAMUCIRUMAB 100 MG/10ML IV SOLN,"$2,970.45",$0.00,"$2,970.45","$1,336.70","$2,120.01","$1,168.38",$511.79,$0.00,$0.00,"$1,402.25","$2,970.45","$1,226.80","$1,485.23","$2,352.60","$2,376.36","$1,694.15","$1,402.25",$0.00,"$1,335.18","$1,221.26"
124207,ERX,HCPCS 63700001,00378-0088-01,CARBIDOPA-LEVODOPA ER 25-100 MG PO TBCR,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
124207,ERX,HCPCS 63700001,51079-0978-01,CARBIDOPA-LEVODOPA ER 25-100 MG PO TBCR,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
124207,ERX,HCPCS 63700001,51079-0978-20,CARBIDOPA-LEVODOPA ER 25-100 MG PO TBCR,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
124207,ERX,HCPCS 63700001,62756-0461-88,CARBIDOPA-LEVODOPA ER 25-100 MG PO TBCR,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
124207,ERX,HCPCS 63700001,68084-0281-01,CARBIDOPA-LEVODOPA ER 25-100 MG PO TBCR,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
124207,ERX,HCPCS 63700001,68084-0281-11,CARBIDOPA-LEVODOPA ER 25-100 MG PO TBCR,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
124228,ERX,HCPCS J3380,64764-0300-20,VEDOLIZUMAB 300 MG IV SOLR,"$16,550.02",$0.00,"$16,550.02","$7,447.51","$5,158.80","$5,959.20","$2,851.49",$0.00,$0.00,"$7,134.60","$16,550.02","$6,257.16","$8,275.01","$13,107.62","$13,240.02","$8,640.84","$7,134.60",$0.00,"$6,793.35","$6,197.40"
124458,ERX,HCPCS 63700001,00069-0830-38,SUNITINIB MALATE 37.5 MG PO CAPS,"$1,662.96",$0.00,"$1,662.96",$0.00,"$1,186.85",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,662.96",$0.00,$831.48,"$1,317.06","$1,330.37",$0.00,$0.00,$0.00,$0.00,$0.00
124486,ERX,HCPCS J0875,57970-0100-01,DALBAVANCIN HCL 500 MG IV SOLR,"$3,888.63",$0.00,"$3,888.63","$1,749.88","$2,775.32","$1,494.50",$669.99,$0.00,$0.00,"$1,769.55","$3,888.63","$1,569.23","$1,944.32","$3,079.79","$3,110.90","$2,167.03","$1,769.55",$0.00,"$1,684.91","$1,494.50"
124555,ERX,HCPCS 25000001,00536-1186-12,PHENYLEPHRINE-COCOA BUTTER 0.25-88.44 % RECTAL SUPP,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
124599,ERX,HCPCS 63700001,00006-3603-61,RALTEGRAVIR POTASSIUM 100 MG PO PACK,$28.50,$0.00,$28.50,$0.00,$20.34,$0.00,$0.00,$0.00,$0.00,$0.00,$28.50,$0.00,$14.25,$22.57,$22.80,$0.00,$0.00,$0.00,$0.00,$0.00
124607,ERX,HCPCS J8530,00054-0383-25,CYCLOPHOSPHAMIDE 50 MG PO CAPS,$65.29,$0.00,$65.29,$0.00,$46.60,$0.00,$0.00,$0.00,$0.00,$0.00,$65.29,$0.00,$32.65,$51.71,$52.23,$0.00,$0.00,$0.00,$0.00,$0.00
124728,ERX,HCPCS 25000001,00310-6530-04,EXENATIDE ER 2 MG SC PEN,$584.48,$0.00,$584.48,$0.00,$417.14,$0.00,$0.00,$0.00,$0.00,$0.00,$584.48,$0.00,$292.24,$462.91,$467.58,$0.00,$0.00,$0.00,$0.00,$0.00
124810,ERX,HCPCS 25000001,69543-0268-10,VIRT-PHOS 250 NEUTRAL 155-852-130 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
125122,ERX,HCPCS 63700001,49702-0231-13,TRIUMEQ:ABACAVIR-DOLUTEGRAVIR-LAMIVUD 600-50-300 MG PO TABS,$369.92,$0.00,$369.92,$0.00,$264.01,$0.00,$0.00,$0.00,$0.00,$0.00,$369.92,$0.00,$184.96,$292.98,$295.94,$0.00,$0.00,$0.00,$0.00,$0.00
125240,ERX,HCPCS 63600001,57894-0061-03,USTEKINUMAB 90 MG/ML SC SOSY,"$56,783.80",$0.00,"$56,783.80",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$56,783.80",$0.00,"$28,391.90","$44,972.77","$45,427.04",$0.00,$0.00,$0.00,$0.00,$0.00
125241,ERX,HCPCS 63700001,58406-0435-01,ETANERCEPT 50 MG/ML SC SOSY,"$3,417.54",$0.00,"$3,417.54",$0.00,"$2,439.10",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,417.54",$0.00,"$1,708.77","$2,706.69","$2,734.03",$0.00,$0.00,$0.00,$0.00,$0.00
125244,ERX,HCPCS 63600001,00006-4897-00,HAEMOPHILUS B POLYSAC CONJ VAC 7.5 MCG/0.5 ML IM SUSP,$109.66,$0.00,$109.66,$0.00,$81.32,$0.00,$0.00,$0.00,$0.00,$0.00,$109.66,$0.00,$54.83,$86.85,$87.73,$0.00,$0.00,$0.00,$0.00,$0.00
125258,ERX,HCPCS J7321,89130-4444-01,SODIUM HYALURONATE 25 MG/2.5ML I-ARTICULAR SOSY,$732.36,$0.00,$732.36,$329.56,$522.69,$0.00,$126.18,$0.00,$0.00,$97.35,$732.36,$0.00,$366.18,$580.03,$585.89,$0.00,$97.35,$0.00,$92.69,$0.00
125724,ERX,HCPCS J2370,00641-6142-25,PHENYLEPHRINE HCL 50 MG/5 ML IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.96,$0.00,$0.00,$4.31,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$4.31,$0.00,$4.11,$0.00
125724,ERX,HCPCS J2370,00641-6188-01,PHENYLEPHRINE HCL 50 MG/5 ML IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.96,$0.00,$0.00,$4.31,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$4.31,$0.00,$4.11,$0.00
125724,ERX,HCPCS J2370,00641-6188-10,PHENYLEPHRINE HCL 50 MG/5 ML IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.96,$0.00,$0.00,$4.31,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$4.31,$0.00,$4.11,$0.00
125724,ERX,HCPCS J2370,42023-0213-25,PHENYLEPHRINE HCL 50 MG/5 ML IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.96,$0.00,$0.00,$4.31,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$4.31,$0.00,$4.11,$0.00
125724,ERX,HCPCS J2370,42023-0214-01,PHENYLEPHRINE HCL 50 MG/5 ML IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.96,$0.00,$0.00,$4.31,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$4.31,$0.00,$4.11,$0.00
125724,ERX,HCPCS J2370,42023-0214-10,PHENYLEPHRINE HCL 50 MG/5 ML IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.96,$0.00,$0.00,$4.31,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$4.31,$0.00,$4.11,$0.00
125724,ERX,HCPCS J2370,63323-0751-01,PHENYLEPHRINE HCL 50 MG/5 ML IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.96,$0.00,$0.00,$4.31,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$4.31,$0.00,$4.11,$0.00
125724,ERX,HCPCS J2370,70121-1577-01,PHENYLEPHRINE HCL 50 MG/5 ML IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.96,$0.00,$0.00,$4.31,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$4.31,$0.00,$4.11,$0.00
125724,ERX,HCPCS J2370,70121-1577-05,PHENYLEPHRINE HCL 50 MG/5 ML IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.96,$0.00,$0.00,$4.31,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$4.31,$0.00,$4.11,$0.00
125724,ERX,HCPCS J2370,76014-0004-10,PHENYLEPHRINE HCL 50 MG/5 ML IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.96,$0.00,$0.00,$4.31,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$4.31,$0.00,$4.11,$0.00
126034,ERX,HCPCS J7188,00944-5001-01,OBIZUR:ANTIHEMOPHILIC FACTOR RPFVIII 500 UNITS IV SOLR,"$3,331.25",$0.00,"$3,331.25",$0.00,"$2,377.51",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,331.25",$0.00,"$1,665.63","$2,638.35","$2,665.00",$0.00,$0.00,$0.00,$0.00,$0.00
126034,ERX,HCPCS J7188,00944-5011-01,OBIZUR:ANTIHEMOPHILIC FACTOR RPFVIII 500 UNITS IV SOLR,"$3,331.25",$0.00,"$3,331.25",$0.00,"$2,377.51",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,331.25",$0.00,"$1,665.63","$2,638.35","$2,665.00",$0.00,$0.00,$0.00,$0.00,$0.00
126056,ERX,HCPCS 25000001,00005-0100-05,MENINGOCOCCAL B VAC (RECOMB) IM SUSY,$548.15,$0.00,$548.15,$0.00,$391.21,$0.00,$0.00,$0.00,$0.00,$0.00,$548.15,$0.00,$274.08,$434.13,$438.52,$0.00,$0.00,$0.00,$0.00,$0.00
126084,ERX,HCPCS 25000001,42023-0164-25,VASOPRESSIN 20 UNIT/ML IV SOLN,$224.04,$0.00,$224.04,$0.00,$159.90,$0.00,$0.00,$0.00,$0.00,$0.00,$224.04,$0.00,$112.02,$177.44,$179.23,$0.00,$0.00,$0.00,$0.00,$0.00
126108,ERX,HCPCS 25000001,08317-5411-00,GLUCOCARD SHINE W/DEVICE KIT,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
126110,ERX,HCPCS 25000001,08317-5400-50,GLUCOCARD SHINE TEST VI STRP,$68.40,$0.00,$68.40,$0.00,$48.82,$0.00,$0.00,$0.00,$0.00,$0.00,$68.40,$0.00,$34.20,$54.17,$54.72,$0.00,$0.00,$0.00,$0.00,$0.00
126226,ERX,HCPCS J2547,61364-0181-03,PERAMIVIR 200 MG/20ML IV SOLN,"$1,007.00",$0.00,"$1,007.00",$0.00,$718.70,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,007.00",$0.00,$503.50,$797.54,$805.60,$0.00,$0.00,$0.00,$0.00,$0.00
126226,ERX,HCPCS J2547,72769-0181-03,PERAMIVIR 200 MG/20ML IV SOLN,"$1,007.00",$0.00,"$1,007.00",$0.00,$718.70,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,007.00",$0.00,$503.50,$797.54,$805.60,$0.00,$0.00,$0.00,$0.00,$0.00
126229,ERX,HCPCS 63700001,00173-0873-10,UMECLIDINIUM BROMIDE 62.5 MCG/INH IN AEPB,"$1,093.29",$0.00,"$1,093.29",$0.00,$780.28,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,093.29",$0.00,$546.65,$865.89,$874.63,$0.00,$0.00,$0.00,$0.00,$0.00
126242,ERX,HCPCS J7313,68611-0190-02,FLUOCINOLONE ACETONIDE 0.19 MG INTRAVITREAL IMPL,"$21,648.00",$0.00,"$21,648.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,648.00",$0.00,"$10,824.00","$17,145.22","$17,318.40",$0.00,$0.00,$0.00,$0.00,$0.00
126317,ERX,HCPCS 90651,00006-4119-01,HPV 9-VALENT RECOMB VACCINE IM SUSP,$724.43,$0.00,$724.43,$325.99,$542.80,$135.38,$124.82,$0.00,$0.00,$267.82,$724.43,$0.00,$362.22,$573.75,$579.54,$434.66,$267.82,$0.00,$255.01,$0.00
126317,ERX,HCPCS 90651,00006-4119-03,HPV 9-VALENT RECOMB VACCINE IM SUSP,$724.43,$0.00,$724.43,$325.99,$542.80,$135.38,$124.82,$0.00,$0.00,$267.82,$724.43,$0.00,$362.22,$573.75,$579.54,$434.66,$267.82,$0.00,$255.01,$0.00
126371,ERX,HCPCS J0695,67919-0030-01,CEFTOLOZANE-TAZOBACTAM 1.5 (1-0.5) G IV SOLR,$458.31,$0.00,$458.31,$0.00,$327.10,$0.00,$0.00,$0.00,$0.00,$0.00,$458.31,$0.00,$229.16,$362.98,$366.65,$0.00,$0.00,$0.00,$0.00,$0.00
126373,ERX,HCPCS J9299,00003-3772-11,NIVOLUMAB 40 MG/4ML IV SOLN,"$2,697.99",$0.00,"$2,697.99","$1,214.10","$1,925.56","$1,112.20",$464.85,$0.00,$0.00,"$1,323.52","$2,697.99","$1,167.81","$1,349.00","$2,136.81","$2,158.39","$1,612.69","$1,323.52",$0.00,"$1,260.22","$1,141.36"
126374,ERX,HCPCS J9299,00003-3774-12,NIVOLUMAB 100 MG/10ML IV SOLN,"$6,744.96",$0.00,"$6,744.96","$3,035.23","$4,813.88","$2,780.50","$1,162.12",$0.00,$0.00,"$3,308.80","$6,744.96","$2,919.53","$3,372.48","$5,342.01","$5,395.97","$4,031.73","$3,308.80",$0.00,"$3,150.54","$2,853.40"
126594,ERX,HCPCS 90620,58160-0976-02,MENINGOCOCCAL B RECOMB OMV ADJ IM SUSY,$587.89,$0.00,$587.89,$264.55,$419.58,$0.00,$101.29,$0.00,$0.00,$200.63,$587.89,$0.00,$293.95,$465.61,$470.31,$352.73,$200.63,$0.00,$0.00,$0.00
126594,ERX,HCPCS 90620,58160-0976-20,MENINGOCOCCAL B RECOMB OMV ADJ IM SUSY,$587.89,$0.00,$587.89,$264.55,$419.58,$0.00,$101.29,$0.00,$0.00,$200.63,$587.89,$0.00,$293.95,$465.61,$470.31,$352.73,$200.63,$0.00,$0.00,$0.00
126697,ERX,HCPCS J9271,00006-3026-02,PEMBROLIZUMAB 100 MG/4ML IV SOLN,"$11,960.63",$0.00,"$12,140.01","$5,463.00","$5,158.80","$4,938.90","$2,060.76",$0.00,$0.00,"$5,905.55","$12,140.01","$5,185.85","$6,070.01","$9,472.82","$9,712.01","$7,161.41","$5,905.55",$0.00,"$5,623.09","$5,092.70"
126882,ERX,HCPCS 63700001,59676-0575-30,PREZCOBIX:DARUNAVIR-COBICISTAT 800-150 MG PO TABS,$254.30,$0.00,$254.30,$0.00,$181.49,$0.00,$0.00,$0.00,$0.00,$0.00,$254.30,$0.00,$127.15,$201.41,$203.44,$0.00,$0.00,$0.00,$0.00,$0.00
126886,ERX,HCPCS 63700002,68546-0317-30,GLATIRAMER ACETATE 20 MG/ML SC SOSY,$754.09,$0.00,$754.09,$0.00,$538.19,$0.00,$0.00,$0.00,$0.00,$0.00,$754.09,$0.00,$377.05,$597.24,$603.27,$0.00,$0.00,$0.00,$0.00,$0.00
126887,ERX,HCPCS 25000001,00409-4093-01,CHROMIC CHLORIDE 40 MCG/10ML IV SOLN,$82.08,$0.00,$82.08,$0.00,$58.58,$0.00,$0.00,$0.00,$0.00,$0.00,$82.08,$0.00,$41.04,$65.01,$65.66,$0.00,$0.00,$0.00,$0.00,$0.00
126888,ERX,HCPCS 25000001,63323-0086-05,POTASSIUM PHOSPHATES 15 MMOLE/5ML IV SOLN,$67.53,$0.00,$67.53,$0.00,$48.20,$0.00,$0.00,$0.00,$0.00,$0.00,$67.53,$0.00,$33.77,$53.48,$54.02,$0.00,$0.00,$0.00,$0.00,$0.00
126888,ERX,HCPCS 25000001,65219-0052-29,POTASSIUM PHOSPHATES 15 MMOLE/5ML IV SOLN,$67.53,$0.00,$67.53,$0.00,$48.20,$0.00,$0.00,$0.00,$0.00,$0.00,$67.53,$0.00,$33.77,$53.48,$54.02,$0.00,$0.00,$0.00,$0.00,$0.00
126893,ERX,HCPCS 25000001,00781-3040-95,PYRIDOSTIGMINE BROMIDE 10 MG/2ML IV SOLN,$29.19,$0.00,$29.19,$0.00,$20.83,$0.00,$0.00,$0.00,$0.00,$0.00,$29.19,$0.00,$14.60,$23.12,$23.35,$0.00,$0.00,$0.00,$0.00,$0.00
126894,ERX,HCPCS J0135 ,00074-4339-02,ADALIMUMAB 40 MG/0.8ML SC PNKT,"$6,835.07",$0.00,"$6,835.07",$0.00,"$4,878.19",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,835.07",$0.00,"$3,417.54","$5,413.38","$5,468.06",$0.00,$0.00,$0.00,$0.00,$0.00
126894,ERX,HCPCS J0135 ,00074-4339-06,ADALIMUMAB 40 MG/0.8ML SC PNKT,"$6,835.07",$0.00,"$6,835.07",$0.00,"$4,878.19",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,835.07",$0.00,"$3,417.54","$5,413.38","$5,468.06",$0.00,$0.00,$0.00,$0.00,$0.00
126894,ERX,HCPCS J0135 ,00074-4339-07,ADALIMUMAB 40 MG/0.8ML SC PNKT,"$6,835.07",$0.00,"$6,835.07",$0.00,"$4,878.19",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,835.07",$0.00,"$3,417.54","$5,413.38","$5,468.06",$0.00,$0.00,$0.00,$0.00,$0.00
126921,ERX,HCPCS 25000001,00078-0639-68,SECUKINUMAB 150 MG/ML SC SOAJ,"$13,631.93",$0.00,"$13,631.93",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,631.93",$0.00,"$6,815.97","$10,796.49","$10,905.54",$0.00,$0.00,$0.00,$0.00,$0.00
126934,ERX,HCPCS 63700001,00003-3641-11,EVOTAZ:ATAZANAVIR-COBICISTAT 300-150 MG PO TABS,$202.29,$0.00,$202.29,$0.00,$144.37,$0.00,$0.00,$0.00,$0.00,$0.00,$202.29,$0.00,$101.15,$160.21,$161.83,$0.00,$0.00,$0.00,$0.00,$0.00
126960,ERX,HCPCS 25000001,00069-0187-21,PALBOCICLIB 75 MG PO CAPS,"$1,707.35",$0.00,"$1,707.35",$0.00,"$1,218.54",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,707.35",$0.00,$853.68,"$1,352.22","$1,365.88",$0.00,$0.00,$0.00,$0.00,$0.00
126961,ERX,HCPCS 25000001,00069-0188-21,PALBOCICLIB 100 MG PO CAPS,"$1,707.35",$0.00,"$1,707.35",$0.00,"$1,218.54",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,707.35",$0.00,$853.68,"$1,352.22","$1,365.88",$0.00,$0.00,$0.00,$0.00,$0.00
126962,ERX,HCPCS 25000001,00069-0189-21,PALBOCICLIB 125 MG PO CAPS,"$1,707.35",$0.00,"$1,707.35",$0.00,"$1,218.54",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,707.35",$0.00,$853.68,"$1,352.22","$1,365.88",$0.00,$0.00,$0.00,$0.00,$0.00
127008,ERX,HCPCS 63700001,62856-0720-05,LENVATINIB (20 MG DAILY DOSE) 2 X 10 MG PO CPPK,"$1,826.02",$0.00,"$1,826.02",$0.00,"$1,303.23",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,826.02",$0.00,$913.01,"$1,446.21","$1,460.82",$0.00,$0.00,$0.00,$0.00,$0.00
127008,ERX,HCPCS 63700001,62856-0720-30,LENVATINIB (20 MG DAILY DOSE) 2 X 10 MG PO CPPK,"$1,826.02",$0.00,"$1,826.02",$0.00,"$1,303.23",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,826.02",$0.00,$913.01,"$1,446.21","$1,460.82",$0.00,$0.00,$0.00,$0.00,$0.00
127009,ERX,HCPCS 63700001,62856-0714-05,LENVATINIB (14 MG DAILY DOSE) 10 & 4 MG PO CPPK,"$1,008.12",$0.00,"$1,008.12",$0.00,$719.50,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,008.12",$0.00,$504.06,$798.43,$806.50,$0.00,$0.00,$0.00,$0.00,$0.00
127009,ERX,HCPCS 63700001,62856-0714-30,LENVATINIB (14 MG DAILY DOSE) 10 & 4 MG PO CPPK,"$1,008.12",$0.00,"$1,008.12",$0.00,$719.50,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,008.12",$0.00,$504.06,$798.43,$806.50,$0.00,$0.00,$0.00,$0.00,$0.00
127013,ERX,HCPCS 63700001,62856-0710-05,LENVATINIB (10 MG DAILY DOSE) 10 MG PO CPPK,"$1,826.02",$0.00,"$1,826.02",$0.00,"$1,303.23",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,826.02",$0.00,$913.01,"$1,446.21","$1,460.82",$0.00,$0.00,$0.00,$0.00,$0.00
127013,ERX,HCPCS 63700001,62856-0710-30,LENVATINIB (10 MG DAILY DOSE) 10 MG PO CPPK,"$1,826.02",$0.00,"$1,826.02",$0.00,"$1,303.23",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,826.02",$0.00,$913.01,"$1,446.21","$1,460.82",$0.00,$0.00,$0.00,$0.00,$0.00
127014,ERX,HCPCS 63700001,62856-0724-05,LENVATINIB (24 MG DAILY DOSE) 2 X 10 MG & 4 MG PO CPPK,$672.08,$0.00,$672.08,$0.00,$479.66,$0.00,$0.00,$0.00,$0.00,$0.00,$672.08,$0.00,$336.04,$532.29,$537.66,$0.00,$0.00,$0.00,$0.00,$0.00
127014,ERX,HCPCS 63700001,62856-0724-30,LENVATINIB (24 MG DAILY DOSE) 2 X 10 MG & 4 MG PO CPPK,$672.08,$0.00,$672.08,$0.00,$479.66,$0.00,$0.00,$0.00,$0.00,$0.00,$672.08,$0.00,$336.04,$532.29,$537.66,$0.00,$0.00,$0.00,$0.00,$0.00
127054,ERX,HCPCS 25000001,,SCOPOLAMINE 1 MG/3DAYS TD PT72 (1 MG BASE),$74.90,$0.00,$74.90,$0.00,$53.46,$0.00,$0.00,$0.00,$0.00,$0.00,$74.90,$0.00,$37.45,$59.32,$59.92,$0.00,$0.00,$0.00,$0.00,$0.00
127054,ERX,HCPCS 25000001,00378-6470-16,SCOPOLAMINE 1 MG/3DAYS TD PT72 (1 MG BASE),$74.90,$0.00,$74.90,$0.00,$53.46,$0.00,$0.00,$0.00,$0.00,$0.00,$74.90,$0.00,$37.45,$59.32,$59.92,$0.00,$0.00,$0.00,$0.00,$0.00
127054,ERX,HCPCS 25000001,00378-6470-99,SCOPOLAMINE 1 MG/3DAYS TD PT72 (1 MG BASE),$74.90,$0.00,$74.90,$0.00,$53.46,$0.00,$0.00,$0.00,$0.00,$0.00,$74.90,$0.00,$37.45,$59.32,$59.92,$0.00,$0.00,$0.00,$0.00,$0.00
127054,ERX,HCPCS 25000001,10019-0553-03,SCOPOLAMINE 1 MG/3DAYS TD PT72 (1 MG BASE),$74.90,$0.00,$74.90,$0.00,$53.46,$0.00,$0.00,$0.00,$0.00,$0.00,$74.90,$0.00,$37.45,$59.32,$59.92,$0.00,$0.00,$0.00,$0.00,$0.00
127054,ERX,HCPCS 25000001,10019-0553-04,SCOPOLAMINE 1 MG/3DAYS TD PT72 (1 MG BASE),$74.90,$0.00,$74.90,$0.00,$53.46,$0.00,$0.00,$0.00,$0.00,$0.00,$74.90,$0.00,$37.45,$59.32,$59.92,$0.00,$0.00,$0.00,$0.00,$0.00
127054,ERX,HCPCS 25000001,45802-0580-84,SCOPOLAMINE 1 MG/3DAYS TD PT72 (1 MG BASE),$74.90,$0.00,$74.90,$0.00,$53.46,$0.00,$0.00,$0.00,$0.00,$0.00,$74.90,$0.00,$37.45,$59.32,$59.92,$0.00,$0.00,$0.00,$0.00,$0.00
127054,ERX,HCPCS 25000001,66758-0208-58,SCOPOLAMINE 1 MG/3DAYS TD PT72 (1 MG BASE),$74.90,$0.00,$74.90,$0.00,$53.46,$0.00,$0.00,$0.00,$0.00,$0.00,$74.90,$0.00,$37.45,$59.32,$59.92,$0.00,$0.00,$0.00,$0.00,$0.00
127096,ERX,HCPCS 25000001,,PLENAMINE 15 % IV SOLN,"$1,314.40",$0.00,"$1,314.40",$0.00,$938.09,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,314.40",$0.00,$657.20,"$1,041.00","$1,051.52",$0.00,$0.00,$0.00,$0.00,$0.00
127096,ERX,HCPCS 25000001,00338-0502-06,PLENAMINE 15 % IV SOLN,"$1,314.40",$0.00,"$1,314.40",$0.00,$938.09,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,314.40",$0.00,$657.20,"$1,041.00","$1,051.52",$0.00,$0.00,$0.00,$0.00,$0.00
127226,ERX,HCPCS 25000001,,NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN,$84.97,$0.00,$84.97,$0.00,$60.64,$0.00,$0.00,$0.00,$0.00,$0.00,$84.97,$0.00,$42.49,$67.30,$67.98,$0.00,$0.00,$0.00,$0.00,$0.00
127226,ERX,HCPCS 25000001,00143-9318-01,NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN,$84.97,$0.00,$84.97,$0.00,$60.64,$0.00,$0.00,$0.00,$0.00,$0.00,$84.97,$0.00,$42.49,$67.30,$67.98,$0.00,$0.00,$0.00,$0.00,$0.00
127226,ERX,HCPCS 25000001,00143-9318-10,NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN,$84.97,$0.00,$84.97,$0.00,$60.64,$0.00,$0.00,$0.00,$0.00,$0.00,$84.97,$0.00,$42.49,$67.30,$67.98,$0.00,$0.00,$0.00,$0.00,$0.00
127226,ERX,HCPCS 25000001,00409-3375-04,NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN,$84.97,$0.00,$84.97,$0.00,$60.64,$0.00,$0.00,$0.00,$0.00,$0.00,$84.97,$0.00,$42.49,$67.30,$67.98,$0.00,$0.00,$0.00,$0.00,$0.00
127226,ERX,HCPCS 25000001,00409-3375-14,NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN,$84.97,$0.00,$84.97,$0.00,$60.64,$0.00,$0.00,$0.00,$0.00,$0.00,$84.97,$0.00,$42.49,$67.30,$67.98,$0.00,$0.00,$0.00,$0.00,$0.00
127226,ERX,HCPCS 25000001,36000-0162-10,NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN,$84.97,$0.00,$84.97,$0.00,$60.64,$0.00,$0.00,$0.00,$0.00,$0.00,$84.97,$0.00,$42.49,$67.30,$67.98,$0.00,$0.00,$0.00,$0.00,$0.00
127226,ERX,HCPCS 25000001,67457-0852-00,NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN,$84.97,$0.00,$84.97,$0.00,$60.64,$0.00,$0.00,$0.00,$0.00,$0.00,$84.97,$0.00,$42.49,$67.30,$67.98,$0.00,$0.00,$0.00,$0.00,$0.00
127226,ERX,HCPCS 25000001,67457-0852-04,NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN,$84.97,$0.00,$84.97,$0.00,$60.64,$0.00,$0.00,$0.00,$0.00,$0.00,$84.97,$0.00,$42.49,$67.30,$67.98,$0.00,$0.00,$0.00,$0.00,$0.00
127226,ERX,HCPCS 25000001,70121-1576-07,NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN,$84.97,$0.00,$84.97,$0.00,$60.64,$0.00,$0.00,$0.00,$0.00,$0.00,$84.97,$0.00,$42.49,$67.30,$67.98,$0.00,$0.00,$0.00,$0.00,$0.00
127500,ERX,HCPCS J0714,00456-2700-10,CEFTAZIDIME-AVIBACTAM 2.5 (2-0.5) G IV SOLR,"$1,141.02",$0.00,"$1,141.02",$0.00,$814.35,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,141.02",$0.00,$570.51,$903.69,$912.82,$0.00,$0.00,$0.00,$0.00,$0.00
127503,ERX,HCPCS 25000001,00469-0520-14,ISAVUCONAZONIUM SULFATE 186 MG PO CAPS,$588.72,$0.00,$588.72,$0.00,$420.17,$0.00,$0.00,$0.00,$0.00,$0.00,$588.72,$0.00,$294.36,$466.27,$470.98,$0.00,$0.00,$0.00,$0.00,$0.00
127504,ERX,HCPCS J1833,00469-0420-99,ISAVUCONAZONIUM SULFATE 372 MG IV SOLR,"$1,002.95",$0.00,"$1,002.95",$451.33,$715.81,$291.65,$172.80,$0.00,$0.00,$175.61,"$1,002.95",$306.23,$501.48,$794.34,$802.36,$422.89,$156.96,$0.00,$159.67,$294.25
127505,ERX,HCPCS J7297,00023-5858-01,LEVONORGESTREL 19.5 MCG/DAY IU IUD,"$2,266.18",$0.00,"$2,266.18","$1,019.78","$1,617.37",$403.38,$390.45,$0.00,$0.00,$880.55,"$2,266.18",$0.00,"$1,133.09","$1,794.81","$1,812.94","$1,359.71",$880.55,$0.00,$838.43,$0.00
127687,ERX,HCPCS 63700001,55513-0800-60,IVABRADINE HCL 5 MG PO TABS,$35.28,$0.00,$35.28,$0.00,$25.18,$0.00,$0.00,$0.00,$0.00,$0.00,$35.28,$0.00,$17.64,$27.94,$28.22,$0.00,$0.00,$0.00,$0.00,$0.00
128092,ERX,HCPCS J1610,63323-0593-03,GLUCAGON HCL 1 MG IJ SOLR,$312.02,$0.00,$312.02,$140.41,$222.69,$199.27,$88.07,$0.00,$0.00,$255.63,$312.02,$209.24,$156.01,$247.12,$249.62,$288.94,$255.63,$0.00,$243.41,$199.13
128092,ERX,HCPCS J1610,63323-0596-11,GLUCAGON HCL 1 MG IJ SOLR,$312.02,$0.00,$312.02,$140.41,$222.69,$199.27,$88.07,$0.00,$0.00,$255.63,$312.02,$209.24,$156.01,$247.12,$249.62,$288.94,$255.63,$0.00,$243.41,$199.13
128092,ERX,HCPCS J1610,63323-0596-13,GLUCAGON HCL 1 MG IJ SOLR,$312.02,$0.00,$312.02,$140.41,$222.69,$199.27,$88.07,$0.00,$0.00,$255.63,$312.02,$209.24,$156.01,$247.12,$249.62,$288.94,$255.63,$0.00,$243.41,$199.13
128092,ERX,HCPCS J1610,63323-0596-16,GLUCAGON HCL 1 MG IJ SOLR,$312.02,$0.00,$312.02,$140.41,$222.69,$199.27,$88.07,$0.00,$0.00,$255.63,$312.02,$209.24,$156.01,$247.12,$249.62,$288.94,$255.63,$0.00,$243.41,$199.13
128482,ERX,HCPCS C9460,10122-0620-01,CANGRELOR TETRASODIUM 50 MG IV SOLR,"$2,157.12",$0.00,"$2,157.12",$0.00,"$1,539.54",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,157.12",$0.00,"$1,078.56","$1,708.44","$1,725.70",$0.00,$0.00,$0.00,$0.00,$0.00
128482,ERX,HCPCS C9460,10122-0620-10,CANGRELOR TETRASODIUM 50 MG IV SOLR,"$2,157.12",$0.00,"$2,157.12",$0.00,"$1,539.54",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,157.12",$0.00,"$1,078.56","$1,708.44","$1,725.70",$0.00,$0.00,$0.00,$0.00,$0.00
128545,ERX,HCPCS 25000001,00078-0659-20,SACUBITRIL-VALSARTAN 24-26 MG PO TABS,$35.21,$0.00,$35.21,$0.00,$25.13,$0.00,$0.00,$0.00,$0.00,$0.00,$35.21,$0.00,$17.61,$27.89,$28.17,$0.00,$0.00,$0.00,$0.00,$0.00
128546,ERX,HCPCS 25000001,00078-0777-20,SACUBITRIL-VALSARTAN 49-51 MG PO TABS,$35.21,$0.00,$35.21,$0.00,$25.13,$0.00,$0.00,$0.00,$0.00,$0.00,$35.21,$0.00,$17.61,$27.89,$28.17,$0.00,$0.00,$0.00,$0.00,$0.00
128547,ERX,HCPCS 25000001,00078-0696-20,SACUBITRIL-VALSARTAN 97-103 MG PO TABS,$41.41,$0.00,$41.41,$0.00,$29.55,$0.00,$0.00,$0.00,$0.00,$0.00,$41.41,$0.00,$20.71,$32.80,$33.13,$0.00,$0.00,$0.00,$0.00,$0.00
128559,ERX,HCPCS 63700001,99999-6006-28,AMINOCAPROIC ACID 0.25 GM/ML PO SOLN,$307.44,$0.00,"$6,875.79",$0.00,"$4,907.25",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,875.79",$0.00,"$3,437.90",$243.49,"$5,500.63",$0.00,$0.00,$0.00,$0.00,$0.00
128559,ERX,HCPCS 63700001,49411-0052-08,AMINOCAPROIC ACID 0.25 GM/ML PO SOLN,"$6,875.79",$0.00,"$6,875.79",$0.00,"$4,907.25",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,875.79",$0.00,"$3,437.90","$5,445.63","$5,500.63",$0.00,$0.00,$0.00,$0.00,$0.00
128685,ERX,HCPCS J2280,63323-0850-74,MOXIFLOXACIN HCL 400 MG/250ML IV SOLN,$174.04,$0.00,$174.04,$0.00,$124.21,$0.00,$0.00,$0.00,$0.00,$0.00,$174.04,$0.00,$87.02,$137.84,$139.23,$0.00,$0.00,$0.00,$0.00,$0.00
129082,ERX,HCPCS Q5101,61314-0318-05,FILGRASTIM-SNDZ 300 MCG/0.5ML IJ SOSY,$872.48,$0.00,$872.48,$0.00,$622.69,$0.00,$150.32,$0.00,$0.00,$193.88,$872.48,$0.00,$436.24,$691.00,$697.98,$0.00,$193.88,$0.00,$0.00,$0.00
129082,ERX,HCPCS Q5101,61314-0318-10,FILGRASTIM-SNDZ 300 MCG/0.5ML IJ SOSY,$872.48,$0.00,$872.48,$0.00,$622.69,$0.00,$150.32,$0.00,$0.00,$193.88,$872.48,$0.00,$436.24,$691.00,$697.98,$0.00,$193.88,$0.00,$0.00,$0.00
129083,ERX,HCPCS Q5101,61314-0326-10,FILGRASTIM-SNDZ 480 MCG/0.8ML IJ SOSY,"$1,264.28",$0.00,"$1,264.28",$0.00,$902.32,$0.00,$217.83,$0.00,$0.00,$310.20,"$1,264.28",$0.00,$632.14,"$1,001.31","$1,011.42",$0.00,$310.20,$0.00,$0.00,$0.00
129084,ERX,HCPCS J9310,50242-0051-21,RITUXIMAB 100 MG/10ML IV SOLN,"$2,311.22",$0.00,"$2,311.22","$1,040.05","$1,649.52",$946.67,$398.21,$0.00,$0.00,"$1,109.32","$2,311.22",$994.00,"$1,155.61","$1,830.49","$1,848.98","$1,372.67","$1,109.32",$0.00,"$1,056.26",$946.67
129085,ERX,HCPCS J9310,50242-0053-06,RITUXIMAB 500 MG/50ML IV SOLN,"$11,556.06",$0.00,"$11,556.06","$5,200.23","$5,158.80","$4,733.35","$1,991.05",$0.00,$0.00,"$5,546.59","$11,556.06","$4,970.02","$5,778.03","$9,152.40","$9,244.85","$6,863.36","$5,546.59",$0.00,"$5,281.30","$4,733.35"
129088,ERX,HCPCS J3475,00409-6729-23,MAGNESIUM SULFATE 4 GM/100ML IV SOLN,$33.06,$0.00,$33.06,$14.88,$23.59,$0.00,$0.47,$0.00,$0.00,$5.92,$33.06,$0.00,$16.53,$26.18,$26.45,$0.00,$5.92,$0.00,$5.64,$0.00
129091,ERX,HCPCS J3475,00409-6730-13,MAGNESIUM SULFATE 4 GM/50ML IV SOLN,$52.00,$0.00,$52.00,$23.40,$37.11,$0.00,$0.47,$0.00,$0.00,$5.92,$52.00,$0.00,$26.00,$41.18,$41.60,$0.00,$5.92,$0.00,$5.64,$0.00
129092,ERX,HCPCS J2505,55513-0190-01,PEGFILGRASTIM 6 MG/0.6ML SC SOSY,"$15,328.41",$0.00,"$15,328.41","$6,897.78","$5,158.80","$4,432.56","$2,557.01",$0.00,$0.00,"$5,002.09","$15,328.41","$4,654.18","$7,664.21","$12,140.10","$12,262.73","$6,427.20","$5,002.09",$0.00,"$4,762.84","$3,807.30"
129102,ERX,HCPCS J3230,00641-1398-35,CHLORPROMAZINE HCL 50 MG/2ML IJ SOLN,$75.48,$0.00,$75.48,$33.97,$53.87,$0.00,$9.35,$0.00,$0.00,$37.08,$75.48,$0.00,$37.74,$59.78,$60.38,$0.00,$37.08,$0.00,$35.31,$0.00
129103,ERX,HCPCS 63700001,62175-0310-37,METHYLPHENIDATE HCL ER 18 MG PO TB24,$23.65,$0.00,$23.65,$0.00,$16.88,$0.00,$0.00,$0.00,$0.00,$0.00,$23.65,$0.00,$11.83,$18.73,$18.92,$0.00,$0.00,$0.00,$0.00,$0.00
129105,ERX,HCPCS 63700001,00406-0136-01,METHYLPHENIDATE HCL ER 36 MG PO TB24,$25.01,$0.00,$25.01,$0.00,$17.85,$0.00,$0.00,$0.00,$0.00,$0.00,$25.01,$0.00,$12.51,$19.81,$20.01,$0.00,$0.00,$0.00,$0.00,$0.00
129106,ERX,HCPCS 63700001,00406-0154-01,METHYLPHENIDATE HCL ER 54 MG PO TB24,$27.21,$0.00,$27.21,$0.00,$19.42,$0.00,$0.00,$0.00,$0.00,$0.00,$27.21,$0.00,$13.61,$21.55,$21.77,$0.00,$0.00,$0.00,$0.00,$0.00
129107,ERX,HCPCS J0881,55513-0057-04,DARBEPOETIN ALFA 25 MCG/0.42ML IJ SOSY,$615.33,$0.00,$615.33,$276.90,$439.16,$96.30,$89.89,$0.00,$0.00,$112.21,$615.33,$101.12,$307.67,$487.34,$492.26,$139.64,$112.21,$0.00,$106.85,$94.65
129109,ERX,HCPCS J0881,55513-0021-01,DARBEPOETIN ALFA 40 MCG/0.4ML IJ SOSY,$984.53,$0.00,$984.53,$443.04,$702.66,$154.08,$143.82,$0.00,$0.00,$179.54,$984.53,$161.78,$492.27,$779.75,$787.62,$223.42,$179.54,$0.00,$170.95,$151.44
129109,ERX,HCPCS J0881,55513-0021-04,DARBEPOETIN ALFA 40 MCG/0.4ML IJ SOSY,$984.53,$0.00,$984.53,$443.04,$702.66,$154.08,$143.82,$0.00,$0.00,$179.54,$984.53,$161.78,$492.27,$779.75,$787.62,$223.42,$179.54,$0.00,$170.95,$151.44
129111,ERX,HCPCS J0881,55513-0023-01,DARBEPOETIN ALFA 60 MCG/0.3ML IJ SOSY,"$1,337.48",$0.00,"$1,337.48",$601.87,$954.56,$231.12,$215.73,$0.00,$0.00,$269.31,"$1,337.48",$242.68,$668.74,"$1,059.28","$1,069.98",$335.12,$269.31,$0.00,$256.43,$227.16
129111,ERX,HCPCS J0881,55513-0023-04,DARBEPOETIN ALFA 60 MCG/0.3ML IJ SOSY,"$1,337.48",$0.00,"$1,337.48",$601.87,$954.56,$231.12,$215.73,$0.00,$0.00,$269.31,"$1,337.48",$242.68,$668.74,"$1,059.28","$1,069.98",$335.12,$269.31,$0.00,$256.43,$227.16
129113,ERX,HCPCS J0881,55513-0025-01,DARBEPOETIN ALFA 100 MCG/0.5ML IJ SOSY,"$2,229.12",$0.00,"$2,229.12","$1,003.10","$1,590.92",$385.20,$359.55,$0.00,$0.00,$448.85,"$2,229.12",$404.46,"$1,114.56","$1,765.46","$1,783.30",$558.54,$448.85,$0.00,$427.38,$378.60
129113,ERX,HCPCS J0881,55513-0025-04,DARBEPOETIN ALFA 100 MCG/0.5ML IJ SOSY,"$2,229.12",$0.00,"$2,229.12","$1,003.10","$1,590.92",$385.20,$359.55,$0.00,$0.00,$448.85,"$2,229.12",$404.46,"$1,114.56","$1,765.46","$1,783.30",$558.54,$448.85,$0.00,$427.38,$378.60
129115,ERX,HCPCS J0881,55513-0027-04,DARBEPOETIN ALFA 150 MCG/0.3ML IJ SOSY,"$2,856.06",$0.00,"$2,856.06","$1,285.23","$2,038.37",$577.80,$539.33,$0.00,$0.00,$673.28,"$2,856.06",$606.69,"$1,428.03","$2,262.00","$2,284.85",$837.81,$673.28,$0.00,$641.07,$567.90
129116,ERX,HCPCS J0881,55513-0028-01,DARBEPOETIN ALFA 200 MCG/0.4ML IJ SOSY,"$3,808.08",$0.00,"$3,808.08","$1,713.64","$2,717.83",$770.40,$719.10,$0.00,$0.00,$897.70,"$3,808.08",$808.92,"$1,904.04","$3,016.00","$3,046.46","$1,117.08",$897.70,$0.00,$854.76,$757.20
129117,ERX,HCPCS J0881,55513-0111-01,DARBEPOETIN ALFA 300 MCG/0.6ML IJ SOSY,"$5,712.12",$0.00,"$5,712.12","$2,570.45","$4,076.74","$1,155.60","$1,078.65",$0.00,$0.00,"$1,346.55","$5,712.12","$1,213.38","$2,856.06","$4,524.00","$4,569.70","$1,675.62","$1,346.55",$0.00,"$1,282.14","$1,135.80"
129118,ERX,HCPCS J0881,55513-0032-01,DARBEPOETIN ALFA 500 MCG/ML IJ SOSY,"$9,520.20",$0.00,"$9,520.20","$4,284.09","$5,158.80","$1,926.00","$1,797.75",$0.00,$0.00,"$2,244.25","$9,520.20","$2,022.30","$4,760.10","$7,540.00","$7,616.16","$2,792.70","$2,244.25",$0.00,"$2,136.91","$1,893.00"
129167,ERX,HCPCS 63700001,00186-0776-60,TICAGRELOR 60 MG PO TABS,$29.88,$0.00,$29.88,$0.00,$21.33,$0.00,$0.00,$0.00,$0.00,$0.00,$29.88,$0.00,$14.94,$23.66,$23.90,$0.00,$0.00,$0.00,$0.00,$0.00
129213,ERX,HCPCS J2710,62295-3324-05,NEOSTIGMINE METHYLSULFATE 5 MG/5ML IV SOSY,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.12,$0.00,$0.00,$2.03,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$2.03,$0.00,$1.94,$0.00
129243,ERX,HCPCS 25000001,64842-1025-01,TRIFLURIDINE-TIPIRACIL 15-6.14 MG PO TABS,$546.70,$0.00,$546.70,$0.00,$390.18,$0.00,$0.00,$0.00,$0.00,$0.00,$546.70,$0.00,$273.35,$432.99,$437.36,$0.00,$0.00,$0.00,$0.00,$0.00
129243,ERX,HCPCS 25000001,64842-1025-02,TRIFLURIDINE-TIPIRACIL 15-6.14 MG PO TABS,$546.70,$0.00,$546.70,$0.00,$390.18,$0.00,$0.00,$0.00,$0.00,$0.00,$546.70,$0.00,$273.35,$432.99,$437.36,$0.00,$0.00,$0.00,$0.00,$0.00
129243,ERX,HCPCS 25000001,64842-1025-03,TRIFLURIDINE-TIPIRACIL 15-6.14 MG PO TABS,$546.70,$0.00,$546.70,$0.00,$390.18,$0.00,$0.00,$0.00,$0.00,$0.00,$546.70,$0.00,$273.35,$432.99,$437.36,$0.00,$0.00,$0.00,$0.00,$0.00
129244,ERX,HCPCS 25000001,64842-1020-01,TRIFLURIDINE-TIPIRACIL 20-8.19 MG PO TABS,$728.93,$0.00,$728.93,$0.00,$520.24,$0.00,$0.00,$0.00,$0.00,$0.00,$728.93,$0.00,$364.47,$577.31,$583.14,$0.00,$0.00,$0.00,$0.00,$0.00
129244,ERX,HCPCS 25000001,64842-1020-02,TRIFLURIDINE-TIPIRACIL 20-8.19 MG PO TABS,$728.93,$0.00,$728.93,$0.00,$520.24,$0.00,$0.00,$0.00,$0.00,$0.00,$728.93,$0.00,$364.47,$577.31,$583.14,$0.00,$0.00,$0.00,$0.00,$0.00
129244,ERX,HCPCS 25000001,64842-1020-03,TRIFLURIDINE-TIPIRACIL 20-8.19 MG PO TABS,$728.93,$0.00,$728.93,$0.00,$520.24,$0.00,$0.00,$0.00,$0.00,$0.00,$728.93,$0.00,$364.47,$577.31,$583.14,$0.00,$0.00,$0.00,$0.00,$0.00
129506,ERX,HCPCS J9352,59676-0610-01,TRABECTEDIN 1 MG IV SOLR,"$7,469.92",$0.00,"$7,469.92",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,469.92",$0.00,"$3,734.96","$5,916.18","$5,975.94",$0.00,$0.00,$0.00,$0.00,$0.00
129598,ERX,HCPCS J3490,00597-0197-05,IDARUCIZUMAB 2.5 GM/50ML IV SOLN,"$9,856.81",$0.00,"$9,856.81","$4,435.56","$5,158.80",$0.00,"$1,698.28",$0.00,$0.00,"$1,725.85","$9,856.81",$0.00,"$4,928.41","$7,806.59","$7,885.45",$0.00,"$1,542.59",$0.00,"$1,569.20",$0.00
129781,ERX,HCPCS 63700001,53436-0084-04,PATIROMER SORBITEX CALCIUM 8.4 G PO PACK,$168.00,$0.00,$168.00,$0.00,$119.90,$0.00,$0.00,$0.00,$0.00,$0.00,$168.00,$0.00,$84.00,$133.06,$134.40,$0.00,$0.00,$0.00,$0.00,$0.00
129834,ERX,HCPCS 25000001,61958-1901-01,GENVOYA:150-150-200-10 MG PO TABLET,$395.08,$0.00,$395.08,$0.00,$281.97,$0.00,$0.00,$0.00,$0.00,$0.00,$395.08,$0.00,$197.54,$312.90,$316.06,$0.00,$0.00,$0.00,$0.00,$0.00
129853,ERX,HCPCS 25000001,50242-0717-01,COBIMETINIB FUMARATE 20 MG PO TABS,$406.96,$0.00,$406.96,$0.00,$290.45,$0.00,$0.00,$0.00,$0.00,$0.00,$406.96,$0.00,$203.48,$322.31,$325.57,$0.00,$0.00,$0.00,$0.00,$0.00
129873,ERX,HCPCS 63700001,00310-1349-30,OSIMERTINIB MESYLATE 40 MG PO TABS,"$1,460.02",$0.00,"$1,460.02",$0.00,"$1,042.02",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,460.02",$0.00,$730.01,"$1,156.34","$1,168.02",$0.00,$0.00,$0.00,$0.00,$0.00
129874,ERX,HCPCS 63700001,00310-1350-30,OSIMERTINIB MESYLATE 80 MG PO TABS,"$1,460.02",$0.00,"$1,460.02",$0.00,"$1,042.02",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,460.02",$0.00,$730.01,"$1,156.34","$1,168.02",$0.00,$0.00,$0.00,$0.00,$0.00
129889,ERX,HCPCS J9145,57894-0502-05,DARATUMUMAB 100 MG/5ML IV SOLN,"$1,600.37",$0.00,"$1,600.37",$720.17,"$1,142.18",$539.48,$275.74,$0.00,$0.00,$634.85,"$1,600.37",$566.45,$800.19,"$1,267.49","$1,280.30",$782.25,$634.85,$0.00,$604.49,$539.48
129890,ERX,HCPCS J9145,57894-0502-20,DARATUMUMAB 400 MG/20ML IV SOLN,"$5,467.89",$0.00,"$5,467.89","$2,460.55","$3,902.43","$2,157.92",$942.09,$0.00,$0.00,"$2,539.41","$5,467.89","$2,265.82","$2,733.95","$4,330.57","$4,374.31","$3,128.98","$2,539.41",$0.00,"$2,417.95","$2,157.92"
129908,ERX,HCPCS 25000001,69547-0353-02,NALOXONE HCL 4 MG/0.1ML NA LIQD,$236.25,$0.00,$236.25,$0.00,$168.61,$0.00,$0.00,$0.00,$0.00,$0.00,$236.25,$0.00,$118.13,$187.11,$189.00,$0.00,$0.00,$0.00,$0.00,$0.00
129912,ERX,HCPCS 63700001,63020-0078-02,IXAZOMIB CITRATE 2.3 MG PO CAPS,"$8,589.50",$0.00,"$8,589.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,589.50",$0.00,"$4,294.75","$6,802.88","$6,871.60",$0.00,$0.00,$0.00,$0.00,$0.00
129913,ERX,HCPCS 63700001,63020-0079-02,IXAZOMIB CITRATE 3 MG PO CAPS,"$8,589.50",$0.00,"$8,589.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,589.50",$0.00,"$4,294.75","$6,802.88","$6,871.60",$0.00,$0.00,$0.00,$0.00,$0.00
129914,ERX,HCPCS 63700001,63020-0080-02,IXAZOMIB CITRATE 4 MG PO CAPS,"$8,589.50",$0.00,"$8,589.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,589.50",$0.00,"$4,294.75","$6,802.88","$6,871.60",$0.00,$0.00,$0.00,$0.00,$0.00
129989,ERX,HCPCS J1976,00003-2291-11,ELOTUZUMAB 300 MG IV SOLR,"$4,777.22",$0.00,"$4,777.22","$2,149.75","$3,409.50","$1,948.80",$823.09,$0.00,$0.00,"$2,319.45","$4,777.22","$2,046.24","$2,388.61","$3,783.56","$3,821.78","$2,825.76","$2,319.45",$0.00,"$2,208.51","$1,948.80"
129990,ERX,HCPCS J1976,00003-4522-11,ELOTUZUMAB 400 MG IV SOLR,"$6,369.60",$0.00,"$6,369.60","$2,866.32","$4,545.98","$2,598.40","$1,097.45",$0.00,$0.00,"$3,092.60","$6,369.60","$2,728.32","$3,184.80","$5,044.72","$5,095.68","$3,767.68","$3,092.60",$0.00,"$2,944.68","$2,598.40"
130051,ERX,HCPCS J9034,63459-0348-04,BENDAMUSTINE HCL 100 MG/4ML IV SOLN,"$6,085.55",$0.00,"$6,085.55","$2,738.50","$4,343.26","$2,284.90","$1,048.51",$0.00,$0.00,"$2,553.28","$6,085.55","$2,399.15","$3,042.78","$4,819.76","$4,868.44","$3,313.11","$2,553.28",$0.00,"$2,431.15","$2,284.90"
130073,ERX,HCPCS 25000001,50242-0130-01,ALECTINIB HCL 150 MG PO CAPS,$242.49,$0.00,$242.49,$0.00,$173.07,$0.00,$0.00,$0.00,$0.00,$0.00,$242.49,$0.00,$121.25,$192.05,$193.99,$0.00,$0.00,$0.00,$0.00,$0.00
130409,ERX,HCPCS 25000001,00006-5423-12,SUGAMMADEX SODIUM 200 MG/2ML IV SOLN,$383.28,$0.00,$383.28,$0.00,$273.55,$0.00,$0.00,$0.00,$0.00,$0.00,$383.28,$0.00,$191.64,$303.56,$306.62,$0.00,$0.00,$0.00,$0.00,$0.00
130411,ERX,HCPCS 25000001,00006-5423-15,SUGAMMADEX SODIUM 500 MG/5ML IV SOLN,$609.93,$0.00,$609.93,$0.00,$435.31,$0.00,$0.00,$0.00,$0.00,$0.00,$609.93,$0.00,$304.97,$483.06,$487.94,$0.00,$0.00,$0.00,$0.00,$0.00
130411,ERX,HCPCS 25000001,00006-5425-15,SUGAMMADEX SODIUM 500 MG/5ML IV SOLN,$609.93,$0.00,$609.93,$0.00,$435.31,$0.00,$0.00,$0.00,$0.00,$0.00,$609.93,$0.00,$304.97,$483.06,$487.94,$0.00,$0.00,$0.00,$0.00,$0.00
130462,ERX,HCPCS 63700001,63044-0150-05,PRENATAL VITAMIN PLUS LOW IRON 27-1 MG PO TABS,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
130656,ERX,HCPCS 25000001,69468-0151-04,URIDINE TRIACETATE 10 G PO PACK,"$9,871.98",$0.00,"$9,871.98",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$9,871.98",$0.00,"$4,935.99","$7,818.61","$7,897.58",$0.00,$0.00,$0.00,$0.00,$0.00
130656,ERX,HCPCS 25000001,69468-0151-20,URIDINE TRIACETATE 10 G PO PACK,"$9,871.98",$0.00,"$9,871.98",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$9,871.98",$0.00,"$4,935.99","$7,818.61","$7,897.58",$0.00,$0.00,$0.00,$0.00,$0.00
130661,ERX,HCPCS 25000001,00006-3074-02,ELBASVIR-GRAZOPREVIR 50-100 MG PO TABS,$826.80,$0.00,$826.80,$0.00,$590.09,$0.00,$0.00,$0.00,$0.00,$0.00,$826.80,$0.00,$413.40,$654.83,$661.44,$0.00,$0.00,$0.00,$0.00,$0.00
130884,ERX,HCPCS J2020,00009-4992-01,LINEZOLID 600 MG/300ML IV SOLN,$245.70,$0.00,$245.70,$0.00,$175.36,$0.00,$0.00,$0.00,$0.00,$0.00,$245.70,$0.00,$122.85,$194.59,$196.56,$0.00,$0.00,$0.00,$0.00,$0.00
130884,ERX,HCPCS J2020,00009-4992-02,LINEZOLID 600 MG/300ML IV SOLN,$245.70,$0.00,$245.70,$0.00,$175.36,$0.00,$0.00,$0.00,$0.00,$0.00,$245.70,$0.00,$122.85,$194.59,$196.56,$0.00,$0.00,$0.00,$0.00,$0.00
130884,ERX,HCPCS J2020,00009-5140-04,LINEZOLID 600 MG/300ML IV SOLN,$245.70,$0.00,$245.70,$0.00,$175.36,$0.00,$0.00,$0.00,$0.00,$0.00,$245.70,$0.00,$122.85,$194.59,$196.56,$0.00,$0.00,$0.00,$0.00,$0.00
130884,ERX,HCPCS J2020,00781-3433-95,LINEZOLID 600 MG/300ML IV SOLN,$245.70,$0.00,$245.70,$0.00,$175.36,$0.00,$0.00,$0.00,$0.00,$0.00,$245.70,$0.00,$122.85,$194.59,$196.56,$0.00,$0.00,$0.00,$0.00,$0.00
130884,ERX,HCPCS J2020,25021-0169-87,LINEZOLID 600 MG/300ML IV SOLN,$245.70,$0.00,$245.70,$0.00,$175.36,$0.00,$0.00,$0.00,$0.00,$0.00,$245.70,$0.00,$122.85,$194.59,$196.56,$0.00,$0.00,$0.00,$0.00,$0.00
130884,ERX,HCPCS J2020,55150-0242-51,LINEZOLID 600 MG/300ML IV SOLN,$245.70,$0.00,$245.70,$0.00,$175.36,$0.00,$0.00,$0.00,$0.00,$0.00,$245.70,$0.00,$122.85,$194.59,$196.56,$0.00,$0.00,$0.00,$0.00,$0.00
130884,ERX,HCPCS J2020,63323-0713-13,LINEZOLID 600 MG/300ML IV SOLN,$245.70,$0.00,$245.70,$0.00,$175.36,$0.00,$0.00,$0.00,$0.00,$0.00,$245.70,$0.00,$122.85,$194.59,$196.56,$0.00,$0.00,$0.00,$0.00,$0.00
130886,ERX,HCPCS J9065,63323-0140-10,CLADRIBINE 10 MG/10ML IV SOLN,"$1,252.80",$0.00,"$1,252.80",$0.00,$894.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,252.80",$0.00,$626.40,$992.22,"$1,002.24",$0.00,$0.00,$0.00,$0.00,$0.00
130887,ERX,HCPCS 25000001,00074-4382-20,CISATRACURIUM BESYLATE (PF) 200 MG/20ML IV SOLN,$944.46,$0.00,$944.46,$0.00,$674.06,$0.00,$0.00,$0.00,$0.00,$0.00,$944.46,$0.00,$472.23,$748.01,$755.57,$0.00,$0.00,$0.00,$0.00,$0.00
130887,ERX,HCPCS 25000001,00074-4382-93,CISATRACURIUM BESYLATE (PF) 200 MG/20ML IV SOLN,$944.46,$0.00,$944.46,$0.00,$674.06,$0.00,$0.00,$0.00,$0.00,$0.00,$944.46,$0.00,$472.23,$748.01,$755.57,$0.00,$0.00,$0.00,$0.00,$0.00
130897,ERX,HCPCS J1455,76310-0024-01,FOSCARNET SODIUM 6000 MG/250ML IV SOLN,"$1,361.40",$0.00,"$1,361.40",$0.00,$971.63,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,361.40",$0.00,$680.70,"$1,078.23","$1,089.12",$0.00,$0.00,$0.00,$0.00,$0.00
130897,ERX,HCPCS J1455,76310-0024-11,FOSCARNET SODIUM 6000 MG/250ML IV SOLN,"$1,361.40",$0.00,"$1,361.40",$0.00,$971.63,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,361.40",$0.00,$680.70,"$1,078.23","$1,089.12",$0.00,$0.00,$0.00,$0.00,$0.00
130897,ERX,HCPCS J1455,76310-0024-15,FOSCARNET SODIUM 6000 MG/250ML IV SOLN,"$1,361.40",$0.00,"$1,361.40",$0.00,$971.63,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,361.40",$0.00,$680.70,"$1,078.23","$1,089.12",$0.00,$0.00,$0.00,$0.00,$0.00
130897,ERX,HCPCS J1455,76310-0024-25,FOSCARNET SODIUM 6000 MG/250ML IV SOLN,"$1,361.40",$0.00,"$1,361.40",$0.00,$971.63,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,361.40",$0.00,$680.70,"$1,078.23","$1,089.12",$0.00,$0.00,$0.00,$0.00,$0.00
130900,ERX,HCPCS 25000001,00013-1114-21,TRANEXAMIC ACID 1000 MG/10ML IV SOLN,$189.00,$0.00,$189.00,$0.00,$134.89,$0.00,$0.00,$0.00,$0.00,$0.00,$189.00,$0.00,$94.50,$149.69,$151.20,$0.00,$0.00,$0.00,$0.00,$0.00
130900,ERX,HCPCS 25000001,39822-1000-01,TRANEXAMIC ACID 1000 MG/10ML IV SOLN,$189.00,$0.00,$189.00,$0.00,$134.89,$0.00,$0.00,$0.00,$0.00,$0.00,$189.00,$0.00,$94.50,$149.69,$151.20,$0.00,$0.00,$0.00,$0.00,$0.00
130900,ERX,HCPCS 25000001,39822-1001-06,TRANEXAMIC ACID 1000 MG/10ML IV SOLN,$189.00,$0.00,$189.00,$0.00,$134.89,$0.00,$0.00,$0.00,$0.00,$0.00,$189.00,$0.00,$94.50,$149.69,$151.20,$0.00,$0.00,$0.00,$0.00,$0.00
130900,ERX,HCPCS 25000001,39822-1001-07,TRANEXAMIC ACID 1000 MG/10ML IV SOLN,$189.00,$0.00,$189.00,$0.00,$134.89,$0.00,$0.00,$0.00,$0.00,$0.00,$189.00,$0.00,$94.50,$149.69,$151.20,$0.00,$0.00,$0.00,$0.00,$0.00
130900,ERX,HCPCS 25000001,47781-0601-91,TRANEXAMIC ACID 1000 MG/10ML IV SOLN,$189.00,$0.00,$189.00,$0.00,$134.89,$0.00,$0.00,$0.00,$0.00,$0.00,$189.00,$0.00,$94.50,$149.69,$151.20,$0.00,$0.00,$0.00,$0.00,$0.00
130900,ERX,HCPCS 25000001,55150-0188-10,TRANEXAMIC ACID 1000 MG/10ML IV SOLN,$189.00,$0.00,$189.00,$0.00,$134.89,$0.00,$0.00,$0.00,$0.00,$0.00,$189.00,$0.00,$94.50,$149.69,$151.20,$0.00,$0.00,$0.00,$0.00,$0.00
130900,ERX,HCPCS 25000001,63323-0563-10,TRANEXAMIC ACID 1000 MG/10ML IV SOLN,$189.00,$0.00,$189.00,$0.00,$134.89,$0.00,$0.00,$0.00,$0.00,$0.00,$189.00,$0.00,$94.50,$149.69,$151.20,$0.00,$0.00,$0.00,$0.00,$0.00
130900,ERX,HCPCS 25000001,67850-0042-10,TRANEXAMIC ACID 1000 MG/10ML IV SOLN,$189.00,$0.00,$189.00,$0.00,$134.89,$0.00,$0.00,$0.00,$0.00,$0.00,$189.00,$0.00,$94.50,$149.69,$151.20,$0.00,$0.00,$0.00,$0.00,$0.00
130900,ERX,HCPCS 25000001,70860-0400-10,TRANEXAMIC ACID 1000 MG/10ML IV SOLN,$189.00,$0.00,$189.00,$0.00,$134.89,$0.00,$0.00,$0.00,$0.00,$0.00,$189.00,$0.00,$94.50,$149.69,$151.20,$0.00,$0.00,$0.00,$0.00,$0.00
130900,ERX,HCPCS 25000001,70860-0400-41,TRANEXAMIC ACID 1000 MG/10ML IV SOLN,$189.00,$0.00,$189.00,$0.00,$134.89,$0.00,$0.00,$0.00,$0.00,$0.00,$189.00,$0.00,$94.50,$149.69,$151.20,$0.00,$0.00,$0.00,$0.00,$0.00
130905,ERX,HCPCS J2704,00409-4699-30,PROPOFOL 200 MG/20ML IV EMUL,$26.60,$0.00,$26.60,$11.97,$18.98,$0.00,$4.58,$0.00,$0.00,$4.66,$26.60,$0.00,$13.30,$21.07,$21.28,$0.00,$4.16,$0.00,$4.23,$0.00
130905,ERX,HCPCS J2704,00409-4699-50,PROPOFOL 200 MG/20ML IV EMUL,$26.60,$0.00,$26.60,$11.97,$18.98,$0.00,$4.58,$0.00,$0.00,$4.66,$26.60,$0.00,$13.30,$21.07,$21.28,$0.00,$4.16,$0.00,$4.23,$0.00
130905,ERX,HCPCS J2704,00591-2136-95,PROPOFOL 200 MG/20ML IV EMUL,$26.60,$0.00,$26.60,$11.97,$18.98,$0.00,$4.58,$0.00,$0.00,$4.66,$26.60,$0.00,$13.30,$21.07,$21.28,$0.00,$4.16,$0.00,$4.23,$0.00
130905,ERX,HCPCS J2704,25021-0608-20,PROPOFOL 200 MG/20ML IV EMUL,$26.60,$0.00,$26.60,$11.97,$18.98,$0.00,$4.58,$0.00,$0.00,$4.66,$26.60,$0.00,$13.30,$21.07,$21.28,$0.00,$4.16,$0.00,$4.23,$0.00
130905,ERX,HCPCS J2704,43598-0265-20,PROPOFOL 200 MG/20ML IV EMUL,$26.60,$0.00,$26.60,$11.97,$18.98,$0.00,$4.58,$0.00,$0.00,$4.66,$26.60,$0.00,$13.30,$21.07,$21.28,$0.00,$4.16,$0.00,$4.23,$0.00
130905,ERX,HCPCS J2704,43598-0265-25,PROPOFOL 200 MG/20ML IV EMUL,$26.60,$0.00,$26.60,$11.97,$18.98,$0.00,$4.58,$0.00,$0.00,$4.66,$26.60,$0.00,$13.30,$21.07,$21.28,$0.00,$4.16,$0.00,$4.23,$0.00
130905,ERX,HCPCS J2704,43598-0265-58,PROPOFOL 200 MG/20ML IV EMUL,$26.60,$0.00,$26.60,$11.97,$18.98,$0.00,$4.58,$0.00,$0.00,$4.66,$26.60,$0.00,$13.30,$21.07,$21.28,$0.00,$4.16,$0.00,$4.23,$0.00
130905,ERX,HCPCS J2704,63323-0269-29,PROPOFOL 200 MG/20ML IV EMUL,$26.60,$0.00,$26.60,$11.97,$18.98,$0.00,$4.58,$0.00,$0.00,$4.66,$26.60,$0.00,$13.30,$21.07,$21.28,$0.00,$4.16,$0.00,$4.23,$0.00
131019,ERX,HCPCS 63700001,61958-2101-01,ODEFSEY:EMTRICIT-RILPIV-TENOFOV AF 200-25-25 MG TAB,$359.55,$0.00,$359.55,$0.00,$256.61,$0.00,$0.00,$0.00,$0.00,$0.00,$359.55,$0.00,$179.78,$284.76,$287.64,$0.00,$0.00,$0.00,$0.00,$0.00
131430,ERX,HCPCS 25000001,00299-3921-08,CETAPHIL GENTLE CLEANSER EX LIQD,$24.32,$0.00,$24.32,$0.00,$17.36,$0.00,$0.00,$0.00,$0.00,$0.00,$24.32,$0.00,$12.16,$19.26,$19.46,$0.00,$0.00,$0.00,$0.00,$0.00
131443,ERX,HCPCS J1815,00002-8824-27,INSULIN REGULAR HUMAN (CONC) 500 UNIT/ML SC SOPN,$15.00,$0.00,$302.08,$8.15,$10.71,$0.00,$109.28,$0.00,$0.00,$2.63,$15.00,$0.00,$7.50,$11.88,$12.00,$0.00,$0.00,$0.00,$302.08,$0.00
131448,ERX,HCPCS 63700001,50474-0470-66,BRIVARACETAM 25 MG PO TABS,$82.56,$0.00,$82.56,$0.00,$58.92,$0.00,$0.00,$0.00,$0.00,$0.00,$82.56,$0.00,$41.28,$65.39,$66.05,$0.00,$0.00,$0.00,$0.00,$0.00
131449,ERX,HCPCS 25000001,50474-0570-09,BRIVARACETAM 50 MG PO TABS,$82.56,$0.00,$82.56,$0.00,$58.92,$0.00,$0.00,$0.00,$0.00,$0.00,$82.56,$0.00,$41.28,$65.39,$66.05,$0.00,$0.00,$0.00,$0.00,$0.00
131451,ERX,HCPCS 25000001,50474-0770-09,BRIVARACETAM 100 MG PO TABS,$82.56,$0.00,$82.56,$0.00,$58.92,$0.00,$0.00,$0.00,$0.00,$0.00,$82.56,$0.00,$41.28,$65.39,$66.05,$0.00,$0.00,$0.00,$0.00,$0.00
131458,ERX,HCPCS J2786,59310-0610-31,RESLIZUMAB 100 MG/10ML IV SOLN,"$2,292.72",$0.00,"$2,339.46",$0.00,"$1,669.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,339.46",$0.00,"$1,169.73","$1,815.83","$1,871.57",$0.00,$0.00,$0.00,$0.00,$0.00
131469,ERX,HCPCS J0330,62295-3323-07,SUCCINYLCHOLINE CHLORIDE 200 MG/10ML IV SOSY,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$3.85,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.44,$0.00,$3.50,$0.00
131499,ERX,HCPCS 63700001,61958-2002-01,DESCOVY:EMTRICITABINE-TENOFOVIR AF 200-25 MG TAB,$232.13,$0.00,$232.13,$0.00,$165.67,$0.00,$0.00,$0.00,$0.00,$0.00,$232.13,$0.00,$116.07,$183.85,$185.70,$0.00,$0.00,$0.00,$0.00,$0.00
131521,ERX,HCPCS J7183,68982-0182-02,WILATE:ANTIHEMOPHILIC FACTOR-VWF 1000-1000 UNITS IV KIT,"$3,444.00",$0.00,"$3,444.00",$0.00,"$2,457.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,444.00",$0.00,"$1,722.00","$2,727.65","$2,755.20",$0.00,$0.00,$0.00,$0.00,$0.00
131529,ERX,HCPCS 25000001,00074-0576-22,VENETOCLAX 100 MG PO TABS,$374.96,$0.00,$374.96,$0.00,$267.61,$0.00,$0.00,$0.00,$0.00,$0.00,$374.96,$0.00,$187.48,$296.97,$299.97,$0.00,$0.00,$0.00,$0.00,$0.00
131530,ERX,HCPCS 25000001,00074-0579-28,VENETOCLAX 10 & 50 & 100 MG PO TBPK,$238.81,$0.00,$238.81,$0.00,$170.44,$0.00,$0.00,$0.00,$0.00,$0.00,$238.81,$0.00,$119.41,$189.14,$191.05,$0.00,$0.00,$0.00,$0.00,$0.00
131538,ERX,HCPCS 25000001,24571-0116-06,PHOXILLUM BK4/2.5 32-4-2.5-1 MEQ-MMOL/L IV SOLN,$252.00,$0.00,$252.00,$0.00,$179.85,$0.00,$0.00,$0.00,$0.00,$0.00,$252.00,$0.00,$126.00,$199.58,$201.60,$0.00,$0.00,$0.00,$0.00,$0.00
131594,ERX,HCPCS 63700001,42388-0024-26,CABOZANTINIB S-MALATE 20 MG PO TABS,"$1,934.54",$0.00,"$1,934.54",$0.00,"$1,380.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,934.54",$0.00,$967.27,"$1,532.16","$1,547.63",$0.00,$0.00,$0.00,$0.00,$0.00
131595,ERX,HCPCS 63700001,42388-0025-26,CABOZANTINIB S-MALATE 40 MG PO TABS,"$1,934.54",$0.00,"$1,934.54",$0.00,"$1,380.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,934.54",$0.00,$967.27,"$1,532.16","$1,547.63",$0.00,$0.00,$0.00,$0.00,$0.00
131596,ERX,HCPCS 63700001,42388-0023-26,CABOZANTINIB S-MALATE 60 MG PO TABS,"$1,934.54",$0.00,"$1,934.54",$0.00,"$1,380.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,934.54",$0.00,$967.27,"$1,532.16","$1,547.63",$0.00,$0.00,$0.00,$0.00,$0.00
131610,ERX,HCPCS 63700001,24510-0115-10,OXYCODONE ER 13.5 MG PO C12A,$32.88,$0.00,$32.88,$0.00,$23.47,$0.00,$0.00,$0.00,$0.00,$0.00,$32.88,$0.00,$16.44,$26.04,$26.30,$0.00,$0.00,$0.00,$0.00,$0.00
131700,ERX,HCPCS J9022,50242-0917-01,ATEZOLIZUMAB 1200 MG/20ML IV SOLN,"$22,617.33",$0.00,"$22,617.33","$10,177.80","$5,158.80","$9,240.96","$3,896.85",$0.00,$0.00,"$8,138.89","$22,617.33","$9,703.01","$11,308.67","$17,912.93","$18,093.86","$13,399.39","$8,138.89",$0.00,"$8,138.89","$9,240.96"
131713,ERX,HCPCS 63700001,62856-0708-05,LENVATINIB (8 MG DAILY DOSE) 2 X 4 MG PO CPPK,"$1,826.02",$0.00,"$1,826.02",$0.00,"$1,303.23",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,826.02",$0.00,$913.01,"$1,446.21","$1,460.82",$0.00,$0.00,$0.00,$0.00,$0.00
131713,ERX,HCPCS 63700001,62856-0708-30,LENVATINIB (8 MG DAILY DOSE) 2 X 4 MG PO CPPK,"$1,826.02",$0.00,"$1,826.02",$0.00,"$1,303.23",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,826.02",$0.00,$913.01,"$1,446.21","$1,460.82",$0.00,$0.00,$0.00,$0.00,$0.00
131714,ERX,HCPCS 63700001,62856-0718-05,LENVATINIB (18 MG DAILY DOSE) 10 MG & 2 X 4 MG PO CPPK,$672.08,$0.00,$672.08,$0.00,$479.66,$0.00,$0.00,$0.00,$0.00,$0.00,$672.08,$0.00,$336.04,$532.29,$537.66,$0.00,$0.00,$0.00,$0.00,$0.00
131714,ERX,HCPCS 63700001,62856-0718-30,LENVATINIB (18 MG DAILY DOSE) 10 MG & 2 X 4 MG PO CPPK,$672.08,$0.00,$672.08,$0.00,$479.66,$0.00,$0.00,$0.00,$0.00,$0.00,$672.08,$0.00,$336.04,$532.29,$537.66,$0.00,$0.00,$0.00,$0.00,$0.00
131923,ERX,HCPCS 25000001,00781-3269-71,EPHEDRINE SULFATE 50 MG/ML IV SOLN,$25.35,$0.00,$25.35,$0.00,$18.09,$0.00,$0.00,$0.00,$0.00,$0.00,$25.35,$0.00,$12.68,$20.08,$20.28,$0.00,$0.00,$0.00,$0.00,$0.00
131923,ERX,HCPCS 25000001,00781-3269-95,EPHEDRINE SULFATE 50 MG/ML IV SOLN,$25.35,$0.00,$25.35,$0.00,$18.09,$0.00,$0.00,$0.00,$0.00,$0.00,$25.35,$0.00,$12.68,$20.08,$20.28,$0.00,$0.00,$0.00,$0.00,$0.00
131923,ERX,HCPCS 25000001,42023-0216-25,EPHEDRINE SULFATE 50 MG/ML IV SOLN,$25.35,$0.00,$25.35,$0.00,$18.09,$0.00,$0.00,$0.00,$0.00,$0.00,$25.35,$0.00,$12.68,$20.08,$20.28,$0.00,$0.00,$0.00,$0.00,$0.00
131923,ERX,HCPCS 25000001,76014-0005-25,EPHEDRINE SULFATE 50 MG/ML IV SOLN,$25.35,$0.00,$25.35,$0.00,$18.09,$0.00,$0.00,$0.00,$0.00,$0.00,$25.35,$0.00,$12.68,$20.08,$20.28,$0.00,$0.00,$0.00,$0.00,$0.00
131923,ERX,HCPCS 25000001,76014-0005-30,EPHEDRINE SULFATE 50 MG/ML IV SOLN,$25.35,$0.00,$25.35,$0.00,$18.09,$0.00,$0.00,$0.00,$0.00,$0.00,$25.35,$0.00,$12.68,$20.08,$20.28,$0.00,$0.00,$0.00,$0.00,$0.00
132039,ERX,HCPCS J9047,76075-0102-01,CARFILZOMIB 30 MG IV SOLR,"$2,995.57",$0.00,"$2,995.57","$1,348.01","$2,137.94","$1,127.97",$516.12,$0.00,$0.00,"$1,323.29","$2,995.57","$1,184.37","$1,497.79","$2,372.49","$2,396.46","$1,635.56","$1,323.29",$0.00,"$1,259.99","$1,169.16"
132135,ERX,HCPCS 63700001,72626-2701-01,(EPCLUSA) SOFOSBUVIR-VELPATASVIR 400-100 MG PO TABS,$908.58,$0.00,$908.58,$0.00,$648.45,$0.00,$0.00,$0.00,$0.00,$0.00,$908.58,$0.00,$454.29,$719.60,$726.86,$0.00,$0.00,$0.00,$0.00,$0.00
132336,ERX,HCPCS 25000001,00310-4600-39,BEVESPI:GLYCOPYRROLATE-FORMOTEROL 9-4.8 MCG/ACT IN AERO,"$1,218.33",$0.00,"$1,218.33",$0.00,$869.52,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,218.33",$0.00,$609.17,$964.92,$974.66,$0.00,$0.00,$0.00,$0.00,$0.00
132337,ERX,HCPCS 90674,70461-0320-04,INFLUENZA VAC SUBUNIT QUAD 0.5 ML IM SUSY,$107.69,$0.00,$107.69,$48.46,$76.86,$28.00,$18.55,$0.00,$0.00,$18.86,$107.69,$15.72,$53.85,$85.29,$86.15,$15.72,$16.85,$28.00,$17.14,$28.00
132344,ERX,HCPCS 25000001,00065-0426-36,GENTEAL TEARS 0.1-0.2-0.3 % OP SOLN,$27.36,$0.00,$27.36,$0.00,$19.53,$0.00,$0.00,$0.00,$0.00,$0.00,$27.36,$0.00,$13.68,$21.67,$21.89,$0.00,$0.00,$0.00,$0.00,$0.00
132344,ERX,HCPCS 25000001,00065-0426-37,GENTEAL TEARS 0.1-0.2-0.3 % OP SOLN,$27.36,$0.00,$27.36,$0.00,$19.53,$0.00,$0.00,$0.00,$0.00,$0.00,$27.36,$0.00,$13.68,$21.67,$21.89,$0.00,$0.00,$0.00,$0.00,$0.00
132810,ERX,HCPCS 25800001,63323-0820-74,FAT EMUL FISH OIL/PLANT BASED 20 % IV EMUL,$109.38,$0.00,$109.38,$0.00,$78.06,$0.00,$0.00,$0.00,$0.00,$0.00,$109.38,$0.00,$54.69,$86.63,$87.50,$0.00,$0.00,$0.00,$0.00,$0.00
132810,ERX,HCPCS 25800001,63323-0820-50,FAT EMUL FISH OIL/PLANT BASED 20 % IV EMUL,$143.50,$0.00,$113.65,$0.00,$78.06,$0.00,$0.00,$0.00,$0.00,$0.00,$109.38,$0.00,$54.69,$113.65,$87.50,$0.00,$0.00,$0.00,$0.00,$0.00
132815,ERX,HCPCS J3490,00517-0374-01,METHYLENE BLUE 50 MG/10ML IV SOLN,$756.74,$0.00,$756.74,$340.53,$540.09,$0.00,$130.38,$0.00,$0.00,$132.50,$756.74,$0.00,$378.37,$599.34,$605.39,$0.00,$118.43,$0.00,$120.47,$0.00
132815,ERX,HCPCS J3490,00517-0374-05,METHYLENE BLUE 50 MG/10ML IV SOLN,$756.74,$0.00,$756.74,$340.53,$540.09,$0.00,$130.38,$0.00,$0.00,$132.50,$756.74,$0.00,$378.37,$599.34,$605.39,$0.00,$118.43,$0.00,$120.47,$0.00
132818,ERX,HCPCS J2400,00143-9210-01,CHLOROPROCAINE HCL (PF) 3 % IJ SOLN,$94.01,$0.00,$94.01,$0.00,$67.09,$0.00,$0.00,$0.00,$0.00,$0.00,$94.01,$0.00,$47.01,$74.46,$75.21,$0.00,$0.00,$0.00,$0.00,$0.00
132818,ERX,HCPCS J2400,00143-9210-10,CHLOROPROCAINE HCL (PF) 3 % IJ SOLN,$94.01,$0.00,$94.01,$0.00,$67.09,$0.00,$0.00,$0.00,$0.00,$0.00,$94.01,$0.00,$47.01,$74.46,$75.21,$0.00,$0.00,$0.00,$0.00,$0.00
132818,ERX,HCPCS J2400,63323-0478-27,CHLOROPROCAINE HCL (PF) 3 % IJ SOLN,$94.01,$0.00,$94.01,$0.00,$67.09,$0.00,$0.00,$0.00,$0.00,$0.00,$94.01,$0.00,$47.01,$74.46,$75.21,$0.00,$0.00,$0.00,$0.00,$0.00
132822,ERX,HCPCS J3246,25208-0002-02,TIROFIBAN HCL IN NACL 12.5-0.9 MG/250ML-% IV SOLN,$759.89,$0.00,$759.89,$0.00,$542.33,$0.00,$0.00,$0.00,$0.00,$0.00,$759.89,$0.00,$379.95,$601.83,$607.91,$0.00,$0.00,$0.00,$0.00,$0.00
132824,ERX,HCPCS J2310,00409-1219-01,NALOXONE HCL 4 MG/10ML IJ SOLN,$434.60,$0.00,$434.60,$195.57,$310.17,$0.00,$17.48,$0.00,$0.00,$62.42,$434.60,$0.00,$217.30,$344.20,$347.68,$0.00,$62.42,$0.00,$59.43,$0.00
132824,ERX,HCPCS J2310,17478-0042-10,NALOXONE HCL 4 MG/10ML IJ SOLN,$434.60,$0.00,$434.60,$195.57,$310.17,$0.00,$17.48,$0.00,$0.00,$62.42,$434.60,$0.00,$217.30,$344.20,$347.68,$0.00,$62.42,$0.00,$59.43,$0.00
132824,ERX,HCPCS J2310,67457-0299-10,NALOXONE HCL 4 MG/10ML IJ SOLN,$434.60,$0.00,$434.60,$195.57,$310.17,$0.00,$17.48,$0.00,$0.00,$62.42,$434.60,$0.00,$217.30,$344.20,$347.68,$0.00,$62.42,$0.00,$59.43,$0.00
132826,ERX,HCPCS J7195,58394-0633-03,COAGULATION FACTOR IX (RECOMB) 250 UNITS IV KIT,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
132827,ERX,HCPCS J7195,58394-0634-03,COAGULATION FACTOR IX (RECOMB) 500 UNITS IV KIT,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
132828,ERX,HCPCS J7195,58394-0635-03,COAGULATION FACTOR IX (RECOMB BENEFIX) 1000 UNITS IV KIT,"$3,362.00",$0.00,"$3,362.00",$0.00,"$2,399.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,362.00",$0.00,"$1,681.00","$2,662.70","$2,689.60",$0.00,$0.00,$0.00,$0.00,$0.00
132829,ERX,HCPCS J7195,58394-0636-03,COAGULATION FACTOR IX (RECOMB) 2000 UNITS IV KIT,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
132871,ERX,HCPCS 63700001,65649-0150-90,METHYLNALTREXONE BROMIDE 150 MG PO TABS,$87.27,$0.00,$87.27,$0.00,$62.28,$0.00,$0.00,$0.00,$0.00,$0.00,$87.27,$0.00,$43.64,$69.12,$69.82,$0.00,$0.00,$0.00,$0.00,$0.00
133343,ERX,HCPCS 25000001,61703-0421-53,M.V.I. PEDIATRIC IV SOLR,$28.73,$0.00,$28.73,$0.00,$20.50,$0.00,$0.00,$0.00,$0.00,$0.00,$28.73,$0.00,$14.37,$22.75,$22.98,$0.00,$0.00,$0.00,$0.00,$0.00
133367,ERX,HCPCS J3358,57894-0054-27,USTEKINUMAB 130 MG/26ML IV SOLN,"$4,128.89",$0.00,"$4,128.89","$1,858.00","$2,946.79","$1,564.81",$711.39,$0.00,$0.00,"$1,822.31","$4,128.89","$1,643.05","$2,064.45","$3,270.08","$3,303.11","$2,268.97","$1,822.31",$0.00,"$1,735.15","$1,564.81"
133767,ERX,HCPCS 63700001,59310-0302-40,BECLOMETHASONE DIPROP HFA 40 MCG/ACT IN AERB,$604.87,$0.00,$604.87,$0.00,$431.70,$0.00,$0.00,$0.00,$0.00,$0.00,$604.87,$0.00,$302.44,$479.06,$483.90,$0.00,$0.00,$0.00,$0.00,$0.00
133768,ERX,HCPCS 63700001,59310-0304-80,BECLOMETHASONE DIPROP HFA 80 MCG/ACT IN AERB,$809.90,$0.00,$809.90,$0.00,$578.03,$0.00,$0.00,$0.00,$0.00,$0.00,$809.90,$0.00,$404.95,$641.44,$647.92,$0.00,$0.00,$0.00,$0.00,$0.00
133781,ERX,HCPCS Q5103,00069-0809-01,INFLIXIMAB-DYYB 100 MG IV SOLR,"$2,327.86",$0.00,"$2,327.86",$0.00,"$1,661.39",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,327.86",$0.00,"$1,163.93","$1,843.67","$1,862.29",$0.00,$0.00,$0.00,$0.00,$0.00
133797,ERX,HCPCS J7999,42852-0862-25,NOREPINEPHRINE-SODIUM CHLORIDE 8-0.9 MG/250ML-% IV SOLN,$173.25,$0.00,$173.25,$77.96,$123.65,$0.00,$29.85,$0.00,$0.00,$30.33,$173.25,$0.00,$86.63,$137.21,$138.60,$0.00,$27.11,$0.00,$27.58,$0.00
133797,ERX,HCPCS J7999,70324-0676-01,NOREPINEPHRINE-SODIUM CHLORIDE 8-0.9 MG/250ML-% IV SOLN,$173.25,$0.00,$173.25,$77.96,$123.65,$0.00,$29.85,$0.00,$0.00,$30.33,$173.25,$0.00,$86.63,$137.21,$138.60,$0.00,$27.11,$0.00,$27.58,$0.00
133797,ERX,HCPCS J7999,76154-0475-15,NOREPINEPHRINE-SODIUM CHLORIDE 8-0.9 MG/250ML-% IV SOLN,$173.25,$0.00,$173.25,$77.96,$123.65,$0.00,$29.85,$0.00,$0.00,$30.33,$173.25,$0.00,$86.63,$137.21,$138.60,$0.00,$27.11,$0.00,$27.58,$0.00
133797,ERX,HCPCS J7999,99999-6011-03,NOREPINEPHRINE-SODIUM CHLORIDE 8-0.9 MG/250ML-% IV SOLN,$173.25,$0.00,$173.25,$77.96,$123.65,$0.00,$29.85,$0.00,$0.00,$30.33,$173.25,$0.00,$86.63,$137.21,$138.60,$0.00,$27.11,$0.00,$27.58,$0.00
133838,ERX,HCPCS J7296,50419-0424-01,LEVONORGESTREL 19.5 MG IU IUD,"$2,345.64",$0.00,"$2,345.64",$0.00,"$1,674.08",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,345.64",$0.00,"$1,172.82","$1,857.75","$1,876.51",$0.00,$0.00,$0.00,$0.00,$0.00
134020,ERX,HCPCS J9285,00002-8926-01,OLARATUMAB 500 MG/50ML IV SOLN,"$6,041.76",$0.00,"$6,041.76",$0.00,"$4,312.00",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,041.76",$0.00,"$3,020.88","$4,785.07","$4,833.41",$0.00,$0.00,$0.00,$0.00,$0.00
134049,ERX,HCPCS J3246,25208-0001-04,TIROFIBAN HCL 3.75 MG/15ML IV CONC,$211.68,$0.00,$211.68,$0.00,$151.08,$0.00,$0.00,$0.00,$0.00,$0.00,$211.68,$0.00,$105.84,$167.65,$169.34,$0.00,$0.00,$0.00,$0.00,$0.00
134129,ERX,HCPCS 63700001,61958-2301-01,TENOFOVIR ALAFENAMIDE FUMARATE 25 MG PO TABS,$164.17,$0.00,$164.17,$0.00,$117.17,$0.00,$0.00,$0.00,$0.00,$0.00,$164.17,$0.00,$82.09,$130.02,$131.34,$0.00,$0.00,$0.00,$0.00,$0.00
134529,ERX,HCPCS 25000001,62530-0000-11,UREA 15 G PO PACK,$15.96,$0.00,$15.96,$0.00,$11.39,$0.00,$0.00,$0.00,$0.00,$0.00,$15.96,$0.00,$7.98,$12.64,$12.77,$0.00,$0.00,$0.00,$0.00,$0.00
134557,ERX,HCPCS 63600001,69660-0201-91,RUCAPARIB CAMSYLATE 200 MG PO TABS,$509.42,$0.00,$509.42,$0.00,$363.57,$0.00,$0.00,$0.00,$0.00,$0.00,$509.42,$0.00,$254.71,$403.46,$407.54,$0.00,$0.00,$0.00,$0.00,$0.00
134558,ERX,HCPCS 63600001,69660-0203-91,RUCAPARIB CAMSYLATE 300 MG PO TABS,$509.42,$0.00,$509.42,$0.00,$363.57,$0.00,$0.00,$0.00,$0.00,$0.00,$509.42,$0.00,$254.71,$403.46,$407.54,$0.00,$0.00,$0.00,$0.00,$0.00
134827,ERX,HCPCS J7999,71285-6044-01,OXYTOCIN-SODIUM CHLORIDE 30-0.9 UT/500ML-% IV SOLN,$48.57,$0.00,$48.57,$21.86,$34.66,$0.00,$8.37,$0.00,$0.00,$8.50,$48.57,$0.00,$24.29,$38.47,$38.86,$0.00,$7.60,$0.00,$7.73,$0.00
134827,ERX,HCPCS J7999,99999-6006-08,OXYTOCIN-SODIUM CHLORIDE 30-0.9 UT/500ML-% IV SOLN,$48.57,$0.00,$48.57,$21.86,$34.66,$0.00,$8.37,$0.00,$0.00,$8.50,$48.57,$0.00,$24.29,$38.47,$38.86,$0.00,$7.60,$0.00,$7.73,$0.00
134890,ERX,HCPCS 25000001,00283-0679-02,BENZOCAINE 20 % MT AERO,$142.45,$0.00,$142.45,$0.00,$101.67,$0.00,$0.00,$0.00,$0.00,$0.00,$142.45,$0.00,$71.23,$112.82,$113.96,$0.00,$0.00,$0.00,$0.00,$0.00
134890,ERX,HCPCS 25000001,00283-0679-60,BENZOCAINE 20 % MT AERO,$142.45,$0.00,$142.45,$0.00,$101.67,$0.00,$0.00,$0.00,$0.00,$0.00,$142.45,$0.00,$71.23,$112.82,$113.96,$0.00,$0.00,$0.00,$0.00,$0.00
134897,ERX,HCPCS 25000001,63323-0170-05,SODIUM PHOSPHATES 15 MMOLE/5ML IV SOLN,$73.61,$0.00,$73.61,$0.00,$52.54,$0.00,$0.00,$0.00,$0.00,$0.00,$73.61,$0.00,$36.81,$58.30,$58.89,$0.00,$0.00,$0.00,$0.00,$0.00
134898,ERX,HCPCS 25000001,00409-7391-72,SODIUM PHOSPHATES 45 MMOLE/15ML IV SOLN,$138.66,$0.00,$138.66,$0.00,$98.96,$0.00,$0.00,$0.00,$0.00,$0.00,$138.66,$0.00,$69.33,$109.82,$110.93,$0.00,$0.00,$0.00,$0.00,$0.00
134898,ERX,HCPCS 25000001,63323-0170-15,SODIUM PHOSPHATES 45 MMOLE/15ML IV SOLN,$138.66,$0.00,$138.66,$0.00,$98.96,$0.00,$0.00,$0.00,$0.00,$0.00,$138.66,$0.00,$69.33,$109.82,$110.93,$0.00,$0.00,$0.00,$0.00,$0.00
134923,ERX,HCPCS J0461,00409-1630-10,ATROPINE SULFATE 1 MG/10ML IJ SOSY,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$0.94,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.94,$0.00,$0.90,$0.00
134923,ERX,HCPCS J0461,00409-1630-15,ATROPINE SULFATE 1 MG/10ML IJ SOSY,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$0.94,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.94,$0.00,$0.90,$0.00
134923,ERX,HCPCS J0461,00409-4911-11,ATROPINE SULFATE 1 MG/10ML IJ SOSY,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$0.94,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.94,$0.00,$0.90,$0.00
134923,ERX,HCPCS J0461,00409-4911-34,ATROPINE SULFATE 1 MG/10ML IJ SOSY,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$0.94,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.94,$0.00,$0.90,$0.00
134923,ERX,HCPCS J0461,76329-3339-01,ATROPINE SULFATE 1 MG/10ML IJ SOSY,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$0.94,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.94,$0.00,$0.90,$0.00
134969,ERX,HCPCS J0461,00641-6006-01,ATROPINE SULFATE 8 MG/20ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$1.88,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.88,$0.00,$1.79,$0.00
134969,ERX,HCPCS J0461,00641-6006-10,ATROPINE SULFATE 8 MG/20ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$1.88,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.88,$0.00,$1.79,$0.00
135137,ERX,HCPCS 25000001,00121-1971-00,ACETAMINOPHEN 650 MG/20.3ML PO SOLN,$9.26,$0.00,$9.26,$0.00,$6.61,$0.00,$0.00,$0.00,$0.00,$0.00,$9.26,$0.00,$4.63,$7.33,$7.41,$0.00,$0.00,$0.00,$0.00,$0.00
135137,ERX,HCPCS 25000001,00121-1971-21,ACETAMINOPHEN 650 MG/20.3ML PO SOLN,$9.26,$0.00,$9.26,$0.00,$6.61,$0.00,$0.00,$0.00,$0.00,$0.00,$9.26,$0.00,$4.63,$7.33,$7.41,$0.00,$0.00,$0.00,$0.00,$0.00
135307,ERX,HCPCS J9285,00002-7190-01,OLARATUMAB 190 MG/19ML IV SOLN,"$2,295.87",$0.00,"$2,295.87",$0.00,"$1,638.56",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,295.87",$0.00,"$1,147.94","$1,818.33","$1,836.70",$0.00,$0.00,$0.00,$0.00,$0.00
135334,ERX,HCPCS 25000001,61938-0456-03,CALFACTANT IN NACL 35-0.9 MG/ML-% INTRATRACHEA SUSP,"$1,234.80",$0.00,"$1,234.80",$0.00,$881.28,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,234.80",$0.00,$617.40,$977.96,$987.84,$0.00,$0.00,$0.00,$0.00,$0.00
135357,ERX,HCPCS 25000001,70183-0125-84,TELOTRISTAT ETHYL(AS ETIPRATE) 250 MG PO TABS,$295.16,$0.00,$295.16,$0.00,$224.16,$0.00,$0.00,$0.00,$0.00,$0.00,$295.16,$0.00,$147.58,$233.77,$236.13,$0.00,$0.00,$0.00,$0.00,$0.00
135365,ERX,HCPCS 25000001,49348-0274-72,SM DOUBLE ANTIBIOTIC 500-10000 UNIT/GM EX OINT,$12.63,$0.00,$12.63,$0.00,$9.01,$0.00,$0.00,$0.00,$0.00,$0.00,$12.63,$0.00,$6.32,$10.00,$10.10,$0.00,$0.00,$0.00,$0.00,$0.00
135444,ERX,HCPCS 25000001,51754-1006-01,NITROPRUSSIDE SODIUM-NACL 50-0.9 MG/100ML-% IV SOLN,$207.90,$0.00,$207.90,$0.00,$148.38,$0.00,$0.00,$0.00,$0.00,$0.00,$207.90,$0.00,$103.95,$164.66,$166.32,$0.00,$0.00,$0.00,$0.00,$0.00
135513,ERX,HCPCS C9399,44087-3535-01,AVELUMAB 200 MG/10ML IV SOLN,"$4,045.56",$0.00,"$4,045.56",$0.00,"$2,887.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,045.56",$0.00,"$2,022.78","$3,204.08","$3,236.45",$0.00,$0.00,$0.00,$0.00,$0.00
135585,ERX,HCPCS J2260,00143-9719-01,MILRINONE LACTATE IN DEXTROSE 20-5 MG/100ML-% IV SOLN,$121.45,$0.00,$121.45,$54.65,$86.68,$0.00,$20.93,$0.00,$0.00,$7.19,$121.45,$0.00,$60.73,$96.19,$97.16,$0.00,$7.19,$0.00,$6.85,$0.00
135585,ERX,HCPCS J2260,00143-9719-10,MILRINONE LACTATE IN DEXTROSE 20-5 MG/100ML-% IV SOLN,$121.45,$0.00,$121.45,$54.65,$86.68,$0.00,$20.93,$0.00,$0.00,$7.19,$121.45,$0.00,$60.73,$96.19,$97.16,$0.00,$7.19,$0.00,$6.85,$0.00
135585,ERX,HCPCS J2260,00338-6010-48,MILRINONE LACTATE IN DEXTROSE 20-5 MG/100ML-% IV SOLN,$121.45,$0.00,$121.45,$54.65,$86.68,$0.00,$20.93,$0.00,$0.00,$7.19,$121.45,$0.00,$60.73,$96.19,$97.16,$0.00,$7.19,$0.00,$6.85,$0.00
135585,ERX,HCPCS J2260,00409-2776-23,MILRINONE LACTATE IN DEXTROSE 20-5 MG/100ML-% IV SOLN,$121.45,$0.00,$121.45,$54.65,$86.68,$0.00,$20.93,$0.00,$0.00,$7.19,$121.45,$0.00,$60.73,$96.19,$97.16,$0.00,$7.19,$0.00,$6.85,$0.00
135586,ERX,HCPCS 25000001,00065-0092-65,FLUORESCEIN SODIUM 10 % IV SOLN,$34.68,$0.00,$34.68,$0.00,$24.75,$0.00,$0.00,$0.00,$0.00,$0.00,$34.68,$0.00,$17.34,$27.47,$27.74,$0.00,$0.00,$0.00,$0.00,$0.00
135586,ERX,HCPCS 25000001,17478-0253-10,FLUORESCEIN SODIUM 10 % IV SOLN,$34.68,$0.00,$34.68,$0.00,$24.75,$0.00,$0.00,$0.00,$0.00,$0.00,$34.68,$0.00,$17.34,$27.47,$27.74,$0.00,$0.00,$0.00,$0.00,$0.00
135587,ERX,HCPCS 25000001,17478-0250-20,FLUORESCEIN SODIUM 25 % IV SOLN,$159.70,$0.00,$159.70,$0.00,$113.98,$0.00,$0.00,$0.00,$0.00,$0.00,$159.70,$0.00,$79.85,$126.48,$127.76,$0.00,$0.00,$0.00,$0.00,$0.00
135612,ERX,HCPCS J2350,50242-0150-01,OCRELIZUMAB 300 MG/10ML IV SOLN,"$39,975.00",$0.00,"$39,975.00","$17,988.75","$5,158.80","$17,225.10","$6,887.49",$0.00,$0.00,"$8,138.89","$39,975.00","$18,086.36","$19,987.50","$31,660.20","$31,980.00","$24,976.40","$8,138.89",$0.00,"$8,138.89","$17,225.10"
136063,ERX,HCPCS J8999,00069-0193-01,BOSUTINIB 400 MG PO TABS,"$1,504.61",$0.00,"$1,504.61",$0.00,"$1,073.84",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,504.61",$0.00,$752.31,"$1,191.65","$1,203.69",$0.00,$0.00,$0.00,$0.00,$0.00
136139,ERX,HCPCS 63700001,69656-0103-90,NIRAPARIB TOSYLATE 100 MG PO CAPS,$591.01,$0.00,$468.08,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$468.08,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
136459,ERX,HCPCS J9355,50242-0132-01,TRASTUZUMAB 150 MG IV SOLR,"$3,833.71",$0.00,"$3,833.71","$1,725.17","$2,736.12","$1,599.33","$1,086.41",$0.00,$0.00,"$1,865.78","$3,833.71","$1,679.30","$1,916.86","$3,036.30","$3,066.97","$2,319.03","$1,865.78",$0.00,"$1,776.54","$1,534.76"
136518,ERX,HCPCS 63700001,00078-0698-51,MIDOSTAURIN 25 MG PO CAPS,"$1,018.56",$0.00,"$1,018.56",$0.00,$726.95,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,018.56",$0.00,$509.28,$806.70,$814.85,$0.00,$0.00,$0.00,$0.00,$0.00
136518,ERX,HCPCS 63700001,00078-0698-99,MIDOSTAURIN 25 MG PO CAPS,"$1,018.56",$0.00,"$1,018.56",$0.00,$726.95,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,018.56",$0.00,$509.28,$806.70,$814.85,$0.00,$0.00,$0.00,$0.00,$0.00
136524,ERX,HCPCS J9173,00310-4500-12,DURVALUMAB 120 MG/2.4ML IV SOLN,"$2,196.29",$0.00,"$2,196.29",$988.33,"$1,567.49",$895.63,$378.41,$0.00,$0.00,"$1,065.68","$2,196.29",$940.41,"$1,098.15","$1,739.46","$1,757.03","$1,298.67","$1,065.68",$0.00,"$1,014.71",$895.63
136525,ERX,HCPCS J9173,00310-4611-50,DURVALUMAB 500 MG/10ML IV SOLN,"$9,151.16",$0.00,"$9,151.16","$4,118.02","$5,158.80","$3,731.80","$1,576.70",$0.00,$0.00,"$4,440.33","$9,151.16","$3,918.39","$4,575.58","$7,247.72","$7,320.93","$5,411.11","$4,440.33",$0.00,"$4,227.95","$3,731.80"
136642,ERX,HCPCS 25000001,56151-1625-01,GLUCOSE 15 GM/32ML PO GEL,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
136839,ERX,HCPCS J9017,63459-0601-06,ARSENIC TRIOXIDE 12 MG/6ML IV SOLN,"$2,191.86",$0.00,"$2,191.86",$986.34,"$1,564.33",$531.77,$377.65,$0.00,$0.00,$621.39,"$2,191.86",$558.36,"$1,095.93","$1,735.95","$1,753.49",$771.06,$621.39,$0.00,$591.67,$344.03
137000,ERX,HCPCS J9311,50242-0108-01,RITUXIMAB-HYALURONIDASE HUMAN 1400-23400 MG -UT/11.7ML SC SOLN,"$16,178.39",$0.00,"$16,178.39",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$16,178.39",$0.00,"$8,089.20","$12,813.28","$12,942.71",$0.00,$0.00,$0.00,$0.00,$0.00
137001,ERX,HCPCS J9311,50242-0109-01,RITUXIMAB-HYALURONIDASE HUMAN 1600-26800 MG -UT/13.4ML SC SOLN,"$18,489.60",$0.00,"$18,489.60",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$18,489.60",$0.00,"$9,244.80","$14,643.76","$14,791.68",$0.00,$0.00,$0.00,$0.00,$0.00
137149,ERX,HCPCS Q5104,00006-4305-01,INFLIXIMAB-ABDA 100 MG IV SOLR,"$2,169.77",$0.00,"$2,169.77",$976.40,"$1,548.56",$533.95,$373.84,$0.00,$0.00,$608.06,"$2,169.77",$560.65,"$1,084.89","$1,718.46","$1,735.82",$774.23,$608.06,$0.00,$578.98,$533.95
137149,ERX,HCPCS Q5104,00006-4305-02,INFLIXIMAB-ABDA 100 MG IV SOLR,"$2,169.77",$0.00,"$2,169.77",$976.40,"$1,548.56",$533.95,$373.84,$0.00,$0.00,$608.06,"$2,169.77",$560.65,"$1,084.89","$1,718.46","$1,735.82",$774.23,$608.06,$0.00,$578.98,$533.95
137213,ERX,HCPCS 25000001,70437-0240-26,NERATINIB MALEATE 40 MG PO TABS,$290.29,$0.00,$290.29,$0.00,$207.18,$0.00,$0.00,$0.00,$0.00,$0.00,$290.29,$0.00,$145.15,$229.91,$232.23,$0.00,$0.00,$0.00,$0.00,$0.00
137683,ERX,HCPCS 25000001,99999-6004-60,CALCIUM CARBONATE ANTACID 1250 MG/5ML PO SUSP,$11.00,$0.00,$11.00,$0.00,$7.85,$0.00,$0.00,$0.00,$0.00,$0.00,$11.00,$0.00,$5.50,$8.71,$8.80,$0.00,$0.00,$0.00,$0.00,$0.00
137683,ERX,HCPCS 25000001,99999-6010-66,CALCIUM CARBONATE ANTACID 1250 MG/5ML PO SUSP,$11.00,$0.00,$11.00,$0.00,$7.85,$0.00,$0.00,$0.00,$0.00,$0.00,$11.00,$0.00,$5.50,$8.71,$8.80,$0.00,$0.00,$0.00,$0.00,$0.00
137683,ERX,HCPCS 25000001,00121-0766-16,CALCIUM CARBONATE ANTACID 1250 MG/5ML PO SUSP,$46.74,$0.00,$37.02,$0.00,$7.85,$0.00,$0.00,$0.00,$0.00,$0.00,$11.00,$0.00,$5.50,$37.02,$8.80,$0.00,$0.00,$0.00,$0.00,$0.00
137683,ERX,HCPCS 25000001,00054-3117-63,CALCIUM CARBONATE ANTACID 1250 MG/5ML PO SUSP,$47.50,$0.00,$37.62,$0.00,$7.85,$0.00,$0.00,$0.00,$0.00,$0.00,$11.00,$0.00,$5.50,$37.62,$8.80,$0.00,$0.00,$0.00,$0.00,$0.00
137687,ERX,HCPCS 25000001,00023-4554-30,CARBOXYMETHYLCELLULOSE SOD PF 1 % OP GEL,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
137688,ERX,HCPCS J0401,59148-0045-80,ARIPIPRAZOLE ER 300 MG IM PRSY,"$2,238.34",$0.00,"$2,238.34",$0.00,"$1,597.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,238.34",$0.00,"$1,119.17","$1,772.77","$1,790.67",$0.00,$0.00,$0.00,$0.00,$0.00
137726,ERX,HCPCS J3490,70842-0120-06,MEROPENEM-VABORBACTAM 2 (1-1) G IV SOLR,$566.68,$0.00,$566.68,$255.01,$404.44,$0.00,$97.64,$0.00,$0.00,$99.22,$566.68,$0.00,$283.34,$448.81,$453.34,$0.00,$88.69,$0.00,$90.22,$0.00
137728,ERX,HCPCS J9203,00008-4510-01,GEMTUZUMAB OZOGAMICIN 4.5 MG IV SOLR,"$21,400.49",$0.00,"$21,400.49",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,400.49",$0.00,"$10,700.25","$16,949.19","$17,120.39",$0.00,$0.00,$0.00,$0.00,$0.00
137823,ERX,HCPCS 25000001,00409-4712-01,LIDOCAINE IN DEXTROSE 5-7.5 % INTRASPINAL SOLN,$41.61,$0.00,$41.61,$0.00,$29.70,$0.00,$0.00,$0.00,$0.00,$0.00,$41.61,$0.00,$20.81,$32.96,$33.29,$0.00,$0.00,$0.00,$0.00,$0.00
137829,ERX,HCPCS J0171,42023-0159-01,EPINEPHRINE (ANAPHYLAXIS) 1 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$0.96,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.96,$0.00,$0.92,$0.00
137829,ERX,HCPCS J0171,42023-0159-25,EPINEPHRINE (ANAPHYLAXIS) 1 MG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$0.96,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.96,$0.00,$0.92,$0.00
137999,ERX,HCPCS J3370,66288-7100-01,VANCOMYCIN HCL 100 G IV SOLR,"$1,440.00",$0.00,"$1,440.00",$648.00,"$1,027.73",$0.00,$723.80,$0.00,$0.00,$796.65,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$796.65,$0.00,$758.55,$0.00
138034,ERX,HCPCS 25000001,00002-4483-54,ABEMACICLIB 50 MG PO TABS,$702.85,$0.00,$702.85,$0.00,$501.62,$0.00,$0.00,$0.00,$0.00,$0.00,$702.85,$0.00,$351.43,$556.66,$562.28,$0.00,$0.00,$0.00,$0.00,$0.00
138035,ERX,HCPCS 25000001,00002-4815-54,ABEMACICLIB 100 MG PO TABS,$702.85,$0.00,$702.85,$0.00,$501.62,$0.00,$0.00,$0.00,$0.00,$0.00,$702.85,$0.00,$351.43,$556.66,$562.28,$0.00,$0.00,$0.00,$0.00,$0.00
138036,ERX,HCPCS 25000001,00002-5337-54,ABEMACICLIB 150 MG PO TABS,$702.85,$0.00,$702.85,$0.00,$501.62,$0.00,$0.00,$0.00,$0.00,$0.00,$702.85,$0.00,$351.43,$556.66,$562.28,$0.00,$0.00,$0.00,$0.00,$0.00
138037,ERX,HCPCS 25000001,00002-6216-54,ABEMACICLIB 200 MG PO TABS,$702.85,$0.00,$702.85,$0.00,$501.62,$0.00,$0.00,$0.00,$0.00,$0.00,$702.85,$0.00,$351.43,$556.66,$562.28,$0.00,$0.00,$0.00,$0.00,$0.00
138138,ERX,HCPCS J0171,42023-0168-01,EPINEPHRINE 30 MG/30ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$2.89,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$2.89,$0.00,$2.75,$0.00
138195,ERX,HCPCS J7170,50242-0921-01,EMICIZUMAB-KXWH 60 MG/0.4ML SC SOLN,"$14,788.68",$0.00,"$14,788.68",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$14,788.68",$0.00,"$7,394.34","$11,712.63","$11,830.94",$0.00,$0.00,$0.00,$0.00,$0.00
138537,ERX,HCPCS J3490,68547-0501-02,ANGIOTENSIN II ACETATE 2.5 MG/ML IV SOLN,"$3,690.00",$0.00,"$3,690.00","$1,660.50","$2,633.55",$0.00,$635.77,$0.00,$0.00,$646.09,"$3,690.00",$0.00,"$1,845.00","$2,922.48","$2,952.00",$0.00,$577.49,$0.00,$587.45,$0.00
138555,ERX,HCPCS J9299,00003-3734-13,NIVOLUMAB 240 MG/24ML IV SOLN,"$16,187.94",$0.00,"$16,187.94","$7,284.57","$5,158.80","$6,673.20","$2,789.10",$0.00,$0.00,"$7,941.12","$16,187.94","$7,006.86","$8,093.97","$12,820.85","$12,950.35","$9,676.14","$7,941.12",$0.00,"$7,561.30","$6,848.16"
138899,ERX,HCPCS J8499,61958-2501-01,BIKTARVY:BICTEGRAVIR-EMTRICITABINE-TENOFOVIR ALAFENAMIDE 50-200-25 PO TAB,$395.08,$0.00,$395.08,$214.53,$281.97,$70.32,$68.07,$0.00,$0.00,$69.18,$395.08,$0.00,$197.54,$312.90,$316.06,$237.05,$0.00,$0.00,$62.90,$0.00
138939,ERX,HCPCS 25000001,59676-0600-12,APALUTAMIDE 60 MG PO TABS,"$1,298.03",$0.00,"$1,298.03",$0.00,$926.40,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,298.03",$0.00,$649.02,"$1,028.04","$1,038.42",$0.00,$0.00,$0.00,$0.00,$0.00
139004,ERX,HCPCS 63700001,57962-0070-28,IBRUTINIB 70 MG PO CAPS,"$4,556.66",$0.00,"$4,556.66",$0.00,"$3,252.09",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,556.66",$0.00,"$2,278.33","$3,608.87","$3,645.33",$0.00,$0.00,$0.00,$0.00,$0.00
139005,ERX,HCPCS J8999,57962-0014-28,IBRUTINIB 140 MG PO TABS,"$2,278.33",$0.00,"$2,278.33",$0.00,"$1,626.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,278.33",$0.00,"$1,139.17","$1,804.44","$1,822.66",$0.00,$0.00,$0.00,$0.00,$0.00
139006,ERX,HCPCS 63700001,57962-0280-28,IBRUTINIB 280 MG PO TABS,"$2,278.33",$0.00,"$2,278.33",$0.00,"$1,626.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,278.33",$0.00,"$1,139.17","$1,804.44","$1,822.66",$0.00,$0.00,$0.00,$0.00,$0.00
139007,ERX,HCPCS 63700001,57962-0420-28,IBRUTINIB 420 MG PO TABS,"$1,333.66",$0.00,"$1,333.66",$0.00,$951.83,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,333.66",$0.00,$666.83,"$1,056.26","$1,066.93",$0.00,$0.00,$0.00,$0.00,$0.00
139008,ERX,HCPCS 63700001,57962-0560-28,IBRUTINIB 560 MG PO TABS,"$1,333.66",$0.00,"$1,333.66",$0.00,$951.83,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,333.66",$0.00,$666.83,"$1,056.26","$1,066.93",$0.00,$0.00,$0.00,$0.00,$0.00
139272,ERX,HCPCS J0690,00338-3503-41,CEFAZOLIN 1G IN 50ML DEXTROSE (ISO-OSMOTIC) PREMIXED SOLUTION,$23.94,$0.00,$23.94,$10.77,$17.09,$0.00,$1.39,$0.00,$0.00,$1.93,$23.94,$0.00,$11.97,$18.96,$19.15,$0.00,$1.93,$0.00,$1.83,$0.00
139273,ERX,HCPCS 25000001,00781-3126-46,NAFCILLIN SODIUM 10 G IV SOLR,$423.25,$0.00,$423.25,$0.00,$302.07,$0.00,$0.00,$0.00,$0.00,$0.00,$423.25,$0.00,$211.63,$335.21,$338.60,$0.00,$0.00,$0.00,$0.00,$0.00
139273,ERX,HCPCS 25000001,00781-3126-95,NAFCILLIN SODIUM 10 G IV SOLR,$423.25,$0.00,$423.25,$0.00,$302.07,$0.00,$0.00,$0.00,$0.00,$0.00,$423.25,$0.00,$211.63,$335.21,$338.60,$0.00,$0.00,$0.00,$0.00,$0.00
139275,ERX,HCPCS 25000001,00065-0418-81,DEXTRAN 70-HYPROMELLOSE 0.1-0.3 % OP SOLN,$16.53,$0.00,$16.53,$0.00,$11.80,$0.00,$0.00,$0.00,$0.00,$0.00,$16.53,$0.00,$8.27,$13.09,$13.22,$0.00,$0.00,$0.00,$0.00,$0.00
139276,ERX,HCPCS 25000001,00065-0416-63,DEXTRAN 70-HYPROMELLOSE (PF) 0.1-0.3 % OP SOLN,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
139276,ERX,HCPCS 25000001,00065-8063-01,DEXTRAN 70-HYPROMELLOSE (PF) 0.1-0.3 % OP SOLN,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
139283,ERX,HCPCS 25000001,00023-0506-01,POLYVINYL ALCOHOL-POVIDONE PF 1.4-0.6 % OP SOLN,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
139283,ERX,HCPCS 25000001,00023-0506-50,POLYVINYL ALCOHOL-POVIDONE PF 1.4-0.6 % OP SOLN,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
139285,ERX,HCPCS 25000001,71740-0112-30,POTASSIUM IODIDE (EXPECTORANT) 1 GM/ML PO SOLN,$78.96,$0.00,$78.96,$0.00,$56.35,$0.00,$0.00,$0.00,$0.00,$0.00,$78.96,$0.00,$39.48,$62.54,$63.17,$0.00,$0.00,$0.00,$0.00,$0.00
139286,ERX,HCPCS J0583,00409-8300-10,BIVALIRUDIN TRIFLUOROACETATE 250 MG IV SOLR,$530.70,$0.00,$530.70,$0.00,$378.76,$0.00,$0.00,$0.00,$0.00,$0.00,$530.70,$0.00,$265.35,$420.31,$424.56,$0.00,$0.00,$0.00,$0.00,$0.00
139286,ERX,HCPCS J0583,00781-3158-94,BIVALIRUDIN TRIFLUOROACETATE 250 MG IV SOLR,$530.70,$0.00,$530.70,$0.00,$378.76,$0.00,$0.00,$0.00,$0.00,$0.00,$530.70,$0.00,$265.35,$420.31,$424.56,$0.00,$0.00,$0.00,$0.00,$0.00
139286,ERX,HCPCS J0583,00781-3158-95,BIVALIRUDIN TRIFLUOROACETATE 250 MG IV SOLR,$530.70,$0.00,$530.70,$0.00,$378.76,$0.00,$0.00,$0.00,$0.00,$0.00,$530.70,$0.00,$265.35,$420.31,$424.56,$0.00,$0.00,$0.00,$0.00,$0.00
139286,ERX,HCPCS J0583,55111-0652-37,BIVALIRUDIN TRIFLUOROACETATE 250 MG IV SOLR,$530.70,$0.00,$530.70,$0.00,$378.76,$0.00,$0.00,$0.00,$0.00,$0.00,$530.70,$0.00,$265.35,$420.31,$424.56,$0.00,$0.00,$0.00,$0.00,$0.00
139286,ERX,HCPCS J0583,70860-0402-10,BIVALIRUDIN TRIFLUOROACETATE 250 MG IV SOLR,$530.70,$0.00,$530.70,$0.00,$378.76,$0.00,$0.00,$0.00,$0.00,$0.00,$530.70,$0.00,$265.35,$420.31,$424.56,$0.00,$0.00,$0.00,$0.00,$0.00
139292,ERX,HCPCS J0770,39822-0615-01,COLISTIMETHATE SODIUM (CBA) 150 MG IJ SOLR,$99.75,$0.00,$99.75,$0.00,$71.19,$0.00,$0.00,$0.00,$0.00,$0.00,$99.75,$0.00,$49.88,$79.00,$79.80,$0.00,$0.00,$0.00,$0.00,$0.00
139292,ERX,HCPCS J0770,42023-0131-01,COLISTIMETHATE SODIUM (CBA) 150 MG IJ SOLR,$99.75,$0.00,$99.75,$0.00,$71.19,$0.00,$0.00,$0.00,$0.00,$0.00,$99.75,$0.00,$49.88,$79.00,$79.80,$0.00,$0.00,$0.00,$0.00,$0.00
139292,ERX,HCPCS J0770,63323-0393-06,COLISTIMETHATE SODIUM (CBA) 150 MG IJ SOLR,$99.75,$0.00,$99.75,$0.00,$71.19,$0.00,$0.00,$0.00,$0.00,$0.00,$99.75,$0.00,$49.88,$79.00,$79.80,$0.00,$0.00,$0.00,$0.00,$0.00
139365,ERX,HCPCS J1746,62064-0122-02,IBALIZUMAB-UIYK 200 MG/1.33ML IV SOLN,"$3,043.40",$0.00,"$3,043.40","$1,369.53","$2,172.07","$1,203.10",$524.36,$0.00,$0.00,"$1,333.63","$3,043.40","$1,263.26","$1,521.70","$2,410.37","$2,434.72","$1,744.50","$1,333.63",$0.00,"$1,269.84","$1,203.10"
139459,ERX,HCPCS 25000001,00078-0951-66,NILOTINIB HCL 50 MG PO CAPS,$480.90,$0.00,$480.90,$0.00,$343.22,$0.00,$0.00,$0.00,$0.00,$0.00,$480.90,$0.00,$240.45,$380.87,$384.72,$0.00,$0.00,$0.00,$0.00,$0.00
139649,ERX,HCPCS 25000001,62327-0222-02,TALC 2 G PL POWD,$387.96,$0.00,$387.96,$0.00,$276.89,$0.00,$0.00,$0.00,$0.00,$0.00,$387.96,$0.00,$193.98,$307.26,$310.37,$0.00,$0.00,$0.00,$0.00,$0.00
139651,ERX,HCPCS 25000001,62327-0333-03,TALC 3 G PL POWD,$486.78,$0.00,$486.78,$0.00,$347.41,$0.00,$0.00,$0.00,$0.00,$0.00,$486.78,$0.00,$243.39,$385.53,$389.42,$0.00,$0.00,$0.00,$0.00,$0.00
139651,ERX,HCPCS 25000001,62327-0333-43,TALC 3 G PL POWD,$486.78,$0.00,$486.78,$0.00,$347.41,$0.00,$0.00,$0.00,$0.00,$0.00,$486.78,$0.00,$243.39,$385.53,$389.42,$0.00,$0.00,$0.00,$0.00,$0.00
139692,ERX,HCPCS 90375,13533-0318-05,RABIES IMMUNE GLOBULIN 1500 UNIT/5ML IJ SOLN,"$8,246.40",$0.00,"$8,246.40",$0.00,"$5,158.80",$0.00,$164.89,$0.00,$0.00,$325.87,"$8,246.40",$0.00,"$4,123.20","$6,531.15","$6,597.12",$0.00,$325.87,$0.00,$0.00,$0.00
139937,ERX,HCPCS 63700001,00074-3399-30,RITONAVIR 100 MG PO PACK,$39.10,$0.00,$39.10,$0.00,$27.91,$0.00,$0.00,$0.00,$0.00,$0.00,$39.10,$0.00,$19.55,$30.97,$31.28,$0.00,$0.00,$0.00,$0.00,$0.00
139948,ERX,HCPCS 25000001,64950-0362-04,COCAINE HCL 40 MG/ML NA SOLN,$779.10,$0.00,$779.10,$0.00,$556.04,$0.00,$0.00,$0.00,$0.00,$0.00,$779.10,$0.00,$389.55,$617.05,$623.28,$0.00,$0.00,$0.00,$0.00,$0.00
139956,ERX,HCPCS J0171,70324-0077-01,EPINEPHRINE HCL-NACL 8-0.9 MG/250ML-% IV SOLN,$236.25,$0.00,$236.25,$106.31,$168.61,$0.00,$40.70,$0.00,$0.00,$77.08,$236.25,$0.00,$118.13,$187.11,$189.00,$0.00,$77.08,$0.00,$73.39,$0.00
139956,ERX,HCPCS J0171,76154-0814-15,EPINEPHRINE HCL-NACL 8-0.9 MG/250ML-% IV SOLN,$236.25,$0.00,$236.25,$106.31,$168.61,$0.00,$40.70,$0.00,$0.00,$77.08,$236.25,$0.00,$118.13,$187.11,$189.00,$0.00,$77.08,$0.00,$73.39,$0.00
140052,ERX,HCPCS Q5106,00069-1305-01,EPOETIN ALFA-EPBX 2000 UNIT/ML IJ SOLN,$92.66,$0.00,$92.66,$50.31,$0.00,$19.26,$15.96,$0.00,$0.00,$16.22,$92.66,$20.22,$46.33,$73.39,$74.13,$27.93,$14.50,$0.00,$20.81,$19.26
140052,ERX,HCPCS Q5106,00069-1305-10,EPOETIN ALFA-EPBX 2000 UNIT/ML IJ SOLN,$92.66,$0.00,$92.66,$50.31,$0.00,$19.26,$15.96,$0.00,$0.00,$16.22,$92.66,$20.22,$46.33,$73.39,$74.13,$27.93,$14.50,$0.00,$20.81,$19.26
140054,ERX,HCPCS Q5106,00069-1307-01,EPOETIN ALFA-EPBX 4000 UNIT/ML IJ SOLN,$166.78,$0.00,$166.78,$90.56,$0.00,$38.52,$28.74,$0.00,$0.00,$29.20,$166.78,$40.45,$83.39,$132.09,$133.42,$55.85,$26.10,$0.00,$41.62,$38.52
140054,ERX,HCPCS Q5106,00069-1307-10,EPOETIN ALFA-EPBX 4000 UNIT/ML IJ SOLN,$166.78,$0.00,$166.78,$90.56,$0.00,$38.52,$28.74,$0.00,$0.00,$29.20,$166.78,$40.45,$83.39,$132.09,$133.42,$55.85,$26.10,$0.00,$41.62,$38.52
140055,ERX,HCPCS Q5106,00069-1308-01,EPOETIN ALFA-EPBX 10000 UNIT/ML IJ SOLN,$403.70,$0.00,$403.70,$219.21,$0.00,$96.30,$69.56,$0.00,$0.00,$70.68,$403.70,$101.12,$201.85,$319.73,$322.96,$139.64,$63.18,$0.00,$104.05,$96.30
140055,ERX,HCPCS Q5106,00069-1308-10,EPOETIN ALFA-EPBX 10000 UNIT/ML IJ SOLN,$403.70,$0.00,$403.70,$219.21,$0.00,$96.30,$69.56,$0.00,$0.00,$70.68,$403.70,$101.12,$201.85,$319.73,$322.96,$139.64,$63.18,$0.00,$104.05,$96.30
140089,ERX,HCPCS J9150,00703-5233-13,DAUNORUBICIN HCL 20 MG/4ML IV SOLN,$490.97,$0.00,$490.97,$0.00,$350.41,$0.00,$0.00,$0.00,$0.00,$0.00,$490.97,$0.00,$245.49,$388.85,$392.78,$0.00,$0.00,$0.00,$0.00,$0.00
140312,ERX,HCPCS J0878,25021-0179-15,DAPTOMYCIN 350 MG IV SOLR,$880.86,$0.00,$880.86,$396.39,$628.67,$115.50,$156.28,$0.00,$0.00,$119.26,$880.86,$121.28,$440.43,$697.64,$704.69,$167.48,$119.26,$0.00,$113.56,$47.60
140312,ERX,HCPCS J0878,25021-0179-16,DAPTOMYCIN 350 MG IV SOLR,$880.86,$0.00,$880.86,$396.39,$628.67,$115.50,$156.28,$0.00,$0.00,$119.26,$880.86,$121.28,$440.43,$697.64,$704.69,$167.48,$119.26,$0.00,$113.56,$47.60
140359,ERX,HCPCS Q5108,67457-0833-06,PEGFILGRASTIM-JMDB 6 MG/0.6ML SC SOSY,"$10,270.50",$0.00,"$10,270.50","$4,621.73","$5,158.80","$3,928.96","$1,769.56",$0.00,$0.00,"$1,798.28","$10,270.50","$4,125.40","$5,135.25","$8,134.24","$8,216.40","$5,696.99","$1,607.33",$0.00,"$1,635.06","$3,928.96"
140422,ERX,HCPCS J1644,00409-7651-03,HEPARIN (PORCINE) 50 UNIT/ML 500 ML IV SOLN,$34.20,$0.00,$34.20,$15.39,$24.41,$0.00,$5.88,$0.00,$0.00,$7.05,$34.20,$0.00,$17.10,$27.09,$27.36,$0.00,$7.05,$0.00,$6.71,$0.00
140467,ERX,HCPCS 63700001,70255-0010-02,BINIMETINIB 15 MG PO TABS,$251.14,$0.00,$251.14,$0.00,$179.24,$0.00,$0.00,$0.00,$0.00,$0.00,$251.14,$0.00,$125.57,$198.90,$200.91,$0.00,$0.00,$0.00,$0.00,$0.00
140469,ERX,HCPCS 63700001,70255-0025-01,ENCORAFENIB 75 MG PO CAPS,$255.97,$0.00,$255.97,$0.00,$182.69,$0.00,$0.00,$0.00,$0.00,$0.00,$255.97,$0.00,$127.99,$202.73,$204.78,$0.00,$0.00,$0.00,$0.00,$0.00
140469,ERX,HCPCS 63700001,70255-0025-02,ENCORAFENIB 75 MG PO CAPS,$255.97,$0.00,$255.97,$0.00,$182.69,$0.00,$0.00,$0.00,$0.00,$0.00,$255.97,$0.00,$127.99,$202.73,$204.78,$0.00,$0.00,$0.00,$0.00,$0.00
140469,ERX,HCPCS 63700001,70255-0025-03,ENCORAFENIB 75 MG PO CAPS,$255.97,$0.00,$255.97,$0.00,$182.69,$0.00,$0.00,$0.00,$0.00,$0.00,$255.97,$0.00,$127.99,$202.73,$204.78,$0.00,$0.00,$0.00,$0.00,$0.00
140469,ERX,HCPCS 63700001,70255-0025-04,ENCORAFENIB 75 MG PO CAPS,$255.97,$0.00,$255.97,$0.00,$182.69,$0.00,$0.00,$0.00,$0.00,$0.00,$255.97,$0.00,$127.99,$202.73,$204.78,$0.00,$0.00,$0.00,$0.00,$0.00
140572,ERX,HCPCS 25000001,71334-0100-01,IVOSIDENIB 250 MG PO TABS,"$1,316.20",$0.00,"$1,316.20",$0.00,$939.37,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,316.20",$0.00,$658.10,"$1,042.43","$1,052.96",$0.00,$0.00,$0.00,$0.00,$0.00
140767,ERX,HCPCS J9047,76075-0103-01,CARFILZOMIB 10 MG IV SOLR,"$1,290.77",$0.00,"$1,290.77",$580.85,$921.22,$375.99,$222.39,$0.00,$0.00,$441.10,"$1,290.77",$394.79,$645.39,"$1,022.29","$1,032.62",$545.19,$441.10,$0.00,$420.00,$389.72
140769,ERX,HCPCS 63600001,76329-3316-01,EPINEPHRINE 1 MG/10ML IJ SOSY,$39.90,$0.00,$39.90,$0.00,$28.48,$0.00,$0.00,$0.00,$0.00,$0.00,$39.90,$0.00,$19.95,$31.60,$31.92,$0.00,$0.00,$0.00,$0.00,$0.00
140776,ERX,HCPCS 25000001,00310-1105-30,SODIUM ZIRCONIUM CYCLOSILICATE 5 G PO PACK,$94.46,$0.00,$94.46,$0.00,$67.42,$0.00,$0.00,$0.00,$0.00,$0.00,$94.46,$0.00,$47.23,$74.81,$75.57,$0.00,$0.00,$0.00,$0.00,$0.00
140796,ERX,HCPCS 90739,43528-0003-05,HEPATITIS B VAC RECOMB ADJ 20 MCG/0.5ML IM SOSY,$441.03,$0.00,$441.03,$198.46,$314.76,$114.67,$75.99,$0.00,$0.00,$154.04,$441.03,$0.00,$220.52,$349.30,$352.82,$264.62,$154.04,$114.67,$146.67,$114.67
140845,ERX,HCPCS J2370,69374-0957-10,PHENYLEPHRINE HCL 1 MG/10ML IV SOSY,$27.00,$0.00,$27.00,$12.15,$19.27,$0.00,$0.96,$0.00,$0.00,$4.31,$27.00,$0.00,$13.50,$21.38,$21.60,$0.00,$4.31,$0.00,$4.11,$0.00
140890,ERX,HCPCS J9204,42747-0761-01,MOGAMULIZUMAB-KPKC 20 MG/5ML IV SOLN,"$9,605.20",$0.00,"$9,605.20",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$9,605.20",$0.00,"$4,802.60","$7,607.32","$7,684.16",$0.00,$0.00,$0.00,$0.00,$0.00
140942,ERX,HCPCS 63700001,62856-0712-05,LENVATINIB (12 MG DAILY DOSE) 3 X 4 MG PO CPPK,"$1,826.02",$0.00,"$1,826.02",$0.00,"$1,303.23",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,826.02",$0.00,$913.01,"$1,446.21","$1,460.82",$0.00,$0.00,$0.00,$0.00,$0.00
140942,ERX,HCPCS 63700001,62856-0712-30,LENVATINIB (12 MG DAILY DOSE) 3 X 4 MG PO CPPK,"$1,826.02",$0.00,"$1,826.02",$0.00,"$1,303.23",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,826.02",$0.00,$913.01,"$1,446.21","$1,460.82",$0.00,$0.00,$0.00,$0.00,$0.00
140943,ERX,HCPCS 63700001,62856-0704-05,LENVATINIB (4 MG DAILY DOSE) 4 MG PO CPPK,"$1,826.02",$0.00,"$1,826.02",$0.00,"$1,303.23",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,826.02",$0.00,$913.01,"$1,446.21","$1,460.82",$0.00,$0.00,$0.00,$0.00,$0.00
140943,ERX,HCPCS 63700001,62856-0704-30,LENVATINIB (4 MG DAILY DOSE) 4 MG PO CPPK,"$1,826.02",$0.00,"$1,826.02",$0.00,"$1,303.23",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,826.02",$0.00,$913.01,"$1,446.21","$1,460.82",$0.00,$0.00,$0.00,$0.00,$0.00
141226,ERX,HCPCS J2357,50242-0215-01,OMALIZUMAB 150 MG/ML SC SOSY,"$2,776.07",$0.00,"$2,776.07","$1,249.23","$1,981.28","$1,103.34",$697.95,$0.00,$0.00,"$1,316.94","$2,776.07","$1,158.51","$1,388.04","$2,198.65","$2,220.86","$1,599.84","$1,316.94",$0.00,"$1,253.95","$1,130.79"
141227,ERX,HCPCS J2357,50242-0214-01,OMALIZUMAB 75 MG/0.5ML SC SOSY,"$1,625.02",$0.00,"$1,625.02",$731.26,"$1,159.78",$551.67,$348.98,$0.00,$0.00,$658.47,"$1,625.02",$579.25,$812.51,"$1,287.02","$1,300.02",$799.92,$658.47,$0.00,$626.98,$565.40
141229,ERX,HCPCS J0841,66621-0790-02,CROTALIDAE IMMUNE FAB (EQUINE) IV SOLR,"$12,004.80",$0.00,"$12,004.80",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$12,004.80",$0.00,"$6,002.40","$9,507.80","$9,603.84",$0.00,$0.00,$0.00,$0.00,$0.00
141259,ERX,HCPCS 63700001,00378-0871-16,CLONIDINE 0.1 MG/24HR TD PTWK,$115.94,$0.00,$115.94,$0.00,$82.75,$0.00,$0.00,$0.00,$0.00,$0.00,$115.94,$0.00,$57.97,$91.82,$92.75,$0.00,$0.00,$0.00,$0.00,$0.00
141259,ERX,HCPCS 63700001,00378-0871-99,CLONIDINE 0.1 MG/24HR TD PTWK,$115.94,$0.00,$115.94,$0.00,$82.75,$0.00,$0.00,$0.00,$0.00,$0.00,$115.94,$0.00,$57.97,$91.82,$92.75,$0.00,$0.00,$0.00,$0.00,$0.00
141259,ERX,HCPCS 63700001,00591-3508-04,CLONIDINE 0.1 MG/24HR TD PTWK,$115.94,$0.00,$115.94,$0.00,$82.75,$0.00,$0.00,$0.00,$0.00,$0.00,$115.94,$0.00,$57.97,$91.82,$92.75,$0.00,$0.00,$0.00,$0.00,$0.00
141260,ERX,HCPCS 63700001,00378-0872-16,CLONIDINE 0.2 MG/24HR TD PTWK,$175.66,$0.00,$175.66,$0.00,$125.37,$0.00,$0.00,$0.00,$0.00,$0.00,$175.66,$0.00,$87.83,$139.12,$140.53,$0.00,$0.00,$0.00,$0.00,$0.00
141260,ERX,HCPCS 63700001,00378-0872-99,CLONIDINE 0.2 MG/24HR TD PTWK,$175.66,$0.00,$175.66,$0.00,$125.37,$0.00,$0.00,$0.00,$0.00,$0.00,$175.66,$0.00,$87.83,$139.12,$140.53,$0.00,$0.00,$0.00,$0.00,$0.00
141261,ERX,HCPCS 63700001,00378-0873-99,CLONIDINE 0.3 MG/24HR TD PTWK,$243.69,$0.00,$243.69,$0.00,$173.92,$0.00,$0.00,$0.00,$0.00,$0.00,$243.69,$0.00,$121.85,$193.00,$194.95,$0.00,$0.00,$0.00,$0.00,$0.00
141261,ERX,HCPCS 63700001,51862-0455-01,CLONIDINE 0.3 MG/24HR TD PTWK,$243.69,$0.00,$243.69,$0.00,$173.92,$0.00,$0.00,$0.00,$0.00,$0.00,$243.69,$0.00,$121.85,$193.00,$194.95,$0.00,$0.00,$0.00,$0.00,$0.00
141261,ERX,HCPCS 63700001,51862-0455-04,CLONIDINE 0.3 MG/24HR TD PTWK,$243.69,$0.00,$243.69,$0.00,$173.92,$0.00,$0.00,$0.00,$0.00,$0.00,$243.69,$0.00,$121.85,$193.00,$194.95,$0.00,$0.00,$0.00,$0.00,$0.00
141262,ERX,HCPCS 90710,00006-4171-00,MEASLES-MUMPS-RUBELLA-VARICELL SC SUSR,$713.71,$0.00,$713.71,$321.17,$534.56,$0.00,$122.97,$0.00,$0.00,$124.96,$713.71,$0.00,$356.86,$565.26,$570.97,$0.00,$111.70,$0.00,$119.24,$0.00
141263,ERX,HCPCS J3370,00409-6533-01,VANCOMYCIN HCL 1 G IV SOLR,$36.58,$0.00,$36.58,$16.46,$26.11,$0.00,$3.62,$0.00,$0.00,$3.98,$36.58,$0.00,$18.29,$28.97,$29.26,$0.00,$3.98,$0.00,$3.79,$0.00
141263,ERX,HCPCS J3370,00409-6533-31,VANCOMYCIN HCL 1 G IV SOLR,$36.58,$0.00,$36.58,$16.46,$26.11,$0.00,$3.62,$0.00,$0.00,$3.98,$36.58,$0.00,$18.29,$28.97,$29.26,$0.00,$3.98,$0.00,$3.79,$0.00
141263,ERX,HCPCS J3370,63323-0284-20,VANCOMYCIN HCL 1 G IV SOLR,$36.58,$0.00,$36.58,$16.46,$26.11,$0.00,$3.62,$0.00,$0.00,$3.98,$36.58,$0.00,$18.29,$28.97,$29.26,$0.00,$3.98,$0.00,$3.79,$0.00
141263,ERX,HCPCS J3370,67457-0340-00,VANCOMYCIN HCL 1 G IV SOLR,$36.58,$0.00,$36.58,$16.46,$26.11,$0.00,$3.62,$0.00,$0.00,$3.98,$36.58,$0.00,$18.29,$28.97,$29.26,$0.00,$3.98,$0.00,$3.79,$0.00
141263,ERX,HCPCS J3370,67457-0340-01,VANCOMYCIN HCL 1 G IV SOLR,$36.58,$0.00,$36.58,$16.46,$26.11,$0.00,$3.62,$0.00,$0.00,$3.98,$36.58,$0.00,$18.29,$28.97,$29.26,$0.00,$3.98,$0.00,$3.79,$0.00
141263,ERX,HCPCS J3370,70860-0105-20,VANCOMYCIN HCL 1 G IV SOLR,$36.58,$0.00,$36.58,$16.46,$26.11,$0.00,$3.62,$0.00,$0.00,$3.98,$36.58,$0.00,$18.29,$28.97,$29.26,$0.00,$3.98,$0.00,$3.79,$0.00
141264,ERX,HCPCS J3370,00409-6509-01,VANCOMYCIN HCL 5 G IV SOLR,$325.50,$0.00,$325.50,$146.48,$232.31,$0.00,$36.19,$0.00,$0.00,$39.83,$325.50,$0.00,$162.75,$257.80,$260.40,$0.00,$39.83,$0.00,$37.93,$0.00
141264,ERX,HCPCS J3370,25021-0157-99,VANCOMYCIN HCL 5 G IV SOLR,$325.50,$0.00,$325.50,$146.48,$232.31,$0.00,$36.19,$0.00,$0.00,$39.83,$325.50,$0.00,$162.75,$257.80,$260.40,$0.00,$39.83,$0.00,$37.93,$0.00
141264,ERX,HCPCS J3370,67457-0341-05,VANCOMYCIN HCL 5 G IV SOLR,$325.50,$0.00,$325.50,$146.48,$232.31,$0.00,$36.19,$0.00,$0.00,$39.83,$325.50,$0.00,$162.75,$257.80,$260.40,$0.00,$39.83,$0.00,$37.93,$0.00
141306,ERX,HCPCS 63700001,00006-3069-01,DORAVIRINE 100 MG PO TABS,$182.58,$0.00,$182.58,$0.00,$130.31,$0.00,$0.00,$0.00,$0.00,$0.00,$182.58,$0.00,$91.29,$144.60,$146.06,$0.00,$0.00,$0.00,$0.00,$0.00
141425,ERX,HCPCS J0713,00264-3145-11,CEFTAZIDIME AND DEXTROSE 2-5 GM-%(50ML) IV SOLR,$92.36,$0.00,$92.36,$41.56,$65.92,$0.00,$15.91,$0.00,$0.00,$16.17,$92.36,$0.00,$46.18,$73.15,$73.89,$0.00,$14.45,$0.00,$14.70,$0.00
141430,ERX,HCPCS J0690,00264-3105-11,CEFAZOLIN SODIUM-DEXTROSE 2-3 GM-%(50ML) IV SOLR,$58.23,$0.00,$58.23,$26.20,$41.56,$0.00,$2.77,$0.00,$0.00,$3.85,$58.23,$0.00,$29.12,$46.12,$46.58,$0.00,$3.85,$0.00,$3.67,$0.00
141478,ERX,HCPCS J9119,61755-0008-01,CEMIPLIMAB-RWLC 350 MG/7ML IV SOLN,"$22,386.00",$0.00,"$22,386.00","$10,073.70","$5,158.80","$9,606.45","$3,857.00",$0.00,$0.00,"$8,138.89","$22,386.00","$10,086.77","$11,193.00","$17,729.71","$17,908.80","$13,929.35","$8,138.89",$0.00,"$8,138.89","$9,606.45"
141582,ERX,HCPCS 25000001,00069-0296-30,TALAZOPARIB TOSYLATE 0.25 MG PO CAPS,"$1,959.56",$0.00,"$1,959.56",$0.00,"$1,398.54",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,959.56",$0.00,$979.78,"$1,551.97","$1,567.65",$0.00,$0.00,$0.00,$0.00,$0.00
141584,ERX,HCPCS 25000001,00069-1195-30,TALAZOPARIB TOSYLATE 1 MG PO CAPS,"$1,469.67",$0.00,"$1,469.67",$0.00,"$1,048.90",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,469.67",$0.00,$734.84,"$1,163.98","$1,175.74",$0.00,$0.00,$0.00,$0.00,$0.00
141712,ERX,HCPCS 63700001,00069-0227-01,LORLATINIB 25 MG PO TABS,$595.68,$0.00,$595.68,$0.00,$425.14,$0.00,$0.00,$0.00,$0.00,$0.00,$595.68,$0.00,$297.84,$471.78,$476.54,$0.00,$0.00,$0.00,$0.00,$0.00
141713,ERX,HCPCS 63700001,00069-0231-01,LORLATINIB 100 MG PO TABS,"$1,618.43",$0.00,"$1,618.43",$0.00,"$1,155.07",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,618.43",$0.00,$809.22,"$1,281.80","$1,294.74",$0.00,$0.00,$0.00,$0.00,$0.00
142188,ERX,HCPCS 63700001,00173-0889-39,TAFENOQUINE SUCCINATE 150 MG PO TABS,$72.96,$0.00,$72.96,$0.00,$52.07,$0.00,$0.00,$0.00,$0.00,$0.00,$72.96,$0.00,$36.48,$57.78,$58.37,$0.00,$0.00,$0.00,$0.00,$0.00
142198,ERX,HCPCS Q5111,70114-0101-01,PEGFILGRASTIM-CBQV 6 MG/0.6ML SC SOSY,"$10,270.50",$0.00,"$10,270.50","$4,621.73","$5,158.80","$4,164.67","$1,769.56",$0.00,$0.00,"$4,744.93","$10,270.50","$4,372.91","$5,135.25","$8,134.24","$8,216.40","$6,038.77","$4,744.93",$0.00,"$4,517.98","$4,164.67"
142286,ERX,HCPCS 25000001,67684-1901-02,LIPIODOL IJ OIL,$400.41,$0.00,$447.99,$0.00,$319.73,$0.00,$0.00,$0.00,$0.00,$0.00,$447.99,$0.00,$224.00,$317.12,$358.39,$0.00,$0.00,$0.00,$0.00,$0.00
142324,ERX,HCPCS J3490,00169-2662-11,INSULIN DEGLUDEC 100 UNIT/ML SC SOLN,$12.50,$0.00,$12.50,$6.79,$8.92,$0.00,$2.15,$0.00,$0.00,$2.19,$12.50,$0.00,$6.25,$9.90,$10.00,$0.00,$0.00,$0.00,$1.99,$0.00
142346,ERX,HCPCS 63700001,00078-0972-61,ELTROMBOPAG OLAMINE 12.5 MG PO PACK,$558.77,$0.00,$558.77,$0.00,$398.79,$0.00,$0.00,$0.00,$0.00,$0.00,$558.77,$0.00,$279.39,$442.55,$447.02,$0.00,$0.00,$0.00,$0.00,$0.00
142802,ERX,HCPCS C9047,58468-0225-01,CAPLACIZUMAB-YHDP 11 MG IJ KIT,"$17,958.00",$0.00,"$17,958.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$17,958.00",$0.00,"$8,979.00","$14,222.74","$14,366.40",$0.00,$0.00,$0.00,$0.00,$0.00
143112,ERX,HCPCS J0780,00641-6135-25,PROCHLORPERAZINE EDISYLATE 10 MG/2ML IJ SOLN,$42.18,$0.00,$42.18,$18.98,$30.10,$0.00,$2.40,$0.00,$0.00,$10.15,$42.18,$0.00,$21.09,$33.41,$33.74,$0.00,$10.15,$0.00,$9.67,$0.00
143112,ERX,HCPCS J0780,23155-0294-41,PROCHLORPERAZINE EDISYLATE 10 MG/2ML IJ SOLN,$42.18,$0.00,$42.18,$18.98,$30.10,$0.00,$2.40,$0.00,$0.00,$10.15,$42.18,$0.00,$21.09,$33.41,$33.74,$0.00,$10.15,$0.00,$9.67,$0.00
143112,ERX,HCPCS J0780,23155-0294-42,PROCHLORPERAZINE EDISYLATE 10 MG/2ML IJ SOLN,$42.18,$0.00,$42.18,$18.98,$30.10,$0.00,$2.40,$0.00,$0.00,$10.15,$42.18,$0.00,$21.09,$33.41,$33.74,$0.00,$10.15,$0.00,$9.67,$0.00
143112,ERX,HCPCS J0780,23155-0497-42,PROCHLORPERAZINE EDISYLATE 10 MG/2ML IJ SOLN,$42.18,$0.00,$42.18,$18.98,$30.10,$0.00,$2.40,$0.00,$0.00,$10.15,$42.18,$0.00,$21.09,$33.41,$33.74,$0.00,$10.15,$0.00,$9.67,$0.00
143112,ERX,HCPCS J0780,67457-0640-00,PROCHLORPERAZINE EDISYLATE 10 MG/2ML IJ SOLN,$42.18,$0.00,$42.18,$18.98,$30.10,$0.00,$2.40,$0.00,$0.00,$10.15,$42.18,$0.00,$21.09,$33.41,$33.74,$0.00,$10.15,$0.00,$9.67,$0.00
143112,ERX,HCPCS J0780,67457-0640-02,PROCHLORPERAZINE EDISYLATE 10 MG/2ML IJ SOLN,$42.18,$0.00,$42.18,$18.98,$30.10,$0.00,$2.40,$0.00,$0.00,$10.15,$42.18,$0.00,$21.09,$33.41,$33.74,$0.00,$10.15,$0.00,$9.67,$0.00
143120,ERX,HCPCS J1190,47781-0578-07,DEXRAZOXANE HCL 500 MG IV SOLR,"$1,352.93",$0.00,"$1,352.93",$0.00,$965.59,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,352.93",$0.00,$676.47,"$1,071.52","$1,082.34",$0.00,$0.00,$0.00,$48.16,$0.00
143121,ERX,HCPCS J2426,50458-0560-01,PALIPERIDONE PALMITATE ER 39 MG/0.25ML IM SUSY,"$1,346.50",$0.00,"$1,346.50",$605.93,$961.00,$453.57,$232.00,$0.00,$0.00,$530.65,"$1,346.50",$476.25,$673.25,"$1,066.43","$1,077.20",$657.68,$530.65,$0.00,$505.27,$469.17
143122,ERX,HCPCS J2426,50458-0561-01,PALIPERIDONE PALMITATE ER 78 MG/0.5ML IM SUSY,"$2,300.33",$0.00,"$2,300.33","$1,035.15","$1,641.75",$907.14,$396.34,$0.00,$0.00,"$1,061.31","$2,300.33",$952.50,"$1,150.17","$1,821.86","$1,840.26","$1,315.35","$1,061.31",$0.00,"$1,010.54",$938.34
143139,ERX,HCPCS 25000001,76329-3390-01,LIDOCAINE HCL (CARDIAC) 100 MG/5ML IV SOSY,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
143140,ERX,HCPCS 25000001,00409-1323-05,LIDOCAINE HCL (CARDIAC) PF 100 MG/5ML IV SOSY,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
143142,ERX,HCPCS 90636,58160-0815-52,HEPATITIS A-HEP B RECOMB VAC 720-20 ELU-MCG/ML IM SUSY,$398.49,$0.00,$398.49,$179.32,$284.40,$0.00,$107.88,$0.00,$0.00,$122.20,$398.49,$0.00,$199.25,$315.60,$318.79,$0.00,$122.20,$0.00,$116.36,$0.00
143143,ERX,HCPCS J0897,55513-0710-01,DENOSUMAB 60 MG/ML SC SOSY,"$3,145.83",$0.00,"$3,145.83","$1,415.62","$2,245.18","$1,156.56",$542.01,$0.00,$0.00,"$1,359.24","$3,145.83","$1,214.39","$1,572.92","$2,491.50","$2,516.66","$1,677.01","$1,359.24",$0.00,"$1,294.23","$1,194.06"
143147,ERX,HCPCS 63600001,64193-0426-02,ANTIINHIBITOR COAGULANT CMPLX 500 UNITS IV SOLR,"$2,767.50",$0.00,"$2,767.50",$0.00,"$1,975.16",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,767.50",$0.00,"$1,383.75","$2,191.86","$2,214.00",$0.00,$0.00,$0.00,$0.00,$0.00
143148,ERX,HCPCS J7198,64193-0324-01,ANTIINHIBITOR COAGULANT CMPLX 1000 UNITS IV SOLR,"$5,535.00",$0.00,"$5,535.00",$0.00,"$3,950.33",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,535.00",$0.00,"$2,767.50","$4,383.72","$4,428.00",$0.00,$0.00,$0.00,$0.00,$0.00
143148,ERX,HCPCS J7198,64193-0424-02,ANTIINHIBITOR COAGULANT CMPLX 1000 UNITS IV SOLR,"$5,535.00",$0.00,"$5,535.00",$0.00,"$3,950.33",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,535.00",$0.00,"$2,767.50","$4,383.72","$4,428.00",$0.00,$0.00,$0.00,$0.00,$0.00
143149,ERX,HCPCS J7198,64193-0325-01,ANTIINHIBITOR COAGULANT CMPLX 2500 UNITS IV SOLR,"$13,837.50",$0.00,"$13,837.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,837.50",$0.00,"$6,918.75","$10,959.30","$11,070.00",$0.00,$0.00,$0.00,$0.00,$0.00
143149,ERX,HCPCS J7198,64193-0425-02,ANTIINHIBITOR COAGULANT CMPLX 2500 UNITS IV SOLR,"$13,837.50",$0.00,"$13,837.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,837.50",$0.00,"$6,918.75","$10,959.30","$11,070.00",$0.00,$0.00,$0.00,$0.00,$0.00
143152,ERX,HCPCS 25000001,17478-0711-10,LIDOCAINE HCL URETHRAL/MUCOSAL 2 % EX GEL,$31.92,$0.00,$63.39,$0.00,$45.24,$0.00,$0.00,$0.00,$0.00,$0.00,$63.39,$0.00,$31.70,$25.28,$50.71,$0.00,$0.00,$0.00,$0.00,$0.00
143152,ERX,HCPCS 25000001,17478-0711-31,LIDOCAINE HCL URETHRAL/MUCOSAL 2 % EX GEL,$31.92,$0.00,$63.39,$0.00,$45.24,$0.00,$0.00,$0.00,$0.00,$0.00,$63.39,$0.00,$31.70,$25.28,$50.71,$0.00,$0.00,$0.00,$0.00,$0.00
143152,ERX,HCPCS 25000001,17478-0711-30,LIDOCAINE HCL URETHRAL/MUCOSAL 2 % EX GEL,$63.39,$0.00,$63.39,$0.00,$45.24,$0.00,$0.00,$0.00,$0.00,$0.00,$63.39,$0.00,$31.70,$50.20,$50.71,$0.00,$0.00,$0.00,$0.00,$0.00
143153,ERX,HCPCS J1644,00264-9872-10,HEPARIN (PORCINE) IN NACL 1000-0.9 UT/500ML-% IV SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.24,$0.00,$0.00,$0.28,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.28,$0.00,$0.27,$0.00
143157,ERX,HCPCS J3370,70594-0042-03,VANCOMYCIN HCL 1000 MG/200ML IV SOLN,$126.00,$0.00,$126.00,$56.70,$89.93,$0.00,$7.24,$0.00,$0.00,$7.97,$126.00,$0.00,$63.00,$99.79,$100.80,$0.00,$7.97,$0.00,$7.59,$0.00
143158,ERX,HCPCS J3370,70594-0043-02,VANCOMYCIN HCL 1500 MG/300ML IV SOLN,$170.10,$0.00,$170.10,$76.55,$121.40,$0.00,$10.86,$0.00,$0.00,$11.95,$170.10,$0.00,$85.05,$134.72,$136.08,$0.00,$11.95,$0.00,$11.38,$0.00
143187,ERX,HCPCS 25000001,99999-6005-85,PYRIDOSTIGMINE BROMIDE 60 MG/5ML PO SOLN,$40.36,$0.00,$40.36,$0.00,$28.80,$0.00,$0.00,$0.00,$0.00,$0.00,$40.36,$0.00,$20.18,$31.97,$32.29,$0.00,$0.00,$0.00,$0.00,$0.00
143187,ERX,HCPCS 25000001,00187-3012-20,PYRIDOSTIGMINE BROMIDE 60 MG/5ML PO SOLN,"$3,233.79",$0.00,"$2,561.16",$0.00,$28.80,$0.00,$0.00,$0.00,$0.00,$0.00,$40.36,$0.00,$20.18,"$2,561.16",$32.29,$0.00,$0.00,$0.00,$0.00,$0.00
143206,ERX,HCPCS J9022,50242-0918-01,ATEZOLIZUMAB 840 MG/14ML IV SOLN,"$15,832.10",$0.00,"$15,832.10","$7,124.45","$5,158.80","$6,468.67","$2,727.79",$0.00,$0.00,"$7,684.78","$15,832.10","$6,792.11","$7,916.05","$12,539.02","$12,665.68","$9,379.57","$7,684.78",$0.00,"$7,317.22","$6,468.67"
143520,ERX,HCPCS 63700001,49702-0246-13,DOVATO:DOLUTEGRAVIR-LAMIVUDINE 50-300 MG PO TABS,$303.46,$0.00,$303.46,$0.00,$216.58,$0.00,$0.00,$0.00,$0.00,$0.00,$303.46,$0.00,$151.73,$240.34,$242.77,$0.00,$0.00,$0.00,$0.00,$0.00
144008,ERX,HCPCS J9309,50242-0105-01,POLATUZUMAB VEDOTIN-PIIQ 140 MG IV SOLR,"$36,900.00",$0.00,"$36,900.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$36,900.00",$0.00,"$18,450.00","$29,224.80","$29,520.00",$0.00,$0.00,$0.00,$0.00,$0.00
144263,ERX,HCPCS Q5107,55513-0206-01,BEVACIZUMAB-AWWB 100 MG/4ML IV SOLN,"$1,950.92",$0.00,"$1,950.92",$0.00,"$1,392.37",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,950.92",$0.00,$975.46,"$1,545.13","$1,560.74",$0.00,$0.00,$0.00,$0.00,$0.00
144264,ERX,HCPCS Q5107,55513-0207-01,BEVACIZUMAB-AWWB 400 MG/16ML IV SOLN,"$6,665.62",$0.00,"$6,665.62",$0.00,"$4,757.25",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,665.62",$0.00,"$3,332.81","$5,279.17","$5,332.50",$0.00,$0.00,$0.00,$0.00,$0.00
144270,ERX,HCPCS J3370,70594-0044-02,VANCOMYCIN HCL 2000 MG/400ML IV SOLN,$226.80,$0.00,$226.80,$102.06,$161.87,$0.00,$14.48,$0.00,$0.00,$15.93,$226.80,$0.00,$113.40,$179.63,$181.44,$0.00,$15.93,$0.00,$15.17,$0.00
144275,ERX,HCPCS Q5117,55513-0132-01,TRASTUZUMAB-ANNS 420 MG IV SOLR,"$9,095.26",$0.00,"$9,095.26",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$9,095.26",$0.00,"$4,547.63","$7,203.45","$7,276.21",$0.00,$0.00,$0.00,$0.00,$0.00
144426,ERX,HCPCS 63700001,24338-0124-03,ERYTHROMYCIN 333 MG PO TBEC,$40.14,$0.00,$40.14,$0.00,$28.65,$0.00,$0.00,$0.00,$0.00,$0.00,$40.14,$0.00,$20.07,$31.79,$32.11,$0.00,$0.00,$0.00,$0.00,$0.00
144426,ERX,HCPCS 63700001,24338-0124-13,ERYTHROMYCIN 333 MG PO TBEC,$40.14,$0.00,$40.14,$0.00,$28.65,$0.00,$0.00,$0.00,$0.00,$0.00,$40.14,$0.00,$20.07,$31.79,$32.11,$0.00,$0.00,$0.00,$0.00,$0.00
144426,ERX,HCPCS 63700001,52536-0183-03,ERYTHROMYCIN 333 MG PO TBEC,$40.14,$0.00,$40.14,$0.00,$28.65,$0.00,$0.00,$0.00,$0.00,$0.00,$40.14,$0.00,$20.07,$31.79,$32.11,$0.00,$0.00,$0.00,$0.00,$0.00
144767,ERX,HCPCS 25000001,50383-0261-61,DORZOLAMIDE HCL-TIMOLOL MAL PF 2-0.5 % OP SOLN,$148.32,$0.00,$148.32,$0.00,$105.86,$0.00,$0.00,$0.00,$0.00,$0.00,$148.32,$0.00,$74.16,$117.47,$118.66,$0.00,$0.00,$0.00,$0.00,$0.00
144767,ERX,HCPCS 25000001,65862-0947-15,DORZOLAMIDE HCL-TIMOLOL MAL PF 2-0.5 % OP SOLN,$148.32,$0.00,$148.32,$0.00,$105.86,$0.00,$0.00,$0.00,$0.00,$0.00,$148.32,$0.00,$74.16,$117.47,$118.66,$0.00,$0.00,$0.00,$0.00,$0.00
144767,ERX,HCPCS 25000001,65862-0947-60,DORZOLAMIDE HCL-TIMOLOL MAL PF 2-0.5 % OP SOLN,$148.32,$0.00,$148.32,$0.00,$105.86,$0.00,$0.00,$0.00,$0.00,$0.00,$148.32,$0.00,$74.16,$117.47,$118.66,$0.00,$0.00,$0.00,$0.00,$0.00
144934,ERX,HCPCS 90707,00006-4681-00,"MEASLES, MUMPS & RUBELLA VAC IJ SOLR",$295.99,$0.00,$295.99,$133.20,$221.55,$0.00,$11.75,$0.00,$0.00,$92.45,$295.99,$0.00,$148.00,$234.42,$236.79,$0.00,$92.45,$0.00,$88.03,$0.00
144934,ERX,HCPCS 90707,00006-4681-01,"MEASLES, MUMPS & RUBELLA VAC IJ SOLR",$295.99,$0.00,$295.99,$133.20,$221.55,$0.00,$11.75,$0.00,$0.00,$92.45,$295.99,$0.00,$148.00,$234.42,$236.79,$0.00,$92.45,$0.00,$88.03,$0.00
144938,ERX,HCPCS 25000001,00078-0639-41,SECUKINUMAB (300 MG DOSE) 150 MG/ML SC SOAJ,"$6,815.97",$0.00,"$6,815.97",$0.00,"$4,864.56",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,815.97",$0.00,"$3,407.99","$5,398.25","$5,452.78",$0.00,$0.00,$0.00,$0.00,$0.00
144946,ERX,HCPCS J2794,50458-0306-11,RISPERIDONE MICROSPHERES ER 25 MG IM SRER,"$1,464.48",$0.00,"$1,464.48",$0.00,"$1,045.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,464.48",$0.00,$732.24,"$1,159.87","$1,171.58",$0.00,$0.00,$0.00,$0.00,$0.00
144962,ERX,HCPCS 25000001,00409-4888-01,SODIUM CHLORIDE (PF) 0.9 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
144962,ERX,HCPCS 25000001,00409-4888-10,SODIUM CHLORIDE (PF) 0.9 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
144962,ERX,HCPCS 25000001,00409-4888-12,SODIUM CHLORIDE (PF) 0.9 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
144962,ERX,HCPCS 25000001,63323-0186-01,SODIUM CHLORIDE (PF) 0.9 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
144962,ERX,HCPCS 25000001,63323-0186-10,SODIUM CHLORIDE (PF) 0.9 % IJ SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
145128,ERX,HCPCS 63700001,99999-6009-67,ERGOCALCIFEROL 8000 UNIT/ML PO SOLN,$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
145128,ERX,HCPCS 63700001,00091-4150-60,ERGOCALCIFEROL 8000 UNIT/ML PO SOLN,$314.31,$0.00,$248.93,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$248.93,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
145128,ERX,HCPCS 63700001,39328-0357-60,ERGOCALCIFEROL 8000 UNIT/ML PO SOLN,$314.31,$0.00,$248.93,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$248.93,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
145128,ERX,HCPCS 63700001,69543-0234-60,ERGOCALCIFEROL 8000 UNIT/ML PO SOLN,$314.31,$0.00,$248.93,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$248.93,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
145128,ERX,HCPCS 63700001,75834-0010-60,ERGOCALCIFEROL 8000 UNIT/ML PO SOLN,$314.31,$0.00,$248.93,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$248.93,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
145154,ERX,HCPCS 25000001,76329-3011-05,LIDOCAINE HCL URETHRAL/MUCOSAL 2 % EX PRSY,$26.22,$0.00,$29.23,$0.00,$20.86,$0.00,$0.00,$0.00,$0.00,$0.00,$29.23,$0.00,$14.62,$20.77,$23.38,$0.00,$0.00,$0.00,$0.00,$0.00
145154,ERX,HCPCS 25000001,76329-3012-05,LIDOCAINE HCL URETHRAL/MUCOSAL 2 % EX PRSY,$26.22,$0.00,$29.23,$0.00,$20.86,$0.00,$0.00,$0.00,$0.00,$0.00,$29.23,$0.00,$14.62,$20.77,$23.38,$0.00,$0.00,$0.00,$0.00,$0.00
145154,ERX,HCPCS 25000001,76329-3013-05,LIDOCAINE HCL URETHRAL/MUCOSAL 2 % EX PRSY,$29.23,$0.00,$29.23,$0.00,$20.86,$0.00,$0.00,$0.00,$0.00,$0.00,$29.23,$0.00,$14.62,$23.15,$23.38,$0.00,$0.00,$0.00,$0.00,$0.00
145230,ERX,HCPCS 25000001,00087-0866-44,CHOLECALCIFEROL 400 UNIT/ML PO LIQD,$87.50,$0.00,$87.50,$0.00,$62.45,$0.00,$0.00,$0.00,$0.00,$0.00,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$0.00,$0.00,$0.00,$0.00
145230,ERX,HCPCS 25000001,54838-0006-50,CHOLECALCIFEROL 400 UNIT/ML PO LIQD,$87.50,$0.00,$87.50,$0.00,$62.45,$0.00,$0.00,$0.00,$0.00,$0.00,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$0.00,$0.00,$0.00,$0.00
145469,ERX,HCPCS q5114,67457-0847-44,TRASTUZUMAB-DKST 420 MG IV SOLR,"$9,095.26",$0.00,"$9,095.26",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$9,095.26",$0.00,"$4,547.63","$7,203.45","$7,276.21",$0.00,$0.00,$0.00,$0.00,$0.00
145473,ERX,HCPCS Q5114,67457-0991-15,TRASTUZUMAB-DKST 150 MG IV SOLR,"$3,258.66",$0.00,"$3,258.66",$0.00,"$2,325.71",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,258.66",$0.00,"$1,629.33","$2,580.86","$2,606.93",$0.00,$0.00,$0.00,$0.00,$0.00
145641,ERX,HCPCS Q5117,55513-0141-01,TRASTUZUMAB-ANNS 150 MG IV SOLR,"$3,248.31",$0.00,"$3,248.31",$0.00,"$2,318.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,248.31",$0.00,"$1,624.16","$2,572.66","$2,598.65",$0.00,$0.00,$0.00,$0.00,$0.00
145743,ERX,HCPCS Q5115,63459-0103-10,RITUXIMAB-ABBS 100 MG/10ML IV SOLN,"$2,080.06",$0.00,"$2,080.06",$936.03,"$1,484.54",$0.00,$358.38,$0.00,$0.00,$364.20,"$2,080.06",$0.00,"$1,040.03","$1,647.41","$1,664.05",$0.00,$325.53,$0.00,$331.15,$0.00
145744,ERX,HCPCS Q5115,63459-0104-50,RITUXIMAB-ABBS 500 MG/50ML IV SOLN,"$10,400.27",$0.00,"$10,400.27","$4,680.12","$5,158.80",$0.00,"$1,791.91",$0.00,$0.00,"$1,821.00","$10,400.27",$0.00,"$5,200.14","$8,237.01","$8,320.22",$0.00,"$1,627.64",$0.00,"$1,655.72",$0.00
145824,ERX,HCPCS C9053,00078-0883-61,CRIZANLIZUMAB-TMCA 100 MG/10ML IV SOLN,"$5,798.57",$0.00,"$5,798.57","$2,609.36","$4,138.44",$0.00,$999.06,$0.00,$0.00,"$1,015.28","$5,798.57",$0.00,"$2,899.29","$4,592.47","$4,638.86",$0.00,$907.48,$0.00,$923.13,$0.00
146009,ERX,HCPCS 25000001,44677-0102-02,LANSINOH LANOLIN EX CREA,$11.00,$0.00,$11.00,$0.00,$7.85,$0.00,$0.00,$0.00,$0.00,$0.00,$11.00,$0.00,$5.50,$8.71,$8.80,$0.00,$0.00,$0.00,$0.00,$0.00
146059,ERX,HCPCS J9177,51144-0020-01,ENFORTUMAB VEDOTIN-EJFV 20 MG IV SOLR,"$5,190.60",$0.00,"$5,392.32",$0.00,"$3,848.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,392.32",$0.00,"$2,696.16","$4,110.96","$4,313.86",$0.00,$0.00,$0.00,$0.00,$0.00
146060,ERX,HCPCS J9177,51144-0030-01,ENFORTUMAB VEDOTIN-EJFV 30 MG IV SOLR,"$7,785.90",$0.00,"$8,088.48",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,088.48",$0.00,"$4,044.24","$6,166.43","$6,470.78",$0.00,$0.00,$0.00,$0.00,$0.00
146089,ERX,HCPCS J9358,65597-0406-01,FAM-TRASTUZUMAB DERUXTEC-NXKI 100 MG IV SOLR,"$5,648.08",$0.00,"$5,648.08",$0.00,"$4,031.03",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,648.08",$0.00,"$2,824.04","$4,473.28","$4,518.46",$0.00,$0.00,$0.00,$0.00,$0.00
146213,ERX,HCPCS Q5118,00069-0315-01,BEVACIZUMAB-BVZR 100 MG/4ML IV SOLN,"$1,766.60",$0.00,"$1,766.60",$0.00,"$1,260.82",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,766.60",$0.00,$883.30,"$1,399.15","$1,413.28",$0.00,$0.00,$0.00,$0.00,$0.00
146214,ERX,HCPCS Q5118,00069-0342-01,BEVACIZUMAB-BVZR 400 MG/16ML IV SOLN,"$6,035.86",$0.00,"$6,035.86",$0.00,"$4,307.79",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,035.86",$0.00,"$3,017.93","$4,780.40","$4,828.69",$0.00,$0.00,$0.00,$0.00,$0.00
146561,ERX,HCPCS J3490,59630-0266-01,CEFIDEROCOL SULFATE TOSYLATE 1 G IV SOLR,$503.25,$0.00,$503.25,$226.46,$359.17,$0.00,$86.71,$0.00,$0.00,$88.12,$503.25,$0.00,$251.63,$398.57,$402.60,$0.00,$78.76,$0.00,$80.12,$0.00
146561,ERX,HCPCS J3490,59630-0266-10,CEFIDEROCOL SULFATE TOSYLATE 1 G IV SOLR,$503.25,$0.00,$503.25,$226.46,$359.17,$0.00,$86.71,$0.00,$0.00,$88.12,$503.25,$0.00,$251.63,$398.57,$402.60,$0.00,$78.76,$0.00,$80.12,$0.00
146761,ERX,HCPCS 25000001,00409-7295-01,POTASSIUM PHOSPHATES(66 MEQ K) 45 MMOLE/15ML IV SOLN,$66.47,$0.00,$66.47,$0.00,$47.44,$0.00,$0.00,$0.00,$0.00,$0.00,$66.47,$0.00,$33.24,$52.64,$53.18,$0.00,$0.00,$0.00,$0.00,$0.00
146761,ERX,HCPCS 25000001,63323-0086-15,POTASSIUM PHOSPHATES(66 MEQ K) 45 MMOLE/15ML IV SOLN,$66.47,$0.00,$66.47,$0.00,$47.44,$0.00,$0.00,$0.00,$0.00,$0.00,$66.47,$0.00,$33.24,$52.64,$53.18,$0.00,$0.00,$0.00,$0.00,$0.00
147244,ERX,HCPCS Q5113,63459-0305-47,TRASTUZUMAB-PKRB 420 MG IV SOLR,"$9,660.42",$0.00,"$9,660.42",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$9,660.42",$0.00,"$4,830.21","$7,651.05","$7,728.34",$0.00,$0.00,$0.00,$0.00,$0.00
147295,ERX,HCPCS Q5113,63459-0303-43,TRASTUZUMAB-PKRB 150 MG IV SOLR,"$3,450.15",$0.00,"$3,450.15",$0.00,"$2,462.37",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,450.15",$0.00,"$1,725.08","$2,732.52","$2,760.12",$0.00,$0.00,$0.00,$0.00,$0.00
147298,ERX,HCPCS J9155,55566-8403-01,DEGARELIX ACETATE(240 MG DOSE) 120 MG/VIAL SC SOLR,"$1,463.22",$0.00,"$1,463.22",$0.00,"$1,044.30",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,463.22",$0.00,$731.61,"$1,158.87","$1,170.58",$0.00,$0.00,$0.00,$0.00,$0.00
147299,ERX,HCPCS 25000001,39328-0064-12,SODIUM HYPOCHLORITE 0.125 % EX SOLN,$48.53,$0.00,$52.13,$0.00,$37.21,$0.00,$0.00,$0.00,$0.00,$0.00,$52.13,$0.00,$26.07,$38.44,$41.70,$0.00,$0.00,$0.00,$0.00,$0.00
147300,ERX,HCPCS 25000001,39328-0063-25,SODIUM HYPOCHLORITE 0.25 % EX SOLN,$48.53,$0.00,$52.13,$0.00,$37.21,$0.00,$0.00,$0.00,$0.00,$0.00,$52.13,$0.00,$26.07,$38.44,$41.70,$0.00,$0.00,$0.00,$0.00,$0.00
147301,ERX,HCPCS 25000001,39328-0062-50,SODIUM HYPOCHLORITE 0.5 % EX SOLN,$48.53,$0.00,$52.13,$0.00,$37.21,$0.00,$0.00,$0.00,$0.00,$0.00,$52.13,$0.00,$26.07,$38.44,$41.70,$0.00,$0.00,$0.00,$0.00,$0.00
147303,ERX,HCPCS 25000001,00069-0284-03,PALBOCICLIB 75 MG PO TABS,"$1,707.35",$0.00,"$1,707.35",$0.00,"$1,218.54",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,707.35",$0.00,$853.68,"$1,352.22","$1,365.88",$0.00,$0.00,$0.00,$0.00,$0.00
147303,ERX,HCPCS 25000001,00069-0284-07,PALBOCICLIB 75 MG PO TABS,"$1,707.35",$0.00,"$1,707.35",$0.00,"$1,218.54",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,707.35",$0.00,$853.68,"$1,352.22","$1,365.88",$0.00,$0.00,$0.00,$0.00,$0.00
147304,ERX,HCPCS 25000001,00069-0486-03,PALBOCICLIB 100 MG PO TABS,"$1,707.35",$0.00,"$1,707.35",$0.00,"$1,218.54",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,707.35",$0.00,$853.68,"$1,352.22","$1,365.88",$0.00,$0.00,$0.00,$0.00,$0.00
147304,ERX,HCPCS 25000001,00069-0486-07,PALBOCICLIB 100 MG PO TABS,"$1,707.35",$0.00,"$1,707.35",$0.00,"$1,218.54",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,707.35",$0.00,$853.68,"$1,352.22","$1,365.88",$0.00,$0.00,$0.00,$0.00,$0.00
147305,ERX,HCPCS 25000001,00069-0688-03,PALBOCICLIB 125 MG PO TABS,"$1,707.35",$0.00,"$1,707.35",$0.00,"$1,218.54",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,707.35",$0.00,$853.68,"$1,352.22","$1,365.88",$0.00,$0.00,$0.00,$0.00,$0.00
147305,ERX,HCPCS 25000001,00069-0688-07,PALBOCICLIB 125 MG PO TABS,"$1,707.35",$0.00,"$1,707.35",$0.00,"$1,218.54",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,707.35",$0.00,$853.68,"$1,352.22","$1,365.88",$0.00,$0.00,$0.00,$0.00,$0.00
147467,ERX,HCPCS 25000001,62559-0430-01,HYDROCORTISONE (PERIANAL) 1 % EX CREA,$189.03,$0.00,$189.03,$0.00,$134.91,$0.00,$0.00,$0.00,$0.00,$0.00,$189.03,$0.00,$94.52,$149.71,$151.22,$0.00,$0.00,$0.00,$0.00,$0.00
147467,ERX,HCPCS 25000001,64980-0302-30,HYDROCORTISONE (PERIANAL) 1 % EX CREA,$189.03,$0.00,$189.03,$0.00,$134.91,$0.00,$0.00,$0.00,$0.00,$0.00,$189.03,$0.00,$94.52,$149.71,$151.22,$0.00,$0.00,$0.00,$0.00,$0.00
147467,ERX,HCPCS 25000001,65649-0501-30,HYDROCORTISONE (PERIANAL) 1 % EX CREA,$189.03,$0.00,$189.03,$0.00,$134.91,$0.00,$0.00,$0.00,$0.00,$0.00,$189.03,$0.00,$94.52,$149.71,$151.22,$0.00,$0.00,$0.00,$0.00,$0.00
147827,ERX,HCPCS Q5112,00006-5033-02,TRASTUZUMAB-DTTB 150 MG IV SOLR,"$3,258.66",$0.00,"$3,258.66",$0.00,"$2,325.71",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,258.66",$0.00,"$1,629.33","$2,580.86","$2,606.93",$0.00,$0.00,$0.00,$0.00,$0.00
147869,ERX,HCPCS J3490,61958-2901-01,REMDESIVIR 100 MG IV SOLR,$22.00,$0.00,"$1,068.84",$9.90,"$1,068.84",$0.00,$0.00,$0.00,$0.00,$3.85,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$238.42,$0.00
147917,ERX,HCPCS 63700001,24338-0230-05,NIMODIPINE 6 MG/ML PO SOLN,$171.66,$0.00,$171.66,$0.00,$122.51,$0.00,$0.00,$0.00,$0.00,$0.00,$171.66,$0.00,$85.83,$135.95,$137.33,$0.00,$0.00,$0.00,$0.00,$0.00
147917,ERX,HCPCS 63700001,24338-0230-12,NIMODIPINE 6 MG/ML PO SOLN,$171.66,$0.00,$171.66,$0.00,$122.51,$0.00,$0.00,$0.00,$0.00,$0.00,$171.66,$0.00,$85.83,$135.95,$137.33,$0.00,$0.00,$0.00,$0.00,$0.00
147933,ERX,HCPCS Q5112,00006-5034-02,TRASTUZUMAB-DTTB 420 MG IV SOLR,"$9,124.25",$0.00,"$9,124.25",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$9,124.25",$0.00,"$4,562.13","$7,226.41","$7,299.40",$0.00,$0.00,$0.00,$0.00,$0.00
147956,ERX,HCPCS 25000001,51144-0001-60,TUCATINIB 50 MG PO TABS,$289.80,$0.00,$289.80,$0.00,$206.83,$0.00,$0.00,$0.00,$0.00,$0.00,$289.80,$0.00,$144.90,$229.52,$231.84,$0.00,$0.00,$0.00,$0.00,$0.00
147957,ERX,HCPCS 25000001,51144-0002-12,TUCATINIB 150 MG PO TABS,$564.25,$0.00,$564.25,$0.00,$402.71,$0.00,$0.00,$0.00,$0.00,$0.00,$564.25,$0.00,$282.13,$446.89,$451.40,$0.00,$0.00,$0.00,$0.00,$0.00
147957,ERX,HCPCS 25000001,51144-0002-60,TUCATINIB 150 MG PO TABS,$564.25,$0.00,$564.25,$0.00,$402.71,$0.00,$0.00,$0.00,$0.00,$0.00,$564.25,$0.00,$282.13,$446.89,$451.40,$0.00,$0.00,$0.00,$0.00,$0.00
147974,ERX,HCPCS C9066,55135-0132-01,SACITUZUMAB GOVITECAN-HZIY 180 MG IV SOLR,"$4,950.75",$0.00,"$4,950.75",$0.00,"$3,533.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,950.75",$0.00,"$2,475.38","$3,920.99","$3,960.60",$0.00,$0.00,$0.00,$0.00,$0.00
147993,ERX,HCPCS J2250,51754-9130-01,MIDAZOLAM HCL-SODIUM CHLORIDE 50-0.8 MG/50ML-% IV SOLN,$69.72,$0.00,$69.72,$31.37,$49.76,$0.00,$9.40,$0.00,$0.00,$7.05,$69.72,$0.00,$34.86,$55.22,$55.78,$0.00,$7.05,$0.00,$6.71,$0.00
147993,ERX,HCPCS J2250,51754-9130-05,MIDAZOLAM HCL-SODIUM CHLORIDE 50-0.8 MG/50ML-% IV SOLN,$69.72,$0.00,$69.72,$31.37,$49.76,$0.00,$9.40,$0.00,$0.00,$7.05,$69.72,$0.00,$34.86,$55.22,$55.78,$0.00,$7.05,$0.00,$6.71,$0.00
147994,ERX,HCPCS J2250,51754-9131-01,MIDAZOLAM HCL-SODIUM CHLORIDE 100-0.8 MG/100ML-% IV SOLN,$107.40,$0.00,$107.40,$48.33,$76.65,$0.00,$18.80,$0.00,$0.00,$14.10,$107.40,$0.00,$53.70,$85.06,$85.92,$0.00,$14.10,$0.00,$13.43,$0.00
147994,ERX,HCPCS J2250,51754-9131-05,MIDAZOLAM HCL-SODIUM CHLORIDE 100-0.8 MG/100ML-% IV SOLN,$107.40,$0.00,$107.40,$48.33,$76.65,$0.00,$18.80,$0.00,$0.00,$14.10,$107.40,$0.00,$53.70,$85.06,$85.92,$0.00,$14.10,$0.00,$13.43,$0.00
148482,ERX,HCPCS 25000001,70324-0326-03,SODIUM BICARBONATE-DEXTROSE 150-5 MEQ/L-% IV SOLN,$147.00,$0.00,$147.00,$0.00,$104.91,$0.00,$0.00,$0.00,$0.00,$0.00,$147.00,$0.00,$73.50,$116.42,$117.60,$0.00,$0.00,$0.00,$0.00,$0.00
148738,ERX,HCPCS 63700001,00087-0402-03,POLY-VI-SOL 50 MG/ML PO SOLN,$32.49,$0.00,$32.49,$0.00,$23.19,$0.00,$0.00,$0.00,$0.00,$0.00,$32.49,$0.00,$16.25,$25.73,$25.99,$0.00,$0.00,$0.00,$0.00,$0.00
148740,ERX,HCPCS 63700001,00087-0405-01,POLY-VI-SOL/IRON 11 MG/ML PO SOLN,$32.49,$0.00,$32.49,$0.00,$23.19,$0.00,$0.00,$0.00,$0.00,$0.00,$32.49,$0.00,$16.25,$25.73,$25.99,$0.00,$0.00,$0.00,$0.00,$0.00
149258,ERX,HCPCS J3370,70594-0057-01,VANCOMYCIN HCL 1250 MG/250ML IV SOLN,$157.50,$0.00,$157.50,$70.88,$112.41,$0.00,$0.00,$0.00,$0.00,$7.97,$157.50,$0.00,$78.75,$124.74,$126.00,$0.00,$0.00,$0.00,$7.59,$0.00
149258,ERX,HCPCS J3370,70594-0057-02,VANCOMYCIN HCL 1250 MG/250ML IV SOLN,$157.50,$0.00,$157.50,$70.88,$112.41,$0.00,$0.00,$0.00,$0.00,$7.97,$157.50,$0.00,$78.75,$124.74,$126.00,$0.00,$0.00,$0.00,$7.59,$0.00
149259,ERX,HCPCS J3370,70594-0058-01,VANCOMYCIN HCL 1750 MG/350ML IV SOLN,$198.45,$0.00,$198.45,$89.30,$141.63,$0.00,$0.00,$0.00,$0.00,$11.95,$198.45,$0.00,$99.23,$157.17,$158.76,$0.00,$0.00,$0.00,$11.38,$0.00
149259,ERX,HCPCS J3370,70594-0058-02,VANCOMYCIN HCL 1750 MG/350ML IV SOLN,$198.45,$0.00,$198.45,$89.30,$141.63,$0.00,$0.00,$0.00,$0.00,$11.95,$198.45,$0.00,$99.23,$157.17,$158.76,$0.00,$0.00,$0.00,$11.38,$0.00
400291,ERX,HCPCS J7040,00264-7800-10,SODIUM CHLORIDE 0.9 % IV BOLUS,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.63,$0.00,$0.00,$1.52,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.52,$0.00,$1.44,$0.00
400291,ERX,HCPCS J7040,00338-0049-03,SODIUM CHLORIDE 0.9 % IV BOLUS,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.63,$0.00,$0.00,$1.52,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.52,$0.00,$1.44,$0.00
400291,ERX,HCPCS J7040,00338-0049-04,SODIUM CHLORIDE 0.9 % IV BOLUS,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.63,$0.00,$0.00,$1.52,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.52,$0.00,$1.44,$0.00
400292,ERX,HCPCS 25000001,00338-0043-03,SODIUM CHLORIDE 0.45 % IV BOLUS,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
400292,ERX,HCPCS 25000001,00338-0043-04,SODIUM CHLORIDE 0.45 % IV BOLUS,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
400293,ERX,HCPCS 25000001,00338-0017-02,DEXTROSE 5 % IV BOLUS,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
400293,ERX,HCPCS 25000001,00338-0017-03,DEXTROSE 5 % IV BOLUS,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
400293,ERX,HCPCS 25000001,00338-0017-04,DEXTROSE 5 % IV BOLUS,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
400294,ERX,HCPCS 25000001,00338-0089-03,DEXTROSE 5 % AND 0.9 % NACL IV BOLUS,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
400294,ERX,HCPCS 25000001,00338-0089-04,DEXTROSE 5 % AND 0.9 % NACL IV BOLUS,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
400295,ERX,HCPCS 25000001,00338-0085-03,DEXTROSE 5 % AND 0.45 % NACL IV BOLUS,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
400295,ERX,HCPCS 25000001,00338-0085-04,DEXTROSE 5 % AND 0.45 % NACL IV BOLUS,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
400296,ERX,HCPCS 25000001,00264-7750-00,LACTATED RINGERS IV BOLUS ML,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
400296,ERX,HCPCS 25000001,00264-7750-20,LACTATED RINGERS IV BOLUS ML,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
400296,ERX,HCPCS 25000001,00338-0117-03,LACTATED RINGERS IV BOLUS ML,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
400296,ERX,HCPCS 25000001,00338-0117-04,LACTATED RINGERS IV BOLUS ML,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
400296,ERX,HCPCS 25000001,00409-7953-03,LACTATED RINGERS IV BOLUS ML,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
400297,ERX,HCPCS 25000001,00264-7751-10,DEXTROSE 5 % IN LACTATED RINGERS IV BOLUS,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
400297,ERX,HCPCS 25000001,00338-0125-04,DEXTROSE 5 % IN LACTATED RINGERS IV BOLUS,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
600002,ERX,HCPCS 25000001,99999-6008-77,ACETIC ACID 6% SOLN,$11.00,$0.00,$14.82,$0.00,$10.58,$0.00,$0.00,$0.00,$0.00,$0.00,$14.82,$0.00,$7.41,$8.71,$11.86,$0.00,$0.00,$0.00,$0.00,$0.00
600002,ERX,HCPCS 25000001,99999-6000-02,ACETIC ACID 6% SOLN,$14.82,$0.00,$14.82,$0.00,$10.58,$0.00,$0.00,$0.00,$0.00,$0.00,$14.82,$0.00,$7.41,$11.74,$11.86,$0.00,$0.00,$0.00,$0.00,$0.00
600003,ERX,HCPCS 25000001,99999-6006-90,ADULT MAGIC MOUTHWASH(MLX:BEN:NYS:LIDO),$22.42,$0.00,$22.42,$0.00,$16.00,$0.00,$0.00,$0.00,$0.00,$0.00,$22.42,$0.00,$11.21,$17.76,$17.94,$0.00,$0.00,$0.00,$0.00,$0.00
600007,ERX,HCPCS J0290,99999-6000-07,AMPICILLIN 1 G/100ML NS MB PLUS,$64.71,$0.00,$64.71,$29.12,$46.18,$0.00,$5.22,$0.00,$0.00,$2.30,$64.71,$0.00,$32.36,$51.25,$51.77,$0.00,$2.30,$0.00,$2.19,$0.00
600007,ERX,HCPCS J0290,99999-6010-85,AMPICILLIN 1 G/100ML NS MB PLUS,$64.71,$0.00,$64.71,$29.12,$46.18,$0.00,$5.22,$0.00,$0.00,$2.30,$64.71,$0.00,$32.36,$51.25,$51.77,$0.00,$2.30,$0.00,$2.19,$0.00
600008,ERX,HCPCS J0290,99999-6000-08,AMPICILLIN 2 G/ NS 100ML MB PLUS,$74.01,$0.00,$74.01,$33.30,$52.82,$0.00,$10.43,$0.00,$0.00,$4.61,$74.01,$0.00,$37.01,$58.62,$59.21,$0.00,$4.61,$0.00,$4.39,$0.00
600009,ERX,HCPCS J0713,99999-6011-20,CEFTAZIDIME 1G/D5W 100 ML MB PLUS,$55.54,$0.00,$55.54,$24.99,$39.64,$0.00,$9.57,$0.00,$0.00,$9.72,$55.54,$0.00,$27.77,$43.99,$44.43,$0.00,$8.69,$0.00,$8.84,$0.00
600010,ERX,HCPCS J0713,99999-6000-10,CEFTAZIDIME 2 G/D5W 100ML MB PLUS,$106.56,$0.00,$106.56,$47.95,$76.05,$0.00,$18.36,$0.00,$0.00,$18.66,$106.56,$0.00,$53.28,$84.40,$85.25,$0.00,$16.68,$0.00,$16.96,$0.00
600011,ERX,HCPCS 25000001,99999-6011-16,NAFCILLIN 1 G/D5W 100 ML MB PLUS,$97.74,$0.00,$97.74,$0.00,$69.76,$0.00,$0.00,$0.00,$0.00,$0.00,$97.74,$0.00,$48.87,$77.41,$78.19,$0.00,$0.00,$0.00,$0.00,$0.00
600012,ERX,HCPCS 25000001,99999-6000-12,NAFCILLIN 2GM/D5W 100ML MB PLUS,$144.50,$0.00,$144.50,$0.00,$103.13,$0.00,$0.00,$0.00,$0.00,$0.00,$144.50,$0.00,$72.25,$114.44,$115.60,$0.00,$0.00,$0.00,$0.00,$0.00
600013,ERX,HCPCS J0743,99999-6000-13,IMIPENEM-CILAST 500MG/NS 100ML MB PLUS,$185.86,$0.00,$185.86,$0.00,$132.65,$0.00,$0.00,$0.00,$0.00,$0.00,$185.86,$0.00,$92.93,$147.20,$148.69,$0.00,$0.00,$0.00,$0.00,$0.00
600014,ERX,HCPCS J0696,99999-6011-31,CEFTRIAXONE 1 G/D5W 100 ML MB PLUS,$52.00,$0.00,$52.00,$23.40,$37.11,$0.00,$5.64,$0.00,$0.00,$2.82,$52.00,$0.00,$26.00,$41.18,$41.60,$0.00,$2.82,$0.00,$2.69,$0.00
600015,ERX,HCPCS J0295,99999-6000-15,AMPICILLIN-SULB 1.5 G/NS 50ML MB PLUS,$100.75,$0.00,$100.75,$45.34,$71.91,$0.00,$4.24,$0.00,$0.00,$3.03,$100.75,$0.00,$50.38,$79.79,$80.60,$0.00,$3.03,$0.00,$2.89,$0.00
600016,ERX,HCPCS J0295,99999-6000-16,AMPICILLIN-SULB 3 G/NS 100ML MB PLUS,$130.26,$0.00,$130.26,$58.62,$92.97,$0.00,$8.48,$0.00,$0.00,$6.06,$130.26,$0.00,$65.13,$103.17,$104.21,$0.00,$6.06,$0.00,$5.77,$0.00
600017,ERX,HCPCS j3370,99999-6000-17,VANCOMYCIN 1000 MG/250 ML D5W MB PLUS,$52.00,$0.00,$52.00,$23.40,$37.11,$9.26,$8.96,$0.00,$0.00,$9.10,$52.00,$0.00,$26.00,$41.18,$41.60,$31.20,$8.14,$0.00,$8.28,$0.00
600018,ERX,HCPCS J0697,99999-6000-18,CEFUROXIME 0.75 G/D5W 100 ML MB PLUS,$91.16,$0.00,$91.16,$0.00,$65.06,$0.00,$0.00,$0.00,$0.00,$0.00,$91.16,$0.00,$45.58,$72.20,$72.93,$0.00,$0.00,$0.00,$0.00,$0.00
600018,ERX,HCPCS J0697,99999-6011-23,CEFUROXIME 0.75 G/D5W 100 ML MB PLUS,$91.16,$0.00,$91.16,$0.00,$65.06,$0.00,$0.00,$0.00,$0.00,$0.00,$91.16,$0.00,$45.58,$72.20,$72.93,$0.00,$0.00,$0.00,$0.00,$0.00
600019,ERX,HCPCS J0697,99999-6000-19,CEFUROXIME 1.5 G/D5W 100ML MB PLUS,$116.29,$0.00,$116.29,$0.00,$83.00,$0.00,$0.00,$0.00,$0.00,$0.00,$116.29,$0.00,$58.15,$92.10,$93.03,$0.00,$0.00,$0.00,$0.00,$0.00
600020,ERX,HCPCS J0690,99999-6000-20,CEFAZOLIN 1GM/D5W 50ML MB PLUS,$52.00,$0.00,$52.00,$23.40,$37.11,$0.00,$1.39,$0.00,$0.00,$1.93,$52.00,$0.00,$26.00,$41.18,$41.60,$0.00,$1.93,$0.00,$1.83,$0.00
600021,ERX,HCPCS 25000001,99999-6000-21,DOXYCYCLINE 100MG/ NS 100ML MB PLUS,$100.94,$0.00,$100.94,$0.00,$72.04,$0.00,$0.00,$0.00,$0.00,$0.00,$100.94,$0.00,$50.47,$79.94,$80.75,$0.00,$0.00,$0.00,$0.00,$0.00
600021,ERX,HCPCS 25000001,99999-6010-83,DOXYCYCLINE 100MG/ NS 100ML MB PLUS,$100.94,$0.00,$100.94,$0.00,$72.04,$0.00,$0.00,$0.00,$0.00,$0.00,$100.94,$0.00,$50.47,$79.94,$80.75,$0.00,$0.00,$0.00,$0.00,$0.00
600022,ERX,HCPCS j3370,99999-6000-22,VANCOMYCIN 500MG/100 ML D5W MB PLUS,$54.54,$0.00,$54.54,$24.54,$38.93,$9.71,$9.40,$0.00,$0.00,$9.55,$54.54,$0.00,$27.27,$43.20,$43.63,$32.72,$8.54,$0.00,$8.68,$0.00
600023,ERX,HCPCS J0694,99999-6011-24,CEFOXITIN 1 G/D5W 100 ML MB PLUS,$109.43,$0.00,$109.43,$49.24,$78.10,$0.00,$8.06,$0.00,$0.00,$6.22,$109.43,$0.00,$54.72,$86.67,$87.54,$0.00,$6.22,$0.00,$5.92,$0.00
600027,ERX,HCPCS J0694,99999-6000-27,CEFOXITIN 2 G/D5W 100ML MB PLUS,$98.55,$0.00,$98.55,$44.35,$70.34,$0.00,$16.12,$0.00,$0.00,$12.43,$98.55,$0.00,$49.28,$78.05,$78.84,$0.00,$12.43,$0.00,$11.84,$0.00
600028,ERX,HCPCS 25000001,99999-6000-28,UVC FLUID 100ML,$31.70,$0.00,$31.70,$0.00,$22.62,$0.00,$0.00,$0.00,$0.00,$0.00,$31.70,$0.00,$15.85,$25.11,$25.36,$0.00,$0.00,$0.00,$0.00,$0.00
600029,ERX,HCPCS 25000001,99999-6000-29,UAC FLUID 100ML,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
600030,ERX,HCPCS 25000001,99999-6000-30,PAL FLUID 100ML,$62.19,$0.00,$62.19,$0.00,$44.39,$0.00,$0.00,$0.00,$0.00,$0.00,$62.19,$0.00,$31.10,$49.25,$49.75,$0.00,$0.00,$0.00,$0.00,$0.00
600031,ERX,HCPCS J0456,99999-6000-31,AZITHROMYCIN 500MG/D5W 250ML MB PLUS,$52.00,$0.00,$52.00,$23.40,$37.11,$0.00,$8.96,$0.00,$0.00,$9.10,$52.00,$0.00,$26.00,$41.18,$41.60,$0.00,$8.14,$0.00,$8.28,$0.00
600032,ERX,HCPCS J0698,99999-6011-21,CEFOTAXIME 1 G/D5W 100 ML MB PLUS,$89.34,$0.00,$89.34,$0.00,$63.76,$0.00,$0.00,$0.00,$0.00,$0.00,$89.34,$0.00,$44.67,$70.76,$71.47,$0.00,$0.00,$0.00,$0.00,$0.00
600033,ERX,HCPCS J2543,99999-6000-33,PIPERACIL-TAZO 2.25 G/D5W 50ML MB PLUS,$71.68,$0.00,$71.68,$32.26,$51.16,$0.00,$13.09,$0.00,$0.00,$4.35,$71.68,$0.00,$35.84,$56.77,$57.34,$0.00,$4.35,$0.00,$4.14,$0.00
600034,ERX,HCPCS J2543,99999-6000-34,PIPERACIL-TAZ 3.375 G/D5W 50ML MB PLUS,$88.37,$0.00,$88.37,$39.77,$63.07,$0.00,$19.63,$0.00,$0.00,$6.52,$88.37,$0.00,$44.19,$69.99,$70.70,$0.00,$6.52,$0.00,$6.21,$0.00
600035,ERX,HCPCS J2543,99999-6000-35,PIPERACIL-TAZO 4.5 G/100 ML D5W MB PLUS,$95.18,$0.00,$95.18,$42.83,$67.93,$0.00,$26.18,$0.00,$0.00,$8.70,$95.18,$0.00,$47.59,$75.38,$76.14,$0.00,$8.70,$0.00,$8.28,$0.00
600036,ERX,HCPCS J3010,99999-6000-36,FENTANYL 2000MCG/NS 100ML PREMIX,$217.35,$0.00,$217.35,$97.81,$155.12,$0.00,$37.45,$0.00,$0.00,$23.27,$217.35,$0.00,$108.68,$172.14,$173.88,$0.00,$23.27,$0.00,$22.15,$0.00
600037,ERX,HCPCS J2250,99999-6000-37,MIDAZOLAM 50MG/NS 50ML PREMIX,$102.94,$0.00,$102.94,$46.32,$73.47,$0.00,$9.40,$0.00,$0.00,$7.05,$102.94,$0.00,$51.47,$81.53,$82.35,$0.00,$7.05,$0.00,$6.71,$0.00
600038,ERX,HCPCS J1335,99999-6000-38,ERTAPENEM 1 G/NS 50ML MB PLUS,$233.61,$0.00,$233.61,$105.12,$166.73,$0.00,$40.25,$0.00,$0.00,$90.95,$233.61,$0.00,$116.81,$185.02,$186.89,$0.00,$90.95,$0.00,$86.60,$0.00
600040,ERX,HCPCS J2185,99999-6000-40,MEROPENEM 1 G/NS 100 ML MB PLUS,$169.81,$0.00,$169.81,$0.00,$121.19,$0.00,$0.00,$0.00,$0.00,$0.00,$169.81,$0.00,$84.91,$134.49,$135.85,$0.00,$0.00,$0.00,$0.00,$0.00
600041,ERX,HCPCS J2700,99999-6000-41,OXACILLIN 2 G/D5W 100ML MB PLUS,$120.81,$0.00,$120.81,$0.00,$86.22,$0.00,$0.00,$0.00,$0.00,$0.00,$120.81,$0.00,$60.41,$95.68,$96.65,$0.00,$0.00,$0.00,$0.00,$0.00
600042,ERX,HCPCS J2700,99999-6011-22,OXACILLIN 1 G/D5W 100 ML MB PLUS,$94.98,$0.00,$94.98,$0.00,$67.79,$0.00,$0.00,$0.00,$0.00,$0.00,$94.98,$0.00,$47.49,$75.22,$75.98,$0.00,$0.00,$0.00,$0.00,$0.00
600043,ERX,HCPCS J0696,99999-6011-32,CEFTRIAXONE 2 G/D5W 100 ML MB PLUS,$145.20,$0.00,$145.20,$65.34,$103.63,$0.00,$11.28,$0.00,$0.00,$5.64,$145.20,$0.00,$72.60,$115.00,$116.16,$0.00,$5.64,$0.00,$5.37,$0.00
600046,ERX,HCPCS 25000001,99999-6000-46,TOBRAMYCIN FORT 95MG/7ML OPHTH SOLN,$38.00,$0.00,$38.00,$0.00,$27.12,$0.00,$0.00,$0.00,$0.00,$0.00,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
600048,ERX,HCPCS 25000001,99999-6000-48,CEFAZOLIN FORT OPHTH 50 MG/ML 10ML,$47.50,$0.00,$47.50,$0.00,$33.90,$0.00,$0.00,$0.00,$0.00,$0.00,$47.50,$0.00,$23.75,$37.62,$38.00,$0.00,$0.00,$0.00,$0.00,$0.00
600049,ERX,HCPCS 25000001,99999-6000-49,VANCOMYCIN 30 MG/ML (3%) OPHTH SOLN,$79.36,$0.00,$79.36,$0.00,$56.64,$0.00,$0.00,$0.00,$0.00,$0.00,$79.36,$0.00,$39.68,$62.85,$63.49,$0.00,$0.00,$0.00,$0.00,$0.00
600051,ERX,HCPCS 25000001,99999-6000-51,GENTAMICIN FORT 95MG/7ML OPHTH SOL,$38.00,$0.00,$38.00,$0.00,$27.12,$0.00,$0.00,$0.00,$0.00,$0.00,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
600052,ERX,HCPCS 25000001,99999-6000-52,LEECH,$76.00,$0.00,$76.00,$0.00,$54.24,$0.00,$0.00,$0.00,$0.00,$0.00,$76.00,$0.00,$38.00,$60.19,$60.80,$0.00,$0.00,$0.00,$0.00,$0.00
600053,ERX,HCPCS 25000001,99999-6000-53,BEER,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
600054,ERX,HCPCS 25000001,99999-6000-54,L.E.T. TOPICAL GEL 3ML,$19.00,$0.00,$19.00,$0.00,$13.56,$0.00,$0.00,$0.00,$0.00,$0.00,$19.00,$0.00,$9.50,$15.05,$15.20,$0.00,$0.00,$0.00,$0.00,$0.00
600055,ERX,HCPCS 25000001,99999-6000-55,MIDAZOLAM 2MG/1 ML ORAL SYRINGE,$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
600056,ERX,HCPCS 25000001,99999-6000-56,MIDAZOLAM 5MG/2.5ML ORAL SYRINGE,$11.40,$0.00,$11.40,$0.00,$8.14,$0.00,$0.00,$0.00,$0.00,$0.00,$11.40,$0.00,$5.70,$9.03,$9.12,$0.00,$0.00,$0.00,$0.00,$0.00
600058,ERX,HCPCS 25000001,99999-6000-58,METHADONE 1MG/1ML ORAL SYRINGE,$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
600060,ERX,HCPCS 25000001,99999-6000-60,METHADONE 0.5MG/0.5ML ORAL SYRINGE (NICU),$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
600061,ERX,HCPCS 63700001,99999-6000-61,METHADONE 5MG/5ML ORAL SYRINGE,$9.50,$0.00,$9.50,$0.00,$6.78,$0.00,$0.00,$0.00,$0.00,$0.00,$9.50,$0.00,$4.75,$7.52,$7.60,$0.00,$0.00,$0.00,$0.00,$0.00
600062,ERX,HCPCS 25000001,99999-6000-62,OXYCODONE LIQ 120MG/6ML ORAL SYRINGE,$26.16,$0.00,$26.16,$0.00,$18.67,$0.00,$0.00,$0.00,$0.00,$0.00,$26.16,$0.00,$13.08,$20.72,$20.93,$0.00,$0.00,$0.00,$0.00,$0.00
600063,ERX,HCPCS 25000001,99999-6000-63,DIAZEPAM ELIXIR 1MG/ML ORAL SYRINGE,$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
600065,ERX,HCPCS 63700001,99999-6000-65,OXANDROLONE 1MG/1ML ORAL SYRINGE,$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
600066,ERX,HCPCS 63700001,99999-6000-66,OXANDROLONE 10MG/10ML ORAL SYRINGE,$584.78,$0.00,$584.78,$0.00,$417.36,$0.00,$0.00,$0.00,$0.00,$0.00,$584.78,$0.00,$292.39,$463.15,$467.82,$0.00,$0.00,$0.00,$0.00,$0.00
600067,ERX,HCPCS 25000001,99999-6000-67,MORPHINE SULFATE 20MG/ML O/S 5ML,$10.45,$0.00,$10.45,$0.00,$7.46,$0.00,$0.00,$0.00,$0.00,$0.00,$10.45,$0.00,$5.23,$8.28,$8.36,$0.00,$0.00,$0.00,$0.00,$0.00
600068,ERX,HCPCS 25000001,99999-6000-68,MORPHINE SULFATE 20MG/ML O/S 3ML,$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
600069,ERX,HCPCS 25000001,99999-6000-69,MORPHINE SULFATE 20MG/ML O/S 2ML,$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
600079,ERX,HCPCS 25000001,99999-6000-79,CALCITRIOL 1MCG/ML ORAL SYRINGE (NICU),$45.34,$0.00,$45.34,$0.00,$32.36,$0.00,$0.00,$0.00,$0.00,$0.00,$45.34,$0.00,$22.67,$35.91,$36.27,$0.00,$0.00,$0.00,$0.00,$0.00
600107,ERX,HCPCS 63700001,99999-6001-07,FUROSEMIDE 10MG/ML ORAL SYRINGE (NICU),$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
600109,ERX,HCPCS 25000001,99999-6001-09,NEVIRAPINE 10MG/ML ORAL SYRINGE (NICU),$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
600112,ERX,HCPCS 25000001,99999-6001-12,ALUM-MG HYDRX-SIMETH 15ML ORAL SYRINGE,$17.10,$0.00,$17.10,$0.00,$12.20,$0.00,$0.00,$0.00,$0.00,$0.00,$17.10,$0.00,$8.55,$13.54,$13.68,$0.00,$0.00,$0.00,$0.00,$0.00
600126,ERX,HCPCS 63700001,99999-6001-26,KALETRA 80MG/20MG/ML ORAL SYRINGE,$49.18,$0.00,$49.18,$0.00,$35.10,$0.00,$0.00,$0.00,$0.00,$0.00,$49.18,$0.00,$24.59,$38.95,$39.34,$0.00,$0.00,$0.00,$0.00,$0.00
600134,ERX,HCPCS 63700001,99999-6001-34,POSACONAZOLE 200MG/5 ML ORAL SYRINGE,$99.93,$0.00,$99.93,$0.00,$71.32,$0.00,$0.00,$0.00,$0.00,$0.00,$99.93,$0.00,$49.97,$79.14,$79.94,$0.00,$0.00,$0.00,$0.00,$0.00
600137,ERX,HCPCS 63700001,99999-6001-37,ERGOCALCIFEROL 8000 UNITS/ML (NICU) ORAL SYRINGE,$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
600138,ERX,HCPCS 25000001,99999-6001-38,PENICILLIN VK 50MG/ML ORAL SYRINGE,$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
600141,ERX,HCPCS 25000001,99999-6001-41,TRIFLUOPERAZINE 10MG/ML ORAL SYRINGE,$9.09,$0.00,$9.09,$0.00,$6.49,$0.00,$0.00,$0.00,$0.00,$0.00,$9.09,$0.00,$4.55,$7.20,$7.27,$0.00,$0.00,$0.00,$0.00,$0.00
600144,ERX,HCPCS 63700001,99999-6001-44,ZIDOVUDINE 10MG/ML ORAL SYRINGE (NICU),$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
600151,ERX,HCPCS 25000001,99999-6001-51,BACLOFEN 1MG/ML ORAL SYRINGE,$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
600152,ERX,HCPCS 25000001,99999-6001-52,BACLOFEN 10MG/ML ORAL SYRINGE HI CONC,$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
600153,ERX,HCPCS 25000001,99999-6001-53,SIMETHICONE 40MG/0.6ML ORAL SYRINGE (NICU),$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
600157,ERX,HCPCS 25000001,99999-6001-57,LANSOPRAZOLE 3MG/ML ORAL SYRINGE (NICU),$62.48,$0.00,$62.48,$0.00,$44.59,$0.00,$0.00,$0.00,$0.00,$0.00,$62.48,$0.00,$31.24,$49.48,$49.98,$0.00,$0.00,$0.00,$0.00,$0.00
600159,ERX,HCPCS 63700001,99999-6001-59,MULTIPLE VIT W/IRON ORAL SYRINGE (NICU),$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
600162,ERX,HCPCS 25000001,99999-6001-62,PREDNISOLONE 9MG/3ML ORAL SYRINGE,$15.39,$0.00,$15.39,$0.00,$10.98,$0.00,$0.00,$0.00,$0.00,$0.00,$15.39,$0.00,$7.70,$12.19,$12.31,$0.00,$0.00,$0.00,$0.00,$0.00
600163,ERX,HCPCS 25000001,99999-6001-63,PREDNISOLONE 30MG/10ML ORAL SYRINGE,$157.50,$0.00,$157.50,$0.00,$112.41,$0.00,$0.00,$0.00,$0.00,$0.00,$157.50,$0.00,$78.75,$124.74,$126.00,$0.00,$0.00,$0.00,$0.00,$0.00
600164,ERX,HCPCS 25000001,99999-6001-64,PREDNISOLONE 15MG/5ML ORAL SYRINGE,$25.65,$0.00,$25.65,$0.00,$18.31,$0.00,$0.00,$0.00,$0.00,$0.00,$25.65,$0.00,$12.83,$20.31,$20.52,$0.00,$0.00,$0.00,$0.00,$0.00
600166,ERX,HCPCS 25000001,99999-6001-66,CHLORHEXIDINE MTHWASH 0.12% 1ML ORAL SYRINGE,$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
600175,ERX,HCPCS 63700001,99999-6001-75,NYSTATIN 100000U/ML ORAL SYRINGE (NICU),$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
600176,ERX,HCPCS 25000001,99999-6001-76,NYSTATIN 50000U/0.5ML ORAL SYRNGE,$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
600177,ERX,HCPCS 63700001,99999-6001-77,NYSTATIN 200000U/2ML ORAL SYRNGE,$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
600181,ERX,HCPCS 63700001,99999-6001-81,SODIUM CHLORIDE 4 MEQ/ML ORAL SYRINGE (NICU),$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
600191,ERX,HCPCS 63700001,99999-6001-91,FLUOXETINE 4MG/ML ORAL SYRINGE,$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
600199,ERX,HCPCS 63700001,99999-6001-99,FLUPHENAZINE 2.5MG/5ML ORAL SYRINGE,$35.27,$0.00,$35.27,$0.00,$25.17,$0.00,$0.00,$0.00,$0.00,$0.00,$35.27,$0.00,$17.64,$27.93,$28.22,$0.00,$0.00,$0.00,$0.00,$0.00
600200,ERX,HCPCS 63700001,99999-6002-00,FLUPHENAZINE 0.5MG/ML ORAL SYRINGE,$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
600206,ERX,HCPCS 63700001,99999-6002-06,SULFAMETHOXAZOLE-TMP SUSP 1ML O/S DOSE # 1,$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
600207,ERX,HCPCS 63700001,99999-6002-07,SULFAMETHOXAZOLE-TMP SUSP 1ML O/S DOSE # 2,$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
600208,ERX,HCPCS 63700001,99999-6002-08,SULFAMETHOXAZOLE-TMP SUSP 1ML O/S DOSE # 3,$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
600209,ERX,HCPCS 63700001,99999-6002-09,SULFAMETHOXAZOLE-TMP SUSP 5ML O/S DOSE # 5,$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
600210,ERX,HCPCS 63700001,99999-6002-10,SULFAMETHOXAZOLE-TMP SUSP 20ML O/S DOSE # 6,$9.12,$0.00,$9.12,$0.00,$6.51,$0.00,$0.00,$0.00,$0.00,$0.00,$9.12,$0.00,$4.56,$7.22,$7.30,$0.00,$0.00,$0.00,$0.00,$0.00
600211,ERX,HCPCS 63700001,99999-6002-11,SULFAMETHOXAZOLE-TMP SUSP 1ML O/S DOSE # 4,$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
600220,ERX,HCPCS 63700001,99999-6002-20,MULTIPLE VITAMIN (NICU) ORAL SYRINGE,$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
600221,ERX,HCPCS 25000001,99999-6002-21,GUAIFENESIN DM 1ML ORAL SYRINGE,$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
600231,ERX,HCPCS 25000001,99999-6002-31,NITAZOXANIDE 100MG/5ML ORAL SYRNGE,$117.25,$0.00,$117.25,$0.00,$83.68,$0.00,$0.00,$0.00,$0.00,$0.00,$117.25,$0.00,$58.63,$92.86,$93.80,$0.00,$0.00,$0.00,$0.00,$0.00
600232,ERX,HCPCS 25000001,99999-6002-32,BENADRYL/MAALOX 1:1,$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
600237,ERX,HCPCS 63700001,99999-6002-37,RISPERIDONE 2 MG/2 ML ORAL SYRINGE,$50.01,$0.00,$50.01,$0.00,$35.69,$0.00,$0.00,$0.00,$0.00,$0.00,$50.01,$0.00,$25.01,$39.61,$40.01,$0.00,$0.00,$0.00,$0.00,$0.00
600240,ERX,HCPCS 25000001,99999-6002-40,HYDROMORPHONE 15000MCG/30ML NS PED,$27.00,$0.00,$27.00,$0.00,$19.27,$0.00,$0.00,$0.00,$0.00,$0.00,$27.00,$0.00,$13.50,$21.38,$21.60,$0.00,$0.00,$0.00,$0.00,$0.00
600241,ERX,HCPCS 25000001,99999-6002-41,HYDROMORPHONE 30000MCG/30ML NS PED,$37.70,$0.00,$37.70,$0.00,$26.91,$0.00,$0.00,$0.00,$0.00,$0.00,$37.70,$0.00,$18.85,$29.86,$30.16,$0.00,$0.00,$0.00,$0.00,$0.00
600245,ERX,HCPCS 25000001,99999-6010-93,AZTREONAM 1 G/100ML D5W MB PLUS,$178.42,$0.00,$178.42,$0.00,$127.34,$0.00,$0.00,$0.00,$0.00,$0.00,$178.42,$0.00,$89.21,$141.31,$142.74,$0.00,$0.00,$0.00,$0.00,$0.00
600246,ERX,HCPCS 25000001,99999-6010-94,AZTREONAM 2 G/100ML D5W MB PLUS,$290.60,$0.00,$290.60,$0.00,$207.40,$0.00,$0.00,$0.00,$0.00,$0.00,$290.60,$0.00,$145.30,$230.16,$232.48,$0.00,$0.00,$0.00,$0.00,$0.00
600247,ERX,HCPCS 25000001,99999-6002-47,KETAMINE 50MG/1 ML IV SYRINGE,$27.00,$0.00,$27.00,$0.00,$19.27,$0.00,$0.00,$0.00,$0.00,$0.00,$27.00,$0.00,$13.50,$21.38,$21.60,$0.00,$0.00,$0.00,$0.00,$0.00
600253,ERX,HCPCS 25000001,99999-6002-53,AMPHOTERICIN B 5MCG/0.1ML OPHTH SYRINGE,$27.00,$0.00,$27.00,$0.00,$19.27,$0.00,$0.00,$0.00,$0.00,$0.00,$27.00,$0.00,$13.50,$21.38,$21.60,$0.00,$0.00,$0.00,$0.00,$0.00
600255,ERX,HCPCS 25000001,99999-6002-55,GANCICLOVIR 2MG/0.1 ML OPHTH SYRINGE,$306.41,$0.00,$306.41,$0.00,$218.68,$0.00,$0.00,$0.00,$0.00,$0.00,$306.41,$0.00,$153.21,$242.68,$245.13,$0.00,$0.00,$0.00,$0.00,$0.00
600263,ERX,HCPCS 25000001,99999-6002-63,NICARDIPINE 1MG/10ML NS,$145.95,$0.00,$145.95,$0.00,$104.16,$0.00,$0.00,$0.00,$0.00,$0.00,$145.95,$0.00,$72.98,$115.59,$116.76,$0.00,$0.00,$0.00,$0.00,$0.00
600273,ERX,HCPCS 25000001,99999-6002-73,AMIKACIN 400MCG/0.1ML OPHTH SYRINGE,$27.00,$0.00,$27.00,$0.00,$19.27,$0.00,$0.00,$0.00,$0.00,$0.00,$27.00,$0.00,$13.50,$21.38,$21.60,$0.00,$0.00,$0.00,$0.00,$0.00
600283,ERX,HCPCS 25000001,99999-6002-83,VORICONAZOLE 40MCG/0.1 ML NS OPHTH SYRINGE,$465.37,$0.00,$465.37,$0.00,$332.13,$0.00,$0.00,$0.00,$0.00,$0.00,$465.37,$0.00,$232.69,$368.57,$372.30,$0.00,$0.00,$0.00,$0.00,$0.00
600285,ERX,HCPCS 25000001,99999-6002-85,COSYNTROPIN 1 MCG/1 ML (NICU) IV SYRINGE,$27.00,$0.00,$27.00,$0.00,$19.27,$0.00,$0.00,$0.00,$0.00,$0.00,$27.00,$0.00,$13.50,$21.38,$21.60,$0.00,$0.00,$0.00,$0.00,$0.00
600297,ERX,HCPCS 25000001,99999-6002-97,NACL 0.45% FLUSH 2ML IV SYRINGE (NICU),$27.00,$0.00,$27.00,$0.00,$19.27,$0.00,$0.00,$0.00,$0.00,$0.00,$27.00,$0.00,$13.50,$21.38,$21.60,$0.00,$0.00,$0.00,$0.00,$0.00
600306,ERX,HCPCS 25000001,99999-6003-06,CEFTAZIDIME 2.25MG/0.1ML OPHTH SYRINGE,$27.00,$0.00,$27.00,$0.00,$19.27,$0.00,$0.00,$0.00,$0.00,$0.00,$27.00,$0.00,$13.50,$21.38,$21.60,$0.00,$0.00,$0.00,$0.00,$0.00
600307,ERX,HCPCS 25000001,99999-6003-07,VITAMIN A 5000U/0.1ML IM SYRINGE (NICU),$27.00,$0.00,$27.00,$0.00,$19.27,$0.00,$0.00,$0.00,$0.00,$0.00,$27.00,$0.00,$13.50,$21.38,$21.60,$0.00,$0.00,$0.00,$0.00,$0.00
600313,ERX,HCPCS 25000001,99999-6003-13,VANCOMYCIN 0.75MG/0.1ML OPHTH SYRINGE,$27.00,$0.00,$27.00,$0.00,$19.27,$0.00,$0.00,$0.00,$0.00,$0.00,$27.00,$0.00,$13.50,$21.38,$21.60,$0.00,$0.00,$0.00,$0.00,$0.00
600314,ERX,HCPCS 25000001,99999-6003-14,VANCOMYCIN 1MG/0.1ML OPHTH SYRINGE,$27.00,$0.00,$27.00,$0.00,$19.27,$0.00,$0.00,$0.00,$0.00,$0.00,$27.00,$0.00,$13.50,$21.38,$21.60,$0.00,$0.00,$0.00,$0.00,$0.00
600316,ERX,HCPCS 25000001,99999-6003-16,VASOPRESSIN 4 UNITS/10 ML NS,$41.04,$0.00,$41.04,$0.00,$29.29,$0.00,$0.00,$0.00,$0.00,$0.00,$41.04,$0.00,$20.52,$32.50,$32.83,$0.00,$0.00,$0.00,$0.00,$0.00
600328,ERX,HCPCS 25000001,99999-6003-28,HEPARIN FLUSH 1 UNIT/ML 0.45% NS (NICU) 6ML,$27.00,$0.00,$27.00,$0.00,$19.27,$0.00,$0.00,$0.00,$0.00,$0.00,$27.00,$0.00,$13.50,$21.38,$21.60,$0.00,$0.00,$0.00,$0.00,$0.00
600328,ERX,HCPCS 25000001,99999-6011-72,HEPARIN FLUSH 1 UNIT/ML 0.45% NS (NICU) 6ML,$27.00,$0.00,$27.00,$0.00,$19.27,$0.00,$0.00,$0.00,$0.00,$0.00,$27.00,$0.00,$13.50,$21.38,$21.60,$0.00,$0.00,$0.00,$0.00,$0.00
600333,ERX,HCPCS J2997,99999-6003-33,ALTEPLASE 1MG/1 ML SW IV SYRINGE(NICU),$517.93,$0.00,$517.93,$233.07,$369.65,$87.64,$89.24,$0.00,$0.00,$90.69,$517.93,$92.02,$258.97,$410.20,$414.34,$127.08,$81.06,$0.00,$82.45,$87.89
600340,ERX,HCPCS 25000001,99999-6003-40,EPHEDRINE 50MG/10ML NS IV SYRINGE,$57.61,$0.00,$57.61,$0.00,$41.12,$0.00,$0.00,$0.00,$0.00,$0.00,$57.61,$0.00,$28.81,$45.63,$46.09,$0.00,$0.00,$0.00,$0.00,$0.00
600356,ERX,HCPCS 25000001,99999-6003-56,ON-Q PUMP 270 ML 2 ML/HR SINGLE LUMEN,$491.39,$0.00,$491.39,$0.00,$350.71,$0.00,$0.00,$0.00,$0.00,$0.00,$491.39,$0.00,$245.70,$389.18,$393.11,$0.00,$0.00,$0.00,$0.00,$0.00
600357,ERX,HCPCS 25000001,99999-6003-57,ON-Q PUMP 400 ML 4 ML/HR DUAL LUMEN,"$1,320.00",$0.00,"$1,320.00",$0.00,$942.08,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,320.00",$0.00,$660.00,"$1,045.44","$1,056.00",$0.00,$0.00,$0.00,$0.00,$0.00
600358,ERX,HCPCS 25000001,99999-6003-58,ON-Q PUMP 400 ML 5 ML/HR SINGLE LUMEN,$695.63,$0.00,$695.63,$0.00,$496.47,$0.00,$0.00,$0.00,$0.00,$0.00,$695.63,$0.00,$347.82,$550.94,$556.50,$0.00,$0.00,$0.00,$0.00,$0.00
600359,ERX,HCPCS 25000001,99999-6003-59,ON-Q C-BLOC PUMP 400ML,$795.00,$0.00,$795.00,$0.00,$567.39,$0.00,$0.00,$0.00,$0.00,$0.00,$795.00,$0.00,$397.50,$629.64,$636.00,$0.00,$0.00,$0.00,$0.00,$0.00
600360,ERX,HCPCS 25000001,99999-6003-60,FOSCARNET SODIUM 2.4MG/0.1ML OPHTH SYRINGE,$749.95,$0.00,$749.95,$0.00,$535.24,$0.00,$0.00,$0.00,$0.00,$0.00,$749.95,$0.00,$374.98,$593.96,$599.96,$0.00,$0.00,$0.00,$0.00,$0.00
600362,ERX,HCPCS J0690,99999-6003-62,CEFAZOLIN 1GM/NS 50ML MB PLUS-OR ONLY,$52.00,$0.00,$52.00,$23.40,$37.11,$0.00,$1.39,$0.00,$0.00,$1.93,$52.00,$0.00,$26.00,$41.18,$41.60,$0.00,$1.93,$0.00,$1.83,$0.00
600364,ERX,HCPCS J2543,99999-6003-64,PIPERACIL-TAZ 3.375 G/NS 50ML MB PLUS,$88.37,$0.00,$88.37,$39.77,$63.07,$0.00,$19.63,$0.00,$0.00,$6.52,$88.37,$0.00,$44.19,$69.99,$70.70,$0.00,$6.52,$0.00,$6.21,$0.00
600365,ERX,HCPCS J2543,99999-6003-65,PIPERACIL-TAZO 4.5 G/NS 100ML MB PLUS,$95.18,$0.00,$95.18,$42.83,$67.93,$0.00,$26.18,$0.00,$0.00,$8.70,$95.18,$0.00,$47.59,$75.38,$76.14,$0.00,$8.70,$0.00,$8.28,$0.00
600367,ERX,HCPCS J0694,99999-6011-25,CEFOXITIN 1 G/NS 100 ML MB PLUS-OR ONLY,$109.43,$0.00,$109.43,$49.24,$78.10,$0.00,$8.06,$0.00,$0.00,$6.22,$109.43,$0.00,$54.72,$86.67,$87.54,$0.00,$6.22,$0.00,$5.92,$0.00
600368,ERX,HCPCS 25000001,99999-6003-68,PENICILLIN G 2 MU/NS 50ML-OR ONLY,$180.85,$0.00,$180.85,$0.00,$129.07,$0.00,$0.00,$0.00,$0.00,$0.00,$180.85,$0.00,$90.43,$143.23,$144.68,$0.00,$0.00,$0.00,$0.00,$0.00
600369,ERX,HCPCS 25000001,99999-6003-69,DESMOPRESSIN 0.25MCG/0.5ML NS SYRINGE,$33.54,$0.00,$33.54,$0.00,$23.94,$0.00,$0.00,$0.00,$0.00,$0.00,$33.54,$0.00,$16.77,$26.56,$26.83,$0.00,$0.00,$0.00,$0.00,$0.00
600378,ERX,HCPCS 25000001,99999-6003-78,KAOPECTATE AND BENADRYL 1:1 ORAL SOLUTION,$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
600380,ERX,HCPCS 25000001,99999-6003-80,GENTAMICIN 0.5ML (80MG/ML) WITH 0.5ML OF DEXAMETHASONE-OR,$52.00,$0.00,$52.00,$0.00,$37.11,$0.00,$0.00,$0.00,$0.00,$0.00,$52.00,$0.00,$26.00,$41.18,$41.60,$0.00,$0.00,$0.00,$0.00,$0.00
600381,ERX,HCPCS 25000001,99999-6003-81,"EPINEPHRINE 0.3ML (1:1000,1MG/ML) IN 500ML BSS PLUS-OR",$92.53,$0.00,$92.53,$0.00,$66.04,$0.00,$0.00,$0.00,$0.00,$0.00,$92.53,$0.00,$46.27,$73.28,$74.02,$0.00,$0.00,$0.00,$0.00,$0.00
600382,ERX,HCPCS 25000001,99999-6003-82,LIDOCAINE 2% 3ML/.75% MARCAINE 3ML/200MG WYDASE 1ML,$212.92,$0.00,$212.92,$0.00,$151.96,$0.00,$0.00,$0.00,$0.00,$0.00,$212.92,$0.00,$106.46,$168.63,$170.34,$0.00,$0.00,$0.00,$0.00,$0.00
600383,ERX,HCPCS 25000001,99999-6003-83,SUGARCAINE MIXTURE 5ML-OR,$44.10,$0.00,$44.10,$0.00,$31.47,$0.00,$0.00,$0.00,$0.00,$0.00,$44.10,$0.00,$22.05,$34.93,$35.28,$0.00,$0.00,$0.00,$0.00,$0.00
600384,ERX,HCPCS 25000001,99999-6003-84,LIDOCAINE/BUPIVACAINE/HYALURONIDASE - OR EYE BLOCK,$220.36,$0.00,$220.36,$0.00,$157.27,$0.00,$0.00,$0.00,$0.00,$0.00,$220.36,$0.00,$110.18,$174.53,$176.29,$0.00,$0.00,$0.00,$0.00,$0.00
600385,ERX,HCPCS 25000001,99999-6003-85,LIDOCAINE/EPI/NS-OR TUMESCENT MIXTURE,$58.29,$0.00,$58.29,$0.00,$41.60,$0.00,$0.00,$0.00,$0.00,$0.00,$58.29,$0.00,$29.15,$46.17,$46.63,$0.00,$0.00,$0.00,$0.00,$0.00
600386,ERX,HCPCS 25000001,99999-6003-86,LIDOCAINE 1% 14 ML/PAPAVERINE (30 MG/ML) 2 ML-OR,$52.00,$0.00,$52.00,$0.00,$37.11,$0.00,$0.00,$0.00,$0.00,$0.00,$52.00,$0.00,$26.00,$41.18,$41.60,$0.00,$0.00,$0.00,$0.00,$0.00
600388,ERX,HCPCS 25000001,99999-6003-88,"BACITRACIN 50,000 UNITS IN 1000 ML NS - OR NEURO",$96.20,$0.00,$96.20,$0.00,$68.66,$0.00,$0.00,$0.00,$0.00,$0.00,$96.20,$0.00,$48.10,$76.19,$76.96,$0.00,$0.00,$0.00,$0.00,$0.00
600389,ERX,HCPCS 25000001,99999-6003-89,IOHEXOL 300 MG/ML 50 ML MIXED WITH 50ML STERILE WATER-OR GU,$224.48,$0.00,$224.48,$0.00,$160.21,$0.00,$0.00,$0.00,$0.00,$0.00,$224.48,$0.00,$112.24,$177.79,$179.58,$0.00,$0.00,$0.00,$0.00,$0.00
600390,ERX,HCPCS 25000001,99999-6003-90,VASOPRESSIN 20 UNITS IN 50 ML NS - OR GYN,$52.00,$0.00,$52.00,$0.00,$37.11,$0.00,$0.00,$0.00,$0.00,$0.00,$52.00,$0.00,$26.00,$41.18,$41.60,$0.00,$0.00,$0.00,$0.00,$0.00
600391,ERX,HCPCS 25000001,99999-6003-91,VASOPRESSIN 20 UNITS IN 100 ML NS - OR GYN,$52.00,$0.00,$52.00,$0.00,$37.11,$0.00,$0.00,$0.00,$0.00,$0.00,$52.00,$0.00,$26.00,$41.18,$41.60,$0.00,$0.00,$0.00,$0.00,$0.00
600392,ERX,HCPCS 25000001,99999-6003-92,VASOPRESSIN 20 UNITS IN 200 ML OF NS - OR GYN,$52.00,$0.00,$52.00,$0.00,$37.11,$0.00,$0.00,$0.00,$0.00,$0.00,$52.00,$0.00,$26.00,$41.18,$41.60,$0.00,$0.00,$0.00,$0.00,$0.00
600393,ERX,HCPCS 25000001,99999-6003-93,INDIGO CARMINE 5 ML/100 ML 0.9% SODIUM CHLORIDE -OR,$87.20,$0.00,$87.20,$0.00,$62.23,$0.00,$0.00,$0.00,$0.00,$0.00,$87.20,$0.00,$43.60,$69.06,$69.76,$0.00,$0.00,$0.00,$0.00,$0.00
600394,ERX,HCPCS 25000001,99999-6003-94,INDIGO CARMINE 5 ML/200 ML 0.9% SODIUM CHLORIDE -OR,$87.20,$0.00,$87.20,$0.00,$62.23,$0.00,$0.00,$0.00,$0.00,$0.00,$87.20,$0.00,$43.60,$69.06,$69.76,$0.00,$0.00,$0.00,$0.00,$0.00
600395,ERX,HCPCS 25000001,99999-6003-95,INDIGO CARMINE 5 ML/250 ML 0.9% SODIUM CHLORIDE -OR,$87.20,$0.00,$87.20,$0.00,$62.23,$0.00,$0.00,$0.00,$0.00,$0.00,$87.20,$0.00,$43.60,$69.06,$69.76,$0.00,$0.00,$0.00,$0.00,$0.00
600396,ERX,HCPCS 25000001,99999-6003-96,INDIGO CARMINE 5 ML/300 ML 0.9% SODIUM CHLORIDE -OR,$87.20,$0.00,$87.20,$0.00,$62.23,$0.00,$0.00,$0.00,$0.00,$0.00,$87.20,$0.00,$43.60,$69.06,$69.76,$0.00,$0.00,$0.00,$0.00,$0.00
600397,ERX,HCPCS J3475,15082-0902-05,MAGNESIUM SULFATE 2 G IN 50ML D5W PREMIX,$52.00,$0.00,$52.00,$23.40,$37.11,$0.00,$0.24,$0.00,$0.00,$2.96,$52.00,$0.00,$26.00,$41.18,$41.60,$0.00,$2.96,$0.00,$2.82,$0.00
600397,ERX,HCPCS J3475,42852-0902-05,MAGNESIUM SULFATE 2 G IN 50ML D5W PREMIX,$52.00,$0.00,$52.00,$23.40,$37.11,$0.00,$0.24,$0.00,$0.00,$2.96,$52.00,$0.00,$26.00,$41.18,$41.60,$0.00,$2.96,$0.00,$2.82,$0.00
600397,ERX,HCPCS J3475,99999-6008-51,MAGNESIUM SULFATE 2 G IN 50ML D5W PREMIX,$52.00,$0.00,$52.00,$23.40,$37.11,$0.00,$0.24,$0.00,$0.00,$2.96,$52.00,$0.00,$26.00,$41.18,$41.60,$0.00,$2.96,$0.00,$2.82,$0.00
600398,ERX,HCPCS J3475,15082-0903-05,MAGNESIUM SULFATE 4 G IN 50ML D5W PREMIX,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.47,$0.00,$0.00,$5.92,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$5.92,$0.00,$5.64,$0.00
600398,ERX,HCPCS J3475,99999-6006-44,MAGNESIUM SULFATE 4 G IN 50ML D5W PREMIX,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$0.47,$0.00,$0.00,$5.92,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$5.92,$0.00,$5.64,$0.00
600399,ERX,HCPCS J3475,24200-0015-13,MAGNESIUM SULFATE 50 G IN 600ML LR PREMIX,$85.35,$0.00,$85.35,$38.41,$60.91,$0.00,$5.88,$0.00,$0.00,$74.03,$85.35,$0.00,$42.68,$67.60,$68.28,$0.00,$74.03,$0.00,$70.48,$0.00
600399,ERX,HCPCS J3475,24200-1015-13,MAGNESIUM SULFATE 50 G IN 600ML LR PREMIX,$85.35,$0.00,$85.35,$38.41,$60.91,$0.00,$5.88,$0.00,$0.00,$74.03,$85.35,$0.00,$42.68,$67.60,$68.28,$0.00,$74.03,$0.00,$70.48,$0.00
600399,ERX,HCPCS J3475,99999-6006-77,MAGNESIUM SULFATE 50 G IN 600ML LR PREMIX,$85.35,$0.00,$85.35,$38.41,$60.91,$0.00,$5.88,$0.00,$0.00,$74.03,$85.35,$0.00,$42.68,$67.60,$68.28,$0.00,$74.03,$0.00,$70.48,$0.00
600403,ERX,HCPCS 25000001,15082-0211-10,FENTANYL 200MCG + 0.1% BUPIVACAINE/100ML NS EPIDURAL,$52.00,$0.00,$52.00,$0.00,$37.11,$0.00,$0.00,$0.00,$0.00,$0.00,$52.00,$0.00,$26.00,$41.18,$41.60,$0.00,$0.00,$0.00,$0.00,$0.00
600403,ERX,HCPCS 25000001,99999-6007-22,FENTANYL 200MCG + 0.1% BUPIVACAINE/100ML NS EPIDURAL,$52.00,$0.00,$52.00,$0.00,$37.11,$0.00,$0.00,$0.00,$0.00,$0.00,$52.00,$0.00,$26.00,$41.18,$41.60,$0.00,$0.00,$0.00,$0.00,$0.00
600420,ERX,HCPCS 25000001,99999-6008-76,ACETIC ACID 3% SOLN,$11.00,$0.00,$219.72,$0.00,$156.81,$0.00,$0.00,$0.00,$0.00,$0.00,$219.72,$0.00,$109.86,$8.71,$175.78,$0.00,$0.00,$0.00,$0.00,$0.00
600420,ERX,HCPCS 25000001,99999-6004-23,ACETIC ACID 3% SOLN,$219.72,$0.00,$219.72,$0.00,$156.81,$0.00,$0.00,$0.00,$0.00,$0.00,$219.72,$0.00,$109.86,$174.02,$175.78,$0.00,$0.00,$0.00,$0.00,$0.00
600421,ERX,HCPCS 25000001,535rf-p401-0j,NXSTAGE RFP 401 DIALYSIS SOLUTION,$83.13,$0.00,$83.13,$0.00,$59.33,$0.00,$0.00,$0.00,$0.00,$0.00,$83.13,$0.00,$41.57,$65.84,$66.50,$0.00,$0.00,$0.00,$0.00,$0.00
600421,ERX,HCPCS 25000001,99999-6004-24,NXSTAGE RFP 401 DIALYSIS SOLUTION,$83.13,$0.00,$83.13,$0.00,$59.33,$0.00,$0.00,$0.00,$0.00,$0.00,$83.13,$0.00,$41.57,$65.84,$66.50,$0.00,$0.00,$0.00,$0.00,$0.00
600422,ERX,HCPCS 25000001,535rf-p400-0i,NXSTAGE RFP 400 DIALYSIS SOLUTION,$83.13,$0.00,$83.13,$0.00,$59.33,$0.00,$0.00,$0.00,$0.00,$0.00,$83.13,$0.00,$41.57,$65.84,$66.50,$0.00,$0.00,$0.00,$0.00,$0.00
600422,ERX,HCPCS 25000001,99999-6004-25,NXSTAGE RFP 400 DIALYSIS SOLUTION,$83.13,$0.00,$83.13,$0.00,$59.33,$0.00,$0.00,$0.00,$0.00,$0.00,$83.13,$0.00,$41.57,$65.84,$66.50,$0.00,$0.00,$0.00,$0.00,$0.00
600423,ERX,HCPCS 25000001,99999-6004-27,CLINDAMYCIN 50MG/ML OPHTH SOLN 5 ML,$44.08,$0.00,$44.08,$0.00,$31.46,$0.00,$0.00,$0.00,$0.00,$0.00,$44.08,$0.00,$22.04,$34.91,$35.26,$0.00,$0.00,$0.00,$0.00,$0.00
600426,ERX,HCPCS 25000001,99999-6004-26,MECHLORETHAMINE 0.01% OINT,"$1,920.00",$0.00,"$1,920.00",$0.00,"$1,370.30",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,920.00",$0.00,$960.00,"$1,520.64","$1,536.00",$0.00,$0.00,$0.00,$0.00,$0.00
600435,ERX,HCPCS 25000001,99999-6004-39,CHOCOLATE SYRUP,$11.00,$0.00,$11.00,$0.00,$7.85,$0.00,$0.00,$0.00,$0.00,$0.00,$11.00,$0.00,$5.50,$8.71,$8.80,$0.00,$0.00,$0.00,$0.00,$0.00
600438,ERX,HCPCS 25000001,99999-6005-87,OR NEOMYCIN-POLYMYXIN B (NEOSPORIN GU) 3 ML/3000 ML NS IR,$216.78,$0.00,$216.78,$0.00,$154.72,$0.00,$0.00,$0.00,$0.00,$0.00,$216.78,$0.00,$108.39,$171.69,$173.42,$0.00,$0.00,$0.00,$0.00,$0.00
600450,ERX,HCPCS 25000001,99999-6004-58,PENICILLIN 160 UNITS/ML D5W DESENSITIZATION,$27.00,$0.00,$27.00,$0.00,$19.27,$0.00,$0.00,$0.00,$0.00,$0.00,$27.00,$0.00,$13.50,$21.38,$21.60,$0.00,$0.00,$0.00,$0.00,$0.00
600453,ERX,HCPCS J1644,15082-0747-99,HEPARIN 4000 UNITS/1000 ML NS IR,$119.00,$0.00,$119.00,$53.55,$84.93,$0.00,$0.94,$0.00,$0.00,$1.13,$119.00,$0.00,$59.50,$94.25,$95.20,$0.00,$1.13,$0.00,$1.07,$0.00
600453,ERX,HCPCS J1644,42852-0747-99,HEPARIN 4000 UNITS/1000 ML NS IR,$119.00,$0.00,$119.00,$53.55,$84.93,$0.00,$0.94,$0.00,$0.00,$1.13,$119.00,$0.00,$59.50,$94.25,$95.20,$0.00,$1.13,$0.00,$1.07,$0.00
600453,ERX,HCPCS J1644,71285-7022-01,HEPARIN 4000 UNITS/1000 ML NS IR,$119.00,$0.00,$119.00,$53.55,$84.93,$0.00,$0.94,$0.00,$0.00,$1.13,$119.00,$0.00,$59.50,$94.25,$95.20,$0.00,$1.13,$0.00,$1.07,$0.00
600456,ERX,HCPCS 25000001,99999-6005-64,DEXTROSE 5% FLUSH 2 ML IV SYRINGE (NICU),$27.00,$0.00,$27.00,$0.00,$19.27,$0.00,$0.00,$0.00,$0.00,$0.00,$27.00,$0.00,$13.50,$21.38,$21.60,$0.00,$0.00,$0.00,$0.00,$0.00
600457,ERX,HCPCS 25000001,00338-0023-03,DEXTROSE 10% (NICU) IV BOLUS SYRINGE,$22.80,$0.00,$22.80,$0.00,$16.27,$0.00,$0.00,$0.00,$0.00,$0.00,$22.80,$0.00,$11.40,$18.06,$18.24,$0.00,$0.00,$0.00,$0.00,$0.00
600493,ERX,HCPCS 25000001,99999-6005-84,MYCOPHENOLATE MOFETIL 200 MG/ML ORAL SYRINGE,$24.92,$0.00,$24.92,$0.00,$17.79,$0.00,$0.00,$0.00,$0.00,$0.00,$24.92,$0.00,$12.46,$19.74,$19.94,$0.00,$0.00,$0.00,$0.00,$0.00
600494,ERX,HCPCS 25000001,99999-6005-83,MULTIVITAMIN (AQUADEKS) ORAL SYRINGE (NICU),$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
600496,ERX,HCPCS 63700001,99999-6005-77,VITAMIN K 1 MG/ML (NICU) ORAL SYRINGE,$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
600499,ERX,HCPCS 25000001,99999-6005-65,AMPHOTERICIN 1MG/ML (NICU) COMPOUNDING,$85.75,$0.00,$85.75,$0.00,$61.20,$0.00,$0.00,$0.00,$0.00,$0.00,$85.75,$0.00,$42.88,$67.91,$68.60,$0.00,$0.00,$0.00,$0.00,$0.00
600501,ERX,HCPCS 25000001,99999-6005-66,OR ONLY-CEFAZOLIN 1G/NS 1000ML IRRIGATION SOLN,$62.37,$0.00,$62.37,$0.00,$44.51,$0.00,$0.00,$0.00,$0.00,$0.00,$62.37,$0.00,$31.19,$49.40,$49.90,$0.00,$0.00,$0.00,$0.00,$0.00
600502,ERX,HCPCS 25000001,99999-6005-67,OR ONLY-CEFAZOLIN 1GM/NS 1500ML IRRIG,$83.27,$0.00,$83.27,$0.00,$59.43,$0.00,$0.00,$0.00,$0.00,$0.00,$83.27,$0.00,$41.64,$65.95,$66.62,$0.00,$0.00,$0.00,$0.00,$0.00
600506,ERX,HCPCS C9257,99999-6005-71,BEVACIZUMAB 5 MG/0.2 ML OPHTH SYRINGE,$120.32,$0.00,$120.32,$54.14,$85.87,$40.60,$20.73,$0.00,$0.00,$21.07,$120.32,$42.63,$60.16,$95.29,$96.26,$58.87,$18.83,$0.00,$19.15,$39.20
600511,ERX,HCPCS 25000001,99999-6005-80,HYDROXYPROGESTERONE-17 250 MG/ML IM INJ,"$1,987.20",$0.00,"$1,987.20",$0.00,"$1,418.26",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,987.20",$0.00,$993.60,"$1,573.86","$1,589.76",$0.00,$0.00,$0.00,$0.00,$0.00
600521,ERX,HCPCS 25000001,99999-6005-97,"OR BACITRACIN 50,000 UNITS IN 1500 ML NS IR-NEURO",$103.95,$0.00,$103.95,$0.00,$74.19,$0.00,$0.00,$0.00,$0.00,$0.00,$103.95,$0.00,$51.98,$82.33,$83.16,$0.00,$0.00,$0.00,$0.00,$0.00
600522,ERX,HCPCS 25000001,99999-6005-98,OR NEOMYCIN-POLYMYXIN B 2 ML/1500 ML NS IR,$113.54,$0.00,$113.54,$0.00,$81.03,$0.00,$0.00,$0.00,$0.00,$0.00,$113.54,$0.00,$56.77,$89.92,$90.83,$0.00,$0.00,$0.00,$0.00,$0.00
600523,ERX,HCPCS 25000001,99999-6005-99,"OR CEFAZOLIN 1G+BACITRACIN 50,000UNITS+GENT80/1500 ML",$115.59,$0.00,$115.59,$0.00,$82.50,$0.00,$0.00,$0.00,$0.00,$0.00,$115.59,$0.00,$57.80,$91.55,$92.47,$0.00,$0.00,$0.00,$0.00,$0.00
600524,ERX,HCPCS 25000001,99999-6006-06,CIDOFOVIR 1% CREAM 37.5G,"$2,141.05",$0.00,"$2,141.05",$0.00,"$1,528.07",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,141.05",$0.00,"$1,070.53","$1,695.71","$1,712.84",$0.00,$0.00,$0.00,$0.00,$0.00
600531,ERX,HCPCS 25000001,99999-6006-16,OR CHLORHEXIDINE 0.12% 473 ML WITH 500 ML NSIR,$73.76,$0.00,$73.76,$0.00,$52.64,$0.00,$0.00,$0.00,$0.00,$0.00,$73.76,$0.00,$36.88,$58.42,$59.01,$0.00,$0.00,$0.00,$0.00,$0.00
600534,ERX,HCPCS 25000001,99999-6006-19,CEFTRIAXONE +LIDOCAINE 1% IM INJ,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
600536,ERX,HCPCS 25000001,99999-6006-22,OXYCHLOROSENE 0.4% IRRIGATION SOLN (2 G/500 ML NS),$12.92,$0.00,$12.92,$0.00,$9.22,$0.00,$0.00,$0.00,$0.00,$0.00,$12.92,$0.00,$6.46,$10.23,$10.34,$0.00,$0.00,$0.00,$0.00,$0.00
600539,ERX,HCPCS 25000001,99999-6006-24,AMIKACIN 250 MG/ML NEBU SOLN,$16.88,$0.00,$16.88,$0.00,$12.05,$0.00,$0.00,$0.00,$0.00,$0.00,$16.88,$0.00,$8.44,$13.37,$13.50,$0.00,$0.00,$0.00,$0.00,$0.00
600541,ERX,HCPCS 25000001,99999-6006-26,TOBRAMYCIN 40 MG/ML NEBU SOLN,$15.46,$0.00,$15.46,$0.00,$11.03,$0.00,$0.00,$0.00,$0.00,$0.00,$15.46,$0.00,$7.73,$12.24,$12.37,$0.00,$0.00,$0.00,$0.00,$0.00
600543,ERX,HCPCS J0878,99999-6006-30,DAPTOMYCIN 500MG/NS 50ML MB PLUS,$855.58,$0.00,$855.58,$385.01,$610.63,$165.00,$223.25,$0.00,$0.00,$170.38,$855.58,$173.25,$427.79,$677.62,$684.46,$239.25,$170.38,$0.00,$162.23,$68.00
600544,ERX,HCPCS 25000001,99999-6006-32,SODIUM BICARBONATE 1% ET IRRIGATION SOLUTION,$18.62,$0.00,$18.62,$0.00,$13.29,$0.00,$0.00,$0.00,$0.00,$0.00,$18.62,$0.00,$9.31,$14.75,$14.90,$0.00,$0.00,$0.00,$0.00,$0.00
600548,ERX,HCPCS 25000001,99999-6006-38,PODOPHYLLUM 40% IN BENZOIN,$251.94,$0.00,$251.94,$0.00,$179.81,$0.00,$0.00,$0.00,$0.00,$0.00,$251.94,$0.00,$125.97,$199.54,$201.55,$0.00,$0.00,$0.00,$0.00,$0.00
600550,ERX,HCPCS 25000001,99999-6006-43,VITAMIN K1 1 MG/0.1ML (NICU) >=1250 G,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
600556,ERX,HCPCS 25000001,,"PENICILLIN G 10,000 UNITS/ML ID INJ",$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
600557,ERX,HCPCS 25000001,99999-6006-55,SQUARIC ACID 2% TOP SOLN,$457.50,$0.00,$457.50,$0.00,$326.52,$0.00,$0.00,$0.00,$0.00,$0.00,$457.50,$0.00,$228.75,$362.34,$366.00,$0.00,$0.00,$0.00,$0.00,$0.00
600559,ERX,HCPCS 25000001,99999-6006-58,HISTAMINE BASE 1 MG/ML ID SOLN,$32.84,$0.00,$32.84,$0.00,$23.44,$0.00,$0.00,$0.00,$0.00,$0.00,$32.84,$0.00,$16.42,$26.01,$26.27,$0.00,$0.00,$0.00,$0.00,$0.00
600560,ERX,HCPCS J0640,99999-6006-60,LEUCOVORIN 50 MG/50 ML NS IVPB MB PLUS,$52.00,$0.00,$52.00,$23.40,$37.11,$0.00,$1.05,$0.00,$0.00,$3.91,$52.00,$0.00,$26.00,$41.18,$41.60,$0.00,$3.91,$0.00,$3.73,$0.00
600561,ERX,HCPCS 25000001,99999-6006-59,POLYMYXIN B 10 MG/ML D5W DESENSITIZATION,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
600562,ERX,HCPCS 25000001,99999-6006-61,POLYMYXIN B 1 MG/ML D5W DESENSITIZATION,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
600563,ERX,HCPCS 25000001,99999-6006-62,POLYMYXIN B 0.1 MG/ML D5W DESENSITIZATION,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
600564,ERX,HCPCS 25000001,99999-6006-63,POLYMYXIN B 0.01 MG/ML D5W DESENSITIZATION,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
600565,ERX,HCPCS 25000001,99999-6006-64,POLYMYXIN B 0.001 MG/ML D5W DESENSITIZATION,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
600566,ERX,HCPCS 25000001,99999-6006-65,POLYMYXIN B 0.0001 MG/ML D5W DESENSITIZATION,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
600570,ERX,HCPCS 25000001,00002-1036-13,DOMPERIDONE 10 MG TABLET,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
600571,ERX,HCPCS 25000001,99999-6006-72,VANCOMYCIN 15 MG/ML(1.5%) OPHTH SOLN,$53.19,$0.00,$53.19,$0.00,$37.96,$0.00,$0.00,$0.00,$0.00,$0.00,$53.19,$0.00,$26.60,$42.13,$42.55,$0.00,$0.00,$0.00,$0.00,$0.00
600575,ERX,HCPCS J8530,99999-6006-76,CYCLOPHOSPHAMIDE 100 MG/10 ML ORAL SYRINGE,$105.00,$0.00,$105.00,$0.00,$74.94,$0.00,$0.00,$0.00,$0.00,$0.00,$105.00,$0.00,$52.50,$83.16,$84.00,$0.00,$0.00,$0.00,$0.00,$0.00
600578,ERX,HCPCS 25000001,99999-6006-82,VANCOMYCIN 10MG-HEPARIN 5000 UNITS/2 ML FLUSH,$52.00,$0.00,$52.00,$0.00,$37.11,$0.00,$0.00,$0.00,$0.00,$0.00,$52.00,$0.00,$26.00,$41.18,$41.60,$0.00,$0.00,$0.00,$0.00,$0.00
600589,ERX,HCPCS 25000001,99999-6007-00,STREPTOMYCIN 5 MG/ML NS (NICU) IV SYRINGE,$27.00,$0.00,$27.00,$0.00,$19.27,$0.00,$0.00,$0.00,$0.00,$0.00,$27.00,$0.00,$13.50,$21.38,$21.60,$0.00,$0.00,$0.00,$0.00,$0.00
600595,ERX,HCPCS 25000001,99999-6007-08,TRICHLOROACETIC ACID 70 % EXTERNAL SOLN,$167.58,$0.00,$167.58,$0.00,$119.60,$0.00,$0.00,$0.00,$0.00,$0.00,$167.58,$0.00,$83.79,$132.72,$134.06,$0.00,$0.00,$0.00,$0.00,$0.00
600603,ERX,HCPCS 25000001,99999-6007-15,DILTIAZEM 2% OINTMENT,$19.46,$0.00,$19.46,$0.00,$13.89,$0.00,$0.00,$0.00,$0.00,$0.00,$19.46,$0.00,$9.73,$15.41,$15.57,$0.00,$0.00,$0.00,$0.00,$0.00
600608,ERX,HCPCS J0610,24200-0066-10,CALCIUM GLUCONATE 3 GM IN SODIUM CHLORIDE 250 ML,$57.00,$0.00,$57.00,$25.65,$40.68,$0.00,$1.02,$0.00,$0.00,$12.13,$57.00,$0.00,$28.50,$45.14,$45.60,$0.00,$12.13,$0.00,$11.55,$0.00
600626,ERX,HCPCS 25000001,99999-6007-47,BOSENTAN 6.25 MG/ML (NICU) ORAL SYRINGE,$48.00,$0.00,$48.00,$0.00,$34.26,$0.00,$0.00,$0.00,$0.00,$0.00,$48.00,$0.00,$24.00,$38.02,$38.40,$0.00,$0.00,$0.00,$0.00,$0.00
600627,ERX,HCPCS 25000001,99999-6007-49,CEFTAZIDIME 50MG/ML FORTIFIED OPHTH SOLN 10 ML,$38.00,$0.00,$38.00,$0.00,$27.12,$0.00,$0.00,$0.00,$0.00,$0.00,$38.00,$0.00,$19.00,$30.10,$30.40,$0.00,$0.00,$0.00,$0.00,$0.00
600632,ERX,HCPCS 25000001,99999-6007-51,GENTAMICIN 40 MG/ML NEBU SOLN,$9.24,$0.00,$9.24,$0.00,$6.59,$0.00,$0.00,$0.00,$0.00,$0.00,$9.24,$0.00,$4.62,$7.32,$7.39,$0.00,$0.00,$0.00,$0.00,$0.00
600633,ERX,HCPCS 63700001,99999-6007-52,AZATHIOPRINE 50 MG/ML ORAL SYRINGE,$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
600638,ERX,HCPCS 25000001,99999-6007-56,CYCLOSPORINE 2% OPHTH SOLN,$114.35,$0.00,$114.35,$0.00,$81.61,$0.00,$0.00,$0.00,$0.00,$0.00,$114.35,$0.00,$57.18,$90.57,$91.48,$0.00,$0.00,$0.00,$0.00,$0.00
600639,ERX,HCPCS 25000001,99999-6007-57,DEXTROSE 5% FLUSH IV SYRINGE (ADULT),$27.00,$0.00,$27.00,$0.00,$19.27,$0.00,$0.00,$0.00,$0.00,$0.00,$27.00,$0.00,$13.50,$21.38,$21.60,$0.00,$0.00,$0.00,$0.00,$0.00
600640,ERX,HCPCS 25000001,99999-6007-58,PEDIATRACE ELEMENTS,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
600641,ERX,HCPCS 25000001,99999-6007-59,METRONIDAZOLE 0.005 MG/ML NS IV DESENSITIZATION,$27.00,$0.00,$27.00,$0.00,$19.27,$0.00,$0.00,$0.00,$0.00,$0.00,$27.00,$0.00,$13.50,$21.38,$21.60,$0.00,$0.00,$0.00,$0.00,$0.00
600642,ERX,HCPCS 25000001,99999-6007-60,METRONIDAZOLE 0.05 MG/ML NS IV DESENSITIZATION,$27.00,$0.00,$27.00,$0.00,$19.27,$0.00,$0.00,$0.00,$0.00,$0.00,$27.00,$0.00,$13.50,$21.38,$21.60,$0.00,$0.00,$0.00,$0.00,$0.00
600643,ERX,HCPCS 25000001,99999-6007-61,METRONIDAZOLE 0.5 MG/ML NS IV DESENSITIZATION,$27.00,$0.00,$27.00,$0.00,$19.27,$0.00,$0.00,$0.00,$0.00,$0.00,$27.00,$0.00,$13.50,$21.38,$21.60,$0.00,$0.00,$0.00,$0.00,$0.00
600644,ERX,HCPCS 25000001,99999-6007-62,METRONIDAZOLE 5 MG/ML NS IV DESENSITIZATION,$27.00,$0.00,$27.00,$0.00,$19.27,$0.00,$0.00,$0.00,$0.00,$0.00,$27.00,$0.00,$13.50,$21.38,$21.60,$0.00,$0.00,$0.00,$0.00,$0.00
600646,ERX,HCPCS 25000001,99999-6007-64,VANCOMYCIN 125 MG/5 ML ORAL SOLUTION UNIT-DOSE CUP,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
600647,ERX,HCPCS 25000001,99999-6007-65,HEPARIN SODIUM NEBU 5000 UNITS/1 ML SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
600658,ERX,HCPCS 25000001,99999-6007-79,ASPIRIN 1 MG/1 ML SUSP DESENSITIZATION BTL A,$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
600660,ERX,HCPCS 63600001,99999-6007-81,TERBUTALINE SULFATE 1 MG/ML NEBU SOLN,$75.56,$0.00,$75.56,$0.00,$53.93,$0.00,$0.00,$0.00,$0.00,$0.00,$75.56,$0.00,$37.78,$59.84,$60.45,$0.00,$0.00,$0.00,$0.00,$0.00
600661,ERX,HCPCS 25000001,99999-6007-85,CLINDAMYCIN 1 MG/0.1 ML NS 0.5 ML INTRAVITREAL SYRINGE,$27.00,$0.00,$27.00,$0.00,$19.27,$0.00,$0.00,$0.00,$0.00,$0.00,$27.00,$0.00,$13.50,$21.38,$21.60,$0.00,$0.00,$0.00,$0.00,$0.00
600668,ERX,HCPCS 25000001,99999-6007-92,OSELTAMIVIR PEDS 6 MG/ML ORAL SYRINGE,$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
600672,ERX,HCPCS 63700001,99999-6007-94,CHOLECALCIFEROL 400 UNIT/ML (NICU) ORAL SYRINGE,$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
600673,ERX,HCPCS 25000001,99999-6007-95,AMPHOTERICIN B ORAL SOLUTION 1MG/ML,$556.32,$0.00,$556.32,$0.00,$397.05,$0.00,$0.00,$0.00,$0.00,$0.00,$556.32,$0.00,$278.16,$440.61,$445.06,$0.00,$0.00,$0.00,$0.00,$0.00
600676,ERX,HCPCS 25000001,99999-6007-97,MORPHINE SULF 0.4 MG/1 ML ORAL SYRINGE (NICU),$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
600683,ERX,HCPCS Q4074,99999-6008-05,ILOPROST 5 MCG/0.25 ML NEB SYRINGE,$45.65,$0.00,$45.65,$0.00,$32.58,$0.00,$0.00,$0.00,$0.00,$0.00,$45.65,$0.00,$22.83,$36.15,$36.52,$0.00,$0.00,$0.00,$0.00,$0.00
600686,ERX,HCPCS J0712,99999-6008-78,CEFTAROLINE FOSAMIL 400MG/NS 250 ML MB PLUS,$477.43,$0.00,$477.43,$0.00,$340.74,$0.00,$0.00,$0.00,$0.00,$0.00,$477.43,$0.00,$238.72,$378.12,$381.94,$0.00,$0.00,$0.00,$0.00,$0.00
600689,ERX,HCPCS 25000001,99999-6008-11,DIGOXIN 2 MG (0.25 MG/ML)/8 ML SYRINGE INTRA-AMNIOTIC,$26.97,$0.00,$26.97,$0.00,$19.25,$0.00,$0.00,$0.00,$0.00,$0.00,$26.97,$0.00,$13.49,$21.36,$21.58,$0.00,$0.00,$0.00,$0.00,$0.00
600690,ERX,HCPCS 25000001,85412-0034-62,STERILE EMPTY CONTAINER 1000 ML,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
600690,ERX,HCPCS 25000001,99999-6009-23,STERILE EMPTY CONTAINER 1000 ML,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
600692,ERX,HCPCS J2543,99999-6008-21,PIPERACIL-TAZ 2.25 G/NS 50 ML MB PLUS,$71.62,$0.00,$71.62,$32.23,$51.12,$0.00,$13.09,$0.00,$0.00,$4.35,$71.62,$0.00,$35.81,$56.72,$57.30,$0.00,$4.35,$0.00,$4.14,$0.00
600698,ERX,HCPCS 25000001,99999-6008-27,LIDOCAINE HCL 0.1 % IJ SOLN-ALLERGY CLINIC,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
600699,ERX,HCPCS 25000001,99999-6008-28,LIDOCAINE HCL 0.01 % IJ SOLN-ALLERGY CLINIC,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
600700,ERX,HCPCS 25000001,99999-6008-30,ONDANSETRON 0.8 MG/ML ORAL SYRINGE (NICU),$23.70,$0.00,$23.70,$0.00,$16.91,$0.00,$0.00,$0.00,$0.00,$0.00,$23.70,$0.00,$11.85,$18.77,$18.96,$0.00,$0.00,$0.00,$0.00,$0.00
600701,ERX,HCPCS J0696,00409-7332-01,CEFTRIAXONE CUSTOM 1 G VIAL FOR DESENSITIZATION,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$5.64,$0.00,$0.00,$2.82,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$2.82,$0.00,$2.69,$0.00
600706,ERX,HCPCS Q9967,00407-1413-58,IOHEXOL 300 MG/ML 30 ML PO SOLUTION,$174.41,$0.00,$174.41,$78.48,$124.48,$0.00,$30.05,$0.00,$0.00,$0.14,$174.41,$0.00,$87.21,$138.13,$139.53,$0.00,$0.13,$0.00,$27.77,$0.00
600706,ERX,HCPCS Q9967,00407-1413-59,IOHEXOL 300 MG/ML 30 ML PO SOLUTION,$174.41,$0.00,$174.41,$78.48,$124.48,$0.00,$30.05,$0.00,$0.00,$0.14,$174.41,$0.00,$87.21,$138.13,$139.53,$0.00,$0.13,$0.00,$27.77,$0.00
600707,ERX,HCPCS 95165,99999-6008-39,ALLERGEN EXTRACTS PREPARATION,$87.50,$0.00,$87.50,$0.00,$62.45,$0.00,$0.00,$0.00,$0.00,$0.00,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$0.00,$0.00,$0.00,$0.00
600710,ERX,HCPCS 25000001,99999-6008-42,METHOHEXITAL 1MG/ML SW IV SYRINGE-NEURO,$27.00,$0.00,$27.00,$0.00,$19.27,$0.00,$0.00,$0.00,$0.00,$0.00,$27.00,$0.00,$13.50,$21.38,$21.60,$0.00,$0.00,$0.00,$0.00,$0.00
600714,ERX,HCPCS 25000001,99999-6008-45,KPHOS 0.05 MM/ML D5W (NICU) IV SYRINGE,$27.00,$0.00,$27.00,$0.00,$19.27,$0.00,$0.00,$0.00,$0.00,$0.00,$27.00,$0.00,$13.50,$21.38,$21.60,$0.00,$0.00,$0.00,$0.00,$0.00
600715,ERX,HCPCS 25000001,99999-6008-46,SODIUM PHOSPHATE 0.05 MM/ML D5W (NICU) IV SYRINGE,$27.00,$0.00,$27.00,$0.00,$19.27,$0.00,$0.00,$0.00,$0.00,$0.00,$27.00,$0.00,$13.50,$21.38,$21.60,$0.00,$0.00,$0.00,$0.00,$0.00
600722,ERX,HCPCS 25000001,00338-0221-04,PLASMA-LYTE A IV BOLUS,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
600725,ERX,HCPCS 25000001,99999-6008-55,VORICONAZOLE 100MCG/0.1 ML NS OPHTH SYRINGE,$465.37,$0.00,$465.37,$0.00,$332.13,$0.00,$0.00,$0.00,$0.00,$0.00,$465.37,$0.00,$232.69,$368.57,$372.30,$0.00,$0.00,$0.00,$0.00,$0.00
600726,ERX,HCPCS 25000001,99999-6008-56,DEXTROSE 25% SOLN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
600727,ERX,HCPCS 25000001,99999-6008-57,AMPHOTERICIN B 0.15% OPHTHALMIC SOLN,$51.99,$0.00,$51.99,$0.00,$37.11,$0.00,$0.00,$0.00,$0.00,$0.00,$51.99,$0.00,$26.00,$41.18,$41.59,$0.00,$0.00,$0.00,$0.00,$0.00
600732,ERX,HCPCS 25000001,99999-6008-64,ASCORBIC ACID OPHTH SOLN 100 MG/ML,$27.33,$0.00,$27.33,$0.00,$19.51,$0.00,$0.00,$0.00,$0.00,$0.00,$27.33,$0.00,$13.67,$21.65,$21.86,$0.00,$0.00,$0.00,$0.00,$0.00
600733,ERX,HCPCS J9214,99999-6008-65,INTERFERON ALFA-2B OPHTH SOLN 1000000 UNITS/ML,"$4,956.90",$0.00,"$4,956.90",$0.00,"$3,537.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,956.90",$0.00,"$2,478.45","$3,925.86","$3,965.52",$0.00,$0.00,$0.00,$0.00,$0.00
600735,ERX,HCPCS 25000001,99999-6008-66,METRONIDAZOLE 0.0005MG/ML ORAL SYRINGE DESENSITIZATIO,$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
600736,ERX,HCPCS 25000001,99999-6008-67,METRONIDAZOLE 0.005MG/ML ORAL SYRINGE DESENSITIZATION,$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
600737,ERX,HCPCS 25000001,99999-6008-68,METRONIDAZOLE 0.05MG/ML ORAL SYRINGE DESENSITIZATION,$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
600738,ERX,HCPCS 25000001,99999-6008-69,METRONIDAZOLE 0.5MG/ML ORAL SYRINGE DESENSITIZATION,$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
600739,ERX,HCPCS 25000001,99999-6008-70,METRONIDAZOLE 5MG/ML ORAL SYRINGE DESENSITIZATION,$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
600743,ERX,HCPCS 63700001,99999-6008-74,MERCAPTOPURINE 25 MG PO TAB,$7.78,$0.00,$7.78,$0.00,$5.55,$0.00,$0.00,$0.00,$0.00,$0.00,$7.78,$0.00,$3.89,$6.16,$6.22,$0.00,$0.00,$0.00,$0.00,$0.00
600744,ERX,HCPCS 25000001,99999-6008-75,WHISKY (40% ABV),$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
600745,ERX,HCPCS J0712,99999-6008-79,CEFTAROLINE FOSAMIL 600MG/NS 250 ML MB PLUS,$477.43,$0.00,$477.43,$0.00,$340.74,$0.00,$0.00,$0.00,$0.00,$0.00,$477.43,$0.00,$238.72,$378.12,$381.94,$0.00,$0.00,$0.00,$0.00,$0.00
600747,ERX,HCPCS J3301,99999-6008-81,TRIAMCINOLONE 40MG/1 ML + LIDOCAINE 1% 1 ML,$52.00,$0.00,$52.00,$23.40,$37.11,$0.00,$3.55,$0.00,$0.00,$3.67,$52.00,$0.00,$26.00,$41.18,$41.60,$0.00,$3.67,$0.00,$3.49,$0.00
600756,ERX,HCPCS 25000001,99999-6008-94,GENTIAN VIOLET 0.00165% SOLUTION ,$131.25,$0.00,$131.25,$0.00,$93.67,$0.00,$0.00,$0.00,$0.00,$0.00,$131.25,$0.00,$65.63,$103.95,$105.00,$0.00,$0.00,$0.00,$0.00,$0.00
600765,ERX,HCPCS 25000001,99999-6009-00,NALOXONE ORAL SYRINGE 0.4 MG/ML,$299.25,$0.00,$299.25,$0.00,$213.57,$0.00,$0.00,$0.00,$0.00,$0.00,$299.25,$0.00,$149.63,$237.01,$239.40,$0.00,$0.00,$0.00,$0.00,$0.00
600767,ERX,HCPCS 25000001,99999-6009-02,GLYCOPYRROLATE 0.2 MG/ML NEBU SOLN,$6.00,$0.00,$6.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$4.75,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
600768,ERX,HCPCS J1580,99999-6009-04,GENTAMICIN 80 MG/500 ML NS FOR IRRIGATION,$52.00,$0.00,$52.00,$23.40,$37.11,$0.00,$1.02,$0.00,$0.00,$2.31,$52.00,$0.00,$26.00,$41.18,$41.60,$0.00,$2.31,$0.00,$2.20,$0.00
600772,ERX,HCPCS 25000001,99999-6009-09,PEDIATRIC MAGIC MOUTH WASH,$539.85,$0.00,$539.85,$0.00,$385.29,$0.00,$0.00,$0.00,$0.00,$0.00,$539.85,$0.00,$269.93,$427.56,$431.88,$0.00,$0.00,$0.00,$0.00,$0.00
600773,ERX,HCPCS 25000001,15082-0828-68,GLYCOPYRROLATE 0.6 MG/3 ML IV SYRINGE,$124.11,$0.00,$124.11,$0.00,$88.58,$0.00,$0.00,$0.00,$0.00,$0.00,$124.11,$0.00,$62.06,$98.30,$99.29,$0.00,$0.00,$0.00,$0.00,$0.00
600774,ERX,HCPCS 25000001,99999-6009-11,WBC NUCLEAR ISOTOPE,$927.50,$0.00,$927.50,$0.00,$661.96,$0.00,$0.00,$0.00,$0.00,$0.00,$927.50,$0.00,$463.75,$734.58,$742.00,$0.00,$0.00,$0.00,$0.00,$0.00
600779,ERX,HCPCS 25000001,99999-6009-17,DEXTROSE 5 % FLUSH-AMPHO PANEL,"$1,656.00",$0.00,"$1,656.00",$0.00,"$1,181.89",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,656.00",$0.00,$828.00,"$1,311.55","$1,324.80",$0.00,$0.00,$0.00,$0.00,$0.00
600779,ERX,HCPCS 25000001,99999-6010-37,DEXTROSE 5 % FLUSH-AMPHO PANEL,"$1,656.00",$0.00,"$1,656.00",$0.00,"$1,181.89",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,656.00",$0.00,$828.00,"$1,311.55","$1,324.80",$0.00,$0.00,$0.00,$0.00,$0.00
600789,ERX,HCPCS J0690,99999-6009-29,CEFAZOLIN 2 G/D5W 100 ML IVPB,$52.00,$0.00,$52.00,$23.40,$37.11,$0.00,$2.77,$0.00,$0.00,$3.85,$52.00,$0.00,$26.00,$41.18,$41.60,$0.00,$3.85,$0.00,$3.67,$0.00
600798,ERX,HCPCS 25000001,99999-6009-41,RBC NUCLEAR ISOTOPE,$927.50,$0.00,$927.50,$0.00,$661.96,$0.00,$0.00,$0.00,$0.00,$0.00,$927.50,$0.00,$463.75,$734.58,$742.00,$0.00,$0.00,$0.00,$0.00,$0.00
600799,ERX,HCPCS 25000001,99999-6009-42,METRONIDAZOLE 20MG/ML PEDIATRIC ORAL SUSPENSION,$316.44,$0.00,$316.44,$0.00,$225.84,$0.00,$0.00,$0.00,$0.00,$0.00,$316.44,$0.00,$158.22,$250.62,$253.15,$0.00,$0.00,$0.00,$0.00,$0.00
600801,ERX,HCPCS 63700001,99999-6009-44,MISOPROSTOL 25 MCG PO TABLET,$12.63,$0.00,$12.63,$0.00,$9.01,$0.00,$0.00,$0.00,$0.00,$0.00,$12.63,$0.00,$6.32,$10.00,$10.10,$0.00,$0.00,$0.00,$0.00,$0.00
600811,ERX,HCPCS 25000001,,NITROGLYCERIN 200 MCG/ML D5W 5 ML IV SYRINGE ANGIO,$27.00,$0.00,$27.00,$0.00,$19.27,$0.00,$0.00,$0.00,$0.00,$0.00,$27.00,$0.00,$13.50,$21.38,$21.60,$0.00,$0.00,$0.00,$0.00,$0.00
600811,ERX,HCPCS 25000001,99999-6009-52,NITROGLYCERIN 200 MCG/ML D5W 5 ML IV SYRINGE ANGIO,$27.00,$0.00,$27.00,$0.00,$19.27,$0.00,$0.00,$0.00,$0.00,$0.00,$27.00,$0.00,$13.50,$21.38,$21.60,$0.00,$0.00,$0.00,$0.00,$0.00
600814,ERX,HCPCS 25000001,99999-6009-55,ARGATROBAN 100 MCG/1000 ML NS,"$1,033.50",$0.00,"$1,033.50",$0.00,$737.61,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,033.50",$0.00,$516.75,$818.53,$826.80,$0.00,$0.00,$0.00,$0.00,$0.00
600816,ERX,HCPCS 63700001,99999-6011-79,HYDROXYUREA ORAL SOLN 100 MG/ML,$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
600821,ERX,HCPCS J1956,99999-6009-64,LEVOFLOXACIN 7.5 MG/1.5 ML D5W PO SOLN,$9.00,$0.00,$9.00,$4.05,$6.42,$0.00,$1.55,$0.00,$0.00,$1.58,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$1.41,$0.00,$1.43,$0.00
600822,ERX,HCPCS J1956,99999-6009-65,LEVOFLOXACIN 75 MG/15 ML D5W PO SOLN,$12.77,$0.00,$12.77,$5.75,$9.11,$0.00,$2.20,$0.00,$0.00,$2.24,$12.77,$0.00,$6.39,$10.11,$10.22,$0.00,$2.00,$0.00,$2.03,$0.00
600824,ERX,HCPCS 25000001,,CANTHARIDIN 0.7% TOPICAL LIQUID,$608.48,$0.00,$608.48,$0.00,$434.27,$0.00,$0.00,$0.00,$0.00,$0.00,$608.48,$0.00,$304.24,$481.92,$486.78,$0.00,$0.00,$0.00,$0.00,$0.00
600827,ERX,HCPCS C9132,99999-6009-70,"PROTHROMBIN COMPLEX CONCENTRATE, 4-FACTOR (KCENTRA) IV 1500 UNITS/60ML","$8,148.75",$0.00,"$8,148.75",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,148.75",$0.00,"$4,074.38","$6,453.81","$6,519.00",$0.00,$0.00,$0.00,$0.00,$0.00
600845,ERX,HCPCS J3370,99999-6009-81,VANCOMYCIN 1.5 G IN D5W 500 ML PREMIX,$79.60,$0.00,$79.60,$35.82,$56.81,$0.00,$10.86,$0.00,$0.00,$11.95,$79.60,$0.00,$39.80,$63.04,$63.68,$0.00,$11.95,$0.00,$11.38,$0.00
600855,ERX,HCPCS J2543,99999-6009-85,PIPERACIL-TAZO 4.5 G/50 ML D5W MB PLUS,$95.18,$0.00,$95.18,$42.83,$67.93,$0.00,$26.18,$0.00,$0.00,$8.70,$95.18,$0.00,$47.59,$75.38,$76.14,$0.00,$8.70,$0.00,$8.28,$0.00
600858,ERX,HCPCS 25000001,00264-7750-00,LACTATED RINGERS IV BOLUS ML/KG,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
600858,ERX,HCPCS 25000001,00338-0117-04,LACTATED RINGERS IV BOLUS ML/KG,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
600858,ERX,HCPCS 25000001,00264-7750-20,LACTATED RINGERS IV BOLUS ML/KG,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
600858,ERX,HCPCS 25000001,00338-0117-03,LACTATED RINGERS IV BOLUS ML/KG,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
600858,ERX,HCPCS 25000001,00409-7953-03,LACTATED RINGERS IV BOLUS ML/KG,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
600859,ERX,HCPCS 25000001,99999-6009-88,GENTAMICIN 160MG+POLYMIXIN B 200MG+NEOMYCIN 1000MG/2L  IRRIGATION SOLN,$610.00,$0.00,$610.00,$0.00,$435.36,$0.00,$0.00,$0.00,$0.00,$0.00,$610.00,$0.00,$305.00,$483.12,$488.00,$0.00,$0.00,$0.00,$0.00,$0.00
600865,ERX,HCPCS 25000001,99999-6009-95,AMIKACIN 4 MG/ML OPHTH SOLN 10 ML,$16.88,$0.00,$16.88,$0.00,$12.05,$0.00,$0.00,$0.00,$0.00,$0.00,$16.88,$0.00,$8.44,$13.37,$13.50,$0.00,$0.00,$0.00,$0.00,$0.00
600868,ERX,HCPCS J3301,99999-6009-98,TRIAMCINOLONE ACETONIDE 2.5 MG/ML IJ SUSP,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.77,$0.00,$0.00,$1.83,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.83,$0.00,$1.75,$0.00
600869,ERX,HCPCS J3301,99999-6009-99,TRIAMCINOLONE ACETONIDE 5 MG/ML IJ SUSP,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.77,$0.00,$0.00,$1.83,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.83,$0.00,$1.75,$0.00
600870,ERX,HCPCS J3301,99999-6010-00,TRIAMCINOLONE ACETONIDE 4 MG/ML IJ SUSP,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.77,$0.00,$0.00,$1.83,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.83,$0.00,$1.75,$0.00
600871,ERX,HCPCS J3301,99999-6010-01,TRIAMCINOLONE ACETONIDE 20 MG/ML IJ SUSP,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.55,$0.00,$0.00,$3.67,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.67,$0.00,$3.49,$0.00
600878,ERX,HCPCS 25000001,68065-1134-72,"ON-Q PAIN PUMP SINGLE LUMEN SELECT-A-FLOW, 400 ML, 2-14 ML/HR",$728.75,$0.00,$728.75,$0.00,$520.11,$0.00,$0.00,$0.00,$0.00,$0.00,$728.75,$0.00,$364.38,$577.17,$583.00,$0.00,$0.00,$0.00,$0.00,$0.00
600878,ERX,HCPCS 25000001,99999-6010-06,"ON-Q PAIN PUMP SINGLE LUMEN SELECT-A-FLOW, 400 ML, 2-14 ML/HR",$728.75,$0.00,$728.75,$0.00,$520.11,$0.00,$0.00,$0.00,$0.00,$0.00,$728.75,$0.00,$364.38,$577.17,$583.00,$0.00,$0.00,$0.00,$0.00,$0.00
600878,ERX,HCPCS 25000001,99999-6011-27,"ON-Q PAIN PUMP SINGLE LUMEN SELECT-A-FLOW, 400 ML, 2-14 ML/HR",$728.75,$0.00,$728.75,$0.00,$520.11,$0.00,$0.00,$0.00,$0.00,$0.00,$728.75,$0.00,$364.38,$577.17,$583.00,$0.00,$0.00,$0.00,$0.00,$0.00
600879,ERX,HCPCS 25000001,,"ON-Q PAIN PUMP DUAL LUMEN SELECT-A-FLOW, 400 ML, 2-14 ML/HR",$878.74,$0.00,$878.74,$0.00,$627.16,$0.00,$0.00,$0.00,$0.00,$0.00,$878.74,$0.00,$439.37,$695.96,$702.99,$0.00,$0.00,$0.00,$0.00,$0.00
600879,ERX,HCPCS 25000001,68065-1316-14,"ON-Q PAIN PUMP DUAL LUMEN SELECT-A-FLOW, 400 ML, 2-14 ML/HR",$878.74,$0.00,$878.74,$0.00,$627.16,$0.00,$0.00,$0.00,$0.00,$0.00,$878.74,$0.00,$439.37,$695.96,$702.99,$0.00,$0.00,$0.00,$0.00,$0.00
600879,ERX,HCPCS 25000001,99999-6010-07,"ON-Q PAIN PUMP DUAL LUMEN SELECT-A-FLOW, 400 ML, 2-14 ML/HR",$878.74,$0.00,$878.74,$0.00,$627.16,$0.00,$0.00,$0.00,$0.00,$0.00,$878.74,$0.00,$439.37,$695.96,$702.99,$0.00,$0.00,$0.00,$0.00,$0.00
600880,ERX,HCPCS J0692,99999-6011-00,CEFEPIME 1 G/100 ML NS MB PLUS,$52.00,$0.00,$52.00,$23.40,$37.11,$0.00,$8.96,$0.00,$0.00,$9.10,$52.00,$0.00,$26.00,$41.18,$41.60,$0.00,$8.14,$0.00,$8.28,$0.00
600881,ERX,HCPCS J0692,99999-6011-01,CEFEPIME 2 G/100 ML NS MB PLUS,$60.60,$0.00,$60.60,$27.27,$43.25,$0.00,$10.44,$0.00,$0.00,$10.61,$60.60,$0.00,$30.30,$48.00,$48.48,$0.00,$9.48,$0.00,$9.65,$0.00
600885,ERX,HCPCS J0295,99999-6010-13,AMPICILLIN-SULB 3 G/D5W 100ML MB PLUS,$130.15,$0.00,$130.15,$58.57,$92.89,$0.00,$8.48,$0.00,$0.00,$6.06,$130.15,$0.00,$65.08,$103.08,$104.12,$0.00,$6.06,$0.00,$5.77,$0.00
600886,ERX,HCPCS J0290,99999-6012-11,AMPICILLIN 2 G/100ML D5W MB PLUS,$74.01,$0.00,$74.01,$33.30,$52.82,$0.00,$10.43,$0.00,$0.00,$4.61,$74.01,$0.00,$37.01,$58.62,$59.21,$0.00,$4.61,$0.00,$4.39,$0.00
600889,ERX,HCPCS J3370,99999-6010-17,VANCOMYCIN 1.5 G IN NS 250 ML PREMIX,$282.75,$0.00,$282.75,$127.24,$201.80,$0.00,$10.86,$0.00,$0.00,$11.95,$282.75,$0.00,$141.38,$223.94,$226.20,$0.00,$11.95,$0.00,$11.38,$0.00
600892,ERX,HCPCS J0740,,CIDOFOVIR INTRALESIONAL 15 MG/ML INJ,$541.68,$0.00,$541.68,$0.00,$386.60,$0.00,$0.00,$0.00,$0.00,$0.00,$541.68,$0.00,$270.84,$429.01,$433.34,$0.00,$0.00,$0.00,$0.00,$0.00
600893,ERX,HCPCS 25000001,99999-6011-34,ADULT MAGIC MOUTHWASH(MLX:BEN:LIDO) SUSPENSION,$22.42,$0.00,$82.60,$0.00,$58.95,$0.00,$0.00,$0.00,$0.00,$0.00,$82.60,$0.00,$41.30,$17.76,$66.08,$0.00,$0.00,$0.00,$0.00,$0.00
600893,ERX,HCPCS 25000001,99999-6011-33,ADULT MAGIC MOUTHWASH(MLX:BEN:LIDO) SUSPENSION,$82.60,$0.00,$82.60,$0.00,$58.95,$0.00,$0.00,$0.00,$0.00,$0.00,$82.60,$0.00,$41.30,$65.42,$66.08,$0.00,$0.00,$0.00,$0.00,$0.00
600894,ERX,HCPCS 25000001,99999-6011-35,NITROFURANTOIN 10MG/ML ORAL SUSPENSION  ,$51.76,$0.00,$51.76,$0.00,$36.94,$0.00,$0.00,$0.00,$0.00,$0.00,$51.76,$0.00,$25.88,$40.99,$41.41,$0.00,$0.00,$0.00,$0.00,$0.00
600895,ERX,HCPCS J3010,99999-6011-36,FENTANYL DRIP SYRINGE,$74.73,$0.00,$74.73,$33.63,$53.33,$0.00,$12.88,$0.00,$0.00,$29.08,$74.73,$0.00,$37.37,$59.19,$59.78,$0.00,$29.08,$0.00,$27.69,$0.00
600897,ERX,HCPCS J3010,99999-6011-36,FENTANYL CITRATE PF PCA 50 MCG/ML IV SOLN 50 ML,$74.73,$0.00,$74.73,$33.63,$53.33,$0.00,$12.88,$0.00,$0.00,$29.08,$74.73,$0.00,$37.37,$59.19,$59.78,$0.00,$29.08,$0.00,$27.69,$0.00
600898,ERX,HCPCS J3010,99999-6011-38,FENTANYL 2500 MCG/50 ML PREMIX,$89.73,$0.00,$89.73,$40.38,$64.04,$0.00,$15.46,$0.00,$0.00,$29.08,$89.73,$0.00,$44.87,$71.07,$71.78,$0.00,$29.08,$0.00,$27.69,$0.00
600900,ERX,HCPCS J3010,99999-6011-41,FENTANYL 5000 MCG/100 ML PREMIX,$164.45,$0.00,$164.45,$74.00,$117.37,$0.00,$28.33,$0.00,$0.00,$58.16,$164.45,$0.00,$82.23,$130.24,$131.56,$0.00,$58.16,$0.00,$55.38,$0.00
600915,ERX,HCPCS J0834,99999-6011-50,COSYNTROPIN 2 MCG/ML SYRINGE- ENDOCRINOLOGY CLINIC,$22.00,$0.00,$44.56,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$44.56,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$44.56,$0.00,$42.42,$0.00
600925,ERX,HCPCS 25000001,99999-6011-65,GANCICLOVIR 5 MG/ML NS (NICU) IV SYRINGE,$27.00,$0.00,$27.00,$0.00,$19.27,$0.00,$0.00,$0.00,$0.00,$0.00,$27.00,$0.00,$13.50,$21.38,$21.60,$0.00,$0.00,$0.00,$0.00,$0.00
600926,ERX,HCPCS J1561,99999-6011-67,IMMUNE GLOBULIN (HUMAN) 10 GM/100ML- MD,"$2,860.98",$0.00,"$2,860.98","$1,287.44","$2,041.88",$782.80,$492.93,$0.00,$0.00,$948.23,"$2,860.98",$821.94,"$1,430.49","$2,265.90","$2,288.78","$1,135.06",$948.23,$0.00,$902.87,$833.82
600931,ERX,HCPCS J9250,99999-6011-73,METHOTREXATE PF OPHTHALMIC INJECTION 0.4 MG/0.1 ML,$57.00,$0.00,$57.00,$25.65,$40.68,$0.00,$9.82,$0.00,$0.00,$0.29,$57.00,$0.00,$28.50,$45.14,$45.60,$0.00,$0.29,$0.00,$0.28,$0.00
600932,ERX,HCPCS 25000001,99999-6011-74,SELENIUM 4 MCG/ML IV SOLN- TPN,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
600975,ERX,HCPCS J3490,99999-6012-29,REMDESIVIR 100 MG/ NS 100 ML MB+ - EMERGENCY USE,"$1,263.00",$0.00,"$1,263.00",$568.35,$901.40,$0.00,$217.61,$0.00,$0.00,$221.14,"$1,263.00",$0.00,$631.50,"$1,000.30","$1,010.40",$0.00,$197.66,$0.00,$201.07,$0.00
600981,ERX,HCPCS 25000001,99999-6012-35,TRANEXAMIC ACID - NEBULIZER 1000 MG/10 ML FOR HEMOPTYSIS,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
600982,ERX,HCPCS 25000001,99999-6012-36,VANCOMYCIN 500 MG/20 ML ORAL SOLUTION UNIT-DOSE CUP,$9.12,$0.00,$9.12,$0.00,$6.51,$0.00,$0.00,$0.00,$0.00,$0.00,$9.12,$0.00,$4.56,$7.22,$7.30,$0.00,$0.00,$0.00,$0.00,$0.00
600983,ERX,HCPCS 25000001,99999-6012-37,DEXMEDETOMIDINE 1000 MCG/ 250 ML NS PREMIXED,$644.64,$0.00,$644.64,$0.00,$460.08,$0.00,$0.00,$0.00,$0.00,$0.00,$644.64,$0.00,$322.32,$510.55,$515.71,$0.00,$0.00,$0.00,$0.00,$0.00
600990,ERX,HCPCS J2543,99999-6010-18,PIPERACIL-TAZO 4.5 G/NS 70 ML IVPB,$95.18,$0.00,$95.18,$42.83,$67.93,$0.00,$26.18,$0.00,$0.00,$8.70,$95.18,$0.00,$47.59,$75.38,$76.14,$0.00,$8.70,$0.00,$8.28,$0.00
600991,ERX,HCPCS 25000001,99999-6010-19,PEDIATRIC OPHTHALMIC DILATING DROPS-EYE CLINIC USE ONLY (CYCLOPENTOLATE/PHENYLEPHRINE/TETRACAINE/TROPICAMIDE),$175.00,$0.00,$175.00,$0.00,$124.90,$0.00,$0.00,$0.00,$0.00,$0.00,$175.00,$0.00,$87.50,$138.60,$140.00,$0.00,$0.00,$0.00,$0.00,$0.00
600995,ERX,HCPCS 25000001,99999-6010-28,UVC FLUID 250 ML,$72.98,$0.00,$72.98,$0.00,$52.09,$0.00,$0.00,$0.00,$0.00,$0.00,$72.98,$0.00,$36.49,$57.80,$58.38,$0.00,$0.00,$0.00,$0.00,$0.00
600996,ERX,HCPCS 25000001,99999-6010-29,UAC FLUID 60 ML,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
600997,ERX,HCPCS 25000001,99999-6010-30,PAL FLUID 60 ML,$57.00,$0.00,$57.00,$0.00,$40.68,$0.00,$0.00,$0.00,$0.00,$0.00,$57.00,$0.00,$28.50,$45.14,$45.60,$0.00,$0.00,$0.00,$0.00,$0.00
601004,ERX,HCPCS J0697,00143-9979-22,CEFUROXIME SODIUM 750 MG IM SOLR,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
601004,ERX,HCPCS J0697,25021-0118-10,CEFUROXIME SODIUM 750 MG IM SOLR,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
601005,ERX,HCPCS J0697,00143-9567-25,CEFUROXIME SODIUM 1.5 G IM SOLR,$26.66,$0.00,$26.66,$0.00,$19.03,$0.00,$0.00,$0.00,$0.00,$0.00,$26.66,$0.00,$13.33,$21.11,$21.33,$0.00,$0.00,$0.00,$0.00,$0.00
601005,ERX,HCPCS J0697,00143-9977-22,CEFUROXIME SODIUM 1.5 G IM SOLR,$26.66,$0.00,$26.66,$0.00,$19.03,$0.00,$0.00,$0.00,$0.00,$0.00,$26.66,$0.00,$13.33,$21.11,$21.33,$0.00,$0.00,$0.00,$0.00,$0.00
601007,ERX,HCPCS J2185,99999-6010-39,MEROPENEM 500 MG/NS 100ML MB PLUS     ,$173.35,$0.00,$173.35,$0.00,$123.72,$0.00,$0.00,$0.00,$0.00,$0.00,$173.35,$0.00,$86.68,$137.29,$138.68,$0.00,$0.00,$0.00,$0.00,$0.00
601009,ERX,HCPCS J0295,99999-6010-92,AMPICILLIN-SULB 1.5 G/D5W 100ML MB PLUS,$101.10,$0.00,$101.10,$45.50,$72.16,$0.00,$4.24,$0.00,$0.00,$3.03,$101.10,$0.00,$50.55,$80.07,$80.88,$0.00,$3.03,$0.00,$2.89,$0.00
601010,ERX,HCPCS 25000001,42852-0301-67,KETAMINE 50MG/5ML IV SYRINGE,$27.00,$0.00,$27.00,$0.00,$19.27,$0.00,$0.00,$0.00,$0.00,$0.00,$27.00,$0.00,$13.50,$21.38,$21.60,$0.00,$0.00,$0.00,$0.00,$0.00
601010,ERX,HCPCS 25000001,71286-3022-01,KETAMINE 50MG/5ML IV SYRINGE,$27.00,$0.00,$27.00,$0.00,$19.27,$0.00,$0.00,$0.00,$0.00,$0.00,$27.00,$0.00,$13.50,$21.38,$21.60,$0.00,$0.00,$0.00,$0.00,$0.00
601010,ERX,HCPCS 25000001,99999-6010-44,KETAMINE 50MG/5ML IV SYRINGE,$27.00,$0.00,$27.00,$0.00,$19.27,$0.00,$0.00,$0.00,$0.00,$0.00,$27.00,$0.00,$13.50,$21.38,$21.60,$0.00,$0.00,$0.00,$0.00,$0.00
601011,ERX,HCPCS J1335,99999-6010-45,ERTAPENEM 1 G/NS 100ML MB PLUS,$233.61,$0.00,$233.61,$105.12,$166.73,$0.00,$40.25,$0.00,$0.00,$90.95,$233.61,$0.00,$116.81,$185.02,$186.89,$0.00,$90.95,$0.00,$86.60,$0.00
601016,ERX,HCPCS 25000001,99999-6010-53,MORPHINE 0.1% TOPICAL GEL 15G,$54.31,$0.00,$54.31,$0.00,$38.76,$0.00,$0.00,$0.00,$0.00,$0.00,$54.31,$0.00,$27.16,$43.01,$43.45,$0.00,$0.00,$0.00,$0.00,$0.00
601018,ERX,HCPCS J1650,99999-6010-54,ENOXAPARIN SODIUM 10 MG/0.1ML SC SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$3.85,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.44,$0.00,$3.50,$0.00
601019,ERX,HCPCS J1650,99999-6010-55,ENOXAPARIN SODIUM 20 MG/0.2ML SC SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$3.85,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.44,$0.00,$3.50,$0.00
601020,ERX,HCPCS 25000001,99999-6010-57,ZINC (ELEMENTAL) 1 MG/ML (NICU) ORAL SYRINGE,$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
601021,ERX,HCPCS J2590,42852-0703-99,OXYTOCIN 20 UNITS IN 1000ML NS PREMIX ,$190.00,$0.00,$190.00,$85.50,$135.60,$0.00,$2.94,$0.00,$0.00,$33.27,$190.00,$0.00,$95.00,$150.48,$152.00,$0.00,$29.74,$0.00,$30.25,$0.00
601021,ERX,HCPCS J2590,71285-6043-01,OXYTOCIN 20 UNITS IN 1000ML NS PREMIX ,$190.00,$0.00,$190.00,$85.50,$135.60,$0.00,$2.94,$0.00,$0.00,$33.27,$190.00,$0.00,$95.00,$150.48,$152.00,$0.00,$29.74,$0.00,$30.25,$0.00
601021,ERX,HCPCS J2590,99999-6011-30,OXYTOCIN 20 UNITS IN 1000ML NS PREMIX ,$190.00,$0.00,$190.00,$85.50,$135.60,$0.00,$2.94,$0.00,$0.00,$33.27,$190.00,$0.00,$95.00,$150.48,$152.00,$0.00,$29.74,$0.00,$30.25,$0.00
601024,ERX,HCPCS 25000001,99999-6010-63,KETAMINE 10MG/1 ML IV SYRINGE,$27.00,$0.00,$27.00,$0.00,$19.27,$0.00,$0.00,$0.00,$0.00,$0.00,$27.00,$0.00,$13.50,$21.38,$21.60,$0.00,$0.00,$0.00,$0.00,$0.00
601025,ERX,HCPCS 25000001,99999-6010-64,NITROGLYCERIN 0.2 % OINT,$157.95,$0.00,$157.95,$0.00,$112.73,$0.00,$0.00,$0.00,$0.00,$0.00,$157.95,$0.00,$78.98,$125.10,$126.36,$0.00,$0.00,$0.00,$0.00,$0.00
601028,ERX,HCPCS P9041,99999-6010-76,ALBUMIN 5 % IV CONTINUOUS INFUSION SYRINGE (NICU),$27.00,$0.00,$27.00,$0.00,$19.27,$0.00,$0.00,$0.00,$0.00,$0.00,$27.00,$0.00,$13.50,$21.38,$21.60,$0.00,$0.00,$0.00,$0.00,$0.00
601030,ERX,HCPCS J1170,00409-1283-04,HYDROMORPHONE 0.5MG/0.5ML INJ,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.56,$0.00,$0.00,$3.64,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.64,$0.00,$3.47,$0.00
601030,ERX,HCPCS J1170,00409-1283-05,HYDROMORPHONE 0.5MG/0.5ML INJ,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.56,$0.00,$0.00,$3.64,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.64,$0.00,$3.47,$0.00
601030,ERX,HCPCS J1170,76045-0009-05,HYDROMORPHONE 0.5MG/0.5ML INJ,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.56,$0.00,$0.00,$3.64,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.64,$0.00,$3.47,$0.00
601030,ERX,HCPCS J1170,76045-0009-06,HYDROMORPHONE 0.5MG/0.5ML INJ,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.56,$0.00,$0.00,$3.64,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.64,$0.00,$3.47,$0.00
601030,ERX,HCPCS J1170,76045-0009-96,HYDROMORPHONE 0.5MG/0.5ML INJ,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$1.56,$0.00,$0.00,$3.64,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.64,$0.00,$3.47,$0.00
601033,ERX,HCPCS 25000001,,SYMTUZA:DARUNAVIR-COBICISTAT-TENOFOVIR AF-EMTRICITABINE 800-150-10-200MG TABLET,$424.81,$0.00,$424.81,$0.00,$303.19,$0.00,$0.00,$0.00,$0.00,$0.00,$424.81,$0.00,$212.41,$336.45,$339.85,$0.00,$0.00,$0.00,$0.00,$0.00
601034,ERX,HCPCS 25000001,99999-6010-84,ESMOLOL DRIP (NICU) 10 MG/ML,$163.11,$0.00,$163.11,$0.00,$116.41,$0.00,$0.00,$0.00,$0.00,$0.00,$163.11,$0.00,$81.56,$129.18,$130.49,$0.00,$0.00,$0.00,$0.00,$0.00
601034,ERX,HCPCS 25000001,99999-6010-90,ESMOLOL DRIP (NICU) 10 MG/ML,$315.86,$0.00,$250.16,$0.00,$116.41,$0.00,$0.00,$0.00,$0.00,$0.00,$163.11,$0.00,$81.56,$250.16,$130.49,$0.00,$0.00,$0.00,$0.00,$0.00
601035,ERX,HCPCS 25000001,76154-0477-05,VASOPRESSIN 20 UNITS/100 ML NS PREMIX,$326.35,$0.00,$326.35,$0.00,$232.92,$0.00,$0.00,$0.00,$0.00,$0.00,$326.35,$0.00,$163.18,$258.47,$261.08,$0.00,$0.00,$0.00,$0.00,$0.00
601036,ERX,HCPCS 25000001,76154-0477-05,VASOPRESSIN 20 UNITS/100 ML NS FOR DIABETES INSIPIDUS PREMIX,$326.35,$0.00,$326.35,$0.00,$232.92,$0.00,$0.00,$0.00,$0.00,$0.00,$326.35,$0.00,$163.18,$258.47,$261.08,$0.00,$0.00,$0.00,$0.00,$0.00
601047,ERX,HCPCS j3370,99999-6011-04,VANCOMYCIN 500MG/NS 100ML MB PLUS,$54.54,$0.00,$54.54,$24.54,$38.93,$9.71,$9.40,$0.00,$0.00,$9.55,$54.54,$0.00,$27.27,$43.20,$43.63,$32.72,$8.54,$0.00,$8.68,$0.00
601048,ERX,HCPCS J3370,99999-6011-05,VANCOMYCIN 750MG/D5W 250ML MB PLUS,$62.12,$0.00,$49.20,$0.00,$0.00,$0.00,$3.62,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$49.20,$0.00,$0.00,$3.98,$0.00,$0.00,$0.00
601049,ERX,HCPCS J3370,99999-6011-06,VANCOMYCIN 750MG/NS 250ML MB PLUS,$62.12,$0.00,$49.20,$0.00,$0.00,$0.00,$3.62,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$49.20,$0.00,$0.00,$3.98,$0.00,$0.00,$0.00
601050,ERX,HCPCS J1335,00006-3843-71,ERTAPENEM SODIUM 1 G IJ SOLR FOR DESENSITIZATION,$428.48,$0.00,$428.48,$192.82,$305.81,$0.00,$73.82,$0.00,$0.00,$90.95,$428.48,$0.00,$214.24,$339.36,$342.78,$0.00,$90.95,$0.00,$86.60,$0.00
601050,ERX,HCPCS J1335,42023-0221-10,ERTAPENEM SODIUM 1 G IJ SOLR FOR DESENSITIZATION,$428.48,$0.00,$428.48,$192.82,$305.81,$0.00,$73.82,$0.00,$0.00,$90.95,$428.48,$0.00,$214.24,$339.36,$342.78,$0.00,$90.95,$0.00,$86.60,$0.00
601050,ERX,HCPCS J1335,55150-0282-20,ERTAPENEM SODIUM 1 G IJ SOLR FOR DESENSITIZATION,$428.48,$0.00,$428.48,$192.82,$305.81,$0.00,$73.82,$0.00,$0.00,$90.95,$428.48,$0.00,$214.24,$339.36,$342.78,$0.00,$90.95,$0.00,$86.60,$0.00
601053,ERX,HCPCS 25000001,99999-6100-01,METHACHOLINE (PROVOCHOLINE) 1 MG/ML INHALATION SOLN C,$105.00,$0.00,$105.00,$0.00,$74.94,$0.00,$0.00,$0.00,$0.00,$0.00,$105.00,$0.00,$52.50,$83.16,$84.00,$0.00,$0.00,$0.00,$0.00,$0.00
601053,ERX,HCPCS 25000001,99999-6011-09,METHACHOLINE (PROVOCHOLINE) 1 MG/ML INHALATION SOLN C,$457.50,$0.00,$362.34,$0.00,$74.94,$0.00,$0.00,$0.00,$0.00,$0.00,$105.00,$0.00,$52.50,$362.34,$84.00,$0.00,$0.00,$0.00,$0.00,$0.00
601054,ERX,HCPCS 25000001,99999-6100-02,METHACHOLINE (PROVOCHOLINE) 0.25 MG/ML INH SOLN D,$105.00,$0.00,$105.00,$0.00,$74.94,$0.00,$0.00,$0.00,$0.00,$0.00,$105.00,$0.00,$52.50,$83.16,$84.00,$0.00,$0.00,$0.00,$0.00,$0.00
601054,ERX,HCPCS 25000001,99999-6011-10,METHACHOLINE (PROVOCHOLINE) 0.25 MG/ML INH SOLN D,$457.50,$0.00,$362.34,$0.00,$74.94,$0.00,$0.00,$0.00,$0.00,$0.00,$105.00,$0.00,$52.50,$362.34,$84.00,$0.00,$0.00,$0.00,$0.00,$0.00
601055,ERX,HCPCS 25000001,99999-6100-03,METHACHOLINE (PROVOCHOLINE) 0.0625 MG/ML INH SOLN E,$105.00,$0.00,$457.50,$0.00,$326.52,$0.00,$0.00,$0.00,$0.00,$0.00,$457.50,$0.00,$228.75,$83.16,$366.00,$0.00,$0.00,$0.00,$0.00,$0.00
601055,ERX,HCPCS 25000001,99999-6011-11,METHACHOLINE (PROVOCHOLINE) 0.0625 MG/ML INH SOLN E,$457.50,$0.00,$457.50,$0.00,$326.52,$0.00,$0.00,$0.00,$0.00,$0.00,$457.50,$0.00,$228.75,$362.34,$366.00,$0.00,$0.00,$0.00,$0.00,$0.00
601058,ERX,HCPCS 25000001,99999-6100-04,METHACHOLINE (PROVOCHOLINE) 4 MG/ML INH SOLN B,$105.00,$0.00,$105.00,$0.00,$74.94,$0.00,$0.00,$0.00,$0.00,$0.00,$105.00,$0.00,$52.50,$83.16,$84.00,$0.00,$0.00,$0.00,$0.00,$0.00
601058,ERX,HCPCS 25000001,99999-6011-14,METHACHOLINE (PROVOCHOLINE) 4 MG/ML INH SOLN B,$457.50,$0.00,$362.34,$0.00,$74.94,$0.00,$0.00,$0.00,$0.00,$0.00,$105.00,$0.00,$52.50,$362.34,$84.00,$0.00,$0.00,$0.00,$0.00,$0.00
601059,ERX,HCPCS 25000001,99999-6100-05,METHACHOLINE (PROVOCHOLINE) 16 MG/ML INH SOLN A,$105.00,$0.00,$105.00,$0.00,$74.94,$0.00,$0.00,$0.00,$0.00,$0.00,$105.00,$0.00,$52.50,$83.16,$84.00,$0.00,$0.00,$0.00,$0.00,$0.00
601059,ERX,HCPCS 25000001,99999-6011-15,METHACHOLINE (PROVOCHOLINE) 16 MG/ML INH SOLN A,$189.00,$0.00,$149.69,$0.00,$74.94,$0.00,$0.00,$0.00,$0.00,$0.00,$105.00,$0.00,$52.50,$149.69,$84.00,$0.00,$0.00,$0.00,$0.00,$0.00
601060,ERX,HCPCS 25000001,99999-6011-17,NAFCILLIN 2 G/NS 100ML MB PLUS,$97.74,$0.00,$97.74,$0.00,$69.76,$0.00,$0.00,$0.00,$0.00,$0.00,$97.74,$0.00,$48.87,$77.41,$78.19,$0.00,$0.00,$0.00,$0.00,$0.00
601061,ERX,HCPCS 25000001,99999-6011-18,NAFCILLIN 1 G/NS 100ML MB PLUS,$97.74,$0.00,$97.74,$0.00,$69.76,$0.00,$0.00,$0.00,$0.00,$0.00,$97.74,$0.00,$48.87,$77.41,$78.19,$0.00,$0.00,$0.00,$0.00,$0.00
601063,ERX,HCPCS 63600001,00338-0017-04,DEXTROSE 5% FLUID - DIALYSIS,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
601063,ERX,HCPCS 63600001,00338-0017-18,DEXTROSE 5% FLUID - DIALYSIS,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
601063,ERX,HCPCS 63600001,00338-0017-38,DEXTROSE 5% FLUID - DIALYSIS,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
601063,ERX,HCPCS 63600001,00338-0017-48,DEXTROSE 5% FLUID - DIALYSIS,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
601063,ERX,HCPCS 63600001,00338-0551-18,DEXTROSE 5% FLUID - DIALYSIS,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
601063,ERX,HCPCS 63600001,00264-7510-20,DEXTROSE 5% FLUID - DIALYSIS,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
601063,ERX,HCPCS 63600001,00338-0017-02,DEXTROSE 5% FLUID - DIALYSIS,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
601063,ERX,HCPCS 63600001,00264-1510-31,DEXTROSE 5% FLUID - DIALYSIS,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
601063,ERX,HCPCS 63600001,00338-0017-11,DEXTROSE 5% FLUID - DIALYSIS,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
601063,ERX,HCPCS 63600001,00338-0017-31,DEXTROSE 5% FLUID - DIALYSIS,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
601063,ERX,HCPCS 63600001,00338-0017-41,DEXTROSE 5% FLUID - DIALYSIS,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
601063,ERX,HCPCS 63600001,00338-0551-11,DEXTROSE 5% FLUID - DIALYSIS,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
601063,ERX,HCPCS 63600001,00264-7510-10,DEXTROSE 5% FLUID - DIALYSIS,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
601063,ERX,HCPCS 63600001,00338-0017-03,DEXTROSE 5% FLUID - DIALYSIS,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
601063,ERX,HCPCS 63600001,63323-0624-75,DEXTROSE 5% FLUID - DIALYSIS,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
601064,ERX,HCPCS 63600001,99999-6006-29,SODIUM CHLORIDE 3% IV SOLUTION - DIALYSIS,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
601064,ERX,HCPCS 63600001,00264-7805-10,SODIUM CHLORIDE 3% IV SOLUTION - DIALYSIS,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
601064,ERX,HCPCS 63600001,00338-0054-03,SODIUM CHLORIDE 3% IV SOLUTION - DIALYSIS,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
601072,ERX,HCPCS J1940,00409-6102-10,FUROSEMIDE 100 MG/10 ML INJ- OUTPATIENT IV DIURETIC CLINIC ONLY,$26.22,$0.00,$26.22,$11.80,$18.71,$0.00,$1.23,$0.00,$0.00,$3.47,$26.22,$0.00,$13.11,$20.77,$20.98,$0.00,$3.47,$0.00,$3.30,$0.00
601072,ERX,HCPCS J1940,00409-6102-27,FUROSEMIDE 100 MG/10 ML INJ- OUTPATIENT IV DIURETIC CLINIC ONLY,$26.22,$0.00,$26.22,$11.80,$18.71,$0.00,$1.23,$0.00,$0.00,$3.47,$26.22,$0.00,$13.11,$20.77,$20.98,$0.00,$3.47,$0.00,$3.30,$0.00
601072,ERX,HCPCS J1940,00409-6102-37,FUROSEMIDE 100 MG/10 ML INJ- OUTPATIENT IV DIURETIC CLINIC ONLY,$26.22,$0.00,$26.22,$11.80,$18.71,$0.00,$1.23,$0.00,$0.00,$3.47,$26.22,$0.00,$13.11,$20.77,$20.98,$0.00,$3.47,$0.00,$3.30,$0.00
601072,ERX,HCPCS J1940,23155-0473-44,FUROSEMIDE 100 MG/10 ML INJ- OUTPATIENT IV DIURETIC CLINIC ONLY,$26.22,$0.00,$26.22,$11.80,$18.71,$0.00,$1.23,$0.00,$0.00,$3.47,$26.22,$0.00,$13.11,$20.77,$20.98,$0.00,$3.47,$0.00,$3.30,$0.00
601073,ERX,HCPCS 25000001,99999-6012-08,DOXYCYCLINE 100MG/D5W 100ML MB PLUS,$100.94,$0.00,$100.94,$0.00,$72.04,$0.00,$0.00,$0.00,$0.00,$0.00,$100.94,$0.00,$50.47,$79.94,$80.75,$0.00,$0.00,$0.00,$0.00,$0.00
601074,ERX,HCPCS J0290,99999-6012-12,AMPICILLIN 1 G/50 ML NS MB PLUS,$64.71,$0.00,$64.71,$29.12,$46.18,$0.00,$5.22,$0.00,$0.00,$2.30,$64.71,$0.00,$32.36,$51.25,$51.77,$0.00,$2.30,$0.00,$2.19,$0.00
900083,ERX,HCPCS 63700001,99999-9000-83,AMLODIPINE 1MG/ML ORAL SUSP,$32.77,$0.00,$32.77,$0.00,$23.39,$0.00,$0.00,$0.00,$0.00,$0.00,$32.77,$0.00,$16.39,$25.95,$26.22,$0.00,$0.00,$0.00,$0.00,$0.00
900092,ERX,HCPCS 25000001,99999-9000-92,OMEPRAZOLE 2MG/ML ORAL SUSP 50ML,$50.88,$0.00,$50.88,$0.00,$36.31,$0.00,$0.00,$0.00,$0.00,$0.00,$50.88,$0.00,$25.44,$40.30,$40.70,$0.00,$0.00,$0.00,$0.00,$0.00
900093,ERX,HCPCS 63700001,99999-9000-93,PYRAZINAMIDE 100MG/ML 120ML SUSP,$105.42,$0.00,$105.42,$0.00,$75.24,$0.00,$0.00,$0.00,$0.00,$0.00,$105.42,$0.00,$52.71,$83.49,$84.34,$0.00,$0.00,$0.00,$0.00,$0.00
900094,ERX,HCPCS 63700001,99999-9000-94,RIFABUTIN 1200MG/60ML SUSPENSION,$139.62,$0.00,$139.62,$0.00,$99.65,$0.00,$0.00,$0.00,$0.00,$0.00,$139.62,$0.00,$69.81,$110.58,$111.70,$0.00,$0.00,$0.00,$0.00,$0.00
900095,ERX,HCPCS 63700001,99999-6010-59,RIFAMPIN 10MG/ML ORAL SUSP,$15.05,$0.00,$60.20,$0.00,$42.96,$0.00,$0.00,$0.00,$0.00,$0.00,$60.20,$0.00,$30.10,$11.92,$48.16,$0.00,$0.00,$0.00,$0.00,$0.00
900095,ERX,HCPCS 63700001,99999-9000-95,RIFAMPIN 10MG/ML ORAL SUSP,$60.20,$0.00,$60.20,$0.00,$42.96,$0.00,$0.00,$0.00,$0.00,$0.00,$60.20,$0.00,$30.10,$47.68,$48.16,$0.00,$0.00,$0.00,$0.00,$0.00
900097,ERX,HCPCS 25000001,99999-6006-02,DAKINS (1/8 STRENGTH) 0.0625% EX SOLN,$35.57,$0.00,$35.57,$0.00,$25.39,$0.00,$0.00,$0.00,$0.00,$0.00,$35.57,$0.00,$17.79,$28.17,$28.46,$0.00,$0.00,$0.00,$0.00,$0.00
900098,ERX,HCPCS 25000001,99999-6008-14,URSODIOL 15MG/ML ORAL SOLUTION,$17.64,$0.00,$52.90,$0.00,$37.75,$0.00,$0.00,$0.00,$0.00,$0.00,$52.90,$0.00,$26.45,$13.97,$42.32,$0.00,$0.00,$0.00,$0.00,$0.00
900098,ERX,HCPCS 25000001,99999-6008-54,URSODIOL 15MG/ML ORAL SOLUTION,$52.90,$0.00,$52.90,$0.00,$37.75,$0.00,$0.00,$0.00,$0.00,$0.00,$52.90,$0.00,$26.45,$41.90,$42.32,$0.00,$0.00,$0.00,$0.00,$0.00
900131,ERX,HCPCS J1644,99999-6006-11,HEPARIN 1500 UNITS IN NS 500 ML IR USE ONLY,$68.40,$0.00,$68.40,$30.78,$48.82,$0.00,$0.24,$0.00,$0.00,$0.28,$68.40,$0.00,$34.20,$54.17,$54.72,$0.00,$0.28,$0.00,$0.27,$0.00
900147,ERX,HCPCS 63700001,99999-6005-86,OPIUM TINCTURE 6MG/0.6ML ORAL SYRINGE,$10.48,$0.00,$10.48,$0.00,$7.48,$0.00,$0.00,$0.00,$0.00,$0.00,$10.48,$0.00,$5.24,$8.30,$8.38,$0.00,$0.00,$0.00,$0.00,$0.00
900288,ERX,HCPCS 25000001,99999-6010-21,"MAFENIDE 5% (PLUS NYSTATIN 500,000 UNITS) TOP SOL-50GM/1000ML SW",$167.85,$0.00,$167.85,$0.00,$119.79,$0.00,$0.00,$0.00,$0.00,$0.00,$167.85,$0.00,$83.93,$132.94,$134.28,$0.00,$0.00,$0.00,$0.00,$0.00
900333,ERX,HCPCS J9201,00409-0181-01,GEMCITABINE 2G INTRAVESICAL SYRINGE-UROLOGY CLINIC ONLY,$326.80,$0.00,"$1,623.73",$147.06,$233.24,$0.00,"$1,623.73",$0.00,$0.00,$48.88,$326.80,$0.00,$163.40,$258.83,$261.44,$0.00,$48.88,$0.00,$46.54,$0.00
900333,ERX,HCPCS J9201,60505-6114-00,GEMCITABINE 2G INTRAVESICAL SYRINGE-UROLOGY CLINIC ONLY,$326.80,$0.00,"$1,623.73",$147.06,$233.24,$0.00,"$1,623.73",$0.00,$0.00,$48.88,$326.80,$0.00,$163.40,$258.83,$261.44,$0.00,$48.88,$0.00,$46.54,$0.00
900575,ERX,HCPCS 25000001,99999-6009-03,PHENYLEPHRINE BOLUS FROM IV BAG FOR CARDIAC NARRATOR,$22.00,$0.00,$22.00,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
900576,ERX,HCPCS 63600001,99999-6009-80,EPINEPHRINE 16000 MCG/500 ML NS - ANE,$152.25,$0.00,$152.25,$0.00,$108.66,$0.00,$0.00,$0.00,$0.00,$0.00,$152.25,$0.00,$76.13,$120.58,$121.80,$0.00,$0.00,$0.00,$0.00,$0.00
4083037,ERX,HCPCS J3010,00409-9093-35,FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$1.16,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.16,$0.00,$1.11,$0.00
4083037,ERX,HCPCS J3010,00409-9093-37,FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$1.16,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.16,$0.00,$1.11,$0.00
4083037,ERX,HCPCS J3010,00409-9093-45,FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$1.16,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.16,$0.00,$1.11,$0.00
4083037,ERX,HCPCS J3010,00409-9094-12,FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$1.16,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.16,$0.00,$1.11,$0.00
4083037,ERX,HCPCS J3010,00409-9094-22,FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$1.16,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.16,$0.00,$1.11,$0.00
4083037,ERX,HCPCS J3010,00409-9094-25,FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$1.16,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.16,$0.00,$1.11,$0.00
4083037,ERX,HCPCS J3010,00409-9094-31,FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$1.16,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.16,$0.00,$1.11,$0.00
4083037,ERX,HCPCS J3010,00409-9094-61,FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$1.16,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.16,$0.00,$1.11,$0.00
4083037,ERX,HCPCS J3010,00641-6027-01,FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$1.16,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.16,$0.00,$1.11,$0.00
4083037,ERX,HCPCS J3010,00641-6027-25,FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$1.16,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.16,$0.00,$1.11,$0.00
4083037,ERX,HCPCS J3010,00641-6028-01,FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$1.16,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.16,$0.00,$1.11,$0.00
4083037,ERX,HCPCS J3010,00641-6028-25,FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$1.16,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.16,$0.00,$1.11,$0.00
4083037,ERX,HCPCS J3010,00641-6029-01,FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$1.16,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.16,$0.00,$1.11,$0.00
4083037,ERX,HCPCS J3010,00641-6029-25,FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$1.16,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.16,$0.00,$1.11,$0.00
4083037,ERX,HCPCS J3010,00641-6030-01,FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$1.16,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.16,$0.00,$1.11,$0.00
4083037,ERX,HCPCS J3010,17478-0030-05,FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$1.16,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.16,$0.00,$1.11,$0.00
4083037,ERX,HCPCS J3010,63323-0806-14,FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$1.16,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.16,$0.00,$1.11,$0.00
4083037,ERX,HCPCS J3010,63323-0806-50,FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$1.16,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$1.16,$0.00,$1.11,$0.00
40811150,ERX,HCPCS J2704,00409-4699-33,PROPOFOL 10 MG/ML IV EMUL 50 OR 100 ML,$66.69,$0.00,$119.70,$53.87,$85.43,$0.00,$20.62,$0.00,$0.00,$20.96,$119.70,$0.00,$59.85,$52.82,$95.76,$0.00,$18.73,$0.00,$19.06,$0.00
40811150,ERX,HCPCS J2704,25021-0608-50,PROPOFOL 10 MG/ML IV EMUL 50 OR 100 ML,$66.69,$0.00,$119.70,$53.87,$85.43,$0.00,$20.62,$0.00,$0.00,$20.96,$119.70,$0.00,$59.85,$52.82,$95.76,$0.00,$18.73,$0.00,$19.06,$0.00
40811150,ERX,HCPCS J2704,43598-0548-21,PROPOFOL 10 MG/ML IV EMUL 50 OR 100 ML,$66.69,$0.00,$119.70,$53.87,$85.43,$0.00,$20.62,$0.00,$0.00,$20.96,$119.70,$0.00,$59.85,$52.82,$95.76,$0.00,$18.73,$0.00,$19.06,$0.00
40811150,ERX,HCPCS J2704,43598-0548-50,PROPOFOL 10 MG/ML IV EMUL 50 OR 100 ML,$66.69,$0.00,$119.70,$53.87,$85.43,$0.00,$20.62,$0.00,$0.00,$20.96,$119.70,$0.00,$59.85,$52.82,$95.76,$0.00,$18.73,$0.00,$19.06,$0.00
40811150,ERX,HCPCS J2704,00409-4699-24,PROPOFOL 10 MG/ML IV EMUL 50 OR 100 ML,$119.70,$0.00,$119.70,$53.87,$85.43,$0.00,$20.62,$0.00,$0.00,$20.96,$119.70,$0.00,$59.85,$94.80,$95.76,$0.00,$18.73,$0.00,$19.06,$0.00
40811150,ERX,HCPCS J2704,00409-4699-54,PROPOFOL 10 MG/ML IV EMUL 50 OR 100 ML,$119.70,$0.00,$119.70,$53.87,$85.43,$0.00,$20.62,$0.00,$0.00,$20.96,$119.70,$0.00,$59.85,$94.80,$95.76,$0.00,$18.73,$0.00,$19.06,$0.00
40811150,ERX,HCPCS J2704,00591-2136-57,PROPOFOL 10 MG/ML IV EMUL 50 OR 100 ML,$119.70,$0.00,$119.70,$53.87,$85.43,$0.00,$20.62,$0.00,$0.00,$20.96,$119.70,$0.00,$59.85,$94.80,$95.76,$0.00,$18.73,$0.00,$19.06,$0.00
40811150,ERX,HCPCS J2704,25021-0608-51,PROPOFOL 10 MG/ML IV EMUL 50 OR 100 ML,$119.70,$0.00,$119.70,$53.87,$85.43,$0.00,$20.62,$0.00,$0.00,$20.96,$119.70,$0.00,$59.85,$94.80,$95.76,$0.00,$18.73,$0.00,$19.06,$0.00
40811150,ERX,HCPCS J2704,43598-0549-10,PROPOFOL 10 MG/ML IV EMUL 50 OR 100 ML,$119.70,$0.00,$119.70,$53.87,$85.43,$0.00,$20.62,$0.00,$0.00,$20.96,$119.70,$0.00,$59.85,$94.80,$95.76,$0.00,$18.73,$0.00,$19.06,$0.00
40811150,ERX,HCPCS J2704,43598-0549-52,PROPOFOL 10 MG/ML IV EMUL 50 OR 100 ML,$119.70,$0.00,$119.70,$53.87,$85.43,$0.00,$20.62,$0.00,$0.00,$20.96,$119.70,$0.00,$59.85,$94.80,$95.76,$0.00,$18.73,$0.00,$19.06,$0.00
40811150,ERX,HCPCS J2704,63323-0269-67,PROPOFOL 10 MG/ML IV EMUL 50 OR 100 ML,$119.70,$0.00,$119.70,$53.87,$85.43,$0.00,$20.62,$0.00,$0.00,$20.96,$119.70,$0.00,$59.85,$94.80,$95.76,$0.00,$18.73,$0.00,$19.06,$0.00
600015848,ERX,HCPCS J1644,00409-7651-03,HEPARIN IN NS 50-0.45 UNIT/ML-% IJ SOLN,$34.20,$0.00,$34.20,$15.39,$24.41,$0.00,$5.88,$0.00,$0.00,$7.05,$34.20,$0.00,$17.10,$27.09,$27.36,$0.00,$7.05,$0.00,$6.71,$0.00
4.081E+12,ERX,HCPCS J1815,00002-7510-01,INSULIN LISPRO 100 UNIT/ML SC SOLN,$15.00,$0.00,$15.00,$8.15,$10.71,$0.00,$0.36,$0.00,$0.00,$2.63,$15.00,$0.00,$7.50,$11.88,$12.00,$0.00,$0.00,$0.00,$1.01,$0.00
15,SUP,Custom 27203010,,00015  -  HANDGRIP CRCH CHLD GRY,$15.40,$0.00,$15.40,$0.00,$10.99,$0.00,$0.00,$0.00,$0.00,$0.00,$15.40,$0.00,$7.70,$12.20,$12.32,$0.00,$0.00,$0.00,$0.00,$0.00
15.201,SUP,HCPCS C1713,,015.2010  -  PLATE SQ RECT GRID MESH 1.5 MM SCR CRANIAL TI TIMESH BONE,"$1,010.00",$0.00,"$1,010.00",$454.50,$720.84,$0.00,$174.02,$0.00,$0.00,$176.84,"$1,010.00",$0.00,$505.00,$799.92,$808.00,$0.00,$158.07,$0.00,$160.79,$0.00
76,SUP,Custom 27203010,,000076  -  PLUG CATH CAP STRL LATEX FREE,$0.78,$0.00,$0.78,$0.00,$0.55,$0.00,$0.00,$0.00,$0.00,$0.00,$0.78,$0.00,$0.39,$0.62,$0.62,$0.00,$0.00,$0.00,$0.00,$0.00
86,SUP,HCPCS C1886,,0086  -  NOVASURE 2007 ENDOMETRIAL ABLATION SYSTEM,"$3,050.00",$0.00,"$3,050.00","$1,656.15","$2,176.79",$0.00,$525.50,$0.00,$0.00,$534.03,"$3,050.00",$0.00,"$1,525.00","$2,415.60","$2,440.00",$0.00,$477.33,$0.00,$485.56,$0.00
90,SUP,Custom 27803010,,90  -  PLATE BN 152X152MM MESH PNL TI CRNM,"$2,316.25",$0.00,"$2,316.25",$0.00,"$1,653.11",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,316.25",$0.00,"$1,158.13","$1,834.47","$1,853.00",$0.00,$0.00,$0.00,$0.00,$0.00
100,SUP,Custom 27203010,,CONTROL VRTRL 1 LOW POS IMMUN,$272.50,$0.00,$272.50,$0.00,$194.48,$0.00,$0.00,$0.00,$0.00,$0.00,$272.50,$0.00,$136.25,$215.82,$218.00,$0.00,$0.00,$0.00,$0.00,$0.00
101.107,SUP,Custom 27803010,,101.107  -  SPACER SPNL SM 22X10X7MM NS LF SUST RDLCNT PEEK LMBR INTRBD,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.109,SUP,Custom 27803010,,101.109  -  SPACER SPNL SM 22X10X9MM NS LF SUST RDLCNT PEEK LMBR INTRBD,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.111,SUP,Custom 27803010,,101.111  -  SPACER SPNL SM 22X10X11MM NS LF SUST RDLCNT PEEK LMBR INTRBD,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.113,SUP,Custom 27803010,,101.113  -  SPACER SPNL SM 22X10X13MM NS LF SUST RDLCNT PEEK LMBR INTRBD,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.115,SUP,Custom 27803010,,101.115  -  SPACER SPNL SM 22X10X15MM NS LF SUST RDLCNT PEEK LMBR INTRBD,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.117,SUP,Custom 27803010,,101.117  -  SPACER SPNL SM 22X10X17MM NS LF SUST RDLCNT PEEK LMBR INTRBD,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.205,SUP,Custom 27803010,,101.205  -  SPACER SPNL 13MM MED PRLL 14X5MM NS LF SUST RDLCNT PEEK LMBR,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.206,SUP,Custom 27803010,,101.206  -  SPACER SPNL 13MM MED PRLL 14X6MM NS LF SUST RDLCNT PEEK LMBR,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.207,SUP,Custom 27803010,,101.207  -  SPACER SPNL 13MM MED PRLL 14X7MM NS LF SUST RDLCNT PEEK LMBR,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.208,SUP,Custom 27803010,,101.208  -  SPACER SPNL 13MM MED PRLL 14X8MM NS LF SUST RDLCNT PEEK LMBR,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.209,SUP,Custom 27803010,,101.209  -  SPACER SPNL 13MM MED PRLL 14X9MM NS LF SUST RDLCNT PEEK LMBR,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.21,SUP,Custom 27803010,,101.210  -  SPACER SPNL 13MM MED PRLL 14X10MM NS LF SUST RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.211,SUP,Custom 27803010,,101.211  -  SPACER SPNL 13MM MED PRLL 14X11MM NS LF SUST RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.212,SUP,Custom 27803010,,101.212  -  SPACER SPNL 13MM MED PRLL 14X12MM NS LF SUST RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.225,SUP,Custom 27803010,,101.225  -  SPACER SPNL 7D LRDTC 13MM MED 14X5MM NS LF SUST RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.226,SUP,Custom 27803010,,101.226  -  SPACER SPNL 7D LRDTC 13MM MED 14X6MM NS LF SUST RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.227,SUP,Custom 27803010,,101.227  -  SPACER SPNL 7D LRDTC 13MM MED 14X7MM NS LF SUST RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.228,SUP,Custom 27803010,,101.228  -  SPACER SPNL 7D LRDTC 13MM MED 14X8MM NS LF SUST RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.229,SUP,Custom 27803010,,101.229  -  SPACER SPNL 7D LRDTC 13MM MED 14X9MM NS LF SUST RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.23,SUP,Custom 27803010,,101.230  -  SPACER SPNL 7D LRDTC 13MM MED 14X10MM NS LF SUST RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.231,SUP,Custom 27803010,,101.231  -  SPACER SPNL 7D LRDTC 13MM MED 14X11MM NS LF SUST RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.232,SUP,Custom 27803010,,101.232  -  SPACER SPNL 7D LRDTC 13MM MED 14X12MM NS LF SUST RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.245,SUP,Custom 27803010,,101.245  -  SPACER SPNL 13MM MED CNVX 14X5MM NS LF SUST RDLCNT PEEK LMBR,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.246,SUP,Custom 27803010,,101.246  -  SPACER SPNL 13MM MED CNVX 14X6MM NS LF SUST RDLCNT PEEK LMBR,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.247,SUP,Custom 27803010,,101.247  -  SPACER SPNL 13MM MED CNVX 14X7MM NS LF SUST RDLCNT PEEK LMBR,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.248,SUP,Custom 27803010,,101.248  -  SPACER SPNL 13MM MED CNVX 14X8MM NS LF SUST RDLCNT PEEK LMBR,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.249,SUP,Custom 27803010,,101.249  -  SPACER SPNL 13MM MED CNVX 14X9MM NS LF SUST RDLCNT PEEK LMBR,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.25,SUP,Custom 27803010,,101.250  -  SPACER SPNL 13MM MED CNVX 14X10MM NS LF SUST RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.251,SUP,Custom 27803010,,101.251  -  SPACER SPNL 13MM MED CNVX 14X11MM NS LF SUST RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.252,SUP,Custom 27803010,,101.252  -  SPACER SPNL 13MM MED CNVX 14X12MM NS LF SUST RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.309,SUP,Custom 27803010,,101.309  -  SPACER SPNL 31MM LG 25X9MM NS LF SUST RDLCNT PEEK THORLMBR,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.311,SUP,Custom 27803010,,101.311  -  SPACER SPNL 31MM LG 25X11MM NS LF SUST RDLCNT PEEK THORLMBR,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.313,SUP,Custom 27803010,,101.313  -  SPACER SPNL 31MM LG 25X13MM NS LF SUST RDLCNT PEEK THORLMBR,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.315,SUP,Custom 27803010,,101.315  -  SPACER SPNL 31MM LG 25X15MM NS LF SUST RDLCNT PEEK THORLMBR,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.317,SUP,Custom 27803010,,101.317  -  SPACER SPNL 31MM LG 25X17MM NS LF SUST RDLCNT PEEK THORLMBR,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.319,SUP,Custom 27803010,,101.319  -  SPACER SPNL 31MM LG 25X19MM NS LF SUST RDLCNT PEEK THORLMBR,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.321,SUP,Custom 27803010,,101.321  -  SPACER SPNL 31MM LG 25X21MM NS LF SUST RDLCNT PEEK THORLMBR,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.409,SUP,Custom 27803010,,101.409  -  SPACER SPNL 31MM LG 25X9MM NS LF SUST RDLCNT PEEK LAT INTRBD,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.411,SUP,Custom 27803010,,101.411  -  SPACER SPNL 31MM LG 25X11MM NS LF SUST RDLCNT PEEK LAT,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.413,SUP,Custom 27803010,,101.413  -  SPACER SPNL 31MM LG 25X13MM NS LF SUST RDLCNT PEEK LAT,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.415,SUP,Custom 27803010,,101.415  -  SPACER SPNL 31MM LG 25X15MM NS LF SUST RDLCNT PEEK LAT,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.417,SUP,Custom 27803010,,101.417  -  SPACER SPNL 31MM LG 25X17MM NS LF SUST RDLCNT PEEK LAT,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.419,SUP,Custom 27803010,,101.419  -  SPACER SPNL 31MM LG 25X19MM NS LF SUST RDLCNT PEEK LAT,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.421,SUP,Custom 27803010,,101.421  -  SPACER SPNL 31MM LG 25X21MM NS LF SUST RDLCNT PEEK LAT,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.509,SUP,Custom 27803010,,101.509  -  SPACER SPNL 31MM LG 25X9MM NS LF SUST RDLCNT PEEK ALAT,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.511,SUP,Custom 27803010,,101.511  -  SPACER SPNL 31MM LG 25X11MM NS LF SUST RDLCNT PEEK ALAT,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.513,SUP,Custom 27803010,,101.513  -  SPACER SPNL 31MM LG 25X13MM NS LF SUST RDLCNT PEEK ALAT,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.515,SUP,Custom 27803010,,101.515  -  SPACER SPNL 31MM LG 25X15MM NS LF SUST RDLCNT PEEK ALAT,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.517,SUP,Custom 27803010,,101.517  -  SPACER SPNL 31MM LG 25X17MM NS LF SUST RDLCNT PEEK ALAT,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.519,SUP,Custom 27803010,,101.519  -  SPACER SPNL 31MM LG 25X19MM NS LF SUST RDLCNT PEEK ALAT,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.521,SUP,Custom 27803010,,101.521  -  SPACER SPNL 31MM LG 25X21MM NS LF SUST RDLCNT PEEK ALAT,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.607,SUP,Custom 27803010,,101.607  -  SPACER SPNL ARCH 27X9.5X7MM NS LF SUST RDLCNT PEEK LMBR,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.609,SUP,Custom 27803010,,101.609  -  SPACER SPNL ARCH 27X9.5X9MM NS LF SUST RDLCNT PEEK LMBR,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.611,SUP,Custom 27803010,,101.611  -  SPACER SPNL ARCH 27X9.5X11MM NS LF SUST RDLCNT PEEK LMBR,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.613,SUP,Custom 27803010,,101.613  -  SPACER SPNL ARCH 27X9.5X13MM NS LF SUST RDLCNT PEEK LMBR,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.615,SUP,Custom 27803010,,101.615  -  SPACER SPNL ARCH 27X9.5X15MM NS LF SUST RDLCNT PEEK LMBR,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.617,SUP,Custom 27803010,,101.617  -  SPACER SPNL ARCH 27X9.5X17MM NS LF SUST RDLCNT PEEK LMBR,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.707,SUP,Custom 27803010,,101.707  -  SPACER SPNL SM NAR 22X8X7MM NS LF SUST RDLCNT PEEK LMBR,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.709,SUP,Custom 27803010,,101.709  -  SPACER SPNL SM NAR 22X8X9MM NS LF SUST RDLCNT PEEK LMBR,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.711,SUP,Custom 27803010,,101.711  -  SPACER SPNL SM NAR 22X8X11MM NS LF SUST RDLCNT PEEK LMBR,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.713,SUP,Custom 27803010,,101.713  -  SPACER SPNL SM NAR 22X8X13MM NS LF SUST RDLCNT PEEK LMBR,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.715,SUP,Custom 27803010,,101.715  -  SPACER SPNL SM NAR 22X8X15MM NS LF SUST RDLCNT PEEK LMBR,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.717,SUP,Custom 27803010,,101.717  -  SPACER SPNL SM NAR 22X8X17MM NS LF SUST RDLCNT PEEK LMBR,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.805,SUP,Custom 27803010,,101.805  -  SPACER SPNL 11MM MED NAR PRLL 12X5MM NS LF SUST RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.806,SUP,Custom 27803010,,101.806  -  SPACER SPNL 11MM MED NAR PRLL 12X6MM NS LF SUST RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.807,SUP,Custom 27803010,,101.807  -  SPACER SPNL 11MM MED NAR PRLL 12X7MM NS LF SUST RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.808,SUP,Custom 27803010,,101.808  -  SPACER SPNL 11MM MED NAR PRLL 12X8MM NS LF SUST RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.809,SUP,Custom 27803010,,101.809  -  SPACER SPNL 11MM MED NAR PRLL 12X9MM NS LF SUST RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.81,SUP,Custom 27803010,,101.810  -  SPACER SPNL 11MM MED NAR PRLL 12X10MM NS LF SUST RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.811,SUP,Custom 27803010,,101.811  -  SPACER SPNL 11MM MED NAR PRLL 12X11MM NS LF SUST RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.812,SUP,Custom 27803010,,101.812  -  SPACER SPNL 11MM MED NAR PRLL 12X12MM NS LF SUST RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.825,SUP,Custom 27803010,,101.825  -  SPACER SPNL 7D LRDTC MED NAR 12X5MM NS LF SUST RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.826,SUP,Custom 27803010,,101.826  -  SPACER SPNL 7D LRDTC MED NAR 12X6MM NS LF SUST RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.827,SUP,Custom 27803010,,101.827  -  SPACER SPNL 7D LRDTC MED NAR 12X7MM NS LF SUST RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.828,SUP,Custom 27803010,,101.828  -  SPACER SPNL 7D LRDTC MED NAR 12X8MM NS LF SUST RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.829,SUP,Custom 27803010,,101.829  -  SPACER SPNL 7D LRDTC MED NAR 12X9MM NS LF SUST RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.83,SUP,Custom 27803010,,101.830  -  SPACER SPNL 7D LRDTC MED NAR 12X10MM NS LF SUST RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.831,SUP,Custom 27803010,,101.831  -  SPACER SPNL 7D LRDTC MED NAR 12X11MM NS LF SUST RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.832,SUP,Custom 27803010,,101.832  -  SPACER SPNL 7D LRDTC MED NAR 12X12MM NS LF SUST RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.845,SUP,Custom 27803010,,101.845  -  SPACER SPNL 11MM MED CNVX NAR 12X5MM NS LF SUST RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.846,SUP,Custom 27803010,,101.846  -  SPACER SPNL 11MM MED CNVX NAR 12X6MM NS LF SUST RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.847,SUP,Custom 27803010,,101.847  -  SPACER SPNL 11MM MED CNVX NAR 12X7MM NS LF SUST RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.848,SUP,Custom 27803010,,101.848  -  SPACER SPNL 11MM MED CNVX NAR 12X8MM NS LF SUST RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.849,SUP,Custom 27803010,,101.849  -  SPACER SPNL 11MM MED CNVX NAR 12X9MM NS LF SUST RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.85,SUP,Custom 27803010,,101.850  -  SPACER SPNL 11MM MED CNVX NAR 12X10MM NS LF SUST RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.851,SUP,Custom 27803010,,101.851  -  SPACER SPNL 11MM MED CNVX NAR 12X11MM NS LF SUST RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
101.852,SUP,Custom 27803010,,101.852  -  SPACER SPNL 11MM MED CNVX NAR 12X12MM NS LF SUST RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
102.041,SUP,HCPCS C1713,,102.041  -  7.0MM PROTEX MONOAXIAL PEDICLE SCREW 70MM,"$3,627.50",$0.00,"$3,627.50","$1,632.38","$2,588.95",$0.00,$625.00,$0.00,$0.00,$635.15,"$3,627.50",$0.00,"$1,813.75","$2,872.98","$2,902.00",$0.00,$567.70,$0.00,$577.50,$0.00
102.042,SUP,HCPCS C1713,,102.042  -  7.0MM PROTEX MONOAXIAL PEDICLE SCREW 75MM,"$3,627.50",$0.00,"$3,627.50","$1,632.38","$2,588.95",$0.00,$625.00,$0.00,$0.00,$635.15,"$3,627.50",$0.00,"$1,813.75","$2,872.98","$2,902.00",$0.00,$567.70,$0.00,$577.50,$0.00
102.043,SUP,HCPCS C1713,,102.043  -  7.0MM PROTEX MONOAXIAL PEDICLE SCREW 80MM,"$3,627.50",$0.00,"$3,627.50","$1,632.38","$2,588.95",$0.00,$625.00,$0.00,$0.00,$635.15,"$3,627.50",$0.00,"$1,813.75","$2,872.98","$2,902.00",$0.00,$567.70,$0.00,$577.50,$0.00
102.044,SUP,HCPCS C1713,,102.044  -  7.0MM PROTEX MONOAXIAL PEDICLE SCREW 85MM,"$3,627.50",$0.00,"$3,627.50","$1,632.38","$2,588.95",$0.00,$625.00,$0.00,$0.00,$635.15,"$3,627.50",$0.00,"$1,813.75","$2,872.98","$2,902.00",$0.00,$567.70,$0.00,$577.50,$0.00
102.045,SUP,HCPCS C1713,,102.045  -  7.0MM PROTEX MONOAXIAL PEDICLE SCREW 90MM,"$3,627.50",$0.00,"$3,627.50","$1,632.38","$2,588.95",$0.00,$625.00,$0.00,$0.00,$635.15,"$3,627.50",$0.00,"$1,813.75","$2,872.98","$2,902.00",$0.00,$567.70,$0.00,$577.50,$0.00
102.051,SUP,HCPCS C1713,,102.051  -  8.0MM PROTEX MONOAXIAL PEDICLE SCREW 70MM,"$3,627.50",$0.00,"$3,627.50","$1,632.38","$2,588.95",$0.00,$625.00,$0.00,$0.00,$635.15,"$3,627.50",$0.00,"$1,813.75","$2,872.98","$2,902.00",$0.00,$567.70,$0.00,$577.50,$0.00
102.052,SUP,HCPCS C1713,,102.052  -  8.0MM PROTEX MONOAXIAL PEDICLE SCREW 75MM,"$3,627.50",$0.00,"$3,627.50","$1,632.38","$2,588.95",$0.00,$625.00,$0.00,$0.00,$635.15,"$3,627.50",$0.00,"$1,813.75","$2,872.98","$2,902.00",$0.00,$567.70,$0.00,$577.50,$0.00
102.053,SUP,HCPCS C1713,,102.053  -  8.0MM PROTEX MONOAXIAL PEDICLE SCREW 80MM,"$3,627.50",$0.00,"$3,627.50","$1,632.38","$2,588.95",$0.00,$625.00,$0.00,$0.00,$635.15,"$3,627.50",$0.00,"$1,813.75","$2,872.98","$2,902.00",$0.00,$567.70,$0.00,$577.50,$0.00
102.054,SUP,HCPCS C1713,,102.054  -  8.0MM PROTEX MONOAXIAL PEDICLE SCREW 85MM,"$3,627.50",$0.00,"$3,627.50","$1,632.38","$2,588.95",$0.00,$625.00,$0.00,$0.00,$635.15,"$3,627.50",$0.00,"$1,813.75","$2,872.98","$2,902.00",$0.00,$567.70,$0.00,$577.50,$0.00
102.055,SUP,HCPCS C1713,,102.055  -  8.0MM PROTEX MONOAXIAL PEDICLE SCREW 90MM,"$3,627.50",$0.00,"$3,627.50","$1,632.38","$2,588.95",$0.00,$625.00,$0.00,$0.00,$635.15,"$3,627.50",$0.00,"$1,813.75","$2,872.98","$2,902.00",$0.00,$567.70,$0.00,$577.50,$0.00
102.061,SUP,HCPCS C1713,,102.061  -  9.0MM PROTEX MONOAXIAL PEDICLE SCREW 70MM,"$3,627.50",$0.00,"$3,627.50","$1,632.38","$2,588.95",$0.00,$625.00,$0.00,$0.00,$635.15,"$3,627.50",$0.00,"$1,813.75","$2,872.98","$2,902.00",$0.00,$567.70,$0.00,$577.50,$0.00
102.062,SUP,HCPCS C1713,,102.062  -  9.0MM PROTEX MONOAXIAL PEDICLE SCREW 75MM,"$3,627.50",$0.00,"$3,627.50","$1,632.38","$2,588.95",$0.00,$625.00,$0.00,$0.00,$635.15,"$3,627.50",$0.00,"$1,813.75","$2,872.98","$2,902.00",$0.00,$567.70,$0.00,$577.50,$0.00
102.063,SUP,HCPCS C1713,,102.063  -  9.0MM PROTEX MONOAXIAL PEDICLE SCREW 80MM,"$3,627.50",$0.00,"$3,627.50","$1,632.38","$2,588.95",$0.00,$625.00,$0.00,$0.00,$635.15,"$3,627.50",$0.00,"$1,813.75","$2,872.98","$2,902.00",$0.00,$567.70,$0.00,$577.50,$0.00
102.064,SUP,HCPCS C1713,,102.064  -  9.0MM PROTEX MONOAXIAL PEDICLE SCREW 85MM,"$3,627.50",$0.00,"$3,627.50","$1,632.38","$2,588.95",$0.00,$625.00,$0.00,$0.00,$635.15,"$3,627.50",$0.00,"$1,813.75","$2,872.98","$2,902.00",$0.00,$567.70,$0.00,$577.50,$0.00
102.065,SUP,HCPCS C1713,,102.065  -  9.0MM PROTEX MONOAXIAL PEDICLE SCREW 90MM,"$3,627.50",$0.00,"$3,627.50","$1,632.38","$2,588.95",$0.00,$625.00,$0.00,$0.00,$635.15,"$3,627.50",$0.00,"$1,813.75","$2,872.98","$2,902.00",$0.00,$567.70,$0.00,$577.50,$0.00
102.071,SUP,HCPCS C1713,,102.071  -  7.0MM PROTEX PEDICLE SCREW 70MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
102.072,SUP,HCPCS C1713,,102.072  -  7.0MM PROTEX PEDICLE SCREW 75MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
102.073,SUP,HCPCS C1713,,102.073  -  7.0MM PROTEX PEDICLE SCREW 80MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
102.074,SUP,HCPCS C1713,,102.074  -  7.0MM PROTEX PEDICLE SCREW 85MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
102.075,SUP,HCPCS C1713,,102.075  -  7.0MM PROTEX PEDICLE SCREW 90MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
102.081,SUP,HCPCS C1713,,102.081  -  8.0MM PROTEX PEDICLE SCREW 70MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
102.082,SUP,HCPCS C1713,,102.082  -  8.0MM PROTEX PEDICLE SCREW 75MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
102.083,SUP,HCPCS C1713,,102.083  -  8.0MM PROTEX PEDICLE SCREW 80MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
102.084,SUP,HCPCS C1713,,102.084  -  8.0MM PROTEX PEDICLE SCREW 85MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
102.085,SUP,HCPCS C1713,,102.085  -  8.0MM PROTEX PEDICLE SCREW 90MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
102.091,SUP,HCPCS C1713,,102.091  -  9.0MM PROTEX PEDICLE SCREW 70MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
102.092,SUP,HCPCS C1713,,102.092  -  9.0MM PROTEX PEDICLE SCREW 75MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
102.093,SUP,HCPCS C1713,,102.093  -  9.0MM PROTEX PEDICLE SCREW 80MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
102.094,SUP,HCPCS C1713,,102.094  -  9.0MM PROTEX PEDICLE SCREW 85MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
102.095,SUP,HCPCS C1713,,102.095  -  9.0MM PROTEX PEDICLE SCREW 90MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
102.352,SUP,HCPCS C1713,,102.352  -  5.0MM PROTEX MONOAXIAL PEDICLE SCREW 30MM,"$3,627.50",$0.00,"$3,627.50","$1,632.38","$2,588.95",$0.00,$625.00,$0.00,$0.00,$635.15,"$3,627.50",$0.00,"$1,813.75","$2,872.98","$2,902.00",$0.00,$567.70,$0.00,$577.50,$0.00
102.353,SUP,HCPCS C1713,,102.353  -  5.0MM PROTEX MONOAXIAL PEDICLE SCREW 35MM,"$3,627.50",$0.00,"$3,627.50","$1,632.38","$2,588.95",$0.00,$625.00,$0.00,$0.00,$635.15,"$3,627.50",$0.00,"$1,813.75","$2,872.98","$2,902.00",$0.00,$567.70,$0.00,$577.50,$0.00
102.354,SUP,HCPCS C1713,,102.354  -  5.0MM PROTEX MONOAXIAL PEDICLE SCREW 40MM,"$3,627.50",$0.00,"$3,627.50","$1,632.38","$2,588.95",$0.00,$625.00,$0.00,$0.00,$635.15,"$3,627.50",$0.00,"$1,813.75","$2,872.98","$2,902.00",$0.00,$567.70,$0.00,$577.50,$0.00
102.355,SUP,HCPCS C1713,,102.355  -  5.0MM PROTEX MONOAXIAL PEDICLE SCREW 45MM,"$3,627.50",$0.00,"$3,627.50","$1,632.38","$2,588.95",$0.00,$625.00,$0.00,$0.00,$635.15,"$3,627.50",$0.00,"$1,813.75","$2,872.98","$2,902.00",$0.00,$567.70,$0.00,$577.50,$0.00
102.356,SUP,HCPCS C1713,,102.356  -  5.0MM PROTEX MONOAXIAL PEDICLE SCREW 50MM,"$3,627.50",$0.00,"$3,627.50","$1,632.38","$2,588.95",$0.00,$625.00,$0.00,$0.00,$635.15,"$3,627.50",$0.00,"$1,813.75","$2,872.98","$2,902.00",$0.00,$567.70,$0.00,$577.50,$0.00
102.357,SUP,HCPCS C1713,,102.357  -  5.0MM PROTEX MONOAXIAL PEDICLE SCREW 55MM,"$3,627.50",$0.00,"$3,627.50","$1,632.38","$2,588.95",$0.00,$625.00,$0.00,$0.00,$635.15,"$3,627.50",$0.00,"$1,813.75","$2,872.98","$2,902.00",$0.00,$567.70,$0.00,$577.50,$0.00
102.362,SUP,HCPCS C1713,,102.362  -  6.0MM PROTEX MONOAXIAL PEDICLE SCREW 30MM,"$3,627.50",$0.00,"$3,627.50","$1,632.38","$2,588.95",$0.00,$625.00,$0.00,$0.00,$635.15,"$3,627.50",$0.00,"$1,813.75","$2,872.98","$2,902.00",$0.00,$567.70,$0.00,$577.50,$0.00
102.363,SUP,HCPCS C1713,,102.363  -  6.0MM PROTEX MONOAXIAL PEDICLE SCREW 35MM,"$3,627.50",$0.00,"$3,627.50","$1,632.38","$2,588.95",$0.00,$625.00,$0.00,$0.00,$635.15,"$3,627.50",$0.00,"$1,813.75","$2,872.98","$2,902.00",$0.00,$567.70,$0.00,$577.50,$0.00
102.364,SUP,HCPCS C1713,,102.364  -  6.0MM PROTEX MONOAXIAL PEDICLE SCREW 40MM,"$3,627.50",$0.00,"$3,627.50","$1,632.38","$2,588.95",$0.00,$625.00,$0.00,$0.00,$635.15,"$3,627.50",$0.00,"$1,813.75","$2,872.98","$2,902.00",$0.00,$567.70,$0.00,$577.50,$0.00
102.365,SUP,HCPCS C1713,,102.365  -  6.0MM PROTEX MONOAXIAL PEDICLE SCREW 45MM,"$3,627.50",$0.00,"$3,627.50","$1,632.38","$2,588.95",$0.00,$625.00,$0.00,$0.00,$635.15,"$3,627.50",$0.00,"$1,813.75","$2,872.98","$2,902.00",$0.00,$567.70,$0.00,$577.50,$0.00
102.366,SUP,HCPCS C1713,,102.366  -  6.0MM PROTEX MONOAXIAL PEDICLE SCREW 50MM,"$3,627.50",$0.00,"$3,627.50","$1,632.38","$2,588.95",$0.00,$625.00,$0.00,$0.00,$635.15,"$3,627.50",$0.00,"$1,813.75","$2,872.98","$2,902.00",$0.00,$567.70,$0.00,$577.50,$0.00
102.367,SUP,HCPCS C1713,,102.367  -  6.0MM PROTEX MONOAXIAL PEDICLE SCREW 55MM,"$3,627.50",$0.00,"$3,627.50","$1,632.38","$2,588.95",$0.00,$625.00,$0.00,$0.00,$635.15,"$3,627.50",$0.00,"$1,813.75","$2,872.98","$2,902.00",$0.00,$567.70,$0.00,$577.50,$0.00
102.368,SUP,HCPCS C1713,,102.368  -  6.0MM PROTEX MONOAXIAL PEDICLE SCREW 60MM,"$3,627.50",$0.00,"$3,627.50","$1,632.38","$2,588.95",$0.00,$625.00,$0.00,$0.00,$635.15,"$3,627.50",$0.00,"$1,813.75","$2,872.98","$2,902.00",$0.00,$567.70,$0.00,$577.50,$0.00
102.369,SUP,HCPCS C1713,,102.369  -  6.0MM PROTEX MONOAXIAL PEDICLE SCREW 65MM,"$3,627.50",$0.00,"$3,627.50","$1,632.38","$2,588.95",$0.00,$625.00,$0.00,$0.00,$635.15,"$3,627.50",$0.00,"$1,813.75","$2,872.98","$2,902.00",$0.00,$567.70,$0.00,$577.50,$0.00
102.372,SUP,HCPCS C1713,,102.372  -  7.0MM PROTEX MONOAXIAL PEDICLE SCREW 30MM,"$3,627.50",$0.00,"$3,627.50","$1,632.38","$2,588.95",$0.00,$625.00,$0.00,$0.00,$635.15,"$3,627.50",$0.00,"$1,813.75","$2,872.98","$2,902.00",$0.00,$567.70,$0.00,$577.50,$0.00
102.373,SUP,HCPCS C1713,,102.373  -  7.0MM PROTEX MONOAXIAL PEDICLE SCREW 35MM,"$3,627.50",$0.00,"$3,627.50","$1,632.38","$2,588.95",$0.00,$625.00,$0.00,$0.00,$635.15,"$3,627.50",$0.00,"$1,813.75","$2,872.98","$2,902.00",$0.00,$567.70,$0.00,$577.50,$0.00
102.374,SUP,HCPCS C1713,,102.374  -  7.0MM PROTEX MONOAXIAL PEDICLE SCREW 40MM,"$3,627.50",$0.00,"$3,627.50","$1,632.38","$2,588.95",$0.00,$625.00,$0.00,$0.00,$635.15,"$3,627.50",$0.00,"$1,813.75","$2,872.98","$2,902.00",$0.00,$567.70,$0.00,$577.50,$0.00
102.375,SUP,HCPCS C1713,,102.375  -  7.0MM PROTEX MONOAXIAL PEDICLE SCREW 45MM,"$3,627.50",$0.00,"$3,627.50","$1,632.38","$2,588.95",$0.00,$625.00,$0.00,$0.00,$635.15,"$3,627.50",$0.00,"$1,813.75","$2,872.98","$2,902.00",$0.00,$567.70,$0.00,$577.50,$0.00
102.376,SUP,HCPCS C1713,,102.376  -  7.0MM PROTEX MONOAXIAL PEDICLE SCREW 50MM,"$3,627.50",$0.00,"$3,627.50","$1,632.38","$2,588.95",$0.00,$625.00,$0.00,$0.00,$635.15,"$3,627.50",$0.00,"$1,813.75","$2,872.98","$2,902.00",$0.00,$567.70,$0.00,$577.50,$0.00
102.377,SUP,HCPCS C1713,,102.377  -  7.0MM PROTEX MONOAXIAL PEDICLE SCREW 55MM,"$3,627.50",$0.00,"$3,627.50","$1,632.38","$2,588.95",$0.00,$625.00,$0.00,$0.00,$635.15,"$3,627.50",$0.00,"$1,813.75","$2,872.98","$2,902.00",$0.00,$567.70,$0.00,$577.50,$0.00
102.378,SUP,HCPCS C1713,,102.378  -  7.0MM PROTEX MONOAXIAL PEDICLE SCREW 60MM,"$3,627.50",$0.00,"$3,627.50","$1,632.38","$2,588.95",$0.00,$625.00,$0.00,$0.00,$635.15,"$3,627.50",$0.00,"$1,813.75","$2,872.98","$2,902.00",$0.00,$567.70,$0.00,$577.50,$0.00
102.379,SUP,HCPCS C1713,,102.379  -  7.0MM PROTEX MONOAXIAL PEDICLE SCREW 65MM,"$3,627.50",$0.00,"$3,627.50","$1,632.38","$2,588.95",$0.00,$625.00,$0.00,$0.00,$635.15,"$3,627.50",$0.00,"$1,813.75","$2,872.98","$2,902.00",$0.00,$567.70,$0.00,$577.50,$0.00
102.382,SUP,HCPCS C1713,,102.382  -  8.0MM PROTEX MONOAXIAL PEDICLE SCREW 30MM,"$3,627.50",$0.00,"$3,627.50","$1,632.38","$2,588.95",$0.00,$625.00,$0.00,$0.00,$635.15,"$3,627.50",$0.00,"$1,813.75","$2,872.98","$2,902.00",$0.00,$567.70,$0.00,$577.50,$0.00
102.383,SUP,HCPCS C1713,,102.383  -  8.0MM PROTEX MONOAXIAL PEDICLE SCREW 35MM,"$3,627.50",$0.00,"$3,627.50","$1,632.38","$2,588.95",$0.00,$625.00,$0.00,$0.00,$635.15,"$3,627.50",$0.00,"$1,813.75","$2,872.98","$2,902.00",$0.00,$567.70,$0.00,$577.50,$0.00
102.384,SUP,HCPCS C1713,,102.384  -  8.0MM PROTEX MONOAXIAL PEDICLE SCREW 40MM,"$3,627.50",$0.00,"$3,627.50","$1,632.38","$2,588.95",$0.00,$625.00,$0.00,$0.00,$635.15,"$3,627.50",$0.00,"$1,813.75","$2,872.98","$2,902.00",$0.00,$567.70,$0.00,$577.50,$0.00
102.385,SUP,HCPCS C1713,,102.385  -  8.0MM PROTEX MONOAXIAL PEDICLE SCREW 45MM,"$3,627.50",$0.00,"$3,627.50","$1,632.38","$2,588.95",$0.00,$625.00,$0.00,$0.00,$635.15,"$3,627.50",$0.00,"$1,813.75","$2,872.98","$2,902.00",$0.00,$567.70,$0.00,$577.50,$0.00
102.386,SUP,HCPCS C1713,,102.386  -  8.0MM PROTEX MONOAXIAL PEDICLE SCREW 50MM,"$3,627.50",$0.00,"$3,627.50","$1,632.38","$2,588.95",$0.00,$625.00,$0.00,$0.00,$635.15,"$3,627.50",$0.00,"$1,813.75","$2,872.98","$2,902.00",$0.00,$567.70,$0.00,$577.50,$0.00
102.387,SUP,HCPCS C1713,,102.387  -  8.0MM PROTEX MONOAXIAL PEDICLE SCREW 55MM,"$3,627.50",$0.00,"$3,627.50","$1,632.38","$2,588.95",$0.00,$625.00,$0.00,$0.00,$635.15,"$3,627.50",$0.00,"$1,813.75","$2,872.98","$2,902.00",$0.00,$567.70,$0.00,$577.50,$0.00
102.388,SUP,HCPCS C1713,,102.388  -  8.0MM PROTEX MONOAXIAL PEDICLE SCREW 60MM,"$3,627.50",$0.00,"$3,627.50","$1,632.38","$2,588.95",$0.00,$625.00,$0.00,$0.00,$635.15,"$3,627.50",$0.00,"$1,813.75","$2,872.98","$2,902.00",$0.00,$567.70,$0.00,$577.50,$0.00
102.389,SUP,HCPCS C1713,,102.389  -  8.0MM PROTEX MONOAXIAL PEDICLE SCREW 65MM,"$3,627.50",$0.00,"$3,627.50","$1,632.38","$2,588.95",$0.00,$625.00,$0.00,$0.00,$635.15,"$3,627.50",$0.00,"$1,813.75","$2,872.98","$2,902.00",$0.00,$567.70,$0.00,$577.50,$0.00
102.392,SUP,HCPCS C1713,,102.392  -  9.0MM PROTEX MONOAXIAL PEDICLE SCREW 30MM,"$3,627.50",$0.00,"$3,627.50","$1,632.38","$2,588.95",$0.00,$625.00,$0.00,$0.00,$635.15,"$3,627.50",$0.00,"$1,813.75","$2,872.98","$2,902.00",$0.00,$567.70,$0.00,$577.50,$0.00
102.393,SUP,HCPCS C1713,,102.393  -  9.0MM PROTEX MONOAXIAL PEDICLE SCREW 35MM,"$3,627.50",$0.00,"$3,627.50","$1,632.38","$2,588.95",$0.00,$625.00,$0.00,$0.00,$635.15,"$3,627.50",$0.00,"$1,813.75","$2,872.98","$2,902.00",$0.00,$567.70,$0.00,$577.50,$0.00
102.394,SUP,HCPCS C1713,,102.394  -  9.0MM PROTEX MONOAXIAL PEDICLE SCREW 40MM,"$3,627.50",$0.00,"$3,627.50","$1,632.38","$2,588.95",$0.00,$625.00,$0.00,$0.00,$635.15,"$3,627.50",$0.00,"$1,813.75","$2,872.98","$2,902.00",$0.00,$567.70,$0.00,$577.50,$0.00
102.395,SUP,HCPCS C1713,,102.395  -  9.0MM PROTEX MONOAXIAL PEDICLE SCREW 45MM,"$3,627.50",$0.00,"$3,627.50","$1,632.38","$2,588.95",$0.00,$625.00,$0.00,$0.00,$635.15,"$3,627.50",$0.00,"$1,813.75","$2,872.98","$2,902.00",$0.00,$567.70,$0.00,$577.50,$0.00
102.396,SUP,HCPCS C1713,,102.396  -  9.0MM PROTEX MONOAXIAL PEDICLE SCREW 50MM,"$3,627.50",$0.00,"$3,627.50","$1,632.38","$2,588.95",$0.00,$625.00,$0.00,$0.00,$635.15,"$3,627.50",$0.00,"$1,813.75","$2,872.98","$2,902.00",$0.00,$567.70,$0.00,$577.50,$0.00
102.397,SUP,HCPCS C1713,,102.397  -  9.0MM PROTEX MONOAXIAL PEDICLE SCREW 55MM,"$3,627.50",$0.00,"$3,627.50","$1,632.38","$2,588.95",$0.00,$625.00,$0.00,$0.00,$635.15,"$3,627.50",$0.00,"$1,813.75","$2,872.98","$2,902.00",$0.00,$567.70,$0.00,$577.50,$0.00
102.398,SUP,HCPCS C1713,,102.398  -  9.0MM PROTEX MONOAXIAL PEDICLE SCREW 60MM,"$3,627.50",$0.00,"$3,627.50","$1,632.38","$2,588.95",$0.00,$625.00,$0.00,$0.00,$635.15,"$3,627.50",$0.00,"$1,813.75","$2,872.98","$2,902.00",$0.00,$567.70,$0.00,$577.50,$0.00
102.399,SUP,HCPCS C1713,,102.399  -  9.0MM PROTEX MONOAXIAL PEDICLE SCREW 65MM,"$3,627.50",$0.00,"$3,627.50","$1,632.38","$2,588.95",$0.00,$625.00,$0.00,$0.00,$635.15,"$3,627.50",$0.00,"$1,813.75","$2,872.98","$2,902.00",$0.00,$567.70,$0.00,$577.50,$0.00
102.452,SUP,HCPCS C1713,,102.452  -  5.0MM PROTEX PEDICLE SCREW 30MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
102.453,SUP,HCPCS C1713,,102.453  -  5.0MM PROTEX PEDICLE SCREW 35MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
102.454,SUP,HCPCS C1713,,102.454  -  5.0MM PROTEX PEDICLE SCREW 40MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
102.455,SUP,HCPCS C1713,,102.455  -  5.0MM PROTEX PEDICLE SCREW 45MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
102.456,SUP,HCPCS C1713,,102.456  -  5.0MM PROTEX PEDICLE SCREW 50MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
102.457,SUP,HCPCS C1713,,102.457  -  5.0MM PROTEX PEDICLE SCREW 55MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
102.462,SUP,HCPCS C1713,,102.462  -  6.0MM PROTEX PEDICLE SCREW 30MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
102.463,SUP,HCPCS C1713,,102.463  -  6.0MM PROTEX PEDICLE SCREW 35MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
102.464,SUP,HCPCS C1713,,102.464  -  6.0MM PROTEX PEDICLE SCREW 40MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
102.465,SUP,HCPCS C1713,,102.465  -  6.0MM PROTEX PEDICLE SCREW 45MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
102.466,SUP,HCPCS C1713,,102.466  -  6.0MM PROTEX PEDICLE SCREW 50MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
102.467,SUP,HCPCS C1713,,102.467  -  6.0MM PROTEX PEDICLE SCREW 55MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
102.468,SUP,HCPCS C1713,,102.468  -  6.0MM PROTEX PEDICLE SCREW 60MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
102.469,SUP,HCPCS C1713,,102.469  -  6.0MM PROTEX PEDICLE SCREW 65MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
102.472,SUP,HCPCS C1713,,102.472  -  7.0MM PROTEX PEDICLE SCREW 30MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
102.473,SUP,HCPCS C1713,,102.473  -  7.0MM PROTEX PEDICLE SCREW 35MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
102.474,SUP,HCPCS C1713,,102.474  -  7.0MM PROTEX PEDICLE SCREW 40MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
102.475,SUP,HCPCS C1713,,102.475  -  7.0MM PROTEX PEDICLE SCREW 45MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
102.476,SUP,HCPCS C1713,,102.476  -  7.0MM PROTEX PEDICLE SCREW 50MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
102.477,SUP,HCPCS C1713,,102.477  -  7.0MM PROTEX PEDICLE SCREW 55MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
102.478,SUP,HCPCS C1713,,102.478  -  7.0MM PROTEX PEDICLE SCREW 60MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
102.479,SUP,HCPCS C1713,,102.479  -  7.0MM PROTEX PEDICLE SCREW 65MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
102.482,SUP,HCPCS C1713,,102.482  -  8.0MM PROTEX PEDICLE SCREW 30MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
102.483,SUP,HCPCS C1713,,102.483  -  8.0MM PROTEX PEDICLE SCREW 35MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
102.484,SUP,HCPCS C1713,,102.484  -  8.0MM PROTEX PEDICLE SCREW 40MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
102.485,SUP,HCPCS C1713,,102.485  -  8.0MM PROTEX PEDICLE SCREW 45MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
102.486,SUP,HCPCS C1713,,102.486  -  8.0MM PROTEX PEDICLE SCREW 50MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
102.487,SUP,HCPCS C1713,,102.487  -  8.0MM PROTEX PEDICLE SCREW 55MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
102.488,SUP,HCPCS C1713,,102.488  -  8.0MM PROTEX PEDICLE SCREW 60MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
102.489,SUP,HCPCS C1713,,102.489  -  8.0MM PROTEX PEDICLE SCREW 65MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
102.49,SUP,HCPCS C1713,,102.490  -  PROTEX LOCKING CAP,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
102.492,SUP,HCPCS C1713,,102.492  -  9.0MM PROTEX PEDICLE SCREW 30MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
102.493,SUP,HCPCS C1713,,102.493  -  9.0MM PROTEX PEDICLE SCREW 35MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
102.494,SUP,HCPCS C1713,,102.494  -  9.0MM PROTEX PEDICLE SCREW 40MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
102.495,SUP,HCPCS C1713,,102.495  -  9.0MM PROTEX PEDICLE SCREW 45MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
102.496,SUP,HCPCS C1713,,102.496  -  9.0MM PROTEX PEDICLE SCREW 50MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
102.497,SUP,HCPCS C1713,,102.497  -  9.0MM PROTEX PEDICLE SCREW 55MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
102.498,SUP,HCPCS C1713,,102.498  -  9.0MM PROTEX PEDICLE SCREW 60MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
102.499,SUP,HCPCS C1713,,102.499  -  9.0MM PROTEX PEDICLE SCREW 65MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
102.51,SUP,Custom 27803010,,"102.510  -  6.5MM STRAIGHT ROD, 100MM",$465.00,$0.00,$465.00,$0.00,$331.87,$0.00,$0.00,$0.00,$0.00,$0.00,$465.00,$0.00,$232.50,$368.28,$372.00,$0.00,$0.00,$0.00,$0.00,$0.00
102.512,SUP,Custom 27803010,,"102.512  -  6.5MM STRAIGHT ROD, 125MM",$465.00,$0.00,$465.00,$0.00,$331.87,$0.00,$0.00,$0.00,$0.00,$0.00,$465.00,$0.00,$232.50,$368.28,$372.00,$0.00,$0.00,$0.00,$0.00,$0.00
102.515,SUP,Custom 27803010,,"102.515  -  6.5MM STRAIGHT ROD, 150MM",$465.00,$0.00,$465.00,$0.00,$331.87,$0.00,$0.00,$0.00,$0.00,$0.00,$465.00,$0.00,$232.50,$368.28,$372.00,$0.00,$0.00,$0.00,$0.00,$0.00
102.517,SUP,Custom 27803010,,"102.517  -  6.5MM STRAIGHT ROD, 200MM",$795.00,$0.00,$795.00,$0.00,$567.39,$0.00,$0.00,$0.00,$0.00,$0.00,$795.00,$0.00,$397.50,$629.64,$636.00,$0.00,$0.00,$0.00,$0.00,$0.00
102.519,SUP,Custom 27803010,,"102.519  -  6.5MM STRAIGHT ROD, 300MM",$927.50,$0.00,$927.50,$0.00,$661.96,$0.00,$0.00,$0.00,$0.00,$0.00,$927.50,$0.00,$463.75,$734.58,$742.00,$0.00,$0.00,$0.00,$0.00,$0.00
102.52,SUP,Custom 27803010,,"102.520  -  6.5MM STRAIGHT ROD, 400MM","$1,527.50",$0.00,"$1,527.50",$0.00,"$1,090.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,527.50",$0.00,$763.75,"$1,209.78","$1,222.00",$0.00,$0.00,$0.00,$0.00,$0.00
102.521,SUP,Custom 27803010,,102.521  -  ROD SPNL STRG 6.5MM 500MM PRTX,"$1,060.00",$0.00,"$1,060.00",$0.00,$756.52,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,060.00",$0.00,$530.00,$839.52,$848.00,$0.00,$0.00,$0.00,$0.00,$0.00
102.53,SUP,Custom 27803010,,"102.530  -  6.5MM STRAIGHT ROD, 30MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
102.535,SUP,Custom 27803010,,"102.535  -  6.5MM STRAIGHT ROD, 35MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
102.54,SUP,Custom 27803010,,"102.540  -  6.5MM STRAIGHT ROD, 40MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
102.545,SUP,Custom 27803010,,"102.545  -  6.5MM STRAIGHT ROD, 45MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
102.55,SUP,Custom 27803010,,"102.550  -  6.5MM STRAIGHT ROD, 50MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
102.555,SUP,Custom 27803010,,"102.555  -  6.5MM STRAIGHT ROD, 55MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
102.56,SUP,Custom 27803010,,"102.560  -  6.5MM STRAIGHT ROD, 60MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
102.565,SUP,Custom 27803010,,"102.565  -  6.5MM STRAIGHT ROD, 65MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
102.57,SUP,Custom 27803010,,"102.570  -  6.5MM STRAIGHT ROD, 70MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
102.575,SUP,Custom 27803010,,"102.575  -  6.5MM STRAIGHT ROD, 75MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
102.58,SUP,Custom 27803010,,"102.580  -  6.5MM STRAIGHT ROD, 80MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
102.585,SUP,Custom 27803010,,"102.585  -  6.5MM STRAIGHT ROD, 85MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
102.61,SUP,Custom 27803010,,"102.610  -  6.5MM CURVED ROD, 100MM",$765.00,$0.00,$765.00,$0.00,$545.98,$0.00,$0.00,$0.00,$0.00,$0.00,$765.00,$0.00,$382.50,$605.88,$612.00,$0.00,$0.00,$0.00,$0.00,$0.00
102.612,SUP,Custom 27803010,,"102.612  -  6.5MM CURVED ROD, 120MM",$765.00,$0.00,$765.00,$0.00,$545.98,$0.00,$0.00,$0.00,$0.00,$0.00,$765.00,$0.00,$382.50,$605.88,$612.00,$0.00,$0.00,$0.00,$0.00,$0.00
102.615,SUP,Custom 27803010,,"102.615  -  6.5MM CURVED ROD, 150MM",$765.00,$0.00,$765.00,$0.00,$545.98,$0.00,$0.00,$0.00,$0.00,$0.00,$765.00,$0.00,$382.50,$605.88,$612.00,$0.00,$0.00,$0.00,$0.00,$0.00
102.635,SUP,Custom 27803010,,"102.635  -  6.5MM CURVED ROD, 35MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
102.64,SUP,Custom 27803010,,"102.640  -  6.5MM CURVED ROD, 40MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
102.645,SUP,Custom 27803010,,"102.645  -  6.5MM CURVED ROD, 45MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
102.65,SUP,Custom 27803010,,"102.650  -  6.5MM CURVED ROD, 50MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
102.655,SUP,Custom 27803010,,"102.655  -  6.5MM CURVED ROD, 55MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
102.66,SUP,Custom 27803010,,"102.660  -  6.5MM CURVED ROD, 60MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
102.665,SUP,Custom 27803010,,"102.665  -  6.5MM CURVED ROD, 65MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
102.67,SUP,Custom 27803010,,"102.670  -  6.5MM CURVED ROD, 70MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
102.675,SUP,Custom 27803010,,"102.675  -  6.5MM CURVED ROD, 75MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
102.68,SUP,Custom 27803010,,"102.680  -  6.5MM CURVED ROD, 80MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
102.685,SUP,Custom 27803010,,"102.685  -  6.5MM CURVED ROD, 85MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
102.911,SUP,Custom 27803010,,"102.911  -  ADJUSTABLE T CONNECTOR, 28MM-40MM","$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
102.912,SUP,Custom 27803010,,"102.912  -  ADJUSTABLE T CONNECTOR, 38MM-50MM","$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
102.913,SUP,Custom 27803010,,"102.913  -  ADJUSTABLE T CONNECTOR, 48MM-60MM","$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
102.914,SUP,Custom 27803010,,"102.914  -  ADJUSTABLE T CONNECTOR, 58MM-70MM","$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
102.915,SUP,Custom 27803010,,"102.915  -  ADJUSTABLE T CONNECTOR, 68MM-80MM","$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
102.916,SUP,Custom 27803010,,"102.916  -  ADJUSTABLE T CONNECTOR, 78MM-90MM","$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
102.921,SUP,Custom 27803010,,"102.921  -  PROTEX LAMINA HOOK, SMALL","$3,055.00",$0.00,"$3,055.00",$0.00,"$2,180.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,055.00",$0.00,"$1,527.50","$2,419.56","$2,444.00",$0.00,$0.00,$0.00,$0.00,$0.00
102.922,SUP,Custom 27803010,,"102.922  -  PROTEX LAMINA HOOK, MEDIUM","$3,055.00",$0.00,"$3,055.00",$0.00,"$2,180.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,055.00",$0.00,"$1,527.50","$2,419.56","$2,444.00",$0.00,$0.00,$0.00,$0.00,$0.00
102.923,SUP,Custom 27803010,,"102.923  -  PROTEX LAMINA HOOK, LARGE","$3,055.00",$0.00,"$3,055.00",$0.00,"$2,180.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,055.00",$0.00,"$1,527.50","$2,419.56","$2,444.00",$0.00,$0.00,$0.00,$0.00,$0.00
102.925,SUP,Custom 27803010,,"102.925  -  PROTEX ANGLED LAMINA HOOK, SMALL","$3,055.00",$0.00,"$3,055.00",$0.00,"$2,180.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,055.00",$0.00,"$1,527.50","$2,419.56","$2,444.00",$0.00,$0.00,$0.00,$0.00,$0.00
102.926,SUP,Custom 27803010,,"102.926  -  PROTEX ANGLED LAMINA HOOK, MEDIUM","$3,055.00",$0.00,"$3,055.00",$0.00,"$2,180.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,055.00",$0.00,"$1,527.50","$2,419.56","$2,444.00",$0.00,$0.00,$0.00,$0.00,$0.00
102.927,SUP,Custom 27803010,,"102.927  -  PROTEX ANGLED LAMINA HOOK, LARGE","$3,055.00",$0.00,"$3,055.00",$0.00,"$2,180.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,055.00",$0.00,"$1,527.50","$2,419.56","$2,444.00",$0.00,$0.00,$0.00,$0.00,$0.00
102.941,SUP,Custom 27803010,,102.941  -  PROTEX PEDICLE HOOK,"$3,055.00",$0.00,"$3,055.00",$0.00,"$2,180.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,055.00",$0.00,"$1,527.50","$2,419.56","$2,444.00",$0.00,$0.00,$0.00,$0.00,$0.00
102.951,SUP,Custom 27803010,,"102.951  -  PROTEX TRANSVERSE PROCESS HOOK, RIGHT","$3,055.00",$0.00,"$3,055.00",$0.00,"$2,180.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,055.00",$0.00,"$1,527.50","$2,419.56","$2,444.00",$0.00,$0.00,$0.00,$0.00,$0.00
102.952,SUP,Custom 27803010,,"102.952  -  PROTEX TRANSVERSE PROCESS HOOK, LEFT","$3,055.00",$0.00,"$3,055.00",$0.00,"$2,180.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,055.00",$0.00,"$1,527.50","$2,419.56","$2,444.00",$0.00,$0.00,$0.00,$0.00,$0.00
102.971,SUP,Custom 27803010,,"102.971  -  PARALLEL CONNECTOR, 6.5MM TO 6.5MM","$2,120.00",$0.00,"$2,120.00",$0.00,"$1,513.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,120.00",$0.00,"$1,060.00","$1,679.04","$1,696.00",$0.00,$0.00,$0.00,$0.00,$0.00
102.974,SUP,Custom 27803010,,"102.974  -  OFFSET CONNECTOR, 15MM",$572.50,$0.00,$572.50,$0.00,$408.59,$0.00,$0.00,$0.00,$0.00,$0.00,$572.50,$0.00,$286.25,$453.42,$458.00,$0.00,$0.00,$0.00,$0.00,$0.00
102.975,SUP,Custom 27803010,,"102.975  -  OFFSET CONNECTOR, 20MM",$572.50,$0.00,$572.50,$0.00,$408.59,$0.00,$0.00,$0.00,$0.00,$0.00,$572.50,$0.00,$286.25,$453.42,$458.00,$0.00,$0.00,$0.00,$0.00,$0.00
102.976,SUP,Custom 27803010,,"102.976  -  OFFSET CONNECTOR, 25MM",$572.50,$0.00,$572.50,$0.00,$408.59,$0.00,$0.00,$0.00,$0.00,$0.00,$572.50,$0.00,$286.25,$453.42,$458.00,$0.00,$0.00,$0.00,$0.00,$0.00
102.99,SUP,Custom 27803010,,"102.990  -  6.0MM, CLOSED OFFSET CONNECTOR, 6.5MM ROD, 15MM","$1,325.00",$0.00,"$1,325.00",$0.00,$945.65,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,325.00",$0.00,$662.50,"$1,049.40","$1,060.00",$0.00,$0.00,$0.00,$0.00,$0.00
102.991,SUP,Custom 27803010,,"102.991  -  6.0MM, CLOSED OFFSET CONNECTOR, 6.5MM ROD, 20MM","$1,325.00",$0.00,"$1,325.00",$0.00,$945.65,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,325.00",$0.00,$662.50,"$1,049.40","$1,060.00",$0.00,$0.00,$0.00,$0.00,$0.00
102.992,SUP,Custom 27803010,,"102.992  -  6.0MM, CLOSED OFFSET CONNECTOR, 6.5MM ROD, 25MM","$1,325.00",$0.00,"$1,325.00",$0.00,$945.65,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,325.00",$0.00,$662.50,"$1,049.40","$1,060.00",$0.00,$0.00,$0.00,$0.00,$0.00
102.993,SUP,Custom 27803010,,"102.993  -  6.0MM, CLOSED OFFSET CONNECTOR, 6.5MM ROD, 30MM","$1,325.00",$0.00,"$1,325.00",$0.00,$945.65,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,325.00",$0.00,$662.50,"$1,049.40","$1,060.00",$0.00,$0.00,$0.00,$0.00,$0.00
102.994,SUP,Custom 27803010,,"102.994  -  6.0MM, CLOSED OFFSET CONNECTOR, 6.5MM ROD, 35MM","$1,325.00",$0.00,"$1,325.00",$0.00,$945.65,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,325.00",$0.00,$662.50,"$1,049.40","$1,060.00",$0.00,$0.00,$0.00,$0.00,$0.00
102.995,SUP,Custom 27803010,,"102.995  -  6.0MM, CLOSED OFFSET CONNECTOR, 6.5MM ROD, 100MM","$1,457.50",$0.00,"$1,457.50",$0.00,"$1,040.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,457.50",$0.00,$728.75,"$1,154.34","$1,166.00",$0.00,$0.00,$0.00,$0.00,$0.00
102.996,SUP,Custom 27803010,,"102.996  -  6.0MM, CLOSED OFFSET CONNECTOR, 6.5MM ROD, 120MM","$1,457.50",$0.00,"$1,457.50",$0.00,"$1,040.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,457.50",$0.00,$728.75,"$1,154.34","$1,166.00",$0.00,$0.00,$0.00,$0.00,$0.00
102.997,SUP,Custom 27803010,,"102.997  -  6.0MM, CLOSED OFFSET CONNECTOR, 6.5MM ROD, 150MM","$1,457.50",$0.00,"$1,457.50",$0.00,"$1,040.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,457.50",$0.00,$728.75,"$1,154.34","$1,166.00",$0.00,$0.00,$0.00,$0.00,$0.00
103,SUP,HCPCS C1767,,103  -  GENERATOR ELECTROSURGICAL NCP DEMIPULSE,"$54,430.00",$0.00,"$43,108.56",$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,"$43,108.56",$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
104,SUP,HCPCS C1713,,104  -  PLATE 104 SINGLE T 3H X 3H,$408.00,$0.00,$323.14,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$323.14,$4.80,$0.00,$0.00,$0.00,$64.95,$0.00
105,SUP,HCPCS C1713,,105  -  PLATE 105 SINGLE T 3H X 2H,$408.00,$0.00,$323.14,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$323.14,$4.80,$0.00,$0.00,$0.00,$64.95,$0.00
109.041,SUP,HCPCS C1713,,"109.041  -  7.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 70MM","$2,517.50",$0.00,"$2,517.50","$1,132.88","$1,796.74",$0.00,$433.75,$0.00,$0.00,$440.79,"$2,517.50",$0.00,"$1,258.75","$1,993.86","$2,014.00",$0.00,$393.99,$0.00,$400.79,$0.00
109.042,SUP,HCPCS C1713,,"109.042  -  7.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 75MM","$2,517.50",$0.00,"$2,517.50","$1,132.88","$1,796.74",$0.00,$433.75,$0.00,$0.00,$440.79,"$2,517.50",$0.00,"$1,258.75","$1,993.86","$2,014.00",$0.00,$393.99,$0.00,$400.79,$0.00
109.043,SUP,HCPCS C1713,,"109.043  -  7.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 80MM","$2,517.50",$0.00,"$2,517.50","$1,132.88","$1,796.74",$0.00,$433.75,$0.00,$0.00,$440.79,"$2,517.50",$0.00,"$1,258.75","$1,993.86","$2,014.00",$0.00,$393.99,$0.00,$400.79,$0.00
109.044,SUP,HCPCS C1713,,"109.044  -  7.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 85MM","$2,517.50",$0.00,"$2,517.50","$1,132.88","$1,796.74",$0.00,$433.75,$0.00,$0.00,$440.79,"$2,517.50",$0.00,"$1,258.75","$1,993.86","$2,014.00",$0.00,$393.99,$0.00,$400.79,$0.00
109.045,SUP,HCPCS C1713,,"109.045  -  7.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 90MM","$2,517.50",$0.00,"$2,517.50","$1,132.88","$1,796.74",$0.00,$433.75,$0.00,$0.00,$440.79,"$2,517.50",$0.00,"$1,258.75","$1,993.86","$2,014.00",$0.00,$393.99,$0.00,$400.79,$0.00
109.051,SUP,HCPCS C1713,,"109.051  -  8.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 70MM","$2,517.50",$0.00,"$2,517.50","$1,132.88","$1,796.74",$0.00,$433.75,$0.00,$0.00,$440.79,"$2,517.50",$0.00,"$1,258.75","$1,993.86","$2,014.00",$0.00,$393.99,$0.00,$400.79,$0.00
109.052,SUP,HCPCS C1713,,"109.052  -  8.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 75MM","$2,517.50",$0.00,"$2,517.50","$1,132.88","$1,796.74",$0.00,$433.75,$0.00,$0.00,$440.79,"$2,517.50",$0.00,"$1,258.75","$1,993.86","$2,014.00",$0.00,$393.99,$0.00,$400.79,$0.00
109.053,SUP,HCPCS C1713,,"109.053  -  8.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 80MM","$2,517.50",$0.00,"$2,517.50","$1,132.88","$1,796.74",$0.00,$433.75,$0.00,$0.00,$440.79,"$2,517.50",$0.00,"$1,258.75","$1,993.86","$2,014.00",$0.00,$393.99,$0.00,$400.79,$0.00
109.054,SUP,HCPCS C1713,,"109.054  -  8.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 85MM","$2,517.50",$0.00,"$2,517.50","$1,132.88","$1,796.74",$0.00,$433.75,$0.00,$0.00,$440.79,"$2,517.50",$0.00,"$1,258.75","$1,993.86","$2,014.00",$0.00,$393.99,$0.00,$400.79,$0.00
109.055,SUP,HCPCS C1713,,"109.055  -  8.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 90MM","$2,517.50",$0.00,"$2,517.50","$1,132.88","$1,796.74",$0.00,$433.75,$0.00,$0.00,$440.79,"$2,517.50",$0.00,"$1,258.75","$1,993.86","$2,014.00",$0.00,$393.99,$0.00,$400.79,$0.00
109.061,SUP,HCPCS C1713,,"109.061  -  9.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 70MM","$2,517.50",$0.00,"$2,517.50","$1,132.88","$1,796.74",$0.00,$433.75,$0.00,$0.00,$440.79,"$2,517.50",$0.00,"$1,258.75","$1,993.86","$2,014.00",$0.00,$393.99,$0.00,$400.79,$0.00
109.062,SUP,HCPCS C1713,,"109.062  -  9.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 75MM","$2,517.50",$0.00,"$2,517.50","$1,132.88","$1,796.74",$0.00,$433.75,$0.00,$0.00,$440.79,"$2,517.50",$0.00,"$1,258.75","$1,993.86","$2,014.00",$0.00,$393.99,$0.00,$400.79,$0.00
109.063,SUP,HCPCS C1713,,"109.063  -  9.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 80MM","$2,517.50",$0.00,"$2,517.50","$1,132.88","$1,796.74",$0.00,$433.75,$0.00,$0.00,$440.79,"$2,517.50",$0.00,"$1,258.75","$1,993.86","$2,014.00",$0.00,$393.99,$0.00,$400.79,$0.00
109.064,SUP,HCPCS C1713,,"109.064  -  9.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 85MM","$2,517.50",$0.00,"$2,517.50","$1,132.88","$1,796.74",$0.00,$433.75,$0.00,$0.00,$440.79,"$2,517.50",$0.00,"$1,258.75","$1,993.86","$2,014.00",$0.00,$393.99,$0.00,$400.79,$0.00
109.065,SUP,HCPCS C1713,,"109.065  -  9.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 90MM","$2,517.50",$0.00,"$2,517.50","$1,132.88","$1,796.74",$0.00,$433.75,$0.00,$0.00,$440.79,"$2,517.50",$0.00,"$1,258.75","$1,993.86","$2,014.00",$0.00,$393.99,$0.00,$400.79,$0.00
109.071,SUP,HCPCS C1713,,109.071  -  7.0MM PROTEX SOLID PEDICLE SCREW 70MM,"$4,580.00",$0.00,"$4,580.00","$2,061.00","$3,268.75",$0.00,$789.11,$0.00,$0.00,$801.92,"$4,580.00",$0.00,"$2,290.00","$3,627.36","$3,664.00",$0.00,$716.77,$0.00,$729.14,$0.00
109.072,SUP,HCPCS C1713,,109.072  -  7.0MM PROTEX SOLID PEDICLE SCREW 75MM,"$4,580.00",$0.00,"$4,580.00","$2,061.00","$3,268.75",$0.00,$789.11,$0.00,$0.00,$801.92,"$4,580.00",$0.00,"$2,290.00","$3,627.36","$3,664.00",$0.00,$716.77,$0.00,$729.14,$0.00
109.073,SUP,HCPCS C1713,,109.073  -  7.0MM PROTEX SOLID PEDICLE SCREW 80MM,"$4,580.00",$0.00,"$4,580.00","$2,061.00","$3,268.75",$0.00,$789.11,$0.00,$0.00,$801.92,"$4,580.00",$0.00,"$2,290.00","$3,627.36","$3,664.00",$0.00,$716.77,$0.00,$729.14,$0.00
109.074,SUP,HCPCS C1713,,109.074  -  7.0MM PROTEX SOLID PEDICLE SCREW 85MM,"$4,580.00",$0.00,"$4,580.00","$2,061.00","$3,268.75",$0.00,$789.11,$0.00,$0.00,$801.92,"$4,580.00",$0.00,"$2,290.00","$3,627.36","$3,664.00",$0.00,$716.77,$0.00,$729.14,$0.00
109.075,SUP,HCPCS C1713,,109.075  -  7.0MM PROTEX SOLID PEDICLE SCREW 90MM,"$4,580.00",$0.00,"$4,580.00","$2,061.00","$3,268.75",$0.00,$789.11,$0.00,$0.00,$801.92,"$4,580.00",$0.00,"$2,290.00","$3,627.36","$3,664.00",$0.00,$716.77,$0.00,$729.14,$0.00
109.081,SUP,HCPCS C1713,,109.081  -  8.0MM PROTEX SOLID PEDICLE SCREW 70MM,"$4,580.00",$0.00,"$4,580.00","$2,061.00","$3,268.75",$0.00,$789.11,$0.00,$0.00,$801.92,"$4,580.00",$0.00,"$2,290.00","$3,627.36","$3,664.00",$0.00,$716.77,$0.00,$729.14,$0.00
109.082,SUP,HCPCS C1713,,109.082  -  8.0MM PROTEX SOLID PEDICLE SCREW 75MM,"$4,580.00",$0.00,"$4,580.00","$2,061.00","$3,268.75",$0.00,$789.11,$0.00,$0.00,$801.92,"$4,580.00",$0.00,"$2,290.00","$3,627.36","$3,664.00",$0.00,$716.77,$0.00,$729.14,$0.00
109.083,SUP,HCPCS C1713,,109.083  -  8.0MM PROTEX SOLID PEDICLE SCREW 80MM,"$4,580.00",$0.00,"$4,580.00","$2,061.00","$3,268.75",$0.00,$789.11,$0.00,$0.00,$801.92,"$4,580.00",$0.00,"$2,290.00","$3,627.36","$3,664.00",$0.00,$716.77,$0.00,$729.14,$0.00
109.084,SUP,HCPCS C1713,,109.084  -  8.0MM PROTEX SOLID PEDICLE SCREW 85MM,"$4,580.00",$0.00,"$4,580.00","$2,061.00","$3,268.75",$0.00,$789.11,$0.00,$0.00,$801.92,"$4,580.00",$0.00,"$2,290.00","$3,627.36","$3,664.00",$0.00,$716.77,$0.00,$729.14,$0.00
109.085,SUP,HCPCS C1713,,109.085  -  8.0MM PROTEX SOLID PEDICLE SCREW 90MM,"$4,580.00",$0.00,"$4,580.00","$2,061.00","$3,268.75",$0.00,$789.11,$0.00,$0.00,$801.92,"$4,580.00",$0.00,"$2,290.00","$3,627.36","$3,664.00",$0.00,$716.77,$0.00,$729.14,$0.00
109.091,SUP,HCPCS C1713,,109.091  -  9.0MM PROTEX SOLID PEDICLE SCREW 70MM,"$4,580.00",$0.00,"$4,580.00","$2,061.00","$3,268.75",$0.00,$789.11,$0.00,$0.00,$801.92,"$4,580.00",$0.00,"$2,290.00","$3,627.36","$3,664.00",$0.00,$716.77,$0.00,$729.14,$0.00
109.092,SUP,HCPCS C1713,,109.092  -  9.0MM PROTEX SOLID PEDICLE SCREW 75MM,"$4,580.00",$0.00,"$4,580.00","$2,061.00","$3,268.75",$0.00,$789.11,$0.00,$0.00,$801.92,"$4,580.00",$0.00,"$2,290.00","$3,627.36","$3,664.00",$0.00,$716.77,$0.00,$729.14,$0.00
109.093,SUP,HCPCS C1713,,109.093  -  9.0MM PROTEX SOLID PEDICLE SCREW 80MM,"$4,580.00",$0.00,"$4,580.00","$2,061.00","$3,268.75",$0.00,$789.11,$0.00,$0.00,$801.92,"$4,580.00",$0.00,"$2,290.00","$3,627.36","$3,664.00",$0.00,$716.77,$0.00,$729.14,$0.00
109.094,SUP,HCPCS C1713,,109.094  -  9.0MM PROTEX SOLID PEDICLE SCREW 85MM,"$4,580.00",$0.00,"$4,580.00","$2,061.00","$3,268.75",$0.00,$789.11,$0.00,$0.00,$801.92,"$4,580.00",$0.00,"$2,290.00","$3,627.36","$3,664.00",$0.00,$716.77,$0.00,$729.14,$0.00
109.095,SUP,HCPCS C1713,,109.095  -  9.0MM PROTEX SOLID PEDICLE SCREW 90MM,"$4,580.00",$0.00,"$4,580.00","$2,061.00","$3,268.75",$0.00,$789.11,$0.00,$0.00,$801.92,"$4,580.00",$0.00,"$2,290.00","$3,627.36","$3,664.00",$0.00,$716.77,$0.00,$729.14,$0.00
109.351,SUP,HCPCS C1713,,"109.351  -  5.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 25MM","$2,517.50",$0.00,"$2,517.50","$1,132.88","$1,796.74",$0.00,$433.75,$0.00,$0.00,$440.79,"$2,517.50",$0.00,"$1,258.75","$1,993.86","$2,014.00",$0.00,$393.99,$0.00,$400.79,$0.00
109.352,SUP,HCPCS C1713,,"109.352  -  5.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 30MM","$2,517.50",$0.00,"$2,517.50","$1,132.88","$1,796.74",$0.00,$433.75,$0.00,$0.00,$440.79,"$2,517.50",$0.00,"$1,258.75","$1,993.86","$2,014.00",$0.00,$393.99,$0.00,$400.79,$0.00
109.353,SUP,HCPCS C1713,,"109.353  -  5.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 35MM","$2,517.50",$0.00,"$2,517.50","$1,132.88","$1,796.74",$0.00,$433.75,$0.00,$0.00,$440.79,"$2,517.50",$0.00,"$1,258.75","$1,993.86","$2,014.00",$0.00,$393.99,$0.00,$400.79,$0.00
109.354,SUP,HCPCS C1713,,"109.354  -  5.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 40MM","$2,517.50",$0.00,"$2,517.50","$1,132.88","$1,796.74",$0.00,$433.75,$0.00,$0.00,$440.79,"$2,517.50",$0.00,"$1,258.75","$1,993.86","$2,014.00",$0.00,$393.99,$0.00,$400.79,$0.00
109.355,SUP,HCPCS C1713,,"109.355  -  5.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 45MM","$2,517.50",$0.00,"$2,517.50","$1,132.88","$1,796.74",$0.00,$433.75,$0.00,$0.00,$440.79,"$2,517.50",$0.00,"$1,258.75","$1,993.86","$2,014.00",$0.00,$393.99,$0.00,$400.79,$0.00
109.356,SUP,HCPCS C1713,,"109.356  -  5.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 50MM","$2,517.50",$0.00,"$2,517.50","$1,132.88","$1,796.74",$0.00,$433.75,$0.00,$0.00,$440.79,"$2,517.50",$0.00,"$1,258.75","$1,993.86","$2,014.00",$0.00,$393.99,$0.00,$400.79,$0.00
109.357,SUP,HCPCS C1713,,"109.357  -  5.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 55MM","$2,517.50",$0.00,"$2,517.50","$1,132.88","$1,796.74",$0.00,$433.75,$0.00,$0.00,$440.79,"$2,517.50",$0.00,"$1,258.75","$1,993.86","$2,014.00",$0.00,$393.99,$0.00,$400.79,$0.00
109.358,SUP,HCPCS C1713,,"109.358  -  5.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 60MM","$2,517.50",$0.00,"$2,517.50","$1,132.88","$1,796.74",$0.00,$433.75,$0.00,$0.00,$440.79,"$2,517.50",$0.00,"$1,258.75","$1,993.86","$2,014.00",$0.00,$393.99,$0.00,$400.79,$0.00
109.359,SUP,HCPCS C1713,,"109.359  -  5.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 65MM","$2,517.50",$0.00,"$2,517.50","$1,132.88","$1,796.74",$0.00,$433.75,$0.00,$0.00,$440.79,"$2,517.50",$0.00,"$1,258.75","$1,993.86","$2,014.00",$0.00,$393.99,$0.00,$400.79,$0.00
109.362,SUP,HCPCS C1713,,"109.362  -  6.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 30MM","$2,517.50",$0.00,"$2,517.50","$1,132.88","$1,796.74",$0.00,$433.75,$0.00,$0.00,$440.79,"$2,517.50",$0.00,"$1,258.75","$1,993.86","$2,014.00",$0.00,$393.99,$0.00,$400.79,$0.00
109.363,SUP,HCPCS C1713,,"109.363  -  6.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 35MM","$2,517.50",$0.00,"$2,517.50","$1,132.88","$1,796.74",$0.00,$433.75,$0.00,$0.00,$440.79,"$2,517.50",$0.00,"$1,258.75","$1,993.86","$2,014.00",$0.00,$393.99,$0.00,$400.79,$0.00
109.364,SUP,HCPCS C1713,,"109.364  -  6.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 40MM","$2,517.50",$0.00,"$2,517.50","$1,132.88","$1,796.74",$0.00,$433.75,$0.00,$0.00,$440.79,"$2,517.50",$0.00,"$1,258.75","$1,993.86","$2,014.00",$0.00,$393.99,$0.00,$400.79,$0.00
109.365,SUP,HCPCS C1713,,"109.365  -  6.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 45MM","$2,517.50",$0.00,"$2,517.50","$1,132.88","$1,796.74",$0.00,$433.75,$0.00,$0.00,$440.79,"$2,517.50",$0.00,"$1,258.75","$1,993.86","$2,014.00",$0.00,$393.99,$0.00,$400.79,$0.00
109.366,SUP,HCPCS C1713,,"109.366  -  6.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 50MM","$2,517.50",$0.00,"$2,517.50","$1,132.88","$1,796.74",$0.00,$433.75,$0.00,$0.00,$440.79,"$2,517.50",$0.00,"$1,258.75","$1,993.86","$2,014.00",$0.00,$393.99,$0.00,$400.79,$0.00
109.367,SUP,HCPCS C1713,,"109.367  -  6.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 55MM","$2,517.50",$0.00,"$2,517.50","$1,132.88","$1,796.74",$0.00,$433.75,$0.00,$0.00,$440.79,"$2,517.50",$0.00,"$1,258.75","$1,993.86","$2,014.00",$0.00,$393.99,$0.00,$400.79,$0.00
109.368,SUP,HCPCS C1713,,"109.368  -  6.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 60MM","$2,517.50",$0.00,"$2,517.50","$1,132.88","$1,796.74",$0.00,$433.75,$0.00,$0.00,$440.79,"$2,517.50",$0.00,"$1,258.75","$1,993.86","$2,014.00",$0.00,$393.99,$0.00,$400.79,$0.00
109.369,SUP,HCPCS C1713,,"109.369  -  6.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 65MM","$2,517.50",$0.00,"$2,517.50","$1,132.88","$1,796.74",$0.00,$433.75,$0.00,$0.00,$440.79,"$2,517.50",$0.00,"$1,258.75","$1,993.86","$2,014.00",$0.00,$393.99,$0.00,$400.79,$0.00
109.372,SUP,HCPCS C1713,,"109.372  -  7.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 30MM","$2,517.50",$0.00,"$2,517.50","$1,132.88","$1,796.74",$0.00,$433.75,$0.00,$0.00,$440.79,"$2,517.50",$0.00,"$1,258.75","$1,993.86","$2,014.00",$0.00,$393.99,$0.00,$400.79,$0.00
109.373,SUP,HCPCS C1713,,"109.373  -  7.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 35MM","$2,517.50",$0.00,"$2,517.50","$1,132.88","$1,796.74",$0.00,$433.75,$0.00,$0.00,$440.79,"$2,517.50",$0.00,"$1,258.75","$1,993.86","$2,014.00",$0.00,$393.99,$0.00,$400.79,$0.00
109.374,SUP,HCPCS C1713,,"109.374  -  7.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 40MM","$2,517.50",$0.00,"$2,517.50","$1,132.88","$1,796.74",$0.00,$433.75,$0.00,$0.00,$440.79,"$2,517.50",$0.00,"$1,258.75","$1,993.86","$2,014.00",$0.00,$393.99,$0.00,$400.79,$0.00
109.375,SUP,HCPCS C1713,,"109.375  -  7.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 45MM","$2,517.50",$0.00,"$2,517.50","$1,132.88","$1,796.74",$0.00,$433.75,$0.00,$0.00,$440.79,"$2,517.50",$0.00,"$1,258.75","$1,993.86","$2,014.00",$0.00,$393.99,$0.00,$400.79,$0.00
109.376,SUP,HCPCS C1713,,"109.376  -  7.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 50MM","$2,517.50",$0.00,"$2,517.50","$1,132.88","$1,796.74",$0.00,$433.75,$0.00,$0.00,$440.79,"$2,517.50",$0.00,"$1,258.75","$1,993.86","$2,014.00",$0.00,$393.99,$0.00,$400.79,$0.00
109.377,SUP,HCPCS C1713,,"109.377  -  7.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 55MM","$2,517.50",$0.00,"$2,517.50","$1,132.88","$1,796.74",$0.00,$433.75,$0.00,$0.00,$440.79,"$2,517.50",$0.00,"$1,258.75","$1,993.86","$2,014.00",$0.00,$393.99,$0.00,$400.79,$0.00
109.378,SUP,HCPCS C1713,,"109.378  -  7.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 60MM","$2,517.50",$0.00,"$2,517.50","$1,132.88","$1,796.74",$0.00,$433.75,$0.00,$0.00,$440.79,"$2,517.50",$0.00,"$1,258.75","$1,993.86","$2,014.00",$0.00,$393.99,$0.00,$400.79,$0.00
109.379,SUP,HCPCS C1713,,"109.379  -  7.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 65MM","$2,517.50",$0.00,"$2,517.50","$1,132.88","$1,796.74",$0.00,$433.75,$0.00,$0.00,$440.79,"$2,517.50",$0.00,"$1,258.75","$1,993.86","$2,014.00",$0.00,$393.99,$0.00,$400.79,$0.00
109.382,SUP,HCPCS C1713,,"109.382  -  8.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 30MM","$2,517.50",$0.00,"$2,517.50","$1,132.88","$1,796.74",$0.00,$433.75,$0.00,$0.00,$440.79,"$2,517.50",$0.00,"$1,258.75","$1,993.86","$2,014.00",$0.00,$393.99,$0.00,$400.79,$0.00
109.383,SUP,HCPCS C1713,,"109.383  -  8.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 35MM","$2,517.50",$0.00,"$2,517.50","$1,132.88","$1,796.74",$0.00,$433.75,$0.00,$0.00,$440.79,"$2,517.50",$0.00,"$1,258.75","$1,993.86","$2,014.00",$0.00,$393.99,$0.00,$400.79,$0.00
109.384,SUP,HCPCS C1713,,"109.384  -  8.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 40MM","$2,517.50",$0.00,"$2,517.50","$1,132.88","$1,796.74",$0.00,$433.75,$0.00,$0.00,$440.79,"$2,517.50",$0.00,"$1,258.75","$1,993.86","$2,014.00",$0.00,$393.99,$0.00,$400.79,$0.00
109.385,SUP,HCPCS C1713,,"109.385  -  8.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 45MM","$2,517.50",$0.00,"$2,517.50","$1,132.88","$1,796.74",$0.00,$433.75,$0.00,$0.00,$440.79,"$2,517.50",$0.00,"$1,258.75","$1,993.86","$2,014.00",$0.00,$393.99,$0.00,$400.79,$0.00
109.386,SUP,HCPCS C1713,,"109.386  -  8.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 50MM","$2,517.50",$0.00,"$2,517.50","$1,132.88","$1,796.74",$0.00,$433.75,$0.00,$0.00,$440.79,"$2,517.50",$0.00,"$1,258.75","$1,993.86","$2,014.00",$0.00,$393.99,$0.00,$400.79,$0.00
109.387,SUP,HCPCS C1713,,"109.387  -  8.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 55MM","$2,517.50",$0.00,"$2,517.50","$1,132.88","$1,796.74",$0.00,$433.75,$0.00,$0.00,$440.79,"$2,517.50",$0.00,"$1,258.75","$1,993.86","$2,014.00",$0.00,$393.99,$0.00,$400.79,$0.00
109.388,SUP,HCPCS C1713,,"109.388  -  8.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 60MM","$2,517.50",$0.00,"$2,517.50","$1,132.88","$1,796.74",$0.00,$433.75,$0.00,$0.00,$440.79,"$2,517.50",$0.00,"$1,258.75","$1,993.86","$2,014.00",$0.00,$393.99,$0.00,$400.79,$0.00
109.389,SUP,HCPCS C1713,,"109.389  -  8.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 65MM","$2,517.50",$0.00,"$2,517.50","$1,132.88","$1,796.74",$0.00,$433.75,$0.00,$0.00,$440.79,"$2,517.50",$0.00,"$1,258.75","$1,993.86","$2,014.00",$0.00,$393.99,$0.00,$400.79,$0.00
109.392,SUP,HCPCS C1713,,"109.392  -  9.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 30MM","$2,517.50",$0.00,"$2,517.50","$1,132.88","$1,796.74",$0.00,$433.75,$0.00,$0.00,$440.79,"$2,517.50",$0.00,"$1,258.75","$1,993.86","$2,014.00",$0.00,$393.99,$0.00,$400.79,$0.00
109.393,SUP,HCPCS C1713,,"109.393  -  9.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 35MM","$2,517.50",$0.00,"$2,517.50","$1,132.88","$1,796.74",$0.00,$433.75,$0.00,$0.00,$440.79,"$2,517.50",$0.00,"$1,258.75","$1,993.86","$2,014.00",$0.00,$393.99,$0.00,$400.79,$0.00
109.394,SUP,HCPCS C1713,,"109.394  -  9.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 40MM","$2,517.50",$0.00,"$2,517.50","$1,132.88","$1,796.74",$0.00,$433.75,$0.00,$0.00,$440.79,"$2,517.50",$0.00,"$1,258.75","$1,993.86","$2,014.00",$0.00,$393.99,$0.00,$400.79,$0.00
109.395,SUP,HCPCS C1713,,"109.395  -  9.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 45MM","$2,517.50",$0.00,"$2,517.50","$1,132.88","$1,796.74",$0.00,$433.75,$0.00,$0.00,$440.79,"$2,517.50",$0.00,"$1,258.75","$1,993.86","$2,014.00",$0.00,$393.99,$0.00,$400.79,$0.00
109.396,SUP,HCPCS C1713,,"109.396  -  9.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 50MM","$2,517.50",$0.00,"$2,517.50","$1,132.88","$1,796.74",$0.00,$433.75,$0.00,$0.00,$440.79,"$2,517.50",$0.00,"$1,258.75","$1,993.86","$2,014.00",$0.00,$393.99,$0.00,$400.79,$0.00
109.397,SUP,HCPCS C1713,,"109.397  -  9.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 55MM","$2,517.50",$0.00,"$2,517.50","$1,132.88","$1,796.74",$0.00,$433.75,$0.00,$0.00,$440.79,"$2,517.50",$0.00,"$1,258.75","$1,993.86","$2,014.00",$0.00,$393.99,$0.00,$400.79,$0.00
109.398,SUP,HCPCS C1713,,"109.398  -  9.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 60MM","$2,517.50",$0.00,"$2,517.50","$1,132.88","$1,796.74",$0.00,$433.75,$0.00,$0.00,$440.79,"$2,517.50",$0.00,"$1,258.75","$1,993.86","$2,014.00",$0.00,$393.99,$0.00,$400.79,$0.00
109.399,SUP,HCPCS C1713,,"109.399  -  9.0MM PROTEX MONOAXIAL SCREW, 6.0MM ROD, 65MM","$2,517.50",$0.00,"$2,517.50","$1,132.88","$1,796.74",$0.00,$433.75,$0.00,$0.00,$440.79,"$2,517.50",$0.00,"$1,258.75","$1,993.86","$2,014.00",$0.00,$393.99,$0.00,$400.79,$0.00
109.441,SUP,HCPCS C1713,,"109.441  -  4.5MM PROTEX SOLID PEDICLE SCREW, 25MM","$4,580.00",$0.00,"$4,580.00","$2,061.00","$3,268.75",$0.00,$789.11,$0.00,$0.00,$801.92,"$4,580.00",$0.00,"$2,290.00","$3,627.36","$3,664.00",$0.00,$716.77,$0.00,$729.14,$0.00
109.442,SUP,HCPCS C1713,,"109.442  -  4.5MM PROTEX SOLID PEDICLE SCREW, 30MM","$4,580.00",$0.00,"$4,580.00","$2,061.00","$3,268.75",$0.00,$789.11,$0.00,$0.00,$801.92,"$4,580.00",$0.00,"$2,290.00","$3,627.36","$3,664.00",$0.00,$716.77,$0.00,$729.14,$0.00
109.443,SUP,HCPCS C1713,,"109.443  -  4.5MM PROTEX SOLID PEDICLE SCREW, 35MM","$4,580.00",$0.00,"$4,580.00","$2,061.00","$3,268.75",$0.00,$789.11,$0.00,$0.00,$801.92,"$4,580.00",$0.00,"$2,290.00","$3,627.36","$3,664.00",$0.00,$716.77,$0.00,$729.14,$0.00
109.444,SUP,HCPCS C1713,,"109.444  -  4.5MM PROTEX SOLID PEDICLE SCREW, 40MM","$4,580.00",$0.00,"$4,580.00","$2,061.00","$3,268.75",$0.00,$789.11,$0.00,$0.00,$801.92,"$4,580.00",$0.00,"$2,290.00","$3,627.36","$3,664.00",$0.00,$716.77,$0.00,$729.14,$0.00
109.445,SUP,HCPCS C1713,,"109.445  -  4.5MM PROTEX SOLID PEDICLE SCREW, 45MM","$4,580.00",$0.00,"$4,580.00","$2,061.00","$3,268.75",$0.00,$789.11,$0.00,$0.00,$801.92,"$4,580.00",$0.00,"$2,290.00","$3,627.36","$3,664.00",$0.00,$716.77,$0.00,$729.14,$0.00
109.446,SUP,HCPCS C1713,,"109.446  -  4.5MM PROTEX SOLID PEDICLE SCREW, 50MM","$4,580.00",$0.00,"$4,580.00","$2,061.00","$3,268.75",$0.00,$789.11,$0.00,$0.00,$801.92,"$4,580.00",$0.00,"$2,290.00","$3,627.36","$3,664.00",$0.00,$716.77,$0.00,$729.14,$0.00
109.452,SUP,HCPCS C1713,,109.452  -  5.0MM PROTEX SOLID PEDICLE SCREW 30MM,"$2,915.00",$0.00,"$2,915.00","$1,311.75","$2,080.44",$0.00,$502.24,$0.00,$0.00,$510.39,"$2,915.00",$0.00,"$1,457.50","$2,308.68","$2,332.00",$0.00,$456.20,$0.00,$464.07,$0.00
109.453,SUP,HCPCS C1713,,109.453  -  5.0MM PROTEX SOLID PEDICLE SCREW 35MM,"$2,915.00",$0.00,"$2,915.00","$1,311.75","$2,080.44",$0.00,$502.24,$0.00,$0.00,$510.39,"$2,915.00",$0.00,"$1,457.50","$2,308.68","$2,332.00",$0.00,$456.20,$0.00,$464.07,$0.00
109.454,SUP,HCPCS C1713,,109.454  -  5.0MM PROTEX SOLID PEDICLE SCREW 40MM,"$2,915.00",$0.00,"$2,915.00","$1,311.75","$2,080.44",$0.00,$502.24,$0.00,$0.00,$510.39,"$2,915.00",$0.00,"$1,457.50","$2,308.68","$2,332.00",$0.00,$456.20,$0.00,$464.07,$0.00
109.455,SUP,HCPCS C1713,,109.455  -  5.0MM PROTEX SOLID PEDICLE SCREW 45MM,"$2,915.00",$0.00,"$2,915.00","$1,311.75","$2,080.44",$0.00,$502.24,$0.00,$0.00,$510.39,"$2,915.00",$0.00,"$1,457.50","$2,308.68","$2,332.00",$0.00,$456.20,$0.00,$464.07,$0.00
109.456,SUP,HCPCS C1713,,109.456  -  5.0MM PROTEX SOLID PEDICLE SCREW 50MM,"$2,915.00",$0.00,"$2,915.00","$1,311.75","$2,080.44",$0.00,$502.24,$0.00,$0.00,$510.39,"$2,915.00",$0.00,"$1,457.50","$2,308.68","$2,332.00",$0.00,$456.20,$0.00,$464.07,$0.00
109.457,SUP,HCPCS C1713,,109.457  -  5.0MM PROTEX SOLID PEDICLE SCREW 55MM,"$2,915.00",$0.00,"$2,915.00","$1,311.75","$2,080.44",$0.00,$502.24,$0.00,$0.00,$510.39,"$2,915.00",$0.00,"$1,457.50","$2,308.68","$2,332.00",$0.00,$456.20,$0.00,$464.07,$0.00
109.462,SUP,HCPCS C1713,,109.462  -  6.0MM PROTEX SOLID PEDICLE SCREW 30MM,"$2,915.00",$0.00,"$2,915.00","$1,311.75","$2,080.44",$0.00,$502.24,$0.00,$0.00,$510.39,"$2,915.00",$0.00,"$1,457.50","$2,308.68","$2,332.00",$0.00,$456.20,$0.00,$464.07,$0.00
109.463,SUP,HCPCS C1713,,109.463  -  6.0MM PROTEX SOLID PEDICLE SCREW 35MM,"$2,915.00",$0.00,"$2,915.00","$1,311.75","$2,080.44",$0.00,$502.24,$0.00,$0.00,$510.39,"$2,915.00",$0.00,"$1,457.50","$2,308.68","$2,332.00",$0.00,$456.20,$0.00,$464.07,$0.00
109.464,SUP,HCPCS C1713,,109.464  -  6.0MM PROTEX SOLID PEDICLE SCREW 40MM,"$2,915.00",$0.00,"$2,915.00","$1,311.75","$2,080.44",$0.00,$502.24,$0.00,$0.00,$510.39,"$2,915.00",$0.00,"$1,457.50","$2,308.68","$2,332.00",$0.00,$456.20,$0.00,$464.07,$0.00
109.465,SUP,HCPCS C1713,,109.465  -  6.0MM PROTEX SOLID PEDICLE SCREW 45MM,"$2,915.00",$0.00,"$2,915.00","$1,311.75","$2,080.44",$0.00,$502.24,$0.00,$0.00,$510.39,"$2,915.00",$0.00,"$1,457.50","$2,308.68","$2,332.00",$0.00,$456.20,$0.00,$464.07,$0.00
109.466,SUP,HCPCS C1713,,109.466  -  6.0MM PROTEX SOLID PEDICLE SCREW 50MM,"$2,915.00",$0.00,"$2,915.00","$1,311.75","$2,080.44",$0.00,$502.24,$0.00,$0.00,$510.39,"$2,915.00",$0.00,"$1,457.50","$2,308.68","$2,332.00",$0.00,$456.20,$0.00,$464.07,$0.00
109.467,SUP,HCPCS C1713,,109.467  -  6.0MM PROTEX SOLID PEDICLE SCREW 55MM,"$2,915.00",$0.00,"$2,915.00","$1,311.75","$2,080.44",$0.00,$502.24,$0.00,$0.00,$510.39,"$2,915.00",$0.00,"$1,457.50","$2,308.68","$2,332.00",$0.00,$456.20,$0.00,$464.07,$0.00
109.468,SUP,HCPCS C1713,,109.468  -  6.0MM PROTEX SOLID PEDICLE SCREW 60MM,"$2,915.00",$0.00,"$2,915.00","$1,311.75","$2,080.44",$0.00,$502.24,$0.00,$0.00,$510.39,"$2,915.00",$0.00,"$1,457.50","$2,308.68","$2,332.00",$0.00,$456.20,$0.00,$464.07,$0.00
109.469,SUP,HCPCS C1713,,109.469  -  6.0MM PROTEX SOLID PEDICLE SCREW 65MM,"$2,915.00",$0.00,"$2,915.00","$1,311.75","$2,080.44",$0.00,$502.24,$0.00,$0.00,$510.39,"$2,915.00",$0.00,"$1,457.50","$2,308.68","$2,332.00",$0.00,$456.20,$0.00,$464.07,$0.00
109.472,SUP,HCPCS C1713,,109.472  -  7.0MM PROTEX SOLID PEDICLE SCREW 30MM,"$2,915.00",$0.00,"$2,915.00","$1,311.75","$2,080.44",$0.00,$502.24,$0.00,$0.00,$510.39,"$2,915.00",$0.00,"$1,457.50","$2,308.68","$2,332.00",$0.00,$456.20,$0.00,$464.07,$0.00
109.473,SUP,HCPCS C1713,,109.473  -  7.0MM PROTEX SOLID PEDICLE SCREW 35MM,"$2,915.00",$0.00,"$2,915.00","$1,311.75","$2,080.44",$0.00,$502.24,$0.00,$0.00,$510.39,"$2,915.00",$0.00,"$1,457.50","$2,308.68","$2,332.00",$0.00,$456.20,$0.00,$464.07,$0.00
109.474,SUP,HCPCS C1713,,109.474  -  7.0MM PROTEX SOLID PEDICLE SCREW 40MM,"$2,915.00",$0.00,"$2,915.00","$1,311.75","$2,080.44",$0.00,$502.24,$0.00,$0.00,$510.39,"$2,915.00",$0.00,"$1,457.50","$2,308.68","$2,332.00",$0.00,$456.20,$0.00,$464.07,$0.00
109.475,SUP,HCPCS C1713,,109.475  -  7.0MM PROTEX SOLID PEDICLE SCREW 45MM,"$2,915.00",$0.00,"$2,915.00","$1,311.75","$2,080.44",$0.00,$502.24,$0.00,$0.00,$510.39,"$2,915.00",$0.00,"$1,457.50","$2,308.68","$2,332.00",$0.00,$456.20,$0.00,$464.07,$0.00
109.476,SUP,HCPCS C1713,,109.476  -  7.0MM PROTEX SOLID PEDICLE SCREW 50MM,"$2,915.00",$0.00,"$2,915.00","$1,311.75","$2,080.44",$0.00,$502.24,$0.00,$0.00,$510.39,"$2,915.00",$0.00,"$1,457.50","$2,308.68","$2,332.00",$0.00,$456.20,$0.00,$464.07,$0.00
109.477,SUP,HCPCS C1713,,109.477  -  7.0MM PROTEX SOLID PEDICLE SCREW 55MM,"$2,915.00",$0.00,"$2,915.00","$1,311.75","$2,080.44",$0.00,$502.24,$0.00,$0.00,$510.39,"$2,915.00",$0.00,"$1,457.50","$2,308.68","$2,332.00",$0.00,$456.20,$0.00,$464.07,$0.00
109.478,SUP,HCPCS C1713,,109.478  -  7.0MM PROTEX SOLID PEDICLE SCREW 60MM,"$2,915.00",$0.00,"$2,915.00","$1,311.75","$2,080.44",$0.00,$502.24,$0.00,$0.00,$510.39,"$2,915.00",$0.00,"$1,457.50","$2,308.68","$2,332.00",$0.00,$456.20,$0.00,$464.07,$0.00
109.479,SUP,HCPCS C1713,,109.479  -  7.0MM PROTEX SOLID PEDICLE SCREW 65MM,"$2,915.00",$0.00,"$2,915.00","$1,311.75","$2,080.44",$0.00,$502.24,$0.00,$0.00,$510.39,"$2,915.00",$0.00,"$1,457.50","$2,308.68","$2,332.00",$0.00,$456.20,$0.00,$464.07,$0.00
109.482,SUP,HCPCS C1713,,109.482  -  8.0MM PROTEX SOLID PEDICLE SCREW 30MM,"$2,915.00",$0.00,"$2,915.00","$1,311.75","$2,080.44",$0.00,$502.24,$0.00,$0.00,$510.39,"$2,915.00",$0.00,"$1,457.50","$2,308.68","$2,332.00",$0.00,$456.20,$0.00,$464.07,$0.00
109.483,SUP,HCPCS C1713,,109.483  -  8.0MM PROTEX SOLID PEDICLE SCREW 35MM,"$2,915.00",$0.00,"$2,915.00","$1,311.75","$2,080.44",$0.00,$502.24,$0.00,$0.00,$510.39,"$2,915.00",$0.00,"$1,457.50","$2,308.68","$2,332.00",$0.00,$456.20,$0.00,$464.07,$0.00
109.484,SUP,HCPCS C1713,,109.484  -  8.0MM PROTEX SOLID PEDICLE SCREW 40MM,"$2,915.00",$0.00,"$2,915.00","$1,311.75","$2,080.44",$0.00,$502.24,$0.00,$0.00,$510.39,"$2,915.00",$0.00,"$1,457.50","$2,308.68","$2,332.00",$0.00,$456.20,$0.00,$464.07,$0.00
109.485,SUP,HCPCS C1713,,109.485  -  8.0MM PROTEX SOLID PEDICLE SCREW 45MM,"$2,915.00",$0.00,"$2,915.00","$1,311.75","$2,080.44",$0.00,$502.24,$0.00,$0.00,$510.39,"$2,915.00",$0.00,"$1,457.50","$2,308.68","$2,332.00",$0.00,$456.20,$0.00,$464.07,$0.00
109.486,SUP,HCPCS C1713,,109.486  -  8.0MM PROTEX SOLID PEDICLE SCREW 50MM,"$2,915.00",$0.00,"$2,915.00","$1,311.75","$2,080.44",$0.00,$502.24,$0.00,$0.00,$510.39,"$2,915.00",$0.00,"$1,457.50","$2,308.68","$2,332.00",$0.00,$456.20,$0.00,$464.07,$0.00
109.487,SUP,HCPCS C1713,,109.487  -  8.0MM PROTEX SOLID PEDICLE SCREW 55MM,"$2,915.00",$0.00,"$2,915.00","$1,311.75","$2,080.44",$0.00,$502.24,$0.00,$0.00,$510.39,"$2,915.00",$0.00,"$1,457.50","$2,308.68","$2,332.00",$0.00,$456.20,$0.00,$464.07,$0.00
109.488,SUP,HCPCS C1713,,109.488  -  8.0MM PROTEX SOLID PEDICLE SCREW 60MM,"$2,915.00",$0.00,"$2,915.00","$1,311.75","$2,080.44",$0.00,$502.24,$0.00,$0.00,$510.39,"$2,915.00",$0.00,"$1,457.50","$2,308.68","$2,332.00",$0.00,$456.20,$0.00,$464.07,$0.00
109.489,SUP,HCPCS C1713,,109.489  -  8.0MM PROTEX SOLID PEDICLE SCREW 65MM,"$2,915.00",$0.00,"$2,915.00","$1,311.75","$2,080.44",$0.00,$502.24,$0.00,$0.00,$510.39,"$2,915.00",$0.00,"$1,457.50","$2,308.68","$2,332.00",$0.00,$456.20,$0.00,$464.07,$0.00
109.492,SUP,HCPCS C1713,,109.492  -  9.0MM PROTEX SOLID PEDICLE SCREW 30MM,"$2,915.00",$0.00,"$2,915.00","$1,311.75","$2,080.44",$0.00,$502.24,$0.00,$0.00,$510.39,"$2,915.00",$0.00,"$1,457.50","$2,308.68","$2,332.00",$0.00,$456.20,$0.00,$464.07,$0.00
109.493,SUP,HCPCS C1713,,109.493  -  9.0MM PROTEX SOLID PEDICLE SCREW 35MM,"$2,915.00",$0.00,"$2,915.00","$1,311.75","$2,080.44",$0.00,$502.24,$0.00,$0.00,$510.39,"$2,915.00",$0.00,"$1,457.50","$2,308.68","$2,332.00",$0.00,$456.20,$0.00,$464.07,$0.00
109.494,SUP,HCPCS C1713,,109.494  -  9.0MM PROTEX SOLID PEDICLE SCREW 40MM,"$2,915.00",$0.00,"$2,915.00","$1,311.75","$2,080.44",$0.00,$502.24,$0.00,$0.00,$510.39,"$2,915.00",$0.00,"$1,457.50","$2,308.68","$2,332.00",$0.00,$456.20,$0.00,$464.07,$0.00
109.495,SUP,HCPCS C1713,,109.495  -  9.0MM PROTEX SOLID PEDICLE SCREW 45MM,"$2,915.00",$0.00,"$2,915.00","$1,311.75","$2,080.44",$0.00,$502.24,$0.00,$0.00,$510.39,"$2,915.00",$0.00,"$1,457.50","$2,308.68","$2,332.00",$0.00,$456.20,$0.00,$464.07,$0.00
109.496,SUP,HCPCS C1713,,109.496  -  9.0MM PROTEX SOLID PEDICLE SCREW 50MM,"$2,915.00",$0.00,"$2,915.00","$1,311.75","$2,080.44",$0.00,$502.24,$0.00,$0.00,$510.39,"$2,915.00",$0.00,"$1,457.50","$2,308.68","$2,332.00",$0.00,$456.20,$0.00,$464.07,$0.00
109.497,SUP,HCPCS C1713,,109.497  -  9.0MM PROTEX SOLID PEDICLE SCREW 55MM,"$2,915.00",$0.00,"$2,915.00","$1,311.75","$2,080.44",$0.00,$502.24,$0.00,$0.00,$510.39,"$2,915.00",$0.00,"$1,457.50","$2,308.68","$2,332.00",$0.00,$456.20,$0.00,$464.07,$0.00
109.498,SUP,HCPCS C1713,,109.498  -  9.0MM PROTEX SOLID PEDICLE SCREW 60MM,"$2,915.00",$0.00,"$2,915.00","$1,311.75","$2,080.44",$0.00,$502.24,$0.00,$0.00,$510.39,"$2,915.00",$0.00,"$1,457.50","$2,308.68","$2,332.00",$0.00,$456.20,$0.00,$464.07,$0.00
109.499,SUP,HCPCS C1713,,109.499  -  9.0MM PROTEX SOLID PEDICLE SCREW 65MM,"$2,915.00",$0.00,"$2,915.00","$1,311.75","$2,080.44",$0.00,$502.24,$0.00,$0.00,$510.39,"$2,915.00",$0.00,"$1,457.50","$2,308.68","$2,332.00",$0.00,$456.20,$0.00,$464.07,$0.00
109.51,SUP,HCPCS C1713,,"109.510  -  6.00MM STRAIGHT ROD, 100MM",$670.00,$0.00,$670.00,$301.50,$478.18,$0.00,$115.44,$0.00,$0.00,$117.31,$670.00,$0.00,$335.00,$530.64,$536.00,$0.00,$104.86,$0.00,$106.66,$0.00
109.512,SUP,Custom 27803010,,"109.512  -  6.00MM STRAIGHT ROD, 125MM",$670.00,$0.00,$670.00,$0.00,$478.18,$0.00,$0.00,$0.00,$0.00,$0.00,$670.00,$0.00,$335.00,$530.64,$536.00,$0.00,$0.00,$0.00,$0.00,$0.00
109.515,SUP,Custom 27803010,,"109.515  -  6.00MM STRAIGHT ROD, 150MM",$670.00,$0.00,$670.00,$0.00,$478.18,$0.00,$0.00,$0.00,$0.00,$0.00,$670.00,$0.00,$335.00,$530.64,$536.00,$0.00,$0.00,$0.00,$0.00,$0.00
109.517,SUP,Custom 27803010,,"109.517  -  6.00MM STRAIGHT ROD, 200MM",$795.00,$0.00,$795.00,$0.00,$567.39,$0.00,$0.00,$0.00,$0.00,$0.00,$795.00,$0.00,$397.50,$629.64,$636.00,$0.00,$0.00,$0.00,$0.00,$0.00
109.519,SUP,Custom 27803010,,"109.519  -  6.00MM STRAIGHT ROD, 300MM",$927.50,$0.00,$927.50,$0.00,$661.96,$0.00,$0.00,$0.00,$0.00,$0.00,$927.50,$0.00,$463.75,$734.58,$742.00,$0.00,$0.00,$0.00,$0.00,$0.00
109.52,SUP,Custom 27803010,,"109.520  -  6.00MM STRAIGHT ROD, 400MM","$1,527.50",$0.00,"$1,527.50",$0.00,"$1,090.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,527.50",$0.00,$763.75,"$1,209.78","$1,222.00",$0.00,$0.00,$0.00,$0.00,$0.00
109.521,SUP,Custom 27803010,,"109.521  -  6.00MM STRAIGHT ROD, 500MM","$1,060.00",$0.00,"$1,060.00",$0.00,$756.52,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,060.00",$0.00,$530.00,$839.52,$848.00,$0.00,$0.00,$0.00,$0.00,$0.00
109.53,SUP,Custom 27803010,,"109.530  -  6.00MM STRAIGHT ROD, 30MM",$670.00,$0.00,$670.00,$0.00,$478.18,$0.00,$0.00,$0.00,$0.00,$0.00,$670.00,$0.00,$335.00,$530.64,$536.00,$0.00,$0.00,$0.00,$0.00,$0.00
109.535,SUP,Custom 27803010,,"109.535  -  6.00MM STRAIGHT ROD, 35MM",$465.00,$0.00,$465.00,$0.00,$331.87,$0.00,$0.00,$0.00,$0.00,$0.00,$465.00,$0.00,$232.50,$368.28,$372.00,$0.00,$0.00,$0.00,$0.00,$0.00
109.54,SUP,Custom 27803010,,"109.540  -  6.00MM STRAIGHT ROD, 40MM",$465.00,$0.00,$465.00,$0.00,$331.87,$0.00,$0.00,$0.00,$0.00,$0.00,$465.00,$0.00,$232.50,$368.28,$372.00,$0.00,$0.00,$0.00,$0.00,$0.00
109.545,SUP,Custom 27803010,,"109.545  -  6.00MM STRAIGHT ROD, 45MM",$465.00,$0.00,$465.00,$0.00,$331.87,$0.00,$0.00,$0.00,$0.00,$0.00,$465.00,$0.00,$232.50,$368.28,$372.00,$0.00,$0.00,$0.00,$0.00,$0.00
109.55,SUP,Custom 27803010,,"109.550  -  6.00MM STRAIGHT ROD, 50MM",$465.00,$0.00,$465.00,$0.00,$331.87,$0.00,$0.00,$0.00,$0.00,$0.00,$465.00,$0.00,$232.50,$368.28,$372.00,$0.00,$0.00,$0.00,$0.00,$0.00
109.555,SUP,Custom 27803010,,"109.555  -  6.00MM STRAIGHT ROD, 55MM",$465.00,$0.00,$465.00,$0.00,$331.87,$0.00,$0.00,$0.00,$0.00,$0.00,$465.00,$0.00,$232.50,$368.28,$372.00,$0.00,$0.00,$0.00,$0.00,$0.00
109.56,SUP,Custom 27803010,,"109.560  -  6.00MM STRAIGHT ROD, 60MM",$465.00,$0.00,$465.00,$0.00,$331.87,$0.00,$0.00,$0.00,$0.00,$0.00,$465.00,$0.00,$232.50,$368.28,$372.00,$0.00,$0.00,$0.00,$0.00,$0.00
109.565,SUP,Custom 27803010,,"109.565  -  6.00MM STRAIGHT ROD, 65MM",$465.00,$0.00,$465.00,$0.00,$331.87,$0.00,$0.00,$0.00,$0.00,$0.00,$465.00,$0.00,$232.50,$368.28,$372.00,$0.00,$0.00,$0.00,$0.00,$0.00
109.57,SUP,Custom 27803010,,"109.570  -  6.00MM STRAIGHT ROD, 70MM",$465.00,$0.00,$465.00,$0.00,$331.87,$0.00,$0.00,$0.00,$0.00,$0.00,$465.00,$0.00,$232.50,$368.28,$372.00,$0.00,$0.00,$0.00,$0.00,$0.00
109.575,SUP,Custom 27803010,,"109.575  -  6.00MM STRAIGHT ROD, 75MM",$465.00,$0.00,$465.00,$0.00,$331.87,$0.00,$0.00,$0.00,$0.00,$0.00,$465.00,$0.00,$232.50,$368.28,$372.00,$0.00,$0.00,$0.00,$0.00,$0.00
109.58,SUP,Custom 27803010,,"109.580  -  6.00MM STRAIGHT ROD, 80MM",$465.00,$0.00,$465.00,$0.00,$331.87,$0.00,$0.00,$0.00,$0.00,$0.00,$465.00,$0.00,$232.50,$368.28,$372.00,$0.00,$0.00,$0.00,$0.00,$0.00
109.585,SUP,Custom 27803010,,"109.585  -  6.00MM STRAIGHT ROD, 85MM",$465.00,$0.00,$465.00,$0.00,$331.87,$0.00,$0.00,$0.00,$0.00,$0.00,$465.00,$0.00,$232.50,$368.28,$372.00,$0.00,$0.00,$0.00,$0.00,$0.00
109.61,SUP,Custom 27803010,,"109.610  -  6.00MM CURVED ROD, 100MM",$765.00,$0.00,$765.00,$0.00,$545.98,$0.00,$0.00,$0.00,$0.00,$0.00,$765.00,$0.00,$382.50,$605.88,$612.00,$0.00,$0.00,$0.00,$0.00,$0.00
109.612,SUP,Custom 27803010,,"109.612  -  6.00MM CURVED ROD, 120MM",$765.00,$0.00,$765.00,$0.00,$545.98,$0.00,$0.00,$0.00,$0.00,$0.00,$765.00,$0.00,$382.50,$605.88,$612.00,$0.00,$0.00,$0.00,$0.00,$0.00
109.615,SUP,Custom 27803010,,"109.615  -  6.00MM CURVED ROD, 150MM",$765.00,$0.00,$765.00,$0.00,$545.98,$0.00,$0.00,$0.00,$0.00,$0.00,$765.00,$0.00,$382.50,$605.88,$612.00,$0.00,$0.00,$0.00,$0.00,$0.00
109.635,SUP,Custom 27803010,,"109.635  -  6.00MM CURVED ROD, 35MM",$530.00,$0.00,$530.00,$0.00,$378.26,$0.00,$0.00,$0.00,$0.00,$0.00,$530.00,$0.00,$265.00,$419.76,$424.00,$0.00,$0.00,$0.00,$0.00,$0.00
109.64,SUP,Custom 27803010,,"109.640  -  6.00MM CURVED ROD, 40MM",$530.00,$0.00,$530.00,$0.00,$378.26,$0.00,$0.00,$0.00,$0.00,$0.00,$530.00,$0.00,$265.00,$419.76,$424.00,$0.00,$0.00,$0.00,$0.00,$0.00
109.645,SUP,Custom 27803010,,"109.645  -  6.00MM CURVED ROD, 45MM",$530.00,$0.00,$530.00,$0.00,$378.26,$0.00,$0.00,$0.00,$0.00,$0.00,$530.00,$0.00,$265.00,$419.76,$424.00,$0.00,$0.00,$0.00,$0.00,$0.00
109.65,SUP,Custom 27803010,,"109.650  -  6.00MM CURVED ROD, 50MM",$530.00,$0.00,$530.00,$0.00,$378.26,$0.00,$0.00,$0.00,$0.00,$0.00,$530.00,$0.00,$265.00,$419.76,$424.00,$0.00,$0.00,$0.00,$0.00,$0.00
109.655,SUP,Custom 27803010,,"109.655  -  6.00MM CURVED ROD, 55MM",$530.00,$0.00,$530.00,$0.00,$378.26,$0.00,$0.00,$0.00,$0.00,$0.00,$530.00,$0.00,$265.00,$419.76,$424.00,$0.00,$0.00,$0.00,$0.00,$0.00
109.66,SUP,Custom 27803010,,"109.660  -  6.00MM CURVED ROD, 60MM",$530.00,$0.00,$530.00,$0.00,$378.26,$0.00,$0.00,$0.00,$0.00,$0.00,$530.00,$0.00,$265.00,$419.76,$424.00,$0.00,$0.00,$0.00,$0.00,$0.00
109.665,SUP,Custom 27803010,,"109.665  -  6.00MM CURVED ROD, 65MM",$530.00,$0.00,$530.00,$0.00,$378.26,$0.00,$0.00,$0.00,$0.00,$0.00,$530.00,$0.00,$265.00,$419.76,$424.00,$0.00,$0.00,$0.00,$0.00,$0.00
109.67,SUP,Custom 27803010,,"109.670  -  6.00MM CURVED ROD, 70MM",$530.00,$0.00,$530.00,$0.00,$378.26,$0.00,$0.00,$0.00,$0.00,$0.00,$530.00,$0.00,$265.00,$419.76,$424.00,$0.00,$0.00,$0.00,$0.00,$0.00
109.675,SUP,Custom 27803010,,"109.675  -  6.00MM CURVED ROD, 75MM",$530.00,$0.00,$530.00,$0.00,$378.26,$0.00,$0.00,$0.00,$0.00,$0.00,$530.00,$0.00,$265.00,$419.76,$424.00,$0.00,$0.00,$0.00,$0.00,$0.00
109.68,SUP,Custom 27803010,,"109.680  -  6.00MM CURVED ROD, 80MM",$530.00,$0.00,$530.00,$0.00,$378.26,$0.00,$0.00,$0.00,$0.00,$0.00,$530.00,$0.00,$265.00,$419.76,$424.00,$0.00,$0.00,$0.00,$0.00,$0.00
109.685,SUP,Custom 27803010,,"109.685  -  6.00MM CURVED ROD, 85MM",$530.00,$0.00,$530.00,$0.00,$378.26,$0.00,$0.00,$0.00,$0.00,$0.00,$530.00,$0.00,$265.00,$419.76,$424.00,$0.00,$0.00,$0.00,$0.00,$0.00
109.921,SUP,Custom 27803010,,"109.921  -  PROTEX LAMINA HOOK, 6.0MM ROD, SMALL","$2,120.00",$0.00,"$2,120.00",$0.00,"$1,513.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,120.00",$0.00,"$1,060.00","$1,679.04","$1,696.00",$0.00,$0.00,$0.00,$0.00,$0.00
109.922,SUP,Custom 27803010,,"109.922  -  PROTEX LAMINA HOOK, 6.0MM ROD, MEDIUM","$2,120.00",$0.00,"$2,120.00",$0.00,"$1,513.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,120.00",$0.00,"$1,060.00","$1,679.04","$1,696.00",$0.00,$0.00,$0.00,$0.00,$0.00
109.923,SUP,Custom 27803010,,"109.923  -  PROTEX LAMINA HOOK, 6.0MM ROD, LARGE","$2,120.00",$0.00,"$2,120.00",$0.00,"$1,513.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,120.00",$0.00,"$1,060.00","$1,679.04","$1,696.00",$0.00,$0.00,$0.00,$0.00,$0.00
109.925,SUP,Custom 27803010,,"109.925  -  PROTEX ANGLED LAMINA HOOK, 6.0MM ROD, SMALL","$2,120.00",$0.00,"$2,120.00",$0.00,"$1,513.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,120.00",$0.00,"$1,060.00","$1,679.04","$1,696.00",$0.00,$0.00,$0.00,$0.00,$0.00
109.926,SUP,Custom 27803010,,"109.926  -  PROTEX ANGLED LAMINA HOOK, 6.0MM ROD, MEDIUM","$2,120.00",$0.00,"$2,120.00",$0.00,"$1,513.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,120.00",$0.00,"$1,060.00","$1,679.04","$1,696.00",$0.00,$0.00,$0.00,$0.00,$0.00
109.927,SUP,Custom 27803010,,"109.927  -  PROTEX ANGLED LAMINA HOOK, 6.0MM ROD, LARGE","$2,120.00",$0.00,"$2,120.00",$0.00,"$1,513.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,120.00",$0.00,"$1,060.00","$1,679.04","$1,696.00",$0.00,$0.00,$0.00,$0.00,$0.00
109.941,SUP,Custom 27803010,,"109.941  -  PROTEX PEDICLE HOOK, 6.0MM ROD","$2,120.00",$0.00,"$2,120.00",$0.00,"$1,513.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,120.00",$0.00,"$1,060.00","$1,679.04","$1,696.00",$0.00,$0.00,$0.00,$0.00,$0.00
109.951,SUP,Custom 27803010,,"109.951  -  PROTEX TRANSVERSE PROCESS HOOK, 6.0MM ROD, RIGHT","$2,120.00",$0.00,"$2,120.00",$0.00,"$1,513.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,120.00",$0.00,"$1,060.00","$1,679.04","$1,696.00",$0.00,$0.00,$0.00,$0.00,$0.00
109.952,SUP,Custom 27803010,,"109.952  -  PROTEX TRANSVERSE PROCESS HOOK, 6.0MM ROD, LEFT","$2,120.00",$0.00,"$2,120.00",$0.00,"$1,513.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,120.00",$0.00,"$1,060.00","$1,679.04","$1,696.00",$0.00,$0.00,$0.00,$0.00,$0.00
110.01,SUP,HCPCS C1713,,"110.010  -  4.0MM RIGID SCREW, SELF-DRILLING, 10MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
110.012,SUP,HCPCS C1713,,"110.012  -  4.0MM RIGID SCREW, SELF-DRILLING, 12MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
110.014,SUP,HCPCS C1713,,"110.014  -  4.0MM RIGID SCREW, SELF-DRILLING, 14MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
110.016,SUP,HCPCS C1713,,110.016  -  SCREW BONE 4MM 16MM ASR TI ANT CERV SPN SLFDRILL RGD,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
110.026,SUP,HCPCS C1713,,"110.026  -  4.0MM RIGID SCREW, SELF-TAPPING, 6MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
110.028,SUP,HCPCS C1713,,"110.028  -  4.0MM RIGID SCREW, SELF-TAPPING, 8MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
110.03,SUP,HCPCS C1713,,"110.030  -  4.0MM RIGID SCREW, SELF-TAPPING, 10MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
110.032,SUP,HCPCS C1713,,"110.032  -  4.0MM RIGID SCREW, SELF-TAPPING, 12MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
110.034,SUP,HCPCS C1713,,110.034  -  SCREW BONE 4MM 14MM ASR TI ANT CERV SPN SLFTAP RGD,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
110.036,SUP,HCPCS C1713,,110.036  -  SCREW BONE 4MM 16MM ASR TI ANT CERV SPN SLFTAP RGD,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
110.038,SUP,HCPCS C1713,,110.038  -  SCREW BONE 4MM 18MM ASR SPNL SLFTAP RGD,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
110.04,SUP,HCPCS C1713,,"110.040  -  4.0MM RIGID SCREW, SELF-TAPPING, 20MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
110.05,SUP,HCPCS C1713,,110.050  -  SCREW SET TI ANT CERV SPN RGD,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
110.11,SUP,HCPCS C1713,,"110.110  -  ASSURE CERVICAL PLATE 1-LEVEL, 10MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
110.112,SUP,HCPCS C1713,,"110.112  -  ASSURE CERVICAL PLATE 1-LEVEL, 12MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
110.114,SUP,HCPCS C1713,,110.114  -  PLATE 14MM TI 1 LVL ASR BONE ANT CERV SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
110.116,SUP,HCPCS C1713,,110.116  -  PLATE 16MM TI 1 LVL ASR BONE ANT CERV SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
110.118,SUP,HCPCS C1713,,"110.118  -  ASSURE CERVICAL PLATE 1-LEVEL, 18MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
110.12,SUP,HCPCS C1713,,"110.120  -  ASSURE CERVICAL PLATE 1-LEVEL, 20MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
110.122,SUP,HCPCS C1713,,"110.122  -  ASSURE CERVICAL PLATE 1-LEVEL, 22MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
110.124,SUP,HCPCS C1713,,110.124  -  PLATE 24MM TI 1 LVL ASR BONE ANT CERV SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
110.126,SUP,HCPCS C1713,,"110.126  -  ASSURE CERVICAL PLATE 1-LEVEL, 26MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
110.224,SUP,HCPCS C1713,,"110.224  -  ASSURE CERVICAL PLATE 2-LEVEL, 24MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
110.226,SUP,HCPCS C1713,,"110.226  -  ASSURE CERVICAL PLATE 2-LEVEL, 26MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
110.228,SUP,HCPCS C1713,,110.228  -  PLATE 28MM TI 2 LVL ASR BONE ANT CERV SPN,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
110.23,SUP,HCPCS C1713,,110.230  -  PLATE 30MM TI 2 LVL ASR BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
110.232,SUP,HCPCS C1713,,110.232  -  PLATE 32MM TI 2 LVL ASR BONE ANT CERV SPN,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
110.234,SUP,HCPCS C1713,,110.234  -  PLATE 34MM TI 2 LVL ASR BONE ANT CERV SPN,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
110.236,SUP,HCPCS C1713,,110.236  -  PLATE 36MM TI 2 LVL ASR BONE ANT CERV SPN,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
110.238,SUP,HCPCS C1713,,"110.238  -  ASSURE CERVICAL PLATE 2-LEVEL, 38MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
110.24,SUP,HCPCS C1713,,"110.240  -  ASSURE CERVICAL PLATE 2-LEVEL, 40MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
110.242,SUP,HCPCS C1713,,"110.242  -  ASSURE CERVICAL PLATE 2-LEVEL, 42MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
110.244,SUP,HCPCS C1713,,"110.244  -  ASSURE CERVICAL PLATE 2-LEVEL, 44MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
110.246,SUP,HCPCS C1713,,"110.246  -  ASSURE CERVICAL PLATE 2-LEVEL, 46MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
110.339,SUP,HCPCS C1713,,"110.339  -  ASSURE CERVICAL PLATE 3-LEVEL, 39MM","$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
110.342,SUP,HCPCS C1713,,"110.342  -  ASSURE CERVICAL PLATE 3-LEVEL, 42MM","$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
110.345,SUP,HCPCS C1713,,"110.345  -  ASSURE CERVICAL PLATE 3-LEVEL, 45MM","$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
110.348,SUP,HCPCS C1713,,"110.348  -  ASSURE CERVICAL PLATE 3-LEVEL, 48MM","$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
110.351,SUP,HCPCS C1713,,"110.351  -  ASSURE CERVICAL PLATE 3-LEVEL, 51MM","$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
110.354,SUP,HCPCS C1713,,"110.354  -  ASSURE CERVICAL PLATE 3-LEVEL, 54MM","$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
110.357,SUP,HCPCS C1713,,"110.357  -  ASSURE CERVICAL PLATE 3-LEVEL, 57MM","$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
110.36,SUP,HCPCS C1713,,"110.360  -  ASSURE CERVICAL PLATE 3-LEVEL, 60MM","$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
110.363,SUP,HCPCS C1713,,"110.363  -  ASSURE CERVICAL PLATE 3-LEVEL, 63MM","$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
110.366,SUP,HCPCS C1713,,"110.366  -  ASSURE CERVICAL PLATE 3-LEVEL, 66MM","$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
110.369,SUP,HCPCS C1713,,"110.369  -  ASSURE CERVICAL PLATE 3-LEVEL, 69MM","$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
110.46,SUP,HCPCS C1713,,"110.460  -  ASSURE CERVICAL PLATE 4-LEVEL, 60MM","$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
110.464,SUP,HCPCS C1713,,"110.464  -  ASSURE CERVICAL PLATE 4-LEVEL, 64MM","$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
110.468,SUP,HCPCS C1713,,"110.468  -  ASSURE CERVICAL PLATE 4-LEVEL, 68MM","$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
110.472,SUP,HCPCS C1713,,"110.472  -  ASSURE CERVICAL PLATE 4-LEVEL, 72MM","$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
110.476,SUP,HCPCS C1713,,"110.476  -  ASSURE CERVICAL PLATE 4-LEVEL, 76MM","$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
110.48,SUP,HCPCS C1713,,"110.480  -  ASSURE CERVICAL PLATE 4-LEVEL, 80MM","$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
110.484,SUP,HCPCS C1713,,"110.484  -  ASSURE CERVICAL PLATE 4-LEVEL, 84MM","$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
110.488,SUP,HCPCS C1713,,"110.488  -  ASSURE CERVICAL PLATE 4-LEVEL, 88MM","$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
110.492,SUP,HCPCS C1713,,"110.492  -  ASSURE CERVICAL PLATE 4-LEVEL, 92MM","$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
110.496,SUP,HCPCS C1713,,"110.496  -  ASSURE CERVICAL PLATE 4-LEVEL, 96MM","$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
110.5,SUP,HCPCS C1713,,"110.500  -  ASSURE CERVICAL PLATE 4-LEVEL, 100MM","$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
110.512,SUP,HCPCS C1713,,"110.512  -  4.5MM RIGID SCREW, SELF-DRILLING, 12MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
110.514,SUP,HCPCS C1713,,"110.514  -  4.5MM RIGID SCREW, SELF-DRILLING, 14MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
110.516,SUP,HCPCS C1713,,"110.516  -  4.5MM RIGID SCREW, SELF-DRILLING, 16MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
110.526,SUP,HCPCS C1713,,"110.526  -  4.5MM RIGID SCREW, SELF-TAPPING, 6MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
110.528,SUP,HCPCS C1713,,"110.528  -  4.5MM RIGID SCREW, SELF-TAPPING, 8MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
110.53,SUP,HCPCS C1713,,"110.530  -  4.5MM RIGID SCREW, SELF-TAPPING, 10MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
110.532,SUP,HCPCS C1713,,"110.532  -  4.5MM RIGID SCREW, SELF-TAPPING, 12MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
110.534,SUP,HCPCS C1713,,"110.534  -  4.5MM RIGID SCREW, SELF-TAPPING, 14MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
110.536,SUP,HCPCS C1713,,110.536  -  SCREW BONE 4.5MM 16MM ASR TI SPNL SLFTAP RGD,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
110.538,SUP,HCPCS C1713,,"110.538  -  4.5MM RIGID SCREW, SELF-TAPPING, 18MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
110.54,SUP,HCPCS C1713,,"110.540  -  4.5MM RIGID SCREW, SELF-TAPPING, 20MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
110.61,SUP,HCPCS C1713,,"110.610  -  4.0MM STANDARD SCREW, SELF-DRILLING, 10MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
110.612,SUP,HCPCS C1713,,"110.612  -  4.0MM STANDARD SCREW, SELF-DRILLING, 12MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
110.614,SUP,HCPCS C1713,,"110.614  -  4.0MM STANDARD SCREW, SELF-DRILLING, 14MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
110.616,SUP,HCPCS C1713,,110.616  -  SCREW BONE 4MM 16MM ASR TI STD SPNL SLFDRILL,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
110.712,SUP,HCPCS C1713,,"110.712  -  4.5MM STANDARD SCREW, SELF-DRILLING, 12MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
110.714,SUP,HCPCS C1713,,"110.714  -  4.5MM STANDARD SCREW, SELF-DRILLING, 14MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
110.716,SUP,HCPCS C1713,,110.716  -  SCREW BONE 4.5MM 16MM ASR TI STD SPNL SLFDRILL,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
110.806,SUP,HCPCS C1713,,110.806  -  SCREW BN STD 4MM 6MM PRTX CT ST SPNE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
110.808,SUP,HCPCS C1713,,110.808  -  SCREW BONE 4MM 8MM TI STD SPNL SLFTAP,$967.50,$0.00,$967.50,$435.38,$690.50,$0.00,$166.70,$0.00,$0.00,$169.40,$967.50,$0.00,$483.75,$766.26,$774.00,$0.00,$151.41,$0.00,$154.03,$0.00
110.81,SUP,HCPCS C1713,,"110.810  -  4.0MM STANDARD SCREW, SELF-TAPPING, 10MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
110.812,SUP,HCPCS C1713,,"110.812  -  4.0MM STANDARD SCREW, SELF-TAPPING, 12MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
110.814,SUP,HCPCS C1713,,110.814  -  SCREW BONE 4MM 14MM ASR TI STD ANT CERV SPN SLFTAP,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
110.816,SUP,HCPCS C1713,,110.816  -  SCREW BONE 4MM 16MM ASR TI STD SPNL SLFTAP,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
110.818,SUP,HCPCS C1713,,110.818  -  SCREW BONE 4MM 18MM ASR TI STD SPNL SLFTAP,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
110.82,SUP,HCPCS C1713,,"110.820  -  4.0MM STANDARD SCREW, SELF-TAPPING, 20MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
110.906,SUP,HCPCS C1713,,"110.906  -  4.5MM STANDARD SCREW, SELF-TAPPING, 6MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
110.908,SUP,HCPCS C1713,,"110.908  -  4.5MM STANDARD SCREW, SELF-TAPPING, 8MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
110.91,SUP,HCPCS C1713,,"110.910  -  4.5MM STANDARD SCREW, SELF-TAPPING, 10MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
110.912,SUP,HCPCS C1713,,110.912  -  SCREW BONE 4.5MM 12MM ASR TI STD ANT CERV SPN SLFTAP,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
110.914,SUP,HCPCS C1713,,"110.914  -  4.5MM STANDARD SCREW, SELF-TAPPING, 14MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
110.916,SUP,HCPCS C1713,,110.916  -  SCREW BONE 4.5MM 16MM ASR TI STD ANT CERV SPN SLFTAP,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
110.918,SUP,HCPCS C1713,,110.918  -  SCREW BONE 4.5MM 18MM ASR TI STD SPNL SLFTAP,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
110.92,SUP,HCPCS C1713,,110.920  -  SCREW BONE 4.5MM 20MM PRTX TI STD THORLMBR SPN SLFTAP,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
111,SUP,Custom 27203010,,111  -  ADAPTER SUCTION 15MM 15MM CLOSE SYSTEM SWIVEL LATEX FREE,$79.68,$0.00,$79.68,$0.00,$56.87,$0.00,$0.00,$0.00,$0.00,$0.00,$79.68,$0.00,$39.84,$63.11,$63.74,$0.00,$0.00,$0.00,$0.00,$0.00
115,SUP,HCPCS C1713,,"115.000  -  SET SCREW, M4 X 0.75, ROUND TIP, 2.5MM HEX",$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
115.222,SUP,HCPCS C1713,,"115.222  -  3.5MM PROTEX CT POLYAXIAL SHOULDER SCREW, 22MM","$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
115.224,SUP,HCPCS C1713,,"115.224  -  3.5MM PROTEX CT POLYAXIAL SHOULDER SCREW, 24MM","$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
115.226,SUP,HCPCS C1713,,"115.226  -  3.5MM PROTEX CT POLYAXIAL SHOULDER SCREW, 26MM","$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
115.228,SUP,HCPCS C1713,,"115.228  -  3.5MM PROTEX CT POLYAXIAL SHOULDER SCREW, 28MM","$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
115.23,SUP,HCPCS C1713,,"115.230  -  3.5MM PROTEX CT POLYAXIAL SHOULDER SCREW, 30MM","$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
115.232,SUP,HCPCS C1713,,"115.232  -  3.5MM PROTEX CT POLYAXIAL SHOULDER SCREW, 32MM","$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
115.234,SUP,HCPCS C1713,,"115.234  -  3.5MM PROTEX CT POLYAXIAL SHOULDER SCREW, 34MM","$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
115.236,SUP,HCPCS C1713,,"115.236  -  3.5MM PROTEX CT POLYAXIAL SHOULDER SCREW, 36MM","$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
115.308,SUP,HCPCS C1713,,115.308  -  SCREW BONE 3.5MM 8MM PRTX CTTI OCT SPN POLYAX,"$3,097.50",$0.00,"$3,097.50","$1,393.88","$2,210.69",$0.00,$533.68,$0.00,$0.00,$542.35,"$3,097.50",$0.00,"$1,548.75","$2,453.22","$2,478.00",$0.00,$484.76,$0.00,$493.12,$0.00
115.31,SUP,HCPCS C1713,,115.310  -  SCREW BONE 3.5MM 10MM PRTX CTTI POST THOR SPN,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
115.312,SUP,HCPCS C1713,,115.312  -  SCREW BONE 3.5MM 12MM PRTX CTTI OCT SPN POLYAX,"$3,097.50",$0.00,"$3,097.50","$1,393.88","$2,210.69",$0.00,$533.68,$0.00,$0.00,$542.35,"$3,097.50",$0.00,"$1,548.75","$2,453.22","$2,478.00",$0.00,$484.76,$0.00,$493.12,$0.00
115.314,SUP,HCPCS C1713,,115.314  -  SCREW BONE 3.5MM 14MM PRTX CTTI OCT SPN POLYAX,"$3,097.50",$0.00,"$3,097.50","$1,393.88","$2,210.69",$0.00,$533.68,$0.00,$0.00,$542.35,"$3,097.50",$0.00,"$1,548.75","$2,453.22","$2,478.00",$0.00,$484.76,$0.00,$493.12,$0.00
115.316,SUP,HCPCS C1713,,115.316  -  SCREW BONE 3.5MM 16MM PRTX CTTI OCT SPN POLYAX,"$3,097.50",$0.00,"$3,097.50","$1,393.88","$2,210.69",$0.00,$533.68,$0.00,$0.00,$542.35,"$3,097.50",$0.00,"$1,548.75","$2,453.22","$2,478.00",$0.00,$484.76,$0.00,$493.12,$0.00
115.318,SUP,HCPCS C1713,,115.318  -  3.5MM PROTEX CT POLYAXIAL SCREW 18MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
115.32,SUP,HCPCS C1713,,115.320  -  3.5MM PROTEX CT POLYAXIAL SCREW 20MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
115.322,SUP,HCPCS C1713,,115.322  -  3.5MM PROTEX CT POLYAXIAL SCREW 22MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
115.324,SUP,HCPCS C1713,,115.324  -  3.5MM PROTEX CT POLYAXIAL SCREW 24MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
115.326,SUP,HCPCS C1713,,115.326  -  3.5MM PROTEX CT POLYAXIAL SCREW 26MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
115.328,SUP,HCPCS C1713,,115.328  -  3.5MM PROTEX CT POLYAXIAL SCREW 28MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
115.33,SUP,HCPCS C1713,,115.330  -  3.5MM PROTEX CT POLYAXIAL SCREW 30MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
115.332,SUP,HCPCS C1713,,115.332  -  3.5MM PROTEX CT POLYAXIAL SCREW 32MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
115.334,SUP,HCPCS C1713,,115.334  -  3.5MM PROTEX CT POLYAXIAL SCREW 34MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
115.336,SUP,HCPCS C1713,,115.336  -  3.5MM PROTEX CT POLYAXIAL SCREW 36MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
115.338,SUP,HCPCS C1713,,115.338  -  3.5MM PROTEX CT POLYAXIAL SCREW 38MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
115.34,SUP,HCPCS C1713,,115.340  -  3.5MM PROTEX CT POLYAXIAL SCREW 40MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
115.342,SUP,HCPCS C1713,,115.342  -  3.5MM PROTEX CT POLYAXIAL SCREW 42MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
115.344,SUP,HCPCS C1713,,115.344  -  3.5MM PROTEX CT POLYAXIAL SCREW 44MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
115.346,SUP,HCPCS C1713,,115.346  -  3.5MM PROTEX CT POLYAXIAL SCREW 46MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
115.348,SUP,HCPCS C1713,,115.348  -  3.5MM PROTEX CT POLYAXIAL SCREW 48MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
115.35,SUP,HCPCS C1713,,115.350  -  3.5MM PROTEX CT POLYAXIAL SCREW 50MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
115.41,SUP,HCPCS C1713,,115.410  -  SCREW BONE 4MM 10MM PRTX CTTI OCT SPN POLYAX SLFTAP,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
115.412,SUP,HCPCS C1713,,115.412  -  SCREW BN 4MM 12MM PRTX CT PA SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
115.414,SUP,HCPCS C1713,,115.414  -  SCREW BN 4MM 14MM PRTX CT PA SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
115.416,SUP,HCPCS C1713,,115.416  -  4.0MM PROTEX CT POLYAXIAL SCREW 16MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
115.418,SUP,HCPCS C1713,,115.418  -  SCREW BN 4MM 18MM PRTX CT PA SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
115.42,SUP,HCPCS C1713,,115.420  -  4.0MM PROTEX CT POLYAXIAL SCREW 20MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
115.422,SUP,HCPCS C1713,,115.422  -  4.0MM PROTEX CT POLYAXIAL SCREW 22MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
115.424,SUP,HCPCS C1713,,115.424  -  4.0MM PROTEX CT POLYAXIAL SCREW 24MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
115.426,SUP,HCPCS C1713,,115.426  -  4.0MM PROTEX CT POLYAXIAL SCREW 26MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
115.428,SUP,HCPCS C1713,,115.428  -  4.0MM PROTEX CT POLYAXIAL SCREW 28MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
115.43,SUP,HCPCS C1713,,115.430  -  4.0MM PROTEX CT POLYAXIAL SCREW 30MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
115.432,SUP,HCPCS C1713,,115.432  -  4.0MM PROTEX CT POLYAXIAL SCREW 32MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
115.434,SUP,HCPCS C1713,,115.434  -  4.0MM PROTEX CT POLYAXIAL SCREW 34MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
115.436,SUP,HCPCS C1713,,115.436  -  4.0MM PROTEX CT POLYAXIAL SCREW 36MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
115.438,SUP,HCPCS C1713,,115.438  -  4.0MM PROTEX CT POLYAXIAL SCREW 38MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
115.44,SUP,HCPCS C1713,,115.440  -  4.0MM PROTEX CT POLYAXIAL SCREW 40MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
115.442,SUP,HCPCS C1713,,115.442  -  4.0MM PROTEX CT POLYAXIAL SCREW 42MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
115.444,SUP,HCPCS C1713,,115.444  -  4.0MM PROTEX CT POLYAXIAL SCREW 44MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
115.446,SUP,HCPCS C1713,,115.446  -  4.0MM PROTEX CT POLYAXIAL SCREW 46MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
115.448,SUP,HCPCS C1713,,115.448  -  4.0MM PROTEX CT POLYAXIAL SCREW 48MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
115.45,SUP,HCPCS C1713,,115.450  -  4.0MM PROTEX CT POLYAXIAL SCREW 50MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
115.5,SUP,Custom 27803010,,115.500  -  CAP LCK PRTX CTTI STD OCT SPN POLYAX,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
115.501,SUP,Custom 27803010,,115.501  -  PROTEX CT HOOK,$955.00,$0.00,$955.00,$0.00,$681.58,$0.00,$0.00,$0.00,$0.00,$0.00,$955.00,$0.00,$477.50,$756.36,$764.00,$0.00,$0.00,$0.00,$0.00,$0.00
115.503,SUP,Custom 27803010,,"115.503  -  PROTEX CT HOOK, RIGHT",$955.00,$0.00,$955.00,$0.00,$681.58,$0.00,$0.00,$0.00,$0.00,$0.00,$955.00,$0.00,$477.50,$756.36,$764.00,$0.00,$0.00,$0.00,$0.00,$0.00
115.504,SUP,Custom 27803010,,"115.504  -  PROTEX CT HOOK, LEFT",$955.00,$0.00,$955.00,$0.00,$681.58,$0.00,$0.00,$0.00,$0.00,$0.00,$955.00,$0.00,$477.50,$756.36,$764.00,$0.00,$0.00,$0.00,$0.00,$0.00
115.506,SUP,Custom 27803010,,"115.506  -  PROTEX CT HOOK, 7MM OFFSET, LEFT",$955.00,$0.00,$955.00,$0.00,$681.58,$0.00,$0.00,$0.00,$0.00,$0.00,$955.00,$0.00,$477.50,$756.36,$764.00,$0.00,$0.00,$0.00,$0.00,$0.00
115.507,SUP,Custom 27803010,,"115.507  -  PROTEX CT HOOK, 5MM OFFSET, LEFT",$955.00,$0.00,$955.00,$0.00,$681.58,$0.00,$0.00,$0.00,$0.00,$0.00,$955.00,$0.00,$477.50,$756.36,$764.00,$0.00,$0.00,$0.00,$0.00,$0.00
115.508,SUP,Custom 27803010,,"115.508  -  PROTEX CT HOOK, 7MM OFFSET, RIGHT",$955.00,$0.00,$955.00,$0.00,$681.58,$0.00,$0.00,$0.00,$0.00,$0.00,$955.00,$0.00,$477.50,$756.36,$764.00,$0.00,$0.00,$0.00,$0.00,$0.00
115.509,SUP,Custom 27803010,,"115.509  -  PROTEX CT HOOK, 5MM OFFSET, RIGHT",$955.00,$0.00,$955.00,$0.00,$681.58,$0.00,$0.00,$0.00,$0.00,$0.00,$955.00,$0.00,$477.50,$756.36,$764.00,$0.00,$0.00,$0.00,$0.00,$0.00
115.51,SUP,HCPCS C1713,,115.510  -  4.5MM PROTEX CT POLYAXIAL SCREW 10MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
115.512,SUP,HCPCS C1713,,115.512  -  4.5MM PROTEX CT POLYAXIAL SCREW 12MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
115.514,SUP,HCPCS C1713,,115.514  -  4.5MM PROTEX CT POLYAXIAL SCREW 14MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
115.516,SUP,HCPCS C1713,,115.516  -  4.5MM PROTEX CT POLYAXIAL SCREW 16MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
115.518,SUP,HCPCS C1713,,115.518  -  4.5MM PROTEX CT POLYAXIAL SCREW 18MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
115.52,SUP,HCPCS C1713,,115.520  -  SCREW BONE 4.5MM 20MM PRTX CTTI OCT SPN SLFTAP,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
115.522,SUP,HCPCS C1713,,115.522  -  4.5MM PROTEX CT POLYAXIAL SCREW 22MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
115.524,SUP,HCPCS C1713,,115.524  -  SCREW BONE 4.5MM 24MM PRTX CTTI OCT SPN POLYAX,"$3,365.00",$0.00,"$3,365.00","$1,514.25","$2,401.60",$0.00,$579.77,$0.00,$0.00,$589.18,"$3,365.00",$0.00,"$1,682.50","$2,665.08","$2,692.00",$0.00,$526.62,$0.00,$535.71,$0.00
115.526,SUP,HCPCS C1713,,115.526  -  SCREW BONE 4.5MM 26MM PRTX CT OCT SPN SLFTAP LP POLYAX,"$3,365.00",$0.00,"$3,365.00","$1,514.25","$2,401.60",$0.00,$579.77,$0.00,$0.00,$589.18,"$3,365.00",$0.00,"$1,682.50","$2,665.08","$2,692.00",$0.00,$526.62,$0.00,$535.71,$0.00
115.528,SUP,HCPCS C1713,,115.528  -  4.5MM PROTEX CT POLYAXIAL SCREW 28MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
115.53,SUP,HCPCS C1713,,115.530  -  4.5MM PROTEX CT POLYAXIAL SCREW 30MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
115.532,SUP,HCPCS C1713,,115.532  -  4.5MM PROTEX CT POLYAXIAL SCREW 32MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
115.534,SUP,HCPCS C1713,,115.534  -  4.5MM PROTEX CT POLYAXIAL SCREW 34MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
115.536,SUP,HCPCS C1713,,115.536  -  4.5MM PROTEX CT POLYAXIAL SCREW 36MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
115.538,SUP,HCPCS C1713,,115.538  -  4.5MM PROTEX CT POLYAXIAL SCREW 38MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
115.54,SUP,HCPCS C1713,,115.540  -  4.5MM PROTEX CT POLYAXIAL SCREW 40MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
115.542,SUP,HCPCS C1713,,115.542  -  4.5MM PROTEX CT POLYAXIAL SCREW 42MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
115.544,SUP,HCPCS C1713,,115.544  -  4.5MM PROTEX CT POLYAXIAL SCREW 44MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
115.546,SUP,HCPCS C1713,,115.546  -  4.5MM PROTEX CT POLYAXIAL SCREW 46MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
115.548,SUP,HCPCS C1713,,115.548  -  4.5MM PROTEX CT POLYAXIAL SCREW 48MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
115.55,SUP,HCPCS C1713,,115.550  -  4.5MM PROTEX CT POLYAXIAL SCREW 50MM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
115.701,SUP,Custom 27803010,,115.701  -  ROD SPNL 80MM CONNCTNG GLOBUS,$777.50,$0.00,$777.50,$0.00,$554.90,$0.00,$0.00,$0.00,$0.00,$0.00,$777.50,$0.00,$388.75,$615.78,$622.00,$0.00,$0.00,$0.00,$0.00,$0.00
115.702,SUP,Custom 27803010,,"115.702  -  3.2MM STRAIGHT TI ROD, 120MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
115.703,SUP,Custom 27803010,,115.703  -  ROD SPNL STRG 3.2MM 240MM NS PRTX CTTI,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
115.704,SUP,Custom 27803010,,"115.704  -  3.2MM STRAIGHT TI ROD, 40MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
115.801,SUP,Custom 27803010,,115.801  -  ROD SPNL 80MM 3.7MM PRTX CTTI STR,$777.50,$0.00,$777.50,$0.00,$554.90,$0.00,$0.00,$0.00,$0.00,$0.00,$777.50,$0.00,$388.75,$615.78,$622.00,$0.00,$0.00,$0.00,$0.00,$0.00
115.802,SUP,Custom 27803010,,115.802  -  ROD SPNL 120MM 3.7MM PRTX CTTI STR,$967.50,$0.00,$967.50,$0.00,$690.50,$0.00,$0.00,$0.00,$0.00,$0.00,$967.50,$0.00,$483.75,$766.26,$774.00,$0.00,$0.00,$0.00,$0.00,$0.00
115.803,SUP,Custom 27803010,,"115.803  -  3.7MM STRAIGHT ROD, 240MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
115.804,SUP,Custom 27803010,,"115.804  -  3.7MM STRAIGHT ROD, 40MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
115.911,SUP,Custom 27803010,,115.911  -  CONCTR ROD 20-41MM 3.7MM PRTX CTTI TRNSVRS ADJ OCT SPN,"$3,482.50",$0.00,"$3,482.50",$0.00,"$2,485.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,482.50",$0.00,"$1,741.25","$2,758.14","$2,786.00",$0.00,$0.00,$0.00,$0.00,$0.00
115.912,SUP,Custom 27803010,,"115.912  -  ADJUSTABLE T-CONNECTOR FOR 3.7MM ROD, 41-56MM","$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
115.918,SUP,Custom 27803010,,"115.918  -  TOP-LOADING T-CONNECTOR FOR 3.2MM ROD, 21-33MM, STRAIGHT","$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
115.919,SUP,Custom 27803010,,"115.919  -  TOP-LOADING T-CONNECTOR FOR 3.2MM ROD, 26-46MM, CURVED","$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
115.92,SUP,Custom 27803010,,"115.920  -  TOP-LOADING T-CONNECTOR FOR 3.2MM ROD, 26-46MM, STRAIGHT","$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
115.921,SUP,Custom 27803010,,"115.921  -  TOP-LOADING T-CONNECTOR FOR 3.2MM ROD, 36-56MM, CURVED","$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
115.922,SUP,Custom 27803010,,"115.922  -  TOP-LOADING T-CONNECTOR FOR 3.2MM ROD, 36-56, STRAIGHT","$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
115.923,SUP,Custom 27803010,,"115.923  -  TOP-LOADING T-CONNECTOR FOR 3.7MM ROD, 21-33MM, STRAIGHT","$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
115.924,SUP,Custom 27803010,,115.924  -  CONCTR ROD 26-46MM CVD TOP LD T 3.7MM,"$3,915.00",$0.00,"$3,915.00",$0.00,"$2,794.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,915.00",$0.00,"$1,957.50","$3,100.68","$3,132.00",$0.00,$0.00,$0.00,$0.00,$0.00
115.925,SUP,Custom 27803010,,"115.925  -  TOP-LOADING T-CONNECTOR FOR 3.7MM ROD, 26-46MM, STRAIGHT","$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
115.926,SUP,Custom 27803010,,"115.926  -  TOP-LOADING T-CONNECTOR FOR 3.7MM ROD, 36-56MM, CURVED","$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
115.927,SUP,Custom 27803010,,"115.927  -  TOP-LOADING T-CONNECTOR FOR 3.7MM ROD, 36-56, STRAIGHT","$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
115.93,SUP,Custom 27803010,,"115.930  -  CLAMP FOR T-CONNECTOR, LEFT","$1,832.50",$0.00,"$1,832.50",$0.00,"$1,307.86",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,832.50",$0.00,$916.25,"$1,451.34","$1,466.00",$0.00,$0.00,$0.00,$0.00,$0.00
115.931,SUP,Custom 27803010,,"115.931  -  CLAMP FOR T-CONNECTOR, RIGHT","$1,832.50",$0.00,"$1,832.50",$0.00,"$1,307.86",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,832.50",$0.00,$916.25,"$1,451.34","$1,466.00",$0.00,$0.00,$0.00,$0.00,$0.00
115.949,SUP,Custom 27803010,,"115.949  -  SET SCREW, M4.5X0.75, ROUND TIP, 2.5MM HEX",$192.50,$0.00,$192.50,$0.00,$137.39,$0.00,$0.00,$0.00,$0.00,$0.00,$192.50,$0.00,$96.25,$152.46,$154.00,$0.00,$0.00,$0.00,$0.00,$0.00
115.95,SUP,Custom 27803010,,"115.950  -  OCCIPITAL CLAMP, SINGLE, SHORT",$795.00,$0.00,$795.00,$0.00,$567.39,$0.00,$0.00,$0.00,$0.00,$0.00,$795.00,$0.00,$397.50,$629.64,$636.00,$0.00,$0.00,$0.00,$0.00,$0.00
115.951,SUP,Custom 27803010,,"115.951  -  OCCIPITAL CLAMP, SINGLE, LONG",$795.00,$0.00,$795.00,$0.00,$567.39,$0.00,$0.00,$0.00,$0.00,$0.00,$795.00,$0.00,$397.50,$629.64,$636.00,$0.00,$0.00,$0.00,$0.00,$0.00
115.952,SUP,HCPCS C1713,,"115.952  -  SET SCREW, M4.5 X 0.75",$192.50,$0.00,$192.50,$86.63,$137.39,$0.00,$33.17,$0.00,$0.00,$33.71,$192.50,$0.00,$96.25,$152.46,$154.00,$0.00,$30.13,$0.00,$30.65,$0.00
115.953,SUP,Custom 27803010,,"115.953  -  3.7MM OCCIPITAL ROD, 240MM, 100 DEG","$1,527.50",$0.00,"$1,527.50",$0.00,"$1,090.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,527.50",$0.00,$763.75,"$1,209.78","$1,222.00",$0.00,$0.00,$0.00,$0.00,$0.00
115.954,SUP,Custom 27803010,,"115.954  -  3.7MM OCCIPITAL ROD, 240MM, 115 DEG","$1,527.50",$0.00,"$1,527.50",$0.00,"$1,090.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,527.50",$0.00,$763.75,"$1,209.78","$1,222.00",$0.00,$0.00,$0.00,$0.00,$0.00
115.955,SUP,Custom 27803010,,115.955  -  ROD SPNL 240MM 3.7MM PRTX CTTI 130 OCCPTL,"$1,547.50",$0.00,"$1,547.50",$0.00,"$1,104.45",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,547.50",$0.00,$773.75,"$1,225.62","$1,238.00",$0.00,$0.00,$0.00,$0.00,$0.00
115.956,SUP,Custom 27803010,,"115.956  -  OCCIPITAL CLAMP, TRIPLE, SHORT","$1,272.50",$0.00,"$1,272.50",$0.00,$908.18,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,272.50",$0.00,$636.25,"$1,007.82","$1,018.00",$0.00,$0.00,$0.00,$0.00,$0.00
115.957,SUP,Custom 27803010,,"115.957  -  OCCIPITAL CLAMP, TRIPLE, LONG","$1,272.50",$0.00,"$1,272.50",$0.00,$908.18,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,272.50",$0.00,$636.25,"$1,007.82","$1,018.00",$0.00,$0.00,$0.00,$0.00,$0.00
115.958,SUP,Custom 27803010,,"115.958  -  OCCIPITAL CLAMP, DOUBLE, SHORT","$1,035.00",$0.00,"$1,035.00",$0.00,$738.68,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,035.00",$0.00,$517.50,$819.72,$828.00,$0.00,$0.00,$0.00,$0.00,$0.00
115.959,SUP,Custom 27803010,,115.959  -  CLAMP SPNL LNG OCCPTL DBL,"$1,260.00",$0.00,"$1,260.00",$0.00,$899.26,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,260.00",$0.00,$630.00,$997.92,"$1,008.00",$0.00,$0.00,$0.00,$0.00,$0.00
115.96,SUP,Custom 27803010,,"115.960  -  PARALLEL CONNECTOR, 3.7MM ROD TO 3.7MM ROD","$1,432.50",$0.00,"$1,432.50",$0.00,"$1,022.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,432.50",$0.00,$716.25,"$1,134.54","$1,146.00",$0.00,$0.00,$0.00,$0.00,$0.00
115.961,SUP,Custom 27803010,,"115.961  -  PARALLEL CONNECTOR, 3.7MM ROD TO 4.5MM ROD","$1,432.50",$0.00,"$1,432.50",$0.00,"$1,022.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,432.50",$0.00,$716.25,"$1,134.54","$1,146.00",$0.00,$0.00,$0.00,$0.00,$0.00
115.962,SUP,Custom 27803010,,"115.962  -  PARALLEL CONNECTOR, 3.7MM ROD TO 5.0MM ROD","$1,432.50",$0.00,"$1,432.50",$0.00,"$1,022.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,432.50",$0.00,$716.25,"$1,134.54","$1,146.00",$0.00,$0.00,$0.00,$0.00,$0.00
115.963,SUP,Custom 27803010,,"115.963  -  PARALLEL CONNECTOR, 3.7MM ROD TO 5.5MM ROD","$1,432.50",$0.00,"$1,432.50",$0.00,"$1,022.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,432.50",$0.00,$716.25,"$1,134.54","$1,146.00",$0.00,$0.00,$0.00,$0.00,$0.00
115.964,SUP,Custom 27803010,,"115.964  -  PARALLEL CONNECTOR, 3.7MM ROD TO 6.0MM ROD","$1,432.50",$0.00,"$1,432.50",$0.00,"$1,022.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,432.50",$0.00,$716.25,"$1,134.54","$1,146.00",$0.00,$0.00,$0.00,$0.00,$0.00
115.965,SUP,Custom 27803010,,"115.965  -  PARALLEL CONNECTOR, 3.7MM ROD TO 6.5MM ROD","$1,432.50",$0.00,"$1,432.50",$0.00,"$1,022.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,432.50",$0.00,$716.25,"$1,134.54","$1,146.00",$0.00,$0.00,$0.00,$0.00,$0.00
115.966,SUP,Custom 27803010,,"115.966  -  PARALLEL CONNECTOR, 3.7MM ROD TO 4.0MM ROD","$1,717.50",$0.00,"$1,717.50",$0.00,"$1,225.78",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,717.50",$0.00,$858.75,"$1,360.26","$1,374.00",$0.00,$0.00,$0.00,$0.00,$0.00
115.979,SUP,Custom 27803010,,"115.979  -  TAPERED ROD, 3.2MM TO 3.7MM, 240MM","$1,620.00",$0.00,"$1,620.00",$0.00,"$1,156.19",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,620.00",$0.00,$810.00,"$1,283.04","$1,296.00",$0.00,$0.00,$0.00,$0.00,$0.00
115.981,SUP,Custom 27803010,,"115.981  -  TAPERED ROD, 3.7MM TO 6.5MM, 350MM","$1,527.50",$0.00,"$1,527.50",$0.00,"$1,090.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,527.50",$0.00,$763.75,"$1,209.78","$1,222.00",$0.00,$0.00,$0.00,$0.00,$0.00
115.983,SUP,Custom 27803010,,"115.983  -  TAPERED ROD, 3.7MM TO 6.0MM, 350MM","$1,527.50",$0.00,"$1,527.50",$0.00,"$1,090.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,527.50",$0.00,$763.75,"$1,209.78","$1,222.00",$0.00,$0.00,$0.00,$0.00,$0.00
115.984,SUP,Custom 27803010,,"115.984  -  TAPERED ROD, 3.7MM TO 5.5MM, 350MM","$1,527.50",$0.00,"$1,527.50",$0.00,"$1,090.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,527.50",$0.00,$763.75,"$1,209.78","$1,222.00",$0.00,$0.00,$0.00,$0.00,$0.00
115.985,SUP,Custom 27803010,,"115.985  -  TAPERED ROD, 3.7MM TO 5.0MM, 350MM","$1,527.50",$0.00,"$1,527.50",$0.00,"$1,090.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,527.50",$0.00,$763.75,"$1,209.78","$1,222.00",$0.00,$0.00,$0.00,$0.00,$0.00
115.986,SUP,Custom 27803010,,"115.986  -  TAPERED ROD, 3.7MM TO 4.5MM, 350MM","$1,527.50",$0.00,"$1,527.50",$0.00,"$1,090.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,527.50",$0.00,$763.75,"$1,209.78","$1,222.00",$0.00,$0.00,$0.00,$0.00,$0.00
115.987,SUP,Custom 27803010,,"115.987  -  TAPERED ROD, 3.7MM TO 4.0MM, 350MM","$1,527.50",$0.00,"$1,527.50",$0.00,"$1,090.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,527.50",$0.00,$763.75,"$1,209.78","$1,222.00",$0.00,$0.00,$0.00,$0.00,$0.00
115.988,SUP,Custom 27803010,,"115.988  -  TAPERED ROD, 3.2MM TO 5.5MM, 350MM","$1,620.00",$0.00,"$1,620.00",$0.00,"$1,156.19",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,620.00",$0.00,$810.00,"$1,283.04","$1,296.00",$0.00,$0.00,$0.00,$0.00,$0.00
115.989,SUP,Custom 27803010,,"115.989  -  TAPERED ROD, 3.7MM TO 5.5MM, 500MM","$1,060.00",$0.00,"$1,060.00",$0.00,$756.52,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,060.00",$0.00,$530.00,$839.52,$848.00,$0.00,$0.00,$0.00,$0.00,$0.00
115.99,SUP,Custom 27803010,,115.990  -  LATERAL CONNECTOR,"$1,527.50",$0.00,"$1,527.50",$0.00,"$1,090.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,527.50",$0.00,$763.75,"$1,209.78","$1,222.00",$0.00,$0.00,$0.00,$0.00,$0.00
115.991,SUP,Custom 27803010,,"115.991  -  LATERAL CONNECTOR, SHORT","$1,527.50",$0.00,"$1,527.50",$0.00,"$1,090.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,527.50",$0.00,$763.75,"$1,209.78","$1,222.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.001,SUP,Custom 27203010,,116.001  -  SPACER SPNL 0D 25MM LG 32X29MM NS LF XPAND SLF DSTRCT SMTH,"$18,607.50",$0.00,"$18,607.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$18,607.50",$0.00,"$9,303.75","$14,737.14","$14,886.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.002,SUP,Custom 27203010,,116.002  -  SPACER SPNL 0D 25MM LG 32X32MM NS LF XPAND SLF DSTRCT SMTH,"$18,607.50",$0.00,"$18,607.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$18,607.50",$0.00,"$9,303.75","$14,737.14","$14,886.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.003,SUP,Custom 27203010,,116.003  -  SPACER SPNL 0D 25MM LG 32X44MM NS LF XPAND SLF DSTRCT SMTH,"$18,607.50",$0.00,"$18,607.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$18,607.50",$0.00,"$9,303.75","$14,737.14","$14,886.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.004,SUP,Custom 27203010,,116.004  -  SPACER SPNL 8D 25MM LG 32X39MM NS LF XPAND SLF DSTRCT SMTH,"$18,607.50",$0.00,"$18,607.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$18,607.50",$0.00,"$9,303.75","$14,737.14","$14,886.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.005,SUP,Custom 27203010,,116.005  -  SPACER SPNL 8D 25MM LG 32X40MM NS LF XPAND SLF DSTRCT SMTH,"$18,607.50",$0.00,"$18,607.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$18,607.50",$0.00,"$9,303.75","$14,737.14","$14,886.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.006,SUP,Custom 27203010,,116.006  -  SPACER SPNL 8D 25MM LG 32X60MM NS LF XPAND SLF DSTRCT SMTH,"$18,607.50",$0.00,"$18,607.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$18,607.50",$0.00,"$9,303.75","$14,737.14","$14,886.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.007,SUP,Custom 27203010,,116.007  -  SPACER SPNL 16D 25MM LG 32X41MM NS LF XPAND SLF DSTRCT SMTH,"$18,607.50",$0.00,"$18,607.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$18,607.50",$0.00,"$9,303.75","$14,737.14","$14,886.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.008,SUP,Custom 27203010,,116.008  -  SPACER SPNL 16D 25MM LG 32X57MM NS LF XPAND SLF DSTRCT SMTH,"$18,607.50",$0.00,"$18,607.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$18,607.50",$0.00,"$9,303.75","$14,737.14","$14,886.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.009,SUP,Custom 27203010,,116.009  -  SPACER SPNL -8D 25MM LG 32X47MM NS LF XPAND SLF DSTRCT SMTH,"$18,607.50",$0.00,"$18,607.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$18,607.50",$0.00,"$9,303.75","$14,737.14","$14,886.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.01,SUP,Custom 27203010,,116.010  -  SPACER SPNL 8D 25MM LG 32X61MM NS LF XPAND SLF DSTRCT SMTH,"$18,607.50",$0.00,"$18,607.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$18,607.50",$0.00,"$9,303.75","$14,737.14","$14,886.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.011,SUP,Custom 27203010,,116.011  -  SPACER SPNL 16D 25MM LG 32X47MM NS LF XPAND SLF DSTRCT SMTH,"$18,607.50",$0.00,"$18,607.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$18,607.50",$0.00,"$9,303.75","$14,737.14","$14,886.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.012,SUP,Custom 27203010,,116.012  -  SPACER SPNL 16D 25MM LG 32X58MM NS LF XPAND SLF DSTRCT SMTH,"$18,607.50",$0.00,"$18,607.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$18,607.50",$0.00,"$9,303.75","$14,737.14","$14,886.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.013,SUP,Custom 27203010,,116.013  -  SPACER SPNL 16D 25MM LG 32X73MM NS LF XPAND SLF DSTRCT SMTH,"$18,607.50",$0.00,"$18,607.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$18,607.50",$0.00,"$9,303.75","$14,737.14","$14,886.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.014,SUP,Custom 27203010,,116.014  -  SPACER SPNL 0D 25MM LG 32X39MM NS LF XPAND SLF DSTRCT SMTH,"$18,607.50",$0.00,"$18,607.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$18,607.50",$0.00,"$9,303.75","$14,737.14","$14,886.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.015,SUP,Custom 27203010,,116.015  -  SPACER SPNL 16D 25MM LG 32X51MM NS LF XPAND SLF DSTRCT SMTH,"$18,607.50",$0.00,"$18,607.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$18,607.50",$0.00,"$9,303.75","$14,737.14","$14,886.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.016,SUP,Custom 27203010,,116.016  -  SPACER SPNL -8D 25MM LG 32X29MM NS LF XPAND SLF DSTRCT SMTH,"$18,607.50",$0.00,"$18,607.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$18,607.50",$0.00,"$9,303.75","$14,737.14","$14,886.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.017,SUP,Custom 27803010,,116.017  -  SPACER SPNL 0D 25MM LG 32X41MM NS LF XPAND SLF DSTRCT SMTH,"$18,607.50",$0.00,"$18,607.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$18,607.50",$0.00,"$9,303.75","$14,737.14","$14,886.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.018,SUP,Custom 27203010,,116.018  -  SPACER SPNL 8D 25MM LG 32X41MM NS LF XPAND SLF DSTRCT SMTH,"$18,607.50",$0.00,"$18,607.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$18,607.50",$0.00,"$9,303.75","$14,737.14","$14,886.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.019,SUP,Custom 27203010,,116.019  -  SPACER SPNL 0D 25MM LG 32X51MM NS LF XPAND SLF DSTRCT SMTH,"$18,607.50",$0.00,"$18,607.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$18,607.50",$0.00,"$9,303.75","$14,737.14","$14,886.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.02,SUP,Custom 27203010,,116.020  -  SPACER SPNL 8D 25MM LG 32X51MM NS LF XPAND SLF DSTRCT SMTH,"$18,607.50",$0.00,"$18,607.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$18,607.50",$0.00,"$9,303.75","$14,737.14","$14,886.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.021,SUP,Custom 27203010,,116.021  -  SPACER SPNL 16D 25MM LG 32X51MM NS LF XPAND SLF DSTRCT SMTH,"$18,607.50",$0.00,"$18,607.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$18,607.50",$0.00,"$9,303.75","$14,737.14","$14,886.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.022,SUP,Custom 27203010,,116.022  -  SPACER SPNL -8D 25MM LG 32X29MM NS LF XPAND SLF DSTRCT SMTH,"$18,607.50",$0.00,"$18,607.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$18,607.50",$0.00,"$9,303.75","$14,737.14","$14,886.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.023,SUP,Custom 27203010,,116.023  -  SPACER SPNL 0D 25MM LG 32X29MM NS LF XPAND SLF DSTRCT SMTH,"$18,607.50",$0.00,"$18,607.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$18,607.50",$0.00,"$9,303.75","$14,737.14","$14,886.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.024,SUP,Custom 27203010,,116.024  -  SPACER SPNL 0D 25MM LG 32X32MM NS LF XPAND SLF DSTRCT SMTH,"$18,607.50",$0.00,"$18,607.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$18,607.50",$0.00,"$9,303.75","$14,737.14","$14,886.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.101,SUP,Custom 27203010,,116.101  -  SPACER SPNL 0D 12MM SM 14X15MM NS LF XPAND SLF DSTRCT SMTH,"$14,315.00",$0.00,"$14,315.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$14,315.00",$0.00,"$7,157.50","$11,337.48","$11,452.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.102,SUP,Custom 27203010,,116.102  -  SPACER SPNL 0D 12MM SM 14X18MM NS LF XPAND SLF DSTRCT SMTH,"$14,315.00",$0.00,"$14,315.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$14,315.00",$0.00,"$7,157.50","$11,337.48","$11,452.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.103,SUP,Custom 27203010,,116.103  -  SPACER SPNL 0D 12MM SM 14X23MM NS LF XPAND SLF DSTRCT SMTH,"$14,315.00",$0.00,"$14,315.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$14,315.00",$0.00,"$7,157.50","$11,337.48","$11,452.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.104,SUP,Custom 27203010,,116.104  -  SPACER SPNL 0D 12MM SM 14X32MM NS LF XPAND SLF DSTRCT SMTH,"$14,315.00",$0.00,"$14,315.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$14,315.00",$0.00,"$7,157.50","$11,337.48","$11,452.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.105,SUP,Custom 27203010,,116.105  -  SPACER SPNL 0D 12MM SM 14X42MM NS LF XPAND SLF DSTRCT SMTH,"$14,315.00",$0.00,"$14,315.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$14,315.00",$0.00,"$7,157.50","$11,337.48","$11,452.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.106,SUP,Custom 27203010,,116.106  -  SPACER SPNL 0D 12MM SM 14X56MM NS LF XPAND SLF DSTRCT SMTH,"$14,315.00",$0.00,"$14,315.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$14,315.00",$0.00,"$7,157.50","$11,337.48","$11,452.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.107,SUP,Custom 27203010,,116.107  -  SPACER SPNL 7D 12MM SM 14X15MM NS LF XPAND SLF DSTRCT SMTH,"$14,315.00",$0.00,"$14,315.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$14,315.00",$0.00,"$7,157.50","$11,337.48","$11,452.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.108,SUP,Custom 27203010,,116.108  -  SPACER SPNL 7D 12MM SM 14X18MM NS LF XPAND SLF DSTRCT SMTH,"$14,315.00",$0.00,"$14,315.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$14,315.00",$0.00,"$7,157.50","$11,337.48","$11,452.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.109,SUP,Custom 27203010,,116.109  -  SPACER SPNL 7D 12MM SM 14X26MM NS LF XPAND SLF DSTRCT SMTH,"$14,315.00",$0.00,"$14,315.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$14,315.00",$0.00,"$7,157.50","$11,337.48","$11,452.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.11,SUP,Custom 27203010,,116.110  -  SPACER SPNL 7D 12MM SM 14X28MM NS LF XPAND SLF DSTRCT SMTH,"$14,315.00",$0.00,"$14,315.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$14,315.00",$0.00,"$7,157.50","$11,337.48","$11,452.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.111,SUP,Custom 27203010,,116.111  -  SPACER SPNL 7D 12MM SM 14X42MM NS LF XPAND SLF DSTRCT SMTH,"$14,315.00",$0.00,"$14,315.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$14,315.00",$0.00,"$7,157.50","$11,337.48","$11,452.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.112,SUP,Custom 27203010,,116.112  -  SPACER SPNL 7D 12MM SM 14X56MM NS LF XPAND SLF DSTRCT SMTH,"$14,315.00",$0.00,"$14,315.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$14,315.00",$0.00,"$7,157.50","$11,337.48","$11,452.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.113,SUP,Custom 27203010,,116.113  -  SPACER SPNL 16D 12MM SM 14X56MM NS LF XPAND SLF DSTRCT SMTH,"$14,315.00",$0.00,"$14,315.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$14,315.00",$0.00,"$7,157.50","$11,337.48","$11,452.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.114,SUP,Custom 27203010,,116.114  -  SPACER SPNL 0D 12MM SM 14X74MM NS LF XPAND SLF DSTRCT SMTH,"$14,315.00",$0.00,"$14,315.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$14,315.00",$0.00,"$7,157.50","$11,337.48","$11,452.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.115,SUP,Custom 27203010,,116.115  -  SPACER SPNL 7D 12MM SM 14X74MM NS LF XPAND SLF DSTRCT SMTH,"$14,315.00",$0.00,"$14,315.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$14,315.00",$0.00,"$7,157.50","$11,337.48","$11,452.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.116,SUP,Custom 27203010,,116.116  -  SPACER SPNL 16D 12MM SM 14X74MM NS LF XPAND SLF DSTRCT SMTH,"$14,315.00",$0.00,"$14,315.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$14,315.00",$0.00,"$7,157.50","$11,337.48","$11,452.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.117,SUP,Custom 27203010,,116.117  -  SPACER SPNL 0D 12MM SM 14X19MM NS LF XPAND SLF DSTRCT SMTH,"$14,315.00",$0.00,"$14,315.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$14,315.00",$0.00,"$7,157.50","$11,337.48","$11,452.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.118,SUP,Custom 27203010,,116.118  -  SPACER SPNL 7D 12MM SM 14X19MM NS LF XPAND SLF DSTRCT SMTH,"$14,315.00",$0.00,"$14,315.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$14,315.00",$0.00,"$7,157.50","$11,337.48","$11,452.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.119,SUP,Custom 27203010,,116.119  -  SPACER SPNL 0D 12MM SM 14X29MM NS LF XPAND SLF DSTRCT SMTH,"$14,315.00",$0.00,"$14,315.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$14,315.00",$0.00,"$7,157.50","$11,337.48","$11,452.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.12,SUP,Custom 27203010,,116.120  -  SPACER SPNL 7D 12MM SM 14X29MM NS LF XPAND SLF DSTRCT SMTH,"$14,315.00",$0.00,"$14,315.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$14,315.00",$0.00,"$7,157.50","$11,337.48","$11,452.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.121,SUP,Custom 27203010,,116.121  -  SPACER SPNL 0D 12MM SM 14X15MM NS LF XPAND SLF DSTRCT SMTH,"$14,315.00",$0.00,"$14,315.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$14,315.00",$0.00,"$7,157.50","$11,337.48","$11,452.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.122,SUP,Custom 27203010,,116.122  -  SPACER SPNL 7D 12MM SM 14X15MM NS LF XPAND SLF DSTRCT SMTH,"$14,315.00",$0.00,"$14,315.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$14,315.00",$0.00,"$7,157.50","$11,337.48","$11,452.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.123,SUP,Custom 27203010,,116.123  -  SPACER SPNL 0D 12MM SM 14X18MM NS LF XPAND SLF DSTRCT SMTH,"$14,315.00",$0.00,"$14,315.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$14,315.00",$0.00,"$7,157.50","$11,337.48","$11,452.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.124,SUP,Custom 27203010,,116.124  -  SPACER SPNL 7D 12MM SM 14X18MM NS LF XPAND SLF DSTRCT SMTH,"$14,315.00",$0.00,"$14,315.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$14,315.00",$0.00,"$7,157.50","$11,337.48","$11,452.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.125,SUP,Custom 27203010,,116.125  -  SPACER SPNL 0D 12MM SM 14X19MM NS LF XPAND SLF DSTRCT SMTH,"$14,315.00",$0.00,"$14,315.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$14,315.00",$0.00,"$7,157.50","$11,337.48","$11,452.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.126,SUP,Custom 27203010,,116.126  -  SPACER SPNL 7D 12MM SM 14X29MM NS LF XPAND SLF DSTRCT SMTH,"$14,315.00",$0.00,"$14,315.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$14,315.00",$0.00,"$7,157.50","$11,337.48","$11,452.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.201,SUP,Custom 27203010,,116.201  -  SPACER SPNL -6D 21MM MED 23X24MM NS LF XPAND SLF DSTRCT SMTH,"$16,222.50",$0.00,"$16,222.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$16,222.50",$0.00,"$8,111.25","$12,848.22","$12,978.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.202,SUP,Custom 27203010,,116.202  -  SPACER SPNL -6D 21MM MED 23X27MM NS LF XPAND SLF DSTRCT SMTH,"$16,222.50",$0.00,"$16,222.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$16,222.50",$0.00,"$8,111.25","$12,848.22","$12,978.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.203,SUP,Custom 27203010,,116.203  -  SPACER SPNL -6D 21MM MED 23X37MM NS LF XPAND SLF DSTRCT SMTH,"$17,655.00",$0.00,"$17,655.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$17,655.00",$0.00,"$8,827.50","$13,982.76","$14,124.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.204,SUP,Custom 27203010,,116.204  -  SPACER SPNL -6D 21MM MED 23X49MM NS LF XPAND SLF DSTRCT SMTH,"$20,040.00",$0.00,"$20,040.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$20,040.00",$0.00,"$10,020.00","$15,871.68","$16,032.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.205,SUP,Custom 27203010,,116.205  -  SPACER SPNL 0D 21MM MED 23X24MM NS LF XPAND SLF DSTRCT SMTH,"$16,222.50",$0.00,"$16,222.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$16,222.50",$0.00,"$8,111.25","$12,848.22","$12,978.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.206,SUP,Custom 27203010,,116.206  -  SPACER SPNL 0D 21MM MED 23X27MM NS LF XPAND SLF DSTRCT SMTH,"$16,222.50",$0.00,"$16,222.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$16,222.50",$0.00,"$8,111.25","$12,848.22","$12,978.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.207,SUP,Custom 27203010,,116.207  -  SPACER SPNL 0D 21MM MED 23X37MM NS LF XPAND SLF DSTRCT SMTH,"$17,655.00",$0.00,"$17,655.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$17,655.00",$0.00,"$8,827.50","$13,982.76","$14,124.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.208,SUP,Custom 27203010,,116.208  -  SPACER SPNL 0D 21MM MED 23X49MM NS LF XPAND SLF DSTRCT SMTH,"$20,040.00",$0.00,"$20,040.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$20,040.00",$0.00,"$10,020.00","$15,871.68","$16,032.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.209,SUP,Custom 27203010,,116.209  -  SPACER SPNL 0D 21MM MED 23X33MM NS LF XPAND SLF DSTRCT SMTH,"$16,222.50",$0.00,"$16,222.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$16,222.50",$0.00,"$8,111.25","$12,848.22","$12,978.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.21,SUP,Custom 27203010,,116.210  -  SPACER SPNL -6D 21MM MED 23X33MM NS LF XPAND SLF DSTRCT SMTH,"$16,222.50",$0.00,"$16,222.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$16,222.50",$0.00,"$8,111.25","$12,848.22","$12,978.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.211,SUP,Custom 27203010,,116.211  -  SPACER SPNL 0D 21MM MED 23X43MM NS LF XPAND SLF DSTRCT SMTH,"$18,017.50",$0.00,"$18,017.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$18,017.50",$0.00,"$9,008.75","$14,269.86","$14,414.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.212,SUP,Custom 27203010,,116.212  -  SPACER SPNL -6D 21MM MED 23X43MM NS LF XPAND SLF DSTRCT SMTH,"$18,017.50",$0.00,"$18,017.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$18,017.50",$0.00,"$9,008.75","$14,269.86","$14,414.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.213,SUP,Custom 27203010,,116.213  -  SPACER SPNL 8D 21MM MED 23X24MM NS LF XPAND SLF DSTRCT SMTH,"$16,222.50",$0.00,"$16,222.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$16,222.50",$0.00,"$8,111.25","$12,848.22","$12,978.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.214,SUP,Custom 27203010,,116.214  -  SPACER SPNL 8D 21MM MED 23X27MM NS LF XPAND SLF DSTRCT SMTH,"$16,222.50",$0.00,"$16,222.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$16,222.50",$0.00,"$8,111.25","$12,848.22","$12,978.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.215,SUP,Custom 27203010,,116.215  -  SPACER SPNL 8D 21MM MED 23X33MM NS LF XPAND SLF DSTRCT SMTH,"$16,222.50",$0.00,"$16,222.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$16,222.50",$0.00,"$8,111.25","$12,848.22","$12,978.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.216,SUP,Custom 27203010,,116.216  -  SPACER SPNL 8D 21MM MED 23X37MM NS LF XPAND SLF DSTRCT SMTH,"$18,017.50",$0.00,"$18,017.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$18,017.50",$0.00,"$9,008.75","$14,269.86","$14,414.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.217,SUP,Custom 27203010,,116.217  -  SPACER SPNL 8D 21MM MED 23X43MM NS LF XPAND SLF DSTRCT SMTH,"$18,017.50",$0.00,"$18,017.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$18,017.50",$0.00,"$9,008.75","$14,269.86","$14,414.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.218,SUP,Custom 27203010,,116.218  -  SPACER SPNL 8D 21MM MED 23X49MM NS LF XPAND SLF DSTRCT SMTH,"$18,017.50",$0.00,"$18,017.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$18,017.50",$0.00,"$9,008.75","$14,269.86","$14,414.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.219,SUP,Custom 27203010,,116.219  -  SPACER SPNL 8D 21MM MED 23X24MM NS LF XPAND SLF DSTRCT SMTH,"$16,222.50",$0.00,"$16,222.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$16,222.50",$0.00,"$8,111.25","$12,848.22","$12,978.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.22,SUP,Custom 27203010,,116.220  -  SPACER SPNL 8D 21MM MED 23X27MM NS LF XPAND SLF DSTRCT SMTH,"$16,222.50",$0.00,"$16,222.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$16,222.50",$0.00,"$8,111.25","$12,848.22","$12,978.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.221,SUP,Custom 27203010,,116.221  -  SPACER SPNL -6D 21MM MED 23X24MM NS LF XPAND SLF DSTRCT SMTH,"$16,222.50",$0.00,"$16,222.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$16,222.50",$0.00,"$8,111.25","$12,848.22","$12,978.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.222,SUP,Custom 27203010,,116.222  -  SPACER SPNL -6D 21MM MED 23X27MM NS LF XPAND SLF DSTRCT SMTH,"$16,222.50",$0.00,"$16,222.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$16,222.50",$0.00,"$8,111.25","$12,848.22","$12,978.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.223,SUP,Custom 27203010,,116.223  -  SPACER SPNL 0D 21MM MED 23X24MM NS LF XPAND SLF DSTRCT SMTH,"$16,222.50",$0.00,"$16,222.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$16,222.50",$0.00,"$8,111.25","$12,848.22","$12,978.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.224,SUP,Custom 27203010,,116.224  -  SPACER SPNL 0D 21MM MED 23X27MM NS LF XPAND SLF DSTRCT SMTH,"$16,222.50",$0.00,"$16,222.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$16,222.50",$0.00,"$8,111.25","$12,848.22","$12,978.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.301,SUP,Custom 27203010,,116.301  -  SPACER SPNL 0D 21MM S/MED 23X18MM NS LF XPAND SLF DSTRCT,"$15,267.50",$0.00,"$15,267.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$15,267.50",$0.00,"$7,633.75","$12,091.86","$12,214.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.302,SUP,Custom 27203010,,116.302  -  SPACER SPNL 0D 21MM S/MED 23X19MM NS LF XPAND SLF DSTRCT,"$15,267.50",$0.00,"$15,267.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$15,267.50",$0.00,"$7,633.75","$12,091.86","$12,214.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.303,SUP,Custom 27203010,,116.303  -  SPACER SPNL 0D 21MM S/MED 23X21MM NS LF XPAND SLF DSTRCT,"$15,267.50",$0.00,"$15,267.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$15,267.50",$0.00,"$7,633.75","$12,091.86","$12,214.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.304,SUP,Custom 27203010,,116.304  -  SPACER SPNL 0D 21MM S/MED 23X18MM NS LF XPAND SLF DSTRCT,"$15,267.50",$0.00,"$15,267.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$15,267.50",$0.00,"$7,633.75","$12,091.86","$12,214.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.305,SUP,Custom 27203010,,116.305  -  SPACER SPNL 0D 21MM S/MED 23X19MM NS LF XPAND SLF DSTRCT,"$15,267.50",$0.00,"$15,267.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$15,267.50",$0.00,"$7,633.75","$12,091.86","$12,214.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.306,SUP,Custom 27203010,,116.306  -  SPACER SPNL 0D 21MM S/MED 23X21MM NS LF XPAND SLF DSTRCT,"$15,267.50",$0.00,"$15,267.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$15,267.50",$0.00,"$7,633.75","$12,091.86","$12,214.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.401,SUP,Custom 27203010,,116.401  -  SPACER SPNL 0D 25MM MED LG 32X24MM NS LF XPAND SLF DSTRCT,"$17,412.50",$0.00,"$17,412.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$17,412.50",$0.00,"$8,706.25","$13,790.70","$13,930.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.402,SUP,Custom 27203010,,116.402  -  SPACER SPNL 0D 25MM MED LG 32X26MM NS LF XPAND SLF DSTRCT,"$17,412.50",$0.00,"$17,412.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$17,412.50",$0.00,"$8,706.25","$13,790.70","$13,930.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.403,SUP,Custom 27203010,,116.403  -  SPACER SPNL 0D 25MM MED LG 32X29MM NS LF XPAND SLF DSTRCT,"$18,130.00",$0.00,"$18,130.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$18,130.00",$0.00,"$9,065.00","$14,358.96","$14,504.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.404,SUP,Custom 27203010,,116.404  -  SPACER SPNL 0D 25MM MED LG 32X41MM NS LF XPAND SLF DSTRCT,"$20,277.50",$0.00,"$20,277.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$20,277.50",$0.00,"$10,138.75","$16,059.78","$16,222.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.405,SUP,Custom 27203010,,116.405  -  SPACER SPNL 0D 25MM MED LG 32X51MM NS LF XPAND SLF DSTRCT,"$20,992.50",$0.00,"$20,992.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$20,992.50",$0.00,"$10,496.25","$16,626.06","$16,794.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.406,SUP,Custom 27203010,,116.406  -  SPACER SPNL 0D 25MM MED LG 32X24MM NS LF XPAND SLF DSTRCT,"$17,417.50",$0.00,"$17,417.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$17,417.50",$0.00,"$8,708.75","$13,794.66","$13,934.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.407,SUP,Custom 27203010,,116.407  -  SPACER SPNL 0D 25MM MED LG 32X26MM NS LF XPAND SLF DSTRCT,"$17,417.50",$0.00,"$17,417.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$17,417.50",$0.00,"$8,708.75","$13,794.66","$13,934.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.408,SUP,Custom 27203010,,116.408  -  SPACER SPNL 0D 25MM MED LG 32X29MM NS LF XPAND SLF DSTRCT,"$18,130.00",$0.00,"$18,130.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$18,130.00",$0.00,"$9,065.00","$14,358.96","$14,504.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.409,SUP,Custom 27203010,,116.409  -  SPACER SPNL 0D 25MM MED LG 32X41MM NS LF XPAND SLF DSTRCT,"$20,277.50",$0.00,"$20,277.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$20,277.50",$0.00,"$10,138.75","$16,059.78","$16,222.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.41,SUP,Custom 27203010,,116.410  -  SPACER SPNL 0D 25MM MED LG 32X51MM NS LF XPAND SLF DSTRCT,"$20,992.50",$0.00,"$20,992.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$20,992.50",$0.00,"$10,496.25","$16,626.06","$16,794.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.411,SUP,Custom 27203010,,116.411  -  SPACER SPNL 0D 25MM MED LG 32X36MM NS LF XPAND SLF DSTRCT,"$19,202.50",$0.00,"$19,202.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$19,202.50",$0.00,"$9,601.25","$15,208.38","$15,362.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.412,SUP,Custom 27203010,,116.412  -  SPACER SPNL 0D 25MM MED LG 32X36MM NS LF XPAND SLF DSTRCT,"$19,202.50",$0.00,"$19,202.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$19,202.50",$0.00,"$9,601.25","$15,208.38","$15,362.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.413,SUP,Custom 27203010,,116.413  -  SPACER SPNL 0D 25MM MED LG 32X26MM NS LF XPAND SLF DSTRCT,"$17,417.50",$0.00,"$17,417.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$17,417.50",$0.00,"$8,708.75","$13,794.66","$13,934.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.414,SUP,Custom 27203010,,116.414  -  SPACER SPNL 0D 25MM MED LG 32X26MM NS LF XPAND SLF DSTRCT,"$17,417.50",$0.00,"$17,417.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$17,417.50",$0.00,"$8,708.75","$13,794.66","$13,934.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.415,SUP,Custom 27203010,,116.415  -  SPACER SPNL 0D 25MM MED LG 32X29MM NS LF XPAND SLF DSTRCT,"$18,130.00",$0.00,"$18,130.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$18,130.00",$0.00,"$9,065.00","$14,358.96","$14,504.00",$0.00,$0.00,$0.00,$0.00,$0.00
116.416,SUP,Custom 27203010,,116.416  -  SPACER SPNL 0D 25MM MED LG 32X29MM NS LF XPAND SLF DSTRCT,"$18,130.00",$0.00,"$18,130.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$18,130.00",$0.00,"$9,065.00","$14,358.96","$14,504.00",$0.00,$0.00,$0.00,$0.00,$0.00
117.112,SUP,HCPCS C1713,,"117.112  -  ASSURE TRANSLATIONAL CERVICAL PLATE 1-LEVEL, 12MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
117.114,SUP,HCPCS C1713,,"117.114  -  ASSURE TRANSLATIONAL CERVICAL PLATE 1-LEVEL, 14MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
117.116,SUP,HCPCS C1713,,"117.116  -  ASSURE TRANSLATIONAL CERVICAL PLATE 1-LEVEL, 16MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
117.118,SUP,HCPCS C1713,,"117.118  -  ASSURE TRANSLATIONAL CERVICAL PLATE 1-LEVEL, 18MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
117.12,SUP,HCPCS C1713,,"117.120  -  ASSURE TRANSLATIONAL CERVICAL PLATE 1-LEVEL, 20MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
117.122,SUP,HCPCS C1713,,"117.122  -  ASSURE TRANSLATIONAL CERVICAL PLATE 1-LEVEL, 22MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
117.124,SUP,HCPCS C1713,,"117.124  -  ASSURE TRANSLATIONAL CERVICAL PLATE 1-LEVEL, 24MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
117.126,SUP,HCPCS C1713,,"117.126  -  ASSURE TRANSLATIONAL CERVICAL PLATE 1-LEVEL, 26MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
117.226,SUP,HCPCS C1713,,"117.226  -  ASSURE TRANSLATIONAL CERVICAL PLATE 2-LEVEL, 26MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
117.228,SUP,HCPCS C1713,,"117.228  -  ASSURE TRANSLATIONAL CERVICAL PLATE 2-LEVEL, 28MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
117.23,SUP,HCPCS C1713,,"117.230  -  ASSURE TRANSLATIONAL CERVICAL PLATE 2-LEVEL, 30MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
117.232,SUP,HCPCS C1713,,"117.232  -  ASSURE TRANSLATIONAL CERVICAL PLATE 2-LEVEL, 32MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
117.234,SUP,HCPCS C1713,,"117.234  -  ASSURE TRANSLATIONAL CERVICAL PLATE 2-LEVEL, 34MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
117.236,SUP,HCPCS C1713,,"117.236  -  ASSURE TRANSLATIONAL CERVICAL PLATE 2-LEVEL, 36MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
117.238,SUP,HCPCS C1713,,"117.238  -  ASSURE TRANSLATIONAL CERVICAL PLATE 2-LEVEL, 38MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
117.24,SUP,HCPCS C1713,,"117.240  -  ASSURE TRANSLATIONAL CERVICAL PLATE 2-LEVEL, 40MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
117.242,SUP,HCPCS C1713,,"117.242  -  ASSURE TRANSLATIONAL CERVICAL PLATE 2-LEVEL, 42MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
117.244,SUP,HCPCS C1713,,"117.244  -  ASSURE TRANSLATIONAL CERVICAL PLATE 2-LEVEL, 44MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
117.246,SUP,HCPCS C1713,,"117.246  -  ASSURE TRANSLATIONAL CERVICAL PLATE 2-LEVEL, 46MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
117.345,SUP,HCPCS C1713,,"117.345  -  ASSURE TRANSLATIONAL CERVICAL PLATE 3-LEVEL, 45MM","$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
117.348,SUP,HCPCS C1713,,"117.348  -  ASSURE TRANSLATIONAL CERVICAL PLATE 3-LEVEL, 48MM","$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
117.351,SUP,HCPCS C1713,,"117.351  -  ASSURE TRANSLATIONAL CERVICAL PLATE 3-LEVEL, 51MM","$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
117.354,SUP,HCPCS C1713,,"117.354  -  ASSURE TRANSLATIONAL CERVICAL PLATE 3-LEVEL, 54MM","$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
117.357,SUP,HCPCS C1713,,"117.357  -  ASSURE TRANSLATIONAL CERVICAL PLATE 3-LEVEL, 57MM","$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
117.36,SUP,HCPCS C1713,,117.360  -  PLATE BN 60MM NS ASR LVL 3 TRANSLATIONAL SPNE CRV,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
117.363,SUP,HCPCS C1713,,"117.363  -  ASSURE TRANSLATIONAL CERVICAL PLATE 3-LEVEL, 63MM","$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
117.366,SUP,HCPCS C1713,,"117.366  -  ASSURE TRANSLATIONAL CERVICAL PLATE 3-LEVEL, 66MM","$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
117.369,SUP,HCPCS C1713,,"117.369  -  ASSURE TRANSLATIONAL CERVICAL PLATE 3-LEVEL, 69MM","$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
117.46,SUP,HCPCS C1713,,"117.460  -  ASSURE TRANSLATIONAL CERVICAL PLATE 4-LEVEL, 60MM","$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
117.464,SUP,HCPCS C1713,,"117.464  -  ASSURE TRANSLATIONAL CERVICAL PLATE 4-LEVEL, 64MM","$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
117.468,SUP,HCPCS C1713,,"117.468  -  ASSURE TRANSLATIONAL CERVICAL PLATE 4-LEVEL, 68MM","$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
117.472,SUP,HCPCS C1713,,"117.472  -  ASSURE TRANSLATIONAL CERVICAL PLATE 4-LEVEL, 72MM","$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
117.476,SUP,HCPCS C1713,,"117.476  -  ASSURE TRANSLATIONAL CERVICAL PLATE 4-LEVEL, 76MM","$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
117.48,SUP,HCPCS C1713,,"117.480  -  ASSURE TRANSLATIONAL CERVICAL PLATE 4-LEVEL, 80MM","$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
117.484,SUP,HCPCS C1713,,"117.484  -  ASSURE TRANSLATIONAL CERVICAL PLATE 4-LEVEL, 84MM","$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
117.488,SUP,HCPCS C1713,,"117.488  -  ASSURE TRANSLATIONAL CERVICAL PLATE 4-LEVEL, 88MM","$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
117.492,SUP,HCPCS C1713,,"117.492  -  ASSURE TRANSLATIONAL CERVICAL PLATE 4-LEVEL, 92MM","$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
117.496,SUP,HCPCS C1713,,"117.496  -  ASSURE TRANSLATIONAL CERVICAL PLATE 4-LEVEL, 96MM","$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
117.5,SUP,HCPCS C1713,,"117.500  -  ASSURE TRANSLATIONAL CERVICAL PLATE 4-LEVEL, 100MM","$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
124,SUP,HCPCS C1713,,124.000  -  LOCKING CAPS,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
124.001,SUP,Custom 27803010,,"124.001  -  5.5MM STRAIGHT ROD, CP, 300MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
124.002,SUP,Custom 27803010,,"124.002  -  5.5MM STRAIGHT ROD, CP, 400MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
124.003,SUP,Custom 27803010,,"124.003  -  5.5MM STRAIGHT ROD, CP, 500MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
124.004,SUP,Custom 27803010,,"124.004  -  5.5MM STRAIGHT ROD, CP2, 300MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
124.005,SUP,Custom 27803010,,"124.005  -  5.5MM STRAIGHT ROD, CP2, 400MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
124.006,SUP,Custom 27803010,,"124.006  -  5.5MM STRAIGHT ROD, CP2, 500MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
124.012,SUP,Custom 27803010,,"124.012  -  REVERE LOW PROFILE ADJUSTABLE T-CONNECTOR, 24MM-25MM","$2,000.00",$0.00,"$2,000.00",$0.00,"$1,427.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
124.013,SUP,Custom 27803010,,"124.013  -  REVERE LOW PROFILE ADJUSTABLE T-CONNECTOR, 26MM-28MM","$2,000.00",$0.00,"$2,000.00",$0.00,"$1,427.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
124.014,SUP,Custom 27803010,,"124.014  -  REVERE LOW PROFILE ADJUSTABLE T-CONNECTOR, 29MM-34MM","$2,000.00",$0.00,"$2,000.00",$0.00,"$1,427.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
124.051,SUP,HCPCS C1713,,124.051  -  5.0MM REVERE PEDICLE SCREW 25MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.052,SUP,HCPCS C1713,,124.052  -  5.0MM REVERE PEDICLE SCREW 30MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.053,SUP,HCPCS C1713,,124.053  -  5.0MM REVERE PEDICLE SCREW 35MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.054,SUP,HCPCS C1713,,124.054  -  5.0MM REVERE PEDICLE SCREW 40MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.055,SUP,HCPCS C1713,,124.055  -  5.0MM REVERE PEDICLE SCREW 45MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.056,SUP,HCPCS C1713,,124.056  -  5.0MM REVERE PEDICLE SCREW 50MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.057,SUP,HCPCS C1713,,124.057  -  5.0MM REVERE PEDICLE SCREW 55MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.071,SUP,HCPCS C1713,,124.071  -  7.5MM REVERE PEDICLE SCREW 70MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.072,SUP,HCPCS C1713,,124.072  -  7.5MM REVERE PEDICLE SCREW 75MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.073,SUP,HCPCS C1713,,124.073  -  7.5MM REVERE PEDICLE SCREW 80MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.074,SUP,HCPCS C1713,,124.074  -  7.5MM REVERE PEDICLE SCREW 85MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.075,SUP,HCPCS C1713,,124.075  -  7.5MM REVERE PEDICLE SCREW 90MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.081,SUP,HCPCS C1713,,124.081  -  8.5MM REVERE PEDICLE SCREW 70MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.082,SUP,HCPCS C1713,,124.082  -  8.5MM REVERE PEDICLE SCREW 75MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.083,SUP,HCPCS C1713,,124.083  -  8.5MM REVERE PEDICLE SCREW 80MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.084,SUP,HCPCS C1713,,124.084  -  8.5MM REVERE PEDICLE SCREW 85MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.085,SUP,HCPCS C1713,,124.085  -  8.5MM REVERE PEDICLE SCREW 90MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.111,SUP,HCPCS C1713,,"124.111  -  5.5MM REVERE MONOAXIAL SCREW, 27MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.112,SUP,HCPCS C1713,,"124.112  -  5.5MM REVERE MONOAXIAL SCREW, 32MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.113,SUP,HCPCS C1713,,"124.113  -  5.5MM REVERE MONOAXIAL SCREW, 37MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.114,SUP,HCPCS C1713,,"124.114  -  5.5MM REVERE MONOAXIAL SCREW, 42MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.115,SUP,HCPCS C1713,,"124.115  -  5.5MM REVERE MONOAXIAL SCREW, 47MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.121,SUP,HCPCS C1713,,"124.121  -  6.5MM REVERE MONOAXIAL SCREW, 27MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.122,SUP,HCPCS C1713,,"124.122  -  6.5MM REVERE MONOAXIAL SCREW, 32MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.123,SUP,HCPCS C1713,,"124.123  -  6.5MM REVERE MONOAXIAL SCREW, 37MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.124,SUP,HCPCS C1713,,"124.124  -  6.5MM REVERE MONOAXIAL SCREW, 42MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.125,SUP,HCPCS C1713,,"124.125  -  6.5MM REVERE MONOAXIAL SCREW, 47MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.131,SUP,HCPCS C1713,,"124.131  -  7.5MM REVERE MONOAXIAL SCREW, 27MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.132,SUP,HCPCS C1713,,"124.132  -  7.5MM REVERE MONOAXIAL SCREW, 32MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.133,SUP,HCPCS C1713,,"124.133  -  7.5MM REVERE MONOAXIAL SCREW, 37MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.134,SUP,HCPCS C1713,,"124.134  -  7.5MM REVERE MONOAXIAL SCREW, 42MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.135,SUP,HCPCS C1713,,"124.135  -  7.5MM REVERE MONOAXIAL SCREW, 47MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.171,SUP,HCPCS C1713,,124.171  -  6.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 75MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.172,SUP,HCPCS C1713,,124.172  -  6.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 80MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.173,SUP,HCPCS C1713,,124.173  -  6.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 85MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.174,SUP,HCPCS C1713,,124.174  -  6.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 90MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.175,SUP,HCPCS C1713,,124.175  -  6.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 95MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.176,SUP,HCPCS C1713,,124.176  -  6.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 100MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.181,SUP,HCPCS C1713,,124.181  -  7.0MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 75MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.182,SUP,HCPCS C1713,,124.182  -  7.0MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 80MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.183,SUP,HCPCS C1713,,124.183  -  7.0MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 85MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.184,SUP,HCPCS C1713,,124.184  -  7.0MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 90MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.185,SUP,HCPCS C1713,,124.185  -  7.0MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 95MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.186,SUP,HCPCS C1713,,124.186  -  7.0MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 100MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.2,SUP,HCPCS C1713,,124.200  -  4.0MM REVERE MONOAXIAL SCREW 20MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.201,SUP,HCPCS C1713,,124.201  -  4.0MM REVERE MONOAXIAL SCREW 25MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.202,SUP,HCPCS C1713,,124.202  -  4.0MM REVERE MONOAXIAL SCREW 30MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.203,SUP,HCPCS C1713,,124.203  -  4.0MM REVERE MONOAXIAL SCREW 35MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.204,SUP,HCPCS C1713,,124.204  -  4.0MM REVERE MONOAXIAL SCREW 40MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.241,SUP,HCPCS C1713,,124.241  -  4.5MM REVERE MONOAXIAL SCREW 25MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.242,SUP,HCPCS C1713,,124.242  -  4.5MM REVERE MONOAXIAL SCREW 30MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.243,SUP,HCPCS C1713,,124.243  -  4.5MM REVERE MONOAXIAL SCREW 35MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.244,SUP,HCPCS C1713,,124.244  -  4.5MM REVERE MONOAXIAL SCREW 40MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.245,SUP,HCPCS C1713,,124.245  -  4.5MM REVERE MONOAXIAL SCREW 45MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.251,SUP,HCPCS C1713,,124.251  -  5.5MM REVERE MONOAXIAL SCREW 25MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.252,SUP,HCPCS C1713,,124.252  -  5.5MM REVERE MONOAXIAL SCREW 30MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.253,SUP,HCPCS C1713,,124.253  -  5.5MM REVERE MONOAXIAL SCREW 35MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.254,SUP,HCPCS C1713,,124.254  -  5.5MM REVERE MONOAXIAL SCREW 40MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.255,SUP,HCPCS C1713,,124.255  -  5.5MM REVERE MONOAXIAL SCREW 45MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.256,SUP,HCPCS C1713,,124.256  -  5.5MM REVERE MONOAXIAL SCREW 50MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.257,SUP,HCPCS C1713,,124.257  -  5.5MM REVERE MONOAXIAL SCREW 55MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.258,SUP,HCPCS C1713,,124.258  -  5.5MM REVERE MONOAXIAL SCREW 60MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.259,SUP,HCPCS C1713,,124.259  -  5.5MM REVERE MONOAXIAL SCREW 65MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.261,SUP,HCPCS C1713,,124.261  -  6.5MM REVERE MONOAXIAL SCREW 25MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.262,SUP,HCPCS C1713,,124.262  -  6.5MM REVERE MONOAXIAL SCREW 30MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.263,SUP,HCPCS C1713,,124.263  -  6.5MM REVERE MONOAXIAL SCREW 35MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.264,SUP,HCPCS C1713,,124.264  -  6.5MM REVERE MONOAXIAL SCREW 40MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.265,SUP,HCPCS C1713,,124.265  -  6.5MM REVERE MONOAXIAL SCREW 45MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.266,SUP,HCPCS C1713,,124.266  -  6.5MM REVERE MONOAXIAL SCREW 50MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.267,SUP,HCPCS C1713,,124.267  -  6.5MM REVERE MONOAXIAL SCREW 55MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.268,SUP,HCPCS C1713,,124.268  -  6.5MM REVERE MONOAXIAL SCREW 60MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.269,SUP,HCPCS C1713,,124.269  -  6.5MM REVERE MONOAXIAL SCREW 65MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.271,SUP,HCPCS C1713,,124.271  -  7.5MM REVERE MONOAXIAL SCREW 25MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.272,SUP,HCPCS C1713,,124.272  -  7.5MM REVERE MONOAXIAL SCREW 30MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.273,SUP,HCPCS C1713,,124.273  -  7.5MM REVERE MONOAXIAL SCREW 35MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.274,SUP,HCPCS C1713,,124.274  -  7.5MM REVERE MONOAXIAL SCREW 40MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.275,SUP,HCPCS C1713,,124.275  -  7.5MM REVERE MONOAXIAL SCREW 45MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.276,SUP,HCPCS C1713,,124.276  -  7.5MM REVERE MONOAXIAL SCREW 50MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.277,SUP,HCPCS C1713,,124.277  -  7.5MM REVERE MONOAXIAL SCREW 55MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.278,SUP,HCPCS C1713,,124.278  -  7.5MM REVERE MONOAXIAL SCREW 60MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.279,SUP,HCPCS C1713,,124.279  -  7.5MM REVERE MONOAXIAL SCREW 65MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.281,SUP,HCPCS C1713,,124.281  -  8.5MM REVERE MONOAXIAL SCREW 25MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.282,SUP,HCPCS C1713,,124.282  -  8.5MM REVERE MONOAXIAL SCREW 30MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.283,SUP,HCPCS C1713,,124.283  -  8.5MM REVERE MONOAXIAL SCREW 35MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.284,SUP,HCPCS C1713,,124.284  -  8.5MM REVERE MONOAXIAL SCREW 40MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.285,SUP,HCPCS C1713,,124.285  -  8.5MM REVERE MONOAXIAL SCREW 45MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.286,SUP,HCPCS C1713,,124.286  -  8.5MM REVERE MONOAXIAL SCREW 50MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.287,SUP,HCPCS C1713,,124.287  -  8.5MM REVERE MONOAXIAL SCREW 55MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.288,SUP,HCPCS C1713,,124.288  -  8.5MM REVERE MONOAXIAL SCREW 60MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.289,SUP,HCPCS C1713,,124.289  -  8.5MM REVERE MONOAXIAL SCREW 65MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.351,SUP,HCPCS C1713,,124.351  -  5.5MM REVERE CANNULATED PEDICLE SCREW 25MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.352,SUP,HCPCS C1713,,124.352  -  5.5MM REVERE CANNULATED PEDICLE SCREW 30MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.353,SUP,HCPCS C1713,,124.353  -  5.5MM REVERE CANNULATED PEDICLE SCREW 35MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.354,SUP,HCPCS C1713,,124.354  -  5.5MM REVERE CANNULATED PEDICLE SCREW 40MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.355,SUP,HCPCS C1713,,124.355  -  5.5MM REVERE CANNULATED PEDICLE SCREW 45MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.356,SUP,HCPCS C1713,,124.356  -  5.5MM REVERE CANNULATED PEDICLE SCREW 50MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.357,SUP,HCPCS C1713,,124.357  -  5.5MM REVERE CANNULATED PEDICLE SCREW 55MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.361,SUP,HCPCS C1713,,124.361  -  6.5MM REVERE CANNULATED PEDICLE SCREW 25MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.362,SUP,HCPCS C1713,,124.362  -  6.5MM REVERE CANNULATED PEDICLE SCREW 30MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.363,SUP,HCPCS C1713,,124.363  -  6.5MM REVERE CANNULATED PEDICLE SCREW 35MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.364,SUP,HCPCS C1713,,124.364  -  6.5MM REVERE CANNULATED PEDICLE SCREW 40MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.365,SUP,HCPCS C1713,,124.365  -  6.5MM REVERE CANNULATED PEDICLE SCREW 45MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.366,SUP,HCPCS C1713,,124.366  -  6.5MM REVERE CANNULATED PEDICLE SCREW 50MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.367,SUP,HCPCS C1713,,124.367  -  6.5MM REVERE CANNULATED PEDICLE SCREW 55MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.368,SUP,HCPCS C1713,,124.368  -  6.5MM REVERE CANNULATED PEDICLE SCREW 60MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.369,SUP,HCPCS C1713,,124.369  -  6.5MM REVERE CANNULATED PEDICLE SCREW 65MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.371,SUP,HCPCS C1713,,124.371  -  7.5MM REVERE CANNULATED PEDICLE SCREW 25MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.372,SUP,HCPCS C1713,,124.372  -  7.5MM REVERE CANNULATED PEDICLE SCREW 30MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.373,SUP,HCPCS C1713,,124.373  -  7.5MM REVERE CANNULATED PEDICLE SCREW 35MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.374,SUP,HCPCS C1713,,124.374  -  7.5MM REVERE CANNULATED PEDICLE SCREW 40MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.375,SUP,HCPCS C1713,,124.375  -  7.5MM REVERE CANNULATED PEDICLE SCREW 45MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.376,SUP,HCPCS C1713,,124.376  -  7.5MM REVERE CANNULATED PEDICLE SCREW 50MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.377,SUP,HCPCS C1713,,124.377  -  7.5MM REVERE CANNULATED PEDICLE SCREW 55MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.378,SUP,HCPCS C1713,,124.378  -  7.5MM REVERE CANNULATED PEDICLE SCREW 60MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.379,SUP,HCPCS C1713,,124.379  -  7.5MM REVERE CANNULATED PEDICLE SCREW 65MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.381,SUP,HCPCS C1713,,124.381  -  8.5MM REVERE CANNULATED PEDICLE SCREW 25MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.382,SUP,HCPCS C1713,,124.382  -  8.5MM REVERE CANNULATED PEDICLE SCREW 30MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.383,SUP,HCPCS C1713,,124.383  -  8.5MM REVERE CANNULATED PEDICLE SCREW 35MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.384,SUP,HCPCS C1713,,124.384  -  8.5MM REVERE CANNULATED PEDICLE SCREW 40MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.385,SUP,HCPCS C1713,,124.385  -  8.5MM REVERE CANNULATED PEDICLE SCREW 45MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.386,SUP,HCPCS C1713,,124.386  -  8.5MM REVERE CANNULATED PEDICLE SCREW 50MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.387,SUP,HCPCS C1713,,124.387  -  8.5MM REVERE CANNULATED PEDICLE SCREW 55MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.388,SUP,HCPCS C1713,,124.388  -  8.5MM REVERE CANNULATED PEDICLE SCREW 60MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.389,SUP,HCPCS C1713,,124.389  -  8.5MM REVERE CANNULATED PEDICLE SCREW 65MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.441,SUP,HCPCS C1713,,124.441  -  4.5MM REVERE PEDICLE SCREW 25MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.442,SUP,HCPCS C1713,,124.442  -  SCREW BONE 4.5MM 30MM REVERE TI PDCL SPNL POLYAX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.443,SUP,HCPCS C1713,,124.443  -  SCREW BONE 4.5MM 35MM REVERE TI PDCL SPNL POLYAX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.444,SUP,HCPCS C1713,,124.444  -  SCREW BONE 4.5MM 40MM REVERE TI PDCL SPNL POLYAX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.445,SUP,HCPCS C1713,,124.445  -  4.5MM REVERE PEDICLE SCREW 45MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.451,SUP,HCPCS C1713,,124.451  -  5.5MM REVERE PEDICLE SCREW 25MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.452,SUP,HCPCS C1713,,124.452  -  SCREW BONE 5.5MM 30MM REVERE TI PDCL SPNL POLYAX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.453,SUP,HCPCS C1713,,124.453  -  SCREW BONE 5.5MM 35MM REVERE TI PDCL SPNL POLYAX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.454,SUP,HCPCS C1713,,124.454  -  SCREW BONE 5.5MM 40MM REVERE TI PDCL SPNL POLYAX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.455,SUP,HCPCS C1713,,124.455  -  SCREW BONE 5.5MM 45MM REVERE TI PDCL SPNL POLYAX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.456,SUP,HCPCS C1713,,124.456  -  5.5MM REVERE PEDICLE SCREW 50MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.457,SUP,HCPCS C1713,,124.457  -  5.5MM REVERE PEDICLE SCREW 55MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.461,SUP,HCPCS C1713,,124.461  -  6.5MM REVERE PEDICLE SCREW 25MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.462,SUP,HCPCS C1713,,124.462  -  6.5MM REVERE PEDICLE SCREW 30MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.463,SUP,HCPCS C1713,,124.463  -  6.5MM REVERE PEDICLE SCREW 35MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.464,SUP,HCPCS C1713,,124.464  -  SCREW BONE 6.5MM 40MM REVERE TI PDCL SPNL POLYAX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.465,SUP,HCPCS C1713,,124.465  -  SCREW BONE 6.5MM 45MM REVERE TI PDCL SPNL POLYAX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.466,SUP,HCPCS C1713,,124.466  -  SCREW BONE 6.5MM 50MM REVERE TI PDCL SPNL POLYAX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.467,SUP,HCPCS C1713,,124.467  -  6.5MM REVERE PEDICLE SCREW 55MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.468,SUP,HCPCS C1713,,124.468  -  6.5MM REVERE PEDICLE SCREW 60MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.469,SUP,HCPCS C1713,,124.469  -  6.5MM REVERE PEDICLE SCREW 65MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.471,SUP,HCPCS C1713,,124.471  -  7.5MM REVERE PEDICLE SCREW 25MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.472,SUP,HCPCS C1713,,124.472  -  7.5MM REVERE PEDICLE SCREW 30MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.473,SUP,HCPCS C1713,,124.473  -  7.5MM REVERE PEDICLE SCREW 35MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.474,SUP,HCPCS C1713,,124.474  -  7.5MM REVERE PEDICLE SCREW 40MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.475,SUP,HCPCS C1713,,124.475  -  SCREW BONE 7.5MM 45MM REVERE TI PDCL SPNL POLYAX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.476,SUP,HCPCS C1713,,124.476  -  7.5MM REVERE PEDICLE SCREW 50MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.477,SUP,HCPCS C1713,,124.477  -  7.5MM REVERE PEDICLE SCREW 55MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.478,SUP,HCPCS C1713,,124.478  -  7.5MM REVERE PEDICLE SCREW 60MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.479,SUP,HCPCS C1713,,124.479  -  7.5MM REVERE PEDICLE SCREW 65MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.481,SUP,HCPCS C1713,,124.481  -  8.5MM REVERE PEDICLE SCREW 25MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.482,SUP,HCPCS C1713,,124.482  -  8.5MM REVERE PEDICLE SCREW 30MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.483,SUP,HCPCS C1713,,124.483  -  8.5MM REVERE PEDICLE SCREW 35MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.484,SUP,HCPCS C1713,,124.484  -  8.5MM REVERE PEDICLE SCREW 40MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.485,SUP,HCPCS C1713,,124.485  -  8.5MM REVERE PEDICLE SCREW 45MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.486,SUP,HCPCS C1713,,124.486  -  8.5MM REVERE PEDICLE SCREW 50MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.487,SUP,HCPCS C1713,,124.487  -  8.5MM REVERE PEDICLE SCREW 55MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.488,SUP,HCPCS C1713,,124.488  -  8.5MM REVERE PEDICLE SCREW 60MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.489,SUP,HCPCS C1713,,124.489  -  8.5MM REVERE PEDICLE SCREW 65MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.51,SUP,Custom 27803010,,"124.510  -  5.5MM STRAIGHT ROD, 100MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
124.512,SUP,Custom 27803010,,"124.512  -  5.5MM STRAIGHT ROD, 125MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
124.515,SUP,Custom 27803010,,124.515  -  ROD SPNL 150MM 5.5MM REVERE PDCL TI STR,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
124.517,SUP,Custom 27803010,,124.517  -  ROD SPNL 200MM 5.5MM REVERE PDCL TI STR,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
124.519,SUP,Custom 27803010,,124.519  -  ROD SPNL 350MM 5.5MM REVERE PDCL TI STR,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
124.52,SUP,Custom 27803010,,"124.520  -  5.5MM STRAIGHT ROD, 400MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
124.521,SUP,Custom 27803010,,"124.521  -  5.5MM STRAIGHT ROD, 500MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
124.53,SUP,Custom 27803010,,"124.530  -  5.5MM STRAIGHT ROD, 30MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
124.535,SUP,Custom 27803010,,"124.535  -  5.5MM STRAIGHT ROD, 35MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
124.54,SUP,Custom 27803010,,124.540  -  ROD SPNL 40MM 5.5MM REVERE TI STR,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
124.545,SUP,Custom 27803010,,"124.545  -  5.5MM STRAIGHT ROD, 45MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
124.55,SUP,Custom 27803010,,"124.550  -  5.5MM STRAIGHT ROD, 50MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
124.555,SUP,Custom 27803010,,"124.555  -  5.5MM STRAIGHT ROD, 55MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
124.56,SUP,Custom 27803010,,"124.560  -  5.5MM STRAIGHT ROD, 60MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
124.565,SUP,Custom 27803010,,"124.565  -  5.5MM STRAIGHT ROD, 65MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
124.57,SUP,Custom 27803010,,"124.570  -  5.5MM STRAIGHT ROD, 70MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
124.575,SUP,Custom 27803010,,"124.575  -  5.5MM STRAIGHT ROD, 75MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
124.58,SUP,Custom 27803010,,"124.580  -  5.5MM STRAIGHT ROD, 80MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
124.585,SUP,Custom 27803010,,124.585  -  ROD SPNL 85MM 5.5MM REVERE PDCL TI STR,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
124.61,SUP,Custom 27803010,,"124.610  -  5.5MM CURVED ROD, 100MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
124.612,SUP,Custom 27803010,,"124.612  -  5.5MM CURVED ROD, 125MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
124.615,SUP,Custom 27803010,,"124.615  -  5.5MM CURVED ROD, 150MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
124.635,SUP,Custom 27803010,,"124.635  -  5.5MM CURVED ROD, 35MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
124.64,SUP,Custom 27803010,,124.640  -  ROD SPNL 40MM 5.5MM REVERE PDCL TI CVD,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
124.645,SUP,Custom 27803010,,124.645  -  ROD SPNL 45MM 5.5MM REVERE PDCL TI CVD,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
124.65,SUP,Custom 27803010,,"124.650  -  5.5MM CURVED ROD, 50MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
124.655,SUP,Custom 27803010,,124.655  -  ROD SPNL 55MM 5.5MM REVERE PDCL TI CVD,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
124.66,SUP,Custom 27803010,,"124.660  -  5.5MM CURVED ROD, 60MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
124.665,SUP,Custom 27803010,,124.665  -  ROD SPNL 65MM 5.5MM REVERE PDCL TI CVD,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
124.67,SUP,Custom 27803010,,"124.670  -  5.5MM CURVED ROD, 70MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
124.675,SUP,Custom 27803010,,"124.675  -  5.5MM CURVED ROD, 75MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
124.68,SUP,Custom 27803010,,"124.680  -  5.5MM CURVED ROD, 80MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
124.685,SUP,Custom 27803010,,"124.685  -  5.5MM CURVED ROD, 85MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
124.69,SUP,Custom 27803010,,"124.690  -  5.5MM CURVED ROD, 90MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
124.695,SUP,Custom 27803010,,"124.695  -  5.5MM CURVED ROD, 95MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
124.751,SUP,HCPCS C1713,,124.751  -  5.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 30MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.752,SUP,HCPCS C1713,,124.752  -  5.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 35MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.753,SUP,HCPCS C1713,,124.753  -  5.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 40MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.754,SUP,HCPCS C1713,,124.754  -  5.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 45MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.755,SUP,HCPCS C1713,,124.755  -  5.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 50MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.756,SUP,HCPCS C1713,,124.756  -  5.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 55MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.757,SUP,HCPCS C1713,,124.757  -  5.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 60MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.758,SUP,HCPCS C1713,,124.758  -  5.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 65MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.761,SUP,HCPCS C1713,,124.761  -  6.0MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 30MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.762,SUP,HCPCS C1713,,124.762  -  6.0MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 35MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.763,SUP,HCPCS C1713,,124.763  -  6.0MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 40MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.764,SUP,HCPCS C1713,,124.764  -  6.0MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 45MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.765,SUP,HCPCS C1713,,124.765  -  6.0MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 50MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.766,SUP,HCPCS C1713,,124.766  -  6.0MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 55MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.767,SUP,HCPCS C1713,,124.767  -  6.0MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 60MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.768,SUP,HCPCS C1713,,124.768  -  6.0MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 65MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.771,SUP,HCPCS C1713,,124.771  -  6.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 30MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.772,SUP,HCPCS C1713,,124.772  -  6.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 35MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.773,SUP,HCPCS C1713,,124.773  -  6.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 40MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.774,SUP,HCPCS C1713,,124.774  -  6.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 45MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.775,SUP,HCPCS C1713,,124.775  -  6.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 50MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.776,SUP,HCPCS C1713,,124.776  -  6.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 55MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.777,SUP,HCPCS C1713,,124.777  -  6.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 60MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.778,SUP,HCPCS C1713,,124.778  -  6.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 65MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.779,SUP,HCPCS C1713,,124.779  -  6.5MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 70MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.781,SUP,HCPCS C1713,,124.781  -  7.0MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 30MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.782,SUP,HCPCS C1713,,124.782  -  7.0MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 35MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.783,SUP,HCPCS C1713,,124.783  -  7.0MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 40MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.784,SUP,HCPCS C1713,,124.784  -  7.0MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 45MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.785,SUP,HCPCS C1713,,124.785  -  SCREW BN 7MM 50MM NS REVERE 2 DIA PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.786,SUP,HCPCS C1713,,124.786  -  7.0MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 55MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.787,SUP,HCPCS C1713,,124.787  -  7.0MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 60MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.788,SUP,HCPCS C1713,,124.788  -  7.0MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 65MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.789,SUP,HCPCS C1713,,124.789  -  7.0MM REVERE DUAL OUTER DIAMETER POLYAXIAL SCREW 70MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
124.851,SUP,HCPCS C1713,,124.851  -  5.0MM REVERE MONOAXIAL SCREW 25MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.852,SUP,HCPCS C1713,,124.852  -  5.0MM REVERE MONOAXIAL SCREW 30MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.853,SUP,HCPCS C1713,,124.853  -  5.0MM REVERE MONOAXIAL SCREW 35MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.854,SUP,HCPCS C1713,,124.854  -  5.0MM REVERE MONOAXIAL SCREW 40MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.855,SUP,HCPCS C1713,,124.855  -  5.0MM REVERE MONOAXIAL SCREW 45MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.856,SUP,HCPCS C1713,,124.856  -  5.0MM REVERE MONOAXIAL SCREW 50MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.857,SUP,HCPCS C1713,,124.857  -  5.0MM REVERE MONOAXIAL SCREW 55MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.871,SUP,HCPCS C1713,,124.871  -  7.5MM REVERE MONOAXIAL SCREW 70MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.872,SUP,HCPCS C1713,,124.872  -  7.5MM REVERE MONOAXIAL SCREW 75MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.873,SUP,HCPCS C1713,,124.873  -  7.5MM REVERE MONOAXIAL SCREW 80MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.874,SUP,HCPCS C1713,,124.874  -  7.5MM REVERE MONOAXIAL SCREW 85MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.875,SUP,HCPCS C1713,,124.875  -  7.5MM REVERE MONOAXIAL SCREW 90MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.881,SUP,HCPCS C1713,,124.881  -  8.5MM REVERE MONOAXIAL SCREW 70MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.882,SUP,HCPCS C1713,,124.882  -  8.5MM REVERE MONOAXIAL SCREW 75MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.883,SUP,HCPCS C1713,,124.883  -  8.5MM REVERE MONOAXIAL SCREW 80MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.884,SUP,HCPCS C1713,,124.884  -  8.5MM REVERE MONOAXIAL SCREW 85MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.885,SUP,HCPCS C1713,,124.885  -  8.5MM REVERE MONOAXIAL SCREW 90MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
124.891,SUP,Custom 27803010,,"124.891  -  REVERE LOW PROFILE PEDICLE HOOK, SMALL","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
124.892,SUP,Custom 27803010,,"124.892  -  REVERE LOW PROFILE PEDICLE HOOK, MEDIUM","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
124.893,SUP,Custom 27803010,,"124.893  -  REVERE LOW PROFILE PEDICLE HOOK, LARGE","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
124.901,SUP,Custom 27803010,,"124.901  -  REVERE THORACIC LAMINA HOOK, NARROW, SMALL","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
124.902,SUP,Custom 27803010,,"124.902  -  REVERE THORACIC LAMINA HOOK, NARROW, MEDIUM","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
124.904,SUP,Custom 27803010,,"124.904  -  REVERE THORACIC LAMINA HOOK, SMALL","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
124.905,SUP,Custom 27803010,,"124.905  -  REVERE THORACIC LAMINA HOOK, MEDIUM","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
124.907,SUP,Custom 27803010,,"124.907  -  REVERE UPGOING THORACIC LAMINA HOOK, MEDIUM","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
124.908,SUP,Custom 27803010,,"124.908  -  REVERE UPGOING THORACIC LAMINA HOOK, LARGE","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
124.912,SUP,Custom 27803010,,124.912  -  CONCTR ROD 29-33MM REVERE TRNSVRS ADJ TI PDCL,"$2,000.00",$0.00,"$2,000.00",$0.00,"$1,427.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
124.913,SUP,Custom 27803010,,"124.913  -  REVERE ADJUSTABLE T CONNECTOR, 33MM-41MM","$2,000.00",$0.00,"$2,000.00",$0.00,"$1,427.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
124.914,SUP,Custom 27803010,,124.914  -  CONCTR ROD 38-51MM REVERE TRNSVRS ADJ TI PDCL,"$2,000.00",$0.00,"$2,000.00",$0.00,"$1,427.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
124.915,SUP,Custom 27803010,,124.915  -  CONCTR ROD 48-68MM REVERE TRNSVRS ADJ TI PDCL,"$2,000.00",$0.00,"$2,000.00",$0.00,"$1,427.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
124.916,SUP,Custom 27803010,,124.916  -  CONCTR ROD 58-71MM REVERE TRNSVRS ADJ TI PDCL,"$2,000.00",$0.00,"$2,000.00",$0.00,"$1,427.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
124.917,SUP,Custom 27803010,,"124.917  -  REVERE ADJUSTABLE T CONNECTOR, 68MM-81MM","$2,000.00",$0.00,"$2,000.00",$0.00,"$1,427.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
124.918,SUP,Custom 27803010,,"124.918  -  REVERE ADJUSTABLE T CONNECTOR, 78MM-91MM","$2,000.00",$0.00,"$2,000.00",$0.00,"$1,427.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
124.921,SUP,Custom 27803010,,"124.921  -  REVERE OFFSET LAMINA HOOK, RIGHT","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
124.922,SUP,Custom 27803010,,"124.922  -  REVERE OFFSET LAMINA HOOK, LEFT","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
124.924,SUP,Custom 27803010,,"124.924  -  REVERE TRANSVERSE PROCESS HOOK, RIGHT","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
124.925,SUP,Custom 27803010,,"124.925  -  REVERE TRANSVERSE PROCESS HOOK, LEFT","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
124.927,SUP,Custom 27803010,,"124.927  -  REVERE PEDICLE HOOK, SMALL","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
124.928,SUP,Custom 27803010,,"124.928  -  REVERE PEDICLE HOOK, MEDIUM","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
124.929,SUP,Custom 27803010,,"124.929  -  REVERE PEDICLE HOOK, LARGE","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
124.931,SUP,Custom 27803010,,"124.931  -  REVERE LAMINA HOOK, TRANSVERSE, SMALL","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
124.932,SUP,Custom 27803010,,"124.932  -  REVERE LAMINA HOOK, TRANSVERSE, MEDIUM","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
124.933,SUP,Custom 27803010,,"124.933  -  REVERE LAMINA HOOK, TRANSVERSE, LARGE","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
124.935,SUP,Custom 27803010,,"124.935  -  REVERE PEDICLE HOOK, TRANSVERSE, SMALL","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
124.936,SUP,Custom 27803010,,"124.936  -  REVERE PEDICLE HOOK, TRANSVERSE, MEDIUM","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
124.937,SUP,Custom 27803010,,"124.937  -  REVERE PEDICLE HOOK, TRANSVERSE, LARGE","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
124.94,SUP,Custom 27803010,,"124.940  -  REVERE LAMINA HOOK, NARROW, SMALL","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
124.941,SUP,Custom 27803010,,"124.941  -  REVERE LAMINA HOOK, NARROW, MEDIUM","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
124.942,SUP,Custom 27803010,,"124.942  -  REVERE LAMINA HOOK, NARROW, LARGE","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
124.944,SUP,Custom 27803010,,"124.944  -  REVERE LAMINA HOOK, SMALL","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
124.945,SUP,Custom 27803010,,"124.945  -  REVERE LAMINA HOOK, MEDIUM","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
124.946,SUP,Custom 27803010,,"124.946  -  REVERE LAMINA HOOK, LARGE","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
124.948,SUP,Custom 27803010,,"124.948  -  REVERE LAMINA HOOK, WIDE, SMALL","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
124.949,SUP,Custom 27803010,,"124.949  -  REVERE LAMINA HOOK, WIDE, MEDIUM","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
124.95,SUP,Custom 27803010,,"124.950  -  REVERE LAMINA HOOK, WIDE, LARGE","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
124.952,SUP,Custom 27803010,,"124.952  -  REVERE LAMINA HOOK, TALL BODY, SMALL","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
124.953,SUP,Custom 27803010,,"124.953  -  REVERE LAMINA HOOK, TALL BODY, MEDIUM","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
124.954,SUP,Custom 27803010,,"124.954  -  REVERE LAMINA HOOK, TALL BODY, LARGE","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
124.955,SUP,Custom 27803010,,"124.955  -  REVERE ANGLED LAMINA HOOK, SMALL","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
124.956,SUP,Custom 27803010,,"124.956  -  REVERE ANGLED LAMINA HOOK, MEDIUM","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
124.957,SUP,Custom 27803010,,"124.957  -  REVERE ANGLED LAMINA HOOK, LARGE","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
124.96,SUP,Custom 27803010,,"124.960  -  PARALLEL CONNECTOR, 5.5MM TO 5.5MM","$1,272.50",$0.00,"$1,272.50",$0.00,$908.18,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,272.50",$0.00,$636.25,"$1,007.82","$1,018.00",$0.00,$0.00,$0.00,$0.00,$0.00
124.961,SUP,Custom 27803010,,"124.961  -  PARALLEL CONNECTOR, 5.5MM TO 5.5MM, WIDE","$1,272.50",$0.00,"$1,272.50",$0.00,$908.18,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,272.50",$0.00,$636.25,"$1,007.82","$1,018.00",$0.00,$0.00,$0.00,$0.00,$0.00
124.962,SUP,Custom 27803010,,"124.962  -  ROD TO ROD CLAMP, 5.5MM TO 5.5MM","$1,287.50",$0.00,"$1,287.50",$0.00,$918.89,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,287.50",$0.00,$643.75,"$1,019.70","$1,030.00",$0.00,$0.00,$0.00,$0.00,$0.00
124.963,SUP,Custom 27803010,,"124.963  -  ROD TO ROD CLAMP, 5.5MM TO 5.5MM, WIDE","$1,287.50",$0.00,"$1,287.50",$0.00,$918.89,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,287.50",$0.00,$643.75,"$1,019.70","$1,030.00",$0.00,$0.00,$0.00,$0.00,$0.00
124.964,SUP,Custom 27803010,,"124.964  -  PARALLEL CONNECTOR CLAMP, 5.5MM TO 5.5MM","$1,287.50",$0.00,"$1,287.50",$0.00,$918.89,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,287.50",$0.00,$643.75,"$1,019.70","$1,030.00",$0.00,$0.00,$0.00,$0.00,$0.00
124.965,SUP,Custom 27803010,,"124.965  -  PARALLEL CONNECTOR CLAMP, 5.5MM TO 5.5MM, WIDE","$1,287.50",$0.00,"$1,287.50",$0.00,$918.89,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,287.50",$0.00,$643.75,"$1,019.70","$1,030.00",$0.00,$0.00,$0.00,$0.00,$0.00
124.97,SUP,Custom 27803010,,"124.970  -  5.5MM OFFSET CONNECTOR, 15MM","$1,145.00",$0.00,"$1,145.00",$0.00,$817.19,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,145.00",$0.00,$572.50,$906.84,$916.00,$0.00,$0.00,$0.00,$0.00,$0.00
124.971,SUP,Custom 27803010,,"124.971  -  5.5MM OFFSET CONNECTOR, 20MM","$1,145.00",$0.00,"$1,145.00",$0.00,$817.19,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,145.00",$0.00,$572.50,$906.84,$916.00,$0.00,$0.00,$0.00,$0.00,$0.00
124.972,SUP,Custom 27803010,,"124.972  -  5.5MM OFFSET CONNECTOR, 25MM","$1,145.00",$0.00,"$1,145.00",$0.00,$817.19,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,145.00",$0.00,$572.50,$906.84,$916.00,$0.00,$0.00,$0.00,$0.00,$0.00
124.973,SUP,Custom 27803010,,"124.973  -  5.5MM ROD CLAMP, 100MM","$1,362.50",$0.00,"$1,362.50",$0.00,$972.42,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,362.50",$0.00,$681.25,"$1,079.10","$1,090.00",$0.00,$0.00,$0.00,$0.00,$0.00
124.974,SUP,Custom 27803010,,"124.974  -  5.5MM ROD CLAMP, 120MM","$1,362.50",$0.00,"$1,362.50",$0.00,$972.42,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,362.50",$0.00,$681.25,"$1,079.10","$1,090.00",$0.00,$0.00,$0.00,$0.00,$0.00
124.975,SUP,Custom 27803010,,"124.975  -  5.5MM ROD CLAMP, 150MM","$1,362.50",$0.00,"$1,362.50",$0.00,$972.42,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,362.50",$0.00,$681.25,"$1,079.10","$1,090.00",$0.00,$0.00,$0.00,$0.00,$0.00
124.976,SUP,Custom 27803010,,"124.976  -  5.5MM OFFSET CONNECTOR, 30MM","$1,287.50",$0.00,"$1,287.50",$0.00,$918.89,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,287.50",$0.00,$643.75,"$1,019.70","$1,030.00",$0.00,$0.00,$0.00,$0.00,$0.00
124.977,SUP,Custom 27803010,,"124.977  -  5.5MM OFFSET CONNECTOR, 35MM","$1,287.50",$0.00,"$1,287.50",$0.00,$918.89,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,287.50",$0.00,$643.75,"$1,019.70","$1,030.00",$0.00,$0.00,$0.00,$0.00,$0.00
124.98,SUP,Custom 27803010,,"124.980  -  IN-LINE CONNECTOR, 5.5MM TO 5.5MM","$1,362.50",$0.00,"$1,362.50",$0.00,$972.42,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,362.50",$0.00,$681.25,"$1,079.10","$1,090.00",$0.00,$0.00,$0.00,$0.00,$0.00
124.99,SUP,Custom 27803010,,"124.990  -  5.5MM CLOSED OFFSET CONNECTOR, 5.5MM ROD, 15MM","$1,362.50",$0.00,"$1,362.50",$0.00,$972.42,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,362.50",$0.00,$681.25,"$1,079.10","$1,090.00",$0.00,$0.00,$0.00,$0.00,$0.00
124.991,SUP,Custom 27803010,,"124.991  -  5.5MM CLOSED OFFSET CONNECTOR, 5.5MM ROD, 20MM","$1,362.50",$0.00,"$1,362.50",$0.00,$972.42,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,362.50",$0.00,$681.25,"$1,079.10","$1,090.00",$0.00,$0.00,$0.00,$0.00,$0.00
124.992,SUP,Custom 27803010,,"124.992  -  5.5MM CLOSED OFFSET CONNECTOR, 5.5MM ROD, 25MM","$1,362.50",$0.00,"$1,362.50",$0.00,$972.42,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,362.50",$0.00,$681.25,"$1,079.10","$1,090.00",$0.00,$0.00,$0.00,$0.00,$0.00
124.993,SUP,Custom 27803010,,"124.993  -  5.5MM CLOSED OFFSET CONNECTOR, 5.5MM ROD, 30MM","$1,362.50",$0.00,"$1,362.50",$0.00,$972.42,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,362.50",$0.00,$681.25,"$1,079.10","$1,090.00",$0.00,$0.00,$0.00,$0.00,$0.00
124.994,SUP,Custom 27803010,,"124.994  -  5.5MM CLOSED OFFSET CONNECTOR, 5.5MM ROD, 35MM","$1,362.50",$0.00,"$1,362.50",$0.00,$972.42,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,362.50",$0.00,$681.25,"$1,079.10","$1,090.00",$0.00,$0.00,$0.00,$0.00,$0.00
124.995,SUP,Custom 27803010,,"124.995  -  5.5MM CLOSED OFFSET CONNECTOR, 5.5MM ROD, 100MM","$1,362.50",$0.00,"$1,362.50",$0.00,$972.42,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,362.50",$0.00,$681.25,"$1,079.10","$1,090.00",$0.00,$0.00,$0.00,$0.00,$0.00
124.996,SUP,Custom 27803010,,"124.996  -  5.5MM CLOSED OFFSET CONNECTOR, 5.5MM ROD, 120MM","$1,362.50",$0.00,"$1,362.50",$0.00,$972.42,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,362.50",$0.00,$681.25,"$1,079.10","$1,090.00",$0.00,$0.00,$0.00,$0.00,$0.00
124.997,SUP,Custom 27803010,,"124.997  -  5.5MM CLOSED OFFSET CONNECTOR, 5.5MM ROD, 150MM","$1,362.50",$0.00,"$1,362.50",$0.00,$972.42,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,362.50",$0.00,$681.25,"$1,079.10","$1,090.00",$0.00,$0.00,$0.00,$0.00,$0.00
129.436,SUP,HCPCS C1713,,"129.436  -  GATEWAY THORACOLUMBAR PLATE, 36MM","$14,030.00",$0.00,"$14,030.00","$6,313.50","$5,158.80",$0.00,"$2,417.30",$0.00,$0.00,"$2,456.54","$14,030.00",$0.00,"$7,015.00","$11,111.76","$11,224.00",$0.00,"$2,195.70",$0.00,"$2,233.58",$0.00
129.438,SUP,HCPCS C1713,,"129.438  -  GATEWAY THORACOLUMBAR PLATE, 38MM","$14,030.00",$0.00,"$14,030.00","$6,313.50","$5,158.80",$0.00,"$2,417.30",$0.00,$0.00,"$2,456.54","$14,030.00",$0.00,"$7,015.00","$11,111.76","$11,224.00",$0.00,"$2,195.70",$0.00,"$2,233.58",$0.00
129.44,SUP,HCPCS C1713,,"129.440  -  GATEWAY THORACOLUMBAR PLATE, 40MM","$14,030.00",$0.00,"$14,030.00","$6,313.50","$5,158.80",$0.00,"$2,417.30",$0.00,$0.00,"$2,456.54","$14,030.00",$0.00,"$7,015.00","$11,111.76","$11,224.00",$0.00,"$2,195.70",$0.00,"$2,233.58",$0.00
129.442,SUP,HCPCS C1713,,"129.442  -  GATEWAY THORACOLUMBAR PLATE, 42MM","$14,030.00",$0.00,"$14,030.00","$6,313.50","$5,158.80",$0.00,"$2,417.30",$0.00,$0.00,"$2,456.54","$14,030.00",$0.00,"$7,015.00","$11,111.76","$11,224.00",$0.00,"$2,195.70",$0.00,"$2,233.58",$0.00
129.444,SUP,HCPCS C1713,,"129.444  -  GATEWAY THORACOLUMBAR PLATE, 44MM","$14,030.00",$0.00,"$14,030.00","$6,313.50","$5,158.80",$0.00,"$2,417.30",$0.00,$0.00,"$2,456.54","$14,030.00",$0.00,"$7,015.00","$11,111.76","$11,224.00",$0.00,"$2,195.70",$0.00,"$2,233.58",$0.00
129.448,SUP,HCPCS C1713,,"129.448  -  GATEWAY THORACOLUMBAR PLATE, 48MM","$14,030.00",$0.00,"$14,030.00","$6,313.50","$5,158.80",$0.00,"$2,417.30",$0.00,$0.00,"$2,456.54","$14,030.00",$0.00,"$7,015.00","$11,111.76","$11,224.00",$0.00,"$2,195.70",$0.00,"$2,233.58",$0.00
129.452,SUP,HCPCS C1713,,"129.452  -  GATEWAY THORACOLUMBAR PLATE, 52MM","$14,030.00",$0.00,"$14,030.00","$6,313.50","$5,158.80",$0.00,"$2,417.30",$0.00,$0.00,"$2,456.54","$14,030.00",$0.00,"$7,015.00","$11,111.76","$11,224.00",$0.00,"$2,195.70",$0.00,"$2,233.58",$0.00
129.456,SUP,HCPCS C1713,,"129.456  -  GATEWAY THORACOLUMBAR PLATE, 56MM","$14,030.00",$0.00,"$14,030.00","$6,313.50","$5,158.80",$0.00,"$2,417.30",$0.00,$0.00,"$2,456.54","$14,030.00",$0.00,"$7,015.00","$11,111.76","$11,224.00",$0.00,"$2,195.70",$0.00,"$2,233.58",$0.00
129.46,SUP,HCPCS C1713,,"129.460  -  GATEWAY THORACOLUMBAR PLATE, 60MM","$14,030.00",$0.00,"$14,030.00","$6,313.50","$5,158.80",$0.00,"$2,417.30",$0.00,$0.00,"$2,456.54","$14,030.00",$0.00,"$7,015.00","$11,111.76","$11,224.00",$0.00,"$2,195.70",$0.00,"$2,233.58",$0.00
129.464,SUP,HCPCS C1713,,"129.464  -  GATEWAY THORACOLUMBAR PLATE, 64MM","$14,030.00",$0.00,"$14,030.00","$6,313.50","$5,158.80",$0.00,"$2,417.30",$0.00,$0.00,"$2,456.54","$14,030.00",$0.00,"$7,015.00","$11,111.76","$11,224.00",$0.00,"$2,195.70",$0.00,"$2,233.58",$0.00
129.468,SUP,HCPCS C1713,,"129.468  -  GATEWAY THORACOLUMBAR PLATE, 68MM","$14,030.00",$0.00,"$14,030.00","$6,313.50","$5,158.80",$0.00,"$2,417.30",$0.00,$0.00,"$2,456.54","$14,030.00",$0.00,"$7,015.00","$11,111.76","$11,224.00",$0.00,"$2,195.70",$0.00,"$2,233.58",$0.00
129.472,SUP,HCPCS C1713,,"129.472  -  GATEWAY THORACOLUMBAR PLATE, 72MM","$14,030.00",$0.00,"$14,030.00","$6,313.50","$5,158.80",$0.00,"$2,417.30",$0.00,$0.00,"$2,456.54","$14,030.00",$0.00,"$7,015.00","$11,111.76","$11,224.00",$0.00,"$2,195.70",$0.00,"$2,233.58",$0.00
129.476,SUP,HCPCS C1713,,"129.476  -  GATEWAY THORACOLUMBAR PLATE, 76MM","$14,030.00",$0.00,"$14,030.00","$6,313.50","$5,158.80",$0.00,"$2,417.30",$0.00,$0.00,"$2,456.54","$14,030.00",$0.00,"$7,015.00","$11,111.76","$11,224.00",$0.00,"$2,195.70",$0.00,"$2,233.58",$0.00
129.48,SUP,HCPCS C1713,,"129.480  -  GATEWAY THORACOLUMBAR PLATE, 80MM","$14,030.00",$0.00,"$14,030.00","$6,313.50","$5,158.80",$0.00,"$2,417.30",$0.00,$0.00,"$2,456.54","$14,030.00",$0.00,"$7,015.00","$11,111.76","$11,224.00",$0.00,"$2,195.70",$0.00,"$2,233.58",$0.00
129.484,SUP,HCPCS C1713,,"129.484  -  GATEWAY THORACOLUMBAR PLATE, 84MM","$14,030.00",$0.00,"$14,030.00","$6,313.50","$5,158.80",$0.00,"$2,417.30",$0.00,$0.00,"$2,456.54","$14,030.00",$0.00,"$7,015.00","$11,111.76","$11,224.00",$0.00,"$2,195.70",$0.00,"$2,233.58",$0.00
129.488,SUP,HCPCS C1713,,"129.488  -  GATEWAY THORACOLUMBAR PLATE, 88MM","$14,030.00",$0.00,"$14,030.00","$6,313.50","$5,158.80",$0.00,"$2,417.30",$0.00,$0.00,"$2,456.54","$14,030.00",$0.00,"$7,015.00","$11,111.76","$11,224.00",$0.00,"$2,195.70",$0.00,"$2,233.58",$0.00
129.492,SUP,HCPCS C1713,,"129.492  -  GATEWAY THORACOLUMBAR PLATE, 92MM","$14,030.00",$0.00,"$14,030.00","$6,313.50","$5,158.80",$0.00,"$2,417.30",$0.00,$0.00,"$2,456.54","$14,030.00",$0.00,"$7,015.00","$11,111.76","$11,224.00",$0.00,"$2,195.70",$0.00,"$2,233.58",$0.00
129.496,SUP,HCPCS C1713,,"129.496  -  GATEWAY THORACOLUMBAR PLATE, 96MM","$14,030.00",$0.00,"$14,030.00","$6,313.50","$5,158.80",$0.00,"$2,417.30",$0.00,$0.00,"$2,456.54","$14,030.00",$0.00,"$7,015.00","$11,111.76","$11,224.00",$0.00,"$2,195.70",$0.00,"$2,233.58",$0.00
129.5,SUP,HCPCS C1713,,"129.500  -  GATEWAY THORACOLUMBAR PLATE, 100MM","$14,030.00",$0.00,"$14,030.00","$6,313.50","$5,158.80",$0.00,"$2,417.30",$0.00,$0.00,"$2,456.54","$14,030.00",$0.00,"$7,015.00","$11,111.76","$11,224.00",$0.00,"$2,195.70",$0.00,"$2,233.58",$0.00
129.65,SUP,Custom 27203010,,"129.650  -  SINGLE STAPLE, 5.0MM","$1,772.50",$0.00,"$1,772.50",$0.00,"$1,265.03",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,772.50",$0.00,$886.25,"$1,403.82","$1,418.00",$0.00,$0.00,$0.00,$0.00,$0.00
129.655,SUP,Custom 27203010,,"129.655  -  SINGLE STAPLE, 5.5MM","$1,772.50",$0.00,"$1,772.50",$0.00,"$1,265.03",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,772.50",$0.00,$886.25,"$1,403.82","$1,418.00",$0.00,$0.00,$0.00,$0.00,$0.00
129.665,SUP,Custom 27203010,,"129.665  -  SINGLE STAPLE, 6.5MM","$1,772.50",$0.00,"$1,772.50",$0.00,"$1,265.03",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,772.50",$0.00,$886.25,"$1,403.82","$1,418.00",$0.00,$0.00,$0.00,$0.00,$0.00
129.675,SUP,Custom 27203010,,"129.675  -  SINGLE STAPLE, 7.5MM","$1,772.50",$0.00,"$1,772.50",$0.00,"$1,265.03",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,772.50",$0.00,$886.25,"$1,403.82","$1,418.00",$0.00,$0.00,$0.00,$0.00,$0.00
129.685,SUP,Custom 27203010,,"129.685  -  SINGLE STAPLE, 8.5MM","$1,772.50",$0.00,"$1,772.50",$0.00,"$1,265.03",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,772.50",$0.00,$886.25,"$1,403.82","$1,418.00",$0.00,$0.00,$0.00,$0.00,$0.00
130.12,SUP,HCPCS C1713,,"130.120  -  CITADEL ANTERIOR LUMBAR PLATE, 1-LEVEL, 20MM","$11,635.00",$0.00,"$11,635.00","$5,235.75","$5,158.80",$0.00,"$2,004.65",$0.00,$0.00,"$2,037.20","$11,635.00",$0.00,"$5,817.50","$9,214.92","$9,308.00",$0.00,"$1,820.88",$0.00,"$1,852.29",$0.00
130.122,SUP,HCPCS C1713,,"130.122  -  CITADEL ANTERIOR LUMBAR PLATE, 1-LEVEL, 22MM","$11,635.00",$0.00,"$11,635.00","$5,235.75","$5,158.80",$0.00,"$2,004.65",$0.00,$0.00,"$2,037.20","$11,635.00",$0.00,"$5,817.50","$9,214.92","$9,308.00",$0.00,"$1,820.88",$0.00,"$1,852.29",$0.00
130.124,SUP,HCPCS C1713,,"130.124  -  CITADEL ANTERIOR LUMBAR PLATE, 1-LEVEL, 24MM","$11,635.00",$0.00,"$11,635.00","$5,235.75","$5,158.80",$0.00,"$2,004.65",$0.00,$0.00,"$2,037.20","$11,635.00",$0.00,"$5,817.50","$9,214.92","$9,308.00",$0.00,"$1,820.88",$0.00,"$1,852.29",$0.00
130.126,SUP,HCPCS C1713,,"130.126  -  CITADEL ANTERIOR LUMBAR PLATE, 1-LEVEL, 26MM","$11,635.00",$0.00,"$11,635.00","$5,235.75","$5,158.80",$0.00,"$2,004.65",$0.00,$0.00,"$2,037.20","$11,635.00",$0.00,"$5,817.50","$9,214.92","$9,308.00",$0.00,"$1,820.88",$0.00,"$1,852.29",$0.00
130.128,SUP,HCPCS C1713,,"130.128  -  CITADEL ANTERIOR LUMBAR PLATE, 1-LEVEL, 28MM","$11,635.00",$0.00,"$11,635.00","$5,235.75","$5,158.80",$0.00,"$2,004.65",$0.00,$0.00,"$2,037.20","$11,635.00",$0.00,"$5,817.50","$9,214.92","$9,308.00",$0.00,"$1,820.88",$0.00,"$1,852.29",$0.00
130.13,SUP,HCPCS C1713,,"130.130  -  CITADEL ANTERIOR LUMBAR PLATE, 1-LEVEL, 30MM","$11,635.00",$0.00,"$11,635.00","$5,235.75","$5,158.80",$0.00,"$2,004.65",$0.00,$0.00,"$2,037.20","$11,635.00",$0.00,"$5,817.50","$9,214.92","$9,308.00",$0.00,"$1,820.88",$0.00,"$1,852.29",$0.00
130.132,SUP,HCPCS C1713,,"130.132  -  CITADEL ANTERIOR LUMBAR PLATE, 1-LEVEL, 32MM","$11,635.00",$0.00,"$11,635.00","$5,235.75","$5,158.80",$0.00,"$2,004.65",$0.00,$0.00,"$2,037.20","$11,635.00",$0.00,"$5,817.50","$9,214.92","$9,308.00",$0.00,"$1,820.88",$0.00,"$1,852.29",$0.00
130.134,SUP,HCPCS C1713,,"130.134  -  CITADEL ANTERIOR LUMBAR PLATE, 1-LEVEL, 34MM","$11,635.00",$0.00,"$11,635.00","$5,235.75","$5,158.80",$0.00,"$2,004.65",$0.00,$0.00,"$2,037.20","$11,635.00",$0.00,"$5,817.50","$9,214.92","$9,308.00",$0.00,"$1,820.88",$0.00,"$1,852.29",$0.00
130.136,SUP,HCPCS C1713,,"130.136  -  CITADEL ANTERIOR LUMBAR PLATE, 1-LEVEL, 36MM","$11,635.00",$0.00,"$11,635.00","$5,235.75","$5,158.80",$0.00,"$2,004.65",$0.00,$0.00,"$2,037.20","$11,635.00",$0.00,"$5,817.50","$9,214.92","$9,308.00",$0.00,"$1,820.88",$0.00,"$1,852.29",$0.00
130.138,SUP,HCPCS C1713,,"130.138  -  CITADEL ANTERIOR LUMBAR PLATE, 1-LEVEL, 38MM","$11,635.00",$0.00,"$11,635.00","$5,235.75","$5,158.80",$0.00,"$2,004.65",$0.00,$0.00,"$2,037.20","$11,635.00",$0.00,"$5,817.50","$9,214.92","$9,308.00",$0.00,"$1,820.88",$0.00,"$1,852.29",$0.00
130.142,SUP,HCPCS C1713,,"130.142  -  CITADEL ANTERIOR LUMBAR PLATE, 2-LEVEL, 42MM","$12,925.00",$0.00,"$12,925.00","$5,816.25","$5,158.80",$0.00,"$2,226.91",$0.00,$0.00,"$2,263.06","$12,925.00",$0.00,"$6,462.50","$10,236.60","$10,340.00",$0.00,"$2,022.76",$0.00,"$2,057.66",$0.00
130.148,SUP,HCPCS C1713,,"130.148  -  CITADEL ANTERIOR LUMBAR PLATE, 2-LEVEL, 48MM","$12,925.00",$0.00,"$12,925.00","$5,816.25","$5,158.80",$0.00,"$2,226.91",$0.00,$0.00,"$2,263.06","$12,925.00",$0.00,"$6,462.50","$10,236.60","$10,340.00",$0.00,"$2,022.76",$0.00,"$2,057.66",$0.00
130.154,SUP,HCPCS C1713,,"130.154  -  CITADEL ANTERIOR LUMBAR PLATE, 2-LEVEL, 54MM","$12,925.00",$0.00,"$12,925.00","$5,816.25","$5,158.80",$0.00,"$2,226.91",$0.00,$0.00,"$2,263.06","$12,925.00",$0.00,"$6,462.50","$10,236.60","$10,340.00",$0.00,"$2,022.76",$0.00,"$2,057.66",$0.00
130.16,SUP,HCPCS C1713,,"130.160  -  CITADEL ANTERIOR LUMBAR PLATE, 2-LEVEL, 60MM","$12,925.00",$0.00,"$12,925.00","$5,816.25","$5,158.80",$0.00,"$2,226.91",$0.00,$0.00,"$2,263.06","$12,925.00",$0.00,"$6,462.50","$10,236.60","$10,340.00",$0.00,"$2,022.76",$0.00,"$2,057.66",$0.00
130.163,SUP,HCPCS C1713,,"130.163  -  CITADEL ANTERIOR LUMBAR PLATE, 2-LEVEL, 63MM","$12,925.00",$0.00,"$12,925.00","$5,816.25","$5,158.80",$0.00,"$2,226.91",$0.00,$0.00,"$2,263.06","$12,925.00",$0.00,"$6,462.50","$10,236.60","$10,340.00",$0.00,"$2,022.76",$0.00,"$2,057.66",$0.00
130.166,SUP,HCPCS C1713,,"130.166  -  CITADEL ANTERIOR LUMBAR PLATE, 2-LEVEL, 66MM","$12,925.00",$0.00,"$12,925.00","$5,816.25","$5,158.80",$0.00,"$2,226.91",$0.00,$0.00,"$2,263.06","$12,925.00",$0.00,"$6,462.50","$10,236.60","$10,340.00",$0.00,"$2,022.76",$0.00,"$2,057.66",$0.00
130.169,SUP,HCPCS C1713,,"130.169  -  CITADEL ANTERIOR LUMBAR PLATE, 2-LEVEL, 69MM","$12,925.00",$0.00,"$12,925.00","$5,816.25","$5,158.80",$0.00,"$2,226.91",$0.00,$0.00,"$2,263.06","$12,925.00",$0.00,"$6,462.50","$10,236.60","$10,340.00",$0.00,"$2,022.76",$0.00,"$2,057.66",$0.00
130.172,SUP,HCPCS C1713,,"130.172  -  CITADEL ANTERIOR LUMBAR PLATE, 2-LEVEL, 72MM","$12,925.00",$0.00,"$12,925.00","$5,816.25","$5,158.80",$0.00,"$2,226.91",$0.00,$0.00,"$2,263.06","$12,925.00",$0.00,"$6,462.50","$10,236.60","$10,340.00",$0.00,"$2,022.76",$0.00,"$2,057.66",$0.00
130.175,SUP,HCPCS C1713,,"130.175  -  CITADEL ANTERIOR LUMBAR PLATE, 2-LEVEL, 75MM","$12,925.00",$0.00,"$12,925.00","$5,816.25","$5,158.80",$0.00,"$2,226.91",$0.00,$0.00,"$2,263.06","$12,925.00",$0.00,"$6,462.50","$10,236.60","$10,340.00",$0.00,"$2,022.76",$0.00,"$2,057.66",$0.00
130.178,SUP,HCPCS C1713,,"130.178  -  CITADEL ANTERIOR LUMBAR PLATE, 2-LEVEL, 78MM","$12,925.00",$0.00,"$12,925.00","$5,816.25","$5,158.80",$0.00,"$2,226.91",$0.00,$0.00,"$2,263.06","$12,925.00",$0.00,"$6,462.50","$10,236.60","$10,340.00",$0.00,"$2,022.76",$0.00,"$2,057.66",$0.00
130.181,SUP,HCPCS C1713,,"130.181  -  CITADEL ANTERIOR LUMBAR PLATE, 2-LEVEL, 81MM","$12,925.00",$0.00,"$12,925.00","$5,816.25","$5,158.80",$0.00,"$2,226.91",$0.00,$0.00,"$2,263.06","$12,925.00",$0.00,"$6,462.50","$10,236.60","$10,340.00",$0.00,"$2,022.76",$0.00,"$2,057.66",$0.00
130.184,SUP,HCPCS C1713,,"130.184  -  CITADEL ANTERIOR LUMBAR PLATE, 2-LEVEL, 84MM","$12,925.00",$0.00,"$12,925.00","$5,816.25","$5,158.80",$0.00,"$2,226.91",$0.00,$0.00,"$2,263.06","$12,925.00",$0.00,"$6,462.50","$10,236.60","$10,340.00",$0.00,"$2,022.76",$0.00,"$2,057.66",$0.00
130.187,SUP,HCPCS C1713,,"130.187  -  CITADEL ANTERIOR LUMBAR PLATE, 2-LEVEL, 87MM","$12,925.00",$0.00,"$12,925.00","$5,816.25","$5,158.80",$0.00,"$2,226.91",$0.00,$0.00,"$2,263.06","$12,925.00",$0.00,"$6,462.50","$10,236.60","$10,340.00",$0.00,"$2,022.76",$0.00,"$2,057.66",$0.00
130.19,SUP,HCPCS C1713,,"130.190  -  CITADEL ANTERIOR LUMBAR PLATE, 2-LEVEL, 90MM","$12,925.00",$0.00,"$12,925.00","$5,816.25","$5,158.80",$0.00,"$2,226.91",$0.00,$0.00,"$2,263.06","$12,925.00",$0.00,"$6,462.50","$10,236.60","$10,340.00",$0.00,"$2,022.76",$0.00,"$2,057.66",$0.00
130.193,SUP,HCPCS C1713,,"130.193  -  CITADEL ANTERIOR LUMBAR PLATE, 2-LEVEL, 93MM","$12,925.00",$0.00,"$12,925.00","$5,816.25","$5,158.80",$0.00,"$2,226.91",$0.00,$0.00,"$2,263.06","$12,925.00",$0.00,"$6,462.50","$10,236.60","$10,340.00",$0.00,"$2,022.76",$0.00,"$2,057.66",$0.00
130.196,SUP,HCPCS C1713,,"130.196  -  CITADEL ANTERIOR LUMBAR PLATE, 2-LEVEL, 96MM","$12,925.00",$0.00,"$12,925.00","$5,816.25","$5,158.80",$0.00,"$2,226.91",$0.00,$0.00,"$2,263.06","$12,925.00",$0.00,"$6,462.50","$10,236.60","$10,340.00",$0.00,"$2,022.76",$0.00,"$2,057.66",$0.00
130.199,SUP,HCPCS C1713,,"130.199  -  CITADEL ANTERIOR LUMBAR PLATE, 2-LEVEL, 99MM","$12,925.00",$0.00,"$12,925.00","$5,816.25","$5,158.80",$0.00,"$2,226.91",$0.00,$0.00,"$2,263.06","$12,925.00",$0.00,"$6,462.50","$10,236.60","$10,340.00",$0.00,"$2,022.76",$0.00,"$2,057.66",$0.00
130.22,SUP,HCPCS C1713,,"130.220  -  CITADEL ANTERIOR LUMBOSACRAL PLATE, 1-LEVEL, 20MM","$12,277.50",$0.00,"$12,277.50","$5,524.88","$5,158.80",$0.00,"$2,115.35",$0.00,$0.00,"$2,149.69","$12,277.50",$0.00,"$6,138.75","$9,723.78","$9,822.00",$0.00,"$1,921.43",$0.00,"$1,954.58",$0.00
130.222,SUP,HCPCS C1713,,"130.222  -  CITADEL ANTERIOR LUMBOSACRAL PLATE, 1-LEVEL, 22MM","$12,277.50",$0.00,"$12,277.50","$5,524.88","$5,158.80",$0.00,"$2,115.35",$0.00,$0.00,"$2,149.69","$12,277.50",$0.00,"$6,138.75","$9,723.78","$9,822.00",$0.00,"$1,921.43",$0.00,"$1,954.58",$0.00
130.224,SUP,HCPCS C1713,,"130.224  -  CITADEL ANTERIOR LUMBOSACRAL PLATE, 1-LEVEL, 24MM","$12,277.50",$0.00,"$12,277.50","$5,524.88","$5,158.80",$0.00,"$2,115.35",$0.00,$0.00,"$2,149.69","$12,277.50",$0.00,"$6,138.75","$9,723.78","$9,822.00",$0.00,"$1,921.43",$0.00,"$1,954.58",$0.00
130.226,SUP,HCPCS C1713,,"130.226  -  CITADEL ANTERIOR LUMBOSACRAL PLATE, 1-LEVEL, 26MM","$12,277.50",$0.00,"$12,277.50","$5,524.88","$5,158.80",$0.00,"$2,115.35",$0.00,$0.00,"$2,149.69","$12,277.50",$0.00,"$6,138.75","$9,723.78","$9,822.00",$0.00,"$1,921.43",$0.00,"$1,954.58",$0.00
130.228,SUP,HCPCS C1713,,"130.228  -  CITADEL ANTERIOR LUMBOSACRAL PLATE, 1-LEVEL, 28MM","$12,277.50",$0.00,"$12,277.50","$5,524.88","$5,158.80",$0.00,"$2,115.35",$0.00,$0.00,"$2,149.69","$12,277.50",$0.00,"$6,138.75","$9,723.78","$9,822.00",$0.00,"$1,921.43",$0.00,"$1,954.58",$0.00
130.23,SUP,HCPCS C1713,,130.230  -  PLATE BN 30MM NS CITADEL LVL 1 SPNE LS ANT,"$12,277.50",$0.00,"$12,277.50","$5,524.88","$5,158.80",$0.00,"$2,115.35",$0.00,$0.00,"$2,149.69","$12,277.50",$0.00,"$6,138.75","$9,723.78","$9,822.00",$0.00,"$1,921.43",$0.00,"$1,954.58",$0.00
130.232,SUP,HCPCS C1713,,130.232  -  PLATE BN 32MM NS CITADEL LVL 1 SPNE LS ANT,"$12,277.50",$0.00,"$12,277.50","$5,524.88","$5,158.80",$0.00,"$2,115.35",$0.00,$0.00,"$2,149.69","$12,277.50",$0.00,"$6,138.75","$9,723.78","$9,822.00",$0.00,"$1,921.43",$0.00,"$1,954.58",$0.00
130.234,SUP,HCPCS C1713,,130.234  -  PLATE BN 34MM NS CITADEL LVL 1 SPNE LS ANT,"$12,277.50",$0.00,"$12,277.50","$5,524.88","$5,158.80",$0.00,"$2,115.35",$0.00,$0.00,"$2,149.69","$12,277.50",$0.00,"$6,138.75","$9,723.78","$9,822.00",$0.00,"$1,921.43",$0.00,"$1,954.58",$0.00
130.236,SUP,HCPCS C1713,,"130.236  -  CITADEL ANTERIOR LUMBOSACRAL PLATE, 1-LEVEL, 36MM","$12,277.50",$0.00,"$12,277.50","$5,524.88","$5,158.80",$0.00,"$2,115.35",$0.00,$0.00,"$2,149.69","$12,277.50",$0.00,"$6,138.75","$9,723.78","$9,822.00",$0.00,"$1,921.43",$0.00,"$1,954.58",$0.00
130.238,SUP,HCPCS C1713,,130.238  -  PLATE BN 38MM NS CITADEL LVL 1 SPNE LS ANT,"$12,277.50",$0.00,"$12,277.50","$5,524.88","$5,158.80",$0.00,"$2,115.35",$0.00,$0.00,"$2,149.69","$12,277.50",$0.00,"$6,138.75","$9,723.78","$9,822.00",$0.00,"$1,921.43",$0.00,"$1,954.58",$0.00
130.263,SUP,HCPCS C1713,,"130.263  -  CITADEL ANTERIOR LUMBOSACRAL PLATE, 2-LEVEL, 63MM","$13,572.50",$0.00,"$13,572.50","$6,107.63","$5,158.80",$0.00,"$2,338.47",$0.00,$0.00,"$2,376.44","$13,572.50",$0.00,"$6,786.25","$10,749.42","$10,858.00",$0.00,"$2,124.10",$0.00,"$2,160.74",$0.00
130.266,SUP,HCPCS C1713,,"130.266  -  CITADEL ANTERIOR LUMBOSACRAL PLATE, 2-LEVEL, 66MM","$13,572.50",$0.00,"$13,572.50","$6,107.63","$5,158.80",$0.00,"$2,338.47",$0.00,$0.00,"$2,376.44","$13,572.50",$0.00,"$6,786.25","$10,749.42","$10,858.00",$0.00,"$2,124.10",$0.00,"$2,160.74",$0.00
130.269,SUP,HCPCS C1713,,"130.269  -  CITADEL ANTERIOR LUMBOSACRAL PLATE, 2-LEVEL, 69MM","$13,572.50",$0.00,"$13,572.50","$6,107.63","$5,158.80",$0.00,"$2,338.47",$0.00,$0.00,"$2,376.44","$13,572.50",$0.00,"$6,786.25","$10,749.42","$10,858.00",$0.00,"$2,124.10",$0.00,"$2,160.74",$0.00
130.272,SUP,HCPCS C1713,,"130.272  -  CITADEL ANTERIOR LUMBOSACRAL PLATE, 2-LEVEL, 72MM","$13,572.50",$0.00,"$13,572.50","$6,107.63","$5,158.80",$0.00,"$2,338.47",$0.00,$0.00,"$2,376.44","$13,572.50",$0.00,"$6,786.25","$10,749.42","$10,858.00",$0.00,"$2,124.10",$0.00,"$2,160.74",$0.00
130.275,SUP,HCPCS C1713,,"130.275  -  CITADEL ANTERIOR LUMBOSACRAL PLATE, 2-LEVEL, 75MM","$13,572.50",$0.00,"$13,572.50","$6,107.63","$5,158.80",$0.00,"$2,338.47",$0.00,$0.00,"$2,376.44","$13,572.50",$0.00,"$6,786.25","$10,749.42","$10,858.00",$0.00,"$2,124.10",$0.00,"$2,160.74",$0.00
130.278,SUP,HCPCS C1713,,"130.278  -  CITADEL ANTERIOR LUMBOSACRAL PLATE, 2-LEVEL, 78MM","$13,572.50",$0.00,"$13,572.50","$6,107.63","$5,158.80",$0.00,"$2,338.47",$0.00,$0.00,"$2,376.44","$13,572.50",$0.00,"$6,786.25","$10,749.42","$10,858.00",$0.00,"$2,124.10",$0.00,"$2,160.74",$0.00
130.281,SUP,HCPCS C1713,,"130.281  -  CITADEL ANTERIOR LUMBOSACRAL PLATE, 2-LEVEL, 81MM","$13,572.50",$0.00,"$13,572.50","$6,107.63","$5,158.80",$0.00,"$2,338.47",$0.00,$0.00,"$2,376.44","$13,572.50",$0.00,"$6,786.25","$10,749.42","$10,858.00",$0.00,"$2,124.10",$0.00,"$2,160.74",$0.00
130.284,SUP,HCPCS C1713,,"130.284  -  CITADEL ANTERIOR LUMBOSACRAL PLATE, 2-LEVEL, 84MM","$13,572.50",$0.00,"$13,572.50","$6,107.63","$5,158.80",$0.00,"$2,338.47",$0.00,$0.00,"$2,376.44","$13,572.50",$0.00,"$6,786.25","$10,749.42","$10,858.00",$0.00,"$2,124.10",$0.00,"$2,160.74",$0.00
130.287,SUP,HCPCS C1713,,"130.287  -  CITADEL ANTERIOR LUMBOSACRAL PLATE, 2-LEVEL, 87MM","$13,572.50",$0.00,"$13,572.50","$6,107.63","$5,158.80",$0.00,"$2,338.47",$0.00,$0.00,"$2,376.44","$13,572.50",$0.00,"$6,786.25","$10,749.42","$10,858.00",$0.00,"$2,124.10",$0.00,"$2,160.74",$0.00
130.29,SUP,HCPCS C1713,,"130.290  -  CITADEL ANTERIOR LUMBOSACRAL PLATE, 2-LEVEL, 90MM","$13,572.50",$0.00,"$13,572.50","$6,107.63","$5,158.80",$0.00,"$2,338.47",$0.00,$0.00,"$2,376.44","$13,572.50",$0.00,"$6,786.25","$10,749.42","$10,858.00",$0.00,"$2,124.10",$0.00,"$2,160.74",$0.00
130.501,SUP,HCPCS C1713,,"130.501  -  CLAMPING SET SCREW, 2.25MM",$7.50,$0.00,$7.50,$3.38,$5.35,$0.00,$1.29,$0.00,$0.00,$1.31,$7.50,$0.00,$3.75,$5.94,$6.00,$0.00,$1.17,$0.00,$1.19,$0.00
130.542,SUP,HCPCS C1713,,"130.542  -  CITADEL ANTERIOR SYMMETRICAL LUMBROSACRAL PLATE, 2-LEVEL, 42","$13,572.50",$0.00,"$13,572.50","$6,107.63","$5,158.80",$0.00,"$2,338.47",$0.00,$0.00,"$2,376.44","$13,572.50",$0.00,"$6,786.25","$10,749.42","$10,858.00",$0.00,"$2,124.10",$0.00,"$2,160.74",$0.00
130.548,SUP,HCPCS C1713,,"130.548  -  CITADEL ANTERIOR SYMMETRICAL LUMBROSACRAL PLATE, 2-LEVEL, 48","$13,572.50",$0.00,"$13,572.50","$6,107.63","$5,158.80",$0.00,"$2,338.47",$0.00,$0.00,"$2,376.44","$13,572.50",$0.00,"$6,786.25","$10,749.42","$10,858.00",$0.00,"$2,124.10",$0.00,"$2,160.74",$0.00
130.554,SUP,HCPCS C1713,,"130.554  -  CITADEL ANTERIOR SYMMETRICAL LUMBROSACRAL PLATE, 2-LEVEL, 54","$13,572.50",$0.00,"$13,572.50","$6,107.63","$5,158.80",$0.00,"$2,338.47",$0.00,$0.00,"$2,376.44","$13,572.50",$0.00,"$6,786.25","$10,749.42","$10,858.00",$0.00,"$2,124.10",$0.00,"$2,160.74",$0.00
130.56,SUP,HCPCS C1713,,"130.560  -  CITADEL ANTERIOR SYMMETRICAL LUMBROSACRAL PLATE, 2-LEVEL, 60","$13,572.50",$0.00,"$13,572.50","$6,107.63","$5,158.80",$0.00,"$2,338.47",$0.00,$0.00,"$2,376.44","$13,572.50",$0.00,"$6,786.25","$10,749.42","$10,858.00",$0.00,"$2,124.10",$0.00,"$2,160.74",$0.00
130.566,SUP,HCPCS C1713,,"130.566  -  CITADEL ANTERIOR SYMMETRICAL LUMBROSACRAL PLATE, 2-LEVEL, 66","$13,572.50",$0.00,"$13,572.50","$6,107.63","$5,158.80",$0.00,"$2,338.47",$0.00,$0.00,"$2,376.44","$13,572.50",$0.00,"$6,786.25","$10,749.42","$10,858.00",$0.00,"$2,124.10",$0.00,"$2,160.74",$0.00
130.572,SUP,HCPCS C1713,,"130.572  -  CITADEL ANTERIOR SYMMETRICAL LUMBROSACRAL PLATE, 2-LEVEL, 72","$13,572.50",$0.00,"$13,572.50","$6,107.63","$5,158.80",$0.00,"$2,338.47",$0.00,$0.00,"$2,376.44","$13,572.50",$0.00,"$6,786.25","$10,749.42","$10,858.00",$0.00,"$2,124.10",$0.00,"$2,160.74",$0.00
130.578,SUP,HCPCS C1713,,"130.578  -  CITADEL ANTERIOR SYMMETRICAL LUMBROSACRAL PLATE, 2-LEVEL, 78","$13,572.50",$0.00,"$13,572.50","$6,107.63","$5,158.80",$0.00,"$2,338.47",$0.00,$0.00,"$2,376.44","$13,572.50",$0.00,"$6,786.25","$10,749.42","$10,858.00",$0.00,"$2,124.10",$0.00,"$2,160.74",$0.00
130.584,SUP,HCPCS C1713,,"130.584  -  CITADEL ANTERIOR SYMMETRICAL LUMBROSACRAL PLATE, 2-LEVEL, 84","$13,572.50",$0.00,"$13,572.50","$6,107.63","$5,158.80",$0.00,"$2,338.47",$0.00,$0.00,"$2,376.44","$13,572.50",$0.00,"$6,786.25","$10,749.42","$10,858.00",$0.00,"$2,124.10",$0.00,"$2,160.74",$0.00
130.622,SUP,HCPCS C1713,,"130.622  -  6.5MM SELF-TAPPING SCREW, VARIABLE ANGLE, 22MM","$1,940.00",$0.00,"$1,940.00",$873.00,"$1,384.58",$0.00,$334.25,$0.00,$0.00,$339.68,"$1,940.00",$0.00,$970.00,"$1,536.48","$1,552.00",$0.00,$303.61,$0.00,$308.85,$0.00
130.624,SUP,HCPCS C1713,,"130.624  -  6.5MM SELF-TAPPING SCREW, VARIABLE ANGLE, 24MM","$1,940.00",$0.00,"$1,940.00",$873.00,"$1,384.58",$0.00,$334.25,$0.00,$0.00,$339.68,"$1,940.00",$0.00,$970.00,"$1,536.48","$1,552.00",$0.00,$303.61,$0.00,$308.85,$0.00
130.626,SUP,HCPCS C1713,,"130.626  -  6.5MM SELF-TAPPING SCREW, VARIABLE ANGLE, 26MM","$1,940.00",$0.00,"$1,940.00",$873.00,"$1,384.58",$0.00,$334.25,$0.00,$0.00,$339.68,"$1,940.00",$0.00,$970.00,"$1,536.48","$1,552.00",$0.00,$303.61,$0.00,$308.85,$0.00
130.628,SUP,HCPCS C1713,,"130.628  -  6.5MM SELF-TAPPING SCREW, VARIABLE ANGLE, 28MM","$1,940.00",$0.00,"$1,940.00",$873.00,"$1,384.58",$0.00,$334.25,$0.00,$0.00,$339.68,"$1,940.00",$0.00,$970.00,"$1,536.48","$1,552.00",$0.00,$303.61,$0.00,$308.85,$0.00
130.63,SUP,HCPCS C1713,,"130.630  -  6.5MM SELF-TAPPING SCREW, VARIABLE ANGLE, 30MM","$1,940.00",$0.00,"$1,940.00",$873.00,"$1,384.58",$0.00,$334.25,$0.00,$0.00,$339.68,"$1,940.00",$0.00,$970.00,"$1,536.48","$1,552.00",$0.00,$303.61,$0.00,$308.85,$0.00
130.633,SUP,HCPCS C1713,,"130.633  -  6.5MM SELF-TAPPING SCREW, VARIABLE ANGLE, 33MM","$1,940.00",$0.00,"$1,940.00",$873.00,"$1,384.58",$0.00,$334.25,$0.00,$0.00,$339.68,"$1,940.00",$0.00,$970.00,"$1,536.48","$1,552.00",$0.00,$303.61,$0.00,$308.85,$0.00
130.636,SUP,HCPCS C1713,,"130.636  -  6.5MM SELF-TAPPING SCREW, VARIABLE ANGLE, 36MM","$1,940.00",$0.00,"$1,940.00",$873.00,"$1,384.58",$0.00,$334.25,$0.00,$0.00,$339.68,"$1,940.00",$0.00,$970.00,"$1,536.48","$1,552.00",$0.00,$303.61,$0.00,$308.85,$0.00
130.639,SUP,HCPCS C1713,,"130.639  -  6.5MM SELF-TAPPING SCREW, VARIABLE ANGLE, 39MM","$1,940.00",$0.00,"$1,940.00",$873.00,"$1,384.58",$0.00,$334.25,$0.00,$0.00,$339.68,"$1,940.00",$0.00,$970.00,"$1,536.48","$1,552.00",$0.00,$303.61,$0.00,$308.85,$0.00
130.642,SUP,HCPCS C1713,,"130.642  -  6.5MM SELF-TAPPING SCREW, VARIABLE ANGLE, 42MM","$1,940.00",$0.00,"$1,940.00",$873.00,"$1,384.58",$0.00,$334.25,$0.00,$0.00,$339.68,"$1,940.00",$0.00,$970.00,"$1,536.48","$1,552.00",$0.00,$303.61,$0.00,$308.85,$0.00
130.645,SUP,HCPCS C1713,,"130.645  -  6.5MM SELF-TAPPING SCREW, VARIABLE ANGLE, 45MM","$1,940.00",$0.00,"$1,940.00",$873.00,"$1,384.58",$0.00,$334.25,$0.00,$0.00,$339.68,"$1,940.00",$0.00,$970.00,"$1,536.48","$1,552.00",$0.00,$303.61,$0.00,$308.85,$0.00
130.648,SUP,HCPCS C1713,,"130.648  -  6.5MM SELF-TAPPING SCREW, VARIABLE ANGLE, 48MM","$1,940.00",$0.00,"$1,940.00",$873.00,"$1,384.58",$0.00,$334.25,$0.00,$0.00,$339.68,"$1,940.00",$0.00,$970.00,"$1,536.48","$1,552.00",$0.00,$303.61,$0.00,$308.85,$0.00
130.651,SUP,HCPCS C1713,,"130.651  -  6.5MM SELF-TAPPING SCREW, VARIABLE ANGLE, 51MM","$1,940.00",$0.00,"$1,940.00",$873.00,"$1,384.58",$0.00,$334.25,$0.00,$0.00,$339.68,"$1,940.00",$0.00,$970.00,"$1,536.48","$1,552.00",$0.00,$303.61,$0.00,$308.85,$0.00
130.654,SUP,HCPCS C1713,,"130.654  -  6.5MM SELF-TAPPING SCREW, VARIABLE ANGLE, 54MM","$1,940.00",$0.00,"$1,940.00",$873.00,"$1,384.58",$0.00,$334.25,$0.00,$0.00,$339.68,"$1,940.00",$0.00,$970.00,"$1,536.48","$1,552.00",$0.00,$303.61,$0.00,$308.85,$0.00
130.657,SUP,HCPCS C1713,,"130.657  -  6.5MM SELF-TAPPING SCREW, VARIABLE ANGLE, 57MM","$1,940.00",$0.00,"$1,940.00",$873.00,"$1,384.58",$0.00,$334.25,$0.00,$0.00,$339.68,"$1,940.00",$0.00,$970.00,"$1,536.48","$1,552.00",$0.00,$303.61,$0.00,$308.85,$0.00
130.822,SUP,HCPCS C1713,,"130.822  -  6.5MM SELF-TAPPING  SCREW, FIXED ANGLE, 22MM","$1,940.00",$0.00,"$1,940.00",$873.00,"$1,384.58",$0.00,$334.25,$0.00,$0.00,$339.68,"$1,940.00",$0.00,$970.00,"$1,536.48","$1,552.00",$0.00,$303.61,$0.00,$308.85,$0.00
130.824,SUP,HCPCS C1713,,"130.824  -  6.5MM SELF-TAPPING  SCREW, FIXED ANGLE, 24MM","$1,940.00",$0.00,"$1,940.00",$873.00,"$1,384.58",$0.00,$334.25,$0.00,$0.00,$339.68,"$1,940.00",$0.00,$970.00,"$1,536.48","$1,552.00",$0.00,$303.61,$0.00,$308.85,$0.00
130.826,SUP,HCPCS C1713,,"130.826  -  6.5MM SELF-TAPPING  SCREW, FIXED ANGLE, 26MM","$1,940.00",$0.00,"$1,940.00",$873.00,"$1,384.58",$0.00,$334.25,$0.00,$0.00,$339.68,"$1,940.00",$0.00,$970.00,"$1,536.48","$1,552.00",$0.00,$303.61,$0.00,$308.85,$0.00
130.828,SUP,HCPCS C1713,,"130.828  -  6.5MM SELF-TAPPING  SCREW, FIXED ANGLE, 28MM","$1,940.00",$0.00,"$1,940.00",$873.00,"$1,384.58",$0.00,$334.25,$0.00,$0.00,$339.68,"$1,940.00",$0.00,$970.00,"$1,536.48","$1,552.00",$0.00,$303.61,$0.00,$308.85,$0.00
130.83,SUP,HCPCS C1713,,"130.830  -  6.5MM SELF-TAPPING  SCREW, FIXED ANGLE, 30MM","$1,940.00",$0.00,"$1,940.00",$873.00,"$1,384.58",$0.00,$334.25,$0.00,$0.00,$339.68,"$1,940.00",$0.00,$970.00,"$1,536.48","$1,552.00",$0.00,$303.61,$0.00,$308.85,$0.00
130.833,SUP,HCPCS C1713,,"130.833  -  6.5MM SELF-TAPPING SCREW, FIXED ANGLE, 33MM","$1,940.00",$0.00,"$1,940.00",$873.00,"$1,384.58",$0.00,$334.25,$0.00,$0.00,$339.68,"$1,940.00",$0.00,$970.00,"$1,536.48","$1,552.00",$0.00,$303.61,$0.00,$308.85,$0.00
130.836,SUP,HCPCS C1713,,"130.836  -  6.5MM SELF-TAPPING SCREW, FIXED ANGLE, 36MM","$1,940.00",$0.00,"$1,940.00",$873.00,"$1,384.58",$0.00,$334.25,$0.00,$0.00,$339.68,"$1,940.00",$0.00,$970.00,"$1,536.48","$1,552.00",$0.00,$303.61,$0.00,$308.85,$0.00
130.839,SUP,HCPCS C1713,,"130.839  -  6.5MM SELF-TAPPING SCREW, FIXED ANGLE, 39MM","$1,940.00",$0.00,"$1,940.00",$873.00,"$1,384.58",$0.00,$334.25,$0.00,$0.00,$339.68,"$1,940.00",$0.00,$970.00,"$1,536.48","$1,552.00",$0.00,$303.61,$0.00,$308.85,$0.00
130.842,SUP,HCPCS C1713,,"130.842  -  6.5MM SELF-TAPPING SCREW, FIXED ANGLE, 42MM","$1,940.00",$0.00,"$1,940.00",$873.00,"$1,384.58",$0.00,$334.25,$0.00,$0.00,$339.68,"$1,940.00",$0.00,$970.00,"$1,536.48","$1,552.00",$0.00,$303.61,$0.00,$308.85,$0.00
130.845,SUP,HCPCS C1713,,"130.845  -  6.5MM SELF-TAPPING SCREW, FIXED ANGLE, 45MM","$1,940.00",$0.00,"$1,940.00",$873.00,"$1,384.58",$0.00,$334.25,$0.00,$0.00,$339.68,"$1,940.00",$0.00,$970.00,"$1,536.48","$1,552.00",$0.00,$303.61,$0.00,$308.85,$0.00
130.848,SUP,HCPCS C1713,,"130.848  -  6.5MM SELF-TAPPING SCREW, FIXED ANGLE, 48MM","$1,940.00",$0.00,"$1,940.00",$873.00,"$1,384.58",$0.00,$334.25,$0.00,$0.00,$339.68,"$1,940.00",$0.00,$970.00,"$1,536.48","$1,552.00",$0.00,$303.61,$0.00,$308.85,$0.00
130.851,SUP,HCPCS C1713,,"130.851  -  6.5MM SELF-TAPPING SCREW, FIXED ANGLE, 51MM","$1,940.00",$0.00,"$1,940.00",$873.00,"$1,384.58",$0.00,$334.25,$0.00,$0.00,$339.68,"$1,940.00",$0.00,$970.00,"$1,536.48","$1,552.00",$0.00,$303.61,$0.00,$308.85,$0.00
130.854,SUP,HCPCS C1713,,"130.854  -  6.5MM SELF-TAPPING SCREW, FIXED ANGLE, 54MM","$1,940.00",$0.00,"$1,940.00",$873.00,"$1,384.58",$0.00,$334.25,$0.00,$0.00,$339.68,"$1,940.00",$0.00,$970.00,"$1,536.48","$1,552.00",$0.00,$303.61,$0.00,$308.85,$0.00
130.857,SUP,HCPCS C1713,,"130.857  -  6.5MM SELF-TAPPING SCREW, FIXED ANGLE, 57MM","$1,940.00",$0.00,"$1,940.00",$873.00,"$1,384.58",$0.00,$334.25,$0.00,$0.00,$339.68,"$1,940.00",$0.00,$970.00,"$1,536.48","$1,552.00",$0.00,$303.61,$0.00,$308.85,$0.00
131.001,SUP,Custom 27203010,,"131.001  -  DUAL STAPLE, SMALL, ROSTRAL","$2,712.50",$0.00,"$2,712.50",$0.00,"$1,935.91",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,712.50",$0.00,"$1,356.25","$2,148.30","$2,170.00",$0.00,$0.00,$0.00,$0.00,$0.00
131.002,SUP,Custom 27203010,,"131.002  -  DUAL STAPLE, SMALL, CAUDAL","$2,712.50",$0.00,"$2,712.50",$0.00,"$1,935.91",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,712.50",$0.00,"$1,356.25","$2,148.30","$2,170.00",$0.00,$0.00,$0.00,$0.00,$0.00
131.003,SUP,Custom 27203010,,"131.003  -  DUAL STAPLE, MEDIUM, ROSTRAL","$2,712.50",$0.00,"$2,712.50",$0.00,"$1,935.91",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,712.50",$0.00,"$1,356.25","$2,148.30","$2,170.00",$0.00,$0.00,$0.00,$0.00,$0.00
131.004,SUP,Custom 27203010,,"131.004  -  DUAL STAPLE, MEDIUM, CAUDAL","$2,712.50",$0.00,"$2,712.50",$0.00,"$1,935.91",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,712.50",$0.00,"$1,356.25","$2,148.30","$2,170.00",$0.00,$0.00,$0.00,$0.00,$0.00
131.005,SUP,Custom 27203010,,"131.005  -  DUAL STAPLE, LARGE, ROSTRAL","$2,712.50",$0.00,"$2,712.50",$0.00,"$1,935.91",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,712.50",$0.00,"$1,356.25","$2,148.30","$2,170.00",$0.00,$0.00,$0.00,$0.00,$0.00
131.006,SUP,Custom 27203010,,"131.006  -  DUAL STAPLE, LARGE, CAUDAL","$2,712.50",$0.00,"$2,712.50",$0.00,"$1,935.91",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,712.50",$0.00,"$1,356.25","$2,148.30","$2,170.00",$0.00,$0.00,$0.00,$0.00,$0.00
131.007,SUP,Custom 27203010,,"131.007  -  DUAL STAPLE, X-LARGE, ROSTRAL","$2,712.50",$0.00,"$2,712.50",$0.00,"$1,935.91",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,712.50",$0.00,"$1,356.25","$2,148.30","$2,170.00",$0.00,$0.00,$0.00,$0.00,$0.00
131.008,SUP,Custom 27203010,,"131.008  -  DUAL STAPLE, X-LARGE, CAUDAL","$2,712.50",$0.00,"$2,712.50",$0.00,"$1,935.91",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,712.50",$0.00,"$1,356.25","$2,148.30","$2,170.00",$0.00,$0.00,$0.00,$0.00,$0.00
131.011,SUP,Custom 27203010,,"131.011  -  SINGLE STAPLE, SMALL","$1,945.00",$0.00,"$1,945.00",$0.00,"$1,388.15",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,945.00",$0.00,$972.50,"$1,540.44","$1,556.00",$0.00,$0.00,$0.00,$0.00,$0.00
131.012,SUP,Custom 27203010,,"131.012  -  SINGLE STAPLE, MEDIUM","$1,945.00",$0.00,"$1,945.00",$0.00,"$1,388.15",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,945.00",$0.00,$972.50,"$1,540.44","$1,556.00",$0.00,$0.00,$0.00,$0.00,$0.00
131.013,SUP,Custom 27203010,,131.013  -  STAPLE BONE LG SGL,"$1,945.00",$0.00,"$1,945.00",$0.00,"$1,388.15",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,945.00",$0.00,$972.50,"$1,540.44","$1,556.00",$0.00,$0.00,$0.00,$0.00,$0.00
131.113,SUP,Custom 27803010,,"131.113  -  CROSS CONNECTOR, 13MM","$2,000.00",$0.00,"$2,000.00",$0.00,"$1,427.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
131.114,SUP,Custom 27803010,,"131.114  -  CROSS CONNECTOR, 14MM","$2,000.00",$0.00,"$2,000.00",$0.00,"$1,427.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
131.115,SUP,Custom 27803010,,"131.115  -  CROSS CONNECTOR, 15MM","$2,000.00",$0.00,"$2,000.00",$0.00,"$1,427.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
131.116,SUP,Custom 27803010,,"131.116  -  CROSS CONNECTOR, 16MM","$2,000.00",$0.00,"$2,000.00",$0.00,"$1,427.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
131.117,SUP,Custom 27803010,,"131.117  -  CROSS CONNECTOR, 17MM","$2,000.00",$0.00,"$2,000.00",$0.00,"$1,427.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
131.118,SUP,Custom 27803010,,"131.118  -  CROSS CONNECTOR, 18MM","$2,000.00",$0.00,"$2,000.00",$0.00,"$1,427.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
131.119,SUP,Custom 27803010,,"131.119  -  CROSS CONNECTOR, 19MM","$2,000.00",$0.00,"$2,000.00",$0.00,"$1,427.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
131.12,SUP,Custom 27803010,,"131.120  -  CROSS CONNECTOR, 20MM","$2,000.00",$0.00,"$2,000.00",$0.00,"$1,427.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
131.121,SUP,Custom 27803010,,"131.121  -  CROSS CONNECTOR, 21MM","$2,545.00",$0.00,"$2,545.00",$0.00,"$1,816.37",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,545.00",$0.00,"$1,272.50","$2,015.64","$2,036.00",$0.00,$0.00,$0.00,$0.00,$0.00
131.122,SUP,Custom 27803010,,"131.122  -  CROSS CONNECTOR, 22MM","$2,545.00",$0.00,"$2,545.00",$0.00,"$1,816.37",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,545.00",$0.00,"$1,272.50","$2,015.64","$2,036.00",$0.00,$0.00,$0.00,$0.00,$0.00
131.123,SUP,Custom 27803010,,"131.123  -  CROSS CONNECTOR, 23MM","$2,545.00",$0.00,"$2,545.00",$0.00,"$1,816.37",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,545.00",$0.00,"$1,272.50","$2,015.64","$2,036.00",$0.00,$0.00,$0.00,$0.00,$0.00
131.124,SUP,Custom 27803010,,"131.124  -  CROSS CONNECTOR, 24MM","$2,545.00",$0.00,"$2,545.00",$0.00,"$1,816.37",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,545.00",$0.00,"$1,272.50","$2,015.64","$2,036.00",$0.00,$0.00,$0.00,$0.00,$0.00
131.125,SUP,Custom 27803010,,"131.125  -  CROSS CONNECTOR, 25MM","$2,545.00",$0.00,"$2,545.00",$0.00,"$1,816.37",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,545.00",$0.00,"$1,272.50","$2,015.64","$2,036.00",$0.00,$0.00,$0.00,$0.00,$0.00
131.126,SUP,Custom 27803010,,"131.126  -  CROSS CONNECTOR, 26MM","$2,545.00",$0.00,"$2,545.00",$0.00,"$1,816.37",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,545.00",$0.00,"$1,272.50","$2,015.64","$2,036.00",$0.00,$0.00,$0.00,$0.00,$0.00
131.127,SUP,Custom 27803010,,"131.127  -  CROSS CONNECTOR, 27MM","$2,545.00",$0.00,"$2,545.00",$0.00,"$1,816.37",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,545.00",$0.00,"$1,272.50","$2,015.64","$2,036.00",$0.00,$0.00,$0.00,$0.00,$0.00
131.128,SUP,Custom 27803010,,"131.128  -  CROSS CONNECTOR, 28MM","$2,545.00",$0.00,"$2,545.00",$0.00,"$1,816.37",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,545.00",$0.00,"$1,272.50","$2,015.64","$2,036.00",$0.00,$0.00,$0.00,$0.00,$0.00
131.201,SUP,HCPCS C1713,,"131.201  -  STAPLE WASHER, SMALL",$722.50,$0.00,$722.50,$325.13,$515.65,$0.00,$124.48,$0.00,$0.00,$126.50,$722.50,$0.00,$361.25,$572.22,$578.00,$0.00,$113.07,$0.00,$115.02,$0.00
131.202,SUP,HCPCS C1713,,"131.202  -  STAPLE WASHER, MEDIUM",$797.50,$0.00,$797.50,$358.88,$569.18,$0.00,$137.41,$0.00,$0.00,$139.64,$797.50,$0.00,$398.75,$631.62,$638.00,$0.00,$124.81,$0.00,$126.96,$0.00
131.203,SUP,HCPCS C1713,,"131.203  -  STAPLE WASHER, LARGE",$840.00,$0.00,$840.00,$378.00,$599.51,$0.00,$144.73,$0.00,$0.00,$147.08,$840.00,$0.00,$420.00,$665.28,$672.00,$0.00,$131.46,$0.00,$133.73,$0.00
131.351,SUP,HCPCS C1713,,"131.351  -  5.5MM BONE SCREW, ANTERIOR PLATE, 25MM","$1,910.00",$0.00,"$1,910.00",$859.50,"$1,363.17",$0.00,$329.08,$0.00,$0.00,$334.43,"$1,910.00",$0.00,$955.00,"$1,512.72","$1,528.00",$0.00,$298.92,$0.00,$304.07,$0.00
131.352,SUP,HCPCS C1713,,"131.352  -  5.5MM BONE SCREW, ANTERIOR PLATE, 30MM","$1,910.00",$0.00,"$1,910.00",$859.50,"$1,363.17",$0.00,$329.08,$0.00,$0.00,$334.43,"$1,910.00",$0.00,$955.00,"$1,512.72","$1,528.00",$0.00,$298.92,$0.00,$304.07,$0.00
131.353,SUP,HCPCS C1713,,"131.353  -  5.5MM BONE SCREW, ANTERIOR PLATE, 35MM","$1,910.00",$0.00,"$1,910.00",$859.50,"$1,363.17",$0.00,$329.08,$0.00,$0.00,$334.43,"$1,910.00",$0.00,$955.00,"$1,512.72","$1,528.00",$0.00,$298.92,$0.00,$304.07,$0.00
131.354,SUP,HCPCS C1713,,"131.354  -  5.5MM BONE SCREW, ANTERIOR PLATE, 40MM","$1,910.00",$0.00,"$1,910.00",$859.50,"$1,363.17",$0.00,$329.08,$0.00,$0.00,$334.43,"$1,910.00",$0.00,$955.00,"$1,512.72","$1,528.00",$0.00,$298.92,$0.00,$304.07,$0.00
131.355,SUP,HCPCS C1713,,"131.355  -  5.5MM BONE SCREW, ANTERIOR PLATE, 45MM","$1,910.00",$0.00,"$1,910.00",$859.50,"$1,363.17",$0.00,$329.08,$0.00,$0.00,$334.43,"$1,910.00",$0.00,$955.00,"$1,512.72","$1,528.00",$0.00,$298.92,$0.00,$304.07,$0.00
131.356,SUP,HCPCS C1713,,"131.356  -  5.5MM BONE SCREW, ANTERIOR PLATE, 50MM","$1,910.00",$0.00,"$1,910.00",$859.50,"$1,363.17",$0.00,$329.08,$0.00,$0.00,$334.43,"$1,910.00",$0.00,$955.00,"$1,512.72","$1,528.00",$0.00,$298.92,$0.00,$304.07,$0.00
131.361,SUP,HCPCS C1713,,"131.361  -  6.5MM BONE SCREW, ANTERIOR PLATE, 25MM","$1,910.00",$0.00,"$1,910.00",$859.50,"$1,363.17",$0.00,$329.08,$0.00,$0.00,$334.43,"$1,910.00",$0.00,$955.00,"$1,512.72","$1,528.00",$0.00,$298.92,$0.00,$304.07,$0.00
131.362,SUP,HCPCS C1713,,"131.362  -  6.5MM BONE SCREW, ANTERIOR PLATE, 30MM","$1,910.00",$0.00,"$1,910.00",$859.50,"$1,363.17",$0.00,$329.08,$0.00,$0.00,$334.43,"$1,910.00",$0.00,$955.00,"$1,512.72","$1,528.00",$0.00,$298.92,$0.00,$304.07,$0.00
131.363,SUP,HCPCS C1713,,"131.363  -  6.5MM BONE SCREW, ANTERIOR PLATE, 35MM","$1,910.00",$0.00,"$1,910.00",$859.50,"$1,363.17",$0.00,$329.08,$0.00,$0.00,$334.43,"$1,910.00",$0.00,$955.00,"$1,512.72","$1,528.00",$0.00,$298.92,$0.00,$304.07,$0.00
131.364,SUP,HCPCS C1713,,"131.364  -  6.5MM BONE SCREW, ANTERIOR PLATE, 40MM","$1,910.00",$0.00,"$1,910.00",$859.50,"$1,363.17",$0.00,$329.08,$0.00,$0.00,$334.43,"$1,910.00",$0.00,$955.00,"$1,512.72","$1,528.00",$0.00,$298.92,$0.00,$304.07,$0.00
131.365,SUP,HCPCS C1713,,"131.365  -  6.5MM BONE SCREW, ANTERIOR PLATE, 45MM","$1,910.00",$0.00,"$1,910.00",$859.50,"$1,363.17",$0.00,$329.08,$0.00,$0.00,$334.43,"$1,910.00",$0.00,$955.00,"$1,512.72","$1,528.00",$0.00,$298.92,$0.00,$304.07,$0.00
131.366,SUP,HCPCS C1713,,"131.366  -  6.5MM BONE SCREW, ANTERIOR PLATE, 50MM","$1,910.00",$0.00,"$1,910.00",$859.50,"$1,363.17",$0.00,$329.08,$0.00,$0.00,$334.43,"$1,910.00",$0.00,$955.00,"$1,512.72","$1,528.00",$0.00,$298.92,$0.00,$304.07,$0.00
132.14,SUP,Custom 27803010,,"132.140  -  5.5MM CURVED ROD, CONE TIP, 40MM",$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
132.145,SUP,Custom 27803010,,"132.145  -  5.5MM CURVED ROD, CONE TIP, 45MM",$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
132.15,SUP,Custom 27803010,,"132.150  -  5.5MM CURVED ROD, CONE TIP, 50MM",$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
132.155,SUP,Custom 27803010,,"132.155  -  5.5MM CURVED ROD, CONE TIP, 55MM",$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
132.16,SUP,Custom 27803010,,"132.160  -  5.5MM CURVED ROD, CONE TIP, 60MM",$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
132.165,SUP,Custom 27803010,,"132.165  -  5.5MM CURVED ROD, CONE TIP, 65MM",$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
132.17,SUP,Custom 27803010,,"132.170  -  5.5MM CURVED ROD, CONE TIP, 70MM",$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
132.175,SUP,Custom 27803010,,"132.175  -  5.5MM CURVED ROD, CONE TIP, 75MM",$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
132.18,SUP,Custom 27803010,,"132.180  -  5.5MM CURVED ROD, CONE TIP, 80MM",$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
132.185,SUP,Custom 27803010,,"132.185  -  5.5MM CURVED ROD, CONE TIP, 85MM",$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
136.404,SUP,HCPCS C1713,,"136.404  -  RELIEVE 2.2MM SCREW, SELF-DRILLING, 4MM",$362.50,$0.00,$362.50,$163.13,$258.72,$0.00,$62.46,$0.00,$0.00,$63.47,$362.50,$0.00,$181.25,$287.10,$290.00,$0.00,$56.73,$0.00,$57.71,$0.00
136.406,SUP,HCPCS C1713,,"136.406  -  RELIEVE 2.2MM SCREW, SELF-DRILLING, 6MM",$362.50,$0.00,$362.50,$163.13,$258.72,$0.00,$62.46,$0.00,$0.00,$63.47,$362.50,$0.00,$181.25,$287.10,$290.00,$0.00,$56.73,$0.00,$57.71,$0.00
136.408,SUP,HCPCS C1713,,"136.408  -  RELIEVE 2.2MM SCREW, SELF-DRILLING, 8MM",$362.50,$0.00,$362.50,$163.13,$258.72,$0.00,$62.46,$0.00,$0.00,$63.47,$362.50,$0.00,$181.25,$287.10,$290.00,$0.00,$56.73,$0.00,$57.71,$0.00
136.41,SUP,HCPCS C1713,,"136.410  -  RELIEVE 2.2MM SCREW, SELF-DRILLING, 10MM",$362.50,$0.00,$362.50,$163.13,$258.72,$0.00,$62.46,$0.00,$0.00,$63.47,$362.50,$0.00,$181.25,$287.10,$290.00,$0.00,$56.73,$0.00,$57.71,$0.00
136.412,SUP,HCPCS C1713,,"136.412  -  RELIEVE 2.2MM SCREW, SELF-DRILLING, 12MM",$362.50,$0.00,$362.50,$163.13,$258.72,$0.00,$62.46,$0.00,$0.00,$63.47,$362.50,$0.00,$181.25,$287.10,$290.00,$0.00,$56.73,$0.00,$57.71,$0.00
136.504,SUP,HCPCS C1713,,"136.504  -  RELIEVE 2.2MM SCREW, SELF-TAPPING, 4MM",$362.50,$0.00,$362.50,$163.13,$258.72,$0.00,$62.46,$0.00,$0.00,$63.47,$362.50,$0.00,$181.25,$287.10,$290.00,$0.00,$56.73,$0.00,$57.71,$0.00
136.506,SUP,HCPCS C1713,,"136.506  -  RELIEVE 2.2MM SCREW, SELF-TAPPING, 6MM",$362.50,$0.00,$362.50,$163.13,$258.72,$0.00,$62.46,$0.00,$0.00,$63.47,$362.50,$0.00,$181.25,$287.10,$290.00,$0.00,$56.73,$0.00,$57.71,$0.00
136.508,SUP,HCPCS C1713,,"136.508  -  RELIEVE 2.2MM SCREW, SELF-TAPPING, 8MM",$362.50,$0.00,$362.50,$163.13,$258.72,$0.00,$62.46,$0.00,$0.00,$63.47,$362.50,$0.00,$181.25,$287.10,$290.00,$0.00,$56.73,$0.00,$57.71,$0.00
136.51,SUP,HCPCS C1713,,"136.510  -  RELIEVE 2.2MM SCREW, SELF-TAPPING, 10MM",$362.50,$0.00,$362.50,$163.13,$258.72,$0.00,$62.46,$0.00,$0.00,$63.47,$362.50,$0.00,$181.25,$287.10,$290.00,$0.00,$56.73,$0.00,$57.71,$0.00
136.512,SUP,HCPCS C1713,,"136.512  -  RELIEVE 2.2MM SCREW, SELF-TAPPING, 12MM",$362.50,$0.00,$362.50,$163.13,$258.72,$0.00,$62.46,$0.00,$0.00,$63.47,$362.50,$0.00,$181.25,$287.10,$290.00,$0.00,$56.73,$0.00,$57.71,$0.00
136.704,SUP,HCPCS C1713,,"136.704  -  RELIEVE 2.6MM SCREW, SELF-TAPPING, 4MM",$527.50,$0.00,$527.50,$237.38,$376.48,$0.00,$90.89,$0.00,$0.00,$92.36,$527.50,$0.00,$263.75,$417.78,$422.00,$0.00,$82.55,$0.00,$83.98,$0.00
136.706,SUP,HCPCS C1713,,"136.706  -  RELIEVE 2.6MM SCREW, SELF-TAPPING, 6MM",$527.50,$0.00,$527.50,$237.38,$376.48,$0.00,$90.89,$0.00,$0.00,$92.36,$527.50,$0.00,$263.75,$417.78,$422.00,$0.00,$82.55,$0.00,$83.98,$0.00
136.708,SUP,HCPCS C1713,,"136.708  -  RELIEVE 2.6MM SCREW, SELF-TAPPING, 8MM",$527.50,$0.00,$527.50,$237.38,$376.48,$0.00,$90.89,$0.00,$0.00,$92.36,$527.50,$0.00,$263.75,$417.78,$422.00,$0.00,$82.55,$0.00,$83.98,$0.00
136.71,SUP,HCPCS C1713,,"136.710  -  RELIEVE 2.6MM SCREW, SELF-TAPPING, 10MM",$527.50,$0.00,$527.50,$237.38,$376.48,$0.00,$90.89,$0.00,$0.00,$92.36,$527.50,$0.00,$263.75,$417.78,$422.00,$0.00,$82.55,$0.00,$83.98,$0.00
136.712,SUP,HCPCS C1713,,"136.712  -  RELIEVE 2.6MM SCREW, SELF-TAPPING, 12MM",$527.50,$0.00,$527.50,$237.38,$376.48,$0.00,$90.89,$0.00,$0.00,$92.36,$527.50,$0.00,$263.75,$417.78,$422.00,$0.00,$82.55,$0.00,$83.98,$0.00
141,SUP,Custom 27203010,,KIT OSOM STRP GRP A DPSTK CLIA WVD MCBLTST 50 TST,$174.90,$0.00,$174.90,$0.00,$124.83,$0.00,$0.00,$0.00,$0.00,$0.00,$174.90,$0.00,$87.45,$138.52,$139.92,$0.00,$0.00,$0.00,$0.00,$0.00
142,SUP,HCPCS A4624,,142  -  CATHETER SCT 16FR 12FR STRL LF HALYARD DRCT O2 PORT ATRM TIP,$110.64,$0.00,$110.64,$0.00,$78.96,$0.00,$0.00,$0.00,$0.00,$0.00,$110.64,$0.00,$55.32,$87.63,$88.51,$0.00,$0.00,$0.00,$0.00,$0.00
145,SUP,Custom 27203010,,CONTROL CARD MRKR LQCHK 3LVL 3ML IMMUN,$325.00,$0.00,$325.00,$0.00,$231.95,$0.00,$0.00,$0.00,$0.00,$0.00,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$0.00,$0.00,$0.00,$0.00
150.01,SUP,HCPCS C1713,,"150.010  -  PROVIDENCE 4.2MM FIXED ANGLE SCREW, SELF-DRILLING, 10MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.011,SUP,HCPCS C1713,,"150.011  -  PROVIDENCE 4.2MM FIXED ANGLE SCREW, SELF-DRILLING, 11MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.012,SUP,HCPCS C1713,,"150.012  -  PROVIDENCE 4.2MM FIXED ANGLE SCREW, SELF-DRILLING, 12MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.013,SUP,HCPCS C1713,,"150.013  -  PROVIDENCE 4.2MM FIXED ANGLE SCREW, SELF-DRILLING, 13MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.014,SUP,HCPCS C1713,,150.014  -  SCREW BONE 4.2MM 14MM PRTX CTTI OCT SPN SLFDRILL FIXANG,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.015,SUP,HCPCS C1713,,"150.015  -  PROVIDENCE 4.2MM FIXED ANGLE SCREW, SELF-DRILLING, 15MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.016,SUP,HCPCS C1713,,150.016  -  SCREW BN 4.2MM 16MM NS PRTX CTTI SLF DRL FX ANG SPNE OCT PRV,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.03,SUP,HCPCS C1713,,"150.030  -  PROVIDENCE 4.2MM FIXED ANGLE SCREW, SELF-TAPPING 10MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.031,SUP,HCPCS C1713,,"150.031  -  PROVIDENCE 4.2MM FIXED ANGLE SCREW, SELF-TAPPING 11MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.032,SUP,HCPCS C1713,,"150.032  -  PROVIDENCE 4.2MM FIXED ANGLE SCREW, SELF-TAPPING 12MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.033,SUP,HCPCS C1713,,"150.033  -  PROVIDENCE 4.2MM FIXED ANGLE SCREW, SELF-TAPPING 13MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.034,SUP,HCPCS C1713,,"150.034  -  PROVIDENCE 4.2MM FIXED ANGLE SCREW, SELF-TAPPING 14MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.035,SUP,HCPCS C1713,,"150.035  -  PROVIDENCE 4.2MM FIXED ANGLE SCREW, SELF-TAPPING 15MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.036,SUP,HCPCS C1713,,"150.036  -  PROVIDENCE 4.2MM FIXED ANGLE SCREW, SELF-TAPPING 16MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.038,SUP,HCPCS C1713,,"150.038  -  PROVIDENCE 4.2MM FIXED ANGLE SCREW, SELF-TAPPING 18MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.04,SUP,HCPCS C1713,,"150.040  -  PROVIDENCE 4.2MM FIXED ANGLE SCREW, SELF-TAPPING 20MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.042,SUP,HCPCS C1713,,"150.042  -  PROVIDENCE 4.2MM FIXED ANGLE SCREW, SELF-TAPPING 22MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.044,SUP,HCPCS C1713,,"150.044  -  PROVIDENCE 4.2MM FIXED ANGLE SCREW, SELF-TAPPING 24MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.046,SUP,HCPCS C1713,,"150.046  -  PROVIDENCE 4.2MM FIXED ANGLE SCREW, SELF-TAPPING 26MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.11,SUP,HCPCS C1713,,150.110  -  PLATE BN 10MM NS PRV LVL 1 SPNE CRV ANT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
150.112,SUP,HCPCS C1713,,150.112  -  PLATE BN 12MM NS PRV LVL 1 SPNE CRV ANT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
150.114,SUP,HCPCS C1713,,150.114  -  PLATE BN 14MM NS PRV LVL 1 SPNE CRV ANT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
150.116,SUP,HCPCS C1713,,150.116  -  PLATE BN 16MM NS PRV LVL 1 SPNE CRV ANT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
150.118,SUP,HCPCS C1713,,150.118  -  PLATE BN 18MM NS PRV LVL 1 SPNE CRV ANT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
150.12,SUP,HCPCS C1713,,"150.120  -  PROVIDENCE ANTERIOR CERVICAL PLATE 1-LEVEL, 20MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
150.122,SUP,HCPCS C1713,,"150.122  -  PROVIDENCE ANTERIOR CERVICAL PLATE 1-LEVEL, 22MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
150.124,SUP,HCPCS C1713,,150.124  -  PLATE BN 24MM NS PRV LVL 1 SPNE CRV ANT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
150.126,SUP,HCPCS C1713,,"150.126  -  PROVIDENCE ANTERIOR CERVICAL PLATE 1-LEVEL, 26MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
150.13,SUP,HCPCS C1713,,"150.130  -  PROVIDENCE ANTERIOR CERVICAL PLATE 1-LEVEL, EXTRA LORDOTIC,","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
150.132,SUP,HCPCS C1713,,"150.132  -  PROVIDENCE ANTERIOR CERVICAL PLATE 1-LEVEL, EXTRA LORDOTIC,","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
150.134,SUP,HCPCS C1713,,"150.134  -  PROVIDENCE ANTERIOR CERVICAL PLATE 1-LEVEL, EXTRA LORDOTIC,","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
150.224,SUP,HCPCS C1713,,150.224  -  PLATE BN 24MM NS PRV LVL 2 SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
150.226,SUP,HCPCS C1713,,150.226  -  PLATE BN 26MM NS PRV LVL 2 SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
150.228,SUP,HCPCS C1713,,150.228  -  PLATE BN 28MM NS PRV LVL 2 SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
150.23,SUP,HCPCS C1713,,150.230  -  PLATE BN 30MM NS PRV LVL 2 SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
150.232,SUP,HCPCS C1713,,150.232  -  PLATE BN 32MM NS PRV 2 LVL TI SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
150.234,SUP,HCPCS C1713,,150.234  -  PLATE BN 34MM NS PRV LVL 2 SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
150.236,SUP,HCPCS C1713,,150.236  -  PLATE BN 36MM NS PRV LVL 2 SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
150.238,SUP,HCPCS C1713,,150.238  -  PLATE BN 38MM NS PRV LVL 2 SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
150.24,SUP,HCPCS C1713,,150.240  -  PLATE BN 40MM NS PRV LVL 2 SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
150.242,SUP,HCPCS C1713,,"150.242  -  PROVIDENCE ANTERIOR CERVICAL PLATE 2-LEVEL, 42MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
150.244,SUP,HCPCS C1713,,"150.244  -  PROVIDENCE ANTERIOR CERVICAL PLATE 2-LEVEL, 44MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
150.246,SUP,HCPCS C1713,,"150.246  -  PROVIDENCE ANTERIOR CERVICAL PLATE 2-LEVEL, 46MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
150.254,SUP,HCPCS C1713,,"150.254  -  PROVIDENCE ANTERIOR CERVICAL PLATE 2-LEVEL, EXTRA LORDOTIC,","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
150.256,SUP,HCPCS C1713,,"150.256  -  PROVIDENCE ANTERIOR CERVICAL PLATE 2-LEVEL, EXTRA LORDOTIC,","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
150.339,SUP,HCPCS C1713,,150.339  -  PLATE BN 39MM NS PRV LVL 3 SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
150.342,SUP,HCPCS C1713,,150.342  -  PLATE BN 42MM NS PRV LVL 3 SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
150.345,SUP,HCPCS C1713,,150.345  -  PLATE BN 45MM NS PRV 3 LVL TI SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
150.348,SUP,HCPCS C1713,,150.348  -  PLATE BN 48MM NS PRV LVL 3 SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
150.351,SUP,HCPCS C1713,,150.351  -  PLATE BN 51MM NS PRV LVL 3 SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
150.354,SUP,HCPCS C1713,,150.354  -  PLATE BN 54MM NS PRV LVL 3 SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
150.357,SUP,HCPCS C1713,,150.357  -  PLATE BN 57MM NS PRV LVL 3 SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
150.36,SUP,HCPCS C1713,,"150.360  -  PROVIDENCE ANTERIOR CERVICAL PLATE 3-LEVEL, 60MM","$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
150.363,SUP,HCPCS C1713,,"150.363  -  PROVIDENCE ANTERIOR CERVICAL PLATE 3-LEVEL, 63MM","$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
150.366,SUP,HCPCS C1713,,150.366  -  PLATE BN 66MM NS PRV LVL 3 SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
150.369,SUP,HCPCS C1713,,150.369  -  PLATE BN 69MM NS PRV LVL 3 SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
150.379,SUP,HCPCS C1713,,"150.379  -  PROVIDENCE ANTERIOR CERVICAL PLATE 3-LEVEL, EXTRA LORDOTIC,","$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
150.46,SUP,HCPCS C1713,,150.460  -  PLATE BN 60MM NS PRV LVL 4 SPNE CRV ANT,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
150.463,SUP,HCPCS C1713,,150.463  -  PLATE BN 63MM NS PRV LVL 4 SPNE CRV ANT,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
150.466,SUP,HCPCS C1713,,150.466  -  PLATE BN 66MM NS PRV LVL 4 SPNE CRV ANT,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
150.469,SUP,HCPCS C1713,,"150.469  -  PROVIDENCE ANTERIOR CERVICAL PLATE 4-LEVEL, 69MM","$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
150.472,SUP,HCPCS C1713,,"150.472  -  PROVIDENCE ANTERIOR CERVICAL PLATE 4-LEVEL, 72MM","$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
150.475,SUP,HCPCS C1713,,"150.475  -  PROVIDENCE ANTERIOR CERVICAL PLATE 4-LEVEL, 75MM","$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
150.478,SUP,HCPCS C1713,,150.478  -  PLATE BN 78MM NS PRV LVL 4 SPNE CRV ANT,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
150.481,SUP,HCPCS C1713,,"150.481  -  PROVIDENCE ANTERIOR CERVICAL PLATE 4-LEVEL, 81MM","$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
150.484,SUP,HCPCS C1713,,"150.484  -  PROVIDENCE ANTERIOR CERVICAL PLATE 4-LEVEL, 84MM","$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
150.487,SUP,HCPCS C1713,,"150.487  -  PROVIDENCE ANTERIOR CERVICAL PLATE 4-LEVEL, 87MM","$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
150.49,SUP,HCPCS C1713,,"150.490  -  PROVIDENCE ANTERIOR CERVICAL PLATE 4-LEVEL, 90MM","$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
150.493,SUP,HCPCS C1713,,"150.493  -  PROVIDENCE ANTERIOR CERVICAL PLATE 4-LEVEL, 93MM","$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
150.51,SUP,HCPCS C1713,,"150.510  -  PROVIDENCE 4.6MM FIXED ANGLE SCREW, SELF-DRILLING, 10MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.511,SUP,HCPCS C1713,,"150.511  -  PROVIDENCE 4.6MM FIXED ANGLE SCREW, SELF-DRILLING, 11MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.512,SUP,HCPCS C1713,,"150.512  -  PROVIDENCE 4.6MM FIXED ANGLE SCREW, SELF-DRILLING, 12MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.513,SUP,HCPCS C1713,,"150.513  -  PROVIDENCE 4.6MM FIXED ANGLE SCREW, SELF-DRILLING, 13MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.514,SUP,HCPCS C1713,,"150.514  -  PROVIDENCE 4.6MM FIXED ANGLE SCREW, SELF-DRILLING, 14MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.515,SUP,HCPCS C1713,,"150.515  -  PROVIDENCE 4.6MM FIXED ANGLE SCREW, SELF-DRILLING, 15MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.516,SUP,HCPCS C1713,,150.516  -  SCREW BN 4.6MM 16MM NS PRTX CTTI SLF DRL FX ANG SPNE OCT PRV,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.53,SUP,HCPCS C1713,,"150.530  -  PROVIDENCE 4.6MM FIXED ANGLE SCREW, SELF-TAPPING 10MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.531,SUP,HCPCS C1713,,"150.531  -  PROVIDENCE 4.6MM FIXED ANGLE SCREW, SELF-TAPPING 11MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.532,SUP,HCPCS C1713,,"150.532  -  PROVIDENCE 4.6MM FIXED ANGLE SCREW, SELF-TAPPING 12MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.533,SUP,HCPCS C1713,,"150.533  -  PROVIDENCE 4.6MM FIXED ANGLE SCREW, SELF-TAPPING 13MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.534,SUP,HCPCS C1713,,"150.534  -  PROVIDENCE 4.6MM FIXED ANGLE SCREW, SELF-TAPPING 14MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.535,SUP,HCPCS C1713,,"150.535  -  PROVIDENCE 4.6MM FIXED ANGLE SCREW, SELF-TAPPING 15MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.536,SUP,HCPCS C1713,,"150.536  -  PROVIDENCE 4.6MM FIXED ANGLE SCREW, SELF-TAPPING 16MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.538,SUP,HCPCS C1713,,"150.538  -  PROVIDENCE 4.6MM FIXED ANGLE SCREW, SELF-TAPPING 18MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.54,SUP,HCPCS C1713,,"150.540  -  PROVIDENCE 4.6MM FIXED ANGLE SCREW, SELF-TAPPING 20MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.542,SUP,HCPCS C1713,,"150.542  -  PROVIDENCE 4.6MM FIXED ANGLE SCREW, SELF-TAPPING 22MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.544,SUP,HCPCS C1713,,"150.544  -  PROVIDENCE 4.6MM FIXED ANGLE SCREW, SELF-TAPPING 24MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.546,SUP,HCPCS C1713,,"150.546  -  PROVIDENCE 4.6MM FIXED ANGLE SCREW, SELF-TAPPING 26MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.58,SUP,HCPCS C1713,,"150.580  -  PROVIDENCE ANTERIOR CERVICAL PLATE 5-LEVEL, 80MM","$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
150.583,SUP,HCPCS C1713,,"150.583  -  PROVIDENCE ANTERIOR CERVICAL PLATE 5-LEVEL, 83MM","$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
150.586,SUP,HCPCS C1713,,"150.586  -  PROVIDENCE ANTERIOR CERVICAL PLATE 5-LEVEL, 86MM","$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
150.589,SUP,HCPCS C1713,,"150.589  -  PROVIDENCE ANTERIOR CERVICAL PLATE 5-LEVEL, 89MM","$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
150.592,SUP,HCPCS C1713,,"150.592  -  PROVIDENCE ANTERIOR CERVICAL PLATE 5-LEVEL, 92MM","$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
150.595,SUP,HCPCS C1713,,150.595  -  PLATE BN 95MM NS PRV LVL 5 SPNE CRV ANT,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
150.598,SUP,HCPCS C1713,,"150.598  -  PROVIDENCE ANTERIOR CERVICAL PLATE 5-LEVEL, 98MM","$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
150.601,SUP,HCPCS C1713,,"150.601  -  PROVIDENCE ANTERIOR CERVICAL PLATE 5-LEVEL, 101MM","$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
150.604,SUP,HCPCS C1713,,"150.604  -  PROVIDENCE ANTERIOR CERVICAL PLATE 5-LEVEL, 104MM","$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
150.61,SUP,HCPCS C1713,,"150.610  -  PROVIDENCE 4.2MM VARIABLE ANGLE SCREW, SELF-DRILLING, 10MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.611,SUP,HCPCS C1713,,"150.611  -  PROVIDENCE 4.2MM VARIABLE ANGLE SCREW, SELF-DRILLING, 11MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.612,SUP,HCPCS C1713,,"150.612  -  PROVIDENCE 4.2MM VARIABLE ANGLE SCREW, SELF-DRILLING, 12MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.613,SUP,HCPCS C1713,,"150.613  -  PROVIDENCE 4.2MM VARIABLE ANGLE SCREW, SELF-DRILLING, 13MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.614,SUP,HCPCS C1713,,150.614  -  SCREW BONE 4.2MM 14MM PRTX CT SPNL SLFDRILL,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.615,SUP,HCPCS C1713,,"150.615  -  PROVIDENCE 4.2MM VARIABLE ANGLE SCREW, SELF-DRILLING, 15MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.616,SUP,HCPCS C1713,,150.616  -  SCREW BN 4.2MM 16MM NS PRTX CTTI SLF DRL VA SPNE OCT PRV,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.618,SUP,HCPCS C1713,,"150.618  -  PROVIDENCE 4.2MM VARIABLE ANGLE SCREW, SELF-DRILLING, 18MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.71,SUP,HCPCS C1713,,"150.710  -  PROVIDENCE 4.6MM VARIABLE ANGLE SCREW, SELF-DRILLING, 10MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.711,SUP,HCPCS C1713,,"150.711  -  PROVIDENCE 4.6MM VARIABLE ANGLE SCREW, SELF-DRILLING, 11MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.712,SUP,HCPCS C1713,,"150.712  -  PROVIDENCE 4.6MM VARIABLE ANGLE SCREW, SELF-DRILLING, 12MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.713,SUP,HCPCS C1713,,"150.713  -  PROVIDENCE 4.6MM VARIABLE ANGLE SCREW, SELF-DRILLING, 13MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.714,SUP,HCPCS C1713,,"150.714  -  PROVIDENCE 4.6MM VARIABLE ANGLE SCREW, SELF-DRILLING, 14MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.715,SUP,HCPCS C1713,,"150.715  -  PROVIDENCE 4.6MM VARIABLE ANGLE SCREW, SELF-DRILLING, 15MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.716,SUP,HCPCS C1713,,150.716  -  SCREW BONE 4.6MM 16MM PRTX CTTI OCT SPN SLFDRILL VAR ANG,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.81,SUP,HCPCS C1713,,"150.810  -  PROVIDENCE 4.2MM VARIABLE ANGLE SCREW, SELF-TAPPING 10MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.811,SUP,HCPCS C1713,,"150.811  -  PROVIDENCE 4.2MM VARIABLE ANGLE SCREW, SELF-TAPPING 11MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.812,SUP,HCPCS C1713,,"150.812  -  PROVIDENCE 4.2MM VARIABLE ANGLE SCREW, SELF-TAPPING 12MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.813,SUP,HCPCS C1713,,"150.813  -  PROVIDENCE 4.2MM VARIABLE ANGLE SCREW, SELF-TAPPING 13MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.814,SUP,HCPCS C1713,,"150.814  -  PROVIDENCE 4.2MM VARIABLE ANGLE SCREW, SELF-TAPPING 14MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.815,SUP,HCPCS C1713,,"150.815  -  PROVIDENCE 4.2MM VARIABLE ANGLE SCREW, SELF-TAPPING 15MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.816,SUP,HCPCS C1713,,"150.816  -  PROVIDENCE 4.2MM VARIABLE ANGLE SCREW, SELF-TAPPING 16MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.818,SUP,HCPCS C1713,,"150.818  -  PROVIDENCE 4.2MM VARIABLE ANGLE SCREW, SELF-TAPPING 18MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.82,SUP,HCPCS C1713,,"150.820  -  PROVIDENCE 4.2MM VARIABLE ANGLE SCREW, SELF-TAPPING 20MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.822,SUP,HCPCS C1713,,"150.822  -  PROVIDENCE 4.2MM VARIABLE ANGLE SCREW, SELF-TAPPING 22MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.824,SUP,HCPCS C1713,,"150.824  -  PROVIDENCE 4.2MM VARIABLE ANGLE SCREW, SELF-TAPPING 24MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.826,SUP,HCPCS C1713,,"150.826  -  PROVIDENCE 4.2MM VARIABLE ANGLE SCREW, SELF-TAPPING 26MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.91,SUP,HCPCS C1713,,"150.910  -  PROVIDENCE 4.6MM VARIABLE ANGLE SCREW, SELF-TAPPING 10MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.911,SUP,HCPCS C1713,,"150.911  -  PROVIDENCE 4.6MM VARIABLE ANGLE SCREW, SELF-TAPPING 11MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.912,SUP,HCPCS C1713,,"150.912  -  PROVIDENCE 4.6MM VARIABLE ANGLE SCREW, SELF-TAPPING 12MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.913,SUP,HCPCS C1713,,"150.913  -  PROVIDENCE 4.6MM VARIABLE ANGLE SCREW, SELF-TAPPING 13MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.914,SUP,HCPCS C1713,,"150.914  -  PROVIDENCE 4.6MM VARIABLE ANGLE SCREW, SELF-TAPPING 14MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.915,SUP,HCPCS C1713,,"150.915  -  PROVIDENCE 4.6MM VARIABLE ANGLE SCREW, SELF-TAPPING 15MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.916,SUP,HCPCS C1713,,"150.916  -  PROVIDENCE 4.6MM VARIABLE ANGLE SCREW, SELF-TAPPING 16MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.918,SUP,HCPCS C1713,,"150.918  -  PROVIDENCE 4.6MM VARIABLE ANGLE SCREW, SELF-TAPPING 18MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.92,SUP,HCPCS C1713,,"150.920  -  PROVIDENCE 4.6MM VARIABLE ANGLE SCREW, SELF-TAPPING 20MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.922,SUP,HCPCS C1713,,"150.922  -  PROVIDENCE 4.6MM VARIABLE ANGLE SCREW, SELF-TAPPING 22MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.924,SUP,HCPCS C1713,,"150.924  -  PROVIDENCE 4.6MM VARIABLE ANGLE SCREW, SELF-TAPPING 24MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
150.926,SUP,HCPCS C1713,,"150.926  -  PROVIDENCE 4.6MM VARIABLE ANGLE SCREW, SELF-TAPPING 26MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
151,SUP,Custom 27203010,,MARKER RAD A-SPOT LT IMG SEE THR PALPABLE MASS 3ANG MAMGR,$202.50,$0.00,$202.50,$0.00,$144.52,$0.00,$0.00,$0.00,$0.00,$0.00,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$0.00,$0.00,$0.00,$0.00
151.001,SUP,Custom 27803010,,151.001  -  SPACER SPNL 0D 12MM 12X15MM NS LF FORTIFY NO SPK,"$16,080.00",$0.00,"$16,080.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$16,080.00",$0.00,"$8,040.00","$12,735.36","$12,864.00",$0.00,$0.00,$0.00,$0.00,$0.00
151.002,SUP,Custom 27803010,,151.002  -  SPACER SPNL 0D 12MM 12X16MM NS LF FORTIFY,"$16,080.00",$0.00,"$16,080.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$16,080.00",$0.00,"$8,040.00","$12,735.36","$12,864.00",$0.00,$0.00,$0.00,$0.00,$0.00
151.003,SUP,Custom 27803010,,151.003  -  SPACER SPNL 3.5D 12MM 12X16MM NS LF FORTIFY NO SPK,"$16,080.00",$0.00,"$16,080.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$16,080.00",$0.00,"$8,040.00","$12,735.36","$12,864.00",$0.00,$0.00,$0.00,$0.00,$0.00
151.004,SUP,Custom 27803010,,151.004  -  SPACER SPNL 3.5D 12MM 12X17MM NS LF FORTIFY,"$16,080.00",$0.00,"$16,080.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$16,080.00",$0.00,"$8,040.00","$12,735.36","$12,864.00",$0.00,$0.00,$0.00,$0.00,$0.00
151.05,SUP,Custom 27803010,,151.050  -  SPACER SPNL 12MM 12X18MM NS LF FORTIFY,"$16,080.00",$0.00,"$16,080.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$16,080.00",$0.00,"$8,040.00","$12,735.36","$12,864.00",$0.00,$0.00,$0.00,$0.00,$0.00
151.051,SUP,Custom 27803010,,151.051  -  SPACER SPNL 12MM 12X19MM NS LF FORTIFY,"$16,080.00",$0.00,"$16,080.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$16,080.00",$0.00,"$8,040.00","$12,735.36","$12,864.00",$0.00,$0.00,$0.00,$0.00,$0.00
151.052,SUP,Custom 27803010,,151.052  -  SPACER SPNL 12MM 12X21MM NS LF FORTIFY,"$16,080.00",$0.00,"$16,080.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$16,080.00",$0.00,"$8,040.00","$12,735.36","$12,864.00",$0.00,$0.00,$0.00,$0.00,$0.00
151.053,SUP,Custom 27803010,,151.053  -  SPACER SPNL 12MM 12X25MM NS LF FORTIFY,"$16,080.00",$0.00,"$16,080.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$16,080.00",$0.00,"$8,040.00","$12,735.36","$12,864.00",$0.00,$0.00,$0.00,$0.00,$0.00
151.054,SUP,Custom 27803010,,151.054  -  SPACER SPNL 12MM 12X33MM NS LF FORTIFY,"$16,080.00",$0.00,"$16,080.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$16,080.00",$0.00,"$8,040.00","$12,735.36","$12,864.00",$0.00,$0.00,$0.00,$0.00,$0.00
151.055,SUP,Custom 27803010,,151.055  -  SPACER SPNL 12MM 12X48MM NS LF FORTIFY,"$16,080.00",$0.00,"$16,080.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$16,080.00",$0.00,"$8,040.00","$12,735.36","$12,864.00",$0.00,$0.00,$0.00,$0.00,$0.00
151.056,SUP,Custom 27803010,,151.056  -  SPACER SPNL 12MM 12X67MM NS LF FORTIFY,"$16,080.00",$0.00,"$16,080.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$16,080.00",$0.00,"$8,040.00","$12,735.36","$12,864.00",$0.00,$0.00,$0.00,$0.00,$0.00
151.15,SUP,Custom 27803010,,151.150  -  SPACER SPNL 20MM 20X23MM NS LF FORTIFY,"$21,100.00",$0.00,"$21,100.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,100.00",$0.00,"$10,550.00","$16,711.20","$16,880.00",$0.00,$0.00,$0.00,$0.00,$0.00
151.151,SUP,Custom 27803010,,151.151  -  SPACER SPNL 20MM 20X26MM NS LF FORTIFY,"$21,100.00",$0.00,"$21,100.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,100.00",$0.00,"$10,550.00","$16,711.20","$16,880.00",$0.00,$0.00,$0.00,$0.00,$0.00
151.152,SUP,Custom 27803010,,151.152  -  SPACER SPNL 20MM 20X31MM NS LF FORTIFY,"$21,100.00",$0.00,"$21,100.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,100.00",$0.00,"$10,550.00","$16,711.20","$16,880.00",$0.00,$0.00,$0.00,$0.00,$0.00
151.153,SUP,Custom 27803010,,151.153  -  SPACER SPNL 20MM 20X41MM NS LF FORTIFY,"$21,100.00",$0.00,"$21,100.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,100.00",$0.00,"$10,550.00","$16,711.20","$16,880.00",$0.00,$0.00,$0.00,$0.00,$0.00
151.154,SUP,Custom 27803010,,151.154  -  SPACER SPNL 20MM 20X62MM NS LF FORTIFY,"$21,100.00",$0.00,"$21,100.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,100.00",$0.00,"$10,550.00","$16,711.20","$16,880.00",$0.00,$0.00,$0.00,$0.00,$0.00
151.155,SUP,Custom 27803010,,151.155  -  SPACER SPNL 20MM 20X90MM NS LF FORTIFY,"$21,100.00",$0.00,"$21,100.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,100.00",$0.00,"$10,550.00","$16,711.20","$16,880.00",$0.00,$0.00,$0.00,$0.00,$0.00
151.32,SUP,HCPCS C1713,,151.320  -  SPACER SPNL 0D 12MM 14X12MM NS LF FORTIFY FTPRNT UPR EPLT,"$1,335.00",$0.00,"$1,335.00",$600.75,$952.79,$0.00,$230.01,$0.00,$0.00,$233.75,"$1,335.00",$0.00,$667.50,"$1,057.32","$1,068.00",$0.00,$208.93,$0.00,$212.53,$0.00
151.321,SUP,HCPCS C1713,,151.321  -  SPACER SPNL 0D 12MM 14X12MM NS LF FORTIFY FTPRNT UPR EPLT,"$1,335.00",$0.00,"$1,335.00",$600.75,$952.79,$0.00,$230.01,$0.00,$0.00,$233.75,"$1,335.00",$0.00,$667.50,"$1,057.32","$1,068.00",$0.00,$208.93,$0.00,$212.53,$0.00
151.322,SUP,HCPCS C1713,,151.322  -  SPACER SPNL 3.5D 12MM 14X12MM NS LF FORTIFY FTPRNT UPR EPLT,"$1,335.00",$0.00,"$1,335.00",$600.75,$952.79,$0.00,$230.01,$0.00,$0.00,$233.75,"$1,335.00",$0.00,$667.50,"$1,057.32","$1,068.00",$0.00,$208.93,$0.00,$212.53,$0.00
151.323,SUP,HCPCS C1713,,151.323  -  SPACER SPNL 3.5D 12MM 14X12MM NS LF FORTIFY FTPRNT UPR EPLT,"$1,335.00",$0.00,"$1,335.00",$600.75,$952.79,$0.00,$230.01,$0.00,$0.00,$233.75,"$1,335.00",$0.00,$667.50,"$1,057.32","$1,068.00",$0.00,$208.93,$0.00,$212.53,$0.00
151.324,SUP,HCPCS C1713,,151.324  -  SPACER SPNL 7D 12MM 14X12MM NS LF FORTIFY FTPRNT UPR EPLT,"$1,335.00",$0.00,"$1,335.00",$600.75,$952.79,$0.00,$230.01,$0.00,$0.00,$233.75,"$1,335.00",$0.00,$667.50,"$1,057.32","$1,068.00",$0.00,$208.93,$0.00,$212.53,$0.00
151.331,SUP,HCPCS C1713,,151.331  -  SPACER SPNL 0D 15MM 18X12MM NS LF FORTIFY FTPRNT UPR EPLT,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
151.333,SUP,HCPCS C1713,,151.333  -  SPACER SPNL 3.5D 15MM 18X12MM NS LF FORTIFY FTPRNT UPR EPLT,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
151.334,SUP,HCPCS C1713,,151.334  -  SPACER SPNL 7D 15MM 18X12MM NS LF FORTIFY FTPRNT UPR EPLT,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
151.371,SUP,HCPCS C1713,,151.371  -  SPACER SPNL 0D 12MM 14X12MM NS LF FORTIFY FTPRNT LWR EPLT,"$1,335.00",$0.00,"$1,335.00",$600.75,$952.79,$0.00,$230.01,$0.00,$0.00,$233.75,"$1,335.00",$0.00,$667.50,"$1,057.32","$1,068.00",$0.00,$208.93,$0.00,$212.53,$0.00
151.373,SUP,HCPCS C1713,,151.373  -  SPACER SPNL 3.5D 12MM 14X12MM NS LF FORTIFY FTPRNT LWR EPLT,"$1,335.00",$0.00,"$1,335.00",$600.75,$952.79,$0.00,$230.01,$0.00,$0.00,$233.75,"$1,335.00",$0.00,$667.50,"$1,057.32","$1,068.00",$0.00,$208.93,$0.00,$212.53,$0.00
151.374,SUP,HCPCS C1713,,151.374  -  SPACER SPNL 7D 12MM 14X12MM NS LF FORTIFY FTPRNT LWR EPLT,"$1,335.00",$0.00,"$1,335.00",$600.75,$952.79,$0.00,$230.01,$0.00,$0.00,$233.75,"$1,335.00",$0.00,$667.50,"$1,057.32","$1,068.00",$0.00,$208.93,$0.00,$212.53,$0.00
151.381,SUP,HCPCS C1713,,151.381  -  SPACER SPNL 0D 15MM 18X12MM NS LF FORTIFY FTPRNT LWR EPLT,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
151.383,SUP,HCPCS C1713,,151.383  -  SPACER SPNL 3.5D 15MM 18X12MM NS LF FORTIFY FTPRNT LWR EPLT,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
151.384,SUP,HCPCS C1713,,151.384  -  SPACER SPNL 7D 15MM 18X12MM NS LF FORTIFY FTPRNT LWR EPLT,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
151.401,SUP,HCPCS C1713,,151.401  -  SPACER SPNL 0D 20MM 20X20MM NS LF FORTIFY FTPRNT UPR EPLT,"$1,335.00",$0.00,"$1,335.00",$600.75,$952.79,$0.00,$230.01,$0.00,$0.00,$233.75,"$1,335.00",$0.00,$667.50,"$1,057.32","$1,068.00",$0.00,$208.93,$0.00,$212.53,$0.00
151.403,SUP,HCPCS C1713,,151.403  -  SPACER SPNL 4D 20MM 20X20MM NS LF FORTIFY FTPRNT UPR EPLT,"$1,335.00",$0.00,"$1,335.00",$600.75,$952.79,$0.00,$230.01,$0.00,$0.00,$233.75,"$1,335.00",$0.00,$667.50,"$1,057.32","$1,068.00",$0.00,$208.93,$0.00,$212.53,$0.00
151.404,SUP,HCPCS C1713,,151.404  -  SPACER SPNL 8D 20MM 20X20MM NS LF FORTIFY FTPRNT UPR EPLT,"$1,335.00",$0.00,"$1,335.00",$600.75,$952.79,$0.00,$230.01,$0.00,$0.00,$233.75,"$1,335.00",$0.00,$667.50,"$1,057.32","$1,068.00",$0.00,$208.93,$0.00,$212.53,$0.00
151.411,SUP,HCPCS C1713,,151.411  -  SPACER SPNL 0D 21MM 23X20MM NS LF FORTIFY FTPRNT UPR EPLT,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
151.413,SUP,HCPCS C1713,,151.413  -  SPACER SPNL 4D 21MM 23X20MM NS LF FORTIFY FTPRNT UPR EPLT,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
151.414,SUP,HCPCS C1713,,151.414  -  SPACER SPNL 8D 21MM 23X20MM NS LF FORTIFY FTPRNT UPR EPLT,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
151.431,SUP,HCPCS C1713,,151.431  -  SPACER SPNL 0D 25MM 30X20MM NS LF FORTIFY FTPRNT UPR EPLT,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
151.433,SUP,HCPCS C1713,,151.433  -  SPACER SPNL 4D 25MM 30X20MM NS LF FORTIFY FTPRNT UPR EPLT,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
151.434,SUP,HCPCS C1713,,151.434  -  SPACER SPNL 8D 25MM 30X20MM NS LF FORTIFY FTPRNT UPR EPLT,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
151.451,SUP,HCPCS C1713,,151.451  -  SPACER SPNL 0D 20MM 20X20MM NS LF FORTIFY FTPRNT LWR EPLT,"$1,335.00",$0.00,"$1,335.00",$600.75,$952.79,$0.00,$230.01,$0.00,$0.00,$233.75,"$1,335.00",$0.00,$667.50,"$1,057.32","$1,068.00",$0.00,$208.93,$0.00,$212.53,$0.00
151.453,SUP,HCPCS C1713,,151.453  -  SPACER SPNL 4D 20MM 20X20MM NS LF FORTIFY FTPRNT LWR EPLT,"$1,335.00",$0.00,"$1,335.00",$600.75,$952.79,$0.00,$230.01,$0.00,$0.00,$233.75,"$1,335.00",$0.00,$667.50,"$1,057.32","$1,068.00",$0.00,$208.93,$0.00,$212.53,$0.00
151.454,SUP,HCPCS C1713,,151.454  -  SPACER SPNL 8D 20MM 20X20MM NS LF FORTIFY FTPRNT LWR EPLT,"$1,335.00",$0.00,"$1,335.00",$600.75,$952.79,$0.00,$230.01,$0.00,$0.00,$233.75,"$1,335.00",$0.00,$667.50,"$1,057.32","$1,068.00",$0.00,$208.93,$0.00,$212.53,$0.00
151.461,SUP,HCPCS C1713,,151.461  -  SPACER SPNL 0D 21MM 23X20MM NS LF FORTIFY FTPRNT LWR EPLT,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
151.463,SUP,HCPCS C1713,,151.463  -  SPACER SPNL 4D 21MM 23X20MM NS LF FORTIFY FTPRNT LWR EPLT,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
151.464,SUP,HCPCS C1713,,151.464  -  SPACER SPNL 8D 21MM 23X20MM NS LF FORTIFY FTPRNT LWR EPLT,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
151.481,SUP,HCPCS C1713,,151.481  -  SPACER SPNL 0D 25MM 30X20MM NS LF FORTIFY FTPRNT LWR EPLT,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
151.483,SUP,HCPCS C1713,,151.483  -  SPACER SPNL 4D 25MM 30X20MM NS LF FORTIFY FTPRNT LWR EPLT,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
151.484,SUP,HCPCS C1713,,151.484  -  SPACER SPNL 8D 25MM 30X20MM NS LF FORTIFY FTPRNT LWR EPLT,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
151.485,SUP,HCPCS C1713,,151.485  -  SPACER SPNL 12D 25MM 30X20MM NS LF FORTIFY FTPRNT LWR EPLT,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
151.486,SUP,HCPCS C1713,,151.486  -  SPACER SPNL 16D 25MM 30X20MM NS LF FORTIFY FTPRNT LWR EPLT,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
151.601,SUP,HCPCS C1713,,151.601  -  SPACER SPNL 0D 22MM 40X20MM NS LF FORTIFY UPR EPLT SGTL PRFL,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
151.603,SUP,HCPCS C1713,,151.603  -  SPACER SPNL 4D 22MM 40X20MM NS LF FORTIFY UPR EPLT SGTL PRFL,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
151.604,SUP,HCPCS C1713,,151.604  -  SPACER SPNL 8D 22MM 40X20MM NS LF FORTIFY UPR EPLT SGTL PRFL,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
151.605,SUP,HCPCS C1713,,151.605  -  SPACER SPNL 12D 22MM 40X20MM NS LF FORTIFY UPR EPLT SGTL,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
151.611,SUP,HCPCS C1713,,151.611  -  SPACER SPNL 0D 22MM 45X20MM NS LF FORTIFY UPR EPLT SGTL PRFL,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
151.613,SUP,HCPCS C1713,,151.613  -  SPACER SPNL 4D 22MM 45X20MM NS LF FORTIFY UPR EPLT SGTL PRFL,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
151.614,SUP,HCPCS C1713,,151.614  -  SPACER SPNL 8D 22MM 45X20MM NS LF FORTIFY UPR EPLT SGTL PRFL,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
151.615,SUP,HCPCS C1713,,151.615  -  SPACER SPNL 12D 22MM 45X20MM NS LF FORTIFY UPR EPLT SGTL,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
151.621,SUP,HCPCS C1713,,151.621  -  SPACER SPNL 0D 22MM 50X20MM NS LF FORTIFY UPR EPLT SGTL PRFL,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
151.623,SUP,HCPCS C1713,,151.623  -  SPACER SPNL 4D 22MM 50X20MM NS LF FORTIFY UPR EPLT SGTL PRFL,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
151.624,SUP,HCPCS C1713,,151.624  -  SPACER SPNL 8D 22MM 50X20MM NS LF FORTIFY UPR EPLT SGTL PRFL,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
151.625,SUP,HCPCS C1713,,151.625  -  SPACER SPNL 12D 22MM 50X20MM NS LF FORTIFY UPR EPLT SGTL,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
151.651,SUP,HCPCS C1713,,151.651  -  SPACER SPNL 0D 22MM 40X20MM NS LF FORTIFY LWR EPLT SGTL PRFL,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
151.653,SUP,HCPCS C1713,,151.653  -  SPACER SPNL 4D 22MM 40X20MM NS LF FORTIFY LWR EPLT SGTL PRFL,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
151.654,SUP,HCPCS C1713,,151.654  -  SPACER SPNL 8D 22MM 40X20MM NS LF FORTIFY LWR EPLT SGTL PRFL,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
151.655,SUP,HCPCS C1713,,151.655  -  SPACER SPNL 12D 22MM 40X20MM NS LF FORTIFY LWR EPLT SGTL,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
151.661,SUP,HCPCS C1713,,151.661  -  SPACER SPNL 0D 22MM 45X20MM NS LF FORTIFY LWR EPLT SGTL PRFL,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
151.663,SUP,HCPCS C1713,,151.663  -  SPACER SPNL 4D 22MM 45X20MM NS LF FORTIFY LWR EPLT SGTL PRFL,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
151.664,SUP,HCPCS C1713,,151.664  -  SPACER SPNL 8D 22MM 45X20MM NS LF FORTIFY LWR EPLT SGTL PRFL,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
151.665,SUP,HCPCS C1713,,151.665  -  SPACER SPNL 12D 22MM 45X20MM NS LF FORTIFY LWR EPLT SGTL,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
151.671,SUP,HCPCS C1713,,151.671  -  SPACER SPNL 0D 22MM 50X20MM NS LF FORTIFY LWR EPLT SGTL PRFL,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
151.673,SUP,HCPCS C1713,,151.673  -  SPACER SPNL 4D 22MM 50X20MM NS LF FORTIFY LWR EPLT SGTL PRFL,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
151.674,SUP,HCPCS C1713,,151.674  -  SPACER SPNL 8D 22MM 50X20MM NS LF FORTIFY LWR EPLT SGTL PRFL,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
151.675,SUP,HCPCS C1713,,151.675  -  SPACER SPNL 12D 22MM 50X20MM NS LF FORTIFY LWR EPLT SGTL,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
151.701,SUP,HCPCS C1713,,151.701  -  SPACER SPNL 0D 14MM 16X12MM NS LF FORTIFY UPR EPLT SGTL PRFL,"$1,335.00",$0.00,"$1,335.00",$600.75,$952.79,$0.00,$230.01,$0.00,$0.00,$233.75,"$1,335.00",$0.00,$667.50,"$1,057.32","$1,068.00",$0.00,$208.93,$0.00,$212.53,$0.00
151.703,SUP,HCPCS C1713,,151.703  -  SPACER SPNL 3.5D 14MM 16X12MM NS LF FORTIFY UPR EPLT SGTL,"$1,335.00",$0.00,"$1,335.00",$600.75,$952.79,$0.00,$230.01,$0.00,$0.00,$233.75,"$1,335.00",$0.00,$667.50,"$1,057.32","$1,068.00",$0.00,$208.93,$0.00,$212.53,$0.00
151.704,SUP,HCPCS C1713,,151.704  -  SPACER SPNL 7D 14MM 16X12MM NS LF FORTIFY UPR EPLT SGTL PRFL,"$1,335.00",$0.00,"$1,335.00",$600.75,$952.79,$0.00,$230.01,$0.00,$0.00,$233.75,"$1,335.00",$0.00,$667.50,"$1,057.32","$1,068.00",$0.00,$208.93,$0.00,$212.53,$0.00
151.751,SUP,HCPCS C1713,,151.751  -  SPACER SPNL 0D 14MM 16X12MM NS LF FORTIFY LWR EPLT SGTL PRFL,"$1,335.00",$0.00,"$1,335.00",$600.75,$952.79,$0.00,$230.01,$0.00,$0.00,$233.75,"$1,335.00",$0.00,$667.50,"$1,057.32","$1,068.00",$0.00,$208.93,$0.00,$212.53,$0.00
151.753,SUP,HCPCS C1713,,151.753  -  SPACER SPNL 3.5D 14MM 16X12MM NS LF FORTIFY LWR EPLT SGTL,"$1,335.00",$0.00,"$1,335.00",$600.75,$952.79,$0.00,$230.01,$0.00,$0.00,$233.75,"$1,335.00",$0.00,$667.50,"$1,057.32","$1,068.00",$0.00,$208.93,$0.00,$212.53,$0.00
151.754,SUP,HCPCS C1713,,151.754  -  SPACER SPNL 7D 14MM 16X12MM NS LF FORTIFY LWR EPLT SGTL PRFL,"$1,335.00",$0.00,"$1,335.00",$600.75,$952.79,$0.00,$230.01,$0.00,$0.00,$233.75,"$1,335.00",$0.00,$667.50,"$1,057.32","$1,068.00",$0.00,$208.93,$0.00,$212.53,$0.00
154.7,SUP,Custom 27803010,,"154.700  -  REVERE IN-LINE EXTENSION CLAMP, 5.5MM-6.0MM, 5.5MM ROD, LEFT","$10,800.00",$0.00,"$10,800.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$10,800.00",$0.00,"$5,400.00","$8,553.60","$8,640.00",$0.00,$0.00,$0.00,$0.00,$0.00
154.705,SUP,Custom 27803010,,"154.705  -  REVERE IN-LINE EXTENSION CLAMP, 5.5MM-6.0MM, 5.5MM ROD, RIGH","$10,800.00",$0.00,"$10,800.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$10,800.00",$0.00,"$5,400.00","$8,553.60","$8,640.00",$0.00,$0.00,$0.00,$0.00,$0.00
154.71,SUP,Custom 27803010,,"154.710  -  REVERE IN-LINE EXTENSION CLAMP, 6.0MM-6.5MM, 5.5MM ROD, LEFT","$10,800.00",$0.00,"$10,800.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$10,800.00",$0.00,"$5,400.00","$8,553.60","$8,640.00",$0.00,$0.00,$0.00,$0.00,$0.00
154.715,SUP,Custom 27803010,,"154.715  -  REVERE IN-LINE EXTENSION CLAMP, 6.0MM-6.5MM, 5.5MM ROD, RIGH","$10,800.00",$0.00,"$10,800.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$10,800.00",$0.00,"$5,400.00","$8,553.60","$8,640.00",$0.00,$0.00,$0.00,$0.00,$0.00
154.72,SUP,Custom 27803010,,"154.720  -  REVERE OFFSET EXTENSION CLAMP, 5.5MM-6.0MM, 5.5MM ROD, LEFT,","$10,800.00",$0.00,"$10,800.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$10,800.00",$0.00,"$5,400.00","$8,553.60","$8,640.00",$0.00,$0.00,$0.00,$0.00,$0.00
154.725,SUP,Custom 27803010,,"154.725  -  REVERE OFFSET EXTENSION CLAMP, 5.5MM-6.0MM, 5.5MM ROD, RIGHT","$10,800.00",$0.00,"$10,800.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$10,800.00",$0.00,"$5,400.00","$8,553.60","$8,640.00",$0.00,$0.00,$0.00,$0.00,$0.00
154.73,SUP,Custom 27803010,,"154.730  -  REVERE OFFSET EXTENSION CLAMP, 6.0MM-6.5MM, 5.5MM ROD, LEFT,","$10,800.00",$0.00,"$10,800.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$10,800.00",$0.00,"$5,400.00","$8,553.60","$8,640.00",$0.00,$0.00,$0.00,$0.00,$0.00
154.735,SUP,Custom 27803010,,"154.735  -  REVERE OFFSET EXTENSION CLAMP, 6.0MM-6.5MM, 5.5MM ROD, RIGHT","$10,800.00",$0.00,"$10,800.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$10,800.00",$0.00,"$5,400.00","$8,553.60","$8,640.00",$0.00,$0.00,$0.00,$0.00,$0.00
154.74,SUP,Custom 27803010,,"154.740  -  REVERE Y OFFSET CONNECTOR, 5.5MM-6.0MM","$2,620.00",$0.00,"$2,620.00",$0.00,"$1,869.89",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,620.00",$0.00,"$1,310.00","$2,075.04","$2,096.00",$0.00,$0.00,$0.00,$0.00,$0.00
154.745,SUP,Custom 27803010,,"154.745  -  REVERE Y OFFSET CONNECTOR, 6.0MM-6.5MM","$2,620.00",$0.00,"$2,620.00",$0.00,"$1,869.89",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,620.00",$0.00,"$1,310.00","$2,075.04","$2,096.00",$0.00,$0.00,$0.00,$0.00,$0.00
154.754,SUP,Custom 27803010,,"154.754  -  PARALLEL CONNECTOR CLAMP, 5.5MM TO 6.5MM, SINGLE","$1,310.00",$0.00,"$1,310.00",$0.00,$934.95,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,310.00",$0.00,$655.00,"$1,037.52","$1,048.00",$0.00,$0.00,$0.00,$0.00,$0.00
154.756,SUP,Custom 27803010,,"154.756  -  PARALLEL CONNECTOR CLAMP, 5.5MM TO 6.5MM, 18MM WIDE, SINGLE","$1,310.00",$0.00,"$1,310.00",$0.00,$934.95,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,310.00",$0.00,$655.00,"$1,037.52","$1,048.00",$0.00,$0.00,$0.00,$0.00,$0.00
154.758,SUP,Custom 27803010,,"154.758  -  ROD TO ROD CLAMP, 5.5MM TO 5.5MM, SINGLE","$1,310.00",$0.00,"$1,310.00",$0.00,$934.95,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,310.00",$0.00,$655.00,"$1,037.52","$1,048.00",$0.00,$0.00,$0.00,$0.00,$0.00
154.76,SUP,Custom 27803010,,"154.760  -  ROD TO ROD CLAMP, 5.5MM TO 5.5MM, 18MM WIDE, SINGLE","$1,310.00",$0.00,"$1,310.00",$0.00,$934.95,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,310.00",$0.00,$655.00,"$1,037.52","$1,048.00",$0.00,$0.00,$0.00,$0.00,$0.00
154.854,SUP,Custom 27803010,,"154.854  -  PARALLEL CONNECTOR CLAMP, 6.5MM TO 6.5MM, SINGLE","$1,310.00",$0.00,"$1,310.00",$0.00,$934.95,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,310.00",$0.00,$655.00,"$1,037.52","$1,048.00",$0.00,$0.00,$0.00,$0.00,$0.00
154.856,SUP,Custom 27803010,,"154.856  -  PARALLEL CONNECTOR CLAMP, 6.5MM TO 6.5MM, 18MM WIDE, SINGLE","$1,310.00",$0.00,"$1,310.00",$0.00,$934.95,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,310.00",$0.00,$655.00,"$1,037.52","$1,048.00",$0.00,$0.00,$0.00,$0.00,$0.00
154.858,SUP,Custom 27803010,,"154.858  -  ROD TO ROD CLAMP, 6.5MM TO 6.5MM, SINGLE","$1,310.00",$0.00,"$1,310.00",$0.00,$934.95,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,310.00",$0.00,$655.00,"$1,037.52","$1,048.00",$0.00,$0.00,$0.00,$0.00,$0.00
154.86,SUP,Custom 27803010,,"154.860  -  ROD TO ROD CLAMP, 6.5MM TO 6.5MM, 18MM WIDE, SINGLE","$1,310.00",$0.00,"$1,310.00",$0.00,$934.95,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,310.00",$0.00,$655.00,"$1,037.52","$1,048.00",$0.00,$0.00,$0.00,$0.00,$0.00
154.862,SUP,Custom 27803010,,"154.862  -  ROD TO ROD CLAMP, 5.5MM TO 6.5MM","$1,310.00",$0.00,"$1,310.00",$0.00,$934.95,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,310.00",$0.00,$655.00,"$1,037.52","$1,048.00",$0.00,$0.00,$0.00,$0.00,$0.00
154.864,SUP,Custom 27803010,,"154.864  -  ROD TO ROD CLAMP, 5.5MM TO 6.5MM, WIDE","$1,310.00",$0.00,"$1,310.00",$0.00,$934.95,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,310.00",$0.00,$655.00,"$1,037.52","$1,048.00",$0.00,$0.00,$0.00,$0.00,$0.00
154.865,SUP,Custom 27803010,,"154.865  -  ROD TO ROD CLAMP ASSEMBLY, 5.5MM TO 6.5MM, 18MM WIDE","$1,445.00",$0.00,"$1,445.00",$0.00,"$1,031.30",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,445.00",$0.00,$722.50,"$1,144.44","$1,156.00",$0.00,$0.00,$0.00,$0.00,$0.00
154.866,SUP,Custom 27803010,,"154.866  -  PARALLEL CONNECTOR CLAMP, 6.5MM TO 6.5MM","$1,310.00",$0.00,"$1,310.00",$0.00,$934.95,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,310.00",$0.00,$655.00,"$1,037.52","$1,048.00",$0.00,$0.00,$0.00,$0.00,$0.00
154.868,SUP,Custom 27803010,,"154.868  -  PARALLEL CONNECTOR CLAMP, 6.5MM TO 6.5MM WIDE","$1,310.00",$0.00,"$1,310.00",$0.00,$934.95,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,310.00",$0.00,$655.00,"$1,037.52","$1,048.00",$0.00,$0.00,$0.00,$0.00,$0.00
154.869,SUP,Custom 27803010,,"154.869  -  PARALLEL CONNECTOR CLAMP ASSEMBLY, 6.5MM TO 6.5MM, 18MM WIDE","$1,330.00",$0.00,"$1,330.00",$0.00,$949.22,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,330.00",$0.00,$665.00,"$1,053.36","$1,064.00",$0.00,$0.00,$0.00,$0.00,$0.00
155.051,SUP,HCPCS C1713,,"155.051  -  BEACON 5.0MM POSTED SCREW, 25MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.052,SUP,HCPCS C1713,,"155.052  -  BEACON 5.0MM POSTED SCREW, 30MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.053,SUP,HCPCS C1713,,"155.053  -  BEACON 5.0MM POSTED SCREW, 35MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.054,SUP,HCPCS C1713,,"155.054  -  BEACON 5.0MM POSTED SCREW, 40MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.055,SUP,HCPCS C1713,,"155.055  -  BEACON 5.0MM POSTED SCREW, 45MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.056,SUP,HCPCS C1713,,"155.056  -  BEACON 5.0MM POSTED SCREW, 50MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.057,SUP,HCPCS C1713,,"155.057  -  BEACON 5.0MM POSTED SCREW, 55MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.071,SUP,HCPCS C1713,,"155.071  -  BEACON 7.5MM POSTED SCREW, 70MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.072,SUP,HCPCS C1713,,"155.072  -  BEACON 7.5MM POSTED SCREW, 75MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.073,SUP,HCPCS C1713,,"155.073  -  BEACON 7.5MM POSTED SCREW, 80MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.074,SUP,HCPCS C1713,,"155.074  -  BEACON 7.5MM POSTED SCREW, 85MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.075,SUP,HCPCS C1713,,"155.075  -  BEACON 7.5MM POSTED SCREW, 90MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.081,SUP,HCPCS C1713,,"155.081  -  BEACON 8.5MM POSTED SCREW, 70MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.082,SUP,HCPCS C1713,,"155.082  -  BEACON 8.5MM POSTED SCREW, 75MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.083,SUP,HCPCS C1713,,"155.083  -  BEACON 8.5MM POSTED SCREW, 80MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.084,SUP,HCPCS C1713,,"155.084  -  BEACON 8.5MM POSTED SCREW, 85MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.085,SUP,HCPCS C1713,,"155.085  -  BEACON 8.5MM POSTED SCREW, 90MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.091,SUP,HCPCS C1713,,"155.091  -  BEACON 9.5MM POSTED SCREW, 70MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.092,SUP,HCPCS C1713,,"155.092  -  BEACON 9.5MM POSTED SCREW, 75MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.093,SUP,HCPCS C1713,,"155.093  -  BEACON 9.5MM POSTED SCREW, 80MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.094,SUP,HCPCS C1713,,"155.094  -  BEACON 9.5MM POSTED SCREW, 85MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.095,SUP,HCPCS C1713,,"155.095  -  BEACON 9.5MM POSTED SCREW, 90MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.101,SUP,Custom 27803010,,"155.101  -  BEACON 5.5MM STRAIGHT CLAMP, LARGE","$4,995.00",$0.00,"$4,995.00",$0.00,"$3,564.93",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,995.00",$0.00,"$2,497.50","$3,956.04","$3,996.00",$0.00,$0.00,$0.00,$0.00,$0.00
155.102,SUP,Custom 27803010,,"155.102  -  BEACON 5.5MM STRAIGHT CLAMP, MEDIUM","$4,995.00",$0.00,"$4,995.00",$0.00,"$3,564.93",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,995.00",$0.00,"$2,497.50","$3,956.04","$3,996.00",$0.00,$0.00,$0.00,$0.00,$0.00
155.103,SUP,Custom 27803010,,"155.103  -  BEACON 5.5MM STRAIGHT CLAMP, SMALL","$4,995.00",$0.00,"$4,995.00",$0.00,"$3,564.93",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,995.00",$0.00,"$2,497.50","$3,956.04","$3,996.00",$0.00,$0.00,$0.00,$0.00,$0.00
155.104,SUP,Custom 27803010,,"155.104  -  BEACON 5.5MM LEFT OFFSET CLAMP, LARGE","$4,995.00",$0.00,"$4,995.00",$0.00,"$3,564.93",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,995.00",$0.00,"$2,497.50","$3,956.04","$3,996.00",$0.00,$0.00,$0.00,$0.00,$0.00
155.105,SUP,Custom 27803010,,"155.105  -  BEACON 5.5MM LEFT OFFSET CLAMP, MEDIUM","$4,995.00",$0.00,"$4,995.00",$0.00,"$3,564.93",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,995.00",$0.00,"$2,497.50","$3,956.04","$3,996.00",$0.00,$0.00,$0.00,$0.00,$0.00
155.106,SUP,Custom 27803010,,"155.106  -  BEACON 5.5MM LEFT OFFSET CLAMP, SMALL","$4,995.00",$0.00,"$4,995.00",$0.00,"$3,564.93",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,995.00",$0.00,"$2,497.50","$3,956.04","$3,996.00",$0.00,$0.00,$0.00,$0.00,$0.00
155.107,SUP,Custom 27803010,,"155.107  -  BEACON 5.5MM RIGHT OFFSET CLAMP, LARGE","$4,995.00",$0.00,"$4,995.00",$0.00,"$3,564.93",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,995.00",$0.00,"$2,497.50","$3,956.04","$3,996.00",$0.00,$0.00,$0.00,$0.00,$0.00
155.108,SUP,Custom 27803010,,"155.108  -  BEACON 5.5MM RIGHT OFFSET CLAMP, MEDIUM","$4,995.00",$0.00,"$4,995.00",$0.00,"$3,564.93",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,995.00",$0.00,"$2,497.50","$3,956.04","$3,996.00",$0.00,$0.00,$0.00,$0.00,$0.00
155.109,SUP,Custom 27803010,,"155.109  -  BEACON 5.5MM RIGHT OFFSET CLAMP, SMALL","$4,995.00",$0.00,"$4,995.00",$0.00,"$3,564.93",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,995.00",$0.00,"$2,497.50","$3,956.04","$3,996.00",$0.00,$0.00,$0.00,$0.00,$0.00
155.111,SUP,Custom 27803010,,"155.111  -  BEACON 6.35MM STRAIGHT CLAMP, LARGE","$4,995.00",$0.00,"$4,995.00",$0.00,"$3,564.93",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,995.00",$0.00,"$2,497.50","$3,956.04","$3,996.00",$0.00,$0.00,$0.00,$0.00,$0.00
155.112,SUP,Custom 27803010,,"155.112  -  BEACON 6.35MM STRAIGHT CLAMP, MEDIUM","$4,995.00",$0.00,"$4,995.00",$0.00,"$3,564.93",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,995.00",$0.00,"$2,497.50","$3,956.04","$3,996.00",$0.00,$0.00,$0.00,$0.00,$0.00
155.113,SUP,Custom 27803010,,"155.113  -  BEACON 6.35MM STRAIGHT CLAMP, SMALL","$4,995.00",$0.00,"$4,995.00",$0.00,"$3,564.93",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,995.00",$0.00,"$2,497.50","$3,956.04","$3,996.00",$0.00,$0.00,$0.00,$0.00,$0.00
155.114,SUP,Custom 27803010,,"155.114  -  BEACON 6.35MM LEFT OFFSET CLAMP, LARGE","$4,995.00",$0.00,"$4,995.00",$0.00,"$3,564.93",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,995.00",$0.00,"$2,497.50","$3,956.04","$3,996.00",$0.00,$0.00,$0.00,$0.00,$0.00
155.115,SUP,Custom 27803010,,"155.115  -  BEACON 6.35MM LEFT OFFSET CLAMP, MEDIUM","$4,995.00",$0.00,"$4,995.00",$0.00,"$3,564.93",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,995.00",$0.00,"$2,497.50","$3,956.04","$3,996.00",$0.00,$0.00,$0.00,$0.00,$0.00
155.116,SUP,Custom 27803010,,"155.116  -  BEACON 6.35MM LEFT OFFSET CLAMP, SMALL","$4,995.00",$0.00,"$4,995.00",$0.00,"$3,564.93",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,995.00",$0.00,"$2,497.50","$3,956.04","$3,996.00",$0.00,$0.00,$0.00,$0.00,$0.00
155.117,SUP,Custom 27803010,,"155.117  -  BEACON 6.35MM RIGHT OFFSET CLAMP, LARGE","$4,995.00",$0.00,"$4,995.00",$0.00,"$3,564.93",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,995.00",$0.00,"$2,497.50","$3,956.04","$3,996.00",$0.00,$0.00,$0.00,$0.00,$0.00
155.118,SUP,Custom 27803010,,"155.118  -  BEACON 6.35MM RIGHT OFFSET CLAMP, MEDIUM","$4,995.00",$0.00,"$4,995.00",$0.00,"$3,564.93",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,995.00",$0.00,"$2,497.50","$3,956.04","$3,996.00",$0.00,$0.00,$0.00,$0.00,$0.00
155.119,SUP,Custom 27803010,,"155.119  -  BEACON 6.35MM RIGHT OFFSET CLAMP, SMALL","$4,995.00",$0.00,"$4,995.00",$0.00,"$3,564.93",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,995.00",$0.00,"$2,497.50","$3,956.04","$3,996.00",$0.00,$0.00,$0.00,$0.00,$0.00
155.151,SUP,HCPCS C1713,,"155.151  -  BEACON 5.0MM REDUCTION SCREW, 25MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
155.152,SUP,HCPCS C1713,,"155.152  -  BEACON 5.0MM REDUCTION SCREW, 30MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
155.153,SUP,HCPCS C1713,,"155.153  -  BEACON 5.0MM REDUCTION SCREW, 35MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
155.154,SUP,HCPCS C1713,,"155.154  -  BEACON 5.0MM REDUCTION SCREW, 40MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
155.155,SUP,HCPCS C1713,,"155.155  -  BEACON 5.0MM REDUCTION SCREW, 45MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
155.156,SUP,HCPCS C1713,,"155.156  -  BEACON 5.0MM REDUCTION SCREW, 50MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
155.157,SUP,HCPCS C1713,,"155.157  -  BEACON 5.0MM REDUCTION SCREW, 55MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
155.171,SUP,HCPCS C1713,,"155.171  -  BEACON 7.5MM REDUCTION SCREW, 70MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
155.172,SUP,HCPCS C1713,,"155.172  -  BEACON 7.5MM REDUCTION SCREW, 75MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
155.173,SUP,HCPCS C1713,,"155.173  -  BEACON 7.5MM REDUCTION SCREW, 80MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
155.174,SUP,HCPCS C1713,,"155.174  -  BEACON 7.5MM REDUCTION SCREW, 85MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
155.175,SUP,HCPCS C1713,,"155.175  -  BEACON 7.5MM REDUCTION SCREW, 90MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
155.181,SUP,HCPCS C1713,,"155.181  -  BEACON 8.5MM REDUCTION SCREW, 70MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
155.182,SUP,HCPCS C1713,,"155.182  -  BEACON 8.5MM REDUCTION SCREW, 75MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
155.183,SUP,HCPCS C1713,,"155.183  -  BEACON 8.5MM REDUCTION SCREW, 80MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
155.184,SUP,HCPCS C1713,,"155.184  -  BEACON 8.5MM REDUCTION SCREW, 85MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
155.185,SUP,HCPCS C1713,,"155.185  -  BEACON 8.5MM REDUCTION SCREW, 90MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
155.341,SUP,HCPCS C1713,,"155.341  -  BEACON 4.5MM REDUCTION SCREW, 25MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
155.342,SUP,HCPCS C1713,,"155.342  -  BEACON 4.5MM REDUCTION SCREW, 30MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
155.343,SUP,HCPCS C1713,,"155.343  -  BEACON 4.5MM REDUCTION SCREW, 35MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
155.344,SUP,HCPCS C1713,,"155.344  -  BEACON 4.5MM REDUCTION SCREW, 40MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
155.345,SUP,HCPCS C1713,,"155.345  -  BEACON 4.5MM REDUCTION SCREW, 45MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
155.351,SUP,HCPCS C1713,,"155.351  -  BEACON 5.5MM REDUCTION SCREW, 25MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
155.352,SUP,HCPCS C1713,,"155.352  -  BEACON 5.5MM REDUCTION SCREW, 30MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
155.353,SUP,HCPCS C1713,,"155.353  -  BEACON 5.5MM REDUCTION SCREW, 35MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
155.354,SUP,HCPCS C1713,,"155.354  -  BEACON 5.5MM REDUCTION SCREW, 40MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
155.355,SUP,HCPCS C1713,,"155.355  -  BEACON 5.5MM REDUCTION SCREW, 45MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
155.356,SUP,HCPCS C1713,,"155.356  -  BEACON 5.5MM REDUCTION SCREW, 50MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
155.357,SUP,HCPCS C1713,,"155.357  -  BEACON 5.5MM REDUCTION SCREW, 55MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
155.361,SUP,HCPCS C1713,,"155.361  -  BEACON 6.5MM REDUCTION SCREW, 25MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
155.362,SUP,HCPCS C1713,,"155.362  -  BEACON 6.5MM REDUCTION SCREW, 30MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
155.363,SUP,HCPCS C1713,,"155.363  -  BEACON 6.5MM REDUCTION SCREW, 35MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
155.364,SUP,HCPCS C1713,,"155.364  -  BEACON 6.5MM REDUCTION SCREW, 40MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
155.365,SUP,HCPCS C1713,,"155.365  -  BEACON 6.5MM REDUCTION SCREW, 45MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
155.366,SUP,HCPCS C1713,,"155.366  -  BEACON 6.5MM REDUCTION SCREW, 50MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
155.367,SUP,HCPCS C1713,,"155.367  -  BEACON 6.5MM REDUCTION SCREW, 55MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
155.368,SUP,HCPCS C1713,,"155.368  -  BEACON 6.5MM REDUCTION SCREW, 60MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
155.369,SUP,HCPCS C1713,,"155.369  -  BEACON 6.5MM REDUCTION SCREW, 65MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
155.371,SUP,HCPCS C1713,,"155.371  -  BEACON 7.5MM REDUCTION SCREW, 25MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
155.372,SUP,HCPCS C1713,,"155.372  -  BEACON 7.5MM REDUCTION SCREW, 30MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
155.373,SUP,HCPCS C1713,,"155.373  -  BEACON 7.5MM REDUCTION SCREW, 35MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
155.374,SUP,HCPCS C1713,,"155.374  -  BEACON 7.5MM REDUCTION SCREW, 40MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
155.375,SUP,HCPCS C1713,,"155.375  -  BEACON 7.5MM REDUCTION SCREW, 45MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
155.376,SUP,HCPCS C1713,,"155.376  -  BEACON 7.5MM REDUCTION SCREW, 50MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
155.377,SUP,HCPCS C1713,,"155.377  -  BEACON 7.5MM REDUCTION SCREW, 55MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
155.378,SUP,HCPCS C1713,,"155.378  -  BEACON 7.5MM REDUCTION SCREW, 60MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
155.379,SUP,HCPCS C1713,,"155.379  -  BEACON 7.5MM REDUCTION SCREW, 65MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
155.381,SUP,HCPCS C1713,,"155.381  -  BEACON 8.5MM REDUCTION SCREW, 25MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
155.382,SUP,HCPCS C1713,,"155.382  -  BEACON 8.5MM REDUCTION SCREW, 30MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
155.383,SUP,HCPCS C1713,,"155.383  -  BEACON 8.5MM REDUCTION SCREW, 35MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
155.384,SUP,HCPCS C1713,,"155.384  -  BEACON 8.5MM REDUCTION SCREW, 40MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
155.385,SUP,HCPCS C1713,,"155.385  -  BEACON 8.5MM REDUCTION SCREW, 45MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
155.386,SUP,HCPCS C1713,,"155.386  -  BEACON 8.5MM REDUCTION SCREW, 50MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
155.387,SUP,HCPCS C1713,,"155.387  -  BEACON 8.5MM REDUCTION SCREW, 55MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
155.388,SUP,HCPCS C1713,,"155.388  -  BEACON 8.5MM REDUCTION SCREW, 60MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
155.389,SUP,HCPCS C1713,,"155.389  -  BEACON 8.5MM REDUCTION SCREW, 65MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
155.441,SUP,HCPCS C1713,,"155.441  -  BEACON 4.5MM POSTED SCREW, 25MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.442,SUP,HCPCS C1713,,"155.442  -  BEACON 4.5MM POSTED SCREW, 30MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.443,SUP,HCPCS C1713,,"155.443  -  BEACON 4.5MM POSTED SCREW, 35MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.444,SUP,HCPCS C1713,,"155.444  -  BEACON 4.5MM POSTED SCREW, 40MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.445,SUP,HCPCS C1713,,"155.445  -  BEACON 4.5MM POSTED SCREW, 45MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.451,SUP,HCPCS C1713,,"155.451  -  BEACON 5.5MM POSTED SCREW, 25MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.452,SUP,HCPCS C1713,,"155.452  -  BEACON 5.5MM POSTED SCREW, 30MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.453,SUP,HCPCS C1713,,"155.453  -  BEACON 5.5MM POSTED SCREW, 35MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.454,SUP,HCPCS C1713,,"155.454  -  BEACON 5.5MM POSTED SCREW, 40MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.455,SUP,HCPCS C1713,,"155.455  -  BEACON 5.5MM POSTED SCREW, 45MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.456,SUP,HCPCS C1713,,"155.456  -  BEACON 5.5MM POSTED SCREW, 50MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.457,SUP,HCPCS C1713,,"155.457  -  BEACON 5.5MM POSTED SCREW, 55MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.461,SUP,HCPCS C1713,,"155.461  -  BEACON 6.5MM POSTED SCREW, 25MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.462,SUP,HCPCS C1713,,"155.462  -  BEACON 6.5MM POSTED SCREW, 30MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.463,SUP,HCPCS C1713,,"155.463  -  BEACON 6.5MM POSTED SCREW, 35MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.464,SUP,HCPCS C1713,,"155.464  -  BEACON 6.5MM POSTED SCREW, 40MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.465,SUP,HCPCS C1713,,"155.465  -  BEACON 6.5MM POSTED SCREW, 45MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.466,SUP,HCPCS C1713,,"155.466  -  BEACON 6.5MM POSTED SCREW, 50MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.467,SUP,HCPCS C1713,,"155.467  -  BEACON 6.5MM POSTED SCREW, 55MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.468,SUP,HCPCS C1713,,"155.468  -  BEACON 6.5MM POSTED SCREW, 60MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.469,SUP,HCPCS C1713,,"155.469  -  BEACON 6.5MM POSTED SCREW, 65MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.471,SUP,HCPCS C1713,,"155.471  -  BEACON 7.5MM POSTED SCREW, 25MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.472,SUP,HCPCS C1713,,"155.472  -  BEACON 7.5MM POSTED SCREW, 30MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.473,SUP,HCPCS C1713,,"155.473  -  BEACON 7.5MM POSTED SCREW, 35MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.474,SUP,HCPCS C1713,,"155.474  -  BEACON 7.5MM POSTED SCREW, 40MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.475,SUP,HCPCS C1713,,"155.475  -  BEACON 7.5MM POSTED SCREW, 45MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.476,SUP,HCPCS C1713,,"155.476  -  BEACON 7.5MM POSTED SCREW, 50MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.477,SUP,HCPCS C1713,,"155.477  -  BEACON 7.5MM POSTED SCREW, 55MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.478,SUP,HCPCS C1713,,"155.478  -  BEACON 7.5MM POSTED SCREW, 60MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.479,SUP,HCPCS C1713,,"155.479  -  BEACON 7.5MM POSTED SCREW, 65MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.481,SUP,HCPCS C1713,,"155.481  -  BEACON 8.5MM POSTED SCREW, 25MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.482,SUP,HCPCS C1713,,"155.482  -  BEACON 8.5MM POSTED SCREW, 30MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.483,SUP,HCPCS C1713,,"155.483  -  BEACON 8.5MM POSTED SCREW, 35MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.484,SUP,HCPCS C1713,,"155.484  -  BEACON 8.5MM POSTED SCREW, 40MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.485,SUP,HCPCS C1713,,"155.485  -  BEACON 8.5MM POSTED SCREW, 45MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.486,SUP,HCPCS C1713,,"155.486  -  BEACON 8.5MM POSTED SCREW, 50MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.487,SUP,HCPCS C1713,,"155.487  -  BEACON 8.5MM POSTED SCREW, 55MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.488,SUP,HCPCS C1713,,"155.488  -  BEACON 8.5MM POSTED SCREW, 60MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.489,SUP,HCPCS C1713,,"155.489  -  BEACON 8.5MM POSTED SCREW, 65MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.491,SUP,HCPCS C1713,,"155.491  -  BEACON 9.5MM POSTED SCREW, 25MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.492,SUP,HCPCS C1713,,"155.492  -  BEACON 9.5MM POSTED SCREW, 30MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.493,SUP,HCPCS C1713,,"155.493  -  BEACON 9.5MM POSTED SCREW, 35MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.494,SUP,HCPCS C1713,,"155.494  -  BEACON 9.5MM POSTED SCREW, 40MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.495,SUP,HCPCS C1713,,"155.495  -  BEACON 9.5MM POSTED SCREW, 45MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.496,SUP,HCPCS C1713,,"155.496  -  BEACON 9.5MM POSTED SCREW, 50MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.497,SUP,HCPCS C1713,,"155.497  -  BEACON 9.5MM POSTED SCREW, 55MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.498,SUP,HCPCS C1713,,"155.498  -  BEACON 9.5MM POSTED SCREW, 60MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.499,SUP,HCPCS C1713,,"155.499  -  BEACON 9.5MM POSTED SCREW, 65MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.51,SUP,Custom 27803010,,"155.510  -  6.35MM STRAIGHT ROD, 100MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
155.512,SUP,Custom 27803010,,"155.512  -  6.35MM STRAIGHT ROD, 125MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
155.515,SUP,Custom 27803010,,155.515  -  ROD SPNL STRG 6.35MM 150MM BCN HEX END,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
155.517,SUP,Custom 27803010,,"155.517  -  6.35MM STRAIGHT ROD, HEX END, 200MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
155.519,SUP,Custom 27803010,,"155.519  -  6.35MM STRAIGHT ROD, HEX END, 300MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
155.52,SUP,Custom 27803010,,"155.520  -  6.35MM STRAIGHT ROD, HEX END, 400MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
155.521,SUP,Custom 27803010,,"155.521  -  6.35MM STRAIGHT ROD, HEX END, 500MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
155.53,SUP,Custom 27803010,,"155.530  -  6.35MM STRAIGHT ROD, 30MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
155.535,SUP,Custom 27803010,,"155.535  -  6.35MM STRAIGHT ROD, 35MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
155.54,SUP,Custom 27803010,,"155.540  -  6.35MM STRAIGHT ROD, 40MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
155.545,SUP,Custom 27803010,,"155.545  -  6.35MM STRAIGHT ROD, 45MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
155.55,SUP,Custom 27803010,,"155.550  -  6.35MM STRAIGHT ROD, 50MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
155.555,SUP,Custom 27803010,,"155.555  -  6.35MM STRAIGHT ROD, 55MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
155.56,SUP,Custom 27803010,,"155.560  -  6.35MM STRAIGHT ROD, 60MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
155.565,SUP,Custom 27803010,,"155.565  -  6.35MM STRAIGHT ROD, 65MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
155.57,SUP,Custom 27803010,,"155.570  -  6.35MM STRAIGHT ROD, 70MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
155.575,SUP,Custom 27803010,,"155.575  -  6.35MM STRAIGHT ROD, 75MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
155.58,SUP,Custom 27803010,,"155.580  -  6.35MM STRAIGHT ROD, 80MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
155.585,SUP,Custom 27803010,,"155.585  -  6.35MM STRAIGHT ROD, 85MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
155.61,SUP,Custom 27803010,,"155.610  -  6.35MM CURVED ROD, 100MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
155.635,SUP,Custom 27803010,,"155.635  -  6.35MM CURVED ROD, 35MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
155.64,SUP,Custom 27803010,,"155.640  -  6.35MM CURVED ROD, 40MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
155.645,SUP,Custom 27803010,,"155.645  -  6.35MM CURVED ROD, 45MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
155.65,SUP,Custom 27803010,,"155.650  -  6.35MM CURVED ROD, 50MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
155.655,SUP,Custom 27803010,,"155.655  -  6.35MM CURVED ROD, 55MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
155.66,SUP,Custom 27803010,,"155.660  -  6.35MM CURVED ROD, 60MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
155.665,SUP,Custom 27803010,,"155.665  -  6.35MM CURVED ROD, 65MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
155.67,SUP,Custom 27803010,,"155.670  -  6.35MM CURVED ROD, 70MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
155.675,SUP,Custom 27803010,,"155.675  -  6.35MM CURVED ROD, 75MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
155.68,SUP,Custom 27803010,,"155.680  -  6.35MM CURVED ROD, 80MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
155.685,SUP,Custom 27803010,,"155.685  -  6.35MM CURVED ROD, 85MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
155.69,SUP,Custom 27803010,,"155.690  -  6.35MM CURVED ROD, 90MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
155.695,SUP,HCPCS C1713,,"155.695  -  6.35MM CURVED ROD, 95MM",$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
155.761,SUP,HCPCS C1713,,"155.761  -  BEACON 6.5MM POSTED SCREW, 17MM SHANK, 25MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.762,SUP,HCPCS C1713,,"155.762  -  BEACON 6.5MM POSTED SCREW, 17MM SHANK, 30MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.763,SUP,HCPCS C1713,,"155.763  -  BEACON 6.5MM POSTED SCREW, 17MM SHANK, 35MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.764,SUP,HCPCS C1713,,"155.764  -  BEACON 6.5MM POSTED SCREW, 17MM SHANK, 40MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.765,SUP,HCPCS C1713,,"155.765  -  BEACON 6.5MM POSTED SCREW, 17MM SHANK, 45MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.766,SUP,HCPCS C1713,,"155.766  -  BEACON 6.5MM POSTED SCREW, 17MM SHANK, 50MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.767,SUP,HCPCS C1713,,"155.767  -  BEACON 6.5MM POSTED SCREW, 17MM SHANK, 55MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.768,SUP,HCPCS C1713,,"155.768  -  BEACON 6.5MM POSTED SCREW, 17MM SHANK, 60MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.769,SUP,HCPCS C1713,,"155.769  -  BEACON 6.5MM POSTED SCREW, 17MM SHANK, 65MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.771,SUP,HCPCS C1713,,"155.771  -  BEACON 7.5MM POSTED SCREW, 17MM SHANK, 25MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.772,SUP,HCPCS C1713,,"155.772  -  BEACON 7.5MM POSTED SCREW, 17MM SHANK, 30MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.773,SUP,HCPCS C1713,,"155.773  -  BEACON 7.5MM POSTED SCREW, 17MM SHANK, 35MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.774,SUP,HCPCS C1713,,"155.774  -  BEACON 7.5MM POSTED SCREW, 17MM SHANK, 40MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.775,SUP,HCPCS C1713,,"155.775  -  BEACON 7.5MM POSTED SCREW, 17MM SHANK, 45MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.776,SUP,HCPCS C1713,,"155.776  -  BEACON 7.5MM POSTED SCREW, 17MM SHANK, 50MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.777,SUP,HCPCS C1713,,"155.777  -  BEACON 7.5MM POSTED SCREW, 17MM SHANK, 55MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.778,SUP,HCPCS C1713,,"155.778  -  BEACON 7.5MM POSTED SCREW, 17MM SHANK, 60MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.779,SUP,HCPCS C1713,,"155.779  -  BEACON 7.5MM POSTED SCREW, 17MM SHANK, 65MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
155.95,SUP,Custom 27803010,,"155.950  -  BEACON 5.5MM OFFSET CONNECTOR, OPEN, 15MM","$1,410.00",$0.00,"$1,410.00",$0.00,"$1,006.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,410.00",$0.00,$705.00,"$1,116.72","$1,128.00",$0.00,$0.00,$0.00,$0.00,$0.00
155.951,SUP,Custom 27803010,,"155.951  -  BEACON 5.5MM OFFSET CONNECTOR, OPEN, 20MM","$1,410.00",$0.00,"$1,410.00",$0.00,"$1,006.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,410.00",$0.00,$705.00,"$1,116.72","$1,128.00",$0.00,$0.00,$0.00,$0.00,$0.00
155.952,SUP,Custom 27803010,,"155.952  -  BEACON 5.5MM OFFSET CONNECTOR, OPEN, 25MM","$1,410.00",$0.00,"$1,410.00",$0.00,"$1,006.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,410.00",$0.00,$705.00,"$1,116.72","$1,128.00",$0.00,$0.00,$0.00,$0.00,$0.00
155.953,SUP,Custom 27803010,,"155.953  -  BEACON 5.5MM OFFSET CONNECTOR, OPEN, 30MM","$1,410.00",$0.00,"$1,410.00",$0.00,"$1,006.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,410.00",$0.00,$705.00,"$1,116.72","$1,128.00",$0.00,$0.00,$0.00,$0.00,$0.00
155.954,SUP,Custom 27803010,,"155.954  -  BEACON 5.5MM OFFSET CONNECTOR, OPEN, 35MM","$1,410.00",$0.00,"$1,410.00",$0.00,"$1,006.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,410.00",$0.00,$705.00,"$1,116.72","$1,128.00",$0.00,$0.00,$0.00,$0.00,$0.00
155.96,SUP,Custom 27803010,,"155.960  -  BEACON 5.5MM OFFSET CONNECTOR, CLOSED, 15MM","$1,410.00",$0.00,"$1,410.00",$0.00,"$1,006.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,410.00",$0.00,$705.00,"$1,116.72","$1,128.00",$0.00,$0.00,$0.00,$0.00,$0.00
155.961,SUP,Custom 27803010,,"155.961  -  BEACON 5.5MM OFFSET CONNECTOR, CLOSED, 20MM","$1,410.00",$0.00,"$1,410.00",$0.00,"$1,006.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,410.00",$0.00,$705.00,"$1,116.72","$1,128.00",$0.00,$0.00,$0.00,$0.00,$0.00
155.962,SUP,Custom 27803010,,"155.962  -  BEACON 5.5MM OFFSET CONNECTOR, CLOSED, 25MM","$1,410.00",$0.00,"$1,410.00",$0.00,"$1,006.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,410.00",$0.00,$705.00,"$1,116.72","$1,128.00",$0.00,$0.00,$0.00,$0.00,$0.00
155.963,SUP,Custom 27803010,,"155.963  -  BEACON 5.5MM OFFSET CONNECTOR, CLOSED, 30MM","$1,410.00",$0.00,"$1,410.00",$0.00,"$1,006.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,410.00",$0.00,$705.00,"$1,116.72","$1,128.00",$0.00,$0.00,$0.00,$0.00,$0.00
155.964,SUP,Custom 27803010,,"155.964  -  BEACON 5.5MM OFFSET CONNECTOR, CLOSED, 35MM","$1,410.00",$0.00,"$1,410.00",$0.00,"$1,006.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,410.00",$0.00,$705.00,"$1,116.72","$1,128.00",$0.00,$0.00,$0.00,$0.00,$0.00
155.97,SUP,Custom 27803010,,"155.970  -  BEACON 6.35MM OFFSET CONNECTOR, OPEN, 15MM","$1,410.00",$0.00,"$1,410.00",$0.00,"$1,006.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,410.00",$0.00,$705.00,"$1,116.72","$1,128.00",$0.00,$0.00,$0.00,$0.00,$0.00
155.971,SUP,Custom 27803010,,"155.971  -  BEACON 6.35MM OFFSET CONNECTOR, OPEN, 20MM","$1,410.00",$0.00,"$1,410.00",$0.00,"$1,006.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,410.00",$0.00,$705.00,"$1,116.72","$1,128.00",$0.00,$0.00,$0.00,$0.00,$0.00
155.972,SUP,Custom 27803010,,"155.972  -  BEACON 6.35MM OFFSET CONNECTOR, OPEN, 25MM","$1,410.00",$0.00,"$1,410.00",$0.00,"$1,006.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,410.00",$0.00,$705.00,"$1,116.72","$1,128.00",$0.00,$0.00,$0.00,$0.00,$0.00
155.973,SUP,Custom 27803010,,"155.973  -  BEACON 6.35MM OFFSET CONNECTOR, OPEN, 30MM","$1,410.00",$0.00,"$1,410.00",$0.00,"$1,006.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,410.00",$0.00,$705.00,"$1,116.72","$1,128.00",$0.00,$0.00,$0.00,$0.00,$0.00
155.974,SUP,Custom 27803010,,"155.974  -  BEACON 6.35 OFFSET CONNECTOR, OPEN, 35MM","$1,410.00",$0.00,"$1,410.00",$0.00,"$1,006.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,410.00",$0.00,$705.00,"$1,116.72","$1,128.00",$0.00,$0.00,$0.00,$0.00,$0.00
155.98,SUP,Custom 27803010,,"155.980  -  BEACON 6.35MM OFFSET CONNECTOR, CLOSED, 15MM","$1,410.00",$0.00,"$1,410.00",$0.00,"$1,006.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,410.00",$0.00,$705.00,"$1,116.72","$1,128.00",$0.00,$0.00,$0.00,$0.00,$0.00
155.981,SUP,Custom 27803010,,"155.981  -  BEACON 6.35MM OFFSET CONNECTOR, CLOSED, 20MM","$1,410.00",$0.00,"$1,410.00",$0.00,"$1,006.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,410.00",$0.00,$705.00,"$1,116.72","$1,128.00",$0.00,$0.00,$0.00,$0.00,$0.00
155.982,SUP,Custom 27803010,,"155.982  -  BEACON 6.35MM OFFSET CONNECTOR, CLOSED, 25MM","$1,410.00",$0.00,"$1,410.00",$0.00,"$1,006.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,410.00",$0.00,$705.00,"$1,116.72","$1,128.00",$0.00,$0.00,$0.00,$0.00,$0.00
155.983,SUP,Custom 27803010,,"155.983  -  BEACON 6.35MM OFFSET CONNECTOR, CLOSED, 30MM","$1,410.00",$0.00,"$1,410.00",$0.00,"$1,006.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,410.00",$0.00,$705.00,"$1,116.72","$1,128.00",$0.00,$0.00,$0.00,$0.00,$0.00
155.984,SUP,Custom 27803010,,"155.984  -  BEACON 6.35MM OFFSET CONNECTOR, CLOSED, 35MM","$1,410.00",$0.00,"$1,410.00",$0.00,"$1,006.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,410.00",$0.00,$705.00,"$1,116.72","$1,128.00",$0.00,$0.00,$0.00,$0.00,$0.00
170.051,SUP,HCPCS C1713,,170.051  -  REVERE 5.0MM UNIPLANAR FRACTURE REDUCTION SCREW 25MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
170.052,SUP,HCPCS C1713,,170.052  -  REVERE 5.0MM UNIPLANAR FRACTURE REDUCTION SCREW 30MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
170.053,SUP,HCPCS C1713,,170.053  -  REVERE 5.0MM UNIPLANAR FRACTURE REDUCTION SCREW 35MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
170.054,SUP,HCPCS C1713,,170.054  -  REVERE 5.0MM UNIPLANAR FRACTURE REDUCTION SCREW 40MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
170.055,SUP,HCPCS C1713,,170.055  -  REVERE 5.0MM UNIPLANAR FRACTURE REDUCTION SCREW 45MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
170.056,SUP,HCPCS C1713,,170.056  -  REVERE 5.0MM UNIPLANAR FRACTURE REDUCTION SCREW 50MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
170.057,SUP,HCPCS C1713,,170.057  -  REVERE 5.0MM UNIPLANAR FRACTURE REDUCTION SCREW 55MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
170.141,SUP,HCPCS C1713,,170.141  -  REVERE 4.5MM UNIPLANAR FRACTURE REDUCTION SCREW 25MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
170.142,SUP,HCPCS C1713,,170.142  -  REVERE 4.5MM UNIPLANAR FRACTURE REDUCTION SCREW 30MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
170.143,SUP,HCPCS C1713,,170.143  -  REVERE 4.5MM UNIPLANAR FRACTURE REDUCTION SCREW 35MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
170.144,SUP,HCPCS C1713,,170.144  -  REVERE 4.5MM UNIPLANAR FRACTURE REDUCTION SCREW 40MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
170.145,SUP,HCPCS C1713,,170.145  -  REVERE 4.5MM UNIPLANAR FRACTURE REDUCTION SCREW 45MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
170.146,SUP,HCPCS C1713,,170.146  -  REVERE 4.5MM UNIPLANAR FRACTURE REDUCTION SCREW 50MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
170.147,SUP,HCPCS C1713,,170.147  -  REVERE 4.5MM UNIPLANAR FRACTURE REDUCTION SCREW 55MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
170.151,SUP,HCPCS C1713,,170.151  -  REVERE 5.5MM UNIPLANAR FRACTURE REDUCTION SCREW 25MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
170.152,SUP,HCPCS C1713,,170.152  -  REVERE 5.5MM UNIPLANAR FRACTURE REDUCTION SCREW 30MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
170.153,SUP,HCPCS C1713,,170.153  -  REVERE 5.5MM UNIPLANAR FRACTURE REDUCTION SCREW 35MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
170.154,SUP,HCPCS C1713,,170.154  -  REVERE 5.5MM UNIPLANAR FRACTURE REDUCTION SCREW 40MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
170.155,SUP,HCPCS C1713,,170.155  -  REVERE 5.5MM UNIPLANAR FRACTURE REDUCTION SCREW 45MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
170.156,SUP,HCPCS C1713,,170.156  -  REVERE 5.5MM UNIPLANAR FRACTURE REDUCTION SCREW 50MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
170.157,SUP,HCPCS C1713,,170.157  -  REVERE 5.5MM UNIPLANAR FRACTURE REDUCTION SCREW 55MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
170.161,SUP,HCPCS C1713,,170.161  -  REVERE 6.5MM UNIPLANAR FRACTURE REDUCTION SCREW 25MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
170.162,SUP,HCPCS C1713,,170.162  -  REVERE 6.5MM UNIPLANAR FRACTURE REDUCTION SCREW 30MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
170.163,SUP,HCPCS C1713,,170.163  -  REVERE 6.5MM UNIPLANAR FRACTURE REDUCTION SCREW 35MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
170.164,SUP,HCPCS C1713,,170.164  -  REVERE 6.5MM UNIPLANAR FRACTURE REDUCTION SCREW 40MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
170.165,SUP,HCPCS C1713,,170.165  -  REVERE 6.5MM UNIPLANAR FRACTURE REDUCTION SCREW 45MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
170.166,SUP,HCPCS C1713,,170.166  -  REVERE 6.5MM UNIPLANAR FRACTURE REDUCTION SCREW 50MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
170.167,SUP,HCPCS C1713,,170.167  -  REVERE 6.5MM UNIPLANAR FRACTURE REDUCTION SCREW 55MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
171.012,SUP,HCPCS C1713,,"171.012  -  VIP 4.6MM VARIABLE ANGLE SCREW, SELF-DRILLING, 12MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
171.014,SUP,HCPCS C1713,,"171.014  -  VIP 4.6MM VARIABLE ANGLE SCREW, SELF-DRILLING, 14MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
171.016,SUP,HCPCS C1713,,"171.016  -  VIP 4.6MM VARIABLE ANGLE SCREW, SELF-DRILLING, 16MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
171.113,SUP,HCPCS C1713,,"171.113  -  VIP ANTERIOR CERVICAL PLATE 1-LEVEL, 13MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
171.115,SUP,HCPCS C1713,,"171.115  -  VIP ANTERIOR CERVICAL PLATE 1-LEVEL, 15MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
171.117,SUP,HCPCS C1713,,"171.117  -  VIP ANTERIOR CERVICAL PLATE 1-LEVEL, 17MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
171.119,SUP,HCPCS C1713,,"171.119  -  VIP ANTERIOR CERVICAL PLATE 1-LEVEL, 19MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
171.121,SUP,HCPCS C1713,,"171.121  -  VIP ANTERIOR CERVICAL PLATE 1-LEVEL, 21MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
171.123,SUP,HCPCS C1713,,"171.123  -  VIP ANTERIOR CERVICAL PLATE 1-LEVEL, 23MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
171.125,SUP,HCPCS C1713,,"171.125  -  VIP ANTERIOR CERVICAL PLATE 1-LEVEL, 25MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
171.163,SUP,HCPCS C1713,,"171.163  -  VIP ANTERIOR CERVICAL PLATE 1-LEVEL, 13MM, EXTRA LORDOTIC","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
171.165,SUP,HCPCS C1713,,"171.165  -  VIP ANTERIOR CERVICAL PLATE 1-LEVEL, 15MM, EXTRA LORDOTIC","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
171.167,SUP,HCPCS C1713,,"171.167  -  VIP ANTERIOR CERVICAL PLATE 1-LEVEL, 17MM, EXTRA LORDOTIC","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
171.169,SUP,HCPCS C1713,,"171.169  -  VIP ANTERIOR CERVICAL PLATE 1-LEVEL, 19MM, EXTRA LORDOTIC","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
171.226,SUP,HCPCS C1713,,"171.226  -  VIP CERVICAL PLATE 2-LEVEL, 26MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
171.228,SUP,HCPCS C1713,,"171.228  -  VIP CERVICAL PLATE 2-LEVEL, 28MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
171.23,SUP,HCPCS C1713,,"171.230  -  VIP CERVICAL PLATE 2-LEVEL, 30MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
171.232,SUP,HCPCS C1713,,"171.232  -  VIP CERVICAL PLATE 2-LEVEL, 32MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
171.234,SUP,HCPCS C1713,,"171.234  -  VIP CERVICAL PLATE 2-LEVEL, 34MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
171.236,SUP,HCPCS C1713,,"171.236  -  VIP CERVICAL PLATE 2-LEVEL, 36MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
171.238,SUP,HCPCS C1713,,"171.238  -  VIP CERVICAL PLATE 2-LEVEL, 38MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
171.24,SUP,HCPCS C1713,,"171.240  -  VIP CERVICAL PLATE 2-LEVEL, 40MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
171.242,SUP,HCPCS C1713,,"171.242  -  VIP CERVICAL PLATE 2-LEVEL, 42MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
171.244,SUP,HCPCS C1713,,"171.244  -  VIP CERVICAL PLATE 2-LEVEL, 44MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
171.246,SUP,HCPCS C1713,,"171.246  -  VIP CERVICAL PLATE 2-LEVEL, 46MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
171.276,SUP,HCPCS C1713,,"171.276  -  VIP ANTERIOR CERVICAL PLATE 2-LEVEL, 26MM, EXTRA LORDOTIC","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
171.278,SUP,HCPCS C1713,,"171.278  -  VIP ANTERIOR CERVICAL PLATE 2-LEVEL, 28MM, EXTRA LORDOTIC","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
171.28,SUP,HCPCS C1713,,"171.280  -  VIP ANTERIOR CERVICAL PLATE 2-LEVEL, 30MM, EXTRA LORDOTIC","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
171.282,SUP,HCPCS C1713,,"171.282  -  VIP ANTERIOR CERVICAL PLATE 2-LEVEL, 32MM, EXTRA LORDOTIC","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
171.312,SUP,HCPCS C1713,,"171.312  -  VIP 4.6MM VARIABLE ANGLE SCREW, SELF-TAPPING, 12MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
171.314,SUP,HCPCS C1713,,"171.314  -  VIP 4.6MM VARIABLE ANGLE SCREW, SELF-TAPPING, 14MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
171.316,SUP,HCPCS C1713,,"171.316  -  VIP 4.6MM VARIABLE ANGLE SCREW, SELF-TAPPING, 16MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
171.318,SUP,HCPCS C1713,,"171.318  -  VIP 4.6MM VARIABLE ANGLE SCREW, SELF-TAPPING, 18MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
171.32,SUP,HCPCS C1713,,"171.320  -  VIP 4.6MM VARIABLE ANGLE SCREW, SELF-TAPPING, 20MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
171.322,SUP,HCPCS C1713,,"171.322  -  VIP 4.6MM VARIABLE ANGLE SCREW, SELF-TAPPING, 22MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
171.324,SUP,HCPCS C1713,,"171.324  -  VIP 4.6MM VARIABLE ANGLE SCREW, SELF-TAPPING, 24MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
171.326,SUP,HCPCS C1713,,"171.326  -  VIP 4.6MM VARIABLE ANGLE SCREW, SELF-TAPPING, 26MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
171.412,SUP,HCPCS C1713,,"171.412  -  VIP 5.1MM VARIABLE ANGLE SCREW, SELF-DRILLING, 12MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
171.414,SUP,HCPCS C1713,,"171.414  -  VIP 5.1MM VARIABLE ANGLE SCREW, SELF-DRILLING, 14MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
171.416,SUP,HCPCS C1713,,"171.416  -  VIP 5.1MM VARIABLE ANGLE SCREW, SELF-DRILLING, 16MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
171.512,SUP,HCPCS C1713,,"171.512  -  VIP 5.1MM VARIABLE ANGLE SCREW, SELF-TAPPING, 12MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
171.514,SUP,HCPCS C1713,,"171.514  -  VIP 5.1MM VARIABLE ANGLE SCREW, SELF-TAPPING, 14MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
171.516,SUP,HCPCS C1713,,"171.516  -  VIP 5.1MM VARIABLE ANGLE SCREW, SELF-TAPPING, 16MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
171.518,SUP,HCPCS C1713,,"171.518  -  VIP 5.1MM VARIABLE ANGLE SCREW, SELF-TAPPING, 18MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
171.52,SUP,HCPCS C1713,,"171.520  -  VIP 5.1MM VARIABLE ANGLE SCREW, SELF-TAPPING, 20MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
171.522,SUP,HCPCS C1713,,"171.522  -  VIP 5.1MM VARIABLE ANGLE SCREW, SELF-TAPPING, 22MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
171.524,SUP,HCPCS C1713,,"171.524  -  VIP 5.1MM VARIABLE ANGLE SCREW, SELF-TAPPING, 24MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
171.526,SUP,HCPCS C1713,,"171.526  -  VIP 5.1MM VARIABLE ANGLE SCREW, SELF-TAPPING, 26MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
171.612,SUP,HCPCS C1713,,"171.612  -  VIP 4.6MM FIXED ANGLE SCREW, SELF-DRILLING, 12MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
171.614,SUP,HCPCS C1713,,"171.614  -  VIP 4.6MM FIXED ANGLE SCREW, SELF-DRILLING, 14MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
171.616,SUP,HCPCS C1713,,"171.616  -  VIP 4.6MM FIXED ANGLE SCREW, SELF-DRILLING, 16MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
171.712,SUP,HCPCS C1713,,"171.712  -  VIP 4.6MM FIXED ANGLE SCREW, SELF-TAPPING, 12MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
171.714,SUP,HCPCS C1713,,"171.714  -  VIP 4.6MM FIXED ANGLE SCREW, SELF-TAPPING, 14MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
171.716,SUP,HCPCS C1713,,"171.716  -  VIP 4.6MM FIXED ANGLE SCREW, SELF-TAPPING, 16MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
171.718,SUP,HCPCS C1713,,"171.718  -  VIP 4.6MM FIXED ANGLE SCREW, SELF-TAPPING, 18MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
171.72,SUP,HCPCS C1713,,"171.720  -  VIP 4.6MM FIXED ANGLE SCREW, SELF-TAPPING, 20MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
171.722,SUP,HCPCS C1713,,"171.722  -  VIP 4.6MM FIXED ANGLE SCREW, SELF-TAPPING, 22MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
171.724,SUP,HCPCS C1713,,"171.724  -  VIP 4.6MM FIXED ANGLE SCREW, SELF-TAPPING, 24MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
171.726,SUP,HCPCS C1713,,"171.726  -  VIP 4.6MM FIXED ANGLE SCREW, SELF-TAPPING, 26MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
171.812,SUP,HCPCS C1713,,"171.812  -  VIP 5.1MM FIXED ANGLE SCREW, SELF-DRILLING, 12MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
171.814,SUP,HCPCS C1713,,"171.814  -  VIP 5.1MM FIXED ANGLE SCREW, SELF-DRILLING, 14MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
171.816,SUP,HCPCS C1713,,"171.816  -  VIP 5.1MM FIXED ANGLE SCREW, SELF-DRILLING, 16MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
171.912,SUP,HCPCS C1713,,"171.912  -  VIP 5.1MM FIXED ANGLE SCREW, SELF-TAPPING, 12MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
171.914,SUP,HCPCS C1713,,"171.914  -  VIP 5.1MM FIXED ANGLE SCREW, SELF-TAPPING, 14MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
171.916,SUP,HCPCS C1713,,"171.916  -  VIP 5.1MM FIXED ANGLE SCREW, SELF-TAPPING, 16MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
171.918,SUP,HCPCS C1713,,"171.918  -  VIP 5.1MM FIXED ANGLE SCREW, SELF-TAPPING, 18MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
171.92,SUP,HCPCS C1713,,"171.920  -  VIP 5.1MM FIXED ANGLE SCREW, SELF-TAPPING, 20MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
171.922,SUP,HCPCS C1713,,"171.922  -  VIP 5.1MM FIXED ANGLE SCREW, SELF-TAPPING, 22MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
171.924,SUP,HCPCS C1713,,"171.924  -  VIP 5.1MM FIXED ANGLE SCREW, SELF-TAPPING, 24MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
171.926,SUP,HCPCS C1713,,"171.926  -  VIP 5.1MM FIXED ANGLE SCREW, SELF-TAPPING, 26MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
172.511,SUP,Custom 27803010,,"172.511  -  H-LINK 05.5MM ROD, 38MM-51MM X 40MM","$5,527.50",$0.00,"$5,527.50",$0.00,"$3,944.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,527.50",$0.00,"$2,763.75","$4,377.78","$4,422.00",$0.00,$0.00,$0.00,$0.00,$0.00
172.512,SUP,Custom 27803010,,"172.512  -  H-LINK 05.5MM ROD, 48MM-61MM X 40MM","$5,527.50",$0.00,"$5,527.50",$0.00,"$3,944.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,527.50",$0.00,"$2,763.75","$4,377.78","$4,422.00",$0.00,$0.00,$0.00,$0.00,$0.00
172.513,SUP,Custom 27803010,,"172.513  -  H-LINK 05.5MM ROD, 58MM-71MM X 40MM","$5,527.50",$0.00,"$5,527.50",$0.00,"$3,944.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,527.50",$0.00,"$2,763.75","$4,377.78","$4,422.00",$0.00,$0.00,$0.00,$0.00,$0.00
172.521,SUP,Custom 27803010,,"172.521  -  H-LINK 05.5MM ROD, 38MM-51MM X 45MM","$5,527.50",$0.00,"$5,527.50",$0.00,"$3,944.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,527.50",$0.00,"$2,763.75","$4,377.78","$4,422.00",$0.00,$0.00,$0.00,$0.00,$0.00
172.522,SUP,Custom 27803010,,"172.522  -  H-LINK 05.5MM ROD, 48MM-61MM X 45MM","$5,527.50",$0.00,"$5,527.50",$0.00,"$3,944.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,527.50",$0.00,"$2,763.75","$4,377.78","$4,422.00",$0.00,$0.00,$0.00,$0.00,$0.00
172.523,SUP,Custom 27803010,,"172.523  -  H-LINK 05.5MM ROD, 58MM-71MM X 45MM","$5,527.50",$0.00,"$5,527.50",$0.00,"$3,944.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,527.50",$0.00,"$2,763.75","$4,377.78","$4,422.00",$0.00,$0.00,$0.00,$0.00,$0.00
172.531,SUP,Custom 27803010,,"172.531  -  H-LINK 05.5MM ROD, 38MM-51MM X 35MM","$5,527.50",$0.00,"$5,527.50",$0.00,"$3,944.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,527.50",$0.00,"$2,763.75","$4,377.78","$4,422.00",$0.00,$0.00,$0.00,$0.00,$0.00
172.532,SUP,Custom 27803010,,"172.532  -  H-LINK 05.5MM ROD, 48MM-61MM X 35MM","$5,527.50",$0.00,"$5,527.50",$0.00,"$3,944.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,527.50",$0.00,"$2,763.75","$4,377.78","$4,422.00",$0.00,$0.00,$0.00,$0.00,$0.00
172.533,SUP,Custom 27803010,,"172.533  -  H-LINK 05.5MM ROD, 58MM-71MM X 35MM","$5,527.50",$0.00,"$5,527.50",$0.00,"$3,944.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,527.50",$0.00,"$2,763.75","$4,377.78","$4,422.00",$0.00,$0.00,$0.00,$0.00,$0.00
172.581,SUP,Custom 27803010,,"172.581  -  H-LINK 05.5MM ROD, 38MM-51MM X 100MM","$5,527.50",$0.00,"$5,527.50",$0.00,"$3,944.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,527.50",$0.00,"$2,763.75","$4,377.78","$4,422.00",$0.00,$0.00,$0.00,$0.00,$0.00
172.582,SUP,Custom 27803010,,"172.582  -  H-LINK 05.5MM ROD, 48MM-61MM X 100MM","$5,527.50",$0.00,"$5,527.50",$0.00,"$3,944.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,527.50",$0.00,"$2,763.75","$4,377.78","$4,422.00",$0.00,$0.00,$0.00,$0.00,$0.00
172.583,SUP,Custom 27803010,,"172.583  -  H-LINK 05.5MM ROD, 58MM-71MM X 100MM","$5,527.50",$0.00,"$5,527.50",$0.00,"$3,944.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,527.50",$0.00,"$2,763.75","$4,377.78","$4,422.00",$0.00,$0.00,$0.00,$0.00,$0.00
172.611,SUP,Custom 27803010,,"172.611  -  H-LINK 06.35MM ROD, 38MM-51MM X 40MM","$5,527.50",$0.00,"$5,527.50",$0.00,"$3,944.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,527.50",$0.00,"$2,763.75","$4,377.78","$4,422.00",$0.00,$0.00,$0.00,$0.00,$0.00
172.612,SUP,Custom 27803010,,"172.612  -  H-LINK 06.35MM ROD, 48MM-61MM X 40MM","$5,527.50",$0.00,"$5,527.50",$0.00,"$3,944.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,527.50",$0.00,"$2,763.75","$4,377.78","$4,422.00",$0.00,$0.00,$0.00,$0.00,$0.00
172.613,SUP,Custom 27803010,,"172.613  -  H-LINK 06.35MM ROD, 58MM-71MM X 40MM","$5,527.50",$0.00,"$5,527.50",$0.00,"$3,944.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,527.50",$0.00,"$2,763.75","$4,377.78","$4,422.00",$0.00,$0.00,$0.00,$0.00,$0.00
172.621,SUP,Custom 27803010,,"172.621  -  H-LINK 06.35MM ROD, 38MM-51MM X 45MM","$5,527.50",$0.00,"$5,527.50",$0.00,"$3,944.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,527.50",$0.00,"$2,763.75","$4,377.78","$4,422.00",$0.00,$0.00,$0.00,$0.00,$0.00
172.622,SUP,Custom 27803010,,"172.622  -  H-LINK 06.35MM ROD, 48MM-61MM X 45MM","$5,527.50",$0.00,"$5,527.50",$0.00,"$3,944.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,527.50",$0.00,"$2,763.75","$4,377.78","$4,422.00",$0.00,$0.00,$0.00,$0.00,$0.00
172.623,SUP,Custom 27803010,,"172.623  -  H-LINK 06.35MM ROD, 58MM-71MM X 45MM","$5,527.50",$0.00,"$5,527.50",$0.00,"$3,944.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,527.50",$0.00,"$2,763.75","$4,377.78","$4,422.00",$0.00,$0.00,$0.00,$0.00,$0.00
172.681,SUP,Custom 27803010,,"172.681  -  H-LINK 06.35MM ROD, 38MM-51MM X 100MM","$5,527.50",$0.00,"$5,527.50",$0.00,"$3,944.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,527.50",$0.00,"$2,763.75","$4,377.78","$4,422.00",$0.00,$0.00,$0.00,$0.00,$0.00
172.682,SUP,Custom 27803010,,"172.682  -  H-LINK 06.35MM ROD, 48MM-61MM X 100MM","$5,527.50",$0.00,"$5,527.50",$0.00,"$3,944.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,527.50",$0.00,"$2,763.75","$4,377.78","$4,422.00",$0.00,$0.00,$0.00,$0.00,$0.00
172.683,SUP,Custom 27803010,,"172.683  -  H-LINK 06.35MM ROD, 58MM-71MM X 100MM","$5,527.50",$0.00,"$5,527.50",$0.00,"$3,944.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,527.50",$0.00,"$2,763.75","$4,377.78","$4,422.00",$0.00,$0.00,$0.00,$0.00,$0.00
176.12,SUP,HCPCS C1713,,"176.120  -  BONE SCREW, FIXED ANGLE 5.5MM, 20MM","$1,692.50",$0.00,"$1,692.50",$761.63,"$1,207.94",$0.00,$291.61,$0.00,$0.00,$296.34,"$1,692.50",$0.00,$846.25,"$1,340.46","$1,354.00",$0.00,$264.88,$0.00,$269.45,$0.00
176.125,SUP,HCPCS C1713,,"176.125  -  BONE SCREW, FIXED ANGLE 5.5MM, 25MM","$1,692.50",$0.00,"$1,692.50",$761.63,"$1,207.94",$0.00,$291.61,$0.00,$0.00,$296.34,"$1,692.50",$0.00,$846.25,"$1,340.46","$1,354.00",$0.00,$264.88,$0.00,$269.45,$0.00
176.13,SUP,HCPCS C1713,,"176.130  -  BONE SCREW, FIXED ANGLE 5.5MM, 30MM","$1,692.50",$0.00,"$1,692.50",$761.63,"$1,207.94",$0.00,$291.61,$0.00,$0.00,$296.34,"$1,692.50",$0.00,$846.25,"$1,340.46","$1,354.00",$0.00,$264.88,$0.00,$269.45,$0.00
176.135,SUP,HCPCS C1713,,"176.135  -  BONE SCREW, FIXED ANGLE 5.5MM, 35MM","$1,692.50",$0.00,"$1,692.50",$761.63,"$1,207.94",$0.00,$291.61,$0.00,$0.00,$296.34,"$1,692.50",$0.00,$846.25,"$1,340.46","$1,354.00",$0.00,$264.88,$0.00,$269.45,$0.00
176.14,SUP,HCPCS C1713,,"176.140  -  BONE SCREW, FIXED ANGLE 5.5MM, 40MM","$1,692.50",$0.00,"$1,692.50",$761.63,"$1,207.94",$0.00,$291.61,$0.00,$0.00,$296.34,"$1,692.50",$0.00,$846.25,"$1,340.46","$1,354.00",$0.00,$264.88,$0.00,$269.45,$0.00
176.145,SUP,HCPCS C1713,,"176.145  -  BONE SCREW, FIXED ANGLE 5.5MM, 45MM","$1,692.50",$0.00,"$1,692.50",$761.63,"$1,207.94",$0.00,$291.61,$0.00,$0.00,$296.34,"$1,692.50",$0.00,$846.25,"$1,340.46","$1,354.00",$0.00,$264.88,$0.00,$269.45,$0.00
176.15,SUP,HCPCS C1713,,"176.150  -  BONE SCREW, FIXED ANGLE 5.5MM, 50MM","$1,692.50",$0.00,"$1,692.50",$761.63,"$1,207.94",$0.00,$291.61,$0.00,$0.00,$296.34,"$1,692.50",$0.00,$846.25,"$1,340.46","$1,354.00",$0.00,$264.88,$0.00,$269.45,$0.00
176.22,SUP,HCPCS C1713,,"176.220  -  BONE SCREW, VARIABLE ANGLE 5.5MM, 20MM","$1,692.50",$0.00,"$1,692.50",$761.63,"$1,207.94",$0.00,$291.61,$0.00,$0.00,$296.34,"$1,692.50",$0.00,$846.25,"$1,340.46","$1,354.00",$0.00,$264.88,$0.00,$269.45,$0.00
176.225,SUP,HCPCS C1713,,"176.225  -  BONE SCREW, VARIABLE ANGLE 5.5MM, 25MM","$1,692.50",$0.00,"$1,692.50",$761.63,"$1,207.94",$0.00,$291.61,$0.00,$0.00,$296.34,"$1,692.50",$0.00,$846.25,"$1,340.46","$1,354.00",$0.00,$264.88,$0.00,$269.45,$0.00
176.23,SUP,HCPCS C1713,,"176.230  -  BONE SCREW, VARIABLE ANGLE 5.5MM, 30MM","$1,692.50",$0.00,"$1,692.50",$761.63,"$1,207.94",$0.00,$291.61,$0.00,$0.00,$296.34,"$1,692.50",$0.00,$846.25,"$1,340.46","$1,354.00",$0.00,$264.88,$0.00,$269.45,$0.00
176.235,SUP,HCPCS C1713,,"176.235  -  BONE SCREW, VARIABLE ANGLE 5.5MM, 35MM","$1,692.50",$0.00,"$1,692.50",$761.63,"$1,207.94",$0.00,$291.61,$0.00,$0.00,$296.34,"$1,692.50",$0.00,$846.25,"$1,340.46","$1,354.00",$0.00,$264.88,$0.00,$269.45,$0.00
176.24,SUP,HCPCS C1713,,"176.240  -  BONE SCREW, VARIABLE ANGLE 5.5MM, 40MM","$1,692.50",$0.00,"$1,692.50",$761.63,"$1,207.94",$0.00,$291.61,$0.00,$0.00,$296.34,"$1,692.50",$0.00,$846.25,"$1,340.46","$1,354.00",$0.00,$264.88,$0.00,$269.45,$0.00
176.245,SUP,HCPCS C1713,,"176.245  -  BONE SCREW, VARIABLE ANGLE 5.5MM, 45MM","$1,692.50",$0.00,"$1,692.50",$761.63,"$1,207.94",$0.00,$291.61,$0.00,$0.00,$296.34,"$1,692.50",$0.00,$846.25,"$1,340.46","$1,354.00",$0.00,$264.88,$0.00,$269.45,$0.00
176.25,SUP,HCPCS C1713,,"176.250  -  BONE SCREW, VARIABLE ANGLE 5.5MM, 50MM","$1,692.50",$0.00,"$1,692.50",$761.63,"$1,207.94",$0.00,$291.61,$0.00,$0.00,$296.34,"$1,692.50",$0.00,$846.25,"$1,340.46","$1,354.00",$0.00,$264.88,$0.00,$269.45,$0.00
182.222,SUP,HCPCS C1713,,"182.222  -  3.5MM ELLIPSE POLYAXIAL SHOULDER SCREW, 22MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.224,SUP,HCPCS C1713,,"182.224  -  3.5MM ELLIPSE POLYAXIAL SHOULDER SCREW, 24MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.226,SUP,HCPCS C1713,,"182.226  -  3.5MM ELLIPSE POLYAXIAL SHOULDER SCREW, 26MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.228,SUP,HCPCS C1713,,"182.228  -  3.5MM ELLIPSE POLYAXIAL SHOULDER SCREW, 28MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.23,SUP,HCPCS C1713,,"182.230  -  3.5MM ELLIPSE POLYAXIAL SHOULDER SCREW, 30MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.232,SUP,HCPCS C1713,,"182.232  -  3.5MM ELLIPSE POLYAXIAL SHOULDER SCREW, 32MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.234,SUP,HCPCS C1713,,"182.234  -  3.5MM ELLIPSE POLYAXIAL SHOULDER SCREW, 34MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.236,SUP,HCPCS C1713,,"182.236  -  3.5MM ELLIPSE POLYAXIAL SHOULDER SCREW, 36MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.308,SUP,HCPCS C1713,,"182.308  -  3.5MM ELLIPSE POLYAXIAL SCREW, 8MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.31,SUP,HCPCS C1713,,"182.310  -  3.5MM ELLIPSE POLYAXIAL SCREW, 10MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.312,SUP,HCPCS C1713,,"182.312  -  3.5MM ELLIPSE POLYAXIAL SCREW, 12MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.314,SUP,HCPCS C1713,,"182.314  -  3.5MM ELLIPSE POLYAXIAL SCREW, 14MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.316,SUP,HCPCS C1713,,"182.316  -  3.5MM ELLIPSE POLYAXIAL SCREW, 16MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.318,SUP,HCPCS C1713,,"182.318  -  3.5MM ELLIPSE POLYAXIAL SCREW, 18MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.32,SUP,HCPCS C1713,,"182.320  -  3.5MM ELLIPSE POLYAXIAL SCREW, 20MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.322,SUP,HCPCS C1713,,"182.322  -  3.5MM ELLIPSE POLYAXIAL SCREW, 22MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.324,SUP,HCPCS C1713,,"182.324  -  3.5MM ELLIPSE POLYAXIAL SCREW, 24MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.326,SUP,HCPCS C1713,,"182.326  -  3.5MM ELLIPSE POLYAXIAL SCREW, 26MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.328,SUP,HCPCS C1713,,"182.328  -  3.5MM ELLIPSE POLYAXIAL SCREW, 28MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.33,SUP,HCPCS C1713,,"182.330  -  3.5MM ELLIPSE POLYAXIAL SCREW, 30MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.332,SUP,HCPCS C1713,,"182.332  -  3.5MM ELLIPSE POLYAXIAL SCREW, 32MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.334,SUP,HCPCS C1713,,"182.334  -  3.5MM ELLIPSE POLYAXIAL SCREW, 34MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.336,SUP,HCPCS C1713,,"182.336  -  3.5MM ELLIPSE POLYAXIAL SCREW, 36MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.338,SUP,HCPCS C1713,,"182.338  -  3.5MM ELLIPSE POLYAXIAL SCREW, 38MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.34,SUP,HCPCS C1713,,"182.340  -  3.5MM ELLIPSE POLYAXIAL SCREW, 40MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.342,SUP,HCPCS C1713,,"182.342  -  3.5MM ELLIPSE POLYAXIAL SCREW, 42MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.344,SUP,HCPCS C1713,,"182.344  -  3.5MM ELLIPSE POLYAXIAL SCREW, 44MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.346,SUP,HCPCS C1713,,"182.346  -  3.5MM ELLIPSE POLYAXIAL SCREW, 46MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.348,SUP,HCPCS C1713,,"182.348  -  3.5MM ELLIPSE POLYAXIAL SCREW, 48MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.35,SUP,HCPCS C1713,,"182.350  -  3.5MM ELLIPSE POLYAXIAL SCREW, 50MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.41,SUP,HCPCS C1713,,"182.410  -  4.0MM ELLIPSE POLYAXIAL SCREW, 10MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.412,SUP,HCPCS C1713,,"182.412  -  4.0MM ELLIPSE POLYAXIAL SCREW, 12MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.414,SUP,HCPCS C1713,,"182.414  -  4.0MM ELLIPSE POLYAXIAL SCREW, 14MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.416,SUP,HCPCS C1713,,"182.416  -  4.0MM ELLIPSE POLYAXIAL SCREW, 16MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.418,SUP,HCPCS C1713,,"182.418  -  4.0MM ELLIPSE POLYAXIAL SCREW, 18MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.42,SUP,HCPCS C1713,,"182.420  -  4.0MM ELLIPSE POLYAXIAL SCREW, 20MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.422,SUP,HCPCS C1713,,"182.422  -  4.0MM ELLIPSE POLYAXIAL SCREW, 22MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.424,SUP,HCPCS C1713,,"182.424  -  4.0MM ELLIPSE POLYAXIAL SCREW, 24MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.426,SUP,HCPCS C1713,,"182.426  -  4.0MM ELLIPSE POLYAXIAL SCREW, 26MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.428,SUP,HCPCS C1713,,"182.428  -  4.0MM ELLIPSE POLYAXIAL SCREW, 28MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.43,SUP,HCPCS C1713,,"182.430  -  4.0MM ELLIPSE POLYAXIAL SCREW, 30MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.432,SUP,HCPCS C1713,,"182.432  -  4.0MM ELLIPSE POLYAXIAL SCREW, 32MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.434,SUP,HCPCS C1713,,"182.434  -  4.0MM ELLIPSE POLYAXIAL SCREW, 34MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.436,SUP,HCPCS C1713,,"182.436  -  4.0MM ELLIPSE POLYAXIAL SCREW, 36MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.438,SUP,HCPCS C1713,,"182.438  -  4.0MM ELLIPSE POLYAXIAL SCREW, 38MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.44,SUP,HCPCS C1713,,"182.440  -  4.0MM ELLIPSE POLYAXIAL SCREW, 40MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.442,SUP,HCPCS C1713,,"182.442  -  4.0MM ELLIPSE POLYAXIAL SCREW, 42MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.444,SUP,HCPCS C1713,,"182.444  -  4.0MM ELLIPSE POLYAXIAL SCREW, 44MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.446,SUP,HCPCS C1713,,"182.446  -  4.0MM ELLIPSE POLYAXIAL SCREW, 46MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.448,SUP,HCPCS C1713,,"182.448  -  4.0MM ELLIPSE POLYAXIAL SCREW, 48MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.45,SUP,HCPCS C1713,,"182.450  -  4.0MM ELLIPSE POLYAXIAL SCREW, 50MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.5,SUP,HCPCS C1713,,182.500  -  ELLIPSE LOCKING CAP,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
182.501,SUP,Custom 27803010,,182.501  -  ELLIPSE INLINE HOOK,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
182.503,SUP,Custom 27803010,,"182.503  -  ELLIPSE INLINE HOOK, RIGHT","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
182.504,SUP,Custom 27803010,,"182.504  -  ELLIPSE INLINE HOOK, LEFT","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
182.506,SUP,Custom 27803010,,"182.506  -  ELLIPSE OFFSET HOOK, LEFT, 7MM","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
182.507,SUP,Custom 27803010,,"182.507  -  ELLIPSE OFFSET HOOK, LEFT, 5MM","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
182.508,SUP,Custom 27803010,,"182.508  -  ELLIPSE OFFSET HOOK, RIGHT, 7MM","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
182.509,SUP,Custom 27803010,,"182.509  -  ELLIPSE OFFSET HOOK, RIGHT, 5MM","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
182.51,SUP,HCPCS C1713,,"182.510  -  4.5MM ELLIPSE POLYAXIAL SCREW, 10MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.512,SUP,HCPCS C1713,,"182.512  -  4.5MM ELLIPSE POLYAXIAL SCREW, 12MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.514,SUP,HCPCS C1713,,"182.514  -  4.5MM ELLIPSE POLYAXIAL SCREW, 14MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.516,SUP,HCPCS C1713,,"182.516  -  4.5MM ELLIPSE POLYAXIAL SCREW, 16MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.518,SUP,HCPCS C1713,,"182.518  -  4.5MM ELLIPSE POLYAXIAL SCREW, 18MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.52,SUP,HCPCS C1713,,"182.520  -  4.5MM ELLIPSE POLYAXIAL SCREW, 20MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.522,SUP,HCPCS C1713,,"182.522  -  4.5MM ELLIPSE POLYAXIAL SCREW, 22MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.524,SUP,HCPCS C1713,,"182.524  -  4.5MM ELLIPSE POLYAXIAL SCREW, 24MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.526,SUP,HCPCS C1713,,"182.526  -  4.5MM ELLIPSE POLYAXIAL SCREW, 26MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.528,SUP,HCPCS C1713,,"182.528  -  4.5MM ELLIPSE POLYAXIAL SCREW, 28MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.53,SUP,HCPCS C1713,,"182.530  -  4.5MM ELLIPSE POLYAXIAL SCREW, 30MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.532,SUP,HCPCS C1713,,"182.532  -  4.5MM ELLIPSE POLYAXIAL SCREW, 32MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.534,SUP,HCPCS C1713,,"182.534  -  4.5MM ELLIPSE POLYAXIAL SCREW, 34MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.536,SUP,HCPCS C1713,,"182.536  -  4.5MM ELLIPSE POLYAXIAL SCREW, 36MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.538,SUP,HCPCS C1713,,"182.538  -  4.5MM ELLIPSE POLYAXIAL SCREW, 38MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.54,SUP,HCPCS C1713,,"182.540  -  4.5MM ELLIPSE POLYAXIAL SCREW, 40MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.542,SUP,HCPCS C1713,,"182.542  -  4.5MM ELLIPSE POLYAXIAL SCREW, 42MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.544,SUP,HCPCS C1713,,"182.544  -  4.5MM ELLIPSE POLYAXIAL SCREW, 44MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.546,SUP,HCPCS C1713,,"182.546  -  4.5MM ELLIPSE POLYAXIAL SCREW, 46MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.548,SUP,HCPCS C1713,,"182.548  -  4.5MM ELLIPSE POLYAXIAL SCREW, 48MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.55,SUP,HCPCS C1713,,"182.550  -  4.5MM ELLIPSE POLYAXIAL SCREW, 50MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
182.801,SUP,Custom 27803010,,"182.801  -  3.5MM ELLIPSE ROD, 80MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
182.802,SUP,Custom 27803010,,"182.802  -  3.5MM ELLIPSE ROD, 120MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
182.803,SUP,Custom 27803010,,"182.803  -  3.5MM ELLIPSE ROD, 240MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
182.804,SUP,Custom 27803010,,"182.804  -  3.5MM ELLIPSE ROD, 40MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
182.9,SUP,Custom 27803010,,182.900  -  ELLIPSE LOCKING CAP FOR HEAD-TO-HEAD T-CONNECTOR,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
182.901,SUP,Custom 27803010,,182.901  -  ELLIPSE LOCKING NUT FOR HEAD-TO-HEAD T-CONNECTOR,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
182.911,SUP,Custom 27803010,,"182.911  -  ELLIPSE HEAD TO HEAD T-CONNECTOR FOR 3.5MM ROD, 21-27MM","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
182.912,SUP,Custom 27803010,,"182.912  -  ELLIPSE HEAD TO HEAD T-CONNECTOR FOR 3.5MM ROD, 27-33MM","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
182.913,SUP,Custom 27803010,,"182.913  -  ELLIPSE HEAD TO HEAD T-CONNECTOR FOR 3.5MM ROD, 33-39MM","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
182.914,SUP,Custom 27803010,,"182.914  -  ELLIPSE HEAD TO HEAD T-CONNECTOR FOR 3.5MM ROD, 39-45MM","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
182.915,SUP,Custom 27803010,,"182.915  -  ELLIPSE HEAD TO HEAD T-CONNECTOR FOR 3.5MM ROD, 45-51MM","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
182.916,SUP,Custom 27803010,,"182.916  -  ELLIPSE HEAD TO HEAD T-CONNECTOR FOR 3.5MM ROD, 51-57MM","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
182.917,SUP,Custom 27803010,,"182.917  -  ELLIPSE HEAD TO HEAD T-CONNECTOR FOR 3.5MM ROD, 57-63MM","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
182.923,SUP,Custom 27803010,,"182.923  -  ELLIPSE TOP-LOADING T-CONNECTOR FOR 3.5MM ROD, 21-33, STRAIG","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
182.924,SUP,Custom 27803010,,"182.924  -  ELLIPSE TOP-LOADING T-CONNECTOR FOR 3.5MM ROD, 26-46, CURVED","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
182.925,SUP,Custom 27803010,,"182.925  -  ELLIPSE TOP-LOADING T-CONNECTOR FOR 3.5MM ROD, 26-46, STRAIG","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
182.926,SUP,Custom 27803010,,"182.926  -  ELLIPSE TOP-LOADING T-CONNECTOR FOR 3.5MM ROD, 36-56, CURVED","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
182.927,SUP,Custom 27803010,,"182.927  -  ELLIPSE TOP-LOADING T-CONNECTOR FOR 3.5MM ROD, 36-56, STRAIG","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
182.95,SUP,HCPCS C1713,,"182.950  -  ELLIPSE OCCIPITAL PLATE, SMALL","$7,145.00",$0.00,"$7,145.00","$3,215.25","$5,099.39",$0.00,"$1,231.05",$0.00,$0.00,"$1,251.03","$7,145.00",$0.00,"$3,572.50","$5,658.84","$5,716.00",$0.00,"$1,118.19",$0.00,"$1,137.48",$0.00
182.952,SUP,HCPCS C1713,,"182.952  -  ELLIPSE OCCIPITAL PLATE, LARGE","$7,145.00",$0.00,"$7,145.00","$3,215.25","$5,099.39",$0.00,"$1,231.05",$0.00,$0.00,"$1,251.03","$7,145.00",$0.00,"$3,572.50","$5,658.84","$5,716.00",$0.00,"$1,118.19",$0.00,"$1,137.48",$0.00
182.953,SUP,Custom 27803010,,182.953  -  ROD SPNL 100D 3.5MM 240MM ELLIPSE OCPTL,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
182.954,SUP,Custom 27803010,,182.954  -  ROD SPNL 115D 3.5MM 240MM ELLIPSE OCPTL,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
182.955,SUP,Custom 27803010,,182.955  -  ROD SPNL 130D 3.5MM 240MM ELLIPSE OCPTL,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
182.96,SUP,Custom 27803010,,182.960  -  ELLIPSE PARALLEL CONNECTOR 3.5MM ROD TO 3.5MM ROD,"$1,357.50",$0.00,"$1,357.50",$0.00,$968.85,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,357.50",$0.00,$678.75,"$1,075.14","$1,086.00",$0.00,$0.00,$0.00,$0.00,$0.00
182.961,SUP,Custom 27803010,,182.961  -  ELLIPSE PARALLEL CONNECTOR 3.5MM ROD TO 4.0MM ROD,"$1,357.50",$0.00,"$1,357.50",$0.00,$968.85,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,357.50",$0.00,$678.75,"$1,075.14","$1,086.00",$0.00,$0.00,$0.00,$0.00,$0.00
182.962,SUP,Custom 27803010,,182.962  -  ELLIPSE PARALLEL CONNECTOR 3.5MM ROD TO 4.5MM ROD,"$1,357.50",$0.00,"$1,357.50",$0.00,$968.85,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,357.50",$0.00,$678.75,"$1,075.14","$1,086.00",$0.00,$0.00,$0.00,$0.00,$0.00
182.963,SUP,Custom 27803010,,182.963  -  ELLIPSE PARALLEL CONNECTOR 3.5MM ROD TO 5.0MM ROD,"$1,357.50",$0.00,"$1,357.50",$0.00,$968.85,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,357.50",$0.00,$678.75,"$1,075.14","$1,086.00",$0.00,$0.00,$0.00,$0.00,$0.00
182.964,SUP,Custom 27803010,,182.964  -  ELLIPSE PARALLEL CONNECTOR 3.5MM ROD TO 5.5MM ROD,"$1,357.50",$0.00,"$1,357.50",$0.00,$968.85,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,357.50",$0.00,$678.75,"$1,075.14","$1,086.00",$0.00,$0.00,$0.00,$0.00,$0.00
182.965,SUP,Custom 27803010,,182.965  -  ELLIPSE PARALLEL CONNECTOR 3.5MM ROD TO 6.0MM ROD,"$1,357.50",$0.00,"$1,357.50",$0.00,$968.85,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,357.50",$0.00,$678.75,"$1,075.14","$1,086.00",$0.00,$0.00,$0.00,$0.00,$0.00
182.966,SUP,Custom 27803010,,182.966  -  ELLIPSE PARALLEL CONNECTOR 3.5MM ROD TO 6.35MM ROD,"$1,357.50",$0.00,"$1,357.50",$0.00,$968.85,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,357.50",$0.00,$678.75,"$1,075.14","$1,086.00",$0.00,$0.00,$0.00,$0.00,$0.00
182.967,SUP,Custom 27803010,,182.967  -  ELLIPSE PARALLEL CONNECTOR 3.5MM ROD TO 6.5MM ROD,"$1,357.50",$0.00,"$1,357.50",$0.00,$968.85,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,357.50",$0.00,$678.75,"$1,075.14","$1,086.00",$0.00,$0.00,$0.00,$0.00,$0.00
182.975,SUP,Custom 27803010,,182.975  -  ELLIPSE LATERAL CONNECTOR,"$1,187.50",$0.00,"$1,187.50",$0.00,$847.52,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,187.50",$0.00,$593.75,$940.50,$950.00,$0.00,$0.00,$0.00,$0.00,$0.00
182.98,SUP,Custom 27803010,,"182.980  -  ELLIPSE TAPERED ROD, 3.5MM TO 4.0MM, 350MM","$1,187.50",$0.00,"$1,187.50",$0.00,$847.52,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,187.50",$0.00,$593.75,$940.50,$950.00,$0.00,$0.00,$0.00,$0.00,$0.00
182.981,SUP,Custom 27803010,,"182.981  -  ELLIPSE TAPERED ROD, 3.5MM TO 4.5MM, 350MM","$1,187.50",$0.00,"$1,187.50",$0.00,$847.52,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,187.50",$0.00,$593.75,$940.50,$950.00,$0.00,$0.00,$0.00,$0.00,$0.00
182.982,SUP,Custom 27803010,,"182.982  -  ELLIPSE TAPERED ROD, 3.5MM TO 5.0MM, 350MM","$1,187.50",$0.00,"$1,187.50",$0.00,$847.52,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,187.50",$0.00,$593.75,$940.50,$950.00,$0.00,$0.00,$0.00,$0.00,$0.00
182.983,SUP,Custom 27803010,,"182.983  -  ELLIPSE TAPERED ROD, 3.5MM TO 5.5MM, 350MM","$1,187.50",$0.00,"$1,187.50",$0.00,$847.52,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,187.50",$0.00,$593.75,$940.50,$950.00,$0.00,$0.00,$0.00,$0.00,$0.00
182.984,SUP,Custom 27803010,,"182.984  -  ELLIPSE TAPERED ROD, 3.5MM TO 6.0MM, 350MM","$1,187.50",$0.00,"$1,187.50",$0.00,$847.52,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,187.50",$0.00,$593.75,$940.50,$950.00,$0.00,$0.00,$0.00,$0.00,$0.00
182.985,SUP,Custom 27803010,,"182.985  -  ELLIPSE TAPERED ROD, 3.5MM TO 6.35MM, 350MM","$1,187.50",$0.00,"$1,187.50",$0.00,$847.52,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,187.50",$0.00,$593.75,$940.50,$950.00,$0.00,$0.00,$0.00,$0.00,$0.00
182.986,SUP,Custom 27803010,,"182.986  -  ELLIPSE TAPERED ROD, 3.5MM TO 6.5MM, 350MM","$1,187.50",$0.00,"$1,187.50",$0.00,$847.52,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,187.50",$0.00,$593.75,$940.50,$950.00,$0.00,$0.00,$0.00,$0.00,$0.00
182.989,SUP,Custom 27803010,,"182.989  -  ELLIPSE TAPERED ROD, 3.5MM TO 5.5MM, 500MM","$1,187.50",$0.00,"$1,187.50",$0.00,$847.52,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,187.50",$0.00,$593.75,$940.50,$950.00,$0.00,$0.00,$0.00,$0.00,$0.00
182.99,SUP,Custom 27803010,,"182.990  -  ELLIPSE LATERAL CONNECTOR, LONG","$1,187.50",$0.00,"$1,187.50",$0.00,$847.52,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,187.50",$0.00,$593.75,$940.50,$950.00,$0.00,$0.00,$0.00,$0.00,$0.00
182.991,SUP,Custom 27803010,,"182.991  -  ELLIPSE LATERAL CONNECTOR, SHORT","$1,187.50",$0.00,"$1,187.50",$0.00,$847.52,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,187.50",$0.00,$593.75,$940.50,$950.00,$0.00,$0.00,$0.00,$0.00,$0.00
184.012,SUP,HCPCS C1713,,"184.012  -  4.2MM BONE SCREW, VARIABLE, SELF-TAPPING, 12MM","$1,312.50",$0.00,"$1,312.50",$590.63,$936.73,$0.00,$226.14,$0.00,$0.00,$229.81,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$205.41,$0.00,$208.95,$0.00
184.014,SUP,HCPCS C1713,,"184.014  -  4.2MM BONE SCREW, VARIABLE, SELF-TAPPING, 14MM","$1,312.50",$0.00,"$1,312.50",$590.63,$936.73,$0.00,$226.14,$0.00,$0.00,$229.81,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$205.41,$0.00,$208.95,$0.00
184.016,SUP,HCPCS C1713,,"184.016  -  4.2MM BONE SCREW, VARIABLE, SELF-TAPPING, 16MM","$1,312.50",$0.00,"$1,312.50",$590.63,$936.73,$0.00,$226.14,$0.00,$0.00,$229.81,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$205.41,$0.00,$208.95,$0.00
184.018,SUP,HCPCS C1713,,"184.018  -  4.2MM BONE SCREW, VARIABLE, SELF-TAPPING, 18MM","$1,312.50",$0.00,"$1,312.50",$590.63,$936.73,$0.00,$226.14,$0.00,$0.00,$229.81,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$205.41,$0.00,$208.95,$0.00
184.02,SUP,HCPCS C1713,,184.020  -  SCREW BN 4.2MM 20MM VA ST SPNE,"$1,312.50",$0.00,"$1,312.50",$590.63,$936.73,$0.00,$226.14,$0.00,$0.00,$229.81,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$205.41,$0.00,$208.95,$0.00
184.032,SUP,HCPCS C1713,,"184.032  -  4.2MM BONE SCREW, FIXED, SELF-TAPPING, 12MM","$1,312.50",$0.00,"$1,312.50",$590.63,$936.73,$0.00,$226.14,$0.00,$0.00,$229.81,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$205.41,$0.00,$208.95,$0.00
184.034,SUP,HCPCS C1713,,"184.034  -  4.2MM BONE SCREW, FIXED, SELF-TAPPING, 14MM","$1,312.50",$0.00,"$1,312.50",$590.63,$936.73,$0.00,$226.14,$0.00,$0.00,$229.81,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$205.41,$0.00,$208.95,$0.00
184.036,SUP,HCPCS C1713,,"184.036  -  4.2MM BONE SCREW, FIXED, SELF-TAPPING, 16MM","$1,312.50",$0.00,"$1,312.50",$590.63,$936.73,$0.00,$226.14,$0.00,$0.00,$229.81,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$205.41,$0.00,$208.95,$0.00
184.038,SUP,HCPCS C1713,,"184.038  -  4.2MM BONE SCREW, FIXED, SELF-TAPPING, 18MM","$1,312.50",$0.00,"$1,312.50",$590.63,$936.73,$0.00,$226.14,$0.00,$0.00,$229.81,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$205.41,$0.00,$208.95,$0.00
184.04,SUP,HCPCS C1713,,184.040  -  SCREW BN 4.2MM 20MM FX ANG ST SPNE,"$1,312.50",$0.00,"$1,312.50",$590.63,$936.73,$0.00,$226.14,$0.00,$0.00,$229.81,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$205.41,$0.00,$208.95,$0.00
184.052,SUP,HCPCS C1713,,"184.052  -  4.2MM BONE SCREW, VARIABLE, SELF-DRILLING, 12MM","$1,312.50",$0.00,"$1,312.50",$590.63,$936.73,$0.00,$226.14,$0.00,$0.00,$229.81,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$205.41,$0.00,$208.95,$0.00
184.054,SUP,HCPCS C1713,,"184.054  -  4.2MM BONE SCREW, VARIABLE, SELF-DRILLING, 14MM","$1,312.50",$0.00,"$1,312.50",$590.63,$936.73,$0.00,$226.14,$0.00,$0.00,$229.81,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$205.41,$0.00,$208.95,$0.00
184.056,SUP,HCPCS C1713,,"184.056  -  4.2MM BONE SCREW, VARIABLE, SELF-DRILLING, 16MM","$1,312.50",$0.00,"$1,312.50",$590.63,$936.73,$0.00,$226.14,$0.00,$0.00,$229.81,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$205.41,$0.00,$208.95,$0.00
184.058,SUP,HCPCS C1713,,"184.058  -  4.2MM BONE SCREW, VARIABLE, SELF-DRILLING, 18MM","$1,312.50",$0.00,"$1,312.50",$590.63,$936.73,$0.00,$226.14,$0.00,$0.00,$229.81,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$205.41,$0.00,$208.95,$0.00
184.06,SUP,HCPCS C1713,,184.060  -  SCREW BN 4.2MM 20MM VA SLF DRL SPNE,"$1,312.50",$0.00,"$1,312.50",$590.63,$936.73,$0.00,$226.14,$0.00,$0.00,$229.81,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$205.41,$0.00,$208.95,$0.00
184.072,SUP,HCPCS C1713,,"184.072  -  4.2MM BONE SCREW, FIXED, SELF-DRILLING, 12MM","$1,312.50",$0.00,"$1,312.50",$590.63,$936.73,$0.00,$226.14,$0.00,$0.00,$229.81,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$205.41,$0.00,$208.95,$0.00
184.074,SUP,HCPCS C1713,,"184.074  -  4.2MM BONE SCREW, FIXED, SELF-DRILLING, 14MM","$1,312.50",$0.00,"$1,312.50",$590.63,$936.73,$0.00,$226.14,$0.00,$0.00,$229.81,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$205.41,$0.00,$208.95,$0.00
184.076,SUP,HCPCS C1713,,"184.076  -  4.2MM BONE SCREW, FIXED, SELF-DRILLING, 16MM","$1,312.50",$0.00,"$1,312.50",$590.63,$936.73,$0.00,$226.14,$0.00,$0.00,$229.81,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$205.41,$0.00,$208.95,$0.00
184.078,SUP,HCPCS C1713,,"184.078  -  4.2MM BONE SCREW, FIXED, SELF-DRILLING, 18MM","$1,312.50",$0.00,"$1,312.50",$590.63,$936.73,$0.00,$226.14,$0.00,$0.00,$229.81,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$205.41,$0.00,$208.95,$0.00
184.08,SUP,HCPCS C1713,,184.080  -  SCREW BN 4.2MM 20MM FX ANG SLF DRL SPNE,"$1,312.50",$0.00,"$1,312.50",$590.63,$936.73,$0.00,$226.14,$0.00,$0.00,$229.81,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$205.41,$0.00,$208.95,$0.00
184.112,SUP,HCPCS C1713,,"184.112  -  3.6MM BONE SCREW, VARIABLE, SELF-TAPPING, 12MM","$1,312.50",$0.00,"$1,312.50",$590.63,$936.73,$0.00,$226.14,$0.00,$0.00,$229.81,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$205.41,$0.00,$208.95,$0.00
184.114,SUP,HCPCS C1713,,"184.114  -  3.6MM BONE SCREW, VARIABLE, SELF-TAPPING, 14MM","$1,312.50",$0.00,"$1,312.50",$590.63,$936.73,$0.00,$226.14,$0.00,$0.00,$229.81,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$205.41,$0.00,$208.95,$0.00
184.116,SUP,HCPCS C1713,,"184.116  -  3.6MM BONE SCREW, VARIABLE, SELF-TAPPING, 16MM","$1,312.50",$0.00,"$1,312.50",$590.63,$936.73,$0.00,$226.14,$0.00,$0.00,$229.81,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$205.41,$0.00,$208.95,$0.00
184.118,SUP,HCPCS C1713,,"184.118  -  3.6MM BONE SCREW, VARIABLE, SELF-TAPPING, 18MM","$1,312.50",$0.00,"$1,312.50",$590.63,$936.73,$0.00,$226.14,$0.00,$0.00,$229.81,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$205.41,$0.00,$208.95,$0.00
184.12,SUP,HCPCS C1713,,184.120  -  SCREW BN 3.6MM 20MM VA ST SPNE,"$1,312.50",$0.00,"$1,312.50",$590.63,$936.73,$0.00,$226.14,$0.00,$0.00,$229.81,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$205.41,$0.00,$208.95,$0.00
184.132,SUP,HCPCS C1713,,"184.132  -  3.6MM BONE SCREW, FIXED, SELF-TAPPING, 12MM","$1,312.50",$0.00,"$1,312.50",$590.63,$936.73,$0.00,$226.14,$0.00,$0.00,$229.81,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$205.41,$0.00,$208.95,$0.00
184.134,SUP,HCPCS C1713,,"184.134  -  3.6MM BONE SCREW, FIXED, SELF-TAPPING, 14MM","$1,312.50",$0.00,"$1,312.50",$590.63,$936.73,$0.00,$226.14,$0.00,$0.00,$229.81,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$205.41,$0.00,$208.95,$0.00
184.136,SUP,HCPCS C1713,,"184.136  -  3.6MM BONE SCREW, FIXED, SELF-TAPPING, 16MM","$1,312.50",$0.00,"$1,312.50",$590.63,$936.73,$0.00,$226.14,$0.00,$0.00,$229.81,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$205.41,$0.00,$208.95,$0.00
184.138,SUP,HCPCS C1713,,"184.138  -  3.6MM BONE SCREW, FIXED, SELF-TAPPING, 18MM","$1,312.50",$0.00,"$1,312.50",$590.63,$936.73,$0.00,$226.14,$0.00,$0.00,$229.81,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$205.41,$0.00,$208.95,$0.00
184.14,SUP,HCPCS C1713,,184.140  -  SCREW BN 3.6MM 20MM FX ANG ST SPNE,"$1,312.50",$0.00,"$1,312.50",$590.63,$936.73,$0.00,$226.14,$0.00,$0.00,$229.81,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$205.41,$0.00,$208.95,$0.00
184.152,SUP,HCPCS C1713,,"184.152  -  3.6MM BONE SCREW, VARIABLE, SELF-DRILLING, 12MM","$1,312.50",$0.00,"$1,312.50",$590.63,$936.73,$0.00,$226.14,$0.00,$0.00,$229.81,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$205.41,$0.00,$208.95,$0.00
184.154,SUP,HCPCS C1713,,"184.154  -  3.6MM BONE SCREW, VARIABLE, SELF-DRILLING, 14MM","$1,312.50",$0.00,"$1,312.50",$590.63,$936.73,$0.00,$226.14,$0.00,$0.00,$229.81,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$205.41,$0.00,$208.95,$0.00
184.156,SUP,HCPCS C1713,,"184.156  -  3.6MM BONE SCREW, VARIABLE, SELF-DRILLING, 16MM","$1,312.50",$0.00,"$1,312.50",$590.63,$936.73,$0.00,$226.14,$0.00,$0.00,$229.81,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$205.41,$0.00,$208.95,$0.00
184.158,SUP,HCPCS C1713,,"184.158  -  3.6MM BONE SCREW, VARIABLE, SELF-DRILLING, 18MM","$1,312.50",$0.00,"$1,312.50",$590.63,$936.73,$0.00,$226.14,$0.00,$0.00,$229.81,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$205.41,$0.00,$208.95,$0.00
184.16,SUP,HCPCS C1713,,184.160  -  SCREW BN 3.6MM 20MM VA SLF DRL SPNE,"$1,312.50",$0.00,"$1,312.50",$590.63,$936.73,$0.00,$226.14,$0.00,$0.00,$229.81,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$205.41,$0.00,$208.95,$0.00
184.172,SUP,HCPCS C1713,,"184.172  -  3.6MM BONE SCREW, FIXED, SELF-DRILLING, 12MM","$1,312.50",$0.00,"$1,312.50",$590.63,$936.73,$0.00,$226.14,$0.00,$0.00,$229.81,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$205.41,$0.00,$208.95,$0.00
184.174,SUP,HCPCS C1713,,"184.174  -  3.6MM BONE SCREW, FIXED, SELF-DRILLING, 14MM","$1,312.50",$0.00,"$1,312.50",$590.63,$936.73,$0.00,$226.14,$0.00,$0.00,$229.81,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$205.41,$0.00,$208.95,$0.00
184.176,SUP,HCPCS C1713,,"184.176  -  3.6MM BONE SCREW, FIXED, SELF-DRILLING, 16MM","$1,312.50",$0.00,"$1,312.50",$590.63,$936.73,$0.00,$226.14,$0.00,$0.00,$229.81,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$205.41,$0.00,$208.95,$0.00
184.178,SUP,HCPCS C1713,,"184.178  -  3.6MM BONE SCREW, FIXED, SELF-DRILLING, 18MM","$1,312.50",$0.00,"$1,312.50",$590.63,$936.73,$0.00,$226.14,$0.00,$0.00,$229.81,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$205.41,$0.00,$208.95,$0.00
184.18,SUP,HCPCS C1713,,184.180  -  SCREW BN 3.6MM 20MM FX ANG SLF DRL SPNE,"$1,312.50",$0.00,"$1,312.50",$590.63,$936.73,$0.00,$226.14,$0.00,$0.00,$229.81,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$205.41,$0.00,$208.95,$0.00
185,SUP,HCPCS C1713,,185.000  -  REVOLVE LOCKING CAP,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
185.081,SUP,HCPCS C1713,,"185.081  -  8.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 70MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
185.082,SUP,HCPCS C1713,,"185.082  -  8.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 75MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
185.083,SUP,HCPCS C1713,,"185.083  -  8.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 80MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
185.084,SUP,HCPCS C1713,,"185.084  -  8.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 85MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
185.085,SUP,HCPCS C1713,,"185.085  -  8.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 90MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
185.24,SUP,Custom 27803010,,"185.240  -  5.5MM REVOLVE ROD, 40MM",$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
185.245,SUP,Custom 27803010,,"185.245  -  5.5MM REVOLVE ROD, 45MM",$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
185.25,SUP,Custom 27803010,,"185.250  -  5.5MM REVOLVE ROD, 50MM",$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
185.255,SUP,Custom 27803010,,"185.255  -  5.5MM REVOLVE ROD, 55MM",$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
185.26,SUP,Custom 27803010,,"185.260  -  5.5MM REVOLVE ROD, 60MM",$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
185.265,SUP,Custom 27803010,,"185.265  -  5.5MM REVOLVE ROD, 65MM",$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
185.27,SUP,Custom 27803010,,"185.270  -  5.5MM REVOLVE ROD, 70MM",$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
185.275,SUP,Custom 27803010,,"185.275  -  5.5MM REVOLVE ROD, 75MM",$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
185.28,SUP,Custom 27803010,,"185.280  -  5.5MM REVOLVE ROD, 80MM",$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
185.29,SUP,Custom 27803010,,"185.290  -  5.5MM REVOLVE ROD, 90MM",$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
185.3,SUP,Custom 27803010,,"185.300  -  5.5MM REVOLVE ROD, 100MM",$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
185.31,SUP,Custom 27803010,,"185.310  -  5.5MM REVOLVE ROD, 110MM",$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
185.32,SUP,Custom 27803010,,"185.320  -  5.5MM REVOLVE ROD, 120MM",$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
185.33,SUP,Custom 27803010,,"185.330  -  5.5MM REVOLVE ROD, 130MM",$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
185.34,SUP,Custom 27803010,,"185.340  -  5.5MM REVOLVE ROD, 140MM",$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
185.35,SUP,Custom 27803010,,"185.350  -  5.5MM REVOLVE ROD, 150MM",$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
185.36,SUP,Custom 27803010,,"185.360  -  5.5MM REVOLVE ROD, 160MM",$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
185.37,SUP,Custom 27803010,,"185.370  -  5.5MM REVOLVE ROD, 170MM",$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
185.38,SUP,Custom 27803010,,"185.380  -  5.5MM REVOLVE ROD, 180MM",$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
185.39,SUP,Custom 27803010,,"185.390  -  5.5MM REVOLVE ROD, 190MM",$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
185.4,SUP,Custom 27803010,,"185.400  -  5.5MM REVOLVE ROD, 200MM",$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
185.41,SUP,Custom 27803010,,"185.410  -  5.5MM REVOLVE ROD, 210MM",$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
185.42,SUP,Custom 27803010,,"185.420  -  5.5MM REVOLVE ROD, 220MM",$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
185.43,SUP,Custom 27803010,,"185.430  -  5.5MM REVOLVE ROD, 230MM",$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
185.44,SUP,Custom 27803010,,"185.440  -  5.5MM REVOLVE ROD, 240MM",$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
185.451,SUP,HCPCS C1713,,"185.451  -  5.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 25MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
185.452,SUP,HCPCS C1713,,"185.452  -  5.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 30MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
185.453,SUP,HCPCS C1713,,"185.453  -  5.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 35MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
185.454,SUP,HCPCS C1713,,"185.454  -  5.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 40MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
185.455,SUP,HCPCS C1713,,"185.455  -  5.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 45MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
185.456,SUP,HCPCS C1713,,"185.456  -  5.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 50MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
185.457,SUP,HCPCS C1713,,"185.457  -  5.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 55MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
185.461,SUP,HCPCS C1713,,"185.461  -  6.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 25MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
185.462,SUP,HCPCS C1713,,"185.462  -  6.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 30MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
185.463,SUP,HCPCS C1713,,"185.463  -  6.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 35MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
185.464,SUP,HCPCS C1713,,"185.464  -  6.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 40MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
185.465,SUP,HCPCS C1713,,"185.465  -  6.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 45MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
185.466,SUP,HCPCS C1713,,"185.466  -  6.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 50MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
185.467,SUP,HCPCS C1713,,"185.467  -  6.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 55MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
185.468,SUP,HCPCS C1713,,"185.468  -  6.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 60MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
185.469,SUP,HCPCS C1713,,"185.469  -  6.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 65MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
185.471,SUP,HCPCS C1713,,"185.471  -  7.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 25MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
185.472,SUP,HCPCS C1713,,"185.472  -  7.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 30MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
185.473,SUP,HCPCS C1713,,"185.473  -  7.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 35MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
185.474,SUP,HCPCS C1713,,"185.474  -  7.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 40MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
185.475,SUP,HCPCS C1713,,"185.475  -  7.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 45MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
185.476,SUP,HCPCS C1713,,"185.476  -  7.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 50MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
185.477,SUP,HCPCS C1713,,"185.477  -  7.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 55MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
185.478,SUP,HCPCS C1713,,"185.478  -  7.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 60MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
185.479,SUP,HCPCS C1713,,"185.479  -  7.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 65MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
185.481,SUP,HCPCS C1713,,"185.481  -  8.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 25MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
185.482,SUP,HCPCS C1713,,"185.482  -  8.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 30MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
185.483,SUP,HCPCS C1713,,"185.483  -  8.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 35MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
185.484,SUP,HCPCS C1713,,"185.484  -  8.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 40MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
185.485,SUP,HCPCS C1713,,"185.485  -  8.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 45MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
185.486,SUP,HCPCS C1713,,"185.486  -  8.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 50MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
185.487,SUP,HCPCS C1713,,"185.487  -  8.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 55MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
185.488,SUP,HCPCS C1713,,"185.488  -  8.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 60MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
185.489,SUP,HCPCS C1713,,"185.489  -  8.5MM REVOLVE POLYAXIAL PEDICLE SCREW, 65MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
185.5,SUP,Custom 27803010,,"185.500  -  5.5MM REVOLVE ROD, 300MM",$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
192.142,SUP,HCPCS C1768,,STENT URET 7FR 24CM WO GUIDEWIRE DUAL DRMTR PLRS UL HDR+,$356.40,$0.00,$356.40,$160.38,$254.36,$0.00,$61.41,$0.00,$0.00,$62.40,$356.40,$0.00,$178.20,$282.27,$285.12,$0.00,$55.78,$0.00,$56.74,$0.00
198,SUP,Custom 27203010,,198  -  CATHETER SUCTION 8FR 2.6MM 12IN SOFT Y ADAPTER TACTILE,$32.35,$0.00,$32.35,$0.00,$23.09,$0.00,$0.00,$0.00,$0.00,$0.00,$32.35,$0.00,$16.18,$25.62,$25.88,$0.00,$0.00,$0.00,$0.00,$0.00
200.006,SUP,HCPCS C1713,,200.006  -  SCREW BONE STANDARD 1.5MM 3MM 6MM CRCIFRM RECESS DCP,$52.88,$0.00,$52.88,$23.79,$37.74,$0.00,$7.75,$0.00,$0.00,$9.26,$52.88,$0.00,$26.44,$41.88,$42.30,$0.00,$7.04,$0.00,$8.42,$0.00
200.007,SUP,HCPCS C1713,,200.007  -  SCREW BONE STANDARD 1.5MM 3MM 7MM CRCIFRM RECESS DCP,$52.88,$0.00,$52.88,$23.79,$37.74,$0.00,$8.84,$0.00,$0.00,$9.26,$52.88,$0.00,$26.44,$41.88,$42.30,$0.00,$8.03,$0.00,$8.42,$0.00
200.008,SUP,HCPCS C1713,,200.008  -  SCREW BONE STANDARD 1.5MM 3MM 8MM CRCIFRM RECESS DCP,$52.88,$0.00,$52.88,$23.79,$37.74,$0.00,$8.84,$0.00,$0.00,$9.26,$52.88,$0.00,$26.44,$41.88,$42.30,$0.00,$8.03,$0.00,$8.42,$0.00
200.009,SUP,HCPCS C1713,,200.009  -  SCREW BONE STANDARD 1.5MM 3MM 9MM CRCIFRM RECESS DCP,$52.88,$0.00,$52.88,$23.79,$37.74,$0.00,$8.84,$0.00,$0.00,$9.26,$52.88,$0.00,$26.44,$41.88,$42.30,$0.00,$8.03,$0.00,$8.42,$0.00
200.01,SUP,HCPCS C1713,,200.010  -  SCREW BONE STANDARD 1.5MM 10MM CRCIFRM RECESS DCP STAINLESS,$52.88,$0.00,$52.88,$23.79,$37.74,$0.00,$8.84,$0.00,$0.00,$9.26,$52.88,$0.00,$26.44,$41.88,$42.30,$0.00,$8.03,$0.00,$8.42,$0.00
200.011,SUP,HCPCS C1713,,200.011  -  SCREW BONE STANDARD 1.5MM 3MM 11MM CRCIFRM RECESS DCP,$52.88,$0.00,$52.88,$23.79,$37.74,$0.00,$8.84,$0.00,$0.00,$9.26,$52.88,$0.00,$26.44,$41.88,$42.30,$0.00,$8.03,$0.00,$8.42,$0.00
200.012,SUP,HCPCS C1713,,200.012  -  SCREW BONE STANDARD 1.5MM 3MM 12MM CRCIFRM RECESS DCP,$52.88,$0.00,$52.88,$23.79,$37.74,$0.00,$8.84,$0.00,$0.00,$9.26,$52.88,$0.00,$26.44,$41.88,$42.30,$0.00,$8.03,$0.00,$8.42,$0.00
200.014,SUP,HCPCS C1713,,200.014  -  SCREW BONE STANDARD 1.5MM 3MM 14MM CRCIFRM RECESS DCP,$52.88,$0.00,$52.88,$23.79,$37.74,$0.00,$8.84,$0.00,$0.00,$9.26,$52.88,$0.00,$26.44,$41.88,$42.30,$0.00,$8.03,$0.00,$8.42,$0.00
200.016,SUP,HCPCS C1713,,200.016  -  SCREW BONE STANDARD 1.5MM 3MM 16MM CRCIFRM RECESS DCP,$52.88,$0.00,$52.88,$23.79,$37.74,$0.00,$8.84,$0.00,$0.00,$9.26,$52.88,$0.00,$26.44,$41.88,$42.30,$0.00,$8.03,$0.00,$8.42,$0.00
200.018,SUP,HCPCS C1713,,200.018  -  SCREW BONE STANDARD 1.5MM 3MM 18MM CRCIFRM RECESS DCP,$51.33,$0.00,$51.33,$23.10,$36.63,$0.00,$8.84,$0.00,$0.00,$8.99,$51.33,$0.00,$25.66,$40.65,$41.06,$0.00,$8.03,$0.00,$8.17,$0.00
200.02,SUP,HCPCS C1713,,200.020  -  SCREW BONE STANDARD 1.5MM 3MM 20MM CRCIFRM RECESS DCP,$51.33,$0.00,$51.33,$23.10,$36.63,$0.00,$8.84,$0.00,$0.00,$8.99,$51.33,$0.00,$25.66,$40.65,$41.06,$0.00,$8.03,$0.00,$8.17,$0.00
200.19,SUP,Custom 27203010,,200.190  -  PIN FIX 1.8MM 12MM T8 STARDRIVE RECESS BUTTRESS LCP,$212.90,$0.00,$212.90,$0.00,$151.95,$0.00,$0.00,$0.00,$0.00,$0.00,$212.90,$0.00,$106.45,$168.62,$170.32,$0.00,$0.00,$0.00,$0.00,$0.00
200.191,SUP,Custom 27203010,,200.191  -  PIN FIX 1.8MM 14MM T8 STARDRIVE RECESS BUTTRESS LCP,$212.90,$0.00,$212.90,$0.00,$151.95,$0.00,$0.00,$0.00,$0.00,$0.00,$212.90,$0.00,$106.45,$168.62,$170.32,$0.00,$0.00,$0.00,$0.00,$0.00
200.192,SUP,Custom 27203010,,200.192  -  PIN FIX 1.8MM 16MM T8 STARDRIVE RECESS BUTTRESS LCP,$212.90,$0.00,$212.90,$0.00,$151.95,$0.00,$0.00,$0.00,$0.00,$0.00,$212.90,$0.00,$106.45,$168.62,$170.32,$0.00,$0.00,$0.00,$0.00,$0.00
200.193,SUP,Custom 27203010,,200.193  -  PIN FIX 1.8MM 18MM T8 STARDRIVE RECESS BUTTRESS LCP,$212.90,$0.00,$212.90,$0.00,$151.95,$0.00,$0.00,$0.00,$0.00,$0.00,$212.90,$0.00,$106.45,$168.62,$170.32,$0.00,$0.00,$0.00,$0.00,$0.00
200.195,SUP,Custom 27203010,,200.195  -  PIN FIX ROUND 1.8MM 22MM T8 STARDRIVE RECESS BUTTRESS SMOOTH,$212.90,$0.00,$212.90,$0.00,$151.95,$0.00,$0.00,$0.00,$0.00,$0.00,$212.90,$0.00,$106.45,$168.62,$170.32,$0.00,$0.00,$0.00,$0.00,$0.00
200.197,SUP,Custom 27203010,,200.197  -  PIN FIX 1.8MM 24MM BUTTRESS STARDRIVE STAINLESS STEEL,$212.90,$0.00,$212.90,$0.00,$151.95,$0.00,$0.00,$0.00,$0.00,$0.00,$212.90,$0.00,$106.45,$168.62,$170.32,$0.00,$0.00,$0.00,$0.00,$0.00
200.198,SUP,Custom 27203010,,200.198  -  PIN FIX 1.8MM 26MM BUTTRESS STARDRIVE STAINLESS STEEL,$212.90,$0.00,$212.90,$0.00,$151.95,$0.00,$0.00,$0.00,$0.00,$0.00,$212.90,$0.00,$106.45,$168.62,$170.32,$0.00,$0.00,$0.00,$0.00,$0.00
200.199,SUP,Custom 27203010,,200.199  -  PIN FIX 1.8MM 28MM BUTTRESS STARDRIVE STAINLESS STEEL,$212.90,$0.00,$212.90,$0.00,$151.95,$0.00,$0.00,$0.00,$0.00,$0.00,$212.90,$0.00,$106.45,$168.62,$170.32,$0.00,$0.00,$0.00,$0.00,$0.00
200.526,SUP,HCPCS C1713,,200.526  -  SCREW BONE 1MM 1.6MM 6MM SELF TAP CRCIFRM LP HEAD STAINLESS,$133.05,$0.00,$133.05,$59.87,$94.96,$0.00,$22.26,$0.00,$0.00,$23.30,$133.05,$0.00,$66.53,$105.38,$106.44,$0.00,$20.22,$0.00,$21.18,$0.00
200.527,SUP,HCPCS C1713,,200.527  -  SCREW BONE LP 1MM 1.6MM 7MM SELF TAP CRCIFRM DCP STAINLESS,$133.05,$0.00,$133.05,$59.87,$94.96,$0.00,$22.26,$0.00,$0.00,$23.30,$133.05,$0.00,$66.53,$105.38,$106.44,$0.00,$20.22,$0.00,$21.18,$0.00
200.528,SUP,HCPCS C1713,,200.528  -  SCREW BONE 1MM 1.6MM 8MM SELF TAP CRCIFRM LP HEAD STAINLESS,$133.05,$0.00,$133.05,$59.87,$94.96,$0.00,$22.26,$0.00,$0.00,$23.30,$133.05,$0.00,$66.53,$105.38,$106.44,$0.00,$20.22,$0.00,$21.18,$0.00
200.529,SUP,HCPCS C1713,,200.529  -  SCREW BONE LP 1MM 1.6MM 9MM SELF TAP CRCIFRM DCP STAINLESS,$133.05,$0.00,$133.05,$59.87,$94.96,$0.00,$22.26,$0.00,$0.00,$23.30,$133.05,$0.00,$66.53,$105.38,$106.44,$0.00,$20.22,$0.00,$21.18,$0.00
200.53,SUP,HCPCS C1713,,200.530  -  SCREW BONE LP 1MM 1.6MM 10MM SELF TAP CRCIFRM DCP STAINLESS,$133.05,$0.00,$133.05,$59.87,$94.96,$0.00,$22.26,$0.00,$0.00,$23.30,$133.05,$0.00,$66.53,$105.38,$106.44,$0.00,$20.22,$0.00,$21.18,$0.00
200.531,SUP,HCPCS C1713,,200.531  -  SCREW BONE LP 1MM 1.6MM 11MM SELF TAP CRCIFRM DCP STAINLESS,$133.05,$0.00,$133.05,$59.87,$94.96,$0.00,$22.26,$0.00,$0.00,$23.30,$133.05,$0.00,$66.53,$105.38,$106.44,$0.00,$20.22,$0.00,$21.18,$0.00
200.532,SUP,HCPCS C1713,,200.532  -  SCREW BONE LP 1MM 1.6MM 12MM SELF TAP CRCIFRM DCP STAINLESS,$133.05,$0.00,$133.05,$59.87,$94.96,$0.00,$22.26,$0.00,$0.00,$23.30,$133.05,$0.00,$66.53,$105.38,$106.44,$0.00,$20.22,$0.00,$21.18,$0.00
200.533,SUP,HCPCS C1713,,200.533  -  SCREW BONE 1MM 1.6MM 13MM SELF TAP CRCIFRM LP HEAD STAINLESS,$133.05,$0.00,$133.05,$59.87,$94.96,$0.00,$22.26,$0.00,$0.00,$23.30,$133.05,$0.00,$66.53,$105.38,$106.44,$0.00,$20.22,$0.00,$21.18,$0.00
200.534,SUP,HCPCS C1713,,200.534  -  SCREW BONE LP 1MM 1.6MM 14MM SELF TAP CRCIFRM DCP STAINLESS,$133.05,$0.00,$133.05,$59.87,$94.96,$0.00,$22.26,$0.00,$0.00,$23.30,$133.05,$0.00,$66.53,$105.38,$106.44,$0.00,$20.22,$0.00,$21.18,$0.00
200.686,SUP,HCPCS C1713,,200.686  -  SCREW BONE 1.3MM 2.4MM 6MM SELF TAP CRCIFRM RECESS LP HEAD,$139.20,$0.00,$139.20,$62.64,$99.35,$0.00,$23.29,$0.00,$0.00,$24.37,$139.20,$0.00,$69.60,$110.25,$111.36,$0.00,$21.15,$0.00,$22.16,$0.00
200.687,SUP,HCPCS C1713,,200.687  -  SCREW BONE LP 1.3MM 2.4MM 7MM SELF TAP CRCIFRM DCP STAINLESS,$139.20,$0.00,$139.20,$62.64,$99.35,$0.00,$23.29,$0.00,$0.00,$24.37,$139.20,$0.00,$69.60,$110.25,$111.36,$0.00,$21.15,$0.00,$22.16,$0.00
200.688,SUP,HCPCS C1713,,200.688  -  SCREW BONE LP 1.3MM 2.4MM 8MM SELF TAP CRCIFRM DCP STAINLESS,$139.20,$0.00,$139.20,$62.64,$99.35,$0.00,$23.29,$0.00,$0.00,$24.37,$139.20,$0.00,$69.60,$110.25,$111.36,$0.00,$21.15,$0.00,$22.16,$0.00
200.689,SUP,HCPCS C1713,,200.689  -  SCREW BONE LP 1.3MM 2.4MM 9MM SELF TAP CRCIFRM DCP STAINLESS,$139.20,$0.00,$139.20,$62.64,$99.35,$0.00,$23.29,$0.00,$0.00,$24.37,$139.20,$0.00,$69.60,$110.25,$111.36,$0.00,$21.15,$0.00,$22.16,$0.00
200.69,SUP,HCPCS C1713,,200.690  -  SCREW BONE 1.3MM 2.4MM 10MM SLFTAP CRCIFRM RECESS LP HEAD,$139.20,$0.00,$139.20,$62.64,$99.35,$0.00,$23.29,$0.00,$0.00,$24.37,$139.20,$0.00,$69.60,$110.25,$111.36,$0.00,$21.15,$0.00,$22.16,$0.00
200.691,SUP,HCPCS C1713,,200.691  -  SCREW BONE LP 1.3MM 2.4MM 11MM SELF TAP CRCIFRM DCP,$139.20,$0.00,$139.20,$62.64,$99.35,$0.00,$23.29,$0.00,$0.00,$24.37,$139.20,$0.00,$69.60,$110.25,$111.36,$0.00,$21.15,$0.00,$22.16,$0.00
200.692,SUP,HCPCS C1713,,200.692  -  SCREW BONE LP 1.3MM 2.4MM 12MM SELF TAP CRCIFRM DCP,$139.20,$0.00,$139.20,$62.64,$99.35,$0.00,$23.29,$0.00,$0.00,$24.37,$139.20,$0.00,$69.60,$110.25,$111.36,$0.00,$21.15,$0.00,$22.16,$0.00
200.693,SUP,HCPCS C1713,,200.693  -  SCREW BONE 1.3MM 2.4MM 13MM SELF TAP CRCIFRM LP HEAD,$139.20,$0.00,$139.20,$62.64,$99.35,$0.00,$23.29,$0.00,$0.00,$24.37,$139.20,$0.00,$69.60,$110.25,$111.36,$0.00,$21.15,$0.00,$22.16,$0.00
200.694,SUP,HCPCS C1713,,200.694  -  SCREW BONE LP 1.3MM 2.4MM 14MM SELF TAP CRCIFRM DCP,$139.20,$0.00,$139.20,$62.64,$99.35,$0.00,$23.29,$0.00,$0.00,$24.37,$139.20,$0.00,$69.60,$110.25,$111.36,$0.00,$21.15,$0.00,$22.16,$0.00
200.696,SUP,HCPCS C1713,,200.696  -  SCREW BONE LP 1.3MM 2.4MM 16MM SELF TAP CRCIFRM DCP,$139.20,$0.00,$139.20,$62.64,$99.35,$0.00,$23.29,$0.00,$0.00,$24.37,$139.20,$0.00,$69.60,$110.25,$111.36,$0.00,$21.15,$0.00,$22.16,$0.00
200.698,SUP,HCPCS C1713,,200.698  -  SCREW BONE LP 1.3MM 2.4MM 18MM SELF TAP CRCIFRM DCP,$139.20,$0.00,$139.20,$62.64,$99.35,$0.00,$23.29,$0.00,$0.00,$24.37,$139.20,$0.00,$69.60,$110.25,$111.36,$0.00,$21.15,$0.00,$22.16,$0.00
200.806,SUP,HCPCS C1713,,200.806  -  SCREW BONE LP 1.5MM 3MM 6MM SELF TAP CRCIFRM DCP STAINLESS,$59.03,$0.00,$59.03,$26.56,$42.13,$0.00,$9.87,$0.00,$0.00,$10.33,$59.03,$0.00,$29.51,$46.75,$47.22,$0.00,$8.97,$0.00,$9.40,$0.00
200.807,SUP,HCPCS C1713,,200.807  -  SCREW BONE LP 1.5MM 3MM 7MM SELF TAP CRCIFRM DCP STAINLESS,$59.03,$0.00,$59.03,$26.56,$42.13,$0.00,$9.87,$0.00,$0.00,$10.33,$59.03,$0.00,$29.51,$46.75,$47.22,$0.00,$8.97,$0.00,$9.40,$0.00
200.808,SUP,HCPCS C1713,,200.808  -  SCREW BONE LP 1.5MM 3MM 8MM SELF TAP CRCIFRM DCP STAINLESS,$59.03,$0.00,$59.03,$26.56,$42.13,$0.00,$9.87,$0.00,$0.00,$10.33,$59.03,$0.00,$29.51,$46.75,$47.22,$0.00,$8.97,$0.00,$9.40,$0.00
200.809,SUP,HCPCS C1713,,200.809  -  SCREW BONE LP 1.5MM 3MM 9MM SELF TAP CRCIFRM DCP STAINLESS,$59.03,$0.00,$59.03,$26.56,$42.13,$0.00,$9.87,$0.00,$0.00,$10.33,$59.03,$0.00,$29.51,$46.75,$47.22,$0.00,$8.97,$0.00,$9.40,$0.00
200.81,SUP,HCPCS C1713,,200.810  -  SCREW BONE LP 1.5MM 3MM 10MM SELF TAP CRCIFRM DCP STAINLESS,$59.03,$0.00,$59.03,$26.56,$42.13,$0.00,$9.87,$0.00,$0.00,$10.33,$59.03,$0.00,$29.51,$46.75,$47.22,$0.00,$8.97,$0.00,$9.40,$0.00
200.811,SUP,HCPCS C1713,,200.811  -  SCREW BONE LP 1.5MM 3MM 11MM SELF TAP CRCIFRM DCP STAINLESS,$59.03,$0.00,$59.03,$26.56,$42.13,$0.00,$9.87,$0.00,$0.00,$10.33,$59.03,$0.00,$29.51,$46.75,$47.22,$0.00,$8.97,$0.00,$9.40,$0.00
200.812,SUP,HCPCS C1713,,200.812  -  SCREW BONE LP 1.5MM 3MM 12MM SELF TAP CRCIFRM DCP STAINLESS,$59.03,$0.00,$59.03,$26.56,$42.13,$0.00,$9.87,$0.00,$0.00,$10.33,$59.03,$0.00,$29.51,$46.75,$47.22,$0.00,$8.97,$0.00,$9.40,$0.00
200.813,SUP,HCPCS C1713,,200.813  -  SCREW BONE LP 1.5MM 3MM 13MM SELF TAP CRCIFRM DCP STAINLESS,$59.03,$0.00,$59.03,$26.56,$42.13,$0.00,$9.87,$0.00,$0.00,$10.33,$59.03,$0.00,$29.51,$46.75,$47.22,$0.00,$8.97,$0.00,$9.40,$0.00
200.814,SUP,HCPCS C1713,,200.814  -  SCREW BONE LP 1.5MM 3MM 14MM SELF TAP CRCIFRM DCP STAINLESS,$59.03,$0.00,$59.03,$26.56,$42.13,$0.00,$9.87,$0.00,$0.00,$10.33,$59.03,$0.00,$29.51,$46.75,$47.22,$0.00,$8.97,$0.00,$9.40,$0.00
200.816,SUP,HCPCS C1713,,200.816  -  SCREW BONE LP 1.5MM 3MM 16MM SELF TAP CRCIFRM DCP STAINLESS,$59.03,$0.00,$59.03,$26.56,$42.13,$0.00,$9.87,$0.00,$0.00,$10.33,$59.03,$0.00,$29.51,$46.75,$47.22,$0.00,$8.97,$0.00,$9.40,$0.00
200.818,SUP,HCPCS C1713,,200.818  -  SCREW BONE LP 1.5MM 3MM 18MM SELF TAP CRCIFRM DCP STAINLESS,$59.03,$0.00,$59.03,$26.56,$42.13,$0.00,$9.30,$0.00,$0.00,$10.33,$59.03,$0.00,$29.51,$46.75,$47.22,$0.00,$8.45,$0.00,$9.40,$0.00
200.82,SUP,HCPCS C1713,,200.820  -  SCREW BONE LP 1.5MM 3MM 20MM SELF TAP CRCIFRM DCP STAINLESS,$59.03,$0.00,$59.03,$26.56,$42.13,$0.00,$9.87,$0.00,$0.00,$10.33,$59.03,$0.00,$29.51,$46.75,$47.22,$0.00,$8.97,$0.00,$9.40,$0.00
200.822,SUP,HCPCS C1713,,200.822  -  SCREW BONE LP 1.5MM 3MM 22MM SELF TAP CRCIFRM DCP STAINLESS,$59.03,$0.00,$59.03,$26.56,$42.13,$0.00,$9.87,$0.00,$0.00,$10.33,$59.03,$0.00,$29.51,$46.75,$47.22,$0.00,$8.97,$0.00,$9.40,$0.00
200.824,SUP,HCPCS C1713,,200.824  -  SCREW BONE LP 1.5MM 3MM 24MM SELF TAP CRCIFRM DCP STAINLESS,$59.03,$0.00,$59.03,$26.56,$42.13,$0.00,$9.87,$0.00,$0.00,$10.33,$59.03,$0.00,$29.51,$46.75,$47.22,$0.00,$8.97,$0.00,$9.40,$0.00
201.006,SUP,HCPCS C1713,,201.006  -  SCREW BN STD 2MM 3.5MM 6MM NS CRFRM SS CORT MN FRAG SET MDLR,$52.20,$0.00,$52.20,$23.49,$37.26,$0.00,$7.75,$0.00,$0.00,$9.14,$52.20,$0.00,$26.10,$41.34,$41.76,$0.00,$7.04,$0.00,$8.31,$0.00
201.008,SUP,HCPCS C1713,,201.008  -  SCREW BONE STANDARD 2MM 8MM CRCIFRM RECESS DCP STAINLESS,$52.20,$0.00,$52.20,$23.49,$37.26,$0.00,$7.75,$0.00,$0.00,$9.14,$52.20,$0.00,$26.10,$41.34,$41.76,$0.00,$7.04,$0.00,$8.31,$0.00
201.01,SUP,HCPCS C1713,,201.010  -  SCREW BONE STANDARD 2MM 10MM CRCIFRM HEAD DCP STAINLESS,$52.20,$0.00,$52.20,$23.49,$37.26,$0.00,$7.75,$0.00,$0.00,$9.14,$52.20,$0.00,$26.10,$41.34,$41.76,$0.00,$7.04,$0.00,$8.31,$0.00
201.012,SUP,HCPCS C1713,,201.012  -  SCREW BONE STANDARD 2MM 3.5MM 12MM CRCIFRM RECESS DCP,$52.20,$0.00,$52.20,$23.49,$37.26,$0.00,$7.75,$0.00,$0.00,$9.14,$52.20,$0.00,$26.10,$41.34,$41.76,$0.00,$7.04,$0.00,$8.31,$0.00
201.014,SUP,HCPCS C1713,,201.014  -  SCREW BONE STANDARD 2MM 3.5MM 14MM CRCIFRM DCP STAINLESS,$52.20,$0.00,$52.20,$23.49,$37.26,$0.00,$7.75,$0.00,$0.00,$9.14,$52.20,$0.00,$26.10,$41.34,$41.76,$0.00,$7.04,$0.00,$8.31,$0.00
201.016,SUP,HCPCS C1713,,201.016  -  SCREW BONE STANDARD 2MM 3.5MM 16MM CRCIFRM RECESS DCP,$52.20,$0.00,$52.20,$23.49,$37.26,$0.00,$7.75,$0.00,$0.00,$9.14,$52.20,$0.00,$26.10,$41.34,$41.76,$0.00,$7.04,$0.00,$8.31,$0.00
201.018,SUP,HCPCS C1713,,201.018  -  SCREW BONE STANDARD 2MM 18MM CRCIFRM RECESS DCP STAINLESS,$52.20,$0.00,$52.20,$23.49,$37.26,$0.00,$8.73,$0.00,$0.00,$9.14,$52.20,$0.00,$26.10,$41.34,$41.76,$0.00,$7.93,$0.00,$8.31,$0.00
201.02,SUP,HCPCS C1713,,201.020  -  SCREW BONE STANDARD 2MM 20MM CRCIFRM RECESS DCP STAINLESS,$52.20,$0.00,$52.20,$23.49,$37.26,$0.00,$8.73,$0.00,$0.00,$9.14,$52.20,$0.00,$26.10,$41.34,$41.76,$0.00,$7.93,$0.00,$8.31,$0.00
201.022,SUP,HCPCS C1713,,201.022  -  SCREW BONE STANDARD 2MM 3.5MM 22MM CRCIFRM DCP STAINLESS,$50.68,$0.00,$50.68,$22.80,$36.17,$0.00,$8.73,$0.00,$0.00,$8.87,$50.68,$0.00,$25.34,$40.14,$40.54,$0.00,$7.93,$0.00,$8.07,$0.00
201.024,SUP,HCPCS C1713,,201.024  -  SCREW BONE 2MM 24MM DCP STAINLESS STEEL CORTICAL NONSTRL,$50.68,$0.00,$50.68,$22.80,$36.17,$0.00,$8.73,$0.00,$0.00,$8.87,$50.68,$0.00,$25.34,$40.14,$40.54,$0.00,$7.93,$0.00,$8.07,$0.00
201.026,SUP,HCPCS C1713,,201.026  -  SCREW BONE 2MM 26MM DCP STAINLESS STEEL CORTICAL NONSTRL,$52.20,$0.00,$52.20,$23.49,$37.26,$0.00,$8.73,$0.00,$0.00,$9.14,$52.20,$0.00,$26.10,$41.34,$41.76,$0.00,$7.93,$0.00,$8.31,$0.00
201.028,SUP,HCPCS C1713,,201.028  -  SCREW BONE 2MM 28MM DCP STAINLESS STEEL CORTICAL NONSTRL,$52.20,$0.00,$52.20,$23.49,$37.26,$0.00,$8.73,$0.00,$0.00,$9.14,$52.20,$0.00,$26.10,$41.34,$41.76,$0.00,$7.93,$0.00,$8.31,$0.00
201.03,SUP,HCPCS C1713,,201.030  -  SCREW BONE 2MM 30MM DCP STAINLESS STEEL CORTICAL NONSTRL,$52.20,$0.00,$52.20,$23.49,$37.26,$0.00,$8.73,$0.00,$0.00,$9.14,$52.20,$0.00,$26.10,$41.34,$41.76,$0.00,$7.93,$0.00,$8.31,$0.00
201.032,SUP,HCPCS C1713,,201.032  -  SCREW BONE 2MM 32MM DCP STAINLESS STEEL CORTICAL NONSTRL,$52.20,$0.00,$52.20,$23.49,$37.26,$0.00,$8.73,$0.00,$0.00,$9.14,$52.20,$0.00,$26.10,$41.34,$41.76,$0.00,$7.93,$0.00,$8.31,$0.00
201.034,SUP,HCPCS C1713,,201.034  -  SCREW BONE 2MM 34MM DCP STAINLESS STEEL CORTICAL NONSTRL,$52.20,$0.00,$52.20,$23.49,$37.26,$0.00,$8.73,$0.00,$0.00,$9.14,$52.20,$0.00,$26.10,$41.34,$41.76,$0.00,$7.93,$0.00,$8.31,$0.00
201.036,SUP,HCPCS C1713,,201.036  -  SCREW BONE 2MM 36MM DCP STAINLESS STEEL CORTICAL NONSTRL,$52.20,$0.00,$52.20,$23.49,$37.26,$0.00,$8.73,$0.00,$0.00,$9.14,$52.20,$0.00,$26.10,$41.34,$41.76,$0.00,$7.93,$0.00,$8.31,$0.00
201.038,SUP,HCPCS C1713,,201.038  -  SCREW BONE 2MM 38MM DCP STAINLESS STEEL CORTICAL NONSTRL,$52.20,$0.00,$52.20,$23.49,$37.26,$0.00,$8.73,$0.00,$0.00,$9.14,$52.20,$0.00,$26.10,$41.34,$41.76,$0.00,$7.93,$0.00,$8.31,$0.00
201.04,SUP,HCPCS C1713,,201.040  -  SCREW BONE 2MM 40MM DCP STAINLESS STEEL CORTICAL NONSTRL,$52.20,$0.00,$52.20,$23.49,$37.26,$0.00,$8.73,$0.00,$0.00,$9.14,$52.20,$0.00,$26.10,$41.34,$41.76,$0.00,$7.93,$0.00,$8.31,$0.00
201.042,SUP,HCPCS C1713,,201.042  -  SCREW BONE 2MM 42MM DCP STAINLESS STEEL CORTICAL NONSTRL,$52.20,$0.00,$52.20,$23.49,$37.26,$0.00,$8.73,$0.00,$0.00,$9.14,$52.20,$0.00,$26.10,$41.34,$41.76,$0.00,$7.93,$0.00,$8.31,$0.00
201.044,SUP,HCPCS C1713,,201.044  -  SCREW BONE 2MM 44MM DCP STAINLESS STEEL CORTICAL NONSTRL,$52.20,$0.00,$52.20,$23.49,$37.26,$0.00,$8.73,$0.00,$0.00,$9.14,$52.20,$0.00,$26.10,$41.34,$41.76,$0.00,$7.93,$0.00,$8.31,$0.00
201.046,SUP,HCPCS C1713,,201.046  -  SCREW BONE 2MM 46MM DCP STAINLESS STEEL CORTICAL NONSTRL,$52.20,$0.00,$52.20,$23.49,$37.26,$0.00,$8.73,$0.00,$0.00,$9.14,$52.20,$0.00,$26.10,$41.34,$41.76,$0.00,$7.93,$0.00,$8.31,$0.00
201.506,SUP,HCPCS C1713,,201.506  -  SCREW BONE 2.4MM 3.5MM 6MM SLFTAP STAINLESS STEEL MAXILLA,$91.25,$0.00,$91.25,$41.06,$65.13,$0.00,$15.72,$0.00,$0.00,$15.98,$91.25,$0.00,$45.63,$72.27,$73.00,$0.00,$14.28,$0.00,$14.53,$0.00
201.508,SUP,HCPCS C1713,,201.508  -  SCREW BONE 2.4MM 3.5MM 8MM SLFTAP STAINLESS STEEL MAXILLA,$91.25,$0.00,$91.25,$41.06,$65.13,$0.00,$15.72,$0.00,$0.00,$15.98,$91.25,$0.00,$45.63,$72.27,$73.00,$0.00,$14.28,$0.00,$14.53,$0.00
201.51,SUP,HCPCS C1713,,201.510  -  SCREW BONE 2.4MM 3.5MM 10MM SLFTAP STAINLESS STEEL MAXILLA,$91.25,$0.00,$91.25,$41.06,$65.13,$0.00,$15.72,$0.00,$0.00,$15.98,$91.25,$0.00,$45.63,$72.27,$73.00,$0.00,$14.28,$0.00,$14.53,$0.00
201.512,SUP,HCPCS C1713,,201.512  -  SCREW SS 12MM 2.4MM CORT MAXL SLFTAP BONE NONSTRL,$75.38,$0.00,$75.38,$33.92,$53.80,$0.00,$12.99,$0.00,$0.00,$13.20,$75.38,$0.00,$37.69,$59.70,$60.30,$0.00,$11.80,$0.00,$12.00,$0.00
201.514,SUP,HCPCS C1713,,201.514  -  SCREW BONE 2.4MM 14MM SLFTAP STAINLESS STEEL MAXILLA,$91.25,$0.00,$91.25,$41.06,$65.13,$0.00,$15.72,$0.00,$0.00,$15.98,$91.25,$0.00,$45.63,$72.27,$73.00,$0.00,$14.28,$0.00,$14.53,$0.00
201.612,SUP,HCPCS C1713,,201.612  -  SCREW BONE 2.4MM 3.5MM 12MM SELF TAP CRCIFRM STAINLESS STEEL,$87.35,$0.00,$87.35,$39.31,$62.34,$0.00,$14.61,$0.00,$0.00,$15.29,$87.35,$0.00,$43.68,$69.18,$69.88,$0.00,$13.27,$0.00,$13.91,$0.00
201.614,SUP,HCPCS C1713,,201.614  -  SCREW BONE 2.4MM 3.5MM 14MM SELF TAP STAINLESS STEEL CORTEX,$87.35,$0.00,$87.35,$39.31,$62.34,$0.00,$14.61,$0.00,$0.00,$15.29,$87.35,$0.00,$43.68,$69.18,$69.88,$0.00,$13.27,$0.00,$13.91,$0.00
201.616,SUP,HCPCS C1713,,201.616  -  SCREW BONE 2.4MM 3.5MM 16MM SELF TAP CRCIFRM LCP STAINLESS,$87.35,$0.00,$87.35,$39.31,$62.34,$0.00,$14.61,$0.00,$0.00,$15.29,$87.35,$0.00,$43.68,$69.18,$69.88,$0.00,$13.27,$0.00,$13.91,$0.00
201.618,SUP,HCPCS C1713,,201.618  -  SCREW BONE 2.4MM 3.5MM 18MM SELF TAP CRCIFRM STAINLESS STEEL,$87.35,$0.00,$87.35,$39.31,$62.34,$0.00,$14.61,$0.00,$0.00,$15.29,$87.35,$0.00,$43.68,$69.18,$69.88,$0.00,$13.27,$0.00,$13.91,$0.00
201.62,SUP,HCPCS C1713,,201.620  -  SCREW BONE 2.4MM 20MM SLFTAP STAINLESS STEEL RAD CORTICAL,$87.35,$0.00,$87.35,$39.31,$62.34,$0.00,$14.61,$0.00,$0.00,$15.29,$87.35,$0.00,$43.68,$69.18,$69.88,$0.00,$13.27,$0.00,$13.91,$0.00
201.622,SUP,HCPCS C1713,,201.622  -  SCREW BONE 2.4MM 3.5MM 22MM SELF TAP CRCIFRM STAINLESS STEEL,$87.35,$0.00,$87.35,$39.31,$62.34,$0.00,$14.61,$0.00,$0.00,$15.29,$87.35,$0.00,$43.68,$69.18,$69.88,$0.00,$13.27,$0.00,$13.91,$0.00
201.624,SUP,HCPCS C1713,,201.624  -  SCREW BONE 2.4MM 3.5MM 24MM SELF TAP CRCIFRM STAINLESS STEEL,$87.35,$0.00,$87.35,$39.31,$62.34,$0.00,$14.61,$0.00,$0.00,$15.29,$87.35,$0.00,$43.68,$69.18,$69.88,$0.00,$13.27,$0.00,$13.91,$0.00
201.626,SUP,HCPCS C1713,,201.626  -  SCREW BONE 2.4MM 3.5MM 26MM SELF TAP CRCIFRM STAINLESS STEEL,$87.35,$0.00,$87.35,$39.31,$62.34,$0.00,$14.61,$0.00,$0.00,$15.29,$87.35,$0.00,$43.68,$69.18,$69.88,$0.00,$13.27,$0.00,$13.91,$0.00
201.628,SUP,HCPCS C1713,,201.628  -  SCREW BONE 2.4MM 28MM SLFTAP STAINLESS STEEL RAD CORTICAL,$87.35,$0.00,$87.35,$39.31,$62.34,$0.00,$14.61,$0.00,$0.00,$15.29,$87.35,$0.00,$43.68,$69.18,$69.88,$0.00,$13.27,$0.00,$13.91,$0.00
201.63,SUP,HCPCS C1713,,201.630  -  SCREW BONE 2.4MM 3.5MM 30MM SLFTAP CRCIFRM RECESS STAINLESS,$87.35,$0.00,$87.35,$39.31,$62.34,$0.00,$14.61,$0.00,$0.00,$15.29,$87.35,$0.00,$43.68,$69.18,$69.88,$0.00,$13.27,$0.00,$13.91,$0.00
201.636,SUP,HCPCS C1713,,201.636  -  SCREW BONE CONE LP 2.4MM 4.5MM 6MM SELF TAP THREAD CRCIFRM,$90.08,$0.00,$90.08,$40.53,$64.29,$0.00,$15.07,$0.00,$0.00,$15.77,$90.08,$0.00,$45.04,$71.34,$72.06,$0.00,$13.69,$0.00,$14.34,$0.00
201.637,SUP,HCPCS C1713,,201.637  -  SCREW BONE CONE LP 2.4MM 4.5MM 7MM SELF TAP THREAD CRCIFRM,$90.08,$0.00,$90.08,$40.53,$64.29,$0.00,$15.07,$0.00,$0.00,$15.77,$90.08,$0.00,$45.04,$71.34,$72.06,$0.00,$13.69,$0.00,$14.34,$0.00
201.638,SUP,HCPCS C1713,,201.638  -  SCREW BONE CONE LP 2.4MM 4.5MM 8MM SELF TAP THREAD CRCIFRM,$87.35,$0.00,$87.35,$39.31,$62.34,$0.00,$14.61,$0.00,$0.00,$15.29,$87.35,$0.00,$43.68,$69.18,$69.88,$0.00,$13.27,$0.00,$13.91,$0.00
201.639,SUP,HCPCS C1713,,201.639  -  SCREW BONE CONE LP 2.4MM 4.5MM 9MM SELF TAP THREAD CRCIFRM,$90.08,$0.00,$90.08,$40.53,$64.29,$0.00,$15.07,$0.00,$0.00,$15.77,$90.08,$0.00,$45.04,$71.34,$72.06,$0.00,$13.69,$0.00,$14.34,$0.00
201.64,SUP,HCPCS C1713,,201.640  -  SCREW BONE CONE LP 2.4MM 4.5MM 10MM SELF TAP THREAD CRCIFRM,$87.35,$0.00,$87.35,$39.31,$62.34,$0.00,$14.61,$0.00,$0.00,$15.29,$87.35,$0.00,$43.68,$69.18,$69.88,$0.00,$13.27,$0.00,$13.91,$0.00
201.641,SUP,HCPCS C1713,,201.641  -  SCREW BONE CONE LP 2.4MM 4.5MM 11MM SELF TAP THREAD CRCIFRM,$90.08,$0.00,$90.08,$40.53,$64.29,$0.00,$15.07,$0.00,$0.00,$15.77,$90.08,$0.00,$45.04,$71.34,$72.06,$0.00,$13.69,$0.00,$14.34,$0.00
201.642,SUP,HCPCS C1713,,201.642  -  SCREW BONE CONE LP 2.4MM 4.5MM 12MM SELF TAP THREAD CRCIFRM,$87.35,$0.00,$87.35,$39.31,$62.34,$0.00,$14.61,$0.00,$0.00,$15.29,$87.35,$0.00,$43.68,$69.18,$69.88,$0.00,$13.27,$0.00,$13.91,$0.00
201.643,SUP,HCPCS C1713,,201.643  -  SCREW BONE CONE LP 2.4MM 4.5MM 13MM SELF TAP THREAD CRCIFRM,$90.08,$0.00,$90.08,$40.53,$64.29,$0.00,$15.07,$0.00,$0.00,$15.77,$90.08,$0.00,$45.04,$71.34,$72.06,$0.00,$13.69,$0.00,$14.34,$0.00
201.644,SUP,HCPCS C1713,,201.644  -  SCREW BONE CONE LP 2.4MM 4.5MM 14MM SELF TAP THREAD CRCIFRM,$87.35,$0.00,$87.35,$39.31,$62.34,$0.00,$14.61,$0.00,$0.00,$15.29,$87.35,$0.00,$43.68,$69.18,$69.88,$0.00,$13.27,$0.00,$13.91,$0.00
201.646,SUP,HCPCS C1713,,201.646  -  SCREW BONE CONE LP 2.4MM 4.5MM 16MM SELF TAP THREAD CRCIFRM,$87.35,$0.00,$87.35,$39.31,$62.34,$0.00,$14.61,$0.00,$0.00,$15.29,$87.35,$0.00,$43.68,$69.18,$69.88,$0.00,$13.27,$0.00,$13.91,$0.00
201.648,SUP,HCPCS C1713,,201.648  -  SCREW BONE CONE LP 2.4MM 4.5MM 18MM SELF TAP THREAD CRCIFRM,$87.35,$0.00,$87.35,$39.31,$62.34,$0.00,$14.61,$0.00,$0.00,$15.29,$87.35,$0.00,$43.68,$69.18,$69.88,$0.00,$13.27,$0.00,$13.91,$0.00
201.65,SUP,HCPCS C1713,,201.650  -  SCREW BONE CONE LP 2.4MM 4.5MM 20MM SELF TAP THREAD CRCIFRM,$87.35,$0.00,$87.35,$39.31,$62.34,$0.00,$14.61,$0.00,$0.00,$15.29,$87.35,$0.00,$43.68,$69.18,$69.88,$0.00,$13.27,$0.00,$13.91,$0.00
201.652,SUP,HCPCS C1713,,201.652  -  SCREW BONE CONE LP 2.4MM 4.5MM 22MM SELF TAP THREAD CRCIFRM,$87.35,$0.00,$87.35,$39.31,$62.34,$0.00,$14.61,$0.00,$0.00,$15.29,$87.35,$0.00,$43.68,$69.18,$69.88,$0.00,$13.27,$0.00,$13.91,$0.00
201.654,SUP,HCPCS C1713,,201.654  -  SCREW BONE CONE LP 2.4MM 4.5MM 24MM SELF TAP THREAD CRCIFRM,$87.35,$0.00,$87.35,$39.31,$62.34,$0.00,$14.61,$0.00,$0.00,$15.29,$87.35,$0.00,$43.68,$69.18,$69.88,$0.00,$13.27,$0.00,$13.91,$0.00
201.656,SUP,HCPCS C1713,,201.656  -  SCREW BONE CONE LP 2.4MM 4.5MM 26MM SELF TAP THREAD CRCIFRM,$87.35,$0.00,$87.35,$39.31,$62.34,$0.00,$14.61,$0.00,$0.00,$15.29,$87.35,$0.00,$43.68,$69.18,$69.88,$0.00,$13.27,$0.00,$13.91,$0.00
201.658,SUP,HCPCS C1713,,201.658  -  SCREW BONE CONE LP 2.4MM 4.5MM 28MM SELF TAP THREAD CRCIFRM,$87.35,$0.00,$87.35,$39.31,$62.34,$0.00,$14.61,$0.00,$0.00,$15.29,$87.35,$0.00,$43.68,$69.18,$69.88,$0.00,$13.27,$0.00,$13.91,$0.00
201.66,SUP,HCPCS C1713,,201.660  -  SCREW BONE CONE LP 2.4MM 4.5MM 30MM SELF TAP THREAD CRCIFRM,$87.35,$0.00,$87.35,$39.31,$62.34,$0.00,$14.61,$0.00,$0.00,$15.29,$87.35,$0.00,$43.68,$69.18,$69.88,$0.00,$13.27,$0.00,$13.91,$0.00
201.662,SUP,HCPCS C1713,,201.662  -  SCREW BONE CONE LP 2.4MM 4.5MM 32MM SELF TAP THREAD CRCIFRM,$87.35,$0.00,$87.35,$39.31,$62.34,$0.00,$14.61,$0.00,$0.00,$15.29,$87.35,$0.00,$43.68,$69.18,$69.88,$0.00,$13.27,$0.00,$13.91,$0.00
201.664,SUP,HCPCS C1713,,201.664  -  SCREW BONE CONE LP 2.4MM 4.5MM 34MM SELF TAP THREAD CRCIFRM,$87.35,$0.00,$87.35,$39.31,$62.34,$0.00,$14.61,$0.00,$0.00,$15.29,$87.35,$0.00,$43.68,$69.18,$69.88,$0.00,$13.27,$0.00,$13.91,$0.00
201.666,SUP,HCPCS C1713,,201.666  -  SCREW BONE 2.4MM 4MM 36MM SELF TAP STAINLESS STEEL SMALL,$87.35,$0.00,$87.35,$39.31,$62.34,$0.00,$14.61,$0.00,$0.00,$15.29,$87.35,$0.00,$43.68,$69.18,$69.88,$0.00,$13.27,$0.00,$13.91,$0.00
201.668,SUP,HCPCS C1713,,201.668  -  SCREW BONE CONE LP 2.4MM 4.5MM 38MM SELF TAP THREAD CRCIFRM,$87.35,$0.00,$87.35,$39.31,$62.34,$0.00,$14.61,$0.00,$0.00,$15.29,$87.35,$0.00,$43.68,$69.18,$69.88,$0.00,$13.27,$0.00,$13.91,$0.00
201.67,SUP,HCPCS C1713,,201.670  -  SCREW BONE CONE LP 2.4MM 4.5MM 40MM SELF TAP THREAD CRCIFRM,$87.35,$0.00,$87.35,$39.31,$62.34,$0.00,$14.61,$0.00,$0.00,$15.29,$87.35,$0.00,$43.68,$69.18,$69.88,$0.00,$13.27,$0.00,$13.91,$0.00
201.676,SUP,HCPCS C1713,,201.676  -  SCREW BONE 3.5MM HEAD 2.4MM 6MM SLFTAP STAINLESS STEEL,$113.28,$0.00,$113.28,$50.97,$80.84,$0.00,$18.95,$0.00,$0.00,$19.83,$113.28,$0.00,$56.64,$89.72,$90.62,$0.00,$17.21,$0.00,$18.03,$0.00
201.677,SUP,HCPCS C1713,,201.677  -  SCREW BONE 2.3MM 3.5MM 7MM HEAD SLFTAP CORTICAL,$113.28,$0.00,$113.28,$50.97,$80.84,$0.00,$18.95,$0.00,$0.00,$19.83,$113.28,$0.00,$56.64,$89.72,$90.62,$0.00,$17.21,$0.00,$18.03,$0.00
201.678,SUP,HCPCS C1713,,201.678  -  SCREW BONE 3.5MM HEAD 2.4MM 8MM SLFTAP STAINLESS STEEL,$113.28,$0.00,$113.28,$50.97,$80.84,$0.00,$18.95,$0.00,$0.00,$19.83,$113.28,$0.00,$56.64,$89.72,$90.62,$0.00,$17.21,$0.00,$18.03,$0.00
201.679,SUP,HCPCS C1713,,201.679  -  SCREW BONE 2.3MM 3.5MM 9MM HEAD SLFTAP CORTICAL,$113.28,$0.00,$113.28,$50.97,$80.84,$0.00,$18.95,$0.00,$0.00,$19.83,$113.28,$0.00,$56.64,$89.72,$90.62,$0.00,$17.21,$0.00,$18.03,$0.00
201.68,SUP,HCPCS C1713,,201.680  -  CLIP ANEURYSM 10MM OPENING 20X1.88MM SUPER BAYONET LATEX,$113.28,$0.00,$113.28,$50.97,$80.84,$0.00,$18.95,$0.00,$0.00,$19.83,$113.28,$0.00,$56.64,$89.72,$90.62,$0.00,$17.21,$0.00,$18.03,$0.00
201.681,SUP,HCPCS C1713,,201.681  -  SCREW BONE 2.3MM 3.5MM 11MM HEAD SLFTAP CORTICAL,$113.28,$0.00,$113.28,$50.97,$80.84,$0.00,$18.95,$0.00,$0.00,$19.83,$113.28,$0.00,$56.64,$89.72,$90.62,$0.00,$17.21,$0.00,$18.03,$0.00
201.683,SUP,HCPCS C1713,,201.683  -  SCREW BONE 3.5MM HEAD 2.4MM 13MM SLFTAP STAINLESS STEEL,$113.28,$0.00,$113.28,$50.97,$80.84,$0.00,$18.95,$0.00,$0.00,$19.83,$113.28,$0.00,$56.64,$89.72,$90.62,$0.00,$17.21,$0.00,$18.03,$0.00
201.685,SUP,HCPCS C1713,,201.685  -  SCREW BONE 3.5MM HEAD 2.3MM 15MM SLFTAP CORTICAL,$113.28,$0.00,$113.28,$50.97,$80.84,$0.00,$18.95,$0.00,$0.00,$19.83,$113.28,$0.00,$56.64,$89.72,$90.62,$0.00,$17.21,$0.00,$18.03,$0.00
201.686,SUP,HCPCS C1713,,201.686  -  SCREW BONE 2.3MM 3.5MM 32MM HEAD SLFTAP CORTICAL,$113.28,$0.00,$113.28,$50.97,$80.84,$0.00,$18.95,$0.00,$0.00,$19.83,$113.28,$0.00,$56.64,$89.72,$90.62,$0.00,$17.21,$0.00,$18.03,$0.00
201.687,SUP,HCPCS C1713,,201.687  -  SCREW BONE 2.3MM 3.5MM 34MM HEAD SLFTAP CORTICAL,$113.28,$0.00,$113.28,$50.97,$80.84,$0.00,$18.95,$0.00,$0.00,$19.83,$113.28,$0.00,$56.64,$89.72,$90.62,$0.00,$17.21,$0.00,$18.03,$0.00
201.688,SUP,HCPCS C1713,,201.688  -  SCREW BONE 2.3MM 3.5MM 36MM HEAD SLFTAP CORTICAL,$113.28,$0.00,$113.28,$50.97,$80.84,$0.00,$18.95,$0.00,$0.00,$19.83,$113.28,$0.00,$56.64,$89.72,$90.62,$0.00,$17.21,$0.00,$18.03,$0.00
201.689,SUP,HCPCS C1713,,201.689  -  SCREW BONE 2.3MM 3.5MM 38MM HEAD SLFTAP CORTICAL,$113.28,$0.00,$113.28,$50.97,$80.84,$0.00,$18.95,$0.00,$0.00,$19.83,$113.28,$0.00,$56.64,$89.72,$90.62,$0.00,$17.21,$0.00,$18.03,$0.00
201.69,SUP,HCPCS C1713,,201.690  -  SCREW BONE 3.5MM HEAD 2.3MM 40MM SLFTAP CORTICAL,$113.28,$0.00,$113.28,$50.97,$80.84,$0.00,$18.95,$0.00,$0.00,$19.83,$113.28,$0.00,$56.64,$89.72,$90.62,$0.00,$17.21,$0.00,$18.03,$0.00
201.691,SUP,HCPCS C1713,,201.691  -  SCREW BONE 2.3MM 3.5MM 42MM HEAD SLFTAP CORTICAL,$113.28,$0.00,$113.28,$50.97,$80.84,$0.00,$18.95,$0.00,$0.00,$19.83,$113.28,$0.00,$56.64,$89.72,$90.62,$0.00,$17.21,$0.00,$18.03,$0.00
201.692,SUP,HCPCS C1713,,201.692  -  SCREW BONE 2.4MM 44MM SLFTAP STAINLESS STEEL CORTICAL,$113.28,$0.00,$113.28,$50.97,$80.84,$0.00,$18.95,$0.00,$0.00,$19.83,$113.28,$0.00,$56.64,$89.72,$90.62,$0.00,$17.21,$0.00,$18.03,$0.00
201.693,SUP,HCPCS C1713,,201.693  -  SCREW BONE 2.3MM 3.5MM 46MM HEAD SLFTAP CORTICAL,$113.28,$0.00,$113.28,$50.97,$80.84,$0.00,$18.95,$0.00,$0.00,$19.83,$113.28,$0.00,$56.64,$89.72,$90.62,$0.00,$17.21,$0.00,$18.03,$0.00
201.694,SUP,HCPCS C1713,,201.694  -  SCREW BONE 2.3MM 3.5MM 48MM HEAD SLFTAP CORTICAL,$113.28,$0.00,$113.28,$50.97,$80.84,$0.00,$18.95,$0.00,$0.00,$19.83,$113.28,$0.00,$56.64,$89.72,$90.62,$0.00,$17.21,$0.00,$18.03,$0.00
201.695,SUP,HCPCS C1713,,201.695  -  SCREW BONE 3.5MM HEAD 2.3MM 50MM SLFTAP CORTICAL,$113.28,$0.00,$113.28,$50.97,$80.84,$0.00,$18.95,$0.00,$0.00,$19.83,$113.28,$0.00,$56.64,$89.72,$90.62,$0.00,$17.21,$0.00,$18.03,$0.00
201.696,SUP,HCPCS C1713,,201.696  -  SCREW BONE 3.5MM HEAD 2.4MM 52MM SLFTAP STAINLESS STEEL,$113.28,$0.00,$113.28,$50.97,$80.84,$0.00,$18.95,$0.00,$0.00,$19.83,$113.28,$0.00,$56.64,$89.72,$90.62,$0.00,$17.21,$0.00,$18.03,$0.00
201.697,SUP,HCPCS C1713,,201.697  -  SCREW BONE 2.3MM 3.5MM 54MM HEAD SLFTAP CORTICAL,$113.28,$0.00,$113.28,$50.97,$80.84,$0.00,$18.95,$0.00,$0.00,$19.83,$113.28,$0.00,$56.64,$89.72,$90.62,$0.00,$17.21,$0.00,$18.03,$0.00
201.698,SUP,HCPCS C1713,,201.698  -  SCREW BONE 3.5MM HEAD 2.4MM 56MM SLFTAP STAINLESS STEEL,$113.28,$0.00,$113.28,$50.97,$80.84,$0.00,$18.95,$0.00,$0.00,$19.83,$113.28,$0.00,$56.64,$89.72,$90.62,$0.00,$17.21,$0.00,$18.03,$0.00
201.699,SUP,HCPCS C1713,,201.699  -  SCREW BONE 2.3MM 3.5MM 58MM HEAD SLFTAP CORTICAL,$113.28,$0.00,$113.28,$50.97,$80.84,$0.00,$18.95,$0.00,$0.00,$19.83,$113.28,$0.00,$56.64,$89.72,$90.62,$0.00,$17.21,$0.00,$18.03,$0.00
201.7,SUP,HCPCS C1713,,201.700  -  SCREW BONE 2.4MM 3.5MM 60MM SLFTAP CRCIFRM RECESS STAINLESS,$113.28,$0.00,$113.28,$50.97,$80.84,$0.00,$18.95,$0.00,$0.00,$19.83,$113.28,$0.00,$56.64,$89.72,$90.62,$0.00,$17.21,$0.00,$18.03,$0.00
201.756,SUP,HCPCS C1713,,201.756  -  SCREW BONE T8 LP 2.4MM 4MM 6MM SELF TAP STARDRIVE LCP,$102.35,$0.00,$102.35,$46.06,$73.05,$0.00,$17.12,$0.00,$0.00,$17.92,$102.35,$0.00,$51.18,$81.06,$81.88,$0.00,$15.55,$0.00,$16.29,$0.00
201.757,SUP,HCPCS C1713,,201.757  -  SCREW BONE T8 LP 2.4MM 4MM 7MM SELF TAP STARDRIVE LCP,$102.35,$0.00,$102.35,$46.06,$73.05,$0.00,$17.12,$0.00,$0.00,$17.92,$102.35,$0.00,$51.18,$81.06,$81.88,$0.00,$15.55,$0.00,$16.29,$0.00
201.758,SUP,HCPCS C1713,,201.758  -  SCREW BONE T8 LP 2.4MM 4MM 8MM SELF TAP STARDRIVE LCP,$102.35,$0.00,$102.35,$46.06,$73.05,$0.00,$17.12,$0.00,$0.00,$17.92,$102.35,$0.00,$51.18,$81.06,$81.88,$0.00,$15.55,$0.00,$16.29,$0.00
201.759,SUP,HCPCS C1713,,201.759  -  SCREW BONE T8 LP 2.4MM 4MM 9MM SELF TAP STARDRIVE LCP,$102.35,$0.00,$102.35,$46.06,$73.05,$0.00,$17.12,$0.00,$0.00,$17.92,$102.35,$0.00,$51.18,$81.06,$81.88,$0.00,$15.55,$0.00,$16.29,$0.00
201.76,SUP,HCPCS C1713,,201.760  -  SCREW BONE T8 LP 2.4MM 4MM 10MM SELF TAP STARDRIVE LCP,$102.35,$0.00,$102.35,$46.06,$73.05,$0.00,$17.12,$0.00,$0.00,$17.92,$102.35,$0.00,$51.18,$81.06,$81.88,$0.00,$15.55,$0.00,$16.29,$0.00
201.761,SUP,HCPCS C1713,,201.761  -  SCREW BONE T8 LP 2.4MM 4MM 11MM SELF TAP STARDRIVE LCP,$102.35,$0.00,$102.35,$46.06,$73.05,$0.00,$17.12,$0.00,$0.00,$17.92,$102.35,$0.00,$51.18,$81.06,$81.88,$0.00,$15.55,$0.00,$16.29,$0.00
201.762,SUP,HCPCS C1713,,201.762  -  SCREW BONE T8 LP 2.4MM 4MM 12MM SELF TAP STARDRIVE LCP,$102.35,$0.00,$102.35,$46.06,$73.05,$0.00,$17.12,$0.00,$0.00,$17.92,$102.35,$0.00,$51.18,$81.06,$81.88,$0.00,$15.55,$0.00,$16.29,$0.00
201.763,SUP,HCPCS C1713,,201.763  -  SCREW BONE T8 LP 2.4MM 4MM 13MM SELF TAP STARDRIVE LCP,$102.35,$0.00,$102.35,$46.06,$73.05,$0.00,$17.12,$0.00,$0.00,$17.92,$102.35,$0.00,$51.18,$81.06,$81.88,$0.00,$15.55,$0.00,$16.29,$0.00
201.764,SUP,HCPCS C1713,,201.764  -  SCREW BONE T8 LP 2.4MM 4MM 14MM SELF TAP STARDRIVE LCP,$102.35,$0.00,$102.35,$46.06,$73.05,$0.00,$17.12,$0.00,$0.00,$17.92,$102.35,$0.00,$51.18,$81.06,$81.88,$0.00,$15.55,$0.00,$16.29,$0.00
201.766,SUP,HCPCS C1713,,201.766  -  SCREW BONE 2.4MM 4MM 16MM T8 STARDRIVE SELF TAP LP HEAD VAR,$102.35,$0.00,$102.35,$46.06,$73.05,$0.00,$17.12,$0.00,$0.00,$17.92,$102.35,$0.00,$51.18,$81.06,$81.88,$0.00,$15.55,$0.00,$16.29,$0.00
201.768,SUP,HCPCS C1713,,201.768  -  SCREW BONE T8 LP 2.4MM 4MM 18MM SELF TAP STARDRIVE LCP,$102.35,$0.00,$102.35,$46.06,$73.05,$0.00,$17.12,$0.00,$0.00,$17.92,$102.35,$0.00,$51.18,$81.06,$81.88,$0.00,$15.55,$0.00,$16.29,$0.00
201.77,SUP,HCPCS C1713,,201.770  -  SCREW BONE T8 LP 2.4MM 4MM 20MM SELF TAP STARDRIVE LCP,$102.35,$0.00,$102.35,$46.06,$73.05,$0.00,$17.12,$0.00,$0.00,$17.92,$102.35,$0.00,$51.18,$81.06,$81.88,$0.00,$15.55,$0.00,$16.29,$0.00
201.772,SUP,HCPCS C1713,,201.772  -  SCREW BONE T8 LP 2.4MM 4MM 22MM SELF TAP STARDRIVE LCP,$102.35,$0.00,$102.35,$46.06,$73.05,$0.00,$17.12,$0.00,$0.00,$17.92,$102.35,$0.00,$51.18,$81.06,$81.88,$0.00,$15.55,$0.00,$16.29,$0.00
201.774,SUP,HCPCS C1713,,201.774  -  SCREW BONE T8 LP 2.4MM 4MM 24MM SELF TAP STARDRIVE LCP,$102.35,$0.00,$102.35,$46.06,$73.05,$0.00,$17.12,$0.00,$0.00,$17.92,$102.35,$0.00,$51.18,$81.06,$81.88,$0.00,$15.55,$0.00,$16.29,$0.00
201.776,SUP,HCPCS C1713,,201.776  -  SCREW BONE T8 LP 2.4MM 4MM 26MM SELF TAP STARDRIVE LCP,$102.35,$0.00,$102.35,$46.06,$73.05,$0.00,$17.12,$0.00,$0.00,$17.92,$102.35,$0.00,$51.18,$81.06,$81.88,$0.00,$15.55,$0.00,$16.29,$0.00
201.778,SUP,HCPCS C1713,,201.778  -  SCREW BONE T8 LP 2.4MM 4MM 28MM SELF TAP STARDRIVE LCP,$102.35,$0.00,$102.35,$46.06,$73.05,$0.00,$17.12,$0.00,$0.00,$17.92,$102.35,$0.00,$51.18,$81.06,$81.88,$0.00,$15.55,$0.00,$16.29,$0.00
201.78,SUP,HCPCS C1713,,201.780  -  SCREW BONE T8 LP 2.4MM 4MM 30MM SELF TAP STARDRIVE LCP,$102.35,$0.00,$102.35,$46.06,$73.05,$0.00,$17.12,$0.00,$0.00,$17.92,$102.35,$0.00,$51.18,$81.06,$81.88,$0.00,$15.55,$0.00,$16.29,$0.00
201.782,SUP,HCPCS C1713,,201.782  -  SCREW BONE 2.4MM 3.5MM 32MM SELF TAP CRCIFRM T8 STARDRIVE,$102.35,$0.00,$102.35,$46.06,$73.05,$0.00,$17.12,$0.00,$0.00,$17.92,$102.35,$0.00,$51.18,$81.06,$81.88,$0.00,$15.55,$0.00,$16.29,$0.00
201.784,SUP,HCPCS C1713,,201.784  -  SCREW BONE T8 LP 2.4MM 4MM 34MM SELF TAP STARDRIVE LCP,$102.35,$0.00,$102.35,$46.06,$73.05,$0.00,$17.12,$0.00,$0.00,$17.92,$102.35,$0.00,$51.18,$81.06,$81.88,$0.00,$15.55,$0.00,$16.29,$0.00
201.786,SUP,HCPCS C1713,,201.786  -  SCREW BONE T8 LP 2.4MM 4MM 36MM SELF TAP STARDRIVE LCP,$102.35,$0.00,$102.35,$46.06,$73.05,$0.00,$17.12,$0.00,$0.00,$17.92,$102.35,$0.00,$51.18,$81.06,$81.88,$0.00,$15.55,$0.00,$16.29,$0.00
201.788,SUP,HCPCS C1713,,201.788  -  SCREW BONE 2.4MM 4MM 38MM VARIABLESELF TAPPING T8 STARDRIVE,$102.35,$0.00,$102.35,$46.06,$73.05,$0.00,$17.12,$0.00,$0.00,$17.92,$102.35,$0.00,$51.18,$81.06,$81.88,$0.00,$15.55,$0.00,$16.29,$0.00
201.79,SUP,HCPCS C1713,,201.790  -  SCREW BONE T8 LP 2.4MM 4MM 40MM SELF TAP STARDRIVE LCP,$102.35,$0.00,$102.35,$46.06,$73.05,$0.00,$17.12,$0.00,$0.00,$17.92,$102.35,$0.00,$51.18,$81.06,$81.88,$0.00,$15.55,$0.00,$16.29,$0.00
201.806,SUP,HCPCS C1713,,201.806  -  SCREW BONE 2MM 3.5MM 6MM SELF TAP CRCIFRM DCP STAINLESS,$59.03,$0.00,$59.03,$26.56,$42.13,$0.00,$9.87,$0.00,$0.00,$10.33,$59.03,$0.00,$29.51,$46.75,$47.22,$0.00,$8.97,$0.00,$9.40,$0.00
201.807,SUP,HCPCS C1713,,201.807  -  SCREW BONE 2MM 3.5MM 7MM SELF TAP CRCIFRM DCP STAINLESS,$59.03,$0.00,$59.03,$26.56,$42.13,$0.00,$9.87,$0.00,$0.00,$10.33,$59.03,$0.00,$29.51,$46.75,$47.22,$0.00,$8.97,$0.00,$9.40,$0.00
201.808,SUP,HCPCS C1713,,201.808  -  SCREW BONE 2MM 3.5MM 8MM SELF TAP CRCIFRM STAINLESS STEEL FT,$59.03,$0.00,$59.03,$26.56,$42.13,$0.00,$9.87,$0.00,$0.00,$10.33,$59.03,$0.00,$29.51,$46.75,$47.22,$0.00,$8.97,$0.00,$9.40,$0.00
201.809,SUP,HCPCS C1713,,201.809  -  SCREW BONE 2MM 3.5MM 9MM SELF TAP CRCIFRM DCP STAINLESS,$59.03,$0.00,$59.03,$26.56,$42.13,$0.00,$9.87,$0.00,$0.00,$10.33,$59.03,$0.00,$29.51,$46.75,$47.22,$0.00,$8.97,$0.00,$9.40,$0.00
201.81,SUP,HCPCS C1713,,201.810  -  SCREW BONE 2MM 3.5MM 10MM SELF TAP CRCIFRM DCP STAINLESS,$59.03,$0.00,$59.03,$26.56,$42.13,$0.00,$9.87,$0.00,$0.00,$10.33,$59.03,$0.00,$29.51,$46.75,$47.22,$0.00,$8.97,$0.00,$9.40,$0.00
201.811,SUP,HCPCS C1713,,201.811  -  SCREW BONE 2MM 3.5MM 11MM SELF TAP CRCIFRM DCP STAINLESS,$59.03,$0.00,$59.03,$26.56,$42.13,$0.00,$9.87,$0.00,$0.00,$10.33,$59.03,$0.00,$29.51,$46.75,$47.22,$0.00,$8.97,$0.00,$9.40,$0.00
201.812,SUP,HCPCS C1713,,201.812  -  SCREW BONE 2MM 3.5MM 12MM SELF TAP CRCIFRM DCP STAINLESS,$59.03,$0.00,$59.03,$26.56,$42.13,$0.00,$9.87,$0.00,$0.00,$10.33,$59.03,$0.00,$29.51,$46.75,$47.22,$0.00,$8.97,$0.00,$9.40,$0.00
201.813,SUP,HCPCS C1713,,201.813  -  SCREW BN 2MM 13MM NS ST SS CORT MDLR HND SYS,$59.03,$0.00,$59.03,$26.56,$42.13,$0.00,$9.87,$0.00,$0.00,$10.33,$59.03,$0.00,$29.51,$46.75,$47.22,$0.00,$8.97,$0.00,$9.40,$0.00
201.814,SUP,HCPCS C1713,,201.814  -  SCREW BONE 2MM 3.5MM 14MM SELF TAP CRCIFRM DCP STAINLESS,$59.03,$0.00,$59.03,$26.56,$42.13,$0.00,$9.87,$0.00,$0.00,$10.33,$59.03,$0.00,$29.51,$46.75,$47.22,$0.00,$8.97,$0.00,$9.40,$0.00
201.816,SUP,HCPCS C1713,,201.816  -  SCREW BONE 2MM 3.5MM 16MM SELF TAP CRCIFRM DCP STAINLESS,$59.03,$0.00,$59.03,$26.56,$42.13,$0.00,$9.87,$0.00,$0.00,$10.33,$59.03,$0.00,$29.51,$46.75,$47.22,$0.00,$8.97,$0.00,$9.40,$0.00
201.818,SUP,HCPCS C1713,,201.818  -  SCREW BONE 2MM 3.5MM 18MM SELF TAP CRCIFRM DCP STAINLESS,$59.03,$0.00,$59.03,$26.56,$42.13,$0.00,$9.87,$0.00,$0.00,$10.33,$59.03,$0.00,$29.51,$46.75,$47.22,$0.00,$8.97,$0.00,$9.40,$0.00
201.82,SUP,HCPCS C1713,,201.820  -  SCREW BONE 2MM 3.5MM 20MM SELF TAP CRCIFRM DCP STAINLESS,$59.03,$0.00,$59.03,$26.56,$42.13,$0.00,$9.87,$0.00,$0.00,$10.33,$59.03,$0.00,$29.51,$46.75,$47.22,$0.00,$8.97,$0.00,$9.40,$0.00
201.822,SUP,HCPCS C1713,,201.822  -  SCREW BONE 2MM 3.5MM 22MM SELF TAP CRCIFRM DCP STAINLESS,$59.03,$0.00,$59.03,$26.56,$42.13,$0.00,$9.87,$0.00,$0.00,$10.33,$59.03,$0.00,$29.51,$46.75,$47.22,$0.00,$8.97,$0.00,$9.40,$0.00
201.824,SUP,HCPCS C1713,,201.824  -  SCREW BONE 2MM 3.5MM 24MM SELF TAP CRCIFRM DCP STAINLESS,$59.03,$0.00,$59.03,$26.56,$42.13,$0.00,$9.87,$0.00,$0.00,$10.33,$59.03,$0.00,$29.51,$46.75,$47.22,$0.00,$8.97,$0.00,$9.40,$0.00
201.826,SUP,HCPCS C1713,,201.826  -  SCREW BONE 2MM 3.5MM 26MM SELF TAP CRCIFRM DCP STAINLESS,$59.03,$0.00,$59.03,$26.56,$42.13,$0.00,$9.87,$0.00,$0.00,$10.33,$59.03,$0.00,$29.51,$46.75,$47.22,$0.00,$8.97,$0.00,$9.40,$0.00
201.828,SUP,HCPCS C1713,,201.828  -  SCREW BONE 2MM 3.5MM 28MM SELF TAP CRCIFRM DCP STAINLESS,$59.03,$0.00,$59.03,$26.56,$42.13,$0.00,$9.87,$0.00,$0.00,$10.33,$59.03,$0.00,$29.51,$46.75,$47.22,$0.00,$8.97,$0.00,$9.40,$0.00
201.83,SUP,HCPCS C1713,,201.830  -  SCREW BONE 2MM 3.5MM 30MM SELF TAP CRCIFRM DCP STAINLESS,$59.03,$0.00,$59.03,$26.56,$42.13,$0.00,$9.87,$0.00,$0.00,$10.33,$59.03,$0.00,$29.51,$46.75,$47.22,$0.00,$8.97,$0.00,$9.40,$0.00
201.832,SUP,HCPCS C1713,,201.832  -  SCREW BONE 2MM 3.5MM 32MM SELF TAP CRCIFRM DCP STAINLESS,$59.03,$0.00,$59.03,$26.56,$42.13,$0.00,$9.87,$0.00,$0.00,$10.33,$59.03,$0.00,$29.51,$46.75,$47.22,$0.00,$8.97,$0.00,$9.40,$0.00
201.834,SUP,HCPCS C1713,,201.834  -  SCREW BONE 2MM 3.5MM 34MM SELF TAP CRCIFRM LCP STAINLESS,$59.03,$0.00,$59.03,$26.56,$42.13,$0.00,$9.87,$0.00,$0.00,$10.33,$59.03,$0.00,$29.51,$46.75,$47.22,$0.00,$8.97,$0.00,$9.40,$0.00
201.836,SUP,HCPCS C1713,,201.836  -  SCREW BONE 2MM 3.5MM 36MM SELF TAP CRCIFRM DCP STAINLESS,$59.03,$0.00,$59.03,$26.56,$42.13,$0.00,$9.87,$0.00,$0.00,$10.33,$59.03,$0.00,$29.51,$46.75,$47.22,$0.00,$8.97,$0.00,$9.40,$0.00
201.838,SUP,HCPCS C1713,,201.838  -  SCREW BONE 2MM 3.5MM 38MM SELF TAP CRCIFRM DCP STAINLESS,$59.03,$0.00,$59.03,$26.56,$42.13,$0.00,$9.87,$0.00,$0.00,$10.33,$59.03,$0.00,$29.51,$46.75,$47.22,$0.00,$8.97,$0.00,$9.40,$0.00
201.84,SUP,HCPCS C1713,,201.840  -  SCREW BONE 2MM 3.5MM 40MM SELF TAP CRCIFRM LCP STAINLESS,$59.03,$0.00,$59.03,$26.56,$42.13,$0.00,$9.87,$0.00,$0.00,$10.33,$59.03,$0.00,$29.51,$46.75,$47.22,$0.00,$8.97,$0.00,$9.40,$0.00
201.876,SUP,HCPCS C1713,,201.876  -  SCREW BONE T6 2MM 6MM SELF TAP STARDRIVE LCP STAINLESS STEEL,$208.80,$0.00,$208.80,$93.96,$149.02,$0.00,$34.93,$0.00,$0.00,$36.56,$208.80,$0.00,$104.40,$165.37,$167.04,$0.00,$31.73,$0.00,$33.24,$0.00
201.877,SUP,HCPCS C1713,,201.877  -  SCREW BONE T6 2MM 7MM SELF TAP STARDRIVE LCP STAINLESS STEEL,$208.80,$0.00,$208.80,$93.96,$149.02,$0.00,$34.93,$0.00,$0.00,$36.56,$208.80,$0.00,$104.40,$165.37,$167.04,$0.00,$31.73,$0.00,$33.24,$0.00
201.878,SUP,HCPCS C1713,,201.878  -  SCREW BONE T6 2MM 8MM SELF TAP STARDRIVE LCP STAINLESS STEEL,$208.80,$0.00,$208.80,$93.96,$149.02,$0.00,$34.93,$0.00,$0.00,$36.56,$208.80,$0.00,$104.40,$165.37,$167.04,$0.00,$31.73,$0.00,$33.24,$0.00
201.879,SUP,HCPCS C1713,,201.879  -  SCREW BONE T6 2MM 9MM SELF TAP STARDRIVE LCP STAINLESS STEEL,$208.80,$0.00,$208.80,$93.96,$149.02,$0.00,$34.93,$0.00,$0.00,$36.56,$208.80,$0.00,$104.40,$165.37,$167.04,$0.00,$31.73,$0.00,$33.24,$0.00
201.88,SUP,HCPCS C1713,,201.880  -  SCREW BONE T6 2MM 10MM SELF TAP STARDRIVE LCP STAINLESS,$208.80,$0.00,$208.80,$93.96,$149.02,$0.00,$34.93,$0.00,$0.00,$36.56,$208.80,$0.00,$104.40,$165.37,$167.04,$0.00,$31.73,$0.00,$33.24,$0.00
201.881,SUP,HCPCS C1713,,201.881  -  SCREW BONE T6 2MM 11MM SELF TAP STARDRIVE LCP STAINLESS,$208.80,$0.00,$208.80,$93.96,$149.02,$0.00,$34.93,$0.00,$0.00,$36.56,$208.80,$0.00,$104.40,$165.37,$167.04,$0.00,$31.73,$0.00,$33.24,$0.00
201.882,SUP,HCPCS C1713,,201.882  -  SCREW BONE T6 2MM 12MM SELF TAP STARDRIVE LCP STAINLESS,$208.80,$0.00,$208.80,$93.96,$149.02,$0.00,$34.93,$0.00,$0.00,$36.56,$208.80,$0.00,$104.40,$165.37,$167.04,$0.00,$31.73,$0.00,$33.24,$0.00
201.883,SUP,HCPCS C1713,,201.883  -  SCREW BONE T6 2MM 13MM SELF TAP STARDRIVE LCP STAINLESS,$208.80,$0.00,$208.80,$93.96,$149.02,$0.00,$34.93,$0.00,$0.00,$36.56,$208.80,$0.00,$104.40,$165.37,$167.04,$0.00,$31.73,$0.00,$33.24,$0.00
201.884,SUP,HCPCS C1713,,201.884  -  SCREW BONE T6 2MM 14MM SELF TAP STARDRIVE LCP STAINLESS,$208.80,$0.00,$208.80,$93.96,$149.02,$0.00,$34.93,$0.00,$0.00,$36.56,$208.80,$0.00,$104.40,$165.37,$167.04,$0.00,$31.73,$0.00,$33.24,$0.00
201.886,SUP,HCPCS C1713,,201.886  -  SCREW BONE T6 2MM 16MM SELF TAP STARDRIVE LCP STAINLESS,$208.80,$0.00,$208.80,$93.96,$149.02,$0.00,$34.93,$0.00,$0.00,$36.56,$208.80,$0.00,$104.40,$165.37,$167.04,$0.00,$31.73,$0.00,$33.24,$0.00
201.888,SUP,HCPCS C1713,,201.888  -  SCREW BONE T6 2MM 18MM SELF TAP STARDRIVE LCP STAINLESS,$208.80,$0.00,$208.80,$93.96,$149.02,$0.00,$34.93,$0.00,$0.00,$36.56,$208.80,$0.00,$104.40,$165.37,$167.04,$0.00,$31.73,$0.00,$33.24,$0.00
201.89,SUP,HCPCS C1713,,201.890  -  SCREW BONE T6 2MM 20MM SELF TAP STARDRIVE LCP STAINLESS,$208.80,$0.00,$208.80,$93.96,$149.02,$0.00,$34.93,$0.00,$0.00,$36.56,$208.80,$0.00,$104.40,$165.37,$167.04,$0.00,$31.73,$0.00,$33.24,$0.00
201.892,SUP,HCPCS C1713,,201.892  -  SCREW BONE T6 2MM 22MM SELF TAP STARDRIVE LCP STAINLESS,$208.80,$0.00,$208.80,$93.96,$149.02,$0.00,$34.93,$0.00,$0.00,$36.56,$208.80,$0.00,$104.40,$165.37,$167.04,$0.00,$31.73,$0.00,$33.24,$0.00
201.894,SUP,HCPCS C1713,,201.894  -  SCREW BONE T6 2MM 24MM SELF TAP STARDRIVE LCP STAINLESS,$208.80,$0.00,$208.80,$93.96,$149.02,$0.00,$34.93,$0.00,$0.00,$36.56,$208.80,$0.00,$104.40,$165.37,$167.04,$0.00,$31.73,$0.00,$33.24,$0.00
201.896,SUP,HCPCS C1713,,201.896  -  SCREW BONE T6 2MM 26MM SELF TAP STARDRIVE LCP STAINLESS,$208.80,$0.00,$208.80,$93.96,$149.02,$0.00,$34.93,$0.00,$0.00,$36.56,$208.80,$0.00,$104.40,$165.37,$167.04,$0.00,$31.73,$0.00,$33.24,$0.00
201.898,SUP,HCPCS C1713,,201.898  -  SCREW BONE T6 2MM 28MM SELF TAP STARDRIVE LCP STAINLESS,$208.80,$0.00,$208.80,$93.96,$149.02,$0.00,$34.93,$0.00,$0.00,$36.56,$208.80,$0.00,$104.40,$165.37,$167.04,$0.00,$31.73,$0.00,$33.24,$0.00
201.9,SUP,HCPCS C1713,,201.900  -  SCREW BONE 2MM 30MM T6 STAR DRIVE RECESS SLFTAP LCP,$208.80,$0.00,$208.80,$93.96,$149.02,$0.00,$34.93,$0.00,$0.00,$36.56,$208.80,$0.00,$104.40,$165.37,$167.04,$0.00,$31.73,$0.00,$33.24,$0.00
201.928,SUP,HCPCS C1713,,201.928  -  SCREW BONE 8MM 2MM MAXFACL SS SLF DRILING IMF NONSTRL,$205.88,$0.00,$205.88,$92.64,$146.93,$0.00,$35.47,$0.00,$0.00,$36.05,$205.88,$0.00,$102.94,$163.06,$164.70,$0.00,$32.22,$0.00,$32.78,$0.00
201.962,SUP,Custom 27203010,,201.962  -  PIN FIX 1.8MM 12MM BUTTRESS STAINLESS STEEL DISTAL RAD,$113.95,$0.00,$113.95,$0.00,$81.33,$0.00,$0.00,$0.00,$0.00,$0.00,$113.95,$0.00,$56.98,$90.25,$91.16,$0.00,$0.00,$0.00,$0.00,$0.00
201.964,SUP,Custom 27203010,,201.964  -  PIN FIX 1.8MM 14MM BUTTRESS STAINLESS STEEL DISTAL RAD,$113.95,$0.00,$113.95,$0.00,$81.33,$0.00,$0.00,$0.00,$0.00,$0.00,$113.95,$0.00,$56.98,$90.25,$91.16,$0.00,$0.00,$0.00,$0.00,$0.00
201.966,SUP,Custom 27203010,,201.966  -  PIN FIX 1.8MM 16MM BUTTRESS STAINLESS STEEL DISTAL RAD,$113.95,$0.00,$113.95,$0.00,$81.33,$0.00,$0.00,$0.00,$0.00,$0.00,$113.95,$0.00,$56.98,$90.25,$91.16,$0.00,$0.00,$0.00,$0.00,$0.00
201.968,SUP,Custom 27203010,,201.968  -  PIN FIX 1.8MM 18MM BUTTRESS LCP STAINLESS STEEL DISTAL RAD,$113.95,$0.00,$113.95,$0.00,$81.33,$0.00,$0.00,$0.00,$0.00,$0.00,$113.95,$0.00,$56.98,$90.25,$91.16,$0.00,$0.00,$0.00,$0.00,$0.00
201.972,SUP,Custom 27203010,,201.972  -  PIN FIX 1.8MM 22MM BUTTRESS STAINLESS STEEL DISTAL RAD,$113.95,$0.00,$113.95,$0.00,$81.33,$0.00,$0.00,$0.00,$0.00,$0.00,$113.95,$0.00,$56.98,$90.25,$91.16,$0.00,$0.00,$0.00,$0.00,$0.00
201.974,SUP,Custom 27203010,,201.974  -  PIN FIX 1.8MM 24MM BUTTRESS STAINLESS STEEL DISTAL RAD,$113.95,$0.00,$113.95,$0.00,$81.33,$0.00,$0.00,$0.00,$0.00,$0.00,$113.95,$0.00,$56.98,$90.25,$91.16,$0.00,$0.00,$0.00,$0.00,$0.00
201.976,SUP,Custom 27203010,,201.976  -  PIN FIX 1.8MM 26MM BUTTRESS STAINLESS STEEL DISTAL RAD,$113.95,$0.00,$113.95,$0.00,$81.33,$0.00,$0.00,$0.00,$0.00,$0.00,$113.95,$0.00,$56.98,$90.25,$91.16,$0.00,$0.00,$0.00,$0.00,$0.00
201.978,SUP,Custom 27203010,,201.978  -  PIN FIX 1.8MM 28MM BUTTRESS STAINLESS STEEL DISTAL RAD,$113.95,$0.00,$113.95,$0.00,$81.33,$0.00,$0.00,$0.00,$0.00,$0.00,$113.95,$0.00,$56.98,$90.25,$91.16,$0.00,$0.00,$0.00,$0.00,$0.00
201.98,SUP,Custom 27203010,,201.980  -  PIN FIX 1.8MM 30MM BUTTRESS STAINLESS STEEL DISTAL RAD,$113.95,$0.00,$113.95,$0.00,$81.33,$0.00,$0.00,$0.00,$0.00,$0.00,$113.95,$0.00,$56.98,$90.25,$91.16,$0.00,$0.00,$0.00,$0.00,$0.00
202.006,SUP,HCPCS C1713,,202.006  -  SCREW BONE 2.5MM STANDARD 2.7MM 6MM SPHERICAL HEAD SMALL,$54.93,$0.00,$54.93,$24.72,$39.20,$0.00,$9.19,$0.00,$0.00,$9.62,$54.93,$0.00,$27.46,$43.50,$43.94,$0.00,$8.35,$0.00,$8.74,$0.00
202.008,SUP,HCPCS C1713,,202.008  -  SCREW BONE STANDARD 2.7MM 5MM 8MM SPHERICAL HEAD SMALL,$54.93,$0.00,$54.93,$24.72,$39.20,$0.00,$9.19,$0.00,$0.00,$9.62,$54.93,$0.00,$27.46,$43.50,$43.94,$0.00,$8.35,$0.00,$8.74,$0.00
202.01,SUP,HCPCS C1713,,202.010  -  SCREW BN STD FT 2.7MM 5MM 10MM NS 2.5MM SPHRCL HD SM HEX,$54.93,$0.00,$54.93,$24.72,$39.20,$0.00,$7.34,$0.00,$0.00,$9.62,$54.93,$0.00,$27.46,$43.50,$43.94,$0.00,$6.67,$0.00,$8.74,$0.00
202.012,SUP,HCPCS C1713,,202.012  -  SCREW BONE STANDARD 2.7MM 5MM 12MM SPHERICAL HEAD SMALL,$54.93,$0.00,$54.93,$24.72,$39.20,$0.00,$9.19,$0.00,$0.00,$9.62,$54.93,$0.00,$27.46,$43.50,$43.94,$0.00,$8.35,$0.00,$8.74,$0.00
202.014,SUP,HCPCS C1713,,202.014  -  SCREW BONE STANDARD 2.7MM 5MM 14MM SPHERICAL HEAD SMALL,$54.93,$0.00,$54.93,$24.72,$39.20,$0.00,$9.19,$0.00,$0.00,$9.62,$54.93,$0.00,$27.46,$43.50,$43.94,$0.00,$8.35,$0.00,$8.74,$0.00
202.016,SUP,HCPCS C1713,,202.016  -  SCREW BONE STANDARD 2.7MM 5MM 16MM SPHERICAL HEAD SMALL,$54.93,$0.00,$54.93,$24.72,$39.20,$0.00,$9.19,$0.00,$0.00,$9.62,$54.93,$0.00,$27.46,$43.50,$43.94,$0.00,$8.35,$0.00,$8.74,$0.00
202.018,SUP,HCPCS C1713,,202.018  -  SCREW BONE STANDARD 2.7MM 5MM 18MM SPHERICAL HEAD SMALL,$54.93,$0.00,$54.93,$24.72,$39.20,$0.00,$9.19,$0.00,$0.00,$9.62,$54.93,$0.00,$27.46,$43.50,$43.94,$0.00,$8.35,$0.00,$8.74,$0.00
202.02,SUP,HCPCS C1713,,202.020  -  SCREW BONE STANDARD 2.7MM 5MM 20MM SPHERICAL HEAD SMALL,$54.93,$0.00,$54.93,$24.72,$39.20,$0.00,$9.19,$0.00,$0.00,$9.62,$54.93,$0.00,$27.46,$43.50,$43.94,$0.00,$8.35,$0.00,$8.74,$0.00
202.022,SUP,HCPCS C1713,,202.022  -  SCREW BONE STANDARD 2.7MM 5MM 22MM SPHERICAL HEAD SMALL,$54.93,$0.00,$54.93,$24.72,$39.20,$0.00,$9.19,$0.00,$0.00,$9.62,$54.93,$0.00,$27.46,$43.50,$43.94,$0.00,$8.35,$0.00,$8.74,$0.00
202.024,SUP,HCPCS C1713,,202.024  -  SCREW BONE STANDARD 2.7MM 5MM 24MM SPHERICAL HEAD SMALL,$54.93,$0.00,$54.93,$24.72,$39.20,$0.00,$9.19,$0.00,$0.00,$9.62,$54.93,$0.00,$27.46,$43.50,$43.94,$0.00,$8.35,$0.00,$8.74,$0.00
202.026,SUP,HCPCS C1713,,202.026  -  SCREW BONE STANDARD 2.7MM 26MM DCP STAINLESS STEEL CORTICAL,$54.93,$0.00,$54.93,$24.72,$39.20,$0.00,$9.19,$0.00,$0.00,$9.62,$54.93,$0.00,$27.46,$43.50,$43.94,$0.00,$8.35,$0.00,$8.74,$0.00
202.028,SUP,HCPCS C1713,,202.028  -  SCREW BONE 2.7MM 28MM DCP SS CORT NONSTRL SM FRAG,$42.60,$0.00,$42.60,$19.17,$30.40,$0.00,$7.34,$0.00,$0.00,$7.46,$42.60,$0.00,$21.30,$33.74,$34.08,$0.00,$6.67,$0.00,$6.78,$0.00
202.03,SUP,HCPCS C1713,,202.030  -  SCREW BONE 2.7MM 30MM DCP STAINLESS STEEL CORTICAL NONSTRL,$54.93,$0.00,$54.93,$24.72,$39.20,$0.00,$9.19,$0.00,$0.00,$9.62,$54.93,$0.00,$27.46,$43.50,$43.94,$0.00,$8.35,$0.00,$8.74,$0.00
202.032,SUP,HCPCS C1713,,202.032  -  SCREW BONE 2.7MM 32MM DCP STAINLESS STEEL CORTICAL NONSTRL,$54.93,$0.00,$54.93,$24.72,$39.20,$0.00,$9.19,$0.00,$0.00,$9.62,$54.93,$0.00,$27.46,$43.50,$43.94,$0.00,$8.35,$0.00,$8.74,$0.00
202.034,SUP,HCPCS C1713,,202.034  -  SCREW BONE STANDARD 2.7MM 5MM 34MM 2.5MM SMALL HEXAGON,$54.93,$0.00,$54.93,$24.72,$39.20,$0.00,$7.34,$0.00,$0.00,$9.62,$54.93,$0.00,$27.46,$43.50,$43.94,$0.00,$6.67,$0.00,$8.74,$0.00
202.036,SUP,HCPCS C1713,,202.036  -  SCREW BONE STANDARD SMALL HEXAGON SPHERE 2.7MM 5MM 36MM,$54.93,$0.00,$54.93,$24.72,$39.20,$0.00,$9.19,$0.00,$0.00,$9.62,$54.93,$0.00,$27.46,$43.50,$43.94,$0.00,$8.35,$0.00,$8.74,$0.00
202.038,SUP,HCPCS C1713,,202.038  -  SCREW BONE STANDARD 2.7MM 5MM 38MM 2.5MM SMALL HEXAGON,$54.93,$0.00,$54.93,$24.72,$39.20,$0.00,$9.19,$0.00,$0.00,$9.62,$54.93,$0.00,$27.46,$43.50,$43.94,$0.00,$8.35,$0.00,$8.74,$0.00
202.04,SUP,HCPCS C1713,,202.040  -  SCREW BONE STANDARD SMALL HEXAGON SPHERE 2.7MM 5MM 40MM,$54.93,$0.00,$54.93,$24.72,$39.20,$0.00,$9.19,$0.00,$0.00,$9.62,$54.93,$0.00,$27.46,$43.50,$43.94,$0.00,$8.35,$0.00,$8.74,$0.00
202.045,SUP,HCPCS C1713,,202.045  -  SCREW BONE STANDARD SMALL HEXAGON SPHERE 2.7MM 5MM 45MM,$54.93,$0.00,$54.93,$24.72,$39.20,$0.00,$9.19,$0.00,$0.00,$9.62,$54.93,$0.00,$27.46,$43.50,$43.94,$0.00,$8.35,$0.00,$8.74,$0.00
202.05,SUP,HCPCS C1713,,202.050  -  SCREW BONE STANDARD SMALL HEXAGON SPHERE 2.7MM 5MM 50MM,$54.93,$0.00,$54.93,$24.72,$39.20,$0.00,$9.19,$0.00,$0.00,$9.62,$54.93,$0.00,$27.46,$43.50,$43.94,$0.00,$8.35,$0.00,$8.74,$0.00
202.055,SUP,HCPCS C1713,,202.055  -  SCREW BONE STANDARD SMALL HEXAGON SPHERE 2.7MM 5MM 55MM,$54.93,$0.00,$54.93,$24.72,$39.20,$0.00,$9.19,$0.00,$0.00,$9.62,$54.93,$0.00,$27.46,$43.50,$43.94,$0.00,$8.35,$0.00,$8.74,$0.00
202.208,SUP,HCPCS C1713,,202.208  -  SCREW BONE T8 2.7MM 2.1MM 8MM SELF TAP MODULAR STARDRIVE LCP,$215.63,$0.00,$215.63,$97.03,$153.89,$0.00,$36.07,$0.00,$0.00,$37.75,$215.63,$0.00,$107.81,$170.78,$172.50,$0.00,$32.76,$0.00,$34.33,$0.00
202.21,SUP,HCPCS C1713,,202.210  -  SCREW BONE 2.7MM 10MM LOCKING SLFTAP T8 STARDRIVE RECESS LCP,$215.63,$0.00,$215.63,$97.03,$153.89,$0.00,$36.07,$0.00,$0.00,$37.75,$215.63,$0.00,$107.81,$170.78,$172.50,$0.00,$32.76,$0.00,$34.33,$0.00
202.212,SUP,HCPCS C1713,,202.212  -  SCREW BONE T8 2.7MM 2.1MM 12MM SELF TAP MODULAR STARDRIVE,$215.63,$0.00,$215.63,$97.03,$153.89,$0.00,$36.07,$0.00,$0.00,$37.75,$215.63,$0.00,$107.81,$170.78,$172.50,$0.00,$32.76,$0.00,$34.33,$0.00
202.214,SUP,HCPCS C1713,,202.214  -  SCREW BONE T8 2.7MM 2.1MM 14MM SELF TAP MODULAR STARDRIVE,$215.63,$0.00,$215.63,$97.03,$153.89,$0.00,$36.07,$0.00,$0.00,$37.75,$215.63,$0.00,$107.81,$170.78,$172.50,$0.00,$32.76,$0.00,$34.33,$0.00
202.216,SUP,HCPCS C1713,,202.216  -  SCREW BONE 2.7MM 2.1MM 16MM T8 STARDRIVE RECESS SLFTAP,$215.63,$0.00,$215.63,$97.03,$153.89,$0.00,$36.07,$0.00,$0.00,$37.75,$215.63,$0.00,$107.81,$170.78,$172.50,$0.00,$32.76,$0.00,$34.33,$0.00
202.218,SUP,HCPCS C1713,,202.218  -  SCREW BONE T8 2.7MM 2.1MM 18MM SELF TAP MODULAR STARDRIVE,$215.63,$0.00,$215.63,$97.03,$153.89,$0.00,$36.07,$0.00,$0.00,$37.75,$215.63,$0.00,$107.81,$170.78,$172.50,$0.00,$32.76,$0.00,$34.33,$0.00
202.22,SUP,HCPCS C1713,,202.220  -  SCREW BONE T8 2.7MM 2.1MM 20MM SELF TAP MODULAR STARDRIVE,$215.63,$0.00,$215.63,$97.03,$153.89,$0.00,$36.07,$0.00,$0.00,$37.75,$215.63,$0.00,$107.81,$170.78,$172.50,$0.00,$32.76,$0.00,$34.33,$0.00
202.222,SUP,HCPCS C1713,,202.222  -  SCREW BONE T8 2.7MM 2.1MM 22MM SELF TAP MODULAR STARDRIVE,$215.63,$0.00,$215.63,$97.03,$153.89,$0.00,$36.07,$0.00,$0.00,$37.75,$215.63,$0.00,$107.81,$170.78,$172.50,$0.00,$32.76,$0.00,$34.33,$0.00
202.224,SUP,HCPCS C1713,,202.224  -  SCREW BONE T8 2.7MM 2.1MM 24MM SELF TAP MODULAR STARDRIVE,$215.63,$0.00,$215.63,$97.03,$153.89,$0.00,$36.07,$0.00,$0.00,$37.75,$215.63,$0.00,$107.81,$170.78,$172.50,$0.00,$32.76,$0.00,$34.33,$0.00
202.226,SUP,HCPCS C1713,,202.226  -  SCREW BONE 2.7MM 26MM LOCKING SLFTAP T8 STARDRIVE RECESS LCP,$215.63,$0.00,$215.63,$97.03,$153.89,$0.00,$36.07,$0.00,$0.00,$37.75,$215.63,$0.00,$107.81,$170.78,$172.50,$0.00,$32.76,$0.00,$34.33,$0.00
202.228,SUP,HCPCS C1713,,202.228  -  SCREW BONE T8 2.7MM 2.1MM 28MM SELF TAP MODULAR STARDRIVE,$215.63,$0.00,$215.63,$97.03,$153.89,$0.00,$36.07,$0.00,$0.00,$37.75,$215.63,$0.00,$107.81,$170.78,$172.50,$0.00,$32.76,$0.00,$34.33,$0.00
202.23,SUP,HCPCS C1713,,202.230  -  SCREW BONE T8 2.7MM 2.1MM 30MM SELF TAP MODULAR STARDRIVE,$215.63,$0.00,$215.63,$97.03,$153.89,$0.00,$36.07,$0.00,$0.00,$37.75,$215.63,$0.00,$107.81,$170.78,$172.50,$0.00,$32.76,$0.00,$34.33,$0.00
202.232,SUP,HCPCS C1713,,202.232  -  SCREW BONE T8 2.7MM 2.1MM 32MM SELF TAP MODULAR STARDRIVE,$215.63,$0.00,$215.63,$97.03,$153.89,$0.00,$36.07,$0.00,$0.00,$37.75,$215.63,$0.00,$107.81,$170.78,$172.50,$0.00,$32.76,$0.00,$34.33,$0.00
202.234,SUP,HCPCS C1713,,202.234  -  SCREW BONE T8 2.7MM 2.1MM 34MM SELF TAP MODULAR STARDRIVE,$215.63,$0.00,$215.63,$97.03,$153.89,$0.00,$36.07,$0.00,$0.00,$37.75,$215.63,$0.00,$107.81,$170.78,$172.50,$0.00,$32.76,$0.00,$34.33,$0.00
202.236,SUP,HCPCS C1713,,202.236  -  SCREW BONE T8 2.7MM 2.1MM 36MM SELF TAP MODULAR STARDRIVE,$215.63,$0.00,$215.63,$97.03,$153.89,$0.00,$36.07,$0.00,$0.00,$37.75,$215.63,$0.00,$107.81,$170.78,$172.50,$0.00,$32.76,$0.00,$34.33,$0.00
202.238,SUP,HCPCS C1713,,202.238  -  SCREW BONE T8 2.7MM 2.1MM 38MM SELF TAP MODULAR STARDRIVE,$215.63,$0.00,$215.63,$97.03,$153.89,$0.00,$36.07,$0.00,$0.00,$37.75,$215.63,$0.00,$107.81,$170.78,$172.50,$0.00,$32.76,$0.00,$34.33,$0.00
202.24,SUP,HCPCS C1713,,202.240  -  SCREW BONE T8 2.7MM 2.1MM 40MM SELF TAP MODULAR STARDRIVE,$215.63,$0.00,$215.63,$97.03,$153.89,$0.00,$36.07,$0.00,$0.00,$37.75,$215.63,$0.00,$107.81,$170.78,$172.50,$0.00,$32.76,$0.00,$34.33,$0.00
202.242,SUP,HCPCS C1713,,202.242  -  SCREW BONE 2.7MM 42MM T8 STARDRIVE RECESS SLFTAP LOCKING LCP,$215.63,$0.00,$215.63,$97.03,$153.89,$0.00,$36.07,$0.00,$0.00,$37.75,$215.63,$0.00,$107.81,$170.78,$172.50,$0.00,$32.76,$0.00,$34.33,$0.00
202.244,SUP,HCPCS C1713,,202.244  -  SCREW BONE T8 2.7MM 2.1MM 44MM SELF TAP MODULAR STARDRIVE,$215.63,$0.00,$215.63,$97.03,$153.89,$0.00,$36.07,$0.00,$0.00,$37.75,$215.63,$0.00,$107.81,$170.78,$172.50,$0.00,$32.76,$0.00,$34.33,$0.00
202.246,SUP,HCPCS C1713,,202.246  -  SCREW BONE T8 2.7MM 2.1MM 46MM SELF TAP MODULAR STARDRIVE,$215.63,$0.00,$215.63,$97.03,$153.89,$0.00,$36.07,$0.00,$0.00,$37.75,$215.63,$0.00,$107.81,$170.78,$172.50,$0.00,$32.76,$0.00,$34.33,$0.00
202.248,SUP,HCPCS C1713,,202.248  -  SCREW BONE T8 2.7MM 2.1MM 48MM SELF TAP MODULAR STARDRIVE,$215.63,$0.00,$215.63,$97.03,$153.89,$0.00,$36.07,$0.00,$0.00,$37.75,$215.63,$0.00,$107.81,$170.78,$172.50,$0.00,$32.76,$0.00,$34.33,$0.00
202.25,SUP,HCPCS C1713,,202.250  -  SCREW BONE T8 2.7MM 2.1MM 50MM SELF TAP MODULAR STARDRIVE,$215.63,$0.00,$215.63,$97.03,$153.89,$0.00,$36.07,$0.00,$0.00,$37.75,$215.63,$0.00,$107.81,$170.78,$172.50,$0.00,$32.76,$0.00,$34.33,$0.00
202.255,SUP,HCPCS C1713,,202.255  -  SCREW BONE T8 2.7MM 2.1MM 55MM SELF TAP MODULAR STARDRIVE,$215.63,$0.00,$215.63,$97.03,$153.89,$0.00,$36.07,$0.00,$0.00,$37.75,$215.63,$0.00,$107.81,$170.78,$172.50,$0.00,$32.76,$0.00,$34.33,$0.00
202.26,SUP,HCPCS C1713,,202.260  -  SCREW BONE T8 2.7MM 2.1MM 60MM SELF TAP MODULAR STARDRIVE,$215.63,$0.00,$215.63,$97.03,$153.89,$0.00,$36.07,$0.00,$0.00,$37.75,$215.63,$0.00,$107.81,$170.78,$172.50,$0.00,$32.76,$0.00,$34.33,$0.00
202.608,SUP,HCPCS C1713,,202.608  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 8MM SELF DRILL SELF,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
202.609,SUP,HCPCS C1713,,202.609  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 9MM SELF DRILL SELF,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
202.61,SUP,HCPCS C1713,,202.610  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 10MM SELF DRILL SELF,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
202.611,SUP,HCPCS C1713,,202.611  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 11MM SELF DRILL SELF,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
202.612,SUP,HCPCS C1713,,202.612  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 12MM SELF DRILL SELF,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
202.613,SUP,HCPCS C1713,,202.613  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 13MM SELF DRILL SELF,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
202.614,SUP,HCPCS C1713,,202.614  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 14MM SELF DRILL SELF,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
202.615,SUP,HCPCS C1713,,202.615  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 15MM SELF DRILL SELF,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
202.616,SUP,HCPCS C1713,,202.616  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 16MM SELF DRILL SELF,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
202.617,SUP,HCPCS C1713,,202.617  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 17MM SELF DRILL SELF,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
202.618,SUP,HCPCS C1713,,202.618  -  SCREW BONE SHORT THREAD 3MM 18MM CANN STAINLESS STEEL WRIST,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
202.619,SUP,HCPCS C1713,,202.619  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 19MM SELF DRILL SELF,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
202.62,SUP,HCPCS C1713,,202.620  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 20MM SELF DRILL SELF,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
202.621,SUP,HCPCS C1713,,202.621  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 21MM SELF DRILL SELF,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
202.622,SUP,HCPCS C1713,,202.622  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 22MM SELF DRILL SELF,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
202.623,SUP,HCPCS C1713,,202.623  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 23MM SELF DRILL SELF,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
202.624,SUP,HCPCS C1713,,202.624  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 24MM SELF DRILL SELF,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
202.625,SUP,HCPCS C1713,,202.625  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 25MM SELF DRILL SELF,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
202.626,SUP,HCPCS C1713,,202.626  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 26MM SELF DRILL SELF,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
202.627,SUP,HCPCS C1713,,202.627  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 27MM SELF DRILL SELF,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
202.628,SUP,HCPCS C1713,,202.628  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 28MM SELF DRILL SELF,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
202.629,SUP,HCPCS C1713,,202.629  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 29MM SELF DRILL SELF,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
202.63,SUP,HCPCS C1713,,202.630  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 30MM SELF DRILL SELF,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
202.632,SUP,HCPCS C1713,,202.632  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 32MM SELF DRILL SELF,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
202.634,SUP,HCPCS C1713,,202.634  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 34MM SELF DRILL SELF,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
202.636,SUP,HCPCS C1713,,202.636  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 36MM SELF DRILL SELF,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
202.638,SUP,HCPCS C1713,,202.638  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 38MM SELF DRILL SELF,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
202.64,SUP,HCPCS C1713,,202.640  -  SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 40MM SELF DRILL SELF,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
202.714,SUP,HCPCS C1713,,202.714  -  SCREW BONE .5 THREAD LP 3MM 4MM 1.2MM 14MM SELF DRILL SELF,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
202.715,SUP,HCPCS C1713,,202.715  -  SCREW BONE .5 THREAD LP 3MM 4MM 1.2MM 15MM SELF DRILL SELF,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
202.716,SUP,HCPCS C1713,,202.716  -  SCREW BONE .5 THREAD LP 3MM 4MM 1.2MM 16MM SELF DRILL SELF,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
202.717,SUP,HCPCS C1713,,202.717  -  SCREW BONE .5 THREAD LP 3MM 4MM 1.2MM 17MM SELF DRILL SELF,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
202.718,SUP,HCPCS C1713,,202.718  -  SCREW BONE .5 THREAD LP 3MM 4MM 1.2MM 18MM SELF DRILL SELF,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
202.719,SUP,HCPCS C1713,,202.719  -  SCREW BONE .5 THREAD LP 3MM 4MM 1.2MM 19MM SELF DRILL SELF,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
202.72,SUP,HCPCS C1713,,202.720  -  SCREW BONE .5 THREAD LP 3MM 4MM 1.2MM 20MM SELF DRILL SELF,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
202.721,SUP,HCPCS C1713,,202.721  -  SCREW BONE .5 THREAD LP 3MM 4MM 1.2MM 21MM SELF DRILL SELF,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
202.722,SUP,HCPCS C1713,,202.722  -  SCREW BONE .5 THREAD LP 3MM 4MM 1.2MM 22MM SELF DRILL SELF,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$83.10,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$75.48,$0.00,$57.57,$0.00
202.723,SUP,HCPCS C1713,,202.723  -  SCREW BONE LNGTHRD 3MM 4MM 23MM CANN SLFDRILL SLFTAP,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
202.724,SUP,HCPCS C1713,,202.724  -  SCREW BONE .5 THREAD LP 3MM 4MM 1.2MM 24MM SELF DRILL SELF,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
202.725,SUP,HCPCS C1713,,202.725  -  SCREW BONE LNGTHRD 3MM 4MM 25MM CANN CRCIFRM RECESS SLFDRILL,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
202.726,SUP,HCPCS C1713,,202.726  -  SCREW BONE LNGTHRD 3MM 26MM CANN STAINLESS STEEL WRIST HAND,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
202.727,SUP,HCPCS C1713,,202.727  -  SCREW BONE LNGTHRD 3MM 27MM CANN STAINLESS STEEL WRIST HAND,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
202.728,SUP,HCPCS C1713,,202.728  -  SCREW BONE .5 THREAD LP 3MM 4MM 1.2MM 28MM SELF DRILL SELF,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
202.729,SUP,HCPCS C1713,,202.729  -  SCREW BONE LNGTHRD 3MM 29MM CANN STAINLESS STEEL WRIST HAND,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
202.73,SUP,HCPCS C1713,,202.730  -  SCREW BONE .5 THREAD LP 3MM 4MM 1.2MM 30MM SELF DRILL SELF,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
202.732,SUP,HCPCS C1713,,202.732  -  SCREW BONE .5 THREAD LP 3MM 4MM 1.2MM 32MM SELF DRILL SELF,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
202.734,SUP,HCPCS C1713,,202.734  -  SCREW BONE LNGTHRD 3MM 34MM CANN STAINLESS STEEL WRIST HAND,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
202.736,SUP,HCPCS C1713,,202.736  -  SCREW BONE .5 THREAD LP 3MM 4MM 1.2MM 36MM SELF DRILL SELF,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
202.738,SUP,HCPCS C1713,,202.738  -  SCREW BONE .5 THREAD LP 3MM 4MM 1.2MM 38MM SELF DRILL SELF,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
202.74,SUP,HCPCS C1713,,202.740  -  SCREW BONE .5 THREAD LP 3MM 4MM 1.2MM 40MM SELF DRILL SELF,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
202.806,SUP,HCPCS C1713,,202.806  -  SCREW BONE 2.7MM 5MM 6MM SELF TAP CRCIFRM DCP STAINLESS,$59.70,$0.00,$59.70,$26.87,$42.61,$0.00,$9.98,$0.00,$0.00,$10.45,$59.70,$0.00,$29.85,$47.28,$47.76,$0.00,$9.07,$0.00,$9.50,$0.00
202.808,SUP,HCPCS C1713,,202.808  -  SCREW BONE 2.7MM 5MM 8MM SELF TAP CRCIFRM DCP STAINLESS,$59.70,$0.00,$59.70,$26.87,$42.61,$0.00,$9.98,$0.00,$0.00,$10.45,$59.70,$0.00,$29.85,$47.28,$47.76,$0.00,$9.07,$0.00,$9.50,$0.00
202.81,SUP,HCPCS C1713,,202.810  -  SCREW BONE 2.7MM 5MM 10MM SLFTAP SMALL HEXAGONAL SOCKET,$59.70,$0.00,$59.70,$26.87,$42.61,$0.00,$9.98,$0.00,$0.00,$10.45,$59.70,$0.00,$29.85,$47.28,$47.76,$0.00,$9.07,$0.00,$9.50,$0.00
202.812,SUP,HCPCS C1713,,202.812  -  SCREW BONE SHORT THREAD 2.7MM 12MM SLFTAP DCP STAINLESS,$59.70,$0.00,$59.70,$26.87,$42.61,$0.00,$9.98,$0.00,$0.00,$10.45,$59.70,$0.00,$29.85,$47.28,$47.76,$0.00,$9.07,$0.00,$9.50,$0.00
202.814,SUP,HCPCS C1713,,202.814  -  SCREW BONE 2.7MM 5MM 14MM SELF TAP CRCIFRM DCP STAINLESS,$59.70,$0.00,$59.70,$26.87,$42.61,$0.00,$9.98,$0.00,$0.00,$10.45,$59.70,$0.00,$29.85,$47.28,$47.76,$0.00,$9.07,$0.00,$9.50,$0.00
202.816,SUP,HCPCS C1713,,202.816  -  SCREW BONE 2.7MM 16MM SLFTAP LC-DCP STAINLESS STEEL CORTICAL,$59.70,$0.00,$59.70,$26.87,$42.61,$0.00,$9.98,$0.00,$0.00,$10.45,$59.70,$0.00,$29.85,$47.28,$47.76,$0.00,$9.07,$0.00,$9.50,$0.00
202.818,SUP,HCPCS C1713,,202.818  -  SCREW BN FT 2.7MM 5MM 18MM NS 2.5MM ST SPHRCL HD SM HEX SCKT,$59.70,$0.00,$59.70,$26.87,$42.61,$0.00,$9.98,$0.00,$0.00,$10.45,$59.70,$0.00,$29.85,$47.28,$47.76,$0.00,$9.07,$0.00,$9.50,$0.00
202.82,SUP,HCPCS C1713,,202.820  -  SCREW BONE SHORT THREAD 2.7MM 20MM SLFTAP DCP STAINLESS,$59.70,$0.00,$59.70,$26.87,$42.61,$0.00,$9.98,$0.00,$0.00,$10.45,$59.70,$0.00,$29.85,$47.28,$47.76,$0.00,$9.07,$0.00,$9.50,$0.00
202.822,SUP,HCPCS C1713,,202.822  -  SCREW BONE 2.7MM 22MM SLFTAP LCP DCP STAINLESS STEEL,$59.70,$0.00,$59.70,$26.87,$42.61,$0.00,$9.98,$0.00,$0.00,$10.45,$59.70,$0.00,$29.85,$47.28,$47.76,$0.00,$9.07,$0.00,$9.50,$0.00
202.824,SUP,HCPCS C1713,,202.824  -  SCREW BN FT 2.7MM 5MM 24MM NS 2.5MM ST SPHRCL HD SM HEX SCKT,$59.70,$0.00,$59.70,$26.87,$42.61,$0.00,$9.98,$0.00,$0.00,$10.45,$59.70,$0.00,$29.85,$47.28,$47.76,$0.00,$9.07,$0.00,$9.50,$0.00
202.826,SUP,HCPCS C1713,,202.826  -  SCREW BONE SHORT THREAD 2.7MM 26MM SLFTAP DCP STAINLESS,$59.70,$0.00,$59.70,$26.87,$42.61,$0.00,$9.98,$0.00,$0.00,$10.45,$59.70,$0.00,$29.85,$47.28,$47.76,$0.00,$9.07,$0.00,$9.50,$0.00
202.828,SUP,HCPCS C1713,,202.828  -  SCREW BONE FULTHD 2.7MM 5MM 28MM SLFTAP SMALL HEXAGONAL,$59.70,$0.00,$59.70,$26.87,$42.61,$0.00,$9.98,$0.00,$0.00,$10.45,$59.70,$0.00,$29.85,$47.28,$47.76,$0.00,$9.07,$0.00,$9.50,$0.00
202.83,SUP,HCPCS C1713,,202.83  -  SCREW BONE 2.7MM 30MM LCP DCP SS CORT DISTAL RADL/TIBIAL,$50.03,$0.00,$59.70,$26.87,$42.61,$0.00,$9.98,$0.00,$0.00,$10.45,$59.70,$0.00,$29.85,$39.62,$47.76,$0.00,$9.07,$0.00,$9.50,$0.00
202.83,SUP,HCPCS C1713,,202.830  -  SCREW BONE FULTHD SMALL HEXAGON SPHERE 2.7MM 5MM 30MM SELF,$59.70,$0.00,$59.70,$26.87,$42.61,$0.00,$9.98,$0.00,$0.00,$10.45,$59.70,$0.00,$29.85,$47.28,$47.76,$0.00,$9.07,$0.00,$9.50,$0.00
202.832,SUP,HCPCS C1713,,202.832  -  SCREW BONE 2.7MM 5MM 32MM SLFTAP SPHERICAL HEAD SMALL,$59.70,$0.00,$59.70,$26.87,$42.61,$0.00,$9.98,$0.00,$0.00,$10.45,$59.70,$0.00,$29.85,$47.28,$47.76,$0.00,$9.07,$0.00,$9.50,$0.00
202.834,SUP,HCPCS C1713,,202.834  -  SCREW BONE 2.7MM 5MM 34MM SLFTAP SPHERICAL HEAD SMALL,$59.70,$0.00,$59.70,$26.87,$42.61,$0.00,$9.98,$0.00,$0.00,$10.45,$59.70,$0.00,$29.85,$47.28,$47.76,$0.00,$9.07,$0.00,$9.50,$0.00
202.836,SUP,HCPCS C1713,,202.836  -  SCREW BONE 2.7MM 5MM 36MM SLFTAP SPHERICAL HEAD SMALL,$59.70,$0.00,$59.70,$26.87,$42.61,$0.00,$9.98,$0.00,$0.00,$10.45,$59.70,$0.00,$29.85,$47.28,$47.76,$0.00,$9.07,$0.00,$9.50,$0.00
202.838,SUP,HCPCS C1713,,202.838  -  SCREW BONE 2.7MM 5MM 38MM SLFTAP SPHERICAL HEAD SMALL,$59.70,$0.00,$59.70,$26.87,$42.61,$0.00,$9.98,$0.00,$0.00,$10.45,$59.70,$0.00,$29.85,$47.28,$47.76,$0.00,$9.07,$0.00,$9.50,$0.00
202.84,SUP,HCPCS C1713,,202.84  -  SCREW BONE 2.7MM 40MM LCP DCP SS CORT DISTAL RADL/TIBIAL,$49.98,$0.00,$59.70,$26.87,$42.61,$0.00,$9.98,$0.00,$0.00,$10.45,$59.70,$0.00,$29.85,$39.58,$47.76,$0.00,$9.07,$0.00,$9.50,$0.00
202.84,SUP,HCPCS C1713,,202.840  -  SCREW BONE 2.7MM 40MM SLFTAP LCP DCP STAINLESS STEEL,$59.70,$0.00,$59.70,$26.87,$42.61,$0.00,$9.98,$0.00,$0.00,$10.45,$59.70,$0.00,$29.85,$47.28,$47.76,$0.00,$9.07,$0.00,$9.50,$0.00
202.842,SUP,HCPCS C1713,,202.842  -  SCREW BONE 2.7MM 5MM 42MM SELF TAP CRCIFRM DCP STAINLESS,$59.70,$0.00,$59.70,$26.87,$42.61,$0.00,$9.98,$0.00,$0.00,$10.45,$59.70,$0.00,$29.85,$47.28,$47.76,$0.00,$9.07,$0.00,$9.50,$0.00
202.844,SUP,HCPCS C1713,,202.844  -  SCREW BONE 2.7MM 5MM 44MM SELF TAP CRCIFRM DCP STAINLESS,$59.70,$0.00,$59.70,$26.87,$42.61,$0.00,$9.98,$0.00,$0.00,$10.45,$59.70,$0.00,$29.85,$47.28,$47.76,$0.00,$9.07,$0.00,$9.50,$0.00
202.845,SUP,HCPCS C1713,,202.845  -  SCREW BONE 2.7MM 5MM 45MM SLFTAP SPHERICAL HEAD SMALL,$59.70,$0.00,$59.70,$26.87,$42.61,$0.00,$9.98,$0.00,$0.00,$10.45,$59.70,$0.00,$29.85,$47.28,$47.76,$0.00,$9.07,$0.00,$9.50,$0.00
202.846,SUP,HCPCS C1713,,202.846  -  SCREW BONE 2.7MM 5MM 46MM SELF TAP CRCIFRM DCP STAINLESS,$59.70,$0.00,$59.70,$26.87,$42.61,$0.00,$9.98,$0.00,$0.00,$10.45,$59.70,$0.00,$29.85,$47.28,$47.76,$0.00,$9.07,$0.00,$9.50,$0.00
202.848,SUP,HCPCS C1713,,202.848  -  SCREW BONE 2.7MM 5MM 48MM SELF TAP CRCIFRM DCP STAINLESS,$59.70,$0.00,$59.70,$26.87,$42.61,$0.00,$9.98,$0.00,$0.00,$10.45,$59.70,$0.00,$29.85,$47.28,$47.76,$0.00,$9.07,$0.00,$9.50,$0.00
202.85,SUP,HCPCS C1713,,202.85  -  SCREW BONE 2.7MM 50MM LCP DCP SS CORT DISTAL RADL/TIBIAL,$49.98,$0.00,$59.70,$26.87,$42.61,$0.00,$9.98,$0.00,$0.00,$10.45,$59.70,$0.00,$29.85,$39.58,$47.76,$0.00,$9.07,$0.00,$9.50,$0.00
202.85,SUP,HCPCS C1713,,202.850  -  SCREW BONE SHORT THREAD 2.7MM 50MM SLFTAP DCP STAINLESS,$59.70,$0.00,$59.70,$26.87,$42.61,$0.00,$9.98,$0.00,$0.00,$10.45,$59.70,$0.00,$29.85,$47.28,$47.76,$0.00,$9.07,$0.00,$9.50,$0.00
202.855,SUP,HCPCS C1713,,202.855  -  SCREW BONE 2.7MM 55MM SLFTAP LCP DCP STAINLESS STEEL,$59.70,$0.00,$59.70,$26.87,$42.61,$0.00,$9.98,$0.00,$0.00,$10.45,$59.70,$0.00,$29.85,$47.28,$47.76,$0.00,$9.07,$0.00,$9.50,$0.00
202.87,SUP,HCPCS C1713,,202.870  -  SCREW BONE T8 2.7MM 5MM 10MM VAR ANG SELF TAP MODULAR,$69.60,$0.00,$69.60,$31.32,$49.67,$0.00,$11.64,$0.00,$0.00,$12.19,$69.60,$0.00,$34.80,$55.12,$55.68,$0.00,$10.58,$0.00,$11.08,$0.00
202.872,SUP,HCPCS C1713,,202.872  -  SCREW BONE T8 2.7MM 5MM 12MM VAR ANG SELF TAP MODULAR,$69.60,$0.00,$69.60,$31.32,$49.67,$0.00,$11.64,$0.00,$0.00,$12.19,$69.60,$0.00,$34.80,$55.12,$55.68,$0.00,$10.58,$0.00,$11.08,$0.00
202.874,SUP,HCPCS C1713,,202.874  -  SCREW BONE 2.7MM 14MM T8 STARDRIVE SELF TAP LCP STAINLESS,$69.60,$0.00,$69.60,$31.32,$49.67,$0.00,$11.64,$0.00,$0.00,$12.19,$69.60,$0.00,$34.80,$55.12,$55.68,$0.00,$10.58,$0.00,$11.08,$0.00
202.876,SUP,HCPCS C1713,,202.876  -  SCREW BONE 2.7MM 16MM T8 STARDRIVE RECESS SLFTAP LCP,$69.60,$0.00,$69.60,$31.32,$49.67,$0.00,$11.64,$0.00,$0.00,$12.19,$69.60,$0.00,$34.80,$55.12,$55.68,$0.00,$10.58,$0.00,$11.08,$0.00
202.878,SUP,HCPCS C1713,,202.878  -  SCREW BONE T8 2.7MM 5MM 18MM VAR ANG SELF TAP MODULAR,$69.60,$0.00,$69.60,$31.32,$49.67,$0.00,$11.64,$0.00,$0.00,$12.19,$69.60,$0.00,$34.80,$55.12,$55.68,$0.00,$10.58,$0.00,$11.08,$0.00
202.88,SUP,HCPCS C1713,,202.880  -  SCREW BONE T8 2.7MM 5MM 20MM VAR ANG SELF TAP MODULAR,$69.60,$0.00,$69.60,$31.32,$49.67,$0.00,$11.64,$0.00,$0.00,$12.19,$69.60,$0.00,$34.80,$55.12,$55.68,$0.00,$10.58,$0.00,$11.08,$0.00
202.882,SUP,HCPCS C1713,,202.882  -  SCREW BONE T8 2.7MM 5MM 22MM VAR ANG SELF TAP MODULAR,$69.60,$0.00,$69.60,$31.32,$49.67,$0.00,$11.64,$0.00,$0.00,$12.19,$69.60,$0.00,$34.80,$55.12,$55.68,$0.00,$10.58,$0.00,$11.08,$0.00
202.884,SUP,HCPCS C1713,,202.884  -  SCREW BONE T8 2.7MM 5MM 24MM VAR ANG SELF TAP MODULAR,$69.60,$0.00,$69.60,$31.32,$49.67,$0.00,$11.64,$0.00,$0.00,$12.19,$69.60,$0.00,$34.80,$55.12,$55.68,$0.00,$10.58,$0.00,$11.08,$0.00
202.886,SUP,HCPCS C1713,,202.886  -  SCREW BONE T8 2.7MM 5MM 26MM VAR ANG SELF TAP MODULAR,$69.60,$0.00,$69.60,$31.32,$49.67,$0.00,$11.64,$0.00,$0.00,$12.19,$69.60,$0.00,$34.80,$55.12,$55.68,$0.00,$10.58,$0.00,$11.08,$0.00
202.888,SUP,HCPCS C1713,,202.888  -  SCREW BONE T8 2.7MM 5MM 28MM VAR ANG SELF TAP MODULAR,$69.60,$0.00,$69.60,$31.32,$49.67,$0.00,$11.64,$0.00,$0.00,$12.19,$69.60,$0.00,$34.80,$55.12,$55.68,$0.00,$10.58,$0.00,$11.08,$0.00
202.89,SUP,HCPCS C1713,,202.890  -  SCREW BONE T8 2.7MM 5MM 30MM VAR ANG SELF TAP MODULAR,$69.60,$0.00,$69.60,$31.32,$49.67,$0.00,$11.64,$0.00,$0.00,$12.19,$69.60,$0.00,$34.80,$55.12,$55.68,$0.00,$10.58,$0.00,$11.08,$0.00
202.892,SUP,HCPCS C1713,,202.892  -  SCREW BONE T8 2.7MM 5MM 32MM VAR ANG SELF TAP MODULAR,$69.60,$0.00,$69.60,$31.32,$49.67,$0.00,$11.64,$0.00,$0.00,$12.19,$69.60,$0.00,$34.80,$55.12,$55.68,$0.00,$10.58,$0.00,$11.08,$0.00
202.894,SUP,HCPCS C1713,,202.894  -  SCREW BONE T8 2.7MM 5MM 34MM VAR ANG SELF TAP MODULAR,$69.60,$0.00,$69.60,$31.32,$49.67,$0.00,$11.64,$0.00,$0.00,$12.19,$69.60,$0.00,$34.80,$55.12,$55.68,$0.00,$10.58,$0.00,$11.08,$0.00
202.896,SUP,HCPCS C1713,,202.896  -  SCREW BONE T8 2.7MM 5MM 36MM VAR ANG SELF TAP MODULAR,$69.60,$0.00,$69.60,$31.32,$49.67,$0.00,$11.64,$0.00,$0.00,$12.19,$69.60,$0.00,$34.80,$55.12,$55.68,$0.00,$10.58,$0.00,$11.08,$0.00
202.898,SUP,HCPCS C1713,,202.898  -  SCREW BONE T8 2.7MM 5MM 38MM VAR ANG SELF TAP MODULAR,$69.60,$0.00,$69.60,$31.32,$49.67,$0.00,$11.64,$0.00,$0.00,$12.19,$69.60,$0.00,$34.80,$55.12,$55.68,$0.00,$10.58,$0.00,$11.08,$0.00
202.9,SUP,HCPCS C1713,,202.900  -  SCREW BONE T8 2.7MM 5MM 40MM VAR ANG SELF TAP MODULAR,$69.60,$0.00,$69.60,$31.32,$49.67,$0.00,$11.64,$0.00,$0.00,$12.19,$69.60,$0.00,$34.80,$55.12,$55.68,$0.00,$10.58,$0.00,$11.08,$0.00
202.962,SUP,HCPCS C1713,,202.962  -  SCREW BONE T8 2.7MM 5MM 42MM VAR ANG SELF TAP MODULAR,$69.60,$0.00,$69.60,$31.32,$49.67,$0.00,$11.64,$0.00,$0.00,$12.19,$69.60,$0.00,$34.80,$55.12,$55.68,$0.00,$10.58,$0.00,$11.08,$0.00
202.963,SUP,HCPCS C1713,,202.963  -  SCREW BONE T8 2.7MM 5MM 44MM VAR ANG SELF TAP MODULAR,$69.60,$0.00,$69.60,$31.32,$49.67,$0.00,$11.64,$0.00,$0.00,$12.19,$69.60,$0.00,$34.80,$55.12,$55.68,$0.00,$10.58,$0.00,$11.08,$0.00
202.965,SUP,HCPCS C1713,,202.965  -  SCREW BONE T8 2.7MM 5MM 46MM VAR ANG SELF TAP MODULAR,$69.60,$0.00,$69.60,$31.32,$49.67,$0.00,$11.64,$0.00,$0.00,$12.19,$69.60,$0.00,$34.80,$55.12,$55.68,$0.00,$10.58,$0.00,$11.08,$0.00
202.966,SUP,HCPCS C1713,,202.966  -  SCREW BONE T8 2.7MM 5MM 48MM VAR ANG SELF TAP MODULAR,$69.60,$0.00,$69.60,$31.32,$49.67,$0.00,$11.64,$0.00,$0.00,$12.19,$69.60,$0.00,$34.80,$55.12,$55.68,$0.00,$10.58,$0.00,$11.08,$0.00
202.967,SUP,HCPCS C1713,,202.967  -  SCREW BONE T8 2.7MM 5MM 50MM VAR ANG SELF TAP MODULAR,$69.60,$0.00,$69.60,$31.32,$49.67,$0.00,$11.64,$0.00,$0.00,$12.19,$69.60,$0.00,$34.80,$55.12,$55.68,$0.00,$10.58,$0.00,$11.08,$0.00
202.968,SUP,HCPCS C1713,,202.968  -  SCREW BONE T8 2.7MM 5MM 55MM VAR ANG SELF TAP MODULAR,$69.60,$0.00,$69.60,$31.32,$49.67,$0.00,$11.64,$0.00,$0.00,$12.19,$69.60,$0.00,$34.80,$55.12,$55.68,$0.00,$10.58,$0.00,$11.08,$0.00
202.969,SUP,HCPCS C1713,,202.969  -  SCREW BONE T8 2.7MM 5MM 60MM VAR ANG SELF TAP MODULAR,$69.60,$0.00,$69.60,$31.32,$49.67,$0.00,$11.64,$0.00,$0.00,$12.19,$69.60,$0.00,$34.80,$55.12,$55.68,$0.00,$10.58,$0.00,$11.08,$0.00
204.01,SUP,HCPCS C1713,,204.010  -  SCREW BONE STANDARD 3.5MM 6MM 10MM SMALL HEXAGONAL SOCKET,$27.63,$0.00,$27.63,$12.43,$19.72,$0.00,$4.62,$0.00,$0.00,$4.84,$27.63,$0.00,$13.81,$21.88,$22.10,$0.00,$4.20,$0.00,$4.40,$0.00
204.012,SUP,HCPCS C1713,,204.012  -  SCREW BONE STANDARD 3.5MM 6MM 12MM SMALL HEXAGONAL SOCKET,$27.63,$0.00,$27.63,$12.43,$19.72,$0.00,$4.62,$0.00,$0.00,$4.84,$27.63,$0.00,$13.81,$21.88,$22.10,$0.00,$4.20,$0.00,$4.40,$0.00
204.014,SUP,HCPCS C1713,,204.014  -  SCREW BONE 3.5MM 14MM SMALL HEXAGONAL SOCKET DCP LC-DCP,$27.63,$0.00,$27.63,$12.43,$19.72,$0.00,$4.62,$0.00,$0.00,$4.84,$27.63,$0.00,$13.81,$21.88,$22.10,$0.00,$4.20,$0.00,$4.40,$0.00
204.016,SUP,HCPCS C1713,,204.016  -  SCREW BONE STANDARD 3.5MM 6MM 16MM HEXAGONAL SOCKET LC-DCP,$27.63,$0.00,$27.63,$12.43,$19.72,$0.00,$4.62,$0.00,$0.00,$4.84,$27.63,$0.00,$13.81,$21.88,$22.10,$0.00,$4.20,$0.00,$4.40,$0.00
204.018,SUP,HCPCS C1713,,204.018  -  SCREW BONE STANDARD 3.5MM 6MM 18MM HEXAGONAL SOCKET LC-DCP,$27.63,$0.00,$27.63,$12.43,$19.72,$0.00,$4.62,$0.00,$0.00,$4.84,$27.63,$0.00,$13.81,$21.88,$22.10,$0.00,$4.20,$0.00,$4.40,$0.00
204.02,SUP,HCPCS C1713,,204.020  -  SCREW BONE STANDARD 3.5MM 6MM 20MM SMALL HEXAGONAL SOCKET,$27.63,$0.00,$27.63,$12.43,$19.72,$0.00,$4.62,$0.00,$0.00,$4.84,$27.63,$0.00,$13.81,$21.88,$22.10,$0.00,$4.20,$0.00,$4.40,$0.00
204.022,SUP,HCPCS C1713,,204.022  -  SCREW BONE STANDARD SMALL HEXAGON 3.5MM 6MM 22MM SOCKET DCP,$27.63,$0.00,$27.63,$12.43,$19.72,$0.00,$7.45,$0.00,$0.00,$4.84,$27.63,$0.00,$13.81,$21.88,$22.10,$0.00,$6.76,$0.00,$4.40,$0.00
204.024,SUP,HCPCS C1713,,204.024  -  SCREW BONE 2.5MM STANDARD 3.5MM 6MM 24MM SMALL HEXAGONAL,$27.63,$0.00,$27.63,$12.43,$19.72,$0.00,$4.62,$0.00,$0.00,$4.84,$27.63,$0.00,$13.81,$21.88,$22.10,$0.00,$4.20,$0.00,$4.40,$0.00
204.026,SUP,HCPCS C1713,,204.026  -  SCREW BONE 4MM 26MM LOCKING SLFTAP STARDRIVE RECESS LCP,$27.63,$0.00,$27.63,$12.43,$19.72,$0.00,$4.62,$0.00,$0.00,$4.84,$27.63,$0.00,$13.81,$21.88,$22.10,$0.00,$4.20,$0.00,$4.40,$0.00
204.028,SUP,HCPCS C1713,,204.028  -  SCREW BONE STANDARD 3.5MM 6MM 28MM SMALL HEXAGONAL SOCKET,$27.63,$0.00,$27.63,$12.43,$19.72,$0.00,$4.62,$0.00,$0.00,$4.84,$27.63,$0.00,$13.81,$21.88,$22.10,$0.00,$4.20,$0.00,$4.40,$0.00
204.03,SUP,HCPCS C1713,,204.030  -  SCREW BONE SMALL STANDARD 3.5MM 6MM 30MM HEXAGONAL SOCKET,$27.63,$0.00,$27.63,$12.43,$19.72,$0.00,$4.62,$0.00,$0.00,$4.84,$27.63,$0.00,$13.81,$21.88,$22.10,$0.00,$4.20,$0.00,$4.40,$0.00
204.032,SUP,HCPCS C1713,,204.032  -  SCREW BONE STANDARD 3.5MM 6MM 32MM SLFTAP SMALL HEXAGON,$27.63,$0.00,$27.63,$12.43,$19.72,$0.00,$4.62,$0.00,$0.00,$4.84,$27.63,$0.00,$13.81,$21.88,$22.10,$0.00,$4.20,$0.00,$4.40,$0.00
204.034,SUP,HCPCS C1713,,204.034  -  SCREW BONE T25 3.5MM 2.4MM 34MM LOCKING SLFTAP STARDRIVE,$27.63,$0.00,$27.63,$12.43,$19.72,$0.00,$4.62,$0.00,$0.00,$4.84,$27.63,$0.00,$13.81,$21.88,$22.10,$0.00,$4.20,$0.00,$4.40,$0.00
204.036,SUP,HCPCS C1713,,204.036  -  SCREW BONE 3.5MM 36MM SMALL FRAGMENT LC-DCP STAINLESS STEEL,$27.63,$0.00,$27.63,$12.43,$19.72,$0.00,$4.62,$0.00,$0.00,$4.84,$27.63,$0.00,$13.81,$21.88,$22.10,$0.00,$4.20,$0.00,$4.40,$0.00
204.038,SUP,HCPCS C1713,,204.038  -  SCREW BONE STANDARD 3.5MM 6MM 38MM SLFTAP SMALL HEXAGON,$27.63,$0.00,$27.63,$12.43,$19.72,$0.00,$4.62,$0.00,$0.00,$4.84,$27.63,$0.00,$13.81,$21.88,$22.10,$0.00,$4.20,$0.00,$4.40,$0.00
204.04,SUP,HCPCS C1713,,204.040  -  SCREW BONE STANDARD 3.5MM 6MM 40MM SLFTAP SMALL HEXAGONAL,$27.63,$0.00,$27.63,$12.43,$19.72,$0.00,$4.62,$0.00,$0.00,$4.84,$27.63,$0.00,$13.81,$21.88,$22.10,$0.00,$4.20,$0.00,$4.40,$0.00
204.045,SUP,HCPCS C1713,,204.045  -  SCREW BONE 2.5MM SMALL STANDARD 3.5MM 45MM SMALL HEXAGONAL,$27.63,$0.00,$27.63,$12.43,$19.72,$0.00,$4.62,$0.00,$0.00,$4.84,$27.63,$0.00,$13.81,$21.88,$22.10,$0.00,$4.20,$0.00,$4.40,$0.00
204.05,SUP,HCPCS C1713,,204.050  -  SCREW BONE STANDARD 3.5MM 6MM 50MM SLFTAP SMALL HEXAGON,$27.63,$0.00,$27.63,$12.43,$19.72,$0.00,$4.62,$0.00,$0.00,$4.84,$27.63,$0.00,$13.81,$21.88,$22.10,$0.00,$4.20,$0.00,$4.40,$0.00
204.055,SUP,HCPCS C1713,,204.055  -  SCREW BONE STANDARD 3.5MM 6MM 55MM HEXAGONAL SOCKET LC-DCP,$27.63,$0.00,$27.63,$12.43,$19.72,$0.00,$4.62,$0.00,$0.00,$4.84,$27.63,$0.00,$13.81,$21.88,$22.10,$0.00,$4.20,$0.00,$4.40,$0.00
204.06,SUP,HCPCS C1713,,204.060  -  SCREW BONE STANDARD 3.5MM 6MM 60MM SELF TAP SMALL HEXAGONAL,$27.63,$0.00,$27.63,$12.43,$19.72,$0.00,$4.62,$0.00,$0.00,$4.84,$27.63,$0.00,$13.81,$21.88,$22.10,$0.00,$4.20,$0.00,$4.40,$0.00
204.065,SUP,HCPCS C1713,,204.065  -  SCREW BONE STANDARD 3.5MM 6MM 65MM SLFTAP SMALL HEXAGONAL,$44.68,$0.00,$44.68,$20.10,$31.88,$0.00,$7.47,$0.00,$0.00,$7.82,$44.68,$0.00,$22.34,$35.39,$35.74,$0.00,$6.79,$0.00,$7.11,$0.00
204.07,SUP,HCPCS C1713,,204.070  -  SCREW BONE STANDARD 3.5MM 6MM 70MM SMALL HEXAGONAL SOCKET,$44.68,$0.00,$44.68,$20.10,$31.88,$0.00,$11.38,$0.00,$0.00,$7.82,$44.68,$0.00,$22.34,$35.39,$35.74,$0.00,$10.33,$0.00,$7.11,$0.00
204.075,SUP,HCPCS C1713,,204.075  -  SCREW BONE STANDARD 3.5MM 6MM 75MM SLFTAP SMALL HEXAGON,$44.68,$0.00,$44.68,$20.10,$31.88,$0.00,$11.38,$0.00,$0.00,$7.82,$44.68,$0.00,$22.34,$35.39,$35.74,$0.00,$10.33,$0.00,$7.11,$0.00
204.08,SUP,HCPCS C1713,,204.080  -  SCREW BONE STANDARD 3.5MM 6MM 80MM SMALL HEXAGONAL SOCKET,$44.68,$0.00,$44.68,$20.10,$31.88,$0.00,$7.47,$0.00,$0.00,$7.82,$44.68,$0.00,$22.34,$35.39,$35.74,$0.00,$6.79,$0.00,$7.11,$0.00
204.085,SUP,HCPCS C1713,,204.085  -  SCREW BONE STANDARD 3.5MM 6MM 85MM SMALL HEXAGONAL SOCKET,$44.68,$0.00,$44.68,$20.10,$31.88,$0.00,$11.38,$0.00,$0.00,$7.82,$44.68,$0.00,$22.34,$35.39,$35.74,$0.00,$10.33,$0.00,$7.11,$0.00
204.09,SUP,HCPCS C1713,,204.090  -  SCREW BONE STANDARD 3.5MM 6MM 90MM SMALL HEXAGONAL SOCKET,$44.68,$0.00,$44.68,$20.10,$31.88,$0.00,$7.47,$0.00,$0.00,$7.82,$44.68,$0.00,$22.34,$35.39,$35.74,$0.00,$6.79,$0.00,$7.11,$0.00
204.095,SUP,HCPCS C1713,,204.095  -  SCREW BONE STANDARD 3.5MM 6MM 95MM SLFTAP SMALL HEXAGON,$44.68,$0.00,$44.68,$20.10,$31.88,$0.00,$7.47,$0.00,$0.00,$7.82,$44.68,$0.00,$22.34,$35.39,$35.74,$0.00,$6.79,$0.00,$7.11,$0.00
204.1,SUP,HCPCS C1713,,204.100  -  SCREW BONE 3.5MM 100MM LC-DCP STAINLESS STEEL CORTICAL,$44.68,$0.00,$44.68,$20.10,$31.88,$0.00,$7.47,$0.00,$0.00,$7.82,$44.68,$0.00,$22.34,$35.39,$35.74,$0.00,$6.79,$0.00,$7.11,$0.00
204.105,SUP,HCPCS C1713,,204.105  -  SCREW BONE STANDARD 3.5MM 6MM 105MM SLFTAP SMALL HEXAGON,$44.68,$0.00,$44.68,$20.10,$31.88,$0.00,$7.47,$0.00,$0.00,$7.82,$44.68,$0.00,$22.34,$35.39,$35.74,$0.00,$6.79,$0.00,$7.11,$0.00
204.11,SUP,HCPCS C1713,,204.110  -  SCREW BONE STANDARD 3.5MM 6MM 110MM SLFTAP SMALL HEXAGON,$44.68,$0.00,$44.68,$20.10,$31.88,$0.00,$7.47,$0.00,$0.00,$7.82,$44.68,$0.00,$22.34,$35.39,$35.74,$0.00,$6.79,$0.00,$7.11,$0.00
204.115,SUP,HCPCS C1713,,204.115  -  SCREW BONE 3.5MM 115MM LC-DCP STAINLESS STEEL CORTICAL,$44.68,$0.00,$44.68,$20.10,$31.88,$0.00,$7.47,$0.00,$0.00,$7.82,$44.68,$0.00,$22.34,$35.39,$35.74,$0.00,$6.79,$0.00,$7.11,$0.00
204.12,SUP,HCPCS C1713,,204.120  -  SCREW BONE STANDARD 3.5MM 6MM 120MM SLFTAP SMALL HEXAGONAL,$44.68,$0.00,$44.68,$20.10,$31.88,$0.00,$7.47,$0.00,$0.00,$7.82,$44.68,$0.00,$22.34,$35.39,$35.74,$0.00,$6.79,$0.00,$7.11,$0.00
204.216,SUP,HCPCS C1713,,204.216  -  SCREW BONE PTHRD 3.5MM 6MM 16MM 6MM SHAFT SMALL HEXAGONAL,$32.75,$0.00,$32.75,$14.74,$23.37,$0.00,$5.48,$0.00,$0.00,$5.73,$32.75,$0.00,$16.38,$25.94,$26.20,$0.00,$4.98,$0.00,$5.21,$0.00
204.218,SUP,HCPCS C1713,,204.218  -  SCREW BONE SMALL HEXAGON 3.5MM 6MM 18MM 6MM SELF TAP SOCKET,$32.75,$0.00,$32.75,$14.74,$23.37,$0.00,$5.48,$0.00,$0.00,$5.73,$32.75,$0.00,$16.38,$25.94,$26.20,$0.00,$4.98,$0.00,$5.21,$0.00
204.22,SUP,HCPCS C1713,,204.220  -  SCREW BONE PTHRD 3.5MM 6MM 20MM 6MM SHAFT SMALL HEXAGONAL,$32.75,$0.00,$32.75,$14.74,$23.37,$0.00,$5.48,$0.00,$0.00,$5.73,$32.75,$0.00,$16.38,$25.94,$26.20,$0.00,$4.98,$0.00,$5.21,$0.00
204.222,SUP,HCPCS C1713,,204.222  -  SCREW BONE SMALL HEXAGON 3.5MM 6MM 22MM 6MM SELF TAP SOCKET,$32.75,$0.00,$32.75,$14.74,$23.37,$0.00,$5.48,$0.00,$0.00,$5.73,$32.75,$0.00,$16.38,$25.94,$26.20,$0.00,$4.98,$0.00,$5.21,$0.00
204.224,SUP,HCPCS C1713,,204.224  -  SCREW BONE SMALL HEXAGON 3.5MM 6MM 24MM 10MM SELF TAP SOCKET,$32.75,$0.00,$32.75,$14.74,$23.37,$0.00,$5.48,$0.00,$0.00,$5.73,$32.75,$0.00,$16.38,$25.94,$26.20,$0.00,$4.98,$0.00,$5.21,$0.00
204.226,SUP,HCPCS C1713,,204.226  -  SCREW BONE PTHRD 3.5MM 6MM 26MM 10MM SHAFT SMALL HEXAGONAL,$32.75,$0.00,$32.75,$14.74,$23.37,$0.00,$5.48,$0.00,$0.00,$5.73,$32.75,$0.00,$16.38,$25.94,$26.20,$0.00,$4.98,$0.00,$5.21,$0.00
204.228,SUP,HCPCS C1713,,204.228  -  SCREW BONE SMALL HEXAGON 3.5MM 6MM 28MM 10MM SELF TAP SOCKET,$32.75,$0.00,$32.75,$14.74,$23.37,$0.00,$5.48,$0.00,$0.00,$5.73,$32.75,$0.00,$16.38,$25.94,$26.20,$0.00,$4.98,$0.00,$5.21,$0.00
204.23,SUP,HCPCS C1713,,204.230  -  SCREW BONE SMALL HEXAGON 3.5MM 6MM 30MM 10MM SELF TAP SOCKET,$32.75,$0.00,$32.75,$14.74,$23.37,$0.00,$5.48,$0.00,$0.00,$5.73,$32.75,$0.00,$16.38,$25.94,$26.20,$0.00,$4.98,$0.00,$5.21,$0.00
204.232,SUP,HCPCS C1713,,204.232  -  SCREW BONE SMALL HEXAGON 3.5MM 6MM 32MM 12MM SELF TAP SOCKET,$32.75,$0.00,$32.75,$14.74,$23.37,$0.00,$5.48,$0.00,$0.00,$5.73,$32.75,$0.00,$16.38,$25.94,$26.20,$0.00,$4.98,$0.00,$5.21,$0.00
204.234,SUP,HCPCS C1713,,204.234  -  SCREW BONE SMALL HEXAGON 3.5MM 6MM 34MM 12MM SELF TAP SOCKET,$32.75,$0.00,$32.75,$14.74,$23.37,$0.00,$5.48,$0.00,$0.00,$5.73,$32.75,$0.00,$16.38,$25.94,$26.20,$0.00,$4.98,$0.00,$5.21,$0.00
204.236,SUP,HCPCS C1713,,204.236  -  SCREW BONE SMALL HEXAGON 3.5MM 6MM 36MM 12MM SELF TAP SOCKET,$32.75,$0.00,$32.75,$14.74,$23.37,$0.00,$5.48,$0.00,$0.00,$5.73,$32.75,$0.00,$16.38,$25.94,$26.20,$0.00,$4.98,$0.00,$5.21,$0.00
204.238,SUP,HCPCS C1713,,204.238  -  SCREW BONE PTHRD 3.5MM 6MM 38MM 12MM SHAFT SMALL HEXAGONAL,$32.75,$0.00,$32.75,$14.74,$23.37,$0.00,$5.48,$0.00,$0.00,$5.73,$32.75,$0.00,$16.38,$25.94,$26.20,$0.00,$4.98,$0.00,$5.21,$0.00
204.24,SUP,HCPCS C1713,,204.240  -  SCREW BONE SMALL HEXAGON 3.5MM 6MM 40MM 12MM SELF TAP SOCKET,$32.75,$0.00,$32.75,$14.74,$23.37,$0.00,$5.48,$0.00,$0.00,$5.73,$32.75,$0.00,$16.38,$25.94,$26.20,$0.00,$4.98,$0.00,$5.21,$0.00
204.245,SUP,HCPCS C1713,,204.245  -  SCREW BONE 3.5MM 45MM SHAFT LC-DCP STAINLESS STEEL TIBIA,$31.80,$0.00,$31.80,$14.31,$22.70,$0.00,$5.48,$0.00,$0.00,$5.57,$31.80,$0.00,$15.90,$25.19,$25.44,$0.00,$4.98,$0.00,$5.06,$0.00
204.25,SUP,HCPCS C1713,,204.250  -  SCREW BONE 3.5MM 6MM 50MM SMALL HEXAGON SOCKET DCP LC-DCP,$31.80,$0.00,$31.80,$14.31,$22.70,$0.00,$5.48,$0.00,$0.00,$5.57,$31.80,$0.00,$15.90,$25.19,$25.44,$0.00,$4.98,$0.00,$5.06,$0.00
204.64,SUP,HCPCS C1713,,204.640  -  SCREW BONE 3.5MM 6MM 40MM SELF TAP SMALL HEXAGONAL SOCKET,$51.85,$0.00,$51.85,$23.33,$37.01,$0.00,$8.68,$0.00,$0.00,$9.08,$51.85,$0.00,$25.93,$41.07,$41.48,$0.00,$7.88,$0.00,$8.25,$0.00
204.645,SUP,HCPCS C1713,,204.645  -  SCREW BONE SMALL HEXAGON LP 3.5MM 6MM 45MM SELF TAP SOCKET,$51.85,$0.00,$51.85,$23.33,$37.01,$0.00,$8.68,$0.00,$0.00,$9.08,$51.85,$0.00,$25.93,$41.07,$41.48,$0.00,$7.88,$0.00,$8.25,$0.00
204.65,SUP,HCPCS C1713,,204.650  -  SCREW BONE 3.5MM 6MM 50MM SELF TAP SMALL HEXAGONAL SOCKET,$51.85,$0.00,$51.85,$23.33,$37.01,$0.00,$8.68,$0.00,$0.00,$9.08,$51.85,$0.00,$25.93,$41.07,$41.48,$0.00,$7.88,$0.00,$8.25,$0.00
204.655,SUP,HCPCS C1713,,204.655  -  SCREW BONE SMALL HEXAGON LP 3.5MM 6MM 55MM SELF TAP SOCKET,$51.85,$0.00,$51.85,$23.33,$37.01,$0.00,$8.68,$0.00,$0.00,$9.08,$51.85,$0.00,$25.93,$41.07,$41.48,$0.00,$7.88,$0.00,$8.25,$0.00
204.66,SUP,HCPCS C1713,,204.660  -  SCREW BONE SMALL HEXAGON LP 3.5MM 6MM 60MM SELF TAP SOCKET,$51.85,$0.00,$51.85,$23.33,$37.01,$0.00,$8.68,$0.00,$0.00,$9.08,$51.85,$0.00,$25.93,$41.07,$41.48,$0.00,$7.88,$0.00,$8.25,$0.00
204.665,SUP,HCPCS C1713,,204.665  -  SCREW BONE SMALL HEXAGON LP 3.5MM 6MM 65MM SELF TAP SOCKET,$51.85,$0.00,$51.85,$23.33,$37.01,$0.00,$8.68,$0.00,$0.00,$9.08,$51.85,$0.00,$25.93,$41.07,$41.48,$0.00,$7.88,$0.00,$8.25,$0.00
204.67,SUP,HCPCS C1713,,204.670  -  SCREW BONE 3.5MM 6MM 70MM SELF TAP SMALL HEXAGONAL SOCKET,$51.85,$0.00,$51.85,$23.33,$37.01,$0.00,$8.68,$0.00,$0.00,$9.08,$51.85,$0.00,$25.93,$41.07,$41.48,$0.00,$7.88,$0.00,$8.25,$0.00
204.675,SUP,HCPCS C1713,,204.675  -  SCREW BONE 3.5MM 6MM 75MM SELF TAP SMALL HEXAGONAL SOCKET,$51.85,$0.00,$51.85,$23.33,$37.01,$0.00,$8.68,$0.00,$0.00,$9.08,$51.85,$0.00,$25.93,$41.07,$41.48,$0.00,$7.88,$0.00,$8.25,$0.00
204.68,SUP,HCPCS C1713,,204.680  -  SCREW BONE SMALL HEXAGON LP 3.5MM 6MM 80MM SELF TAP SOCKET,$51.85,$0.00,$51.85,$23.33,$37.01,$0.00,$8.68,$0.00,$0.00,$9.08,$51.85,$0.00,$25.93,$41.07,$41.48,$0.00,$7.88,$0.00,$8.25,$0.00
204.685,SUP,HCPCS C1713,,204.685  -  SCREW BONE SMALL HEXAGON LP 3.5MM 6MM 85MM SELF TAP SOCKET,$51.85,$0.00,$51.85,$23.33,$37.01,$0.00,$8.68,$0.00,$0.00,$9.08,$51.85,$0.00,$25.93,$41.07,$41.48,$0.00,$7.88,$0.00,$8.25,$0.00
204.69,SUP,HCPCS C1713,,204.690  -  SCREW BONE 3.5MM 6MM 90MM SELF TAP SMALL HEXAGONAL SOCKET,$51.85,$0.00,$51.85,$23.33,$37.01,$0.00,$8.68,$0.00,$0.00,$9.08,$51.85,$0.00,$25.93,$41.07,$41.48,$0.00,$7.88,$0.00,$8.25,$0.00
204.695,SUP,HCPCS C1713,,204.695  -  SCREW BONE SMALL HEXAGON LP 3.5MM 6MM 95MM SELF TAP SOCKET,$51.85,$0.00,$51.85,$23.33,$37.01,$0.00,$8.68,$0.00,$0.00,$9.08,$51.85,$0.00,$25.93,$41.07,$41.48,$0.00,$7.88,$0.00,$8.25,$0.00
204.7,SUP,HCPCS C1713,,204.700  -  SCREW BONE 3.5MM 6MM 100MM SELF TAP SMALL HEXAGONAL SOCKET,$51.85,$0.00,$51.85,$23.33,$37.01,$0.00,$8.68,$0.00,$0.00,$9.08,$51.85,$0.00,$25.93,$41.07,$41.48,$0.00,$7.88,$0.00,$8.25,$0.00
204.705,SUP,HCPCS C1713,,204.705  -  SCREW BONE 3.5MM 6MM 105MM SELF TAP SMALL HEXAGONAL SOCKET,$51.85,$0.00,$51.85,$23.33,$37.01,$0.00,$8.68,$0.00,$0.00,$9.08,$51.85,$0.00,$25.93,$41.07,$41.48,$0.00,$7.88,$0.00,$8.25,$0.00
204.71,SUP,HCPCS C1713,,204.710  -  SCREW BONE SMALL HEXAGON LP 3.5MM 6MM 110MM SELF TAP SOCKET,$51.85,$0.00,$51.85,$23.33,$37.01,$0.00,$8.68,$0.00,$0.00,$9.08,$51.85,$0.00,$25.93,$41.07,$41.48,$0.00,$7.88,$0.00,$8.25,$0.00
204.715,SUP,HCPCS C1713,,204.715  -  SCREW BONE SMALL HEXAGON LP 3.5MM 6MM 115MM SELF TAP SOCKET,$51.85,$0.00,$51.85,$23.33,$37.01,$0.00,$8.68,$0.00,$0.00,$9.08,$51.85,$0.00,$25.93,$41.07,$41.48,$0.00,$7.88,$0.00,$8.25,$0.00
204.72,SUP,HCPCS C1713,,204.720  -  SCREW BONE 3.5MM 120MM SLFTAP LC-DCP STAINLESS STEEL CORTEX,$51.85,$0.00,$51.85,$23.33,$37.01,$0.00,$8.68,$0.00,$0.00,$9.08,$51.85,$0.00,$25.93,$41.07,$41.48,$0.00,$7.88,$0.00,$8.25,$0.00
204.725,SUP,HCPCS C1713,,204.725  -  SCREW BONE SMALL HEXAGON LP 3.5MM 6MM 125MM SELF TAP SOCKET,$51.85,$0.00,$51.85,$23.33,$37.01,$0.00,$8.68,$0.00,$0.00,$9.08,$51.85,$0.00,$25.93,$41.07,$41.48,$0.00,$7.88,$0.00,$8.25,$0.00
204.73,SUP,HCPCS C1713,,204.730  -  SCREW BONE 3.5MM 6MM 130MM SLFTAP LP SMALL HEXAGONAL SOCKET,$165.13,$0.00,$165.13,$74.31,$117.85,$0.00,$27.62,$0.00,$0.00,$28.91,$165.13,$0.00,$82.56,$130.78,$132.10,$0.00,$25.09,$0.00,$26.29,$0.00
204.735,SUP,HCPCS C1713,,204.735  -  SCREW BONE SMALL HEXAGON LP 3.5MM 6MM 135MM SELF TAP SOCKET,$165.13,$0.00,$165.13,$74.31,$117.85,$0.00,$27.62,$0.00,$0.00,$28.91,$165.13,$0.00,$82.56,$130.78,$132.10,$0.00,$25.09,$0.00,$26.29,$0.00
204.74,SUP,HCPCS C1713,,204.740  -  SCREW BONE 3.5MM 6MM 140MM SLFTAP LP SMALL HEXAGONAL SOCKET,$165.13,$0.00,$165.13,$74.31,$117.85,$0.00,$27.62,$0.00,$0.00,$28.91,$165.13,$0.00,$82.56,$130.78,$132.10,$0.00,$25.09,$0.00,$26.29,$0.00
204.745,SUP,HCPCS C1713,,204.745  -  SCREW BONE SMALL HEXAGON LP 3.5MM 6MM 145MM SELF TAP SOCKET,$165.13,$0.00,$165.13,$74.31,$117.85,$0.00,$27.62,$0.00,$0.00,$28.91,$165.13,$0.00,$82.56,$130.78,$132.10,$0.00,$25.09,$0.00,$26.29,$0.00
204.75,SUP,HCPCS C1713,,204.750  -  SCREW BONE 3.5MM 6MM 150MM SLFTAP LP SMALL HEXAGONAL SOCKET,$165.13,$0.00,$165.13,$74.31,$117.85,$0.00,$27.62,$0.00,$0.00,$28.91,$165.13,$0.00,$82.56,$130.78,$132.10,$0.00,$25.09,$0.00,$26.29,$0.00
204.81,SUP,HCPCS C1713,,204.810  -  SCREW BONE FULTHD HEXAGON 3.5MM 6MM 10MM SELF TAP LC-DCP DCP,$38.55,$0.00,$38.55,$17.35,$27.51,$0.00,$6.45,$0.00,$0.00,$6.75,$38.55,$0.00,$19.28,$30.53,$30.84,$0.00,$5.86,$0.00,$6.14,$0.00
204.812,SUP,HCPCS C1713,,204.812  -  SCREW BONE FULTHD 3.5MM 6MM 12MM SLFTAP SMALL HEXAGONAL,$38.55,$0.00,$38.55,$17.35,$27.51,$0.00,$6.45,$0.00,$0.00,$6.75,$38.55,$0.00,$19.28,$30.53,$30.84,$0.00,$5.86,$0.00,$6.14,$0.00
204.814,SUP,HCPCS C1713,,204.814  -  SCREW BONE FULTHD 3.5MM 6MM 14MM SELF TAP SMALL HEXAGONAL,$38.55,$0.00,$38.55,$17.35,$27.51,$0.00,$6.45,$0.00,$0.00,$6.75,$38.55,$0.00,$19.28,$30.53,$30.84,$0.00,$5.86,$0.00,$6.14,$0.00
204.816,SUP,HCPCS C1713,,204.816  -  SCREW BONE FULTHD 3.5MM 6MM 16MM SLFTAP SMALL HEXAGONAL,$38.55,$0.00,$38.55,$17.35,$27.51,$0.00,$6.45,$0.00,$0.00,$6.75,$38.55,$0.00,$19.28,$30.53,$30.84,$0.00,$5.86,$0.00,$6.14,$0.00
204.818,SUP,HCPCS C1713,,204.818  -  SCREW BONE 3.5MM 18MM SLFTAP LCP STAINLESS STEEL CORTICAL,$38.55,$0.00,$38.55,$17.35,$27.51,$0.00,$6.45,$0.00,$0.00,$6.75,$38.55,$0.00,$19.28,$30.53,$30.84,$0.00,$5.86,$0.00,$6.14,$0.00
204.82,SUP,HCPCS C1713,,204.820  -  SCREW BONE FULTHD HEXAGON 3.5MM 6MM 20MM SELF TAP LC-DCP DCP,$38.55,$0.00,$38.55,$17.35,$27.51,$0.00,$6.45,$0.00,$0.00,$6.75,$38.55,$0.00,$19.28,$30.53,$30.84,$0.00,$5.86,$0.00,$6.14,$0.00
204.822,SUP,HCPCS C1713,,204.822  -  SCREW BONE 3.5MM 22MM SLFTAP LCP STAINLESS STEEL CORTICAL,$38.55,$0.00,$38.55,$17.35,$27.51,$0.00,$6.45,$0.00,$0.00,$6.75,$38.55,$0.00,$19.28,$30.53,$30.84,$0.00,$5.86,$0.00,$6.14,$0.00
204.824,SUP,HCPCS C1713,,204.824  -  SCREW BONE 3.5MM 24MM SLFTAP LCP STAINLESS STEEL CORTICAL,$38.55,$0.00,$38.55,$17.35,$27.51,$0.00,$6.45,$0.00,$0.00,$6.75,$38.55,$0.00,$19.28,$30.53,$30.84,$0.00,$5.86,$0.00,$6.14,$0.00
204.826,SUP,HCPCS C1713,,204.826  -  SCREW BONE 3.5MM 26MM SLFTAP LCP STAINLESS STEEL CORTICAL,$38.55,$0.00,$38.55,$17.35,$27.51,$0.00,$6.45,$0.00,$0.00,$6.75,$38.55,$0.00,$19.28,$30.53,$30.84,$0.00,$5.86,$0.00,$6.14,$0.00
204.828,SUP,HCPCS C1713,,204.828  -  SCREW BONE 3.5MM 28MM SLFTAP HEXAGONAL RECESS DCP LC-DCP,$38.55,$0.00,$38.55,$17.35,$27.51,$0.00,$6.45,$0.00,$0.00,$6.75,$38.55,$0.00,$19.28,$30.53,$30.84,$0.00,$5.86,$0.00,$6.14,$0.00
204.83,SUP,HCPCS C1713,,204.830  -  SCREW BONE FULTHD HEXAGON 3.5MM 6MM 30MM SELF TAP LC-DCP DCP,$38.55,$0.00,$38.55,$17.35,$27.51,$0.00,$6.45,$0.00,$0.00,$6.75,$38.55,$0.00,$19.28,$30.53,$30.84,$0.00,$5.86,$0.00,$6.14,$0.00
204.832,SUP,HCPCS C1713,,204.832  -  SCREW BONE FULTHD 3.5MM 6MM 32MM SLFTAP SMALL HEXAGONAL,$38.55,$0.00,$38.55,$17.35,$27.51,$0.00,$6.45,$0.00,$0.00,$6.75,$38.55,$0.00,$19.28,$30.53,$30.84,$0.00,$5.86,$0.00,$6.14,$0.00
204.834,SUP,HCPCS C1713,,204.834  -  SCREW BONE FULTHD 3.5MM 6MM 34MM SLFTAP SMALL HEXAGONAL,$38.55,$0.00,$38.55,$17.35,$27.51,$0.00,$6.45,$0.00,$0.00,$6.75,$38.55,$0.00,$19.28,$30.53,$30.84,$0.00,$5.86,$0.00,$6.14,$0.00
204.836,SUP,HCPCS C1713,,204.836  -  SCREW BONE FULTHD 3.5MM 6MM 36MM SLFTAP SMALL HEXAGONAL,$38.55,$0.00,$38.55,$17.35,$27.51,$0.00,$6.45,$0.00,$0.00,$6.75,$38.55,$0.00,$19.28,$30.53,$30.84,$0.00,$5.86,$0.00,$6.14,$0.00
204.838,SUP,HCPCS C1713,,204.838  -  SCREW BONE 3.5MM 38MM SLFTAP HEXAGONAL RECESS DCP LC-DCP,$38.55,$0.00,$38.55,$17.35,$27.51,$0.00,$6.45,$0.00,$0.00,$6.75,$38.55,$0.00,$19.28,$30.53,$30.84,$0.00,$5.86,$0.00,$6.14,$0.00
204.84,SUP,HCPCS C1713,,204.840  -  SCREW BONE FULTHD HEXAGON 3.5MM 6MM 40MM SELF TAP LC-DCP DCP,$38.55,$0.00,$38.55,$17.35,$27.51,$0.00,$6.45,$0.00,$0.00,$6.75,$38.55,$0.00,$19.28,$30.53,$30.84,$0.00,$5.86,$0.00,$6.14,$0.00
204.842,SUP,HCPCS C1713,,204.842  -  SCREW BONE FULTHD HEXAGON 3.5MM 6MM 42MM SELF TAP SOCKET DCP,$38.55,$0.00,$38.55,$17.35,$27.51,$0.00,$6.45,$0.00,$0.00,$6.75,$38.55,$0.00,$19.28,$30.53,$30.84,$0.00,$5.86,$0.00,$6.14,$0.00
204.844,SUP,HCPCS C1713,,204.844  -  SCREW BONE FULTHD HEXAGON 3.5MM 6MM 44MM SELF TAP SOCKET DCP,$38.55,$0.00,$38.55,$17.35,$27.51,$0.00,$6.45,$0.00,$0.00,$6.75,$38.55,$0.00,$19.28,$30.53,$30.84,$0.00,$5.86,$0.00,$6.14,$0.00
204.845,SUP,HCPCS C1713,,204.845  -  SCREW BONE 3.5MM 45MM SLFTAP LCP STAINLESS STEEL CORTICAL,$38.55,$0.00,$38.55,$17.35,$27.51,$0.00,$6.45,$0.00,$0.00,$6.75,$38.55,$0.00,$19.28,$30.53,$30.84,$0.00,$5.86,$0.00,$6.14,$0.00
204.846,SUP,HCPCS C1713,,204.846  -  SCREW BONE FULTHD HEXAGON 3.5MM 6MM 46MM SELF TAP SOCKET DCP,$38.55,$0.00,$38.55,$17.35,$27.51,$0.00,$6.45,$0.00,$0.00,$6.75,$38.55,$0.00,$19.28,$30.53,$30.84,$0.00,$5.86,$0.00,$6.14,$0.00
204.848,SUP,HCPCS C1713,,204.848  -  SCREW BONE FULTHD HEXAGON 3.5MM 6MM 48MM SELF TAP SOCKET DCP,$38.55,$0.00,$38.55,$17.35,$27.51,$0.00,$6.45,$0.00,$0.00,$6.75,$38.55,$0.00,$19.28,$30.53,$30.84,$0.00,$5.86,$0.00,$6.14,$0.00
204.85,SUP,HCPCS C1713,,204.850  -  SCREW BONE FULTHD 3.5MM 6MM 50MM SLFTAP SMALL HEXAGONAL,$38.55,$0.00,$38.55,$17.35,$27.51,$0.00,$6.45,$0.00,$0.00,$6.75,$38.55,$0.00,$19.28,$30.53,$30.84,$0.00,$5.86,$0.00,$6.14,$0.00
204.855,SUP,HCPCS C1713,,204.855  -  SCREW BONE 3.5MM 55MM SLFTAP HEXAGONAL RECESS DCP LC-DCP,$38.55,$0.00,$38.55,$17.35,$27.51,$0.00,$6.45,$0.00,$0.00,$6.75,$38.55,$0.00,$19.28,$30.53,$30.84,$0.00,$5.86,$0.00,$6.14,$0.00
204.86,SUP,HCPCS C1713,,204.860  -  SCREW BONE FULTHD 3.5MM 6MM 60MM SLFTAP SMALL HEXAGONAL,$38.55,$0.00,$38.55,$17.35,$27.51,$0.00,$6.45,$0.00,$0.00,$6.75,$38.55,$0.00,$19.28,$30.53,$30.84,$0.00,$5.86,$0.00,$6.14,$0.00
204.865,SUP,HCPCS C1713,,204.865  -  SCREW BONE FULTHD HEXAGON 3.5MM 6MM 65MM SELF TAP SOCKET DCP,$38.55,$0.00,$38.55,$17.35,$27.51,$0.00,$6.45,$0.00,$0.00,$6.75,$38.55,$0.00,$19.28,$30.53,$30.84,$0.00,$5.86,$0.00,$6.14,$0.00
204.87,SUP,HCPCS C1713,,204.870  -  SCREW BONE FULTHD 3.5MM 6MM 70MM SLFTAP SMALL HEXAGONAL,$38.55,$0.00,$38.55,$17.35,$27.51,$0.00,$6.45,$0.00,$0.00,$6.75,$38.55,$0.00,$19.28,$30.53,$30.84,$0.00,$5.86,$0.00,$6.14,$0.00
204.875,SUP,HCPCS C1713,,204.875  -  SCREW BONE FULTHD 3.5MM 6MM 75MM SLFTAP SMALL HEXAGONAL,$38.55,$0.00,$38.55,$17.35,$27.51,$0.00,$6.45,$0.00,$0.00,$6.75,$38.55,$0.00,$19.28,$30.53,$30.84,$0.00,$5.86,$0.00,$6.14,$0.00
204.88,SUP,HCPCS C1713,,204.880  -  SCREW BONE FULTHD HEXAGON 3.5MM 6MM 80MM SELF TAP SOCKET DCP,$38.55,$0.00,$38.55,$17.35,$27.51,$0.00,$6.45,$0.00,$0.00,$6.75,$38.55,$0.00,$19.28,$30.53,$30.84,$0.00,$5.86,$0.00,$6.14,$0.00
204.885,SUP,HCPCS C1713,,204.885  -  SCREW BONE FULTHD HEXAGON 3.5MM 6MM 85MM SELF TAP SOCKET DCP,$38.55,$0.00,$38.55,$17.35,$27.51,$0.00,$6.45,$0.00,$0.00,$6.75,$38.55,$0.00,$19.28,$30.53,$30.84,$0.00,$5.86,$0.00,$6.14,$0.00
204.89,SUP,HCPCS C1713,,204.890  -  SCREW BONE FULTHD HEXAGON 3.5MM 6MM 90MM SELF TAP SOCKET DCP,$38.55,$0.00,$38.55,$17.35,$27.51,$0.00,$9.51,$0.00,$0.00,$6.75,$38.55,$0.00,$19.28,$30.53,$30.84,$0.00,$8.63,$0.00,$6.14,$0.00
204.89,SUP,HCPCS C1713,,204.89  -  SCREW BONE 3.5MM 90MM LC DCP SS CORT PROX MDL PLVC TIBIAL,$50.55,$0.00,$40.04,$17.35,$27.51,$0.00,$9.51,$0.00,$0.00,$6.75,$38.55,$0.00,$19.28,$40.04,$30.84,$0.00,$8.63,$0.00,$6.14,$0.00
204.895,SUP,HCPCS C1713,,204.895  -  SCREW BONE FULTHD HEXAGON 3.5MM 6MM 95MM SELF TAP SOCKET DCP,$38.55,$0.00,$38.55,$17.35,$27.51,$0.00,$6.45,$0.00,$0.00,$6.75,$38.55,$0.00,$19.28,$30.53,$30.84,$0.00,$5.86,$0.00,$6.14,$0.00
204.9,SUP,HCPCS C1713,,204.900  -  SCREW BONE 3.5MM 100MM SLFTAP LC-DCP STAINLESS STEEL TIBIA,$38.55,$0.00,$38.55,$17.35,$27.51,$0.00,$6.45,$0.00,$0.00,$6.75,$38.55,$0.00,$19.28,$30.53,$30.84,$0.00,$5.86,$0.00,$6.14,$0.00
204.905,SUP,HCPCS C1713,,204.905  -  SCREW BONE 3.5MM 105MM SLFTAP LC-DCP STAINLESS STEEL TIBIA,$38.55,$0.00,$38.55,$17.35,$27.51,$0.00,$6.45,$0.00,$0.00,$6.75,$38.55,$0.00,$19.28,$30.53,$30.84,$0.00,$5.86,$0.00,$6.14,$0.00
204.91,SUP,HCPCS C1713,,204.910  -  SCREW BONE 3.5MM 110MM SLFTAP LC-DCP STAINLESS STEEL TIBIA,$38.55,$0.00,$38.55,$17.35,$27.51,$0.00,$6.45,$0.00,$0.00,$6.75,$38.55,$0.00,$19.28,$30.53,$30.84,$0.00,$5.86,$0.00,$6.14,$0.00
205.01,SUP,HCPCS C1713,,205.010  -  SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5,$343.93,$0.00,$343.93,$154.77,$245.46,$0.00,$57.53,$0.00,$0.00,$60.22,$343.93,$0.00,$171.96,$272.39,$275.14,$0.00,$52.26,$0.00,$54.75,$0.00
205.012,SUP,HCPCS C1713,,205.012  -  SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5,$343.93,$0.00,$343.93,$154.77,$245.46,$0.00,$77.32,$0.00,$0.00,$60.22,$343.93,$0.00,$171.96,$272.39,$275.14,$0.00,$70.23,$0.00,$54.75,$0.00
205.014,SUP,HCPCS C1713,,205.014  -  SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5,$343.93,$0.00,$343.93,$154.77,$245.46,$0.00,$57.53,$0.00,$0.00,$60.22,$343.93,$0.00,$171.96,$272.39,$275.14,$0.00,$52.26,$0.00,$54.75,$0.00
205.016,SUP,HCPCS C1713,,205.016  -  SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5,$343.93,$0.00,$343.93,$154.77,$245.46,$0.00,$57.53,$0.00,$0.00,$60.22,$343.93,$0.00,$171.96,$272.39,$275.14,$0.00,$52.26,$0.00,$54.75,$0.00
205.018,SUP,HCPCS C1713,,205.018  -  SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5,$343.93,$0.00,$343.93,$154.77,$245.46,$0.00,$57.53,$0.00,$0.00,$60.22,$343.93,$0.00,$171.96,$272.39,$275.14,$0.00,$52.26,$0.00,$54.75,$0.00
205.02,SUP,HCPCS C1713,,205.020  -  SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5,$343.93,$0.00,$343.93,$154.77,$245.46,$0.00,$57.53,$0.00,$0.00,$60.22,$343.93,$0.00,$171.96,$272.39,$275.14,$0.00,$52.26,$0.00,$54.75,$0.00
205.022,SUP,HCPCS C1713,,205.022  -  SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5,$343.93,$0.00,$343.93,$154.77,$245.46,$0.00,$57.53,$0.00,$0.00,$60.22,$343.93,$0.00,$171.96,$272.39,$275.14,$0.00,$52.26,$0.00,$54.75,$0.00
205.024,SUP,HCPCS C1713,,205.024  -  SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5,$343.93,$0.00,$343.93,$154.77,$245.46,$0.00,$57.53,$0.00,$0.00,$60.22,$343.93,$0.00,$171.96,$272.39,$275.14,$0.00,$52.26,$0.00,$54.75,$0.00
205.026,SUP,HCPCS C1713,,205.026  -  SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5,$343.93,$0.00,$343.93,$154.77,$245.46,$0.00,$57.53,$0.00,$0.00,$60.22,$343.93,$0.00,$171.96,$272.39,$275.14,$0.00,$52.26,$0.00,$54.75,$0.00
205.028,SUP,HCPCS C1713,,205.028  -  SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5,$343.93,$0.00,$343.93,$154.77,$245.46,$0.00,$57.53,$0.00,$0.00,$60.22,$343.93,$0.00,$171.96,$272.39,$275.14,$0.00,$52.26,$0.00,$54.75,$0.00
205.03,SUP,HCPCS C1713,,205.030  -  SCREW BONE PTHRD 3.5MM 30MM 10MM CANN HEMISPHERICAL HEAD,$343.93,$0.00,$343.93,$154.77,$245.46,$0.00,$57.53,$0.00,$0.00,$60.22,$343.93,$0.00,$171.96,$272.39,$275.14,$0.00,$52.26,$0.00,$54.75,$0.00
205.032,SUP,HCPCS C1713,,205.032  -  SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5,$343.93,$0.00,$343.93,$154.77,$245.46,$0.00,$57.53,$0.00,$0.00,$60.22,$343.93,$0.00,$171.96,$272.39,$275.14,$0.00,$52.26,$0.00,$54.75,$0.00
205.034,SUP,HCPCS C1713,,205.034  -  SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5,$343.93,$0.00,$343.93,$154.77,$245.46,$0.00,$57.53,$0.00,$0.00,$60.22,$343.93,$0.00,$171.96,$272.39,$275.14,$0.00,$52.26,$0.00,$54.75,$0.00
205.036,SUP,HCPCS C1713,,205.036  -  SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5,$343.93,$0.00,$343.93,$154.77,$245.46,$0.00,$57.53,$0.00,$0.00,$60.22,$343.93,$0.00,$171.96,$272.39,$275.14,$0.00,$52.26,$0.00,$54.75,$0.00
205.038,SUP,HCPCS C1713,,205.038  -  SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5,$343.93,$0.00,$343.93,$154.77,$245.46,$0.00,$57.53,$0.00,$0.00,$60.22,$343.93,$0.00,$171.96,$272.39,$275.14,$0.00,$52.26,$0.00,$54.75,$0.00
205.04,SUP,HCPCS C1713,,205.040  -  SCREW BONE PTHRD 3.5MM 40MM 13MM CANN HEMISPHERICAL HEAD,$343.93,$0.00,$343.93,$154.77,$245.46,$0.00,$57.53,$0.00,$0.00,$60.22,$343.93,$0.00,$171.96,$272.39,$275.14,$0.00,$52.26,$0.00,$54.75,$0.00
205.042,SUP,HCPCS C1713,,205.042  -  SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5,$343.93,$0.00,$343.93,$154.77,$245.46,$0.00,$57.53,$0.00,$0.00,$60.22,$343.93,$0.00,$171.96,$272.39,$275.14,$0.00,$52.26,$0.00,$54.75,$0.00
205.044,SUP,HCPCS C1713,,205.044  -  SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5,$343.93,$0.00,$343.93,$154.77,$245.46,$0.00,$57.53,$0.00,$0.00,$60.22,$343.93,$0.00,$171.96,$272.39,$275.14,$0.00,$52.26,$0.00,$54.75,$0.00
205.046,SUP,HCPCS C1713,,205.046  -  SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5,$343.93,$0.00,$343.93,$154.77,$245.46,$0.00,$57.53,$0.00,$0.00,$60.22,$343.93,$0.00,$171.96,$272.39,$275.14,$0.00,$52.26,$0.00,$54.75,$0.00
205.048,SUP,HCPCS C1713,,205.048  -  SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5,$343.93,$0.00,$343.93,$154.77,$245.46,$0.00,$57.53,$0.00,$0.00,$60.22,$343.93,$0.00,$171.96,$272.39,$275.14,$0.00,$52.26,$0.00,$54.75,$0.00
205.05,SUP,HCPCS C1713,,205.050  -  SCREW BONE PTHRD 3.5MM 50MM 16MM CANN HEMISPHERICAL HEAD,$343.93,$0.00,$343.93,$154.77,$245.46,$0.00,$57.53,$0.00,$0.00,$60.22,$343.93,$0.00,$171.96,$272.39,$275.14,$0.00,$52.26,$0.00,$54.75,$0.00
205.21,SUP,HCPCS C1713,,205.210  -  SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5,$353.48,$0.00,$353.48,$159.06,$252.28,$0.00,$59.13,$0.00,$0.00,$61.89,$353.48,$0.00,$176.74,$279.96,$282.78,$0.00,$53.71,$0.00,$56.27,$0.00
205.212,SUP,HCPCS C1713,,205.212  -  SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5,$353.48,$0.00,$353.48,$159.06,$252.28,$0.00,$59.13,$0.00,$0.00,$61.89,$353.48,$0.00,$176.74,$279.96,$282.78,$0.00,$53.71,$0.00,$56.27,$0.00
205.214,SUP,HCPCS C1713,,205.214  -  SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5,$353.48,$0.00,$353.48,$159.06,$252.28,$0.00,$59.13,$0.00,$0.00,$61.89,$353.48,$0.00,$176.74,$279.96,$282.78,$0.00,$53.71,$0.00,$56.27,$0.00
205.216,SUP,HCPCS C1713,,205.216  -  SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5,$353.48,$0.00,$353.48,$159.06,$252.28,$0.00,$59.13,$0.00,$0.00,$61.89,$353.48,$0.00,$176.74,$279.96,$282.78,$0.00,$53.71,$0.00,$56.27,$0.00
205.218,SUP,HCPCS C1713,,205.218  -  SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5,$353.48,$0.00,$353.48,$159.06,$252.28,$0.00,$59.13,$0.00,$0.00,$61.89,$353.48,$0.00,$176.74,$279.96,$282.78,$0.00,$53.71,$0.00,$56.27,$0.00
205.22,SUP,HCPCS C1713,,205.220  -  SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5,$353.48,$0.00,$353.48,$159.06,$252.28,$0.00,$77.32,$0.00,$0.00,$61.89,$353.48,$0.00,$176.74,$279.96,$282.78,$0.00,$70.23,$0.00,$56.27,$0.00
205.222,SUP,HCPCS C1713,,205.222  -  SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5,$353.48,$0.00,$353.48,$159.06,$252.28,$0.00,$77.32,$0.00,$0.00,$61.89,$353.48,$0.00,$176.74,$279.96,$282.78,$0.00,$70.23,$0.00,$56.27,$0.00
205.224,SUP,HCPCS C1713,,205.224  -  SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5,$353.48,$0.00,$353.48,$159.06,$252.28,$0.00,$59.13,$0.00,$0.00,$61.89,$353.48,$0.00,$176.74,$279.96,$282.78,$0.00,$53.71,$0.00,$56.27,$0.00
205.226,SUP,HCPCS C1713,,205.226  -  SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5,$353.48,$0.00,$353.48,$159.06,$252.28,$0.00,$59.13,$0.00,$0.00,$61.89,$353.48,$0.00,$176.74,$279.96,$282.78,$0.00,$53.71,$0.00,$56.27,$0.00
205.228,SUP,HCPCS C1713,,205.228  -  SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5,$353.48,$0.00,$353.48,$159.06,$252.28,$0.00,$77.32,$0.00,$0.00,$61.89,$353.48,$0.00,$176.74,$279.96,$282.78,$0.00,$70.23,$0.00,$56.27,$0.00
205.23,SUP,HCPCS C1713,,205.230  -  SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5,$353.48,$0.00,$353.48,$159.06,$252.28,$0.00,$59.13,$0.00,$0.00,$61.89,$353.48,$0.00,$176.74,$279.96,$282.78,$0.00,$53.71,$0.00,$56.27,$0.00
205.232,SUP,HCPCS C1713,,205.232  -  SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5,$353.48,$0.00,$353.48,$159.06,$252.28,$0.00,$59.13,$0.00,$0.00,$61.89,$353.48,$0.00,$176.74,$279.96,$282.78,$0.00,$53.71,$0.00,$56.27,$0.00
205.234,SUP,HCPCS C1713,,205.234  -  SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5,$353.48,$0.00,$353.48,$159.06,$252.28,$0.00,$59.13,$0.00,$0.00,$61.89,$353.48,$0.00,$176.74,$279.96,$282.78,$0.00,$53.71,$0.00,$56.27,$0.00
205.236,SUP,HCPCS C1713,,205.236  -  SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5,$353.48,$0.00,$353.48,$159.06,$252.28,$0.00,$59.13,$0.00,$0.00,$61.89,$353.48,$0.00,$176.74,$279.96,$282.78,$0.00,$53.71,$0.00,$56.27,$0.00
205.238,SUP,HCPCS C1713,,205.238  -  SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5,$353.48,$0.00,$353.48,$159.06,$252.28,$0.00,$59.13,$0.00,$0.00,$61.89,$353.48,$0.00,$176.74,$279.96,$282.78,$0.00,$53.71,$0.00,$56.27,$0.00
205.24,SUP,HCPCS C1713,,205.240  -  SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5,$353.48,$0.00,$353.48,$159.06,$252.28,$0.00,$59.13,$0.00,$0.00,$61.89,$353.48,$0.00,$176.74,$279.96,$282.78,$0.00,$53.71,$0.00,$56.27,$0.00
205.242,SUP,HCPCS C1713,,205.242  -  SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5,$353.48,$0.00,$353.48,$159.06,$252.28,$0.00,$59.13,$0.00,$0.00,$61.89,$353.48,$0.00,$176.74,$279.96,$282.78,$0.00,$53.71,$0.00,$56.27,$0.00
205.244,SUP,HCPCS C1713,,205.244  -  SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5,$353.48,$0.00,$353.48,$159.06,$252.28,$0.00,$59.13,$0.00,$0.00,$61.89,$353.48,$0.00,$176.74,$279.96,$282.78,$0.00,$53.71,$0.00,$56.27,$0.00
205.246,SUP,HCPCS C1713,,205.246  -  SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5,$353.48,$0.00,$353.48,$159.06,$252.28,$0.00,$59.13,$0.00,$0.00,$61.89,$353.48,$0.00,$176.74,$279.96,$282.78,$0.00,$53.71,$0.00,$56.27,$0.00
205.248,SUP,HCPCS C1713,,205.248  -  SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5,$353.48,$0.00,$353.48,$159.06,$252.28,$0.00,$59.13,$0.00,$0.00,$61.89,$353.48,$0.00,$176.74,$279.96,$282.78,$0.00,$53.71,$0.00,$56.27,$0.00
205.25,SUP,HCPCS C1713,,205.250  -  SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5,$353.48,$0.00,$353.48,$159.06,$252.28,$0.00,$59.13,$0.00,$0.00,$61.89,$353.48,$0.00,$176.74,$279.96,$282.78,$0.00,$53.71,$0.00,$56.27,$0.00
206.01,SUP,HCPCS C1713,,206.010  -  SCREW BN FT 4MM 6MM 10MM NS SM HEX SCKT SS CANC SM FRAG SET,$31.73,$0.00,$31.73,$14.28,$22.64,$0.00,$5.31,$0.00,$0.00,$5.55,$31.73,$0.00,$15.86,$25.13,$25.38,$0.00,$4.82,$0.00,$5.05,$0.00
206.01,SUP,HCPCS C1713,,206.01  -  SCREW BONE 4MM 10MM LC DCP SS CANC PROX MDL TIBIAL FULTHD,$41.88,$0.00,$33.17,$14.28,$22.64,$0.00,$5.31,$0.00,$0.00,$5.55,$31.73,$0.00,$15.86,$33.17,$25.38,$0.00,$4.82,$0.00,$5.05,$0.00
206.012,SUP,HCPCS C1713,,206.012  -  SCREW BONE FULTHD 4MM 12MM FULTHRD LCP STAINLESS STEEL,$31.73,$0.00,$31.73,$14.28,$22.64,$0.00,$5.31,$0.00,$0.00,$5.55,$31.73,$0.00,$15.86,$25.13,$25.38,$0.00,$4.82,$0.00,$5.05,$0.00
206.014,SUP,HCPCS C1713,,206.014  -  SCREW BONE PTHRD 4MM 6MM 14MM SMALL HEXAGONAL SOCKET LCP,$31.73,$0.00,$31.73,$14.28,$22.64,$0.00,$5.31,$0.00,$0.00,$5.55,$31.73,$0.00,$15.86,$25.13,$25.38,$0.00,$4.82,$0.00,$5.05,$0.00
206.016,SUP,HCPCS C1713,,206.016  -  SCREW BONE PTHRD 4MM 6MM 16MM SMALL HEXAGONAL SOCKET LCP,$31.73,$0.00,$31.73,$14.28,$22.64,$0.00,$5.31,$0.00,$0.00,$5.55,$31.73,$0.00,$15.86,$25.13,$25.38,$0.00,$4.82,$0.00,$5.05,$0.00
206.018,SUP,HCPCS C1713,,206.018  -  SCREW BONE PTHRD 4MM 6MM 18MM SMALL HEXAGONAL SOCKET LCP,$31.73,$0.00,$31.73,$14.28,$22.64,$0.00,$5.31,$0.00,$0.00,$5.55,$31.73,$0.00,$15.86,$25.13,$25.38,$0.00,$4.82,$0.00,$5.05,$0.00
206.02,SUP,HCPCS C1713,,206.020  -  SCREW BONE PTHRD 4MM 6MM 20MM SMALL HEXAGONAL SOCKET LCP,$31.73,$0.00,$31.73,$14.28,$22.64,$0.00,$5.31,$0.00,$0.00,$5.55,$31.73,$0.00,$15.86,$25.13,$25.38,$0.00,$4.82,$0.00,$5.05,$0.00
206.02,SUP,HCPCS C1713,,206.02  -  SCREW BONE 4MM 20MM LC DCP SS CANC PROX MDL TIBIAL FULTHD,$40.65,$0.00,$32.19,$14.28,$22.64,$0.00,$5.31,$0.00,$0.00,$5.55,$31.73,$0.00,$15.86,$32.19,$25.38,$0.00,$4.82,$0.00,$5.05,$0.00
206.022,SUP,HCPCS C1713,,206.022  -  SCREW BONE FULTHD 4MM 22MM LOCKING SLFTAP LCP STAINLESS,$31.73,$0.00,$31.73,$14.28,$22.64,$0.00,$5.31,$0.00,$0.00,$5.55,$31.73,$0.00,$15.86,$25.13,$25.38,$0.00,$4.82,$0.00,$5.05,$0.00
206.024,SUP,HCPCS C1713,,206.024  -  SCREW BONE PTHRD 4MM 6MM 24MM SMALL HEXAGONAL SOCKET LCP,$31.73,$0.00,$31.73,$14.28,$22.64,$0.00,$5.31,$0.00,$0.00,$5.55,$31.73,$0.00,$15.86,$25.13,$25.38,$0.00,$4.82,$0.00,$5.05,$0.00
206.026,SUP,HCPCS C1713,,206.026  -  SCREW BONE 2.5MM FULTHD 4MM 26MM SELF TAP HEXAGONAL SHAFT,$31.73,$0.00,$31.73,$14.28,$22.64,$0.00,$5.31,$0.00,$0.00,$5.55,$31.73,$0.00,$15.86,$25.13,$25.38,$0.00,$4.82,$0.00,$5.05,$0.00
206.028,SUP,HCPCS C1713,,206.028  -  SCREW BONE 2.5MM FULTHD 4MM 28MM SELF TAP HEXAGONAL SHAFT,$31.73,$0.00,$31.73,$14.28,$22.64,$0.00,$5.31,$0.00,$0.00,$5.55,$31.73,$0.00,$15.86,$25.13,$25.38,$0.00,$4.82,$0.00,$5.05,$0.00
206.03,SUP,HCPCS C1713,,206.030  -  SCREW BONE FULTHD HEXAGON 4MM 6MM 30MM SELF TAP SOCKET LCP,$31.73,$0.00,$31.73,$14.28,$22.64,$0.00,$5.31,$0.00,$0.00,$5.55,$31.73,$0.00,$15.86,$25.13,$25.38,$0.00,$4.82,$0.00,$5.05,$0.00
206.03,SUP,HCPCS C1713,,206.03  -  SCREW BONE 4MM 30MM LC DCP SS CANC PROX MDL TIBIAL FULTHD,$40.65,$0.00,$32.19,$14.28,$22.64,$0.00,$5.31,$0.00,$0.00,$5.55,$31.73,$0.00,$15.86,$32.19,$25.38,$0.00,$4.82,$0.00,$5.05,$0.00
206.032,SUP,HCPCS C1713,,206.032  -  SCREW BONE FULTHD 4MM 32MM LOCK SELF TAP LCP STAINLESS STEEL,$31.73,$0.00,$31.73,$14.28,$22.64,$0.00,$5.31,$0.00,$0.00,$5.55,$31.73,$0.00,$15.86,$25.13,$25.38,$0.00,$4.82,$0.00,$5.05,$0.00
206.035,SUP,HCPCS C1713,,206.035  -  SCREW BONE 2.5MM FULTHD 4MM 35MM SELF TAP HEXAGONAL SHAFT,$31.73,$0.00,$31.73,$14.28,$22.64,$0.00,$5.31,$0.00,$0.00,$5.55,$31.73,$0.00,$15.86,$25.13,$25.38,$0.00,$4.82,$0.00,$5.05,$0.00
206.036,SUP,HCPCS C1713,,206.036  -  SCREW BONE 2.5MM FULTHD 4MM 36MM SELF TAP HEXAGONAL SHAFT,$31.73,$0.00,$31.73,$14.28,$22.64,$0.00,$5.31,$0.00,$0.00,$5.55,$31.73,$0.00,$15.86,$25.13,$25.38,$0.00,$4.82,$0.00,$5.05,$0.00
206.04,SUP,HCPCS C1713,,206.040  -  SCREW BONE 2.5MM FULTHD 4MM 40MM LOCKING HEXAGONAL SOCKET,$31.73,$0.00,$39.53,$17.79,$28.21,$0.00,$6.81,$0.00,$0.00,$6.92,$39.53,$0.00,$19.76,$25.13,$31.62,$0.00,$6.19,$0.00,$6.29,$0.00
206.04,SUP,HCPCS C1713,,206.04  -  SCREW BONE 4MM 40MM LC DCP SS CANC PROX MDL TIBIAL FULTHD,$39.53,$0.00,$39.53,$17.79,$28.21,$0.00,$6.81,$0.00,$0.00,$6.92,$39.53,$0.00,$19.76,$31.31,$31.62,$0.00,$6.19,$0.00,$6.29,$0.00
206.045,SUP,HCPCS C1713,,206.045  -  SCREW BONE FULTHD 4MM 45MM LOCKING SLFTAP LCP STAINLESS,$31.73,$0.00,$31.73,$14.28,$22.64,$0.00,$5.31,$0.00,$0.00,$5.55,$31.73,$0.00,$15.86,$25.13,$25.38,$0.00,$4.82,$0.00,$5.05,$0.00
206.05,SUP,HCPCS C1713,,206.050  -  SCREW BONE FULTHD 4MM 6MM 50MM 15MM SMALL HEXOGONAL SOCKET,$31.73,$0.00,$31.73,$14.28,$22.64,$0.00,$5.31,$0.00,$0.00,$5.55,$31.73,$0.00,$15.86,$25.13,$25.38,$0.00,$4.82,$0.00,$5.05,$0.00
206.055,SUP,HCPCS C1713,,206.055  -  SCREW BONE PTHRD 4MM 6MM 55MM SMALL HEXAGONAL SOCKET LCP,$31.73,$0.00,$31.73,$14.28,$22.64,$0.00,$5.31,$0.00,$0.00,$5.55,$31.73,$0.00,$15.86,$25.13,$25.38,$0.00,$4.82,$0.00,$5.05,$0.00
206.06,SUP,HCPCS C1713,,206.060  -  SCREW BONE FULTHD 4MM 60MM 15MM LOCKING SLFTAP LCP STAINLESS,$31.73,$0.00,$31.73,$14.28,$22.64,$0.00,$7.96,$0.00,$0.00,$5.55,$31.73,$0.00,$15.86,$25.13,$25.38,$0.00,$7.23,$0.00,$5.05,$0.00
206.06,SUP,HCPCS C1713,,206.06  -  SCREW BONE 4MM 60MM LC DCP SS CANC PROX MDL TIBIAL FULTHD,$40.65,$0.00,$32.19,$14.28,$22.64,$0.00,$7.96,$0.00,$0.00,$5.55,$31.73,$0.00,$15.86,$32.19,$25.38,$0.00,$7.23,$0.00,$5.05,$0.00
206.065,SUP,HCPCS C1713,,206.065  -  SCREW BONE FULTHD 4MM 65MM LOCKING SLFTAP LCP STAINLESS,$34.80,$0.00,$34.80,$15.66,$24.84,$0.00,$5.82,$0.00,$0.00,$6.09,$34.80,$0.00,$17.40,$27.56,$27.84,$0.00,$5.29,$0.00,$5.54,$0.00
206.07,SUP,HCPCS C1713,,206.070  -  SCREW BONE FULTHD 4MM 70MM LOCKING SLFTAP LCP STAINLESS,$34.80,$0.00,$34.80,$15.66,$24.84,$0.00,$5.82,$0.00,$0.00,$6.09,$34.80,$0.00,$17.40,$27.56,$27.84,$0.00,$5.29,$0.00,$5.54,$0.00
206.08,SUP,HCPCS C1713,,206.080  -  SCREW BONE FULTHD 4MM 80MM LOCKING SLFTAP LCP STAINLESS,$34.80,$0.00,$34.80,$15.66,$24.84,$0.00,$5.82,$0.00,$0.00,$6.09,$34.80,$0.00,$17.40,$27.56,$27.84,$0.00,$5.29,$0.00,$5.54,$0.00
206.085,SUP,HCPCS C1713,,206.085  -  SCREW BONE FULTHD 4MM 85MM LOCKING SLFTAP LCP STAINLESS,$34.80,$0.00,$34.80,$15.66,$24.84,$0.00,$5.82,$0.00,$0.00,$6.09,$34.80,$0.00,$17.40,$27.56,$27.84,$0.00,$5.29,$0.00,$5.54,$0.00
206.09,SUP,HCPCS C1713,,206.090  -  SCREW BONE FULTHD 4MM 90MM LOCKING SLFTAP LCP STAINLESS,$34.80,$0.00,$34.80,$15.66,$24.84,$0.00,$5.82,$0.00,$0.00,$6.09,$34.80,$0.00,$17.40,$27.56,$27.84,$0.00,$5.29,$0.00,$5.54,$0.00
206.095,SUP,HCPCS C1713,,206.095  -  SCREW BONE FULTHD 4MM 95MM LOCKING SLFTAP LCP STAINLESS,$34.80,$0.00,$34.80,$15.66,$24.84,$0.00,$5.82,$0.00,$0.00,$6.09,$34.80,$0.00,$17.40,$27.56,$27.84,$0.00,$5.29,$0.00,$5.54,$0.00
206.1,SUP,HCPCS C1713,,206.100  -  SCREW BONE FULTHD 4MM 100MM LOCKING SLFTAP LCP STAINLESS,$34.80,$0.00,$34.80,$15.66,$24.84,$0.00,$5.82,$0.00,$0.00,$6.09,$34.80,$0.00,$17.40,$27.56,$27.84,$0.00,$5.29,$0.00,$5.54,$0.00
206.414,SUP,HCPCS C1713,,206.414  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 14MM SELF TAP,$47.78,$0.00,$47.78,$21.50,$34.10,$0.00,$7.99,$0.00,$0.00,$8.37,$47.78,$0.00,$23.89,$37.84,$38.22,$0.00,$7.26,$0.00,$7.61,$0.00
206.416,SUP,HCPCS C1713,,206.416  -  SCREW BONE 2.5MM SMALL FULTHD HEXAGON 4MM 6MM 16MM SELF TAP,$47.78,$0.00,$47.78,$21.50,$34.10,$0.00,$7.99,$0.00,$0.00,$8.37,$47.78,$0.00,$23.89,$37.84,$38.22,$0.00,$7.26,$0.00,$7.61,$0.00
206.418,SUP,HCPCS C1713,,206.418  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 18MM SELF TAP,$47.78,$0.00,$47.78,$21.50,$34.10,$0.00,$7.99,$0.00,$0.00,$8.37,$47.78,$0.00,$23.89,$37.84,$38.22,$0.00,$7.26,$0.00,$7.61,$0.00
206.42,SUP,HCPCS C1713,,206.420  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 20MM SELF TAP,$47.78,$0.00,$47.78,$21.50,$34.10,$0.00,$7.99,$0.00,$0.00,$8.37,$47.78,$0.00,$23.89,$37.84,$38.22,$0.00,$7.26,$0.00,$7.61,$0.00
206.422,SUP,HCPCS C1713,,206.422  -  SCREW BONE 2.5MM SMALL FULTHD HEXAGON 4MM 6MM 22MM SELF TAP,$47.78,$0.00,$47.78,$21.50,$34.10,$0.00,$7.99,$0.00,$0.00,$8.37,$47.78,$0.00,$23.89,$37.84,$38.22,$0.00,$7.26,$0.00,$7.61,$0.00
206.424,SUP,HCPCS C1713,,206.424  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 24MM SELF TAP,$47.78,$0.00,$47.78,$21.50,$34.10,$0.00,$7.99,$0.00,$0.00,$8.37,$47.78,$0.00,$23.89,$37.84,$38.22,$0.00,$7.26,$0.00,$7.61,$0.00
206.426,SUP,HCPCS C1713,,206.426  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 26MM SELF TAP,$47.78,$0.00,$47.78,$21.50,$34.10,$0.00,$7.99,$0.00,$0.00,$8.37,$47.78,$0.00,$23.89,$37.84,$38.22,$0.00,$7.26,$0.00,$7.61,$0.00
206.428,SUP,HCPCS C1713,,206.428  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 28MM SELF TAP,$47.78,$0.00,$47.78,$21.50,$34.10,$0.00,$7.99,$0.00,$0.00,$8.37,$47.78,$0.00,$23.89,$37.84,$38.22,$0.00,$7.26,$0.00,$7.61,$0.00
206.43,SUP,HCPCS C1713,,206.430  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 30MM SELF TAP,$47.78,$0.00,$47.78,$21.50,$34.10,$0.00,$7.99,$0.00,$0.00,$8.37,$47.78,$0.00,$23.89,$37.84,$38.22,$0.00,$7.26,$0.00,$7.61,$0.00
206.432,SUP,HCPCS C1713,,206.432  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 32MM SELF TAP,$47.78,$0.00,$47.78,$21.50,$34.10,$0.00,$7.99,$0.00,$0.00,$8.37,$47.78,$0.00,$23.89,$37.84,$38.22,$0.00,$7.26,$0.00,$7.61,$0.00
206.434,SUP,HCPCS C1713,,206.434  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 34MM SELF TAP,$47.78,$0.00,$47.78,$21.50,$34.10,$0.00,$7.99,$0.00,$0.00,$8.37,$47.78,$0.00,$23.89,$37.84,$38.22,$0.00,$7.26,$0.00,$7.61,$0.00
206.436,SUP,HCPCS C1713,,206.436  -  SCREW BONE 2.5MM SMALL FULTHD HEXAGON 4MM 6MM 36MM SELF TAP,$47.78,$0.00,$47.78,$21.50,$34.10,$0.00,$7.99,$0.00,$0.00,$8.37,$47.78,$0.00,$23.89,$37.84,$38.22,$0.00,$7.26,$0.00,$7.61,$0.00
206.438,SUP,HCPCS C1713,,206.438  -  SCREW BONE FULTHD 4MM 6MM 38MM SLFTAP HEXAGON RECESS LCP,$47.78,$0.00,$47.78,$21.50,$34.10,$0.00,$7.99,$0.00,$0.00,$8.37,$47.78,$0.00,$23.89,$37.84,$38.22,$0.00,$7.26,$0.00,$7.61,$0.00
206.44,SUP,HCPCS C1713,,206.440  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 40MM SELF TAP,$47.78,$0.00,$47.78,$21.50,$34.10,$0.00,$7.99,$0.00,$0.00,$8.37,$47.78,$0.00,$23.89,$37.84,$38.22,$0.00,$7.26,$0.00,$7.61,$0.00
206.442,SUP,HCPCS C1713,,206.442  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 42MM SELF TAP,$47.78,$0.00,$47.78,$21.50,$34.10,$0.00,$7.99,$0.00,$0.00,$8.37,$47.78,$0.00,$23.89,$37.84,$38.22,$0.00,$7.26,$0.00,$7.61,$0.00
206.444,SUP,HCPCS C1713,,206.444  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 44MM SELF TAP,$47.78,$0.00,$47.78,$21.50,$34.10,$0.00,$11.27,$0.00,$0.00,$8.37,$47.78,$0.00,$23.89,$37.84,$38.22,$0.00,$10.24,$0.00,$7.61,$0.00
206.446,SUP,HCPCS C1713,,206.446  -  SCREW BONE 2.5MM FULTHD 4MM 6MM 46MM SELF TAP SMALL,$47.78,$0.00,$47.78,$21.50,$34.10,$0.00,$7.99,$0.00,$0.00,$8.37,$47.78,$0.00,$23.89,$37.84,$38.22,$0.00,$7.26,$0.00,$7.61,$0.00
206.448,SUP,HCPCS C1713,,206.448  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 48MM SELF TAP,$47.78,$0.00,$47.78,$21.50,$34.10,$0.00,$7.99,$0.00,$0.00,$8.37,$47.78,$0.00,$23.89,$37.84,$38.22,$0.00,$7.26,$0.00,$7.61,$0.00
206.45,SUP,HCPCS C1713,,206.450  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 50MM SELF TAP,$47.78,$0.00,$47.78,$21.50,$34.10,$0.00,$7.99,$0.00,$0.00,$8.37,$47.78,$0.00,$23.89,$37.84,$38.22,$0.00,$7.26,$0.00,$7.61,$0.00
206.452,SUP,HCPCS C1713,,206.452  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 52MM SELF TAP,$47.78,$0.00,$47.78,$21.50,$34.10,$0.00,$7.99,$0.00,$0.00,$8.37,$47.78,$0.00,$23.89,$37.84,$38.22,$0.00,$7.26,$0.00,$7.61,$0.00
206.454,SUP,HCPCS C1713,,206.454  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 54MM SELF TAP,$47.78,$0.00,$47.78,$21.50,$34.10,$0.00,$7.99,$0.00,$0.00,$8.37,$47.78,$0.00,$23.89,$37.84,$38.22,$0.00,$7.26,$0.00,$7.61,$0.00
206.456,SUP,HCPCS C1713,,206.456  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 56MM SELF TAP,$47.78,$0.00,$47.78,$21.50,$34.10,$0.00,$7.99,$0.00,$0.00,$8.37,$47.78,$0.00,$23.89,$37.84,$38.22,$0.00,$7.26,$0.00,$7.61,$0.00
206.458,SUP,HCPCS C1713,,206.458  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 58MM SELF TAP,$47.78,$0.00,$47.78,$21.50,$34.10,$0.00,$7.99,$0.00,$0.00,$8.37,$47.78,$0.00,$23.89,$37.84,$38.22,$0.00,$7.26,$0.00,$7.61,$0.00
206.46,SUP,HCPCS C1713,,206.460  -  SCREW BONE FULTHD 4MM 6MM 60MM SLFTAP HEXAGON RECESS LCP,$47.78,$0.00,$47.78,$21.50,$34.10,$0.00,$7.99,$0.00,$0.00,$8.37,$47.78,$0.00,$23.89,$37.84,$38.22,$0.00,$7.26,$0.00,$7.61,$0.00
206.465,SUP,HCPCS C1713,,206.465  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 65MM SELF TAP,$47.78,$0.00,$47.78,$21.50,$34.10,$0.00,$7.99,$0.00,$0.00,$8.37,$47.78,$0.00,$23.89,$37.84,$38.22,$0.00,$7.26,$0.00,$7.61,$0.00
206.47,SUP,HCPCS C1713,,206.470  -  SCREW BONE FULTHD 4MM 6MM 70MM SELF TAP SMALL HEXAGONAL,$47.78,$0.00,$47.78,$21.50,$34.10,$0.00,$7.99,$0.00,$0.00,$8.37,$47.78,$0.00,$23.89,$37.84,$38.22,$0.00,$7.26,$0.00,$7.61,$0.00
206.475,SUP,HCPCS C1713,,206.475  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 75MM SELF TAP,$85.28,$0.00,$85.28,$38.37,$60.86,$0.00,$14.27,$0.00,$0.00,$14.93,$85.28,$0.00,$42.64,$67.54,$68.22,$0.00,$12.96,$0.00,$13.58,$0.00
206.48,SUP,HCPCS C1713,,206.480  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 80MM SELF TAP,$85.28,$0.00,$85.28,$38.37,$60.86,$0.00,$14.27,$0.00,$0.00,$14.93,$85.28,$0.00,$42.64,$67.54,$68.22,$0.00,$12.96,$0.00,$13.58,$0.00
206.485,SUP,HCPCS C1713,,206.485  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 85MM SELF TAP,$85.28,$0.00,$85.28,$38.37,$60.86,$0.00,$14.27,$0.00,$0.00,$14.93,$85.28,$0.00,$42.64,$67.54,$68.22,$0.00,$12.96,$0.00,$13.58,$0.00
206.49,SUP,HCPCS C1713,,206.490  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 90MM SELF TAP,$85.28,$0.00,$85.28,$38.37,$60.86,$0.00,$14.27,$0.00,$0.00,$14.93,$85.28,$0.00,$42.64,$67.54,$68.22,$0.00,$12.96,$0.00,$13.58,$0.00
206.495,SUP,HCPCS C1713,,206.495  -  SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 95MM SELF TAP,$85.28,$0.00,$85.28,$38.37,$60.86,$0.00,$14.27,$0.00,$0.00,$14.93,$85.28,$0.00,$42.64,$67.54,$68.22,$0.00,$12.96,$0.00,$13.58,$0.00
206.5,SUP,HCPCS C1713,,206.500  -  SCREW BONE 4MM 100MM SLFTAP STAINLESS STEEL CORTICAL NONSTRL,$85.28,$0.00,$85.28,$38.37,$60.86,$0.00,$14.27,$0.00,$0.00,$14.93,$85.28,$0.00,$42.64,$67.54,$68.22,$0.00,$12.96,$0.00,$13.58,$0.00
207.01,SUP,HCPCS C1713,,207.010  -  SCREW BONE PTHRD 4MM 2.5MM 10MM 7MM SMALL HEXAGONAL SOCKET,$30.03,$0.00,$30.03,$13.51,$21.43,$0.00,$5.02,$0.00,$0.00,$5.26,$30.03,$0.00,$15.01,$23.78,$24.02,$0.00,$4.56,$0.00,$4.78,$0.00
207.012,SUP,HCPCS C1713,,207.012  -  SCREW BONE PTHRD 4MM 2.5MM 12MM 7MM SMALL HEXAGONAL SOCKET,$30.03,$0.00,$30.03,$13.51,$21.43,$0.00,$7.96,$0.00,$0.00,$5.26,$30.03,$0.00,$15.01,$23.78,$24.02,$0.00,$7.23,$0.00,$4.78,$0.00
207.014,SUP,HCPCS C1713,,207.014  -  SCREW BONE PTHRD 4MM 14MM 5MM SMALL HEXAGONAL SOCKET LCP,$30.03,$0.00,$30.03,$13.51,$21.43,$0.00,$5.02,$0.00,$0.00,$5.26,$30.03,$0.00,$15.01,$23.78,$24.02,$0.00,$4.56,$0.00,$4.78,$0.00
207.016,SUP,HCPCS C1713,,207.016  -  SCREW BONE PTHRD 4MM 16MM 6MM SMALL HEXAGONAL SOCKET LCP,$30.03,$0.00,$30.03,$13.51,$21.43,$0.00,$5.02,$0.00,$0.00,$5.26,$30.03,$0.00,$15.01,$23.78,$24.02,$0.00,$4.56,$0.00,$4.78,$0.00
207.018,SUP,HCPCS C1713,,207.018  -  SCREW BONE PTHRD 4MM 2.5MM 18MM 7MM SMALL HEXAGONAL SOCKET,$30.03,$0.00,$30.03,$13.51,$21.43,$0.00,$5.02,$0.00,$0.00,$5.26,$30.03,$0.00,$15.01,$23.78,$24.02,$0.00,$4.56,$0.00,$4.78,$0.00
207.02,SUP,HCPCS C1713,,207.020  -  SCREW BONE PTHRD 4MM 20MM LCP STAINLESS STEEL CANCELLOUS RAD,$30.03,$0.00,$30.03,$13.51,$21.43,$0.00,$5.02,$0.00,$0.00,$5.26,$30.03,$0.00,$15.01,$23.78,$24.02,$0.00,$4.56,$0.00,$4.78,$0.00
207.02,SUP,HCPCS C1713,,207.02  -  SCREW BONE 4MM 20MM LC DCP SS CANC PROX MDL TIBIAL P/T NSTRL,$40.65,$0.00,$32.19,$13.51,$21.43,$0.00,$5.02,$0.00,$0.00,$5.26,$30.03,$0.00,$15.01,$32.19,$24.02,$0.00,$4.56,$0.00,$4.78,$0.00
207.022,SUP,HCPCS C1713,,207.022  -  SCREW BONE PTHRD 4MM 22MM 9MM SMALL HEXAGONAL SOCKET LCP,$30.03,$0.00,$30.03,$13.51,$21.43,$0.00,$5.02,$0.00,$0.00,$5.26,$30.03,$0.00,$15.01,$23.78,$24.02,$0.00,$4.56,$0.00,$4.78,$0.00
207.024,SUP,HCPCS C1713,,207.024  -  SCREW BONE PTHRD 4MM 24MM 10MM SMALL HEXAGONAL SOCKET LCP,$30.03,$0.00,$30.03,$13.51,$21.43,$0.00,$5.02,$0.00,$0.00,$5.26,$30.03,$0.00,$15.01,$23.78,$24.02,$0.00,$4.56,$0.00,$4.78,$0.00
207.026,SUP,HCPCS C1713,,207.026  -  SCREW BONE PTHRD 4MM 26MM 12MM SMALL HEXAGONAL SOCKET LCP,$30.03,$0.00,$30.03,$13.51,$21.43,$0.00,$5.02,$0.00,$0.00,$5.26,$30.03,$0.00,$15.01,$23.78,$24.02,$0.00,$4.56,$0.00,$4.78,$0.00
207.028,SUP,HCPCS C1713,,207.028  -  SCREW BONE PTHRD 4MM 28MM 14MM SMALL HEXAGONAL SOCKET LCP,$30.03,$0.00,$30.03,$13.51,$21.43,$0.00,$5.02,$0.00,$0.00,$5.26,$30.03,$0.00,$15.01,$23.78,$24.02,$0.00,$4.56,$0.00,$4.78,$0.00
207.03,SUP,HCPCS C1713,,207.030  -  SCREW BONE PTHRD 4MM 30MM 6MM SMALL HEXAGONAL SOCKET LCP,$30.03,$0.00,$30.03,$13.51,$21.43,$0.00,$5.02,$0.00,$0.00,$5.26,$30.03,$0.00,$15.01,$23.78,$24.02,$0.00,$4.56,$0.00,$4.78,$0.00
207.035,SUP,HCPCS C1713,,207.035  -  SCREW BONE PTHRD 4MM 35MM LCP STAINLESS STEEL CANCELLOUS RAD,$30.03,$0.00,$30.03,$13.51,$21.43,$0.00,$5.02,$0.00,$0.00,$5.26,$30.03,$0.00,$15.01,$23.78,$24.02,$0.00,$4.56,$0.00,$4.78,$0.00
207.04,SUP,HCPCS C1713,,207.040  -  SCREW BONE PTHRD 4MM 40MM 14MM SMALL HEXAGONAL SOCKET LCP,$30.03,$0.00,$30.03,$13.51,$21.43,$0.00,$5.02,$0.00,$0.00,$5.26,$30.03,$0.00,$15.01,$23.78,$24.02,$0.00,$4.56,$0.00,$4.78,$0.00
207.045,SUP,HCPCS C1713,,207.045  -  SCREW BONE PTHRD 4MM 45MM SELF TAP HEXAGONAL SHAFT LC-DCP,$30.03,$0.00,$30.03,$13.51,$21.43,$0.00,$5.02,$0.00,$0.00,$5.26,$30.03,$0.00,$15.01,$23.78,$24.02,$0.00,$4.56,$0.00,$4.78,$0.00
207.05,SUP,HCPCS C1713,,207.050  -  SCREW BONE 4MM 50MM LCP SS PTHRD CANC TIB NONSTRL SM FRAG,$30.03,$0.00,$30.03,$13.51,$21.43,$0.00,$5.02,$0.00,$0.00,$5.26,$30.03,$0.00,$15.01,$23.78,$24.02,$0.00,$4.56,$0.00,$4.78,$0.00
207.055,SUP,HCPCS C1713,,207.055  -  SCREW BONE SMALL HEXAGON 4MM 6MM 55MM 15MM SOCKET LCP,$30.03,$0.00,$30.03,$13.51,$21.43,$0.00,$5.02,$0.00,$0.00,$5.26,$30.03,$0.00,$15.01,$23.78,$24.02,$0.00,$4.56,$0.00,$4.78,$0.00
207.06,SUP,HCPCS C1713,,207.060  -  SCREW BONE SMALL HEXAGON 4MM 6MM 60MM 15MM SOCKET LCP,$30.03,$0.00,$30.03,$13.51,$21.43,$0.00,$5.02,$0.00,$0.00,$5.26,$30.03,$0.00,$15.01,$23.78,$24.02,$0.00,$4.56,$0.00,$4.78,$0.00
207.065,SUP,HCPCS C1713,,207.065  -  SCREW BONE PTHRD 4MM 65MM PTHRD LCP STAINLESS STEEL,$34.13,$0.00,$34.13,$15.36,$24.36,$0.00,$5.71,$0.00,$0.00,$5.98,$34.13,$0.00,$17.06,$27.03,$27.30,$0.00,$5.18,$0.00,$5.43,$0.00
207.07,SUP,HCPCS C1713,,207.070  -  SCREW BONE PTHRD 4MM 70MM PTTHRD LCP STAINLESS STEEL,$34.13,$0.00,$34.13,$15.36,$24.36,$0.00,$5.71,$0.00,$0.00,$5.98,$34.13,$0.00,$17.06,$27.03,$27.30,$0.00,$5.18,$0.00,$5.43,$0.00
207.075,SUP,HCPCS C1713,,207.075  -  SCREW BONE PTHRD 4MM 75MM PTHRD LCP STAINLESS STEEL,$34.13,$0.00,$34.13,$15.36,$24.36,$0.00,$5.71,$0.00,$0.00,$5.98,$34.13,$0.00,$17.06,$27.03,$27.30,$0.00,$5.18,$0.00,$5.43,$0.00
207.08,SUP,HCPCS C1713,,207.080  -  SCREW BONE PTHRD 4MM 80MM PTTHRD LCP STAINLESS STEEL,$34.13,$0.00,$34.13,$15.36,$24.36,$0.00,$5.71,$0.00,$0.00,$5.98,$34.13,$0.00,$17.06,$27.03,$27.30,$0.00,$5.18,$0.00,$5.43,$0.00
207.085,SUP,HCPCS C1713,,207.085  -  SCREW BONE 4MM 85MM PTHRD LC-DCP DCP STAINLESS STEEL,$34.13,$0.00,$34.13,$15.36,$24.36,$0.00,$5.71,$0.00,$0.00,$5.98,$34.13,$0.00,$17.06,$27.03,$27.30,$0.00,$5.18,$0.00,$5.43,$0.00
207.09,SUP,HCPCS C1713,,207.090  -  SCREW BONE PTHRD 4MM 90MM PTTHRD LCP STAINLESS STEEL,$34.13,$0.00,$34.13,$15.36,$24.36,$0.00,$5.71,$0.00,$0.00,$5.98,$34.13,$0.00,$17.06,$27.03,$27.30,$0.00,$5.18,$0.00,$5.43,$0.00
207.095,SUP,HCPCS C1713,,207.095  -  SCREW BONE PTHRD 4MM 95MM PTHRD LCP STAINLESS STEEL,$34.13,$0.00,$34.13,$15.36,$24.36,$0.00,$5.71,$0.00,$0.00,$5.98,$34.13,$0.00,$17.06,$27.03,$27.30,$0.00,$5.18,$0.00,$5.43,$0.00
207.1,SUP,HCPCS C1713,,207.100  -  SCREW BONE 4MM 100MM PTTHRD LC-DCP DCP STAINLESS STEEL,$34.13,$0.00,$34.13,$15.36,$24.36,$0.00,$5.71,$0.00,$0.00,$5.98,$34.13,$0.00,$17.06,$27.03,$27.30,$0.00,$5.18,$0.00,$5.43,$0.00
207.61,SUP,HCPCS C1713,,207.610  -  SCREW BONE SHORT THREAD 4MM 10MM CANN LCP STAINLESS STEEL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$81.45,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$73.99,$0.00,$56.93,$0.00
207.612,SUP,HCPCS C1713,,207.612  -  SCREW BONE SHORT THREAD 4MM 12MM CANN LCP STAINLESS STEEL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$81.45,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$73.99,$0.00,$56.93,$0.00
207.614,SUP,HCPCS C1713,,207.614  -  SCREW BONE SHORT THREAD 4MM 14MM CANN LCP STAINLESS STEEL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$81.45,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$73.99,$0.00,$56.93,$0.00
207.616,SUP,HCPCS C1713,,207.616  -  SCREW BONE SHORT THREAD 4MM 16MM 1/3MM CANN LCP STAINLESS,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
207.618,SUP,HCPCS C1713,,207.618  -  SCREW BONE SHORT THREAD 4MM 18MM CANN LCP STAINLESS STEEL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
207.622,SUP,HCPCS C1713,,207.622  -  SCREW BONE SHORT THREAD 4MM 22MM CANN LCP STAINLESS STEEL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
207.624,SUP,HCPCS C1713,,207.624  -  SCREW BONE SHORT THREAD 4MM 24MM CANN LCP STAINLESS STEEL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
207.626,SUP,HCPCS C1713,,207.626  -  SCREW BONE SHORT THREAD 4MM 26MM CANN LCP STAINLESS STEEL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
207.628,SUP,HCPCS C1713,,207.628  -  SCREW BONE SHORT THREAD 4MM 28MM CANN LCP STAINLESS STEEL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
207.63,SUP,HCPCS C1713,,207.630  -  SCREW BONE SHORT THREAD 4MM 30MM CANN LCP STAINLESS STEEL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
207.63,SUP,HCPCS C1713,,207.63  -  SCREW BONE 4MM 30MM LCP SS ST ORTH CANN NSTRL SM FRAG SET,$434.78,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$344.35,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
207.632,SUP,HCPCS C1713,,207.632  -  SCREW BONE SHORT THREAD 4MM 32MM CANN LCP STAINLESS STEEL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
207.634,SUP,HCPCS C1713,,207.634  -  SCREW BONE SHORT THREAD 4MM 34MM 11MM CANN LCP STAINLESS,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
207.636,SUP,HCPCS C1713,,207.636  -  SCREW BONE SHORT THREAD 4MM 36MM CANN LCP STAINLESS STEEL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
207.638,SUP,HCPCS C1713,,207.638  -  SCREW BONE SHORT THREAD 4MM 38MM CANN LCP STAINLESS STEEL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
207.64,SUP,HCPCS C1713,,207.640  -  SCREW BONE SHORT THREAD 4MM 40MM CANN LCP STAINLESS STEEL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
207.64,SUP,HCPCS C1713,,207.64  -  SCREW BONE 4MM 40MM LCP SS ST ORTH CANN NSTRL SM FRAG SET,$415.98,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$329.46,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
207.642,SUP,HCPCS C1713,,207.642  -  SCREW BONE SHORT THREAD 4MM 42MM CANN SHORT THREAD LCP,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
207.644,SUP,HCPCS C1713,,207.644  -  SCREW BONE SHORT THREAD 4MM 44MM 1/3MM CANN LCP STAINLESS,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
207.646,SUP,HCPCS C1713,,207.646  -  SCREW BONE SHORT THREAD 4MM 46MM CANN LCP STAINLESS STEEL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
207.648,SUP,HCPCS C1713,,207.648  -  SCREW BONE SHORT THREAD 4MM 48MM CANN LCP STAINLESS STEEL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
207.65,SUP,HCPCS C1713,,207.650  -  SCREW BONE SHORT THREAD HEXAGON LP 4MM 5MM 50MM SELF DRILL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
207.65,SUP,HCPCS C1713,,207.65  -  SCREW BONE 4MM 50MM LCP SS ST ORTH CANN NSTRL SM FRAG SET,$415.98,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$329.46,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
207.652,SUP,HCPCS C1713,,207.652  -  SCREW BONE 2.5MM SHORT THREAD SMALL HEXAGON 4MM 5MM 1.35MM,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
207.654,SUP,HCPCS C1713,,207.654  -  SCREW BONE 2.5MM SHORT THREAD SMALL HEXAGON 4MM 5MM 1.35MM,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
207.656,SUP,HCPCS C1713,,207.656  -  SCREW BONE 2.5MM SHORT THREAD SMALL HEXAGON 4MM 5MM 1.35MM,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
207.658,SUP,HCPCS C1713,,207.658  -  SCREW BONE 2.5MM SHORT THREAD SMALL HEXAGON 4MM 5MM 1.35MM,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
207.66,SUP,HCPCS C1713,,207.660  -  SCREW BONE 2.5MM SHORT THREAD SMALL HEXAGON 4MM 5MM 1.35MM,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
207.664,SUP,HCPCS C1713,,207.664  -  SCREW BONE 2.5MM SHORT THREAD SMALL HEXAGON 4MM 5MM 1.35MM,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
207.668,SUP,HCPCS C1713,,207.668  -  SCREW BONE 2.5MM SHORT THREAD SMALL HEXAGON 4MM 5MM 1.35MM,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
207.672,SUP,HCPCS C1713,,207.672  -  SCREW BONE 2.5MM SHORT THREAD SMALL HEXAGON 4MM 5MM 1.35MM,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
207.716,SUP,HCPCS C1713,,207.716  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
207.718,SUP,HCPCS C1713,,207.718  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
207.72,SUP,HCPCS C1713,,207.720  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
207.722,SUP,HCPCS C1713,,207.722  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
207.724,SUP,HCPCS C1713,,207.724  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
207.726,SUP,HCPCS C1713,,207.726  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
207.728,SUP,HCPCS C1713,,207.728  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$81.45,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$73.99,$0.00,$56.93,$0.00
207.73,SUP,HCPCS C1713,,207.730  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
207.732,SUP,HCPCS C1713,,207.732  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
207.734,SUP,HCPCS C1713,,207.734  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
207.736,SUP,HCPCS C1713,,207.736  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
207.738,SUP,HCPCS C1713,,207.738  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
207.74,SUP,HCPCS C1713,,207.740  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
207.74,SUP,HCPCS C1713,,207.74  -  SCREW BONE 4MM 40MM SS L/T ORTH CANN NSTRL,$434.78,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$344.35,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
207.742,SUP,HCPCS C1713,,207.742  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
207.744,SUP,HCPCS C1713,,207.744  -  SCREW BONE LNGTHRD 4MM 5MM 44MM CANN SLFDRILL SLFTAP SMALL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
207.746,SUP,HCPCS C1713,,207.746  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
207.748,SUP,HCPCS C1713,,207.748  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
207.75,SUP,HCPCS C1713,,207.750  -  SCREW BONE LNGTHRD 4MM 5MM 50MM CANN SLFDRILL SLFTAP SMALL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
207.75,SUP,HCPCS C1713,,207.75  -  SCREW BONE 4MM 50MM SS L/T ORTH CANN NSTRL,$415.98,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$329.46,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
207.752,SUP,HCPCS C1713,,207.752  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
207.754,SUP,HCPCS C1713,,207.754  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
207.756,SUP,HCPCS C1713,,207.756  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
207.758,SUP,HCPCS C1713,,207.758  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
207.76,SUP,HCPCS C1713,,207.760  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
207.764,SUP,HCPCS C1713,,207.764  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
207.768,SUP,HCPCS C1713,,207.768  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
207.772,SUP,HCPCS C1713,,207.772  -  SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
207.916,SUP,HCPCS C1713,,207.916  -  SCREW BONE 5MM 4MM 6MM 16MM 8MM DCP LC-DCP STAINLESS STEEL,$35.48,$0.00,$35.48,$15.96,$25.32,$0.00,$5.94,$0.00,$0.00,$6.21,$35.48,$0.00,$17.74,$28.10,$28.38,$0.00,$5.39,$0.00,$5.65,$0.00
207.918,SUP,HCPCS C1713,,207.918  -  SCREW BONE 5MM 4MM 6MM 18MM 8MM DCP LC-DCP STAINLESS STEEL,$35.48,$0.00,$35.48,$15.96,$25.32,$0.00,$5.94,$0.00,$0.00,$6.21,$35.48,$0.00,$17.74,$28.10,$28.38,$0.00,$5.39,$0.00,$5.65,$0.00
207.92,SUP,HCPCS C1713,,207.920  -  SCREW BONE 5MM 4MM 6MM 20MM 10MM DCP LC-DCP STAINLESS STEEL,$35.48,$0.00,$35.48,$15.96,$25.32,$0.00,$5.94,$0.00,$0.00,$6.21,$35.48,$0.00,$17.74,$28.10,$28.38,$0.00,$5.39,$0.00,$5.65,$0.00
207.922,SUP,HCPCS C1713,,207.922  -  SCREW BONE 5MM 4MM 6MM 22MM 10MM DCP LC-DCP STAINLESS STEEL,$35.48,$0.00,$35.48,$15.96,$25.32,$0.00,$5.94,$0.00,$0.00,$6.21,$35.48,$0.00,$17.74,$28.10,$28.38,$0.00,$5.39,$0.00,$5.65,$0.00
207.924,SUP,HCPCS C1713,,207.924  -  SCREW BONE 5MM 4MM 6MM 24MM 10MM DCP LC-DCP STAINLESS STEEL,$35.48,$0.00,$35.48,$15.96,$25.32,$0.00,$5.94,$0.00,$0.00,$6.21,$35.48,$0.00,$17.74,$28.10,$28.38,$0.00,$5.39,$0.00,$5.65,$0.00
207.926,SUP,HCPCS C1713,,207.926  -  SCREW BONE 5MM 4MM 6MM 26MM 12MM DCP LC-DCP STAINLESS STEEL,$35.48,$0.00,$35.48,$15.96,$25.32,$0.00,$5.94,$0.00,$0.00,$6.21,$35.48,$0.00,$17.74,$28.10,$28.38,$0.00,$5.39,$0.00,$5.65,$0.00
207.928,SUP,HCPCS C1713,,207.928  -  SCREW BONE 5MM 4MM 6MM 28MM 12MM DCP LC-DCP STAINLESS STEEL,$35.48,$0.00,$35.48,$15.96,$25.32,$0.00,$5.94,$0.00,$0.00,$6.21,$35.48,$0.00,$17.74,$28.10,$28.38,$0.00,$5.39,$0.00,$5.65,$0.00
207.93,SUP,HCPCS C1713,,207.930  -  SCREW BONE 5MM 4MM 6MM 30MM 12MM DCP LC-DCP STAINLESS STEEL,$35.48,$0.00,$35.48,$15.96,$25.32,$0.00,$5.94,$0.00,$0.00,$6.21,$35.48,$0.00,$17.74,$28.10,$28.38,$0.00,$5.39,$0.00,$5.65,$0.00
207.932,SUP,HCPCS C1713,,207.932  -  SCREW BONE 5MM 4MM 6MM 32MM 14MM DCP LC-DCP STAINLESS STEEL,$35.48,$0.00,$35.48,$15.96,$25.32,$0.00,$5.94,$0.00,$0.00,$6.21,$35.48,$0.00,$17.74,$28.10,$28.38,$0.00,$5.39,$0.00,$5.65,$0.00
207.934,SUP,HCPCS C1713,,207.934  -  SCREW BONE 5MM 4MM 6MM 34MM 14MM DCP LC-DCP STAINLESS STEEL,$35.48,$0.00,$35.48,$15.96,$25.32,$0.00,$5.94,$0.00,$0.00,$6.21,$35.48,$0.00,$17.74,$28.10,$28.38,$0.00,$5.39,$0.00,$5.65,$0.00
207.936,SUP,HCPCS C1713,,207.936  -  SCREW BONE 5MM 4MM 6MM 36MM 14MM DCP LC-DCP STAINLESS STEEL,$35.48,$0.00,$35.48,$15.96,$25.32,$0.00,$5.94,$0.00,$0.00,$6.21,$35.48,$0.00,$17.74,$28.10,$28.38,$0.00,$5.39,$0.00,$5.65,$0.00
207.938,SUP,HCPCS C1713,,207.938  -  SCREW BONE 5MM HEAD 4MM 38MM PTHRD LC-DCP DCP STAINLESS,$35.48,$0.00,$35.48,$15.96,$25.32,$0.00,$5.94,$0.00,$0.00,$6.21,$35.48,$0.00,$17.74,$28.10,$28.38,$0.00,$5.39,$0.00,$5.65,$0.00
207.94,SUP,HCPCS C1713,,207.940  -  SCREW BONE 5MM HEAD 4MM 40MM PTHRD LC-DCP STAINLESS STEEL,$35.48,$0.00,$35.48,$15.96,$25.32,$0.00,$5.94,$0.00,$0.00,$6.21,$35.48,$0.00,$17.74,$28.10,$28.38,$0.00,$5.39,$0.00,$5.65,$0.00
207.942,SUP,HCPCS C1713,,207.942  -  SCREW BONE 5MM HEAD 4MM 42MM PTHRD LC-DCP DCP STAINLESS,$35.48,$0.00,$35.48,$15.96,$25.32,$0.00,$5.94,$0.00,$0.00,$6.21,$35.48,$0.00,$17.74,$28.10,$28.38,$0.00,$5.39,$0.00,$5.65,$0.00
207.944,SUP,HCPCS C1713,,207.944  -  SCREW BONE 5MM HEAD 4MM 44MM PTHRD LC-DCP DCP STAINLESS,$35.48,$0.00,$35.48,$15.96,$25.32,$0.00,$5.94,$0.00,$0.00,$6.21,$35.48,$0.00,$17.74,$28.10,$28.38,$0.00,$5.39,$0.00,$5.65,$0.00
207.946,SUP,HCPCS C1713,,207.946  -  SCREW BONE 5MM HEAD 4MM 46MM PTHRD LC-DCP STAINLESS STEEL,$35.48,$0.00,$35.48,$15.96,$25.32,$0.00,$5.94,$0.00,$0.00,$6.21,$35.48,$0.00,$17.74,$28.10,$28.38,$0.00,$5.39,$0.00,$5.65,$0.00
207.948,SUP,HCPCS C1713,,207.948  -  SCREW BONE 5MM HEAD 4MM 48MM PTHRD LC-DCP DCP STAINLESS,$35.48,$0.00,$35.48,$15.96,$25.32,$0.00,$5.94,$0.00,$0.00,$6.21,$35.48,$0.00,$17.74,$28.10,$28.38,$0.00,$5.39,$0.00,$5.65,$0.00
207.95,SUP,HCPCS C1713,,207.950  -  SCREW BONE 5MM HEAD 4MM 50MM PTHRD LC-DCP STAINLESS STEEL,$35.48,$0.00,$35.48,$15.96,$25.32,$0.00,$5.94,$0.00,$0.00,$6.21,$35.48,$0.00,$17.74,$28.10,$28.38,$0.00,$5.39,$0.00,$5.65,$0.00
207.952,SUP,HCPCS C1713,,207.952  -  SCREW BONE 5MM HEAD 4MM 52MM PTHRD LC-DCP DCP STAINLESS,$35.48,$0.00,$35.48,$15.96,$25.32,$0.00,$5.94,$0.00,$0.00,$6.21,$35.48,$0.00,$17.74,$28.10,$28.38,$0.00,$5.39,$0.00,$5.65,$0.00
208.03,SUP,HCPCS C1713,,208.030  -  SCREW BONE 7MM 8MM 30MM 16MM CANN THREADED LARGE HEXOGONAL,$481.75,$0.00,$481.75,$216.79,$343.82,$0.00,$80.59,$0.00,$0.00,$84.35,$481.75,$0.00,$240.88,$381.55,$385.40,$0.00,$73.20,$0.00,$76.69,$0.00
208.035,SUP,HCPCS C1713,,208.035  -  SCREW BONE 7MM 8MM 35MM 16MM CANN THREADED LARGE HEXOGONAL,$481.75,$0.00,$481.75,$216.79,$343.82,$0.00,$80.59,$0.00,$0.00,$84.35,$481.75,$0.00,$240.88,$381.55,$385.40,$0.00,$73.20,$0.00,$76.69,$0.00
208.04,SUP,HCPCS C1713,,208.040  -  SCREW BONE 7MM 8MM 40MM 16MM CANN THREADED LARGE HEXOGONAL,$481.75,$0.00,$481.75,$216.79,$343.82,$0.00,$80.59,$0.00,$0.00,$84.35,$481.75,$0.00,$240.88,$381.55,$385.40,$0.00,$73.20,$0.00,$76.69,$0.00
208.045,SUP,HCPCS C1713,,208.045  -  SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7MM 8,$481.75,$0.00,$481.75,$216.79,$343.82,$0.00,$80.59,$0.00,$0.00,$84.35,$481.75,$0.00,$240.88,$381.55,$385.40,$0.00,$73.20,$0.00,$76.69,$0.00
208.05,SUP,HCPCS C1713,,208.050  -  SCREW BONE 7MM 8MM 50MM 16MM CANN THREADED LARGE HEXOGONAL,$481.75,$0.00,$481.75,$216.79,$343.82,$0.00,$80.59,$0.00,$0.00,$84.35,$481.75,$0.00,$240.88,$381.55,$385.40,$0.00,$73.20,$0.00,$76.69,$0.00
208.055,SUP,HCPCS C1713,,208.055  -  SCREW BONE 7MM 8MM 55MM 16MM CANN THREADED LARGE HEXOGONAL,$481.75,$0.00,$481.75,$216.79,$343.82,$0.00,$80.59,$0.00,$0.00,$84.35,$481.75,$0.00,$240.88,$381.55,$385.40,$0.00,$73.20,$0.00,$76.69,$0.00
208.06,SUP,HCPCS C1713,,208.060  -  SCREW BONE 7MM 8MM 60MM 16MM CANN THREADED LARGE HEXOGONAL,$481.75,$0.00,$481.75,$216.79,$343.82,$0.00,$80.59,$0.00,$0.00,$84.35,$481.75,$0.00,$240.88,$381.55,$385.40,$0.00,$73.20,$0.00,$76.69,$0.00
208.065,SUP,HCPCS C1713,,208.065  -  SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7MM 8,$481.75,$0.00,$481.75,$216.79,$343.82,$0.00,$80.59,$0.00,$0.00,$84.35,$481.75,$0.00,$240.88,$381.55,$385.40,$0.00,$73.20,$0.00,$76.69,$0.00
208.07,SUP,HCPCS C1713,,208.070  -  SCREW BONE 7MM 8MM 70MM 16MM CANN LARGE HEXAGONAL SOCKET,$481.75,$0.00,$481.75,$216.79,$343.82,$0.00,$80.59,$0.00,$0.00,$84.35,$481.75,$0.00,$240.88,$381.55,$385.40,$0.00,$73.20,$0.00,$76.69,$0.00
208.075,SUP,HCPCS C1713,,208.075  -  SCREW BONE 7MM 8MM 75MM 16MM CANN THREADED LARGE HEXOGONAL,$481.75,$0.00,$481.75,$216.79,$343.82,$0.00,$80.59,$0.00,$0.00,$84.35,$481.75,$0.00,$240.88,$381.55,$385.40,$0.00,$73.20,$0.00,$76.69,$0.00
208.08,SUP,HCPCS C1713,,208.080  -  SCREW BONE 3.5MM 7MM 8MM 80MM 16MM CANN LARGE HEXAGONAL,$481.75,$0.00,$481.75,$216.79,$343.82,$0.00,$80.59,$0.00,$0.00,$84.35,$481.75,$0.00,$240.88,$381.55,$385.40,$0.00,$73.20,$0.00,$76.69,$0.00
208.085,SUP,HCPCS C1713,,208.085  -  SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7MM 8,$481.75,$0.00,$481.75,$216.79,$343.82,$0.00,$80.59,$0.00,$0.00,$84.35,$481.75,$0.00,$240.88,$381.55,$385.40,$0.00,$73.20,$0.00,$76.69,$0.00
208.09,SUP,HCPCS C1713,,208.090  -  SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7MM 8,$481.75,$0.00,$481.75,$216.79,$343.82,$0.00,$80.59,$0.00,$0.00,$84.35,$481.75,$0.00,$240.88,$381.55,$385.40,$0.00,$73.20,$0.00,$76.69,$0.00
208.095,SUP,HCPCS C1713,,208.095  -  SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7MM 8,$481.75,$0.00,$481.75,$216.79,$343.82,$0.00,$80.59,$0.00,$0.00,$84.35,$481.75,$0.00,$240.88,$381.55,$385.40,$0.00,$73.20,$0.00,$76.69,$0.00
208.1,SUP,HCPCS C1713,,208.100  -  SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7MM 8,$481.75,$0.00,$481.75,$216.79,$343.82,$0.00,$80.59,$0.00,$0.00,$84.35,$481.75,$0.00,$240.88,$381.55,$385.40,$0.00,$73.20,$0.00,$76.69,$0.00
208.105,SUP,HCPCS C1713,,208.105  -  SCREW BONE 7MM 8MM 105MM 16MM CANN THREADED LARGE HEXOGONAL,$481.75,$0.00,$481.75,$216.79,$343.82,$0.00,$80.59,$0.00,$0.00,$84.35,$481.75,$0.00,$240.88,$381.55,$385.40,$0.00,$73.20,$0.00,$76.69,$0.00
208.11,SUP,HCPCS C1713,,208.110  -  SCREW BONE 7MM 8MM 110MM 16MM CANN THREADED LARGE HEXOGONAL,$481.75,$0.00,$481.75,$216.79,$343.82,$0.00,$80.59,$0.00,$0.00,$84.35,$481.75,$0.00,$240.88,$381.55,$385.40,$0.00,$73.20,$0.00,$76.69,$0.00
208.115,SUP,HCPCS C1713,,208.115  -  SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7MM 8,$481.75,$0.00,$481.75,$216.79,$343.82,$0.00,$80.59,$0.00,$0.00,$84.35,$481.75,$0.00,$240.88,$381.55,$385.40,$0.00,$73.20,$0.00,$76.69,$0.00
208.12,SUP,HCPCS C1713,,208.120  -  SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7MM 8,$481.75,$0.00,$481.75,$216.79,$343.82,$0.00,$80.59,$0.00,$0.00,$84.35,$481.75,$0.00,$240.88,$381.55,$385.40,$0.00,$73.20,$0.00,$76.69,$0.00
208.125,SUP,HCPCS C1713,,208.125  -  SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7MM 8,$481.75,$0.00,$481.75,$216.79,$343.82,$0.00,$80.59,$0.00,$0.00,$84.35,$481.75,$0.00,$240.88,$381.55,$385.40,$0.00,$73.20,$0.00,$76.69,$0.00
208.13,SUP,HCPCS C1713,,208.130  -  SCREW BONE 7MM 8MM 130MM 16MM CANN THREADED LARGE HEXOGONAL,$481.75,$0.00,$481.75,$216.79,$343.82,$0.00,$80.59,$0.00,$0.00,$84.35,$481.75,$0.00,$240.88,$381.55,$385.40,$0.00,$73.20,$0.00,$76.69,$0.00
208.135,SUP,HCPCS C1713,,208.135  -  SCREW BONE 7MM 135MM 16MM CANN STAINLESS STEEL ORTHOPEDIC,$496.78,$0.00,$496.78,$223.55,$354.55,$0.00,$83.10,$0.00,$0.00,$86.98,$496.78,$0.00,$248.39,$393.45,$397.42,$0.00,$75.48,$0.00,$79.09,$0.00
208.14,SUP,HCPCS C1713,,208.140  -  SCREW BONE 7MM 140MM 16MM THREADED CANN STAINLESS STEEL,$496.78,$0.00,$496.78,$223.55,$354.55,$0.00,$83.10,$0.00,$0.00,$86.98,$496.78,$0.00,$248.39,$393.45,$397.42,$0.00,$75.48,$0.00,$79.09,$0.00
208.145,SUP,HCPCS C1713,,208.145  -  SCREW BONE 7MM 145MM 16MM CANN STAINLESS STEEL ORTHOPEDIC,$496.78,$0.00,$496.78,$223.55,$354.55,$0.00,$83.10,$0.00,$0.00,$86.98,$496.78,$0.00,$248.39,$393.45,$397.42,$0.00,$75.48,$0.00,$79.09,$0.00
208.15,SUP,HCPCS C1713,,208.150  -  SCREW BONE 7MM 150MM 16MM CANN STAINLESS STEEL ORTHOPEDIC,$496.78,$0.00,$496.78,$223.55,$354.55,$0.00,$83.10,$0.00,$0.00,$86.98,$496.78,$0.00,$248.39,$393.45,$397.42,$0.00,$75.48,$0.00,$79.09,$0.00
208.401,SUP,HCPCS C1713,,208.401  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 30,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.402,SUP,HCPCS C1713,,208.402  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 35,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.403,SUP,HCPCS C1713,,208.403  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 40,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.404,SUP,HCPCS C1713,,208.404  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 45,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.405,SUP,HCPCS C1713,,208.405  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 50,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.406,SUP,HCPCS C1713,,208.406  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 55,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.407,SUP,HCPCS C1713,,208.407  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 60,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.408,SUP,HCPCS C1713,,208.408  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 65,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.409,SUP,HCPCS C1713,,208.409  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 70,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.41,SUP,HCPCS C1713,,208.410  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 75,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.411,SUP,HCPCS C1713,,208.411  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 80,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.412,SUP,HCPCS C1713,,208.412  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 85,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.413,SUP,HCPCS C1713,,208.413  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 90,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.414,SUP,HCPCS C1713,,208.414  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 95,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.415,SUP,HCPCS C1713,,208.415  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.416,SUP,HCPCS C1713,,208.416  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.417,SUP,HCPCS C1713,,208.417  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.418,SUP,HCPCS C1713,,208.418  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.419,SUP,HCPCS C1713,,208.419  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.42,SUP,HCPCS C1713,,208.420  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.421,SUP,HCPCS C1713,,208.421  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.422,SUP,HCPCS C1713,,208.422  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.423,SUP,HCPCS C1713,,208.423  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.424,SUP,HCPCS C1713,,208.424  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.425,SUP,HCPCS C1713,,208.425  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.426,SUP,HCPCS C1713,,208.426  -  SCREW BONE 6.5MM 160MM 16MM CANN STAINLESS STEEL ORTHOPEDIC,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.427,SUP,HCPCS C1713,,208.427  -  SCREW BONE 6.5MM 170MM 16MM CANN STAINLESS STEEL ORTHOPEDIC,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.428,SUP,HCPCS C1713,,208.428  -  SCREW BONE 6.5MM 180MM 16MM CANN STAINLESS STEEL ORTHOPEDIC,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.431,SUP,HCPCS C1713,,208.431  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 45,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.432,SUP,HCPCS C1713,,208.432  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 50,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.433,SUP,HCPCS C1713,,208.433  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 55,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.434,SUP,HCPCS C1713,,208.434  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 60,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.435,SUP,HCPCS C1713,,208.435  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 65,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.436,SUP,HCPCS C1713,,208.436  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 70,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.437,SUP,HCPCS C1713,,208.437  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 75,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.438,SUP,HCPCS C1713,,208.438  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 80,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.439,SUP,HCPCS C1713,,208.439  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 85,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.44,SUP,HCPCS C1713,,208.440  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 90,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.441,SUP,HCPCS C1713,,208.441  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 95,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.442,SUP,HCPCS C1713,,208.442  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.443,SUP,HCPCS C1713,,208.443  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.444,SUP,HCPCS C1713,,208.444  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.445,SUP,HCPCS C1713,,208.445  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.446,SUP,HCPCS C1713,,208.446  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.447,SUP,HCPCS C1713,,208.447  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.448,SUP,HCPCS C1713,,208.448  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.449,SUP,HCPCS C1713,,208.449  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.45,SUP,HCPCS C1713,,208.450  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.451,SUP,HCPCS C1713,,208.451  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.452,SUP,HCPCS C1713,,208.452  -  SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.453,SUP,HCPCS C1713,,208.453  -  SCREW BONE 6.5MM 160MM 32MM CANN STAINLESS STEEL ORTHOPEDIC,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.454,SUP,HCPCS C1713,,208.454  -  SCREW BONE 6.5MM 170MM 32MM CANN STAINLESS STEEL ORTHOPEDIC,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.455,SUP,HCPCS C1713,,208.455  -  SCREW BONE 6.5MM 180MM 32MM CANN STAINLESS STEEL ORTHOPEDIC,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.46,SUP,HCPCS C1713,,208.460  -  SCREW BONE FULTHD HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.461,SUP,HCPCS C1713,,208.461  -  SCREW BONE FULTHD HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.462,SUP,HCPCS C1713,,208.462  -  SCREW BONE FULTHD HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.463,SUP,HCPCS C1713,,208.463  -  SCREW BONE 6.5MM 35MM FULTHRD STAINLESS STEEL CANN NONSTRL,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.464,SUP,HCPCS C1713,,208.464  -  SCREW BONE 6.5MM 40MM FULTHRD STAINLESS STEEL CANN NONSTRL,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.465,SUP,HCPCS C1713,,208.465  -  SCREW BONE FULTHD 6.5MM 45MM CANN STAINLESS STEEL ORTHOPEDIC,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.466,SUP,HCPCS C1713,,208.466  -  SCREW BONE FULTHD 6.5MM 50MM CANN STAINLESS STEEL FEMUR,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.467,SUP,HCPCS C1713,,208.467  -  SCREW BONE FULTHD 6.5MM 55MM CANN STAINLESS STEEL FEMUR,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.468,SUP,HCPCS C1713,,208.468  -  SCREW BONE FULTHD 6.5MM 60MM CANN STAINLESS STEEL FEMUR,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.469,SUP,HCPCS C1713,,208.469  -  SCREW BONE FULTHD 6.5MM 65MM CANN STAINLESS STEEL FEMUR,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.47,SUP,HCPCS C1713,,208.470  -  SCREW BONE FULTHD 6.5MM 70MM CANN STAINLESS STEEL FEMUR,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.471,SUP,HCPCS C1713,,208.471  -  SCREW BONE FULTHD 6.5MM 75MM CANN STAINLESS STEEL FEMUR,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.472,SUP,HCPCS C1713,,208.472  -  SCREW BONE FULTHD 6.5MM 80MM CANN STAINLESS STEEL FEMUR,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.473,SUP,HCPCS C1713,,208.473  -  SCREW BONE FULTHD 6.5MM 85MM CANN STAINLESS STEEL FEMUR,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.474,SUP,HCPCS C1713,,208.474  -  SCREW BONE FULTHD 6.5MM 90MM CANN STAINLESS STEEL FEMUR,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.475,SUP,HCPCS C1713,,208.475  -  SCREW BONE FULTHD 6.5MM 95MM CANN STAINLESS STEEL FEMUR,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.476,SUP,HCPCS C1713,,208.476  -  SCREW BONE FULTHD 6.5MM 100MM CANN STAINLESS STEEL FEMUR,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.477,SUP,HCPCS C1713,,208.477  -  SCREW BONE FULTHD 6.5MM 105MM CANN FULTHRD STAINLESS STEEL,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.478,SUP,HCPCS C1713,,208.478  -  SCREW BONE FULTHD 6.5MM 110MM CANN FULTHRD STAINLESS STEEL,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.479,SUP,HCPCS C1713,,208.479  -  SCREW BONE 6.5MM 115MM CANN FULTHRD STAINLESS STEEL,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.48,SUP,HCPCS C1713,,208.480  -  SCREW BONE 6.5MM 120MM FULTHRD STAINLESS STEEL CANN NONSTRL,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.481,SUP,HCPCS C1713,,208.481  -  SCREW BONE 6.5MM 125MM CANN FULTHRD STAINLESS STEEL,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.482,SUP,HCPCS C1713,,208.482  -  SCREW BONE 6.5MM 130MM CANN FULTHRD STAINLESS STEEL,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
208.483,SUP,HCPCS C1713,,208.483  -  SCREW BONE FULTHD 6.5MM 140MM CANN STAINLESS STEEL,$487.23,$0.00,$487.23,$219.25,$347.73,$0.00,$81.50,$0.00,$0.00,$85.31,$487.23,$0.00,$243.61,$385.89,$389.78,$0.00,$74.03,$0.00,$77.57,$0.00
208.484,SUP,HCPCS C1713,,208.484  -  SCREW BONE FULTHD 6.5MM 150MM CANN STAINLESS STEEL,$487.23,$0.00,$487.23,$219.25,$347.73,$0.00,$81.50,$0.00,$0.00,$85.31,$487.23,$0.00,$243.61,$385.89,$389.78,$0.00,$74.03,$0.00,$77.57,$0.00
208.485,SUP,HCPCS C1713,,208.485  -  SCREW BONE FULTHD 6.5MM 160MM CANN STAINLESS STEEL,$487.23,$0.00,$487.23,$219.25,$347.73,$0.00,$81.50,$0.00,$0.00,$85.31,$487.23,$0.00,$243.61,$385.89,$389.78,$0.00,$74.03,$0.00,$77.57,$0.00
208.486,SUP,HCPCS C1713,,208.486  -  SCREW BONE FULTHD 6.5MM 170MM CANN STAINLESS STEEL,$487.23,$0.00,$487.23,$219.25,$347.73,$0.00,$81.50,$0.00,$0.00,$85.31,$487.23,$0.00,$243.61,$385.89,$389.78,$0.00,$74.03,$0.00,$77.57,$0.00
208.487,SUP,HCPCS C1713,,208.487  -  SCREW BONE 6.5MM 180MM CANN FULTHD STAINLESS STEEL,$487.23,$0.00,$487.23,$219.25,$347.73,$0.00,$81.50,$0.00,$0.00,$85.31,$487.23,$0.00,$243.61,$385.89,$389.78,$0.00,$74.03,$0.00,$77.57,$0.00
208.83,SUP,HCPCS C1713,,208.830  -  SCREW BONE PTHRD 7.3MM 30MM 16MM CANN SLFDRILL SLFTAP,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$105.85,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$96.14,$0.00,$74.74,$0.00
208.835,SUP,HCPCS C1713,,208.835  -  SCREW BONE PTHRD 7.3MM 35MM 16MM CANN SLFDRILL SLFTAP,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
208.84,SUP,HCPCS C1713,,208.840  -  SCREW BONE 7.3MM 40MM 16MM CANN STAINLESS STEEL FEMUR,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
208.845,SUP,HCPCS C1713,,208.845  -  SCREW BONE PTHRD 7.3MM 45MM 16MM CANN SLFDRILL SLFTAP,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
208.85,SUP,HCPCS C1713,,208.850  -  SCREW BONE 7.3MM 50MM 16MM CANN STAINLESS STEEL CANCELLOUS,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
208.855,SUP,HCPCS C1713,,208.855  -  SCREW BONE PTHRD 7.3MM 55MM 16MM CANN SLFDRILL SLFTAP,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
208.86,SUP,HCPCS C1713,,208.860  -  SCREW BONE PTHRD 7.3MM 60MM 16MM CANN SLFDRILL SLFTAP,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
208.865,SUP,HCPCS C1713,,208.865  -  SCREW BONE PTHRD 7.3MM 65MM 16MM CANN SLFDRILL SLFTAP,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
208.87,SUP,HCPCS C1713,,208.870  -  SCREW BONE PTHRD 7.3MM 70MM 16MM CANN SLFDRILL SLFTAP,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
208.875,SUP,HCPCS C1713,,208.875  -  SCREW BONE PTHRD 7.3MM 75MM 16MM CANN SLFDRILL SLFTAP,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
208.88,SUP,HCPCS C1713,,208.880  -  SCREW BONE PTHRD 7.3MM 80MM 16MM CANN SLFDRILL SLFTAP,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
208.885,SUP,HCPCS C1713,,208.885  -  SCREW BONE PTHRD 7.3MM 85MM 16MM CANN SLFDRILL SLFTAP,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
208.89,SUP,HCPCS C1713,,208.890  -  SCREW BONE 7.3MM 90MM 16MM CANN STAINLESS STEEL CANN NONSTRL,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
208.895,SUP,HCPCS C1713,,208.895  -  SCREW BONE PTHRD 7.3MM 95MM 16MM CANN SLFDRILL SLFTAP,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$105.85,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$96.14,$0.00,$74.74,$0.00
208.9,SUP,HCPCS C1713,,208.900  -  SCREW BONE PTHRD 7.3MM 100MM 16MM CANN SLFDRILL SLFTAP,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
208.905,SUP,HCPCS C1713,,208.905  -  SCREW BONE PTHRD 7.3MM 105MM 16MM CANN SLFDRILL SLFTAP,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
208.91,SUP,HCPCS C1713,,208.910  -  SCREW BONE PTHRD 7.3MM 110MM 16MM CANN SLFDRILL SLFTAP,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
208.915,SUP,HCPCS C1713,,208.915  -  SCREW BONE PTHRD 7.3MM 115MM 16MM CANN SLFDRILL SLFTAP,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
208.92,SUP,HCPCS C1713,,208.920  -  SCREW BONE PTHRD 7.3MM 120MM 16MM CANN SLFDRILL SLFTAP,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
208.925,SUP,HCPCS C1713,,208.925  -  SCREW BONE PTHRD 7.3MM 125MM 16MM CANN SLFDRILL SLFTAP,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
208.93,SUP,HCPCS C1713,,208.930  -  SCREW BONE PTHRD 7.3MM 130MM 16MM CANN SLFDRILL SLFTAP,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
208.935,SUP,HCPCS C1713,,208.935  -  SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7.3MM,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
208.94,SUP,HCPCS C1713,,208.940  -  SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7.3MM,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
208.945,SUP,HCPCS C1713,,208.945  -  SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7.3MM,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
208.95,SUP,HCPCS C1713,,208.950  -  SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7.3MM,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
208.955,SUP,HCPCS C1713,,208.955  -  SCREW BONE 7.3MM 8.2MM 155MM 16X4MM CANNULARED SLFDRILL,$485.85,$0.00,$485.85,$218.63,$346.75,$0.00,$81.27,$0.00,$0.00,$85.07,$485.85,$0.00,$242.93,$384.79,$388.68,$0.00,$73.82,$0.00,$77.35,$0.00
208.96,SUP,HCPCS C1713,,208.960  -  SCREW BONE 7.3MM 8.2MM 160MM 16X4MM CANNULARED SLFDRILL,$485.85,$0.00,$485.85,$218.63,$346.75,$0.00,$81.27,$0.00,$0.00,$85.07,$485.85,$0.00,$242.93,$384.79,$388.68,$0.00,$73.82,$0.00,$77.35,$0.00
208.965,SUP,HCPCS C1713,,208.965  -  SCREW BONE 7.3MM 8.2MM 165MM 16X4MM CANNULARED SLFDRILL,$485.85,$0.00,$485.85,$218.63,$346.75,$0.00,$81.27,$0.00,$0.00,$85.07,$485.85,$0.00,$242.93,$384.79,$388.68,$0.00,$73.82,$0.00,$77.35,$0.00
208.97,SUP,HCPCS C1713,,208.970  -  SCREW BONE 7.3MM 8.2MM 170MM 16X4MM CANNULARED SLFDRILL,$485.85,$0.00,$485.85,$218.63,$346.75,$0.00,$81.27,$0.00,$0.00,$85.07,$485.85,$0.00,$242.93,$384.79,$388.68,$0.00,$73.82,$0.00,$77.35,$0.00
208.975,SUP,HCPCS C1713,,208.975  -  SCREW BONE 7.3MM 8.2MM 75MM 16X4MM L THREAD SLFDRILL SLFTAP,$485.85,$0.00,$485.85,$218.63,$346.75,$0.00,$81.27,$0.00,$0.00,$85.07,$485.85,$0.00,$242.93,$384.79,$388.68,$0.00,$73.82,$0.00,$77.35,$0.00
208.98,SUP,HCPCS C1713,,208.980  -  SCREW BONE 7.3MM 8.2MM 80MM 16X4MM L THREAD SLFDRILL SLFTAP,$485.85,$0.00,$485.85,$218.63,$346.75,$0.00,$81.27,$0.00,$0.00,$85.07,$485.85,$0.00,$242.93,$384.79,$388.68,$0.00,$73.82,$0.00,$77.35,$0.00
209,SUP,Custom 27203010,,MARKER RAD OSPT SKN SEM RDLCNT RING,$205.00,$0.00,$205.00,$0.00,$146.31,$0.00,$0.00,$0.00,$0.00,$0.00,$205.00,$0.00,$102.50,$162.36,$164.00,$0.00,$0.00,$0.00,$0.00,$0.00
209.045,SUP,HCPCS C1713,,209.045  -  SCREW BONE 7MM 8MM 45MM 32MM CANN THREADED LARGE HEXOGONAL,$481.75,$0.00,$481.75,$216.79,$343.82,$0.00,$80.59,$0.00,$0.00,$84.35,$481.75,$0.00,$240.88,$381.55,$385.40,$0.00,$73.20,$0.00,$76.69,$0.00
209.05,SUP,HCPCS C1713,,209.050  -  SCREW BONE 7MM 8MM 50MM 32MM CANN LARGE HEXOGONAL SOCKET,$481.75,$0.00,$481.75,$216.79,$343.82,$0.00,$80.59,$0.00,$0.00,$84.35,$481.75,$0.00,$240.88,$381.55,$385.40,$0.00,$73.20,$0.00,$76.69,$0.00
209.055,SUP,HCPCS C1713,,209.055  -  SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7MM 8,$481.75,$0.00,$481.75,$216.79,$343.82,$0.00,$80.59,$0.00,$0.00,$84.35,$481.75,$0.00,$240.88,$381.55,$385.40,$0.00,$73.20,$0.00,$76.69,$0.00
209.06,SUP,HCPCS C1713,,209.060  -  SCREW BONE REVERSE CUT FLUTE 7MM 8MM 60MM 32MM CANN LARGE,$481.75,$0.00,$481.75,$216.79,$343.82,$0.00,$80.59,$0.00,$0.00,$84.35,$481.75,$0.00,$240.88,$381.55,$385.40,$0.00,$73.20,$0.00,$76.69,$0.00
209.065,SUP,HCPCS C1713,,209.065  -  SCREW BONE 7MM 8MM 65MM 32MM CANN THREADED LARGE HEXOGONAL,$481.75,$0.00,$481.75,$216.79,$343.82,$0.00,$80.59,$0.00,$0.00,$84.35,$481.75,$0.00,$240.88,$381.55,$385.40,$0.00,$73.20,$0.00,$76.69,$0.00
209.07,SUP,HCPCS C1713,,209.070  -  SCREW BONE 7MM 8MM 70MM 32MM CANN THREADED LARGE HEXOGONAL,$481.75,$0.00,$481.75,$216.79,$343.82,$0.00,$80.59,$0.00,$0.00,$84.35,$481.75,$0.00,$240.88,$381.55,$385.40,$0.00,$73.20,$0.00,$76.69,$0.00
209.075,SUP,HCPCS C1713,,209.075  -  SCREW BONE 7MM 8MM 75MM 32MM CANN THREADED LARGE HEXOGONAL,$481.75,$0.00,$481.75,$216.79,$343.82,$0.00,$80.59,$0.00,$0.00,$84.35,$481.75,$0.00,$240.88,$381.55,$385.40,$0.00,$73.20,$0.00,$76.69,$0.00
209.08,SUP,HCPCS C1713,,209.080  -  SCREW BONE LARGE 7MM 8MM 80MM 32MM CANN THREADED LARGE,$481.75,$0.00,$481.75,$216.79,$343.82,$0.00,$80.59,$0.00,$0.00,$84.35,$481.75,$0.00,$240.88,$381.55,$385.40,$0.00,$73.20,$0.00,$76.69,$0.00
209.085,SUP,HCPCS C1713,,209.085  -  SCREW BONE 7MM 8MM 85MM 32MM CANN THREADED LARGE HEXOGONAL,$481.75,$0.00,$481.75,$216.79,$343.82,$0.00,$80.59,$0.00,$0.00,$84.35,$481.75,$0.00,$240.88,$381.55,$385.40,$0.00,$73.20,$0.00,$76.69,$0.00
209.09,SUP,HCPCS C1713,,209.090  -  SCREW BONE 7MM 8MM 90MM 32MM CANN THREADED LARGE HEXOGONAL,$481.75,$0.00,$481.75,$216.79,$343.82,$0.00,$80.59,$0.00,$0.00,$84.35,$481.75,$0.00,$240.88,$381.55,$385.40,$0.00,$73.20,$0.00,$76.69,$0.00
209.095,SUP,HCPCS C1713,,209.095  -  SCREW BONE 7MM 8MM 95MM 32MM CANN THREADED LARGE HEXOGONAL,$481.75,$0.00,$481.75,$216.79,$343.82,$0.00,$80.59,$0.00,$0.00,$84.35,$481.75,$0.00,$240.88,$381.55,$385.40,$0.00,$73.20,$0.00,$76.69,$0.00
209.1,SUP,HCPCS C1713,,209.100  -  SCREW BONE 7MM 8MM 100MM 32MM CANN THREADED LARGE HEXOGONAL,$481.75,$0.00,$481.75,$216.79,$343.82,$0.00,$80.59,$0.00,$0.00,$84.35,$481.75,$0.00,$240.88,$381.55,$385.40,$0.00,$73.20,$0.00,$76.69,$0.00
209.105,SUP,HCPCS C1713,,209.105  -  SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7MM 8,$481.75,$0.00,$481.75,$216.79,$343.82,$0.00,$80.59,$0.00,$0.00,$84.35,$481.75,$0.00,$240.88,$381.55,$385.40,$0.00,$73.20,$0.00,$76.69,$0.00
209.11,SUP,HCPCS C1713,,209.110  -  SCREW BONE 7MM 8MM 110MM 32MM CANN THREADED LARGE HEXOGONAL,$481.75,$0.00,$481.75,$216.79,$343.82,$0.00,$80.59,$0.00,$0.00,$84.35,$481.75,$0.00,$240.88,$381.55,$385.40,$0.00,$73.20,$0.00,$76.69,$0.00
209.115,SUP,HCPCS C1713,,209.115  -  SCREW BONE 7MM 8MM 115MM 32MM CANN THREADED LARGE HEXOGONAL,$481.75,$0.00,$481.75,$216.79,$343.82,$0.00,$80.59,$0.00,$0.00,$84.35,$481.75,$0.00,$240.88,$381.55,$385.40,$0.00,$73.20,$0.00,$76.69,$0.00
209.12,SUP,HCPCS C1713,,209.120  -  SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7MM 8,$481.75,$0.00,$481.75,$216.79,$343.82,$0.00,$80.59,$0.00,$0.00,$84.35,$481.75,$0.00,$240.88,$381.55,$385.40,$0.00,$73.20,$0.00,$76.69,$0.00
209.125,SUP,HCPCS C1713,,209.125  -  SCREW BONE 7MM 8MM 125MM 32MM CANN THREADED LARGE HEXOGONAL,$481.75,$0.00,$481.75,$216.79,$343.82,$0.00,$80.59,$0.00,$0.00,$84.35,$481.75,$0.00,$240.88,$381.55,$385.40,$0.00,$73.20,$0.00,$76.69,$0.00
209.13,SUP,HCPCS C1713,,209.130  -  SCREW BONE 7MM 8MM 130MM 32MM CANN THREADED LARGE HEXOGONAL,$481.75,$0.00,$481.75,$216.79,$343.82,$0.00,$80.59,$0.00,$0.00,$84.35,$481.75,$0.00,$240.88,$381.55,$385.40,$0.00,$73.20,$0.00,$76.69,$0.00
209.135,SUP,HCPCS C1713,,209.135  -  SCREW BONE 7MM 135MM 32MM CANN STAINLESS STEEL ORTHOPEDIC,$496.78,$0.00,$496.78,$223.55,$354.55,$0.00,$83.10,$0.00,$0.00,$86.98,$496.78,$0.00,$248.39,$393.45,$397.42,$0.00,$75.48,$0.00,$79.09,$0.00
209.14,SUP,HCPCS C1713,,209.140  -  SCREW BONE 7MM 140MM 32MM CANN THREADED,$496.78,$0.00,$496.78,$223.55,$354.55,$0.00,$83.10,$0.00,$0.00,$86.98,$496.78,$0.00,$248.39,$393.45,$397.42,$0.00,$75.48,$0.00,$79.09,$0.00
209.145,SUP,HCPCS C1713,,209.145  -  SCREW BONE 7MM 145MM 32MM CANN THREADED,$496.78,$0.00,$496.78,$223.55,$354.55,$0.00,$83.10,$0.00,$0.00,$86.98,$496.78,$0.00,$248.39,$393.45,$397.42,$0.00,$75.48,$0.00,$79.09,$0.00
209.15,SUP,HCPCS C1713,,209.150  -  SCREW BONE 7MM 150MM 32MM CANN THREADED,$496.78,$0.00,$496.78,$223.55,$354.55,$0.00,$83.10,$0.00,$0.00,$86.98,$496.78,$0.00,$248.39,$393.45,$397.42,$0.00,$75.48,$0.00,$79.09,$0.00
209.42,SUP,HCPCS C1713,,209.420  -  SCREW BONE 7MM 20MM CANN FULTHRD STAINLESS STEEL ORTHOPEDIC,$496.78,$0.00,$496.78,$223.55,$354.55,$0.00,$83.10,$0.00,$0.00,$86.98,$496.78,$0.00,$248.39,$393.45,$397.42,$0.00,$75.48,$0.00,$79.09,$0.00
209.425,SUP,HCPCS C1713,,209.425  -  SCREW BONE FULTHD 7MM 25MM CANN STAINLESS STEEL ORTHOPEDIC,$496.78,$0.00,$496.78,$223.55,$354.55,$0.00,$83.10,$0.00,$0.00,$86.98,$496.78,$0.00,$248.39,$393.45,$397.42,$0.00,$75.48,$0.00,$79.09,$0.00
209.43,SUP,HCPCS C1713,,209.430  -  SCREW ORTHOPEDIC 7MM 30MM CANN FULTHRD STAINLESS STEEL,$496.78,$0.00,$496.78,$223.55,$354.55,$0.00,$83.10,$0.00,$0.00,$86.98,$496.78,$0.00,$248.39,$393.45,$397.42,$0.00,$75.48,$0.00,$79.09,$0.00
209.435,SUP,HCPCS C1713,,209.435  -  SCREW BONE FULTHD 7MM 35MM CANN STAINLESS STEEL ORTHOPEDIC,$496.78,$0.00,$496.78,$223.55,$354.55,$0.00,$83.10,$0.00,$0.00,$86.98,$496.78,$0.00,$248.39,$393.45,$397.42,$0.00,$75.48,$0.00,$79.09,$0.00
209.44,SUP,HCPCS C1713,,209.440  -  SCREW BONE 7MM 40MM CANN FULTHRD STAINLESS STEEL ORTHOPEDIC,$496.78,$0.00,$496.78,$223.55,$354.55,$0.00,$83.10,$0.00,$0.00,$86.98,$496.78,$0.00,$248.39,$393.45,$397.42,$0.00,$75.48,$0.00,$79.09,$0.00
209.445,SUP,HCPCS C1713,,209.445  -  SCREW BONE FULTHD 7MM 45MM CANN STAINLESS STEEL ORTHOPEDIC,$496.78,$0.00,$496.78,$223.55,$354.55,$0.00,$83.10,$0.00,$0.00,$86.98,$496.78,$0.00,$248.39,$393.45,$397.42,$0.00,$75.48,$0.00,$79.09,$0.00
209.45,SUP,HCPCS C1713,,209.450  -  SCREW BONE FULTHD 7MM 50MM CANN STAINLESS STEEL ORTHOPEDIC,$496.78,$0.00,$496.78,$223.55,$354.55,$0.00,$83.10,$0.00,$0.00,$86.98,$496.78,$0.00,$248.39,$393.45,$397.42,$0.00,$75.48,$0.00,$79.09,$0.00
209.455,SUP,HCPCS C1713,,209.455  -  SCREW BONE FULTHD 7MM 55MM CANN STAINLESS STEEL ORTHOPEDIC,$496.78,$0.00,$496.78,$223.55,$354.55,$0.00,$83.10,$0.00,$0.00,$86.98,$496.78,$0.00,$248.39,$393.45,$397.42,$0.00,$75.48,$0.00,$79.09,$0.00
209.46,SUP,HCPCS C1713,,209.460  -  SCREW BONE 7MM 60MM CANN FULTHRD STAINLESS STEEL NONSTRL,$496.78,$0.00,$496.78,$223.55,$354.55,$0.00,$83.10,$0.00,$0.00,$86.98,$496.78,$0.00,$248.39,$393.45,$397.42,$0.00,$75.48,$0.00,$79.09,$0.00
209.465,SUP,HCPCS C1713,,209.465  -  SCREW BONE FULTHD 7MM 65MM CANN STAINLESS STEEL ORTHOPEDIC,$496.78,$0.00,$496.78,$223.55,$354.55,$0.00,$83.10,$0.00,$0.00,$86.98,$496.78,$0.00,$248.39,$393.45,$397.42,$0.00,$75.48,$0.00,$79.09,$0.00
209.47,SUP,HCPCS C1713,,209.470  -  SCREW BONE 7MM 70MM CANN FULTHRD STAINLESS STEEL ORTHOPEDIC,$496.78,$0.00,$496.78,$223.55,$354.55,$0.00,$83.10,$0.00,$0.00,$86.98,$496.78,$0.00,$248.39,$393.45,$397.42,$0.00,$75.48,$0.00,$79.09,$0.00
209.475,SUP,HCPCS C1713,,209.475  -  SCREW BONE FULTHD 7MM 75MM CANN STAINLESS STEEL ORTHOPEDIC,$496.78,$0.00,$496.78,$223.55,$354.55,$0.00,$83.10,$0.00,$0.00,$86.98,$496.78,$0.00,$248.39,$393.45,$397.42,$0.00,$75.48,$0.00,$79.09,$0.00
209.48,SUP,HCPCS C1713,,209.480  -  SCREW BONE 7MM 80MM CANN FULTHRD STAINLESS STEEL ORTHOPEDIC,$496.78,$0.00,$496.78,$223.55,$354.55,$0.00,$83.10,$0.00,$0.00,$86.98,$496.78,$0.00,$248.39,$393.45,$397.42,$0.00,$75.48,$0.00,$79.09,$0.00
209.485,SUP,HCPCS C1713,,209.485  -  SCREW BONE 7MM 85MM CANN FULTHRD STAINLESS STEEL ORTHOPEDIC,$496.78,$0.00,$496.78,$223.55,$354.55,$0.00,$83.10,$0.00,$0.00,$86.98,$496.78,$0.00,$248.39,$393.45,$397.42,$0.00,$75.48,$0.00,$79.09,$0.00
209.49,SUP,HCPCS C1713,,209.490  -  SCREW BONE 7MM 90MM CANN FULTHRD STAINLESS STEEL ORTHOPEDIC,$496.78,$0.00,$496.78,$223.55,$354.55,$0.00,$83.10,$0.00,$0.00,$86.98,$496.78,$0.00,$248.39,$393.45,$397.42,$0.00,$75.48,$0.00,$79.09,$0.00
209.495,SUP,HCPCS C1713,,209.495  -  SCREW BONE 7MM 95MM CANN FULTHRD STAINLESS STEEL ORTHOPEDIC,$496.78,$0.00,$496.78,$223.55,$354.55,$0.00,$83.10,$0.00,$0.00,$86.98,$496.78,$0.00,$248.39,$393.45,$397.42,$0.00,$75.48,$0.00,$79.09,$0.00
209.5,SUP,HCPCS C1713,,209.500  -  SCREW BONE 7MM 100MM CANN FULTHRD STAINLESS STEEL ORTHOPEDIC,$496.78,$0.00,$496.78,$223.55,$354.55,$0.00,$83.10,$0.00,$0.00,$86.98,$496.78,$0.00,$248.39,$393.45,$397.42,$0.00,$75.48,$0.00,$79.09,$0.00
209.505,SUP,HCPCS C1713,,209.505  -  SCREW BONE FULTHD 7MM 105MM CANN STAINLESS STEEL ORTHOPEDIC,$496.78,$0.00,$496.78,$223.55,$354.55,$0.00,$83.10,$0.00,$0.00,$86.98,$496.78,$0.00,$248.39,$393.45,$397.42,$0.00,$75.48,$0.00,$79.09,$0.00
209.51,SUP,HCPCS C1713,,209.510  -  SCREW BONE FULTHD 7MM 8MM 110MM CANN LARGE HEXAGONAL SOCKET,$496.78,$0.00,$496.78,$223.55,$354.55,$0.00,$83.10,$0.00,$0.00,$86.98,$496.78,$0.00,$248.39,$393.45,$397.42,$0.00,$75.48,$0.00,$79.09,$0.00
209.515,SUP,HCPCS C1713,,209.515  -  SCREW BONE FULTHD 7MM 115MM CANN STAINLESS STEEL ORTHOPEDIC,$496.78,$0.00,$496.78,$223.55,$354.55,$0.00,$83.10,$0.00,$0.00,$86.98,$496.78,$0.00,$248.39,$393.45,$397.42,$0.00,$75.48,$0.00,$79.09,$0.00
209.52,SUP,HCPCS C1713,,209.520  -  SCREW BONE 7MM 120MM CANN FULTHRD STAINLESS STEEL CORTICAL,$496.78,$0.00,$496.78,$223.55,$354.55,$0.00,$83.10,$0.00,$0.00,$86.98,$496.78,$0.00,$248.39,$393.45,$397.42,$0.00,$75.48,$0.00,$79.09,$0.00
209.525,SUP,HCPCS C1713,,209.525  -  SCREW BONE FULTHD 7MM 125MM CANN STAINLESS STEEL ORTHOPEDIC,$496.78,$0.00,$496.78,$223.55,$354.55,$0.00,$83.10,$0.00,$0.00,$86.98,$496.78,$0.00,$248.39,$393.45,$397.42,$0.00,$75.48,$0.00,$79.09,$0.00
209.53,SUP,HCPCS C1713,,209.530  -  SCREW BONE 7MM 130MM FULTHRD STAINLESS STEEL ORTHOPEDIC,$496.78,$0.00,$496.78,$223.55,$354.55,$0.00,$83.10,$0.00,$0.00,$86.98,$496.78,$0.00,$248.39,$393.45,$397.42,$0.00,$75.48,$0.00,$79.09,$0.00
209.62,SUP,HCPCS C1713,,209.620  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
209.625,SUP,HCPCS C1713,,209.625  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
209.63,SUP,HCPCS C1713,,209.630  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
209.635,SUP,HCPCS C1713,,209.635  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
209.64,SUP,HCPCS C1713,,209.640  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
209.645,SUP,HCPCS C1713,,209.645  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
209.65,SUP,HCPCS C1713,,209.650  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
209.655,SUP,HCPCS C1713,,209.655  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
209.66,SUP,HCPCS C1713,,209.660  -  SCREW BONE FULLY THREAD LARGE HEXAGON 7.3MM 4MM 60MM CANN,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
209.665,SUP,HCPCS C1713,,209.665  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
209.67,SUP,HCPCS C1713,,209.670  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
209.675,SUP,HCPCS C1713,,209.675  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
209.68,SUP,HCPCS C1713,,209.680  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
209.685,SUP,HCPCS C1713,,209.685  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
209.69,SUP,HCPCS C1713,,209.690  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
209.695,SUP,HCPCS C1713,,209.695  -  SCREW BONE FULTHD 7.3MM 8.2MM 95MM CANN SHAFT LP HEAD,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
209.7,SUP,HCPCS C1713,,209.700  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
209.705,SUP,HCPCS C1713,,209.705  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
209.71,SUP,HCPCS C1713,,209.710  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
209.715,SUP,HCPCS C1713,,209.715  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
209.72,SUP,HCPCS C1713,,209.720  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
209.725,SUP,HCPCS C1713,,209.725  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
209.73,SUP,HCPCS C1713,,209.730  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
209.735,SUP,HCPCS C1713,,209.735  -  SCREW BONE FULTHD 7.3MM 8.2MM 135MM 4MM CANN SLFDRILL SLFTAP,$485.85,$0.00,$485.85,$218.63,$346.75,$0.00,$81.27,$0.00,$0.00,$85.07,$485.85,$0.00,$242.93,$384.79,$388.68,$0.00,$73.82,$0.00,$77.35,$0.00
209.74,SUP,HCPCS C1713,,209.740  -  SCREW BONE 4MM FULTHD 7.3MM 8.2MM 140MM CANN SLFDRILL SLFTAP,$485.85,$0.00,$485.85,$218.63,$346.75,$0.00,$81.27,$0.00,$0.00,$85.07,$485.85,$0.00,$242.93,$384.79,$388.68,$0.00,$73.82,$0.00,$77.35,$0.00
209.745,SUP,HCPCS C1713,,209.745  -  SCREW BONE FULTHD 7.3MM 8.2MM 145MM 4MM CANN SLFDRILL SLFTAP,$485.85,$0.00,$485.85,$218.63,$346.75,$0.00,$81.27,$0.00,$0.00,$85.07,$485.85,$0.00,$242.93,$384.79,$388.68,$0.00,$73.82,$0.00,$77.35,$0.00
209.75,SUP,HCPCS C1713,,209.750  -  SCREW BONE FULTHD 7.3MM 50MM CANN NONSTRL,$485.85,$0.00,$485.85,$218.63,$346.75,$0.00,$81.27,$0.00,$0.00,$85.07,$485.85,$0.00,$242.93,$384.79,$388.68,$0.00,$73.82,$0.00,$77.35,$0.00
209.755,SUP,HCPCS C1713,,209.755  -  SCREW BONE FULTHD 7.3MM 55MM CANN NONSTRL,$485.85,$0.00,$485.85,$218.63,$346.75,$0.00,$81.27,$0.00,$0.00,$85.07,$485.85,$0.00,$242.93,$384.79,$388.68,$0.00,$73.82,$0.00,$77.35,$0.00
209.76,SUP,HCPCS C1713,,209.760  -  SCREW BONE 4MM FULTHD 7.3MM 8.2MM 160MM CANN SLFDRILL SLFTAP,$485.85,$0.00,$485.85,$218.63,$346.75,$0.00,$81.27,$0.00,$0.00,$85.07,$485.85,$0.00,$242.93,$384.79,$388.68,$0.00,$73.82,$0.00,$77.35,$0.00
209.765,SUP,HCPCS C1713,,209.765  -  SCREW BONE FULTHD 7.3MM 8.2MM 165MM 4MM CANN SLFDRILL SLFTAP,$485.85,$0.00,$485.85,$218.63,$346.75,$0.00,$81.27,$0.00,$0.00,$85.07,$485.85,$0.00,$242.93,$384.79,$388.68,$0.00,$73.82,$0.00,$77.35,$0.00
209.77,SUP,HCPCS C1713,,209.770  -  SCREW BONE FULTHD 7.3MM 8.2MM 170MM 4MM CANN SLFDRILL SLFTAP,$485.85,$0.00,$485.85,$218.63,$346.75,$0.00,$81.27,$0.00,$0.00,$85.07,$485.85,$0.00,$242.93,$384.79,$388.68,$0.00,$73.82,$0.00,$77.35,$0.00
209.775,SUP,HCPCS C1713,,209.775  -  SCREW BONE FULTHD 7.3MM 75MM CANN STAINLESS STEEL,$485.85,$0.00,$485.85,$218.63,$346.75,$0.00,$81.27,$0.00,$0.00,$85.07,$485.85,$0.00,$242.93,$384.79,$388.68,$0.00,$73.82,$0.00,$77.35,$0.00
209.78,SUP,HCPCS C1713,,209.780  -  SCREW BONE FULTHD 7.3MM 8.2MM 180MM 4MM CANN SLFDRILL SLFTAP,$485.85,$0.00,$485.85,$218.63,$346.75,$0.00,$81.27,$0.00,$0.00,$85.07,$485.85,$0.00,$242.93,$384.79,$388.68,$0.00,$73.82,$0.00,$77.35,$0.00
209.845,SUP,HCPCS C1713,,209.845  -  SCREW BONE PTHRD 7.3MM 8.2MM 45MM 32MM CANN SHAFT LP HEAD,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
209.85,SUP,HCPCS C1713,,209.850  -  SCREW BONE 7.3MM 8.2MM 50MM 32MM CANN SHAFT LP HEAD SLFDRILL,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
209.855,SUP,HCPCS C1713,,209.855  -  SCREW BONE 4MM 7.3MM 8.2MM 55MM 32MM CANN SHAFT LP HEAD,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
209.86,SUP,HCPCS C1713,,209.860  -  SCREW BONE PTHRD 7.3MM 8.2MM 60MM 32MM CANN SHAFT LP HEAD,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
209.865,SUP,HCPCS C1713,,209.865  -  SCREW BONE 4MM 7.3MM 8.2MM 65MM 32MM CANN SHAFT LP HEAD,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
209.87,SUP,HCPCS C1713,,209.870  -  SCREW BONE PTHRD 7.3MM 8.2MM 70MM 32MM CANN SHAFT LP HEAD,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
209.875,SUP,HCPCS C1713,,209.875  -  SCREW BONE 4MM 7.3MM 8.2MM 75MM 32MM CANN SHAFT LP HEAD,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
209.88,SUP,HCPCS C1713,,209.880  -  SCREW BONE PTHRD 7.3MM 8.2MM 80MM 32MM CANN SHAFT LP HEAD,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
209.885,SUP,HCPCS C1713,,209.885  -  SCREW BONE 4MM PTHRD 7.3MM 8.2MM 85MM 32MM CANN SHAFT LP,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
209.89,SUP,HCPCS C1713,,209.890  -  SCREW BONE 4MM PTHRD 7.3MM 8.2MM 90MM 32MM CANN SHAFT LP,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
209.895,SUP,HCPCS C1713,,209.895  -  SCREW BONE 4MM PTHRD 7.3MM 8.2MM 95MM 32MM CANN SHAFT LP,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
209.9,SUP,HCPCS C1713,,209.900  -  SCREW BONE 4MM PTHRD 7.3MM 8.2MM 100MM 32MM CANN SHAFT LP,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
209.905,SUP,HCPCS C1713,,209.905  -  SCREW BONE 4MM 7.3MM 8.2MM 105MM 32MM CANN SHAFT LP HEAD,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
209.91,SUP,HCPCS C1713,,209.910  -  SCREW BONE 4MM PTHRD 7.3MM 8.2MM 110MM 32MM CANN SHAFT LP,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
209.915,SUP,HCPCS C1713,,209.915  -  SCREW BONE 7.3MM 8.2MM 115MM 32MM CANN SHAFT LP HEAD,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
209.92,SUP,HCPCS C1713,,209.920  -  SCREW BONE 4MM 7.3MM 8.2MM 120MM 32MM CANN SHAFT LP HEAD,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
209.925,SUP,HCPCS C1713,,209.925  -  SCREW BONE 4MM 7.3MM 8.2MM 125MM 32MM CANN SHAFT LP HEAD,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
209.93,SUP,HCPCS C1713,,209.930  -  SCREW BONE 4MM PTHRD 7.3MM 8.2MM 130MM 32MM CANN SHAFT LP,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
209.935,SUP,HCPCS C1713,,209.935  -  SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7.3MM,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
209.94,SUP,HCPCS C1713,,209.940  -  SCREW BONE HEXAGON 7.3MM 4MM 140MM 32MM CANN SELF DRILL SELF,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
209.945,SUP,HCPCS C1713,,209.945  -  SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7.3MM,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
209.95,SUP,HCPCS C1713,,209.950  -  SCREW BONE HEXAGON 7.3MM 4MM 150MM 32MM CANN SELF DRILL SELF,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
209.955,SUP,HCPCS C1713,,209.955  -  SCREW BONE 7.3MM 8.2MM 155MM 32X4MM CANN SLFDRILL SLFTAP,$485.85,$0.00,$485.85,$218.63,$346.75,$0.00,$81.27,$0.00,$0.00,$85.07,$485.85,$0.00,$242.93,$384.79,$388.68,$0.00,$73.82,$0.00,$77.35,$0.00
209.96,SUP,HCPCS C1713,,209.960  -  SCREW BONE 7.3MM 160MM CANN THREADED STAINLESS STEEL NONSTRL,$485.85,$0.00,$485.85,$218.63,$346.75,$0.00,$81.27,$0.00,$0.00,$85.07,$485.85,$0.00,$242.93,$384.79,$388.68,$0.00,$73.82,$0.00,$77.35,$0.00
209.965,SUP,HCPCS C1713,,209.965  -  SCREW BONE 7.3MM 8.2MM 165MM 32X4MM CANN SLFDRILL SLFTAP,$485.85,$0.00,$485.85,$218.63,$346.75,$0.00,$81.27,$0.00,$0.00,$85.07,$485.85,$0.00,$242.93,$384.79,$388.68,$0.00,$73.82,$0.00,$77.35,$0.00
209.97,SUP,HCPCS C1713,,209.970  -  SCREW BONE 7.3MM 8.2MM 170MM 32X4MM CANN SLFDRILL SLFTAP,$485.85,$0.00,$485.85,$218.63,$346.75,$0.00,$81.27,$0.00,$0.00,$85.07,$485.85,$0.00,$242.93,$384.79,$388.68,$0.00,$73.82,$0.00,$77.35,$0.00
209.975,SUP,HCPCS C1713,,209.975  -  SCREW BONE 7.3MM 8.2MM 175MM 32X4MM CANN SLFDRILL SLFTAP,$485.85,$0.00,$485.85,$218.63,$346.75,$0.00,$81.27,$0.00,$0.00,$85.07,$485.85,$0.00,$242.93,$384.79,$388.68,$0.00,$73.82,$0.00,$77.35,$0.00
209.98,SUP,HCPCS C1713,,209.980  -  SCREW BONE 7.3MM 180MM CANN STAINLESS STEEL NONSTRL,$485.85,$0.00,$485.85,$218.63,$346.75,$0.00,$81.27,$0.00,$0.00,$85.07,$485.85,$0.00,$242.93,$384.79,$388.68,$0.00,$73.82,$0.00,$77.35,$0.00
211.81,SUP,HCPCS C1713,,211.810  -  SCREW BONE .5 THREAD T8 2.4MM 3.5MM 10MM SELF DRILL SELF TAP,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
211.811,SUP,HCPCS C1713,,211.811  -  SCREW BONE LNGTHRD 2.4MM 11MM 5MM CANN STAINLESS STEEL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
211.812,SUP,HCPCS C1713,,211.812  -  SCREW BONE .5 THREAD T8 2.4MM 3.5MM 12MM SELF DRILL SELF TAP,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
211.813,SUP,HCPCS C1713,,211.813  -  SCREW BONE LNGTHRD 2.4MM 13MM 6MM CANN STAINLESS STEEL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
211.814,SUP,HCPCS C1713,,211.814  -  SCREW BONE .5 THREAD T8 2.4MM 3.5MM 14MM SELF DRILL SELF TAP,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
211.815,SUP,HCPCS C1713,,211.815  -  SCREW BONE LNGTHRD 2.4MM 3.5MM 15MM 7MM CANN REVERSE CUTTING,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
211.816,SUP,HCPCS C1713,,211.816  -  SCREW BONE .5 THREAD T8 2.4MM 3.5MM 16MM SELF DRILL SELF TAP,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
211.817,SUP,HCPCS C1713,,211.817  -  SCREW BONE LNGTHRD 2.4MM 17MM 8MM CANN STAINLESS STEEL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
211.818,SUP,HCPCS C1713,,211.818  -  SCREW BONE LNGTHRD 2.4MM 35MM 18MM 8MM CANN T8 STARDRIVE,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
211.819,SUP,HCPCS C1713,,211.819  -  SCREW BONE LNGTHRD 2.4MM 19MM 9MM CANN STAINLESS STEEL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
211.82,SUP,HCPCS C1713,,211.820  -  SCREW BONE LNGTHRD 2.4MM 3.5MM 20MM 9MM CANN REVERSE CUTTING,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
211.822,SUP,HCPCS C1713,,211.822  -  SCREW BONE LNGTHRD 2.4MM 3.5MM 22MM 10MM CANN REVERSE,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
211.824,SUP,HCPCS C1713,,211.824  -  SCREW BONE LNGTHRD 2.4MM 3.5MM 24MM 10MM CANN REVERSE,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
211.826,SUP,HCPCS C1713,,211.826  -  SCREW BONE LNGTHRD 2.4MM 3.5MM 26MM 12MM CANN REVERSE,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
211.828,SUP,HCPCS C1713,,211.828  -  SCREW BONE LNGTHRD 2.4MM 28MM 12MM CANN STAINLESS STEEL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
211.83,SUP,HCPCS C1713,,211.830  -  SCREW BONE LNGTHRD 2.4MM 3.5MM 30MM 14MM CANN REVERSE,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
211.841,SUP,HCPCS C1713,,211.841  -  SCREW BONE SHORT THREAD 2.4MM 3.5MM 17MM 5MM CANN SLFDRILL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
211.842,SUP,HCPCS C1713,,211.842  -  SCREW BONE SHORT THREAD 2.4MM 3.5MM 18MM 5MM CANN T8,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
211.843,SUP,HCPCS C1713,,211.843  -  SCREW BONE SHORT THREAD 2.4MM 19MM 5MM CANN STAINLESS STEEL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
211.844,SUP,HCPCS C1713,,211.844  -  SCREW BONE SHORT THREAD 20MM 204MM 5MM CANN STAINLESS STEEL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
211.845,SUP,HCPCS C1713,,211.845  -  SCREW BONE SHORT THREAD 2.4MM 22MM 5MM CANN STAINLESS STEEL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
211.846,SUP,HCPCS C1713,,211.846  -  SCREW BONE SHORT THREAD 2.4MM 3.5MM 24MM 6MM CANN REVERSE,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
211.847,SUP,HCPCS C1713,,211.847  -  SCREW BONE SHORT THREAD 2.4MM 3.5MM 26MM 6MM CANN REVERSE,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
211.848,SUP,HCPCS C1713,,211.848  -  SCREW BONE SHORT THREAD 2.4MM 3.5MM 28MM 6MM CANN REVERSE,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
211.849,SUP,HCPCS C1713,,211.849  -  SCREW BONE SHORT THREAD 2.4MM 3.5MM 30MM 6MM CANN REVERSE,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
211.89,SUP,HCPCS C1713,,211.890  -  SCREW BONE 2.4MM 90MM COMPRESSION LCP DHHS STAINLESS STEEL,$79.83,$0.00,$79.83,$35.92,$56.97,$0.00,$13.35,$0.00,$0.00,$13.98,$79.83,$0.00,$39.91,$63.23,$63.86,$0.00,$12.13,$0.00,$12.71,$0.00
212.101,SUP,HCPCS C1713,,212.101  -  SCREW BONE FULTHD 3.5MM 2.9MM 10MM T15 STARDRIVE RECESS,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
212.102,SUP,HCPCS C1713,,212.102  -  SCREW BONE FULTHD 3.5MM 12MM STARDRIVE RECESS SLFTAP TIP,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
212.103,SUP,HCPCS C1713,,212.103  -  SCREW BONE FULTHD 3.5MM 14MM STARDRIVE RECESS SLFTAP TIP,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
212.104,SUP,HCPCS C1713,,212.104  -  SCREW BONE FULTHD 3.5MM 16MM STARDRIVE RECESS SLFTAP TIP,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
212.105,SUP,HCPCS C1713,,212.105  -  SCREW BONE 3.5MM 18MM LOCKING SLFTAP T15 STAR DRIVE RECESS,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
212.106,SUP,HCPCS C1713,,212.106  -  SCREW BONE 3.5MM 20MM LOCKING SLFTAP STARDRIVE RECESS LCP,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
212.107,SUP,HCPCS C1713,,212.107  -  SCREW BONE T15 FULTHD CONE LP 3.5MM 22MM FIX ANGLE SELF TAP,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
212.108,SUP,HCPCS C1713,,212.108  -  SCREW BONE 3.5MM 24MM T15 STARDRIVE RECESS ANGULAR STABILITY,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
212.109,SUP,HCPCS C1713,,212.109  -  SCREW BONE FULTHD 3.5MM 26MM STARDRIVE RECESS SLFTAP TIP,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
212.11,SUP,HCPCS C1713,,212.110  -  SCREW BONE 3.5MM 28MM LOCKING STARDRIVE SLFTAP LCP STAINLESS,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
212.11,SUP,HCPCS C1713,,212.11  -  SCREW BONE 3.5MM 28MM LCP SS PROX MDL PLVC TIBIAL SLFTAP LCK,$249.18,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$197.35,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
212.111,SUP,HCPCS C1713,,212.111  -  SCREW BONE 3.5MM 30MM LOCKING SLFTAP STARDRIVE RECESS LCP,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
212.112,SUP,HCPCS C1713,,212.112  -  SCREW BONE FULTHD 3.5MM 32MM STARDRIVE RECESS SLFTAP TIP,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
212.113,SUP,HCPCS C1713,,212.113  -  SCREW BONE 3.5MM 34MM T15 STARDRIVE RECESS ANGULAR STABILITY,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
212.114,SUP,HCPCS C1713,,212.114  -  SCREW BONE T15 FULTHD CONE LP 3.5MM 35MM FIX ANGLE SELF TAP,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
212.115,SUP,HCPCS C1713,,212.115  -  SCREW BONE FULTHD 3.5MM 36MM T15 STARDRIVE SELF TAP FIX,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
212.116,SUP,HCPCS C1713,,212.116  -  SCREW BONE FULTHD 3.5MM 38MM T15 STARDRIVE SELF TAP FIX,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
212.117,SUP,HCPCS C1713,,212.117  -  SCREW BONE 3.5MM 40MM LOCKING STARDRIVE SLFTAP LCP STAINLESS,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
212.118,SUP,HCPCS C1713,,212.118  -  SCREW BONE T15 FULTHD CONE LP 3.5MM 42MM FIX ANGLE SELF TAP,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
212.119,SUP,HCPCS C1713,,212.119  -  SCREW BONE FULTHD 3.5MM 45MM STARDRIVE SELF TAP LOCK LP LCP,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
212.12,SUP,HCPCS C1713,,212.120  -  SCREW BONE T15 FULTHD CONE LP 3.5MM 48MM FIX ANGLE SELF TAP,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
212.121,SUP,HCPCS C1713,,212.121  -  SCREW BONE 3.5MM 50MM LOCKING SLFTAP T15 STAR DRIVE RECESS,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
212.122,SUP,HCPCS C1713,,212.122  -  SCREW BONE T15 FULTHD CONE LP 3.5MM 52MM FIX ANGLE SELF TAP,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
212.123,SUP,HCPCS C1713,,212.123  -  SCREW BONE T15 FULTHD CONE LP 3.5MM 55MM FIX ANGLE SELF TAP,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
212.124,SUP,HCPCS C1713,,212.124  -  SCREW BONE FULTHD 3.5MM 60MM STARDRIVE RECESS SLFTAP TIP,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
212.125,SUP,HCPCS C1713,,212.125  -  SCREW BONE T15 FULTHD CONE LP 3.5MM 65MM FIX ANGLE SELF TAP,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
212.126,SUP,HCPCS C1713,,212.126  -  SCREW BONE T15 FULTHD CONE LP 3.5MM 70MM FIX ANGLE SELF TAP,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
212.127,SUP,HCPCS C1713,,212.127  -  SCREW BONE T15 FULTHD CONE LP 3.5MM 75MM FIX ANGLE SELF TAP,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
212.128,SUP,HCPCS C1713,,212.128  -  SCREW BONE T15 FULTHD CONE LP 3.5MM 80MM FIX ANGLE SELF TAP,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
212.129,SUP,HCPCS C1713,,212.129  -  SCREW BONE T15 FULTHD CONE LP 3.5MM 85MM FIX ANGLE SELF TAP,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
212.13,SUP,HCPCS C1713,,212.130  -  SCREW BONE T15 FULTHD CONE LP 3.5MM 90MM FIX ANGLE SELF TAP,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
212.131,SUP,HCPCS C1713,,212.131  -  SCREW BONE T15 FULTHD CONE LP 3.5MM 95MM FIX ANGLE SELF TAP,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
212.134,SUP,HCPCS C1713,,212.134  -  SCREW BONE FULTHD CONE LP 3.5MM 44MM FIX ANGLE SELF TAP,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
212.136,SUP,HCPCS C1713,,212.136  -  SCREW BONE FULTHD CONE LP 3.5MM 46MM FIX ANGLE SELF TAP,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
212.201,SUP,HCPCS C1713,,212.201  -  SCREW BONE FULTHD 5MM 14MM T25 STARDRIVE RECESS SLFTAP,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
212.202,SUP,HCPCS C1713,,212.202  -  SCREW BONE T25 FULTHD CONE 5MM 16MM FIX ANGLE SELF TAP,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
212.203,SUP,HCPCS C1713,,212.203  -  SCREW BONE FULTHD 5MM 18MM T25 STARDRIVE RECESS SLFTAP,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
212.205,SUP,HCPCS C1713,,212.205  -  SCREW BONE T25 FULTHD CONE 5MM 22MM FIX ANGLE SELF TAP,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
212.206,SUP,HCPCS C1713,,212.206  -  SCREW BONE FULTHD 5MM 24MM SLFTAP TIP LOCKING FIXANG CONICAL,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
212.207,SUP,HCPCS C1713,,212.207  -  SCREW BONE FULTHD CONICAL 5MM 26MM SELF TAP LOCK FIX ANGLE T,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
212.208,SUP,HCPCS C1713,,212.208  -  SCREW BONE T25 FULTHD CONE 5MM 28MM FIX ANGLE SELF TAP,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
212.209,SUP,HCPCS C1713,,212.209  -  SCREW BONE T25 FULTHD CONE 5MM 30MM FIX ANGLE SELF TAP,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
212.21,SUP,HCPCS C1713,,212.210  -  SCREW BONE FULTHD 5MM 32MM T25 STARDRIVE RECESS SLFTAP,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
212.211,SUP,HCPCS C1713,,212.211  -  SCREW BONE T25 FULTHD CONE 5MM 34MM FIX ANGLE SELF TAP,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
212.212,SUP,HCPCS C1713,,212.212  -  SCREW BONE T25 FULTHD CONE 5MM 36MM FIX ANGLE SELF TAP,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
212.213,SUP,HCPCS C1713,,212.213  -  SCREW BONE T25 FULTHD CONE 5MM 38MM FIX ANGLE SELF TAP,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
212.214,SUP,HCPCS C1713,,212.214  -  SCREW BONE T25 FULTHD CONE 5MM 40MM FIX ANGLE SELF TAP,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
212.215,SUP,HCPCS C1713,,212.215  -  SCREW BONE T25 FULTHD CONE 5MM 42MM FIX ANGLE SELF TAP,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
212.216,SUP,HCPCS C1713,,212.216  -  SCREW BONE FULTHD 5MM 44MM SLFTAP LOCKING FIXANG T25,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
212.217,SUP,HCPCS C1713,,212.217  -  SCREW BONE T25 FULTHD CONE 5MM 46MM FIX ANGLE SELF TAP,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
212.218,SUP,HCPCS C1713,,212.218  -  SCREW BONE T25 FULTHD CONE 5MM 48MM FIX ANGLE SELF TAP,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
212.219,SUP,HCPCS C1713,,212.219  -  SCREW BONE T25 FULTHD CONE 5MM 50MM FIX ANGLE SELF TAP,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
212.22,SUP,HCPCS C1713,,212.220  -  SCREW BONE T25 FULTHD CONE 5MM 55MM FIX ANGLE SELF TAP,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
212.221,SUP,HCPCS C1713,,212.221  -  SCREW BONE T25 FULTHD CONE 5MM 60MM FIX ANGLE SELF TAP,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
212.222,SUP,HCPCS C1713,,212.222  -  SCREW BONE FULTHD 5MM 65MM T25 STARDRIVE RECESS SLFTAP TIP,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
212.223,SUP,HCPCS C1713,,212.223  -  SCREW BONE T25 FULTHD CONE 5MM 70MM FIX ANGLE SELF TAP,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
212.224,SUP,HCPCS C1713,,212.224  -  SCREW BONE FULTHD 5MM 75MM SLFTAP TIP LOCKING FIXANG T25,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
212.225,SUP,HCPCS C1713,,212.225  -  SCREW BONE FULTHD 5MM 80MM T25 STARDRIVE SELF TAP LOCK FIX,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
212.226,SUP,HCPCS C1713,,212.226  -  SCREW BONE T25 FULTHD CONE 5MM 85MM FIX ANGLE SELF TAP,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
212.227,SUP,HCPCS C1713,,212.227  -  SCREW BONE T25 FULTHD CONE 5MM 90MM FIX ANGLE SELF TAP,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
212.251,SUP,HCPCS C1713,,212.251  -  SCREW BONE 5MM 51MM SLFDRILL LOCKING THREADED LCP STAINLESS,$385.58,$0.00,$385.58,$173.51,$275.18,$0.00,$66.43,$0.00,$0.00,$67.51,$385.58,$0.00,$192.79,$305.38,$308.46,$0.00,$60.34,$0.00,$61.38,$0.00
212.252,SUP,HCPCS C1713,,212.252  -  SCREW BONE 5MM 18MM SLFDRILL LOCKING STARDRIVE RECESS LISS,$385.58,$0.00,$385.58,$173.51,$275.18,$0.00,$66.43,$0.00,$0.00,$67.51,$385.58,$0.00,$192.79,$305.38,$308.46,$0.00,$60.34,$0.00,$61.38,$0.00
212.253,SUP,HCPCS C1713,,212.253  -  SCREW BONE 5MM 22MM SLFDRILL LOCKING STARDRIVE RECESS LISS,$385.58,$0.00,$385.58,$173.51,$275.18,$0.00,$66.43,$0.00,$0.00,$67.51,$385.58,$0.00,$192.79,$305.38,$308.46,$0.00,$60.34,$0.00,$61.38,$0.00
212.254,SUP,HCPCS C1713,,212.254  -  SCREW BONE 5MM 26MM SLFDRILL LOCKING STARDRIVE RECESS LISS,$385.58,$0.00,$385.58,$173.51,$275.18,$0.00,$66.43,$0.00,$0.00,$67.51,$385.58,$0.00,$192.79,$305.38,$308.46,$0.00,$60.34,$0.00,$61.38,$0.00
212.255,SUP,HCPCS C1713,,212.255  -  SCREW BONE 5MM 30MM SLFDRILL LOCKING STARDRIVE RECESS LISS,$385.58,$0.00,$385.58,$173.51,$275.18,$0.00,$66.43,$0.00,$0.00,$67.51,$385.58,$0.00,$192.79,$305.38,$308.46,$0.00,$60.34,$0.00,$61.38,$0.00
212.256,SUP,HCPCS C1713,,212.256  -  SCREW BONE 5MM 35MM SLFDRILL LOCKING STARDRIVE RECESS LISS,$385.58,$0.00,$385.58,$173.51,$275.18,$0.00,$66.43,$0.00,$0.00,$67.51,$385.58,$0.00,$192.79,$305.38,$308.46,$0.00,$60.34,$0.00,$61.38,$0.00
212.257,SUP,HCPCS C1713,,212.257  -  SCREW BONE 5MM 40MM SLFDRILL LOCKING STARDRIVE RECESS LISS,$385.58,$0.00,$385.58,$173.51,$275.18,$0.00,$66.43,$0.00,$0.00,$67.51,$385.58,$0.00,$192.79,$305.38,$308.46,$0.00,$60.34,$0.00,$61.38,$0.00
212.258,SUP,HCPCS C1713,,212.258  -  SCREW BONE 5MM 45MM SLFDRILL LOCKING STARDRIVE RECESS LISS,$385.58,$0.00,$385.58,$173.51,$275.18,$0.00,$66.43,$0.00,$0.00,$67.51,$385.58,$0.00,$192.79,$305.38,$308.46,$0.00,$60.34,$0.00,$61.38,$0.00
212.259,SUP,HCPCS C1713,,212.259  -  SCREW BONE 5MM 50MM SLFDRILL LOCKING STARDRIVE RECESS LISS,$385.58,$0.00,$385.58,$173.51,$275.18,$0.00,$66.43,$0.00,$0.00,$67.51,$385.58,$0.00,$192.79,$305.38,$308.46,$0.00,$60.34,$0.00,$61.38,$0.00
212.26,SUP,HCPCS C1713,,212.260  -  SCREW BONE 5MM 55MM SLFDRILL LOCKING STARDRIVE RECESS LISS,$385.58,$0.00,$385.58,$173.51,$275.18,$0.00,$66.43,$0.00,$0.00,$67.51,$385.58,$0.00,$192.79,$305.38,$308.46,$0.00,$60.34,$0.00,$61.38,$0.00
212.261,SUP,HCPCS C1713,,212.261  -  SCREW BONE 5MM 60MM SLFDRILL LOCKING STARDRIVE RECESS LISS,$385.58,$0.00,$385.58,$173.51,$275.18,$0.00,$66.43,$0.00,$0.00,$67.51,$385.58,$0.00,$192.79,$305.38,$308.46,$0.00,$60.34,$0.00,$61.38,$0.00
212.262,SUP,HCPCS C1713,,212.262  -  SCREW BONE 5MM 65MM SLFDRILL LOCKING STARDRIVE RECESS LISS,$385.58,$0.00,$385.58,$173.51,$275.18,$0.00,$66.43,$0.00,$0.00,$67.51,$385.58,$0.00,$192.79,$305.38,$308.46,$0.00,$60.34,$0.00,$61.38,$0.00
212.263,SUP,HCPCS C1713,,212.263  -  SCREW BONE 5MM 70MM SLFDRILL LOCKING STARDRIVE RECESS LISS,$385.58,$0.00,$385.58,$173.51,$275.18,$0.00,$66.43,$0.00,$0.00,$67.51,$385.58,$0.00,$192.79,$305.38,$308.46,$0.00,$60.34,$0.00,$61.38,$0.00
212.264,SUP,HCPCS C1713,,212.264  -  SCREW BONE 5MM 75MM SLFDRILL LOCKING STARDRIVE RECESS LISS,$385.58,$0.00,$385.58,$173.51,$275.18,$0.00,$66.43,$0.00,$0.00,$67.51,$385.58,$0.00,$192.79,$305.38,$308.46,$0.00,$60.34,$0.00,$61.38,$0.00
212.265,SUP,HCPCS C1713,,212.265  -  SCREW BONE 5MM 80MM SLFDRILL LOCKING STARDRIVE RECESS LISS,$385.58,$0.00,$385.58,$173.51,$275.18,$0.00,$66.43,$0.00,$0.00,$67.51,$385.58,$0.00,$192.79,$305.38,$308.46,$0.00,$60.34,$0.00,$61.38,$0.00
212.266,SUP,HCPCS C1713,,212.266  -  SCREW BONE 5MM 85MM SLFDRILL LOCKING STARDRIVE RECESS LISS,$385.58,$0.00,$385.58,$173.51,$275.18,$0.00,$66.43,$0.00,$0.00,$67.51,$385.58,$0.00,$192.79,$305.38,$308.46,$0.00,$60.34,$0.00,$61.38,$0.00
212.267,SUP,HCPCS C1713,,212.267  -  SCREW BONE 5MM 90MM SLFDRILL LOCKING STARDRIVE RECESS LISS,$385.58,$0.00,$385.58,$173.51,$275.18,$0.00,$66.43,$0.00,$0.00,$67.51,$385.58,$0.00,$192.79,$305.38,$308.46,$0.00,$60.34,$0.00,$61.38,$0.00
212.317,SUP,HCPCS C1713,,212.317  -  SCREW BONE FULTHD 3.5MM 40MM SLFTAP CONICAL STARDRIVE RECESS,$256.58,$0.00,$256.58,$115.46,$183.12,$0.00,$42.92,$0.00,$0.00,$44.92,$256.58,$0.00,$128.29,$203.21,$205.26,$0.00,$38.98,$0.00,$40.85,$0.00
212.319,SUP,HCPCS C1713,,212.319  -  SCREW BONE FULTHD 3.5MM 45MM SLFTAP CONICAL STARDRIVE RECESS,$256.58,$0.00,$256.58,$115.46,$183.12,$0.00,$42.92,$0.00,$0.00,$44.92,$256.58,$0.00,$128.29,$203.21,$205.26,$0.00,$38.98,$0.00,$40.85,$0.00
212.321,SUP,HCPCS C1713,,212.321  -  SCREW BONE FULTHD 3.5MM 50MM SLFTAP CONICAL STARDRIVE RECESS,$256.58,$0.00,$256.58,$115.46,$183.12,$0.00,$42.92,$0.00,$0.00,$44.92,$256.58,$0.00,$128.29,$203.21,$205.26,$0.00,$38.98,$0.00,$40.85,$0.00
212.323,SUP,HCPCS C1713,,212.323  -  SCREW BONE FULTHD 3.5MM 55MM SLFTAP CONICAL STARDRIVE RECESS,$256.58,$0.00,$256.58,$115.46,$183.12,$0.00,$42.92,$0.00,$0.00,$44.92,$256.58,$0.00,$128.29,$203.21,$205.26,$0.00,$38.98,$0.00,$40.85,$0.00
212.324,SUP,HCPCS C1713,,212.324  -  SCREW BONE FULTHD 3.5MM 60MM SLFTAP CONICAL STARDRIVE RECESS,$256.58,$0.00,$256.58,$115.46,$183.12,$0.00,$42.92,$0.00,$0.00,$44.92,$256.58,$0.00,$128.29,$203.21,$205.26,$0.00,$38.98,$0.00,$40.85,$0.00
212.325,SUP,HCPCS C1713,,212.325  -  SCREW BONE FULTHD CONE 3.5MM 2.9MM 65MM SELF TAP SMOOTH,$249.75,$0.00,$249.75,$112.39,$178.25,$0.00,$41.78,$0.00,$0.00,$43.73,$249.75,$0.00,$124.88,$197.80,$199.80,$0.00,$37.95,$0.00,$39.76,$0.00
212.326,SUP,HCPCS C1713,,212.326  -  SCREW BONE FULTHD CONE 3.5MM 2.9MM 70MM SELF TAP SMOOTH,$249.75,$0.00,$249.75,$112.39,$178.25,$0.00,$41.78,$0.00,$0.00,$43.73,$249.75,$0.00,$124.88,$197.80,$199.80,$0.00,$37.95,$0.00,$39.76,$0.00
212.327,SUP,HCPCS C1713,,212.327  -  SCREW BONE FULTHD CONE 3.5MM 2.9MM 75MM SELF TAP SMOOTH,$249.75,$0.00,$249.75,$112.39,$178.25,$0.00,$41.78,$0.00,$0.00,$43.73,$249.75,$0.00,$124.88,$197.80,$199.80,$0.00,$37.95,$0.00,$39.76,$0.00
212.328,SUP,HCPCS C1713,,212.328  -  SCREW BONE FULTHD CONE 3.5MM 2.9MM 80MM SELF TAP SMOOTH,$249.75,$0.00,$249.75,$112.39,$178.25,$0.00,$41.78,$0.00,$0.00,$43.73,$249.75,$0.00,$124.88,$197.80,$199.80,$0.00,$37.95,$0.00,$39.76,$0.00
212.329,SUP,HCPCS C1713,,212.329  -  SCREW BONE FULTHD CONE 3.5MM 2.9MM 85MM SELF TAP SMOOTH,$249.75,$0.00,$249.75,$112.39,$178.25,$0.00,$41.78,$0.00,$0.00,$43.73,$249.75,$0.00,$124.88,$197.80,$199.80,$0.00,$37.95,$0.00,$39.76,$0.00
212.33,SUP,HCPCS C1713,,212.330  -  SCREW BONE FULTHD 3.5MM 2.9MM 90MM SLFTAP STARDRIVE RECESS,$249.75,$0.00,$249.75,$112.39,$178.25,$0.00,$41.78,$0.00,$0.00,$43.73,$249.75,$0.00,$124.88,$197.80,$199.80,$0.00,$37.95,$0.00,$39.76,$0.00
212.331,SUP,HCPCS C1713,,212.331  -  SCREW BONE FULTHD CONE 3.5MM 2.9MM 95MM SELF TAP SMOOTH,$249.75,$0.00,$249.75,$112.39,$178.25,$0.00,$41.78,$0.00,$0.00,$43.73,$249.75,$0.00,$124.88,$197.80,$199.80,$0.00,$37.95,$0.00,$39.76,$0.00
212.417,SUP,HCPCS C1713,,212.417  -  SCREW BONE 3.5MM 40MM SLFTAP CONICAL STARDRIVE RECESS PTHRD,$256.58,$0.00,$256.58,$115.46,$183.12,$0.00,$42.92,$0.00,$0.00,$44.92,$256.58,$0.00,$128.29,$203.21,$205.26,$0.00,$38.98,$0.00,$40.85,$0.00
212.419,SUP,HCPCS C1713,,212.419  -  SCREW BONE 3.5MM 45MM SLFTAP CONICAL STARDRIVE RECESS PTHRD,$256.58,$0.00,$256.58,$115.46,$183.12,$0.00,$42.92,$0.00,$0.00,$44.92,$256.58,$0.00,$128.29,$203.21,$205.26,$0.00,$38.98,$0.00,$40.85,$0.00
212.421,SUP,HCPCS C1713,,212.421  -  SCREW BONE 3.5MM 50MM SLFTAP CONICAL STARDRIVE RECESS PTHRD,$256.58,$0.00,$256.58,$115.46,$183.12,$0.00,$42.92,$0.00,$0.00,$44.92,$256.58,$0.00,$128.29,$203.21,$205.26,$0.00,$38.98,$0.00,$40.85,$0.00
212.423,SUP,HCPCS C1713,,212.423  -  SCREW BONE 3.5MM 55MM SLFTAP CONICAL STARDRIVE RECESS PTHRD,$256.58,$0.00,$256.58,$115.46,$183.12,$0.00,$42.92,$0.00,$0.00,$44.92,$256.58,$0.00,$128.29,$203.21,$205.26,$0.00,$38.98,$0.00,$40.85,$0.00
212.424,SUP,HCPCS C1713,,212.424  -  SCREW BONE 3.5MM 60MM SLFTAP CONICAL STARDRIVE RECESS PTHRD,$256.58,$0.00,$256.58,$115.46,$183.12,$0.00,$42.92,$0.00,$0.00,$44.92,$256.58,$0.00,$128.29,$203.21,$205.26,$0.00,$38.98,$0.00,$40.85,$0.00
212.425,SUP,HCPCS C1713,,212.425  -  SCREW BONE PTHRD CONE 3.5MM 2.9MM 65MM SELF TAP SMOOTH,$249.75,$0.00,$249.75,$112.39,$178.25,$0.00,$41.78,$0.00,$0.00,$43.73,$249.75,$0.00,$124.88,$197.80,$199.80,$0.00,$37.95,$0.00,$39.76,$0.00
212.426,SUP,HCPCS C1713,,212.426  -  SCREW BONE PTHRD CONE 3.5MM 2.9MM 70MM SELF TAP SMOOTH,$249.75,$0.00,$249.75,$112.39,$178.25,$0.00,$41.78,$0.00,$0.00,$43.73,$249.75,$0.00,$124.88,$197.80,$199.80,$0.00,$37.95,$0.00,$39.76,$0.00
212.427,SUP,HCPCS C1713,,212.427  -  SCREW BONE PTHRD CONE 3.5MM 2.9MM 75MM SELF TAP SMOOTH,$249.75,$0.00,$249.75,$112.39,$178.25,$0.00,$41.78,$0.00,$0.00,$43.73,$249.75,$0.00,$124.88,$197.80,$199.80,$0.00,$37.95,$0.00,$39.76,$0.00
212.428,SUP,HCPCS C1713,,212.428  -  SCREW BONE PTHRD CONE 3.5MM 2.9MM 80MM SELF TAP SMOOTH,$249.75,$0.00,$249.75,$112.39,$178.25,$0.00,$41.78,$0.00,$0.00,$43.73,$249.75,$0.00,$124.88,$197.80,$199.80,$0.00,$37.95,$0.00,$39.76,$0.00
212.429,SUP,HCPCS C1713,,212.429  -  SCREW BONE PTHRD CONE 3.5MM 2.9MM 85MM SELF TAP SMOOTH,$249.75,$0.00,$249.75,$112.39,$178.25,$0.00,$41.78,$0.00,$0.00,$43.73,$249.75,$0.00,$124.88,$197.80,$199.80,$0.00,$37.95,$0.00,$39.76,$0.00
212.43,SUP,HCPCS C1713,,212.430  -  SCREW BONE PTHRD CONE 3.5MM 2.9MM 90MM SELF TAP SMOOTH,$249.75,$0.00,$249.75,$112.39,$178.25,$0.00,$41.78,$0.00,$0.00,$43.73,$249.75,$0.00,$124.88,$197.80,$199.80,$0.00,$37.95,$0.00,$39.76,$0.00
212.431,SUP,HCPCS C1713,,212.431  -  SCREW BONE PTHRD CONE 3.5MM 2.9MM 95MM SELF TAP SMOOTH,$249.75,$0.00,$249.75,$112.39,$178.25,$0.00,$41.78,$0.00,$0.00,$43.73,$249.75,$0.00,$124.88,$197.80,$199.80,$0.00,$37.95,$0.00,$39.76,$0.00
212.504,SUP,HCPCS C1713,,212.504  -  SCREW BONE 5MM 20MM STARDRIVE SS PROX FEM LCK SLFTAP T25,$314.40,$0.00,$314.40,$141.48,$224.39,$0.00,$54.17,$0.00,$0.00,$55.05,$314.40,$0.00,$157.20,$249.00,$251.52,$0.00,$49.20,$0.00,$50.05,$0.00
212.806,SUP,HCPCS C1713,,212.806  -  SCREW BONE T8 CONE 2.4MM 1.9MM 6MM FIX ANGLE SELF TAP,$212.90,$0.00,$212.90,$95.81,$151.95,$0.00,$35.61,$0.00,$0.00,$37.28,$212.90,$0.00,$106.45,$168.62,$170.32,$0.00,$32.35,$0.00,$33.89,$0.00
212.807,SUP,HCPCS C1713,,212.807  -  SCREW BONE T8 CONE 2.4MM 1.9MM 7MM FIX ANGLE SELF TAP,$212.90,$0.00,$212.90,$95.81,$151.95,$0.00,$35.61,$0.00,$0.00,$37.28,$212.90,$0.00,$106.45,$168.62,$170.32,$0.00,$32.35,$0.00,$33.89,$0.00
212.808,SUP,HCPCS C1713,,212.808  -  SCREW BONE T8 CONE 2.4MM 1.9MM 8MM FIX ANGLE SELF TAP,$212.90,$0.00,$212.90,$95.81,$151.95,$0.00,$35.61,$0.00,$0.00,$37.28,$212.90,$0.00,$106.45,$168.62,$170.32,$0.00,$32.35,$0.00,$33.89,$0.00
212.809,SUP,HCPCS C1713,,212.809  -  SCREW BONE T8 CONE 2.4MM 1.9MM 9MM FIX ANGLE SELF TAP,$212.90,$0.00,$212.90,$95.81,$151.95,$0.00,$35.61,$0.00,$0.00,$37.28,$212.90,$0.00,$106.45,$168.62,$170.32,$0.00,$32.35,$0.00,$33.89,$0.00
212.81,SUP,HCPCS C1713,,212.810  -  SCREW BONE T8 CONE 2.4MM 1.9MM 10MM FIX ANGLE SELF TAP,$212.90,$0.00,$212.90,$95.81,$151.95,$0.00,$35.61,$0.00,$0.00,$37.28,$212.90,$0.00,$106.45,$168.62,$170.32,$0.00,$32.35,$0.00,$33.89,$0.00
212.811,SUP,HCPCS C1713,,212.811  -  SCREW BONE T8 CONE 2.4MM 1.9MM 11MM FIX ANGLE SELF TAP,$212.90,$0.00,$212.90,$95.81,$151.95,$0.00,$35.61,$0.00,$0.00,$37.28,$212.90,$0.00,$106.45,$168.62,$170.32,$0.00,$32.35,$0.00,$33.89,$0.00
212.812,SUP,HCPCS C1713,,212.812  -  SCREW BONE T8 2.4MM 12MM SELF TAP LOCK STARDRIVE LCP,$212.90,$0.00,$212.90,$95.81,$151.95,$0.00,$35.61,$0.00,$0.00,$37.28,$212.90,$0.00,$106.45,$168.62,$170.32,$0.00,$32.35,$0.00,$33.89,$0.00
212.813,SUP,HCPCS C1713,,212.813  -  SCREW BONE T8 CONE 2.4MM 1.9MM 13MM FIX ANGLE SELF TAP,$212.90,$0.00,$212.90,$95.81,$151.95,$0.00,$35.61,$0.00,$0.00,$37.28,$212.90,$0.00,$106.45,$168.62,$170.32,$0.00,$32.35,$0.00,$33.89,$0.00
212.814,SUP,HCPCS C1713,,212.814  -  SCREW BONE T8 2.4MM 14MM SELF TAP LOCK STARDRIVE LCP,$212.90,$0.00,$212.90,$95.81,$151.95,$0.00,$35.61,$0.00,$0.00,$37.28,$212.90,$0.00,$106.45,$168.62,$170.32,$0.00,$32.35,$0.00,$33.89,$0.00
212.816,SUP,HCPCS C1713,,212.816  -  SCREW BONE T8 CONE 2.4MM 1.9MM 16MM FIX ANGLE SELF TAP,$212.90,$0.00,$212.90,$95.81,$151.95,$0.00,$35.61,$0.00,$0.00,$37.28,$212.90,$0.00,$106.45,$168.62,$170.32,$0.00,$32.35,$0.00,$33.89,$0.00
212.818,SUP,HCPCS C1713,,212.818  -  SCREW BONE 2.4MM 1.9MM 18MM T8 STARDRIVE RECESS SLFTAP,$212.90,$0.00,$212.90,$95.81,$151.95,$0.00,$35.61,$0.00,$0.00,$37.28,$212.90,$0.00,$106.45,$168.62,$170.32,$0.00,$32.35,$0.00,$33.89,$0.00
212.82,SUP,HCPCS C1713,,212.820  -  SCREW BONE 2.4MM 20MM T8 STARDRIVE RECESS SLFTAP LOCKING,$212.90,$0.00,$212.90,$95.81,$151.95,$0.00,$35.61,$0.00,$0.00,$37.28,$212.90,$0.00,$106.45,$168.62,$170.32,$0.00,$32.35,$0.00,$33.89,$0.00
212.822,SUP,HCPCS C1713,,212.822  -  SCREW BONE 2.4MM 22MM T8 STARDRIVE RECESS SLFTAP LOCKING,$212.90,$0.00,$212.90,$95.81,$151.95,$0.00,$35.61,$0.00,$0.00,$37.28,$212.90,$0.00,$106.45,$168.62,$170.32,$0.00,$32.35,$0.00,$33.89,$0.00
212.824,SUP,HCPCS C1713,,212.824  -  SCREW BONE T8 CONE 2.4MM 1.9MM 24MM FIX ANGLE SELF TAP,$212.90,$0.00,$212.90,$95.81,$151.95,$0.00,$35.61,$0.00,$0.00,$37.28,$212.90,$0.00,$106.45,$168.62,$170.32,$0.00,$32.35,$0.00,$33.89,$0.00
212.826,SUP,HCPCS C1713,,212.826  -  SCREW BONE 2.4MM 26MM T8 STARDRIVE RECESS SLFTAP LOCKING,$212.90,$0.00,$212.90,$95.81,$151.95,$0.00,$35.61,$0.00,$0.00,$37.28,$212.90,$0.00,$106.45,$168.62,$170.32,$0.00,$32.35,$0.00,$33.89,$0.00
212.828,SUP,HCPCS C1713,,212.828  -  SCREW BONE 2.4MM 1.9MM 28MM FIX ANGLE SELF TAP T8 STARDRIVE,$212.90,$0.00,$212.90,$95.81,$151.95,$0.00,$35.61,$0.00,$0.00,$37.28,$212.90,$0.00,$106.45,$168.62,$170.32,$0.00,$32.35,$0.00,$33.89,$0.00
212.83,SUP,HCPCS C1713,,212.830  -  SCREW BONE T8 CONE 2.4MM 1.9MM 30MM FIX ANGLE SELF TAP,$212.90,$0.00,$212.90,$95.81,$151.95,$0.00,$35.61,$0.00,$0.00,$37.28,$212.90,$0.00,$106.45,$168.62,$170.32,$0.00,$32.35,$0.00,$33.89,$0.00
213.018,SUP,HCPCS C1713,,213.018  -  SCREW BONE SMALL HEXAGON 3.5MM 2.9MM 18MM SELF TAP THREAD,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
213.02,SUP,HCPCS C1713,,213.020  -  SCREW BONE SMALL HEXAGON 3.5MM 2.9MM 20MM SELF TAP THREAD,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
213.022,SUP,HCPCS C1713,,213.022  -  SCREW BONE SMALL HEXAGON 3.5MM 2.9MM 22MM SELF TAP THREAD,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
213.024,SUP,HCPCS C1713,,213.024  -  SCREW BONE SMALL HEXAGON 3.5MM 2.9MM 24MM SELF TAP THREAD,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
213.026,SUP,HCPCS C1713,,213.026  -  SCREW BONE SMALL HEXAGON 3.5MM 2.9MM 26MM SELF TAP THREAD,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
213.028,SUP,HCPCS C1713,,213.028  -  SCREW BONE SMALL HEXAGON 3.5MM 2.9MM 28MM SELF TAP THREAD,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
213.03,SUP,HCPCS C1713,,213.030  -  SCREW BONE 2.5MM 3.5MM 30MM SELF TAP LOCK SMALL HEXAGONAL,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
213.032,SUP,HCPCS C1713,,213.032  -  SCREW BONE SMALL HEXAGON 3.5MM 2.9MM 32MM SELF TAP THREAD,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
213.034,SUP,HCPCS C1713,,213.034  -  SCREW BONE 3.5MM 2.9MM 34MM SELF TAP LOCK SMALL HEXAGONAL,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
213.036,SUP,HCPCS C1713,,213.036  -  SCREW BONE 3.5MM 2.9MM 36MM SELF TAP LOCK SMALL HEXAGONAL,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
213.038,SUP,HCPCS C1713,,213.038  -  SCREW BONE 3.5MM 2.9MM 38MM SELF TAP LOCK SMALL HEXAGONAL,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
213.04,SUP,HCPCS C1713,,213.040  -  SCREW BONE 2.5MM 3.5MM 40MM SELF TAP SMALL HEXAGONAL RECESS,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
213.045,SUP,HCPCS C1713,,213.045  -  SCREW BONE 3.5MM 2.9MM 45MM SLFTAP LOCKING SMALL HEXAGONAL,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
213.05,SUP,HCPCS C1713,,213.050  -  SCREW BONE 3.5MM 2.9MM 50MM SLFTAP LOCKING SMALL HEXAGONAL,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
213.414,SUP,HCPCS C1713,,213.414  -  SCREW BONE 5MM 14MM SLFDRILL LOCKING LISS STAINLESS STEEL,$378.95,$0.00,$378.95,$170.53,$270.46,$0.00,$65.29,$0.00,$0.00,$66.35,$378.95,$0.00,$189.48,$300.13,$303.16,$0.00,$59.31,$0.00,$60.33,$0.00
213.418,SUP,HCPCS C1713,,213.418  -  SCREW BONE 5MM 18MM SLFDRILL LOCKING LCP LISS STAINLESS,$390.33,$0.00,$390.33,$175.65,$278.57,$0.00,$65.29,$0.00,$0.00,$68.34,$390.33,$0.00,$195.16,$309.14,$312.26,$0.00,$59.31,$0.00,$62.14,$0.00
213.422,SUP,HCPCS C1713,,213.422  -  SCREW BONE 5MM 22MM SLFDRILL LOCKING LISS STAINLESS STEEL,$378.95,$0.00,$378.95,$170.53,$270.46,$0.00,$65.29,$0.00,$0.00,$66.35,$378.95,$0.00,$189.48,$300.13,$303.16,$0.00,$59.31,$0.00,$60.33,$0.00
213.426,SUP,HCPCS C1713,,213.426  -  SCREW BONE 5MM 26MM SLFDRILL LOCKING LCP LISS STAINLESS,$390.33,$0.00,$390.33,$175.65,$278.57,$0.00,$65.29,$0.00,$0.00,$68.34,$390.33,$0.00,$195.16,$309.14,$312.26,$0.00,$59.31,$0.00,$62.14,$0.00
213.43,SUP,HCPCS C1713,,213.430  -  SCREW BONE 5MM 30MM SLFDRILL LOCKING LISS STAINLESS STEEL,$378.95,$0.00,$378.95,$170.53,$270.46,$0.00,$65.29,$0.00,$0.00,$66.35,$378.95,$0.00,$189.48,$300.13,$303.16,$0.00,$59.31,$0.00,$60.33,$0.00
213.435,SUP,HCPCS C1713,,213.435  -  SCREW BONE 5MM 35MM SLFDRILL LOCKING STAINLESS STEEL,$378.95,$0.00,$378.95,$170.53,$270.46,$0.00,$65.29,$0.00,$0.00,$66.35,$378.95,$0.00,$189.48,$300.13,$303.16,$0.00,$59.31,$0.00,$60.33,$0.00
213.44,SUP,HCPCS C1713,,213.440  -  SCREW BONE 5MM 40MM SLFDRILL LOCKING LCP LISS STAINLESS,$390.33,$0.00,$390.33,$175.65,$278.57,$0.00,$65.29,$0.00,$0.00,$68.34,$390.33,$0.00,$195.16,$309.14,$312.26,$0.00,$59.31,$0.00,$62.14,$0.00
213.445,SUP,HCPCS C1713,,213.445  -  SCREW BONE 5MM 45MM SLFDRILL LOCKING STAINLESS STEEL,$378.95,$0.00,$378.95,$170.53,$270.46,$0.00,$65.29,$0.00,$0.00,$66.35,$378.95,$0.00,$189.48,$300.13,$303.16,$0.00,$59.31,$0.00,$60.33,$0.00
213.45,SUP,HCPCS C1713,,213.450  -  SCREW BONE 5MM 50MM SLFDRILL LOCKING STAINLESS STEEL,$378.95,$0.00,$378.95,$170.53,$270.46,$0.00,$65.29,$0.00,$0.00,$66.35,$378.95,$0.00,$189.48,$300.13,$303.16,$0.00,$59.31,$0.00,$60.33,$0.00
213.455,SUP,HCPCS C1713,,213.455  -  SCREW BONE 5MM 55MM SLFDRILL LOCKING LCP LISS STAINLESS,$390.33,$0.00,$390.33,$175.65,$278.57,$0.00,$65.29,$0.00,$0.00,$68.34,$390.33,$0.00,$195.16,$309.14,$312.26,$0.00,$59.31,$0.00,$62.14,$0.00
213.465,SUP,HCPCS C1713,,213.465  -  SCREW BONE 5MM 65MM SLFDRILL LOCKING LCP LISS STAINLESS,$390.33,$0.00,$390.33,$175.65,$278.57,$0.00,$65.29,$0.00,$0.00,$68.34,$390.33,$0.00,$195.16,$309.14,$312.26,$0.00,$59.31,$0.00,$62.14,$0.00
213.47,SUP,HCPCS C1713,,213.470  -  SCREW BONE 5MM 70MM SLFDRILL LOCKING STAINLESS STEEL,$378.95,$0.00,$378.95,$170.53,$270.46,$0.00,$65.29,$0.00,$0.00,$66.35,$378.95,$0.00,$189.48,$300.13,$303.16,$0.00,$59.31,$0.00,$60.33,$0.00
213.475,SUP,HCPCS C1713,,213.475  -  SCREW BONE 5MM 75MM SLFDRILL LOCKING LCP LISS STAINLESS,$390.33,$0.00,$390.33,$175.65,$278.57,$0.00,$65.29,$0.00,$0.00,$68.34,$390.33,$0.00,$195.16,$309.14,$312.26,$0.00,$59.31,$0.00,$62.14,$0.00
213.48,SUP,HCPCS C1713,,213.480  -  SCREW BONE 5MM 80MM SLFDRILL LOCKING STAINLESS STEEL,$378.95,$0.00,$378.95,$170.53,$270.46,$0.00,$65.29,$0.00,$0.00,$66.35,$378.95,$0.00,$189.48,$300.13,$303.16,$0.00,$59.31,$0.00,$60.33,$0.00
213.485,SUP,HCPCS C1713,,213.485  -  SCREW BONE 5MM 85MM SLFDRILL LOCKING LCP LISS STAINLESS,$390.33,$0.00,$390.33,$175.65,$278.57,$0.00,$65.29,$0.00,$0.00,$68.34,$390.33,$0.00,$195.16,$309.14,$312.26,$0.00,$59.31,$0.00,$62.14,$0.00
213.49,SUP,HCPCS C1713,,213.490  -  SCREW BONE 5MM 90MM SLFDRILL LOCKING STAINLESS STEEL,$378.95,$0.00,$378.95,$170.53,$270.46,$0.00,$65.29,$0.00,$0.00,$66.35,$378.95,$0.00,$189.48,$300.13,$303.16,$0.00,$59.31,$0.00,$60.33,$0.00
213.508,SUP,HCPCS C1713,,213.508  -  SCREW BONE 4.5MM 8MM SS STRNL CANN NONSTRL,$236.25,$0.00,$236.25,$106.31,$168.61,$0.00,$40.70,$0.00,$0.00,$41.37,$236.25,$0.00,$118.13,$187.11,$189.00,$0.00,$36.97,$0.00,$37.61,$0.00
213.509,SUP,HCPCS C1713,,213.509  -  SCREW BONE 4.5MM 9MM SS STRNL CANN NONSTRL,$236.25,$0.00,$236.25,$106.31,$168.61,$0.00,$40.70,$0.00,$0.00,$41.37,$236.25,$0.00,$118.13,$187.11,$189.00,$0.00,$36.97,$0.00,$37.61,$0.00
213.51,SUP,HCPCS C1713,,213.510  -  SCREW BONE 4.5MM 10MM SS STRNL CANN NONSTRL,$236.25,$0.00,$236.25,$106.31,$168.61,$0.00,$40.70,$0.00,$0.00,$41.37,$236.25,$0.00,$118.13,$187.11,$189.00,$0.00,$36.97,$0.00,$37.61,$0.00
213.511,SUP,HCPCS C1713,,213.511  -  SCREW BONE 4.5MM 11MM SS STRNL CANN NONSTRL,$236.25,$0.00,$236.25,$106.31,$168.61,$0.00,$40.70,$0.00,$0.00,$41.37,$236.25,$0.00,$118.13,$187.11,$189.00,$0.00,$36.97,$0.00,$37.61,$0.00
213.512,SUP,HCPCS C1713,,213.512  -  SCREW BONE 4.5MM 12MM SS STRNL CANN NONSTRL,$236.25,$0.00,$236.25,$106.31,$168.61,$0.00,$40.70,$0.00,$0.00,$41.37,$236.25,$0.00,$118.13,$187.11,$189.00,$0.00,$36.97,$0.00,$37.61,$0.00
213.513,SUP,HCPCS C1713,,213.513  -  SCREW BONE 4.5MM 13MM SS STRNL CANN NONSTRL,$236.25,$0.00,$236.25,$106.31,$168.61,$0.00,$40.70,$0.00,$0.00,$41.37,$236.25,$0.00,$118.13,$187.11,$189.00,$0.00,$36.97,$0.00,$37.61,$0.00
213.514,SUP,HCPCS C1713,,213.514  -  SCREW BONE 4.5MM 14MM SS STRNL CANN NONSTRL,$236.25,$0.00,$236.25,$106.31,$168.61,$0.00,$40.70,$0.00,$0.00,$41.37,$236.25,$0.00,$118.13,$187.11,$189.00,$0.00,$36.97,$0.00,$37.61,$0.00
213.515,SUP,HCPCS C1713,,213.515  -  SCREW BONE 4.5MM 15MM SS STRNL CANN NONSTRL,$236.25,$0.00,$236.25,$106.31,$168.61,$0.00,$40.70,$0.00,$0.00,$41.37,$236.25,$0.00,$118.13,$187.11,$189.00,$0.00,$36.97,$0.00,$37.61,$0.00
213.516,SUP,HCPCS C1713,,213.516  -  SCREW BONE 4.5MM 16MM SS STRNL CANN NONSTRL,$236.25,$0.00,$236.25,$106.31,$168.61,$0.00,$40.70,$0.00,$0.00,$41.37,$236.25,$0.00,$118.13,$187.11,$189.00,$0.00,$36.97,$0.00,$37.61,$0.00
213.517,SUP,HCPCS C1713,,213.517  -  SCREW BONE 4.5MM 17MM SS STRNL CANN NONSTRL,$236.25,$0.00,$236.25,$106.31,$168.61,$0.00,$40.70,$0.00,$0.00,$41.37,$236.25,$0.00,$118.13,$187.11,$189.00,$0.00,$36.97,$0.00,$37.61,$0.00
213.518,SUP,HCPCS C1713,,213.518  -  SCREW BONE 4.5MM 18MM SS STRNL CANN NONSTRL,$236.25,$0.00,$236.25,$106.31,$168.61,$0.00,$40.70,$0.00,$0.00,$41.37,$236.25,$0.00,$118.13,$187.11,$189.00,$0.00,$36.97,$0.00,$37.61,$0.00
213.519,SUP,HCPCS C1713,,213.519  -  SCREW BONE 4.5MM 19MM SS STRNL CANN NONSTRL,$236.25,$0.00,$236.25,$106.31,$168.61,$0.00,$40.70,$0.00,$0.00,$41.37,$236.25,$0.00,$118.13,$187.11,$189.00,$0.00,$36.97,$0.00,$37.61,$0.00
213.52,SUP,HCPCS C1713,,213.520  -  SCREW BONE 4.5MM 20MM SS STRNL CANN NONSTRL,$236.25,$0.00,$236.25,$106.31,$168.61,$0.00,$40.70,$0.00,$0.00,$41.37,$236.25,$0.00,$118.13,$187.11,$189.00,$0.00,$36.97,$0.00,$37.61,$0.00
213.521,SUP,HCPCS C1713,,213.521  -  SCREW BONE 4.5MM 21MM SS STRNL CANN NONSTRL,$236.25,$0.00,$236.25,$106.31,$168.61,$0.00,$40.70,$0.00,$0.00,$41.37,$236.25,$0.00,$118.13,$187.11,$189.00,$0.00,$36.97,$0.00,$37.61,$0.00
213.522,SUP,HCPCS C1713,,213.522  -  SCREW BONE 4.5MM 22MM SS STRNL CANN NONSTRL,$236.25,$0.00,$236.25,$106.31,$168.61,$0.00,$40.70,$0.00,$0.00,$41.37,$236.25,$0.00,$118.13,$187.11,$189.00,$0.00,$36.97,$0.00,$37.61,$0.00
213.523,SUP,HCPCS C1713,,213.523  -  SCREW BONE 4.5MM 23MM SS STRNL CANN NONSTRL,$236.25,$0.00,$236.25,$106.31,$168.61,$0.00,$40.70,$0.00,$0.00,$41.37,$236.25,$0.00,$118.13,$187.11,$189.00,$0.00,$36.97,$0.00,$37.61,$0.00
213.524,SUP,HCPCS C1713,,213.524  -  SCREW BONE 4.5MM 24MM SS STRNL CANN NONSTRL,$236.25,$0.00,$236.25,$106.31,$168.61,$0.00,$40.70,$0.00,$0.00,$41.37,$236.25,$0.00,$118.13,$187.11,$189.00,$0.00,$36.97,$0.00,$37.61,$0.00
213.525,SUP,HCPCS C1713,,213.525  -  4.5MM STERNAL CANNULATED SCREW 25MM,$236.25,$0.00,$236.25,$106.31,$168.61,$0.00,$40.70,$0.00,$0.00,$41.37,$236.25,$0.00,$118.13,$187.11,$189.00,$0.00,$36.97,$0.00,$37.61,$0.00
213.526,SUP,HCPCS C1713,,213.526  -  4.5MM STERNAL CANNULATED SCREW 26MM,$236.25,$0.00,$236.25,$106.31,$168.61,$0.00,$40.70,$0.00,$0.00,$41.37,$236.25,$0.00,$118.13,$187.11,$189.00,$0.00,$36.97,$0.00,$37.61,$0.00
213.527,SUP,HCPCS C1713,,213.527  -  4.5MM STERNAL CANNULATED SCREW 27MM,$236.25,$0.00,$236.25,$106.31,$168.61,$0.00,$40.70,$0.00,$0.00,$41.37,$236.25,$0.00,$118.13,$187.11,$189.00,$0.00,$36.97,$0.00,$37.61,$0.00
213.528,SUP,HCPCS C1713,,213.528  -  4.5MM STERNAL CANNULATED SCREW 28MM,$236.25,$0.00,$236.25,$106.31,$168.61,$0.00,$40.70,$0.00,$0.00,$41.37,$236.25,$0.00,$118.13,$187.11,$189.00,$0.00,$36.97,$0.00,$37.61,$0.00
214.014,SUP,HCPCS C1713,,214.014  -  SCREW BONE STANDARD 4.5MM 8MM 14MM LARGE HEXGONAL SOCKET,$29.68,$0.00,$29.68,$13.35,$21.18,$0.00,$4.96,$0.00,$0.00,$5.20,$29.68,$0.00,$14.84,$23.51,$23.74,$0.00,$4.51,$0.00,$4.72,$0.00
214.016,SUP,HCPCS C1713,,214.016  -  SCREW BONE STANDARD 4.5MM 8MM 16MM LARGE HEXGONAL SOCKET,$29.68,$0.00,$29.68,$13.35,$21.18,$0.00,$4.96,$0.00,$0.00,$5.20,$29.68,$0.00,$14.84,$23.51,$23.74,$0.00,$4.51,$0.00,$4.72,$0.00
214.018,SUP,HCPCS C1713,,214.018  -  SCREW BONE 4.5MM 8MM 18MM HEXAGONAL SOCKET STAINLESS STEEL,$29.68,$0.00,$29.68,$13.35,$21.18,$0.00,$4.96,$0.00,$0.00,$5.20,$29.68,$0.00,$14.84,$23.51,$23.74,$0.00,$4.51,$0.00,$4.72,$0.00
214.02,SUP,HCPCS C1713,,214.020  -  SCREW BONE STANDARD 4.5MM 8MM 20MM LARGE HEXAGONAL SOCKET,$29.68,$0.00,$29.68,$13.35,$21.18,$0.00,$4.96,$0.00,$0.00,$5.20,$29.68,$0.00,$14.84,$23.51,$23.74,$0.00,$4.51,$0.00,$4.72,$0.00
214.022,SUP,HCPCS C1713,,214.022  -  SCREW BONE STANDARD 4.5MM 8MM 22MM LARGE HEXAGONAL SOCKET,$29.68,$0.00,$29.68,$13.35,$21.18,$0.00,$4.96,$0.00,$0.00,$5.20,$29.68,$0.00,$14.84,$23.51,$23.74,$0.00,$4.51,$0.00,$4.72,$0.00
214.024,SUP,HCPCS C1713,,214.024  -  SCREW BONE STANDARD 4.5MM 8MM 24MM LARGE HEXGONAL SOCKET,$29.68,$0.00,$29.68,$13.35,$21.18,$0.00,$4.96,$0.00,$0.00,$5.20,$29.68,$0.00,$14.84,$23.51,$23.74,$0.00,$4.51,$0.00,$4.72,$0.00
214.026,SUP,HCPCS C1713,,214.026  -  SCREW BONE STANDARD 4.5MM 8MM 26MM LARGE HEXGONAL SOCKET,$29.68,$0.00,$29.68,$13.35,$21.18,$0.00,$4.96,$0.00,$0.00,$5.20,$29.68,$0.00,$14.84,$23.51,$23.74,$0.00,$4.51,$0.00,$4.72,$0.00
214.028,SUP,HCPCS C1713,,214.028  -  SCREW BONE STANDARD 4.5MM 8MM 28MM LARGE HEXGONAL SOCKET,$29.68,$0.00,$29.68,$13.35,$21.18,$0.00,$4.96,$0.00,$0.00,$5.20,$29.68,$0.00,$14.84,$23.51,$23.74,$0.00,$4.51,$0.00,$4.72,$0.00
214.03,SUP,HCPCS C1713,,214.030  -  SCREW BONE STANDARD 4.5MM 8MM 30MM LARGE HEXGONAL SOCKET,$29.68,$0.00,$29.68,$13.35,$21.18,$0.00,$4.96,$0.00,$0.00,$5.20,$29.68,$0.00,$14.84,$23.51,$23.74,$0.00,$4.51,$0.00,$4.72,$0.00
214.032,SUP,HCPCS C1713,,214.032  -  SCREW BONE STANDARD 4.5MM 8MM 32MM LARGE HEXGONAL SOCKET,$29.68,$0.00,$29.68,$13.35,$21.18,$0.00,$4.96,$0.00,$0.00,$5.20,$29.68,$0.00,$14.84,$23.51,$23.74,$0.00,$4.51,$0.00,$4.72,$0.00
214.034,SUP,HCPCS C1713,,214.034  -  SCREW BONE STANDARD 4.5MM 8MM 34MM LARGE HEXGONAL SOCKET,$29.68,$0.00,$29.68,$13.35,$21.18,$0.00,$4.96,$0.00,$0.00,$5.20,$29.68,$0.00,$14.84,$23.51,$23.74,$0.00,$4.51,$0.00,$4.72,$0.00
214.036,SUP,HCPCS C1713,,214.036  -  SCREW BONE STANDARD 4.5MM 8MM 36MM LARGE HEXGONAL SOCKET,$29.68,$0.00,$29.68,$13.35,$21.18,$0.00,$4.96,$0.00,$0.00,$5.20,$29.68,$0.00,$14.84,$23.51,$23.74,$0.00,$4.51,$0.00,$4.72,$0.00
214.038,SUP,HCPCS C1713,,214.038  -  SCREW BONE STANDARD 4.5MM 8MM 38MM LARGE HEXGONAL SOCKET,$29.68,$0.00,$29.68,$13.35,$21.18,$0.00,$4.96,$0.00,$0.00,$5.20,$29.68,$0.00,$14.84,$23.51,$23.74,$0.00,$4.51,$0.00,$4.72,$0.00
214.04,SUP,HCPCS C1713,,214.040  -  SCREW BONE STANDARD 4.5MM 8MM 40MM LARGE HEXGONAL SOCKET,$29.68,$0.00,$29.68,$13.35,$21.18,$0.00,$4.96,$0.00,$0.00,$5.20,$29.68,$0.00,$14.84,$23.51,$23.74,$0.00,$4.51,$0.00,$4.72,$0.00
214.042,SUP,HCPCS C1713,,214.042  -  SCREW BONE 4.5MM 8MM 42MM HEXAGONAL SOCKET STAINLESS STEEL,$29.68,$0.00,$29.68,$13.35,$21.18,$0.00,$4.96,$0.00,$0.00,$5.20,$29.68,$0.00,$14.84,$23.51,$23.74,$0.00,$4.51,$0.00,$4.72,$0.00
214.044,SUP,HCPCS C1713,,214.044  -  SCREW BONE STANDARD 4.5MM 8MM 44MM LARGE HEXGONAL SOCKET,$29.68,$0.00,$29.68,$13.35,$21.18,$0.00,$4.96,$0.00,$0.00,$5.20,$29.68,$0.00,$14.84,$23.51,$23.74,$0.00,$4.51,$0.00,$4.72,$0.00
214.046,SUP,HCPCS C1713,,214.046  -  SCREW BONE STANDARD 4.5MM 8MM 46MM LARGE HEXGONAL SOCKET,$29.68,$0.00,$29.68,$13.35,$21.18,$0.00,$4.96,$0.00,$0.00,$5.20,$29.68,$0.00,$14.84,$23.51,$23.74,$0.00,$4.51,$0.00,$4.72,$0.00
214.048,SUP,HCPCS C1713,,214.048  -  SCREW BONE STANDARD LARGE HEXAGON 4.5MM 8MM 48MM SOCKET,$29.68,$0.00,$29.68,$13.35,$21.18,$0.00,$4.96,$0.00,$0.00,$5.20,$29.68,$0.00,$14.84,$23.51,$23.74,$0.00,$4.51,$0.00,$4.72,$0.00
214.05,SUP,HCPCS C1713,,214.050  -  SCREW BONE STANDARD 4.5MM 8MM 50MM LARGE HEXGONAL SOCKET,$29.68,$0.00,$29.68,$13.35,$21.18,$0.00,$4.96,$0.00,$0.00,$5.20,$29.68,$0.00,$14.84,$23.51,$23.74,$0.00,$4.51,$0.00,$4.72,$0.00
214.052,SUP,HCPCS C1713,,214.052  -  SCREW BONE STANDARD 4.5MM 8MM 52MM LARGE HEXGONAL SOCKET,$29.68,$0.00,$29.68,$13.35,$21.18,$0.00,$4.96,$0.00,$0.00,$5.20,$29.68,$0.00,$14.84,$23.51,$23.74,$0.00,$4.51,$0.00,$4.72,$0.00
214.054,SUP,HCPCS C1713,,214.054  -  SCREW BONE STANDARD 4.5MM 8MM 54MM LARGE HEXGONAL SOCKET,$29.68,$0.00,$29.68,$13.35,$21.18,$0.00,$4.96,$0.00,$0.00,$5.20,$29.68,$0.00,$14.84,$23.51,$23.74,$0.00,$4.51,$0.00,$4.72,$0.00
214.056,SUP,HCPCS C1713,,214.056  -  SCREW BONE 3.5MM STANDARD 4.5MM 8MM 56MM LARGE HEXAGONAL,$29.68,$0.00,$29.68,$13.35,$21.18,$0.00,$4.96,$0.00,$0.00,$5.20,$29.68,$0.00,$14.84,$23.51,$23.74,$0.00,$4.51,$0.00,$4.72,$0.00
214.058,SUP,HCPCS C1713,,214.058  -  SCREW BONE STANDARD 4.5MM 8MM 58MM CORTEX PROXIMAL MEDIAL,$29.68,$0.00,$29.68,$13.35,$21.18,$0.00,$4.96,$0.00,$0.00,$5.20,$29.68,$0.00,$14.84,$23.51,$23.74,$0.00,$4.51,$0.00,$4.72,$0.00
214.06,SUP,HCPCS C1713,,214.060  -  SCREW BONE STANDARD 4.5MM 8MM 60MM LARGE HEXAGONAL SOCKET,$29.68,$0.00,$29.68,$13.35,$21.18,$0.00,$4.96,$0.00,$0.00,$5.20,$29.68,$0.00,$14.84,$23.51,$23.74,$0.00,$4.51,$0.00,$4.72,$0.00
214.062,SUP,HCPCS C1713,,214.062  -  SCREW BONE STANDARD 4.5MM 8MM 62MM NONSELF TAP LARGE HEXAGON,$29.68,$0.00,$29.68,$13.35,$21.18,$0.00,$4.96,$0.00,$0.00,$5.20,$29.68,$0.00,$14.84,$23.51,$23.74,$0.00,$4.51,$0.00,$4.72,$0.00
214.064,SUP,HCPCS C1713,,214.064  -  SCREW BONE STANDARD 4.5MM 8MM 64MM LARGE HEXAGONAL SOCKET,$29.68,$0.00,$29.68,$13.35,$21.18,$0.00,$4.96,$0.00,$0.00,$5.20,$29.68,$0.00,$14.84,$23.51,$23.74,$0.00,$4.51,$0.00,$4.72,$0.00
214.066,SUP,HCPCS C1713,,214.066  -  SCREW BONE STANDARD 4.5MM 8MM 66MM NONSELF TAP LARGE HEXAGON,$29.68,$0.00,$29.68,$13.35,$21.18,$0.00,$4.96,$0.00,$0.00,$5.20,$29.68,$0.00,$14.84,$23.51,$23.74,$0.00,$4.51,$0.00,$4.72,$0.00
214.068,SUP,HCPCS C1713,,214.068  -  SCREW BONE STANDARD 4.5MM 8MM 68MM NONSELF TAP LARGE HEXAGON,$29.68,$0.00,$29.68,$13.35,$21.18,$0.00,$4.96,$0.00,$0.00,$5.20,$29.68,$0.00,$14.84,$23.51,$23.74,$0.00,$4.51,$0.00,$4.72,$0.00
214.07,SUP,HCPCS C1713,,214.070  -  SCREW BONE STANDARD 4.5MM 8MM 70MM NONSELF TAP LARGE HEXAGON,$29.68,$0.00,$29.68,$13.35,$21.18,$0.00,$4.96,$0.00,$0.00,$5.20,$29.68,$0.00,$14.84,$23.51,$23.74,$0.00,$4.51,$0.00,$4.72,$0.00
214.072,SUP,HCPCS C1713,,214.072  -  SCREW BONE STANDARD 4.5MM 8MM 72MM NONSELF TAPPING LARGE,$29.68,$0.00,$29.68,$13.35,$21.18,$0.00,$4.96,$0.00,$0.00,$5.20,$29.68,$0.00,$14.84,$23.51,$23.74,$0.00,$4.51,$0.00,$4.72,$0.00
214.076,SUP,HCPCS C1713,,214.076  -  SCREW BONE 4.5MM 76MM LC-DCP DHS DCS STAINLESS STEEL,$49.80,$0.00,$49.80,$22.41,$35.54,$0.00,$8.33,$0.00,$0.00,$8.72,$49.80,$0.00,$24.90,$39.44,$39.84,$0.00,$7.57,$0.00,$7.93,$0.00
214.08,SUP,HCPCS C1713,,214.080  -  SCREW BONE STANDARD 4.5MM 8MM 80MM NONSELF TAPPING LARGE,$49.80,$0.00,$49.80,$22.41,$35.54,$0.00,$8.33,$0.00,$0.00,$8.72,$49.80,$0.00,$24.90,$39.44,$39.84,$0.00,$7.57,$0.00,$7.93,$0.00
214.085,SUP,HCPCS C1713,,214.085  -  SCREW BONE STANDARD 4.5MM 8MM 85MM LARGE HEXAGONAL SOCKET,$49.80,$0.00,$49.80,$22.41,$35.54,$0.00,$8.33,$0.00,$0.00,$8.72,$49.80,$0.00,$24.90,$39.44,$39.84,$0.00,$7.57,$0.00,$7.93,$0.00
214.09,SUP,HCPCS C1713,,214.090  -  SCREW BONE 4.5MM 90MM LC-DCP DHS DCS STAINLESS STEEL,$49.80,$0.00,$49.80,$22.41,$35.54,$0.00,$8.33,$0.00,$0.00,$8.72,$49.80,$0.00,$24.90,$39.44,$39.84,$0.00,$7.57,$0.00,$7.93,$0.00
214.095,SUP,HCPCS C1713,,214.095  -  SCREW BONE STANDARD 4.5MM 8MM 95MM LARGE HEXAGONAL SOCKET,$49.80,$0.00,$49.80,$22.41,$35.54,$0.00,$8.33,$0.00,$0.00,$8.72,$49.80,$0.00,$24.90,$39.44,$39.84,$0.00,$7.57,$0.00,$7.93,$0.00
214.1,SUP,HCPCS C1713,,214.100  -  SCREW BONE 4.5MM 100MM LC-DCP DHS DCS STAINLESS STEEL,$49.80,$0.00,$49.80,$22.41,$35.54,$0.00,$8.33,$0.00,$0.00,$8.72,$49.80,$0.00,$24.90,$39.44,$39.84,$0.00,$7.57,$0.00,$7.93,$0.00
214.105,SUP,HCPCS C1713,,214.105  -  SCREW BONE 4.5MM 105MM LC-DCP DHS DCS STAINLESS STEEL,$49.80,$0.00,$49.80,$22.41,$35.54,$0.00,$8.33,$0.00,$0.00,$8.72,$49.80,$0.00,$24.90,$39.44,$39.84,$0.00,$7.57,$0.00,$7.93,$0.00
214.11,SUP,HCPCS C1713,,214.110  -  SCREW BONE 4.5MM 110MM LC-DCP DHS DCS STAINLESS STEEL,$49.80,$0.00,$49.80,$22.41,$35.54,$0.00,$8.33,$0.00,$0.00,$8.72,$49.80,$0.00,$24.90,$39.44,$39.84,$0.00,$7.57,$0.00,$7.93,$0.00
214.115,SUP,HCPCS C1713,,214.115  -  SCREW BONE 4.5MM 115MM LC-DCP DHS DCS STAINLESS STEEL,$49.80,$0.00,$49.80,$22.41,$35.54,$0.00,$8.33,$0.00,$0.00,$8.72,$49.80,$0.00,$24.90,$39.44,$39.84,$0.00,$7.57,$0.00,$7.93,$0.00
214.12,SUP,HCPCS C1713,,214.120  -  SCREW BONE 3.5MM STANDARD 4.5MM 8MM 120MM LARGE HEXGONAL,$49.80,$0.00,$49.80,$22.41,$35.54,$0.00,$8.33,$0.00,$0.00,$8.72,$49.80,$0.00,$24.90,$39.44,$39.84,$0.00,$7.57,$0.00,$7.93,$0.00
214.125,SUP,HCPCS C1713,,214.125  -  SCREW BONE 4.5MM 125MM LC-DCP DHS DCS STAINLESS STEEL,$49.80,$0.00,$49.80,$22.41,$35.54,$0.00,$8.33,$0.00,$0.00,$8.72,$49.80,$0.00,$24.90,$39.44,$39.84,$0.00,$7.57,$0.00,$7.93,$0.00
214.13,SUP,HCPCS C1713,,214.130  -  SCREW BONE 4.5MM 130MM DHS/DCP LC-DCP DCS STAINLESS STEEL,$49.80,$0.00,$49.80,$22.41,$35.54,$0.00,$8.33,$0.00,$0.00,$8.72,$49.80,$0.00,$24.90,$39.44,$39.84,$0.00,$7.57,$0.00,$7.93,$0.00
214.135,SUP,HCPCS C1713,,214.135  -  SCREW BONE 4.5MM 135MM LC-DCP DHS DCS STAINLESS STEEL,$49.80,$0.00,$49.80,$22.41,$35.54,$0.00,$8.33,$0.00,$0.00,$8.72,$49.80,$0.00,$24.90,$39.44,$39.84,$0.00,$7.57,$0.00,$7.93,$0.00
214.14,SUP,HCPCS C1713,,214.140  -  SCREW BONE 4.5MM 140MM DHS/DCP LC-DCP DCS STAINLESS STEEL,$49.80,$0.00,$49.80,$22.41,$35.54,$0.00,$8.33,$0.00,$0.00,$8.72,$49.80,$0.00,$24.90,$39.44,$39.84,$0.00,$7.57,$0.00,$7.93,$0.00
214.145,SUP,HCPCS C1713,,214.145  -  SCREW BONE 4.5MM 145MM LC-DCP DHS DCS STAINLESS STEEL,$49.80,$0.00,$49.80,$22.41,$35.54,$0.00,$8.33,$0.00,$0.00,$8.72,$49.80,$0.00,$24.90,$39.44,$39.84,$0.00,$7.57,$0.00,$7.93,$0.00
214.15,SUP,HCPCS C1713,,214.150  -  SCREW BONE 4.5MM 150MM LC-DCP DHS DCS STAINLESS STEEL,$68.90,$0.00,$68.90,$31.01,$49.17,$0.00,$11.53,$0.00,$0.00,$12.06,$68.90,$0.00,$34.45,$54.57,$55.12,$0.00,$10.47,$0.00,$10.97,$0.00
214.155,SUP,HCPCS C1713,,214.155  -  SCREW BONE 4.5MM 155MM LC-DCP DHS DCS STAINLESS STEEL,$68.90,$0.00,$68.90,$31.01,$49.17,$0.00,$11.53,$0.00,$0.00,$12.06,$68.90,$0.00,$34.45,$54.57,$55.12,$0.00,$10.47,$0.00,$10.97,$0.00
214.16,SUP,HCPCS C1713,,214.160  -  SCREW BONE 4.5MM 160MM NON SLFTAP STAINLESS STEEL CORTICAL,$68.90,$0.00,$68.90,$31.01,$49.17,$0.00,$11.53,$0.00,$0.00,$12.06,$68.90,$0.00,$34.45,$54.57,$55.12,$0.00,$10.47,$0.00,$10.97,$0.00
214.222,SUP,HCPCS C1713,,214.222  -  SCREW BONE 4.5MM 22MM SHAFT LC-DCP DHS DCS STAINLESS STEEL,$30.13,$0.00,$30.13,$13.56,$21.50,$0.00,$5.19,$0.00,$0.00,$5.27,$30.13,$0.00,$15.06,$23.86,$24.10,$0.00,$4.71,$0.00,$4.80,$0.00
214.224,SUP,HCPCS C1713,,214.224  -  SCREW BONE 4.5MM 24MM SHAFT LC-DCP DHS DCS STAINLESS STEEL,$30.13,$0.00,$30.13,$13.56,$21.50,$0.00,$5.19,$0.00,$0.00,$5.27,$30.13,$0.00,$15.06,$23.86,$24.10,$0.00,$4.71,$0.00,$4.80,$0.00
214.226,SUP,HCPCS C1713,,214.226  -  SCREW BONE 4.5MM 26MM SHAFT LC-DCP DHS DCS STAINLESS STEEL,$30.13,$0.00,$30.13,$13.56,$21.50,$0.00,$5.19,$0.00,$0.00,$5.27,$30.13,$0.00,$15.06,$23.86,$24.10,$0.00,$4.71,$0.00,$4.80,$0.00
214.228,SUP,HCPCS C1713,,214.228  -  SCREW BONE LARGE HEXAGON 4.5MM 8MM 28MM 12MM SOCKET DCP,$30.13,$0.00,$30.13,$13.56,$21.50,$0.00,$5.19,$0.00,$0.00,$5.27,$30.13,$0.00,$15.06,$23.86,$24.10,$0.00,$4.71,$0.00,$4.80,$0.00
214.23,SUP,HCPCS C1713,,214.230  -  SCREW BONE LARGE HEXAGON 4.5MM 8MM 30MM 12MM SOCKET DCP,$30.13,$0.00,$30.13,$13.56,$21.50,$0.00,$5.19,$0.00,$0.00,$5.27,$30.13,$0.00,$15.06,$23.86,$24.10,$0.00,$4.71,$0.00,$4.80,$0.00
214.232,SUP,HCPCS C1713,,214.232  -  SCREW BONE LARGE HEXAGON 4.5MM 8MM 32MM 12MM SOCKET DCP,$31.03,$0.00,$31.03,$13.96,$22.14,$0.00,$5.19,$0.00,$0.00,$5.43,$31.03,$0.00,$15.51,$24.58,$24.82,$0.00,$4.71,$0.00,$4.94,$0.00
214.234,SUP,HCPCS C1713,,214.234  -  SCREW BONE LARGE HEXAGON 4.5MM 8MM 34MM 12MM SOCKET DCP,$31.03,$0.00,$31.03,$13.96,$22.14,$0.00,$5.19,$0.00,$0.00,$5.43,$31.03,$0.00,$15.51,$24.58,$24.82,$0.00,$4.71,$0.00,$4.94,$0.00
214.236,SUP,HCPCS C1713,,214.236  -  SCREW BONE LARGE HEXAGON 4.5MM 8MM 36MM 12MM SOCKET DCP,$31.03,$0.00,$31.03,$13.96,$22.14,$0.00,$5.19,$0.00,$0.00,$5.43,$31.03,$0.00,$15.51,$24.58,$24.82,$0.00,$4.71,$0.00,$4.94,$0.00
214.238,SUP,HCPCS C1713,,214.238  -  SCREW BONE LARGE HEXAGON 4.5MM 8MM 38MM 12MM SOCKET DCP,$30.13,$0.00,$30.13,$13.56,$21.50,$0.00,$5.19,$0.00,$0.00,$5.27,$30.13,$0.00,$15.06,$23.86,$24.10,$0.00,$4.71,$0.00,$4.80,$0.00
214.24,SUP,HCPCS C1713,,214.240  -  SCREW BONE LARGE HEXAGON 4.5MM 8MM 40MM 12MM SOCKET DCP,$30.13,$0.00,$30.13,$13.56,$21.50,$0.00,$5.19,$0.00,$0.00,$5.27,$30.13,$0.00,$15.06,$23.86,$24.10,$0.00,$4.71,$0.00,$4.80,$0.00
214.242,SUP,HCPCS C1713,,214.242  -  SCREW BONE PTHRD 4.5MM 8MM 42MM 12MM LCP STAINLESS STEEL,$33.45,$0.00,$33.45,$15.05,$23.87,$0.00,$5.76,$0.00,$0.00,$5.86,$33.45,$0.00,$16.73,$26.49,$26.76,$0.00,$5.23,$0.00,$5.33,$0.00
214.244,SUP,HCPCS C1713,,214.244  -  SCREW BONE PTHRD 4.5MM 8MM 44MM 12MM LCP STAINLESS STEEL,$33.45,$0.00,$33.45,$15.05,$23.87,$0.00,$5.76,$0.00,$0.00,$5.86,$33.45,$0.00,$16.73,$26.49,$26.76,$0.00,$5.23,$0.00,$5.33,$0.00
214.246,SUP,HCPCS C1713,,214.246  -  SCREW BONE LARGE HEXAGON 4.5MM 8MM 46MM 12MM SOCKET DCP,$34.45,$0.00,$34.45,$15.50,$24.59,$0.00,$5.76,$0.00,$0.00,$6.03,$34.45,$0.00,$17.23,$27.28,$27.56,$0.00,$5.23,$0.00,$5.48,$0.00
214.248,SUP,HCPCS C1713,,214.248  -  SCREW BONE PTHRD 4.5MM 8MM 50MM 12MM LCP STAINLESS STEEL,$34.45,$0.00,$34.45,$15.50,$24.59,$0.00,$5.76,$0.00,$0.00,$6.03,$34.45,$0.00,$17.23,$27.28,$27.56,$0.00,$5.23,$0.00,$5.48,$0.00
214.25,SUP,HCPCS C1713,,214.250  -  SCREW BONE LARGE HEXAGON 4.5MM 8MM 50MM 12MM SOCKET DCP,$33.45,$0.00,$33.45,$15.05,$23.87,$0.00,$5.76,$0.00,$0.00,$5.86,$33.45,$0.00,$16.73,$26.49,$26.76,$0.00,$5.23,$0.00,$5.33,$0.00
214.252,SUP,HCPCS C1713,,214.252  -  SCREW BONE 4.5MM 52MM SHAFT LC-DCP DHS DCS STAINLESS STEEL,$33.45,$0.00,$33.45,$15.05,$23.87,$0.00,$5.76,$0.00,$0.00,$5.86,$33.45,$0.00,$16.73,$26.49,$26.76,$0.00,$5.23,$0.00,$5.33,$0.00
214.254,SUP,HCPCS C1713,,214.254  -  SCREW BONE 4.5MM 54MM SHAFT LC-DCP STAINLESS STEEL CORTICAL,$33.45,$0.00,$33.45,$15.05,$23.87,$0.00,$5.76,$0.00,$0.00,$5.86,$33.45,$0.00,$16.73,$26.49,$26.76,$0.00,$5.23,$0.00,$5.33,$0.00
214.256,SUP,HCPCS C1713,,214.256  -  SCREW BONE 4.5MM 8MM 56MM 15MM SHAFT LC-DCP DHS DCS,$33.45,$0.00,$33.45,$15.05,$23.87,$0.00,$5.76,$0.00,$0.00,$5.86,$33.45,$0.00,$16.73,$26.49,$26.76,$0.00,$5.23,$0.00,$5.33,$0.00
214.26,SUP,HCPCS C1713,,214.260  -  SCREW BONE 4.5MM 60MM SHAFT LC-DCP DHS DCS STAINLESS STEEL,$33.45,$0.00,$33.45,$15.05,$23.87,$0.00,$5.76,$0.00,$0.00,$5.86,$33.45,$0.00,$16.73,$26.49,$26.76,$0.00,$5.23,$0.00,$5.33,$0.00
214.268,SUP,HCPCS C1713,,214.268  -  SCREW BONE 4.5MM 68MM SHAFT LC-DCP DHS DCS STAINLESS STEEL,$33.45,$0.00,$33.45,$15.05,$23.87,$0.00,$5.76,$0.00,$0.00,$5.86,$33.45,$0.00,$16.73,$26.49,$26.76,$0.00,$5.23,$0.00,$5.33,$0.00
214.272,SUP,HCPCS C1713,,214.272  -  SCREW BONE 4.5MM 8MM 72MM 18MM SHAFT LC-DCP DHS DCS,$33.45,$0.00,$33.45,$15.05,$23.87,$0.00,$5.76,$0.00,$0.00,$5.86,$33.45,$0.00,$16.73,$26.49,$26.76,$0.00,$5.23,$0.00,$5.33,$0.00
214.276,SUP,HCPCS C1713,,214.276  -  SCREW BONE 4.5MM 76MM SHAFT LC-DCP DHS DCS STAINLESS STEEL,$39.75,$0.00,$39.75,$17.89,$28.37,$0.00,$6.85,$0.00,$0.00,$6.96,$39.75,$0.00,$19.88,$31.48,$31.80,$0.00,$6.22,$0.00,$6.33,$0.00
214.28,SUP,HCPCS C1713,,214.280  -  SCREW BONE 4.5MM 80MM SHAFT DCP LC-DCP STAINLESS STEEL,$39.75,$0.00,$39.75,$17.89,$28.37,$0.00,$6.85,$0.00,$0.00,$6.96,$39.75,$0.00,$19.88,$31.48,$31.80,$0.00,$6.22,$0.00,$6.33,$0.00
214.29,SUP,HCPCS C1713,,214.290  -  SCREW BONE 4.5MM 90MM SHAFT LC-DCP STAINLESS STEEL,$39.75,$0.00,$39.75,$17.89,$28.37,$0.00,$6.85,$0.00,$0.00,$6.96,$39.75,$0.00,$19.88,$31.48,$31.80,$0.00,$6.22,$0.00,$6.33,$0.00
214.295,SUP,HCPCS C1713,,214.295  -  SCREW BONE 4.5MM 95MM SHAFT LC-DCP STAINLESS STEEL,$39.75,$0.00,$39.75,$17.89,$28.37,$0.00,$6.85,$0.00,$0.00,$6.96,$39.75,$0.00,$19.88,$31.48,$31.80,$0.00,$6.22,$0.00,$6.33,$0.00
214.3,SUP,HCPCS C1713,,214.300  -  SCREW BONE 4.5MM 100MM SHAFT LC-DCP DCP STAINLESS STEEL,$39.75,$0.00,$39.75,$17.89,$28.37,$0.00,$6.85,$0.00,$0.00,$6.96,$39.75,$0.00,$19.88,$31.48,$31.80,$0.00,$6.22,$0.00,$6.33,$0.00
214.52,SUP,HCPCS C1713,,214.520  -  SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT,$365.75,$0.00,$365.75,$164.59,$261.04,$0.00,$61.18,$0.00,$0.00,$64.04,$365.75,$0.00,$182.88,$289.67,$292.60,$0.00,$55.57,$0.00,$58.23,$0.00
214.522,SUP,HCPCS C1713,,214.522  -  SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT,$365.75,$0.00,$365.75,$164.59,$261.04,$0.00,$61.18,$0.00,$0.00,$64.04,$365.75,$0.00,$182.88,$289.67,$292.60,$0.00,$55.57,$0.00,$58.23,$0.00
214.524,SUP,HCPCS C1713,,214.524  -  SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT,$365.75,$0.00,$365.75,$164.59,$261.04,$0.00,$61.18,$0.00,$0.00,$64.04,$365.75,$0.00,$182.88,$289.67,$292.60,$0.00,$55.57,$0.00,$58.23,$0.00
214.526,SUP,HCPCS C1713,,214.526  -  SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT,$365.75,$0.00,$365.75,$164.59,$261.04,$0.00,$61.18,$0.00,$0.00,$64.04,$365.75,$0.00,$182.88,$289.67,$292.60,$0.00,$55.57,$0.00,$58.23,$0.00
214.528,SUP,HCPCS C1713,,214.528  -  SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT,$365.75,$0.00,$365.75,$164.59,$261.04,$0.00,$61.18,$0.00,$0.00,$64.04,$365.75,$0.00,$182.88,$289.67,$292.60,$0.00,$55.57,$0.00,$58.23,$0.00
214.53,SUP,HCPCS C1713,,214.530  -  SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT,$365.75,$0.00,$365.75,$164.59,$261.04,$0.00,$61.18,$0.00,$0.00,$64.04,$365.75,$0.00,$182.88,$289.67,$292.60,$0.00,$55.57,$0.00,$58.23,$0.00
214.532,SUP,HCPCS C1713,,214.532  -  SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT,$365.75,$0.00,$365.75,$164.59,$261.04,$0.00,$61.18,$0.00,$0.00,$64.04,$365.75,$0.00,$182.88,$289.67,$292.60,$0.00,$55.57,$0.00,$58.23,$0.00
214.534,SUP,HCPCS C1713,,214.534  -  SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT,$365.75,$0.00,$365.75,$164.59,$261.04,$0.00,$61.18,$0.00,$0.00,$64.04,$365.75,$0.00,$182.88,$289.67,$292.60,$0.00,$55.57,$0.00,$58.23,$0.00
214.536,SUP,HCPCS C1713,,214.536  -  SCREW BONE PTHRD 4.5MM 6.5MM 36MM CANN SLFTAP SLFDRILL LARGE,$365.75,$0.00,$365.75,$164.59,$261.04,$0.00,$61.18,$0.00,$0.00,$64.04,$365.75,$0.00,$182.88,$289.67,$292.60,$0.00,$55.57,$0.00,$58.23,$0.00
214.538,SUP,HCPCS C1713,,214.538  -  SCREW BONE PTHRD 4.5MM 6.5MM 38MM CANN LARGE HEXAGONAL,$365.75,$0.00,$365.75,$164.59,$261.04,$0.00,$82.69,$0.00,$0.00,$64.04,$365.75,$0.00,$182.88,$289.67,$292.60,$0.00,$75.11,$0.00,$58.23,$0.00
214.54,SUP,HCPCS C1713,,214.540  -  SCREW BONE PTHRD 4.5MM 6.5MM 40MM CANN REVERSE CUTTING FLUTE,$365.75,$0.00,$365.75,$164.59,$261.04,$0.00,$82.69,$0.00,$0.00,$64.04,$365.75,$0.00,$182.88,$289.67,$292.60,$0.00,$75.11,$0.00,$58.23,$0.00
214.542,SUP,HCPCS C1713,,214.542  -  SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT,$365.75,$0.00,$365.75,$164.59,$261.04,$0.00,$61.18,$0.00,$0.00,$64.04,$365.75,$0.00,$182.88,$289.67,$292.60,$0.00,$55.57,$0.00,$58.23,$0.00
214.544,SUP,HCPCS C1713,,214.544  -  SCREW BONE PTHRD 4.5MM 6.5MM 44MM CANN SLFTAP SLFDRILL LARGE,$365.75,$0.00,$365.75,$164.59,$261.04,$0.00,$82.69,$0.00,$0.00,$64.04,$365.75,$0.00,$182.88,$289.67,$292.60,$0.00,$75.11,$0.00,$58.23,$0.00
214.546,SUP,HCPCS C1713,,214.546  -  SCREW BONE PTHRD 4.5MM 6.5MM 46MM CANN LP HEMISPHERICAL HEAD,$365.75,$0.00,$365.75,$164.59,$261.04,$0.00,$61.18,$0.00,$0.00,$64.04,$365.75,$0.00,$182.88,$289.67,$292.60,$0.00,$55.57,$0.00,$58.23,$0.00
214.548,SUP,HCPCS C1713,,214.548  -  SCREW BONE PTHRD 4.5MM 6.5MM 48MM CANN SLFTAP SLFDRILL LARGE,$365.75,$0.00,$365.75,$164.59,$261.04,$0.00,$61.18,$0.00,$0.00,$64.04,$365.75,$0.00,$182.88,$289.67,$292.60,$0.00,$55.57,$0.00,$58.23,$0.00
214.55,SUP,HCPCS C1713,,214.550  -  SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT,$365.75,$0.00,$365.75,$164.59,$261.04,$0.00,$61.18,$0.00,$0.00,$64.04,$365.75,$0.00,$182.88,$289.67,$292.60,$0.00,$55.57,$0.00,$58.23,$0.00
214.552,SUP,HCPCS C1713,,214.552  -  SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT,$365.75,$0.00,$365.75,$164.59,$261.04,$0.00,$61.18,$0.00,$0.00,$64.04,$365.75,$0.00,$182.88,$289.67,$292.60,$0.00,$55.57,$0.00,$58.23,$0.00
214.554,SUP,HCPCS C1713,,214.554  -  SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT,$365.75,$0.00,$365.75,$164.59,$261.04,$0.00,$61.18,$0.00,$0.00,$64.04,$365.75,$0.00,$182.88,$289.67,$292.60,$0.00,$55.57,$0.00,$58.23,$0.00
214.556,SUP,HCPCS C1713,,214.556  -  SCREW BONE PTHRD 4.5MM 6.5MM 56MM CANN SLFTAP SLFDRILL LARGE,$365.75,$0.00,$365.75,$164.59,$261.04,$0.00,$61.18,$0.00,$0.00,$64.04,$365.75,$0.00,$182.88,$289.67,$292.60,$0.00,$55.57,$0.00,$58.23,$0.00
214.56,SUP,HCPCS C1713,,214.560  -  SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT,$365.75,$0.00,$365.75,$164.59,$261.04,$0.00,$61.18,$0.00,$0.00,$64.04,$365.75,$0.00,$182.88,$289.67,$292.60,$0.00,$55.57,$0.00,$58.23,$0.00
214.564,SUP,HCPCS C1713,,214.564  -  SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT,$365.75,$0.00,$365.75,$164.59,$261.04,$0.00,$61.18,$0.00,$0.00,$64.04,$365.75,$0.00,$182.88,$289.67,$292.60,$0.00,$55.57,$0.00,$58.23,$0.00
214.568,SUP,HCPCS C1713,,214.568  -  SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT,$365.75,$0.00,$365.75,$164.59,$261.04,$0.00,$61.18,$0.00,$0.00,$64.04,$365.75,$0.00,$182.88,$289.67,$292.60,$0.00,$55.57,$0.00,$58.23,$0.00
214.572,SUP,HCPCS C1713,,214.572  -  SCREW BONE 4.5MM 72MM 24MM CANN PTTHRD STAINLESS STEEL,$365.75,$0.00,$365.75,$164.59,$261.04,$0.00,$61.18,$0.00,$0.00,$64.04,$365.75,$0.00,$182.88,$289.67,$292.60,$0.00,$55.57,$0.00,$58.23,$0.00
214.576,SUP,HCPCS C1713,,214.576  -  SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT,$376.68,$0.00,$376.68,$169.50,$268.83,$0.00,$63.01,$0.00,$0.00,$65.95,$376.68,$0.00,$188.34,$298.33,$301.34,$0.00,$57.23,$0.00,$59.97,$0.00
214.58,SUP,HCPCS C1713,,214.580  -  SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT,$376.68,$0.00,$376.68,$169.50,$268.83,$0.00,$63.01,$0.00,$0.00,$65.95,$376.68,$0.00,$188.34,$298.33,$301.34,$0.00,$57.23,$0.00,$59.97,$0.00
214.72,SUP,HCPCS C1713,,214.720  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE,$376.68,$0.00,$376.68,$169.50,$268.83,$0.00,$63.01,$0.00,$0.00,$65.95,$376.68,$0.00,$188.34,$298.33,$301.34,$0.00,$57.23,$0.00,$59.97,$0.00
214.722,SUP,HCPCS C1713,,214.722  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE,$376.68,$0.00,$376.68,$169.50,$268.83,$0.00,$63.01,$0.00,$0.00,$65.95,$376.68,$0.00,$188.34,$298.33,$301.34,$0.00,$57.23,$0.00,$59.97,$0.00
214.724,SUP,HCPCS C1713,,214.724  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE,$376.68,$0.00,$376.68,$169.50,$268.83,$0.00,$63.01,$0.00,$0.00,$65.95,$376.68,$0.00,$188.34,$298.33,$301.34,$0.00,$57.23,$0.00,$59.97,$0.00
214.726,SUP,HCPCS C1713,,214.726  -  SCREW BONE HEMISPHERE FULTHD 4.5MM 6.5MM 1.75MM 26MM CANN,$376.68,$0.00,$376.68,$169.50,$268.83,$0.00,$63.01,$0.00,$0.00,$65.95,$376.68,$0.00,$188.34,$298.33,$301.34,$0.00,$57.23,$0.00,$59.97,$0.00
214.728,SUP,HCPCS C1713,,214.728  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE,$376.68,$0.00,$376.68,$169.50,$268.83,$0.00,$63.01,$0.00,$0.00,$65.95,$376.68,$0.00,$188.34,$298.33,$301.34,$0.00,$57.23,$0.00,$59.97,$0.00
214.73,SUP,HCPCS C1713,,214.730  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE,$376.68,$0.00,$376.68,$169.50,$268.83,$0.00,$63.01,$0.00,$0.00,$65.95,$376.68,$0.00,$188.34,$298.33,$301.34,$0.00,$57.23,$0.00,$59.97,$0.00
214.732,SUP,HCPCS C1713,,214.732  -  SCREW BONE HEMISPHERE FULTHD 4.5MM 6.5MM 1.75MM 32MM CANN,$376.68,$0.00,$376.68,$169.50,$268.83,$0.00,$63.01,$0.00,$0.00,$65.95,$376.68,$0.00,$188.34,$298.33,$301.34,$0.00,$57.23,$0.00,$59.97,$0.00
214.734,SUP,HCPCS C1713,,214.734  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE,$376.68,$0.00,$376.68,$169.50,$268.83,$0.00,$63.01,$0.00,$0.00,$65.95,$376.68,$0.00,$188.34,$298.33,$301.34,$0.00,$57.23,$0.00,$59.97,$0.00
214.736,SUP,HCPCS C1713,,214.736  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE,$376.68,$0.00,$376.68,$169.50,$268.83,$0.00,$63.01,$0.00,$0.00,$65.95,$376.68,$0.00,$188.34,$298.33,$301.34,$0.00,$57.23,$0.00,$59.97,$0.00
214.738,SUP,HCPCS C1713,,214.738  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE,$376.68,$0.00,$376.68,$169.50,$268.83,$0.00,$63.01,$0.00,$0.00,$65.95,$376.68,$0.00,$188.34,$298.33,$301.34,$0.00,$57.23,$0.00,$59.97,$0.00
214.74,SUP,HCPCS C1713,,214.740  -  SCREW BONE 3.5MM FULTHD 4.5MM 6.5MM 40MM CANN SELF DRILL,$376.68,$0.00,$376.68,$169.50,$268.83,$0.00,$63.01,$0.00,$0.00,$65.95,$376.68,$0.00,$188.34,$298.33,$301.34,$0.00,$57.23,$0.00,$59.97,$0.00
214.742,SUP,HCPCS C1713,,214.742  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE,$376.68,$0.00,$376.68,$169.50,$268.83,$0.00,$63.01,$0.00,$0.00,$65.95,$376.68,$0.00,$188.34,$298.33,$301.34,$0.00,$57.23,$0.00,$59.97,$0.00
214.744,SUP,HCPCS C1713,,214.744  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE,$376.68,$0.00,$376.68,$169.50,$268.83,$0.00,$63.01,$0.00,$0.00,$65.95,$376.68,$0.00,$188.34,$298.33,$301.34,$0.00,$57.23,$0.00,$59.97,$0.00
214.746,SUP,HCPCS C1713,,214.746  -  SCREW BONE FULTHD 4.5MM 6.5MM 46MM CANN SELF TAP LARGE,$376.68,$0.00,$376.68,$169.50,$268.83,$0.00,$63.01,$0.00,$0.00,$65.95,$376.68,$0.00,$188.34,$298.33,$301.34,$0.00,$57.23,$0.00,$59.97,$0.00
214.748,SUP,HCPCS C1713,,214.748  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE,$376.68,$0.00,$376.68,$169.50,$268.83,$0.00,$63.01,$0.00,$0.00,$65.95,$376.68,$0.00,$188.34,$298.33,$301.34,$0.00,$57.23,$0.00,$59.97,$0.00
214.75,SUP,HCPCS C1713,,214.750  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE,$376.68,$0.00,$376.68,$169.50,$268.83,$0.00,$63.01,$0.00,$0.00,$65.95,$376.68,$0.00,$188.34,$298.33,$301.34,$0.00,$57.23,$0.00,$59.97,$0.00
214.752,SUP,HCPCS C1713,,214.752  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE,$376.68,$0.00,$376.68,$169.50,$268.83,$0.00,$63.01,$0.00,$0.00,$65.95,$376.68,$0.00,$188.34,$298.33,$301.34,$0.00,$57.23,$0.00,$59.97,$0.00
214.754,SUP,HCPCS C1713,,214.754  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE,$376.68,$0.00,$376.68,$169.50,$268.83,$0.00,$63.01,$0.00,$0.00,$65.95,$376.68,$0.00,$188.34,$298.33,$301.34,$0.00,$57.23,$0.00,$59.97,$0.00
214.756,SUP,HCPCS C1713,,214.756  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE,$376.68,$0.00,$376.68,$169.50,$268.83,$0.00,$63.01,$0.00,$0.00,$65.95,$376.68,$0.00,$188.34,$298.33,$301.34,$0.00,$57.23,$0.00,$59.97,$0.00
214.76,SUP,HCPCS C1713,,214.760  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE,$376.68,$0.00,$376.68,$169.50,$268.83,$0.00,$63.01,$0.00,$0.00,$65.95,$376.68,$0.00,$188.34,$298.33,$301.34,$0.00,$57.23,$0.00,$59.97,$0.00
214.764,SUP,HCPCS C1713,,214.764  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE,$376.68,$0.00,$376.68,$169.50,$268.83,$0.00,$63.01,$0.00,$0.00,$65.95,$376.68,$0.00,$188.34,$298.33,$301.34,$0.00,$57.23,$0.00,$59.97,$0.00
214.768,SUP,HCPCS C1713,,214.768  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE,$376.68,$0.00,$376.68,$169.50,$268.83,$0.00,$63.01,$0.00,$0.00,$65.95,$376.68,$0.00,$188.34,$298.33,$301.34,$0.00,$57.23,$0.00,$59.97,$0.00
214.772,SUP,HCPCS C1713,,214.772  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE,$376.68,$0.00,$376.68,$169.50,$268.83,$0.00,$63.01,$0.00,$0.00,$65.95,$376.68,$0.00,$188.34,$298.33,$301.34,$0.00,$57.23,$0.00,$59.97,$0.00
214.776,SUP,HCPCS C1713,,214.776  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE,$376.68,$0.00,$376.68,$169.50,$268.83,$0.00,$63.01,$0.00,$0.00,$65.95,$376.68,$0.00,$188.34,$298.33,$301.34,$0.00,$57.23,$0.00,$59.97,$0.00
214.777,SUP,HCPCS C1713,,214.777  -  SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE,$376.68,$0.00,$376.68,$169.50,$268.83,$0.00,$63.01,$0.00,$0.00,$65.95,$376.68,$0.00,$188.34,$298.33,$301.34,$0.00,$57.23,$0.00,$59.97,$0.00
214.814,SUP,HCPCS C1713,,214.814  -  SCREW BONE 4.5MM 8MM 14MM SLFTAP LARGE HEXAGONAL SOCKET LCP,$38.88,$0.00,$38.88,$17.49,$27.75,$0.00,$6.50,$0.00,$0.00,$6.81,$38.88,$0.00,$19.44,$30.79,$31.10,$0.00,$5.91,$0.00,$6.19,$0.00
214.816,SUP,HCPCS C1713,,214.816  -  SCREW BONE LARGE HEXAGON 4.5MM 8MM 16MM SELF TAP SOCKET LCP,$38.88,$0.00,$38.88,$17.49,$27.75,$0.00,$6.50,$0.00,$0.00,$6.81,$38.88,$0.00,$19.44,$30.79,$31.10,$0.00,$5.91,$0.00,$6.19,$0.00
214.818,SUP,HCPCS C1713,,214.818  -  SCREW BONE 4.5MM 8MM 18MM SLFTAP LARGE HEXAGONAL SOCKET LCP,$38.88,$0.00,$38.88,$17.49,$27.75,$0.00,$6.50,$0.00,$0.00,$6.81,$38.88,$0.00,$19.44,$30.79,$31.10,$0.00,$5.91,$0.00,$6.19,$0.00
214.82,SUP,HCPCS C1713,,214.820  -  SCREW BONE LARGE HEXAGON 4.5MM 8MM 20MM SELF TAP SOCKET LCP,$38.88,$0.00,$38.88,$17.49,$27.75,$0.00,$6.50,$0.00,$0.00,$6.81,$38.88,$0.00,$19.44,$30.79,$31.10,$0.00,$5.91,$0.00,$6.19,$0.00
214.822,SUP,HCPCS C1713,,214.822  -  SCREW BONE LARGE HEXAGON 4.5MM 8MM 22MM SELF TAP SOCKET LCP,$38.88,$0.00,$38.88,$17.49,$27.75,$0.00,$6.50,$0.00,$0.00,$6.81,$38.88,$0.00,$19.44,$30.79,$31.10,$0.00,$5.91,$0.00,$6.19,$0.00
214.824,SUP,HCPCS C1713,,214.824  -  SCREW BONE 4.5MM 8MM 24MM SLFTAP LARGE HEXAGONAL SOCKET LCP,$38.88,$0.00,$38.88,$17.49,$27.75,$0.00,$6.50,$0.00,$0.00,$6.81,$38.88,$0.00,$19.44,$30.79,$31.10,$0.00,$5.91,$0.00,$6.19,$0.00
214.826,SUP,HCPCS C1713,,214.826  -  SCREW BONE 4.5MM 8MM 26MM SLFTAP LARGE HEXAGONAL SOCKET LCP,$38.88,$0.00,$38.88,$17.49,$27.75,$0.00,$6.50,$0.00,$0.00,$6.81,$38.88,$0.00,$19.44,$30.79,$31.10,$0.00,$5.91,$0.00,$6.19,$0.00
214.828,SUP,HCPCS C1713,,214.828  -  SCREW BONE 4.5MM 28MM SLFTAP LCP STAINLESS STEEL PEDIATRIC,$38.88,$0.00,$38.88,$17.49,$27.75,$0.00,$6.50,$0.00,$0.00,$6.81,$38.88,$0.00,$19.44,$30.79,$31.10,$0.00,$5.91,$0.00,$6.19,$0.00
214.83,SUP,HCPCS C1713,,214.830  -  SCREW BONE 4.5MM 8MM 30MM SLFTAP LARGE HEXAGONAL SOCKET LCP,$38.88,$0.00,$38.88,$17.49,$27.75,$0.00,$6.50,$0.00,$0.00,$6.81,$38.88,$0.00,$19.44,$30.79,$31.10,$0.00,$5.91,$0.00,$6.19,$0.00
214.83,SUP,HCPCS C1713,,214.83  -  SCREW BONE 4.5MM 8MM 30MM SLFTAP LARGE HEXAGONAL SOCKET LCP,$113.25,$0.00,$89.69,$17.49,$27.75,$0.00,$6.50,$0.00,$0.00,$6.81,$38.88,$0.00,$19.44,$89.69,$31.10,$0.00,$5.91,$0.00,$6.19,$0.00
214.832,SUP,HCPCS C1713,,214.832  -  SCREW BONE 4.5MM 8MM 32MM SLFTAP LARGE HEXAGONAL SOCKET LCP,$38.88,$0.00,$38.88,$17.49,$27.75,$0.00,$6.50,$0.00,$0.00,$6.81,$38.88,$0.00,$19.44,$30.79,$31.10,$0.00,$5.91,$0.00,$6.19,$0.00
214.834,SUP,HCPCS C1713,,214.834  -  SCREW BONE 4.5MM 8MM 34MM SLFTAP LARGE HEXAGONAL SOCKET LCP,$38.88,$0.00,$38.88,$17.49,$27.75,$0.00,$6.50,$0.00,$0.00,$6.81,$38.88,$0.00,$19.44,$30.79,$31.10,$0.00,$5.91,$0.00,$6.19,$0.00
214.836,SUP,HCPCS C1713,,214.836  -  SCREW BONE 4.5MM 8MM 36MM SLFTAP LARGE HEXAGONAL SOCKET LCP,$38.88,$0.00,$38.88,$17.49,$27.75,$0.00,$6.50,$0.00,$0.00,$6.81,$38.88,$0.00,$19.44,$30.79,$31.10,$0.00,$5.91,$0.00,$6.19,$0.00
214.838,SUP,HCPCS C1713,,214.838  -  SCREW BONE 4.5MM 38MM SLFTAP LC-DCP DHS DCS STAINLESS STEEL,$38.88,$0.00,$38.88,$17.49,$27.75,$0.00,$6.50,$0.00,$0.00,$6.81,$38.88,$0.00,$19.44,$30.79,$31.10,$0.00,$5.91,$0.00,$6.19,$0.00
214.84,SUP,HCPCS C1713,,214.840  -  SCREW BONE STANDARD 4.5MM 40MM SLFTAP TIP LCP STAINLESS,$38.88,$0.00,$226.50,$101.93,$161.65,$0.00,$39.02,$0.00,$0.00,$39.66,$226.50,$0.00,$113.25,$30.79,$181.20,$0.00,$35.45,$0.00,$36.06,$0.00
214.84,SUP,HCPCS C1713,,214.84  -  SCREW BN 4.5MM 8MM 40MM NS ST LG HEX SCKT SS CORT LG FRAG,$226.50,$0.00,$226.50,$101.93,$161.65,$0.00,$39.02,$0.00,$0.00,$39.66,$226.50,$0.00,$113.25,$179.39,$181.20,$0.00,$35.45,$0.00,$36.06,$0.00
214.842,SUP,HCPCS C1713,,214.842  -  SCREW BONE 4.5MM 8MM 42MM SLFTAP LARGE HEXAGONAL SOCKET LCP,$38.88,$0.00,$38.88,$17.49,$27.75,$0.00,$6.50,$0.00,$0.00,$6.81,$38.88,$0.00,$19.44,$30.79,$31.10,$0.00,$5.91,$0.00,$6.19,$0.00
214.844,SUP,HCPCS C1713,,214.844  -  SCREW BONE 4.5MM 8MM 44MM SLFTAP LARGE HEXAGONAL SOCKET LCP,$38.88,$0.00,$38.88,$17.49,$27.75,$0.00,$6.50,$0.00,$0.00,$6.81,$38.88,$0.00,$19.44,$30.79,$31.10,$0.00,$5.91,$0.00,$6.19,$0.00
214.846,SUP,HCPCS C1713,,214.846  -  SCREW BONE 4.5MM 46MM SLFTAP TIP LCP STAINLESS STEEL,$38.88,$0.00,$38.88,$17.49,$27.75,$0.00,$6.50,$0.00,$0.00,$6.81,$38.88,$0.00,$19.44,$30.79,$31.10,$0.00,$5.91,$0.00,$6.19,$0.00
214.848,SUP,HCPCS C1713,,214.848  -  SCREW BONE 4.5MM 48MM SLFTAP LC-DCP DHS DCS STAINLESS STEEL,$38.88,$0.00,$38.88,$17.49,$27.75,$0.00,$6.50,$0.00,$0.00,$6.81,$38.88,$0.00,$19.44,$30.79,$31.10,$0.00,$5.91,$0.00,$6.19,$0.00
214.85,SUP,HCPCS C1713,,214.850  -  SCREW BONE 4.5MM 8MM 50MM SLFTAP LARGE HEXAGONAL SOCKET LCP,$38.88,$0.00,$113.25,$50.96,$80.83,$0.00,$19.51,$0.00,$0.00,$19.83,$113.25,$0.00,$56.63,$30.79,$90.60,$0.00,$17.72,$0.00,$18.03,$0.00
214.85,SUP,HCPCS C1713,,214.85  -  SCREW BONE 4.5MM 8MM 50MM SLFTAP LARGE HEXAGONAL SOCKET LCP,$113.25,$0.00,$113.25,$50.96,$80.83,$0.00,$19.51,$0.00,$0.00,$19.83,$113.25,$0.00,$56.63,$89.69,$90.60,$0.00,$17.72,$0.00,$18.03,$0.00
214.852,SUP,HCPCS C1713,,214.852  -  SCREW BONE 4.5MM 52MM SELF TAP LC-DCP DHS DCS STAINLESS,$38.88,$0.00,$38.88,$17.49,$27.75,$0.00,$6.50,$0.00,$0.00,$6.81,$38.88,$0.00,$19.44,$30.79,$31.10,$0.00,$5.91,$0.00,$6.19,$0.00
214.854,SUP,HCPCS C1713,,214.854  -  SCREW BONE 4.5MM 54MM SLFTAP LC-DCP DHS DCS STAINLESS STEEL,$38.88,$0.00,$38.88,$17.49,$27.75,$0.00,$6.50,$0.00,$0.00,$6.81,$38.88,$0.00,$19.44,$30.79,$31.10,$0.00,$5.91,$0.00,$6.19,$0.00
214.856,SUP,HCPCS C1713,,214.856  -  SCREW BONE 4.5MM 56MM SLFTAP LC-DCP DHS DCS STAINLESS STEEL,$38.88,$0.00,$38.88,$17.49,$27.75,$0.00,$6.50,$0.00,$0.00,$6.81,$38.88,$0.00,$19.44,$30.79,$31.10,$0.00,$5.91,$0.00,$6.19,$0.00
214.858,SUP,HCPCS C1713,,214.858  -  SCREW BONE LARGE HEXAGON 4.5MM 8MM 58MM SELF TAP SOCKET LCP,$38.88,$0.00,$38.88,$17.49,$27.75,$0.00,$6.50,$0.00,$0.00,$6.81,$38.88,$0.00,$19.44,$30.79,$31.10,$0.00,$5.91,$0.00,$6.19,$0.00
214.86,SUP,HCPCS C1713,,214.860  -  SCREW BONE 4.5MM 8MM 60MM SELF TAP HEXAGONAL SOCKET LCP,$38.88,$0.00,$38.88,$17.49,$27.75,$0.00,$6.50,$0.00,$0.00,$6.81,$38.88,$0.00,$19.44,$30.79,$31.10,$0.00,$5.91,$0.00,$6.19,$0.00
214.86,SUP,HCPCS C1713,,214.86  -  SCREW BONE 4.5MM 8MM 60MM SELF TAP HEXAGONAL SOCKET LCP,$75.50,$0.00,$59.80,$17.49,$27.75,$0.00,$6.50,$0.00,$0.00,$6.81,$38.88,$0.00,$19.44,$59.80,$31.10,$0.00,$5.91,$0.00,$6.19,$0.00
214.862,SUP,HCPCS C1713,,214.862  -  SCREW BONE LARGE HEXAGON 4.5MM 8MM 62MM SELF TAP SOCKET LCP,$38.88,$0.00,$38.88,$17.49,$27.75,$0.00,$6.50,$0.00,$0.00,$6.81,$38.88,$0.00,$19.44,$30.79,$31.10,$0.00,$5.91,$0.00,$6.19,$0.00
214.864,SUP,HCPCS C1713,,214.864  -  SCREW BONE 4.5MM 8MM 64MM SLFTAP LARGE HEXAGONAL SOCKET LCP,$38.88,$0.00,$38.88,$17.49,$27.75,$0.00,$6.50,$0.00,$0.00,$6.81,$38.88,$0.00,$19.44,$30.79,$31.10,$0.00,$5.91,$0.00,$6.19,$0.00
214.866,SUP,HCPCS C1713,,214.866  -  SCREW BONE LARGE HEXAGON 4.5MM 8MM 66MM SELF TAP SOCKET LCP,$38.88,$0.00,$38.88,$17.49,$27.75,$0.00,$6.50,$0.00,$0.00,$6.81,$38.88,$0.00,$19.44,$30.79,$31.10,$0.00,$5.91,$0.00,$6.19,$0.00
214.868,SUP,HCPCS C1713,,214.868  -  SCREW BONE 4.5MM 8MM 68MM SLFTAP LARGE HEXAGONAL SOCKET LCP,$38.88,$0.00,$38.88,$17.49,$27.75,$0.00,$6.50,$0.00,$0.00,$6.81,$38.88,$0.00,$19.44,$30.79,$31.10,$0.00,$5.91,$0.00,$6.19,$0.00
214.87,SUP,HCPCS C1713,,214.870  -  SCREW BONE LARGE HEXAGON 4.5MM 8MM 70MM SELF TAP SOCKET LCP,$38.88,$0.00,$75.50,$33.98,$53.88,$0.00,$13.01,$0.00,$0.00,$13.22,$75.50,$0.00,$37.75,$30.79,$60.40,$0.00,$11.82,$0.00,$12.02,$0.00
214.87,SUP,HCPCS C1713,,214.87  -  SCREW BONE LARGE HEXAGON 4.5MM 8MM 70MM SELF TAP SOCKET LCP,$75.50,$0.00,$75.50,$33.98,$53.88,$0.00,$13.01,$0.00,$0.00,$13.22,$75.50,$0.00,$37.75,$59.80,$60.40,$0.00,$11.82,$0.00,$12.02,$0.00
214.872,SUP,HCPCS C1713,,214.872  -  SCREW BONE 4.5MM 8MM 72MM SELF TAP HEXAGONAL SOCKET LCP,$38.88,$0.00,$38.88,$17.49,$27.75,$0.00,$6.50,$0.00,$0.00,$6.81,$38.88,$0.00,$19.44,$30.79,$31.10,$0.00,$5.91,$0.00,$6.19,$0.00
214.876,SUP,HCPCS C1713,,214.876  -  SCREW BONE 4.5MM 8MM 76MM SELF TAP HEXAGONAL SOCKET LCP,$64.15,$0.00,$64.15,$28.87,$45.78,$0.00,$10.73,$0.00,$0.00,$11.23,$64.15,$0.00,$32.08,$50.81,$51.32,$0.00,$9.75,$0.00,$10.21,$0.00
214.88,SUP,HCPCS C1713,,214.880  -  SCREW BONE 4.5MM 80MM SLFTAP LARGE HEXAGONAL SOCKET LCP,$64.15,$0.00,$64.15,$28.87,$45.78,$0.00,$15.71,$0.00,$0.00,$11.23,$64.15,$0.00,$32.08,$50.81,$51.32,$0.00,$14.27,$0.00,$10.21,$0.00
214.885,SUP,HCPCS C1713,,214.885  -  SCREW BONE 4.5MM 8MM 85MM SELF TAP HEXAGONAL SOCKET LCP,$64.15,$0.00,$64.15,$28.87,$45.78,$0.00,$15.71,$0.00,$0.00,$11.23,$64.15,$0.00,$32.08,$50.81,$51.32,$0.00,$14.27,$0.00,$10.21,$0.00
214.89,SUP,HCPCS C1713,,214.890  -  SCREW BONE 4.5MM 8MM 90MM SELF TAP HEXAGONAL SOCKET LCP,$64.15,$0.00,$64.15,$28.87,$45.78,$0.00,$10.73,$0.00,$0.00,$11.23,$64.15,$0.00,$32.08,$50.81,$51.32,$0.00,$9.75,$0.00,$10.21,$0.00
214.895,SUP,HCPCS C1713,,214.895  -  SCREW BONE 4.5MM 8MM 95MM SELF TAP LARGE HEXAGONAL SOCKET,$64.15,$0.00,$64.15,$28.87,$45.78,$0.00,$10.73,$0.00,$0.00,$11.23,$64.15,$0.00,$32.08,$50.81,$51.32,$0.00,$9.75,$0.00,$10.21,$0.00
214.9,SUP,HCPCS C1713,,214.900  -  SCREW BONE 4.5MM 8MM 100MM SELF TAP HEXAGONAL SOCKET LCP,$64.15,$0.00,$64.15,$28.87,$45.78,$0.00,$15.71,$0.00,$0.00,$11.23,$64.15,$0.00,$32.08,$50.81,$51.32,$0.00,$14.27,$0.00,$10.21,$0.00
214.905,SUP,HCPCS C1713,,214.905  -  SCREW BONE 4.5MM 8MM 105MM SELF TAP HEXAGONAL SOCKET LCP,$64.15,$0.00,$64.15,$28.87,$45.78,$0.00,$10.73,$0.00,$0.00,$11.23,$64.15,$0.00,$32.08,$50.81,$51.32,$0.00,$9.75,$0.00,$10.21,$0.00
214.91,SUP,HCPCS C1713,,214.910  -  SCREW BONE 4.5MM 8MM 110MM SELF TAP HEXAGONAL SOCKET LCP,$64.15,$0.00,$64.15,$28.87,$45.78,$0.00,$10.73,$0.00,$0.00,$11.23,$64.15,$0.00,$32.08,$50.81,$51.32,$0.00,$9.75,$0.00,$10.21,$0.00
214.915,SUP,HCPCS C1713,,214.915  -  SCREW BONE 4.5MM 8MM 115MM SELF TAP HEXAGONAL SOCKET LCP,$64.15,$0.00,$64.15,$28.87,$45.78,$0.00,$10.73,$0.00,$0.00,$11.23,$64.15,$0.00,$32.08,$50.81,$51.32,$0.00,$9.75,$0.00,$10.21,$0.00
214.92,SUP,HCPCS C1713,,214.920  -  SCREW BONE LARGE HEXAGON 4.5MM 8MM 120MM SELF TAP SOCKET LCP,$64.15,$0.00,$64.15,$28.87,$45.78,$0.00,$10.73,$0.00,$0.00,$11.23,$64.15,$0.00,$32.08,$50.81,$51.32,$0.00,$9.75,$0.00,$10.21,$0.00
214.925,SUP,HCPCS C1713,,214.925  -  SCREW BONE 4.5MM 8MM 125MM SELF TAP HEXAGONAL SOCKET LCP,$64.15,$0.00,$64.15,$28.87,$45.78,$0.00,$10.73,$0.00,$0.00,$11.23,$64.15,$0.00,$32.08,$50.81,$51.32,$0.00,$9.75,$0.00,$10.21,$0.00
214.93,SUP,HCPCS C1713,,214.930  -  SCREW BONE LARGE HEXAGON 4.5MM 8MM 130MM SELF TAP SOCKET LCP,$64.15,$0.00,$64.15,$28.87,$45.78,$0.00,$10.73,$0.00,$0.00,$11.23,$64.15,$0.00,$32.08,$50.81,$51.32,$0.00,$9.75,$0.00,$10.21,$0.00
214.935,SUP,HCPCS C1713,,214.935  -  SCREW BONE 4.5MM 8MM 135MM SELF TAP HEXAGONAL SOCKET LCP,$64.15,$0.00,$64.15,$28.87,$45.78,$0.00,$10.73,$0.00,$0.00,$11.23,$64.15,$0.00,$32.08,$50.81,$51.32,$0.00,$9.75,$0.00,$10.21,$0.00
214.94,SUP,HCPCS C1713,,214.940  -  SCREW BONE 4.5MM 8MM 140MM SLFTAP LARGE HEXAGONAL SOCKET LCP,$64.15,$0.00,$64.15,$28.87,$45.78,$0.00,$10.73,$0.00,$0.00,$11.23,$64.15,$0.00,$32.08,$50.81,$51.32,$0.00,$9.75,$0.00,$10.21,$0.00
214.945,SUP,HCPCS C1713,,214.945  -  SCREW BONE 4.5MM 8MM 145MM SELF TAP HEXAGONAL SOCKET LCP,$64.15,$0.00,$64.15,$28.87,$45.78,$0.00,$10.73,$0.00,$0.00,$11.23,$64.15,$0.00,$32.08,$50.81,$51.32,$0.00,$9.75,$0.00,$10.21,$0.00
215.025,SUP,HCPCS C1713,,215.025  -  SCREW BONE 3.5MM HEXAGON 4.5MM 8MM 25MM 12MM DCP LC-DCP,$56.30,$0.00,$56.30,$25.34,$40.18,$0.00,$9.70,$0.00,$0.00,$9.86,$56.30,$0.00,$28.15,$44.59,$45.04,$0.00,$8.81,$0.00,$8.96,$0.00
215.03,SUP,HCPCS C1713,,215.030  -  SCREW BONE PTHRD 4.5MM 8MM 30MM 15MM HEXAGONAL SOCKET LCP,$56.30,$0.00,$56.30,$25.34,$40.18,$0.00,$9.70,$0.00,$0.00,$9.86,$56.30,$0.00,$28.15,$44.59,$45.04,$0.00,$8.81,$0.00,$8.96,$0.00
215.035,SUP,HCPCS C1713,,215.035  -  SCREW BONE 4.5MM 35MM IMPLANT LC-DCP DCP MALLEOLAR LARGE,$56.30,$0.00,$56.30,$25.34,$40.18,$0.00,$9.70,$0.00,$0.00,$9.86,$56.30,$0.00,$28.15,$44.59,$45.04,$0.00,$8.81,$0.00,$8.96,$0.00
215.04,SUP,HCPCS C1713,,215.040  -  SCREW BONE 4.5MM 40MM DCP LC-DCP STAINLESS STEEL MALLEOLAR,$56.30,$0.00,$56.30,$25.34,$40.18,$0.00,$9.70,$0.00,$0.00,$9.86,$56.30,$0.00,$28.15,$44.59,$45.04,$0.00,$8.81,$0.00,$8.96,$0.00
215.045,SUP,HCPCS C1713,,215.045  -  SCREW BONE 3.5MM 4.5MM 8MM 45MM 22MM HEXAGONAL SOCKET LC-DCP,$56.30,$0.00,$56.30,$25.34,$40.18,$0.00,$9.70,$0.00,$0.00,$9.86,$56.30,$0.00,$28.15,$44.59,$45.04,$0.00,$8.81,$0.00,$8.96,$0.00
215.05,SUP,HCPCS C1713,,215.050  -  SCREW BONE PTHRD 4.5MM 8MM 50MM 24MM HEXAGONAL SOCKET LCP,$56.30,$0.00,$56.30,$25.34,$40.18,$0.00,$9.70,$0.00,$0.00,$9.86,$56.30,$0.00,$28.15,$44.59,$45.04,$0.00,$8.81,$0.00,$8.96,$0.00
215.055,SUP,HCPCS C1713,,215.055  -  SCREW BONE 3.5MM HEXAGON 4.5MM 8MM 55MM 26MM DCP LC-DCP,$56.30,$0.00,$56.30,$25.34,$40.18,$0.00,$9.70,$0.00,$0.00,$9.86,$56.30,$0.00,$28.15,$44.59,$45.04,$0.00,$8.81,$0.00,$8.96,$0.00
215.06,SUP,HCPCS C1713,,215.060  -  SCREW BONE 3.5MM 4.5MM 8MM 60MM 28MM HEXAGONAL SOCKET LCP,$56.30,$0.00,$56.30,$25.34,$40.18,$0.00,$9.70,$0.00,$0.00,$9.86,$56.30,$0.00,$28.15,$44.59,$45.04,$0.00,$8.81,$0.00,$8.96,$0.00
215.065,SUP,HCPCS C1713,,215.065  -  SCREW BONE 3.5MM 4.5MM 65MM 30MM HEXAGONAL SOCKET LCP,$56.30,$0.00,$56.30,$25.34,$40.18,$0.00,$9.70,$0.00,$0.00,$9.86,$56.30,$0.00,$28.15,$44.59,$45.04,$0.00,$8.81,$0.00,$8.96,$0.00
215.07,SUP,HCPCS C1713,,215.070  -  SCREW BONE 3.5MM 4.5MM 8MM 70MM 32MM HEXAGONAL SOCKET LCP,$56.30,$0.00,$56.30,$25.34,$40.18,$0.00,$9.70,$0.00,$0.00,$9.86,$56.30,$0.00,$28.15,$44.59,$45.04,$0.00,$8.81,$0.00,$8.96,$0.00
215.075,SUP,HCPCS C1713,,215.075  -  SCREW BONE 4.5MM 75MM LC-DCP STAINLESS STEEL MALLEOLAR,$56.30,$0.00,$56.30,$25.34,$40.18,$0.00,$9.70,$0.00,$0.00,$9.86,$56.30,$0.00,$28.15,$44.59,$45.04,$0.00,$8.81,$0.00,$8.96,$0.00
215.08,SUP,HCPCS C1713,,215.080  -  SCREW BONE 4.5MM 80MM LC-DCP STAINLESS STEEL MALLEOLAR,$56.30,$0.00,$56.30,$25.34,$40.18,$0.00,$9.70,$0.00,$0.00,$9.86,$56.30,$0.00,$28.15,$44.59,$45.04,$0.00,$8.81,$0.00,$8.96,$0.00
215.222,SUP,HCPCS C1713,,"215.222  -  3.5MM SS PROTEX CT POLYAXAIL SHOULDER SCREW, 22MM","$4,000.00",$0.00,"$4,000.00","$1,800.00","$2,854.80",$0.00,$689.18,$0.00,$0.00,$700.37,"$4,000.00",$0.00,"$2,000.00","$3,168.00","$3,200.00",$0.00,$626.00,$0.00,$636.80,$0.00
215.224,SUP,HCPCS C1713,,"215.224  -  3.5MM SS PROTEX CT POLYAXAIL SHOULDER SCREW, 24MM","$4,000.00",$0.00,"$4,000.00","$1,800.00","$2,854.80",$0.00,$689.18,$0.00,$0.00,$700.37,"$4,000.00",$0.00,"$2,000.00","$3,168.00","$3,200.00",$0.00,$626.00,$0.00,$636.80,$0.00
215.226,SUP,HCPCS C1713,,"215.226  -  3.5MM SS PROTEX CT POLYAXAIL SHOULDER SCREW, 26MM","$4,000.00",$0.00,"$4,000.00","$1,800.00","$2,854.80",$0.00,$689.18,$0.00,$0.00,$700.37,"$4,000.00",$0.00,"$2,000.00","$3,168.00","$3,200.00",$0.00,$626.00,$0.00,$636.80,$0.00
215.228,SUP,HCPCS C1713,,"215.228  -  3.5MM SS PROTEX CT POLYAXAIL SHOULDER SCREW, 28MM","$4,000.00",$0.00,"$4,000.00","$1,800.00","$2,854.80",$0.00,$689.18,$0.00,$0.00,$700.37,"$4,000.00",$0.00,"$2,000.00","$3,168.00","$3,200.00",$0.00,$626.00,$0.00,$636.80,$0.00
215.23,SUP,HCPCS C1713,,"215.230  -  3.5MM SS PROTEX CT POLYAXAIL SHOULDER SCREW, 30MM","$4,000.00",$0.00,"$4,000.00","$1,800.00","$2,854.80",$0.00,$689.18,$0.00,$0.00,$700.37,"$4,000.00",$0.00,"$2,000.00","$3,168.00","$3,200.00",$0.00,$626.00,$0.00,$636.80,$0.00
215.232,SUP,HCPCS C1713,,"215.232  -  3.5MM SS PROTEX CT POLYAXAIL SHOULDER SCREW, 32MM","$4,000.00",$0.00,"$4,000.00","$1,800.00","$2,854.80",$0.00,$689.18,$0.00,$0.00,$700.37,"$4,000.00",$0.00,"$2,000.00","$3,168.00","$3,200.00",$0.00,$626.00,$0.00,$636.80,$0.00
215.234,SUP,HCPCS C1713,,"215.234  -  3.5MM SS PROTEX CT POLYAXAIL SHOULDER SCREW, 34MM","$4,000.00",$0.00,"$4,000.00","$1,800.00","$2,854.80",$0.00,$689.18,$0.00,$0.00,$700.37,"$4,000.00",$0.00,"$2,000.00","$3,168.00","$3,200.00",$0.00,$626.00,$0.00,$636.80,$0.00
215.236,SUP,HCPCS C1713,,"215.236  -  3.5MM SS PROTEX CT POLYAXAIL SHOULDER SCREW, 36MM","$4,000.00",$0.00,"$4,000.00","$1,800.00","$2,854.80",$0.00,$689.18,$0.00,$0.00,$700.37,"$4,000.00",$0.00,"$2,000.00","$3,168.00","$3,200.00",$0.00,$626.00,$0.00,$636.80,$0.00
215.308,SUP,HCPCS C1713,,"215.308  -  3.5MM SS PROTEX CT POLYAXIAL SCREW, 8MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
215.31,SUP,HCPCS C1713,,"215.310  -  3.5MM SS PROTEX CT POLYAXIAL SCREW, 10MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
215.312,SUP,HCPCS C1713,,"215.312  -  3.5MM SS PROTEX CT POLYAXIAL SCREW, 12MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
215.314,SUP,HCPCS C1713,,"215.314  -  3.5MM SS PROTEX CT POLYAXIAL SCREW, 14MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
215.316,SUP,HCPCS C1713,,"215.316  -  3.5MM SS PROTEX CT POLYAXIAL SCREW, 16MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
215.318,SUP,HCPCS C1713,,"215.318  -  3.5MM SS PROTEX CT POLYAXIAL SCREW, 18MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
215.32,SUP,HCPCS C1713,,"215.320  -  3.5MM SS PROTEX CT POLYAXIAL SCREW, 20MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
215.322,SUP,HCPCS C1713,,"215.322  -  3.5MM SS PROTEX CT POLYAXIAL SCREW, 22MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
215.324,SUP,HCPCS C1713,,"215.324  -  3.5MM SS PROTEX CT POLYAXIAL SCREW, 24MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
215.326,SUP,HCPCS C1713,,"215.326  -  3.5MM SS PROTEX CT POLYAXIAL SCREW, 26MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
215.328,SUP,HCPCS C1713,,"215.328  -  3.5MM SS PROTEX CT POLYAXIAL SCREW, 28MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
215.33,SUP,HCPCS C1713,,"215.330  -  3.5MM SS PROTEX CT POLYAXIAL SCREW, 30MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
215.335,SUP,HCPCS C1713,,"215.335  -  3.5MM SS PROTEX CT POLYAXIAL SCREW, 35MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
215.34,SUP,HCPCS C1713,,"215.340  -  3.5MM SS PROTEX CT POLYAXIAL SCREW, 40MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
215.345,SUP,HCPCS C1713,,"215.345  -  3.5MM SS PROTEX CT POLYAXIAL SCREW, 45MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
215.35,SUP,HCPCS C1713,,"215.350  -  3.5MM SS PROTEX CT POLYAXIAL SCREW, 50MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
215.41,SUP,HCPCS C1713,,"215.410  -  4.0MM SS PROTEX? CT POLYAXIAL SCREW, 10MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
215.412,SUP,HCPCS C1713,,"215.412  -  4.0MM SS PROTEX CT POLYAXIAL SCREW, 12MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
215.414,SUP,HCPCS C1713,,"215.414  -  4.0MM SS PROTEX CT POLYAXIAL SCREW, 14MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
215.416,SUP,HCPCS C1713,,"215.416  -  4.0MM SS PROTEX CT POLYAXIAL SCREW, 16MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
215.418,SUP,HCPCS C1713,,"215.418  -  4.0MM SS PROTEX CT POLYAXIAL SCREW, 18MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
215.42,SUP,HCPCS C1713,,"215.420  -  4.0MM SS PROTEX CT POLYAXIAL SCREW, 20MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
215.422,SUP,HCPCS C1713,,"215.422  -  4.0MM SS PROTEX CT POLYAXIAL SCREW, 22MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
215.424,SUP,HCPCS C1713,,"215.424  -  4.0MM SS PROTEX CT POLYAXIAL SCREW, 24MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
215.426,SUP,HCPCS C1713,,"215.426  -  4.0MM SS PROTEX CT POLYAXIAL SCREW, 26MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
215.428,SUP,HCPCS C1713,,"215.428  -  4.0MM SS PROTEX CT POLYAXIAL SCREW, 28MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
215.43,SUP,HCPCS C1713,,"215.430  -  4.0MM SS PROTEX CT POLYAXIAL SCREW, 30MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
215.435,SUP,HCPCS C1713,,"215.435  -  4.0MM SS PROTEX CT POLYAXIAL SCREW, 35MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
215.44,SUP,HCPCS C1713,,"215.440  -  4.0MM SS PROTEX CT POLYAXIAL SCREW, 40MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
215.445,SUP,HCPCS C1713,,"215.445  -  4.0MM SS PROTEX CT POLYAXIAL SCREW, 45MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
215.45,SUP,HCPCS C1713,,"215.450  -  4.0MM SS PROTEX CT POLYAXIAL SCREW, 50MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
215.5,SUP,HCPCS C1713,,215.500  -  SS PROTEX CT LOCKING CAP,"$1,000.00",$0.00,"$1,000.00",$450.00,$713.70,$0.00,$172.30,$0.00,$0.00,$175.09,"$1,000.00",$0.00,$500.00,$792.00,$800.00,$0.00,$156.50,$0.00,$159.20,$0.00
215.501,SUP,HCPCS C1713,,215.501  -  SS PROTEX HOOK,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
215.503,SUP,Custom 27803010,,"215.503  -  SS PROTEX HOOK, RIGHT","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
215.504,SUP,Custom 27803010,,"215.504  -  SS PROTEX HOOK, LEFT","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
215.506,SUP,Custom 27803010,,"215.506  -  SS PROTEX HOOK, 7MM OFFSET, LEFT","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
215.507,SUP,Custom 27803010,,"215.507  -  SS PROTEX HOOK, 5MM OFFSET, LEFT","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
215.508,SUP,Custom 27803010,,"215.508  -  SS PROTEX HOOK, 7MM OFFSET, RIGHT","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
215.509,SUP,Custom 27803010,,"215.509  -  SS PROTEX HOOK, 5MM OFFSET, RIGHT","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
215.51,SUP,HCPCS C1713,,"215.510  -  4.5MM SS PROTEX CT POLYAXIAL SCREW, 10MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
215.512,SUP,HCPCS C1713,,"215.512  -  4.5MM SS PROTEX CT POLYAXIAL SCREW, 12MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
215.514,SUP,HCPCS C1713,,"215.514  -  4.5MM SS PROTEX CT POLYAXIAL SCREW, 14MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
215.516,SUP,HCPCS C1713,,"215.516  -  4.5MM SS PROTEX CT POLYAXIAL SCREW, 16MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
215.518,SUP,HCPCS C1713,,"215.518  -  4.5MM SS PROTEX CT POLYAXIAL SCREW, 18MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
215.52,SUP,HCPCS C1713,,"215.520  -  4.5MM SS PROTEX CT POLYAXIAL SCREW, 20MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
215.522,SUP,HCPCS C1713,,"215.522  -  4.5MM SS PROTEX CT POLYAXIAL SCREW, 22MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
215.524,SUP,HCPCS C1713,,"215.524  -  4.5MM SS PROTEX CT POLYAXIAL SCREW, 24MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
215.526,SUP,HCPCS C1713,,"215.526  -  4.5MM SS PROTEX CT POLYAXIAL SCREW, 26MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
215.528,SUP,HCPCS C1713,,"215.528  -  4.5MM SS PROTEX CT POLYAXIAL SCREW, 28MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
215.53,SUP,HCPCS C1713,,"215.530  -  4.5MM SS PROTEX CT POLYAXIAL SCREW, 30MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
215.535,SUP,HCPCS C1713,,"215.535  -  4.5MM SS PROTEX CT POLYAXIAL SCREW, 35MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
215.54,SUP,HCPCS C1713,,"215.540  -  4.5MM SS PROTEX CT POLYAXIAL SCREW, 40MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
215.545,SUP,HCPCS C1713,,"215.545  -  4.5MM SS PROTEX CT POLYAXIAL SCREW, 45MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
215.55,SUP,HCPCS C1713,,"215.550  -  4.5MM SS PROTEX CT POLYAXIAL SCREW, 50MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
215.625,SUP,HCPCS C1713,,"215.625  -  5.0MM SS PROTEX CT POLYAXIAL SCREW, 25MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
215.63,SUP,HCPCS C1713,,"215.630  -  5.0MM SS PROTEX CT POLYAXIAL SCREW, 30MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
215.635,SUP,HCPCS C1713,,"215.635  -  5.0MM SS PROTEX CT POLYAXIAL SCREW, 35MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
215.64,SUP,HCPCS C1713,,"215.640  -  5.0MM SS PROTEX CT POLYAXIAL SCREW, 40MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
215.645,SUP,HCPCS C1713,,"215.645  -  5.0MM SS PROTEX CT POLYAXIAL SCREW, 45MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
215.65,SUP,HCPCS C1713,,"215.650  -  5.0MM SS PROTEX CT POLYAXIAL SCREW, 50MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
215.801,SUP,Custom 27803010,,"215.801  -  3.7MM SS STRAIGHT ROD, 80MM",$825.00,$0.00,$825.00,$0.00,$588.80,$0.00,$0.00,$0.00,$0.00,$0.00,$825.00,$0.00,$412.50,$653.40,$660.00,$0.00,$0.00,$0.00,$0.00,$0.00
215.802,SUP,Custom 27803010,,"215.802  -  3.7MM SS STRAIGHT ROD, 120MM","$1,000.00",$0.00,"$1,000.00",$0.00,$713.70,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,000.00",$0.00,$500.00,$792.00,$800.00,$0.00,$0.00,$0.00,$0.00,$0.00
215.803,SUP,Custom 27803010,,"215.803  -  3.7MM SS STRAIGHT ROD, 240MM","$1,187.50",$0.00,"$1,187.50",$0.00,$847.52,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,187.50",$0.00,$593.75,$940.50,$950.00,$0.00,$0.00,$0.00,$0.00,$0.00
215.804,SUP,Custom 27803010,,"215.804  -  3.7MM SS STRAIGHT ROD, 40MM",$675.00,$0.00,$675.00,$0.00,$481.75,$0.00,$0.00,$0.00,$0.00,$0.00,$675.00,$0.00,$337.50,$534.60,$540.00,$0.00,$0.00,$0.00,$0.00,$0.00
215.806,SUP,HCPCS C1713,,"215.806  -  4.0MM SS PROTEX CT OC STANDARD SCREW, SELF-TAPPING, 6MM","$1,062.50",$0.00,"$1,062.50",$478.13,$758.31,$0.00,$183.06,$0.00,$0.00,$186.04,"$1,062.50",$0.00,$531.25,$841.50,$850.00,$0.00,$166.28,$0.00,$169.15,$0.00
215.808,SUP,HCPCS C1713,,"215.808  -  4.0MM SS PROTEX CT OC STANDARD SCREW, SELF-TAPPING, 8MM","$1,062.50",$0.00,"$1,062.50",$478.13,$758.31,$0.00,$183.06,$0.00,$0.00,$186.04,"$1,062.50",$0.00,$531.25,$841.50,$850.00,$0.00,$166.28,$0.00,$169.15,$0.00
215.81,SUP,HCPCS C1713,,"215.810  -  4.0MM SS PROTEX CT OC STANDARD SCREW, SELF-TAPPING, 10MM","$1,062.50",$0.00,"$1,062.50",$478.13,$758.31,$0.00,$183.06,$0.00,$0.00,$186.04,"$1,062.50",$0.00,$531.25,$841.50,$850.00,$0.00,$166.28,$0.00,$169.15,$0.00
215.812,SUP,HCPCS C1713,,"215.812  -  4.0MM SS PROTEX CT OC STANDARD SCREW, SELF-TAPPING, 12MM","$1,062.50",$0.00,"$1,062.50",$478.13,$758.31,$0.00,$183.06,$0.00,$0.00,$186.04,"$1,062.50",$0.00,$531.25,$841.50,$850.00,$0.00,$166.28,$0.00,$169.15,$0.00
215.814,SUP,HCPCS C1713,,"215.814  -  4.0MM SS PROTEX CT OC STANDARD SCREW, SELF-TAPPING, 14MM","$1,062.50",$0.00,"$1,062.50",$478.13,$758.31,$0.00,$183.06,$0.00,$0.00,$186.04,"$1,062.50",$0.00,$531.25,$841.50,$850.00,$0.00,$166.28,$0.00,$169.15,$0.00
215.816,SUP,HCPCS C1713,,"215.816  -  4.0MM SS PROTEX CT OC STANDARD SCREW, SELF-TAPPING, 16MM","$1,062.50",$0.00,"$1,062.50",$478.13,$758.31,$0.00,$183.06,$0.00,$0.00,$186.04,"$1,062.50",$0.00,$531.25,$841.50,$850.00,$0.00,$166.28,$0.00,$169.15,$0.00
215.906,SUP,HCPCS C1713,,"215.906  -  4.5MM SS PROTEX CT OC STANDARD SCREW, SELF-TAPPING, 6MM","$1,062.50",$0.00,"$1,062.50",$478.13,$758.31,$0.00,$183.06,$0.00,$0.00,$186.04,"$1,062.50",$0.00,$531.25,$841.50,$850.00,$0.00,$166.28,$0.00,$169.15,$0.00
215.908,SUP,HCPCS C1713,,"215.908  -  4.5MM SS PROTEX CT OC STANDARD SCREW, SELF-TAPPING, 8MM","$1,062.50",$0.00,"$1,062.50",$478.13,$758.31,$0.00,$183.06,$0.00,$0.00,$186.04,"$1,062.50",$0.00,$531.25,$841.50,$850.00,$0.00,$166.28,$0.00,$169.15,$0.00
215.91,SUP,HCPCS C1713,,"215.910  -  4.5MM SS PROTEX CT OC STANDARD SCREW, SELF-TAPPING, 10MM","$1,062.50",$0.00,"$1,062.50",$478.13,$758.31,$0.00,$183.06,$0.00,$0.00,$186.04,"$1,062.50",$0.00,$531.25,$841.50,$850.00,$0.00,$166.28,$0.00,$169.15,$0.00
215.912,SUP,HCPCS C1713,,"215.912  -  4.5MM SS PROTEX CT OC STANDARD SCREW, SELF-TAPPING, 12MM","$1,062.50",$0.00,"$1,062.50",$478.13,$758.31,$0.00,$183.06,$0.00,$0.00,$186.04,"$1,062.50",$0.00,$531.25,$841.50,$850.00,$0.00,$166.28,$0.00,$169.15,$0.00
215.914,SUP,HCPCS C1713,,"215.914  -  4.5MM SS PROTEX CT OC STANDARD SCREW, SELF-TAPPING, 14MM","$1,062.50",$0.00,"$1,062.50",$478.13,$758.31,$0.00,$183.06,$0.00,$0.00,$186.04,"$1,062.50",$0.00,$531.25,$841.50,$850.00,$0.00,$166.28,$0.00,$169.15,$0.00
215.916,SUP,HCPCS C1713,,"215.916  -  4.5MM SS PROTEX CT OC STANDARD SCREW, SELF-TAPPING, 16MM","$1,062.50",$0.00,"$1,062.50",$478.13,$758.31,$0.00,$183.06,$0.00,$0.00,$186.04,"$1,062.50",$0.00,$531.25,$841.50,$850.00,$0.00,$166.28,$0.00,$169.15,$0.00
215.923,SUP,Custom 27803010,,"215.923  -  SS TOP LOADING T-CONNECTOR FOR 3.7MM ROD, 21-33MM, STRAIGHT","$4,000.00",$0.00,"$4,000.00",$0.00,"$2,854.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,000.00",$0.00,"$2,000.00","$3,168.00","$3,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
215.925,SUP,Custom 27803010,,"215.925  -  SS TOP LOADING T-CONNECTOR FOR 3.7MM ROD, 26-46MM, STRAIGHT","$4,000.00",$0.00,"$4,000.00",$0.00,"$2,854.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,000.00",$0.00,"$2,000.00","$3,168.00","$3,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
215.927,SUP,Custom 27803010,,"215.927  -  SS TOP LOADING T-CONNECTOR FOR 3.7MM ROD, 36-56MM, STRAIGHT","$4,000.00",$0.00,"$4,000.00",$0.00,"$2,854.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,000.00",$0.00,"$2,000.00","$3,168.00","$3,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
215.949,SUP,HCPCS C1713,,"215.949  -  SS SET SCREW, M4.5 X 0.75, ROUND TIP, 2.5MM HEX",$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
215.95,SUP,Custom 27803010,,"215.950  -  SS OCCIPITAL CLAMP, SINGLE, SHORT","$1,050.00",$0.00,"$1,050.00",$0.00,$749.39,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,050.00",$0.00,$525.00,$831.60,$840.00,$0.00,$0.00,$0.00,$0.00,$0.00
215.951,SUP,Custom 27803010,,"215.951  -  SS OCCIPITAL CLAMP, SINGLE, LONG","$1,050.00",$0.00,"$1,050.00",$0.00,$749.39,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,050.00",$0.00,$525.00,$831.60,$840.00,$0.00,$0.00,$0.00,$0.00,$0.00
215.952,SUP,HCPCS C1713,,"215.952  -  SS SET SCREW, M4.5 X 0.75",$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
215.953,SUP,Custom 27803010,,"215.953  -  SS 3.7MM OCCIPITAL ROD, 240MM, 100DEG","$1,575.00",$0.00,"$1,575.00",$0.00,"$1,124.08",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$0.00,$0.00,$0.00,$0.00
215.954,SUP,Custom 27803010,,"215.954  -  SS 3.7MM OCCIPITAL ROD, 240MM, 115DEG","$1,575.00",$0.00,"$1,575.00",$0.00,"$1,124.08",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$0.00,$0.00,$0.00,$0.00
215.955,SUP,Custom 27803010,,"215.955  -  SS 3.7MM OCCIPITAL ROD, 240MM, 130DEG","$1,575.00",$0.00,"$1,575.00",$0.00,"$1,124.08",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$0.00,$0.00,$0.00,$0.00
215.956,SUP,Custom 27803010,,"215.956  -  SS OCCIPITAL CLAMP, TRIPLE, SHORT","$1,575.00",$0.00,"$1,575.00",$0.00,"$1,124.08",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$0.00,$0.00,$0.00,$0.00
215.957,SUP,Custom 27803010,,"215.957  -  SS OCCIPITAL CLAMP, TRIPLE, LONG","$1,575.00",$0.00,"$1,575.00",$0.00,"$1,124.08",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$0.00,$0.00,$0.00,$0.00
215.958,SUP,Custom 27803010,,"215.958  -  SS OCCIPITAL CLAMP, DOUBLE, SHORT","$1,312.50",$0.00,"$1,312.50",$0.00,$936.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$0.00,$0.00,$0.00,$0.00
215.959,SUP,Custom 27803010,,"215.959  -  SS OCCIPITAL CLAMP, DOUBLE, LONG","$1,312.50",$0.00,"$1,312.50",$0.00,$936.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$0.00,$0.00,$0.00,$0.00
215.96,SUP,Custom 27803010,,"215.960  -  SS PARALLEL CONNECTOR, 3.7MM ROD TO 3.7MM ROD","$1,787.50",$0.00,"$1,787.50",$0.00,"$1,275.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,787.50",$0.00,$893.75,"$1,415.70","$1,430.00",$0.00,$0.00,$0.00,$0.00,$0.00
215.963,SUP,Custom 27803010,,"215.963  -  SS PARALLEL CONNECTOR, 3.7MM ROD TO 5.5MM ROD","$1,787.50",$0.00,"$1,787.50",$0.00,"$1,275.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,787.50",$0.00,$893.75,"$1,415.70","$1,430.00",$0.00,$0.00,$0.00,$0.00,$0.00
215.984,SUP,Custom 27803010,,"215.984  -  SS TAPERED ROD, 3.7MM TO 5.5MM, 350MM","$1,625.00",$0.00,"$1,625.00",$0.00,"$1,159.76",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,625.00",$0.00,$812.50,"$1,287.00","$1,300.00",$0.00,$0.00,$0.00,$0.00,$0.00
215.99,SUP,Custom 27803010,,215.990  -  SS LATERAL CONNECTOR,"$1,625.00",$0.00,"$1,625.00",$0.00,"$1,159.76",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,625.00",$0.00,$812.50,"$1,287.00","$1,300.00",$0.00,$0.00,$0.00,$0.00,$0.00
215.991,SUP,Custom 27803010,,"215.991  -  SS LATERAL CONNECTOR, SHORT","$1,625.00",$0.00,"$1,625.00",$0.00,"$1,159.76",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,625.00",$0.00,$812.50,"$1,287.00","$1,300.00",$0.00,$0.00,$0.00,$0.00,$0.00
216.03,SUP,HCPCS C1713,,216.030  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 30MM 16MM SOCKET LCP DCP,$59.35,$0.00,$59.35,$26.71,$42.36,$0.00,$14.99,$0.00,$0.00,$10.39,$59.35,$0.00,$29.68,$47.01,$47.48,$0.00,$13.61,$0.00,$9.45,$0.00
216.035,SUP,HCPCS C1713,,216.035  -  SCREW BONE PTHRD 6.5MM 8MM 35MM 16MM LARGE HEXAGONAL SOCKET,$59.35,$0.00,$59.35,$26.71,$42.36,$0.00,$9.93,$0.00,$0.00,$10.39,$59.35,$0.00,$29.68,$47.01,$47.48,$0.00,$9.02,$0.00,$9.45,$0.00
216.04,SUP,HCPCS C1713,,216.040  -  SCREW BONE PTHRD 6.5MM 8MM 40MM 16MM LARGE HEXAGONAL SOCKET,$59.35,$0.00,$59.35,$26.71,$42.36,$0.00,$9.93,$0.00,$0.00,$10.39,$59.35,$0.00,$29.68,$47.01,$47.48,$0.00,$9.02,$0.00,$9.45,$0.00
216.045,SUP,HCPCS C1713,,216.045  -  SCREW BONE PTHRD 6.5MM 8MM 45MM 16MM LARGE HEXAGONAL SOCKET,$59.35,$0.00,$59.35,$26.71,$42.36,$0.00,$14.99,$0.00,$0.00,$10.39,$59.35,$0.00,$29.68,$47.01,$47.48,$0.00,$13.61,$0.00,$9.45,$0.00
216.05,SUP,HCPCS C1713,,216.050  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 50MM 16MM SOCKET LCP DCP,$59.35,$0.00,$59.35,$26.71,$42.36,$0.00,$14.99,$0.00,$0.00,$10.39,$59.35,$0.00,$29.68,$47.01,$47.48,$0.00,$13.61,$0.00,$9.45,$0.00
216.055,SUP,HCPCS C1713,,216.055  -  SCREW BONE PTHRD 6.5MM 8MM 55MM 16MM LARGE HEXAGONAL SOCKET,$59.35,$0.00,$59.35,$26.71,$42.36,$0.00,$14.99,$0.00,$0.00,$10.39,$59.35,$0.00,$29.68,$47.01,$47.48,$0.00,$13.61,$0.00,$9.45,$0.00
216.06,SUP,HCPCS C1713,,216.060  -  SCREW BONE PTHRD 6.5MM 8MM 60MM 16MM LARGE HEXAGONAL SOCKET,$59.35,$0.00,$59.35,$26.71,$42.36,$0.00,$14.99,$0.00,$0.00,$10.39,$59.35,$0.00,$29.68,$47.01,$47.48,$0.00,$13.61,$0.00,$9.45,$0.00
216.065,SUP,HCPCS C1713,,216.065  -  SCREW BONE PTHRD 6.5MM 8MM 65MM 16MM LARGE HEXAGONAL SOCKET,$59.35,$0.00,$59.35,$26.71,$42.36,$0.00,$14.99,$0.00,$0.00,$10.39,$59.35,$0.00,$29.68,$47.01,$47.48,$0.00,$13.61,$0.00,$9.45,$0.00
216.07,SUP,HCPCS C1713,,216.070  -  SCREW BONE PTHRD 6.5MM 8MM 70MM 16MM LARGE HEXAGONAL SOCKET,$59.35,$0.00,$59.35,$26.71,$42.36,$0.00,$14.99,$0.00,$0.00,$10.39,$59.35,$0.00,$29.68,$47.01,$47.48,$0.00,$13.61,$0.00,$9.45,$0.00
216.075,SUP,HCPCS C1713,,216.075  -  SCREW BONE PTHRD 6.5MM 8MM 75MM 16MM LARGE HEXAGONAL SOCKET,$59.35,$0.00,$59.35,$26.71,$42.36,$0.00,$14.99,$0.00,$0.00,$10.39,$59.35,$0.00,$29.68,$47.01,$47.48,$0.00,$13.61,$0.00,$9.45,$0.00
216.08,SUP,HCPCS C1713,,216.080  -  SCREW BONE PTHRD 6.5MM 8MM 80MM 16MM LARGE HEXAGONAL SOCKET,$59.35,$0.00,$59.35,$26.71,$42.36,$0.00,$14.99,$0.00,$0.00,$10.39,$59.35,$0.00,$29.68,$47.01,$47.48,$0.00,$13.61,$0.00,$9.45,$0.00
216.085,SUP,HCPCS C1713,,216.085  -  SCREW BONE PTHRD 6.5MM 8MM 85MM 16MM LARGE HEXAGONAL SOCKET,$64.15,$0.00,$64.15,$28.87,$45.78,$0.00,$16.54,$0.00,$0.00,$11.23,$64.15,$0.00,$32.08,$50.81,$51.32,$0.00,$15.02,$0.00,$10.21,$0.00
216.09,SUP,HCPCS C1713,,216.090  -  SCREW BONE PTHRD 6.5MM 8MM 90MM 16MM LARGE HEXAGONAL SOCKET,$64.15,$0.00,$64.15,$28.87,$45.78,$0.00,$16.54,$0.00,$0.00,$11.23,$64.15,$0.00,$32.08,$50.81,$51.32,$0.00,$15.02,$0.00,$10.21,$0.00
216.095,SUP,HCPCS C1713,,216.095  -  SCREW BONE PTHRD 6.5MM 8MM 95MM 16MM LARGE HEXAGONAL SOCKET,$64.15,$0.00,$64.15,$28.87,$45.78,$0.00,$16.54,$0.00,$0.00,$11.23,$64.15,$0.00,$32.08,$50.81,$51.32,$0.00,$15.02,$0.00,$10.21,$0.00
216.1,SUP,HCPCS C1713,,216.100  -  SCREW BONE PTHRD 6.5MM 8MM 100MM 16MM LARGE HEXAGONAL SOCKET,$64.15,$0.00,$64.15,$28.87,$45.78,$0.00,$16.54,$0.00,$0.00,$11.23,$64.15,$0.00,$32.08,$50.81,$51.32,$0.00,$15.02,$0.00,$10.21,$0.00
216.105,SUP,HCPCS C1713,,216.105  -  SCREW BONE PTHRD 6.5MM 8MM 105MM 16MM LARGE HEXAGONAL SOCKET,$64.15,$0.00,$64.15,$28.87,$45.78,$0.00,$16.54,$0.00,$0.00,$11.23,$64.15,$0.00,$32.08,$50.81,$51.32,$0.00,$15.02,$0.00,$10.21,$0.00
216.11,SUP,HCPCS C1713,,216.110  -  SCREW BONE PTHRD 6.5MM 110MM 16MM THREAD LCP STAINLESS STEEL,$64.15,$0.00,$64.15,$28.87,$45.78,$0.00,$16.54,$0.00,$0.00,$11.23,$64.15,$0.00,$32.08,$50.81,$51.32,$0.00,$15.02,$0.00,$10.21,$0.00
216.115,SUP,HCPCS C1713,,216.115  -  SCREW BONE PTHRD 6.5MM 8MM 115MM 16MM HEXAGONAL SOCKET LCP,$79.83,$0.00,$79.83,$35.92,$56.97,$0.00,$13.35,$0.00,$0.00,$13.98,$79.83,$0.00,$39.91,$63.23,$63.86,$0.00,$12.13,$0.00,$12.71,$0.00
216.12,SUP,HCPCS C1713,,216.120  -  SCREW BONE PTHRD 6.5MM 8MM 120MM 16MM HEXAGONAL SOCKET LCP,$79.83,$0.00,$79.83,$35.92,$56.97,$0.00,$13.35,$0.00,$0.00,$13.98,$79.83,$0.00,$39.91,$63.23,$63.86,$0.00,$12.13,$0.00,$12.71,$0.00
216.125,SUP,HCPCS C1713,,216.125  -  SCREW BONE 6.5MM 125MM 16MM THREAD LC-DCP STAINLESS STEEL,$79.83,$0.00,$79.83,$35.92,$56.97,$0.00,$13.35,$0.00,$0.00,$13.98,$79.83,$0.00,$39.91,$63.23,$63.86,$0.00,$12.13,$0.00,$12.71,$0.00
216.13,SUP,HCPCS C1713,,216.130  -  SCREW BONE PTHRD 6.5MM 8MM 130MM 16MM LARGE HEXAGONAL SOCKET,$79.83,$0.00,$79.83,$35.92,$56.97,$0.00,$13.35,$0.00,$0.00,$13.98,$79.83,$0.00,$39.91,$63.23,$63.86,$0.00,$12.13,$0.00,$12.71,$0.00
216.135,SUP,HCPCS C1713,,216.135  -  SCREW BONE 6.5MM 135MM 16MM THREAD LC-DCP STAINLESS STEEL,$79.83,$0.00,$79.83,$35.92,$56.97,$0.00,$13.35,$0.00,$0.00,$13.98,$79.83,$0.00,$39.91,$63.23,$63.86,$0.00,$12.13,$0.00,$12.71,$0.00
216.14,SUP,HCPCS C1713,,216.140  -  SCREW BONE PTHRD 6.5MM 8MM 140MM 16MM LARGE HEXAGONAL SOCKET,$79.83,$0.00,$79.83,$35.92,$56.97,$0.00,$13.35,$0.00,$0.00,$13.98,$79.83,$0.00,$39.91,$63.23,$63.86,$0.00,$12.13,$0.00,$12.71,$0.00
216.145,SUP,HCPCS C1713,,216.145  -  SCREW BONE 6.5MM 145MM 16MM THREAD LC-DCP STAINLESS STEEL,$79.83,$0.00,$79.83,$35.92,$56.97,$0.00,$13.35,$0.00,$0.00,$13.98,$79.83,$0.00,$39.91,$63.23,$63.86,$0.00,$12.13,$0.00,$12.71,$0.00
216.15,SUP,HCPCS C1713,,216.150  -  SCREW BONE 6.5MM 150MM 16MM LOCKING THREADED LC-DCP,$79.83,$0.00,$79.83,$35.92,$56.97,$0.00,$13.35,$0.00,$0.00,$13.98,$79.83,$0.00,$39.91,$63.23,$63.86,$0.00,$12.13,$0.00,$12.71,$0.00
216.24,SUP,HCPCS C1713,,216.240  -  SCREW BONE 6.5MM 40MM 24MM THREAD LC-DCP STAINLESS STEEL,$57.63,$0.00,$57.63,$25.93,$41.13,$0.00,$9.93,$0.00,$0.00,$10.09,$57.63,$0.00,$28.81,$45.64,$46.10,$0.00,$9.02,$0.00,$9.17,$0.00
216.25,SUP,HCPCS C1713,,216.250  -  SCREW BONE 6.5MM 8MM 50MM 24MM LARGE HEXAGONAL SOCKET DCP,$57.63,$0.00,$57.63,$25.93,$41.13,$0.00,$9.93,$0.00,$0.00,$10.09,$57.63,$0.00,$28.81,$45.64,$46.10,$0.00,$9.02,$0.00,$9.17,$0.00
216.26,SUP,HCPCS C1713,,216.260  -  SCREW BONE 6.5MM 60MM 24MM THREAD LC-DCP STAINLESS STEEL,$57.63,$0.00,$57.63,$25.93,$41.13,$0.00,$9.93,$0.00,$0.00,$10.09,$57.63,$0.00,$28.81,$45.64,$46.10,$0.00,$9.02,$0.00,$9.17,$0.00
216.27,SUP,HCPCS C1713,,216.270  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 70MM 24MM SOCKET LCP DCP,$57.63,$0.00,$57.63,$25.93,$41.13,$0.00,$9.93,$0.00,$0.00,$10.09,$57.63,$0.00,$28.81,$45.64,$46.10,$0.00,$9.02,$0.00,$9.17,$0.00
216.28,SUP,HCPCS C1713,,216.280  -  SCREW BONE 6.5MM 80MM 24MM THREAD LC-DCP STAINLESS STEEL,$57.63,$0.00,$57.63,$25.93,$41.13,$0.00,$9.93,$0.00,$0.00,$10.09,$57.63,$0.00,$28.81,$45.64,$46.10,$0.00,$9.02,$0.00,$9.17,$0.00
216.29,SUP,HCPCS C1713,,216.290  -  SCREW BONE 6.5MM 90MM 24MM THREAD LC-DCP STAINLESS STEEL,$62.28,$0.00,$62.28,$28.02,$44.45,$0.00,$10.73,$0.00,$0.00,$10.90,$62.28,$0.00,$31.14,$49.33,$49.82,$0.00,$9.75,$0.00,$9.91,$0.00
216.295,SUP,HCPCS C1713,,216.295  -  SCREW BONE 6.5MM 95MM 24MM THREAD LC-DCP STAINLESS STEEL,$62.28,$0.00,$62.28,$28.02,$44.45,$0.00,$10.73,$0.00,$0.00,$10.90,$62.28,$0.00,$31.14,$49.33,$49.82,$0.00,$9.75,$0.00,$9.91,$0.00
216.3,SUP,HCPCS C1713,,216.300  -  SCREW BONE 6.5MM 100MM 24MM THREAD LC-DCP STAINLESS STEEL,$62.28,$0.00,$62.28,$28.02,$44.45,$0.00,$10.73,$0.00,$0.00,$10.90,$62.28,$0.00,$31.14,$49.33,$49.82,$0.00,$9.75,$0.00,$9.91,$0.00
216.305,SUP,HCPCS C1713,,216.305  -  SCREW BONE 6.5MM 105MM 24MM THREAD LC-DCP STAINLESS STEEL,$62.28,$0.00,$62.28,$28.02,$44.45,$0.00,$10.73,$0.00,$0.00,$10.90,$62.28,$0.00,$31.14,$49.33,$49.82,$0.00,$9.75,$0.00,$9.91,$0.00
216.31,SUP,HCPCS C1713,,216.310  -  SCREW BONE 6.5MM 110MM 24MM THREAD LC-DCP STAINLESS STEEL,$62.28,$0.00,$62.28,$28.02,$44.45,$0.00,$10.73,$0.00,$0.00,$10.90,$62.28,$0.00,$31.14,$49.33,$49.82,$0.00,$9.75,$0.00,$9.91,$0.00
216.315,SUP,HCPCS C1713,,216.315  -  SCREW BONE 6.5MM 115MM 24MM THREAD LC-DCP STAINLESS STEEL,$77.50,$0.00,$77.50,$34.88,$55.31,$0.00,$13.35,$0.00,$0.00,$13.57,$77.50,$0.00,$38.75,$61.38,$62.00,$0.00,$12.13,$0.00,$12.34,$0.00
216.32,SUP,HCPCS C1713,,216.320  -  SCREW BONE 6.5MM 120MM 24MM THREAD LC-DCP STAINLESS STEEL,$77.50,$0.00,$77.50,$34.88,$55.31,$0.00,$13.35,$0.00,$0.00,$13.57,$77.50,$0.00,$38.75,$61.38,$62.00,$0.00,$12.13,$0.00,$12.34,$0.00
216.325,SUP,HCPCS C1713,,216.325  -  SCREW BONE 6.5MM 125MM 24MM THREAD LC-DCP STAINLESS STEEL,$77.50,$0.00,$77.50,$34.88,$55.31,$0.00,$13.35,$0.00,$0.00,$13.57,$77.50,$0.00,$38.75,$61.38,$62.00,$0.00,$12.13,$0.00,$12.34,$0.00
216.33,SUP,HCPCS C1713,,216.330  -  SCREW BONE 6.5MM 130MM 24MM THREAD LC-DCP STAINLESS STEEL,$77.50,$0.00,$77.50,$34.88,$55.31,$0.00,$13.35,$0.00,$0.00,$13.57,$77.50,$0.00,$38.75,$61.38,$62.00,$0.00,$12.13,$0.00,$12.34,$0.00
216.34,SUP,HCPCS C1713,,216.340  -  SCREW BONE 6.5MM 140MM 24MM THREAD LC-DCP STAINLESS STEEL,$77.50,$0.00,$77.50,$34.88,$55.31,$0.00,$13.35,$0.00,$0.00,$13.57,$77.50,$0.00,$38.75,$61.38,$62.00,$0.00,$12.13,$0.00,$12.34,$0.00
216.35,SUP,HCPCS C1713,,216.350  -  SCREW BONE 6.5MM 150MM 24MM THREAD LC-DCP STAINLESS STEEL,$77.50,$0.00,$77.50,$34.88,$55.31,$0.00,$13.35,$0.00,$0.00,$13.57,$77.50,$0.00,$38.75,$61.38,$62.00,$0.00,$12.13,$0.00,$12.34,$0.00
217.045,SUP,HCPCS C1713,,217.045  -  SCREW BONE PTHRD 6.5MM 8MM 45MM 32MM LARGE HEXAGONAL SOCKET,$59.35,$0.00,$59.35,$26.71,$42.36,$0.00,$14.99,$0.00,$0.00,$10.39,$59.35,$0.00,$29.68,$47.01,$47.48,$0.00,$13.61,$0.00,$9.45,$0.00
217.05,SUP,HCPCS C1713,,217.050  -  SCREW BONE PTHRD 6.5MM 8MM 50MM 32MM LARGE HEXAGONAL SOCKET,$59.35,$0.00,$59.35,$26.71,$42.36,$0.00,$14.99,$0.00,$0.00,$10.39,$59.35,$0.00,$29.68,$47.01,$47.48,$0.00,$13.61,$0.00,$9.45,$0.00
217.055,SUP,HCPCS C1713,,217.055  -  SCREW BONE PTHRD 6.5MM 55MM 32MM LCP STAINLESS STEEL HUMERUS,$59.35,$0.00,$59.35,$26.71,$42.36,$0.00,$14.99,$0.00,$0.00,$10.39,$59.35,$0.00,$29.68,$47.01,$47.48,$0.00,$13.61,$0.00,$9.45,$0.00
217.06,SUP,HCPCS C1713,,217.060  -  SCREW BONE PTHRD 6.5MM 60MM 32MM LCP STAINLESS STEEL HUMERUS,$59.35,$0.00,$59.35,$26.71,$42.36,$0.00,$14.99,$0.00,$0.00,$10.39,$59.35,$0.00,$29.68,$47.01,$47.48,$0.00,$13.61,$0.00,$9.45,$0.00
217.065,SUP,HCPCS C1713,,217.065  -  SCREW BONE PTHRD 6.5MM 8MM 65MM 32MM LARGE HEXAGONAL SOCKET,$59.35,$0.00,$59.35,$26.71,$42.36,$0.00,$14.99,$0.00,$0.00,$10.39,$59.35,$0.00,$29.68,$47.01,$47.48,$0.00,$13.61,$0.00,$9.45,$0.00
217.07,SUP,HCPCS C1713,,217.070  -  SCREW BONE PTHRD 6.5MM 8MM 70MM 32MM LARGE HEXAGONAL SOCKET,$59.35,$0.00,$59.35,$26.71,$42.36,$0.00,$9.93,$0.00,$0.00,$10.39,$59.35,$0.00,$29.68,$47.01,$47.48,$0.00,$9.02,$0.00,$9.45,$0.00
217.075,SUP,HCPCS C1713,,217.075  -  SCREW BONE PTHRD 6.5MM 8MM 75MM 32MM LARGE HEXAGONAL SOCKET,$59.35,$0.00,$59.35,$26.71,$42.36,$0.00,$9.93,$0.00,$0.00,$10.39,$59.35,$0.00,$29.68,$47.01,$47.48,$0.00,$9.02,$0.00,$9.45,$0.00
217.08,SUP,HCPCS C1713,,217.080  -  SCREW BONE PTHRD 6.5MM 80MM 32MM LCP STAINLESS STEEL HUMERUS,$59.35,$0.00,$59.35,$26.71,$42.36,$0.00,$9.93,$0.00,$0.00,$10.39,$59.35,$0.00,$29.68,$47.01,$47.48,$0.00,$9.02,$0.00,$9.45,$0.00
217.08,SUP,HCPCS C1713,,217.08  -  SCREW BONE 6.5MM 80MM 32MM LC DCP SS CANC PERIART NSTRL LG,$78.13,$0.00,$61.88,$26.71,$42.36,$0.00,$9.93,$0.00,$0.00,$10.39,$59.35,$0.00,$29.68,$61.88,$47.48,$0.00,$9.02,$0.00,$9.45,$0.00
217.085,SUP,HCPCS C1713,,217.085  -  SCREW BONE PTHRD 6.5MM 8MM 85MM 32MM LARGE HEXAGONAL SOCKET,$64.15,$0.00,$64.15,$28.87,$45.78,$0.00,$10.73,$0.00,$0.00,$11.23,$64.15,$0.00,$32.08,$50.81,$51.32,$0.00,$9.75,$0.00,$10.21,$0.00
217.09,SUP,HCPCS C1713,,217.090  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 90MM 32MM SOCKET LCP DCP,$64.15,$0.00,$64.15,$28.87,$45.78,$0.00,$16.54,$0.00,$0.00,$11.23,$64.15,$0.00,$32.08,$50.81,$51.32,$0.00,$15.02,$0.00,$10.21,$0.00
217.095,SUP,HCPCS C1713,,217.095  -  SCREW BONE PTHRD 6.5MM 8MM 95MM 32MM LARGE HEXAGONAL SOCKET,$64.15,$0.00,$64.15,$28.87,$45.78,$0.00,$10.73,$0.00,$0.00,$11.23,$64.15,$0.00,$32.08,$50.81,$51.32,$0.00,$9.75,$0.00,$10.21,$0.00
217.1,SUP,HCPCS C1713,,217.100  -  SCREW BONE PTHRD 6.5MM 8MM 100MM 32MM LARGE HEXAGONAL SOCKET,$64.15,$0.00,$64.15,$28.87,$45.78,$0.00,$16.54,$0.00,$0.00,$11.23,$64.15,$0.00,$32.08,$50.81,$51.32,$0.00,$15.02,$0.00,$10.21,$0.00
217.105,SUP,HCPCS C1713,,217.105  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 105MM 32MM SOCKET LCP DCP,$64.15,$0.00,$64.15,$28.87,$45.78,$0.00,$10.73,$0.00,$0.00,$11.23,$64.15,$0.00,$32.08,$50.81,$51.32,$0.00,$9.75,$0.00,$10.21,$0.00
217.11,SUP,HCPCS C1713,,217.110  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 110MM 32MM SOCKET LCP DCP,$64.15,$0.00,$64.15,$28.87,$45.78,$0.00,$10.73,$0.00,$0.00,$11.23,$64.15,$0.00,$32.08,$50.81,$51.32,$0.00,$9.75,$0.00,$10.21,$0.00
217.115,SUP,HCPCS C1713,,217.115  -  SCREW BONE 6.5MM 8MM 115MM 32MM HEXAGONAL SOCKET LC-DCP,$79.83,$0.00,$79.83,$35.92,$56.97,$0.00,$13.35,$0.00,$0.00,$13.98,$79.83,$0.00,$39.91,$63.23,$63.86,$0.00,$12.13,$0.00,$12.71,$0.00
217.12,SUP,HCPCS C1713,,217.120  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 120MM 32MM SOCKET LCP DCP,$79.83,$0.00,$79.83,$35.92,$56.97,$0.00,$13.35,$0.00,$0.00,$13.98,$79.83,$0.00,$39.91,$63.23,$63.86,$0.00,$12.13,$0.00,$12.71,$0.00
217.125,SUP,HCPCS C1713,,217.125  -  SCREW BONE 6.5MM 8MM 125MM 32MM LARGE HEXAGONAL SOCKET,$79.83,$0.00,$79.83,$35.92,$56.97,$0.00,$13.35,$0.00,$0.00,$13.98,$79.83,$0.00,$39.91,$63.23,$63.86,$0.00,$12.13,$0.00,$12.71,$0.00
217.13,SUP,HCPCS C1713,,217.130  -  SCREW BONE 6.5MM 8MM 130MM 32MM LARGE HEXAGONAL SOCKET,$79.83,$0.00,$79.83,$35.92,$56.97,$0.00,$13.35,$0.00,$0.00,$13.98,$79.83,$0.00,$39.91,$63.23,$63.86,$0.00,$12.13,$0.00,$12.71,$0.00
217.135,SUP,HCPCS C1713,,217.135  -  SCREW BONE 6.5MM 8MM 135MM 32MM LARGE HEXAGONAL SOCKET DCP,$79.83,$0.00,$79.83,$35.92,$56.97,$0.00,$13.35,$0.00,$0.00,$13.98,$79.83,$0.00,$39.91,$63.23,$63.86,$0.00,$12.13,$0.00,$12.71,$0.00
217.14,SUP,HCPCS C1713,,217.140  -  SCREW BONE 6.5MM 8MM 140MM 32MM LARGE HEXAGONAL SOCKET,$79.83,$0.00,$79.83,$35.92,$56.97,$0.00,$13.35,$0.00,$0.00,$13.98,$79.83,$0.00,$39.91,$63.23,$63.86,$0.00,$12.13,$0.00,$12.71,$0.00
217.145,SUP,HCPCS C1713,,217.145  -  SCREW BONE 6.5MM 8MM 145MM 32MM LARGE HEXAGONAL SOCKET,$79.83,$0.00,$79.83,$35.92,$56.97,$0.00,$13.35,$0.00,$0.00,$13.98,$79.83,$0.00,$39.91,$63.23,$63.86,$0.00,$12.13,$0.00,$12.71,$0.00
217.15,SUP,HCPCS C1713,,217.150  -  SCREW BONE 6.5MM 8MM 150MM 32MM LARGE HEXAGONAL SOCKET DCP,$79.83,$0.00,$79.83,$35.92,$56.97,$0.00,$13.35,$0.00,$0.00,$13.98,$79.83,$0.00,$39.91,$63.23,$63.86,$0.00,$12.13,$0.00,$12.71,$0.00
218.009,SUP,HCPCS C1713,,218.009  -  SCREW BONE 6.5MM 60MM LCP STAINLESS STEEL CANCELLOUS NONSTRL,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
218.01,SUP,HCPCS C1713,,218.010  -  CASE STERILIZATION 2IN 11X7IN CASTANEDA RETRACTOR KIT,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
218.011,SUP,HCPCS C1713,,218.011  -  SCREW BONE 6.5MM 70MM LCP STAINLESS STEEL CANCELLOUS NONSTRL,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
218.012,SUP,HCPCS C1713,,218.012  -  SCREW BONE 6.5MM 75MM LCP STAINLESS STEEL CANCELLOUS NONSTRL,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
218.013,SUP,HCPCS C1713,,218.013  -  SCREW BONE 6.5MM 80MM LCP STAINLESS STEEL CANCELLOUS NONSTRL,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
218.014,SUP,HCPCS C1713,,218.014  -  SCREW BONE 6.5MM 85MM LCP STAINLESS STEEL CANCELLOUS NONSTRL,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
218.015,SUP,HCPCS C1713,,218.015  -  SCREW BONE 6.5MM 90MM LCP STAINLESS STEEL CANCELLOUS NONSTRL,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
218.016,SUP,HCPCS C1713,,218.016  -  SCREW BONE 6.5MM 95MM LCP STAINLESS STEEL CANCELLOUS NONSTRL,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
218.017,SUP,HCPCS C1713,,218.017  -  SCREW BONE 6.5MM 100MM LCP STAINLESS STEEL CANCELLOUS,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
218.018,SUP,HCPCS C1713,,218.018  -  SCREW BONE 6.5MM 105MM LCP STAINLESS STEEL CANCELLOUS,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
218.019,SUP,HCPCS C1713,,218.019  -  SCREW BONE 6.5MM 110MM LCP STAINLESS STEEL CANCELLOUS,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
218.02,SUP,HCPCS C1713,,218.020  -  SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 20MM SOCKET LCP,$59.35,$0.00,$59.35,$26.71,$42.36,$0.00,$9.93,$0.00,$0.00,$10.39,$59.35,$0.00,$29.68,$47.01,$47.48,$0.00,$9.02,$0.00,$9.45,$0.00
218.025,SUP,HCPCS C1713,,218.025  -  SCREW BONE 6.5MM 25MM FULTHD LC-DCP STAINLESS STEEL,$59.35,$0.00,$59.35,$26.71,$42.36,$0.00,$9.93,$0.00,$0.00,$10.39,$59.35,$0.00,$29.68,$47.01,$47.48,$0.00,$9.02,$0.00,$9.45,$0.00
218.03,SUP,HCPCS C1713,,218.030  -  SCREW BONE FULTHD 6.5MM 8MM 30MM LARGE HEXAGONAL SOCKET LCP,$59.35,$0.00,$59.35,$26.71,$42.36,$0.00,$14.99,$0.00,$0.00,$10.39,$59.35,$0.00,$29.68,$47.01,$47.48,$0.00,$13.61,$0.00,$9.45,$0.00
218.035,SUP,HCPCS C1713,,218.035  -  SCREW BONE FULTHD 6.5MM 8MM 35MM LARGE HEXAGONAL SOCKET LCP,$59.35,$0.00,$59.35,$26.71,$42.36,$0.00,$14.99,$0.00,$0.00,$10.39,$59.35,$0.00,$29.68,$47.01,$47.48,$0.00,$13.61,$0.00,$9.45,$0.00
218.04,SUP,HCPCS C1713,,218.040  -  SCREW BONE FULTHD 6.5MM 8MM 40MM LARGE HEXAGONAL SOCKET LCP,$59.35,$0.00,$59.35,$26.71,$42.36,$0.00,$9.93,$0.00,$0.00,$10.39,$59.35,$0.00,$29.68,$47.01,$47.48,$0.00,$9.02,$0.00,$9.45,$0.00
218.045,SUP,HCPCS C1713,,218.045  -  SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 45MM SOCKET LCP,$59.35,$0.00,$59.35,$26.71,$42.36,$0.00,$14.99,$0.00,$0.00,$10.39,$59.35,$0.00,$29.68,$47.01,$47.48,$0.00,$13.61,$0.00,$9.45,$0.00
218.05,SUP,HCPCS C1713,,218.050  -  SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 50MM SOCKET LCP,$59.35,$0.00,$59.35,$26.71,$42.36,$0.00,$9.93,$0.00,$0.00,$10.39,$59.35,$0.00,$29.68,$47.01,$47.48,$0.00,$9.02,$0.00,$9.45,$0.00
218.055,SUP,HCPCS C1713,,218.055  -  SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 55MM SOCKET LCP,$59.35,$0.00,$59.35,$26.71,$42.36,$0.00,$9.93,$0.00,$0.00,$10.39,$59.35,$0.00,$29.68,$47.01,$47.48,$0.00,$9.02,$0.00,$9.45,$0.00
218.06,SUP,HCPCS C1713,,218.060  -  SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 60MM SOCKET LCP,$59.35,$0.00,$59.35,$26.71,$42.36,$0.00,$9.93,$0.00,$0.00,$10.39,$59.35,$0.00,$29.68,$47.01,$47.48,$0.00,$9.02,$0.00,$9.45,$0.00
218.065,SUP,HCPCS C1713,,218.065  -  SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 65MM SOCKET LCP,$59.35,$0.00,$59.35,$26.71,$42.36,$0.00,$9.93,$0.00,$0.00,$10.39,$59.35,$0.00,$29.68,$47.01,$47.48,$0.00,$9.02,$0.00,$9.45,$0.00
218.07,SUP,HCPCS C1713,,218.070  -  SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 70MM SOCKET LCP,$59.35,$0.00,$59.35,$26.71,$42.36,$0.00,$9.93,$0.00,$0.00,$10.39,$59.35,$0.00,$29.68,$47.01,$47.48,$0.00,$9.02,$0.00,$9.45,$0.00
218.075,SUP,HCPCS C1713,,218.075  -  SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 75MM SOCKET LCP,$59.35,$0.00,$59.35,$26.71,$42.36,$0.00,$9.93,$0.00,$0.00,$10.39,$59.35,$0.00,$29.68,$47.01,$47.48,$0.00,$9.02,$0.00,$9.45,$0.00
218.08,SUP,HCPCS C1713,,218.080  -  SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 80MM SOCKET LCP,$59.35,$0.00,$59.35,$26.71,$42.36,$0.00,$9.93,$0.00,$0.00,$10.39,$59.35,$0.00,$29.68,$47.01,$47.48,$0.00,$9.02,$0.00,$9.45,$0.00
218.085,SUP,HCPCS C1713,,218.085  -  SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 85MM SOCKET LCP,$64.15,$0.00,$64.15,$28.87,$45.78,$0.00,$10.73,$0.00,$0.00,$11.23,$64.15,$0.00,$32.08,$50.81,$51.32,$0.00,$9.75,$0.00,$10.21,$0.00
218.09,SUP,HCPCS C1713,,218.090  -  SCREW BONE FULTHD 6.5MM 8MM 90MM 3.5MM HEXAGONAL SOCKET DCP,$64.15,$0.00,$64.15,$28.87,$45.78,$0.00,$10.73,$0.00,$0.00,$11.23,$64.15,$0.00,$32.08,$50.81,$51.32,$0.00,$9.75,$0.00,$10.21,$0.00
218.095,SUP,HCPCS C1713,,218.095  -  SCREW BONE FULTHD 6.5MM 8MM 95MM 3.5MM HEXAGONAL SOCKET DCP,$64.15,$0.00,$64.15,$28.87,$45.78,$0.00,$10.73,$0.00,$0.00,$11.23,$64.15,$0.00,$32.08,$50.81,$51.32,$0.00,$9.75,$0.00,$10.21,$0.00
218.1,SUP,HCPCS C1713,,218.100  -  SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 100MM SOCKET LCP,$64.15,$0.00,$64.15,$28.87,$45.78,$0.00,$10.73,$0.00,$0.00,$11.23,$64.15,$0.00,$32.08,$50.81,$51.32,$0.00,$9.75,$0.00,$10.21,$0.00
218.105,SUP,HCPCS C1713,,218.105  -  SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 105MM SOCKET LCP,$64.15,$0.00,$64.15,$28.87,$45.78,$0.00,$10.73,$0.00,$0.00,$11.23,$64.15,$0.00,$32.08,$50.81,$51.32,$0.00,$9.75,$0.00,$10.21,$0.00
218.11,SUP,HCPCS C1713,,218.110  -  SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 110MM SOCKET LCP,$64.15,$0.00,$64.15,$28.87,$45.78,$0.00,$10.73,$0.00,$0.00,$11.23,$64.15,$0.00,$32.08,$50.81,$51.32,$0.00,$9.75,$0.00,$10.21,$0.00
218.115,SUP,HCPCS C1713,,218.115  -  SCREW BONE FULTHD 6.5MM 8MM 115MM LARGE HEXAGONAL SOCKET,$79.83,$0.00,$79.83,$35.92,$56.97,$0.00,$13.35,$0.00,$0.00,$13.98,$79.83,$0.00,$39.91,$63.23,$63.86,$0.00,$12.13,$0.00,$12.71,$0.00
218.12,SUP,HCPCS C1713,,218.120  -  SCREW BONE FULTHD 6.5MM 8MM 120MM LARGE HEXAGONAL SOCKET,$79.83,$0.00,$79.83,$35.92,$56.97,$0.00,$13.35,$0.00,$0.00,$13.98,$79.83,$0.00,$39.91,$63.23,$63.86,$0.00,$12.13,$0.00,$12.71,$0.00
218.125,SUP,HCPCS C1713,,218.125  -  SCREW BONE FULTHD 6.5MM 8MM 125MM LARGE HEXAGONAL SOCKET,$79.83,$0.00,$79.83,$35.92,$56.97,$0.00,$13.35,$0.00,$0.00,$13.98,$79.83,$0.00,$39.91,$63.23,$63.86,$0.00,$12.13,$0.00,$12.71,$0.00
218.13,SUP,HCPCS C1713,,218.130  -  SCREW BONE 6.5MM 130MM FULTHRD LC-DCP STAINLESS STEEL,$79.83,$0.00,$79.83,$35.92,$56.97,$0.00,$13.35,$0.00,$0.00,$13.98,$79.83,$0.00,$39.91,$63.23,$63.86,$0.00,$12.13,$0.00,$12.71,$0.00
218.135,SUP,HCPCS C1713,,218.135  -  SCREW BONE FULTHD 6.5MM 8MM 135MM LARGE HEXAGONAL SOCKET,$79.83,$0.00,$79.83,$35.92,$56.97,$0.00,$13.35,$0.00,$0.00,$13.98,$79.83,$0.00,$39.91,$63.23,$63.86,$0.00,$12.13,$0.00,$12.71,$0.00
218.14,SUP,HCPCS C1713,,218.140  -  SCREW BONE 6.5MM 140MM FULTHRD DCP LC-DCP STAINLESS STEEL,$79.83,$0.00,$79.83,$35.92,$56.97,$0.00,$13.35,$0.00,$0.00,$13.98,$79.83,$0.00,$39.91,$63.23,$63.86,$0.00,$12.13,$0.00,$12.71,$0.00
218.145,SUP,HCPCS C1713,,218.145  -  SCREW BONE FULTHD 6.5MM 8MM 145MM LARGE HEXAGONAL SOCKET,$79.83,$0.00,$79.83,$35.92,$56.97,$0.00,$13.35,$0.00,$0.00,$13.98,$79.83,$0.00,$39.91,$63.23,$63.86,$0.00,$12.13,$0.00,$12.71,$0.00
218.15,SUP,HCPCS C1713,,218.150  -  SCREW BONE 6.5MM 150MM FULTHRD DCP LC-DCP STAINLESS STEEL,$79.83,$0.00,$79.83,$35.92,$56.97,$0.00,$13.35,$0.00,$0.00,$13.98,$79.83,$0.00,$39.91,$63.23,$63.86,$0.00,$12.13,$0.00,$12.71,$0.00
218.215,SUP,HCPCS C1713,,218.215  -  SCREW BONE FULTHD 6.5MM 115MM LCP STAINLESS STEEL CANCELLOUS,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
218.22,SUP,HCPCS C1713,,218.220  -  SCREW BONE FULTHD LP 6.5MM 8MM 120MM HIGH BENDING STABILITY,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
218.225,SUP,HCPCS C1713,,218.225  -  SCREW BONE FULTHD 6.5MM 125MM LCP STAINLESS STEEL CANCELLOUS,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
218.23,SUP,HCPCS C1713,,218.230  -  SCREW BONE FULTHD LP 6.5MM 8MM 130MM HIGH BENDING STABILITY,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
219.89,SUP,Custom 27803010,,219.89  -  WASHER ORTHOPEDIC THREAD LCP STAINLESS STEEL NONSTRL 3 MM,$251.13,$0.00,$251.13,$0.00,$179.23,$0.00,$0.00,$0.00,$0.00,$0.00,$251.13,$0.00,$125.56,$198.89,$200.90,$0.00,$0.00,$0.00,$0.00,$0.00
219.91,SUP,Custom 27803010,,219.91  -  WASHER ORTHOPEDIC 10MM LCP STAINLESS STEEL NONSTRL 4.5MM,$48.43,$0.00,$48.43,$0.00,$34.56,$0.00,$0.00,$0.00,$0.00,$0.00,$48.43,$0.00,$24.21,$38.36,$38.74,$0.00,$0.00,$0.00,$0.00,$0.00
219.931,SUP,Custom 27803010,,219.931  -  WASHER ORTHOPEDIC 8MM 3.2MM SPIKE LCP STAINLESS STEEL,$131.68,$0.00,$131.68,$0.00,$93.98,$0.00,$0.00,$0.00,$0.00,$0.00,$131.68,$0.00,$65.84,$104.29,$105.34,$0.00,$0.00,$0.00,$0.00,$0.00
219.941,SUP,Custom 27803010,,219.941  -  WASHER ORTHOPEDIC 13.5MM 4MM SPIKE LCP STAINLESS STEEL,$222.45,$0.00,$222.45,$0.00,$158.76,$0.00,$0.00,$0.00,$0.00,$0.00,$222.45,$0.00,$111.23,$176.18,$177.96,$0.00,$0.00,$0.00,$0.00,$0.00
219.951,SUP,Custom 27803010,,219.951  -  WASHER ORTHOPEDIC 13.5MM 5.5MM SPIKE LC-DCP PEEK-OPTIMA 6%,$219.73,$0.00,$219.73,$0.00,$156.82,$0.00,$0.00,$0.00,$0.00,$0.00,$219.73,$0.00,$109.86,$174.03,$175.78,$0.00,$0.00,$0.00,$0.00,$0.00
219.96,SUP,Custom 27803010,,219.96  -  NUT ORTHOPEDIC LC-DCP STAINLESS STEEL NONSTRL 4.5 MM,$54.23,$0.00,$54.23,$0.00,$38.70,$0.00,$0.00,$0.00,$0.00,$0.00,$54.23,$0.00,$27.11,$42.95,$43.38,$0.00,$0.00,$0.00,$0.00,$0.00
219.97,SUP,Custom 27803010,,219.97  -  WASHER ORTHOPEDIC 4.5MM FRAGMENT DCP STAINLESS STEEL NONSTRL,$41.60,$0.00,$41.60,$0.00,$29.69,$0.00,$0.00,$0.00,$0.00,$0.00,$41.60,$0.00,$20.80,$32.95,$33.28,$0.00,$0.00,$0.00,$0.00,$0.00
219.972,SUP,Custom 27803010,,219.972  -  WASHER ORTHOPEDIC 6.5MM 3.3MM LCP STAINLESS STEEL NONSTRL 3,$54.23,$0.00,$54.23,$0.00,$38.70,$0.00,$0.00,$0.00,$0.00,$0.00,$54.23,$0.00,$27.11,$42.95,$43.38,$0.00,$0.00,$0.00,$0.00,$0.00
219.98,SUP,Custom 27803010,,219.98  -  WASHER ORTHOPEDIC SMALL 7MM 3.6MM LCP STAINLESS STEEL,$46.05,$0.00,$46.05,$0.00,$32.87,$0.00,$0.00,$0.00,$0.00,$0.00,$46.05,$0.00,$23.03,$36.47,$36.84,$0.00,$0.00,$0.00,$0.00,$0.00
219.99,SUP,Custom 27803010,,219.99  -  WASHER ORTHOPEDIC 13MM 6.6MM LCP STAINLESS STEEL NONSTRL,$51.18,$0.00,$51.18,$0.00,$36.52,$0.00,$0.00,$0.00,$0.00,$0.00,$51.18,$0.00,$25.59,$40.53,$40.94,$0.00,$0.00,$0.00,$0.00,$0.00
221.306,SUP,HCPCS C1713,,221.306  -  PLATE BONE STR 6 HOLE LP PRECONTOUR RECONSTRUCTION ANATOMIC,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
221.312,SUP,HCPCS C1713,,221.312  -  PLATE BONE STR 12 HOLE LP PRECONTOUR RECONSTRUCTION ANATOMIC,$451.73,$0.00,$451.73,$203.28,$322.40,$0.00,$75.56,$0.00,$0.00,$79.09,$451.73,$0.00,$225.86,$357.77,$361.38,$0.00,$68.64,$0.00,$71.91,$0.00
221.32,SUP,HCPCS C1713,,221.320  -  PLATE BN H 19MMX.5MM NS 8 HL XTD LOPRFL PRECONTOUR SS HND RT,$431.25,$0.00,$431.25,$194.06,$307.78,$0.00,$72.14,$0.00,$0.00,$75.51,$431.25,$0.00,$215.63,$341.55,$345.00,$0.00,$65.53,$0.00,$68.66,$0.00
221.321,SUP,HCPCS C1713,,221.321  -  PLATE BN H 19MMX.5MM NS 8 HL XTD LOPRFL PRECONTOUR SS HND LT,$431.25,$0.00,$431.25,$194.06,$307.78,$0.00,$72.14,$0.00,$0.00,$75.51,$431.25,$0.00,$215.63,$341.55,$345.00,$0.00,$65.53,$0.00,$68.66,$0.00
221.333,SUP,HCPCS C1713,,221.333  -  SCREW BONE 4MM 46MM T25 STARDRIVE RECESS LOCK SELF TAP LCP,$413.53,$0.00,$413.53,$186.09,$295.13,$0.00,$69.17,$0.00,$0.00,$72.40,$413.53,$0.00,$206.76,$327.52,$330.82,$0.00,$62.83,$0.00,$65.83,$0.00
221.334,SUP,HCPCS C1713,,221.334  -  PLATE BONE T 4X8 HOLE LP PRECONTOUR RECONSTRUCTION ANATOMIC,$431.25,$0.00,$431.25,$194.06,$307.78,$0.00,$72.14,$0.00,$0.00,$75.51,$431.25,$0.00,$215.63,$341.55,$345.00,$0.00,$65.53,$0.00,$68.66,$0.00
221.335,SUP,HCPCS C1713,,221.335  -  PLATE BONE Y 3X8 HOLE LP PRECONTOUR RECONSTRUCTION ANATOMIC,$413.53,$0.00,$413.53,$186.09,$295.13,$0.00,$69.17,$0.00,$0.00,$72.40,$413.53,$0.00,$206.76,$327.52,$330.82,$0.00,$62.83,$0.00,$65.83,$0.00
222.02,SUP,HCPCS C1713,,222.02  -  PLATE BN SMTB 39X12X1MM NS 2 HL SS 3.5/4.5MM SCR LG FRAG,$122.13,$0.00,$122.13,$54.96,$87.16,$0.00,$20.43,$0.00,$0.00,$21.38,$122.13,$0.00,$61.06,$96.73,$97.70,$0.00,$18.56,$0.00,$19.44,$0.00
222.03,SUP,HCPCS C1713,,222.03  -  PLATE BN SMTB 55X12X1MM NS 3 HL SS 3.5/4.5MM SCR LG FRAG,$130.33,$0.00,$130.33,$58.65,$93.01,$0.00,$21.80,$0.00,$0.00,$22.82,$130.33,$0.00,$65.16,$103.22,$104.26,$0.00,$19.80,$0.00,$20.75,$0.00
222.04,SUP,HCPCS C1713,,222.04  -  PLATE BONE SEMITUBULAR 71X12X1MM 4 HOLE SEMITUBULAR DCP,$140.58,$0.00,$140.58,$63.26,$100.33,$0.00,$23.51,$0.00,$0.00,$24.61,$140.58,$0.00,$70.29,$111.34,$112.46,$0.00,$21.36,$0.00,$22.38,$0.00
222.05,SUP,HCPCS C1713,,222.05  -  PLATE BONE SEMITUBULAR 87X12X1MM 5 HOLE SEMITUBULAR DCP,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$24.88,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$22.60,$0.00,$23.68,$0.00
222.06,SUP,HCPCS C1713,,222.06  -  PLATE BONE SEMITUBULAR 103X12X1MM 6 HOLE SEMITUBULAR DCP,$158.30,$0.00,$158.30,$71.24,$112.98,$0.00,$26.48,$0.00,$0.00,$27.72,$158.30,$0.00,$79.15,$125.37,$126.64,$0.00,$24.05,$0.00,$25.20,$0.00
222.07,SUP,HCPCS C1713,,222.07  -  PLATE BONE SEMITUBULAR 119X12X1MM 7 HOLE SEMITUBULAR DCP,$169.23,$0.00,$169.23,$76.15,$120.78,$0.00,$28.31,$0.00,$0.00,$29.63,$169.23,$0.00,$84.61,$134.03,$135.38,$0.00,$25.71,$0.00,$26.94,$0.00
222.08,SUP,HCPCS C1713,,222.08  -  PLATE BONE SEMITUBULAR 135X12X1MM 8 HOLE SEMITUBULAR DCP,$184.25,$0.00,$184.25,$82.91,$131.50,$0.00,$30.82,$0.00,$0.00,$32.26,$184.25,$0.00,$92.13,$145.93,$147.40,$0.00,$27.99,$0.00,$29.33,$0.00
222.09,SUP,HCPCS C1713,,222.09  -  PLATE BONE 151X12X1MM 9 HOLE SEMITUBULAR DCP LC-DCP,$206.08,$0.00,$206.08,$92.73,$147.08,$0.00,$34.47,$0.00,$0.00,$36.08,$206.08,$0.00,$103.04,$163.22,$164.86,$0.00,$31.31,$0.00,$32.81,$0.00
222.1,SUP,HCPCS C1713,,222.10  -  PLATE BONE TUBE 167X12X1MM 10 HOLE LOCK LCP STAINLESS STEEL,$201.98,$0.00,$201.98,$90.89,$144.15,$0.00,$33.79,$0.00,$0.00,$35.36,$201.98,$0.00,$100.99,$159.97,$161.58,$0.00,$30.69,$0.00,$32.15,$0.00
222.11,SUP,HCPCS C1713,,222.11  -  PLATE BONE 183X12X1MM 11 HOLE SEMITUBULAR LC-DCP STAINLESS,$222.45,$0.00,$222.45,$100.10,$158.76,$0.00,$37.21,$0.00,$0.00,$38.95,$222.45,$0.00,$111.23,$176.18,$177.96,$0.00,$33.80,$0.00,$35.41,$0.00
222.12,SUP,HCPCS C1713,,222.12  -  PLATE BONE 199X12X1MM 12 HOLE SEMITUBULAR LC-DCP STAINLESS,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
222.22,SUP,HCPCS C1713,,222.220  -  ANCHOR SUTURE 2MM 2 END THREAD TAB TACIT,"$2,763.63",$0.00,"$2,763.63","$1,243.63","$1,972.40",$0.00,$462.29,$0.00,$0.00,$483.89,"$2,763.63",$0.00,"$1,381.81","$2,188.79","$2,210.90",$0.00,$419.91,$0.00,$439.97,$0.00
222.221,SUP,HCPCS C1713,,222.221  -  PLATE BONE 140MM 5 HOLE LCP STAINLESS STEEL TIBIA LEFT,"$2,763.63",$0.00,"$2,763.63","$1,243.63","$1,972.40",$0.00,$462.29,$0.00,$0.00,$483.89,"$2,763.63",$0.00,"$1,381.81","$2,188.79","$2,210.90",$0.00,$419.91,$0.00,$439.97,$0.00
222.222,SUP,HCPCS C1713,,222.222  -  PLATE BONE 180MM 7 HOLE LCP STAINLESS STEEL TIBIA RIGHT,"$2,819.58",$0.00,"$2,819.58","$1,268.81","$2,012.33",$0.00,$471.65,$0.00,$0.00,$493.69,"$2,819.58",$0.00,"$1,409.79","$2,233.11","$2,255.66",$0.00,$428.41,$0.00,$448.88,$0.00
222.223,SUP,HCPCS C1713,,222.223  -  PLATE BONE 180MM 7 HOLE LCP STAINLESS STEEL TIBIA LEFT,"$2,819.58",$0.00,"$2,819.58","$1,268.81","$2,012.33",$0.00,$471.65,$0.00,$0.00,$493.69,"$2,819.58",$0.00,"$1,409.79","$2,233.11","$2,255.66",$0.00,$428.41,$0.00,$448.88,$0.00
222.224,SUP,HCPCS C1713,,222.224  -  PLATE BONE 220MM 9 HOLE LCP STAINLESS STEEL TIBIA RIGHT,"$2,878.25",$0.00,"$2,878.25","$1,295.21","$2,054.21",$0.00,$481.47,$0.00,$0.00,$503.96,"$2,878.25",$0.00,"$1,439.13","$2,279.57","$2,302.60",$0.00,$437.33,$0.00,$458.22,$0.00
222.225,SUP,HCPCS C1713,,222.225  -  PLATE BONE 220MM 9 HOLE LCP STAINLESS STEEL TIBIA LEFT,"$2,878.25",$0.00,"$2,878.25","$1,295.21","$2,054.21",$0.00,$481.47,$0.00,$0.00,$503.96,"$2,878.25",$0.00,"$1,439.13","$2,279.57","$2,302.60",$0.00,$437.33,$0.00,$458.22,$0.00
222.226,SUP,HCPCS C1713,,222.226  -  PLATE BONE 260MM 11 HOLE LCP STAINLESS STEEL TIBIA RIGHT,"$2,934.23",$0.00,"$2,934.23","$1,320.40","$2,094.16",$0.00,$490.83,$0.00,$0.00,$513.76,"$2,934.23",$0.00,"$1,467.11","$2,323.91","$2,347.38",$0.00,$445.83,$0.00,$467.13,$0.00
222.227,SUP,HCPCS C1713,,222.227  -  PLATE BONE 260MM 11 HOLE LCP STAINLESS STEEL TIBIA LEFT,"$2,934.23",$0.00,"$2,934.23","$1,320.40","$2,094.16",$0.00,$490.83,$0.00,$0.00,$513.76,"$2,934.23",$0.00,"$1,467.11","$2,323.91","$2,347.38",$0.00,$445.83,$0.00,$467.13,$0.00
222.228,SUP,HCPCS C1713,,222.228  -  PLATE BONE 300MM 13 HOLE LCP STAINLESS STEEL TIBIA RIGHT,"$2,991.53",$0.00,"$2,991.53","$1,346.19","$2,135.05",$0.00,$500.41,$0.00,$0.00,$523.79,"$2,991.53",$0.00,"$1,495.76","$2,369.29","$2,393.22",$0.00,$454.54,$0.00,$476.25,$0.00
222.229,SUP,HCPCS C1713,,222.229  -  PLATE BONE 300MM 13 HOLE LCP STAINLESS STEEL TIBIA LEFT,"$2,991.53",$0.00,"$2,991.53","$1,346.19","$2,135.05",$0.00,$500.41,$0.00,$0.00,$523.79,"$2,991.53",$0.00,"$1,495.76","$2,369.29","$2,393.22",$0.00,$454.54,$0.00,$476.25,$0.00
222.25,SUP,HCPCS C1713,,222.250  -  PLATE BONE 156MM 5 HOLE LCP STAINLESS STEEL FEMUR RIGHT,"$2,763.63",$0.00,"$2,763.63","$1,243.63","$1,972.40",$0.00,$462.29,$0.00,$0.00,$483.89,"$2,763.63",$0.00,"$1,381.81","$2,188.79","$2,210.90",$0.00,$419.91,$0.00,$439.97,$0.00
222.251,SUP,HCPCS C1713,,222.251  -  PLATE BONE 156MM 5 HOLE LCP STAINLESS STEEL LEFT CNDYLR,"$2,763.63",$0.00,"$2,763.63","$1,243.63","$1,972.40",$0.00,$462.29,$0.00,$0.00,$483.89,"$2,763.63",$0.00,"$1,381.81","$2,188.79","$2,210.90",$0.00,$419.91,$0.00,$439.97,$0.00
222.252,SUP,HCPCS C1713,,222.252  -  PLATE BONE 196MM 7 HOLE LCP STAINLESS STEEL FEMUR RIGHT,"$2,819.58",$0.00,"$2,819.58","$1,268.81","$2,012.33",$0.00,$471.65,$0.00,$0.00,$493.69,"$2,819.58",$0.00,"$1,409.79","$2,233.11","$2,255.66",$0.00,$428.41,$0.00,$448.88,$0.00
222.253,SUP,HCPCS C1713,,222.253  -  PLATE BONE 196MM 7 HOLE LCP STAINLESS STEEL FEMUR LEFT,"$2,819.58",$0.00,"$2,819.58","$1,268.81","$2,012.33",$0.00,$471.65,$0.00,$0.00,$493.69,"$2,819.58",$0.00,"$1,409.79","$2,233.11","$2,255.66",$0.00,$428.41,$0.00,$448.88,$0.00
222.254,SUP,HCPCS C1713,,222.254  -  PLATE BONE 236MM 9 HOLE LCP STAINLESS STEEL FEMUR RIGHT,"$2,878.25",$0.00,"$2,878.25","$1,295.21","$2,054.21",$0.00,$481.47,$0.00,$0.00,$503.96,"$2,878.25",$0.00,"$1,439.13","$2,279.57","$2,302.60",$0.00,$437.33,$0.00,$458.22,$0.00
222.255,SUP,HCPCS C1713,,222.255  -  PLATE BONE 236MM 9 HOLE LCP STAINLESS STEEL FEMUR LEFT,"$2,878.25",$0.00,"$2,878.25","$1,295.21","$2,054.21",$0.00,$481.47,$0.00,$0.00,$503.96,"$2,878.25",$0.00,"$1,439.13","$2,279.57","$2,302.60",$0.00,$437.33,$0.00,$458.22,$0.00
222.256,SUP,HCPCS C1713,,222.256  -  PLATE BONE 276MM 11 HOLE LCP STAINLESS STEEL FEMUR RIGHT,"$2,934.23",$0.00,"$2,934.23","$1,320.40","$2,094.16",$0.00,$490.83,$0.00,$0.00,$513.76,"$2,934.23",$0.00,"$1,467.11","$2,323.91","$2,347.38",$0.00,$445.83,$0.00,$467.13,$0.00
222.257,SUP,HCPCS C1713,,222.257  -  PLATE BONE 276MM 11 HOLE LCP STAINLESS STEEL FEMUR LEFT,"$2,934.23",$0.00,"$2,934.23","$1,320.40","$2,094.16",$0.00,$490.83,$0.00,$0.00,$513.76,"$2,934.23",$0.00,"$1,467.11","$2,323.91","$2,347.38",$0.00,$445.83,$0.00,$467.13,$0.00
222.258,SUP,HCPCS C1713,,222.258  -  PLATE BONE 316MM 13 HOLE LCP STAINLESS STEEL FEMUR RIGHT,"$2,991.53",$0.00,"$2,991.53","$1,346.19","$2,135.05",$0.00,$500.41,$0.00,$0.00,$523.79,"$2,991.53",$0.00,"$1,495.76","$2,369.29","$2,393.22",$0.00,$454.54,$0.00,$476.25,$0.00
222.259,SUP,HCPCS C1713,,222.259  -  PLATE BONE 316MM 13 HOLE LCP STAINLESS STEEL FEMUR LEFT,"$2,991.53",$0.00,"$2,991.53","$1,346.19","$2,135.05",$0.00,$500.41,$0.00,$0.00,$523.79,"$2,991.53",$0.00,"$1,495.76","$2,369.29","$2,393.22",$0.00,$454.54,$0.00,$476.25,$0.00
222.402,SUP,HCPCS C1713,,222.402  -  SCREW BONE 5MM 14MM SLFTAP LOCKING LCP LISS STAINLESS STEEL,$393.05,$0.00,$393.05,$176.87,$280.52,$0.00,$65.75,$0.00,$0.00,$68.82,$393.05,$0.00,$196.53,$311.30,$314.44,$0.00,$59.72,$0.00,$62.57,$0.00
222.404,SUP,HCPCS C1713,,222.404  -  SCREW BONE 5MM 18MM SLFTAP LOCKING LCP LISS STAINLESS STEEL,$386.23,$0.00,$386.23,$173.80,$275.65,$0.00,$64.61,$0.00,$0.00,$67.62,$386.23,$0.00,$193.11,$305.89,$308.98,$0.00,$58.68,$0.00,$61.49,$0.00
222.537,SUP,HCPCS C1713,,222.537  -  SCREW BONE 5MM 35MM LCP SS PROX PERIART FEM/TIB CANN LCK,$444.08,$0.00,$444.08,$199.83,$316.94,$0.00,$76.51,$0.00,$0.00,$77.75,$444.08,$0.00,$222.04,$351.71,$355.26,$0.00,$69.50,$0.00,$70.70,$0.00
222.538,SUP,HCPCS C1713,,222.538  -  SCREW BONE 5MM 40MM LCP TI PROX PERIART FEM/TIB CANN LCK,$444.08,$0.00,$444.08,$199.83,$316.94,$0.00,$76.51,$0.00,$0.00,$77.75,$444.08,$0.00,$222.04,$351.71,$355.26,$0.00,$69.50,$0.00,$70.70,$0.00
222.541,SUP,HCPCS C1713,,222.541  -  SCREW BONE 5MM 55MM LCP SS PROX PERIART FEM/TIB CANN LCK,$444.08,$0.00,$444.08,$199.83,$316.94,$0.00,$76.51,$0.00,$0.00,$77.75,$444.08,$0.00,$222.04,$351.71,$355.26,$0.00,$69.50,$0.00,$70.70,$0.00
222.542,SUP,HCPCS C1713,,222.542  -  SCREW BONE 5MM 60MM LCP SS PROX PERIART FEM/TIB CANN LCK,$444.08,$0.00,$444.08,$199.83,$316.94,$0.00,$76.51,$0.00,$0.00,$77.75,$444.08,$0.00,$222.04,$351.71,$355.26,$0.00,$69.50,$0.00,$70.70,$0.00
222.543,SUP,HCPCS C1713,,222.543  -  SCREW BONE 5MM 65MM LCP SS PROX PERIART FEM/TIB CANN LCK,$387.78,$0.00,$387.78,$174.50,$276.76,$0.00,$66.81,$0.00,$0.00,$67.90,$387.78,$0.00,$193.89,$307.12,$310.22,$0.00,$60.69,$0.00,$61.73,$0.00
222.545,SUP,HCPCS C1713,,222.545  -  SCREW BONE 5MM 75MM LCP SS PROX PERIART FEM/TIB CANN LCK,$444.08,$0.00,$444.08,$199.83,$316.94,$0.00,$76.51,$0.00,$0.00,$77.75,$444.08,$0.00,$222.04,$351.71,$355.26,$0.00,$69.50,$0.00,$70.70,$0.00
222.546,SUP,HCPCS C1713,,222.546  -  SCREW BONE 5MM 80MM LCP SS PROX PERIART FEM/TIB CANN LCK,$444.08,$0.00,$444.08,$199.83,$316.94,$0.00,$76.51,$0.00,$0.00,$77.75,$444.08,$0.00,$222.04,$351.71,$355.26,$0.00,$69.50,$0.00,$70.70,$0.00
222.547,SUP,HCPCS C1713,,222.547  -  SCREW BONE 5MM 85MM LCP SS PROX PERIART FEM/TIB CANN LCK,$444.08,$0.00,$444.08,$199.83,$316.94,$0.00,$76.51,$0.00,$0.00,$77.75,$444.08,$0.00,$222.04,$351.71,$355.26,$0.00,$69.50,$0.00,$70.70,$0.00
222.548,SUP,HCPCS C1713,,222.548  -  SCREW BONE 5MM 90MM LCP SS PROX PERIART FEM/TIB CANN LCK,$444.08,$0.00,$444.08,$199.83,$316.94,$0.00,$76.51,$0.00,$0.00,$77.75,$444.08,$0.00,$222.04,$351.71,$355.26,$0.00,$69.50,$0.00,$70.70,$0.00
222.554,SUP,HCPCS C1713,,222.554  -  SCREW BONE 5MM 40MM LCP SS PROX PERIART FEM/TIB CANN CONICAL,$340.75,$0.00,$340.75,$153.34,$243.19,$0.00,$58.71,$0.00,$0.00,$59.66,$340.75,$0.00,$170.38,$269.87,$272.60,$0.00,$53.33,$0.00,$54.25,$0.00
222.564,SUP,HCPCS C1713,,222.564  -  SCREW BONE 5MM 90MM LCP SS PROX PERIART FEM/TIB CANN CONICAL,$390.60,$0.00,$390.60,$175.77,$278.77,$0.00,$67.30,$0.00,$0.00,$68.39,$390.60,$0.00,$195.30,$309.36,$312.48,$0.00,$61.13,$0.00,$62.18,$0.00
222.571,SUP,HCPCS C1713,,222.571  -  SCREW BONE 7.3MM 70MM LCP SS PROX PERIART FEM/TIB CANN LCK,$657.98,$0.00,$657.98,$296.09,$469.60,$0.00,$113.37,$0.00,$0.00,$115.21,$657.98,$0.00,$328.99,$521.12,$526.38,$0.00,$102.97,$0.00,$104.75,$0.00
222.572,SUP,HCPCS C1713,,222.572  -  SCREW BONE 7.3MM 75MM LCP SS PROX PERIART FEM/TIB CANN LCK,$657.98,$0.00,$657.98,$296.09,$469.60,$0.00,$113.37,$0.00,$0.00,$115.21,$657.98,$0.00,$328.99,$521.12,$526.38,$0.00,$102.97,$0.00,$104.75,$0.00
222.573,SUP,HCPCS C1713,,222.573  -  SCREW BONE 7.3MM 80MM LCP SS PROX PERIART FEM/TIB CANN LCK,$657.98,$0.00,$657.98,$296.09,$469.60,$0.00,$113.37,$0.00,$0.00,$115.21,$657.98,$0.00,$328.99,$521.12,$526.38,$0.00,$102.97,$0.00,$104.75,$0.00
222.575,SUP,HCPCS C1713,,222.575  -  SCREW BONE 7.3MM 90MM LCP SS PROX PERIART FEM/TIB CANN LCK,$657.98,$0.00,$657.98,$296.09,$469.60,$0.00,$113.37,$0.00,$0.00,$115.21,$657.98,$0.00,$328.99,$521.12,$526.38,$0.00,$102.97,$0.00,$104.75,$0.00
222.578,SUP,Custom 27803010,,222.578  -  NUT ORTHOPEDIC 4MM 12MM SELF CUTTING SERRATED TIP LCP,$294.78,$0.00,$294.78,$0.00,$210.38,$0.00,$0.00,$0.00,$0.00,$0.00,$294.78,$0.00,$147.39,$233.47,$235.82,$0.00,$0.00,$0.00,$0.00,$0.00
222.58,SUP,HCPCS C1713,,222.580  -  SCREW BONE LARGE CONE HEXAGON 4MM 3.4MM 14MM SELF TAP LCP,$262.03,$0.00,$262.03,$117.91,$187.01,$0.00,$43.83,$0.00,$0.00,$45.88,$262.03,$0.00,$131.01,$207.53,$209.62,$0.00,$39.81,$0.00,$41.71,$0.00
222.581,SUP,HCPCS C1713,,222.581  -  SCREW BONE LARGE CONE HEXAGON 4MM 3.4MM 16MM SELF TAP LCP,$262.03,$0.00,$262.03,$117.91,$187.01,$0.00,$43.83,$0.00,$0.00,$45.88,$262.03,$0.00,$131.01,$207.53,$209.62,$0.00,$39.81,$0.00,$41.71,$0.00
222.582,SUP,HCPCS C1713,,222.582  -  SCREW BONE LARGE CONE HEXAGON 4MM 3.4MM 18MM SELF TAP LCP,$262.03,$0.00,$262.03,$117.91,$187.01,$0.00,$43.83,$0.00,$0.00,$45.88,$262.03,$0.00,$131.01,$207.53,$209.62,$0.00,$39.81,$0.00,$41.71,$0.00
222.583,SUP,HCPCS C1713,,222.583  -  SCREW BONE LARGE CONE HEXAGON 4MM 3.4MM 22MM SELF TAP LCP,$262.03,$0.00,$262.03,$117.91,$187.01,$0.00,$43.83,$0.00,$0.00,$45.88,$262.03,$0.00,$131.01,$207.53,$209.62,$0.00,$39.81,$0.00,$41.71,$0.00
222.584,SUP,HCPCS C1713,,222.584  -  SCREW BONE LARGE CONE HEXAGON 4MM 3.4MM 26MM SELF TAP LCP,$262.03,$0.00,$262.03,$117.91,$187.01,$0.00,$43.83,$0.00,$0.00,$45.88,$262.03,$0.00,$131.01,$207.53,$209.62,$0.00,$39.81,$0.00,$41.71,$0.00
222.585,SUP,HCPCS C1713,,222.585  -  SCREW BONE LARGE CONE HEXAGON 4MM 3.4MM 30MM SELF TAP LCP,$262.03,$0.00,$262.03,$117.91,$187.01,$0.00,$43.83,$0.00,$0.00,$45.88,$262.03,$0.00,$131.01,$207.53,$209.62,$0.00,$39.81,$0.00,$41.71,$0.00
222.586,SUP,HCPCS C1713,,222.586  -  SCREW BONE LARGE CONE HEXAGON 4MM 3.4MM 34MM SELF TAP LCP,$262.03,$0.00,$262.03,$117.91,$187.01,$0.00,$43.83,$0.00,$0.00,$45.88,$262.03,$0.00,$131.01,$207.53,$209.62,$0.00,$39.81,$0.00,$41.71,$0.00
222.587,SUP,HCPCS C1713,,222.587  -  SCREW BONE LARGE CONE HEXAGON 4MM 3.4MM 38MM SELF TAP LCP,$262.03,$0.00,$262.03,$117.91,$187.01,$0.00,$43.83,$0.00,$0.00,$45.88,$262.03,$0.00,$131.01,$207.53,$209.62,$0.00,$39.81,$0.00,$41.71,$0.00
222.588,SUP,HCPCS C1713,,222.588  -  SCREW BONE LARGE CONE HEXAGON 4MM 3.4MM 42MM SELF TAP LCP,$262.03,$0.00,$262.03,$117.91,$187.01,$0.00,$43.83,$0.00,$0.00,$45.88,$262.03,$0.00,$131.01,$207.53,$209.62,$0.00,$39.81,$0.00,$41.71,$0.00
222.589,SUP,HCPCS C1713,,222.589  -  SCREW BONE LARGE CONE HEXAGON 4MM 3.4MM 46MM SELF TAP LCP,$262.03,$0.00,$262.03,$117.91,$187.01,$0.00,$43.83,$0.00,$0.00,$45.88,$262.03,$0.00,$131.01,$207.53,$209.62,$0.00,$39.81,$0.00,$41.71,$0.00
222.59,SUP,HCPCS C1713,,222.590  -  SCREW BONE LARGE CONE HEXAGON 4MM 3.4MM 50MM SELF TAP LCP,$262.03,$0.00,$262.03,$117.91,$187.01,$0.00,$43.83,$0.00,$0.00,$45.88,$262.03,$0.00,$131.01,$207.53,$209.62,$0.00,$39.81,$0.00,$41.71,$0.00
222.591,SUP,HCPCS C1713,,222.591  -  SCREW BONE LARGE CONE HEXAGON 4MM 3.4MM 54MM SELF TAP LCP,$262.03,$0.00,$262.03,$117.91,$187.01,$0.00,$43.83,$0.00,$0.00,$45.88,$262.03,$0.00,$131.01,$207.53,$209.62,$0.00,$39.81,$0.00,$41.71,$0.00
222.592,SUP,HCPCS C1713,,222.592  -  SCREW BONE LARGE CONE HEXAGON 4MM 3.4MM 58MM SELF TAP LCP,$262.03,$0.00,$262.03,$117.91,$187.01,$0.00,$43.83,$0.00,$0.00,$45.88,$262.03,$0.00,$131.01,$207.53,$209.62,$0.00,$39.81,$0.00,$41.71,$0.00
222.593,SUP,HCPCS C1713,,222.593  -  SCREW BONE LARGE CONE HEXAGON 4MM 3.4MM 62MM SELF TAP LCP,$262.03,$0.00,$262.03,$117.91,$187.01,$0.00,$43.83,$0.00,$0.00,$45.88,$262.03,$0.00,$131.01,$207.53,$209.62,$0.00,$39.81,$0.00,$41.71,$0.00
222.608,SUP,HCPCS C1713,,222.608  -  SCREW BONE 7.3MM 85MM LCP SS FULTHD PROX PERIART FEM/TIB,$514.65,$0.00,$514.65,$231.59,$367.31,$0.00,$88.67,$0.00,$0.00,$90.11,$514.65,$0.00,$257.33,$407.60,$411.72,$0.00,$80.54,$0.00,$81.93,$0.00
222.609,SUP,HCPCS C1713,,222.609  -  SCREW BONE 7.3MM 90MM LCP SS FULTHD PROX PERIART FEM/TIB,$534.23,$0.00,$534.23,$240.40,$381.28,$0.00,$92.04,$0.00,$0.00,$93.54,$534.23,$0.00,$267.11,$423.11,$427.38,$0.00,$83.61,$0.00,$85.05,$0.00
222.645,SUP,HCPCS C1713,,222.645  -  SCREW BONE 7.3MM 75MM LCP SS PROX PERIART FEM/TIB CANN,$534.23,$0.00,$534.23,$240.40,$381.28,$0.00,$92.04,$0.00,$0.00,$93.54,$534.23,$0.00,$267.11,$423.11,$427.38,$0.00,$83.61,$0.00,$85.05,$0.00
222.646,SUP,HCPCS C1713,,222.646  -  SCREW BONE 7.3MM 80MM LCP SS PROX PERIART FEM/TIB CANN,$588.23,$0.00,$588.23,$264.70,$419.82,$0.00,$101.35,$0.00,$0.00,$102.99,$588.23,$0.00,$294.11,$465.88,$470.58,$0.00,$92.06,$0.00,$93.65,$0.00
222.656,SUP,HCPCS C1713,,222.656  -  PLATE BN 170X17.5X5.2MM NS LCP CMBN 6 HL LOPRFL LMT CNTCT,"$2,803.20",$0.00,"$2,803.20","$1,261.44","$2,000.64",$0.00,$468.91,$0.00,$0.00,$490.82,"$2,803.20",$0.00,"$1,401.60","$2,220.13","$2,242.56",$0.00,$425.92,$0.00,$446.27,$0.00
222.657,SUP,HCPCS C1713,,222.657  -  PLATE BN 170X17.5X5.2MM NS LCP CMBN 6 HL LOPRFL LMT CNTCT,"$2,803.20",$0.00,"$2,803.20","$1,261.44","$2,000.64",$0.00,$468.91,$0.00,$0.00,$490.82,"$2,803.20",$0.00,"$1,401.60","$2,220.13","$2,242.56",$0.00,$425.92,$0.00,$446.27,$0.00
222.658,SUP,HCPCS C1713,,222.658  -  PLATE BN 206X17.5X5.2MM NS LCP CMBN 8 HL LOPRFL LMT CNTCT,"$2,855.05",$0.00,"$2,855.05","$1,284.77","$2,037.65",$0.00,$477.58,$0.00,$0.00,$499.90,"$2,855.05",$0.00,"$1,427.53","$2,261.20","$2,284.04",$0.00,$433.80,$0.00,$454.52,$0.00
222.659,SUP,HCPCS C1713,,222.659  -  PLATE BN 206X17.5X5.2MM NS LCP CMBN 8 HL LOPRFL LMT CNTCT,"$2,855.05",$0.00,"$2,855.05","$1,284.77","$2,037.65",$0.00,$477.58,$0.00,$0.00,$499.90,"$2,855.05",$0.00,"$1,427.53","$2,261.20","$2,284.04",$0.00,$433.80,$0.00,$454.52,$0.00
222.66,SUP,HCPCS C1713,,222.660  -  PLATE BN 242X17.5X5.2MM NS LCP CMBN 10 HL LOPRFL LMT CNTCT,"$2,961.50",$0.00,"$2,961.50","$1,332.68","$2,113.62",$0.00,$495.39,$0.00,$0.00,$518.53,"$2,961.50",$0.00,"$1,480.75","$2,345.51","$2,369.20",$0.00,$449.98,$0.00,$471.47,$0.00
222.661,SUP,HCPCS C1713,,222.661  -  PLATE BN 242X17.5X5.2MM NS LCP CMBN 10 HL LOPRFL LMT CNTCT,"$2,961.50",$0.00,"$2,961.50","$1,332.68","$2,113.62",$0.00,$495.39,$0.00,$0.00,$518.53,"$2,961.50",$0.00,"$1,480.75","$2,345.51","$2,369.20",$0.00,$449.98,$0.00,$471.47,$0.00
222.662,SUP,HCPCS C1713,,222.662  -  PLATE BN 278X17.5X5.2MM NS LCP CMBN 12 HL LOPRFL LMT CNTCT,"$3,021.55",$0.00,"$3,021.55","$1,359.70","$2,156.48",$0.00,$505.44,$0.00,$0.00,$529.05,"$3,021.55",$0.00,"$1,510.78","$2,393.07","$2,417.24",$0.00,$459.10,$0.00,$481.03,$0.00
222.663,SUP,HCPCS C1713,,222.663  -  PLATE BN 278X17.5X5.2MM NS LCP CMBN 12 HL LOPRFL LMT CNTCT,"$3,021.55",$0.00,"$3,021.55","$1,359.70","$2,156.48",$0.00,$505.44,$0.00,$0.00,$529.05,"$3,021.55",$0.00,"$1,510.78","$2,393.07","$2,417.24",$0.00,$459.10,$0.00,$481.03,$0.00
222.664,SUP,HCPCS C1713,,222.664  -  PLATE BN 314X17.5X5.2MM NS LCP CMBN 14 HL LOPRFL LMT CNTCT,"$3,185.33",$0.00,"$3,185.33","$1,433.40","$2,273.37",$0.00,$532.83,$0.00,$0.00,$557.72,"$3,185.33",$0.00,"$1,592.66","$2,522.78","$2,548.26",$0.00,$483.98,$0.00,$507.10,$0.00
222.665,SUP,HCPCS C1713,,222.665  -  PLATE BN 314X17.5X5.2MM NS LCP CMBN 14 HL LOPRFL LMT CNTCT,"$3,185.33",$0.00,"$3,185.33","$1,433.40","$2,273.37",$0.00,$532.83,$0.00,$0.00,$557.72,"$3,185.33",$0.00,"$1,592.66","$2,522.78","$2,548.26",$0.00,$483.98,$0.00,$507.10,$0.00
222.666,SUP,HCPCS C1713,,222.666  -  PLATE BONE CURVE 350X17.5X5.2MM 16 HOLE LP ANATOMIC HEAD,"$3,249.48",$0.00,"$3,249.48","$1,462.26","$2,319.15",$0.00,$543.56,$0.00,$0.00,$568.96,"$3,249.48",$0.00,"$1,624.74","$2,573.59","$2,599.58",$0.00,$493.73,$0.00,$517.32,$0.00
222.667,SUP,HCPCS C1713,,222.667  -  PLATE BONE CURVE 350X17.5X5.2MM 16 HOLE LP ANATOMIC HEAD,"$3,249.48",$0.00,"$3,249.48","$1,462.26","$2,319.15",$0.00,$543.56,$0.00,$0.00,$568.96,"$3,249.48",$0.00,"$1,624.74","$2,573.59","$2,599.58",$0.00,$493.73,$0.00,$517.32,$0.00
222.668,SUP,HCPCS C1713,,222.668  -  PLATE BONE CURVE 386X17.5X5.2MM 18 HOLE LP ANATOMIC HEAD,"$3,314.98",$0.00,"$3,314.98","$1,491.74","$2,365.90",$0.00,$554.52,$0.00,$0.00,$580.43,"$3,314.98",$0.00,"$1,657.49","$2,625.46","$2,651.98",$0.00,$503.68,$0.00,$527.74,$0.00
222.669,SUP,HCPCS C1713,,222.669  -  PLATE BONE CURVE 386X17.5X5.2MM 18 HOLE LP ANATOMIC HEAD,"$3,314.98",$0.00,"$3,314.98","$1,491.74","$2,365.90",$0.00,$554.52,$0.00,$0.00,$580.43,"$3,314.98",$0.00,"$1,657.49","$2,625.46","$2,651.98",$0.00,$503.68,$0.00,$527.74,$0.00
222.675,SUP,HCPCS C1713,,222.675  -  SCREW BONE 4MM 30MM LCP SS PROX PERIART FEM/TIB CANN LCK,$318.53,$0.00,$318.53,$143.34,$227.33,$0.00,$54.88,$0.00,$0.00,$55.77,$318.53,$0.00,$159.26,$252.28,$254.82,$0.00,$49.85,$0.00,$50.71,$0.00
222.676,SUP,HCPCS C1713,,222.676  -  SCREW BONE 4MM 34MM LCP SS PROX MDL TIB LCK SLFTAP STARDRIVE,$444.08,$0.00,$444.08,$199.83,$316.94,$0.00,$76.51,$0.00,$0.00,$77.75,$444.08,$0.00,$222.04,$351.71,$355.26,$0.00,$69.50,$0.00,$70.70,$0.00
222.677,SUP,HCPCS C1713,,222.677  -  SCREW BONE 4MM 38MM LCP SS PROX MDL TIB LCK SLFTAP NONSTRL,$318.53,$0.00,$318.53,$143.34,$227.33,$0.00,$54.88,$0.00,$0.00,$55.77,$318.53,$0.00,$159.26,$252.28,$254.82,$0.00,$49.85,$0.00,$50.71,$0.00
223.406,SUP,HCPCS C1713,,223.406  -  PLATE BONE 86X11X3.3MM 6 HOLE LOCKING TAPERED ROUNDED TIP,"$1,624.05",$0.00,"$1,624.05",$730.82,"$1,159.08",$0.00,$271.67,$0.00,$0.00,$284.36,"$1,624.05",$0.00,$812.03,"$1,286.25","$1,299.24",$0.00,$246.76,$0.00,$258.55,$0.00
223.407,SUP,HCPCS C1713,,223.407  -  PLATE BONE 99X11X3.3MM 7 HOLE LOCKING TAPERED ROUNDED TIP,"$1,655.45",$0.00,"$1,655.45",$744.95,"$1,181.49",$0.00,$276.92,$0.00,$0.00,$289.86,"$1,655.45",$0.00,$827.73,"$1,311.12","$1,324.36",$0.00,$251.53,$0.00,$263.55,$0.00
223.408,SUP,HCPCS C1713,,223.408  -  PLATE BONE 112X11X3.3MM 8 HOLE LCP STAINLESS STEEL,"$1,680.00",$0.00,"$1,680.00",$756.00,"$1,199.02",$0.00,$281.03,$0.00,$0.00,$294.15,"$1,680.00",$0.00,$840.00,"$1,330.56","$1,344.00",$0.00,$255.26,$0.00,$267.46,$0.00
223.409,SUP,HCPCS C1713,,223.409  -  PLATE BONE 125MM 9 HOLE LOCKING LCP STAINLESS STEEL,"$1,707.30",$0.00,"$1,707.30",$768.29,"$1,218.50",$0.00,$285.59,$0.00,$0.00,$298.93,"$1,707.30",$0.00,$853.65,"$1,352.18","$1,365.84",$0.00,$259.41,$0.00,$271.80,$0.00
223.41,SUP,HCPCS C1713,,223.410  -  PLATE BN TPR 138X11X3.3MM NS LCP CMBN 10 HL RND TIP THN PRFL,"$1,735.95",$0.00,"$1,735.95",$781.18,"$1,238.95",$0.00,$363.41,$0.00,$0.00,$303.95,"$1,735.95",$0.00,$867.98,"$1,374.87","$1,388.76",$0.00,$330.10,$0.00,$276.36,$0.00
223.411,SUP,HCPCS C1713,,223.411  -  PLATE BONE 151MM 11 HOLE LOCKING LCP STAINLESS STEEL,"$1,764.63",$0.00,"$1,764.63",$794.08,"$1,259.41",$0.00,$295.18,$0.00,$0.00,$308.97,"$1,764.63",$0.00,$882.31,"$1,397.59","$1,411.70",$0.00,$268.12,$0.00,$280.93,$0.00
223.412,SUP,HCPCS C1713,,223.412  -  PLATE BONE 164MM 12 HOLE LOCKING LCP STAINLESS STEEL,"$2,277.78",$0.00,"$2,277.78","$1,025.00","$1,625.65",$0.00,$381.02,$0.00,$0.00,$398.82,"$2,277.78",$0.00,"$1,138.89","$1,804.00","$1,822.22",$0.00,$346.09,$0.00,$362.62,$0.00
223.414,SUP,HCPCS C1713,,223.414  -  PLATE BONE 190MM 14 HOLE LOCKING LCP STAINLESS STEEL,"$2,351.48",$0.00,"$2,351.48","$1,058.16","$1,678.25",$0.00,$393.35,$0.00,$0.00,$411.72,"$2,351.48",$0.00,"$1,175.74","$1,862.37","$1,881.18",$0.00,$357.29,$0.00,$374.35,$0.00
223.416,SUP,HCPCS C1713,,223.416  -  PLATE BONE 216MM 16 HOLE LOCKING LCP STAINLESS STEEL,"$2,401.95",$0.00,"$2,401.95","$1,080.88","$1,714.27",$0.00,$401.79,$0.00,$0.00,$420.56,"$2,401.95",$0.00,"$1,200.98","$1,902.34","$1,921.56",$0.00,$364.96,$0.00,$382.39,$0.00
223.418,SUP,HCPCS C1713,,223.418  -  PLATE BONE 242MM 18 HOLE LOCKING LCP STAINLESS STEEL,"$2,351.48",$0.00,"$2,351.48","$1,058.16","$1,678.25",$0.00,$393.35,$0.00,$0.00,$411.72,"$2,351.48",$0.00,"$1,175.74","$1,862.37","$1,881.18",$0.00,$357.29,$0.00,$374.35,$0.00
223.506,SUP,HCPCS C1713,,223.506  -  PLATE BN 95MM 6 HL SS TIB RT DIST MDL 3.5MM SCR,$990.80,$0.00,$990.80,$445.86,$707.13,$0.00,$165.74,$0.00,$0.00,$173.48,$990.80,$0.00,$495.40,$784.71,$792.64,$0.00,$150.55,$0.00,$157.74,$0.00
223.507,SUP,HCPCS C1713,,223.507  -  PLATE BN 95MM 6 HL SS TIB LT DIST MDL 3.5MM SCR,$990.80,$0.00,$990.80,$445.86,$707.13,$0.00,$165.74,$0.00,$0.00,$173.48,$990.80,$0.00,$495.40,$784.71,$792.64,$0.00,$150.55,$0.00,$157.74,$0.00
223.508,SUP,HCPCS C1713,,223.508  -  PLATE BN 121MM 8 HL SS TIB RT DIST MDL 3.5MM SCR,"$1,151.85",$0.00,"$1,151.85",$518.33,$822.08,$0.00,$192.68,$0.00,$0.00,$201.68,"$1,151.85",$0.00,$575.93,$912.27,$921.48,$0.00,$175.01,$0.00,$183.37,$0.00
223.509,SUP,HCPCS C1713,,223.509  -  PLATE BN 121MM 8 HL SS TIB LT DIST MDL 3.5MM SCR,"$1,151.85",$0.00,"$1,151.85",$518.33,$822.08,$0.00,$192.68,$0.00,$0.00,$201.68,"$1,151.85",$0.00,$575.93,$912.27,$921.48,$0.00,$175.01,$0.00,$183.37,$0.00
223.51,SUP,HCPCS C1713,,223.510  -  PLATE BONE 147X10.2X2.2MM 10 HOLE LCP STAINLESS STEEL RIGHT,"$1,315.63",$0.00,"$1,315.63",$592.03,$938.96,$0.00,$220.07,$0.00,$0.00,$230.36,"$1,315.63",$0.00,$657.81,"$1,041.98","$1,052.50",$0.00,$199.90,$0.00,$209.45,$0.00
223.511,SUP,HCPCS C1713,,223.511  -  PLATE BN 147MM 10 HL SS TIB LT DIST MDL 3.5MM SCR,"$1,315.63",$0.00,"$1,315.63",$592.03,$938.96,$0.00,$220.07,$0.00,$0.00,$230.36,"$1,315.63",$0.00,$657.81,"$1,041.98","$1,052.50",$0.00,$199.90,$0.00,$209.45,$0.00
223.512,SUP,HCPCS C1713,,223.512  -  PLATE BONE 173X10.2X2.2MM 11X3.3MM 12 HOLE LCP STAINLESS,"$1,468.48",$0.00,"$1,468.48",$660.81,"$1,048.05",$0.00,$245.64,$0.00,$0.00,$257.12,"$1,468.48",$0.00,$734.24,"$1,163.04","$1,174.78",$0.00,$223.12,$0.00,$233.78,$0.00
223.513,SUP,HCPCS C1713,,223.513  -  PLATE BONE 173X10.2X2.2MM 11X3.3MM 12 HOLE LCP STAINLESS,"$1,468.48",$0.00,"$1,468.48",$660.81,"$1,048.05",$0.00,$245.64,$0.00,$0.00,$257.12,"$1,468.48",$0.00,$734.24,"$1,163.04","$1,174.78",$0.00,$223.12,$0.00,$233.78,$0.00
223.514,SUP,HCPCS C1713,,223.514  -  PLATE BONE 199X10.2X2.2MM 11X3.3MM 14 HOLE LCP STAINLESS,"$1,639.08",$0.00,"$1,639.08",$737.58,"$1,169.81",$0.00,$274.18,$0.00,$0.00,$286.99,"$1,639.08",$0.00,$819.54,"$1,298.15","$1,311.26",$0.00,$249.04,$0.00,$260.94,$0.00
223.515,SUP,HCPCS C1713,,223.515  -  PLATE BONE 199X10.2X2.2MM 11X3.3MM 14 HOLE LCP STAINLESS,"$1,639.08",$0.00,"$1,639.08",$737.58,"$1,169.81",$0.00,$274.18,$0.00,$0.00,$286.99,"$1,639.08",$0.00,$819.54,"$1,298.15","$1,311.26",$0.00,$249.04,$0.00,$260.94,$0.00
223.516,SUP,HCPCS C1713,,223.516  -  PLATE BONE 225MM 16 HOLE STAINLESS STEEL TIBIA RIGHT DISTAL,"$1,856.05",$0.00,"$1,856.05",$835.22,"$1,324.66",$0.00,$310.48,$0.00,$0.00,$324.98,"$1,856.05",$0.00,$928.03,"$1,469.99","$1,484.84",$0.00,$282.01,$0.00,$295.48,$0.00
223.517,SUP,HCPCS C1713,,223.517  -  PLATE BONE 225MM 16 HOLE STAINLESS STEEL TIBIA LEFT DISTAL,"$1,856.05",$0.00,"$1,856.05",$835.22,"$1,324.66",$0.00,$310.48,$0.00,$0.00,$324.98,"$1,856.05",$0.00,$928.03,"$1,469.99","$1,484.84",$0.00,$282.01,$0.00,$295.48,$0.00
223.518,SUP,HCPCS C1713,,223.518  -  PLATE BONE 251MM 18 HOLE STAINLESS STEEL TIBIA RIGHT DISTAL,"$2,026.65",$0.00,"$2,026.65",$911.99,"$1,446.42",$0.00,$339.01,$0.00,$0.00,$354.85,"$2,026.65",$0.00,"$1,013.33","$1,605.11","$1,621.32",$0.00,$307.93,$0.00,$322.64,$0.00
223.519,SUP,HCPCS C1713,,223.519  -  PLATE BONE 251MM 18 HOLE STAINLESS STEEL TIBIA LEFT DISTAL,"$2,026.65",$0.00,"$2,026.65",$911.99,"$1,446.42",$0.00,$339.01,$0.00,$0.00,$354.85,"$2,026.65",$0.00,"$1,013.33","$1,605.11","$1,621.32",$0.00,$307.93,$0.00,$322.64,$0.00
223.52,SUP,HCPCS C1713,,223.52  -  PLATE BONE 25X11X3.3MM 2 HOLE LC-DCP STAINLESS STEEL DISTAL,$225.18,$0.00,$225.18,$101.33,$160.71,$0.00,$37.67,$0.00,$0.00,$39.43,$225.18,$0.00,$112.59,$178.34,$180.14,$0.00,$34.21,$0.00,$35.85,$0.00
223.521,SUP,HCPCS C1713,,223.521  -  PLATE BN 33MM NS LCP CMBN 2 HL LMT CNTCT TPR END SS 3.5MM,$476.30,$0.00,$476.30,$214.34,$339.94,$0.00,$79.67,$0.00,$0.00,$83.40,$476.30,$0.00,$238.15,$377.23,$381.04,$0.00,$72.37,$0.00,$75.83,$0.00
223.53,SUP,HCPCS C1713,,223.53  -  PLATE BONE 38X11X3.3MM 3 HOLE LC-DCP STAINLESS STEEL DISTAL,$229.28,$0.00,$229.28,$103.17,$163.63,$0.00,$38.35,$0.00,$0.00,$40.14,$229.28,$0.00,$114.64,$181.59,$183.42,$0.00,$34.84,$0.00,$36.50,$0.00
223.531,SUP,HCPCS C1713,,223.531  -  PLATE BN 46X11X3.4MM NS LCP CMBN 3 HL LMT CNTCT TPR END SS,$495.40,$0.00,$495.40,$222.93,$353.57,$0.00,$82.87,$0.00,$0.00,$86.74,$495.40,$0.00,$247.70,$392.36,$396.32,$0.00,$75.27,$0.00,$78.87,$0.00
223.54,SUP,HCPCS C1713,,223.54  -  PLATE BN 51MM NS LC DCP 4 HL SS 3.5MM SCR,$236.10,$0.00,$236.10,$106.25,$168.50,$0.00,$39.49,$0.00,$0.00,$41.34,$236.10,$0.00,$118.05,$186.99,$188.88,$0.00,$35.87,$0.00,$37.59,$0.00
223.541,SUP,HCPCS C1713,,223.541  -  PLATE BN 59MM NS LCP CMBN 4 HL SS 3.5MM SCR SM FRAG,$517.25,$0.00,$517.25,$232.76,$369.16,$0.00,$86.52,$0.00,$0.00,$90.57,$517.25,$0.00,$258.63,$409.66,$413.80,$0.00,$78.59,$0.00,$82.35,$0.00
223.55,SUP,HCPCS C1713,,223.55  -  PLATE BONE 64X11X3.3MM 5 HOLE LC-DCP STAINLESS STEEL,$256.58,$0.00,$256.58,$115.46,$183.12,$0.00,$42.92,$0.00,$0.00,$44.92,$256.58,$0.00,$128.29,$203.21,$205.26,$0.00,$38.98,$0.00,$40.85,$0.00
223.551,SUP,HCPCS C1713,,223.551  -  PLATE BN 72X11X3.4MM NS LCP CMBN 5 HL LMT CNTCT TPR END SS,$533.63,$0.00,$533.63,$240.13,$380.85,$0.00,$89.26,$0.00,$0.00,$93.43,$533.63,$0.00,$266.81,$422.63,$426.90,$0.00,$81.08,$0.00,$84.95,$0.00
223.56,SUP,HCPCS C1713,,223.56  -  PLATE BONE 77X11X3.3MM 6 HOLE LC-DCP STAINLESS STEEL DISTAL,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
223.561,SUP,HCPCS C1713,,223.561  -  PLATE BN 85X11X3.4MM NS LCP CMBN 6 HL LMT CNTCT TPR END SS,$567.73,$0.00,$567.73,$255.48,$405.19,$0.00,$94.97,$0.00,$0.00,$99.40,$567.73,$0.00,$283.86,$449.64,$454.18,$0.00,$86.26,$0.00,$90.38,$0.00
223.57,SUP,HCPCS C1713,,223.57  -  PLATE BONE 90X11X3.3MM 7 HOLE LC-DCP STAINLESS STEEL DISTAL,$275.68,$0.00,$275.68,$124.05,$196.75,$0.00,$46.11,$0.00,$0.00,$48.27,$275.68,$0.00,$137.84,$218.34,$220.54,$0.00,$41.89,$0.00,$43.89,$0.00
223.571,SUP,HCPCS C1713,,223.571  -  PLATE BN 98X11X3.4MM NS LCP CMBN 7 HL LMT CNTCT TPR END SS,$590.93,$0.00,$590.93,$265.92,$421.74,$0.00,$98.85,$0.00,$0.00,$103.47,$590.93,$0.00,$295.46,$468.02,$472.74,$0.00,$89.79,$0.00,$94.08,$0.00
223.58,SUP,HCPCS C1713,,223.58  -  PLATE BONE 103X11X3.3MM 8 HOLE LC-DCP STAINLESS STEEL DISTAL,$290.70,$0.00,$290.70,$130.82,$207.47,$0.00,$48.63,$0.00,$0.00,$50.90,$290.70,$0.00,$145.35,$230.23,$232.56,$0.00,$44.17,$0.00,$46.28,$0.00
223.581,SUP,HCPCS C1713,,223.581  -  PLATE BN 111X11X3.4MM NS LCP CMBN 8 HL LMT CNTCT TPR END SS,$620.95,$0.00,$620.95,$279.43,$443.17,$0.00,$103.87,$0.00,$0.00,$108.72,$620.95,$0.00,$310.48,$491.79,$496.76,$0.00,$94.35,$0.00,$98.86,$0.00
223.59,SUP,HCPCS C1713,,223.59  -  PLATE BONE 116X11X3.3MM 9 HOLE LC-DCP STAINLESS STEEL DISTAL,$304.35,$0.00,$304.35,$136.96,$217.21,$0.00,$50.91,$0.00,$0.00,$53.29,$304.35,$0.00,$152.18,$241.05,$243.48,$0.00,$46.24,$0.00,$48.45,$0.00
223.591,SUP,HCPCS C1713,,223.591  -  PLATE BN 124X11X3.4MM NS LCP CMBN 9 HL LMT CNTCT TPR END SS,$645.53,$0.00,$645.53,$290.49,$460.71,$0.00,$107.98,$0.00,$0.00,$113.03,$645.53,$0.00,$322.76,$511.26,$516.42,$0.00,$98.08,$0.00,$102.77,$0.00
223.6,SUP,HCPCS C1713,,223.60  -  PLATE BONE 129X11X3.3MM 10 HOLE LOCK LC-DCP STAINLESS STEEL,$308.43,$0.00,$308.43,$138.79,$220.12,$0.00,$51.59,$0.00,$0.00,$54.00,$308.43,$0.00,$154.21,$244.28,$246.74,$0.00,$46.86,$0.00,$49.10,$0.00
223.6,SUP,HCPCS C1713,,223.6  -  PLATE 129MM SS 3.5MM SCR SM FRAG SET 10 HOLE LC DCP LCP BONE,$344.18,$0.00,$308.43,$138.79,$220.12,$0.00,$51.59,$0.00,$0.00,$54.00,$308.43,$0.00,$154.21,$272.59,$246.74,$0.00,$46.86,$0.00,$49.10,$0.00
223.601,SUP,HCPCS C1713,,223.601  -  PLATE BN 137X11X3.4MM NS LCP CMBN 10 HL LMT CNTCT TPR END SS,$666.00,$0.00,$666.00,$299.70,$475.32,$0.00,$111.41,$0.00,$0.00,$116.61,$666.00,$0.00,$333.00,$527.47,$532.80,$0.00,$101.19,$0.00,$106.03,$0.00
223.61,SUP,HCPCS C1713,,223.61  -  PLATE BN 142X11X3.3MM NS LC DCP 11 HL SS 3.5MM SCR SM FRAG,$334.38,$0.00,$334.38,$150.47,$238.64,$0.00,$55.93,$0.00,$0.00,$58.55,$334.38,$0.00,$167.19,$264.83,$267.50,$0.00,$50.80,$0.00,$53.23,$0.00
223.611,SUP,HCPCS C1713,,223.611  -  PLATE BN 150MM NS LCP CMBN 11 HL LMT CNTCT TPR END SS 3.5MM,$694.65,$0.00,$694.65,$312.59,$495.77,$0.00,$116.20,$0.00,$0.00,$121.63,$694.65,$0.00,$347.33,$550.16,$555.72,$0.00,$105.55,$0.00,$110.59,$0.00
223.62,SUP,HCPCS C1713,,223.62  -  PLATE BN 155X11X3.3MM NS LC DCP 12 HL SS 3.5MM SCR SM FRAG,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
223.621,SUP,HCPCS C1713,,223.621  -  PLATE BN 163X11X3.4MM NS LCP CMBN 12 HL LMT CNTCT TPR END SS,$734.23,$0.00,$734.23,$330.40,$524.02,$0.00,$122.82,$0.00,$0.00,$128.56,$734.23,$0.00,$367.11,$581.51,$587.38,$0.00,$111.56,$0.00,$116.89,$0.00
223.631,SUP,HCPCS C1713,,223.631  -  PLATE BN 176X11X3.4MM NS LCP CMBN 13 HL SS 3.5MM SCR,$846.15,$0.00,$846.15,$380.77,$603.90,$0.00,$141.54,$0.00,$0.00,$148.15,$846.15,$0.00,$423.08,$670.15,$676.92,$0.00,$128.56,$0.00,$134.71,$0.00
223.64,SUP,HCPCS C1713,,223.64  -  PLATE BN 181X11X3.3MM NS LC DCP 14 HL SS 3.5MM SCR SM FRAG,$661.90,$0.00,$661.90,$297.86,$472.40,$0.00,$110.72,$0.00,$0.00,$115.89,$661.90,$0.00,$330.95,$524.22,$529.52,$0.00,$100.57,$0.00,$105.37,$0.00
223.641,SUP,HCPCS C1713,,223.641  -  PLATE BN 189X11X3.4MM NS LCP CMBN 14 HL LMT CNTCT TPR END SS,"$1,101.35",$0.00,"$1,101.35",$495.61,$786.03,$0.00,$184.23,$0.00,$0.00,$192.84,"$1,101.35",$0.00,$550.68,$872.27,$881.08,$0.00,$167.34,$0.00,$175.33,$0.00
223.65,SUP,HCPCS C1713,,223.65  -  PLATE BONE 195X11X3.3MM 15 HOLE LC-DCP STAINLESS STEEL,$693.30,$0.00,$693.30,$311.99,$494.81,$0.00,$115.97,$0.00,$0.00,$121.39,$693.30,$0.00,$346.65,$549.09,$554.64,$0.00,$105.34,$0.00,$110.37,$0.00
223.651,SUP,HCPCS C1713,,223.651  -  PLATE BONE 202X11X3.4MM 15 HOLE LCP STAINLESS STEEL PROXIMAL,"$1,179.15",$0.00,"$1,179.15",$530.62,$841.56,$0.00,$197.24,$0.00,$0.00,$206.46,"$1,179.15",$0.00,$589.58,$933.89,$943.32,$0.00,$179.16,$0.00,$187.72,$0.00
223.66,SUP,HCPCS C1713,,223.66  -  PLATE BONE 208X11X3.3MM 16 HOLE LC-DCP STAINLESS STEEL,$760.18,$0.00,$760.18,$342.08,$542.54,$0.00,$127.16,$0.00,$0.00,$133.10,$760.18,$0.00,$380.09,$602.06,$608.14,$0.00,$115.50,$0.00,$121.02,$0.00
223.661,SUP,HCPCS C1713,,223.661  -  PLATE BN 215X11X3.4MM NS LCP CMBN 16 HL LMT CNTCT TPR END SS,"$1,233.73",$0.00,"$1,233.73",$555.18,$880.51,$0.00,$206.37,$0.00,$0.00,$216.02,"$1,233.73",$0.00,$616.86,$977.11,$986.98,$0.00,$187.46,$0.00,$196.41,$0.00
223.671,SUP,HCPCS C1713,,223.671  -  PLATE BN 241X11X3.4MM NS LCP CMBN 18 HL LMT CNTCT TPR END SS,"$1,383.85",$0.00,"$1,383.85",$622.73,$987.65,$0.00,$231.49,$0.00,$0.00,$242.30,"$1,383.85",$0.00,$691.93,"$1,096.01","$1,107.08",$0.00,$210.27,$0.00,$220.31,$0.00
223.68,SUP,HCPCS C1713,,223.68  -  PLATE BONE 233X11X3.3MM 18 HOLE LC-DCP STAINLESS STEEL,$850.25,$0.00,$850.25,$382.61,$606.82,$0.00,$142.23,$0.00,$0.00,$148.87,$850.25,$0.00,$425.13,$673.40,$680.20,$0.00,$129.19,$0.00,$135.36,$0.00
223.681,SUP,HCPCS C1713,,223.681  -  PLATE BN 267X11X3.4MM NS LCP CMBN 20 HL LMT CNTCT TPR END SS,"$1,536.70",$0.00,"$1,536.70",$691.52,"$1,096.74",$0.00,$257.06,$0.00,$0.00,$269.06,"$1,536.70",$0.00,$768.35,"$1,217.07","$1,229.36",$0.00,$233.49,$0.00,$244.64,$0.00
223.691,SUP,HCPCS C1713,,223.691  -  PLATE BONE 293X11X3.4MM 22 HOLE LCP STAINLESS STEEL PROXIMAL,"$1,538.08",$0.00,"$1,538.08",$692.13,"$1,097.72",$0.00,$257.28,$0.00,$0.00,$269.30,"$1,538.08",$0.00,$769.04,"$1,218.16","$1,230.46",$0.00,$233.70,$0.00,$244.86,$0.00
223.7,SUP,HCPCS C1713,,223.70  -  PLATE BONE 259X11X3.3MM 20 HOLE LC-DCP STAINLESS STEEL,$941.68,$0.00,$941.68,$423.75,$672.07,$0.00,$157.52,$0.00,$0.00,$164.88,$941.68,$0.00,$470.84,$745.81,$753.34,$0.00,$143.08,$0.00,$149.91,$0.00
224,SUP,Custom 27803010,,224.000  -  STAINLESS STEEL REVERE LOCKING CAP,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
224.001,SUP,Custom 27803010,,"224.001  -  5.5MM STAINLESS STEEL STRAIGHT ROD, 300MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
224.002,SUP,Custom 27803010,,"224.002  -  5.5MM STAINLESS STEEL STRAIGHT ROD, 400MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
224.003,SUP,Custom 27803010,,"224.003  -  5.5MM STAINLESS STEEL STRAIGHT ROD, 500MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
224.012,SUP,Custom 27803010,,"224.012  -  REVERE LOW PROFILE ADJUSTABLE T-CONNECTOR, 24MM-25MM","$2,000.00",$0.00,"$2,000.00",$0.00,"$1,427.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
224.013,SUP,Custom 27803010,,"224.013  -  REVERE LOW PROFILE ADJUSTABLE T-CONNECTOR, 26MM-28MM","$2,000.00",$0.00,"$2,000.00",$0.00,"$1,427.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
224.014,SUP,Custom 27803010,,"224.014  -  REVERE LOW PROFILE ADJUSTABLE T-CONNECTOR, 29MM-34MM","$2,000.00",$0.00,"$2,000.00",$0.00,"$1,427.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
224.02,SUP,HCPCS C1713,,224.02  -  PLATE BN NAR 39X12X3.8MM NS DCP 2 HL SS 4.5MM SCR LG FRAG,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
224.04,SUP,HCPCS C1713,,224.04  -  PLATE BN NAR 71X12X3.8MM NS DCP 4 HL SS 4.5MM SCR LG FRAG,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
224.041,SUP,HCPCS C1713,,224.041  -  PLATE BONE 61MM 4 HOLE DCP STAINLESS STEEL ORTHOPEDIC,$828.40,$0.00,$828.40,$372.78,$591.23,$0.00,$138.57,$0.00,$0.00,$145.05,$828.40,$0.00,$414.20,$656.09,$662.72,$0.00,$125.87,$0.00,$131.88,$0.00
224.05,SUP,HCPCS C1713,,224.05  -  PLATE BN NAR 87X12X3.8MM NS DCP 5 HL SS 4.5MM SCR LG FRAG,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
224.051,SUP,HCPCS C1713,,224.051  -  5.0MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 25MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.052,SUP,HCPCS C1713,,224.052  -  5.0MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 30MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.053,SUP,HCPCS C1713,,224.053  -  5.0MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 35MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.054,SUP,HCPCS C1713,,224.054  -  5.0MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 40MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.055,SUP,HCPCS C1713,,224.055  -  5.0MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 45MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.056,SUP,HCPCS C1713,,224.056  -  5.0MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 50MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.057,SUP,HCPCS C1713,,224.057  -  5.0MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 55MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.06,SUP,HCPCS C1713,,224.06  -  PLATE BN NAR 103X12X3.8MM NS DCP 6 HL SS 4.5MM SCR LG FRAG,$302.98,$0.00,$302.98,$136.34,$216.23,$0.00,$50.68,$0.00,$0.00,$53.05,$302.98,$0.00,$151.49,$239.96,$242.38,$0.00,$46.03,$0.00,$48.23,$0.00
224.061,SUP,HCPCS C1713,,224.061  -  7.5MM SS REVERE REDUCTION SCREW 70MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.062,SUP,HCPCS C1713,,224.062  -  7.5MM SS REVERE REDUCTION SCREW 75MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.063,SUP,HCPCS C1713,,224.063  -  7.5MM SS REVERE REDUCTION SCREW 80MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.064,SUP,HCPCS C1713,,224.064  -  7.5MM SS REVERE REDUCTION SCREW 85MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.065,SUP,HCPCS C1713,,224.065  -  7.5MM SS REVERE REDUCTION SCREW 90MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.07,SUP,HCPCS C1713,,224.07  -  PLATE BN NAR 119X12X3.8MM NS DCP 7 HL SS 4.5MM SCR LG FRAG,$302.98,$0.00,$302.98,$136.34,$216.23,$0.00,$50.68,$0.00,$0.00,$53.05,$302.98,$0.00,$151.49,$239.96,$242.38,$0.00,$46.03,$0.00,$48.23,$0.00
224.071,SUP,HCPCS C1713,,224.071  -  7.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 70MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.072,SUP,HCPCS C1713,,224.072  -  7.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 75MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.073,SUP,HCPCS C1713,,224.073  -  7.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 80MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.074,SUP,HCPCS C1713,,224.074  -  7.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 85MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.075,SUP,HCPCS C1713,,224.075  -  7.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 90MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.08,SUP,HCPCS C1713,,224.08  -  PLATE BN NAR 135X12X3.8MM NS DCP 8 HL SS 4.5MM SCR LG FRAG,$302.98,$0.00,$302.98,$136.34,$216.23,$0.00,$50.68,$0.00,$0.00,$53.05,$302.98,$0.00,$151.49,$239.96,$242.38,$0.00,$46.03,$0.00,$48.23,$0.00
224.081,SUP,HCPCS C1713,,224.081  -  8.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 70MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.082,SUP,HCPCS C1713,,224.082  -  8.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 75MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.083,SUP,HCPCS C1713,,224.083  -  8.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 80MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.084,SUP,HCPCS C1713,,224.084  -  8.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 85MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.085,SUP,HCPCS C1713,,224.085  -  8.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 90MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.09,SUP,HCPCS C1713,,224.09  -  PLATE BN NAR 151X12X3.8MM NS DCP 9 HL SS 4.5MM SCR LG FRAG,$302.98,$0.00,$302.98,$136.34,$216.23,$0.00,$50.68,$0.00,$0.00,$53.05,$302.98,$0.00,$151.49,$239.96,$242.38,$0.00,$46.03,$0.00,$48.23,$0.00
224.1,SUP,HCPCS C1713,,224.10  -  PLATE BN NAR 167X12X3.8MM NS DCP 10 HL SS 4.5MM SCR LG FRAG,$399.88,$0.00,$399.88,$179.94,$285.39,$0.00,$66.89,$0.00,$0.00,$70.01,$399.88,$0.00,$199.94,$316.70,$319.90,$0.00,$60.76,$0.00,$63.66,$0.00
224.11,SUP,HCPCS C1713,,224.11  -  PLATE BONE NARROW 183X12X3.8MM 11 HOLE DCP STAINLESS STEEL,$398.83,$0.00,$398.83,$179.47,$284.64,$0.00,$68.72,$0.00,$0.00,$69.83,$398.83,$0.00,$199.41,$315.87,$319.06,$0.00,$62.42,$0.00,$63.49,$0.00
224.111,SUP,HCPCS C1713,,224.111  -  SCREW BN 5.5MM 27MM REVERE MA SS SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.112,SUP,HCPCS C1713,,224.112  -  SCREW BN 5.5MM 32MM REVERE MA SS SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.113,SUP,HCPCS C1713,,224.113  -  SCREW BN 5.5MM 37MM REVERE MA SS SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.114,SUP,HCPCS C1713,,224.114  -  SCREW BN 5.5MM 42MM REVERE MA SS SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.115,SUP,HCPCS C1713,,224.115  -  SCREW BN 5.5MM 47MM REVERE MA SS SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.12,SUP,HCPCS C1713,,224.12  -  PLATE BN NAR 199X12X3.8MM NS DCP 12 HL SS 4.5MM SCR LG FRAG,$399.88,$0.00,$399.88,$179.94,$285.39,$0.00,$66.89,$0.00,$0.00,$70.01,$399.88,$0.00,$199.94,$316.70,$319.90,$0.00,$60.76,$0.00,$63.66,$0.00
224.121,SUP,HCPCS C1713,,224.121  -  SCREW BN 6.5MM 27MM REVERE MA SS SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.122,SUP,HCPCS C1713,,224.122  -  SCREW BN 6.5MM 32MM REVERE MA SS SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.123,SUP,HCPCS C1713,,224.123  -  SCREW BN 6.5MM 37MM REVERE MA SS SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.124,SUP,HCPCS C1713,,224.124  -  SCREW BN 6.5MM 42MM REVERE MA SS SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.125,SUP,HCPCS C1713,,224.125  -  SCREW BN 6.5MM 47MM REVERE MA SS SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.131,SUP,HCPCS C1713,,224.131  -  SCREW BN 7.5MM 27MM REVERE MA SS SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.132,SUP,HCPCS C1713,,224.132  -  SCREW BN 7.5MM 32MM REVERE MA SS SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.133,SUP,HCPCS C1713,,224.133  -  SCREW BN 7.5MM 37MM REVERE MA SS SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.134,SUP,HCPCS C1713,,224.134  -  SCREW BN 7.5MM 42MM REVERE MA SS SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.135,SUP,HCPCS C1713,,224.135  -  SCREW BN 7.5MM 47MM REVERE MA SS SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.14,SUP,HCPCS C1713,,224.14  -  PLATE NAR SS 4.5MM SCR LG FRAG SET 14 HOLE DCP BONE ORTH,$561.50,$0.00,$561.50,$252.68,$400.74,$0.00,$96.74,$0.00,$0.00,$98.31,$561.50,$0.00,$280.75,$444.71,$449.20,$0.00,$87.87,$0.00,$89.39,$0.00
224.141,SUP,HCPCS C1713,,224.141  -  5.5MM SS REVERE REDUCTION SCREW 25MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.142,SUP,HCPCS C1713,,224.142  -  5.5MM SS REVERE REDUCTION SCREW 30MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.143,SUP,HCPCS C1713,,224.143  -  5.5MM SS REVERE REDUCTION SCREW 35MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.144,SUP,HCPCS C1713,,224.144  -  5.5MM SS REVERE REDUCTION SCREW 40MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.145,SUP,HCPCS C1713,,224.145  -  5.5MM SS REVERE REDUCTION SCREW 45MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.146,SUP,HCPCS C1713,,224.146  -  5.5MM SS REVERE REDUCTION SCREW 50MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.147,SUP,HCPCS C1713,,224.147  -  5.5MM SS REVERE REDUCTION SCREW 55MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.151,SUP,HCPCS C1713,,224.151  -  6.5MM SS REVERE REDUCTION SCREW 25MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.152,SUP,HCPCS C1713,,224.152  -  6.5MM SS REVERE REDUCTION SCREW 30MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.153,SUP,HCPCS C1713,,224.153  -  6.5MM SS REVERE REDUCTION SCREW 35MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.154,SUP,HCPCS C1713,,224.154  -  6.5MM SS REVERE REDUCTION SCREW 40MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.155,SUP,HCPCS C1713,,224.155  -  6.5MM SS REVERE REDUCTION SCREW 45MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.156,SUP,HCPCS C1713,,224.156  -  6.5MM SS REVERE REDUCTION SCREW 50MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.157,SUP,HCPCS C1713,,224.157  -  6.5MM SS REVERE REDUCTION SCREW 55MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.158,SUP,HCPCS C1713,,224.158  -  6.5MM SS REVERE REDUCTION SCREW 60MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.159,SUP,HCPCS C1713,,224.159  -  6.5MM SS REVERE REDUCTION SCREW 65MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.161,SUP,HCPCS C1713,,224.161  -  7.5MM SS REVERE REDUCTION SCREW 25MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.162,SUP,HCPCS C1713,,224.162  -  7.5MM SS REVERE REDUCTION SCREW 30MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.163,SUP,HCPCS C1713,,224.163  -  7.5MM SS REVERE REDUCTION SCREW 35MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.164,SUP,HCPCS C1713,,224.164  -  7.5MM SS REVERE REDUCTION SCREW 40MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.165,SUP,HCPCS C1713,,224.165  -  7.5MM SS REVERE REDUCTION SCREW 45MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.166,SUP,HCPCS C1713,,224.166  -  7.5MM SS REVERE REDUCTION SCREW 50MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.167,SUP,HCPCS C1713,,224.167  -  7.5MM SS REVERE REDUCTION SCREW 55MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.168,SUP,HCPCS C1713,,224.168  -  7.5MM SS REVERE REDUCTION SCREW 60MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.169,SUP,HCPCS C1713,,224.169  -  7.5MM SS REVERE REDUCTION SCREW 65MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.2,SUP,HCPCS C1713,,224.20  -  PLATE BN NAR 326X12X3.8MM NS DCP 20 HL SS 4.5MM SCR LG FRAG,$816.13,$0.00,$816.13,$367.26,$582.47,$0.00,$136.52,$0.00,$0.00,$142.90,$816.13,$0.00,$408.06,$646.37,$652.90,$0.00,$124.00,$0.00,$129.93,$0.00
224.2,SUP,HCPCS C1713,,"224.200  -  4.0MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 20MM","$2,000.00",$0.00,"$1,584.00",$367.26,$582.47,$0.00,$136.52,$0.00,$0.00,$142.90,$816.13,$0.00,$408.06,"$1,584.00",$652.90,$0.00,$124.00,$0.00,$129.93,$0.00
224.201,SUP,HCPCS C1713,,"224.201  -  4.0MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 25MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.202,SUP,HCPCS C1713,,"224.202  -  4.0MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 30MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.203,SUP,HCPCS C1713,,"224.203  -  4.0MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 35MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.204,SUP,HCPCS C1713,,"224.204  -  4.0MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 40MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.241,SUP,HCPCS C1713,,"224.241  -  4.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 25MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.242,SUP,HCPCS C1713,,"224.242  -  4.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 30MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.243,SUP,HCPCS C1713,,"224.243  -  4.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 35MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.244,SUP,HCPCS C1713,,"224.244  -  4.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 40MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.245,SUP,HCPCS C1713,,"224.245  -  4.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 45MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.251,SUP,HCPCS C1713,,224.251  -  SCREW BN 5.5MM 25MM REVERE MA SS SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.252,SUP,HCPCS C1713,,"224.252  -  5.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 30MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.253,SUP,HCPCS C1713,,"224.253  -  5.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 35MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.254,SUP,HCPCS C1713,,"224.254  -  5.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 40MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.255,SUP,HCPCS C1713,,"224.255  -  5.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 45MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.256,SUP,HCPCS C1713,,"224.256  -  5.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 50MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.257,SUP,HCPCS C1713,,"224.257  -  5.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 55MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.258,SUP,HCPCS C1713,,"224.258  -  5.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 60MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.259,SUP,HCPCS C1713,,"224.259  -  5.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 65MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.262,SUP,HCPCS C1713,,"224.262  -  6.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 30MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.263,SUP,HCPCS C1713,,"224.263  -  6.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 35MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.264,SUP,HCPCS C1713,,"224.264  -  6.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 40MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.265,SUP,HCPCS C1713,,"224.265  -  6.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 45MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.266,SUP,HCPCS C1713,,"224.266  -  6.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 50MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.267,SUP,HCPCS C1713,,"224.267  -  6.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 55MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.268,SUP,HCPCS C1713,,"224.268  -  6.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 60MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.269,SUP,HCPCS C1713,,"224.269  -  6.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 65MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.271,SUP,HCPCS C1713,,"224.271  -  7.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 25MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.272,SUP,HCPCS C1713,,"224.272  -  7.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 30MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.273,SUP,HCPCS C1713,,"224.273  -  7.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 35MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.274,SUP,HCPCS C1713,,"224.274  -  7.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 40MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.275,SUP,HCPCS C1713,,"224.275  -  7.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 45MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.276,SUP,HCPCS C1713,,"224.276  -  7.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 50MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.277,SUP,HCPCS C1713,,"224.277  -  7.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 55MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.278,SUP,HCPCS C1713,,"224.278  -  7.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 60MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.279,SUP,HCPCS C1713,,"224.279  -  7.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 65MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.281,SUP,HCPCS C1713,,224.281  -  SCREW BN 8.5MM 25MM REVERE MA SS SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.282,SUP,HCPCS C1713,,"224.282  -  8.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 30MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.283,SUP,HCPCS C1713,,"224.283  -  8.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 35MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.284,SUP,HCPCS C1713,,"224.284  -  8.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 40MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.285,SUP,HCPCS C1713,,"224.285  -  8.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 45MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.286,SUP,HCPCS C1713,,"224.286  -  8.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 50MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.287,SUP,HCPCS C1713,,"224.287  -  8.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 55MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.288,SUP,HCPCS C1713,,"224.288  -  8.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 60MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.289,SUP,HCPCS C1713,,"224.289  -  8.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 65MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.351,SUP,HCPCS C1713,,224.351  -  5.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 25MM,"$5,262.50",$0.00,"$5,262.50","$2,368.13","$3,755.85",$0.00,$906.70,$0.00,$0.00,$921.42,"$5,262.50",$0.00,"$2,631.25","$4,167.90","$4,210.00",$0.00,$823.58,$0.00,$837.79,$0.00
224.352,SUP,HCPCS C1713,,224.352  -  5.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 30MM,"$5,262.50",$0.00,"$5,262.50","$2,368.13","$3,755.85",$0.00,$906.70,$0.00,$0.00,$921.42,"$5,262.50",$0.00,"$2,631.25","$4,167.90","$4,210.00",$0.00,$823.58,$0.00,$837.79,$0.00
224.353,SUP,HCPCS C1713,,224.353  -  5.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 35MM,"$5,262.50",$0.00,"$5,262.50","$2,368.13","$3,755.85",$0.00,$906.70,$0.00,$0.00,$921.42,"$5,262.50",$0.00,"$2,631.25","$4,167.90","$4,210.00",$0.00,$823.58,$0.00,$837.79,$0.00
224.354,SUP,HCPCS C1713,,224.354  -  5.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 40MM,"$5,262.50",$0.00,"$5,262.50","$2,368.13","$3,755.85",$0.00,$906.70,$0.00,$0.00,$921.42,"$5,262.50",$0.00,"$2,631.25","$4,167.90","$4,210.00",$0.00,$823.58,$0.00,$837.79,$0.00
224.355,SUP,HCPCS C1713,,224.355  -  5.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 45MM,"$5,262.50",$0.00,"$5,262.50","$2,368.13","$3,755.85",$0.00,$906.70,$0.00,$0.00,$921.42,"$5,262.50",$0.00,"$2,631.25","$4,167.90","$4,210.00",$0.00,$823.58,$0.00,$837.79,$0.00
224.356,SUP,HCPCS C1713,,224.356  -  5.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 50MM,"$5,262.50",$0.00,"$5,262.50","$2,368.13","$3,755.85",$0.00,$906.70,$0.00,$0.00,$921.42,"$5,262.50",$0.00,"$2,631.25","$4,167.90","$4,210.00",$0.00,$823.58,$0.00,$837.79,$0.00
224.357,SUP,HCPCS C1713,,224.357  -  5.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 55MM,"$5,262.50",$0.00,"$5,262.50","$2,368.13","$3,755.85",$0.00,$906.70,$0.00,$0.00,$921.42,"$5,262.50",$0.00,"$2,631.25","$4,167.90","$4,210.00",$0.00,$823.58,$0.00,$837.79,$0.00
224.361,SUP,HCPCS C1713,,224.361  -  6.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 25MM,"$5,262.50",$0.00,"$5,262.50","$2,368.13","$3,755.85",$0.00,$906.70,$0.00,$0.00,$921.42,"$5,262.50",$0.00,"$2,631.25","$4,167.90","$4,210.00",$0.00,$823.58,$0.00,$837.79,$0.00
224.362,SUP,HCPCS C1713,,224.362  -  6.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 30MM,"$5,262.50",$0.00,"$5,262.50","$2,368.13","$3,755.85",$0.00,$906.70,$0.00,$0.00,$921.42,"$5,262.50",$0.00,"$2,631.25","$4,167.90","$4,210.00",$0.00,$823.58,$0.00,$837.79,$0.00
224.363,SUP,HCPCS C1713,,224.363  -  6.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 35MM,"$5,262.50",$0.00,"$5,262.50","$2,368.13","$3,755.85",$0.00,$906.70,$0.00,$0.00,$921.42,"$5,262.50",$0.00,"$2,631.25","$4,167.90","$4,210.00",$0.00,$823.58,$0.00,$837.79,$0.00
224.364,SUP,HCPCS C1713,,224.364  -  6.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 40MM,"$5,262.50",$0.00,"$5,262.50","$2,368.13","$3,755.85",$0.00,$906.70,$0.00,$0.00,$921.42,"$5,262.50",$0.00,"$2,631.25","$4,167.90","$4,210.00",$0.00,$823.58,$0.00,$837.79,$0.00
224.365,SUP,HCPCS C1713,,224.365  -  6.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 45MM,"$5,262.50",$0.00,"$5,262.50","$2,368.13","$3,755.85",$0.00,$906.70,$0.00,$0.00,$921.42,"$5,262.50",$0.00,"$2,631.25","$4,167.90","$4,210.00",$0.00,$823.58,$0.00,$837.79,$0.00
224.366,SUP,HCPCS C1713,,224.366  -  6.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 50MM,"$5,262.50",$0.00,"$5,262.50","$2,368.13","$3,755.85",$0.00,$906.70,$0.00,$0.00,$921.42,"$5,262.50",$0.00,"$2,631.25","$4,167.90","$4,210.00",$0.00,$823.58,$0.00,$837.79,$0.00
224.367,SUP,HCPCS C1713,,224.367  -  6.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 55MM,"$5,262.50",$0.00,"$5,262.50","$2,368.13","$3,755.85",$0.00,$906.70,$0.00,$0.00,$921.42,"$5,262.50",$0.00,"$2,631.25","$4,167.90","$4,210.00",$0.00,$823.58,$0.00,$837.79,$0.00
224.368,SUP,HCPCS C1713,,224.368  -  6.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 60MM,"$5,262.50",$0.00,"$5,262.50","$2,368.13","$3,755.85",$0.00,$906.70,$0.00,$0.00,$921.42,"$5,262.50",$0.00,"$2,631.25","$4,167.90","$4,210.00",$0.00,$823.58,$0.00,$837.79,$0.00
224.369,SUP,HCPCS C1713,,224.369  -  6.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 65MM,"$5,262.50",$0.00,"$5,262.50","$2,368.13","$3,755.85",$0.00,$906.70,$0.00,$0.00,$921.42,"$5,262.50",$0.00,"$2,631.25","$4,167.90","$4,210.00",$0.00,$823.58,$0.00,$837.79,$0.00
224.371,SUP,HCPCS C1713,,224.371  -  7.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 25MM,"$5,262.50",$0.00,"$5,262.50","$2,368.13","$3,755.85",$0.00,$906.70,$0.00,$0.00,$921.42,"$5,262.50",$0.00,"$2,631.25","$4,167.90","$4,210.00",$0.00,$823.58,$0.00,$837.79,$0.00
224.372,SUP,HCPCS C1713,,224.372  -  7.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 30MM,"$5,262.50",$0.00,"$5,262.50","$2,368.13","$3,755.85",$0.00,$906.70,$0.00,$0.00,$921.42,"$5,262.50",$0.00,"$2,631.25","$4,167.90","$4,210.00",$0.00,$823.58,$0.00,$837.79,$0.00
224.373,SUP,HCPCS C1713,,224.373  -  7.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 35MM,"$5,262.50",$0.00,"$5,262.50","$2,368.13","$3,755.85",$0.00,$906.70,$0.00,$0.00,$921.42,"$5,262.50",$0.00,"$2,631.25","$4,167.90","$4,210.00",$0.00,$823.58,$0.00,$837.79,$0.00
224.374,SUP,HCPCS C1713,,224.374  -  7.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 40MM,"$5,262.50",$0.00,"$5,262.50","$2,368.13","$3,755.85",$0.00,$906.70,$0.00,$0.00,$921.42,"$5,262.50",$0.00,"$2,631.25","$4,167.90","$4,210.00",$0.00,$823.58,$0.00,$837.79,$0.00
224.375,SUP,HCPCS C1713,,224.375  -  7.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 45MM,"$5,262.50",$0.00,"$5,262.50","$2,368.13","$3,755.85",$0.00,$906.70,$0.00,$0.00,$921.42,"$5,262.50",$0.00,"$2,631.25","$4,167.90","$4,210.00",$0.00,$823.58,$0.00,$837.79,$0.00
224.376,SUP,HCPCS C1713,,224.376  -  7.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 50MM,"$5,262.50",$0.00,"$5,262.50","$2,368.13","$3,755.85",$0.00,$906.70,$0.00,$0.00,$921.42,"$5,262.50",$0.00,"$2,631.25","$4,167.90","$4,210.00",$0.00,$823.58,$0.00,$837.79,$0.00
224.377,SUP,HCPCS C1713,,224.377  -  7.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 55MM,"$5,262.50",$0.00,"$5,262.50","$2,368.13","$3,755.85",$0.00,$906.70,$0.00,$0.00,$921.42,"$5,262.50",$0.00,"$2,631.25","$4,167.90","$4,210.00",$0.00,$823.58,$0.00,$837.79,$0.00
224.378,SUP,HCPCS C1713,,224.378  -  7.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 60MM,"$5,262.50",$0.00,"$5,262.50","$2,368.13","$3,755.85",$0.00,$906.70,$0.00,$0.00,$921.42,"$5,262.50",$0.00,"$2,631.25","$4,167.90","$4,210.00",$0.00,$823.58,$0.00,$837.79,$0.00
224.379,SUP,HCPCS C1713,,224.379  -  7.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 65MM,"$5,262.50",$0.00,"$5,262.50","$2,368.13","$3,755.85",$0.00,$906.70,$0.00,$0.00,$921.42,"$5,262.50",$0.00,"$2,631.25","$4,167.90","$4,210.00",$0.00,$823.58,$0.00,$837.79,$0.00
224.381,SUP,HCPCS C1713,,224.381  -  8.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 25MM,"$5,262.50",$0.00,"$5,262.50","$2,368.13","$3,755.85",$0.00,$906.70,$0.00,$0.00,$921.42,"$5,262.50",$0.00,"$2,631.25","$4,167.90","$4,210.00",$0.00,$823.58,$0.00,$837.79,$0.00
224.382,SUP,HCPCS C1713,,224.382  -  8.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 30MM,"$5,262.50",$0.00,"$5,262.50","$2,368.13","$3,755.85",$0.00,$906.70,$0.00,$0.00,$921.42,"$5,262.50",$0.00,"$2,631.25","$4,167.90","$4,210.00",$0.00,$823.58,$0.00,$837.79,$0.00
224.383,SUP,HCPCS C1713,,224.383  -  8.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 35MM,"$5,262.50",$0.00,"$5,262.50","$2,368.13","$3,755.85",$0.00,$906.70,$0.00,$0.00,$921.42,"$5,262.50",$0.00,"$2,631.25","$4,167.90","$4,210.00",$0.00,$823.58,$0.00,$837.79,$0.00
224.384,SUP,HCPCS C1713,,224.384  -  8.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 40MM,"$5,262.50",$0.00,"$5,262.50","$2,368.13","$3,755.85",$0.00,$906.70,$0.00,$0.00,$921.42,"$5,262.50",$0.00,"$2,631.25","$4,167.90","$4,210.00",$0.00,$823.58,$0.00,$837.79,$0.00
224.385,SUP,HCPCS C1713,,224.385  -  8.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 45MM,"$5,262.50",$0.00,"$5,262.50","$2,368.13","$3,755.85",$0.00,$906.70,$0.00,$0.00,$921.42,"$5,262.50",$0.00,"$2,631.25","$4,167.90","$4,210.00",$0.00,$823.58,$0.00,$837.79,$0.00
224.386,SUP,HCPCS C1713,,224.386  -  8.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 50MM,"$5,262.50",$0.00,"$5,262.50","$2,368.13","$3,755.85",$0.00,$906.70,$0.00,$0.00,$921.42,"$5,262.50",$0.00,"$2,631.25","$4,167.90","$4,210.00",$0.00,$823.58,$0.00,$837.79,$0.00
224.387,SUP,HCPCS C1713,,224.387  -  8.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 55MM,"$5,262.50",$0.00,"$5,262.50","$2,368.13","$3,755.85",$0.00,$906.70,$0.00,$0.00,$921.42,"$5,262.50",$0.00,"$2,631.25","$4,167.90","$4,210.00",$0.00,$823.58,$0.00,$837.79,$0.00
224.388,SUP,HCPCS C1713,,224.388  -  8.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 60MM,"$5,262.50",$0.00,"$5,262.50","$2,368.13","$3,755.85",$0.00,$906.70,$0.00,$0.00,$921.42,"$5,262.50",$0.00,"$2,631.25","$4,167.90","$4,210.00",$0.00,$823.58,$0.00,$837.79,$0.00
224.389,SUP,HCPCS C1713,,224.389  -  8.5MM STAINLESS STEEL REVERE CANNULATED PEDICLE SCREW 65MM,"$5,262.50",$0.00,"$5,262.50","$2,368.13","$3,755.85",$0.00,$906.70,$0.00,$0.00,$921.42,"$5,262.50",$0.00,"$2,631.25","$4,167.90","$4,210.00",$0.00,$823.58,$0.00,$837.79,$0.00
224.441,SUP,HCPCS C1713,,224.441  -  4.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 25MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.442,SUP,HCPCS C1713,,224.442  -  4.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 30MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.443,SUP,HCPCS C1713,,224.443  -  4.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 35MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.444,SUP,HCPCS C1713,,224.444  -  4.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 40MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.445,SUP,HCPCS C1713,,224.445  -  4.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 45MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.451,SUP,HCPCS C1713,,224.451  -  5.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 25MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.452,SUP,HCPCS C1713,,224.452  -  5.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 30MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.453,SUP,HCPCS C1713,,224.453  -  5.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 35MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.454,SUP,HCPCS C1713,,224.454  -  5.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 40MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.455,SUP,HCPCS C1713,,224.455  -  5.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 45MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.456,SUP,HCPCS C1713,,224.456  -  5.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 50MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.457,SUP,HCPCS C1713,,224.457  -  5.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 55MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.461,SUP,HCPCS C1713,,224.461  -  6.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 25MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.462,SUP,HCPCS C1713,,224.462  -  6.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 30MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.463,SUP,HCPCS C1713,,224.463  -  6.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 35MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.464,SUP,HCPCS C1713,,224.464  -  6.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 40MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.465,SUP,HCPCS C1713,,224.465  -  6.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 45MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.466,SUP,HCPCS C1713,,224.466  -  6.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 50MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.467,SUP,HCPCS C1713,,224.467  -  6.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 55MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.468,SUP,HCPCS C1713,,224.468  -  6.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 60MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.469,SUP,HCPCS C1713,,224.469  -  6.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 65MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.471,SUP,HCPCS C1713,,224.471  -  7.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 25MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.472,SUP,HCPCS C1713,,224.472  -  7.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 30MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.473,SUP,HCPCS C1713,,224.473  -  7.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 35MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.474,SUP,HCPCS C1713,,224.474  -  7.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 40MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.475,SUP,HCPCS C1713,,224.475  -  7.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 45MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.476,SUP,HCPCS C1713,,224.476  -  7.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 50MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.477,SUP,HCPCS C1713,,224.477  -  7.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 55MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.478,SUP,HCPCS C1713,,224.478  -  7.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 60MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.479,SUP,HCPCS C1713,,224.479  -  7.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 65MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.481,SUP,HCPCS C1713,,224.481  -  8.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 25MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.482,SUP,HCPCS C1713,,224.482  -  8.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 30MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.483,SUP,HCPCS C1713,,224.483  -  8.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 35MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.484,SUP,HCPCS C1713,,224.484  -  8.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 40MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.485,SUP,HCPCS C1713,,224.485  -  8.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 45MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.486,SUP,HCPCS C1713,,224.486  -  8.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 50MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.487,SUP,HCPCS C1713,,224.487  -  8.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 55MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.488,SUP,HCPCS C1713,,224.488  -  8.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 60MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.489,SUP,HCPCS C1713,,224.489  -  8.5MM STAINLESS STEEL REVERE SOLID PEDICLE SCREW 65MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.506,SUP,HCPCS C1713,,224.506  -  PLATE BONE 125MM 6 HOLE STAINLESS STEEL TIBIA RIGHT DISTAL,"$1,116.38",$0.00,"$1,116.38",$502.37,$796.76,$0.00,$186.74,$0.00,$0.00,$195.47,"$1,116.38",$0.00,$558.19,$884.17,$893.10,$0.00,$169.62,$0.00,$177.73,$0.00
224.507,SUP,HCPCS C1713,,224.507  -  PLATE BONE 125MM 6 HOLE STAINLESS STEEL TIBIA LEFT DISTAL,"$1,116.38",$0.00,"$1,116.38",$502.37,$796.76,$0.00,$186.74,$0.00,$0.00,$195.47,"$1,116.38",$0.00,$558.19,$884.17,$893.10,$0.00,$169.62,$0.00,$177.73,$0.00
224.508,SUP,HCPCS C1713,,224.508  -  PLATE BONE 161MM 8 HOLE STAINLESS STEEL TIBIA RIGHT DISTAL,"$1,258.30",$0.00,"$1,258.30",$566.24,$898.05,$0.00,$210.48,$0.00,$0.00,$220.32,"$1,258.30",$0.00,$629.15,$996.57,"$1,006.64",$0.00,$191.19,$0.00,$200.32,$0.00
224.509,SUP,HCPCS C1713,,224.509  -  PLATE BONE 161MM 8 HOLE STAINLESS STEEL TIBIA LEFT DISTAL,"$1,258.30",$0.00,"$1,258.30",$566.24,$898.05,$0.00,$210.48,$0.00,$0.00,$220.32,"$1,258.30",$0.00,$629.15,$996.57,"$1,006.64",$0.00,$191.19,$0.00,$200.32,$0.00
224.51,SUP,HCPCS C1713,,224.510  -  PLATE BONE 197X14X3.8MM 10 HOLE DCP STAINLESS STEEL RIGHT,"$1,434.35",$0.00,"$1,434.35",$645.46,"$1,023.70",$0.00,$239.93,$0.00,$0.00,$251.14,"$1,434.35",$0.00,$717.18,"$1,136.01","$1,147.48",$0.00,$217.94,$0.00,$228.35,$0.00
224.511,SUP,HCPCS C1713,,224.511  -  PLATE BONE 197X14X3.8MM 10 HOLE STAINLESS STEEL LEFT MEDIAL,"$1,434.35",$0.00,"$1,434.35",$645.46,"$1,023.70",$0.00,$239.93,$0.00,$0.00,$251.14,"$1,434.35",$0.00,$717.18,"$1,136.01","$1,147.48",$0.00,$217.94,$0.00,$228.35,$0.00
224.512,SUP,Custom 27803010,,224.512  -  PLATE BONE 233X14X3.8MM 12 HOLE STAINLESS STEEL RIGHT MEDIAL,"$1,602.23",$0.00,"$1,602.23",$0.00,"$1,143.51",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,602.23",$0.00,$801.11,"$1,268.97","$1,281.78",$0.00,$0.00,$0.00,$0.00,$0.00
224.513,SUP,HCPCS C1713,,224.513  -  PLATE BONE 233X14X3.8MM 12 HOLE STAINLESS STEEL LEFT MEDIAL,"$1,602.23",$0.00,"$1,602.23",$721.00,"$1,143.51",$0.00,$268.01,$0.00,$0.00,$280.54,"$1,602.23",$0.00,$801.11,"$1,268.97","$1,281.78",$0.00,$243.44,$0.00,$255.07,$0.00
224.514,SUP,HCPCS C1713,,224.514  -  PLATE BONE 269X14X3.8MM 14 HOLE STAINLESS STEEL RIGHT MEDIAL,"$1,786.45",$0.00,"$1,786.45",$803.90,"$1,274.99",$0.00,$298.83,$0.00,$0.00,$312.79,"$1,786.45",$0.00,$893.23,"$1,414.87","$1,429.16",$0.00,$271.44,$0.00,$284.40,$0.00
224.515,SUP,Custom 27803010,,224.515  -  PLATE BONE 269X14X3.8MM 14 HOLE STAINLESS STEEL LEFT MEDIAL,"$1,786.45",$0.00,"$1,786.45",$0.00,"$1,274.99",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,786.45",$0.00,$893.23,"$1,414.87","$1,429.16",$0.00,$0.00,$0.00,$0.00,$0.00
224.517,SUP,Custom 27803010,,"224.517  -  5.5MM STAINLESS STEEL STRAIGHT ROD, 200MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
224.52,SUP,HCPCS C1713,,224.52  -  PLATE BONE NARROW 34X13.5X4.2MM 2 HOLE LCP STAINLESS STEEL,$300.78,$0.00,$300.78,$135.35,$214.66,$0.00,$51.82,$0.00,$0.00,$52.66,$300.78,$0.00,$150.39,$238.22,$240.62,$0.00,$47.07,$0.00,$47.88,$0.00
224.52,SUP,Custom 27803010,,224.520  -  ROD SPNL 5.5MM 400MM REVERE STRG SS,$500.00,$0.00,$396.00,$135.35,$214.66,$0.00,$51.82,$0.00,$0.00,$52.66,$300.78,$0.00,$150.39,$396.00,$240.62,$0.00,$47.07,$0.00,$47.88,$0.00
224.521,SUP,Custom 27803010,,224.521  -  PLATE BN NAR 44X13.5X4.2MM NS LCP CMBN 2 HL LMT CNTCT TPR,$590.93,$0.00,$590.93,$0.00,$421.74,$0.00,$0.00,$0.00,$0.00,$0.00,$590.93,$0.00,$295.46,$468.02,$472.74,$0.00,$0.00,$0.00,$0.00,$0.00
224.53,SUP,HCPCS C1713,,224.53  -  PLATE BONE NARROW 62X13.5X4.2MM 3 HOLE LC-DCP STAINLESS,$310.05,$0.00,$310.05,$139.52,$221.28,$0.00,$53.42,$0.00,$0.00,$54.29,$310.05,$0.00,$155.03,$245.56,$248.04,$0.00,$48.52,$0.00,$49.36,$0.00
224.53,SUP,Custom 27803010,,"224.530  -  5.5MM STAINLESS STEEL STRAIGHT ROD, 30MM",$500.00,$0.00,$396.00,$139.52,$221.28,$0.00,$53.42,$0.00,$0.00,$54.29,$310.05,$0.00,$155.03,$396.00,$248.04,$0.00,$48.52,$0.00,$49.36,$0.00
224.531,SUP,HCPCS C1713,,224.531  -  PLATE BN NAR 62X13.5X4.2MM NS LCP CMBN 3 HL LMT CNTCT TPR,$597.75,$0.00,$597.75,$268.99,$426.61,$0.00,$99.99,$0.00,$0.00,$104.66,$597.75,$0.00,$298.88,$473.42,$478.20,$0.00,$90.82,$0.00,$95.16,$0.00
224.535,SUP,Custom 27803010,,"224.535  -  5.5MM STAINLESS STEEL STRAIGHT ROD, 35MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
224.54,SUP,HCPCS C1713,,224.54  -  PLATE BN NAR 70X13.5X4.2MM NS LC DCP 4 HL SS 4.5MM SCR LG,$309.80,$0.00,$309.80,$139.41,$221.10,$0.00,$51.82,$0.00,$0.00,$54.24,$309.80,$0.00,$154.90,$245.36,$247.84,$0.00,$47.07,$0.00,$49.32,$0.00
224.54,SUP,Custom 27803010,,"224.540  -  5.5MM STAINLESS STEEL STRAIGHT ROD, 40MM",$500.00,$0.00,$396.00,$139.41,$221.10,$0.00,$51.82,$0.00,$0.00,$54.24,$309.80,$0.00,$154.90,$396.00,$247.84,$0.00,$47.07,$0.00,$49.32,$0.00
224.541,SUP,HCPCS C1713,,224.541  -  PLATE BN NAR 80X13.5X4.2MM NS LCP CMBN 4 HL LMT CNTCT TPR,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
224.545,SUP,Custom 27803010,,"224.545  -  5.5MM STAINLESS STEEL STRAIGHT ROD, 45MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
224.55,SUP,HCPCS C1713,,224.55  -  PLATE BN NAR 88X13.5X4.2MM NS LC DCP 5 HL SS 4.5MM SCR LG,$309.80,$0.00,$309.80,$139.41,$221.10,$0.00,$51.82,$0.00,$0.00,$54.24,$309.80,$0.00,$154.90,$245.36,$247.84,$0.00,$47.07,$0.00,$49.32,$0.00
224.55,SUP,Custom 27803010,,"224.550  -  5.5MM STAINLESS STEEL STRAIGHT ROD, 50MM",$500.00,$0.00,$396.00,$139.41,$221.10,$0.00,$51.82,$0.00,$0.00,$54.24,$309.80,$0.00,$154.90,$396.00,$247.84,$0.00,$47.07,$0.00,$49.32,$0.00
224.551,SUP,HCPCS C1713,,224.551  -  PLATE BN NAR 98X13.5X4.2MM NS LCP CMBN 5 HL LMT CNTCT TPR,$674.18,$0.00,$674.18,$303.38,$481.16,$0.00,$112.78,$0.00,$0.00,$118.04,$674.18,$0.00,$337.09,$533.95,$539.34,$0.00,$102.44,$0.00,$107.33,$0.00
224.555,SUP,Custom 27803010,,"224.555  -  5.5MM STAINLESS STEEL STRAIGHT ROD, 55MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
224.56,SUP,HCPCS C1713,,224.56  -  PLATE BN NAR 106X13.5X4.2MM NS LC DCP 6 HL SS 4.5MM SCR LG,$349.38,$0.00,$349.38,$157.22,$249.35,$0.00,$58.44,$0.00,$0.00,$61.17,$349.38,$0.00,$174.69,$276.71,$279.50,$0.00,$53.08,$0.00,$55.62,$0.00
224.56,SUP,Custom 27803010,,"224.560  -  5.5MM STAINLESS STEEL STRAIGHT ROD, 60MM",$500.00,$0.00,$396.00,$157.22,$249.35,$0.00,$58.44,$0.00,$0.00,$61.17,$349.38,$0.00,$174.69,$396.00,$279.50,$0.00,$53.08,$0.00,$55.62,$0.00
224.561,SUP,HCPCS C1713,,224.561  -  PLATE BN NAR 116MM NS LCP CMBN 6 HL SS 4.5MM SCR LG FRAG SET,$713.78,$0.00,$713.78,$321.20,$509.42,$0.00,$119.40,$0.00,$0.00,$124.98,$713.78,$0.00,$356.89,$565.31,$571.02,$0.00,$108.45,$0.00,$113.63,$0.00
224.565,SUP,Custom 27803010,,"224.565  -  5.5MM STAINLESS STEEL STRAIGHT ROD, 65MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
224.57,SUP,HCPCS C1713,,224.57  -  PLATE BN NAR 124X13.5X4.2MM NS LC DCP 7 HL SS 4.5MM SCR LG,$349.38,$0.00,$349.38,$157.22,$249.35,$0.00,$58.44,$0.00,$0.00,$61.17,$349.38,$0.00,$174.69,$276.71,$279.50,$0.00,$53.08,$0.00,$55.62,$0.00
224.57,SUP,Custom 27803010,,"224.570  -  5.5MM STAINLESS STEEL STRAIGHT ROD, 70MM",$500.00,$0.00,$396.00,$157.22,$249.35,$0.00,$58.44,$0.00,$0.00,$61.17,$349.38,$0.00,$174.69,$396.00,$279.50,$0.00,$53.08,$0.00,$55.62,$0.00
224.571,SUP,HCPCS C1713,,224.571  -  PLATE BN NAR 134X13.5X4.2MM NS LCP CMBN 7 HL LMT CNTCT TPR,$825.68,$0.00,$825.68,$371.55,$589.28,$0.00,$138.12,$0.00,$0.00,$144.57,$825.68,$0.00,$412.84,$653.94,$660.54,$0.00,$125.45,$0.00,$131.45,$0.00
224.575,SUP,Custom 27803010,,"224.575  -  5.5MM STAINLESS STEEL STRAIGHT ROD, 75MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
224.58,SUP,HCPCS C1713,,224.58  -  PLATE BN NAR 142X13.5X4.2MM NS LC DCP 8 HL SS 4.5MM SCR LG,$349.38,$0.00,$349.38,$157.22,$249.35,$0.00,$58.44,$0.00,$0.00,$61.17,$349.38,$0.00,$174.69,$276.71,$279.50,$0.00,$53.08,$0.00,$55.62,$0.00
224.58,SUP,Custom 27803010,,"224.580  -  5.5MM STAINLESS STEEL STRAIGHT ROD, 80MM",$500.00,$0.00,$396.00,$157.22,$249.35,$0.00,$58.44,$0.00,$0.00,$61.17,$349.38,$0.00,$174.69,$396.00,$279.50,$0.00,$53.08,$0.00,$55.62,$0.00
224.581,SUP,HCPCS C1713,,224.581  -  PLATE BN NAR 152X13.5X4.2MM NS LCP CMBN 8 HL LMT CNTCT TPR,$873.45,$0.00,$873.45,$393.05,$623.38,$0.00,$146.11,$0.00,$0.00,$152.93,$873.45,$0.00,$436.73,$691.77,$698.76,$0.00,$132.71,$0.00,$139.05,$0.00
224.585,SUP,Custom 27803010,,"224.585  -  5.5MM STAINLESS STEEL STRAIGHT ROD, 85MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
224.59,SUP,HCPCS C1713,,224.59  -  PLATE BN NAR 160X13.5X4.2MM NS LC DCP 9 HL SS 4.5MM SCR LG,$349.38,$0.00,$349.38,$157.22,$249.35,$0.00,$58.44,$0.00,$0.00,$61.17,$349.38,$0.00,$174.69,$276.71,$279.50,$0.00,$53.08,$0.00,$55.62,$0.00
224.591,SUP,HCPCS C1713,,224.591  -  PLATE BN NAR 170X13.5X4.2MM NS LCP CMBN 9 HL LMT CNTCT TPR,$914.38,$0.00,$914.38,$411.47,$652.59,$0.00,$152.95,$0.00,$0.00,$160.10,$914.38,$0.00,$457.19,$724.19,$731.50,$0.00,$138.93,$0.00,$145.57,$0.00
224.6,SUP,HCPCS C1713,,224.60  -  PLATE BN NAR 178X13.5X4.2MM NS LC DCP 10 HL SS 4.5MM SCR LG,$454.45,$0.00,$454.45,$204.50,$324.34,$0.00,$76.02,$0.00,$0.00,$79.57,$454.45,$0.00,$227.23,$359.92,$363.56,$0.00,$69.05,$0.00,$72.35,$0.00
224.601,SUP,HCPCS C1713,,224.601  -  PLATE BN NAR 188X13.5X4.2MM NS LCP CMBN 10 HL LMT CNTCT TPR,$993.55,$0.00,$993.55,$447.10,$709.10,$0.00,$166.20,$0.00,$0.00,$173.96,$993.55,$0.00,$496.78,$786.89,$794.84,$0.00,$150.96,$0.00,$158.17,$0.00
224.61,SUP,HCPCS C1713,,224.61  -  PLATE BN NAR 196X13.5X4.2MM NS LC DCP 11 HL SS 4.5MM SCR LG,$454.45,$0.00,$454.45,$204.50,$324.34,$0.00,$76.02,$0.00,$0.00,$79.57,$454.45,$0.00,$227.23,$359.92,$363.56,$0.00,$69.05,$0.00,$72.35,$0.00
224.61,SUP,Custom 27803010,,"224.610  -  5.5MM STAINLESS STEEL CURVED ROD, 100MM",$500.00,$0.00,$454.45,$204.50,$324.34,$0.00,$76.02,$0.00,$0.00,$79.57,$454.45,$0.00,$227.23,$396.00,$363.56,$0.00,$69.05,$0.00,$72.35,$0.00
224.611,SUP,HCPCS C1713,,224.611  -  PLATE BN NAR 206X13.5X4.2MM NS LCP CMBN 11 HL LMT CNTCT TPR,"$1,069.98",$0.00,"$1,069.98",$481.49,$763.64,$0.00,$178.98,$0.00,$0.00,$187.34,"$1,069.98",$0.00,$534.99,$847.42,$855.98,$0.00,$162.57,$0.00,$170.34,$0.00
224.612,SUP,Custom 27803010,,"224.612  -  5.5MM STAINLESS STEEL CURVED ROD, 125MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
224.615,SUP,Custom 27803010,,"224.615  -  5.5MM STAINLESS STEEL CURVED ROD, 150MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
224.62,SUP,HCPCS C1713,,224.62  -  PLATE BN NAR 214X13.5X4.2MM NS LC DCP 12 HL SS 4.5MM SCR LG,$454.45,$0.00,$454.45,$204.50,$324.34,$0.00,$76.02,$0.00,$0.00,$79.57,$454.45,$0.00,$227.23,$359.92,$363.56,$0.00,$69.05,$0.00,$72.35,$0.00
224.621,SUP,HCPCS C1713,,224.621  -  PLATE BN NAR 224X13.5X4.2MM NS LCP CMBN 12 HL LMT CNTCT TPR,"$1,150.48",$0.00,"$1,150.48",$517.71,$821.09,$0.00,$192.45,$0.00,$0.00,$201.44,"$1,150.48",$0.00,$575.24,$911.18,$920.38,$0.00,$174.81,$0.00,$183.16,$0.00
224.635,SUP,Custom 27803010,,"224.635  -  5.5MM STAINLESS STEEL CURVED ROD, 35MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
224.64,SUP,HCPCS C1713,,224.64  -  PLATE BONE NARROW 250X13.5X4.2MM 14 HOLE LC-DCP STAINLESS,$441.23,$0.00,$441.23,$198.55,$314.90,$0.00,$76.02,$0.00,$0.00,$77.25,$441.23,$0.00,$220.61,$349.45,$352.98,$0.00,$69.05,$0.00,$70.24,$0.00
224.64,SUP,Custom 27803010,,"224.640  -  5.5MM STAINLESS STEEL CURVED ROD, 40MM",$500.00,$0.00,$441.23,$198.55,$314.90,$0.00,$76.02,$0.00,$0.00,$77.25,$441.23,$0.00,$220.61,$396.00,$352.98,$0.00,$69.05,$0.00,$70.24,$0.00
224.641,SUP,HCPCS C1713,,224.641  -  PLATE BN NAR 260X13.5X4.2MM NS LCP CMBN 14 HL LMT CNTCT TPR,"$1,289.70",$0.00,"$1,289.70",$580.37,$920.46,$0.00,$215.73,$0.00,$0.00,$225.82,"$1,289.70",$0.00,$644.85,"$1,021.44","$1,031.76",$0.00,$195.96,$0.00,$205.32,$0.00
224.645,SUP,Custom 27803010,,"224.645  -  5.5MM STAINLESS STEEL CURVED ROD, 45MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
224.65,SUP,Custom 27803010,,"224.650  -  5.5MM STAINLESS STEEL CURVED ROD, 50MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
224.655,SUP,Custom 27803010,,"224.655  -  5.5MM STAINLESS STEEL CURVED ROD, 55MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
224.66,SUP,Custom 27803010,,"224.660  -  5.5MM STAINLESS STEEL CURVED ROD, 60MM",$500.00,$0.00,$545.90,$245.66,$389.61,$0.00,$91.32,$0.00,$0.00,$95.58,$545.90,$0.00,$272.95,$396.00,$436.72,$0.00,$82.95,$0.00,$86.91,$0.00
224.66,SUP,HCPCS C1713,,224.66  -  PLATE BONE NARROW 286X13.5X4.2MM 16 HOLE LC-DCP STAINLESS,$545.90,$0.00,$545.90,$245.66,$389.61,$0.00,$91.32,$0.00,$0.00,$95.58,$545.90,$0.00,$272.95,$432.35,$436.72,$0.00,$82.95,$0.00,$86.91,$0.00
224.661,SUP,HCPCS C1713,,224.661  -  PLATE BN NAR 296X13.5X4.2MM NS LCP CMBN 16 HL LMT CNTCT TPR,"$1,508.05",$0.00,"$1,508.05",$678.62,"$1,076.30",$0.00,$252.26,$0.00,$0.00,$264.05,"$1,508.05",$0.00,$754.03,"$1,194.38","$1,206.44",$0.00,$229.14,$0.00,$240.08,$0.00
224.665,SUP,Custom 27803010,,"224.665  -  5.5MM STAINLESS STEEL CURVED ROD, 65MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
224.67,SUP,Custom 27803010,,"224.670  -  5.5MM STAINLESS STEEL CURVED ROD, 70MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
224.675,SUP,Custom 27803010,,"224.675  -  5.5MM STAINLESS STEEL CURVED ROD, 75MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
224.68,SUP,Custom 27803010,,"224.680  -  5.5MM STAINLESS STEEL CURVED ROD, 80MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
224.681,SUP,HCPCS C1713,,224.681  -  PLATE BONE NARROW 332MM 18 HOLE LCP STAINLESS STEEL,"$1,831.50",$0.00,"$1,831.50",$824.18,"$1,307.14",$0.00,$306.37,$0.00,$0.00,$320.68,"$1,831.50",$0.00,$915.75,"$1,450.55","$1,465.20",$0.00,$278.28,$0.00,$291.57,$0.00
224.685,SUP,Custom 27803010,,"224.685  -  5.5MM STAINLESS STEEL CURVED ROD, 85MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
224.7,SUP,HCPCS C1713,,224.70  -  PLATE BONE NARROW 358MM 20 HOLE LC-DCP STAINLESS STEEL,"$1,155.95",$0.00,"$1,155.95",$520.18,$825.00,$0.00,$193.36,$0.00,$0.00,$202.40,"$1,155.95",$0.00,$577.98,$915.51,$924.76,$0.00,$175.64,$0.00,$184.03,$0.00
224.701,SUP,HCPCS C1713,,224.701  -  PLATE BONE NARROW 368MM 20 HOLE LCP STAINLESS STEEL,"$2,328.28",$0.00,"$2,328.28","$1,047.72","$1,661.69",$0.00,$389.46,$0.00,$0.00,$407.66,"$2,328.28",$0.00,"$1,164.14","$1,844.00","$1,862.62",$0.00,$353.76,$0.00,$370.66,$0.00
224.702,SUP,HCPCS C1713,,"224.702  -  SS REVERE 4.5MM UNIPLANAR REDUCTION SCREW, 30MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.703,SUP,HCPCS C1713,,"224.703  -  SS REVERE 4.5MM UNIPLANAR REDUCTION SCREW, 35MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.704,SUP,HCPCS C1713,,"224.704  -  SS REVERE 4.5MM UNIPLANAR REDUCTION SCREW, 40MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.705,SUP,HCPCS C1713,,"224.705  -  SS REVERE 4.5MM UNIPLANAR REDUCTION SCREW, 45MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.706,SUP,HCPCS C1713,,"224.706  -  SS REVERE 4.5MM UNIPLANAR REDUCTION SCREW, 50MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.707,SUP,HCPCS C1713,,"224.707  -  SS REVERE 4.5MM UNIPLANAR REDUCTION SCREW, 55MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.711,SUP,HCPCS C1713,,"224.711  -  SS REVERE 5.0MM UNIPLANAR REDUCTION SCREW, 25MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.712,SUP,HCPCS C1713,,"224.712  -  SS REVERE 5.0MM UNIPLANAR REDUCTION SCREW, 30MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.713,SUP,HCPCS C1713,,"224.713  -  SS REVERE 5.0MM UNIPLANAR REDUCTION SCREW, 35MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.714,SUP,HCPCS C1713,,"224.714  -  SS REVERE 5.0MM UNIPLANAR REDUCTION SCREW, 40MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.715,SUP,HCPCS C1713,,"224.715  -  SS REVERE 5.0MM UNIPLANAR REDUCTION SCREW, 45MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.716,SUP,HCPCS C1713,,"224.716  -  SS REVERE 5.0MM UNIPLANAR REDUCTION SCREW, 50MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.717,SUP,HCPCS C1713,,"224.717  -  SS REVERE 5.0MM UNIPLANAR REDUCTION SCREW, 55MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.721,SUP,HCPCS C1713,,224.721  -  PLATE BONE NARROW 404MM 22 HOLE LCP STAINLESS STEEL,"$2,542.53",$0.00,"$2,542.53","$1,144.14","$1,814.60",$0.00,$425.31,$0.00,$0.00,$445.18,"$2,542.53",$0.00,"$1,271.26","$2,013.68","$2,034.02",$0.00,$386.32,$0.00,$404.77,$0.00
224.722,SUP,HCPCS C1713,,"224.722  -  SS REVERE 5.5MM UNIPLANAR REDUCTION SCREW, 30MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.723,SUP,HCPCS C1713,,"224.723  -  SS REVERE 5.5MM UNIPLANAR REDUCTION SCREW, 35MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.724,SUP,HCPCS C1713,,"224.724  -  SS REVERE 5.5MM UNIPLANAR REDUCTION SCREW, 40MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.725,SUP,HCPCS C1713,,"224.725  -  SS REVERE 5.5MM UNIPLANAR REDUCTION SCREW, 45MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.726,SUP,HCPCS C1713,,"224.726  -  SS REVERE 5.5MM UNIPLANAR REDUCTION SCREW, 50MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.727,SUP,HCPCS C1713,,"224.727  -  SS REVERE 5.5MM UNIPLANAR REDUCTION SCREW, 55MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.731,SUP,HCPCS C1713,,"224.731  -  SS REVERE 6.5MM UNIPLANAR REDUCTION SCREW, 25MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.732,SUP,HCPCS C1713,,"224.732  -  SS REVERE 6.5MM UNIPLANAR REDUCTION SCREW, 30MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.733,SUP,HCPCS C1713,,"224.733  -  SS REVERE 6.5MM UNIPLANAR REDUCTION SCREW, 35MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.734,SUP,HCPCS C1713,,"224.734  -  SS REVERE 6.5MM UNIPLANAR REDUCTION SCREW, 40MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.735,SUP,HCPCS C1713,,"224.735  -  SS REVERE 6.5MM UNIPLANAR REDUCTION SCREW, 45MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.736,SUP,HCPCS C1713,,"224.736  -  SS REVERE 6.5MM UNIPLANAR REDUCTION SCREW, 50MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.737,SUP,HCPCS C1713,,"224.737  -  SS REVERE 6.5MM UNIPLANAR REDUCTION SCREW, 55MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.753,SUP,HCPCS C1713,,224.753  -  PLATE BN 118X11X4.2MM NS LCP CMBN 8 HL LMT CNTCT TPR END SS,"$1,680.00",$0.00,"$1,680.00",$756.00,"$1,199.02",$0.00,$281.03,$0.00,$0.00,$294.15,"$1,680.00",$0.00,$840.00,"$1,330.56","$1,344.00",$0.00,$255.26,$0.00,$267.46,$0.00
224.754,SUP,HCPCS C1713,,224.754  -  PLATE BN 136X11X4.2MM NS LCP CMBN 9 HL LMT CNTCT TPR END SS,"$1,707.30",$0.00,"$1,707.30",$768.29,"$1,218.50",$0.00,$285.59,$0.00,$0.00,$298.93,"$1,707.30",$0.00,$853.65,"$1,352.18","$1,365.84",$0.00,$259.41,$0.00,$271.80,$0.00
224.755,SUP,HCPCS C1713,,224.755  -  PLATE BN 154X11X4.2MM NS LCP CMBN 10 HL LMT CNTCT TPR END SS,"$1,735.95",$0.00,"$1,735.95",$781.18,"$1,238.95",$0.00,$290.39,$0.00,$0.00,$303.95,"$1,735.95",$0.00,$867.98,"$1,374.87","$1,388.76",$0.00,$263.77,$0.00,$276.36,$0.00
224.756,SUP,HCPCS C1713,,224.756  -  PLATE BONE 172MM 11 HOLE LCP STAINLESS STEEL METAPHYSEAL,"$1,764.63",$0.00,"$1,764.63",$794.08,"$1,259.41",$0.00,$295.18,$0.00,$0.00,$308.97,"$1,764.63",$0.00,$882.31,"$1,397.59","$1,411.70",$0.00,$268.12,$0.00,$280.93,$0.00
224.757,SUP,HCPCS C1713,,224.757  -  PLATE BONE 190MM 12 HOLE LCP STAINLESS STEEL METAPHYSEAL,"$2,277.78",$0.00,"$2,277.78","$1,025.00","$1,625.65",$0.00,$381.02,$0.00,$0.00,$398.82,"$2,277.78",$0.00,"$1,138.89","$1,804.00","$1,822.22",$0.00,$346.09,$0.00,$362.62,$0.00
224.758,SUP,HCPCS C1713,,224.758  -  PLATE BONE 208MM 8X5 HOLE LCP STAINLESS STEEL METAPHYSEAL,"$2,300.98",$0.00,"$2,300.98","$1,035.44","$1,642.21",$0.00,$384.90,$0.00,$0.00,$402.88,"$2,300.98",$0.00,"$1,150.49","$1,822.38","$1,840.78",$0.00,$349.61,$0.00,$366.32,$0.00
224.759,SUP,HCPCS C1713,,224.759  -  PLATE BONE 226MM 9X5 HOLE LCP STAINLESS STEEL METAPHYSEAL,"$2,351.48",$0.00,"$2,351.48","$1,058.16","$1,678.25",$0.00,$393.35,$0.00,$0.00,$411.72,"$2,351.48",$0.00,"$1,175.74","$1,862.37","$1,881.18",$0.00,$357.29,$0.00,$374.35,$0.00
224.761,SUP,HCPCS C1713,,224.761  -  PLATE BONE 262MM 11X5 HOLE LCP STAINLESS STEEL METAPHYSEAL,"$2,468.83",$0.00,"$2,468.83","$1,110.97","$1,762.00",$0.00,$412.98,$0.00,$0.00,$432.27,"$2,468.83",$0.00,"$1,234.41","$1,955.31","$1,975.06",$0.00,$375.12,$0.00,$393.04,$0.00
224.763,SUP,HCPCS C1713,,224.763  -  PLATE BONE 298MM 13X5 HOLE LCP STAINLESS STEEL METAPHYSEAL,"$2,515.23",$0.00,"$2,515.23","$1,131.85","$1,795.12",$0.00,$420.74,$0.00,$0.00,$440.40,"$2,515.23",$0.00,"$1,257.61","$1,992.06","$2,012.18",$0.00,$382.17,$0.00,$400.42,$0.00
224.765,SUP,HCPCS C1713,,224.765  -  PLATE BONE 334MM 20 HOLE LCP STAINLESS STEEL METAPHYSEAL,"$2,629.88",$0.00,"$2,629.88","$1,183.44","$1,876.94",$0.00,$439.92,$0.00,$0.00,$460.47,"$2,629.88",$0.00,"$1,314.94","$2,082.86","$2,103.90",$0.00,$399.59,$0.00,$418.68,$0.00
224.801,SUP,HCPCS C1713,,"224.801  -  SS REVERE 4.5MM UNIPLANAR SCREW, 25MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.802,SUP,HCPCS C1713,,"224.802  -  SS REVERE 4.5MM UNIPLANAR SCREW, 30MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.803,SUP,HCPCS C1713,,"224.803  -  SS REVERE 4.5MM UNIPLANAR SCREW, 35MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.804,SUP,HCPCS C1713,,"224.804  -  SS REVERE 4.5MM UNIPLANAR SCREW, 40MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.805,SUP,HCPCS C1713,,"224.805  -  SS REVERE 4.5MM UNIPLANAR SCREW, 45MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.806,SUP,HCPCS C1713,,"224.806  -  SS REVERE 4.5MM UNIPLANAR SCREW, 50MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.807,SUP,HCPCS C1713,,"224.807  -  SS REVERE 4.5MM UNIPLANAR SCREW, 55MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.811,SUP,HCPCS C1713,,"224.811  -  SS REVERE 5.0MM UNIPLANAR SCREW, 25MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.812,SUP,HCPCS C1713,,"224.812  -  SS REVERE 5.0MM UNIPLANAR SCREW, 30MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.813,SUP,HCPCS C1713,,"224.813  -  SS REVERE 5.0MM UNIPLANAR SCREW, 35MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.814,SUP,HCPCS C1713,,"224.814  -  SS REVERE 5.0MM UNIPLANAR SCREW, 40MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.815,SUP,HCPCS C1713,,"224.815  -  SS REVERE 5.0MM UNIPLANAR SCREW, 45MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.816,SUP,HCPCS C1713,,"224.816  -  SS REVERE 5.0MM UNIPLANAR SCREW, 50MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.817,SUP,HCPCS C1713,,"224.817  -  SS REVERE 5.0MM UNIPLANAR SCREW, 55MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.821,SUP,HCPCS C1713,,"224.821  -  SS REVERE 5.5MM UNIPLANAR SCREW, 25MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.822,SUP,HCPCS C1713,,"224.822  -  SS REVERE 5.5MM UNIPLANAR SCREW, 30MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.823,SUP,HCPCS C1713,,"224.823  -  SS REVERE 5.5MM UNIPLANAR SCREW, 35MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.824,SUP,HCPCS C1713,,"224.824  -  SS REVERE 5.5MM UNIPLANAR SCREW, 40MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.825,SUP,HCPCS C1713,,"224.825  -  SS REVERE 5.5MM UNIPLANAR SCREW, 45MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.826,SUP,HCPCS C1713,,"224.826  -  SS REVERE 5.5MM UNIPLANAR SCREW, 50MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.827,SUP,HCPCS C1713,,"224.827  -  SS REVERE 5.5MM UNIPLANAR SCREW, 55MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.831,SUP,HCPCS C1713,,"224.831  -  SS REVERE 6.5MM UNIPLANAR SCREW, 25MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.832,SUP,HCPCS C1713,,"224.832  -  SS REVERE 6.5MM UNIPLANAR SCREW, 30MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.833,SUP,HCPCS C1713,,"224.833  -  SS REVERE 6.5MM UNIPLANAR SCREW, 35MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.834,SUP,HCPCS C1713,,"224.834  -  SS REVERE 6.5MM UNIPLANAR SCREW, 40MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.835,SUP,HCPCS C1713,,"224.835  -  SS REVERE 6.5MM UNIPLANAR SCREW, 45MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.836,SUP,HCPCS C1713,,"224.836  -  SS REVERE 6.5MM UNIPLANAR SCREW, 50MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.837,SUP,HCPCS C1713,,"224.837  -  SS REVERE 6.5MM UNIPLANAR SCREW, 55MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
224.851,SUP,HCPCS C1713,,"224.851  -  5.0MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 25MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.852,SUP,HCPCS C1713,,"224.852  -  5.0MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 30MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.853,SUP,HCPCS C1713,,"224.853  -  5.0MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 35MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.854,SUP,HCPCS C1713,,"224.854  -  5.0MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 40MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.855,SUP,HCPCS C1713,,"224.855  -  5.0MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 45MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.856,SUP,HCPCS C1713,,"224.856  -  5.0MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 50MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.857,SUP,HCPCS C1713,,"224.857  -  5.0MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 55MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.871,SUP,HCPCS C1713,,"224.871  -  7.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 70MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.872,SUP,HCPCS C1713,,"224.872  -  7.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 75MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.873,SUP,HCPCS C1713,,"224.873  -  7.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 80MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.874,SUP,HCPCS C1713,,"224.874  -  7.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 85MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.875,SUP,HCPCS C1713,,"224.875  -  7.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 90MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.881,SUP,HCPCS C1713,,"224.881  -  8.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 70MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.882,SUP,HCPCS C1713,,"224.882  -  8.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 75MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.883,SUP,HCPCS C1713,,"224.883  -  8.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 80MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.884,SUP,HCPCS C1713,,"224.884  -  8.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 85MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.885,SUP,HCPCS C1713,,"224.885  -  8.5MM STAINLESS STEEL REVERE MONOAXIAL SCREW, 90MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
224.891,SUP,Custom 27803010,,"224.891  -  SS REVERE LOW PROFILE PEDICLE HOOK, SMALL","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
224.892,SUP,Custom 27803010,,"224.892  -  SS REVERE LOW PROFILE PEDICLE HOOK, MEDIUM","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
224.893,SUP,Custom 27803010,,"224.893  -  SS REVERE LOW PROFILE PEDICLE HOOK, LARGE","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
224.901,SUP,Custom 27803010,,"224.901  -  STAINLESS STEEL REVERE THORACIC LAMINA HOOK, NARROW, SMALL","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
224.902,SUP,Custom 27803010,,"224.902  -  STAINLESS STEEL REVERE THORACIC LAMINA HOOK, NARROW, MEDIUM","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
224.904,SUP,Custom 27803010,,"224.904  -  STAINLESS STEEL REVERE THORACIC LAMINA HOOK, SMALL","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
224.905,SUP,Custom 27803010,,"224.905  -  STAINLESS STEEL REVERE THORACIC LAMINA HOOK, MEDIUM","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
224.907,SUP,Custom 27803010,,"224.907  -  STAINLESS STEEL REVERE UPGOING LAMINA HOOK, MEDIUM","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
224.908,SUP,Custom 27803010,,"224.908  -  STAINLESS STEEL REVERE UPGOING LAMINA HOOK, LARGE","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
224.912,SUP,Custom 27803010,,"224.912  -  STAINLESS STEEL REVERE ADJUSTABLE T CONNECTOR, 29MM-33MM","$2,000.00",$0.00,"$2,000.00",$0.00,"$1,427.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
224.913,SUP,Custom 27803010,,"224.913  -  STAINLESS STEEL REVERE ADJUSTABLE T CONNECTOR, 33MM-41MM","$2,000.00",$0.00,"$2,000.00",$0.00,"$1,427.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
224.914,SUP,Custom 27803010,,"224.914  -  STAINLESS STEEL REVERE ADJUSTABLE T CONNECTOR, 38MM-51MM","$2,000.00",$0.00,"$2,000.00",$0.00,"$1,427.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
224.915,SUP,Custom 27803010,,"224.915  -  STAINLESS STEEL REVERE ADJUSTABLE T CONNECTOR, 48MM-61MM","$2,000.00",$0.00,"$2,000.00",$0.00,"$1,427.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
224.916,SUP,Custom 27803010,,"224.916  -  STAINLESS STEEL REVERE ADJUSTABLE T CONNECTOR, 58MM-71MM","$2,000.00",$0.00,"$2,000.00",$0.00,"$1,427.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
224.917,SUP,Custom 27803010,,"224.917  -  STAINLESS STEEL REVERE ADJUSTABLE T CONNECTOR, 68MM-81MM","$2,000.00",$0.00,"$2,000.00",$0.00,"$1,427.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
224.918,SUP,Custom 27803010,,"224.918  -  STAINLESS STEEL REVERE ADJUSTABLE T CONNECTOR, 78MM-91MM","$2,000.00",$0.00,"$2,000.00",$0.00,"$1,427.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
224.921,SUP,Custom 27803010,,"224.921  -  STAINLESS STEEL REVERE OFFSET LAMINA HOOK, RIGHT","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
224.922,SUP,Custom 27803010,,"224.922  -  STAINLESS STEEL REVERE OFFSET LAMINA HOOK, LEFT","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
224.924,SUP,Custom 27803010,,"224.924  -  STAINLESS STEEL REVERE TRANSVERSE PROCESS HOOK, RIGHT","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
224.925,SUP,Custom 27803010,,"224.925  -  STAINLESS STEEL REVERE TRANSVERSE PROCESS HOOK, LEFT","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
224.927,SUP,Custom 27803010,,"224.927  -  STAINLESS STEEL REVERE PEDICLE HOOK, SMALL","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
224.928,SUP,Custom 27803010,,"224.928  -  STAINLESS STEEL REVERE PEDICLE HOOK, MEDIUM","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
224.929,SUP,Custom 27803010,,"224.929  -  STAINLESS STEEL REVERE PEDICLE HOOK, LARGE","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
224.931,SUP,Custom 27803010,,"224.931  -  STAINLESS STEEL REVERE LAMINA HOOK, TRANSVERSE, SMALL","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
224.932,SUP,Custom 27803010,,"224.932  -  STAINLESS STEEL REVERE LAMINA HOOK, TRANSVERSE, MEDIUM","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
224.933,SUP,Custom 27803010,,"224.933  -  STAINLESS STEEL REVERE LAMINA HOOK, TRANSVERSE, LARGE","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
224.935,SUP,Custom 27803010,,"224.935  -  STAINLESS STEEL REVERE PEDICLE HOOK, TRANSVERSE, SMALL","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
224.936,SUP,Custom 27803010,,"224.936  -  STAINLESS STEEL REVERE PEDICLE HOOK, TRANSVERSE, MEDIUM","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
224.937,SUP,Custom 27803010,,"224.937  -  STAINLESS STEEL REVERE PEDICLE HOOK, TRANSVERSE, LARGE","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
224.94,SUP,Custom 27803010,,"224.940  -  STAINLESS STEEL REVERE LAMINA HOOK, NARROW, SMALL","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
224.941,SUP,Custom 27803010,,"224.941  -  STAINLESS STEEL REVERE LAMINA HOOK, NARROW, MEDIUM","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
224.942,SUP,Custom 27803010,,"224.942  -  STAINLESS STEEL REVERE LAMINA HOOK, NARROW, LARGE","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
224.944,SUP,Custom 27803010,,"224.944  -  STAINLESS STEEL REVERE LAMINA HOOK, SMALL","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
224.945,SUP,Custom 27803010,,"224.945  -  STAINLESS STEEL REVERE LAMINA HOOK, MEDIUM","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
224.946,SUP,Custom 27803010,,"224.946  -  STAINLESS STEEL REVERE LAMINA HOOK, LARGE","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
224.948,SUP,Custom 27803010,,"224.948  -  STAINLESS STEEL REVERE LAMINA HOOK, WIDE, SMALL","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
224.949,SUP,Custom 27803010,,"224.949  -  STAINLESS STEEL REVERE LAMINA HOOK, WIDE, MEDIUM","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
224.95,SUP,Custom 27803010,,"224.950  -  STAINLESS STEEL REVERE LAMINA HOOK, WIDE, LARGE","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
224.952,SUP,Custom 27803010,,"224.952  -  STAINLESS STEEL REVERE LAMINA HOOK, TALL BODY, SMALL","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
224.953,SUP,Custom 27803010,,"224.953  -  STAINLESS STEEL REVERE LAMINA HOOK, TALL BODY, MEDIUM","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
224.954,SUP,Custom 27803010,,"224.954  -  STAINLESS STEEL REVERE LAMINA HOOK, TALL BODY, LARGE","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
224.955,SUP,Custom 27803010,,"224.955  -  STAINLESS STEEL REVERE ANGLED LAMINA HOOK, SMALL","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
224.956,SUP,Custom 27803010,,"224.956  -  STAINLESS STEEL REVERE ANGLED LAMINA HOOK, MEDIUM","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
224.957,SUP,Custom 27803010,,"224.957  -  STAINLESS STEEL REVERE ANGLED LAMINA HOOK, LARGE","$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
224.96,SUP,Custom 27803010,,"224.960  -  STAINLESS STEEL PARALLEL CONNECTOR, 5.5MM TO 5.5MM","$1,142.50",$0.00,"$1,142.50",$0.00,$815.40,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,142.50",$0.00,$571.25,$904.86,$914.00,$0.00,$0.00,$0.00,$0.00,$0.00
224.961,SUP,Custom 27803010,,"224.961  -  STAINLESS STEEL PARALLEL CONNECTOR, 5.5MM TO 5.5MM, WIDE","$1,142.50",$0.00,"$1,142.50",$0.00,$815.40,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,142.50",$0.00,$571.25,$904.86,$914.00,$0.00,$0.00,$0.00,$0.00,$0.00
224.962,SUP,Custom 27803010,,"224.962  -  STAINLESS STEEL ROD TO ROD CLAMP, 5.5MM TO 5.5MM","$1,142.50",$0.00,"$1,142.50",$0.00,$815.40,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,142.50",$0.00,$571.25,$904.86,$914.00,$0.00,$0.00,$0.00,$0.00,$0.00
224.963,SUP,Custom 27803010,,"224.963  -  STAINLESS STEEL ROD TO ROD CLAMP, 5.5MM TO 5.5MM, WIDE","$1,142.50",$0.00,"$1,142.50",$0.00,$815.40,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,142.50",$0.00,$571.25,$904.86,$914.00,$0.00,$0.00,$0.00,$0.00,$0.00
224.964,SUP,Custom 27803010,,"224.964  -  STAINLESS STEEL PARALLEL CONNECTOR CLAMP, 5.5MM TO 5.5MM","$1,142.50",$0.00,"$1,142.50",$0.00,$815.40,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,142.50",$0.00,$571.25,$904.86,$914.00,$0.00,$0.00,$0.00,$0.00,$0.00
224.965,SUP,Custom 27803010,,"224.965  -  STAINLESS STEEL PARALLEL CONNECTOR CLAMP, 5.5MM TO 5.5MM, WI","$1,142.50",$0.00,"$1,142.50",$0.00,$815.40,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,142.50",$0.00,$571.25,$904.86,$914.00,$0.00,$0.00,$0.00,$0.00,$0.00
224.97,SUP,Custom 27803010,,"224.970  -  5.5MM STAINLESS STEEL OFFSET CONNECTOR, 15MM","$1,025.00",$0.00,"$1,025.00",$0.00,$731.54,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,025.00",$0.00,$512.50,$811.80,$820.00,$0.00,$0.00,$0.00,$0.00,$0.00
224.971,SUP,Custom 27803010,,"224.971  -  5.5MMM STAINLESS STEEL OFFSET CONNECTOR, 20MM","$1,025.00",$0.00,"$1,025.00",$0.00,$731.54,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,025.00",$0.00,$512.50,$811.80,$820.00,$0.00,$0.00,$0.00,$0.00,$0.00
224.972,SUP,Custom 27803010,,"224.972  -  5.5MM STAINLESS STEEL OFFSET CONNECTOR, 25MM","$1,025.00",$0.00,"$1,025.00",$0.00,$731.54,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,025.00",$0.00,$512.50,$811.80,$820.00,$0.00,$0.00,$0.00,$0.00,$0.00
224.973,SUP,Custom 27803010,,"224.973  -  5.5MM STAINLESS STEEL ROD CLAMP, 100MM","$1,217.50",$0.00,"$1,217.50",$0.00,$868.93,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,217.50",$0.00,$608.75,$964.26,$974.00,$0.00,$0.00,$0.00,$0.00,$0.00
224.974,SUP,Custom 27803010,,"224.974  -  5.5MM STAINLESS STEEL ROD CLAMP, 120MM","$1,217.50",$0.00,"$1,217.50",$0.00,$868.93,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,217.50",$0.00,$608.75,$964.26,$974.00,$0.00,$0.00,$0.00,$0.00,$0.00
224.975,SUP,Custom 27803010,,"224.975  -  5.5MM STAINLESS STEEL ROD CLAMP, 150MM","$1,217.50",$0.00,"$1,217.50",$0.00,$868.93,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,217.50",$0.00,$608.75,$964.26,$974.00,$0.00,$0.00,$0.00,$0.00,$0.00
224.976,SUP,Custom 27803010,,"224.976  -  5.5MM STAINLESS STEEL OFFSET CONNECTOR, 30MM","$1,132.50",$0.00,"$1,132.50",$0.00,$808.27,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,132.50",$0.00,$566.25,$896.94,$906.00,$0.00,$0.00,$0.00,$0.00,$0.00
224.977,SUP,Custom 27803010,,"224.977  -  5.5MM STAINLESS STEEL OFFSET CONNECTOR, 35MM","$1,132.50",$0.00,"$1,132.50",$0.00,$808.27,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,132.50",$0.00,$566.25,$896.94,$906.00,$0.00,$0.00,$0.00,$0.00,$0.00
224.98,SUP,Custom 27803010,,"224.980  -  STAINLESS STEEL IN-LINE CONNECTOR, 5.5MM TO 5.5MM","$1,217.50",$0.00,"$1,217.50",$0.00,$868.93,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,217.50",$0.00,$608.75,$964.26,$974.00,$0.00,$0.00,$0.00,$0.00,$0.00
224.99,SUP,Custom 27803010,,"224.990  -  SS 5.5MM CLOSED OFFSET CONNECTOR, 5.5MM ROD, 15MM","$1,300.00",$0.00,"$1,300.00",$0.00,$927.81,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,300.00",$0.00,$650.00,"$1,029.60","$1,040.00",$0.00,$0.00,$0.00,$0.00,$0.00
224.991,SUP,Custom 27803010,,"224.991  -  SS 5.5MM CLOSED OFFSET CONNECTOR, 5.5MM ROD, 20MM","$1,300.00",$0.00,"$1,300.00",$0.00,$927.81,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,300.00",$0.00,$650.00,"$1,029.60","$1,040.00",$0.00,$0.00,$0.00,$0.00,$0.00
224.992,SUP,Custom 27803010,,"224.992  -  SS 5.5MM CLOSED OFFSET CONNECTOR, 5.5MM ROD, 25MM","$1,300.00",$0.00,"$1,300.00",$0.00,$927.81,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,300.00",$0.00,$650.00,"$1,029.60","$1,040.00",$0.00,$0.00,$0.00,$0.00,$0.00
224.993,SUP,Custom 27803010,,"224.993  -  SS 5.5MM CLOSED OFFSET CONNECTOR, 5.5MM ROD, 30MM","$1,300.00",$0.00,"$1,300.00",$0.00,$927.81,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,300.00",$0.00,$650.00,"$1,029.60","$1,040.00",$0.00,$0.00,$0.00,$0.00,$0.00
224.994,SUP,Custom 27803010,,"224.994  -  SS 5.5MM CLOSED OFFSET CONNECTOR, 5.5MM ROD, 35MM","$1,300.00",$0.00,"$1,300.00",$0.00,$927.81,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,300.00",$0.00,$650.00,"$1,029.60","$1,040.00",$0.00,$0.00,$0.00,$0.00,$0.00
224.995,SUP,Custom 27803010,,"224.995  -  SS 5.5MM CLOSED OFFSET CONNECTOR, 5.5MM ROD, 100MM","$1,450.00",$0.00,"$1,450.00",$0.00,"$1,034.87",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,450.00",$0.00,$725.00,"$1,148.40","$1,160.00",$0.00,$0.00,$0.00,$0.00,$0.00
224.996,SUP,Custom 27803010,,"224.996  -  SS 5.5MM CLOSED OFFSET CONNECTOR, 5.5MM ROD, 120MM","$1,450.00",$0.00,"$1,450.00",$0.00,"$1,034.87",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,450.00",$0.00,$725.00,"$1,148.40","$1,160.00",$0.00,$0.00,$0.00,$0.00,$0.00
224.997,SUP,Custom 27803010,,"224.997  -  SS 5.5MM CLOSED OFFSET CONNECTOR, 5.5MM ROD, 150MM","$1,450.00",$0.00,"$1,450.00",$0.00,"$1,034.87",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,450.00",$0.00,$725.00,"$1,148.40","$1,160.00",$0.00,$0.00,$0.00,$0.00,$0.00
225.007,SUP,HCPCS C1713,,225.007  -  PLATE BRD 90MM SS 3.5MM SCR 7 HOLE LC DCP BONE ORTH NONSTRL,$377.43,$0.00,$377.43,$169.84,$269.37,$0.00,$65.03,$0.00,$0.00,$66.08,$377.43,$0.00,$188.71,$298.92,$301.94,$0.00,$59.07,$0.00,$60.09,$0.00
225.008,SUP,HCPCS C1713,,225.008  -  PLATE BRD 103MM SS 3.5MM SCR 8 HOLE LC DCP BONE ORTH NONSTRL,$393.73,$0.00,$393.73,$177.18,$281.00,$0.00,$67.84,$0.00,$0.00,$68.94,$393.73,$0.00,$196.86,$311.83,$314.98,$0.00,$61.62,$0.00,$62.68,$0.00
225.009,SUP,HCPCS C1713,,225.009  -  PLATE BRD SS 3.5MM SCR 9 HOLE LCP BONE ORTH NONSTRL,$412.38,$0.00,$412.38,$185.57,$294.31,$0.00,$71.05,$0.00,$0.00,$72.20,$412.38,$0.00,$206.19,$326.60,$329.90,$0.00,$64.54,$0.00,$65.65,$0.00
225.01,SUP,HCPCS C1713,,225.010  -  PLATE BRD 129MM SS 3.5MM SCR 10 HOLE LC DCP BONE ORTH,$417.05,$0.00,$417.05,$187.67,$297.65,$0.00,$71.86,$0.00,$0.00,$73.02,$417.05,$0.00,$208.53,$330.30,$333.64,$0.00,$65.27,$0.00,$66.39,$0.00
225.011,SUP,HCPCS C1713,,225.011  -  PLATE BRD 142MM SS 3.5MM SCR 11 HOLE LC DCP BONE ORTH,$435.70,$0.00,$435.70,$196.07,$310.96,$0.00,$75.07,$0.00,$0.00,$76.29,$435.70,$0.00,$217.85,$345.07,$348.56,$0.00,$68.19,$0.00,$69.36,$0.00
225.012,SUP,HCPCS C1713,,225.012  -  PLATE BRD 155MM SS 3.5MM SCR 12 HOLE LC DCP BONE ORTH,$465.95,$0.00,$465.95,$209.68,$332.55,$0.00,$80.28,$0.00,$0.00,$81.58,$465.95,$0.00,$232.98,$369.03,$372.76,$0.00,$72.92,$0.00,$74.18,$0.00
225.013,SUP,HCPCS C1713,,225.013  -  PLATE BRD 168MM SS 3.5MM SCR 13 HOLE LC DCP BONE ORTH,$628.05,$0.00,$628.05,$282.62,$448.24,$0.00,$108.21,$0.00,$0.00,$109.97,$628.05,$0.00,$314.03,$497.42,$502.44,$0.00,$98.29,$0.00,$99.99,$0.00
225.014,SUP,HCPCS C1713,,225.014  -  PLATE BRD 181MM SS 3.5MM SCR 14 HOLE LC DCP BONE RIGHT,$709.28,$0.00,$709.28,$319.17,$506.21,$0.00,$122.20,$0.00,$0.00,$124.19,$709.28,$0.00,$354.64,$561.75,$567.42,$0.00,$111.00,$0.00,$112.92,$0.00
225.015,SUP,HCPCS C1713,,225.015  -  PLATE BRD 194MM SS 3.5MM SCR 15 HOLE LC DCP BONE ORTH,$788.35,$0.00,$788.35,$354.76,$562.65,$0.00,$135.83,$0.00,$0.00,$138.03,$788.35,$0.00,$394.18,$624.37,$630.68,$0.00,$123.38,$0.00,$125.51,$0.00
225.016,SUP,HCPCS C1713,,225.016  -  PLATE BRD 207MM SS 3.5MM SCR 16 HOLE LC DCP BONE ORTH,$869.60,$0.00,$869.60,$391.32,$620.63,$0.00,$149.83,$0.00,$0.00,$152.26,$869.60,$0.00,$434.80,$688.72,$695.68,$0.00,$136.09,$0.00,$138.44,$0.00
225.017,SUP,HCPCS C1713,,225.017  -  PLATE BRD 220MM SS 3.5MM SCR 17 HOLE LC DCP BONE ORTH,$948.65,$0.00,$948.65,$426.89,$677.05,$0.00,$163.45,$0.00,$0.00,$166.10,$948.65,$0.00,$474.33,$751.33,$758.92,$0.00,$148.46,$0.00,$151.03,$0.00
225.018,SUP,HCPCS C1713,,225.018  -  PLATE BRD 233MM SS 3.5MM SCR 18 HOLE LC DCP BONE ORTH,"$1,029.90",$0.00,"$1,029.90",$463.46,$735.04,$0.00,$177.45,$0.00,$0.00,$180.33,"$1,029.90",$0.00,$514.95,$815.68,$823.92,$0.00,$161.18,$0.00,$163.96,$0.00
225.02,SUP,HCPCS C1713,,225.020  -  PLATE BRD 259MM SS 3.5MM SCR 20 HOLE LC DCP BONE ORTH,"$1,169.53",$0.00,"$1,169.53",$526.29,$834.69,$0.00,$201.50,$0.00,$0.00,$204.77,"$1,169.53",$0.00,$584.76,$926.27,$935.62,$0.00,$183.03,$0.00,$186.19,$0.00
225.022,SUP,HCPCS C1713,,225.022  -  PLATE BRD 285MM SS 3.5MM SCR 22 HOLE LC DCP BONE ORTH,"$1,279.00",$0.00,"$1,279.00",$575.55,$912.82,$0.00,$220.37,$0.00,$0.00,$223.94,"$1,279.00",$0.00,$639.50,"$1,012.97","$1,023.20",$0.00,$200.16,$0.00,$203.62,$0.00
226.06,SUP,HCPCS C1713,,226.06  -  PLATE BN BRD 103X16X4.8MM NS DCP 6 HL SS 4.5MM SCR LG FRAG,$403.98,$0.00,$403.98,$181.79,$288.32,$0.00,$67.57,$0.00,$0.00,$70.73,$403.98,$0.00,$201.99,$319.95,$323.18,$0.00,$61.38,$0.00,$64.31,$0.00
226.07,SUP,HCPCS C1713,,226.07  -  PLATE BN BRD 119X16X4.8MM NS DCP 7 HL SS 4.5MM SCR LG FRAG,$414.88,$0.00,$414.88,$186.69,$296.10,$0.00,$69.40,$0.00,$0.00,$72.64,$414.88,$0.00,$207.44,$328.58,$331.90,$0.00,$63.04,$0.00,$66.05,$0.00
226.08,SUP,HCPCS C1713,,226.08  -  PLATE BONE BROAD 135X16X4.8MM 8 HOLE DCP STAINLESS STEEL,$503.60,$0.00,$503.60,$226.62,$359.42,$0.00,$84.24,$0.00,$0.00,$88.18,$503.60,$0.00,$251.80,$398.85,$402.88,$0.00,$76.52,$0.00,$80.17,$0.00
226.09,SUP,HCPCS C1713,,226.09  -  PLATE BN BRD 151X16X4.8MM NS DCP 9 HL SS 4.5MM SCR LG FRAG,$503.60,$0.00,$503.60,$226.62,$359.42,$0.00,$84.24,$0.00,$0.00,$88.18,$503.60,$0.00,$251.80,$398.85,$402.88,$0.00,$76.52,$0.00,$80.17,$0.00
226.1,SUP,HCPCS C1713,,226.10  -  PLATE BN BRD 167X16X4.8MM NS DCP 10 HL SS 4.5MM SCR LG FRAG,$503.60,$0.00,$503.60,$226.62,$359.42,$0.00,$84.24,$0.00,$0.00,$88.18,$503.60,$0.00,$251.80,$398.85,$402.88,$0.00,$76.52,$0.00,$80.17,$0.00
226.12,SUP,HCPCS C1713,,226.12  -  PLATE BN BRD 199X16X4.8MM NS DCP 12 HL SS 4.5MM SCR LG FRAG,$530.90,$0.00,$530.90,$238.91,$378.90,$0.00,$88.81,$0.00,$0.00,$92.96,$530.90,$0.00,$265.45,$420.47,$424.72,$0.00,$80.66,$0.00,$84.52,$0.00
226.14,SUP,HCPCS C1713,,226.14  -  PLATE BONE BROAD 231X16X4.8MM 14 HOLE DCP STAINLESS STEEL,$530.90,$0.00,$530.90,$238.91,$378.90,$0.00,$88.81,$0.00,$0.00,$92.96,$530.90,$0.00,$265.45,$420.47,$424.72,$0.00,$80.66,$0.00,$84.52,$0.00
226.16,SUP,HCPCS C1713,,226.16  -  PLATE BONE BROAD 4.5MM 263X16X4.8MM 16 HOLE DCP STAINLESS,$563.13,$0.00,$563.13,$253.41,$401.90,$0.00,$97.02,$0.00,$0.00,$98.60,$563.13,$0.00,$281.56,$446.00,$450.50,$0.00,$88.13,$0.00,$89.65,$0.00
226.2,SUP,HCPCS C1713,,226.20  -  PLATE BN BRD 326X16X4.8MM NS DCP 20 HL SS 4.5MM SCR LG FRAG,$918.48,$0.00,$918.48,$413.31,$655.52,$0.00,$153.64,$0.00,$0.00,$160.82,$918.48,$0.00,$459.24,$727.44,$734.78,$0.00,$139.55,$0.00,$146.22,$0.00
226.22,SUP,HCPCS C1713,,226.22  -  PLATE BONE BROAD 358MM 22 HOLE DCP STAINLESS STEEL,$968.58,$0.00,$968.58,$435.86,$691.27,$0.00,$166.88,$0.00,$0.00,$169.59,$968.58,$0.00,$484.29,$767.12,$774.86,$0.00,$151.58,$0.00,$154.20,$0.00
226.24,SUP,HCPCS C1713,,226.24  -  PLATE BONE BROAD 390MM 24 HOLE DCP STAINLESS STEEL,"$1,037.48",$0.00,"$1,037.48",$466.86,$740.45,$0.00,$178.75,$0.00,$0.00,$181.65,"$1,037.48",$0.00,$518.74,$821.68,$829.98,$0.00,$162.36,$0.00,$165.17,$0.00
226.56,SUP,HCPCS C1713,,226.56  -  PLATE BN BRD 106X17.5X5.2MM NS LC DCP 6 HL SS 4.5MM SCR LG,$474.93,$0.00,$474.93,$213.72,$338.95,$0.00,$79.45,$0.00,$0.00,$83.16,$474.93,$0.00,$237.46,$376.14,$379.94,$0.00,$72.16,$0.00,$75.61,$0.00
226.561,SUP,HCPCS C1713,,226.561  -  PLATE BN BRD 116X17.5X5.2MM NS LCP CMBN 6 HL LMT CNTCT TPR,$761.53,$0.00,$761.53,$342.69,$543.50,$0.00,$127.39,$0.00,$0.00,$133.34,$761.53,$0.00,$380.76,$603.13,$609.22,$0.00,$115.71,$0.00,$121.23,$0.00
226.57,SUP,HCPCS C1713,,226.57  -  PLATE BN BRD 124X17.5X5.2MM NS LC DCP 7 HL SS 4.5MM SCR LG,$514.50,$0.00,$514.50,$231.53,$367.20,$0.00,$86.07,$0.00,$0.00,$90.08,$514.50,$0.00,$257.25,$407.48,$411.60,$0.00,$78.18,$0.00,$81.91,$0.00
226.571,SUP,HCPCS C1713,,226.571  -  PLATE BN BRD 134MM NS LCP CMBN 7 HL SS 4.5MM SCR LG FRAG SET,$809.30,$0.00,$809.30,$364.19,$577.60,$0.00,$135.38,$0.00,$0.00,$141.70,$809.30,$0.00,$404.65,$640.97,$647.44,$0.00,$122.97,$0.00,$128.84,$0.00
226.58,SUP,HCPCS C1713,,226.58  -  PLATE BN BRD 142X17.5X5.2MM NS LC DCP 8 HL SS 4.5MM SCR LG,$571.83,$0.00,$571.83,$257.32,$408.11,$0.00,$95.65,$0.00,$0.00,$100.12,$571.83,$0.00,$285.91,$452.89,$457.46,$0.00,$86.88,$0.00,$91.03,$0.00
226.581,SUP,HCPCS C1713,,226.581  -  PLATE BN BRD 152MM NS LCP CMBN 8 HL SS 4.5MM SCR LG FRAG SET,$989.45,$0.00,$989.45,$445.25,$706.17,$0.00,$165.51,$0.00,$0.00,$173.24,$989.45,$0.00,$494.73,$783.64,$791.56,$0.00,$150.34,$0.00,$157.52,$0.00
226.59,SUP,HCPCS C1713,,226.59  -  PLATE BN BRD 160X17.5X5.2MM NS LC DCP 9 HL SS 4.5MM SCR LG,$571.83,$0.00,$571.83,$257.32,$408.11,$0.00,$95.65,$0.00,$0.00,$100.12,$571.83,$0.00,$285.91,$452.89,$457.46,$0.00,$86.88,$0.00,$91.03,$0.00
226.591,SUP,HCPCS C1713,,226.591  -  PLATE BN BRD 170X17.5X5.2MM NS LCP CMBN 9 HL LMT CNTCT TPR,"$1,069.98",$0.00,"$1,069.98",$481.49,$763.64,$0.00,$178.98,$0.00,$0.00,$187.34,"$1,069.98",$0.00,$534.99,$847.42,$855.98,$0.00,$162.57,$0.00,$170.34,$0.00
226.6,SUP,HCPCS C1713,,226.60  -  PLATE BN BRD 178X17.5X5.2MM NS LC DCP 10 HL SS 4.5MM SCR LG,$571.83,$0.00,$571.83,$257.32,$408.11,$0.00,$95.65,$0.00,$0.00,$100.12,$571.83,$0.00,$285.91,$452.89,$457.46,$0.00,$86.88,$0.00,$91.03,$0.00
226.601,SUP,HCPCS C1713,,226.601  -  PLATE BN BRD 188X17.5X5.2MM NS LCP CMBN 10 HL LMT CNTCT TPR,"$1,150.48",$0.00,"$1,150.48",$517.71,$821.09,$0.00,$192.45,$0.00,$0.00,$201.44,"$1,150.48",$0.00,$575.24,$911.18,$920.38,$0.00,$174.81,$0.00,$183.16,$0.00
226.61,SUP,HCPCS C1713,,226.61  -  PLATE BN BRD 196X17.5X5.2MM NS LC DCP 11 HL SS 4.5MM SCR LG,$614.15,$0.00,$614.15,$276.37,$438.32,$0.00,$102.73,$0.00,$0.00,$107.53,$614.15,$0.00,$307.08,$486.41,$491.32,$0.00,$93.31,$0.00,$97.77,$0.00
226.611,SUP,HCPCS C1713,,226.611  -  PLATE BN BRD 206X17.5X5.2MM NS LCP CMBN 11 HL LMT CNTCT TPR,"$1,225.55",$0.00,"$1,225.55",$551.50,$874.68,$0.00,$205.01,$0.00,$0.00,$214.58,"$1,225.55",$0.00,$612.78,$970.64,$980.44,$0.00,$186.21,$0.00,$195.11,$0.00
226.62,SUP,HCPCS C1713,,226.62  -  PLATE BN BRD 214X17.5X5.2MM NS LC DCP 12 HL SS 4.5MM SCR LG,$614.15,$0.00,$614.15,$276.37,$438.32,$0.00,$102.73,$0.00,$0.00,$107.53,$614.15,$0.00,$307.08,$486.41,$491.32,$0.00,$93.31,$0.00,$97.77,$0.00
226.621,SUP,HCPCS C1713,,226.621  -  PLATE BN BRD 224X17.5X5.2MM NS LCP CMBN 12 HL LMT CNTCT TPR,"$1,300.60",$0.00,"$1,300.60",$585.27,$928.24,$0.00,$217.56,$0.00,$0.00,$227.72,"$1,300.60",$0.00,$650.30,"$1,030.08","$1,040.48",$0.00,$197.62,$0.00,$207.06,$0.00
226.622,SUP,HCPCS C1713,,226.622  -  PLATE BN BRD CRV 229X17.5X5.2MM NS LCP CMBN 12 HL LMT CNTCT,"$1,300.60",$0.00,"$1,300.60",$585.27,$928.24,$0.00,$217.56,$0.00,$0.00,$227.72,"$1,300.60",$0.00,$650.30,"$1,030.08","$1,040.48",$0.00,$197.62,$0.00,$207.06,$0.00
226.632,SUP,HCPCS C1713,,226.632  -  PLATE BONE BROAD CURVE 247MM 13 HOLE LCP STAINLESS STEEL,"$1,378.40",$0.00,"$1,378.40",$620.28,$983.76,$0.00,$230.57,$0.00,$0.00,$241.35,"$1,378.40",$0.00,$689.20,"$1,091.69","$1,102.72",$0.00,$209.44,$0.00,$219.44,$0.00
226.64,SUP,HCPCS C1713,,226.64  -  PLATE BN BRD 250X17.5X5.2MM NS LC DCP 14 HL SS 4.5MM SCR LG,$614.15,$0.00,$614.15,$276.37,$438.32,$0.00,$102.73,$0.00,$0.00,$107.53,$614.15,$0.00,$307.08,$486.41,$491.32,$0.00,$93.31,$0.00,$97.77,$0.00
226.641,SUP,HCPCS C1713,,226.641  -  PLATE BN BRD 260X17.5X5.2MM NS LCP CMBN 14 HL LMT CNTCT TPR,"$1,448.00",$0.00,"$1,448.00",$651.60,"$1,033.44",$0.00,$242.22,$0.00,$0.00,$253.53,"$1,448.00",$0.00,$724.00,"$1,146.82","$1,158.40",$0.00,$220.01,$0.00,$230.52,$0.00
226.642,SUP,HCPCS C1713,,226.642  -  PLATE BN BRD CRV 265X17.5X5.2MM NS LCP CMBN 14 HL LMT CNTCT,"$1,448.00",$0.00,"$1,448.00",$651.60,"$1,033.44",$0.00,$242.22,$0.00,$0.00,$253.53,"$1,448.00",$0.00,$724.00,"$1,146.82","$1,158.40",$0.00,$220.01,$0.00,$230.52,$0.00
226.652,SUP,HCPCS C1713,,226.652  -  PLATE BONE BROAD CURVE 282MM 15 HOLE LCP STAINLESS STEEL,"$1,607.68",$0.00,"$1,607.68",$723.45,"$1,147.40",$0.00,$268.93,$0.00,$0.00,$281.49,"$1,607.68",$0.00,$803.84,"$1,273.28","$1,286.14",$0.00,$244.27,$0.00,$255.94,$0.00
226.66,SUP,HCPCS C1713,,226.66  -  PLATE BN BRD 286X17.5X5.2MM NS LC DCP 16 HL SS 4.5MM SCR LG,$697.38,$0.00,$697.38,$313.82,$497.72,$0.00,$116.66,$0.00,$0.00,$122.10,$697.38,$0.00,$348.69,$552.32,$557.90,$0.00,$105.96,$0.00,$111.02,$0.00
226.661,SUP,HCPCS C1713,,226.661  -  PLATE BN BRD 296X17.5X5.2MM NS LCP CMBN 16 HL LMT CNTCT TPR,"$1,759.18",$0.00,"$1,759.18",$791.63,"$1,255.52",$0.00,$294.27,$0.00,$0.00,$308.02,"$1,759.18",$0.00,$879.59,"$1,393.27","$1,407.34",$0.00,$267.29,$0.00,$280.06,$0.00
226.662,SUP,HCPCS C1713,,226.662  -  PLATE BN BRD CRV 300X17.5X5.2MM NS LCP CMBN 16 HL LMT CNTCT,"$1,759.18",$0.00,"$1,759.18",$791.63,"$1,255.52",$0.00,$294.27,$0.00,$0.00,$308.02,"$1,759.18",$0.00,$879.59,"$1,393.27","$1,407.34",$0.00,$267.29,$0.00,$280.06,$0.00
226.672,SUP,HCPCS C1713,,226.672  -  PLATE BONE BROAD CURVE 318MM 17 HOLE LCP STAINLESS STEEL,"$1,842.43",$0.00,"$1,842.43",$829.09,"$1,314.94",$0.00,$308.19,$0.00,$0.00,$322.59,"$1,842.43",$0.00,$921.21,"$1,459.20","$1,473.94",$0.00,$279.94,$0.00,$293.31,$0.00
226.68,SUP,HCPCS C1713,,226.68  -  PLATE BN BRD 332X17.5X5.2MM NS LC DCP 18 HL SS 4.5MM SCR LG,$788.83,$0.00,$788.83,$354.97,$562.98,$0.00,$131.95,$0.00,$0.00,$138.12,$788.83,$0.00,$394.41,$624.75,$631.06,$0.00,$119.86,$0.00,$125.58,$0.00
226.681,SUP,HCPCS C1713,,226.681  -  PLATE BONE BROAD 332X17.5X5.2MM 18 HOLE LCP STAINLESS STEEL,"$2,139.93",$0.00,"$2,139.93",$962.97,"$1,527.26",$0.00,$357.96,$0.00,$0.00,$374.68,"$2,139.93",$0.00,"$1,069.96","$1,694.82","$1,711.94",$0.00,$325.14,$0.00,$340.68,$0.00
226.682,SUP,HCPCS C1713,,226.682  -  PLATE BN BRD CRV 336X17.5X5.2MM NS LCP CMBN 18 HL LMT CNTCT,"$2,007.55",$0.00,"$2,007.55",$903.40,"$1,432.79",$0.00,$335.82,$0.00,$0.00,$351.51,"$2,007.55",$0.00,"$1,003.78","$1,589.98","$1,606.04",$0.00,$305.03,$0.00,$319.60,$0.00
226.7,SUP,HCPCS C1713,,226.70  -  PLATE BONE BROAD 358X17.5X5.2MM 20 HOLE LC-DCP STAINLESS,"$1,155.95",$0.00,"$1,155.95",$520.18,$825.00,$0.00,$193.36,$0.00,$0.00,$202.40,"$1,155.95",$0.00,$577.98,$915.51,$924.76,$0.00,$175.64,$0.00,$184.03,$0.00
226.701,SUP,HCPCS C1713,,226.701  -  PLATE BONE BROAD 368MM 20 HOLE LCP STAINLESS STEEL,"$2,365.10",$0.00,"$2,365.10","$1,064.30","$1,687.97",$0.00,$395.63,$0.00,$0.00,$414.11,"$2,365.10",$0.00,"$1,182.55","$1,873.16","$1,892.08",$0.00,$359.36,$0.00,$376.52,$0.00
226.72,SUP,HCPCS C1713,,226.72  -  PLATE BONE BROAD 394X17.5X5.2MM 22 HOLE LC-DCP STAINLESS,"$1,209.73",$0.00,"$1,209.73",$544.38,$863.38,$0.00,$208.43,$0.00,$0.00,$211.81,"$1,209.73",$0.00,$604.86,$958.11,$967.78,$0.00,$189.32,$0.00,$192.59,$0.00
226.721,SUP,HCPCS C1713,,226.721  -  PLATE BONE BROAD 404MM 22 HOLE LCP STAINLESS STEEL,"$2,591.65",$0.00,"$2,591.65","$1,166.24","$1,849.66",$0.00,$433.52,$0.00,$0.00,$453.78,"$2,591.65",$0.00,"$1,295.83","$2,052.59","$2,073.32",$0.00,$393.78,$0.00,$412.59,$0.00
227.11,SUP,HCPCS C1713,,227.11  -  PLATE BONE BROAD 179MM 10 HOLE STAINLESS STEEL ORTHOPEDIC,$695.63,$0.00,$695.63,$313.03,$496.47,$0.00,$119.85,$0.00,$0.00,$121.80,$695.63,$0.00,$347.81,$550.94,$556.50,$0.00,$108.87,$0.00,$110.74,$0.00
227.13,SUP,HCPCS C1713,,227.13  -  PLATE BONE BROAD 199MM 10 HOLE STAINLESS STEEL ORTHOPEDIC,$777.78,$0.00,$777.78,$350.00,$555.10,$0.00,$134.01,$0.00,$0.00,$136.18,$777.78,$0.00,$388.89,$616.00,$622.22,$0.00,$121.72,$0.00,$123.82,$0.00
227.14,SUP,HCPCS C1713,,227.14  -  PLATE BONE BROAD 209MM 10 HOLE STAINLESS STEEL ORTHOPEDIC,$777.78,$0.00,$777.78,$350.00,$555.10,$0.00,$134.01,$0.00,$0.00,$136.18,$777.78,$0.00,$388.89,$616.00,$622.22,$0.00,$121.72,$0.00,$123.82,$0.00
227.18,SUP,HCPCS C1713,,227.18  -  PLATE BONE BROAD 249MM 10 HOLE STAINLESS STEEL ORTHOPEDIC,$809.58,$0.00,$809.58,$364.31,$577.79,$0.00,$139.49,$0.00,$0.00,$141.75,$809.58,$0.00,$404.79,$641.19,$647.66,$0.00,$126.70,$0.00,$128.88,$0.00
227.81,SUP,HCPCS C1713,,227.81  -  PLATE BONE BROAD 135MM 8 HOLE STAINLESS STEEL ORTHOPEDIC,$674.43,$0.00,$674.43,$303.49,$481.34,$0.00,$116.20,$0.00,$0.00,$118.09,$674.43,$0.00,$337.21,$534.15,$539.54,$0.00,$105.55,$0.00,$107.37,$0.00
227.83,SUP,HCPCS C1713,,227.83  -  PLATE BONE BROAD 155MM 8 HOLE STAINLESS STEEL ORTHOPEDIC,$674.43,$0.00,$674.43,$303.49,$481.34,$0.00,$116.20,$0.00,$0.00,$118.09,$674.43,$0.00,$337.21,$534.15,$539.54,$0.00,$105.55,$0.00,$107.37,$0.00
227.84,SUP,HCPCS C1713,,227.84  -  PLATE BONE BROAD 185MM 8 HOLE STAINLESS STEEL ORTHOPEDIC,$674.43,$0.00,$674.43,$303.49,$481.34,$0.00,$116.20,$0.00,$0.00,$118.09,$674.43,$0.00,$337.21,$534.15,$539.54,$0.00,$105.55,$0.00,$107.37,$0.00
228.85,SUP,HCPCS C1713,,228.85  -  PLATE BONE NARROW 175MM 8 HOLE STAINLESS STEEL ORTHOPEDIC,$502.18,$0.00,$502.18,$225.98,$358.40,$0.00,$86.52,$0.00,$0.00,$87.93,$502.18,$0.00,$251.09,$397.73,$401.74,$0.00,$78.59,$0.00,$79.95,$0.00
229.33,SUP,HCPCS C1713,,229.33  -  PLATE BN STRG 45X12X3MM NS LC DCP 3 HL RECON SS 4.5MM CORT,$652.35,$0.00,$652.35,$293.56,$465.58,$0.00,$109.12,$0.00,$0.00,$114.22,$652.35,$0.00,$326.18,$516.66,$521.88,$0.00,$99.12,$0.00,$103.85,$0.00
229.331,SUP,HCPCS C1713,,229.331  -  PLATE BONE 56MM 3 HOLE STR RECONSTRUCTION LCP STAINLESS,$779.28,$0.00,$779.28,$350.67,$556.17,$0.00,$130.35,$0.00,$0.00,$136.44,$779.28,$0.00,$389.64,$617.19,$623.42,$0.00,$118.40,$0.00,$124.06,$0.00
229.34,SUP,HCPCS C1713,,229.34  -  PLATE BN STRG 61X12X3MM NS LC DCP 4 HL RECON SS 4.5MM CORT,$679.65,$0.00,$679.65,$305.84,$485.07,$0.00,$113.69,$0.00,$0.00,$119.00,$679.65,$0.00,$339.83,$538.28,$543.72,$0.00,$103.27,$0.00,$108.20,$0.00
229.341,SUP,HCPCS C1713,,229.341  -  PLATE BONE 75MM 4 HOLE STR RECONSTRUCTION LCP STAINLESS,$816.13,$0.00,$816.13,$367.26,$582.47,$0.00,$136.52,$0.00,$0.00,$142.90,$816.13,$0.00,$408.06,$646.37,$652.90,$0.00,$124.00,$0.00,$129.93,$0.00
229.35,SUP,HCPCS C1713,,229.35  -  PLATE BONE STR 77X12X3MM 5 HOLE RECONSTRUCTION LC-DCP,$739.70,$0.00,$739.70,$332.87,$527.92,$0.00,$123.73,$0.00,$0.00,$129.52,$739.70,$0.00,$369.85,$585.84,$591.76,$0.00,$112.39,$0.00,$117.76,$0.00
229.351,SUP,HCPCS C1713,,229.351  -  PLATE BONE 94MM 5 HOLE STR RECONSTRUCTION LCP STAINLESS,$881.63,$0.00,$881.63,$396.73,$629.22,$0.00,$147.48,$0.00,$0.00,$154.37,$881.63,$0.00,$440.81,$698.25,$705.30,$0.00,$133.96,$0.00,$140.35,$0.00
229.36,SUP,HCPCS C1713,,229.36  -  PLATE BN 93X12X3MM NS LC DCP 6 HL RECON SS 4.5MM SCR,$784.73,$0.00,$784.73,$353.13,$560.06,$0.00,$131.27,$0.00,$0.00,$137.40,$784.73,$0.00,$392.36,$621.51,$627.78,$0.00,$119.23,$0.00,$124.93,$0.00
229.361,SUP,HCPCS C1713,,229.361  -  PLATE BONE 113MM 6 HOLE STR RECONSTRUCTION LCP STAINLESS,$941.68,$0.00,$941.68,$423.75,$672.07,$0.00,$157.52,$0.00,$0.00,$164.88,$941.68,$0.00,$470.84,$745.81,$753.34,$0.00,$143.08,$0.00,$149.91,$0.00
229.37,SUP,HCPCS C1713,,229.37  -  PLATE BONE STR 109X12X3MM 7 HOLE RECONSTRUCTION LC-DCP,$820.23,$0.00,$820.23,$369.10,$585.39,$0.00,$137.20,$0.00,$0.00,$143.61,$820.23,$0.00,$410.11,$649.62,$656.18,$0.00,$124.62,$0.00,$130.58,$0.00
229.371,SUP,HCPCS C1713,,229.371  -  PLATE BONE 132MM 7 HOLE STR RECONSTRUCTION LCP STAINLESS,$985.35,$0.00,$985.35,$443.41,$703.24,$0.00,$164.83,$0.00,$0.00,$172.53,$985.35,$0.00,$492.68,$780.40,$788.28,$0.00,$149.72,$0.00,$156.87,$0.00
229.38,SUP,HCPCS C1713,,229.38  -  PLATE BN STRG 125X12X3MM NS LC DCP 8 HL RECON SS 4.5MM CORT,$863.88,$0.00,$863.88,$388.74,$616.55,$0.00,$144.51,$0.00,$0.00,$151.26,$863.88,$0.00,$431.94,$684.19,$691.10,$0.00,$131.26,$0.00,$137.53,$0.00
229.381,SUP,HCPCS C1713,,229.381  -  PLATE BONE 151MM 8 HOLE STR RECONSTRUCTION LCP STAINLESS,"$1,035.85",$0.00,"$1,035.85",$466.13,$739.29,$0.00,$173.27,$0.00,$0.00,$181.37,"$1,035.85",$0.00,$517.93,$820.39,$828.68,$0.00,$157.39,$0.00,$164.91,$0.00
229.39,SUP,HCPCS C1713,,229.39  -  PLATE BONE STR 141X12X3MM 9 HOLE RECONSTRUCTION LC-DCP,$926.68,$0.00,$926.68,$417.00,$661.37,$0.00,$155.01,$0.00,$0.00,$162.25,$926.68,$0.00,$463.34,$733.93,$741.34,$0.00,$140.80,$0.00,$147.53,$0.00
229.391,SUP,HCPCS C1713,,229.391  -  PLATE BONE 170MM 9 HOLE STR RECONSTRUCTION LCP STAINLESS,"$1,109.55",$0.00,"$1,109.55",$499.30,$791.89,$0.00,$185.60,$0.00,$0.00,$194.27,"$1,109.55",$0.00,$554.78,$878.76,$887.64,$0.00,$168.59,$0.00,$176.64,$0.00
229.4,SUP,HCPCS C1713,,229.40  -  PLATE BN 157MM NS LC DCP 10 HL RECON 4.5MM SCR,$970.33,$0.00,$970.33,$436.65,$692.52,$0.00,$162.31,$0.00,$0.00,$169.90,$970.33,$0.00,$485.16,$768.50,$776.26,$0.00,$147.43,$0.00,$154.48,$0.00
229.401,SUP,HCPCS C1713,,229.401  -  PLATE BONE 189MM 10 HOLE STR RECONSTRUCTION LCP STAINLESS,"$1,162.78",$0.00,"$1,162.78",$523.25,$829.87,$0.00,$194.50,$0.00,$0.00,$203.59,"$1,162.78",$0.00,$581.39,$920.92,$930.22,$0.00,$176.67,$0.00,$185.11,$0.00
229.41,SUP,HCPCS C1713,,229.41  -  PLATE BONE 173MM 11 HOLE STR RECONSTRUCTION LC-DCP DCP,"$1,004.45",$0.00,"$1,004.45",$452.00,$716.88,$0.00,$168.02,$0.00,$0.00,$175.87,"$1,004.45",$0.00,$502.23,$795.52,$803.56,$0.00,$152.62,$0.00,$159.91,$0.00
229.411,SUP,HCPCS C1713,,229.411  -  PLATE BONE 208MM 11 HOLE STR RECONSTRUCTION LCP STAINLESS,"$1,200.98",$0.00,"$1,200.98",$540.44,$857.14,$0.00,$200.90,$0.00,$0.00,$210.28,"$1,200.98",$0.00,$600.49,$951.18,$960.78,$0.00,$182.48,$0.00,$191.20,$0.00
229.42,SUP,HCPCS C1713,,229.42  -  PLATE BONE STR 189X12X3MM 12 HOLE RECONSTRUCTION LC-DCP,"$1,050.85",$0.00,"$1,050.85",$472.88,$749.99,$0.00,$175.78,$0.00,$0.00,$184.00,"$1,050.85",$0.00,$525.43,$832.27,$840.68,$0.00,$159.67,$0.00,$167.30,$0.00
229.421,SUP,HCPCS C1713,,229.421  -  PLATE BONE 227MM 12 HOLE STR RECONSTRUCTION LCP STAINLESS,"$1,258.30",$0.00,"$1,258.30",$566.24,$898.05,$0.00,$210.48,$0.00,$0.00,$220.32,"$1,258.30",$0.00,$629.15,$996.57,"$1,006.64",$0.00,$191.19,$0.00,$200.32,$0.00
229.43,SUP,HCPCS C1713,,229.43  -  PLATE BONE STR 205X12X3MM 13 HOLE RECONSTRUCTION LC-DCP,"$1,119.10",$0.00,"$1,119.10",$503.60,$798.70,$0.00,$187.20,$0.00,$0.00,$195.95,"$1,119.10",$0.00,$559.55,$886.33,$895.28,$0.00,$170.04,$0.00,$178.16,$0.00
229.431,SUP,HCPCS C1713,,229.431  -  PLATE BONE 246MM 13 HOLE STR RECONSTRUCTION LCP STAINLESS,"$1,338.83",$0.00,"$1,338.83",$602.47,$955.52,$0.00,$223.95,$0.00,$0.00,$234.42,"$1,338.83",$0.00,$669.41,"$1,060.35","$1,071.06",$0.00,$203.42,$0.00,$213.14,$0.00
229.44,SUP,HCPCS C1713,,229.44  -  PLATE BONE 221MM 14 HOLE RECONSTRUCTION DCP LC-DCP STAINLESS,"$1,150.48",$0.00,"$1,150.48",$517.71,$821.09,$0.00,$192.45,$0.00,$0.00,$201.44,"$1,150.48",$0.00,$575.24,$911.18,$920.38,$0.00,$174.81,$0.00,$183.16,$0.00
229.441,SUP,HCPCS C1713,,229.441  -  PLATE BONE 265MM 14 HOLE STR RECONSTRUCTION LCP STAINLESS,"$1,375.68",$0.00,"$1,375.68",$619.05,$981.82,$0.00,$230.12,$0.00,$0.00,$240.87,"$1,375.68",$0.00,$687.84,"$1,089.54","$1,100.54",$0.00,$209.02,$0.00,$219.01,$0.00
229.451,SUP,HCPCS C1713,,229.451  -  PLATE BONE 284MM 15 HOLE STR RECONSTRUCTION LCP STAINLESS,"$1,433.00",$0.00,"$1,433.00",$644.85,"$1,022.73",$0.00,$239.71,$0.00,$0.00,$250.91,"$1,433.00",$0.00,$716.50,"$1,134.94","$1,146.40",$0.00,$217.73,$0.00,$228.13,$0.00
229.461,SUP,HCPCS C1713,,229.461  -  PLATE BONE 303MM 16 HOLE STR RECONSTRUCTION LCP STAINLESS,"$1,471.20",$0.00,"$1,471.20",$662.04,"$1,050.00",$0.00,$246.10,$0.00,$0.00,$257.60,"$1,471.20",$0.00,$735.60,"$1,165.19","$1,176.96",$0.00,$223.54,$0.00,$234.22,$0.00
231.001,SUP,Custom 27203010,,"231.001  -  STAINLESS STEEL, DUAL STAPLE, SMALL, ROSTRAL","$2,522.50",$0.00,"$2,522.50",$0.00,"$1,800.31",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,522.50",$0.00,"$1,261.25","$1,997.82","$2,018.00",$0.00,$0.00,$0.00,$0.00,$0.00
231.002,SUP,Custom 27203010,,"231.002  -  STAINLESS STEEL, DUAL STAPLE, SMALL, CAUDAL","$2,522.50",$0.00,"$2,522.50",$0.00,"$1,800.31",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,522.50",$0.00,"$1,261.25","$1,997.82","$2,018.00",$0.00,$0.00,$0.00,$0.00,$0.00
231.003,SUP,Custom 27203010,,"231.003  -  STAINLESS STEEL, DUAL STAPLE, MEDIUM, ROSTRAL","$2,522.50",$0.00,"$2,522.50",$0.00,"$1,800.31",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,522.50",$0.00,"$1,261.25","$1,997.82","$2,018.00",$0.00,$0.00,$0.00,$0.00,$0.00
231.004,SUP,Custom 27203010,,"231.004  -  STAINLESS STEEL, DUAL STAPLE, MEDIUM, CAUDAL","$2,522.50",$0.00,"$2,522.50",$0.00,"$1,800.31",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,522.50",$0.00,"$1,261.25","$1,997.82","$2,018.00",$0.00,$0.00,$0.00,$0.00,$0.00
231.005,SUP,Custom 27203010,,"231.005  -  STAINLESS STEEL, DUAL STAPLE, LARGE, ROSTRAL","$2,522.50",$0.00,"$2,522.50",$0.00,"$1,800.31",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,522.50",$0.00,"$1,261.25","$1,997.82","$2,018.00",$0.00,$0.00,$0.00,$0.00,$0.00
231.006,SUP,Custom 27203010,,"231.006  -  STAINLESS STEEL, DUAL STAPLE, LARGE, CAUDAL","$2,522.50",$0.00,"$2,522.50",$0.00,"$1,800.31",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,522.50",$0.00,"$1,261.25","$1,997.82","$2,018.00",$0.00,$0.00,$0.00,$0.00,$0.00
231.007,SUP,Custom 27203010,,"231.007  -  STAINLESS STEEL, DUAL STAPLE, X-LARGE, ROSTRAL","$2,522.50",$0.00,"$2,522.50",$0.00,"$1,800.31",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,522.50",$0.00,"$1,261.25","$1,997.82","$2,018.00",$0.00,$0.00,$0.00,$0.00,$0.00
231.008,SUP,Custom 27203010,,"231.008  -  STAINLESS STEEL, DUAL STAPLE, X-LARGE, CAUDAL","$2,522.50",$0.00,"$2,522.50",$0.00,"$1,800.31",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,522.50",$0.00,"$1,261.25","$1,997.82","$2,018.00",$0.00,$0.00,$0.00,$0.00,$0.00
231.011,SUP,Custom 27203010,,"231.011  -  STAINLESS STEEL SINGLE STAPLE, SMALL","$1,822.50",$0.00,"$1,822.50",$0.00,"$1,300.72",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,822.50",$0.00,$911.25,"$1,443.42","$1,458.00",$0.00,$0.00,$0.00,$0.00,$0.00
231.012,SUP,Custom 27203010,,"231.012  -  STAINLESS STEEL SINGLE STAPLE, MEDIUM","$1,822.50",$0.00,"$1,822.50",$0.00,"$1,300.72",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,822.50",$0.00,$911.25,"$1,443.42","$1,458.00",$0.00,$0.00,$0.00,$0.00,$0.00
231.013,SUP,Custom 27203010,,"231.013  -  STAINLESS STEEL SINGLE STAPLE, LARGE","$1,822.50",$0.00,"$1,822.50",$0.00,"$1,300.72",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,822.50",$0.00,$911.25,"$1,443.42","$1,458.00",$0.00,$0.00,$0.00,$0.00,$0.00
231.113,SUP,Custom 27803010,,"231.113  -  STAINLESS STEEL CROSS CONNECTOR, 13MM","$2,000.00",$0.00,"$2,000.00",$0.00,"$1,427.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
231.114,SUP,Custom 27803010,,"231.114  -  STAINLESS STEEL CROSS CONNECTOR, 14MM","$2,000.00",$0.00,"$2,000.00",$0.00,"$1,427.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
231.115,SUP,Custom 27803010,,"231.115  -  STAINLESS STEEL CROSS CONNECTOR, 15MM","$2,000.00",$0.00,"$2,000.00",$0.00,"$1,427.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
231.116,SUP,Custom 27803010,,"231.116  -  STAINLESS STEEL CROSS CONNECTOR, 16MM","$2,000.00",$0.00,"$2,000.00",$0.00,"$1,427.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
231.117,SUP,Custom 27803010,,"231.117  -  STAINLESS STEEL CROSS CONNECTOR, 17MM","$2,000.00",$0.00,"$2,000.00",$0.00,"$1,427.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
231.118,SUP,Custom 27803010,,"231.118  -  STAINLESS STEEL CROSS CONNECTOR, 18MM","$2,000.00",$0.00,"$2,000.00",$0.00,"$1,427.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
231.119,SUP,Custom 27803010,,"231.119  -  STAINLESS STEEL CROSS CONNECTOR, 19MM","$2,000.00",$0.00,"$2,000.00",$0.00,"$1,427.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
231.12,SUP,Custom 27803010,,"231.120  -  STAINLESS STEEL CROSS CONNECTOR, 20MM","$2,000.00",$0.00,"$2,000.00",$0.00,"$1,427.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
231.201,SUP,HCPCS C1713,,"231.201  -  STAINLESS STEEL WASHER, SMALL",$700.00,$0.00,$700.00,$315.00,$499.59,$0.00,$120.61,$0.00,$0.00,$122.56,$700.00,$0.00,$350.00,$554.40,$560.00,$0.00,$109.55,$0.00,$111.44,$0.00
231.202,SUP,HCPCS C1713,,"231.202  -  STAINLESS STEEL WASHER, MEDIUM",$700.00,$0.00,$700.00,$315.00,$499.59,$0.00,$120.61,$0.00,$0.00,$122.56,$700.00,$0.00,$350.00,$554.40,$560.00,$0.00,$109.55,$0.00,$111.44,$0.00
231.203,SUP,HCPCS C1713,,"231.203  -  STAINLESS STEEL WASHER, LARGE",$700.00,$0.00,$700.00,$315.00,$499.59,$0.00,$120.61,$0.00,$0.00,$122.56,$700.00,$0.00,$350.00,$554.40,$560.00,$0.00,$109.55,$0.00,$111.44,$0.00
232.006,SUP,HCPCS C1713,,232.006  -  PLATE BONE 90D 132MM 30X9.2MM 10 HOLE LIMITED CONTACT ANGLED,"$1,876.20",$0.00,"$1,876.20",$844.29,"$1,339.04",$0.00,$323.26,$0.00,$0.00,$328.51,"$1,876.20",$0.00,$938.10,"$1,485.95","$1,500.96",$0.00,$293.63,$0.00,$298.69,$0.00
232.007,SUP,HCPCS C1713,,232.007  -  PLATE BONE 90D 132MM 35X9.2MM 10 HOLE LIMITED CONTACT ANGLED,"$1,876.20",$0.00,"$1,876.20",$844.29,"$1,339.04",$0.00,$323.26,$0.00,$0.00,$328.51,"$1,876.20",$0.00,$938.10,"$1,485.95","$1,500.96",$0.00,$293.63,$0.00,$298.69,$0.00
232.008,SUP,HCPCS C1713,,232.008  -  PLATE BONE 90D 132MM 40X9.2MM 10 HOLE LIMITED CONTACT ANGLED,"$1,876.20",$0.00,"$1,876.20",$844.29,"$1,339.04",$0.00,$323.26,$0.00,$0.00,$328.51,"$1,876.20",$0.00,$938.10,"$1,485.95","$1,500.96",$0.00,$293.63,$0.00,$298.69,$0.00
232.009,SUP,HCPCS C1713,,232.009  -  PLATE BONE 90D 132MM 45X9.2MM 10 HOLE LIMITED CONTACT ANGLED,"$1,876.20",$0.00,"$1,876.20",$844.29,"$1,339.04",$0.00,$323.26,$0.00,$0.00,$328.51,"$1,876.20",$0.00,$938.10,"$1,485.95","$1,500.96",$0.00,$293.63,$0.00,$298.69,$0.00
232.046,SUP,HCPCS C1713,,232.046  -  PLATE BONE 90D 54MM 30X9.2MM 4 HOLE LIMITED CONTACT ANGLED,"$1,495.93",$0.00,"$1,495.93",$673.17,"$1,067.64",$0.00,$257.74,$0.00,$0.00,$261.92,"$1,495.93",$0.00,$747.96,"$1,184.78","$1,196.74",$0.00,$234.11,$0.00,$238.15,$0.00
232.047,SUP,HCPCS C1713,,232.047  -  PLATE BONE 90D 54MM 35X9.2MM 4 HOLE LIMITED CONTACT ANGLED,"$1,495.93",$0.00,"$1,495.93",$673.17,"$1,067.64",$0.00,$257.74,$0.00,$0.00,$261.92,"$1,495.93",$0.00,$747.96,"$1,184.78","$1,196.74",$0.00,$234.11,$0.00,$238.15,$0.00
232.048,SUP,HCPCS C1713,,232.048  -  PLATE BN 90D 40X9.2MM NS 4 HL LMT CNTCT ANG BLDE CNN SS 3.5,"$1,495.93",$0.00,"$1,495.93",$673.17,"$1,067.64",$0.00,$257.74,$0.00,$0.00,$261.92,"$1,495.93",$0.00,$747.96,"$1,184.78","$1,196.74",$0.00,$234.11,$0.00,$238.15,$0.00
232.049,SUP,HCPCS C1713,,232.049  -  PLATE BONE 90D 54MM 45X9.2MM 4 HOLE LIMITED CONTACT ANGLED,"$1,495.93",$0.00,"$1,495.93",$673.17,"$1,067.64",$0.00,$257.74,$0.00,$0.00,$261.92,"$1,495.93",$0.00,$747.96,"$1,184.78","$1,196.74",$0.00,$234.11,$0.00,$238.15,$0.00
232.056,SUP,HCPCS C1713,,232.056  -  PLATE BONE 90D 67MM 30X9.2MM 5 HOLE LIMITED CONTACT ANGLED,"$1,582.05",$0.00,"$1,582.05",$711.92,"$1,129.11",$0.00,$272.58,$0.00,$0.00,$277.00,"$1,582.05",$0.00,$791.03,"$1,252.98","$1,265.64",$0.00,$247.59,$0.00,$251.86,$0.00
232.057,SUP,HCPCS C1713,,232.057  -  PLATE BONE 90D 67MM 35X9.2MM 5 HOLE LIMITED CONTACT ANGLED,"$1,582.05",$0.00,"$1,582.05",$711.92,"$1,129.11",$0.00,$272.58,$0.00,$0.00,$277.00,"$1,582.05",$0.00,$791.03,"$1,252.98","$1,265.64",$0.00,$247.59,$0.00,$251.86,$0.00
232.058,SUP,HCPCS C1713,,232.058  -  PLATE BONE 90D 67MM 40X9.2MM 5 HOLE LIMITED CONTACT ANGLED,"$1,582.05",$0.00,"$1,582.05",$711.92,"$1,129.11",$0.00,$272.58,$0.00,$0.00,$277.00,"$1,582.05",$0.00,$791.03,"$1,252.98","$1,265.64",$0.00,$247.59,$0.00,$251.86,$0.00
232.059,SUP,HCPCS C1713,,232.059  -  PLATE BONE 90D 67MM 45X9.2MM 5 HOLE LIMITED CONTACT ANGLED,"$1,582.05",$0.00,"$1,582.05",$711.92,"$1,129.11",$0.00,$272.58,$0.00,$0.00,$277.00,"$1,582.05",$0.00,$791.03,"$1,252.98","$1,265.64",$0.00,$247.59,$0.00,$251.86,$0.00
232.066,SUP,HCPCS C1713,,232.066  -  PLATE BONE 90D 80MM 30X9.2MM 6 HOLE LIMITED CONTACT ANGLED,"$1,649.63",$0.00,"$1,649.63",$742.33,"$1,177.34",$0.00,$284.22,$0.00,$0.00,$288.84,"$1,649.63",$0.00,$824.81,"$1,306.51","$1,319.70",$0.00,$258.17,$0.00,$262.62,$0.00
232.067,SUP,HCPCS C1713,,232.067  -  PLATE BONE 90D 80MM 35X9.2MM 6 HOLE LIMITED CONTACT ANGLED,"$1,649.63",$0.00,"$1,649.63",$742.33,"$1,177.34",$0.00,$284.22,$0.00,$0.00,$288.84,"$1,649.63",$0.00,$824.81,"$1,306.51","$1,319.70",$0.00,$258.17,$0.00,$262.62,$0.00
232.068,SUP,HCPCS C1713,,232.068  -  PLATE BONE 90D 80MM 40X9.2MM 6 HOLE LIMITED CONTACT ANGLED,"$1,649.63",$0.00,"$1,649.63",$742.33,"$1,177.34",$0.00,$284.22,$0.00,$0.00,$288.84,"$1,649.63",$0.00,$824.81,"$1,306.51","$1,319.70",$0.00,$258.17,$0.00,$262.62,$0.00
232.069,SUP,HCPCS C1713,,232.069  -  PLATE BONE 90D 80MM 45X9.2MM 6 HOLE LIMITED CONTACT ANGLED,"$1,649.63",$0.00,"$1,649.63",$742.33,"$1,177.34",$0.00,$284.22,$0.00,$0.00,$288.84,"$1,649.63",$0.00,$824.81,"$1,306.51","$1,319.70",$0.00,$258.17,$0.00,$262.62,$0.00
232.086,SUP,HCPCS C1713,,232.086  -  PLATE BONE 90D 106MM 30X9.2MM 8 HOLE LIMITED CONTACT ANGLED,"$1,770.20",$0.00,"$1,770.20",$796.59,"$1,263.39",$0.00,$305.00,$0.00,$0.00,$309.95,"$1,770.20",$0.00,$885.10,"$1,402.00","$1,416.16",$0.00,$277.04,$0.00,$281.82,$0.00
232.087,SUP,HCPCS C1713,,232.087  -  PLATE BN 90D 35X9.2MM NS 8 HL LMT CNTCT ANG BLDE CNN SS 3.5,"$1,770.20",$0.00,"$1,770.20",$796.59,"$1,263.39",$0.00,$305.00,$0.00,$0.00,$309.95,"$1,770.20",$0.00,$885.10,"$1,402.00","$1,416.16",$0.00,$277.04,$0.00,$281.82,$0.00
232.088,SUP,HCPCS C1713,,232.088  -  PLATE BONE 90D 106MM 40X9.2MM 8 HOLE LIMITED CONTACT ANGLED,"$1,770.20",$0.00,"$1,770.20",$796.59,"$1,263.39",$0.00,$305.00,$0.00,$0.00,$309.95,"$1,770.20",$0.00,$885.10,"$1,402.00","$1,416.16",$0.00,$277.04,$0.00,$281.82,$0.00
232.089,SUP,HCPCS C1713,,232.089  -  PLATE BONE 90D 106MM 45X9.2MM 8 HOLE LIMITED CONTACT ANGLED,"$1,770.20",$0.00,"$1,770.20",$796.59,"$1,263.39",$0.00,$305.00,$0.00,$0.00,$309.95,"$1,770.20",$0.00,$885.10,"$1,402.00","$1,416.16",$0.00,$277.04,$0.00,$281.82,$0.00
235,SUP,Custom 27803010,,235  -  PANEL 235 128MM X 79MM X .025,"$1,623.50",$0.00,"$1,623.50",$0.00,"$1,158.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,623.50",$0.00,$811.75,"$1,285.81","$1,298.80",$0.00,$0.00,$0.00,$0.00,$0.00
235.17,SUP,HCPCS C1713,,235.170  -  PLATE BONE 80D 8MM DISPLACEMENT 35MM DCP CAPOS STAINLESS,$937.58,$0.00,$937.58,$421.91,$669.15,$0.00,$156.84,$0.00,$0.00,$164.16,$937.58,$0.00,$468.79,$742.56,$750.06,$0.00,$142.46,$0.00,$149.26,$0.00
235.19,SUP,HCPCS C1713,,235.190  -  PLATE BONE 80D 8MM DISPLACEMENT 45MM ANGLED DCP CAPOS,$937.58,$0.00,$937.58,$421.91,$669.15,$0.00,$156.84,$0.00,$0.00,$164.16,$937.58,$0.00,$468.79,$742.56,$750.06,$0.00,$142.46,$0.00,$149.26,$0.00
235.27,SUP,HCPCS C1713,,235.270  -  PLATE BN 90D 8MM DSPL 35MMX74.5MM NS DCP CAPOS 3 HL T PRFL,$937.58,$0.00,$937.58,$421.91,$669.15,$0.00,$156.84,$0.00,$0.00,$164.16,$937.58,$0.00,$468.79,$742.56,$750.06,$0.00,$142.46,$0.00,$149.26,$0.00
235.29,SUP,HCPCS C1713,,235.290  -  PLATE BN 90D 8MM DSPL 45MMX74.5MM NS DCP CAPOS 3 HL T PRFL,$937.58,$0.00,$937.58,$421.91,$669.15,$0.00,$156.84,$0.00,$0.00,$164.16,$937.58,$0.00,$468.79,$742.56,$750.06,$0.00,$142.46,$0.00,$149.26,$0.00
235.37,SUP,HCPCS C1713,,235.370  -  PLATE BONE 100D 8MM DISPLACEMENT 35MM DCP CAPOS STAINLESS,$937.58,$0.00,$937.58,$421.91,$669.15,$0.00,$156.84,$0.00,$0.00,$164.16,$937.58,$0.00,$468.79,$742.56,$750.06,$0.00,$142.46,$0.00,$149.26,$0.00
235.39,SUP,HCPCS C1713,,235.390  -  PLATE BONE 100D 45MM 8MM DCP CAPOS STAINLESS STEEL PEDIATRIC,$937.58,$0.00,$937.58,$421.91,$669.15,$0.00,$156.84,$0.00,$0.00,$164.16,$937.58,$0.00,$468.79,$742.56,$750.06,$0.00,$142.46,$0.00,$149.26,$0.00
235.6,SUP,HCPCS C1713,,235.600  -  PLATE BN 90D 10MM DSPL 50MMX78MM NS DCP CAPOS 3 HL T PRFL,$937.58,$0.00,$937.58,$421.91,$669.15,$0.00,$156.84,$0.00,$0.00,$164.16,$937.58,$0.00,$468.79,$742.56,$750.06,$0.00,$142.46,$0.00,$149.26,$0.00
235.601,SUP,HCPCS C1713,,235.601  -  PLATE BONE 100D 10MM DISPLACEMENT 50MM DCP CAPOS STAINLESS,$937.58,$0.00,$937.58,$421.91,$669.15,$0.00,$156.84,$0.00,$0.00,$164.16,$937.58,$0.00,$468.79,$742.56,$750.06,$0.00,$142.46,$0.00,$149.26,$0.00
235.68,SUP,HCPCS C1713,,235.680  -  PLATE BN 90D 10MM DSPL 40MMX78MM NS DCP CAPOS 3 HL T PRFL,$937.58,$0.00,$937.58,$421.91,$669.15,$0.00,$156.84,$0.00,$0.00,$164.16,$937.58,$0.00,$468.79,$742.56,$750.06,$0.00,$142.46,$0.00,$149.26,$0.00
235.681,SUP,HCPCS C1713,,235.681  -  PLATE BONE 100D 10MM DISPLACEMENT 40MM DCP CAPOS STAINLESS,$937.58,$0.00,$937.58,$421.91,$669.15,$0.00,$156.84,$0.00,$0.00,$164.16,$937.58,$0.00,$468.79,$742.56,$750.06,$0.00,$142.46,$0.00,$149.26,$0.00
235.7,SUP,HCPCS C1713,,235.700  -  PLATE BN 90D 15MM DSPL 50MMX78MM NS DCP CAPOS 3 HL T PRFL,$937.58,$0.00,$937.58,$421.91,$669.15,$0.00,$156.84,$0.00,$0.00,$164.16,$937.58,$0.00,$468.79,$742.56,$750.06,$0.00,$142.46,$0.00,$149.26,$0.00
235.701,SUP,HCPCS C1713,,235.701  -  PLATE BONE 100D 10MM DISPLACEMENT 50MM DCP CAPOS STAINLESS,$937.58,$0.00,$937.58,$421.91,$669.15,$0.00,$156.84,$0.00,$0.00,$164.16,$937.58,$0.00,$468.79,$742.56,$750.06,$0.00,$142.46,$0.00,$149.26,$0.00
235.72,SUP,HCPCS C1713,,235.720  -  PLATE BN 90D 15MM DSPL 60MMX78MM NS DCP CAPOS 3 HL T PRFL,$937.58,$0.00,$937.58,$421.91,$669.15,$0.00,$156.84,$0.00,$0.00,$164.16,$937.58,$0.00,$468.79,$742.56,$750.06,$0.00,$142.46,$0.00,$149.26,$0.00
235.721,SUP,HCPCS C1713,,235.721  -  PLATE BONE 100D 15MM DISPLACEMENT 60MM DCP CAPOS STAINLESS,$937.58,$0.00,$937.58,$421.91,$669.15,$0.00,$156.84,$0.00,$0.00,$164.16,$937.58,$0.00,$468.79,$742.56,$750.06,$0.00,$142.46,$0.00,$149.26,$0.00
235.78,SUP,HCPCS C1713,,235.780  -  PLATE BN 90D 15MM DSPL 40MMX78MM NS DCP CAPOS 3 HL T PRFL,$937.58,$0.00,$937.58,$421.91,$669.15,$0.00,$156.84,$0.00,$0.00,$164.16,$937.58,$0.00,$468.79,$742.56,$750.06,$0.00,$142.46,$0.00,$149.26,$0.00
235.781,SUP,HCPCS C1713,,235.781  -  PLATE BONE 100D 10MM DISPLACEMENT 40MM DCP CAPOS STAINLESS,$937.58,$0.00,$937.58,$421.91,$669.15,$0.00,$156.84,$0.00,$0.00,$164.16,$937.58,$0.00,$468.79,$742.56,$750.06,$0.00,$142.46,$0.00,$149.26,$0.00
236.001,SUP,HCPCS C1713,,236.001  -  PLATE BONE 90D 4MM DISPLACEMENT 26MM ANGLED DCP CAPOS,$937.58,$0.00,$937.58,$421.91,$669.15,$0.00,$156.84,$0.00,$0.00,$164.16,$937.58,$0.00,$468.79,$742.56,$750.06,$0.00,$142.46,$0.00,$149.26,$0.00
236.002,SUP,HCPCS C1713,,236.002  -  PLATE BN 90D 4MM DSPL 32MMX67MM NS 9.5X3.2MM DCP CAPOS 3 HL,$937.58,$0.00,$937.58,$421.91,$669.15,$0.00,$156.84,$0.00,$0.00,$164.16,$937.58,$0.00,$468.79,$742.56,$750.06,$0.00,$142.46,$0.00,$149.26,$0.00
236.003,SUP,HCPCS C1713,,236.003  -  PLATE BONE 90D 4MM DISPLACEMENT 38MM DCP CAPOS STAINLESS,$937.58,$0.00,$937.58,$421.91,$669.15,$0.00,$156.84,$0.00,$0.00,$164.16,$937.58,$0.00,$468.79,$742.56,$750.06,$0.00,$142.46,$0.00,$149.26,$0.00
236.011,SUP,HCPCS C1713,,236.011  -  PLATE BONE 90D 8MM DISPLACEMENT ANGLED 26MM DCP CAPOS,$937.58,$0.00,$937.58,$421.91,$669.15,$0.00,$156.84,$0.00,$0.00,$164.16,$937.58,$0.00,$468.79,$742.56,$750.06,$0.00,$142.46,$0.00,$149.26,$0.00
236.012,SUP,HCPCS C1713,,236.012  -  PLATE BN 90D 8MM DSPL 32MMX67MM NS 9.5X3.2MM DCP CAPOS 3 HL,$937.58,$0.00,$937.58,$421.91,$669.15,$0.00,$156.84,$0.00,$0.00,$164.16,$937.58,$0.00,$468.79,$742.56,$750.06,$0.00,$142.46,$0.00,$149.26,$0.00
236.013,SUP,HCPCS C1713,,236.013  -  PLATE BN 90D 8MM DSPL 38MMX67MM NS 9.5X3.2MM DCP CAPOS 3 HL,$937.58,$0.00,$937.58,$421.91,$669.15,$0.00,$156.84,$0.00,$0.00,$164.16,$937.58,$0.00,$468.79,$742.56,$750.06,$0.00,$142.46,$0.00,$149.26,$0.00
236.101,SUP,HCPCS C1713,,236.101  -  PLATE BONE 100D 4MM DISPLACEMENT 26MM ANGLED DCP CAPOS,$937.58,$0.00,$937.58,$421.91,$669.15,$0.00,$156.84,$0.00,$0.00,$164.16,$937.58,$0.00,$468.79,$742.56,$750.06,$0.00,$142.46,$0.00,$149.26,$0.00
236.102,SUP,HCPCS C1713,,236.102  -  PLATE BN 100D 4MM DSPL 32MMX67MM NS 9.5X3.2MM DCP CAPOS 3 HL,$937.58,$0.00,$937.58,$421.91,$669.15,$0.00,$156.84,$0.00,$0.00,$164.16,$937.58,$0.00,$468.79,$742.56,$750.06,$0.00,$142.46,$0.00,$149.26,$0.00
236.103,SUP,HCPCS C1713,,236.103  -  PLATE BN 100D 4MM DSPL 38MMX67MM NS 9.5X3.2MM DCP CAPOS 3 HL,$937.58,$0.00,$937.58,$421.91,$669.15,$0.00,$156.84,$0.00,$0.00,$164.16,$937.58,$0.00,$468.79,$742.56,$750.06,$0.00,$142.46,$0.00,$149.26,$0.00
236.104,SUP,HCPCS C1713,,236.104  -  PLATE BN 100D 4MM DSPL 44MMX67MM NS 9.5X3.2MM DCP CAPOS 3 HL,$937.58,$0.00,$937.58,$421.91,$669.15,$0.00,$156.84,$0.00,$0.00,$164.16,$937.58,$0.00,$468.79,$742.56,$750.06,$0.00,$142.46,$0.00,$149.26,$0.00
236.111,SUP,HCPCS C1713,,236.111  -  PLATE BONE 100D 8MM DISPLACEMENT 26MM CANN ANGLED BLADE DCP,$937.58,$0.00,$937.58,$421.91,$669.15,$0.00,$156.84,$0.00,$0.00,$164.16,$937.58,$0.00,$468.79,$742.56,$750.06,$0.00,$142.46,$0.00,$149.26,$0.00
236.112,SUP,HCPCS C1713,,236.112  -  PLATE BN 100D 8MM DSPL 32MMX67MM NS 9.5X3.2MM DCP CAPOS 3 HL,$937.58,$0.00,$937.58,$421.91,$669.15,$0.00,$156.84,$0.00,$0.00,$164.16,$937.58,$0.00,$468.79,$742.56,$750.06,$0.00,$142.46,$0.00,$149.26,$0.00
236.113,SUP,HCPCS C1713,,236.113  -  PLATE BN 100D 8MM DSPL 38MMX67MM NS 9.5X3.2MM DCP CAPOS 3 HL,$937.58,$0.00,$937.58,$421.91,$669.15,$0.00,$156.84,$0.00,$0.00,$164.16,$937.58,$0.00,$468.79,$742.56,$750.06,$0.00,$142.46,$0.00,$149.26,$0.00
236.114,SUP,HCPCS C1713,,236.114  -  PLATE BN 100D 8MM DSPL 44MMX67MM NS 9.5X3.2MM DCP CAPOS 3 HL,$937.58,$0.00,$937.58,$421.91,$669.15,$0.00,$156.84,$0.00,$0.00,$164.16,$937.58,$0.00,$468.79,$742.56,$750.06,$0.00,$142.46,$0.00,$149.26,$0.00
236.25,SUP,HCPCS C1713,,236.250  -  PLATE BN 90D 7MM DSPL 25MMX46MM NS 8X2MM DCP CAPOS 3 HL T,$805.20,$0.00,$805.20,$362.34,$574.67,$0.00,$134.69,$0.00,$0.00,$140.98,$805.20,$0.00,$402.60,$637.72,$644.16,$0.00,$122.34,$0.00,$128.19,$0.00
236.26,SUP,HCPCS C1713,,236.260  -  PLATE BN 90D 7MM DSPL 32MMX46MM NS 8X2MM DCP CAPOS 3 HL T,$805.20,$0.00,$805.20,$362.34,$574.67,$0.00,$134.69,$0.00,$0.00,$140.98,$805.20,$0.00,$402.60,$637.72,$644.16,$0.00,$122.34,$0.00,$128.19,$0.00
236.35,SUP,HCPCS C1713,,236.350  -  PLATE BN 90D 12MM DSPL 25MMX46MM NS 8X2MM DCP CAPOS SS INF,$805.20,$0.00,$805.20,$362.34,$574.67,$0.00,$134.69,$0.00,$0.00,$140.98,$805.20,$0.00,$402.60,$637.72,$644.16,$0.00,$122.34,$0.00,$128.19,$0.00
236.36,SUP,HCPCS C1713,,236.360  -  PLATE BN 90D 12MM DSPL 32MMX46MM NS 8X2MM DCP CAPOS 3 HL T,$805.20,$0.00,$805.20,$362.34,$574.67,$0.00,$134.69,$0.00,$0.00,$140.98,$805.20,$0.00,$402.60,$637.72,$644.16,$0.00,$122.34,$0.00,$128.19,$0.00
236.4,SUP,HCPCS C1713,,236.400  -  PLATE BN 115D 5MM DSPL 2 BRCH 30MM NS DCP CAPOS 2 HL SS,$537.70,$0.00,$537.70,$241.97,$383.76,$0.00,$89.95,$0.00,$0.00,$94.15,$537.70,$0.00,$268.85,$425.86,$430.16,$0.00,$81.70,$0.00,$85.60,$0.00
236.43,SUP,HCPCS C1713,,236.430  -  PLATE BN 115D 5MM DSPL 2 BRCH 35MM NS DCP CAPOS 2 HL SS,$537.70,$0.00,$537.70,$241.97,$383.76,$0.00,$89.95,$0.00,$0.00,$94.15,$537.70,$0.00,$268.85,$425.86,$430.16,$0.00,$81.70,$0.00,$85.60,$0.00
236.502,SUP,HCPCS C1713,,236.502  -  PLATE BONE 86MM 2 HOLE LCP STAINLESS STEEL RIGHT OLECRANON,"$1,596.75",$0.00,"$1,596.75",$718.54,"$1,139.60",$0.00,$267.10,$0.00,$0.00,$279.58,"$1,596.75",$0.00,$798.38,"$1,264.63","$1,277.40",$0.00,$242.61,$0.00,$254.20,$0.00
236.503,SUP,HCPCS C1713,,236.503  -  PLATE BONE 86MM 2 HOLE PRECONTOUR LCP STAINLESS STEEL LEFT,"$1,596.75",$0.00,"$1,596.75",$718.54,"$1,139.60",$0.00,$267.10,$0.00,$0.00,$279.58,"$1,596.75",$0.00,$798.38,"$1,264.63","$1,277.40",$0.00,$242.61,$0.00,$254.20,$0.00
236.504,SUP,HCPCS C1713,,236.504  -  PLATE BONE 112MM 4 HOLE PRECONTOUR LCP STAINLESS STEEL RIGHT,"$1,666.35",$0.00,"$1,666.35",$749.86,"$1,189.27",$0.00,$278.74,$0.00,$0.00,$291.76,"$1,666.35",$0.00,$833.18,"$1,319.75","$1,333.08",$0.00,$253.19,$0.00,$265.28,$0.00
236.505,SUP,HCPCS C1713,,236.505  -  PLATE BONE 112MM 4 HOLE LCP STAINLESS STEEL LEFT OLECRANON,"$1,666.35",$0.00,"$1,666.35",$749.86,"$1,189.27",$0.00,$278.74,$0.00,$0.00,$291.76,"$1,666.35",$0.00,$833.18,"$1,319.75","$1,333.08",$0.00,$253.19,$0.00,$265.28,$0.00
236.506,SUP,HCPCS C1713,,236.506  -  PLATE BONE 3.5MM 138MM 6 HOLE LCP STAINLESS STEEL RIGHT,"$1,719.58",$0.00,"$1,719.58",$773.81,"$1,227.26",$0.00,$383.26,$0.00,$0.00,$301.08,"$1,719.58",$0.00,$859.79,"$1,361.91","$1,375.66",$0.00,$348.13,$0.00,$273.76,$0.00
236.507,SUP,HCPCS C1713,,236.507  -  PLATE BONE 138MM 6 HOLE PRECONTOUR LCP STAINLESS STEEL LEFT,"$1,719.58",$0.00,"$1,719.58",$773.81,"$1,227.26",$0.00,$287.65,$0.00,$0.00,$301.08,"$1,719.58",$0.00,$859.79,"$1,361.91","$1,375.66",$0.00,$261.28,$0.00,$273.76,$0.00
236.508,SUP,HCPCS C1713,,236.508  -  PLATE BONE 164MM 8 HOLE LCP STAINLESS STEEL RIGHT OLECRANON,"$1,772.80",$0.00,"$1,772.80",$797.76,"$1,265.25",$0.00,$296.55,$0.00,$0.00,$310.40,"$1,772.80",$0.00,$886.40,"$1,404.06","$1,418.24",$0.00,$269.36,$0.00,$282.23,$0.00
236.509,SUP,HCPCS C1713,,236.509  -  PLATE BONE 164MM 8 HOLE LCP STAINLESS STEEL LEFT OLECRANON,"$1,772.80",$0.00,"$1,772.80",$797.76,"$1,265.25",$0.00,$296.55,$0.00,$0.00,$310.40,"$1,772.80",$0.00,$886.40,"$1,404.06","$1,418.24",$0.00,$269.36,$0.00,$282.23,$0.00
236.51,SUP,HCPCS C1713,,236.510  -  PLATE BONE 190MM 10 HOLE LCP STAINLESS STEEL RIGHT OLECRANON,"$1,821.95",$0.00,"$1,821.95",$819.88,"$1,300.33",$0.00,$304.77,$0.00,$0.00,$319.01,"$1,821.95",$0.00,$910.98,"$1,442.98","$1,457.56",$0.00,$276.83,$0.00,$290.05,$0.00
236.511,SUP,HCPCS C1713,,236.511  -  PLATE BONE 190MM 10 HOLE LCP STAINLESS STEEL LEFT OLECRANON,"$1,821.95",$0.00,"$1,821.95",$819.88,"$1,300.33",$0.00,$304.77,$0.00,$0.00,$319.01,"$1,821.95",$0.00,$910.98,"$1,442.98","$1,457.56",$0.00,$276.83,$0.00,$290.05,$0.00
236.512,SUP,HCPCS C1713,,236.512  -  PLATE BONE 216MM 12 HOLE LCP STAINLESS STEEL RIGHT OLECRANON,"$1,854.70",$0.00,"$1,854.70",$834.62,"$1,323.70",$0.00,$310.25,$0.00,$0.00,$324.74,"$1,854.70",$0.00,$927.35,"$1,468.92","$1,483.76",$0.00,$281.81,$0.00,$295.27,$0.00
236.513,SUP,HCPCS C1713,,236.513  -  PLATE BONE 215MM 12 HOLE LCP STAINLESS STEEL LEFT OLECRANON,"$1,854.70",$0.00,"$1,854.70",$834.62,"$1,323.70",$0.00,$310.25,$0.00,$0.00,$324.74,"$1,854.70",$0.00,$927.35,"$1,468.92","$1,483.76",$0.00,$281.81,$0.00,$295.27,$0.00
237.2,SUP,HCPCS C1713,,237.20  -  PLATE BONE 95D 50MM 12 HOLE ANGLED BLADE DCP STAINLESS STEEL,"$1,177.78",$0.00,"$1,177.78",$530.00,$840.58,$0.00,$197.02,$0.00,$0.00,$206.22,"$1,177.78",$0.00,$588.89,$932.80,$942.22,$0.00,$178.95,$0.00,$187.50,$0.00
237.22,SUP,HCPCS C1713,,237.22  -  PLATE BN 95D 60MM NS 204MM DCP 12 HL SS HIP CNDRL,"$1,177.78",$0.00,"$1,177.78",$530.00,$840.58,$0.00,$197.02,$0.00,$0.00,$206.22,"$1,177.78",$0.00,$588.89,$932.80,$942.22,$0.00,$178.95,$0.00,$187.50,$0.00
237.24,SUP,HCPCS C1713,,237.24  -  PLATE BN 95D 70MM NS 240MM DCP 12 HL SS HIP CNDRL,"$1,177.78",$0.00,"$1,177.78",$530.00,$840.58,$0.00,$197.02,$0.00,$0.00,$206.22,"$1,177.78",$0.00,$588.89,$932.80,$942.22,$0.00,$178.95,$0.00,$187.50,$0.00
237.26,SUP,HCPCS C1713,,237.26  -  PLATE BN 95D 70MM NS 204MM DCP 12 HL SS HIP CNDRL,"$1,177.78",$0.00,"$1,177.78",$530.00,$840.58,$0.00,$197.02,$0.00,$0.00,$206.22,"$1,177.78",$0.00,$588.89,$932.80,$942.22,$0.00,$178.95,$0.00,$187.50,$0.00
237.261,SUP,HCPCS C1713,,237.261  -  PLATE 95D SS 26 HOLE ANG DCP BONE 60MM CNDYLR NONSTRL,"$2,689.95",$0.00,"$2,689.95","$1,210.48","$1,919.82",$0.00,$463.46,$0.00,$0.00,$470.99,"$2,689.95",$0.00,"$1,344.98","$2,130.44","$2,151.96",$0.00,$420.98,$0.00,$428.24,$0.00
237.262,SUP,HCPCS C1713,,237.262  -  PLATE 95D SS 26 HOLE ANG DCP BONE 70MM CNDYLR NONSTRL,"$2,535.53",$0.00,"$2,535.53","$1,140.99","$1,809.60",$0.00,$436.86,$0.00,$0.00,$443.95,"$2,535.53",$0.00,"$1,267.76","$2,008.14","$2,028.42",$0.00,$396.81,$0.00,$403.66,$0.00
237.4,SUP,HCPCS C1713,,237.40  -  PLATE BONE 95D 50MM 235MM 14 HOLE DCP STAINLESS STEEL,"$1,764.63",$0.00,"$1,764.63",$794.08,"$1,259.41",$0.00,$295.18,$0.00,$0.00,$308.97,"$1,764.63",$0.00,$882.31,"$1,397.59","$1,411.70",$0.00,$268.12,$0.00,$280.93,$0.00
237.42,SUP,HCPCS C1713,,237.42  -  PLATE BONE 95D 60MM 235MM 14 HOLE DCP STAINLESS STEEL,"$1,764.63",$0.00,"$1,764.63",$794.08,"$1,259.41",$0.00,$295.18,$0.00,$0.00,$308.97,"$1,764.63",$0.00,$882.31,"$1,397.59","$1,411.70",$0.00,$268.12,$0.00,$280.93,$0.00
237.44,SUP,HCPCS C1713,,237.44  -  PLATE BN 95D 70MM NS 235MM DCP 14 HL SS HIP CNDRL,"$1,764.63",$0.00,"$1,764.63",$794.08,"$1,259.41",$0.00,$295.18,$0.00,$0.00,$308.97,"$1,764.63",$0.00,$882.31,"$1,397.59","$1,411.70",$0.00,$268.12,$0.00,$280.93,$0.00
237.46,SUP,HCPCS C1713,,237.46  -  PLATE BONE 95D 80MM 235MM 14 HOLE DCP STAINLESS STEEL,"$1,764.63",$0.00,"$1,764.63",$794.08,"$1,259.41",$0.00,$295.18,$0.00,$0.00,$308.97,"$1,764.63",$0.00,$882.31,"$1,397.59","$1,411.70",$0.00,$268.12,$0.00,$280.93,$0.00
237.5,SUP,HCPCS C1713,,237.50  -  PLATE BN 95D 50MM NS 92MM DCP 5 HL SS HIP CNDRL,$978.53,$0.00,$978.53,$440.34,$698.37,$0.00,$163.68,$0.00,$0.00,$171.33,$978.53,$0.00,$489.26,$775.00,$782.82,$0.00,$148.68,$0.00,$155.78,$0.00
237.52,SUP,HCPCS C1713,,237.52  -  PLATE BONE 95D 60MM 92MM 5 HOLE DCP STAINLESS STEEL CONDYLE,$978.53,$0.00,$978.53,$440.34,$698.37,$0.00,$163.68,$0.00,$0.00,$171.33,$978.53,$0.00,$489.26,$775.00,$782.82,$0.00,$148.68,$0.00,$155.78,$0.00
237.54,SUP,HCPCS C1713,,237.54  -  PLATE BN 95D 70MM NS 92MM DCP 5 HL SS HIP CNDRL,$978.53,$0.00,$978.53,$440.34,$698.37,$0.00,$163.68,$0.00,$0.00,$171.33,$978.53,$0.00,$489.26,$775.00,$782.82,$0.00,$148.68,$0.00,$155.78,$0.00
237.56,SUP,HCPCS C1713,,237.56  -  PLATE BONE 95D 80MM 92MM 5 HOLE DCP STAINLESS STEEL CONDYLE,$978.53,$0.00,$978.53,$440.34,$698.37,$0.00,$163.68,$0.00,$0.00,$171.33,$978.53,$0.00,$489.26,$775.00,$782.82,$0.00,$148.68,$0.00,$155.78,$0.00
237.62,SUP,HCPCS C1713,,237.62  -  PLATE BONE 95D 60MM 267MM 16 HOLE DCP STAINLESS STEEL,"$1,865.63",$0.00,"$1,865.63",$839.53,"$1,331.50",$0.00,$312.07,$0.00,$0.00,$326.66,"$1,865.63",$0.00,$932.81,"$1,477.58","$1,492.50",$0.00,$283.46,$0.00,$297.01,$0.00
237.64,SUP,HCPCS C1713,,237.64  -  PLATE BN 95D 70MM NS 267MM DCP 16 HL SS HIP CNDRL,"$1,865.63",$0.00,"$1,865.63",$839.53,"$1,331.50",$0.00,$312.07,$0.00,$0.00,$326.66,"$1,865.63",$0.00,$932.81,"$1,477.58","$1,492.50",$0.00,$283.46,$0.00,$297.01,$0.00
237.66,SUP,HCPCS C1713,,237.66  -  PLATE BN 95D 80MM NS 267MM DCP 16 HL SS HIP CNDRL,"$1,865.63",$0.00,"$1,865.63",$839.53,"$1,331.50",$0.00,$312.07,$0.00,$0.00,$326.66,"$1,865.63",$0.00,$932.81,"$1,477.58","$1,492.50",$0.00,$283.46,$0.00,$297.01,$0.00
237.7,SUP,HCPCS C1713,,237.70  -  PLATE BONE 95D 124MM 50MM 7 HOLE BLADE DCP STAINLESS STEEL,"$1,031.75",$0.00,"$1,031.75",$464.29,$736.36,$0.00,$172.59,$0.00,$0.00,$180.65,"$1,031.75",$0.00,$515.88,$817.15,$825.40,$0.00,$156.77,$0.00,$164.25,$0.00
237.72,SUP,HCPCS C1713,,237.72  -  PLATE BN 95D 60MM NS 124MM DCP 7 HL SS HIP CNDRL,"$1,031.75",$0.00,"$1,031.75",$464.29,$736.36,$0.00,$172.59,$0.00,$0.00,$180.65,"$1,031.75",$0.00,$515.88,$817.15,$825.40,$0.00,$156.77,$0.00,$164.25,$0.00
237.74,SUP,HCPCS C1713,,237.74  -  PLATE BN 95D 70MM NS 124MM DCP 7 HL SS HIP CNDRL,"$1,031.75",$0.00,"$1,031.75",$464.29,$736.36,$0.00,$172.59,$0.00,$0.00,$180.65,"$1,031.75",$0.00,$515.88,$817.15,$825.40,$0.00,$156.77,$0.00,$164.25,$0.00
237.76,SUP,HCPCS C1713,,237.76  -  PLATE BN 95D 80MM NS 124MM DCP 7 HL SS HIP CNDRL,"$1,031.75",$0.00,"$1,031.75",$464.29,$736.36,$0.00,$172.59,$0.00,$0.00,$180.65,"$1,031.75",$0.00,$515.88,$817.15,$825.40,$0.00,$156.77,$0.00,$164.25,$0.00
237.82,SUP,HCPCS C1713,,237.82  -  PLATE BONE 95D 299MM 60MM 18 HOLE DCP STAINLESS STEEL,"$2,064.88",$0.00,"$2,064.88",$929.19,"$1,473.70",$0.00,$345.40,$0.00,$0.00,$361.54,"$2,064.88",$0.00,"$1,032.44","$1,635.38","$1,651.90",$0.00,$313.74,$0.00,$328.73,$0.00
237.84,SUP,HCPCS C1713,,237.84  -  PLATE BN 95D 80MM NS 299MM DCP 18 HL SS HIP CNDRL,"$2,064.88",$0.00,"$2,064.88",$929.19,"$1,473.70",$0.00,$345.40,$0.00,$0.00,$361.54,"$2,064.88",$0.00,"$1,032.44","$1,635.38","$1,651.90",$0.00,$313.74,$0.00,$328.73,$0.00
237.86,SUP,HCPCS C1713,,237.86  -  PLATE BN 95D 80MM NS 299MM DCP 18 HL SS HIP CNDRL,"$2,064.88",$0.00,"$2,064.88",$929.19,"$1,473.70",$0.00,$345.40,$0.00,$0.00,$361.54,"$2,064.88",$0.00,"$1,032.44","$1,635.38","$1,651.90",$0.00,$313.74,$0.00,$328.73,$0.00
237.9,SUP,HCPCS C1713,,237.90  -  PLATE BN 95D 50MM NS 156MM DCP 9 HL SS HIP CNDRL,"$1,080.88",$0.00,"$1,080.88",$486.39,$771.42,$0.00,$180.81,$0.00,$0.00,$189.25,"$1,080.88",$0.00,$540.44,$856.06,$864.70,$0.00,$164.23,$0.00,$172.08,$0.00
237.92,SUP,HCPCS C1713,,237.92  -  PLATE BN 95D 60MM NS 156MM DCP 9 HL SS HIP CNDRL,"$1,080.88",$0.00,"$1,080.88",$486.39,$771.42,$0.00,$180.81,$0.00,$0.00,$189.25,"$1,080.88",$0.00,$540.44,$856.06,$864.70,$0.00,$164.23,$0.00,$172.08,$0.00
237.94,SUP,HCPCS C1713,,237.94  -  PLATE BN 95D 70MM NS 156MM DCP 9 HL SS HIP CNDRL,"$1,080.88",$0.00,"$1,080.88",$486.39,$771.42,$0.00,$180.81,$0.00,$0.00,$189.25,"$1,080.88",$0.00,$540.44,$856.06,$864.70,$0.00,$164.23,$0.00,$172.08,$0.00
237.96,SUP,HCPCS C1713,,237.96  -  PLATE BN 95D 80MM NS 156MM DCP 9 HL SS HIP CNDRL,"$1,080.88",$0.00,"$1,080.88",$486.39,$771.42,$0.00,$180.81,$0.00,$0.00,$189.25,"$1,080.88",$0.00,$540.44,$856.06,$864.70,$0.00,$164.23,$0.00,$172.08,$0.00
237.995,SUP,HCPCS C1713,,237.995  -  PLATE BONE 90D 35MM 5 HOLE ANGLED DCP STAINLESS STEEL,"$1,393.90",$0.00,"$1,393.90",$627.26,$994.83,$0.00,$240.16,$0.00,$0.00,$244.06,"$1,393.90",$0.00,$696.95,"$1,103.97","$1,115.12",$0.00,$218.15,$0.00,$221.91,$0.00
237.997,SUP,HCPCS C1713,,237.997  -  PLATE BONE 90D 35MM 7 HOLE ANGLED DCP STAINLESS STEEL,"$1,393.90",$0.00,"$1,393.90",$627.26,$994.83,$0.00,$240.16,$0.00,$0.00,$244.06,"$1,393.90",$0.00,$696.95,"$1,103.97","$1,115.12",$0.00,$218.15,$0.00,$221.91,$0.00
238.24,SUP,HCPCS C1713,,238.24  -  PLATE BONE 130D 70MM 12 HOLE ANGLED DCP STAINLESS STEEL,"$1,158.68",$0.00,"$1,158.68",$521.40,$826.95,$0.00,$193.82,$0.00,$0.00,$202.87,"$1,158.68",$0.00,$579.34,$917.67,$926.94,$0.00,$176.05,$0.00,$184.46,$0.00
238.26,SUP,HCPCS C1713,,238.26  -  PLATE BONE 130D 80MM 12 HOLE ANGLED DCP STAINLESS STEEL,"$1,158.68",$0.00,"$1,158.68",$521.40,$826.95,$0.00,$193.82,$0.00,$0.00,$202.87,"$1,158.68",$0.00,$579.34,$917.67,$926.94,$0.00,$176.05,$0.00,$184.46,$0.00
238.28,SUP,HCPCS C1713,,238.28  -  PLATE BONE 130D 90MM 12 HOLE ANGLED DCP STAINLESS STEEL,"$1,158.68",$0.00,"$1,158.68",$521.40,$826.95,$0.00,$193.82,$0.00,$0.00,$202.87,"$1,158.68",$0.00,$579.34,$917.67,$926.94,$0.00,$176.05,$0.00,$184.46,$0.00
238.36,SUP,HCPCS C1713,,238.36  -  PLATE BONE 130D 50MM 4 HOLE ANGLED DCP STAINLESS STEEL,$850.25,$0.00,$850.25,$382.61,$606.82,$0.00,$142.23,$0.00,$0.00,$148.87,$850.25,$0.00,$425.13,$673.40,$680.20,$0.00,$129.19,$0.00,$135.36,$0.00
238.38,SUP,HCPCS C1713,,238.38  -  PLATE BONE 130D 60MM 4 HOLE ANGLED BLADE DCP STAINLESS STEEL,$850.25,$0.00,$850.25,$382.61,$606.82,$0.00,$142.23,$0.00,$0.00,$148.87,$850.25,$0.00,$425.13,$673.40,$680.20,$0.00,$129.19,$0.00,$135.36,$0.00
238.4,SUP,HCPCS C1713,,238.40  -  PLATE BONE 130D 100MM 60MM 4 HOLE DCP STAINLESS STEEL SMALL,$850.25,$0.00,$850.25,$382.61,$606.82,$0.00,$142.23,$0.00,$0.00,$148.87,$850.25,$0.00,$425.13,$673.40,$680.20,$0.00,$129.19,$0.00,$135.36,$0.00
238.41,SUP,HCPCS C1713,,238.41  -  PLATE BONE 130D 105MM 4 HOLE ANGLED DCP STAINLESS STEEL,$850.25,$0.00,$850.25,$382.61,$606.82,$0.00,$142.23,$0.00,$0.00,$148.87,$850.25,$0.00,$425.13,$673.40,$680.20,$0.00,$129.19,$0.00,$135.36,$0.00
238.42,SUP,HCPCS C1713,,238.42  -  PLATE BONE 130D 110MM 4 HOLE ANGLED DCP STAINLESS STEEL,$850.25,$0.00,$850.25,$382.61,$606.82,$0.00,$142.23,$0.00,$0.00,$148.87,$850.25,$0.00,$425.13,$673.40,$680.20,$0.00,$129.19,$0.00,$135.36,$0.00
238.44,SUP,HCPCS C1713,,238.44  -  PLATE BONE 130D 70MM 4 HOLE ANGLED DCP STAINLESS STEEL,$850.25,$0.00,$850.25,$382.61,$606.82,$0.00,$142.23,$0.00,$0.00,$148.87,$850.25,$0.00,$425.13,$673.40,$680.20,$0.00,$129.19,$0.00,$135.36,$0.00
238.45,SUP,HCPCS C1713,,238.45  -  PLATE BONE 130D 75MM 4 HOLE ANGLED DCP STAINLESS STEEL,$850.25,$0.00,$850.25,$382.61,$606.82,$0.00,$142.23,$0.00,$0.00,$148.87,$850.25,$0.00,$425.13,$673.40,$680.20,$0.00,$129.19,$0.00,$135.36,$0.00
238.46,SUP,HCPCS C1713,,238.46  -  PLATE BONE 130D 80MM 4 HOLE ANGLED DCP STAINLESS STEEL,$850.25,$0.00,$850.25,$382.61,$606.82,$0.00,$142.23,$0.00,$0.00,$148.87,$850.25,$0.00,$425.13,$673.40,$680.20,$0.00,$129.19,$0.00,$135.36,$0.00
238.47,SUP,HCPCS C1713,,238.47  -  PLATE BONE 130D 85MM 4 HOLE ANGLED DCP STAINLESS STEEL,$850.25,$0.00,$850.25,$382.61,$606.82,$0.00,$142.23,$0.00,$0.00,$148.87,$850.25,$0.00,$425.13,$673.40,$680.20,$0.00,$129.19,$0.00,$135.36,$0.00
238.48,SUP,HCPCS C1713,,238.48  -  PLATE BONE 130D 90MM 4 HOLE ANGLED DCP STAINLESS STEEL,$850.25,$0.00,$850.25,$382.61,$606.82,$0.00,$142.23,$0.00,$0.00,$148.87,$850.25,$0.00,$425.13,$673.40,$680.20,$0.00,$129.19,$0.00,$135.36,$0.00
238.49,SUP,HCPCS C1713,,238.49  -  PLATE BONE 130D 95MM 4 HOLE ANGLED DCP STAINLESS STEEL,$850.25,$0.00,$850.25,$382.61,$606.82,$0.00,$142.23,$0.00,$0.00,$148.87,$850.25,$0.00,$425.13,$673.40,$680.20,$0.00,$129.19,$0.00,$135.36,$0.00
238.6,SUP,HCPCS C1713,,238.60  -  PLATE BONE 130D 104MM 50MM 6 HOLE DCP STAINLESS STEEL SMALL,$913.03,$0.00,$913.03,$410.86,$651.63,$0.00,$152.73,$0.00,$0.00,$159.86,$913.03,$0.00,$456.51,$723.12,$730.42,$0.00,$138.73,$0.00,$145.35,$0.00
238.62,SUP,HCPCS C1713,,238.62  -  PLATE BONE 130D 104MM 60MM 6 HOLE DCP STAINLESS STEEL,$913.03,$0.00,$913.03,$410.86,$651.63,$0.00,$152.73,$0.00,$0.00,$159.86,$913.03,$0.00,$456.51,$723.12,$730.42,$0.00,$138.73,$0.00,$145.35,$0.00
238.64,SUP,HCPCS C1713,,238.64  -  PLATE BN 130D 70MM NS 104MM DCP 6 HL SS HIP CNDRL,$913.03,$0.00,$913.03,$410.86,$651.63,$0.00,$152.73,$0.00,$0.00,$159.86,$913.03,$0.00,$456.51,$723.12,$730.42,$0.00,$138.73,$0.00,$145.35,$0.00
238.66,SUP,HCPCS C1713,,238.66  -  PLATE BONE 130D 104MM 80MM 6 HOLE DCP STAINLESS STEEL,$913.03,$0.00,$913.03,$410.86,$651.63,$0.00,$152.73,$0.00,$0.00,$159.86,$913.03,$0.00,$456.51,$723.12,$730.42,$0.00,$138.73,$0.00,$145.35,$0.00
238.68,SUP,HCPCS C1713,,238.68  -  PLATE BN 130D 90MM NS 104MM DCP 6 HL SS HIP CNDRL,$913.03,$0.00,$913.03,$410.86,$651.63,$0.00,$152.73,$0.00,$0.00,$159.86,$913.03,$0.00,$456.51,$723.12,$730.42,$0.00,$138.73,$0.00,$145.35,$0.00
238.7,SUP,HCPCS C1713,,238.700  -  PLATE BONE 116MM 13.5X3.7MM 4 HOLE LCP STAINLESS STEEL RIGHT,"$2,606.68",$0.00,"$2,606.68","$1,173.00","$1,860.38",$0.00,$436.04,$0.00,$0.00,$456.41,"$2,606.68",$0.00,"$1,303.34","$2,064.49","$2,085.34",$0.00,$396.06,$0.00,$414.98,$0.00
238.701,SUP,HCPCS C1713,,238.701  -  PLATE BONE 116MM 13.5X3.7MM 4 HOLE LCP STAINLESS STEEL LEFT,"$2,606.68",$0.00,"$2,606.68","$1,173.00","$1,860.38",$0.00,$436.04,$0.00,$0.00,$456.41,"$2,606.68",$0.00,"$1,303.34","$2,064.49","$2,085.34",$0.00,$396.06,$0.00,$414.98,$0.00
238.702,SUP,HCPCS C1713,,238.702  -  PLATE BONE 142MM 6 HOLE LCP STAINLESS STEEL RIGHT DISTAL,"$2,636.70",$0.00,"$2,636.70","$1,186.52","$1,881.81",$0.00,$441.06,$0.00,$0.00,$461.67,"$2,636.70",$0.00,"$1,318.35","$2,088.27","$2,109.36",$0.00,$400.62,$0.00,$419.76,$0.00
238.703,SUP,HCPCS C1713,,238.703  -  PLATE BONE 142MM 13.5X3.7MM 6 HOLE LCP STAINLESS STEEL LEFT,"$2,636.70",$0.00,"$2,636.70","$1,186.52","$1,881.81",$0.00,$441.06,$0.00,$0.00,$461.67,"$2,636.70",$0.00,"$1,318.35","$2,088.27","$2,109.36",$0.00,$400.62,$0.00,$419.76,$0.00
238.704,SUP,HCPCS C1713,,238.704  -  PLATE BONE 168MM 13.5X3.7MM 8 HOLE LCP STAINLESS STEEL RIGHT,"$2,662.63",$0.00,"$2,662.63","$1,198.18","$1,900.32",$0.00,$445.40,$0.00,$0.00,$466.20,"$2,662.63",$0.00,"$1,331.31","$2,108.80","$2,130.10",$0.00,$404.56,$0.00,$423.89,$0.00
238.705,SUP,HCPCS C1713,,238.705  -  PLATE BONE 168MM 13.5X3.7MM 8 HOLE LCP STAINLESS STEEL LEFT,"$2,662.63",$0.00,"$2,662.63","$1,198.18","$1,900.32",$0.00,$445.40,$0.00,$0.00,$466.20,"$2,662.63",$0.00,"$1,331.31","$2,108.80","$2,130.10",$0.00,$404.56,$0.00,$423.89,$0.00
238.706,SUP,HCPCS C1713,,238.706  -  PLATE BONE 194MM 13.5X3.7MM 10 HOLE LCP STAINLESS STEEL,"$2,689.93",$0.00,"$2,689.93","$1,210.47","$1,919.80",$0.00,$449.96,$0.00,$0.00,$470.98,"$2,689.93",$0.00,"$1,344.96","$2,130.42","$2,151.94",$0.00,$408.71,$0.00,$428.24,$0.00
238.707,SUP,HCPCS C1713,,238.707  -  PLATE BONE 194MM 13.5X3.7MM 10 HOLE LCP STAINLESS STEEL LEFT,"$2,689.93",$0.00,"$2,689.93","$1,210.47","$1,919.80",$0.00,$449.96,$0.00,$0.00,$470.98,"$2,689.93",$0.00,"$1,344.96","$2,130.42","$2,151.94",$0.00,$408.71,$0.00,$428.24,$0.00
238.708,SUP,HCPCS C1713,,238.708  -  PLATE BONE 220MM 13.5X3.7MM 12 HOLE LCP STAINLESS STEEL,"$2,719.95",$0.00,"$2,719.95","$1,223.98","$1,941.23",$0.00,$454.98,$0.00,$0.00,$476.24,"$2,719.95",$0.00,"$1,359.98","$2,154.20","$2,175.96",$0.00,$413.27,$0.00,$433.02,$0.00
238.709,SUP,HCPCS C1713,,238.709  -  PLATE BONE 220MM 13.5X3.7MM 12 HOLE LCP STAINLESS STEEL LEFT,"$2,719.95",$0.00,"$2,719.95","$1,223.98","$1,941.23",$0.00,$454.98,$0.00,$0.00,$476.24,"$2,719.95",$0.00,"$1,359.98","$2,154.20","$2,175.96",$0.00,$413.27,$0.00,$433.02,$0.00
238.71,SUP,HCPCS C1713,,238.710  -  PLATE BONE 246MM 14 HOLE LCP STAINLESS STEEL RIGHT DISTAL,"$2,755.43",$0.00,"$2,755.43","$1,239.94","$1,966.55",$0.00,$460.92,$0.00,$0.00,$482.45,"$2,755.43",$0.00,"$1,377.71","$2,182.30","$2,204.34",$0.00,$418.66,$0.00,$438.66,$0.00
238.711,SUP,HCPCS C1713,,238.711  -  PLATE BONE 246MM 13.5X3.7MM 14 HOLE LCP STAINLESS STEEL LEFT,"$2,755.43",$0.00,"$2,755.43","$1,239.94","$1,966.55",$0.00,$460.92,$0.00,$0.00,$482.45,"$2,755.43",$0.00,"$1,377.71","$2,182.30","$2,204.34",$0.00,$418.66,$0.00,$438.66,$0.00
238.94,SUP,HCPCS C1713,,238.94  -  PLATE BONE 130D 152MM 70MM 9 HOLE DCP STAINLESS STEEL,"$1,007.18",$0.00,"$1,007.18",$453.23,$718.82,$0.00,$168.48,$0.00,$0.00,$176.35,"$1,007.18",$0.00,$503.59,$797.69,$805.74,$0.00,$153.03,$0.00,$160.34,$0.00
238.96,SUP,HCPCS C1713,,238.96  -  PLATE BONE 130D 152MM 80MM 9 HOLE DCP STAINLESS STEEL,"$1,007.18",$0.00,"$1,007.18",$453.23,$718.82,$0.00,$168.48,$0.00,$0.00,$176.35,"$1,007.18",$0.00,$503.59,$797.69,$805.74,$0.00,$153.03,$0.00,$160.34,$0.00
238.98,SUP,HCPCS C1713,,238.98  -  PLATE BONE 130D 154MM 90MM 9 HOLE DCP STAINLESS STEEL,"$1,007.18",$0.00,"$1,007.18",$453.23,$718.82,$0.00,$168.48,$0.00,$0.00,$176.35,"$1,007.18",$0.00,$503.59,$797.69,$805.74,$0.00,$153.03,$0.00,$160.34,$0.00
239.2,SUP,HCPCS C1713,,239.20  -  PLATE BN 90D 10MM DSPL 50MM NS DCP SS ADLT OSTM,"$1,007.18",$0.00,"$1,007.18",$453.23,$718.82,$0.00,$168.48,$0.00,$0.00,$176.35,"$1,007.18",$0.00,$503.59,$797.69,$805.74,$0.00,$153.03,$0.00,$160.34,$0.00
239.21,SUP,HCPCS C1713,,239.21  -  PLATE BN 90D 10MM DSPL 55MM NS DCP SS ADLT OSTM,"$1,007.18",$0.00,"$1,007.18",$453.23,$718.82,$0.00,$168.48,$0.00,$0.00,$176.35,"$1,007.18",$0.00,$503.59,$797.69,$805.74,$0.00,$153.03,$0.00,$160.34,$0.00
239.22,SUP,HCPCS C1713,,239.22  -  PLATE BONE 90D 10MM 60MMX94MM 4X1 HOLE BLADE DCP STAINLESS,"$1,007.18",$0.00,"$1,007.18",$453.23,$718.82,$0.00,$168.48,$0.00,$0.00,$176.35,"$1,007.18",$0.00,$503.59,$797.69,$805.74,$0.00,$153.03,$0.00,$160.34,$0.00
239.23,SUP,HCPCS C1713,,239.23  -  PLATE BONE 90D 10MM 65MMX94MM 4X1 HOLE BLADE DCP STAINLESS,"$1,007.18",$0.00,"$1,007.18",$453.23,$718.82,$0.00,$168.48,$0.00,$0.00,$176.35,"$1,007.18",$0.00,$503.59,$797.69,$805.74,$0.00,$153.03,$0.00,$160.34,$0.00
239.24,SUP,HCPCS C1713,,239.24  -  PLATE BONE 90D 10MM 70MMX94MM 4X1 HOLE BLADE DCP STAINLESS,"$1,007.18",$0.00,"$1,007.18",$453.23,$718.82,$0.00,$168.48,$0.00,$0.00,$176.35,"$1,007.18",$0.00,$503.59,$797.69,$805.74,$0.00,$153.03,$0.00,$160.34,$0.00
239.28,SUP,HCPCS C1713,,239.28  -  PLATE BN 90D 10MM DSPL 40MM NS DCP SS ADLT OSTM,"$1,007.18",$0.00,"$1,007.18",$453.23,$718.82,$0.00,$168.48,$0.00,$0.00,$176.35,"$1,007.18",$0.00,$503.59,$797.69,$805.74,$0.00,$153.03,$0.00,$160.34,$0.00
239.3,SUP,HCPCS C1713,,239.30  -  PLATE BONE 100D 10MM 50MMX94MM 4X1 HOLE BLADE DCP STAINLESS,"$1,007.18",$0.00,"$1,007.18",$453.23,$718.82,$0.00,$168.48,$0.00,$0.00,$176.35,"$1,007.18",$0.00,$503.59,$797.69,$805.74,$0.00,$153.03,$0.00,$160.34,$0.00
239.32,SUP,HCPCS C1713,,239.32  -  PLATE BONE 100D 10MM 60MMX94MM 4X1 HOLE BLADE DCP STAINLESS,"$1,007.18",$0.00,"$1,007.18",$453.23,$718.82,$0.00,$168.48,$0.00,$0.00,$176.35,"$1,007.18",$0.00,$503.59,$797.69,$805.74,$0.00,$153.03,$0.00,$160.34,$0.00
239.43,SUP,HCPCS C1713,,239.43  -  PLATE BONE 110D 65MMX94MM 4X1 HOLE ANGLED BLADE DCP,"$1,007.18",$0.00,"$1,007.18",$453.23,$718.82,$0.00,$168.48,$0.00,$0.00,$176.35,"$1,007.18",$0.00,$503.59,$797.69,$805.74,$0.00,$153.03,$0.00,$160.34,$0.00
239.45,SUP,HCPCS C1713,,239.45  -  PLATE BONE 110D 75MMX94MM 4X1 HOLE ANGLED BLADE DCP,"$1,007.18",$0.00,"$1,007.18",$453.23,$718.82,$0.00,$168.48,$0.00,$0.00,$176.35,"$1,007.18",$0.00,$503.59,$797.69,$805.74,$0.00,$153.03,$0.00,$160.34,$0.00
239.47,SUP,HCPCS C1713,,239.47  -  PLATE BONE 110D 85MMX94MM 4X1 HOLE ANGLED BLADE DCP,"$1,007.18",$0.00,"$1,007.18",$453.23,$718.82,$0.00,$168.48,$0.00,$0.00,$176.35,"$1,007.18",$0.00,$503.59,$797.69,$805.74,$0.00,$153.03,$0.00,$160.34,$0.00
239.53,SUP,HCPCS C1713,,239.53  -  PLATE BONE 120D 65MMX94MM 4X1 HOLE ANGLED BLADE DCP,"$1,007.18",$0.00,"$1,007.18",$453.23,$718.82,$0.00,$168.48,$0.00,$0.00,$176.35,"$1,007.18",$0.00,$503.59,$797.69,$805.74,$0.00,$153.03,$0.00,$160.34,$0.00
239.55,SUP,HCPCS C1713,,239.55  -  PLATE BONE 120D 75MMX94MM 4X1 HOLE ANGLED BLADE DCP,"$1,007.18",$0.00,"$1,007.18",$453.23,$718.82,$0.00,$168.48,$0.00,$0.00,$176.35,"$1,007.18",$0.00,$503.59,$797.69,$805.74,$0.00,$153.03,$0.00,$160.34,$0.00
239.57,SUP,HCPCS C1713,,239.57  -  PLATE BONE 120D 85MMX94MM 4X1 HOLE ANGLED BLADE DCP,"$1,007.18",$0.00,"$1,007.18",$453.23,$718.82,$0.00,$168.48,$0.00,$0.00,$176.35,"$1,007.18",$0.00,$503.59,$797.69,$805.74,$0.00,$153.03,$0.00,$160.34,$0.00
239.6,SUP,HCPCS C1713,,239.60  -  PLATE BONE 90D 10MM 50MMX94MM 4X1 HOLE ANGLED BLADE DCP,"$1,007.18",$0.00,"$1,007.18",$453.23,$718.82,$0.00,$168.48,$0.00,$0.00,$176.35,"$1,007.18",$0.00,$503.59,$797.69,$805.74,$0.00,$153.03,$0.00,$160.34,$0.00
239.62,SUP,HCPCS C1713,,239.62  -  PLATE BONE 90D 20MM 60MMX94MM 4X1 HOLE BLADE DCP STAINLESS,"$1,007.18",$0.00,"$1,007.18",$453.23,$718.82,$0.00,$168.48,$0.00,$0.00,$176.35,"$1,007.18",$0.00,$503.59,$797.69,$805.74,$0.00,$153.03,$0.00,$160.34,$0.00
239.64,SUP,HCPCS C1713,,239.64  -  PLATE BONE 90D 20MM 70MMX94MM 4X1 HOLE BLADE DCP STAINLESS,"$1,007.18",$0.00,"$1,007.18",$453.23,$718.82,$0.00,$168.48,$0.00,$0.00,$176.35,"$1,007.18",$0.00,$503.59,$797.69,$805.74,$0.00,$153.03,$0.00,$160.34,$0.00
239.7,SUP,HCPCS C1713,,239.70  -  PLATE BONE 90D 15MM 50MMX94MM 4X1 HOLE ANGLED BLADE DCP,"$1,007.18",$0.00,"$1,007.18",$453.23,$718.82,$0.00,$168.48,$0.00,$0.00,$176.35,"$1,007.18",$0.00,$503.59,$797.69,$805.74,$0.00,$153.03,$0.00,$160.34,$0.00
239.71,SUP,HCPCS C1713,,239.71  -  PLATE BONE 90D 15MM 55MMX94MM 4X1 HOLE ANGLED BLADE DCP,"$1,007.18",$0.00,"$1,007.18",$453.23,$718.82,$0.00,$168.48,$0.00,$0.00,$176.35,"$1,007.18",$0.00,$503.59,$797.69,$805.74,$0.00,$153.03,$0.00,$160.34,$0.00
239.72,SUP,HCPCS C1713,,239.72  -  PLATE BONE 90D 15MM 60MMX94MM 4X1 HOLE ANGLED BLADE DCP,"$1,007.18",$0.00,"$1,007.18",$453.23,$718.82,$0.00,$168.48,$0.00,$0.00,$176.35,"$1,007.18",$0.00,$503.59,$797.69,$805.74,$0.00,$153.03,$0.00,$160.34,$0.00
239.73,SUP,HCPCS C1713,,239.73  -  PLATE BONE 90D 15MM 65MMX94MM 4X1 HOLE ANGLED BLADE DCP,"$1,007.18",$0.00,"$1,007.18",$453.23,$718.82,$0.00,$168.48,$0.00,$0.00,$176.35,"$1,007.18",$0.00,$503.59,$797.69,$805.74,$0.00,$153.03,$0.00,$160.34,$0.00
239.74,SUP,HCPCS C1713,,239.74  -  PLATE BONE 90D 15MM 70MMX94MM 4X1 HOLE ANGLED BLADE DCP,"$1,007.18",$0.00,"$1,007.18",$453.23,$718.82,$0.00,$168.48,$0.00,$0.00,$176.35,"$1,007.18",$0.00,$503.59,$797.69,$805.74,$0.00,$153.03,$0.00,$160.34,$0.00
239.78,SUP,HCPCS C1713,,239.78  -  PLATE BONE 90D 15MM 40MMX94MM 4X1 HOLE BLADE DCP STAINLESS,"$1,007.18",$0.00,"$1,007.18",$453.23,$718.82,$0.00,$168.48,$0.00,$0.00,$176.35,"$1,007.18",$0.00,$503.59,$797.69,$805.74,$0.00,$153.03,$0.00,$160.34,$0.00
239.8,SUP,HCPCS C1713,,239.80  -  PLATE BONE 130D 100MMX94MM 4X1 HOLE: ANGLED BLADE DCP,"$1,007.18",$0.00,"$1,007.18",$453.23,$718.82,$0.00,$168.48,$0.00,$0.00,$176.35,"$1,007.18",$0.00,$503.59,$797.69,$805.74,$0.00,$153.03,$0.00,$160.34,$0.00
239.81,SUP,HCPCS C1713,,239.81  -  PLATE BONE 130D 105MMX94MM 4X1 HOLE: ANGLED BLADE DCP,$977.85,$0.00,$977.85,$440.03,$697.89,$0.00,$168.48,$0.00,$0.00,$171.21,$977.85,$0.00,$488.93,$774.46,$782.28,$0.00,$153.03,$0.00,$155.67,$0.00
239.83,SUP,HCPCS C1713,,239.83  -  PLATE BONE 130D 65MMX94MM 4X1 HOLE: ANGLED BLADE DCP,"$1,007.18",$0.00,"$1,007.18",$453.23,$718.82,$0.00,$168.48,$0.00,$0.00,$176.35,"$1,007.18",$0.00,$503.59,$797.69,$805.74,$0.00,$153.03,$0.00,$160.34,$0.00
239.84,SUP,HCPCS C1713,,239.84  -  PLATE BONE 130D 65MM 70MM 4X1 HOLE: ANGLED BLADE DCP,"$1,007.18",$0.00,"$1,007.18",$453.23,$718.82,$0.00,$168.48,$0.00,$0.00,$176.35,"$1,007.18",$0.00,$503.59,$797.69,$805.74,$0.00,$153.03,$0.00,$160.34,$0.00
239.85,SUP,HCPCS C1713,,239.85  -  PLATE BONE 130D 75MMX94MM 4X1 HOLE: ANGLED BLADE DCP,"$1,007.18",$0.00,"$1,007.18",$453.23,$718.82,$0.00,$168.48,$0.00,$0.00,$176.35,"$1,007.18",$0.00,$503.59,$797.69,$805.74,$0.00,$153.03,$0.00,$160.34,$0.00
239.86,SUP,HCPCS C1713,,239.86  -  PLATE BONE 130D 80MMX94MM 4X1 HOLE: ANGLED BLADE DCP,"$1,007.18",$0.00,"$1,007.18",$453.23,$718.82,$0.00,$168.48,$0.00,$0.00,$176.35,"$1,007.18",$0.00,$503.59,$797.69,$805.74,$0.00,$153.03,$0.00,$160.34,$0.00
239.87,SUP,HCPCS C1713,,239.87  -  PLATE BONE 130D 85MMX94MM 4X1 HOLE: ANGLED BLADE DCP,"$1,007.18",$0.00,"$1,007.18",$453.23,$718.82,$0.00,$168.48,$0.00,$0.00,$176.35,"$1,007.18",$0.00,$503.59,$797.69,$805.74,$0.00,$153.03,$0.00,$160.34,$0.00
239.88,SUP,HCPCS C1713,,239.88  -  PLATE BONE 130D 90MMX94MM 4X1 HOLE: ANGLED BLADE DCP,"$1,007.18",$0.00,"$1,007.18",$453.23,$718.82,$0.00,$168.48,$0.00,$0.00,$176.35,"$1,007.18",$0.00,$503.59,$797.69,$805.74,$0.00,$153.03,$0.00,$160.34,$0.00
239.89,SUP,HCPCS C1713,,239.89  -  PLATE BONE 130D 95MMX94MM 4X1 HOLE: ANGLED BLADE DCP,"$1,007.18",$0.00,"$1,007.18",$453.23,$718.82,$0.00,$168.48,$0.00,$0.00,$176.35,"$1,007.18",$0.00,$503.59,$797.69,$805.74,$0.00,$153.03,$0.00,$160.34,$0.00
239.9,SUP,HCPCS C1713,,239.900  -  PLATE BONE 116X11X3.7MM 4 HOLE PRECONTOUR LCP STAINLESS,"$2,734.95",$0.00,"$2,734.95","$1,230.73","$1,951.93",$0.00,$457.49,$0.00,$0.00,$478.87,"$2,734.95",$0.00,"$1,367.48","$2,166.08","$2,187.96",$0.00,$415.55,$0.00,$435.40,$0.00
239.901,SUP,HCPCS C1713,,239.901  -  PLATE BONE 116X11X3.7MM 4 HOLE PRECONTOUR LCP STAINLESS,"$2,734.95",$0.00,"$2,734.95","$1,230.73","$1,951.93",$0.00,$457.49,$0.00,$0.00,$478.87,"$2,734.95",$0.00,"$1,367.48","$2,166.08","$2,187.96",$0.00,$415.55,$0.00,$435.40,$0.00
239.904,SUP,HCPCS C1713,,239.904  -  PLATE BONE 142X11X3.7MM 6 HOLE PRECONTOUR LCP STAINLESS,"$2,763.63",$0.00,"$2,763.63","$1,243.63","$1,972.40",$0.00,$462.29,$0.00,$0.00,$483.89,"$2,763.63",$0.00,"$1,381.81","$2,188.79","$2,210.90",$0.00,$419.91,$0.00,$439.97,$0.00
239.905,SUP,HCPCS C1713,,239.905  -  PLATE BONE 142X11X3.7MM 6 HOLE PRECONTOUR LCP STAINLESS,"$2,763.63",$0.00,"$2,763.63","$1,243.63","$1,972.40",$0.00,$462.29,$0.00,$0.00,$483.89,"$2,763.63",$0.00,"$1,381.81","$2,188.79","$2,210.90",$0.00,$419.91,$0.00,$439.97,$0.00
239.908,SUP,HCPCS C1713,,239.908  -  PLATE BONE 168X11X3.7MM 8 HOLE PRECONTOURED LCP STAINLESS,"$2,789.55",$0.00,"$2,789.55","$1,255.30","$1,990.90",$0.00,$466.63,$0.00,$0.00,$488.43,"$2,789.55",$0.00,"$1,394.78","$2,209.32","$2,231.64",$0.00,$423.85,$0.00,$444.10,$0.00
239.909,SUP,HCPCS C1713,,239.909  -  PLATE BONE 168X11X3.7MM 8 HOLE PRECONTOURED LCP STAINLESS,"$2,789.55",$0.00,"$2,789.55","$1,255.30","$1,990.90",$0.00,$466.63,$0.00,$0.00,$488.43,"$2,789.55",$0.00,"$1,394.78","$2,209.32","$2,231.64",$0.00,$423.85,$0.00,$444.10,$0.00
239.912,SUP,HCPCS C1713,,239.912  -  PLATE BONE 194X11X3.7MM 10 HOLE PRECONTOUR LCP STAINLESS,"$2,820.95",$0.00,"$2,820.95","$1,269.43","$2,013.31",$0.00,$471.88,$0.00,$0.00,$493.93,"$2,820.95",$0.00,"$1,410.48","$2,234.19","$2,256.76",$0.00,$428.62,$0.00,$449.10,$0.00
239.913,SUP,HCPCS C1713,,239.913  -  PLATE BONE 194X11X3.7MM 10 HOLE PRECONTOUR LCP STAINLESS,"$2,820.95",$0.00,"$2,820.95","$1,269.43","$2,013.31",$0.00,$471.88,$0.00,$0.00,$493.93,"$2,820.95",$0.00,"$1,410.48","$2,234.19","$2,256.76",$0.00,$428.62,$0.00,$449.10,$0.00
239.916,SUP,HCPCS C1713,,239.916  -  PLATE BONE 220X11X3.7MM 12 HOLE PRECONTOUR LCP STAINLESS,"$2,850.98",$0.00,"$2,850.98","$1,282.94","$2,034.74",$0.00,$476.90,$0.00,$0.00,$499.18,"$2,850.98",$0.00,"$1,425.49","$2,257.98","$2,280.78",$0.00,$433.18,$0.00,$453.88,$0.00
239.917,SUP,HCPCS C1713,,239.917  -  PLATE BONE 220X11X3.7MM 12 HOLE PRECONTOUR LCP STAINLESS,"$2,850.98",$0.00,"$2,850.98","$1,282.94","$2,034.74",$0.00,$476.90,$0.00,$0.00,$499.18,"$2,850.98",$0.00,"$1,425.49","$2,257.98","$2,280.78",$0.00,$433.18,$0.00,$453.88,$0.00
239.92,SUP,HCPCS C1713,,239.920  -  PLATE BONE 246X11X3.7MM 14 HOLE PRECONTOUR LCP STAINLESS,"$2,886.45",$0.00,"$2,886.45","$1,298.90","$2,060.06",$0.00,$482.84,$0.00,$0.00,$505.39,"$2,886.45",$0.00,"$1,443.23","$2,286.07","$2,309.16",$0.00,$438.57,$0.00,$459.52,$0.00
239.921,SUP,HCPCS C1713,,239.921  -  PLATE BONE 246X11X3.7MM 14 HOLE PRECONTOUR LCP STAINLESS,"$2,886.45",$0.00,"$2,886.45","$1,298.90","$2,060.06",$0.00,$482.84,$0.00,$0.00,$505.39,"$2,886.45",$0.00,"$1,443.23","$2,286.07","$2,309.16",$0.00,$438.57,$0.00,$459.52,$0.00
239.934,SUP,HCPCS C1713,,239.934  -  PLATE BN CNTR 81MM NS LCP CMBN 4 HL LMT CNTCT SS TIB RT PROX,"$2,586.20",$0.00,"$2,586.20","$1,163.79","$1,845.77",$0.00,$432.61,$0.00,$0.00,$452.82,"$2,586.20",$0.00,"$1,293.10","$2,048.27","$2,068.96",$0.00,$392.95,$0.00,$411.72,$0.00
239.935,SUP,HCPCS C1713,,239.935  -  PLATE BN CNTR 81MM NS LCP CMBN 4 HL LMT CNTCT SS TIB LT PROX,"$2,586.20",$0.00,"$2,586.20","$1,163.79","$1,845.77",$0.00,$432.61,$0.00,$0.00,$452.82,"$2,586.20",$0.00,"$1,293.10","$2,048.27","$2,068.96",$0.00,$392.95,$0.00,$411.72,$0.00
239.936,SUP,HCPCS C1713,,239.936  -  PLATE BN CNTR 107MM NS LCP CMBN 6 HL LMT CNTCT SS TIB RT,"$2,617.60",$0.00,"$2,617.60","$1,177.92","$1,868.18",$0.00,$437.86,$0.00,$0.00,$458.32,"$2,617.60",$0.00,"$1,308.80","$2,073.14","$2,094.08",$0.00,$397.72,$0.00,$416.72,$0.00
239.937,SUP,HCPCS C1713,,239.937  -  PLATE BN CNTR 107MM NS LCP CMBN 6 HL LMT CNTCT SS TIB LT,"$2,617.60",$0.00,"$2,617.60","$1,177.92","$1,868.18",$0.00,$437.86,$0.00,$0.00,$458.32,"$2,617.60",$0.00,"$1,308.80","$2,073.14","$2,094.08",$0.00,$397.72,$0.00,$416.72,$0.00
239.938,SUP,HCPCS C1713,,239.938  -  PLATE BN CNTR 133MM NS LCP CMBN 8 HL LMT CNTCT SS TIB RT,"$2,647.63",$0.00,"$2,647.63","$1,191.43","$1,889.61",$0.00,$442.88,$0.00,$0.00,$463.58,"$2,647.63",$0.00,"$1,323.81","$2,096.92","$2,118.10",$0.00,$402.28,$0.00,$421.50,$0.00
239.939,SUP,HCPCS C1713,,239.939  -  PLATE BN CNTR 133MM NS LCP CMBN 8 HL LMT CNTCT SS TIB LT,"$2,647.63",$0.00,"$2,647.63","$1,191.43","$1,889.61",$0.00,$442.88,$0.00,$0.00,$463.58,"$2,647.63",$0.00,"$1,323.81","$2,096.92","$2,118.10",$0.00,$402.28,$0.00,$421.50,$0.00
239.94,SUP,HCPCS C1713,,239.940  -  PLATE BN CNTR 159MM NS LCP CMBN 10 HL LMT CNTCT SS TIB RT,"$2,676.28",$0.00,"$2,676.28","$1,204.32","$1,910.06",$0.00,$447.68,$0.00,$0.00,$468.59,"$2,676.28",$0.00,"$1,338.14","$2,119.61","$2,141.02",$0.00,$406.64,$0.00,$426.06,$0.00
239.941,SUP,HCPCS C1713,,239.941  -  PLATE BN CNTR 159MM NS LCP CMBN 10 HL LMT CNTCT SS TIB LT,"$2,676.28",$0.00,"$2,676.28","$1,204.32","$1,910.06",$0.00,$447.68,$0.00,$0.00,$468.59,"$2,676.28",$0.00,"$1,338.14","$2,119.61","$2,141.02",$0.00,$406.64,$0.00,$426.06,$0.00
239.942,SUP,HCPCS C1713,,239.942  -  PLATE BN CNTR 185MM NS LCP CMBN 12 HL LMT CNTCT SS TIB RT,"$2,711.75",$0.00,"$2,711.75","$1,220.29","$1,935.38",$0.00,$453.61,$0.00,$0.00,$474.81,"$2,711.75",$0.00,"$1,355.88","$2,147.71","$2,169.40",$0.00,$412.03,$0.00,$431.71,$0.00
239.943,SUP,HCPCS C1713,,239.943  -  PLATE BN CNTR 185MM NS LCP CMBN 12 HL LMT CNTCT SS TIB LT,"$2,711.75",$0.00,"$2,711.75","$1,220.29","$1,935.38",$0.00,$453.61,$0.00,$0.00,$474.81,"$2,711.75",$0.00,"$1,355.88","$2,147.71","$2,169.40",$0.00,$412.03,$0.00,$431.71,$0.00
239.944,SUP,HCPCS C1713,,239.944  -  PLATE BN CNTR 211MM NS LCP CMBN 14 HL LMT CNTCT SS TIB RT,"$2,740.43",$0.00,"$2,740.43","$1,233.19","$1,955.84",$0.00,$458.41,$0.00,$0.00,$479.83,"$2,740.43",$0.00,"$1,370.21","$2,170.42","$2,192.34",$0.00,$416.38,$0.00,$436.28,$0.00
239.945,SUP,HCPCS C1713,,239.945  -  PLATE BN CNTR 211MM NS LCP CMBN 14 HL LMT CNTCT SS TIB LT,"$2,833.23",$0.00,"$2,833.23","$1,274.95","$2,022.07",$0.00,$473.93,$0.00,$0.00,$496.08,"$2,833.23",$0.00,"$1,416.61","$2,243.92","$2,266.58",$0.00,$430.48,$0.00,$451.05,$0.00
239.946,SUP,HCPCS C1713,,239.946  -  PLATE BN CNTR 237MM NS LCP CMBN 16 HL LMT CNTCT SS TIB RT,"$2,932.85",$0.00,"$2,932.85","$1,319.78","$2,093.18",$0.00,$490.60,$0.00,$0.00,$513.52,"$2,932.85",$0.00,"$1,466.43","$2,322.82","$2,346.28",$0.00,$445.62,$0.00,$466.91,$0.00
239.947,SUP,HCPCS C1713,,239.947  -  PLATE BN CNTR 237MM NS LCP CMBN 16 HL LMT CNTCT SS TIB LT,"$2,932.85",$0.00,"$2,932.85","$1,319.78","$2,093.18",$0.00,$490.60,$0.00,$0.00,$513.52,"$2,932.85",$0.00,"$1,466.43","$2,322.82","$2,346.28",$0.00,$445.62,$0.00,$466.91,$0.00
239.954,SUP,HCPCS C1713,,239.954  -  PLATE 94MM SS 3.5MM SCR 4 HOLE LCP BONE RIGHT PROX TIB,"$3,263.43",$0.00,"$3,263.43","$1,468.54","$2,329.11",$0.00,$562.27,$0.00,$0.00,$571.40,"$3,263.43",$0.00,"$1,631.71","$2,584.64","$2,610.74",$0.00,$510.73,$0.00,$519.54,$0.00
239.955,SUP,HCPCS C1713,,239.955  -  PLATE BN CNTR 93MM NS LCP CMBN 4 HL LMT CNTCT SS TIB LT PROX,"$2,502.93",$0.00,"$2,502.93","$1,126.32","$1,786.34",$0.00,$431.24,$0.00,$0.00,$438.24,"$2,502.93",$0.00,"$1,251.46","$1,982.32","$2,002.34",$0.00,$391.71,$0.00,$398.47,$0.00
239.956,SUP,HCPCS C1713,,239.956  -  PLATE 119MM SS 3.5MM SCR 6 HOLE LCP BONE RIGHT MDL PROX TIB,"$3,304.25",$0.00,"$3,304.25","$1,486.91","$2,358.24",$0.00,$569.31,$0.00,$0.00,$578.55,"$3,304.25",$0.00,"$1,652.13","$2,616.97","$2,643.40",$0.00,$517.12,$0.00,$526.04,$0.00
239.957,SUP,HCPCS C1713,,239.957  -  PLATE BN CNTR 119MM NS LCP CMBN 6 HL LMT CNTCT SS TIB LT,"$2,612.13",$0.00,"$2,612.13","$1,175.46","$1,864.27",$0.00,$436.95,$0.00,$0.00,$457.36,"$2,612.13",$0.00,"$1,306.06","$2,068.81","$2,089.70",$0.00,$396.89,$0.00,$415.85,$0.00
239.958,SUP,HCPCS C1713,,239.958  -  PLATE BN CNTR 145MM NS LCP CMBN 8 HL LMT CNTCT SS TIB RT,"$2,643.53",$0.00,"$2,643.53","$1,189.59","$1,886.68",$0.00,$442.20,$0.00,$0.00,$462.86,"$2,643.53",$0.00,"$1,321.76","$2,093.68","$2,114.82",$0.00,$401.66,$0.00,$420.85,$0.00
239.959,SUP,HCPCS C1713,,239.959  -  PLATE BN CNTR 145MM NS LCP CMBN 8 HL LMT CNTCT SS TIB LT,"$2,643.53",$0.00,"$2,643.53","$1,189.59","$1,886.68",$0.00,$442.20,$0.00,$0.00,$462.86,"$2,643.53",$0.00,"$1,321.76","$2,093.68","$2,114.82",$0.00,$401.66,$0.00,$420.85,$0.00
239.96,SUP,HCPCS C1713,,239.960  -  PLATE BN CNTR 171MM NS LCP CMBN 10 HL LMT CNTCT SS TIB RT,"$2,673.55",$0.00,"$2,673.55","$1,203.10","$1,908.11",$0.00,$447.22,$0.00,$0.00,$468.12,"$2,673.55",$0.00,"$1,336.78","$2,117.45","$2,138.84",$0.00,$406.22,$0.00,$425.63,$0.00
239.961,SUP,HCPCS C1713,,239.961  -  PLATE BN CNTR 171MM NS LCP CMBN 10 HL LMT CNTCT SS TIB LT,"$2,673.55",$0.00,"$2,673.55","$1,203.10","$1,908.11",$0.00,$447.22,$0.00,$0.00,$468.12,"$2,673.55",$0.00,"$1,336.78","$2,117.45","$2,138.84",$0.00,$406.22,$0.00,$425.63,$0.00
239.962,SUP,HCPCS C1713,,239.962  -  PLATE BN CNTR 197MM NS LCP CMBN 12 HL LMT CNTCT SS TIB RT,"$2,702.20",$0.00,"$2,702.20","$1,215.99","$1,928.56",$0.00,$452.02,$0.00,$0.00,$473.13,"$2,702.20",$0.00,"$1,351.10","$2,140.14","$2,161.76",$0.00,$410.58,$0.00,$430.19,$0.00
239.963,SUP,HCPCS C1713,,239.963  -  PLATE BN CNTR 197MM NS LCP CMBN 12 HL LMT CNTCT SS TIB LT,"$2,702.20",$0.00,"$2,702.20","$1,215.99","$1,928.56",$0.00,$452.02,$0.00,$0.00,$473.13,"$2,702.20",$0.00,"$1,351.10","$2,140.14","$2,161.76",$0.00,$410.58,$0.00,$430.19,$0.00
239.964,SUP,HCPCS C1713,,239.964  -  PLATE BN CNTR 223MM NS LCP CMBN 4 HL LMT CNTCT SS TIB RT,"$2,734.95",$0.00,"$2,734.95","$1,230.73","$1,951.93",$0.00,$457.49,$0.00,$0.00,$478.87,"$2,734.95",$0.00,"$1,367.48","$2,166.08","$2,187.96",$0.00,$415.55,$0.00,$435.40,$0.00
239.965,SUP,HCPCS C1713,,239.965  -  PLATE BN CNTR 223MM NS LCP CMBN 4 HL LMT CNTCT SS TIB LT,"$2,734.95",$0.00,"$2,734.95","$1,230.73","$1,951.93",$0.00,$457.49,$0.00,$0.00,$478.87,"$2,734.95",$0.00,"$1,367.48","$2,166.08","$2,187.96",$0.00,$415.55,$0.00,$435.40,$0.00
239.966,SUP,HCPCS C1713,,239.966  -  PLATE BN CNTR 249MM NS LCP CMBN 16 HL LMT CNTCT SS TIB RT,"$2,926.03",$0.00,"$2,926.03","$1,316.71","$2,088.30",$0.00,$489.46,$0.00,$0.00,$512.32,"$2,926.03",$0.00,"$1,463.01","$2,317.42","$2,340.82",$0.00,$444.59,$0.00,$465.82,$0.00
239.967,SUP,HCPCS C1713,,239.967  -  PLATE BN CNTR 249MM NS LCP CMBN 16 HL LMT CNTCT SS TIB LT,"$2,926.03",$0.00,"$2,926.03","$1,316.71","$2,088.30",$0.00,$489.46,$0.00,$0.00,$512.32,"$2,926.03",$0.00,"$1,463.01","$2,317.42","$2,340.82",$0.00,$444.59,$0.00,$465.82,$0.00
239.968,SUP,HCPCS C1713,,239.968  -  PLATE BN CNTR 275MM NS LCP CMBN 18 HL LMT CNTCT SS TIB RT,"$3,031.10",$0.00,"$3,031.10","$1,364.00","$2,163.30",$0.00,$507.03,$0.00,$0.00,$530.72,"$3,031.10",$0.00,"$1,515.55","$2,400.63","$2,424.88",$0.00,$460.55,$0.00,$482.55,$0.00
239.969,SUP,HCPCS C1713,,239.969  -  PLATE BN CNTR 275MM NS LCP CMBN 18 HL LMT CNTCT SS TIB LT,"$3,031.10",$0.00,"$3,031.10","$1,364.00","$2,163.30",$0.00,$507.03,$0.00,$0.00,$530.72,"$3,031.10",$0.00,"$1,515.55","$2,400.63","$2,424.88",$0.00,$460.55,$0.00,$482.55,$0.00
239.97,SUP,HCPCS C1713,,239.970  -  PLATE BN CNTR 301MM NS LCP CMBN 20 HL LMT CNTCT SS TIB RT,"$3,130.73",$0.00,"$3,130.73","$1,408.83","$2,234.40",$0.00,$523.70,$0.00,$0.00,$548.16,"$3,130.73",$0.00,"$1,565.36","$2,479.54","$2,504.58",$0.00,$475.69,$0.00,$498.41,$0.00
239.971,SUP,HCPCS C1713,,239.971  -  PLATE BN CNTR 301MM NS LCP CMBN 20 HL LMT CNTCT SS TIB LT,"$3,130.73",$0.00,"$3,130.73","$1,408.83","$2,234.40",$0.00,$523.70,$0.00,$0.00,$548.16,"$3,130.73",$0.00,"$1,565.36","$2,479.54","$2,504.58",$0.00,$475.69,$0.00,$498.41,$0.00
239.984,SUP,HCPCS C1713,,239.984  -  PLATE BONE 106MM 4 HOLE PRECONTOUR LCP STAINLESS STEEL RIGHT,"$2,587.58",$0.00,"$2,587.58","$1,164.41","$1,846.75",$0.00,$432.84,$0.00,$0.00,$453.06,"$2,587.58",$0.00,"$1,293.79","$2,049.36","$2,070.06",$0.00,$393.16,$0.00,$411.94,$0.00
239.985,SUP,HCPCS C1713,,239.985  -  PLATE BONE 106MM 4 HOLE PRECONTOUR LCP STAINLESS STEEL LEFT,"$2,587.58",$0.00,"$2,587.58","$1,164.41","$1,846.75",$0.00,$432.84,$0.00,$0.00,$453.06,"$2,587.58",$0.00,"$1,293.79","$2,049.36","$2,070.06",$0.00,$393.16,$0.00,$411.94,$0.00
239.986,SUP,HCPCS C1713,,239.986  -  PLATE BONE 142MM 6 HOLE PRECONTOUR LCP STAINLESS STEEL RIGHT,"$2,618.95",$0.00,"$2,618.95","$1,178.53","$1,869.14",$0.00,$438.09,$0.00,$0.00,$458.56,"$2,618.95",$0.00,"$1,309.48","$2,074.21","$2,095.16",$0.00,$397.93,$0.00,$416.94,$0.00
239.987,SUP,HCPCS C1713,,239.987  -  PLATE BONE 142MM 6 HOLE PRECONTOUR LCP STAINLESS STEEL LEFT,"$2,618.95",$0.00,"$2,618.95","$1,178.53","$1,869.14",$0.00,$438.09,$0.00,$0.00,$458.56,"$2,618.95",$0.00,"$1,309.48","$2,074.21","$2,095.16",$0.00,$397.93,$0.00,$416.94,$0.00
239.988,SUP,HCPCS C1713,,239.988  -  PLATE BONE 178MM 8 HOLE LIMITED CONTACT PROFILE LCP,"$2,648.98",$0.00,"$2,648.98","$1,192.04","$1,890.57",$0.00,$443.11,$0.00,$0.00,$463.81,"$2,648.98",$0.00,"$1,324.49","$2,097.99","$2,119.18",$0.00,$402.49,$0.00,$421.72,$0.00
239.989,SUP,HCPCS C1713,,239.989  -  PLATE BONE 178MM 8 HOLE LIMITED CONTACT PROFILE LCP,"$2,648.98",$0.00,"$2,648.98","$1,192.04","$1,890.57",$0.00,$443.11,$0.00,$0.00,$463.81,"$2,648.98",$0.00,"$1,324.49","$2,097.99","$2,119.18",$0.00,$402.49,$0.00,$421.72,$0.00
239.99,SUP,HCPCS C1713,,239.990  -  PLATE BONE 214MM 10 HOLE LCP STAINLESS STEEL RIGHT PROXIMAL,"$2,677.65",$0.00,"$2,677.65","$1,204.94","$1,911.04",$0.00,$447.91,$0.00,$0.00,$468.84,"$2,677.65",$0.00,"$1,338.83","$2,120.70","$2,142.12",$0.00,$406.85,$0.00,$426.28,$0.00
239.991,SUP,HCPCS C1713,,239.991  -  PLATE BONE 214MM 10 HOLE LOCKING LCP STAINLESS STEEL,"$2,677.65",$0.00,"$2,677.65","$1,204.94","$1,911.04",$0.00,$447.91,$0.00,$0.00,$468.84,"$2,677.65",$0.00,"$1,338.83","$2,120.70","$2,142.12",$0.00,$406.85,$0.00,$426.28,$0.00
239.992,SUP,HCPCS C1713,,239.992  -  PLATE BONE 250MM 12 HOLE LCP STAINLESS STEEL TIBIA RIGHT,"$2,803.20",$0.00,"$2,803.20","$1,261.44","$2,000.64",$0.00,$468.91,$0.00,$0.00,$490.82,"$2,803.20",$0.00,"$1,401.60","$2,220.13","$2,242.56",$0.00,$425.92,$0.00,$446.27,$0.00
239.993,SUP,HCPCS C1713,,239.993  -  PLATE BONE 250MM 12 HOLE LIMITED CONTACT PROFILE LCP,"$2,803.20",$0.00,"$2,803.20","$1,261.44","$2,000.64",$0.00,$468.91,$0.00,$0.00,$490.82,"$2,803.20",$0.00,"$1,401.60","$2,220.13","$2,242.56",$0.00,$425.92,$0.00,$446.27,$0.00
239.994,SUP,HCPCS C1713,,239.994  -  PLATE BONE 286MM 14 HOLE LOCKING LCP STAINLESS STEEL,"$2,833.23",$0.00,"$2,833.23","$1,274.95","$2,022.07",$0.00,$473.93,$0.00,$0.00,$496.08,"$2,833.23",$0.00,"$1,416.61","$2,243.92","$2,266.58",$0.00,$430.48,$0.00,$451.05,$0.00
239.995,SUP,HCPCS C1713,,239.995  -  PLATE BONE 286MM 14 HOLE LOCKING LCP STAINLESS STEEL,"$2,833.23",$0.00,"$2,833.23","$1,274.95","$2,022.07",$0.00,$473.93,$0.00,$0.00,$496.08,"$2,833.23",$0.00,"$1,416.61","$2,243.92","$2,266.58",$0.00,$430.48,$0.00,$451.05,$0.00
239.996,SUP,HCPCS C1713,,239.996  -  PLATE BONE 322MM 16 HOLE LOCKING LCP STAINLESS STEEL,"$2,861.88",$0.00,"$2,861.88","$1,287.84","$2,042.52",$0.00,$478.73,$0.00,$0.00,$501.09,"$2,861.88",$0.00,"$1,430.94","$2,266.61","$2,289.50",$0.00,$434.84,$0.00,$455.61,$0.00
239.997,SUP,HCPCS C1713,,239.997  -  PLATE BONE 322MM 16 HOLE LCP STAINLESS STEEL LEFT PROXIMAL,"$2,861.88",$0.00,"$2,861.88","$1,287.84","$2,042.52",$0.00,$478.73,$0.00,$0.00,$501.09,"$2,861.88",$0.00,"$1,430.94","$2,266.61","$2,289.50",$0.00,$434.84,$0.00,$455.61,$0.00
240.002,SUP,HCPCS C1713,,240.002  -  PLATE BONE 41MM 2 HOLE LCP STAINLESS STEEL TIBIA RIGHT,"$2,092.15",$0.00,"$2,092.15",$941.47,"$1,493.17",$0.00,$349.97,$0.00,$0.00,$366.32,"$2,092.15",$0.00,"$1,046.08","$1,656.98","$1,673.72",$0.00,$317.89,$0.00,$333.07,$0.00
240.003,SUP,HCPCS C1713,,240.003  -  PLATE BONE 41MM 2 HOLE LCP STAINLESS STEEL TIBIA LEFT,"$2,092.15",$0.00,"$2,092.15",$941.47,"$1,493.17",$0.00,$349.97,$0.00,$0.00,$366.32,"$2,092.15",$0.00,"$1,046.08","$1,656.98","$1,673.72",$0.00,$317.89,$0.00,$333.07,$0.00
240.004,SUP,HCPCS C1713,,240.004  -  PLATE BONE 73MM 4 HOLE LCP STAINLESS STEEL RIGHT PROXIMAL,"$2,097.63",$0.00,"$2,097.63",$943.93,"$1,497.07",$0.00,$350.88,$0.00,$0.00,$367.28,"$2,097.63",$0.00,"$1,048.81","$1,661.32","$1,678.10",$0.00,$318.72,$0.00,$333.94,$0.00
240.005,SUP,HCPCS C1713,,240.005  -  PLATE BONE 73MM 4 HOLE LCP STAINLESS STEEL TIBIA LEFT,"$2,097.63",$0.00,"$2,097.63",$943.93,"$1,497.07",$0.00,$350.88,$0.00,$0.00,$367.28,"$2,097.63",$0.00,"$1,048.81","$1,661.32","$1,678.10",$0.00,$318.72,$0.00,$333.94,$0.00
240.006,SUP,HCPCS C1713,,240.006  -  PLATE BONE 109MM 6 HOLE LCP STAINLESS STEEL TIBIA RIGHT,"$2,101.73",$0.00,"$2,101.73",$945.78,"$1,500.00",$0.00,$351.57,$0.00,$0.00,$368.00,"$2,101.73",$0.00,"$1,050.86","$1,664.57","$1,681.38",$0.00,$319.34,$0.00,$334.59,$0.00
240.007,SUP,HCPCS C1713,,240.007  -  PLATE BONE 109MM 6 HOLE LCP STAINLESS STEEL TIBIA LEFT,"$2,101.73",$0.00,"$2,101.73",$945.78,"$1,500.00",$0.00,$351.57,$0.00,$0.00,$368.00,"$2,101.73",$0.00,"$1,050.86","$1,664.57","$1,681.38",$0.00,$319.34,$0.00,$334.59,$0.00
240.008,SUP,HCPCS C1713,,240.008  -  PLATE BONE 145MM 8 HOLE LCP STAINLESS STEEL RIGHT PROXIMAL,"$2,175.40",$0.00,"$2,175.40",$978.93,"$1,552.58",$0.00,$363.90,$0.00,$0.00,$380.90,"$2,175.40",$0.00,"$1,087.70","$1,722.92","$1,740.32",$0.00,$330.54,$0.00,$346.32,$0.00
240.009,SUP,HCPCS C1713,,240.009  -  PLATE BONE 145MM 8 HOLE LCP STAINLESS STEEL LEFT PROXIMAL,"$2,175.40",$0.00,"$2,175.40",$978.93,"$1,552.58",$0.00,$363.90,$0.00,$0.00,$380.90,"$2,175.40",$0.00,"$1,087.70","$1,722.92","$1,740.32",$0.00,$330.54,$0.00,$346.32,$0.00
240.01,SUP,HCPCS C1713,,240.010  -  PLATE BONE 181MM 10 HOLE LCP STAINLESS STEEL RIGHT PROXIMAL,"$2,180.88",$0.00,"$2,180.88",$981.39,"$1,556.49",$0.00,$364.81,$0.00,$0.00,$381.85,"$2,180.88",$0.00,"$1,090.44","$1,727.26","$1,744.70",$0.00,$331.37,$0.00,$347.20,$0.00
240.011,SUP,HCPCS C1713,,240.011  -  PLATE BONE 181MM 10 HOLE LCP STAINLESS STEEL LEFT PROXIMAL,"$2,180.88",$0.00,"$2,180.88",$981.39,"$1,556.49",$0.00,$364.81,$0.00,$0.00,$381.85,"$2,180.88",$0.00,"$1,090.44","$1,727.26","$1,744.70",$0.00,$331.37,$0.00,$347.20,$0.00
240.012,SUP,HCPCS C1713,,240.012  -  PLATE BONE 217MM 12 HOLE LCP STAINLESS STEEL RIGHT PROXIMAL,"$2,332.35",$0.00,"$2,332.35","$1,049.56","$1,664.60",$0.00,$390.15,$0.00,$0.00,$408.38,"$2,332.35",$0.00,"$1,166.18","$1,847.22","$1,865.88",$0.00,$354.38,$0.00,$371.31,$0.00
240.013,SUP,HCPCS C1713,,240.013  -  PLATE BONE 217MM 12 HOLE LCP STAINLESS STEEL TIBIA LEFT,"$2,268.23",$0.00,"$2,268.23","$1,020.70","$1,618.83",$0.00,$379.42,$0.00,$0.00,$397.15,"$2,268.23",$0.00,"$1,134.11","$1,796.44","$1,814.58",$0.00,$344.64,$0.00,$361.10,$0.00
240.014,SUP,HCPCS C1713,,240.014  -  PLATE BONE 4.5MM 14 HOLE LCP STAINLESS STEEL RIGHT PROXIMAL,"$2,317.35",$0.00,"$2,317.35","$1,042.81","$1,653.89",$0.00,$387.64,$0.00,$0.00,$405.75,"$2,317.35",$0.00,"$1,158.68","$1,835.34","$1,853.88",$0.00,$352.10,$0.00,$368.92,$0.00
240.015,SUP,HCPCS C1713,,240.015  -  PLATE BONE 4.5MM 14 HOLE LCP STAINLESS STEEL LEFT PROXIMAL,"$2,317.35",$0.00,"$2,317.35","$1,042.81","$1,653.89",$0.00,$387.64,$0.00,$0.00,$405.75,"$2,317.35",$0.00,"$1,158.68","$1,835.34","$1,853.88",$0.00,$352.10,$0.00,$368.92,$0.00
240.019,SUP,Custom 27803010,,240.019  -  WASHER ORTHOPEDIC 4.5MM 3.5MM LCP STAINLESS STEEL NONSTRL,$96.20,$0.00,$96.20,$0.00,$68.66,$0.00,$0.00,$0.00,$0.00,$0.00,$96.20,$0.00,$48.10,$76.19,$76.96,$0.00,$0.00,$0.00,$0.00,$0.00
240.036,SUP,HCPCS C1713,,240.036  -  PLATE BN CNTR 82MM NS LCP CMBN 4 HL LMT CNTCT TPR END SS TIB,"$2,588.93",$0.00,"$2,588.93","$1,165.02","$1,847.72",$0.00,$433.07,$0.00,$0.00,$453.30,"$2,588.93",$0.00,"$1,294.46","$2,050.43","$2,071.14",$0.00,$393.37,$0.00,$412.16,$0.00
240.037,SUP,HCPCS C1713,,240.037  -  PLATE BN CNTR 82MM NS LCP CMBN 4 HL LMT CNTCT TPR END SS TIB,"$2,588.93",$0.00,"$2,588.93","$1,165.02","$1,847.72",$0.00,$433.07,$0.00,$0.00,$453.30,"$2,588.93",$0.00,"$1,294.46","$2,050.43","$2,071.14",$0.00,$393.37,$0.00,$412.16,$0.00
240.038,SUP,HCPCS C1713,,240.038  -  PLATE BN CNTR 118MM NS LCP CMBN 4 HL LMT CNTCT TPR END SS,"$2,620.33",$0.00,"$2,620.33","$1,179.15","$1,870.13",$0.00,$438.32,$0.00,$0.00,$458.80,"$2,620.33",$0.00,"$1,310.16","$2,075.30","$2,096.26",$0.00,$398.14,$0.00,$417.16,$0.00
240.039,SUP,HCPCS C1713,,240.039  -  PLATE BN CNTR 118MM NS LCP CMBN 4 HL LMT CNTCT TPR END SS,"$2,620.33",$0.00,"$2,620.33","$1,179.15","$1,870.13",$0.00,$438.32,$0.00,$0.00,$458.80,"$2,620.33",$0.00,"$1,310.16","$2,075.30","$2,096.26",$0.00,$398.14,$0.00,$417.16,$0.00
240.04,SUP,HCPCS C1713,,240.040  -  PLATE BN CNTR 154MM NS LCP CMBN 4 HL LMT CNTCT TPR END SS,"$2,650.35",$0.00,"$2,650.35","$1,192.66","$1,891.55",$0.00,$443.34,$0.00,$0.00,$464.06,"$2,650.35",$0.00,"$1,325.18","$2,099.08","$2,120.28",$0.00,$402.70,$0.00,$421.94,$0.00
240.041,SUP,HCPCS C1713,,240.041  -  PLATE BN CNTR 154MM NS LCP CMBN 4 HL LMT CNTCT TPR END SS,"$2,650.35",$0.00,"$2,650.35","$1,192.66","$1,891.55",$0.00,$443.34,$0.00,$0.00,$464.06,"$2,650.35",$0.00,"$1,325.18","$2,099.08","$2,120.28",$0.00,$402.70,$0.00,$421.94,$0.00
240.042,SUP,HCPCS C1713,,240.042  -  PLATE BN CNTR 190MM NS LCP CMBN 4 HL LMT CNTCT TPR END SS,"$2,679.00",$0.00,"$2,679.00","$1,205.55","$1,912.00",$0.00,$448.13,$0.00,$0.00,$469.07,"$2,679.00",$0.00,"$1,339.50","$2,121.77","$2,143.20",$0.00,$407.05,$0.00,$426.50,$0.00
240.043,SUP,HCPCS C1713,,240.043  -  PLATE BN CNTR 190MM NS LCP CMBN 4 HL LMT CNTCT TPR END SS,"$2,679.00",$0.00,"$2,679.00","$1,205.55","$1,912.00",$0.00,$448.13,$0.00,$0.00,$469.07,"$2,679.00",$0.00,"$1,339.50","$2,121.77","$2,143.20",$0.00,$407.05,$0.00,$426.50,$0.00
240.044,SUP,HCPCS C1713,,240.044  -  PLATE BN CNTR 226MM NS LCP CMBN 4 HL LMT CNTCT TPR END SS,"$2,710.40",$0.00,"$2,710.40","$1,219.68","$1,934.41",$0.00,$453.39,$0.00,$0.00,$474.57,"$2,710.40",$0.00,"$1,355.20","$2,146.64","$2,168.32",$0.00,$411.82,$0.00,$431.50,$0.00
240.045,SUP,HCPCS C1713,,240.045  -  PLATE BN CNTR 226MM NS LCP CMBN 4 HL LMT CNTCT TPR END SS,"$2,710.40",$0.00,"$2,710.40","$1,219.68","$1,934.41",$0.00,$453.39,$0.00,$0.00,$474.57,"$2,710.40",$0.00,"$1,355.20","$2,146.64","$2,168.32",$0.00,$411.82,$0.00,$431.50,$0.00
240.046,SUP,HCPCS C1713,,240.046  -  PLATE BN CNTR 262MM NS LCP CMBN 4 HL LMT CNTCT TPR END SS,"$2,739.05",$0.00,"$2,739.05","$1,232.57","$1,954.86",$0.00,$458.18,$0.00,$0.00,$479.59,"$2,739.05",$0.00,"$1,369.53","$2,169.33","$2,191.24",$0.00,$416.18,$0.00,$436.06,$0.00
240.047,SUP,HCPCS C1713,,240.047  -  PLATE BN CNTR 262MM NS LCP CMBN 4 HL LMT CNTCT TPR END SS,"$2,739.05",$0.00,"$2,739.05","$1,232.57","$1,954.86",$0.00,$458.18,$0.00,$0.00,$479.59,"$2,739.05",$0.00,"$1,369.53","$2,169.33","$2,191.24",$0.00,$416.18,$0.00,$436.06,$0.00
240.064,SUP,HCPCS C1713,,240.064  -  PLATE BONE 4 HOLE SCALLOPED STAINLESS STEEL TIBIA DISTAL,$482.30,$0.00,$482.30,$217.04,$344.22,$0.00,$83.10,$0.00,$0.00,$84.45,$482.30,$0.00,$241.15,$381.98,$385.84,$0.00,$75.48,$0.00,$76.78,$0.00
240.065,SUP,HCPCS C1713,,240.065  -  PLATE BONE 5 HOLE SCALLOPED STAINLESS STEEL TIBIA DISTAL,$514.10,$0.00,$514.10,$231.35,$366.91,$0.00,$88.58,$0.00,$0.00,$90.01,$514.10,$0.00,$257.05,$407.17,$411.28,$0.00,$80.46,$0.00,$81.84,$0.00
240.066,SUP,HCPCS C1713,,240.066  -  PLATE BONE 6 HOLE SCALLOPED STAINLESS STEEL TIBIA DISTAL,$544.58,$0.00,$544.58,$245.06,$388.66,$0.00,$93.83,$0.00,$0.00,$95.35,$544.58,$0.00,$272.29,$431.31,$435.66,$0.00,$85.23,$0.00,$86.70,$0.00
240.067,SUP,HCPCS C1713,,240.067  -  PLATE BONE 7 HOLE SCALLOPED STAINLESS STEEL TIBIA DISTAL,$580.35,$0.00,$580.35,$261.16,$414.20,$0.00,$99.99,$0.00,$0.00,$101.61,$580.35,$0.00,$290.18,$459.64,$464.28,$0.00,$90.82,$0.00,$92.39,$0.00
240.068,SUP,HCPCS C1713,,240.068  -  PLATE BONE 8 HOLE SCALLOPED STAINLESS STEEL TIBIA DISTAL,$614.80,$0.00,$614.80,$276.66,$438.78,$0.00,$105.93,$0.00,$0.00,$107.65,$614.80,$0.00,$307.40,$486.92,$491.84,$0.00,$96.22,$0.00,$97.88,$0.00
240.069,SUP,HCPCS C1713,,240.069  -  PLATE BONE 9 HOLE SCALLOPED STAINLESS STEEL TIBIA DISTAL,$643.95,$0.00,$643.95,$289.78,$459.59,$0.00,$110.95,$0.00,$0.00,$112.75,$643.95,$0.00,$321.98,$510.01,$515.16,$0.00,$100.78,$0.00,$102.52,$0.00
240.07,SUP,HCPCS C1713,,240.070  -  LASER SURG 20 BACKSTOP,$677.08,$0.00,$677.08,$304.68,$483.23,$0.00,$116.66,$0.00,$0.00,$118.55,$677.08,$0.00,$338.54,$536.25,$541.66,$0.00,$105.96,$0.00,$107.79,$0.00
240.071,SUP,HCPCS C1713,,240.071  -  PLATE BONE 11 HOLE SCALLOPED STAINLESS STEEL TIBIA DISTAL,$734.05,$0.00,$734.05,$330.32,$523.89,$0.00,$126.47,$0.00,$0.00,$128.53,$734.05,$0.00,$367.03,$581.37,$587.24,$0.00,$114.88,$0.00,$116.86,$0.00
240.072,SUP,HCPCS C1713,,240.072  -  PLATE BONE 12 HOLE SCALLOPED STAINLESS STEEL TIBIA DISTAL,$760.55,$0.00,$760.55,$342.25,$542.80,$0.00,$131.04,$0.00,$0.00,$133.17,$760.55,$0.00,$380.28,$602.36,$608.44,$0.00,$119.03,$0.00,$121.08,$0.00
240.073,SUP,HCPCS C1713,,240.073  -  PLATE BONE 13 HOLE SCALLOPED STAINLESS STEEL TIBIA DISTAL,$812.23,$0.00,$812.23,$365.50,$579.68,$0.00,$139.94,$0.00,$0.00,$142.21,$812.23,$0.00,$406.11,$643.29,$649.78,$0.00,$127.11,$0.00,$129.31,$0.00
240.074,SUP,HCPCS C1713,,240.074  -  PLATE BONE 14 HOLE SCALLOPED STAINLESS STEEL TIBIA DISTAL,$857.28,$0.00,$857.28,$385.77,$611.84,$0.00,$147.70,$0.00,$0.00,$150.10,$857.28,$0.00,$428.64,$678.97,$685.82,$0.00,$134.16,$0.00,$136.48,$0.00
240.075,SUP,HCPCS C1713,,240.075  -  PLATE BONE 15 HOLE SCALLOPED STAINLESS STEEL TIBIA DISTAL,$912.93,$0.00,$912.93,$410.82,$651.55,$0.00,$157.29,$0.00,$0.00,$159.85,$912.93,$0.00,$456.46,$723.04,$730.34,$0.00,$142.87,$0.00,$145.34,$0.00
240.076,SUP,HCPCS C1713,,240.076  -  PLATE BONE 16 HOLE SCALLOPED STAINLESS STEEL TIBIA DISTAL,$995.08,$0.00,$995.08,$447.78,$710.19,$0.00,$171.45,$0.00,$0.00,$174.23,$995.08,$0.00,$497.54,$788.10,$796.06,$0.00,$155.73,$0.00,$158.42,$0.00
240.082,SUP,HCPCS C1713,,240.082  -  PLATE BONE 173MM 7 HOLE PILON LCP STAINLESS STEEL DISTAL,"$3,118.45",$0.00,"$3,118.45","$1,403.30","$2,225.64",$0.00,$659.85,$0.00,$0.00,$546.02,"$3,118.45",$0.00,"$1,559.23","$2,469.81","$2,494.76",$0.00,$599.36,$0.00,$496.46,$0.00
240.083,SUP,HCPCS C1713,,240.083  -  PLATE BONE 173MM 9 HOLE PILON CNTOUR LCP STAINLESS STEEL,"$3,282.23",$0.00,"$3,282.23","$1,477.00","$2,342.52",$0.00,$549.04,$0.00,$0.00,$574.69,"$3,282.23",$0.00,"$1,641.11","$2,599.53","$2,625.78",$0.00,$498.71,$0.00,$522.53,$0.00
240.13,SUP,HCPCS C1713,,240.13  -  PLATE BONE T 68MM 3 HOLE DCP LC-DCP STAINLESS STEEL FT,$490.25,$0.00,$490.25,$220.61,$349.89,$0.00,$84.47,$0.00,$0.00,$85.84,$490.25,$0.00,$245.13,$388.28,$392.20,$0.00,$76.72,$0.00,$78.05,$0.00
240.14,SUP,HCPCS C1713,,240.14  -  PLATE BN T 84MM NS 4 HL SHFT SS 4.5MM SCR LG FRAG SET,$534.98,$0.00,$534.98,$240.74,$381.81,$0.00,$89.49,$0.00,$0.00,$93.67,$534.98,$0.00,$267.49,$423.70,$427.98,$0.00,$81.29,$0.00,$85.17,$0.00
240.141,SUP,HCPCS C1713,,240.141  -  PLATE BN T 83MM NS LCP CMBN 4 HL LMT CNTCT TPR END SS 4.5/5,"$1,104.08",$0.00,"$1,104.08",$496.83,$787.98,$0.00,$184.69,$0.00,$0.00,$193.31,"$1,104.08",$0.00,$552.04,$874.43,$883.26,$0.00,$167.76,$0.00,$175.77,$0.00
240.15,SUP,HCPCS C1713,,240.15  -  PLATE BONE 100MM 5 HOLE T DCP LC-DCP STAINLESS STEEL FT,$560.48,$0.00,$560.48,$252.21,$400.01,$0.00,$96.57,$0.00,$0.00,$98.13,$560.48,$0.00,$280.24,$443.90,$448.38,$0.00,$87.71,$0.00,$89.23,$0.00
240.16,SUP,HCPCS C1713,,240.16  -  PLATE BN T 116MM NS 6 HL SHFT SS 4.5MM SCR LG FRAG SET,$638.70,$0.00,$638.70,$287.42,$455.84,$0.00,$106.84,$0.00,$0.00,$111.83,$638.70,$0.00,$319.35,$505.85,$510.96,$0.00,$97.05,$0.00,$101.68,$0.00
240.161,SUP,HCPCS C1713,,240.161  -  PLATE BN T 115MM NS LCP CMBN 6 HL LMT CNTCT TPR END SS 4.5/5,"$1,266.50",$0.00,"$1,266.50",$569.93,$903.90,$0.00,$211.85,$0.00,$0.00,$221.75,"$1,266.50",$0.00,$633.25,"$1,003.07","$1,013.20",$0.00,$192.43,$0.00,$201.63,$0.00
240.18,SUP,HCPCS C1713,,240.18  -  PLATE BN T 148MM NS 8 HL SHFT SS 4.5MM SCR LG FRAG SET,$865.25,$0.00,$865.25,$389.36,$617.53,$0.00,$144.74,$0.00,$0.00,$151.50,$865.25,$0.00,$432.63,$685.28,$692.20,$0.00,$131.47,$0.00,$137.75,$0.00
240.181,SUP,HCPCS C1713,,240.181  -  PLATE BN T 147MM NS LCP CMBN 8 HL LMT CNTCT TPR END SS 4.5/5,"$1,461.65",$0.00,"$1,461.65",$657.74,"$1,043.18",$0.00,$244.50,$0.00,$0.00,$255.92,"$1,461.65",$0.00,$730.83,"$1,157.63","$1,169.32",$0.00,$222.09,$0.00,$232.69,$0.00
240.34,SUP,HCPCS C1713,,240.34  -  PLATE BN TBTRS 80MM NS DCP 4 HL SHFT SS 4.5MM SCR LG FRAG,$814.88,$0.00,$814.88,$366.69,$581.58,$0.00,$140.40,$0.00,$0.00,$142.68,$814.88,$0.00,$407.44,$645.38,$651.90,$0.00,$127.53,$0.00,$129.73,$0.00
240.35,SUP,HCPCS C1713,,240.35  -  PLATE BONE T 96MM 5 HOLE BUTTRESS DCP LC-DCP STAINLESS STEEL,$857.28,$0.00,$857.28,$385.77,$611.84,$0.00,$147.70,$0.00,$0.00,$150.10,$857.28,$0.00,$428.64,$678.97,$685.82,$0.00,$134.16,$0.00,$136.48,$0.00
240.36,SUP,HCPCS C1713,,240.36  -  PLATE BONE T 112MM 6 HOLE BUTTRESS DCP STAINLESS STEEL FT,$913.03,$0.00,$913.03,$410.86,$651.63,$0.00,$152.73,$0.00,$0.00,$159.86,$913.03,$0.00,$456.51,$723.12,$730.42,$0.00,$138.73,$0.00,$145.35,$0.00
240.403,SUP,HCPCS C1713,,240.403  -  PLATE BONE 87MM 3 HOLE BUTTRESS DCP STAINLESS STEEL TIBIAL,"$1,057.35",$0.00,"$1,057.35",$475.81,$754.63,$0.00,$182.18,$0.00,$0.00,$185.13,"$1,057.35",$0.00,$528.68,$837.42,$845.88,$0.00,$165.48,$0.00,$168.33,$0.00
240.406,SUP,HCPCS C1713,,240.406  -  PLATE BONE LEFT ANGLE L 115MM 6 HOLE BUTTRESS LC-DCP,"$1,018.10",$0.00,"$1,018.10",$458.15,$726.62,$0.00,$170.30,$0.00,$0.00,$178.26,"$1,018.10",$0.00,$509.05,$806.34,$814.48,$0.00,$154.69,$0.00,$162.08,$0.00
240.407,SUP,HCPCS C1713,,240.407  -  PLATE BONE LEFT ANGLE L 132MM 7 HOLE BUTTRESS LC-DCP,"$1,075.90",$0.00,"$1,075.90",$484.16,$767.87,$0.00,$185.37,$0.00,$0.00,$188.38,"$1,075.90",$0.00,$537.95,$852.11,$860.72,$0.00,$168.38,$0.00,$171.28,$0.00
240.408,SUP,HCPCS C1713,,240.408  -  PLATE BONE LEFT ANGLE L 148MM 8 HOLE BUTTRESS LC-DCP,"$1,162.78",$0.00,"$1,162.78",$523.25,$829.87,$0.00,$194.50,$0.00,$0.00,$203.59,"$1,162.78",$0.00,$581.39,$920.92,$930.22,$0.00,$176.67,$0.00,$185.11,$0.00
240.44,SUP,HCPCS C1713,,240.44  -  PLATE BN ANG LT L BTRS 86X14X3.8MM NS DCP 4 HL SHFT SS TIB,$734.23,$0.00,$734.23,$330.40,$524.02,$0.00,$122.82,$0.00,$0.00,$128.56,$734.23,$0.00,$367.11,$581.51,$587.38,$0.00,$111.56,$0.00,$116.89,$0.00
240.46,SUP,HCPCS C1713,,240.46  -  PLATE BN BTRS 118X14X3.8MM NS DCP 5 HL SHFT SS TIBHD RL LG,"$1,266.50",$0.00,"$1,266.50",$569.93,$903.90,$0.00,$211.85,$0.00,$0.00,$221.75,"$1,266.50",$0.00,$633.25,"$1,003.07","$1,013.20",$0.00,$192.43,$0.00,$201.63,$0.00
240.47,SUP,HCPCS C1713,,240.47  -  PLATE BN BTRS 149X14X3.8MM NS DCP 7 HL SHFT SS TIBHD RL LG,"$1,360.65",$0.00,"$1,360.65",$612.29,$971.10,$0.00,$227.61,$0.00,$0.00,$238.24,"$1,360.65",$0.00,$680.33,"$1,077.63","$1,088.52",$0.00,$206.74,$0.00,$216.62,$0.00
240.48,SUP,HCPCS C1713,,240.48  -  PLATE BN BTRS 181X14X3.8MM NS DCP 9 HL SHFT SS TIBHD RL LG,"$1,452.10",$0.00,"$1,452.10",$653.45,"$1,036.36",$0.00,$242.90,$0.00,$0.00,$254.25,"$1,452.10",$0.00,$726.05,"$1,150.06","$1,161.68",$0.00,$220.63,$0.00,$231.17,$0.00
240.5,SUP,HCPCS C1713,,240.50  -  PLATE BONE 240MM 13 HOLE BUTTRESS DCP STAINLESS STEEL TIBIA,"$1,604.95",$0.00,"$1,604.95",$722.23,"$1,145.45",$0.00,$268.47,$0.00,$0.00,$281.01,"$1,604.95",$0.00,$802.48,"$1,271.12","$1,283.96",$0.00,$243.86,$0.00,$255.51,$0.00
240.505,SUP,HCPCS C1713,,240.505  -  PLATE BONE RIGHT ANG L 101MM 5 HOLE BUTTRESS LC-DCP,$983.15,$0.00,$983.15,$442.42,$701.67,$0.00,$169.39,$0.00,$0.00,$172.14,$983.15,$0.00,$491.58,$778.65,$786.52,$0.00,$153.86,$0.00,$156.52,$0.00
240.506,SUP,HCPCS C1713,,240.506  -  PLATE BONE RIGHT ANG L 115MM 6 HOLE BUTTRESS LC-DCP,"$1,018.10",$0.00,"$1,018.10",$458.15,$726.62,$0.00,$170.30,$0.00,$0.00,$178.26,"$1,018.10",$0.00,$509.05,$806.34,$814.48,$0.00,$154.69,$0.00,$162.08,$0.00
240.508,SUP,HCPCS C1713,,240.508  -  PLATE BONE RIGHT ANG L 148MM 8 HOLE BUTTRESS LC-DCP,"$1,162.78",$0.00,"$1,162.78",$523.25,$829.87,$0.00,$194.50,$0.00,$0.00,$203.59,"$1,162.78",$0.00,$581.39,$920.92,$930.22,$0.00,$176.67,$0.00,$185.11,$0.00
240.509,SUP,HCPCS C1713,,240.509  -  PLATE BONE 162MM BUTTRESS L 9 HOLE LC-DCP TITANIUM LEFT,"$1,175.28",$0.00,"$1,175.28",$528.87,$838.79,$0.00,$202.49,$0.00,$0.00,$205.78,"$1,175.28",$0.00,$587.64,$930.82,$940.22,$0.00,$183.93,$0.00,$187.10,$0.00
240.54,SUP,HCPCS C1713,,240.54  -  PLATE BN ANG RT L BTRS 86X14X3.8MM NS DCP 4 HL SHFT SS TIB,$734.23,$0.00,$734.23,$330.40,$524.02,$0.00,$122.82,$0.00,$0.00,$128.56,$734.23,$0.00,$367.11,$581.51,$587.38,$0.00,$111.56,$0.00,$116.89,$0.00
240.56,SUP,HCPCS C1713,,240.56  -  PLATE BN BTRS 118X14X3.8MM NS DCP 5 HL SHFT SS TIBHD L/L 4.5,"$1,266.50",$0.00,"$1,266.50",$569.93,$903.90,$0.00,$211.85,$0.00,$0.00,$221.75,"$1,266.50",$0.00,$633.25,"$1,003.07","$1,013.20",$0.00,$192.43,$0.00,$201.63,$0.00
240.57,SUP,HCPCS C1713,,240.57  -  PLATE BN BTRS 149X14X3.8MM NS DCP 7 HL SHFT SS TIBHD L/L LG,"$1,360.65",$0.00,"$1,360.65",$612.29,$971.10,$0.00,$227.61,$0.00,$0.00,$238.24,"$1,360.65",$0.00,$680.33,"$1,077.63","$1,088.52",$0.00,$206.74,$0.00,$216.62,$0.00
240.58,SUP,HCPCS C1713,,240.58  -  PLATE BN BTRS 181X14X3.8MM NS DCP 9 HL SHFT SS TIBHD L/L LG,"$1,452.10",$0.00,"$1,452.10",$653.45,"$1,036.36",$0.00,$242.90,$0.00,$0.00,$254.25,"$1,452.10",$0.00,$726.05,"$1,150.06","$1,161.68",$0.00,$220.63,$0.00,$231.17,$0.00
240.6,SUP,HCPCS C1713,,240.60  -  PLATE BONE 240X14X3.8MM 13 HOLE SHAFT BUTTRESS DCP STAINLESS,"$1,604.95",$0.00,"$1,604.95",$722.23,"$1,145.45",$0.00,$268.47,$0.00,$0.00,$281.01,"$1,604.95",$0.00,$802.48,"$1,271.12","$1,283.96",$0.00,$243.86,$0.00,$255.51,$0.00
240.7,SUP,HCPCS C1713,,240.70  -  PLATE BONE BUTTRESS 221X16X5MM 11 HOLE SHAFT DCP STAINLESS,"$1,539.45",$0.00,"$1,539.45",$692.75,"$1,098.71",$0.00,$257.51,$0.00,$0.00,$269.55,"$1,539.45",$0.00,$769.73,"$1,219.24","$1,231.56",$0.00,$233.90,$0.00,$245.08,$0.00
240.71,SUP,HCPCS C1713,,240.71  -  PLATE BONE BUTTRESS 253X16X5MM 11 HOLE SHAFT DCP STAINLESS,"$1,582.05",$0.00,"$1,582.05",$711.92,"$1,129.11",$0.00,$272.58,$0.00,$0.00,$277.00,"$1,582.05",$0.00,$791.03,"$1,252.98","$1,265.64",$0.00,$247.59,$0.00,$251.86,$0.00
240.72,SUP,HCPCS C1713,,240.72  -  PLATE BONE 285MM BUTTRESS 15 HOLE DCP STAINLESS STEEL,"$1,624.45",$0.00,"$1,624.45",$731.00,"$1,159.37",$0.00,$279.88,$0.00,$0.00,$284.43,"$1,624.45",$0.00,$812.23,"$1,286.56","$1,299.56",$0.00,$254.23,$0.00,$258.61,$0.00
240.73,SUP,HCPCS C1713,,240.73  -  PLATE BONE BUTTRESS 221X16X5MM 11 HOLE SHAFT DCP STAINLESS,"$1,537.00",$0.00,"$1,537.00",$691.65,"$1,096.96",$0.00,$264.82,$0.00,$0.00,$269.12,"$1,537.00",$0.00,$768.50,"$1,217.30","$1,229.60",$0.00,$240.54,$0.00,$244.69,$0.00
240.75,SUP,HCPCS C1713,,240.75  -  PLATE BONE 285MM 15 HOLE BUTTRESS DCP STAINLESS STEEL,"$1,624.45",$0.00,"$1,624.45",$731.00,"$1,159.37",$0.00,$279.88,$0.00,$0.00,$284.43,"$1,624.45",$0.00,$812.23,"$1,286.56","$1,299.56",$0.00,$254.23,$0.00,$258.61,$0.00
240.8,SUP,HCPCS C1713,,240.80  -  PLATE BONE 128MM 4 HOLE HOOK BUTTRESS DCP STAINLESS STEEL,"$1,257.43",$0.00,"$1,257.43",$565.84,$897.42,$0.00,$216.65,$0.00,$0.00,$220.17,"$1,257.43",$0.00,$628.71,$995.88,"$1,005.94",$0.00,$196.79,$0.00,$200.18,$0.00
240.9,SUP,HCPCS C1713,,240.90  -  PLATE 202MM SS LG FRAG SET 10 HOLE CBR HEAD DCP BONE ORTH,"$1,158.05",$0.00,"$1,158.05",$521.12,$826.50,$0.00,$199.53,$0.00,$0.00,$202.77,"$1,158.05",$0.00,$579.03,$917.18,$926.44,$0.00,$181.23,$0.00,$184.36,$0.00
240.91,SUP,HCPCS C1713,,240.91  -  PLATE BONE 218MM 11 HOLE COBRA HEAD LC-DCP STAINLESS STEEL,"$1,220.33",$0.00,"$1,220.33",$549.15,$870.95,$0.00,$210.26,$0.00,$0.00,$213.67,"$1,220.33",$0.00,$610.16,$966.50,$976.26,$0.00,$190.98,$0.00,$194.28,$0.00
240.92,SUP,HCPCS C1713,,240.92  -  PLATE BN BTRS 158X16X5MM NS DCP 7 HL SHFT SS FEM LT CNDRL,"$1,356.55",$0.00,"$1,356.55",$610.45,$968.17,$0.00,$226.92,$0.00,$0.00,$237.52,"$1,356.55",$0.00,$678.28,"$1,074.39","$1,085.24",$0.00,$206.12,$0.00,$215.96,$0.00
240.93,SUP,HCPCS C1713,,240.93  -  PLATE BN BTRS 190X16X5MM NS DCP 9 HL SHFT SS FEM LT CNDRL,"$1,467.10",$0.00,"$1,467.10",$660.20,"$1,047.07",$0.00,$245.41,$0.00,$0.00,$256.88,"$1,467.10",$0.00,$733.55,"$1,161.94","$1,173.68",$0.00,$222.91,$0.00,$233.56,$0.00
240.94,SUP,HCPCS C1713,,240.94  -  PLATE BN BTRS 158X16X5MM NS DCP 7 HL SHFT SS FEM RT CNDRL,"$1,356.55",$0.00,"$1,356.55",$610.45,$968.17,$0.00,$226.92,$0.00,$0.00,$237.52,"$1,356.55",$0.00,$678.28,"$1,074.39","$1,085.24",$0.00,$206.12,$0.00,$215.96,$0.00
240.95,SUP,HCPCS C1713,,240.95  -  PLATE BN BTRS 190X16X5MM NS DCP 9 HL SHFT SS FEM RT CNDRL,"$1,467.10",$0.00,"$1,467.10",$660.20,"$1,047.07",$0.00,$245.41,$0.00,$0.00,$256.88,"$1,467.10",$0.00,$733.55,"$1,161.94","$1,173.68",$0.00,$222.91,$0.00,$233.56,$0.00
240.98,SUP,HCPCS C1713,,240.98  -  PLATE BONE 170MM 8 HOLE COBRA HEAD DCP STAINLESS STEEL,"$1,030.85",$0.00,"$1,030.85",$463.88,$735.72,$0.00,$177.61,$0.00,$0.00,$180.49,"$1,030.85",$0.00,$515.43,$816.43,$824.68,$0.00,$161.33,$0.00,$164.11,$0.00
240.99,SUP,HCPCS C1713,,240.99  -  PLATE BONE 186MM 9 HOLE COBRA HEAD DCP STAINLESS STEEL,"$1,098.43",$0.00,"$1,098.43",$494.29,$783.95,$0.00,$189.25,$0.00,$0.00,$192.33,"$1,098.43",$0.00,$549.21,$869.96,$878.74,$0.00,$171.90,$0.00,$174.87,$0.00
241.004,SUP,HCPCS C1713,,241.004  -  PLATE BN 60MM NS 4 HL SHFT SS TIB RT PROX 3.5MM SCR SM FRAG,"$2,108.55",$0.00,"$2,108.55",$948.85,"$1,504.87",$0.00,$352.71,$0.00,$0.00,$369.19,"$2,108.55",$0.00,"$1,054.28","$1,669.97","$1,686.84",$0.00,$320.38,$0.00,$335.68,$0.00
241.005,SUP,HCPCS C1713,,241.005  -  PLATE BONE 60MM 4 HOLE STAINLESS STEEL TIBIA LEFT PROXIMAL,"$2,108.55",$0.00,"$2,108.55",$948.85,"$1,504.87",$0.00,$352.71,$0.00,$0.00,$369.19,"$2,108.55",$0.00,"$1,054.28","$1,669.97","$1,686.84",$0.00,$320.38,$0.00,$335.68,$0.00
241.006,SUP,HCPCS C1713,,241.006  -  PLATE BONE 85MM 6 HOLE STAINLESS STEEL TIBIA RIGHT PROXIMAL,"$2,116.73",$0.00,"$2,116.73",$952.53,"$1,510.71",$0.00,$354.08,$0.00,$0.00,$370.62,"$2,116.73",$0.00,"$1,058.36","$1,676.45","$1,693.38",$0.00,$321.62,$0.00,$336.98,$0.00
241.007,SUP,HCPCS C1713,,241.007  -  PLATE BONE 85MM 6 HOLE STAINLESS STEEL TIBIA LEFT PROXIMAL,"$2,116.73",$0.00,"$2,116.73",$952.53,"$1,510.71",$0.00,$354.08,$0.00,$0.00,$370.62,"$2,116.73",$0.00,"$1,058.36","$1,676.45","$1,693.38",$0.00,$321.62,$0.00,$336.98,$0.00
241.008,SUP,HCPCS C1713,,241.008  -  PLATE BN 111MM NS 8 HL SHFT SS TIB RT PROX 3.5MM SCR SM FRAG,"$2,184.98",$0.00,"$2,184.98",$983.24,"$1,559.42",$0.00,$365.49,$0.00,$0.00,$382.57,"$2,184.98",$0.00,"$1,092.49","$1,730.50","$1,747.98",$0.00,$331.99,$0.00,$347.85,$0.00
241.009,SUP,HCPCS C1713,,241.009  -  PLATE BN 111MM NS 8 HL SHFT SS TIB LT PROX 3.5MM SCR SM FRAG,"$2,184.98",$0.00,"$2,184.98",$983.24,"$1,559.42",$0.00,$365.49,$0.00,$0.00,$382.57,"$2,184.98",$0.00,"$1,092.49","$1,730.50","$1,747.98",$0.00,$331.99,$0.00,$347.85,$0.00
241.01,SUP,HCPCS C1713,,241.010  -  PLATE BONE 137MM 10 HOLE STAINLESS STEEL TIBIA RIGHT,"$2,197.25",$0.00,"$2,197.25",$988.76,"$1,568.18",$0.00,$367.55,$0.00,$0.00,$384.72,"$2,197.25",$0.00,"$1,098.63","$1,740.22","$1,757.80",$0.00,$333.85,$0.00,$349.80,$0.00
241.011,SUP,HCPCS C1713,,241.011  -  PLATE BN 137MM NS 10 HL SHFT SS TIB LT PROX 3.5MM SCR SM,"$2,197.25",$0.00,"$2,197.25",$988.76,"$1,568.18",$0.00,$367.55,$0.00,$0.00,$384.72,"$2,197.25",$0.00,"$1,098.63","$1,740.22","$1,757.80",$0.00,$333.85,$0.00,$349.80,$0.00
241.012,SUP,HCPCS C1713,,241.012  -  PLATE BN 137MM NS 12 HL SHFT SS TIB RT PROX 3.5MM SCR SM,"$2,279.13",$0.00,"$2,279.13","$1,025.61","$1,626.61",$0.00,$381.25,$0.00,$0.00,$399.06,"$2,279.13",$0.00,"$1,139.56","$1,805.07","$1,823.30",$0.00,$346.30,$0.00,$362.84,$0.00
241.013,SUP,HCPCS C1713,,241.013  -  PLATE BN 163MM NS 12 HL SHFT SS TIB LT PROX 3.5MM SCR SM,"$2,279.13",$0.00,"$2,279.13","$1,025.61","$1,626.61",$0.00,$381.25,$0.00,$0.00,$399.06,"$2,279.13",$0.00,"$1,139.56","$1,805.07","$1,823.30",$0.00,$346.30,$0.00,$362.84,$0.00
241.014,SUP,HCPCS C1713,,241.014  -  PLATE BONE 163MM 14 HOLE STAINLESS STEEL TIBIA RIGHT,"$2,328.28",$0.00,"$2,328.28","$1,047.72","$1,661.69",$0.00,$389.46,$0.00,$0.00,$407.66,"$2,328.28",$0.00,"$1,164.14","$1,844.00","$1,862.62",$0.00,$353.76,$0.00,$370.66,$0.00
241.015,SUP,HCPCS C1713,,241.015  -  PLATE BONE 189MM 14 HOLE STAINLESS STEEL TIBIA LEFT PROXIMAL,"$2,328.28",$0.00,"$2,328.28","$1,047.72","$1,661.69",$0.00,$389.46,$0.00,$0.00,$407.66,"$2,328.28",$0.00,"$1,164.14","$1,844.00","$1,862.62",$0.00,$353.76,$0.00,$370.66,$0.00
241.016,SUP,HCPCS C1713,,241.016  -  PLATE BN 215MM NS 16 HL SHFT SS TIB RT PROX 3.5MM SCR SM,"$2,376.03",$0.00,"$2,376.03","$1,069.21","$1,695.77",$0.00,$397.45,$0.00,$0.00,$416.02,"$2,376.03",$0.00,"$1,188.01","$1,881.82","$1,900.82",$0.00,$361.02,$0.00,$378.26,$0.00
241.017,SUP,HCPCS C1713,,241.017  -  PLATE BONE 215MM 16 HOLE STAINLESS STEEL TIBIA LEFT PROXIMAL,"$2,376.03",$0.00,"$2,376.03","$1,069.21","$1,695.77",$0.00,$397.45,$0.00,$0.00,$416.02,"$2,376.03",$0.00,"$1,188.01","$1,881.82","$1,900.82",$0.00,$361.02,$0.00,$378.26,$0.00
241.031,SUP,HCPCS C1713,,241.031  -  PLATE BN OB R T 52X10X1.5MM NS LCP CMBN 3 HLE/HD 3 HL SHFT,$642.80,$0.00,$642.80,$289.26,$458.77,$0.00,$107.53,$0.00,$0.00,$112.55,$642.80,$0.00,$321.40,$509.10,$514.24,$0.00,$97.67,$0.00,$102.33,$0.00
241.041,SUP,HCPCS C1713,,241.041  -  PLATE BN OB R T 63X10X1.5MM NS LCP CMBN 3 HLE/HD 4 HL SHFT,$672.83,$0.00,$672.83,$302.77,$480.20,$0.00,$112.55,$0.00,$0.00,$117.81,$672.83,$0.00,$336.41,$532.88,$538.26,$0.00,$102.23,$0.00,$107.11,$0.00
241.051,SUP,HCPCS C1713,,241.051  -  PLATE BN OB R T 74X10X1.5MM NS LCP CMBN 3 HLE/HD 5 HL SHFT,$702.85,$0.00,$702.85,$316.28,$501.62,$0.00,$155.45,$0.00,$0.00,$123.06,$702.85,$0.00,$351.43,$556.66,$562.28,$0.00,$141.20,$0.00,$111.89,$0.00
241.061,SUP,HCPCS C1713,,241.061  -  PLATE BONE T 85X10X1.5MM 3X6 HOLE OBLIQUE RIGHT LCP,$753.35,$0.00,$753.35,$339.01,$537.67,$0.00,$126.02,$0.00,$0.00,$131.91,$753.35,$0.00,$376.68,$596.65,$602.68,$0.00,$114.46,$0.00,$119.93,$0.00
241.062,SUP,HCPCS C1713,,241.062  -  PLATE BONE 15MM 6 HOLE HOOK LC-DCP DCP STAINLESS STEEL RIGHT,"$1,272.00",$0.00,"$1,272.00",$572.40,$907.83,$0.00,$219.16,$0.00,$0.00,$222.72,"$1,272.00",$0.00,$636.00,"$1,007.42","$1,017.60",$0.00,$199.07,$0.00,$202.50,$0.00
241.063,SUP,HCPCS C1713,,241.063  -  PLATE BONE 15MM 6 HOLE HOOK LC-DCP STAINLESS STEEL LEFT,"$1,272.00",$0.00,"$1,272.00",$572.40,$907.83,$0.00,$219.16,$0.00,$0.00,$222.72,"$1,272.00",$0.00,$636.00,"$1,007.42","$1,017.60",$0.00,$199.07,$0.00,$202.50,$0.00
241.064,SUP,HCPCS C1713,,241.064  -  PLATE BONE 18MM 6 HOLE HOOK LC-DCP DCP STAINLESS STEEL RIGHT,"$1,272.00",$0.00,"$1,272.00",$572.40,$907.83,$0.00,$219.16,$0.00,$0.00,$222.72,"$1,272.00",$0.00,$636.00,"$1,007.42","$1,017.60",$0.00,$199.07,$0.00,$202.50,$0.00
241.065,SUP,HCPCS C1713,,241.065  -  PLATE BONE 18MM 6 HOLE HOOK LC-DCP STAINLESS STEEL LEFT,"$1,272.00",$0.00,"$1,272.00",$572.40,$907.83,$0.00,$219.16,$0.00,$0.00,$222.72,"$1,272.00",$0.00,$636.00,"$1,007.42","$1,017.60",$0.00,$199.07,$0.00,$202.50,$0.00
241.066,SUP,HCPCS C1713,,241.066  -  PLATE BONE 15MM 8 HOLE HOOK LC-DCP STAINLESS STEEL RIGHT,"$1,364.75",$0.00,"$1,364.75",$614.14,$974.02,$0.00,$235.14,$0.00,$0.00,$238.96,"$1,364.75",$0.00,$682.38,"$1,080.88","$1,091.80",$0.00,$213.58,$0.00,$217.27,$0.00
241.067,SUP,HCPCS C1713,,241.067  -  PLATE BONE 15MM 8 HOLE HOOK LC-DCP STAINLESS STEEL LEFT,"$1,364.75",$0.00,"$1,364.75",$614.14,$974.02,$0.00,$235.14,$0.00,$0.00,$238.96,"$1,364.75",$0.00,$682.38,"$1,080.88","$1,091.80",$0.00,$213.58,$0.00,$217.27,$0.00
241.068,SUP,HCPCS C1713,,241.068  -  PLATE BONE 18MM 8 HOLE HOOK LC-DCP STAINLESS STEEL RIGHT,"$1,364.75",$0.00,"$1,364.75",$614.14,$974.02,$0.00,$235.14,$0.00,$0.00,$238.96,"$1,364.75",$0.00,$682.38,"$1,080.88","$1,091.80",$0.00,$213.58,$0.00,$217.27,$0.00
241.069,SUP,HCPCS C1713,,241.069  -  PLATE BN 18MM 77X10X3.3MM NS LC DCP 8 HL HK PRECONTOUR SS,"$1,364.75",$0.00,"$1,364.75",$614.14,$974.02,$0.00,$235.14,$0.00,$0.00,$238.96,"$1,364.75",$0.00,$682.38,"$1,080.88","$1,091.80",$0.00,$213.58,$0.00,$217.27,$0.00
241.071,SUP,HCPCS C1713,,241.071  -  PLATE BN OB R T 96X10X1.5MM NS LCP CMBN 3 HLE/HD 7 HL SHFT,$762.90,$0.00,$762.90,$343.31,$544.48,$0.00,$169.09,$0.00,$0.00,$133.58,$762.90,$0.00,$381.45,$604.22,$610.32,$0.00,$153.59,$0.00,$121.45,$0.00
241.081,SUP,HCPCS C1713,,241.081  -  PLATE BONE T 107X10X1.5MM 3X8 HOLE OBLIQUE RIGHT LCP,$828.40,$0.00,$828.40,$372.78,$591.23,$0.00,$138.57,$0.00,$0.00,$145.05,$828.40,$0.00,$414.20,$656.09,$662.72,$0.00,$125.87,$0.00,$131.88,$0.00
241.13,SUP,HCPCS C1713,,241.13  -  PLATE BN RT ANG T 50X10X1.2MM NS LC DCP 3 HLE/HD 3 HL SHFT,$233.38,$0.00,$233.38,$105.02,$166.56,$0.00,$39.04,$0.00,$0.00,$40.86,$233.38,$0.00,$116.69,$184.84,$186.70,$0.00,$35.46,$0.00,$37.15,$0.00
241.131,SUP,HCPCS C1713,,241.131  -  PLATE BONE T RIGHT ANG 50X10X1.5MM 3X3 HOLE LCP STAINLESS,$574.55,$0.00,$574.55,$258.55,$410.06,$0.00,$96.11,$0.00,$0.00,$100.60,$574.55,$0.00,$287.28,$455.04,$459.64,$0.00,$87.30,$0.00,$91.47,$0.00
241.132,SUP,HCPCS C1713,,241.132  -  PLATE BONE T RIGHT ANG 50X11X1.5MM 4X3 HOLE LCP STAINLESS,$589.58,$0.00,$589.58,$265.31,$420.78,$0.00,$98.62,$0.00,$0.00,$103.23,$589.58,$0.00,$294.79,$466.95,$471.66,$0.00,$89.58,$0.00,$93.86,$0.00
241.14,SUP,HCPCS C1713,,241.14  -  PLATE BN RT ANG T 56X10X1.2MM NS LC DCP 4 HLE/HD 4 HL SHFT,$241.55,$0.00,$241.55,$108.70,$172.39,$0.00,$40.41,$0.00,$0.00,$42.29,$241.55,$0.00,$120.78,$191.31,$193.24,$0.00,$36.70,$0.00,$38.45,$0.00
241.141,SUP,HCPCS C1713,,241.141  -  PLATE BN RT ANG T 56X11X1.5MM NS LCP CMBN 4 HLE/HD 4 HL SHFT,$592.30,$0.00,$592.30,$266.54,$422.72,$0.00,$99.08,$0.00,$0.00,$103.71,$592.30,$0.00,$296.15,$469.10,$473.84,$0.00,$90.00,$0.00,$94.29,$0.00
241.142,SUP,HCPCS C1713,,241.142  -  PLATE BN RT ANG T 57X10X1.5MM NS LCP CMBN 3 HLE/HD 4 HL SHFT,$611.40,$0.00,$611.40,$275.13,$436.36,$0.00,$102.27,$0.00,$0.00,$107.05,$611.40,$0.00,$305.70,$484.23,$489.12,$0.00,$92.90,$0.00,$97.33,$0.00
241.15,SUP,HCPCS C1713,,241.15  -  PLATE BN RT ANG T 67X10X1.2MM NS LC DCP 3 HLE/HD 5 HL SHFT,$267.50,$0.00,$267.50,$120.38,$190.91,$0.00,$44.75,$0.00,$0.00,$46.84,$267.50,$0.00,$133.75,$211.86,$214.00,$0.00,$40.64,$0.00,$42.59,$0.00
241.151,SUP,HCPCS C1713,,241.151  -  PLATE BN RT ANG T 67X10X1.5MM NS LCP CMBN 3 HLE/HD 5 HL SHFT,$652.35,$0.00,$652.35,$293.56,$465.58,$0.00,$109.12,$0.00,$0.00,$114.22,$652.35,$0.00,$326.18,$516.66,$521.88,$0.00,$99.12,$0.00,$103.85,$0.00
241.152,SUP,HCPCS C1713,,241.152  -  PLATE BONE 67MM 3X5 HOLE T RIGHT ANG LCP STAINLESS STEEL,$671.45,$0.00,$671.45,$302.15,$479.21,$0.00,$112.32,$0.00,$0.00,$117.57,$671.45,$0.00,$335.73,$531.79,$537.16,$0.00,$102.02,$0.00,$106.89,$0.00
241.16,SUP,HCPCS C1713,,241.16  -  PLATE BONE ANGLE RIGHT T 75X10X1.2MM 4X6 HOLE LCP STAINLESS,$311.18,$0.00,$311.18,$140.03,$222.09,$0.00,$52.05,$0.00,$0.00,$54.48,$311.18,$0.00,$155.59,$246.45,$248.94,$0.00,$47.28,$0.00,$49.54,$0.00
241.161,SUP,HCPCS C1713,,241.161  -  PLATE BN RT ANG T 78X11X1.5MM NS LCP CMBN 4 HLE/HD 6 HL SHFT,$760.18,$0.00,$760.18,$342.08,$542.54,$0.00,$127.16,$0.00,$0.00,$133.10,$760.18,$0.00,$380.09,$602.06,$608.14,$0.00,$115.50,$0.00,$121.02,$0.00
241.162,SUP,HCPCS C1713,,241.162  -  PLATE BONE T RIGHT ANG 77X10X1.5MM 3X6 HOLE LCP STAINLESS,$780.63,$0.00,$780.63,$351.28,$557.13,$0.00,$130.58,$0.00,$0.00,$136.68,$780.63,$0.00,$390.31,$618.26,$624.50,$0.00,$118.61,$0.00,$124.28,$0.00
241.17,SUP,HCPCS C1713,,241.17  -  PLATE BONE T RIGHT ANG 90X10X1.2MM 4X7 HOLE LCP STAINLESS,$399.88,$0.00,$399.88,$179.94,$285.39,$0.00,$66.89,$0.00,$0.00,$70.01,$399.88,$0.00,$199.94,$316.70,$319.90,$0.00,$60.76,$0.00,$63.66,$0.00
241.171,SUP,HCPCS C1713,,241.171  -  PLATE BN RT ANG T 87X10X1.5MM NS LCP CMBN 3 HLE/HD 7 HL SHFT,$952.60,$0.00,$952.60,$428.67,$679.87,$0.00,$159.35,$0.00,$0.00,$166.79,$952.60,$0.00,$476.30,$754.46,$762.08,$0.00,$144.74,$0.00,$151.65,$0.00
241.172,SUP,HCPCS C1713,,241.172  -  PLATE BONE T RIGHT ANG 89X11X1.5MM 4X7 HOLE LCP STAINLESS,$948.50,$0.00,$948.50,$426.83,$676.94,$0.00,$158.66,$0.00,$0.00,$166.07,$948.50,$0.00,$474.25,$751.21,$758.80,$0.00,$144.12,$0.00,$151.00,$0.00
241.18,SUP,HCPCS C1713,,241.18  -  PLATE BONE 100MM 4 HOLE HEAD 8 HOLE SHAFT T RIGHT ANG LC-DCP,$464.03,$0.00,$464.03,$208.81,$331.17,$0.00,$77.62,$0.00,$0.00,$81.25,$464.03,$0.00,$232.01,$367.51,$371.22,$0.00,$70.50,$0.00,$73.87,$0.00
241.181,SUP,HCPCS C1713,,241.181  -  PLATE BONE T RIGHT ANG 97X10X1.5MM 3X8 HOLE LCP STAINLESS,"$1,140.93",$0.00,"$1,140.93",$513.42,$814.28,$0.00,$190.85,$0.00,$0.00,$199.77,"$1,140.93",$0.00,$570.46,$903.62,$912.74,$0.00,$173.36,$0.00,$181.64,$0.00
241.182,SUP,HCPCS C1713,,241.182  -  PLATE BONE T RIGHT ANG 100X10X1.5MM 4X8 HOLE LCP STAINLESS,"$1,136.83",$0.00,"$1,136.83",$511.57,$811.35,$0.00,$190.17,$0.00,$0.00,$199.05,"$1,136.83",$0.00,$568.41,$900.37,$909.46,$0.00,$172.73,$0.00,$180.98,$0.00
241.189,SUP,HCPCS C1713,,241.189  -  PLATE BONE 112MM 4 HOLE HEAD 9 HOLE SHAFT T RIGHT ANG LC-DCP,$502.23,$0.00,$502.23,$226.00,$358.44,$0.00,$84.01,$0.00,$0.00,$87.94,$502.23,$0.00,$251.11,$397.77,$401.78,$0.00,$76.31,$0.00,$79.95,$0.00
241.23,SUP,HCPCS C1713,,241.23  -  PLATE BN OBLQ T 53X10X1.5MM NS LC DCP 3 HLE/HD 3 HL SHFT SS,$401.23,$0.00,$401.23,$180.55,$286.35,$0.00,$67.12,$0.00,$0.00,$70.25,$401.23,$0.00,$200.61,$317.77,$320.98,$0.00,$60.96,$0.00,$63.88,$0.00
241.231,SUP,HCPCS C1713,,241.231  -  PLATE BONE 53MM 3X3 HOLE T OBLIQUE ANGLE LCP STAINLESS STEEL,$427.98,$0.00,$427.98,$192.59,$305.45,$0.00,$73.74,$0.00,$0.00,$74.93,$427.98,$0.00,$213.99,$338.96,$342.38,$0.00,$66.98,$0.00,$68.13,$0.00
241.24,SUP,HCPCS C1713,,241.24  -  PLATE BN OBLQ T 63X10X1.5MM NS LC DCP 3 HLE/HD 4 HL SHFT SS,$424.43,$0.00,$424.43,$190.99,$302.91,$0.00,$71.00,$0.00,$0.00,$74.31,$424.43,$0.00,$212.21,$336.15,$339.54,$0.00,$64.49,$0.00,$67.57,$0.00
241.241,SUP,HCPCS C1713,,241.241  -  PLATE BONE 63MM 3 HOLE HEAD 3 HOLE SHAFT T OBLIQUE STAINLESS,$449.18,$0.00,$449.18,$202.13,$320.58,$0.00,$77.39,$0.00,$0.00,$78.65,$449.18,$0.00,$224.59,$355.75,$359.34,$0.00,$70.30,$0.00,$71.51,$0.00
241.25,SUP,HCPCS C1713,,241.25  -  PLATE BN OBLQ T 75X10X1.5MM NS LC DCP 3 HLE/HD 5 HL SHFT SS,$436.73,$0.00,$436.73,$196.53,$311.69,$0.00,$73.05,$0.00,$0.00,$76.47,$436.73,$0.00,$218.36,$345.89,$349.38,$0.00,$66.36,$0.00,$69.53,$0.00
241.252,SUP,HCPCS C1713,,241.252  -  PLATE BONE 75MM 3 HOLE HEAD 3 HOLE SHAFT T OBLIQUE STAINLESS,$459.78,$0.00,$459.78,$206.90,$328.14,$0.00,$79.22,$0.00,$0.00,$80.50,$459.78,$0.00,$229.89,$364.15,$367.82,$0.00,$71.95,$0.00,$73.20,$0.00
241.262,SUP,HCPCS C1713,,241.262  -  PLATE BN 65X11X2.5MM NS LCP CMBN 3 HL PRECONTOUR LMT CNTCT,"$1,681.38",$0.00,"$1,681.38",$756.62,"$1,200.00",$0.00,$281.25,$0.00,$0.00,$294.40,"$1,681.38",$0.00,$840.69,"$1,331.65","$1,345.10",$0.00,$255.47,$0.00,$267.67,$0.00
241.263,SUP,HCPCS C1713,,241.263  -  PLATE BN 65X11X2.5MM NS LCP CMBN 3 HL PRECONTOUR LMT CNTCT,"$1,681.38",$0.00,"$1,681.38",$756.62,"$1,200.00",$0.00,$281.25,$0.00,$0.00,$294.40,"$1,681.38",$0.00,$840.69,"$1,331.65","$1,345.10",$0.00,$255.47,$0.00,$267.67,$0.00
241.264,SUP,HCPCS C1713,,241.264  -  PLATE BN 90X11X2.5MM NS LCP CMBN 5 HL PRECONTOUR LMT CNTCT,"$1,865.63",$0.00,"$1,865.63",$839.53,"$1,331.50",$0.00,$312.07,$0.00,$0.00,$326.66,"$1,865.63",$0.00,$932.81,"$1,477.58","$1,492.50",$0.00,$283.46,$0.00,$297.01,$0.00
241.265,SUP,HCPCS C1713,,241.265  -  PLATE BN 90X11X2.5MM NS LCP CMBN 5 HL PRECONTOUR LMT CNTCT,"$1,865.63",$0.00,"$1,865.63",$839.53,"$1,331.50",$0.00,$312.07,$0.00,$0.00,$326.66,"$1,865.63",$0.00,$932.81,"$1,477.58","$1,492.50",$0.00,$283.46,$0.00,$297.01,$0.00
241.266,SUP,HCPCS C1713,,241.266  -  PLATE BN 116X11X2.5MM NS LCP CMBN 7 HL PRECONTOUR LMT CNTCT,"$2,051.23",$0.00,"$2,051.23",$923.05,"$1,463.96",$0.00,$343.12,$0.00,$0.00,$359.15,"$2,051.23",$0.00,"$1,025.61","$1,624.57","$1,640.98",$0.00,$311.67,$0.00,$326.56,$0.00
241.267,SUP,HCPCS C1713,,241.267  -  PLATE BN 116X11X2.5MM NS LCP CMBN 7 HL PRECONTOUR LMT CNTCT,"$2,051.23",$0.00,"$2,051.23",$923.05,"$1,463.96",$0.00,$343.12,$0.00,$0.00,$359.15,"$2,051.23",$0.00,"$1,025.61","$1,624.57","$1,640.98",$0.00,$311.67,$0.00,$326.56,$0.00
241.268,SUP,HCPCS C1713,,241.268  -  PLATE BN 142X11X2.5MM NS LCP CMBN 9 HL PRECONTOUR LMT CNTCT,"$2,215.00",$0.00,"$2,215.00",$996.75,"$1,580.85",$0.00,$370.52,$0.00,$0.00,$387.83,"$2,215.00",$0.00,"$1,107.50","$1,754.28","$1,772.00",$0.00,$336.55,$0.00,$352.63,$0.00
241.269,SUP,HCPCS C1713,,241.269  -  PLATE BN 142X11X2.5MM NS LCP CMBN 9 HL PRECONTOUR LMT CNTCT,"$2,215.00",$0.00,"$2,215.00",$996.75,"$1,580.85",$0.00,$370.52,$0.00,$0.00,$387.83,"$2,215.00",$0.00,"$1,107.50","$1,754.28","$1,772.00",$0.00,$336.55,$0.00,$352.63,$0.00
241.272,SUP,HCPCS C1713,,241.272  -  PLATE BN 65X11X2.5MM NS LCP CMBN 3 HL PRECONTOUR LMT CNTCT,"$1,928.40",$0.00,"$1,928.40",$867.78,"$1,376.30",$0.00,$322.58,$0.00,$0.00,$337.65,"$1,928.40",$0.00,$964.20,"$1,527.29","$1,542.72",$0.00,$293.00,$0.00,$307.00,$0.00
241.273,SUP,HCPCS C1713,,241.273  -  PLATE BN 65X11X2.5MM NS LCP CMBN 3 HL PRECONTOUR LMT CNTCT,"$1,928.40",$0.00,"$1,928.40",$867.78,"$1,376.30",$0.00,$322.58,$0.00,$0.00,$337.65,"$1,928.40",$0.00,$964.20,"$1,527.29","$1,542.72",$0.00,$293.00,$0.00,$307.00,$0.00
241.274,SUP,HCPCS C1713,,241.274  -  PLATE BN 90X11X2.5MM NS LCP CMBN 5 HL PRECONTOUR LMT CNTCT,"$2,103.08",$0.00,"$2,103.08",$946.38,"$1,500.96",$0.00,$351.80,$0.00,$0.00,$368.23,"$2,103.08",$0.00,"$1,051.54","$1,665.64","$1,682.46",$0.00,$319.55,$0.00,$334.81,$0.00
241.275,SUP,HCPCS C1713,,241.275  -  PLATE BN 90X11X2.5MM NS LCP CMBN 5 HL PRECONTOUR LMT CNTCT,"$2,103.08",$0.00,"$2,103.08",$946.38,"$1,500.96",$0.00,$351.80,$0.00,$0.00,$368.23,"$2,103.08",$0.00,"$1,051.54","$1,665.64","$1,682.46",$0.00,$319.55,$0.00,$334.81,$0.00
241.276,SUP,HCPCS C1713,,241.276  -  PLATE BN 116X11X2.5MM NS LCP CMBN 7 HL PRECONTOUR LMT CNTCT,"$2,279.13",$0.00,"$2,279.13","$1,025.61","$1,626.61",$0.00,$381.25,$0.00,$0.00,$399.06,"$2,279.13",$0.00,"$1,139.56","$1,805.07","$1,823.30",$0.00,$346.30,$0.00,$362.84,$0.00
241.277,SUP,HCPCS C1713,,241.277  -  PLATE BN 116X11X2.5MM NS LCP CMBN 7 HL PRECONTOUR LMT CNTCT,"$2,279.13",$0.00,"$2,279.13","$1,025.61","$1,626.61",$0.00,$381.25,$0.00,$0.00,$399.06,"$2,279.13",$0.00,"$1,139.56","$1,805.07","$1,823.30",$0.00,$346.30,$0.00,$362.84,$0.00
241.278,SUP,HCPCS C1713,,241.278  -  PLATE BN 142X11X2.5MM NS LCP CMBN 9 HL PRECONTOUR LMT CNTCT,"$2,472.93",$0.00,"$2,472.93","$1,112.82","$1,764.93",$0.00,$413.66,$0.00,$0.00,$432.99,"$2,472.93",$0.00,"$1,236.46","$1,958.56","$1,978.34",$0.00,$375.74,$0.00,$393.69,$0.00
241.279,SUP,HCPCS C1713,,241.279  -  PLATE BN 142X11X2.5MM NS LCP CMBN 9 HL PRECONTOUR LMT CNTCT,"$2,472.93",$0.00,"$2,472.93","$1,112.82","$1,764.93",$0.00,$413.66,$0.00,$0.00,$432.99,"$2,472.93",$0.00,"$1,236.46","$1,958.56","$1,978.34",$0.00,$375.74,$0.00,$393.69,$0.00
241.282,SUP,HCPCS C1713,,241.282  -  PLATE BN 58X11X2.5MM NS LCP CMBN 3 HL PRECONTOUR LMT CNTCT,"$1,681.38",$0.00,"$1,681.38",$756.62,"$1,200.00",$0.00,$281.25,$0.00,$0.00,$294.40,"$1,681.38",$0.00,$840.69,"$1,331.65","$1,345.10",$0.00,$255.47,$0.00,$267.67,$0.00
241.283,SUP,HCPCS C1713,,241.283  -  PLATE BN 58X11X2.5MM NS LCP CMBN 3 HL PRECONTOUR LMT CNTCT,"$1,681.38",$0.00,"$1,681.38",$756.62,"$1,200.00",$0.00,$281.25,$0.00,$0.00,$294.40,"$1,681.38",$0.00,$840.69,"$1,331.65","$1,345.10",$0.00,$255.47,$0.00,$267.67,$0.00
241.284,SUP,HCPCS C1713,,241.284  -  PLATE BN 83X11X2.5MM NS LCP CMBN 5 HL PRECONTOUR LMT CNTCT,"$1,865.63",$0.00,"$1,865.63",$839.53,"$1,331.50",$0.00,$312.07,$0.00,$0.00,$326.66,"$1,865.63",$0.00,$932.81,"$1,477.58","$1,492.50",$0.00,$283.46,$0.00,$297.01,$0.00
241.285,SUP,HCPCS C1713,,241.285  -  PLATE BN 83X11X2.5MM NS LCP CMBN 5 HL PRECONTOUR LMT CNTCT,"$1,865.63",$0.00,"$1,865.63",$839.53,"$1,331.50",$0.00,$312.07,$0.00,$0.00,$326.66,"$1,865.63",$0.00,$932.81,"$1,477.58","$1,492.50",$0.00,$283.46,$0.00,$297.01,$0.00
241.286,SUP,HCPCS C1713,,241.286  -  PLATE BN 110X11X2.5MM NS LCP CMBN 7 HL PRECONTOUR LMT CNTCT,"$2,051.23",$0.00,"$2,051.23",$923.05,"$1,463.96",$0.00,$343.12,$0.00,$0.00,$359.15,"$2,051.23",$0.00,"$1,025.61","$1,624.57","$1,640.98",$0.00,$311.67,$0.00,$326.56,$0.00
241.287,SUP,HCPCS C1713,,241.287  -  PLATE BN 110X11X2.5MM NS LCP CMBN 7 HL PRECONTOUR LMT CNTCT,"$2,051.23",$0.00,"$2,051.23",$923.05,"$1,463.96",$0.00,$343.12,$0.00,$0.00,$359.15,"$2,051.23",$0.00,"$1,025.61","$1,624.57","$1,640.98",$0.00,$311.67,$0.00,$326.56,$0.00
241.288,SUP,HCPCS C1713,,241.288  -  PLATE BN 136X11X2.5MM NS LCP CMBN 9 HL PRECONTOUR LMT CNTCT,"$2,215.00",$0.00,"$2,215.00",$996.75,"$1,580.85",$0.00,$370.52,$0.00,$0.00,$387.83,"$2,215.00",$0.00,"$1,107.50","$1,754.28","$1,772.00",$0.00,$336.55,$0.00,$352.63,$0.00
241.289,SUP,HCPCS C1713,,241.289  -  PLATE BN 136X11X2.5MM NS LCP CMBN 9 HL PRECONTOUR LMT CNTCT,"$2,215.00",$0.00,"$2,215.00",$996.75,"$1,580.85",$0.00,$370.52,$0.00,$0.00,$387.83,"$2,215.00",$0.00,"$1,107.50","$1,754.28","$1,772.00",$0.00,$336.55,$0.00,$352.63,$0.00
241.3,SUP,HCPCS C1713,,241.300  -  PLATE BN 208X11X2.5MM NS LCP CMBN 14 HL PRECONTOUR LMT CNTCT,"$2,279.13",$0.00,"$2,279.13","$1,025.61","$1,626.61",$0.00,$381.25,$0.00,$0.00,$399.06,"$2,279.13",$0.00,"$1,139.56","$1,805.07","$1,823.30",$0.00,$346.30,$0.00,$362.84,$0.00
241.301,SUP,HCPCS C1713,,241.301  -  PLATE BN 208X11X2.5MM NS LCP CMBN 14 HL PRECONTOUR LMT CNTCT,"$2,279.13",$0.00,"$2,279.13","$1,025.61","$1,626.61",$0.00,$381.25,$0.00,$0.00,$399.06,"$2,279.13",$0.00,"$1,139.56","$1,805.07","$1,823.30",$0.00,$346.30,$0.00,$362.84,$0.00
241.302,SUP,HCPCS C1713,,241.302  -  PLATE BN 208X11X2.5MM NS LCP CMBN 14 HL PRECONTOUR LMT CNTCT,"$2,408.78",$0.00,"$2,408.78","$1,083.95","$1,719.14",$0.00,$402.93,$0.00,$0.00,$421.76,"$2,408.78",$0.00,"$1,204.39","$1,907.75","$1,927.02",$0.00,$365.99,$0.00,$383.48,$0.00
241.303,SUP,HCPCS C1713,,241.303  -  PLATE BN 208X11X2.5MM NS LCP CMBN 14 HL PRECONTOUR LMT CNTCT,"$2,408.78",$0.00,"$2,408.78","$1,083.95","$1,719.14",$0.00,$402.93,$0.00,$0.00,$421.76,"$2,408.78",$0.00,"$1,204.39","$1,907.75","$1,927.02",$0.00,$365.99,$0.00,$383.48,$0.00
241.304,SUP,HCPCS C1713,,241.304  -  PLATE BN 201X11X2.5MM NS LCP CMBN 14 HL PRECONTOUR LMT CNTCT,"$2,279.13",$0.00,"$2,279.13","$1,025.61","$1,626.61",$0.00,$381.25,$0.00,$0.00,$399.06,"$2,279.13",$0.00,"$1,139.56","$1,805.07","$1,823.30",$0.00,$346.30,$0.00,$362.84,$0.00
241.305,SUP,HCPCS C1713,,241.305  -  PLATE BN 201X11X2.5MM NS LCP CMBN 14 HL PRECONTOUR LMT CNTCT,"$2,279.13",$0.00,"$2,279.13","$1,025.61","$1,626.61",$0.00,$381.25,$0.00,$0.00,$399.06,"$2,279.13",$0.00,"$1,139.56","$1,805.07","$1,823.30",$0.00,$346.30,$0.00,$362.84,$0.00
241.32,SUP,HCPCS C1713,,241.32  -  PLATE BN 1/3 TBLR 12MM 25X9X1MM NS .5MM 2 HL COLR SS 3.5MM,$101.65,$0.00,$101.65,$45.74,$72.55,$0.00,$17.01,$0.00,$0.00,$17.80,$101.65,$0.00,$50.83,$80.51,$81.32,$0.00,$15.45,$0.00,$16.18,$0.00
241.33,SUP,HCPCS C1713,,241.33  -  PLATE BN 1/3 TBLR 12MM 37X9X1MM NS .5MM 3 HL COLR SS 3.5MM,$104.40,$0.00,$104.40,$46.98,$74.51,$0.00,$17.46,$0.00,$0.00,$18.28,$104.40,$0.00,$52.20,$82.68,$83.52,$0.00,$15.86,$0.00,$16.62,$0.00
241.331,SUP,HCPCS C1713,,241.331  -  PLATE BONE 33X9X1MM .7MM 1/3 TUBULAR 3 HOLE COLLAR LCP,$274.33,$0.00,$274.33,$123.45,$195.79,$0.00,$45.89,$0.00,$0.00,$48.03,$274.33,$0.00,$137.16,$217.27,$219.46,$0.00,$41.68,$0.00,$43.67,$0.00
241.34,SUP,HCPCS C1713,,241.34  -  PLATE BN 1/3 TBLR 12MM 49X9X1MM NS .5MM 4 HL COLR SS 3.5MM,$120.10,$0.00,$120.10,$54.05,$85.72,$0.00,$20.09,$0.00,$0.00,$21.03,$120.10,$0.00,$60.05,$95.12,$96.08,$0.00,$18.25,$0.00,$19.12,$0.00
241.341,SUP,HCPCS C1713,,241.341  -  PLATE BN 1/3 TBLR 12MM 45X9X1MM NS .7MM LCP 4 HL COLR SS,$316.63,$0.00,$316.63,$142.48,$225.98,$0.00,$52.96,$0.00,$0.00,$55.44,$316.63,$0.00,$158.31,$250.77,$253.30,$0.00,$48.11,$0.00,$50.41,$0.00
241.35,SUP,HCPCS C1713,,241.35  -  PLATE BN 1/3 TBLR 12MM 61X9X1MM NS .5MM 5 HL COLR SS 3.5MM,$120.10,$0.00,$120.10,$54.05,$85.72,$0.00,$20.09,$0.00,$0.00,$21.03,$120.10,$0.00,$60.05,$95.12,$96.08,$0.00,$18.25,$0.00,$19.12,$0.00
241.351,SUP,HCPCS C1713,,241.351  -  PLATE BN 1/3 TBLR 12MM 57X9X1MM NS .7MM LCP 5 HL COLR SS,$307.08,$0.00,$307.08,$138.18,$219.16,$0.00,$51.37,$0.00,$0.00,$53.77,$307.08,$0.00,$153.54,$243.21,$245.66,$0.00,$46.66,$0.00,$48.89,$0.00
241.36,SUP,HCPCS C1713,,241.36  -  PLATE BN 1/3 TBLR 12MM 73X9X1MM NS .5MM 6 HL COLR SS 3.5MM,$124.85,$0.00,$124.85,$56.18,$89.11,$0.00,$20.89,$0.00,$0.00,$21.86,$124.85,$0.00,$62.43,$98.88,$99.88,$0.00,$18.97,$0.00,$19.88,$0.00
241.361,SUP,HCPCS C1713,,241.361  -  PLATE BN 1/3 TBLR 12MM 69X9X1MM NS .7MM LCP 6 HL COLR SS,$307.08,$0.00,$307.08,$138.18,$219.16,$0.00,$51.37,$0.00,$0.00,$53.77,$307.08,$0.00,$153.54,$243.21,$245.66,$0.00,$46.66,$0.00,$48.89,$0.00
241.37,SUP,HCPCS C1713,,241.37  -  PLATE BN 1/3 TBLR 12MM 85X9X1MM NS .5MM 7 HL COLR SS 3.5MM,$124.85,$0.00,$124.85,$56.18,$89.11,$0.00,$20.89,$0.00,$0.00,$21.86,$124.85,$0.00,$62.43,$98.88,$99.88,$0.00,$18.97,$0.00,$19.88,$0.00
241.371,SUP,HCPCS C1713,,241.371  -  PLATE BN 1/3 TBLR 12MM 81X9X1MM NS .7MM LCP 7 HL COLR SS,$313.90,$0.00,$313.90,$141.26,$224.03,$0.00,$52.51,$0.00,$0.00,$54.96,$313.90,$0.00,$156.95,$248.61,$251.12,$0.00,$47.69,$0.00,$49.97,$0.00
241.38,SUP,HCPCS C1713,,241.38  -  PLATE BN 1/3 TBLR 12MM 97X9X1MM NS .5MM 8 HL COLR SS 3.5MM,$129.65,$0.00,$129.65,$58.34,$92.53,$0.00,$21.69,$0.00,$0.00,$22.70,$129.65,$0.00,$64.83,$102.68,$103.72,$0.00,$19.70,$0.00,$20.64,$0.00
241.381,SUP,HCPCS C1713,,241.381  -  PLATE BN 1/3 TBLR 12MM 93X9X1MM NS .7MM LCP 8 HL COLR SS,$330.28,$0.00,$330.28,$148.62,$235.72,$0.00,$55.25,$0.00,$0.00,$57.83,$330.28,$0.00,$165.14,$261.58,$264.22,$0.00,$50.18,$0.00,$52.58,$0.00
241.39,SUP,HCPCS C1713,,241.39  -  PLATE BONE 1/3 TUBE 109X9X1MM .5MM 9 HOLE COLLAR DCP LC-DCP,$133.05,$0.00,$133.05,$59.87,$94.96,$0.00,$22.26,$0.00,$0.00,$23.30,$133.05,$0.00,$66.53,$105.38,$106.44,$0.00,$20.22,$0.00,$21.18,$0.00
241.391,SUP,HCPCS C1713,,241.391  -  PLATE BN 1/3 TBLR 12MM 105X9X1MM NS .7MM LCP 9 HL COLR SS,$330.28,$0.00,$330.28,$148.62,$235.72,$0.00,$55.25,$0.00,$0.00,$57.83,$330.28,$0.00,$165.14,$261.58,$264.22,$0.00,$50.18,$0.00,$52.58,$0.00
241.4,SUP,HCPCS C1713,,241.40  -  PLATE BN 1/3 TBLR 12MM 121X9X1MM NS .5MM 10 HL COLR SS 3.5MM,$133.05,$0.00,$133.05,$59.87,$94.96,$0.00,$22.26,$0.00,$0.00,$23.30,$133.05,$0.00,$66.53,$105.38,$106.44,$0.00,$20.22,$0.00,$21.18,$0.00
241.4,SUP,HCPCS C1713,,241.4  -  PLATE 121MM SS SM FRAG SET 10 HOLE 1/3 TBLR COLLAR LC DCP,$142.55,$0.00,$133.05,$59.87,$94.96,$0.00,$22.26,$0.00,$0.00,$23.30,$133.05,$0.00,$66.53,$112.90,$106.44,$0.00,$20.22,$0.00,$21.18,$0.00
241.401,SUP,HCPCS C1713,,241.401  -  PLATE BN 1/3 TBLR 12MM 117X9X1MM NS .7MM LCP 10 HL COLR SS,$330.28,$0.00,$330.28,$148.62,$235.72,$0.00,$55.25,$0.00,$0.00,$57.83,$330.28,$0.00,$165.14,$261.58,$264.22,$0.00,$50.18,$0.00,$52.58,$0.00
241.42,SUP,HCPCS C1713,,241.42  -  PLATE BN 1/3 TBLR 12MM 145X9X1MM NS .5MM 12 HL COLR SS 3.5MM,$139.20,$0.00,$139.20,$62.64,$99.35,$0.00,$23.29,$0.00,$0.00,$24.37,$139.20,$0.00,$69.60,$110.25,$111.36,$0.00,$21.15,$0.00,$22.16,$0.00
241.421,SUP,HCPCS C1713,,241.421  -  PLATE BN 1/3 TBLR 12MM 141X9X1MM NS .7MM LCP 12 HL COLR SS,$341.20,$0.00,$341.20,$153.54,$243.51,$0.00,$57.07,$0.00,$0.00,$59.74,$341.20,$0.00,$170.60,$270.23,$272.96,$0.00,$51.84,$0.00,$54.32,$0.00
241.44,SUP,HCPCS C1713,,241.440  -  PLATE BONE 80MM 5 HOLE LCP STAINLESS STEEL RIGHT DISTAL,"$2,774.53",$0.00,"$2,774.53","$1,248.54","$1,980.18",$0.00,$464.12,$0.00,$0.00,$485.80,"$2,774.53",$0.00,"$1,387.26","$2,197.43","$2,219.62",$0.00,$421.57,$0.00,$441.70,$0.00
241.441,SUP,HCPCS C1713,,241.441  -  PLATE BONE 80MM 5 HOLE ANATOMIC TAPERED TIP LCP STAINLESS,"$2,774.53",$0.00,"$2,774.53","$1,248.54","$1,980.18",$0.00,$464.12,$0.00,$0.00,$485.80,"$2,774.53",$0.00,"$1,387.26","$2,197.43","$2,219.62",$0.00,$421.57,$0.00,$441.70,$0.00
241.442,SUP,HCPCS C1713,,241.442  -  PLATE BONE 106MM 7 HOLE ANATOMIC TAPERED TIP LCP STAINLESS,"$2,714.50",$0.00,"$2,714.50","$1,221.53","$1,937.34",$0.00,$454.07,$0.00,$0.00,$475.29,"$2,714.50",$0.00,"$1,357.25","$2,149.88","$2,171.60",$0.00,$412.44,$0.00,$432.15,$0.00
241.443,SUP,HCPCS C1713,,241.443  -  PLATE BONE 106MM 7 HOLE ANATOMIC TAPERED TIP LCP STAINLESS,"$2,714.50",$0.00,"$2,714.50","$1,221.53","$1,937.34",$0.00,$454.07,$0.00,$0.00,$475.29,"$2,714.50",$0.00,"$1,357.25","$2,149.88","$2,171.60",$0.00,$412.44,$0.00,$432.15,$0.00
241.444,SUP,HCPCS C1713,,241.444  -  PLATE BONE 132MM 9 HOLE ANATOMIC TAPERED TIP LCP STAINLESS,"$2,741.78",$0.00,"$2,741.78","$1,233.80","$1,956.80",$0.00,$458.64,$0.00,$0.00,$480.06,"$2,741.78",$0.00,"$1,370.89","$2,171.49","$2,193.42",$0.00,$416.59,$0.00,$436.49,$0.00
241.445,SUP,HCPCS C1713,,241.445  -  PLATE BONE 132MM 9 HOLE ANATOMIC TAPERED TIP LCP STAINLESS,"$2,741.78",$0.00,"$2,741.78","$1,233.80","$1,956.80",$0.00,$458.64,$0.00,$0.00,$480.06,"$2,741.78",$0.00,"$1,370.89","$2,171.49","$2,193.42",$0.00,$416.59,$0.00,$436.49,$0.00
241.446,SUP,HCPCS C1713,,241.446  -  PLATE BONE 158MM 11 HOLE ANATOMIC TAPERED TIP LCP STAINLESS,"$2,767.73",$0.00,"$2,767.73","$1,245.48","$1,975.33",$0.00,$462.97,$0.00,$0.00,$484.61,"$2,767.73",$0.00,"$1,383.86","$2,192.04","$2,214.18",$0.00,$420.53,$0.00,$440.62,$0.00
241.447,SUP,HCPCS C1713,,241.447  -  PLATE BONE 158MM 11 HOLE LCP STAINLESS STEEL LEFT DISTAL,"$2,767.73",$0.00,"$2,767.73","$1,245.48","$1,975.33",$0.00,$462.97,$0.00,$0.00,$484.61,"$2,767.73",$0.00,"$1,383.86","$2,192.04","$2,214.18",$0.00,$420.53,$0.00,$440.62,$0.00
241.448,SUP,HCPCS C1713,,241.448  -  PLATE BONE 184MM 13 HOLE ANATOMIC TAPERED TIP LCP STAINLESS,"$2,799.10",$0.00,"$2,799.10","$1,259.60","$1,997.72",$0.00,$468.22,$0.00,$0.00,$490.10,"$2,799.10",$0.00,"$1,399.55","$2,216.89","$2,239.28",$0.00,$425.30,$0.00,$445.62,$0.00
241.449,SUP,HCPCS C1713,,241.449  -  PLATE BONE 184MM 13 HOLE ANATOMIC TAPERED TIP LCP STAINLESS,"$2,799.10",$0.00,"$2,799.10","$1,259.60","$1,997.72",$0.00,$468.22,$0.00,$0.00,$490.10,"$2,799.10",$0.00,"$1,399.55","$2,216.89","$2,239.28",$0.00,$425.30,$0.00,$445.62,$0.00
241.45,SUP,HCPCS C1713,,241.450  -  PLATE BONE 210MM 15 HOLE LCP STAINLESS STEEL RIGHT DISTAL,"$2,835.95",$0.00,"$2,835.95","$1,276.18","$2,024.02",$0.00,$474.39,$0.00,$0.00,$496.55,"$2,835.95",$0.00,"$1,417.98","$2,246.07","$2,268.76",$0.00,$430.90,$0.00,$451.48,$0.00
241.451,SUP,HCPCS C1713,,241.451  -  PLATE BONE 210MM 15 HOLE LCP STAINLESS STEEL TIBIA LEFT,"$2,835.95",$0.00,"$2,835.95","$1,276.18","$2,024.02",$0.00,$474.39,$0.00,$0.00,$496.55,"$2,835.95",$0.00,"$1,417.98","$2,246.07","$2,268.76",$0.00,$430.90,$0.00,$451.48,$0.00
241.452,SUP,HCPCS C1713,,241.452  -  PLATE BONE 236MM 17 HOLE LCP STAINLESS STEEL TIBIA RIGHT,"$2,958.78",$0.00,"$2,958.78","$1,331.45","$2,111.68",$0.00,$494.93,$0.00,$0.00,$518.06,"$2,958.78",$0.00,"$1,479.39","$2,343.35","$2,367.02",$0.00,$449.56,$0.00,$471.04,$0.00
241.453,SUP,HCPCS C1713,,241.453  -  PLATE BONE 236MM 17 HOLE LCP STAINLESS STEEL TIBIA LEFT,"$2,958.78",$0.00,"$2,958.78","$1,331.45","$2,111.68",$0.00,$494.93,$0.00,$0.00,$518.06,"$2,958.78",$0.00,"$1,479.39","$2,343.35","$2,367.02",$0.00,$449.56,$0.00,$471.04,$0.00
241.454,SUP,HCPCS C1713,,241.454  -  PLATE BONE 262MM 19 HOLE LCP STAINLESS STEEL TIBIA RIGHT,"$2,981.98",$0.00,"$2,981.98","$1,341.89","$2,128.24",$0.00,$498.82,$0.00,$0.00,$522.12,"$2,981.98",$0.00,"$1,490.99","$2,361.73","$2,385.58",$0.00,$453.09,$0.00,$474.73,$0.00
241.455,SUP,HCPCS C1713,,241.455  -  PLATE BONE 262MM 19 HOLE LCP STAINLESS STEEL TIBIA LEFT,"$2,981.98",$0.00,"$2,981.98","$1,341.89","$2,128.24",$0.00,$498.82,$0.00,$0.00,$522.12,"$2,981.98",$0.00,"$1,490.99","$2,361.73","$2,385.58",$0.00,$453.09,$0.00,$474.73,$0.00
241.456,SUP,HCPCS C1713,,241.456  -  PLATE BONE 288MM 21 HOLE LCP STAINLESS STEEL TIBIA RIGHT,"$3,010.65",$0.00,"$3,010.65","$1,354.79","$2,148.70",$0.00,$503.61,$0.00,$0.00,$527.14,"$3,010.65",$0.00,"$1,505.33","$2,384.43","$2,408.52",$0.00,$457.44,$0.00,$479.30,$0.00
241.457,SUP,HCPCS C1713,,241.457  -  PLATE BONE 288MM 21 HOLE LCP STAINLESS STEEL TIBIA LEFT,"$3,010.65",$0.00,"$3,010.65","$1,354.79","$2,148.70",$0.00,$503.61,$0.00,$0.00,$527.14,"$3,010.65",$0.00,"$1,505.33","$2,384.43","$2,408.52",$0.00,$457.44,$0.00,$479.30,$0.00
241.61,SUP,HCPCS C1713,,241.61  -  PLATE BN 60MMX1.2MM NS LCP SS CALC 3.5MM CORT 4MM CANC 3.5MM,$945.78,$0.00,$945.78,$425.60,$675.00,$0.00,$158.21,$0.00,$0.00,$165.60,$945.78,$0.00,$472.89,$749.06,$756.62,$0.00,$143.70,$0.00,$150.57,$0.00
241.618,SUP,HCPCS C1713,,241.618  -  PLATE BONE MINI 64MM LOCK LCP STAINLESS STEEL RIGHT,"$1,119.10",$0.00,"$1,119.10",$503.60,$798.70,$0.00,$187.20,$0.00,$0.00,$195.95,"$1,119.10",$0.00,$559.55,$886.33,$895.28,$0.00,$170.04,$0.00,$178.16,$0.00
241.619,SUP,HCPCS C1713,,241.619  -  PLATE BONE MINI 64MM LOCK LCP STAINLESS STEEL LEFT CALCANEAL,"$1,119.10",$0.00,"$1,119.10",$503.60,$798.70,$0.00,$187.20,$0.00,$0.00,$195.95,"$1,119.10",$0.00,$559.55,$886.33,$895.28,$0.00,$170.04,$0.00,$178.16,$0.00
241.62,SUP,HCPCS C1713,,241.62  -  PLATE BN 70MMX1.2MM NS LCP SS CALC 3.5MM CORT 4MM CANC 3.5MM,$964.88,$0.00,$964.88,$434.19,$688.63,$0.00,$161.40,$0.00,$0.00,$168.94,$964.88,$0.00,$482.44,$764.18,$771.90,$0.00,$146.61,$0.00,$153.61,$0.00
241.622,SUP,HCPCS C1713,,241.622  -  PLATE BN SHRT 69MMX2MM NS LCP LCK SS CALC RT 2.7/3.5MM CORT,"$1,254.20",$0.00,"$1,254.20",$564.39,$895.12,$0.00,$209.80,$0.00,$0.00,$219.60,"$1,254.20",$0.00,$627.10,$993.33,"$1,003.36",$0.00,$190.57,$0.00,$199.67,$0.00
241.623,SUP,HCPCS C1713,,241.623  -  PLATE BN SHRT 69MMX2MM NS LCP LCK SS CALC LT 2.7/3.5MM CORT,"$1,254.20",$0.00,"$1,254.20",$564.39,$895.12,$0.00,$209.80,$0.00,$0.00,$219.60,"$1,254.20",$0.00,$627.10,$993.33,"$1,003.36",$0.00,$190.57,$0.00,$199.67,$0.00
241.624,SUP,HCPCS C1713,,241.624  -  PLATE BN LNG 76MMX2MM NS LCP LCK SS CALC RT 2.7/3.5MM CORT,"$1,337.45",$0.00,"$1,337.45",$601.85,$954.54,$0.00,$223.73,$0.00,$0.00,$234.18,"$1,337.45",$0.00,$668.73,"$1,059.26","$1,069.96",$0.00,$203.22,$0.00,$212.92,$0.00
241.625,SUP,HCPCS C1713,,241.625  -  PLATE BONE LONG 76MM LOCKING BENDABLE TAB LCP STAINLESS,"$1,337.45",$0.00,"$1,337.45",$601.85,$954.54,$0.00,$223.73,$0.00,$0.00,$234.18,"$1,337.45",$0.00,$668.73,"$1,059.26","$1,069.96",$0.00,$203.22,$0.00,$212.92,$0.00
241.626,SUP,HCPCS C1713,,241.626  -  PLATE BN XLNG 81MMX2MM NS LCP LCK SS CALC RT 2.7/3.5MM CORT,"$1,382.50",$0.00,"$1,382.50",$622.13,$986.69,$0.00,$231.26,$0.00,$0.00,$242.06,"$1,382.50",$0.00,$691.25,"$1,094.94","$1,106.00",$0.00,$210.06,$0.00,$220.09,$0.00
241.627,SUP,HCPCS C1713,,241.627  -  PLATE BN XLNG 81MMX2MM NS LCP LCK SS CALC LT 2.7/3.5MM CORT,"$1,382.50",$0.00,"$1,382.50",$622.13,$986.69,$0.00,$231.26,$0.00,$0.00,$242.06,"$1,382.50",$0.00,$691.25,"$1,094.94","$1,106.00",$0.00,$210.06,$0.00,$220.09,$0.00
241.65,SUP,HCPCS C1713,,241.65  -  PLATE BN Y 87MMX2MM NS LCP SS CALC 3.5MM CORT 4MM CANC 3.5MM,$964.88,$0.00,$964.88,$434.19,$688.63,$0.00,$161.40,$0.00,$0.00,$168.94,$964.88,$0.00,$482.44,$764.18,$771.90,$0.00,$146.61,$0.00,$153.61,$0.00
241.68,SUP,HCPCS C1713,,241.680  -  PLATE BONE 34MM 2 HOLE LCP STAINLESS STEEL RIGHT RADIAL HEAD,"$1,112.28",$0.00,"$1,112.28",$500.52,$793.83,$0.00,$186.06,$0.00,$0.00,$194.75,"$1,112.28",$0.00,$556.14,$880.93,$889.82,$0.00,$169.00,$0.00,$177.07,$0.00
241.681,SUP,HCPCS C1713,,241.681  -  PLATE BN 34MM NS LCP CMBN 2 HL RIM PRECONTOUR LMT CNTCT SS,"$1,112.28",$0.00,"$1,112.28",$500.52,$793.83,$0.00,$186.06,$0.00,$0.00,$194.75,"$1,112.28",$0.00,$556.14,$880.93,$889.82,$0.00,$169.00,$0.00,$177.07,$0.00
241.682,SUP,HCPCS C1713,,241.682  -  PLATE BONE 46MM 3 HOLE HEAD LCP STAINLESS STEEL RIGHT RADIAL,"$1,143.65",$0.00,"$1,143.65",$514.64,$816.22,$0.00,$191.31,$0.00,$0.00,$200.24,"$1,143.65",$0.00,$571.83,$905.77,$914.92,$0.00,$173.77,$0.00,$182.07,$0.00
241.683,SUP,HCPCS C1713,,241.683  -  PLATE BONE 46MM 3 HOLE RIM LCP STAINLESS STEEL LEFT RADIAL,"$1,143.65",$0.00,"$1,143.65",$514.64,$816.22,$0.00,$191.31,$0.00,$0.00,$200.24,"$1,143.65",$0.00,$571.83,$905.77,$914.92,$0.00,$173.77,$0.00,$182.07,$0.00
241.684,SUP,HCPCS C1713,,241.684  -  PLATE BONE 56MM 4 HOLE RIM LCP STAINLESS STEEL RIGHT RADIAL,"$1,164.13",$0.00,"$1,164.13",$523.86,$830.84,$0.00,$194.73,$0.00,$0.00,$203.83,"$1,164.13",$0.00,$582.06,$921.99,$931.30,$0.00,$176.88,$0.00,$185.33,$0.00
241.685,SUP,HCPCS C1713,,241.685  -  PLATE BONE 56MM 4 HOLE RIM LCP STAINLESS STEEL LEFT RADIAL,"$1,164.13",$0.00,"$1,164.13",$523.86,$830.84,$0.00,$194.73,$0.00,$0.00,$203.83,"$1,164.13",$0.00,$582.06,$921.99,$931.30,$0.00,$176.88,$0.00,$185.33,$0.00
241.69,SUP,HCPCS C1713,,241.690  -  PLATE BN 28MM NS LCP CMBN 2 HL NK PRECONTOUR LMT CNTCT SS,"$1,112.28",$0.00,"$1,112.28",$500.52,$793.83,$0.00,$186.06,$0.00,$0.00,$194.75,"$1,112.28",$0.00,$556.14,$880.93,$889.82,$0.00,$169.00,$0.00,$177.07,$0.00
241.691,SUP,HCPCS C1713,,241.691  -  PLATE BN 40MM NS LCP CMBN 3 HL NK PRECONTOUR LMT CNTCT SS,"$1,143.65",$0.00,"$1,143.65",$514.64,$816.22,$0.00,$191.31,$0.00,$0.00,$200.24,"$1,143.65",$0.00,$571.83,$905.77,$914.92,$0.00,$173.77,$0.00,$182.07,$0.00
241.692,SUP,HCPCS C1713,,241.692  -  PLATE BONE 50MM 4 HOLE LCP STAINLESS STEEL RADIAL HEAD,"$1,165.50",$0.00,"$1,165.50",$524.48,$831.82,$0.00,$194.96,$0.00,$0.00,$204.07,"$1,165.50",$0.00,$582.75,$923.08,$932.40,$0.00,$177.09,$0.00,$185.55,$0.00
241.83,SUP,HCPCS C1713,,241.83  -  PLATE BN CLVRLF 88X15X2MM NS 1.2MM LC DCP 3 HL THN BLDE,$552.73,$0.00,$552.73,$248.73,$394.48,$0.00,$92.46,$0.00,$0.00,$96.78,$552.73,$0.00,$276.36,$437.76,$442.18,$0.00,$83.98,$0.00,$87.99,$0.00
241.84,SUP,HCPCS C1713,,241.84  -  PLATE BN CLVRLF 104X15X2MM NS 1.2MM LC DCP 4 HL THN BLDE,$590.93,$0.00,$590.93,$265.92,$421.74,$0.00,$98.85,$0.00,$0.00,$103.47,$590.93,$0.00,$295.46,$468.02,$472.74,$0.00,$89.79,$0.00,$94.08,$0.00
241.85,SUP,HCPCS C1713,,241.85  -  PLATE BN CLVRLF 120X15X2MM NS 5 HL THN BLDE SS 3.5MM SCR,$768.35,$0.00,$768.35,$345.76,$548.37,$0.00,$128.53,$0.00,$0.00,$134.53,$768.35,$0.00,$384.18,$608.53,$614.68,$0.00,$116.75,$0.00,$122.32,$0.00
241.86,SUP,HCPCS C1713,,241.86  -  PLATE BONE THIN CLOVERLEAF 136MM 6 HOLE LC-DCP STAINLESS,$833.85,$0.00,$833.85,$375.23,$595.12,$0.00,$139.49,$0.00,$0.00,$146.00,$833.85,$0.00,$416.93,$660.41,$667.08,$0.00,$126.70,$0.00,$132.75,$0.00
241.87,SUP,HCPCS C1713,,241.87  -  PLATE BN CLVRLF 152X15X2MM NS 1.2MM LC DCP 7 HL THN BLDE,$898.00,$0.00,$898.00,$404.10,$640.90,$0.00,$150.22,$0.00,$0.00,$157.23,$898.00,$0.00,$449.00,$711.22,$718.40,$0.00,$136.44,$0.00,$142.96,$0.00
241.88,SUP,HCPCS C1713,,241.88  -  PLATE BN CLVRLF 168X15X2MM NS 1.2MM LC DCP 8 HL THN BLDE,$953.95,$0.00,$953.95,$429.28,$680.83,$0.00,$159.58,$0.00,$0.00,$167.03,$953.95,$0.00,$476.98,$755.53,$763.16,$0.00,$144.95,$0.00,$151.87,$0.00
241.89,SUP,HCPCS C1713,,241.89  -  PLATE BONE THIN 200X15X1.2MM 10 HOLE CLOVERLEAF THIN BLADE,"$1,030.38",$0.00,"$1,030.38",$463.67,$735.38,$0.00,$172.36,$0.00,$0.00,$180.41,"$1,030.38",$0.00,$515.19,$816.06,$824.30,$0.00,$156.56,$0.00,$164.04,$0.00
241.901,SUP,HCPCS C1713,,241.901  -  PLATE BN STD 90X12X2.5MM NS LCP CMBN PHLS 3 HL SHFT LCK CMPR,"$2,774.53",$0.00,"$2,774.53","$1,248.54","$1,980.18",$0.00,$464.12,$0.00,$0.00,$485.80,"$2,774.53",$0.00,"$1,387.26","$2,197.43","$2,219.62",$0.00,$421.57,$0.00,$441.70,$0.00
241.903,SUP,HCPCS C1713,,241.903  -  PLATE BN STD 114X12X2.5MM NS LCP CMBN PHLS 5 HL SHFT LCK,"$2,861.88",$0.00,"$2,861.88","$1,287.84","$2,042.52",$0.00,$478.73,$0.00,$0.00,$501.09,"$2,861.88",$0.00,"$1,430.94","$2,266.61","$2,289.50",$0.00,$434.84,$0.00,$455.61,$0.00
241.918,SUP,HCPCS C1713,,241.918  -  PLATE BN 142X12X3.7MM NS LCP CMBN PHLS LNG 5 HL SHFT LCK,"$2,889.18",$0.00,"$2,889.18","$1,300.13","$2,062.00",$0.00,$483.29,$0.00,$0.00,$505.87,"$2,889.18",$0.00,"$1,444.59","$2,288.23","$2,311.34",$0.00,$438.99,$0.00,$459.96,$0.00
241.919,SUP,HCPCS C1713,,241.919  -  PLATE LNG 160MM SS 3.5MM SCR SM FRAG SET 6 HOLE LCP BONE,"$3,582.78",$0.00,"$3,582.78","$1,612.25","$2,557.03",$0.00,$617.29,$0.00,$0.00,$627.32,"$3,582.78",$0.00,"$1,791.39","$2,837.56","$2,866.22",$0.00,$560.70,$0.00,$570.38,$0.00
241.921,SUP,HCPCS C1713,,241.921  -  PLATE BN 196X12X3.7MM NS LCP CMBN PHLS LNG 8 HL SHFT LCK,"$3,119.83",$0.00,"$3,119.83","$1,403.92","$2,226.62",$0.00,$521.87,$0.00,$0.00,$546.26,"$3,119.83",$0.00,"$1,559.91","$2,470.91","$2,495.86",$0.00,$474.03,$0.00,$496.68,$0.00
241.923,SUP,HCPCS C1713,,241.923  -  PLATE BN 232X12X3.7MM NS LCP CMBN PHLS LNG 10 HL SHFT LCK,"$3,235.83",$0.00,"$3,235.83","$1,456.12","$2,309.41",$0.00,$541.28,$0.00,$0.00,$566.57,"$3,235.83",$0.00,"$1,617.91","$2,562.78","$2,588.66",$0.00,$491.66,$0.00,$515.14,$0.00
241.925,SUP,HCPCS C1713,,241.925  -  PLATE BN 268X12X3.7MM NS LCP CMBN PHLS LNG 12 HL SHFT LCK,"$3,347.73",$0.00,"$3,347.73","$1,506.48","$2,389.27",$0.00,$560.00,$0.00,$0.00,$586.16,"$3,347.73",$0.00,"$1,673.86","$2,651.40","$2,678.18",$0.00,$508.66,$0.00,$532.96,$0.00
241.931,SUP,HCPCS C1713,,241.931  -  PLATE BN OB L T 52X10X1.5MM NS LCP CMBN 3 HLE/HD 3 HL SHFT,$644.15,$0.00,$644.15,$289.87,$459.73,$0.00,$107.75,$0.00,$0.00,$112.79,$644.15,$0.00,$322.08,$510.17,$515.32,$0.00,$97.88,$0.00,$102.55,$0.00
241.941,SUP,HCPCS C1713,,241.941  -  PLATE BN OB L T 63X10X1.5MM NS LCP CMBN 3 HLE/HD 4 HL SHFT,$675.55,$0.00,$675.55,$304.00,$482.14,$0.00,$113.00,$0.00,$0.00,$118.28,$675.55,$0.00,$337.78,$535.04,$540.44,$0.00,$102.64,$0.00,$107.55,$0.00
241.951,SUP,HCPCS C1713,,241.951  -  PLATE BN OB L T 74X10X1.5MM NS LCP CMBN 3 HLE/HD 5 HL SHFT,$705.58,$0.00,$705.58,$317.51,$503.57,$0.00,$118.03,$0.00,$0.00,$123.54,$705.58,$0.00,$352.79,$558.82,$564.46,$0.00,$107.21,$0.00,$112.33,$0.00
241.961,SUP,HCPCS C1713,,241.961  -  PLATE BONE T THK1.5MM 85X10MM 3X6 HOLE LEFT OBLIQUE LOCKING,$756.08,$0.00,$756.08,$340.23,$539.61,$0.00,$126.47,$0.00,$0.00,$132.38,$756.08,$0.00,$378.04,$598.82,$604.86,$0.00,$114.88,$0.00,$120.37,$0.00
241.971,SUP,HCPCS C1713,,241.971  -  PLATE BN OB L T 96X10X1.5MM NS LCP CMBN 3 HLE/HD 7 HL SHFT,$764.25,$0.00,$764.25,$343.91,$545.45,$0.00,$127.84,$0.00,$0.00,$133.81,$764.25,$0.00,$382.13,$605.29,$611.40,$0.00,$116.12,$0.00,$121.67,$0.00
241.981,SUP,HCPCS C1713,,241.981  -  PLATE BONE T THK1.5MM 107X10MM 3X8 HOLE LEFT OBLIQUE LOCKING,$831.13,$0.00,$831.13,$374.01,$593.17,$0.00,$139.03,$0.00,$0.00,$145.52,$831.13,$0.00,$415.56,$658.25,$664.90,$0.00,$126.28,$0.00,$132.32,$0.00
242.03,SUP,HCPCS C1713,,242.03  -  PLATE BN .25 TBLR 23X7X1MM NS .3MM 3 HL COLR SS 2.7MM SCR MN,$141.93,$0.00,$141.93,$63.87,$101.29,$0.00,$23.74,$0.00,$0.00,$24.85,$141.93,$0.00,$70.96,$112.41,$113.54,$0.00,$21.57,$0.00,$22.59,$0.00
242.04,SUP,HCPCS C1713,,242.04  -  PLATE BONE .25 TUBE LP 31X7X1MM .3MM 4 HOLE COLLAR STAINLESS,$151.48,$0.00,$151.48,$68.16,$108.11,$0.00,$25.34,$0.00,$0.00,$26.52,$151.48,$0.00,$75.74,$119.97,$121.18,$0.00,$23.02,$0.00,$24.11,$0.00
242.05,SUP,HCPCS C1713,,242.05  -  PLATE BONE 39X7X1MM .3MM 5 HOLE QUARTER TUBULAR COLLAR LCP,$161.05,$0.00,$161.05,$72.47,$114.94,$0.00,$26.94,$0.00,$0.00,$28.20,$161.05,$0.00,$80.53,$127.55,$128.84,$0.00,$24.47,$0.00,$25.64,$0.00
242.06,SUP,HCPCS C1713,,242.06  -  PLATE BONE .25 TUBULAR 47X7X1MM .3MM 6 HOLE COLLAR DCP,$174.70,$0.00,$174.70,$78.62,$124.68,$0.00,$29.22,$0.00,$0.00,$30.59,$174.70,$0.00,$87.35,$138.36,$139.76,$0.00,$26.54,$0.00,$27.81,$0.00
242.07,SUP,HCPCS C1713,,242.07  -  PLATE BONE .75 TUBE 55X7X1MM .3MM 7 HOLE COLLAR STAINLESS,$185.60,$0.00,$185.60,$83.52,$132.46,$0.00,$31.05,$0.00,$0.00,$32.50,$185.60,$0.00,$92.80,$147.00,$148.48,$0.00,$28.20,$0.00,$29.55,$0.00
242.08,SUP,HCPCS C1713,,242.08  -  PLATE BONE .25 TUBE 63MM .3MM 8 HOLE COLLAR DCP STAINLESS,$191.08,$0.00,$191.08,$85.98,$136.37,$0.00,$31.96,$0.00,$0.00,$33.46,$191.08,$0.00,$95.54,$151.34,$152.86,$0.00,$29.03,$0.00,$30.42,$0.00
242.102,SUP,HCPCS C1713,,242.102  -  PLATE BONE 139MM 2 HOLE LCP STAINLESS STEEL FEMUR LEFT,"$2,538.43",$0.00,"$2,538.43","$1,142.29","$1,811.67",$0.00,$424.62,$0.00,$0.00,$444.46,"$2,538.43",$0.00,"$1,269.21","$2,010.44","$2,030.74",$0.00,$385.69,$0.00,$404.12,$0.00
242.104,SUP,HCPCS C1713,,242.104  -  PLATE BN 175MM NS LCP CMBN 4 HL LMT CNTCT SS FEM LT PROX 4.5,"$2,588.93",$0.00,"$2,588.93","$1,165.02","$1,847.72",$0.00,$433.07,$0.00,$0.00,$453.30,"$2,588.93",$0.00,"$1,294.46","$2,050.43","$2,071.14",$0.00,$393.37,$0.00,$412.16,$0.00
242.106,SUP,HCPCS C1713,,242.106  -  PLATE BN 211MM NS LCP CMBN 6 HL LMT CNTCT SS FEM LT PROX 4.5,"$2,639.43",$0.00,"$2,639.43","$1,187.74","$1,883.76",$0.00,$441.51,$0.00,$0.00,$462.14,"$2,639.43",$0.00,"$1,319.71","$2,090.43","$2,111.54",$0.00,$401.04,$0.00,$420.20,$0.00
242.108,SUP,HCPCS C1713,,242.108  -  PLATE BN 247MM NS LCP CMBN 8 HL LMT CNTCT SS FEM LT PROX 4.5,"$2,769.08",$0.00,"$2,769.08","$1,246.08","$1,976.29",$0.00,$463.20,$0.00,$0.00,$484.84,"$2,769.08",$0.00,"$1,384.54","$2,193.11","$2,215.26",$0.00,$420.74,$0.00,$440.84,$0.00
242.11,SUP,HCPCS C1713,,242.110  -  PLATE BN 283MM NS LCP CMBN 10 HL LMT CNTCT SS FEM LT PROX,"$2,966.98",$0.00,"$2,966.98","$1,335.14","$2,117.53",$0.00,$496.30,$0.00,$0.00,$519.49,"$2,966.98",$0.00,"$1,483.49","$2,349.85","$2,373.58",$0.00,$450.81,$0.00,$472.34,$0.00
242.112,SUP,HCPCS C1713,,242.112  -  PLATE BN 319MM NS LCP CMBN 12 HL LMT CNTCT SS FEM LT PROX,"$3,141.65",$0.00,"$3,141.65","$1,413.74","$2,242.20",$0.00,$525.53,$0.00,$0.00,$550.08,"$3,141.65",$0.00,"$1,570.83","$2,488.19","$2,513.32",$0.00,$477.35,$0.00,$500.15,$0.00
242.114,SUP,HCPCS C1713,,242.114  -  PLATE BN 355MM NS LCP CMBN 14 HL LMT CNTCT SS FEM LT PROX,"$3,394.13",$0.00,"$3,394.13","$1,527.36","$2,422.39",$0.00,$567.76,$0.00,$0.00,$594.28,"$3,394.13",$0.00,"$1,697.06","$2,688.15","$2,715.30",$0.00,$515.71,$0.00,$540.34,$0.00
242.116,SUP,HCPCS C1713,,242.116  -  PLATE BN 391MM NS LCP CMBN 16 HL LMT CNTCT SS FEM LT PROX,"$3,496.50",$0.00,"$3,496.50","$1,573.43","$2,495.45",$0.00,$584.88,$0.00,$0.00,$612.21,"$3,496.50",$0.00,"$1,748.25","$2,769.23","$2,797.20",$0.00,$531.26,$0.00,$556.64,$0.00
242.12,SUP,HCPCS C1713,,242.120  -  PLATE BONE 133MM 2 HOLE HOOK LCP STAINLESS STEEL PROXIMAL,"$2,941.03",$0.00,"$2,941.03","$1,323.46","$2,099.01",$0.00,$491.97,$0.00,$0.00,$514.95,"$2,941.03",$0.00,"$1,470.51","$2,329.30","$2,352.82",$0.00,$446.87,$0.00,$468.21,$0.00
242.121,SUP,HCPCS C1713,,242.121  -  PLATE BONE 169MM 4 HOLE HOOK LCP STAINLESS STEEL FEMUR,"$2,981.98",$0.00,"$2,981.98","$1,341.89","$2,128.24",$0.00,$498.82,$0.00,$0.00,$522.12,"$2,981.98",$0.00,"$1,490.99","$2,361.73","$2,385.58",$0.00,$453.09,$0.00,$474.73,$0.00
242.122,SUP,HCPCS C1713,,242.122  -  PLATE BONE 205MM 6 HOLE HOOK LCP STAINLESS STEEL FEMUR,"$3,028.38",$0.00,"$3,028.38","$1,362.77","$2,161.35",$0.00,$506.58,$0.00,$0.00,$530.24,"$3,028.38",$0.00,"$1,514.19","$2,398.48","$2,422.70",$0.00,$460.14,$0.00,$482.12,$0.00
242.123,SUP,HCPCS C1713,,242.123  -  PLATE BONE 241MM 8 HOLE HOOK LCP STAINLESS STEEL FEMUR,"$3,140.30",$0.00,"$3,140.30","$1,413.14","$2,241.23",$0.00,$525.30,$0.00,$0.00,$549.84,"$3,140.30",$0.00,"$1,570.15","$2,487.12","$2,512.24",$0.00,$477.14,$0.00,$499.94,$0.00
242.124,SUP,HCPCS C1713,,242.124  -  PLATE BONE 277MM 10 HOLE HOOK LCP STAINLESS STEEL PROXIMAL,"$3,301.33",$0.00,"$3,301.33","$1,485.60","$2,356.16",$0.00,$552.24,$0.00,$0.00,$578.04,"$3,301.33",$0.00,"$1,650.66","$2,614.65","$2,641.06",$0.00,$501.61,$0.00,$525.57,$0.00
242.125,SUP,HCPCS C1713,,242.125  -  PLATE BONE 313MM 12 HOLE HOOK LCP STAINLESS STEEL FEMUR,"$3,409.15",$0.00,"$3,409.15","$1,534.12","$2,433.11",$0.00,$570.27,$0.00,$0.00,$596.91,"$3,409.15",$0.00,"$1,704.58","$2,700.05","$2,727.32",$0.00,$517.99,$0.00,$542.74,$0.00
242.126,SUP,HCPCS C1713,,242.126  -  PLATE BONE 349MM 14 HOLE HOOK LCP STAINLESS STEEL FEMUR,"$3,448.73",$0.00,"$3,448.73","$1,551.93","$2,461.36",$0.00,$576.89,$0.00,$0.00,$603.84,"$3,448.73",$0.00,"$1,724.36","$2,731.39","$2,758.98",$0.00,$524.01,$0.00,$549.04,$0.00
242.127,SUP,HCPCS C1713,,242.127  -  PLATE BONE 385MM 16 HOLE HOOK LCP STAINLESS STEEL FEMUR,"$3,563.35",$0.00,"$3,563.35","$1,603.51","$2,543.16",$0.00,$596.07,$0.00,$0.00,$623.91,"$3,563.35",$0.00,"$1,781.68","$2,822.17","$2,850.68",$0.00,$541.42,$0.00,$567.29,$0.00
242.128,SUP,HCPCS C1713,,242.128  -  PLATE BONE 421MM 18 HOLE HOOK LCP STAINLESS STEEL FEMUR,"$3,678.00",$0.00,"$3,678.00","$1,655.10","$2,624.99",$0.00,$615.24,$0.00,$0.00,$643.99,"$3,678.00",$0.00,"$1,839.00","$2,912.98","$2,942.40",$0.00,$558.84,$0.00,$585.54,$0.00
242.204,SUP,HCPCS C1713,,242.204  -  PLATE BONE 41MMX2.6MM 4 HOLE LC-DCP STAINLESS STEEL FT,$240.20,$0.00,$240.20,$108.09,$171.43,$0.00,$40.18,$0.00,$0.00,$42.06,$240.20,$0.00,$120.10,$190.24,$192.16,$0.00,$36.50,$0.00,$38.24,$0.00
242.205,SUP,HCPCS C1713,,242.205  -  PLATE BONE 50MM 5 HOLE LC-DCP STAINLESS STEEL ORTHOPEDIC,$249.75,$0.00,$249.75,$112.39,$178.25,$0.00,$41.78,$0.00,$0.00,$43.73,$249.75,$0.00,$124.88,$197.80,$199.80,$0.00,$37.95,$0.00,$39.76,$0.00
242.206,SUP,HCPCS C1713,,242.206  -  PLATE BONE 59MM 6 HOLE LC-DCP STAINLESS STEEL FT NONSTRL 2.7,$262.03,$0.00,$262.03,$117.91,$187.01,$0.00,$43.83,$0.00,$0.00,$45.88,$262.03,$0.00,$131.01,$207.53,$209.62,$0.00,$39.81,$0.00,$41.71,$0.00
242.207,SUP,HCPCS C1713,,242.207  -  PLATE BONE 68MM 7 HOLE LC-DCP STAINLESS STEEL ORTHOPEDIC,$272.95,$0.00,$272.95,$122.83,$194.80,$0.00,$45.66,$0.00,$0.00,$47.79,$272.95,$0.00,$136.48,$216.18,$218.36,$0.00,$41.47,$0.00,$43.45,$0.00
242.208,SUP,HCPCS C1713,,242.208  -  PLATE BONE 77MM 8 HOLE LC-DCP STAINLESS STEEL FT NONSTRL 2.7,$285.23,$0.00,$285.23,$128.35,$203.57,$0.00,$47.71,$0.00,$0.00,$49.94,$285.23,$0.00,$142.61,$225.90,$228.18,$0.00,$43.34,$0.00,$45.41,$0.00
242.209,SUP,HCPCS C1713,,242.209  -  PLATE BONE 86MM 9 HOLE LC-DCP STAINLESS STEEL ORTHOPEDIC,$292.05,$0.00,$292.05,$131.42,$208.44,$0.00,$48.85,$0.00,$0.00,$51.14,$292.05,$0.00,$146.03,$231.30,$233.64,$0.00,$44.38,$0.00,$46.49,$0.00
242.21,SUP,HCPCS C1713,,242.21  -  PLATE BONE 44MM 7 HOLE MULTIPLE FRAGMENT DCP STAINLESS STEEL,$126.93,$0.00,$126.93,$57.12,$90.59,$0.00,$21.23,$0.00,$0.00,$22.22,$126.93,$0.00,$63.46,$100.53,$101.54,$0.00,$19.28,$0.00,$20.21,$0.00
242.22,SUP,HCPCS C1713,,242.220  -  PLATE BONE 95MM 10 HOLE LC-DCP STAINLESS STEEL ORTHOPEDIC,$308.43,$0.00,$308.43,$138.79,$220.12,$0.00,$51.59,$0.00,$0.00,$54.00,$308.43,$0.00,$154.21,$244.28,$246.74,$0.00,$46.86,$0.00,$49.10,$0.00
242.221,SUP,HCPCS C1713,,242.221  -  PLATE BONE 104MM 11 HOLE LC-DCP STAINLESS STEEL ORTHOPEDIC,$322.08,$0.00,$322.08,$144.93,$229.86,$0.00,$53.88,$0.00,$0.00,$56.39,$322.08,$0.00,$161.04,$255.09,$257.66,$0.00,$48.94,$0.00,$51.27,$0.00
242.222,SUP,HCPCS C1713,,242.222  -  PLATE BONE 113MM 12 HOLE LC-DCP STAINLESS STEEL ORTHOPEDIC,$334.38,$0.00,$334.38,$150.47,$238.64,$0.00,$55.93,$0.00,$0.00,$58.55,$334.38,$0.00,$167.19,$264.83,$267.50,$0.00,$50.80,$0.00,$53.23,$0.00
242.31,SUP,HCPCS C1713,,242.31  -  PLATE BN L 32MM NS DCP 3 HLE/HD 2 HL SHFT SS FT LT 2.7MM SCR,$100.30,$0.00,$100.30,$45.14,$71.58,$0.00,$16.78,$0.00,$0.00,$17.56,$100.30,$0.00,$50.15,$79.44,$80.24,$0.00,$15.24,$0.00,$15.97,$0.00
242.32,SUP,HCPCS C1713,,242.32  -  PLATE BONE L 32MM 2X3 HOLE DCP STAINLESS STEEL FT RIGHT,$100.30,$0.00,$100.30,$45.14,$71.58,$0.00,$16.78,$0.00,$0.00,$17.56,$100.30,$0.00,$50.15,$79.44,$80.24,$0.00,$15.24,$0.00,$15.97,$0.00
242.33,SUP,HCPCS C1713,,242.33  -  PLATE BN OB L L 34X7X1MM NS DCP 3 HL SS 2.7MM SCR MN FRAG,$111.23,$0.00,$111.23,$50.05,$79.38,$0.00,$18.60,$0.00,$0.00,$19.47,$111.23,$0.00,$55.61,$88.09,$88.98,$0.00,$16.90,$0.00,$17.71,$0.00
242.34,SUP,HCPCS C1713,,242.34  -  PLATE BN OB R L 34X7X1MM NS DCP 3 HL SS 2.7MM SCR MN FRAG,$111.23,$0.00,$111.23,$50.05,$79.38,$0.00,$18.60,$0.00,$0.00,$19.47,$111.23,$0.00,$55.61,$88.09,$88.98,$0.00,$16.90,$0.00,$17.71,$0.00
242.41,SUP,HCPCS C1713,,242.41  -  PLATE BN T 32X7X1.2MM NS 3 HL SS 2.7MM SCR MN FRAG SET,$111.23,$0.00,$111.23,$50.05,$79.38,$0.00,$18.60,$0.00,$0.00,$19.47,$111.23,$0.00,$55.61,$88.09,$88.98,$0.00,$16.90,$0.00,$17.71,$0.00
242.458,SUP,HCPCS C1713,,242.458  -  PLATE BN 48X6.3X1.6MM NS LCP 5 HLE/HD 3 HL SHFT PRECONTOUR,"$1,491.68",$0.00,"$1,491.68",$671.25,"$1,064.61",$0.00,$249.52,$0.00,$0.00,$261.18,"$1,491.68",$0.00,$745.84,"$1,181.41","$1,193.34",$0.00,$226.65,$0.00,$237.47,$0.00
242.459,SUP,HCPCS C1713,,242.459  -  PLATE BN 66X6.3X1.6MM NS LCP 5 HLE/HD 5 HL SHFT PRECONTOUR,"$1,579.03",$0.00,"$1,579.03",$710.56,"$1,126.95",$0.00,$264.13,$0.00,$0.00,$276.47,"$1,579.03",$0.00,$789.51,"$1,250.59","$1,263.22",$0.00,$239.92,$0.00,$251.38,$0.00
242.461,SUP,HCPCS C1713,,242.461  -  PLATE BN 48X6.3X1.6MM NS LCP 5 HLE/HD 3 HL SHFT PRECONTOUR,"$1,491.68",$0.00,"$1,491.68",$671.25,"$1,064.61",$0.00,$249.52,$0.00,$0.00,$261.18,"$1,491.68",$0.00,$745.84,"$1,181.41","$1,193.34",$0.00,$226.65,$0.00,$237.47,$0.00
242.462,SUP,HCPCS C1713,,242.462  -  PLATE BN 66X6.3X1.6MM NS LCP 5 HLE/HD 5 HL SHFT PRECONTOUR,"$1,579.03",$0.00,"$1,579.03",$710.56,"$1,126.95",$0.00,$264.13,$0.00,$0.00,$276.47,"$1,579.03",$0.00,$789.51,"$1,250.59","$1,263.22",$0.00,$239.92,$0.00,$251.38,$0.00
242.464,SUP,HCPCS C1713,,242.464  -  PLATE BN 47X6.3X1.6MM NS LCP 4 HLE/HD 3 HL SHFT PRECONTOUR,"$1,491.68",$0.00,"$1,491.68",$671.25,"$1,064.61",$0.00,$249.52,$0.00,$0.00,$261.18,"$1,491.68",$0.00,$745.84,"$1,181.41","$1,193.34",$0.00,$226.65,$0.00,$237.47,$0.00
242.465,SUP,HCPCS C1713,,242.465  -  PLATE BN 65X6.3X1.6MM NS LCP 4 HLE/HD 5 HL SHFT PRECONTOUR,"$1,579.03",$0.00,"$1,579.03",$710.56,"$1,126.95",$0.00,$264.13,$0.00,$0.00,$276.47,"$1,579.03",$0.00,$789.51,"$1,250.59","$1,263.22",$0.00,$239.92,$0.00,$251.38,$0.00
242.467,SUP,HCPCS C1713,,242.467  -  PLATE BN 47X6.3X1.6MM NS LCP 4 HLE/HD 3 HL SHFT PRECONTOUR,"$1,491.68",$0.00,"$1,491.68",$671.25,"$1,064.61",$0.00,$249.52,$0.00,$0.00,$261.18,"$1,491.68",$0.00,$745.84,"$1,181.41","$1,193.34",$0.00,$226.65,$0.00,$237.47,$0.00
242.468,SUP,HCPCS C1713,,242.468  -  PLATE BN 65X6.3X1.6MM NS LCP 4 HLE/HD 5 HL SHFT PRECONTOUR,"$1,579.03",$0.00,"$1,579.03",$710.56,"$1,126.95",$0.00,$264.13,$0.00,$0.00,$276.47,"$1,579.03",$0.00,$789.51,"$1,250.59","$1,263.22",$0.00,$239.92,$0.00,$251.38,$0.00
242.472,SUP,HCPCS C1713,,242.472  -  PLATE SS BONE RIGHT DISTAL DORSAL RAD NONSTRL,"$1,868.43",$0.00,"$1,868.43",$840.79,"$1,333.49",$0.00,$321.92,$0.00,$0.00,$327.15,"$1,868.43",$0.00,$934.21,"$1,479.80","$1,494.74",$0.00,$292.41,$0.00,$297.45,$0.00
242.473,SUP,HCPCS C1713,,242.473  -  PLATE SS LCP BONE RIGHT DISTAL VOLR RADL NONSTRL,"$1,542.28",$0.00,"$1,542.28",$694.02,"$1,100.72",$0.00,$265.73,$0.00,$0.00,$270.04,"$1,542.28",$0.00,$771.14,"$1,221.49","$1,233.82",$0.00,$241.37,$0.00,$245.53,$0.00
242.477,SUP,HCPCS C1713,,242.477  -  PLATE BN T 40X6.3X1.6MM NS LCP CMBN 3 HLE/HD 3 HL SHFT,$851.60,$0.00,$851.60,$383.22,$607.79,$0.00,$142.45,$0.00,$0.00,$149.11,$851.60,$0.00,$425.80,$674.47,$681.28,$0.00,$129.39,$0.00,$135.57,$0.00
242.478,SUP,HCPCS C1713,,242.478  -  PLATE BN T 49X6.3X1.6MM NS LCP CMBN 3 HLE/HD 4 HL SHFT,$887.10,$0.00,$887.10,$399.20,$633.12,$0.00,$148.39,$0.00,$0.00,$155.32,$887.10,$0.00,$443.55,$702.58,$709.68,$0.00,$134.79,$0.00,$141.23,$0.00
242.479,SUP,HCPCS C1713,,242.479  -  PLATE BN STRG 48X6.3X1.6MM NS LCP CMBN 5 HL LOPRFL RND EDG,$807.93,$0.00,$807.93,$363.57,$576.62,$0.00,$135.15,$0.00,$0.00,$141.46,$807.93,$0.00,$403.96,$639.88,$646.34,$0.00,$122.76,$0.00,$128.62,$0.00
242.482,SUP,HCPCS C1713,,242.482  -  PLATE SS BONE LEFT DISTAL DORSAL RADL NONSTRL,"$1,868.43",$0.00,"$1,868.43",$840.79,"$1,333.49",$0.00,$321.92,$0.00,$0.00,$327.15,"$1,868.43",$0.00,$934.21,"$1,479.80","$1,494.74",$0.00,$292.41,$0.00,$297.45,$0.00
242.483,SUP,HCPCS C1713,,242.483  -  PLATE SS BONE LEFT DISTAL VOLR RADL NONSTRL,"$1,542.28",$0.00,"$1,542.28",$694.02,"$1,100.72",$0.00,$265.73,$0.00,$0.00,$270.04,"$1,542.28",$0.00,$771.14,"$1,221.49","$1,233.82",$0.00,$241.37,$0.00,$245.53,$0.00
242.49,SUP,HCPCS C1713,,242.490  -  PLATE BN STRG 57X6.3X1.6MM NS LCP CMBN 6 HL LOPRFL RND EDG,$851.60,$0.00,$851.60,$383.22,$607.79,$0.00,$142.45,$0.00,$0.00,$149.11,$851.60,$0.00,$425.80,$674.47,$681.28,$0.00,$129.39,$0.00,$135.57,$0.00
242.491,SUP,HCPCS C1713,,242.491  -  PLATE BN 43X7.5X1.6MM NS LCP CMBN 5 HLE/HD 3 HL SHFT,"$1,491.68",$0.00,"$1,491.68",$671.25,"$1,064.61",$0.00,$322.90,$0.00,$0.00,$261.18,"$1,491.68",$0.00,$745.84,"$1,181.41","$1,193.34",$0.00,$293.30,$0.00,$237.47,$0.00
242.492,SUP,HCPCS C1713,,242.492  -  PLATE BN 61X7.5X1.6MM NS LCP CMBN 5 HLE/HD 5 HL SHFT,"$1,579.03",$0.00,"$1,579.03",$710.56,"$1,126.95",$0.00,$342.32,$0.00,$0.00,$276.47,"$1,579.03",$0.00,$789.51,"$1,250.59","$1,263.22",$0.00,$310.94,$0.00,$251.38,$0.00
242.493,SUP,HCPCS C1713,,242.493  -  PLATE BN 43X7.5X1.6MM NS LCP CMBN 5 HLE/HD 3 HL SHFT,"$1,491.68",$0.00,"$1,491.68",$671.25,"$1,064.61",$0.00,$322.90,$0.00,$0.00,$261.18,"$1,491.68",$0.00,$745.84,"$1,181.41","$1,193.34",$0.00,$293.30,$0.00,$237.47,$0.00
242.494,SUP,HCPCS C1713,,242.494  -  PLATE BN 61X7.5X1.6MM NS LCP CMBN 5 HLE/HD 5 HL SHFT,"$1,579.03",$0.00,"$1,579.03",$710.56,"$1,126.95",$0.00,$264.13,$0.00,$0.00,$276.47,"$1,579.03",$0.00,$789.51,"$1,250.59","$1,263.22",$0.00,$239.92,$0.00,$251.38,$0.00
242.5,SUP,HCPCS C1713,,242.500  -  PLATE BN -90D L 40X6.3X1.6MM NS LCP CMBN 2 HLE/HD 3 HL SHFT,$822.95,$0.00,$822.95,$370.33,$587.34,$0.00,$137.66,$0.00,$0.00,$144.09,$822.95,$0.00,$411.48,$651.78,$658.36,$0.00,$125.04,$0.00,$131.01,$0.00
242.501,SUP,HCPCS C1713,,242.501  -  PLATE BN -90D L 49X6.3X1.6MM NS LCP CMBN 2 HLE/HD 4 HL SHFT,$863.88,$0.00,$863.88,$388.74,$616.55,$0.00,$144.51,$0.00,$0.00,$151.26,$863.88,$0.00,$431.94,$684.19,$691.10,$0.00,$131.26,$0.00,$137.53,$0.00
242.502,SUP,HCPCS C1713,,242.502  -  PLATE BN +90D L 40X6.3X1.6MM NS LCP CMBN 2 HLE/HD 3 HL SHFT,$822.95,$0.00,$822.95,$370.33,$587.34,$0.00,$137.66,$0.00,$0.00,$144.09,$822.95,$0.00,$411.48,$651.78,$658.36,$0.00,$125.04,$0.00,$131.01,$0.00
242.503,SUP,HCPCS C1713,,242.503  -  PLATE BN +90D L 49X6.3X1.6MM NS LCP CMBN 2 HLE/HD 4 HL SHFT,$863.88,$0.00,$863.88,$388.74,$616.55,$0.00,$144.51,$0.00,$0.00,$151.26,$863.88,$0.00,$431.94,$684.19,$691.10,$0.00,$131.26,$0.00,$137.53,$0.00
242.504,SUP,HCPCS C1713,,242.504  -  PLATE BN +90D L 40X6.3X1.6MM NS LCP CMBN 3 HLE/HD 3 HL SHFT,$822.95,$0.00,$822.95,$370.33,$587.34,$0.00,$137.66,$0.00,$0.00,$144.09,$822.95,$0.00,$411.48,$651.78,$658.36,$0.00,$125.04,$0.00,$131.01,$0.00
242.505,SUP,HCPCS C1713,,242.505  -  PLATE BN +90D L 49X6.3X1.6MM NS LCP CMBN 3 HLE/HD 4 HL SHFT,$863.88,$0.00,$863.88,$388.74,$616.55,$0.00,$144.51,$0.00,$0.00,$151.26,$863.88,$0.00,$431.94,$684.19,$691.10,$0.00,$131.26,$0.00,$137.53,$0.00
242.506,SUP,HCPCS C1713,,242.506  -  PLATE BN -90D L 40X6.3X1.6MM NS LCP CMBN 3 HLE/HD 3 HL SHFT,$822.95,$0.00,$822.95,$370.33,$587.34,$0.00,$137.66,$0.00,$0.00,$144.09,$822.95,$0.00,$411.48,$651.78,$658.36,$0.00,$125.04,$0.00,$131.01,$0.00
242.507,SUP,HCPCS C1713,,242.507  -  PLATE BN -90D L 49X6.3X1.6MM NS LCP CMBN 3 HLE/HD 4 HL SHFT,$863.88,$0.00,$863.88,$388.74,$616.55,$0.00,$144.51,$0.00,$0.00,$151.26,$863.88,$0.00,$431.94,$684.19,$691.10,$0.00,$131.26,$0.00,$137.53,$0.00
242.508,SUP,HCPCS C1713,,242.508  -  PLATE BN +20D L 43X6.3X1.6MM NS LCP CMBN 3 HLE/HD 3 HL SHFT,$822.95,$0.00,$822.95,$370.33,$587.34,$0.00,$137.66,$0.00,$0.00,$144.09,$822.95,$0.00,$411.48,$651.78,$658.36,$0.00,$125.04,$0.00,$131.01,$0.00
242.509,SUP,HCPCS C1713,,242.509  -  PLATE BN +20D L 52X6.3X1.6MM NS LCP CMBN 3 HLE/HD 4 HL SHFT,$863.88,$0.00,$863.88,$388.74,$616.55,$0.00,$144.51,$0.00,$0.00,$151.26,$863.88,$0.00,$431.94,$684.19,$691.10,$0.00,$131.26,$0.00,$137.53,$0.00
242.51,SUP,HCPCS C1713,,242.510  -  PLATE BONE STANDARD BEND 8 HOLE FUSION LCP STAINLESS STEEL,"$1,973.43",$0.00,"$1,973.43",$888.04,"$1,408.43",$0.00,$330.11,$0.00,$0.00,$345.53,"$1,973.43",$0.00,$986.71,"$1,562.96","$1,578.74",$0.00,$299.85,$0.00,$314.17,$0.00
242.511,SUP,HCPCS C1713,,242.511  -  PLATE BN -20D L 43X6.3X1.6MM NS LCP CMBN 3 HLE/HD 3 HL SHFT,$822.95,$0.00,$822.95,$370.33,$587.34,$0.00,$137.66,$0.00,$0.00,$144.09,$822.95,$0.00,$411.48,$651.78,$658.36,$0.00,$125.04,$0.00,$131.01,$0.00
242.512,SUP,HCPCS C1713,,242.512  -  PLATE BN -20D L 52X6.3X1.6MM NS LCP CMBN 3 HLE/HD 4 HL SHFT,$863.88,$0.00,$863.88,$388.74,$616.55,$0.00,$144.51,$0.00,$0.00,$151.26,$863.88,$0.00,$431.94,$684.19,$691.10,$0.00,$131.26,$0.00,$137.53,$0.00
242.52,SUP,HCPCS C1713,,242.520  -  PLATE BONE SHORT BEND 8 HOLE STAINLESS STEEL WRIST NONSTRL,"$1,973.43",$0.00,"$1,973.43",$888.04,"$1,408.43",$0.00,$330.11,$0.00,$0.00,$345.53,"$1,973.43",$0.00,$986.71,"$1,562.96","$1,578.74",$0.00,$299.85,$0.00,$314.17,$0.00
242.53,SUP,HCPCS C1713,,242.530  -  PLATE BONE 9 HOLE STR FUSION STAINLESS STEEL WRIST NONSTRL,"$1,973.43",$0.00,"$1,973.43",$888.04,"$1,408.43",$0.00,$330.11,$0.00,$0.00,$345.53,"$1,973.43",$0.00,$986.71,"$1,562.96","$1,578.74",$0.00,$299.85,$0.00,$314.17,$0.00
242.535,SUP,HCPCS C1713,,242.535  -  PLATE BN 31MMX1.2MM NS 5 HL MDLR SS HND/MDFT 2.7MM SCR,$436.73,$0.00,$436.73,$196.53,$311.69,$0.00,$73.05,$0.00,$0.00,$76.47,$436.73,$0.00,$218.36,$345.89,$349.38,$0.00,$66.36,$0.00,$69.53,$0.00
242.536,SUP,HCPCS C1713,,242.536  -  PLATE BN 45MMX1.2MM NS 8 HL MDLR SS HND/MDFT 2.7MM SCR,$451.73,$0.00,$451.73,$203.28,$322.40,$0.00,$75.56,$0.00,$0.00,$79.09,$451.73,$0.00,$225.86,$357.77,$361.38,$0.00,$68.64,$0.00,$71.91,$0.00
242.61,SUP,HCPCS C1713,,242.61  -  PLATE BONE 57MM 7 HOLE DCP STAINLESS STEEL CONDYLE LEFT,$517.25,$0.00,$517.25,$232.76,$369.16,$0.00,$86.52,$0.00,$0.00,$90.57,$517.25,$0.00,$258.63,$409.66,$413.80,$0.00,$78.59,$0.00,$82.35,$0.00
242.62,SUP,HCPCS C1713,,242.62  -  PLATE BONE 57MM 7 HOLE DCP STAINLESS STEEL CONDYLE RIGHT,$517.25,$0.00,$517.25,$232.76,$369.16,$0.00,$86.52,$0.00,$0.00,$90.57,$517.25,$0.00,$258.63,$409.66,$413.80,$0.00,$78.59,$0.00,$82.35,$0.00
242.802,SUP,HCPCS C1713,,242.802  -  PLATE BONE 139MM 2 HOLE LCP STAINLESS STEEL RIGHT PROXIMAL,"$2,538.43",$0.00,"$2,538.43","$1,142.29","$1,811.67",$0.00,$424.62,$0.00,$0.00,$444.46,"$2,538.43",$0.00,"$1,269.21","$2,010.44","$2,030.74",$0.00,$385.69,$0.00,$404.12,$0.00
242.804,SUP,HCPCS C1713,,242.804  -  PLATE BN 175MM NS LCP CMBN 4 HL LMT CNTCT SS FEM RT PROX 4.5,"$2,588.93",$0.00,"$2,588.93","$1,165.02","$1,847.72",$0.00,$563.51,$0.00,$0.00,$453.30,"$2,588.93",$0.00,"$1,294.46","$2,050.43","$2,071.14",$0.00,$511.85,$0.00,$412.16,$0.00
242.806,SUP,HCPCS C1713,,242.806  -  PLATE BN 211MM NS LCP CMBN 6 HL LMT CNTCT SS FEM RT PROX 4.5,"$2,639.43",$0.00,"$2,639.43","$1,187.74","$1,883.76",$0.00,$441.51,$0.00,$0.00,$462.14,"$2,639.43",$0.00,"$1,319.71","$2,090.43","$2,111.54",$0.00,$401.04,$0.00,$420.20,$0.00
242.808,SUP,HCPCS C1713,,242.808  -  PLATE BN 247MM NS LCP CMBN 8 HL LMT CNTCT SS FEM RT PROX 4.5,"$2,769.08",$0.00,"$2,769.08","$1,246.08","$1,976.29",$0.00,$463.20,$0.00,$0.00,$484.84,"$2,769.08",$0.00,"$1,384.54","$2,193.11","$2,215.26",$0.00,$420.74,$0.00,$440.84,$0.00
242.81,SUP,HCPCS C1713,,242.810  -  PLATE BONE 283MM 10 HOLE LCP STAINLESS STEEL FEMUR RIGHT,"$2,966.98",$0.00,"$2,966.98","$1,335.14","$2,117.53",$0.00,$496.30,$0.00,$0.00,$519.49,"$2,966.98",$0.00,"$1,483.49","$2,349.85","$2,373.58",$0.00,$450.81,$0.00,$472.34,$0.00
242.812,SUP,HCPCS C1713,,242.812  -  PLATE BN 319MM NS LCP CMBN 12 HL LMT CNTCT SS FEM RT PROX,"$3,141.65",$0.00,"$3,141.65","$1,413.74","$2,242.20",$0.00,$525.53,$0.00,$0.00,$550.08,"$3,141.65",$0.00,"$1,570.83","$2,488.19","$2,513.32",$0.00,$477.35,$0.00,$500.15,$0.00
242.814,SUP,HCPCS C1713,,242.814  -  PLATE BN 355MM NS LCP CMBN 14 HL LMT CNTCT SS FEM RT PROX,"$3,394.13",$0.00,"$3,394.13","$1,527.36","$2,422.39",$0.00,$567.76,$0.00,$0.00,$594.28,"$3,394.13",$0.00,"$1,697.06","$2,688.15","$2,715.30",$0.00,$515.71,$0.00,$540.34,$0.00
242.816,SUP,HCPCS C1713,,242.816  -  PLATE BN 391MM NS LCP CMBN 16 HL LMT CNTCT SS FEM RT PROX,"$3,496.50",$0.00,"$3,496.50","$1,573.43","$2,495.45",$0.00,$584.88,$0.00,$0.00,$612.21,"$3,496.50",$0.00,"$1,748.25","$2,769.23","$2,797.20",$0.00,$531.26,$0.00,$556.64,$0.00
243.091,SUP,HCPCS C1713,,243.091  -  PLATE BONE STR 12 HOLE ADAPTION STAINLESS STEEL HAND NONSTRL,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
243.13,SUP,HCPCS C1713,,243.13  -  PLATE BONE STR 17X5X1MM 3 HOLE DCP STAINLESS STEEL FT,$100.30,$0.00,$100.30,$45.14,$71.58,$0.00,$16.78,$0.00,$0.00,$17.56,$100.30,$0.00,$50.15,$79.44,$80.24,$0.00,$15.24,$0.00,$15.97,$0.00
243.14,SUP,HCPCS C1713,,243.14  -  PLATE BONE STR 23X5X1MM 4 HOLE DCP STAINLESS STEEL FT,$110.55,$0.00,$110.55,$49.75,$78.90,$0.00,$18.49,$0.00,$0.00,$19.36,$110.55,$0.00,$55.28,$87.56,$88.44,$0.00,$16.80,$0.00,$17.60,$0.00
243.15,SUP,HCPCS C1713,,243.15  -  PLATE BONE STR 29X5X1MM 5 HOLE DCP STAINLESS STEEL FT,$118.05,$0.00,$118.05,$53.12,$84.25,$0.00,$25.43,$0.00,$0.00,$20.67,$118.05,$0.00,$59.03,$93.50,$94.44,$0.00,$23.10,$0.00,$18.79,$0.00
243.16,SUP,HCPCS C1713,,243.16  -  PLATE BN STRG 35X5X1MM NS 6 HL SS 2MM SCR MN FRAG SET,$133.05,$0.00,$133.05,$59.87,$94.96,$0.00,$22.26,$0.00,$0.00,$23.30,$133.05,$0.00,$66.53,$105.38,$106.44,$0.00,$20.22,$0.00,$21.18,$0.00
243.19,SUP,HCPCS C1713,,243.19  -  PLATE BONE 2MM 100MM 20 HOLE DCP STAINLESS STEEL ORTHOPEDIC,$408.05,$0.00,$408.05,$183.62,$291.23,$0.00,$68.26,$0.00,$0.00,$71.45,$408.05,$0.00,$204.03,$323.18,$326.44,$0.00,$62.00,$0.00,$64.96,$0.00
243.23,SUP,HCPCS C1713,,243.23  -  PLATE BONE 2MM 12 HOLE T DCP STAINLESS STEEL ORTHOPEDIC,$371.00,$0.00,$371.00,$166.95,$264.78,$0.00,$63.92,$0.00,$0.00,$64.96,$371.00,$0.00,$185.50,$293.83,$296.80,$0.00,$58.06,$0.00,$59.06,$0.00
243.234,SUP,HCPCS C1713,,243.234  -  PLATE BN T 65MMX1.2MM NS DCP 3 HLE/HD 10 HL SHFT SS FT 2MM,$449.00,$0.00,$449.00,$202.05,$320.45,$0.00,$75.11,$0.00,$0.00,$78.62,$449.00,$0.00,$224.50,$355.61,$359.20,$0.00,$68.22,$0.00,$71.48,$0.00
243.24,SUP,HCPCS C1713,,243.24  -  PLATE BONE 2MM 50MM T 4 HOLE HEAD 9 HOLE SHAFT DCP STAINLESS,$382.13,$0.00,$382.13,$171.96,$272.72,$0.00,$63.92,$0.00,$0.00,$66.91,$382.13,$0.00,$191.06,$302.65,$305.70,$0.00,$58.06,$0.00,$60.83,$0.00
243.31,SUP,HCPCS C1713,,243.31  -  PLATE BONE L 17X5X1MM 2 HOLE OBLIQUE DCP STAINLESS STEEL,$103.73,$0.00,$103.73,$46.68,$74.03,$0.00,$17.35,$0.00,$0.00,$18.16,$103.73,$0.00,$51.86,$82.15,$82.98,$0.00,$15.76,$0.00,$16.51,$0.00
243.32,SUP,HCPCS C1713,,243.32  -  PLATE BONE L 17X5X1MM 2 HOLE OBLIQUE DCP STAINLESS STEEL,$103.73,$0.00,$103.73,$46.68,$74.03,$0.00,$17.35,$0.00,$0.00,$18.16,$103.73,$0.00,$51.86,$82.15,$82.98,$0.00,$15.76,$0.00,$16.51,$0.00
243.33,SUP,HCPCS C1713,,243.33  -  PLATE BN OB L L 19X5X1MM NS DCP 2 HL SS 2MM SCR MN FRAG SET,$100.30,$0.00,$100.30,$45.14,$71.58,$0.00,$16.78,$0.00,$0.00,$17.56,$100.30,$0.00,$50.15,$79.44,$80.24,$0.00,$15.24,$0.00,$15.97,$0.00
243.34,SUP,HCPCS C1713,,243.34  -  PLATE BN OB R L 19X5X1MM NS DCP 2 HL SS 2MM SCR MN FRAG SET,$100.30,$0.00,$100.30,$45.14,$71.58,$0.00,$16.78,$0.00,$0.00,$17.56,$100.30,$0.00,$50.15,$79.44,$80.24,$0.00,$15.24,$0.00,$15.97,$0.00
243.41,SUP,HCPCS C1713,,243.41  -  PLATE BONE T 18MM 2X2 HOLE DCP STAINLESS STEEL FT NONSTRL,$100.30,$0.00,$100.30,$45.14,$71.58,$0.00,$16.78,$0.00,$0.00,$17.56,$100.30,$0.00,$50.15,$79.44,$80.24,$0.00,$15.24,$0.00,$15.97,$0.00
243.48,SUP,HCPCS C1713,,243.48  -  PLATE BONE H 6MM 4 HOLE DCP STAINLESS STEEL FT NONSTRL MINI,$301.60,$0.00,$301.60,$135.72,$215.25,$0.00,$50.45,$0.00,$0.00,$52.81,$301.60,$0.00,$150.80,$238.87,$241.28,$0.00,$45.83,$0.00,$48.01,$0.00
243.54,SUP,HCPCS C1713,,243.54  -  PLATE BONE 2MM 22MM 4 HOLE DCP STAINLESS STEEL ORTHOPEDIC,$305.70,$0.00,$305.70,$137.57,$218.18,$0.00,$51.14,$0.00,$0.00,$53.53,$305.70,$0.00,$152.85,$242.11,$244.56,$0.00,$46.45,$0.00,$48.67,$0.00
243.55,SUP,HCPCS C1713,,243.55  -  PLATE BONE 27X5MM 5 HOLE DCP STAINLESS STEEL NONSTRL 2MM,$316.63,$0.00,$316.63,$142.48,$225.98,$0.00,$52.96,$0.00,$0.00,$55.44,$316.63,$0.00,$158.31,$250.77,$253.30,$0.00,$48.11,$0.00,$50.41,$0.00
243.56,SUP,HCPCS C1713,,243.56  -  PLATE BONE 32MM 2MM 6 HOLE DCP STAINLESS STEEL ORTHOPEDIC,$330.28,$0.00,$330.28,$148.62,$235.72,$0.00,$55.25,$0.00,$0.00,$57.83,$330.28,$0.00,$165.14,$261.58,$264.22,$0.00,$50.18,$0.00,$52.58,$0.00
243.57,SUP,HCPCS C1713,,243.57  -  PLATE BONE 2MM 37MM 7 HOLE RECONSTRUCTION DCP STAINLESS,$348.00,$0.00,$348.00,$156.60,$248.37,$0.00,$58.21,$0.00,$0.00,$60.93,$348.00,$0.00,$174.00,$275.62,$278.40,$0.00,$52.88,$0.00,$55.40,$0.00
243.58,SUP,HCPCS C1713,,243.58  -  PLATE BONE 2MM 42MM 8 HOLE DCP STAINLESS STEEL ORTHOPEDIC,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
243.584,SUP,HCPCS C1713,,243.584  -  PLATE BN 27MMX1.2MM NS LC DCP 4 HL SS 2MM SCR MDLR HND SYS,$383.50,$0.00,$383.50,$172.58,$273.70,$0.00,$64.15,$0.00,$0.00,$67.15,$383.50,$0.00,$191.75,$303.73,$306.80,$0.00,$58.27,$0.00,$61.05,$0.00
243.585,SUP,HCPCS C1713,,243.585  -  PLATE BONE 33MM 5 HOLE LC-DCP STAINLESS STEEL ORTHOPEDIC,$408.05,$0.00,$408.05,$183.62,$291.23,$0.00,$68.26,$0.00,$0.00,$71.45,$408.05,$0.00,$204.03,$323.18,$326.44,$0.00,$62.00,$0.00,$64.96,$0.00
243.586,SUP,HCPCS C1713,,243.586  -  PLATE BN 39MMX1.2MM NS LC DCP 6 HL SS 2MM SCR MDLR HND SYS,$450.38,$0.00,$450.38,$202.67,$321.43,$0.00,$75.34,$0.00,$0.00,$78.86,$450.38,$0.00,$225.19,$356.70,$360.30,$0.00,$68.43,$0.00,$71.70,$0.00
243.587,SUP,HCPCS C1713,,243.587  -  PLATE BONE 45MM 7 HOLE LC-DCP STAINLESS STEEL ORTHOPEDIC,$481.75,$0.00,$481.75,$216.79,$343.82,$0.00,$80.59,$0.00,$0.00,$84.35,$481.75,$0.00,$240.88,$381.55,$385.40,$0.00,$73.20,$0.00,$76.69,$0.00
243.588,SUP,HCPCS C1713,,243.588  -  PLATE BN 51MMX1.2MM NS LC DCP 8 HL SS 2MM SCR MDLR HND SYS,$515.88,$0.00,$515.88,$232.14,$368.18,$0.00,$86.29,$0.00,$0.00,$90.33,$515.88,$0.00,$257.94,$408.58,$412.70,$0.00,$78.38,$0.00,$82.13,$0.00
243.61,SUP,HCPCS C1713,,243.61  -  PLATE BN 39X5X1.2MM NS DCP 7 HL SS CNDYL LT 2MM SCR,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
243.62,SUP,HCPCS C1713,,243.62  -  PLATE BN 39X5X1.2MM NS DCP 7 HL SS CNDYL RT 2MM SCR,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
244.02,SUP,HCPCS C1713,,244.02  -  PLATE BONE 20MM 2 HOLE DCP STAINLESS STEEL NONSTRL 2.7MM,$218.35,$0.00,$218.35,$98.26,$155.84,$0.00,$36.53,$0.00,$0.00,$38.23,$218.35,$0.00,$109.18,$172.93,$174.68,$0.00,$33.18,$0.00,$34.76,$0.00
244.04,SUP,HCPCS C1713,,244.04  -  PLATE BN 36X8X2MM NS DCP 4 HL SS 2.7MM SCR MN FRAG SET,$245.65,$0.00,$245.65,$110.54,$175.32,$0.00,$41.09,$0.00,$0.00,$43.01,$245.65,$0.00,$122.83,$194.55,$196.52,$0.00,$37.33,$0.00,$39.11,$0.00
244.05,SUP,HCPCS C1713,,244.05  -  PLATE BONE 44X8X2MM 5 HOLE DCP STAINLESS STEEL NONSTRL 2.7MM,$279.78,$0.00,$279.78,$125.90,$199.68,$0.00,$46.80,$0.00,$0.00,$48.99,$279.78,$0.00,$139.89,$221.59,$223.82,$0.00,$42.51,$0.00,$44.54,$0.00
244.06,SUP,HCPCS C1713,,244.06  -  PLATE BONE 52X8X2MM 6 HOLE DCP STAINLESS STEEL NONSTRL 2.7MM,$302.98,$0.00,$302.98,$136.34,$216.23,$0.00,$50.68,$0.00,$0.00,$53.05,$302.98,$0.00,$151.49,$239.96,$242.38,$0.00,$46.03,$0.00,$48.23,$0.00
244.07,SUP,HCPCS C1713,,244.07  -  PLATE BN 60X8X2.5MM NS DCP 7 HL SS 2.7MM SCR MN FRAG SET,$346.65,$0.00,$346.65,$155.99,$247.40,$0.00,$57.99,$0.00,$0.00,$60.70,$346.65,$0.00,$173.33,$274.55,$277.32,$0.00,$52.67,$0.00,$55.19,$0.00
244.08,SUP,HCPCS C1713,,244.08  -  PLATE BONE 68X8X2.5MM 8 HOLE DCP STAINLESS STEEL NONSTRL 2.7,$384.85,$0.00,$384.85,$173.18,$274.67,$0.00,$64.38,$0.00,$0.00,$67.38,$384.85,$0.00,$192.43,$304.80,$307.88,$0.00,$58.48,$0.00,$61.27,$0.00
244.09,SUP,HCPCS C1713,,244.09  -  PLATE BN 76X8X2.5MM NS DCP 9 HL SS 2.7MM SCR MN FRAG SET,$399.88,$0.00,$399.88,$179.94,$285.39,$0.00,$66.89,$0.00,$0.00,$70.01,$399.88,$0.00,$199.94,$316.70,$319.90,$0.00,$60.76,$0.00,$63.66,$0.00
244.1,SUP,HCPCS C1713,,244.10  -  PLATE BONE 84X8X2.5MM 10 HOLE DCP STAINLESS STEEL FT NONSTRL,$443.55,$0.00,$443.55,$199.60,$316.56,$0.00,$74.19,$0.00,$0.00,$77.66,$443.55,$0.00,$221.78,$351.29,$354.84,$0.00,$67.39,$0.00,$70.61,$0.00
244.12,SUP,HCPCS C1713,,244.12  -  PLATE BONE 100X8X2.5MM 12MM 12 HOLE DCP STAINLESS STEEL,$499.50,$0.00,$499.50,$224.78,$356.49,$0.00,$83.55,$0.00,$0.00,$87.46,$499.50,$0.00,$249.75,$395.60,$399.60,$0.00,$75.89,$0.00,$79.52,$0.00
244.22,SUP,HCPCS C1713,,244.22  -  PLATE BONE 2.7MM 26MM 2 HOLE DCP STAINLESS STEEL ORTHOPEDIC,$259.30,$0.00,$259.30,$116.69,$185.06,$0.00,$43.38,$0.00,$0.00,$45.40,$259.30,$0.00,$129.65,$205.37,$207.44,$0.00,$39.40,$0.00,$41.28,$0.00
245,SUP,HCPCS C1713,,245.00  -  PLATE BONE STR 118MM 10 HOLE RECONSTRUCTION LC-DCP STAINLESS,$813.40,$0.00,$813.40,$366.03,$580.52,$0.00,$136.06,$0.00,$0.00,$142.42,$813.40,$0.00,$406.70,$644.21,$650.72,$0.00,$123.59,$0.00,$129.49,$0.00
245,SUP,HCPCS C1713,,245  -  PLATE 118MM SS 3.5MM SCR SM FRAG SET 10 HOLE RECON LC DCP,$946.28,$0.00,$813.40,$366.03,$580.52,$0.00,$136.06,$0.00,$0.00,$142.42,$813.40,$0.00,$406.70,$749.45,$650.72,$0.00,$123.59,$0.00,$129.49,$0.00
245.01,SUP,HCPCS C1713,,245.01  -  PLATE BONE 130MM 11 HOLE RECONSTRUCTION LC-DCP STAINLESS,$854.33,$0.00,$854.33,$384.45,$609.73,$0.00,$142.91,$0.00,$0.00,$149.59,$854.33,$0.00,$427.16,$676.63,$683.46,$0.00,$129.81,$0.00,$136.01,$0.00
245.02,SUP,HCPCS C1713,,245.02  -  PLATE BONE STR 142MM 12 HOLE RECONSTRUCTION LC-DCP STAINLESS,$891.18,$0.00,$891.18,$401.03,$636.03,$0.00,$149.07,$0.00,$0.00,$156.04,$891.18,$0.00,$445.59,$705.81,$712.94,$0.00,$135.41,$0.00,$141.88,$0.00
245.023,SUP,HCPCS C1713,,245.023  -  PLATE BN STRG 39X10.2X2.7MM NS LC DCP 3 HL LOPRFL RECON SS,$589.58,$0.00,$589.58,$265.31,$420.78,$0.00,$98.62,$0.00,$0.00,$103.23,$589.58,$0.00,$294.79,$466.95,$471.66,$0.00,$89.58,$0.00,$93.86,$0.00
245.024,SUP,HCPCS C1713,,245.024  -  PLATE BONE 52X10.2X2.7MM 4 HOLE LP STAINLESS STEEL CALCANEUS,$616.88,$0.00,$616.88,$277.59,$440.26,$0.00,$103.19,$0.00,$0.00,$108.01,$616.88,$0.00,$308.44,$488.57,$493.50,$0.00,$93.73,$0.00,$98.21,$0.00
245.025,SUP,HCPCS C1713,,245.025  -  PLATE BN STRG 65X10.2X2.7MM NS LC DCP 5 HL LOPRFL RECON SS,$642.80,$0.00,$642.80,$289.26,$458.77,$0.00,$107.53,$0.00,$0.00,$112.55,$642.80,$0.00,$321.40,$509.10,$514.24,$0.00,$97.67,$0.00,$102.33,$0.00
245.026,SUP,HCPCS C1713,,245.026  -  PLATE BONE 78X10.2X2.7MM 6 HOLE LP RECONSTRUCTION STAINLESS,$712.40,$0.00,$712.40,$320.58,$508.44,$0.00,$119.17,$0.00,$0.00,$124.74,$712.40,$0.00,$356.20,$564.22,$569.92,$0.00,$108.24,$0.00,$113.41,$0.00
245.027,SUP,HCPCS C1713,,245.027  -  PLATE BONE 91X10.2X2.7MM 7 HOLE LP RECONSTRUCTION STAINLESS,$747.88,$0.00,$747.88,$336.54,$533.76,$0.00,$125.10,$0.00,$0.00,$130.95,$747.88,$0.00,$373.94,$592.32,$598.30,$0.00,$113.63,$0.00,$119.06,$0.00
245.028,SUP,HCPCS C1713,,245.028  -  PLATE BN STRG 104X10.2X2.7MM NS LC DCP 8 HL LOPRFL RECON SS,$777.90,$0.00,$777.90,$350.06,$555.19,$0.00,$130.13,$0.00,$0.00,$136.20,$777.90,$0.00,$388.95,$616.10,$622.32,$0.00,$118.20,$0.00,$123.84,$0.00
245.029,SUP,HCPCS C1713,,245.029  -  PLATE BONE 11.7X1.02X.27CM 9 HOLE LP RECONSTRUCTION,$798.38,$0.00,$798.38,$359.27,$569.80,$0.00,$133.55,$0.00,$0.00,$139.79,$798.38,$0.00,$399.19,$632.32,$638.70,$0.00,$121.31,$0.00,$127.10,$0.00
245.03,SUP,HCPCS C1713,,245.030  -  PLATE BONE 130MM 10 HOLE LP STAINLESS STEEL PELVIC NONSTRL,$802.48,$0.00,$802.48,$361.11,$572.73,$0.00,$134.24,$0.00,$0.00,$140.51,$802.48,$0.00,$401.24,$635.56,$641.98,$0.00,$121.93,$0.00,$127.75,$0.00
245.03,SUP,HCPCS C1713,,245.03  -  PLATE BN 154MM NS LC DCP 13 HL RECON SS 3.5MM SCR SM FRAG,$932.13,$0.00,$802.48,$361.11,$572.73,$0.00,$134.24,$0.00,$0.00,$140.51,$802.48,$0.00,$401.24,$738.25,$641.98,$0.00,$121.93,$0.00,$127.75,$0.00
245.031,SUP,HCPCS C1713,,245.031  -  PLATE BONE 143MM 11 HOLE LP RECONSTRUCTION STAINLESS STEEL,$847.50,$0.00,$847.50,$381.38,$604.86,$0.00,$141.77,$0.00,$0.00,$148.39,$847.50,$0.00,$423.75,$671.22,$678.00,$0.00,$128.77,$0.00,$134.92,$0.00
245.032,SUP,HCPCS C1713,,245.032  -  PLATE BN STRG 156X10.2X2.7MM NS LC DCP 12 HL LOPRFL RECON SS,$880.28,$0.00,$880.28,$396.12,$628.25,$0.00,$147.25,$0.00,$0.00,$154.13,$880.28,$0.00,$440.14,$697.18,$704.22,$0.00,$133.75,$0.00,$140.14,$0.00
245.033,SUP,HCPCS C1713,,245.033  -  PLATE BONE 169MM 13 HOLE LP RECONSTRUCTION STAINLESS STEEL,$922.58,$0.00,$922.58,$415.16,$658.44,$0.00,$154.32,$0.00,$0.00,$161.54,$922.58,$0.00,$461.29,$730.68,$738.06,$0.00,$140.18,$0.00,$146.87,$0.00
245.034,SUP,HCPCS C1713,,245.034  -  PLATE BONE 182MM 14 HOLE LP RECONSTRUCTION STAINLESS STEEL,$956.70,$0.00,$956.70,$430.52,$682.80,$0.00,$160.03,$0.00,$0.00,$167.51,$956.70,$0.00,$478.35,$757.71,$765.36,$0.00,$145.36,$0.00,$152.31,$0.00
245.035,SUP,HCPCS C1713,,245.035  -  PLATE BONE 195MM 15 HOLE LP RECONSTRUCTION STAINLESS STEEL,"$1,004.45",$0.00,"$1,004.45",$452.00,$716.88,$0.00,$168.02,$0.00,$0.00,$175.87,"$1,004.45",$0.00,$502.23,$795.52,$803.56,$0.00,$152.62,$0.00,$159.91,$0.00
245.036,SUP,HCPCS C1713,,245.036  -  PLATE BONE 208MM 16 HOLE LP RECONSTRUCTION STAINLESS STEEL,"$1,049.50",$0.00,"$1,049.50",$472.28,$749.03,$0.00,$175.56,$0.00,$0.00,$183.76,"$1,049.50",$0.00,$524.75,$831.20,$839.60,$0.00,$159.46,$0.00,$167.08,$0.00
245.038,SUP,HCPCS C1713,,245.038  -  PLATE BONE 234MM 18 HOLE LP RECONSTRUCTION STAINLESS STEEL,"$1,094.53",$0.00,"$1,094.53",$492.54,$781.16,$0.00,$183.09,$0.00,$0.00,$191.64,"$1,094.53",$0.00,$547.26,$866.87,$875.62,$0.00,$166.30,$0.00,$174.25,$0.00
245.039,SUP,HCPCS C1713,,245.039  -  PLATE BONE 260MM 20 HOLE LP RECONSTRUCTION STAINLESS STEEL,"$1,314.25",$0.00,"$1,314.25",$591.41,$937.98,$0.00,$219.84,$0.00,$0.00,$230.11,"$1,314.25",$0.00,$657.13,"$1,040.89","$1,051.40",$0.00,$199.69,$0.00,$209.23,$0.00
245.04,SUP,HCPCS C1713,,245.04  -  PLATE BONE 3.5MM 166MM 14 HOLE RECONSTRUCTION LC-DCP,$967.60,$0.00,$967.60,$435.42,$690.58,$0.00,$161.86,$0.00,$0.00,$169.42,$967.60,$0.00,$483.80,$766.34,$774.08,$0.00,$147.02,$0.00,$154.04,$0.00
245.041,SUP,HCPCS C1713,,245.041  -  PLATE BN 56MM NS LCP 4 HL RECON SS 3.5MM SCR SM FRAG SYS,$803.85,$0.00,$803.85,$361.73,$573.71,$0.00,$134.46,$0.00,$0.00,$140.75,$803.85,$0.00,$401.93,$636.65,$643.08,$0.00,$122.14,$0.00,$127.97,$0.00
245.05,SUP,HCPCS C1713,,245.05  -  PLATE BONE 3.5MM 178MM 15 HOLE RECONSTRUCTION DCP LC-DCP,"$1,004.45",$0.00,"$1,004.45",$452.00,$716.88,$0.00,$168.02,$0.00,$0.00,$175.87,"$1,004.45",$0.00,$502.23,$795.52,$803.56,$0.00,$152.62,$0.00,$159.91,$0.00
245.051,SUP,HCPCS C1713,,245.051  -  PLATE BONE STR 70X10.1X3.5MM 5 HOLE RECONSTRUCTION LCP,$786.10,$0.00,$786.10,$353.75,$561.04,$0.00,$131.50,$0.00,$0.00,$137.64,$786.10,$0.00,$393.05,$622.59,$628.88,$0.00,$119.44,$0.00,$125.15,$0.00
245.06,SUP,HCPCS C1713,,245.06  -  PLATE BN 190MM NS LC DCP 16 HL RECON SS 3.5MM SCR SM FRAG,"$1,048.13",$0.00,"$1,048.13",$471.66,$748.05,$0.00,$175.33,$0.00,$0.00,$183.52,"$1,048.13",$0.00,$524.06,$830.12,$838.50,$0.00,$159.25,$0.00,$166.86,$0.00
245.061,SUP,HCPCS C1713,,245.061  -  PLATE BONE STR 84X10.1X3.5MM 6 HOLE RECONSTRUCTION LCP,$908.93,$0.00,$908.93,$409.02,$648.70,$0.00,$152.04,$0.00,$0.00,$159.15,$908.93,$0.00,$454.46,$719.87,$727.14,$0.00,$138.10,$0.00,$144.70,$0.00
245.071,SUP,HCPCS C1713,,245.071  -  PLATE BONE STR 98X10.1X3.5MM 7 HOLE RECONSTRUCTION LCP,$953.95,$0.00,$953.95,$429.28,$680.83,$0.00,$211.68,$0.00,$0.00,$167.03,$953.95,$0.00,$476.98,$755.53,$763.16,$0.00,$192.28,$0.00,$151.87,$0.00
245.08,SUP,HCPCS C1713,,245.08  -  PLATE BONE STR 214MM 18 HOLE RECONSTRUCTION LC-DCP STAINLESS,"$1,095.90",$0.00,"$1,095.90",$493.16,$782.14,$0.00,$183.32,$0.00,$0.00,$191.88,"$1,095.90",$0.00,$547.95,$867.95,$876.72,$0.00,$166.51,$0.00,$174.47,$0.00
245.081,SUP,HCPCS C1713,,245.081  -  PLATE BONE STR 112X10.1X3.5MM 8 HOLE RECONSTRUCTION LCP,$994.90,$0.00,$994.90,$447.71,$710.06,$0.00,$166.42,$0.00,$0.00,$174.20,$994.90,$0.00,$497.45,$787.96,$795.92,$0.00,$151.17,$0.00,$158.39,$0.00
245.091,SUP,HCPCS C1713,,245.091  -  PLATE BN 126X10.1X3.5MM NS LCP CMBN 9 HL RECON SS 3.5MM SCR,"$1,048.13",$0.00,"$1,048.13",$471.66,$748.05,$0.00,$175.33,$0.00,$0.00,$183.52,"$1,048.13",$0.00,$524.06,$830.12,$838.50,$0.00,$159.25,$0.00,$166.86,$0.00
245.1,SUP,HCPCS C1713,,245.10  -  PLATE BN 238MM NS LC DCP 20 HL RECON SS 3.5MM SCR SM FRAG,"$1,329.28",$0.00,"$1,329.28",$598.17,$948.70,$0.00,$222.36,$0.00,$0.00,$232.75,"$1,329.28",$0.00,$664.64,"$1,052.79","$1,063.42",$0.00,$201.97,$0.00,$211.62,$0.00
245.101,SUP,HCPCS C1713,,245.101  -  PLATE BONE STR 140X10.1X3.5MM 10 HOLE RECONSTRUCTION LCP,"$1,031.75",$0.00,"$1,031.75",$464.29,$736.36,$0.00,$172.59,$0.00,$0.00,$180.65,"$1,031.75",$0.00,$515.88,$817.15,$825.40,$0.00,$156.77,$0.00,$164.25,$0.00
245.111,SUP,HCPCS C1713,,245.111  -  PLATE BN 154X10.1X3.5MM NS LCP CMBN 11 HL SHFT RECON SS 3.5,"$1,116.38",$0.00,"$1,116.38",$502.37,$796.76,$0.00,$186.74,$0.00,$0.00,$195.47,"$1,116.38",$0.00,$558.19,$884.17,$893.10,$0.00,$169.62,$0.00,$177.73,$0.00
245.12,SUP,HCPCS C1713,,245.12  -  PLATE BONE STR 3.5MM 263MM 22 HOLE RECONSTRUCTION LC-DCP,"$1,383.85",$0.00,"$1,383.85",$622.73,$987.65,$0.00,$231.49,$0.00,$0.00,$242.30,"$1,383.85",$0.00,$691.93,"$1,096.01","$1,107.08",$0.00,$210.27,$0.00,$220.31,$0.00
245.121,SUP,HCPCS C1713,,245.121  -  PLATE BONE STR 168X10.1X3.5MM 12 HOLE RECONSTRUCTION LCP,"$1,142.30",$0.00,"$1,142.30",$514.04,$815.26,$0.00,$191.08,$0.00,$0.00,$200.01,"$1,142.30",$0.00,$571.15,$904.70,$913.84,$0.00,$173.56,$0.00,$181.85,$0.00
245.131,SUP,HCPCS C1713,,245.131  -  PLATE BONE STR 182X10.1X3.5MM 13 HOLE RECONSTRUCTION LCP,"$1,236.48",$0.00,"$1,236.48",$556.41,$882.47,$0.00,$206.83,$0.00,$0.00,$216.50,"$1,236.48",$0.00,$618.24,$979.29,$989.18,$0.00,$187.87,$0.00,$196.85,$0.00
245.14,SUP,HCPCS C1713,,245.14  -  PLATE BONE STR 46X10.1X3.5MM 4 HOLE RECONSTRUCTION LC-DCP,$616.88,$0.00,$616.88,$277.59,$440.26,$0.00,$103.19,$0.00,$0.00,$108.01,$616.88,$0.00,$308.44,$488.57,$493.50,$0.00,$93.73,$0.00,$98.21,$0.00
245.141,SUP,HCPCS C1713,,245.141  -  PLATE BONE STR 196X10.1X3.5MM 14 HOLE RECONSTRUCTION LCP,"$1,284.23",$0.00,"$1,284.23",$577.90,$916.55,$0.00,$214.82,$0.00,$0.00,$224.86,"$1,284.23",$0.00,$642.11,"$1,017.11","$1,027.38",$0.00,$195.13,$0.00,$204.45,$0.00
245.15,SUP,HCPCS C1713,,245.15  -  PLATE BONE STR 58MM 5 HOLE RECONSTRUCTION LC-DCP STAINLESS,$627.78,$0.00,$627.78,$282.50,$448.04,$0.00,$105.01,$0.00,$0.00,$109.92,$627.78,$0.00,$313.89,$497.20,$502.22,$0.00,$95.39,$0.00,$99.94,$0.00
245.16,SUP,HCPCS C1713,,245.16  -  PLATE BONE STR 70MM 6 HOLE RECONSTRUCTION LC-DCP STAINLESS,$720.60,$0.00,$720.60,$324.27,$514.29,$0.00,$120.54,$0.00,$0.00,$126.17,$720.60,$0.00,$360.30,$570.72,$576.48,$0.00,$109.49,$0.00,$114.72,$0.00
245.161,SUP,HCPCS C1713,,245.161  -  PLATE BONE STR 224X10.1X3.5MM 16 HOLE RECONSTRUCTION LCP,"$1,392.05",$0.00,"$1,392.05",$626.42,$993.51,$0.00,$232.86,$0.00,$0.00,$243.74,"$1,392.05",$0.00,$696.03,"$1,102.50","$1,113.64",$0.00,$211.51,$0.00,$221.61,$0.00
245.17,SUP,HCPCS C1713,,245.17  -  PLATE BONE STR 82MM 7 HOLE RECONSTRUCTION LC-DCP STAINLESS,$756.08,$0.00,$756.08,$340.23,$539.61,$0.00,$156.70,$0.00,$0.00,$132.38,$756.08,$0.00,$378.04,$598.82,$604.86,$0.00,$142.33,$0.00,$120.37,$0.00
245.18,SUP,HCPCS C1713,,245.18  -  PLATE BONE STR 94MM 8 HOLE RECONSTRUCTION LC-DCP STAINLESS,$787.45,$0.00,$787.45,$354.35,$562.00,$0.00,$131.72,$0.00,$0.00,$137.88,$787.45,$0.00,$393.73,$623.66,$629.96,$0.00,$119.65,$0.00,$125.36,$0.00
245.181,SUP,HCPCS C1713,,245.181  -  PLATE BONE STR 252X10.1X3.5MM 18 HOLE RECONSTRUCTION LCP,"$1,457.55",$0.00,"$1,457.55",$655.90,"$1,040.25",$0.00,$243.81,$0.00,$0.00,$255.21,"$1,457.55",$0.00,$728.78,"$1,154.38","$1,166.04",$0.00,$221.46,$0.00,$232.04,$0.00
245.19,SUP,HCPCS C1713,,245.19  -  PLATE BN 106MM NS LC DCP 9 HL RECON SS 3.5MM SCR SM FRAG SET,$806.58,$0.00,$806.58,$362.96,$575.65,$0.00,$134.92,$0.00,$0.00,$141.22,$806.58,$0.00,$403.29,$638.81,$645.26,$0.00,$122.55,$0.00,$128.41,$0.00
245.2,SUP,HCPCS C1713,,245.20  -  PLATE BN 48X8X3.3MM NS 6 HL RECON 2.7MM SCR,$559.55,$0.00,$559.55,$251.80,$399.35,$0.00,$93.60,$0.00,$0.00,$97.97,$559.55,$0.00,$279.78,$443.16,$447.64,$0.00,$85.02,$0.00,$89.08,$0.00
245.201,SUP,HCPCS C1713,,245.201  -  PLATE BONE STR 280X10.1X3.5MM 20 HOLE RECONSTRUCTION LCP,"$1,770.08",$0.00,"$1,770.08",$796.53,"$1,263.30",$0.00,$296.09,$0.00,$0.00,$309.93,"$1,770.08",$0.00,$885.04,"$1,401.90","$1,416.06",$0.00,$268.95,$0.00,$281.80,$0.00
245.21,SUP,HCPCS C1713,,245.21  -  PLATE BN 64X8X3.3MM NS 8 HL RECON 2.7MM SCR,$580.03,$0.00,$580.03,$261.01,$413.96,$0.00,$97.02,$0.00,$0.00,$101.56,$580.03,$0.00,$290.01,$459.38,$464.02,$0.00,$88.13,$0.00,$92.34,$0.00
245.22,SUP,HCPCS C1713,,245.22  -  PLATE BN 80X8X3.3MM NS 10 HL RECON 2.7MM SCR,$619.60,$0.00,$619.60,$278.82,$442.21,$0.00,$103.64,$0.00,$0.00,$108.49,$619.60,$0.00,$309.80,$490.72,$495.68,$0.00,$94.14,$0.00,$98.64,$0.00
245.221,SUP,HCPCS C1713,,245.221  -  PLATE BN 308X10.1X3.5MM NS LCP CMBN 22 HL RECON SS 3.5MM SCR,"$1,838.33",$0.00,"$1,838.33",$827.25,"$1,312.01",$0.00,$307.51,$0.00,$0.00,$321.88,"$1,838.33",$0.00,$919.16,"$1,455.96","$1,470.66",$0.00,$279.32,$0.00,$292.66,$0.00
245.23,SUP,HCPCS C1713,,245.23  -  PLATE BONE STR 96MM 12 HOLE RECONSTRUCTION LCP STAINLESS,$739.70,$0.00,$739.70,$332.87,$527.92,$0.00,$123.73,$0.00,$0.00,$129.52,$739.70,$0.00,$369.85,$585.84,$591.76,$0.00,$112.39,$0.00,$117.76,$0.00
245.24,SUP,HCPCS C1713,,245.24  -  PLATE BN 112X8X3.3MM NS 14 HL RECON 2.7MM SCR,$787.45,$0.00,$787.45,$354.35,$562.00,$0.00,$131.72,$0.00,$0.00,$137.88,$787.45,$0.00,$393.73,$623.66,$629.96,$0.00,$119.65,$0.00,$125.36,$0.00
245.25,SUP,HCPCS C1713,,245.25  -  PLATE BONE STR 128X8X3.3MM 16 HOLE RECONSTRUCTION LCP,$857.08,$0.00,$857.08,$385.68,$611.69,$0.00,$143.37,$0.00,$0.00,$150.07,$857.08,$0.00,$428.54,$678.81,$685.66,$0.00,$130.22,$0.00,$136.45,$0.00
245.26,SUP,HCPCS C1713,,245.26  -  PLATE BONE 144MM 18 HOLE RECONSTRUCTION LC-DCP STAINLESS,"$1,065.88",$0.00,"$1,065.88",$479.64,$760.71,$0.00,$178.30,$0.00,$0.00,$186.63,"$1,065.88",$0.00,$532.94,$844.18,$852.70,$0.00,$161.95,$0.00,$169.69,$0.00
245.27,SUP,HCPCS C1713,,245.27  -  PLATE BONE 160MM 20 HOLE RECONSTRUCTION DCP STAINLESS STEEL,"$1,109.03",$0.00,"$1,109.03",$499.06,$791.51,$0.00,$191.08,$0.00,$0.00,$194.18,"$1,109.03",$0.00,$554.51,$878.35,$887.22,$0.00,$173.56,$0.00,$176.56,$0.00
245.28,SUP,HCPCS C1713,,245.28  -  PLATE BONE 176MM 22 HOLE RECONSTRUCTION DCP STAINLESS STEEL,"$1,329.28",$0.00,"$1,329.28",$598.17,$948.70,$0.00,$222.36,$0.00,$0.00,$232.75,"$1,329.28",$0.00,$664.64,"$1,052.79","$1,063.42",$0.00,$201.97,$0.00,$211.62,$0.00
245.29,SUP,HCPCS C1713,,245.29  -  PLATE BONE 192MM 24 HOLE RECONSTRUCTION DCP STAINLESS STEEL,"$1,497.13",$0.00,"$1,497.13",$673.71,"$1,068.50",$0.00,$250.44,$0.00,$0.00,$262.13,"$1,497.13",$0.00,$748.56,"$1,185.73","$1,197.70",$0.00,$227.48,$0.00,$238.34,$0.00
245.3,SUP,HCPCS C1713,,245.30  -  PLATE BONE CURVE 70X10X3.6MM 6 HOLE RECONSTRUCTION LC-DCP,$780.63,$0.00,$780.63,$351.28,$557.13,$0.00,$130.58,$0.00,$0.00,$136.68,$780.63,$0.00,$390.31,$618.26,$624.50,$0.00,$118.61,$0.00,$124.28,$0.00
245.31,SUP,HCPCS C1713,,245.31  -  PLATE BN CRV 94X10X3.6MM NS LC DCP 8 HL RECON SS 3.5MM CORT,$847.50,$0.00,$847.50,$381.38,$604.86,$0.00,$141.77,$0.00,$0.00,$148.39,$847.50,$0.00,$423.75,$671.22,$678.00,$0.00,$128.77,$0.00,$134.92,$0.00
245.32,SUP,HCPCS C1713,,245.32  -  PLATE BN CRV 118X10X3.6MM NS LC DCP 10 HL RECON SS 3.5MM,$891.18,$0.00,$891.18,$401.03,$636.03,$0.00,$149.07,$0.00,$0.00,$156.04,$891.18,$0.00,$445.59,$705.81,$712.94,$0.00,$135.41,$0.00,$141.88,$0.00
245.33,SUP,HCPCS C1713,,245.33  -  PLATE BONE CURVE 142X10X3.6MM 12 HOLE RECONSTRUCTION LC-DCP,$928.03,$0.00,$928.03,$417.61,$662.33,$0.00,$155.24,$0.00,$0.00,$162.49,$928.03,$0.00,$464.01,$735.00,$742.42,$0.00,$141.01,$0.00,$147.74,$0.00
245.34,SUP,HCPCS C1713,,245.34  -  PLATE BONE CURVE 166X10X3.6MM 14 HOLE RECONSTRUCTION LC-DCP,"$1,041.30",$0.00,"$1,041.30",$468.59,$743.18,$0.00,$174.19,$0.00,$0.00,$182.32,"$1,041.30",$0.00,$520.65,$824.71,$833.04,$0.00,$158.22,$0.00,$165.77,$0.00
245.341,SUP,HCPCS C1713,,245.341  -  PLATE BONE 55MM 4 HOLE SHAFT CVD RECONSTRUCTION LCP,"$1,254.20",$0.00,"$1,254.20",$564.39,$895.12,$0.00,$209.80,$0.00,$0.00,$219.60,"$1,254.20",$0.00,$627.10,$993.33,"$1,003.36",$0.00,$190.57,$0.00,$199.67,$0.00
245.35,SUP,HCPCS C1713,,245.35  -  PLATE BN CRV 190X10X3.6MM NS LC DCP 16 HL RECON SS 3.5MM,"$1,108.18",$0.00,"$1,108.18",$498.68,$790.90,$0.00,$185.37,$0.00,$0.00,$194.03,"$1,108.18",$0.00,$554.09,$877.68,$886.54,$0.00,$168.38,$0.00,$176.42,$0.00
245.36,SUP,HCPCS C1713,,245.36  -  PLATE BONE CURVE 214X10X3.6MM 18 HOLE RECONSTRUCTION LC-DCP,"$1,194.15",$0.00,"$1,194.15",$537.37,$852.26,$0.00,$199.75,$0.00,$0.00,$209.09,"$1,194.15",$0.00,$597.08,$945.77,$955.32,$0.00,$181.44,$0.00,$190.11,$0.00
245.361,SUP,HCPCS C1713,,245.361  -  PLATE BONE 82MM 6 HOLE SHAFT CVD RECONSTRUCTION LCP,"$1,357.93",$0.00,"$1,357.93",$611.07,$969.15,$0.00,$227.15,$0.00,$0.00,$237.76,"$1,357.93",$0.00,$678.96,"$1,075.48","$1,086.34",$0.00,$206.33,$0.00,$216.18,$0.00
245.381,SUP,HCPCS C1713,,245.381  -  PLATE BN CRV 106X10.1X3.5MM NS LCP 8 HL SHFT RECON SS 3.5MM,"$1,472.58",$0.00,"$1,472.58",$662.66,"$1,050.98",$0.00,$246.33,$0.00,$0.00,$257.84,"$1,472.58",$0.00,$736.29,"$1,166.28","$1,178.06",$0.00,$223.74,$0.00,$234.43,$0.00
245.401,SUP,HCPCS C1713,,245.401  -  PLATE BONE 140MM 10 HOLE CVD RECONSTRUCTION LCP STAINLESS,"$1,542.18",$0.00,"$1,542.18",$693.98,"$1,100.65",$0.00,$257.97,$0.00,$0.00,$270.02,"$1,542.18",$0.00,$771.09,"$1,221.41","$1,233.74",$0.00,$234.32,$0.00,$245.51,$0.00
245.421,SUP,HCPCS C1713,,245.421  -  PLATE BONE 149MM 12 HOLE SHAFT CVD RECONSTRUCTION LCP,"$1,614.50",$0.00,"$1,614.50",$726.53,"$1,152.27",$0.00,$270.07,$0.00,$0.00,$282.69,"$1,614.50",$0.00,$807.25,"$1,278.68","$1,291.60",$0.00,$245.31,$0.00,$257.03,$0.00
245.441,SUP,HCPCS C1713,,245.441  -  PLATE BONE 166MM 14 HOLE SHAFT CVD RECONSTRUCTION LCP,"$1,813.75",$0.00,"$1,813.75",$816.19,"$1,294.47",$0.00,$303.40,$0.00,$0.00,$317.57,"$1,813.75",$0.00,$906.88,"$1,436.49","$1,451.00",$0.00,$275.58,$0.00,$288.75,$0.00
245.461,SUP,HCPCS C1713,,245.461  -  PLATE BONE 180MM 16 HOLE SHAFT CVD RECONSTRUCTION LCP,"$1,937.95",$0.00,"$1,937.95",$872.08,"$1,383.11",$0.00,$324.17,$0.00,$0.00,$339.32,"$1,937.95",$0.00,$968.98,"$1,534.86","$1,550.36",$0.00,$294.45,$0.00,$308.52,$0.00
245.481,SUP,HCPCS C1713,,245.481  -  PLATE BONE 190MM 18 HOLE SHAFT CVD RECONSTRUCTION LCP,"$2,089.43",$0.00,"$2,089.43",$940.24,"$1,491.22",$0.00,$349.51,$0.00,$0.00,$365.84,"$2,089.43",$0.00,"$1,044.71","$1,654.83","$1,671.54",$0.00,$317.47,$0.00,$332.64,$0.00
245.876,SUP,HCPCS C1713,,245.876  -  PLATE BONE 108MM RAD 78MM 6 HOLE LP CVD RECONSTRUCTION,$790.20,$0.00,$790.20,$355.59,$563.97,$0.00,$132.18,$0.00,$0.00,$138.36,$790.20,$0.00,$395.10,$625.84,$632.16,$0.00,$120.06,$0.00,$125.80,$0.00
245.878,SUP,HCPCS C1713,,245.878  -  PLATE BN 108MM RDS CRV 104X10.2X2.7MM NS 8 HL LOPRFL RECON,$858.43,$0.00,$858.43,$386.29,$612.66,$0.00,$143.59,$0.00,$0.00,$150.30,$858.43,$0.00,$429.21,$679.88,$686.74,$0.00,$130.43,$0.00,$136.66,$0.00
245.88,SUP,HCPCS C1713,,245.880  -  PLATE BONE 108MM RAD CVD 130MM 8 HOLE LP RECONSTRUCTION,$926.68,$0.00,$926.68,$417.00,$661.37,$0.00,$155.01,$0.00,$0.00,$162.25,$926.68,$0.00,$463.34,$733.93,$741.34,$0.00,$140.80,$0.00,$147.53,$0.00
245.882,SUP,HCPCS C1713,,245.882  -  PLATE BN 108MM RDS CRV 156MMX10.2MMX2.7M NS 12 HL LOPRFL,"$1,000.35",$0.00,"$1,000.35",$450.16,$713.95,$0.00,$167.34,$0.00,$0.00,$175.15,"$1,000.35",$0.00,$500.18,$792.28,$800.28,$0.00,$152.00,$0.00,$159.26,$0.00
245.884,SUP,HCPCS C1713,,245.884  -  PLATE BONE 108MM RAD 182MM 14 HOLE LP CVD RECONSTRUCTION,"$1,075.43",$0.00,"$1,075.43",$483.94,$767.53,$0.00,$179.89,$0.00,$0.00,$188.30,"$1,075.43",$0.00,$537.71,$851.74,$860.34,$0.00,$163.40,$0.00,$171.21,$0.00
245.886,SUP,HCPCS C1713,,245.886  -  PLATE BONE 108MM RAD 208MM 16 HOLE LP CVD RECONSTRUCTION,"$1,150.48",$0.00,"$1,150.48",$517.71,$821.09,$0.00,$192.45,$0.00,$0.00,$201.44,"$1,150.48",$0.00,$575.24,$911.18,$920.38,$0.00,$174.81,$0.00,$183.16,$0.00
245.906,SUP,HCPCS C1713,,245.906  -  PLATE BONE 88MM RAD 78MM 6 HOLE LP CVD RECONSTRUCTION,$790.20,$0.00,$790.20,$355.59,$563.97,$0.00,$132.18,$0.00,$0.00,$138.36,$790.20,$0.00,$395.10,$625.84,$632.16,$0.00,$120.06,$0.00,$125.80,$0.00
245.908,SUP,HCPCS C1713,,245.908  -  PLATE BN 88MM RDS CRV 104MMX10.2MMX2.7M NS 8 HL LOPRFL RECON,$858.43,$0.00,$858.43,$386.29,$612.66,$0.00,$143.59,$0.00,$0.00,$150.30,$858.43,$0.00,$429.21,$679.88,$686.74,$0.00,$130.43,$0.00,$136.66,$0.00
245.91,SUP,HCPCS C1713,,245.910  -  PLATE BONE 88MM RAD LP CURVE 130MM 10 HOLE RECONSTRUCTION,$926.68,$0.00,$926.68,$417.00,$661.37,$0.00,$155.01,$0.00,$0.00,$162.25,$926.68,$0.00,$463.34,$733.93,$741.34,$0.00,$140.80,$0.00,$147.53,$0.00
245.912,SUP,HCPCS C1713,,245.912  -  PLATE BN 88MM RDS CRV 156MMX10.2MMX2.7M NS 12 HL LOPRFL,"$1,000.35",$0.00,"$1,000.35",$450.16,$713.95,$0.00,$167.34,$0.00,$0.00,$175.15,"$1,000.35",$0.00,$500.18,$792.28,$800.28,$0.00,$152.00,$0.00,$159.26,$0.00
245.914,SUP,HCPCS C1713,,245.914  -  PLATE BONE 88MM RAD 182MM 14 HOLE LP CVD RECONSTRUCTION,"$1,075.43",$0.00,"$1,075.43",$483.94,$767.53,$0.00,$179.89,$0.00,$0.00,$188.30,"$1,075.43",$0.00,$537.71,$851.74,$860.34,$0.00,$163.40,$0.00,$171.21,$0.00
245.916,SUP,HCPCS C1713,,245.916  -  PLATE BONE 88MM RAD 208MM 16 HOLE LP CVD RECONSTRUCTION,"$1,150.48",$0.00,"$1,150.48",$517.71,$821.09,$0.00,$192.45,$0.00,$0.00,$201.44,"$1,150.48",$0.00,$575.24,$911.18,$920.38,$0.00,$174.81,$0.00,$183.16,$0.00
245.92,SUP,HCPCS C1713,,245.920  -  PLATE BONE J RIGHT 130X10X3.4MM 3.5MM 10 HOLE RECONSTRUCTION,$926.68,$0.00,$926.68,$417.00,$661.37,$0.00,$155.01,$0.00,$0.00,$162.25,$926.68,$0.00,$463.34,$733.93,$741.34,$0.00,$140.80,$0.00,$147.53,$0.00
245.922,SUP,HCPCS C1713,,245.922  -  PLATE BONE 88MM RAD 156MM 12 HOLE J LP RECONSTRUCTION,"$1,000.35",$0.00,"$1,000.35",$450.16,$713.95,$0.00,$167.34,$0.00,$0.00,$175.15,"$1,000.35",$0.00,$500.18,$792.28,$800.28,$0.00,$152.00,$0.00,$159.26,$0.00
245.924,SUP,HCPCS C1713,,245.924  -  PLATE BONE 88MM RAD 182MM 14 HOLE J LP RECONSTRUCTION,"$1,075.43",$0.00,"$1,075.43",$483.94,$767.53,$0.00,$179.89,$0.00,$0.00,$188.30,"$1,075.43",$0.00,$537.71,$851.74,$860.34,$0.00,$163.40,$0.00,$171.21,$0.00
245.926,SUP,HCPCS C1713,,245.926  -  PLATE BN 88MM RDS J 208X10.2X2.7MM NS 16 HL LOPRFL RECON SS,"$1,150.48",$0.00,"$1,150.48",$517.71,$821.09,$0.00,$192.45,$0.00,$0.00,$201.44,"$1,150.48",$0.00,$575.24,$911.18,$920.38,$0.00,$174.81,$0.00,$183.16,$0.00
245.93,SUP,HCPCS C1713,,245.930  -  PLATE BONE 88MM RAD J 130X10.2X2.7MM 10 HOLE LP,$926.68,$0.00,$926.68,$417.00,$661.37,$0.00,$155.01,$0.00,$0.00,$162.25,$926.68,$0.00,$463.34,$733.93,$741.34,$0.00,$140.80,$0.00,$147.53,$0.00
245.932,SUP,HCPCS C1713,,245.932  -  PLATE BONE 88MM RAD 156MM 12 HOLE J LP RECONSTRUCTION,"$1,000.35",$0.00,"$1,000.35",$450.16,$713.95,$0.00,$167.34,$0.00,$0.00,$175.15,"$1,000.35",$0.00,$500.18,$792.28,$800.28,$0.00,$152.00,$0.00,$159.26,$0.00
245.934,SUP,HCPCS C1713,,245.934  -  PLATE BONE 88MM RAD 182MM 14 HOLE J LP RECONSTRUCTION,"$1,075.43",$0.00,"$1,075.43",$483.94,$767.53,$0.00,$179.89,$0.00,$0.00,$188.30,"$1,075.43",$0.00,$537.71,$851.74,$860.34,$0.00,$163.40,$0.00,$171.21,$0.00
245.936,SUP,HCPCS C1713,,245.936  -  PLATE BN 88MM RDS J 208X10.2X2.7MM NS 16 HL LOPRFL RECON SS,"$1,150.48",$0.00,"$1,150.48",$517.71,$821.09,$0.00,$192.45,$0.00,$0.00,$201.44,"$1,150.48",$0.00,$575.24,$911.18,$920.38,$0.00,$174.81,$0.00,$183.16,$0.00
245.98,SUP,HCPCS C1713,,245.98  -  PLATE BN 64X8X2.5MM NS 8 HL RECON SS CALC 2.7MM SCR,$645.53,$0.00,$645.53,$290.49,$460.71,$0.00,$107.98,$0.00,$0.00,$113.03,$645.53,$0.00,$322.76,$511.26,$516.42,$0.00,$98.08,$0.00,$102.77,$0.00
245.99,SUP,HCPCS C1713,,245.99  -  PLATE BN 72X8X2.5MM NS 9 HL RECON SS CALC 2.7MM SCR,$668.73,$0.00,$668.73,$300.93,$477.27,$0.00,$111.86,$0.00,$0.00,$117.09,$668.73,$0.00,$334.36,$529.63,$534.98,$0.00,$101.61,$0.00,$106.46,$0.00
246.031,SUP,HCPCS C1713,,246.031  -  PLATE BN STRG 29X3.8X.8MM NS PRO-PK 6 HL LOPRFL PRECONTOUR,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
246.19,SUP,HCPCS C1713,,246.19  -  PLATE BONE 100MM 20 HOLE STR DCP STAINLESS STEEL ORTHOPEDIC,$464.03,$0.00,$464.03,$208.81,$331.17,$0.00,$77.62,$0.00,$0.00,$81.25,$464.03,$0.00,$232.01,$367.51,$371.22,$0.00,$70.50,$0.00,$73.87,$0.00
246.191,SUP,HCPCS C1713,,246.191  -  PLATE BN STRG 59X3.8X.8MM NS PRO-PK 12 HL LOPRFL PRECONTOUR,$451.73,$0.00,$451.73,$203.28,$322.40,$0.00,$75.56,$0.00,$0.00,$79.09,$451.73,$0.00,$225.86,$357.77,$361.38,$0.00,$68.64,$0.00,$71.91,$0.00
246.23,SUP,HCPCS C1713,,246.23  -  PLATE BN T 50MM NS DCP 3 HLE/HD 9 HL SHFT SS 1.5MM SCR,$405.33,$0.00,$405.33,$182.40,$289.28,$0.00,$67.80,$0.00,$0.00,$70.97,$405.33,$0.00,$202.66,$321.02,$324.26,$0.00,$61.59,$0.00,$64.53,$0.00
246.233,SUP,HCPCS C1713,,246.233  -  PLATE BN T 44X4X1MM NS PRO-PK 3 HLE/HD 8 HL SHFT LOPRFL,$413.53,$0.00,$413.53,$186.09,$295.13,$0.00,$69.17,$0.00,$0.00,$72.40,$413.53,$0.00,$206.76,$327.52,$330.82,$0.00,$62.83,$0.00,$65.83,$0.00
246.234,SUP,HCPCS C1713,,246.234  -  PLATE BN T 44X4X1MM NS PRO-PK 4 HLE/HD 8 HL SHFT LOPRFL,$431.25,$0.00,$431.25,$194.06,$307.78,$0.00,$72.14,$0.00,$0.00,$75.51,$431.25,$0.00,$215.63,$341.55,$345.00,$0.00,$65.53,$0.00,$68.66,$0.00
246.24,SUP,HCPCS C1713,,246.24  -  PLATE BONE 50MM 4 HOLE HEAD 9 HOLE SHAFT T DCP STAINLESS,$436.73,$0.00,$436.73,$196.53,$311.69,$0.00,$73.05,$0.00,$0.00,$76.47,$436.73,$0.00,$218.36,$345.89,$349.38,$0.00,$66.36,$0.00,$69.53,$0.00
246.48,SUP,HCPCS C1713,,246.48  -  PLATE BONE 4 HOLE H LCP STAINLESS STEEL ORTHOPEDIC NONSTRL,$399.88,$0.00,$399.88,$179.94,$285.39,$0.00,$66.89,$0.00,$0.00,$70.01,$399.88,$0.00,$199.94,$316.70,$319.90,$0.00,$60.76,$0.00,$63.66,$0.00
246.482,SUP,HCPCS C1713,,246.482  -  PLATE BN H 22MM NS PRO-PK 8 HL XTD LOPRFL PRECONTOUR SS RT,$431.25,$0.00,$431.25,$194.06,$307.78,$0.00,$72.14,$0.00,$0.00,$75.51,$431.25,$0.00,$215.63,$341.55,$345.00,$0.00,$65.53,$0.00,$68.66,$0.00
246.483,SUP,HCPCS C1713,,246.483  -  PLATE BN H 22MM NS PRO-PK 8 HL XTD LOPRFL PRECONTOUR SS LT,$431.25,$0.00,$431.25,$194.06,$307.78,$0.00,$72.14,$0.00,$0.00,$75.51,$431.25,$0.00,$215.63,$341.55,$345.00,$0.00,$65.53,$0.00,$68.66,$0.00
246.61,SUP,HCPCS C1713,,246.61  -  PLATE BN 36X3.5X.9MM NS 7 HL SS CNDYL LT 1.5MM SCR MDLR HND,$514.50,$0.00,$514.50,$231.53,$367.20,$0.00,$86.07,$0.00,$0.00,$90.08,$514.50,$0.00,$257.25,$407.48,$411.60,$0.00,$78.18,$0.00,$81.91,$0.00
246.612,SUP,HCPCS C1713,,246.612  -  PLATE BN Y 46X4X1MM NS PRO-PK 3 HLE/HD 8 HL SHFT LOPRFL,$413.53,$0.00,$413.53,$186.09,$295.13,$0.00,$69.17,$0.00,$0.00,$72.40,$413.53,$0.00,$206.76,$327.52,$330.82,$0.00,$62.83,$0.00,$65.83,$0.00
246.62,SUP,HCPCS C1713,,246.62  -  PLATE BN 36X3.5X.9MM NS 7 HL SS CNDYL RT 1.5MM SCR MDLR HND,$514.50,$0.00,$514.50,$231.53,$367.20,$0.00,$86.07,$0.00,$0.00,$90.08,$514.50,$0.00,$257.25,$407.48,$411.60,$0.00,$78.18,$0.00,$81.91,$0.00
247.031,SUP,HCPCS C1713,,247.031  -  PLATE BN STRG 35X5X1.2MM NS PRO-PK 6 HL LOPRFL PRECONTOUR,$393.05,$0.00,$393.05,$176.87,$280.52,$0.00,$65.75,$0.00,$0.00,$68.82,$393.05,$0.00,$196.53,$311.30,$314.44,$0.00,$59.72,$0.00,$62.57,$0.00
247.232,SUP,HCPCS C1713,,247.232  -  PLATE BN T 53X5X1.2MM NS PRO-PK 2 HLE/HD 8 HL SHFT LOPRFL,$431.25,$0.00,$431.25,$194.06,$307.78,$0.00,$72.14,$0.00,$0.00,$75.51,$431.25,$0.00,$215.63,$341.55,$345.00,$0.00,$65.53,$0.00,$68.66,$0.00
247.233,SUP,HCPCS C1713,,247.233  -  PLATE BN T 53X5X1.2MM NS PRO-PK 3 HLE/HD 8 HL SHFT LOPRFL,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
247.344,SUP,HCPCS C1713,,247.344  -  PLATE BN 31MM NS LCP PRO-PK 4 HL LOPRFL CUT TO LGTH SS 2MM,$446.28,$0.00,$446.28,$200.82,$318.51,$0.00,$74.65,$0.00,$0.00,$78.14,$446.28,$0.00,$223.14,$353.45,$357.02,$0.00,$67.81,$0.00,$71.05,$0.00
247.345,SUP,HCPCS C1713,,247.345  -  PLATE BN 38MM NS LCP PRO-PK 5 HL LOPRFL CUT TO LGTH SS 2MM,$446.28,$0.00,$446.28,$200.82,$318.51,$0.00,$74.65,$0.00,$0.00,$78.14,$446.28,$0.00,$223.14,$353.45,$357.02,$0.00,$67.81,$0.00,$71.05,$0.00
247.346,SUP,HCPCS C1713,,247.346  -  PLATE BN 45MM NS LCP PRO-PK 6 HL LOPRFL CUT TO LGTH SS 2MM,$446.28,$0.00,$446.28,$200.82,$318.51,$0.00,$74.65,$0.00,$0.00,$78.14,$446.28,$0.00,$223.14,$353.45,$357.02,$0.00,$67.81,$0.00,$71.05,$0.00
247.347,SUP,HCPCS C1713,,247.347  -  PLATE BN 52MM NS LCP PRO-PK 7 HL LOPRFL CUT TO LGTH SS 2MM,$446.28,$0.00,$446.28,$200.82,$318.51,$0.00,$74.65,$0.00,$0.00,$78.14,$446.28,$0.00,$223.14,$353.45,$357.02,$0.00,$67.81,$0.00,$71.05,$0.00
247.348,SUP,HCPCS C1713,,247.348  -  PLATE BN 59MM NS LCP PRO-PK 8 HL LOPRFL CUT TO LGTH SS 2MM,$446.28,$0.00,$446.28,$200.82,$318.51,$0.00,$74.65,$0.00,$0.00,$78.14,$446.28,$0.00,$223.14,$353.45,$357.02,$0.00,$67.81,$0.00,$71.05,$0.00
247.349,SUP,HCPCS C1713,,247.349  -  PLATE BN 54MM NS LCP PRO-PK 7 HL SHFT LOPRFL CUT TO LGTH SS,"$1,404.33",$0.00,"$1,404.33",$631.95,"$1,002.27",$0.00,$234.91,$0.00,$0.00,$245.89,"$1,404.33",$0.00,$702.16,"$1,112.23","$1,123.46",$0.00,$213.38,$0.00,$223.57,$0.00
247.35,SUP,HCPCS C1713,,247.350  -  PLATE BN Y 55MM NS LCP PRO-PK 3 HLE/HD 7 HL SHFT LOPRFL CUT,$788.83,$0.00,$788.83,$354.97,$562.98,$0.00,$131.95,$0.00,$0.00,$138.12,$788.83,$0.00,$394.41,$624.75,$631.06,$0.00,$119.86,$0.00,$125.58,$0.00
247.351,SUP,HCPCS C1713,,247.351  -  PLATE BN T 53MM NS LCP PRO-PK 2 HLE/HD 7 HL SHFT LOPRFL CUT,$788.83,$0.00,$788.83,$354.97,$562.98,$0.00,$131.95,$0.00,$0.00,$138.12,$788.83,$0.00,$394.41,$624.75,$631.06,$0.00,$119.86,$0.00,$125.58,$0.00
247.36,SUP,HCPCS C1713,,247.360  -  PLATE BN 73MM NS LCP PRO-PK 10 HL LOPRFL CUT TO LGTH SS 2MM,$446.28,$0.00,$446.28,$200.82,$318.51,$0.00,$74.65,$0.00,$0.00,$78.14,$446.28,$0.00,$223.14,$353.45,$357.02,$0.00,$67.81,$0.00,$71.05,$0.00
247.362,SUP,HCPCS C1713,,247.362  -  PLATE BN 81MM NS LCP PRO-PK 12 HL ADP LOPRFL CUT TO LGTH SS,$754.70,$0.00,$754.70,$339.62,$538.63,$0.00,$126.24,$0.00,$0.00,$132.14,$754.70,$0.00,$377.35,$597.72,$603.76,$0.00,$114.67,$0.00,$120.15,$0.00
247.364,SUP,HCPCS C1713,,247.364  -  PLATE BN 84MM NS LCP PRO-PK 10 HL LOPRFL CUT TO LGTH SS 2.4,$713.78,$0.00,$713.78,$321.20,$509.42,$0.00,$119.40,$0.00,$0.00,$124.98,$713.78,$0.00,$356.89,$565.31,$571.02,$0.00,$108.45,$0.00,$113.63,$0.00
247.366,SUP,HCPCS C1713,,247.366  -  PLATE BN 88MM NS LCP PRO-PK 12 HL ADP LOPRFL CUT TO LGTH SS,$831.13,$0.00,$831.13,$374.01,$593.17,$0.00,$139.03,$0.00,$0.00,$145.52,$831.13,$0.00,$415.56,$658.25,$664.90,$0.00,$126.28,$0.00,$132.32,$0.00
247.37,SUP,HCPCS C1713,,247.370  -  PLATE BN 97MM NS LCP PRO-PK 12 HL ADP LOPRFL CUT TO LGTH SS,$831.13,$0.00,$831.13,$374.01,$593.17,$0.00,$183.57,$0.00,$0.00,$145.52,$831.13,$0.00,$415.56,$658.25,$664.90,$0.00,$166.74,$0.00,$132.32,$0.00
247.372,SUP,HCPCS C1713,,247.372  -  PLATE BN 76MM NS LCP PRO-PK 8 HL LOPRFL CUT TO LGTH SS 2.7MM,$753.35,$0.00,$753.35,$339.01,$537.67,$0.00,$166.20,$0.00,$0.00,$131.91,$753.35,$0.00,$376.68,$596.65,$602.68,$0.00,$150.97,$0.00,$119.93,$0.00
247.374,SUP,HCPCS C1713,,247.374  -  PLATE BN 94MM NS LCP PRO-PK 10 HL LOPRFL CUT TO LGTH SS 2.7,$753.35,$0.00,$753.35,$339.01,$537.67,$0.00,$126.02,$0.00,$0.00,$131.91,$753.35,$0.00,$376.68,$596.65,$602.68,$0.00,$114.46,$0.00,$119.93,$0.00
247.375,SUP,HCPCS C1713,,247.375  -  PLATE BN 44MM NS LCP PRO-PK 5 HL LOPRFL CUT TO LGTH SS 2.4MM,$713.78,$0.00,$713.78,$321.20,$509.42,$0.00,$119.40,$0.00,$0.00,$124.98,$713.78,$0.00,$356.89,$565.31,$571.02,$0.00,$108.45,$0.00,$113.63,$0.00
247.377,SUP,HCPCS C1713,,247.377  -  PLATE BN 60MM NS LCP PRO-PK 7 HL LOPRFL CUT TO LGTH SS 2.4MM,$713.78,$0.00,$713.78,$321.20,$509.42,$0.00,$119.40,$0.00,$0.00,$124.98,$713.78,$0.00,$356.89,$565.31,$571.02,$0.00,$108.45,$0.00,$113.63,$0.00
247.612,SUP,HCPCS C1713,,247.612  -  PLATE BN Y 48X5X1.2MM NS PRO-PK 3 HLE/HD 8 HL SHFT LOPRFL,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
247.615,SUP,HCPCS C1713,,247.615  -  PLATE BN T 53MM NS LCP PRO-PK 3 HLE/HD 7 HL SHFT LOPRFL CUT,$788.83,$0.00,$788.83,$354.97,$562.98,$0.00,$131.95,$0.00,$0.00,$138.12,$788.83,$0.00,$394.41,$624.75,$631.06,$0.00,$119.86,$0.00,$125.58,$0.00
247.702,SUP,HCPCS C1713,,247.702  -  PLATE BONE X SMALL 24X18MM LOCK STAINLESS STEEL ANKLE FT,"$1,397.50",$0.00,"$1,397.50",$628.88,$997.40,$0.00,$233.77,$0.00,$0.00,$244.69,"$1,397.50",$0.00,$698.75,"$1,106.82","$1,118.00",$0.00,$212.34,$0.00,$222.48,$0.00
247.704,SUP,HCPCS C1713,,247.704  -  PLATE BN MED X 30X20MM NS LCK RND THRD HL SS FT/ANKL 2.4/2.7,"$1,415.25",$0.00,"$1,415.25",$636.86,"$1,010.06",$0.00,$236.74,$0.00,$0.00,$247.80,"$1,415.25",$0.00,$707.63,"$1,120.88","$1,132.20",$0.00,$215.03,$0.00,$225.31,$0.00
247.706,SUP,HCPCS C1713,,247.706  -  PLATE BONE LARGE 36MM LOCK STAINLESS STEEL ORTHOPEDIC,"$1,434.35",$0.00,"$1,434.35",$645.46,"$1,023.70",$0.00,$239.93,$0.00,$0.00,$251.14,"$1,434.35",$0.00,$717.18,"$1,136.01","$1,147.48",$0.00,$217.94,$0.00,$228.35,$0.00
247.71,SUP,HCPCS C1713,,247.710  -  PLATE BONE 18MM 2 HOLE LOCKING STAINLESS STEEL ANKLE FT,$681.00,$0.00,$681.00,$306.45,$486.03,$0.00,$113.92,$0.00,$0.00,$119.24,$681.00,$0.00,$340.50,$539.35,$544.80,$0.00,$103.47,$0.00,$108.42,$0.00
247.711,SUP,HCPCS C1713,,247.711  -  PLATE BONE XS 2.4MM 4MM,"$1,417.98",$0.00,"$1,417.98",$638.09,"$1,012.01",$0.00,$237.19,$0.00,$0.00,$248.28,"$1,417.98",$0.00,$708.99,"$1,123.04","$1,134.38",$0.00,$215.45,$0.00,$225.74,$0.00
248.02,SUP,HCPCS C1713,,248.02  -  PLATE BONE 25MM 2 HOLE DCP STAINLESS STEEL ORTHOPEDIC,$238.83,$0.00,$238.83,$107.47,$170.45,$0.00,$39.95,$0.00,$0.00,$41.82,$238.83,$0.00,$119.41,$189.15,$191.06,$0.00,$36.29,$0.00,$38.02,$0.00
248.03,SUP,HCPCS C1713,,248.03  -  PLATE BONE 3.5MM 37X10X3.3MM 3 HOLE DCP STAINLESS STEEL,$245.65,$0.00,$245.65,$110.54,$175.32,$0.00,$41.09,$0.00,$0.00,$43.01,$245.65,$0.00,$122.83,$194.55,$196.52,$0.00,$37.33,$0.00,$39.11,$0.00
248.04,SUP,HCPCS C1713,,248.04  -  PLATE BN 49X10X3.3MM NS DCP 4 HL SS PLV 3.5MM CORT SCR SM,$253.85,$0.00,$253.85,$114.23,$181.17,$0.00,$42.46,$0.00,$0.00,$44.45,$253.85,$0.00,$126.93,$201.05,$203.08,$0.00,$38.57,$0.00,$40.41,$0.00
248.05,SUP,HCPCS C1713,,248.05  -  PLATE BONE 61X10X3.3MM 5 HOLE DCP STAINLESS STEEL PELVIS,$272.95,$0.00,$272.95,$122.83,$194.80,$0.00,$45.66,$0.00,$0.00,$47.79,$272.95,$0.00,$136.48,$216.18,$218.36,$0.00,$41.47,$0.00,$43.45,$0.00
248.06,SUP,HCPCS C1713,,248.06  -  PLATE BN 73X10X3.3MM NS DCP 6 HL SS PLV 3.5MM CORT SCR SM,$283.88,$0.00,$283.88,$127.74,$202.60,$0.00,$47.48,$0.00,$0.00,$49.70,$283.88,$0.00,$141.94,$224.83,$227.10,$0.00,$43.13,$0.00,$45.19,$0.00
248.07,SUP,HCPCS C1713,,248.07  -  PLATE BONE 85X10X3.3MM 7 HOLE DCP STAINLESS STEEL PELVIS,$294.78,$0.00,$294.78,$132.65,$210.38,$0.00,$49.31,$0.00,$0.00,$51.61,$294.78,$0.00,$147.39,$233.47,$235.82,$0.00,$44.79,$0.00,$46.93,$0.00
248.08,SUP,HCPCS C1713,,248.08  -  PLATE BN 97X10X3.3MM NS DCP 8 HL SS PLV 3.5MM CORT SCR SM,$307.08,$0.00,$307.08,$138.18,$219.16,$0.00,$51.37,$0.00,$0.00,$53.77,$307.08,$0.00,$153.54,$243.21,$245.66,$0.00,$46.66,$0.00,$48.89,$0.00
248.09,SUP,HCPCS C1713,,248.09  -  PLATE BN 109X10X3.3MM NS DCP 9 HL SS PLV 3.5MM CORT SCR SM,$326.18,$0.00,$326.18,$146.78,$232.79,$0.00,$54.56,$0.00,$0.00,$57.11,$326.18,$0.00,$163.09,$258.33,$260.94,$0.00,$49.56,$0.00,$51.93,$0.00
248.1,SUP,HCPCS C1713,,248.10  -  PLATE BONE 121X10X3.3MM 10 HOLE DCP STAINLESS STEEL PELVIS,$328.90,$0.00,$328.90,$148.01,$234.74,$0.00,$55.02,$0.00,$0.00,$57.59,$328.90,$0.00,$164.45,$260.49,$263.12,$0.00,$49.97,$0.00,$52.36,$0.00
248.12,SUP,HCPCS C1713,,248.12  -  PLATE BONE 145X10X3.3MM 12 HOLE DCP STAINLESS STEEL PELVIS,$382.13,$0.00,$382.13,$171.96,$272.72,$0.00,$63.92,$0.00,$0.00,$66.91,$382.13,$0.00,$191.06,$302.65,$305.70,$0.00,$58.06,$0.00,$60.83,$0.00
248.14,SUP,HCPCS C1713,,248.14  -  PLATE BONE 169X10X3.3MM 14 HOLE DCP STAINLESS STEEL PELVIS,$702.85,$0.00,$702.85,$316.28,$501.62,$0.00,$117.57,$0.00,$0.00,$123.06,$702.85,$0.00,$351.43,$556.66,$562.28,$0.00,$106.79,$0.00,$111.89,$0.00
248.16,SUP,HCPCS C1713,,248.16  -  PLATE BONE 194X10X3.3MM 16 HOLE DCP STAINLESS STEEL PELVIS,$809.30,$0.00,$809.30,$364.19,$577.60,$0.00,$135.38,$0.00,$0.00,$141.70,$809.30,$0.00,$404.65,$640.97,$647.44,$0.00,$122.97,$0.00,$128.84,$0.00
248.18,SUP,HCPCS C1713,,248.18  -  PLATE BONE 217X10X3.3MM 18 HOLE DCP STAINLESS STEEL PELVIS,$906.20,$0.00,$906.20,$407.79,$646.75,$0.00,$151.59,$0.00,$0.00,$158.67,$906.20,$0.00,$453.10,$717.71,$724.96,$0.00,$137.69,$0.00,$144.27,$0.00
248.2,SUP,HCPCS C1713,,248.20  -  PLATE BONE 3.5MM 242X10X3.3MM 20 HOLE DCP STAINLESS STEEL,$999.00,$0.00,$999.00,$449.55,$712.99,$0.00,$167.11,$0.00,$0.00,$174.92,$999.00,$0.00,$499.50,$791.21,$799.20,$0.00,$151.79,$0.00,$159.04,$0.00
248.22,SUP,HCPCS C1713,,248.22  -  PLATE BONE 3.5MM 265X10X3.3MM 22 HOLE DCP STAINLESS STEEL,"$1,090.43",$0.00,"$1,090.43",$490.69,$778.24,$0.00,$182.40,$0.00,$0.00,$190.92,"$1,090.43",$0.00,$545.21,$863.62,$872.34,$0.00,$165.68,$0.00,$173.60,$0.00
249.615,SUP,HCPCS C1713,,249.615  -  PLATE BONE T 58MM 7X3 HOLE LCP STAINLESS STEEL SMALL BONE,"$1,311.53",$0.00,"$1,311.53",$590.19,$936.04,$0.00,$219.39,$0.00,$0.00,$229.64,"$1,311.53",$0.00,$655.76,"$1,038.73","$1,049.22",$0.00,$199.28,$0.00,$208.79,$0.00
249.669,SUP,HCPCS C1713,,249.669  -  PLATE BONE Y 60MM 3X7 HOLE LCP STAINLESS STEEL ANKLE FT,"$1,311.53",$0.00,"$1,311.53",$590.19,$936.04,$0.00,$219.39,$0.00,$0.00,$229.64,"$1,311.53",$0.00,$655.76,"$1,038.73","$1,049.22",$0.00,$199.28,$0.00,$208.79,$0.00
249.67,SUP,HCPCS C1713,,249.670  -  PLATE BONE T 58MM 2X7 HOLE LCP STAINLESS STEEL ANKLE FT,"$1,311.53",$0.00,"$1,311.53",$590.19,$936.04,$0.00,$219.39,$0.00,$0.00,$229.64,"$1,311.53",$0.00,$655.76,"$1,038.73","$1,049.22",$0.00,$199.28,$0.00,$208.79,$0.00
249.674,SUP,HCPCS C1713,,249.674  -  PLATE BONE 36MM 4 HOLE LCP STAINLESS STEEL ANKLE FT NONSTRL,$713.78,$0.00,$713.78,$321.20,$509.42,$0.00,$119.40,$0.00,$0.00,$124.98,$713.78,$0.00,$356.89,$565.31,$571.02,$0.00,$108.45,$0.00,$113.63,$0.00
249.676,SUP,HCPCS C1713,,249.676  -  PLATE BONE 52MM 6 HOLE LP LCP STAINLESS STEEL SMALL BONE,$713.78,$0.00,$713.78,$321.20,$509.42,$0.00,$119.40,$0.00,$0.00,$124.98,$713.78,$0.00,$356.89,$565.31,$571.02,$0.00,$108.45,$0.00,$113.63,$0.00
249.678,SUP,HCPCS C1713,,249.678  -  PLATE BONE 68MM 8 HOLE LCP STAINLESS STEEL SMALL BONE,$713.78,$0.00,$713.78,$321.20,$509.42,$0.00,$119.40,$0.00,$0.00,$124.98,$713.78,$0.00,$356.89,$565.31,$571.02,$0.00,$108.45,$0.00,$113.63,$0.00
249.679,SUP,HCPCS C1713,,249.679  -  PLATE BONE 59MM 7 SHAFT HOLE LCP STAINLESS STEEL CONDYLE,"$1,071.33",$0.00,"$1,071.33",$482.10,$764.60,$0.00,$179.21,$0.00,$0.00,$187.58,"$1,071.33",$0.00,$535.66,$848.49,$857.06,$0.00,$162.78,$0.00,$170.55,$0.00
249.68,SUP,HCPCS C1713,,249.680  -  PLATE BN 40MM NS LCP 4 HL LOPRFL CUT TO LGTH SS 2.7MM SCR,$753.35,$0.00,$753.35,$339.01,$537.67,$0.00,$126.02,$0.00,$0.00,$131.91,$753.35,$0.00,$376.68,$596.65,$602.68,$0.00,$114.46,$0.00,$119.93,$0.00
249.681,SUP,HCPCS C1713,,249.681  -  PLATE BONE 49MM 5 HOLE LCP STAINLESS STEEL ANKLE FT NONSTRL,$753.35,$0.00,$753.35,$339.01,$537.67,$0.00,$126.02,$0.00,$0.00,$131.91,$753.35,$0.00,$376.68,$596.65,$602.68,$0.00,$114.46,$0.00,$119.93,$0.00
249.682,SUP,HCPCS C1713,,249.682  -  PLATE BONE LP 58MM 6 HOLE CUT TO LENGTH LCP STAINLESS STEEL,$753.35,$0.00,$753.35,$339.01,$537.67,$0.00,$126.02,$0.00,$0.00,$131.91,$753.35,$0.00,$376.68,$596.65,$602.68,$0.00,$114.46,$0.00,$119.93,$0.00
249.683,SUP,HCPCS C1713,,249.683  -  PLATE BONE 6.7CM 7 HOLE LCP STAINLESS STEEL SMALL BONE,$753.35,$0.00,$753.35,$339.01,$537.67,$0.00,$126.02,$0.00,$0.00,$131.91,$753.35,$0.00,$376.68,$596.65,$602.68,$0.00,$114.46,$0.00,$119.93,$0.00
249.684,SUP,HCPCS C1713,,249.684  -  PLATE BONE 66MM 7 HOLE LCP STAINLESS STEEL CONDYLE NONSTRL,"$1,168.23",$0.00,"$1,168.23",$525.70,$833.76,$0.00,$195.42,$0.00,$0.00,$204.55,"$1,168.23",$0.00,$584.11,$925.24,$934.58,$0.00,$177.50,$0.00,$185.98,$0.00
249.685,SUP,HCPCS C1713,,249.685  -  PLATE BONE T 32MM 2X3 HOLE LCP STAINLESS STEEL ANKLE FT,"$1,311.53",$0.00,"$1,311.53",$590.19,$936.04,$0.00,$219.39,$0.00,$0.00,$229.64,"$1,311.53",$0.00,$655.76,"$1,038.73","$1,049.22",$0.00,$199.28,$0.00,$208.79,$0.00
249.686,SUP,HCPCS C1713,,249.686  -  PLATE BN OB R L 35MM NS LCP 2 HLE/HD 3 HL SHFT LOPRFL CUT TO,$715.13,$0.00,$715.13,$321.81,$510.38,$0.00,$119.62,$0.00,$0.00,$125.21,$715.13,$0.00,$357.56,$566.38,$572.10,$0.00,$108.66,$0.00,$113.85,$0.00
249.687,SUP,HCPCS C1713,,249.687  -  PLATE BN OB L L 35MM NS LCP 2 HLE/HD 3 HL SHFT LOPRFL CUT TO,$715.13,$0.00,$715.13,$321.81,$510.38,$0.00,$158.35,$0.00,$0.00,$125.21,$715.13,$0.00,$357.56,$566.38,$572.10,$0.00,$143.84,$0.00,$113.85,$0.00
249.688,SUP,HCPCS C1713,,249.688  -  PLATE BONE L 32MM 2X3 HOLE RIGHT OBLIQUE LCP STAINLESS STEEL,$715.13,$0.00,$715.13,$321.81,$510.38,$0.00,$119.62,$0.00,$0.00,$125.21,$715.13,$0.00,$357.56,$566.38,$572.10,$0.00,$108.66,$0.00,$113.85,$0.00
249.689,SUP,HCPCS C1713,,249.689  -  PLATE BN L 32MM NS LCP 2 HLE/HD 3 HL SHFT LOPRFL CUT TO LGTH,$715.13,$0.00,$715.13,$321.81,$510.38,$0.00,$119.62,$0.00,$0.00,$125.21,$715.13,$0.00,$357.56,$566.38,$572.10,$0.00,$108.66,$0.00,$113.85,$0.00
249.69,SUP,HCPCS C1713,,249.690  -  PLATE BONE 31MM 5 HOLE LOCKING HIND MIDFT NONSTRL 2.4-2.7MM,"$1,454.83",$0.00,"$1,454.83",$654.67,"$1,038.31",$0.00,$243.36,$0.00,$0.00,$254.73,"$1,454.83",$0.00,$727.41,"$1,152.23","$1,163.86",$0.00,$221.05,$0.00,$231.61,$0.00
249.691,SUP,HCPCS C1713,,249.691  -  PLATE BN 45MM NS 8 HL LCK SS HND/MDFT 2.4/2.7MM SCR,"$1,484.85",$0.00,"$1,484.85",$668.18,"$1,059.74",$0.00,$248.38,$0.00,$0.00,$259.99,"$1,484.85",$0.00,$742.43,"$1,176.00","$1,187.88",$0.00,$225.61,$0.00,$236.39,$0.00
249.697,SUP,HCPCS C1713,,249.697  -  PLATE BONE 32MM 2X4 HOLE T LCP STAINLESS STEEL CONDYLE,"$1,311.53",$0.00,"$1,311.53",$590.19,$936.04,$0.00,$219.39,$0.00,$0.00,$229.64,"$1,311.53",$0.00,$655.76,"$1,038.73","$1,049.22",$0.00,$199.28,$0.00,$208.79,$0.00
249.698,SUP,HCPCS C1713,,249.698  -  PLATE BONE 42MM 2 HOLE HEAD 4 HOLE SHAFT L RIGHT OBLIQUE LCP,$723.33,$0.00,$723.33,$325.50,$516.24,$0.00,$120.99,$0.00,$0.00,$126.65,$723.33,$0.00,$361.66,$572.88,$578.66,$0.00,$109.90,$0.00,$115.15,$0.00
249.699,SUP,HCPCS C1713,,249.699  -  PLATE BONE T 42MM 2 HOLE HEAD 4 HOLE SHAFT LEFT OBLIQUE LCP,$723.33,$0.00,$723.33,$325.50,$516.24,$0.00,$120.99,$0.00,$0.00,$126.65,$723.33,$0.00,$361.66,$572.88,$578.66,$0.00,$109.90,$0.00,$115.15,$0.00
249.701,SUP,HCPCS C1713,,249.701  -  PLATE BONE 40MM 2 HOLE HEAD 4 HOLE SHAFT L LCP STAINLESS,$723.33,$0.00,$723.33,$325.50,$516.24,$0.00,$120.99,$0.00,$0.00,$126.65,$723.33,$0.00,$361.66,$572.88,$578.66,$0.00,$109.90,$0.00,$115.15,$0.00
249.702,SUP,HCPCS C1713,,249.702  -  PLATE BONE L 40MM 2X4 HOLE LCP STAINLESS STEEL LEFT SMALL,$723.33,$0.00,$723.33,$325.50,$516.24,$0.00,$120.99,$0.00,$0.00,$126.65,$723.33,$0.00,$361.66,$572.88,$578.66,$0.00,$109.90,$0.00,$115.15,$0.00
249.906,SUP,HCPCS C1713,,249.906  -  PLATE BN STRG 36X6.3X1.25MM NS 6 HL LOPRFL PRECONTOUR CUT TO,$431.25,$0.00,$431.25,$194.06,$307.78,$0.00,$72.14,$0.00,$0.00,$75.51,$431.25,$0.00,$215.63,$341.55,$345.00,$0.00,$65.53,$0.00,$68.66,$0.00
249.912,SUP,HCPCS C1713,,249.912  -  PLATE BN STRG 72X6.3X1.25MM NS 12 HL LOPRFL PRECONTOUR CUT,$507.68,$0.00,$507.68,$228.45,$362.33,$0.00,$84.92,$0.00,$0.00,$88.89,$507.68,$0.00,$253.84,$402.08,$406.14,$0.00,$77.14,$0.00,$80.82,$0.00
249.913,SUP,HCPCS C1713,,249.913  -  PLATE BN T 54X6.3X1.25MM NS 2 HLE/HD 8 HL SHFT LOPRFL,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
249.914,SUP,HCPCS C1713,,249.914  -  PLATE BN T 54X6.3X1.25MM NS 3 HLE/HD 8 HL SHFT LOPRFL,$502.23,$0.00,$502.23,$226.00,$358.44,$0.00,$84.01,$0.00,$0.00,$87.94,$502.23,$0.00,$251.11,$397.77,$401.78,$0.00,$76.31,$0.00,$79.95,$0.00
249.915,SUP,HCPCS C1713,,249.915  -  PLATE BN Y 56X6.3X1.25MM NS 3 HLE/HD 8 HL SHFT LOPRFL,$499.50,$0.00,$499.50,$224.78,$356.49,$0.00,$83.55,$0.00,$0.00,$87.46,$499.50,$0.00,$249.75,$395.60,$399.60,$0.00,$75.89,$0.00,$79.52,$0.00
249.916,SUP,HCPCS C1713,,249.916  -  PLATE BN 57X6.3X1.25MM NS 8 HL LOPRFL PRECONTOUR CUT TO LGTH,$500.88,$0.00,$500.88,$225.39,$357.47,$0.00,$83.78,$0.00,$0.00,$87.70,$500.88,$0.00,$250.44,$396.70,$400.70,$0.00,$76.10,$0.00,$79.74,$0.00
249.917,SUP,HCPCS C1713,,249.917  -  PLATE BN 57X6.3X1.25MM NS 8 HL LOPRFL PRECONTOUR CUT TO LGTH,$500.88,$0.00,$500.88,$225.39,$357.47,$0.00,$83.78,$0.00,$0.00,$87.70,$500.88,$0.00,$250.44,$396.70,$400.70,$0.00,$76.10,$0.00,$79.74,$0.00
249.919,SUP,HCPCS C1713,,249.919  -  PLATE BN T 66MM NS 3 HLE/HD 10 HL SHFT LOPRFL CUT TO LGTH SS,$458.55,$0.00,$458.55,$206.35,$327.27,$0.00,$76.71,$0.00,$0.00,$80.29,$458.55,$0.00,$229.28,$363.17,$366.84,$0.00,$69.67,$0.00,$73.00,$0.00
249.921,SUP,HCPCS C1713,,249.921  -  PLATE BN NS LOPRFL CUT TO LGTH SS CUBOID 2.4 MM SCR MODFT,$668.73,$0.00,$668.73,$300.93,$477.27,$0.00,$111.86,$0.00,$0.00,$117.09,$668.73,$0.00,$334.36,$529.63,$534.98,$0.00,$101.61,$0.00,$106.46,$0.00
249.924,SUP,HCPCS C1713,,249.924  -  PLATE BN 31X6.5X1.6MM NS LC DCP 4 HL LOPRFL PRECONTOUR CUT,$532.25,$0.00,$532.25,$239.51,$379.87,$0.00,$89.03,$0.00,$0.00,$93.19,$532.25,$0.00,$266.13,$421.54,$425.80,$0.00,$80.87,$0.00,$84.73,$0.00
249.926,SUP,HCPCS C1713,,249.926  -  PLATE BN 47X6.5X1.6MM NS LC DCP 6 HL LOPRFL PRECONTOUR CUT,$600.50,$0.00,$600.50,$270.23,$428.58,$0.00,$100.45,$0.00,$0.00,$105.14,$600.50,$0.00,$300.25,$475.60,$480.40,$0.00,$91.24,$0.00,$95.60,$0.00
249.928,SUP,HCPCS C1713,,249.928  -  PLATE BN 63X6.5X1.6MM NS LC DCP 8 HL LOPRFL PRECONTOUR CUT,$648.25,$0.00,$648.25,$291.71,$462.66,$0.00,$108.44,$0.00,$0.00,$113.50,$648.25,$0.00,$324.13,$513.41,$518.60,$0.00,$98.50,$0.00,$103.20,$0.00
254.862,SUP,Custom 27803010,,"254.862  -  SS ROD TO ROD CLAMP, 5.5MM TO 6.5MM","$1,217.50",$0.00,"$1,217.50",$0.00,$868.93,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,217.50",$0.00,$608.75,$964.26,$974.00,$0.00,$0.00,$0.00,$0.00,$0.00
254.864,SUP,Custom 27803010,,"254.864  -  SS ROD TO ROD CLAMP, 5.5MM TO 6.5MM, WIDE","$1,217.50",$0.00,"$1,217.50",$0.00,$868.93,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,217.50",$0.00,$608.75,$964.26,$974.00,$0.00,$0.00,$0.00,$0.00,$0.00
254.866,SUP,Custom 27803010,,"254.866  -  SS PARALLEL CONNECTOR CLAMP, 6.5MM TO 6.5MM","$1,217.50",$0.00,"$1,217.50",$0.00,$868.93,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,217.50",$0.00,$608.75,$964.26,$974.00,$0.00,$0.00,$0.00,$0.00,$0.00
254.868,SUP,Custom 27803010,,"254.868  -  SS PARALLEL CONNECTOR CLAMP, 6.5MM TO 6.5MM WIDE","$1,217.50",$0.00,"$1,217.50",$0.00,$868.93,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,217.50",$0.00,$608.75,$964.26,$974.00,$0.00,$0.00,$0.00,$0.00,$0.00
260.06,SUP,HCPCS C1713,,260.060  -  PLATE 80MM SS 4.5MM SCR 10 HOLE RECON BONE STRNL NONSTRL,"$2,682.50",$0.00,"$2,682.50","$1,207.13","$1,914.50",$0.00,$462.18,$0.00,$0.00,$469.68,"$2,682.50",$0.00,"$1,341.25","$2,124.54","$2,146.00",$0.00,$419.81,$0.00,$427.05,$0.00
260.062,SUP,HCPCS C1713,,260.062  -  PLATE 96MM SS 4.5MM SCR 12 HOLE RECON BONE STRNL NONSTRL,"$2,760.00",$0.00,"$2,760.00","$1,242.00","$1,969.81",$0.00,$475.53,$0.00,$0.00,$483.25,"$2,760.00",$0.00,"$1,380.00","$2,185.92","$2,208.00",$0.00,$431.94,$0.00,$439.39,$0.00
260.064,SUP,HCPCS C1713,,260.064  -  PLATE 112MM SS 4.5MM SCR 14 HOLE RECON BONE STRNL NONSTRL,"$2,835.00",$0.00,"$2,835.00","$1,275.75","$2,023.34",$0.00,$488.46,$0.00,$0.00,$496.39,"$2,835.00",$0.00,"$1,417.50","$2,245.32","$2,268.00",$0.00,$443.68,$0.00,$451.33,$0.00
260.066,SUP,HCPCS C1713,,260.066  -  PLATE 128MM SS 4.5MM SCR 16 HOLE RECON BONE STRNL NONSTRL,"$2,912.50",$0.00,"$2,912.50","$1,310.63","$2,078.65",$0.00,$501.81,$0.00,$0.00,$509.96,"$2,912.50",$0.00,"$1,456.25","$2,306.70","$2,330.00",$0.00,$455.81,$0.00,$463.67,$0.00
260.068,SUP,HCPCS C1713,,260.068  -  PLATE 144MM SS 4.5MM SCR 18 HOLE RECON BONE STRNL NONSTRL,"$2,990.00",$0.00,"$2,990.00","$1,345.50","$2,133.96",$0.00,$515.16,$0.00,$0.00,$523.53,"$2,990.00",$0.00,"$1,495.00","$2,368.08","$2,392.00",$0.00,$467.94,$0.00,$476.01,$0.00
260.07,SUP,HCPCS C1713,,260.070  -  PLATE 160MM SS 4.5MM SCR 20 HOLE RECON BONE STRNL NONSTRL,"$3,067.50",$0.00,"$3,067.50","$1,380.38","$2,189.27",$0.00,$528.51,$0.00,$0.00,$537.09,"$3,067.50",$0.00,"$1,533.75","$2,429.46","$2,454.00",$0.00,$480.06,$0.00,$488.35,$0.00
260.072,SUP,HCPCS C1713,,260.072  -  PLATE 176MM SS 4.5MM SCR 22 HOLE RECON BONE STRNL NONSTRL,"$3,137.50",$0.00,"$3,137.50","$1,411.88","$2,239.23",$0.00,$540.58,$0.00,$0.00,$549.35,"$3,137.50",$0.00,"$1,568.75","$2,484.90","$2,510.00",$0.00,$491.02,$0.00,$499.49,$0.00
260.074,SUP,HCPCS C1713,,260.074  -  PLATE 192MM SS 4.5MM SCR 24 HOLE RECON BONE STRNL NONSTRL,"$3,217.50",$0.00,"$3,217.50","$1,447.88","$2,296.33",$0.00,$554.36,$0.00,$0.00,$563.36,"$3,217.50",$0.00,"$1,608.75","$2,548.26","$2,574.00",$0.00,$503.54,$0.00,$512.23,$0.00
275.9,SUP,Custom 27803010,,275.900  -  CAP END 3-4MM STAINLESS STEEL ORTHOPEDIC ELSTIC NAIL,$151.48,$0.00,$151.48,$0.00,$108.11,$0.00,$0.00,$0.00,$0.00,$0.00,$151.48,$0.00,$75.74,$119.97,$121.18,$0.00,$0.00,$0.00,$0.00,$0.00
275.905,SUP,Custom 27803010,,275.905  -  CAP END STAINLESS STEEL NONSTRL 1.5-2.5 MM ELAST NAIL,$151.48,$0.00,$151.48,$0.00,$108.11,$0.00,$0.00,$0.00,$0.00,$0.00,$151.48,$0.00,$75.74,$119.97,$121.18,$0.00,$0.00,$0.00,$0.00,$0.00
275.915,SUP,HCPCS C1713,,275.915  -  NAIL INTRAMEDULLARY 1.5MM 300MM ELAST STAINLESS STEEL,$479.03,$0.00,$479.03,$215.56,$341.88,$0.00,$80.13,$0.00,$0.00,$83.87,$479.03,$0.00,$239.51,$379.39,$383.22,$0.00,$72.78,$0.00,$76.26,$0.00
275.92,SUP,HCPCS C1713,,275.920  -  NAIL INTRAMEDULLARY 2MM 440MM ELAST STAINLESS STEEL,$513.15,$0.00,$513.15,$230.92,$366.24,$0.00,$85.84,$0.00,$0.00,$89.85,$513.15,$0.00,$256.58,$406.41,$410.52,$0.00,$77.97,$0.00,$81.69,$0.00
275.925,SUP,HCPCS C1713,,275.925  -  NAIL INTRAMEDULLARY 2.5MM 440MM ELAST STAINLESS STEEL,$551.35,$0.00,$551.35,$248.11,$393.50,$0.00,$92.23,$0.00,$0.00,$96.54,$551.35,$0.00,$275.68,$436.67,$441.08,$0.00,$83.77,$0.00,$87.77,$0.00
275.93,SUP,HCPCS C1713,,275.930  -  NAIL INTRAMEDULLARY 3MM 440MM ELAST STAINLESS STEEL,$582.75,$0.00,$582.75,$262.24,$415.91,$0.00,$97.48,$0.00,$0.00,$102.03,$582.75,$0.00,$291.38,$461.54,$466.20,$0.00,$88.54,$0.00,$92.77,$0.00
275.935,SUP,HCPCS C1713,,275.935  -  NAIL INTRAMEDULLARY 3.5MM 440MM ELAST STAINLESS STEEL,$616.88,$0.00,$616.88,$277.59,$440.26,$0.00,$103.19,$0.00,$0.00,$108.01,$616.88,$0.00,$308.44,$488.57,$493.50,$0.00,$93.73,$0.00,$98.21,$0.00
275.94,SUP,HCPCS C1713,,275.940  -  NAIL INTRAMEDULLARY 4MM 440MM ELAST STAINLESS STEEL,$661.90,$0.00,$661.90,$297.86,$472.40,$0.00,$110.72,$0.00,$0.00,$115.89,$661.90,$0.00,$330.95,$524.22,$529.52,$0.00,$100.57,$0.00,$105.37,$0.00
280,SUP,HCPCS C1713,,280.000  -  SCREW BONE 12.7MM 8.2MM 2.7MM 100MM 22MM CANN LAG DHS/DCS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
280.05,SUP,HCPCS C1713,,280.050  -  SCREW BONE 12.7MM 8.2MM 2.7MM 105MM 22MM CANN LAG DHS/DCS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
280.1,SUP,HCPCS C1713,,280.100  -  SCREW BONE 12.7MM 8.2MM 2.7MM 110MM 22MM CANN LAG DHS/DCS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
280.15,SUP,HCPCS C1713,,280.150  -  SCREW BONE 12.7MM 8.2MM 115MM 22MM CANN THREADED LAG DHS/DCS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
280.2,SUP,HCPCS C1713,,280.200  -  SCREW BONE 12.7MM 8.2MM 120MM 22MM CANN THREADED LAG DHS/DCS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
280.25,SUP,HCPCS C1713,,280.250  -  SCREW BONE 12.7MM 8.2MM 125MM 22MM CANN THREADED LAG DHS/DCS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
280.251,SUP,HCPCS C1713,,280.251  -  SCREW BONE 12.7MM 50MM LAG DHS/DCS STAINLESS STEEL HIP,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
280.255,SUP,HCPCS C1713,,280.255  -  SCREW BONE 12.7MM 55MM LAG DHS/DCS STAINLESS STEEL HIP,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
280.26,SUP,HCPCS C1713,,280.260  -  SCREW BONE 12.7MM 60MM LAG DHS/DCS STAINLESS STEEL HIP,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
280.265,SUP,HCPCS C1713,,280.265  -  SCREW BONE 12.7MM 65MM LAG DHS/DCS STAINLESS STEEL HIP,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
280.27,SUP,HCPCS C1713,,280.270  -  SCREW BONE 12.7MM 70MM LAG DHS/DCS STAINLESS STEEL HIP,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
280.275,SUP,HCPCS C1713,,280.275  -  SCREW BONE 12.7MM 75MM LAG DHS/DCS STAINLESS STEEL HIP,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
280.28,SUP,HCPCS C1713,,280.280  -  SCREW BONE 12.7MM 80MM LAG DHS/DCS STAINLESS STEEL HIP,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
280.285,SUP,HCPCS C1713,,280.285  -  SCREW BN 12MM 8MM 2.7MM 85MM NS 22MM DHS DCS LG CNN SS HIP,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
280.29,SUP,HCPCS C1713,,280.290  -  SCREW BONE 12.7MM 90MM LAG DHS/DCS STAINLESS STEEL HIP,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
280.295,SUP,HCPCS C1713,,280.295  -  SCREW BONE 12.7MM 95MM LAG DHS/DCS STAINLESS STEEL HIP,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
280.3,SUP,HCPCS C1713,,280.300  -  SCREW BONE 12.7MM 130MM 22MM DHS/DCS SS CNDYLR HIP LAG CANN,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
280.301,SUP,HCPCS C1713,,280.301  -  SCREW BONE 12.7MM 100MM LAG DHS/DCS STAINLESS STEEL HIP,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
280.305,SUP,HCPCS C1713,,280.305  -  SCREW BONE 12.7MM 105MM 22MM LAG CANN DHS/DCS STAINLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
280.31,SUP,HCPCS C1713,,280.310  -  SCREW BONE 12.7MM 110MM LAG DHS/DCS STAINLESS STEEL HIP,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
280.315,SUP,HCPCS C1713,,280.315  -  SCREW BONE 12.7MM 115MM LAG DHS/DCS STAINLESS STEEL HIP,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
280.32,SUP,HCPCS C1713,,280.320  -  SCREW BONE 12.7MM 120MM LAG DHS/DCS STAINLESS STEEL HIP,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
280.325,SUP,HCPCS C1713,,280.325  -  SCREW BONE 12.7MM 125MM LAG DHS/DCS STAINLESS STEEL HIP,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
280.33,SUP,HCPCS C1713,,280.330  -  SCREW BONE 12.7MM 130MM LAG DHS/DCS STAINLESS STEEL HIP,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
280.335,SUP,HCPCS C1713,,280.335  -  SCREW BONE 13MM 135MM 22MM LAG CANN OCTAGONAL DHS/DCS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
280.34,SUP,HCPCS C1713,,280.340  -  SCREW BONE 12MM 8MM 2.7MM 140MM 22MM 1 STEP LAG CANN DHS/DCS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
280.345,SUP,HCPCS C1713,,280.345  -  SCREW BONE 12MM 8MM 2.7MM 145MM 22MM 1 STEP LAG CANN DHS/DCS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
280.35,SUP,HCPCS C1713,,280.350  -  SCREW BONE 12.7MM 8.2MM 135MM 22MM CANN THREADED LAG DHS/DCS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
280.4,SUP,HCPCS C1713,,280.400  -  SCREW BONE 12.7MM 140MM 22MM 1 STEP LAG THREADED DHS/DCS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
280.451,SUP,HCPCS C1713,,280.451  -  SCREW BONE 12.7MM 8.2MM 2.7MM 145MM 22MM CANN LAG DHS/DCS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
280.454,SUP,HCPCS C1713,,280.454  -  SCREW BONE 14MM 2.7MM 50MM 22MM LAG CANN DHS/DCS STAINLESS,$701.48,$0.00,$701.48,$315.66,$500.64,$0.00,$117.34,$0.00,$0.00,$122.82,$701.48,$0.00,$350.74,$555.57,$561.18,$0.00,$106.58,$0.00,$111.67,$0.00
280.455,SUP,HCPCS C1713,,280.455  -  SCREW BONE 14MM 8.2MM 55MM 22MM CANN THREADED LAG DHS/DCS,$701.48,$0.00,$701.48,$315.66,$500.64,$0.00,$117.34,$0.00,$0.00,$122.82,$701.48,$0.00,$350.74,$555.57,$561.18,$0.00,$106.58,$0.00,$111.67,$0.00
280.46,SUP,HCPCS C1713,,280.460  -  SCREW BONE 14MM 8.2MM 60MM 22MM CANN THREADED LAG DHS/DCS,$701.48,$0.00,$701.48,$315.66,$500.64,$0.00,$117.34,$0.00,$0.00,$122.82,$701.48,$0.00,$350.74,$555.57,$561.18,$0.00,$106.58,$0.00,$111.67,$0.00
280.465,SUP,HCPCS C1713,,280.465  -  SCREW BONE LARGE 14MM 65MM 14MM THREAD DHS/DCS STAINLESS,$701.48,$0.00,$701.48,$315.66,$500.64,$0.00,$117.34,$0.00,$0.00,$122.82,$701.48,$0.00,$350.74,$555.57,$561.18,$0.00,$106.58,$0.00,$111.67,$0.00
280.47,SUP,HCPCS C1713,,280.470  -  SCREW BONE 14MM 8.2MM 70MM 22MM CANN THREADED LAG DHS/DCS,$701.48,$0.00,$701.48,$315.66,$500.64,$0.00,$117.34,$0.00,$0.00,$122.82,$701.48,$0.00,$350.74,$555.57,$561.18,$0.00,$106.58,$0.00,$111.67,$0.00
280.475,SUP,HCPCS C1713,,280.475  -  SCREW BONE 14MM 8.2MM 75MM 22MM CANN THREADED LAG DHS/DCS,$701.48,$0.00,$701.48,$315.66,$500.64,$0.00,$117.34,$0.00,$0.00,$122.82,$701.48,$0.00,$350.74,$555.57,$561.18,$0.00,$106.58,$0.00,$111.67,$0.00
280.48,SUP,HCPCS C1713,,280.480  -  SCREW BONE 14MM 8.2MM 80MM 22MM CANN THREADED LAG DHS/DCS,$701.48,$0.00,$701.48,$315.66,$500.64,$0.00,$117.34,$0.00,$0.00,$122.82,$701.48,$0.00,$350.74,$555.57,$561.18,$0.00,$106.58,$0.00,$111.67,$0.00
280.485,SUP,HCPCS C1713,,280.485  -  SCREW BONE 14MM 8.2MM 85MM 22MM CANN THREADED LAG DHS/DCS,$701.48,$0.00,$701.48,$315.66,$500.64,$0.00,$117.34,$0.00,$0.00,$122.82,$701.48,$0.00,$350.74,$555.57,$561.18,$0.00,$106.58,$0.00,$111.67,$0.00
280.49,SUP,HCPCS C1713,,280.490  -  SCREW BONE 14MM 8.2MM 90MM 22MM CANN THREADED LAG DHS/DCS,$701.48,$0.00,$701.48,$315.66,$500.64,$0.00,$117.34,$0.00,$0.00,$122.82,$701.48,$0.00,$350.74,$555.57,$561.18,$0.00,$106.58,$0.00,$111.67,$0.00
280.495,SUP,HCPCS C1713,,280.495  -  SCREW BONE 14MM 8.2MM 95MM 22MM CANN THREADED LAG DHS/DCS,$701.48,$0.00,$701.48,$315.66,$500.64,$0.00,$117.34,$0.00,$0.00,$122.82,$701.48,$0.00,$350.74,$555.57,$561.18,$0.00,$106.58,$0.00,$111.67,$0.00
280.501,SUP,HCPCS C1713,,280.501  -  SCREW BONE 12.7MM 8.2MM 50MM 22MM CANN THREADED LAG DHS/DCS,$682.38,$0.00,$682.38,$307.07,$487.01,$0.00,$114.15,$0.00,$0.00,$119.48,$682.38,$0.00,$341.19,$540.44,$545.90,$0.00,$103.68,$0.00,$108.63,$0.00
280.504,SUP,HCPCS C1713,,280.504  -  SCREW BONE 14MM 8MM 2.7MM 100MM 22MM LAG CANN DHS/DCS,$701.48,$0.00,$701.48,$315.66,$500.64,$0.00,$117.34,$0.00,$0.00,$122.82,$701.48,$0.00,$350.74,$555.57,$561.18,$0.00,$106.58,$0.00,$111.67,$0.00
280.505,SUP,HCPCS C1713,,280.505  -  SCREW BONE 14MM 8.2MM 105MM 22MM CANN THREADED LAG DHS/DCS,$701.48,$0.00,$701.48,$315.66,$500.64,$0.00,$117.34,$0.00,$0.00,$122.82,$701.48,$0.00,$350.74,$555.57,$561.18,$0.00,$106.58,$0.00,$111.67,$0.00
280.51,SUP,HCPCS C1713,,280.510  -  SCREW BONE 14MM 8.2MM 110MM 22MM CANN THREADED LAG DHS/DCS,$701.48,$0.00,$701.48,$315.66,$500.64,$0.00,$117.34,$0.00,$0.00,$122.82,$701.48,$0.00,$350.74,$555.57,$561.18,$0.00,$106.58,$0.00,$111.67,$0.00
280.515,SUP,HCPCS C1713,,280.515  -  SCREW BONE 14MM 8.2MM 115MM 22MM CANN THREADED LAG DHS/DCS,$701.48,$0.00,$701.48,$315.66,$500.64,$0.00,$117.34,$0.00,$0.00,$122.82,$701.48,$0.00,$350.74,$555.57,$561.18,$0.00,$106.58,$0.00,$111.67,$0.00
280.52,SUP,HCPCS C1713,,280.520  -  SCREW BONE 14MM 8.2MM 120MM 22MM CANN THREADED LAG DHS/DCS,$701.48,$0.00,$701.48,$315.66,$500.64,$0.00,$117.34,$0.00,$0.00,$122.82,$701.48,$0.00,$350.74,$555.57,$561.18,$0.00,$106.58,$0.00,$111.67,$0.00
280.525,SUP,HCPCS C1713,,280.525  -  SCREW BONE 14MM 8.2MM 125MM 22MM CANN THREADED LAG DHS/DCS,$701.48,$0.00,$701.48,$315.66,$500.64,$0.00,$117.34,$0.00,$0.00,$122.82,$701.48,$0.00,$350.74,$555.57,$561.18,$0.00,$106.58,$0.00,$111.67,$0.00
280.53,SUP,HCPCS C1713,,280.530  -  SCREW BONE 14MM 8.2MM 130MM 22MM CANN LAG DHS/DCS STAINLESS,$701.48,$0.00,$701.48,$315.66,$500.64,$0.00,$117.34,$0.00,$0.00,$122.82,$701.48,$0.00,$350.74,$555.57,$561.18,$0.00,$106.58,$0.00,$111.67,$0.00
280.535,SUP,HCPCS C1713,,280.535  -  SCREW BONE 14MM 135MM 22MM LAG THREAD DHS/DCS STAINLESS,$701.48,$0.00,$701.48,$315.66,$500.64,$0.00,$117.34,$0.00,$0.00,$122.82,$701.48,$0.00,$350.74,$555.57,$561.18,$0.00,$106.58,$0.00,$111.67,$0.00
280.54,SUP,HCPCS C1713,,280.540  -  SCREW BONE 14MM 8.2MM 130MM 22MM CANN LAG DHS/DCS STAINLESS,$701.48,$0.00,$701.48,$315.66,$500.64,$0.00,$117.34,$0.00,$0.00,$122.82,$701.48,$0.00,$350.74,$555.57,$561.18,$0.00,$106.58,$0.00,$111.67,$0.00
280.545,SUP,HCPCS C1713,,280.545  -  SCREW BONE 14MM 145MM 22MM LAG THREAD DHS/DCS STAINLESS,$701.48,$0.00,$701.48,$315.66,$500.64,$0.00,$117.34,$0.00,$0.00,$122.82,$701.48,$0.00,$350.74,$555.57,$561.18,$0.00,$106.58,$0.00,$111.67,$0.00
280.55,SUP,HCPCS C1713,,280.550  -  SCREW BONE 8MM 55MM 22MM CANN THREADED LAG DHS/DCS STAINLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
280.6,SUP,HCPCS C1713,,280.600  -  SCREW BONE 12.7MM 8.2MM 2.7MM 60MM 22MM CANN LAG DHS/DCS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
280.65,SUP,HCPCS C1713,,280.650  -  SCREW BONE 12.7MM 8.2MM 65MM 22MM CANN THREADED LAG DHS/DCS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
280.66,SUP,HCPCS C1713,,280.660  -  SCREW BONE 14MM 8.2MM 60MM 22MM 1 STEP LAG CANN DHS/DCS,$701.48,$0.00,$701.48,$315.66,$500.64,$0.00,$117.34,$0.00,$0.00,$122.82,$701.48,$0.00,$350.74,$555.57,$561.18,$0.00,$106.58,$0.00,$111.67,$0.00
280.67,SUP,HCPCS C1713,,280.670  -  SCREW BONE 14MM 70MM 22MM 1 STEP LAG THREAD DHS/DCS,$701.48,$0.00,$701.48,$315.66,$500.64,$0.00,$117.34,$0.00,$0.00,$122.82,$701.48,$0.00,$350.74,$555.57,$561.18,$0.00,$106.58,$0.00,$111.67,$0.00
280.68,SUP,HCPCS C1713,,280.680  -  SCREW BONE 14MM 80MM 22MM LAG CANN DHS/DCS STAINLESS STEEL,$701.48,$0.00,$701.48,$315.66,$500.64,$0.00,$117.34,$0.00,$0.00,$122.82,$701.48,$0.00,$350.74,$555.57,$561.18,$0.00,$106.58,$0.00,$111.67,$0.00
280.69,SUP,HCPCS C1713,,280.690  -  SCREW BONE 14MM 90MM 22MM LAG CANN DHS/DCS STAINLESS STEEL,$701.48,$0.00,$701.48,$315.66,$500.64,$0.00,$117.34,$0.00,$0.00,$122.82,$701.48,$0.00,$350.74,$555.57,$561.18,$0.00,$106.58,$0.00,$111.67,$0.00
280.7,SUP,HCPCS C1713,,280.700  -  SCREW BN 12.7MM 8MM 2.7MM 70MM NS 22MM DHS DCS LG CNN SS HIP,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
280.71,SUP,HCPCS C1713,,280.710  -  SCREW BONE 14MM 8.2MM 110MM 22MM 1 STEP LAG CANN DHS/DCS,$701.48,$0.00,$701.48,$315.66,$500.64,$0.00,$117.34,$0.00,$0.00,$122.82,$701.48,$0.00,$350.74,$555.57,$561.18,$0.00,$106.58,$0.00,$111.67,$0.00
280.72,SUP,HCPCS C1713,,280.720  -  SCREW BONE 14MM 8.2MM 120MM 22MM 1 STEP LAG CANN DHS/DCS,$701.48,$0.00,$701.48,$315.66,$500.64,$0.00,$117.34,$0.00,$0.00,$122.82,$701.48,$0.00,$350.74,$555.57,$561.18,$0.00,$106.58,$0.00,$111.67,$0.00
280.73,SUP,HCPCS C1713,,280.730  -  SCREW BONE 14MM 8.2MM 60MM 22MM 1 STEP LAG CANN DHS/DCS,$701.48,$0.00,$701.48,$315.66,$500.64,$0.00,$117.34,$0.00,$0.00,$122.82,$701.48,$0.00,$350.74,$555.57,$561.18,$0.00,$106.58,$0.00,$111.67,$0.00
280.74,SUP,HCPCS C1713,,280.740  -  SCREW BONE 14MM 8.2MM 140MM 22MM 1 STEP LAG CANN DHS/DCS,$701.48,$0.00,$701.48,$315.66,$500.64,$0.00,$117.34,$0.00,$0.00,$122.82,$701.48,$0.00,$350.74,$555.57,$561.18,$0.00,$106.58,$0.00,$111.67,$0.00
280.75,SUP,HCPCS C1713,,280.750  -  SCREW BONE 12.7MM 8.2MM 75MM 22MM CANN THREADED LAG DHS/DCS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
280.8,SUP,HCPCS C1713,,280.800  -  SCREW BONE 12.7MM 8.2MM 80MM 22MM CANN THREADED LAG DHS/DCS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
280.85,SUP,HCPCS C1713,,280.850  -  SCREW BONE 12.7MM 8.2MM 85MM 22MM CANN THREADED LAG DHS/DCS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
280.9,SUP,HCPCS C1713,,280.900  -  SCREW BONE 12.7MM 8MM 2.7MM 90MM 22MM LAG DHS/DCS STAINLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
280.95,SUP,HCPCS C1713,,280.950  -  SCREW BONE 12.7MM 8.2MM 95MM 22MM CANN THREADED LAG DHS/DCS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
280.99,SUP,HCPCS C1713,,280.990  -  SCREW BONE 12.7MM 36MM 22MM COMPRESSION DHS/DCS STAINLESS,$79.83,$0.00,$79.83,$35.92,$56.97,$0.00,$13.35,$0.00,$0.00,$13.98,$79.83,$0.00,$39.91,$63.23,$63.86,$0.00,$12.13,$0.00,$12.71,$0.00
281.01,SUP,HCPCS C1713,,281.010  -  PLATE BONE 130D STANDARD BARREL 174MM 38MM 10 HOLE DHS/DCP,"$1,295.15",$0.00,"$1,295.15",$582.82,$924.35,$0.00,$216.65,$0.00,$0.00,$226.77,"$1,295.15",$0.00,$647.58,"$1,025.76","$1,036.12",$0.00,$196.79,$0.00,$206.19,$0.00
281.012,SUP,HCPCS C1713,,281.012  -  PLATE BN 130D STD BRL 206MM NS 38MM DHS 12 HL SS HIP 4.5MM,"$1,295.15",$0.00,"$1,295.15",$582.82,$924.35,$0.00,$216.65,$0.00,$0.00,$226.77,"$1,295.15",$0.00,$647.58,"$1,025.76","$1,036.12",$0.00,$196.79,$0.00,$206.19,$0.00
281.014,SUP,HCPCS C1713,,281.014  -  PLATE BN 130D STD BRL 238MM NS 38MM DHS 14 HL SS HIP 4.5MM,"$1,720.95",$0.00,"$1,720.95",$774.43,"$1,228.24",$0.00,$287.87,$0.00,$0.00,$301.32,"$1,720.95",$0.00,$860.48,"$1,362.99","$1,376.76",$0.00,$261.48,$0.00,$273.98,$0.00
281.02,SUP,HCPCS C1713,,281.020  -  PLATE BONE 135D STANDARD BARREL 333X19X5.8MM 38MM 20 HOLE,"$1,771.45",$0.00,"$1,771.45",$797.15,"$1,264.28",$0.00,$296.32,$0.00,$0.00,$310.17,"$1,771.45",$0.00,$885.73,"$1,402.99","$1,417.16",$0.00,$269.16,$0.00,$282.01,$0.00
281.021,SUP,HCPCS C1713,,281.021  -  PLATE BN 130D STD BRL 46MM NS 38MM DHS 2 HL SS HIP 4.5MM,$974.43,$0.00,$974.43,$438.49,$695.45,$0.00,$163.00,$0.00,$0.00,$170.61,$974.43,$0.00,$487.21,$771.75,$779.54,$0.00,$148.06,$0.00,$155.13,$0.00
281.031,SUP,HCPCS C1713,,281.031  -  PLATE BONE 130D STANDARD BARREL 62MM 38MM 3 HOLE DHS/DCS,$974.43,$0.00,$974.43,$438.49,$695.45,$0.00,$163.00,$0.00,$0.00,$170.61,$974.43,$0.00,$487.21,$771.75,$779.54,$0.00,$148.06,$0.00,$155.13,$0.00
281.04,SUP,HCPCS C1713,,281.040  -  PLATE BN 130D STD BRL 12.6MM 78X19X5.8MM NS 38MM DHS DCP 4,$974.43,$0.00,$974.43,$438.49,$695.45,$0.00,$163.00,$0.00,$0.00,$170.61,$974.43,$0.00,$487.21,$771.75,$779.54,$0.00,$148.06,$0.00,$155.13,$0.00
281.05,SUP,HCPCS C1713,,281.050  -  PLATE BN 130D STD BRL 12.6MM 94X19X5.8MM NS 38MM DHS DCP 5,$974.43,$0.00,$974.43,$438.49,$695.45,$0.00,$163.00,$0.00,$0.00,$170.61,$974.43,$0.00,$487.21,$771.75,$779.54,$0.00,$148.06,$0.00,$155.13,$0.00
281.06,SUP,HCPCS C1713,,281.060  -  PLATE BN 130D STD BRL 12.6MM 110X19X5.8MM NS 38MM DHS DCP 6,$974.43,$0.00,$974.43,$438.49,$695.45,$0.00,$163.00,$0.00,$0.00,$170.61,$974.43,$0.00,$487.21,$771.75,$779.54,$0.00,$148.06,$0.00,$155.13,$0.00
281.081,SUP,HCPCS C1713,,281.081  -  PLATE BONE 130D STANDARD BARREL 142MM 38MM 8 HOLE,"$1,295.15",$0.00,"$1,295.15",$582.82,$924.35,$0.00,$216.65,$0.00,$0.00,$226.77,"$1,295.15",$0.00,$647.58,"$1,025.76","$1,036.12",$0.00,$196.79,$0.00,$206.19,$0.00
281.1,SUP,HCPCS C1713,,281.100  -  PLATE BN 135D STD BRL 12.6MM 174X19X5.8MM NS 38MM DHS DCP 10,"$1,295.15",$0.00,"$1,295.15",$582.82,$924.35,$0.00,$216.65,$0.00,$0.00,$226.77,"$1,295.15",$0.00,$647.58,"$1,025.76","$1,036.12",$0.00,$196.79,$0.00,$206.19,$0.00
281.102,SUP,HCPCS C1713,,281.102  -  PLATE BN 135D STD BRL 46MM NS 38MM DHS 2 HL SS HIP 4.5MM,$974.43,$0.00,$974.43,$438.49,$695.45,$0.00,$163.00,$0.00,$0.00,$170.61,$974.43,$0.00,$487.21,$771.75,$779.54,$0.00,$148.06,$0.00,$155.13,$0.00
281.11,SUP,HCPCS C1713,,281.110  -  PLATE BN 135D STD BRL 12.6MM 206X19X5.8MM NS 38MM DHS DCP 12,"$1,295.15",$0.00,"$1,295.15",$582.82,$924.35,$0.00,$216.65,$0.00,$0.00,$226.77,"$1,295.15",$0.00,$647.58,"$1,025.76","$1,036.12",$0.00,$196.79,$0.00,$206.19,$0.00
281.13,SUP,HCPCS C1713,,281.130  -  PLATE BN 135D STD BRL 12.6MM 238X19X5.8MM NS 38MM DHS DCP 14,"$1,720.95",$0.00,"$1,720.95",$774.43,"$1,228.24",$0.00,$287.87,$0.00,$0.00,$301.32,"$1,720.95",$0.00,$860.48,"$1,362.99","$1,376.76",$0.00,$261.48,$0.00,$273.98,$0.00
281.131,SUP,HCPCS C1713,,281.131  -  PLATE BN 135D STD BRL 12.6MM 62X19X5.8MM NS 38MM DHS DCP 3,$974.43,$0.00,$974.43,$438.49,$695.45,$0.00,$163.00,$0.00,$0.00,$170.61,$974.43,$0.00,$487.21,$771.75,$779.54,$0.00,$148.06,$0.00,$155.13,$0.00
281.14,SUP,HCPCS C1713,,281.140  -  PLATE BN 135D STD BRL 12.6MM 78X19X5.8MM NS 38MM DHS DCP 4,$974.43,$0.00,$974.43,$438.49,$695.45,$0.00,$163.00,$0.00,$0.00,$170.61,$974.43,$0.00,$487.21,$771.75,$779.54,$0.00,$148.06,$0.00,$155.13,$0.00
281.15,SUP,HCPCS C1713,,281.150  -  PLATE BN 135D STD BRL 12.6MM 94X19X5.8MM NS 38MM DHS DCP 5,$974.43,$0.00,$974.43,$438.49,$695.45,$0.00,$163.00,$0.00,$0.00,$170.61,$974.43,$0.00,$487.21,$771.75,$779.54,$0.00,$148.06,$0.00,$155.13,$0.00
281.16,SUP,HCPCS C1713,,281.160  -  PLATE BN 135D STD BRL 12.6MM 110X19X5.8MM NS 38MM DHS DCP 6,$974.43,$0.00,$974.43,$438.49,$695.45,$0.00,$163.00,$0.00,$0.00,$170.61,$974.43,$0.00,$487.21,$771.75,$779.54,$0.00,$148.06,$0.00,$155.13,$0.00
281.17,SUP,HCPCS C1713,,281.170  -  PLATE BN 135D STD BRL 12.6MM 270X19X5.8MM NS 38MM DHS DCP 16,"$1,720.95",$0.00,"$1,720.95",$774.43,"$1,228.24",$0.00,$287.87,$0.00,$0.00,$301.32,"$1,720.95",$0.00,$860.48,"$1,362.99","$1,376.76",$0.00,$261.48,$0.00,$273.98,$0.00
281.18,SUP,HCPCS C1713,,281.180  -  PLATE BN 135D STD BRL 12.6MM 142X19X5.8MM NS 38MM DHS DCP 8,"$1,295.15",$0.00,"$1,295.15",$582.82,$924.35,$0.00,$216.65,$0.00,$0.00,$226.77,"$1,295.15",$0.00,$647.58,"$1,025.76","$1,036.12",$0.00,$196.79,$0.00,$206.19,$0.00
281.19,SUP,HCPCS C1713,,281.190  -  PLATE BONE 135D STANDARD BARREL 302X19X5.8MM 38MM 18 HOLE,"$1,771.45",$0.00,"$1,771.45",$797.15,"$1,264.28",$0.00,$296.32,$0.00,$0.00,$310.17,"$1,771.45",$0.00,$885.73,"$1,402.99","$1,417.16",$0.00,$269.16,$0.00,$282.01,$0.00
281.2,SUP,HCPCS C1713,,281.200  -  PLATE BN 140D STD BRL 174MM NS 38MM DHS 10 HL SS HIP 4.5MM,"$1,295.15",$0.00,"$1,295.15",$582.82,$924.35,$0.00,$216.65,$0.00,$0.00,$226.77,"$1,295.15",$0.00,$647.58,"$1,025.76","$1,036.12",$0.00,$196.79,$0.00,$206.19,$0.00
281.212,SUP,HCPCS C1713,,281.212  -  PLATE BONE STANDARD BARREL 140D 206MM 38MM 12 HOLE DHS,"$1,295.15",$0.00,"$1,295.15",$582.82,$924.35,$0.00,$216.65,$0.00,$0.00,$226.77,"$1,295.15",$0.00,$647.58,"$1,025.76","$1,036.12",$0.00,$196.79,$0.00,$206.19,$0.00
281.214,SUP,HCPCS C1713,,281.214  -  PLATE BN 140D STD BRL 238MM NS 38MM DHS 14 HL SS HIP 4.5MM,"$1,720.95",$0.00,"$1,720.95",$774.43,"$1,228.24",$0.00,$287.87,$0.00,$0.00,$301.32,"$1,720.95",$0.00,$860.48,"$1,362.99","$1,376.76",$0.00,$261.48,$0.00,$273.98,$0.00
281.216,SUP,HCPCS C1713,,281.216  -  PLATE BONE 140D STANDARD BARREL 12.6MM 270MM 38MM 16 HOLE,"$1,720.95",$0.00,"$1,720.95",$774.43,"$1,228.24",$0.00,$287.87,$0.00,$0.00,$301.32,"$1,720.95",$0.00,$860.48,"$1,362.99","$1,376.76",$0.00,$261.48,$0.00,$273.98,$0.00
281.22,SUP,HCPCS C1713,,281.220  -  PLATE BN 140D STD BRL 46MM NS 38MM DHS 2 HL SS HIP 4.5MM,$974.43,$0.00,$974.43,$438.49,$695.45,$0.00,$163.00,$0.00,$0.00,$170.61,$974.43,$0.00,$487.21,$771.75,$779.54,$0.00,$148.06,$0.00,$155.13,$0.00
281.23,SUP,HCPCS C1713,,281.230  -  PLATE BONE 140D STANDARD BARREL 62MM 38MM 3 HOLE COMPRESSION,$974.43,$0.00,$974.43,$438.49,$695.45,$0.00,$163.00,$0.00,$0.00,$170.61,$974.43,$0.00,$487.21,$771.75,$779.54,$0.00,$148.06,$0.00,$155.13,$0.00
281.24,SUP,HCPCS C1713,,281.240  -  PLATE BN 140D STD BRL 12.6MM 78X19X5.8MM NS 38MM DHS DCP 4,$974.43,$0.00,$974.43,$438.49,$695.45,$0.00,$200.10,$0.00,$0.00,$170.61,$974.43,$0.00,$487.21,$771.75,$779.54,$0.00,$181.76,$0.00,$155.13,$0.00
281.25,SUP,HCPCS C1713,,281.250  -  PLATE BN 140D STD BRL 12.6MM 94X19X5.8MM NS 38MM DHS DCP 5,$974.43,$0.00,$974.43,$438.49,$695.45,$0.00,$163.00,$0.00,$0.00,$170.61,$974.43,$0.00,$487.21,$771.75,$779.54,$0.00,$148.06,$0.00,$155.13,$0.00
281.26,SUP,HCPCS C1713,,281.260  -  PLATE BN 140D STD BRL 12.6MM 110X19X5.8MM NS 38MM DHS DCP 6,$974.43,$0.00,$974.43,$438.49,$695.45,$0.00,$163.00,$0.00,$0.00,$170.61,$974.43,$0.00,$487.21,$771.75,$779.54,$0.00,$148.06,$0.00,$155.13,$0.00
281.28,SUP,HCPCS C1713,,281.280  -  PLATE BN 140D STD BRL 142MM NS 38MM DHS 8 HL SS HIP 4.5MM,"$1,295.15",$0.00,"$1,295.15",$582.82,$924.35,$0.00,$216.65,$0.00,$0.00,$226.77,"$1,295.15",$0.00,$647.58,"$1,025.76","$1,036.12",$0.00,$196.79,$0.00,$206.19,$0.00
281.308,SUP,HCPCS C1713,,281.308  -  PLATE BN 145D STD BRL 142MM NS 38MM DHS 8 HL SS HIP 4.5MM,"$1,295.15",$0.00,"$1,295.15",$582.82,$924.35,$0.00,$216.65,$0.00,$0.00,$226.77,"$1,295.15",$0.00,$647.58,"$1,025.76","$1,036.12",$0.00,$196.79,$0.00,$206.19,$0.00
281.31,SUP,HCPCS C1713,,281.310  -  PLATE BN 145D STD BRL 174MM NS 38MM DHS 10 HL SS HIP 4.5MM,"$1,295.15",$0.00,"$1,295.15",$582.82,$924.35,$0.00,$216.65,$0.00,$0.00,$226.77,"$1,295.15",$0.00,$647.58,"$1,025.76","$1,036.12",$0.00,$196.79,$0.00,$206.19,$0.00
281.312,SUP,HCPCS C1713,,281.312  -  PLATE BONE 145D 206MM 38MM 12 HOLE ANGLED STANDARD BARREL,"$1,295.15",$0.00,"$1,295.15",$582.82,$924.35,$0.00,$216.65,$0.00,$0.00,$226.77,"$1,295.15",$0.00,$647.58,"$1,025.76","$1,036.12",$0.00,$196.79,$0.00,$206.19,$0.00
281.314,SUP,HCPCS C1713,,281.314  -  PLATE BONE 145D STANDARD BARREL 238MM 38MM 14 HOLE DHS,"$1,720.95",$0.00,"$1,720.95",$774.43,"$1,228.24",$0.00,$287.87,$0.00,$0.00,$301.32,"$1,720.95",$0.00,$860.48,"$1,362.99","$1,376.76",$0.00,$261.48,$0.00,$273.98,$0.00
281.316,SUP,HCPCS C1713,,281.316  -  PLATE BONE 145D STANDARD BARREL 270MM 38MM 16 HOLE DHS,"$1,720.95",$0.00,"$1,720.95",$774.43,"$1,228.24",$0.00,$287.87,$0.00,$0.00,$301.32,"$1,720.95",$0.00,$860.48,"$1,362.99","$1,376.76",$0.00,$261.48,$0.00,$273.98,$0.00
281.32,SUP,HCPCS C1713,,281.320  -  PLATE BN 145D STD BRL 46MM NS 38MM DHS 2 HL SS HIP 4.5MM,$974.43,$0.00,$974.43,$438.49,$695.45,$0.00,$163.00,$0.00,$0.00,$170.61,$974.43,$0.00,$487.21,$771.75,$779.54,$0.00,$148.06,$0.00,$155.13,$0.00
281.33,SUP,HCPCS C1713,,281.330  -  PLATE BONE 145D STANDARD BARREL 62MM 38MM 3 HOLE COMPRESSION,$974.43,$0.00,$974.43,$438.49,$695.45,$0.00,$163.00,$0.00,$0.00,$170.61,$974.43,$0.00,$487.21,$771.75,$779.54,$0.00,$148.06,$0.00,$155.13,$0.00
281.34,SUP,HCPCS C1713,,281.340  -  PLATE BN 145D STD BRL 12.6MM 78X19X5.8MM NS 38MM DHS DCP 4,$974.43,$0.00,$974.43,$438.49,$695.45,$0.00,$163.00,$0.00,$0.00,$170.61,$974.43,$0.00,$487.21,$771.75,$779.54,$0.00,$148.06,$0.00,$155.13,$0.00
281.35,SUP,HCPCS C1713,,281.350  -  PLATE BN 145D STD BRL 12.6MM 94X19X5.8MM NS 38MM DHS DCP 5,$974.43,$0.00,$974.43,$438.49,$695.45,$0.00,$163.00,$0.00,$0.00,$170.61,$974.43,$0.00,$487.21,$771.75,$779.54,$0.00,$148.06,$0.00,$155.13,$0.00
281.36,SUP,HCPCS C1713,,281.360  -  PLATE BN 145D STD BRL 12.6MM 110X19X5.8MM NS 38MM DHS DCP 6,$974.43,$0.00,$974.43,$438.49,$695.45,$0.00,$163.00,$0.00,$0.00,$170.61,$974.43,$0.00,$487.21,$771.75,$779.54,$0.00,$148.06,$0.00,$155.13,$0.00
281.4,SUP,HCPCS C1713,,281.400  -  PLATE BN 150D STD BRL 174MM NS 38MM DHS 10 HL SS HIP 4.5MM,"$1,295.15",$0.00,"$1,295.15",$582.82,$924.35,$0.00,$216.65,$0.00,$0.00,$226.77,"$1,295.15",$0.00,$647.58,"$1,025.76","$1,036.12",$0.00,$196.79,$0.00,$206.19,$0.00
281.402,SUP,HCPCS C1713,,281.402  -  PLATE BONE 150D STANDARD BARREL 46X19X5.8MM 38MM 2 HOLE,$974.43,$0.00,$974.43,$438.49,$695.45,$0.00,$163.00,$0.00,$0.00,$170.61,$974.43,$0.00,$487.21,$771.75,$779.54,$0.00,$148.06,$0.00,$155.13,$0.00
281.41,SUP,HCPCS C1713,,281.410  -  PLATE BONE 150D STANDARD BARREL 12.6MM 206MM 38MM 12 HOLE,"$1,295.15",$0.00,"$1,295.15",$582.82,$924.35,$0.00,$216.65,$0.00,$0.00,$226.77,"$1,295.15",$0.00,$647.58,"$1,025.76","$1,036.12",$0.00,$196.79,$0.00,$206.19,$0.00
281.414,SUP,HCPCS C1713,,281.414  -  PLATE BONE 150D STANDARD BARREL 238MM 38MM 14 HOLE DHS,"$1,720.95",$0.00,"$1,720.95",$774.43,"$1,228.24",$0.00,$287.87,$0.00,$0.00,$301.32,"$1,720.95",$0.00,$860.48,"$1,362.99","$1,376.76",$0.00,$261.48,$0.00,$273.98,$0.00
281.416,SUP,HCPCS C1713,,281.416  -  PLATE BONE 150D STANDARD BARREL 270MM 38MM 16 HOLE DHS,"$1,720.95",$0.00,"$1,720.95",$774.43,"$1,228.24",$0.00,$287.87,$0.00,$0.00,$301.32,"$1,720.95",$0.00,$860.48,"$1,362.99","$1,376.76",$0.00,$261.48,$0.00,$273.98,$0.00
281.418,SUP,HCPCS C1713,,281.418  -  PLATE BONE 150D STANDARD BARRAL 302MM 38MM 18 HOLE DHS/DCP,"$1,771.45",$0.00,"$1,771.45",$797.15,"$1,264.28",$0.00,$296.32,$0.00,$0.00,$310.17,"$1,771.45",$0.00,$885.73,"$1,402.99","$1,417.16",$0.00,$269.16,$0.00,$282.01,$0.00
281.421,SUP,HCPCS C1713,,281.421  -  PLATE BONE 150D STANDARD BARREL 333MM 38MM 20 HOLE DHS/DCP,"$1,771.45",$0.00,"$1,771.45",$797.15,"$1,264.28",$0.00,$296.32,$0.00,$0.00,$310.17,"$1,771.45",$0.00,$885.73,"$1,402.99","$1,417.16",$0.00,$269.16,$0.00,$282.01,$0.00
281.43,SUP,HCPCS C1713,,281.430  -  PLATE BONE 150D STANDARD BARREL 62MM 38MM 3 HOLE DHS/DCP,$974.43,$0.00,$974.43,$438.49,$695.45,$0.00,$163.00,$0.00,$0.00,$170.61,$974.43,$0.00,$487.21,$771.75,$779.54,$0.00,$148.06,$0.00,$155.13,$0.00
281.44,SUP,HCPCS C1713,,281.440  -  PLATE BN 150D STD BRL 12.6MM 78X19X5.8MM NS 38MM DHS DCP 4,$974.43,$0.00,$974.43,$438.49,$695.45,$0.00,$200.10,$0.00,$0.00,$170.61,$974.43,$0.00,$487.21,$771.75,$779.54,$0.00,$181.76,$0.00,$155.13,$0.00
281.45,SUP,HCPCS C1713,,281.450  -  PLATE BN 150D STD BRL 12.6MM 94X19X5.8MM NS 38MM DHS DCP 5,$974.43,$0.00,$974.43,$438.49,$695.45,$0.00,$163.00,$0.00,$0.00,$170.61,$974.43,$0.00,$487.21,$771.75,$779.54,$0.00,$148.06,$0.00,$155.13,$0.00
281.46,SUP,HCPCS C1713,,281.460  -  PLATE BN 150D STD BRL 12.6MM 110X19X5.8MM NS 38MM DHS DCP 6,$974.43,$0.00,$974.43,$438.49,$695.45,$0.00,$163.00,$0.00,$0.00,$170.61,$974.43,$0.00,$487.21,$771.75,$779.54,$0.00,$148.06,$0.00,$155.13,$0.00
281.48,SUP,HCPCS C1713,,281.480  -  PLATE BN 150D STD BRL 142MM NS 38MM DHS 8 HL SS HIP 4.5MM,"$1,295.15",$0.00,"$1,295.15",$582.82,$924.35,$0.00,$216.65,$0.00,$0.00,$226.77,"$1,295.15",$0.00,$647.58,"$1,025.76","$1,036.12",$0.00,$196.79,$0.00,$206.19,$0.00
281.502,SUP,HCPCS C1713,,281.502  -  PLATE BONE 130D SHORT BARREL 46MM 25MM 2 HOLE DHS/DCP,$974.43,$0.00,$974.43,$438.49,$695.45,$0.00,$163.00,$0.00,$0.00,$170.61,$974.43,$0.00,$487.21,$771.75,$779.54,$0.00,$148.06,$0.00,$155.13,$0.00
281.503,SUP,HCPCS C1713,,281.503  -  PLATE BONE 130D SHORT BARREL 62MM 25MM 3 HOLE DHS/DCP,$974.43,$0.00,$974.43,$438.49,$695.45,$0.00,$163.00,$0.00,$0.00,$170.61,$974.43,$0.00,$487.21,$771.75,$779.54,$0.00,$148.06,$0.00,$155.13,$0.00
281.504,SUP,HCPCS C1713,,281.504  -  PLATE BONE 130D SHORT BARREL 78MM 25MM 4 HOLE DHS/DCP,$974.43,$0.00,$974.43,$438.49,$695.45,$0.00,$163.00,$0.00,$0.00,$170.61,$974.43,$0.00,$487.21,$771.75,$779.54,$0.00,$148.06,$0.00,$155.13,$0.00
281.505,SUP,HCPCS C1713,,281.505  -  PLATE BONE 130D SHORT BARREL 94MM 25MM 5 HOLE DHS/DCP,$974.43,$0.00,$974.43,$438.49,$695.45,$0.00,$163.00,$0.00,$0.00,$170.61,$974.43,$0.00,$487.21,$771.75,$779.54,$0.00,$148.06,$0.00,$155.13,$0.00
281.506,SUP,HCPCS C1713,,281.506  -  PLATE BONE 130D SHORT BARREL 110MM 25MM 6 HOLE DHS/DCP,$974.43,$0.00,$974.43,$438.49,$695.45,$0.00,$163.00,$0.00,$0.00,$170.61,$974.43,$0.00,$487.21,$771.75,$779.54,$0.00,$148.06,$0.00,$155.13,$0.00
281.52,SUP,HCPCS C1713,,281.520  -  PLATE BN 135D SHRT BRL 46MM NS 25MM DHS 2 HL SS HIP 4.5MM,$974.43,$0.00,$974.43,$438.49,$695.45,$0.00,$163.00,$0.00,$0.00,$170.61,$974.43,$0.00,$487.21,$771.75,$779.54,$0.00,$148.06,$0.00,$155.13,$0.00
281.53,SUP,HCPCS C1713,,281.530  -  PLATE BONE 135D SHORT BARREL 62MM 25MM 3 HOLE COMPRESSION,$974.43,$0.00,$974.43,$438.49,$695.45,$0.00,$163.00,$0.00,$0.00,$170.61,$974.43,$0.00,$487.21,$771.75,$779.54,$0.00,$148.06,$0.00,$155.13,$0.00
281.54,SUP,HCPCS C1713,,281.540  -  PLATE BN 135D SHRT BRL 12.6MM 78X19X5.8MM NS 25MM DHS DCP 4,$974.43,$0.00,$974.43,$438.49,$695.45,$0.00,$163.00,$0.00,$0.00,$170.61,$974.43,$0.00,$487.21,$771.75,$779.54,$0.00,$148.06,$0.00,$155.13,$0.00
281.55,SUP,HCPCS C1713,,281.550  -  PLATE BONE 135D SHORT BARREL 94MM 25MM 5 HOLE DHS/DCP,$974.43,$0.00,$974.43,$438.49,$695.45,$0.00,$163.00,$0.00,$0.00,$170.61,$974.43,$0.00,$487.21,$771.75,$779.54,$0.00,$148.06,$0.00,$155.13,$0.00
281.56,SUP,HCPCS C1713,,281.560  -  PLATE BONE 135D SHORT BARREL 110MM 6 HOLE DHS STAINLESS,$974.43,$0.00,$974.43,$438.49,$695.45,$0.00,$163.00,$0.00,$0.00,$170.61,$974.43,$0.00,$487.21,$771.75,$779.54,$0.00,$148.06,$0.00,$155.13,$0.00
281.62,SUP,HCPCS C1713,,281.620  -  PLATE BN 140D SHRT BRL 46MM NS 25MM DHS 2 HL SS HIP 4.5MM,$974.43,$0.00,$974.43,$438.49,$695.45,$0.00,$163.00,$0.00,$0.00,$170.61,$974.43,$0.00,$487.21,$771.75,$779.54,$0.00,$148.06,$0.00,$155.13,$0.00
281.63,SUP,HCPCS C1713,,281.630  -  PLATE BONE 140D SHORT BARREL 62MM 25MM 3 HOLE DHS/DCP,$974.43,$0.00,$974.43,$438.49,$695.45,$0.00,$163.00,$0.00,$0.00,$170.61,$974.43,$0.00,$487.21,$771.75,$779.54,$0.00,$148.06,$0.00,$155.13,$0.00
281.64,SUP,HCPCS C1713,,281.640  -  PLATE BONE 140D SHORT BARREL 78MM 25MM 4 HOLE DHS/DCP,$974.43,$0.00,$974.43,$438.49,$695.45,$0.00,$163.00,$0.00,$0.00,$170.61,$974.43,$0.00,$487.21,$771.75,$779.54,$0.00,$148.06,$0.00,$155.13,$0.00
281.65,SUP,HCPCS C1713,,281.650  -  PLATE BONE 140D SHORT BARREL 94MM 25MM 5 HOLE DHS STAINLESS,$974.43,$0.00,$974.43,$438.49,$695.45,$0.00,$163.00,$0.00,$0.00,$170.61,$974.43,$0.00,$487.21,$771.75,$779.54,$0.00,$148.06,$0.00,$155.13,$0.00
281.66,SUP,HCPCS C1713,,281.660  -  PLATE BONE 140D SHORT BARREL 110MM 25MM 6 HOLE DHS/DCP,$974.43,$0.00,$974.43,$438.49,$695.45,$0.00,$163.00,$0.00,$0.00,$170.61,$974.43,$0.00,$487.21,$771.75,$779.54,$0.00,$148.06,$0.00,$155.13,$0.00
281.72,SUP,HCPCS C1713,,281.720  -  PLATE BN 145D SHRT BRL 46MM NS 25MM DHS 2 HL SS HIP 4.5MM,$974.43,$0.00,$974.43,$438.49,$695.45,$0.00,$163.00,$0.00,$0.00,$170.61,$974.43,$0.00,$487.21,$771.75,$779.54,$0.00,$148.06,$0.00,$155.13,$0.00
281.73,SUP,HCPCS C1713,,281.730  -  PLATE BONE 145D SHORT BARREL 62MM 25MM 3 HOLE DHS/DCP,$974.43,$0.00,$974.43,$438.49,$695.45,$0.00,$163.00,$0.00,$0.00,$170.61,$974.43,$0.00,$487.21,$771.75,$779.54,$0.00,$148.06,$0.00,$155.13,$0.00
281.74,SUP,HCPCS C1713,,281.740  -  PLATE BONE 145D SHORT BARREL 78MM 25MM 4 HOLE DHS/DCP,$974.43,$0.00,$974.43,$438.49,$695.45,$0.00,$163.00,$0.00,$0.00,$170.61,$974.43,$0.00,$487.21,$771.75,$779.54,$0.00,$148.06,$0.00,$155.13,$0.00
281.75,SUP,HCPCS C1713,,281.750  -  PLATE BONE 145D SHORT BARREL 94MM 25MM 5 HOLE DHS/DCP,$974.43,$0.00,$974.43,$438.49,$695.45,$0.00,$163.00,$0.00,$0.00,$170.61,$974.43,$0.00,$487.21,$771.75,$779.54,$0.00,$148.06,$0.00,$155.13,$0.00
281.76,SUP,HCPCS C1713,,281.760  -  PLATE BONE 145D SHORT BARREL 110MM 25MM 6 HOLE DHS/DCP,$974.43,$0.00,$974.43,$438.49,$695.45,$0.00,$163.00,$0.00,$0.00,$170.61,$974.43,$0.00,$487.21,$771.75,$779.54,$0.00,$148.06,$0.00,$155.13,$0.00
281.82,SUP,HCPCS C1713,,281.820  -  PLATE BONE 150D 2 FLAT LP SHORT BARREL 12.6MM 46X19X5.8MM 25,$974.43,$0.00,$974.43,$438.49,$695.45,$0.00,$163.00,$0.00,$0.00,$170.61,$974.43,$0.00,$487.21,$771.75,$779.54,$0.00,$148.06,$0.00,$155.13,$0.00
281.83,SUP,HCPCS C1713,,281.830  -  PLATE BONE 150D SHORT BARREL 62MM 25MM 3 HOLE DHS/DCP,$974.43,$0.00,$974.43,$438.49,$695.45,$0.00,$163.00,$0.00,$0.00,$170.61,$974.43,$0.00,$487.21,$771.75,$779.54,$0.00,$148.06,$0.00,$155.13,$0.00
281.84,SUP,HCPCS C1713,,281.840  -  PLATE BN 150D SHRT BRL 12.6MM 78X19X5.8MM NS 25MM DHS DCP 4,$974.43,$0.00,$974.43,$438.49,$695.45,$0.00,$163.00,$0.00,$0.00,$170.61,$974.43,$0.00,$487.21,$771.75,$779.54,$0.00,$148.06,$0.00,$155.13,$0.00
281.85,SUP,HCPCS C1713,,281.850  -  PLATE BONE 150D SHORT BARREL 94MM 25MM 5 HOLE DHS/DCP,$974.43,$0.00,$974.43,$438.49,$695.45,$0.00,$163.00,$0.00,$0.00,$170.61,$974.43,$0.00,$487.21,$771.75,$779.54,$0.00,$148.06,$0.00,$155.13,$0.00
281.86,SUP,HCPCS C1713,,281.860  -  PLATE BN 150D SHRT BRL 12.6MM 110X19X5.8MM NS 25MM DHS DCP 6,$974.43,$0.00,$974.43,$438.49,$695.45,$0.00,$163.00,$0.00,$0.00,$170.61,$974.43,$0.00,$487.21,$771.75,$779.54,$0.00,$148.06,$0.00,$155.13,$0.00
281.869,SUP,HCPCS C1713,,281.869  -  PLATE BN SHRT 138MM NS SS DHS TROCH STAB,"$1,042.68",$0.00,"$1,042.68",$469.20,$744.16,$0.00,$174.41,$0.00,$0.00,$182.56,"$1,042.68",$0.00,$521.34,$825.80,$834.14,$0.00,$158.42,$0.00,$165.99,$0.00
281.87,SUP,HCPCS C1713,,281.870  -  PLATE BN LNG 148MM NS SS DHS TROCH STAB,"$1,042.68",$0.00,"$1,042.68",$469.20,$744.16,$0.00,$174.41,$0.00,$0.00,$182.56,"$1,042.68",$0.00,$521.34,$825.80,$834.14,$0.00,$158.42,$0.00,$165.99,$0.00
281.9,SUP,HCPCS C1713,,281.900  -  PLATE BN 95D SHRT BRL 12.6MM 178X16X5.4MM NS 25MM DCS DCP 10,"$1,685.48",$0.00,"$1,685.48",$758.46,"$1,202.92",$0.00,$281.94,$0.00,$0.00,$295.11,"$1,685.48",$0.00,$842.74,"$1,334.90","$1,348.38",$0.00,$256.09,$0.00,$268.33,$0.00
281.925,SUP,HCPCS C1713,,281.925  -  PLATE BN 95D SHRT BRL 210MM NS 25MM DCS 12 HL SS CNDRL 4.5MM,"$1,905.20",$0.00,"$1,905.20",$857.34,"$1,359.74",$0.00,$318.69,$0.00,$0.00,$333.59,"$1,905.20",$0.00,$952.60,"$1,508.92","$1,524.16",$0.00,$289.48,$0.00,$303.31,$0.00
281.93,SUP,HCPCS C1713,,281.930  -  PLATE BN 95D SHRT BRL 12.6MM 242X16X5.4MM NS 25MM DCS DCP 14,"$1,905.20",$0.00,"$1,905.20",$857.34,"$1,359.74",$0.00,$318.69,$0.00,$0.00,$333.59,"$1,905.20",$0.00,$952.60,"$1,508.92","$1,524.16",$0.00,$289.48,$0.00,$303.31,$0.00
281.94,SUP,HCPCS C1713,,281.940  -  PLATE BN 95D SHRT BRL 12.6MM 274X16X5.4MM NS 25MM DCS DCP 16,"$2,030.75",$0.00,"$2,030.75",$913.84,"$1,449.35",$0.00,$339.70,$0.00,$0.00,$355.57,"$2,030.75",$0.00,"$1,015.38","$1,608.35","$1,624.60",$0.00,$308.56,$0.00,$323.30,$0.00
281.95,SUP,HCPCS C1713,,281.950  -  PLATE BONE 95D 306MM 25MM 18 HOLE DCS STAINLESS STEEL,"$2,590.30",$0.00,"$2,590.30","$1,165.64","$1,848.70",$0.00,$433.30,$0.00,$0.00,$453.54,"$2,590.30",$0.00,"$1,295.15","$2,051.52","$2,072.24",$0.00,$393.57,$0.00,$412.38,$0.00
281.96,SUP,HCPCS C1713,,281.960  -  PLATE BN 95D SHRT BRL 12.6MM 114X16X5.4MM NS 25MM DCS DCP 6,"$1,685.48",$0.00,"$1,685.48",$758.46,"$1,202.92",$0.00,$281.94,$0.00,$0.00,$295.11,"$1,685.48",$0.00,$842.74,"$1,334.90","$1,348.38",$0.00,$256.09,$0.00,$268.33,$0.00
281.97,SUP,HCPCS C1713,,281.970  -  PLATE BONE 95D 338MM 25MM 20 HOLE DCS DCP STAINLESS STEEL,"$2,676.28",$0.00,"$2,676.28","$1,204.32","$1,910.06",$0.00,$447.68,$0.00,$0.00,$468.59,"$2,676.28",$0.00,"$1,338.14","$2,119.61","$2,141.02",$0.00,$406.64,$0.00,$426.06,$0.00
281.98,SUP,HCPCS C1713,,281.980  -  PLATE BN 95D SHRT BRL 12.6MM 146X16X5.4MM NS 25MM DCS DCP 8,"$1,685.48",$0.00,"$1,685.48",$758.46,"$1,202.92",$0.00,$281.94,$0.00,$0.00,$295.11,"$1,685.48",$0.00,$842.74,"$1,334.90","$1,348.38",$0.00,$256.09,$0.00,$268.33,$0.00
281.99,SUP,HCPCS C1713,,281.990  -  PLATE BONE 95D BARREL 370MM 22 HOLE DCS STAINLESS STEEL,"$2,795.00",$0.00,"$2,795.00","$1,257.75","$1,994.79",$0.00,$467.54,$0.00,$0.00,$489.38,"$2,795.00",$0.00,"$1,397.50","$2,213.64","$2,236.00",$0.00,$424.68,$0.00,$444.96,$0.00
282.235,SUP,HCPCS C1713,,282.235  -  BLADE IM NAIL 80MM LCP DHHS HIP SS CMPR PLT NONSTRL,$687.60,$0.00,$687.60,$309.42,$490.74,$0.00,$118.47,$0.00,$0.00,$120.39,$687.60,$0.00,$343.80,$544.58,$550.08,$0.00,$107.61,$0.00,$109.47,$0.00
282.236,SUP,HCPCS C1713,,282.236  -  BLADE IM NAIL 85MM LCP DHHS HIP SS CMPR PLT NONSTRL,$687.60,$0.00,$687.60,$309.42,$490.74,$0.00,$118.47,$0.00,$0.00,$120.39,$687.60,$0.00,$343.80,$544.58,$550.08,$0.00,$107.61,$0.00,$109.47,$0.00
282.24,SUP,HCPCS C1713,,282.240  -  BLADE 105MM HLX LCP DHHS SS ORTH SURG NONSTRL,$741.88,$0.00,$741.88,$333.84,$529.48,$0.00,$127.82,$0.00,$0.00,$129.90,$741.88,$0.00,$370.94,$587.57,$593.50,$0.00,$116.10,$0.00,$118.11,$0.00
282.241,SUP,HCPCS C1713,,282.241  -  BLADE FIX 110MM LCP DHHS SS HLCL STRL,$741.88,$0.00,$741.88,$333.84,$529.48,$0.00,$127.82,$0.00,$0.00,$129.90,$741.88,$0.00,$370.94,$587.57,$593.50,$0.00,$116.10,$0.00,$118.11,$0.00
282.242,SUP,HCPCS C1713,,282.242  -  BLADE FIX 115MM LCP DHHS SS HLCL STRL,$741.88,$0.00,$741.88,$333.84,$529.48,$0.00,$127.82,$0.00,$0.00,$129.90,$741.88,$0.00,$370.94,$587.57,$593.50,$0.00,$116.10,$0.00,$118.11,$0.00
282.5,SUP,HCPCS C1713,,282.50  -  PLATE 95D 92 MMX 50MM SS 5 HOLE DCP BONE SM ADLT/YTH 50MM,$934.85,$0.00,$934.85,$420.68,$667.20,$0.00,$156.38,$0.00,$0.00,$163.68,$934.85,$0.00,$467.43,$740.40,$747.88,$0.00,$142.04,$0.00,$148.83,$0.00
282.52,SUP,HCPCS C1713,,282.52  -  PLATE BONE 95D SMALL STATURE 92MM 60MM 5 HOLE DCP STAINLESS,$934.85,$0.00,$934.85,$420.68,$667.20,$0.00,$156.38,$0.00,$0.00,$163.68,$934.85,$0.00,$467.43,$740.40,$747.88,$0.00,$142.04,$0.00,$148.83,$0.00
282.54,SUP,HCPCS C1713,,282.54  -  PLATE BONE 95D SMALL STATURE 92MM 70MM 5 HOLE DCP LC-DCP,$934.85,$0.00,$934.85,$420.68,$667.20,$0.00,$156.38,$0.00,$0.00,$163.68,$934.85,$0.00,$467.43,$740.40,$747.88,$0.00,$142.04,$0.00,$148.83,$0.00
282.58,SUP,HCPCS C1713,,282.58  -  PLATE BONE 95D SMALL STATURE 40MM 92MM 5 HOLE DCP STAINLESS,$934.85,$0.00,$934.85,$420.68,$667.20,$0.00,$156.38,$0.00,$0.00,$163.68,$934.85,$0.00,$467.43,$740.40,$747.88,$0.00,$142.04,$0.00,$148.83,$0.00
282.6,SUP,HCPCS C1713,,282.600  -  SIDEPLATE BONE 130D STANDARD BARREL 54MM 38MM 2 HOLE LCP,"$1,056.33",$0.00,"$1,056.33",$475.35,$753.90,$0.00,$176.70,$0.00,$0.00,$184.95,"$1,056.33",$0.00,$528.16,$836.61,$845.06,$0.00,$160.50,$0.00,$168.17,$0.00
282.601,SUP,HCPCS C1713,,282.601  -  SIDEPLATE BONE 130D STANDARD BARREL 72MM 38MM 3 HOLE LCP,"$1,056.33",$0.00,"$1,056.33",$475.35,$753.90,$0.00,$176.70,$0.00,$0.00,$184.95,"$1,056.33",$0.00,$528.16,$836.61,$845.06,$0.00,$160.50,$0.00,$168.17,$0.00
282.602,SUP,HCPCS C1713,,282.602  -  SIDEPLATE BONE 130D STANDARD BARREL 90MM 4 HOLE LCP DHHS,"$1,056.33",$0.00,"$1,056.33",$475.35,$753.90,$0.00,$176.70,$0.00,$0.00,$184.95,"$1,056.33",$0.00,$528.16,$836.61,$845.06,$0.00,$160.50,$0.00,$168.17,$0.00
282.603,SUP,HCPCS C1713,,282.603  -  SIDEPLATE BONE 130D STANDARD BARREL 108MM 5 HOLE LCP DHHS,"$1,056.33",$0.00,"$1,056.33",$475.35,$753.90,$0.00,$176.70,$0.00,$0.00,$184.95,"$1,056.33",$0.00,$528.16,$836.61,$845.06,$0.00,$160.50,$0.00,$168.17,$0.00
282.604,SUP,HCPCS C1713,,282.604  -  SIDEPLATE BONE 130D STANDARD BARREL 126MM 38MM 6 HOLE LCP,"$1,056.33",$0.00,"$1,056.33",$475.35,$753.90,$0.00,$176.70,$0.00,$0.00,$184.95,"$1,056.33",$0.00,$528.16,$836.61,$845.06,$0.00,$160.50,$0.00,$168.17,$0.00
282.61,SUP,HCPCS C1713,,282.610  -  SIDEPLATE BONE 135D STANDARD BARREL 54MM 38MM 2 HOLE LCP,"$1,056.33",$0.00,"$1,056.33",$475.35,$753.90,$0.00,$176.70,$0.00,$0.00,$184.95,"$1,056.33",$0.00,$528.16,$836.61,$845.06,$0.00,$160.50,$0.00,$168.17,$0.00
282.611,SUP,HCPCS C1713,,282.611  -  SIDEPLATE BONE 135D STANDARD BARREL 72MM 38MM 3 HOLE LCP,"$1,056.33",$0.00,"$1,056.33",$475.35,$753.90,$0.00,$176.70,$0.00,$0.00,$184.95,"$1,056.33",$0.00,$528.16,$836.61,$845.06,$0.00,$160.50,$0.00,$168.17,$0.00
282.612,SUP,HCPCS C1713,,282.612  -  SIDEPLATE BONE 135D STANDARD BARREL 90MM 38MM 4 HOLE LCP,"$1,056.33",$0.00,"$1,056.33",$475.35,$753.90,$0.00,$176.70,$0.00,$0.00,$184.95,"$1,056.33",$0.00,$528.16,$836.61,$845.06,$0.00,$160.50,$0.00,$168.17,$0.00
282.613,SUP,HCPCS C1713,,282.613  -  SIDEPLATE BONE 135D STANDARD BARREL 108MM 38MM 5 HOLE LCP,"$1,056.33",$0.00,"$1,056.33",$475.35,$753.90,$0.00,$176.70,$0.00,$0.00,$184.95,"$1,056.33",$0.00,$528.16,$836.61,$845.06,$0.00,$160.50,$0.00,$168.17,$0.00
282.614,SUP,HCPCS C1713,,282.614  -  SIDEPLATE BONE 135D STANDARD BARREL 126MM 38MM 6 HOLE LCP,"$1,056.33",$0.00,"$1,056.33",$475.35,$753.90,$0.00,$176.70,$0.00,$0.00,$184.95,"$1,056.33",$0.00,$528.16,$836.61,$845.06,$0.00,$160.50,$0.00,$168.17,$0.00
282.63,SUP,HCPCS C1713,,282.630  -  SIDEPLATE BONE 140D STANDARD BARREL LP 54MM 38MM 2 HOLE LCP,"$1,056.33",$0.00,"$1,056.33",$475.35,$753.90,$0.00,$176.70,$0.00,$0.00,$184.95,"$1,056.33",$0.00,$528.16,$836.61,$845.06,$0.00,$160.50,$0.00,$168.17,$0.00
282.631,SUP,HCPCS C1713,,282.631  -  SIDEPLATE BONE 140D STANDARD BARREL 72MM 38MM 3 HOLE,"$1,056.33",$0.00,"$1,056.33",$475.35,$753.90,$0.00,$176.70,$0.00,$0.00,$184.95,"$1,056.33",$0.00,$528.16,$836.61,$845.06,$0.00,$160.50,$0.00,$168.17,$0.00
282.632,SUP,HCPCS C1713,,282.632  -  SIDEPLATE BONE 140D STANDARD BARREL 90MM 38MM 4 HOLE,"$1,056.33",$0.00,"$1,056.33",$475.35,$753.90,$0.00,$176.70,$0.00,$0.00,$184.95,"$1,056.33",$0.00,$528.16,$836.61,$845.06,$0.00,$160.50,$0.00,$168.17,$0.00
282.633,SUP,HCPCS C1713,,282.633  -  SIDEPLATE BONE 140D STANDARD BARREL 108MM 38MM 5 HOLE,"$1,056.33",$0.00,"$1,056.33",$475.35,$753.90,$0.00,$176.70,$0.00,$0.00,$184.95,"$1,056.33",$0.00,$528.16,$836.61,$845.06,$0.00,$160.50,$0.00,$168.17,$0.00
282.634,SUP,HCPCS C1713,,282.634  -  SIDEPLATE BONE 140D STANDARD BARREL 126MM 38MM 6 HOLE,"$1,056.33",$0.00,"$1,056.33",$475.35,$753.90,$0.00,$176.70,$0.00,$0.00,$184.95,"$1,056.33",$0.00,$528.16,$836.61,$845.06,$0.00,$160.50,$0.00,$168.17,$0.00
282.64,SUP,HCPCS C1713,,282.640  -  SIDEPLATE BONE 145D STANDARD BARREL LP 54MM 38MM 2 HOLE LCP,"$1,056.33",$0.00,"$1,056.33",$475.35,$753.90,$0.00,$176.70,$0.00,$0.00,$184.95,"$1,056.33",$0.00,$528.16,$836.61,$845.06,$0.00,$160.50,$0.00,$168.17,$0.00
282.641,SUP,HCPCS C1713,,282.641  -  SIDEPLATE BONE 145D STANDARD BARREL 72MM 38MM 3 HOLE,"$1,056.33",$0.00,"$1,056.33",$475.35,$753.90,$0.00,$176.70,$0.00,$0.00,$184.95,"$1,056.33",$0.00,$528.16,$836.61,$845.06,$0.00,$160.50,$0.00,$168.17,$0.00
282.642,SUP,HCPCS C1713,,282.642  -  SIDEPLATE BONE 145D STANDARD BARREL 90MM 38MM 4 HOLE,"$1,056.33",$0.00,"$1,056.33",$475.35,$753.90,$0.00,$176.70,$0.00,$0.00,$184.95,"$1,056.33",$0.00,$528.16,$836.61,$845.06,$0.00,$160.50,$0.00,$168.17,$0.00
282.643,SUP,HCPCS C1713,,282.643  -  SIDEPLATE BONE 145D STANDARD BARREL 108MM 38MM 5 HOLE,"$1,056.33",$0.00,"$1,056.33",$475.35,$753.90,$0.00,$176.70,$0.00,$0.00,$184.95,"$1,056.33",$0.00,$528.16,$836.61,$845.06,$0.00,$160.50,$0.00,$168.17,$0.00
282.644,SUP,HCPCS C1713,,282.644  -  SIDEPLATE BONE 145D STANDARD BARREL 126MM 38MM 6 HOLE,"$1,056.33",$0.00,"$1,056.33",$475.35,$753.90,$0.00,$176.70,$0.00,$0.00,$184.95,"$1,056.33",$0.00,$528.16,$836.61,$845.06,$0.00,$160.50,$0.00,$168.17,$0.00
282.65,SUP,HCPCS C1713,,282.650  -  SIDEPLATE BONE 150D STANDARD BARREL LP 54MM 38MM 2 HOLE LCP,"$1,056.33",$0.00,"$1,056.33",$475.35,$753.90,$0.00,$176.70,$0.00,$0.00,$184.95,"$1,056.33",$0.00,$528.16,$836.61,$845.06,$0.00,$160.50,$0.00,$168.17,$0.00
282.651,SUP,HCPCS C1713,,282.651  -  SIDEPLATE BONE 150D STANDARD BARREL 72MM 38MM 3 HOLE LCP,"$1,056.33",$0.00,"$1,056.33",$475.35,$753.90,$0.00,$176.70,$0.00,$0.00,$184.95,"$1,056.33",$0.00,$528.16,$836.61,$845.06,$0.00,$160.50,$0.00,$168.17,$0.00
282.652,SUP,HCPCS C1713,,282.652  -  SIDEPLATE BONE 150D STANDARD BARREL 90MM 38MM 4 HOLE LCP,"$1,056.33",$0.00,"$1,056.33",$475.35,$753.90,$0.00,$176.70,$0.00,$0.00,$184.95,"$1,056.33",$0.00,$528.16,$836.61,$845.06,$0.00,$160.50,$0.00,$168.17,$0.00
282.653,SUP,HCPCS C1713,,282.653  -  SIDEPLATE BONE 150D STANDARD BARREL 108MM 38MM 5 HOLE LCP,"$1,056.33",$0.00,"$1,056.33",$475.35,$753.90,$0.00,$176.70,$0.00,$0.00,$184.95,"$1,056.33",$0.00,$528.16,$836.61,$845.06,$0.00,$160.50,$0.00,$168.17,$0.00
282.654,SUP,HCPCS C1713,,282.654  -  SIDEPLATE BONE 150D STANDARD BARREL 126MM 38MM 6 HOLE LCP,"$1,056.33",$0.00,"$1,056.33",$475.35,$753.90,$0.00,$176.70,$0.00,$0.00,$184.95,"$1,056.33",$0.00,$528.16,$836.61,$845.06,$0.00,$160.50,$0.00,$168.17,$0.00
282.67,SUP,HCPCS C1713,,282.670  -  SIDEPLATE BONE 130D SHORT BARREL LP 54MM 25MM 2 HOLE LCP,"$1,056.33",$0.00,"$1,056.33",$475.35,$753.90,$0.00,$176.70,$0.00,$0.00,$184.95,"$1,056.33",$0.00,$528.16,$836.61,$845.06,$0.00,$160.50,$0.00,$168.17,$0.00
282.672,SUP,HCPCS C1713,,282.672  -  SIDEPLATE BONE 130D SHORT BARREL 90MM 25MM 4 HOLE LCP DHHS,"$1,056.33",$0.00,"$1,056.33",$475.35,$753.90,$0.00,$176.70,$0.00,$0.00,$184.95,"$1,056.33",$0.00,$528.16,$836.61,$845.06,$0.00,$160.50,$0.00,$168.17,$0.00
282.676,SUP,HCPCS C1713,,282.676  -  SIDEPLATE BONE 135D SHORT BARREL 54MM 25MM 2 HOLE LCP DHHS,"$1,056.33",$0.00,"$1,056.33",$475.35,$753.90,$0.00,$176.70,$0.00,$0.00,$184.95,"$1,056.33",$0.00,$528.16,$836.61,$845.06,$0.00,$160.50,$0.00,$168.17,$0.00
282.678,SUP,HCPCS C1713,,282.678  -  SIDEPLATE BONE 135D SHORT BARREL 90MM 25MM 4 HOLE LCP DHHS,"$1,056.33",$0.00,"$1,056.33",$475.35,$753.90,$0.00,$176.70,$0.00,$0.00,$184.95,"$1,056.33",$0.00,$528.16,$836.61,$845.06,$0.00,$160.50,$0.00,$168.17,$0.00
282.683,SUP,HCPCS C1713,,282.683  -  SIDEPLATE BONE 140D SHORT BARREL 90MM 25MM 4 HOLE LCP DHHS,"$1,056.33",$0.00,"$1,056.33",$475.35,$753.90,$0.00,$176.70,$0.00,$0.00,$184.95,"$1,056.33",$0.00,$528.16,$836.61,$845.06,$0.00,$160.50,$0.00,$168.17,$0.00
282.688,SUP,HCPCS C1713,,282.688  -  SIDEPLATE BONE 145D SHORT BARREL 90MM 25MM 4 HOLE LCP DHHS,"$1,056.33",$0.00,"$1,056.33",$475.35,$753.90,$0.00,$176.70,$0.00,$0.00,$184.95,"$1,056.33",$0.00,$528.16,$836.61,$845.06,$0.00,$160.50,$0.00,$168.17,$0.00
282.691,SUP,HCPCS C1713,,282.691  -  SIDEPLATE BONE 150D SHORT BARREL 54MM 25MM 2 HOLE LCP DHHS,"$1,056.33",$0.00,"$1,056.33",$475.35,$753.90,$0.00,$176.70,$0.00,$0.00,$184.95,"$1,056.33",$0.00,$528.16,$836.61,$845.06,$0.00,$160.50,$0.00,$168.17,$0.00
282.693,SUP,HCPCS C1713,,282.693  -  SIDEPLATE BONE 150D SHORT BARREL 90MM 25MM 4 HOLE LCP DHHS,"$1,056.33",$0.00,"$1,056.33",$475.35,$753.90,$0.00,$176.70,$0.00,$0.00,$184.95,"$1,056.33",$0.00,$528.16,$836.61,$845.06,$0.00,$160.50,$0.00,$168.17,$0.00
282.7,SUP,HCPCS C1713,,282.70  -  PLATE BONE 95D SMALL STATURE T PROFILE 124MM 50MM 7 HOLE DCP,$978.53,$0.00,$978.53,$440.34,$698.37,$0.00,$163.68,$0.00,$0.00,$171.33,$978.53,$0.00,$489.26,$775.00,$782.82,$0.00,$148.68,$0.00,$155.78,$0.00
282.72,SUP,HCPCS C1713,,282.72  -  PLATE BONE 95D SMALL STATURE 124MM 60MM 7 HOLE ANGLED DCP,$978.53,$0.00,$978.53,$440.34,$698.37,$0.00,$163.68,$0.00,$0.00,$171.33,$978.53,$0.00,$489.26,$775.00,$782.82,$0.00,$148.68,$0.00,$155.78,$0.00
282.74,SUP,HCPCS C1713,,282.74  -  PLATE BONE 95D SMALL STATURE 124MM 70MM 7 HOLE CNDYLR DCP,$978.53,$0.00,$978.53,$440.34,$698.37,$0.00,$163.68,$0.00,$0.00,$171.33,$978.53,$0.00,$489.26,$775.00,$782.82,$0.00,$148.68,$0.00,$155.78,$0.00
282.78,SUP,HCPCS C1713,,282.78  -  PLATE BONE 95D SMALL STATURE 124MM 40MM 7 HOLE DCP CAPOS,$978.53,$0.00,$978.53,$440.34,$698.37,$0.00,$163.68,$0.00,$0.00,$171.33,$978.53,$0.00,$489.26,$775.00,$782.82,$0.00,$148.68,$0.00,$155.78,$0.00
282.8,SUP,Custom 27803010,,282.80  -  STAPLE BONE 23X20X3MM STAINLESS STEEL NONSTRL,$251.75,$0.00,$251.75,$0.00,$179.67,$0.00,$0.00,$0.00,$0.00,$0.00,$251.75,$0.00,$125.88,$199.39,$201.40,$0.00,$0.00,$0.00,$0.00,$0.00
282.82,SUP,Custom 27803010,,282.82  -  STAPLE BONE 24MM STAINLESS STEEL ORTHOPEDIC NONSTRL,$251.75,$0.00,$251.75,$0.00,$179.67,$0.00,$0.00,$0.00,$0.00,$0.00,$251.75,$0.00,$125.88,$199.39,$201.40,$0.00,$0.00,$0.00,$0.00,$0.00
282.9,SUP,HCPCS C1713,,282.90  -  PLATE BONE 95D SMALL STATURE T PROFILE 156MM 50MM 9 HOLE DCP,"$1,046.78",$0.00,"$1,046.78",$471.05,$747.08,$0.00,$175.10,$0.00,$0.00,$183.28,"$1,046.78",$0.00,$523.39,$829.05,$837.42,$0.00,$159.05,$0.00,$166.65,$0.00
282.92,SUP,HCPCS C1713,,282.92  -  PLATE BONE 95D SMALL STATURE 156MM 60MM 9 HOLE ANGLED BLADE,"$1,046.78",$0.00,"$1,046.78",$471.05,$747.08,$0.00,$175.10,$0.00,$0.00,$183.28,"$1,046.78",$0.00,$523.39,$829.05,$837.42,$0.00,$159.05,$0.00,$166.65,$0.00
282.94,SUP,HCPCS C1713,,282.94  -  PLATE BONE 95D SMALL STATURE 156MM 70MM 9 HOLE DCP STAINLESS,"$1,046.78",$0.00,"$1,046.78",$471.05,$747.08,$0.00,$175.10,$0.00,$0.00,$183.28,"$1,046.78",$0.00,$523.39,$829.05,$837.42,$0.00,$159.05,$0.00,$166.65,$0.00
282.98,SUP,HCPCS C1713,,282.98  -  PLATE BONE 95D SMALL STATURE 156X40MM 40MM 9 HOLE CNDYLR DCP,"$1,046.78",$0.00,"$1,046.78",$471.05,$747.08,$0.00,$175.10,$0.00,$0.00,$183.28,"$1,046.78",$0.00,$523.39,$829.05,$837.42,$0.00,$159.05,$0.00,$166.65,$0.00
283.4,SUP,HCPCS C1713,,283.40  -  PLATE BONE 130D SMALL STATURE 50MM 60MM 4 HOLE ANGLED BLADE,$937.58,$0.00,$937.58,$421.91,$669.15,$0.00,$156.84,$0.00,$0.00,$164.16,$937.58,$0.00,$468.79,$742.56,$750.06,$0.00,$142.46,$0.00,$149.26,$0.00
283.42,SUP,HCPCS C1713,,283.42  -  PLATE BONE 130D SMALL STATURE 60MM 4 HOLE ANGLED BLADE DCP,$937.58,$0.00,$937.58,$421.91,$669.15,$0.00,$156.84,$0.00,$0.00,$164.16,$937.58,$0.00,$468.79,$742.56,$750.06,$0.00,$142.46,$0.00,$149.26,$0.00
283.44,SUP,HCPCS C1713,,283.44  -  PLATE BONE 130D SMALL STATURE 70MM 60MM ANGLED BLADE DCP,$937.58,$0.00,$937.58,$421.91,$669.15,$0.00,$156.84,$0.00,$0.00,$164.16,$937.58,$0.00,$468.79,$742.56,$750.06,$0.00,$142.46,$0.00,$149.26,$0.00
283.46,SUP,HCPCS C1713,,283.46  -  PLATE BONE 130D SMALL STATURE 80MM 60MM 4 HOLE ANGLED BLADE,$937.58,$0.00,$937.58,$421.91,$669.15,$0.00,$156.84,$0.00,$0.00,$164.16,$937.58,$0.00,$468.79,$742.56,$750.06,$0.00,$142.46,$0.00,$149.26,$0.00
283.6,SUP,HCPCS C1713,,283.60  -  PLATE BONE 130D 104MM 50MM 6 HOLE ANGLED BLADE DCP STAINLESS,$993.55,$0.00,$993.55,$447.10,$709.10,$0.00,$166.20,$0.00,$0.00,$173.96,$993.55,$0.00,$496.78,$786.89,$794.84,$0.00,$150.96,$0.00,$158.17,$0.00
283.62,SUP,HCPCS C1713,,283.62  -  PLATE BONE 130D 104MM 60MM 6 HOLE ANGLED BLADE DCP STAINLESS,$993.55,$0.00,$993.55,$447.10,$709.10,$0.00,$166.20,$0.00,$0.00,$173.96,$993.55,$0.00,$496.78,$786.89,$794.84,$0.00,$150.96,$0.00,$158.17,$0.00
283.64,SUP,HCPCS C1713,,283.64  -  PLATE BLADE 130D 104MM 70MM 6 HOLE ANGLED DCP STAINLESS,$993.55,$0.00,$993.55,$447.10,$709.10,$0.00,$166.20,$0.00,$0.00,$173.96,$993.55,$0.00,$496.78,$786.89,$794.84,$0.00,$150.96,$0.00,$158.17,$0.00
283.66,SUP,HCPCS C1713,,283.66  -  SCREW BONE 130D 104MM 80MM 6 HOLE ANGLED BLADE DCP STAINLESS,$993.55,$0.00,$993.55,$447.10,$709.10,$0.00,$166.20,$0.00,$0.00,$173.96,$993.55,$0.00,$496.78,$786.89,$794.84,$0.00,$150.96,$0.00,$158.17,$0.00
283.9,SUP,HCPCS C1713,,283.90  -  PLATE BONE 130D SMALL STATURE 152MM 50MM 9 HOLE DCP CAPOS,"$1,072.70",$0.00,"$1,072.70",$482.72,$765.59,$0.00,$179.44,$0.00,$0.00,$187.82,"$1,072.70",$0.00,$536.35,$849.58,$858.16,$0.00,$162.99,$0.00,$170.77,$0.00
283.92,SUP,HCPCS C1713,,283.92  -  PLATE BONE 130D 4.5MM 152MM 60MM 9 HOLE BLADE ANGLED DCP,"$1,072.70",$0.00,"$1,072.70",$482.72,$765.59,$0.00,$179.44,$0.00,$0.00,$187.82,"$1,072.70",$0.00,$536.35,$849.58,$858.16,$0.00,$162.99,$0.00,$170.77,$0.00
283.94,SUP,HCPCS C1713,,283.94  -  PLATE BONE 130D 152MM 70MM 9 HOLE BLADE DCP STAINLESS STEEL,"$1,072.70",$0.00,"$1,072.70",$482.72,$765.59,$0.00,$179.44,$0.00,$0.00,$187.82,"$1,072.70",$0.00,$536.35,$849.58,$858.16,$0.00,$162.99,$0.00,$170.77,$0.00
283.96,SUP,HCPCS C1713,,283.96  -  PLATE BONE 130D 80MM 152MM 80MM 9 HOLE ANGLED BLADE DCP,"$1,072.70",$0.00,"$1,072.70",$482.72,$765.59,$0.00,$179.44,$0.00,$0.00,$187.82,"$1,072.70",$0.00,$536.35,$849.58,$858.16,$0.00,$162.99,$0.00,$170.77,$0.00
288.025,SUP,Custom 27803010,,288.025  -  DISTRACTOR SURG 10MM BODY STAINLESS STEEL NONSTRL,"$11,697.50",$0.00,"$11,697.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,697.50",$0.00,"$5,848.75","$9,264.42","$9,358.00",$0.00,$0.00,$0.00,$0.00,$0.00
288.026,SUP,Custom 27803010,,288.026  -  DISTRACTOR SURG 15MM BODY STAINLESS STEEL NONSTRL,"$11,697.50",$0.00,"$11,697.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,697.50",$0.00,"$5,848.75","$9,264.42","$9,358.00",$0.00,$0.00,$0.00,$0.00,$0.00
288.027,SUP,Custom 27803010,,288.027  -  DISTRACTOR SURG 20MM BODY STAINLESS STEEL NONSTRL,"$11,697.50",$0.00,"$11,697.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,697.50",$0.00,"$5,848.75","$9,264.42","$9,358.00",$0.00,$0.00,$0.00,$0.00,$0.00
288.028,SUP,Custom 27803010,,288.028  -  DISTRACTOR SURG 25MM BODY STAINLESS STEEL NONSTRL,"$11,697.50",$0.00,"$11,697.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,697.50",$0.00,"$5,848.75","$9,264.42","$9,358.00",$0.00,$0.00,$0.00,$0.00,$0.00
288.038,SUP,Custom 27803010,,288.038  -  FOOTPLATE BONE 6MM SPLINT STAINLESS STEEL RIGHT ANTERIOR,"$1,485.00",$0.00,"$1,485.00",$0.00,"$1,059.84",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,485.00",$0.00,$742.50,"$1,176.12","$1,188.00",$0.00,$0.00,$0.00,$0.00,$0.00
288.039,SUP,Custom 27803010,,288.039  -  FOOTPLATE BONE 10MM SPLINT STAINLESS STEEL RIGHT ANTERIOR,"$1,485.00",$0.00,"$1,485.00",$0.00,"$1,059.84",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,485.00",$0.00,$742.50,"$1,176.12","$1,188.00",$0.00,$0.00,$0.00,$0.00,$0.00
288.04,SUP,Custom 27803010,,288.040  -  FOOTPLATE BONE 14MM SPLINT STAINLESS STEEL RIGHT ANTERIOR,"$1,485.00",$0.00,"$1,485.00",$0.00,"$1,059.84",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,485.00",$0.00,$742.50,"$1,176.12","$1,188.00",$0.00,$0.00,$0.00,$0.00,$0.00
288.042,SUP,Custom 27803010,,288.042  -  FOOTPLATE BONE 6MM SPLINT STAINLESS STEEL LEFT ANTERIOR MAXL,"$1,485.00",$0.00,"$1,485.00",$0.00,"$1,059.84",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,485.00",$0.00,$742.50,"$1,176.12","$1,188.00",$0.00,$0.00,$0.00,$0.00,$0.00
288.043,SUP,Custom 27803010,,288.043  -  FOOTPLATE BONE 10MM SPLINT STAINLESS STEEL LEFT ANTERIOR,"$1,485.00",$0.00,"$1,485.00",$0.00,"$1,059.84",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,485.00",$0.00,$742.50,"$1,176.12","$1,188.00",$0.00,$0.00,$0.00,$0.00,$0.00
288.044,SUP,Custom 27803010,,288.044  -  FOOTPLATE BONE 14MM SPLINT STAINLESS STEEL LEFT ANTERIOR,"$1,485.00",$0.00,"$1,485.00",$0.00,"$1,059.84",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,485.00",$0.00,$742.50,"$1,176.12","$1,188.00",$0.00,$0.00,$0.00,$0.00,$0.00
288.052,SUP,Custom 27803010,,288.052  -  FOOTPLATE BONE SHORT 7MM OFFST STAINLESS STEEL POSTERIOR,"$2,952.50",$0.00,"$2,952.50",$0.00,"$2,107.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,952.50",$0.00,"$1,476.25","$2,338.38","$2,362.00",$0.00,$0.00,$0.00,$0.00,$0.00
288.053,SUP,Custom 27803010,,288.053  -  FOOTPLATE BONE SHORT 12MM OFFST STAINLESS STEEL POSTERIOR,"$2,952.50",$0.00,"$2,952.50",$0.00,"$2,107.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,952.50",$0.00,"$1,476.25","$2,338.38","$2,362.00",$0.00,$0.00,$0.00,$0.00,$0.00
288.055,SUP,Custom 27803010,,288.055  -  FOOTPLATE BONE MEDIUM 7MM OFFST STAINLESS STEEL POSTERIOR,"$2,952.50",$0.00,"$2,952.50",$0.00,"$2,107.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,952.50",$0.00,"$1,476.25","$2,338.38","$2,362.00",$0.00,$0.00,$0.00,$0.00,$0.00
288.056,SUP,Custom 27803010,,288.056  -  FOOTPLATE BONE MEDIUM 12MM OFFST STAINLESS STEEL POSTERIOR,"$2,952.50",$0.00,"$2,952.50",$0.00,"$2,107.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,952.50",$0.00,"$1,476.25","$2,338.38","$2,362.00",$0.00,$0.00,$0.00,$0.00,$0.00
288.058,SUP,Custom 27803010,,288.058  -  FOOTPLATE BONE TALL 7MM OFFST STAINLESS STEEL POSTERIOR MAXL,"$2,952.50",$0.00,"$2,952.50",$0.00,"$2,107.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,952.50",$0.00,"$1,476.25","$2,338.38","$2,362.00",$0.00,$0.00,$0.00,$0.00,$0.00
288.059,SUP,Custom 27803010,,288.059  -  FOOTPLATE BONE TALL 12MM OFFST STAINLESS STEEL POSTERIOR,"$2,952.50",$0.00,"$2,952.50",$0.00,"$2,107.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,952.50",$0.00,"$1,476.25","$2,338.38","$2,362.00",$0.00,$0.00,$0.00,$0.00,$0.00
288.065,SUP,HCPCS C1713,,288.065  -  SCREW EXTERNAL DISTRCT 3.5MM STAINLESS STEEL NONSTRL,$302.50,$0.00,$302.50,$136.13,$215.89,$0.00,$52.12,$0.00,$0.00,$52.97,$302.50,$0.00,$151.25,$239.58,$242.00,$0.00,$47.34,$0.00,$48.16,$0.00
291.01,SUP,Custom 27803010,,291.01  -  WIRE CERCLAGE 1MM 280MM EYE KWIRE STAINLESS STEEL NONSTRL,$14.74,$0.00,$14.74,$0.00,$10.52,$0.00,$0.00,$0.00,$0.00,$0.00,$14.74,$0.00,$7.37,$11.67,$11.79,$0.00,$0.00,$0.00,$0.00,$0.00
291.02,SUP,Custom 27203010,,291.02  -  WIRE CERCLAGE 1.25MM 280MM EYE STAINLESS STEEL NONSTRL,$14.74,$0.00,$14.74,$0.00,$10.52,$0.00,$0.00,$0.00,$0.00,$0.00,$14.74,$0.00,$7.37,$11.67,$11.79,$0.00,$0.00,$0.00,$0.00,$0.00
291.03,SUP,Custom 27803010,,291.03  -  WIRE CERCLAGE 1MM 600MM EYE STAINLESS STEEL NONSTRL,$22.25,$0.00,$22.25,$0.00,$15.88,$0.00,$0.00,$0.00,$0.00,$0.00,$22.25,$0.00,$11.12,$17.62,$17.80,$0.00,$0.00,$0.00,$0.00,$0.00
291.04,SUP,Custom 27203010,,291.04  -  WIRE FIX 1.25MM 600MM CERCLAGE EYE STAINLESS STEEL,$22.25,$0.00,$22.25,$0.00,$15.88,$0.00,$0.00,$0.00,$0.00,$0.00,$22.25,$0.00,$11.12,$17.62,$17.80,$0.00,$0.00,$0.00,$0.00,$0.00
291.05,SUP,Custom 27203010,,291.05  -  WIRE CERCLAGE 1MM 10MR COIL STAINLESS STEEL NONSTRL,$124.85,$0.00,$124.85,$0.00,$89.11,$0.00,$0.00,$0.00,$0.00,$0.00,$124.85,$0.00,$62.43,$98.88,$99.88,$0.00,$0.00,$0.00,$0.00,$0.00
291.06,SUP,Custom 27803010,,291.06  -  WIRE CERCLAGE 1.25MM 1MM COIL STAINLESS STEEL NONSTRL,$124.85,$0.00,$124.85,$0.00,$89.11,$0.00,$0.00,$0.00,$0.00,$0.00,$124.85,$0.00,$62.43,$98.88,$99.88,$0.00,$0.00,$0.00,$0.00,$0.00
291.08,SUP,Custom 27803010,,291.08  -  WIRE CERCLAGE .8MM 280MM EYE STAINLESS STEEL NONSTRL,$10.30,$0.00,$10.30,$0.00,$7.35,$0.00,$0.00,$0.00,$0.00,$0.00,$10.30,$0.00,$5.15,$8.16,$8.24,$0.00,$0.00,$0.00,$0.00,$0.00
291.09,SUP,Custom 27203010,,291.09  -  WIRE CERCLAGE .8MM 10MR COIL STAINLESS STEEL NONSTRL,$124.85,$0.00,$124.85,$0.00,$89.11,$0.00,$0.00,$0.00,$0.00,$0.00,$124.85,$0.00,$62.43,$98.88,$99.88,$0.00,$0.00,$0.00,$0.00,$0.00
291.11,SUP,Custom 27803010,,291.11  -  WIRE CERCLAGE 1.5MM 280MM EYE STAINLESS STEEL ORTHOPEDIC,$14.74,$0.00,$14.74,$0.00,$10.52,$0.00,$0.00,$0.00,$0.00,$0.00,$14.74,$0.00,$7.37,$11.67,$11.79,$0.00,$0.00,$0.00,$0.00,$0.00
291.12,SUP,Custom 27203010,,291.12  -  WIRE CERCLAGE 1.5MM 600MM EYE STAINLESS STEEL NONSTRL,$22.25,$0.00,$22.25,$0.00,$15.88,$0.00,$0.00,$0.00,$0.00,$0.00,$22.25,$0.00,$11.12,$17.62,$17.80,$0.00,$0.00,$0.00,$0.00,$0.00
291.13,SUP,Custom 27203010,,291.13  -  WIRE CERCLAGE 1.5MM 10MM COIL STAINLESS STEEL NONSTRL,$124.85,$0.00,$124.85,$0.00,$89.11,$0.00,$0.00,$0.00,$0.00,$0.00,$124.85,$0.00,$62.43,$98.88,$99.88,$0.00,$0.00,$0.00,$0.00,$0.00
291.22,SUP,Custom 27203010,,291.22  -  WIRE FX .4MM 150MM NS CRLGE SFT PCUT SS,$13.92,$0.00,$13.92,$0.00,$9.93,$0.00,$0.00,$0.00,$0.00,$0.00,$13.92,$0.00,$6.96,$11.02,$11.14,$0.00,$0.00,$0.00,$0.00,$0.00
291.24,SUP,Custom 27203010,,291.24  -  WIRE CERCLAGE .6MM 175MM SOFT PRECUT STAINLESS STEEL NONSTRL,$14.74,$0.00,$14.74,$0.00,$10.52,$0.00,$0.00,$0.00,$0.00,$0.00,$14.74,$0.00,$7.37,$11.67,$11.79,$0.00,$0.00,$0.00,$0.00,$0.00
291.26,SUP,Custom 27203010,,291.26  -  WIRE CERCLAGE .8MM 200MM SOFT PRECUT STAINLESS STEEL NONSTRL,$16.79,$0.00,$16.79,$0.00,$11.98,$0.00,$0.00,$0.00,$0.00,$0.00,$16.79,$0.00,$8.39,$13.30,$13.43,$0.00,$0.00,$0.00,$0.00,$0.00
291.27,SUP,Custom 27203010,,291.27  -  WIRE CRLGE 1MM 250MM NS PCUT SFT SS,$18.29,$0.00,$18.29,$0.00,$13.05,$0.00,$0.00,$0.00,$0.00,$0.00,$18.29,$0.00,$9.14,$14.49,$14.63,$0.00,$0.00,$0.00,$0.00,$0.00
291.28,SUP,Custom 27203010,,291.28  -  WIRE CRLGE 1.25MM 300MM NS PCUT SFT SS,$20.88,$0.00,$20.88,$0.00,$14.90,$0.00,$0.00,$0.00,$0.00,$0.00,$20.88,$0.00,$10.44,$16.54,$16.70,$0.00,$0.00,$0.00,$0.00,$0.00
292.02,SUP,HCPCS C1713,,292.020  -  GWIRE ORTH 200MM 1.25MM,$24.68,$0.00,$24.68,$11.10,$17.61,$0.00,$4.25,$0.00,$0.00,$4.32,$24.68,$0.00,$12.34,$19.55,$19.74,$0.00,$3.86,$0.00,$3.93,$0.00
292.06,SUP,Custom 27203010,,292.06  -  WIRE FIX .6MM 70MM TROCAR POINT KWIRE STAINLESS STEEL,$13.92,$0.00,$13.92,$0.00,$9.93,$0.00,$0.00,$0.00,$0.00,$0.00,$13.92,$0.00,$6.96,$11.02,$11.14,$0.00,$0.00,$0.00,$0.00,$0.00
292.08,SUP,Custom 27203010,,292.08  -  WIRE FIX .8MM 70MM TROCAR POINT KWIRE STAINLESS STEEL,$13.92,$0.00,$13.92,$0.00,$9.93,$0.00,$0.00,$0.00,$0.00,$0.00,$13.92,$0.00,$6.96,$11.02,$11.14,$0.00,$0.00,$0.00,$0.00,$0.00
292.1,SUP,Custom 27203010,,292.10  -  WIRE FIX 1MM 150MM TROCAR POINT KWIRE STAINLESS STEEL,$15.64,$0.00,$15.64,$0.00,$11.16,$0.00,$0.00,$0.00,$0.00,$0.00,$15.64,$0.00,$7.82,$12.39,$12.51,$0.00,$0.00,$0.00,$0.00,$0.00
292.11,SUP,Custom 27203010,,292.11  -  WIRE FIX 1MM 285MM TROCAR POINT KWIRE STAINLESS STEEL,$20.06,$0.00,$20.06,$0.00,$14.32,$0.00,$0.00,$0.00,$0.00,$0.00,$20.06,$0.00,$10.03,$15.89,$16.05,$0.00,$0.00,$0.00,$0.00,$0.00
292.13,SUP,Custom 27203010,,292.13  -  WIRE FX 1.25MM 285MM NS KRSH TROC PNT SS,$20.06,$0.00,$20.06,$0.00,$14.32,$0.00,$0.00,$0.00,$0.00,$0.00,$20.06,$0.00,$10.03,$15.89,$16.05,$0.00,$0.00,$0.00,$0.00,$0.00
292.18,SUP,Custom 27203010,,292.18  -  WIRE FIX 1.6MM 285MM 5MM THREADED TROCAR POINT KWIRE,$20.06,$0.00,$20.06,$0.00,$14.32,$0.00,$0.00,$0.00,$0.00,$0.00,$20.06,$0.00,$10.03,$15.89,$16.05,$0.00,$0.00,$0.00,$0.00,$0.00
292.21,SUP,Custom 27203010,,292.21  -  WIRE FIX 2MM 285MM TROCAR POINT KWIRE STAINLESS STEEL,$23.30,$0.00,$23.30,$0.00,$16.63,$0.00,$0.00,$0.00,$0.00,$0.00,$23.30,$0.00,$11.65,$18.45,$18.64,$0.00,$0.00,$0.00,$0.00,$0.00
292.25,SUP,Custom 27203010,,292.25  -  WIRE FIX 2.5MM 150MM TROCAR POINT KWIRE STAINLESS STEEL,$16.11,$0.00,$16.11,$0.00,$11.49,$0.00,$0.00,$0.00,$0.00,$0.00,$16.11,$0.00,$8.05,$12.76,$12.88,$0.00,$0.00,$0.00,$0.00,$0.00
292.26,SUP,Custom 27203010,,292.26  -  WIRE FIX 2.5MM 285MM TROCAR KWIRE STAINLESS STEEL NONSTRL,$20.06,$0.00,$20.06,$0.00,$14.32,$0.00,$0.00,$0.00,$0.00,$0.00,$20.06,$0.00,$10.03,$15.89,$16.05,$0.00,$0.00,$0.00,$0.00,$0.00
292.3,SUP,Custom 27203010,,292.30  -  WIRE FIX TROCAR 3MM 150MM KWIRE STAINLESS STEEL NONSTRL,$16.11,$0.00,$16.11,$0.00,$11.49,$0.00,$0.00,$0.00,$0.00,$0.00,$16.11,$0.00,$8.05,$12.76,$12.88,$0.00,$0.00,$0.00,$0.00,$0.00
292.31,SUP,Custom 27203010,,292.31  -  WIRE FIX 3MM 285MM TROCAR POINT KWIRE STAINLESS STEEL,$20.06,$0.00,$20.06,$0.00,$14.32,$0.00,$0.00,$0.00,$0.00,$0.00,$20.06,$0.00,$10.03,$15.89,$16.05,$0.00,$0.00,$0.00,$0.00,$0.00
292.38,SUP,Custom 27203010,,292.38  -  WIRE FIX 1.8MM 350MM SPADE POINT KWIRE STAINLESS STEEL,$115.73,$0.00,$115.73,$0.00,$82.59,$0.00,$0.00,$0.00,$0.00,$0.00,$115.73,$0.00,$57.86,$91.66,$92.58,$0.00,$0.00,$0.00,$0.00,$0.00
292.39,SUP,Custom 27203010,,292.39  -  WIRE FIX 1.8MM 400MM SPADE POINT REDX KWIRE STAINLESS STEEL,$360.15,$0.00,$360.15,$0.00,$257.04,$0.00,$0.00,$0.00,$0.00,$0.00,$360.15,$0.00,$180.08,$285.24,$288.12,$0.00,$0.00,$0.00,$0.00,$0.00
292.4,SUP,Custom 27203010,,292.40  -  WIRE FIX 2MM 350MM SPADE POINT KWIRE STAINLESS STEEL NONSTRL,$115.73,$0.00,$115.73,$0.00,$82.59,$0.00,$0.00,$0.00,$0.00,$0.00,$115.73,$0.00,$57.86,$91.66,$92.58,$0.00,$0.00,$0.00,$0.00,$0.00
292.41,SUP,Custom 27203010,,292.41  -  WIRE FIX 2MM 400MM SPADE POINT REDX KWIRE STAINLESS STEEL,$360.15,$0.00,$360.15,$0.00,$257.04,$0.00,$0.00,$0.00,$0.00,$0.00,$360.15,$0.00,$180.08,$285.24,$288.12,$0.00,$0.00,$0.00,$0.00,$0.00
292.46,SUP,Custom 27203010,,292.46  -  WIRE FX .6MM 70MM NS KRSH 2 END TROC PNT SS,$16.79,$0.00,$16.79,$0.00,$11.98,$0.00,$0.00,$0.00,$0.00,$0.00,$16.79,$0.00,$8.39,$13.30,$13.43,$0.00,$0.00,$0.00,$0.00,$0.00
292.48,SUP,Custom 27203010,,292.48  -  WIRE FX .8MM 70MM NS KRSH 2 END TROC PNT SS,$16.79,$0.00,$16.79,$0.00,$11.98,$0.00,$0.00,$0.00,$0.00,$0.00,$16.79,$0.00,$8.39,$13.30,$13.43,$0.00,$0.00,$0.00,$0.00,$0.00
292.5,SUP,Custom 27203010,,292.50  -  WIRE FIX 1MM 150MM 2 END TROCAR POINT KWIRE STAINLESS STEEL,$18.97,$0.00,$18.97,$0.00,$13.54,$0.00,$0.00,$0.00,$0.00,$0.00,$18.97,$0.00,$9.49,$15.02,$15.18,$0.00,$0.00,$0.00,$0.00,$0.00
292.52,SUP,Custom 27203010,,292.52  -  WIRE FIX TROCAR 1.25MM 150MM KWIRE STAINLESS STEEL NONSTRL,$18.97,$0.00,$18.97,$0.00,$13.54,$0.00,$0.00,$0.00,$0.00,$0.00,$18.97,$0.00,$9.49,$15.02,$15.18,$0.00,$0.00,$0.00,$0.00,$0.00
292.56,SUP,Custom 27203010,,292.56  -  WIRE FIX TROCAR 1.6MM 150MM 2 END KWIRE STAINLESS STEEL,$18.97,$0.00,$18.97,$0.00,$13.54,$0.00,$0.00,$0.00,$0.00,$0.00,$18.97,$0.00,$9.49,$15.02,$15.18,$0.00,$0.00,$0.00,$0.00,$0.00
292.58,SUP,Custom 27203010,,292.58  -  WIRE FX 2MM 150MM NS KRSH 2 END TROC PNT SS,$18.97,$0.00,$18.97,$0.00,$13.54,$0.00,$0.00,$0.00,$0.00,$0.00,$18.97,$0.00,$9.49,$15.02,$15.18,$0.00,$0.00,$0.00,$0.00,$0.00
292.6,SUP,Custom 27203010,,292.600  -  WIRE FX 1.25MM 100MM NS KRSH THRD TIP SS MN XTRNFXTR,$81.22,$0.00,$81.22,$0.00,$57.97,$0.00,$0.00,$0.00,$0.00,$0.00,$81.22,$0.00,$40.61,$64.33,$64.98,$0.00,$0.00,$0.00,$0.00,$0.00
292.619,SUP,HCPCS C1769,,292.619  -  GUIDEWIRE ORTHOPEDIC .8MM 100MM SPADE POINT STAINLESS STEEL,$27.43,$0.00,$45.89,$14.90,$19.58,$0.00,$45.89,$0.00,$0.00,$4.80,$27.43,$0.00,$13.72,$21.72,$21.95,$0.00,$41.68,$0.00,$4.37,$0.00
292.62,SUP,HCPCS C1769,,292.62  -  GWIRE ORTH 150MM 1.25MM SS THRD,$59.13,$0.00,$59.13,$32.10,$42.20,$0.00,$10.19,$0.00,$0.00,$10.35,$59.13,$0.00,$29.56,$46.83,$47.30,$0.00,$9.25,$0.00,$9.41,$0.00
292.621,SUP,HCPCS C1713,,292.621  -  GUIDEWIRE ORTHOPEDIC 1.25MM 150MM THREADED SPADE POINT ON 2,$51.50,$0.00,$51.50,$23.18,$36.76,$0.00,$8.61,$0.00,$0.00,$9.02,$51.50,$0.00,$25.75,$40.79,$41.20,$0.00,$7.83,$0.00,$8.20,$0.00
292.622,SUP,HCPCS C1713,,292.622  -  GUIDEWIRE ORTHOPEDIC 1.1MM 150MM THREAD STAINLESS STEEL,$53.90,$0.00,$53.90,$24.26,$38.47,$0.00,$9.02,$0.00,$0.00,$9.44,$53.90,$0.00,$26.95,$42.69,$43.12,$0.00,$8.19,$0.00,$8.58,$0.00
292.623,SUP,HCPCS C1713,,292.623  -  GUIDEWIRE ORTHOPEDIC 1.1MM 150MM NONTHREADED STAINLESS STEEL,$51.18,$0.00,$51.18,$23.03,$36.52,$0.00,$8.56,$0.00,$0.00,$8.96,$51.18,$0.00,$25.59,$40.53,$40.94,$0.00,$7.77,$0.00,$8.15,$0.00
292.626,SUP,HCPCS C1769,,292.626  -  GUIDEWIRE ORTHOPEDIC 150MM 1 END SPADE PONT STAINLESS STEEL,$62.40,$0.00,$62.40,$33.88,$44.53,$0.00,$10.75,$0.00,$0.00,$10.93,$62.40,$0.00,$31.20,$49.42,$49.92,$0.00,$9.77,$0.00,$9.93,$0.00
292.65,SUP,HCPCS C1769,,292.65  -  GUIDEWIRE ORTHOPEDIC SPADE 2MM 230MM THREAD BLACK STAINLESS,$73.00,$0.00,$73.00,$39.64,$52.10,$0.00,$12.21,$0.00,$0.00,$12.78,$73.00,$0.00,$36.50,$57.82,$58.40,$0.00,$11.09,$0.00,$11.62,$0.00
292.651,SUP,HCPCS C1713,,292.651  -  GUIDEWIRE ORTHOPEDIC 2MM 230MM THREADED SPADE POINT,$83.25,$0.00,$83.25,$37.46,$59.42,$0.00,$13.93,$0.00,$0.00,$14.58,$83.25,$0.00,$41.63,$65.93,$66.60,$0.00,$12.65,$0.00,$13.25,$0.00
292.652,SUP,HCPCS C1713,,292.652  -  GUIDEWIRE ORTHOPEDIC 2MM 230MM THREADED SPADE POINT,$71.63,$0.00,$71.63,$32.23,$51.12,$0.00,$11.98,$0.00,$0.00,$12.54,$71.63,$0.00,$35.81,$56.73,$57.30,$0.00,$10.88,$0.00,$11.40,$0.00
292.653,SUP,Custom 27203010,,292.653  -  GUIDEWIRE ORTHOPEDIC 2MM 330MM TROCAR THREAD STAINLESS STEEL,$107.83,$0.00,$107.83,$0.00,$76.95,$0.00,$0.00,$0.00,$0.00,$0.00,$107.83,$0.00,$53.91,$85.40,$86.26,$0.00,$0.00,$0.00,$0.00,$0.00
292.655,SUP,Custom 27203010,,292.655  -  GUIDEWIRE ORTHOPEDIC 1.6MM 410MM,$98.93,$0.00,$98.93,$0.00,$70.60,$0.00,$0.00,$0.00,$0.00,$0.00,$98.93,$0.00,$49.46,$78.35,$79.14,$0.00,$0.00,$0.00,$0.00,$0.00
292.656,SUP,HCPCS C1713,,292.656  -  GUIDEWIRE ORTHOPEDIC 2MM 230MM NONTHREADED STAINLESS STEEL,$68.90,$0.00,$68.90,$31.01,$49.17,$0.00,$11.53,$0.00,$0.00,$12.06,$68.90,$0.00,$34.45,$54.57,$55.12,$0.00,$10.47,$0.00,$10.97,$0.00
292.68,SUP,HCPCS C1713,,292.68  -  GUIDEWIRE ORTHOPEDIC 2.8MM 300MM TROCAR THREAD STAINLESS,$83.25,$0.00,$83.25,$37.46,$59.42,$0.00,$13.93,$0.00,$0.00,$14.58,$83.25,$0.00,$41.63,$65.93,$66.60,$0.00,$12.65,$0.00,$13.25,$0.00
292.69,SUP,Custom 27203010,,292.69  -  GUIDEWIRE ORTHOPEDIC 3.2MM 300MM CALIBRATE STAINLESS STEEL,$225.18,$0.00,$225.18,$0.00,$160.71,$0.00,$0.00,$0.00,$0.00,$0.00,$225.18,$0.00,$112.59,$178.34,$180.14,$0.00,$0.00,$0.00,$0.00,$0.00
292.699,SUP,Custom 27203010,,292.699  -  WIRE FX 2MM 280MM NS KRSH THRD SPD PNT TIP SS,$74.38,$0.00,$74.38,$0.00,$53.08,$0.00,$0.00,$0.00,$0.00,$0.00,$74.38,$0.00,$37.19,$58.91,$59.50,$0.00,$0.00,$0.00,$0.00,$0.00
292.708,SUP,Custom 27203010,,292.708  -  WIRE FX 1.6MM 100MM NS KRSH THRD TIP SS MN XTRNFXTR,$836.60,$0.00,$836.60,$0.00,$597.08,$0.00,$0.00,$0.00,$0.00,$0.00,$836.60,$0.00,$418.30,$662.59,$669.28,$0.00,$0.00,$0.00,$0.00,$0.00
292.71,SUP,Custom 27203010,,292.71  -  WIRE FIX 1.6MM 15CM 5MM THREADED TROCAR POINT KWIRE,$294.15,$0.00,$294.15,$0.00,$209.93,$0.00,$0.00,$0.00,$0.00,$0.00,$294.15,$0.00,$147.08,$232.97,$235.32,$0.00,$0.00,$0.00,$0.00,$0.00
292.72,SUP,HCPCS C1713,,292.72  -  GUIDEWIRE ORTHOPEDIC 1.6MM 150MM THREAD STAINLESS STEEL,$61.43,$0.00,$61.43,$27.64,$43.84,$0.00,$13.12,$0.00,$0.00,$10.76,$61.43,$0.00,$30.71,$48.65,$49.14,$0.00,$11.92,$0.00,$9.78,$0.00
292.721,SUP,HCPCS C1713,,292.721  -  GUIDEWIRE ORTHOPEDIC 1.6MM 150MM THREADED SPADE POINT,$71.63,$0.00,$71.63,$32.23,$51.12,$0.00,$11.98,$0.00,$0.00,$12.54,$71.63,$0.00,$35.81,$56.73,$57.30,$0.00,$10.88,$0.00,$11.40,$0.00
292.722,SUP,HCPCS C1713,,292.722  -  GUIDEWIRE ORTHOPEDIC 1.6MM 150MM THREADED SPADE POINT,$53.55,$0.00,$53.55,$24.10,$38.22,$0.00,$8.96,$0.00,$0.00,$9.38,$53.55,$0.00,$26.78,$42.41,$42.84,$0.00,$8.14,$0.00,$8.53,$0.00
292.727,SUP,HCPCS C1713,,292.727  -  GUIDEWIRE ORTHOPEDIC 1.6MM 150MM NONTHREADED SPADE POINT,$51.50,$0.00,$51.50,$23.18,$36.76,$0.00,$8.61,$0.00,$0.00,$9.02,$51.50,$0.00,$25.75,$40.79,$41.20,$0.00,$7.83,$0.00,$8.20,$0.00
292.73,SUP,Custom 27203010,,292.73  -  WIRE FX 1.6MM 150MM NS 15MM KRSH TROC PNT THRD SS,$29.42,$0.00,$29.42,$0.00,$20.99,$0.00,$0.00,$0.00,$0.00,$0.00,$29.42,$0.00,$14.71,$23.30,$23.53,$0.00,$0.00,$0.00,$0.00,$0.00
292.75,SUP,Custom 27203010,,292.75  -  WIRE FX 2.5MM 150MM NS 15MM KRSH TROC PNT THRD SS,$32.33,$0.00,$32.33,$0.00,$23.07,$0.00,$0.00,$0.00,$0.00,$0.00,$32.33,$0.00,$16.17,$25.61,$25.86,$0.00,$0.00,$0.00,$0.00,$0.00
292.76,SUP,Custom 27203010,,292.76  -  WIRE FIX 2.5MM 200MM 15MM THREADED TROCAR POINT KWIRE,$34.53,$0.00,$34.53,$0.00,$24.64,$0.00,$0.00,$0.00,$0.00,$0.00,$34.53,$0.00,$17.26,$27.35,$27.62,$0.00,$0.00,$0.00,$0.00,$0.00
292.79,SUP,Custom 27203010,,292.79  -  WIRE FX 2MM 150MM NS 15MM KRSH TROC PNT THRD SS,$31.25,$0.00,$31.25,$0.00,$22.30,$0.00,$0.00,$0.00,$0.00,$0.00,$31.25,$0.00,$15.63,$24.75,$25.00,$0.00,$0.00,$0.00,$0.00,$0.00
292.801,SUP,Custom 27203010,,292.801  -  WIRE FX 2MM 150MM NS 15MM KRSH CLBRT THRD TROC PNT SS,$83.25,$0.00,$83.25,$0.00,$59.42,$0.00,$0.00,$0.00,$0.00,$0.00,$83.25,$0.00,$41.63,$65.93,$66.60,$0.00,$0.00,$0.00,$0.00,$0.00
292.81,SUP,HCPCS C1713,,292.81  -  GUIDEWIRE ORTHOPEDIC 2.8MM 300MM 150MM NONTHREADED STAINLESS,$184.25,$0.00,$184.25,$82.91,$131.50,$0.00,$30.82,$0.00,$0.00,$32.26,$184.25,$0.00,$92.13,$145.93,$147.40,$0.00,$27.99,$0.00,$29.33,$0.00
293.35,SUP,Custom 27203010,,293.35  -  PIN FIX 3.5MM 120MM STEINMANN STAINLESS STEEL ORTHOPEDIC,$65.98,$0.00,$65.98,$0.00,$47.09,$0.00,$0.00,$0.00,$0.00,$0.00,$65.98,$0.00,$32.99,$52.26,$52.78,$0.00,$0.00,$0.00,$0.00,$0.00
293.36,SUP,Custom 27203010,,293.36  -  PIN FIX 3.5MM 150MM TRACTION STEINMANN STAINLESS STEEL,$65.98,$0.00,$65.98,$0.00,$47.09,$0.00,$0.00,$0.00,$0.00,$0.00,$65.98,$0.00,$32.99,$52.26,$52.78,$0.00,$0.00,$0.00,$0.00,$0.00
293.4,SUP,Custom 27203010,,293.40  -  PIN FIX 4MM 150MM STEINMANN STAINLESS STEEL NONSTRL TRACTION,$65.98,$0.00,$65.98,$0.00,$47.09,$0.00,$0.00,$0.00,$0.00,$0.00,$65.98,$0.00,$32.99,$52.26,$52.78,$0.00,$0.00,$0.00,$0.00,$0.00
293.41,SUP,Custom 27203010,,293.41  -  PIN FIX LARGE 4MM 180MM EXTERNAL IMPLANT TRACTION STEINMANN,$65.98,$0.00,$65.98,$0.00,$47.09,$0.00,$0.00,$0.00,$0.00,$0.00,$65.98,$0.00,$32.99,$52.26,$52.78,$0.00,$0.00,$0.00,$0.00,$0.00
293.42,SUP,Custom 27203010,,293.42  -  PIN FIX 4MM 200MM STEINMANN STAINLESS STEEL NONSTRL LARGE,$65.98,$0.00,$65.98,$0.00,$47.09,$0.00,$0.00,$0.00,$0.00,$0.00,$65.98,$0.00,$32.99,$52.26,$52.78,$0.00,$0.00,$0.00,$0.00,$0.00
293.44,SUP,Custom 27203010,,293.44  -  PIN FIX 4.5MM 120MM STEINMANN STAINLESS STEEL ORTHOPEDIC,$122.20,$0.00,$122.20,$0.00,$87.21,$0.00,$0.00,$0.00,$0.00,$0.00,$122.20,$0.00,$61.10,$96.78,$97.76,$0.00,$0.00,$0.00,$0.00,$0.00
293.45,SUP,Custom 27203010,,293.45  -  PIN FIX 4.5MM 150MM STEINMANN STAINLESS STEEL NONSTRL LARGE,$122.20,$0.00,$122.20,$0.00,$87.21,$0.00,$0.00,$0.00,$0.00,$0.00,$122.20,$0.00,$61.10,$96.78,$97.76,$0.00,$0.00,$0.00,$0.00,$0.00
293.46,SUP,Custom 27203010,,293.46  -  PIN FIX 4.5MM 180MM STEINMANN STAINLESS STEEL NONSTRL LARGE,$122.20,$0.00,$122.20,$0.00,$87.21,$0.00,$0.00,$0.00,$0.00,$0.00,$122.20,$0.00,$61.10,$96.78,$97.76,$0.00,$0.00,$0.00,$0.00,$0.00
293.47,SUP,Custom 27203010,,293.47  -  PIN FIX 4.5MM 200MM STEINMANN STAINLESS STEEL NONSTRL LARGE,$122.20,$0.00,$122.20,$0.00,$87.21,$0.00,$0.00,$0.00,$0.00,$0.00,$122.20,$0.00,$61.10,$96.78,$97.76,$0.00,$0.00,$0.00,$0.00,$0.00
293.48,SUP,Custom 27203010,,293.48  -  PIN FIX 4.5MM 250MM STEINMANN STAINLESS STEEL NONSTRL LARGE,$122.20,$0.00,$122.20,$0.00,$87.21,$0.00,$0.00,$0.00,$0.00,$0.00,$122.20,$0.00,$61.10,$96.78,$97.76,$0.00,$0.00,$0.00,$0.00,$0.00
293.49,SUP,Custom 27203010,,293.49  -  PIN FIX 4.5MM 225MM STEINMANN STAINLESS STEEL ORTHOPEDIC,$122.20,$0.00,$122.20,$0.00,$87.21,$0.00,$0.00,$0.00,$0.00,$0.00,$122.20,$0.00,$61.10,$96.78,$97.76,$0.00,$0.00,$0.00,$0.00,$0.00
293.5,SUP,Custom 27203010,,293.50  -  PIN FIX 5MM 150MM STEINMANN STAINLESS STEEL NONSTRL LARGE,$122.20,$0.00,$122.20,$0.00,$87.21,$0.00,$0.00,$0.00,$0.00,$0.00,$122.20,$0.00,$61.10,$96.78,$97.76,$0.00,$0.00,$0.00,$0.00,$0.00
293.51,SUP,Custom 27203010,,293.51  -  PIN FIX 5MM 180MM STEINMANN STAINLESS STEEL NONSTRL LARGE,$122.20,$0.00,$122.20,$0.00,$87.21,$0.00,$0.00,$0.00,$0.00,$0.00,$122.20,$0.00,$61.10,$96.78,$97.76,$0.00,$0.00,$0.00,$0.00,$0.00
293.52,SUP,Custom 27203010,,293.52  -  PIN FIX 5MM 200MM STEINMANN STAINLESS STEEL NONSTRL LARGE,$122.20,$0.00,$122.20,$0.00,$87.21,$0.00,$0.00,$0.00,$0.00,$0.00,$122.20,$0.00,$61.10,$96.78,$97.76,$0.00,$0.00,$0.00,$0.00,$0.00
293.53,SUP,Custom 27203010,,293.53  -  PIN FIX 5MM 250MM STEINMANN STAINLESS STEEL NONSTRL LARGE,$122.20,$0.00,$122.20,$0.00,$87.21,$0.00,$0.00,$0.00,$0.00,$0.00,$122.20,$0.00,$61.10,$96.78,$97.76,$0.00,$0.00,$0.00,$0.00,$0.00
293.54,SUP,Custom 27203010,,293.54  -  PIN FIX 5MM 300MM STEINMANN STAINLESS STEEL ORTHOPEDIC,$122.20,$0.00,$122.20,$0.00,$87.21,$0.00,$0.00,$0.00,$0.00,$0.00,$122.20,$0.00,$61.10,$96.78,$97.76,$0.00,$0.00,$0.00,$0.00,$0.00
293.58,SUP,Custom 27203010,,293.58  -  PIN FIX 5MM 225MM STEINMANN STAINLESS STEEL ORTHOPEDIC,$122.20,$0.00,$122.20,$0.00,$87.21,$0.00,$0.00,$0.00,$0.00,$0.00,$122.20,$0.00,$61.10,$96.78,$97.76,$0.00,$0.00,$0.00,$0.00,$0.00
293.59,SUP,Custom 27203010,,293.59  -  PIN FIX 5MM 275MM STEINMANN ORTHOPEDIC NONSTRL LARGE EXFIX,$122.20,$0.00,$122.20,$0.00,$87.21,$0.00,$0.00,$0.00,$0.00,$0.00,$122.20,$0.00,$61.10,$96.78,$97.76,$0.00,$0.00,$0.00,$0.00,$0.00
293.62,SUP,Custom 27203010,,293.62  -  PIN FIX 4MM 150MM CENTRL THREAD STEINMANN STAINLESS STEEL,$184.93,$0.00,$184.93,$0.00,$131.98,$0.00,$0.00,$0.00,$0.00,$0.00,$184.93,$0.00,$92.46,$146.46,$147.94,$0.00,$0.00,$0.00,$0.00,$0.00
293.63,SUP,Custom 27203010,,293.63  -  PIN FIX 4.5MM 5MM 150MM CENTRL THREAD STEINMANN STAINLESS,$184.93,$0.00,$184.93,$0.00,$131.98,$0.00,$0.00,$0.00,$0.00,$0.00,$184.93,$0.00,$92.46,$146.46,$147.94,$0.00,$0.00,$0.00,$0.00,$0.00
293.67,SUP,Custom 27203010,,293.67  -  PIN FIX 4MM 180MM CENTRL THREAD STEINMANN STAINLESS STEEL,$184.93,$0.00,$184.93,$0.00,$131.98,$0.00,$0.00,$0.00,$0.00,$0.00,$184.93,$0.00,$92.46,$146.46,$147.94,$0.00,$0.00,$0.00,$0.00,$0.00
293.68,SUP,Custom 27203010,,293.68  -  PIN FX CNTR THRD 4.5MM 5MM 180MM NS STNM SS LG XTRNFXTR,$207.65,$0.00,$207.65,$0.00,$148.20,$0.00,$0.00,$0.00,$0.00,$0.00,$207.65,$0.00,$103.83,$164.46,$166.12,$0.00,$0.00,$0.00,$0.00,$0.00
293.69,SUP,Custom 27203010,,293.69  -  PIN FIX 5MM 5.5MM 175MM CENTRL THREAD STEINMANN STAINLESS,$207.65,$0.00,$207.65,$0.00,$148.20,$0.00,$0.00,$0.00,$0.00,$0.00,$207.65,$0.00,$103.83,$164.46,$166.12,$0.00,$0.00,$0.00,$0.00,$0.00
293.72,SUP,Custom 27203010,,293.72  -  PIN FIX 4MM 4.5MM 200MM CENTRL THREAD STEINMANN STAINLESS,$184.93,$0.00,$184.93,$0.00,$131.98,$0.00,$0.00,$0.00,$0.00,$0.00,$184.93,$0.00,$92.46,$146.46,$147.94,$0.00,$0.00,$0.00,$0.00,$0.00
293.73,SUP,Custom 27203010,,293.73  -  PIN FIX 4.5MM 200MM CENTRL THREAD STEINMANN STAINLESS STEEL,$207.65,$0.00,$207.65,$0.00,$148.20,$0.00,$0.00,$0.00,$0.00,$0.00,$207.65,$0.00,$103.83,$164.46,$166.12,$0.00,$0.00,$0.00,$0.00,$0.00
293.74,SUP,Custom 27203010,,293.74  -  PIN FX CNTR THRD 5MM 5.5MM 200MM NS STNM SS LG XTRNFXTR,$207.65,$0.00,$207.65,$0.00,$148.20,$0.00,$0.00,$0.00,$0.00,$0.00,$207.65,$0.00,$103.83,$164.46,$166.12,$0.00,$0.00,$0.00,$0.00,$0.00
293.78,SUP,Custom 27203010,,293.78  -  PIN FX CNTR THRD 4.5MM 5MM 225MM NS STNM SS LG XTRNFXTR,$207.65,$0.00,$207.65,$0.00,$148.20,$0.00,$0.00,$0.00,$0.00,$0.00,$207.65,$0.00,$103.83,$164.46,$166.12,$0.00,$0.00,$0.00,$0.00,$0.00
293.79,SUP,Custom 27203010,,293.790  -  PIN FIX CENTRL THREAD 5MM 5.5MM 225MM STEINMANN STAINLESS,$207.65,$0.00,$207.65,$0.00,$148.20,$0.00,$0.00,$0.00,$0.00,$0.00,$207.65,$0.00,$103.83,$164.46,$166.12,$0.00,$0.00,$0.00,$0.00,$0.00
293.83,SUP,Custom 27203010,,293.83  -  PIN FIX 4.5MM 250MM CENTRL THREAD STEINMANN STAINLESS STEEL,$207.65,$0.00,$207.65,$0.00,$148.20,$0.00,$0.00,$0.00,$0.00,$0.00,$207.65,$0.00,$103.83,$164.46,$166.12,$0.00,$0.00,$0.00,$0.00,$0.00
293.84,SUP,Custom 27203010,,293.840  -  PIN FIX 5MM 5.5MM 250MM 3 FLAT END CENTRL THREAD ROUND,$207.65,$0.00,$207.65,$0.00,$148.20,$0.00,$0.00,$0.00,$0.00,$0.00,$207.65,$0.00,$103.83,$164.46,$166.12,$0.00,$0.00,$0.00,$0.00,$0.00
293.88,SUP,Custom 27203010,,293.88  -  PIN FX CNTR THRD 4.5MM 5MM 275MM NS STNM SS LG XTRNFXTR,$207.65,$0.00,$207.65,$0.00,$148.20,$0.00,$0.00,$0.00,$0.00,$0.00,$207.65,$0.00,$103.83,$164.46,$166.12,$0.00,$0.00,$0.00,$0.00,$0.00
293.89,SUP,Custom 27203010,,293.890  -  PIN FIX 5MM 275MM CENTRL THREAD STEINMANN STAINLESS STEEL,$207.65,$0.00,$207.65,$0.00,$148.20,$0.00,$0.00,$0.00,$0.00,$0.00,$207.65,$0.00,$103.83,$164.46,$166.12,$0.00,$0.00,$0.00,$0.00,$0.00
293.93,SUP,Custom 27203010,,293.93  -  PIN FIX 4.5MM 300MM CENTRL THREAD STEINMANN STAINLESS STEEL,$207.65,$0.00,$207.65,$0.00,$148.20,$0.00,$0.00,$0.00,$0.00,$0.00,$207.65,$0.00,$103.83,$164.46,$166.12,$0.00,$0.00,$0.00,$0.00,$0.00
293.94,SUP,HCPCS C1713,,293.940  -  PIN FIX 5MM 300MM CENTRL THREAD STEINMANN STAINLESS STEEL,$207.65,$0.00,$207.65,$93.44,$148.20,$0.00,$34.73,$0.00,$0.00,$36.36,$207.65,$0.00,$103.83,$164.46,$166.12,$0.00,$31.55,$0.00,$33.06,$0.00
294.3,SUP,HCPCS C1713,,294.30  -  SCREW XTRNFX 4MM 3MM 80MM NS 20MM SCHNZ TROC PNT MR,$124.38,$0.00,$124.38,$55.97,$88.77,$0.00,$20.80,$0.00,$0.00,$21.78,$124.38,$0.00,$62.19,$98.51,$99.50,$0.00,$18.90,$0.00,$19.80,$0.00
294.43,SUP,HCPCS C1713,,294.43  -  SCREW XTRNFX 4MM 60MM NS SCHNZ SPD PNT SS LG XTRNFXTR,$124.38,$0.00,$124.38,$55.97,$88.77,$0.00,$20.80,$0.00,$0.00,$21.78,$124.38,$0.00,$62.19,$98.51,$99.50,$0.00,$18.90,$0.00,$19.80,$0.00
294.44,SUP,HCPCS C1713,,294.44  -  SCREW XTRNFX 4MM 80MM NS SCHNZ SPD PNT MR CONDITIONAL SS LG,$124.38,$0.00,$124.38,$55.97,$88.77,$0.00,$20.80,$0.00,$0.00,$21.78,$124.38,$0.00,$62.19,$98.51,$99.50,$0.00,$18.90,$0.00,$19.80,$0.00
294.45,SUP,HCPCS C1713,,294.45  -  SCREW XTRNFX 4MM 100MM NS 25MM SCHNZ SPD PNT SS PLVC LG,$124.38,$0.00,$124.38,$55.97,$88.77,$0.00,$20.80,$0.00,$0.00,$21.78,$124.38,$0.00,$62.19,$98.51,$99.50,$0.00,$18.90,$0.00,$19.80,$0.00
294.455,SUP,HCPCS C1713,,294.455  -  SCREW BONE 4MM 100MM 38IN SPADE POINT PTHRD SCHANZ,$124.38,$0.00,$124.38,$55.97,$88.77,$0.00,$20.80,$0.00,$0.00,$21.78,$124.38,$0.00,$62.19,$98.51,$99.50,$0.00,$18.90,$0.00,$19.80,$0.00
294.46,SUP,HCPCS C1713,,294.46  -  SCREW XTRNFX 4MM 120MM NS SCHNZ SPD PNT MR CONDITIONAL SS,$124.38,$0.00,$124.38,$55.97,$88.77,$0.00,$20.80,$0.00,$0.00,$21.78,$124.38,$0.00,$62.19,$98.51,$99.50,$0.00,$18.90,$0.00,$19.80,$0.00
294.48,SUP,HCPCS C1713,,294.48  -  SCREW XTRNFX 4MM 150MM NS 25MM SCHNZ SPD PNT SS PLVC LG,$124.38,$0.00,$124.38,$55.97,$88.77,$0.00,$20.80,$0.00,$0.00,$21.78,$124.38,$0.00,$62.19,$98.51,$99.50,$0.00,$18.90,$0.00,$19.80,$0.00
294.52,SUP,HCPCS C1713,,294.52  -  SCREW XTRNFX XLNG 5MM 100MM NS SCHNZ BLNT TROC PNT MR,$137.35,$0.00,$137.35,$61.81,$98.03,$0.00,$22.98,$0.00,$0.00,$24.05,$137.35,$0.00,$68.68,$108.78,$109.88,$0.00,$20.87,$0.00,$21.87,$0.00
294.53,SUP,HCPCS C1713,,294.53  -  SCREW XTRNFX 5MM 125MM NS SCHNZ BLNT TROC PNT MR CONDITIONAL,$137.35,$0.00,$137.35,$61.81,$98.03,$0.00,$22.98,$0.00,$0.00,$24.05,$137.35,$0.00,$68.68,$108.78,$109.88,$0.00,$20.87,$0.00,$21.87,$0.00
294.54,SUP,HCPCS C1713,,294.54  -  SCREW XTRNFX 5MM 150MM NS SCHNZ BLNT TROC PNT MR CONDITIONAL,$137.35,$0.00,$137.35,$61.81,$98.03,$0.00,$22.98,$0.00,$0.00,$24.05,$137.35,$0.00,$68.68,$108.78,$109.88,$0.00,$20.87,$0.00,$21.87,$0.00
294.55,SUP,HCPCS C1713,,294.55  -  SCREW XTRNFX XLNG 5MM 170MM NS 50MM SCHNZ BLNT TROC PNT SS,$158.98,$0.00,$158.98,$71.54,$113.46,$0.00,$37.70,$0.00,$0.00,$27.84,$158.98,$0.00,$79.49,$125.91,$127.18,$0.00,$34.25,$0.00,$25.31,$0.00
294.56,SUP,HCPCS C1713,,294.56  -  SCREW XTRNFX 5MM 200MM NS SCHNZ BLNT TROC PNT MR CONDITIONAL,$158.98,$0.00,$158.98,$71.54,$113.46,$0.00,$26.59,$0.00,$0.00,$27.84,$158.98,$0.00,$79.49,$125.91,$127.18,$0.00,$24.16,$0.00,$25.31,$0.00
294.57,SUP,HCPCS C1713,,294.57  -  SCREW XTRNFX 5MM 250MM NS SCHNZ BLNT TROC PNT MR CONDITIONAL,$158.98,$0.00,$158.98,$71.54,$113.46,$0.00,$26.59,$0.00,$0.00,$27.84,$158.98,$0.00,$79.49,$125.91,$127.18,$0.00,$24.16,$0.00,$25.31,$0.00
294.65,SUP,HCPCS C1713,,294.65  -  SCREW XTRNFX 6MM 100MM NS 50MM SCHNZ SPD PNT SS LG XTRNFXTR,$137.35,$0.00,$137.35,$61.81,$98.03,$0.00,$22.98,$0.00,$0.00,$24.05,$137.35,$0.00,$68.68,$108.78,$109.88,$0.00,$20.87,$0.00,$21.87,$0.00
294.66,SUP,HCPCS C1713,,294.66  -  SCREW EXFIX BLUNT SPADE 6MM 130MM 50MM TROCAR SCHANZ,$137.35,$0.00,$137.35,$61.81,$98.03,$0.00,$22.98,$0.00,$0.00,$24.05,$137.35,$0.00,$68.68,$108.78,$109.88,$0.00,$20.87,$0.00,$21.87,$0.00
294.67,SUP,HCPCS C1713,,294.67  -  SCREW XTRNFX 6MM 160MM NS 50MM SCHNZ SPD PNT SS LG XTRNFXTR,$142.75,$0.00,$142.75,$64.24,$101.88,$0.00,$23.88,$0.00,$0.00,$24.99,$142.75,$0.00,$71.38,$113.06,$114.20,$0.00,$21.69,$0.00,$22.73,$0.00
294.68,SUP,HCPCS C1713,,294.68  -  SCREW XTRNFX 6MM 190MM NS 50MM SCHNZ SPD PNT SS LG XTRNFXTR,$142.75,$0.00,$142.75,$64.24,$101.88,$0.00,$23.88,$0.00,$0.00,$24.99,$142.75,$0.00,$71.38,$113.06,$114.20,$0.00,$21.69,$0.00,$22.73,$0.00
294.71,SUP,HCPCS C1713,,294.71  -  SCREW EXFIX BLUNT SPADE 4.5MM 80MM 18MM TROCAR SCHANZ,$121.13,$0.00,$121.13,$54.51,$86.45,$0.00,$20.26,$0.00,$0.00,$21.21,$121.13,$0.00,$60.56,$95.93,$96.90,$0.00,$18.40,$0.00,$19.28,$0.00
294.72,SUP,HCPCS C1713,,294.72  -  SCREW XTRNFX ST 4.5MM 100MM NS 18MM SCHNZ BLNT TROC PNT SS,$121.13,$0.00,$121.13,$54.51,$86.45,$0.00,$20.26,$0.00,$0.00,$21.21,$121.13,$0.00,$60.56,$95.93,$96.90,$0.00,$18.40,$0.00,$19.28,$0.00
294.73,SUP,HCPCS C1713,,294.73  -  SCREW XTRNFX ST 4.5MM 125MM NS 18MM SCHNZ BLNT TROC PNT SS,$121.13,$0.00,$121.13,$54.51,$86.45,$0.00,$20.26,$0.00,$0.00,$21.21,$121.13,$0.00,$60.56,$95.93,$96.90,$0.00,$18.40,$0.00,$19.28,$0.00
294.74,SUP,HCPCS C1713,,294.74  -  SCREW XTRNFX ST 4.5MM 150MM NS 18MM SCHNZ BLNT TROC PNT SS,$121.13,$0.00,$121.13,$54.51,$86.45,$0.00,$20.26,$0.00,$0.00,$21.21,$121.13,$0.00,$60.56,$95.93,$96.90,$0.00,$18.40,$0.00,$19.28,$0.00
294.75,SUP,HCPCS C1713,,294.75  -  SCREW XTRNFX ST 4.5MM 175MM NS 18MM SCHNZ BLNT TROC PNT SS,$142.75,$0.00,$142.75,$64.24,$101.88,$0.00,$23.88,$0.00,$0.00,$24.99,$142.75,$0.00,$71.38,$113.06,$114.20,$0.00,$21.69,$0.00,$22.73,$0.00
294.76,SUP,HCPCS C1713,,294.76  -  SCREW XTRNFX 4.5MM 200MM NS SCHNZ BLNT TROC PNT MR,$142.75,$0.00,$142.75,$64.24,$101.88,$0.00,$23.88,$0.00,$0.00,$24.99,$142.75,$0.00,$71.38,$113.06,$114.20,$0.00,$21.69,$0.00,$22.73,$0.00
294.767,SUP,HCPCS C1713,,294.767  -  SCREW BONE 4MM 2.5MM 65MM 18MM SLFDRILL TROCAR POINT SCHANZ,$215.23,$0.00,$215.23,$96.85,$153.61,$0.00,$36.00,$0.00,$0.00,$37.68,$215.23,$0.00,$107.61,$170.46,$172.18,$0.00,$32.70,$0.00,$34.26,$0.00
294.768,SUP,HCPCS C1713,,294.768  -  SCREW BONE 4MM 2.5MM 80MM 20MM SLFDRILL TROCAR POINT SCHANZ,$215.23,$0.00,$215.23,$96.85,$153.61,$0.00,$36.00,$0.00,$0.00,$37.68,$215.23,$0.00,$107.61,$170.46,$172.18,$0.00,$32.70,$0.00,$34.26,$0.00
294.769,SUP,HCPCS C1713,,294.769  -  SCREW XTRNFX 4MM 2.5MM 80MM NS 20MM SCHNZ SLF DRL MR,$242.25,$0.00,$242.25,$109.01,$172.89,$0.00,$40.52,$0.00,$0.00,$42.42,$242.25,$0.00,$121.13,$191.86,$193.80,$0.00,$36.81,$0.00,$38.57,$0.00
294.771,SUP,HCPCS C1713,,294.771  -  SCREW XTRNFX 4MM 3MM 80MM NS 20MM SCHNZ SLF DRL MR,$242.25,$0.00,$242.25,$109.01,$172.89,$0.00,$40.52,$0.00,$0.00,$42.42,$242.25,$0.00,$121.13,$191.86,$193.80,$0.00,$36.81,$0.00,$38.57,$0.00
294.772,SUP,HCPCS C1713,,294.772  -  SCREW BONE 4/3MM 100MM 20MM SLFDRILL SCHANZ STAINLESS STEEL,$242.25,$0.00,$242.25,$109.01,$172.89,$0.00,$40.52,$0.00,$0.00,$42.42,$242.25,$0.00,$121.13,$191.86,$193.80,$0.00,$36.81,$0.00,$38.57,$0.00
294.773,SUP,HCPCS C1713,,294.773  -  SCREW BONE 4MM 3MM 65MM 18MM SELF DRILL SCHANZ STAINLESS,$242.25,$0.00,$242.25,$109.01,$172.89,$0.00,$40.52,$0.00,$0.00,$42.42,$242.25,$0.00,$121.13,$191.86,$193.80,$0.00,$36.81,$0.00,$38.57,$0.00
294.774,SUP,HCPCS C1713,,294.774  -  SCREW BONE 4MM 60MM 20MM SELF DRILL SCHANZ STAINLESS STEEL,$242.25,$0.00,$242.25,$109.01,$172.89,$0.00,$40.52,$0.00,$0.00,$42.42,$242.25,$0.00,$121.13,$191.86,$193.80,$0.00,$36.81,$0.00,$38.57,$0.00
294.775,SUP,HCPCS C1713,,294.775  -  SCREW XTRNFX 4MM 80MM NS 20MM SCHNZ SLF DRL MR CONDITIONAL,$242.25,$0.00,$242.25,$109.01,$172.89,$0.00,$40.52,$0.00,$0.00,$42.42,$242.25,$0.00,$121.13,$191.86,$193.80,$0.00,$36.81,$0.00,$38.57,$0.00
294.776,SUP,HCPCS C1713,,294.776  -  SCREW XTRNFX 4MM 100MM NS 30MM SCHNZ SLF DRL MR CONDITIONAL,$242.25,$0.00,$242.25,$109.01,$172.89,$0.00,$40.52,$0.00,$0.00,$42.42,$242.25,$0.00,$121.13,$191.86,$193.80,$0.00,$36.81,$0.00,$38.57,$0.00
294.777,SUP,HCPCS C1713,,294.777  -  SCREW XTRNFX 4MM 125MM NS 40MM SCHNZ SLF DRL MR CONDITIONAL,$242.25,$0.00,$242.25,$109.01,$172.89,$0.00,$40.52,$0.00,$0.00,$42.42,$242.25,$0.00,$121.13,$191.86,$193.80,$0.00,$36.81,$0.00,$38.57,$0.00
294.778,SUP,HCPCS C1713,,294.778  -  SCREW XTRNFX 4MM 150MM NS 40MM SCHNZ SLF DRL MR CONDITIONAL,$242.25,$0.00,$242.25,$109.01,$172.89,$0.00,$40.52,$0.00,$0.00,$42.42,$242.25,$0.00,$121.13,$191.86,$193.80,$0.00,$36.81,$0.00,$38.57,$0.00
294.779,SUP,HCPCS C1713,,294.779  -  SCREW XTRNFX 4MM 175MM NS 40MM SCHNZ SLF DRL MR CONDITIONAL,$242.25,$0.00,$242.25,$109.01,$172.89,$0.00,$40.52,$0.00,$0.00,$42.42,$242.25,$0.00,$121.13,$191.86,$193.80,$0.00,$36.81,$0.00,$38.57,$0.00
294.782,SUP,HCPCS C1713,,294.782  -  SCREW XTRNFX 5MM 100MM NS 30MM SCHNZ SLF DRL MR CONDITIONAL,$273.63,$0.00,$273.63,$123.13,$195.29,$0.00,$45.77,$0.00,$0.00,$47.91,$273.63,$0.00,$136.81,$216.71,$218.90,$0.00,$41.57,$0.00,$43.56,$0.00
294.783,SUP,HCPCS C1713,,294.783  -  SCREW XTRNFX 5MM 125MM NS 40MM SCHNZ SLF DRL SS HIP CNDYL LG,$273.63,$0.00,$273.63,$123.13,$195.29,$0.00,$45.77,$0.00,$0.00,$47.91,$273.63,$0.00,$136.81,$216.71,$218.90,$0.00,$41.57,$0.00,$43.56,$0.00
294.784,SUP,HCPCS C1713,,294.784  -  SCREW XTRNFX 5MM 150MM NS 60MM SCHNZ SLF DRL MR CONDITIONAL,$273.63,$0.00,$273.63,$123.13,$195.29,$0.00,$45.77,$0.00,$0.00,$47.91,$273.63,$0.00,$136.81,$216.71,$218.90,$0.00,$41.57,$0.00,$43.56,$0.00
294.785,SUP,HCPCS C1713,,294.785  -  SCREW XTRNFX 5MM 175MM NS 60MM SCHNZ SLF DRL MR CONDITIONAL,$273.63,$0.00,$273.63,$123.13,$195.29,$0.00,$45.77,$0.00,$0.00,$47.91,$273.63,$0.00,$136.81,$216.71,$218.90,$0.00,$41.57,$0.00,$43.56,$0.00
294.786,SUP,HCPCS C1713,,294.786  -  SCREW XTRNFX 5MM 200MM NS 80MM SCHNZ SLF DRL MR CONDITIONAL,$273.63,$0.00,$273.63,$123.13,$195.29,$0.00,$45.77,$0.00,$0.00,$47.91,$273.63,$0.00,$136.81,$216.71,$218.90,$0.00,$41.57,$0.00,$43.56,$0.00
294.788,SUP,HCPCS C1713,,294.788  -  SCREW XTRNFX 5MM 250MM NS 80MM SCHNZ SLF DRL MR CONDITIONAL,$273.63,$0.00,$273.63,$123.13,$195.29,$0.00,$45.77,$0.00,$0.00,$47.91,$273.63,$0.00,$136.81,$216.71,$218.90,$0.00,$41.57,$0.00,$43.56,$0.00
294.792,SUP,HCPCS C1713,,294.792  -  SCREW BONE 6MM 100MM 30MM SLFDRILL SCHANZ STAINLESS STEEL,$292.00,$0.00,$292.00,$131.40,$208.40,$0.00,$48.85,$0.00,$0.00,$51.13,$292.00,$0.00,$146.00,$231.26,$233.60,$0.00,$44.37,$0.00,$46.49,$0.00
294.793,SUP,HCPCS C1713,,294.793  -  SCREW BONE 6MM 125MM 40MM SLFDRILL SCHANZ STAINLESS STEEL,$292.00,$0.00,$292.00,$131.40,$208.40,$0.00,$48.85,$0.00,$0.00,$51.13,$292.00,$0.00,$146.00,$231.26,$233.60,$0.00,$44.37,$0.00,$46.49,$0.00
294.794,SUP,HCPCS C1713,,294.794  -  SCREW BONE 6MM 150MM 60MM SELF DRILL SCHANZ STAINLESS STEEL,$292.00,$0.00,$292.00,$131.40,$208.40,$0.00,$48.85,$0.00,$0.00,$51.13,$292.00,$0.00,$146.00,$231.26,$233.60,$0.00,$44.37,$0.00,$46.49,$0.00
294.795,SUP,HCPCS C1713,,294.795  -  SCREW BONE 6MM 175MM 60MM SLFDRILL SCHANZ STAINLESS STEEL,$292.00,$0.00,$292.00,$131.40,$208.40,$0.00,$48.85,$0.00,$0.00,$51.13,$292.00,$0.00,$146.00,$231.26,$233.60,$0.00,$44.37,$0.00,$46.49,$0.00
294.796,SUP,HCPCS C1713,,294.796  -  SCREW BONE 6MM 200MM 80MM SELF DRILL SCHANZ STAINLESS STEEL,$292.00,$0.00,$292.00,$131.40,$208.40,$0.00,$48.85,$0.00,$0.00,$51.13,$292.00,$0.00,$146.00,$231.26,$233.60,$0.00,$44.37,$0.00,$46.49,$0.00
294.798,SUP,HCPCS C1713,,294.798  -  SCREW XTRNFX 4MM 175MM NS 40MM SCHNZ SLF DRL MR CONDITIONAL,$292.00,$0.00,$292.00,$131.40,$208.40,$0.00,$48.85,$0.00,$0.00,$51.13,$292.00,$0.00,$146.00,$231.26,$233.60,$0.00,$44.37,$0.00,$46.49,$0.00
294.95,SUP,Custom 27203010,,294.950  -  PIN FIX 6MM 225MM TRANSFIXATION STEINMANN STAINLESS STEEL,$208.73,$0.00,$208.73,$0.00,$148.97,$0.00,$0.00,$0.00,$0.00,$0.00,$208.73,$0.00,$104.36,$165.31,$166.98,$0.00,$0.00,$0.00,$0.00,$0.00
296.757,SUP,Custom 27803010,,296.757  -  NUT ORTH 6MM SCRL SS RND NONSTRL,$264.00,$0.00,$264.00,$0.00,$188.42,$0.00,$0.00,$0.00,$0.00,$0.00,$264.00,$0.00,$132.00,$209.09,$211.20,$0.00,$0.00,$0.00,$0.00,$0.00
296.758,SUP,Custom 27803010,,296.758  -  WASHER SPNL 6MM SCRL SS NONSTRL,$264.00,$0.00,$264.00,$0.00,$188.42,$0.00,$0.00,$0.00,$0.00,$0.00,$264.00,$0.00,$132.00,$209.09,$211.20,$0.00,$0.00,$0.00,$0.00,$0.00
296.759,SUP,Custom 27803010,,296.759  -  NUT ORTH 6MM SCRL SS HEX NONSTRL,$244.75,$0.00,$244.75,$0.00,$174.68,$0.00,$0.00,$0.00,$0.00,$0.00,$244.75,$0.00,$122.38,$193.84,$195.80,$0.00,$0.00,$0.00,$0.00,$0.00
296.761,SUP,HCPCS C1713,,296.761  -  BAR SPNL 160MM 6MM SCRL SPN SS THRD NONSTRL,"$1,334.50",$0.00,"$1,334.50",$600.53,$952.43,$0.00,$229.93,$0.00,$0.00,$233.66,"$1,334.50",$0.00,$667.25,"$1,056.92","$1,067.60",$0.00,$208.85,$0.00,$212.45,$0.00
296.763,SUP,HCPCS C1713,,296.763  -  BAR SPINAL 6MM 200MM THREADED KIT SACRAL NONSTRL,"$1,175.05",$0.00,"$1,175.05",$528.77,$838.63,$0.00,$196.56,$0.00,$0.00,$205.74,"$1,175.05",$0.00,$587.53,$930.64,$940.04,$0.00,$178.54,$0.00,$187.07,$0.00
296.765,SUP,HCPCS C1713,,296.765  -  BAR SPNL 240MM 6MM SCRL SPN SS THRD NONSTRL,"$1,415.75",$0.00,"$1,415.75",$637.09,"$1,010.42",$0.00,$243.93,$0.00,$0.00,$247.89,"$1,415.75",$0.00,$707.88,"$1,121.27","$1,132.60",$0.00,$221.56,$0.00,$225.39,$0.00
296.766,SUP,HCPCS C1713,,296.766  -  BAR SPINAL 6MM 260MM THREAD STAINLESS STEEL SACRAL SPN,"$1,175.05",$0.00,"$1,175.05",$528.77,$838.63,$0.00,$196.56,$0.00,$0.00,$205.74,"$1,175.05",$0.00,$587.53,$930.64,$940.04,$0.00,$178.54,$0.00,$187.07,$0.00
304,SUP,HCPCS C1778,,304  -  LEAD NEUROSTIMULATOR 3MM 43CM BIPOL PERENNIAFLEX SILICONE,"$17,070.00",$0.00,"$17,070.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$17,070.00",$0.00,"$8,535.00","$13,519.44","$13,656.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.008,SUP,Custom 27803010,,304.008  -  SPACER SPNL OBLQ 26X10X8MM NS LF SUST O RDLCNT PEEK LMBR,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.009,SUP,Custom 27803010,,304.009  -  SPACER SPNL OBLQ 26X10X9MM NS LF SUST RDLCNT PEEK LMBR,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.01,SUP,Custom 27803010,,304.010  -  SPACER SPNL OBLQ 26X10X10MM NS LF SUST O RDLCNT PEEK LMBR,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.011,SUP,Custom 27803010,,304.011  -  SPACER SPNL OBLQ 26X10X11MM NS LF SUST O RDLCNT PEEK LMBR,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.012,SUP,Custom 27803010,,304.012  -  SPACER SPNL OBLQ 26X10X12MM NS LF SUST O RDLCNT PEEK LMBR,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.013,SUP,Custom 27803010,,304.013  -  SPACER SPNL OBLQ 26X10X13MM NS LF SUST O RDLCNT PEEK LMBR,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.014,SUP,Custom 27803010,,304.014  -  SPACER SPNL OBLQ 26X10X14MM NS LF SUST O RDLCNT PEEK LMBR,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.015,SUP,Custom 27803010,,304.015  -  SPACER SPNL OBLQ 26X10X15MM NS LF SUST O RDLCNT PEEK LMBR,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.017,SUP,Custom 27803010,,304.017  -  SPACER SPNL OBLQ 26X10X17MM NS LF SUST O RDLCNT PEEK LMBR,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.065,SUP,Custom 27803010,,304.065  -  SPACER SPNL 13MM MED CNVX 14X5MM NS LF SUST O RDLCNT BEAD,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.066,SUP,Custom 27803010,,304.066  -  SPACER SPNL 13MM MED CNVX 14X6MM NS LF SUST O RDLCNT BEAD,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.067,SUP,Custom 27803010,,304.067  -  SPACER SPNL 13MM MED CNVX 14X7MM NS LF SUST O RDLCNT BEAD,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.068,SUP,Custom 27803010,,304.068  -  SPACER SPNL 13MM MED CNVX 14X8MM NS LF SUST O RDLCNT BEAD,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.069,SUP,Custom 27803010,,304.069  -  SPACER SPNL 13MM MED CNVX 14X9MM NS LF SUST O RDLCNT BEAD,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.07,SUP,Custom 27803010,,304.070  -  SPACER SPNL 13MM MED CNVX 14X10MM NS LF SUST O RDLCNT BEAD,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.071,SUP,Custom 27803010,,304.071  -  SPACER SPNL 13MM MED CNVX 14X11MM NS LF SUST O RDLCNT BEAD,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.072,SUP,Custom 27803010,,304.072  -  SPACER SPNL 13MM MED CNVX 14X12MM NS LF SUST O RDLCNT BEAD,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.078,SUP,Custom 27803010,,304.078  -  SPACER SPNL SM OBLQ 22X8X8MM NS LF SUST O RDLCNT PEEK LMBR,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.079,SUP,Custom 27803010,,304.079  -  SPACER SPNL SM OBLQ 22X8X9MM NS LF SUST O RDLCNT PEEK LMBR,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.08,SUP,Custom 27803010,,304.080  -  SPACER SPNL SM OBLQ 22X8X10MM NS LF SUST O RDLCNT PEEK LMBR,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.081,SUP,Custom 27803010,,304.081  -  SPACER SPNL SM OBLQ 22X8X11MM NS LF SUST O RDLCNT PEEK LMBR,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.082,SUP,Custom 27803010,,304.082  -  SPACER SPNL SM OBLQ 22X8X12MM NS LF SUST O RDLCNT PEEK LMBR,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.083,SUP,Custom 27803010,,304.083  -  SPACER SPNL SM OBLQ 22X8X13MM NS LF SUST O RDLCNT PEEK LMBR,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.085,SUP,Custom 27803010,,304.085  -  SPACER SPNL SM OBLQ 22X8X15MM NS LF SUST O RDLCNT PEEK LMBR,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.087,SUP,Custom 27803010,,304.087  -  SPACER SPNL SM OBLQ 22X8X17MM NS LF SUST O RDLCNT PEEK LMBR,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.088,SUP,Custom 27803010,,304.088  -  SPACER SPNL SM OBLQ 22X10X8MM NS LF SUST O RDLCNT PEEK LMBR,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.089,SUP,Custom 27803010,,304.089  -  SPACER SPNL SM OBLQ 22X10X9MM NS LF SUST O RDLCNT PEEK LMBR,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.09,SUP,Custom 27803010,,304.090  -  SPACER SPNL SM OBLQ 22X10X10MM NS LF SUST O RDLCNT PEEK LMBR,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.091,SUP,Custom 27803010,,304.091  -  SPACER SPNL SM OBLQ 22X10X11MM NS LF SUST O RDLCNT PEEK LMBR,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.092,SUP,Custom 27803010,,304.092  -  SPACER SPNL SM OBLQ 22X10X12MM NS LF SUST O RDLCNT PEEK LMBR,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.093,SUP,Custom 27803010,,304.093  -  SPACER SPNL SM OBLQ 22X10X13MM NS LF SUST O RDLCNT PEEK LMBR,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.095,SUP,Custom 27803010,,304.095  -  SPACER SPNL SM OBLQ 22X10X15MM NS LF SUST O RDLCNT PEEK LMBR,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.097,SUP,Custom 27803010,,304.097  -  SPACER SPNL SM OBLQ 22X10X17MM NS LF SUST O RDLCNT PEEK LMBR,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.104,SUP,Custom 27803010,,304.104  -  MARKER SRG 4MM WHT SCR LGTH SLFDRL SCR,$106.88,$0.00,$106.88,$0.00,$76.28,$0.00,$0.00,$0.00,$0.00,$0.00,$106.88,$0.00,$53.44,$84.65,$85.50,$0.00,$0.00,$0.00,$0.00,$0.00
304.105,SUP,Custom 27803010,,304.105  -  MARKER SRG 5MM WHT SCR LGTH SLF DRL SCR,$106.88,$0.00,$106.88,$0.00,$76.28,$0.00,$0.00,$0.00,$0.00,$0.00,$106.88,$0.00,$53.44,$84.65,$85.50,$0.00,$0.00,$0.00,$0.00,$0.00
304.107,SUP,Custom 27803010,,304.107  -  SPACER SPNL SM 22X10X7MM NS LF SUST O RDLCNT PEEK LMBR,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.109,SUP,Custom 27803010,,304.109  -  SPACER SPNL SM 22X10X9MM NS LF SUST O RDLCNT PEEK LMBR,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.111,SUP,Custom 27803010,,304.111  -  SPACER SPNL SM 22X10X11MM NS LF SUST O RDLCNT PEEK LMBR,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.113,SUP,Custom 27803010,,304.113  -  SPACER SPNL SM 22X10X13MM NS LF SUST O RDLCNT PEEK LMBR,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.115,SUP,Custom 27803010,,304.115  -  SPACER SPNL SM 22X10X15MM NS LF SUST O RDLCNT PEEK LMBR,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.117,SUP,Custom 27803010,,304.117  -  SPACER SPNL SM 22X10X17MM NS LF SUST O RDLCNT PEEK LMBR,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.119,SUP,Custom 27803010,,304.119  -  SPACER SPNL SM 22X10X19MM NS LF SUST O RDLCNT PEEK LMBR,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.121,SUP,Custom 27803010,,304.121  -  SPACER SPNL SM 22X10X21MM NS LF SUST O RDLCNT PEEK LMBR,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.159,SUP,Custom 27803010,,304.159  -  SPACER SPNL SM 18X10X9MM NS LF SUST O RDLCNT PEEK LMBR,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.161,SUP,Custom 27803010,,304.161  -  SPACER SPNL SM 18X10X11MM NS LF SUST O RDLCNT PEEK LMBR,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.163,SUP,Custom 27803010,,304.163  -  SPACER SPNL SM 18X10X13MM NS LF SUST O RDLCNT PEEK LMBR,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.165,SUP,Custom 27803010,,304.165  -  SPACER SPNL SM 18X10X15MM NS LF SUST O RDLCNT PEEK LMBR,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.167,SUP,Custom 27803010,,304.167  -  SPACER SPNL SM 18X10X17MM NS LF SUST O RDLCNT PEEK LMBR,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.205,SUP,Custom 27803010,,304.205  -  SPACER SPNL 13MM MED PRLL 14X5MM NS LF SUST O RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.206,SUP,Custom 27803010,,304.206  -  SPACER SPNL 13MM MED PRLL 14X6MM NS LF SUST O RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.207,SUP,Custom 27803010,,304.207  -  SPACER SPNL 13MM MED PRLL 14X7MM NS LF SUST R RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.208,SUP,Custom 27803010,,304.208  -  SPACER SPNL 13MM MED PRLL 14X8MM NS LF SUST R RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.209,SUP,Custom 27803010,,304.209  -  SPACER SPNL 13MM MED PRLL 14X9MM NS LF SUST R RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.21,SUP,Custom 27803010,,304.210  -  SPACER SPNL 13MM MED PRLL 14X10MM NS LF SUST R RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.211,SUP,Custom 27803010,,304.211  -  SPACER SPNL 13MM MED PRLL 14X11MM NS LF SUST O RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.212,SUP,Custom 27803010,,304.212  -  SPACER SPNL 13MM MED PRLL 14X12MM NS LF SUST O RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.225,SUP,Custom 27803010,,304.225  -  SPACER SPNL 7D LRDTC 13MM MED 14X5MM NS LF SUST R RDLCNT,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.226,SUP,Custom 27803010,,304.226  -  SPACER SPNL 7D LRDTC 13MM MED 14X6MM NS LF SUST R RDLCNT,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.227,SUP,Custom 27803010,,304.227  -  SPACER SPNL 7D LRDTC 13MM MED 14X7MM NS LF SUST R RDLCNT,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.228,SUP,Custom 27803010,,304.228  -  SPACER SPNL 7D LRDTC 13MM MED 14X8MM NS LF SUST R RDLCNT,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.229,SUP,Custom 27803010,,304.229  -  SPACER SPNL 7D LRDTC 13MM MED 14X9MM NS LF SUST R RDLCNT,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.23,SUP,Custom 27803010,,304.230  -  SPACER SPNL 7D LRDTC 13MM MED 14X10MM NS LF SUST R RDLCNT,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.231,SUP,Custom 27803010,,304.231  -  SPACER SPNL 7D LRDTC 13MM MED 14X11MM NS LF SUST O RDLCNT,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.232,SUP,Custom 27803010,,304.232  -  SPACER SPNL 7D LRDTC 13MM MED 14X12MM NS LF SUST O RDLCNT,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.245,SUP,Custom 27803010,,304.245  -  SPACER SPNL 13MM MED CNVX 14X5MM NS LF SUST O RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.246,SUP,Custom 27803010,,304.246  -  SPACER SPNL 13MM MED CNVX 14X6MM NS LF SUST O RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.247,SUP,Custom 27803010,,304.247  -  SPACER SPNL 13MM MED CNVX 14X7MM NS LF SUST O RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.248,SUP,Custom 27803010,,304.248  -  SPACER SPNL 13MM MED CNVX 14X8MM NS LF SUST O RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.249,SUP,Custom 27803010,,304.249  -  SPACER SPNL 13MM MED CNVX 14X9MM NS LF SUST O RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.25,SUP,Custom 27803010,,304.250  -  SPACER SPNL 13MM MED CNVX 14X10MM NS LF SUST O RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.251,SUP,Custom 27803010,,304.251  -  SPACER SPNL 13MM MED CNVX 14X11MM NS LF SUST O RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.252,SUP,Custom 27803010,,304.252  -  SPACER SPNL 13MM MED CNVX 14X12MM NS LF SUST O RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.265,SUP,Custom 27803010,,304.265  -  SPACER SPNL 13MM MED PRLL 14X5MM NS LF SUST O RDLCNT BEAD,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.266,SUP,Custom 27803010,,304.266  -  SPACER SPNL 13MM MED PRLL 14X6MM NS LF SUST O RDLCNT BEAD,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.267,SUP,Custom 27803010,,304.267  -  SPACER SPNL 13MM MED PRLL 14X7MM NS LF SUST O RDLCNT BEAD,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.268,SUP,Custom 27803010,,304.268  -  SPACER SPNL 13MM MED PRLL 14X8MM NS LF SUST O RDLCNT BEAD,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.269,SUP,Custom 27803010,,304.269  -  SPACER SPNL 13MM MED PRLL 14X9MM NS LF SUST O RDLCNT BEAD,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.27,SUP,Custom 27803010,,304.270  -  SPACER SPNL 13MM MED PRLL 14X10MM NS LF SUST O RDLCNT BEAD,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.271,SUP,Custom 27803010,,304.271  -  SPACER SPNL 13MM MED PRLL 14X11MM NS LF SUST O RDLCNT BEAD,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.272,SUP,Custom 27803010,,304.272  -  SPACER SPNL 13MM MED PRLL 14X12MM NS LF SUST O RDLCNT BEAD,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.275,SUP,Custom 27803010,,304.275  -  SPACER SPNL 7D LRDTC 13MM MED 14X5MM NS LF SUST O RDLCNT,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.276,SUP,Custom 27803010,,304.276  -  SPACER SPNL 7D LRDTC 13MM MED 14X6MM NS LF SUST O RDLCNT,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.277,SUP,Custom 27803010,,304.277  -  SPACER SPNL 7D LRDTC 13MM MED 14X7MM NS LF SUST O RDLCNT,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.278,SUP,Custom 27803010,,304.278  -  SPACER SPNL 7D LRDTC 13MM MED 14X8MM NS LF SUST O RDLCNT,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.279,SUP,Custom 27803010,,304.279  -  SPACER SPNL 7D LRDTC 13MM MED 14X9MM NS LF SUST O RDLCNT,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.28,SUP,Custom 27803010,,304.280  -  SPACER SPNL 7D LRDTC 13MM MED 14X10MM NS LF SUST O RDLCNT,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.281,SUP,Custom 27803010,,304.281  -  SPACER SPNL 7D LRDTC 13MM MED 14X11MM NS LF SUST O RDLCNT,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.282,SUP,Custom 27803010,,304.282  -  SPACER SPNL 7D LRDTC 13MM MED 14X12MM NS LF SUST O RDLCNT,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.309,SUP,Custom 27803010,,304.309  -  SPACER SPNL 31MM LG 25X9MM NS LF SUST O RDLCNT PEEK THORLMBR,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.311,SUP,Custom 27803010,,304.311  -  SPACER SPNL 31MM LG 25X11MM NS LF SUST O RDLCNT PEEK,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.313,SUP,Custom 27803010,,304.313  -  SPACER SPNL 31MM LG 25X13MM NS LF SUST O RDLCNT PEEK,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.315,SUP,Custom 27803010,,304.315  -  SPACER SPNL 31MM LG 25X15MM NS LF SUST O RDLCNT PEEK,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.317,SUP,Custom 27803010,,304.317  -  SPACER SPNL 31MM LG 25X17MM NS LF SUST O RDLCNT PEEK,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.319,SUP,Custom 27803010,,304.319  -  SPACER SPNL 31MM LG 25X19MM NS LF SUST O RDLCNT PEEK,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.321,SUP,Custom 27803010,,304.321  -  SPACER SPNL 31MM LG 25X21MM NS LF SUST O RDLCNT PEEK,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.351,SUP,Custom 27803010,,304.351  -  SPACER SPNL 15D LRDTC 31MM LG 25X11MM NS LF SUST O RDLCNT,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.352,SUP,Custom 27803010,,304.352  -  SPACER SPNL 15D LRDTC 31MM LG 25X13MM NS LF SUST O RDLCNT,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.353,SUP,Custom 27803010,,304.353  -  SPACER SPNL 15D LRDTC 31MM LG 25X15MM NS LF SUST O RDLCNT,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.354,SUP,Custom 27803010,,304.354  -  SPACER SPNL 15D LRDTC 31MM LG 25X17MM NS LF SUST O RDLCNT,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.355,SUP,Custom 27803010,,304.355  -  SPACER SPNL 15D LRDTC 31MM LG 25X19MM NS LF SUST O RDLCNT,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.356,SUP,Custom 27803010,,304.356  -  SPACER SPNL 15D LRDTC 31MM LG 25X21MM NS LF SUST O RDLCNT,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.359,SUP,Custom 27803010,,304.359  -  SPACER SPNL 42MM XL 28X9MM NS LF SUST O RDLCNT PEEK THORLMBR,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.361,SUP,Custom 27803010,,304.361  -  SPACER SPNL 42MM XL 28X11MM NS LF SUST O RDLCNT PEEK,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.363,SUP,Custom 27803010,,304.363  -  SPACER SPNL 42MM XL 28X13MM NS LF SUST O RDLCNT PEEK,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.365,SUP,Custom 27803010,,304.365  -  SPACER SPNL 42MM XL 28X15MM NS LF SUST O RDLCNT PEEK,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.367,SUP,Custom 27803010,,304.367  -  SPACER SPNL 42MM XL 28X17MM NS LF SUST O RDLCNT PEEK,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.369,SUP,Custom 27803010,,304.369  -  SPACER SPNL 42MM XL 28X19MM NS LF SUST O RDLCNT PEEK,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.371,SUP,Custom 27803010,,304.371  -  SPACER SPNL 42MM XL 28X21MM NS LF SUST O RDLCNT PEEK,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.379,SUP,Custom 27803010,,304.379  -  SPACER SPNL 42MM XL 28X9MM NS LF SUST O RDLCNT PEEK ALAT,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.381,SUP,Custom 27803010,,304.381  -  SPACER SPNL 42MM XL 28X11MM NS LF SUST O RDLCNT PEEK ALAT,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.383,SUP,Custom 27803010,,304.383  -  SPACER SPNL 42MM XL 28X13MM NS LF SUST O RDLCNT PEEK ALAT,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.385,SUP,Custom 27803010,,304.385  -  SPACER SPNL 42MM XL 28X15MM NS LF SUST O RDLCNT PEEK ALAT,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.387,SUP,Custom 27803010,,304.387  -  SPACER SPNL 42MM XL 28X17MM NS LF SUST O RDLCNT PEEK ALAT,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.389,SUP,Custom 27803010,,304.389  -  SPACER SPNL 42MM XL 28X19MM NS LF SUST O RDLCNT PEEK ALAT,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.391,SUP,Custom 27803010,,304.391  -  SPACER SPNL 42MM XL 28X21MM NS LF SUST O RDLCNT PEEK ALAT,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.409,SUP,Custom 27803010,,304.409  -  SPACER SPNL 31MM LG 25X9MM NS LF SUST O RDLCNT PEEK LAT,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.411,SUP,Custom 27803010,,304.411  -  SPACER SPNL 31MM LG 25X11MM NS LF SUST O RDLCNT PEEK LAT,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.413,SUP,Custom 27803010,,304.413  -  SPACER SPNL 31MM LG 25X13MM NS LF SUST O RDLCNT PEEK LAT,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.415,SUP,Custom 27803010,,304.415  -  SPACER SPNL 31MM LG 25X15MM NS LF SUST O RDLCNT PEEK LAT,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.417,SUP,Custom 27803010,,304.417  -  SPACER SPNL 31MM LG 25X17MM NS LF SUST O RDLCNT PEEK LAT,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.419,SUP,Custom 27803010,,304.419  -  SPACER SPNL 31MM LG 25X19MM NS LF SUST O RDLCNT PEEK LAT,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.421,SUP,Custom 27803010,,304.421  -  SPACER SPNL 31MM LG 25X21MM NS LF SUST O RDLCNT PEEK LAT,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.45,SUP,Custom 27803010,,304.450  -  SPACER SPNL 4D LRDTC 31MM LG 25X9MM NS LF SUST O RDLCNT PEEK,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.451,SUP,Custom 27803010,,304.451  -  SPACER SPNL 4D LRDTC 31MM LG 25X11MM NS LF SUST O RDLCNT,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.452,SUP,Custom 27803010,,304.452  -  SPACER SPNL 4D LRDTC 31MM LG 25X13MM NS LF SUST O RDLCNT,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.453,SUP,Custom 27803010,,304.453  -  SPACER SPNL 4D LRDTC 31MM LG 25X15MM NS LF SUST O RDLCNT,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.454,SUP,Custom 27803010,,304.454  -  SPACER SPNL 4D LRDTC 31MM LG 25X17MM NS LF SUST O RDLCNT,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.455,SUP,Custom 27803010,,304.455  -  SPACER SPNL 4D LRDTC 31MM LG 25X19MM NS LF SUST O RDLCNT,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.456,SUP,Custom 27803010,,304.456  -  SPACER SPNL 4D LRDTC 31MM LG 25X21MM NS LF SUST O RDLCNT,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.509,SUP,Custom 27803010,,304.509  -  SPACER SPNL 31MM LG 25X9MM NS LF SUST O RDLCNT PEEK ALAT,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.511,SUP,Custom 27803010,,304.511  -  SPACER SPNL 31MM LG 25X11MM NS LF SUST O RDLCNT PEEK ALAT,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.513,SUP,Custom 27803010,,304.513  -  SPACER SPNL 31MM LG 25X13MM NS LF SUST O RDLCNT PEEK ALAT,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.515,SUP,Custom 27803010,,304.515  -  SPACER SPNL 31MM LG 25X15MM NS LF SUST O RDLCNT PEEK ALAT,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.517,SUP,Custom 27803010,,304.517  -  SPACER SPNL 31MM LG 25X17MM NS LF SUST O RDLCNT PEEK ALAT,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.519,SUP,Custom 27803010,,304.519  -  SPACER SPNL 31MM LG 25X19MM NS LF SUST O RDLCNT PEEK ALAT,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.521,SUP,Custom 27803010,,304.521  -  SPACER SPNL 31MM LG 25X21MM NS LF SUST O RDLCNT PEEK ALAT,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.607,SUP,Custom 27803010,,304.607  -  SPACER SPNL SM ARCH 27X9.5X7MM NS LF SUST RDLCNT PEEK TLIF,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.609,SUP,Custom 27803010,,304.609  -  SPACER SPNL SM ARCH 27X9.5X9MM NS LF SUST RDLCNT PEEK TLIF,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.611,SUP,Custom 27803010,,304.611  -  SPACER SPNL SM ARCH 27X9.5X11MM NS LF SUST RDLCNT PEEK TLIF,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.613,SUP,Custom 27803010,,304.613  -  SPACER SPNL SM ARCH 27X9.5X13MM NS LF SUST RDLCNT PEEK TLIF,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.615,SUP,Custom 27803010,,304.615  -  SPACER SPNL SM ARCH 27X9.5X15MM NS LF SUST RDLCNT PEEK TLIF,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.617,SUP,Custom 27803010,,304.617  -  SPACER SPNL SM ARCH 27X9.5X17MM NS LF SUST RDLCNT PEEK TLIF,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.707,SUP,Custom 27803010,,304.707  -  SPACER SPNL SM NAR 22X8X7MM NS LF SUST R RDLCNT PEEK LMBR,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.709,SUP,Custom 27803010,,304.709  -  SPACER SPNL SM NAR 22X8X9MM NS LF SUST R RDLCNT PEEK LMBR,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.711,SUP,Custom 27803010,,304.711  -  SPACER SPNL SM NAR 22X8X11MM NS LF SUST R RDLCNT PEEK LMBR,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.713,SUP,Custom 27803010,,304.713  -  SPACER SPNL SM NAR 22X8X13MM NS LF SUST R RDLCNT PEEK LMBR,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.715,SUP,Custom 27803010,,304.715  -  SPACER SPNL SM NAR 22X8X15MM NS LF SUST R RDLCNT PEEK LMBR,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.717,SUP,Custom 27803010,,304.717  -  SPACER SPNL SM NAR 22X8X17MM NS LF SUST R RDLCNT PEEK LMBR,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.808,SUP,Custom 27803010,,304.808  -  SPACER SPNL OBLQ 30X10X8MM NS LF SUST RDLCNT PEEK LMBR,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.809,SUP,Custom 27803010,,304.809  -  SPACER SPNL OBLQ 30X10X9MM NS LF SUST RDLCNT PEEK LMBR,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.81,SUP,Custom 27803010,,304.810  -  SPACER SPNL OBLQ 30X10X10MM NS LF SUST RDLCNT PEEK LMBR,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.811,SUP,Custom 27803010,,304.811  -  SPACER SPNL OBLQ 30X10X11MM NS LF SUST RDLCNT PEEK LMBR,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.812,SUP,Custom 27803010,,304.812  -  SPACER SPNL OBLQ 30X10X12MM NS LF SUST RDLCNT PEEK LMBR,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.813,SUP,Custom 27803010,,304.813  -  SPACER SPNL OBLQ 30X10X13MM NS LF SUST RDLCNT PEEK LMBR,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.814,SUP,Custom 27803010,,304.814  -  SPACER SPNL OBLQ 30X10X14MM NS LF SUST RDLCNT PEEK LMBR,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.815,SUP,Custom 27803010,,304.815  -  SPACER SPNL OBLQ 30X10X15MM NS LF SUST RDLCNT PEEK LMBR,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.817,SUP,Custom 27803010,,304.817  -  SPACER SPNL OBLQ 30X10X17MM NS LF SUST RDLCNT PEEK LMBR,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.868,SUP,Custom 27803010,,304.868  -  SPACER SPNL OBLQ 30X12X8MM NS LF SUST RDLCNT PEEK LMBR,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.869,SUP,Custom 27803010,,304.869  -  SPACER SPNL OBLQ 30X12X9MM NS LF SUST RDLCNT PEEK LMBR,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.87,SUP,Custom 27803010,,304.870  -  SPACER SPNL OBLQ 30X12X10MM NS LF SUST RDLCNT PEEK LMBR,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.871,SUP,Custom 27803010,,304.871  -  SPACER SPNL OBLQ 30X12X11MM NS LF SUST RDLCNT PEEK LMBR,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.872,SUP,Custom 27803010,,304.872  -  SPACER SPNL OBLQ 30X12X12MM NS LF SUST RDLCNT PEEK LMBR,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.873,SUP,Custom 27803010,,304.873  -  SPACER SPNL OBLQ 30X12X13MM NS LF SUST RDLCNT PEEK LMBR,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.874,SUP,Custom 27803010,,304.874  -  SPACER SPNL OBLQ 30X12X14MM NS LF SUST RDLCNT PEEK LMBR,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.875,SUP,Custom 27803010,,304.875  -  SPACER SPNL OBLQ 30X12X15MM NS LF SUST RDLCNT PEEK LMBR,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.877,SUP,Custom 27803010,,304.877  -  SPACER SPNL OBLQ 30X12X17MM NS LF SUST RDLCNT PEEK LMBR,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.905,SUP,Custom 27803010,,304.905  -  SPACER SPNL 11MM MED NAR PRLL 12X5MM NS LF SUST RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.906,SUP,Custom 27803010,,304.906  -  SPACER SPNL 11MM MED NAR PRLL 12X6MM NS LF SUST RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.907,SUP,Custom 27803010,,304.907  -  SPACER SPNL 11MM MED NAR PRLL 12X7MM NS LF SUST RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.908,SUP,Custom 27803010,,304.908  -  SPACER SPNL 11MM MED NAR PRLL 12X8MM NS LF SUST RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.909,SUP,Custom 27803010,,304.909  -  SPACER SPNL 11MM MED NAR PRLL 12X9MM NS LF SUST RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.91,SUP,Custom 27803010,,304.910  -  SPACER SPNL 11MM MED NAR PRLL 12X10MM NS LF SUST RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.911,SUP,Custom 27803010,,304.911  -  SPACER SPNL 11MM MED NAR PRLL 12X11MM NS LF SUST RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.912,SUP,Custom 27803010,,304.912  -  SPACER SPNL 11MM MED NAR PRLL 12X12MM NS LF SUST RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.925,SUP,Custom 27803010,,304.925  -  SPACER SPNL 11MM LRDTC MED NAR 12X5MM NS LF SUST RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.926,SUP,Custom 27803010,,304.926  -  SPACER SPNL 11MM LRDTC MED NAR 12X6MM NS LF SUST RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.927,SUP,Custom 27803010,,304.927  -  SPACER SPNL 11MM LRDTC MED NAR 12X7MM NS LF SUST RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.928,SUP,Custom 27803010,,304.928  -  SPACER SPNL 11MM LRDTC MED NAR 12X8MM NS LF SUST RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.929,SUP,Custom 27803010,,304.929  -  SPACER SPNL 11MM LRDTC MED NAR 12X9MM NS LF SUST RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.93,SUP,Custom 27803010,,304.930  -  SPACER SPNL 11MM LRDTC MED NAR 12X10MM NS LF SUST RDLCNT,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.931,SUP,Custom 27803010,,304.931  -  SPACER SPNL 11MM LRDTC MED NAR 12X11MM NS LF SUST RDLCNT,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.932,SUP,Custom 27803010,,304.932  -  SPACER SPNL 11MM LRDTC MED NAR 12X12MM NS LF SUST RDLCNT,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.945,SUP,Custom 27803010,,304.945  -  SPACER SPNL 11MM MED CNVX NAR 12X5MM NS LF SUST RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.946,SUP,Custom 27803010,,304.946  -  SPACER SPNL 11MM MED CNVX NAR 12X6MM NS LF SUST RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.947,SUP,Custom 27803010,,304.947  -  SPACER SPNL 11MM MED CNVX NAR 12X7MM NS LF SUST RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.948,SUP,Custom 27803010,,304.948  -  SPACER SPNL 11MM MED CNVX NAR 12X8MM NS LF SUST RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.949,SUP,Custom 27803010,,304.949  -  SPACER SPNL 11MM MED CNVX NAR 12X9MM NS LF SUST RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.95,SUP,Custom 27803010,,304.950  -  SPACER SPNL 11MM MED CNVX NAR 12X10MM NS LF SUST RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.951,SUP,Custom 27803010,,304.951  -  SPACER SPNL 11MM MED CNVX NAR 12X11MM NS LF SUST RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.952,SUP,Custom 27803010,,304.952  -  SPACER SPNL 11MM MED CNVX NAR 12X12MM NS LF SUST RDLCNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.968,SUP,Custom 27803010,,304.968  -  SPACER SPNL OBLQ 26X12X8MM NS LF SUST RDLCNT PEEK INTRBD FS,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.969,SUP,Custom 27803010,,304.969  -  SPACER SPNL OBLQ 26X12X9MM NS LF SUST RDLCNT PEEK INTRBD FS,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.97,SUP,Custom 27803010,,304.970  -  SPACER SPNL OBLQ 26X12X10MM NS LF SUST RDLCNT PEEK INTRBD FS,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.971,SUP,Custom 27803010,,304.971  -  SPACER SPNL OBLQ 26X12X11MM NS LF SUST RDLCNT PEEK INTRBD FS,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.972,SUP,Custom 27803010,,304.972  -  SPACER SPNL OBLQ 26X12X12MM NS LF SUST RDLCNT PEEK INTRBD FS,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.973,SUP,Custom 27803010,,304.973  -  SPACER SPNL OBLQ 26X12X13MM NS LF SUST RDLCNT PEEK INTRBD FS,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.974,SUP,Custom 27803010,,304.974  -  SPACER SPNL OBLQ 26X12X14MM NS LF SUST RDLCNT PEEK INTRBD FS,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.975,SUP,Custom 27803010,,304.975  -  SPACER SPNL OBLQ 26X12X15MM NS LF SUST RDLCNT PEEK INTRBD FS,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
304.977,SUP,Custom 27803010,,304.977  -  SPACER SPNL OBLQ 26X12X17MM NS LF SUST RDLCNT PEEK INTRBD FS,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
308,SUP,HCPCS C1879,,308  -  MARKER CHARM MARGINMAP BRST BIOP 10MM STRL,$37.50,$0.00,$37.50,$0.00,$26.76,$0.00,$0.00,$0.00,$0.00,$0.00,$37.50,$0.00,$18.75,$29.70,$30.00,$0.00,$0.00,$0.00,$0.00,$0.00
309.521,SUP,HCPCS C1713,,309.521  -  SCREW BONE 3.5MM 21MM EXTRACTION FIBULA DISTAL NONSTRL,$121.48,$0.00,$121.48,$54.66,$86.70,$0.00,$20.32,$0.00,$0.00,$21.27,$121.48,$0.00,$60.74,$96.21,$97.18,$0.00,$18.46,$0.00,$19.34,$0.00
310.02,SUP,Custom 27203010,,310.02  -  BIT DRL 3.2MM 225MM NS QC UNV NL SYS,$278.40,$0.00,$278.40,$0.00,$198.69,$0.00,$0.00,$0.00,$0.00,$0.00,$278.40,$0.00,$139.20,$220.49,$222.72,$0.00,$0.00,$0.00,$0.00,$0.00
310.1,SUP,Custom 27203010,,310.10  -  BIT DRILL 1.1MM 45MM JACOBS CHUCK NONSTRL MINI FRAGMENT,$124.20,$0.00,$124.20,$0.00,$88.64,$0.00,$0.00,$0.00,$0.00,$0.00,$124.20,$0.00,$62.10,$98.37,$99.36,$0.00,$0.00,$0.00,$0.00,$0.00
310.11,SUP,Custom 27203010,,310.11  -  BIT DRL 1.1MM 60MM NS QC MN FRAG SYS,$131.68,$0.00,$131.68,$0.00,$93.98,$0.00,$0.00,$0.00,$0.00,$0.00,$131.68,$0.00,$65.84,$104.29,$105.34,$0.00,$0.00,$0.00,$0.00,$0.00
310.111,SUP,Custom 27203010,,310.111  -  BIT DRL 1.1MM 55MM NS MNQK CPLNG 1.5/2MM ROT CRRT PLT,$135.10,$0.00,$135.10,$0.00,$96.42,$0.00,$0.00,$0.00,$0.00,$0.00,$135.10,$0.00,$67.55,$107.00,$108.08,$0.00,$0.00,$0.00,$0.00,$0.00
310.113,SUP,Custom 27203010,,310.113  -  BIT DRL 1.1MM 65MM NS JLTCH CPLNG CPLNG STRYK,$135.10,$0.00,$135.10,$0.00,$96.42,$0.00,$0.00,$0.00,$0.00,$0.00,$135.10,$0.00,$67.55,$107.00,$108.08,$0.00,$0.00,$0.00,$0.00,$0.00
310.133,SUP,Custom 27203010,,310.133  -  BIT DRILL 45MM 1.3MM 3MM STOP JLTCH CPLNG NONSTRL,$326.25,$0.00,$326.25,$0.00,$232.84,$0.00,$0.00,$0.00,$0.00,$0.00,$326.25,$0.00,$163.13,$258.39,$261.00,$0.00,$0.00,$0.00,$0.00,$0.00
310.134,SUP,Custom 27203010,,310.134  -  BIT DRILL 52MM 1.3MM 3MM STOP HEX CPLNG NONSTRL,$326.25,$0.00,$326.25,$0.00,$232.84,$0.00,$0.00,$0.00,$0.00,$0.00,$326.25,$0.00,$163.13,$258.39,$261.00,$0.00,$0.00,$0.00,$0.00,$0.00
310.136,SUP,Custom 27203010,,310.136  -  BIT DRL 4MM 1.3MM 45MM NS JLTCH CPLNG CPLNG SLF STP STRYK,$326.25,$0.00,$326.25,$0.00,$232.84,$0.00,$0.00,$0.00,$0.00,$0.00,$326.25,$0.00,$163.13,$258.39,$261.00,$0.00,$0.00,$0.00,$0.00,$0.00
310.137,SUP,Custom 27203010,,310.137  -  BIT DRILL 45MM 1.3MM 6MM STOP JLTCH CPLNG NONSTRL,$326.25,$0.00,$326.25,$0.00,$232.84,$0.00,$0.00,$0.00,$0.00,$0.00,$326.25,$0.00,$163.13,$258.39,$261.00,$0.00,$0.00,$0.00,$0.00,$0.00
310.138,SUP,Custom 27203010,,310.138  -  BIT DRILL 52MM 1.3MM 4MM STOP HEX CPLNG NONSTRL,$326.25,$0.00,$326.25,$0.00,$232.84,$0.00,$0.00,$0.00,$0.00,$0.00,$326.25,$0.00,$163.13,$258.39,$261.00,$0.00,$0.00,$0.00,$0.00,$0.00
310.139,SUP,Custom 27203010,,310.139  -  BIT DRILL 52MM 1.3MM 6MM STOP HEX CPLNG NONSTRL,$326.25,$0.00,$326.25,$0.00,$232.84,$0.00,$0.00,$0.00,$0.00,$0.00,$326.25,$0.00,$163.13,$258.39,$261.00,$0.00,$0.00,$0.00,$0.00,$0.00
310.14,SUP,Custom 27203010,,310.14  -  BIT DRL 1.5MM 70MM NS JCHK MN FRAG SYS,$131.68,$0.00,$131.68,$0.00,$93.98,$0.00,$0.00,$0.00,$0.00,$0.00,$131.68,$0.00,$65.84,$104.29,$105.34,$0.00,$0.00,$0.00,$0.00,$0.00
310.141,SUP,Custom 27203010,,310.141  -  BIT DRL 1.5MM 65MM NS MNQK CPLNG 1.5/2MM ROT CRRT PLT,$135.10,$0.00,$135.10,$0.00,$96.42,$0.00,$0.00,$0.00,$0.00,$0.00,$135.10,$0.00,$67.55,$107.00,$108.08,$0.00,$0.00,$0.00,$0.00,$0.00
310.143,SUP,Custom 27203010,,310.143  -  BIT DRL 1.5MM 75MM NS JLTCH CPLNG CPLNG STRYK,$135.10,$0.00,$135.10,$0.00,$96.42,$0.00,$0.00,$0.00,$0.00,$0.00,$135.10,$0.00,$67.55,$107.00,$108.08,$0.00,$0.00,$0.00,$0.00,$0.00
310.15,SUP,Custom 27203010,,310.15  -  BIT DRL 1.5MM 85MM NS QC,$131.68,$0.00,$131.68,$0.00,$93.98,$0.00,$0.00,$0.00,$0.00,$0.00,$131.68,$0.00,$65.84,$104.29,$105.34,$0.00,$0.00,$0.00,$0.00,$0.00
310.153,SUP,Custom 27203010,,310.153  -  BIT DRILL 75MM 1.5MM JLTCH NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
310.16,SUP,Custom 27203010,,310.16  -  BIT DRILL 1.5MM 110MM QUICK COUPLING STAINLESS STEEL NONSTRL,$131.68,$0.00,$131.68,$0.00,$93.98,$0.00,$0.00,$0.00,$0.00,$0.00,$131.68,$0.00,$65.84,$104.29,$105.34,$0.00,$0.00,$0.00,$0.00,$0.00
310.161,SUP,Custom 27203010,,310.161  -  BIT DRILL 1.5MM 110MM J LATCH DEPTH MARK NONSTRL,$271.58,$0.00,$271.58,$0.00,$193.82,$0.00,$0.00,$0.00,$0.00,$0.00,$271.58,$0.00,$135.79,$215.09,$217.26,$0.00,$0.00,$0.00,$0.00,$0.00
310.162,SUP,Custom 27203010,,310.162  -  BIT DRILL 1.8MM 110MM J LATCH DEPTH MARK NONSTRL,$271.58,$0.00,$271.58,$0.00,$193.82,$0.00,$0.00,$0.00,$0.00,$0.00,$271.58,$0.00,$135.79,$215.09,$217.26,$0.00,$0.00,$0.00,$0.00,$0.00
310.17,SUP,Custom 27203010,,310.170  -  BIT DRILL 125MM 1.5MM 8MM STOP QC NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
310.171,SUP,Custom 27203010,,310.171  -  BIT DRILL 125MM 1.5MM 8MM STOP UNV HALL CPLNG NONSTRL,$342.00,$0.00,$342.00,$0.00,$244.09,$0.00,$0.00,$0.00,$0.00,$0.00,$342.00,$0.00,$171.00,$270.86,$273.60,$0.00,$0.00,$0.00,$0.00,$0.00
310.172,SUP,Custom 27203010,,310.172  -  BIT DRILL 125MM 1.5MM 8MM STOP JLTCH NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
310.173,SUP,Custom 27203010,,310.173  -  BIT DRILL 125MM 1.5MM 8MM STOP MINI QC NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
310.177,SUP,Custom 27203010,,310.177  -  BIT DRILL 1.5MM 4MM STOP JLTCH NONSTRL,$346.50,$0.00,$346.50,$0.00,$247.30,$0.00,$0.00,$0.00,$0.00,$0.00,$346.50,$0.00,$173.25,$274.43,$277.20,$0.00,$0.00,$0.00,$0.00,$0.00
310.182,SUP,Custom 27203010,,310.182  -  BIT DRILL 1.5MM 4MM STOP HEX CPLNG NONSTRL,$346.50,$0.00,$346.50,$0.00,$247.30,$0.00,$0.00,$0.00,$0.00,$0.00,$346.50,$0.00,$173.25,$274.43,$277.20,$0.00,$0.00,$0.00,$0.00,$0.00
310.19,SUP,Custom 27203010,,310.19  -  BIT DRL 2MM 100MM NS QC,$139.20,$0.00,$139.20,$0.00,$99.35,$0.00,$0.00,$0.00,$0.00,$0.00,$139.20,$0.00,$69.60,$110.25,$111.36,$0.00,$0.00,$0.00,$0.00,$0.00
310.2,SUP,Custom 27203010,,310.20  -  BIT DRILL STANDARD 2MM 85MM SET BASIC ARTICULATE TENSION,$131.68,$0.00,$131.68,$0.00,$93.98,$0.00,$0.00,$0.00,$0.00,$0.00,$131.68,$0.00,$65.84,$104.29,$105.34,$0.00,$0.00,$0.00,$0.00,$0.00
310.201,SUP,Custom 27203010,,310.201  -  BIT DRL 2MM 65MM NS MNQK CPLNG,$135.10,$0.00,$135.10,$0.00,$96.42,$0.00,$0.00,$0.00,$0.00,$0.00,$135.10,$0.00,$67.55,$107.00,$108.08,$0.00,$0.00,$0.00,$0.00,$0.00
310.203,SUP,Custom 27203010,,310.203  -  BIT DRL 2MM 75MM NS JLTCH CPLNG STRYK,$135.10,$0.00,$135.10,$0.00,$96.42,$0.00,$0.00,$0.00,$0.00,$0.00,$135.10,$0.00,$67.55,$107.00,$108.08,$0.00,$0.00,$0.00,$0.00,$0.00
310.21,SUP,Custom 27203010,,310.21  -  BIT DRL 2MM 125MM NS QC,$147.40,$0.00,$147.40,$0.00,$105.20,$0.00,$0.00,$0.00,$0.00,$0.00,$147.40,$0.00,$73.70,$116.74,$117.92,$0.00,$0.00,$0.00,$0.00,$0.00
310.215,SUP,Custom 27203010,,310.215  -  BIT DRILL 1.7MM .9MM 100MM 2.4MM QUICK COUPLING CANN NONSTRL,$825.68,$0.00,$825.68,$0.00,$589.28,$0.00,$0.00,$0.00,$0.00,$0.00,$825.68,$0.00,$412.84,$653.94,$660.54,$0.00,$0.00,$0.00,$0.00,$0.00
310.221,SUP,Custom 27203010,,310.221  -  BIT DRL 2MM 150MM NS CNN QC,$765.63,$0.00,$765.63,$0.00,$546.43,$0.00,$0.00,$0.00,$0.00,$0.00,$765.63,$0.00,$382.81,$606.38,$612.50,$0.00,$0.00,$0.00,$0.00,$0.00
310.229,SUP,Custom 27203010,,310.229  -  BIT DRL 2.9MM 150MM NS QC 4MM CORT SCR,$163.78,$0.00,$163.78,$0.00,$116.89,$0.00,$0.00,$0.00,$0.00,$0.00,$163.78,$0.00,$81.89,$129.71,$131.02,$0.00,$0.00,$0.00,$0.00,$0.00
310.23,SUP,Custom 27203010,,310.23  -  BIT DRILL 2.5MM 180MM QUICK COUPLING GOLD STAINLESS STEEL,$147.40,$0.00,$147.40,$0.00,$105.20,$0.00,$0.00,$0.00,$0.00,$0.00,$147.40,$0.00,$73.70,$116.74,$117.92,$0.00,$0.00,$0.00,$0.00,$0.00
310.24,SUP,Custom 27203010,,310.24  -  BIT DRILL 2.5MM 95MM JACOBS CHUCK GOLD STAINLESS STEEL,$131.68,$0.00,$131.68,$0.00,$93.98,$0.00,$0.00,$0.00,$0.00,$0.00,$131.68,$0.00,$65.84,$104.29,$105.34,$0.00,$0.00,$0.00,$0.00,$0.00
310.243,SUP,Custom 27203010,,310.243  -  GUIDEWIRE ORTHOPEDIC 2.5MM 200MM DRILL TIP LCP STAINLESS,$118.05,$0.00,$118.05,$0.00,$84.25,$0.00,$0.00,$0.00,$0.00,$0.00,$118.05,$0.00,$59.03,$93.50,$94.44,$0.00,$0.00,$0.00,$0.00,$0.00
310.25,SUP,Custom 27203010,,310.25  -  BIT DRL 2.5MM 110MM AU NS QC,$131.68,$0.00,$131.68,$0.00,$93.98,$0.00,$0.00,$0.00,$0.00,$0.00,$131.68,$0.00,$65.84,$104.29,$105.34,$0.00,$0.00,$0.00,$0.00,$0.00
310.26,SUP,Custom 27203010,,310.26  -  BIT DRL 2.7MM 100MM NS QC,$131.68,$0.00,$131.68,$0.00,$93.98,$0.00,$0.00,$0.00,$0.00,$0.00,$131.68,$0.00,$65.84,$104.29,$105.34,$0.00,$0.00,$0.00,$0.00,$0.00
310.27,SUP,Custom 27203010,,310.27  -  BIT DRL 2.7MM 85MM NS JCHK,$131.68,$0.00,$131.68,$0.00,$93.98,$0.00,$0.00,$0.00,$0.00,$0.00,$131.68,$0.00,$65.84,$104.29,$105.34,$0.00,$0.00,$0.00,$0.00,$0.00
310.28,SUP,Custom 27203010,,310.28  -  BIT DRL 2.7MM 125MM NS QC,$147.40,$0.00,$147.40,$0.00,$105.20,$0.00,$0.00,$0.00,$0.00,$0.00,$147.40,$0.00,$73.70,$116.74,$117.92,$0.00,$0.00,$0.00,$0.00,$0.00
310.284,SUP,Custom 27203010,,310.284  -  BIT DRILL 2.8MM 165MM 2 FLUTE QUICK COUPLING LCP NONSTRL,$163.78,$0.00,$163.78,$0.00,$116.89,$0.00,$0.00,$0.00,$0.00,$0.00,$163.78,$0.00,$81.89,$129.71,$131.02,$0.00,$0.00,$0.00,$0.00,$0.00
310.288,SUP,Custom 27203010,,310.288  -  BIT DRL 2.8MM 165MM NS QC,$163.78,$0.00,$163.78,$0.00,$116.89,$0.00,$0.00,$0.00,$0.00,$0.00,$163.78,$0.00,$81.89,$129.71,$131.02,$0.00,$0.00,$0.00,$0.00,$0.00
310.29,SUP,Custom 27203010,,310.29  -  BIT DRILL 3.2MM 195MM QUICK COUPLING STAINLESS STEEL NONSTRL,$215.63,$0.00,$215.63,$0.00,$153.89,$0.00,$0.00,$0.00,$0.00,$0.00,$215.63,$0.00,$107.81,$170.78,$172.50,$0.00,$0.00,$0.00,$0.00,$0.00
310.3,SUP,Custom 27203010,,310.30  -  BIT DRL 3.2MM 180MM NS JCHK,$165.13,$0.00,$165.13,$0.00,$117.85,$0.00,$0.00,$0.00,$0.00,$0.00,$165.13,$0.00,$82.56,$130.78,$132.10,$0.00,$0.00,$0.00,$0.00,$0.00
310.31,SUP,Custom 27203010,,310.31  -  BIT DRL 3.2MM 145MM NS QC,$129.65,$0.00,$129.65,$0.00,$92.53,$0.00,$0.00,$0.00,$0.00,$0.00,$129.65,$0.00,$64.83,$102.68,$103.72,$0.00,$0.00,$0.00,$0.00,$0.00
310.32,SUP,Custom 27203010,,310.32  -  BIT DRL 3.2MM 130MM NS JCHK,$127.60,$0.00,$127.60,$0.00,$91.07,$0.00,$0.00,$0.00,$0.00,$0.00,$127.60,$0.00,$63.80,$101.06,$102.08,$0.00,$0.00,$0.00,$0.00,$0.00
310.35,SUP,Custom 27203010,,310.35  -  BIT DRL 3.5MM 110MM NS QC,$139.20,$0.00,$139.20,$0.00,$99.35,$0.00,$0.00,$0.00,$0.00,$0.00,$139.20,$0.00,$69.60,$110.25,$111.36,$0.00,$0.00,$0.00,$0.00,$0.00
310.36,SUP,Custom 27203010,,310.36  -  BIT DRL 3.5MM 95MM NS JCHK,$131.68,$0.00,$131.68,$0.00,$93.98,$0.00,$0.00,$0.00,$0.00,$0.00,$131.68,$0.00,$65.84,$104.29,$105.34,$0.00,$0.00,$0.00,$0.00,$0.00
310.37,SUP,Custom 27203010,,310.37  -  BIT DRL 3.5MM 195MM NS QC,$147.40,$0.00,$147.40,$0.00,$105.20,$0.00,$0.00,$0.00,$0.00,$0.00,$147.40,$0.00,$73.70,$116.74,$117.92,$0.00,$0.00,$0.00,$0.00,$0.00
310.38,SUP,Custom 27203010,,310.38  -  BIT DRL 3.5MM 180MM NS JCHK,$147.40,$0.00,$147.40,$0.00,$105.20,$0.00,$0.00,$0.00,$0.00,$0.00,$147.40,$0.00,$73.70,$116.74,$117.92,$0.00,$0.00,$0.00,$0.00,$0.00
310.4,SUP,Custom 27203010,,310.40  -  BIT DRILL 4MM 197MM QUICK COUPLING NONSTRL,$158.30,$0.00,$158.30,$0.00,$112.98,$0.00,$0.00,$0.00,$0.00,$0.00,$158.30,$0.00,$79.15,$125.37,$126.64,$0.00,$0.00,$0.00,$0.00,$0.00
310.401,SUP,Custom 27203010,,310.401  -  BIT DRL 4MM 160MM NS QC,$155.58,$0.00,$155.58,$0.00,$111.03,$0.00,$0.00,$0.00,$0.00,$0.00,$155.58,$0.00,$77.79,$123.22,$124.46,$0.00,$0.00,$0.00,$0.00,$0.00
310.423,SUP,Custom 27203010,,310.423  -  BIT DRL 4.3MM 280MM NS QC,$687.83,$0.00,$687.83,$0.00,$490.90,$0.00,$0.00,$0.00,$0.00,$0.00,$687.83,$0.00,$343.91,$544.76,$550.26,$0.00,$0.00,$0.00,$0.00,$0.00
310.43,SUP,Custom 27203010,,310.430  -  BIT DRILL 4.3MM 221MM QUICK COUPLING CANN NONSTRL,$399.88,$0.00,$399.88,$0.00,$285.39,$0.00,$0.00,$0.00,$0.00,$0.00,$399.88,$0.00,$199.94,$316.70,$319.90,$0.00,$0.00,$0.00,$0.00,$0.00
310.431,SUP,Custom 27203010,,310.431  -  BIT DRL 4.3MM 180MM NS QC 5MM LCK SCR,$223.83,$0.00,$223.83,$0.00,$159.74,$0.00,$0.00,$0.00,$0.00,$0.00,$223.83,$0.00,$111.91,$177.27,$179.06,$0.00,$0.00,$0.00,$0.00,$0.00
310.44,SUP,Custom 27203010,,310.44  -  BIT DRL 4.5MM 145MM NS QC,$129.65,$0.00,$129.65,$0.00,$92.53,$0.00,$0.00,$0.00,$0.00,$0.00,$129.65,$0.00,$64.83,$102.68,$103.72,$0.00,$0.00,$0.00,$0.00,$0.00
310.45,SUP,Custom 27203010,,310.45  -  BIT DRILL 4.5MM 130MM JACOBS CHUCK COUPLING STAINLESS STEEL,$127.60,$0.00,$127.60,$0.00,$91.07,$0.00,$0.00,$0.00,$0.00,$0.00,$127.60,$0.00,$63.80,$101.06,$102.08,$0.00,$0.00,$0.00,$0.00,$0.00
310.48,SUP,Custom 27203010,,310.48  -  BIT DRILL 4.5MM 195MM QUICK COUPLING STAINLESS STEEL NONSTRL,$215.63,$0.00,$215.63,$0.00,$153.89,$0.00,$0.00,$0.00,$0.00,$0.00,$215.63,$0.00,$107.81,$170.78,$172.50,$0.00,$0.00,$0.00,$0.00,$0.00
310.49,SUP,Custom 27203010,,310.49  -  BIT DRILL 4.5MM 180MM JACOBS CHUCK STAINLESS STEEL NONSTRL,$165.13,$0.00,$165.13,$0.00,$117.85,$0.00,$0.00,$0.00,$0.00,$0.00,$165.13,$0.00,$82.56,$130.78,$132.10,$0.00,$0.00,$0.00,$0.00,$0.00
310.495,SUP,Custom 27203010,,310.495  -  BIT DRL 7.3MM 2.9MM 300MM NS CNN LG QC,$810.65,$0.00,$810.65,$0.00,$578.56,$0.00,$0.00,$0.00,$0.00,$0.00,$810.65,$0.00,$405.33,$642.03,$648.52,$0.00,$0.00,$0.00,$0.00,$0.00
310.507,SUP,Custom 27203010,,310.507  -  BIT DRL 1.5MM 96MM NS MNQK CPLNG D MRK,$271.58,$0.00,$271.58,$0.00,$193.82,$0.00,$0.00,$0.00,$0.00,$0.00,$271.58,$0.00,$135.79,$215.09,$217.26,$0.00,$0.00,$0.00,$0.00,$0.00
310.509,SUP,Custom 27203010,,310.509  -  BIT DRL 1.8MM 110MM NS QC D MRK,$271.58,$0.00,$271.58,$0.00,$193.82,$0.00,$0.00,$0.00,$0.00,$0.00,$271.58,$0.00,$135.79,$215.09,$217.26,$0.00,$0.00,$0.00,$0.00,$0.00
310.51,SUP,Custom 27203010,,310.510  -  BIT DRL 1.8MM 100MM NS QC D MRK,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
310.511,SUP,Custom 27203010,,310.511  -  BIT DRILL 100MM 1.8MM UNV HALL CPLNG NONSTRL,$342.00,$0.00,$342.00,$0.00,$244.09,$0.00,$0.00,$0.00,$0.00,$0.00,$342.00,$0.00,$171.00,$270.86,$273.60,$0.00,$0.00,$0.00,$0.00,$0.00
310.512,SUP,Custom 27203010,,310.512  -  BIT DRL 1.8MM 100MM NS JLTCH CPLNG STRYK,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
310.513,SUP,Custom 27203010,,310.513  -  BIT DRILL 100MM 1.8MM MINI MANDIB QC JLTCH NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
310.52,SUP,Custom 27203010,,310.520  -  BIT DRL 1.8MM 125MM NS QC,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
310.521,SUP,Custom 27203010,,310.521  -  BIT DRILL 125MM 1.8MM UNV HALL CPLNG NONSTRL,$342.00,$0.00,$342.00,$0.00,$244.09,$0.00,$0.00,$0.00,$0.00,$0.00,$342.00,$0.00,$171.00,$270.86,$273.60,$0.00,$0.00,$0.00,$0.00,$0.00
310.522,SUP,Custom 27203010,,310.522  -  BIT DRL 1.8MM 125MM NS JLTCH CPLNG STRYK,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
310.523,SUP,Custom 27203010,,310.523  -  BIT DRILL 125MM 1.8MM MINI QC 2.4MM SCR NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
310.53,SUP,Custom 27203010,,310.530  -  BIT DRL 2.4MM 100MM NS QC D MRK,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
310.531,SUP,Custom 27203010,,310.531  -  BIT DRILL 100MM 2.4MM UNV HALL CPLNG NONSTRL,$342.00,$0.00,$342.00,$0.00,$244.09,$0.00,$0.00,$0.00,$0.00,$0.00,$342.00,$0.00,$171.00,$270.86,$273.60,$0.00,$0.00,$0.00,$0.00,$0.00
310.532,SUP,Custom 27203010,,310.532  -  BIT DRL 2.4MM 100MM NS JLTCH CPLNG STRYK,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
310.533,SUP,Custom 27203010,,310.533  -  BIT DRILL 100MM 2.4MM MINI QC NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
310.54,SUP,Custom 27203010,,310.540  -  BIT DRL 2.4MM 125MM NS QC,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
310.541,SUP,Custom 27203010,,310.541  -  BIT DRILL 125MM 2.4MM UNV HALL CPLNG NONSTRL,$342.00,$0.00,$342.00,$0.00,$244.09,$0.00,$0.00,$0.00,$0.00,$0.00,$342.00,$0.00,$171.00,$270.86,$273.60,$0.00,$0.00,$0.00,$0.00,$0.00
310.542,SUP,Custom 27203010,,310.542  -  BIT DRILL 125MM 2.4MM JLTCH NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
310.543,SUP,Custom 27203010,,310.543  -  BIT DRILL 125MM 2.4MM MINI QC NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
310.562,SUP,Custom 27203010,,310.562  -  BIT DRILL 75MM 1.8MM JLTCH NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
310.572,SUP,Custom 27203010,,310.572  -  BIT DRL 2.4MM 75MM NS JLTCH CPLNG STRYK,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
310.582,SUP,Custom 27203010,,310.582  -  BIT DRILL 50MM 1.5MM JLTCH NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
310.592,SUP,Custom 27203010,,310.592  -  BIT DRILL 50MM 1.8MM JLTCH NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
310.6,SUP,Custom 27203010,,310.60  -  BIT DRILL 6MM 195MM QUICK COUPLING NONSTRL,$302.98,$0.00,$302.98,$0.00,$216.23,$0.00,$0.00,$0.00,$0.00,$0.00,$302.98,$0.00,$151.49,$239.96,$242.38,$0.00,$0.00,$0.00,$0.00,$0.00
310.63,SUP,Custom 27203010,,310.63  -  BIT DRL 5MM 2.9MM 300MM NS CNN LG QC,$798.38,$0.00,$798.38,$0.00,$569.80,$0.00,$0.00,$0.00,$0.00,$0.00,$798.38,$0.00,$399.19,$632.32,$638.70,$0.00,$0.00,$0.00,$0.00,$0.00
310.632,SUP,Custom 27203010,,310.632  -  BIT DRL SHRT FLUT 5MM 200MM NS CNN QC 7.3MM SCR,$637.35,$0.00,$637.35,$0.00,$454.88,$0.00,$0.00,$0.00,$0.00,$0.00,$637.35,$0.00,$318.68,$504.78,$509.88,$0.00,$0.00,$0.00,$0.00,$0.00
310.634,SUP,Custom 27203010,,310.634  -  BIT DRL LNG FLUT 4.3MM 200MM NS CNN QC 5MM SCR,$637.35,$0.00,$637.35,$0.00,$454.88,$0.00,$0.00,$0.00,$0.00,$0.00,$637.35,$0.00,$318.68,$504.78,$509.88,$0.00,$0.00,$0.00,$0.00,$0.00
310.65,SUP,Custom 27203010,,310.65  -  BIT DRL 3.2MM 1.7MM 170MM NS CNN QC,$794.28,$0.00,$794.28,$0.00,$566.87,$0.00,$0.00,$0.00,$0.00,$0.00,$794.28,$0.00,$397.14,$629.07,$635.42,$0.00,$0.00,$0.00,$0.00,$0.00
310.66,SUP,Custom 27203010,,310.66  -  BIT DRL 4.5MM 1.7MM 170MM NS CNN QC,$794.28,$0.00,$794.28,$0.00,$566.87,$0.00,$0.00,$0.00,$0.00,$0.00,$794.28,$0.00,$397.14,$629.07,$635.42,$0.00,$0.00,$0.00,$0.00,$0.00
310.67,SUP,Custom 27203010,,310.67  -  BIT DRL 2.7MM 160MM NS CNN QC,$809.30,$0.00,$809.30,$0.00,$577.60,$0.00,$0.00,$0.00,$0.00,$0.00,$809.30,$0.00,$404.65,$640.97,$647.44,$0.00,$0.00,$0.00,$0.00,$0.00
310.68,SUP,Custom 27203010,,310.68  -  BIT DRL 3.5MM 160MM NS CNN QC,$809.30,$0.00,$809.30,$0.00,$577.60,$0.00,$0.00,$0.00,$0.00,$0.00,$809.30,$0.00,$404.65,$640.97,$647.44,$0.00,$0.00,$0.00,$0.00,$0.00
310.69,SUP,Custom 27203010,,310.69  -  BIT DRL 4.5MM 233MM NS CNN JCHK,$794.28,$0.00,$794.28,$0.00,$566.87,$0.00,$0.00,$0.00,$0.00,$0.00,$794.28,$0.00,$397.14,$629.07,$635.42,$0.00,$0.00,$0.00,$0.00,$0.00
310.8,SUP,Custom 27203010,,310.80  -  CNTRSNK DRILL CENTERING PIN 2.4 MM CORT SCR NONSTRL,"$1,460.25",$0.00,"$1,460.25",$0.00,"$1,042.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,460.25",$0.00,$730.13,"$1,156.52","$1,168.20",$0.00,$0.00,$0.00,$0.00,$0.00
310.805,SUP,Custom 27203010,,310.805  -  COUNTERSINK W/CENTERING PINS FOR 2.4MM SCREWS/HEX COUPLING,"$1,518.75",$0.00,"$1,518.75",$0.00,"$1,083.93",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,518.75",$0.00,$759.38,"$1,202.85","$1,215.00",$0.00,$0.00,$0.00,$0.00,$0.00
310.81,SUP,Custom 27203010,,310.81  -  CNTRSNK DRILL QC CENTERING PIN 1.5 MM 2 MM 2.7 MM SCR,"$1,518.75",$0.00,"$1,518.75",$0.00,"$1,083.93",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,518.75",$0.00,$759.38,"$1,202.85","$1,215.00",$0.00,$0.00,$0.00,$0.00,$0.00
310.811,SUP,Custom 27203010,,310.811  -  COUNTERSINK W/CENTERING PINS FOR 2.0MM SCREWS/HEX COUPLING,"$1,584.00",$0.00,"$1,584.00",$0.00,"$1,130.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,584.00",$0.00,$792.00,"$1,254.53","$1,267.20",$0.00,$0.00,$0.00,$0.00,$0.00
310.883,SUP,Custom 27203010,,310.883  -  CNTRSNK DRILL HEX CPLNG 2 MM 2.4 MM SCR,"$1,471.50",$0.00,"$1,471.50",$0.00,"$1,050.21",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,471.50",$0.00,$735.75,"$1,165.43","$1,177.20",$0.00,$0.00,$0.00,$0.00,$0.00
311.014,SUP,Custom 27203010,,311.014  -  SCRDRVR SM SURG RCHT NONSTRL,"$3,096.00",$0.00,"$3,096.00",$0.00,"$2,209.62",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,096.00",$0.00,"$1,548.00","$2,452.03","$2,476.80",$0.00,$0.00,$0.00,$0.00,$0.00
311.12,SUP,HCPCS C1713,,311.120  -  TAP MNQK CPLNG SURG 1.3 MM CORTEX SCR,$326.25,$0.00,$326.25,$146.81,$232.84,$0.00,$56.21,$0.00,$0.00,$57.12,$326.25,$0.00,$163.13,$258.39,$261.00,$0.00,$51.06,$0.00,$51.94,$0.00
311.15,SUP,HCPCS C1713,,311.15  -  TAP SURG 50MM MINI QUICK COUPLING NONSTRL 1.5MM CORTICAL,$178.78,$0.00,$178.78,$80.45,$127.59,$0.00,$29.91,$0.00,$0.00,$31.30,$178.78,$0.00,$89.39,$141.59,$143.02,$0.00,$27.16,$0.00,$28.46,$0.00
311.204,SUP,HCPCS C1713,,311.204  -  TAP 100MM SURG 2MM MANDIB LCK SCR,$243.00,$0.00,$243.00,$109.35,$173.43,$0.00,$41.87,$0.00,$0.00,$42.55,$243.00,$0.00,$121.50,$192.46,$194.40,$0.00,$38.03,$0.00,$38.69,$0.00
311.209,SUP,HCPCS C1713,,311.209  -  TAP HEX CPLNG SURG 2 MM COARSE PTCH SCR,$324.00,$0.00,$324.00,$145.80,$231.24,$0.00,$55.82,$0.00,$0.00,$56.73,$324.00,$0.00,$162.00,$256.61,$259.20,$0.00,$50.71,$0.00,$51.58,$0.00
311.211,SUP,HCPCS C1713,,311.211  -  TAP HEX CPLNG SURG 2 MM CORTEX SCR,$290.25,$0.00,$290.25,$130.61,$207.15,$0.00,$50.01,$0.00,$0.00,$50.82,$290.25,$0.00,$145.13,$229.88,$232.20,$0.00,$45.42,$0.00,$46.21,$0.00
311.23,SUP,HCPCS C1713,,311.23  -  TAP QC SURG 2.4 MM CORTEX SCR,$407.25,$0.00,$407.25,$183.26,$290.65,$0.00,$70.17,$0.00,$0.00,$71.31,$407.25,$0.00,$203.63,$322.54,$325.80,$0.00,$63.73,$0.00,$64.83,$0.00
311.24,SUP,HCPCS C1713,,311.24  -  TAP LNG QC SURG 2.4MM CORTEX SCR,$407.25,$0.00,$407.25,$183.26,$290.65,$0.00,$70.17,$0.00,$0.00,$71.31,$407.25,$0.00,$203.63,$322.54,$325.80,$0.00,$63.73,$0.00,$64.83,$0.00
311.241,SUP,HCPCS C1713,,311.241  -  TAP HEX CPLNG SURG 2.4 MM CORTEX SCR,$423.00,$0.00,$423.00,$190.35,$301.90,$0.00,$72.88,$0.00,$0.00,$74.06,$423.00,$0.00,$211.50,$335.02,$338.40,$0.00,$66.20,$0.00,$67.34,$0.00
311.26,SUP,Custom 27203010,,311.26  -  TAP SURG LONG 100MM QUICK COUPLING NONSTRL 2.7MM CORTICAL,$210.18,$0.00,$210.18,$0.00,$150.00,$0.00,$0.00,$0.00,$0.00,$0.00,$210.18,$0.00,$105.09,$166.46,$168.14,$0.00,$0.00,$0.00,$0.00,$0.00
311.32,SUP,HCPCS C1713,,311.32  -  TAP SURG LONG 110MM QUICK COUPLING GOLD NONSTRL 3.5MM,$210.18,$0.00,$210.18,$94.58,$150.00,$0.00,$35.16,$0.00,$0.00,$36.80,$210.18,$0.00,$105.09,$166.46,$168.14,$0.00,$31.93,$0.00,$33.46,$0.00
311.34,SUP,HCPCS C1713,,311.34  -  TAP SURG 110MM NONSTRL 4MM CANCELLOUS SCREW,$210.18,$0.00,$255.58,$115.01,$182.40,$0.00,$35.16,$0.00,$0.00,$44.75,$255.58,$0.00,$127.79,$166.46,$204.46,$0.00,$31.93,$0.00,$40.69,$0.00
311.349,SUP,HCPCS C1713,,311.349  -  TAP 50MM CLBRT SURG CANC SPNL 3.5 SCR NONSTRL,$323.75,$0.00,$323.75,$145.69,$231.06,$0.00,$55.78,$0.00,$0.00,$56.69,$323.75,$0.00,$161.88,$256.41,$259.00,$0.00,$50.67,$0.00,$51.54,$0.00
311.449,SUP,Custom 27203010,,311.449  -  DEVICE TARGET 4.5MM PUSH PULL REDX LCP NONSTRL 4.5MM LCP,$470.85,$0.00,$470.85,$0.00,$336.05,$0.00,$0.00,$0.00,$0.00,$0.00,$470.85,$0.00,$235.43,$372.91,$376.68,$0.00,$0.00,$0.00,$0.00,$0.00
311.63,SUP,Custom 27203010,,311.63  -  TAP SURG 147MM CANN NONSTRL 4MM SCREW,$828.40,$0.00,$983.93,$0.00,$702.23,$0.00,$0.00,$0.00,$0.00,$0.00,$983.93,$0.00,$491.96,$656.09,$787.14,$0.00,$0.00,$0.00,$0.00,$0.00
312.3,SUP,Custom 27203010,,312.30  -  SLEEVE DRILL 3.5MM 2.5MM INSERT LCP NONSTRL,$204.73,$0.00,$204.73,$0.00,$146.11,$0.00,$0.00,$0.00,$0.00,$0.00,$204.73,$0.00,$102.36,$162.15,$163.78,$0.00,$0.00,$0.00,$0.00,$0.00
312.35,SUP,Custom 27203010,,312.35  -  SLEEVE DRILL 2.7MM 1.25MM 2 END NONSTRL,$756.08,$0.00,$756.08,$0.00,$539.61,$0.00,$0.00,$0.00,$0.00,$0.00,$756.08,$0.00,$378.04,$598.82,$604.86,$0.00,$0.00,$0.00,$0.00,$0.00
312.648,SUP,HCPCS C1713,,312.648  -  GUIDE DRILL 2.8MM 2.8MM THRD,$239.78,$0.00,$239.78,$107.90,$171.13,$0.00,$41.31,$0.00,$0.00,$41.98,$239.78,$0.00,$119.89,$189.91,$191.82,$0.00,$37.52,$0.00,$38.17,$0.00
313.25,SUP,Custom 27203010,,313.250  -  BIT DRILL 44.5MM MINI 4MM STOP QC NONSTRL,$281.25,$0.00,$281.25,$0.00,$200.73,$0.00,$0.00,$0.00,$0.00,$0.00,$281.25,$0.00,$140.63,$222.75,$225.00,$0.00,$0.00,$0.00,$0.00,$0.00
314.03,SUP,Custom 27203010,,314.03  -  SHAFT SCREWDRIVER 2.5MM SMALL HEXAGON NONSTRL,$98.93,$0.00,$98.93,$0.00,$70.60,$0.00,$0.00,$0.00,$0.00,$0.00,$98.93,$0.00,$49.46,$78.35,$79.14,$0.00,$0.00,$0.00,$0.00,$0.00
314.23,SUP,Custom 27203010,,314.23  -  SHAFT SCREWDRIVER 4MM HEXAGONAL CANN QUICK COUPLING,$584.13,$0.00,$584.13,$0.00,$416.89,$0.00,$0.00,$0.00,$0.00,$0.00,$584.13,$0.00,$292.06,$462.63,$467.30,$0.00,$0.00,$0.00,$0.00,$0.00
314.467,SUP,Custom 27203010,,314.467  -  SHAFT SCREWDRIVER T8 105MM SELF RETAINING QUICK COUPLING,$540.45,$0.00,$540.45,$0.00,$385.72,$0.00,$0.00,$0.00,$0.00,$0.00,$540.45,$0.00,$270.23,$428.04,$432.36,$0.00,$0.00,$0.00,$0.00,$0.00
314.57,SUP,Custom 27203010,,314.57  -  SCREWDRIVER SURG LONG SMALL HEXAGONAL 3.5MM CORTEX 4MM,$410.80,$0.00,$410.80,$0.00,$293.19,$0.00,$0.00,$0.00,$0.00,$0.00,$410.80,$0.00,$205.40,$325.35,$328.64,$0.00,$0.00,$0.00,$0.00,$0.00
314.743,SUP,Custom 27203010,,314.743  -  REAMER SURG 520MM DRIVE SHAFT NONSTRL RIA,"$8,617.88",$0.00,"$8,617.88",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,617.88",$0.00,"$4,308.94","$6,825.36","$6,894.30",$0.00,$0.00,$0.00,$0.00,$0.00
315.05,SUP,Custom 27203010,,315.05  -  BIT DRILL 3.5MM 225MM 3 FLUTED QUICK COUPLING NONSTRL,$218.35,$0.00,$218.35,$0.00,$155.84,$0.00,$0.00,$0.00,$0.00,$0.00,$218.35,$0.00,$109.18,$172.93,$174.68,$0.00,$0.00,$0.00,$0.00,$0.00
315.19,SUP,Custom 27203010,,315.19  -  BIT DRILL 2MM 100MM 3 FLUTED QUICK COUPLING NONSTRL,$186.98,$0.00,$186.98,$0.00,$133.44,$0.00,$0.00,$0.00,$0.00,$0.00,$186.98,$0.00,$93.49,$148.09,$149.58,$0.00,$0.00,$0.00,$0.00,$0.00
315.21,SUP,Custom 27203010,,315.21  -  BIT DRILL 2MM 125MM 3 FLUTED QUICK COUPLING NONSTRL,$186.98,$0.00,$186.98,$0.00,$133.44,$0.00,$0.00,$0.00,$0.00,$0.00,$186.98,$0.00,$93.49,$148.09,$149.58,$0.00,$0.00,$0.00,$0.00,$0.00
315.23,SUP,Custom 27203010,,315.23  -  BIT DRILL 2.5MM 180MM 3 FLUTED NONSTRL,$203.35,$0.00,$203.35,$0.00,$145.13,$0.00,$0.00,$0.00,$0.00,$0.00,$203.35,$0.00,$101.68,$161.05,$162.68,$0.00,$0.00,$0.00,$0.00,$0.00
315.25,SUP,Custom 27203010,,315.25  -  BIT DRILL 2.5MM 110MM 3 FLUTED QUICK COUPLING NONSTRL,$203.35,$0.00,$203.35,$0.00,$145.13,$0.00,$0.00,$0.00,$0.00,$0.00,$203.35,$0.00,$101.68,$161.05,$162.68,$0.00,$0.00,$0.00,$0.00,$0.00
315.26,SUP,Custom 27203010,,315.26  -  BIT DRILL 3 FLUTED 2.7MM 110MM QUICK COUPLING NONSTRL,$210.18,$0.00,$210.18,$0.00,$150.00,$0.00,$0.00,$0.00,$0.00,$0.00,$210.18,$0.00,$105.09,$166.46,$168.14,$0.00,$0.00,$0.00,$0.00,$0.00
315.28,SUP,Custom 27203010,,315.28  -  BIT DRL 3 FLUT 2.7MM 125MM NS QC,$210.18,$0.00,$210.18,$0.00,$150.00,$0.00,$0.00,$0.00,$0.00,$0.00,$210.18,$0.00,$105.09,$166.46,$168.14,$0.00,$0.00,$0.00,$0.00,$0.00
315.29,SUP,Custom 27203010,,315.29  -  BIT DRL 3 FLUT 3.2MM 195MM NS QC,$251.13,$0.00,$251.13,$0.00,$179.23,$0.00,$0.00,$0.00,$0.00,$0.00,$251.13,$0.00,$125.56,$198.89,$200.90,$0.00,$0.00,$0.00,$0.00,$0.00
315.31,SUP,Custom 27203010,,315.31  -  BIT DRILL 3.2MM 145MM 3 FLUTED QUICK COUPLING NONSTRL,$169.23,$0.00,$169.23,$0.00,$120.78,$0.00,$0.00,$0.00,$0.00,$0.00,$169.23,$0.00,$84.61,$134.03,$135.38,$0.00,$0.00,$0.00,$0.00,$0.00
315.33,SUP,Custom 27203010,,315.330  -  BIT DRILL 3.2MM 210MM 68MM 3 FLUTED QUICK COUPLING,$302.98,$0.00,$302.98,$0.00,$216.23,$0.00,$0.00,$0.00,$0.00,$0.00,$302.98,$0.00,$151.49,$239.96,$242.38,$0.00,$0.00,$0.00,$0.00,$0.00
315.35,SUP,Custom 27203010,,315.35  -  BIT DRILL 3.5MM 110MM 3 FLUTED QUICK COUPLING CANN NONSTRL,$185.53,$0.00,$185.53,$0.00,$132.41,$0.00,$0.00,$0.00,$0.00,$0.00,$185.53,$0.00,$92.76,$146.94,$148.42,$0.00,$0.00,$0.00,$0.00,$0.00
315.37,SUP,Custom 27203010,,315.37  -  BIT DRILL 3.5MM 195MM 3 FLUTE QUICK COUPLING CANN NONSTRL,$277.58,$0.00,$277.58,$0.00,$198.11,$0.00,$0.00,$0.00,$0.00,$0.00,$277.58,$0.00,$138.79,$219.84,$222.06,$0.00,$0.00,$0.00,$0.00,$0.00
315.4,SUP,Custom 27203010,,315.40  -  BIT DRILL 3 FLUTE 4MM 195MM QUICK COUPLING NONSTRL,$277.58,$0.00,$277.58,$0.00,$198.11,$0.00,$0.00,$0.00,$0.00,$0.00,$277.58,$0.00,$138.79,$219.84,$222.06,$0.00,$0.00,$0.00,$0.00,$0.00
315.4,SUP,Custom 27203010,,BIT DRILL 195MM 4MM QC 3 FLT NSTRL,$300.85,$0.00,$277.58,$0.00,$198.11,$0.00,$0.00,$0.00,$0.00,$0.00,$277.58,$0.00,$138.79,$238.27,$222.06,$0.00,$0.00,$0.00,$0.00,$0.00
315.44,SUP,Custom 27203010,,315.44  -  BIT DRILL 4.5MM 145MM QUICK COUPLING 3 FLUTE NONSTRL,$169.23,$0.00,$169.23,$0.00,$120.78,$0.00,$0.00,$0.00,$0.00,$0.00,$169.23,$0.00,$84.61,$134.03,$135.38,$0.00,$0.00,$0.00,$0.00,$0.00
315.48,SUP,Custom 27203010,,315.48  -  BIT DRL 3 FLUT 4.5MM 195MM NS QC,$251.13,$0.00,$251.13,$0.00,$179.23,$0.00,$0.00,$0.00,$0.00,$0.00,$251.13,$0.00,$125.56,$198.89,$200.90,$0.00,$0.00,$0.00,$0.00,$0.00
315.6,SUP,Custom 27203010,,315.60  -  BIT DRILL 6MM 195MM QUICK COUPLING 3 FLUTED NONSTRL,$324.80,$0.00,$324.80,$0.00,$231.81,$0.00,$0.00,$0.00,$0.00,$0.00,$324.80,$0.00,$162.40,$257.24,$259.84,$0.00,$0.00,$0.00,$0.00,$0.00
315.92,SUP,Custom 27203010,,315.92  -  BIT DRL 3 FLUT 2.5MM 230MM NS 200MM QC CLBRT,$339.83,$0.00,$339.83,$0.00,$242.53,$0.00,$0.00,$0.00,$0.00,$0.00,$339.83,$0.00,$169.91,$269.15,$271.86,$0.00,$0.00,$0.00,$0.00,$0.00
315.93,SUP,Custom 27203010,,315.93  -  BIT DRILL 200MM 3.2MM 230MM 3 FLUTED QUICK COUPLING,$420.35,$0.00,$420.35,$0.00,$300.00,$0.00,$0.00,$0.00,$0.00,$0.00,$420.35,$0.00,$210.18,$332.92,$336.28,$0.00,$0.00,$0.00,$0.00,$0.00
316.001,SUP,Custom 27203010,,316.001  -  SPACER SPNL 0D 25MM LG 30X33MM NS LF XPAND-R RDLCNT SLF,"$20,400.00",$0.00,"$20,400.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$20,400.00",$0.00,"$10,200.00","$16,156.80","$16,320.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.002,SUP,Custom 27203010,,316.002  -  SPACER SPNL 0D 25MM LG 30X41MM NS LF XPAND-R RDLCNT SLF,"$20,400.00",$0.00,"$20,400.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$20,400.00",$0.00,"$10,200.00","$16,156.80","$16,320.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.003,SUP,Custom 27203010,,316.003  -  SPACER SPNL 0D 25MM LG 30X45MM NS LF XPAND-R RDLCNT SLF,"$20,400.00",$0.00,"$20,400.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$20,400.00",$0.00,"$10,200.00","$16,156.80","$16,320.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.004,SUP,Custom 27803010,,316.004  -  SPACER SPNL 0D 25MM LG 30X53MM NS LF XPAND-R RDLCNT SLF,"$21,832.50",$0.00,"$21,832.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,832.50",$0.00,"$10,916.25","$17,291.34","$17,466.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.005,SUP,Custom 27803010,,316.005  -  SPACER SPNL 0D 25MM LG 30X69MM NS LF XPAND-R RDLCNT SLF,"$22,190.00",$0.00,"$22,190.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$22,190.00",$0.00,"$11,095.00","$17,574.48","$17,752.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.006,SUP,Custom 27803010,,316.006  -  SPACER SPNL 8D 25MM LG 30X33MM NS LF XPAND-R RDLCNT SLF,"$20,400.00",$0.00,"$20,400.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$20,400.00",$0.00,"$10,200.00","$16,156.80","$16,320.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.007,SUP,Custom 27803010,,316.007  -  SPACER SPNL 8D 25MM LG 30X41MM NS LF XPAND-R RDLCNT SLF,"$20,400.00",$0.00,"$20,400.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$20,400.00",$0.00,"$10,200.00","$16,156.80","$16,320.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.008,SUP,Custom 27803010,,316.008  -  SPACER SPNL 8D 25MM LG 30X45MM NS LF XPAND-R RDLCNT SLF,"$20,400.00",$0.00,"$20,400.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$20,400.00",$0.00,"$10,200.00","$16,156.80","$16,320.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.009,SUP,Custom 27803010,,316.009  -  SPACER SPNL 8D 25MM LG 30X53MM NS LF XPAND-R RDLCNT SLF,"$21,832.50",$0.00,"$21,832.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,832.50",$0.00,"$10,916.25","$17,291.34","$17,466.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.01,SUP,Custom 27803010,,316.010  -  SPACER SPNL 8D 25MM LG 30X69MM NS LF XPAND-R RDLCNT SLF,"$22,190.00",$0.00,"$22,190.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$22,190.00",$0.00,"$11,095.00","$17,574.48","$17,752.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.011,SUP,Custom 27803010,,316.011  -  SPACER SPNL 8D 25MM LG 30X45MM NS LF XPAND-R RDLCNT SLF,"$20,400.00",$0.00,"$20,400.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$20,400.00",$0.00,"$10,200.00","$16,156.80","$16,320.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.012,SUP,Custom 27803010,,316.012  -  SPACER SPNL 16D 25MM LG 30X45MM NS LF XPAND-R RDLCNT SLF,"$21,832.50",$0.00,"$21,832.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,832.50",$0.00,"$10,916.25","$17,291.34","$17,466.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.013,SUP,Custom 27803010,,316.013  -  SPACER SPNL 16D 25MM LG 30X63MM NS LF XPAND-R RDLCNT SLF,"$22,190.00",$0.00,"$22,190.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$22,190.00",$0.00,"$11,095.00","$17,574.48","$17,752.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.014,SUP,Custom 27803010,,316.014  -  SPACER SPNL 16D 25MM LG 30X39MM NS LF XPAND-R RDLCNT SLF,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
316.015,SUP,Custom 27803010,,316.015  -  SPACER SPNL 16D 25MM LG 30X48MM NS LF XPAND-R RDLCNT SLF,"$20,400.00",$0.00,"$20,400.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$20,400.00",$0.00,"$10,200.00","$16,156.80","$16,320.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.016,SUP,Custom 27803010,,316.016  -  SPACER SPNL 16D 25MM LG 30X57MM NS LF XPAND-R RDLCNT SLF,"$21,832.50",$0.00,"$21,832.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,832.50",$0.00,"$10,916.25","$17,291.34","$17,466.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.017,SUP,Custom 27803010,,316.017  -  SPACER SPNL 16D 25MM LG 30X74MM NS LF XPAND-R RDLCNT SLF,"$23,740.00",$0.00,"$23,740.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$23,740.00",$0.00,"$11,870.00","$18,802.08","$18,992.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.018,SUP,Custom 27803010,,316.018  -  SPACER SPNL 16D 25MM LG 30X91MM NS LF XPAND-R RDLCNT SLF,"$23,740.00",$0.00,"$23,740.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$23,740.00",$0.00,"$11,870.00","$18,802.08","$18,992.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.019,SUP,Custom 27803010,,316.019  -  SPACER SPNL -8D 25MM LG 30X33MM NS LF XPAND-R RDLCNT SLF,"$20,400.00",$0.00,"$20,400.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$20,400.00",$0.00,"$10,200.00","$16,156.80","$16,320.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.02,SUP,Custom 27803010,,316.020  -  SPACER SPNL -8D 25MM LG 30X41MM NS LF XPAND-R RDLCNT SLF,"$20,400.00",$0.00,"$20,400.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$20,400.00",$0.00,"$10,200.00","$16,156.80","$16,320.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.021,SUP,Custom 27803010,,316.021  -  SPACER SPNL -8D 25MM LG 30X45MM NS LF XPAND-R RDLCNT SLF,"$20,400.00",$0.00,"$20,400.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$20,400.00",$0.00,"$10,200.00","$16,156.80","$16,320.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.022,SUP,Custom 27803010,,316.022  -  SPACER SPNL -8D 25MM LG 30X53MM NS LF XPAND-R RDLCNT SLF,"$21,832.50",$0.00,"$21,832.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,832.50",$0.00,"$10,916.25","$17,291.34","$17,466.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.023,SUP,Custom 27803010,,316.023  -  SPACER SPNL -8D 25MM LG 30X69MM NS LF XPAND-R RDLCNT SLF,"$22,190.00",$0.00,"$22,190.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$22,190.00",$0.00,"$11,095.00","$17,574.48","$17,752.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.024,SUP,Custom 27803010,,316.024  -  SPACER SPNL 0D 25MM LG 30X33MM NS LF XPAND-R RDLCNT SLF,"$20,400.00",$0.00,"$20,400.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$20,400.00",$0.00,"$10,200.00","$16,156.80","$16,320.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.025,SUP,Custom 27803010,,316.025  -  SPACER SPNL 8D 25MM LG 30X33MM NS LF XPAND-R RDLCNT SLF,"$20,400.00",$0.00,"$20,400.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$20,400.00",$0.00,"$10,200.00","$16,156.80","$16,320.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.026,SUP,Custom 27803010,,316.026  -  SPACER SPNL -8D 25MM LG 30X33MM NS LF XPAND-R RDLCNT SLF,"$20,400.00",$0.00,"$20,400.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$20,400.00",$0.00,"$10,200.00","$16,156.80","$16,320.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.027,SUP,Custom 27803010,,316.027  -  SPACER SPNL 16D 25MM LG 30X39MM NS LF XPAND-R RDLCNT SLF,"$20,400.00",$0.00,"$20,400.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$20,400.00",$0.00,"$10,200.00","$16,156.80","$16,320.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.03,SUP,Custom 27203010,,316.03  -  BIT DRILL 44.5MM .7MM 3MM STOP UNV HALL CPLNG NONSTRL,$342.00,$0.00,$342.00,$0.00,$244.09,$0.00,$0.00,$0.00,$0.00,$0.00,$342.00,$0.00,$171.00,$270.86,$273.60,$0.00,$0.00,$0.00,$0.00,$0.00
316.05,SUP,Custom 27203010,,316.05  -  BIT DRILL 44.5MM .76MM 5MM STOP UNV HALL CPLNG NONSTRL,$342.00,$0.00,$342.00,$0.00,$244.09,$0.00,$0.00,$0.00,$0.00,$0.00,$342.00,$0.00,$171.00,$270.86,$273.60,$0.00,$0.00,$0.00,$0.00,$0.00
316.08,SUP,Custom 27203010,,316.08  -  BIT DRILL 44.5MM .76MM 8MM STOP UNV HALL CPLNG NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
316.101,SUP,Custom 27803010,,316.101  -  SPACER SPNL 0D 13MM SM 15X20MM NS LF XPAND-R RDLCNT SLF,"$16,105.00",$0.00,"$16,105.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$16,105.00",$0.00,"$8,052.50","$12,755.16","$12,884.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.102,SUP,Custom 27803010,,316.102  -  SPACER SPNL 0D 13MM SM 15X22MM NS LF XPAND-R RDLCNT SLF,"$16,105.00",$0.00,"$16,105.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$16,105.00",$0.00,"$8,052.50","$12,755.16","$12,884.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.103,SUP,Custom 27803010,,316.103  -  SPACER SPNL 0D 13MM SM 15X28MM NS LF XPAND-R RDLCNT SLF,"$16,105.00",$0.00,"$16,105.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$16,105.00",$0.00,"$8,052.50","$12,755.16","$12,884.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.104,SUP,Custom 27803010,,316.104  -  SPACER SPNL 0D 13MM SM 15X30MM NS LF XPAND-R RDLCNT SLF,"$16,105.00",$0.00,"$16,105.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$16,105.00",$0.00,"$8,052.50","$12,755.16","$12,884.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.105,SUP,Custom 27803010,,316.105  -  SPACER SPNL 0D 13MM SM 15X32MM NS LF XPAND-R RDLCNT SLF,"$16,105.00",$0.00,"$16,105.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$16,105.00",$0.00,"$8,052.50","$12,755.16","$12,884.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.106,SUP,Custom 27803010,,316.106  -  SPACER SPNL 0D 13MM SM 15X38MM NS LF XPAND-R RDLCNT SLF,"$16,105.00",$0.00,"$16,105.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$16,105.00",$0.00,"$8,052.50","$12,755.16","$12,884.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.107,SUP,Custom 27803010,,316.107  -  SPACER SPNL 0D 13MM SM 15X44MM NS LF XPAND-R RDLCNT SLF,"$16,105.00",$0.00,"$16,105.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$16,105.00",$0.00,"$8,052.50","$12,755.16","$12,884.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.108,SUP,Custom 27803010,,316.108  -  SPACER SPNL 0D 13MM SM 15X52MM NS LF XPAND-R RDLCNT SLF,"$17,540.00",$0.00,"$17,540.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$17,540.00",$0.00,"$8,770.00","$13,891.68","$14,032.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.109,SUP,Custom 27803010,,316.109  -  SPACER SPNL 0D 13MM SM 15X58MM NS LF XPAND-R RDLCNT SLF,"$17,540.00",$0.00,"$17,540.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$17,540.00",$0.00,"$8,770.00","$13,891.68","$14,032.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.11,SUP,Custom 27803010,,316.110  -  SPACER SPNL 0D 13MM SM 15X64MM NS LF XPAND-R RDLCNT SLF,"$17,540.00",$0.00,"$17,540.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$17,540.00",$0.00,"$8,770.00","$13,891.68","$14,032.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.111,SUP,Custom 27803010,,316.111  -  SPACER SPNL 0D 13MM SM 15X72MM NS LF XPAND-R RDLCNT SLF,"$18,972.50",$0.00,"$18,972.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$18,972.50",$0.00,"$9,486.25","$15,026.22","$15,178.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.112,SUP,Custom 27803010,,316.112  -  SPACER SPNL 0D 13MM SM 15X80MM NS LF XPAND-R RDLCNT SLF,"$18,972.50",$0.00,"$18,972.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$18,972.50",$0.00,"$9,486.25","$15,026.22","$15,178.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.113,SUP,Custom 27803010,,316.113  -  SPACER SPNL 7D 13MM SM 15X20MM NS LF XPAND-R RDLCNT SLF,"$16,105.00",$0.00,"$16,105.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$16,105.00",$0.00,"$8,052.50","$12,755.16","$12,884.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.114,SUP,Custom 27803010,,316.114  -  SPACER SPNL 7D 13MM SM 15X22MM NS LF XPAND-R RDLCNT SLF,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
316.115,SUP,Custom 27803010,,316.115  -  SPACER SPNL 7D 13MM SM 15X28MM NS LF XPAND-R RDLCNT SLF,"$16,105.00",$0.00,"$16,105.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$16,105.00",$0.00,"$8,052.50","$12,755.16","$12,884.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.116,SUP,Custom 27803010,,316.116  -  SPACER SPNL 7D 13MM SM 15X30MM NS LF XPAND-R RDLCNT SLF,"$16,105.00",$0.00,"$16,105.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$16,105.00",$0.00,"$8,052.50","$12,755.16","$12,884.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.117,SUP,Custom 27803010,,316.117  -  SPACER SPNL 7D 13MM SM 15X32MM NS LF XPAND-R RDLCNT SLF,"$16,105.00",$0.00,"$16,105.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$16,105.00",$0.00,"$8,052.50","$12,755.16","$12,884.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.118,SUP,Custom 27803010,,316.118  -  SPACER SPNL 7D 13MM SM 15X38MM NS LF XPAND-R RDLCNT SLF,"$16,105.00",$0.00,"$16,105.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$16,105.00",$0.00,"$8,052.50","$12,755.16","$12,884.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.119,SUP,Custom 27803010,,316.119  -  SPACER SPNL 7D 13MM SM 15X44MM NS LF XPAND-R RDLCNT SLF,"$16,105.00",$0.00,"$16,105.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$16,105.00",$0.00,"$8,052.50","$12,755.16","$12,884.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.12,SUP,Custom 27803010,,316.120  -  SPACER SPNL 7D 13MM SM 15X52MM NS LF XPAND-R RDLCNT SLF,"$17,540.00",$0.00,"$17,540.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$17,540.00",$0.00,"$8,770.00","$13,891.68","$14,032.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.121,SUP,Custom 27803010,,316.121  -  SPACER SPNL 7D 13MM SM 15X58MM NS LF XPAND-R RDLCNT SLF,"$17,540.00",$0.00,"$17,540.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$17,540.00",$0.00,"$8,770.00","$13,891.68","$14,032.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.122,SUP,Custom 27803010,,316.122  -  SPACER SPNL 7D 13MM SM 15X64MM NS LF XPAND-R RDLCNT SLF,"$17,540.00",$0.00,"$17,540.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$17,540.00",$0.00,"$8,770.00","$13,891.68","$14,032.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.123,SUP,Custom 27803010,,316.123  -  SPACER SPNL 7D 13MM SM 15X72MM NS LF XPAND-R RDLCNT SLF,"$18,972.50",$0.00,"$18,972.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$18,972.50",$0.00,"$9,486.25","$15,026.22","$15,178.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.124,SUP,Custom 27803010,,316.124  -  SPACER SPNL 7D 13MM SM 15X80MM NS LF XPAND-R RDLCNT SLF,"$18,972.50",$0.00,"$18,972.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$18,972.50",$0.00,"$9,486.25","$15,026.22","$15,178.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.125,SUP,Custom 27803010,,316.125  -  SPACER SPNL 16D 13MM SM 15X56MM NS LF XPAND-R RDLCNT SLF,"$17,540.00",$0.00,"$17,540.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$17,540.00",$0.00,"$8,770.00","$13,891.68","$14,032.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.126,SUP,Custom 27803010,,316.126  -  SPACER SPNL 16D 13MM SM 15X64MM NS LF XPAND-R RDLCNT SLF,"$17,540.00",$0.00,"$17,540.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$17,540.00",$0.00,"$8,770.00","$13,891.68","$14,032.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.127,SUP,Custom 27803010,,316.127  -  SPACER SPNL 16D 13MM SM 15X72MM NS LF XPAND-R RDLCNT SLF,"$18,972.50",$0.00,"$18,972.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$18,972.50",$0.00,"$9,486.25","$15,026.22","$15,178.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.128,SUP,Custom 27803010,,316.128  -  SPACER SPNL 16D 13MM SM 15X80MM NS LF XPAND-R RDLCNT SLF,"$18,972.50",$0.00,"$18,972.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$18,972.50",$0.00,"$9,486.25","$15,026.22","$15,178.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.129,SUP,Custom 27803010,,316.129  -  SPACER SPNL 0D 13MM SM 15X20MM NS LF XPAND-R RDLCNT SLF,"$16,105.00",$0.00,"$16,105.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$16,105.00",$0.00,"$8,052.50","$12,755.16","$12,884.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.13,SUP,Custom 27203010,,316.13  -  BIT DRL 3MM .7MM 44.5MM NS JLTCH CPLNG SLF STP STRYK,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
316.13,SUP,Custom 27803010,,316.130  -  SPACER SPNL 7D 13MM SM 15X20MM NS LF XPAND-R RDLCNT SLF,"$16,105.00",$0.00,"$12,755.16",$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,"$12,755.16",$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
316.131,SUP,Custom 27803010,,316.131  -  SPACER SPNL 0D 13MM SM 15X22MM NS LF XPAND-R RDLCNT SLF,"$16,105.00",$0.00,"$16,105.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$16,105.00",$0.00,"$8,052.50","$12,755.16","$12,884.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.132,SUP,Custom 27803010,,316.132  -  SPACER SPNL 7D 13MM SM 15X22MM NS LF XPAND-R RDLCNT SLF,"$16,105.00",$0.00,"$16,105.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$16,105.00",$0.00,"$8,052.50","$12,755.16","$12,884.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.15,SUP,Custom 27203010,,316.15  -  BIT DRILL 44.5MM .76MM CPLNG JLTCH STOP 5MM NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
316.18,SUP,Custom 27203010,,316.18  -  BIT DRILL 44.5MM .76MM JLTCH STOP 8MM NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
316.201,SUP,Custom 27803010,,316.201  -  SPACER SPNL 6D 21MM MED 23X32MM NS LF XPAND-R RDLCNT SLF,"$18,017.50",$0.00,"$18,017.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$18,017.50",$0.00,"$9,008.75","$14,269.86","$14,414.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.202,SUP,Custom 27803010,,316.202  -  SPACER SPNL 6D 21MM MED 23X34MM NS LF XPAND-R RDLCNT SLF,"$18,017.50",$0.00,"$18,017.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$18,017.50",$0.00,"$9,008.75","$14,269.86","$14,414.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.203,SUP,Custom 27803010,,316.203  -  SPACER SPNL 6D 21MM MED 23X38MM NS LF XPAND-R RDLCNT SLF,"$19,447.50",$0.00,"$19,447.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$19,447.50",$0.00,"$9,723.75","$15,402.42","$15,558.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.204,SUP,Custom 27803010,,316.204  -  SPACER SPNL -6D 21MM MED 23X46MM NS LF XPAND-R RDLCNT SLF,"$19,807.50",$0.00,"$19,807.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$19,807.50",$0.00,"$9,903.75","$15,687.54","$15,846.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.205,SUP,Custom 27803010,,316.205  -  SPACER SPNL 6D 21MM MED 23X56MM NS LF XPAND-R RDLCNT SLF,"$21,832.50",$0.00,"$21,832.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,832.50",$0.00,"$10,916.25","$17,291.34","$17,466.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.206,SUP,Custom 27803010,,316.206  -  SPACER SPNL -6D 21MM MED 23X64MM NS LF XPAND-R RDLCNT SLF,"$21,832.50",$0.00,"$21,832.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,832.50",$0.00,"$10,916.25","$17,291.34","$17,466.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.207,SUP,Custom 27803010,,316.207  -  SPACER SPNL 0D 21MM MED 23X32MM NS LF XPAND-R RDLCNT SLF,"$18,017.50",$0.00,"$18,017.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$18,017.50",$0.00,"$9,008.75","$14,269.86","$14,414.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.208,SUP,Custom 27803010,,316.208  -  SPACER SPNL 0D 21MM MED 23X34MM NS LF XPAND-R RDLCNT SLF,"$18,017.50",$0.00,"$18,017.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$18,017.50",$0.00,"$9,008.75","$14,269.86","$14,414.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.209,SUP,Custom 27803010,,316.209  -  SPACER SPNL 0D 21MM MED 23X38MM NS LF XPAND-R RDLCNT SLF,"$19,447.50",$0.00,"$19,447.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$19,447.50",$0.00,"$9,723.75","$15,402.42","$15,558.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.21,SUP,Custom 27803010,,316.210  -  SPACER SPNL 0D 21MM MED 23X46MM NS LF XPAND-R RDLCNT SLF,"$19,807.50",$0.00,"$19,807.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$19,807.50",$0.00,"$9,903.75","$15,687.54","$15,846.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.211,SUP,Custom 27803010,,316.211  -  SPACER SPNL 0D 21MM MED 23X56MM NS LF XPAND-R RDLCNT SLF,"$21,832.50",$0.00,"$21,832.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,832.50",$0.00,"$10,916.25","$17,291.34","$17,466.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.212,SUP,Custom 27803010,,316.212  -  SPACER SPNL 0D 21MM MED 23X64MM NS LF XPAND-R RDLCNT SLF,"$21,832.50",$0.00,"$21,832.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,832.50",$0.00,"$10,916.25","$17,291.34","$17,466.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.213,SUP,Custom 27803010,,316.213  -  SPACER SPNL 8D 21MM MED 23X32MM NS LF XPAND-R RDLCNT SLF,"$18,017.50",$0.00,"$18,017.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$18,017.50",$0.00,"$9,008.75","$14,269.86","$14,414.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.214,SUP,Custom 27803010,,316.214  -  SPACER SPNL 8D 21MM MED 23X34MM NS LF XPAND-R RDLCNT SLF,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
316.215,SUP,Custom 27803010,,316.215  -  SPACER SPNL 8D 21MM MED 23X38MM NS LF XPAND-R RDLCNT SLF,"$19,447.50",$0.00,"$19,447.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$19,447.50",$0.00,"$9,723.75","$15,402.42","$15,558.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.216,SUP,Custom 27803010,,316.216  -  SPACER SPNL 8D 21MM MED 23X46MM NS LF XPAND-R RDLCNT SLF,"$19,807.50",$0.00,"$19,807.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$19,807.50",$0.00,"$9,903.75","$15,687.54","$15,846.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.217,SUP,Custom 27803010,,316.217  -  SPACER SPNL 8D 21MM MED 23X56MM NS LF XPAND-R RDLCNT SLF,"$21,832.50",$0.00,"$21,832.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,832.50",$0.00,"$10,916.25","$17,291.34","$17,466.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.218,SUP,Custom 27803010,,316.218  -  SPACER SPNL 8D 21MM MED 23X64MM NS LF XPAND-R RDLCNT SLF,"$21,832.50",$0.00,"$21,832.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,832.50",$0.00,"$10,916.25","$17,291.34","$17,466.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.219,SUP,Custom 27803010,,316.219  -  SPACER SPNL 8D 21MM MED 23X73MM NS LF XPAND-R RDLCNT SLF,"$21,832.50",$0.00,"$21,832.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,832.50",$0.00,"$10,916.25","$17,291.34","$17,466.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.22,SUP,Custom 27803010,,316.220  -  SPACER SPNL 8D 21MM MED 23X42MM NS LF XPAND-R RDLCNT SLF,"$21,832.50",$0.00,"$21,832.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,832.50",$0.00,"$10,916.25","$17,291.34","$17,466.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.221,SUP,Custom 27803010,,316.221  -  SPACER SPNL 0D 21MM MED 23X73MM NS LF XPAND-R RDLCNT SLF,"$21,832.50",$0.00,"$21,832.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,832.50",$0.00,"$10,916.25","$17,291.34","$17,466.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.222,SUP,Custom 27803010,,316.222  -  SPACER SPNL 0D 21MM MED 23X82MM NS LF XPAND-R RDLCNT SLF,"$21,832.50",$0.00,"$21,832.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,832.50",$0.00,"$10,916.25","$17,291.34","$17,466.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.23,SUP,Custom 27203010,,316.23  -  BIT DRILL 60MM .7MM 3MM STOP QC,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
316.232,SUP,Custom 27203010,,316.232  -  BIT DRILL 60MM 1MM UNV HALL CPLNG NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
316.235,SUP,Custom 27203010,,316.235  -  BIT DRL 1MM 60MM NS JLTCH CPLNG WO SLF STP STRYK,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
316.236,SUP,Custom 27203010,,316.236  -  BIT DRL 1MM 60MM NS JLTCH CPLNG STRYK MDLR HND SYS,$122.13,$0.00,$122.13,$0.00,$87.16,$0.00,$0.00,$0.00,$0.00,$0.00,$122.13,$0.00,$61.06,$96.73,$97.70,$0.00,$0.00,$0.00,$0.00,$0.00
316.238,SUP,Custom 27203010,,316.238  -  BIT DRILL 50MM 1MM MINI QC NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
316.25,SUP,Custom 27203010,,316.25  -  BIT DRILL 44.5MM .76MM 5MM STOP MINI QC NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
316.28,SUP,Custom 27203010,,316.28  -  BIT DRILL 8MM STOP QC NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
316.286,SUP,Custom 27203010,,316.286  -  BIT DRILL MINI .76MM 44.5MM 6MM MINI QUICK COUPLING STOP,$270.23,$0.00,$270.23,$0.00,$192.86,$0.00,$0.00,$0.00,$0.00,$0.00,$270.23,$0.00,$135.11,$214.02,$216.18,$0.00,$0.00,$0.00,$0.00,$0.00
316.288,SUP,Custom 27203010,,316.288  -  BIT DRILL MINI .76MM 44.5MM 8MM QUICK COUPLING STOP LCP,$270.23,$0.00,$270.23,$0.00,$192.86,$0.00,$0.00,$0.00,$0.00,$0.00,$270.23,$0.00,$135.11,$214.02,$216.18,$0.00,$0.00,$0.00,$0.00,$0.00
316.29,SUP,Custom 27203010,,316.290  -  BIT DRILL MINI .76MM 10MM QUICK COUPLING STAINLESS STEEL,$270.23,$0.00,$270.23,$0.00,$192.86,$0.00,$0.00,$0.00,$0.00,$0.00,$270.23,$0.00,$135.11,$214.02,$216.18,$0.00,$0.00,$0.00,$0.00,$0.00
316.292,SUP,Custom 27203010,,316.292  -  BIT DRILL MINI .76MM 44.5MM 12MM MINI QUICK COUPLING STOP,$270.23,$0.00,$270.23,$0.00,$192.86,$0.00,$0.00,$0.00,$0.00,$0.00,$270.23,$0.00,$135.11,$214.02,$216.18,$0.00,$0.00,$0.00,$0.00,$0.00
316.294,SUP,Custom 27203010,,316.294  -  BIT DRILL .76MM 44.5MM 14MM MINI QUICK COULPING STOP NONSTRL,$270.23,$0.00,$270.23,$0.00,$192.86,$0.00,$0.00,$0.00,$0.00,$0.00,$270.23,$0.00,$135.11,$214.02,$216.18,$0.00,$0.00,$0.00,$0.00,$0.00
316.301,SUP,Custom 27803010,,316.301  -  SPACER SPNL 0D 21MM S/MED 23X23MM NS LF XPAND-R RDLCNT SLF,"$17,062.50",$0.00,"$17,062.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$17,062.50",$0.00,"$8,531.25","$13,513.50","$13,650.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.302,SUP,Custom 27803010,,316.302  -  SPACER SPNL 0D 21MM S/MED 23X24MM NS LF XPAND-R RDLCNT SLF,"$17,062.50",$0.00,"$17,062.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$17,062.50",$0.00,"$8,531.25","$13,513.50","$13,650.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.303,SUP,Custom 27803010,,316.303  -  SPACER SPNL 0D 21MM S/MED 23X30MM NS LF XPAND-R RDLCNT SLF,"$17,062.50",$0.00,"$17,062.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$17,062.50",$0.00,"$8,531.25","$13,513.50","$13,650.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.304,SUP,Custom 27803010,,316.304  -  SPACER SPNL 0D 21MM S/MED 23X23MM NS LF XPAND-R RDLCNT SLF,"$17,062.50",$0.00,"$17,062.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$17,062.50",$0.00,"$8,531.25","$13,513.50","$13,650.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.305,SUP,Custom 27803010,,316.305  -  SPACER SPNL 0D 21MM S/MED 23X24MM NS LF XPAND-R RDLCNT SLF,"$17,062.50",$0.00,"$17,062.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$17,062.50",$0.00,"$8,531.25","$13,513.50","$13,650.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.306,SUP,Custom 27203010,,316.306  -  BIT DRL 6MM .76MM 44.5MM NS JLTCH CPLNG SLF STP 1MM SCR MDLR,$270.23,$0.00,$270.23,$0.00,$192.86,$0.00,$0.00,$0.00,$0.00,$0.00,$270.23,$0.00,$135.11,$214.02,$216.18,$0.00,$0.00,$0.00,$0.00,$0.00
316.308,SUP,Custom 27203010,,316.308  -  BIT DRILL 8MM STOP .76MM 44.5MM J LATCH NONSTRL,$270.23,$0.00,$270.23,$0.00,$192.86,$0.00,$0.00,$0.00,$0.00,$0.00,$270.23,$0.00,$135.11,$214.02,$216.18,$0.00,$0.00,$0.00,$0.00,$0.00
316.31,SUP,Custom 27203010,,316.310  -  BIT DRL 10MM .76MM 44.5MM NS JLTCH CPLNG SLF STP 1MM SCR,$270.23,$0.00,$270.23,$0.00,$192.86,$0.00,$0.00,$0.00,$0.00,$0.00,$270.23,$0.00,$135.11,$214.02,$216.18,$0.00,$0.00,$0.00,$0.00,$0.00
316.312,SUP,Custom 27203010,,316.312  -  BIT DRL 12MM .76MM 44.5MM NS JLTCH CPLNG SLF STP 1MM SCR,$270.23,$0.00,$270.23,$0.00,$192.86,$0.00,$0.00,$0.00,$0.00,$0.00,$270.23,$0.00,$135.11,$214.02,$216.18,$0.00,$0.00,$0.00,$0.00,$0.00
316.314,SUP,Custom 27203010,,316.314  -  BIT DRL 14MM .76MM 44.5MM NS JLTCH CPLNG SLF STP 1MM SCR,$270.23,$0.00,$270.23,$0.00,$192.86,$0.00,$0.00,$0.00,$0.00,$0.00,$270.23,$0.00,$135.11,$214.02,$216.18,$0.00,$0.00,$0.00,$0.00,$0.00
316.33,SUP,Custom 27203010,,316.33  -  BIT DRILL 17MM .76MM 3MM STOP MINI QC 90D SCRDRVR NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
316.332,SUP,Custom 27203010,,316.332  -  BIT DRILL 65MM 1.3MM UNV HALL CPLNG NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
316.335,SUP,Custom 27203010,,316.335  -  BIT DRILL 65MM 1.3MM JLTCH NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
316.338,SUP,Custom 27203010,,316.338  -  BIT DRILL 55MM 1.3MM MINI QC NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
316.35,SUP,Custom 27203010,,316.35  -  BIT DRILL 19MM .76MM 5MM STOP MINI QC 90D SCRDRVR NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
316.38,SUP,Custom 27203010,,316.38  -  BIT DRILL 22MM .76MM 8MM STOP MINI QC 90D SCRDRVR NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
316.396,SUP,Custom 27203010,,316.396  -  BIT DRILL MINI 1MM 50MM QUICK COUPLING STAINLESS STEEL,$135.10,$0.00,$135.10,$0.00,$96.42,$0.00,$0.00,$0.00,$0.00,$0.00,$135.10,$0.00,$67.55,$107.00,$108.08,$0.00,$0.00,$0.00,$0.00,$0.00
316.401,SUP,Custom 27803010,,316.401  -  SPACER SPNL 0D 25MM MED LG 30X28MM NS LF XPAND-R RDLCNT SLF,"$19,922.50",$0.00,"$19,922.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$19,922.50",$0.00,"$9,961.25","$15,778.62","$15,938.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.402,SUP,Custom 27803010,,316.402  -  BIT DRILL MINI 1.3MM 55MM QUICK COUPLING STAINLESS STEEL,$135.10,$0.00,$135.10,$0.00,$96.42,$0.00,$0.00,$0.00,$0.00,$0.00,$135.10,$0.00,$67.55,$107.00,$108.08,$0.00,$0.00,$0.00,$0.00,$0.00
316.403,SUP,Custom 27803010,,316.403  -  BIT DRILL 1.3MM 65MM J LATCH NONSTRL,$135.10,$0.00,$135.10,$0.00,$96.42,$0.00,$0.00,$0.00,$0.00,$0.00,$135.10,$0.00,$67.55,$107.00,$108.08,$0.00,$0.00,$0.00,$0.00,$0.00
316.404,SUP,Custom 27803010,,316.404  -  SPACER SPNL 0D 25MM MED LG 30X45MM NS LF XPAND-R RDLCNT SLF,"$22,070.00",$0.00,"$22,070.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$22,070.00",$0.00,"$11,035.00","$17,479.44","$17,656.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.405,SUP,Custom 27803010,,316.405  -  SPACER SPNL 0D 25MM MED LG 30X55MM NS LF XPAND-R RDLCNT SLF,"$22,785.00",$0.00,"$22,785.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$22,785.00",$0.00,"$11,392.50","$18,045.72","$18,228.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.406,SUP,Custom 27803010,,316.406  -  SPACER SPNL 0D 25MM MED LG 30X61MM NS LF XPAND-R RDLCNT SLF,"$22,785.00",$0.00,"$22,785.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$22,785.00",$0.00,"$11,392.50","$18,045.72","$18,228.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.407,SUP,Custom 27803010,,316.407  -  SPACER SPNL 3D 25MM MED LG 30X28MM NS LF XPAND-R RDLCNT SLF,"$19,922.50",$0.00,"$19,922.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$19,922.50",$0.00,"$9,961.25","$15,778.62","$15,938.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.408,SUP,Custom 27803010,,316.408  -  SPACER SPNL 3D 25MM MED LG 30X35MM NS LF XPAND-R RDLCNT SLF,"$19,922.50",$0.00,"$19,922.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$19,922.50",$0.00,"$9,961.25","$15,778.62","$15,938.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.409,SUP,Custom 27803010,,316.409  -  SPACER SPNL 3D 25MM MED LG 30X39MM NS LF XPAND-R RDLCNT SLF,"$22,070.00",$0.00,"$22,070.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$22,070.00",$0.00,"$11,035.00","$17,479.44","$17,656.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.41,SUP,Custom 27803010,,316.410  -  SPACER SPNL 3D 25MM MED LG 30X45MM NS LF XPAND-R RDLCNT SLF,"$22,070.00",$0.00,"$22,070.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$22,070.00",$0.00,"$11,035.00","$17,479.44","$17,656.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.411,SUP,Custom 27803010,,316.411  -  SPACER SPNL 3D 25MM MED LG 30X55MM NS LF XPAND-R RDLCNT SLF,"$22,785.00",$0.00,"$22,785.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$22,785.00",$0.00,"$11,392.50","$18,045.72","$18,228.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.412,SUP,Custom 27803010,,316.412  -  SPACER SPNL 3D 25MM MED LG 30X61MM NS LF XPAND-R RDLCNT SLF,"$22,785.00",$0.00,"$22,785.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$22,785.00",$0.00,"$11,392.50","$18,045.72","$18,228.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.413,SUP,Custom 27803010,,316.413  -  SPACER SPNL 3D 25MM MED LG 30X28MM NS LF XPAND-R RDLCNT SLF,"$19,922.50",$0.00,"$19,922.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$19,922.50",$0.00,"$9,961.25","$15,778.62","$15,938.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.414,SUP,Custom 27803010,,316.414  -  SPACER SPNL 3D 25MM MED LG 30X34MM NS LF XPAND-R RDLCNT SLF,"$19,922.50",$0.00,"$19,922.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$19,922.50",$0.00,"$9,961.25","$15,778.62","$15,938.00",$0.00,$0.00,$0.00,$0.00,$0.00
316.441,SUP,Custom 27203010,,316.441  -  BIT DRL 4MM 1MM 44.5MM NS U HL CPLNG SLF STP .5MM SCR,$342.00,$0.00,$342.00,$0.00,$244.09,$0.00,$0.00,$0.00,$0.00,$0.00,$342.00,$0.00,$171.00,$270.86,$273.60,$0.00,$0.00,$0.00,$0.00,$0.00
316.442,SUP,Custom 27203010,,316.442  -  BIT DRL 6MM 1MM 44.5MM NS U HL CPLNG SLF STP .5MM SCR,$342.00,$0.00,$342.00,$0.00,$244.09,$0.00,$0.00,$0.00,$0.00,$0.00,$342.00,$0.00,$171.00,$270.86,$273.60,$0.00,$0.00,$0.00,$0.00,$0.00
316.443,SUP,Custom 27203010,,316.443  -  BIT DRL 8MM 1MM 44.5MM NS U HL CPLNG SLF STP .5MM SCR,$342.00,$0.00,$342.00,$0.00,$244.09,$0.00,$0.00,$0.00,$0.00,$0.00,$342.00,$0.00,$171.00,$270.86,$273.60,$0.00,$0.00,$0.00,$0.00,$0.00
316.446,SUP,Custom 27203010,,316.446  -  BIT DRILL 44.5MM 1MM JLTCH STOP 4MM NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
316.447,SUP,Custom 27203010,,316.447  -  BIT DRILL 6MM 1MM JLTCH STOP NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
316.448,SUP,Custom 27203010,,316.448  -  BIT DRILL 8MM 1MM JLTCH STOP NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
316.451,SUP,Custom 27203010,,316.451  -  BIT DRILL 1MM 4MM STOP MINI QC NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
316.452,SUP,Custom 27203010,,316.452  -  BIT DRILL 44.5MM 1MM 6MM STOP MINI QC NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
316.453,SUP,Custom 27203010,,316.453  -  BIT DRILL 44.5MM 1MM 8MM STOP MINI QC NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
316.605,SUP,Custom 27203010,,316.605  -  BIT DRILL 52MM .76MM 5MM STOP HEX CPLNG NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
316.608,SUP,Custom 27203010,,316.608  -  BIT DRILL 52MM .76MM 8MM STOP HEX CPLNG NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
316.614,SUP,Custom 27203010,,316.614  -  BIT DRILL 52MM 1MM 4MM STOP HEX CPLNG NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
316.616,SUP,Custom 27203010,,316.616  -  BIT DRILL 52MM 1MM 6MM STOP HEX CPLNG NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
316.618,SUP,Custom 27203010,,316.618  -  BIT DRILL 52MM 1MM 8MM STOP HEX CPLNG NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
316.624,SUP,Custom 27203010,,316.624  -  BIT DRILL 1.1MM STOP HEX 4MM 1.5MM CRANFCL SCR NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
316.626,SUP,Custom 27203010,,316.626  -  BIT DRILL 52MM 1.1MM 6MM STOP HEX CPLNG NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
316.628,SUP,Custom 27203010,,316.628  -  BIT DRILL 52MM 1.1MM 8MM STOP HEX CPLNG NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
316.632,SUP,Custom 27203010,,316.632  -  BIT DRILL 52MM 1.1MM 12MM STOP HEX CPLNG NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
316.644,SUP,Custom 27203010,,316.644  -  BIT DRILL 52MM 1.5MM 4MM STOP HEX CPLNG NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
316.646,SUP,Custom 27203010,,316.646  -  BIT DRILL 52MM 1.5MM 6MM STOP HEX CPLNG NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
316.648,SUP,Custom 27203010,,316.648  -  BIT DRILL 52MM 1.5MM 8MM STOP HEX CPLNG NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
316.652,SUP,Custom 27203010,,316.652  -  BIT DRILL 52MM 1.5MM 12MM STOP HEX CPLNG NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
317.04,SUP,Custom 27203010,,317.04  -  BIT DRILL 44.5MM 1.1MM 4MM STOP UNV HALL CPLNG NONSTRL,$342.00,$0.00,$342.00,$0.00,$244.09,$0.00,$0.00,$0.00,$0.00,$0.00,$342.00,$0.00,$171.00,$270.86,$273.60,$0.00,$0.00,$0.00,$0.00,$0.00
317.06,SUP,Custom 27203010,,317.06  -  BIT DRILL 44.5MM 1.1MM 6MM STOP UNV HALL CPLNG NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
317.08,SUP,Custom 27203010,,317.08  -  BIT DRILL 44.5MM 1.1MM 8MM STOP UNV HALL CPLNG NONSTRL,$342.00,$0.00,$342.00,$0.00,$244.09,$0.00,$0.00,$0.00,$0.00,$0.00,$342.00,$0.00,$171.00,$270.86,$273.60,$0.00,$0.00,$0.00,$0.00,$0.00
317.106,SUP,Custom 27203010,,317.106  -  BIT DRILL 20MM 1.1MM 6MM STOP MINI QC 90D SCRDRVR NONSTRL,$135.00,$0.00,$135.00,$0.00,$96.35,$0.00,$0.00,$0.00,$0.00,$0.00,$135.00,$0.00,$67.50,$106.92,$108.00,$0.00,$0.00,$0.00,$0.00,$0.00
317.112,SUP,Custom 27203010,,317.112  -  BIT DRILL 26MM 1.1MM 12MM STOP MINI QC 90D SCRDRVR NONSTRL,$135.00,$0.00,$135.00,$0.00,$96.35,$0.00,$0.00,$0.00,$0.00,$0.00,$135.00,$0.00,$67.50,$106.92,$108.00,$0.00,$0.00,$0.00,$0.00,$0.00
317.118,SUP,Custom 27203010,,317.118  -  BIT DRILL 32MM 1.1MM 18MM STOP MINI QC 90D SCRDRVR NONSTRL,$135.00,$0.00,$135.00,$0.00,$96.35,$0.00,$0.00,$0.00,$0.00,$0.00,$135.00,$0.00,$67.50,$106.92,$108.00,$0.00,$0.00,$0.00,$0.00,$0.00
317.12,SUP,Custom 27203010,,317.12  -  BIT DRILL 44.5MM 1.1MM 2MM STOP JLTCH NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
317.14,SUP,Custom 27203010,,317.14  -  BIT DRL 4MM 1.1MM 44.5MM NS JLTCH CPLNG SLF STP 1/1.5MM SCR,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
317.16,SUP,Custom 27203010,,317.16  -  BIT DRL 6MM 1.1MM 44.5MM NS JLTCH CPLNG SLF STP 1/1.5MM SCR,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
317.18,SUP,Custom 27203010,,317.18  -  BIT DRL 8MM 1.1MM 44.5MM NS JLTCH CPLNG SLF STP 1/1.5MM SCR,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
317.22,SUP,Custom 27203010,,317.22  -  BIT DRL 12MM 1.1MM 44.5MM NS JLTCH CPLNG SLF STP 1/1.5MM SCR,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
317.232,SUP,Custom 27203010,,317.232  -  BIT DRILL 65MM 1.1MM UNV HALL CPLNG NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
317.235,SUP,Custom 27203010,,317.235  -  BIT DRILL 65MM 1.1MM 40MM STOP JLTCH NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
317.238,SUP,Custom 27203010,,317.238  -  BIT DRILL 65MM 1.1MM MINI QC NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
317.24,SUP,Custom 27203010,,317.24  -  BIT DRILL 44.5MM 1.1MM 4MM STOP MINI QC NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
317.26,SUP,Custom 27203010,,317.26  -  BIT DRILL 44.5MM 1.1MM 6MM STOP MINI QC NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
317.28,SUP,Custom 27203010,,317.28  -  BIT DRILL 44.5MM 1.1MM 8MM STOP MINI QC NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
317.32,SUP,Custom 27203010,,317.32  -  BIT DRILL 44.5MM 1.1MM 12MM STOP MINI QC NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
317.332,SUP,Custom 27203010,,317.332  -  BIT DRILL 110MM 1.1MM UNV HALL CPLNG NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
317.335,SUP,Custom 27203010,,317.335  -  BIT DRILL 65MM 1.1MM JLTCH NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
317.338,SUP,Custom 27203010,,317.338  -  BIT DRILL 110MM 1.1MM MINI QC NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
317.432,SUP,Custom 27203010,,317.432  -  BIT DRILL 85MM 1.5MM UNV HALL CPLNG NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
317.435,SUP,Custom 27203010,,317.435  -  BIT DRL 1.5MM 85MM NS JLTCH CPLNG WO SLF STP 1/1.5MM SCR,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
317.438,SUP,Custom 27203010,,317.438  -  BIT DRILL 85MM 1.5MM MINI QC NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
317.452,SUP,Custom 27203010,,317.452  -  BIT DRILL 100MM 2MM UNV HALL CPLNG NONSTRL,$342.00,$0.00,$342.00,$0.00,$244.09,$0.00,$0.00,$0.00,$0.00,$0.00,$342.00,$0.00,$171.00,$270.86,$273.60,$0.00,$0.00,$0.00,$0.00,$0.00
317.458,SUP,Custom 27203010,,317.458  -  BIT DRILL 90MM 2MM MINI QC NONSTRL,$342.00,$0.00,$342.00,$0.00,$244.09,$0.00,$0.00,$0.00,$0.00,$0.00,$342.00,$0.00,$171.00,$270.86,$273.60,$0.00,$0.00,$0.00,$0.00,$0.00
317.506,SUP,Custom 27203010,,317.506  -  BIT DRILL 20MM 1.5MM 6MM STOP MINI QC NONSTRL,$135.00,$0.00,$135.00,$0.00,$96.35,$0.00,$0.00,$0.00,$0.00,$0.00,$135.00,$0.00,$67.50,$106.92,$108.00,$0.00,$0.00,$0.00,$0.00,$0.00
317.512,SUP,Custom 27203010,,317.512  -  BIT DRILL 26MM 1.5MM 12MM STOP MINI QC NONSTRL,$135.00,$0.00,$135.00,$0.00,$96.35,$0.00,$0.00,$0.00,$0.00,$0.00,$135.00,$0.00,$67.50,$106.92,$108.00,$0.00,$0.00,$0.00,$0.00,$0.00
317.518,SUP,Custom 27203010,,317.518  -  BIT DRILL 32MM 1.5MM 18MM STOP MINI QC NONSTRL,$135.00,$0.00,$135.00,$0.00,$96.35,$0.00,$0.00,$0.00,$0.00,$0.00,$135.00,$0.00,$67.50,$106.92,$108.00,$0.00,$0.00,$0.00,$0.00,$0.00
317.54,SUP,Custom 27203010,,317.54  -  BIT DRILL 44.5MM 1.5MM 4MM STOP UNV HALL CPLNG NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
317.56,SUP,Custom 27203010,,317.56  -  BIT DRILL 44.5MM 1.5MM 6MM STOP UNV HALL CPLNG NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
317.58,SUP,Custom 27203010,,317.58  -  BIT DRILL 44.5MM 1.5MM 8MM STOP UNV HALL CPLNG NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
317.62,SUP,Custom 27203010,,317.62  -  BIT DRILL 44.5MM 1.5MM 12MM STOP UNV HALL CPLNG NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
317.64,SUP,Custom 27203010,,317.64  -  BIT DRL 4MM 1.5MM 44.5MM NS JLTCH CPLNG SLF STP 1/1.5MM SCR,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
317.66,SUP,Custom 27203010,,317.66  -  BIT DRL 6MM 1.5MM 44.5MM NS JLTCH CPLNG SLF STP 1/1.5MM SCR,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
317.68,SUP,Custom 27203010,,317.68  -  BIT DRL 8MM 1.5MM 44.5MM NS JLTCH CPLNG SLF STP 1/1.5MM SCR,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
317.72,SUP,Custom 27203010,,317.72  -  BIT DRL 12MM 1.5MM 44.5MM NS JLTCH CPLNG SLF STP 1/1.5MM SCR,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
317.74,SUP,Custom 27203010,,317.74  -  BIT DRILL 44.5MM 1.5MM 4MM STOP MINI QC NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
317.76,SUP,Custom 27203010,,317.76  -  BIT DRILL 44.5MM 1.5MM 6MM STOP MINI QC NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
317.78,SUP,Custom 27203010,,317.78  -  BIT DRILL 44.5MM 1.5MM 8MM STOP MINI QC NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
317.781,SUP,Custom 27203010,,317.781  -  BIT DRILL 91MM 1.5MM 4MM STOP GUIDE NONSTRL,$224.00,$0.00,$224.00,$0.00,$159.87,$0.00,$0.00,$0.00,$0.00,$0.00,$224.00,$0.00,$112.00,$177.41,$179.20,$0.00,$0.00,$0.00,$0.00,$0.00
317.782,SUP,Custom 27203010,,317.782  -  BIT DRILL 91MM 1.5MM 6MM STOP GUIDE NONSTRL,$224.00,$0.00,$224.00,$0.00,$159.87,$0.00,$0.00,$0.00,$0.00,$0.00,$224.00,$0.00,$112.00,$177.41,$179.20,$0.00,$0.00,$0.00,$0.00,$0.00
317.806,SUP,Custom 27203010,,317.806  -  BIT DRILL 20MM 1.8MM MINI QC,$135.00,$0.00,$135.00,$0.00,$96.35,$0.00,$0.00,$0.00,$0.00,$0.00,$135.00,$0.00,$67.50,$106.92,$108.00,$0.00,$0.00,$0.00,$0.00,$0.00
317.812,SUP,Custom 27203010,,317.812  -  BIT DRILL 26MM 1.8MM MINI QC,$135.00,$0.00,$135.00,$0.00,$96.35,$0.00,$0.00,$0.00,$0.00,$0.00,$135.00,$0.00,$67.50,$106.92,$108.00,$0.00,$0.00,$0.00,$0.00,$0.00
317.818,SUP,Custom 27203010,,317.818  -  BIT DRILL 32MM 18MM MINI QC,$135.00,$0.00,$135.00,$0.00,$96.35,$0.00,$0.00,$0.00,$0.00,$0.00,$135.00,$0.00,$67.50,$106.92,$108.00,$0.00,$0.00,$0.00,$0.00,$0.00
317.82,SUP,Custom 27203010,,317.82  -  BIT DRILL 44.5MM 1.5MM 12MM STOP MINI QC NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
317.832,SUP,Custom 27203010,,317.832  -  BIT DRILL 110MM 1.5MM HEX CPLNG NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
317.835,SUP,Custom 27203010,,317.835  -  BIT DRILL 110MM 1.5MM JLTCH NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
317.836,SUP,Custom 27203010,,317.836  -  BIT DRILL 125MM 1.5MM JLTCH NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
317.838,SUP,Custom 27203010,,317.838  -  BIT DRILL 110MM 1.5MM MINI QC NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
317.852,SUP,Custom 27203010,,317.852  -  BIT DRILL 110MM 2MM UNV HALL CPLNG NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
317.855,SUP,Custom 27203010,,317.855  -  BIT DRL 2MM 110MM NS JLTCH CPLNG WO SLF STP STRYK,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
317.856,SUP,Custom 27203010,,317.856  -  BIT DRILL 125MM 2MM JLTCH,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
317.858,SUP,Custom 27203010,,317.858  -  BIT DRILL 110MM 2MM MINI QC NONSTRL,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
317.861,SUP,Custom 27203010,,317.861  -  BIT DRL 1.8MM 80MM NS MNQK CPLNG D MRK,$131.68,$0.00,$131.68,$0.00,$93.98,$0.00,$0.00,$0.00,$0.00,$0.00,$131.68,$0.00,$65.84,$104.29,$105.34,$0.00,$0.00,$0.00,$0.00,$0.00
317.867,SUP,Custom 27203010,,317.867  -  BIT DRL 1.8MM 90MM NS JLTCH CPLNG 2.4MM SCR MDLR HND SYS,$131.68,$0.00,$131.68,$0.00,$93.98,$0.00,$0.00,$0.00,$0.00,$0.00,$131.68,$0.00,$65.84,$104.29,$105.34,$0.00,$0.00,$0.00,$0.00,$0.00
317.871,SUP,Custom 27203010,,317.871  -  BIT DRL 2.4MM 80MM NS MNQK CPLNG 2.4MM SCR MDLR HND SYS,$131.68,$0.00,$131.68,$0.00,$93.98,$0.00,$0.00,$0.00,$0.00,$0.00,$131.68,$0.00,$65.84,$104.29,$105.34,$0.00,$0.00,$0.00,$0.00,$0.00
317.872,SUP,Custom 27203010,,317.872  -  BIT DRL 2.4MM 90MM NS JLTCH CPLNG STRYK,$131.68,$0.00,$131.68,$0.00,$93.98,$0.00,$0.00,$0.00,$0.00,$0.00,$131.68,$0.00,$65.84,$104.29,$105.34,$0.00,$0.00,$0.00,$0.00,$0.00
317.875,SUP,Custom 27203010,,317.875  -  BIT DRL 6MM 1.5MM 100MM NS QC TROC STP,$380.25,$0.00,$380.25,$0.00,$271.38,$0.00,$0.00,$0.00,$0.00,$0.00,$380.25,$0.00,$190.13,$301.16,$304.20,$0.00,$0.00,$0.00,$0.00,$0.00
317.876,SUP,Custom 27203010,,317.876  -  BIT DRL 8-18MM 1.5MM 100MM NS QC TROC CLBRT,$427.50,$0.00,$427.50,$0.00,$305.11,$0.00,$0.00,$0.00,$0.00,$0.00,$427.50,$0.00,$213.75,$338.58,$342.00,$0.00,$0.00,$0.00,$0.00,$0.00
317.877,SUP,Custom 27203010,,317.877  -  BIT DRL 6MM 1.8MM 100MM NS QC TROC STP,$380.25,$0.00,$380.25,$0.00,$271.38,$0.00,$0.00,$0.00,$0.00,$0.00,$380.25,$0.00,$190.13,$301.16,$304.20,$0.00,$0.00,$0.00,$0.00,$0.00
317.878,SUP,Custom 27203010,,317.878  -  BIT DRL 8-18MM 1.8MM 100MM NS QC TROC CLBRT,$427.50,$0.00,$427.50,$0.00,$305.11,$0.00,$0.00,$0.00,$0.00,$0.00,$427.50,$0.00,$213.75,$338.58,$342.00,$0.00,$0.00,$0.00,$0.00,$0.00
319.006,SUP,Custom 27203010,,319.006  -  GAUGE DEPTH 2 MM 2.4 MM SCREW,"$1,052.23",$0.00,"$1,052.23",$0.00,$750.97,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,052.23",$0.00,$526.11,$833.37,$841.78,$0.00,$0.00,$0.00,$0.00,$0.00
319.01,SUP,Custom 27203010,,319.01  -  GAUGE DEPTH MEASURE LCP NONSTRL 2.7/3.5/4 MM SCREW,$739.70,$0.00,$739.70,$0.00,$527.92,$0.00,$0.00,$0.00,$0.00,$0.00,$739.70,$0.00,$369.85,$585.84,$591.76,$0.00,$0.00,$0.00,$0.00,$0.00
323.062,SUP,Custom 27203010,,323.062  -  BIT DRL 2MM 140MM NS QC D MRK,$271.58,$0.00,$271.58,$0.00,$193.82,$0.00,$0.00,$0.00,$0.00,$0.00,$271.58,$0.00,$135.79,$215.09,$217.26,$0.00,$0.00,$0.00,$0.00,$0.00
323.36,SUP,Custom 27203010,,323.36  -  GUIDE DRILL 3.5MM LCP UNV,"$1,013.33",$0.00,"$1,013.33",$0.00,$723.21,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,013.33",$0.00,$506.66,$802.56,$810.66,$0.00,$0.00,$0.00,$0.00,$0.00
323.46,SUP,Custom 27203010,,323.46  -  GUIDE DRILL UNIVERSAL 4.5MM LC-DCP,$751.98,$0.00,$751.98,$0.00,$536.68,$0.00,$0.00,$0.00,$0.00,$0.00,$751.98,$0.00,$375.99,$595.57,$601.58,$0.00,$0.00,$0.00,$0.00,$0.00
324.101,SUP,Custom 27203010,,324.101  -  HOLDER IMPL VCTR ANT CERV SPN TEMP INS SLFRET HLD SLV ANT,$264.25,$0.00,$264.25,$0.00,$188.60,$0.00,$0.00,$0.00,$0.00,$0.00,$264.25,$0.00,$132.13,$209.29,$211.40,$0.00,$0.00,$0.00,$0.00,$0.00
324.153,SUP,Custom 27203010,,324.153  -  BIT DRL 2.5MM 14MM NS STP,$516.25,$0.00,$516.25,$0.00,$368.45,$0.00,$0.00,$0.00,$0.00,$0.00,$516.25,$0.00,$258.13,$408.87,$413.00,$0.00,$0.00,$0.00,$0.00,$0.00
324.155,SUP,Custom 27203010,,324.155  -  BIT DRL 2.5MM 16MM NS STP,$516.25,$0.00,$516.25,$0.00,$368.45,$0.00,$0.00,$0.00,$0.00,$0.00,$516.25,$0.00,$258.13,$408.87,$413.00,$0.00,$0.00,$0.00,$0.00,$0.00
324.174,SUP,HCPCS C1769,,324.174  -  GUIDEWIRE ORTHOPEDIC 2.5MM NONSTRL 5MM SCREW,$267.50,$0.00,$267.50,$145.25,$190.91,$0.00,$44.75,$0.00,$0.00,$46.84,$267.50,$0.00,$133.75,$211.86,$214.00,$0.00,$40.64,$0.00,$42.59,$0.00
324.203,SUP,Custom 27203010,,324.203  -  GUIDE DRILL 4.3MM THREAD PERCUTANEOUS,$697.38,$0.00,$697.38,$0.00,$497.72,$0.00,$0.00,$0.00,$0.00,$0.00,$697.38,$0.00,$348.69,$552.32,$557.90,$0.00,$0.00,$0.00,$0.00,$0.00
324.21,SUP,Custom 27203010,,324.210  -  BIT DRL 2.5MM 300MM NS 200MM QC CLBRT,$341.20,$0.00,$341.20,$0.00,$243.51,$0.00,$0.00,$0.00,$0.00,$0.00,$341.20,$0.00,$170.60,$270.23,$272.96,$0.00,$0.00,$0.00,$0.00,$0.00
324.211,SUP,Custom 27203010,,324.211  -  BIT DRL 2.8MM 300MM NS 200MM QC CLBRT,$341.20,$0.00,$341.20,$0.00,$243.51,$0.00,$0.00,$0.00,$0.00,$0.00,$341.20,$0.00,$170.60,$270.23,$272.96,$0.00,$0.00,$0.00,$0.00,$0.00
324.212,SUP,Custom 27203010,,324.212  -  BIT DRL 3.2MM 300MM NS QC CLBRT PERC,$341.20,$0.00,$341.20,$0.00,$243.51,$0.00,$0.00,$0.00,$0.00,$0.00,$341.20,$0.00,$170.60,$270.23,$272.96,$0.00,$0.00,$0.00,$0.00,$0.00
324.213,SUP,Custom 27203010,,324.213  -  BIT DRL 4.3MM 300MM NS QC CLBRT PERC,$341.20,$0.00,$341.20,$0.00,$243.51,$0.00,$0.00,$0.00,$0.00,$0.00,$341.20,$0.00,$170.60,$270.23,$272.96,$0.00,$0.00,$0.00,$0.00,$0.00
324.214,SUP,Custom 27203010,,324.214  -  BIT DRL 2.8MM 200MM NS QC CLBRT,$315.25,$0.00,$315.25,$0.00,$224.99,$0.00,$0.00,$0.00,$0.00,$0.00,$315.25,$0.00,$157.63,$249.68,$252.20,$0.00,$0.00,$0.00,$0.00,$0.00
325.16,SUP,Custom 27203010,,325.160  -  ROD EXFIX 3MM 270MM THREAD SELF DRILL NONSTRL,$459.93,$0.00,$459.93,$0.00,$328.25,$0.00,$0.00,$0.00,$0.00,$0.00,$459.93,$0.00,$229.96,$364.26,$367.94,$0.00,$0.00,$0.00,$0.00,$0.00
328.16,SUP,Custom 27203010,,328.160  -  ROD EXFIX 5MM 380MM THREADED SLFDRILL TIP NONSTRL,$556.83,$0.00,$556.83,$0.00,$397.41,$0.00,$0.00,$0.00,$0.00,$0.00,$556.83,$0.00,$278.41,$441.01,$445.46,$0.00,$0.00,$0.00,$0.00,$0.00
328.17,SUP,Custom 27203010,,328.170  -  ROD EXFIX BLUNT 5MM 1.6MM 335MM THREAD CANN NONSTRL,$556.83,$0.00,$556.83,$0.00,$397.41,$0.00,$0.00,$0.00,$0.00,$0.00,$556.83,$0.00,$278.41,$441.01,$445.46,$0.00,$0.00,$0.00,$0.00,$0.00
329.08,SUP,Custom 27203010,,329.08  -  IRON BENDING NONSTRL 3.5/4.5 MM RECONSTRUCTION PLATE,$585.48,$0.00,$585.48,$0.00,$417.85,$0.00,$0.00,$0.00,$0.00,$0.00,$585.48,$0.00,$292.74,$463.70,$468.38,$0.00,$0.00,$0.00,$0.00,$0.00
336.105,SUP,HCPCS C1713,,"336.105  -  RELIEVE RADIOLUCENT PLATE, OPEN DOOR, 5MM","$4,877.50",$0.00,"$4,877.50","$2,194.88","$3,481.07",$0.00,$840.37,$0.00,$0.00,$854.01,"$4,877.50",$0.00,"$2,438.75","$3,862.98","$3,902.00",$0.00,$763.33,$0.00,$776.50,$0.00
336.107,SUP,HCPCS C1713,,"336.107  -  RELIEVE RADIOLUCENT PLATE, OPEN DOOR, 7MM","$4,877.50",$0.00,"$4,877.50","$2,194.88","$3,481.07",$0.00,$840.37,$0.00,$0.00,$854.01,"$4,877.50",$0.00,"$2,438.75","$3,862.98","$3,902.00",$0.00,$763.33,$0.00,$776.50,$0.00
336.109,SUP,HCPCS C1713,,"336.109  -  RELIEVE RADIOLUCENT PLATE, OPEN DOOR, 9MM","$4,877.50",$0.00,"$4,877.50","$2,194.88","$3,481.07",$0.00,$840.37,$0.00,$0.00,$854.01,"$4,877.50",$0.00,"$2,438.75","$3,862.98","$3,902.00",$0.00,$763.33,$0.00,$776.50,$0.00
336.111,SUP,HCPCS C1713,,"336.111  -  RELIEVE RADIOLUCENT PLATE, OPEN DOOR, 11MM","$4,877.50",$0.00,"$4,877.50","$2,194.88","$3,481.07",$0.00,$840.37,$0.00,$0.00,$854.01,"$4,877.50",$0.00,"$2,438.75","$3,862.98","$3,902.00",$0.00,$763.33,$0.00,$776.50,$0.00
336.113,SUP,HCPCS C1713,,"336.113  -  RELIEVE RADIOLUCENT PLATE, OPEN DOOR, 13MM","$4,877.50",$0.00,"$4,877.50","$2,194.88","$3,481.07",$0.00,$840.37,$0.00,$0.00,$854.01,"$4,877.50",$0.00,"$2,438.75","$3,862.98","$3,902.00",$0.00,$763.33,$0.00,$776.50,$0.00
337.92,SUP,Custom 27203010,,337.92  -  CANNULA OPHTHALMIC 45D 25GA GRIESHABER DSP STERILE,$540.75,$0.00,$540.75,$0.00,$385.93,$0.00,$0.00,$0.00,$0.00,$0.00,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$0.00,$0.00,$0.00,$0.00
338.002,SUP,Custom 27203010,,338.002  -  GUIDEWIRE ORTHOPEDIC 2.5MM 300MM 12MM DRILL TIP THEADED,$128.28,$0.00,$128.28,$0.00,$91.55,$0.00,$0.00,$0.00,$0.00,$0.00,$128.28,$0.00,$64.14,$101.60,$102.62,$0.00,$0.00,$0.00,$0.00,$0.00
338.13,SUP,Custom 27203010,,338.13  -  REAMER SURG 3 COMPLETE DHS NONSTRL,"$2,606.68",$0.00,"$2,606.68",$0.00,"$1,860.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,606.68",$0.00,"$1,303.34","$2,064.49","$2,085.34",$0.00,$0.00,$0.00,$0.00,$0.00
338.17,SUP,Custom 27203010,,338.17  -  TAP SURG 220MM DHS/DCS 12.5MM SCREWS,$637.35,$0.00,$637.35,$0.00,$454.88,$0.00,$0.00,$0.00,$0.00,$0.00,$637.35,$0.00,$318.68,$504.78,$509.88,$0.00,$0.00,$0.00,$0.00,$0.00
338.31,SUP,Custom 27203010,,338.31  -  GUIDE SURG COUPLING SCREW SOLID LATEX FREE DHS/DCS STAINLESS,$724.68,$0.00,$724.68,$0.00,$517.20,$0.00,$0.00,$0.00,$0.00,$0.00,$724.68,$0.00,$362.34,$573.95,$579.74,$0.00,$0.00,$0.00,$0.00,$0.00
338.333,SUP,Custom 27203010,,338.333  -  REAMER SURG HEAD DHS,"$1,491.68",$0.00,"$1,491.68",$0.00,"$1,064.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,491.68",$0.00,$745.84,"$1,181.41","$1,193.34",$0.00,$0.00,$0.00,$0.00,$0.00
338.348,SUP,HCPCS C1713,,338.348  -  IMPACTOR SURG CAP LCP DHHS,$263.40,$0.00,$263.40,$118.53,$187.99,$0.00,$44.06,$0.00,$0.00,$46.12,$263.40,$0.00,$131.70,$208.61,$210.72,$0.00,$40.02,$0.00,$41.93,$0.00
339.21,SUP,Custom 27203010,,339.21  -  PROBE VITRECTOMY 30D 25GA DSP POINTED TIP DIATHERMY,$695.25,$0.00,$695.25,$0.00,$496.20,$0.00,$0.00,$0.00,$0.00,$0.00,$695.25,$0.00,$347.63,$550.64,$556.20,$0.00,$0.00,$0.00,$0.00,$0.00
342.715,SUP,Custom 27803010,,342.715  -  SPACER SPNL 0D 12MM SM 14X15MM NS LF NIKO PEEK-OPTM,"$7,635.00",$0.00,"$7,635.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,635.00",$0.00,"$3,817.50","$6,046.92","$6,108.00",$0.00,$0.00,$0.00,$0.00,$0.00
342.717,SUP,Custom 27803010,,342.717  -  SPACER SPNL 0D 12MM SM 14X17MM NS LF NIKO PEEK-OPTM,"$7,635.00",$0.00,"$7,635.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,635.00",$0.00,"$3,817.50","$6,046.92","$6,108.00",$0.00,$0.00,$0.00,$0.00,$0.00
342.719,SUP,Custom 27803010,,342.719  -  SPACER SPNL 0D 12MM SM 14X19MM NS LF NIKO PEEK-OPTM,"$7,635.00",$0.00,"$7,635.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,635.00",$0.00,"$3,817.50","$6,046.92","$6,108.00",$0.00,$0.00,$0.00,$0.00,$0.00
342.721,SUP,Custom 27803010,,342.721  -  SPACER SPNL 0D 12MM SM 14X21MM NS LF NIKO PEEK-OPTM,"$7,635.00",$0.00,"$7,635.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,635.00",$0.00,"$3,817.50","$6,046.92","$6,108.00",$0.00,$0.00,$0.00,$0.00,$0.00
342.723,SUP,Custom 27803010,,342.723  -  SPACER SPNL 0D 12MM SM 14X23MM NS LF NIKO PEEK-OPTM,"$7,635.00",$0.00,"$7,635.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,635.00",$0.00,"$3,817.50","$6,046.92","$6,108.00",$0.00,$0.00,$0.00,$0.00,$0.00
342.725,SUP,Custom 27803010,,342.725  -  SPACER SPNL 0D 12MM SM 14X25MM NS LF NIKO PEEK-OPTM,"$7,635.00",$0.00,"$7,635.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,635.00",$0.00,"$3,817.50","$6,046.92","$6,108.00",$0.00,$0.00,$0.00,$0.00,$0.00
342.727,SUP,Custom 27803010,,342.727  -  SPACER SPNL 0D 12MM SM 14X27MM NS LF NIKO PEEK-OPTM,"$7,635.00",$0.00,"$7,635.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,635.00",$0.00,"$3,817.50","$6,046.92","$6,108.00",$0.00,$0.00,$0.00,$0.00,$0.00
342.729,SUP,Custom 27803010,,342.729  -  SPACER SPNL 0D 12MM SM 14X29MM NS LF NIKO PEEK-OPTM,"$7,635.00",$0.00,"$7,635.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,635.00",$0.00,"$3,817.50","$6,046.92","$6,108.00",$0.00,$0.00,$0.00,$0.00,$0.00
342.731,SUP,Custom 27803010,,342.731  -  SPACER SPNL 0D 12MM SM 14X31MM NS LF NIKO PEEK-OPTM,"$7,635.00",$0.00,"$7,635.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,635.00",$0.00,"$3,817.50","$6,046.92","$6,108.00",$0.00,$0.00,$0.00,$0.00,$0.00
342.733,SUP,Custom 27803010,,342.733  -  SPACER SPNL 0D 12MM SM 14X33MM NS LF NIKO PEEK-OPTM,"$7,635.00",$0.00,"$7,635.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,635.00",$0.00,"$3,817.50","$6,046.92","$6,108.00",$0.00,$0.00,$0.00,$0.00,$0.00
342.815,SUP,Custom 27803010,,342.815  -  SPACER SPNL 7D 12MM SM 14X15MM NS LF NIKO PEEK-OPTM,"$7,635.00",$0.00,"$7,635.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,635.00",$0.00,"$3,817.50","$6,046.92","$6,108.00",$0.00,$0.00,$0.00,$0.00,$0.00
342.817,SUP,Custom 27803010,,342.817  -  SPACER SPNL 7D 12MM SM 14X17MM NS LF NIKO PEEK-OPTM,"$7,635.00",$0.00,"$7,635.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,635.00",$0.00,"$3,817.50","$6,046.92","$6,108.00",$0.00,$0.00,$0.00,$0.00,$0.00
342.819,SUP,Custom 27803010,,342.819  -  SPACER SPNL 7D 12MM SM 14X19MM NS LF NIKO PEEK-OPTM,"$7,635.00",$0.00,"$7,635.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,635.00",$0.00,"$3,817.50","$6,046.92","$6,108.00",$0.00,$0.00,$0.00,$0.00,$0.00
342.821,SUP,Custom 27803010,,342.821  -  SPACER SPNL 7D 12MM SM 14X21MM NS LF NIKO PEEK-OPTM,"$7,635.00",$0.00,"$7,635.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,635.00",$0.00,"$3,817.50","$6,046.92","$6,108.00",$0.00,$0.00,$0.00,$0.00,$0.00
342.823,SUP,Custom 27803010,,342.823  -  SPACER SPNL 7D 12MM SM 14X23MM NS LF NIKO PEEK-OPTM,"$7,635.00",$0.00,"$7,635.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,635.00",$0.00,"$3,817.50","$6,046.92","$6,108.00",$0.00,$0.00,$0.00,$0.00,$0.00
342.825,SUP,Custom 27803010,,342.825  -  SPACER SPNL 7D 12MM SM 14X25MM NS LF NIKO PEEK-OPTM,"$7,635.00",$0.00,"$7,635.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,635.00",$0.00,"$3,817.50","$6,046.92","$6,108.00",$0.00,$0.00,$0.00,$0.00,$0.00
342.827,SUP,Custom 27803010,,342.827  -  SPACER SPNL 7D 12MM SM 14X27MM NS LF NIKO PEEK-OPTM,"$7,635.00",$0.00,"$7,635.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,635.00",$0.00,"$3,817.50","$6,046.92","$6,108.00",$0.00,$0.00,$0.00,$0.00,$0.00
342.829,SUP,Custom 27803010,,342.829  -  SPACER SPNL 7D 12MM SM 14X29MM NS LF NIKO PEEK-OPTM,"$7,635.00",$0.00,"$7,635.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,635.00",$0.00,"$3,817.50","$6,046.92","$6,108.00",$0.00,$0.00,$0.00,$0.00,$0.00
342.831,SUP,Custom 27803010,,342.831  -  SPACER SPNL 7D 12MM SM 14X31MM NS LF NIKO PEEK-OPTM,"$7,635.00",$0.00,"$7,635.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,635.00",$0.00,"$3,817.50","$6,046.92","$6,108.00",$0.00,$0.00,$0.00,$0.00,$0.00
342.833,SUP,Custom 27803010,,342.833  -  SPACER SPNL 7D 12MM SM 14X33MM NS LF NIKO PEEK-OPTM,"$7,635.00",$0.00,"$7,635.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,635.00",$0.00,"$3,817.50","$6,046.92","$6,108.00",$0.00,$0.00,$0.00,$0.00,$0.00
342.915,SUP,Custom 27803010,,342.915  -  SPACER SPNL 5D 12MM SM 14X15MM NS LF NIKO PEEK-OPTM,"$7,635.00",$0.00,"$7,635.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,635.00",$0.00,"$3,817.50","$6,046.92","$6,108.00",$0.00,$0.00,$0.00,$0.00,$0.00
342.917,SUP,Custom 27803010,,342.917  -  SPACER SPNL 5D 12MM SM 14X17MM NS LF NIKO PEEK-OPTM,"$7,635.00",$0.00,"$7,635.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,635.00",$0.00,"$3,817.50","$6,046.92","$6,108.00",$0.00,$0.00,$0.00,$0.00,$0.00
342.919,SUP,Custom 27803010,,342.919  -  SPACER SPNL 5D 12MM SM 14X19MM NS LF NIKO PEEK-OPTM,"$7,635.00",$0.00,"$7,635.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,635.00",$0.00,"$3,817.50","$6,046.92","$6,108.00",$0.00,$0.00,$0.00,$0.00,$0.00
342.921,SUP,Custom 27803010,,342.921  -  SPACER SPNL 5D 12MM SM 14X21MM NS LF NIKO PEEK-OPTM,"$7,635.00",$0.00,"$7,635.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,635.00",$0.00,"$3,817.50","$6,046.92","$6,108.00",$0.00,$0.00,$0.00,$0.00,$0.00
342.923,SUP,Custom 27803010,,342.923  -  SPACER SPNL 5D 12MM SM 14X23MM NS LF NIKO PEEK-OPTM,"$7,635.00",$0.00,"$7,635.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,635.00",$0.00,"$3,817.50","$6,046.92","$6,108.00",$0.00,$0.00,$0.00,$0.00,$0.00
342.925,SUP,Custom 27803010,,342.925  -  SPACER SPNL 5D 12MM SM 14X25MM NS LF NIKO PEEK-OPTM,"$7,635.00",$0.00,"$7,635.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,635.00",$0.00,"$3,817.50","$6,046.92","$6,108.00",$0.00,$0.00,$0.00,$0.00,$0.00
342.927,SUP,Custom 27803010,,342.927  -  SPACER SPNL 5D 12MM SM 14X27MM NS LF NIKO PEEK-OPTM,"$7,635.00",$0.00,"$7,635.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,635.00",$0.00,"$3,817.50","$6,046.92","$6,108.00",$0.00,$0.00,$0.00,$0.00,$0.00
342.929,SUP,Custom 27803010,,342.929  -  SPACER SPNL 5D 12MM SM 14X29MM NS LF NIKO PEEK-OPTM,"$7,635.00",$0.00,"$7,635.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,635.00",$0.00,"$3,817.50","$6,046.92","$6,108.00",$0.00,$0.00,$0.00,$0.00,$0.00
342.931,SUP,Custom 27803010,,342.931  -  SPACER SPNL 5D 12MM SM 14X31MM NS LF NIKO PEEK-OPTM,"$7,635.00",$0.00,"$7,635.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,635.00",$0.00,"$3,817.50","$6,046.92","$6,108.00",$0.00,$0.00,$0.00,$0.00,$0.00
342.933,SUP,Custom 27803010,,342.933  -  SPACER SPNL 5D 12MM SM 14X33MM NS LF NIKO PEEK-OPTM,"$7,635.00",$0.00,"$7,635.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,635.00",$0.00,"$3,817.50","$6,046.92","$6,108.00",$0.00,$0.00,$0.00,$0.00,$0.00
351.001,SUP,Custom 27803010,,351.001  -  ENDPLATE SPNL 0D 14MM 14X15MM NS LF FORTIFY-R FTPRNT NO SPK,"$19,050.00",$0.00,"$19,050.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$19,050.00",$0.00,"$9,525.00","$15,087.60","$15,240.00",$0.00,$0.00,$0.00,$0.00,$0.00
351.002,SUP,Custom 27803010,,351.002  -  ENDPLATE SPNL 0D 14MM 14X17MM NS LF FORTIFY-R FTPRNT,"$19,050.00",$0.00,"$19,050.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$19,050.00",$0.00,"$9,525.00","$15,087.60","$15,240.00",$0.00,$0.00,$0.00,$0.00,$0.00
351.003,SUP,Custom 27803010,,351.003  -  ENDPLATE SPNL 3.5D 14MM 14X17MM NS LF FORTIFY-R FTPRNT NO,"$19,050.00",$0.00,"$19,050.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$19,050.00",$0.00,"$9,525.00","$15,087.60","$15,240.00",$0.00,$0.00,$0.00,$0.00,$0.00
351.004,SUP,Custom 27803010,,351.004  -  ENDPLATE SPNL 3.5D 14MM 14X19MM NS LF FORTIFY-R FTPRNT,"$19,050.00",$0.00,"$19,050.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$19,050.00",$0.00,"$9,525.00","$15,087.60","$15,240.00",$0.00,$0.00,$0.00,$0.00,$0.00
351.005,SUP,Custom 27803010,,351.005  -  ENDPLATE SPNL 0D 14MM 14X16MM NS LF FORTIFY-R FTPRNT NO SPK,"$19,050.00",$0.00,"$19,050.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$19,050.00",$0.00,"$9,525.00","$15,087.60","$15,240.00",$0.00,$0.00,$0.00,$0.00,$0.00
351.006,SUP,Custom 27803010,,351.006  -  ENDPLATE SPNL 0D 14MM 14X18MM NS LF FORTIFY-R FTPRNT,"$19,050.00",$0.00,"$19,050.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$19,050.00",$0.00,"$9,525.00","$15,087.60","$15,240.00",$0.00,$0.00,$0.00,$0.00,$0.00
351.007,SUP,Custom 27803010,,351.007  -  ENDPLATE SPNL 3.5D 14MM 14X18MM NS LF FORTIFY-R FTPRNT NO,"$19,050.00",$0.00,"$19,050.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$19,050.00",$0.00,"$9,525.00","$15,087.60","$15,240.00",$0.00,$0.00,$0.00,$0.00,$0.00
351.008,SUP,Custom 27803010,,351.008  -  ENDPLATE SPNL 3.5D 14MM 14X20MM NS LF FORTIFY-R FTPRNT,"$19,050.00",$0.00,"$19,050.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$19,050.00",$0.00,"$9,525.00","$15,087.60","$15,240.00",$0.00,$0.00,$0.00,$0.00,$0.00
351.009,SUP,Custom 27803010,,351.009  -  ENDPLATE SPNL 0D 14MM 14X18MM NS LF FORTIFY-R FTPRNT NO SPK,"$19,050.00",$0.00,"$19,050.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$19,050.00",$0.00,"$9,525.00","$15,087.60","$15,240.00",$0.00,$0.00,$0.00,$0.00,$0.00
351.01,SUP,Custom 27803010,,351.010  -  ENDPLATE SPNL 0D 14MM 14X20MM NS LF FORTIFY-R FTPRNT,"$19,050.00",$0.00,"$19,050.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$19,050.00",$0.00,"$9,525.00","$15,087.60","$15,240.00",$0.00,$0.00,$0.00,$0.00,$0.00
351.011,SUP,Custom 27803010,,351.011  -  ENDPLATE SPNL 3.5D 14MM 14X20MM NS LF FORTIFY-R FTPRNT NO,"$19,050.00",$0.00,"$19,050.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$19,050.00",$0.00,"$9,525.00","$15,087.60","$15,240.00",$0.00,$0.00,$0.00,$0.00,$0.00
351.012,SUP,Custom 27803010,,351.012  -  ENDPLATE SPNL 3.5D 14MM 14X22MM NS LF FORTIFY-R FTPRNT,"$19,050.00",$0.00,"$19,050.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$19,050.00",$0.00,"$9,525.00","$15,087.60","$15,240.00",$0.00,$0.00,$0.00,$0.00,$0.00
351.05,SUP,Custom 27803010,,351.050  -  ENDPLATE SPNL 14MM 14X24MM NS LF FORTIFY-R,"$18,600.00",$0.00,"$18,600.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$18,600.00",$0.00,"$9,300.00","$14,731.20","$14,880.00",$0.00,$0.00,$0.00,$0.00,$0.00
351.051,SUP,Custom 27803010,,351.051  -  ENDPLATE SPNL 14MM 14X28MM NS LF FORTIFY-R,"$18,600.00",$0.00,"$18,600.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$18,600.00",$0.00,"$9,300.00","$14,731.20","$14,880.00",$0.00,$0.00,$0.00,$0.00,$0.00
351.052,SUP,Custom 27803010,,351.052  -  ENDPLATE SPNL 14MM 14X35MM NS LF FORTIFY-R,"$18,600.00",$0.00,"$18,600.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$18,600.00",$0.00,"$9,300.00","$14,731.20","$14,880.00",$0.00,$0.00,$0.00,$0.00,$0.00
351.053,SUP,Custom 27803010,,351.053  -  ENDPLATE SPNL 14MM 14X49MM NS LF FORTIFY-R,"$18,600.00",$0.00,"$18,600.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$18,600.00",$0.00,"$9,300.00","$14,731.20","$14,880.00",$0.00,$0.00,$0.00,$0.00,$0.00
351.054,SUP,Custom 27803010,,351.054  -  ENDPLATE SPNL 14MM 14X66MM NS LF FORTIFY-R,"$18,600.00",$0.00,"$18,600.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$18,600.00",$0.00,"$9,300.00","$14,731.20","$14,880.00",$0.00,$0.00,$0.00,$0.00,$0.00
351.15,SUP,Custom 27803010,,351.150  -  ENDPLATE SPNL 14MM 20X26MM NS LF FORTIFY-R,"$23,600.00",$0.00,"$23,600.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$23,600.00",$0.00,"$11,800.00","$18,691.20","$18,880.00",$0.00,$0.00,$0.00,$0.00,$0.00
351.151,SUP,Custom 27803010,,351.151  -  ENDPLATE SPNL 20MM 20X28MM NS LF FORTIFY-R,"$23,600.00",$0.00,"$23,600.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$23,600.00",$0.00,"$11,800.00","$18,691.20","$18,880.00",$0.00,$0.00,$0.00,$0.00,$0.00
351.152,SUP,Custom 27803010,,351.152  -  ENDPLATE SPNL 20MM 20X33MM NS LF FORTIFY-R,"$23,600.00",$0.00,"$23,600.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$23,600.00",$0.00,"$11,800.00","$18,691.20","$18,880.00",$0.00,$0.00,$0.00,$0.00,$0.00
351.153,SUP,Custom 27803010,,351.153  -  ENDPLATE SPNL 20MM 20X43MM NS LF FORTIFY-R,"$23,600.00",$0.00,"$23,600.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$23,600.00",$0.00,"$11,800.00","$18,691.20","$18,880.00",$0.00,$0.00,$0.00,$0.00,$0.00
351.154,SUP,Custom 27803010,,351.154  -  ENDPLATE SPNL 20MM 20X61MM NS LF FORTIFY-R,"$23,600.00",$0.00,"$23,600.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$23,600.00",$0.00,"$11,800.00","$18,691.20","$18,880.00",$0.00,$0.00,$0.00,$0.00,$0.00
351.155,SUP,Custom 27803010,,351.155  -  ENDPLATE SPNL 20MM 20X80MM NS LF FORTIFY-R,"$23,600.00",$0.00,"$23,600.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$23,600.00",$0.00,"$11,800.00","$18,691.20","$18,880.00",$0.00,$0.00,$0.00,$0.00,$0.00
351.156,SUP,Custom 27803010,,351.156  -  ENDPLATE SPNL 20MM 20X99MM NS LF FORTIFY-R,"$23,600.00",$0.00,"$23,600.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$23,600.00",$0.00,"$11,800.00","$18,691.20","$18,880.00",$0.00,$0.00,$0.00,$0.00,$0.00
351.27,SUP,Custom 27203010,,351.27  -  BIT DRILL 13MM 300MM CANN NONSTRL,"$1,084.85",$0.00,"$1,084.85",$0.00,$774.26,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,084.85",$0.00,$542.43,$859.20,$867.88,$0.00,$0.00,$0.00,$0.00,$0.00
351.3,SUP,HCPCS C1713,,351.300  -  SPACER SPNL 0D 14MM 14MM NS LF FORTIFY-R FTPRNT UPR EPLT NO,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
351.301,SUP,HCPCS C1713,,351.301  -  SPACER SPNL 0D 14MM 14MM NS LF FORTIFY-R FTPRNT UPR EPLT,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
351.302,SUP,HCPCS C1713,,351.302  -  SPACER SPNL 3.5D 14MM 14MM NS LF FORTIFY-R FTPRNT UPR EPLT,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
351.303,SUP,HCPCS C1713,,351.303  -  SPACER SPNL 3.5D 14MM 14MM NS LF FORTIFY-R FTPRNT UPR EPLT,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
351.304,SUP,HCPCS C1713,,351.304  -  SPACER SPNL 7D 14MM 14MM NS LF FORTIFY-R FTPRNT UPR EPLT,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
351.311,SUP,HCPCS C1713,,351.311  -  SPACER SPNL 0D 14MM 16MM NS LF FORTIFY-R FTPRNT UPR EPLT,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
351.313,SUP,HCPCS C1713,,351.313  -  SPACER SPNL 3.5D 14MM 16MM NS LF FORTIFY-R FTPRNT UPR EPLT,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
351.314,SUP,HCPCS C1713,,351.314  -  SPACER SPNL 7D 14MM 16MM NS LF FORTIFY-R FTPRNT UPR EPLT,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
351.321,SUP,HCPCS C1713,,351.321  -  SPACER SPNL 0D 15MM 18MM NS LF FORTIFY-R FTPRNT UPR EPLT,"$1,815.00",$0.00,"$1,815.00",$816.75,"$1,295.37",$0.00,$312.72,$0.00,$0.00,$317.79,"$1,815.00",$0.00,$907.50,"$1,437.48","$1,452.00",$0.00,$284.05,$0.00,$288.95,$0.00
351.323,SUP,HCPCS C1713,,351.323  -  SPACER SPNL 3.5D 15MM 18MM NS LF FORTIFY-R FTPRNT UPR EPLT,"$1,815.00",$0.00,"$1,815.00",$816.75,"$1,295.37",$0.00,$312.72,$0.00,$0.00,$317.79,"$1,815.00",$0.00,$907.50,"$1,437.48","$1,452.00",$0.00,$284.05,$0.00,$288.95,$0.00
351.324,SUP,HCPCS C1713,,351.324  -  SPACER SPNL 7D 15MM 18MM NS LF FORTIFY-R FTPRNT UPR EPLT,"$1,815.00",$0.00,"$1,815.00",$816.75,"$1,295.37",$0.00,$312.72,$0.00,$0.00,$317.79,"$1,815.00",$0.00,$907.50,"$1,437.48","$1,452.00",$0.00,$284.05,$0.00,$288.95,$0.00
351.351,SUP,HCPCS C1713,,351.351  -  SPACER SPNL 0D 14MM 14MM NS LF FORTIFY-R FTPRNT LWR EPLT,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
351.353,SUP,HCPCS C1713,,351.353  -  SPACER SPNL 3.5D 14MM 14MM NS LF FORTIFY-R FTPRNT LWR EPLT,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
351.354,SUP,HCPCS C1713,,351.354  -  SPACER SPNL 7D 14MM 14MM NS LF FORTIFY-R FTPRNT LWR EPLT,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
351.361,SUP,HCPCS C1713,,351.361  -  SPACER SPNL 0D 14MM 16MM NS LF FORTIFY-R FTPRNT LWR EPLT,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
351.363,SUP,HCPCS C1713,,351.363  -  SPACER SPNL 3.5D 14MM 16MM NS LF FORTIFY-R FTPRNT LWR EPLT,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
351.364,SUP,HCPCS C1713,,351.364  -  SPACER SPNL 7D 14MM 16MM NS LF FORTIFY-R FTPRNT LWR EPLT,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
351.371,SUP,HCPCS C1713,,351.371  -  SPACER SPNL 0D 15MM 18MM NS LF FORTIFY-R FTPRNT LWR EPLT,"$1,815.00",$0.00,"$1,815.00",$816.75,"$1,295.37",$0.00,$312.72,$0.00,$0.00,$317.79,"$1,815.00",$0.00,$907.50,"$1,437.48","$1,452.00",$0.00,$284.05,$0.00,$288.95,$0.00
351.373,SUP,HCPCS C1713,,351.373  -  SPACER SPNL 3.5D 15MM 18MM NS LF FORTIFY-R FTPRNT LWR EPLT,"$1,815.00",$0.00,"$1,815.00",$816.75,"$1,295.37",$0.00,$312.72,$0.00,$0.00,$317.79,"$1,815.00",$0.00,$907.50,"$1,437.48","$1,452.00",$0.00,$284.05,$0.00,$288.95,$0.00
351.374,SUP,HCPCS C1713,,351.374  -  SPACER SPNL 7D 15MM 18MM NS LF FORTIFY-R FTPRNT LWR EPLT,"$1,815.00",$0.00,"$1,815.00",$816.75,"$1,295.37",$0.00,$312.72,$0.00,$0.00,$317.79,"$1,815.00",$0.00,$907.50,"$1,437.48","$1,452.00",$0.00,$284.05,$0.00,$288.95,$0.00
351.401,SUP,HCPCS C1713,,351.401  -  SPACER SPNL 0D 20MM 20MM NS LF FORTIFY-R FTPRNT UPR EPLT,"$1,335.00",$0.00,"$1,335.00",$600.75,$952.79,$0.00,$230.01,$0.00,$0.00,$233.75,"$1,335.00",$0.00,$667.50,"$1,057.32","$1,068.00",$0.00,$208.93,$0.00,$212.53,$0.00
351.403,SUP,HCPCS C1713,,351.403  -  SPACER SPNL 4D 20MM 20MM NS LF FORTIFY-R FTPRNT UPR EPLT,"$1,335.00",$0.00,"$1,335.00",$600.75,$952.79,$0.00,$230.01,$0.00,$0.00,$233.75,"$1,335.00",$0.00,$667.50,"$1,057.32","$1,068.00",$0.00,$208.93,$0.00,$212.53,$0.00
351.404,SUP,HCPCS C1713,,351.404  -  SPACER SPNL 8D 20MM 20MM NS LF FORTIFY-R FTPRNT UPR EPLT,"$1,335.00",$0.00,"$1,335.00",$600.75,$952.79,$0.00,$230.01,$0.00,$0.00,$233.75,"$1,335.00",$0.00,$667.50,"$1,057.32","$1,068.00",$0.00,$208.93,$0.00,$212.53,$0.00
351.411,SUP,HCPCS C1713,,351.411  -  SPACER SPNL 0D 21MM 23MM NS LF FORTIFY-R FTPRNT UPR EPLT,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
351.413,SUP,HCPCS C1713,,351.413  -  SPACER SPNL 4D 21MM 23MM NS LF FORTIFY-R FTPRNT UPR EPLT,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
351.414,SUP,HCPCS C1713,,351.414  -  SPACER SPNL 8D 21MM 23MM NS LF FORTIFY-R FTPRNT UPR EPLT,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
351.431,SUP,HCPCS C1713,,351.431  -  SPACER SPNL 0D 25MM 30MM NS LF FORTIFY-R FTPRNT UPR EPLT,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
351.433,SUP,HCPCS C1713,,351.433  -  SPACER SPNL 4D 25MM 30MM NS LF FORTIFY-R FTPRNT UPR EPLT,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
351.434,SUP,HCPCS C1713,,351.434  -  SPACER SPNL 8D 25MM 30MM NS LF FORTIFY-R FTPRNT UPR EPLT,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
351.451,SUP,HCPCS C1713,,351.451  -  SPACER SPNL 0D 20MM 20MM NS LF FORTIFY-R FTPRNT LWR EPLT,"$1,335.00",$0.00,"$1,335.00",$600.75,$952.79,$0.00,$230.01,$0.00,$0.00,$233.75,"$1,335.00",$0.00,$667.50,"$1,057.32","$1,068.00",$0.00,$208.93,$0.00,$212.53,$0.00
351.453,SUP,HCPCS C1713,,351.453  -  SPACER SPNL 4D 20MM 20MM NS LF FORTIFY-R FTPRNT LWR EPLT,"$1,335.00",$0.00,"$1,335.00",$600.75,$952.79,$0.00,$230.01,$0.00,$0.00,$233.75,"$1,335.00",$0.00,$667.50,"$1,057.32","$1,068.00",$0.00,$208.93,$0.00,$212.53,$0.00
351.454,SUP,HCPCS C1713,,351.454  -  SPACER SPNL 8D 20MM 20MM NS LF FORTIFY-R FTPRNT LWR EPLT,"$1,335.00",$0.00,"$1,335.00",$600.75,$952.79,$0.00,$230.01,$0.00,$0.00,$233.75,"$1,335.00",$0.00,$667.50,"$1,057.32","$1,068.00",$0.00,$208.93,$0.00,$212.53,$0.00
351.461,SUP,HCPCS C1713,,351.461  -  SPACER SPNL 0D 21MM 23MM NS LF FORTIFY-R FTPRNT LWR EPLT,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
351.463,SUP,HCPCS C1713,,351.463  -  SPACER SPNL 4D 21MM 23MM NS LF FORTIFY-R FTPRNT LWR EPLT,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
351.464,SUP,HCPCS C1713,,351.464  -  SPACER SPNL 8D 21MM 23MM NS LF FORTIFY-R FTPRNT LWR EPLT,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
351.481,SUP,HCPCS C1713,,351.481  -  SPACER SPNL 0D 25MM 30MM NS LF FORTIFY-R FTPRNT LWR EPLT,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
351.483,SUP,HCPCS C1713,,351.483  -  SPACER SPNL 4D 25MM 30MM NS LF FORTIFY-R FTPRNT LWR EPLT,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
351.485,SUP,HCPCS C1713,,351.485  -  SPACER SPNL 12D 25MM 30MM NS LF FORTIFY-R FTPRNT LWR EPLT,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
351.486,SUP,HCPCS C1713,,351.486  -  SPACER SPNL 16D 25MM 30MM NS LF FORTIFY-R FTPRNT LWR EPLT,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
351.92,SUP,Custom 27203010,,351.92  -  REAMER HAND 6MM 450MM NONSTRL,$532.50,$0.00,$532.50,$0.00,$380.05,$0.00,$0.00,$0.00,$0.00,$0.00,$532.50,$0.00,$266.25,$421.74,$426.00,$0.00,$0.00,$0.00,$0.00,$0.00
351.95,SUP,Custom 27203010,,351.95  -  REAMER HAND 9MM 450MM NONSTRL,$550.93,$0.00,$550.93,$0.00,$393.20,$0.00,$0.00,$0.00,$0.00,$0.00,$550.93,$0.00,$275.46,$436.34,$440.74,$0.00,$0.00,$0.00,$0.00,$0.00
352.04,SUP,Custom 27203010,,352.04  -  MANIPULATOR SURG FLEXIBLE STEM 5MM,"$5,855.00",$0.00,"$5,855.00",$0.00,"$4,178.71",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,855.00",$0.00,"$2,927.50","$4,637.16","$4,684.00",$0.00,$0.00,$0.00,$0.00,$0.00
352.085,SUP,Custom 27203010,,352.085  -  HEAD RMR 8.5MM MDLRY,$570.75,$0.00,$570.75,$0.00,$407.34,$0.00,$0.00,$0.00,$0.00,$0.00,$570.75,$0.00,$285.38,$452.03,$456.60,$0.00,$0.00,$0.00,$0.00,$0.00
352.1,SUP,Custom 27203010,,352.100  -  REAMER SURG 10MM HEAD SDCT MDLRY NSTRL,$678.55,$0.00,$678.55,$0.00,$484.28,$0.00,$0.00,$0.00,$0.00,$0.00,$678.55,$0.00,$339.28,$537.41,$542.84,$0.00,$0.00,$0.00,$0.00,$0.00
352.165,SUP,Custom 27203010,,352.165  -  REAMER SURG 16.5MM HEAD SIDE CUT MEDULLARY NONSTRL,$719.88,$0.00,$719.88,$0.00,$513.77,$0.00,$0.00,$0.00,$0.00,$0.00,$719.88,$0.00,$359.94,$570.14,$575.90,$0.00,$0.00,$0.00,$0.00,$0.00
355.9,SUP,Custom 27203010,,355.90  -  BIT DRILL 4.5MM 4MM 225MM QUICK COUPLING NONSTRL,$362.55,$0.00,$362.55,$0.00,$258.75,$0.00,$0.00,$0.00,$0.00,$0.00,$362.55,$0.00,$181.28,$287.14,$290.04,$0.00,$0.00,$0.00,$0.00,$0.00
356.95,SUP,Custom 27203010,,356.95  -  BIT DRILL 4MM 4.5MM 225MM QUICK COUPLING 3 FLUTED NONSTRL,$446.28,$0.00,$446.28,$0.00,$318.51,$0.00,$0.00,$0.00,$0.00,$0.00,$446.28,$0.00,$223.14,$353.45,$357.02,$0.00,$0.00,$0.00,$0.00,$0.00
356.97,SUP,Custom 27203010,,356.97  -  BIT DRILL 3.2MM 215MM 80MM 3 FLUTED CALIBRATED QUICK,$396.55,$0.00,$396.55,$0.00,$283.02,$0.00,$0.00,$0.00,$0.00,$0.00,$396.55,$0.00,$198.28,$314.07,$317.24,$0.00,$0.00,$0.00,$0.00,$0.00
356.972,SUP,Custom 27203010,,356.972  -  BIT DRILL 82MM CALIBRATION 3.2MM 215MM QUICK COUPLING 3,$392.30,$0.00,$392.30,$0.00,$279.98,$0.00,$0.00,$0.00,$0.00,$0.00,$392.30,$0.00,$196.15,$310.70,$313.84,$0.00,$0.00,$0.00,$0.00,$0.00
356.98,SUP,Custom 27203010,,356.98  -  BIT DRILL 4MM 270MM 95MM 3 FLUTED CALIBRATED QUICK COUPLING,$463.13,$0.00,$463.13,$0.00,$330.53,$0.00,$0.00,$0.00,$0.00,$0.00,$463.13,$0.00,$231.56,$366.80,$370.50,$0.00,$0.00,$0.00,$0.00,$0.00
356.982,SUP,Custom 27203010,,356.982  -  BIT DRILL 4MM 215MM 80MM 3 FLUTED CALIBRATED QUICK COUPLING,$448.95,$0.00,$448.95,$0.00,$320.42,$0.00,$0.00,$0.00,$0.00,$0.00,$448.95,$0.00,$224.48,$355.57,$359.16,$0.00,$0.00,$0.00,$0.00,$0.00
357.039,SUP,Custom 27203010,,357.039  -  GUIDEWIRE ORTHOPEDIC 2.8MM 350MM THREADED TROCAR POINT,$90.08,$0.00,$90.08,$0.00,$64.29,$0.00,$0.00,$0.00,$0.00,$0.00,$90.08,$0.00,$45.04,$71.34,$72.06,$0.00,$0.00,$0.00,$0.00,$0.00
357.047,SUP,Custom 27203010,,357.047  -  BIT DRILL 6.5MM 330MM QUICK COUPLING CANN,"$1,150.48",$0.00,"$1,150.48",$0.00,$821.09,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.48",$0.00,$575.24,$911.18,$920.38,$0.00,$0.00,$0.00,$0.00,$0.00
357.099,SUP,Custom 27203010,,357.099  -  BIT DRILL 5MM 330MM 100MM 3 FLUTED CALIBRATED QUICK COUPLING,$567.93,$0.00,$567.93,$0.00,$405.33,$0.00,$0.00,$0.00,$0.00,$0.00,$567.93,$0.00,$283.96,$449.80,$454.34,$0.00,$0.00,$0.00,$0.00,$0.00
357.394,SUP,Custom 27203010,,357.394  -  BIT DRL 17MM 300MM NS CNN LG QC,"$1,470.08",$0.00,"$1,470.08",$0.00,"$1,049.19",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,470.08",$0.00,$735.04,"$1,164.30","$1,176.06",$0.00,$0.00,$0.00,$0.00,$0.00
357.399,SUP,Custom 27203010,,357.399  -  GUIDEWIRE ORTHOPEDIC 3.2MM 400MM THREAD TIBIA NONSTRL,$181.28,$0.00,$181.28,$0.00,$129.38,$0.00,$0.00,$0.00,$0.00,$0.00,$181.28,$0.00,$90.64,$143.57,$145.02,$0.00,$0.00,$0.00,$0.00,$0.00
357.403,SUP,Custom 27203010,,357.403  -  BIT DRILL 6/10MM 435MM LARGE QUICK COUPLING CANN TAPERED,"$1,056.53",$0.00,"$1,056.53",$0.00,$754.04,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,056.53",$0.00,$528.26,$836.77,$845.22,$0.00,$0.00,$0.00,$0.00,$0.00
357.404,SUP,Custom 27203010,,357.404  -  BIT DRILL LARGE 11MM 280MM LARGE QUICK COUPLING CANN TAPERED,$931.90,$0.00,$931.90,$0.00,$665.10,$0.00,$0.00,$0.00,$0.00,$0.00,$931.90,$0.00,$465.95,$738.06,$745.52,$0.00,$0.00,$0.00,$0.00,$0.00
357.407,SUP,Custom 27203010,,357.407  -  BIT DRL 65MM 3 FLUT 4MM 260MM NS QC CLBRT,$380.98,$0.00,$380.98,$0.00,$271.90,$0.00,$0.00,$0.00,$0.00,$0.00,$380.98,$0.00,$190.49,$301.74,$304.78,$0.00,$0.00,$0.00,$0.00,$0.00
358.691,SUP,Custom 27203010,,358.691  -  BIT DRILL 102MM STOP 4.5MM 170MM 102MM JACOBS CHUCK CANN,$693.98,$0.00,$693.98,$0.00,$495.29,$0.00,$0.00,$0.00,$0.00,$0.00,$693.98,$0.00,$346.99,$549.63,$555.18,$0.00,$0.00,$0.00,$0.00,$0.00
359.079,SUP,Custom 27203010,,359.079  -  BIT DRILL LARGE 10.5MM 250MM QUICK COUPLING CANN FLEXIBLE,$921.20,$0.00,$921.20,$0.00,$657.46,$0.00,$0.00,$0.00,$0.00,$0.00,$921.20,$0.00,$460.60,$729.59,$736.96,$0.00,$0.00,$0.00,$0.00,$0.00
359.081,SUP,Custom 27203010,,359.081  -  BIT DRILL LARGE 8MM 250MM QUICK COUPLING CANN FLEXIBLE,$921.20,$0.00,$921.20,$0.00,$657.46,$0.00,$0.00,$0.00,$0.00,$0.00,$921.20,$0.00,$460.60,$729.59,$736.96,$0.00,$0.00,$0.00,$0.00,$0.00
360.01,SUP,Custom 27203010,,360.01  -  BIT DRILL LARGE 6MM 190MM QUICK COUPLING CANN NONSTRL,"$1,065.88",$0.00,"$1,065.88",$0.00,$760.71,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,065.88",$0.00,$532.94,$844.18,$852.70,$0.00,$0.00,$0.00,$0.00,$0.00
360.02,SUP,Custom 27203010,,360.02  -  BIT DRILL LARGE 7MM 190MM QUICK COUPLING CANN NONSTRL,"$1,065.88",$0.00,"$1,065.88",$0.00,$760.71,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,065.88",$0.00,$532.94,$844.18,$852.70,$0.00,$0.00,$0.00,$0.00,$0.00
360.03,SUP,Custom 27203010,,360.03  -  BIT DRILL LARGE 8MM 190MM QUICK COUPLING CANN NONSTRL,"$1,065.88",$0.00,"$1,065.88",$0.00,$760.71,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,065.88",$0.00,$532.94,$844.18,$852.70,$0.00,$0.00,$0.00,$0.00,$0.00
360.04,SUP,Custom 27203010,,360.04  -  BIT DRILL LARGE 9MM 190MM QUICK COUPLING CANN NONSTRL,"$1,065.88",$0.00,"$1,065.88",$0.00,$760.71,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,065.88",$0.00,$532.94,$844.18,$852.70,$0.00,$0.00,$0.00,$0.00,$0.00
360.05,SUP,Custom 27203010,,360.05  -  BIT DRILL LARGE 10MM 190MM QUICK COUPLING CANN NONSTRL,"$1,065.88",$0.00,"$1,065.88",$0.00,$760.71,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,065.88",$0.00,$532.94,$844.18,$852.70,$0.00,$0.00,$0.00,$0.00,$0.00
360.06,SUP,Custom 27203010,,360.06  -  BIT DRILL LARGE 11MM 190MM QUICK COUPLING CANN NONSTRL,"$1,119.10",$0.00,"$1,119.10",$0.00,$798.70,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,119.10",$0.00,$559.55,$886.33,$895.28,$0.00,$0.00,$0.00,$0.00,$0.00
360.07,SUP,Custom 27203010,,360.07  -  BIT DRILL LARGE 12MM 190MM QUICK COUPLING CANN NONSTRL,"$1,119.10",$0.00,"$1,119.10",$0.00,$798.70,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,119.10",$0.00,$559.55,$886.33,$895.28,$0.00,$0.00,$0.00,$0.00,$0.00
360.257,SUP,Custom 27203010,,360.257  -  BIT DRL 13MM 385MM NS LG QC FLXB,$771.08,$0.00,$771.08,$0.00,$550.32,$0.00,$0.00,$0.00,$0.00,$0.00,$771.08,$0.00,$385.54,$610.70,$616.86,$0.00,$0.00,$0.00,$0.00,$0.00
360.258,SUP,Custom 27203010,,360.258  -  BIT DRL 15.5MM 385MM NS LG QC FLXB,$771.08,$0.00,$771.08,$0.00,$550.32,$0.00,$0.00,$0.00,$0.00,$0.00,$771.08,$0.00,$385.54,$610.70,$616.86,$0.00,$0.00,$0.00,$0.00,$0.00
364.009,SUP,Custom 27803010,,364.009  -  SPACER SPNL 0D 20MM XS 25X9MM NS LF CNTNTL PEEK ALIF,"$13,642.50",$0.00,"$13,642.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,642.50",$0.00,"$6,821.25","$10,804.86","$10,914.00",$0.00,$0.00,$0.00,$0.00,$0.00
364.011,SUP,Custom 27803010,,364.011  -  SPACER SPNL 0D 20MM XS 25X11MM NS LF CNTNTL PEEK ALIF,"$13,642.50",$0.00,"$13,642.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,642.50",$0.00,"$6,821.25","$10,804.86","$10,914.00",$0.00,$0.00,$0.00,$0.00,$0.00
364.013,SUP,Custom 27803010,,364.013  -  SPACER SPNL 0D 20MM XS 25X13MM NS LF CNTNTL PEEK ALIF,"$13,642.50",$0.00,"$13,642.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,642.50",$0.00,"$6,821.25","$10,804.86","$10,914.00",$0.00,$0.00,$0.00,$0.00,$0.00
364.015,SUP,Custom 27803010,,364.015  -  SPACER SPNL 0D 20MM XS 25X15MM NS LF CNTNTL PEEK ALIF,"$13,642.50",$0.00,"$13,642.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,642.50",$0.00,"$6,821.25","$10,804.86","$10,914.00",$0.00,$0.00,$0.00,$0.00,$0.00
364.017,SUP,Custom 27803010,,364.017  -  SPACER SPNL 0D 20MM XS 25X17MM NS LF CNTNTL PEEK ALIF,"$13,642.50",$0.00,"$13,642.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,642.50",$0.00,"$6,821.25","$10,804.86","$10,914.00",$0.00,$0.00,$0.00,$0.00,$0.00
364.109,SUP,Custom 27803010,,364.109  -  SPACER SPNL 0D 22MM SM 29X9MM NS LF CNTNTL PEEK ALIF,"$13,642.50",$0.00,"$13,642.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,642.50",$0.00,"$6,821.25","$10,804.86","$10,914.00",$0.00,$0.00,$0.00,$0.00,$0.00
364.111,SUP,Custom 27803010,,364.111  -  SPACER SPNL 0D 22MM SM 29X11MM NS LF CNTNTL PEEK ALIF,"$13,642.50",$0.00,"$13,642.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,642.50",$0.00,"$6,821.25","$10,804.86","$10,914.00",$0.00,$0.00,$0.00,$0.00,$0.00
364.113,SUP,Custom 27803010,,364.113  -  SPACER SPNL 0D 22MM SM 29X13MM NS LF CNTNTL PEEK ALIF,"$13,642.50",$0.00,"$13,642.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,642.50",$0.00,"$6,821.25","$10,804.86","$10,914.00",$0.00,$0.00,$0.00,$0.00,$0.00
364.115,SUP,Custom 27803010,,364.115  -  SPACER SPNL 0D 22MM SM 29X15MM NS LF CNTNTL PEEK ALIF,"$13,642.50",$0.00,"$13,642.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,642.50",$0.00,"$6,821.25","$10,804.86","$10,914.00",$0.00,$0.00,$0.00,$0.00,$0.00
364.117,SUP,Custom 27803010,,364.117  -  SPACER SPNL 0D 22MM SM 29X17MM NS LF CNTNTL PEEK ALIF,"$13,642.50",$0.00,"$13,642.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,642.50",$0.00,"$6,821.25","$10,804.86","$10,914.00",$0.00,$0.00,$0.00,$0.00,$0.00
364.209,SUP,Custom 27803010,,364.209  -  SPACER SPNL 8D LRDTC 22MM SM 29X9MM NS LF CNTNTL PEEK ALIF,"$13,642.50",$0.00,"$13,642.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,642.50",$0.00,"$6,821.25","$10,804.86","$10,914.00",$0.00,$0.00,$0.00,$0.00,$0.00
364.211,SUP,Custom 27803010,,364.211  -  SPACER SPNL 8D LRDTC 22MM SM 29X11MM NS LF CNTNTL PEEK ALIF,"$13,642.50",$0.00,"$13,642.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,642.50",$0.00,"$6,821.25","$10,804.86","$10,914.00",$0.00,$0.00,$0.00,$0.00,$0.00
364.213,SUP,Custom 27803010,,364.213  -  SPACER SPNL 8D LRDTC 22MM SM 29X13MM NS LF CNTNTL PEEK ALIF,"$13,642.50",$0.00,"$13,642.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,642.50",$0.00,"$6,821.25","$10,804.86","$10,914.00",$0.00,$0.00,$0.00,$0.00,$0.00
364.215,SUP,Custom 27803010,,364.215  -  SPACER SPNL 8D LRDTC 22MM SM 29X15MM NS LF CNTNTL PEEK ALIF,"$13,642.50",$0.00,"$13,642.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,642.50",$0.00,"$6,821.25","$10,804.86","$10,914.00",$0.00,$0.00,$0.00,$0.00,$0.00
364.217,SUP,Custom 27803010,,364.217  -  SPACER SPNL 8D LRDTC 22MM SM 29X17MM NS LF CNTNTL PEEK ALIF,"$13,642.50",$0.00,"$13,642.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,642.50",$0.00,"$6,821.25","$10,804.86","$10,914.00",$0.00,$0.00,$0.00,$0.00,$0.00
364.311,SUP,Custom 27803010,,364.311  -  SPACER SPNL 15D LRDTC 22MM SM 29X11MM NS LF CNTNTL PEEK ALIF,"$13,642.50",$0.00,"$13,642.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,642.50",$0.00,"$6,821.25","$10,804.86","$10,914.00",$0.00,$0.00,$0.00,$0.00,$0.00
364.313,SUP,Custom 27803010,,364.313  -  SPACER SPNL 15D LRDTC 22MM SM 29X13MM NS LF CNTNTL PEEK ALIF,"$13,642.50",$0.00,"$13,642.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,642.50",$0.00,"$6,821.25","$10,804.86","$10,914.00",$0.00,$0.00,$0.00,$0.00,$0.00
364.315,SUP,Custom 27803010,,364.315  -  SPACER SPNL 15D LRDTC 22MM SM 29X15MM NS LF CNTNTL PEEK ALIF,"$13,642.50",$0.00,"$13,642.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,642.50",$0.00,"$6,821.25","$10,804.86","$10,914.00",$0.00,$0.00,$0.00,$0.00,$0.00
364.317,SUP,Custom 27803010,,364.317  -  SPACER SPNL 15D LRDTC 22MM SM 29X17MM NS LF CNTNTL PEEK ALIF,"$13,642.50",$0.00,"$13,642.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,642.50",$0.00,"$6,821.25","$10,804.86","$10,914.00",$0.00,$0.00,$0.00,$0.00,$0.00
364.409,SUP,Custom 27803010,,364.409  -  SPACER SPNL 0D 24MM MED 35X9MM NS LF CNTNTL PEEK ALIF,"$13,642.50",$0.00,"$13,642.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,642.50",$0.00,"$6,821.25","$10,804.86","$10,914.00",$0.00,$0.00,$0.00,$0.00,$0.00
364.411,SUP,Custom 27803010,,364.411  -  SPACER SPNL 0D 24MM MED 35X11MM NS LF CNTNTL PEEK ALIF,"$13,642.50",$0.00,"$13,642.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,642.50",$0.00,"$6,821.25","$10,804.86","$10,914.00",$0.00,$0.00,$0.00,$0.00,$0.00
364.413,SUP,Custom 27803010,,364.413  -  SPACER SPNL 0D 24MM MED 35X13MM NS LF CNTNTL PEEK ALIF,"$13,642.50",$0.00,"$13,642.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,642.50",$0.00,"$6,821.25","$10,804.86","$10,914.00",$0.00,$0.00,$0.00,$0.00,$0.00
364.415,SUP,Custom 27803010,,364.415  -  SPACER SPNL 0D 24MM MED 35X15MM NS LF CNTNTL PEEK ALIF,"$13,642.50",$0.00,"$13,642.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,642.50",$0.00,"$6,821.25","$10,804.86","$10,914.00",$0.00,$0.00,$0.00,$0.00,$0.00
364.417,SUP,Custom 27803010,,364.417  -  SPACER SPNL 0D 24MM MED 35X17MM NS LF CNTNTL PEEK ALIF,"$13,642.50",$0.00,"$13,642.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,642.50",$0.00,"$6,821.25","$10,804.86","$10,914.00",$0.00,$0.00,$0.00,$0.00,$0.00
364.419,SUP,Custom 27803010,,364.419  -  SPACER SPNL 0D 24MM MED 35X19MM NS LF CNTNTL PEEK ALIF,"$13,642.50",$0.00,"$13,642.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,642.50",$0.00,"$6,821.25","$10,804.86","$10,914.00",$0.00,$0.00,$0.00,$0.00,$0.00
364.421,SUP,Custom 27803010,,364.421  -  SPACER SPNL 0D 24MM MED 35X21MM NS LF CNTNTL PEEK ALIF,"$13,642.50",$0.00,"$13,642.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,642.50",$0.00,"$6,821.25","$10,804.86","$10,914.00",$0.00,$0.00,$0.00,$0.00,$0.00
364.509,SUP,Custom 27803010,,364.509  -  SPACER SPNL 8D LRDTC 24MM MED 35X9MM NS LF CNTNTL PEEK ALIF,"$13,642.50",$0.00,"$13,642.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,642.50",$0.00,"$6,821.25","$10,804.86","$10,914.00",$0.00,$0.00,$0.00,$0.00,$0.00
364.511,SUP,Custom 27803010,,364.511  -  SPACER SPNL 8D LRDTC 24MM MED 35X11MM NS LF CNTNTL PEEK ALIF,"$13,642.50",$0.00,"$13,642.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,642.50",$0.00,"$6,821.25","$10,804.86","$10,914.00",$0.00,$0.00,$0.00,$0.00,$0.00
364.513,SUP,Custom 27803010,,364.513  -  SPACER SPNL 8D LRDTC 24MM MED 35X13MM NS LF CNTNTL PEEK ALIF,"$13,642.50",$0.00,"$13,642.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,642.50",$0.00,"$6,821.25","$10,804.86","$10,914.00",$0.00,$0.00,$0.00,$0.00,$0.00
364.515,SUP,Custom 27803010,,364.515  -  SPACER SPNL 8D LRDTC 24MM MED 35X15MM NS LF CNTNTL PEEK ALIF,"$13,642.50",$0.00,"$13,642.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,642.50",$0.00,"$6,821.25","$10,804.86","$10,914.00",$0.00,$0.00,$0.00,$0.00,$0.00
364.517,SUP,Custom 27803010,,364.517  -  SPACER SPNL 8D LRDTC 24MM MED 35X17MM NS LF CNTNTL PEEK ALIF,"$13,642.50",$0.00,"$13,642.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,642.50",$0.00,"$6,821.25","$10,804.86","$10,914.00",$0.00,$0.00,$0.00,$0.00,$0.00
364.519,SUP,Custom 27803010,,364.519  -  SPACER SPNL 8D LRDTC 24MM MED 35X19MM NS LF CNTNTL PEEK ALIF,"$13,642.50",$0.00,"$13,642.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,642.50",$0.00,"$6,821.25","$10,804.86","$10,914.00",$0.00,$0.00,$0.00,$0.00,$0.00
364.521,SUP,Custom 27803010,,364.521  -  SPACER SPNL 8D LRDTC 24MM MED 35X21MM NS LF CNTNTL PEEK ALIF,"$13,642.50",$0.00,"$13,642.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,642.50",$0.00,"$6,821.25","$10,804.86","$10,914.00",$0.00,$0.00,$0.00,$0.00,$0.00
364.611,SUP,Custom 27803010,,364.611  -  SPACER SPNL 15D LRDTC 24MM MED 35X11MM NS LF CNTNTL PEEK,"$13,642.50",$0.00,"$13,642.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,642.50",$0.00,"$6,821.25","$10,804.86","$10,914.00",$0.00,$0.00,$0.00,$0.00,$0.00
364.613,SUP,Custom 27803010,,364.613  -  SPACER SPNL 15D LRDTC 24MM MED 35X13MM NS LF CNTNTL PEEK,"$13,642.50",$0.00,"$13,642.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,642.50",$0.00,"$6,821.25","$10,804.86","$10,914.00",$0.00,$0.00,$0.00,$0.00,$0.00
364.615,SUP,Custom 27803010,,364.615  -  SPACER SPNL 15D LRDTC 24MM MED 35X15MM NS LF CNTNTL PEEK,"$13,642.50",$0.00,"$13,642.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,642.50",$0.00,"$6,821.25","$10,804.86","$10,914.00",$0.00,$0.00,$0.00,$0.00,$0.00
364.617,SUP,Custom 27803010,,364.617  -  SPACER SPNL 15D LRDTC 24MM MED 35X17MM NS LF CNTNTL PEEK,"$13,642.50",$0.00,"$13,642.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,642.50",$0.00,"$6,821.25","$10,804.86","$10,914.00",$0.00,$0.00,$0.00,$0.00,$0.00
364.619,SUP,Custom 27803010,,364.619  -  SPACER SPNL 15D LRDTC 24MM MED 35X19MM NS LF CNTNTL PEEK,"$13,642.50",$0.00,"$13,642.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,642.50",$0.00,"$6,821.25","$10,804.86","$10,914.00",$0.00,$0.00,$0.00,$0.00,$0.00
364.621,SUP,Custom 27803010,,364.621  -  SPACER SPNL 15D LRDTC 24MM MED 35X21MM NS LF CNTNTL PEEK,"$13,642.50",$0.00,"$13,642.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,642.50",$0.00,"$6,821.25","$10,804.86","$10,914.00",$0.00,$0.00,$0.00,$0.00,$0.00
364.711,SUP,Custom 27803010,,364.711  -  SPACER SPNL 8D LRDTC 28MM LG 39X11MM NS LF CNTNTL PEEK ALIF,"$13,642.50",$0.00,"$13,642.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,642.50",$0.00,"$6,821.25","$10,804.86","$10,914.00",$0.00,$0.00,$0.00,$0.00,$0.00
364.713,SUP,Custom 27803010,,364.713  -  SPACER SPNL 8D LRDTC 28MM LG 39X13MM NS LF CNTNTL PEEK ALIF,"$13,642.50",$0.00,"$13,642.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,642.50",$0.00,"$6,821.25","$10,804.86","$10,914.00",$0.00,$0.00,$0.00,$0.00,$0.00
364.715,SUP,Custom 27803010,,364.715  -  SPACER SPNL 8D LRDTC 28MM LG 39X15MM NS LF CNTNTL PEEK ALIF,"$13,642.50",$0.00,"$13,642.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,642.50",$0.00,"$6,821.25","$10,804.86","$10,914.00",$0.00,$0.00,$0.00,$0.00,$0.00
364.717,SUP,Custom 27803010,,364.717  -  SPACER SPNL 8D LRDTC 28MM LG 39X17MM NS LF CNTNTL PEEK ALIF,"$13,642.50",$0.00,"$13,642.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,642.50",$0.00,"$6,821.25","$10,804.86","$10,914.00",$0.00,$0.00,$0.00,$0.00,$0.00
364.719,SUP,Custom 27803010,,364.719  -  SPACER SPNL 8D LRDTC 28MM LG 39X19MM NS LF CNTNTL PEEK ALIF,"$13,642.50",$0.00,"$13,642.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,642.50",$0.00,"$6,821.25","$10,804.86","$10,914.00",$0.00,$0.00,$0.00,$0.00,$0.00
364.721,SUP,Custom 27803010,,364.721  -  SPACER SPNL 8D LRDTC 28MM LG 39X21MM NS LF CNTNTL PEEK ALIF,"$13,642.50",$0.00,"$13,642.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,642.50",$0.00,"$6,821.25","$10,804.86","$10,914.00",$0.00,$0.00,$0.00,$0.00,$0.00
364.759,SUP,Custom 27803010,,"364.759  -  CONTINENTAL ALIF SPACER, LARGE 5 DEG, 9MM","$13,642.50",$0.00,"$13,642.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,642.50",$0.00,"$6,821.25","$10,804.86","$10,914.00",$0.00,$0.00,$0.00,$0.00,$0.00
364.813,SUP,Custom 27803010,,364.813  -  SPACER SPNL 15D LRDTC 28MM LG 39X13MM NS LF CNTNTL PEEK ALIF,"$13,642.50",$0.00,"$13,642.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,642.50",$0.00,"$6,821.25","$10,804.86","$10,914.00",$0.00,$0.00,$0.00,$0.00,$0.00
364.815,SUP,Custom 27803010,,364.815  -  SPACER SPNL 15D LRDTC 28MM LG 39X15MM NS LF CNTNTL PEEK ALIF,"$13,642.50",$0.00,"$13,642.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,642.50",$0.00,"$6,821.25","$10,804.86","$10,914.00",$0.00,$0.00,$0.00,$0.00,$0.00
364.817,SUP,Custom 27803010,,364.817  -  SPACER SPNL 15D LRDTC 28MM LG 39X17MM NS LF CNTNTL PEEK ALIF,"$13,642.50",$0.00,"$13,642.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,642.50",$0.00,"$6,821.25","$10,804.86","$10,914.00",$0.00,$0.00,$0.00,$0.00,$0.00
364.819,SUP,Custom 27803010,,364.819  -  SPACER SPNL 15D LRDTC 28MM LG 39X19MM NS LF CNTNTL PEEK ALIF,"$13,642.50",$0.00,"$13,642.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,642.50",$0.00,"$6,821.25","$10,804.86","$10,914.00",$0.00,$0.00,$0.00,$0.00,$0.00
364.821,SUP,Custom 27803010,,364.821  -  SPACER SPNL 15D LRDTC 28MM LG 39X21MM NS LF CNTNTL PEEK ALIF,"$13,642.50",$0.00,"$13,642.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,642.50",$0.00,"$6,821.25","$10,804.86","$10,914.00",$0.00,$0.00,$0.00,$0.00,$0.00
365.005,SUP,Custom 27803010,,365.005  -  SPACER SPNL 11MM SM PRLL 12X5MM NS LF CLN PEEK ACDF,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
365.006,SUP,Custom 27803010,,365.006  -  SPACER SPNL 11MM SM PRLL 12X6MM NS LF CLN PEEK ACDF,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
365.007,SUP,Custom 27803010,,365.007  -  SPACER SPNL 11MM SM PRLL 12X7MM NS LF CLN PEEK ACDF,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
365.008,SUP,Custom 27803010,,365.008  -  SPACER SPNL 11MM SM PRLL 12X8MM NS LF CLN PEEK ACDF,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
365.009,SUP,Custom 27803010,,365.009  -  SPACER SPNL 11MM SM PRLL 12X9MM NS LF CLN PEEK ACDF,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
365.01,SUP,Custom 27803010,,365.010  -  SPACER SPNL 11MM SM PRLL 12X10MM NS LF CLN PEEK ACDF,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
365.011,SUP,Custom 27803010,,365.011  -  SPACER SPNL 11MM SM PRLL 12X11MM NS LF CLN PEEK ACDF,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
365.012,SUP,Custom 27803010,,365.012  -  SPACER SPNL 11MM SM PRLL 12X12MM NS LF CLN PEEK ACDF,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
365.045,SUP,Custom 27803010,,365.045  -  SPACER SPNL 15MM 2XL PRLL 18X5MM NS LF CLN PEEK ACDF,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
365.046,SUP,Custom 27803010,,365.046  -  SPACER SPNL 15MM 2XL PRLL 18X6MM NS LF CLN PEEK ACDF,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
365.047,SUP,Custom 27803010,,365.047  -  SPACER SPNL 15MM 2XL PRLL 18X7MM NS LF CLN PEEK ACDF,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
365.048,SUP,Custom 27803010,,365.048  -  SPACER SPNL 15MM 2XL PRLL 18X8MM NS LF CLN PEEK ACDF,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
365.049,SUP,Custom 27803010,,365.049  -  SPACER SPNL 15MM 2XL PRLL 18X9MM NS LF CLN PEEK ACDF,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
365.05,SUP,Custom 27803010,,365.050  -  SPACER SPNL 15MM 2XL PRLL 18X10MM NS LF CLN PEEK ACDF,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
365.051,SUP,Custom 27803010,,365.051  -  SPACER SPNL 15MM 2XL PRLL 18X11MM NS LF CLN PEEK ACDF,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
365.052,SUP,Custom 27803010,,365.052  -  SPACER SPNL 15MM 2XL PRLL 18X12MM NS LF CLN PEEK ACDF,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
365.065,SUP,Custom 27803010,,365.065  -  SPACER SPNL 7D LRDTC 15MM 2XL 18X5MM NS LF CLN PEEK ACDF,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
365.066,SUP,Custom 27803010,,365.066  -  SPACER SPNL 7D LRDTC 15MM 2XL 18X6MM NS LF CLN PEEK ACDF,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
365.067,SUP,Custom 27803010,,365.067  -  SPACER SPNL 7D LRDTC 15MM 2XL 18X7MM NS LF CLN PEEK ACDF,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
365.068,SUP,Custom 27803010,,365.068  -  SPACER SPNL 7D LRDTC 15MM 2XL 18X8MM NS LF CLN PEEK ACDF,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
365.069,SUP,Custom 27803010,,365.069  -  SPACER SPNL 7D LRDTC 15MM 2XL 18X9MM NS LF CLN PEEK ACDF,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
365.07,SUP,Custom 27803010,,365.070  -  SPACER SPNL 7D LRDTC 15MM 2XL 18X10MM NS LF CLN PEEK ACDF,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
365.071,SUP,Custom 27803010,,365.071  -  SPACER SPNL 7D LRDTC 15MM 2XL 18X11MM NS LF CLN PEEK ACDF,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
365.072,SUP,Custom 27803010,,365.072  -  SPACER SPNL 7D LRDTC 15MM 2XL 18X12MM NS LF CLN PEEK ACDF,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
365.105,SUP,Custom 27803010,,365.105  -  SPACER SPNL 7D LRDTC 11MM SM 12X5MM NS LF CLN PEEK ACDF,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
365.106,SUP,Custom 27803010,,365.106  -  SPACER SPNL 7D LRDTC 11MM SM 12X6MM NS LF CLN PEEK ACDF,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
365.107,SUP,Custom 27803010,,365.107  -  SPACER SPNL 7D LRDTC 11MM SM 12X7MM NS LF CLN PEEK ACDF,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
365.108,SUP,Custom 27803010,,365.108  -  SPACER SPNL 7D LRDTC 11MM SM 12X8MM NS LF CLN PEEK ACDF,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
365.109,SUP,Custom 27803010,,365.109  -  SPACER SPNL 7D LRDTC 11MM SM 12X9MM NS LF CLN PEEK ACDF,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
365.11,SUP,Custom 27803010,,365.110  -  SPACER SPNL 7D LRDTC 11MM SM 12X10MM NS LF CLN PEEK ACDF,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
365.111,SUP,Custom 27803010,,365.111  -  SPACER SPNL 7D LRDTC 11MM SM 12X11MM NS LF CLN PEEK ACDF,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
365.112,SUP,Custom 27803010,,365.112  -  SPACER SPNL 7D LRDTC 11MM SM 12X12MM NS LF CLN PEEK ACDF,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
365.305,SUP,Custom 27803010,,365.305  -  SPACER SPNL 12MM LG PRLL 14X5MM NS LF CLN PEEK ACDF,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
365.306,SUP,Custom 27803010,,365.306  -  SPACER SPNL 12MM LG PRLL 14X6MM NS LF CLN PEEK ACDF,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
365.307,SUP,Custom 27803010,,365.307  -  SPACER SPNL 12MM LG PRLL 14X7MM NS LF CLN PEEK ACDF,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
365.308,SUP,Custom 27803010,,365.308  -  SPACER SPNL 12MM LG PRLL 14X8MM NS LF CLN PEEK ACDF,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
365.309,SUP,Custom 27803010,,365.309  -  SPACER SPNL 12MM LG PRLL 14X9MM NS LF CLN PEEK ACDF,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
365.31,SUP,Custom 27803010,,365.310  -  SPACER SPNL 12MM LG PRLL 14X10MM NS LF CLN PEEK ACDF,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
365.311,SUP,Custom 27803010,,365.311  -  SPACER SPNL 12MM LG PRLL 14X11MM NS LF CLN PEEK ACDF,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
365.312,SUP,Custom 27803010,,365.312  -  SPACER SPNL 12MM LG PRLL 14X12MM NS LF CLN PEEK ACDF,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
365.405,SUP,Custom 27803010,,365.405  -  SPACER SPNL 7D LRDTC 12MM LG 14X5MM NS LF CLN PEEK ACDF,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
365.406,SUP,Custom 27803010,,365.406  -  SPACER SPNL 7D LRDTC 12MM LG 14X6MM NS LF CLN PEEK ACDF,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
365.407,SUP,Custom 27803010,,365.407  -  SPACER SPNL 7D LRDTC 12MM LG 14X7MM NS LF CLN PEEK ACDF,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
365.408,SUP,Custom 27803010,,365.408  -  SPACER SPNL 7D LRDTC 12MM LG 14X8MM NS LF CLN PEEK ACDF,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
365.409,SUP,Custom 27803010,,365.409  -  SPACER SPNL 7D LRDTC 12MM LG 14X9MM NS LF CLN PEEK ACDF,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
365.41,SUP,Custom 27803010,,365.410  -  SPACER SPNL 7D LRDTC 12MM LG 14X10MM NS LF CLN PEEK ACDF,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
365.411,SUP,Custom 27803010,,365.411  -  SPACER SPNL 7D LRDTC 12MM LG 14X11MM NS LF CLN PEEK ACDF,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
365.412,SUP,Custom 27803010,,365.412  -  SPACER SPNL 7D LRDTC 12MM LG 14X12MM NS LF CLN PEEK ACDF,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
365.705,SUP,Custom 27803010,,365.705  -  SPACER SPNL 7D LRDTC 14MM XL 16X5MM NS LF CLN PEEK ACDF,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
365.706,SUP,Custom 27803010,,365.706  -  SPACER SPNL 7D LRDTC 14MM XL 16X6MM NS LF CLN PEEK ACDF,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
365.707,SUP,Custom 27803010,,365.707  -  SPACER SPNL 7D LRDTC 14MM XL 16X7MM NS LF CLN PEEK ACDF,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
365.708,SUP,Custom 27803010,,365.708  -  SPACER SPNL 7D LRDTC 14MM XL 16X8MM NS LF CLN PEEK ACDF,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
365.709,SUP,Custom 27803010,,365.709  -  SPACER SPNL 7D LRDTC 14MM XL 16X9MM NS LF CLN PEEK ACDF,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
365.71,SUP,Custom 27803010,,365.710  -  SPACER SPNL 7D LRDTC 14MM XL 16X10MM NS LF CLN PEEK ACDF,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
365.711,SUP,Custom 27803010,,365.711  -  SPACER SPNL 7D LRDTC 14MM XL 16X11MM NS LF CLN PEEK ACDF,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
365.712,SUP,Custom 27803010,,365.712  -  SPACER SPNL 7D LRDTC 14MM XL 16X12MM NS LF CLN PEEK ACDF,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
365.805,SUP,Custom 27803010,,365.805  -  SPACER SPNL 7D LRDTC 14MM XL 16X5MM NS LF CLN PEEK ACDF,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
365.806,SUP,Custom 27803010,,365.806  -  SPACER SPNL 7D LRDTC 14MM XL 16X6MM NS LF CLN PEEK ACDF,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
365.807,SUP,Custom 27803010,,365.807  -  SPACER SPNL 7D LRDTC 14MM XL 16X7MM NS LF CLN PEEK ACDF,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
365.808,SUP,Custom 27803010,,365.808  -  SPACER SPNL 7D LRDTC 14MM XL 16X8MM NS LF CLN PEEK ACDF,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
365.809,SUP,Custom 27803010,,365.809  -  SPACER SPNL 7D LRDTC 14MM XL 16X9MM NS LF CLN PEEK ACDF,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
365.81,SUP,Custom 27803010,,365.810  -  SPACER SPNL 7D LRDTC 14MM XL 16X10MM NS LF CLN PEEK ACDF,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
365.811,SUP,Custom 27803010,,365.811  -  SPACER SPNL 7D LRDTC 14MM XL 16X11MM NS LF CLN PEEK ACDF,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
365.812,SUP,Custom 27803010,,365.812  -  SPACER SPNL 7D LRDTC 14MM XL 16X12MM NS LF CLN PEEK ACDF,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
368.207,SUP,Custom 27803010,,368.207  -  SPACER SPNL SM 28X10X7MM NS SGNTR PEEK TLIF,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
368.208,SUP,Custom 27803010,,368.208  -  SPACER SPNL SM 28X10X8MM NS SGNTR PEEK TLIF,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
368.209,SUP,Custom 27803010,,368.209  -  SPACER SPNL SM 28X10X9MM NS SGNTR PEEK TLIF,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
368.21,SUP,Custom 27803010,,368.210  -  SPACER SPNL SM 28X10X10MM NS SGNTR PEEK TLIF,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
368.211,SUP,Custom 27803010,,368.211  -  SPACER SPNL SM 28X10X11MM NS SGNTR PEEK TLIF,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
368.212,SUP,Custom 27803010,,368.212  -  SPACER SPNL SM 28X10X12MM NS SGNTR PEEK TLIF,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
368.213,SUP,Custom 27803010,,368.213  -  SPACER SPNL SM 28X10X13MM NS SGNTR PEEK TLIF,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
368.215,SUP,Custom 27803010,,368.215  -  SPACER SPNL SM 28X10X15MM NS SGNTR PEEK TLIF,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
368.217,SUP,Custom 27803010,,368.217  -  SPACER SPNL SM 28X10X17MM NS SGNTR PEEK TLIF,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
368.307,SUP,Custom 27803010,,368.307  -  SPACER SPNL LG 33X11X7MM NS SGNTR PEEK TLIF,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
368.308,SUP,Custom 27803010,,368.308  -  SPACER SPNL LG 33X11X8MM NS SGNTR PEEK TLIF,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
368.309,SUP,Custom 27803010,,368.309  -  SPACER SPNL LG 33X11X9MM NS SGNTR PEEK TLIF,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
368.31,SUP,Custom 27803010,,368.310  -  SPACER SPNL LG 33X11X10MM NS SGNTR PEEK TLIF,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
368.311,SUP,Custom 27803010,,368.311  -  SPACER SPNL LG 33X11X11MM NS SGNTR PEEK TLIF,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
368.312,SUP,Custom 27803010,,368.312  -  SPACER SPNL LG 33X11X12MM NS SGNTR PEEK TLIF,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
368.313,SUP,Custom 27803010,,368.313  -  SPACER SPNL LG 33X11X13MM NS SGNTR PEEK TLIF,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
368.315,SUP,Custom 27803010,,368.315  -  SPACER SPNL LG 33X11X15MM NS SGNTR PEEK TLIF,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
368.317,SUP,Custom 27803010,,368.317  -  SPACER SPNL LG 33X11X17MM NS SGNTR PEEK TLIF,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
375.008,SUP,Custom 27803010,,"375.008  -  TRANSCONTINENTAL LLIF SPACER, SMALL, 0 DEG, 8MM","$19,642.50",$0.00,"$19,642.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$19,642.50",$0.00,"$9,821.25","$15,556.86","$15,714.00",$0.00,$0.00,$0.00,$0.00,$0.00
375.009,SUP,Custom 27803010,,375.009  -  SPACER SPNL 0D SM 45X18X9MM NS LF TRANSCONTINENTAL PEEK LAT,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
375.011,SUP,Custom 27803010,,375.011  -  SPACER SPNL 0D SM 45X18X11MM NS LF TRANSCONTINENTAL PEEK LAT,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
375.013,SUP,Custom 27803010,,375.013  -  SPACER SPNL 0D SM 45X18X13MM NS LF TRANSCONTINENTAL PEEK LAT,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
375.015,SUP,Custom 27803010,,375.015  -  SPACER SPNL 0D SM 45X18X15MM NS LF TRANSCONTINENTAL PEEK LAT,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
375.017,SUP,Custom 27803010,,375.017  -  SPACER SPNL 0D SM 45X18X17MM NS LF TRANSCONTINENTAL PEEK LAT,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
375.019,SUP,Custom 27803010,,375.019  -  SPACER SPNL 0D SM 45X18X19MM NS LF TRANSCONTINENTAL PEEK LAT,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
375.021,SUP,Custom 27803010,,375.021  -  SPACER SPNL 0D SM 45X18X21MM NS LF TRANSCONTINENTAL PEEK LAT,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
375.109,SUP,Custom 27803010,,375.109  -  SPACER SPNL 6D LRDTC SM 45X18X9MM NS LF TRANSCONTINENTAL,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
375.111,SUP,Custom 27803010,,375.111  -  SPACER SPNL 6D LRDTC SM 45X18X11MM NS LF TRANSCONTINENTAL,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
375.113,SUP,Custom 27803010,,375.113  -  SPACER SPNL 6D LRDTC SM 45X18X13MM NS LF TRANSCONTINENTAL,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
375.115,SUP,Custom 27803010,,375.115  -  SPACER SPNL 6D LRDTC SM 45X18X15MM NS LF TRANSCONTINENTAL,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
375.117,SUP,Custom 27803010,,375.117  -  SPACER SPNL 6D LRDTC SM 45X18X17MM NS LF TRANSCONTINENTAL,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
375.119,SUP,Custom 27803010,,375.119  -  SPACER SPNL 6D LRDTC SM 45X18X19MM NS LF TRANSCONTINENTAL,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
375.121,SUP,Custom 27803010,,375.121  -  SPACER SPNL 6D LRDTC SM 45X18X21MM NS LF TRANSCONTINENTAL,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
375.209,SUP,Custom 27803010,,375.209  -  SPACER SPNL 0D MED 50X18X9MM NS LF TRANSCONTINENTAL PEEK LAT,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
375.211,SUP,Custom 27803010,,375.211  -  SPACER SPNL 0D MED 50X18X11MM NS LF TRANSCONTINENTAL PEEK,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
375.213,SUP,Custom 27803010,,375.213  -  SPACER SPNL 0D MED 50X18X13MM NS LF TRANSCONTINENTAL PEEK,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
375.215,SUP,Custom 27803010,,375.215  -  SPACER SPNL 0D MED 50X18X15MM NS LF TRANSCONTINENTAL PEEK,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
375.217,SUP,Custom 27803010,,375.217  -  SPACER SPNL 0D MED 50X18X17MM NS LF TRANSCONTINENTAL PEEK,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
375.219,SUP,Custom 27803010,,375.219  -  SPACER SPNL 0D MED 50X18X19MM NS LF TRANSCONTINENTAL PEEK,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
375.221,SUP,Custom 27803010,,375.221  -  SPACER SPNL 0D MED 50X18X21MM NS LF TRANSCONTINENTAL PEEK,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
375.309,SUP,Custom 27803010,,375.309  -  SPACER SPNL 6D LRDTC MED 50X18X9MM NS LF TRANSCONTINENTAL,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
375.311,SUP,Custom 27803010,,375.311  -  SPACER SPNL 6D LRDTC MED 50X18X11MM NS LF TRANSCONTINENTAL,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
375.313,SUP,Custom 27803010,,375.313  -  SPACER SPNL 6D LRDTC MED 50X18X13MM NS LF TRANSCONTINENTAL,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
375.315,SUP,Custom 27803010,,375.315  -  SPACER SPNL 6D LRDTC MED 50X18X15MM NS LF TRANSCONTINENTAL,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
375.317,SUP,Custom 27803010,,375.317  -  SPACER SPNL 6D LRDTC MED 50X18X17MM NS LF TRANSCONTINENTAL,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
375.319,SUP,Custom 27803010,,375.319  -  SPACER SPNL 6D LRDTC MED 50X18X19MM NS LF TRANSCONTINENTAL,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
375.321,SUP,Custom 27803010,,375.321  -  SPACER SPNL 6D LRDTC MED 50X18X21MM NS LF TRANSCONTINENTAL,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
375.409,SUP,Custom 27803010,,375.409  -  SPACER SPNL 0D LG 55X18X9MM NS LF TRANSCONTINENTAL PEEK LAT,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
375.411,SUP,Custom 27803010,,375.411  -  SPACER SPNL 0D LG 55X18X11MM NS LF TRANSCONTINENTAL PEEK LAT,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
375.413,SUP,Custom 27803010,,375.413  -  SPACER SPNL 0D LG 55X18X13MM NS LF TRANSCONTINENTAL PEEK LAT,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
375.415,SUP,Custom 27803010,,375.415  -  SPACER SPNL 0D LG 55X18X15MM NS LF TRANSCONTINENTAL PEEK LAT,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
375.417,SUP,Custom 27803010,,375.417  -  SPACER SPNL 0D LG 55X18X17MM NS LF TRANSCONTINENTAL PEEK LAT,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
375.419,SUP,Custom 27803010,,375.419  -  SPACER SPNL 0D LG 55X18X19MM NS LF TRANSCONTINENTAL PEEK LAT,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
375.421,SUP,Custom 27803010,,375.421  -  SPACER SPNL 0D LG 55X18X21MM NS LF TRANSCONTINENTAL PEEK LAT,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
375.509,SUP,Custom 27803010,,375.509  -  SPACER SPNL 6D LRDTC LG 55X18X9MM NS LF TRANSCONTINENTAL,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
375.511,SUP,Custom 27803010,,375.511  -  SPACER SPNL 6D LRDTC LG 55X18X11MM NS LF TRANSCONTINENTAL,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
375.513,SUP,Custom 27803010,,375.513  -  SPACER SPNL 6D LRDTC LG 55X18X13MM NS LF TRANSCONTINENTAL,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
375.515,SUP,Custom 27803010,,375.515  -  SPACER SPNL 6D LRDTC LG 55X18X15MM NS LF TRANSCONTINENTAL,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
375.517,SUP,Custom 27803010,,375.517  -  SPACER SPNL 6D LRDTC LG 55X18X17MM NS LF TRANSCONTINENTAL,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
375.519,SUP,Custom 27803010,,375.519  -  SPACER SPNL 6D LRDTC LG 55X18X19MM NS LF TRANSCONTINENTAL,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
375.521,SUP,Custom 27803010,,375.521  -  SPACER SPNL 6D LRDTC LG 55X18X21MM NS LF TRANSCONTINENTAL,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
375.609,SUP,Custom 27803010,,375.609  -  SPACER SPNL 0D XL 60X18X9MM NS LF TRANSCONTINENTAL PEEK LAT,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
375.611,SUP,Custom 27803010,,375.611  -  SPACER SPNL 0D XL 60X18X11MM NS LF TRANSCONTINENTAL PEEK LAT,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
375.613,SUP,Custom 27803010,,375.613  -  SPACER SPNL 0D XL 60X18X13MM NS LF TRANSCONTINENTAL PEEK LAT,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
375.615,SUP,Custom 27803010,,375.615  -  SPACER SPNL 0D XL 60X18X15MM NS LF TRANSCONTINENTAL PEEK LAT,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
375.617,SUP,Custom 27803010,,375.617  -  SPACER SPNL 0D XL 60X18X17MM NS LF TRANSCONTINENTAL PEEK LAT,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
375.619,SUP,Custom 27803010,,375.619  -  SPACER SPNL 0D XL 60X18X19MM NS LF TRANSCONTINENTAL PEEK LAT,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
375.621,SUP,Custom 27803010,,375.621  -  SPACER SPNL 0D XL 60X18X21MM NS LF TRANSCONTINENTAL PEEK LAT,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
375.709,SUP,Custom 27803010,,375.709  -  SPACER SPNL 6D LRDTC XL 60X18X9MM NS LF TRANSCONTINENTAL,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
375.711,SUP,Custom 27803010,,375.711  -  SPACER SPNL 6D LRDTC XL 60X18X11MM NS LF TRANSCONTINENTAL,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
375.713,SUP,Custom 27803010,,375.713  -  SPACER SPNL 6D LRDTC XL 60X18X13MM NS LF TRANSCONTINENTAL,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
375.715,SUP,Custom 27803010,,375.715  -  SPACER SPNL 6D LRDTC XL 60X18X15MM NS LF TRANSCONTINENTAL,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
375.717,SUP,Custom 27803010,,375.717  -  SPACER SPNL 6D LRDTC XL 60X18X17MM NS LF TRANSCONTINENTAL,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
375.719,SUP,Custom 27803010,,375.719  -  SPACER SPNL 6D LRDTC XL 60X18X19MM NS LF TRANSCONTINENTAL,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
375.721,SUP,Custom 27803010,,375.721  -  SPACER SPNL 6D LRDTC XL 60X18X21MM NS LF TRANSCONTINENTAL,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
375.809,SUP,Custom 27803010,,375.809  -  SPACER SPNL 0D XS 40X18X9MM NS LF TRANSCONTINENTAL PEEK LAT,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
375.811,SUP,Custom 27803010,,375.811  -  SPACER SPNL 0D XS 40X18X11MM NS LF TRANSCONTINENTAL PEEK LAT,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
375.813,SUP,Custom 27803010,,375.813  -  SPACER SPNL 0D XS 40X18X13MM NS LF TRANSCONTINENTAL PEEK LAT,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
375.815,SUP,Custom 27803010,,375.815  -  SPACER SPNL 0D XS 40X18X15MM NS LF TRANSCONTINENTAL PEEK LAT,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
375.817,SUP,Custom 27803010,,375.817  -  SPACER SPNL 0D XS 40X18X17MM NS LF TRANSCONTINENTAL PEEK LAT,"$21,065.00",$0.00,"$21,065.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,065.00",$0.00,"$10,532.50","$16,683.48","$16,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
376.111,SUP,Custom 27803010,,"376.111  -  INDEPENDENCE SPACER, SMALL, 8&DEG, 11MM","$25,250.00",$0.00,"$25,250.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$25,250.00",$0.00,"$12,625.00","$19,998.00","$20,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
376.113,SUP,Custom 27803010,,376.113  -  SPACER SPNL 8D LRDTC 24MM SM 30X13MM NS LF INDPD PLT PEEK,"$25,250.00",$0.00,"$25,250.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$25,250.00",$0.00,"$12,625.00","$19,998.00","$20,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
376.115,SUP,Custom 27803010,,376.115  -  SPACER SPNL 8D LRDTC 24MM SM 30X15MM NS LF INDPD PLT PEEK,"$25,250.00",$0.00,"$25,250.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$25,250.00",$0.00,"$12,625.00","$19,998.00","$20,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
376.117,SUP,Custom 27803010,,376.117  -  SPACER SPNL 8D LRDTC 24MM SM 30X17MM NS LF INDPD PLT PEEK,"$25,250.00",$0.00,"$25,250.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$25,250.00",$0.00,"$12,625.00","$19,998.00","$20,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
376.211,SUP,Custom 27803010,,376.211  -  SPACER SPNL 15D LRDTC 24MM SM 30X11MM NS LF INDPD PLT PEEK,"$25,250.00",$0.00,"$25,250.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$25,250.00",$0.00,"$12,625.00","$19,998.00","$20,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
376.213,SUP,Custom 27803010,,376.213  -  SPACER SPNL 15D LRDTC 24MM SM 30X13MM NS LF INDPD PLT PEEK,"$25,250.00",$0.00,"$25,250.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$25,250.00",$0.00,"$12,625.00","$19,998.00","$20,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
376.215,SUP,Custom 27803010,,376.215  -  SPACER SPNL 15D LRDTC 24MM SM 30X15MM NS LF INDPD PLT PEEK,"$25,250.00",$0.00,"$25,250.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$25,250.00",$0.00,"$12,625.00","$19,998.00","$20,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
376.217,SUP,Custom 27803010,,376.217  -  SPACER SPNL 15D LRDTC 24MM SM 30X17MM NS LF INDPD PLT PEEK,"$25,250.00",$0.00,"$25,250.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$25,250.00",$0.00,"$12,625.00","$19,998.00","$20,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
376.411,SUP,Custom 27803010,,"376.411  -  INDEPENDENCE SPACER, MEDIUM, 8&DEG, 11MM","$25,250.00",$0.00,"$25,250.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$25,250.00",$0.00,"$12,625.00","$19,998.00","$20,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
376.413,SUP,Custom 27803010,,376.413  -  SPACER SPNL 8D LRDTC 26MM MED 34X13MM NS LF INDPD PLT PEEK,"$25,250.00",$0.00,"$25,250.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$25,250.00",$0.00,"$12,625.00","$19,998.00","$20,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
376.415,SUP,Custom 27803010,,"376.415  -  INDEPENDENCE SPACER, MEDIUM, 8&DEG, 15MM","$25,250.00",$0.00,"$25,250.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$25,250.00",$0.00,"$12,625.00","$19,998.00","$20,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
376.417,SUP,Custom 27803010,,376.417  -  SPACER SPNL 8D LRDTC 26MM MED 34X17MM NS LF INDPD PLT PEEK,"$25,250.00",$0.00,"$25,250.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$25,250.00",$0.00,"$12,625.00","$19,998.00","$20,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
376.419,SUP,Custom 27803010,,376.419  -  SPACER SPNL 8D LRDTC 26MM MED 34X19MM NS LF INDPD PLT PEEK,"$25,250.00",$0.00,"$25,250.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$25,250.00",$0.00,"$12,625.00","$19,998.00","$20,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
376.421,SUP,Custom 27803010,,376.421  -  SPACER SPNL 8D LRDTC 26MM MED 34X21MM NS LF INDPD PLT PEEK,"$25,250.00",$0.00,"$25,250.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$25,250.00",$0.00,"$12,625.00","$19,998.00","$20,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
376.511,SUP,Custom 27803010,,376.511  -  SPACER SPNL 15D LRDTC 26MM MED 24X11MM NS LF INDPD PLT PEEK,"$25,250.00",$0.00,"$25,250.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$25,250.00",$0.00,"$12,625.00","$19,998.00","$20,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
376.513,SUP,Custom 27803010,,376.513  -  SPACER SPNL 15D LRDTC 26MM MED 34X13MM NS LF INDPD PLT PEEK,"$25,250.00",$0.00,"$25,250.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$25,250.00",$0.00,"$12,625.00","$19,998.00","$20,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
376.515,SUP,Custom 27803010,,376.515  -  SPACER SPNL 15D LRDTC 26MM MED 34X15MM NS LF INDPD PLT PEEK,"$25,250.00",$0.00,"$25,250.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$25,250.00",$0.00,"$12,625.00","$19,998.00","$20,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
376.517,SUP,Custom 27803010,,376.517  -  SPACER SPNL 15D LRDTC 26MM MED 34X17MM NS LF INDPD PLT PEEK,"$25,250.00",$0.00,"$25,250.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$25,250.00",$0.00,"$12,625.00","$19,998.00","$20,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
376.519,SUP,Custom 27803010,,376.519  -  SPACER SPNL 15D LRDTC 26MM MED 34X19MM NS LF INDPD PLT PEEK,"$25,250.00",$0.00,"$25,250.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$25,250.00",$0.00,"$12,625.00","$19,998.00","$20,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
376.521,SUP,Custom 27803010,,376.521  -  SPACER SPNL 15D LRDTC 26MM MED 34X21MM NS LF INDPD PLT PEEK,"$25,250.00",$0.00,"$25,250.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$25,250.00",$0.00,"$12,625.00","$19,998.00","$20,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
376.711,SUP,Custom 27803010,,376.711  -  SPACER SPNL 8D LRDTC 29MM LG 39X11MM NS LF INDPD PLT PEEK,"$25,250.00",$0.00,"$25,250.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$25,250.00",$0.00,"$12,625.00","$19,998.00","$20,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
376.713,SUP,Custom 27803010,,376.713  -  SPACER SPNL 8D LRDTC 29MM LG 39X13MM NS LF INDPD PLT PEEK,"$25,250.00",$0.00,"$25,250.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$25,250.00",$0.00,"$12,625.00","$19,998.00","$20,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
376.715,SUP,Custom 27803010,,376.715  -  SPACER SPNL 8D LRDTC 29MM LG 39X15MM NS LF INDPD PLT PEEK,"$25,250.00",$0.00,"$25,250.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$25,250.00",$0.00,"$12,625.00","$19,998.00","$20,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
376.717,SUP,Custom 27803010,,376.717  -  SPACER SPNL 8D LRDTC 29MM LG 39X17MM NS LF INDPD PLT PEEK,"$25,250.00",$0.00,"$25,250.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$25,250.00",$0.00,"$12,625.00","$19,998.00","$20,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
376.719,SUP,Custom 27803010,,376.719  -  SPACER SPNL 8D LRDTC 29MM LG 39X19MM NS LF INDPD PLT PEEK,"$25,250.00",$0.00,"$25,250.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$25,250.00",$0.00,"$12,625.00","$19,998.00","$20,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
376.721,SUP,Custom 27803010,,376.721  -  SPACER SPNL 8D LRDTC 29MM LG 39X21MM NS LF INDPD PLT PEEK,"$25,250.00",$0.00,"$25,250.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$25,250.00",$0.00,"$12,625.00","$19,998.00","$20,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
376.813,SUP,Custom 27803010,,376.813  -  SPACER SPNL 15D LRDTC 29MM LG 39X13MM NS LF INDPD PLT PEEK,"$25,250.00",$0.00,"$25,250.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$25,250.00",$0.00,"$12,625.00","$19,998.00","$20,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
376.815,SUP,Custom 27803010,,"376.815  -  INDEPENDENCE SPACER, LARGE, 15&DEG, 15MM","$25,250.00",$0.00,"$25,250.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$25,250.00",$0.00,"$12,625.00","$19,998.00","$20,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
376.817,SUP,Custom 27803010,,376.817  -  SPACER SPNL 15D LRDTC 29MM LG 39X17MM NS LF INDPD PLT PEEK,"$25,250.00",$0.00,"$25,250.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$25,250.00",$0.00,"$12,625.00","$19,998.00","$20,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
376.819,SUP,Custom 27803010,,376.819  -  SPACER SPNL 15D LRDTC 29MM LG 39X19MM NS LF INDPD PLT PEEK,"$25,250.00",$0.00,"$25,250.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$25,250.00",$0.00,"$12,625.00","$19,998.00","$20,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
376.821,SUP,Custom 27803010,,376.821  -  SPACER SPNL 15D LRDTC 29MM LG 39X21MM NS LF INDPD PLT PEEK,"$25,250.00",$0.00,"$25,250.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$25,250.00",$0.00,"$12,625.00","$19,998.00","$20,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
384.006,SUP,Custom 27803010,,384.006  -  SPACER SPNL 0D 12MM 14X6MM NS LF COALITION PEEK ACDF,"$12,052.50",$0.00,"$12,052.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$12,052.50",$0.00,"$6,026.25","$9,545.58","$9,642.00",$0.00,$0.00,$0.00,$0.00,$0.00
384.007,SUP,Custom 27803010,,384.007  -  SPACER SPNL 0D 12MM 14X7MM NS LF COALITION PEEK ACDF,"$12,052.50",$0.00,"$12,052.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$12,052.50",$0.00,"$6,026.25","$9,545.58","$9,642.00",$0.00,$0.00,$0.00,$0.00,$0.00
384.008,SUP,Custom 27803010,,384.008  -  SPACER SPNL 0D 12MM 14X8MM NS LF COALITION PEEK ACDF,"$12,052.50",$0.00,"$12,052.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$12,052.50",$0.00,"$6,026.25","$9,545.58","$9,642.00",$0.00,$0.00,$0.00,$0.00,$0.00
384.009,SUP,Custom 27803010,,384.009  -  SPACER SPNL 0D 12MM 14X9MM NS LF COALITION PEEK ACDF,"$12,052.50",$0.00,"$12,052.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$12,052.50",$0.00,"$6,026.25","$9,545.58","$9,642.00",$0.00,$0.00,$0.00,$0.00,$0.00
384.01,SUP,Custom 27803010,,384.010  -  SPACER SPNL 0D 12MM 14X10MM NS LF COALITION PEEK ACDF,"$12,052.50",$0.00,"$12,052.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$12,052.50",$0.00,"$6,026.25","$9,545.58","$9,642.00",$0.00,$0.00,$0.00,$0.00,$0.00
384.011,SUP,Custom 27803010,,384.011  -  SPACER SPNL 0D 12MM 14X11MM NS LF COALITION PEEK ACDF,"$12,052.50",$0.00,"$12,052.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$12,052.50",$0.00,"$6,026.25","$9,545.58","$9,642.00",$0.00,$0.00,$0.00,$0.00,$0.00
384.012,SUP,Custom 27803010,,384.012  -  SPACER SPNL 0D 12MM 14X12MM NS LF COALITION PEEK ACDF,"$12,052.50",$0.00,"$12,052.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$12,052.50",$0.00,"$6,026.25","$9,545.58","$9,642.00",$0.00,$0.00,$0.00,$0.00,$0.00
384.106,SUP,Custom 27803010,,384.106  -  SPACER SPNL 7D LRDTC 12MM 14X6MM NS LF COALITION PEEK ACDF,"$12,052.50",$0.00,"$12,052.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$12,052.50",$0.00,"$6,026.25","$9,545.58","$9,642.00",$0.00,$0.00,$0.00,$0.00,$0.00
384.107,SUP,Custom 27803010,,384.107  -  SPACER SPNL 7D LRDTC 12MM 14X7MM NS LF COALITION PEEK ACDF,"$12,052.50",$0.00,"$12,052.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$12,052.50",$0.00,"$6,026.25","$9,545.58","$9,642.00",$0.00,$0.00,$0.00,$0.00,$0.00
384.108,SUP,Custom 27803010,,384.108  -  SPACER SPNL 7D LRDTC 12MM 14X8MM NS LF COALITION PEEK ACDF,"$12,052.50",$0.00,"$12,052.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$12,052.50",$0.00,"$6,026.25","$9,545.58","$9,642.00",$0.00,$0.00,$0.00,$0.00,$0.00
384.109,SUP,Custom 27803010,,384.109  -  SPACER SPNL 7D LRDTC 12MM 14X9MM NS LF COALITION PEEK ACDF,"$12,052.50",$0.00,"$12,052.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$12,052.50",$0.00,"$6,026.25","$9,545.58","$9,642.00",$0.00,$0.00,$0.00,$0.00,$0.00
384.11,SUP,Custom 27803010,,384.110  -  SPACER SPNL 7D LRDTC 12MM 14X10MM NS LF COALITION PEEK ACDF,"$12,052.50",$0.00,"$12,052.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$12,052.50",$0.00,"$6,026.25","$9,545.58","$9,642.00",$0.00,$0.00,$0.00,$0.00,$0.00
384.111,SUP,Custom 27803010,,384.111  -  SPACER SPNL 7D LRDTC 12MM 14X11MM NS LF COALITION PEEK ACDF,"$12,052.50",$0.00,"$12,052.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$12,052.50",$0.00,"$6,026.25","$9,545.58","$9,642.00",$0.00,$0.00,$0.00,$0.00,$0.00
384.112,SUP,Custom 27803010,,384.112  -  SPACER SPNL 7D LRDTC 12MM 14X12MM NS LF COALITION PEEK ACDF,"$12,052.50",$0.00,"$12,052.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$12,052.50",$0.00,"$6,026.25","$9,545.58","$9,642.00",$0.00,$0.00,$0.00,$0.00,$0.00
384.206,SUP,Custom 27803010,,384.206  -  SPACER SPNL 0D 14MM 16X6MM NS LF COALITION PEEK ACDF,"$12,052.50",$0.00,"$12,052.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$12,052.50",$0.00,"$6,026.25","$9,545.58","$9,642.00",$0.00,$0.00,$0.00,$0.00,$0.00
384.207,SUP,Custom 27803010,,384.207  -  SPACER SPNL 0D 14MM 16X7MM NS LF COALITION PEEK ACDF,"$12,052.50",$0.00,"$12,052.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$12,052.50",$0.00,"$6,026.25","$9,545.58","$9,642.00",$0.00,$0.00,$0.00,$0.00,$0.00
384.208,SUP,Custom 27803010,,384.208  -  SPACER SPNL 0D 14MM 16X8MM NS LF COALITION PEEK ACDF,"$12,052.50",$0.00,"$12,052.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$12,052.50",$0.00,"$6,026.25","$9,545.58","$9,642.00",$0.00,$0.00,$0.00,$0.00,$0.00
384.209,SUP,Custom 27803010,,384.209  -  SPACER SPNL 0D 14MM 16X9MM NS LF COALITION PEEK ACDF,"$12,052.50",$0.00,"$12,052.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$12,052.50",$0.00,"$6,026.25","$9,545.58","$9,642.00",$0.00,$0.00,$0.00,$0.00,$0.00
384.21,SUP,Custom 27803010,,384.210  -  SPACER SPNL 0D 14MM 16X10MM NS LF COALITION PEEK ACDF,"$12,052.50",$0.00,"$12,052.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$12,052.50",$0.00,"$6,026.25","$9,545.58","$9,642.00",$0.00,$0.00,$0.00,$0.00,$0.00
384.211,SUP,Custom 27803010,,384.211  -  SPACER SPNL 0D 14MM 16X14MM NS LF COALITION PEEK ACDF,"$12,052.50",$0.00,"$12,052.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$12,052.50",$0.00,"$6,026.25","$9,545.58","$9,642.00",$0.00,$0.00,$0.00,$0.00,$0.00
384.212,SUP,Custom 27803010,,384.212  -  SPACER SPNL 0D 14MM 16X12MM NS LF COALITION PEEK ACDF,"$12,052.50",$0.00,"$12,052.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$12,052.50",$0.00,"$6,026.25","$9,545.58","$9,642.00",$0.00,$0.00,$0.00,$0.00,$0.00
384.306,SUP,Custom 27803010,,384.306  -  SPACER SPNL 7D LRDTC 14MM 16X6MM NS LF COALITION PEEK ACDF,"$12,052.50",$0.00,"$12,052.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$12,052.50",$0.00,"$6,026.25","$9,545.58","$9,642.00",$0.00,$0.00,$0.00,$0.00,$0.00
384.307,SUP,Custom 27803010,,384.307  -  SPACER SPNL 7D LRDTC 14MM 16X7MM NS LF COALITION PEEK ACDF,"$12,052.50",$0.00,"$12,052.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$12,052.50",$0.00,"$6,026.25","$9,545.58","$9,642.00",$0.00,$0.00,$0.00,$0.00,$0.00
384.308,SUP,Custom 27803010,,384.308  -  SPACER SPNL 7D LRDTC 14MM 16X8MM NS LF COALITION PEEK ACDF,"$12,052.50",$0.00,"$12,052.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$12,052.50",$0.00,"$6,026.25","$9,545.58","$9,642.00",$0.00,$0.00,$0.00,$0.00,$0.00
384.309,SUP,Custom 27803010,,384.309  -  SPACER SPNL 7D LRDTC 14MM 16X9MM NS LF COALITION PEEK ACDF,"$12,052.50",$0.00,"$12,052.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$12,052.50",$0.00,"$6,026.25","$9,545.58","$9,642.00",$0.00,$0.00,$0.00,$0.00,$0.00
384.31,SUP,Custom 27803010,,384.310  -  SPACER SPNL 7D LRDTC 14MM 16X10MM NS LF COALITION PEEK ACDF,"$12,052.50",$0.00,"$12,052.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$12,052.50",$0.00,"$6,026.25","$9,545.58","$9,642.00",$0.00,$0.00,$0.00,$0.00,$0.00
384.311,SUP,Custom 27803010,,384.311  -  SPACER SPNL 7D LRDTC 14MM 16X11MM NS LF COALITION PEEK ACDF,"$12,052.50",$0.00,"$12,052.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$12,052.50",$0.00,"$6,026.25","$9,545.58","$9,642.00",$0.00,$0.00,$0.00,$0.00,$0.00
384.312,SUP,Custom 27803010,,384.312  -  SPACER SPNL 7D LRDTC 14MM 16X12MM NS LF COALITION PEEK ACDF,"$12,052.50",$0.00,"$12,052.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$12,052.50",$0.00,"$6,026.25","$9,545.58","$9,642.00",$0.00,$0.00,$0.00,$0.00,$0.00
384.406,SUP,Custom 27803010,,384.406  -  SPACER SPNL 0D 15MM 18X6MM NS LF COALITION PEEK ACDF,"$12,052.50",$0.00,"$12,052.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$12,052.50",$0.00,"$6,026.25","$9,545.58","$9,642.00",$0.00,$0.00,$0.00,$0.00,$0.00
384.407,SUP,Custom 27803010,,384.407  -  SPACER SPNL 0D 15MM 18X7MM NS LF COALITION PEEK ACDF,"$12,052.50",$0.00,"$12,052.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$12,052.50",$0.00,"$6,026.25","$9,545.58","$9,642.00",$0.00,$0.00,$0.00,$0.00,$0.00
384.408,SUP,Custom 27803010,,384.408  -  SPACER SPNL 0D 15MM 18X8MM NS LF COALITION PEEK ACDF,"$12,052.50",$0.00,"$12,052.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$12,052.50",$0.00,"$6,026.25","$9,545.58","$9,642.00",$0.00,$0.00,$0.00,$0.00,$0.00
384.409,SUP,Custom 27803010,,384.409  -  SPACER SPNL 0D 15MM 18X9MM NS LF COALITION PEEK ACDF,"$12,052.50",$0.00,"$12,052.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$12,052.50",$0.00,"$6,026.25","$9,545.58","$9,642.00",$0.00,$0.00,$0.00,$0.00,$0.00
384.41,SUP,Custom 27803010,,384.410  -  SPACER SPNL 0D 15MM 18X10MM NS LF COALITION PEEK ACDF,"$12,052.50",$0.00,"$12,052.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$12,052.50",$0.00,"$6,026.25","$9,545.58","$9,642.00",$0.00,$0.00,$0.00,$0.00,$0.00
384.411,SUP,Custom 27803010,,384.411  -  SPACER SPNL 0D 15MM 18X11MM NS LF COALITION PEEK ACDF,"$12,052.50",$0.00,"$12,052.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$12,052.50",$0.00,"$6,026.25","$9,545.58","$9,642.00",$0.00,$0.00,$0.00,$0.00,$0.00
384.412,SUP,Custom 27803010,,384.412  -  SPACER SPNL 0D 15MM 18X12MM NS LF COALITION PEEK ACDF,"$12,052.50",$0.00,"$12,052.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$12,052.50",$0.00,"$6,026.25","$9,545.58","$9,642.00",$0.00,$0.00,$0.00,$0.00,$0.00
384.506,SUP,Custom 27803010,,384.506  -  SPACER SPNL 7D LRDTC 15MM 18X6MM NS LF COALITION PEEK ACDF,"$12,052.50",$0.00,"$12,052.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$12,052.50",$0.00,"$6,026.25","$9,545.58","$9,642.00",$0.00,$0.00,$0.00,$0.00,$0.00
384.507,SUP,Custom 27803010,,384.507  -  SPACER SPNL 7D LRDTC 15MM 18X7MM NS LF COALITION PEEK ACDF,"$12,052.50",$0.00,"$12,052.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$12,052.50",$0.00,"$6,026.25","$9,545.58","$9,642.00",$0.00,$0.00,$0.00,$0.00,$0.00
384.508,SUP,Custom 27803010,,384.508  -  SPACER SPNL 7D LRDTC 15MM 18X8MM NS LF COALITION PEEK ACDF,"$12,052.50",$0.00,"$12,052.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$12,052.50",$0.00,"$6,026.25","$9,545.58","$9,642.00",$0.00,$0.00,$0.00,$0.00,$0.00
384.509,SUP,Custom 27803010,,384.509  -  SPACER SPNL 7D LRDTC 15MM 18X9MM NS LF COALITION PEEK ACDF,"$12,052.50",$0.00,"$12,052.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$12,052.50",$0.00,"$6,026.25","$9,545.58","$9,642.00",$0.00,$0.00,$0.00,$0.00,$0.00
384.51,SUP,Custom 27803010,,384.510  -  SPACER SPNL 7D LRDTC 15MM 18X10MM NS LF COALITION PEEK ACDF,"$12,052.50",$0.00,"$12,052.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$12,052.50",$0.00,"$6,026.25","$9,545.58","$9,642.00",$0.00,$0.00,$0.00,$0.00,$0.00
384.511,SUP,Custom 27803010,,384.511  -  SPACER SPNL 7D LRDTC 15MM 18X11MM NS LF COALITION PEEK ACDF,"$12,052.50",$0.00,"$12,052.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$12,052.50",$0.00,"$6,026.25","$9,545.58","$9,642.00",$0.00,$0.00,$0.00,$0.00,$0.00
384.512,SUP,Custom 27803010,,384.512  -  SPACER SPNL 7D LRDTC 15MM 18X12MM NS LF COALITION PEEK ACDF,"$12,052.50",$0.00,"$12,052.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$12,052.50",$0.00,"$6,026.25","$9,545.58","$9,642.00",$0.00,$0.00,$0.00,$0.00,$0.00
387.21,SUP,Custom 27203010,,387.21  -  BIT DRILL THORPE,$375.75,$0.00,$375.75,$0.00,$268.17,$0.00,$0.00,$0.00,$0.00,$0.00,$375.75,$0.00,$187.88,$297.59,$300.60,$0.00,$0.00,$0.00,$0.00,$0.00
387.604,SUP,Custom 27203010,,387.604  -  BIT DRILL 3MM QC STOP,$444.50,$0.00,$444.50,$0.00,$317.24,$0.00,$0.00,$0.00,$0.00,$0.00,$444.50,$0.00,$222.25,$352.04,$355.60,$0.00,$0.00,$0.00,$0.00,$0.00
388.174,SUP,Custom 27203010,,388.174  -  BIT DRILL 91MM 1.5MM STOP 4-12MM NONSTRL,$224.00,$0.00,$224.00,$0.00,$159.87,$0.00,$0.00,$0.00,$0.00,$0.00,$224.00,$0.00,$112.00,$177.41,$179.20,$0.00,$0.00,$0.00,$0.00,$0.00
388.175,SUP,Custom 27203010,,388.175  -  BIT DRILL 91MM STOP ARCH 1.5MM NONSTRL QUICK COUPLING,$217.50,$0.00,$217.50,$0.00,$155.23,$0.00,$0.00,$0.00,$0.00,$0.00,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$0.00,$0.00,$0.00,$0.00
388.177,SUP,Custom 27203010,,388.177  -  BIT DRILL 91MM 10MM STOP 1.5MM NONSTRL,$217.50,$0.00,$217.50,$0.00,$155.23,$0.00,$0.00,$0.00,$0.00,$0.00,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$0.00,$0.00,$0.00,$0.00
388.178,SUP,Custom 27203010,,388.178  -  BIT DRILL 91MM 1.5MM 12MM STOP GUIDE NONSTRL,$224.00,$0.00,$224.00,$0.00,$159.87,$0.00,$0.00,$0.00,$0.00,$0.00,$224.00,$0.00,$112.00,$177.41,$179.20,$0.00,$0.00,$0.00,$0.00,$0.00
388.394,SUP,Custom 27203010,,388.394  -  BIT DRL 65MM 2.4MM NS QC STP,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
388.868,SUP,HCPCS C1713,,388.868  -  TRIAL SPNL 3.5MM ROD,$470.00,$0.00,$470.00,$211.50,$335.44,$0.00,$80.98,$0.00,$0.00,$82.29,$470.00,$0.00,$235.00,$372.24,$376.00,$0.00,$73.56,$0.00,$74.82,$0.00
388.906,SUP,HCPCS C1713,,388.906  -  TEMPLATE ROD 150MM NS COAT 5.5MM ROD,$447.50,$0.00,$447.50,$201.38,$319.38,$0.00,$77.10,$0.00,$0.00,$78.35,$447.50,$0.00,$223.75,$354.42,$358.00,$0.00,$70.03,$0.00,$71.24,$0.00
388.907,SUP,Custom 27203010,,388.907  -  TEMPLATE ROD 500MM NS COAT 5/5.5MM ROD,$740.00,$0.00,$740.00,$0.00,$528.14,$0.00,$0.00,$0.00,$0.00,$0.00,$740.00,$0.00,$370.00,$586.08,$592.00,$0.00,$0.00,$0.00,$0.00,$0.00
390.002,SUP,Custom 27203010,,390.002  -  CLAMP EXFIX LARGE 6 POSITION MULTIPIN MR CONDITIONAL NONSTRL,"$1,170.18",$0.00,"$1,170.18",$0.00,$835.15,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,170.18",$0.00,$585.09,$926.78,$936.14,$0.00,$0.00,$0.00,$0.00,$0.00
390.003,SUP,HCPCS C1713,,390.003  -  ROD EXFIX ATTCH NONSTRL LARGE MULTIPIN CLMP,$655.40,$0.00,$655.40,$294.93,$467.76,$0.00,$109.63,$0.00,$0.00,$114.76,$655.40,$0.00,$327.70,$519.08,$524.32,$0.00,$99.58,$0.00,$104.34,$0.00
390.004,SUP,Custom 27203010,,390.004  -  CLAMP EXFIX LARGE 4 POSITION MULTIPIN MR CONDITIONAL NONSTRL,"$1,095.55",$0.00,"$1,095.55",$0.00,$781.89,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,095.55",$0.00,$547.78,$867.68,$876.44,$0.00,$0.00,$0.00,$0.00,$0.00
390.005,SUP,Custom 27203010,,390.005  -  CLAMP EXFIX LARGE COMBO NONSTRL,"$1,023.10",$0.00,"$1,023.10",$0.00,$730.19,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,023.10",$0.00,$511.55,$810.30,$818.48,$0.00,$0.00,$0.00,$0.00,$0.00
390.006,SUP,Custom 27203010,,390.006  -  CLIP XTRNFX NS DYN MR CONDITIONAL LG CMBN CLP,$162.23,$0.00,$162.23,$0.00,$115.78,$0.00,$0.00,$0.00,$0.00,$0.00,$162.23,$0.00,$81.11,$128.49,$129.78,$0.00,$0.00,$0.00,$0.00,$0.00
390.007,SUP,Custom 27203010,,390.007  -  CLAMP EXFIX TUBE TO TUBE MR CONDITIONAL NONSTRL,"$1,056.63",$0.00,"$1,056.63",$0.00,$754.11,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,056.63",$0.00,$528.31,$836.85,$845.30,$0.00,$0.00,$0.00,$0.00,$0.00
390.008,SUP,Custom 27203010,,390.008  -  CLAMP EXFIX LARGE OPEN ADJUSTABLE NONSTRL,$847.90,$0.00,$847.90,$0.00,$605.15,$0.00,$0.00,$0.00,$0.00,$0.00,$847.90,$0.00,$423.95,$671.54,$678.32,$0.00,$0.00,$0.00,$0.00,$0.00
390.009,SUP,Custom 27203010,,390.009  -  CLAMP EXFIX LARGE 4 POSITION PIN NONSTRL LARGE EXFIX,$708.38,$0.00,$708.38,$0.00,$505.57,$0.00,$0.00,$0.00,$0.00,$0.00,$708.38,$0.00,$354.19,$561.04,$566.70,$0.00,$0.00,$0.00,$0.00,$0.00
390.01,SUP,Custom 27203010,,390.010  -  CLAMP EXFIX LARGE 6 POSITION PIN NONSTRL,$727.85,$0.00,$727.85,$0.00,$519.47,$0.00,$0.00,$0.00,$0.00,$0.00,$727.85,$0.00,$363.93,$576.46,$582.28,$0.00,$0.00,$0.00,$0.00,$0.00
390.011,SUP,Custom 27203010,,390.011  -  POST EXFIX STR 11MM OUTRIGGER NONSTRL,$191.43,$0.00,$191.43,$0.00,$136.62,$0.00,$0.00,$0.00,$0.00,$0.00,$191.43,$0.00,$95.71,$151.61,$153.14,$0.00,$0.00,$0.00,$0.00,$0.00
390.012,SUP,Custom 27203010,,390.012  -  POST EXFIX 30D 11MM OUTRIGGER MR SAFE NONSTRL,$191.43,$0.00,$191.43,$0.00,$136.62,$0.00,$0.00,$0.00,$0.00,$0.00,$191.43,$0.00,$95.71,$151.61,$153.14,$0.00,$0.00,$0.00,$0.00,$0.00
390.013,SUP,Custom 27203010,,390.013  -  POST EXFIX 90D 11MM OUTRIGGER NONSTRL,$210.90,$0.00,$210.90,$0.00,$150.52,$0.00,$0.00,$0.00,$0.00,$0.00,$210.90,$0.00,$105.45,$167.03,$168.72,$0.00,$0.00,$0.00,$0.00,$0.00
390.026,SUP,Custom 27203010,,390.026  -  CLAMP EXFIX MEDIUM 4 POSISTION PIN MR SAFE NONSTRL,$669.45,$0.00,$669.45,$0.00,$477.79,$0.00,$0.00,$0.00,$0.00,$0.00,$669.45,$0.00,$334.73,$530.20,$535.56,$0.00,$0.00,$0.00,$0.00,$0.00
390.027,SUP,Custom 27203010,,390.027  -  CLAMP EXFIX MEDIUM 6 POSISTION PIN MR SAFE NONSTRL,$686.75,$0.00,$686.75,$0.00,$490.13,$0.00,$0.00,$0.00,$0.00,$0.00,$686.75,$0.00,$343.38,$543.91,$549.40,$0.00,$0.00,$0.00,$0.00,$0.00
390.028,SUP,Custom 27203010,,390.028  -  POST XTRNFX STRG 8MM NS OTRGR MR CONDITIONAL,$181.70,$0.00,$181.70,$0.00,$129.68,$0.00,$0.00,$0.00,$0.00,$0.00,$181.70,$0.00,$90.85,$143.91,$145.36,$0.00,$0.00,$0.00,$0.00,$0.00
390.029,SUP,Custom 27203010,,390.029  -  POST XTRNFX 30D 8MM NS OTRGR MR CONDITIONAL,$181.70,$0.00,$181.70,$0.00,$129.68,$0.00,$0.00,$0.00,$0.00,$0.00,$181.70,$0.00,$90.85,$143.91,$145.36,$0.00,$0.00,$0.00,$0.00,$0.00
390.03,SUP,Custom 27203010,,390.030  -  POST XTRNFX 90D 8MM NS OTRGR MR CONDITIONAL,$199.00,$0.00,$199.00,$0.00,$142.03,$0.00,$0.00,$0.00,$0.00,$0.00,$199.00,$0.00,$99.50,$157.61,$159.20,$0.00,$0.00,$0.00,$0.00,$0.00
390.031,SUP,Custom 27203010,,390.031  -  CLAMP EXFIX MEDIUM COMBO SELF HOLDING CLIP ON NONSTRL,$832.75,$0.00,$832.75,$0.00,$594.33,$0.00,$0.00,$0.00,$0.00,$0.00,$832.75,$0.00,$416.38,$659.54,$666.20,$0.00,$0.00,$0.00,$0.00,$0.00
390.032,SUP,Custom 27203010,,390.032  -  CLIP XTRNFX NS DYN MR CONDITIONAL MED CMBN CLP,$180.60,$0.00,$180.60,$0.00,$128.89,$0.00,$0.00,$0.00,$0.00,$0.00,$180.60,$0.00,$90.30,$143.04,$144.48,$0.00,$0.00,$0.00,$0.00,$0.00
390.033,SUP,Custom 27203010,,390.033  -  CLAMP EXFIX MEDIUM 4 POSISTION MULTIPIN MR SAFE NONSTRL,"$1,007.95",$0.00,"$1,007.95",$0.00,$719.37,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,007.95",$0.00,$503.98,$798.30,$806.36,$0.00,$0.00,$0.00,$0.00,$0.00
390.034,SUP,Custom 27203010,,390.034  -  CLAMP EXFIX MEDIUM MULTIPIN ROD ATTCH MRI SAFE NONSTRL,$578.60,$0.00,$578.60,$0.00,$412.95,$0.00,$0.00,$0.00,$0.00,$0.00,$578.60,$0.00,$289.30,$458.25,$462.88,$0.00,$0.00,$0.00,$0.00,$0.00
390.035,SUP,Custom 27203010,,390.035  -  CLAMP EXFIX MEDIUM OPEN ADJUSTABLE NONSTRL,$686.75,$0.00,$686.75,$0.00,$490.13,$0.00,$0.00,$0.00,$0.00,$0.00,$686.75,$0.00,$343.38,$543.91,$549.40,$0.00,$0.00,$0.00,$0.00,$0.00
390.036,SUP,Custom 27203010,,390.036  -  CLAMP EXFIX MEDIUM 6 POSISTION MULTIPIN MR SAFE NONSTRL,"$1,096.65",$0.00,"$1,096.65",$0.00,$782.68,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,096.65",$0.00,$548.33,$868.55,$877.32,$0.00,$0.00,$0.00,$0.00,$0.00
390.037,SUP,Custom 27203010,,390.037  -  CLAMP EXFIX MEDIUM 8-11MM COMBO MR SAFE NONSTRL,$958.20,$0.00,$958.20,$0.00,$683.87,$0.00,$0.00,$0.00,$0.00,$0.00,$958.20,$0.00,$479.10,$758.89,$766.56,$0.00,$0.00,$0.00,$0.00,$0.00
390.041,SUP,Custom 27203010,,390.041  -  CLAMP EXFIX SMALL COMBO NONSTRL,$537.50,$0.00,$537.50,$0.00,$383.61,$0.00,$0.00,$0.00,$0.00,$0.00,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$0.00,$0.00,$0.00,$0.00
390.042,SUP,Custom 27203010,,390.042  -  CLAMP EXFIX SM ADJ NONSPANNING MRI SAFE SM EXFIX NONSTRL,$955.33,$0.00,$955.33,$0.00,$681.82,$0.00,$0.00,$0.00,$0.00,$0.00,$955.33,$0.00,$477.66,$756.62,$764.26,$0.00,$0.00,$0.00,$0.00,$0.00
390.101,SUP,Custom 27203010,,BASKET SPEC RTRVL 120CM 2.4FR 12MM STON 4WR SHTH 0TP NTNL,$495.00,$0.00,$495.00,$0.00,$353.28,$0.00,$0.00,$0.00,$0.00,$0.00,$495.00,$0.00,$247.50,$392.04,$396.00,$0.00,$0.00,$0.00,$0.00,$0.00
390.12,SUP,HCPCS C1713,,390.120  -  PIN POSITIONING 40MM TITANIUM CRANIAL NONSTRL EXTERNAL,$390.00,$0.00,$390.00,$175.50,$278.34,$0.00,$67.20,$0.00,$0.00,$68.29,$390.00,$0.00,$195.00,$308.88,$312.00,$0.00,$61.04,$0.00,$62.09,$0.00
390.122,SUP,Custom 27203010,,390.122  -  HOLDER IMPLANT 40MM MOUNT PIN TITANIUM CRANIAL NONSTRL,$600.00,$0.00,$600.00,$0.00,$428.22,$0.00,$0.00,$0.00,$0.00,$0.00,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$0.00,$0.00,$0.00,$0.00
390.124,SUP,Custom 27803010,,390.124  -  PIN FIX 50MM MOUNT MIDFAC NONSTRL EXTERNAL MIDFAC DISTRCT,$600.00,$0.00,$600.00,$0.00,$428.22,$0.00,$0.00,$0.00,$0.00,$0.00,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$0.00,$0.00,$0.00,$0.00
390.126,SUP,Custom 27203010,,390.126  -  HOLDER IMPLANT 40MM MOUNT PIN TITANIUM MIDFAC,$677.50,$0.00,$677.50,$0.00,$483.53,$0.00,$0.00,$0.00,$0.00,$0.00,$677.50,$0.00,$338.75,$536.58,$542.00,$0.00,$0.00,$0.00,$0.00,$0.00
390.128,SUP,Custom 27203010,,390.128  -  PIN SKULL 50MM SLFDRILL CRANIUM NONSTRL,$677.50,$0.00,$677.50,$0.00,$483.53,$0.00,$0.00,$0.00,$0.00,$0.00,$677.50,$0.00,$338.75,$536.58,$542.00,$0.00,$0.00,$0.00,$0.00,$0.00
392.177,SUP,Custom 27203010,,392.177  -  CAP PROTECTIVE CLEAR NONSTRL 1MM 1.25MM K WIRES,$4.68,$0.00,$4.68,$0.00,$3.34,$0.00,$0.00,$0.00,$0.00,$0.00,$4.68,$0.00,$2.34,$3.71,$3.74,$0.00,$0.00,$0.00,$0.00,$0.00
392.178,SUP,Custom 27203010,,392.178  -  CAP PROTECTIVE NONSTRL 1.6 MM KWIRE WIRE,$4.68,$0.00,$4.68,$0.00,$3.34,$0.00,$0.00,$0.00,$0.00,$0.00,$4.68,$0.00,$2.34,$3.71,$3.74,$0.00,$0.00,$0.00,$0.00,$0.00
392.179,SUP,Custom 27203010,,392.179  -  CAP PROTECTIVE NONSTRL 2 MM KWIRE WIRE,$4.54,$0.00,$4.54,$0.00,$3.24,$0.00,$0.00,$0.00,$0.00,$0.00,$4.54,$0.00,$2.27,$3.60,$3.63,$0.00,$0.00,$0.00,$0.00,$0.00
392.18,SUP,Custom 27203010,,392.18  -  CAP PROTECTIVE NONSTRL 1.8-2 MM KWIRE WIRE,$3.81,$0.00,$3.81,$0.00,$2.72,$0.00,$0.00,$0.00,$0.00,$0.00,$3.81,$0.00,$1.91,$3.02,$3.05,$0.00,$0.00,$0.00,$0.00,$0.00
392.24,SUP,Custom 27203010,,392.24  -  CAP PROTECTIVE NONSTRL 2.5 MM KWIRE WIRE,$4.68,$0.00,$4.68,$0.00,$3.34,$0.00,$0.00,$0.00,$0.00,$0.00,$4.68,$0.00,$2.34,$3.71,$3.74,$0.00,$0.00,$0.00,$0.00,$0.00
392.961,SUP,HCPCS C1713,,392.961  -  FIXATOR XTRNFX LG ADJ RADL DIST,"$6,008.83",$0.00,"$6,008.83","$2,703.97","$4,288.50",$0.00,"$1,005.13",$0.00,$0.00,"$1,052.10","$6,008.83",$0.00,"$3,004.41","$4,758.99","$4,807.06",$0.00,$912.99,$0.00,$956.60,$0.00
393.43,SUP,Custom 27203010,,393.43  -  NUT XTRNFX NS RING TO ROD SPRG LD LG XTRNFXTR,$73.55,$0.00,$73.55,$0.00,$52.49,$0.00,$0.00,$0.00,$0.00,$0.00,$73.55,$0.00,$36.78,$58.25,$58.84,$0.00,$0.00,$0.00,$0.00,$0.00
393.436,SUP,Custom 27203010,,393.436  -  CLAMP EXFIX RING TO ROD NONSTRL HYBRID EXFIX,"$1,402.70",$0.00,"$1,402.70",$0.00,"$1,001.11",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,402.70",$0.00,$701.35,"$1,110.94","$1,122.16",$0.00,$0.00,$0.00,$0.00,$0.00
393.464,SUP,Custom 27203010,,393.464  -  CLAMP EXFIX ADJUSTABLE WIRE PIN NONSTRL HYBRID EXFIX,"$1,252.38",$0.00,"$1,252.38",$0.00,$893.82,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,252.38",$0.00,$626.19,$991.88,"$1,001.90",$0.00,$0.00,$0.00,$0.00,$0.00
393.64,SUP,Custom 27203010,,393.64  -  CLAMP EXFIX ADJUSTABLE NONSTRL 4/6 MM SCHANZ SCREW LARGE,$631.60,$0.00,$631.60,$0.00,$450.77,$0.00,$0.00,$0.00,$0.00,$0.00,$631.60,$0.00,$315.80,$500.23,$505.28,$0.00,$0.00,$0.00,$0.00,$0.00
393.66,SUP,Custom 27203010,,393.66  -  CLAMP EXFIX TRNSVRS NONSTRL 4-6 MM SCHANZ SCREW LARGE EXFIX,"$1,056.63",$0.00,"$1,056.63",$0.00,$754.11,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,056.63",$0.00,$528.31,$836.85,$845.30,$0.00,$0.00,$0.00,$0.00,$0.00
393.69,SUP,Custom 27203010,,393.69  -  CLAMP EXFIX OPEN NONSTRL PIN INSERTION CONNECT,$376.35,$0.00,$376.35,$0.00,$268.60,$0.00,$0.00,$0.00,$0.00,$0.00,$376.35,$0.00,$188.18,$298.07,$301.08,$0.00,$0.00,$0.00,$0.00,$0.00
393.721,SUP,Custom 27203010,,393.721  -  RING EXFIX FULL 205MM FULL RING NONSTRL HYBRID FIXATOR,$940.90,$0.00,$940.90,$0.00,$671.52,$0.00,$0.00,$0.00,$0.00,$0.00,$940.90,$0.00,$470.45,$745.19,$752.72,$0.00,$0.00,$0.00,$0.00,$0.00
393.722,SUP,Custom 27203010,,393.722  -  RING EXFIX .75 205MM .75 RING NONSTRL HYBRID FIXATOR,$868.45,$0.00,$868.45,$0.00,$619.81,$0.00,$0.00,$0.00,$0.00,$0.00,$868.45,$0.00,$434.23,$687.81,$694.76,$0.00,$0.00,$0.00,$0.00,$0.00
393.731,SUP,Custom 27203010,,393.731  -  RING EXFIX FULL 115MM FULL RING NONSTRL HYBRID FIXATOR,$711.63,$0.00,$711.63,$0.00,$507.89,$0.00,$0.00,$0.00,$0.00,$0.00,$711.63,$0.00,$355.81,$563.61,$569.30,$0.00,$0.00,$0.00,$0.00,$0.00
393.732,SUP,Custom 27203010,,393.732  -  RING EXFIX .75 115MM .75 RING NONSTRL HYBRID FIXATOR,$639.18,$0.00,$639.18,$0.00,$456.18,$0.00,$0.00,$0.00,$0.00,$0.00,$639.18,$0.00,$319.59,$506.23,$511.34,$0.00,$0.00,$0.00,$0.00,$0.00
393.734,SUP,Custom 27203010,,393.734  -  RING EXFIX .75 140MM NONSTRL HYBRID FIXATOR,$698.65,$0.00,$698.65,$0.00,$498.63,$0.00,$0.00,$0.00,$0.00,$0.00,$698.65,$0.00,$349.33,$553.33,$558.92,$0.00,$0.00,$0.00,$0.00,$0.00
393.735,SUP,Custom 27203010,,393.735  -  RING EXFIX FULL 165MM FULL RING NONSTRL HYBRID FIXATOR,$806.80,$0.00,$806.80,$0.00,$575.81,$0.00,$0.00,$0.00,$0.00,$0.00,$806.80,$0.00,$403.40,$638.99,$645.44,$0.00,$0.00,$0.00,$0.00,$0.00
393.736,SUP,Custom 27203010,,393.736  -  RING EXFIX .75 165MM .75 RING NONSTRL HYBRID FIXATOR,$733.25,$0.00,$733.25,$0.00,$523.32,$0.00,$0.00,$0.00,$0.00,$0.00,$733.25,$0.00,$366.63,$580.73,$586.60,$0.00,$0.00,$0.00,$0.00,$0.00
393.737,SUP,Custom 27203010,,393.737  -  RING EXFIX .25 165MM .25 RING NONSTRL HYBRID FIXATOR,$589.43,$0.00,$589.43,$0.00,$420.67,$0.00,$0.00,$0.00,$0.00,$0.00,$589.43,$0.00,$294.71,$466.83,$471.54,$0.00,$0.00,$0.00,$0.00,$0.00
393.75,SUP,Custom 27203010,,393.75  -  CLAMP EXFIX LARGE UNIVERSAL ADJUSTABLE NONSTRL LARGE EXFIX,"$1,033.93",$0.00,"$1,033.93",$0.00,$737.91,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,033.93",$0.00,$516.96,$818.87,$827.14,$0.00,$0.00,$0.00,$0.00,$0.00
394.05,SUP,Custom 27203010,,394.050  -  FIXATOR XTRNFX NS ADJ RADL DIST,"$2,949.25",$0.00,"$2,949.25",$0.00,"$2,104.88",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,949.25",$0.00,"$1,474.63","$2,335.81","$2,359.40",$0.00,$0.00,$0.00,$0.00,$0.00
394.055,SUP,Custom 27203010,,394.055  -  FIXATOR XTRNFX HNG ELB UNSTBL FX,"$2,248.45",$0.00,"$2,248.45",$0.00,"$1,604.72",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,248.45",$0.00,"$1,124.23","$1,780.77","$1,798.76",$0.00,$0.00,$0.00,$0.00,$0.00
394.46,SUP,Custom 27203010,,394.46  -  SLEEVE DISTRCT 105MM HOLD,$502.90,$0.00,$502.90,$0.00,$358.92,$0.00,$0.00,$0.00,$0.00,$0.00,$502.90,$0.00,$251.45,$398.30,$402.32,$0.00,$0.00,$0.00,$0.00,$0.00
394.79,SUP,Custom 27203010,,394.79  -  ROD EXFIX 180D CURVE 11MM 850MM CARFBR NONSTRL LARGE EXFIX,"$1,195.05",$0.00,"$1,195.05",$0.00,$852.91,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,195.05",$0.00,$597.53,$946.48,$956.04,$0.00,$0.00,$0.00,$0.00,$0.00
394.791,SUP,Custom 27203010,,394.791  -  ROD EXFIX 45D 11MM 207MM CVD SPAN ANGLED CARFBR NONSTRL,$922.53,$0.00,$922.53,$0.00,$658.41,$0.00,$0.00,$0.00,$0.00,$0.00,$922.53,$0.00,$461.26,$730.64,$738.02,$0.00,$0.00,$0.00,$0.00,$0.00
394.792,SUP,Custom 27203010,,394.792  -  ROD EXFIX 90D 11MM 382MM CVD SPAN ANGLED CARFBR NONSTRL,"$1,014.45",$0.00,"$1,014.45",$0.00,$724.01,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,014.45",$0.00,$507.23,$803.44,$811.56,$0.00,$0.00,$0.00,$0.00,$0.00
394.793,SUP,Custom 27203010,,394.793  -  ROD EXFIX 135D 11MM 499MM CVD SPAN ANGLED CARFBR NONSTRL,"$1,107.45",$0.00,"$1,107.45",$0.00,$790.39,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,107.45",$0.00,$553.73,$877.10,$885.96,$0.00,$0.00,$0.00,$0.00,$0.00
394.8,SUP,Custom 27203010,,394.80  -  ROD EXFIX 100MM 11MM SM CARFBR LG EXFIX,$319.30,$0.00,$319.30,$0.00,$227.88,$0.00,$0.00,$0.00,$0.00,$0.00,$319.30,$0.00,$159.65,$252.89,$255.44,$0.00,$0.00,$0.00,$0.00,$0.00
394.81,SUP,Custom 27203010,,394.81  -  ROD EXFIX 11MM 125MM MR CONDITIONAL CARFBR NONSTRL,$350.40,$0.00,$350.40,$0.00,$250.08,$0.00,$0.00,$0.00,$0.00,$0.00,$350.40,$0.00,$175.20,$277.52,$280.32,$0.00,$0.00,$0.00,$0.00,$0.00
394.82,SUP,Custom 27203010,,394.82  -  ROD EXFIX 11MM 150MM RADIOLUCENT MR CONDITIONAL CARFBR,$350.40,$0.00,$350.40,$0.00,$250.08,$0.00,$0.00,$0.00,$0.00,$0.00,$350.40,$0.00,$175.20,$277.52,$280.32,$0.00,$0.00,$0.00,$0.00,$0.00
394.83,SUP,Custom 27203010,,394.83  -  ROD EXFIX 11MM 200MM RADIOLUCENT MR CONDITIONAL CARFBR,$350.40,$0.00,$350.40,$0.00,$250.08,$0.00,$0.00,$0.00,$0.00,$0.00,$350.40,$0.00,$175.20,$277.52,$280.32,$0.00,$0.00,$0.00,$0.00,$0.00
394.84,SUP,Custom 27203010,,394.84  -  ROD EXFIX 11MM 250MM CARFBR NONSTRL,$376.35,$0.00,$376.35,$0.00,$268.60,$0.00,$0.00,$0.00,$0.00,$0.00,$376.35,$0.00,$188.18,$298.07,$301.08,$0.00,$0.00,$0.00,$0.00,$0.00
394.85,SUP,Custom 27203010,,394.85  -  ROD EXFIX 11MM 300MM MR CONDITIONAL CARFBR NONSTRL,$376.35,$0.00,$376.35,$0.00,$268.60,$0.00,$0.00,$0.00,$0.00,$0.00,$376.35,$0.00,$188.18,$298.07,$301.08,$0.00,$0.00,$0.00,$0.00,$0.00
394.86,SUP,Custom 27203010,,394.86  -  ROD EXFIX 11MM 350MM RADIOLUCENT MR CONDITIONAL CARFBR,$376.35,$0.00,$376.35,$0.00,$268.60,$0.00,$0.00,$0.00,$0.00,$0.00,$376.35,$0.00,$188.18,$298.07,$301.08,$0.00,$0.00,$0.00,$0.00,$0.00
394.87,SUP,Custom 27203010,,394.87  -  ROD EXFIX 11MM 400MM MR CONDITIONAL CARFBR NONSTRL,$413.13,$0.00,$413.13,$0.00,$294.85,$0.00,$0.00,$0.00,$0.00,$0.00,$413.13,$0.00,$206.56,$327.20,$330.50,$0.00,$0.00,$0.00,$0.00,$0.00
394.88,SUP,Custom 27203010,,394.88  -  ROD EXFIX 11MM 450MM MR CONDITIONAL CARFBR NONSTRL,$413.13,$0.00,$413.13,$0.00,$294.85,$0.00,$0.00,$0.00,$0.00,$0.00,$413.13,$0.00,$206.56,$327.20,$330.50,$0.00,$0.00,$0.00,$0.00,$0.00
394.89,SUP,Custom 27203010,,394.89  -  ROD EXFIX 11MM 500MM CARFBR NONSTRL LARGE EXFIX,$413.13,$0.00,$413.13,$0.00,$294.85,$0.00,$0.00,$0.00,$0.00,$0.00,$413.13,$0.00,$206.56,$327.20,$330.50,$0.00,$0.00,$0.00,$0.00,$0.00
394.9,SUP,Custom 27203010,,394.90  -  ROD EXFIX 11MM 550MM RADIOLUCENT CARFBR NONSTRL,$446.65,$0.00,$446.65,$0.00,$318.77,$0.00,$0.00,$0.00,$0.00,$0.00,$446.65,$0.00,$223.33,$353.75,$357.32,$0.00,$0.00,$0.00,$0.00,$0.00
394.91,SUP,Custom 27203010,,394.91  -  ROD EXFIX 11MM 600MM CARFBR NONSTRL LARGE EXFIX,$446.65,$0.00,$446.65,$0.00,$318.77,$0.00,$0.00,$0.00,$0.00,$0.00,$446.65,$0.00,$223.33,$353.75,$357.32,$0.00,$0.00,$0.00,$0.00,$0.00
394.92,SUP,Custom 27203010,,394.92  -  ROD EXFIX 11MM 650MM CARFBR NONSTRL LARGE EXFIX,$446.65,$0.00,$446.65,$0.00,$318.77,$0.00,$0.00,$0.00,$0.00,$0.00,$446.65,$0.00,$223.33,$353.75,$357.32,$0.00,$0.00,$0.00,$0.00,$0.00
394.97,SUP,Custom 27203010,,394.97  -  CAP PROTECTIVE NONSTRL 11 MM CARFBR ROD,$2.39,$0.00,$2.39,$0.00,$1.70,$0.00,$0.00,$0.00,$0.00,$0.00,$2.39,$0.00,$1.19,$1.89,$1.91,$0.00,$0.00,$0.00,$0.00,$0.00
394.99,SUP,Custom 27203010,,394.99  -  CAP PROTECTIVE BLACK NONSTRL 4MM CARFBR ROD,$4.68,$0.00,$4.68,$0.00,$3.34,$0.00,$0.00,$0.00,$0.00,$0.00,$4.68,$0.00,$2.34,$3.71,$3.74,$0.00,$0.00,$0.00,$0.00,$0.00
394.991,SUP,Custom 27203010,,394.991  -  CAP PROTECTIVE YELLOW NONSTRL 4MM FIX PIN,$57.85,$0.00,$57.85,$0.00,$41.29,$0.00,$0.00,$0.00,$0.00,$0.00,$57.85,$0.00,$28.93,$45.82,$46.28,$0.00,$0.00,$0.00,$0.00,$0.00
394.992,SUP,Custom 27203010,,394.992  -  CAP PROTECTIVE WHITE NONSTRL 4.5MM FIX PIN,$5.79,$0.00,$5.79,$0.00,$4.13,$0.00,$0.00,$0.00,$0.00,$0.00,$5.79,$0.00,$2.89,$4.59,$4.63,$0.00,$0.00,$0.00,$0.00,$0.00
394.994,SUP,Custom 27203010,,394.994  -  CAP PROTECTIVE GREEN NONSTRL 6MM FIX PIN,$5.79,$0.00,$5.79,$0.00,$4.13,$0.00,$0.00,$0.00,$0.00,$0.00,$5.79,$0.00,$2.89,$4.59,$4.63,$0.00,$0.00,$0.00,$0.00,$0.00
395.103,SUP,Custom 27203010,,395.103  -  BAR EXFIX ANGLED 3MM CONNCTNG ROD STAINLESS STEEL NONSTRL,$81.13,$0.00,$81.13,$0.00,$57.90,$0.00,$0.00,$0.00,$0.00,$0.00,$81.13,$0.00,$40.56,$64.25,$64.90,$0.00,$0.00,$0.00,$0.00,$0.00
395.105,SUP,Custom 27203010,,395.105  -  ROD EXFIX 3MM 25MM CONNCTNG RADIOLUCENT CARFBR NONSTRL MINI,$63.28,$0.00,$63.28,$0.00,$45.16,$0.00,$0.00,$0.00,$0.00,$0.00,$63.28,$0.00,$31.64,$50.12,$50.62,$0.00,$0.00,$0.00,$0.00,$0.00
395.107,SUP,Custom 27203010,,395.107  -  ROD EXFIX 3MM 45MM CARFBR NONSTRL MINI EXFIX,$63.28,$0.00,$63.28,$0.00,$45.16,$0.00,$0.00,$0.00,$0.00,$0.00,$63.28,$0.00,$31.64,$50.12,$50.62,$0.00,$0.00,$0.00,$0.00,$0.00
395.109,SUP,Custom 27203010,,395.109  -  ROD EXFIX 3MM 60MM CARFBR NONSTRL MINI EXFIX,$63.28,$0.00,$63.28,$0.00,$45.16,$0.00,$0.00,$0.00,$0.00,$0.00,$63.28,$0.00,$31.64,$50.12,$50.62,$0.00,$0.00,$0.00,$0.00,$0.00
395.111,SUP,Custom 27203010,,395.111  -  ROD EXFIX 3MM 75MM CONNCTNG RADIOLUCENT CARFBR NONSTRL MINI,$63.28,$0.00,$63.28,$0.00,$45.16,$0.00,$0.00,$0.00,$0.00,$0.00,$63.28,$0.00,$31.64,$50.12,$50.62,$0.00,$0.00,$0.00,$0.00,$0.00
395.125,SUP,Custom 27203010,,395.125  -  CLAMP EXFIX 1.25MM HOLD NONSTRL MINI EXFIX,"$1,109.63",$0.00,"$1,109.63",$0.00,$791.94,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,109.63",$0.00,$554.81,$878.83,$887.70,$0.00,$0.00,$0.00,$0.00,$0.00
395.126,SUP,Custom 27203010,,395.126  -  CLAMP EXFIX 1.6MM HOLD NONSTRL 1.6MM K WIRE MINI EXFIX,"$1,109.63",$0.00,"$1,109.63",$0.00,$791.94,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,109.63",$0.00,$554.81,$878.83,$887.70,$0.00,$0.00,$0.00,$0.00,$0.00
395.133,SUP,Custom 27203010,,395.133  -  CLAMP EXFIX 3MM CONNCTNG NONSTRL MINI EXFIX,"$1,031.75",$0.00,"$1,031.75",$0.00,$736.36,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,031.75",$0.00,$515.88,$817.15,$825.40,$0.00,$0.00,$0.00,$0.00,$0.00
395.134,SUP,Custom 27203010,,395.134  -  CLAMP EXFIX 3X4MM CONNCTNG NONSTRL MINI EXFIX SMALL EXFIX,"$1,031.75",$0.00,"$1,031.75",$0.00,$736.36,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,031.75",$0.00,$515.88,$817.15,$825.40,$0.00,$0.00,$0.00,$0.00,$0.00
395.54,SUP,Custom 27803010,,395.54  -  CLAMP XTRNFX 4MM 2.5MM NS OPN SEF,$506.15,$0.00,$506.15,$0.00,$361.24,$0.00,$0.00,$0.00,$0.00,$0.00,$506.15,$0.00,$253.08,$400.87,$404.92,$0.00,$0.00,$0.00,$0.00,$0.00
395.55,SUP,Custom 27803010,,395.55  -  CLAMP XTRNFX 4MM NS OPN SEF 4MM SCHNZ SCR,$506.15,$0.00,$506.15,$0.00,$361.24,$0.00,$0.00,$0.00,$0.00,$0.00,$506.15,$0.00,$253.08,$400.87,$404.92,$0.00,$0.00,$0.00,$0.00,$0.00
395.56,SUP,Custom 27203010,,395.56  -  CLAMP EXFIX SMALL 2.5MM 4MM NONSTRL SMALL EXFIX,$472.63,$0.00,$472.63,$0.00,$337.31,$0.00,$0.00,$0.00,$0.00,$0.00,$472.63,$0.00,$236.31,$374.32,$378.10,$0.00,$0.00,$0.00,$0.00,$0.00
395.57,SUP,Custom 27203010,,395.57  -  CLAMP EXFIX 4MM 4MM NONSTRL 4MM SCHANZ SCREW CONNECT,$472.63,$0.00,$472.63,$0.00,$337.31,$0.00,$0.00,$0.00,$0.00,$0.00,$472.63,$0.00,$236.31,$374.32,$378.10,$0.00,$0.00,$0.00,$0.00,$0.00
395.575,SUP,Custom 27203010,,395.575  -  CLAMP EXFIX MULTIVECTOR TITANIUM CARFBR RODS,"$2,157.50",$0.00,"$2,157.50",$0.00,"$1,539.81",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,157.50",$0.00,"$1,078.75","$1,708.74","$1,726.00",$0.00,$0.00,$0.00,$0.00,$0.00
395.58,SUP,Custom 27203010,,395.58  -  NUT XTRNFX NS SPRG LD,$53.25,$0.00,$53.25,$0.00,$38.00,$0.00,$0.00,$0.00,$0.00,$0.00,$53.25,$0.00,$26.63,$42.17,$42.60,$0.00,$0.00,$0.00,$0.00,$0.00
395.6,SUP,Custom 27203010,,395.60  -  ROD EXFIX 4MM 60MM CARFBR NONSTRL,$59.48,$0.00,$59.48,$0.00,$42.45,$0.00,$0.00,$0.00,$0.00,$0.00,$59.48,$0.00,$29.74,$47.11,$47.58,$0.00,$0.00,$0.00,$0.00,$0.00
395.61,SUP,Custom 27203010,,395.61  -  ROD EXFIX 4MM 80MM CARFBR NONSTRL SMALL EXFIX,$59.48,$0.00,$59.48,$0.00,$42.45,$0.00,$0.00,$0.00,$0.00,$0.00,$59.48,$0.00,$29.74,$47.11,$47.58,$0.00,$0.00,$0.00,$0.00,$0.00
395.62,SUP,Custom 27203010,,395.62  -  ROD EXFIX 4MM 100MM CARFBR NONSTRL SMALL EXFIX,$59.48,$0.00,$59.48,$0.00,$42.45,$0.00,$0.00,$0.00,$0.00,$0.00,$59.48,$0.00,$29.74,$47.11,$47.58,$0.00,$0.00,$0.00,$0.00,$0.00
395.63,SUP,Custom 27203010,,395.63  -  ROD EXFIX 4MM 120MM CARFBR NONSTRL SMALL EXFIX,$59.48,$0.00,$59.48,$0.00,$42.45,$0.00,$0.00,$0.00,$0.00,$0.00,$59.48,$0.00,$29.74,$47.11,$47.58,$0.00,$0.00,$0.00,$0.00,$0.00
395.64,SUP,Custom 27203010,,395.64  -  ROD EXFIX 4MM 140MM CARFBR NONSTRL SMALL EXFIX,$82.20,$0.00,$82.20,$0.00,$58.67,$0.00,$0.00,$0.00,$0.00,$0.00,$82.20,$0.00,$41.10,$65.10,$65.76,$0.00,$0.00,$0.00,$0.00,$0.00
395.65,SUP,Custom 27203010,,395.65  -  ROD EXFIX 4MM 160MM CARFBR NONSTRL SMALL EXFIX,$82.20,$0.00,$82.20,$0.00,$58.67,$0.00,$0.00,$0.00,$0.00,$0.00,$82.20,$0.00,$41.10,$65.10,$65.76,$0.00,$0.00,$0.00,$0.00,$0.00
395.66,SUP,Custom 27203010,,395.66  -  ROD EXFIX 4MM 180MM CARFBR NONSTRL SMALL EXFIX,$82.20,$0.00,$82.20,$0.00,$58.67,$0.00,$0.00,$0.00,$0.00,$0.00,$82.20,$0.00,$41.10,$65.10,$65.76,$0.00,$0.00,$0.00,$0.00,$0.00
395.67,SUP,Custom 27203010,,395.67  -  ROD EXFIX 4MM 200MM CARFBR NONSTRL,$82.20,$0.00,$82.20,$0.00,$58.67,$0.00,$0.00,$0.00,$0.00,$0.00,$82.20,$0.00,$41.10,$65.10,$65.76,$0.00,$0.00,$0.00,$0.00,$0.00
395.68,SUP,Custom 27203010,,395.680  -  ROD EXFIX 60D CVD 4MM 78MM CARFBR NONSTRL,$274.70,$0.00,$274.70,$0.00,$196.05,$0.00,$0.00,$0.00,$0.00,$0.00,$274.70,$0.00,$137.35,$217.56,$219.76,$0.00,$0.00,$0.00,$0.00,$0.00
395.681,SUP,Custom 27203010,,395.681  -  ROD EXFIX 90D 4MM 117MM CVD SPAN ANGLED CARFBR NONSTRL,$294.18,$0.00,$294.18,$0.00,$209.95,$0.00,$0.00,$0.00,$0.00,$0.00,$294.18,$0.00,$147.09,$232.99,$235.34,$0.00,$0.00,$0.00,$0.00,$0.00
395.682,SUP,Custom 27203010,,395.682  -  ROD EXFIX 120D 4MM 156MM CVD SPAN ANGLED CARFBR NONSTRL,$314.73,$0.00,$314.73,$0.00,$224.62,$0.00,$0.00,$0.00,$0.00,$0.00,$314.73,$0.00,$157.36,$249.27,$251.78,$0.00,$0.00,$0.00,$0.00,$0.00
395.685,SUP,Custom 27203010,,395.685  -  ROD EXFIX ANGLE 4MM 50X80MM T BAR RECYCLED CARFBR NONSTRL,$565.63,$0.00,$565.63,$0.00,$403.69,$0.00,$0.00,$0.00,$0.00,$0.00,$565.63,$0.00,$282.81,$447.98,$452.50,$0.00,$0.00,$0.00,$0.00,$0.00
395.686,SUP,Custom 27203010,,395.686  -  ROD EXFIX ANGLE 4MM 120X80MM T BAR CARFBR NONSTRL,$565.63,$0.00,$565.63,$0.00,$403.69,$0.00,$0.00,$0.00,$0.00,$0.00,$565.63,$0.00,$282.81,$447.98,$452.50,$0.00,$0.00,$0.00,$0.00,$0.00
395.687,SUP,Custom 27203010,,395.687  -  ROD EXFIX ANGLED 4MM 50X110MM T BAR ANGLED CARFBR NONSTRL,$565.63,$0.00,$565.63,$0.00,$403.69,$0.00,$0.00,$0.00,$0.00,$0.00,$565.63,$0.00,$282.81,$447.98,$452.50,$0.00,$0.00,$0.00,$0.00,$0.00
395.688,SUP,Custom 27203010,,395.688  -  ROD EXFIX ANGLED 4MM 120X110MM T BAR ANGLED CARFBR NONSTRL,$565.63,$0.00,$565.63,$0.00,$403.69,$0.00,$0.00,$0.00,$0.00,$0.00,$565.63,$0.00,$282.81,$447.98,$452.50,$0.00,$0.00,$0.00,$0.00,$0.00
395.69,SUP,Custom 27203010,,395.690  -  ROD EXFIX 45D 8MM 214MM CVD CARFBR NONSTRL,$597.00,$0.00,$597.00,$0.00,$426.08,$0.00,$0.00,$0.00,$0.00,$0.00,$597.00,$0.00,$298.50,$472.82,$477.60,$0.00,$0.00,$0.00,$0.00,$0.00
395.691,SUP,Custom 27203010,,395.691  -  ROD EXFIX 90D 8MM 382MM CVD CARFBR NONSTRL,$597.00,$0.00,$597.00,$0.00,$426.08,$0.00,$0.00,$0.00,$0.00,$0.00,$597.00,$0.00,$298.50,$472.82,$477.60,$0.00,$0.00,$0.00,$0.00,$0.00
395.692,SUP,Custom 27203010,,395.692  -  ROD EXFIX 135D 8MM 499MM CVD CARFBR NONSTRL,$579.60,$0.00,$579.60,$0.00,$413.66,$0.00,$0.00,$0.00,$0.00,$0.00,$579.60,$0.00,$289.80,$459.04,$463.68,$0.00,$0.00,$0.00,$0.00,$0.00
395.693,SUP,Custom 27203010,,395.693  -  ROD EXFIX 180D 8MM 540MM CVD SPAN ANGLED CARFBR NONSTRL,$579.60,$0.00,$579.60,$0.00,$413.66,$0.00,$0.00,$0.00,$0.00,$0.00,$579.60,$0.00,$289.80,$459.04,$463.68,$0.00,$0.00,$0.00,$0.00,$0.00
395.7,SUP,Custom 27203010,,395.70  -  BAR XTRNFX 4MM 60MM NS CNCT MRI SAFE SS METACARPUS PHALANX,$47.05,$0.00,$47.05,$0.00,$33.58,$0.00,$0.00,$0.00,$0.00,$0.00,$47.05,$0.00,$23.53,$37.26,$37.64,$0.00,$0.00,$0.00,$0.00,$0.00
395.71,SUP,Custom 27203010,,395.71  -  BAR XTRNFX 4MM 80MM NS CNCT MRI SAFE SS METACARPUS PHALANX,$47.05,$0.00,$47.05,$0.00,$33.58,$0.00,$0.00,$0.00,$0.00,$0.00,$47.05,$0.00,$23.53,$37.26,$37.64,$0.00,$0.00,$0.00,$0.00,$0.00
395.72,SUP,Custom 27203010,,395.72  -  BAR XTRNFX 4MM 100MM NS CNCT MRI SAFE SS METACARPUS PHALANX,$47.05,$0.00,$47.05,$0.00,$33.58,$0.00,$0.00,$0.00,$0.00,$0.00,$47.05,$0.00,$23.53,$37.26,$37.64,$0.00,$0.00,$0.00,$0.00,$0.00
395.73,SUP,Custom 27203010,,395.73  -  BAR XTRNFX 4MM 120MM NS CNCT MRI SAFE SS METACARPUS PHALANX,$47.05,$0.00,$47.05,$0.00,$33.58,$0.00,$0.00,$0.00,$0.00,$0.00,$47.05,$0.00,$23.53,$37.26,$37.64,$0.00,$0.00,$0.00,$0.00,$0.00
395.74,SUP,Custom 27203010,,395.74  -  BAR XTRNFX 4MM 140MM NS CNCT MRI SAFE SS METACARPUS PHALANX,$61.65,$0.00,$61.65,$0.00,$44.00,$0.00,$0.00,$0.00,$0.00,$0.00,$61.65,$0.00,$30.83,$48.83,$49.32,$0.00,$0.00,$0.00,$0.00,$0.00
395.75,SUP,Custom 27203010,,395.75  -  BAR XTRNFX 4MM 160MM NS CNCT MRI SAFE SS METACARPUS PHALANX,$61.65,$0.00,$61.65,$0.00,$44.00,$0.00,$0.00,$0.00,$0.00,$0.00,$61.65,$0.00,$30.83,$48.83,$49.32,$0.00,$0.00,$0.00,$0.00,$0.00
395.76,SUP,Custom 27203010,,395.76  -  BAR XTRNFX 4MM 180MM NS CNCT MRI SAFE SS METACARPUS PHALANX,$61.65,$0.00,$61.65,$0.00,$44.00,$0.00,$0.00,$0.00,$0.00,$0.00,$61.65,$0.00,$30.83,$48.83,$49.32,$0.00,$0.00,$0.00,$0.00,$0.00
395.77,SUP,Custom 27203010,,395.77  -  BAR XTRNFX 4MM 200MM NS CNCT MRI SAFE SS METACARPUS PHALANX,$61.65,$0.00,$61.65,$0.00,$44.00,$0.00,$0.00,$0.00,$0.00,$0.00,$61.65,$0.00,$30.83,$48.83,$49.32,$0.00,$0.00,$0.00,$0.00,$0.00
395.779,SUP,Custom 27203010,,395.779  -  ROD EXFIX MEDIUM 8MM 160MM CARFBR NONSTRL,$239.00,$0.00,$239.00,$0.00,$170.57,$0.00,$0.00,$0.00,$0.00,$0.00,$239.00,$0.00,$119.50,$189.29,$191.20,$0.00,$0.00,$0.00,$0.00,$0.00
395.78,SUP,Custom 27203010,,395.78  -  BAR XTRNFX 4MM 220MM NS CNCT MRI SAFE SS METACARPUS PHALANX,$76.13,$0.00,$76.13,$0.00,$54.33,$0.00,$0.00,$0.00,$0.00,$0.00,$76.13,$0.00,$38.06,$60.29,$60.90,$0.00,$0.00,$0.00,$0.00,$0.00
395.78,SUP,HCPCS C1713,,395.780  -  ROD EXFIX 120MM 8MM MED CARFBR MED EXFIX NONSTRL,$239.00,$0.00,$189.29,$0.00,$54.33,$0.00,$0.00,$0.00,$0.00,$0.00,$76.13,$0.00,$38.06,$189.29,$60.90,$0.00,$0.00,$0.00,$0.00,$0.00
395.782,SUP,Custom 27203010,,395.782  -  ROD EXFIX 8MM 200MM CARFBR DISTAL RAD NONSTRL,$236.85,$0.00,$236.85,$0.00,$169.04,$0.00,$0.00,$0.00,$0.00,$0.00,$236.85,$0.00,$118.43,$187.59,$189.48,$0.00,$0.00,$0.00,$0.00,$0.00
395.784,SUP,Custom 27203010,,395.784  -  ROD EXFIX 8MM 220MM CARFBR DISTAL RAD NONSTRL,$236.85,$0.00,$236.85,$0.00,$169.04,$0.00,$0.00,$0.00,$0.00,$0.00,$236.85,$0.00,$118.43,$187.59,$189.48,$0.00,$0.00,$0.00,$0.00,$0.00
395.786,SUP,Custom 27203010,,395.786  -  ROD EXFIX 8MM 240MM CARFBR DISTAL RAD NONSTRL,$236.85,$0.00,$236.85,$0.00,$169.04,$0.00,$0.00,$0.00,$0.00,$0.00,$236.85,$0.00,$118.43,$187.59,$189.48,$0.00,$0.00,$0.00,$0.00,$0.00
395.788,SUP,Custom 27203010,,395.788  -  ROD EXFIX 8MM 280MM CARFBR DISTAL RAD NONSTRL,$239.00,$0.00,$239.00,$0.00,$170.57,$0.00,$0.00,$0.00,$0.00,$0.00,$239.00,$0.00,$119.50,$189.29,$191.20,$0.00,$0.00,$0.00,$0.00,$0.00
395.79,SUP,Custom 27203010,,395.79  -  BAR XTRNFX 4MM 240MM NS CNCT MRI SAFE SS METACARPUS PHALANX,$76.13,$0.00,$76.13,$0.00,$54.33,$0.00,$0.00,$0.00,$0.00,$0.00,$76.13,$0.00,$38.06,$60.29,$60.90,$0.00,$0.00,$0.00,$0.00,$0.00
395.792,SUP,Custom 27203010,,395.792  -  ROD EXFIX MEDIUM 8MM 320MM CARFBR NONSTRL,$239.00,$0.00,$239.00,$0.00,$170.57,$0.00,$0.00,$0.00,$0.00,$0.00,$239.00,$0.00,$119.50,$189.29,$191.20,$0.00,$0.00,$0.00,$0.00,$0.00
395.796,SUP,Custom 27203010,,395.796  -  ROD EXFIX 8MM 360MM CARFBR NONSTRL,$257.40,$0.00,$257.40,$0.00,$183.71,$0.00,$0.00,$0.00,$0.00,$0.00,$257.40,$0.00,$128.70,$203.86,$205.92,$0.00,$0.00,$0.00,$0.00,$0.00
395.797,SUP,Custom 27203010,,395.797  -  ROD EXFIX MEDIUM 8MM 400MM CARFBR NONSTRL,$257.40,$0.00,$257.40,$0.00,$183.71,$0.00,$0.00,$0.00,$0.00,$0.00,$257.40,$0.00,$128.70,$203.86,$205.92,$0.00,$0.00,$0.00,$0.00,$0.00
395.798,SUP,Custom 27203010,,395.798  -  ROD EXFIX 8MM 460MM CARFBR NONSTRL,$257.40,$0.00,$257.40,$0.00,$183.71,$0.00,$0.00,$0.00,$0.00,$0.00,$257.40,$0.00,$128.70,$203.86,$205.92,$0.00,$0.00,$0.00,$0.00,$0.00
395.8,SUP,Custom 27203010,,395.80  -  BAR XTRNFX 4MM 250MM NS CNCT SS MN XTRNFXTR,$76.13,$0.00,$76.13,$0.00,$54.33,$0.00,$0.00,$0.00,$0.00,$0.00,$76.13,$0.00,$38.06,$60.29,$60.90,$0.00,$0.00,$0.00,$0.00,$0.00
395.81,SUP,Custom 27203010,,395.81  -  BAR EXFIX 4MM 260MM CONNECT NONSTRL,$76.13,$0.00,$76.13,$0.00,$54.33,$0.00,$0.00,$0.00,$0.00,$0.00,$76.13,$0.00,$38.06,$60.29,$60.90,$0.00,$0.00,$0.00,$0.00,$0.00
395.82,SUP,Custom 27203010,,395.82  -  BAR EXFIX 4MM 280MM CONNECT NONSTRL,$76.13,$0.00,$76.13,$0.00,$54.33,$0.00,$0.00,$0.00,$0.00,$0.00,$76.13,$0.00,$38.06,$60.29,$60.90,$0.00,$0.00,$0.00,$0.00,$0.00
395.83,SUP,Custom 27203010,,395.83  -  BAR EXFIX 4MM 300MM CONNECT NONSTRL,$76.13,$0.00,$76.13,$0.00,$54.33,$0.00,$0.00,$0.00,$0.00,$0.00,$76.13,$0.00,$38.06,$60.29,$60.90,$0.00,$0.00,$0.00,$0.00,$0.00
397.283,SUP,Custom 27203010,,397.283  -  BIT DRILL 1.8MM JLTCH NONSTRL,$405.00,$0.00,$405.00,$0.00,$289.05,$0.00,$0.00,$0.00,$0.00,$0.00,$405.00,$0.00,$202.50,$320.76,$324.00,$0.00,$0.00,$0.00,$0.00,$0.00
397.284,SUP,Custom 27203010,,397.284  -  BIT DRILL 2.4MM JLTCH NONSTRL,$405.00,$0.00,$405.00,$0.00,$289.05,$0.00,$0.00,$0.00,$0.00,$0.00,$405.00,$0.00,$202.50,$320.76,$324.00,$0.00,$0.00,$0.00,$0.00,$0.00
397.342,SUP,Custom 27203010,,397.342  -  BIT DRL 140MM 2.5MM 400MM NS JCHK CLBRT,$941.68,$0.00,$941.68,$0.00,$672.07,$0.00,$0.00,$0.00,$0.00,$0.00,$941.68,$0.00,$470.84,$745.81,$753.34,$0.00,$0.00,$0.00,$0.00,$0.00
397.343,SUP,Custom 27203010,,397.343  -  BIT DRL 3.5MM 380MM NS JCHK,$988.08,$0.00,$988.08,$0.00,$705.19,$0.00,$0.00,$0.00,$0.00,$0.00,$988.08,$0.00,$494.04,$782.56,$790.46,$0.00,$0.00,$0.00,$0.00,$0.00
398.756,SUP,Custom 27203010,,398.756  -  CLAMP SURG 206MM HOOK ARM BONE,"$4,936.30",$0.00,"$4,936.30",$0.00,"$3,523.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,936.30",$0.00,"$2,468.15","$3,909.55","$3,949.04",$0.00,$0.00,$0.00,$0.00,$0.00
400.006,SUP,HCPCS C1713,,400.006  -  SCREW BONE STANDARD 1.5MM 3MM 6MM SELF TAP CRCIFRM TITANIUM,$52.88,$0.00,$52.88,$23.79,$37.74,$0.00,$8.84,$0.00,$0.00,$9.26,$52.88,$0.00,$26.44,$41.88,$42.30,$0.00,$8.03,$0.00,$8.42,$0.00
400.007,SUP,HCPCS C1713,,400.007  -  SCREW BONE STANDARD 1.5MM 3MM 7MM SELF TAP CRCIFRM TITANIUM,$52.88,$0.00,$52.88,$23.79,$37.74,$0.00,$8.84,$0.00,$0.00,$9.26,$52.88,$0.00,$26.44,$41.88,$42.30,$0.00,$8.03,$0.00,$8.42,$0.00
400.008,SUP,HCPCS C1713,,400.008  -  SCREW BONE STANDARD 1.5MM 3MM 8MM SELF TAP CRCIFRM TITANIUM,$52.88,$0.00,$52.88,$23.79,$37.74,$0.00,$8.84,$0.00,$0.00,$9.26,$52.88,$0.00,$26.44,$41.88,$42.30,$0.00,$8.03,$0.00,$8.42,$0.00
400.009,SUP,HCPCS C1713,,400.009  -  SCREW BONE STANDARD 1.5MM 3MM 9MM SELF TAP CRCIFRM TITANIUM,$52.88,$0.00,$52.88,$23.79,$37.74,$0.00,$8.84,$0.00,$0.00,$9.26,$52.88,$0.00,$26.44,$41.88,$42.30,$0.00,$8.03,$0.00,$8.42,$0.00
400.01,SUP,HCPCS C1713,,400.010  -  SCREW BONE STANDARD 1.5MM 3MM 10MM SELF TAP CRCIFRM TITANIUM,$52.88,$0.00,$52.88,$23.79,$37.74,$0.00,$8.84,$0.00,$0.00,$9.26,$52.88,$0.00,$26.44,$41.88,$42.30,$0.00,$8.03,$0.00,$8.42,$0.00
400.011,SUP,HCPCS C1713,,400.011  -  SCREW BONE STANDARD 1.5MM 3MM 11MM SELF TAP CRCIFRM TITANIUM,$52.88,$0.00,$52.88,$23.79,$37.74,$0.00,$8.84,$0.00,$0.00,$9.26,$52.88,$0.00,$26.44,$41.88,$42.30,$0.00,$8.03,$0.00,$8.42,$0.00
400.012,SUP,HCPCS C1713,,400.012  -  SCREW BONE STANDARD 1.5MM 3MM 12MM SELF TAP CRCIFRM TITANIUM,$52.88,$0.00,$52.88,$23.79,$37.74,$0.00,$8.84,$0.00,$0.00,$9.26,$52.88,$0.00,$26.44,$41.88,$42.30,$0.00,$8.03,$0.00,$8.42,$0.00
400.014,SUP,HCPCS C1713,,400.014  -  SCREW BONE STANDARD 1.5MM 3MM 14MM SELF TAP CRCIFRM TITANIUM,$52.88,$0.00,$52.88,$23.79,$37.74,$0.00,$8.84,$0.00,$0.00,$9.26,$52.88,$0.00,$26.44,$41.88,$42.30,$0.00,$8.03,$0.00,$8.42,$0.00
400.016,SUP,HCPCS C1713,,400.016  -  SCREW BONE STANDARD 1.5MM 3MM 16MM SELF TAP CRCIFRM TITANIUM,$52.88,$0.00,$52.88,$23.79,$37.74,$0.00,$8.84,$0.00,$0.00,$9.26,$52.88,$0.00,$26.44,$41.88,$42.30,$0.00,$8.03,$0.00,$8.42,$0.00
400.018,SUP,HCPCS C1713,,400.018  -  SCREW BONE STANDARD 1.5MM 3MM 18MM SELF TAP CRCIFRM TITANIUM,$52.88,$0.00,$52.88,$23.79,$37.74,$0.00,$8.84,$0.00,$0.00,$9.26,$52.88,$0.00,$26.44,$41.88,$42.30,$0.00,$8.03,$0.00,$8.42,$0.00
400.02,SUP,HCPCS C1713,,400.020  -  SCREW BONE STANDARD 1.5MM 3MM 20MM SELF TAP CRCIFRM TITANIUM,$52.88,$0.00,$52.88,$23.79,$37.74,$0.00,$8.84,$0.00,$0.00,$9.26,$52.88,$0.00,$26.44,$41.88,$42.30,$0.00,$8.03,$0.00,$8.42,$0.00
400.022,SUP,HCPCS C1713,,400.022  -  SCREW BONE 1.5MM 22MM TITANIUM CORTICAL NONSTRL MINI,$52.88,$0.00,$52.88,$23.79,$37.74,$0.00,$8.84,$0.00,$0.00,$9.26,$52.88,$0.00,$26.44,$41.88,$42.30,$0.00,$8.03,$0.00,$8.42,$0.00
400.024,SUP,HCPCS C1713,,400.024  -  SCREW BONE STANDARD CRCIFRM 1.5MM 3MM 24MM TITANIUM CORTICAL,$52.88,$0.00,$52.88,$23.79,$37.74,$0.00,$8.84,$0.00,$0.00,$9.26,$52.88,$0.00,$26.44,$41.88,$42.30,$0.00,$8.03,$0.00,$8.42,$0.00
400.19,SUP,HCPCS C1713,,400.190  -  PIN FIX 1.8MM 12MM BUTTRESS T8 STARDRIVE RECESS LCP TITANIUM,$212.90,$0.00,$212.90,$95.81,$151.95,$0.00,$35.61,$0.00,$0.00,$37.28,$212.90,$0.00,$106.45,$168.62,$170.32,$0.00,$32.35,$0.00,$33.89,$0.00
400.191,SUP,Custom 27203010,,400.191  -  PIN FIX 1.8MM 14MM T8 STARDRIVE RECESS BUTTRESS LCP TITANIUM,$212.90,$0.00,$212.90,$0.00,$151.95,$0.00,$0.00,$0.00,$0.00,$0.00,$212.90,$0.00,$106.45,$168.62,$170.32,$0.00,$0.00,$0.00,$0.00,$0.00
400.192,SUP,Custom 27203010,,400.192  -  PIN FIX 1.8MM 16MM T8 STARDRIVE RECESS BUTTRESS LCP TITANIUM,$212.90,$0.00,$212.90,$0.00,$151.95,$0.00,$0.00,$0.00,$0.00,$0.00,$212.90,$0.00,$106.45,$168.62,$170.32,$0.00,$0.00,$0.00,$0.00,$0.00
400.193,SUP,Custom 27203010,,400.193  -  PIN FIX 1.8MM 18MM BUTTRESS T8 STARDRIVE RECESS LCP TITANIUM,$212.90,$0.00,$212.90,$0.00,$151.95,$0.00,$0.00,$0.00,$0.00,$0.00,$212.90,$0.00,$106.45,$168.62,$170.32,$0.00,$0.00,$0.00,$0.00,$0.00
400.194,SUP,HCPCS C1713,,400.194  -  PIN FIX 1.8MM 20MM BUTTRESS T8 STARDRIVE RECESS LCP TITANIUM,$212.90,$0.00,$212.90,$95.81,$151.95,$0.00,$35.61,$0.00,$0.00,$37.28,$212.90,$0.00,$106.45,$168.62,$170.32,$0.00,$32.35,$0.00,$33.89,$0.00
400.195,SUP,Custom 27203010,,400.195  -  PIN FIX 1.8MM 22MM BUTTRESS T8 STARDRIVE RECESS LCP TITANIUM,$212.90,$0.00,$212.90,$0.00,$151.95,$0.00,$0.00,$0.00,$0.00,$0.00,$212.90,$0.00,$106.45,$168.62,$170.32,$0.00,$0.00,$0.00,$0.00,$0.00
400.196,SUP,HCPCS C1713,,400.196  -  PIN FIX 1.8MM 24MM BUTTRESS T8 STARDRIVE RECESS LCP TITANIUM,$212.90,$0.00,$212.90,$95.81,$151.95,$0.00,$35.61,$0.00,$0.00,$37.28,$212.90,$0.00,$106.45,$168.62,$170.32,$0.00,$32.35,$0.00,$33.89,$0.00
400.197,SUP,Custom 27203010,,400.197  -  PIN FIX 1.8MM 26MM BUTTRESS T8 STARDRIVE RECESS LCP TITANIUM,$212.90,$0.00,$212.90,$0.00,$151.95,$0.00,$0.00,$0.00,$0.00,$0.00,$212.90,$0.00,$106.45,$168.62,$170.32,$0.00,$0.00,$0.00,$0.00,$0.00
400.198,SUP,HCPCS C1713,,400.198  -  PIN FIX 1.8MM 28MM BUTTRESS T8 STARDRIVE RECESS LCP TITANIUM,$212.90,$0.00,$212.90,$95.81,$151.95,$0.00,$35.61,$0.00,$0.00,$37.28,$212.90,$0.00,$106.45,$168.62,$170.32,$0.00,$32.35,$0.00,$33.89,$0.00
400.199,SUP,Custom 27203010,,400.199  -  PIN FIX 1.8MM 30MM BUTTRESS T8 STARDRIVE RECESS LCP TITANIUM,$212.90,$0.00,$212.90,$0.00,$151.95,$0.00,$0.00,$0.00,$0.00,$0.00,$212.90,$0.00,$106.45,$168.62,$170.32,$0.00,$0.00,$0.00,$0.00,$0.00
400.406,SUP,HCPCS C1713,,400.406  -  SCREW BONE GOLD 6MM 1MM CORT CRANFCL TI SLFTAP +DR RECESS,$157.50,$0.00,$157.50,$70.88,$112.41,$0.00,$27.14,$0.00,$0.00,$27.58,$157.50,$0.00,$78.75,$124.74,$126.00,$0.00,$24.65,$0.00,$25.07,$0.00
400.526,SUP,HCPCS C1713,,400.526  -  SCREW BONE 1MM 1.6MM 6MM SELF TAP CRCIFRM TITANIUM HAND,$133.05,$0.00,$133.05,$59.87,$94.96,$0.00,$22.26,$0.00,$0.00,$23.30,$133.05,$0.00,$66.53,$105.38,$106.44,$0.00,$20.22,$0.00,$21.18,$0.00
400.527,SUP,HCPCS C1713,,400.527  -  SCREW BONE 1MM 1.6MM 7MM SELF TAP CRCIFRM TITANIUM HAND,$133.05,$0.00,$133.05,$59.87,$94.96,$0.00,$22.26,$0.00,$0.00,$23.30,$133.05,$0.00,$66.53,$105.38,$106.44,$0.00,$20.22,$0.00,$21.18,$0.00
400.528,SUP,HCPCS C1713,,400.528  -  SCREW BONE 1MM 1.6MM 8MM SELF TAP CRCIFRM TITANIUM HAND,$133.05,$0.00,$133.05,$59.87,$94.96,$0.00,$22.26,$0.00,$0.00,$23.30,$133.05,$0.00,$66.53,$105.38,$106.44,$0.00,$20.22,$0.00,$21.18,$0.00
400.529,SUP,HCPCS C1713,,400.529  -  SCREW BONE 1MM 1.6MM 9MM SELF TAP CRCIFRM TITANIUM HAND,$133.05,$0.00,$133.05,$59.87,$94.96,$0.00,$22.26,$0.00,$0.00,$23.30,$133.05,$0.00,$66.53,$105.38,$106.44,$0.00,$20.22,$0.00,$21.18,$0.00
400.53,SUP,HCPCS C1713,,400.530  -  SCREW BONE 1MM 1.6MM 10MM SELF TAP CRCIFRM TITANIUM HAND,$133.05,$0.00,$133.05,$59.87,$94.96,$0.00,$22.26,$0.00,$0.00,$23.30,$133.05,$0.00,$66.53,$105.38,$106.44,$0.00,$20.22,$0.00,$21.18,$0.00
400.531,SUP,HCPCS C1713,,400.531  -  SCREW BONE 1MM 1.6MM 11MM SELF TAP CRCIFRM TITANIUM HAND,$133.05,$0.00,$133.05,$59.87,$94.96,$0.00,$22.26,$0.00,$0.00,$23.30,$133.05,$0.00,$66.53,$105.38,$106.44,$0.00,$20.22,$0.00,$21.18,$0.00
400.532,SUP,HCPCS C1713,,400.532  -  SCREW BONE 1MM 1.6MM 12MM SELF TAP CRCIFRM TITANIUM HAND,$133.05,$0.00,$133.05,$59.87,$94.96,$0.00,$22.26,$0.00,$0.00,$23.30,$133.05,$0.00,$66.53,$105.38,$106.44,$0.00,$20.22,$0.00,$21.18,$0.00
400.533,SUP,HCPCS C1713,,400.533  -  SCREW BONE 1MM 1.6MM 13MM SELF TAP CRCIFRM TITANIUM HAND,$133.05,$0.00,$133.05,$59.87,$94.96,$0.00,$22.26,$0.00,$0.00,$23.30,$133.05,$0.00,$66.53,$105.38,$106.44,$0.00,$20.22,$0.00,$21.18,$0.00
400.534,SUP,HCPCS C1713,,400.534  -  SCREW BONE 1MM 1.6MM 14MM SELF TAP CRCIFRM TITANIUM HAND,$133.05,$0.00,$133.05,$59.87,$94.96,$0.00,$22.26,$0.00,$0.00,$23.30,$133.05,$0.00,$66.53,$105.38,$106.44,$0.00,$20.22,$0.00,$21.18,$0.00
400.686,SUP,HCPCS C1713,,400.686  -  SCREW BONE 1.3MM 2.4MM 6MM SELF TAP CRCIFRM TITANIUM HAND,$139.20,$0.00,$139.20,$62.64,$99.35,$0.00,$23.29,$0.00,$0.00,$24.37,$139.20,$0.00,$69.60,$110.25,$111.36,$0.00,$21.15,$0.00,$22.16,$0.00
400.687,SUP,HCPCS C1713,,400.687  -  SCREW BONE 1.3MM 2.4MM 7MM SELF TAP CRCIFRM TITANIUM HAND,$139.20,$0.00,$139.20,$62.64,$99.35,$0.00,$23.29,$0.00,$0.00,$24.37,$139.20,$0.00,$69.60,$110.25,$111.36,$0.00,$21.15,$0.00,$22.16,$0.00
400.688,SUP,HCPCS C1713,,400.688  -  SCREW BONE 1.3MM 2.4MM 8MM SELF TAP CRCIFRM TITANIUM HAND,$139.20,$0.00,$139.20,$62.64,$99.35,$0.00,$23.29,$0.00,$0.00,$24.37,$139.20,$0.00,$69.60,$110.25,$111.36,$0.00,$21.15,$0.00,$22.16,$0.00
400.689,SUP,HCPCS C1713,,400.689  -  SCREW BONE 1.3MM 2.4MM 9MM SELF TAP CRCIFRM TITANIUM HAND,$139.20,$0.00,$139.20,$62.64,$99.35,$0.00,$30.60,$0.00,$0.00,$24.37,$139.20,$0.00,$69.60,$110.25,$111.36,$0.00,$27.80,$0.00,$22.16,$0.00
400.69,SUP,HCPCS C1713,,400.690  -  SCREW BONE 1.3MM 2.4MM 10MM SLFTAP CRCIFRM RECESS TITANIUM,$139.20,$0.00,$139.20,$62.64,$99.35,$0.00,$23.29,$0.00,$0.00,$24.37,$139.20,$0.00,$69.60,$110.25,$111.36,$0.00,$21.15,$0.00,$22.16,$0.00
400.691,SUP,HCPCS C1713,,400.691  -  SCREW BONE 1.3MM 2.4MM 11MM SELF TAP CRCIFRM TITANIUM HAND,$139.20,$0.00,$139.20,$62.64,$99.35,$0.00,$23.29,$0.00,$0.00,$24.37,$139.20,$0.00,$69.60,$110.25,$111.36,$0.00,$21.15,$0.00,$22.16,$0.00
400.692,SUP,HCPCS C1713,,400.692  -  SCREW BONE 1.3MM 2.4MM 12MM SELF TAP CRCIFRM TITANIUM HAND,$139.20,$0.00,$139.20,$62.64,$99.35,$0.00,$23.29,$0.00,$0.00,$24.37,$139.20,$0.00,$69.60,$110.25,$111.36,$0.00,$21.15,$0.00,$22.16,$0.00
400.693,SUP,HCPCS C1713,,400.693  -  SCREW BONE 1.3MM 2.4MM 13MM SELF TAP CRCIFRM TITANIUM HAND,$139.20,$0.00,$139.20,$62.64,$99.35,$0.00,$23.29,$0.00,$0.00,$24.37,$139.20,$0.00,$69.60,$110.25,$111.36,$0.00,$21.15,$0.00,$22.16,$0.00
400.694,SUP,HCPCS C1713,,400.694  -  SCREW BONE 1.3MM 2.4MM 14MM SELF TAP CRCIFRM TITANIUM HAND,$139.20,$0.00,$139.20,$62.64,$99.35,$0.00,$23.29,$0.00,$0.00,$24.37,$139.20,$0.00,$69.60,$110.25,$111.36,$0.00,$21.15,$0.00,$22.16,$0.00
400.696,SUP,HCPCS C1713,,400.696  -  SCREW BONE 1.3MM 2.4MM 16MM SELF TAP CRCIFRM TITANIUM HAND,$139.20,$0.00,$139.20,$62.64,$99.35,$0.00,$23.29,$0.00,$0.00,$24.37,$139.20,$0.00,$69.60,$110.25,$111.36,$0.00,$21.15,$0.00,$22.16,$0.00
400.698,SUP,HCPCS C1713,,400.698  -  SCREW BONE 1.3MM 2.4MM 18MM SLFTAP CRCIFRM RECESS TITANIUM,$139.20,$0.00,$139.20,$62.64,$99.35,$0.00,$23.29,$0.00,$0.00,$24.37,$139.20,$0.00,$69.60,$110.25,$111.36,$0.00,$21.15,$0.00,$22.16,$0.00
400.806,SUP,HCPCS C1713,,400.806  -  SCREW BONE 1.5MM 3MM 6MM SELF TAP CRCIFRM TITANIUM HAND,$63.45,$0.00,$63.45,$28.55,$45.28,$0.00,$10.61,$0.00,$0.00,$11.11,$63.45,$0.00,$31.73,$50.25,$50.76,$0.00,$9.64,$0.00,$10.10,$0.00
400.807,SUP,HCPCS C1713,,400.807  -  SCREW BONE 1.5MM 3MM 7MM SELF TAP CRCIFRM TITANIUM HAND,$63.45,$0.00,$63.45,$28.55,$45.28,$0.00,$10.61,$0.00,$0.00,$11.11,$63.45,$0.00,$31.73,$50.25,$50.76,$0.00,$9.64,$0.00,$10.10,$0.00
400.808,SUP,HCPCS C1713,,400.808  -  SCREW BONE 1.5MM 3MM 8MM SELF TAP CRCIFRM TITANIUM HAND,$63.45,$0.00,$63.45,$28.55,$45.28,$0.00,$10.61,$0.00,$0.00,$11.11,$63.45,$0.00,$31.73,$50.25,$50.76,$0.00,$9.64,$0.00,$10.10,$0.00
400.809,SUP,HCPCS C1713,,400.809  -  SCREW BONE 1.5MM 3MM 9MM SELF TAP CRCIFRM TITANIUM HAND,$63.45,$0.00,$63.45,$28.55,$45.28,$0.00,$10.61,$0.00,$0.00,$11.11,$63.45,$0.00,$31.73,$50.25,$50.76,$0.00,$9.64,$0.00,$10.10,$0.00
400.81,SUP,HCPCS C1713,,400.810  -  SCREW BONE 1.5MM 3MM 10MM SELF TAP CRCIFRM TITANIUM HAND,$63.45,$0.00,$63.45,$28.55,$45.28,$0.00,$10.61,$0.00,$0.00,$11.11,$63.45,$0.00,$31.73,$50.25,$50.76,$0.00,$9.64,$0.00,$10.10,$0.00
400.811,SUP,HCPCS C1713,,400.811  -  SCREW BONE 1.5MM 3MM 11MM SELF TAP CRCIFRM TITANIUM HAND,$63.45,$0.00,$63.45,$28.55,$45.28,$0.00,$10.61,$0.00,$0.00,$11.11,$63.45,$0.00,$31.73,$50.25,$50.76,$0.00,$9.64,$0.00,$10.10,$0.00
400.812,SUP,HCPCS C1713,,400.812  -  SCREW BONE 1.5MM 3MM 12MM SELF TAP CRCIFRM RECESS TITANIUM,$63.45,$0.00,$63.45,$28.55,$45.28,$0.00,$10.61,$0.00,$0.00,$11.11,$63.45,$0.00,$31.73,$50.25,$50.76,$0.00,$9.64,$0.00,$10.10,$0.00
400.814,SUP,HCPCS C1713,,400.814  -  SCREW BONE 1.5MM 3MM 14MM SELF TAP CRCIFRM TITANIUM HAND,$63.45,$0.00,$63.45,$28.55,$45.28,$0.00,$10.61,$0.00,$0.00,$11.11,$63.45,$0.00,$31.73,$50.25,$50.76,$0.00,$9.64,$0.00,$10.10,$0.00
400.816,SUP,HCPCS C1713,,400.816  -  SCREW BONE 1.5MM 3MM 16MM SELF TAP CRCIFRM TITANIUM HAND,$63.45,$0.00,$63.45,$28.55,$45.28,$0.00,$10.61,$0.00,$0.00,$11.11,$63.45,$0.00,$31.73,$50.25,$50.76,$0.00,$9.64,$0.00,$10.10,$0.00
400.818,SUP,HCPCS C1713,,400.818  -  SCREW BONE 1.5MM 3MM 18MM SELF TAP CRCIFRM TITANIUM HAND,$63.45,$0.00,$63.45,$28.55,$45.28,$0.00,$10.61,$0.00,$0.00,$11.11,$63.45,$0.00,$31.73,$50.25,$50.76,$0.00,$9.64,$0.00,$10.10,$0.00
400.82,SUP,HCPCS C1713,,400.820  -  SCREW BONE 1.5MM 3MM 20MM SELF TAP CRCIFRM TITANIUM HAND,$63.45,$0.00,$63.45,$28.55,$45.28,$0.00,$10.61,$0.00,$0.00,$11.11,$63.45,$0.00,$31.73,$50.25,$50.76,$0.00,$9.64,$0.00,$10.10,$0.00
400.822,SUP,HCPCS C1713,,400.822  -  SCREW BONE 1.5MM 3MM 22MM SLFTAP CRCIFRM RECESS TITANIUM,$63.45,$0.00,$63.45,$28.55,$45.28,$0.00,$10.61,$0.00,$0.00,$11.11,$63.45,$0.00,$31.73,$50.25,$50.76,$0.00,$9.64,$0.00,$10.10,$0.00
400.824,SUP,HCPCS C1713,,400.824  -  SCREW BONE 1.5MM 3MM 24MM SLFTAP CRCIFRM RECESS TITANIUM,$63.45,$0.00,$63.45,$28.55,$45.28,$0.00,$10.61,$0.00,$0.00,$11.11,$63.45,$0.00,$31.73,$50.25,$50.76,$0.00,$9.64,$0.00,$10.10,$0.00
400.834,SUP,HCPCS C1713,,400.834  -  SCREW BONE 4MM 1.5MM CORT CRANFCL TI SLFDRILL LP NONSTRL,$151.38,$0.00,$151.38,$68.12,$108.04,$0.00,$26.08,$0.00,$0.00,$26.50,$151.38,$0.00,$75.69,$119.89,$121.10,$0.00,$23.69,$0.00,$24.10,$0.00
400.835,SUP,HCPCS C1713,,400.835  -  SCREW BONE 5MM 1.5MM CORT CRANFCL TI SLFDRILL LP NONSTRL,$151.38,$0.00,$151.38,$68.12,$108.04,$0.00,$26.08,$0.00,$0.00,$26.50,$151.38,$0.00,$75.69,$119.89,$121.10,$0.00,$23.69,$0.00,$24.10,$0.00
400.996,SUP,HCPCS C1713,,400.996  -  SCREW BONE 1.4MM 15MM SLFDRILL WIRE FIX TITANIUM MIDFAC,$347.50,$0.00,$347.50,$156.38,$248.01,$0.00,$59.87,$0.00,$0.00,$60.84,$347.50,$0.00,$173.75,$275.22,$278.00,$0.00,$54.38,$0.00,$55.32,$0.00
400.997,SUP,HCPCS C1713,,400.997  -  SCREW BONE 1.4MM 21MM SLFDRILL WIRE FIX TITANIUM MIDFAC,$347.50,$0.00,$347.50,$156.38,$248.01,$0.00,$59.87,$0.00,$0.00,$60.84,$347.50,$0.00,$173.75,$275.22,$278.00,$0.00,$54.38,$0.00,$55.32,$0.00
401.006,SUP,HCPCS C1713,,401.006  -  SCREW BONE STANDARD 2MM 3.5MM 6MM CRCIFRM TITANIUM CORTICAL,$52.20,$0.00,$52.20,$23.49,$37.26,$0.00,$8.73,$0.00,$0.00,$9.14,$52.20,$0.00,$26.10,$41.34,$41.76,$0.00,$7.93,$0.00,$8.31,$0.00
401.008,SUP,HCPCS C1713,,401.008  -  SCREW BONE STANDARD 2MM 3.5MM 8MM CRCIFRM TITANIUM CORTICAL,$52.20,$0.00,$52.20,$23.49,$37.26,$0.00,$8.73,$0.00,$0.00,$9.14,$52.20,$0.00,$26.10,$41.34,$41.76,$0.00,$7.93,$0.00,$8.31,$0.00
401.012,SUP,HCPCS C1713,,401.012  -  SCREW BONE STANDARD 2MM 3.5MM 12MM CRCIFRM TITANIUM CORTICAL,$52.20,$0.00,$52.20,$23.49,$37.26,$0.00,$8.73,$0.00,$0.00,$9.14,$52.20,$0.00,$26.10,$41.34,$41.76,$0.00,$7.93,$0.00,$8.31,$0.00
401.02,SUP,HCPCS C1713,,401.020  -  SCREW BONE STANDARD 2MM 3.5MM 20MM CRCIFRM TITANIUM CORTICAL,$52.20,$0.00,$52.20,$23.49,$37.26,$0.00,$8.73,$0.00,$0.00,$9.14,$52.20,$0.00,$26.10,$41.34,$41.76,$0.00,$7.93,$0.00,$8.31,$0.00
401.022,SUP,HCPCS C1713,,401.022  -  SCREW BONE STANDARD 2MM 3.5MM 22MM CRCIFRM TITANIUM CORTICAL,$52.20,$0.00,$52.20,$23.49,$37.26,$0.00,$8.73,$0.00,$0.00,$9.14,$52.20,$0.00,$26.10,$41.34,$41.76,$0.00,$7.93,$0.00,$8.31,$0.00
401.024,SUP,HCPCS C1713,,401.024  -  SCREW BONE STANDARD 2MM 3.5MM 24MM SLFTAP CRCIFRM RECESS,$52.20,$0.00,$52.20,$23.49,$37.26,$0.00,$8.73,$0.00,$0.00,$9.14,$52.20,$0.00,$26.10,$41.34,$41.76,$0.00,$7.93,$0.00,$8.31,$0.00
401.026,SUP,HCPCS C1713,,401.026  -  SCREW BONE 2MM 26MM TITANIUM CORTICAL NONSTRL MINI FRAGMENT,$52.20,$0.00,$52.20,$23.49,$37.26,$0.00,$8.73,$0.00,$0.00,$9.14,$52.20,$0.00,$26.10,$41.34,$41.76,$0.00,$7.93,$0.00,$8.31,$0.00
401.028,SUP,HCPCS C1713,,401.028  -  SCREW BONE 2MM 28MM TITANIUM CORTICAL NONSTRL MINI FRAGMENT,$52.20,$0.00,$52.20,$23.49,$37.26,$0.00,$8.73,$0.00,$0.00,$9.14,$52.20,$0.00,$26.10,$41.34,$41.76,$0.00,$7.93,$0.00,$8.31,$0.00
401.03,SUP,HCPCS C1713,,401.030  -  SCREW BONE 2MM 30MM TITANIUM CORTICAL NONSTRL MINI FRAGMENT,$52.20,$0.00,$52.20,$23.49,$37.26,$0.00,$8.73,$0.00,$0.00,$9.14,$52.20,$0.00,$26.10,$41.34,$41.76,$0.00,$7.93,$0.00,$8.31,$0.00
401.032,SUP,HCPCS C1713,,401.032  -  SCREW BONE 2MM 32MM TITANIUM CORTICAL NONSTRL MINI FRAGMENT,$52.20,$0.00,$52.20,$23.49,$37.26,$0.00,$8.73,$0.00,$0.00,$9.14,$52.20,$0.00,$26.10,$41.34,$41.76,$0.00,$7.93,$0.00,$8.31,$0.00
401.034,SUP,HCPCS C1713,,401.034  -  SCREW BONE 2MM 34MM TITANIUM CORTICAL NONSTRL MINI FRAGMENT,$52.20,$0.00,$52.20,$23.49,$37.26,$0.00,$8.73,$0.00,$0.00,$9.14,$52.20,$0.00,$26.10,$41.34,$41.76,$0.00,$7.93,$0.00,$8.31,$0.00
401.036,SUP,HCPCS C1713,,401.036  -  SCREW BONE 2MM 36MM TITANIUM CORTICAL NONSTRL MINI FRAGMENT,$52.20,$0.00,$52.20,$23.49,$37.26,$0.00,$8.73,$0.00,$0.00,$9.14,$52.20,$0.00,$26.10,$41.34,$41.76,$0.00,$7.93,$0.00,$8.31,$0.00
401.038,SUP,HCPCS C1713,,401.038  -  SCREW BONE 2MM 38MM TITANIUM CORTICAL NONSTRL MINI FRAGMENT,$52.20,$0.00,$52.20,$23.49,$37.26,$0.00,$8.73,$0.00,$0.00,$9.14,$52.20,$0.00,$26.10,$41.34,$41.76,$0.00,$7.93,$0.00,$8.31,$0.00
401.158,SUP,HCPCS C1713,,401.158  -  SCREW BONE 8MM 2MM CORT CRANFCL TI SLFTAP FLUT TIP NONSTRL,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
401.292,SUP,HCPCS C1713,,401.292  -  SCREW BONE BLUE 6MM 2MM CRANFCL TI SLFTAP +DR RECESS LCK,"$1,091.25",$0.00,"$1,091.25",$491.06,$778.83,$0.00,$188.02,$0.00,$0.00,$191.07,"$1,091.25",$0.00,$545.63,$864.27,$873.00,$0.00,$170.78,$0.00,$173.73,$0.00
401.295,SUP,HCPCS C1713,,401.295  -  SCREW BONE BLUE 10MM 2MM CRNMXF TI SLFTAP LCK +DR RECESS,$218.25,$0.00,$218.25,$98.21,$155.77,$0.00,$37.60,$0.00,$0.00,$38.21,$218.25,$0.00,$109.13,$172.85,$174.60,$0.00,$34.16,$0.00,$34.75,$0.00
401.296,SUP,HCPCS C1713,,401.296  -  SCREW BONE BLUE 12MM 2MM CRNMXF TI SLFTAP LCK +DR RECESS,$218.25,$0.00,$218.25,$98.21,$155.77,$0.00,$37.60,$0.00,$0.00,$38.21,$218.25,$0.00,$109.13,$172.85,$174.60,$0.00,$34.16,$0.00,$34.75,$0.00
401.297,SUP,HCPCS C1713,,401.297  -  SCREW BONE BLUE 14MM 2MM CRNMXF TI SLFTAP LCK +DR RECESS,$218.25,$0.00,$218.25,$98.21,$155.77,$0.00,$37.60,$0.00,$0.00,$38.21,$218.25,$0.00,$109.13,$172.85,$174.60,$0.00,$34.16,$0.00,$34.75,$0.00
401.298,SUP,HCPCS C1713,,401.298  -  SCREW BONE BLUE 16MM 2MM CRNMXF TI SLFTAP LCK +DR RECESS,$218.25,$0.00,$218.25,$98.21,$155.77,$0.00,$37.60,$0.00,$0.00,$38.21,$218.25,$0.00,$109.13,$172.85,$174.60,$0.00,$34.16,$0.00,$34.75,$0.00
401.305,SUP,HCPCS C1713,,401.305  -  SCREW BONE 5MM 2.4MM CRNMXF TI ER CRCIFRM RECESS NONSTRL,$119.25,$0.00,$119.25,$53.66,$85.11,$0.00,$20.55,$0.00,$0.00,$20.88,$119.25,$0.00,$59.63,$94.45,$95.40,$0.00,$18.66,$0.00,$18.98,$0.00
401.508,SUP,HCPCS C1713,,401.508  -  SCREW BONE 2.4MM 8MM TI CORT CRNMXF SLFTAP STRL GOLD,$169.88,$0.00,$169.88,$76.44,$121.24,$0.00,$29.27,$0.00,$0.00,$29.74,$169.88,$0.00,$84.94,$134.54,$135.90,$0.00,$26.59,$0.00,$27.04,$0.00
401.51,SUP,HCPCS C1713,,401.510  -  SCREW BONE 2.4MM 10MM TI CORT CRNMXF MANDIB SLFTAP NONSTRL,$169.88,$0.00,$169.88,$76.44,$121.24,$0.00,$29.27,$0.00,$0.00,$29.74,$169.88,$0.00,$84.94,$134.54,$135.90,$0.00,$26.59,$0.00,$27.04,$0.00
401.516,SUP,HCPCS C1713,,401.516  -  SCREW BONE 2.4MM 16MM TI CORT CRNMXF SLFTAP STRL GOLD,$169.88,$0.00,$169.88,$76.44,$121.24,$0.00,$29.27,$0.00,$0.00,$29.74,$169.88,$0.00,$84.94,$134.54,$135.90,$0.00,$26.59,$0.00,$27.04,$0.00
401.518,SUP,HCPCS C1713,,401.518  -  SCREW BONE 2.4MM 18MM TI CORT CRNMXF MANDIB SLFTAP NONSTRL,$169.88,$0.00,$169.88,$76.44,$121.24,$0.00,$29.27,$0.00,$0.00,$29.74,$169.88,$0.00,$84.94,$134.54,$135.90,$0.00,$26.59,$0.00,$27.04,$0.00
401.612,SUP,HCPCS C1713,,401.612  -  SCREW BONE 2.4MM 3.5MM 12MM SELF TAP SMALL CRCIFRM RECESS,$115.93,$0.00,$115.93,$52.17,$82.74,$0.00,$19.97,$0.00,$0.00,$20.30,$115.93,$0.00,$57.96,$91.82,$92.74,$0.00,$18.14,$0.00,$18.46,$0.00
401.614,SUP,HCPCS C1713,,401.614  -  SCREW BONE SMALL 2.4MM 3.5MM 14MM SELF TAP CRCIFRM TITANIUM,$115.93,$0.00,$115.93,$52.17,$82.74,$0.00,$19.97,$0.00,$0.00,$20.30,$115.93,$0.00,$57.96,$91.82,$92.74,$0.00,$18.14,$0.00,$18.46,$0.00
401.616,SUP,HCPCS C1713,,401.616  -  SCREW BONE SMALL 2.4MM 3.5MM 16MM SELF TAP CRCIFRM TITANIUM,$115.93,$0.00,$115.93,$52.17,$82.74,$0.00,$19.97,$0.00,$0.00,$20.30,$115.93,$0.00,$57.96,$91.82,$92.74,$0.00,$18.14,$0.00,$18.46,$0.00
401.618,SUP,HCPCS C1713,,401.618  -  SCREW BONE SMALL 2.4MM 3.5MM 18MM SELF TAP CRCIFRM TITANIUM,$115.93,$0.00,$115.93,$52.17,$82.74,$0.00,$19.97,$0.00,$0.00,$20.30,$115.93,$0.00,$57.96,$91.82,$92.74,$0.00,$18.14,$0.00,$18.46,$0.00
401.62,SUP,HCPCS C1713,,401.620  -  SCREW BONE 2.4MM 3.5MM 20MM SLFTAP CRCIFRM RECESS TITANIUM,$115.93,$0.00,$115.93,$52.17,$82.74,$0.00,$19.97,$0.00,$0.00,$20.30,$115.93,$0.00,$57.96,$91.82,$92.74,$0.00,$18.14,$0.00,$18.46,$0.00
401.622,SUP,HCPCS C1713,,401.622  -  SCREW BONE SMALL 2.4MM 3.5MM 22MM SELF TAP CRCIFRM TITANIUM,$115.93,$0.00,$115.93,$52.17,$82.74,$0.00,$19.97,$0.00,$0.00,$20.30,$115.93,$0.00,$57.96,$91.82,$92.74,$0.00,$18.14,$0.00,$18.46,$0.00
401.624,SUP,HCPCS C1713,,401.624  -  SCREW BONE SMALL 2.4MM 3.5MM 24MM SELF TAP CRCIFRM TITANIUM,$115.93,$0.00,$115.93,$52.17,$82.74,$0.00,$19.97,$0.00,$0.00,$20.30,$115.93,$0.00,$57.96,$91.82,$92.74,$0.00,$18.14,$0.00,$18.46,$0.00
401.626,SUP,HCPCS C1713,,401.626  -  SCREW BONE SMALL 2.4MM 3.5MM 26MM SELF TAP CRCIFRM TITANIUM,$115.93,$0.00,$115.93,$52.17,$82.74,$0.00,$19.97,$0.00,$0.00,$20.30,$115.93,$0.00,$57.96,$91.82,$92.74,$0.00,$18.14,$0.00,$18.46,$0.00
401.628,SUP,HCPCS C1713,,401.628  -  SCREW BONE SMALL 2.4MM 3.5MM 28MM SELF TAP CRCIFRM TITANIUM,$115.93,$0.00,$115.93,$52.17,$82.74,$0.00,$19.97,$0.00,$0.00,$20.30,$115.93,$0.00,$57.96,$91.82,$92.74,$0.00,$18.14,$0.00,$18.46,$0.00
401.63,SUP,HCPCS C1713,,401.630  -  SCREW BONE SMALL 2.4MM 3.5MM 30MM SELF TAP CRCIFRM TITANIUM,$115.93,$0.00,$115.93,$52.17,$82.74,$0.00,$19.97,$0.00,$0.00,$20.30,$115.93,$0.00,$57.96,$91.82,$92.74,$0.00,$18.14,$0.00,$18.46,$0.00
401.756,SUP,HCPCS C1713,,401.756  -  SCREW BONE 2.4MM 6MM SLFTAP STARDRIVE RECESS LCP TITANIUM,$101.65,$0.00,$101.65,$45.74,$72.55,$0.00,$17.01,$0.00,$0.00,$17.80,$101.65,$0.00,$50.83,$80.51,$81.32,$0.00,$15.45,$0.00,$16.18,$0.00
401.757,SUP,HCPCS C1713,,401.757  -  SCREW BONE 2.4MM 7MM SLFTAP LCP TITANIUM CORTICAL NONSTRL,$101.65,$0.00,$101.65,$45.74,$72.55,$0.00,$17.01,$0.00,$0.00,$17.80,$101.65,$0.00,$50.83,$80.51,$81.32,$0.00,$15.45,$0.00,$16.18,$0.00
401.758,SUP,HCPCS C1713,,401.758  -  SCREW BONE 2.4MM 8MM SLFTAP STARDRIVE RECESS LCP TITANIUM,$101.65,$0.00,$101.65,$45.74,$72.55,$0.00,$17.01,$0.00,$0.00,$17.80,$101.65,$0.00,$50.83,$80.51,$81.32,$0.00,$15.45,$0.00,$16.18,$0.00
401.759,SUP,HCPCS C1713,,401.759  -  SCREW BONE 2.4MM 9MM SLFTAP LCP TITANIUM CORTICAL NONSTRL,$101.65,$0.00,$101.65,$45.74,$72.55,$0.00,$17.01,$0.00,$0.00,$17.80,$101.65,$0.00,$50.83,$80.51,$81.32,$0.00,$15.45,$0.00,$16.18,$0.00
401.76,SUP,HCPCS C1713,,401.760  -  SCREW BONE 2.4MM 4MM 10MM SELF TAP STARDRIVE LCP TITANIUM,$101.65,$0.00,$101.65,$45.74,$72.55,$0.00,$17.01,$0.00,$0.00,$17.80,$101.65,$0.00,$50.83,$80.51,$81.32,$0.00,$15.45,$0.00,$16.18,$0.00
401.761,SUP,HCPCS C1713,,401.761  -  SCREW BONE 2.4MM 11MM SLFTAP LCP TITANIUM CORTICAL NONSTRL,$101.65,$0.00,$101.65,$45.74,$72.55,$0.00,$17.01,$0.00,$0.00,$17.80,$101.65,$0.00,$50.83,$80.51,$81.32,$0.00,$15.45,$0.00,$16.18,$0.00
401.762,SUP,HCPCS C1713,,401.762  -  SCREW BONE 2.4MM 4MM 12MM SELF TAP STARDRIVE LCP TITANIUM,$101.65,$0.00,$101.65,$45.74,$72.55,$0.00,$17.01,$0.00,$0.00,$17.80,$101.65,$0.00,$50.83,$80.51,$81.32,$0.00,$15.45,$0.00,$16.18,$0.00
401.763,SUP,HCPCS C1713,,401.763  -  SCREW BONE 2.4MM 13MM SLFTAP LCP TITANIUM CORTICAL NONSTRL,$101.65,$0.00,$101.65,$45.74,$72.55,$0.00,$17.01,$0.00,$0.00,$17.80,$101.65,$0.00,$50.83,$80.51,$81.32,$0.00,$15.45,$0.00,$16.18,$0.00
401.764,SUP,HCPCS C1713,,401.764  -  SCREW BONE 2.4MM 4MM 14MM SELF TAP STARDRIVE LCP TITANIUM,$101.65,$0.00,$101.65,$45.74,$72.55,$0.00,$17.01,$0.00,$0.00,$17.80,$101.65,$0.00,$50.83,$80.51,$81.32,$0.00,$15.45,$0.00,$16.18,$0.00
401.766,SUP,HCPCS C1713,,401.766  -  SCREW BONE 2.4MM 4MM 16MM SELF TAP STARDRIVE LCP TITANIUM,$101.65,$0.00,$101.65,$45.74,$72.55,$0.00,$17.01,$0.00,$0.00,$17.80,$101.65,$0.00,$50.83,$80.51,$81.32,$0.00,$15.45,$0.00,$16.18,$0.00
401.768,SUP,HCPCS C1713,,401.768  -  SCREW BONE 2.4MM 4MM 18MM SELF TAP STARDRIVE LCP TITANIUM,$101.65,$0.00,$101.65,$45.74,$72.55,$0.00,$17.01,$0.00,$0.00,$17.80,$101.65,$0.00,$50.83,$80.51,$81.32,$0.00,$15.45,$0.00,$16.18,$0.00
401.77,SUP,HCPCS C1713,,401.770  -  SCREW BONE 2.4MM 20MM SLFTAP STARDRIVE RECESS LCP TITANIUM,$101.65,$0.00,$101.65,$45.74,$72.55,$0.00,$17.01,$0.00,$0.00,$17.80,$101.65,$0.00,$50.83,$80.51,$81.32,$0.00,$15.45,$0.00,$16.18,$0.00
401.772,SUP,HCPCS C1713,,401.772  -  SCREW BONE 2.4MM 4MM 22MM SELF TAP STARDRIVE LCP TITANIUM,$101.65,$0.00,$101.65,$45.74,$72.55,$0.00,$17.01,$0.00,$0.00,$17.80,$101.65,$0.00,$50.83,$80.51,$81.32,$0.00,$15.45,$0.00,$16.18,$0.00
401.774,SUP,HCPCS C1713,,401.774  -  SCREW BONE 2.4MM 4MM 24MM SELF TAP STARDRIVE LCP TITANIUM,$101.65,$0.00,$101.65,$45.74,$72.55,$0.00,$17.01,$0.00,$0.00,$17.80,$101.65,$0.00,$50.83,$80.51,$81.32,$0.00,$15.45,$0.00,$16.18,$0.00
401.776,SUP,HCPCS C1713,,401.776  -  SCREW BONE 2.4MM 26MM SLFTAP STARDRIVE RECESS LCP TITANIUM,$101.65,$0.00,$101.65,$45.74,$72.55,$0.00,$17.01,$0.00,$0.00,$17.80,$101.65,$0.00,$50.83,$80.51,$81.32,$0.00,$15.45,$0.00,$16.18,$0.00
401.778,SUP,HCPCS C1713,,401.778  -  SCREW BONE 2.4MM 28MM SLFTAP STARDRIVE RECESS LCP TITANIUM,$101.65,$0.00,$101.65,$45.74,$72.55,$0.00,$17.01,$0.00,$0.00,$17.80,$101.65,$0.00,$50.83,$80.51,$81.32,$0.00,$15.45,$0.00,$16.18,$0.00
401.78,SUP,HCPCS C1713,,401.780  -  SCREW BONE 2.4MM 30MM SLFTAP STARDRIVE RECESS LCP TITANIUM,$101.65,$0.00,$101.65,$45.74,$72.55,$0.00,$17.01,$0.00,$0.00,$17.80,$101.65,$0.00,$50.83,$80.51,$81.32,$0.00,$15.45,$0.00,$16.18,$0.00
401.782,SUP,HCPCS C1713,,401.782  -  SCREW BONE 2.4MM 4MM 32MM T8 STARDRIVE RECESS SELF TAP SELF,$101.65,$0.00,$101.65,$45.74,$72.55,$0.00,$17.01,$0.00,$0.00,$17.80,$101.65,$0.00,$50.83,$80.51,$81.32,$0.00,$15.45,$0.00,$16.18,$0.00
401.784,SUP,HCPCS C1713,,401.784  -  SCREW BONE 2.4MM 4MM 34MM T8 STARDRIVE RECESS SELF TAP,$101.65,$0.00,$101.65,$45.74,$72.55,$0.00,$17.01,$0.00,$0.00,$17.80,$101.65,$0.00,$50.83,$80.51,$81.32,$0.00,$15.45,$0.00,$16.18,$0.00
401.786,SUP,HCPCS C1713,,401.786  -  SCREW BONE 2.4MM 36MM SLFTAP STARDRIVE RECESS LCP TITANIUM,$101.65,$0.00,$101.65,$45.74,$72.55,$0.00,$17.01,$0.00,$0.00,$17.80,$101.65,$0.00,$50.83,$80.51,$81.32,$0.00,$15.45,$0.00,$16.18,$0.00
401.788,SUP,HCPCS C1713,,401.788  -  SCREW BONE 2.4MM 4MM 38MM T8 STARDRIVE RECESS SELF TAP LCP,$101.65,$0.00,$101.65,$45.74,$72.55,$0.00,$17.01,$0.00,$0.00,$17.80,$101.65,$0.00,$50.83,$80.51,$81.32,$0.00,$15.45,$0.00,$16.18,$0.00
401.79,SUP,HCPCS C1713,,401.790  -  SCREW BONE 2.4MM 40MM T8 STARDRIVE RECESS SLFTAP TITANIUM,$101.65,$0.00,$101.65,$45.74,$72.55,$0.00,$17.01,$0.00,$0.00,$17.80,$101.65,$0.00,$50.83,$80.51,$81.32,$0.00,$15.45,$0.00,$16.18,$0.00
401.806,SUP,HCPCS C1713,,401.806  -  SCREW BONE 2MM 3.5MM 6MM SELF TAP CRCIFRM RECESS TITANIUM,$63.13,$0.00,$63.13,$28.41,$45.05,$0.00,$10.56,$0.00,$0.00,$11.05,$63.13,$0.00,$31.56,$50.00,$50.50,$0.00,$9.59,$0.00,$10.05,$0.00
401.808,SUP,HCPCS C1713,,401.808  -  SCREW BONE 2MM 3.5MM 8MM SELF TAP CRCIFRM RECESS TITANIUM,$63.13,$0.00,$63.13,$28.41,$45.05,$0.00,$10.56,$0.00,$0.00,$11.05,$63.13,$0.00,$31.56,$50.00,$50.50,$0.00,$9.59,$0.00,$10.05,$0.00
401.81,SUP,HCPCS C1713,,401.810  -  SCREW BONE 2MM 3.5MM 10MM SELF TAP CRCIFRM TITANIUM HAND,$63.13,$0.00,$63.13,$28.41,$45.05,$0.00,$10.56,$0.00,$0.00,$11.05,$63.13,$0.00,$31.56,$50.00,$50.50,$0.00,$9.59,$0.00,$10.05,$0.00
401.812,SUP,HCPCS C1713,,401.812  -  SCREW BONE 2MM 3.5MM 12MM SELF TAP CRCIFRM TITANIUM HAND,$63.13,$0.00,$63.13,$28.41,$45.05,$0.00,$10.56,$0.00,$0.00,$11.05,$63.13,$0.00,$31.56,$50.00,$50.50,$0.00,$9.59,$0.00,$10.05,$0.00
401.814,SUP,HCPCS C1713,,401.814  -  SCREW BONE 2MM 3.5MM 14MM SELF TAP CRCIFRM TITANIUM HAND,$63.13,$0.00,$63.13,$28.41,$45.05,$0.00,$10.56,$0.00,$0.00,$11.05,$63.13,$0.00,$31.56,$50.00,$50.50,$0.00,$9.59,$0.00,$10.05,$0.00
401.816,SUP,HCPCS C1713,,401.816  -  SCREW BONE 2MM 3.5MM 16MM SELF TAP CRCIFRM TITANIUM HAND,$63.13,$0.00,$63.13,$28.41,$45.05,$0.00,$10.56,$0.00,$0.00,$11.05,$63.13,$0.00,$31.56,$50.00,$50.50,$0.00,$9.59,$0.00,$10.05,$0.00
401.818,SUP,HCPCS C1713,,401.818  -  SCREW BONE 2MM 3.5MM 18MM SELF TAP CRCIFRM TITANIUM HAND,$63.13,$0.00,$63.13,$28.41,$45.05,$0.00,$10.56,$0.00,$0.00,$11.05,$63.13,$0.00,$31.56,$50.00,$50.50,$0.00,$9.59,$0.00,$10.05,$0.00
401.82,SUP,HCPCS C1713,,401.820  -  SCREW BONE 2MM 3.5MM 22MM SELF TAP CRCIFRM RECESS TITANIUM,$63.13,$0.00,$63.13,$28.41,$45.05,$0.00,$10.56,$0.00,$0.00,$11.05,$63.13,$0.00,$31.56,$50.00,$50.50,$0.00,$9.59,$0.00,$10.05,$0.00
401.822,SUP,HCPCS C1713,,401.822  -  SCREW BONE 2MM 3.5MM 22MM SELF TAP CRCIFRM TITANIUM HAND,$63.13,$0.00,$63.13,$28.41,$45.05,$0.00,$10.56,$0.00,$0.00,$11.05,$63.13,$0.00,$31.56,$50.00,$50.50,$0.00,$9.59,$0.00,$10.05,$0.00
401.824,SUP,HCPCS C1713,,401.824  -  SCREW BONE 2MM 3.5MM 24MM SELF TAP CRCIFRM TITANIUM HAND,$63.13,$0.00,$63.13,$28.41,$45.05,$0.00,$10.56,$0.00,$0.00,$11.05,$63.13,$0.00,$31.56,$50.00,$50.50,$0.00,$9.59,$0.00,$10.05,$0.00
401.826,SUP,HCPCS C1713,,401.826  -  SCREW BONE 2MM 3.5MM 26MM SELF TAP CRCIFRM TITANIUM HAND,$63.13,$0.00,$63.13,$28.41,$45.05,$0.00,$10.56,$0.00,$0.00,$11.05,$63.13,$0.00,$31.56,$50.00,$50.50,$0.00,$9.59,$0.00,$10.05,$0.00
401.828,SUP,HCPCS C1713,,401.828  -  SCREW BONE 2MM 3.5MM 28MM SELF TAP CRCIFRM TITANIUM HAND,$63.13,$0.00,$63.13,$28.41,$45.05,$0.00,$10.56,$0.00,$0.00,$11.05,$63.13,$0.00,$31.56,$50.00,$50.50,$0.00,$9.59,$0.00,$10.05,$0.00
401.83,SUP,HCPCS C1713,,401.830  -  SCREW BONE 2MM 3.5MM 30MM SLFTAP CRCIFRM RECESS TITANIUM,$63.13,$0.00,$63.13,$28.41,$45.05,$0.00,$10.56,$0.00,$0.00,$11.05,$63.13,$0.00,$31.56,$50.00,$50.50,$0.00,$9.59,$0.00,$10.05,$0.00
401.832,SUP,HCPCS C1713,,401.832  -  SCREW BONE 2MM 3.5MM 32MM SELF TAP CRCIFRM TITANIUM HAND,$63.13,$0.00,$63.13,$28.41,$45.05,$0.00,$10.56,$0.00,$0.00,$11.05,$63.13,$0.00,$31.56,$50.00,$50.50,$0.00,$9.59,$0.00,$10.05,$0.00
401.834,SUP,HCPCS C1713,,401.834  -  SCREW BONE 2MM 3.5MM 34MM SLFTAP CRCIFRM RECESS TITANIUM,$63.13,$0.00,$63.13,$28.41,$45.05,$0.00,$10.56,$0.00,$0.00,$11.05,$63.13,$0.00,$31.56,$50.00,$50.50,$0.00,$9.59,$0.00,$10.05,$0.00
401.836,SUP,HCPCS C1713,,401.836  -  SCREW BONE 2MM 3.5MM 36MM SLFTAP CRCIFRM RECESS TITANIUM,$63.13,$0.00,$63.13,$28.41,$45.05,$0.00,$10.56,$0.00,$0.00,$11.05,$63.13,$0.00,$31.56,$50.00,$50.50,$0.00,$9.59,$0.00,$10.05,$0.00
401.838,SUP,HCPCS C1713,,401.838  -  SCREW BONE 2MM 3.5MM 38MM SLFTAP CRCIFRM RECESS TITANIUM,$63.13,$0.00,$63.13,$28.41,$45.05,$0.00,$10.56,$0.00,$0.00,$11.05,$63.13,$0.00,$31.56,$50.00,$50.50,$0.00,$9.59,$0.00,$10.05,$0.00
401.876,SUP,HCPCS C1713,,401.876  -  SCREW BONE 2MM 6MM SLFTAP LOCKING LCP TITANIUM ORTHOPEDIC,$208.80,$0.00,$208.80,$93.96,$149.02,$0.00,$34.93,$0.00,$0.00,$36.56,$208.80,$0.00,$104.40,$165.37,$167.04,$0.00,$31.73,$0.00,$33.24,$0.00
401.877,SUP,HCPCS C1713,,401.877  -  SCREW BONE 2MM 7MM SLFTAP LOCKING LCP TITANIUM ORTHOPEDIC,$208.80,$0.00,$208.80,$93.96,$149.02,$0.00,$34.93,$0.00,$0.00,$36.56,$208.80,$0.00,$104.40,$165.37,$167.04,$0.00,$31.73,$0.00,$33.24,$0.00
401.878,SUP,HCPCS C1713,,401.878  -  SCREW BONE 2MM 8MM SLFTAP LOCKING LCP TITANIUM CORTICAL,$208.80,$0.00,$208.80,$93.96,$149.02,$0.00,$34.93,$0.00,$0.00,$36.56,$208.80,$0.00,$104.40,$165.37,$167.04,$0.00,$31.73,$0.00,$33.24,$0.00
401.879,SUP,HCPCS C1713,,401.879  -  SCREW BONE 2MM 9MM SLFTAP LOCKING LCP TITANIUM ORTHOPEDIC,$208.80,$0.00,$208.80,$93.96,$149.02,$0.00,$34.93,$0.00,$0.00,$36.56,$208.80,$0.00,$104.40,$165.37,$167.04,$0.00,$31.73,$0.00,$33.24,$0.00
401.88,SUP,HCPCS C1713,,401.880  -  SCREW BONE 2MM 10MM SELF TAP STARDRIVE LCP TITANIUM SMALL,$208.80,$0.00,$208.80,$93.96,$149.02,$0.00,$34.93,$0.00,$0.00,$36.56,$208.80,$0.00,$104.40,$165.37,$167.04,$0.00,$31.73,$0.00,$33.24,$0.00
401.881,SUP,HCPCS C1713,,401.881  -  SCREW BONE 2MM 11MM T6 STARDRIVE RECESS SLFTAP LOCKING LCP,$208.80,$0.00,$208.80,$93.96,$149.02,$0.00,$34.93,$0.00,$0.00,$36.56,$208.80,$0.00,$104.40,$165.37,$167.04,$0.00,$31.73,$0.00,$33.24,$0.00
401.882,SUP,HCPCS C1713,,401.882  -  SCREW BONE 2MM 12MM SELF TAP STARDRIVE LCP TITANIUM SMALL,$208.80,$0.00,$208.80,$93.96,$149.02,$0.00,$34.93,$0.00,$0.00,$36.56,$208.80,$0.00,$104.40,$165.37,$167.04,$0.00,$31.73,$0.00,$33.24,$0.00
401.883,SUP,HCPCS C1713,,401.883  -  SCREW BONE 2MM 13MM SLFTAP LOCKING LCP TITANIUM ORTHOPEDIC,$208.80,$0.00,$208.80,$93.96,$149.02,$0.00,$34.93,$0.00,$0.00,$36.56,$208.80,$0.00,$104.40,$165.37,$167.04,$0.00,$31.73,$0.00,$33.24,$0.00
401.884,SUP,HCPCS C1713,,401.884  -  SCREW BONE 2MM 14MM SELF TAP STARDRIVE LCP TITANIUM SMALL,$208.80,$0.00,$208.80,$93.96,$149.02,$0.00,$34.93,$0.00,$0.00,$36.56,$208.80,$0.00,$104.40,$165.37,$167.04,$0.00,$31.73,$0.00,$33.24,$0.00
401.886,SUP,HCPCS C1713,,401.886  -  SCREW BONE 2MM 16MM SLFTAP LOCKING LCP TITANIUM ORTHOPEDIC,$208.80,$0.00,$208.80,$93.96,$149.02,$0.00,$34.93,$0.00,$0.00,$36.56,$208.80,$0.00,$104.40,$165.37,$167.04,$0.00,$31.73,$0.00,$33.24,$0.00
401.888,SUP,HCPCS C1713,,401.888  -  SCREW BONE 2MM 18MM SLFTAP LOCKING LCP TITANIUM ORTHOPEDIC,$208.80,$0.00,$208.80,$93.96,$149.02,$0.00,$34.93,$0.00,$0.00,$36.56,$208.80,$0.00,$104.40,$165.37,$167.04,$0.00,$31.73,$0.00,$33.24,$0.00
401.89,SUP,HCPCS C1713,,401.890  -  SCREW BONE T6 2MM 20MM SELF TAP LOCK LCP TITANIUM CORTICAL,$208.80,$0.00,$208.80,$93.96,$149.02,$0.00,$34.93,$0.00,$0.00,$36.56,$208.80,$0.00,$104.40,$165.37,$167.04,$0.00,$31.73,$0.00,$33.24,$0.00
401.892,SUP,HCPCS C1713,,401.892  -  SCREW BONE 2MM 22MM SLFTAP LOCKING LCP TITANIUM ORTHOPEDIC,$208.80,$0.00,$208.80,$93.96,$149.02,$0.00,$34.93,$0.00,$0.00,$36.56,$208.80,$0.00,$104.40,$165.37,$167.04,$0.00,$31.73,$0.00,$33.24,$0.00
401.894,SUP,HCPCS C1713,,401.894  -  SCREW BONE 2MM 24MM SLFTAP LOCKING LCP TITANIUM ORTHOPEDIC,$208.80,$0.00,$208.80,$93.96,$149.02,$0.00,$34.93,$0.00,$0.00,$36.56,$208.80,$0.00,$104.40,$165.37,$167.04,$0.00,$31.73,$0.00,$33.24,$0.00
401.896,SUP,HCPCS C1713,,401.896  -  SCREW BONE 2MM 26MM SLFTAP LOCKING LCP TITANIUM ORTHOPEDIC,$208.80,$0.00,$208.80,$93.96,$149.02,$0.00,$34.93,$0.00,$0.00,$36.56,$208.80,$0.00,$104.40,$165.37,$167.04,$0.00,$31.73,$0.00,$33.24,$0.00
401.898,SUP,HCPCS C1713,,401.898  -  SCREW BONE 2MM 28MM SLFTAP LOCKING LCP TITANIUM ORTHOPEDIC,$208.80,$0.00,$208.80,$93.96,$149.02,$0.00,$34.93,$0.00,$0.00,$36.56,$208.80,$0.00,$104.40,$165.37,$167.04,$0.00,$31.73,$0.00,$33.24,$0.00
401.9,SUP,HCPCS C1713,,401.900  -  SCREW BONE 2MM 30MM T6 STARDRIVE RECESS SLFTAP LOCKING LCP,$208.80,$0.00,$208.80,$93.96,$149.02,$0.00,$34.93,$0.00,$0.00,$36.56,$208.80,$0.00,$104.40,$165.37,$167.04,$0.00,$31.73,$0.00,$33.24,$0.00
401.962,SUP,Custom 27203010,,401.962  -  PIN FIX 1.8MM 12MM BUTTRESS TITANIUM DISTAL RADIAL NONSTRL,$111.23,$0.00,$111.23,$0.00,$79.38,$0.00,$0.00,$0.00,$0.00,$0.00,$111.23,$0.00,$55.61,$88.09,$88.98,$0.00,$0.00,$0.00,$0.00,$0.00
401.964,SUP,Custom 27203010,,401.964  -  PIN FIX 1.8MM 14MM BUTTRESS TITANIUM DISTAL RADIAL NONSTRL,$111.23,$0.00,$111.23,$0.00,$79.38,$0.00,$0.00,$0.00,$0.00,$0.00,$111.23,$0.00,$55.61,$88.09,$88.98,$0.00,$0.00,$0.00,$0.00,$0.00
401.966,SUP,Custom 27203010,,401.966  -  PIN FIX 1.8MM 16MM BUTTRESS TITANIUM DISTAL RADIAL NONSTRL,$111.23,$0.00,$111.23,$0.00,$79.38,$0.00,$0.00,$0.00,$0.00,$0.00,$111.23,$0.00,$55.61,$88.09,$88.98,$0.00,$0.00,$0.00,$0.00,$0.00
401.968,SUP,Custom 27203010,,401.968  -  PIN FIX 1.8MM 18MM BUTTRESS TITANIUM NONSTRL,$111.23,$0.00,$111.23,$0.00,$79.38,$0.00,$0.00,$0.00,$0.00,$0.00,$111.23,$0.00,$55.61,$88.09,$88.98,$0.00,$0.00,$0.00,$0.00,$0.00
401.97,SUP,Custom 27203010,,401.970  -  PIN FIX 1.8MM 20MM BUTTRESS TITANIUM DISTAL RAD NONSTRL,$111.23,$0.00,$111.23,$0.00,$79.38,$0.00,$0.00,$0.00,$0.00,$0.00,$111.23,$0.00,$55.61,$88.09,$88.98,$0.00,$0.00,$0.00,$0.00,$0.00
401.972,SUP,Custom 27203010,,401.972  -  PIN FIX 1.8MM 22MM BUTTRESS TITANIUM DISTAL RAD NONSTRL,$111.23,$0.00,$111.23,$0.00,$79.38,$0.00,$0.00,$0.00,$0.00,$0.00,$111.23,$0.00,$55.61,$88.09,$88.98,$0.00,$0.00,$0.00,$0.00,$0.00
401.974,SUP,Custom 27203010,,401.974  -  PIN FIX 1.8MM 24MM BUTTRESS TITANIUM DISTAL RAD NONSTRL,$111.23,$0.00,$111.23,$0.00,$79.38,$0.00,$0.00,$0.00,$0.00,$0.00,$111.23,$0.00,$55.61,$88.09,$88.98,$0.00,$0.00,$0.00,$0.00,$0.00
401.976,SUP,Custom 27203010,,401.976  -  PIN FIX 1.8MM 26MM BUTTRESS TITANIUM DISTAL RAD NONSTRL,$111.23,$0.00,$111.23,$0.00,$79.38,$0.00,$0.00,$0.00,$0.00,$0.00,$111.23,$0.00,$55.61,$88.09,$88.98,$0.00,$0.00,$0.00,$0.00,$0.00
401.978,SUP,Custom 27203010,,401.978  -  PIN FIX 1.8MM 28MM BUTTRESS TITANIUM DISTAL RAD NONSTRL,$111.23,$0.00,$111.23,$0.00,$79.38,$0.00,$0.00,$0.00,$0.00,$0.00,$111.23,$0.00,$55.61,$88.09,$88.98,$0.00,$0.00,$0.00,$0.00,$0.00
401.98,SUP,Custom 27203010,,401.980  -  PIN FIX 1.8MM 30MM BUTTRESS TITANIUM DISTAL RADIAL NONSTRL,$111.23,$0.00,$111.23,$0.00,$79.38,$0.00,$0.00,$0.00,$0.00,$0.00,$111.23,$0.00,$55.61,$88.09,$88.98,$0.00,$0.00,$0.00,$0.00,$0.00
402,SUP,Custom 27204646,,402  -  TUNNELER SURG 2 SLEEVE DISPOSABLE,"$1,080.00",$0.00,"$1,080.00",$0.00,$770.80,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,080.00",$0.00,$540.00,$855.36,$864.00,$0.00,$0.00,$0.00,$0.00,$0.00
402.006,SUP,HCPCS C1713,,402.006  -  SCREW BONE 2.5MM STANDARD SMALL HEXAGON SPHERE 2.7MM 5MM 6MM,$54.93,$0.00,$54.93,$24.72,$39.20,$0.00,$9.19,$0.00,$0.00,$9.62,$54.93,$0.00,$27.46,$43.50,$43.94,$0.00,$8.35,$0.00,$8.74,$0.00
402.008,SUP,HCPCS C1713,,402.008  -  SCREW BONE STANDARD 2.7MM 5MM 8MM SMALL HEXAGONAL SOCKET,$54.93,$0.00,$54.93,$24.72,$39.20,$0.00,$9.19,$0.00,$0.00,$9.62,$54.93,$0.00,$27.46,$43.50,$43.94,$0.00,$8.35,$0.00,$8.74,$0.00
402.01,SUP,HCPCS C1713,,402.010  -  SCREW BONE STANDARD 4MM 2.7MM 10MM T8 STARDRIVE SLFTAP,$54.93,$0.00,$54.93,$24.72,$39.20,$0.00,$9.19,$0.00,$0.00,$9.62,$54.93,$0.00,$27.46,$43.50,$43.94,$0.00,$8.35,$0.00,$8.74,$0.00
402.012,SUP,HCPCS C1713,,402.012  -  SCREW BONE 2.5MM STANDARD 2.7MM 5MM 12MM SPHERICAL HEAD,$54.93,$0.00,$54.93,$24.72,$39.20,$0.00,$9.19,$0.00,$0.00,$9.62,$54.93,$0.00,$27.46,$43.50,$43.94,$0.00,$8.35,$0.00,$8.74,$0.00
402.014,SUP,HCPCS C1713,,402.014  -  SCREW BONE 2.5MM STANDARD 2.7MM 5MM 14MM SPHERICAL HEAD,$54.93,$0.00,$54.93,$24.72,$39.20,$0.00,$9.19,$0.00,$0.00,$9.62,$54.93,$0.00,$27.46,$43.50,$43.94,$0.00,$8.35,$0.00,$8.74,$0.00
402.016,SUP,HCPCS C1713,,402.016  -  SCREW BONE 2.5MM STANDARD 2.7MM 5MM 16MM SMALL HEXAGONAL,$54.93,$0.00,$54.93,$24.72,$39.20,$0.00,$9.19,$0.00,$0.00,$9.62,$54.93,$0.00,$27.46,$43.50,$43.94,$0.00,$8.35,$0.00,$8.74,$0.00
402.018,SUP,HCPCS C1713,,402.018  -  SCREW BONE 2.7MM 18MM TITANIUM CORTICAL NONSTRL MINI,$54.93,$0.00,$54.93,$24.72,$39.20,$0.00,$9.19,$0.00,$0.00,$9.62,$54.93,$0.00,$27.46,$43.50,$43.94,$0.00,$8.35,$0.00,$8.74,$0.00
402.02,SUP,HCPCS C1713,,402.020  -  SCREW BONE 2.5MM STANDARD 2.7MM 5MM 20MM SPHERICAL HEAD,$54.93,$0.00,$54.93,$24.72,$39.20,$0.00,$9.19,$0.00,$0.00,$9.62,$54.93,$0.00,$27.46,$43.50,$43.94,$0.00,$8.35,$0.00,$8.74,$0.00
402.022,SUP,HCPCS C1713,,402.022  -  SCREW BONE 2.5MM STANDARD SMALL HEXAGON SPHERE 2.7MM 5MM 22,$54.93,$0.00,$54.93,$24.72,$39.20,$0.00,$9.19,$0.00,$0.00,$9.62,$54.93,$0.00,$27.46,$43.50,$43.94,$0.00,$8.35,$0.00,$8.74,$0.00
402.024,SUP,HCPCS C1713,,402.024  -  SCREW BONE 2.5MM STANDARD 2.7MM 5MM 24MM SPHERICAL HEAD,$54.93,$0.00,$54.93,$24.72,$39.20,$0.00,$9.19,$0.00,$0.00,$9.62,$54.93,$0.00,$27.46,$43.50,$43.94,$0.00,$8.35,$0.00,$8.74,$0.00
402.026,SUP,HCPCS C1713,,402.026  -  SCREW BONE 2.7MM 26MM TITANIUM CORTICAL NONSTRL MINI,$54.93,$0.00,$54.93,$24.72,$39.20,$0.00,$9.19,$0.00,$0.00,$9.62,$54.93,$0.00,$27.46,$43.50,$43.94,$0.00,$8.35,$0.00,$8.74,$0.00
402.028,SUP,HCPCS C1713,,402.028  -  SCREW BONE STANDARD 2.7MM 5MM 28MM SMALL HEXAGONAL SOCKET,$54.93,$0.00,$54.93,$24.72,$39.20,$0.00,$9.19,$0.00,$0.00,$9.62,$54.93,$0.00,$27.46,$43.50,$43.94,$0.00,$8.35,$0.00,$8.74,$0.00
402.03,SUP,HCPCS C1713,,402.030  -  SCREW BONE STANDARD 2.7MM 5MM 30MM SMALL HEXAGONAL SOCKET,$54.93,$0.00,$54.93,$24.72,$39.20,$0.00,$9.19,$0.00,$0.00,$9.62,$54.93,$0.00,$27.46,$43.50,$43.94,$0.00,$8.35,$0.00,$8.74,$0.00
402.032,SUP,HCPCS C1713,,402.032  -  SCREW BONE STANDARD 2.7MM 5MM 32MM SMALL HEXAGONAL SOCKET,$54.93,$0.00,$54.93,$24.72,$39.20,$0.00,$9.19,$0.00,$0.00,$9.62,$54.93,$0.00,$27.46,$43.50,$43.94,$0.00,$8.35,$0.00,$8.74,$0.00
402.034,SUP,HCPCS C1713,,402.034  -  SCREW BONE 2.7MM 34MM TITANIUM CORTICAL NONSTRL MINI,$54.93,$0.00,$54.93,$24.72,$39.20,$0.00,$9.19,$0.00,$0.00,$9.62,$54.93,$0.00,$27.46,$43.50,$43.94,$0.00,$8.35,$0.00,$8.74,$0.00
402.036,SUP,HCPCS C1713,,402.036  -  SCREW BONE 2.7MM 36MM TITANIUM CORTICAL NONSTRL MINI,$54.93,$0.00,$54.93,$24.72,$39.20,$0.00,$9.19,$0.00,$0.00,$9.62,$54.93,$0.00,$27.46,$43.50,$43.94,$0.00,$8.35,$0.00,$8.74,$0.00
402.038,SUP,HCPCS C1713,,402.038  -  SCREW BONE 2.5MM 38MM TITANIUM CORTICAL NONSTRL MINI,$54.93,$0.00,$54.93,$24.72,$39.20,$0.00,$9.19,$0.00,$0.00,$9.62,$54.93,$0.00,$27.46,$43.50,$43.94,$0.00,$8.35,$0.00,$8.74,$0.00
402.04,SUP,HCPCS C1713,,402.040  -  SCREW BONE 2.7MM 40MM TITANIUM CORTICAL NONSTRL MINI,$54.93,$0.00,$54.93,$24.72,$39.20,$0.00,$9.19,$0.00,$0.00,$9.62,$54.93,$0.00,$27.46,$43.50,$43.94,$0.00,$8.35,$0.00,$8.74,$0.00
402.208,SUP,HCPCS C1713,,402.208  -  SCREW BONE 2.7MM 8MM SLFTAP T8 STARDRIVE RECESS LOCKING LCP,$215.63,$0.00,$215.63,$97.03,$153.89,$0.00,$36.07,$0.00,$0.00,$37.75,$215.63,$0.00,$107.81,$170.78,$172.50,$0.00,$32.76,$0.00,$34.33,$0.00
402.21,SUP,HCPCS C1713,,402.210  -  SCREW BONE 2.7MM 10MM T8 STARDRIVE RECESS SLFTAP LOCKING LCP,$215.63,$0.00,$215.63,$97.03,$153.89,$0.00,$36.07,$0.00,$0.00,$37.75,$215.63,$0.00,$107.81,$170.78,$172.50,$0.00,$32.76,$0.00,$34.33,$0.00
402.212,SUP,HCPCS C1713,,402.212  -  SCREW BONE 2.7MM 12MM T8 STARDRIVE RECESS SELF TAP LOCK,$215.63,$0.00,$215.63,$97.03,$153.89,$0.00,$36.07,$0.00,$0.00,$37.75,$215.63,$0.00,$107.81,$170.78,$172.50,$0.00,$32.76,$0.00,$34.33,$0.00
402.214,SUP,HCPCS C1713,,402.214  -  SCREW BONE 2.7MM 14MM T8 STARDRIVE RECESS SELF TAP LOCK LCP,$215.63,$0.00,$215.63,$97.03,$153.89,$0.00,$36.07,$0.00,$0.00,$37.75,$215.63,$0.00,$107.81,$170.78,$172.50,$0.00,$32.76,$0.00,$34.33,$0.00
402.216,SUP,HCPCS C1713,,402.216  -  SCREW BONE T8 2.7MM 16MM SELF TAP STARDRIVE LCP TITANIUM,$215.63,$0.00,$215.63,$97.03,$153.89,$0.00,$36.07,$0.00,$0.00,$37.75,$215.63,$0.00,$107.81,$170.78,$172.50,$0.00,$32.76,$0.00,$34.33,$0.00
402.218,SUP,HCPCS C1713,,402.218  -  SCREW BONE T8 2.7MM 18MM SELF TAP STARDRIVE LCP TITANIUM,$215.63,$0.00,$215.63,$97.03,$153.89,$0.00,$36.07,$0.00,$0.00,$37.75,$215.63,$0.00,$107.81,$170.78,$172.50,$0.00,$32.76,$0.00,$34.33,$0.00
402.22,SUP,HCPCS C1713,,402.220  -  SCREW BONE T8 2.7MM 20MM SELF TAP STARDRIVE LCP TITANIUM,$215.63,$0.00,$215.63,$97.03,$153.89,$0.00,$36.07,$0.00,$0.00,$37.75,$215.63,$0.00,$107.81,$170.78,$172.50,$0.00,$32.76,$0.00,$34.33,$0.00
402.222,SUP,HCPCS C1713,,402.222  -  SCREW BONE 2.7MM 22MM T8 STARDRIVE RECESS SELF TAP LOCK LCP,$215.63,$0.00,$215.63,$97.03,$153.89,$0.00,$36.07,$0.00,$0.00,$37.75,$215.63,$0.00,$107.81,$170.78,$172.50,$0.00,$32.76,$0.00,$34.33,$0.00
402.224,SUP,HCPCS C1713,,402.224  -  SCREW BONE 2.7MM 24MM CANN SELF TAP LOCK STARDRIVE RECESS,$215.63,$0.00,$215.63,$97.03,$153.89,$0.00,$36.07,$0.00,$0.00,$37.75,$215.63,$0.00,$107.81,$170.78,$172.50,$0.00,$32.76,$0.00,$34.33,$0.00
402.226,SUP,HCPCS C1713,,402.226  -  SCREW BONE 2.7MM 26MM CANN SELF TAP LOCK STARDRIVE RECESS,$215.63,$0.00,$215.63,$97.03,$153.89,$0.00,$36.07,$0.00,$0.00,$37.75,$215.63,$0.00,$107.81,$170.78,$172.50,$0.00,$32.76,$0.00,$34.33,$0.00
402.228,SUP,HCPCS C1713,,402.228  -  SCREW BONE 2.7MM 28MM CANN SELF TAP LOCK STARDRIVE RECESS,$215.63,$0.00,$215.63,$97.03,$153.89,$0.00,$36.07,$0.00,$0.00,$37.75,$215.63,$0.00,$107.81,$170.78,$172.50,$0.00,$32.76,$0.00,$34.33,$0.00
402.23,SUP,HCPCS C1713,,402.230  -  SCREW BONE 2.7MM 30MM SELF TAP LOCK T8 LCP STARDRIVE,$215.63,$0.00,$215.63,$97.03,$153.89,$0.00,$36.07,$0.00,$0.00,$37.75,$215.63,$0.00,$107.81,$170.78,$172.50,$0.00,$32.76,$0.00,$34.33,$0.00
402.232,SUP,HCPCS C1713,,402.232  -  SCREW BONE 2.7MM 32MM CANN SELF TAP LOCK STARDRIVE RECESS,$215.63,$0.00,$215.63,$97.03,$153.89,$0.00,$36.07,$0.00,$0.00,$37.75,$215.63,$0.00,$107.81,$170.78,$172.50,$0.00,$32.76,$0.00,$34.33,$0.00
402.234,SUP,HCPCS C1713,,402.234  -  SCREW BONE 2.7MM 34MM SLFTAP LOCKING STARDRIVE RECESS LCP,$215.63,$0.00,$215.63,$97.03,$153.89,$0.00,$36.07,$0.00,$0.00,$37.75,$215.63,$0.00,$107.81,$170.78,$172.50,$0.00,$32.76,$0.00,$34.33,$0.00
402.236,SUP,HCPCS C1713,,402.236  -  SCREW BONE 2.7MM 36MM CANN SELF TAP LOCK STARDRIVE RECESS,$215.63,$0.00,$215.63,$97.03,$153.89,$0.00,$36.07,$0.00,$0.00,$37.75,$215.63,$0.00,$107.81,$170.78,$172.50,$0.00,$32.76,$0.00,$34.33,$0.00
402.238,SUP,HCPCS C1713,,402.238  -  SCREW BONE 2.7MM 38MM SLFTAP LOCKING T8 STARDRIVE RECESS LCP,$215.63,$0.00,$215.63,$97.03,$153.89,$0.00,$36.07,$0.00,$0.00,$37.75,$215.63,$0.00,$107.81,$170.78,$172.50,$0.00,$32.76,$0.00,$34.33,$0.00
402.24,SUP,HCPCS C1713,,402.240  -  SCREW BONE 2.7MM 40MM SELF TAP LOCK T8 LCP STARDRIVE,$215.63,$0.00,$215.63,$97.03,$153.89,$0.00,$36.07,$0.00,$0.00,$37.75,$215.63,$0.00,$107.81,$170.78,$172.50,$0.00,$32.76,$0.00,$34.33,$0.00
402.242,SUP,HCPCS C1713,,402.242  -  SCREW BONE 2.7MM 42MM SLFTAP LOCKING STARDRIVE RECESS LCP,$215.63,$0.00,$215.63,$97.03,$153.89,$0.00,$36.07,$0.00,$0.00,$37.75,$215.63,$0.00,$107.81,$170.78,$172.50,$0.00,$32.76,$0.00,$34.33,$0.00
402.244,SUP,HCPCS C1713,,402.244  -  SCREW BONE 2.7MM 44MM SLFTAP LOCKING T8 STARDRIVE RECESS LCP,$215.63,$0.00,$215.63,$97.03,$153.89,$0.00,$36.07,$0.00,$0.00,$37.75,$215.63,$0.00,$107.81,$170.78,$172.50,$0.00,$32.76,$0.00,$34.33,$0.00
402.246,SUP,HCPCS C1713,,402.246  -  SCREW BONE 2.7MM 46MM SLFTAP LOCKING T8 STARDRIVE RECESS LCP,$215.63,$0.00,$215.63,$97.03,$153.89,$0.00,$36.07,$0.00,$0.00,$37.75,$215.63,$0.00,$107.81,$170.78,$172.50,$0.00,$32.76,$0.00,$34.33,$0.00
402.248,SUP,HCPCS C1713,,402.248  -  SCREW BONE 2.7MM 48MM SLFTAP LOCKING STARDRIVE RECESS LCP,$215.63,$0.00,$215.63,$97.03,$153.89,$0.00,$36.07,$0.00,$0.00,$37.75,$215.63,$0.00,$107.81,$170.78,$172.50,$0.00,$32.76,$0.00,$34.33,$0.00
402.25,SUP,HCPCS C1713,,402.250  -  SCREW BONE 2MM 50MM T6 STARDRIVE RECESS SLFTAP LOCKING LCP,$215.63,$0.00,$215.63,$97.03,$153.89,$0.00,$36.07,$0.00,$0.00,$37.75,$215.63,$0.00,$107.81,$170.78,$172.50,$0.00,$32.76,$0.00,$34.33,$0.00
402.255,SUP,HCPCS C1713,,402.255  -  SCREW BONE 2.7MM 55MM SLFTAP LOCKING STARDRIVE RECESS LCP,$215.63,$0.00,$215.63,$97.03,$153.89,$0.00,$36.07,$0.00,$0.00,$37.75,$215.63,$0.00,$107.81,$170.78,$172.50,$0.00,$32.76,$0.00,$34.33,$0.00
402.26,SUP,HCPCS C1713,,402.260  -  SCREW BONE 2MM 60MM T6 STARDRIVE RECESS SLFTAP LOCKING LCP,$215.63,$0.00,$215.63,$97.03,$153.89,$0.00,$36.07,$0.00,$0.00,$37.75,$215.63,$0.00,$107.81,$170.78,$172.50,$0.00,$32.76,$0.00,$34.33,$0.00
402.608,SUP,HCPCS C1713,,402.608  -  SCREW BONE 3MM 4MM 1.2MM 8MM 4MM CANN TITANIUM SMALL BONE,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
402.609,SUP,HCPCS C1713,,402.609  -  SCREW BONE 3MM 4MM 1.2MM 9MM 4MM CANN TITANIUM SMALL BONE,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
402.61,SUP,HCPCS C1713,,402.610  -  SCREW BONE 3MM 4MM 1.2MM 10MM 4MM CANN TITANIUM SMALL BONE,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
402.611,SUP,HCPCS C1713,,402.611  -  SCREW BONE 3MM 4MM 1.2MM 11MM 4MM CANN TITANIUM SMALL BONE,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
402.612,SUP,HCPCS C1713,,402.612  -  SCREW BONE 3MM 4MM 1.2MM 12MM 4MM CANN TITANIUM SMALL BONE,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
402.613,SUP,HCPCS C1713,,402.613  -  SCREW BONE 3MM 4MM 1.2MM 13MM 4MM CANN TITANIUM SMALL BONE,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
402.614,SUP,HCPCS C1713,,402.614  -  SCREW BONE SHORT THREAD 3MM 14MM 4MM CANN SELF DRILL SELF,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
402.615,SUP,HCPCS C1713,,402.615  -  SCREW BONE 3MM 4MM 1.2MM 15MM 4MM CANN TITANIUM SMALL BONE,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
402.616,SUP,HCPCS C1713,,402.616  -  SCREW BONE 3MM 4MM 1.2MM 16MM 4MM CANN TITANIUM SMALL BONE,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
402.617,SUP,HCPCS C1713,,402.617  -  SCREW BONE 3MM 4MM 1.2MM 17MM 4MM CANN TITANIUM SMALL BONE,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
402.618,SUP,HCPCS C1713,,402.618  -  SCREW BONE 3MM 4MM 1.2MM 18MM 5MM CANN TITANIUM SMALL BONE,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
402.619,SUP,HCPCS C1713,,402.619  -  SCREW BONE 3MM 4MM 1.2MM 19MM 5MM CANN TITANIUM SMALL BONE,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
402.62,SUP,HCPCS C1713,,402.620  -  SCREW BONE 3MM 4MM 1.2MM 20MM 5MM CANN TITANIUM SMALL BONE,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
402.621,SUP,HCPCS C1713,,402.621  -  SCREW BONE 3MM 4MM 1.2MM 21MM 5MM CANN TITANIUM SMALL BONE,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
402.622,SUP,HCPCS C1713,,402.622  -  SCREW BONE 3MM 4MM 1.2MM 22MM 5MM CANN TITANIUM SMALL BONE,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
402.623,SUP,HCPCS C1713,,402.623  -  SCREW BONE 3MM 4MM 1.2MM 23MM 5MM CANN TITANIUM SMALL BONE,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
402.624,SUP,HCPCS C1713,,402.624  -  SCREW BONE 3MM 4MM 1.2MM 24MM 6MM CANN TITANIUM SMALL BONE,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
402.625,SUP,HCPCS C1713,,402.625  -  SCREW BONE 3MM 4MM 1.2MM 25MM 6MM CANN TITANIUM SMALL BONE,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
402.626,SUP,HCPCS C1713,,402.626  -  SCREW BONE 3MM 4MM 1.2MM 26MM 6MM CANN TITANIUM SMALL BONE,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
402.627,SUP,HCPCS C1713,,402.627  -  SCREW BONE 3MM 4MM 1.2MM 27MM 6MM CANN TITANIUM SMALL BONE,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
402.628,SUP,HCPCS C1713,,402.628  -  SCREW BONE 3MM 4MM 1.2MM 28MM 6MM CANN TITANIUM SMALL BONE,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
402.629,SUP,HCPCS C1713,,402.629  -  SCREW BONE 3MM 4MM 1.2MM 29MM 6MM CANN TITANIUM SMALL BONE,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
402.63,SUP,HCPCS C1713,,402.630  -  SCREW BONE 3MM 4MM 1.2MM 30MM 6MM CANN TITANIUM SMALL BONE,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
402.632,SUP,HCPCS C1713,,402.632  -  SCREW BONE 3MM 4MM 1.2MM 32MM 6MM CANN TITANIUM SMALL BONE,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
402.634,SUP,HCPCS C1713,,402.634  -  SCREW BONE 3MM 4MM 1.2MM 34MM 7MM CANN TITANIUM SMALL BONE,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
402.636,SUP,HCPCS C1713,,402.636  -  SCREW BONE 3MM 4MM 1.2MM 36MM 7MM CANN TITANIUM SMALL BONE,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
402.638,SUP,HCPCS C1713,,402.638  -  SCREW BONE 3MM 4MM 1.2MM 38MM 8MM CANN TITANIUM SMALL BONE,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
402.64,SUP,HCPCS C1713,,402.640  -  SCREW BONE 3MM 4MM 1.2MM 40MM 8MM CANN TITANIUM SMALL BONE,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
402.714,SUP,HCPCS C1713,,402.714  -  SCREW BONE 3MM 4MM 1.2MM 14MM 6MM CANN TITANIUM SMALL BONE,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
402.715,SUP,HCPCS C1713,,402.715  -  SCREW BONE LNGTHRD 3MM 15MM CANN LOCK STARDRIVE RECESS,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
402.716,SUP,HCPCS C1713,,402.716  -  SCREW BONE 3MM 4MM 1.2MM 16MM 7MM CANN TITANIUM SMALL BONE,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
402.717,SUP,HCPCS C1713,,402.717  -  SCREW BONE 3MM 4MM 1.2MM 17MM 8MM CANN TITANIUM SMALL BONE,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
402.718,SUP,HCPCS C1713,,402.718  -  SCREW BONE 3MM 4MM 1.2MM 18MM 8MM CANN TITANIUM SMALL BONE,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
402.719,SUP,HCPCS C1713,,402.719  -  SCREW BONE 3MM 4MM 1.2MM 19MM 9MM CANN TITANIUM SMALL BONE,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
402.72,SUP,HCPCS C1713,,402.720  -  SCREW BONE 3MM 4MM 1.2MM 20MM 9MM CANN TITANIUM SMALL BONE,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
402.721,SUP,HCPCS C1713,,402.721  -  SCREW BONE 3MM 4MM 1.2MM 21MM 9MM CANN TITANIUM SMALL BONE,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
402.722,SUP,HCPCS C1713,,402.722  -  SCREW BONE 3MM 4MM 1.2MM 22MM 10MM CANN TITANIUM SMALL BONE,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
402.723,SUP,HCPCS C1713,,402.723  -  SCREW BONE 3MM 4MM 1.2MM 23MM 10MM CANN TITANIUM SMALL BONE,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
402.724,SUP,HCPCS C1713,,402.724  -  SCREW BONE 3MM 4MM 1.2MM 24MM 10MM CANN TITANIUM SMALL BONE,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
402.725,SUP,HCPCS C1713,,402.725  -  SCREW BONE 3MM 4MM 1.2MM 25MM 10MM CANN TITANIUM SMALL BONE,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
402.726,SUP,HCPCS C1713,,402.726  -  SCREW BONE 3MM 4MM 1.2MM 26MM 12MM CANN TITANIUM SMALL BONE,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
402.727,SUP,HCPCS C1713,,402.727  -  SCREW BONE 3MM 4MM 1.2MM 27MM 12MM CANN TITANIUM SMALL BONE,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
402.728,SUP,HCPCS C1713,,402.728  -  SCREW BONE 3MM 4MM 1.2MM 28MM 12MM CANN TITANIUM SMALL BONE,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
402.729,SUP,HCPCS C1713,,402.729  -  SCREW BONE 3MM 4MM 1.2MM 29MM 12MM CANN TITANIUM SMALL BONE,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
402.73,SUP,HCPCS C1713,,402.730  -  SCREW BONE 3MM 4MM 1.2MM 30MM 14MM CANN TITANIUM SMALL BONE,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
402.732,SUP,HCPCS C1713,,402.732  -  SCREW BONE 3MM 4MM 1.2MM 32MM 14MM CANN TITANIUM SMALL BONE,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
402.734,SUP,HCPCS C1713,,402.734  -  SCREW BONE 3MM 4MM 1.2MM 34MM 16MM CANN TITANIUM SMALL BONE,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
402.736,SUP,HCPCS C1713,,402.736  -  SCREW BONE 3MM 4MM 1.2MM 36MM 16MM CANN TITANIUM SMALL BONE,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
402.738,SUP,HCPCS C1713,,402.738  -  SCREW BONE 3MM 4MM 1.2MM 38MM 18MM CANN TITANIUM SMALL BONE,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
402.74,SUP,HCPCS C1713,,402.740  -  SCREW BONE 3MM 4MM 1.2MM 40MM 18MM CANN TITANIUM SMALL BONE,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$60.50,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$54.95,$0.00,$57.57,$0.00
402.806,SUP,HCPCS C1713,,402.806  -  SCREW BONE FULTHD 2.7MM 5MM 6MM SELF TAP SPHERICAL HEAD,$59.70,$0.00,$59.70,$26.87,$42.61,$0.00,$9.98,$0.00,$0.00,$10.45,$59.70,$0.00,$29.85,$47.28,$47.76,$0.00,$9.07,$0.00,$9.50,$0.00
402.808,SUP,HCPCS C1713,,402.808  -  SCREW BONE FULTHD HEXAGON SPHERE 2.7MM 5MM 8MM SELF TAP,$59.70,$0.00,$59.70,$26.87,$42.61,$0.00,$9.98,$0.00,$0.00,$10.45,$59.70,$0.00,$29.85,$47.28,$47.76,$0.00,$9.07,$0.00,$9.50,$0.00
402.81,SUP,HCPCS C1713,,402.810  -  SCREW BONE 2.7MM 5MM 10MM SELF TAP SPHERICAL HEAD SMALL,$59.70,$0.00,$59.70,$26.87,$42.61,$0.00,$9.98,$0.00,$0.00,$10.45,$59.70,$0.00,$29.85,$47.28,$47.76,$0.00,$9.07,$0.00,$9.50,$0.00
402.812,SUP,HCPCS C1713,,402.812  -  SCREW BONE FULTHD HEXAGON SPHERE 2.7MM 5MM 12MM SELF TAP,$59.70,$0.00,$59.70,$26.87,$42.61,$0.00,$9.98,$0.00,$0.00,$10.45,$59.70,$0.00,$29.85,$47.28,$47.76,$0.00,$9.07,$0.00,$9.50,$0.00
402.814,SUP,HCPCS C1713,,402.814  -  SCREW BONE FULTHD HEXAGON SPHERE 2.7MM 5MM 14MM SELF TAP,$59.70,$0.00,$59.70,$26.87,$42.61,$0.00,$9.98,$0.00,$0.00,$10.45,$59.70,$0.00,$29.85,$47.28,$47.76,$0.00,$9.07,$0.00,$9.50,$0.00
402.816,SUP,HCPCS C1713,,402.816  -  SCREW BONE FULTHD HEXAGON SPHERE 2.7MM 5MM 16MM SELF TAP,$59.70,$0.00,$59.70,$26.87,$42.61,$0.00,$9.98,$0.00,$0.00,$10.45,$59.70,$0.00,$29.85,$47.28,$47.76,$0.00,$9.07,$0.00,$9.50,$0.00
402.818,SUP,HCPCS C1713,,402.818  -  SCREW BONE FULTHD HEXAGON SPHERE 2.7MM 5MM 18MM SELF TAP,$59.70,$0.00,$59.70,$26.87,$42.61,$0.00,$9.98,$0.00,$0.00,$10.45,$59.70,$0.00,$29.85,$47.28,$47.76,$0.00,$9.07,$0.00,$9.50,$0.00
402.82,SUP,HCPCS C1713,,402.820  -  SCREW BONE FULTHD HEXAGON SPHERE 2.7MM 5MM 20MM SELF TAP,$59.70,$0.00,$59.70,$26.87,$42.61,$0.00,$9.98,$0.00,$0.00,$10.45,$59.70,$0.00,$29.85,$47.28,$47.76,$0.00,$9.07,$0.00,$9.50,$0.00
402.822,SUP,HCPCS C1713,,402.822  -  SCREW BONE FULTHD HEXAGON SPHERE 2.7MM 5MM 22MM SELF TAP,$59.70,$0.00,$59.70,$26.87,$42.61,$0.00,$9.98,$0.00,$0.00,$10.45,$59.70,$0.00,$29.85,$47.28,$47.76,$0.00,$9.07,$0.00,$9.50,$0.00
402.824,SUP,HCPCS C1713,,402.824  -  SCREW BONE FULTHD 2.7MM 5MM 24MM SELF TAP SPHERICAL HEAD,$59.70,$0.00,$59.70,$26.87,$42.61,$0.00,$9.98,$0.00,$0.00,$10.45,$59.70,$0.00,$29.85,$47.28,$47.76,$0.00,$9.07,$0.00,$9.50,$0.00
402.826,SUP,HCPCS C1713,,402.826  -  SCREW BONE FULTHD HEXAGON SPHERE 2.7MM 5MM 26MM SELF TAP,$59.70,$0.00,$59.70,$26.87,$42.61,$0.00,$9.98,$0.00,$0.00,$10.45,$59.70,$0.00,$29.85,$47.28,$47.76,$0.00,$9.07,$0.00,$9.50,$0.00
402.828,SUP,HCPCS C1713,,402.828  -  SCREW BONE FULTHD HEXAGON SPHERE 2.7MM 5MM 28MM SELF TAP,$59.70,$0.00,$59.70,$26.87,$42.61,$0.00,$9.98,$0.00,$0.00,$10.45,$59.70,$0.00,$29.85,$47.28,$47.76,$0.00,$9.07,$0.00,$9.50,$0.00
402.83,SUP,HCPCS C1713,,402.830  -  SCREW BONE FULTHD HEXAGON SPHERE 2.7MM 5MM 30MM SELF TAP,$59.70,$0.00,$59.70,$26.87,$42.61,$0.00,$9.98,$0.00,$0.00,$10.45,$59.70,$0.00,$29.85,$47.28,$47.76,$0.00,$9.07,$0.00,$9.50,$0.00
402.832,SUP,HCPCS C1713,,402.832  -  SCREW BONE FULTHD 2.7MM 5MM 32MM SELF TAP HEXAGONAL SOCKET,$59.70,$0.00,$59.70,$26.87,$42.61,$0.00,$9.98,$0.00,$0.00,$10.45,$59.70,$0.00,$29.85,$47.28,$47.76,$0.00,$9.07,$0.00,$9.50,$0.00
402.834,SUP,HCPCS C1713,,402.834  -  SCREW BONE FULTHD 2.7MM 5MM 34MM SELF TAP SPHERICAL HEAD,$59.70,$0.00,$59.70,$26.87,$42.61,$0.00,$9.98,$0.00,$0.00,$10.45,$59.70,$0.00,$29.85,$47.28,$47.76,$0.00,$9.07,$0.00,$9.50,$0.00
402.836,SUP,HCPCS C1713,,402.836  -  SCREW BONE FULTHD 2.7MM 5MM 36MM SELF TAP SPHERICAL HEAD,$59.70,$0.00,$59.70,$26.87,$42.61,$0.00,$9.98,$0.00,$0.00,$10.45,$59.70,$0.00,$29.85,$47.28,$47.76,$0.00,$9.07,$0.00,$9.50,$0.00
402.838,SUP,HCPCS C1713,,402.838  -  SCREW BONE FULTHD HEXAGON SPHERE 2.7MM 5MM 38MM SELF TAP,$59.70,$0.00,$59.70,$26.87,$42.61,$0.00,$9.98,$0.00,$0.00,$10.45,$59.70,$0.00,$29.85,$47.28,$47.76,$0.00,$9.07,$0.00,$9.50,$0.00
402.84,SUP,HCPCS C1713,,402.840  -  SCREW BONE 2.7MM 40MM SLFTAP LCP TITANIUM CORTICAL NONSTRL,$59.70,$0.00,$59.70,$26.87,$42.61,$0.00,$9.98,$0.00,$0.00,$10.45,$59.70,$0.00,$29.85,$47.28,$47.76,$0.00,$9.07,$0.00,$9.50,$0.00
402.845,SUP,HCPCS C1713,,402.845  -  SCREW BONE FULTHD HEXAGON SPHERE 2.7MM 5MM 45MM SELF TAP,$59.70,$0.00,$59.70,$26.87,$42.61,$0.00,$9.98,$0.00,$0.00,$10.45,$59.70,$0.00,$29.85,$47.28,$47.76,$0.00,$9.07,$0.00,$9.50,$0.00
402.85,SUP,HCPCS C1713,,402.850  -  SCREW BONE FULTHD HEXAGON SPHERE 2.7MM 5MM 50MM SELF TAP,$59.70,$0.00,$59.70,$26.87,$42.61,$0.00,$9.98,$0.00,$0.00,$10.45,$59.70,$0.00,$29.85,$47.28,$47.76,$0.00,$9.07,$0.00,$9.50,$0.00
402.855,SUP,HCPCS C1713,,402.855  -  SCREW BONE FULTHD HEXAGON SPHERE 2.7MM 5MM 55MM SELF TAP,$59.70,$0.00,$59.70,$26.87,$42.61,$0.00,$9.98,$0.00,$0.00,$10.45,$59.70,$0.00,$29.85,$47.28,$47.76,$0.00,$9.07,$0.00,$9.50,$0.00
402.87,SUP,HCPCS C1713,,402.870  -  SCREW BONE T8 2.7MM 10MM SELF TAP STARDRIVE LCP TITANIUM RAD,$68.90,$0.00,$68.90,$31.01,$49.17,$0.00,$11.53,$0.00,$0.00,$12.06,$68.90,$0.00,$34.45,$54.57,$55.12,$0.00,$10.47,$0.00,$10.97,$0.00
402.872,SUP,HCPCS C1713,,402.872  -  SCREW BONE T8 2.7MM 12MM SELF TAP STARDRIVE LCP TITANIUM RAD,$68.90,$0.00,$68.90,$31.01,$49.17,$0.00,$11.53,$0.00,$0.00,$12.06,$68.90,$0.00,$34.45,$54.57,$55.12,$0.00,$10.47,$0.00,$10.97,$0.00
402.874,SUP,HCPCS C1713,,402.874  -  SCREW BONE T8 2.7MM 14MM SELF TAP STARDRIVE LCP TITANIUM RAD,$68.90,$0.00,$68.90,$31.01,$49.17,$0.00,$11.53,$0.00,$0.00,$12.06,$68.90,$0.00,$34.45,$54.57,$55.12,$0.00,$10.47,$0.00,$10.97,$0.00
402.876,SUP,HCPCS C1713,,402.876  -  SCREW BONE T8 2.7MM 16MM SELF TAP STARDRIVE LCP TITANIUM RAD,$68.90,$0.00,$68.90,$31.01,$49.17,$0.00,$11.53,$0.00,$0.00,$12.06,$68.90,$0.00,$34.45,$54.57,$55.12,$0.00,$10.47,$0.00,$10.97,$0.00
402.878,SUP,HCPCS C1713,,402.878  -  SCREW BONE T8 2.7MM 18MM SELF TAP STARDRIVE LCP TITANIUM RAD,$68.90,$0.00,$68.90,$31.01,$49.17,$0.00,$11.53,$0.00,$0.00,$12.06,$68.90,$0.00,$34.45,$54.57,$55.12,$0.00,$10.47,$0.00,$10.97,$0.00
402.88,SUP,HCPCS C1713,,402.880  -  SCREW BONE T8 2.7MM 20MM SELF TAP STARDRIVE LCP TITANIUM RAD,$68.90,$0.00,$68.90,$31.01,$49.17,$0.00,$11.53,$0.00,$0.00,$12.06,$68.90,$0.00,$34.45,$54.57,$55.12,$0.00,$10.47,$0.00,$10.97,$0.00
402.882,SUP,HCPCS C1713,,402.882  -  SCREW BONE 2.7MM 22MM T8 STARDRIVE RECESS SLFTAP LCP,$68.90,$0.00,$68.90,$31.01,$49.17,$0.00,$11.53,$0.00,$0.00,$12.06,$68.90,$0.00,$34.45,$54.57,$55.12,$0.00,$10.47,$0.00,$10.97,$0.00
402.884,SUP,HCPCS C1713,,402.884  -  SCREW BONE 2.7MM 24MM T8 STARDRIVE RECESS SLFTAP LCP,$68.90,$0.00,$68.90,$31.01,$49.17,$0.00,$11.53,$0.00,$0.00,$12.06,$68.90,$0.00,$34.45,$54.57,$55.12,$0.00,$10.47,$0.00,$10.97,$0.00
402.886,SUP,HCPCS C1713,,402.886  -  SCREW BONE 2.7MM 26MM T8 STARDRIVE RECESS SLFTAP LCP,$68.90,$0.00,$68.90,$31.01,$49.17,$0.00,$11.53,$0.00,$0.00,$12.06,$68.90,$0.00,$34.45,$54.57,$55.12,$0.00,$10.47,$0.00,$10.97,$0.00
402.888,SUP,HCPCS C1713,,402.888  -  SCREW BONE 2.7MM 28MM T8 STARDRIVE RECESS SLFTAP LCP,$68.90,$0.00,$68.90,$31.01,$49.17,$0.00,$11.53,$0.00,$0.00,$12.06,$68.90,$0.00,$34.45,$54.57,$55.12,$0.00,$10.47,$0.00,$10.97,$0.00
402.89,SUP,HCPCS C1713,,402.890  -  SCREW BONE 2.7MM 30MM T8 STARDRIVE SELF TAP LCP TITANIUM RAD,$68.90,$0.00,$68.90,$31.01,$49.17,$0.00,$11.53,$0.00,$0.00,$12.06,$68.90,$0.00,$34.45,$54.57,$55.12,$0.00,$10.47,$0.00,$10.97,$0.00
402.892,SUP,HCPCS C1713,,402.892  -  SCREW BONE 2.7MM 32MM SLFTAP LCP TITANIUM CORTICAL NONSTRL,$68.90,$0.00,$68.90,$31.01,$49.17,$0.00,$11.53,$0.00,$0.00,$12.06,$68.90,$0.00,$34.45,$54.57,$55.12,$0.00,$10.47,$0.00,$10.97,$0.00
402.894,SUP,HCPCS C1713,,402.894  -  SCREW BONE 2.7MM 34MM SLFTAP LCP TITANIUM CORTICAL NONSTRL,$68.90,$0.00,$68.90,$31.01,$49.17,$0.00,$11.53,$0.00,$0.00,$12.06,$68.90,$0.00,$34.45,$54.57,$55.12,$0.00,$10.47,$0.00,$10.97,$0.00
402.896,SUP,HCPCS C1713,,402.896  -  SCREW BONE 2.7MM 36MM SLFTAP LCP TITANIUM CORTICAL NONSTRL,$68.90,$0.00,$68.90,$31.01,$49.17,$0.00,$11.53,$0.00,$0.00,$12.06,$68.90,$0.00,$34.45,$54.57,$55.12,$0.00,$10.47,$0.00,$10.97,$0.00
402.898,SUP,HCPCS C1713,,402.898  -  SCREW BONE 2.7MM 38MM SLFTAP LCP TITANIUM CORTICAL NONSTRL,$68.90,$0.00,$68.90,$31.01,$49.17,$0.00,$11.53,$0.00,$0.00,$12.06,$68.90,$0.00,$34.45,$54.57,$55.12,$0.00,$10.47,$0.00,$10.97,$0.00
402.9,SUP,HCPCS C1713,,402.900  -  SCREW BONE 2.7MM 5MM 40MM SLFTAP T8 STARDRIVE RECESS LCP,$68.90,$0.00,$68.90,$31.01,$49.17,$0.00,$11.53,$0.00,$0.00,$12.06,$68.90,$0.00,$34.45,$54.57,$55.12,$0.00,$10.47,$0.00,$10.97,$0.00
402.962,SUP,HCPCS C1713,,402.962  -  SCREW BONE 2.7MM 42MM SLFTAP LCP TITANIUM CORTICAL NONSTRL,$68.90,$0.00,$68.90,$31.01,$49.17,$0.00,$11.53,$0.00,$0.00,$12.06,$68.90,$0.00,$34.45,$54.57,$55.12,$0.00,$10.47,$0.00,$10.97,$0.00
402.963,SUP,HCPCS C1713,,402.963  -  SCREW BONE 2.7MM 44MM SLFTAP LCP TITANIUM CORTICAL NONSTRL,$68.90,$0.00,$68.90,$31.01,$49.17,$0.00,$11.53,$0.00,$0.00,$12.06,$68.90,$0.00,$34.45,$54.57,$55.12,$0.00,$10.47,$0.00,$10.97,$0.00
402.965,SUP,HCPCS C1713,,402.965  -  SCREW BONE T8 2.7MM 46MM SELF TAP STARDRIVE LCP TITANIUM RAD,$68.90,$0.00,$68.90,$31.01,$49.17,$0.00,$11.53,$0.00,$0.00,$12.06,$68.90,$0.00,$34.45,$54.57,$55.12,$0.00,$10.47,$0.00,$10.97,$0.00
402.966,SUP,HCPCS C1713,,402.966  -  SCREW BONE T8 2.7MM 48MM SELF TAP STARDRIVE LCP TITANIUM RAD,$68.90,$0.00,$68.90,$31.01,$49.17,$0.00,$11.53,$0.00,$0.00,$12.06,$68.90,$0.00,$34.45,$54.57,$55.12,$0.00,$10.47,$0.00,$10.97,$0.00
402.967,SUP,HCPCS C1713,,402.967  -  SCREW BONE 2.7MM 50MM SLFTAP LCP TITANIUM CORTICAL NONSTRL,$68.90,$0.00,$68.90,$31.01,$49.17,$0.00,$11.53,$0.00,$0.00,$12.06,$68.90,$0.00,$34.45,$54.57,$55.12,$0.00,$10.47,$0.00,$10.97,$0.00
402.968,SUP,HCPCS C1713,,402.968  -  SCREW BONE 2.7MM 55MM SLFTAP LCP TITANIUM CORTICAL NONSTRL,$68.90,$0.00,$68.90,$31.01,$49.17,$0.00,$11.53,$0.00,$0.00,$12.06,$68.90,$0.00,$34.45,$54.57,$55.12,$0.00,$10.47,$0.00,$10.97,$0.00
402.969,SUP,HCPCS C1713,,402.969  -  SCREW BONE 2.7MM 60MM SLFTAP LCP TITANIUM CORTICAL NONSTRL,$68.90,$0.00,$68.90,$31.01,$49.17,$0.00,$11.53,$0.00,$0.00,$12.06,$68.90,$0.00,$34.45,$54.57,$55.12,$0.00,$10.47,$0.00,$10.97,$0.00
404.01,SUP,HCPCS C1713,,404.010  -  SCREW BONE STANDARD 3.5MM 6MM 10MM SMALL HEXAGONAL SOCKET,$26.83,$0.00,$26.83,$12.07,$19.15,$0.00,$4.62,$0.00,$0.00,$4.70,$26.83,$0.00,$13.41,$21.25,$21.46,$0.00,$4.20,$0.00,$4.27,$0.00
404.012,SUP,HCPCS C1713,,404.012  -  SCREW BONE STANDARD HEXAGON 3.5MM 6MM 12MM SELF TAP SOCKET,$26.83,$0.00,$26.83,$12.07,$19.15,$0.00,$4.62,$0.00,$0.00,$4.70,$26.83,$0.00,$13.41,$21.25,$21.46,$0.00,$4.20,$0.00,$4.27,$0.00
404.014,SUP,HCPCS C1713,,404.014  -  SCREW BONE STANDARD HEXAGON 3.5MM 6MM 14MM SELF TAP SOCKET,$26.83,$0.00,$26.83,$12.07,$19.15,$0.00,$4.62,$0.00,$0.00,$4.70,$26.83,$0.00,$13.41,$21.25,$21.46,$0.00,$4.20,$0.00,$4.27,$0.00
404.016,SUP,HCPCS C1713,,404.016  -  SCREW BONE STANDARD HEXAGON 3.5MM 6MM 16MM SELF TAP SOCKET,$26.83,$0.00,$26.83,$12.07,$19.15,$0.00,$4.62,$0.00,$0.00,$4.70,$26.83,$0.00,$13.41,$21.25,$21.46,$0.00,$4.20,$0.00,$4.27,$0.00
404.018,SUP,HCPCS C1713,,404.018  -  SCREW BONE STANDARD HEXAGON 3.5MM 6MM 18MM SELF TAP SOCKET,$27.63,$0.00,$27.63,$12.43,$19.72,$0.00,$4.62,$0.00,$0.00,$4.84,$27.63,$0.00,$13.81,$21.88,$22.10,$0.00,$4.20,$0.00,$4.40,$0.00
404.02,SUP,HCPCS C1713,,404.020  -  SCREW BONE STANDARD HEXAGON 3.5MM 6MM 20MM SELF TAP SOCKET,$27.63,$0.00,$27.63,$12.43,$19.72,$0.00,$4.62,$0.00,$0.00,$4.84,$27.63,$0.00,$13.81,$21.88,$22.10,$0.00,$4.20,$0.00,$4.40,$0.00
404.022,SUP,HCPCS C1713,,404.022  -  SCREW BONE STANDARD HEXAGON 3.5MM 6MM 22MM SELF TAP SOCKET,$27.63,$0.00,$27.63,$12.43,$19.72,$0.00,$4.62,$0.00,$0.00,$4.84,$27.63,$0.00,$13.81,$21.88,$22.10,$0.00,$4.20,$0.00,$4.40,$0.00
404.024,SUP,HCPCS C1713,,404.024  -  SCREW BONE STANDARD HEXAGON 3.5MM 6MM 24MM SELF TAP SOCKET,$27.63,$0.00,$27.63,$12.43,$19.72,$0.00,$4.62,$0.00,$0.00,$4.84,$27.63,$0.00,$13.81,$21.88,$22.10,$0.00,$4.20,$0.00,$4.40,$0.00
404.026,SUP,HCPCS C1713,,404.026  -  SCREW BONE STANDARD HEXAGON 3.5MM 6MM 26MM SELF TAP SOCKET,$27.63,$0.00,$27.63,$12.43,$19.72,$0.00,$4.62,$0.00,$0.00,$4.84,$27.63,$0.00,$13.81,$21.88,$22.10,$0.00,$4.20,$0.00,$4.40,$0.00
404.028,SUP,HCPCS C1713,,404.028  -  SCREW BONE STANDARD HEXAGON 3.5MM 6MM 28MM SELF TAP SOCKET,$27.63,$0.00,$27.63,$12.43,$19.72,$0.00,$4.62,$0.00,$0.00,$4.84,$27.63,$0.00,$13.81,$21.88,$22.10,$0.00,$4.20,$0.00,$4.40,$0.00
404.03,SUP,HCPCS C1713,,404.030  -  SCREW BONE STANDARD SMALL HEXAGON 3.5MM 6MM 30MM SOCKET,$26.83,$0.00,$26.83,$12.07,$19.15,$0.00,$4.62,$0.00,$0.00,$4.70,$26.83,$0.00,$13.41,$21.25,$21.46,$0.00,$4.20,$0.00,$4.27,$0.00
404.032,SUP,HCPCS C1713,,404.032  -  SCREW BONE STANDARD HEXAGON 3.5MM 6MM 32MM SELF TAP SOCKET,$26.83,$0.00,$26.83,$12.07,$19.15,$0.00,$4.62,$0.00,$0.00,$4.70,$26.83,$0.00,$13.41,$21.25,$21.46,$0.00,$4.20,$0.00,$4.27,$0.00
404.034,SUP,HCPCS C1713,,404.034  -  SCREW BONE STANDARD HEXAGON 3.5MM 6MM 34MM SELF TAP SOCKET,$26.83,$0.00,$26.83,$12.07,$19.15,$0.00,$4.62,$0.00,$0.00,$4.70,$26.83,$0.00,$13.41,$21.25,$21.46,$0.00,$4.20,$0.00,$4.27,$0.00
404.036,SUP,HCPCS C1713,,404.036  -  SCREW BONE STANDARD HEXAGON 3.5MM 6MM 36MM SELF TAP SOCKET,$26.83,$0.00,$26.83,$12.07,$19.15,$0.00,$4.62,$0.00,$0.00,$4.70,$26.83,$0.00,$13.41,$21.25,$21.46,$0.00,$4.20,$0.00,$4.27,$0.00
404.038,SUP,HCPCS C1713,,404.038  -  SCREW BONE STANDARD 3.5MM 6MM 38MM SMALL HEXAGONAL SOCKET,$26.83,$0.00,$26.83,$12.07,$19.15,$0.00,$4.62,$0.00,$0.00,$4.70,$26.83,$0.00,$13.41,$21.25,$21.46,$0.00,$4.20,$0.00,$4.27,$0.00
404.04,SUP,HCPCS C1713,,404.040  -  SCREW BONE STANDARD 3.5MM 6MM 40MM SMALL HEXAGONAL SOCKET,$26.83,$0.00,$26.83,$12.07,$19.15,$0.00,$4.62,$0.00,$0.00,$4.70,$26.83,$0.00,$13.41,$21.25,$21.46,$0.00,$4.20,$0.00,$4.27,$0.00
404.045,SUP,HCPCS C1713,,404.045  -  SCREW BONE STANDARD HEXAGON 3.5MM 6MM 45MM SELF TAP SOCKET,$26.83,$0.00,$26.83,$12.07,$19.15,$0.00,$4.62,$0.00,$0.00,$4.70,$26.83,$0.00,$13.41,$21.25,$21.46,$0.00,$4.20,$0.00,$4.27,$0.00
404.05,SUP,HCPCS C1713,,404.050  -  SCREW BONE STANDARD 3.5MM 6MM 50MM SMALL HEXAGONAL SOCKET,$26.83,$0.00,$26.83,$12.07,$19.15,$0.00,$4.62,$0.00,$0.00,$4.70,$26.83,$0.00,$13.41,$21.25,$21.46,$0.00,$4.20,$0.00,$4.27,$0.00
404.055,SUP,HCPCS C1713,,404.055  -  SCREW BONE 2.5MM STANDARD 3.5MM 6MM 55MM SMALL HEXAGONAL,$26.83,$0.00,$26.83,$12.07,$19.15,$0.00,$4.62,$0.00,$0.00,$4.70,$26.83,$0.00,$13.41,$21.25,$21.46,$0.00,$4.20,$0.00,$4.27,$0.00
404.06,SUP,HCPCS C1713,,404.060  -  SCREW BONE 2.5MM STANDARD 3.5MM 6MM 60MM SMALL HEXAGONAL,$26.83,$0.00,$26.83,$12.07,$19.15,$0.00,$4.62,$0.00,$0.00,$4.70,$26.83,$0.00,$13.41,$21.25,$21.46,$0.00,$4.20,$0.00,$4.27,$0.00
404.216,SUP,HCPCS C1713,,404.216  -  SCREW BONE HEXAGON SPHERE 3.5MM 16MM SELF TAP SOCKET LC-DCP,$32.75,$0.00,$32.75,$14.74,$23.37,$0.00,$5.48,$0.00,$0.00,$5.73,$32.75,$0.00,$16.38,$25.94,$26.20,$0.00,$4.98,$0.00,$5.21,$0.00
404.218,SUP,HCPCS C1713,,404.218  -  SCREW BONE HEXAGON SPHERE 3.5MM 18MM SELF TAP SOCKET LC-DCP,$32.75,$0.00,$32.75,$14.74,$23.37,$0.00,$5.48,$0.00,$0.00,$5.73,$32.75,$0.00,$16.38,$25.94,$26.20,$0.00,$4.98,$0.00,$5.21,$0.00
404.22,SUP,HCPCS C1713,,404.220  -  SCREW BONE HEXAGON SPHERE 3.5MM 20MM SELF TAP SOCKET LC-DCP,$32.75,$0.00,$32.75,$14.74,$23.37,$0.00,$5.48,$0.00,$0.00,$5.73,$32.75,$0.00,$16.38,$25.94,$26.20,$0.00,$4.98,$0.00,$5.21,$0.00
404.222,SUP,HCPCS C1713,,404.222  -  SCREW BONE HEXAGON SPHERE 3.5MM 22MM SELF TAP SOCKET LC-DCP,$32.75,$0.00,$32.75,$14.74,$23.37,$0.00,$5.48,$0.00,$0.00,$5.73,$32.75,$0.00,$16.38,$25.94,$26.20,$0.00,$4.98,$0.00,$5.21,$0.00
404.224,SUP,HCPCS C1713,,404.224  -  SCREW BONE HEXAGON SPHERE 3.5MM 24MM SELF TAP SOCKET LC-DCP,$32.75,$0.00,$32.75,$14.74,$23.37,$0.00,$5.48,$0.00,$0.00,$5.73,$32.75,$0.00,$16.38,$25.94,$26.20,$0.00,$4.98,$0.00,$5.21,$0.00
404.226,SUP,HCPCS C1713,,404.226  -  SCREW BONE HEXAGON SPHERE 3.5MM 26MM SELF TAP SOCKET LC-DCP,$32.75,$0.00,$32.75,$14.74,$23.37,$0.00,$5.48,$0.00,$0.00,$5.73,$32.75,$0.00,$16.38,$25.94,$26.20,$0.00,$4.98,$0.00,$5.21,$0.00
404.228,SUP,HCPCS C1713,,404.228  -  SCREW BONE HEXAGON SPHERE 3.5MM 28MM SELF TAP SOCKET LC-DCP,$32.75,$0.00,$32.75,$14.74,$23.37,$0.00,$5.48,$0.00,$0.00,$5.73,$32.75,$0.00,$16.38,$25.94,$26.20,$0.00,$4.98,$0.00,$5.21,$0.00
404.23,SUP,HCPCS C1713,,404.230  -  SCREW BONE PTHRD 3.5MM 6MM 30MM 10MM SMALL HEXAGONAL SOCKET,$32.75,$0.00,$32.75,$14.74,$23.37,$0.00,$5.48,$0.00,$0.00,$5.73,$32.75,$0.00,$16.38,$25.94,$26.20,$0.00,$4.98,$0.00,$5.21,$0.00
404.232,SUP,HCPCS C1713,,404.232  -  SCREW BONE HEXAGON SPHERE 3.5MM 32MM SELF TAP SOCKET LC-DCP,$32.75,$0.00,$32.75,$14.74,$23.37,$0.00,$5.48,$0.00,$0.00,$5.73,$32.75,$0.00,$16.38,$25.94,$26.20,$0.00,$4.98,$0.00,$5.21,$0.00
404.234,SUP,HCPCS C1713,,404.234  -  SCREW BONE HEXAGON SPHERE 3.5MM 34MM SELF TAP SOCKET LC-DCP,$31.80,$0.00,$31.80,$14.31,$22.70,$0.00,$5.48,$0.00,$0.00,$5.57,$31.80,$0.00,$15.90,$25.19,$25.44,$0.00,$4.98,$0.00,$5.06,$0.00
404.236,SUP,HCPCS C1713,,404.236  -  SCREW BONE HEXAGON SPHERE 3.5MM 36MM SELF TAP SOCKET LC-DCP,$31.80,$0.00,$31.80,$14.31,$22.70,$0.00,$5.48,$0.00,$0.00,$5.57,$31.80,$0.00,$15.90,$25.19,$25.44,$0.00,$4.98,$0.00,$5.06,$0.00
404.238,SUP,HCPCS C1713,,404.238  -  SCREW BONE HEXAGON SPHERE 3.5MM 38MM SELF TAP SOCKET LC-DCP,$31.80,$0.00,$31.80,$14.31,$22.70,$0.00,$5.48,$0.00,$0.00,$5.57,$31.80,$0.00,$15.90,$25.19,$25.44,$0.00,$4.98,$0.00,$5.06,$0.00
404.24,SUP,HCPCS C1713,,404.240  -  SCREW BONE HEXAGON SPHERE 3.5MM 40MM SELF TAP SOCKET LC-DCP,$31.80,$0.00,$31.80,$14.31,$22.70,$0.00,$5.48,$0.00,$0.00,$5.57,$31.80,$0.00,$15.90,$25.19,$25.44,$0.00,$4.98,$0.00,$5.06,$0.00
404.245,SUP,HCPCS C1713,,404.245  -  SCREW BONE HEXAGON SPHERE 3.5MM 45MM SELF TAP SOCKET LC-DCP,$31.80,$0.00,$31.80,$14.31,$22.70,$0.00,$5.48,$0.00,$0.00,$5.57,$31.80,$0.00,$15.90,$25.19,$25.44,$0.00,$4.98,$0.00,$5.06,$0.00
404.25,SUP,HCPCS C1713,,404.250  -  SCREW BONE HEXAGON SPHERE 3.5MM 50MM SELF TAP SOCKET LC-DCP,$31.80,$0.00,$31.80,$14.31,$22.70,$0.00,$5.48,$0.00,$0.00,$5.57,$31.80,$0.00,$15.90,$25.19,$25.44,$0.00,$4.98,$0.00,$5.06,$0.00
404.81,SUP,HCPCS C1713,,404.810  -  SCREW BONE FULTHD 3.5MM 6MM 10MM SLFTAP HEXAGONAL RECESS LCP,$38.55,$0.00,$38.55,$17.35,$27.51,$0.00,$6.45,$0.00,$0.00,$6.75,$38.55,$0.00,$19.28,$30.53,$30.84,$0.00,$5.86,$0.00,$6.14,$0.00
404.812,SUP,HCPCS C1713,,404.812  -  SCREW BONE FULTHD 3.5MM 6MM 12MM SELF TAP HEXAGONAL RECESS,$38.55,$0.00,$38.55,$17.35,$27.51,$0.00,$6.45,$0.00,$0.00,$6.75,$38.55,$0.00,$19.28,$30.53,$30.84,$0.00,$5.86,$0.00,$6.14,$0.00
404.814,SUP,HCPCS C1713,,404.814  -  SCREW BONE FULTHD 3.5MM 6MM 14MM SELF TAP HEXAGONAL RECESS,$38.55,$0.00,$38.55,$17.35,$27.51,$0.00,$6.45,$0.00,$0.00,$6.75,$38.55,$0.00,$19.28,$30.53,$30.84,$0.00,$5.86,$0.00,$6.14,$0.00
404.816,SUP,HCPCS C1713,,404.816  -  SCREW BONE FULTHD 3.5MM 6MM 16MM SELF TAP HEXAGONAL RECESS,$38.55,$0.00,$38.55,$17.35,$27.51,$0.00,$10.68,$0.00,$0.00,$6.75,$38.55,$0.00,$19.28,$30.53,$30.84,$0.00,$9.70,$0.00,$6.14,$0.00
404.818,SUP,HCPCS C1713,,404.818  -  SCREW BONE FULTHD HEXAGON 3.5MM 6MM 18MM SELF TAP SOCKET LCP,$38.55,$0.00,$38.55,$17.35,$27.51,$0.00,$6.45,$0.00,$0.00,$6.75,$38.55,$0.00,$19.28,$30.53,$30.84,$0.00,$5.86,$0.00,$6.14,$0.00
404.82,SUP,HCPCS C1713,,404.820  -  SCREW BONE FULTHD HEXAGON 3.5MM 6MM 20MM SELF TAP SOCKET LCP,$38.55,$0.00,$38.55,$17.35,$27.51,$0.00,$10.68,$0.00,$0.00,$6.75,$38.55,$0.00,$19.28,$30.53,$30.84,$0.00,$9.70,$0.00,$6.14,$0.00
404.822,SUP,HCPCS C1713,,404.822  -  SCREW BONE FULTHD HEXAGON 3.5MM 6MM 22MM SELF TAP SOCKET LCP,$38.55,$0.00,$38.55,$17.35,$27.51,$0.00,$6.45,$0.00,$0.00,$6.75,$38.55,$0.00,$19.28,$30.53,$30.84,$0.00,$5.86,$0.00,$6.14,$0.00
404.824,SUP,HCPCS C1713,,404.824  -  SCREW BONE FULTHD HEXAGON 3.5MM 6MM 24MM SELF TAP SOCKET LCP,$38.55,$0.00,$38.55,$17.35,$27.51,$0.00,$6.45,$0.00,$0.00,$6.75,$38.55,$0.00,$19.28,$30.53,$30.84,$0.00,$5.86,$0.00,$6.14,$0.00
404.826,SUP,HCPCS C1713,,404.826  -  SCREW BONE FULTHD 3.5MM 6MM 26MM SELF TAP HEXAGONAL RECESS,$38.55,$0.00,$38.55,$17.35,$27.51,$0.00,$6.45,$0.00,$0.00,$6.75,$38.55,$0.00,$19.28,$30.53,$30.84,$0.00,$5.86,$0.00,$6.14,$0.00
404.828,SUP,HCPCS C1713,,404.828  -  SCREW BONE FULTHD HEXAGON 3.5MM 6MM 28MM SELF TAP SOCKET LCP,$38.55,$0.00,$38.55,$17.35,$27.51,$0.00,$6.45,$0.00,$0.00,$6.75,$38.55,$0.00,$19.28,$30.53,$30.84,$0.00,$5.86,$0.00,$6.14,$0.00
404.83,SUP,HCPCS C1713,,404.830  -  SCREW BONE FULTHD 3.5MM 6MM 30MM SLFTAP HEXAGONAL RECESS LCP,$38.55,$0.00,$38.55,$17.35,$27.51,$0.00,$6.45,$0.00,$0.00,$6.75,$38.55,$0.00,$19.28,$30.53,$30.84,$0.00,$5.86,$0.00,$6.14,$0.00
404.832,SUP,HCPCS C1713,,404.832  -  SCREW BONE FULTHD 3.5MM 6MM 32MM SELF TAP HEXAGONAL RECESS,$38.55,$0.00,$38.55,$17.35,$27.51,$0.00,$6.45,$0.00,$0.00,$6.75,$38.55,$0.00,$19.28,$30.53,$30.84,$0.00,$5.86,$0.00,$6.14,$0.00
404.834,SUP,HCPCS C1713,,404.834  -  SCREW BONE FULTHD 3.5MM 6MM 34MM SELF TAP HEXAGONAL RECESS,$38.55,$0.00,$38.55,$17.35,$27.51,$0.00,$6.45,$0.00,$0.00,$6.75,$38.55,$0.00,$19.28,$30.53,$30.84,$0.00,$5.86,$0.00,$6.14,$0.00
404.836,SUP,HCPCS C1713,,404.836  -  SCREW BONE FULTHD 3.5MM 6MM 36MM SELF TAP HEXAGONAL RECESS,$38.55,$0.00,$38.55,$17.35,$27.51,$0.00,$6.45,$0.00,$0.00,$6.75,$38.55,$0.00,$19.28,$30.53,$30.84,$0.00,$5.86,$0.00,$6.14,$0.00
404.838,SUP,HCPCS C1713,,404.838  -  SCREW BONE FULTHD 3.5MM 6MM 38MM SELF TAP HEXAGONAL RECESS,$38.55,$0.00,$38.55,$17.35,$27.51,$0.00,$6.45,$0.00,$0.00,$6.75,$38.55,$0.00,$19.28,$30.53,$30.84,$0.00,$5.86,$0.00,$6.14,$0.00
404.84,SUP,HCPCS C1713,,404.840  -  SCREW BONE HEXAGON 3.5MM 40MM SLFTAP SMALL RECESS LCP,$38.55,$0.00,$38.55,$17.35,$27.51,$0.00,$6.45,$0.00,$0.00,$6.75,$38.55,$0.00,$19.28,$30.53,$30.84,$0.00,$5.86,$0.00,$6.14,$0.00
404.845,SUP,HCPCS C1713,,404.845  -  SCREW BONE FULTHD HEXAGON 3.5MM 6MM 45MM SELF TAP SOCKET LCP,$38.55,$0.00,$38.55,$17.35,$27.51,$0.00,$6.45,$0.00,$0.00,$6.75,$38.55,$0.00,$19.28,$30.53,$30.84,$0.00,$5.86,$0.00,$6.14,$0.00
404.85,SUP,HCPCS C1713,,404.850  -  SCREW BONE FULTHD 3.5MM 6MM 50MM SELF TAP HEXAGONAL RECESS,$38.55,$0.00,$38.55,$17.35,$27.51,$0.00,$6.45,$0.00,$0.00,$6.75,$38.55,$0.00,$19.28,$30.53,$30.84,$0.00,$5.86,$0.00,$6.14,$0.00
404.855,SUP,HCPCS C1713,,404.855  -  SCREW BONE FULTHD 3.5MM 6MM 55MM SELF TAP HEXAGONAL RECESS,$38.55,$0.00,$38.55,$17.35,$27.51,$0.00,$6.45,$0.00,$0.00,$6.75,$38.55,$0.00,$19.28,$30.53,$30.84,$0.00,$5.86,$0.00,$6.14,$0.00
406.01,SUP,HCPCS C1713,,406.010  -  SCREW BONE FULTHD 4MM 10MM LCP TITANIUM CANCELLOUS CLAVICLE,$31.73,$0.00,$31.73,$14.28,$22.64,$0.00,$5.31,$0.00,$0.00,$5.55,$31.73,$0.00,$15.86,$25.13,$25.38,$0.00,$4.82,$0.00,$5.05,$0.00
406.012,SUP,HCPCS C1713,,406.012  -  SCREW BONE FULTHD HEXAGON 4MM 12MM SOCKET LC-DCP TITANIUM,$31.73,$0.00,$31.73,$14.28,$22.64,$0.00,$5.31,$0.00,$0.00,$5.55,$31.73,$0.00,$15.86,$25.13,$25.38,$0.00,$4.82,$0.00,$5.05,$0.00
406.014,SUP,HCPCS C1713,,406.014  -  SCREW BONE FULTHD HEXAGON 4MM 14MM SOCKET LC-DCP TITANIUM,$31.73,$0.00,$31.73,$14.28,$22.64,$0.00,$5.31,$0.00,$0.00,$5.55,$31.73,$0.00,$15.86,$25.13,$25.38,$0.00,$4.82,$0.00,$5.05,$0.00
406.016,SUP,HCPCS C1713,,406.016  -  SCREW BONE FULTHD HEXAGON 4MM 16MM SOCKET LC-DCP TITANIUM,$31.73,$0.00,$31.73,$14.28,$22.64,$0.00,$5.31,$0.00,$0.00,$5.55,$31.73,$0.00,$15.86,$25.13,$25.38,$0.00,$4.82,$0.00,$5.05,$0.00
406.018,SUP,HCPCS C1713,,406.018  -  SCREW BONE FULTHD HEXAGON 4MM 18MM SOCKET LC-DCP TITANIUM,$31.73,$0.00,$31.73,$14.28,$22.64,$0.00,$8.17,$0.00,$0.00,$5.55,$31.73,$0.00,$15.86,$25.13,$25.38,$0.00,$7.42,$0.00,$5.05,$0.00
406.02,SUP,HCPCS C1713,,406.020  -  SCREW BONE FULTHD HEXAGON 4MM 20MM SOCKET LC-DCP TITANIUM,$31.73,$0.00,$31.73,$14.28,$22.64,$0.00,$8.17,$0.00,$0.00,$5.55,$31.73,$0.00,$15.86,$25.13,$25.38,$0.00,$7.42,$0.00,$5.05,$0.00
406.022,SUP,HCPCS C1713,,406.022  -  SCREW BONE FULTHD 4MM 6MM 22MM 9MM SMALL HEXAGONAL SOCKET,$31.73,$0.00,$31.73,$14.28,$22.64,$0.00,$5.31,$0.00,$0.00,$5.55,$31.73,$0.00,$15.86,$25.13,$25.38,$0.00,$4.82,$0.00,$5.05,$0.00
406.024,SUP,HCPCS C1713,,406.024  -  SCREW BONE FULTHD 4MM 6MM 24MM 10MM SMALL HEXAGONAL SOCKET,$31.73,$0.00,$31.73,$14.28,$22.64,$0.00,$5.31,$0.00,$0.00,$5.55,$31.73,$0.00,$15.86,$25.13,$25.38,$0.00,$4.82,$0.00,$5.05,$0.00
406.026,SUP,HCPCS C1713,,406.026  -  SCREW BONE FULTHD HEXAGON 4MM 26MM SOCKET LC-DCP TITANIUM,$31.73,$0.00,$31.73,$14.28,$22.64,$0.00,$8.17,$0.00,$0.00,$5.55,$31.73,$0.00,$15.86,$25.13,$25.38,$0.00,$7.42,$0.00,$5.05,$0.00
406.028,SUP,HCPCS C1713,,406.028  -  SCREW BONE FULTHD HEXAGON 4MM 28MM SOCKET LC-DCP TITANIUM,$31.73,$0.00,$31.73,$14.28,$22.64,$0.00,$8.17,$0.00,$0.00,$5.55,$31.73,$0.00,$15.86,$25.13,$25.38,$0.00,$7.42,$0.00,$5.05,$0.00
406.03,SUP,HCPCS C1713,,406.030  -  SCREW BONE FULTHD 4MM 6MM 30MM LC-DCP TITANIUM TIBIA,$31.73,$0.00,$31.73,$14.28,$22.64,$0.00,$5.31,$0.00,$0.00,$5.55,$31.73,$0.00,$15.86,$25.13,$25.38,$0.00,$4.82,$0.00,$5.05,$0.00
406.032,SUP,HCPCS C1713,,406.032  -  SCREW BONE FULTHD HEXAGON 4MM 32MM SOCKET LC-DCP TITANIUM,$30.80,$0.00,$30.80,$13.86,$21.98,$0.00,$5.31,$0.00,$0.00,$5.39,$30.80,$0.00,$15.40,$24.39,$24.64,$0.00,$4.82,$0.00,$4.90,$0.00
406.035,SUP,HCPCS C1713,,406.035  -  SCREW BONE FULTHD HEXAGON 4MM 35MM SOCKET LC-DCP TITANIUM,$31.73,$0.00,$31.73,$14.28,$22.64,$0.00,$5.31,$0.00,$0.00,$5.55,$31.73,$0.00,$15.86,$25.13,$25.38,$0.00,$4.82,$0.00,$5.05,$0.00
406.04,SUP,HCPCS C1713,,406.040  -  SCREW BONE FULTHD SMALL HEXAGON 4MM 6MM 40MM SOCKET TITANIUM,$31.73,$0.00,$31.73,$14.28,$22.64,$0.00,$8.17,$0.00,$0.00,$5.55,$31.73,$0.00,$15.86,$25.13,$25.38,$0.00,$7.42,$0.00,$5.05,$0.00
406.045,SUP,HCPCS C1713,,406.045  -  SCREW BONE FULTHD 4MM 6MM 45MM 15MM SMALL HEXAGONAL SOCKET,$31.73,$0.00,$31.73,$14.28,$22.64,$0.00,$5.31,$0.00,$0.00,$5.55,$31.73,$0.00,$15.86,$25.13,$25.38,$0.00,$4.82,$0.00,$5.05,$0.00
406.05,SUP,HCPCS C1713,,406.050  -  SCREW BONE FULTHD HEXAGON 4MM 50MM SOCKET LC-DCP TITANIUM,$31.73,$0.00,$31.73,$14.28,$22.64,$0.00,$5.31,$0.00,$0.00,$5.55,$31.73,$0.00,$15.86,$25.13,$25.38,$0.00,$4.82,$0.00,$5.05,$0.00
406.055,SUP,HCPCS C1713,,406.055  -  SCREW BONE FULTHD 4MM 6MM 55MM 15MM SMALL HEXAGONAL SOCKET,$31.73,$0.00,$31.73,$14.28,$22.64,$0.00,$8.17,$0.00,$0.00,$5.55,$31.73,$0.00,$15.86,$25.13,$25.38,$0.00,$7.42,$0.00,$5.05,$0.00
406.06,SUP,HCPCS C1713,,406.060  -  SCREW BONE FULTHD 4MM 6MM 60MM 15MM SMALL HEXAGONAL SOCKET,$31.73,$0.00,$31.73,$14.28,$22.64,$0.00,$8.17,$0.00,$0.00,$5.55,$31.73,$0.00,$15.86,$25.13,$25.38,$0.00,$7.42,$0.00,$5.05,$0.00
406.065,SUP,HCPCS C1713,,406.065  -  SCREW BONE FULTHD 4MM 65MM LC-DCP TITANIUM TIBIA CANCELLOUS,$34.80,$0.00,$34.80,$15.66,$24.84,$0.00,$5.82,$0.00,$0.00,$6.09,$34.80,$0.00,$17.40,$27.56,$27.84,$0.00,$5.29,$0.00,$5.54,$0.00
406.07,SUP,HCPCS C1713,,406.070  -  SCREW BONE FULTHD 4MM 70MM LCP TITANIUM CANCELLOUS NONSTRL,$34.80,$0.00,$34.80,$15.66,$24.84,$0.00,$5.82,$0.00,$0.00,$6.09,$34.80,$0.00,$17.40,$27.56,$27.84,$0.00,$5.29,$0.00,$5.54,$0.00
406.075,SUP,HCPCS C1713,,406.075  -  SCREW BONE FULTHD 4MM 75MM LC-DCP TITANIUM TIBIA CANCELLOUS,$34.80,$0.00,$34.80,$15.66,$24.84,$0.00,$5.82,$0.00,$0.00,$6.09,$34.80,$0.00,$17.40,$27.56,$27.84,$0.00,$5.29,$0.00,$5.54,$0.00
406.08,SUP,HCPCS C1713,,406.080  -  SCREW BONE FULTHD 4MM 80MM LCP TITANIUM CANCELLOUS NONSTRL,$34.80,$0.00,$34.80,$15.66,$24.84,$0.00,$5.82,$0.00,$0.00,$6.09,$34.80,$0.00,$17.40,$27.56,$27.84,$0.00,$5.29,$0.00,$5.54,$0.00
406.085,SUP,HCPCS C1713,,406.085  -  SCREW BONE FULTHD 4MM 85MM LC-DCP TITANIUM TIBIA CANCELLOUS,$34.80,$0.00,$34.80,$15.66,$24.84,$0.00,$5.82,$0.00,$0.00,$6.09,$34.80,$0.00,$17.40,$27.56,$27.84,$0.00,$5.29,$0.00,$5.54,$0.00
406.09,SUP,HCPCS C1713,,406.090  -  SCREW BONE FULTHD 4MM 90MM LCP TITANIUM CANCELLOUS NONSTRL,$34.80,$0.00,$34.80,$15.66,$24.84,$0.00,$5.82,$0.00,$0.00,$6.09,$34.80,$0.00,$17.40,$27.56,$27.84,$0.00,$5.29,$0.00,$5.54,$0.00
406.095,SUP,HCPCS C1713,,406.095  -  SCREW BONE FULTHD 4MM 95MM LC-DCP TITANIUM TIBIA CANCELLOUS,$34.80,$0.00,$34.80,$15.66,$24.84,$0.00,$5.82,$0.00,$0.00,$6.09,$34.80,$0.00,$17.40,$27.56,$27.84,$0.00,$5.29,$0.00,$5.54,$0.00
406.1,SUP,HCPCS C1713,,406.100  -  SCREW BONE FULTHD 4MM 100MM LC-DCP TITANIUM TIBIA CANCELLOUS,$34.80,$0.00,$34.80,$15.66,$24.84,$0.00,$5.82,$0.00,$0.00,$6.09,$34.80,$0.00,$17.40,$27.56,$27.84,$0.00,$5.29,$0.00,$5.54,$0.00
406.104,SUP,HCPCS C1713,,406.104  -  SCREW BONE LOCK STARDRIVE AXON TITANIUM SPN NONSTRL,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
407.01,SUP,HCPCS C1713,,407.010  -  SCREW BONE PTHRD HEXAGON 4MM 10MM SOCKET LC-DCP TITANIUM,$30.03,$0.00,$30.03,$13.51,$21.43,$0.00,$5.02,$0.00,$0.00,$5.26,$30.03,$0.00,$15.01,$23.78,$24.02,$0.00,$4.56,$0.00,$4.78,$0.00
407.012,SUP,HCPCS C1713,,407.012  -  SCREW BONE PTHRD HEXAGON 4MM 12MM SOCKET LC-DCP TITANIUM,$30.03,$0.00,$30.03,$13.51,$21.43,$0.00,$5.02,$0.00,$0.00,$5.26,$30.03,$0.00,$15.01,$23.78,$24.02,$0.00,$4.56,$0.00,$4.78,$0.00
407.014,SUP,HCPCS C1713,,407.014  -  SCREW BONE PTHRD HEXAGON 4MM 14MM SOCKET LC-DCP TITANIUM,$30.03,$0.00,$30.03,$13.51,$21.43,$0.00,$5.02,$0.00,$0.00,$5.26,$30.03,$0.00,$15.01,$23.78,$24.02,$0.00,$4.56,$0.00,$4.78,$0.00
407.016,SUP,HCPCS C1713,,407.016  -  SCREW BONE PTHRD 4MM 6MM 16MM 6MM SMALL HEXAGONAL SOCKET,$30.03,$0.00,$30.03,$13.51,$21.43,$0.00,$5.02,$0.00,$0.00,$5.26,$30.03,$0.00,$15.01,$23.78,$24.02,$0.00,$4.56,$0.00,$4.78,$0.00
407.018,SUP,HCPCS C1713,,407.018  -  SCREW BONE PTHRD 4MM 6MM 18MM 7MM SMALL HEXAGONAL SOCKET,$30.03,$0.00,$30.03,$13.51,$21.43,$0.00,$5.02,$0.00,$0.00,$5.26,$30.03,$0.00,$15.01,$23.78,$24.02,$0.00,$4.56,$0.00,$4.78,$0.00
407.02,SUP,HCPCS C1713,,407.020  -  SCREW BONE PTHRD HEXAGON 4MM 20MM SOCKET LC-DCP TITANIUM,$30.03,$0.00,$30.03,$13.51,$21.43,$0.00,$5.02,$0.00,$0.00,$5.26,$30.03,$0.00,$15.01,$23.78,$24.02,$0.00,$4.56,$0.00,$4.78,$0.00
407.022,SUP,HCPCS C1713,,407.022  -  SCREW BONE PTHRD 4MM 6MM 22MM 9MM SMALL HEXAGONAL SOCKET,$30.03,$0.00,$30.03,$13.51,$21.43,$0.00,$5.02,$0.00,$0.00,$5.26,$30.03,$0.00,$15.01,$23.78,$24.02,$0.00,$4.56,$0.00,$4.78,$0.00
407.024,SUP,HCPCS C1713,,407.024  -  SCREW BONE PTHRD 4MM 6MM 24MM 10MM SMALL HEXAGONAL SOCKET,$30.03,$0.00,$30.03,$13.51,$21.43,$0.00,$5.02,$0.00,$0.00,$5.26,$30.03,$0.00,$15.01,$23.78,$24.02,$0.00,$4.56,$0.00,$4.78,$0.00
407.026,SUP,HCPCS C1713,,407.026  -  SCREW BONE PTHRD 4MM 6MM 26MM 12MM SMALL HEXAGONAL SOCKET,$30.03,$0.00,$30.03,$13.51,$21.43,$0.00,$5.02,$0.00,$0.00,$5.26,$30.03,$0.00,$15.01,$23.78,$24.02,$0.00,$4.56,$0.00,$4.78,$0.00
407.028,SUP,HCPCS C1713,,407.028  -  SCREW BONE PTHRD 4MM 6MM 28MM 14MM HEXAGONAL SOCKET LC-DCP,$30.03,$0.00,$30.03,$13.51,$21.43,$0.00,$5.02,$0.00,$0.00,$5.26,$30.03,$0.00,$15.01,$23.78,$24.02,$0.00,$4.56,$0.00,$4.78,$0.00
407.03,SUP,HCPCS C1713,,407.030  -  SCREW BONE PTHRD HEXAGON 4MM 30MM SOCKET LC-DCP TITANIUM,$30.03,$0.00,$30.03,$13.51,$21.43,$0.00,$5.02,$0.00,$0.00,$5.26,$30.03,$0.00,$15.01,$23.78,$24.02,$0.00,$4.56,$0.00,$4.78,$0.00
407.035,SUP,HCPCS C1713,,407.035  -  SCREW BONE PTHRD HEXAGON 4MM 35MM SOCKET LC-DCP TITANIUM,$30.03,$0.00,$30.03,$13.51,$21.43,$0.00,$8.17,$0.00,$0.00,$5.26,$30.03,$0.00,$15.01,$23.78,$24.02,$0.00,$7.42,$0.00,$4.78,$0.00
407.04,SUP,HCPCS C1713,,407.040  -  SCREW BONE PTHRD HEXAGON 4MM 40MM SOCKET LC-DCP TITANIUM,$30.03,$0.00,$30.03,$13.51,$21.43,$0.00,$5.02,$0.00,$0.00,$5.26,$30.03,$0.00,$15.01,$23.78,$24.02,$0.00,$4.56,$0.00,$4.78,$0.00
407.045,SUP,HCPCS C1713,,407.045  -  SCREW BONE PTHRD HEXAGON 4MM 45MM SOCKET LC-DCP TITANIUM,$30.03,$0.00,$30.03,$13.51,$21.43,$0.00,$5.02,$0.00,$0.00,$5.26,$30.03,$0.00,$15.01,$23.78,$24.02,$0.00,$4.56,$0.00,$4.78,$0.00
407.05,SUP,HCPCS C1713,,407.050  -  SCREW BONE PTHRD HEXAGON 4MM 50MM SOCKET LC-DCP TITANIUM,$30.03,$0.00,$30.03,$13.51,$21.43,$0.00,$5.02,$0.00,$0.00,$5.26,$30.03,$0.00,$15.01,$23.78,$24.02,$0.00,$4.56,$0.00,$4.78,$0.00
407.055,SUP,HCPCS C1713,,407.055  -  SCREW BONE PTHRD HEXAGON 4MM 55MM SOCKET LC-DCP TITANIUM,$30.03,$0.00,$30.03,$13.51,$21.43,$0.00,$5.02,$0.00,$0.00,$5.26,$30.03,$0.00,$15.01,$23.78,$24.02,$0.00,$4.56,$0.00,$4.78,$0.00
407.06,SUP,HCPCS C1713,,407.060  -  SCREW BONE 4MM 60MM PTHRD LC-DCP TITANIUM TIBIA CANCELLOUS,$30.03,$0.00,$30.03,$13.51,$21.43,$0.00,$5.02,$0.00,$0.00,$5.26,$30.03,$0.00,$15.01,$23.78,$24.02,$0.00,$4.56,$0.00,$4.78,$0.00
407.065,SUP,HCPCS C1713,,407.065  -  SCREW BONE 4MM 65MM PTHRD LC-DCP TITANIUM TIBIA CANCELLOUS,$34.13,$0.00,$34.13,$15.36,$24.36,$0.00,$5.71,$0.00,$0.00,$5.98,$34.13,$0.00,$17.06,$27.03,$27.30,$0.00,$5.18,$0.00,$5.43,$0.00
407.07,SUP,HCPCS C1713,,407.070  -  SCREW BONE PTHRD 4MM 70MM LCP TITANIUM CANCELLOUS NONSTRL,$34.13,$0.00,$34.13,$15.36,$24.36,$0.00,$5.71,$0.00,$0.00,$5.98,$34.13,$0.00,$17.06,$27.03,$27.30,$0.00,$5.18,$0.00,$5.43,$0.00
407.075,SUP,HCPCS C1713,,407.075  -  SCREW BONE 4MM 75MM PTHRD LC-DCP TITANIUM TIBIA CANCELLOUS,$34.13,$0.00,$34.13,$15.36,$24.36,$0.00,$5.71,$0.00,$0.00,$5.98,$34.13,$0.00,$17.06,$27.03,$27.30,$0.00,$5.18,$0.00,$5.43,$0.00
407.08,SUP,HCPCS C1713,,407.080  -  SCREW BONE PTHRD 4MM 80MM LCP TITANIUM CANCELLOUS NONSTRL,$34.13,$0.00,$34.13,$15.36,$24.36,$0.00,$5.71,$0.00,$0.00,$5.98,$34.13,$0.00,$17.06,$27.03,$27.30,$0.00,$5.18,$0.00,$5.43,$0.00
407.085,SUP,HCPCS C1713,,407.085  -  SCREW BONE 4MM 85MM PTHRD LC-DCP TITANIUM TIBIA CANCELLOUS,$34.13,$0.00,$34.13,$15.36,$24.36,$0.00,$5.71,$0.00,$0.00,$5.98,$34.13,$0.00,$17.06,$27.03,$27.30,$0.00,$5.18,$0.00,$5.43,$0.00
407.09,SUP,HCPCS C1713,,407.090  -  SCREW BONE PTHRD 4MM 90MM LCP TITANIUM CANCELLOUS NONSTRL,$34.13,$0.00,$34.13,$15.36,$24.36,$0.00,$5.71,$0.00,$0.00,$5.98,$34.13,$0.00,$17.06,$27.03,$27.30,$0.00,$5.18,$0.00,$5.43,$0.00
407.095,SUP,HCPCS C1713,,407.095  -  SCREW BONE 4MM 95MM PTHRD LC-DCP TITANIUM TIBIA CANCELLOUS,$34.13,$0.00,$34.13,$15.36,$24.36,$0.00,$5.71,$0.00,$0.00,$5.98,$34.13,$0.00,$17.06,$27.03,$27.30,$0.00,$5.18,$0.00,$5.43,$0.00
407.1,SUP,HCPCS C1713,,407.100  -  SCREW BONE PTHRD 4MM 100MM LCP TITANIUM CANCELLOUS NONSTRL,$34.13,$0.00,$34.13,$15.36,$24.36,$0.00,$5.71,$0.00,$0.00,$5.98,$34.13,$0.00,$17.06,$27.03,$27.30,$0.00,$5.18,$0.00,$5.43,$0.00
407.61,SUP,HCPCS C1713,,407.610  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 10MM SELF DRILL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
407.612,SUP,HCPCS C1713,,407.612  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 12MM SELF DRILL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
407.614,SUP,HCPCS C1713,,407.614  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 14MM SELF DRILL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
407.616,SUP,HCPCS C1713,,407.616  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 16MM SELF DRILL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
407.618,SUP,HCPCS C1713,,407.618  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 18MM SELF DRILL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
407.62,SUP,HCPCS C1713,,407.620  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 20MM SELF DRILL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
407.622,SUP,HCPCS C1713,,407.622  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 22MM SELF DRILL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
407.624,SUP,HCPCS C1713,,407.624  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 24MM SELF DRILL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
407.626,SUP,HCPCS C1713,,407.626  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 26MM SELF DRILL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
407.628,SUP,HCPCS C1713,,407.628  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 28MM SELF DRILL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$81.45,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$73.99,$0.00,$56.93,$0.00
407.63,SUP,HCPCS C1713,,407.630  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 30MM SELF DRILL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
407.632,SUP,HCPCS C1713,,407.632  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 32MM SELF DRILL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
407.634,SUP,HCPCS C1713,,407.634  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 34MM SELF DRILL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
407.636,SUP,HCPCS C1713,,407.636  -  SCREW BONE SHORT THREAD 4MM 5MM 36MM CANN HEXAGONAL SOCKET,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
407.638,SUP,HCPCS C1713,,407.638  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 38MM SELF DRILL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
407.64,SUP,HCPCS C1713,,407.640  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 40MM SELF DRILL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
407.642,SUP,HCPCS C1713,,407.642  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 42MM SELF DRILL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
407.644,SUP,HCPCS C1713,,407.644  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 44MM SELF DRILL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
407.646,SUP,HCPCS C1713,,407.646  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 46MM SELF DRILL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
407.648,SUP,HCPCS C1713,,407.648  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 48MM SELF DRILL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
407.65,SUP,HCPCS C1713,,407.650  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 50MM SELF DRILL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$81.45,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$73.99,$0.00,$56.93,$0.00
407.652,SUP,HCPCS C1713,,407.652  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 52MM SELF DRILL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
407.654,SUP,HCPCS C1713,,407.654  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 54MM SELF DRILL,$369.85,$0.00,$369.85,$166.43,$263.96,$0.00,$61.87,$0.00,$0.00,$64.76,$369.85,$0.00,$184.93,$292.92,$295.88,$0.00,$56.20,$0.00,$58.88,$0.00
407.656,SUP,HCPCS C1713,,407.656  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 56MM SELF DRILL,$369.85,$0.00,$369.85,$166.43,$263.96,$0.00,$61.87,$0.00,$0.00,$64.76,$369.85,$0.00,$184.93,$292.92,$295.88,$0.00,$56.20,$0.00,$58.88,$0.00
407.658,SUP,HCPCS C1713,,407.658  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 58MM SELF DRILL,$369.85,$0.00,$369.85,$166.43,$263.96,$0.00,$61.87,$0.00,$0.00,$64.76,$369.85,$0.00,$184.93,$292.92,$295.88,$0.00,$56.20,$0.00,$58.88,$0.00
407.66,SUP,HCPCS C1713,,407.660  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 60MM SELF DRILL,$369.85,$0.00,$369.85,$166.43,$263.96,$0.00,$61.87,$0.00,$0.00,$64.76,$369.85,$0.00,$184.93,$292.92,$295.88,$0.00,$56.20,$0.00,$58.88,$0.00
407.664,SUP,HCPCS C1713,,407.664  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 64MM SELF DRILL,$369.85,$0.00,$369.85,$166.43,$263.96,$0.00,$61.87,$0.00,$0.00,$64.76,$369.85,$0.00,$184.93,$292.92,$295.88,$0.00,$56.20,$0.00,$58.88,$0.00
407.668,SUP,HCPCS C1713,,407.668  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 68MM SELF DRILL,$369.85,$0.00,$369.85,$166.43,$263.96,$0.00,$61.87,$0.00,$0.00,$64.76,$369.85,$0.00,$184.93,$292.92,$295.88,$0.00,$56.20,$0.00,$58.88,$0.00
407.672,SUP,HCPCS C1713,,407.672  -  SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 72MM SELF DRILL,$369.85,$0.00,$369.85,$166.43,$263.96,$0.00,$61.87,$0.00,$0.00,$64.76,$369.85,$0.00,$184.93,$292.92,$295.88,$0.00,$56.20,$0.00,$58.88,$0.00
407.716,SUP,HCPCS C1713,,407.716  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 16MM CANN TITANIUM SMALL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
407.718,SUP,HCPCS C1713,,407.718  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 18MM CANN TITANIUM SMALL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
407.72,SUP,HCPCS C1713,,407.720  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 20MM CANN TITANIUM SMALL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
407.722,SUP,HCPCS C1713,,407.722  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 22MM CANN TITANIUM SMALL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
407.724,SUP,HCPCS C1713,,407.724  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 24MM CANN TITANIUM SMALL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
407.726,SUP,HCPCS C1713,,407.726  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 26MM CANN TITANIUM SMALL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
407.728,SUP,HCPCS C1713,,407.728  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 28MM CANN TITANIUM SMALL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
407.73,SUP,HCPCS C1713,,407.730  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 30MM CANN TITANIUM SMALL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
407.732,SUP,HCPCS C1713,,407.732  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 32MM CANN TITANIUM SMALL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
407.734,SUP,HCPCS C1713,,407.734  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 34MM CANN TITANIUM SMALL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
407.736,SUP,HCPCS C1713,,407.736  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 36MM CANN TITANIUM SMALL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
407.738,SUP,HCPCS C1713,,407.738  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 38MM CANN TITANIUM SMALL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
407.74,SUP,HCPCS C1713,,407.740  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 40MM CANN TITANIUM SMALL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
407.742,SUP,HCPCS C1713,,407.742  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 42MM CANN TITANIUM SMALL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
407.744,SUP,HCPCS C1713,,407.744  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 44MM CANN TITANIUM SMALL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
407.746,SUP,HCPCS C1713,,407.746  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 46MM CANN TITANIUM SMALL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
407.748,SUP,HCPCS C1713,,407.748  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 48MM CANN TITANIUM SMALL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
407.75,SUP,HCPCS C1713,,407.750  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 50MM CANN TITANIUM SMALL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
407.752,SUP,HCPCS C1713,,407.752  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 52MM CANN TITANIUM SMALL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
407.754,SUP,HCPCS C1713,,407.754  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 54MM CANN TITANIUM SMALL,$369.85,$0.00,$369.85,$166.43,$263.96,$0.00,$61.87,$0.00,$0.00,$64.76,$369.85,$0.00,$184.93,$292.92,$295.88,$0.00,$56.20,$0.00,$58.88,$0.00
407.756,SUP,HCPCS C1713,,407.756  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 56MM CANN TITANIUM SMALL,$369.85,$0.00,$369.85,$166.43,$263.96,$0.00,$61.87,$0.00,$0.00,$64.76,$369.85,$0.00,$184.93,$292.92,$295.88,$0.00,$56.20,$0.00,$58.88,$0.00
407.758,SUP,HCPCS C1713,,407.758  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 58MM CANN TITANIUM SMALL,$369.85,$0.00,$369.85,$166.43,$263.96,$0.00,$61.87,$0.00,$0.00,$64.76,$369.85,$0.00,$184.93,$292.92,$295.88,$0.00,$56.20,$0.00,$58.88,$0.00
407.76,SUP,HCPCS C1713,,407.760  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 60MM CANN TITANIUM SMALL,$369.85,$0.00,$369.85,$166.43,$263.96,$0.00,$61.87,$0.00,$0.00,$64.76,$369.85,$0.00,$184.93,$292.92,$295.88,$0.00,$56.20,$0.00,$58.88,$0.00
407.764,SUP,HCPCS C1713,,407.764  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 64MM CANN TITANIUM SMALL,$369.85,$0.00,$369.85,$166.43,$263.96,$0.00,$61.87,$0.00,$0.00,$64.76,$369.85,$0.00,$184.93,$292.92,$295.88,$0.00,$56.20,$0.00,$58.88,$0.00
407.768,SUP,HCPCS C1713,,407.768  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 68MM CANN TITANIUM SMALL,$369.85,$0.00,$369.85,$166.43,$263.96,$0.00,$61.87,$0.00,$0.00,$64.76,$369.85,$0.00,$184.93,$292.92,$295.88,$0.00,$56.20,$0.00,$58.88,$0.00
407.772,SUP,HCPCS C1713,,407.772  -  SCREW BONE .5 THREAD 4MM 5MM 1.35MM 72MM CANN TITANIUM SMALL,$369.85,$0.00,$369.85,$166.43,$263.96,$0.00,$61.87,$0.00,$0.00,$64.76,$369.85,$0.00,$184.93,$292.92,$295.88,$0.00,$56.20,$0.00,$58.88,$0.00
408.401,SUP,HCPCS C1713,,408.401  -  SCREW BONE 6.5MM 30MM 16MM CANN TITANIUM ORTHOPEDIC NONSTRL,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.402,SUP,HCPCS C1713,,408.402  -  SCREW BONE 6.5MM 35MM 16MM CANN TITANIUM ORTHOPEDIC NONSTRL,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.403,SUP,HCPCS C1713,,408.403  -  SCREW BONE 6.5MM 40MM 16MM CANN TITANIUM ORTHOPEDIC NONSTRL,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.404,SUP,HCPCS C1713,,408.404  -  SCREW BONE 6.5MM 45MM 16MM CANN TITANIUM ORTHOPEDIC NONSTRL,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.405,SUP,HCPCS C1713,,408.405  -  SCREW BONE 6.5MM 50MM 16MM CANN TITANIUM ORTHOPEDIC NONSTRL,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.406,SUP,HCPCS C1713,,408.406  -  SCREW BONE 6.5MM 55MM 16MM CANN TITANIUM ORTHOPEDIC NONSTRL,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.407,SUP,HCPCS C1713,,408.407  -  SCREW BONE 6.5MM 7.9MM 2.9MM 60MM 16MM CANN TITANIUM LARGE,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.408,SUP,HCPCS C1713,,408.408  -  SCREW BONE 6.5MM 7.9MM 2.9MM 65MM 16MM CANN TITANIUM LARGE,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.409,SUP,HCPCS C1713,,408.409  -  SCREW BONE 6.5MM 7.9MM 2.9MM 70MM 16MM CANN TITANIUM LARGE,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.41,SUP,HCPCS C1713,,408.410  -  SCREW BONE 6.5MM 7.9MM 2.9MM 75MM 16MM CANN TITANIUM LARGE,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.411,SUP,HCPCS C1713,,408.411  -  SCREW BONE 6.5MM 7.9MM 2.9MM 80MM 16MM CANN TITANIUM LARGE,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.412,SUP,HCPCS C1713,,408.412  -  SCREW BONE 6.5MM 7.9MM 2.9MM 85MM 16MM CANN TITANIUM LARGE,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.413,SUP,HCPCS C1713,,408.413  -  SCREW BONE 6.5MM 7.9MM 2.9MM 90MM 16MM CANN TITANIUM LARGE,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.414,SUP,HCPCS C1713,,408.414  -  SCREW BONE 6.5MM 7.9MM 2.9MM 95MM 16MM CANN TITANIUM LARGE,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.415,SUP,HCPCS C1713,,408.415  -  SCREW BONE 6.5MM 7.9MM 2.9MM 100MM 16MM CANN TITANIUM LARGE,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.416,SUP,HCPCS C1713,,408.416  -  SCREW BONE 6.5MM 7.9MM 2.9MM 105MM 16MM CANN TITANIUM LARGE,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.417,SUP,HCPCS C1713,,408.417  -  SCREW BONE 6.5MM 7.9MM 2.9MM 110MM 16MM CANN TITANIUM LARGE,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.418,SUP,HCPCS C1713,,408.418  -  SCREW BONE 6.5MM 7.9MM 2.9MM 115MM 16MM CANN TITANIUM LARGE,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.419,SUP,HCPCS C1713,,408.419  -  SCREW BONE 6.5MM 7.9MM 2.9MM 120MM 16MM CANN TITANIUM LARGE,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.42,SUP,HCPCS C1713,,408.420  -  SCREW BONE 6.5MM 7.9MM 2.9MM 125MM 16MM CANN TITANIUM LARGE,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.421,SUP,HCPCS C1713,,408.421  -  SCREW BONE 6.5MM 7.9MM 2.9MM 130MM 16MM CANN TITANIUM LARGE,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.422,SUP,HCPCS C1713,,408.422  -  SCREW BONE 6.5MM 7.9MM 2.9MM 135MM 16MM CANN TITANIUM LARGE,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.423,SUP,HCPCS C1713,,408.423  -  SCREW BONE 6.5MM 140MM 16MM CANN TITANIUM ORTHOPEDIC NONSTRL,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.424,SUP,HCPCS C1713,,408.424  -  SCREW BONE 6.5MM 145MM 16MM CANN TITANIUM ORTHOPEDIC NONSTRL,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.425,SUP,HCPCS C1713,,408.425  -  SCREW BONE 6.5MM 150MM 16MM CANN TITANIUM ORTHOPEDIC NONSTRL,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.426,SUP,HCPCS C1713,,408.426  -  SCREW BONE 6.5MM 160MM 16MM CANN TITANIUM ORTHOPEDIC NONSTRL,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.427,SUP,HCPCS C1713,,408.427  -  SCREW BONE 6.5MM 170MM 16MM CANN TITANIUM ORTHOPEDIC NONSTRL,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.428,SUP,HCPCS C1713,,408.428  -  SCREW BONE 6.5MM 180MM 16MM CANN TITANIUM ORTHOPEDIC NONSTRL,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.431,SUP,HCPCS C1713,,408.431  -  SCREW BONE 6.5MM 45MM 32MM CANN TITANIUM ORTHOPEDIC NONSTRL,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.432,SUP,HCPCS C1713,,408.432  -  SCREW BONE 6.5MM 50MM 32MM CANN TITANIUM ORTHOPEDIC NONSTRL,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.433,SUP,HCPCS C1713,,408.433  -  SCREW BONE 6.5MM 55MM 32MM CANN TITANIUM ORTHOPEDIC NONSTRL,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.434,SUP,HCPCS C1713,,408.434  -  SCREW BONE 6.5MM 7.9MM 2.9MM 60MM 32MM CANN TITANIUM LARGE,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.435,SUP,HCPCS C1713,,408.435  -  SCREW BONE 6.5MM 7.9MM 2.9MM 65MM 32MM CANN TITANIUM LARGE,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.436,SUP,HCPCS C1713,,408.436  -  SCREW BONE 6.5MM 7.9MM 2.9MM 70MM 32MM CANN TITANIUM LARGE,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.437,SUP,HCPCS C1713,,408.437  -  SCREW BONE 6.5MM 7.9MM 2.9MM 75MM 32MM CANN TITANIUM LARGE,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.438,SUP,HCPCS C1713,,408.438  -  SCREW BONE 6.5MM 7.9MM 2.9MM 80MM 32MM CANN TITANIUM LARGE,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.439,SUP,HCPCS C1713,,408.439  -  SCREW BONE 6.5MM 7.9MM 2.9MM 85MM 32MM CANN TITANIUM LARGE,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.44,SUP,HCPCS C1713,,408.440  -  SCREW BONE 6.5MM 7.9MM 2.9MM 90MM 32MM CANN TITANIUM LARGE,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.441,SUP,HCPCS C1713,,408.441  -  SCREW BONE 6.5MM 7.9MM 2.9MM 95MM 32MM CANN TITANIUM LARGE,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.442,SUP,HCPCS C1713,,408.442  -  SCREW BONE 6.5MM 7.9MM 2.9MM 100MM 32MM CANN TITANIUM LARGE,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.443,SUP,HCPCS C1713,,408.443  -  SCREW BONE 6.5MM 7.9MM 2.9MM 105MM 32MM CANN TITANIUM LARGE,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.444,SUP,HCPCS C1713,,408.444  -  SCREW BONE 6.5MM 7.9MM 2.9MM 110MM 32MM CANN TITANIUM LARGE,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.445,SUP,HCPCS C1713,,408.445  -  SCREW BONE 6.5MM 7.9MM 2.9MM 115MM 32MM CANN TITANIUM LARGE,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.446,SUP,HCPCS C1713,,408.446  -  SCREW BONE 6.5MM 7.9MM 2.9MM 120MM 32MM CANN TITANIUM LARGE,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.447,SUP,HCPCS C1713,,408.447  -  SCREW BONE 6.5MM 7.9MM 2.9MM 125MM 32MM CANN TITANIUM LARGE,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.448,SUP,HCPCS C1713,,408.448  -  SCREW BONE 6.5MM 7.9MM 2.9MM 130MM 32MM CANN TITANIUM LARGE,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.449,SUP,HCPCS C1713,,408.449  -  SCREW BONE 6.5MM 7.9MM 2.9MM 135MM 32MM CANN TITANIUM LARGE,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.45,SUP,HCPCS C1713,,408.450  -  SCREW BONE 6.5MM 140MM 32MM CANN TITANIUM ORTHOPEDIC NONSTRL,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.451,SUP,HCPCS C1713,,408.451  -  SCREW BONE 6.5MM 145MM 32MM CANN TITANIUM ORTHOPEDIC NONSTRL,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.452,SUP,HCPCS C1713,,408.452  -  SCREW BONE 6.5MM 150MM 32MM CANN TITANIUM ORTHOPEDIC NONSTRL,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.453,SUP,HCPCS C1713,,408.453  -  SCREW BONE 6.5MM 160MM 32MM CANN TITANIUM ORTHOPEDIC NONSTRL,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.454,SUP,HCPCS C1713,,408.454  -  SCREW BONE 6.5MM 170MM 32MM CANN TITANIUM ORTHOPEDIC NONSTRL,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.455,SUP,HCPCS C1713,,408.455  -  SCREW BONE 6.5MM 180MM 32MM CANN TITANIUM ORTHOPEDIC NONSTRL,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.46,SUP,HCPCS C1713,,408.460  -  SCREW BONE FULTHD 6.5MM 20MM CANN TITANIUM FEMUR TIBIA ANKLE,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.461,SUP,HCPCS C1713,,408.461  -  SCREW BONE FULTHD 6.5MM 25MM CANN TITANIUM ORTHOPEDIC,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.462,SUP,HCPCS C1713,,408.462  -  SCREW BONE FULTHD 6.5MM 30MM CANN TITANIUM ORTHOPEDIC,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.463,SUP,HCPCS C1713,,408.463  -  SCREW BONE FULTHD 6.5MM 35MM CANN TITANIUM ORTHOPEDIC,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.464,SUP,HCPCS C1713,,408.464  -  SCREW BONE FULTHD 6.5MM 40MM CANN TITANIUM ORTHOPEDIC,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.465,SUP,HCPCS C1713,,408.465  -  SCREW BONE 6.5MM 45MM FULTHRD TITANIUM CANCELLOUS NONSTRL,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.466,SUP,HCPCS C1713,,408.466  -  SCREW BONE FULTHD 6.5MM 50MM CANN TITANIUM ORTHOPEDIC,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.467,SUP,HCPCS C1713,,408.467  -  SCREW BONE FULTHD 6.5MM 55MM CANN TITANIUM ORTHOPEDIC,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.468,SUP,HCPCS C1713,,408.468  -  SCREW BONE FULTHD 6.5MM 60MM CANN TITANIUM ORTHOPEDIC,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.469,SUP,HCPCS C1713,,408.469  -  SCREW BONE FULTHD 6.5MM 65MM CANN TITANIUM ORTHOPEDIC,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.47,SUP,HCPCS C1713,,408.470  -  SCREW BONE FULTHD 6.5MM 70MM CANN TITANIUM FEMUR TIBIA ANKLE,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.471,SUP,HCPCS C1713,,408.471  -  SCREW BONE FULTHD 6.5MM 75MM CANN TITANIUM ORTHOPEDIC,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.472,SUP,HCPCS C1713,,408.472  -  SCREW BONE FULTHD 6.5MM 80MM CANN TITANIUM ORTHOPEDIC,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.473,SUP,HCPCS C1713,,408.473  -  SCREW BONE FULTHD 6.5MM 85MM CANN TITANIUM ORTHOPEDIC,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.474,SUP,HCPCS C1713,,408.474  -  SCREW BONE FULTHD 6.5MM 90MM CANN TITANIUM ORTHOPEDIC,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.475,SUP,HCPCS C1713,,408.475  -  SCREW BONE FULTHD 6.5MM 95MM CANN TITANIUM ORTHOPEDIC,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.476,SUP,HCPCS C1713,,408.476  -  SCREW BONE FULTHD 6.5MM 100MM CANN TITANIUM ORTHOPEDIC,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.477,SUP,HCPCS C1713,,408.477  -  SCREW BONE FULTHD 6.5MM 105MM CANN TITANIUM ORTHOPEDIC,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.478,SUP,HCPCS C1713,,408.478  -  SCREW BONE FULTHD 6.5MM 110MM CANN TITANIUM ORTHOPEDIC,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.479,SUP,HCPCS C1713,,408.479  -  SCREW BONE FULTHD 6.5MM 115MM CANN TITANIUM ORTHOPEDIC,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.48,SUP,HCPCS C1713,,408.480  -  SCREW BONE FULTHD 6.5MM 120MM CANN TITANIUM FEMUR TIBIA,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.481,SUP,HCPCS C1713,,408.481  -  SCREW BONE FULTHD 6.5MM 125MM CANN TITANIUM ORTHOPEDIC,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.482,SUP,HCPCS C1713,,408.482  -  SCREW BONE FULTHD 6.5MM 130MM CANN TITANIUM ORTHOPEDIC,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
408.483,SUP,HCPCS C1713,,408.483  -  SCREW BONE 6.5MM 140MM CANN FULTHD TITANIUM ORTHOPEDIC,$487.23,$0.00,$487.23,$219.25,$347.73,$0.00,$81.50,$0.00,$0.00,$85.31,$487.23,$0.00,$243.61,$385.89,$389.78,$0.00,$74.03,$0.00,$77.57,$0.00
408.484,SUP,HCPCS C1713,,408.484  -  SCREW BONE FULTHD 6.5MM 150MM CANN TITANIUM ORTHOPEDIC,$487.23,$0.00,$487.23,$219.25,$347.73,$0.00,$81.50,$0.00,$0.00,$85.31,$487.23,$0.00,$243.61,$385.89,$389.78,$0.00,$74.03,$0.00,$77.57,$0.00
408.485,SUP,HCPCS C1713,,408.485  -  SCREW BONE FULTHD 6.5MM 160MM CANN TITANIUM ORTHOPEDIC,$487.23,$0.00,$487.23,$219.25,$347.73,$0.00,$81.50,$0.00,$0.00,$85.31,$487.23,$0.00,$243.61,$385.89,$389.78,$0.00,$74.03,$0.00,$77.57,$0.00
408.486,SUP,HCPCS C1713,,408.486  -  SCREW BONE FULTHD 6.5MM 170MM CANN TITANIUM ORTHOPEDIC,$487.23,$0.00,$487.23,$219.25,$347.73,$0.00,$81.50,$0.00,$0.00,$85.31,$487.23,$0.00,$243.61,$385.89,$389.78,$0.00,$74.03,$0.00,$77.57,$0.00
408.487,SUP,HCPCS C1713,,408.487  -  SCREW BONE FULTHD 6.5MM 180MM CANN TITANIUM ORTHOPEDIC,$487.23,$0.00,$487.23,$219.25,$347.73,$0.00,$81.50,$0.00,$0.00,$85.31,$487.23,$0.00,$243.61,$385.89,$389.78,$0.00,$74.03,$0.00,$77.57,$0.00
408.83,SUP,HCPCS C1713,,408.830  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 30MM,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
408.835,SUP,HCPCS C1713,,408.835  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 35MM,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
408.84,SUP,HCPCS C1713,,408.840  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 40MM,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
408.845,SUP,HCPCS C1713,,408.845  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 45MM,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
408.85,SUP,HCPCS C1713,,408.850  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 50MM,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
408.855,SUP,HCPCS C1713,,408.855  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 55MM,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
408.86,SUP,HCPCS C1713,,408.860  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 60MM,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
408.865,SUP,HCPCS C1713,,408.865  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 65MM,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
408.87,SUP,HCPCS C1713,,408.870  -  SCREW BONE 7.3MM 8.2MM 2.9MM 70MM 16MM CANN SELF TAP SELF,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
408.875,SUP,HCPCS C1713,,408.875  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 75MM,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
408.88,SUP,HCPCS C1713,,408.880  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 80MM,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
408.885,SUP,HCPCS C1713,,408.885  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 85MM,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
408.89,SUP,HCPCS C1713,,408.890  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 90MM,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
408.895,SUP,HCPCS C1713,,408.895  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 95MM,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
408.9,SUP,HCPCS C1713,,408.900  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 100MM,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
408.905,SUP,HCPCS C1713,,408.905  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 105MM,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
408.91,SUP,HCPCS C1713,,408.910  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 110MM,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
408.915,SUP,HCPCS C1713,,408.915  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 115MM,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
408.92,SUP,HCPCS C1713,,408.920  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 120MM,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
408.925,SUP,HCPCS C1713,,408.925  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 125MM,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
408.93,SUP,HCPCS C1713,,408.930  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 130MM,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
408.935,SUP,HCPCS C1713,,408.935  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 135MM,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
408.94,SUP,HCPCS C1713,,408.940  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 140MM,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
408.945,SUP,HCPCS C1713,,408.945  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 145MM,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
408.95,SUP,HCPCS C1713,,408.950  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 150MM,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
409.62,SUP,HCPCS C1713,,409.620  -  SCREW BONE FULTHD 7.3MM 20MM CANN TITANIUM FEMUR TIBIA ANKLE,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
409.625,SUP,HCPCS C1713,,409.625  -  SCREW BONE FULTHD 7.3MM 25MM CANN TITANIUM ORTHOPEDIC,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
409.63,SUP,HCPCS C1713,,409.630  -  SCREW BONE FULTHD 7.3MM 30MM CANN TITANIUM FEMUR TIBIA ANKLE,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
409.635,SUP,HCPCS C1713,,409.635  -  SCREW BONE FULTHD 7.3MM 35MM CANN TITANIUM ORTHOPEDIC,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
409.64,SUP,HCPCS C1713,,409.640  -  SCREW BONE FULTHD 7.3MM 40MM CANN TITANIUM FEMUR TIBIA ANKLE,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
409.645,SUP,HCPCS C1713,,409.645  -  SCREW BONE FULTHD 7.3MM 45MM CANN TITANIUM ORTHOPEDIC,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
409.65,SUP,HCPCS C1713,,409.650  -  SCREW BONE FULTHD 7.3MM 50MM CANN TITANIUM FEMUR TIBIA ANKLE,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
409.655,SUP,HCPCS C1713,,409.655  -  SCREW BONE FULTHD 7.3MM 55MM CANN TITANIUM ORTHOPEDIC,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
409.66,SUP,HCPCS C1713,,409.660  -  SCREW BONE FULTHD 7.3MM 60MM CANN TITANIUM FEMUR TIBIA ANKLE,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
409.665,SUP,HCPCS C1713,,409.665  -  SCREW BONE FULTHD 7.3MM 65MM CANN TITANIUM ORTHOPEDIC,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
409.67,SUP,HCPCS C1713,,409.670  -  SCREW BONE FULTHD 7.3MM 70MM CANN TITANIUM FEMUR TIBIA ANKLE,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
409.675,SUP,HCPCS C1713,,409.675  -  SCREW BONE FULTHD 7.3MM 8MM 2.9MM 75MM CANN SELF DRILL GOLD,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
409.68,SUP,HCPCS C1713,,409.680  -  SCREW BONE FULTHD 7.3MM 8.2MM 80MM CANN SLFDRILL SLFTAP,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
409.685,SUP,HCPCS C1713,,409.685  -  SCREW BONE FULTHD 7.3MM 85MM CANN TITANIUM ORTHOPEDIC,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
409.69,SUP,HCPCS C1713,,409.690  -  SCREW BONE FULTHD 7.3MM 8MM 2.9MM 90MM CANN SELF DRILL GOLD,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
409.695,SUP,HCPCS C1713,,409.695  -  SCREW BONE FULTHD 7.3MM 8MM 2.9MM 95MM CANN SELF DRILL GOLD,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
409.7,SUP,HCPCS C1713,,409.700  -  SCREW BONE FULTHD 7.3MM 100MM CANN TITANIUM ORTHOPEDIC,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
409.705,SUP,HCPCS C1713,,409.705  -  SCREW BONE FULTHD 7.3MM 105MM CANN TITANIUM ORTHOPEDIC,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
409.71,SUP,HCPCS C1713,,409.710  -  SCREW BONE FULTHD 7.3MM 110MM CANN TITANIUM ORTHOPEDIC,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
409.715,SUP,HCPCS C1713,,409.715  -  SCREW BONE FULTHD 7.3MM 115MM CANN TITANIUM ORTHOPEDIC,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
409.72,SUP,HCPCS C1713,,409.720  -  SCREW BONE FULTHD 7.3MM 120MM CANN TITANIUM ORTHOPEDIC,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
409.725,SUP,HCPCS C1713,,409.725  -  SCREW BONE FULTHD 7.3MM 125MM CANN TITANIUM ORTHOPEDIC,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
409.73,SUP,HCPCS C1713,,409.730  -  SCREW BONE FULTHD 7.3MM 130MM CANN TITANIUM ORTHOPEDIC,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
409.845,SUP,HCPCS C1713,,409.845  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 45MM,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
409.85,SUP,HCPCS C1713,,409.850  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 50MM,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
409.855,SUP,HCPCS C1713,,409.855  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 55MM,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
409.86,SUP,HCPCS C1713,,409.860  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 60MM,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
409.865,SUP,HCPCS C1713,,409.865  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 65MM,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
409.87,SUP,HCPCS C1713,,409.870  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 70MM,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
409.875,SUP,HCPCS C1713,,409.875  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 75MM,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
409.88,SUP,HCPCS C1713,,409.880  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 80MM,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
409.885,SUP,HCPCS C1713,,409.885  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 85MM,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
409.89,SUP,HCPCS C1713,,409.890  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 90MM,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
409.895,SUP,HCPCS C1713,,409.895  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 95MM,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
409.9,SUP,HCPCS C1713,,409.900  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 100MM,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
409.905,SUP,HCPCS C1713,,409.905  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 105MM,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
409.91,SUP,HCPCS C1713,,409.910  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 110MM,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
409.915,SUP,HCPCS C1713,,409.915  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 115MM,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
409.92,SUP,HCPCS C1713,,409.920  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 120MM,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
409.925,SUP,HCPCS C1713,,409.925  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 125MM,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
409.93,SUP,HCPCS C1713,,409.930  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 130MM,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
409.935,SUP,HCPCS C1713,,409.935  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 135MM,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
409.94,SUP,HCPCS C1713,,409.940  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 140MM,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
409.945,SUP,HCPCS C1713,,409.945  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 145MM,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
409.95,SUP,HCPCS C1713,,409.950  -  SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 150MM,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
412.101,SUP,HCPCS C1713,,412.101  -  SCREW BONE T15 FULTHD 3.5MM 10MM SELF TAP STARDRIVE LCP,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
412.102,SUP,HCPCS C1713,,412.102  -  SCREW BONE T15 FULTHD 3.5MM 12MM SELF TAP STARDRIVE LCP,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
412.103,SUP,HCPCS C1713,,412.103  -  SCREW BONE T15 FULTHD 3.5MM 14MM SELF TAP STARDRIVE LCP,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
412.104,SUP,HCPCS C1713,,412.104  -  SCREW BONE T15 FULTHD 3.5MM 16MM SELF TAP STARDRIVE LCP,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
412.105,SUP,HCPCS C1713,,412.105  -  SCREW BONE 3.5MM 5MM 18MM SELF TAP LOCK T15 STARDRIVE RECESS,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
412.106,SUP,HCPCS C1713,,412.106  -  SCREW BONE T15 FULTHD 3.5MM 20MM SELF TAP STARDRIVE LCP,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
412.107,SUP,HCPCS C1713,,412.107  -  SCREW BONE T15 FULTHD 3.5MM 22MM SELF TAP STARDRIVE LCP,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
412.108,SUP,HCPCS C1713,,412.108  -  SCREW BONE 3.5MM 24MM SELF TAP LOCK STARDRIVE CONICAL HEAD,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
412.109,SUP,HCPCS C1713,,412.109  -  SCREW BONE T15 FULTHD 3.5MM 26MM SELF TAP STARDRIVE LCP,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
412.11,SUP,HCPCS C1713,,412.110  -  SCREW BONE T15 FULTHD 3.5MM 28MM SELF TAP STARDRIVE LCP,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
412.111,SUP,HCPCS C1713,,412.111  -  SCREW BONE T15 FULTHD 3.5MM 30MM SELF TAP STARDRIVE LCP,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
412.112,SUP,HCPCS C1713,,412.112  -  SCREW BONE T15 FULTHD 3.5MM 32MM SELF TAP STARDRIVE LCP,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
412.113,SUP,HCPCS C1713,,412.113  -  SCREW BONE T15 FULTHD 3.5MM 34MM SELF TAP STARDRIVE LCP,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
412.114,SUP,HCPCS C1713,,412.114  -  SCREW BONE T15 FULTHD 3.5MM 35MM SELF TAP STARDRIVE LCP,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
412.115,SUP,HCPCS C1713,,412.115  -  SCREW BONE T15 FULTHD 3.5MM 36MM SELF TAP STARDRIVE LCP,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$48.79,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$44.32,$0.00,$36.29,$0.00
412.116,SUP,HCPCS C1713,,412.116  -  SCREW BONE T15 FULTHD 3.5MM 38MM SELF TAP STARDRIVE LCP,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
412.117,SUP,HCPCS C1713,,412.117  -  SCREW BONE T15 FULTHD 3.5MM 40MM SELF TAP STARDRIVE LCP,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
412.118,SUP,HCPCS C1713,,412.118  -  SCREW BONE T15 FULTHD 3.5MM 42MM SELF TAP STARDRIVE LCP,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
412.119,SUP,HCPCS C1713,,412.119  -  SCREW BONE T15 FULTHD 3.5MM 45MM SELF TAP STARDRIVE LCP,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
412.12,SUP,HCPCS C1713,,412.120  -  SCREW BONE T15 FULTHD 3.5MM 48MM SELF TAP STARDRIVE LCP,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
412.121,SUP,HCPCS C1713,,412.121  -  SCREW BONE T15 FULTHD 3.5MM 50MM SELF TAP STARDRIVE LCP,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
412.122,SUP,HCPCS C1713,,412.122  -  SCREW BONE T15 FULTHD 3.5MM 52MM SELF TAP STARDRIVE LCP,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
412.123,SUP,HCPCS C1713,,412.123  -  SCREW BONE T15 FULTHD 3.5MM 55MM SELF TAP STARDRIVE LCP,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
412.124,SUP,HCPCS C1713,,412.124  -  SCREW BONE T15 FULTHD 3.5MM 60MM SELF TAP STARDRIVE LCP,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
412.125,SUP,HCPCS C1713,,412.125  -  SCREW BONE 3.5MM 65MM SLFTAP LOCKING STARDRIVE RECESS LCP,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
412.126,SUP,HCPCS C1713,,412.126  -  SCREW BONE T15 FULTHD 3.5MM 70MM SELF TAP STARDRIVE LCP,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
412.127,SUP,HCPCS C1713,,412.127  -  SCREW BONE T15 FULTHD 3.5MM 75MM SELF TAP STARDRIVE LCP,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
412.128,SUP,HCPCS C1713,,412.128  -  SCREW BONE T15 FULTHD 3.5MM 80MM SELF TAP STARDRIVE LCP,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
412.129,SUP,HCPCS C1713,,412.129  -  SCREW BONE 3.5MM 85MM SLFTAP LOCKING STARDRIVE RECESS LCP,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
412.13,SUP,HCPCS C1713,,412.130  -  SCREW BONE 3.5MM 90MM SLFTAP LOCKING STARDRIVE RECESS LCP,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
412.131,SUP,HCPCS C1713,,412.131  -  SCREW BONE 3.5MM 95MM SLFTAP LOCKING STARDRIVE RECESS LCP,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
412.134,SUP,HCPCS C1713,,412.134  -  SCREW BONE T15 FULTHD 3.5MM 44MM SELF TAP STARDRIVE LCP,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
412.136,SUP,HCPCS C1713,,412.136  -  SCREW BONE T15 FULTHD 3.5MM 46MM SELF TAP STARDRIVE LCP,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
412.201,SUP,HCPCS C1713,,412.201  -  SCREW BONE T25 5MM 14MM SELF TAP STARDRIVE LCP TITANIUM,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
412.202,SUP,HCPCS C1713,,412.202  -  SCREW BONE T25 5MM 16MM SELF TAP STARDRIVE LCP TITANIUM,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
412.203,SUP,HCPCS C1713,,412.203  -  SCREW BONE T25 5MM 18MM SELF TAP STARDRIVE LCP TITANIUM,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
412.204,SUP,HCPCS C1713,,412.204  -  SCREW BONE T25 5MM 20MM SELF TAP STARDRIVE LCP TITANIUM,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
412.205,SUP,HCPCS C1713,,412.205  -  SCREW BONE T25 5MM 22MM SELF TAP STARDRIVE LCP TITANIUM,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
412.206,SUP,HCPCS C1713,,412.206  -  SCREW BONE T25 5MM 24MM SELF TAP STARDRIVE LCP TITANIUM,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
412.207,SUP,HCPCS C1713,,412.207  -  SCREW BONE T25 5MM 26MM SELF TAP STARDRIVE LCP TITANIUM,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
412.208,SUP,HCPCS C1713,,412.208  -  SCREW BONE T25 5MM 28MM SELF TAP STARDRIVE LCP TITANIUM,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
412.209,SUP,HCPCS C1713,,412.209  -  SCREW BONE T25 5MM 30MM SELF TAP STARDRIVE LCP TITANIUM,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
412.21,SUP,HCPCS C1713,,412.210  -  SCREW BONE T25 5MM 32MM SELF TAP STARDRIVE LCP TITANIUM,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
412.211,SUP,HCPCS C1713,,412.211  -  SCREW BONE T25 5MM 34MM SELF TAP STARDRIVE LCP TITANIUM,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
412.212,SUP,HCPCS C1713,,412.212  -  SCREW BONE T25 5MM 36MM SELF TAP STARDRIVE LCP TITANIUM,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
412.213,SUP,HCPCS C1713,,412.213  -  SCREW BONE T25 5MM 38MM SELF TAP STARDRIVE LCP TITANIUM,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
412.214,SUP,HCPCS C1713,,412.214  -  SCREW BONE T25 5MM 40MM SELF TAP STARDRIVE LCP TITANIUM,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
412.215,SUP,HCPCS C1713,,412.215  -  SCREW BONE 5MM 6.6MM 42MM LOCK T25 STARDRIVE RECESS LCP,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
412.216,SUP,HCPCS C1713,,412.216  -  SCREW BONE 5MM 44MM LOCKING SLFTAP T25 STARDRIVE RECESS LCP,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
412.217,SUP,HCPCS C1713,,412.217  -  SCREW BONE T25 5MM 46MM SELF TAP STARDRIVE LCP TITANIUM,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
412.218,SUP,HCPCS C1713,,412.218  -  SCREW BONE 5MM 6.6MM 48MM LOCK SELF TAP T25 STARDRIVE LCP,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
412.219,SUP,HCPCS C1713,,412.219  -  SCREW BONE T25 5MM 50MM SELF TAP STARDRIVE LCP TITANIUM,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
412.22,SUP,HCPCS C1713,,412.220  -  SCREW BONE T25 5MM 55MM SELF TAP STARDRIVE LCP TITANIUM,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
412.221,SUP,HCPCS C1713,,412.221  -  SCREW BONE 5MM 60MM LOCKING SLFTAP T25 STARDRIVE RECESS LCP,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
412.222,SUP,HCPCS C1713,,412.222  -  SCREW BONE T25 5MM 65MM SELF TAP STARDRIVE LCP TITANIUM,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
412.223,SUP,HCPCS C1713,,412.223  -  SCREW BONE T25 5MM 70MM SELF TAP STARDRIVE LCP TITANIUM,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
412.224,SUP,HCPCS C1713,,412.224  -  SCREW BONE T25 5MM 75MM SELF TAP STARDRIVE LCP TITANIUM,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
412.225,SUP,HCPCS C1713,,412.225  -  SCREW BONE T25 5MM 80MM SELF TAP STARDRIVE LCP TITANIUM,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
412.226,SUP,HCPCS C1713,,412.226  -  SCREW BONE T25 5MM 85MM SELF TAP STARDRIVE LCP TITANIUM,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
412.227,SUP,HCPCS C1713,,412.227  -  SCREW BONE T25 5MM 90MM SELF TAP STARDRIVE LCP TITANIUM,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
412.251,SUP,HCPCS C1713,,412.251  -  SCREW BONE 5MM 51MM SLFDRILL LOCKING TITANIUM ORTHOPEDIC,$385.58,$0.00,$385.58,$173.51,$275.18,$0.00,$66.43,$0.00,$0.00,$67.51,$385.58,$0.00,$192.79,$305.38,$308.46,$0.00,$60.34,$0.00,$61.38,$0.00
412.252,SUP,HCPCS C1713,,412.252  -  SCREW BONE 5MM 52MM SLFDRILL LOCKING TITANIUM ORTHOPEDIC,$385.58,$0.00,$385.58,$173.51,$275.18,$0.00,$66.43,$0.00,$0.00,$67.51,$385.58,$0.00,$192.79,$305.38,$308.46,$0.00,$60.34,$0.00,$61.38,$0.00
412.253,SUP,HCPCS C1713,,412.253  -  SCREW BONE 5MM 53MM SLFDRILL LOCKING TITANIUM ORTHOPEDIC,$385.58,$0.00,$385.58,$173.51,$275.18,$0.00,$66.43,$0.00,$0.00,$67.51,$385.58,$0.00,$192.79,$305.38,$308.46,$0.00,$60.34,$0.00,$61.38,$0.00
412.254,SUP,HCPCS C1713,,412.254  -  SCREW BONE 5MM 54MM SLFDRILL LOCKING TITANIUM ORTHOPEDIC,$385.58,$0.00,$385.58,$173.51,$275.18,$0.00,$66.43,$0.00,$0.00,$67.51,$385.58,$0.00,$192.79,$305.38,$308.46,$0.00,$60.34,$0.00,$61.38,$0.00
412.255,SUP,HCPCS C1713,,412.255  -  SCREW BONE 5MM 55MM SLFDRILL LOCKING TITANIUM ORTHOPEDIC,$385.58,$0.00,$385.58,$173.51,$275.18,$0.00,$66.43,$0.00,$0.00,$67.51,$385.58,$0.00,$192.79,$305.38,$308.46,$0.00,$60.34,$0.00,$61.38,$0.00
412.256,SUP,HCPCS C1713,,412.256  -  SCREW BONE 5MM 56MM SLFDRILL LOCKING TITANIUM ORTHOPEDIC,$385.58,$0.00,$385.58,$173.51,$275.18,$0.00,$66.43,$0.00,$0.00,$67.51,$385.58,$0.00,$192.79,$305.38,$308.46,$0.00,$60.34,$0.00,$61.38,$0.00
412.257,SUP,HCPCS C1713,,412.257  -  SCREW BONE 5MM 40MM SLFDRILL LOCKING STARDRIVE RECESS LISS,$385.58,$0.00,$385.58,$173.51,$275.18,$0.00,$66.43,$0.00,$0.00,$67.51,$385.58,$0.00,$192.79,$305.38,$308.46,$0.00,$60.34,$0.00,$61.38,$0.00
412.258,SUP,HCPCS C1713,,412.258  -  SCREW BONE 5MM 45MM SLFDRILL LOCKING STARDRIVE RECESS LISS,$385.58,$0.00,$385.58,$173.51,$275.18,$0.00,$66.43,$0.00,$0.00,$67.51,$385.58,$0.00,$192.79,$305.38,$308.46,$0.00,$60.34,$0.00,$61.38,$0.00
412.259,SUP,HCPCS C1713,,412.259  -  SCREW BONE 5MM 50MM SLFDRILL LOCKING STARDRIVE RECESS LISS,$385.58,$0.00,$385.58,$173.51,$275.18,$0.00,$66.43,$0.00,$0.00,$67.51,$385.58,$0.00,$192.79,$305.38,$308.46,$0.00,$60.34,$0.00,$61.38,$0.00
412.26,SUP,HCPCS C1713,,412.260  -  SCREW BONE 5MM 55MM SLFDRILL LOCKING STARDRIVE RECESS LISS,$385.58,$0.00,$385.58,$173.51,$275.18,$0.00,$66.43,$0.00,$0.00,$67.51,$385.58,$0.00,$192.79,$305.38,$308.46,$0.00,$60.34,$0.00,$61.38,$0.00
412.261,SUP,HCPCS C1713,,412.261  -  SCREW BONE 5MM 60MM SLFDRILL LOCKING STARDRIVE RECESS LISS,$385.58,$0.00,$385.58,$173.51,$275.18,$0.00,$66.43,$0.00,$0.00,$67.51,$385.58,$0.00,$192.79,$305.38,$308.46,$0.00,$60.34,$0.00,$61.38,$0.00
412.262,SUP,HCPCS C1713,,412.262  -  SCREW BONE 5MM 65MM SLFDRILL LOCKING STARDRIVE RECESS LISS,$385.58,$0.00,$385.58,$173.51,$275.18,$0.00,$66.43,$0.00,$0.00,$67.51,$385.58,$0.00,$192.79,$305.38,$308.46,$0.00,$60.34,$0.00,$61.38,$0.00
412.263,SUP,HCPCS C1713,,412.263  -  SCREW BONE 5MM 70MM SLFDRILL LOCKING STARDRIVE RECESS LISS,$385.58,$0.00,$385.58,$173.51,$275.18,$0.00,$66.43,$0.00,$0.00,$67.51,$385.58,$0.00,$192.79,$305.38,$308.46,$0.00,$60.34,$0.00,$61.38,$0.00
412.264,SUP,HCPCS C1713,,412.264  -  SCREW BONE 5MM 75MM SLFDRILL LOCKING STARDRIVE RECESS LISS,$385.58,$0.00,$385.58,$173.51,$275.18,$0.00,$66.43,$0.00,$0.00,$67.51,$385.58,$0.00,$192.79,$305.38,$308.46,$0.00,$60.34,$0.00,$61.38,$0.00
412.265,SUP,HCPCS C1713,,412.265  -  SCREW BONE 5MM 80MM SLFDRILL LOCKING STARDRIVE RECESS LISS,$385.58,$0.00,$385.58,$173.51,$275.18,$0.00,$66.43,$0.00,$0.00,$67.51,$385.58,$0.00,$192.79,$305.38,$308.46,$0.00,$60.34,$0.00,$61.38,$0.00
412.266,SUP,HCPCS C1713,,412.266  -  SCREW BONE 5MM 85MM SLFDRILL LOCKING STARDRIVE RECESS LISS,$385.58,$0.00,$385.58,$173.51,$275.18,$0.00,$66.43,$0.00,$0.00,$67.51,$385.58,$0.00,$192.79,$305.38,$308.46,$0.00,$60.34,$0.00,$61.38,$0.00
412.267,SUP,HCPCS C1713,,412.267  -  SCREW BONE 5MM 90MM SLFDRILL LOCKING STARDRIVE RECESS LISS,$385.58,$0.00,$385.58,$173.51,$275.18,$0.00,$66.43,$0.00,$0.00,$67.51,$385.58,$0.00,$192.79,$305.38,$308.46,$0.00,$60.34,$0.00,$61.38,$0.00
412.317,SUP,HCPCS C1713,,412.317  -  SCREW BONE FULTHD 3.5MM 40MM SLFTAP CONICAL STARDRIVE RECESS,$256.58,$0.00,$256.58,$115.46,$183.12,$0.00,$42.92,$0.00,$0.00,$44.92,$256.58,$0.00,$128.29,$203.21,$205.26,$0.00,$38.98,$0.00,$40.85,$0.00
412.319,SUP,HCPCS C1713,,412.319  -  SCREW BONE FULTHD 3.5MM 45MM SLFTAP CONICAL STARDRIVE RECESS,$256.58,$0.00,$256.58,$115.46,$183.12,$0.00,$42.92,$0.00,$0.00,$44.92,$256.58,$0.00,$128.29,$203.21,$205.26,$0.00,$38.98,$0.00,$40.85,$0.00
412.321,SUP,HCPCS C1713,,412.321  -  SCREW BONE FULTHD 3.5MM 50MM SLFTAP CONICAL STARDRIVE RECESS,$256.58,$0.00,$256.58,$115.46,$183.12,$0.00,$42.92,$0.00,$0.00,$44.92,$256.58,$0.00,$128.29,$203.21,$205.26,$0.00,$38.98,$0.00,$40.85,$0.00
412.323,SUP,HCPCS C1713,,412.323  -  SCREW BONE FULTHD 3.5MM 55MM SLFTAP CONICAL STARDRIVE RECESS,$256.58,$0.00,$256.58,$115.46,$183.12,$0.00,$42.92,$0.00,$0.00,$44.92,$256.58,$0.00,$128.29,$203.21,$205.26,$0.00,$38.98,$0.00,$40.85,$0.00
412.324,SUP,HCPCS C1713,,412.324  -  SCREW BONE FULTHD 3.5MM 60MM SLFTAP CONICAL STARDRIVE RECESS,$256.58,$0.00,$256.58,$115.46,$183.12,$0.00,$42.92,$0.00,$0.00,$44.92,$256.58,$0.00,$128.29,$203.21,$205.26,$0.00,$38.98,$0.00,$40.85,$0.00
412.325,SUP,HCPCS C1713,,412.325  -  SCREW BONE FULTHD 3.5MM 65MM SLFTAP LOCKING STARDRIVE RECESS,$256.58,$0.00,$256.58,$115.46,$183.12,$0.00,$42.92,$0.00,$0.00,$44.92,$256.58,$0.00,$128.29,$203.21,$205.26,$0.00,$38.98,$0.00,$40.85,$0.00
412.326,SUP,HCPCS C1713,,412.326  -  SCREW BONE FULTHD 3.5MM 70MM SLFTAP CONICAL STARDRIVE RECESS,$256.58,$0.00,$256.58,$115.46,$183.12,$0.00,$42.92,$0.00,$0.00,$44.92,$256.58,$0.00,$128.29,$203.21,$205.26,$0.00,$38.98,$0.00,$40.85,$0.00
412.327,SUP,HCPCS C1713,,412.327  -  SCREW BONE FULTHD 3.5MM 75MM SLFTAP CONICAL STARDRIVE RECESS,$256.58,$0.00,$256.58,$115.46,$183.12,$0.00,$42.92,$0.00,$0.00,$44.92,$256.58,$0.00,$128.29,$203.21,$205.26,$0.00,$38.98,$0.00,$40.85,$0.00
412.328,SUP,HCPCS C1713,,412.328  -  SCREW BONE FULTHD 3.5MM 80MM SLFTAP LOCKING STARDRIVE RECESS,$249.75,$0.00,$249.75,$112.39,$178.25,$0.00,$41.78,$0.00,$0.00,$43.73,$249.75,$0.00,$124.88,$197.80,$199.80,$0.00,$37.95,$0.00,$39.76,$0.00
412.329,SUP,HCPCS C1713,,412.329  -  SCREW BONE FULTHD 3.5MM 85MM SLFTAP CONICAL STARDRIVE RECESS,$249.75,$0.00,$249.75,$112.39,$178.25,$0.00,$41.78,$0.00,$0.00,$43.73,$249.75,$0.00,$124.88,$197.80,$199.80,$0.00,$37.95,$0.00,$39.76,$0.00
412.33,SUP,HCPCS C1713,,412.330  -  SCREW BONE FULTHD 3.5MM 90MM SLFTAP CONICAL STARDRIVE RECESS,$249.75,$0.00,$249.75,$112.39,$178.25,$0.00,$41.78,$0.00,$0.00,$43.73,$249.75,$0.00,$124.88,$197.80,$199.80,$0.00,$37.95,$0.00,$39.76,$0.00
412.331,SUP,HCPCS C1713,,412.331  -  SCREW BONE FULTHD 3.5MM 95MM SLFTAP CONICAL STARDRIVE RECESS,$249.75,$0.00,$249.75,$112.39,$178.25,$0.00,$41.78,$0.00,$0.00,$43.73,$249.75,$0.00,$124.88,$197.80,$199.80,$0.00,$37.95,$0.00,$39.76,$0.00
412.417,SUP,HCPCS C1713,,412.417  -  SCREW BONE 3.5MM 40MM SLFTAP CONICAL STARDRIVE RECESS PTHRD,$256.58,$0.00,$256.58,$115.46,$183.12,$0.00,$42.92,$0.00,$0.00,$44.92,$256.58,$0.00,$128.29,$203.21,$205.26,$0.00,$38.98,$0.00,$40.85,$0.00
412.419,SUP,HCPCS C1713,,412.419  -  SCREW BONE 3.5MM 45MM SLFTAP CONICAL STARDRIVE RECESS PTHRD,$256.58,$0.00,$256.58,$115.46,$183.12,$0.00,$42.92,$0.00,$0.00,$44.92,$256.58,$0.00,$128.29,$203.21,$205.26,$0.00,$38.98,$0.00,$40.85,$0.00
412.421,SUP,HCPCS C1713,,412.421  -  SCREW BONE 3.5MM 50MM SLFTAP CONICAL STARDRIVE RECESS PTHRD,$256.58,$0.00,$256.58,$115.46,$183.12,$0.00,$42.92,$0.00,$0.00,$44.92,$256.58,$0.00,$128.29,$203.21,$205.26,$0.00,$38.98,$0.00,$40.85,$0.00
412.423,SUP,HCPCS C1713,,412.423  -  SCREW BONE 3.5MM 55MM SLFTAP CONICAL STARDRIVE RECESS PTHRD,$256.58,$0.00,$256.58,$115.46,$183.12,$0.00,$42.92,$0.00,$0.00,$44.92,$256.58,$0.00,$128.29,$203.21,$205.26,$0.00,$38.98,$0.00,$40.85,$0.00
412.424,SUP,HCPCS C1713,,412.424  -  SCREW BONE 3.5MM 60MM SLFTAP CONICAL STARDRIVE RECESS PTHRD,$256.58,$0.00,$256.58,$115.46,$183.12,$0.00,$42.92,$0.00,$0.00,$44.92,$256.58,$0.00,$128.29,$203.21,$205.26,$0.00,$38.98,$0.00,$40.85,$0.00
412.425,SUP,HCPCS C1713,,412.425  -  SCREW BONE 3.5MM 65MM SLFTAP CONICAL STARDRIVE RECESS PTHRD,$249.75,$0.00,$249.75,$112.39,$178.25,$0.00,$41.78,$0.00,$0.00,$43.73,$249.75,$0.00,$124.88,$197.80,$199.80,$0.00,$37.95,$0.00,$39.76,$0.00
412.426,SUP,HCPCS C1713,,412.426  -  SCREW BONE 3.5MM 70MM SLFTAP CONICAL STARDRIVE RECESS PTHRD,$249.75,$0.00,$249.75,$112.39,$178.25,$0.00,$41.78,$0.00,$0.00,$43.73,$249.75,$0.00,$124.88,$197.80,$199.80,$0.00,$37.95,$0.00,$39.76,$0.00
412.427,SUP,HCPCS C1713,,412.427  -  SCREW BONE 3.5MM 75MM SLFTAP CONICAL STARDRIVE RECESS PTHRD,$249.75,$0.00,$249.75,$112.39,$178.25,$0.00,$41.78,$0.00,$0.00,$43.73,$249.75,$0.00,$124.88,$197.80,$199.80,$0.00,$37.95,$0.00,$39.76,$0.00
412.428,SUP,HCPCS C1713,,412.428  -  SCREW BONE 3.5MM 80MM SLFTAP CONICAL STARDRIVE RECESS PTHRD,$249.75,$0.00,$249.75,$112.39,$178.25,$0.00,$41.78,$0.00,$0.00,$43.73,$249.75,$0.00,$124.88,$197.80,$199.80,$0.00,$37.95,$0.00,$39.76,$0.00
412.429,SUP,HCPCS C1713,,412.429  -  SCREW BONE 3.5MM 85MM SLFTAP CONICAL STARDRIVE RECESS PTHRD,$249.75,$0.00,$249.75,$112.39,$178.25,$0.00,$41.78,$0.00,$0.00,$43.73,$249.75,$0.00,$124.88,$197.80,$199.80,$0.00,$37.95,$0.00,$39.76,$0.00
412.43,SUP,HCPCS C1713,,412.430  -  SCREW BONE PTHRD 3.5MM 90MM SLFTAP CONICAL STARDRIVE RECESS,$249.75,$0.00,$249.75,$112.39,$178.25,$0.00,$41.78,$0.00,$0.00,$43.73,$249.75,$0.00,$124.88,$197.80,$199.80,$0.00,$37.95,$0.00,$39.76,$0.00
412.431,SUP,HCPCS C1713,,412.431  -  SCREW BONE 3.5MM 95MM SLFTAP CONICAL STARDRIVE RECESS PTHRD,$249.75,$0.00,$249.75,$112.39,$178.25,$0.00,$41.78,$0.00,$0.00,$43.73,$249.75,$0.00,$124.88,$197.80,$199.80,$0.00,$37.95,$0.00,$39.76,$0.00
412.806,SUP,HCPCS C1713,,412.806  -  SCREW BONE 2.4MM 6MM T8 STARDRIVE RECESS SLFTAP LOCKING,$212.90,$0.00,$212.90,$95.81,$151.95,$0.00,$35.61,$0.00,$0.00,$37.28,$212.90,$0.00,$106.45,$168.62,$170.32,$0.00,$32.35,$0.00,$33.89,$0.00
412.807,SUP,HCPCS C1713,,412.807  -  SCREW BONE 2.4MM 7MM SLFTAP LOCKING LCP TITANIUM ORTHOPEDIC,$212.90,$0.00,$212.90,$95.81,$151.95,$0.00,$35.61,$0.00,$0.00,$37.28,$212.90,$0.00,$106.45,$168.62,$170.32,$0.00,$32.35,$0.00,$33.89,$0.00
412.808,SUP,HCPCS C1713,,412.808  -  SCREW BONE 2.4MM 8MM T8 STARDRIVE RECESS SLFTAP LOCKING,$212.90,$0.00,$212.90,$95.81,$151.95,$0.00,$35.61,$0.00,$0.00,$37.28,$212.90,$0.00,$106.45,$168.62,$170.32,$0.00,$32.35,$0.00,$33.89,$0.00
412.809,SUP,HCPCS C1713,,412.809  -  SCREW BONE 2.4MM 9MM SLFTAP LOCKING LCP TITANIUM ORTHOPEDIC,$212.90,$0.00,$212.90,$95.81,$151.95,$0.00,$35.61,$0.00,$0.00,$37.28,$212.90,$0.00,$106.45,$168.62,$170.32,$0.00,$32.35,$0.00,$33.89,$0.00
412.81,SUP,HCPCS C1713,,412.810  -  SCREW BONE T8 CONE 2.4MM 10MM SELF TAP THREAD STARDRIVE LCP,$212.90,$0.00,$212.90,$95.81,$151.95,$0.00,$35.61,$0.00,$0.00,$37.28,$212.90,$0.00,$106.45,$168.62,$170.32,$0.00,$32.35,$0.00,$33.89,$0.00
412.811,SUP,HCPCS C1713,,412.811  -  SCREW BONE T8 CONE 2.4MM 11MM SELF TAP THREAD STARDRIVE LCP,$212.90,$0.00,$212.90,$95.81,$151.95,$0.00,$35.61,$0.00,$0.00,$37.28,$212.90,$0.00,$106.45,$168.62,$170.32,$0.00,$32.35,$0.00,$33.89,$0.00
412.812,SUP,HCPCS C1713,,412.812  -  SCREW BONE T8 CONE 2.4MM 12MM SELF TAP THREAD STARDRIVE LCP,$212.90,$0.00,$212.90,$95.81,$151.95,$0.00,$35.61,$0.00,$0.00,$37.28,$212.90,$0.00,$106.45,$168.62,$170.32,$0.00,$32.35,$0.00,$33.89,$0.00
412.813,SUP,HCPCS C1713,,412.813  -  SCREW BONE 2.4MM 13MM SLFTAP LOCKING LCP TITANIUM ORTHOPEDIC,$212.90,$0.00,$212.90,$95.81,$151.95,$0.00,$35.61,$0.00,$0.00,$37.28,$212.90,$0.00,$106.45,$168.62,$170.32,$0.00,$32.35,$0.00,$33.89,$0.00
412.814,SUP,HCPCS C1713,,412.814  -  SCREW BONE T8 CONE 2.4MM 14MM SELF TAP THREAD STARDRIVE LCP,$212.90,$0.00,$212.90,$95.81,$151.95,$0.00,$35.61,$0.00,$0.00,$37.28,$212.90,$0.00,$106.45,$168.62,$170.32,$0.00,$32.35,$0.00,$33.89,$0.00
412.816,SUP,HCPCS C1713,,412.816  -  SCREW BONE T8 CONE 2.4MM 16MM SELF TAP THREAD STARDRIVE LCP,$212.90,$0.00,$212.90,$95.81,$151.95,$0.00,$35.61,$0.00,$0.00,$37.28,$212.90,$0.00,$106.45,$168.62,$170.32,$0.00,$32.35,$0.00,$33.89,$0.00
412.818,SUP,HCPCS C1713,,412.818  -  SCREW BONE T8 CONE 2.4MM 18MM SELF TAP THREAD STARDRIVE LCP,$212.90,$0.00,$212.90,$95.81,$151.95,$0.00,$35.61,$0.00,$0.00,$37.28,$212.90,$0.00,$106.45,$168.62,$170.32,$0.00,$32.35,$0.00,$33.89,$0.00
412.82,SUP,HCPCS C1713,,412.820  -  SCREW BONE T8 CONE 2.4MM 20MM SELF TAP THREAD STARDRIVE LCP,$212.90,$0.00,$212.90,$95.81,$151.95,$0.00,$35.61,$0.00,$0.00,$37.28,$212.90,$0.00,$106.45,$168.62,$170.32,$0.00,$32.35,$0.00,$33.89,$0.00
412.822,SUP,HCPCS C1713,,412.822  -  SCREW BONE T8 CONE 2.4MM 22MM SELF TAP THREAD STARDRIVE LCP,$212.90,$0.00,$212.90,$95.81,$151.95,$0.00,$35.61,$0.00,$0.00,$37.28,$212.90,$0.00,$106.45,$168.62,$170.32,$0.00,$32.35,$0.00,$33.89,$0.00
412.824,SUP,HCPCS C1713,,412.824  -  SCREW BONE T8 CONE 2.4MM 24MM SELF TAP THREAD STARDRIVE LCP,$212.90,$0.00,$212.90,$95.81,$151.95,$0.00,$35.61,$0.00,$0.00,$37.28,$212.90,$0.00,$106.45,$168.62,$170.32,$0.00,$32.35,$0.00,$33.89,$0.00
412.826,SUP,HCPCS C1713,,412.826  -  SCREW BONE 2.4MM 1.9MM 26MM T8 STARDRIVE RECESS SLFTAP,$212.90,$0.00,$212.90,$95.81,$151.95,$0.00,$35.61,$0.00,$0.00,$37.28,$212.90,$0.00,$106.45,$168.62,$170.32,$0.00,$32.35,$0.00,$33.89,$0.00
412.828,SUP,HCPCS C1713,,412.828  -  SCREW BONE 2.4MM 28MM T8 STARDRIVE RECESS SLFTAP LOCKING,$212.90,$0.00,$212.90,$95.81,$151.95,$0.00,$35.61,$0.00,$0.00,$37.28,$212.90,$0.00,$106.45,$168.62,$170.32,$0.00,$32.35,$0.00,$33.89,$0.00
412.83,SUP,HCPCS C1713,,412.830  -  SCREW BONE 2.4MM 30MM T8 STARDRIVE RECESS SLFTAP LOCKING,$212.90,$0.00,$212.90,$95.81,$151.95,$0.00,$35.61,$0.00,$0.00,$37.28,$212.90,$0.00,$106.45,$168.62,$170.32,$0.00,$32.35,$0.00,$33.89,$0.00
413.309,SUP,HCPCS C1776,,413.309  -  SPACER TIBIAL 2MM 5MM 5MM TOMOFIX CHRONOS TITANIUM KNEE,$177.43,$0.00,$177.43,$79.84,$126.63,$0.00,$29.68,$0.00,$0.00,$31.07,$177.43,$0.00,$88.71,$140.52,$141.94,$0.00,$26.96,$0.00,$28.25,$0.00
413.324,SUP,HCPCS C1713,,413.324  -  SCREW BONE 5MM 24MM SELF TAP LOCK HEAD TOMOFIX TITANIUM,$390.33,$0.00,$390.33,$175.65,$278.57,$0.00,$65.29,$0.00,$0.00,$68.34,$390.33,$0.00,$195.16,$309.14,$312.26,$0.00,$59.31,$0.00,$62.14,$0.00
413.326,SUP,HCPCS C1713,,413.326  -  SCREW BONE 5MM 26MM SLFTAP LOCKING HEAD TITANIUM NONSTRL,$390.33,$0.00,$390.33,$175.65,$278.57,$0.00,$65.29,$0.00,$0.00,$68.34,$390.33,$0.00,$195.16,$309.14,$312.26,$0.00,$59.31,$0.00,$62.14,$0.00
413.328,SUP,HCPCS C1713,,413.328  -  SCREW BONE 5MM 28MM LOCKING SLFTAP HEX DRIVE TITANIUM FEMUR,$390.33,$0.00,$390.33,$175.65,$278.57,$0.00,$65.29,$0.00,$0.00,$68.34,$390.33,$0.00,$195.16,$309.14,$312.26,$0.00,$59.31,$0.00,$62.14,$0.00
413.33,SUP,HCPCS C1713,,413.330  -  SCREW BONE 5MM 30MM SLFTAP LOCKING HEAD TOMOFIX TITANIUM,$390.33,$0.00,$390.33,$175.65,$278.57,$0.00,$65.29,$0.00,$0.00,$68.34,$390.33,$0.00,$195.16,$309.14,$312.26,$0.00,$59.31,$0.00,$62.14,$0.00
413.332,SUP,HCPCS C1713,,413.332  -  SCREW BONE 5MM 32MM SELF TAP LOCK HEAD TOMOFIX TITANIUM,$390.33,$0.00,$390.33,$175.65,$278.57,$0.00,$65.29,$0.00,$0.00,$68.34,$390.33,$0.00,$195.16,$309.14,$312.26,$0.00,$59.31,$0.00,$62.14,$0.00
413.334,SUP,HCPCS C1713,,413.334  -  SCREW BONE 5MM 34MM SELF TAP LOCK HEAD TOMOFIX TITANIUM,$390.33,$0.00,$390.33,$175.65,$278.57,$0.00,$65.29,$0.00,$0.00,$68.34,$390.33,$0.00,$195.16,$309.14,$312.26,$0.00,$59.31,$0.00,$62.14,$0.00
413.336,SUP,HCPCS C1713,,413.336  -  SCREW BONE 5MM 36MM SELF TAP LOCK HEAD TOMOFIX TITANIUM,$390.33,$0.00,$390.33,$175.65,$278.57,$0.00,$65.29,$0.00,$0.00,$68.34,$390.33,$0.00,$195.16,$309.14,$312.26,$0.00,$59.31,$0.00,$62.14,$0.00
413.338,SUP,HCPCS C1713,,413.338  -  SCREW BONE 5MM 38MM SLFTAP LOCKING HEAD TOMOFIX TITANIUM SPN,$390.33,$0.00,$390.33,$175.65,$278.57,$0.00,$65.29,$0.00,$0.00,$68.34,$390.33,$0.00,$195.16,$309.14,$312.26,$0.00,$59.31,$0.00,$62.14,$0.00
413.34,SUP,HCPCS C1713,,413.340  -  SCREW BONE 5MM 40MM SELF TAP LOCK HEAD TOMOFIX TITANIUM,$390.33,$0.00,$390.33,$175.65,$278.57,$0.00,$65.29,$0.00,$0.00,$68.34,$390.33,$0.00,$195.16,$309.14,$312.26,$0.00,$59.31,$0.00,$62.14,$0.00
413.342,SUP,HCPCS C1713,,413.342  -  SCREW BONE 5MM 42MM SLFTAP LOCKING HEAD TOMOFIX TITANIUM,$390.33,$0.00,$390.33,$175.65,$278.57,$0.00,$65.29,$0.00,$0.00,$68.34,$390.33,$0.00,$195.16,$309.14,$312.26,$0.00,$59.31,$0.00,$62.14,$0.00
413.344,SUP,HCPCS C1713,,413.344  -  SCREW BONE 5MM 44MM SELF TAP LOCK HEAD TOMOFIX TITANIUM,$390.33,$0.00,$390.33,$175.65,$278.57,$0.00,$65.29,$0.00,$0.00,$68.34,$390.33,$0.00,$195.16,$309.14,$312.26,$0.00,$59.31,$0.00,$62.14,$0.00
413.346,SUP,HCPCS C1713,,413.346  -  SCREW BONE 5MM 46MM SLFTAP LOCKING HEAD TOMOFIX TITANIUM,$390.33,$0.00,$390.33,$175.65,$278.57,$0.00,$65.29,$0.00,$0.00,$68.34,$390.33,$0.00,$195.16,$309.14,$312.26,$0.00,$59.31,$0.00,$62.14,$0.00
413.348,SUP,HCPCS C1713,,413.348  -  SCREW BONE 5MM 48MM SELF TAP LOCK HEAD TOMOFIX TITANIUM,$390.33,$0.00,$390.33,$175.65,$278.57,$0.00,$65.29,$0.00,$0.00,$68.34,$390.33,$0.00,$195.16,$309.14,$312.26,$0.00,$59.31,$0.00,$62.14,$0.00
413.35,SUP,HCPCS C1713,,413.350  -  SCREW BONE 5MM 50MM SELF TAP LOCK HEAD TOMOFIX TITANIUM,$390.33,$0.00,$390.33,$175.65,$278.57,$0.00,$65.29,$0.00,$0.00,$68.34,$390.33,$0.00,$195.16,$309.14,$312.26,$0.00,$59.31,$0.00,$62.14,$0.00
413.355,SUP,HCPCS C1713,,413.355  -  SCREW BONE 5MM 55MM SELF TAP LOCK HEAD TOMOFIX TITANIUM,$390.33,$0.00,$390.33,$175.65,$278.57,$0.00,$65.29,$0.00,$0.00,$68.34,$390.33,$0.00,$195.16,$309.14,$312.26,$0.00,$59.31,$0.00,$62.14,$0.00
413.36,SUP,HCPCS C1713,,413.360  -  SCREW BONE 5MM 60MM SELF TAP LOCK HEAD TOMOFIX TITANIUM,$390.33,$0.00,$390.33,$175.65,$278.57,$0.00,$65.29,$0.00,$0.00,$68.34,$390.33,$0.00,$195.16,$309.14,$312.26,$0.00,$59.31,$0.00,$62.14,$0.00
413.365,SUP,HCPCS C1713,,413.365  -  SCREW BONE 5MM 65MM SELF TAP LOCK HEAD TOMOFIX TITANIUM,$390.33,$0.00,$390.33,$175.65,$278.57,$0.00,$65.29,$0.00,$0.00,$68.34,$390.33,$0.00,$195.16,$309.14,$312.26,$0.00,$59.31,$0.00,$62.14,$0.00
413.37,SUP,HCPCS C1713,,413.370  -  SCREW BONE 5MM 70MM SELF TAP LOCK HEAD TOMOFIX TITANIUM,$390.33,$0.00,$390.33,$175.65,$278.57,$0.00,$65.29,$0.00,$0.00,$68.34,$390.33,$0.00,$195.16,$309.14,$312.26,$0.00,$59.31,$0.00,$62.14,$0.00
413.375,SUP,HCPCS C1713,,413.375  -  SCREW BONE 5MM 75MM SELF TAP LOCK HEAD TOMOFIX TITANIUM,$390.33,$0.00,$390.33,$175.65,$278.57,$0.00,$65.29,$0.00,$0.00,$68.34,$390.33,$0.00,$195.16,$309.14,$312.26,$0.00,$59.31,$0.00,$62.14,$0.00
413.38,SUP,HCPCS C1713,,413.380  -  SCREW BONE 5MM 80MM SELF TAP LOCK HEAD TOMOFIX TITANIUM,$390.33,$0.00,$390.33,$175.65,$278.57,$0.00,$65.29,$0.00,$0.00,$68.34,$390.33,$0.00,$195.16,$309.14,$312.26,$0.00,$59.31,$0.00,$62.14,$0.00
413.385,SUP,HCPCS C1713,,413.385  -  SCREW BONE 5MM 85MM SELF TAP LOCK HEAD TOMOFIX TITANIUM,$390.33,$0.00,$390.33,$175.65,$278.57,$0.00,$65.29,$0.00,$0.00,$68.34,$390.33,$0.00,$195.16,$309.14,$312.26,$0.00,$59.31,$0.00,$62.14,$0.00
413.39,SUP,HCPCS C1713,,413.390  -  SCREW BONE 5MM 90MM SELF TAP LOCK HEAD TOMOFIX TITANIUM,$390.33,$0.00,$390.33,$175.65,$278.57,$0.00,$65.29,$0.00,$0.00,$68.34,$390.33,$0.00,$195.16,$309.14,$312.26,$0.00,$59.31,$0.00,$62.14,$0.00
413.414,SUP,HCPCS C1713,,413.414  -  SCREW BONE 5MM 14MM SLFDRILL LOCKING LISS TITANIUM FEMUR,$378.95,$0.00,$378.95,$170.53,$270.46,$0.00,$65.29,$0.00,$0.00,$66.35,$378.95,$0.00,$189.48,$300.13,$303.16,$0.00,$59.31,$0.00,$60.33,$0.00
413.418,SUP,HCPCS C1713,,413.418  -  SCREW BONE 5MM 18MM SLFDRILL LOCKING LISS TITANIUM FEMUR,$378.95,$0.00,$378.95,$170.53,$270.46,$0.00,$65.29,$0.00,$0.00,$66.35,$378.95,$0.00,$189.48,$300.13,$303.16,$0.00,$59.31,$0.00,$60.33,$0.00
413.422,SUP,HCPCS C1713,,413.422  -  SCREW BONE 5MM 22MM SLFDRILL LOCKING LISS TITANIUM FEMUR,$378.95,$0.00,$378.95,$170.53,$270.46,$0.00,$65.29,$0.00,$0.00,$66.35,$378.95,$0.00,$189.48,$300.13,$303.16,$0.00,$59.31,$0.00,$60.33,$0.00
413.426,SUP,HCPCS C1713,,413.426  -  SCREW BONE 5MM 26MM SELF TAP LOCK HEAD TOMOFIX TITANIUM,$390.33,$0.00,$390.33,$175.65,$278.57,$0.00,$65.29,$0.00,$0.00,$68.34,$390.33,$0.00,$195.16,$309.14,$312.26,$0.00,$59.31,$0.00,$62.14,$0.00
413.43,SUP,HCPCS C1713,,413.430  -  SCREW BONE 5MM 30MM SLFDRILL LOCKING LISS TITANIUM FEMUR,$378.95,$0.00,$378.95,$170.53,$270.46,$0.00,$65.29,$0.00,$0.00,$66.35,$378.95,$0.00,$189.48,$300.13,$303.16,$0.00,$59.31,$0.00,$60.33,$0.00
413.435,SUP,HCPCS C1713,,413.435  -  SCREW BONE 5MM 35MM SLFDRILL LOCKING LISS TITANIUM FEMUR,$378.95,$0.00,$378.95,$170.53,$270.46,$0.00,$65.29,$0.00,$0.00,$66.35,$378.95,$0.00,$189.48,$300.13,$303.16,$0.00,$59.31,$0.00,$60.33,$0.00
413.44,SUP,HCPCS C1713,,413.440  -  SCREW BONE 5MM 40MM SLFDRILL LOCKING LISS TITANIUM FEMUR,$378.95,$0.00,$378.95,$170.53,$270.46,$0.00,$65.29,$0.00,$0.00,$66.35,$378.95,$0.00,$189.48,$300.13,$303.16,$0.00,$59.31,$0.00,$60.33,$0.00
413.445,SUP,HCPCS C1713,,413.445  -  SCREW BONE 5MM 45MM SLFDRILL LOCKING LISS TITANIUM FEMUR,$378.95,$0.00,$378.95,$170.53,$270.46,$0.00,$65.29,$0.00,$0.00,$66.35,$378.95,$0.00,$189.48,$300.13,$303.16,$0.00,$59.31,$0.00,$60.33,$0.00
413.45,SUP,HCPCS C1713,,413.450  -  SCREW BONE 5MM 50MM SLFDRILL LOCKING LISS TITANIUM FEMUR,$378.95,$0.00,$378.95,$170.53,$270.46,$0.00,$65.29,$0.00,$0.00,$66.35,$378.95,$0.00,$189.48,$300.13,$303.16,$0.00,$59.31,$0.00,$60.33,$0.00
413.455,SUP,HCPCS C1713,,413.455  -  SCREW BONE 5MM 55MM SLFDRILL LOCKING LISS TITANIUM FEMUR,$378.95,$0.00,$378.95,$170.53,$270.46,$0.00,$65.29,$0.00,$0.00,$66.35,$378.95,$0.00,$189.48,$300.13,$303.16,$0.00,$59.31,$0.00,$60.33,$0.00
413.46,SUP,HCPCS C1713,,413.460  -  SCREW BONE 5MM 60MM SLFDRILL LOCKING LISS TITANIUM FEMUR,$378.95,$0.00,$378.95,$170.53,$270.46,$0.00,$65.29,$0.00,$0.00,$66.35,$378.95,$0.00,$189.48,$300.13,$303.16,$0.00,$59.31,$0.00,$60.33,$0.00
413.465,SUP,HCPCS C1713,,413.465  -  SCREW BONE 5MM 65MM SLFDRILL LOCKING LISS TITANIUM FEMUR,$378.95,$0.00,$378.95,$170.53,$270.46,$0.00,$65.29,$0.00,$0.00,$66.35,$378.95,$0.00,$189.48,$300.13,$303.16,$0.00,$59.31,$0.00,$60.33,$0.00
413.47,SUP,HCPCS C1713,,413.470  -  SCREW BONE 5MM 70MM SLFDRILL LOCKING LISS TITANIUM FEMUR,$378.95,$0.00,$378.95,$170.53,$270.46,$0.00,$65.29,$0.00,$0.00,$66.35,$378.95,$0.00,$189.48,$300.13,$303.16,$0.00,$59.31,$0.00,$60.33,$0.00
413.475,SUP,HCPCS C1713,,413.475  -  SCREW BONE 5MM 75MM SLFDRILL LOCKING TITANIUM FEMUR DISTAL,$378.95,$0.00,$378.95,$170.53,$270.46,$0.00,$65.29,$0.00,$0.00,$66.35,$378.95,$0.00,$189.48,$300.13,$303.16,$0.00,$59.31,$0.00,$60.33,$0.00
413.48,SUP,HCPCS C1713,,413.480  -  SCREW BONE 5MM 80MM SLFDRILL LOCKING TITANIUM FEMUR DISTAL,$378.95,$0.00,$378.95,$170.53,$270.46,$0.00,$65.29,$0.00,$0.00,$66.35,$378.95,$0.00,$189.48,$300.13,$303.16,$0.00,$59.31,$0.00,$60.33,$0.00
413.485,SUP,HCPCS C1713,,413.485  -  SCREW BONE 5MM 85MM SLFDRILL LOCKING TITANIUM FEMUR DISTAL,$378.95,$0.00,$378.95,$170.53,$270.46,$0.00,$65.29,$0.00,$0.00,$66.35,$378.95,$0.00,$189.48,$300.13,$303.16,$0.00,$59.31,$0.00,$60.33,$0.00
413.49,SUP,HCPCS C1713,,413.490  -  SCREW BONE 5MM 90MM SLFDRILL LOCKING TITANIUM FEMUR DISTAL,$378.95,$0.00,$378.95,$170.53,$270.46,$0.00,$65.29,$0.00,$0.00,$66.35,$378.95,$0.00,$189.48,$300.13,$303.16,$0.00,$59.31,$0.00,$60.33,$0.00
414.014,SUP,HCPCS C1713,,414.014  -  SCREW BONE 4.5MM 14MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE,$29.68,$0.00,$29.68,$13.35,$21.18,$0.00,$4.96,$0.00,$0.00,$5.20,$29.68,$0.00,$14.84,$23.51,$23.74,$0.00,$4.51,$0.00,$4.72,$0.00
414.016,SUP,HCPCS C1713,,414.016  -  SCREW BONE 4.5MM 8MM 16MM HEXAGONAL SOCKET LC-DCP TITANIUM,$29.68,$0.00,$29.68,$13.35,$21.18,$0.00,$4.96,$0.00,$0.00,$5.20,$29.68,$0.00,$14.84,$23.51,$23.74,$0.00,$4.51,$0.00,$4.72,$0.00
414.018,SUP,HCPCS C1713,,414.018  -  SCREW BONE 4.5MM 18MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE,$28.80,$0.00,$28.80,$12.96,$20.55,$0.00,$4.96,$0.00,$0.00,$5.04,$28.80,$0.00,$14.40,$22.81,$23.04,$0.00,$4.51,$0.00,$4.58,$0.00
414.02,SUP,HCPCS C1713,,414.020  -  SCREW BONE STANDARD 4.5MM 8MM 20MM LARGE HEXAGONAL SOCKET,$28.80,$0.00,$28.80,$12.96,$20.55,$0.00,$4.96,$0.00,$0.00,$5.04,$28.80,$0.00,$14.40,$22.81,$23.04,$0.00,$4.51,$0.00,$4.58,$0.00
414.022,SUP,HCPCS C1713,,414.022  -  SCREW BONE 4.5MM 8MM 22MM HEXAGONAL SOCKET LC-DCP TITANIUM,$28.80,$0.00,$28.80,$12.96,$20.55,$0.00,$4.96,$0.00,$0.00,$5.04,$28.80,$0.00,$14.40,$22.81,$23.04,$0.00,$4.51,$0.00,$4.58,$0.00
414.024,SUP,HCPCS C1713,,414.024  -  SCREW BONE 4.5MM 24MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE,$28.80,$0.00,$28.80,$12.96,$20.55,$0.00,$4.96,$0.00,$0.00,$5.04,$28.80,$0.00,$14.40,$22.81,$23.04,$0.00,$4.51,$0.00,$4.58,$0.00
414.026,SUP,HCPCS C1713,,414.026  -  SCREW BONE 4.5MM 26MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE,$28.80,$0.00,$28.80,$12.96,$20.55,$0.00,$4.96,$0.00,$0.00,$5.04,$28.80,$0.00,$14.40,$22.81,$23.04,$0.00,$4.51,$0.00,$4.58,$0.00
414.028,SUP,HCPCS C1713,,414.028  -  SCREW BONE 4.5MM 28MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE,$28.80,$0.00,$28.80,$12.96,$20.55,$0.00,$4.96,$0.00,$0.00,$5.04,$28.80,$0.00,$14.40,$22.81,$23.04,$0.00,$4.51,$0.00,$4.58,$0.00
414.03,SUP,HCPCS C1713,,414.030  -  SCREW BONE 4.5MM 30MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE,$29.68,$0.00,$29.68,$13.35,$21.18,$0.00,$4.96,$0.00,$0.00,$5.20,$29.68,$0.00,$14.84,$23.51,$23.74,$0.00,$4.51,$0.00,$4.72,$0.00
414.032,SUP,HCPCS C1713,,414.032  -  SCREW BONE 3.5MM STANDARD 4.5MM 8MM 32MM LARGE HEXAGONAL,$29.68,$0.00,$29.68,$13.35,$21.18,$0.00,$4.96,$0.00,$0.00,$5.20,$29.68,$0.00,$14.84,$23.51,$23.74,$0.00,$4.51,$0.00,$4.72,$0.00
414.034,SUP,HCPCS C1713,,414.034  -  SCREW BONE 4.5MM 34MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE,$29.68,$0.00,$29.68,$13.35,$21.18,$0.00,$4.96,$0.00,$0.00,$5.20,$29.68,$0.00,$14.84,$23.51,$23.74,$0.00,$4.51,$0.00,$4.72,$0.00
414.036,SUP,HCPCS C1713,,414.036  -  SCREW BONE STANDARD 4.5MM 8MM 14MM LARGE HEXAGONAL SOCKET,$29.68,$0.00,$29.68,$13.35,$21.18,$0.00,$4.96,$0.00,$0.00,$5.20,$29.68,$0.00,$14.84,$23.51,$23.74,$0.00,$4.51,$0.00,$4.72,$0.00
414.038,SUP,HCPCS C1713,,414.038  -  SCREW BONE 4.5MM 38MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE,$28.80,$0.00,$28.80,$12.96,$20.55,$0.00,$4.96,$0.00,$0.00,$5.04,$28.80,$0.00,$14.40,$22.81,$23.04,$0.00,$4.51,$0.00,$4.58,$0.00
414.04,SUP,HCPCS C1713,,414.040  -  SCREW BONE 3.5MM STANDARD 4.5MM 8MM 26MM LARGE HEXAGONAL,$28.80,$0.00,$28.80,$12.96,$20.55,$0.00,$4.96,$0.00,$0.00,$5.04,$28.80,$0.00,$14.40,$22.81,$23.04,$0.00,$4.51,$0.00,$4.58,$0.00
414.042,SUP,HCPCS C1713,,414.042  -  SCREW BONE 3.5MM STANDARD 4.5MM 8MM 42MM LARGE HEXAGONAL,$28.80,$0.00,$28.80,$12.96,$20.55,$0.00,$4.96,$0.00,$0.00,$5.04,$28.80,$0.00,$14.40,$22.81,$23.04,$0.00,$4.51,$0.00,$4.58,$0.00
414.044,SUP,HCPCS C1713,,414.044  -  SCREW BONE 3MM STANDARD 4.5MM 8MM 44X3.5MM HEXAGONAL SOCKET,$28.80,$0.00,$28.80,$12.96,$20.55,$0.00,$4.96,$0.00,$0.00,$5.04,$28.80,$0.00,$14.40,$22.81,$23.04,$0.00,$4.51,$0.00,$4.58,$0.00
414.046,SUP,HCPCS C1713,,414.046  -  SCREW BONE 4.5MM 46MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE,$29.68,$0.00,$29.68,$13.35,$21.18,$0.00,$4.96,$0.00,$0.00,$5.20,$29.68,$0.00,$14.84,$23.51,$23.74,$0.00,$4.51,$0.00,$4.72,$0.00
414.048,SUP,HCPCS C1713,,414.048  -  SCREW BONE 4.5MM 48MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE,$28.80,$0.00,$28.80,$12.96,$20.55,$0.00,$4.96,$0.00,$0.00,$5.04,$28.80,$0.00,$14.40,$22.81,$23.04,$0.00,$4.51,$0.00,$4.58,$0.00
414.05,SUP,HCPCS C1713,,414.050  -  SCREW BONE 3.5MM STANDARD 4.5MM 8MM 50MM LARGE HEXAGONAL,$29.68,$0.00,$29.68,$13.35,$21.18,$0.00,$4.96,$0.00,$0.00,$5.20,$29.68,$0.00,$14.84,$23.51,$23.74,$0.00,$4.51,$0.00,$4.72,$0.00
414.052,SUP,HCPCS C1713,,414.052  -  SCREW BONE 3.5MM STANDARD 4.5MM 8MM 52MM LARGE HEXAGONAL,$28.80,$0.00,$28.80,$12.96,$20.55,$0.00,$4.96,$0.00,$0.00,$5.04,$28.80,$0.00,$14.40,$22.81,$23.04,$0.00,$4.51,$0.00,$4.58,$0.00
414.054,SUP,HCPCS C1713,,414.054  -  SCREW BONE 4.5MM 54MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE,$29.68,$0.00,$29.68,$13.35,$21.18,$0.00,$4.96,$0.00,$0.00,$5.20,$29.68,$0.00,$14.84,$23.51,$23.74,$0.00,$4.51,$0.00,$4.72,$0.00
414.056,SUP,HCPCS C1713,,414.056  -  SCREW BONE 4.5MM 56MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE,$29.68,$0.00,$29.68,$13.35,$21.18,$0.00,$4.96,$0.00,$0.00,$5.20,$29.68,$0.00,$14.84,$23.51,$23.74,$0.00,$4.51,$0.00,$4.72,$0.00
414.058,SUP,HCPCS C1713,,414.058  -  SCREW BONE STANDARD LARGE HEXAGON 4.5MM 8MM 14MM SOCKET,$29.68,$0.00,$29.68,$13.35,$21.18,$0.00,$4.96,$0.00,$0.00,$5.20,$29.68,$0.00,$14.84,$23.51,$23.74,$0.00,$4.51,$0.00,$4.72,$0.00
414.06,SUP,HCPCS C1713,,414.060  -  SCREW BONE 4.5MM 60MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE,$29.68,$0.00,$29.68,$13.35,$21.18,$0.00,$4.96,$0.00,$0.00,$5.20,$29.68,$0.00,$14.84,$23.51,$23.74,$0.00,$4.51,$0.00,$4.72,$0.00
414.062,SUP,HCPCS C1713,,414.062  -  SCREW BONE 4.5MM 62MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE,$29.68,$0.00,$29.68,$13.35,$21.18,$0.00,$4.96,$0.00,$0.00,$5.20,$29.68,$0.00,$14.84,$23.51,$23.74,$0.00,$4.51,$0.00,$4.72,$0.00
414.064,SUP,HCPCS C1713,,414.064  -  SCREW BONE 4.5MM 64MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE,$29.68,$0.00,$29.68,$13.35,$21.18,$0.00,$4.96,$0.00,$0.00,$5.20,$29.68,$0.00,$14.84,$23.51,$23.74,$0.00,$4.51,$0.00,$4.72,$0.00
414.066,SUP,HCPCS C1713,,414.066  -  SCREW BONE 4.5MM 66MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE,$29.68,$0.00,$29.68,$13.35,$21.18,$0.00,$4.96,$0.00,$0.00,$5.20,$29.68,$0.00,$14.84,$23.51,$23.74,$0.00,$4.51,$0.00,$4.72,$0.00
414.068,SUP,HCPCS C1713,,414.068  -  SCREW BONE 4.5MM 68MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE,$29.68,$0.00,$29.68,$13.35,$21.18,$0.00,$4.96,$0.00,$0.00,$5.20,$29.68,$0.00,$14.84,$23.51,$23.74,$0.00,$4.51,$0.00,$4.72,$0.00
414.07,SUP,HCPCS C1713,,414.070  -  SCREW BONE STANDARD 4.5MM 8MM 70MM LARGE HEXAGONAL SOCKET,$29.68,$0.00,$29.68,$13.35,$21.18,$0.00,$4.96,$0.00,$0.00,$5.20,$29.68,$0.00,$14.84,$23.51,$23.74,$0.00,$4.51,$0.00,$4.72,$0.00
414.072,SUP,HCPCS C1713,,414.072  -  SCREW BONE 4.5MM 72MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE,$28.80,$0.00,$28.80,$12.96,$20.55,$0.00,$4.96,$0.00,$0.00,$5.04,$28.80,$0.00,$14.40,$22.81,$23.04,$0.00,$4.51,$0.00,$4.58,$0.00
414.076,SUP,HCPCS C1713,,414.076  -  SCREW BONE 4.5MM 76MM SLFTAP LC-DCP TITANIUM CORTICAL,$46.70,$0.00,$46.70,$21.02,$33.33,$0.00,$8.05,$0.00,$0.00,$8.18,$46.70,$0.00,$23.35,$36.99,$37.36,$0.00,$7.31,$0.00,$7.43,$0.00
414.08,SUP,HCPCS C1713,,414.080  -  SCREW BONE 4.5MM 80MM LC DCP TITANIUM CORTICAL NONSTRL LARGE,$46.70,$0.00,$46.70,$21.02,$33.33,$0.00,$8.05,$0.00,$0.00,$8.18,$46.70,$0.00,$23.35,$36.99,$37.36,$0.00,$7.31,$0.00,$7.43,$0.00
414.085,SUP,HCPCS C1713,,414.085  -  SCREW BONE 3.5MM 85MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE,$46.70,$0.00,$46.70,$21.02,$33.33,$0.00,$8.05,$0.00,$0.00,$8.18,$46.70,$0.00,$23.35,$36.99,$37.36,$0.00,$7.31,$0.00,$7.43,$0.00
414.09,SUP,HCPCS C1713,,414.090  -  SCREW BONE 4.5MM 90MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE,$46.70,$0.00,$46.70,$21.02,$33.33,$0.00,$8.05,$0.00,$0.00,$8.18,$46.70,$0.00,$23.35,$36.99,$37.36,$0.00,$7.31,$0.00,$7.43,$0.00
414.095,SUP,HCPCS C1713,,414.095  -  SCREW BONE 4.5MM 95MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE,$46.70,$0.00,$46.70,$21.02,$33.33,$0.00,$8.05,$0.00,$0.00,$8.18,$46.70,$0.00,$23.35,$36.99,$37.36,$0.00,$7.31,$0.00,$7.43,$0.00
414.1,SUP,HCPCS C1713,,414.100  -  SCREW BONE 4.5MM 100MM LC-DCP TITANIUM CORTICAL NONSTRL,$46.70,$0.00,$46.70,$21.02,$33.33,$0.00,$8.05,$0.00,$0.00,$8.18,$46.70,$0.00,$23.35,$36.99,$37.36,$0.00,$7.31,$0.00,$7.43,$0.00
414.105,SUP,HCPCS C1713,,414.105  -  SCREW BONE 4.5MM 105MM LC-DCP TITANIUM CORTICAL NONSTRL,$46.70,$0.00,$46.70,$21.02,$33.33,$0.00,$8.05,$0.00,$0.00,$8.18,$46.70,$0.00,$23.35,$36.99,$37.36,$0.00,$7.31,$0.00,$7.43,$0.00
414.11,SUP,HCPCS C1713,,414.110  -  SCREW BONE 4.5MM 110MM LC-DCP TITANIUM CORTICAL NONSTRL,$46.70,$0.00,$46.70,$21.02,$33.33,$0.00,$8.05,$0.00,$0.00,$8.18,$46.70,$0.00,$23.35,$36.99,$37.36,$0.00,$7.31,$0.00,$7.43,$0.00
414.115,SUP,HCPCS C1713,,414.115  -  SCREW BONE 4.5MM 115MM LC-DCP TITANIUM CORTICAL NONSTRL,$46.70,$0.00,$46.70,$21.02,$33.33,$0.00,$8.05,$0.00,$0.00,$8.18,$46.70,$0.00,$23.35,$36.99,$37.36,$0.00,$7.31,$0.00,$7.43,$0.00
414.12,SUP,HCPCS C1713,,414.120  -  SCREW BONE 4.5MM 120MM LC-DCP TITANIUM CORTICAL NONSTRL,$46.70,$0.00,$46.70,$21.02,$33.33,$0.00,$8.05,$0.00,$0.00,$8.18,$46.70,$0.00,$23.35,$36.99,$37.36,$0.00,$7.31,$0.00,$7.43,$0.00
414.125,SUP,HCPCS C1713,,414.125  -  SCREW BONE 4.5MM 125MM LC-DCP TITANIUM CORTICAL NONSTRL,$46.70,$0.00,$46.70,$21.02,$33.33,$0.00,$8.05,$0.00,$0.00,$8.18,$46.70,$0.00,$23.35,$36.99,$37.36,$0.00,$7.31,$0.00,$7.43,$0.00
414.13,SUP,HCPCS C1713,,414.130  -  SCREW BONE 4.5MM 130MM LC-DCP TITANIUM CORTICAL NONSTRL,$46.70,$0.00,$46.70,$21.02,$33.33,$0.00,$8.05,$0.00,$0.00,$8.18,$46.70,$0.00,$23.35,$36.99,$37.36,$0.00,$7.31,$0.00,$7.43,$0.00
414.135,SUP,HCPCS C1713,,414.135  -  SCREW BONE 4.5MM 135MM LC-DCP TITANIUM CORTICAL NONSTRL,$46.70,$0.00,$46.70,$21.02,$33.33,$0.00,$8.05,$0.00,$0.00,$8.18,$46.70,$0.00,$23.35,$36.99,$37.36,$0.00,$7.31,$0.00,$7.43,$0.00
414.14,SUP,HCPCS C1713,,414.140  -  SCREW BONE 4.5MM 140MM LC-DCP TITANIUM CORTICAL NONSTRL,$46.70,$0.00,$46.70,$21.02,$33.33,$0.00,$8.05,$0.00,$0.00,$8.18,$46.70,$0.00,$23.35,$36.99,$37.36,$0.00,$7.31,$0.00,$7.43,$0.00
414.222,SUP,HCPCS C1713,,414.222  -  SCREW BONE 4.5MM 22MM SHAFT LC-DCP TITANIUM ORTHOPEDIC,$30.13,$0.00,$30.13,$13.56,$21.50,$0.00,$5.19,$0.00,$0.00,$5.27,$30.13,$0.00,$15.06,$23.86,$24.10,$0.00,$4.71,$0.00,$4.80,$0.00
414.224,SUP,HCPCS C1713,,414.224  -  SCREW BONE 4.5MM 24CM SHAFT LC-DCP TITANIUM ORTHOPEDIC,$30.13,$0.00,$30.13,$13.56,$21.50,$0.00,$5.19,$0.00,$0.00,$5.27,$30.13,$0.00,$15.06,$23.86,$24.10,$0.00,$4.71,$0.00,$4.80,$0.00
414.226,SUP,HCPCS C1713,,414.226  -  SCREW BONE 4.5MM 26MM SHAFT LC-DCP TITANIUM ORTHOPEDIC,$30.13,$0.00,$30.13,$13.56,$21.50,$0.00,$5.19,$0.00,$0.00,$5.27,$30.13,$0.00,$15.06,$23.86,$24.10,$0.00,$4.71,$0.00,$4.80,$0.00
414.228,SUP,HCPCS C1713,,414.228  -  SCREW BONE 4.5MM 28MM LC-DCP TITANIUM FEMUR MEDIAL PROXIMAL,$30.13,$0.00,$30.13,$13.56,$21.50,$0.00,$5.19,$0.00,$0.00,$5.27,$30.13,$0.00,$15.06,$23.86,$24.10,$0.00,$4.71,$0.00,$4.80,$0.00
414.23,SUP,HCPCS C1713,,414.230  -  SCREW BONE 4.5MM 30MM LC-DCP TITANIUM FEMUR MEDIAL PROXIMAL,$30.13,$0.00,$30.13,$13.56,$21.50,$0.00,$5.19,$0.00,$0.00,$5.27,$30.13,$0.00,$15.06,$23.86,$24.10,$0.00,$4.71,$0.00,$4.80,$0.00
414.232,SUP,HCPCS C1713,,414.232  -  SCREW BONE 4.5MM 32MM LC-DCP TITANIUM FEMUR MEDIAL PROXIMAL,$31.03,$0.00,$31.03,$13.96,$22.14,$0.00,$5.19,$0.00,$0.00,$5.43,$31.03,$0.00,$15.51,$24.58,$24.82,$0.00,$4.71,$0.00,$4.94,$0.00
414.234,SUP,HCPCS C1713,,414.234  -  SCREW BONE 4.5MM 34MM LC-DCP TITANIUM FEMUR MEDIAL PROXIMAL,$31.03,$0.00,$31.03,$13.96,$22.14,$0.00,$5.19,$0.00,$0.00,$5.43,$31.03,$0.00,$15.51,$24.58,$24.82,$0.00,$4.71,$0.00,$4.94,$0.00
414.236,SUP,HCPCS C1713,,414.236  -  SCREW BONE 4.5MM 36MM LC-DCP TITANIUM FEMUR MEDIAL PROXIMAL,$31.03,$0.00,$31.03,$13.96,$22.14,$0.00,$5.19,$0.00,$0.00,$5.43,$31.03,$0.00,$15.51,$24.58,$24.82,$0.00,$4.71,$0.00,$4.94,$0.00
414.238,SUP,HCPCS C1713,,414.238  -  SCREW BONE 4.5MM 38MM LC-DCP TITANIUM FEMUR MEDIAL PROXIMAL,$30.13,$0.00,$30.13,$13.56,$21.50,$0.00,$5.19,$0.00,$0.00,$5.27,$30.13,$0.00,$15.06,$23.86,$24.10,$0.00,$4.71,$0.00,$4.80,$0.00
414.24,SUP,HCPCS C1713,,414.240  -  SCREW BONE 3.5MM 40MM LC-DCP TITANIUM FEMUR MEDIAL PROXIMAL,$30.13,$0.00,$30.13,$13.56,$21.50,$0.00,$5.19,$0.00,$0.00,$5.27,$30.13,$0.00,$15.06,$23.86,$24.10,$0.00,$4.71,$0.00,$4.80,$0.00
414.242,SUP,HCPCS C1713,,414.242  -  SCREW BONE 4.5MM 42MM LC-DCP TITANIUM FEMUR MEDIAL PROXIMAL,$33.45,$0.00,$33.45,$15.05,$23.87,$0.00,$5.76,$0.00,$0.00,$5.86,$33.45,$0.00,$16.73,$26.49,$26.76,$0.00,$5.23,$0.00,$5.33,$0.00
414.244,SUP,HCPCS C1713,,414.244  -  SCREW BONE 4.5MM 44MM LC-DCP TITANIUM FEMUR MEDIAL PROXIMAL,$33.45,$0.00,$33.45,$15.05,$23.87,$0.00,$5.76,$0.00,$0.00,$5.86,$33.45,$0.00,$16.73,$26.49,$26.76,$0.00,$5.23,$0.00,$5.33,$0.00
414.246,SUP,HCPCS C1713,,414.246  -  SCREW BONE 4.5MM 46MM LC-DCP TITANIUM FEMUR MEDIAL PROXIMAL,$34.45,$0.00,$34.45,$15.50,$24.59,$0.00,$5.76,$0.00,$0.00,$6.03,$34.45,$0.00,$17.23,$27.28,$27.56,$0.00,$5.23,$0.00,$5.48,$0.00
414.248,SUP,HCPCS C1713,,414.248  -  SCREW BONE 4.5MM 48MM LC-DCP TITANIUM FEMUR MEDIAL PROXIMAL,$34.45,$0.00,$34.45,$15.50,$24.59,$0.00,$5.76,$0.00,$0.00,$6.03,$34.45,$0.00,$17.23,$27.28,$27.56,$0.00,$5.23,$0.00,$5.48,$0.00
414.25,SUP,HCPCS C1713,,414.250  -  SCREW BONE 4.5MM 50MM LC-DCP TITANIUM FEMUR MEDIAL PROXIMAL,$33.45,$0.00,$33.45,$15.05,$23.87,$0.00,$5.76,$0.00,$0.00,$5.86,$33.45,$0.00,$16.73,$26.49,$26.76,$0.00,$5.23,$0.00,$5.33,$0.00
414.252,SUP,HCPCS C1713,,414.252  -  SCREW BONE 4.5MM 52MM SHAFT LC-DCP TITANIUM ORTHOPEDIC,$34.45,$0.00,$34.45,$15.50,$24.59,$0.00,$5.76,$0.00,$0.00,$6.03,$34.45,$0.00,$17.23,$27.28,$27.56,$0.00,$5.23,$0.00,$5.48,$0.00
414.254,SUP,HCPCS C1713,,414.254  -  SCREW BONE 4.5MM 54MM SHAFT LC-DCP TITANIUM CORTICAL NONSTRL,$33.45,$0.00,$33.45,$15.05,$23.87,$0.00,$5.76,$0.00,$0.00,$5.86,$33.45,$0.00,$16.73,$26.49,$26.76,$0.00,$5.23,$0.00,$5.33,$0.00
414.256,SUP,HCPCS C1713,,414.256  -  SCREW BONE 4.5MM 56MM SHAFT LC-DCP TITANIUM ORTHOPEDIC,$34.45,$0.00,$34.45,$15.50,$24.59,$0.00,$5.76,$0.00,$0.00,$6.03,$34.45,$0.00,$17.23,$27.28,$27.56,$0.00,$5.23,$0.00,$5.48,$0.00
414.258,SUP,HCPCS C1713,,414.258  -  SCREW BONE 4.5MM 58MM SHAFT LC-DCP TITANIUM CORTICAL NONSTRL,$33.45,$0.00,$33.45,$15.05,$23.87,$0.00,$5.76,$0.00,$0.00,$5.86,$33.45,$0.00,$16.73,$26.49,$26.76,$0.00,$5.23,$0.00,$5.33,$0.00
414.26,SUP,HCPCS C1713,,414.260  -  SCREW BONE 4.5MM 60MM SHAFT LC-DCP TITANIUM ORTHOPEDIC,$33.45,$0.00,$33.45,$15.05,$23.87,$0.00,$5.76,$0.00,$0.00,$5.86,$33.45,$0.00,$16.73,$26.49,$26.76,$0.00,$5.23,$0.00,$5.33,$0.00
414.264,SUP,HCPCS C1713,,414.264  -  SCREW BONE 4.5MM 64MM 20MM PTTHRD SHAFT LC-DCP TITANIUM,$33.45,$0.00,$33.45,$15.05,$23.87,$0.00,$5.76,$0.00,$0.00,$5.86,$33.45,$0.00,$16.73,$26.49,$26.76,$0.00,$5.23,$0.00,$5.33,$0.00
414.268,SUP,HCPCS C1713,,414.268  -  SCREW BONE 4.5MM 68MM SHAFT LC-DCP TITANIUM ORTHOPEDIC,$33.45,$0.00,$33.45,$15.05,$23.87,$0.00,$5.76,$0.00,$0.00,$5.86,$33.45,$0.00,$16.73,$26.49,$26.76,$0.00,$5.23,$0.00,$5.33,$0.00
414.272,SUP,HCPCS C1713,,414.272  -  SCREW BONE 4.5MM 72MM SHAFT LCP TITANIUM ORTHOPEDIC NONSTRL,$33.45,$0.00,$33.45,$15.05,$23.87,$0.00,$5.76,$0.00,$0.00,$5.86,$33.45,$0.00,$16.73,$26.49,$26.76,$0.00,$5.23,$0.00,$5.33,$0.00
414.276,SUP,HCPCS C1713,,414.276  -  SCREW BONE 4.5MM 76MM SHAFT LC-DCP TITANIUM ORTHOPEDIC,$39.75,$0.00,$39.75,$17.89,$28.37,$0.00,$6.85,$0.00,$0.00,$6.96,$39.75,$0.00,$19.88,$31.48,$31.80,$0.00,$6.22,$0.00,$6.33,$0.00
414.28,SUP,HCPCS C1713,,414.280  -  SCREW BONE 4.5MM 80MM SHAFT LC-DCP TITANIUM ORTHOPEDIC,$39.75,$0.00,$39.75,$17.89,$28.37,$0.00,$6.85,$0.00,$0.00,$6.96,$39.75,$0.00,$19.88,$31.48,$31.80,$0.00,$6.22,$0.00,$6.33,$0.00
414.285,SUP,HCPCS C1713,,414.285  -  SCREW BONE 4.5MM 85MM SHAFT LC-DCP TITANIUM CORTICAL NONSTRL,$39.75,$0.00,$39.75,$17.89,$28.37,$0.00,$6.85,$0.00,$0.00,$6.96,$39.75,$0.00,$19.88,$31.48,$31.80,$0.00,$6.22,$0.00,$6.33,$0.00
414.29,SUP,HCPCS C1713,,414.290  -  SCREW BONE 4.5MM 90MM SHAFT LC-DCP TITANIUM CORTICAL NONSTRL,$39.75,$0.00,$39.75,$17.89,$28.37,$0.00,$6.85,$0.00,$0.00,$6.96,$39.75,$0.00,$19.88,$31.48,$31.80,$0.00,$6.22,$0.00,$6.33,$0.00
414.295,SUP,HCPCS C1713,,414.295  -  SCREW BONE 4.5MM 95MM SHAFT LC-DCP TITANIUM ORTHOPEDIC,$39.75,$0.00,$39.75,$17.89,$28.37,$0.00,$6.85,$0.00,$0.00,$6.96,$39.75,$0.00,$19.88,$31.48,$31.80,$0.00,$6.22,$0.00,$6.33,$0.00
414.3,SUP,HCPCS C1713,,414.300  -  SCREW BONE 4.5MM 100MM SHAFT LC-DCP TITANIUM ORTHOPEDIC,$39.75,$0.00,$39.75,$17.89,$28.37,$0.00,$6.85,$0.00,$0.00,$6.96,$39.75,$0.00,$19.88,$31.48,$31.80,$0.00,$6.22,$0.00,$6.33,$0.00
414.305,SUP,HCPCS C1713,,414.305  -  SCREW BONE 4.5MM 105MM SHAFT LC-DCP TITANIUM SHAFT NONSTRL,$39.75,$0.00,$39.75,$17.89,$28.37,$0.00,$6.85,$0.00,$0.00,$6.96,$39.75,$0.00,$19.88,$31.48,$31.80,$0.00,$6.22,$0.00,$6.33,$0.00
414.31,SUP,HCPCS C1713,,414.310  -  SCREW BONE 4.5MM 110MM SHAAFT LC-DCP TITANIUM CORTICAL,$39.75,$0.00,$39.75,$17.89,$28.37,$0.00,$6.85,$0.00,$0.00,$6.96,$39.75,$0.00,$19.88,$31.48,$31.80,$0.00,$6.22,$0.00,$6.33,$0.00
414.52,SUP,HCPCS C1713,,414.520  -  SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT,$365.75,$0.00,$365.75,$164.59,$261.04,$0.00,$61.18,$0.00,$0.00,$64.04,$365.75,$0.00,$182.88,$289.67,$292.60,$0.00,$55.57,$0.00,$58.23,$0.00
414.522,SUP,HCPCS C1713,,414.522  -  SCREW BONE 1/3 THREAD 4.5MM 6.5MM 22MM CANN LARGE HEXAGONAL,$365.75,$0.00,$365.75,$164.59,$261.04,$0.00,$61.18,$0.00,$0.00,$64.04,$365.75,$0.00,$182.88,$289.67,$292.60,$0.00,$55.57,$0.00,$58.23,$0.00
414.524,SUP,HCPCS C1713,,414.524  -  SCREW BONE SHORT THREAD REVERSE CUT FLUTE 4.5MM 6.5MM 1.7MM,$365.75,$0.00,$365.75,$164.59,$261.04,$0.00,$61.18,$0.00,$0.00,$64.04,$365.75,$0.00,$182.88,$289.67,$292.60,$0.00,$55.57,$0.00,$58.23,$0.00
414.526,SUP,HCPCS C1713,,414.526  -  SCREW BONE 1/3 THREAD 4.5MM 6.5MM 26MM CANN LARGE HEXAGONAL,$365.75,$0.00,$365.75,$164.59,$261.04,$0.00,$61.18,$0.00,$0.00,$64.04,$365.75,$0.00,$182.88,$289.67,$292.60,$0.00,$55.57,$0.00,$58.23,$0.00
414.528,SUP,HCPCS C1713,,414.528  -  SCREW BONE 1/3 THREAD 4.5MM 6.5MM 28MM CANN LARGE HEXAGONAL,$365.75,$0.00,$365.75,$164.59,$261.04,$0.00,$61.18,$0.00,$0.00,$64.04,$365.75,$0.00,$182.88,$289.67,$292.60,$0.00,$55.57,$0.00,$58.23,$0.00
414.53,SUP,HCPCS C1713,,414.530  -  SCREW BONE SHORT THREAD REVERSE CUT FLUTE 4.5MM 6.5MM 1.7MM,$365.75,$0.00,$365.75,$164.59,$261.04,$0.00,$61.18,$0.00,$0.00,$64.04,$365.75,$0.00,$182.88,$289.67,$292.60,$0.00,$55.57,$0.00,$58.23,$0.00
414.532,SUP,HCPCS C1713,,414.532  -  SCREW BONE SHORT THREAD REVERSE CUT FLUTE 4.5MM 6.5MM 1.7MM,$365.75,$0.00,$365.75,$164.59,$261.04,$0.00,$61.18,$0.00,$0.00,$64.04,$365.75,$0.00,$182.88,$289.67,$292.60,$0.00,$55.57,$0.00,$58.23,$0.00
414.534,SUP,HCPCS C1713,,414.534  -  SCREW BONE SHORT THREAD REVERSE CUT FLUTE 4.5MM 6.5MM 1.7MM,$365.75,$0.00,$365.75,$164.59,$261.04,$0.00,$61.18,$0.00,$0.00,$64.04,$365.75,$0.00,$182.88,$289.67,$292.60,$0.00,$55.57,$0.00,$58.23,$0.00
414.536,SUP,HCPCS C1713,,414.536  -  SCREW BONE SHORT THREAD REVERSE CUT FLUTE 4.5MM 6.5MM 1.7MM,$365.75,$0.00,$365.75,$164.59,$261.04,$0.00,$61.18,$0.00,$0.00,$64.04,$365.75,$0.00,$182.88,$289.67,$292.60,$0.00,$55.57,$0.00,$58.23,$0.00
414.538,SUP,HCPCS C1713,,414.538  -  SCREW BONE SHORT THREAD REVERSE CUT FLUTE 4.5MM 6.5MM 1.7MM,$365.75,$0.00,$365.75,$164.59,$261.04,$0.00,$61.18,$0.00,$0.00,$64.04,$365.75,$0.00,$182.88,$289.67,$292.60,$0.00,$55.57,$0.00,$58.23,$0.00
414.54,SUP,HCPCS C1713,,414.540  -  SCREW BONE SHORT THREAD REVERSE CUT FLUTE 4.5MM 6.5MM 1.7MM,$365.75,$0.00,$365.75,$164.59,$261.04,$0.00,$61.18,$0.00,$0.00,$64.04,$365.75,$0.00,$182.88,$289.67,$292.60,$0.00,$55.57,$0.00,$58.23,$0.00
414.542,SUP,HCPCS C1713,,414.542  -  SCREW BONE 1/3 THREAD 4.5MM 6.5MM 42MM CANN LARGE HEXAGONAL,$365.75,$0.00,$365.75,$164.59,$261.04,$0.00,$61.18,$0.00,$0.00,$64.04,$365.75,$0.00,$182.88,$289.67,$292.60,$0.00,$55.57,$0.00,$58.23,$0.00
414.544,SUP,HCPCS C1713,,414.544  -  SCREW BONE SHORT THREAD REVERSE CUT FLUTE 4.5MM 6.5MM 1.7MM,$365.75,$0.00,$365.75,$164.59,$261.04,$0.00,$61.18,$0.00,$0.00,$64.04,$365.75,$0.00,$182.88,$289.67,$292.60,$0.00,$55.57,$0.00,$58.23,$0.00
414.546,SUP,HCPCS C1713,,414.546  -  SCREW BONE SHORT THREAD REVERSE CUT FLUTE 4.5MM 6.5MM 1.7MM,$365.75,$0.00,$365.75,$164.59,$261.04,$0.00,$61.18,$0.00,$0.00,$64.04,$365.75,$0.00,$182.88,$289.67,$292.60,$0.00,$55.57,$0.00,$58.23,$0.00
414.548,SUP,HCPCS C1713,,414.548  -  SCREW BONE SHORT THREAD REVERSE CUT FLUTE 4.5MM 6.5MM 1.7MM,$365.75,$0.00,$365.75,$164.59,$261.04,$0.00,$61.18,$0.00,$0.00,$64.04,$365.75,$0.00,$182.88,$289.67,$292.60,$0.00,$55.57,$0.00,$58.23,$0.00
414.55,SUP,HCPCS C1713,,414.550  -  SCREW BONE SHORT THREAD REVERSE CUT FLUTE 4.5MM 6.5MM 1.7MM,$365.75,$0.00,$365.75,$164.59,$261.04,$0.00,$61.18,$0.00,$0.00,$64.04,$365.75,$0.00,$182.88,$289.67,$292.60,$0.00,$55.57,$0.00,$58.23,$0.00
414.552,SUP,HCPCS C1713,,414.552  -  SCREW BONE 1/3 THREAD 4.5MM 6.5MM 52MM CANN LARGE HEXAGONAL,$365.75,$0.00,$365.75,$164.59,$261.04,$0.00,$61.18,$0.00,$0.00,$64.04,$365.75,$0.00,$182.88,$289.67,$292.60,$0.00,$55.57,$0.00,$58.23,$0.00
414.554,SUP,HCPCS C1713,,414.554  -  SCREW BONE SHORT THREAD REVERSE CUT FLUTE 4.5MM 6.5MM 1.7MM,$365.75,$0.00,$365.75,$164.59,$261.04,$0.00,$61.18,$0.00,$0.00,$64.04,$365.75,$0.00,$182.88,$289.67,$292.60,$0.00,$55.57,$0.00,$58.23,$0.00
414.556,SUP,HCPCS C1713,,414.556  -  SCREW BONE SHORT THREAD REVERSE CUT FLUTE 4.5MM 6.5MM 1.7MM,$365.75,$0.00,$365.75,$164.59,$261.04,$0.00,$61.18,$0.00,$0.00,$64.04,$365.75,$0.00,$182.88,$289.67,$292.60,$0.00,$55.57,$0.00,$58.23,$0.00
414.56,SUP,HCPCS C1713,,414.560  -  SCREW BONE 1/3 THREAD 4.5MM 6.5MM 60MM CANN LARGE HEXAGONAL,$365.75,$0.00,$365.75,$164.59,$261.04,$0.00,$61.18,$0.00,$0.00,$64.04,$365.75,$0.00,$182.88,$289.67,$292.60,$0.00,$55.57,$0.00,$58.23,$0.00
414.564,SUP,HCPCS C1713,,414.564  -  SCREW BONE SHORT THREAD REVERSE CUT FLUTE 4.5MM 6.5MM 1.7MM,$365.75,$0.00,$365.75,$164.59,$261.04,$0.00,$61.18,$0.00,$0.00,$64.04,$365.75,$0.00,$182.88,$289.67,$292.60,$0.00,$55.57,$0.00,$58.23,$0.00
414.568,SUP,HCPCS C1713,,414.568  -  SCREW BONE SHORT THREAD REVERSE CUT FLUTE 4.5MM 6.5MM 1.7MM,$365.75,$0.00,$365.75,$164.59,$261.04,$0.00,$61.18,$0.00,$0.00,$64.04,$365.75,$0.00,$182.88,$289.67,$292.60,$0.00,$55.57,$0.00,$58.23,$0.00
414.572,SUP,HCPCS C1713,,414.572  -  SCREW BONE SHORT THREAD REVERSE CUT FLUTE 4.5MM 6.5MM 1.7MM,$365.75,$0.00,$365.75,$164.59,$261.04,$0.00,$61.18,$0.00,$0.00,$64.04,$365.75,$0.00,$182.88,$289.67,$292.60,$0.00,$55.57,$0.00,$58.23,$0.00
414.576,SUP,HCPCS C1713,,414.576  -  SCREW BONE PTHRD 4.5MM 76MM CANN TITANIUM NONSTRL,$376.68,$0.00,$376.68,$169.50,$268.83,$0.00,$63.01,$0.00,$0.00,$65.95,$376.68,$0.00,$188.34,$298.33,$301.34,$0.00,$57.23,$0.00,$59.97,$0.00
414.58,SUP,HCPCS C1713,,414.580  -  SCREW BONE PTHRD 4.5MM 80MM CANN TITANIUM NONSTRL,$376.68,$0.00,$376.68,$169.50,$268.83,$0.00,$63.01,$0.00,$0.00,$65.95,$376.68,$0.00,$188.34,$298.33,$301.34,$0.00,$57.23,$0.00,$59.97,$0.00
414.72,SUP,HCPCS C1713,,414.720  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 20MM CANN TITANIUM,$376.68,$0.00,$376.68,$169.50,$268.83,$0.00,$63.01,$0.00,$0.00,$65.95,$376.68,$0.00,$188.34,$298.33,$301.34,$0.00,$57.23,$0.00,$59.97,$0.00
414.722,SUP,HCPCS C1713,,414.722  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 22MM CANN TITANIUM,$376.68,$0.00,$376.68,$169.50,$268.83,$0.00,$63.01,$0.00,$0.00,$65.95,$376.68,$0.00,$188.34,$298.33,$301.34,$0.00,$57.23,$0.00,$59.97,$0.00
414.724,SUP,HCPCS C1713,,414.724  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 24MM CANN TITANIUM,$376.68,$0.00,$376.68,$169.50,$268.83,$0.00,$63.01,$0.00,$0.00,$65.95,$376.68,$0.00,$188.34,$298.33,$301.34,$0.00,$57.23,$0.00,$59.97,$0.00
414.726,SUP,HCPCS C1713,,414.726  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 26MM CANN TITANIUM,$376.68,$0.00,$376.68,$169.50,$268.83,$0.00,$63.01,$0.00,$0.00,$65.95,$376.68,$0.00,$188.34,$298.33,$301.34,$0.00,$57.23,$0.00,$59.97,$0.00
414.728,SUP,HCPCS C1713,,414.728  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 28MM CANN TITANIUM,$376.68,$0.00,$376.68,$169.50,$268.83,$0.00,$63.01,$0.00,$0.00,$65.95,$376.68,$0.00,$188.34,$298.33,$301.34,$0.00,$57.23,$0.00,$59.97,$0.00
414.73,SUP,HCPCS C1713,,414.730  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 30MM CANN TITANIUM,$376.68,$0.00,$376.68,$169.50,$268.83,$0.00,$63.01,$0.00,$0.00,$65.95,$376.68,$0.00,$188.34,$298.33,$301.34,$0.00,$57.23,$0.00,$59.97,$0.00
414.732,SUP,HCPCS C1713,,414.732  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 32MM CANN TITANIUM,$376.68,$0.00,$376.68,$169.50,$268.83,$0.00,$63.01,$0.00,$0.00,$65.95,$376.68,$0.00,$188.34,$298.33,$301.34,$0.00,$57.23,$0.00,$59.97,$0.00
414.734,SUP,HCPCS C1713,,414.734  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 34MM CANN TITANIUM,$376.68,$0.00,$376.68,$169.50,$268.83,$0.00,$63.01,$0.00,$0.00,$65.95,$376.68,$0.00,$188.34,$298.33,$301.34,$0.00,$57.23,$0.00,$59.97,$0.00
414.736,SUP,HCPCS C1713,,414.736  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 36MM CANN TITANIUM,$376.68,$0.00,$376.68,$169.50,$268.83,$0.00,$63.01,$0.00,$0.00,$65.95,$376.68,$0.00,$188.34,$298.33,$301.34,$0.00,$57.23,$0.00,$59.97,$0.00
414.738,SUP,HCPCS C1713,,414.738  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 38MM CANN TITANIUM,$376.68,$0.00,$376.68,$169.50,$268.83,$0.00,$63.01,$0.00,$0.00,$65.95,$376.68,$0.00,$188.34,$298.33,$301.34,$0.00,$57.23,$0.00,$59.97,$0.00
414.74,SUP,HCPCS C1713,,414.740  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 40MM CANN TITANIUM,$376.68,$0.00,$376.68,$169.50,$268.83,$0.00,$63.01,$0.00,$0.00,$65.95,$376.68,$0.00,$188.34,$298.33,$301.34,$0.00,$57.23,$0.00,$59.97,$0.00
414.742,SUP,HCPCS C1713,,414.742  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 42MM CANN TITANIUM,$376.68,$0.00,$376.68,$169.50,$268.83,$0.00,$63.01,$0.00,$0.00,$65.95,$376.68,$0.00,$188.34,$298.33,$301.34,$0.00,$57.23,$0.00,$59.97,$0.00
414.744,SUP,HCPCS C1713,,414.744  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 44MM CANN TITANIUM,$376.68,$0.00,$376.68,$169.50,$268.83,$0.00,$63.01,$0.00,$0.00,$65.95,$376.68,$0.00,$188.34,$298.33,$301.34,$0.00,$57.23,$0.00,$59.97,$0.00
414.746,SUP,HCPCS C1713,,414.746  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 46MM CANN TITANIUM,$376.68,$0.00,$376.68,$169.50,$268.83,$0.00,$63.01,$0.00,$0.00,$65.95,$376.68,$0.00,$188.34,$298.33,$301.34,$0.00,$57.23,$0.00,$59.97,$0.00
414.748,SUP,HCPCS C1713,,414.748  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 48MM CANN TITANIUM,$376.68,$0.00,$376.68,$169.50,$268.83,$0.00,$63.01,$0.00,$0.00,$65.95,$376.68,$0.00,$188.34,$298.33,$301.34,$0.00,$57.23,$0.00,$59.97,$0.00
414.75,SUP,HCPCS C1713,,414.750  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 50MM CANN TITANIUM,$376.68,$0.00,$376.68,$169.50,$268.83,$0.00,$63.01,$0.00,$0.00,$65.95,$376.68,$0.00,$188.34,$298.33,$301.34,$0.00,$57.23,$0.00,$59.97,$0.00
414.752,SUP,HCPCS C1713,,414.752  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 52MM CANN TITANIUM,$376.68,$0.00,$376.68,$169.50,$268.83,$0.00,$63.01,$0.00,$0.00,$65.95,$376.68,$0.00,$188.34,$298.33,$301.34,$0.00,$57.23,$0.00,$59.97,$0.00
414.754,SUP,HCPCS C1713,,414.754  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 54MM CANN TITANIUM,$376.68,$0.00,$376.68,$169.50,$268.83,$0.00,$63.01,$0.00,$0.00,$65.95,$376.68,$0.00,$188.34,$298.33,$301.34,$0.00,$57.23,$0.00,$59.97,$0.00
414.756,SUP,HCPCS C1713,,414.756  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 56MM CANN TITANIUM,$376.68,$0.00,$376.68,$169.50,$268.83,$0.00,$63.01,$0.00,$0.00,$65.95,$376.68,$0.00,$188.34,$298.33,$301.34,$0.00,$57.23,$0.00,$59.97,$0.00
414.76,SUP,HCPCS C1713,,414.760  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 60MM CANN TITANIUM,$376.68,$0.00,$376.68,$169.50,$268.83,$0.00,$63.01,$0.00,$0.00,$65.95,$376.68,$0.00,$188.34,$298.33,$301.34,$0.00,$57.23,$0.00,$59.97,$0.00
414.764,SUP,HCPCS C1713,,414.764  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 64MM CANN TITANIUM,$376.68,$0.00,$376.68,$169.50,$268.83,$0.00,$63.01,$0.00,$0.00,$65.95,$376.68,$0.00,$188.34,$298.33,$301.34,$0.00,$57.23,$0.00,$59.97,$0.00
414.768,SUP,HCPCS C1713,,414.768  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 68MM CANN TITANIUM,$376.68,$0.00,$376.68,$169.50,$268.83,$0.00,$63.01,$0.00,$0.00,$65.95,$376.68,$0.00,$188.34,$298.33,$301.34,$0.00,$57.23,$0.00,$59.97,$0.00
414.772,SUP,HCPCS C1713,,414.772  -  SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 72MM CANN TITANIUM,$376.68,$0.00,$376.68,$169.50,$268.83,$0.00,$63.01,$0.00,$0.00,$65.95,$376.68,$0.00,$188.34,$298.33,$301.34,$0.00,$57.23,$0.00,$59.97,$0.00
414.776,SUP,HCPCS C1713,,414.776  -  SCREW BONE FULTHD 4.5MM 76MM CANN TITANIUM NONSTRL,$376.68,$0.00,$376.68,$169.50,$268.83,$0.00,$63.01,$0.00,$0.00,$65.95,$376.68,$0.00,$188.34,$298.33,$301.34,$0.00,$57.23,$0.00,$59.97,$0.00
414.777,SUP,HCPCS C1713,,414.777  -  SCREW BONE FULTHD 4.5MM 77MM CANN TITANIUM NONSTRL,$376.68,$0.00,$376.68,$169.50,$268.83,$0.00,$63.01,$0.00,$0.00,$65.95,$376.68,$0.00,$188.34,$298.33,$301.34,$0.00,$57.23,$0.00,$59.97,$0.00
414.814,SUP,HCPCS C1713,,414.814  -  SCREW BONE 4.5MM 8MM 14MM LARGE HEXAGONAL SOCKET SELF TAP,$38.88,$0.00,$38.88,$17.49,$27.75,$0.00,$6.50,$0.00,$0.00,$6.81,$38.88,$0.00,$19.44,$30.79,$31.10,$0.00,$5.91,$0.00,$6.19,$0.00
414.816,SUP,HCPCS C1713,,414.816  -  SCREW BONE 4.5MM 8MM 16MM LARGE HEXAGONAL SOCKET SELF TAP,$38.88,$0.00,$38.88,$17.49,$27.75,$0.00,$6.50,$0.00,$0.00,$6.81,$38.88,$0.00,$19.44,$30.79,$31.10,$0.00,$5.91,$0.00,$6.19,$0.00
414.818,SUP,HCPCS C1713,,414.818  -  SCREW BONE 4.5MM 8MM 18MM HEXAGONAL SOCKET SELF TAP TIP,$38.88,$0.00,$38.88,$17.49,$27.75,$0.00,$6.50,$0.00,$0.00,$6.81,$38.88,$0.00,$19.44,$30.79,$31.10,$0.00,$5.91,$0.00,$6.19,$0.00
414.82,SUP,HCPCS C1713,,414.820  -  SCREW BONE 4.5MM 8MM 20MM LARGE HEXAGONAL SOCKET SELF TAP,$38.88,$0.00,$38.88,$17.49,$27.75,$0.00,$6.50,$0.00,$0.00,$6.81,$38.88,$0.00,$19.44,$30.79,$31.10,$0.00,$5.91,$0.00,$6.19,$0.00
414.822,SUP,HCPCS C1713,,414.822  -  SCREW BONE 4.5MM 8MM 22MM HEXAGONAL SOCKET SELF TAP TIP,$38.88,$0.00,$38.88,$17.49,$27.75,$0.00,$6.50,$0.00,$0.00,$6.81,$38.88,$0.00,$19.44,$30.79,$31.10,$0.00,$5.91,$0.00,$6.19,$0.00
414.824,SUP,HCPCS C1713,,414.824  -  SCREW BONE 4.5MM 8MM 24MM HEXAGONAL SOCKET SELF TAP TIP,$38.88,$0.00,$38.88,$17.49,$27.75,$0.00,$6.50,$0.00,$0.00,$6.81,$38.88,$0.00,$19.44,$30.79,$31.10,$0.00,$5.91,$0.00,$6.19,$0.00
414.826,SUP,HCPCS C1713,,414.826  -  SCREW BONE 4.5MM 8MM 26MM HEXAGONAL SOCKET SELF TAP LC-DCP,$38.88,$0.00,$38.88,$17.49,$27.75,$0.00,$6.50,$0.00,$0.00,$6.81,$38.88,$0.00,$19.44,$30.79,$31.10,$0.00,$5.91,$0.00,$6.19,$0.00
414.828,SUP,HCPCS C1713,,414.828  -  SCREW BONE 4.5MM 8MM 28MM HEXAGONAL SOCKET SELF TAP LC-DCP,$38.88,$0.00,$38.88,$17.49,$27.75,$0.00,$6.50,$0.00,$0.00,$6.81,$38.88,$0.00,$19.44,$30.79,$31.10,$0.00,$5.91,$0.00,$6.19,$0.00
414.83,SUP,HCPCS C1713,,414.830  -  SCREW BONE LARGE HEXAGON 4.5MM 8MM 30MM SELF TAP SOCKET,$38.88,$0.00,$38.88,$17.49,$27.75,$0.00,$6.50,$0.00,$0.00,$6.81,$38.88,$0.00,$19.44,$30.79,$31.10,$0.00,$5.91,$0.00,$6.19,$0.00
414.832,SUP,HCPCS C1713,,414.832  -  SCREW BONE LARGE HEXAGON 4.5MM 8MM 32MM SELF TAP SOCKET,$38.88,$0.00,$38.88,$17.49,$27.75,$0.00,$6.50,$0.00,$0.00,$6.81,$38.88,$0.00,$19.44,$30.79,$31.10,$0.00,$5.91,$0.00,$6.19,$0.00
414.834,SUP,HCPCS C1713,,414.834  -  SCREW BONE 4.5MM 8MM 34MM HEXAGONAL SOCKET SELF TAP LC-DCP,$38.88,$0.00,$38.88,$17.49,$27.75,$0.00,$6.50,$0.00,$0.00,$6.81,$38.88,$0.00,$19.44,$30.79,$31.10,$0.00,$5.91,$0.00,$6.19,$0.00
414.836,SUP,HCPCS C1713,,414.836  -  SCREW BONE LARGE HEXAGON 4.5MM 8MM 36MM SELF TAP SOCKET,$38.88,$0.00,$38.88,$17.49,$27.75,$0.00,$6.50,$0.00,$0.00,$6.81,$38.88,$0.00,$19.44,$30.79,$31.10,$0.00,$5.91,$0.00,$6.19,$0.00
414.838,SUP,HCPCS C1713,,414.838  -  SCREW BONE 4.5MM 8MM 38MM HEXAGONAL SOCKET SELF TAP LC-DCP,$38.88,$0.00,$38.88,$17.49,$27.75,$0.00,$6.50,$0.00,$0.00,$6.81,$38.88,$0.00,$19.44,$30.79,$31.10,$0.00,$5.91,$0.00,$6.19,$0.00
414.84,SUP,HCPCS C1713,,414.840  -  SCREW BONE 4.5MM 8MM 40MM HEXAGONAL SOCKET SELF TAP LC-DCP,$38.88,$0.00,$38.88,$17.49,$27.75,$0.00,$6.50,$0.00,$0.00,$6.81,$38.88,$0.00,$19.44,$30.79,$31.10,$0.00,$5.91,$0.00,$6.19,$0.00
414.842,SUP,HCPCS C1713,,414.842  -  SCREW BONE 4.5MM 8MM 42MM HEXAGONAL SOCKET SELF TAP LC-DCP,$38.88,$0.00,$38.88,$17.49,$27.75,$0.00,$6.50,$0.00,$0.00,$6.81,$38.88,$0.00,$19.44,$30.79,$31.10,$0.00,$5.91,$0.00,$6.19,$0.00
414.844,SUP,HCPCS C1713,,414.844  -  SCREW BONE 4.5MM 8MM 44MM HEXAGONAL SOCKET SELF TAP LC-DCP,$38.88,$0.00,$38.88,$17.49,$27.75,$0.00,$6.50,$0.00,$0.00,$6.81,$38.88,$0.00,$19.44,$30.79,$31.10,$0.00,$5.91,$0.00,$6.19,$0.00
414.846,SUP,HCPCS C1713,,414.846  -  SCREW BONE 4.5MM 8MM 46MM HEXAGONAL SOCKET SELF TAP LC-DCP,$38.88,$0.00,$38.88,$17.49,$27.75,$0.00,$6.50,$0.00,$0.00,$6.81,$38.88,$0.00,$19.44,$30.79,$31.10,$0.00,$5.91,$0.00,$6.19,$0.00
414.848,SUP,HCPCS C1713,,414.848  -  SCREW BONE 4.5MM 48MM SELF TAP LCP TITANIUM CORTEX LARGE,$38.88,$0.00,$38.88,$17.49,$27.75,$0.00,$6.50,$0.00,$0.00,$6.81,$38.88,$0.00,$19.44,$30.79,$31.10,$0.00,$5.91,$0.00,$6.19,$0.00
414.85,SUP,HCPCS C1713,,414.850  -  SCREW BONE 4.5MM 50MM SELF TAP LCP TITANIUM CORTEX LARGE,$38.88,$0.00,$38.88,$17.49,$27.75,$0.00,$6.50,$0.00,$0.00,$6.81,$38.88,$0.00,$19.44,$30.79,$31.10,$0.00,$5.91,$0.00,$6.19,$0.00
414.852,SUP,HCPCS C1713,,414.852  -  SCREW BONE 4.5MM 52MM SELF TAP LCP TITANIUM CORTEX LARGE,$38.88,$0.00,$38.88,$17.49,$27.75,$0.00,$6.50,$0.00,$0.00,$6.81,$38.88,$0.00,$19.44,$30.79,$31.10,$0.00,$5.91,$0.00,$6.19,$0.00
414.854,SUP,HCPCS C1713,,414.854  -  SCREW BONE 4.5MM 54MM SELF TAP LCP TITANIUM CORTEX LARGE,$38.88,$0.00,$38.88,$17.49,$27.75,$0.00,$6.50,$0.00,$0.00,$6.81,$38.88,$0.00,$19.44,$30.79,$31.10,$0.00,$5.91,$0.00,$6.19,$0.00
414.856,SUP,HCPCS C1713,,414.856  -  SCREW BONE 4.5MM 56MM SELF TAP LCP TITANIUM CORTEX LARGE,$38.88,$0.00,$38.88,$17.49,$27.75,$0.00,$6.50,$0.00,$0.00,$6.81,$38.88,$0.00,$19.44,$30.79,$31.10,$0.00,$5.91,$0.00,$6.19,$0.00
414.858,SUP,HCPCS C1713,,414.858  -  SCREW BONE 4.5MM 58MM SELF TAP LCP TITANIUM CORTEX LARGE,$38.88,$0.00,$38.88,$17.49,$27.75,$0.00,$6.50,$0.00,$0.00,$6.81,$38.88,$0.00,$19.44,$30.79,$31.10,$0.00,$5.91,$0.00,$6.19,$0.00
414.86,SUP,HCPCS C1713,,414.860  -  SCREW BONE 4.5MM 8MM 60MM HEXAGONAL SOCKET SELF TAP LC-DCP,$38.88,$0.00,$38.88,$17.49,$27.75,$0.00,$6.50,$0.00,$0.00,$6.81,$38.88,$0.00,$19.44,$30.79,$31.10,$0.00,$5.91,$0.00,$6.19,$0.00
414.862,SUP,HCPCS C1713,,414.862  -  SCREW BONE 4.5MM 62MM SELF TAP LCP TITANIUM CORTEX LARGE,$38.88,$0.00,$38.88,$17.49,$27.75,$0.00,$6.50,$0.00,$0.00,$6.81,$38.88,$0.00,$19.44,$30.79,$31.10,$0.00,$5.91,$0.00,$6.19,$0.00
414.864,SUP,HCPCS C1713,,414.864  -  SCREW BONE 4.5MM 64MM SELF TAP LCP TITANIUM CORTEX LARGE,$38.88,$0.00,$38.88,$17.49,$27.75,$0.00,$6.50,$0.00,$0.00,$6.81,$38.88,$0.00,$19.44,$30.79,$31.10,$0.00,$5.91,$0.00,$6.19,$0.00
414.866,SUP,HCPCS C1713,,414.866  -  SCREW BONE 4.5MM 8MM 66MM HEXAGONAL SOCKET SELF TAP LC-DCP,$38.88,$0.00,$38.88,$17.49,$27.75,$0.00,$6.50,$0.00,$0.00,$6.81,$38.88,$0.00,$19.44,$30.79,$31.10,$0.00,$5.91,$0.00,$6.19,$0.00
414.868,SUP,HCPCS C1713,,414.868  -  SCREW BONE 4.5MM 8MM 68MM HEXAGONAL SOCKET SELF TAP LC-DCP,$38.88,$0.00,$38.88,$17.49,$27.75,$0.00,$6.50,$0.00,$0.00,$6.81,$38.88,$0.00,$19.44,$30.79,$31.10,$0.00,$5.91,$0.00,$6.19,$0.00
414.87,SUP,HCPCS C1713,,414.870  -  SCREW BONE 4.5MM 70MM SELF TAP LCP TITANIUM CORTEX LARGE,$38.88,$0.00,$38.88,$17.49,$27.75,$0.00,$6.50,$0.00,$0.00,$6.81,$38.88,$0.00,$19.44,$30.79,$31.10,$0.00,$5.91,$0.00,$6.19,$0.00
414.872,SUP,HCPCS C1713,,414.872  -  SCREW BONE 4.5MM 8MM 72MM LARGE HEXAGONAL SOCKET SLFTAP,$38.88,$0.00,$38.88,$17.49,$27.75,$0.00,$6.50,$0.00,$0.00,$6.81,$38.88,$0.00,$19.44,$30.79,$31.10,$0.00,$5.91,$0.00,$6.19,$0.00
414.876,SUP,HCPCS C1713,,414.876  -  SCREW BONE 4.5MM 8MM 76MM LARGE HEXAGONAL SOCKET SLFTAP,$62.08,$0.00,$62.08,$27.93,$44.30,$0.00,$10.39,$0.00,$0.00,$10.87,$62.08,$0.00,$31.04,$49.17,$49.66,$0.00,$9.43,$0.00,$9.88,$0.00
414.88,SUP,HCPCS C1713,,414.880  -  SCREW BONE 4.5MM 8MM 80MM LARGE HEXAGONAL SOCKET SLFTAP,$62.08,$0.00,$62.08,$27.93,$44.30,$0.00,$10.39,$0.00,$0.00,$10.87,$62.08,$0.00,$31.04,$49.17,$49.66,$0.00,$9.43,$0.00,$9.88,$0.00
414.885,SUP,HCPCS C1713,,414.885  -  SCREW BONE 4.5MM 8MM 85MM LARGE HEXAGONAL SOCKET SLFTAP,$62.08,$0.00,$62.08,$27.93,$44.30,$0.00,$10.39,$0.00,$0.00,$10.87,$62.08,$0.00,$31.04,$49.17,$49.66,$0.00,$9.43,$0.00,$9.88,$0.00
414.89,SUP,HCPCS C1713,,414.890  -  SCREW BONE 4.5MM 8MM 90MM LARGE HEXAGONAL SOCKET SLFTAP,$62.08,$0.00,$62.08,$27.93,$44.30,$0.00,$10.39,$0.00,$0.00,$10.87,$62.08,$0.00,$31.04,$49.17,$49.66,$0.00,$9.43,$0.00,$9.88,$0.00
414.895,SUP,HCPCS C1713,,414.895  -  SCREW BONE 4.5MM 8MM 95MM LARGE HEXAGONAL SOCKET SLFTAP,$62.08,$0.00,$62.08,$27.93,$44.30,$0.00,$10.39,$0.00,$0.00,$10.87,$62.08,$0.00,$31.04,$49.17,$49.66,$0.00,$9.43,$0.00,$9.88,$0.00
414.9,SUP,HCPCS C1713,,414.900  -  SCREW BONE 4.5MM 8MM 100MM LARGE HEXAGONAL SOCKET SLFTAP,$62.08,$0.00,$62.08,$27.93,$44.30,$0.00,$10.39,$0.00,$0.00,$10.87,$62.08,$0.00,$31.04,$49.17,$49.66,$0.00,$9.43,$0.00,$9.88,$0.00
414.905,SUP,HCPCS C1713,,414.905  -  SCREW BONE 4.5MM 8MM 105MM LARGE HEXAGONAL SOCKET SLFTAP,$62.08,$0.00,$62.08,$27.93,$44.30,$0.00,$10.39,$0.00,$0.00,$10.87,$62.08,$0.00,$31.04,$49.17,$49.66,$0.00,$9.43,$0.00,$9.88,$0.00
414.91,SUP,HCPCS C1713,,414.910  -  SCREW BONE 4.5MM 8MM 110MM LARGE HEXAGONAL SOCKET SLFTAP,$62.08,$0.00,$62.08,$27.93,$44.30,$0.00,$10.39,$0.00,$0.00,$10.87,$62.08,$0.00,$31.04,$49.17,$49.66,$0.00,$9.43,$0.00,$9.88,$0.00
414.915,SUP,HCPCS C1713,,414.915  -  SCREW BONE 4.5MM 8MM 115MM LARGE HEXAGONAL SOCKET SLFTAP,$62.08,$0.00,$62.08,$27.93,$44.30,$0.00,$10.39,$0.00,$0.00,$10.87,$62.08,$0.00,$31.04,$49.17,$49.66,$0.00,$9.43,$0.00,$9.88,$0.00
414.92,SUP,HCPCS C1713,,414.920  -  SCREW BONE 4.5MM 8MM 120MM LARGE HEXAGONAL SOCKET SLFTAP,$62.08,$0.00,$62.08,$27.93,$44.30,$0.00,$10.39,$0.00,$0.00,$10.87,$62.08,$0.00,$31.04,$49.17,$49.66,$0.00,$9.43,$0.00,$9.88,$0.00
414.925,SUP,HCPCS C1713,,414.925  -  SCREW BONE 4.5MM 8MM 125MM LARGE HEXAGONAL SOCKET SLFTAP,$62.08,$0.00,$62.08,$27.93,$44.30,$0.00,$10.39,$0.00,$0.00,$10.87,$62.08,$0.00,$31.04,$49.17,$49.66,$0.00,$9.43,$0.00,$9.88,$0.00
414.93,SUP,HCPCS C1713,,414.930  -  SCREW BONE 4.5MM 8MM 130MM LARGE HEXAGONAL SOCKET SLFTAP,$62.08,$0.00,$62.08,$27.93,$44.30,$0.00,$10.39,$0.00,$0.00,$10.87,$62.08,$0.00,$31.04,$49.17,$49.66,$0.00,$9.43,$0.00,$9.88,$0.00
414.935,SUP,HCPCS C1713,,414.935  -  SCREW BONE 4.5MM 8MM 135MM LARGE HEXAGONAL SOCKET SLFTAP,$62.08,$0.00,$62.08,$27.93,$44.30,$0.00,$10.39,$0.00,$0.00,$10.87,$62.08,$0.00,$31.04,$49.17,$49.66,$0.00,$9.43,$0.00,$9.88,$0.00
414.94,SUP,HCPCS C1713,,414.940  -  SCREW BONE 4.5MM 8MM 140MM LARGE HEXAGONAL SOCKET SLFTAP,$62.08,$0.00,$62.08,$27.93,$44.30,$0.00,$10.39,$0.00,$0.00,$10.87,$62.08,$0.00,$31.04,$49.17,$49.66,$0.00,$9.43,$0.00,$9.88,$0.00
414.945,SUP,HCPCS C1713,,414.945  -  SCREW BONE 4.5MM 8MM 145MM LARGE HEXAGONAL SOCKET SLFTAP,$62.08,$0.00,$62.08,$27.93,$44.30,$0.00,$10.39,$0.00,$0.00,$10.87,$62.08,$0.00,$31.04,$49.17,$49.66,$0.00,$9.43,$0.00,$9.88,$0.00
416.03,SUP,HCPCS C1713,,416.030  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 30MM 16MM SOCKET LC-DCP,$59.35,$0.00,$59.35,$26.71,$42.36,$0.00,$9.93,$0.00,$0.00,$10.39,$59.35,$0.00,$29.68,$47.01,$47.48,$0.00,$9.02,$0.00,$9.45,$0.00
416.035,SUP,HCPCS C1713,,416.035  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 35MM 16MM SOCKET LC-DCP,$59.35,$0.00,$59.35,$26.71,$42.36,$0.00,$9.93,$0.00,$0.00,$10.39,$59.35,$0.00,$29.68,$47.01,$47.48,$0.00,$9.02,$0.00,$9.45,$0.00
416.04,SUP,HCPCS C1713,,416.040  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 40MM 16MM SOCKET LC-DCP,$59.35,$0.00,$59.35,$26.71,$42.36,$0.00,$9.93,$0.00,$0.00,$10.39,$59.35,$0.00,$29.68,$47.01,$47.48,$0.00,$9.02,$0.00,$9.45,$0.00
416.045,SUP,HCPCS C1713,,416.045  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 45MM 16MM SOCKET LC-DCP,$59.35,$0.00,$59.35,$26.71,$42.36,$0.00,$9.93,$0.00,$0.00,$10.39,$59.35,$0.00,$29.68,$47.01,$47.48,$0.00,$9.02,$0.00,$9.45,$0.00
416.05,SUP,HCPCS C1713,,416.050  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 50MM 16MM SOCKET LC-DCP,$59.35,$0.00,$59.35,$26.71,$42.36,$0.00,$9.93,$0.00,$0.00,$10.39,$59.35,$0.00,$29.68,$47.01,$47.48,$0.00,$9.02,$0.00,$9.45,$0.00
416.055,SUP,HCPCS C1713,,416.055  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 55MM 16MM SOCKET LC-DCP,$59.35,$0.00,$59.35,$26.71,$42.36,$0.00,$9.93,$0.00,$0.00,$10.39,$59.35,$0.00,$29.68,$47.01,$47.48,$0.00,$9.02,$0.00,$9.45,$0.00
416.06,SUP,HCPCS C1713,,416.060  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 60MM 16MM SOCKET LC-DCP,$59.35,$0.00,$59.35,$26.71,$42.36,$0.00,$9.93,$0.00,$0.00,$10.39,$59.35,$0.00,$29.68,$47.01,$47.48,$0.00,$9.02,$0.00,$9.45,$0.00
416.065,SUP,HCPCS C1713,,416.065  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 65MM 16MM SOCKET LC-DCP,$59.35,$0.00,$59.35,$26.71,$42.36,$0.00,$9.93,$0.00,$0.00,$10.39,$59.35,$0.00,$29.68,$47.01,$47.48,$0.00,$9.02,$0.00,$9.45,$0.00
416.07,SUP,HCPCS C1713,,416.070  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 70MM 16MM SOCKET LC-DCP,$59.35,$0.00,$59.35,$26.71,$42.36,$0.00,$9.93,$0.00,$0.00,$10.39,$59.35,$0.00,$29.68,$47.01,$47.48,$0.00,$9.02,$0.00,$9.45,$0.00
416.075,SUP,HCPCS C1713,,416.075  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 75MM 16MM SOCKET LC-DCP,$59.35,$0.00,$59.35,$26.71,$42.36,$0.00,$9.93,$0.00,$0.00,$10.39,$59.35,$0.00,$29.68,$47.01,$47.48,$0.00,$9.02,$0.00,$9.45,$0.00
416.08,SUP,HCPCS C1713,,416.080  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 80MM 16MM SOCKET LC-DCP,$59.35,$0.00,$59.35,$26.71,$42.36,$0.00,$9.93,$0.00,$0.00,$10.39,$59.35,$0.00,$29.68,$47.01,$47.48,$0.00,$9.02,$0.00,$9.45,$0.00
416.085,SUP,HCPCS C1713,,416.085  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 85MM 16MM SOCKET LC-DCP,$64.15,$0.00,$64.15,$28.87,$45.78,$0.00,$10.73,$0.00,$0.00,$11.23,$64.15,$0.00,$32.08,$50.81,$51.32,$0.00,$9.75,$0.00,$10.21,$0.00
416.09,SUP,HCPCS C1713,,416.090  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 90MM 16MM SOCKET LC-DCP,$64.15,$0.00,$64.15,$28.87,$45.78,$0.00,$10.73,$0.00,$0.00,$11.23,$64.15,$0.00,$32.08,$50.81,$51.32,$0.00,$9.75,$0.00,$10.21,$0.00
416.095,SUP,HCPCS C1713,,416.095  -  SCREW BONE 6.5MM 8MM 95MM 16MM THREAD LARGE HEXAGONAL SOCKET,$64.15,$0.00,$64.15,$28.87,$45.78,$0.00,$10.73,$0.00,$0.00,$11.23,$64.15,$0.00,$32.08,$50.81,$51.32,$0.00,$9.75,$0.00,$10.21,$0.00
416.1,SUP,HCPCS C1713,,416.100  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 100MM 16MM SOCKET LC-DCP,$64.15,$0.00,$64.15,$28.87,$45.78,$0.00,$10.73,$0.00,$0.00,$11.23,$64.15,$0.00,$32.08,$50.81,$51.32,$0.00,$9.75,$0.00,$10.21,$0.00
416.105,SUP,HCPCS C1713,,416.105  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 105MM 16MM SOCKET LC-DCP,$64.15,$0.00,$64.15,$28.87,$45.78,$0.00,$10.73,$0.00,$0.00,$11.23,$64.15,$0.00,$32.08,$50.81,$51.32,$0.00,$9.75,$0.00,$10.21,$0.00
416.11,SUP,HCPCS C1713,,416.110  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 110MM 16MM SOCKET LC-DCP,$64.15,$0.00,$64.15,$28.87,$45.78,$0.00,$10.73,$0.00,$0.00,$11.23,$64.15,$0.00,$32.08,$50.81,$51.32,$0.00,$9.75,$0.00,$10.21,$0.00
416.115,SUP,HCPCS C1713,,416.115  -  SCREW BONE 6.5MM 115MM 16MM LC-DCP TITANIUM CANCELLOUS,$79.83,$0.00,$79.83,$35.92,$56.97,$0.00,$13.35,$0.00,$0.00,$13.98,$79.83,$0.00,$39.91,$63.23,$63.86,$0.00,$12.13,$0.00,$12.71,$0.00
416.12,SUP,HCPCS C1713,,416.120  -  SCREW BONE 6.5MM 120MM 16MM THREAD LC-DCP TITANIUM,$79.83,$0.00,$79.83,$35.92,$56.97,$0.00,$13.35,$0.00,$0.00,$13.98,$79.83,$0.00,$39.91,$63.23,$63.86,$0.00,$12.13,$0.00,$12.71,$0.00
417.045,SUP,HCPCS C1713,,417.045  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 45MM 32MM SOCKET LC-DCP,$59.35,$0.00,$59.35,$26.71,$42.36,$0.00,$9.93,$0.00,$0.00,$10.39,$59.35,$0.00,$29.68,$47.01,$47.48,$0.00,$9.02,$0.00,$9.45,$0.00
417.05,SUP,HCPCS C1713,,417.050  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 50MM 32MM SOCKET LC-DCP,$59.35,$0.00,$59.35,$26.71,$42.36,$0.00,$9.93,$0.00,$0.00,$10.39,$59.35,$0.00,$29.68,$47.01,$47.48,$0.00,$9.02,$0.00,$9.45,$0.00
417.055,SUP,HCPCS C1713,,417.055  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 55MM 32MM SOCKET LC-DCP,$59.35,$0.00,$59.35,$26.71,$42.36,$0.00,$9.93,$0.00,$0.00,$10.39,$59.35,$0.00,$29.68,$47.01,$47.48,$0.00,$9.02,$0.00,$9.45,$0.00
417.06,SUP,HCPCS C1713,,417.060  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 60MM 32MM SOCKET LC-DCP,$59.35,$0.00,$59.35,$26.71,$42.36,$0.00,$9.93,$0.00,$0.00,$10.39,$59.35,$0.00,$29.68,$47.01,$47.48,$0.00,$9.02,$0.00,$9.45,$0.00
417.065,SUP,HCPCS C1713,,417.065  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 65MM 32MM SOCKET LC-DCP,$59.35,$0.00,$59.35,$26.71,$42.36,$0.00,$9.93,$0.00,$0.00,$10.39,$59.35,$0.00,$29.68,$47.01,$47.48,$0.00,$9.02,$0.00,$9.45,$0.00
417.07,SUP,HCPCS C1713,,417.070  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 70MM 32MM SOCKET LC-DCP,$59.35,$0.00,$59.35,$26.71,$42.36,$0.00,$9.93,$0.00,$0.00,$10.39,$59.35,$0.00,$29.68,$47.01,$47.48,$0.00,$9.02,$0.00,$9.45,$0.00
417.075,SUP,HCPCS C1713,,417.075  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 75MM 32MM SOCKET LC-DCP,$59.35,$0.00,$59.35,$26.71,$42.36,$0.00,$9.93,$0.00,$0.00,$10.39,$59.35,$0.00,$29.68,$47.01,$47.48,$0.00,$9.02,$0.00,$9.45,$0.00
417.08,SUP,HCPCS C1713,,417.080  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 80MM 32MM SOCKET LC-DCP,$59.35,$0.00,$59.35,$26.71,$42.36,$0.00,$9.93,$0.00,$0.00,$10.39,$59.35,$0.00,$29.68,$47.01,$47.48,$0.00,$9.02,$0.00,$9.45,$0.00
417.085,SUP,HCPCS C1713,,417.085  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 85MM 32MM SOCKET LC-DCP,$64.15,$0.00,$64.15,$28.87,$45.78,$0.00,$10.73,$0.00,$0.00,$11.23,$64.15,$0.00,$32.08,$50.81,$51.32,$0.00,$9.75,$0.00,$10.21,$0.00
417.09,SUP,HCPCS C1713,,417.090  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 90MM 32MM SOCKET LC-DCP,$64.15,$0.00,$64.15,$28.87,$45.78,$0.00,$10.73,$0.00,$0.00,$11.23,$64.15,$0.00,$32.08,$50.81,$51.32,$0.00,$9.75,$0.00,$10.21,$0.00
417.095,SUP,HCPCS C1713,,417.095  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 95MM 32MM SOCKET LC-DCP,$64.15,$0.00,$64.15,$28.87,$45.78,$0.00,$10.73,$0.00,$0.00,$11.23,$64.15,$0.00,$32.08,$50.81,$51.32,$0.00,$9.75,$0.00,$10.21,$0.00
417.1,SUP,HCPCS C1713,,417.100  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 100MM 32MM SOCKET LC-DCP,$64.15,$0.00,$64.15,$28.87,$45.78,$0.00,$10.73,$0.00,$0.00,$11.23,$64.15,$0.00,$32.08,$50.81,$51.32,$0.00,$9.75,$0.00,$10.21,$0.00
417.105,SUP,HCPCS C1713,,417.105  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 105MM 32MM SOCKET LC-DCP,$64.15,$0.00,$64.15,$28.87,$45.78,$0.00,$10.73,$0.00,$0.00,$11.23,$64.15,$0.00,$32.08,$50.81,$51.32,$0.00,$9.75,$0.00,$10.21,$0.00
417.11,SUP,HCPCS C1713,,417.110  -  SCREW BONE LARGE HEXAGON 6.5MM 8MM 110MM 32MM SOCKET LC-DCP,$64.15,$0.00,$64.15,$28.87,$45.78,$0.00,$10.73,$0.00,$0.00,$11.23,$64.15,$0.00,$32.08,$50.81,$51.32,$0.00,$9.75,$0.00,$10.21,$0.00
417.115,SUP,HCPCS C1713,,417.115  -  SCREW BONE PTHRD 6.5MM 8MM 115MM 32MM LARGE HEXAGONAL SOCKET,$79.83,$0.00,$79.83,$35.92,$56.97,$0.00,$13.35,$0.00,$0.00,$13.98,$79.83,$0.00,$39.91,$63.23,$63.86,$0.00,$12.13,$0.00,$12.71,$0.00
417.12,SUP,HCPCS C1713,,417.120  -  SCREW BONE PTHRD 6.5MM 8MM 120MM 32MM LARGE HEXAGONAL SOCKET,$79.83,$0.00,$79.83,$35.92,$56.97,$0.00,$13.35,$0.00,$0.00,$13.98,$79.83,$0.00,$39.91,$63.23,$63.86,$0.00,$12.13,$0.00,$12.71,$0.00
417.125,SUP,HCPCS C1713,,417.125  -  SCREW BONE PTHRD 6.5MM 8MM 125MM 32MM LARGE HEXAGONAL SOCKET,$79.83,$0.00,$79.83,$35.92,$56.97,$0.00,$13.35,$0.00,$0.00,$13.98,$79.83,$0.00,$39.91,$63.23,$63.86,$0.00,$12.13,$0.00,$12.71,$0.00
417.13,SUP,HCPCS C1713,,417.130  -  SCREW BONE PTHRD 6.5MM 8MM 130MM 32MM LARGE HEXAGONAL SOCKET,$79.83,$0.00,$79.83,$35.92,$56.97,$0.00,$13.35,$0.00,$0.00,$13.98,$79.83,$0.00,$39.91,$63.23,$63.86,$0.00,$12.13,$0.00,$12.71,$0.00
417.135,SUP,HCPCS C1713,,417.135  -  SCREW BONE PTHRD 6.5MM 8MM 135MM 32MM LARGE HEXAGONAL SOCKET,$79.83,$0.00,$79.83,$35.92,$56.97,$0.00,$13.35,$0.00,$0.00,$13.98,$79.83,$0.00,$39.91,$63.23,$63.86,$0.00,$12.13,$0.00,$12.71,$0.00
417.14,SUP,HCPCS C1713,,417.140  -  SCREW BONE PTHRD 6.5MM 8MM 140MM 32MM LARGE HEXAGONAL SOCKET,$79.83,$0.00,$79.83,$35.92,$56.97,$0.00,$13.35,$0.00,$0.00,$13.98,$79.83,$0.00,$39.91,$63.23,$63.86,$0.00,$12.13,$0.00,$12.71,$0.00
417.145,SUP,HCPCS C1713,,417.145  -  SCREW BONE PTHRD 6.5MM 8MM 145MM 32MM LARGE HEXAGONAL SOCKET,$79.83,$0.00,$79.83,$35.92,$56.97,$0.00,$13.35,$0.00,$0.00,$13.98,$79.83,$0.00,$39.91,$63.23,$63.86,$0.00,$12.13,$0.00,$12.71,$0.00
417.15,SUP,HCPCS C1713,,417.150  -  SCREW BONE PTHRD 6.5MM 8MM 150MM 32MM LARGE HEXAGONAL SOCKET,$79.83,$0.00,$79.83,$35.92,$56.97,$0.00,$13.35,$0.00,$0.00,$13.98,$79.83,$0.00,$39.91,$63.23,$63.86,$0.00,$12.13,$0.00,$12.71,$0.00
418.009,SUP,HCPCS C1713,,418.009  -  SCREW BONE 6.5MM 60MM TITANIUM CANCELLOUS NONSTRL,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
418.01,SUP,HCPCS C1713,,418.010  -  SCREW BONE FULTHD 6.5MM 4MM 65MM TITANIUM CANCELLOUS NONSTRL,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
418.011,SUP,HCPCS C1713,,418.011  -  SCREW BONE 6.5MM 70MM TITANIUM CANCELLOUS NONSTRL,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
418.012,SUP,HCPCS C1713,,418.012  -  SCREW BONE 6.5MM 75MM TITANIUM CANCELLOUS NONSTRL,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
418.013,SUP,HCPCS C1713,,418.013  -  SCREW BONE 6.5MM 80MM TITANIUM CANCELLOUS NONSTRL,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
418.014,SUP,HCPCS C1713,,418.014  -  SCREW BONE 6.5MM 85MM TITANIUM CANCELLOUS NONSTRL,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
418.015,SUP,HCPCS C1713,,418.015  -  SCREW BONE 6.5MM 90MM TITANIUM CANCELLOUS NONSTRL,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
418.016,SUP,HCPCS C1713,,418.016  -  SCREW BONE 6.5MM 95MM TITANIUM CANCELLOUS NONSTRL,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
418.017,SUP,HCPCS C1713,,418.017  -  SCREW BONE 6.5MM 100MM TITANIUM CANCELLOUS NONSTRL,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
418.018,SUP,HCPCS C1713,,418.018  -  SCREW BONE 6.5MM 105MM TITANIUM CANCELLOUS NONSTRL,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
418.019,SUP,HCPCS C1713,,418.019  -  SCREW BONE 6.5MM 110MM TITANIUM CANCELLOUS NONSTRL,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
418.025,SUP,HCPCS C1713,,418.025  -  SCREW BONE 6.5MM 8MM 25MM HEXAGONAL SOCKET LC-DCP TITANIUM,$59.35,$0.00,$59.35,$26.71,$42.36,$0.00,$9.93,$0.00,$0.00,$10.39,$59.35,$0.00,$29.68,$47.01,$47.48,$0.00,$9.02,$0.00,$9.45,$0.00
418.03,SUP,HCPCS C1713,,418.030  -  SCREW BONE 6.5MM 8MM 30MM HEXAGONAL SOCKET LC-DCP TITANIUM,$59.35,$0.00,$59.35,$26.71,$42.36,$0.00,$9.93,$0.00,$0.00,$10.39,$59.35,$0.00,$29.68,$47.01,$47.48,$0.00,$9.02,$0.00,$9.45,$0.00
418.035,SUP,HCPCS C1713,,418.035  -  SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 35MM SOCKET LC-DCP,$59.35,$0.00,$59.35,$26.71,$42.36,$0.00,$9.93,$0.00,$0.00,$10.39,$59.35,$0.00,$29.68,$47.01,$47.48,$0.00,$9.02,$0.00,$9.45,$0.00
418.04,SUP,HCPCS C1713,,418.040  -  SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 40MM SOCKET LC-DCP,$59.35,$0.00,$59.35,$26.71,$42.36,$0.00,$9.93,$0.00,$0.00,$10.39,$59.35,$0.00,$29.68,$47.01,$47.48,$0.00,$9.02,$0.00,$9.45,$0.00
418.045,SUP,HCPCS C1713,,418.045  -  SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 45MM SOCKET LC-DCP,$59.35,$0.00,$59.35,$26.71,$42.36,$0.00,$9.93,$0.00,$0.00,$10.39,$59.35,$0.00,$29.68,$47.01,$47.48,$0.00,$9.02,$0.00,$9.45,$0.00
418.05,SUP,HCPCS C1713,,418.050  -  SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 50MM SOCKET LC-DCP,$59.35,$0.00,$59.35,$26.71,$42.36,$0.00,$9.93,$0.00,$0.00,$10.39,$59.35,$0.00,$29.68,$47.01,$47.48,$0.00,$9.02,$0.00,$9.45,$0.00
418.055,SUP,HCPCS C1713,,418.055  -  SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 55MM SOCKET LC-DCP,$59.35,$0.00,$59.35,$26.71,$42.36,$0.00,$9.93,$0.00,$0.00,$10.39,$59.35,$0.00,$29.68,$47.01,$47.48,$0.00,$9.02,$0.00,$9.45,$0.00
418.06,SUP,HCPCS C1713,,418.060  -  SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 60MM SOCKET LC-DCP,$59.35,$0.00,$59.35,$26.71,$42.36,$0.00,$9.93,$0.00,$0.00,$10.39,$59.35,$0.00,$29.68,$47.01,$47.48,$0.00,$9.02,$0.00,$9.45,$0.00
418.065,SUP,HCPCS C1713,,418.065  -  SCREW BONE FULTHD 6.5MM 8MM 65MM LARGE HEXAGONAL SOCKET,$59.35,$0.00,$59.35,$26.71,$42.36,$0.00,$9.93,$0.00,$0.00,$10.39,$59.35,$0.00,$29.68,$47.01,$47.48,$0.00,$9.02,$0.00,$9.45,$0.00
418.07,SUP,HCPCS C1713,,418.070  -  SCREW BONE FULTHD 6.5MM 8MM 70MM LARGE HEXAGONAL SOCKET,$59.35,$0.00,$59.35,$26.71,$42.36,$0.00,$9.93,$0.00,$0.00,$10.39,$59.35,$0.00,$29.68,$47.01,$47.48,$0.00,$9.02,$0.00,$9.45,$0.00
418.075,SUP,HCPCS C1713,,418.075  -  SCREW BONE FULTHD 6.5MM 8MM 75MM LARGE HEXAGONAL SOCKET,$59.35,$0.00,$59.35,$26.71,$42.36,$0.00,$9.93,$0.00,$0.00,$10.39,$59.35,$0.00,$29.68,$47.01,$47.48,$0.00,$9.02,$0.00,$9.45,$0.00
418.08,SUP,HCPCS C1713,,418.080  -  SCREW BONE FULTHD 6.5MM 8MM 80MM LARGE HEXAGONAL SOCKET,$59.35,$0.00,$59.35,$26.71,$42.36,$0.00,$9.93,$0.00,$0.00,$10.39,$59.35,$0.00,$29.68,$47.01,$47.48,$0.00,$9.02,$0.00,$9.45,$0.00
418.085,SUP,HCPCS C1713,,418.085  -  SCREW BONE FULTHD 6.5MM 8MM 85MM LARGE HEXAGONAL SOCKET,$64.15,$0.00,$64.15,$28.87,$45.78,$0.00,$10.73,$0.00,$0.00,$11.23,$64.15,$0.00,$32.08,$50.81,$51.32,$0.00,$9.75,$0.00,$10.21,$0.00
418.09,SUP,HCPCS C1713,,418.090  -  SCREW BONE FULTHD 6.5MM 8MM 90MM LARGE HEXAGONAL SOCKET,$64.15,$0.00,$64.15,$28.87,$45.78,$0.00,$10.73,$0.00,$0.00,$11.23,$64.15,$0.00,$32.08,$50.81,$51.32,$0.00,$9.75,$0.00,$10.21,$0.00
418.095,SUP,HCPCS C1713,,418.095  -  SCREW BONE FULTHD 6.5MM 8MM 95MM LARGE HEXAGONAL SOCKET,$64.15,$0.00,$64.15,$28.87,$45.78,$0.00,$10.73,$0.00,$0.00,$11.23,$64.15,$0.00,$32.08,$50.81,$51.32,$0.00,$9.75,$0.00,$10.21,$0.00
418.1,SUP,HCPCS C1713,,418.100  -  SCREW BONE FULTHD 6.5MM 8MM 100MM LARGE HEXAGONAL SOCKET,$64.15,$0.00,$64.15,$28.87,$45.78,$0.00,$10.73,$0.00,$0.00,$11.23,$64.15,$0.00,$32.08,$50.81,$51.32,$0.00,$9.75,$0.00,$10.21,$0.00
418.105,SUP,HCPCS C1713,,418.105  -  SCREW BONE FULTHD 6.5MM 8MM 105MM LARGE HEXAGONAL SOCKET,$64.15,$0.00,$64.15,$28.87,$45.78,$0.00,$10.73,$0.00,$0.00,$11.23,$64.15,$0.00,$32.08,$50.81,$51.32,$0.00,$9.75,$0.00,$10.21,$0.00
418.11,SUP,HCPCS C1713,,418.110  -  SCREW BONE FULTHD 6.5MM 8MM 110MM LARGE HEXAGONAL SOCKET,$64.15,$0.00,$64.15,$28.87,$45.78,$0.00,$10.73,$0.00,$0.00,$11.23,$64.15,$0.00,$32.08,$50.81,$51.32,$0.00,$9.75,$0.00,$10.21,$0.00
418.215,SUP,HCPCS C1713,,418.215  -  SCREW BONE FULTHD 6.5MM 115MM TITANIUM CANCELLOUS NONSTRL,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
418.22,SUP,HCPCS C1713,,418.220  -  SCREW BONE FULTHD 6.5MM 4MM 120MM TITANIUM CANCELLOUS,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
418.225,SUP,HCPCS C1713,,418.225  -  SCREW BONE FULTHD 6.5MM 125MM TITANIUM CANCELLOUS NONSTRL,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
418.23,SUP,HCPCS C1713,,418.230  -  SCREW BONE FULTHD 6.5MM 4MM 130MM TITANIUM CANCELLOUS,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
419.89,SUP,Custom 27803010,,419.89  -  WASHER ORTHOPEDIC THREAD TITANIUM NONSTRL 3 MM CANN SCREWS,$251.13,$0.00,$251.13,$0.00,$179.23,$0.00,$0.00,$0.00,$0.00,$0.00,$251.13,$0.00,$125.56,$198.89,$200.90,$0.00,$0.00,$0.00,$0.00,$0.00
419.91,SUP,Custom 27803010,,419.91  -  WASHER ORTHOPEDIC 10MM TITANIUM NONSTRL 4.5MM CANN SCREW,$54.23,$0.00,$54.23,$0.00,$38.70,$0.00,$0.00,$0.00,$0.00,$0.00,$54.23,$0.00,$27.11,$42.95,$43.38,$0.00,$0.00,$0.00,$0.00,$0.00
419.96,SUP,Custom 27803010,,419.96  -  NUT ORTHOPEDIC LC-DCP TITANIUM NONSTRL 4.5 MM CORTICAL SCREW,$54.23,$0.00,$54.23,$0.00,$38.70,$0.00,$0.00,$0.00,$0.00,$0.00,$54.23,$0.00,$27.11,$42.95,$43.38,$0.00,$0.00,$0.00,$0.00,$0.00
419.972,SUP,Custom 27803010,,419.972  -  WASHER ORTHOPEDIC 6.5MM CANN TITANIUM NONSTRL 3MM SCREWS,$53.23,$0.00,$53.23,$0.00,$37.99,$0.00,$0.00,$0.00,$0.00,$0.00,$53.23,$0.00,$26.61,$42.16,$42.58,$0.00,$0.00,$0.00,$0.00,$0.00
419.98,SUP,Custom 27803010,,419.98  -  WASHER ORTHOPEDIC 7MM TITANIUM PROXIMAL TIBIA NONSTRL 4MM,$46.05,$0.00,$46.05,$0.00,$32.87,$0.00,$0.00,$0.00,$0.00,$0.00,$46.05,$0.00,$23.03,$36.47,$36.84,$0.00,$0.00,$0.00,$0.00,$0.00
419.99,SUP,Custom 27803010,,419.99  -  WASHER ORTHOPEDIC 13MM TITANIUM FEMUR NONSTRL 6.5/7.3MM CANN,$51.18,$0.00,$51.18,$0.00,$36.52,$0.00,$0.00,$0.00,$0.00,$0.00,$51.18,$0.00,$25.59,$40.53,$40.94,$0.00,$0.00,$0.00,$0.00,$0.00
420,SUP,HCPCS C1713,,420.00  -  PLATE BONE 40X29MM CRANFCL TI MESH 1MM SCR NONSTRL,"$2,607.75",$0.00,"$2,607.75","$1,173.49","$1,861.15",$0.00,$449.30,$0.00,$0.00,$456.60,"$2,607.75",$0.00,"$1,303.88","$2,065.34","$2,086.20",$0.00,$408.11,$0.00,$415.15,$0.00
420.01,SUP,HCPCS C1713,,420.01  -  PLATE BONE 30X6MM CRANFCL TI 16 HOLE STRUT 1MM SCR NONSTRL,"$1,131.75",$0.00,"$1,131.75",$509.29,$807.73,$0.00,$194.99,$0.00,$0.00,$198.16,"$1,131.75",$0.00,$565.88,$896.35,$905.40,$0.00,$177.12,$0.00,$180.17,$0.00
420.02,SUP,HCPCS C1713,,420.02  -  PLATE BONE 42X38X.4MM CRANFCL TI MESH 1MM SCR NONSTRL,"$3,145.50",$0.00,"$3,145.50","$1,415.48","$2,244.94",$0.00,$541.95,$0.00,$0.00,$550.75,"$3,145.50",$0.00,"$1,572.75","$2,491.24","$2,516.40",$0.00,$492.27,$0.00,$500.76,$0.00
420.031,SUP,HCPCS C1713,,420.031  -  PLATE BONE 50X50MM MIC CRANFCL TI MESH 1MM SCR NONSTRL,"$3,746.25",$0.00,"$3,746.25","$1,685.81","$2,673.70",$0.00,$645.46,$0.00,$0.00,$655.94,"$3,746.25",$0.00,"$1,873.13","$2,967.03","$2,997.00",$0.00,$586.29,$0.00,$596.40,$0.00
420.04,SUP,HCPCS C1713,,420.04  -  PLATE BONE 42X6X.4MM CRANFCL TI 22 HOLE STRUT 1MM SCR,"$1,271.25",$0.00,"$1,271.25",$572.06,$907.29,$0.00,$219.03,$0.00,$0.00,$222.59,"$1,271.25",$0.00,$635.63,"$1,006.83","$1,017.00",$0.00,$198.95,$0.00,$202.38,$0.00
420.05,SUP,HCPCS C1713,,420.05  -  PLATE BONE 100X50X.4MM CRANFCL TI MESH 1MM SCR NONSTRL,"$3,746.25",$0.00,"$3,746.25","$1,685.81","$2,673.70",$0.00,$645.46,$0.00,$0.00,$655.94,"$3,746.25",$0.00,"$1,873.13","$2,967.03","$2,997.00",$0.00,$586.29,$0.00,$596.40,$0.00
420.06,SUP,HCPCS C1713,,420.06  -  PLATE BONE 100X100X.4MM CRANFCL TI MESH 1MM SCR NONSTRL,"$5,346.00",$0.00,"$5,346.00","$2,405.70","$3,815.44",$0.00,$921.09,$0.00,$0.00,$936.04,"$5,346.00",$0.00,"$2,673.00","$4,234.03","$4,276.80",$0.00,$836.65,$0.00,$851.08,$0.00
420.07,SUP,HCPCS C1713,,420.070  -  PLATE BONE 100X100X.1MM CRANFCL TI MESH SCRN 1MM SCR NONSTRL,"$2,691.00",$0.00,"$2,691.00","$1,210.95","$1,920.57",$0.00,$463.65,$0.00,$0.00,$471.17,"$2,691.00",$0.00,"$1,345.50","$2,131.27","$2,152.80",$0.00,$421.14,$0.00,$428.41,$0.00
420.071,SUP,HCPCS C1713,,420.071  -  PLATE BONE 100X100MM CRANFCL TI MESH 1/1.5MM SCR NONSTRL,"$4,603.50",$0.00,"$4,603.50","$2,071.58","$3,285.52",$0.00,$793.16,$0.00,$0.00,$806.04,"$4,603.50",$0.00,"$2,301.75","$3,645.97","$3,682.80",$0.00,$720.45,$0.00,$732.88,$0.00
420.1,SUP,HCPCS C1713,,420.10  -  PLATE BONE 100MM CRNMXF TI 34 HOLE ADP 1MM SCR NONSTRL,"$1,395.00",$0.00,"$1,395.00",$627.75,$995.61,$0.00,$240.35,$0.00,$0.00,$244.25,"$1,395.00",$0.00,$697.50,"$1,104.84","$1,116.00",$0.00,$218.32,$0.00,$222.08,$0.00
420.21,SUP,HCPCS C1713,,420.21  -  PLATE BONE ORBTL RIM TI 11 HOLE 1 MM SCR NONSTRL,$616.50,$0.00,$616.50,$277.43,$440.00,$0.00,$106.22,$0.00,$0.00,$107.94,$616.50,$0.00,$308.25,$488.27,$493.20,$0.00,$96.48,$0.00,$98.15,$0.00
420.302,SUP,HCPCS C1713,,420.302  -  PLATE BONE .2MM ORBTL RIM TI MESH 1MM SCR NONSTRL,"$2,889.00",$0.00,"$2,889.00","$1,300.05","$2,061.88",$0.00,$497.76,$0.00,$0.00,$505.84,"$2,889.00",$0.00,"$1,444.50","$2,288.09","$2,311.20",$0.00,$452.13,$0.00,$459.93,$0.00
420.303,SUP,HCPCS C1713,,420.303  -  PLATE BONE .3MM ORBTL RIM TI MESH 1MM SCR NONSTRL,"$2,889.00",$0.00,"$2,889.00","$1,300.05","$2,061.88",$0.00,$497.76,$0.00,$0.00,$505.84,"$2,889.00",$0.00,"$1,444.50","$2,288.09","$2,311.20",$0.00,$452.13,$0.00,$459.93,$0.00
420.304,SUP,HCPCS C1713,,420.304  -  PLATE BONE .4MM ORBTL RIM TI MESH 1MM SCR NONSTRL,"$2,889.00",$0.00,"$2,889.00","$1,300.05","$2,061.88",$0.00,$497.76,$0.00,$0.00,$505.84,"$2,889.00",$0.00,"$1,444.50","$2,288.09","$2,311.20",$0.00,$452.13,$0.00,$459.93,$0.00
420.4,SUP,HCPCS C1713,,420.40  -  PLATE BONE UNV ORBTL FLR TI 1MM SCR NONSTRL,"$2,772.00",$0.00,"$2,772.00","$1,247.40","$1,978.38",$0.00,$477.60,$0.00,$0.00,$485.36,"$2,772.00",$0.00,"$1,386.00","$2,195.42","$2,217.60",$0.00,$433.82,$0.00,$441.30,$0.00
420.401,SUP,HCPCS C1713,,420.401  -  PLATE SM .3MM TI 1MM SCR ANTM BONE ORBTL FLR NONSTRL,"$2,772.00",$0.00,"$2,772.00","$1,247.40","$1,978.38",$0.00,$477.60,$0.00,$0.00,$485.36,"$2,772.00",$0.00,"$1,386.00","$2,195.42","$2,217.60",$0.00,$433.82,$0.00,$441.30,$0.00
420.402,SUP,HCPCS C1713,,420.402  -  PLATE BONE LG ORBTL FLR TI ANTM 1MM SCR NONSTRL,"$2,772.00",$0.00,"$2,772.00","$1,247.40","$1,978.38",$0.00,$477.60,$0.00,$0.00,$485.36,"$2,772.00",$0.00,"$1,386.00","$2,195.42","$2,217.60",$0.00,$433.82,$0.00,$441.30,$0.00
420.403,SUP,HCPCS C1713,,420.403  -  PLATE BONE MED ORBTL FLR TI ANTM 1MM SCR NONSTRL,"$2,772.00",$0.00,"$2,772.00","$1,247.40","$1,978.38",$0.00,$477.60,$0.00,$0.00,$485.36,"$2,772.00",$0.00,"$1,386.00","$2,195.42","$2,217.60",$0.00,$433.82,$0.00,$441.30,$0.00
420.44,SUP,HCPCS C1713,,420.44  -  PLATE BONE MIC LEFT MDL WL CRANFCL TI 1MM SCR NONSTRL,"$2,772.00",$0.00,"$2,772.00","$1,247.40","$1,978.38",$0.00,$477.60,$0.00,$0.00,$485.36,"$2,772.00",$0.00,"$1,386.00","$2,195.42","$2,217.60",$0.00,$433.82,$0.00,$441.30,$0.00
420.45,SUP,HCPCS C1713,,420.45  -  PLATE BONE MIC RIGHT MDL WL CRANFCL TI 1MM SCR NONSTRL,"$2,772.00",$0.00,"$2,772.00","$1,247.40","$1,978.38",$0.00,$477.60,$0.00,$0.00,$485.36,"$2,772.00",$0.00,"$1,386.00","$2,195.42","$2,217.60",$0.00,$433.82,$0.00,$441.30,$0.00
420.54,SUP,HCPCS C1713,,420.54  -  PLATE TI 1 MM SCR L BONE LEFT ORTH NONSTRL,$555.75,$0.00,$555.75,$250.09,$396.64,$0.00,$95.75,$0.00,$0.00,$97.31,$555.75,$0.00,$277.88,$440.15,$444.60,$0.00,$86.97,$0.00,$88.48,$0.00
420.55,SUP,HCPCS C1713,,420.55  -  SET BONE RIGHT TI 5 HL SHFT 4 BASE 1 MM SCR NONSTRL,$555.75,$0.00,$555.75,$250.09,$396.64,$0.00,$95.75,$0.00,$0.00,$97.31,$555.75,$0.00,$277.88,$440.15,$444.60,$0.00,$86.97,$0.00,$88.48,$0.00
420.62,SUP,HCPCS C1713,,420.62  -  PLATE BONE CRANFCL TI 9 HOLE Y 1 MM SCR NONSTRL,$558.00,$0.00,$558.00,$251.10,$398.24,$0.00,$96.14,$0.00,$0.00,$97.70,$558.00,$0.00,$279.00,$441.94,$446.40,$0.00,$87.33,$0.00,$88.83,$0.00
420.63,SUP,HCPCS C1713,,420.63  -  PLATE BONE CRANFCL TI 13 HOLE Y 1 MM SCR NONSTRL,$558.00,$0.00,$558.00,$251.10,$398.24,$0.00,$96.14,$0.00,$0.00,$97.70,$558.00,$0.00,$279.00,$441.94,$446.40,$0.00,$87.33,$0.00,$88.83,$0.00
420.631,SUP,HCPCS C1713,,420.631  -  PLATE BONE CRANFCL TI 18 HOLE Y 1 MM SCR NONSTRL,$515.25,$0.00,$515.25,$231.86,$367.73,$0.00,$88.77,$0.00,$0.00,$90.22,$515.25,$0.00,$257.63,$408.08,$412.20,$0.00,$80.64,$0.00,$82.03,$0.00
420.68,SUP,HCPCS C1713,,420.68  -  PLATE BONE CRANFCL TI 1X2 HOLE 2 Y 1 MM SCR NONSTRL,$591.75,$0.00,$591.75,$266.29,$422.33,$0.00,$101.96,$0.00,$0.00,$103.61,$591.75,$0.00,$295.88,$468.67,$473.40,$0.00,$92.61,$0.00,$94.21,$0.00
420.7,SUP,HCPCS C1713,,420.70  -  PLATE TI 1 MM SCR 5X5 HOLE T BONE ORTH NONSTRL,$558.00,$0.00,$558.00,$251.10,$398.24,$0.00,$96.14,$0.00,$0.00,$97.70,$558.00,$0.00,$279.00,$441.94,$446.40,$0.00,$87.33,$0.00,$88.83,$0.00
420.71,SUP,HCPCS C1713,,420.71  -  PLATE BONE CRANFCL TI 12 HOLE T 1 MM SCR NONSTRL,$591.75,$0.00,$591.75,$266.29,$422.33,$0.00,$101.96,$0.00,$0.00,$103.61,$591.75,$0.00,$295.88,$468.67,$473.40,$0.00,$92.61,$0.00,$94.21,$0.00
420.81,SUP,HCPCS C1713,,420.81  -  SCREW BONE CORT CRANFCL TI 5 HOLE X NONSTRL,$499.50,$0.00,$499.50,$224.78,$356.49,$0.00,$86.06,$0.00,$0.00,$87.46,$499.50,$0.00,$249.75,$395.60,$399.60,$0.00,$78.17,$0.00,$79.52,$0.00
420.84,SUP,HCPCS C1713,,420.84  -  PLATE BONE CRANFCL TI 6 HOLE H 1 MM SCR NONSTRL,$528.75,$0.00,$528.75,$237.94,$377.37,$0.00,$91.10,$0.00,$0.00,$92.58,$528.75,$0.00,$264.38,$418.77,$423.00,$0.00,$82.75,$0.00,$84.18,$0.00
420.85,SUP,HCPCS C1713,,420.85  -  PLATE BONE CRANFCL TI 11 HOLE H 1 MM SCR NONSTRL,$591.75,$0.00,$591.75,$266.29,$422.33,$0.00,$101.96,$0.00,$0.00,$103.61,$591.75,$0.00,$295.88,$468.67,$473.40,$0.00,$92.61,$0.00,$94.21,$0.00
420.9,SUP,Custom 27803010,,420.900  -  BURR SURG 12MM HOLE COVER,$504.00,$0.00,$504.00,$0.00,$359.70,$0.00,$0.00,$0.00,$0.00,$0.00,$504.00,$0.00,$252.00,$399.17,$403.20,$0.00,$0.00,$0.00,$0.00,$0.00
420.91,SUP,Custom 27803010,,420.91  -  COVER BUR HOLE 17MM CRANFCL TI 6 HOLE 1MM SCR NONSTRL,$504.00,$0.00,$504.00,$0.00,$359.70,$0.00,$0.00,$0.00,$0.00,$0.00,$504.00,$0.00,$252.00,$399.17,$403.20,$0.00,$0.00,$0.00,$0.00,$0.00
421.001,SUP,HCPCS C1713,,421.001  -  PLATE BONE 53X38MM CRANFCL TI MESH MALBLE 1.3MM SCR NONSTRL,"$3,467.25",$0.00,"$3,467.25","$1,560.26","$2,474.58",$0.00,$597.39,$0.00,$0.00,$607.09,"$3,467.25",$0.00,"$1,733.63","$2,746.06","$2,773.80",$0.00,$542.62,$0.00,$551.99,$0.00
421.002,SUP,HCPCS C1713,,421.002  -  PLATE BONE TMPR TI MESH MALBLE 1.3 MM SCR NONSTRL,"$1,851.75",$0.00,"$1,851.75",$833.29,"$1,321.59",$0.00,$319.05,$0.00,$0.00,$324.23,"$1,851.75",$0.00,$925.88,"$1,466.59","$1,481.40",$0.00,$289.80,$0.00,$294.80,$0.00
421.003,SUP,HCPCS C1713,,421.003  -  PLATE BONE CRANIAL TI 8 HOLE CONTUR STRUT 1.3 MM SCR NONSTRL,"$1,365.75",$0.00,"$1,365.75",$614.59,$974.74,$0.00,$235.31,$0.00,$0.00,$239.13,"$1,365.75",$0.00,$682.88,"$1,081.67","$1,092.60",$0.00,$213.74,$0.00,$217.43,$0.00
421.004,SUP,HCPCS C1713,,421.004  -  PLATE BONE NONSTRL TEAL 45X38MM CRANFCL TI CONTUR MESH,"$3,584.25",$0.00,"$3,584.25","$1,612.91","$2,558.08",$0.00,$617.55,$0.00,$0.00,$627.57,"$3,584.25",$0.00,"$1,792.13","$2,838.73","$2,867.40",$0.00,$560.94,$0.00,$570.61,$0.00
421.005,SUP,HCPCS C1713,,421.005  -  PLATE BN RECT 45X38X.6MM NS CNTR MESH RGD TI CRNFCL 1.3MM,"$3,584.25",$0.00,"$3,584.25","$1,612.91","$2,558.08",$0.00,$617.55,$0.00,$0.00,$627.57,"$3,584.25",$0.00,"$1,792.13","$2,838.73","$2,867.40",$0.00,$560.94,$0.00,$570.61,$0.00
421.006,SUP,HCPCS C1713,,421.006  -  PLATE BONE 100X100MM CRANFCL TI 5 HOLE MESH MALBLE 1.3MM SCR,"$5,379.75",$0.00,"$5,379.75","$2,420.89","$3,839.53",$0.00,$926.90,$0.00,$0.00,$941.95,"$5,379.75",$0.00,"$2,689.88","$4,260.76","$4,303.80",$0.00,$841.93,$0.00,$856.46,$0.00
421.007,SUP,HCPCS C1713,,421.007  -  PLATE BONE NONSTRL TEAL 100X100MM CRANFCL TI CONTUR MESH,"$5,595.75",$0.00,"$5,595.75","$2,518.09","$3,993.69",$0.00,$964.12,$0.00,$0.00,$979.77,"$5,595.75",$0.00,"$2,797.88","$4,431.83","$4,476.60",$0.00,$875.73,$0.00,$890.84,$0.00
421.008,SUP,HCPCS C1713,,421.008  -  PLATE BN RECT 100X100X.6MM NS CNTR MESH RGD TI CRNFCL 1.3MM,"$5,595.75",$0.00,"$5,595.75","$2,518.09","$3,993.69",$0.00,$964.12,$0.00,$0.00,$979.77,"$5,595.75",$0.00,"$2,797.88","$4,431.83","$4,476.60",$0.00,$875.73,$0.00,$890.84,$0.00
421.009,SUP,HCPCS C1713,,421.009  -  PLATE BONE NONSTRL GOLD 200X200MM CRANFCL TI CONTUR MESH RGD,"$22,304.25",$0.00,"$22,304.25","$10,036.91","$5,158.80",$0.00,"$3,842.91",$0.00,$0.00,"$3,905.30","$22,304.25",$0.00,"$11,152.13","$17,664.97","$17,843.40",$0.00,"$3,490.62",$0.00,"$3,550.84",$0.00
421.01,SUP,HCPCS C1713,,421.010  -  PLATE BN 95X3.3X.5MM NS 24 HL ADP TI CRNFCL 1.3MM CORT SCR,"$1,446.75",$0.00,"$1,446.75",$651.04,"$1,032.55",$0.00,$249.27,$0.00,$0.00,$253.31,"$1,446.75",$0.00,$723.38,"$1,145.83","$1,157.40",$0.00,$226.42,$0.00,$230.32,$0.00
421.011,SUP,HCPCS C1713,,421.011  -  PLATE BONE NONSTRL TEAL CRANFCL TI CONTUR MESH MALBLE SM ARC,"$1,851.75",$0.00,"$1,851.75",$833.29,"$1,321.59",$0.00,$319.05,$0.00,$0.00,$324.23,"$1,851.75",$0.00,$925.88,"$1,466.59","$1,481.40",$0.00,$289.80,$0.00,$294.80,$0.00
421.012,SUP,HCPCS C1713,,421.012  -  PLATE BONE NONSTRL TEAL CRANFCL TI CONTUR MESH MALBLE LG ARC,"$2,893.50",$0.00,"$2,893.50","$1,302.08","$2,065.09",$0.00,$498.54,$0.00,$0.00,$506.63,"$2,893.50",$0.00,"$1,446.75","$2,291.65","$2,314.80",$0.00,$452.83,$0.00,$460.65,$0.00
421.013,SUP,HCPCS C1713,,421.013  -  PLATE BONE 1.3MM SCR GOLD CRANFCL TI CONTUR MESH RGD SM ARC,"$1,851.75",$0.00,"$1,851.75",$833.29,"$1,321.59",$0.00,$319.05,$0.00,$0.00,$324.23,"$1,851.75",$0.00,$925.88,"$1,466.59","$1,481.40",$0.00,$289.80,$0.00,$294.80,$0.00
421.014,SUP,HCPCS C1713,,421.014  -  PLATE BONE 1.3MM SCR GOLD CRANFCL TI CONTUR MESH RGD LG ARC,"$2,893.50",$0.00,"$2,893.50","$1,302.08","$2,065.09",$0.00,$498.54,$0.00,$0.00,$506.63,"$2,893.50",$0.00,"$1,446.75","$2,291.65","$2,314.80",$0.00,$452.83,$0.00,$460.65,$0.00
421.015,SUP,HCPCS C1713,,421.015  -  PLATE BONE RND CONTUR MESH MALBLE 1.3MM SCR TEAL 30MM,"$1,851.75",$0.00,"$1,851.75",$833.29,"$1,321.59",$0.00,$319.05,$0.00,$0.00,$324.23,"$1,851.75",$0.00,$925.88,"$1,466.59","$1,481.40",$0.00,$289.80,$0.00,$294.80,$0.00
421.016,SUP,HCPCS C1713,,421.016  -  PLATE BONE RND CONTUR MESH MALBLE 1.3MM SCR TEAL 70MM,"$3,845.25",$0.00,"$3,845.25","$1,730.36","$2,744.35",$0.00,$662.52,$0.00,$0.00,$673.27,"$3,845.25",$0.00,"$1,922.63","$3,045.44","$3,076.20",$0.00,$601.78,$0.00,$612.16,$0.00
421.017,SUP,HCPCS C1713,,421.017  -  PLATE BONE RND CONTUR MESH MALBLE 1.3MM SCR TEAL 100MM,"$5,334.75",$0.00,"$5,334.75","$2,400.64","$3,807.41",$0.00,$919.15,$0.00,$0.00,$934.07,"$5,334.75",$0.00,"$2,667.38","$4,225.12","$4,267.80",$0.00,$834.89,$0.00,$849.29,$0.00
421.018,SUP,HCPCS C1713,,421.018  -  PLATE BONE NONSTRL GOLD 30MM CRANFCL TI CONTUR MESH RGD RND,"$1,851.75",$0.00,"$1,851.75",$833.29,"$1,321.59",$0.00,$319.05,$0.00,$0.00,$324.23,"$1,851.75",$0.00,$925.88,"$1,466.59","$1,481.40",$0.00,$289.80,$0.00,$294.80,$0.00
421.019,SUP,HCPCS C1713,,421.019  -  PLATE BONE NONSTRL GOLD 70MM CRANFCL TI CONTUR MESH RGD RND,"$3,845.25",$0.00,"$3,845.25","$1,730.36","$2,744.35",$0.00,$662.52,$0.00,$0.00,$673.27,"$3,845.25",$0.00,"$1,922.63","$3,045.44","$3,076.20",$0.00,$601.78,$0.00,$612.16,$0.00
421.02,SUP,HCPCS C1713,,421.020  -  PLATE BONE NONSTRL GOLD 100MM CRANFCL TI CONTUR MESH RGD RND,"$5,334.75",$0.00,"$5,334.75","$2,400.64","$3,807.41",$0.00,$919.15,$0.00,$0.00,$934.07,"$5,334.75",$0.00,"$2,667.38","$4,225.12","$4,267.80",$0.00,$834.89,$0.00,$849.29,$0.00
421.021,SUP,HCPCS C1713,,421.021  -  PLATE BN 35X3.3X.5MM NS 9 HL TI CRNFCL ORBT RIM 1.3MM CORT,$576.00,$0.00,$576.00,$259.20,$411.09,$0.00,$99.24,$0.00,$0.00,$100.85,$576.00,$0.00,$288.00,$456.19,$460.80,$0.00,$90.14,$0.00,$91.70,$0.00
421.022,SUP,HCPCS C1713,,421.022  -  PLATE BONE 13MM THK.5MM CRANIAL TI 2 HOLE STR 1.3MM SCR,$101.25,$0.00,$101.25,$45.56,$72.26,$0.00,$17.44,$0.00,$0.00,$17.73,$101.25,$0.00,$50.63,$80.19,$81.00,$0.00,$15.85,$0.00,$16.12,$0.00
421.024,SUP,HCPCS C1713,,421.024  -  PLATE BONE 21MM CRANFCL TI 4 HOLE STR 1.3MM SCR NONSTRL,$139.50,$0.00,$139.50,$62.78,$99.56,$0.00,$24.04,$0.00,$0.00,$24.43,$139.50,$0.00,$69.75,$110.48,$111.60,$0.00,$21.83,$0.00,$22.21,$0.00
421.034,SUP,Custom 27803010,,421.034  -  COVER BUR HOLE 17MM CRANIAL TI 5 HOLE SHNT 1.3MM SCR NONSTRL,$567.00,$0.00,$567.00,$0.00,$404.67,$0.00,$0.00,$0.00,$0.00,$0.00,$567.00,$0.00,$283.50,$449.06,$453.60,$0.00,$0.00,$0.00,$0.00,$0.00
421.04,SUP,HCPCS C1713,,421.040  -  PLATE BONE UNV ORBTL FLR TI 1.3MM SCR NONSTRL,"$2,531.25",$0.00,"$2,531.25","$1,139.06","$1,806.55",$0.00,$436.12,$0.00,$0.00,$443.20,"$2,531.25",$0.00,"$1,265.63","$2,004.75","$2,025.00",$0.00,$396.14,$0.00,$402.98,$0.00
421.043,SUP,HCPCS C1713,,421.043  -  PLATE BONE MED ORBTL FLR TI ANTM 1.3MM SCR NONSTRL,"$2,553.75",$0.00,"$2,553.75","$1,149.19","$1,822.61",$0.00,$440.00,$0.00,$0.00,$447.14,"$2,553.75",$0.00,"$1,276.88","$2,022.57","$2,043.00",$0.00,$399.66,$0.00,$406.56,$0.00
421.044,SUP,HCPCS C1713,,421.044  -  PLATE BONE LEFT MDL WL ORBTL FLR TI 1.3 MM SCR NONSTRL,"$2,531.25",$0.00,"$2,531.25","$1,139.06","$1,806.55",$0.00,$436.12,$0.00,$0.00,$443.20,"$2,531.25",$0.00,"$1,265.63","$2,004.75","$2,025.00",$0.00,$396.14,$0.00,$402.98,$0.00
421.045,SUP,HCPCS C1713,,421.045  -  PLATE BONE RIGHT MDL WL ORBTL FLR TI 1.3 MM SCR NONSTRL,"$2,531.25",$0.00,"$2,531.25","$1,139.06","$1,806.55",$0.00,$436.12,$0.00,$0.00,$443.20,"$2,531.25",$0.00,"$1,265.63","$2,004.75","$2,025.00",$0.00,$396.14,$0.00,$402.98,$0.00
421.048,SUP,HCPCS C1713,,421.048  -  PLATE BN SM .3MM NS ANTM TI ORBT FLR 1.3MM CORT SCR,"$2,553.75",$0.00,"$2,553.75","$1,149.19","$1,822.61",$0.00,$440.00,$0.00,$0.00,$447.14,"$2,553.75",$0.00,"$1,276.88","$2,022.57","$2,043.00",$0.00,$399.66,$0.00,$406.56,$0.00
421.049,SUP,HCPCS C1713,,421.049  -  PLATE BN LG .3MM NS ANTM TI ORBT FLR 1.3MM CORT SCR,"$2,553.75",$0.00,"$2,553.75","$1,149.19","$1,822.61",$0.00,$440.00,$0.00,$0.00,$447.14,"$2,553.75",$0.00,"$1,276.88","$2,022.57","$2,043.00",$0.00,$399.66,$0.00,$406.56,$0.00
421.05,SUP,HCPCS C1713,,421.050  -  PLATE BN 100D 9MM SPC L OB L 20X11X.5MM NS 3 HL BS 3 HL SHFT,$576.00,$0.00,$576.00,$259.20,$411.09,$0.00,$99.24,$0.00,$0.00,$100.85,$576.00,$0.00,$288.00,$456.19,$460.80,$0.00,$90.14,$0.00,$91.70,$0.00
421.051,SUP,HCPCS C1713,,421.051  -  PLATE BN 100D 9MM SPC L OB R 20X11X.5MM NS 3 HL BS 3 HL SHFT,$576.00,$0.00,$576.00,$259.20,$411.09,$0.00,$99.24,$0.00,$0.00,$100.85,$576.00,$0.00,$288.00,$456.19,$460.80,$0.00,$90.14,$0.00,$91.70,$0.00
421.052,SUP,HCPCS C1713,,421.052  -  PLATE BN 100D 5MM SPC L OB L 20X11X.5MM NS 3 HL BS 4 HL SHFT,$576.00,$0.00,$576.00,$259.20,$411.09,$0.00,$99.24,$0.00,$0.00,$100.85,$576.00,$0.00,$288.00,$456.19,$460.80,$0.00,$90.14,$0.00,$91.70,$0.00
421.053,SUP,HCPCS C1713,,421.053  -  PLATE BN 100D 5MM SPC L OB R 20X11X.5MM NS 3 HL BS 4 HL SHFT,$576.00,$0.00,$576.00,$259.20,$411.09,$0.00,$99.24,$0.00,$0.00,$100.85,$576.00,$0.00,$288.00,$456.19,$460.80,$0.00,$90.14,$0.00,$91.70,$0.00
421.061,SUP,HCPCS C1713,,421.061  -  PLATE BN Y 20X10X.5MM NS 5 HL TI CRNFCL 1.3MM CORT SCR,$522.00,$0.00,$522.00,$234.90,$372.55,$0.00,$89.94,$0.00,$0.00,$91.40,$522.00,$0.00,$261.00,$413.42,$417.60,$0.00,$81.69,$0.00,$83.10,$0.00
421.067,SUP,HCPCS C1713,,421.067  -  PLATE BONE 22MM CRANFCL TI 6 HOLE DBL Y 1.3MM SCR NONSTRL,$571.50,$0.00,$571.50,$257.18,$407.88,$0.00,$98.47,$0.00,$0.00,$100.07,$571.50,$0.00,$285.75,$452.63,$457.20,$0.00,$89.44,$0.00,$90.98,$0.00
421.068,SUP,HCPCS C1713,,421.068  -  PLATE BN 6MM SPC 2Y 15X9X.5MM NS 2 HL SHFT 1 HL ARM TI,$571.50,$0.00,$571.50,$257.18,$407.88,$0.00,$98.47,$0.00,$0.00,$100.07,$571.50,$0.00,$285.75,$452.63,$457.20,$0.00,$89.44,$0.00,$90.98,$0.00
421.069,SUP,HCPCS C1713,,421.069  -  PLATE BONE 18MM CRANFCL TI 6 HOLE 2Y 1.3MM SCR NONSTRL,$571.50,$0.00,$571.50,$257.18,$407.88,$0.00,$98.47,$0.00,$0.00,$100.07,$571.50,$0.00,$285.75,$452.63,$457.20,$0.00,$89.44,$0.00,$90.98,$0.00
421.071,SUP,HCPCS C1713,,421.071  -  PLATE BONE CRANFCL TI 7 HOLE T 1.3 MM SCR NONSTRL,$576.00,$0.00,$576.00,$259.20,$411.09,$0.00,$99.24,$0.00,$0.00,$100.85,$576.00,$0.00,$288.00,$456.19,$460.80,$0.00,$90.14,$0.00,$91.70,$0.00
421.072,SUP,HCPCS C1713,,421.072  -  PLATE RIGHT MAXL T 1.3MM SCR BONE TI 14MM NONSTRL,$729.00,$0.00,$729.00,$328.05,$520.29,$0.00,$125.60,$0.00,$0.00,$127.64,$729.00,$0.00,$364.50,$577.37,$583.20,$0.00,$114.09,$0.00,$116.06,$0.00
421.073,SUP,HCPCS C1713,,421.073  -  PLATE LEFT MAXL T 1.3MM SCR BONE TI 14MM NONSTRL,$729.00,$0.00,$729.00,$328.05,$520.29,$0.00,$125.60,$0.00,$0.00,$127.64,$729.00,$0.00,$364.50,$577.37,$583.20,$0.00,$114.09,$0.00,$116.06,$0.00
421.074,SUP,HCPCS C1713,,421.074  -  PLATE RIGHT MAXL T 1.3MM SCR BONE TI 8MM NONSTRL,$729.00,$0.00,$729.00,$328.05,$520.29,$0.00,$125.60,$0.00,$0.00,$127.64,$729.00,$0.00,$364.50,$577.37,$583.20,$0.00,$114.09,$0.00,$116.06,$0.00
421.075,SUP,HCPCS C1713,,421.075  -  PLATE LEFT MAXL T 1.3MM SCR BONE TI 8MM NONSTRL,$729.00,$0.00,$729.00,$328.05,$520.29,$0.00,$125.60,$0.00,$0.00,$127.64,$729.00,$0.00,$364.50,$577.37,$583.20,$0.00,$114.09,$0.00,$116.06,$0.00
421.076,SUP,HCPCS C1713,,421.076  -  PLATE RIGHT MAXL T 1.3MM SCR BONE TI 10MM NONSTRL,$729.00,$0.00,$729.00,$328.05,$520.29,$0.00,$125.60,$0.00,$0.00,$127.64,$729.00,$0.00,$364.50,$577.37,$583.20,$0.00,$114.09,$0.00,$116.06,$0.00
421.077,SUP,HCPCS C1713,,421.077  -  PLATE LEFT MAXL T 1.3MM SCR BONE TI 10MM NONSTRL,$729.00,$0.00,$729.00,$328.05,$520.29,$0.00,$125.60,$0.00,$0.00,$127.64,$729.00,$0.00,$364.50,$577.37,$583.20,$0.00,$114.09,$0.00,$116.06,$0.00
421.078,SUP,HCPCS C1713,,421.078  -  PLATE RIGHT MAXL T 1.3MM SCR BONE TI 12MM NONSTRL,$729.00,$0.00,$729.00,$328.05,$520.29,$0.00,$125.60,$0.00,$0.00,$127.64,$729.00,$0.00,$364.50,$577.37,$583.20,$0.00,$114.09,$0.00,$116.06,$0.00
421.079,SUP,HCPCS C1713,,421.079  -  PLATE LEFT MAXL T 1.3MM SCR BONE TI 12MM NONSTRL,$729.00,$0.00,$729.00,$328.05,$520.29,$0.00,$125.60,$0.00,$0.00,$127.64,$729.00,$0.00,$364.50,$577.37,$583.20,$0.00,$114.09,$0.00,$116.06,$0.00
421.08,SUP,HCPCS C1713,,421.080  -  PLATE BN T 43X8X.5MM NS 2X9 HL STRUT TI CRNFCL 1.3MM CORT,"$1,190.25",$0.00,"$1,190.25",$535.61,$849.48,$0.00,$205.07,$0.00,$0.00,$208.40,"$1,190.25",$0.00,$595.13,$942.68,$952.20,$0.00,$186.27,$0.00,$189.49,$0.00
421.081,SUP,HCPCS C1713,,421.081  -  PLATE BONE CRANFCL TI 4 HOLE X 1.3 MM SCR NONSTRL,$522.00,$0.00,$522.00,$234.90,$372.55,$0.00,$89.94,$0.00,$0.00,$91.40,$522.00,$0.00,$261.00,$413.42,$417.60,$0.00,$81.69,$0.00,$83.10,$0.00
421.082,SUP,HCPCS C1713,,421.082  -  PLATE MAXL T STR 1.3MM SCR BONE TI 8MM NONSTRL,$729.00,$0.00,$729.00,$328.05,$520.29,$0.00,$125.60,$0.00,$0.00,$127.64,$729.00,$0.00,$364.50,$577.37,$583.20,$0.00,$114.09,$0.00,$116.06,$0.00
421.083,SUP,HCPCS C1713,,421.083  -  PLATE MAXL T STR 1.3MM SCR BONE TI 10MM NONSTRL,$729.00,$0.00,$729.00,$328.05,$520.29,$0.00,$125.60,$0.00,$0.00,$127.64,$729.00,$0.00,$364.50,$577.37,$583.20,$0.00,$114.09,$0.00,$116.06,$0.00
421.084,SUP,HCPCS C1713,,421.084  -  PLATE MAXL T STR 1.3MM SCR BONE TI 12MM NONSTRL,$729.00,$0.00,$729.00,$328.05,$520.29,$0.00,$125.60,$0.00,$0.00,$127.64,$729.00,$0.00,$364.50,$577.37,$583.20,$0.00,$114.09,$0.00,$116.06,$0.00
421.085,SUP,HCPCS C1713,,421.085  -  PLATE BONE CRANFCL TI 11 HOLE H 1.3 MM SCR NONSTRL,$609.75,$0.00,$609.75,$274.39,$435.18,$0.00,$105.06,$0.00,$0.00,$106.76,$609.75,$0.00,$304.88,$482.92,$487.80,$0.00,$95.43,$0.00,$97.07,$0.00
421.086,SUP,HCPCS C1713,,421.086  -  PLATE MAXL T STR 1.3MM SCR BONE TI 14MM NONSTRL,$729.00,$0.00,$729.00,$328.05,$520.29,$0.00,$125.60,$0.00,$0.00,$127.64,$729.00,$0.00,$364.50,$577.37,$583.20,$0.00,$114.09,$0.00,$116.06,$0.00
421.09,SUP,Custom 27803010,,421.090  -  COVER BUR HOLE 12MM CRANFCL TI 6 HOLE 1.3MM SCR NONSTRL,$632.25,$0.00,$632.25,$0.00,$451.24,$0.00,$0.00,$0.00,$0.00,$0.00,$632.25,$0.00,$316.13,$500.74,$505.80,$0.00,$0.00,$0.00,$0.00,$0.00
421.091,SUP,Custom 27803010,,421.091  -  COVER BUR HOLE 17MM CRANFCL TI 6 HOLE 1.3MM SCR NONSTRL,$632.25,$0.00,$632.25,$0.00,$451.24,$0.00,$0.00,$0.00,$0.00,$0.00,$632.25,$0.00,$316.13,$500.74,$505.80,$0.00,$0.00,$0.00,$0.00,$0.00
421.092,SUP,Custom 27803010,,421.092  -  COVER BUR HOLE 15MM CRANFCL TI 6 HOLE 1.3MM SCR NONSTRL,$567.00,$0.00,$567.00,$0.00,$404.67,$0.00,$0.00,$0.00,$0.00,$0.00,$567.00,$0.00,$283.50,$449.06,$453.60,$0.00,$0.00,$0.00,$0.00,$0.00
421.093,SUP,Custom 27803010,,421.093  -  COVER BUR HOLE 24MM CRANFCL TI 6 HOLE 1.3MM SCR NONSTRL,$567.00,$0.00,$567.00,$0.00,$404.67,$0.00,$0.00,$0.00,$0.00,$0.00,$567.00,$0.00,$283.50,$449.06,$453.60,$0.00,$0.00,$0.00,$0.00,$0.00
421.095,SUP,HCPCS C1713,,421.095  -  PLATE BN BX 13X8MM NS 4 HL TI CRNFCL 1.3MM SCR,$510.75,$0.00,$510.75,$229.84,$364.52,$0.00,$88.00,$0.00,$0.00,$89.43,$510.75,$0.00,$255.38,$404.51,$408.60,$0.00,$79.93,$0.00,$81.31,$0.00
421.096,SUP,HCPCS C1713,,421.096  -  PLATE BONE 13X13MM CRANFCL TI 4 HOLE BOX 1.3MM SCR NONSTRL,$510.75,$0.00,$510.75,$229.84,$364.52,$0.00,$88.00,$0.00,$0.00,$89.43,$510.75,$0.00,$255.38,$404.51,$408.60,$0.00,$79.93,$0.00,$81.31,$0.00
421.099,SUP,HCPCS C1713,,421.099  -  PLATE BONE 100X100MM CRANFCL TI MESH SCRN 1.3MM SCR NONSTRL,"$2,819.25",$0.00,"$2,819.25","$1,268.66","$2,012.10",$0.00,$485.74,$0.00,$0.00,$493.63,"$2,819.25",$0.00,"$1,409.63","$2,232.85","$2,255.40",$0.00,$441.21,$0.00,$448.82,$0.00
421.302,SUP,HCPCS C1713,,421.302  -  PLATE BONE .2MM ORBTL FLR TI MESH 1.3MM SCR NONSTRL,"$2,668.50",$0.00,"$2,668.50","$1,200.83","$1,904.51",$0.00,$459.77,$0.00,$0.00,$467.23,"$2,668.50",$0.00,"$1,334.25","$2,113.45","$2,134.80",$0.00,$417.62,$0.00,$424.83,$0.00
421.303,SUP,HCPCS C1713,,421.303  -  PLATE BONE .3MM ORBTL FLR TI MESH 1.3MM SCR NONSTRL,"$2,668.50",$0.00,"$2,668.50","$1,200.83","$1,904.51",$0.00,$459.77,$0.00,$0.00,$467.23,"$2,668.50",$0.00,"$1,334.25","$2,113.45","$2,134.80",$0.00,$417.62,$0.00,$424.83,$0.00
421.304,SUP,HCPCS C1713,,421.304  -  PLATE BN .4MM AU NS 3 ROW SCR HL MESH MLBL TI ORBT 1.3MM SCR,"$2,668.50",$0.00,"$2,668.50","$1,200.83","$1,904.51",$0.00,$459.77,$0.00,$0.00,$467.23,"$2,668.50",$0.00,"$1,334.25","$2,113.45","$2,134.80",$0.00,$417.62,$0.00,$424.83,$0.00
421.306,SUP,HCPCS C1713,,421.306  -  PLATE BN STRG 23MM NS 6 HL LOPRFL PRECONTOUR RECON TI HND,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
421.312,SUP,HCPCS C1713,,421.312  -  PLATE BN STRG 47MM NS 12 HL LOPRFL PRECONTOUR RECON TI HND,$451.73,$0.00,$451.73,$203.28,$322.40,$0.00,$75.56,$0.00,$0.00,$79.09,$451.73,$0.00,$225.86,$357.77,$361.38,$0.00,$68.64,$0.00,$71.91,$0.00
421.32,SUP,HCPCS C1713,,421.320  -  PLATE BONE H 19MMX.5MM 8 HOLE EXTENDED TITANIUM RIGHT HAND,$431.25,$0.00,$431.25,$194.06,$307.78,$0.00,$72.14,$0.00,$0.00,$75.51,$431.25,$0.00,$215.63,$341.55,$345.00,$0.00,$65.53,$0.00,$68.66,$0.00
421.321,SUP,HCPCS C1713,,421.321  -  PLATE BONE H 8 HOLE EXTEND PRECONTOUR LP TITANIUM HAND LEFT,$431.25,$0.00,$431.25,$194.06,$307.78,$0.00,$72.14,$0.00,$0.00,$75.51,$431.25,$0.00,$215.63,$341.55,$345.00,$0.00,$65.53,$0.00,$68.66,$0.00
421.333,SUP,HCPCS C1713,,421.333  -  PLATE BONE T 32MM 3X8 HOLE PRECONTOUR LP TITANIUM HAND,$413.53,$0.00,$413.53,$186.09,$295.13,$0.00,$69.17,$0.00,$0.00,$72.40,$413.53,$0.00,$206.76,$327.52,$330.82,$0.00,$62.83,$0.00,$65.83,$0.00
421.334,SUP,HCPCS C1713,,421.334  -  PLATE BONE T 32MM 4X8 HOLE PRECONTOUR LP TITANIUM HAND,$431.25,$0.00,$431.25,$194.06,$307.78,$0.00,$72.14,$0.00,$0.00,$75.51,$431.25,$0.00,$215.63,$341.55,$345.00,$0.00,$65.53,$0.00,$68.66,$0.00
421.335,SUP,HCPCS C1713,,421.335  -  PLATE BONE Y 3X8 HOLE PRECONTOUR LP TITANIUM HAND NONSTRL,$413.53,$0.00,$413.53,$186.09,$295.13,$0.00,$69.17,$0.00,$0.00,$72.40,$413.53,$0.00,$206.76,$327.52,$330.82,$0.00,$62.83,$0.00,$65.83,$0.00
421.5,SUP,HCPCS C1713,,421.500  -  PLATE BONE MED TMPR TI CONTUR MESH MALBLE LP NONSTRL,"$2,083.50",$0.00,"$2,083.50",$937.58,"$1,486.99",$0.00,$358.98,$0.00,$0.00,$364.80,"$2,083.50",$0.00,"$1,041.75","$1,650.13","$1,666.80",$0.00,$326.07,$0.00,$331.69,$0.00
421.501,SUP,HCPCS C1713,,421.501  -  PLATE BONE CRANFCL TI 8 HOLE MALBLE CONTUR MESH LP NONSTRL,"$1,572.75",$0.00,"$1,572.75",$707.74,"$1,122.47",$0.00,$270.98,$0.00,$0.00,$275.38,"$1,572.75",$0.00,$786.38,"$1,245.62","$1,258.20",$0.00,$246.14,$0.00,$250.38,$0.00
421.502,SUP,HCPCS C1713,,421.502  -  PLATE BONE CRANFCL TI 2 HOLE STR LP NONSTRL,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
421.503,SUP,HCPCS C1713,,421.503  -  PLATE BONE 9MM CRANFCL TI 2 HOLE STR LP NONSTRL,$124.88,$0.00,$124.88,$56.19,$89.12,$0.00,$21.52,$0.00,$0.00,$21.86,$124.88,$0.00,$62.44,$98.90,$99.90,$0.00,$19.54,$0.00,$19.88,$0.00
421.504,SUP,HCPCS C1713,,421.504  -  PLATE BONE CRANFCL TI 4 HOLE STR LP NONSTRL,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
421.505,SUP,HCPCS C1713,,421.505  -  PLATE BONE ORBTL RIM TI 12 HOLE CVD LP NONSTRL,$783.00,$0.00,$783.00,$352.35,$558.83,$0.00,$134.91,$0.00,$0.00,$137.10,$783.00,$0.00,$391.50,$620.14,$626.40,$0.00,$122.54,$0.00,$124.65,$0.00
421.506,SUP,HCPCS C1713,,421.506  -  PLATE BONE CRANFCL TI 2X3 HOLE L RIGHT OBLQ LP NONSTRL,$654.75,$0.00,$654.75,$294.64,$467.30,$0.00,$112.81,$0.00,$0.00,$114.64,$654.75,$0.00,$327.38,$518.56,$523.80,$0.00,$102.47,$0.00,$104.24,$0.00
421.507,SUP,HCPCS C1713,,421.507  -  PLATE BONE CRANFCL TI 2X3 HOLE L LEFT OBLQ LP NONSTRL,$654.75,$0.00,$654.75,$294.64,$467.30,$0.00,$112.81,$0.00,$0.00,$114.64,$654.75,$0.00,$327.38,$518.56,$523.80,$0.00,$102.47,$0.00,$104.24,$0.00
421.508,SUP,HCPCS C1713,,421.508  -  PLATE BONE CRANFCL TI 3X4 HOLE L RIGHT OBLQ LP NONSTRL,$654.75,$0.00,$654.75,$294.64,$467.30,$0.00,$112.81,$0.00,$0.00,$114.64,$654.75,$0.00,$327.38,$518.56,$523.80,$0.00,$102.47,$0.00,$104.24,$0.00
421.509,SUP,HCPCS C1713,,421.509  -  PLATE BONE CRANFCL TI 3X4 HOLE L LEFT OBLQ LP NONSTRL,$654.75,$0.00,$654.75,$294.64,$467.30,$0.00,$112.81,$0.00,$0.00,$114.64,$654.75,$0.00,$327.38,$518.56,$523.80,$0.00,$102.47,$0.00,$104.24,$0.00
421.51,SUP,HCPCS C1713,,421.510  -  PLATE BN X .5MM NS 4 HL LOPRFL TI CRNMXF NEURO SYS,$636.75,$0.00,$636.75,$286.54,$454.45,$0.00,$109.71,$0.00,$0.00,$111.49,$636.75,$0.00,$318.38,$504.31,$509.40,$0.00,$99.65,$0.00,$101.37,$0.00
421.511,SUP,HCPCS C1713,,421.511  -  PLATE BONE 14X14MM CRANFCL TI 4 HOLE BOX LP NONSTRL,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
421.512,SUP,HCPCS C1713,,421.512  -  PLATE BONE 16X16MM CRANFCL TI 4 HOLE BOX LP NONSTRL,$636.75,$0.00,$636.75,$286.54,$454.45,$0.00,$109.71,$0.00,$0.00,$111.49,$636.75,$0.00,$318.38,$504.31,$509.40,$0.00,$99.65,$0.00,$101.37,$0.00
421.515,SUP,HCPCS C1713,,421.515  -  PLATE BONE 15MM CRANFCL TI 5 HOLE Y LP NONSTRL,$636.75,$0.00,$636.75,$286.54,$454.45,$0.00,$109.71,$0.00,$0.00,$111.49,$636.75,$0.00,$318.38,$504.31,$509.40,$0.00,$99.65,$0.00,$101.37,$0.00
421.516,SUP,HCPCS C1713,,421.516  -  PLATE BONE 18MM CRANFCL TI 6 HOLE 2Y LP NONSTRL,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
421.517,SUP,HCPCS C1713,,421.517  -  PLATE BONE 21MM TI 6 HOLE DBL Y LP,$636.75,$0.00,$636.75,$286.54,$454.45,$0.00,$109.71,$0.00,$0.00,$111.49,$636.75,$0.00,$318.38,$504.31,$509.40,$0.00,$99.65,$0.00,$101.37,$0.00
421.518,SUP,HCPCS C1713,,421.518  -  PLATE BN .5MM NS 5 HL LOPRFL ADP TI CRNMXF NEURO SYS,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
421.519,SUP,HCPCS C1713,,421.519  -  PLATE BN .5MM NS 7 HL LOPRFL ADP TI CRNMXF NEURO SYS,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
421.52,SUP,HCPCS C1713,,421.520  -  PLATE BN .5MM NS 20 HL LOPRFL ADP TI CRNMXF NEURO SYS,"$1,413.00",$0.00,"$1,413.00",$635.85,"$1,008.46",$0.00,$243.45,$0.00,$0.00,$247.40,"$1,413.00",$0.00,$706.50,"$1,119.10","$1,130.40",$0.00,$221.13,$0.00,$224.95,$0.00
421.521,SUP,HCPCS C1713,,421.521  -  PLATE BONE 16X10MM CRANFCL TI 4 HOLE BOX LP NONSTRL,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
421.522,SUP,HCPCS C1713,,421.522  -  PLATE BN .5MM NS 6 HL LOPRFL STRUT TI CRNMXF NEURO SYS,"$1,109.25",$0.00,"$1,109.25",$499.16,$791.67,$0.00,$191.12,$0.00,$0.00,$194.22,"$1,109.25",$0.00,$554.63,$878.53,$887.40,$0.00,$173.60,$0.00,$176.59,$0.00
421.523,SUP,HCPCS C1713,,421.523  -  PLATE BN .5MM NS 8 HL LOPRFL STRUT TI CRNMXF NEURO SYS,"$1,572.75",$0.00,"$1,572.75",$707.74,"$1,122.47",$0.00,$270.98,$0.00,$0.00,$275.38,"$1,572.75",$0.00,$786.38,"$1,245.62","$1,258.20",$0.00,$246.14,$0.00,$250.38,$0.00
421.525,SUP,Custom 27803010,,421.525  -  COVER BUR HOLE 12MM CRANFCL TI LP NONSTRL,$1.00,$0.00,$1.00,$0.00,$0.71,$0.00,$0.00,$0.00,$0.00,$0.00,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.00,$0.00,$0.00,$0.00
421.526,SUP,Custom 27803010,,421.526  -  COVER BUR HOLE 15MM CRANFCL TI LP NONSTRL,$661.50,$0.00,$661.50,$0.00,$472.11,$0.00,$0.00,$0.00,$0.00,$0.00,$661.50,$0.00,$330.75,$523.91,$529.20,$0.00,$0.00,$0.00,$0.00,$0.00
421.527,SUP,Custom 27803010,,421.527  -  COVER BUR HOLE 17MM CRANFCL TI LP NONSTRL,$1.00,$0.00,$1.00,$0.00,$0.71,$0.00,$0.00,$0.00,$0.00,$0.00,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.00,$0.00,$0.00,$0.00
421.528,SUP,Custom 27803010,,421.528  -  COVER BUR HOLE 24MM CRANFCL TI LP NONSTRL,$661.50,$0.00,$661.50,$0.00,$472.11,$0.00,$0.00,$0.00,$0.00,$0.00,$661.50,$0.00,$330.75,$523.91,$529.20,$0.00,$0.00,$0.00,$0.00,$0.00
421.531,SUP,HCPCS C1713,,421.531  -  PLATE BONE 45X38MM CRANFCL TI CONTUR MESH MALBLE LP NONSTRL,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
421.532,SUP,HCPCS C1713,,421.532  -  PLATE THK.6MM 45X38MM TI CONTUR MESH RGD BONE NONSTRL SLVR,"$3,620.25",$0.00,"$3,620.25","$1,629.11","$2,583.77",$0.00,$623.75,$0.00,$0.00,$633.88,"$3,620.25",$0.00,"$1,810.13","$2,867.24","$2,896.20",$0.00,$566.57,$0.00,$576.34,$0.00
421.533,SUP,HCPCS C1713,,421.533  -  PLATE BONE 100X100MM CRANFCL TI CONTUR MESH MALBLE LP,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
421.534,SUP,HCPCS C1713,,421.534  -  PLATE BONE 100X100MM CRANFCL TI CONTUR MESH RGD LP NONSTRL,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
421.535,SUP,HCPCS C1713,,421.535  -  PLATE BONE 200X200MM CRANFCL TI CONTUR MESH RGD LP NONSTRL,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
421.536,SUP,HCPCS C1713,,421.536  -  PLATE BONE CRANFCL TI CONTUR MESH MALBLE LP SM ARC NONSTRL,"$2,083.50",$0.00,"$2,083.50",$937.58,"$1,486.99",$0.00,$358.98,$0.00,$0.00,$364.80,"$2,083.50",$0.00,"$1,041.75","$1,650.13","$1,666.80",$0.00,$326.07,$0.00,$331.69,$0.00
421.537,SUP,HCPCS C1713,,421.537  -  PLATE BONE CRANFCL TI CONTUR MESH MALBLE LP LG ARC NONSTRL,"$3,244.50",$0.00,"$3,244.50","$1,460.03","$2,315.60",$0.00,$559.01,$0.00,$0.00,$568.09,"$3,244.50",$0.00,"$1,622.25","$2,569.64","$2,595.60",$0.00,$507.76,$0.00,$516.52,$0.00
421.538,SUP,HCPCS C1713,,421.538  -  PLATE BONE CRANFCL TI CONTUR MESH RGD LP SM ARC NONSTRL,"$2,083.50",$0.00,"$2,083.50",$937.58,"$1,486.99",$0.00,$358.98,$0.00,$0.00,$364.80,"$2,083.50",$0.00,"$1,041.75","$1,650.13","$1,666.80",$0.00,$326.07,$0.00,$331.69,$0.00
421.539,SUP,HCPCS C1713,,421.539  -  PLATE BONE CRANFCL TI CONTUR MESH RGD LP LG ARC NONSTRL,"$3,244.50",$0.00,"$3,244.50","$1,460.03","$2,315.60",$0.00,$559.01,$0.00,$0.00,$568.09,"$3,244.50",$0.00,"$1,622.25","$2,569.64","$2,595.60",$0.00,$507.76,$0.00,$516.52,$0.00
421.54,SUP,HCPCS C1713,,421.540  -  PLATE BONE 30MM CRANFCL TI CONTUR MESH MALBLE LP NONSTRL,"$2,083.50",$0.00,"$2,083.50",$937.58,"$1,486.99",$0.00,$358.98,$0.00,$0.00,$364.80,"$2,083.50",$0.00,"$1,041.75","$1,650.13","$1,666.80",$0.00,$326.07,$0.00,$331.69,$0.00
421.541,SUP,HCPCS C1713,,421.541  -  PLATE BONE 70MM CRANFCL TI CONTUR MESH MALBLE LP NONSTRL,"$4,311.00",$0.00,"$4,311.00","$1,939.95","$3,076.76",$0.00,$742.76,$0.00,$0.00,$754.82,"$4,311.00",$0.00,"$2,155.50","$3,414.31","$3,448.80",$0.00,$674.67,$0.00,$686.31,$0.00
421.542,SUP,HCPCS C1713,,421.542  -  PLATE BONE 100MM CRANFCL TI CONTUR MESH MALBLE LP NONSTRL,"$5,373.00",$0.00,"$5,373.00","$2,417.85","$3,834.71",$0.00,$925.74,$0.00,$0.00,$940.77,"$5,373.00",$0.00,"$2,686.50","$4,255.42","$4,298.40",$0.00,$840.87,$0.00,$855.38,$0.00
421.543,SUP,HCPCS C1713,,421.543  -  PLATE TI LP CONTUR MESH RGD BONE 30MM NEURO NONSTRL,"$2,083.50",$0.00,"$2,083.50",$937.58,"$1,486.99",$0.00,$358.98,$0.00,$0.00,$364.80,"$2,083.50",$0.00,"$1,041.75","$1,650.13","$1,666.80",$0.00,$326.07,$0.00,$331.69,$0.00
421.544,SUP,HCPCS C1713,,421.544  -  PLATE BONE 70MM CRANFCL TI CONTUR MESH RGD LP NONSTRL,"$4,311.00",$0.00,"$4,311.00","$1,939.95","$3,076.76",$0.00,$742.76,$0.00,$0.00,$754.82,"$4,311.00",$0.00,"$2,155.50","$3,414.31","$3,448.80",$0.00,$674.67,$0.00,$686.31,$0.00
421.545,SUP,HCPCS C1713,,421.545  -  PLATE BONE 100MM TI CONTUR MESH MALBLE LP RND,"$5,373.00",$0.00,"$5,373.00","$2,417.85","$3,834.71",$0.00,$925.74,$0.00,$0.00,$940.77,"$5,373.00",$0.00,"$2,686.50","$4,255.42","$4,298.40",$0.00,$840.87,$0.00,$855.38,$0.00
421.546,SUP,HCPCS C1713,,421.546  -  PLATE BN THK.4MM LG BLU NS CNTR MESH LOPRFL TI CRNL MSTD,"$2,522.25",$0.00,"$2,522.25","$1,135.01","$1,800.13",$0.00,$434.57,$0.00,$0.00,$441.63,"$2,522.25",$0.00,"$1,261.13","$1,997.62","$2,017.80",$0.00,$394.73,$0.00,$401.54,$0.00
421.547,SUP,HCPCS C1713,,421.547  -  PLATE MED .4MM MSTD CONTUR MESH MALBLE LP BONE TI,"$2,054.25",$0.00,"$2,054.25",$924.41,"$1,466.12",$0.00,$353.94,$0.00,$0.00,$359.68,"$2,054.25",$0.00,"$1,027.13","$1,626.97","$1,643.40",$0.00,$321.49,$0.00,$327.04,$0.00
421.553,SUP,Custom 27803010,,421.553  -  COVER BUR HOLE 15MM TI SHNT NEURO LP NONSTRL,$661.50,$0.00,$661.50,$0.00,$472.11,$0.00,$0.00,$0.00,$0.00,$0.00,$661.50,$0.00,$330.75,$523.91,$529.20,$0.00,$0.00,$0.00,$0.00,$0.00
421.554,SUP,Custom 27803010,,421.554  -  COVER BUR HOLE 17MM CRANFCL TI LP SHNT NONSTRL,$661.50,$0.00,$661.50,$0.00,$472.11,$0.00,$0.00,$0.00,$0.00,$0.00,$661.50,$0.00,$330.75,$523.91,$529.20,$0.00,$0.00,$0.00,$0.00,$0.00
422.02,SUP,HCPCS C1713,,422.02  -  PLATE BONE 39X12X1MM 2 HOLE SEMITUBULAR LC-DCP TITANIUM,$125.55,$0.00,$125.55,$56.50,$89.61,$0.00,$21.00,$0.00,$0.00,$21.98,$125.55,$0.00,$62.78,$99.44,$100.44,$0.00,$19.08,$0.00,$19.99,$0.00
422.03,SUP,HCPCS C1713,,422.03  -  PLATE BONE 55X12X1MM 3 HOLE SEMITUBULAR LC-DCP TITANIUM,$133.75,$0.00,$133.75,$60.19,$95.46,$0.00,$22.37,$0.00,$0.00,$23.42,$133.75,$0.00,$66.88,$105.93,$107.00,$0.00,$20.32,$0.00,$21.29,$0.00
422.04,SUP,HCPCS C1713,,422.04  -  PLATE BONE 71X12X1MM 4 HOLE SEMITUBULAR LC-DCP TITANIUM,$144.68,$0.00,$144.68,$65.10,$103.25,$0.00,$24.20,$0.00,$0.00,$25.33,$144.68,$0.00,$72.34,$114.59,$115.74,$0.00,$21.98,$0.00,$23.03,$0.00
422.05,SUP,HCPCS C1713,,422.05  -  PLATE BONE 87X12X1MM 5 HOLE SEMITUBULAR LC-DCP TITANIUM,$152.85,$0.00,$152.85,$68.78,$109.09,$0.00,$25.57,$0.00,$0.00,$26.76,$152.85,$0.00,$76.43,$121.06,$122.28,$0.00,$23.22,$0.00,$24.33,$0.00
422.06,SUP,HCPCS C1713,,422.06  -  PLATE BONE 103X12X1MM 6 HOLE SEMITUBULAR LC-DCP TITANIUM,$162.40,$0.00,$162.40,$73.08,$115.90,$0.00,$27.17,$0.00,$0.00,$28.43,$162.40,$0.00,$81.20,$128.62,$129.92,$0.00,$24.68,$0.00,$25.85,$0.00
422.07,SUP,HCPCS C1713,,422.07  -  PLATE BONE 119X12X1MM 7 HOLE SEMITUBULAR LC-DCP TITANIUM,$169.23,$0.00,$169.23,$76.15,$120.78,$0.00,$28.31,$0.00,$0.00,$29.63,$169.23,$0.00,$84.61,$134.03,$135.38,$0.00,$25.71,$0.00,$26.94,$0.00
422.08,SUP,HCPCS C1713,,422.08  -  PLATE BONE 135X12X1MM 8 HOLE SEMITUBULAR LC-DCP TITANIUM,$184.25,$0.00,$184.25,$82.91,$131.50,$0.00,$30.82,$0.00,$0.00,$32.26,$184.25,$0.00,$92.13,$145.93,$147.40,$0.00,$27.99,$0.00,$29.33,$0.00
422.09,SUP,HCPCS C1713,,422.09  -  PLATE BONE 151X12X1MM 9 HOLE SEMITUBULAR LC-DCP TITANIUM,$206.08,$0.00,$206.08,$92.73,$147.08,$0.00,$34.47,$0.00,$0.00,$36.08,$206.08,$0.00,$103.04,$163.22,$164.86,$0.00,$31.31,$0.00,$32.81,$0.00
422.1,SUP,HCPCS C1713,,422.10  -  PLATE BONE 167X12X1MM 10 HOLE SEMITUBULAR LC-DCP TITANIUM,$207.45,$0.00,$207.45,$93.35,$148.06,$0.00,$34.70,$0.00,$0.00,$36.32,$207.45,$0.00,$103.73,$164.30,$165.96,$0.00,$31.52,$0.00,$33.03,$0.00
422.11,SUP,HCPCS C1713,,422.11  -  PLATE BONE 183X12X1MM 11 HOLE SEMITUBULAR LC-DCP TITANIUM,$222.45,$0.00,$222.45,$100.10,$158.76,$0.00,$37.21,$0.00,$0.00,$38.95,$222.45,$0.00,$111.23,$176.18,$177.96,$0.00,$33.80,$0.00,$35.41,$0.00
422.12,SUP,HCPCS C1713,,422.12  -  PLATE BONE LARGE 183MM 12 HOLE SEMITUBULAR LC-DCP TITANIUM,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
422.22,SUP,HCPCS C1713,,422.220  -  PLATE BONE 140MM 5 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL,"$2,913.75",$0.00,"$2,913.75","$1,311.19","$2,079.54",$0.00,$487.40,$0.00,$0.00,$510.17,"$2,913.75",$0.00,"$1,456.88","$2,307.69","$2,331.00",$0.00,$442.72,$0.00,$463.87,$0.00
422.221,SUP,HCPCS C1713,,422.221  -  PLATE BONE 140MM 5 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL,"$2,913.75",$0.00,"$2,913.75","$1,311.19","$2,079.54",$0.00,$487.40,$0.00,$0.00,$510.17,"$2,913.75",$0.00,"$1,456.88","$2,307.69","$2,331.00",$0.00,$442.72,$0.00,$463.87,$0.00
422.222,SUP,HCPCS C1713,,422.222  -  PLATE BONE 180MM 7 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL,"$2,972.43",$0.00,"$2,972.43","$1,337.59","$2,121.42",$0.00,$497.22,$0.00,$0.00,$520.45,"$2,972.43",$0.00,"$1,486.21","$2,354.16","$2,377.94",$0.00,$451.64,$0.00,$473.21,$0.00
422.223,SUP,HCPCS C1713,,422.223  -  PLATE BONE 180MM 7 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL,"$2,972.43",$0.00,"$2,972.43","$1,337.59","$2,121.42",$0.00,$497.22,$0.00,$0.00,$520.45,"$2,972.43",$0.00,"$1,486.21","$2,354.16","$2,377.94",$0.00,$451.64,$0.00,$473.21,$0.00
422.224,SUP,HCPCS C1713,,422.224  -  PLATE BONE 220MM 9 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL,"$3,033.85",$0.00,"$3,033.85","$1,365.23","$2,165.26",$0.00,$507.49,$0.00,$0.00,$531.20,"$3,033.85",$0.00,"$1,516.93","$2,402.81","$2,427.08",$0.00,$460.97,$0.00,$482.99,$0.00
422.225,SUP,HCPCS C1713,,422.225  -  PLATE BONE 220MM 9 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL,"$3,033.85",$0.00,"$3,033.85","$1,365.23","$2,165.26",$0.00,$507.49,$0.00,$0.00,$531.20,"$3,033.85",$0.00,"$1,516.93","$2,402.81","$2,427.08",$0.00,$460.97,$0.00,$482.99,$0.00
422.226,SUP,HCPCS C1713,,422.226  -  PLATE BONE 260MM 11 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL,"$3,092.53",$0.00,"$3,092.53","$1,391.64","$2,207.14",$0.00,$517.31,$0.00,$0.00,$541.48,"$3,092.53",$0.00,"$1,546.26","$2,449.28","$2,474.02",$0.00,$469.88,$0.00,$492.33,$0.00
422.227,SUP,HCPCS C1713,,422.227  -  PLATE BONE 260MM 11 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL,"$3,092.53",$0.00,"$3,092.53","$1,391.64","$2,207.14",$0.00,$517.31,$0.00,$0.00,$541.48,"$3,092.53",$0.00,"$1,546.26","$2,449.28","$2,474.02",$0.00,$469.88,$0.00,$492.33,$0.00
422.228,SUP,HCPCS C1713,,422.228  -  PLATE BONE 300MM 13 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL,"$3,153.93",$0.00,"$3,153.93","$1,419.27","$2,250.96",$0.00,$527.58,$0.00,$0.00,$552.23,"$3,153.93",$0.00,"$1,576.96","$2,497.91","$2,523.14",$0.00,$479.21,$0.00,$502.10,$0.00
422.229,SUP,HCPCS C1713,,422.229  -  PLATE BONE 300MM 13 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL,"$3,153.93",$0.00,"$3,153.93","$1,419.27","$2,250.96",$0.00,$527.58,$0.00,$0.00,$552.23,"$3,153.93",$0.00,"$1,576.96","$2,497.91","$2,523.14",$0.00,$479.21,$0.00,$502.10,$0.00
422.25,SUP,HCPCS C1713,,422.250  -  PLATE BONE 156MM 5 HOLE LCP TITANIUM FEMUR RIGHT DISTAL,"$2,763.63",$0.00,"$2,763.63","$1,243.63","$1,972.40",$0.00,$462.29,$0.00,$0.00,$483.89,"$2,763.63",$0.00,"$1,381.81","$2,188.79","$2,210.90",$0.00,$419.91,$0.00,$439.97,$0.00
422.251,SUP,HCPCS C1713,,422.251  -  PLATE BONE 156MM 5 HOLE LCP TITANIUM FEMUR LEFT DISTAL,"$2,763.63",$0.00,"$2,763.63","$1,243.63","$1,972.40",$0.00,$462.29,$0.00,$0.00,$483.89,"$2,763.63",$0.00,"$1,381.81","$2,188.79","$2,210.90",$0.00,$419.91,$0.00,$439.97,$0.00
422.252,SUP,HCPCS C1713,,422.252  -  PLATE BONE 196MM 7 HOLE LCP TITANIUM FEMUR RIGHT DISTAL,"$2,819.58",$0.00,"$2,819.58","$1,268.81","$2,012.33",$0.00,$471.65,$0.00,$0.00,$493.69,"$2,819.58",$0.00,"$1,409.79","$2,233.11","$2,255.66",$0.00,$428.41,$0.00,$448.88,$0.00
422.253,SUP,HCPCS C1713,,422.253  -  PLATE BONE 196MM 7 HOLE LCP TITANIUM FEMUR LEFT DISTAL,"$2,819.58",$0.00,"$2,819.58","$1,268.81","$2,012.33",$0.00,$471.65,$0.00,$0.00,$493.69,"$2,819.58",$0.00,"$1,409.79","$2,233.11","$2,255.66",$0.00,$428.41,$0.00,$448.88,$0.00
422.254,SUP,HCPCS C1713,,422.254  -  PLATE BONE 236MM 9 HOLE LCP TITANIUM FEMUR RIGHT DISTAL,"$2,878.25",$0.00,"$2,878.25","$1,295.21","$2,054.21",$0.00,$481.47,$0.00,$0.00,$503.96,"$2,878.25",$0.00,"$1,439.13","$2,279.57","$2,302.60",$0.00,$437.33,$0.00,$458.22,$0.00
422.255,SUP,HCPCS C1713,,422.255  -  PLATE BONE 236MM 9 HOLE LCP TITANIUM FEMUR LEFT DISTAL,"$2,878.25",$0.00,"$2,878.25","$1,295.21","$2,054.21",$0.00,$481.47,$0.00,$0.00,$503.96,"$2,878.25",$0.00,"$1,439.13","$2,279.57","$2,302.60",$0.00,$437.33,$0.00,$458.22,$0.00
422.256,SUP,HCPCS C1713,,422.256  -  PLATE BONE 276MM 11 HOLE LCP TITANIUM FEMUR RIGHT DISTAL,"$2,934.23",$0.00,"$2,934.23","$1,320.40","$2,094.16",$0.00,$490.83,$0.00,$0.00,$513.76,"$2,934.23",$0.00,"$1,467.11","$2,323.91","$2,347.38",$0.00,$445.83,$0.00,$467.13,$0.00
422.257,SUP,HCPCS C1713,,422.257  -  PLATE BONE 276MM 11 HOLE LCP TITANIUM FEMUR LEFT DISTAL,"$2,934.23",$0.00,"$2,934.23","$1,320.40","$2,094.16",$0.00,$490.83,$0.00,$0.00,$513.76,"$2,934.23",$0.00,"$1,467.11","$2,323.91","$2,347.38",$0.00,$445.83,$0.00,$467.13,$0.00
422.258,SUP,HCPCS C1713,,422.258  -  PLATE BONE 316MM 13 HOLE LCP TITANIUM FEMUR RIGHT DISTAL,"$2,991.53",$0.00,"$2,991.53","$1,346.19","$2,135.05",$0.00,$500.41,$0.00,$0.00,$523.79,"$2,991.53",$0.00,"$1,495.76","$2,369.29","$2,393.22",$0.00,$454.54,$0.00,$476.25,$0.00
422.259,SUP,HCPCS C1713,,422.259  -  PLATE BONE 316MM 13 HOLE LCP TITANIUM FEMUR LEFT DISTAL,"$2,991.53",$0.00,"$2,991.53","$1,346.19","$2,135.05",$0.00,$500.41,$0.00,$0.00,$523.79,"$2,991.53",$0.00,"$1,495.76","$2,369.29","$2,393.22",$0.00,$454.54,$0.00,$476.25,$0.00
422.3,SUP,HCPCS C1713,,422.300  -  PLATE BONE 140MM 5 HOLE LISS TITANIUM RIGHT PROXIMAL TIBIA,"$3,003.83",$0.00,"$3,003.83","$1,351.72","$2,143.83",$0.00,$502.47,$0.00,$0.00,$525.95,"$3,003.83",$0.00,"$1,501.91","$2,379.03","$2,403.06",$0.00,$456.40,$0.00,$478.21,$0.00
422.301,SUP,HCPCS C1713,,422.301  -  PLATE BONE 140MM 5 HOLE LISS TITANIUM LEFT PROXIMAL TIBIA,"$3,003.83",$0.00,"$3,003.83","$1,351.72","$2,143.83",$0.00,$502.47,$0.00,$0.00,$525.95,"$3,003.83",$0.00,"$1,501.91","$2,379.03","$2,403.06",$0.00,$456.40,$0.00,$478.21,$0.00
422.304,SUP,HCPCS C1713,,422.304  -  PLATE BONE 3.5MM 220MM 9 HOLE LISS TITANIUM RIGHT PROXIMAL,"$3,003.83",$0.00,"$3,003.83","$1,351.72","$2,143.83",$0.00,$502.47,$0.00,$0.00,$525.95,"$3,003.83",$0.00,"$1,501.91","$2,379.03","$2,403.06",$0.00,$456.40,$0.00,$478.21,$0.00
422.305,SUP,HCPCS C1713,,422.305  -  PLATE BONE 220MM 9 HOLE LISS TITANIUM LEFT PROXIMAL TIBIA,"$3,003.83",$0.00,"$3,003.83","$1,351.72","$2,143.83",$0.00,$502.47,$0.00,$0.00,$525.95,"$3,003.83",$0.00,"$1,501.91","$2,379.03","$2,403.06",$0.00,$456.40,$0.00,$478.21,$0.00
422.308,SUP,HCPCS C1713,,422.308  -  PLATE BONE 300MM 13 HOLE LISS TITANIUM RIGHT PROXIMAL TIBIA,"$3,003.83",$0.00,"$3,003.83","$1,351.72","$2,143.83",$0.00,$502.47,$0.00,$0.00,$525.95,"$3,003.83",$0.00,"$1,501.91","$2,379.03","$2,403.06",$0.00,$456.40,$0.00,$478.21,$0.00
422.309,SUP,HCPCS C1713,,422.309  -  PLATE BONE 300MM 13 HOLE LISS TITANIUM LEFT PROXIMAL TIBIA,"$3,003.83",$0.00,"$3,003.83","$1,351.72","$2,143.83",$0.00,$502.47,$0.00,$0.00,$525.95,"$3,003.83",$0.00,"$1,501.91","$2,379.03","$2,403.06",$0.00,$456.40,$0.00,$478.21,$0.00
422.34,SUP,HCPCS C1713,,422.340  -  PLATE BONE 156MM 5 HOLE LISS TITANIUM FEMUR RIGHT DISTAL,"$3,003.83",$0.00,"$3,003.83","$1,351.72","$2,143.83",$0.00,$502.47,$0.00,$0.00,$525.95,"$3,003.83",$0.00,"$1,501.91","$2,379.03","$2,403.06",$0.00,$456.40,$0.00,$478.21,$0.00
422.341,SUP,HCPCS C1713,,422.341  -  PLATE BN 156MM NS LISS 5 HL TI FEM LT DIST 5MM LCK SCR,"$3,003.83",$0.00,"$3,003.83","$1,351.72","$2,143.83",$0.00,$502.47,$0.00,$0.00,$525.95,"$3,003.83",$0.00,"$1,501.91","$2,379.03","$2,403.06",$0.00,$456.40,$0.00,$478.21,$0.00
422.344,SUP,HCPCS C1713,,422.344  -  PLATE BN 236MM NS LISS 9 HL TI FEM RT DIST 5MM LCK SCR,"$3,003.83",$0.00,"$3,003.83","$1,351.72","$2,143.83",$0.00,$502.47,$0.00,$0.00,$525.95,"$3,003.83",$0.00,"$1,501.91","$2,379.03","$2,403.06",$0.00,$456.40,$0.00,$478.21,$0.00
422.345,SUP,HCPCS C1713,,422.345  -  PLATE BN 236MM NS LISS 9 HL TI FEM LT DIST 5MM LCK SCR,"$3,003.83",$0.00,"$3,003.83","$1,351.72","$2,143.83",$0.00,$502.47,$0.00,$0.00,$525.95,"$3,003.83",$0.00,"$1,501.91","$2,379.03","$2,403.06",$0.00,$456.40,$0.00,$478.21,$0.00
422.348,SUP,HCPCS C1713,,422.348  -  PLATE BN 316MM NS LISS 13 HL TI FEM RT DIST 5MM LCK SCR,"$3,003.83",$0.00,"$3,003.83","$1,351.72","$2,143.83",$0.00,$502.47,$0.00,$0.00,$525.95,"$3,003.83",$0.00,"$1,501.91","$2,379.03","$2,403.06",$0.00,$456.40,$0.00,$478.21,$0.00
422.349,SUP,HCPCS C1713,,422.349  -  PLATE BN 316MM NS LISS 13 HL TI FEM LT DIST 5MM LCK SCR,"$3,003.83",$0.00,"$3,003.83","$1,351.72","$2,143.83",$0.00,$502.47,$0.00,$0.00,$525.95,"$3,003.83",$0.00,"$1,501.91","$2,379.03","$2,403.06",$0.00,$456.40,$0.00,$478.21,$0.00
422.39,SUP,Custom 27203010,,422.390  -  INSERT SCR HL 5MM LISS TI FEM,$176.05,$0.00,$176.05,$0.00,$125.65,$0.00,$0.00,$0.00,$0.00,$0.00,$176.05,$0.00,$88.03,$139.43,$140.84,$0.00,$0.00,$0.00,$0.00,$0.00
422.391,SUP,HCPCS C1713,,422.391  -  SCREW BONE 3.5MM CONE HEXAGON 5MM 4.4MM 18MM SELF DRILL,$383.50,$0.00,$383.50,$172.58,$273.70,$0.00,$64.15,$0.00,$0.00,$67.15,$383.50,$0.00,$191.75,$303.73,$306.80,$0.00,$58.27,$0.00,$61.05,$0.00
422.392,SUP,HCPCS C1713,,422.392  -  SCREW BONE 3.5MM CONE HEXAGON 5MM 4.4MM 26MM SELF DRILL,$383.50,$0.00,$383.50,$172.58,$273.70,$0.00,$64.15,$0.00,$0.00,$67.15,$383.50,$0.00,$191.75,$303.73,$306.80,$0.00,$58.27,$0.00,$61.05,$0.00
422.393,SUP,HCPCS C1713,,422.393  -  SCREW BONE 3.5MM CONE HEXAGON 5MM 4.4MM 40MM SELF DRILL,$383.50,$0.00,$383.50,$172.58,$273.70,$0.00,$64.15,$0.00,$0.00,$67.15,$383.50,$0.00,$191.75,$303.73,$306.80,$0.00,$58.27,$0.00,$61.05,$0.00
422.394,SUP,HCPCS C1713,,422.394  -  SCREW BONE 3.5MM CONE HEXAGON 5MM 4.4MM 55MM SELF DRILL,$390.33,$0.00,$390.33,$175.65,$278.57,$0.00,$65.29,$0.00,$0.00,$68.34,$390.33,$0.00,$195.16,$309.14,$312.26,$0.00,$59.31,$0.00,$62.14,$0.00
422.395,SUP,HCPCS C1713,,422.395  -  SCREW BONE 3.5MM CONE HEXAGON 5MM 4.4MM 65MM SELF DRILL,$390.33,$0.00,$390.33,$175.65,$278.57,$0.00,$65.29,$0.00,$0.00,$68.34,$390.33,$0.00,$195.16,$309.14,$312.26,$0.00,$59.31,$0.00,$62.14,$0.00
422.396,SUP,HCPCS C1713,,422.396  -  SCREW BONE 3.5MM CONE HEXAGON 5MM 4.4MM 75MM SELF DRILL,$390.33,$0.00,$390.33,$175.65,$278.57,$0.00,$65.29,$0.00,$0.00,$68.34,$390.33,$0.00,$195.16,$309.14,$312.26,$0.00,$59.31,$0.00,$62.14,$0.00
422.397,SUP,HCPCS C1713,,422.397  -  SCREW BONE 3.5MM 5MM 4.4MM 85MM SLFDRILL LOCKING THREADED,$390.33,$0.00,$390.33,$175.65,$278.57,$0.00,$65.29,$0.00,$0.00,$68.34,$390.33,$0.00,$195.16,$309.14,$312.26,$0.00,$59.31,$0.00,$62.14,$0.00
422.402,SUP,HCPCS C1713,,422.402  -  SCREW BONE 3.5MM CONE HEXAGON 5MM 4.4MM 14MM SELF DRILL LCP,$397.15,$0.00,$397.15,$178.72,$283.45,$0.00,$66.43,$0.00,$0.00,$69.54,$397.15,$0.00,$198.58,$314.54,$317.72,$0.00,$60.34,$0.00,$63.23,$0.00
422.404,SUP,HCPCS C1713,,422.404  -  SCREW BONE 3.5MM CONE HEXAGON 5MM 4.4MM 18MM SELF DRILL LCP,$397.15,$0.00,$397.15,$178.72,$283.45,$0.00,$66.43,$0.00,$0.00,$69.54,$397.15,$0.00,$198.58,$314.54,$317.72,$0.00,$60.34,$0.00,$63.23,$0.00
422.578,SUP,Custom 27803010,,422.578  -  NUT ORTHOPEDIC 5MM TITANIUM TIBIA PROXIMAL MEDIAL NONSTRL,$294.78,$0.00,$294.78,$0.00,$210.38,$0.00,$0.00,$0.00,$0.00,$0.00,$294.78,$0.00,$147.39,$233.47,$235.82,$0.00,$0.00,$0.00,$0.00,$0.00
423.406,SUP,HCPCS C1713,,423.406  -  PLATE BONE 86MM 6 HOLE LCP TITANIUM METAPHYSEAL NONSTRL 3.5,"$1,670.45",$0.00,"$1,670.45",$751.70,"$1,192.20",$0.00,$279.43,$0.00,$0.00,$292.48,"$1,670.45",$0.00,$835.23,"$1,323.00","$1,336.36",$0.00,$253.81,$0.00,$265.94,$0.00
423.407,SUP,HCPCS C1713,,423.407  -  PLATE BONE 99MM 7 HOLE LCP TITANIUM METAPHYSEAL NONSTRL 3.5,"$1,701.85",$0.00,"$1,701.85",$765.83,"$1,214.61",$0.00,$284.68,$0.00,$0.00,$297.98,"$1,701.85",$0.00,$850.93,"$1,347.87","$1,361.48",$0.00,$258.58,$0.00,$270.93,$0.00
423.408,SUP,HCPCS C1713,,423.408  -  PLATE BONE 112MM 8 HOLE LCP TITANIUM METAPHYSEAL NONSTRL 3.5,"$1,726.40",$0.00,"$1,726.40",$776.88,"$1,232.13",$0.00,$288.79,$0.00,$0.00,$302.28,"$1,726.40",$0.00,$863.20,"$1,367.31","$1,381.12",$0.00,$262.31,$0.00,$274.84,$0.00
423.409,SUP,HCPCS C1713,,423.409  -  PLATE BONE 125MM 9 HOLE LCP TITANIUM METAPHYSEAL NONSTRL 3.5,"$1,755.08",$0.00,"$1,755.08",$789.78,"$1,252.60",$0.00,$293.58,$0.00,$0.00,$307.30,"$1,755.08",$0.00,$877.54,"$1,390.02","$1,404.06",$0.00,$266.67,$0.00,$279.41,$0.00
423.41,SUP,HCPCS C1713,,423.410  -  PLATE BONE 138MM 10 HOLE LCP TITANIUM METAPHYSEAL NONSTRL,"$1,783.73",$0.00,"$1,783.73",$802.68,"$1,273.04",$0.00,$298.38,$0.00,$0.00,$312.32,"$1,783.73",$0.00,$891.86,"$1,412.71","$1,426.98",$0.00,$271.02,$0.00,$283.97,$0.00
423.411,SUP,HCPCS C1713,,423.411  -  PLATE BONE 151MM 11 HOLE LCP TITANIUM METAPHYSEAL NONSTRL,"$1,813.75",$0.00,"$1,813.75",$816.19,"$1,294.47",$0.00,$303.40,$0.00,$0.00,$317.57,"$1,813.75",$0.00,$906.88,"$1,436.49","$1,451.00",$0.00,$275.58,$0.00,$288.75,$0.00
423.412,SUP,HCPCS C1713,,423.412  -  PLATE BONE 164MM 12 HOLE LCP TITANIUM METAPHYSEAL NONSTRL,"$2,340.55",$0.00,"$2,340.55","$1,053.25","$1,670.45",$0.00,$391.52,$0.00,$0.00,$409.81,"$2,340.55",$0.00,"$1,170.28","$1,853.72","$1,872.44",$0.00,$355.63,$0.00,$372.62,$0.00
423.414,SUP,HCPCS C1713,,423.414  -  PLATE BONE 190MM 14 HOLE LCP TITANIUM METAPHYSEAL NONSTRL,"$2,416.98",$0.00,"$2,416.98","$1,087.64","$1,725.00",$0.00,$404.30,$0.00,$0.00,$423.19,"$2,416.98",$0.00,"$1,208.49","$1,914.25","$1,933.58",$0.00,$367.24,$0.00,$384.78,$0.00
423.416,SUP,HCPCS C1713,,423.416  -  PLATE BONE 216MM 16 HOLE LCP TITANIUM METAPHYSEAL NONSTRL,"$2,468.83",$0.00,"$2,468.83","$1,110.97","$1,762.00",$0.00,$412.98,$0.00,$0.00,$432.27,"$2,468.83",$0.00,"$1,234.41","$1,955.31","$1,975.06",$0.00,$375.12,$0.00,$393.04,$0.00
423.418,SUP,HCPCS C1713,,423.418  -  PLATE BONE 242MM 18 HOLE LCP TITANIUM METAPHYSEAL NONSTRL,"$2,416.98",$0.00,"$2,416.98","$1,087.64","$1,725.00",$0.00,$404.30,$0.00,$0.00,$423.19,"$2,416.98",$0.00,"$1,208.49","$1,914.25","$1,933.58",$0.00,$367.24,$0.00,$384.78,$0.00
423.52,SUP,HCPCS C1713,,423.52  -  PLATE BONE 25X11X3.3MM 2 HOLE LC-DCP TITANIUM CLAVICLE,$218.63,$0.00,$218.63,$98.38,$156.03,$0.00,$37.67,$0.00,$0.00,$38.28,$218.63,$0.00,$109.31,$173.15,$174.90,$0.00,$34.21,$0.00,$34.81,$0.00
423.521,SUP,HCPCS C1713,,423.521  -  PLATE BONE 33MM 2 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 3.5MM,$476.30,$0.00,$476.30,$214.34,$339.94,$0.00,$79.67,$0.00,$0.00,$83.40,$476.30,$0.00,$238.15,$377.23,$381.04,$0.00,$72.37,$0.00,$75.83,$0.00
423.53,SUP,HCPCS C1713,,423.53  -  PLATE BONE 38X11X3.3MM 3 HOLE LC-DCP TITANIUM CLAVICLE,$222.60,$0.00,$222.60,$100.17,$158.87,$0.00,$38.35,$0.00,$0.00,$38.98,$222.60,$0.00,$111.30,$176.30,$178.08,$0.00,$34.84,$0.00,$35.44,$0.00
423.531,SUP,HCPCS C1713,,423.531  -  PLATE BONE 46MM 3 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 3.5MM,$495.40,$0.00,$495.40,$222.93,$353.57,$0.00,$82.87,$0.00,$0.00,$86.74,$495.40,$0.00,$247.70,$392.36,$396.32,$0.00,$75.27,$0.00,$78.87,$0.00
423.54,SUP,HCPCS C1713,,423.54  -  PLATE BONE 3.5MM 51X11X3.3MM 4 HOLE LC-DCP TITANIUM CLAVICLE,$229.23,$0.00,$229.23,$103.15,$163.60,$0.00,$39.49,$0.00,$0.00,$40.14,$229.23,$0.00,$114.61,$181.55,$183.38,$0.00,$35.87,$0.00,$36.49,$0.00
423.541,SUP,HCPCS C1713,,423.541  -  PLATE BONE 59MM 4 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 3.5MM,$517.25,$0.00,$517.25,$232.76,$369.16,$0.00,$86.52,$0.00,$0.00,$90.57,$517.25,$0.00,$258.63,$409.66,$413.80,$0.00,$78.59,$0.00,$82.35,$0.00
423.55,SUP,HCPCS C1713,,423.55  -  PLATE BONE 64X11X3.3MM 5 HOLE LC-DCP TITANIUM CLAVICLE,$241.15,$0.00,$241.15,$108.52,$172.11,$0.00,$41.55,$0.00,$0.00,$42.22,$241.15,$0.00,$120.58,$190.99,$192.92,$0.00,$37.74,$0.00,$38.39,$0.00
423.551,SUP,HCPCS C1713,,423.551  -  PLATE BONE 72X11X3.4MM 5 HOLE LCP TITANIUM HUMERUS RAD ULNA,$533.63,$0.00,$533.63,$240.13,$380.85,$0.00,$89.26,$0.00,$0.00,$93.43,$533.63,$0.00,$266.81,$422.63,$426.90,$0.00,$81.08,$0.00,$84.95,$0.00
423.56,SUP,HCPCS C1713,,423.56  -  PLATE BONE 77X11X3.3MM 6 HOLE LC-DCP TITANIUM CLAVICLE,$258.38,$0.00,$258.38,$116.27,$184.40,$0.00,$44.52,$0.00,$0.00,$45.24,$258.38,$0.00,$129.19,$204.64,$206.70,$0.00,$40.44,$0.00,$41.13,$0.00
423.561,SUP,HCPCS C1713,,423.561  -  PLATE BONE 85X11X3.4MM 6 HOLE LCP TITANIUM HUMERUS RAD ULNA,$567.73,$0.00,$567.73,$255.48,$405.19,$0.00,$94.97,$0.00,$0.00,$99.40,$567.73,$0.00,$283.86,$449.64,$454.18,$0.00,$86.26,$0.00,$90.38,$0.00
423.57,SUP,HCPCS C1713,,423.57  -  PLATE BN 90X11X3.3MM NS LC DCP 7 HL TI 3.5MM SCR SM FRAG SET,$267.65,$0.00,$267.65,$120.44,$191.02,$0.00,$46.11,$0.00,$0.00,$46.86,$267.65,$0.00,$133.83,$211.98,$214.12,$0.00,$41.89,$0.00,$42.61,$0.00
423.571,SUP,HCPCS C1713,,423.571  -  PLATE BN 98X11X3.4MM NS LCP CMBN 7 HL LMT CNTCT TPR END TI,$590.93,$0.00,$590.93,$265.92,$421.74,$0.00,$98.85,$0.00,$0.00,$103.47,$590.93,$0.00,$295.46,$468.02,$472.74,$0.00,$89.79,$0.00,$94.08,$0.00
423.58,SUP,HCPCS C1713,,423.58  -  PLATE BONE SMALL 103X11X3.3MM 8 HOLE LC-DCP TITANIUM,$282.23,$0.00,$282.23,$127.00,$201.42,$0.00,$48.63,$0.00,$0.00,$49.42,$282.23,$0.00,$141.11,$223.53,$225.78,$0.00,$44.17,$0.00,$44.93,$0.00
423.581,SUP,HCPCS C1713,,423.581  -  PLATE BN 111X11X3.4MM NS LCP CMBN 8 HL LMT CNTCT TPR END TI,$620.95,$0.00,$620.95,$279.43,$443.17,$0.00,$103.87,$0.00,$0.00,$108.72,$620.95,$0.00,$310.48,$491.79,$496.76,$0.00,$94.35,$0.00,$98.86,$0.00
423.59,SUP,HCPCS C1713,,423.59  -  PLATE BN 116X11X3.3MM NS LC DCP 9 HL TI 3.5MM SCR SM FRAG,$304.75,$0.00,$304.75,$137.14,$217.50,$0.00,$52.51,$0.00,$0.00,$53.36,$304.75,$0.00,$152.38,$241.36,$243.80,$0.00,$47.69,$0.00,$48.52,$0.00
423.591,SUP,HCPCS C1713,,423.591  -  PLATE BONE 124X11X3.4MM 9 HOLE LCP TITANIUM HUMERUS RAD ULNA,$645.53,$0.00,$645.53,$290.49,$460.71,$0.00,$107.98,$0.00,$0.00,$113.03,$645.53,$0.00,$322.76,$511.26,$516.42,$0.00,$98.08,$0.00,$102.77,$0.00
423.6,SUP,HCPCS C1713,,423.60  -  PLATE BONE 129X11X3.3MM 10 HOLE LC-DCP TITANIUM DISTAL TIBIA,$308.73,$0.00,$308.73,$138.93,$220.34,$0.00,$53.19,$0.00,$0.00,$54.06,$308.73,$0.00,$154.36,$244.51,$246.98,$0.00,$48.32,$0.00,$49.15,$0.00
423.601,SUP,HCPCS C1713,,423.601  -  PLATE BONE 137X11X3.4MM 10 HOLE LCP TITANIUM HUMERUS RAD,$666.00,$0.00,$666.00,$299.70,$475.32,$0.00,$111.41,$0.00,$0.00,$116.61,$666.00,$0.00,$333.00,$527.47,$532.80,$0.00,$101.19,$0.00,$106.03,$0.00
423.61,SUP,HCPCS C1713,,423.61  -  PLATE BONE 142X11X3.3MM 11 HOLE LC-DCP TITANIUM CLAVICLE,$324.63,$0.00,$324.63,$146.08,$231.68,$0.00,$55.93,$0.00,$0.00,$56.84,$324.63,$0.00,$162.31,$257.11,$259.70,$0.00,$50.80,$0.00,$51.68,$0.00
423.611,SUP,HCPCS C1713,,423.611  -  PLATE BONE 150MM 11 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 3.5,$715.13,$0.00,$715.13,$321.81,$510.38,$0.00,$119.62,$0.00,$0.00,$125.21,$715.13,$0.00,$357.56,$566.38,$572.10,$0.00,$108.66,$0.00,$113.85,$0.00
423.62,SUP,HCPCS C1713,,423.62  -  PLATE BONE 3.5MM 155X11X3.3MM 12 HOLE LC-DCP TITANIUM,$347.15,$0.00,$347.15,$156.22,$247.76,$0.00,$59.81,$0.00,$0.00,$60.78,$347.15,$0.00,$173.58,$274.94,$277.72,$0.00,$54.33,$0.00,$55.27,$0.00
423.621,SUP,HCPCS C1713,,423.621  -  PLATE BONE 163X11X3.4MM 12 HOLE LCP TITANIUM HUMERUS RAD,$734.23,$0.00,$734.23,$330.40,$524.02,$0.00,$122.82,$0.00,$0.00,$128.56,$734.23,$0.00,$367.11,$581.51,$587.38,$0.00,$111.56,$0.00,$116.89,$0.00
423.631,SUP,HCPCS C1713,,423.631  -  PLATE BONE 176MM 13 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 3.5,$872.08,$0.00,$872.08,$392.43,$622.40,$0.00,$145.88,$0.00,$0.00,$152.69,$872.08,$0.00,$436.04,$690.69,$697.66,$0.00,$132.50,$0.00,$138.83,$0.00
423.64,SUP,HCPCS C1713,,423.64  -  PLATE BONE 181X11X3.3MM 14 HOLE LC-DCP TITANIUM CLAVICLE,$642.63,$0.00,$642.63,$289.18,$458.64,$0.00,$110.72,$0.00,$0.00,$112.52,$642.63,$0.00,$321.31,$508.96,$514.10,$0.00,$100.57,$0.00,$102.31,$0.00
423.641,SUP,HCPCS C1713,,423.641  -  PLATE BONE 189X11X3.4MM 14 HOLE LCP TITANIUM HUMERUS RAD,"$1,101.35",$0.00,"$1,101.35",$495.61,$786.03,$0.00,$184.23,$0.00,$0.00,$192.84,"$1,101.35",$0.00,$550.68,$872.27,$881.08,$0.00,$167.34,$0.00,$175.33,$0.00
423.65,SUP,HCPCS C1713,,423.65  -  PLATE BONE 195X11X3.3MM 15 HOLE LC-DCP TITANIUM CLAVICLE,$673.10,$0.00,$673.10,$302.90,$480.39,$0.00,$115.97,$0.00,$0.00,$117.85,$673.10,$0.00,$336.55,$533.10,$538.48,$0.00,$105.34,$0.00,$107.16,$0.00
423.651,SUP,HCPCS C1713,,423.651  -  PLATE BONE 202MM 15 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 3.5,"$1,179.15",$0.00,"$1,179.15",$530.62,$841.56,$0.00,$197.24,$0.00,$0.00,$206.46,"$1,179.15",$0.00,$589.58,$933.89,$943.32,$0.00,$179.16,$0.00,$187.72,$0.00
423.66,SUP,HCPCS C1713,,423.66  -  PLATE BONE 207X11X3.3MM 16 HOLE LC-DCP TITANIUM CLAVICLE,$738.03,$0.00,$738.03,$332.11,$526.73,$0.00,$127.16,$0.00,$0.00,$129.22,$738.03,$0.00,$369.01,$584.52,$590.42,$0.00,$115.50,$0.00,$117.49,$0.00
423.661,SUP,HCPCS C1713,,423.661  -  PLATE BONE 215MM 16 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 3.5,"$1,233.73",$0.00,"$1,233.73",$555.18,$880.51,$0.00,$206.37,$0.00,$0.00,$216.02,"$1,233.73",$0.00,$616.86,$977.11,$986.98,$0.00,$187.46,$0.00,$196.41,$0.00
423.671,SUP,HCPCS C1713,,423.671  -  PLATE BONE 241MM 18 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 3.5,"$1,383.85",$0.00,"$1,383.85",$622.73,$987.65,$0.00,$231.49,$0.00,$0.00,$242.30,"$1,383.85",$0.00,$691.93,"$1,096.01","$1,107.08",$0.00,$210.27,$0.00,$220.31,$0.00
423.68,SUP,HCPCS C1713,,423.68  -  PLATE BONE 233X11X3.3MM 18 HOLE LC-DCP TITANIUM CLAVICLE,$825.48,$0.00,$825.48,$371.46,$589.14,$0.00,$142.23,$0.00,$0.00,$144.53,$825.48,$0.00,$412.74,$653.78,$660.38,$0.00,$129.19,$0.00,$131.42,$0.00
423.681,SUP,HCPCS C1713,,423.681  -  PLATE BONE 267MM 20 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 3.5,"$1,536.70",$0.00,"$1,536.70",$691.52,"$1,096.74",$0.00,$257.06,$0.00,$0.00,$269.06,"$1,536.70",$0.00,$768.35,"$1,217.07","$1,229.36",$0.00,$233.49,$0.00,$244.64,$0.00
423.691,SUP,HCPCS C1713,,423.691  -  PLATE BONE 293MM 22 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 3.5,"$1,538.08",$0.00,"$1,538.08",$692.13,"$1,097.72",$0.00,$257.28,$0.00,$0.00,$269.30,"$1,538.08",$0.00,$769.04,"$1,218.16","$1,230.46",$0.00,$233.70,$0.00,$244.86,$0.00
423.7,SUP,HCPCS C1713,,423.70  -  PLATE BONE 259X11X3.3MM 20 HOLE LC-DCP TITANIUM CLAVICLE,$914.25,$0.00,$914.25,$411.41,$652.50,$0.00,$157.52,$0.00,$0.00,$160.08,$914.25,$0.00,$457.13,$724.09,$731.40,$0.00,$143.08,$0.00,$145.55,$0.00
424.519,SUP,Custom 27803010,,"424.519  -  5.5MM SS STRAIGHT ROD, HEX-END, 300MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
424.52,SUP,HCPCS C1713,,424.52  -  PLATE BONE NARROW 34X13.5X4.2MM 2 HOLE LC-DCP TITANIUM LONG,$320.73,$0.00,$320.73,$144.33,$228.90,$0.00,$53.65,$0.00,$0.00,$56.16,$320.73,$0.00,$160.36,$254.02,$256.58,$0.00,$48.73,$0.00,$51.06,$0.00
424.52,SUP,Custom 27803010,,"424.520  -  5.5MM SS STRAIGHT ROD, HEX-END, 400MM",$500.00,$0.00,$396.00,$144.33,$228.90,$0.00,$53.65,$0.00,$0.00,$56.16,$320.73,$0.00,$160.36,$396.00,$256.58,$0.00,$48.73,$0.00,$51.06,$0.00
424.521,SUP,Custom 27803010,,424.521  -  PLATE BONE NARROW 44MM 2 HOLE LCP TITANIUM ORTHOPEDIC,$571.83,$0.00,$571.83,$0.00,$408.11,$0.00,$0.00,$0.00,$0.00,$0.00,$571.83,$0.00,$285.91,$452.89,$457.46,$0.00,$0.00,$0.00,$0.00,$0.00
424.53,SUP,HCPCS C1713,,424.53  -  PLATE BONE NARROW 52X13.5X4.2MM 3 HOLE LC-DCP TITANIUM LONG,$320.73,$0.00,$320.73,$144.33,$228.90,$0.00,$53.65,$0.00,$0.00,$56.16,$320.73,$0.00,$160.36,$254.02,$256.58,$0.00,$48.73,$0.00,$51.06,$0.00
424.531,SUP,HCPCS C1713,,424.531  -  PLATE BONE NARROW 62MM 3 HOLE LCP TITANIUM ORTHOPEDIC,$578.65,$0.00,$578.65,$260.39,$412.98,$0.00,$96.80,$0.00,$0.00,$101.32,$578.65,$0.00,$289.33,$458.29,$462.92,$0.00,$87.92,$0.00,$92.12,$0.00
424.54,SUP,HCPCS C1713,,424.54  -  PLATE BONE NARROW 70X13.5X4.2MM 4 HOLE LC-DCP TITANIUM LONG,$320.73,$0.00,$320.73,$144.33,$228.90,$0.00,$53.65,$0.00,$0.00,$56.16,$320.73,$0.00,$160.36,$254.02,$256.58,$0.00,$48.73,$0.00,$51.06,$0.00
424.541,SUP,HCPCS C1713,,424.541  -  PLATE BONE NARROW 80MM 4 HOLE LCP TITANIUM ORTHOPEDIC,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
424.55,SUP,HCPCS C1713,,424.55  -  PLATE BONE NARROW 88X13.5X4.2MM 5 HOLE LC-DCP TITANIUM LONG,$320.73,$0.00,$320.73,$144.33,$228.90,$0.00,$53.65,$0.00,$0.00,$56.16,$320.73,$0.00,$160.36,$254.02,$256.58,$0.00,$48.73,$0.00,$51.06,$0.00
424.551,SUP,HCPCS C1713,,424.551  -  PLATE BONE NARROW 98MM 5 HOLE LCP TITANIUM ORTHOPEDIC,$674.18,$0.00,$674.18,$303.38,$481.16,$0.00,$112.78,$0.00,$0.00,$118.04,$674.18,$0.00,$337.09,$533.95,$539.34,$0.00,$102.44,$0.00,$107.33,$0.00
424.56,SUP,HCPCS C1713,,424.56  -  PLATE BONE NARROW 106X13.5X4.2MM 6 HOLE LC-DCP TITANIUM LONG,$360.30,$0.00,$360.30,$162.14,$257.15,$0.00,$60.27,$0.00,$0.00,$63.09,$360.30,$0.00,$180.15,$285.36,$288.24,$0.00,$54.74,$0.00,$57.36,$0.00
424.561,SUP,HCPCS C1713,,424.561  -  PLATE BONE NARROW 116MM 6 HOLE LCP TITANIUM ORTHOPEDIC,$713.78,$0.00,$713.78,$321.20,$509.42,$0.00,$119.40,$0.00,$0.00,$124.98,$713.78,$0.00,$356.89,$565.31,$571.02,$0.00,$108.45,$0.00,$113.63,$0.00
424.57,SUP,HCPCS C1713,,424.57  -  PLATE BONE NARROW 124X13.5X4.2MM 7 HOLE LC-DCP TITANIUM LONG,$349.80,$0.00,$349.80,$157.41,$249.65,$0.00,$60.27,$0.00,$0.00,$61.25,$349.80,$0.00,$174.90,$277.04,$279.84,$0.00,$54.74,$0.00,$55.69,$0.00
424.571,SUP,HCPCS C1713,,424.571  -  PLATE BONE NARROW 134MM 7 HOLE LCP TITANIUM ORTHOPEDIC 4.5MM,$825.68,$0.00,$825.68,$371.55,$589.28,$0.00,$138.12,$0.00,$0.00,$144.57,$825.68,$0.00,$412.84,$653.94,$660.54,$0.00,$125.45,$0.00,$131.45,$0.00
424.58,SUP,HCPCS C1713,,424.58  -  PLATE BONE NARROW 4.5MM 142X13.5X4.2MM 8 HOLE LC-DCP,$360.30,$0.00,$360.30,$162.14,$257.15,$0.00,$60.27,$0.00,$0.00,$63.09,$360.30,$0.00,$180.15,$285.36,$288.24,$0.00,$54.74,$0.00,$57.36,$0.00
424.581,SUP,HCPCS C1713,,424.581  -  PLATE BONE NARROW 152MM 8 HOLE LCP TITANIUM ORTHOPEDIC,$873.45,$0.00,$873.45,$393.05,$623.38,$0.00,$146.11,$0.00,$0.00,$152.93,$873.45,$0.00,$436.73,$691.77,$698.76,$0.00,$132.71,$0.00,$139.05,$0.00
424.59,SUP,HCPCS C1713,,424.59  -  PLATE BONE NARROW 160X13.5X4.2MM 9 HOLE LC-DCP TITANIUM LONG,$350.75,$0.00,$350.75,$157.84,$250.33,$0.00,$58.67,$0.00,$0.00,$61.41,$350.75,$0.00,$175.38,$277.79,$280.60,$0.00,$53.29,$0.00,$55.84,$0.00
424.591,SUP,HCPCS C1713,,424.591  -  PLATE BONE NARROW 170MM 9 HOLE LCP TITANIUM ORTHOPEDIC,$914.38,$0.00,$914.38,$411.47,$652.59,$0.00,$152.95,$0.00,$0.00,$160.10,$914.38,$0.00,$457.19,$724.19,$731.50,$0.00,$138.93,$0.00,$145.57,$0.00
424.6,SUP,HCPCS C1713,,424.60  -  PLATE BONE NARROW 4.5MM 178X13.5X4.2MM 10 HOLE LC-DCP,$454.45,$0.00,$454.45,$204.50,$324.34,$0.00,$76.02,$0.00,$0.00,$79.57,$454.45,$0.00,$227.23,$359.92,$363.56,$0.00,$69.05,$0.00,$72.35,$0.00
424.601,SUP,HCPCS C1713,,424.601  -  PLATE BONE NARROW 188MM 10 HOLE LCP TITANIUM ORTHOPEDIC,$993.55,$0.00,$993.55,$447.10,$709.10,$0.00,$166.20,$0.00,$0.00,$173.96,$993.55,$0.00,$496.78,$786.89,$794.84,$0.00,$150.96,$0.00,$158.17,$0.00
424.61,SUP,HCPCS C1713,,424.61  -  PLATE BONE NARROW 4.5MM 206MM 11 HOLE LCP TITANIUM NONSTRL,$468.10,$0.00,$468.10,$210.65,$334.08,$0.00,$78.30,$0.00,$0.00,$81.96,$468.10,$0.00,$234.05,$370.74,$374.48,$0.00,$71.13,$0.00,$74.52,$0.00
424.611,SUP,HCPCS C1713,,424.611  -  PLATE BONE NARROW 206MM 11 HOLE LCP TITANIUM ORTHOPEDIC,"$1,069.98",$0.00,"$1,069.98",$481.49,$763.64,$0.00,$178.98,$0.00,$0.00,$187.34,"$1,069.98",$0.00,$534.99,$847.42,$855.98,$0.00,$162.57,$0.00,$170.34,$0.00
424.62,SUP,HCPCS C1713,,424.62  -  PLATE BONE NARROW 214X13.5X4.2MM 12 HOLE LC-DCP TITANIUM,$441.23,$0.00,$441.23,$198.55,$314.90,$0.00,$76.02,$0.00,$0.00,$77.25,$441.23,$0.00,$220.61,$349.45,$352.98,$0.00,$69.05,$0.00,$70.24,$0.00
424.621,SUP,HCPCS C1713,,424.621  -  PLATE BONE NARROW 224MM 12 HOLE LCP TITANIUM ORTHOPEDIC,"$1,150.48",$0.00,"$1,150.48",$517.71,$821.09,$0.00,$192.45,$0.00,$0.00,$201.44,"$1,150.48",$0.00,$575.24,$911.18,$920.38,$0.00,$174.81,$0.00,$183.16,$0.00
424.63,SUP,HCPCS C1713,,424.63  -  PLATE BONE NARROW 232X13.5X4.2MM 13 HOLE LC-DCP TITANIUM,$544.53,$0.00,$544.53,$245.04,$388.63,$0.00,$91.09,$0.00,$0.00,$95.34,$544.53,$0.00,$272.26,$431.27,$435.62,$0.00,$82.74,$0.00,$86.69,$0.00
424.631,SUP,HCPCS C1713,,424.631  -  PLATE BONE NARROW 242MM 13 HOLE LCP TITANIUM ORTHOPEDIC,"$1,228.28",$0.00,"$1,228.28",$552.72,$876.62,$0.00,$205.46,$0.00,$0.00,$215.06,"$1,228.28",$0.00,$614.14,$972.80,$982.62,$0.00,$186.63,$0.00,$195.54,$0.00
424.64,SUP,HCPCS C1713,,424.64  -  PLATE BONE NARROW 4.5MM 250X13.5X4.2MM 14 HOLE LC-DCP,$529.53,$0.00,$529.53,$238.29,$377.92,$0.00,$88.58,$0.00,$0.00,$92.72,$529.53,$0.00,$264.76,$419.39,$423.62,$0.00,$80.46,$0.00,$84.30,$0.00
424.641,SUP,HCPCS C1713,,424.641  -  PLATE BONE NARROW 260MM 14 HOLE LCP TITANIUM ORTHOPEDIC,"$1,289.70",$0.00,"$1,289.70",$580.37,$920.46,$0.00,$215.73,$0.00,$0.00,$225.82,"$1,289.70",$0.00,$644.85,"$1,021.44","$1,031.76",$0.00,$195.96,$0.00,$205.32,$0.00
424.65,SUP,HCPCS C1713,,424.65  -  PLATE BONE NARROW 4.5MM 268MM 15 HOLE LC-DCP TITANIUM,$544.53,$0.00,$544.53,$245.04,$388.63,$0.00,$91.09,$0.00,$0.00,$95.34,$544.53,$0.00,$272.26,$431.27,$435.62,$0.00,$82.74,$0.00,$86.69,$0.00
424.651,SUP,HCPCS C1713,,424.651  -  PLATE BONE NARROW 278MM 15 HOLE LCP TITANIUM ORTHOPEDIC,"$1,402.98",$0.00,"$1,402.98",$631.34,"$1,001.30",$0.00,$234.68,$0.00,$0.00,$245.65,"$1,402.98",$0.00,$701.49,"$1,111.16","$1,122.38",$0.00,$213.17,$0.00,$223.35,$0.00
424.66,SUP,HCPCS C1713,,424.66  -  PLATE BONE NARROW 4.5MM 286MM 16 HOLE LC-DCP TITANIUM,$544.53,$0.00,$544.53,$245.04,$388.63,$0.00,$91.09,$0.00,$0.00,$95.34,$544.53,$0.00,$272.26,$431.27,$435.62,$0.00,$82.74,$0.00,$86.69,$0.00
424.661,SUP,HCPCS C1713,,424.661  -  PLATE BONE NARROW 296MM 16 HOLE LCP TITANIUM ORTHOPEDIC,"$1,508.05",$0.00,"$1,508.05",$678.62,"$1,076.30",$0.00,$252.26,$0.00,$0.00,$264.05,"$1,508.05",$0.00,$754.03,"$1,194.38","$1,206.44",$0.00,$229.14,$0.00,$240.08,$0.00
424.67,SUP,HCPCS C1713,,424.67  -  PLATE BONE NARROW 4.5MM 305MM 17 HOLE LC-DCP TITANIUM,$799.75,$0.00,$799.75,$359.89,$570.78,$0.00,$133.78,$0.00,$0.00,$140.03,$799.75,$0.00,$399.88,$633.40,$639.80,$0.00,$121.51,$0.00,$127.32,$0.00
424.68,SUP,HCPCS C1713,,424.68  -  PLATE BONE NARROW 4.5MM 323MM 18 HOLE LC-DCP TITANIUM,$799.75,$0.00,$799.75,$359.89,$570.78,$0.00,$133.78,$0.00,$0.00,$140.03,$799.75,$0.00,$399.88,$633.40,$639.80,$0.00,$121.51,$0.00,$127.32,$0.00
424.681,SUP,HCPCS C1713,,424.681  -  PLATE BONE NARROW 332MM 18 HOLE LCP TITANIUM ORTHOPEDIC,"$1,771.45",$0.00,"$1,771.45",$797.15,"$1,264.28",$0.00,$296.32,$0.00,$0.00,$310.17,"$1,771.45",$0.00,$885.73,"$1,402.99","$1,417.16",$0.00,$269.16,$0.00,$282.01,$0.00
424.7,SUP,HCPCS C1713,,424.70  -  PLATE BONE NARROW 358X13.5X4.2MM 20 HOLE LC-DCP TITANIUM,"$1,123.20",$0.00,"$1,123.20",$505.44,$801.63,$0.00,$187.88,$0.00,$0.00,$196.66,"$1,123.20",$0.00,$561.60,$889.57,$898.56,$0.00,$170.66,$0.00,$178.81,$0.00
424.701,SUP,HCPCS C1713,,424.701  -  PLATE BONE NARROW 368MM 20 HOLE LCP TITANIUM ORTHOPEDIC,"$2,251.85",$0.00,"$2,251.85","$1,013.33","$1,607.15",$0.00,$376.68,$0.00,$0.00,$394.28,"$2,251.85",$0.00,"$1,125.93","$1,783.47","$1,801.48",$0.00,$342.15,$0.00,$358.49,$0.00
424.72,SUP,HCPCS C1713,,424.72  -  PLATE BONE NARROW 394MM 22 HOLE LC-DCP TITANIUM ORTHOPEDIC,"$1,209.18",$0.00,"$1,209.18",$544.13,$862.99,$0.00,$202.27,$0.00,$0.00,$211.72,"$1,209.18",$0.00,$604.59,$957.67,$967.34,$0.00,$183.72,$0.00,$192.50,$0.00
424.721,SUP,HCPCS C1713,,424.721  -  PLATE BONE NARROW 404MM 22 HOLE LCP TITANIUM ORTHOPEDIC,"$2,459.28",$0.00,"$2,459.28","$1,106.67","$1,755.18",$0.00,$411.38,$0.00,$0.00,$430.60,"$2,459.28",$0.00,"$1,229.64","$1,947.75","$1,967.42",$0.00,$373.67,$0.00,$391.52,$0.00
424.753,SUP,HCPCS C1713,,424.753  -  PLATE BONE 118MM 3/5 HOLE LCP TITANIUM METAPHYSEAL NONSTRL,"$1,726.40",$0.00,"$1,726.40",$776.88,"$1,232.13",$0.00,$288.79,$0.00,$0.00,$302.28,"$1,726.40",$0.00,$863.20,"$1,367.31","$1,381.12",$0.00,$262.31,$0.00,$274.84,$0.00
424.754,SUP,HCPCS C1713,,424.754  -  PLATE BONE 136MM 4/5 HOLE LCP TITANIUM METAPHYSEAL NONSTRL,"$1,755.08",$0.00,"$1,755.08",$789.78,"$1,252.60",$0.00,$293.58,$0.00,$0.00,$307.30,"$1,755.08",$0.00,$877.54,"$1,390.02","$1,404.06",$0.00,$266.67,$0.00,$279.41,$0.00
424.755,SUP,HCPCS C1713,,424.755  -  PLATE BONE 154MM 5/5 HOLE LCP TITANIUM METAPHYSEAL NONSTRL,"$1,783.73",$0.00,"$1,783.73",$802.68,"$1,273.04",$0.00,$298.38,$0.00,$0.00,$312.32,"$1,783.73",$0.00,$891.86,"$1,412.71","$1,426.98",$0.00,$271.02,$0.00,$283.97,$0.00
424.756,SUP,HCPCS C1713,,424.756  -  PLATE BONE 172MM 6/5 HOLE LCP TITANIUM METAPHYSEAL NONSTRL,"$1,813.75",$0.00,"$1,813.75",$816.19,"$1,294.47",$0.00,$303.40,$0.00,$0.00,$317.57,"$1,813.75",$0.00,$906.88,"$1,436.49","$1,451.00",$0.00,$275.58,$0.00,$288.75,$0.00
424.757,SUP,HCPCS C1713,,424.757  -  PLATE BONE 190MM 7/5 HOLE LCP TITANIUM METAPHYSEAL NONSTRL,"$2,340.55",$0.00,"$2,340.55","$1,053.25","$1,670.45",$0.00,$391.52,$0.00,$0.00,$409.81,"$2,340.55",$0.00,"$1,170.28","$1,853.72","$1,872.44",$0.00,$355.63,$0.00,$372.62,$0.00
424.758,SUP,HCPCS C1713,,424.758  -  PLATE BONE 208MM 8/5 HOLE LCP TITANIUM METAPHYSEAL NONSTRL,"$2,365.10",$0.00,"$2,365.10","$1,064.30","$1,687.97",$0.00,$395.63,$0.00,$0.00,$414.11,"$2,365.10",$0.00,"$1,182.55","$1,873.16","$1,892.08",$0.00,$359.36,$0.00,$376.52,$0.00
424.759,SUP,HCPCS C1713,,424.759  -  PLATE BONE 226MM 9/5 HOLE LCP TITANIUM METAPHYSEAL NONSTRL,"$2,416.98",$0.00,"$2,416.98","$1,087.64","$1,725.00",$0.00,$404.30,$0.00,$0.00,$423.19,"$2,416.98",$0.00,"$1,208.49","$1,914.25","$1,933.58",$0.00,$367.24,$0.00,$384.78,$0.00
424.761,SUP,HCPCS C1713,,424.761  -  PLATE BONE 262MM 11/5 HOLE LCP TITANIUM METAPHYSEAL NONSTRL,"$2,468.83",$0.00,"$2,468.83","$1,110.97","$1,762.00",$0.00,$412.98,$0.00,$0.00,$432.27,"$2,468.83",$0.00,"$1,234.41","$1,955.31","$1,975.06",$0.00,$375.12,$0.00,$393.04,$0.00
424.763,SUP,HCPCS C1713,,424.763  -  PLATE BONE 298MM 13/5 HOLE LCP TITANIUM METAPHYSEAL NONSTRL,"$2,515.23",$0.00,"$2,515.23","$1,131.85","$1,795.12",$0.00,$420.74,$0.00,$0.00,$440.40,"$2,515.23",$0.00,"$1,257.61","$1,992.06","$2,012.18",$0.00,$382.17,$0.00,$400.42,$0.00
424.765,SUP,HCPCS C1713,,424.765  -  PLATE BONE 334MM 15/5 HOLE LCP TITANIUM METAPHYSEAL NONSTRL,"$2,629.88",$0.00,"$2,629.88","$1,183.44","$1,876.94",$0.00,$439.92,$0.00,$0.00,$460.47,"$2,629.88",$0.00,"$1,314.94","$2,082.86","$2,103.90",$0.00,$399.59,$0.00,$418.68,$0.00
426.56,SUP,HCPCS C1713,,426.56  -  PLATE BONE BROAD 106X17.5X5.2MM 6 HOLE LC-DCP TITANIUM LONG,$488.58,$0.00,$488.58,$219.86,$348.70,$0.00,$81.73,$0.00,$0.00,$85.55,$488.58,$0.00,$244.29,$386.96,$390.86,$0.00,$74.24,$0.00,$77.78,$0.00
426.561,SUP,HCPCS C1713,,426.561  -  PLATE BONE BROAD 116MM 6 HOLE LCP TITANIUM ORTHOPEDIC,$761.53,$0.00,$761.53,$342.69,$543.50,$0.00,$127.39,$0.00,$0.00,$133.34,$761.53,$0.00,$380.76,$603.13,$609.22,$0.00,$115.71,$0.00,$121.23,$0.00
426.57,SUP,HCPCS C1713,,426.57  -  PLATE BONE BROAD 124X17.5X5.2MM 7 HOLE LC-DCP TITANIUM LONG,$529.53,$0.00,$529.53,$238.29,$377.92,$0.00,$88.58,$0.00,$0.00,$92.72,$529.53,$0.00,$264.76,$419.39,$423.62,$0.00,$80.46,$0.00,$84.30,$0.00
426.571,SUP,HCPCS C1713,,426.571  -  PLATE BONE BROAD 134MM 7 HOLE LCP TITANIUM ORTHOPEDIC,$809.30,$0.00,$809.30,$364.19,$577.60,$0.00,$135.38,$0.00,$0.00,$141.70,$809.30,$0.00,$404.65,$640.97,$647.44,$0.00,$122.97,$0.00,$128.84,$0.00
426.58,SUP,HCPCS C1713,,426.58  -  PLATE BONE BROAD 3.5MM 142X17.5X5.2MM 8 HOLE LC-DCP TITANIUM,$588.20,$0.00,$588.20,$264.69,$419.80,$0.00,$98.39,$0.00,$0.00,$102.99,$588.20,$0.00,$294.10,$465.85,$470.56,$0.00,$89.37,$0.00,$93.64,$0.00
426.581,SUP,HCPCS C1713,,426.581  -  PLATE BONE BROAD 152MM 8 HOLE LCP TITANIUM ORTHOPEDIC,$989.45,$0.00,$989.45,$445.25,$706.17,$0.00,$165.51,$0.00,$0.00,$173.24,$989.45,$0.00,$494.73,$783.64,$791.56,$0.00,$150.34,$0.00,$157.52,$0.00
426.59,SUP,HCPCS C1713,,426.59  -  PLATE BONE BROAD 160X17.5X5.2MM 9 HOLE LC-DCP TITANIUM LONG,$588.20,$0.00,$588.20,$264.69,$419.80,$0.00,$98.39,$0.00,$0.00,$102.99,$588.20,$0.00,$294.10,$465.85,$470.56,$0.00,$89.37,$0.00,$93.64,$0.00
426.591,SUP,HCPCS C1713,,426.591  -  PLATE BONE BROAD 170MM 9 HOLE LCP TITANIUM ORTHOPEDIC,"$1,069.98",$0.00,"$1,069.98",$481.49,$763.64,$0.00,$178.98,$0.00,$0.00,$187.34,"$1,069.98",$0.00,$534.99,$847.42,$855.98,$0.00,$162.57,$0.00,$170.34,$0.00
426.6,SUP,HCPCS C1713,,426.60  -  PLATE BONE BROAD 178X17.5X5.2MM 10 HOLE LC-DCP TITANIUM LONG,$588.20,$0.00,$588.20,$264.69,$419.80,$0.00,$98.39,$0.00,$0.00,$102.99,$588.20,$0.00,$294.10,$465.85,$470.56,$0.00,$89.37,$0.00,$93.64,$0.00
426.601,SUP,HCPCS C1713,,426.601  -  PLATE BONE BROAD 188MM 10 HOLE LCP TITANIUM ORTHOPEDIC,"$1,150.48",$0.00,"$1,150.48",$517.71,$821.09,$0.00,$192.45,$0.00,$0.00,$201.44,"$1,150.48",$0.00,$575.24,$911.18,$920.38,$0.00,$174.81,$0.00,$183.16,$0.00
426.61,SUP,HCPCS C1713,,426.61  -  PLATE BONE BROAD 196X17.5X5.2MM 11 HOLE LC-DCP TITANIUM LONG,$615.50,$0.00,$615.50,$276.98,$439.28,$0.00,$102.96,$0.00,$0.00,$107.77,$615.50,$0.00,$307.75,$487.48,$492.40,$0.00,$93.52,$0.00,$97.99,$0.00
426.611,SUP,HCPCS C1713,,426.611  -  PLATE BONE BROAD 206MM 11 HOLE LCP TITANIUM ORTHOPEDIC,"$1,225.55",$0.00,"$1,225.55",$551.50,$874.68,$0.00,$205.01,$0.00,$0.00,$214.58,"$1,225.55",$0.00,$612.78,$970.64,$980.44,$0.00,$186.21,$0.00,$195.11,$0.00
426.62,SUP,HCPCS C1713,,426.62  -  PLATE BONE BROAD 214X17.5X5.2MM 12 HOLE LC-DCP TITANIUM LONG,$615.50,$0.00,$615.50,$276.98,$439.28,$0.00,$102.96,$0.00,$0.00,$107.77,$615.50,$0.00,$307.75,$487.48,$492.40,$0.00,$93.52,$0.00,$97.99,$0.00
426.621,SUP,HCPCS C1713,,426.621  -  PLATE BONE BROAD 224MM 12 HOLE LCP TITANIUM ORTHOPEDIC,"$1,300.60",$0.00,"$1,300.60",$585.27,$928.24,$0.00,$217.56,$0.00,$0.00,$227.72,"$1,300.60",$0.00,$650.30,"$1,030.08","$1,040.48",$0.00,$197.62,$0.00,$207.06,$0.00
426.622,SUP,HCPCS C1713,,426.622  -  PLATE BONE BROAD 229MM 12 HOLE CVD LCP TITANIUM ORTHOPEDIC,"$1,300.60",$0.00,"$1,300.60",$585.27,$928.24,$0.00,$217.56,$0.00,$0.00,$227.72,"$1,300.60",$0.00,$650.30,"$1,030.08","$1,040.48",$0.00,$197.62,$0.00,$207.06,$0.00
426.632,SUP,HCPCS C1713,,426.632  -  PLATE BONE BROAD 247MM 13 HOLE CVD LCP TITANIUM ORTHOPEDIC,"$1,378.40",$0.00,"$1,378.40",$620.28,$983.76,$0.00,$230.57,$0.00,$0.00,$241.35,"$1,378.40",$0.00,$689.20,"$1,091.69","$1,102.72",$0.00,$209.44,$0.00,$219.44,$0.00
426.64,SUP,HCPCS C1713,,426.64  -  PLATE BONE BROAD 4.5MM 250X17.5X5.2MM 14 HOLE LC-DCP,$614.80,$0.00,$614.80,$276.66,$438.78,$0.00,$105.93,$0.00,$0.00,$107.65,$614.80,$0.00,$307.40,$486.92,$491.84,$0.00,$96.22,$0.00,$97.88,$0.00
426.641,SUP,HCPCS C1713,,426.641  -  PLATE BONE BROAD 260MM 14 HOLE LCP TITANIUM ORTHOPEDIC,"$1,448.00",$0.00,"$1,448.00",$651.60,"$1,033.44",$0.00,$242.22,$0.00,$0.00,$253.53,"$1,448.00",$0.00,$724.00,"$1,146.82","$1,158.40",$0.00,$220.01,$0.00,$230.52,$0.00
426.642,SUP,HCPCS C1713,,426.642  -  PLATE BONE BROAD CVD 265MM 14 HOLE LCP TITANIUM ANKLE,"$1,448.00",$0.00,"$1,448.00",$651.60,"$1,033.44",$0.00,$242.22,$0.00,$0.00,$253.53,"$1,448.00",$0.00,$724.00,"$1,146.82","$1,158.40",$0.00,$220.01,$0.00,$230.52,$0.00
426.652,SUP,HCPCS C1713,,426.652  -  PLATE BONE BROAD 282MM 15 HOLE CVD LCP TITANIUM ORTHOPEDIC,"$1,607.68",$0.00,"$1,607.68",$723.45,"$1,147.40",$0.00,$268.93,$0.00,$0.00,$281.49,"$1,607.68",$0.00,$803.84,"$1,273.28","$1,286.14",$0.00,$244.27,$0.00,$255.94,$0.00
426.66,SUP,HCPCS C1713,,426.66  -  PLATE BONE BROAD 286X17.5X5.2MM 16 HOLE LC-DCP TITANIUM LONG,$696.03,$0.00,$696.03,$313.21,$496.75,$0.00,$116.43,$0.00,$0.00,$121.87,$696.03,$0.00,$348.01,$551.26,$556.82,$0.00,$105.75,$0.00,$110.81,$0.00
426.661,SUP,HCPCS C1713,,426.661  -  PLATE BONE BROAD 296MM 16 HOLE LCP TITANIUM ORTHOPEDIC,"$1,759.18",$0.00,"$1,759.18",$791.63,"$1,255.52",$0.00,$294.27,$0.00,$0.00,$308.02,"$1,759.18",$0.00,$879.59,"$1,393.27","$1,407.34",$0.00,$267.29,$0.00,$280.06,$0.00
426.662,SUP,HCPCS C1713,,426.662  -  PLATE BONE BROAD 300MM 16 HOLE CVD LCP TITANIUM ORTHOPEDIC,"$1,759.18",$0.00,"$1,759.18",$791.63,"$1,255.52",$0.00,$294.27,$0.00,$0.00,$308.02,"$1,759.18",$0.00,$879.59,"$1,393.27","$1,407.34",$0.00,$267.29,$0.00,$280.06,$0.00
426.672,SUP,HCPCS C1713,,426.672  -  PLATE BONE BROAD 318MM 17 HOLE CVD LCP TITANIUM ORTHOPEDIC,"$1,842.43",$0.00,"$1,842.43",$829.09,"$1,314.94",$0.00,$308.19,$0.00,$0.00,$322.59,"$1,842.43",$0.00,$921.21,"$1,459.20","$1,473.94",$0.00,$279.94,$0.00,$293.31,$0.00
426.68,SUP,HCPCS C1713,,426.68  -  PLATE BONE BROAD 4.5MM 322X17.5X5.2MM 18 HOLE LC-DCP,$765.63,$0.00,$765.63,$344.53,$546.43,$0.00,$128.07,$0.00,$0.00,$134.05,$765.63,$0.00,$382.81,$606.38,$612.50,$0.00,$116.33,$0.00,$121.89,$0.00
426.681,SUP,HCPCS C1713,,426.681  -  PLATE BONE BROAD 332MM 18 HOLE LCP TITANIUM ORTHOPEDIC,"$2,070.33",$0.00,"$2,070.33",$931.65,"$1,477.59",$0.00,$346.32,$0.00,$0.00,$362.50,"$2,070.33",$0.00,"$1,035.16","$1,639.70","$1,656.26",$0.00,$314.57,$0.00,$329.60,$0.00
426.682,SUP,HCPCS C1713,,426.682  -  PLATE BONE BROAD 336MM 18 HOLE CVD LCP TITANIUM ORTHOPEDIC,"$2,007.55",$0.00,"$2,007.55",$903.40,"$1,432.79",$0.00,$335.82,$0.00,$0.00,$351.51,"$2,007.55",$0.00,"$1,003.78","$1,589.98","$1,606.04",$0.00,$305.03,$0.00,$319.60,$0.00
426.7,SUP,HCPCS C1713,,426.70  -  PLATE BONE BROAD 358X17.5X5.2MM 20 HOLE LC-DCP TITANIUM LONG,"$1,123.20",$0.00,"$1,123.20",$505.44,$801.63,$0.00,$187.88,$0.00,$0.00,$196.66,"$1,123.20",$0.00,$561.60,$889.57,$898.56,$0.00,$170.66,$0.00,$178.81,$0.00
426.701,SUP,HCPCS C1713,,426.701  -  PLATE BONE BROAD 368MM 20 HOLE LCP TITANIUM ORTHOPEDIC,"$2,287.33",$0.00,"$2,287.33","$1,029.30","$1,632.46",$0.00,$382.62,$0.00,$0.00,$400.49,"$2,287.33",$0.00,"$1,143.66","$1,811.57","$1,829.86",$0.00,$347.54,$0.00,$364.14,$0.00
426.72,SUP,HCPCS C1713,,426.72  -  PLATE BONE BROAD 394X17.5X5.2MM 22 HOLE LC-DCP TITANIUM LONG,"$1,209.18",$0.00,"$1,209.18",$544.13,$862.99,$0.00,$202.27,$0.00,$0.00,$211.72,"$1,209.18",$0.00,$604.59,$957.67,$967.34,$0.00,$183.72,$0.00,$192.50,$0.00
426.721,SUP,HCPCS C1713,,426.721  -  PLATE BONE BROAD 404MM 22 HOLE LCP TITANIUM ORTHOPEDIC,"$2,507.05",$0.00,"$2,507.05","$1,128.17","$1,789.28",$0.00,$419.37,$0.00,$0.00,$438.96,"$2,507.05",$0.00,"$1,253.53","$1,985.58","$2,005.64",$0.00,$380.92,$0.00,$399.12,$0.00
426.74,SUP,HCPCS C1713,,426.74  -  PLATE BONE BROAD 430X17.5X5.2MM 24 HOLE LC-DCP TITANIUM LONG,"$1,295.15",$0.00,"$1,295.15",$582.82,$924.35,$0.00,$216.65,$0.00,$0.00,$226.77,"$1,295.15",$0.00,$647.58,"$1,025.76","$1,036.12",$0.00,$196.79,$0.00,$206.19,$0.00
429.331,SUP,HCPCS C1713,,429.331  -  PLATE BONE 56MM 3 HOLE STR RECONSTRUCTION LCP TITANIUM,$753.35,$0.00,$753.35,$339.01,$537.67,$0.00,$126.02,$0.00,$0.00,$131.91,$753.35,$0.00,$376.68,$596.65,$602.68,$0.00,$114.46,$0.00,$119.93,$0.00
429.341,SUP,HCPCS C1713,,429.341  -  PLATE BONE 75MM 4 HOLE STR RECONSTRUCTION LCP TITANIUM,$788.83,$0.00,$788.83,$354.97,$562.98,$0.00,$131.95,$0.00,$0.00,$138.12,$788.83,$0.00,$394.41,$624.75,$631.06,$0.00,$119.86,$0.00,$125.58,$0.00
429.351,SUP,HCPCS C1713,,429.351  -  PLATE BONE 94MM 5 HOLE STR RECONSTRUCTION LCP TITANIUM,$852.98,$0.00,$852.98,$383.84,$608.77,$0.00,$142.68,$0.00,$0.00,$149.35,$852.98,$0.00,$426.49,$675.56,$682.38,$0.00,$129.60,$0.00,$135.79,$0.00
429.361,SUP,HCPCS C1713,,429.361  -  PLATE BONE 113MM 6 HOLE STR RECONSTRUCTION LCP TITANIUM,$910.30,$0.00,$910.30,$409.64,$649.68,$0.00,$152.27,$0.00,$0.00,$159.39,$910.30,$0.00,$455.15,$720.96,$728.24,$0.00,$138.31,$0.00,$144.92,$0.00
429.371,SUP,HCPCS C1713,,429.371  -  PLATE BONE 132MM 7 HOLE STR RECONSTRUCTION LCP TITANIUM,$952.60,$0.00,$952.60,$428.67,$679.87,$0.00,$159.35,$0.00,$0.00,$166.79,$952.60,$0.00,$476.30,$754.46,$762.08,$0.00,$144.74,$0.00,$151.65,$0.00
429.381,SUP,HCPCS C1713,,429.381  -  PLATE BONE 151MM 8 HOLE STR RECONSTRUCTION LCP TITANIUM,"$1,001.73",$0.00,"$1,001.73",$450.78,$714.93,$0.00,$167.57,$0.00,$0.00,$175.39,"$1,001.73",$0.00,$500.86,$793.37,$801.38,$0.00,$152.20,$0.00,$159.47,$0.00
429.391,SUP,HCPCS C1713,,429.391  -  PLATE BONE 170MM 9 HOLE STR RECONSTRUCTION LCP TITANIUM,"$1,072.70",$0.00,"$1,072.70",$482.72,$765.59,$0.00,$179.44,$0.00,$0.00,$187.82,"$1,072.70",$0.00,$536.35,$849.58,$858.16,$0.00,$162.99,$0.00,$170.77,$0.00
429.401,SUP,HCPCS C1713,,429.401  -  PLATE BONE 189MM 10 HOLE STR RECONSTRUCTION LCP TITANIUM,"$1,124.55",$0.00,"$1,124.55",$506.05,$802.59,$0.00,$188.11,$0.00,$0.00,$196.90,"$1,124.55",$0.00,$562.28,$890.64,$899.64,$0.00,$170.87,$0.00,$179.03,$0.00
429.411,SUP,HCPCS C1713,,429.411  -  PLATE BONE 208MM 11 HOLE STR RECONSTRUCTION LCP TITANIUM,"$1,161.40",$0.00,"$1,161.40",$522.63,$828.89,$0.00,$194.28,$0.00,$0.00,$203.35,"$1,161.40",$0.00,$580.70,$919.83,$929.12,$0.00,$176.47,$0.00,$184.89,$0.00
429.421,SUP,HCPCS C1713,,429.421  -  PLATE BONE 227MM 12 HOLE STR RECONSTRUCTION LCP TITANIUM,"$1,217.35",$0.00,"$1,217.35",$547.81,$868.82,$0.00,$203.64,$0.00,$0.00,$213.15,"$1,217.35",$0.00,$608.68,$964.14,$973.88,$0.00,$184.97,$0.00,$193.80,$0.00
429.431,SUP,HCPCS C1713,,429.431  -  PLATE BONE 246MM 13 HOLE STR RECONSTRUCTION LCP TITANIUM,"$1,295.15",$0.00,"$1,295.15",$582.82,$924.35,$0.00,$216.65,$0.00,$0.00,$226.77,"$1,295.15",$0.00,$647.58,"$1,025.76","$1,036.12",$0.00,$196.79,$0.00,$206.19,$0.00
429.441,SUP,HCPCS C1713,,429.441  -  PLATE BONE 265MM 14 HOLE STR RECONSTRUCTION LCP TITANIUM,"$1,330.63",$0.00,"$1,330.63",$598.78,$949.67,$0.00,$222.58,$0.00,$0.00,$232.98,"$1,330.63",$0.00,$665.31,"$1,053.86","$1,064.50",$0.00,$202.18,$0.00,$211.84,$0.00
429.451,SUP,HCPCS C1713,,429.451  -  PLATE BONE 284MM 15 HOLE STR RECONSTRUCTION LCP TITANIUM,"$1,386.58",$0.00,"$1,386.58",$623.96,$989.60,$0.00,$231.94,$0.00,$0.00,$242.78,"$1,386.58",$0.00,$693.29,"$1,098.17","$1,109.26",$0.00,$210.68,$0.00,$220.74,$0.00
429.461,SUP,HCPCS C1713,,429.461  -  PLATE BONE 303MM 16 HOLE STR RECONSTRUCTION LCP TITANIUM,"$1,423.43",$0.00,"$1,423.43",$640.54,"$1,015.90",$0.00,$238.11,$0.00,$0.00,$249.23,"$1,423.43",$0.00,$711.71,"$1,127.36","$1,138.74",$0.00,$216.28,$0.00,$226.61,$0.00
432.006,SUP,HCPCS C1713,,432.006  -  PLATE BONE 90D 30MM 10 HOLE CANN LC ANGLED TITANIUM,"$1,929.20",$0.00,"$1,929.20",$868.14,"$1,376.87",$0.00,$332.39,$0.00,$0.00,$337.79,"$1,929.20",$0.00,$964.60,"$1,527.93","$1,543.36",$0.00,$301.92,$0.00,$307.13,$0.00
432.007,SUP,HCPCS C1713,,432.007  -  PLATE BONE 90D 35MM 10 HOLE CANN LC ANGLED TITANIUM,"$1,929.20",$0.00,"$1,929.20",$868.14,"$1,376.87",$0.00,$332.39,$0.00,$0.00,$337.79,"$1,929.20",$0.00,$964.60,"$1,527.93","$1,543.36",$0.00,$301.92,$0.00,$307.13,$0.00
432.008,SUP,HCPCS C1713,,432.008  -  PLATE BONE 90D 40MM 10 HOLE CANN LC ANGLED TITANIUM,"$1,929.20",$0.00,"$1,929.20",$868.14,"$1,376.87",$0.00,$332.39,$0.00,$0.00,$337.79,"$1,929.20",$0.00,$964.60,"$1,527.93","$1,543.36",$0.00,$301.92,$0.00,$307.13,$0.00
432.009,SUP,HCPCS C1713,,432.009  -  PLATE BONE 90D 45MM 10 HOLE CANN LC ANGLED TITANIUM,"$1,929.20",$0.00,"$1,929.20",$868.14,"$1,376.87",$0.00,$332.39,$0.00,$0.00,$337.79,"$1,929.20",$0.00,$964.60,"$1,527.93","$1,543.36",$0.00,$301.92,$0.00,$307.13,$0.00
432.046,SUP,HCPCS C1713,,432.046  -  PLATE BONE 90D 30MM 4 HOLE CANN LC ANGLED TITANIUM,"$1,538.33",$0.00,"$1,538.33",$692.25,"$1,097.90",$0.00,$265.05,$0.00,$0.00,$269.35,"$1,538.33",$0.00,$769.16,"$1,218.36","$1,230.66",$0.00,$240.75,$0.00,$244.90,$0.00
432.047,SUP,HCPCS C1713,,432.047  -  PLATE BONE 90D 35MM 4 HOLE CANN LC ANGLED TITANIUM,"$1,538.33",$0.00,"$1,538.33",$692.25,"$1,097.90",$0.00,$265.05,$0.00,$0.00,$269.35,"$1,538.33",$0.00,$769.16,"$1,218.36","$1,230.66",$0.00,$240.75,$0.00,$244.90,$0.00
432.048,SUP,HCPCS C1713,,432.048  -  PLATE BONE 90D 40MM 4 HOLE CANN LC ANGLED TITANIUM,"$1,538.33",$0.00,"$1,538.33",$692.25,"$1,097.90",$0.00,$265.05,$0.00,$0.00,$269.35,"$1,538.33",$0.00,$769.16,"$1,218.36","$1,230.66",$0.00,$240.75,$0.00,$244.90,$0.00
432.049,SUP,HCPCS C1713,,432.049  -  PLATE BONE 90D 45MM 4 HOLE CANN LC ANGLED TITANIUM,"$1,538.33",$0.00,"$1,538.33",$692.25,"$1,097.90",$0.00,$265.05,$0.00,$0.00,$269.35,"$1,538.33",$0.00,$769.16,"$1,218.36","$1,230.66",$0.00,$240.75,$0.00,$244.90,$0.00
432.056,SUP,HCPCS C1713,,432.056  -  PLATE BONE 90D 30MM 5 HOLE CANN LC ANGLED TITANIUM,"$1,625.78",$0.00,"$1,625.78",$731.60,"$1,160.32",$0.00,$280.11,$0.00,$0.00,$284.66,"$1,625.78",$0.00,$812.89,"$1,287.62","$1,300.62",$0.00,$254.43,$0.00,$258.82,$0.00
432.057,SUP,HCPCS C1713,,432.057  -  PLATE BONE 90D 35MM 5 HOLE CANN LC ANGLED TITANIUM,"$1,625.78",$0.00,"$1,625.78",$731.60,"$1,160.32",$0.00,$280.11,$0.00,$0.00,$284.66,"$1,625.78",$0.00,$812.89,"$1,287.62","$1,300.62",$0.00,$254.43,$0.00,$258.82,$0.00
432.058,SUP,HCPCS C1713,,432.058  -  PLATE BONE 90D 40MM 5 HOLE CANN LC ANGLED TITANIUM,"$1,625.78",$0.00,"$1,625.78",$731.60,"$1,160.32",$0.00,$280.11,$0.00,$0.00,$284.66,"$1,625.78",$0.00,$812.89,"$1,287.62","$1,300.62",$0.00,$254.43,$0.00,$258.82,$0.00
432.059,SUP,HCPCS C1713,,432.059  -  PLATE BONE 90D 45MM 5 HOLE CANN LC ANGLED TITANIUM,"$1,625.78",$0.00,"$1,625.78",$731.60,"$1,160.32",$0.00,$280.11,$0.00,$0.00,$284.66,"$1,625.78",$0.00,$812.89,"$1,287.62","$1,300.62",$0.00,$254.43,$0.00,$258.82,$0.00
432.066,SUP,HCPCS C1713,,432.066  -  PLATE BONE 90D 30MM 6 HOLE CANN LC ANGLED TITANIUM,"$1,696.00",$0.00,"$1,696.00",$763.20,"$1,210.44",$0.00,$292.21,$0.00,$0.00,$296.96,"$1,696.00",$0.00,$848.00,"$1,343.23","$1,356.80",$0.00,$265.42,$0.00,$270.00,$0.00
432.067,SUP,HCPCS C1713,,432.067  -  PLATE BONE 90D 35MM 6 HOLE CANN LC ANGLED TITANIUM,"$1,696.00",$0.00,"$1,696.00",$763.20,"$1,210.44",$0.00,$292.21,$0.00,$0.00,$296.96,"$1,696.00",$0.00,$848.00,"$1,343.23","$1,356.80",$0.00,$265.42,$0.00,$270.00,$0.00
432.068,SUP,HCPCS C1713,,432.068  -  PLATE BONE 90D 40MM 6 HOLE CANN LC ANGLED TITANIUM,"$1,696.00",$0.00,"$1,696.00",$763.20,"$1,210.44",$0.00,$292.21,$0.00,$0.00,$296.96,"$1,696.00",$0.00,$848.00,"$1,343.23","$1,356.80",$0.00,$265.42,$0.00,$270.00,$0.00
432.069,SUP,HCPCS C1713,,432.069  -  PLATE BONE 90D 45MM 6 HOLE CANN LC ANGLED TITANIUM,"$1,696.00",$0.00,"$1,696.00",$763.20,"$1,210.44",$0.00,$292.21,$0.00,$0.00,$296.96,"$1,696.00",$0.00,$848.00,"$1,343.23","$1,356.80",$0.00,$265.42,$0.00,$270.00,$0.00
432.086,SUP,HCPCS C1713,,432.086  -  PLATE BONE 90D 30MM 8 HOLE CANN LC ANGLED TITANIUM,"$1,819.23",$0.00,"$1,819.23",$818.65,"$1,298.38",$0.00,$313.44,$0.00,$0.00,$318.53,"$1,819.23",$0.00,$909.61,"$1,440.83","$1,455.38",$0.00,$284.71,$0.00,$289.62,$0.00
432.087,SUP,HCPCS C1713,,432.087  -  PLATE BONE 90D 106MM 35MM 8 HOLE CANN ANGLED TITANIUM,"$1,819.23",$0.00,"$1,819.23",$818.65,"$1,298.38",$0.00,$313.44,$0.00,$0.00,$318.53,"$1,819.23",$0.00,$909.61,"$1,440.83","$1,455.38",$0.00,$284.71,$0.00,$289.62,$0.00
432.088,SUP,HCPCS C1713,,432.088  -  PLATE BONE 90D 40MM 8 HOLE CANN LC ANGLE BLADE TITANIUM,"$1,819.23",$0.00,"$1,819.23",$818.65,"$1,298.38",$0.00,$313.44,$0.00,$0.00,$318.53,"$1,819.23",$0.00,$909.61,"$1,440.83","$1,455.38",$0.00,$284.71,$0.00,$289.62,$0.00
432.089,SUP,HCPCS C1713,,432.089  -  PLATE BONE 90D 45MM 8 HOLE CANN LC ANGLED TITANIUM,"$1,819.23",$0.00,"$1,819.23",$818.65,"$1,298.38",$0.00,$313.44,$0.00,$0.00,$318.53,"$1,819.23",$0.00,$909.61,"$1,440.83","$1,455.38",$0.00,$284.71,$0.00,$289.62,$0.00
433,SUP,Custom 27203010,,433  -  CUTTER 433 WIRE MODIFIED W/CARBIDE,"$1,126.25",$0.00,"$1,126.25",$0.00,$803.80,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,126.25",$0.00,$563.13,$891.99,$901.00,$0.00,$0.00,$0.00,$0.00,$0.00
436.502,SUP,HCPCS C1713,,436.502  -  PLATE BONE 86MM 2 HOLE LCP TITANIUM RIGHT OLECRANON NONSTRL,"$1,651.35",$0.00,"$1,651.35",$743.11,"$1,178.57",$0.00,$276.23,$0.00,$0.00,$289.14,"$1,651.35",$0.00,$825.68,"$1,307.87","$1,321.08",$0.00,$250.91,$0.00,$262.89,$0.00
436.503,SUP,HCPCS C1713,,436.503  -  PLATE BONE 86MM 2 HOLE LCP TITANIUM LEFT OLECRANON NONSTRL,"$1,651.35",$0.00,"$1,651.35",$743.11,"$1,178.57",$0.00,$276.23,$0.00,$0.00,$289.14,"$1,651.35",$0.00,$825.68,"$1,307.87","$1,321.08",$0.00,$250.91,$0.00,$262.89,$0.00
436.506,SUP,HCPCS C1713,,436.506  -  PLATE BONE 138MM 6 HOLE LCP TITANIUM RIGHT OLECRANON NONSTRL,"$1,778.28",$0.00,"$1,778.28",$800.22,"$1,269.15",$0.00,$297.46,$0.00,$0.00,$311.36,"$1,778.28",$0.00,$889.14,"$1,408.40","$1,422.62",$0.00,$270.19,$0.00,$283.10,$0.00
436.507,SUP,HCPCS C1713,,436.507  -  PLATE BONE 138MM 6 HOLE LCP TITANIUM LEFT OLECRANON NONSTRL,"$1,811.03",$0.00,"$1,811.03",$814.96,"$1,292.53",$0.00,$302.94,$0.00,$0.00,$317.10,"$1,811.03",$0.00,$905.51,"$1,434.34","$1,448.82",$0.00,$275.17,$0.00,$288.32,$0.00
436.51,SUP,HCPCS C1713,,436.510  -  PLATE BONE 189MM 10 HOLE LCP TITANIUM RIGHT OLECRANON ELBOW,"$1,918.85",$0.00,"$1,918.85",$863.48,"$1,369.48",$0.00,$320.98,$0.00,$0.00,$335.98,"$1,918.85",$0.00,$959.43,"$1,519.73","$1,535.08",$0.00,$291.55,$0.00,$305.48,$0.00
436.511,SUP,HCPCS C1713,,436.511  -  PLATE BONE 189MM 10 HOLE LCP TITANIUM LEFT OLECRANON ELBOW,"$1,918.85",$0.00,"$1,918.85",$863.48,"$1,369.48",$0.00,$320.98,$0.00,$0.00,$335.98,"$1,918.85",$0.00,$959.43,"$1,519.73","$1,535.08",$0.00,$291.55,$0.00,$305.48,$0.00
436.512,SUP,HCPCS C1713,,436.512  -  PLATE BONE 215MM 12 HOLE LCP TITANIUM RIGHT OLECRANON ELBOW,"$1,954.33",$0.00,"$1,954.33",$879.45,"$1,394.80",$0.00,$326.91,$0.00,$0.00,$342.19,"$1,954.33",$0.00,$977.16,"$1,547.83","$1,563.46",$0.00,$296.94,$0.00,$311.13,$0.00
436.513,SUP,HCPCS C1713,,436.513  -  PLATE BONE 215MM 13 HOLE LCP TITANIUM LEFT OLECRANON ELBOW,"$1,954.33",$0.00,"$1,954.33",$879.45,"$1,394.80",$0.00,$326.91,$0.00,$0.00,$342.19,"$1,954.33",$0.00,$977.16,"$1,547.83","$1,563.46",$0.00,$296.94,$0.00,$311.13,$0.00
437.2,SUP,HCPCS C1713,,437.20  -  PLATE BONE 95D 50MM 12 HOLE DCP TITANIUM CONDYLE NONSTRL,"$1,268.03",$0.00,"$1,268.03",$570.61,$904.99,$0.00,$218.47,$0.00,$0.00,$222.02,"$1,268.03",$0.00,$634.01,"$1,004.28","$1,014.42",$0.00,$198.45,$0.00,$201.87,$0.00
437.22,SUP,HCPCS C1713,,437.22  -  PLATE BONE 95D 204MM 60MM 12 HOLE DCP TITANIUM CONDYLE,"$1,268.03",$0.00,"$1,268.03",$570.61,$904.99,$0.00,$218.47,$0.00,$0.00,$222.02,"$1,268.03",$0.00,$634.01,"$1,004.28","$1,014.42",$0.00,$198.45,$0.00,$201.87,$0.00
437.24,SUP,HCPCS C1713,,437.24  -  PLATE BONE 95D 70MM 12 HOLE DCP TITANIUM CONDYLE NONSTRL,"$1,268.03",$0.00,"$1,268.03",$570.61,$904.99,$0.00,$218.47,$0.00,$0.00,$222.02,"$1,268.03",$0.00,$634.01,"$1,004.28","$1,014.42",$0.00,$198.45,$0.00,$201.87,$0.00
437.26,SUP,HCPCS C1713,,437.26  -  PLATE BONE 95D 204MM 80MM 12 HOLE DCP TITANIUM CONDYLE,"$1,268.03",$0.00,"$1,268.03",$570.61,$904.99,$0.00,$218.47,$0.00,$0.00,$222.02,"$1,268.03",$0.00,$634.01,"$1,004.28","$1,014.42",$0.00,$198.45,$0.00,$201.87,$0.00
437.5,SUP,HCPCS C1713,,437.50  -  PLATE BONE 95D 50MM 5 HOLE DCP TITANIUM CONDYLE NONSTRL,"$1,045.43",$0.00,"$1,045.43",$470.44,$746.12,$0.00,$180.12,$0.00,$0.00,$183.05,"$1,045.43",$0.00,$522.71,$827.98,$836.34,$0.00,$163.61,$0.00,$166.43,$0.00
437.52,SUP,HCPCS C1713,,437.52  -  PLATE BONE 95D 60MM 5 HOLE DCP TITANIUM CONDYLE NONSTRL,"$1,045.43",$0.00,"$1,045.43",$470.44,$746.12,$0.00,$180.12,$0.00,$0.00,$183.05,"$1,045.43",$0.00,$522.71,$827.98,$836.34,$0.00,$163.61,$0.00,$166.43,$0.00
437.54,SUP,HCPCS C1713,,437.54  -  PLATE BONE 95D 70MM 5 HOLE DCP TITANIUM CONDYLE NONSTRL,"$1,045.43",$0.00,"$1,045.43",$470.44,$746.12,$0.00,$180.12,$0.00,$0.00,$183.05,"$1,045.43",$0.00,$522.71,$827.98,$836.34,$0.00,$163.61,$0.00,$166.43,$0.00
437.56,SUP,HCPCS C1713,,437.56  -  PLATE BONE 95D 80MM 5 HOLE DCP TITANIUM CONDYLE NONSTRL,"$1,045.43",$0.00,"$1,045.43",$470.44,$746.12,$0.00,$180.12,$0.00,$0.00,$183.05,"$1,045.43",$0.00,$522.71,$827.98,$836.34,$0.00,$163.61,$0.00,$166.43,$0.00
437.7,SUP,HCPCS C1713,,437.70  -  PLATE BONE 95D 50MM 7 HOLE DCP TITANIUM CONDYLE NONSTRL,"$1,093.13",$0.00,"$1,093.13",$491.91,$780.16,$0.00,$188.34,$0.00,$0.00,$191.40,"$1,093.13",$0.00,$546.56,$865.76,$874.50,$0.00,$171.07,$0.00,$174.03,$0.00
437.72,SUP,HCPCS C1713,,437.72  -  PLATE BONE 95D 60MM 7 HOLE DCP TITANIUM CONDYLE NONSTRL,"$1,093.13",$0.00,"$1,093.13",$491.91,$780.16,$0.00,$188.34,$0.00,$0.00,$191.40,"$1,093.13",$0.00,$546.56,$865.76,$874.50,$0.00,$171.07,$0.00,$174.03,$0.00
437.74,SUP,HCPCS C1713,,437.74  -  PLATE BONE 95D 70MM 7 HOLE DCP TITANIUM CONDYLE NONSTRL,"$1,093.13",$0.00,"$1,093.13",$491.91,$780.16,$0.00,$188.34,$0.00,$0.00,$191.40,"$1,093.13",$0.00,$546.56,$865.76,$874.50,$0.00,$171.07,$0.00,$174.03,$0.00
437.76,SUP,HCPCS C1713,,437.76  -  PLATE BONE 95D 80MM 7 HOLE DCP TITANIUM CONDYLE NONSTRL,"$1,093.13",$0.00,"$1,093.13",$491.91,$780.16,$0.00,$188.34,$0.00,$0.00,$191.40,"$1,093.13",$0.00,$546.56,$865.76,$874.50,$0.00,$171.07,$0.00,$174.03,$0.00
437.9,SUP,HCPCS C1713,,437.90  -  PLATE BONE 95D 50MM 9 HOLE DCP TITANIUM CONDYLE NONSTRL,"$1,147.45",$0.00,"$1,147.45",$516.35,$818.94,$0.00,$197.70,$0.00,$0.00,$200.91,"$1,147.45",$0.00,$573.73,$908.78,$917.96,$0.00,$179.58,$0.00,$182.67,$0.00
437.92,SUP,HCPCS C1713,,437.92  -  PLATE BONE 95D 60MM 9 HOLE DCP TITANIUM CONDYLE NONSTRL,"$1,147.45",$0.00,"$1,147.45",$516.35,$818.94,$0.00,$197.70,$0.00,$0.00,$200.91,"$1,147.45",$0.00,$573.73,$908.78,$917.96,$0.00,$179.58,$0.00,$182.67,$0.00
437.94,SUP,HCPCS C1713,,437.94  -  PLATE BONE 95D 70MM 9 HOLE DCP TITANIUM CONDYLE NONSTRL,"$1,164.68",$0.00,"$1,164.68",$524.10,$831.23,$0.00,$200.67,$0.00,$0.00,$203.93,"$1,164.68",$0.00,$582.34,$922.43,$931.74,$0.00,$182.27,$0.00,$185.42,$0.00
437.96,SUP,HCPCS C1713,,437.96  -  PLATE BONE 95D 80MM 9 HOLE DCP TITANIUM CONDYLE NONSTRL,"$1,164.68",$0.00,"$1,164.68",$524.10,$831.23,$0.00,$200.67,$0.00,$0.00,$203.93,"$1,164.68",$0.00,$582.34,$922.43,$931.74,$0.00,$182.27,$0.00,$185.42,$0.00
438.24,SUP,HCPCS C1713,,438.24  -  PLATE BONE 130D 70MM 12 HOLE ANGLED DCP TITANIUM ORTHOPEDIC,"$1,276.05",$0.00,"$1,276.05",$574.22,$910.72,$0.00,$213.45,$0.00,$0.00,$223.43,"$1,276.05",$0.00,$638.03,"$1,010.63","$1,020.84",$0.00,$193.88,$0.00,$203.15,$0.00
438.26,SUP,HCPCS C1713,,438.26  -  PLATE BONE 130D 80MM 12 HOLE ANGLED DCP TITANIUM ORTHOPEDIC,"$1,276.05",$0.00,"$1,276.05",$574.22,$910.72,$0.00,$213.45,$0.00,$0.00,$223.43,"$1,276.05",$0.00,$638.03,"$1,010.63","$1,020.84",$0.00,$193.88,$0.00,$203.15,$0.00
438.28,SUP,HCPCS C1713,,438.28  -  PLATE BONE 130D 90MM 12 HOLE ANGLED DCP TITANIUM ORTHOPEDIC,"$1,276.05",$0.00,"$1,276.05",$574.22,$910.72,$0.00,$213.45,$0.00,$0.00,$223.43,"$1,276.05",$0.00,$638.03,"$1,010.63","$1,020.84",$0.00,$193.88,$0.00,$203.15,$0.00
438.36,SUP,HCPCS C1713,,438.36  -  PLATE BONE 130D 50MM 4 HOLE ANGLED DCP TITANIUM ORTHOPEDIC,$943.05,$0.00,$943.05,$424.37,$673.05,$0.00,$157.75,$0.00,$0.00,$165.12,$943.05,$0.00,$471.53,$746.90,$754.44,$0.00,$143.29,$0.00,$150.13,$0.00
438.38,SUP,HCPCS C1713,,438.38  -  PLATE BONE 130D 60MM 4 HOLE ANGLED DCP TITANIUM ORTHOPEDIC,$943.05,$0.00,$943.05,$424.37,$673.05,$0.00,$157.75,$0.00,$0.00,$165.12,$943.05,$0.00,$471.53,$746.90,$754.44,$0.00,$143.29,$0.00,$150.13,$0.00
438.4,SUP,HCPCS C1713,,438.40  -  PLATE BONE 130D 100MM 4 HOLE ANGLE BLADE DCP TITANIUM,$943.05,$0.00,$943.05,$424.37,$673.05,$0.00,$157.75,$0.00,$0.00,$165.12,$943.05,$0.00,$471.53,$746.90,$754.44,$0.00,$143.29,$0.00,$150.13,$0.00
438.41,SUP,HCPCS C1713,,438.41  -  PLATE BONE 130D 105MM 4 HOLE ANGLED DCP TITANIUM ORTHOPEDIC,$943.05,$0.00,$943.05,$424.37,$673.05,$0.00,$157.75,$0.00,$0.00,$165.12,$943.05,$0.00,$471.53,$746.90,$754.44,$0.00,$143.29,$0.00,$150.13,$0.00
438.42,SUP,HCPCS C1713,,438.42  -  PLATE BONE 130D 110MM 4 HOLE ANGLED DCP TITANIUM ORTHOPEDIC,$943.05,$0.00,$943.05,$424.37,$673.05,$0.00,$157.75,$0.00,$0.00,$165.12,$943.05,$0.00,$471.53,$746.90,$754.44,$0.00,$143.29,$0.00,$150.13,$0.00
438.44,SUP,HCPCS C1713,,438.44  -  PLATE BONE 130D 70MM 4 HOLE ANGLED DCP TITANIUM ORTHOPEDIC,$943.05,$0.00,$943.05,$424.37,$673.05,$0.00,$157.75,$0.00,$0.00,$165.12,$943.05,$0.00,$471.53,$746.90,$754.44,$0.00,$143.29,$0.00,$150.13,$0.00
438.45,SUP,HCPCS C1713,,438.45  -  PLATE BONE 130D 75MM 4 HOLE ANGLED DCP TITANIUM ORTHOPEDIC,$943.05,$0.00,$943.05,$424.37,$673.05,$0.00,$157.75,$0.00,$0.00,$165.12,$943.05,$0.00,$471.53,$746.90,$754.44,$0.00,$143.29,$0.00,$150.13,$0.00
438.46,SUP,HCPCS C1713,,438.46  -  PLATE BONE 130D 80MM 4 HOLE ANGLED DCP TITANIUM ORTHOPEDIC,$943.05,$0.00,$943.05,$424.37,$673.05,$0.00,$157.75,$0.00,$0.00,$165.12,$943.05,$0.00,$471.53,$746.90,$754.44,$0.00,$143.29,$0.00,$150.13,$0.00
438.47,SUP,HCPCS C1713,,438.47  -  PLATE BONE 130D 85MM 4 HOLE ANGLED DCP TITANIUM ORTHOPEDIC,$943.05,$0.00,$943.05,$424.37,$673.05,$0.00,$157.75,$0.00,$0.00,$165.12,$943.05,$0.00,$471.53,$746.90,$754.44,$0.00,$143.29,$0.00,$150.13,$0.00
438.48,SUP,HCPCS C1713,,438.48  -  PLATE BONE 130D 90MM 4 HOLE ANGLED DCP TITANIUM ORTHOPEDIC,$943.05,$0.00,$943.05,$424.37,$673.05,$0.00,$157.75,$0.00,$0.00,$165.12,$943.05,$0.00,$471.53,$746.90,$754.44,$0.00,$143.29,$0.00,$150.13,$0.00
438.49,SUP,HCPCS C1713,,438.49  -  PLATE BONE 130D 95MM 4 HOLE ANGLED DCP TITANIUM ORTHOPEDIC,$943.05,$0.00,$943.05,$424.37,$673.05,$0.00,$157.75,$0.00,$0.00,$165.12,$943.05,$0.00,$471.53,$746.90,$754.44,$0.00,$143.29,$0.00,$150.13,$0.00
438.6,SUP,HCPCS C1713,,438.60  -  PLATE BONE 130D 50MM 6 HOLE ANGLE BLADE DCP TITANIUM NONSTRL,"$1,007.18",$0.00,"$1,007.18",$453.23,$718.82,$0.00,$168.48,$0.00,$0.00,$176.35,"$1,007.18",$0.00,$503.59,$797.69,$805.74,$0.00,$153.03,$0.00,$160.34,$0.00
438.62,SUP,HCPCS C1713,,438.62  -  PLATE BONE 130D 60MM 6 HOLE ANGLED DCP TITANIUM ORTHOPEDIC,"$1,007.18",$0.00,"$1,007.18",$453.23,$718.82,$0.00,$168.48,$0.00,$0.00,$176.35,"$1,007.18",$0.00,$503.59,$797.69,$805.74,$0.00,$153.03,$0.00,$160.34,$0.00
438.64,SUP,HCPCS C1713,,438.64  -  PLATE BONE 130D 70MM 6 HOLE ANGLED DCP TITANIUM ORTHOPEDIC,"$1,007.18",$0.00,"$1,007.18",$453.23,$718.82,$0.00,$168.48,$0.00,$0.00,$176.35,"$1,007.18",$0.00,$503.59,$797.69,$805.74,$0.00,$153.03,$0.00,$160.34,$0.00
438.66,SUP,HCPCS C1713,,438.66  -  PLATE BONE 130D 80MM 6 HOLE ANGLED DCP TITANIUM ORTHOPEDIC,"$1,007.18",$0.00,"$1,007.18",$453.23,$718.82,$0.00,$168.48,$0.00,$0.00,$176.35,"$1,007.18",$0.00,$503.59,$797.69,$805.74,$0.00,$153.03,$0.00,$160.34,$0.00
438.68,SUP,HCPCS C1713,,438.68  -  PLATE BLADE 130D 90MM 6 HOLE ANGLED DCP TITANIUM ORTHOPEDIC,"$1,007.18",$0.00,"$1,007.18",$453.23,$718.82,$0.00,$168.48,$0.00,$0.00,$176.35,"$1,007.18",$0.00,$503.59,$797.69,$805.74,$0.00,$153.03,$0.00,$160.34,$0.00
438.7,SUP,HCPCS C1713,,438.700  -  PLATE BONE 116MM 4 HOLE W/O TAB LCP TITANIUM TIBIA RIGHT,"$2,530.75",$0.00,"$2,530.75","$1,138.84","$1,806.20",$0.00,$436.04,$0.00,$0.00,$443.11,"$2,530.75",$0.00,"$1,265.38","$2,004.35","$2,024.60",$0.00,$396.06,$0.00,$402.90,$0.00
438.701,SUP,HCPCS C1713,,438.701  -  PLATE 116MM TI 3.5MM SCR 4 HOLE W/O TAB LCP BONE LEFT DISTAL,"$3,294.20",$0.00,"$3,294.20","$1,482.39","$2,351.07",$0.00,$567.57,$0.00,$0.00,$576.79,"$3,294.20",$0.00,"$1,647.10","$2,609.01","$2,635.36",$0.00,$515.54,$0.00,$524.44,$0.00
438.703,SUP,HCPCS C1713,,438.703  -  PLATE 142MM TI 3.5MM SCR 6 HOLE W/O TAB LCP BONE LEFT DISTAL,"$3,234.43",$0.00,"$3,234.43","$1,455.49","$2,308.41",$0.00,$557.28,$0.00,$0.00,$566.32,"$3,234.43",$0.00,"$1,617.21","$2,561.67","$2,587.54",$0.00,$506.19,$0.00,$514.92,$0.00
438.705,SUP,HCPCS C1713,,438.705  -  PLATE 168MM TI 3.5MM SCR 8 HOLE W/O TAB LCP BONE LEFT DISTAL,"$3,266.13",$0.00,"$3,266.13","$1,469.76","$2,331.03",$0.00,$562.74,$0.00,$0.00,$571.87,"$3,266.13",$0.00,"$1,633.06","$2,586.77","$2,612.90",$0.00,$511.15,$0.00,$519.97,$0.00
438.706,SUP,HCPCS C1713,,438.706  -  PLATE 194MM TI 3.5MM SCR 10 HOLE W/O TAB LCP BONE RIGHT,"$3,399.05",$0.00,"$3,399.05","$1,529.57","$2,425.90",$0.00,$585.64,$0.00,$0.00,$595.15,"$3,399.05",$0.00,"$1,699.53","$2,692.05","$2,719.24",$0.00,$531.95,$0.00,$541.13,$0.00
438.708,SUP,HCPCS C1713,,438.708  -  PLATE BONE 220MM 12 HOLE W/O TAB LCP TITANIUM TIBIA RIGHT,"$2,640.73",$0.00,"$2,640.73","$1,188.33","$1,884.69",$0.00,$454.98,$0.00,$0.00,$462.37,"$2,640.73",$0.00,"$1,320.36","$2,091.46","$2,112.58",$0.00,$413.27,$0.00,$420.40,$0.00
438.71,SUP,HCPCS C1713,,438.710  -  PLATE BONE 246MM 14 HOLE W/O TAB LCP TITANIUM TIBIA RIGHT,"$2,675.18",$0.00,"$2,675.18","$1,203.83","$1,909.27",$0.00,$460.92,$0.00,$0.00,$468.40,"$2,675.18",$0.00,"$1,337.59","$2,118.74","$2,140.14",$0.00,$418.66,$0.00,$425.89,$0.00
438.711,SUP,HCPCS C1713,,438.711  -  PLATE BONE 246MM 14 HOLE W/O TAB LCP TITANIUM TIBIA LEFT,"$2,756.00",$0.00,"$2,756.00","$1,240.20","$1,966.96",$0.00,$474.85,$0.00,$0.00,$482.55,"$2,756.00",$0.00,"$1,378.00","$2,182.75","$2,204.80",$0.00,$431.31,$0.00,$438.76,$0.00
438.94,SUP,HCPCS C1713,,438.94  -  PLATE BONE 130D 70MM 9 HOLE ANGLED DCP TITANIUM ORTHOPEDIC,"$1,110.90",$0.00,"$1,110.90",$499.91,$792.85,$0.00,$185.83,$0.00,$0.00,$194.51,"$1,110.90",$0.00,$555.45,$879.83,$888.72,$0.00,$168.79,$0.00,$176.86,$0.00
438.96,SUP,HCPCS C1713,,438.96  -  PLATE BONE 130D 80MM 9 HOLE ANGLED DCP TITANIUM ORTHOPEDIC,"$1,078.55",$0.00,"$1,078.55",$485.35,$769.76,$0.00,$185.83,$0.00,$0.00,$188.85,"$1,078.55",$0.00,$539.28,$854.21,$862.84,$0.00,$168.79,$0.00,$171.71,$0.00
438.98,SUP,HCPCS C1713,,438.98  -  PLATE BONE 130D 90MM 9 HOLE ANGLED DCP TITANIUM ORTHOPEDIC,"$1,110.90",$0.00,"$1,110.90",$499.91,$792.85,$0.00,$185.83,$0.00,$0.00,$194.51,"$1,110.90",$0.00,$555.45,$879.83,$888.72,$0.00,$168.79,$0.00,$176.86,$0.00
439.2,SUP,HCPCS C1713,,439.20  -  PLATE 90D 10MM DSPL 50MM TI OSTMY DCP BONE ADLT ORTH NONSTRL,"$1,290.98",$0.00,"$1,290.98",$580.94,$921.37,$0.00,$222.43,$0.00,$0.00,$226.04,"$1,290.98",$0.00,$645.49,"$1,022.46","$1,032.78",$0.00,$202.04,$0.00,$205.52,$0.00
439.21,SUP,HCPCS C1713,,439.21  -  PLATE BONE 90D 10MM DISPLACEMENT 55MM ANGLED DCP TITANIUM,"$1,078.55",$0.00,"$1,078.55",$485.35,$769.76,$0.00,$185.83,$0.00,$0.00,$188.85,"$1,078.55",$0.00,$539.28,$854.21,$862.84,$0.00,$168.79,$0.00,$171.71,$0.00
439.22,SUP,HCPCS C1713,,439.22  -  PLATE BONE 90D 10MM DISPLACEMENT 60MM DCP TITANIUM ADULT,"$1,078.55",$0.00,"$1,078.55",$485.35,$769.76,$0.00,$185.83,$0.00,$0.00,$188.85,"$1,078.55",$0.00,$539.28,$854.21,$862.84,$0.00,$168.79,$0.00,$171.71,$0.00
439.23,SUP,HCPCS C1713,,439.23  -  PLATE BONE 90D 10MM DISPLACEMENT 65MM ANGLED DCP TITANIUM,"$1,078.55",$0.00,"$1,078.55",$485.35,$769.76,$0.00,$185.83,$0.00,$0.00,$188.85,"$1,078.55",$0.00,$539.28,$854.21,$862.84,$0.00,$168.79,$0.00,$171.71,$0.00
439.24,SUP,HCPCS C1713,,439.24  -  PLATE BONE 90D 10MM DISPLACEMENT 70MM DCP TITANIUM ADULT,"$1,078.55",$0.00,"$1,078.55",$485.35,$769.76,$0.00,$185.83,$0.00,$0.00,$188.85,"$1,078.55",$0.00,$539.28,$854.21,$862.84,$0.00,$168.79,$0.00,$171.71,$0.00
439.25,SUP,HCPCS C1713,,439.25  -  PLATE BONE 90D 10MM DISPLACEMENT 75MM DCP TITANIUM ADULT,"$1,078.55",$0.00,"$1,078.55",$485.35,$769.76,$0.00,$185.83,$0.00,$0.00,$188.85,"$1,078.55",$0.00,$539.28,$854.21,$862.84,$0.00,$168.79,$0.00,$171.71,$0.00
439.28,SUP,HCPCS C1713,,439.28  -  PLATE BONE 90D 10MM DISPLACEMENT 40MM DCP TITANIUM ADULT,"$1,078.55",$0.00,"$1,078.55",$485.35,$769.76,$0.00,$185.83,$0.00,$0.00,$188.85,"$1,078.55",$0.00,$539.28,$854.21,$862.84,$0.00,$168.79,$0.00,$171.71,$0.00
439.32,SUP,HCPCS C1713,,439.32  -  PLATE BONE 100D 10MM DISPLACEMENT 60MM DCP TITANIUM ADULT,"$1,078.55",$0.00,"$1,078.55",$485.35,$769.76,$0.00,$185.83,$0.00,$0.00,$188.85,"$1,078.55",$0.00,$539.28,$854.21,$862.84,$0.00,$168.79,$0.00,$171.71,$0.00
439.43,SUP,HCPCS C1713,,439.43  -  PLATE BONE 110D 65MM DCP TITANIUM ADULT ORTHOPEDIC NONSTRL,"$1,078.55",$0.00,"$1,078.55",$485.35,$769.76,$0.00,$185.83,$0.00,$0.00,$188.85,"$1,078.55",$0.00,$539.28,$854.21,$862.84,$0.00,$168.79,$0.00,$171.71,$0.00
439.45,SUP,HCPCS C1713,,439.45  -  PLATE BONE 110D 75MM DCP TITANIUM ADULT ORTHOPEDIC NONSTRL,"$1,110.90",$0.00,"$1,110.90",$499.91,$792.85,$0.00,$185.83,$0.00,$0.00,$194.51,"$1,110.90",$0.00,$555.45,$879.83,$888.72,$0.00,$168.79,$0.00,$176.86,$0.00
439.47,SUP,HCPCS C1713,,439.47  -  PLATE BONE 110D 85MM DCP TITANIUM ADULT ORTHOPEDIC NONSTRL,"$1,078.55",$0.00,"$1,078.55",$485.35,$769.76,$0.00,$185.83,$0.00,$0.00,$188.85,"$1,078.55",$0.00,$539.28,$854.21,$862.84,$0.00,$168.79,$0.00,$171.71,$0.00
439.53,SUP,HCPCS C1713,,439.53  -  PLATE BONE 120D 65MM DCP TITANIUM ADULT ORTHOPEDIC NONSTRL,"$1,078.55",$0.00,"$1,078.55",$485.35,$769.76,$0.00,$185.83,$0.00,$0.00,$188.85,"$1,078.55",$0.00,$539.28,$854.21,$862.84,$0.00,$168.79,$0.00,$171.71,$0.00
439.55,SUP,HCPCS C1713,,439.55  -  PLATE BONE 120D 75MM ANGLED DCP TITANIUM ADULT ORTHOPEDIC,"$1,078.55",$0.00,"$1,078.55",$485.35,$769.76,$0.00,$185.83,$0.00,$0.00,$188.85,"$1,078.55",$0.00,$539.28,$854.21,$862.84,$0.00,$168.79,$0.00,$171.71,$0.00
439.57,SUP,HCPCS C1713,,439.57  -  PLATE BONE 120D 85MM ANGLED DCP TITANIUM ADULT ORTHOPEDIC,"$1,078.55",$0.00,"$1,078.55",$485.35,$769.76,$0.00,$185.83,$0.00,$0.00,$188.85,"$1,078.55",$0.00,$539.28,$854.21,$862.84,$0.00,$168.79,$0.00,$171.71,$0.00
439.6,SUP,HCPCS C1713,,439.60  -  PLATE BONE 90D 20MM DISPLACEMENT 50MM 20MM DCP TITANIUM,"$1,078.55",$0.00,"$1,078.55",$485.35,$769.76,$0.00,$185.83,$0.00,$0.00,$188.85,"$1,078.55",$0.00,$539.28,$854.21,$862.84,$0.00,$168.79,$0.00,$171.71,$0.00
439.61,SUP,HCPCS C1713,,439.61  -  PLATE BONE 90D 20MM 55MM DCP TITANIUM ADULT ORTHOPEDIC,"$1,078.55",$0.00,"$1,078.55",$485.35,$769.76,$0.00,$185.83,$0.00,$0.00,$188.85,"$1,078.55",$0.00,$539.28,$854.21,$862.84,$0.00,$168.79,$0.00,$171.71,$0.00
439.62,SUP,HCPCS C1713,,439.62  -  PLATE BN 90D 20MM DSPL 60MM NS DCP TI ADLT OSTM,"$1,078.55",$0.00,"$1,078.55",$485.35,$769.76,$0.00,$185.83,$0.00,$0.00,$188.85,"$1,078.55",$0.00,$539.28,$854.21,$862.84,$0.00,$168.79,$0.00,$171.71,$0.00
439.63,SUP,HCPCS C1713,,439.63  -  PLATE BONE 90D 20MM DISPLACEMENT 65MM DCP TITANIUM ADULT,"$1,078.55",$0.00,"$1,078.55",$485.35,$769.76,$0.00,$185.83,$0.00,$0.00,$188.85,"$1,078.55",$0.00,$539.28,$854.21,$862.84,$0.00,$168.79,$0.00,$171.71,$0.00
439.64,SUP,HCPCS C1713,,439.64  -  PLATE BONE 90D 20MM DISPLACEMENT 70MM DCP TITANIUM ADULT,"$1,078.55",$0.00,"$1,078.55",$485.35,$769.76,$0.00,$185.83,$0.00,$0.00,$188.85,"$1,078.55",$0.00,$539.28,$854.21,$862.84,$0.00,$168.79,$0.00,$171.71,$0.00
439.65,SUP,HCPCS C1713,,439.65  -  PLATE BONE 90D 20MM 75MM ANGLED DCP STAINLESS STEEL ADULT,"$1,078.55",$0.00,"$1,078.55",$485.35,$769.76,$0.00,$185.83,$0.00,$0.00,$188.85,"$1,078.55",$0.00,$539.28,$854.21,$862.84,$0.00,$168.79,$0.00,$171.71,$0.00
439.7,SUP,HCPCS C1713,,439.70  -  PLATE BONE 90D 15MM DISPLACEMENT 50MM DCP TITANIUM ADULT,"$1,078.55",$0.00,"$1,078.55",$485.35,$769.76,$0.00,$185.83,$0.00,$0.00,$188.85,"$1,078.55",$0.00,$539.28,$854.21,$862.84,$0.00,$168.79,$0.00,$171.71,$0.00
439.71,SUP,HCPCS C1713,,439.71  -  PLATE BONE 90D 15MM DISPLACEMENT 55MM ANGLED DCP TITANIUM,"$1,078.55",$0.00,"$1,078.55",$485.35,$769.76,$0.00,$185.83,$0.00,$0.00,$188.85,"$1,078.55",$0.00,$539.28,$854.21,$862.84,$0.00,$168.79,$0.00,$171.71,$0.00
439.72,SUP,HCPCS C1713,,439.72  -  PLATE BONE 90D 15MM DISPLACEMENT 60MM DCP TITANIUM ADULT,"$1,078.55",$0.00,"$1,078.55",$485.35,$769.76,$0.00,$185.83,$0.00,$0.00,$188.85,"$1,078.55",$0.00,$539.28,$854.21,$862.84,$0.00,$168.79,$0.00,$171.71,$0.00
439.73,SUP,HCPCS C1713,,439.73  -  PLATE BONE 90D 15MM DISPLACEMENT 65MM DCP TITANIUM ADULT,"$1,078.55",$0.00,"$1,078.55",$485.35,$769.76,$0.00,$185.83,$0.00,$0.00,$188.85,"$1,078.55",$0.00,$539.28,$854.21,$862.84,$0.00,$168.79,$0.00,$171.71,$0.00
439.74,SUP,HCPCS C1713,,439.74  -  PLATE BONE 90D 15MM 70MM DCP TITANIUM ADULT ORTHOPEDIC,"$1,078.55",$0.00,"$1,078.55",$485.35,$769.76,$0.00,$185.83,$0.00,$0.00,$188.85,"$1,078.55",$0.00,$539.28,$854.21,$862.84,$0.00,$168.79,$0.00,$171.71,$0.00
439.76,SUP,HCPCS C1713,,439.76  -  PLATE BONE 90D 15MM DISPLACEMENT 80MM DCP TITANIUM ADULT,"$1,078.55",$0.00,"$1,078.55",$485.35,$769.76,$0.00,$185.83,$0.00,$0.00,$188.85,"$1,078.55",$0.00,$539.28,$854.21,$862.84,$0.00,$168.79,$0.00,$171.71,$0.00
439.78,SUP,HCPCS C1713,,439.78  -  PLATE BONE 90D 15MM DISPLACEMENT 40MM DCP TITANIUM ADULT,"$1,078.55",$0.00,"$1,078.55",$485.35,$769.76,$0.00,$185.83,$0.00,$0.00,$188.85,"$1,078.55",$0.00,$539.28,$854.21,$862.84,$0.00,$168.79,$0.00,$171.71,$0.00
439.8,SUP,HCPCS C1713,,439.80  -  PLATE BONE 130D 100MM DCP TITANIUM ADULT NONSTRL OSTMY,"$1,110.90",$0.00,"$1,110.90",$499.91,$792.85,$0.00,$185.83,$0.00,$0.00,$194.51,"$1,110.90",$0.00,$555.45,$879.83,$888.72,$0.00,$168.79,$0.00,$176.86,$0.00
439.81,SUP,HCPCS C1713,,439.81  -  PLATE BONE 130D 105MM DCP TITANIUM ADULT ORTHOPEDIC NONSTRL,"$1,078.55",$0.00,"$1,078.55",$485.35,$769.76,$0.00,$185.83,$0.00,$0.00,$188.85,"$1,078.55",$0.00,$539.28,$854.21,$862.84,$0.00,$168.79,$0.00,$171.71,$0.00
439.82,SUP,HCPCS C1713,,439.82  -  PLATE BONE 130D 110MM DCP TITANIUM ADULT ORTHOPEDIC NONSTRL,"$1,078.55",$0.00,"$1,078.55",$485.35,$769.76,$0.00,$185.83,$0.00,$0.00,$188.85,"$1,078.55",$0.00,$539.28,$854.21,$862.84,$0.00,$168.79,$0.00,$171.71,$0.00
439.83,SUP,HCPCS C1713,,439.83  -  PLATE BONE 130D 65MM DCP TITANIUM ADULT ORTHOPEDIC NONSTRL,"$1,078.55",$0.00,"$1,078.55",$485.35,$769.76,$0.00,$185.83,$0.00,$0.00,$188.85,"$1,078.55",$0.00,$539.28,$854.21,$862.84,$0.00,$168.79,$0.00,$171.71,$0.00
439.84,SUP,HCPCS C1713,,439.84  -  PLATE BONE 130D 70MM ANGLED DCP TITANIUM ADULT ORTHOPEDIC,"$1,078.55",$0.00,"$1,078.55",$485.35,$769.76,$0.00,$185.83,$0.00,$0.00,$188.85,"$1,078.55",$0.00,$539.28,$854.21,$862.84,$0.00,$168.79,$0.00,$171.71,$0.00
439.85,SUP,HCPCS C1713,,439.85  -  PLATE BONE 130D 75MM DCP TITANIUM ADULT ORTHOPEDIC NONSTRL,"$1,078.55",$0.00,"$1,078.55",$485.35,$769.76,$0.00,$185.83,$0.00,$0.00,$188.85,"$1,078.55",$0.00,$539.28,$854.21,$862.84,$0.00,$168.79,$0.00,$171.71,$0.00
439.86,SUP,HCPCS C1713,,439.86  -  PLATE BONE 130D 80MM DCP TITANIUM ADULT ORTHOPEDIC NONSTRL,"$1,078.55",$0.00,"$1,078.55",$485.35,$769.76,$0.00,$185.83,$0.00,$0.00,$188.85,"$1,078.55",$0.00,$539.28,$854.21,$862.84,$0.00,$168.79,$0.00,$171.71,$0.00
439.87,SUP,HCPCS C1713,,439.87  -  PLATE BONE 130D 85MM ANGLED DCP TITANIUM ADULT ORTHOPEDIC,"$1,078.55",$0.00,"$1,078.55",$485.35,$769.76,$0.00,$185.83,$0.00,$0.00,$188.85,"$1,078.55",$0.00,$539.28,$854.21,$862.84,$0.00,$168.79,$0.00,$171.71,$0.00
439.88,SUP,HCPCS C1713,,439.88  -  PLATE BONE 130D 90MM ANGLED DCP TITANIUM ADULT ORTHOPEDIC,"$1,078.55",$0.00,"$1,078.55",$485.35,$769.76,$0.00,$185.83,$0.00,$0.00,$188.85,"$1,078.55",$0.00,$539.28,$854.21,$862.84,$0.00,$168.79,$0.00,$171.71,$0.00
439.89,SUP,HCPCS C1713,,439.89  -  PLATE BONE 130D 95MM DCP TITANIUM ADULT ORTHOPEDIC NONSTRL,"$1,078.55",$0.00,"$1,078.55",$485.35,$769.76,$0.00,$185.83,$0.00,$0.00,$188.85,"$1,078.55",$0.00,$539.28,$854.21,$862.84,$0.00,$168.79,$0.00,$171.71,$0.00
439.934,SUP,HCPCS C1713,,439.934  -  PLATE BONE 81MM 4 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL,"$2,586.20",$0.00,"$2,586.20","$1,163.79","$1,845.77",$0.00,$432.61,$0.00,$0.00,$452.82,"$2,586.20",$0.00,"$1,293.10","$2,048.27","$2,068.96",$0.00,$392.95,$0.00,$411.72,$0.00
439.935,SUP,HCPCS C1713,,439.935  -  PLATE BONE 81MM 4 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL,"$2,586.20",$0.00,"$2,586.20","$1,163.79","$1,845.77",$0.00,$432.61,$0.00,$0.00,$452.82,"$2,586.20",$0.00,"$1,293.10","$2,048.27","$2,068.96",$0.00,$392.95,$0.00,$411.72,$0.00
439.936,SUP,HCPCS C1713,,439.936  -  PLATE BONE 107MM 6 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL,"$2,617.60",$0.00,"$2,617.60","$1,177.92","$1,868.18",$0.00,$437.86,$0.00,$0.00,$458.32,"$2,617.60",$0.00,"$1,308.80","$2,073.14","$2,094.08",$0.00,$397.72,$0.00,$416.72,$0.00
439.937,SUP,HCPCS C1713,,439.937  -  PLATE BONE 107MM 6 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL,"$2,617.60",$0.00,"$2,617.60","$1,177.92","$1,868.18",$0.00,$437.86,$0.00,$0.00,$458.32,"$2,617.60",$0.00,"$1,308.80","$2,073.14","$2,094.08",$0.00,$397.72,$0.00,$416.72,$0.00
439.938,SUP,HCPCS C1713,,439.938  -  PLATE BONE 133MM 8 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL,"$2,647.63",$0.00,"$2,647.63","$1,191.43","$1,889.61",$0.00,$442.88,$0.00,$0.00,$463.58,"$2,647.63",$0.00,"$1,323.81","$2,096.92","$2,118.10",$0.00,$402.28,$0.00,$421.50,$0.00
439.939,SUP,HCPCS C1713,,439.939  -  PLATE BONE 133MM 8 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL,"$2,647.63",$0.00,"$2,647.63","$1,191.43","$1,889.61",$0.00,$442.88,$0.00,$0.00,$463.58,"$2,647.63",$0.00,"$1,323.81","$2,096.92","$2,118.10",$0.00,$402.28,$0.00,$421.50,$0.00
439.94,SUP,HCPCS C1713,,439.940  -  PLATE BONE 159MM 10 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL,"$2,676.28",$0.00,"$2,676.28","$1,204.32","$1,910.06",$0.00,$447.68,$0.00,$0.00,$468.59,"$2,676.28",$0.00,"$1,338.14","$2,119.61","$2,141.02",$0.00,$406.64,$0.00,$426.06,$0.00
439.941,SUP,HCPCS C1713,,439.941  -  PLATE BONE 159MM 10 HOLE TITANIUM TIBIA LEFT PROXIMAL,"$2,676.28",$0.00,"$2,676.28","$1,204.32","$1,910.06",$0.00,$447.68,$0.00,$0.00,$468.59,"$2,676.28",$0.00,"$1,338.14","$2,119.61","$2,141.02",$0.00,$406.64,$0.00,$426.06,$0.00
439.942,SUP,HCPCS C1713,,439.942  -  PLATE BONE 185MM 12 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL,"$2,711.75",$0.00,"$2,711.75","$1,220.29","$1,935.38",$0.00,$453.61,$0.00,$0.00,$474.81,"$2,711.75",$0.00,"$1,355.88","$2,147.71","$2,169.40",$0.00,$412.03,$0.00,$431.71,$0.00
439.943,SUP,HCPCS C1713,,439.943  -  PLATE BONE 185MM 12 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL,"$2,711.75",$0.00,"$2,711.75","$1,220.29","$1,935.38",$0.00,$453.61,$0.00,$0.00,$474.81,"$2,711.75",$0.00,"$1,355.88","$2,147.71","$2,169.40",$0.00,$412.03,$0.00,$431.71,$0.00
439.944,SUP,HCPCS C1713,,439.944  -  PLATE BONE 211MM 14 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL,"$2,740.43",$0.00,"$2,740.43","$1,233.19","$1,955.84",$0.00,$458.41,$0.00,$0.00,$479.83,"$2,740.43",$0.00,"$1,370.21","$2,170.42","$2,192.34",$0.00,$416.38,$0.00,$436.28,$0.00
439.945,SUP,HCPCS C1713,,439.945  -  PLATE BONE 211MM 14 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL,"$2,740.43",$0.00,"$2,740.43","$1,233.19","$1,955.84",$0.00,$458.41,$0.00,$0.00,$479.83,"$2,740.43",$0.00,"$1,370.21","$2,170.42","$2,192.34",$0.00,$416.38,$0.00,$436.28,$0.00
439.946,SUP,HCPCS C1713,,439.946  -  PLATE BONE 237MM 16 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL,"$2,837.33",$0.00,"$2,837.33","$1,276.80","$2,025.00",$0.00,$474.62,$0.00,$0.00,$496.79,"$2,837.33",$0.00,"$1,418.66","$2,247.17","$2,269.86",$0.00,$431.11,$0.00,$451.70,$0.00
439.947,SUP,HCPCS C1713,,439.947  -  PLATE BONE 237MM 16 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL,"$2,837.33",$0.00,"$2,837.33","$1,276.80","$2,025.00",$0.00,$474.62,$0.00,$0.00,$496.79,"$2,837.33",$0.00,"$1,418.66","$2,247.17","$2,269.86",$0.00,$431.11,$0.00,$451.70,$0.00
439.954,SUP,HCPCS C1713,,439.954  -  PLATE BONE 94MM 4 HOLE LCP TITANIUM TIBIA RIGHT MEDIAL,"$2,578.03",$0.00,"$2,578.03","$1,160.11","$1,839.94",$0.00,$431.24,$0.00,$0.00,$451.39,"$2,578.03",$0.00,"$1,289.01","$2,041.80","$2,062.42",$0.00,$391.71,$0.00,$410.42,$0.00
439.955,SUP,HCPCS C1713,,439.955  -  PLATE BONE 94MM 4 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL,"$2,578.03",$0.00,"$2,578.03","$1,160.11","$1,839.94",$0.00,$431.24,$0.00,$0.00,$451.39,"$2,578.03",$0.00,"$1,289.01","$2,041.80","$2,062.42",$0.00,$391.71,$0.00,$410.42,$0.00
439.956,SUP,HCPCS C1713,,439.956  -  PLATE BONE 119MM 6 HOLE LCP TITANIUM TIBIA RIGHT MEDIAL,"$2,612.13",$0.00,"$2,612.13","$1,175.46","$1,864.27",$0.00,$436.95,$0.00,$0.00,$457.36,"$2,612.13",$0.00,"$1,306.06","$2,068.81","$2,089.70",$0.00,$396.89,$0.00,$415.85,$0.00
439.957,SUP,HCPCS C1713,,439.957  -  PLATE BONE 119MM 6 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL,"$2,612.13",$0.00,"$2,612.13","$1,175.46","$1,864.27",$0.00,$436.95,$0.00,$0.00,$457.36,"$2,612.13",$0.00,"$1,306.06","$2,068.81","$2,089.70",$0.00,$396.89,$0.00,$415.85,$0.00
439.958,SUP,HCPCS C1713,,439.958  -  PLATE BONE 145MM 8 HOLE LCP TITANIUM TIBIA RIGHT MEDIAL,"$2,643.53",$0.00,"$2,643.53","$1,189.59","$1,886.68",$0.00,$442.20,$0.00,$0.00,$462.86,"$2,643.53",$0.00,"$1,321.76","$2,093.68","$2,114.82",$0.00,$401.66,$0.00,$420.85,$0.00
439.959,SUP,HCPCS C1713,,439.959  -  PLATE BONE 145MM 8 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL,"$2,643.53",$0.00,"$2,643.53","$1,189.59","$1,886.68",$0.00,$442.20,$0.00,$0.00,$462.86,"$2,643.53",$0.00,"$1,321.76","$2,093.68","$2,114.82",$0.00,$401.66,$0.00,$420.85,$0.00
439.96,SUP,HCPCS C1713,,439.960  -  PLATE BONE 171MM 10 HOLE LCP TITANIUM TIBIA RIGHT MEDIAL,"$2,673.55",$0.00,"$2,673.55","$1,203.10","$1,908.11",$0.00,$447.22,$0.00,$0.00,$468.12,"$2,673.55",$0.00,"$1,336.78","$2,117.45","$2,138.84",$0.00,$406.22,$0.00,$425.63,$0.00
439.961,SUP,HCPCS C1713,,439.961  -  PLATE BONE 171MM 10 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL,"$2,673.55",$0.00,"$2,673.55","$1,203.10","$1,908.11",$0.00,$447.22,$0.00,$0.00,$468.12,"$2,673.55",$0.00,"$1,336.78","$2,117.45","$2,138.84",$0.00,$406.22,$0.00,$425.63,$0.00
439.962,SUP,HCPCS C1713,,439.962  -  PLATE BONE 197MM 12 HOLE LCP TITANIUM TIBIA RIGHT MEDIAL,"$2,702.20",$0.00,"$2,702.20","$1,215.99","$1,928.56",$0.00,$452.02,$0.00,$0.00,$473.13,"$2,702.20",$0.00,"$1,351.10","$2,140.14","$2,161.76",$0.00,$410.58,$0.00,$430.19,$0.00
439.963,SUP,HCPCS C1713,,439.963  -  PLATE BONE 197MM 12 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL,"$2,702.20",$0.00,"$2,702.20","$1,215.99","$1,928.56",$0.00,$452.02,$0.00,$0.00,$473.13,"$2,702.20",$0.00,"$1,351.10","$2,140.14","$2,161.76",$0.00,$410.58,$0.00,$430.19,$0.00
439.964,SUP,HCPCS C1713,,439.964  -  PLATE BONE 223MM 14 HOLE LCP TITANIUM TIBIA RIGHT MEDIAL,"$2,734.95",$0.00,"$2,734.95","$1,230.73","$1,951.93",$0.00,$457.49,$0.00,$0.00,$478.87,"$2,734.95",$0.00,"$1,367.48","$2,166.08","$2,187.96",$0.00,$415.55,$0.00,$435.40,$0.00
439.965,SUP,HCPCS C1713,,439.965  -  PLATE BONE 223MM 14 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL,"$2,734.95",$0.00,"$2,734.95","$1,230.73","$1,951.93",$0.00,$457.49,$0.00,$0.00,$478.87,"$2,734.95",$0.00,"$1,367.48","$2,166.08","$2,187.96",$0.00,$415.55,$0.00,$435.40,$0.00
439.966,SUP,HCPCS C1713,,439.966  -  PLATE BONE 249MM 16 HOLE LCP TITANIUM TIBIA RIGHT MEDIAL,"$2,830.50",$0.00,"$2,830.50","$1,273.73","$2,020.13",$0.00,$473.48,$0.00,$0.00,$495.60,"$2,830.50",$0.00,"$1,415.25","$2,241.76","$2,264.40",$0.00,$430.07,$0.00,$450.62,$0.00
439.967,SUP,HCPCS C1713,,439.967  -  PLATE BONE 249MM 16 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL,"$2,830.50",$0.00,"$2,830.50","$1,273.73","$2,020.13",$0.00,$473.48,$0.00,$0.00,$495.60,"$2,830.50",$0.00,"$1,415.25","$2,241.76","$2,264.40",$0.00,$430.07,$0.00,$450.62,$0.00
439.968,SUP,HCPCS C1713,,439.968  -  PLATE BONE 275MM 18 HOLE LCP TITANIUM TIBIA RIGHT MEDIAL,"$2,931.48",$0.00,"$2,931.48","$1,319.16","$2,092.19",$0.00,$490.37,$0.00,$0.00,$513.28,"$2,931.48",$0.00,"$1,465.74","$2,321.73","$2,345.18",$0.00,$445.41,$0.00,$466.69,$0.00
439.969,SUP,HCPCS C1713,,439.969  -  PLATE BONE 275MM 18 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL,"$3,020.20",$0.00,"$3,020.20","$1,359.09","$2,155.52",$0.00,$505.21,$0.00,$0.00,$528.81,"$3,020.20",$0.00,"$1,510.10","$2,392.00","$2,416.16",$0.00,$458.89,$0.00,$480.82,$0.00
439.97,SUP,HCPCS C1713,,439.970  -  PLATE BONE 301MM 20 HOLE LCP TITANIUM TIBIA RIGHT MEDIAL,"$3,028.38",$0.00,"$3,028.38","$1,362.77","$2,161.35",$0.00,$506.58,$0.00,$0.00,$530.24,"$3,028.38",$0.00,"$1,514.19","$2,398.48","$2,422.70",$0.00,$460.14,$0.00,$482.12,$0.00
439.971,SUP,HCPCS C1713,,439.971  -  PLATE BONE 301MM 20 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL,"$3,028.38",$0.00,"$3,028.38","$1,362.77","$2,161.35",$0.00,$506.58,$0.00,$0.00,$530.24,"$3,028.38",$0.00,"$1,514.19","$2,398.48","$2,422.70",$0.00,$460.14,$0.00,$482.12,$0.00
439.984,SUP,HCPCS C1713,,439.984  -  PLATE BONE 106MM 4 HOLE LCP TITANIUM TIBIA RIGHT MEDIAL,"$2,587.58",$0.00,"$2,587.58","$1,164.41","$1,846.75",$0.00,$432.84,$0.00,$0.00,$453.06,"$2,587.58",$0.00,"$1,293.79","$2,049.36","$2,070.06",$0.00,$393.16,$0.00,$411.94,$0.00
439.985,SUP,HCPCS C1713,,439.985  -  PLATE BONE 106MM 4 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL,"$2,587.58",$0.00,"$2,587.58","$1,164.41","$1,846.75",$0.00,$432.84,$0.00,$0.00,$453.06,"$2,587.58",$0.00,"$1,293.79","$2,049.36","$2,070.06",$0.00,$393.16,$0.00,$411.94,$0.00
439.986,SUP,HCPCS C1713,,439.986  -  PLATE BONE 142MM 6 HOLE LCP TITANIUM TIBIA RIGHT MEDIAL,"$2,618.95",$0.00,"$2,618.95","$1,178.53","$1,869.14",$0.00,$438.09,$0.00,$0.00,$458.56,"$2,618.95",$0.00,"$1,309.48","$2,074.21","$2,095.16",$0.00,$397.93,$0.00,$416.94,$0.00
439.987,SUP,HCPCS C1713,,439.987  -  PLATE BONE 142MM 6 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL,"$2,618.95",$0.00,"$2,618.95","$1,178.53","$1,869.14",$0.00,$438.09,$0.00,$0.00,$458.56,"$2,618.95",$0.00,"$1,309.48","$2,074.21","$2,095.16",$0.00,$397.93,$0.00,$416.94,$0.00
439.988,SUP,HCPCS C1713,,439.988  -  PLATE BONE 178MM 8 HOLE LCP TITANIUM TIBIA RIGHT MEDIAL,"$2,648.98",$0.00,"$2,648.98","$1,192.04","$1,890.57",$0.00,$443.11,$0.00,$0.00,$463.81,"$2,648.98",$0.00,"$1,324.49","$2,097.99","$2,119.18",$0.00,$402.49,$0.00,$421.72,$0.00
439.989,SUP,HCPCS C1713,,439.989  -  PLATE BONE 178MM 8 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL,"$2,648.98",$0.00,"$2,648.98","$1,192.04","$1,890.57",$0.00,$443.11,$0.00,$0.00,$463.81,"$2,648.98",$0.00,"$1,324.49","$2,097.99","$2,119.18",$0.00,$402.49,$0.00,$421.72,$0.00
439.99,SUP,HCPCS C1713,,439.990  -  PLATE BONE 214MM 10 HOLE LCP TITANIUM TIBIA RIGHT MEDIAL,"$2,677.65",$0.00,"$2,677.65","$1,204.94","$1,911.04",$0.00,$447.91,$0.00,$0.00,$468.84,"$2,677.65",$0.00,"$1,338.83","$2,120.70","$2,142.12",$0.00,$406.85,$0.00,$426.28,$0.00
439.991,SUP,HCPCS C1713,,439.991  -  PLATE BONE 214MM 10 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL,"$2,677.65",$0.00,"$2,677.65","$1,204.94","$1,911.04",$0.00,$447.91,$0.00,$0.00,$468.84,"$2,677.65",$0.00,"$1,338.83","$2,120.70","$2,142.12",$0.00,$406.85,$0.00,$426.28,$0.00
439.992,SUP,HCPCS C1713,,439.992  -  PLATE BONE 250MM 12 HOLE LCP TITANIUM TIBIA RIGHT MEDIAL,"$2,711.75",$0.00,"$2,711.75","$1,220.29","$1,935.38",$0.00,$453.61,$0.00,$0.00,$474.81,"$2,711.75",$0.00,"$1,355.88","$2,147.71","$2,169.40",$0.00,$412.03,$0.00,$431.71,$0.00
439.993,SUP,HCPCS C1713,,439.993  -  PLATE BONE 250MM 12 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL,"$2,711.75",$0.00,"$2,711.75","$1,220.29","$1,935.38",$0.00,$453.61,$0.00,$0.00,$474.81,"$2,711.75",$0.00,"$1,355.88","$2,147.71","$2,169.40",$0.00,$412.03,$0.00,$431.71,$0.00
439.994,SUP,HCPCS C1713,,439.994  -  PLATE BONE 286MM 14 HOLE LCP TITANIUM TIBIA RIGHT MEDIAL,"$2,740.43",$0.00,"$2,740.43","$1,233.19","$1,955.84",$0.00,$458.41,$0.00,$0.00,$479.83,"$2,740.43",$0.00,"$1,370.21","$2,170.42","$2,192.34",$0.00,$416.38,$0.00,$436.28,$0.00
439.995,SUP,HCPCS C1713,,439.995  -  PLATE BONE 286MM 14 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL,"$2,740.43",$0.00,"$2,740.43","$1,233.19","$1,955.84",$0.00,$458.41,$0.00,$0.00,$479.83,"$2,740.43",$0.00,"$1,370.21","$2,170.42","$2,192.34",$0.00,$416.38,$0.00,$436.28,$0.00
439.996,SUP,HCPCS C1713,,439.996  -  PLATE BONE 322MM 16 HOLE LCP TITANIUM TIBIA RIGHT MEDIAL,"$2,767.73",$0.00,"$2,767.73","$1,245.48","$1,975.33",$0.00,$462.97,$0.00,$0.00,$484.61,"$2,767.73",$0.00,"$1,383.86","$2,192.04","$2,214.18",$0.00,$420.53,$0.00,$440.62,$0.00
439.997,SUP,HCPCS C1713,,439.997  -  PLATE BONE 322MM 16 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL,"$2,767.73",$0.00,"$2,767.73","$1,245.48","$1,975.33",$0.00,$462.97,$0.00,$0.00,$484.61,"$2,767.73",$0.00,"$1,383.86","$2,192.04","$2,214.18",$0.00,$420.53,$0.00,$440.62,$0.00
440.036,SUP,HCPCS C1713,,440.036  -  PLATE BONE 82MM 4 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL,"$2,588.93",$0.00,"$2,588.93","$1,165.02","$1,847.72",$0.00,$433.07,$0.00,$0.00,$453.30,"$2,588.93",$0.00,"$1,294.46","$2,050.43","$2,071.14",$0.00,$393.37,$0.00,$412.16,$0.00
440.037,SUP,HCPCS C1713,,440.037  -  PLATE BONE 82MM 4 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL,"$2,588.93",$0.00,"$2,588.93","$1,165.02","$1,847.72",$0.00,$433.07,$0.00,$0.00,$453.30,"$2,588.93",$0.00,"$1,294.46","$2,050.43","$2,071.14",$0.00,$393.37,$0.00,$412.16,$0.00
440.038,SUP,HCPCS C1713,,440.038  -  PLATE BONE 118MM 6 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL,"$2,620.33",$0.00,"$2,620.33","$1,179.15","$1,870.13",$0.00,$438.32,$0.00,$0.00,$458.80,"$2,620.33",$0.00,"$1,310.16","$2,075.30","$2,096.26",$0.00,$398.14,$0.00,$417.16,$0.00
440.039,SUP,HCPCS C1713,,440.039  -  PLATE BONE 118MM 6 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL,"$2,620.33",$0.00,"$2,620.33","$1,179.15","$1,870.13",$0.00,$438.32,$0.00,$0.00,$458.80,"$2,620.33",$0.00,"$1,310.16","$2,075.30","$2,096.26",$0.00,$398.14,$0.00,$417.16,$0.00
440.04,SUP,HCPCS C1713,,440.040  -  PLATE BONE 154MM 8 HOLE LCP TITANIUM RIGHT PROXIMAL TIBIA,"$2,650.35",$0.00,"$2,650.35","$1,192.66","$1,891.55",$0.00,$443.34,$0.00,$0.00,$464.06,"$2,650.35",$0.00,"$1,325.18","$2,099.08","$2,120.28",$0.00,$402.70,$0.00,$421.94,$0.00
440.041,SUP,HCPCS C1713,,440.041  -  PLATE BONE 154MM 8 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL,"$2,650.35",$0.00,"$2,650.35","$1,192.66","$1,891.55",$0.00,$443.34,$0.00,$0.00,$464.06,"$2,650.35",$0.00,"$1,325.18","$2,099.08","$2,120.28",$0.00,$402.70,$0.00,$421.94,$0.00
440.042,SUP,HCPCS C1713,,440.042  -  PLATE BONE 190MM 10 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL,"$2,679.00",$0.00,"$2,679.00","$1,205.55","$1,912.00",$0.00,$448.13,$0.00,$0.00,$469.07,"$2,679.00",$0.00,"$1,339.50","$2,121.77","$2,143.20",$0.00,$407.05,$0.00,$426.50,$0.00
440.043,SUP,HCPCS C1713,,440.043  -  PLATE BONE 190MM 10 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL,"$2,679.00",$0.00,"$2,679.00","$1,205.55","$1,912.00",$0.00,$448.13,$0.00,$0.00,$469.07,"$2,679.00",$0.00,"$1,339.50","$2,121.77","$2,143.20",$0.00,$407.05,$0.00,$426.50,$0.00
440.044,SUP,HCPCS C1713,,440.044  -  PLATE BONE 226MM 12 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL,"$2,710.40",$0.00,"$2,710.40","$1,219.68","$1,934.41",$0.00,$453.39,$0.00,$0.00,$474.57,"$2,710.40",$0.00,"$1,355.20","$2,146.64","$2,168.32",$0.00,$411.82,$0.00,$431.50,$0.00
440.045,SUP,HCPCS C1713,,440.045  -  PLATE BONE 226MM 12 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL,"$2,710.40",$0.00,"$2,710.40","$1,219.68","$1,934.41",$0.00,$453.39,$0.00,$0.00,$474.57,"$2,710.40",$0.00,"$1,355.20","$2,146.64","$2,168.32",$0.00,$411.82,$0.00,$431.50,$0.00
440.046,SUP,HCPCS C1713,,440.046  -  PLATE BONE 262MM 14 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL,"$2,739.05",$0.00,"$2,739.05","$1,232.57","$1,954.86",$0.00,$458.18,$0.00,$0.00,$479.59,"$2,739.05",$0.00,"$1,369.53","$2,169.33","$2,191.24",$0.00,$416.18,$0.00,$436.06,$0.00
440.047,SUP,HCPCS C1713,,440.047  -  PLATE BONE 262MM 14 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL,"$2,739.05",$0.00,"$2,739.05","$1,232.57","$1,954.86",$0.00,$458.18,$0.00,$0.00,$479.59,"$2,739.05",$0.00,"$1,369.53","$2,169.33","$2,191.24",$0.00,$416.18,$0.00,$436.06,$0.00
440.05,SUP,HCPCS C1713,,440.05  -  PLATE BONE 5 HOLE SPOON LC-DCP TITANIUM ORTHOPEDIC NONSTRL,$626.43,$0.00,$626.43,$281.89,$447.08,$0.00,$104.79,$0.00,$0.00,$109.68,$626.43,$0.00,$313.21,$496.13,$501.14,$0.00,$95.18,$0.00,$99.73,$0.00
440.06,SUP,HCPCS C1713,,440.06  -  PLATE BONE SPOON 6 HOLE LC DCP TITANIUM ORTHOPEDIC NONSTRL,$668.73,$0.00,$668.73,$300.93,$477.27,$0.00,$111.86,$0.00,$0.00,$117.09,$668.73,$0.00,$334.36,$529.63,$534.98,$0.00,$101.61,$0.00,$106.46,$0.00
440.13,SUP,HCPCS C1713,,440.13  -  PLATE BONE T 68MM 3 HOLE LC-DCP TITANIUM ORTHOPEDIC NONSTRL,$504.95,$0.00,$504.95,$227.23,$360.38,$0.00,$84.47,$0.00,$0.00,$88.41,$504.95,$0.00,$252.48,$399.92,$403.96,$0.00,$76.72,$0.00,$80.39,$0.00
440.14,SUP,HCPCS C1713,,440.14  -  PLATE BONE T 84MM 4 HOLE LC-DCP TITANIUM HUMERUS TIBIAL,$550.00,$0.00,$550.00,$247.50,$392.54,$0.00,$92.00,$0.00,$0.00,$96.30,$550.00,$0.00,$275.00,$435.60,$440.00,$0.00,$83.57,$0.00,$87.56,$0.00
440.141,SUP,HCPCS C1713,,440.141  -  PLATE BONE 83MM 4 HOLE T LCP TITANIUM ORTHOPEDIC NONSTRL 4.5,"$1,104.08",$0.00,"$1,104.08",$496.83,$787.98,$0.00,$184.69,$0.00,$0.00,$193.31,"$1,104.08",$0.00,$552.04,$874.43,$883.26,$0.00,$167.76,$0.00,$175.77,$0.00
440.15,SUP,HCPCS C1713,,440.15  -  PLATE BONE T 100MM 5 HOLE LC-DCP TITANIUM ORTHOPEDIC NONSTRL,$577.30,$0.00,$577.30,$259.79,$412.02,$0.00,$96.57,$0.00,$0.00,$101.08,$577.30,$0.00,$288.65,$457.22,$461.84,$0.00,$87.71,$0.00,$91.91,$0.00
440.16,SUP,HCPCS C1713,,440.16  -  PLATE BONE T 116MM 6 HOLE LC-DCP TITANIUM HUMERUS TIBIAL,$656.45,$0.00,$656.45,$295.40,$468.51,$0.00,$109.81,$0.00,$0.00,$114.94,$656.45,$0.00,$328.23,$519.91,$525.16,$0.00,$99.74,$0.00,$104.51,$0.00
440.161,SUP,HCPCS C1713,,440.161  -  PLATE BONE 115MM 6 HOLE T LCP TITANIUM ORTHOPEDIC NONSTRL,"$1,266.50",$0.00,"$1,266.50",$569.93,$903.90,$0.00,$211.85,$0.00,$0.00,$221.75,"$1,266.50",$0.00,$633.25,"$1,003.07","$1,013.20",$0.00,$192.43,$0.00,$201.63,$0.00
440.18,SUP,HCPCS C1713,,440.18  -  PLATE BONE T 148MM 8 HOLE LC-DCP TITANIUM HUMERUS TIBIAL,$865.25,$0.00,$865.25,$389.36,$617.53,$0.00,$144.74,$0.00,$0.00,$151.50,$865.25,$0.00,$432.63,$685.28,$692.20,$0.00,$131.47,$0.00,$137.75,$0.00
440.181,SUP,HCPCS C1713,,440.181  -  PLATE BONE 147MM 8 HOLE T LCP TITANIUM ORTHOPEDIC NONSTRL,"$1,461.65",$0.00,"$1,461.65",$657.74,"$1,043.18",$0.00,$244.50,$0.00,$0.00,$255.92,"$1,461.65",$0.00,$730.83,"$1,157.63","$1,169.32",$0.00,$222.09,$0.00,$232.69,$0.00
440.34,SUP,HCPCS C1713,,440.34  -  PLATE BONE T BUTTRESS 80MM 4 HOLE LC-DCP TITANIUM ORTHOPEDIC,$839.33,$0.00,$839.33,$377.70,$599.03,$0.00,$140.40,$0.00,$0.00,$146.96,$839.33,$0.00,$419.66,$664.75,$671.46,$0.00,$127.53,$0.00,$133.62,$0.00
440.35,SUP,HCPCS C1713,,440.35  -  PLATE BONE T BUTTRESS 96MM 5 HOLE LC-DCP TITANIUM ORTHOPEDIC,$883.00,$0.00,$883.00,$397.35,$630.20,$0.00,$147.70,$0.00,$0.00,$154.61,$883.00,$0.00,$441.50,$699.34,$706.40,$0.00,$134.16,$0.00,$140.57,$0.00
440.36,SUP,HCPCS C1713,,440.36  -  PLATE BONE T BUTTRESS 112MM 6 HOLE LC-DCP TITANIUM,$913.03,$0.00,$913.03,$410.86,$651.63,$0.00,$152.73,$0.00,$0.00,$159.86,$913.03,$0.00,$456.51,$723.12,$730.42,$0.00,$138.73,$0.00,$145.35,$0.00
440.44,SUP,HCPCS C1713,,440.44  -  PLATE BN ANG LT L BTRS 86X14X3.8MM NS LC DCP 4 HL SHFT TI,$734.23,$0.00,$734.23,$330.40,$524.02,$0.00,$122.82,$0.00,$0.00,$128.56,$734.23,$0.00,$367.11,$581.51,$587.38,$0.00,$111.56,$0.00,$116.89,$0.00
440.515,SUP,HCPCS C1713,,440.515  -  PLATE BONE 130MM 5 HOLE BUTTRESS LC-DCP TITANIUM TIBIAL HEAD,"$1,396.15",$0.00,"$1,396.15",$628.27,$996.43,$0.00,$233.54,$0.00,$0.00,$244.45,"$1,396.15",$0.00,$698.08,"$1,105.75","$1,116.92",$0.00,$212.13,$0.00,$222.27,$0.00
440.517,SUP,HCPCS C1713,,440.517  -  PLATE BONE 166MM 7 HOLE BUTTRESS LC-DCP TITANIUM TIBIAL HEAD,"$1,495.78",$0.00,"$1,495.78",$673.10,"$1,067.53",$0.00,$250.21,$0.00,$0.00,$261.90,"$1,495.78",$0.00,$747.89,"$1,184.66","$1,196.62",$0.00,$227.27,$0.00,$238.13,$0.00
440.519,SUP,HCPCS C1713,,440.519  -  PLATE BONE 202MM 9 HOLE BUTTRESS LC-DCP TITANIUM TIBIAL HEAD,"$1,604.95",$0.00,"$1,604.95",$722.23,"$1,145.45",$0.00,$268.47,$0.00,$0.00,$281.01,"$1,604.95",$0.00,$802.48,"$1,271.12","$1,283.96",$0.00,$243.86,$0.00,$255.51,$0.00
440.521,SUP,HCPCS C1713,,440.521  -  PLATE BONE 238MM 11 HOLE BUTTRESS LC-DCP TITANIUM TIBIAL,"$1,708.68",$0.00,"$1,708.68",$768.90,"$1,219.48",$0.00,$285.82,$0.00,$0.00,$299.18,"$1,708.68",$0.00,$854.34,"$1,353.27","$1,366.94",$0.00,$259.62,$0.00,$272.02,$0.00
440.523,SUP,HCPCS C1713,,440.523  -  PLATE BONE 274MM 13 HOLE BUTTRESS LC-DCP TITANIUM TIBIAL,"$1,776.90",$0.00,"$1,776.90",$799.61,"$1,268.17",$0.00,$297.23,$0.00,$0.00,$311.12,"$1,776.90",$0.00,$888.45,"$1,407.30","$1,421.52",$0.00,$269.99,$0.00,$282.88,$0.00
440.525,SUP,HCPCS C1713,,440.525  -  PLATE BONE 130MM 5 HOLE BUTTRESS LC-DCP TITANIUM TIBIAL HEAD,"$1,396.15",$0.00,"$1,396.15",$628.27,$996.43,$0.00,$233.54,$0.00,$0.00,$244.45,"$1,396.15",$0.00,$698.08,"$1,105.75","$1,116.92",$0.00,$212.13,$0.00,$222.27,$0.00
440.527,SUP,HCPCS C1713,,440.527  -  PLATE BONE 166MM 7 HOLE BUTTRESS LC-DCP TITANIUM TIBIAL HEAD,"$1,495.78",$0.00,"$1,495.78",$673.10,"$1,067.53",$0.00,$250.21,$0.00,$0.00,$261.90,"$1,495.78",$0.00,$747.89,"$1,184.66","$1,196.62",$0.00,$227.27,$0.00,$238.13,$0.00
440.529,SUP,HCPCS C1713,,440.529  -  PLATE BONE 202MM 9 HOLE BUTTRESS LC-DCP TITANIUM TIBIAL HEAD,"$1,604.95",$0.00,"$1,604.95",$722.23,"$1,145.45",$0.00,$268.47,$0.00,$0.00,$281.01,"$1,604.95",$0.00,$802.48,"$1,271.12","$1,283.96",$0.00,$243.86,$0.00,$255.51,$0.00
440.531,SUP,HCPCS C1713,,440.531  -  PLATE BONE 238MM 11 HOLE BUTTRESS LC-DCP TITANIUM TIBIAL,"$1,708.68",$0.00,"$1,708.68",$768.90,"$1,219.48",$0.00,$285.82,$0.00,$0.00,$299.18,"$1,708.68",$0.00,$854.34,"$1,353.27","$1,366.94",$0.00,$259.62,$0.00,$272.02,$0.00
440.533,SUP,HCPCS C1713,,440.533  -  PLATE BONE 274MM 13 HOLE BUTTRESS LC-DCP TITANIUM TIBIAL,"$1,776.90",$0.00,"$1,776.90",$799.61,"$1,268.17",$0.00,$297.23,$0.00,$0.00,$311.12,"$1,776.90",$0.00,$888.45,"$1,407.30","$1,421.52",$0.00,$269.99,$0.00,$282.88,$0.00
440.54,SUP,HCPCS C1713,,440.54  -  PLATE BN ANG RT L BTRS 86X14X3.8MM NS LC DCP 4 HL SHFT TI,$754.70,$0.00,$754.70,$339.62,$538.63,$0.00,$126.24,$0.00,$0.00,$132.14,$754.70,$0.00,$377.35,$597.72,$603.76,$0.00,$114.67,$0.00,$120.15,$0.00
440.547,SUP,HCPCS C1713,,440.547  -  PLATE BONE 177MM 7 HOLE BUTTRESS LC-DCP TITANIUM CONDYLE,"$1,695.03",$0.00,"$1,695.03",$762.76,"$1,209.74",$0.00,$283.54,$0.00,$0.00,$296.79,"$1,695.03",$0.00,$847.51,"$1,342.46","$1,356.02",$0.00,$257.54,$0.00,$269.85,$0.00
440.549,SUP,HCPCS C1713,,440.549  -  PLATE BONE 213MM 9 HOLE BUTTRESS LC-DCP TITANIUM CONDYLE,"$1,744.15",$0.00,"$1,744.15",$784.87,"$1,244.80",$0.00,$291.76,$0.00,$0.00,$305.39,"$1,744.15",$0.00,$872.08,"$1,381.37","$1,395.32",$0.00,$265.01,$0.00,$277.67,$0.00
440.551,SUP,HCPCS C1713,,440.551  -  PLATE BONE 249MM 11 HOLE BUTTRESS LC-DCP TITANIUM CONDYLE,"$1,786.45",$0.00,"$1,786.45",$803.90,"$1,274.99",$0.00,$298.83,$0.00,$0.00,$312.79,"$1,786.45",$0.00,$893.23,"$1,414.87","$1,429.16",$0.00,$271.44,$0.00,$284.40,$0.00
440.553,SUP,HCPCS C1713,,440.553  -  PLATE BONE 285MM 13 HOLE BUTTRESS LC-DCP TITANIUM CONDYLE,"$1,845.15",$0.00,"$1,845.15",$830.32,"$1,316.88",$0.00,$308.65,$0.00,$0.00,$323.07,"$1,845.15",$0.00,$922.58,"$1,461.36","$1,476.12",$0.00,$280.35,$0.00,$293.75,$0.00
440.555,SUP,HCPCS C1713,,440.555  -  PLATE BONE 321MM 11 HOLE BUTTRESS LC-DCP TITANIUM CONDYLE,"$1,918.85",$0.00,"$1,918.85",$863.48,"$1,369.48",$0.00,$320.98,$0.00,$0.00,$335.98,"$1,918.85",$0.00,$959.43,"$1,519.73","$1,535.08",$0.00,$291.55,$0.00,$305.48,$0.00
440.567,SUP,HCPCS C1713,,440.567  -  PLATE BONE 177MM 7 HOLE BUTTRESS LC-DCP TITANIUM CONDYLE,"$1,695.03",$0.00,"$1,695.03",$762.76,"$1,209.74",$0.00,$283.54,$0.00,$0.00,$296.79,"$1,695.03",$0.00,$847.51,"$1,342.46","$1,356.02",$0.00,$257.54,$0.00,$269.85,$0.00
440.569,SUP,HCPCS C1713,,440.569  -  PLATE BONE 213MM 9 HOLE BUTTRESS LC-DCP TITANIUM CONDYLE,"$1,696.38",$0.00,"$1,696.38",$763.37,"$1,210.70",$0.00,$283.77,$0.00,$0.00,$297.02,"$1,696.38",$0.00,$848.19,"$1,343.53","$1,357.10",$0.00,$257.75,$0.00,$270.06,$0.00
440.571,SUP,HCPCS C1713,,440.571  -  PLATE BONE 249MM 11 HOLE BUTTRESS LC-DCP TITANIUM CONDYLE,"$1,786.45",$0.00,"$1,786.45",$803.90,"$1,274.99",$0.00,$298.83,$0.00,$0.00,$312.79,"$1,786.45",$0.00,$893.23,"$1,414.87","$1,429.16",$0.00,$271.44,$0.00,$284.40,$0.00
440.573,SUP,HCPCS C1713,,440.573  -  PLATE BONE 285MM 13 HOLE BUTTRESS LC-DCP TITANIUM CONDYLE,"$1,791.40",$0.00,"$1,791.40",$806.13,"$1,278.52",$0.00,$308.65,$0.00,$0.00,$313.66,"$1,791.40",$0.00,$895.70,"$1,418.79","$1,433.12",$0.00,$280.35,$0.00,$285.19,$0.00
440.575,SUP,HCPCS C1713,,440.575  -  PLATE BONE 321MM 15 HOLE BUTTRESS LC-DCP TITANIUM CONDYLE,"$1,862.95",$0.00,"$1,862.95",$838.33,"$1,329.59",$0.00,$320.98,$0.00,$0.00,$326.19,"$1,862.95",$0.00,$931.48,"$1,475.46","$1,490.36",$0.00,$291.55,$0.00,$296.58,$0.00
440.831,SUP,HCPCS C1713,,440.831  -  PLATE BONE SMALL 4 HOLE HIGH TOMOFIX TITANIUM TIBIAL MEDIAL,"$2,374.68",$0.00,"$2,374.68","$1,068.60","$1,694.81",$0.00,$397.23,$0.00,$0.00,$415.79,"$2,374.68",$0.00,"$1,187.34","$1,880.75","$1,899.74",$0.00,$360.81,$0.00,$378.05,$0.00
440.834,SUP,HCPCS C1713,,440.834  -  PLATE BONE 4 HOLE HIGH TOMOFIX TITANIUM TIBIAL MEDIAL,"$2,374.68",$0.00,"$2,374.68","$1,068.60","$1,694.81",$0.00,$397.23,$0.00,$0.00,$415.79,"$2,374.68",$0.00,"$1,187.34","$1,880.75","$1,899.74",$0.00,$360.81,$0.00,$378.05,$0.00
440.843,SUP,HCPCS C1713,,440.843  -  PLATE BONE 3 HOLE TOMOFIX TITANIUM TIBIA RIGHT LATERAL,"$2,374.68",$0.00,"$2,374.68","$1,068.60","$1,694.81",$0.00,$397.23,$0.00,$0.00,$415.79,"$2,374.68",$0.00,"$1,187.34","$1,880.75","$1,899.74",$0.00,$360.81,$0.00,$378.05,$0.00
440.853,SUP,HCPCS C1713,,440.853  -  PLATE BONE 3 HOLE TOMOFIX TITANIUM TIBIA LEFT LATERAL,"$2,374.68",$0.00,"$2,374.68","$1,068.60","$1,694.81",$0.00,$397.23,$0.00,$0.00,$415.79,"$2,374.68",$0.00,"$1,187.34","$1,880.75","$1,899.74",$0.00,$360.81,$0.00,$378.05,$0.00
440.864,SUP,HCPCS C1713,,440.864  -  PLATE BONE 4 HOLE TOMOFIX TITANIUM FEMUR RIGHT DISTAL,"$2,374.68",$0.00,"$2,374.68","$1,068.60","$1,694.81",$0.00,$397.23,$0.00,$0.00,$415.79,"$2,374.68",$0.00,"$1,187.34","$1,880.75","$1,899.74",$0.00,$360.81,$0.00,$378.05,$0.00
440.874,SUP,HCPCS C1713,,440.874  -  PLATE BONE 4 HOLE TOMOFIX TITANIUM FEMUR LEFT DISTAL LATERAL,"$2,374.68",$0.00,"$2,374.68","$1,068.60","$1,694.81",$0.00,$397.23,$0.00,$0.00,$415.79,"$2,374.68",$0.00,"$1,187.34","$1,880.75","$1,899.74",$0.00,$360.81,$0.00,$378.05,$0.00
440.885,SUP,HCPCS C1713,,440.885  -  PLATE BONE 121MM 4 HOLE TOMOFIX TITANIUM RIGHT MEDIAL DISTAL,"$2,305.50",$0.00,"$2,305.50","$1,037.48","$1,645.44",$0.00,$397.23,$0.00,$0.00,$403.67,"$2,305.50",$0.00,"$1,152.75","$1,825.96","$1,844.40",$0.00,$360.81,$0.00,$367.04,$0.00
440.895,SUP,HCPCS C1713,,440.895  -  PLATE BONE 121MM 4 HOLE TOMOFIX TITANIUM LEFT MEDIAL DISTAL,"$2,305.50",$0.00,"$2,305.50","$1,037.48","$1,645.44",$0.00,$397.23,$0.00,$0.00,$403.67,"$2,305.50",$0.00,"$1,152.75","$1,825.96","$1,844.40",$0.00,$360.81,$0.00,$367.04,$0.00
441.031,SUP,HCPCS C1713,,441.031  -  PLATE BONE T OBLIQUE RIGHT 52X10X1.5MM 3 HOLE HEAD 3 HOLE,$664.63,$0.00,$664.63,$299.08,$474.34,$0.00,$111.18,$0.00,$0.00,$116.37,$664.63,$0.00,$332.31,$526.39,$531.70,$0.00,$100.99,$0.00,$105.81,$0.00
441.041,SUP,HCPCS C1713,,441.041  -  PLATE BONE T OBLIQUE RIGHT 63X10X1.5MM 3 HOLE HEAD 4 HOLE,$696.03,$0.00,$696.03,$313.21,$496.75,$0.00,$116.43,$0.00,$0.00,$121.87,$696.03,$0.00,$348.01,$551.26,$556.82,$0.00,$105.75,$0.00,$110.81,$0.00
441.051,SUP,HCPCS C1713,,441.051  -  PLATE BONE T OBLIQUE RIGHT 74X10X1.5MM 3 HOLE HEAD 5 HOLE,$726.05,$0.00,$726.05,$326.72,$518.18,$0.00,$121.45,$0.00,$0.00,$127.13,$726.05,$0.00,$363.03,$575.03,$580.84,$0.00,$110.32,$0.00,$115.59,$0.00
441.061,SUP,HCPCS C1713,,441.061  -  PLATE BONE 85MM 3 HOLE HEAD 6 HOLE SHAFT T OBLIQUE RIGHT LCP,$779.28,$0.00,$779.28,$350.67,$556.17,$0.00,$130.35,$0.00,$0.00,$136.44,$779.28,$0.00,$389.64,$617.19,$623.42,$0.00,$118.40,$0.00,$124.06,$0.00
441.062,SUP,HCPCS C1713,,441.062  -  PLATE BONE 15MM 6 HOLE HOOK LCP TITANIUM RIGHT CLAVICLE,"$1,307.78",$0.00,"$1,307.78",$588.50,$933.36,$0.00,$225.32,$0.00,$0.00,$228.98,"$1,307.78",$0.00,$653.89,"$1,035.76","$1,046.22",$0.00,$204.67,$0.00,$208.20,$0.00
441.063,SUP,HCPCS C1713,,441.063  -  PLATE BONE 15MM 6 HOLE HOOK LCP TITANIUM LEFT CLAVICLE,"$1,307.78",$0.00,"$1,307.78",$588.50,$933.36,$0.00,$225.32,$0.00,$0.00,$228.98,"$1,307.78",$0.00,$653.89,"$1,035.76","$1,046.22",$0.00,$204.67,$0.00,$208.20,$0.00
441.064,SUP,HCPCS C1713,,441.064  -  PLATE BONE 18MM 6 HOLE HOOK LCP TITANIUM RIGHT CLAVICLE,"$1,307.78",$0.00,"$1,307.78",$588.50,$933.36,$0.00,$225.32,$0.00,$0.00,$228.98,"$1,307.78",$0.00,$653.89,"$1,035.76","$1,046.22",$0.00,$204.67,$0.00,$208.20,$0.00
441.065,SUP,HCPCS C1713,,441.065  -  PLATE BONE 18MM 6 HOLE HOOK LCP TITANIUM LEFT CLAVICLE,"$1,307.78",$0.00,"$1,307.78",$588.50,$933.36,$0.00,$225.32,$0.00,$0.00,$228.98,"$1,307.78",$0.00,$653.89,"$1,035.76","$1,046.22",$0.00,$204.67,$0.00,$208.20,$0.00
441.066,SUP,HCPCS C1713,,441.066  -  PLATE BONE 15MM 8 HOLE HOOK LCP TITANIUM RIGHT CLAVICLE,"$1,403.18",$0.00,"$1,403.18",$631.43,"$1,001.45",$0.00,$241.76,$0.00,$0.00,$245.68,"$1,403.18",$0.00,$701.59,"$1,111.32","$1,122.54",$0.00,$219.60,$0.00,$223.39,$0.00
441.067,SUP,HCPCS C1713,,441.067  -  PLATE BONE 15MM 8 HOLE HOOK LCP TITANIUM LEFT CLAVICLE,"$1,403.18",$0.00,"$1,403.18",$631.43,"$1,001.45",$0.00,$241.76,$0.00,$0.00,$245.68,"$1,403.18",$0.00,$701.59,"$1,111.32","$1,122.54",$0.00,$219.60,$0.00,$223.39,$0.00
441.068,SUP,HCPCS C1713,,441.068  -  PLATE BN 18MM 3.5MM 77MM NS 8 HL HK TI CLVCL RT 3.5MM 4MM,"$1,403.18",$0.00,"$1,403.18",$631.43,"$1,001.45",$0.00,$241.76,$0.00,$0.00,$245.68,"$1,403.18",$0.00,$701.59,"$1,111.32","$1,122.54",$0.00,$219.60,$0.00,$223.39,$0.00
441.069,SUP,HCPCS C1713,,441.069  -  PLATE BONE 18MM 77MM 8 HOLE HOOK TITANIUM LEFT CLAVICLE,"$1,403.18",$0.00,"$1,403.18",$631.43,"$1,001.45",$0.00,$241.76,$0.00,$0.00,$245.68,"$1,403.18",$0.00,$701.59,"$1,111.32","$1,122.54",$0.00,$219.60,$0.00,$223.39,$0.00
441.071,SUP,HCPCS C1713,,441.071  -  PLATE BONE T RIGHT OBLIQUE 96MM 7 HOLE SHAFT 3 HOLE HEAD LCP,$788.83,$0.00,$788.83,$354.97,$562.98,$0.00,$131.95,$0.00,$0.00,$138.12,$788.83,$0.00,$394.41,$624.75,$631.06,$0.00,$119.86,$0.00,$125.58,$0.00
441.081,SUP,HCPCS C1713,,441.081  -  PLATE BONE 107MM 3X8 HOLE T OBLIQUE RIGHT LCP TITANIUM,$857.08,$0.00,$857.08,$385.68,$611.69,$0.00,$143.37,$0.00,$0.00,$150.07,$857.08,$0.00,$428.54,$678.81,$685.66,$0.00,$130.22,$0.00,$136.45,$0.00
441.13,SUP,HCPCS C1713,,441.13  -  PLATE BONE T RIGHT ANG 50X10X1.2MM 3X3 HOLE LC-DCP TITANIUM,$232.00,$0.00,$232.00,$104.40,$165.58,$0.00,$38.81,$0.00,$0.00,$40.62,$232.00,$0.00,$116.00,$183.74,$185.60,$0.00,$35.25,$0.00,$36.93,$0.00
441.131,SUP,HCPCS C1713,,441.131  -  PLATE BONE T RIGHT ANG 50X10X1.5MM 3 HOLE HEAD 3 HOLE SHAFT,$593.68,$0.00,$593.68,$267.15,$423.71,$0.00,$99.31,$0.00,$0.00,$103.95,$593.68,$0.00,$296.84,$470.19,$474.94,$0.00,$90.20,$0.00,$94.51,$0.00
441.132,SUP,HCPCS C1713,,441.132  -  PLATE BONE 50MM 4 HEAD HOLE 3 SHAFT HOLE T RIGHT ANG LCP,$611.40,$0.00,$611.40,$275.13,$436.36,$0.00,$102.27,$0.00,$0.00,$107.05,$611.40,$0.00,$305.70,$484.23,$489.12,$0.00,$92.90,$0.00,$97.33,$0.00
441.14,SUP,HCPCS C1713,,441.14  -  PLATE BONE 3.5MM 56MM T 4 HEAD HOLE 4 SHAFT HOLE RIGHT ANG,$240.20,$0.00,$240.20,$108.09,$171.43,$0.00,$40.18,$0.00,$0.00,$42.06,$240.20,$0.00,$120.10,$190.24,$192.16,$0.00,$36.50,$0.00,$38.24,$0.00
441.141,SUP,HCPCS C1713,,441.141  -  PLATE BONE T RIGHT ANG 56X11X1.5MM 4 HOLE HEAD 4 HOLE SHAFT,$612.78,$0.00,$612.78,$275.75,$437.34,$0.00,$102.50,$0.00,$0.00,$107.29,$612.78,$0.00,$306.39,$485.32,$490.22,$0.00,$93.11,$0.00,$97.55,$0.00
441.142,SUP,HCPCS C1713,,441.142  -  PLATE BONE 57MM 3 HOLE HEAD 4 HOLE SHAFT T RIGHT ANG LCP,$631.88,$0.00,$631.88,$284.34,$450.97,$0.00,$105.70,$0.00,$0.00,$110.64,$631.88,$0.00,$315.94,$500.45,$505.50,$0.00,$96.01,$0.00,$100.59,$0.00
441.15,SUP,HCPCS C1713,,441.15  -  PLATE BONE T RIGHT ANG 67X10X1.2MM 3X5 HOLE LC-DCP TITANIUM,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
441.151,SUP,HCPCS C1713,,441.151  -  PLATE BONE T RIGHT ANG 67X10X1.5MM 3 HOLE HEAD 5 HOLE SHAFT,$674.18,$0.00,$674.18,$303.38,$481.16,$0.00,$112.78,$0.00,$0.00,$118.04,$674.18,$0.00,$337.09,$533.95,$539.34,$0.00,$102.44,$0.00,$107.33,$0.00
441.152,SUP,HCPCS C1713,,441.152  -  PLATE BONE 67MM 4 HEAD HOLE 5 SHAFT HOLE T RIGHT ANG LCP,$694.65,$0.00,$694.65,$312.59,$495.77,$0.00,$116.20,$0.00,$0.00,$121.63,$694.65,$0.00,$347.33,$550.16,$555.72,$0.00,$105.55,$0.00,$110.59,$0.00
441.16,SUP,HCPCS C1713,,441.16  -  PLATE BONE T RIGHT ANG 78X10X1.2MM 4X6 HOLE LC-DCP TITANIUM,$302.10,$0.00,$302.10,$135.95,$215.61,$0.00,$52.05,$0.00,$0.00,$52.90,$302.10,$0.00,$151.05,$239.26,$241.68,$0.00,$47.28,$0.00,$48.09,$0.00
441.161,SUP,HCPCS C1713,,441.161  -  PLATE BONE T RIGHT ANG 78X11X1.5MM 4 HOLE HEAD 6 HOLE SHAFT,$786.10,$0.00,$786.10,$353.75,$561.04,$0.00,$131.50,$0.00,$0.00,$137.64,$786.10,$0.00,$393.05,$622.59,$628.88,$0.00,$119.44,$0.00,$125.15,$0.00
441.162,SUP,HCPCS C1713,,441.162  -  PLATE BONE 77MM 3 HOLE HEAD 6 HOLE SHAFT T RIGHT ANG LCP,$806.58,$0.00,$806.58,$362.96,$575.65,$0.00,$134.92,$0.00,$0.00,$141.22,$806.58,$0.00,$403.29,$638.81,$645.26,$0.00,$122.55,$0.00,$128.41,$0.00
441.171,SUP,HCPCS C1713,,441.171  -  PLATE BONE T RIGHT ANG 87X10X1.5MM 3 HOLE HEAD 7 HOLE SHAFT,$985.35,$0.00,$985.35,$443.41,$703.24,$0.00,$164.83,$0.00,$0.00,$172.53,$985.35,$0.00,$492.68,$780.40,$788.28,$0.00,$149.72,$0.00,$156.87,$0.00
441.172,SUP,HCPCS C1713,,441.172  -  PLATE BONE 89MM 4 HOLE HEAD 7 HOLE SHAFT T RIGHT ANG LCP,"$1,011.28",$0.00,"$1,011.28",$455.07,$721.75,$0.00,$169.16,$0.00,$0.00,$177.07,"$1,011.28",$0.00,$505.64,$800.93,$809.02,$0.00,$153.66,$0.00,$160.99,$0.00
441.181,SUP,HCPCS C1713,,441.181  -  PLATE BONE 97MM 3 HOLE HEAD 8 HOLE SHAFT T RIGHT ANG LCP,"$1,179.15",$0.00,"$1,179.15",$530.62,$841.56,$0.00,$197.24,$0.00,$0.00,$206.46,"$1,179.15",$0.00,$589.58,$933.89,$943.32,$0.00,$179.16,$0.00,$187.72,$0.00
441.182,SUP,HCPCS C1713,,441.182  -  PLATE BONE 100MM 4 HOLE HEAD 8 HOLE SHAFT T RIGHT ANG LCP,"$1,175.05",$0.00,"$1,175.05",$528.77,$838.63,$0.00,$196.56,$0.00,$0.00,$205.74,"$1,175.05",$0.00,$587.53,$930.64,$940.04,$0.00,$178.54,$0.00,$187.07,$0.00
441.23,SUP,HCPCS C1713,,441.23  -  PLATE BONE T OBLIQUE 53X10X1.2MM 3X3 HOLE LC-DCP TITANIUM,$398.50,$0.00,$398.50,$179.33,$284.41,$0.00,$66.66,$0.00,$0.00,$69.77,$398.50,$0.00,$199.25,$315.61,$318.80,$0.00,$60.55,$0.00,$63.44,$0.00
441.24,SUP,HCPCS C1713,,441.24  -  PLATE BONE T OBLIQUE 63X10X1.2MM 3X4 HOLE LC-DCP TITANIUM,$423.08,$0.00,$423.08,$190.38,$301.95,$0.00,$70.77,$0.00,$0.00,$74.08,$423.08,$0.00,$211.54,$335.08,$338.46,$0.00,$64.28,$0.00,$67.35,$0.00
441.25,SUP,HCPCS C1713,,441.25  -  PLATE BN T OBLQ 75X10X1.5MM LC DCP 3 HLE/HD 5 HL SHFT TI 3.5,$435.35,$0.00,$435.35,$195.91,$310.71,$0.00,$72.82,$0.00,$0.00,$76.23,$435.35,$0.00,$217.68,$344.80,$348.28,$0.00,$66.15,$0.00,$69.31,$0.00
441.262,SUP,HCPCS C1713,,441.262  -  PLATE BONE 55MM 3 HOLE LCP TITANIUM HUMERUS RIGHT POSTLAT,"$1,738.70",$0.00,"$1,738.70",$782.42,"$1,240.91",$0.00,$290.84,$0.00,$0.00,$304.43,"$1,738.70",$0.00,$869.35,"$1,377.05","$1,390.96",$0.00,$264.18,$0.00,$276.80,$0.00
441.263,SUP,HCPCS C1713,,441.263  -  PLATE BONE 55MM 3 HOLE LCP TITANIUM HUMERUS LEFT POSTLAT,"$1,738.70",$0.00,"$1,738.70",$782.42,"$1,240.91",$0.00,$290.84,$0.00,$0.00,$304.43,"$1,738.70",$0.00,$869.35,"$1,377.05","$1,390.96",$0.00,$264.18,$0.00,$276.80,$0.00
441.264,SUP,HCPCS C1713,,441.264  -  PLATE BONE 5 HOLE LCP TITANIUM HUMERUS RIGHT POSTLAT DISTAL,"$1,928.40",$0.00,"$1,928.40",$867.78,"$1,376.30",$0.00,$322.58,$0.00,$0.00,$337.65,"$1,928.40",$0.00,$964.20,"$1,527.29","$1,542.72",$0.00,$293.00,$0.00,$307.00,$0.00
441.265,SUP,HCPCS C1713,,441.265  -  PLATE BONE 5 HOLE LCP TITANIUM HUMERUS LEFT POSTLAT DISTAL,"$1,928.40",$0.00,"$1,928.40",$867.78,"$1,376.30",$0.00,$322.58,$0.00,$0.00,$337.65,"$1,928.40",$0.00,$964.20,"$1,527.29","$1,542.72",$0.00,$293.00,$0.00,$307.00,$0.00
441.266,SUP,HCPCS C1713,,441.266  -  PLATE BONE 116MM 7 HOLE LCP TITANIUM HUMERUS RIGHT POSTLAT,"$2,120.83",$0.00,"$2,120.83",$954.37,"$1,513.63",$0.00,$354.76,$0.00,$0.00,$371.34,"$2,120.83",$0.00,"$1,060.41","$1,679.70","$1,696.66",$0.00,$322.24,$0.00,$337.64,$0.00
441.267,SUP,HCPCS C1713,,441.267  -  PLATE BONE 116MM 7 HOLE LCP TITANIUM HUMERUS LEFT POSTLAT,"$2,120.83",$0.00,"$2,120.83",$954.37,"$1,513.63",$0.00,$354.76,$0.00,$0.00,$371.34,"$2,120.83",$0.00,"$1,060.41","$1,679.70","$1,696.66",$0.00,$322.24,$0.00,$337.64,$0.00
441.268,SUP,HCPCS C1713,,441.268  -  PLATE BONE 9 HOLE LCP TITANIUM HUMERUS RIGHT POSTLAT DISTAL,"$2,290.05",$0.00,"$2,290.05","$1,030.52","$1,634.41",$0.00,$383.07,$0.00,$0.00,$400.97,"$2,290.05",$0.00,"$1,145.03","$1,813.72","$1,832.04",$0.00,$347.95,$0.00,$364.58,$0.00
441.269,SUP,HCPCS C1713,,441.269  -  PLATE BONE 9 HOLE LCP TITANIUM HUMERUS LEFT POSTLAT DISTAL,"$2,290.05",$0.00,"$2,290.05","$1,030.52","$1,634.41",$0.00,$383.07,$0.00,$0.00,$400.97,"$2,290.05",$0.00,"$1,145.03","$1,813.72","$1,832.04",$0.00,$347.95,$0.00,$364.58,$0.00
441.272,SUP,HCPCS C1713,,441.272  -  PLATE BONE 55MM 3 HOLE LATERAL SUPPORT LCP TITANIUM HUMERUS,"$1,993.90",$0.00,"$1,993.90",$897.26,"$1,423.05",$0.00,$333.53,$0.00,$0.00,$349.12,"$1,993.90",$0.00,$996.95,"$1,579.17","$1,595.12",$0.00,$302.96,$0.00,$317.43,$0.00
441.273,SUP,HCPCS C1713,,441.273  -  PLATE BONE 3 HOLE LATERAL SUPPORT LCP TITANIUM HUMERUS LEFT,"$1,993.90",$0.00,"$1,993.90",$897.26,"$1,423.05",$0.00,$333.53,$0.00,$0.00,$349.12,"$1,993.90",$0.00,$996.95,"$1,579.17","$1,595.12",$0.00,$302.96,$0.00,$317.43,$0.00
441.274,SUP,HCPCS C1713,,441.274  -  PLATE BONE 5 HOLE LATERAL SUPPORT LCP TITANIUM HUMERUS RIGHT,"$2,174.05",$0.00,"$2,174.05",$978.32,"$1,551.62",$0.00,$363.67,$0.00,$0.00,$380.66,"$2,174.05",$0.00,"$1,087.03","$1,721.85","$1,739.24",$0.00,$330.33,$0.00,$346.11,$0.00
441.275,SUP,HCPCS C1713,,441.275  -  PLATE BONE 5 HOLE LATERAL SUPPORT LCP TITANIUM HUMERUS LEFT,"$2,174.05",$0.00,"$2,174.05",$978.32,"$1,551.62",$0.00,$363.67,$0.00,$0.00,$380.66,"$2,174.05",$0.00,"$1,087.03","$1,721.85","$1,739.24",$0.00,$330.33,$0.00,$346.11,$0.00
441.276,SUP,HCPCS C1713,,441.276  -  PLATE BONE 116MM 7 HOLE LATERAL SUPPORT LCP TITANIUM HUMERUS,"$2,355.55",$0.00,"$2,355.55","$1,060.00","$1,681.16",$0.00,$394.03,$0.00,$0.00,$412.44,"$2,355.55",$0.00,"$1,177.78","$1,865.60","$1,884.44",$0.00,$357.91,$0.00,$375.00,$0.00
441.277,SUP,HCPCS C1713,,441.277  -  PLATE BONE 7 HOLE LATERAL SUPPORT LCP TITANIUM HUMERUS LEFT,"$2,355.55",$0.00,"$2,355.55","$1,060.00","$1,681.16",$0.00,$394.03,$0.00,$0.00,$412.44,"$2,355.55",$0.00,"$1,177.78","$1,865.60","$1,884.44",$0.00,$357.91,$0.00,$375.00,$0.00
441.278,SUP,HCPCS C1713,,441.278  -  PLATE BONE 9 HOLE LATERAL SUPPORT LCP TITANIUM HUMERUS RIGHT,"$2,556.18",$0.00,"$2,556.18","$1,150.28","$1,824.34",$0.00,$427.59,$0.00,$0.00,$447.57,"$2,556.18",$0.00,"$1,278.09","$2,024.49","$2,044.94",$0.00,$388.39,$0.00,$406.94,$0.00
441.279,SUP,HCPCS C1713,,441.279  -  PLATE BONE 9 HOLE LATERAL SUPPORT LCP TITANIUM HUMERUS LEFT,"$2,556.18",$0.00,"$2,556.18","$1,150.28","$1,824.34",$0.00,$427.59,$0.00,$0.00,$447.57,"$2,556.18",$0.00,"$1,278.09","$2,024.49","$2,044.94",$0.00,$388.39,$0.00,$406.94,$0.00
441.282,SUP,HCPCS C1713,,441.282  -  PLATE BONE 3 HOLE LCP TITANIUM HUMERUS RIGHT MEDIAL DISTAL,"$1,738.70",$0.00,"$1,738.70",$782.42,"$1,240.91",$0.00,$290.84,$0.00,$0.00,$304.43,"$1,738.70",$0.00,$869.35,"$1,377.05","$1,390.96",$0.00,$264.18,$0.00,$276.80,$0.00
441.283,SUP,HCPCS C1713,,441.283  -  PLATE BONE 58MM 3 HOLE LCP TITANIUM HUMERUS LEFT DISTAL,"$1,738.70",$0.00,"$1,738.70",$782.42,"$1,240.91",$0.00,$290.84,$0.00,$0.00,$304.43,"$1,738.70",$0.00,$869.35,"$1,377.05","$1,390.96",$0.00,$264.18,$0.00,$276.80,$0.00
441.284,SUP,HCPCS C1713,,441.284  -  PLATE BONE 5 HOLE LCP TITANIUM HUMERUS RIGHT DISTAL MEDIAL,"$1,928.40",$0.00,"$1,928.40",$867.78,"$1,376.30",$0.00,$322.58,$0.00,$0.00,$337.65,"$1,928.40",$0.00,$964.20,"$1,527.29","$1,542.72",$0.00,$293.00,$0.00,$307.00,$0.00
441.285,SUP,HCPCS C1713,,441.285  -  PLATE BONE 83MM 5 HOLE LCP TITANIUM HUMERUS LEFT DISTAL,"$1,928.40",$0.00,"$1,928.40",$867.78,"$1,376.30",$0.00,$322.58,$0.00,$0.00,$337.65,"$1,928.40",$0.00,$964.20,"$1,527.29","$1,542.72",$0.00,$293.00,$0.00,$307.00,$0.00
441.286,SUP,HCPCS C1713,,441.286  -  PLATE BONE 110MM 7 HOLE LCP TITANIUM HUMERUS RIGHT DISTAL,"$2,120.83",$0.00,"$2,120.83",$954.37,"$1,513.63",$0.00,$354.76,$0.00,$0.00,$371.34,"$2,120.83",$0.00,"$1,060.41","$1,679.70","$1,696.66",$0.00,$322.24,$0.00,$337.64,$0.00
441.287,SUP,HCPCS C1713,,441.287  -  PLATE BN 110X11X2.5MM NS LCP CMBN 7 HL PRECONTOUR LMT CNTCT,"$2,120.83",$0.00,"$2,120.83",$954.37,"$1,513.63",$0.00,$354.76,$0.00,$0.00,$371.34,"$2,120.83",$0.00,"$1,060.41","$1,679.70","$1,696.66",$0.00,$322.24,$0.00,$337.64,$0.00
441.288,SUP,HCPCS C1713,,441.288  -  PLATE BONE 9 HOLE LCP TITANIUM HUMERUS RIGHT MEDIAL DISTAL,"$2,290.05",$0.00,"$2,290.05","$1,030.52","$1,634.41",$0.00,$383.07,$0.00,$0.00,$400.97,"$2,290.05",$0.00,"$1,145.03","$1,813.72","$1,832.04",$0.00,$347.95,$0.00,$364.58,$0.00
441.289,SUP,HCPCS C1713,,441.289  -  PLATE BONE 136MM 9 HOLE LCP TITANIUM HUMERUS LEFT DISTAL,"$2,290.05",$0.00,"$2,290.05","$1,030.52","$1,634.41",$0.00,$383.07,$0.00,$0.00,$400.97,"$2,290.05",$0.00,"$1,145.03","$1,813.72","$1,832.04",$0.00,$347.95,$0.00,$364.58,$0.00
441.3,SUP,HCPCS C1713,,441.300  -  PLATE BONE 14 HOLE LCP TITANIUM HUMERUS RIGHT POSTLAT DISTAL,"$2,355.55",$0.00,"$2,355.55","$1,060.00","$1,681.16",$0.00,$394.03,$0.00,$0.00,$412.44,"$2,355.55",$0.00,"$1,177.78","$1,865.60","$1,884.44",$0.00,$357.91,$0.00,$375.00,$0.00
441.301,SUP,HCPCS C1713,,441.301  -  PLATE BONE 14 HOLE LCP TITANIUM HUMERUS LEFT POSTLAT DISTAL,"$2,355.55",$0.00,"$2,355.55","$1,060.00","$1,681.16",$0.00,$394.03,$0.00,$0.00,$412.44,"$2,355.55",$0.00,"$1,177.78","$1,865.60","$1,884.44",$0.00,$357.91,$0.00,$375.00,$0.00
441.302,SUP,HCPCS C1713,,441.302  -  PLATE BONE 14 HOLE LATERAL SUPPORT LCP TITANIUM HUMERUS,"$2,490.68",$0.00,"$2,490.68","$1,120.80","$1,777.59",$0.00,$416.63,$0.00,$0.00,$436.10,"$2,490.68",$0.00,"$1,245.34","$1,972.62","$1,992.54",$0.00,$378.44,$0.00,$396.52,$0.00
441.303,SUP,HCPCS C1713,,441.303  -  PLATE BONE 14 HOLE LATERAL SUPPORT LCP TITANIUM HUMERUS LEFT,"$2,490.68",$0.00,"$2,490.68","$1,120.80","$1,777.59",$0.00,$416.63,$0.00,$0.00,$436.10,"$2,490.68",$0.00,"$1,245.34","$1,972.62","$1,992.54",$0.00,$378.44,$0.00,$396.52,$0.00
441.304,SUP,HCPCS C1713,,441.304  -  PLATE BONE 14 HOLE LCP TITANIUM HUMERUS RIGHT MEDIAL DISTAL,"$2,355.55",$0.00,"$2,355.55","$1,060.00","$1,681.16",$0.00,$394.03,$0.00,$0.00,$412.44,"$2,355.55",$0.00,"$1,177.78","$1,865.60","$1,884.44",$0.00,$357.91,$0.00,$375.00,$0.00
441.305,SUP,HCPCS C1713,,441.305  -  PLATE BONE 14 HOLE LCP TITANIUM HUMERUS LEFT DISTAL MEDIAL,"$2,355.55",$0.00,"$2,355.55","$1,060.00","$1,681.16",$0.00,$394.03,$0.00,$0.00,$412.44,"$2,355.55",$0.00,"$1,177.78","$1,865.60","$1,884.44",$0.00,$357.91,$0.00,$375.00,$0.00
441.32,SUP,HCPCS C1713,,441.32  -  PLATE BONE 25X9X1MM 2 HOLE 1/3 TUBULAR COLLAR LC-DCP,$105.08,$0.00,$105.08,$47.28,$74.99,$0.00,$17.58,$0.00,$0.00,$18.40,$105.08,$0.00,$52.54,$83.22,$84.06,$0.00,$15.97,$0.00,$16.73,$0.00
441.33,SUP,HCPCS C1713,,441.33  -  PLATE BONE 1/3 TUBULAR 37X9X1MM .5MM 3 HOLE COLLAR LC-DCP,$107.83,$0.00,$107.83,$48.52,$76.95,$0.00,$18.03,$0.00,$0.00,$18.88,$107.83,$0.00,$53.91,$85.40,$86.26,$0.00,$16.38,$0.00,$17.17,$0.00
441.331,SUP,HCPCS C1713,,441.331  -  PLATE BONE 33MM 3 HOLE 1/3 TUBULAR COLLAR LCP TITANIUM,$266.13,$0.00,$266.13,$119.76,$189.93,$0.00,$44.52,$0.00,$0.00,$46.60,$266.13,$0.00,$133.06,$210.77,$212.90,$0.00,$40.44,$0.00,$42.37,$0.00
441.34,SUP,HCPCS C1713,,441.34  -  PLATE BONE 1/3 TUBULAR 49X9X1MM .5MM 4 HOLE COLLAR LC-DCP,$126.93,$0.00,$126.93,$57.12,$90.59,$0.00,$21.23,$0.00,$0.00,$22.22,$126.93,$0.00,$63.46,$100.53,$101.54,$0.00,$19.28,$0.00,$20.21,$0.00
441.341,SUP,HCPCS C1713,,441.341  -  PLATE BONE 45MM 4 HOLE 1/3 TUBULAR COLLAR LCP TITANIUM,$307.08,$0.00,$307.08,$138.18,$219.16,$0.00,$51.37,$0.00,$0.00,$53.77,$307.08,$0.00,$153.54,$243.21,$245.66,$0.00,$46.66,$0.00,$48.89,$0.00
441.35,SUP,HCPCS C1713,,441.35  -  PLATE BONE 61X9X1MM 5 HOLE 1/3 TUBULAR COLLAR LC-DCP,$126.93,$0.00,$126.93,$57.12,$90.59,$0.00,$21.23,$0.00,$0.00,$22.22,$126.93,$0.00,$63.46,$100.53,$101.54,$0.00,$19.28,$0.00,$20.21,$0.00
441.351,SUP,HCPCS C1713,,441.351  -  PLATE BONE 1/3 TUBULAR 57X9X1MM 5 HOLE COLLAR LCP TITANIUM,$307.08,$0.00,$307.08,$138.18,$219.16,$0.00,$67.81,$0.00,$0.00,$53.77,$307.08,$0.00,$153.54,$243.21,$245.66,$0.00,$61.59,$0.00,$48.89,$0.00
441.36,SUP,HCPCS C1713,,441.36  -  PLATE BN 1/3 TBLR 12MM 73X9X1MM NS .5MM 6 HL COLR TI 3.5MM,$131.68,$0.00,$131.68,$59.25,$93.98,$0.00,$22.03,$0.00,$0.00,$23.06,$131.68,$0.00,$65.84,$104.29,$105.34,$0.00,$20.01,$0.00,$20.96,$0.00
441.361,SUP,HCPCS C1713,,441.361  -  PLATE BN 1/3 TBLR 12MM 69X9X1MM NS .7MM LCP 6 HL COLR TI,$307.08,$0.00,$307.08,$138.18,$219.16,$0.00,$51.37,$0.00,$0.00,$53.77,$307.08,$0.00,$153.54,$243.21,$245.66,$0.00,$46.66,$0.00,$48.89,$0.00
441.37,SUP,HCPCS C1713,,441.37  -  PLATE BN 1/3 TBLR 12MM 85X9X1MM NS .5MM 7 HL COLR TI 3.5MM,$131.68,$0.00,$131.68,$59.25,$93.98,$0.00,$22.03,$0.00,$0.00,$23.06,$131.68,$0.00,$65.84,$104.29,$105.34,$0.00,$20.01,$0.00,$20.96,$0.00
441.371,SUP,HCPCS C1713,,441.371  -  PLATE BN 1/3 TBLR 12MM 81X9X1MM NS .7MM LCP 7 HL COLR TI,$313.90,$0.00,$313.90,$141.26,$224.03,$0.00,$52.51,$0.00,$0.00,$54.96,$313.90,$0.00,$156.95,$248.61,$251.12,$0.00,$47.69,$0.00,$49.97,$0.00
441.38,SUP,HCPCS C1713,,441.38  -  PLATE BN 1/3 TBLR 12MM 97X9X1MM NS .5MM 8 HL COLR TI 3.5MM,$136.48,$0.00,$136.48,$61.41,$97.40,$0.00,$22.83,$0.00,$0.00,$23.90,$136.48,$0.00,$68.24,$108.09,$109.18,$0.00,$20.74,$0.00,$21.73,$0.00
441.381,SUP,HCPCS C1713,,441.381  -  PLATE BN 1/3 TBLR 12MM 93X9X1MM NS .7MM LCP 8 HL COLR TI,$330.28,$0.00,$330.28,$148.62,$235.72,$0.00,$55.25,$0.00,$0.00,$57.83,$330.28,$0.00,$165.14,$261.58,$264.22,$0.00,$50.18,$0.00,$52.58,$0.00
441.39,SUP,HCPCS C1713,,441.39  -  PLATE BONE 109X9X1MM 9 HOLE 1/3 TUBULAR COLLAR LC-DCP,$136.48,$0.00,$136.48,$61.41,$97.40,$0.00,$22.83,$0.00,$0.00,$23.90,$136.48,$0.00,$68.24,$108.09,$109.18,$0.00,$20.74,$0.00,$21.73,$0.00
441.391,SUP,HCPCS C1713,,441.391  -  PLATE BONE 105MM 9 HOLE 1/3 TUBULAR COLLAR LCP TITANIUM,$346.65,$0.00,$346.65,$155.99,$247.40,$0.00,$57.99,$0.00,$0.00,$60.70,$346.65,$0.00,$173.33,$274.55,$277.32,$0.00,$52.67,$0.00,$55.19,$0.00
441.4,SUP,HCPCS C1713,,441.40  -  PLATE BONE 121X9X1MM 10 HOLE 1/3 TUBULAR COLLAR LC-DCP,$136.48,$0.00,$136.48,$61.41,$97.40,$0.00,$22.83,$0.00,$0.00,$23.90,$136.48,$0.00,$68.24,$108.09,$109.18,$0.00,$20.74,$0.00,$21.73,$0.00
441.401,SUP,HCPCS C1713,,441.401  -  PLATE BONE 1/3 TUBULAR 12MM 117X9X1MM 10 HOLE COLLAR LCP,$335.73,$0.00,$335.73,$151.08,$239.61,$0.00,$56.16,$0.00,$0.00,$58.78,$335.73,$0.00,$167.86,$265.90,$268.58,$0.00,$51.01,$0.00,$53.45,$0.00
441.42,SUP,HCPCS C1713,,441.42  -  PLATE BONE 145X9X1MM 12 HOLE 1/3 TUBULAR COLLAR TITANIUM RAD,$146.03,$0.00,$146.03,$65.71,$104.22,$0.00,$24.43,$0.00,$0.00,$25.57,$146.03,$0.00,$73.01,$115.66,$116.82,$0.00,$22.19,$0.00,$23.25,$0.00
441.421,SUP,HCPCS C1713,,441.421  -  PLATE BONE 1/3 TUBULAR 12MM 141X9X1MM 12 HOLE COLLAR LCP,$348.00,$0.00,$348.00,$156.60,$248.37,$0.00,$58.21,$0.00,$0.00,$60.93,$348.00,$0.00,$174.00,$275.62,$278.40,$0.00,$52.88,$0.00,$55.40,$0.00
441.44,SUP,HCPCS C1713,,441.440  -  PLATE BONE 80MM 5 HOLE LCP TITANIUM TIBIA RIGHT DISTAL,"$2,774.53",$0.00,"$2,774.53","$1,248.54","$1,980.18",$0.00,$464.12,$0.00,$0.00,$485.80,"$2,774.53",$0.00,"$1,387.26","$2,197.43","$2,219.62",$0.00,$421.57,$0.00,$441.70,$0.00
441.441,SUP,HCPCS C1713,,441.441  -  PLATE BONE 80MM 5 HOLE LCP TITANIUM TIBIA LEFT DISTAL ANTLAT,"$2,774.53",$0.00,"$2,774.53","$1,248.54","$1,980.18",$0.00,$464.12,$0.00,$0.00,$485.80,"$2,774.53",$0.00,"$1,387.26","$2,197.43","$2,219.62",$0.00,$421.57,$0.00,$441.70,$0.00
441.442,SUP,HCPCS C1713,,441.442  -  PLATE BONE 106MM 7 HOLE LCP TITANIUM TIBIA RIGHT DISTAL,"$2,805.93",$0.00,"$2,805.93","$1,262.67","$2,002.59",$0.00,$469.37,$0.00,$0.00,$491.30,"$2,805.93",$0.00,"$1,402.96","$2,222.30","$2,244.74",$0.00,$426.34,$0.00,$446.70,$0.00
441.443,SUP,HCPCS C1713,,441.443  -  PLATE BONE 106MM 7 HOLE LCP TITANIUM TIBIA LEFT DISTAL,"$2,805.93",$0.00,"$2,805.93","$1,262.67","$2,002.59",$0.00,$469.37,$0.00,$0.00,$491.30,"$2,805.93",$0.00,"$1,402.96","$2,222.30","$2,244.74",$0.00,$426.34,$0.00,$446.70,$0.00
441.444,SUP,HCPCS C1713,,441.444  -  PLATE BONE 132MM 9 HOLE LCP TITANIUM TIBIA RIGHT DISTAL,"$2,834.58",$0.00,"$2,834.58","$1,275.56","$2,023.04",$0.00,$474.16,$0.00,$0.00,$496.31,"$2,834.58",$0.00,"$1,417.29","$2,244.99","$2,267.66",$0.00,$430.69,$0.00,$451.26,$0.00
441.445,SUP,HCPCS C1713,,441.445  -  PLATE BONE 132MM 9 HOLE LCP TITANIUM TIBIA LEFT DISTAL,"$2,834.58",$0.00,"$2,834.58","$1,275.56","$2,023.04",$0.00,$474.16,$0.00,$0.00,$496.31,"$2,834.58",$0.00,"$1,417.29","$2,244.99","$2,267.66",$0.00,$430.69,$0.00,$451.26,$0.00
441.446,SUP,HCPCS C1713,,441.446  -  PLATE BONE 158MM 11 HOLE LCP TITANIUM TIBIA RIGHT DISTAL,"$2,861.88",$0.00,"$2,861.88","$1,287.84","$2,042.52",$0.00,$478.73,$0.00,$0.00,$501.09,"$2,861.88",$0.00,"$1,430.94","$2,266.61","$2,289.50",$0.00,$434.84,$0.00,$455.61,$0.00
441.447,SUP,HCPCS C1713,,441.447  -  PLATE BONE 158MM 11 HOLE LCP TITANIUM TIBIA LEFT DISTAL,"$2,861.88",$0.00,"$2,861.88","$1,287.84","$2,042.52",$0.00,$478.73,$0.00,$0.00,$501.09,"$2,861.88",$0.00,"$1,430.94","$2,266.61","$2,289.50",$0.00,$434.84,$0.00,$455.61,$0.00
441.448,SUP,HCPCS C1713,,441.448  -  PLATE BONE 184MM 13 HOLE LCP TITANIUM TIBIA RIGHT DISTAL,"$2,893.28",$0.00,"$2,893.28","$1,301.97","$2,064.93",$0.00,$483.98,$0.00,$0.00,$506.59,"$2,893.28",$0.00,"$1,446.64","$2,291.48","$2,314.62",$0.00,$439.61,$0.00,$460.61,$0.00
441.449,SUP,HCPCS C1713,,441.449  -  PLATE BONE 184MM 13 HOLE LCP TITANIUM TIBIA LEFT DISTAL,"$2,893.28",$0.00,"$2,893.28","$1,301.97","$2,064.93",$0.00,$483.98,$0.00,$0.00,$506.59,"$2,893.28",$0.00,"$1,446.64","$2,291.48","$2,314.62",$0.00,$439.61,$0.00,$460.61,$0.00
441.45,SUP,HCPCS C1713,,441.450  -  PLATE BONE 210MM 15 HOLE LCP TITANIUM TIBIA RIGHT DISTAL,"$2,931.48",$0.00,"$2,931.48","$1,319.16","$2,092.19",$0.00,$490.37,$0.00,$0.00,$513.28,"$2,931.48",$0.00,"$1,465.74","$2,321.73","$2,345.18",$0.00,$445.41,$0.00,$466.69,$0.00
441.451,SUP,HCPCS C1713,,441.451  -  PLATE BONE 210MM 15 HOLE LCP TITANIUM TIBIA LEFT DISTAL,"$2,931.48",$0.00,"$2,931.48","$1,319.16","$2,092.19",$0.00,$490.37,$0.00,$0.00,$513.28,"$2,931.48",$0.00,"$1,465.74","$2,321.73","$2,345.18",$0.00,$445.41,$0.00,$466.69,$0.00
441.452,SUP,HCPCS C1713,,441.452  -  PLATE BONE 236MM 17 HOLE LCP TITANIUM TIBIA RIGHT DISTAL,"$2,958.78",$0.00,"$2,958.78","$1,331.45","$2,111.68",$0.00,$494.93,$0.00,$0.00,$518.06,"$2,958.78",$0.00,"$1,479.39","$2,343.35","$2,367.02",$0.00,$449.56,$0.00,$471.04,$0.00
441.453,SUP,HCPCS C1713,,441.453  -  PLATE BONE 236MM 17 HOLE LCP TITANIUM TIBIA LEFT DISTAL,"$2,958.78",$0.00,"$2,958.78","$1,331.45","$2,111.68",$0.00,$494.93,$0.00,$0.00,$518.06,"$2,958.78",$0.00,"$1,479.39","$2,343.35","$2,367.02",$0.00,$449.56,$0.00,$471.04,$0.00
441.454,SUP,HCPCS C1713,,441.454  -  PLATE BONE 262MM 19 HOLE LCP TITANIUM TIBIA RIGHT DISTAL,"$2,981.98",$0.00,"$2,981.98","$1,341.89","$2,128.24",$0.00,$498.82,$0.00,$0.00,$522.12,"$2,981.98",$0.00,"$1,490.99","$2,361.73","$2,385.58",$0.00,$453.09,$0.00,$474.73,$0.00
441.455,SUP,HCPCS C1713,,441.455  -  PLATE BONE 262MM 19 HOLE LCP TITANIUM TIBIA LEFT DISTAL,"$2,981.98",$0.00,"$2,981.98","$1,341.89","$2,128.24",$0.00,$498.82,$0.00,$0.00,$522.12,"$2,981.98",$0.00,"$1,490.99","$2,361.73","$2,385.58",$0.00,$453.09,$0.00,$474.73,$0.00
441.456,SUP,HCPCS C1713,,441.456  -  PLATE BONE 288MM 21 HOLE LCP TITANIUM TIBIA RIGHT DISTAL,"$3,010.65",$0.00,"$3,010.65","$1,354.79","$2,148.70",$0.00,$503.61,$0.00,$0.00,$527.14,"$3,010.65",$0.00,"$1,505.33","$2,384.43","$2,408.52",$0.00,$457.44,$0.00,$479.30,$0.00
441.457,SUP,HCPCS C1713,,441.457  -  PLATE BONE 288MM 21 HOLE LCP TITANIUM TIBIA LEFT DISTAL,"$3,010.65",$0.00,"$3,010.65","$1,354.79","$2,148.70",$0.00,$503.61,$0.00,$0.00,$527.14,"$3,010.65",$0.00,"$1,505.33","$2,384.43","$2,408.52",$0.00,$457.44,$0.00,$479.30,$0.00
441.61,SUP,HCPCS C1713,,441.61  -  PLATE BONE 60MMX1.2MM LC-DCP TITANIUM CALCANEUS NONSTRL,$992.18,$0.00,$992.18,$446.48,$708.12,$0.00,$165.97,$0.00,$0.00,$173.72,$992.18,$0.00,$496.09,$785.81,$793.74,$0.00,$150.75,$0.00,$157.95,$0.00
441.62,SUP,HCPCS C1713,,441.62  -  PLATE BONE 70MMX1.2MM LC-DCP TITANIUM CALCANEUS NONSTRL,"$1,015.38",$0.00,"$1,015.38",$456.92,$724.67,$0.00,$169.85,$0.00,$0.00,$177.78,"$1,015.38",$0.00,$507.69,$804.18,$812.30,$0.00,$154.28,$0.00,$161.65,$0.00
441.65,SUP,HCPCS C1713,,441.65  -  PLATE BONE Y 87MMX2MM LC-DCP TITANIUM CALCANEUS NONSTRL,"$1,015.38",$0.00,"$1,015.38",$456.92,$724.67,$0.00,$169.85,$0.00,$0.00,$177.78,"$1,015.38",$0.00,$507.69,$804.18,$812.30,$0.00,$154.28,$0.00,$161.65,$0.00
441.68,SUP,HCPCS C1713,,441.680  -  PLATE BONE 2.4MM 34MM IMPLANT RIM 2 HOLE LCP TITANIUM RADIAL,"$1,112.28",$0.00,"$1,112.28",$500.52,$793.83,$0.00,$186.06,$0.00,$0.00,$194.75,"$1,112.28",$0.00,$556.14,$880.93,$889.82,$0.00,$169.00,$0.00,$177.07,$0.00
441.681,SUP,HCPCS C1713,,441.681  -  PLATE BONE 2.4MM 34MM IMPLANT RIM 2 HOLE LCP TITANIUM RADIAL,"$1,112.28",$0.00,"$1,112.28",$500.52,$793.83,$0.00,$186.06,$0.00,$0.00,$194.75,"$1,112.28",$0.00,$556.14,$880.93,$889.82,$0.00,$169.00,$0.00,$177.07,$0.00
441.682,SUP,HCPCS C1713,,441.682  -  PLATE BONE 2.4MM 46MM IMPLANT RIM 3 HOLE LCP TITANIUM RADIAL,"$1,143.65",$0.00,"$1,143.65",$514.64,$816.22,$0.00,$191.31,$0.00,$0.00,$200.24,"$1,143.65",$0.00,$571.83,$905.77,$914.92,$0.00,$173.77,$0.00,$182.07,$0.00
441.683,SUP,HCPCS C1713,,441.683  -  PLATE BONE 2.4MM 46MM IMPLANT RIM 3 HOLE LCP TITANIUM RADIAL,"$1,143.65",$0.00,"$1,143.65",$514.64,$816.22,$0.00,$191.31,$0.00,$0.00,$200.24,"$1,143.65",$0.00,$571.83,$905.77,$914.92,$0.00,$173.77,$0.00,$182.07,$0.00
441.684,SUP,HCPCS C1713,,441.684  -  PLATE BONE 2.4MM 56MM IMPLANT RIM 4 HOLE LCP TITANIUM RADIAL,"$1,164.13",$0.00,"$1,164.13",$523.86,$830.84,$0.00,$194.73,$0.00,$0.00,$203.83,"$1,164.13",$0.00,$582.06,$921.99,$931.30,$0.00,$176.88,$0.00,$185.33,$0.00
441.685,SUP,HCPCS C1713,,441.685  -  PLATE BONE 2.4MM 56MM IMPLANT RIM 4 HOLE LCP TITANIUM RADIAL,"$1,164.13",$0.00,"$1,164.13",$523.86,$830.84,$0.00,$194.73,$0.00,$0.00,$203.83,"$1,164.13",$0.00,$582.06,$921.99,$931.30,$0.00,$176.88,$0.00,$185.33,$0.00
441.69,SUP,HCPCS C1713,,441.690  -  PLATE BONE 2.4MM 28MM IMPLANT 2 HOLE LCP TITANIUM RADIAL,"$1,112.28",$0.00,"$1,112.28",$500.52,$793.83,$0.00,$186.06,$0.00,$0.00,$194.75,"$1,112.28",$0.00,$556.14,$880.93,$889.82,$0.00,$169.00,$0.00,$177.07,$0.00
441.691,SUP,HCPCS C1713,,441.691  -  PLATE BONE 2.4MM 40MM IMPLANT 3 HOLE LCP TITANIUM RADIAL,"$1,143.65",$0.00,"$1,143.65",$514.64,$816.22,$0.00,$191.31,$0.00,$0.00,$200.24,"$1,143.65",$0.00,$571.83,$905.77,$914.92,$0.00,$173.77,$0.00,$182.07,$0.00
441.692,SUP,HCPCS C1713,,441.692  -  PLATE BONE 2.4MM 50MM IMPLANT 4 HOLE LCP TITANIUM RADIAL,"$1,165.50",$0.00,"$1,165.50",$524.48,$831.82,$0.00,$194.96,$0.00,$0.00,$204.07,"$1,165.50",$0.00,$582.75,$923.08,$932.40,$0.00,$177.09,$0.00,$185.55,$0.00
441.83,SUP,HCPCS C1713,,441.83  -  PLATE BONE CLOVERLEAF 88X15X2MM 3 HOLE THIN BLADE LP HEAD,$570.48,$0.00,$570.48,$256.71,$407.15,$0.00,$95.43,$0.00,$0.00,$99.89,$570.48,$0.00,$285.24,$451.82,$456.38,$0.00,$86.68,$0.00,$90.82,$0.00
441.84,SUP,HCPCS C1713,,441.84  -  PLATE BONE CLOVERLEAF 104X15X2MM 4 HOLE THIN BLADE LP HEAD,$610.05,$0.00,$610.05,$274.52,$435.39,$0.00,$102.05,$0.00,$0.00,$106.81,$610.05,$0.00,$305.03,$483.16,$488.04,$0.00,$92.69,$0.00,$97.12,$0.00
441.85,SUP,HCPCS C1713,,441.85  -  PLATE BONE CLOVERLEAF 120X15X2MM 5 HOLE THIN BLADE LP HEAD,$768.35,$0.00,$768.35,$345.76,$548.37,$0.00,$128.53,$0.00,$0.00,$134.53,$768.35,$0.00,$384.18,$608.53,$614.68,$0.00,$116.75,$0.00,$122.32,$0.00
441.86,SUP,HCPCS C1713,,441.86  -  PLATE BONE CLOVERLEAF 136X15X2MM 6 HOLE THIN BLADE LP HEAD,$833.85,$0.00,$833.85,$375.23,$595.12,$0.00,$139.49,$0.00,$0.00,$146.00,$833.85,$0.00,$416.93,$660.41,$667.08,$0.00,$126.70,$0.00,$132.75,$0.00
441.87,SUP,HCPCS C1713,,441.87  -  PLATE BONE CLOVERLEAF 152X15X2MM 7 HOLE THIN BLADE LP HEAD,$898.00,$0.00,$898.00,$404.10,$640.90,$0.00,$150.22,$0.00,$0.00,$157.23,$898.00,$0.00,$449.00,$711.22,$718.40,$0.00,$136.44,$0.00,$142.96,$0.00
441.88,SUP,HCPCS C1713,,441.88  -  PLATE BONE CLOVERLEAF 168X15X2MM 8 HOLE THIN BLADE LP HEAD,$953.95,$0.00,$953.95,$429.28,$680.83,$0.00,$159.58,$0.00,$0.00,$167.03,$953.95,$0.00,$476.98,$755.53,$763.16,$0.00,$144.95,$0.00,$151.87,$0.00
441.89,SUP,HCPCS C1713,,441.89  -  PLATE BONE CLOVERLEAF 200X15X2MM 10 HOLE THIN BLADE LP HEAD,"$1,030.38",$0.00,"$1,030.38",$463.67,$735.38,$0.00,$172.36,$0.00,$0.00,$180.41,"$1,030.38",$0.00,$515.19,$816.06,$824.30,$0.00,$156.56,$0.00,$164.04,$0.00
441.901,SUP,HCPCS C1713,,441.901  -  PLATE BN STD 90X12X2.5MM NS LCP CMBN PHLS 3 HL SHFT LCK CMPR,"$2,868.70",$0.00,"$2,868.70","$1,290.92","$2,047.39",$0.00,$479.87,$0.00,$0.00,$502.29,"$2,868.70",$0.00,"$1,434.35","$2,272.01","$2,294.96",$0.00,$435.88,$0.00,$456.70,$0.00
441.903,SUP,HCPCS C1713,,441.903  -  PLATE BONE STANDARD 114X12X2.5MM 6 HOLE HEAD 5 HOLE SHAFT,"$2,958.78",$0.00,"$2,958.78","$1,331.45","$2,111.68",$0.00,$494.93,$0.00,$0.00,$518.06,"$2,958.78",$0.00,"$1,479.39","$2,343.35","$2,367.02",$0.00,$449.56,$0.00,$471.04,$0.00
441.918,SUP,HCPCS C1713,,441.918  -  PLATE BONE LONG 142MM 5 HOLE LOCKING LCP TITANIUM HUMERUS,"$2,987.45",$0.00,"$2,987.45","$1,344.35","$2,132.14",$0.00,$499.73,$0.00,$0.00,$523.08,"$2,987.45",$0.00,"$1,493.73","$2,366.06","$2,389.96",$0.00,$453.92,$0.00,$475.60,$0.00
441.919,SUP,HCPCS C1713,,441.919  -  PLATE BONE LONG 160MM 6 HOLE LOCKING LCP TITANIUM HUMERUS,"$3,104.80",$0.00,"$3,104.80","$1,397.16","$2,215.90",$0.00,$519.36,$0.00,$0.00,$543.63,"$3,104.80",$0.00,"$1,552.40","$2,459.00","$2,483.84",$0.00,$471.75,$0.00,$494.28,$0.00
441.921,SUP,HCPCS C1713,,441.921  -  PLATE BN 196X12X3.7MM NS LCP CMBN PHLS LNG 8 HL SHFT LCK,"$3,224.90",$0.00,"$3,224.90","$1,451.21","$2,301.61",$0.00,$539.45,$0.00,$0.00,$564.65,"$3,224.90",$0.00,"$1,612.45","$2,554.12","$2,579.92",$0.00,$490.00,$0.00,$513.40,$0.00
441.923,SUP,HCPCS C1713,,441.923  -  PLATE BONE 3.5MM 232MM 10 HOLE LCP TITANIUM HUMERUS PROXIMAL,"$3,345.00",$0.00,"$3,345.00","$1,505.25","$2,387.33",$0.00,$559.54,$0.00,$0.00,$585.68,"$3,345.00",$0.00,"$1,672.50","$2,649.24","$2,676.00",$0.00,$508.25,$0.00,$532.52,$0.00
441.925,SUP,HCPCS C1713,,441.925  -  PLATE BONE LONG 268MM 12 HOLE LOCKING LCP TITANIUM HUMERUS,"$3,461.00",$0.00,"$3,461.00","$1,557.45","$2,470.12",$0.00,$578.95,$0.00,$0.00,$605.99,"$3,461.00",$0.00,"$1,730.50","$2,741.11","$2,768.80",$0.00,$525.87,$0.00,$550.99,$0.00
441.931,SUP,HCPCS C1713,,441.931  -  PLATE BONE T OBLIQUE LEFT 52X10X1.5MM 3 HOLE HEAD 3 HOLE,$700.13,$0.00,$700.13,$315.06,$499.68,$0.00,$117.11,$0.00,$0.00,$122.59,$700.13,$0.00,$350.06,$554.50,$560.10,$0.00,$106.38,$0.00,$111.46,$0.00
441.941,SUP,HCPCS C1713,,441.941  -  PLATE BONE T OBLIQUE LEFT 63X10X1.5MM 3 HOLE HEAD 4 HOLE,$734.23,$0.00,$734.23,$330.40,$524.02,$0.00,$122.82,$0.00,$0.00,$128.56,$734.23,$0.00,$367.11,$581.51,$587.38,$0.00,$111.56,$0.00,$116.89,$0.00
441.951,SUP,HCPCS C1713,,441.951  -  PLATE BONE T OBLIQUE LEFT 74X10X1.5MM 3 HOLE HEAD 5 HOLE,$765.63,$0.00,$765.63,$344.53,$546.43,$0.00,$128.07,$0.00,$0.00,$134.05,$765.63,$0.00,$382.81,$606.38,$612.50,$0.00,$116.33,$0.00,$121.89,$0.00
441.961,SUP,HCPCS C1713,,441.961  -  PLATE BONE 85MM 3 HOLE HEAD 6 HOLE SHAFT T OBLIQUE LEFT LCP,$797.03,$0.00,$797.03,$358.66,$568.84,$0.00,$133.32,$0.00,$0.00,$139.55,$797.03,$0.00,$398.51,$631.25,$637.62,$0.00,$121.10,$0.00,$126.89,$0.00
441.971,SUP,HCPCS C1713,,441.971  -  PLATE BONE T OBLIQUE 96X10X1.5MM 3 HOLE HEAD 7 HOLE SHAFT,$829.78,$0.00,$829.78,$373.40,$592.21,$0.00,$138.80,$0.00,$0.00,$145.29,$829.78,$0.00,$414.89,$657.19,$663.82,$0.00,$126.08,$0.00,$132.10,$0.00
441.981,SUP,HCPCS C1713,,441.981  -  PLATE BONE 107MM 8 SHAFT HOLE 3 HOLE HEAD T OBLIQUE LEFT LCP,$874.80,$0.00,$874.80,$393.66,$624.34,$0.00,$146.33,$0.00,$0.00,$153.17,$874.80,$0.00,$437.40,$692.84,$699.84,$0.00,$132.92,$0.00,$139.27,$0.00
442.03,SUP,HCPCS C1713,,442.03  -  PLATE BONE 23X7X1MM .3MM 3 HOLE .25 TUBULAR COLLAR TITANIUM,$146.03,$0.00,$146.03,$65.71,$104.22,$0.00,$24.43,$0.00,$0.00,$25.57,$146.03,$0.00,$73.01,$115.66,$116.82,$0.00,$22.19,$0.00,$23.25,$0.00
442.04,SUP,HCPCS C1713,,442.04  -  PLATE BONE 31X7X1MM .3MM 4 HOLE .25 TUBULAR COLLAR TITANIUM,$151.48,$0.00,$151.48,$68.16,$108.11,$0.00,$25.34,$0.00,$0.00,$26.52,$151.48,$0.00,$75.74,$119.97,$121.18,$0.00,$23.02,$0.00,$24.11,$0.00
442.05,SUP,HCPCS C1713,,442.05  -  PLATE BONE 39X7X1MM .3MM 5 HOLE .25 TUBULAR COLLAR TITANIUM,$161.05,$0.00,$161.05,$72.47,$114.94,$0.00,$26.94,$0.00,$0.00,$28.20,$161.05,$0.00,$80.53,$127.55,$128.84,$0.00,$24.47,$0.00,$25.64,$0.00
442.06,SUP,HCPCS C1713,,442.06  -  PLATE BONE 47X7X1MM .3MM 6 HOLE .25 TUBULAR COLLAR TITANIUM,$174.70,$0.00,$174.70,$78.62,$124.68,$0.00,$29.22,$0.00,$0.00,$30.59,$174.70,$0.00,$87.35,$138.36,$139.76,$0.00,$26.54,$0.00,$27.81,$0.00
442.07,SUP,HCPCS C1713,,442.07  -  PLATE BONE 55X7X1MM .3MM 7 HOLE .25 TUBULAR COLLAR TITANIUM,$191.08,$0.00,$191.08,$85.98,$136.37,$0.00,$31.96,$0.00,$0.00,$33.46,$191.08,$0.00,$95.54,$151.34,$152.86,$0.00,$29.03,$0.00,$30.42,$0.00
442.08,SUP,HCPCS C1713,,442.08  -  PLATE BONE 63X7X1MM .3MM 8 HOLE .25 TUBULAR COLLAR TITANIUM,$199.25,$0.00,$199.25,$89.66,$142.20,$0.00,$33.33,$0.00,$0.00,$34.89,$199.25,$0.00,$99.63,$157.81,$159.40,$0.00,$30.27,$0.00,$31.72,$0.00
442.33,SUP,HCPCS C1713,,442.33  -  PLATE BONE L LEFT OBLIQUE 34X7X1MM 3 HOLE CNTOUR TITANIUM,$113.28,$0.00,$113.28,$50.97,$80.84,$0.00,$18.95,$0.00,$0.00,$19.83,$113.28,$0.00,$56.64,$89.72,$90.62,$0.00,$17.21,$0.00,$18.03,$0.00
442.34,SUP,HCPCS C1713,,442.34  -  PLATE BONE L RIGHT OBLIQUE 34X7X1MM 3 HOLE CNTOUR TITANIUM,$113.28,$0.00,$113.28,$50.97,$80.84,$0.00,$18.95,$0.00,$0.00,$19.83,$113.28,$0.00,$56.64,$89.72,$90.62,$0.00,$17.21,$0.00,$18.03,$0.00
442.41,SUP,HCPCS C1713,,442.41  -  PLATE BN T 32X7X1.2MM 3 HL TI 2.7MM SCR,$113.28,$0.00,$113.28,$50.97,$80.84,$0.00,$18.95,$0.00,$0.00,$19.83,$113.28,$0.00,$56.64,$89.72,$90.62,$0.00,$17.21,$0.00,$18.03,$0.00
442.472,SUP,HCPCS C1713,,442.472  -  PLATE BN TI RDS RT DIST DRSL,"$1,854.48",$0.00,"$1,854.48",$834.51,"$1,323.54",$0.00,$319.52,$0.00,$0.00,$324.70,"$1,854.48",$0.00,$927.24,"$1,468.75","$1,483.58",$0.00,$290.23,$0.00,$295.23,$0.00
442.473,SUP,HCPCS C1713,,442.473  -  PLATE BN TI RDS RT DIST VOLR,"$1,530.63",$0.00,"$1,530.63",$688.78,"$1,092.41",$0.00,$263.72,$0.00,$0.00,$268.00,"$1,530.63",$0.00,$765.31,"$1,212.26","$1,224.50",$0.00,$239.54,$0.00,$243.68,$0.00
442.477,SUP,HCPCS C1713,,442.477  -  PLATE BONE 40MM 3X3 HOLE LCP TITANIUM DISTAL RAD NONSTRL 2.4,$851.60,$0.00,$851.60,$383.22,$607.79,$0.00,$142.45,$0.00,$0.00,$149.11,$851.60,$0.00,$425.80,$674.47,$681.28,$0.00,$129.39,$0.00,$135.57,$0.00
442.478,SUP,HCPCS C1713,,442.478  -  PLATE BONE 49MM 3X4 HOLE LCP TITANIUM DISTAL RAD NONSTRL 2.4,$887.10,$0.00,$887.10,$399.20,$633.12,$0.00,$148.39,$0.00,$0.00,$155.32,$887.10,$0.00,$443.55,$702.58,$709.68,$0.00,$134.79,$0.00,$141.23,$0.00
442.479,SUP,HCPCS C1713,,442.479  -  PLATE BONE STR 48MM 5 HOLE LCP TITANIUM DISTAL RAD NONSTRL,$807.93,$0.00,$807.93,$363.57,$576.62,$0.00,$135.15,$0.00,$0.00,$141.46,$807.93,$0.00,$403.96,$639.88,$646.34,$0.00,$122.76,$0.00,$128.62,$0.00
442.482,SUP,HCPCS C1713,,442.482  -  PLATE BN TI RDS LT DIST DRSL,"$1,854.48",$0.00,"$1,854.48",$834.51,"$1,323.54",$0.00,$319.52,$0.00,$0.00,$324.70,"$1,854.48",$0.00,$927.24,"$1,468.75","$1,483.58",$0.00,$290.23,$0.00,$295.23,$0.00
442.483,SUP,HCPCS C1713,,442.483  -  PLATE BN TI RDS LT DIST VOLR,"$1,530.63",$0.00,"$1,530.63",$688.78,"$1,092.41",$0.00,$263.72,$0.00,$0.00,$268.00,"$1,530.63",$0.00,$765.31,"$1,212.26","$1,224.50",$0.00,$239.54,$0.00,$243.68,$0.00
442.49,SUP,HCPCS C1713,,442.490  -  PLATE BONE STR 57MM 6 HOLE LCP TITANIUM DISTAL RAD NONSTRL,$851.60,$0.00,$851.60,$383.22,$607.79,$0.00,$142.45,$0.00,$0.00,$149.11,$851.60,$0.00,$425.80,$674.47,$681.28,$0.00,$129.39,$0.00,$135.57,$0.00
442.491,SUP,HCPCS C1713,,442.491  -  PLATE BN 43MM LCP 5 HLE/HD 3 HL SHFT TI RDS LT DIST VOLR 2.4,"$1,491.68",$0.00,"$1,491.68",$671.25,"$1,064.61",$0.00,$249.52,$0.00,$0.00,$261.18,"$1,491.68",$0.00,$745.84,"$1,181.41","$1,193.34",$0.00,$226.65,$0.00,$237.47,$0.00
442.492,SUP,HCPCS C1713,,442.492  -  PLATE BONE 61MM 5X5 HOLE LCP TITANIUM LEFT DISTAL VOLAR RAD,"$1,579.03",$0.00,"$1,579.03",$710.56,"$1,126.95",$0.00,$264.13,$0.00,$0.00,$276.47,"$1,579.03",$0.00,$789.51,"$1,250.59","$1,263.22",$0.00,$239.92,$0.00,$251.38,$0.00
442.493,SUP,HCPCS C1713,,442.493  -  PLATE BONE 43MM 5 HOLE HEAD 3 HOLE SHAFT LCP TITANIUM RAD,"$1,491.68",$0.00,"$1,491.68",$671.25,"$1,064.61",$0.00,$249.52,$0.00,$0.00,$261.18,"$1,491.68",$0.00,$745.84,"$1,181.41","$1,193.34",$0.00,$226.65,$0.00,$237.47,$0.00
442.494,SUP,HCPCS C1713,,442.494  -  PLATE BONE 61MM 5 HOLE HEAD 5 HOLE SHAFT LCP TITANIUM RAD,"$1,579.03",$0.00,"$1,579.03",$710.56,"$1,126.95",$0.00,$264.13,$0.00,$0.00,$276.47,"$1,579.03",$0.00,$789.51,"$1,250.59","$1,263.22",$0.00,$239.92,$0.00,$251.38,$0.00
442.5,SUP,HCPCS C1713,,442.500  -  PLATE BONE -90D L 40MM 2X3 HOLE LCP TITANIUM DISTAL RAD,$822.95,$0.00,$822.95,$370.33,$587.34,$0.00,$137.66,$0.00,$0.00,$144.09,$822.95,$0.00,$411.48,$651.78,$658.36,$0.00,$125.04,$0.00,$131.01,$0.00
442.501,SUP,HCPCS C1713,,442.501  -  PLATE BONE -90D L 49MM 2X4 HOLE LCP TITANIUM DISTAL RAD,$863.88,$0.00,$863.88,$388.74,$616.55,$0.00,$144.51,$0.00,$0.00,$151.26,$863.88,$0.00,$431.94,$684.19,$691.10,$0.00,$131.26,$0.00,$137.53,$0.00
442.502,SUP,HCPCS C1713,,442.502  -  PLATE BONE 90D L 40MM 2X3 HOLE LCP TITANIUM DISTAL RAD,$822.95,$0.00,$822.95,$370.33,$587.34,$0.00,$137.66,$0.00,$0.00,$144.09,$822.95,$0.00,$411.48,$651.78,$658.36,$0.00,$125.04,$0.00,$131.01,$0.00
442.503,SUP,HCPCS C1713,,442.503  -  PLATE BONE 90D L 49MM 2X4 HOLE LCP TITANIUM DISTAL RAD,$863.88,$0.00,$863.88,$388.74,$616.55,$0.00,$144.51,$0.00,$0.00,$151.26,$863.88,$0.00,$431.94,$684.19,$691.10,$0.00,$131.26,$0.00,$137.53,$0.00
442.504,SUP,HCPCS C1713,,442.504  -  PLATE BONE 90D L 40MM 3X3 HOLE LCP TITANIUM DISTAL RAD,$822.95,$0.00,$822.95,$370.33,$587.34,$0.00,$137.66,$0.00,$0.00,$144.09,$822.95,$0.00,$411.48,$651.78,$658.36,$0.00,$125.04,$0.00,$131.01,$0.00
442.505,SUP,HCPCS C1713,,442.505  -  PLATE BONE 90D L 49MM 3X4 HOLE LCP TITANIUM DISTAL RAD,$863.88,$0.00,$863.88,$388.74,$616.55,$0.00,$144.51,$0.00,$0.00,$151.26,$863.88,$0.00,$431.94,$684.19,$691.10,$0.00,$131.26,$0.00,$137.53,$0.00
442.506,SUP,HCPCS C1713,,442.506  -  PLATE BONE -90D L 40MM 3X3 HOLE LCP TITANIUM DISTAL RAD,$822.95,$0.00,$822.95,$370.33,$587.34,$0.00,$137.66,$0.00,$0.00,$144.09,$822.95,$0.00,$411.48,$651.78,$658.36,$0.00,$125.04,$0.00,$131.01,$0.00
442.507,SUP,HCPCS C1713,,442.507  -  PLATE BONE -90D L 49MM 3X4 HOLE LCP TITANIUM DISTAL RAD,$863.88,$0.00,$863.88,$388.74,$616.55,$0.00,$144.51,$0.00,$0.00,$151.26,$863.88,$0.00,$431.94,$684.19,$691.10,$0.00,$131.26,$0.00,$137.53,$0.00
442.508,SUP,HCPCS C1713,,442.508  -  PLATE BONE +20D L 43MM 3X3 HOLE LCP TITANIUM DISTAL RAD,$822.95,$0.00,$822.95,$370.33,$587.34,$0.00,$137.66,$0.00,$0.00,$144.09,$822.95,$0.00,$411.48,$651.78,$658.36,$0.00,$125.04,$0.00,$131.01,$0.00
442.509,SUP,HCPCS C1713,,442.509  -  PLATE BONE +20D L 52MM 3X4 HOLE LCP TITANIUM DISTAL RAD,$863.88,$0.00,$863.88,$388.74,$616.55,$0.00,$144.51,$0.00,$0.00,$151.26,$863.88,$0.00,$431.94,$684.19,$691.10,$0.00,$131.26,$0.00,$137.53,$0.00
442.51,SUP,HCPCS C1713,,442.51  -  PLATE BN STD BND NS 8 HL FSN TI WRST 2.7/3.5MM CORT SCR,"$1,973.43",$0.00,"$1,973.43",$888.04,"$1,408.43",$0.00,$330.11,$0.00,$0.00,$345.53,"$1,973.43",$0.00,$986.71,"$1,562.96","$1,578.74",$0.00,$299.85,$0.00,$314.17,$0.00
442.511,SUP,HCPCS C1713,,442.511  -  PLATE BONE -20D L 43MM 3X3 HOLE LCP TITANIUM DISTAL RAD,$822.95,$0.00,$822.95,$370.33,$587.34,$0.00,$137.66,$0.00,$0.00,$144.09,$822.95,$0.00,$411.48,$651.78,$658.36,$0.00,$125.04,$0.00,$131.01,$0.00
442.512,SUP,HCPCS C1713,,442.512  -  PLATE BONE -20D L 52MM 3X4 HOLE LCP TITANIUM DISTAL RAD,$863.88,$0.00,$863.88,$388.74,$616.55,$0.00,$144.51,$0.00,$0.00,$151.26,$863.88,$0.00,$431.94,$684.19,$691.10,$0.00,$131.26,$0.00,$137.53,$0.00
442.52,SUP,HCPCS C1713,,442.52  -  PLATE BN SHRT BND NS 8 HL FSN TI WRST 2.7/3.5MM CORT SCR,"$1,973.43",$0.00,"$1,973.43",$888.04,"$1,408.43",$0.00,$330.11,$0.00,$0.00,$345.53,"$1,973.43",$0.00,$986.71,"$1,562.96","$1,578.74",$0.00,$299.85,$0.00,$314.17,$0.00
442.53,SUP,HCPCS C1713,,442.53  -  PLATE BN STRG NS 9 HL FSN TI WRST 2.7/3.5MM CORT SCR,"$1,973.43",$0.00,"$1,973.43",$888.04,"$1,408.43",$0.00,$330.11,$0.00,$0.00,$345.53,"$1,973.43",$0.00,$986.71,"$1,562.96","$1,578.74",$0.00,$299.85,$0.00,$314.17,$0.00
442.61,SUP,HCPCS C1713,,442.61  -  PLATE BN 57X7X1.5MM NS 7 HL TI CNDRL LT 2.7MM SCR,$608.68,$0.00,$608.68,$273.90,$434.41,$0.00,$101.82,$0.00,$0.00,$106.57,$608.68,$0.00,$304.34,$482.07,$486.94,$0.00,$92.48,$0.00,$96.90,$0.00
442.62,SUP,HCPCS C1713,,442.62  -  PLATE BN 57X7X1.5MM NS 7 HL TI CNDRL RT 2.7MM SCR,$608.68,$0.00,$608.68,$273.90,$434.41,$0.00,$101.82,$0.00,$0.00,$106.57,$608.68,$0.00,$304.34,$482.07,$486.94,$0.00,$92.48,$0.00,$96.90,$0.00
443.054,SUP,HCPCS C1713,,443.054  -  PLATE BONE 22X5X1MM 4 HOLE DCP TITANIUM ORTHOPEDIC NONSTRL 2,$408.05,$0.00,$408.05,$183.62,$291.23,$0.00,$68.26,$0.00,$0.00,$71.45,$408.05,$0.00,$204.03,$323.18,$326.44,$0.00,$62.00,$0.00,$64.96,$0.00
443.055,SUP,HCPCS C1713,,443.055  -  PLATE BONE 27X5X1MM 5 HOLE DCP TITANIUM ORTHOPEDIC NONSTRL 2,$450.38,$0.00,$450.38,$202.67,$321.43,$0.00,$75.34,$0.00,$0.00,$78.86,$450.38,$0.00,$225.19,$356.70,$360.30,$0.00,$68.43,$0.00,$71.70,$0.00
443.056,SUP,HCPCS C1713,,443.056  -  PLATE BONE 32X5X1MM 6 HOLE DCP TITANIUM ORTHOPEDIC NONSTRL 2,$491.30,$0.00,$491.30,$221.09,$350.64,$0.00,$82.18,$0.00,$0.00,$86.02,$491.30,$0.00,$245.65,$389.11,$393.04,$0.00,$74.65,$0.00,$78.21,$0.00
443.057,SUP,HCPCS C1713,,443.057  -  PLATE BONE 37X5X1.5MM 7 HOLE DCP TITANIUM ORTHOPEDIC NONSTRL,$532.25,$0.00,$532.25,$239.51,$379.87,$0.00,$89.03,$0.00,$0.00,$93.19,$532.25,$0.00,$266.13,$421.54,$425.80,$0.00,$80.87,$0.00,$84.73,$0.00
443.058,SUP,HCPCS C1713,,443.058  -  PLATE BONE 42X5X1.5MM 8 HOLE DCP TITANIUM ORTHOPEDIC NONSTRL,$571.83,$0.00,$571.83,$257.32,$408.11,$0.00,$95.65,$0.00,$0.00,$100.12,$571.83,$0.00,$285.91,$452.89,$457.46,$0.00,$86.88,$0.00,$91.03,$0.00
443.178,SUP,HCPCS C1713,,443.178  -  PLATE 31MM TI 2MM SCR 2 BND ARCH BONE SPNL NONSTRL,"$1,342.25",$0.00,"$1,342.25",$604.01,$957.96,$0.00,$231.26,$0.00,$0.00,$235.02,"$1,342.25",$0.00,$671.13,"$1,063.06","$1,073.80",$0.00,$210.06,$0.00,$213.69,$0.00
443.18,SUP,HCPCS C1713,,443.180  -  PLATE MINI 10MM SPC 33MM TI 2MM SCR 2 BND ARCH BONE SPNL,"$1,342.25",$0.00,"$1,342.25",$604.01,$957.96,$0.00,$231.26,$0.00,$0.00,$235.02,"$1,342.25",$0.00,$671.13,"$1,063.06","$1,073.80",$0.00,$210.06,$0.00,$213.69,$0.00
443.182,SUP,HCPCS C1713,,443.182  -  PLATE MINI 12MM SPC 35MM TI 2MM SCR 2 BND ARCH BONE SPNL,"$1,342.25",$0.00,"$1,342.25",$604.01,$957.96,$0.00,$231.26,$0.00,$0.00,$235.02,"$1,342.25",$0.00,$671.13,"$1,063.06","$1,073.80",$0.00,$210.06,$0.00,$213.69,$0.00
443.19,SUP,HCPCS C1713,,443.19  -  PLATE BN STRG 100X5X1MM NS 20 HL TI 2MM SCR,$458.55,$0.00,$458.55,$206.35,$327.27,$0.00,$76.71,$0.00,$0.00,$80.29,$458.55,$0.00,$229.28,$363.17,$366.84,$0.00,$69.67,$0.00,$73.00,$0.00
443.23,SUP,HCPCS C1713,,443.23  -  PLATE BN T 50X5X1.2MM NS 3 HLE/HD 9 HL SHFT TI 2MM SCR,$390.33,$0.00,$390.33,$175.65,$278.57,$0.00,$65.29,$0.00,$0.00,$68.34,$390.33,$0.00,$195.16,$309.14,$312.26,$0.00,$59.31,$0.00,$62.14,$0.00
443.24,SUP,HCPCS C1713,,443.24  -  PLATE BN T 50X5X1.2MM NS 4 HLE/HD 9 HL SHFT TI 2MM SCR,$421.70,$0.00,$421.70,$189.77,$300.97,$0.00,$70.54,$0.00,$0.00,$73.84,$421.70,$0.00,$210.85,$333.99,$337.36,$0.00,$64.08,$0.00,$67.13,$0.00
443.44,SUP,HCPCS C1713,,443.44  -  PLATE BN 22X5X.9MM NS DCP 4 HL TI ZYG 2MM CORT SCR,$555.75,$0.00,$555.75,$250.09,$396.64,$0.00,$95.75,$0.00,$0.00,$97.31,$555.75,$0.00,$277.88,$440.15,$444.60,$0.00,$86.97,$0.00,$88.48,$0.00
443.45,SUP,HCPCS C1713,,443.45  -  PLATE BN 27X5X.9MM NS DCP 5 HL TI ZYG 2MM SCR,$578.25,$0.00,$578.25,$260.21,$412.70,$0.00,$99.63,$0.00,$0.00,$101.25,$578.25,$0.00,$289.13,$457.97,$462.60,$0.00,$90.50,$0.00,$92.06,$0.00
443.46,SUP,HCPCS C1713,,443.46  -  PLATE BN 32X5X.9MM NS DCP 6 HL TI ZYG 2MM SCR,$621.00,$0.00,$621.00,$279.45,$443.21,$0.00,$107.00,$0.00,$0.00,$108.73,$621.00,$0.00,$310.50,$491.83,$496.80,$0.00,$97.19,$0.00,$98.86,$0.00
443.48,SUP,HCPCS C1713,,443.48  -  PLATE BONE H 12X11MM 4 HOLE TITANIUM CONDYLE NONSTRL 2MM,$398.50,$0.00,$398.50,$179.33,$284.41,$0.00,$66.66,$0.00,$0.00,$69.77,$398.50,$0.00,$199.25,$315.61,$318.80,$0.00,$60.55,$0.00,$63.44,$0.00
443.54,SUP,HCPCS C1713,,443.54  -  PLATE BONE 22MM DCP MINI CRANFCL TI 4 HOLE 2MM SCR NONSTRL,$630.00,$0.00,$630.00,$283.50,$449.63,$0.00,$108.55,$0.00,$0.00,$110.31,$630.00,$0.00,$315.00,$498.96,$504.00,$0.00,$98.60,$0.00,$100.30,$0.00
443.55,SUP,HCPCS C1713,,443.55  -  PLATE BONE 27MM DCP MINI CRANFCL TI 5 HOLE 2MM SCR NONSTRL,$695.25,$0.00,$695.25,$312.86,$496.20,$0.00,$119.79,$0.00,$0.00,$121.73,$695.25,$0.00,$347.63,$550.64,$556.20,$0.00,$108.81,$0.00,$110.68,$0.00
443.56,SUP,HCPCS C1713,,443.56  -  PLATE BONE 32MM DCP MINI CRANFCL TI 6 HOLE 2MM SCR NONSTRL,$760.50,$0.00,$760.50,$342.23,$542.77,$0.00,$131.03,$0.00,$0.00,$133.16,$760.50,$0.00,$380.25,$602.32,$608.40,$0.00,$119.02,$0.00,$121.07,$0.00
443.57,SUP,HCPCS C1713,,443.57  -  PLATE BONE 37MM DCP MINI CRANFCL TI 7 HOLE 2MM SCR NONSTRL,$816.75,$0.00,$816.75,$367.54,$582.91,$0.00,$140.72,$0.00,$0.00,$143.01,$816.75,$0.00,$408.38,$646.87,$653.40,$0.00,$127.82,$0.00,$130.03,$0.00
443.58,SUP,HCPCS C1713,,443.58  -  PLATE BONE 42MM DCP MINI CRANFCL TI 8 HOLE 2MM SCR NONSTRL,$884.25,$0.00,$884.25,$397.91,$631.09,$0.00,$152.35,$0.00,$0.00,$154.83,$884.25,$0.00,$442.13,$700.33,$707.40,$0.00,$138.39,$0.00,$140.77,$0.00
443.61,SUP,HCPCS C1713,,443.61  -  PLATE BN 39X5X1.2MM NS 7 HL TI CNDRL LT 2MM SCR,$551.35,$0.00,$551.35,$248.11,$393.50,$0.00,$92.23,$0.00,$0.00,$96.54,$551.35,$0.00,$275.68,$436.67,$441.08,$0.00,$83.77,$0.00,$87.77,$0.00
443.62,SUP,HCPCS C1713,,443.62  -  PLATE BN 39X5X1.2MM NS 7 HL TI CNDRL RT 2MM SCR,$551.35,$0.00,$551.35,$248.11,$393.50,$0.00,$92.23,$0.00,$0.00,$96.54,$551.35,$0.00,$275.68,$436.67,$441.08,$0.00,$83.77,$0.00,$87.77,$0.00
444.002,SUP,HCPCS C1713,,444.002  -  PLATE BONE 2.7MM 20X8X2MM 2 HOLE DCP TITANIUM FT NONSTRL 2.7,$474.35,$0.00,$474.35,$213.46,$338.54,$0.00,$81.73,$0.00,$0.00,$83.05,$474.35,$0.00,$237.18,$375.69,$379.48,$0.00,$74.24,$0.00,$75.52,$0.00
444.004,SUP,HCPCS C1713,,444.004  -  PLATE BONE 36X8X2MM 4 HOLE DCP TITANIUM FT NONSTRL 2.7MM,$593.60,$0.00,$593.60,$267.12,$423.65,$0.00,$102.27,$0.00,$0.00,$103.93,$593.60,$0.00,$296.80,$470.13,$474.88,$0.00,$92.90,$0.00,$94.50,$0.00
444.005,SUP,HCPCS C1713,,444.005  -  PLATE BONE 44X8X2MM 5 HOLE DCP TITANIUM FT NONSTRL 2.7MM,$669.13,$0.00,$669.13,$301.11,$477.55,$0.00,$115.29,$0.00,$0.00,$117.16,$669.13,$0.00,$334.56,$529.95,$535.30,$0.00,$104.72,$0.00,$106.52,$0.00
444.006,SUP,HCPCS C1713,,444.006  -  PLATE BONE 2.7MM 52X8X2MM 6 HOLE DCP TITANIUM FT NONSTRL 2.7,$716.83,$0.00,$716.83,$322.57,$511.60,$0.00,$123.51,$0.00,$0.00,$125.51,$716.83,$0.00,$358.41,$567.73,$573.46,$0.00,$112.18,$0.00,$114.12,$0.00
444.007,SUP,HCPCS C1713,,444.007  -  PLATE BONE 60X8X2.5MM 7 HOLE DCP TITANIUM FT NONSTRL 2.7MM,$797.65,$0.00,$797.65,$358.94,$569.28,$0.00,$137.43,$0.00,$0.00,$139.66,$797.65,$0.00,$398.83,$631.74,$638.12,$0.00,$124.83,$0.00,$126.99,$0.00
444.008,SUP,HCPCS C1713,,444.008  -  PLATE BONE 68X8X2.5MM 8 HOLE DCP TITANIUM FT NONSTRL 2.7MM,$836.08,$0.00,$836.08,$376.23,$596.71,$0.00,$144.05,$0.00,$0.00,$146.39,$836.08,$0.00,$418.04,$662.18,$668.86,$0.00,$130.85,$0.00,$133.10,$0.00
444.009,SUP,HCPCS C1713,,444.009  -  PLATE BONE 2.7MM 76X8X2.5MM 9 HOLE DCP TITANIUM FT NONSTRL,$910.28,$0.00,$910.28,$409.62,$649.66,$0.00,$156.84,$0.00,$0.00,$159.38,$910.28,$0.00,$455.14,$720.94,$728.22,$0.00,$142.46,$0.00,$144.92,$0.00
444.01,SUP,HCPCS C1713,,444.010  -  PLATE BONE 2.7MM 84X8X2.5MM 10 HOLE DCP TITANIUM FT NONSTRL,$985.80,$0.00,$985.80,$443.61,$703.57,$0.00,$169.85,$0.00,$0.00,$172.61,$985.80,$0.00,$492.90,$780.75,$788.64,$0.00,$154.28,$0.00,$156.94,$0.00
444.012,SUP,HCPCS C1713,,444.012  -  PLATE BONE 2.7MM 100X8X2.5MM 12 HOLE DCP TITANIUM FT NONSTRL,"$1,094.45",$0.00,"$1,094.45",$492.50,$781.11,$0.00,$188.57,$0.00,$0.00,$191.63,"$1,094.45",$0.00,$547.23,$866.80,$875.56,$0.00,$171.28,$0.00,$174.24,$0.00
444.022,SUP,HCPCS C1713,,444.022  -  PLATE BONE 1.5MM 26X8X2.5MM 2 HOLE DCP TITANIUM FT NONSTRL,$494.23,$0.00,$494.23,$222.40,$352.73,$0.00,$85.15,$0.00,$0.00,$86.53,$494.23,$0.00,$247.11,$391.43,$395.38,$0.00,$77.35,$0.00,$78.68,$0.00
445,SUP,HCPCS C1713,,445.00  -  PLATE BONE 3.5MM 118MM 10 HOLE RECONSTRUCTION LC-DCP,$941.68,$0.00,$941.68,$423.75,$672.07,$0.00,$157.52,$0.00,$0.00,$164.88,$941.68,$0.00,$470.84,$745.81,$753.34,$0.00,$143.08,$0.00,$149.91,$0.00
445.01,SUP,HCPCS C1713,,445.01  -  PLATE BN 130MM NS 11 HL RECON TI 3.5MM SCR,$962.15,$0.00,$962.15,$432.97,$686.69,$0.00,$160.95,$0.00,$0.00,$168.46,$962.15,$0.00,$481.08,$762.02,$769.72,$0.00,$146.19,$0.00,$153.17,$0.00
445.041,SUP,HCPCS C1713,,445.041  -  PLATE BONE 56MM 4 HOLE RECONSTRUCTION LCP TITANIUM,$794.28,$0.00,$794.28,$357.42,$566.87,$0.00,$132.87,$0.00,$0.00,$139.07,$794.28,$0.00,$397.14,$629.07,$635.42,$0.00,$120.68,$0.00,$126.45,$0.00
445.051,SUP,HCPCS C1713,,445.051  -  PLATE BN 70X10.1X3.5MM NS LCP CMBN 5 HL RECON TI 3.5MM SCR,$799.75,$0.00,$799.75,$359.89,$570.78,$0.00,$133.78,$0.00,$0.00,$140.03,$799.75,$0.00,$399.88,$633.40,$639.80,$0.00,$121.51,$0.00,$127.32,$0.00
445.061,SUP,HCPCS C1713,,445.061  -  PLATE BN 84X10.1X3.5MM NS LCP CMBN 6 HL RECON TI 3.5MM SCR,$925.30,$0.00,$925.30,$416.39,$660.39,$0.00,$154.78,$0.00,$0.00,$162.01,$925.30,$0.00,$462.65,$732.84,$740.24,$0.00,$140.59,$0.00,$147.31,$0.00
445.071,SUP,HCPCS C1713,,445.071  -  PLATE BONE 98X10.1X3.5MM 7 HOLE LCP TITANIUM CLAVICLE,$973.08,$0.00,$973.08,$437.88,$694.48,$0.00,$162.77,$0.00,$0.00,$170.38,$973.08,$0.00,$486.54,$770.68,$778.46,$0.00,$147.85,$0.00,$154.91,$0.00
445.081,SUP,HCPCS C1713,,445.081  -  PLATE BN 112X10.1X3.5MM NS LCP CMBN 8 HL RECON TI 3.5MM SCR,"$1,015.38",$0.00,"$1,015.38",$456.92,$724.67,$0.00,$169.85,$0.00,$0.00,$177.78,"$1,015.38",$0.00,$507.69,$804.18,$812.30,$0.00,$154.28,$0.00,$161.65,$0.00
445.091,SUP,HCPCS C1713,,445.091  -  PLATE BONE 126MM 9 HOLE RECONSTRUCTION LCP TITANIUM,"$1,068.60",$0.00,"$1,068.60",$480.87,$762.66,$0.00,$178.75,$0.00,$0.00,$187.10,"$1,068.60",$0.00,$534.30,$846.33,$854.88,$0.00,$162.36,$0.00,$170.12,$0.00
445.101,SUP,HCPCS C1713,,445.101  -  PLATE BONE 140X10.1X3.5MM 10 HOLE LCP TITANIUM CLAVICLE,"$1,050.85",$0.00,"$1,050.85",$472.88,$749.99,$0.00,$175.78,$0.00,$0.00,$184.00,"$1,050.85",$0.00,$525.43,$832.27,$840.68,$0.00,$159.67,$0.00,$167.30,$0.00
445.111,SUP,HCPCS C1713,,445.111  -  PLATE BONE 154MM 11 HOLE RECONSTRUCTION LCP TITANIUM,"$1,138.20",$0.00,"$1,138.20",$512.19,$812.33,$0.00,$190.39,$0.00,$0.00,$199.29,"$1,138.20",$0.00,$569.10,$901.45,$910.56,$0.00,$172.94,$0.00,$181.20,$0.00
445.121,SUP,HCPCS C1713,,445.121  -  PLATE BONE 168X10.1X3.5MM 12 HOLE LCP TITANIUM CLAVICLE,"$1,142.30",$0.00,"$1,142.30",$514.04,$815.26,$0.00,$191.08,$0.00,$0.00,$200.01,"$1,142.30",$0.00,$571.15,$904.70,$913.84,$0.00,$173.56,$0.00,$181.85,$0.00
445.131,SUP,HCPCS C1713,,445.131  -  PLATE BONE 182MM 13 HOLE RECONSTRUCTION LCP TITANIUM,"$1,236.48",$0.00,"$1,236.48",$556.41,$882.47,$0.00,$206.83,$0.00,$0.00,$216.50,"$1,236.48",$0.00,$618.24,$979.29,$989.18,$0.00,$187.87,$0.00,$196.85,$0.00
445.141,SUP,HCPCS C1713,,445.141  -  PLATE BONE 196MM 14 HOLE RECONSTRUCTION LCP TITANIUM,"$1,284.23",$0.00,"$1,284.23",$577.90,$916.55,$0.00,$214.82,$0.00,$0.00,$224.86,"$1,284.23",$0.00,$642.11,"$1,017.11","$1,027.38",$0.00,$195.13,$0.00,$204.45,$0.00
445.15,SUP,HCPCS C1713,,445.15  -  PLATE BONE 58MM 5 HOLE RECONSTRUCTION LC-DCP TITANIUM,$716.50,$0.00,$716.50,$322.43,$511.37,$0.00,$119.85,$0.00,$0.00,$125.45,$716.50,$0.00,$358.25,$567.47,$573.20,$0.00,$108.87,$0.00,$114.07,$0.00
445.16,SUP,HCPCS C1713,,445.16  -  PLATE BONE 70MM 6 HOLE RECONSTRUCTION LC-DCP TITANIUM,$825.68,$0.00,$825.68,$371.55,$589.28,$0.00,$138.12,$0.00,$0.00,$144.57,$825.68,$0.00,$412.84,$653.94,$660.54,$0.00,$125.45,$0.00,$131.45,$0.00
445.161,SUP,HCPCS C1713,,445.161  -  PLATE BONE 224MM 16 HOLE RECONSTRUCTION LCP TITANIUM,"$1,392.05",$0.00,"$1,392.05",$626.42,$993.51,$0.00,$232.86,$0.00,$0.00,$243.74,"$1,392.05",$0.00,$696.03,"$1,102.50","$1,113.64",$0.00,$211.51,$0.00,$221.61,$0.00
445.17,SUP,HCPCS C1713,,445.17  -  PLATE BONE 82MM 7 HOLE RECONSTRUCTION LC-DCP TITANIUM,$848.88,$0.00,$848.88,$381.99,$605.84,$0.00,$142.00,$0.00,$0.00,$148.63,$848.88,$0.00,$424.44,$672.31,$679.10,$0.00,$128.98,$0.00,$135.14,$0.00
445.18,SUP,HCPCS C1713,,445.18  -  PLATE BONE 94MM 8 HOLE RECONSTRUCTION LC-DCP TITANIUM,$899.38,$0.00,$899.38,$404.72,$641.88,$0.00,$150.44,$0.00,$0.00,$157.47,$899.38,$0.00,$449.69,$712.31,$719.50,$0.00,$136.65,$0.00,$143.18,$0.00
445.181,SUP,HCPCS C1713,,445.181  -  PLATE BN 252X10.1X3.5MM NS LCP CMBN 18 HL RECON TI 3.5MM SCR,"$1,457.55",$0.00,"$1,457.55",$655.90,"$1,040.25",$0.00,$243.81,$0.00,$0.00,$255.21,"$1,457.55",$0.00,$728.78,"$1,154.38","$1,166.04",$0.00,$221.46,$0.00,$232.04,$0.00
445.19,SUP,HCPCS C1713,,445.19  -  PLATE BONE 106MM 9 HOLE RECONSTRUCTION LC-DCP TITANIUM,$926.68,$0.00,$926.68,$417.00,$661.37,$0.00,$155.01,$0.00,$0.00,$162.25,$926.68,$0.00,$463.34,$733.93,$741.34,$0.00,$140.80,$0.00,$147.53,$0.00
445.201,SUP,HCPCS C1713,,445.201  -  PLATE BN 280X10.1X3.5MM NS LCP CMBN 20 HL RECON TI 3.5MM SCR,"$1,770.08",$0.00,"$1,770.08",$796.53,"$1,263.30",$0.00,$296.09,$0.00,$0.00,$309.93,"$1,770.08",$0.00,$885.04,"$1,401.90","$1,416.06",$0.00,$268.95,$0.00,$281.80,$0.00
445.221,SUP,HCPCS C1713,,445.221  -  PLATE BONE 308MM 22 HOLE RECONSTRUCTION LCP TITANIUM NONSTRL,"$1,804.20",$0.00,"$1,804.20",$811.89,"$1,287.66",$0.00,$301.80,$0.00,$0.00,$315.90,"$1,804.20",$0.00,$902.10,"$1,428.93","$1,443.36",$0.00,$274.13,$0.00,$287.23,$0.00
446.014,SUP,HCPCS C1713,,446.014  -  PLATE BN RECT 45X38X.4MM NS CNTR MESH MLBL TI CRNFCL 1.5MM,"$3,413.25",$0.00,"$3,413.25","$1,535.96","$2,436.04",$0.00,$588.09,$0.00,$0.00,$597.63,"$3,413.25",$0.00,"$1,706.63","$2,703.29","$2,730.60",$0.00,$534.17,$0.00,$543.39,$0.00
446.015,SUP,HCPCS C1713,,446.015  -  PLATE BN RECT 45X38X.6MM NS CNTR MESH RGD TI CRNFCL 1.5MM,"$3,413.25",$0.00,"$3,413.25","$1,535.96","$2,436.04",$0.00,$588.09,$0.00,$0.00,$597.63,"$3,413.25",$0.00,"$1,706.63","$2,703.29","$2,730.60",$0.00,$534.17,$0.00,$543.39,$0.00
446.017,SUP,HCPCS C1713,,446.017  -  PLATE BN RECT 100X100X.3MM NS CNTR MESH MLBL TI CRNFCL 1.5MM,"$5,334.75",$0.00,"$5,334.75","$2,400.64","$3,807.41",$0.00,$919.15,$0.00,$0.00,$934.07,"$5,334.75",$0.00,"$2,667.38","$4,225.12","$4,267.80",$0.00,$834.89,$0.00,$849.29,$0.00
446.018,SUP,HCPCS C1713,,446.018  -  PLATE BN RECT 100X100X.6MM NS CNTR MESH RGD TI CRNFCL 1.5MM,"$5,334.75",$0.00,"$5,334.75","$2,400.64","$3,807.41",$0.00,$919.15,$0.00,$0.00,$934.07,"$5,334.75",$0.00,"$2,667.38","$4,225.12","$4,267.80",$0.00,$834.89,$0.00,$849.29,$0.00
446.019,SUP,HCPCS C1713,,446.019  -  PLATE BONE NONSTRL GOLD 200X200MM CRANFCL TI CONTUR MESH RGD,"$19,163.25",$0.00,"$19,163.25","$8,623.46","$5,158.80",$0.00,"$3,301.73",$0.00,$0.00,"$3,355.33","$19,163.25",$0.00,"$9,581.63","$15,177.29","$15,330.60",$0.00,"$2,999.05",$0.00,"$3,050.79",$0.00
446.02,SUP,HCPCS C1713,,446.020  -  PLATE BONE CRANIAL TI 2 HOLE STR 1.5 MM SCR NONSTRL,$105.75,$0.00,$105.75,$47.59,$75.47,$0.00,$18.22,$0.00,$0.00,$18.52,$105.75,$0.00,$52.88,$83.75,$84.60,$0.00,$16.55,$0.00,$16.84,$0.00
446.024,SUP,HCPCS C1713,,446.024  -  PLATE BONE 25MM CRANFCL TI 4 HOLE STR LP 1.5MM SCR NONSTRL,$144.00,$0.00,$144.00,$64.80,$102.77,$0.00,$24.81,$0.00,$0.00,$25.21,$144.00,$0.00,$72.00,$114.05,$115.20,$0.00,$22.54,$0.00,$22.92,$0.00
446.031,SUP,HCPCS C1713,,446.031  -  PLATE BN STRG 29X3.8X.8MM NS PRO-PK 6 HL LOPRFL PRECONTOUR,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
446.032,SUP,HCPCS C1713,,446.032  -  PLATE BN STRG 59X3.8X.8MM NS PRO-PK 12 HL LOPRFL PRECONTOUR,$451.73,$0.00,$451.73,$203.28,$322.40,$0.00,$75.56,$0.00,$0.00,$79.09,$451.73,$0.00,$225.86,$357.77,$361.38,$0.00,$68.64,$0.00,$71.91,$0.00
446.033,SUP,HCPCS C1713,,446.033  -  PLATE BONE NONSTRL TEAL CRANFCL TI CONTUR MESH MALBLE SM ARC,"$1,768.50",$0.00,"$1,768.50",$795.83,"$1,262.18",$0.00,$304.70,$0.00,$0.00,$309.65,"$1,768.50",$0.00,$884.25,"$1,400.65","$1,414.80",$0.00,$276.77,$0.00,$281.55,$0.00
446.034,SUP,HCPCS C1713,,446.034  -  PLATE BONE NONSTRL TEAL CRANFCL TI CONTUR MESH MALBLE LG ARC,"$2,754.00",$0.00,"$2,754.00","$1,239.30","$1,965.53",$0.00,$474.50,$0.00,$0.00,$482.20,"$2,754.00",$0.00,"$1,377.00","$2,181.17","$2,203.20",$0.00,$431.00,$0.00,$438.44,$0.00
446.035,SUP,HCPCS C1713,,446.035  -  PLATE BONE 1.5MM SCR GOLD CRANFCL TI CONTUR MESH RGD SM ARC,"$1,768.50",$0.00,"$1,768.50",$795.83,"$1,262.18",$0.00,$304.70,$0.00,$0.00,$309.65,"$1,768.50",$0.00,$884.25,"$1,400.65","$1,414.80",$0.00,$276.77,$0.00,$281.55,$0.00
446.036,SUP,HCPCS C1713,,446.036  -  PLATE BONE 1.5MM SCR GOLD CRANFCL TI CONTUR MESH RGD LG ARC,"$2,754.00",$0.00,"$2,754.00","$1,239.30","$1,965.53",$0.00,$474.50,$0.00,$0.00,$482.20,"$2,754.00",$0.00,"$1,377.00","$2,181.17","$2,203.20",$0.00,$431.00,$0.00,$438.44,$0.00
446.04,SUP,HCPCS C1713,,446.040  -  PLATE 0MM RIGHT MAXL PREBNT OFFST ORTHGNAT 1.5MM SCR BONE TI,$967.50,$0.00,$967.50,$435.38,$690.50,$0.00,$166.70,$0.00,$0.00,$169.40,$967.50,$0.00,$483.75,$766.26,$774.00,$0.00,$151.41,$0.00,$154.03,$0.00
446.041,SUP,HCPCS C1713,,446.041  -  PLATE LEFT MAXL PREBNT 1.5MM SCR BONE TI 0MM NONSTRL,$967.50,$0.00,$967.50,$435.38,$690.50,$0.00,$166.70,$0.00,$0.00,$169.40,$967.50,$0.00,$483.75,$766.26,$774.00,$0.00,$151.41,$0.00,$154.03,$0.00
446.042,SUP,HCPCS C1713,,446.042  -  PLATE BN 3MM PREBNT 27.1X.9MM NS TI MXL RT 1.5MM CORT SCR,$967.50,$0.00,$967.50,$435.38,$690.50,$0.00,$166.70,$0.00,$0.00,$169.40,$967.50,$0.00,$483.75,$766.26,$774.00,$0.00,$151.41,$0.00,$154.03,$0.00
446.043,SUP,HCPCS C1713,,446.043  -  PLATE BN 3MM PREBNT 27.1X.9MM NS TI MXL LT 1.5MM CORT SCR,$967.50,$0.00,$967.50,$435.38,$690.50,$0.00,$166.70,$0.00,$0.00,$169.40,$967.50,$0.00,$483.75,$766.26,$774.00,$0.00,$151.41,$0.00,$154.03,$0.00
446.044,SUP,HCPCS C1713,,446.044  -  PLATE BN 5MM PREBNT 27.1X.9MM NS TI MXL RT 1.5MM CORT SCR,$967.50,$0.00,$967.50,$435.38,$690.50,$0.00,$166.70,$0.00,$0.00,$169.40,$967.50,$0.00,$483.75,$766.26,$774.00,$0.00,$151.41,$0.00,$154.03,$0.00
446.045,SUP,HCPCS C1713,,446.045  -  PLATE BN 5MM PREBNT 27.1X.9MM NS TI MXL LT 1.5MM CORT SCR,$967.50,$0.00,$967.50,$435.38,$690.50,$0.00,$166.70,$0.00,$0.00,$169.40,$967.50,$0.00,$483.75,$766.26,$774.00,$0.00,$151.41,$0.00,$154.03,$0.00
446.046,SUP,HCPCS C1713,,446.046  -  PLATE BN 7MM PREBNT 27.1X.9MM NS TI MXL RT 1.5MM CORT SCR,$967.50,$0.00,$967.50,$435.38,$690.50,$0.00,$166.70,$0.00,$0.00,$169.40,$967.50,$0.00,$483.75,$766.26,$774.00,$0.00,$151.41,$0.00,$154.03,$0.00
446.047,SUP,HCPCS C1713,,446.047  -  PLATE LEFT MAXL PREBNT 1.5MM SCR BONE TI 7MM NONSTRL,$967.50,$0.00,$967.50,$435.38,$690.50,$0.00,$166.70,$0.00,$0.00,$169.40,$967.50,$0.00,$483.75,$766.26,$774.00,$0.00,$151.41,$0.00,$154.03,$0.00
446.048,SUP,HCPCS C1713,,446.048  -  PLATE BN 9MM PREBNT 27.1X.9MM NS TI MXL RT 1.5MM CORT SCR,$967.50,$0.00,$967.50,$435.38,$690.50,$0.00,$166.70,$0.00,$0.00,$169.40,$967.50,$0.00,$483.75,$766.26,$774.00,$0.00,$151.41,$0.00,$154.03,$0.00
446.049,SUP,HCPCS C1713,,446.049  -  PLATE BN 9MM PREBNT 27.1X.9MM NS TI MXL LT 1.5MM CORT SCR,$967.50,$0.00,$967.50,$435.38,$690.50,$0.00,$166.70,$0.00,$0.00,$169.40,$967.50,$0.00,$483.75,$766.26,$774.00,$0.00,$151.41,$0.00,$154.03,$0.00
446.05,SUP,HCPCS C1713,,446.050  -  PLATE BONE CONTUR MESH MALBLE 1.5MM SCR TEAL 30MM CRANFCL TI,"$1,768.50",$0.00,"$1,768.50",$795.83,"$1,262.18",$0.00,$304.70,$0.00,$0.00,$309.65,"$1,768.50",$0.00,$884.25,"$1,400.65","$1,414.80",$0.00,$276.77,$0.00,$281.55,$0.00
446.051,SUP,HCPCS C1713,,446.051  -  PLATE BONE CONTUR MESH MALBLE 1.5MM SCR TEAL 70MM CRANFCL TI,"$3,665.25",$0.00,"$3,665.25","$1,649.36","$2,615.89",$0.00,$631.50,$0.00,$0.00,$641.76,"$3,665.25",$0.00,"$1,832.63","$2,902.88","$2,932.20",$0.00,$573.61,$0.00,$583.51,$0.00
446.052,SUP,HCPCS C1713,,446.052  -  PLATE BONE CONTUR MESH MALBLE 1.5MM SCR TEAL 100MM CRANFCL,"$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
446.053,SUP,HCPCS C1713,,446.053  -  PLATE BONE NONSTRL GOLD 30MM CRANFCL TI CONTUR MESH RGD 1.5,"$1,966.50",$0.00,"$1,966.50",$884.93,"$1,403.49",$0.00,$338.82,$0.00,$0.00,$344.32,"$1,966.50",$0.00,$983.25,"$1,557.47","$1,573.20",$0.00,$307.76,$0.00,$313.07,$0.00
446.054,SUP,HCPCS C1713,,446.054  -  PLATE BONE NONSTRL GOLD 70MM CRANFCL TI CONTUR MESH RGD 1.5,"$4,070.25",$0.00,"$4,070.25","$1,831.61","$2,904.94",$0.00,$701.28,$0.00,$0.00,$712.67,"$4,070.25",$0.00,"$2,035.13","$3,223.64","$3,256.20",$0.00,$636.99,$0.00,$647.98,$0.00
446.055,SUP,HCPCS C1713,,446.055  -  PLATE BONE NONSTRL GOLD 100MM CRANFCL TI CONTUR MESH RGD 1.5,"$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
446.06,SUP,HCPCS C1713,,446.060  -  PLATE 11MM ADV RIGHT MAXL PREBNT 1.5MM SCR BONE TI NONSTRL,$967.50,$0.00,$967.50,$435.38,$690.50,$0.00,$166.70,$0.00,$0.00,$169.40,$967.50,$0.00,$483.75,$766.26,$774.00,$0.00,$151.41,$0.00,$154.03,$0.00
446.061,SUP,HCPCS C1713,,446.061  -  PLATE LEFT MAXL PREBNT 1.5MM SCR BONE TI 11MM NONSTRL,$967.50,$0.00,$967.50,$435.38,$690.50,$0.00,$166.70,$0.00,$0.00,$169.40,$967.50,$0.00,$483.75,$766.26,$774.00,$0.00,$151.41,$0.00,$154.03,$0.00
446.09,SUP,HCPCS C1713,,446.090  -  PLATE MANDIB 4X7 HOLE T 1.5 MM SCR BONE TI NONSTRL,$625.50,$0.00,$625.50,$281.48,$446.42,$0.00,$107.77,$0.00,$0.00,$109.52,$625.50,$0.00,$312.75,$495.40,$500.40,$0.00,$97.89,$0.00,$99.58,$0.00
446.091,SUP,HCPCS C1713,,446.091  -  PLATE MANDIB 4X7 HOLE T MALBLE 1.5 MM SCR BONE TI NONSTRL,$553.50,$0.00,$553.50,$249.08,$395.03,$0.00,$95.37,$0.00,$0.00,$96.91,$553.50,$0.00,$276.75,$438.37,$442.80,$0.00,$86.62,$0.00,$88.12,$0.00
446.096,SUP,HCPCS C1713,,446.096  -  PLATE BONE 14X14MM CRANFCL TI 4 HOLE BOX 1.5MM SCR NONSTRL,$553.50,$0.00,$553.50,$249.08,$395.03,$0.00,$95.37,$0.00,$0.00,$96.91,$553.50,$0.00,$276.75,$438.37,$442.80,$0.00,$86.62,$0.00,$88.12,$0.00
446.097,SUP,HCPCS C1713,,446.097  -  PLATE BONE 16X16MM CRANFCL TI 4 HOLE BOX 1.5MM SCR NONSTRL,$553.50,$0.00,$553.50,$249.08,$395.03,$0.00,$95.37,$0.00,$0.00,$96.91,$553.50,$0.00,$276.75,$438.37,$442.80,$0.00,$86.62,$0.00,$88.12,$0.00
446.1,SUP,HCPCS C1713,,446.10  -  PLATE 4.5MM HOLE SPC 90MM TI 1.5MM SCR 20 HOLE ADP BONE,$859.50,$0.00,$859.50,$386.78,$613.43,$0.00,$148.09,$0.00,$0.00,$150.49,$859.50,$0.00,$429.75,$680.72,$687.60,$0.00,$134.51,$0.00,$136.83,$0.00
446.101,SUP,HCPCS C1713,,446.101  -  PLATE BONE 90MM CRANFCL TI 20 HOLE ADP LP 1.5MM SCR NONSTRL,$819.00,$0.00,$819.00,$368.55,$584.52,$0.00,$141.11,$0.00,$0.00,$143.40,$819.00,$0.00,$409.50,$648.65,$655.20,$0.00,$128.17,$0.00,$130.38,$0.00
446.154,SUP,HCPCS C1713,,446.154  -  1.5MM TI 90Ø L-PLATE 17MM 2X2 HOLES LOW-PROFILE/LEFT,$459.00,$0.00,$459.00,$206.55,$327.59,$0.00,$79.08,$0.00,$0.00,$80.37,$459.00,$0.00,$229.50,$363.53,$367.20,$0.00,$71.83,$0.00,$73.07,$0.00
446.155,SUP,HCPCS C1713,,446.155  -  1.5MM TI 90Ø L-PLATE 17MM 2X2 HOLES LOW-PROFILE/RIGHT,$459.00,$0.00,$459.00,$206.55,$327.59,$0.00,$79.08,$0.00,$0.00,$80.37,$459.00,$0.00,$229.50,$363.53,$367.20,$0.00,$71.83,$0.00,$73.07,$0.00
446.156,SUP,HCPCS C1713,,446.156  -  1.5MM TI 90Ø L-PLATE 19MM 2X2 HOLES LOW-PROFILE/LEFT,$459.00,$0.00,$459.00,$206.55,$327.59,$0.00,$79.08,$0.00,$0.00,$80.37,$459.00,$0.00,$229.50,$363.53,$367.20,$0.00,$71.83,$0.00,$73.07,$0.00
446.157,SUP,HCPCS C1713,,446.157  -  1.5MM TI 90Ø L-PLATE 19MM 2X2 HOLES LOW-PROFILE/RIGHT,$459.00,$0.00,$459.00,$206.55,$327.59,$0.00,$79.08,$0.00,$0.00,$80.37,$459.00,$0.00,$229.50,$363.53,$367.20,$0.00,$71.83,$0.00,$73.07,$0.00
446.158,SUP,HCPCS C1713,,446.158  -  1.5MM TI 90Ø L-PLATE 23MM 2X2 HOLES LOW-PROFILE/LEFT,$459.00,$0.00,$459.00,$206.55,$327.59,$0.00,$79.08,$0.00,$0.00,$80.37,$459.00,$0.00,$229.50,$363.53,$367.20,$0.00,$71.83,$0.00,$73.07,$0.00
446.159,SUP,HCPCS C1713,,446.159  -  1.5MM TI 90Ø L-PLATE 23MM 2X2 HOLES LOW-PROFILE/RIGHT,$459.00,$0.00,$459.00,$206.55,$327.59,$0.00,$79.08,$0.00,$0.00,$80.37,$459.00,$0.00,$229.50,$363.53,$367.20,$0.00,$71.83,$0.00,$73.07,$0.00
446.18,SUP,HCPCS C1713,,446.18  -  PLATE BONE ORBTL RIM TI 8 HOLE RGD 1.5 MM SCR NONSTRL,$684.00,$0.00,$684.00,$307.80,$488.17,$0.00,$117.85,$0.00,$0.00,$119.76,$684.00,$0.00,$342.00,$541.73,$547.20,$0.00,$107.05,$0.00,$108.89,$0.00
446.19,SUP,HCPCS C1713,,446.19  -  PLATE BN STRG 100X3.8X.8MM NS 20 HL TI 1.5MM SCR,$438.08,$0.00,$438.08,$197.13,$312.65,$0.00,$73.28,$0.00,$0.00,$76.70,$438.08,$0.00,$219.04,$346.96,$350.46,$0.00,$66.56,$0.00,$69.74,$0.00
446.2,SUP,HCPCS C1713,,446.20  -  PLATE BN 41MM NS 10 HL TI ORBT RIM 1.5MM SCR,$722.25,$0.00,$722.25,$325.01,$515.47,$0.00,$124.44,$0.00,$0.00,$126.46,$722.25,$0.00,$361.13,$572.02,$577.80,$0.00,$113.03,$0.00,$114.98,$0.00
446.22,SUP,HCPCS C1713,,446.22  -  PLATE BN 49MM NS 12 HL TI ORBT RIM 1.5MM SCR,$776.25,$0.00,$776.25,$349.31,$554.01,$0.00,$133.74,$0.00,$0.00,$135.92,$776.25,$0.00,$388.13,$614.79,$621.00,$0.00,$121.48,$0.00,$123.58,$0.00
446.23,SUP,HCPCS C1713,,446.23  -  PLATE BONE T 1.5MM 50MM 3X9 HOLE LCP TITANIUM CONDYLE,$379.40,$0.00,$379.40,$170.73,$270.78,$0.00,$63.46,$0.00,$0.00,$66.43,$379.40,$0.00,$189.70,$300.48,$303.52,$0.00,$57.65,$0.00,$60.40,$0.00
446.233,SUP,HCPCS C1713,,446.233  -  PLATE BN T 44X4X1MM NS PRO-PK 3 HLE/HD 8 HL SHFT LOPRFL,$413.53,$0.00,$413.53,$186.09,$295.13,$0.00,$69.17,$0.00,$0.00,$72.40,$413.53,$0.00,$206.76,$327.52,$330.82,$0.00,$62.83,$0.00,$65.83,$0.00
446.234,SUP,HCPCS C1713,,446.234  -  PLATE BN T 44X4X1MM NS PRO-PK 4 HLE/HD 8 HL SHFT LOPRFL,$431.25,$0.00,$431.25,$194.06,$307.78,$0.00,$72.14,$0.00,$0.00,$75.51,$431.25,$0.00,$215.63,$341.55,$345.00,$0.00,$65.53,$0.00,$68.66,$0.00
446.24,SUP,HCPCS C1713,,446.24  -  PLATE BN T 50X4X1MM NS 4 HLE/HD 9 HL SHFT TI 1.5MM SCR,$413.53,$0.00,$413.53,$186.09,$295.13,$0.00,$69.17,$0.00,$0.00,$72.40,$413.53,$0.00,$206.76,$327.52,$330.82,$0.00,$62.83,$0.00,$65.83,$0.00
446.4,SUP,HCPCS C1713,,446.40  -  PLATE BONE UNV ORBTL FLR TI 1.5MM SCR NONSTRL,"$2,772.00",$0.00,"$2,772.00","$1,247.40","$1,978.38",$0.00,$477.60,$0.00,$0.00,$485.36,"$2,772.00",$0.00,"$1,386.00","$2,195.42","$2,217.60",$0.00,$433.82,$0.00,$441.30,$0.00
446.44,SUP,HCPCS C1713,,446.44  -  PLATE BONE LEFT MDL WL CRANFCL TI 1.5 MM SCR NONSTRL,"$2,457.00",$0.00,"$2,457.00","$1,105.65","$1,753.56",$0.00,$423.33,$0.00,$0.00,$430.20,"$2,457.00",$0.00,"$1,228.50","$1,945.94","$1,965.60",$0.00,$384.52,$0.00,$391.15,$0.00
446.45,SUP,HCPCS C1713,,446.45  -  PLATE BONE RIGHT MDL WL CRANFCL TI 1.5 MM SCR NONSTRL,"$2,457.00",$0.00,"$2,457.00","$1,105.65","$1,753.56",$0.00,$423.33,$0.00,$0.00,$430.20,"$2,457.00",$0.00,"$1,228.50","$1,945.94","$1,965.60",$0.00,$384.52,$0.00,$391.15,$0.00
446.48,SUP,HCPCS C1713,,446.48  -  PLATE BONE H 1.5MM 6MM 4 HOLE TITANIUM HAND NONSTRL 1.5MM,$387.60,$0.00,$387.60,$174.42,$276.63,$0.00,$64.83,$0.00,$0.00,$67.87,$387.60,$0.00,$193.80,$306.98,$310.08,$0.00,$58.89,$0.00,$61.71,$0.00
446.482,SUP,HCPCS C1713,,446.482  -  PLATE BN H 22MM NS PRO-PK 8 HL XTD LOPRFL PRECONTOUR TI RT,$431.25,$0.00,$431.25,$194.06,$307.78,$0.00,$72.14,$0.00,$0.00,$75.51,$431.25,$0.00,$215.63,$341.55,$345.00,$0.00,$65.53,$0.00,$68.66,$0.00
446.483,SUP,HCPCS C1713,,446.483  -  PLATE BN H 22MM NS PRO-PK 8 HL XTD LOPRFL PRECONTOUR TI LT,$431.25,$0.00,$431.25,$194.06,$307.78,$0.00,$72.14,$0.00,$0.00,$75.51,$431.25,$0.00,$215.63,$341.55,$345.00,$0.00,$65.53,$0.00,$68.66,$0.00
446.5,SUP,HCPCS C1713,,446.50  -  PLATE BN OB L L NS 2X3 HL RGD TI CRNFCL 1.5MM SCR,$616.50,$0.00,$616.50,$277.43,$440.00,$0.00,$106.22,$0.00,$0.00,$107.94,$616.50,$0.00,$308.25,$488.27,$493.20,$0.00,$96.48,$0.00,$98.15,$0.00
446.504,SUP,HCPCS C1713,,446.504  -  PLATE RIGHT MAXL 3X3 HOLE L 1.5MM SCR BONE TI 22MM NONSTRL,$596.25,$0.00,$596.25,$268.31,$425.54,$0.00,$102.73,$0.00,$0.00,$104.40,$596.25,$0.00,$298.13,$472.23,$477.00,$0.00,$93.31,$0.00,$94.92,$0.00
446.505,SUP,HCPCS C1713,,446.505  -  PLATE LEFT MAXL 3X3 HOLE L 1.5MM SCR BONE TI 22MM NONSTRL,$596.25,$0.00,$596.25,$268.31,$425.54,$0.00,$102.73,$0.00,$0.00,$104.40,$596.25,$0.00,$298.13,$472.23,$477.00,$0.00,$93.31,$0.00,$94.92,$0.00
446.506,SUP,HCPCS C1713,,446.506  -  PLATE RIGHT MAXL 3X3 HOLE L 1.5MM SCR BONE TI 24MM NONSTRL,$596.25,$0.00,$596.25,$268.31,$425.54,$0.00,$102.73,$0.00,$0.00,$104.40,$596.25,$0.00,$298.13,$472.23,$477.00,$0.00,$93.31,$0.00,$94.92,$0.00
446.507,SUP,HCPCS C1713,,446.507  -  PLATE LEFT MAXL 3X3 HOLE L 1.5MM SCR BONE TI 24MM NONSTRL,$596.25,$0.00,$596.25,$268.31,$425.54,$0.00,$102.73,$0.00,$0.00,$104.40,$596.25,$0.00,$298.13,$472.23,$477.00,$0.00,$93.31,$0.00,$94.92,$0.00
446.508,SUP,HCPCS C1713,,446.508  -  PLATE RIGHT MAXL 3X3 HOLE L 1.5MM SCR BONE TI 26MM NONSTRL,$596.25,$0.00,$596.25,$268.31,$425.54,$0.00,$102.73,$0.00,$0.00,$104.40,$596.25,$0.00,$298.13,$472.23,$477.00,$0.00,$93.31,$0.00,$94.92,$0.00
446.509,SUP,HCPCS C1713,,446.509  -  PLATE LEFT MAXL 3X3 HOLE L 1.5MM SCR BONE TI 26MM NONSTRL,$596.25,$0.00,$596.25,$268.31,$425.54,$0.00,$102.73,$0.00,$0.00,$104.40,$596.25,$0.00,$298.13,$472.23,$477.00,$0.00,$93.31,$0.00,$94.92,$0.00
446.51,SUP,HCPCS C1713,,446.51  -  PLATE BN OB R L NS 2X3 HL RGD TI CRNFCL 1.5MM SCR,$616.50,$0.00,$616.50,$277.43,$440.00,$0.00,$106.22,$0.00,$0.00,$107.94,$616.50,$0.00,$308.25,$488.27,$493.20,$0.00,$96.48,$0.00,$98.15,$0.00
446.515,SUP,HCPCS C1713,,446.515  -  PLATE BONE TEAL 22MM 100D CRANFCL TI 5 HOLE L RIGHT OBLQ,$636.75,$0.00,$636.75,$286.54,$454.45,$0.00,$109.71,$0.00,$0.00,$111.49,$636.75,$0.00,$318.38,$504.31,$509.40,$0.00,$99.65,$0.00,$101.37,$0.00
446.516,SUP,HCPCS C1713,,446.516  -  PLATE BONE TEAL 22MM 100D CRANFCL TI 5 HOLE L LEFT OBLQ,$636.75,$0.00,$636.75,$286.54,$454.45,$0.00,$109.71,$0.00,$0.00,$111.49,$636.75,$0.00,$318.38,$504.31,$509.40,$0.00,$99.65,$0.00,$101.37,$0.00
446.52,SUP,HCPCS C1713,,446.52  -  PLATE BN OB L L 3X4 HL TI CRNFCL 1.5MM SCR,$652.50,$0.00,$652.50,$293.63,$465.69,$0.00,$112.42,$0.00,$0.00,$114.25,$652.50,$0.00,$326.25,$516.78,$522.00,$0.00,$102.12,$0.00,$103.88,$0.00
446.527,SUP,HCPCS C1713,,446.527  -  PLATE BONE TEAL 27MM 100D CRANFCL TI 7 HOLE L LEFT OBLQ,$666.00,$0.00,$666.00,$299.70,$475.32,$0.00,$114.75,$0.00,$0.00,$116.61,$666.00,$0.00,$333.00,$527.47,$532.80,$0.00,$104.23,$0.00,$106.03,$0.00
446.53,SUP,HCPCS C1713,,446.53  -  PLATE BN OB R L NS 3X4 HL RGD TI CRNFCL 1.5MM SCR,$652.50,$0.00,$652.50,$293.63,$465.69,$0.00,$112.42,$0.00,$0.00,$114.25,$652.50,$0.00,$326.25,$516.78,$522.00,$0.00,$102.12,$0.00,$103.88,$0.00
446.537,SUP,HCPCS C1713,,446.537  -  PLATE BONE TEAL 27MM 100D CRANFCL TI 7 HOLE L RIGHT OBLQ,$666.00,$0.00,$666.00,$299.70,$475.32,$0.00,$114.75,$0.00,$0.00,$116.61,$666.00,$0.00,$333.00,$527.47,$532.80,$0.00,$104.23,$0.00,$106.03,$0.00
446.538,SUP,HCPCS C1713,,446.538  -  PLATE BONE TEAL ORBTL RIM TI 8 HOLE MALBLE 1.5MM SCR NONSTRL,$607.50,$0.00,$607.50,$273.38,$433.57,$0.00,$104.67,$0.00,$0.00,$106.37,$607.50,$0.00,$303.75,$481.14,$486.00,$0.00,$95.07,$0.00,$96.71,$0.00
446.54,SUP,HCPCS C1713,,446.540  -  PLATE BONE TEAL ORBTL RIM TI 10 HOLE MALBLE 1.5MM SCR,$641.25,$0.00,$641.25,$288.56,$457.66,$0.00,$110.48,$0.00,$0.00,$112.28,$641.25,$0.00,$320.63,$507.87,$513.00,$0.00,$100.36,$0.00,$102.09,$0.00
446.542,SUP,HCPCS C1713,,446.542  -  PLATE BONE TEAL ORBTL RIM TI 12 HOLE MALBLE 1.5MM SCR,$690.75,$0.00,$690.75,$310.84,$492.99,$0.00,$119.01,$0.00,$0.00,$120.94,$690.75,$0.00,$345.38,$547.07,$552.60,$0.00,$108.10,$0.00,$109.97,$0.00
446.61,SUP,HCPCS C1713,,446.61  -  PLATE BN 36X3.5X.9MM NS 7 HL TI CNDYL LT 1.5MM SCR MDLR HND,$616.50,$0.00,$616.50,$277.43,$440.00,$0.00,$106.22,$0.00,$0.00,$107.94,$616.50,$0.00,$308.25,$488.27,$493.20,$0.00,$96.48,$0.00,$98.15,$0.00
446.611,SUP,HCPCS C1713,,446.611  -  PLATE BONE CRANFCL TI 5 HOLE Y LP 1.5 MM SCR NONSTRL,$616.50,$0.00,$616.50,$277.43,$440.00,$0.00,$106.22,$0.00,$0.00,$107.94,$616.50,$0.00,$308.25,$488.27,$493.20,$0.00,$96.48,$0.00,$98.15,$0.00
446.612,SUP,HCPCS C1713,,446.612  -  PLATE BN Y 46X4X1MM NS PRO-PK 3 HLE/HD 8 HL SHFT LOPRFL,$413.53,$0.00,$413.53,$186.09,$295.13,$0.00,$69.17,$0.00,$0.00,$72.40,$413.53,$0.00,$206.76,$327.52,$330.82,$0.00,$62.83,$0.00,$65.83,$0.00
446.614,SUP,HCPCS C1713,,446.614  -  PLATE BN 2Y 18MM 6 HL TI CRNFCL 1.5MM SCR,$616.50,$0.00,$616.50,$277.43,$440.00,$0.00,$106.22,$0.00,$0.00,$107.94,$616.50,$0.00,$308.25,$488.27,$493.20,$0.00,$96.48,$0.00,$98.15,$0.00
446.615,SUP,HCPCS C1713,,446.615  -  PLATE BN 2Y 21MM 6 HL TI CRNFCL 1.5MM SCR,$616.50,$0.00,$616.50,$277.43,$440.00,$0.00,$106.22,$0.00,$0.00,$107.94,$616.50,$0.00,$308.25,$488.27,$493.20,$0.00,$96.48,$0.00,$98.15,$0.00
446.63,SUP,HCPCS C1713,,446.63  -  PLATE BONE 36X3.5X.9MM 7 HOLE SLFTAP LCP TITANIUM LEFT,$524.08,$0.00,$524.08,$235.83,$374.03,$0.00,$87.66,$0.00,$0.00,$91.76,$524.08,$0.00,$262.04,$415.07,$419.26,$0.00,$79.63,$0.00,$83.43,$0.00
446.64,SUP,HCPCS C1713,,446.64  -  PLATE BONE 36X3.5X.9MM 7 HOLE SLFTAP LCP TITANIUM RIGHT,$524.08,$0.00,$524.08,$235.83,$374.03,$0.00,$87.66,$0.00,$0.00,$91.76,$524.08,$0.00,$262.04,$415.07,$419.26,$0.00,$79.63,$0.00,$83.43,$0.00
446.642,SUP,HCPCS C1713,,446.642  -  PLATE 2MM MAXL 5X3 HOLE T 1.5MM SCR BONE TI NONSTRL,$821.25,$0.00,$821.25,$369.56,$586.13,$0.00,$141.50,$0.00,$0.00,$143.79,$821.25,$0.00,$410.63,$650.43,$657.00,$0.00,$128.53,$0.00,$130.74,$0.00
446.644,SUP,HCPCS C1713,,446.644  -  PLATE 4MM MAXL 5X3 HOLE T 1.5MM SCR BONE TI NONSTRL,$821.25,$0.00,$821.25,$369.56,$586.13,$0.00,$141.50,$0.00,$0.00,$143.79,$821.25,$0.00,$410.63,$650.43,$657.00,$0.00,$128.53,$0.00,$130.74,$0.00
446.646,SUP,HCPCS C1713,,446.646  -  PLATE 6MM MAXL 5X3 HOLE T 1.5MM SCR BONE TI NONSTRL,$821.25,$0.00,$821.25,$369.56,$586.13,$0.00,$141.50,$0.00,$0.00,$143.79,$821.25,$0.00,$410.63,$650.43,$657.00,$0.00,$128.53,$0.00,$130.74,$0.00
446.782,SUP,HCPCS C1713,,446.782  -  PLATE SHRT MAXFACL 2X2 HOLE L RIGHT OBLQ MALBLE 1.5MM SCR,$567.00,$0.00,$567.00,$255.15,$404.67,$0.00,$97.69,$0.00,$0.00,$99.28,$567.00,$0.00,$283.50,$449.06,$453.60,$0.00,$88.74,$0.00,$90.27,$0.00
446.783,SUP,HCPCS C1713,,446.783  -  PLATE SHRT MAXFACL 2X2 HOLE L LEFT OBLQ MALBLE 1.5MM SCR,$567.00,$0.00,$567.00,$255.15,$404.67,$0.00,$97.69,$0.00,$0.00,$99.28,$567.00,$0.00,$283.50,$449.06,$453.60,$0.00,$88.74,$0.00,$90.27,$0.00
446.784,SUP,HCPCS C1713,,446.784  -  PLATE LNG MAXFACL 2X2 HOLE L RIGHT OBLQ MALBLE 1.5MM SCR,$567.00,$0.00,$567.00,$255.15,$404.67,$0.00,$97.69,$0.00,$0.00,$99.28,$567.00,$0.00,$283.50,$449.06,$453.60,$0.00,$88.74,$0.00,$90.27,$0.00
446.785,SUP,HCPCS C1713,,446.785  -  PLATE LNG MAXFACL 2X2 HOLE L LEFT OBLQ MALBLE 1.5MM SCR BONE,$567.00,$0.00,$567.00,$255.15,$404.67,$0.00,$97.69,$0.00,$0.00,$99.28,$567.00,$0.00,$283.50,$449.06,$453.60,$0.00,$88.74,$0.00,$90.27,$0.00
446.786,SUP,HCPCS C1713,,446.786  -  PLATE SHRT RIGHT MAXFACL Z MALBLE 1.5MM SCR BONE TI NONSTRL,$580.50,$0.00,$580.50,$261.23,$414.30,$0.00,$100.02,$0.00,$0.00,$101.64,$580.50,$0.00,$290.25,$459.76,$464.40,$0.00,$90.85,$0.00,$92.42,$0.00
446.787,SUP,HCPCS C1713,,446.787  -  PLATE SHRT LEFT MAXFACL Z MALBLE 1.5MM SCR BONE TI NONSTRL,$580.50,$0.00,$580.50,$261.23,$414.30,$0.00,$100.02,$0.00,$0.00,$101.64,$580.50,$0.00,$290.25,$459.76,$464.40,$0.00,$90.85,$0.00,$92.42,$0.00
446.788,SUP,HCPCS C1713,,446.788  -  PLATE LNG RIGHT MAXFACL Z MALBLE 1.5MM SCR BONE TI NONSTRL,$580.50,$0.00,$580.50,$261.23,$414.30,$0.00,$100.02,$0.00,$0.00,$101.64,$580.50,$0.00,$290.25,$459.76,$464.40,$0.00,$90.85,$0.00,$92.42,$0.00
446.789,SUP,HCPCS C1713,,446.789  -  PLATE LNG LEFT MAXFACL Z MALBLE 1.5MM SCR BONE TI NONSTRL,$580.50,$0.00,$580.50,$261.23,$414.30,$0.00,$100.02,$0.00,$0.00,$101.64,$580.50,$0.00,$290.25,$459.76,$464.40,$0.00,$90.85,$0.00,$92.42,$0.00
446.792,SUP,HCPCS C1713,,446.792  -  PLATE SHRT TI 1.5MM SCR L OBLQ 2X2 HOLE BONE RIGHT NONSTRL,$567.00,$0.00,$567.00,$255.15,$404.67,$0.00,$97.69,$0.00,$0.00,$99.28,$567.00,$0.00,$283.50,$449.06,$453.60,$0.00,$88.74,$0.00,$90.27,$0.00
446.793,SUP,HCPCS C1713,,446.793  -  PLATE SHRT 1.5MM TI 1.5MM SCR L OBLQ 2X2 HOLE BONE LEFT,$567.00,$0.00,$567.00,$255.15,$404.67,$0.00,$97.69,$0.00,$0.00,$99.28,$567.00,$0.00,$283.50,$449.06,$453.60,$0.00,$88.74,$0.00,$90.27,$0.00
446.794,SUP,HCPCS C1713,,446.794  -  PLATE 1.5MM TI 1.5MM SCR 2X2 HOLE L RIGHT OBLQ BONE NONSTRL,$567.00,$0.00,$567.00,$255.15,$404.67,$0.00,$97.69,$0.00,$0.00,$99.28,$567.00,$0.00,$283.50,$449.06,$453.60,$0.00,$88.74,$0.00,$90.27,$0.00
446.795,SUP,HCPCS C1713,,446.795  -  PLATE TI 1.5 MM SCR 2X2 HOLE L LEFT OBLQ BONE NONSTRL,$567.00,$0.00,$567.00,$255.15,$404.67,$0.00,$97.69,$0.00,$0.00,$99.28,$567.00,$0.00,$283.50,$449.06,$453.60,$0.00,$88.74,$0.00,$90.27,$0.00
446.796,SUP,HCPCS C1713,,446.796  -  PLATE SHRT TI 1.5MM SCR Z BONE RIGHT NONSTRL,$654.75,$0.00,$654.75,$294.64,$467.30,$0.00,$112.81,$0.00,$0.00,$114.64,$654.75,$0.00,$327.38,$518.56,$523.80,$0.00,$102.47,$0.00,$104.24,$0.00
446.797,SUP,HCPCS C1713,,446.797  -  PLATE SHRT TI 1.5MM SCR Z BONE LEFT NONSTRL,$654.75,$0.00,$654.75,$294.64,$467.30,$0.00,$112.81,$0.00,$0.00,$114.64,$654.75,$0.00,$327.38,$518.56,$523.80,$0.00,$102.47,$0.00,$104.24,$0.00
446.798,SUP,HCPCS C1713,,446.798  -  PLATE LNG TI 1.5MM SCR Z BONE RIGHT NONSTRL,$654.75,$0.00,$654.75,$294.64,$467.30,$0.00,$112.81,$0.00,$0.00,$114.64,$654.75,$0.00,$327.38,$518.56,$523.80,$0.00,$102.47,$0.00,$104.24,$0.00
446.799,SUP,HCPCS C1713,,446.799  -  PLATE LNG TI 1.5MM SCR Z BONE LEFT NONSTRL,$654.75,$0.00,$654.75,$294.64,$467.30,$0.00,$112.81,$0.00,$0.00,$114.64,$654.75,$0.00,$327.38,$518.56,$523.80,$0.00,$102.47,$0.00,$104.24,$0.00
446.81,SUP,HCPCS C1713,,446.81  -  PLATE BONE CRNMXF TI 4 HOLE X 1.5 MM SCR NONSTRL,$616.50,$0.00,$616.50,$277.43,$440.00,$0.00,$106.22,$0.00,$0.00,$107.94,$616.50,$0.00,$308.25,$488.27,$493.20,$0.00,$96.48,$0.00,$98.15,$0.00
446.811,SUP,HCPCS C1713,,446.811  -  PLATE BONE CRANFCL TI 4 HOLE X LP 1.5 MM SCR NONSTRL,$616.50,$0.00,$616.50,$277.43,$440.00,$0.00,$106.22,$0.00,$0.00,$107.94,$616.50,$0.00,$308.25,$488.27,$493.20,$0.00,$96.48,$0.00,$98.15,$0.00
446.9,SUP,HCPCS C1713,,446.900  -  PLATE BONE 12MM CRANFCL TI 6 HOLE 1.5MM SCR NONSTRL,$573.75,$0.00,$573.75,$258.19,$409.49,$0.00,$98.85,$0.00,$0.00,$100.46,$573.75,$0.00,$286.88,$454.41,$459.00,$0.00,$89.79,$0.00,$91.34,$0.00
446.901,SUP,Custom 27803010,,446.901  -  COVER BUR HOLE 15MM CRANFCL TI 6 HOLE 1.5MM SCR NONSTRL,$573.75,$0.00,$573.75,$0.00,$409.49,$0.00,$0.00,$0.00,$0.00,$0.00,$573.75,$0.00,$286.88,$454.41,$459.00,$0.00,$0.00,$0.00,$0.00,$0.00
446.902,SUP,Custom 27803010,,446.902  -  COVER BUR HOLE 24MM CRANFCL TI 6 HOLE 1.5MM SCR NONSTRL,$573.75,$0.00,$573.75,$0.00,$409.49,$0.00,$0.00,$0.00,$0.00,$0.00,$573.75,$0.00,$286.88,$454.41,$459.00,$0.00,$0.00,$0.00,$0.00,$0.00
446.91,SUP,Custom 27803010,,446.91  -  COVER BUR HOLE 17MM CRANFCL TI 6 HOLE 1.5MM SCR NONSTRL,$573.75,$0.00,$573.75,$0.00,$409.49,$0.00,$0.00,$0.00,$0.00,$0.00,$573.75,$0.00,$286.88,$454.41,$459.00,$0.00,$0.00,$0.00,$0.00,$0.00
446.911,SUP,Custom 27803010,,446.911  -  CLIP CRNL SPRG TI LT 1.5 MM BUR HL,$567.00,$0.00,$567.00,$0.00,$404.67,$0.00,$0.00,$0.00,$0.00,$0.00,$567.00,$0.00,$283.50,$449.06,$453.60,$0.00,$0.00,$0.00,$0.00,$0.00
446.912,SUP,Custom 27803010,,446.912  -  CLIP CRNL SPRG TI RT 1.5 MM BUR HL,$567.00,$0.00,$567.00,$0.00,$404.67,$0.00,$0.00,$0.00,$0.00,$0.00,$567.00,$0.00,$283.50,$449.06,$453.60,$0.00,$0.00,$0.00,$0.00,$0.00
446.913,SUP,Custom 27803010,,446.913  -  CLIP CRNL SPRG TI 1.5 MM BUR HL,$436.50,$0.00,$436.50,$0.00,$311.53,$0.00,$0.00,$0.00,$0.00,$0.00,$436.50,$0.00,$218.25,$345.71,$349.20,$0.00,$0.00,$0.00,$0.00,$0.00
446.916,SUP,HCPCS C1713,,446.916  -  PLATE BONE 16X10MM CRANFCL TI 4 HOLE 1.5MM SCR NONSTRL,$533.25,$0.00,$533.25,$239.96,$380.58,$0.00,$91.88,$0.00,$0.00,$93.37,$533.25,$0.00,$266.63,$422.33,$426.60,$0.00,$83.45,$0.00,$84.89,$0.00
446.917,SUP,HCPCS C1713,,446.917  -  PLATE CHIN 2 BND 1.5MM SCR BONE TI 4MM NONSTRL,$794.25,$0.00,$794.25,$357.41,$566.86,$0.00,$136.85,$0.00,$0.00,$139.07,$794.25,$0.00,$397.13,$629.05,$635.40,$0.00,$124.30,$0.00,$126.44,$0.00
446.918,SUP,HCPCS C1713,,446.918  -  PLATE CHIN 2 BND 1.5MM SCR BONE TI 6MM NONSTRL,$794.25,$0.00,$794.25,$357.41,$566.86,$0.00,$136.85,$0.00,$0.00,$139.07,$794.25,$0.00,$397.13,$629.05,$635.40,$0.00,$124.30,$0.00,$126.44,$0.00
446.919,SUP,HCPCS C1713,,446.919  -  PLATE CHIN 2 BND 1.5MM SCR BONE TI 8MM NONSTRL,$794.25,$0.00,$794.25,$357.41,$566.86,$0.00,$136.85,$0.00,$0.00,$139.07,$794.25,$0.00,$397.13,$629.05,$635.40,$0.00,$124.30,$0.00,$126.44,$0.00
446.92,SUP,HCPCS C1713,,446.920  -  PLATE CHIN 2 BND 1.5MM SCR BONE TI 10MM NONSTRL,$794.25,$0.00,$794.25,$357.41,$566.86,$0.00,$136.85,$0.00,$0.00,$139.07,$794.25,$0.00,$397.13,$629.05,$635.40,$0.00,$124.30,$0.00,$126.44,$0.00
446.923,SUP,Custom 27803010,,446.923  -  COVER BUR HOLE 15MM CRANIAL TI 5 HOLE SHNT 1.5MM SCR NONSTRL,$573.75,$0.00,$573.75,$0.00,$409.49,$0.00,$0.00,$0.00,$0.00,$0.00,$573.75,$0.00,$286.88,$454.41,$459.00,$0.00,$0.00,$0.00,$0.00,$0.00
447.007,SUP,Custom 27803010,,447.007  -  FTPLT BONE ZYG TI 3 HOLE NONSTRL,$499.50,$0.00,$499.50,$0.00,$356.49,$0.00,$0.00,$0.00,$0.00,$0.00,$499.50,$0.00,$249.75,$395.60,$399.60,$0.00,$0.00,$0.00,$0.00,$0.00
447.008,SUP,HCPCS C1713,,447.008  -  PLATE 6MM MAXFACL 6 HOLE CVD LP BONE NONSTRL,$726.75,$0.00,$726.75,$327.04,$518.68,$0.00,$125.22,$0.00,$0.00,$127.25,$726.75,$0.00,$363.38,$575.59,$581.40,$0.00,$113.74,$0.00,$115.70,$0.00
447.009,SUP,HCPCS C1713,,447.009  -  PLATE 10MM TI 2MM SCR 6 HOLE SGTL SPLT CVD LP BONE NONSTRL,$726.75,$0.00,$726.75,$327.04,$518.68,$0.00,$125.22,$0.00,$0.00,$127.25,$726.75,$0.00,$363.38,$575.59,$581.40,$0.00,$113.74,$0.00,$115.70,$0.00
447.01,SUP,HCPCS C1713,,447.010  -  PLATE MAXFACL 6 HOLE CVD SGTL SPLT 2MM SCR BONE TI 6MM,$726.75,$0.00,$726.75,$327.04,$518.68,$0.00,$125.22,$0.00,$0.00,$127.25,$726.75,$0.00,$363.38,$575.59,$581.40,$0.00,$113.74,$0.00,$115.70,$0.00
447.011,SUP,HCPCS C1713,,447.011  -  PLATE MAXFACL 6 HOLE CVD SGTL SPLT 2MM SCR BONE TI 10MM,$726.75,$0.00,$726.75,$327.04,$518.68,$0.00,$125.22,$0.00,$0.00,$127.25,$726.75,$0.00,$363.38,$575.59,$581.40,$0.00,$113.74,$0.00,$115.70,$0.00
447.013,SUP,HCPCS C1713,,447.013  -  PLATE BONE 65MM CRANFCL TI 13 HOLE ADP 2MM SCR NONSTRL,$805.50,$0.00,$805.50,$362.48,$574.89,$0.00,$138.78,$0.00,$0.00,$141.04,$805.50,$0.00,$402.75,$637.96,$644.40,$0.00,$126.06,$0.00,$128.24,$0.00
447.03,SUP,HCPCS C1713,,447.030  -  PLATE 14MM MAXFACL 6 HOLE CVD 2MM SCR BILAT SGTL SPLT OSTMY,$783.00,$0.00,$783.00,$352.35,$558.83,$0.00,$134.91,$0.00,$0.00,$137.10,$783.00,$0.00,$391.50,$620.14,$626.40,$0.00,$122.54,$0.00,$124.65,$0.00
447.031,SUP,HCPCS C1713,,447.031  -  PLATE BN STRG 35X5X1.2MM NS PRO-PK 6 HL LOPRFL PRECONTOUR,$393.05,$0.00,$393.05,$176.87,$280.52,$0.00,$65.75,$0.00,$0.00,$68.82,$393.05,$0.00,$196.53,$311.30,$314.44,$0.00,$59.72,$0.00,$62.57,$0.00
447.032,SUP,HCPCS C1713,,447.032  -  PLATE BN STRG 71X5X1.2MM NS PRO-PK 12 HL LOPRFL PRECONTOUR,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
447.033,SUP,HCPCS C1713,,447.033  -  PLATE 2MM 4MM MAXFACL 6 HOLE BAR CVD LP SGTL SPLT 2MM SCR,$783.00,$0.00,$783.00,$352.35,$558.83,$0.00,$134.91,$0.00,$0.00,$137.10,$783.00,$0.00,$391.50,$620.14,$626.40,$0.00,$122.54,$0.00,$124.65,$0.00
447.034,SUP,HCPCS C1713,,447.034  -  PLATE 8MM MAXFACL 6 HOLE CVD LP 2MM SCR BILAT SGTL SPLT,$783.00,$0.00,$783.00,$352.35,$558.83,$0.00,$134.91,$0.00,$0.00,$137.10,$783.00,$0.00,$391.50,$620.14,$626.40,$0.00,$122.54,$0.00,$124.65,$0.00
447.035,SUP,HCPCS C1713,,447.035  -  PLATE BN CRV 4MMX1.25MM NS 6 HL SGTL SPLT TI CRNFCL 2MM SCR,$783.00,$0.00,$783.00,$352.35,$558.83,$0.00,$134.91,$0.00,$0.00,$137.10,$783.00,$0.00,$391.50,$620.14,$626.40,$0.00,$122.54,$0.00,$124.65,$0.00
447.036,SUP,HCPCS C1713,,447.036  -  PLATE BN CRV 12MMX1.25MM NS 6 HL SGTL SPLT TI CRNFCL 2MM SCR,$783.00,$0.00,$783.00,$352.35,$558.83,$0.00,$134.91,$0.00,$0.00,$137.10,$783.00,$0.00,$391.50,$620.14,$626.40,$0.00,$122.54,$0.00,$124.65,$0.00
447.037,SUP,HCPCS C1713,,447.037  -  PLATE 12MM MAXFACL 6 HOLE CVD LP 2MM SCR BILAT SGTL SPLT,$783.00,$0.00,$783.00,$352.35,$558.83,$0.00,$134.91,$0.00,$0.00,$137.10,$783.00,$0.00,$391.50,$620.14,$626.40,$0.00,$122.54,$0.00,$124.65,$0.00
447.038,SUP,HCPCS C1713,,447.038  -  PLATE BN CRV 8MMX1.25MM NS 6 HL SGTL SPLT TI CRNFCL 2MM SCR,$783.00,$0.00,$783.00,$352.35,$558.83,$0.00,$134.91,$0.00,$0.00,$137.10,$783.00,$0.00,$391.50,$620.14,$626.40,$0.00,$122.54,$0.00,$124.65,$0.00
447.039,SUP,HCPCS C1713,,447.039  -  PLATE 16MM MAXFACL 6 HOLE CVD 2MM SCR BILAT SGTL SPLT OSTMY,$783.00,$0.00,$783.00,$352.35,$558.83,$0.00,$134.91,$0.00,$0.00,$137.10,$783.00,$0.00,$391.50,$620.14,$626.40,$0.00,$122.54,$0.00,$124.65,$0.00
447.04,SUP,HCPCS C1713,,447.040  -  PLATE 25MM MAXL RIGHT 3X3 HOLE L 2MM SCR BONE TI NONSTRL,$515.25,$0.00,$515.25,$231.86,$367.73,$0.00,$88.77,$0.00,$0.00,$90.22,$515.25,$0.00,$257.63,$408.08,$412.20,$0.00,$80.64,$0.00,$82.03,$0.00
447.041,SUP,HCPCS C1713,,447.041  -  PLATE BN L 25X4.8X.9MM NS 15MM 3 HL SHFT 3 HL BS TI MXL LT 2,$515.25,$0.00,$515.25,$231.86,$367.73,$0.00,$88.77,$0.00,$0.00,$90.22,$515.25,$0.00,$257.63,$408.08,$412.20,$0.00,$80.64,$0.00,$82.03,$0.00
447.042,SUP,HCPCS C1713,,447.042  -  PLATE RIGHT MAXL 3X3 HOLE L 2MM SCR BONE TI 27MM NONSTRL,$515.25,$0.00,$515.25,$231.86,$367.73,$0.00,$88.77,$0.00,$0.00,$90.22,$515.25,$0.00,$257.63,$408.08,$412.20,$0.00,$80.64,$0.00,$82.03,$0.00
447.043,SUP,HCPCS C1713,,447.043  -  PLATE LEFT MAXL 3X3 HOLE L 2MM SCR BONE TI 27MM NONSTRL,$515.25,$0.00,$515.25,$231.86,$367.73,$0.00,$88.77,$0.00,$0.00,$90.22,$515.25,$0.00,$257.63,$408.08,$412.20,$0.00,$80.64,$0.00,$82.03,$0.00
447.044,SUP,HCPCS C1713,,447.044  -  PLATE RIGHT MAXL 3X3 HOLE L 2MM SCR BONE TI 29MM NONSTRL,$515.25,$0.00,$515.25,$231.86,$367.73,$0.00,$88.77,$0.00,$0.00,$90.22,$515.25,$0.00,$257.63,$408.08,$412.20,$0.00,$80.64,$0.00,$82.03,$0.00
447.045,SUP,HCPCS C1713,,447.045  -  PLATE LEFT MAXL 3X3 HOLE L 2MM SCR BONE TI 29MM NONSTRL,$515.25,$0.00,$515.25,$231.86,$367.73,$0.00,$88.77,$0.00,$0.00,$90.22,$515.25,$0.00,$257.63,$408.08,$412.20,$0.00,$80.64,$0.00,$82.03,$0.00
447.046,SUP,HCPCS C1713,,447.046  -  PLATE BN MN NAR 4.8X1MM 4 HL LCK MLBL TI MNDB 2MM SCR,$843.75,$0.00,$843.75,$379.69,$602.18,$0.00,$145.37,$0.00,$0.00,$147.73,$843.75,$0.00,$421.88,$668.25,$675.00,$0.00,$132.05,$0.00,$134.33,$0.00
447.047,SUP,HCPCS C1713,,447.047  -  PLATE BN MN NAR 4.8X1MM 6 HL LCK MLBL TI MNDB 2MM SCR,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
447.048,SUP,HCPCS C1713,,447.048  -  PLATE BN MN NAR 4.8X1MM 4 HL LCK MLBL TI MNDB 2MM SCR,$843.75,$0.00,$843.75,$379.69,$602.18,$0.00,$145.37,$0.00,$0.00,$147.73,$843.75,$0.00,$421.88,$668.25,$675.00,$0.00,$132.05,$0.00,$134.33,$0.00
447.049,SUP,HCPCS C1713,,447.049  -  PLATE BN MN NAR 4.8X1MM 6 HL LCK TI MNDB 2MM SCR,$918.00,$0.00,$918.00,$413.10,$655.18,$0.00,$158.17,$0.00,$0.00,$160.73,$918.00,$0.00,$459.00,$727.06,$734.40,$0.00,$143.67,$0.00,$146.15,$0.00
447.05,SUP,HCPCS C1713,,447.050  -  PLATE MINI 1MM MANDIB 12 HOLE LCK ADP 2MM SCR BONE TI,"$1,500.75",$0.00,"$1,500.75",$675.34,"$1,071.09",$0.00,$258.57,$0.00,$0.00,$262.77,"$1,500.75",$0.00,$750.38,"$1,188.59","$1,200.60",$0.00,$234.87,$0.00,$238.92,$0.00
447.051,SUP,HCPCS C1713,,447.051  -  PLATE BN MN 4.8X1MM 20 HL LCK ADP TI MNDB 2MM SCR,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
447.053,SUP,HCPCS C1713,,447.053  -  PLATE BN MN 4.8X1MM 4 HL LCK TNSNBND TI MNDB 2MM SCR,"$1,055.25",$0.00,"$1,055.25",$474.86,$753.13,$0.00,$181.81,$0.00,$0.00,$184.77,"$1,055.25",$0.00,$527.63,$835.76,$844.20,$0.00,$165.15,$0.00,$168.00,$0.00
447.055,SUP,HCPCS C1713,,447.055  -  PLATE BN MN BRD 4.8X1.3MM 4 HL LCK TI MNDB 2MM SCR,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
447.057,SUP,HCPCS C1713,,447.057  -  PLATE BN MN BRD CRV 4.8X1.3MM 4 HL LCK TI MNDB 2MM SCR,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
447.07,SUP,HCPCS C1713,,447.070  -  PLATE SM 15MMX.9MM TI 2MM SCR 4 HOLE STR OFFST PURE BONE 3MM,$571.50,$0.00,$571.50,$257.18,$407.88,$0.00,$98.47,$0.00,$0.00,$100.07,$571.50,$0.00,$285.75,$452.63,$457.20,$0.00,$89.44,$0.00,$90.98,$0.00
447.071,SUP,HCPCS C1713,,447.071  -  PLATE CHIN 4 HOLE STR 2MM SCR BONE TI 5MM NONSTRL,$600.75,$0.00,$600.75,$270.34,$428.76,$0.00,$103.51,$0.00,$0.00,$105.19,$600.75,$0.00,$300.38,$475.79,$480.60,$0.00,$94.02,$0.00,$95.64,$0.00
447.072,SUP,HCPCS C1713,,447.072  -  PLATE CHIN 4 HOLE STR 2MM SCR BONE TI 8MM NONSTRL,$632.25,$0.00,$632.25,$284.51,$451.24,$0.00,$108.93,$0.00,$0.00,$110.70,$632.25,$0.00,$316.13,$500.74,$505.80,$0.00,$98.95,$0.00,$100.65,$0.00
447.073,SUP,HCPCS C1713,,447.073  -  PLATE CHIN 5 HOLE 2 BND 2MM SCR BONE TI 4MM NONSTRL,$708.75,$0.00,$708.75,$318.94,$505.83,$0.00,$122.11,$0.00,$0.00,$124.10,$708.75,$0.00,$354.38,$561.33,$567.00,$0.00,$110.92,$0.00,$112.83,$0.00
447.074,SUP,HCPCS C1713,,447.074  -  PLATE 6MM CHIN 5 HOLE 2 BND 2MM SCR BONE TI NONSTRL,$708.75,$0.00,$708.75,$318.94,$505.83,$0.00,$122.11,$0.00,$0.00,$124.10,$708.75,$0.00,$354.38,$561.33,$567.00,$0.00,$110.92,$0.00,$112.83,$0.00
447.075,SUP,HCPCS C1713,,447.075  -  PLATE CHIN 5 HOLE 2 BND 2MM SCR BONE TI 8MM NONSTRL,$747.00,$0.00,$747.00,$336.15,$533.13,$0.00,$128.70,$0.00,$0.00,$130.79,$747.00,$0.00,$373.50,$591.62,$597.60,$0.00,$116.91,$0.00,$118.92,$0.00
447.076,SUP,HCPCS C1713,,447.076  -  PLATE CHIN 5 HOLE 2 BND 2MM SCR BONE TI 10MM NONSTRL,$747.00,$0.00,$747.00,$336.15,$533.13,$0.00,$128.70,$0.00,$0.00,$130.79,$747.00,$0.00,$373.50,$591.62,$597.60,$0.00,$116.91,$0.00,$118.92,$0.00
447.077,SUP,HCPCS C1713,,447.077  -  PLATE CHIN 5 HOLE 1 BND 2MM SCR BONE TI 3-5MM NONSTRL,$708.75,$0.00,$708.75,$318.94,$505.83,$0.00,$122.11,$0.00,$0.00,$124.10,$708.75,$0.00,$354.38,$561.33,$567.00,$0.00,$110.92,$0.00,$112.83,$0.00
447.078,SUP,HCPCS C1713,,447.078  -  PLATE CHIN 5 HOLE 1 BND 2MM SCR BONE TI 6-8MM NONSTRL,$708.75,$0.00,$708.75,$318.94,$505.83,$0.00,$122.11,$0.00,$0.00,$124.10,$708.75,$0.00,$354.38,$561.33,$567.00,$0.00,$110.92,$0.00,$112.83,$0.00
447.079,SUP,HCPCS C1713,,447.079  -  PLATE CHIN 5 HOLE 1 BND 2MM SCR BONE TI 9-11MM NONSTRL,$708.75,$0.00,$708.75,$318.94,$505.83,$0.00,$122.11,$0.00,$0.00,$124.10,$708.75,$0.00,$354.38,$561.33,$567.00,$0.00,$110.92,$0.00,$112.83,$0.00
447.082,SUP,HCPCS C1713,,447.082  -  PLATE MAXFACL 8 HOLE STRUT 2 MM SCR BILAT SGTL SPLT OSTMY,$942.75,$0.00,$942.75,$424.24,$672.84,$0.00,$162.43,$0.00,$0.00,$165.07,$942.75,$0.00,$471.38,$746.66,$754.20,$0.00,$147.54,$0.00,$150.09,$0.00
447.083,SUP,HCPCS C1713,,447.083  -  PLATE -90D 38MM MAXFACL 10 HOLE CVD SGTL SPLT CURVE 2MM SCR,$828.00,$0.00,$828.00,$372.60,$590.94,$0.00,$142.66,$0.00,$0.00,$144.98,$828.00,$0.00,$414.00,$655.78,$662.40,$0.00,$129.58,$0.00,$131.82,$0.00
447.084,SUP,HCPCS C1713,,447.084  -  PLATE 30MM MAXFACL 4 HOLE STR 2MM SCR BILAT SGTL SPLT OSTMY,$828.00,$0.00,$828.00,$372.60,$590.94,$0.00,$142.66,$0.00,$0.00,$144.98,$828.00,$0.00,$414.00,$655.78,$662.40,$0.00,$129.58,$0.00,$131.82,$0.00
447.088,SUP,HCPCS C1713,,447.088  -  PLATE MAXFACL 8 HOLE CVD 2 MM SCR BILAT SGTL SPLT OSTMY BONE,$828.00,$0.00,$828.00,$372.60,$590.94,$0.00,$142.66,$0.00,$0.00,$144.98,$828.00,$0.00,$414.00,$655.78,$662.40,$0.00,$129.58,$0.00,$131.82,$0.00
447.1,SUP,HCPCS C1713,,447.10  -  PLATE 100MM MIDFAC 20 HOLE ADOPTION 2MM SCR BONE TI NONSTRL,"$1,059.75",$0.00,"$1,059.75",$476.89,$756.34,$0.00,$182.59,$0.00,$0.00,$185.55,"$1,059.75",$0.00,$529.88,$839.32,$847.80,$0.00,$165.85,$0.00,$168.71,$0.00
447.101,SUP,HCPCS C1713,,447.101  -  PLATE MANDIB 6 HOLE INTMD LCK 2 MM SCR BONE TI NONSTRL,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
447.102,SUP,HCPCS C1713,,447.102  -  PLATE MANDIB 12 HOLE INTMD LCK 2 MM SCR BONE TI NONSTRL,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
447.103,SUP,HCPCS C1713,,447.103  -  PLATE LG MANDIB 3X3 HOLE LCK STR 2MM SCR BONE TI NONSTRL,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
447.104,SUP,HCPCS C1713,,447.104  -  PLATE LG MANDIB 6 HOLE LCK STR 2MM SCR BONE TI NONSTRL,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
447.105,SUP,HCPCS C1713,,447.105  -  PLATE BN 8MM SPC LG 95X6.5X1.5MM NS 12 HL LCK LOPRFL TI MNDB,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
447.106,SUP,HCPCS C1713,,447.106  -  PLATE LG MANDIB 20 HOLE LCK STR 2MM SCR BONE TI NONSTRL,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
447.108,SUP,HCPCS C1713,,447.108  -  PLATE LG MANDIB 6X21 HOLE LCK RIGHT ANG 2MM SCR BONE TI,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
447.109,SUP,HCPCS C1713,,447.109  -  PLATE LG MANDIB 6X21 HOLE LCK LEFT ANG 2MM SCR BONE TI,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
447.114,SUP,HCPCS C1713,,447.114  -  PLATE 33MM MAXFACL 4 HOLE ADJ SLDR 2MM SCR BILAT SGTL SPLT,"$1,064.25",$0.00,"$1,064.25",$478.91,$759.56,$0.00,$183.36,$0.00,$0.00,$186.34,"$1,064.25",$0.00,$532.13,$842.89,$851.40,$0.00,$166.56,$0.00,$169.43,$0.00
447.116,SUP,HCPCS C1713,,447.116  -  PLATE 40MM MAXFACL 4 HOLE ADJ SLDR 2MM SCR BILAT SGTL SPLT,"$1,064.25",$0.00,"$1,064.25",$478.91,$759.56,$0.00,$183.36,$0.00,$0.00,$186.34,"$1,064.25",$0.00,$532.13,$842.89,$851.40,$0.00,$166.56,$0.00,$169.43,$0.00
447.117,SUP,HCPCS C1713,,447.117  -  PLATE LG MANDIB 3X3 HOLE LCK CRSNT 2MM SCR BONE TI NONSTRL,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
447.118,SUP,HCPCS C1713,,447.118  -  PLATE LG MANDIB 3X3 HOLE LCK ANG 2MM SCR BONE TI NONSTRL,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
447.119,SUP,HCPCS C1713,,447.119  -  PLATE LG MANDIB 4X4 HOLE LCK ANG 2MM SCR BONE TI NONSTRL,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
447.14,SUP,HCPCS C1713,,447.140  -  PLATE BONE 24MM CRANFCL TI 3X3 HOLE T 2MM SCR NONSTRL,$549.00,$0.00,$549.00,$247.05,$391.82,$0.00,$94.59,$0.00,$0.00,$96.13,$549.00,$0.00,$274.50,$434.81,$439.20,$0.00,$85.92,$0.00,$87.40,$0.00
447.141,SUP,HCPCS C1713,,447.141  -  PLATE CHIN 4 HOLE 2 BND 2MM SCR BONE TI 4MM NONSTRL,$618.75,$0.00,$618.75,$278.44,$441.60,$0.00,$106.61,$0.00,$0.00,$108.34,$618.75,$0.00,$309.38,$490.05,$495.00,$0.00,$96.83,$0.00,$98.51,$0.00
447.142,SUP,HCPCS C1713,,447.142  -  PLATE CHIN 4 HOLE 2 BND 2MM SCR BONE TI 6MM NONSTRL,$618.75,$0.00,$618.75,$278.44,$441.60,$0.00,$106.61,$0.00,$0.00,$108.34,$618.75,$0.00,$309.38,$490.05,$495.00,$0.00,$96.83,$0.00,$98.51,$0.00
447.143,SUP,HCPCS C1713,,447.143  -  PLATE CHIN 4 HOLE 2 BND 2MM SCR BONE TI 8MM NONSTRL,$618.75,$0.00,$618.75,$278.44,$441.60,$0.00,$106.61,$0.00,$0.00,$108.34,$618.75,$0.00,$309.38,$490.05,$495.00,$0.00,$96.83,$0.00,$98.51,$0.00
447.144,SUP,HCPCS C1713,,447.144  -  PLATE CHIN 4 HOLE 2 BND 2MM SCR BONE TI 10MM NONSTRL,$618.75,$0.00,$618.75,$278.44,$441.60,$0.00,$106.61,$0.00,$0.00,$108.34,$618.75,$0.00,$309.38,$490.05,$495.00,$0.00,$96.83,$0.00,$98.51,$0.00
447.145,SUP,HCPCS C1713,,447.145  -  PLATE CHIN 4 HOLE 2 BND 2MM SCR BONE TI 12MM NONSTRL,$618.75,$0.00,$618.75,$278.44,$441.60,$0.00,$106.61,$0.00,$0.00,$108.34,$618.75,$0.00,$309.38,$490.05,$495.00,$0.00,$96.83,$0.00,$98.51,$0.00
447.146,SUP,HCPCS C1713,,447.146  -  PLATE CHIN 4 HOLE 2 BND 2MM SCR BONE TI 6MM NONSTRL,$677.25,$0.00,$677.25,$304.76,$483.35,$0.00,$116.69,$0.00,$0.00,$118.58,$677.25,$0.00,$338.63,$536.38,$541.80,$0.00,$105.99,$0.00,$107.82,$0.00
447.147,SUP,HCPCS C1713,,447.147  -  PLATE CHIN 4 HOLE 2 BND 2MM SCR BONE TI 6MM NONSTRL,$677.25,$0.00,$677.25,$304.76,$483.35,$0.00,$116.69,$0.00,$0.00,$118.58,$677.25,$0.00,$338.63,$536.38,$541.80,$0.00,$105.99,$0.00,$107.82,$0.00
447.148,SUP,HCPCS C1713,,447.148  -  PLATE CHIN 4 HOLE 2 BND 2MM SCR BONE TI 8MM NONSTRL,$677.25,$0.00,$677.25,$304.76,$483.35,$0.00,$116.69,$0.00,$0.00,$118.58,$677.25,$0.00,$338.63,$536.38,$541.80,$0.00,$105.99,$0.00,$107.82,$0.00
447.149,SUP,HCPCS C1713,,447.149  -  PLATE CHIN 4 HOLE 2 BND 2MM SCR BONE TI 8MM NONSTRL,$677.25,$0.00,$677.25,$304.76,$483.35,$0.00,$116.69,$0.00,$0.00,$118.58,$677.25,$0.00,$338.63,$536.38,$541.80,$0.00,$105.99,$0.00,$107.82,$0.00
447.15,SUP,HCPCS C1713,,447.150  -  PLATE RIGHT CHIN 4 HOLE 2 BND 2MM SCR BONE TI 10MM NONSTRL,$677.25,$0.00,$677.25,$304.76,$483.35,$0.00,$116.69,$0.00,$0.00,$118.58,$677.25,$0.00,$338.63,$536.38,$541.80,$0.00,$105.99,$0.00,$107.82,$0.00
447.151,SUP,HCPCS C1713,,447.151  -  PLATE LEFT CHIN 4 HOLE 2 BND 2MM SCR BONE TI 10MM NONSTRL,$677.25,$0.00,$677.25,$304.76,$483.35,$0.00,$116.69,$0.00,$0.00,$118.58,$677.25,$0.00,$338.63,$536.38,$541.80,$0.00,$105.99,$0.00,$107.82,$0.00
447.152,SUP,HCPCS C1713,,447.152  -  PLATE BONE 24MM CRANFCL TI 4 HOLE STR 2MM SCR NONSTRL,$612.00,$0.00,$612.00,$275.40,$436.78,$0.00,$105.44,$0.00,$0.00,$107.16,$612.00,$0.00,$306.00,$484.70,$489.60,$0.00,$95.78,$0.00,$97.43,$0.00
447.153,SUP,HCPCS C1713,,447.153  -  PLATE BONE 30MM CRANFCL TI 4 HOLE STR 2MM SCR NONSTRL,$612.00,$0.00,$612.00,$275.40,$436.78,$0.00,$105.44,$0.00,$0.00,$107.16,$612.00,$0.00,$306.00,$484.70,$489.60,$0.00,$95.78,$0.00,$97.43,$0.00
447.154,SUP,HCPCS C1713,,447.154  -  PLATE BONE 17MM 90D RIGHT CRNMXF TI 2X2 HOLE L LP 2MM SCR,$517.50,$0.00,$517.50,$232.88,$369.34,$0.00,$89.16,$0.00,$0.00,$90.61,$517.50,$0.00,$258.75,$409.86,$414.00,$0.00,$80.99,$0.00,$82.39,$0.00
447.155,SUP,HCPCS C1713,,447.155  -  PLATE BONE 17MM 90D LEFT CRNMXF TI 2X2 HOLE L LP 2MM SCR,$517.50,$0.00,$517.50,$232.88,$369.34,$0.00,$89.16,$0.00,$0.00,$90.61,$517.50,$0.00,$258.75,$409.86,$414.00,$0.00,$80.99,$0.00,$82.39,$0.00
447.156,SUP,HCPCS C1713,,447.156  -  PLATE BONE 19MM 90D RIGHT CRNMXF TI 2X2 HOLE L LP 2MM SCR,$517.50,$0.00,$517.50,$232.88,$369.34,$0.00,$89.16,$0.00,$0.00,$90.61,$517.50,$0.00,$258.75,$409.86,$414.00,$0.00,$80.99,$0.00,$82.39,$0.00
447.157,SUP,HCPCS C1713,,447.157  -  PLATE BONE 19MM 90D LEFT CRNMXF TI 2X2 HOLE L LP 2MM SCR,$517.50,$0.00,$517.50,$232.88,$369.34,$0.00,$89.16,$0.00,$0.00,$90.61,$517.50,$0.00,$258.75,$409.86,$414.00,$0.00,$80.99,$0.00,$82.39,$0.00
447.158,SUP,HCPCS C1713,,447.158  -  PLATE BONE 23MM 90D RIGHT CRNMXF TI 2X2 HOLE L LP 2MM SCR,$517.50,$0.00,$517.50,$232.88,$369.34,$0.00,$89.16,$0.00,$0.00,$90.61,$517.50,$0.00,$258.75,$409.86,$414.00,$0.00,$80.99,$0.00,$82.39,$0.00
447.159,SUP,HCPCS C1713,,447.159  -  PLATE BONE 23MM 90D LEFT CRNMXF TI 2X2 HOLE L LP 2MM SCR,$517.50,$0.00,$517.50,$232.88,$369.34,$0.00,$89.16,$0.00,$0.00,$90.61,$517.50,$0.00,$258.75,$409.86,$414.00,$0.00,$80.99,$0.00,$82.39,$0.00
447.18,SUP,HCPCS C1713,,447.18  -  PLATE BONE ORBTL RIM TI 8 HOLE 2 MM SCR NONSTRL,$528.75,$0.00,$528.75,$237.94,$377.37,$0.00,$91.10,$0.00,$0.00,$92.58,$528.75,$0.00,$264.38,$418.77,$423.00,$0.00,$82.75,$0.00,$84.18,$0.00
447.184,SUP,HCPCS C1713,,447.184  -  2.0MM TI SAGITTAL SPLIT PLATE STRAIGHT LOW-PROFILE/4 H/22MM,$686.25,$0.00,$686.25,$308.81,$489.78,$0.00,$118.24,$0.00,$0.00,$120.16,$686.25,$0.00,$343.13,$543.51,$549.00,$0.00,$107.40,$0.00,$109.25,$0.00
447.185,SUP,HCPCS C1713,,447.185  -  2.0MM TI SAGITTAL SPLIT PLATE STRAIGHT LOW-PROFILE/4 H/29MM,$686.25,$0.00,$686.25,$308.81,$489.78,$0.00,$118.24,$0.00,$0.00,$120.16,$686.25,$0.00,$343.13,$543.51,$549.00,$0.00,$107.40,$0.00,$109.25,$0.00
447.186,SUP,HCPCS C1713,,447.186  -  2.0MM TI SAGITTAL SPLIT PLATE STRAIGHT LOW-PROFILE/4 H/36MM,$686.25,$0.00,$686.25,$308.81,$489.78,$0.00,$118.24,$0.00,$0.00,$120.16,$686.25,$0.00,$343.13,$543.51,$549.00,$0.00,$107.40,$0.00,$109.25,$0.00
447.2,SUP,HCPCS C1713,,447.20  -  PLATE BONE ORBTL RIM TI 10 HOLE 2 MM SCR NONSTRL,$558.00,$0.00,$558.00,$251.10,$398.24,$0.00,$96.14,$0.00,$0.00,$97.70,$558.00,$0.00,$279.00,$441.94,$446.40,$0.00,$87.33,$0.00,$88.83,$0.00
447.204,SUP,HCPCS C1713,,447.204  -  PLATE 1.3MM MANDIB 4 HOLE INTMD LCK CMPR 2MM SCR BONE TI,$816.75,$0.00,$816.75,$367.54,$582.91,$0.00,$140.72,$0.00,$0.00,$143.01,$816.75,$0.00,$408.38,$646.87,$653.40,$0.00,$127.82,$0.00,$130.03,$0.00
447.205,SUP,HCPCS C1713,,447.205  -  PLATE 1.3MM MANDIB 5 HOLE INTMD LCK CMPR 2MM SCR BONE TI,$888.75,$0.00,$888.75,$399.94,$634.30,$0.00,$153.13,$0.00,$0.00,$155.61,$888.75,$0.00,$444.38,$703.89,$711.00,$0.00,$139.09,$0.00,$141.49,$0.00
447.206,SUP,HCPCS C1713,,447.206  -  PLATE 1.3MM MANDIB 6 HOLE INTMD LCK CMPR 2MM SCR BONE TI,$958.50,$0.00,$958.50,$431.33,$684.08,$0.00,$165.14,$0.00,$0.00,$167.83,$958.50,$0.00,$479.25,$759.13,$766.80,$0.00,$150.01,$0.00,$152.59,$0.00
447.208,SUP,HCPCS C1713,,447.208  -  PLATE 1.3MM MANDIB 8 HOLE INTMD LCK CMPR 2MM SCR BONE TI,"$1,084.50",$0.00,"$1,084.50",$488.03,$774.01,$0.00,$186.85,$0.00,$0.00,$189.89,"$1,084.50",$0.00,$542.25,$858.92,$867.60,$0.00,$169.72,$0.00,$172.65,$0.00
447.21,SUP,HCPCS C1713,,447.210  -  PLATE 1.3MM MANDIB 6 HOLE INTMD LCK ANG CMPR 2MM SCR BONE TI,"$1,208.25",$0.00,"$1,208.25",$543.71,$862.33,$0.00,$208.18,$0.00,$0.00,$211.55,"$1,208.25",$0.00,$604.13,$956.93,$966.60,$0.00,$189.09,$0.00,$192.35,$0.00
447.212,SUP,HCPCS C1713,,447.212  -  PLATE 1.3MM MANDIB 8 HOLE INTMD LCK ANG CMPR 2MM SCR BONE TI,"$1,300.50",$0.00,"$1,300.50",$585.23,$928.17,$0.00,$224.07,$0.00,$0.00,$227.71,"$1,300.50",$0.00,$650.25,"$1,030.00","$1,040.40",$0.00,$203.53,$0.00,$207.04,$0.00
447.215,SUP,HCPCS C1713,,447.215  -  PLATE 1.3MM MANDIB 5 HOLE INTMD LCK CRSNT 2MM SCR BONE TI,"$1,084.50",$0.00,"$1,084.50",$488.03,$774.01,$0.00,$186.85,$0.00,$0.00,$189.89,"$1,084.50",$0.00,$542.25,$858.92,$867.60,$0.00,$169.72,$0.00,$172.65,$0.00
447.217,SUP,HCPCS C1713,,447.217  -  PLATE 1.3MM MANDIB 7 HOLE INTMD LCK CRSNT 2MM SCR BONE TI,"$1,154.25",$0.00,"$1,154.25",$519.41,$823.79,$0.00,$198.87,$0.00,$0.00,$202.10,"$1,154.25",$0.00,$577.13,$914.17,$923.40,$0.00,$180.64,$0.00,$183.76,$0.00
447.22,SUP,HCPCS C1713,,447.22  -  PLATE BONE ORBTL RIM CRNMXF TI 12 HOLE CVD 2 MM SCR NONSTRL,$589.50,$0.00,$589.50,$265.28,$420.73,$0.00,$101.57,$0.00,$0.00,$103.22,$589.50,$0.00,$294.75,$466.88,$471.60,$0.00,$92.26,$0.00,$93.85,$0.00
447.232,SUP,HCPCS C1713,,447.232  -  PLATE BN T 53X5X1.2MM NS PRO-PK 2 HLE/HD 8 HL SHFT LOPRFL,$431.25,$0.00,$431.25,$194.06,$307.78,$0.00,$91.37,$0.00,$0.00,$75.51,$431.25,$0.00,$215.63,$341.55,$345.00,$0.00,$83.00,$0.00,$68.66,$0.00
447.233,SUP,HCPCS C1713,,447.233  -  PLATE BN T 53X5X1.2MM NS PRO-PK 3 HLE/HD 8 HL SHFT LOPRFL,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
447.244,SUP,HCPCS C1713,,447.244  -  PLATE BONE 25MM CRANFCL TI 3X4 HOLE T 2MM SCR NONSTRL,$517.50,$0.00,$517.50,$232.88,$369.34,$0.00,$89.16,$0.00,$0.00,$90.61,$517.50,$0.00,$258.75,$409.86,$414.00,$0.00,$80.99,$0.00,$82.39,$0.00
447.304,SUP,HCPCS C1713,,447.304  -  PLATE MINI 1MM RIGHT MANDIB 4 HOLE LCK TNSNBND PREBNT 2MM,$987.75,$0.00,$987.75,$444.49,$704.96,$0.00,$170.18,$0.00,$0.00,$172.95,$987.75,$0.00,$493.88,$782.30,$790.20,$0.00,$154.58,$0.00,$157.25,$0.00
447.305,SUP,HCPCS C1713,,447.305  -  PLATE MINI 1MM LEFT MANDIB 4 HOLE LCK TNSNBND PREBNT 2MM SCR,$987.75,$0.00,$987.75,$444.49,$704.96,$0.00,$170.18,$0.00,$0.00,$172.95,$987.75,$0.00,$493.88,$782.30,$790.20,$0.00,$154.58,$0.00,$157.25,$0.00
447.308,SUP,HCPCS C1713,,447.308  -  PLATE 2 W MINI 1MM MANDIB 12 HOLE LCK MALBLE 2MM SCR BONE TI,"$1,057.50",$0.00,"$1,057.50",$475.88,$754.74,$0.00,$182.20,$0.00,$0.00,$185.16,"$1,057.50",$0.00,$528.75,$837.54,$846.00,$0.00,$165.50,$0.00,$168.35,$0.00
447.309,SUP,HCPCS C1713,,447.309  -  PLATE 2 W MINI 1MM MANDIB 9 HOLE LCK MALBLE 2MM SCR BONE TI,$949.50,$0.00,$949.50,$427.28,$677.66,$0.00,$163.59,$0.00,$0.00,$166.25,$949.50,$0.00,$474.75,$752.00,$759.60,$0.00,$148.60,$0.00,$151.16,$0.00
447.31,SUP,HCPCS C1713,,447.310  -  PLATE MINI 1MM MANDIB 4 HOLE LCK BOX MALBLE 2MM SCR BONE TI,$663.75,$0.00,$663.75,$298.69,$473.72,$0.00,$114.36,$0.00,$0.00,$116.22,$663.75,$0.00,$331.88,$525.69,$531.00,$0.00,$103.88,$0.00,$105.67,$0.00
447.312,SUP,HCPCS C1713,,447.312  -  PLATE MINI 1MM MANDIB 8 HOLE LCK STRUT MALBLE 2MM SCR BONE,"$1,300.50",$0.00,"$1,300.50",$585.23,$928.17,$0.00,$224.07,$0.00,$0.00,$227.71,"$1,300.50",$0.00,$650.25,"$1,030.00","$1,040.40",$0.00,$203.53,$0.00,$207.04,$0.00
447.315,SUP,HCPCS C1713,,447.315  -  PLATE MINI 1MM MANDIB 8 HOLE LCK CVD STRUT MALBLE 2MM SCR,"$1,300.50",$0.00,"$1,300.50",$585.23,$928.17,$0.00,$224.07,$0.00,$0.00,$227.71,"$1,300.50",$0.00,$650.25,"$1,030.00","$1,040.40",$0.00,$203.53,$0.00,$207.04,$0.00
447.317,SUP,HCPCS C1713,,447.317  -  PLATE MINI 1MM MANDIB 6 HOLE LCK 2Y MALBLE 2MM SCR BONE TI,$679.50,$0.00,$679.50,$305.78,$484.96,$0.00,$117.07,$0.00,$0.00,$118.98,$679.50,$0.00,$339.75,$538.16,$543.60,$0.00,$106.34,$0.00,$108.18,$0.00
447.318,SUP,HCPCS C1713,,447.318  -  PLATE MINI 1MM RIGHT MANDIB 5 HOLE LCK L MALBLE 2MM SCR BONE,$627.75,$0.00,$627.75,$282.49,$448.03,$0.00,$108.16,$0.00,$0.00,$109.91,$627.75,$0.00,$313.88,$497.18,$502.20,$0.00,$98.24,$0.00,$99.94,$0.00
447.319,SUP,HCPCS C1713,,447.319  -  PLATE MINI 1MM LEFT MANDIB 5 HOLE LCK L MALBLE 2MM SCR BONE,$627.75,$0.00,$627.75,$282.49,$448.03,$0.00,$108.16,$0.00,$0.00,$109.91,$627.75,$0.00,$313.88,$497.18,$502.20,$0.00,$98.24,$0.00,$99.94,$0.00
447.344,SUP,HCPCS C1713,,447.344  -  PLATE BONE 31MM 4 HOLE LP LCP TITANIUM SMALL BONE CORTICAL,$446.28,$0.00,$446.28,$200.82,$318.51,$0.00,$74.65,$0.00,$0.00,$78.14,$446.28,$0.00,$223.14,$353.45,$357.02,$0.00,$67.81,$0.00,$71.05,$0.00
447.345,SUP,HCPCS C1713,,447.345  -  PLATE BONE 38MM 5 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 2MM,$446.28,$0.00,$446.28,$200.82,$318.51,$0.00,$74.65,$0.00,$0.00,$78.14,$446.28,$0.00,$223.14,$353.45,$357.02,$0.00,$67.81,$0.00,$71.05,$0.00
447.346,SUP,HCPCS C1713,,447.346  -  PLATE BONE 45MM 6 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 2MM,$446.28,$0.00,$446.28,$200.82,$318.51,$0.00,$74.65,$0.00,$0.00,$78.14,$446.28,$0.00,$223.14,$353.45,$357.02,$0.00,$67.81,$0.00,$71.05,$0.00
447.347,SUP,HCPCS C1713,,447.347  -  PLATE BONE 52MM 7 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 2MM,$446.28,$0.00,$446.28,$200.82,$318.51,$0.00,$74.65,$0.00,$0.00,$78.14,$446.28,$0.00,$223.14,$353.45,$357.02,$0.00,$67.81,$0.00,$71.05,$0.00
447.348,SUP,HCPCS C1713,,447.348  -  PLATE BONE 59MM 8 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 2MM,$446.28,$0.00,$446.28,$200.82,$318.51,$0.00,$74.65,$0.00,$0.00,$78.14,$446.28,$0.00,$223.14,$353.45,$357.02,$0.00,$67.81,$0.00,$71.05,$0.00
447.349,SUP,HCPCS C1713,,447.349  -  PLATE BONE 7 HOLE LCP TITANIUM CONDYLE NONSTRL 2 MM SCREWS,"$1,404.33",$0.00,"$1,404.33",$631.95,"$1,002.27",$0.00,$234.91,$0.00,$0.00,$245.89,"$1,404.33",$0.00,$702.16,"$1,112.23","$1,123.46",$0.00,$213.38,$0.00,$223.57,$0.00
447.35,SUP,HCPCS C1713,,447.350  -  PLATE BONE Y 55MM 3X7 HOLE LCP TITANIUM SMALL BONE NONSTRL 2,$788.83,$0.00,$788.83,$354.97,$562.98,$0.00,$131.95,$0.00,$0.00,$138.12,$788.83,$0.00,$394.41,$624.75,$631.06,$0.00,$119.86,$0.00,$125.58,$0.00
447.351,SUP,HCPCS C1713,,447.351  -  PLATE BONE 2 HOLE HEAD 7 HOLE SHAFT T LCP TITANIUM,$788.83,$0.00,$788.83,$354.97,$562.98,$0.00,$131.95,$0.00,$0.00,$138.12,$788.83,$0.00,$394.41,$624.75,$631.06,$0.00,$119.86,$0.00,$125.58,$0.00
447.36,SUP,HCPCS C1713,,447.360  -  PLATE BONE 73MM 10 HOLE LCP TITANIUM SMALL BONE NONSTRL 2MM,$446.28,$0.00,$446.28,$200.82,$318.51,$0.00,$74.65,$0.00,$0.00,$78.14,$446.28,$0.00,$223.14,$353.45,$357.02,$0.00,$67.81,$0.00,$71.05,$0.00
447.362,SUP,HCPCS C1713,,447.362  -  PLATE BONE 81MM 12 HOLE ADAPTION LCP TITANIUM ORTHOPEDIC,$754.70,$0.00,$754.70,$339.62,$538.63,$0.00,$126.24,$0.00,$0.00,$132.14,$754.70,$0.00,$377.35,$597.72,$603.76,$0.00,$114.67,$0.00,$120.15,$0.00
447.364,SUP,HCPCS C1713,,447.364  -  PLATE BONE 84MM 10 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 2.4,$713.78,$0.00,$713.78,$321.20,$509.42,$0.00,$119.40,$0.00,$0.00,$124.98,$713.78,$0.00,$356.89,$565.31,$571.02,$0.00,$108.45,$0.00,$113.63,$0.00
447.366,SUP,HCPCS C1713,,447.366  -  PLATE BONE 88MM 12 HOLE ADAPTION LCP TITANIUM ORTHOPEDIC,$831.13,$0.00,$831.13,$374.01,$593.17,$0.00,$139.03,$0.00,$0.00,$145.52,$831.13,$0.00,$415.56,$658.25,$664.90,$0.00,$126.28,$0.00,$132.32,$0.00
447.37,SUP,HCPCS C1713,,447.370  -  PLATE BONE 97MM 12 HOLE ADAPTION LCP TITANIUM SMALL BONE,$831.13,$0.00,$831.13,$374.01,$593.17,$0.00,$139.03,$0.00,$0.00,$145.52,$831.13,$0.00,$415.56,$658.25,$664.90,$0.00,$126.28,$0.00,$132.32,$0.00
447.372,SUP,HCPCS C1713,,447.372  -  PLATE BONE 76MM 8 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 2.7MM,$753.35,$0.00,$753.35,$339.01,$537.67,$0.00,$126.02,$0.00,$0.00,$131.91,$753.35,$0.00,$376.68,$596.65,$602.68,$0.00,$114.46,$0.00,$119.93,$0.00
447.374,SUP,HCPCS C1713,,447.374  -  PLATE BN 94MM NS LCP PRO-PK 10 HL LOPRFL CUT TO LGTH TI 2.7,$753.35,$0.00,$753.35,$339.01,$537.67,$0.00,$126.02,$0.00,$0.00,$131.91,$753.35,$0.00,$376.68,$596.65,$602.68,$0.00,$114.46,$0.00,$119.93,$0.00
447.375,SUP,HCPCS C1713,,447.375  -  PLATE BONE 44MM 5 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 2.4MM,$713.78,$0.00,$713.78,$321.20,$509.42,$0.00,$119.40,$0.00,$0.00,$124.98,$713.78,$0.00,$356.89,$565.31,$571.02,$0.00,$108.45,$0.00,$113.63,$0.00
447.377,SUP,HCPCS C1713,,447.377  -  PLATE BONE 60MM 7 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 2.4MM,$713.78,$0.00,$713.78,$321.20,$509.42,$0.00,$119.40,$0.00,$0.00,$124.98,$713.78,$0.00,$356.89,$565.31,$571.02,$0.00,$108.45,$0.00,$113.63,$0.00
447.38,SUP,HCPCS C1713,,447.38  -  PLATE BONE 193MM BRD SPC CRANFCL TI 30 HOLE ADP 2MM SCR,"$1,156.50",$0.00,"$1,156.50",$520.43,$825.39,$0.00,$199.26,$0.00,$0.00,$202.49,"$1,156.50",$0.00,$578.25,$915.95,$925.20,$0.00,$180.99,$0.00,$184.11,$0.00
447.404,SUP,HCPCS C1713,,447.404  -  PLATE LG 1.5MM MANDIB 4X20X4 HOLE LCK 2 ANG 2MM SCR BONE TI,"$4,916.25",$0.00,"$4,916.25","$2,212.31","$3,508.73",$0.00,$847.05,$0.00,$0.00,$860.80,"$4,916.25",$0.00,"$2,458.13","$3,893.67","$3,933.00",$0.00,$769.39,$0.00,$782.67,$0.00
447.405,SUP,HCPCS C1713,,447.405  -  PLATE LG 1.5MM MANDIB 5X22X5 HOLE LCK 2 ANG 2MM SCR BONE TI,"$5,190.75",$0.00,"$5,190.75","$2,335.84","$3,704.64",$0.00,$894.34,$0.00,$0.00,$908.86,"$5,190.75",$0.00,"$2,595.38","$4,111.07","$4,152.60",$0.00,$812.35,$0.00,$826.37,$0.00
447.406,SUP,HCPCS C1713,,447.406  -  PLATE LG 1.5MM MANDIB 6X24X6 HOLE LCK 2 ANG 2MM SCR BONE TI,"$5,474.25",$0.00,"$5,474.25","$2,463.41","$3,906.97",$0.00,$943.19,$0.00,$0.00,$958.50,"$5,474.25",$0.00,"$2,737.13","$4,335.61","$4,379.40",$0.00,$856.72,$0.00,$871.50,$0.00
447.412,SUP,HCPCS C1713,,447.412  -  PLATE 2MM MANDIB 12 HOLE X LCK STR 2MM SCR BONE TI NONSTRL,"$1,953.00",$0.00,"$1,953.00",$878.85,"$1,393.86",$0.00,$336.49,$0.00,$0.00,$341.95,"$1,953.00",$0.00,$976.50,"$1,546.78","$1,562.40",$0.00,$305.64,$0.00,$310.92,$0.00
447.42,SUP,HCPCS C1713,,447.420  -  PLATE 2MM MANDIB 20 HOLE X LCK STR 2MM SCR BONE TI NONSTRL,"$2,697.75",$0.00,"$2,697.75","$1,213.99","$1,925.38",$0.00,$464.81,$0.00,$0.00,$472.35,"$2,697.75",$0.00,"$1,348.88","$2,136.62","$2,158.20",$0.00,$422.20,$0.00,$429.48,$0.00
447.422,SUP,HCPCS C1713,,447.422  -  PLATE 2MM MANDIB 6X21 HOLE X LCK RIGHT ANG 2MM SCR BONE TI,"$4,459.50",$0.00,"$4,459.50","$2,006.78","$3,182.75",$0.00,$768.35,$0.00,$0.00,$780.82,"$4,459.50",$0.00,"$2,229.75","$3,531.92","$3,567.60",$0.00,$697.91,$0.00,$709.95,$0.00
447.423,SUP,HCPCS C1713,,447.423  -  PLATE MANDIB 6X21 HOLE X LCK LEFT ANG 2 MM SCR BONE TI,"$4,459.50",$0.00,"$4,459.50","$2,006.78","$3,182.75",$0.00,$768.35,$0.00,$0.00,$780.82,"$4,459.50",$0.00,"$2,229.75","$3,531.92","$3,567.60",$0.00,$697.91,$0.00,$709.95,$0.00
447.424,SUP,HCPCS C1713,,447.424  -  PLATE 2MM MANDIB 4X20X4 HOLE X LCK 2 ANG 2MM SCR BONE TI,"$5,154.75",$0.00,"$5,154.75","$2,319.64","$3,678.95",$0.00,$888.14,$0.00,$0.00,$902.56,"$5,154.75",$0.00,"$2,577.38","$4,082.56","$4,123.80",$0.00,$806.72,$0.00,$820.64,$0.00
447.425,SUP,HCPCS C1713,,447.425  -  PLATE 2MM MANDIB 5X22X5 HOLE X LCK 2 ANG 2MM SCR BONE TI,"$5,447.25",$0.00,"$5,447.25","$2,451.26","$3,887.70",$0.00,$938.53,$0.00,$0.00,$953.77,"$5,447.25",$0.00,"$2,723.63","$4,314.22","$4,357.80",$0.00,$852.49,$0.00,$867.20,$0.00
447.426,SUP,HCPCS C1713,,447.426  -  PLATE 2MM MANDIB 6X24X6 HOLE X LCK 2 ANG 2MM SCR BONE TI,"$5,735.25",$0.00,"$5,735.25","$2,580.86","$4,093.25",$0.00,$988.15,$0.00,$0.00,"$1,004.20","$5,735.25",$0.00,"$2,867.63","$4,542.32","$4,588.20",$0.00,$897.57,$0.00,$913.05,$0.00
447.5,SUP,HCPCS C1713,,447.50  -  PLATE BN 5MM SPC OB L L 25X10X.9MM NS 4.8MM 2 HL BS 3 HL,$558.00,$0.00,$558.00,$251.10,$398.24,$0.00,$96.14,$0.00,$0.00,$97.70,$558.00,$0.00,$279.00,$441.94,$446.40,$0.00,$87.33,$0.00,$88.83,$0.00
447.51,SUP,HCPCS C1713,,447.51  -  PLATE 100D TI 2MM SCR 3 HOLE RIGHT OBLQ BONE ORTH NONSTRL,$558.00,$0.00,$558.00,$251.10,$398.24,$0.00,$96.14,$0.00,$0.00,$97.70,$558.00,$0.00,$279.00,$441.94,$446.40,$0.00,$87.33,$0.00,$88.83,$0.00
447.515,SUP,HCPCS C1713,,447.515  -  PLATE BONE 100D CRANFCL TI 2X3 HOLE L RIGHT OBLQ MALBLE 2MM,$549.00,$0.00,$549.00,$247.05,$391.82,$0.00,$94.59,$0.00,$0.00,$96.13,$549.00,$0.00,$274.50,$434.81,$439.20,$0.00,$85.92,$0.00,$87.40,$0.00
447.516,SUP,HCPCS C1713,,447.516  -  PLATE BONE 100D CRANFCL TI 2X3 HOLE L LEFT OBLQ MALBLE 2MM,$549.00,$0.00,$549.00,$247.05,$391.82,$0.00,$94.59,$0.00,$0.00,$96.13,$549.00,$0.00,$274.50,$434.81,$439.20,$0.00,$85.92,$0.00,$87.40,$0.00
447.52,SUP,HCPCS C1713,,447.52  -  PLATE BN 5MM SPC OB L L 31X15X.9MM NS 4.8MM 3 HL BS 4 HL,$587.25,$0.00,$587.25,$264.26,$419.12,$0.00,$101.18,$0.00,$0.00,$102.82,$587.25,$0.00,$293.63,$465.10,$469.80,$0.00,$91.90,$0.00,$93.49,$0.00
447.521,SUP,HCPCS C1713,,447.521  -  PLATE BONE 100D CRANFCL TI 4X3 HOLE L RIGHT OBLQ NO BAR 2MM,$481.50,$0.00,$481.50,$216.68,$343.65,$0.00,$82.96,$0.00,$0.00,$84.31,$481.50,$0.00,$240.75,$381.35,$385.20,$0.00,$75.35,$0.00,$76.65,$0.00
447.522,SUP,HCPCS C1713,,447.522  -  PLATE BONE 100D CRANFCL TI 4X3 HOLE L LEFT OBLQ NO BAR 2MM,$481.50,$0.00,$481.50,$216.68,$343.65,$0.00,$82.96,$0.00,$0.00,$84.31,$481.50,$0.00,$240.75,$381.35,$385.20,$0.00,$75.35,$0.00,$76.65,$0.00
447.524,SUP,HCPCS C1713,,447.524  -  PLATE BONE 20MM 90D RIGHT CRNMXF TI 2X2 HOLE L 2MM SCR,$488.25,$0.00,$488.25,$219.71,$348.46,$0.00,$84.12,$0.00,$0.00,$85.49,$488.25,$0.00,$244.13,$386.69,$390.60,$0.00,$76.41,$0.00,$77.73,$0.00
447.525,SUP,HCPCS C1713,,447.525  -  PLATE BONE 20MM 90D LEFT CRNMXF TI 2X2 HOLE L 2MM SCR,$488.25,$0.00,$488.25,$219.71,$348.46,$0.00,$84.12,$0.00,$0.00,$85.49,$488.25,$0.00,$244.13,$386.69,$390.60,$0.00,$76.41,$0.00,$77.73,$0.00
447.527,SUP,HCPCS C1713,,447.527  -  PLATE BONE 100D CRANFCL TI 3X4 HOLE L LEFT OBLQ MALBLE 2MM,$576.00,$0.00,$576.00,$259.20,$411.09,$0.00,$99.24,$0.00,$0.00,$100.85,$576.00,$0.00,$288.00,$456.19,$460.80,$0.00,$90.14,$0.00,$91.70,$0.00
447.53,SUP,HCPCS C1713,,447.53  -  PLATE BN 5MM SPC OB R L 31X15X.9MM NS 4.8MM 3 HL BS 4 HL,$587.25,$0.00,$587.25,$264.26,$419.12,$0.00,$101.18,$0.00,$0.00,$102.82,$587.25,$0.00,$293.63,$465.10,$469.80,$0.00,$91.90,$0.00,$93.49,$0.00
447.537,SUP,HCPCS C1713,,447.537  -  PLATE BONE 100D CRANFCL TI 3X4 HOLE L RIGHT OBLQ MALBLE 2MM,$576.00,$0.00,$576.00,$259.20,$411.09,$0.00,$99.24,$0.00,$0.00,$100.85,$576.00,$0.00,$288.00,$456.19,$460.80,$0.00,$90.14,$0.00,$91.70,$0.00
447.54,SUP,HCPCS C1713,,447.54  -  PLATE BN 5MM SPC OB L L 41X20X.9MM NS 4.8MM 4 HL BS 6 HL,$641.25,$0.00,$641.25,$288.56,$457.66,$0.00,$110.48,$0.00,$0.00,$112.28,$641.25,$0.00,$320.63,$507.87,$513.00,$0.00,$100.36,$0.00,$102.09,$0.00
447.546,SUP,HCPCS C1713,,447.546  -  PLATE SHRT MAXFACL 2X2 HOLE L RIGHT OBLQ MALBLE 2MM SCR BONE,$429.75,$0.00,$429.75,$193.39,$306.71,$0.00,$74.04,$0.00,$0.00,$75.25,$429.75,$0.00,$214.88,$340.36,$343.80,$0.00,$67.26,$0.00,$68.42,$0.00
447.547,SUP,HCPCS C1713,,447.547  -  PLATE SHRT MAXFACL 2X2 HOLE L LEFT OBLQ MALBLE 2MM SCR BONE,$429.75,$0.00,$429.75,$193.39,$306.71,$0.00,$74.04,$0.00,$0.00,$75.25,$429.75,$0.00,$214.88,$340.36,$343.80,$0.00,$67.26,$0.00,$68.42,$0.00
447.548,SUP,HCPCS C1713,,447.548  -  PLATE LNG MAXFACL 2X2 HOLE L RIGHT OBLQ MALBLE 2MM SCR BONE,$486.00,$0.00,$486.00,$218.70,$346.86,$0.00,$83.74,$0.00,$0.00,$85.09,$486.00,$0.00,$243.00,$384.91,$388.80,$0.00,$76.06,$0.00,$77.37,$0.00
447.549,SUP,HCPCS C1713,,447.549  -  PLATE LNG MAXFACL 2X2 HOLE L LEFT OBLQ MALBLE 2MM SCR BONE,$486.00,$0.00,$486.00,$218.70,$346.86,$0.00,$83.74,$0.00,$0.00,$85.09,$486.00,$0.00,$243.00,$384.91,$388.80,$0.00,$76.06,$0.00,$77.37,$0.00
447.55,SUP,HCPCS C1713,,447.55  -  PLATE BN 5MM SPC OB R L 41X20X.9MM NS 4.8MM 4 HL BS 6 HL,$641.25,$0.00,$641.25,$288.56,$457.66,$0.00,$110.48,$0.00,$0.00,$112.28,$641.25,$0.00,$320.63,$507.87,$513.00,$0.00,$100.36,$0.00,$102.09,$0.00
447.556,SUP,HCPCS C1713,,447.556  -  PLATE SHRT TI 2MM SCR L 2X2 HOLE BONE LEFT OBLQ NONSTRL,$486.00,$0.00,$486.00,$218.70,$346.86,$0.00,$83.74,$0.00,$0.00,$85.09,$486.00,$0.00,$243.00,$384.91,$388.80,$0.00,$76.06,$0.00,$77.37,$0.00
447.557,SUP,HCPCS C1713,,447.557  -  PLATE SHRT TI 2MM SCR L OBLQ 2X2 HOLE BONE LEFT NONSTRL,$486.00,$0.00,$486.00,$218.70,$346.86,$0.00,$83.74,$0.00,$0.00,$85.09,$486.00,$0.00,$243.00,$384.91,$388.80,$0.00,$76.06,$0.00,$77.37,$0.00
447.558,SUP,HCPCS C1713,,447.558  -  PLATE LNG TI 2MM SCR L OBLQ 2X2 HOLE BONE RIGHT NONSTRL,$486.00,$0.00,$486.00,$218.70,$346.86,$0.00,$83.74,$0.00,$0.00,$85.09,$486.00,$0.00,$243.00,$384.91,$388.80,$0.00,$76.06,$0.00,$77.37,$0.00
447.559,SUP,HCPCS C1713,,447.559  -  PLATE LNG TI 2MM SCR L OBLQ 2X2 HOLE BONE LEFT NONSTRL,$486.00,$0.00,$486.00,$218.70,$346.86,$0.00,$83.74,$0.00,$0.00,$85.09,$486.00,$0.00,$243.00,$384.91,$388.80,$0.00,$76.06,$0.00,$77.37,$0.00
447.562,SUP,HCPCS C1713,,447.562  -  PLATE SHRT TI 2MM SCR Z BONE RIGHT NONSTRL,$551.25,$0.00,$551.25,$248.06,$393.43,$0.00,$94.98,$0.00,$0.00,$96.52,$551.25,$0.00,$275.63,$436.59,$441.00,$0.00,$86.27,$0.00,$87.76,$0.00
447.563,SUP,HCPCS C1713,,447.563  -  PLATE SHRT TI 2MM SCR Z BONE LEFT NONSTRL,$551.25,$0.00,$551.25,$248.06,$393.43,$0.00,$94.98,$0.00,$0.00,$96.52,$551.25,$0.00,$275.63,$436.59,$441.00,$0.00,$86.27,$0.00,$87.76,$0.00
447.564,SUP,HCPCS C1713,,447.564  -  PLATE LNG TI 2MM SCR Z BONE RIGHT NONSTRL,$551.25,$0.00,$551.25,$248.06,$393.43,$0.00,$94.98,$0.00,$0.00,$96.52,$551.25,$0.00,$275.63,$436.59,$441.00,$0.00,$86.27,$0.00,$87.76,$0.00
447.565,SUP,HCPCS C1713,,447.565  -  PLATE LNG TI 2MM SCR Z BONE LEFT NONSTRL,$551.25,$0.00,$551.25,$248.06,$393.43,$0.00,$94.98,$0.00,$0.00,$96.52,$551.25,$0.00,$275.63,$436.59,$441.00,$0.00,$86.27,$0.00,$87.76,$0.00
447.572,SUP,HCPCS C1713,,447.572  -  PLATE SHRT RIGHT MAXFACL Z MALBLE 2MM SCR BONE TI NONSTRL,$551.25,$0.00,$551.25,$248.06,$393.43,$0.00,$94.98,$0.00,$0.00,$96.52,$551.25,$0.00,$275.63,$436.59,$441.00,$0.00,$86.27,$0.00,$87.76,$0.00
447.573,SUP,HCPCS C1713,,447.573  -  PLATE SHRT LEFT MAXFACL Z MALBLE 2MM SCR BONE TI NONSTRL,$551.25,$0.00,$551.25,$248.06,$393.43,$0.00,$94.98,$0.00,$0.00,$96.52,$551.25,$0.00,$275.63,$436.59,$441.00,$0.00,$86.27,$0.00,$87.76,$0.00
447.574,SUP,HCPCS C1713,,447.574  -  PLATE LNG RIGHT MAXFACL Z MALBLE 2MM SCR BONE TI NONSTRL,$551.25,$0.00,$551.25,$248.06,$393.43,$0.00,$94.98,$0.00,$0.00,$96.52,$551.25,$0.00,$275.63,$436.59,$441.00,$0.00,$86.27,$0.00,$87.76,$0.00
447.575,SUP,HCPCS C1713,,447.575  -  PLATE LNG LEFT MAXFACL Z MALBLE 2MM SCR BONE TI NONSTRL,$551.25,$0.00,$551.25,$248.06,$393.43,$0.00,$94.98,$0.00,$0.00,$96.52,$551.25,$0.00,$275.63,$436.59,$441.00,$0.00,$86.27,$0.00,$87.76,$0.00
447.61,SUP,HCPCS C1713,,447.61  -  PLATE BONE CRNMXF TI 5 HOLE Y 2 MM SCR NONSTRL,$567.00,$0.00,$567.00,$255.15,$404.67,$0.00,$97.69,$0.00,$0.00,$99.28,$567.00,$0.00,$283.50,$449.06,$453.60,$0.00,$88.74,$0.00,$90.27,$0.00
447.612,SUP,HCPCS C1713,,447.612  -  PLATE BN Y 48X5X1.2MM NS PRO-PK 3 HLE/HD 8 HL SHFT LOPRFL,$469.48,$0.00,$469.48,$211.26,$335.06,$0.00,$78.53,$0.00,$0.00,$82.20,$469.48,$0.00,$234.74,$371.83,$375.58,$0.00,$71.33,$0.00,$74.74,$0.00
447.615,SUP,HCPCS C1713,,447.615  -  PLATE BONE 3 HOLE HEAD 7 HOLE SHAFT T LCP TITANIUM,$788.83,$0.00,$788.83,$354.97,$562.98,$0.00,$131.95,$0.00,$0.00,$138.12,$788.83,$0.00,$394.41,$624.75,$631.06,$0.00,$119.86,$0.00,$125.58,$0.00
447.62,SUP,HCPCS C1713,,447.62  -  PLATE BN Y 32X19X.9MM NS 4.8MM 2 HLE/HD 4 HL SHFT 2 ARM TI,$580.50,$0.00,$580.50,$261.23,$414.30,$0.00,$100.02,$0.00,$0.00,$101.64,$580.50,$0.00,$290.25,$459.76,$464.40,$0.00,$90.85,$0.00,$92.42,$0.00
447.63,SUP,HCPCS C1713,,447.630  -  PLATE BONE CRANFCL TI 7 HOLE Y 2 MM SCR NONSTRL,$490.50,$0.00,$490.50,$220.73,$350.07,$0.00,$84.51,$0.00,$0.00,$85.88,$490.50,$0.00,$245.25,$388.48,$392.40,$0.00,$76.76,$0.00,$78.09,$0.00
447.68,SUP,HCPCS C1713,,447.68  -  PLATE BONE CRANFCL TI 8 HOLE 2 Y 2 MM SCR NONSTRL,$600.75,$0.00,$600.75,$270.34,$428.76,$0.00,$103.51,$0.00,$0.00,$105.19,$600.75,$0.00,$300.38,$475.79,$480.60,$0.00,$94.02,$0.00,$95.64,$0.00
447.681,SUP,HCPCS C1713,,447.681  -  PLATE TI 2 MM SCR 8 HOLE Y BONE NONSTRL,$600.75,$0.00,$600.75,$270.34,$428.76,$0.00,$103.51,$0.00,$0.00,$105.19,$600.75,$0.00,$300.38,$475.79,$480.60,$0.00,$94.02,$0.00,$95.64,$0.00
447.702,SUP,HCPCS C1713,,447.702  -  PLATE BONE SMALL 24X18MM X LOCKING TITANIUM FT NONSTRL,"$1,397.50",$0.00,"$1,397.50",$628.88,$997.40,$0.00,$233.77,$0.00,$0.00,$244.69,"$1,397.50",$0.00,$698.75,"$1,106.82","$1,118.00",$0.00,$212.34,$0.00,$222.48,$0.00
447.704,SUP,HCPCS C1713,,447.704  -  PLATE BONE MEDIUM 30X20MM X LOCKING TITANIUM FT NONSTRL,"$1,415.25",$0.00,"$1,415.25",$636.86,"$1,010.06",$0.00,$236.74,$0.00,$0.00,$247.80,"$1,415.25",$0.00,$707.63,"$1,120.88","$1,132.20",$0.00,$215.03,$0.00,$225.31,$0.00
447.706,SUP,HCPCS C1713,,447.706  -  PLATE BONE LARGE 36X20MM X LOCKING TITANIUM FT NONSTRL,"$1,434.35",$0.00,"$1,434.35",$645.46,"$1,023.70",$0.00,$239.93,$0.00,$0.00,$251.14,"$1,434.35",$0.00,$717.18,"$1,136.01","$1,147.48",$0.00,$217.94,$0.00,$228.35,$0.00
447.71,SUP,HCPCS C1713,,447.710  -  PLATE BN STRG 17X6X1.6MM NS 2 HL LCK RND THRD HL TI HND/MDFT,$681.00,$0.00,$681.00,$306.45,$486.03,$0.00,$113.92,$0.00,$0.00,$119.24,$681.00,$0.00,$340.50,$539.35,$544.80,$0.00,$103.47,$0.00,$108.42,$0.00
447.711,SUP,HCPCS C1713,,447.711  -  PLATE BONE XS 22X14MM X LOCKING TITANIUM NONSTRL 2.4/2.7MM,"$1,417.98",$0.00,"$1,417.98",$638.09,"$1,012.01",$0.00,$237.19,$0.00,$0.00,$248.28,"$1,417.98",$0.00,$708.99,"$1,123.04","$1,134.38",$0.00,$215.45,$0.00,$225.74,$0.00
447.81,SUP,HCPCS C1713,,447.81  -  PLATE BN 13MM SPC X 18X18X.9MM NS 4.8MM 4 HL TI CRNFCL 2MM,$528.75,$0.00,$528.75,$237.94,$377.37,$0.00,$91.10,$0.00,$0.00,$92.58,$528.75,$0.00,$264.38,$418.77,$423.00,$0.00,$82.75,$0.00,$84.18,$0.00
447.811,SUP,HCPCS C1713,,447.811  -  PLATE BONE CRANFCL TI 4 HOLE X MALBLE 2 MM SCR NONSTRL,$432.00,$0.00,$432.00,$194.40,$308.32,$0.00,$74.43,$0.00,$0.00,$75.64,$432.00,$0.00,$216.00,$342.14,$345.60,$0.00,$67.61,$0.00,$68.77,$0.00
447.85,SUP,HCPCS C1713,,447.85  -  PLATE BONE CRANFCL TI 9 HOLE H 2 MM SCR NONSTRL,$594.00,$0.00,$594.00,$267.30,$423.94,$0.00,$102.34,$0.00,$0.00,$104.00,$594.00,$0.00,$297.00,$470.45,$475.20,$0.00,$92.96,$0.00,$94.56,$0.00
447.86,SUP,HCPCS C1713,,447.86  -  PLATE BONE CRANFCL TI 8 HOLE H 2 MM SCR NONSTRL,$594.00,$0.00,$594.00,$267.30,$423.94,$0.00,$102.34,$0.00,$0.00,$104.00,$594.00,$0.00,$297.00,$470.45,$475.20,$0.00,$92.96,$0.00,$94.56,$0.00
447.915,SUP,HCPCS C1713,,447.915  -  PLATE BONE 13X13MM CRANFCL TI 4 HOLE BOX 2MM SCR NONSTRL,$474.75,$0.00,$474.75,$213.64,$338.83,$0.00,$81.80,$0.00,$0.00,$83.12,$474.75,$0.00,$237.38,$376.00,$379.80,$0.00,$74.30,$0.00,$75.58,$0.00
449.004,SUP,HCPCS C1713,,449.004  -  PLATE BN NAR STRG 29X4.8X1MM NS 4 HL LOPRFL TI MNDB 2MM SCR,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
449.006,SUP,HCPCS C1713,,449.006  -  PLATE BN NAR STRG 42X4.8X1MM NS 6 HL LOPRFL TI MNDB 2MM SCR,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
449.008,SUP,HCPCS C1713,,449.008  -  PLATE NAR 55MM MANDIB 8 HOLE STR 2MM SCR BONE TI NONSTRL,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
449.014,SUP,HCPCS C1713,,449.014  -  PLATE BN CRV NAR 29X4.8X1MM NS 4 HL LOPRFL TI MNDB 2MM SCR,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
449.016,SUP,HCPCS C1713,,449.016  -  PLATE BN CRV NAR 41X4.8X1MM NS 6 HL LOPRFL TI MNDB 2MM SCR,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
449.017,SUP,HCPCS C1713,,449.017  -  PLATE NAR MANDIB 6 HOLE STRUT 2MM SCR BONE TI NONSTRL,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
449.018,SUP,HCPCS C1713,,449.018  -  PLATE MANDIB 8 HOLE CVD STRUT 2 MM SCR BONE TI NONSTRL,"$1,237.50",$0.00,"$1,237.50",$556.88,$883.20,$0.00,$213.22,$0.00,$0.00,$216.68,"$1,237.50",$0.00,$618.75,$980.10,$990.00,$0.00,$193.67,$0.00,$197.01,$0.00
449.02,SUP,HCPCS C1713,,449.020  -  PLATE 119MM MANDIB 20 HOLE ADP 2MM SCR BONE TI NONSTRL,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
449.021,SUP,HCPCS C1713,,449.021  -  PLATE BONE 100MM CRANFCL TI 2X20 HOLE 2 ADP 2MM SCR BILAT,"$1,496.25",$0.00,"$1,496.25",$673.31,"$1,067.87",$0.00,$257.80,$0.00,$0.00,$261.98,"$1,496.25",$0.00,$748.13,"$1,185.03","$1,197.00",$0.00,$234.16,$0.00,$238.20,$0.00
449.024,SUP,HCPCS C1713,,449.024  -  PLATE BN BRD STRG 29X4.8X1.25MM NS 4 HL LOPRFL TI MNDB 2MM,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
449.025,SUP,HCPCS C1713,,449.025  -  PLATE BN BRD CRV 29X4.8X1.25MM NS 4 HL LOPRFL TI MNDB 2MM,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
449.026,SUP,HCPCS C1713,,449.026  -  PLATE BN BRD STRG 42X4.8X1.25MM NS 6 HL LOPRFL TI MNDB 2MM,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
449.027,SUP,HCPCS C1713,,449.027  -  PLATE BN BRD CRV 41X4.8X1.25MM NS 6 HL LOPRFL TI MNDB 2MM,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
449.028,SUP,HCPCS C1713,,449.028  -  PLATE BN BRD STRG 55X4.8X1.25MM NS 8 HL LOPRFL TI MNDB 2MM,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
449.032,SUP,HCPCS C1713,,449.032  -  PLATE 21MM MANDIB 4X4 HOLE ANG 2MM SCR BONE DCP TI NONSTRL,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
449.034,SUP,HCPCS C1713,,449.034  -  PLATE BN 30X5X1.25MM NS DCP 4 HL LOPRFL TI MNDB 2MM SCR MDLR,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
449.035,SUP,HCPCS C1713,,449.035  -  PLATE BN 32X5X1.25MM NS DCP 5 HL LOPRFL TI MNDB 2MM SCR MDLR,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
449.036,SUP,HCPCS C1713,,449.036  -  PLATE BN 42X5X1.25MM NS DCP 6 HL LOPRFL TI MNDB 2MM SCR MDLR,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
449.037,SUP,HCPCS C1713,,449.037  -  PLATE 48MM MANDIB 7 HOLE 2MM SCR BONE DCP TI NONSTRL,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
449.038,SUP,HCPCS C1713,,449.038  -  PLATE 54MM MANDIB 8 HOLE 2MM SCR BONE DCP TI NONSTRL,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
449.04,SUP,HCPCS C1713,,449.04  -  PLATE 22MM MANDIB 4 HOLE STR TNSNBND 2MM SCR BONE TI NONSTRL,$857.25,$0.00,$857.25,$385.76,$611.82,$0.00,$147.70,$0.00,$0.00,$150.10,$857.25,$0.00,$428.63,$678.94,$685.80,$0.00,$134.16,$0.00,$136.47,$0.00
449.05,SUP,HCPCS C1713,,449.05  -  PLATE 25MM MANDIB 4 HOLE STR TNSNBND 2MM SCR BONE TI NONSTRL,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
449.06,SUP,HCPCS C1713,,449.06  -  PLATE 35MM MANDIB 6 HOLE STR TNSNBND 2MM SCR BONE TI NONSTRL,$954.00,$0.00,$954.00,$429.30,$680.87,$0.00,$164.37,$0.00,$0.00,$167.04,$954.00,$0.00,$477.00,$755.57,$763.20,$0.00,$149.30,$0.00,$151.88,$0.00
449.1,SUP,HCPCS C1713,,449.100  -  PLATE 26MM MANDIB 4 HOLE CMPR TNSNBND 2.4MM SCR BONE LC DCP,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
449.11,SUP,HCPCS C1713,,449.110  -  PLATE 36MM MANDIB 6 HOLE CMPR TNSNBND 2.4MM SCR BONE LC DCP,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
449.14,SUP,HCPCS C1713,,449.14  -  PLATE BN 35X6.5X1.65MM NS LC DCP 4 HL TI MNDB 2.4MM SCR,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
449.15,SUP,HCPCS C1713,,449.15  -  PLATE BN 39X6.5X1.65MM NS LC DCP 5 HL TI MNDB 2.4MM SCR,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
449.16,SUP,HCPCS C1713,,449.16  -  PLATE BN 51X6.5X1.65MM NS LC DCP 6 HL TI MNDB 2.4MM SCR,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
449.234,SUP,HCPCS C1713,,449.234  -  PLATE 35MM MANDIB 4 HOLE ECNTRC 2.4MM SCR BONE LC DCP TI,"$1,359.00",$0.00,"$1,359.00",$611.55,$969.92,$0.00,$234.15,$0.00,$0.00,$237.95,"$1,359.00",$0.00,$679.50,"$1,076.33","$1,087.20",$0.00,$212.68,$0.00,$216.35,$0.00
449.236,SUP,HCPCS C1713,,449.236  -  PLATE 6 HOLE ECNTRC 2.4 MM SCR BONE LC DCP TI NONSTRL,"$1,638.00",$0.00,"$1,638.00",$737.10,"$1,169.04",$0.00,$282.22,$0.00,$0.00,$286.80,"$1,638.00",$0.00,$819.00,"$1,297.30","$1,310.40",$0.00,$256.35,$0.00,$260.77,$0.00
449.24,SUP,HCPCS C1713,,449.24  -  PLATE 35X6.5X2MM MANDIB 4 HOLE CRSNT 2.4MM SCR BONE LC DCP,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
449.25,SUP,HCPCS C1713,,449.250  -  PLATE 38MM MANDIB 5 HOLE CRSNT 2.4MM SCR BONE LC DCP TI,"$1,458.00",$0.00,"$1,458.00",$656.10,"$1,040.57",$0.00,$251.21,$0.00,$0.00,$255.28,"$1,458.00",$0.00,$729.00,"$1,154.74","$1,166.40",$0.00,$228.18,$0.00,$232.11,$0.00
449.26,SUP,HCPCS C1713,,449.26  -  PLATE 50MM TI 2.4MM SCR 6 HOLE CRSNT LC DCP BONE MANDIB,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
449.38,SUP,HCPCS C1713,,449.38  -  PLATE UNV 64MM MANDIB 8 HOLE 2.4MM SCR BONE TI NONSTRL,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
449.4,SUP,HCPCS C1713,,449.40  -  PLATE UNV 80MM MANDIB 10 HOLE STR 2.4MM SCR BONE TI NONSTRL,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
449.412,SUP,HCPCS C1713,,449.412  -  PLATE MAXFACL 12 HOLE STR MCVSC 2.4 MM SCR BONE TI NONSTRL,"$1,687.50",$0.00,"$1,687.50",$759.38,"$1,204.37",$0.00,$290.75,$0.00,$0.00,$295.47,"$1,687.50",$0.00,$843.75,"$1,336.50","$1,350.00",$0.00,$264.09,$0.00,$268.65,$0.00
449.416,SUP,HCPCS C1713,,449.416  -  PLATE MAXFACL 16 HOLE STR MCVSC 2.4 MM SCR BONE TI NONSTRL,"$2,310.75",$0.00,"$2,310.75","$1,039.84","$1,649.18",$0.00,$398.13,$0.00,$0.00,$404.59,"$2,310.75",$0.00,"$1,155.38","$1,830.11","$1,848.60",$0.00,$361.63,$0.00,$367.87,$0.00
449.418,SUP,HCPCS C1713,,449.418  -  PLATE MAXFACL 18 HOLE STR MCVSC 2.4 MM SCR BONE TI NONSTRL,"$2,623.50",$0.00,"$2,623.50","$1,180.58","$1,872.39",$0.00,$452.02,$0.00,$0.00,$459.35,"$2,623.50",$0.00,"$1,311.75","$2,077.81","$2,098.80",$0.00,$410.58,$0.00,$417.66,$0.00
449.42,SUP,HCPCS C1713,,449.420  -  PLATE MAXFACL 20 HOLE STR MCVSC 2.4 MM SCR BONE TI NONSTRL,"$2,938.50",$0.00,"$2,938.50","$1,322.33","$2,097.21",$0.00,$506.29,$0.00,$0.00,$514.51,"$2,938.50",$0.00,"$1,469.25","$2,327.29","$2,350.80",$0.00,$459.88,$0.00,$467.81,$0.00
449.422,SUP,HCPCS C1713,,449.422  -  PLATE MAXFACL 22 HOLE STR MCVSC 2.4 MM SCR BONE TI NONSTRL,"$2,938.50",$0.00,"$2,938.50","$1,322.33","$2,097.21",$0.00,$506.29,$0.00,$0.00,$514.51,"$2,938.50",$0.00,"$1,469.25","$2,327.29","$2,350.80",$0.00,$459.88,$0.00,$467.81,$0.00
449.424,SUP,HCPCS C1713,,449.424  -  PLATE MAXFACL 24 HOLE STR MCVSC 2.4 MM SCR BONE TI NONSTRL,"$2,938.50",$0.00,"$2,938.50","$1,322.33","$2,097.21",$0.00,$506.29,$0.00,$0.00,$514.51,"$2,938.50",$0.00,"$1,469.25","$2,327.29","$2,350.80",$0.00,$459.88,$0.00,$467.81,$0.00
449.44,SUP,HCPCS C1713,,449.440  -  PLATE MAXFACL 4X8 HOLE RIGHT ANG MCVSC 2.4 MM SCR BONE TI,"$2,938.50",$0.00,"$2,938.50","$1,322.33","$2,097.21",$0.00,$506.29,$0.00,$0.00,$514.51,"$2,938.50",$0.00,"$1,469.25","$2,327.29","$2,350.80",$0.00,$459.88,$0.00,$467.81,$0.00
449.441,SUP,HCPCS C1713,,449.441  -  PLATE MAXFACL 4X8 HOLE LEFT ANG MCVSC 2.4 MM SCR BONE TI,"$2,938.50",$0.00,"$2,938.50","$1,322.33","$2,097.21",$0.00,$506.29,$0.00,$0.00,$514.51,"$2,938.50",$0.00,"$1,469.25","$2,327.29","$2,350.80",$0.00,$459.88,$0.00,$467.81,$0.00
449.442,SUP,HCPCS C1713,,449.442  -  PLATE MAXFACL 4X16 HOLE RIGHT ANG MCVSC 2.4 MM SCR BONE TI,"$3,343.50",$0.00,"$3,343.50","$1,504.58","$2,386.26",$0.00,$576.07,$0.00,$0.00,$585.42,"$3,343.50",$0.00,"$1,671.75","$2,648.05","$2,674.80",$0.00,$523.26,$0.00,$532.29,$0.00
449.443,SUP,HCPCS C1713,,449.443  -  PLATE MAXFACL 4X16 HOLE LEFT ANG MCVSC 2.4 MM SCR BONE TI,"$3,343.50",$0.00,"$3,343.50","$1,504.58","$2,386.26",$0.00,$576.07,$0.00,$0.00,$585.42,"$3,343.50",$0.00,"$1,671.75","$2,648.05","$2,674.80",$0.00,$523.26,$0.00,$532.29,$0.00
449.444,SUP,HCPCS C1713,,449.444  -  PLATE MAXFACL 5X17 HOLE RIGHT ANG MCVSC 2.4 MM SCR BONE TI,"$3,660.75",$0.00,"$3,660.75","$1,647.34","$2,612.68",$0.00,$630.73,$0.00,$0.00,$640.97,"$3,660.75",$0.00,"$1,830.38","$2,899.31","$2,928.60",$0.00,$572.91,$0.00,$582.79,$0.00
449.445,SUP,HCPCS C1713,,449.445  -  PLATE MAXFACL 5X17 HOLE LEFT ANG MCVSC 2.4 MM SCR BONE TI,"$3,660.75",$0.00,"$3,660.75","$1,647.34","$2,612.68",$0.00,$630.73,$0.00,$0.00,$640.97,"$3,660.75",$0.00,"$1,830.38","$2,899.31","$2,928.60",$0.00,$572.91,$0.00,$582.79,$0.00
449.446,SUP,HCPCS C1713,,449.446  -  PLATE MAXFACL 6X18 HOLE RIGHT ANG MCVSC 2.4 MM SCR BONE TI,"$4,027.50",$0.00,"$4,027.50","$1,812.38","$2,874.43",$0.00,$693.92,$0.00,$0.00,$705.18,"$4,027.50",$0.00,"$2,013.75","$3,189.78","$3,222.00",$0.00,$630.30,$0.00,$641.18,$0.00
449.447,SUP,HCPCS C1713,,449.447  -  PLATE MAXFACL 6X18 HOLE LEFT ANG MCVSC 2.4 MM SCR BONE TI,"$4,027.50",$0.00,"$4,027.50","$1,812.38","$2,874.43",$0.00,$693.92,$0.00,$0.00,$705.18,"$4,027.50",$0.00,"$2,013.75","$3,189.78","$3,222.00",$0.00,$630.30,$0.00,$641.18,$0.00
449.448,SUP,HCPCS C1713,,449.448  -  PLATE MAXFACL 6X21 HOLE RIGHT ANG MCVSC 2.4 MM SCR BONE TI,"$4,401.00",$0.00,"$4,401.00","$1,980.45","$3,140.99",$0.00,$758.27,$0.00,$0.00,$770.58,"$4,401.00",$0.00,"$2,200.50","$3,485.59","$3,520.80",$0.00,$688.76,$0.00,$700.64,$0.00
449.449,SUP,HCPCS C1713,,449.449  -  PLATE MAXFACL 6X21 HOLE LEFT ANG MCVSC 2.4 MM SCR BONE TI,"$4,401.00",$0.00,"$4,401.00","$1,980.45","$3,140.99",$0.00,$758.27,$0.00,$0.00,$770.58,"$4,401.00",$0.00,"$2,200.50","$3,485.59","$3,520.80",$0.00,$688.76,$0.00,$700.64,$0.00
449.45,SUP,HCPCS C1713,,449.450  -  PLATE MAXFACL 4X20X4 HOLE 2 ANG MCVSC 2.4 MM SCR BONE TI,"$7,537.50",$0.00,"$7,537.50","$3,391.88","$5,158.80",$0.00,"$1,298.67",$0.00,$0.00,"$1,319.76","$7,537.50",$0.00,"$3,768.75","$5,969.70","$6,030.00",$0.00,"$1,179.62",$0.00,"$1,199.97",$0.00
449.451,SUP,HCPCS C1713,,449.451  -  PLATE MAXFACL 5X22X5 HOLE 2 ANG MCVSC 2.4 MM SCR BONE TI,"$7,850.25",$0.00,"$7,850.25","$3,532.61","$5,158.80",$0.00,"$1,352.56",$0.00,$0.00,"$1,374.52","$7,850.25",$0.00,"$3,925.13","$6,217.40","$6,280.20",$0.00,"$1,228.56",$0.00,"$1,249.76",$0.00
449.452,SUP,HCPCS C1713,,449.452  -  PLATE MAXFACL 6X24X6 HOLE 2 ANG MCVSC 2.4 MM SCR BONE TI,"$9,411.75",$0.00,"$9,411.75","$4,235.29","$5,158.80",$0.00,"$1,621.60",$0.00,$0.00,"$1,647.92","$9,411.75",$0.00,"$4,705.88","$7,454.11","$7,529.40",$0.00,"$1,472.94",$0.00,"$1,498.35",$0.00
449.612,SUP,HCPCS C1713,,449.612  -  PLATE 96MM MANDIB 12 HOLE LCK STR RECON 2.4/3MM SCR BONE TI,"$2,301.75",$0.00,"$2,301.75","$1,035.79","$1,642.76",$0.00,$396.58,$0.00,$0.00,$403.02,"$2,301.75",$0.00,"$1,150.88","$1,822.99","$1,841.40",$0.00,$360.22,$0.00,$366.44,$0.00
449.615,SUP,HCPCS C1713,,449.615  -  PLATE BONE 3 HOLE HEAD 7 HOLE SHAFT T LCP TITANIUM,"$1,311.53",$0.00,"$1,311.53",$590.19,$936.04,$0.00,$219.39,$0.00,$0.00,$229.64,"$1,311.53",$0.00,$655.76,"$1,038.73","$1,049.22",$0.00,$199.28,$0.00,$208.79,$0.00
449.62,SUP,HCPCS C1713,,449.62  -  PLATE 95MM MANDIB 12 HOLE STR LCK RECON 2.4MM SCR BONE TI,"$2,220.75",$0.00,"$2,220.75",$999.34,"$1,584.95",$0.00,$382.62,$0.00,$0.00,$388.84,"$2,220.75",$0.00,"$1,110.38","$1,758.83","$1,776.60",$0.00,$347.55,$0.00,$353.54,$0.00
449.621,SUP,HCPCS C1713,,449.621  -  PLATE BN STRG 160X8X2.5MM NS 20 HL LCK RECON TI MNDB 2.4/3MM,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
449.632,SUP,HCPCS C1713,,449.632  -  PLATE 214MM MANDIB 6X23 HOLE LEFT ANG LCK RECON 2.4MM SCR,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
449.633,SUP,HCPCS C1713,,449.633  -  PLATE BN ANG 214X44X2.4MM NS 44MM 6 HLE/HD 23 HL SHFT LOPRFL,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
449.636,SUP,HCPCS C1713,,449.636  -  PLATE MANDIB 4X20X4 HOLE LCK 2 ANG RECON 2.4/3 MM SCR BONE,"$5,553.00",$0.00,"$5,553.00","$2,498.85","$3,963.18",$0.00,$956.75,$0.00,$0.00,$972.29,"$5,553.00",$0.00,"$2,776.50","$4,397.98","$4,442.40",$0.00,$869.04,$0.00,$884.04,$0.00
449.637,SUP,HCPCS C1713,,449.637  -  PLATE MANDIB 5X22X5 HOLE LCK 2 ANG RECON 2.4/3 MM SCR BONE,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
449.638,SUP,HCPCS C1713,,449.638  -  PLATE MANDIB 6X24X6 HOLE LCK 2 ANG RECON 2.4/3 MM SCR BONE,"$6,187.50",$0.00,"$6,187.50","$2,784.38","$4,416.02",$0.00,"$1,066.08",$0.00,$0.00,"$1,083.38","$6,187.50",$0.00,"$3,093.75","$4,900.50","$4,950.00",$0.00,$968.34,$0.00,$985.05,$0.00
449.644,SUP,HCPCS C1713,,449.644  -  PLATE RIGHT CNDYLR HEAD MANDIB 3X16 HOLE LCK RECON 2.4 MM,"$9,706.50",$0.00,"$9,706.50","$4,367.93","$5,158.80",$0.00,"$1,672.38",$0.00,$0.00,"$1,699.53","$9,706.50",$0.00,"$4,853.25","$7,687.55","$7,765.20",$0.00,"$1,519.07",$0.00,"$1,545.27",$0.00
449.645,SUP,HCPCS C1713,,449.645  -  PLATE LEFT CNDYLR HEAD MANDIB 3X16 HOLE LCK RECON 2.4 MM SCR,"$9,706.50",$0.00,"$9,706.50","$4,367.93","$5,158.80",$0.00,"$1,672.38",$0.00,$0.00,"$1,699.53","$9,706.50",$0.00,"$4,853.25","$7,687.55","$7,765.20",$0.00,"$1,519.07",$0.00,"$1,545.27",$0.00
449.646,SUP,HCPCS C1713,,449.646  -  PLATE RIGHT CNDYLR HEAD MANDIB 4X18 HOLE LCK RECON 2.4 MM,"$10,248.75",$0.00,"$10,248.75","$4,611.94","$5,158.80",$0.00,"$1,765.81",$0.00,$0.00,"$1,794.47","$10,248.75",$0.00,"$5,124.38","$8,117.01","$8,199.00",$0.00,"$1,603.93",$0.00,"$1,631.60",$0.00
449.647,SUP,HCPCS C1713,,449.647  -  PLATE LEFT CNDYLR HEAD MANDIB 4X18 HOLE LCK RECON 2.4 MM SCR,"$10,248.75",$0.00,"$10,248.75","$4,611.94","$5,158.80",$0.00,"$1,765.81",$0.00,$0.00,"$1,794.47","$10,248.75",$0.00,"$5,124.38","$8,117.01","$8,199.00",$0.00,"$1,603.93",$0.00,"$1,631.60",$0.00
449.648,SUP,HCPCS C1713,,449.648  -  PLATE TI 2.4 MM SCR 5X20 HOLE LCK RECON LCP BONE RIGHT,"$10,782.00",$0.00,"$10,782.00","$4,851.90","$5,158.80",$0.00,"$1,857.68",$0.00,$0.00,"$1,887.84","$10,782.00",$0.00,"$5,391.00","$8,539.34","$8,625.60",$0.00,"$1,687.38",$0.00,"$1,716.49",$0.00
449.649,SUP,HCPCS C1713,,449.649  -  PLATE LEFT CNDYLR HEAD MANDIB 5X20 HOLE LCK RECON 2.4 MM SCR,"$10,782.00",$0.00,"$10,782.00","$4,851.90","$5,158.80",$0.00,"$1,857.68",$0.00,$0.00,"$1,887.84","$10,782.00",$0.00,"$5,391.00","$8,539.34","$8,625.60",$0.00,"$1,687.38",$0.00,"$1,716.49",$0.00
449.651,SUP,HCPCS C1713,,449.651  -  PLATE MANDIB 3X3 HOLE LCK CRSNT ANG RECON 2.4/3 MM SCR BONE,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
449.652,SUP,HCPCS C1713,,449.652  -  PLATE MANDIB 3X3 HOLE LCK ANG RECON 2.4/3 MM SCR BONE TI,"$2,756.25",$0.00,"$2,756.25","$1,240.31","$1,967.14",$0.00,$474.89,$0.00,$0.00,$482.60,"$2,756.25",$0.00,"$1,378.13","$2,182.95","$2,205.00",$0.00,$431.35,$0.00,$438.80,$0.00
449.653,SUP,HCPCS C1713,,449.653  -  PLATE MANDIB 4X4 HOLE LCK ANG RECON 2.4/3 MM SCR BONE TI,"$2,972.25",$0.00,"$2,972.25","$1,337.51","$2,121.29",$0.00,$512.10,$0.00,$0.00,$520.42,"$2,972.25",$0.00,"$1,486.13","$2,354.02","$2,377.80",$0.00,$465.16,$0.00,$473.18,$0.00
449.654,SUP,HCPCS C1713,,449.654  -  PLATE MANDIB 5X8 HOLE LCK LEFT ANG RECON 2.4/3 MM SCR BONE,"$3,242.25",$0.00,"$3,242.25","$1,459.01","$2,313.99",$0.00,$558.62,$0.00,$0.00,$567.69,"$3,242.25",$0.00,"$1,621.13","$2,567.86","$2,593.80",$0.00,$507.41,$0.00,$516.17,$0.00
449.655,SUP,HCPCS C1713,,449.655  -  PLATE MANDIB 5X8 HOLE LCK RIGHT ANG RECON 2.4/3 MM SCR BONE,"$3,242.25",$0.00,"$3,242.25","$1,459.01","$2,313.99",$0.00,$558.62,$0.00,$0.00,$567.69,"$3,242.25",$0.00,"$1,621.13","$2,567.86","$2,593.80",$0.00,$507.41,$0.00,$516.17,$0.00
449.669,SUP,HCPCS C1713,,449.669  -  PLATE BONE 3 HOLE HEAD 7 HOLE SHAFT Y LCP TITANIUM,"$1,311.53",$0.00,"$1,311.53",$590.19,$936.04,$0.00,$219.39,$0.00,$0.00,$229.64,"$1,311.53",$0.00,$655.76,"$1,038.73","$1,049.22",$0.00,$199.28,$0.00,$208.79,$0.00
449.67,SUP,HCPCS C1713,,449.670  -  PLATE BONE T 58MM 2X7 HOLE LCP TITANIUM CONDYLE NONSTRL 2.4,"$1,311.53",$0.00,"$1,311.53",$590.19,$936.04,$0.00,$219.39,$0.00,$0.00,$229.64,"$1,311.53",$0.00,$655.76,"$1,038.73","$1,049.22",$0.00,$199.28,$0.00,$208.79,$0.00
449.674,SUP,HCPCS C1713,,449.674  -  PLATE BONE 36MM 4 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 2.4MM,$713.78,$0.00,$713.78,$321.20,$509.42,$0.00,$119.40,$0.00,$0.00,$124.98,$713.78,$0.00,$356.89,$565.31,$571.02,$0.00,$108.45,$0.00,$113.63,$0.00
449.676,SUP,HCPCS C1713,,449.676  -  PLATE BONE 52MM 6 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 2.4MM,$713.78,$0.00,$713.78,$321.20,$509.42,$0.00,$119.40,$0.00,$0.00,$124.98,$713.78,$0.00,$356.89,$565.31,$571.02,$0.00,$108.45,$0.00,$113.63,$0.00
449.678,SUP,HCPCS C1713,,449.678  -  PLATE BONE 68MM 8 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 2.4MM,$713.78,$0.00,$713.78,$321.20,$509.42,$0.00,$119.40,$0.00,$0.00,$124.98,$713.78,$0.00,$356.89,$565.31,$571.02,$0.00,$108.45,$0.00,$113.63,$0.00
449.679,SUP,HCPCS C1713,,449.679  -  PLATE BONE 7 HOLE LCP TITANIUM CONDYLE NONSTRL 2.4 MM SCREW,"$1,071.33",$0.00,"$1,071.33",$482.10,$764.60,$0.00,$179.21,$0.00,$0.00,$187.58,"$1,071.33",$0.00,$535.66,$848.49,$857.06,$0.00,$162.78,$0.00,$170.55,$0.00
449.68,SUP,HCPCS C1713,,449.680  -  PLATE BONE 40MM 4 HOLE LCP TITANIUM CONDYLE NONSTRL 2.7MM,$753.35,$0.00,$753.35,$339.01,$537.67,$0.00,$126.02,$0.00,$0.00,$131.91,$753.35,$0.00,$376.68,$596.65,$602.68,$0.00,$114.46,$0.00,$119.93,$0.00
449.681,SUP,HCPCS C1713,,449.681  -  PLATE BONE 49MM 5 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 2.7MM,$753.35,$0.00,$753.35,$339.01,$537.67,$0.00,$126.02,$0.00,$0.00,$131.91,$753.35,$0.00,$376.68,$596.65,$602.68,$0.00,$114.46,$0.00,$119.93,$0.00
449.682,SUP,HCPCS C1713,,449.682  -  PLATE BONE 6 HOLE LCP TITANIUM CONDYLE NONSTRL 2.4 MM SCREW,$753.35,$0.00,$753.35,$339.01,$537.67,$0.00,$126.02,$0.00,$0.00,$131.91,$753.35,$0.00,$376.68,$596.65,$602.68,$0.00,$114.46,$0.00,$119.93,$0.00
449.683,SUP,HCPCS C1713,,449.683  -  PLATE BONE 67MM 7 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 2.7MM,$753.35,$0.00,$753.35,$339.01,$537.67,$0.00,$126.02,$0.00,$0.00,$131.91,$753.35,$0.00,$376.68,$596.65,$602.68,$0.00,$114.46,$0.00,$119.93,$0.00
449.684,SUP,HCPCS C1713,,449.684  -  PLATE BONE 7 HOLE LCP TITANIUM CONDYLE NONSTRL 2.7 MM SCREWS,"$1,168.23",$0.00,"$1,168.23",$525.70,$833.76,$0.00,$195.42,$0.00,$0.00,$204.55,"$1,168.23",$0.00,$584.11,$925.24,$934.58,$0.00,$177.50,$0.00,$185.98,$0.00
449.685,SUP,HCPCS C1713,,449.685  -  PLATE BONE 2 HOLE HEAD 3 HOLE SHAFT T LCP TITANIUM,"$1,311.53",$0.00,"$1,311.53",$590.19,$936.04,$0.00,$219.39,$0.00,$0.00,$229.64,"$1,311.53",$0.00,$655.76,"$1,038.73","$1,049.22",$0.00,$199.28,$0.00,$208.79,$0.00
449.686,SUP,HCPCS C1713,,449.686  -  PLATE BONE 2 HOLE HEAD 3 HOLE SHAFT L RIGHT OBLIQUE LCP,$715.13,$0.00,$715.13,$321.81,$510.38,$0.00,$119.62,$0.00,$0.00,$125.21,$715.13,$0.00,$357.56,$566.38,$572.10,$0.00,$108.66,$0.00,$113.85,$0.00
449.687,SUP,HCPCS C1713,,449.687  -  PLATE BONE 2 HOLE HEAD 3 HOLE SHAFT L LEFT OBLIQUE LCP,$715.13,$0.00,$715.13,$321.81,$510.38,$0.00,$119.62,$0.00,$0.00,$125.21,$715.13,$0.00,$357.56,$566.38,$572.10,$0.00,$108.66,$0.00,$113.85,$0.00
449.688,SUP,HCPCS C1713,,449.688  -  PLATE BONE 2 HOLE HEAD 3 HOLE SHAFT L LCP TITANIUM RIGHT,$715.13,$0.00,$715.13,$321.81,$510.38,$0.00,$119.62,$0.00,$0.00,$125.21,$715.13,$0.00,$357.56,$566.38,$572.10,$0.00,$108.66,$0.00,$113.85,$0.00
449.689,SUP,HCPCS C1713,,449.689  -  PLATE BONE 2.7MM 2 HOLE HEAD 3 HOLE SHAFT LCP TITANIUM LEFT,$715.13,$0.00,$715.13,$321.81,$510.38,$0.00,$119.62,$0.00,$0.00,$125.21,$715.13,$0.00,$357.56,$566.38,$572.10,$0.00,$108.66,$0.00,$113.85,$0.00
449.69,SUP,HCPCS C1713,,449.690  -  PLATE BONE 31MM 5 HOLE LOCKING TITANIUM HIND MIDFT NONSTRL,"$1,454.83",$0.00,"$1,454.83",$654.67,"$1,038.31",$0.00,$243.36,$0.00,$0.00,$254.73,"$1,454.83",$0.00,$727.41,"$1,152.23","$1,163.86",$0.00,$221.05,$0.00,$231.61,$0.00
449.691,SUP,HCPCS C1713,,449.691  -  PLATE BONE 45MM 8 HOLE LOCKING TITANIUM HIND MIDFT NONSTRL,"$1,484.85",$0.00,"$1,484.85",$668.18,"$1,059.74",$0.00,$248.38,$0.00,$0.00,$259.99,"$1,484.85",$0.00,$742.43,"$1,176.00","$1,187.88",$0.00,$225.61,$0.00,$236.39,$0.00
449.697,SUP,HCPCS C1713,,449.697  -  PLATE BONE 2 HOLE HEAD 4 HOLE SHAFT T LCP TITANIUM,"$1,311.53",$0.00,"$1,311.53",$590.19,$936.04,$0.00,$219.39,$0.00,$0.00,$229.64,"$1,311.53",$0.00,$655.76,"$1,038.73","$1,049.22",$0.00,$199.28,$0.00,$208.79,$0.00
449.698,SUP,HCPCS C1713,,449.698  -  PLATE BONE 2 HOLE HEAD 4 HOLE SHAFT L RIGHT OBLIQUE LCP,$738.33,$0.00,$738.33,$332.25,$526.94,$0.00,$123.51,$0.00,$0.00,$129.27,$738.33,$0.00,$369.16,$584.76,$590.66,$0.00,$112.18,$0.00,$117.54,$0.00
449.699,SUP,HCPCS C1713,,449.699  -  PLATE BONE 2 HOLE HEAD 4 HOLE SHAFT L LEFT OBLIQUE LCP,$738.33,$0.00,$738.33,$332.25,$526.94,$0.00,$123.51,$0.00,$0.00,$129.27,$738.33,$0.00,$369.16,$584.76,$590.66,$0.00,$112.18,$0.00,$117.54,$0.00
449.7,SUP,HCPCS C1713,,449.70  -  PLATE MANDIB 20 HOLE STR RECON 2.4 MM SCR BONE TI NONSTRL,"$3,154.50",$0.00,"$3,154.50","$1,419.53","$2,251.37",$0.00,$543.50,$0.00,$0.00,$552.33,"$3,154.50",$0.00,"$1,577.25","$2,498.36","$2,523.60",$0.00,$493.68,$0.00,$502.20,$0.00
449.701,SUP,HCPCS C1713,,449.701  -  PLATE BONE 2 HOLE HEAD 4 HOLE SHAFT L LCP TITANIUM RIGHT,$738.33,$0.00,$738.33,$332.25,$526.94,$0.00,$123.51,$0.00,$0.00,$129.27,$738.33,$0.00,$369.16,$584.76,$590.66,$0.00,$112.18,$0.00,$117.54,$0.00
449.702,SUP,HCPCS C1713,,449.702  -  PLATE BONE 2 HOLE HEAD 4 HOLE SHAFT L LCP TITANIUM LEFT,$738.33,$0.00,$738.33,$332.25,$526.94,$0.00,$123.51,$0.00,$0.00,$129.27,$738.33,$0.00,$369.16,$584.76,$590.66,$0.00,$112.18,$0.00,$117.54,$0.00
449.82,SUP,HCPCS C1713,,449.82  -  PLATE UNV 26MM CRNMXF 3X3 HOLE ANG 2.4MM SCR FRAC BONE TI,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
449.84,SUP,HCPCS C1713,,449.84  -  PLATE UNV 32MM MANDIB 4X4 HOLE ANG FRAC 2.4MM SCR BONE TI,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
449.87,SUP,HCPCS C1713,,449.87  -  PLATE 97X47MM MANDIB 5X13 HOLE ANG RECON 2.4MM SCR BONE TI,"$3,471.75",$0.00,"$3,471.75","$1,562.29","$2,477.79",$0.00,$598.17,$0.00,$0.00,$607.88,"$3,471.75",$0.00,"$1,735.88","$2,749.63","$2,777.40",$0.00,$543.33,$0.00,$552.70,$0.00
449.88,SUP,HCPCS C1713,,449.88  -  PLATE MANDIB ANG RECON 2.4 MM SCR BONE TI NONSTRL,"$3,471.75",$0.00,"$3,471.75","$1,562.29","$2,477.79",$0.00,$598.17,$0.00,$0.00,$607.88,"$3,471.75",$0.00,"$1,735.88","$2,749.63","$2,777.40",$0.00,$543.33,$0.00,$552.70,$0.00
449.906,SUP,HCPCS C1713,,449.906  -  PLATE BN STRG 36X6.3X1.25MM NS 6 HL LOPRFL PRECONTOUR CUT TO,$431.25,$0.00,$431.25,$194.06,$307.78,$0.00,$72.14,$0.00,$0.00,$75.51,$431.25,$0.00,$215.63,$341.55,$345.00,$0.00,$65.53,$0.00,$68.66,$0.00
449.912,SUP,HCPCS C1713,,449.912  -  PLATE BN STRG 72X6.3X1.25MM NS 12 HL LOPRFL PRECONTOUR CUT,$507.68,$0.00,$507.68,$228.45,$362.33,$0.00,$84.92,$0.00,$0.00,$88.89,$507.68,$0.00,$253.84,$402.08,$406.14,$0.00,$77.14,$0.00,$80.82,$0.00
449.913,SUP,HCPCS C1713,,449.913  -  PLATE BN T 54X6.3X1.25MM NS 2 HLE/HD 8 HL SHFT LOPRFL,$483.13,$0.00,$483.13,$217.41,$344.81,$0.00,$80.81,$0.00,$0.00,$84.59,$483.13,$0.00,$241.56,$382.64,$386.50,$0.00,$73.41,$0.00,$76.91,$0.00
449.914,SUP,HCPCS C1713,,449.914  -  PLATE BN T 54X6.3X1.25MM NS 3 HLE/HD 8 HL SHFT LOPRFL,$515.88,$0.00,$515.88,$232.14,$368.18,$0.00,$86.29,$0.00,$0.00,$90.33,$515.88,$0.00,$257.94,$408.58,$412.70,$0.00,$78.38,$0.00,$82.13,$0.00
449.915,SUP,HCPCS C1713,,449.915  -  PLATE BN Y 56X6.3X1.25MM NS 3 HLE/HD 8 HL SHFT LOPRFL,$499.50,$0.00,$499.50,$224.78,$356.49,$0.00,$83.55,$0.00,$0.00,$87.46,$499.50,$0.00,$249.75,$395.60,$399.60,$0.00,$75.89,$0.00,$79.52,$0.00
449.916,SUP,HCPCS C1713,,449.916  -  PLATE BN 57X6.3X1.25MM NS 8 HL LOPRFL PRECONTOUR CUT TO LGTH,$563.65,$0.00,$563.65,$253.64,$402.28,$0.00,$94.28,$0.00,$0.00,$98.69,$563.65,$0.00,$281.83,$446.41,$450.92,$0.00,$85.64,$0.00,$89.73,$0.00
449.917,SUP,HCPCS C1713,,449.917  -  PLATE BN 57X6.3X1.25MM NS 8 HL LOPRFL PRECONTOUR CUT TO LGTH,$563.65,$0.00,$563.65,$253.64,$402.28,$0.00,$94.28,$0.00,$0.00,$98.69,$563.65,$0.00,$281.83,$446.41,$450.92,$0.00,$85.64,$0.00,$89.73,$0.00
449.924,SUP,HCPCS C1713,,449.924  -  PLATE BN 31X6.5X1.6MM NS LC DCP 4 HL LOPRFL PRECONTOUR CUT,$600.50,$0.00,$600.50,$270.23,$428.58,$0.00,$100.45,$0.00,$0.00,$105.14,$600.50,$0.00,$300.25,$475.60,$480.40,$0.00,$91.24,$0.00,$95.60,$0.00
449.926,SUP,HCPCS C1713,,449.926  -  PLATE BN 47X6.5X1.6MM NS LC DCP 6 HL LOPRFL PRECONTOUR CUT,$675.55,$0.00,$675.55,$304.00,$482.14,$0.00,$113.00,$0.00,$0.00,$118.28,$675.55,$0.00,$337.78,$535.04,$540.44,$0.00,$102.64,$0.00,$107.55,$0.00
449.928,SUP,HCPCS C1713,,449.928  -  PLATE BN 63X6.5X1.6MM NS LC DCP 8 HL LOPRFL PRECONTOUR CUT,$728.78,$0.00,$728.78,$327.95,$520.13,$0.00,$155.45,$0.00,$0.00,$127.60,$728.78,$0.00,$364.39,$577.19,$583.02,$0.00,$141.20,$0.00,$116.02,$0.00
449.931,SUP,HCPCS C1713,,449.931  -  PLATE BN 24X5.5X1.25MM NS LC DCP 4 HL LOPRFL PRECONTOUR TI,$431.25,$0.00,$431.25,$194.06,$307.78,$0.00,$72.14,$0.00,$0.00,$75.51,$431.25,$0.00,$215.63,$341.55,$345.00,$0.00,$65.53,$0.00,$68.66,$0.00
449.936,SUP,HCPCS C1713,,449.936  -  PLATE BN 36X5.5X1.25MM NS LC DCP 6 HL LOPRFL PRECONTOUR TI,$507.68,$0.00,$507.68,$228.45,$362.33,$0.00,$84.92,$0.00,$0.00,$88.89,$507.68,$0.00,$253.84,$402.08,$406.14,$0.00,$77.14,$0.00,$80.82,$0.00
449.938,SUP,HCPCS C1713,,449.938  -  PLATE BN 48X5.5X1.25MM NS LC DCP 8 HL LOPRFL PRECONTOUR TI,$577.30,$0.00,$577.30,$259.79,$412.02,$0.00,$96.57,$0.00,$0.00,$101.08,$577.30,$0.00,$288.65,$457.22,$461.84,$0.00,$87.71,$0.00,$91.91,$0.00
450.101,SUP,HCPCS C1713,,450.101  -  PLATE BONE 90MM CRANFCL TI 20 HOLE ADP MALBLE 1.5MM SCR,$819.00,$0.00,$819.00,$368.55,$584.52,$0.00,$141.11,$0.00,$0.00,$143.40,$819.00,$0.00,$409.50,$648.65,$655.20,$0.00,$128.17,$0.00,$130.38,$0.00
450.611,SUP,HCPCS C1713,,450.611  -  PLATE BONE CRANFCL TI 5 HOLE Y MALBLE 1.5 MM SCR NONSTRL,$567.00,$0.00,$567.00,$255.15,$404.67,$0.00,$97.69,$0.00,$0.00,$99.28,$567.00,$0.00,$283.50,$449.06,$453.60,$0.00,$88.74,$0.00,$90.27,$0.00
450.861,SUP,HCPCS C1713,,450.861  -  SCREW BONE FULTHD 6MM 45MM SELF TAP LOCKING HEXAGONAL RECESS,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$62.78,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$57.02,$0.00,$57.57,$0.00
450.862,SUP,HCPCS C1713,,450.862  -  SCREW BONE 6MM 50MM LOCKING HEXAGONAL RECESS AQUA TITANIUM,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$62.78,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$57.02,$0.00,$57.57,$0.00
450.863,SUP,HCPCS C1713,,450.863  -  SCREW BONE 6MM 55MM LOCKING HEXAGONAL RECESS AQUA TITANIUM,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$62.78,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$57.02,$0.00,$57.57,$0.00
450.864,SUP,HCPCS C1713,,450.864  -  SCREW BONE 6MM 60MM LOCKING HEXAGONAL RECESS AQUA TITANIUM,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$62.78,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$57.02,$0.00,$57.57,$0.00
450.865,SUP,HCPCS C1713,,450.865  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 6MM 8MM 65MM 2 LEAD,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$62.78,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$57.02,$0.00,$57.57,$0.00
450.866,SUP,HCPCS C1713,,450.866  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 6MM 8MM 70MM 2 LEAD,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$62.78,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$57.02,$0.00,$57.57,$0.00
450.867,SUP,HCPCS C1713,,450.867  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 6MM 8MM 75MM 2 LEAD,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$62.78,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$57.02,$0.00,$57.57,$0.00
450.868,SUP,HCPCS C1713,,450.868  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 6MM 8MM 80MM 2 LEAD,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$62.78,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$57.02,$0.00,$57.57,$0.00
450.869,SUP,HCPCS C1713,,450.869  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 6MM 8MM 85MM 2 LEAD,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$62.78,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$57.02,$0.00,$57.57,$0.00
450.87,SUP,HCPCS C1713,,450.870  -  SCREW BONE 6MM 90MM LOCKING HEXAGONAL RECESS AQUA TITANIUM,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$62.78,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$57.02,$0.00,$57.57,$0.00
450.871,SUP,HCPCS C1713,,450.871  -  SCREW BONE 6MM 95MM LOCKING HEXAGONAL RECESS AQUA TITANIUM,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$62.78,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$57.02,$0.00,$57.57,$0.00
450.872,SUP,HCPCS C1713,,450.872  -  SCREW BONE 6MM 100MM LOCKING HEXAGONAL RECESS AQUA TITANIUM,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$62.78,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$57.02,$0.00,$57.57,$0.00
450.873,SUP,HCPCS C1713,,450.873  -  SCREW BONE 3.5MM FULTHD 6MM 8MM 30MM 2 LEAD THREAD LOCKING,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$62.78,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$57.02,$0.00,$57.57,$0.00
450.874,SUP,HCPCS C1713,,450.874  -  SCREW BONE FULTHD 6MM 4.8MM 35MM 2 LEAD THREAD LOCKING,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$62.78,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$57.02,$0.00,$57.57,$0.00
450.875,SUP,HCPCS C1713,,450.875  -  SCREW BONE FULTHD 6MM 4.8MM 40MM 2 LEAD THREAD LOCKING,$361.65,$0.00,$361.65,$162.74,$258.11,$0.00,$62.78,$0.00,$0.00,$63.32,$361.65,$0.00,$180.83,$286.43,$289.32,$0.00,$57.02,$0.00,$57.57,$0.00
451.101,SUP,HCPCS C1713,,451.101  -  PLATE BONE 100MM CRANFCL TI 20 HOLE ADP MALBLE 1.5MM SCR,"$1,017.00",$0.00,"$1,017.00",$457.65,$725.83,$0.00,$175.22,$0.00,$0.00,$178.07,"$1,017.00",$0.00,$508.50,$805.46,$813.60,$0.00,$159.16,$0.00,$161.91,$0.00
451.611,SUP,HCPCS C1713,,451.611  -  PLATE BONE CRANFCL TI 5 HOLE Y MALBLE 2 MM SCR NONSTRL,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
457.07,SUP,HCPCS C1713,,457.070  -  SCREW BONE 5MM 70MM TI FEM SLFTAP SHFT NONSTRL GOLD,$518.33,$0.00,$518.33,$233.25,$369.93,$0.00,$89.30,$0.00,$0.00,$90.75,$518.33,$0.00,$259.16,$410.52,$414.66,$0.00,$81.12,$0.00,$82.52,$0.00
457.075,SUP,HCPCS C1713,,457.075  -  SCREW BONE 5MM 75MM TI CANC SHFT NONSTRL GOLD IM NAIL,$518.33,$0.00,$518.33,$233.25,$369.93,$0.00,$89.30,$0.00,$0.00,$90.75,$518.33,$0.00,$259.16,$410.52,$414.66,$0.00,$81.12,$0.00,$82.52,$0.00
457.08,SUP,HCPCS C1713,,457.080  -  SCREW BONE 5MM 80MM TI FEM SHFT NONSTRL GOLD,$518.33,$0.00,$518.33,$233.25,$369.93,$0.00,$89.30,$0.00,$0.00,$90.75,$518.33,$0.00,$259.16,$410.52,$414.66,$0.00,$81.12,$0.00,$82.52,$0.00
457.085,SUP,HCPCS C1713,,457.085  -  SCREW BONE 5MM 85MM TI FEM SHFT NONSTRL GOLD,$518.33,$0.00,$518.33,$233.25,$369.93,$0.00,$89.30,$0.00,$0.00,$90.75,$518.33,$0.00,$259.16,$410.52,$414.66,$0.00,$81.12,$0.00,$82.52,$0.00
457.09,SUP,HCPCS C1713,,457.090  -  SCREW BONE 5MM 90MM TI FEM SHFT NONSTRL GOLD,$518.33,$0.00,$518.33,$233.25,$369.93,$0.00,$89.30,$0.00,$0.00,$90.75,$518.33,$0.00,$259.16,$410.52,$414.66,$0.00,$81.12,$0.00,$82.52,$0.00
457.095,SUP,HCPCS C1713,,457.095  -  SCREW BONE 5MM 95MM TI FEM SHFT NONSTRL GOLD,$518.33,$0.00,$518.33,$233.25,$369.93,$0.00,$89.30,$0.00,$0.00,$90.75,$518.33,$0.00,$259.16,$410.52,$414.66,$0.00,$81.12,$0.00,$82.52,$0.00
457.1,SUP,HCPCS C1713,,457.100  -  SCREW BONE 5MM 100MM 16MM TI FEM SLFTAP SHFT FRN CUT FLUT,$518.33,$0.00,$518.33,$233.25,$369.93,$0.00,$89.30,$0.00,$0.00,$90.75,$518.33,$0.00,$259.16,$410.52,$414.66,$0.00,$81.12,$0.00,$82.52,$0.00
457.105,SUP,HCPCS C1713,,457.105  -  SCREW BONE 5MM 105MM TI FEM SHFT NONSTRL GOLD,$518.33,$0.00,$518.33,$233.25,$369.93,$0.00,$89.30,$0.00,$0.00,$90.75,$518.33,$0.00,$259.16,$410.52,$414.66,$0.00,$81.12,$0.00,$82.52,$0.00
457.11,SUP,HCPCS C1713,,457.110  -  SCREW BONE 5MM 110MM TI FEM SLFTAP SHFT FRN CUT FLUT STRL,$518.33,$0.00,$518.33,$233.25,$369.93,$0.00,$89.30,$0.00,$0.00,$90.75,$518.33,$0.00,$259.16,$410.52,$414.66,$0.00,$81.12,$0.00,$82.52,$0.00
457.115,SUP,HCPCS C1713,,457.115  -  SCREW BONE 5MM 115MM TI FEM SHFT NONSTRL GOLD,$518.33,$0.00,$518.33,$233.25,$369.93,$0.00,$89.30,$0.00,$0.00,$90.75,$518.33,$0.00,$259.16,$410.52,$414.66,$0.00,$81.12,$0.00,$82.52,$0.00
457.12,SUP,HCPCS C1713,,457.120  -  SCREW BONE GOLD 120MM 5MM FEM TI SLFTAP SHFT FRN CUT FLUT,$518.33,$0.00,$518.33,$233.25,$369.93,$0.00,$89.30,$0.00,$0.00,$90.75,$518.33,$0.00,$259.16,$410.52,$414.66,$0.00,$81.12,$0.00,$82.52,$0.00
457.125,SUP,HCPCS C1713,,457.125  -  SCREW BONE 5MM 125MM TI FEM SLFTAP SHFT FRN CUT FLUT STRL,$518.33,$0.00,$518.33,$233.25,$369.93,$0.00,$89.30,$0.00,$0.00,$90.75,$518.33,$0.00,$259.16,$410.52,$414.66,$0.00,$81.12,$0.00,$82.52,$0.00
458.818,SUP,HCPCS C1713,,458.818  -  SCREW BONE 4MM 3.3MM 18MM SELF CUTTING TROCAR TIP LOCKING,$330.00,$0.00,$330.00,$148.50,$235.52,$0.00,$56.86,$0.00,$0.00,$57.78,$330.00,$0.00,$165.00,$261.36,$264.00,$0.00,$51.65,$0.00,$52.54,$0.00
458.82,SUP,HCPCS C1713,,458.820  -  SCREW BONE TROCAR 4MM 8MM 20MM 2 LEAD THREAD LOCKING SLFTAP,$330.00,$0.00,$330.00,$148.50,$235.52,$0.00,$56.86,$0.00,$0.00,$57.78,$330.00,$0.00,$165.00,$261.36,$264.00,$0.00,$51.65,$0.00,$52.54,$0.00
458.822,SUP,HCPCS C1713,,458.822  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 22MM 2 LEAD,$330.00,$0.00,$330.00,$148.50,$235.52,$0.00,$56.86,$0.00,$0.00,$57.78,$330.00,$0.00,$165.00,$261.36,$264.00,$0.00,$51.65,$0.00,$52.54,$0.00
458.824,SUP,HCPCS C1713,,458.824  -  SCREW BONE 4MM 3.3MM 24MM SELF CUTTING TROCAR TIP LOCKING,$330.00,$0.00,$330.00,$148.50,$235.52,$0.00,$56.86,$0.00,$0.00,$57.78,$330.00,$0.00,$165.00,$261.36,$264.00,$0.00,$51.65,$0.00,$52.54,$0.00
458.826,SUP,HCPCS C1713,,458.826  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 26MM 2 LEAD,$330.00,$0.00,$330.00,$148.50,$235.52,$0.00,$56.86,$0.00,$0.00,$57.78,$330.00,$0.00,$165.00,$261.36,$264.00,$0.00,$51.65,$0.00,$52.54,$0.00
458.828,SUP,HCPCS C1713,,458.828  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 28MM 2 LEAD,$330.00,$0.00,$330.00,$148.50,$235.52,$0.00,$56.86,$0.00,$0.00,$57.78,$330.00,$0.00,$165.00,$261.36,$264.00,$0.00,$51.65,$0.00,$52.54,$0.00
458.83,SUP,HCPCS C1713,,458.830  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 30MM 2 LEAD,$330.00,$0.00,$330.00,$148.50,$235.52,$0.00,$56.86,$0.00,$0.00,$57.78,$330.00,$0.00,$165.00,$261.36,$264.00,$0.00,$51.65,$0.00,$52.54,$0.00
458.832,SUP,HCPCS C1713,,458.832  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 32MM 2 LEAD,$330.00,$0.00,$330.00,$148.50,$235.52,$0.00,$56.86,$0.00,$0.00,$57.78,$330.00,$0.00,$165.00,$261.36,$264.00,$0.00,$51.65,$0.00,$52.54,$0.00
458.834,SUP,HCPCS C1713,,458.834  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 34MM 2 LEAD,$330.00,$0.00,$330.00,$148.50,$235.52,$0.00,$56.86,$0.00,$0.00,$57.78,$330.00,$0.00,$165.00,$261.36,$264.00,$0.00,$51.65,$0.00,$52.54,$0.00
458.836,SUP,HCPCS C1713,,458.836  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 36MM 2 LEAD,$330.00,$0.00,$330.00,$148.50,$235.52,$0.00,$56.86,$0.00,$0.00,$57.78,$330.00,$0.00,$165.00,$261.36,$264.00,$0.00,$51.65,$0.00,$52.54,$0.00
458.838,SUP,HCPCS C1713,,458.838  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 38MM 2 LEAD,$330.00,$0.00,$330.00,$148.50,$235.52,$0.00,$56.86,$0.00,$0.00,$57.78,$330.00,$0.00,$165.00,$261.36,$264.00,$0.00,$51.65,$0.00,$52.54,$0.00
458.84,SUP,HCPCS C1713,,458.840  -  SCREW BONE HEXAGON TROCAR 4MM 3.3MM 40MM SELF CUT LOCK,$330.00,$0.00,$330.00,$148.50,$235.52,$0.00,$56.86,$0.00,$0.00,$57.78,$330.00,$0.00,$165.00,$261.36,$264.00,$0.00,$51.65,$0.00,$52.54,$0.00
458.842,SUP,HCPCS C1713,,458.842  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 42MM 2 LEAD,$330.00,$0.00,$330.00,$148.50,$235.52,$0.00,$56.86,$0.00,$0.00,$57.78,$330.00,$0.00,$165.00,$261.36,$264.00,$0.00,$51.65,$0.00,$52.54,$0.00
458.844,SUP,HCPCS C1713,,458.844  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 44MM 2 LEAD,$330.00,$0.00,$330.00,$148.50,$235.52,$0.00,$56.86,$0.00,$0.00,$57.78,$330.00,$0.00,$165.00,$261.36,$264.00,$0.00,$51.65,$0.00,$52.54,$0.00
458.846,SUP,HCPCS C1713,,458.846  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 46MM 2 LEAD,$330.00,$0.00,$330.00,$148.50,$235.52,$0.00,$56.86,$0.00,$0.00,$57.78,$330.00,$0.00,$165.00,$261.36,$264.00,$0.00,$51.65,$0.00,$52.54,$0.00
458.848,SUP,HCPCS C1713,,458.848  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 48MM 2 LEAD,$330.00,$0.00,$330.00,$148.50,$235.52,$0.00,$56.86,$0.00,$0.00,$57.78,$330.00,$0.00,$165.00,$261.36,$264.00,$0.00,$51.65,$0.00,$52.54,$0.00
458.85,SUP,HCPCS C1713,,458.850  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 50MM 2 LEAD,$330.00,$0.00,$330.00,$148.50,$235.52,$0.00,$56.86,$0.00,$0.00,$57.78,$330.00,$0.00,$165.00,$261.36,$264.00,$0.00,$51.65,$0.00,$52.54,$0.00
458.852,SUP,HCPCS C1713,,458.852  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 52MM 2 LEAD,$330.00,$0.00,$330.00,$148.50,$235.52,$0.00,$56.86,$0.00,$0.00,$57.78,$330.00,$0.00,$165.00,$261.36,$264.00,$0.00,$51.65,$0.00,$52.54,$0.00
458.854,SUP,HCPCS C1713,,458.854  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 54MM 2 LEAD,$330.00,$0.00,$330.00,$148.50,$235.52,$0.00,$56.86,$0.00,$0.00,$57.78,$330.00,$0.00,$165.00,$261.36,$264.00,$0.00,$51.65,$0.00,$52.54,$0.00
458.856,SUP,HCPCS C1713,,458.856  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 56MM 2 LEAD,$330.00,$0.00,$330.00,$148.50,$235.52,$0.00,$56.86,$0.00,$0.00,$57.78,$330.00,$0.00,$165.00,$261.36,$264.00,$0.00,$51.65,$0.00,$52.54,$0.00
458.858,SUP,HCPCS C1713,,458.858  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 58MM 2 LEAD,$330.00,$0.00,$330.00,$148.50,$235.52,$0.00,$56.86,$0.00,$0.00,$57.78,$330.00,$0.00,$165.00,$261.36,$264.00,$0.00,$51.65,$0.00,$52.54,$0.00
458.86,SUP,HCPCS C1713,,458.860  -  SCREW BONE TROCAR 4MM 8MM 60MM 2 LEAD THREAD LOCKING SLFTAP,$330.00,$0.00,$330.00,$148.50,$235.52,$0.00,$56.86,$0.00,$0.00,$57.78,$330.00,$0.00,$165.00,$261.36,$264.00,$0.00,$51.65,$0.00,$52.54,$0.00
458.862,SUP,HCPCS C1713,,458.862  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 62MM 2 LEAD,$330.00,$0.00,$330.00,$148.50,$235.52,$0.00,$56.86,$0.00,$0.00,$57.78,$330.00,$0.00,$165.00,$261.36,$264.00,$0.00,$51.65,$0.00,$52.54,$0.00
458.864,SUP,HCPCS C1713,,458.864  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 64MM 2 LEAD,$330.00,$0.00,$330.00,$148.50,$235.52,$0.00,$56.86,$0.00,$0.00,$57.78,$330.00,$0.00,$165.00,$261.36,$264.00,$0.00,$51.65,$0.00,$52.54,$0.00
458.866,SUP,HCPCS C1713,,458.866  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 66MM 2 LEAD,$330.00,$0.00,$330.00,$148.50,$235.52,$0.00,$56.86,$0.00,$0.00,$57.78,$330.00,$0.00,$165.00,$261.36,$264.00,$0.00,$51.65,$0.00,$52.54,$0.00
458.868,SUP,HCPCS C1713,,458.868  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 68MM 2 LEAD,$330.00,$0.00,$330.00,$148.50,$235.52,$0.00,$56.86,$0.00,$0.00,$57.78,$330.00,$0.00,$165.00,$261.36,$264.00,$0.00,$51.65,$0.00,$52.54,$0.00
458.87,SUP,HCPCS C1713,,458.870  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 70MM 2 LEAD,$330.00,$0.00,$330.00,$148.50,$235.52,$0.00,$56.86,$0.00,$0.00,$57.78,$330.00,$0.00,$165.00,$261.36,$264.00,$0.00,$51.65,$0.00,$52.54,$0.00
458.872,SUP,HCPCS C1713,,458.872  -  SCREW BONE TROCAR FULTHD 4MM 8MM 72MM 2 LEAD THREAD LOCKING,$330.00,$0.00,$330.00,$148.50,$235.52,$0.00,$56.86,$0.00,$0.00,$57.78,$330.00,$0.00,$165.00,$261.36,$264.00,$0.00,$51.65,$0.00,$52.54,$0.00
458.874,SUP,HCPCS C1713,,458.874  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 74MM 2 LEAD,$330.00,$0.00,$330.00,$148.50,$235.52,$0.00,$56.86,$0.00,$0.00,$57.78,$330.00,$0.00,$165.00,$261.36,$264.00,$0.00,$51.65,$0.00,$52.54,$0.00
458.876,SUP,HCPCS C1713,,458.876  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 76MM 2 LEAD,$330.00,$0.00,$330.00,$148.50,$235.52,$0.00,$56.86,$0.00,$0.00,$57.78,$330.00,$0.00,$165.00,$261.36,$264.00,$0.00,$51.65,$0.00,$52.54,$0.00
458.878,SUP,HCPCS C1713,,458.878  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 78MM 2 LEAD,$330.00,$0.00,$330.00,$148.50,$235.52,$0.00,$56.86,$0.00,$0.00,$57.78,$330.00,$0.00,$165.00,$261.36,$264.00,$0.00,$51.65,$0.00,$52.54,$0.00
458.88,SUP,HCPCS C1713,,458.880  -  SCREW BONE TROCAR 4MM 8MM 80MM 2 LEAD THREAD SLFTAP,$330.00,$0.00,$330.00,$148.50,$235.52,$0.00,$56.86,$0.00,$0.00,$57.78,$330.00,$0.00,$165.00,$261.36,$264.00,$0.00,$51.65,$0.00,$52.54,$0.00
458.926,SUP,HCPCS C1713,,458.926  -  SCREW BONE 5MM 26MM NLEX TI DISTAL FEM/TIB LCK HEX RECESS,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
458.928,SUP,HCPCS C1713,,458.928  -  SCREW BONE NONSTRL IM NAIL 5MM 28MM NLEX TI DISTAL FEM/TIB,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
458.93,SUP,HCPCS C1713,,458.930  -  SCREW BONE NONSTRL 5MM 30MM NLEX TI DISTAL FEM/TIB LCK HEX,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
458.932,SUP,HCPCS C1713,,458.932  -  SCREW BONE NONSTRL IM NAIL 5MM 32MM NLEX TI DISTAL FEM/TIB,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
458.934,SUP,HCPCS C1713,,458.934  -  SCREW BONE NONSTRL IM NAIL 5MM 34MM NLEX TI DISTAL FEM/TIB,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
458.936,SUP,HCPCS C1713,,458.936  -  SCREW BONE NONSTRL IM NAIL 5MM 36MM NLEX TI DISTAL FEM/TIB,$307.65,$0.00,$307.65,$138.44,$219.57,$0.00,$53.01,$0.00,$0.00,$53.87,$307.65,$0.00,$153.83,$243.66,$246.12,$0.00,$48.15,$0.00,$48.98,$0.00
458.938,SUP,HCPCS C1713,,458.938  -  SCREW BONE 5MM 38MM NLEX TI DISTAL FEM/TIB LCK HEX RECESS,$307.65,$0.00,$307.65,$138.44,$219.57,$0.00,$53.01,$0.00,$0.00,$53.87,$307.65,$0.00,$153.83,$243.66,$246.12,$0.00,$48.15,$0.00,$48.98,$0.00
458.94,SUP,HCPCS C1713,,458.940  -  SCREW BONE 5MM 40MM NLEX TI DISTAL FEM/TIB LCK HEX RECESS,$307.65,$0.00,$307.65,$138.44,$219.57,$0.00,$53.01,$0.00,$0.00,$53.87,$307.65,$0.00,$153.83,$243.66,$246.12,$0.00,$48.15,$0.00,$48.98,$0.00
458.942,SUP,HCPCS C1713,,458.942  -  SCREW BONE 5MM 42MM NLEX TI DISTAL FEM/TIB LCK HEX RECESS,$307.65,$0.00,$307.65,$138.44,$219.57,$0.00,$53.01,$0.00,$0.00,$53.87,$307.65,$0.00,$153.83,$243.66,$246.12,$0.00,$48.15,$0.00,$48.98,$0.00
458.944,SUP,HCPCS C1713,,458.944  -  SCREW BONE 5MM 44MM NLEX TI DISTAL FEM/TIB LCK HEX RECESS,$307.65,$0.00,$307.65,$138.44,$219.57,$0.00,$53.01,$0.00,$0.00,$53.87,$307.65,$0.00,$153.83,$243.66,$246.12,$0.00,$48.15,$0.00,$48.98,$0.00
458.946,SUP,HCPCS C1713,,458.946  -  SCREW BONE 5MM 46MM NLEX TI DISTAL FEM/TIB LCK HEX RECESS,$307.65,$0.00,$307.65,$138.44,$219.57,$0.00,$53.01,$0.00,$0.00,$53.87,$307.65,$0.00,$153.83,$243.66,$246.12,$0.00,$48.15,$0.00,$48.98,$0.00
458.948,SUP,HCPCS C1713,,458.948  -  SCREW BONE 5MM 48MM NLEX TI DISTAL FEM/TIB LCK HEX RECESS,$307.65,$0.00,$307.65,$138.44,$219.57,$0.00,$53.01,$0.00,$0.00,$53.87,$307.65,$0.00,$153.83,$243.66,$246.12,$0.00,$48.15,$0.00,$48.98,$0.00
458.95,SUP,HCPCS C1713,,458.950  -  SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 5MM 8MM 50MM 2 LEAD,$330.00,$0.00,$330.00,$148.50,$235.52,$0.00,$56.86,$0.00,$0.00,$57.78,$330.00,$0.00,$165.00,$261.36,$264.00,$0.00,$51.65,$0.00,$52.54,$0.00
458.952,SUP,HCPCS C1713,,458.952  -  SCREW BONE 5MM 52MM NLEX TI DISTAL FEM/TIB LCK HEX RECESS,$307.65,$0.00,$395.83,$178.12,$282.50,$0.00,$53.01,$0.00,$0.00,$69.31,$395.83,$0.00,$197.91,$243.66,$316.66,$0.00,$48.15,$0.00,$63.02,$0.00
458.954,SUP,HCPCS C1713,,458.954  -  SCREW BONE NONSTRL CANN IM NAIL 5MM 54MM NLEX TI DISTAL,$307.65,$0.00,$307.65,$138.44,$219.57,$0.00,$53.01,$0.00,$0.00,$53.87,$307.65,$0.00,$153.83,$243.66,$246.12,$0.00,$48.15,$0.00,$48.98,$0.00
458.956,SUP,HCPCS C1713,,458.956  -  SCREW BONE NONSTRL IM NAIL 5MM 56MM NLEX TI DISTAL FEM/TIB,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
458.958,SUP,HCPCS C1713,,458.958  -  SCREW BONE NONSTRL IM NAIL 5MM 58MM NLEX TI DISTAL FEM/TIB,$307.65,$0.00,$307.65,$138.44,$219.57,$0.00,$53.01,$0.00,$0.00,$53.87,$307.65,$0.00,$153.83,$243.66,$246.12,$0.00,$48.15,$0.00,$48.98,$0.00
458.96,SUP,HCPCS C1713,,458.960  -  SCREW BONE NONSTRL IM NAIL 5MM 60MM NLEX TI DISTAL FEM/TIB,$307.65,$0.00,$307.65,$138.44,$219.57,$0.00,$53.01,$0.00,$0.00,$53.87,$307.65,$0.00,$153.83,$243.66,$246.12,$0.00,$48.15,$0.00,$48.98,$0.00
458.964,SUP,HCPCS C1713,,458.964  -  SCREW BONE 5MM 64MM NLEX TI DISTAL FEM/TIB LCK HEX RECESS,$307.65,$0.00,$307.65,$138.44,$219.57,$0.00,$53.01,$0.00,$0.00,$53.87,$307.65,$0.00,$153.83,$243.66,$246.12,$0.00,$48.15,$0.00,$48.98,$0.00
458.968,SUP,HCPCS C1713,,458.968  -  SCREW BONE NONSTRL CANN IM NAIL 5MM 68MM NLEX TI DISTAL,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
458.972,SUP,HCPCS C1713,,458.972  -  SCREW BONE 5MM 72MM NLEX TI DISTAL FEM/TIB LCK HEX RECESS,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
458.976,SUP,HCPCS C1713,,458.976  -  SCREW BONE 5MM 76MM NLEX TI DISTAL FEM/TIB LCK HEX RECESS,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
458.98,SUP,HCPCS C1713,,458.980  -  SCREW BONE NONSTRL CANN IM NAIL 5MM 80MM NLEX TI DISTAL,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
458.985,SUP,HCPCS C1713,,458.985  -  SCREW BONE 5MM 85MM TI ALLOY LCK SLFTAP NONSTRL,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
458.99,SUP,HCPCS C1713,,458.990  -  SCREW BONE 5MM 90MM NLEX TI DISTAL FEM/TIB LCK HEX RECESS,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
458.995,SUP,HCPCS C1713,,458.995  -  SCREW BONE 5MM 95MM NLEX TI DISTAL FEM/TIB LCK HEX RECESS,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
458.999,SUP,HCPCS C1713,,458.999  -  SCREW BONE 5MM 100MM NLEX TI DISTAL FEM/TIB LCK HEX RECESS,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
459.68,SUP,HCPCS C1713,,459.68  -  BOLT LOCKING HEXAGON 4.9MM 8MM 68MM SELF TAP SELF CUT TROCAR,$328.90,$0.00,$328.90,$148.01,$234.74,$0.00,$57.09,$0.00,$0.00,$57.59,$328.90,$0.00,$164.45,$260.49,$263.12,$0.00,$51.86,$0.00,$52.36,$0.00
460,SUP,Custom 27203010,,460  -  DRESSING GZE 12X12IN LF QUIKCLOT TRAUMAPAD 3 PLY NWVN FLXB,$145.58,$0.00,$145.58,$0.00,$103.90,$0.00,$0.00,$0.00,$0.00,$0.00,$145.58,$0.00,$72.79,$115.30,$116.46,$0.00,$0.00,$0.00,$0.00,$0.00
460.022,SUP,HCPCS C1713,,460.022  -  PIN FIX EMERGENCY RELEASE TITANIUM STERNUM NONSTRL,$226.25,$0.00,$226.25,$101.81,$161.47,$0.00,$38.98,$0.00,$0.00,$39.61,$226.25,$0.00,$113.13,$179.19,$181.00,$0.00,$35.41,$0.00,$36.02,$0.00
460.023,SUP,HCPCS C1713,,460.023  -  PLATE BONE STR 20 HOLE LOCKING TITANIUM STERNUM NONSTRL 2.4,"$5,407.50",$0.00,"$5,407.50","$2,433.38","$3,859.33",$0.00,$931.69,$0.00,$0.00,$946.81,"$5,407.50",$0.00,"$2,703.75","$4,282.74","$4,326.00",$0.00,$846.27,$0.00,$860.87,$0.00
460.027,SUP,HCPCS C1713,,460.027  -  PLATE BONE H SMALL 8 HOLE LOCKING TITANIUM MANUBRIUM STERNUM,"$2,380.00",$0.00,"$2,380.00","$1,071.00","$1,698.61",$0.00,$410.06,$0.00,$0.00,$416.72,"$2,380.00",$0.00,"$1,190.00","$1,884.96","$1,904.00",$0.00,$372.47,$0.00,$378.90,$0.00
460.028,SUP,HCPCS C1713,,460.028  -  PLATE BONE H LARGE 8 HOLE LOCKING TITANIUM MANUBRIUM STERNUM,"$2,380.00",$0.00,"$2,380.00","$1,071.00","$1,698.61",$0.00,$410.06,$0.00,$0.00,$416.72,"$2,380.00",$0.00,"$1,190.00","$1,884.96","$1,904.00",$0.00,$372.47,$0.00,$378.90,$0.00
460.035,SUP,HCPCS C1713,,460.035  -  PLATE BONE STAR 6 HOLE LOCKING TITANIUM STERNUM NONSTRL,"$2,260.00",$0.00,"$2,260.00","$1,017.00","$1,612.96",$0.00,$389.39,$0.00,$0.00,$395.71,"$2,260.00",$0.00,"$1,130.00","$1,789.92","$1,808.00",$0.00,$353.69,$0.00,$359.79,$0.00
460.036,SUP,HCPCS C1713,,460.036  -  PLATE BONE STAR 12 HOLE LOCKING TITANIUM STERNUM NONSTRL,"$2,827.50",$0.00,"$2,827.50","$1,272.38","$2,017.99",$0.00,$487.16,$0.00,$0.00,$495.07,"$2,827.50",$0.00,"$1,413.75","$2,239.38","$2,262.00",$0.00,$442.50,$0.00,$450.14,$0.00
460.037,SUP,HCPCS C1713,,460.037  -  PLATE BONE X 10 HOLE LOCKING TITANIUM STERNUM NONSTRL,"$2,492.50",$0.00,"$2,492.50","$1,121.63","$1,778.90",$0.00,$429.45,$0.00,$0.00,$436.42,"$2,492.50",$0.00,"$1,246.25","$1,974.06","$1,994.00",$0.00,$390.08,$0.00,$396.81,$0.00
460.038,SUP,HCPCS C1713,,460.038  -  PLATE BONE 2T 14 HOLE LOCKING TITANIUM STERNUM NONSTRL,"$2,825.00",$0.00,"$2,825.00","$1,271.25","$2,016.20",$0.00,$486.73,$0.00,$0.00,$494.63,"$2,825.00",$0.00,"$1,412.50","$2,237.40","$2,260.00",$0.00,$442.11,$0.00,$449.74,$0.00
460.039,SUP,HCPCS C1713,,460.039  -  PLATE BONE ANGLED 12 HOLE LOCKING TITANIUM STERNUM NONSTRL,"$3,817.50",$0.00,"$3,817.50","$1,717.88","$2,724.55",$0.00,$657.74,$0.00,$0.00,$668.41,"$3,817.50",$0.00,"$1,908.75","$3,023.46","$3,054.00",$0.00,$597.44,$0.00,$607.75,$0.00
460.04,SUP,HCPCS C1713,,460.040  -  PLATE BONE X 10 HOLE LOCKING TITANIUM STERNUM NONSTRL,"$2,492.50",$0.00,"$2,492.50","$1,121.63","$1,778.90",$0.00,$429.45,$0.00,$0.00,$436.42,"$2,492.50",$0.00,"$1,246.25","$1,974.06","$1,994.00",$0.00,$390.08,$0.00,$396.81,$0.00
460.045,SUP,HCPCS C1713,,460.045  -  PLATE BONE STR 8 HOLE LOCKING TITANIUM STERNUM NONSTRL,"$2,720.00",$0.00,"$2,720.00","$1,224.00","$1,941.26",$0.00,$468.64,$0.00,$0.00,$476.25,"$2,720.00",$0.00,"$1,360.00","$2,154.24","$2,176.00",$0.00,$425.68,$0.00,$433.02,$0.00
460.046,SUP,HCPCS C1713,,460.046  -  PLATE BONE STR 13 HOLE LOCKING TITANIUM STERNUM NONSTRL,"$2,825.00",$0.00,"$2,825.00","$1,271.25","$2,016.20",$0.00,$486.73,$0.00,$0.00,$494.63,"$2,825.00",$0.00,"$1,412.50","$2,237.40","$2,260.00",$0.00,$442.11,$0.00,$449.74,$0.00
461,SUP,Custom 27203010,,461  -  DRESSING GAUZE 4YDX3IN ROLL HEMOSTATIC QUIKCLOT,$1.70,$0.00,$101.22,$0.00,$72.24,$0.00,$0.00,$0.00,$0.00,$0.00,$101.22,$0.00,$50.61,$1.35,$80.98,$0.00,$0.00,$0.00,$0.00,$0.00
462.64,SUP,HCPCS C1713,,462.640  -  BLADE IM NAIL GOLD 40MM HUM TI SPRL SLD NONSTRL,"$1,253.08",$0.00,"$1,253.08",$563.88,$894.32,$0.00,$215.90,$0.00,$0.00,$219.40,"$1,253.08",$0.00,$626.54,$992.44,"$1,002.46",$0.00,$196.11,$0.00,$199.49,$0.00
462.644,SUP,HCPCS C1713,,462.644  -  BLADE IM FIX GOLD 44CM HUM TI SPRL NONSTRL,"$1,253.08",$0.00,"$1,253.08",$563.88,$894.32,$0.00,$215.90,$0.00,$0.00,$219.40,"$1,253.08",$0.00,$626.54,$992.44,"$1,002.46",$0.00,$196.11,$0.00,$199.49,$0.00
476,SUP,Custom 27803010,,00476  -  TUBE NG 45IN 10FR SDPRT WT STY FLXFL PU PED STRL,$22.88,$0.00,$22.88,$0.00,$16.33,$0.00,$0.00,$0.00,$0.00,$0.00,$22.88,$0.00,$11.44,$18.12,$18.30,$0.00,$0.00,$0.00,$0.00,$0.00
482.823,SUP,HCPCS C1713,,482.823  -  PLATE BONE 17X10X.7MM 7 HOLE BUTTON OVAL TITANIUM ORTHOPEDIC,$700.13,$0.00,$700.13,$315.06,$499.68,$0.00,$117.11,$0.00,$0.00,$122.59,$700.13,$0.00,$350.06,$554.50,$560.10,$0.00,$106.38,$0.00,$111.46,$0.00
487.931,SUP,Custom 27803010,,487.931  -  DISTRACTOR SURG MULTI VECTOR BODY TITANIUM MANDIB NONSTRL,"$12,302.50",$0.00,"$12,302.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$12,302.50",$0.00,"$6,151.25","$9,743.58","$9,842.00",$0.00,$0.00,$0.00,$0.00,$0.00
487.933,SUP,Custom 27803010,,487.933  -  DISTRACTOR SURG 15MM MULTI VECTOR ARM TITANIUM MANDIB,$797.50,$0.00,$797.50,$0.00,$569.18,$0.00,$0.00,$0.00,$0.00,$0.00,$797.50,$0.00,$398.75,$631.62,$638.00,$0.00,$0.00,$0.00,$0.00,$0.00
487.934,SUP,Custom 27803010,,487.934  -  DISTRACTOR SURG 25MM MULTI VECTOR ARM TITANIUM MANDIB,$797.50,$0.00,$797.50,$0.00,$569.18,$0.00,$0.00,$0.00,$0.00,$0.00,$797.50,$0.00,$398.75,$631.62,$638.00,$0.00,$0.00,$0.00,$0.00,$0.00
487.935,SUP,Custom 27803010,,487.935  -  DISTRACTOR SURG 35MM MULTI VECTOR ARM TITANIUM MANDIB,$797.50,$0.00,$797.50,$0.00,$569.18,$0.00,$0.00,$0.00,$0.00,$0.00,$797.50,$0.00,$398.75,$631.62,$638.00,$0.00,$0.00,$0.00,$0.00,$0.00
487.937,SUP,Custom 27803010,,487.937  -  DISTRACTOR SURG NUT LINEAR ACTIVATION TITANIUM MANDIB,$297.50,$0.00,$297.50,$0.00,$212.33,$0.00,$0.00,$0.00,$0.00,$0.00,$297.50,$0.00,$148.75,$235.62,$238.00,$0.00,$0.00,$0.00,$0.00,$0.00
487.938,SUP,Custom 27803010,,487.938  -  DISTRACTOR SURG MULTI VECTOR PIN HOLDING CLMP TITANIUM,"$2,622.50",$0.00,"$2,622.50",$0.00,"$1,871.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,622.50",$0.00,"$1,311.25","$2,077.02","$2,098.00",$0.00,$0.00,$0.00,$0.00,$0.00
487.939,SUP,Custom 27803010,,487.939  -  DISTRACTOR SURG MULTI VECTOR PIN HOLDING BODY TITANIUM,"$2,622.50",$0.00,"$2,622.50",$0.00,"$1,871.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,622.50",$0.00,"$1,311.25","$2,077.02","$2,098.00",$0.00,$0.00,$0.00,$0.00,$0.00
487.94,SUP,Custom 27203010,,487.940  -  CLAMP EXFIX UNIVERSAL PIN HOLDING TITANIUM MULTI VECTOR,"$2,622.50",$0.00,"$2,622.50",$0.00,"$1,871.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,622.50",$0.00,"$1,311.25","$2,077.02","$2,098.00",$0.00,$0.00,$0.00,$0.00,$0.00
487.941,SUP,Custom 27203010,,487.941  -  CLAMP EXFIX BODY PIN HOLDING MULTIVECTOR DISTRCT BLUE,"$2,622.50",$0.00,"$2,622.50",$0.00,"$1,871.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,622.50",$0.00,"$1,311.25","$2,077.02","$2,098.00",$0.00,$0.00,$0.00,$0.00,$0.00
487.942,SUP,Custom 27203010,,487.942  -  CLAMP EXFIX RAMUS PIN HOLDING MULTIVECTOR DISTRCT GOLD,"$2,622.50",$0.00,"$2,622.50",$0.00,"$1,871.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,622.50",$0.00,"$1,311.25","$2,077.02","$2,098.00",$0.00,$0.00,$0.00,$0.00,$0.00
487.96,SUP,HCPCS C1713,,487.960  -  PLATE 1.6MM MAXL ASMBLY BONE TI,"$1,838.25",$0.00,"$1,838.25",$827.21,"$1,311.96",$0.00,$316.72,$0.00,$0.00,$321.86,"$1,838.25",$0.00,$919.13,"$1,455.89","$1,470.60",$0.00,$287.69,$0.00,$292.65,$0.00
487.962,SUP,Custom 27803010,,487.962  -  FOOTPLATE BONE 20MM 1 VECTOR DISTRCT BODY TITANIUM MANDIB,"$16,635.00",$0.00,"$16,635.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$16,635.00",$0.00,"$8,317.50","$13,174.92","$13,308.00",$0.00,$0.00,$0.00,$0.00,$0.00
487.963,SUP,Custom 27803010,,487.963  -  FOOTPLATE BONE 20MM 1 VECTOR DISTRCT BODY TITANIUM MANDIB,"$16,635.00",$0.00,"$16,635.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$16,635.00",$0.00,"$8,317.50","$13,174.92","$13,308.00",$0.00,$0.00,$0.00,$0.00,$0.00
487.964,SUP,Custom 27803010,,487.964  -  FOOTPLATE BONE 30MM 1 VECTOR DISTRCT BODY TITANIUM MANDIB,"$16,635.00",$0.00,"$16,635.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$16,635.00",$0.00,"$8,317.50","$13,174.92","$13,308.00",$0.00,$0.00,$0.00,$0.00,$0.00
487.965,SUP,Custom 27803010,,487.965  -  FOOTPLATE BONE 30MM 1 VECTOR DISTRCT BODY TITANIUM MANDIB,"$16,635.00",$0.00,"$16,635.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$16,635.00",$0.00,"$8,317.50","$13,174.92","$13,308.00",$0.00,$0.00,$0.00,$0.00,$0.00
487.966,SUP,Custom 27803010,,487.966  -  DISTRACTOR SURG MULTI VECTOR ASMBLY TITANIUM RIGHT MANDIB,"$19,727.50",$0.00,"$19,727.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$19,727.50",$0.00,"$9,863.75","$15,624.18","$15,782.00",$0.00,$0.00,$0.00,$0.00,$0.00
487.967,SUP,Custom 27803010,,487.967  -  DISTRACTOR SURG MULTI VECTOR ASMBLY TITANIUM MANDIB LEFT,"$19,727.50",$0.00,"$19,727.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$19,727.50",$0.00,"$9,863.75","$15,624.18","$15,782.00",$0.00,$0.00,$0.00,$0.00,$0.00
487.971,SUP,Custom 27803010,,487.971  -  DISTRACTOR SURG 45MM MULTI VECTOR ARM TITANIUM MANDIB,$797.50,$0.00,$797.50,$0.00,$569.18,$0.00,$0.00,$0.00,$0.00,$0.00,$797.50,$0.00,$398.75,$631.62,$638.00,$0.00,$0.00,$0.00,$0.00,$0.00
487.973,SUP,Custom 27803010,,487.973  -  DISTRACTOR SURG 55MM MULTI VECTOR ARM TITANIUM MANDIB,$797.50,$0.00,$797.50,$0.00,$569.18,$0.00,$0.00,$0.00,$0.00,$0.00,$797.50,$0.00,$398.75,$631.62,$638.00,$0.00,$0.00,$0.00,$0.00,$0.00
487.974,SUP,Custom 27803010,,487.974  -  DISTRACTOR SURG 1 VECTOR TITANIUM MANDIB RIGHT NONSTRL,$690.00,$0.00,$690.00,$0.00,$492.45,$0.00,$0.00,$0.00,$0.00,$0.00,$690.00,$0.00,$345.00,$546.48,$552.00,$0.00,$0.00,$0.00,$0.00,$0.00
487.975,SUP,Custom 27803010,,487.975  -  DISTRACTOR SURG 1 VECTOR TITANIUM MANDIB LEFT NONSTRL,$690.00,$0.00,$690.00,$0.00,$492.45,$0.00,$0.00,$0.00,$0.00,$0.00,$690.00,$0.00,$345.00,$546.48,$552.00,$0.00,$0.00,$0.00,$0.00,$0.00
487.976,SUP,Custom 27803010,,487.976  -  DISTRACTOR SURG 65MM MULTI VECTOR ARM TITANIUM MANDIB,$797.50,$0.00,$797.50,$0.00,$569.18,$0.00,$0.00,$0.00,$0.00,$0.00,$797.50,$0.00,$398.75,$631.62,$638.00,$0.00,$0.00,$0.00,$0.00,$0.00
487.977,SUP,Custom 27803010,,487.977  -  DISTRACTOR SURG 75MM MULTI VECTOR ARM TITANIUM MANDIB,$797.50,$0.00,$797.50,$0.00,$569.18,$0.00,$0.00,$0.00,$0.00,$0.00,$797.50,$0.00,$398.75,$631.62,$638.00,$0.00,$0.00,$0.00,$0.00,$0.00
487.978,SUP,Custom 27803010,,487.978  -  DISTRACTOR SURG 85MM MULTI VECTOR ARM TITANIUM MANDIB,$797.50,$0.00,$797.50,$0.00,$569.18,$0.00,$0.00,$0.00,$0.00,$0.00,$797.50,$0.00,$398.75,$631.62,$638.00,$0.00,$0.00,$0.00,$0.00,$0.00
487.98,SUP,Custom 27803010,,487.980  -  DISTRACTOR SURG 7MM NUT HEXAGONAL TITANIUM MIDFAC NONSTRL,$347.50,$0.00,$347.50,$0.00,$248.01,$0.00,$0.00,$0.00,$0.00,$0.00,$347.50,$0.00,$173.75,$275.22,$278.00,$0.00,$0.00,$0.00,$0.00,$0.00
487.982,SUP,Custom 27803010,,487.982  -  DISTRACTOR SURG 40MM ASMBLY TITANIUM MIDFAC NONSTRL,"$13,747.50",$0.00,"$13,747.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,747.50",$0.00,"$6,873.75","$10,888.02","$10,998.00",$0.00,$0.00,$0.00,$0.00,$0.00
487.984,SUP,Custom 27803010,,487.984  -  FOOTPLATE BONE ELEVATE TITANIUM RIGHT ANTERIOR MIDFAC,"$2,452.50",$0.00,"$2,452.50",$0.00,"$1,750.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$0.00,$0.00,$0.00,$0.00
487.985,SUP,Custom 27803010,,487.985  -  FOOTPLATE BONE ELEVATE TITANIUM LEFT ANTERIOR MIDFAC NONSTRL,"$2,452.50",$0.00,"$2,452.50",$0.00,"$1,750.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$0.00,$0.00,$0.00,$0.00
487.986,SUP,Custom 27803010,,487.986  -  FOOTPLATE BONE LP SYMMETRICAL TITANIUM ANTERIOR MIDFAC,"$2,452.50",$0.00,"$2,452.50",$0.00,"$1,750.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$0.00,$0.00,$0.00,$0.00
487.987,SUP,Custom 27803010,,487.987  -  FOOTPLATE BONE ELEVATED SYMMETRICAL TITANIUM ANTERIOR MIDFAC,"$2,452.50",$0.00,"$2,452.50",$0.00,"$1,750.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$0.00,$0.00,$0.00,$0.00
487.988,SUP,Custom 27803010,,487.988  -  FOOTPLATE BONE MESH TITANIUM ANTERIOR MIDFAC NONSTRL MIDFAC,"$1,542.50",$0.00,"$1,542.50",$0.00,"$1,100.88",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,542.50",$0.00,$771.25,"$1,221.66","$1,234.00",$0.00,$0.00,$0.00,$0.00,$0.00
487.989,SUP,Custom 27803010,,487.989  -  FOOTPLATE BONE BUTTRESS TITANIUM ANTERIOR MIDFAC NONSTRL,"$1,542.50",$0.00,"$1,542.50",$0.00,"$1,100.88",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,542.50",$0.00,$771.25,"$1,221.66","$1,234.00",$0.00,$0.00,$0.00,$0.00,$0.00
487.99,SUP,Custom 27803010,,487.990  -  FOOTPLATE BONE 1 VECTOR TITANIUM MIDFAC POSTERIOR NONSTRL,"$2,452.50",$0.00,"$2,452.50",$0.00,"$1,750.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$0.00,$0.00,$0.00,$0.00
487.992,SUP,Custom 27803010,,487.992  -  DISTRACTOR SURG 20MM RIGID EXTN TITANIUM MIDFAC NONSTRL,"$1,252.50",$0.00,"$1,252.50",$0.00,$893.91,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,252.50",$0.00,$626.25,$991.98,"$1,002.00",$0.00,$0.00,$0.00,$0.00,$0.00
487.993,SUP,Custom 27803010,,487.993  -  DISTRACTOR SURG 20MM UNIVERSAL JOINT EXTN TITANIUM,"$2,505.00",$0.00,"$2,505.00",$0.00,"$1,787.82",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,505.00",$0.00,"$1,252.50","$1,983.96","$2,004.00",$0.00,$0.00,$0.00,$0.00,$0.00
487.994,SUP,Custom 27803010,,487.994  -  DISTRACTOR SURG 40MM FLEXIBLE CABLE EXTN TITANIUM MIDFAC,"$2,505.00",$0.00,"$2,505.00",$0.00,"$1,787.82",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,505.00",$0.00,"$1,252.50","$1,983.96","$2,004.00",$0.00,$0.00,$0.00,$0.00,$0.00
487.995,SUP,HCPCS C1713,,487.995  -  SCREW EXTERNAL DISTRCT EXTERNAL MIDFAC DISTRCT SYSTEM,$365.00,$0.00,$365.00,$164.25,$260.50,$0.00,$62.89,$0.00,$0.00,$63.91,$365.00,$0.00,$182.50,$289.08,$292.00,$0.00,$57.12,$0.00,$58.11,$0.00
488.066,SUP,HCPCS C1713,,488.066  -  SCREW BONE 1.6MM MACHINE TITANIUM CRANIAL NONSTRL,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
488.074,SUP,Custom 27803010,,488.074  -  DISTRACTOR SURG 8MM STR PLATE TITANIUM ALVEOLAR NONSTRL,"$2,595.00",$0.00,"$2,595.00",$0.00,"$1,852.05",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,595.00",$0.00,"$1,297.50","$2,055.24","$2,076.00",$0.00,$0.00,$0.00,$0.00,$0.00
488.075,SUP,Custom 27803010,,488.075  -  BODY DISTRCT 12MM STR PLATE TITANIUM ALVEOLAR NONSTRL,"$2,595.00",$0.00,"$2,595.00",$0.00,"$1,852.05",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,595.00",$0.00,"$1,297.50","$2,055.24","$2,076.00",$0.00,$0.00,$0.00,$0.00,$0.00
488.076,SUP,Custom 27803010,,488.076  -  BODY DISTRCT 16MM STR PLATE TITANIUM ALVEOLAR NONSTRL,"$2,595.00",$0.00,"$2,595.00",$0.00,"$1,852.05",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,595.00",$0.00,"$1,297.50","$2,055.24","$2,076.00",$0.00,$0.00,$0.00,$0.00,$0.00
488.75,SUP,HCPCS C1713,,488.750  -  SCREW BONE 4.35MM 25MM TI CANC CERV SPN BTRS LCK XPD HEAD,$547.75,$0.00,$547.75,$246.49,$390.93,$0.00,$94.37,$0.00,$0.00,$95.91,$547.75,$0.00,$273.88,$433.82,$438.20,$0.00,$85.72,$0.00,$87.20,$0.00
488.915,SUP,HCPCS C1713,,488.915  -  PLATE 30MM TI 2 HOLE LCK BTRS BONE SPNL NONSTRL,"$1,232.00",$0.00,"$1,232.00",$554.40,$879.28,$0.00,$212.27,$0.00,$0.00,$215.71,"$1,232.00",$0.00,$616.00,$975.74,$985.60,$0.00,$192.81,$0.00,$196.13,$0.00
492.08,SUP,Custom 27203010,,492.08  -  WIRE FX .8MM 70MM NS KRSH TROC PNT TI,$18.56,$0.00,$18.56,$0.00,$13.25,$0.00,$0.00,$0.00,$0.00,$0.00,$18.56,$0.00,$9.28,$14.70,$14.85,$0.00,$0.00,$0.00,$0.00,$0.00
492.1,SUP,Custom 27203010,,492.10  -  WIRE FX 1MM 150MM NS KRSH TROC PNT TI,$18.56,$0.00,$18.56,$0.00,$13.25,$0.00,$0.00,$0.00,$0.00,$0.00,$18.56,$0.00,$9.28,$14.70,$14.85,$0.00,$0.00,$0.00,$0.00,$0.00
492.12,SUP,Custom 27203010,,492.12  -  WIRE FX 1.25MM 150MM NS KRSH TROC PNT TI,$18.56,$0.00,$18.56,$0.00,$13.25,$0.00,$0.00,$0.00,$0.00,$0.00,$18.56,$0.00,$9.28,$14.70,$14.85,$0.00,$0.00,$0.00,$0.00,$0.00
492.16,SUP,Custom 27203010,,492.16  -  WIRE FX 1.6MM 150MM NS KRSH TROC PNT TI,$18.56,$0.00,$18.56,$0.00,$13.25,$0.00,$0.00,$0.00,$0.00,$0.00,$18.56,$0.00,$9.28,$14.70,$14.85,$0.00,$0.00,$0.00,$0.00,$0.00
492.18,SUP,Custom 27203010,,492.18  -  WIRE FX 1.6MM 285MM NS KRSH TROC PNT TI,$22.38,$0.00,$22.38,$0.00,$15.97,$0.00,$0.00,$0.00,$0.00,$0.00,$22.38,$0.00,$11.19,$17.72,$17.91,$0.00,$0.00,$0.00,$0.00,$0.00
492.2,SUP,Custom 27203010,,492.20  -  WIRE FX 2MM 150MM NS KRSH TROC PNT TI,$18.56,$0.00,$18.56,$0.00,$13.25,$0.00,$0.00,$0.00,$0.00,$0.00,$18.56,$0.00,$9.28,$14.70,$14.85,$0.00,$0.00,$0.00,$0.00,$0.00
492.21,SUP,Custom 27203010,,492.21  -  WIRE FX 2MM 285MM NS KRSH TROC PNT TI,$22.38,$0.00,$22.38,$0.00,$15.97,$0.00,$0.00,$0.00,$0.00,$0.00,$22.38,$0.00,$11.19,$17.72,$17.91,$0.00,$0.00,$0.00,$0.00,$0.00
492.25,SUP,Custom 27203010,,492.25  -  WIRE FX 2.5MM 150MM NS KRSH TROC PNT TI,$18.56,$0.00,$18.56,$0.00,$13.25,$0.00,$0.00,$0.00,$0.00,$0.00,$18.56,$0.00,$9.28,$14.70,$14.85,$0.00,$0.00,$0.00,$0.00,$0.00
492.26,SUP,Custom 27203010,,492.26  -  WIRE FX 2.5MM 285MM NS KRSH TROC PNT TI,$22.38,$0.00,$22.38,$0.00,$15.97,$0.00,$0.00,$0.00,$0.00,$0.00,$22.38,$0.00,$11.19,$17.72,$17.91,$0.00,$0.00,$0.00,$0.00,$0.00
492.3,SUP,Custom 27203010,,492.30  -  WIRE FX 3MM 150MM NS KRSH TROC PNT TI,$18.56,$0.00,$18.56,$0.00,$13.25,$0.00,$0.00,$0.00,$0.00,$0.00,$18.56,$0.00,$9.28,$14.70,$14.85,$0.00,$0.00,$0.00,$0.00,$0.00
492.31,SUP,Custom 27203010,,492.31  -  WIRE FX 3MM 285MM NS KRSH TROC PNT TI,$22.38,$0.00,$22.38,$0.00,$15.97,$0.00,$0.00,$0.00,$0.00,$0.00,$22.38,$0.00,$11.19,$17.72,$17.91,$0.00,$0.00,$0.00,$0.00,$0.00
494.769,SUP,HCPCS C1713,,494.769  -  SCREW BONE 4/2.5MM 80MM 20MM SLFDRILL REINFORCED BONE ANCHOR,$242.25,$0.00,$242.25,$109.01,$172.89,$0.00,$40.52,$0.00,$0.00,$42.42,$242.25,$0.00,$121.13,$191.86,$193.80,$0.00,$36.81,$0.00,$38.57,$0.00
494.771,SUP,HCPCS C1713,,494.771  -  SCREW XTRNFX 4MM 3MM 80MM NS 20MM SCHNZ SLF DRL MR,$270.38,$0.00,$270.38,$121.67,$192.97,$0.00,$45.23,$0.00,$0.00,$47.34,$270.38,$0.00,$135.19,$214.14,$216.30,$0.00,$41.08,$0.00,$43.04,$0.00
494.772,SUP,HCPCS C1713,,494.772  -  SCREW BONE 4/3MM 100MM 20MM SLFDRILL SCHANZ TITANIUM,$270.38,$0.00,$270.38,$121.67,$192.97,$0.00,$45.23,$0.00,$0.00,$47.34,$270.38,$0.00,$135.19,$214.14,$216.30,$0.00,$41.08,$0.00,$43.04,$0.00
494.774,SUP,HCPCS C1713,,494.774  -  SCREW BONE 4MM 60MM 20MM SLFDRILL SCHANZ TITANIUM ORTHOPEDIC,$270.38,$0.00,$270.38,$121.67,$192.97,$0.00,$45.23,$0.00,$0.00,$47.34,$270.38,$0.00,$135.19,$214.14,$216.30,$0.00,$41.08,$0.00,$43.04,$0.00
494.775,SUP,HCPCS C1713,,494.775  -  PIN HALF 4MM 80MM 20MM SLFDRILL SCHANZ TITANIUM ORTHOPEDIC,$270.38,$0.00,$270.38,$121.67,$192.97,$0.00,$45.23,$0.00,$0.00,$47.34,$270.38,$0.00,$135.19,$214.14,$216.30,$0.00,$41.08,$0.00,$43.04,$0.00
494.776,SUP,HCPCS C1713,,494.776  -  SCREW FIX 4MM 100MM 30MM SELF DRILL REINFORCE SYMMETRICAL,$270.38,$0.00,$270.38,$121.67,$192.97,$0.00,$45.23,$0.00,$0.00,$47.34,$270.38,$0.00,$135.19,$214.14,$216.30,$0.00,$41.08,$0.00,$43.04,$0.00
494.777,SUP,HCPCS C1713,,494.777  -  SCREW BONE 4MM 125MM 40MM SLFDRILL SCHANZ TITANIUM,$270.38,$0.00,$270.38,$121.67,$192.97,$0.00,$45.23,$0.00,$0.00,$47.34,$270.38,$0.00,$135.19,$214.14,$216.30,$0.00,$41.08,$0.00,$43.04,$0.00
494.778,SUP,HCPCS C1713,,494.778  -  SCREW BONE 4MM 150MM 40MM SLFDRILL SCHANZ TITANIUM,$270.38,$0.00,$270.38,$121.67,$192.97,$0.00,$45.23,$0.00,$0.00,$47.34,$270.38,$0.00,$135.19,$214.14,$216.30,$0.00,$41.08,$0.00,$43.04,$0.00
494.779,SUP,HCPCS C1713,,494.779  -  PIN HALF 4MM 175MM 40MM SLFDRILL SCHANZ TITANIUM ORTHOPEDIC,$270.38,$0.00,$270.38,$121.67,$192.97,$0.00,$45.23,$0.00,$0.00,$47.34,$270.38,$0.00,$135.19,$214.14,$216.30,$0.00,$41.08,$0.00,$43.04,$0.00
494.782,SUP,HCPCS C1713,,494.782  -  PIN HALF 5MM 100MM 30MM SLFDRILL SCHANZ TITANIUM ORTHOPEDIC,$311.48,$0.00,$311.48,$140.16,$222.30,$0.00,$52.10,$0.00,$0.00,$54.54,$311.48,$0.00,$155.74,$246.69,$249.18,$0.00,$47.33,$0.00,$49.59,$0.00
494.783,SUP,HCPCS C1713,,494.783  -  PIN HALF 5MM 125MM 40MM SLFDRILL SCHANZ TITANIUM ORTHOPEDIC,$311.48,$0.00,$311.48,$140.16,$222.30,$0.00,$52.10,$0.00,$0.00,$54.54,$311.48,$0.00,$155.74,$246.69,$249.18,$0.00,$47.33,$0.00,$49.59,$0.00
494.784,SUP,HCPCS C1713,,494.784  -  SCREW XTRNFX 5MM 150MM NS 60MM SCHNZ SLF DRL TI HIP CNDYL LG,$311.48,$0.00,$311.48,$140.16,$222.30,$0.00,$52.10,$0.00,$0.00,$54.54,$311.48,$0.00,$155.74,$246.69,$249.18,$0.00,$47.33,$0.00,$49.59,$0.00
494.785,SUP,HCPCS C1713,,494.785  -  SCREW XTRNFX 5MM 175MM NS 60MM SCHNZ SLF DRL MR CONDITIONAL,$311.48,$0.00,$311.48,$140.16,$222.30,$0.00,$52.10,$0.00,$0.00,$54.54,$311.48,$0.00,$155.74,$246.69,$249.18,$0.00,$47.33,$0.00,$49.59,$0.00
494.786,SUP,HCPCS C1713,,494.786  -  SCREW XTRNFX 5MM 200MM NS 80MM SCHNZ SLF DRL TI HIP CNDYL LG,$311.48,$0.00,$311.48,$140.16,$222.30,$0.00,$52.10,$0.00,$0.00,$54.54,$311.48,$0.00,$155.74,$246.69,$249.18,$0.00,$47.33,$0.00,$49.59,$0.00
494.788,SUP,HCPCS C1713,,494.788  -  PIN HALF 5MM 250MM 80MM SLFDRILL SCHANZ TITANIUM ORTHOPEDIC,$311.48,$0.00,$311.48,$140.16,$222.30,$0.00,$52.10,$0.00,$0.00,$54.54,$311.48,$0.00,$155.74,$246.69,$249.18,$0.00,$47.33,$0.00,$49.59,$0.00
494.792,SUP,HCPCS C1713,,494.792  -  SCREW BONE 6MM 100MM 30MM SLFDRILL SCHANZ TITANIUM,$332.03,$0.00,$332.03,$149.41,$236.97,$0.00,$55.54,$0.00,$0.00,$58.13,$332.03,$0.00,$166.01,$262.97,$265.62,$0.00,$50.45,$0.00,$52.86,$0.00
494.793,SUP,HCPCS C1713,,494.793  -  PIN HALF 6MM 125MM 40MM SLFDRILL SCHANZ TITANIUM ORTHOPEDIC,$332.03,$0.00,$332.03,$149.41,$236.97,$0.00,$55.54,$0.00,$0.00,$58.13,$332.03,$0.00,$166.01,$262.97,$265.62,$0.00,$50.45,$0.00,$52.86,$0.00
494.794,SUP,HCPCS C1713,,494.794  -  SCREW BONE 6MM 150MM 60MM SLFDRILL SCHANZ TITANIUM,$332.03,$0.00,$332.03,$149.41,$236.97,$0.00,$55.54,$0.00,$0.00,$58.13,$332.03,$0.00,$166.01,$262.97,$265.62,$0.00,$50.45,$0.00,$52.86,$0.00
494.795,SUP,HCPCS C1713,,494.795  -  PIN HALF 6MM 175MM 60MM SLFDRILL SCHANZ TITANIUM ORTHOPEDIC,$332.03,$0.00,$332.03,$149.41,$236.97,$0.00,$55.54,$0.00,$0.00,$58.13,$332.03,$0.00,$166.01,$262.97,$265.62,$0.00,$50.45,$0.00,$52.86,$0.00
494.796,SUP,HCPCS C1713,,494.796  -  SCREW BONE 6MM 200MM 80MM SLFDRILL SCHANZ TITANIUM,$332.03,$0.00,$332.03,$149.41,$236.97,$0.00,$55.54,$0.00,$0.00,$58.13,$332.03,$0.00,$166.01,$262.97,$265.62,$0.00,$50.45,$0.00,$52.86,$0.00
494.798,SUP,HCPCS C1713,,494.798  -  PIN HALF 6MM 250MM 80MM SLFDRILL SCHANZ TITANIUM ORTHOPEDIC,$332.03,$0.00,$332.03,$149.41,$236.97,$0.00,$55.54,$0.00,$0.00,$58.13,$332.03,$0.00,$166.01,$262.97,$265.62,$0.00,$50.45,$0.00,$52.86,$0.00
495.372,SUP,HCPCS C1713,,495.372  -  CAGE SPNL OBLNG 22X17X12MM NS SNMSH TI VERT BD REPL,"$4,375.00",$0.00,"$4,375.00","$1,968.75","$3,122.44",$0.00,$753.79,$0.00,$0.00,$766.03,"$4,375.00",$0.00,"$2,187.50","$3,465.00","$3,500.00",$0.00,$684.69,$0.00,$696.50,$0.00
495.394,SUP,HCPCS C1713,,495.394  -  RING SPNL 5D OBLNG 22MM 17MM 22X17MM NS SNMSH PRFT ALAT,$830.00,$0.00,$830.00,$373.50,$592.37,$0.00,$143.00,$0.00,$0.00,$145.33,$830.00,$0.00,$415.00,$657.36,$664.00,$0.00,$129.90,$0.00,$132.14,$0.00
497.674,SUP,HCPCS C1713,,497.674  -  SCREW TI 14MM 2.4MM MANDIB SLFTAP LCK BONE NONSTRL RECON PLT,$272.25,$0.00,$272.25,$122.51,$194.30,$0.00,$46.91,$0.00,$0.00,$47.67,$272.25,$0.00,$136.13,$215.62,$217.80,$0.00,$42.61,$0.00,$43.34,$0.00
497.676,SUP,HCPCS C1713,,497.676  -  SCREW TI 16MM 2.4MM MANDIB SLFTAP LCK BONE NONSTRL RECON PLT,$272.25,$0.00,$272.25,$122.51,$194.30,$0.00,$46.91,$0.00,$0.00,$47.67,$272.25,$0.00,$136.13,$215.62,$217.80,$0.00,$42.61,$0.00,$43.34,$0.00
497.678,SUP,HCPCS C1713,,497.678  -  SCREW TI 18MM 2.4MM MANDIB SLFTAP LCK BONE NONSTRL RECON PLT,$272.25,$0.00,$272.25,$122.51,$194.30,$0.00,$46.91,$0.00,$0.00,$47.67,$272.25,$0.00,$136.13,$215.62,$217.80,$0.00,$42.61,$0.00,$43.34,$0.00
497.78,SUP,HCPCS C1713,,497.78  -  SCREW BN 1.8MM 5MM LCK TI SPNE,$60.38,$0.00,$60.38,$27.17,$43.09,$0.00,$10.40,$0.00,$0.00,$10.57,$60.38,$0.00,$30.19,$47.82,$48.30,$0.00,$9.45,$0.00,$9.61,$0.00
497.797,SUP,Custom 27803010,,497.797  -  TRNCON ROD 35-41MM 6MM CLICKX PANGEA USS UNV SPNL TI LP,"$2,432.50",$0.00,"$2,432.50",$0.00,"$1,736.08",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,432.50",$0.00,"$1,216.25","$1,926.54","$1,946.00",$0.00,$0.00,$0.00,$0.00,$0.00
498.104,SUP,HCPCS C1713,,498.104  -  ROD SPNL 100MM 6MM USS TI HRD NONSTRL,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
498.105,SUP,HCPCS C1713,,498.105  -  ROD SPNL 125MM 6MM USS TI HRD NONSTRL,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
498.106,SUP,HCPCS C1713,,498.106  -  ROD SPNL 150MM 6MM USS TI HRD NONSTRL,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
498.108,SUP,HCPCS C1713,,498.108  -  ROD SPNL 200MM 6MM USS TI HRD NONSTRL,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
498.116,SUP,HCPCS C1713,,498.116  -  ROD SPNL 400MM 6MM USS TI HRD NONSTRL,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
498.12,SUP,HCPCS C1713,,498.120  -  BAR SPNL 80MM 3.5MM USS TI CONCTR TRNSVRS NONSTRL,$288.75,$0.00,$288.75,$129.94,$206.08,$0.00,$49.75,$0.00,$0.00,$50.56,$288.75,$0.00,$144.38,$228.69,$231.00,$0.00,$45.19,$0.00,$45.97,$0.00
498.125,SUP,HCPCS C1713,,498.125  -  CONNECTOR ROD STR 3.5MM 120MM SET UPPER BAR USS TITANIUM SPN,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
498.136,SUP,HCPCS C1713,,498.136  -  ROD SPNL 40MM 3.5MM AXON TI CVD NONSTRL,$353.50,$0.00,$353.50,$159.08,$252.29,$0.00,$60.91,$0.00,$0.00,$61.90,$353.50,$0.00,$176.75,$279.97,$282.80,$0.00,$55.32,$0.00,$56.28,$0.00
498.137,SUP,HCPCS C1713,,498.137  -  ROD SPINAL CURVE 3.5MM 80MM PREBENT AXON TITANIUM NONSTRL,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
498.141,SUP,HCPCS C1713,,498.141  -  ROD SPNL 65MM 6MM USS TI SFT CVD NONSTRL,$483.00,$0.00,$483.00,$217.35,$344.72,$0.00,$83.22,$0.00,$0.00,$84.57,$483.00,$0.00,$241.50,$382.54,$386.40,$0.00,$75.59,$0.00,$76.89,$0.00
500,SUP,Custom 27203010,,LYPHOCHEK ANEMIA CONTROL,$257.50,$0.00,$257.50,$0.00,$183.78,$0.00,$0.00,$0.00,$0.00,$0.00,$257.50,$0.00,$128.75,$203.94,$206.00,$0.00,$0.00,$0.00,$0.00,$0.00
510.01,SUP,HCPCS C1713,,"510.010  -  4.0MM FIXED SCREW SELF-DRILLING, 10MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
510.012,SUP,HCPCS C1713,,"510.012  -  4.0MM FIXED SCREW SELF-DRILLING, 12MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
510.014,SUP,HCPCS C1713,,"510.014  -  4.0MM FIXED SCREW SELF-DRILLING, 14MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
510.016,SUP,HCPCS C1713,,"510.016  -  4.0MM FIXED SCREW SELF-DRILLING, 16MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
510.03,SUP,HCPCS C1713,,"510.030  -  4.0MM FIXED SCREW SELF-TAPPING, 10MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
510.032,SUP,HCPCS C1713,,"510.032  -  4.0MM FIXED SCREW SELF-TAPPING, 12MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
510.034,SUP,HCPCS C1713,,"510.034  -  4.0MM FIXED SCREW SELF-TAPPING, 14MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
510.036,SUP,HCPCS C1713,,"510.036  -  4.0MM FIXED SCREW SELF-TAPPING, 16MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
510.038,SUP,HCPCS C1713,,"510.038  -  4.0MM FIXED SCREW SELF-TAPPING, 18MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
510.04,SUP,HCPCS C1713,,"510.040  -  4.0MM FIXED SCREW SELF-TAPPING, 20MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
510.512,SUP,HCPCS C1713,,"510.512  -  4.5MM FIXED SCREW SELF-DRILLING, 12MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
510.514,SUP,HCPCS C1713,,"510.514  -  4.5MM FIXED SCREW SELF-DRILLING, 14MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
510.516,SUP,HCPCS C1713,,"510.516  -  4.5MM FIXED SCREW SELF-DRILLING, 16MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
510.53,SUP,HCPCS C1713,,"510.530  -  4.5MM FIXED SCREW SELF-TAPPING, 10MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
510.532,SUP,HCPCS C1713,,"510.532  -  4.5MM FIXED SCREW SELF-TAPPING, 12MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
510.534,SUP,HCPCS C1713,,"510.534  -  4.5MM FIXED SCREW SELF-TAPPING, 14MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
510.536,SUP,HCPCS C1713,,"510.536  -  4.5MM FIXED SCREW SELF-TAPPING, 16MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
510.538,SUP,HCPCS C1713,,"510.538  -  4.5MM FIXED SCREW SELF-TAPPING, 18MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
510.54,SUP,HCPCS C1713,,"510.540  -  4.5MM FIXED SCREW SELF-TAPPING, 20MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
510.61,SUP,HCPCS C1713,,"510.610  -  4.0MM STANDARD SCREW FIXED SELF-DRILLING, 10MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
510.612,SUP,HCPCS C1713,,"510.612  -  4.0MM STANDARD SCREW FIXED SELF-DRILLING, 12MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
510.614,SUP,HCPCS C1713,,"510.614  -  4.0MM STANDARD SCREW FIXED SELF-DRILLING, 14MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
510.616,SUP,HCPCS C1713,,"510.616  -  4.0MM STANDARD SCREW FIXED SELF-DRILLING, 16MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
510.71,SUP,HCPCS C1713,,"510.710  -  4.5MM STANDARD SCREW FIXED SELF-DRILLING, 10MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
510.712,SUP,HCPCS C1713,,"510.712  -  4.5MM STANDARD SCREW FIXED SELF-DRILLING, 12MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
510.714,SUP,HCPCS C1713,,"510.714  -  4.5MM STANDARD SCREW FIXED SELF-DRILLING, 14MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
510.716,SUP,HCPCS C1713,,"510.716  -  4.5MM STANDARD SCREW FIXED SELF-DRILLING, 16MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
510.81,SUP,HCPCS C1713,,"510.810  -  4.0MM STANDARD SCREW FIXED SELF-TAPPING, 10MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
510.812,SUP,HCPCS C1713,,"510.812  -  4.0MM STANDARD SCREW FIXED SELF-TAPPING, 12MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
510.814,SUP,HCPCS C1713,,"510.814  -  4.0MM STANDARD SCREW FIXED SELF-TAPPING, 14MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
510.816,SUP,HCPCS C1713,,"510.816  -  4.0MM STANDARD SCREW FIXED SELF-TAPPING, 16MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
510.818,SUP,HCPCS C1713,,"510.818  -  4.0MM STANDARD SCREW FIXED SELF-TAPPING, 18MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
510.82,SUP,HCPCS C1713,,"510.820  -  4.0MM STANDARD SCREW FIXED SELF-TAPPING, 20MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
510.91,SUP,HCPCS C1713,,"510.910  -  4.5MM STANDARD SCREW FIXED SELF-TAPPING, 10MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
510.912,SUP,HCPCS C1713,,"510.912  -  4.5MM STANDARD SCREW FIXED SELF-TAPPING, 12MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
510.914,SUP,HCPCS C1713,,"510.914  -  4.5MM STANDARD SCREW FIXED SELF-TAPPING, 14MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
510.916,SUP,HCPCS C1713,,"510.916  -  4.5MM STANDARD SCREW FIXED SELF-TAPPING, 16MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
510.918,SUP,HCPCS C1713,,"510.918  -  4.5MM STANDARD SCREW FIXED SELF-TAPPING, 18MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
510.92,SUP,HCPCS C1713,,"510.920  -  4.5MM STANDARD SCREW FIXED SELF-TAPPING, 20MM",$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
511.411,SUP,Custom 27203010,,511.411  -  BIT DRILL 2MM 150MM BRAD POINT 3 FLUTED NONSTRL,$487.20,$0.00,$487.20,$0.00,$347.71,$0.00,$0.00,$0.00,$0.00,$0.00,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$0.00,$0.00,$0.00,$0.00
511.412,SUP,Custom 27203010,,511.412  -  BIT DRILL 2.5MM 150MM BRAD POINT 3 FLUTED NONSTRL,$487.20,$0.00,$487.20,$0.00,$347.71,$0.00,$0.00,$0.00,$0.00,$0.00,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$0.00,$0.00,$0.00,$0.00
511.413,SUP,Custom 27203010,,511.413  -  BIT DRILL 2.7MM 150MM QUICK COUPLING BRAD POINT 3 FLUTED,$487.20,$0.00,$487.20,$0.00,$347.71,$0.00,$0.00,$0.00,$0.00,$0.00,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$0.00,$0.00,$0.00,$0.00
511.414,SUP,Custom 27203010,,511.414  -  BIT DRILL 3 FLUTE 3.2MM 122MM QUICK COUPLING BRAD POINT,$487.20,$0.00,$487.20,$0.00,$347.71,$0.00,$0.00,$0.00,$0.00,$0.00,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$0.00,$0.00,$0.00,$0.00
511.415,SUP,Custom 27203010,,511.415  -  BIT DRILL 3.5MM 150MM QUICK COUPLING BRAD POINT 3 FLUTED,$487.20,$0.00,$487.20,$0.00,$347.71,$0.00,$0.00,$0.00,$0.00,$0.00,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$0.00,$0.00,$0.00,$0.00
511.416,SUP,Custom 27203010,,511.416  -  BIT DRILL 3.6MM 150MM 3 FLUTED QUICK COUPLING BRAD POINT,$487.20,$0.00,$487.20,$0.00,$347.71,$0.00,$0.00,$0.00,$0.00,$0.00,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$0.00,$0.00,$0.00,$0.00
511.417,SUP,Custom 27203010,,511.417  -  BIT DRILL 4MM 150MM 3 FLUTED QUICK COUPLING BRAD POINT,$487.20,$0.00,$487.20,$0.00,$347.71,$0.00,$0.00,$0.00,$0.00,$0.00,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$0.00,$0.00,$0.00,$0.00
511.418,SUP,Custom 27203010,,511.418  -  BIT DRILL 4.5MM 150MM QUICK COUPLING BRAD POINT 3 FLUTED,$487.20,$0.00,$487.20,$0.00,$347.71,$0.00,$0.00,$0.00,$0.00,$0.00,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$0.00,$0.00,$0.00,$0.00
511.431,SUP,Custom 27203010,,511.431  -  BIT DRILL 3.2MM 105MM BRAD POINT 3 FLUTE NONSTRL,$487.20,$0.00,$487.20,$0.00,$347.71,$0.00,$0.00,$0.00,$0.00,$0.00,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$0.00,$0.00,$0.00,$0.00
511.432,SUP,Custom 27203010,,511.432  -  BIT DRILL 4MM 105MM BRAD POINT 3 FLUTED NONSTRL,$487.20,$0.00,$487.20,$0.00,$347.71,$0.00,$0.00,$0.00,$0.00,$0.00,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$0.00,$0.00,$0.00,$0.00
513.01,SUP,Custom 27203010,,513.01  -  BIT DRILL MINI 1.1MM 28MM QUICK COUPLING NONSTRL,$124.55,$0.00,$124.55,$0.00,$88.89,$0.00,$0.00,$0.00,$0.00,$0.00,$124.55,$0.00,$62.28,$98.64,$99.64,$0.00,$0.00,$0.00,$0.00,$0.00
513.03,SUP,Custom 27203010,,513.03  -  BIT DRILL MINI 1.1MM 45MM QUICK COUPLING NONSTRL,$124.55,$0.00,$124.55,$0.00,$88.89,$0.00,$0.00,$0.00,$0.00,$0.00,$124.55,$0.00,$62.28,$98.64,$99.64,$0.00,$0.00,$0.00,$0.00,$0.00
513.05,SUP,Custom 27203010,,513.05  -  BIT DRILL MINI 3MM 28MM QUICK COUPLING NONSTRL,$124.55,$0.00,$124.55,$0.00,$88.89,$0.00,$0.00,$0.00,$0.00,$0.00,$124.55,$0.00,$62.28,$98.64,$99.64,$0.00,$0.00,$0.00,$0.00,$0.00
513.08,SUP,Custom 27203010,,513.08  -  BIT DRILL MINI 1.5MM 52MM QUICK COUPLING NONSTRL,$124.55,$0.00,$124.55,$0.00,$88.89,$0.00,$0.00,$0.00,$0.00,$0.00,$124.55,$0.00,$62.28,$98.64,$99.64,$0.00,$0.00,$0.00,$0.00,$0.00
513.1,SUP,Custom 27203010,,513.10  -  BIT DRILL MINI 2MM 28MM QUICK COUPLING NONSTRL,$124.55,$0.00,$124.55,$0.00,$88.89,$0.00,$0.00,$0.00,$0.00,$0.00,$124.55,$0.00,$62.28,$98.64,$99.64,$0.00,$0.00,$0.00,$0.00,$0.00
513.13,SUP,Custom 27203010,,513.13  -  BIT DRILL MINI 2MM 52MM QUICK COUPLING NONSTRL,$124.55,$0.00,$124.55,$0.00,$88.89,$0.00,$0.00,$0.00,$0.00,$0.00,$124.55,$0.00,$62.28,$98.64,$99.64,$0.00,$0.00,$0.00,$0.00,$0.00
513.14,SUP,Custom 27203010,,513.14  -  BIT DRILL MINI 2MM 67MM QUICK COUPLING NONSTRL,$124.55,$0.00,$124.55,$0.00,$88.89,$0.00,$0.00,$0.00,$0.00,$0.00,$124.55,$0.00,$62.28,$98.64,$99.64,$0.00,$0.00,$0.00,$0.00,$0.00
513.17,SUP,Custom 27203010,,513.17  -  BIT DRILL MINI 2.7MM 28MM QUICK COUPLING NONSTRL,$124.55,$0.00,$124.55,$0.00,$88.89,$0.00,$0.00,$0.00,$0.00,$0.00,$124.55,$0.00,$62.28,$98.64,$99.64,$0.00,$0.00,$0.00,$0.00,$0.00
513.19,SUP,Custom 27203010,,513.19  -  BIT DRILL MINI 2.7MM 67MM QUICK COUPLING NONSTRL,$124.55,$0.00,$124.55,$0.00,$88.89,$0.00,$0.00,$0.00,$0.00,$0.00,$124.55,$0.00,$62.28,$98.64,$99.64,$0.00,$0.00,$0.00,$0.00,$0.00
524.001,SUP,Custom 27803010,,"524.001  -  5.5MM STRAIGHT ROD, HEX-END, CP GRADE 4, 300MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
524.002,SUP,Custom 27803010,,"524.002  -  5.5MM STRAIGHT ROD, HEX-END, CP GRADE 4, 400MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
524.003,SUP,Custom 27803010,,"524.003  -  5.5MM STRAIGHT ROD, HEX-END, CP GRADE 4, 500MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
524.004,SUP,Custom 27803010,,"524.004  -  5.5MM STRAIGHT ROD, HEX-END, CP GRADE 2, 300MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
524.005,SUP,Custom 27803010,,"524.005  -  5.5MM STRAIGHT ROD, HEX-END, CP GRADE 2, 400MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
524.006,SUP,Custom 27803010,,"524.006  -  5.5MM STRAIGHT ROD, HEX-END, CP GRADE 2, 500MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
524.007,SUP,Custom 27803010,,"524.007  -  5.5MM STRAIGHT ROD, HEX-END W/STOP, 500MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
524.008,SUP,Custom 27803010,,"524.008  -  5.5MM STRAIGHT ROD, HEX-END W/STOP, CP, GRADE 4, 500MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
524.009,SUP,Custom 27803010,,"524.009  -  5.5MM STRAIGHT ROD, HEX-END W/STOP, CP, GRADE 2, 500MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
524.051,SUP,HCPCS C1713,,"524.051  -  5.0MM REVERE REDUCTION SCREW, 25MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.052,SUP,HCPCS C1713,,"524.052  -  5.0MM REVERE REDUCTION SCREW, 30MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.053,SUP,HCPCS C1713,,"524.053  -  5.0MM REVERE REDUCTION SCREW, 35MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.054,SUP,HCPCS C1713,,"524.054  -  5.0MM REVERE REDUCTION SCREW, 40MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.055,SUP,HCPCS C1713,,"524.055  -  5.0MM REVERE REDUCTION SCREW, 45MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.056,SUP,HCPCS C1713,,"524.056  -  5.0MM REVERE REDUCTION SCREW, 50MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.057,SUP,HCPCS C1713,,"524.057  -  5.0MM REVERE REDUCTION SCREW, 55MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.071,SUP,HCPCS C1713,,"524.071  -  7.5MM REVERE REDUCTION SCREW, 70MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.072,SUP,HCPCS C1713,,"524.072  -  7.5MM REVERE REDUCTION SCREW, 75MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.073,SUP,HCPCS C1713,,"524.073  -  7.5MM REVERE REDUCTION SCREW, 80MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.074,SUP,HCPCS C1713,,"524.074  -  7.5MM REVERE REDUCTION SCREW, 85MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.075,SUP,HCPCS C1713,,"524.075  -  7.5MM REVERE REDUCTION SCREW, 90MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.081,SUP,HCPCS C1713,,"524.081  -  8.5MM REVERE REDUCTION SCREW, 70MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.082,SUP,HCPCS C1713,,"524.082  -  8.5MM REVERE REDUCTION SCREW, 75MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.083,SUP,HCPCS C1713,,"524.083  -  8.5MM REVERE REDUCTION SCREW, 80MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.084,SUP,HCPCS C1713,,"524.084  -  8.5MM REVERE REDUCTION SCREW, 85MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.085,SUP,HCPCS C1713,,"524.085  -  8.5MM REVERE REDUCTION SCREW, 90MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.2,SUP,HCPCS C1713,,"524.200  -  4.0MM REVERE MONOAXIAL REDUCTION SCREW, 20MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.201,SUP,HCPCS C1713,,"524.201  -  4.0MM REVERE MONOAXIAL REDUCTION SCREW, 25MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.202,SUP,HCPCS C1713,,"524.202  -  4.0MM REVERE MONOAXIAL REDUCTION SCREW, 30MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.203,SUP,HCPCS C1713,,"524.203  -  4.0MM REVERE MONOAXIAL REDUCTION SCREW, 35MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.204,SUP,HCPCS C1713,,"524.204  -  4.0MM REVERE MONOAXIAL REDUCTION SCREW, 40MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.241,SUP,HCPCS C1713,,"524.241  -  4.5MM REVERE MONOAXIAL REDUCTION SCREW, 25MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.242,SUP,HCPCS C1713,,"524.242  -  4.5MM REVERE MONOAXIAL REDUCTION SCREW, 30MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.243,SUP,HCPCS C1713,,"524.243  -  4.5MM REVERE MONOAXIAL REDUCTION SCREW, 35MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.244,SUP,HCPCS C1713,,"524.244  -  4.5MM REVERE MONOAXIAL REDUCTION SCREW, 40MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.245,SUP,HCPCS C1713,,"524.245  -  4.5MM REVERE MONOAXIAL REDUCTION SCREW, 45MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.252,SUP,HCPCS C1713,,"524.252  -  5.5MM REVERE MONOAXIAL REDUCTION SCREW, 30MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.253,SUP,HCPCS C1713,,"524.253  -  5.5MM REVERE MONOAXIAL REDUCTION SCREW, 35MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.254,SUP,HCPCS C1713,,"524.254  -  5.5MM REVERE MONOAXIAL REDUCTION SCREW, 40MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.255,SUP,HCPCS C1713,,"524.255  -  5.5MM REVERE MONOAXIAL REDUCTION SCREW, 45MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.256,SUP,HCPCS C1713,,"524.256  -  5.5MM REVERE MONOAXIAL REDUCTION SCREW, 50MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.257,SUP,HCPCS C1713,,"524.257  -  5.5MM REVERE MONOAXIAL REDUCTION SCREW, 55MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.258,SUP,HCPCS C1713,,"524.258  -  5.5MM REVERE MONOAXIAL REDUCTION SCREW, 60MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.259,SUP,HCPCS C1713,,"524.259  -  5.5MM REVERE MONOAXIAL REDUCTION SCREW, 65MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.262,SUP,HCPCS C1713,,"524.262  -  6.5MM REVERE MONOAXIAL REDUCTION SCREW, 30MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.263,SUP,HCPCS C1713,,"524.263  -  6.5MM REVERE MONOAXIAL REDUCTION SCREW, 35MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.264,SUP,HCPCS C1713,,"524.264  -  6.5MM REVERE MONOAXIAL REDUCTION SCREW, 40MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.265,SUP,HCPCS C1713,,"524.265  -  6.5MM REVERE MONOAXIAL REDUCTION SCREW, 45MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.266,SUP,HCPCS C1713,,"524.266  -  6.5MM REVERE MONOAXIAL REDUCTION SCREW, 50MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.267,SUP,HCPCS C1713,,"524.267  -  6.5MM REVERE MONOAXIAL REDUCTION SCREW, 55MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.268,SUP,HCPCS C1713,,"524.268  -  6.5MM REVERE MONOAXIAL REDUCTION SCREW, 60MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.269,SUP,HCPCS C1713,,"524.269  -  6.5MM REVERE MONOAXIAL REDUCTION SCREW, 65MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.272,SUP,HCPCS C1713,,"524.272  -  7.5MM REVERE MONOAXIAL REDUCTION SCREW, 30MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.273,SUP,HCPCS C1713,,"524.273  -  7.5MM REVERE MONOAXIAL REDUCTION SCREW, 35MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.274,SUP,HCPCS C1713,,"524.274  -  7.5MM REVERE MONOAXIAL REDUCTION SCREW, 40MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.275,SUP,HCPCS C1713,,"524.275  -  7.5MM REVERE MONOAXIAL REDUCTION SCREW, 45MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.276,SUP,HCPCS C1713,,"524.276  -  7.5MM REVERE MONOAXIAL REDUCTION SCREW, 50MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.277,SUP,HCPCS C1713,,"524.277  -  7.5MM REVERE MONOAXIAL REDUCTION SCREW, 55MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.278,SUP,HCPCS C1713,,"524.278  -  7.5MM REVERE MONOAXIAL REDUCTION SCREW, 60MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.279,SUP,HCPCS C1713,,"524.279  -  7.5MM REVERE MONOAXIAL REDUCTION SCREW, 65MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.282,SUP,HCPCS C1713,,"524.282  -  8.5MM REVERE MONOAXIAL REDUCTION SCREW, 30MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.283,SUP,HCPCS C1713,,"524.283  -  8.5MM REVERE MONOAXIAL REDUCTION SCREW, 35MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.284,SUP,HCPCS C1713,,"524.284  -  8.5MM REVERE MONOAXIAL REDUCTION SCREW, 40MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.285,SUP,HCPCS C1713,,"524.285  -  8.5MM REVERE MONOAXIAL REDUCTION SCREW, 45MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.286,SUP,HCPCS C1713,,"524.286  -  8.5MM REVERE MONOAXIAL REDUCTION SCREW, 50MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.287,SUP,HCPCS C1713,,"524.287  -  8.5MM REVERE MONOAXIAL REDUCTION SCREW, 55MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.288,SUP,HCPCS C1713,,"524.288  -  8.5MM REVERE MONOAXIAL REDUCTION SCREW, 60MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.289,SUP,HCPCS C1713,,"524.289  -  8.5MM REVERE MONOAXIAL REDUCTION SCREW, 65MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.341,SUP,HCPCS C1713,,"524.341  -  REVERE 4.5MM UNIPLANAR REDUCTION SCREW, 25MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.342,SUP,HCPCS C1713,,"524.342  -  REVERE 4.5MM UNIPLANAR REDUCTION SCREW, 30MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.343,SUP,HCPCS C1713,,"524.343  -  REVERE 4.5MM UNIPLANAR REDUCTION SCREW, 35MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.344,SUP,HCPCS C1713,,"524.344  -  REVERE 4.5MM UNIPLANAR REDUCTION SCREW, 40MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.345,SUP,HCPCS C1713,,"524.345  -  REVERE 4.5MM UNIPLANAR REDUCTION SCREW, 45MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.346,SUP,HCPCS C1713,,"524.346  -  REVERE 4.5MM UNIPLANAR REDUCTION SCREW, 50MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.347,SUP,HCPCS C1713,,"524.347  -  REVERE 4.5MM UNIPLANAR REDUCTION SCREW, 55MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.351,SUP,HCPCS C1713,,"524.351  -  REVERE 5.0MM UNIPLANAR REDUCTION SCREW, 25MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.352,SUP,HCPCS C1713,,"524.352  -  REVERE 5.0MM UNIPLANAR REDUCTION SCREW, 30MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.353,SUP,HCPCS C1713,,"524.353  -  REVERE 5.0MM UNIPLANAR REDUCTION SCREW, 35MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.354,SUP,HCPCS C1713,,"524.354  -  REVERE 5.0MM UNIPLANAR REDUCTION SCREW, 40MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.355,SUP,HCPCS C1713,,"524.355  -  REVERE 5.0MM UNIPLANAR REDUCTION SCREW, 45MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.356,SUP,HCPCS C1713,,"524.356  -  REVERE 5.0MM UNIPLANAR REDUCTION SCREW, 50MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.357,SUP,HCPCS C1713,,"524.357  -  REVERE 5.0MM UNIPLANAR REDUCTION SCREW, 55MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.361,SUP,HCPCS C1713,,"524.361  -  REVERE 5.5MM UNIPLANAR REDUCTION SCREW, 25MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.362,SUP,HCPCS C1713,,"524.362  -  REVERE 5.5MM UNIPLANAR REDUCTION SCREW, 30MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.363,SUP,HCPCS C1713,,"524.363  -  REVERE 5.5MM UNIPLANAR REDUCTION SCREW, 35MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.364,SUP,HCPCS C1713,,"524.364  -  REVERE 5.5MM UNIPLANAR REDUCTION SCREW, 40MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.365,SUP,HCPCS C1713,,"524.365  -  REVERE 5.5MM UNIPLANAR REDUCTION SCREW, 45MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.366,SUP,HCPCS C1713,,"524.366  -  REVERE 5.5MM UNIPLANAR REDUCTION SCREW, 50MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.367,SUP,HCPCS C1713,,"524.367  -  REVERE 5.5MM UNIPLANAR REDUCTION SCREW, 55MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.371,SUP,HCPCS C1713,,"524.371  -  REVERE 6.5MM UNIPLANAR REDUCTION SCREW, 25MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.372,SUP,HCPCS C1713,,"524.372  -  REVERE 6.5MM UNIPLANAR REDUCTION SCREW, 30MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.373,SUP,HCPCS C1713,,"524.373  -  REVERE 6.5MM UNIPLANAR REDUCTION SCREW, 35MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.374,SUP,HCPCS C1713,,"524.374  -  REVERE 6.5MM UNIPLANAR REDUCTION SCREW, 40MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.375,SUP,HCPCS C1713,,"524.375  -  REVERE 6.5MM UNIPLANAR REDUCTION SCREW, 45MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.376,SUP,HCPCS C1713,,"524.376  -  REVERE 6.5MM UNIPLANAR REDUCTION SCREW, 50MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.377,SUP,HCPCS C1713,,"524.377  -  REVERE 6.5MM UNIPLANAR REDUCTION SCREW, 55MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.441,SUP,HCPCS C1713,,"524.441  -  4.5MM REVERE REDUCTION SCREW, 25MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.442,SUP,HCPCS C1713,,"524.442  -  4.5MM REVERE REDUCTION SCREW, 30MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.443,SUP,HCPCS C1713,,"524.443  -  4.5MM REVERE REDUCTION SCREW, 35MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.444,SUP,HCPCS C1713,,"524.444  -  4.5MM REVERE REDUCTION SCREW, 40MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.445,SUP,HCPCS C1713,,"524.445  -  4.5MM REVERE REDUCTION SCREW, 45MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.451,SUP,HCPCS C1713,,"524.451  -  5.5MM REVERE REDUCTION SCREW, 25MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.452,SUP,HCPCS C1713,,"524.452  -  5.5MM REVERE REDUCTION SCREW, 30MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.453,SUP,HCPCS C1713,,"524.453  -  5.5MM REVERE REDUCTION SCREW, 35MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.454,SUP,HCPCS C1713,,"524.454  -  5.5MM REVERE REDUCTION SCREW, 40MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.455,SUP,HCPCS C1713,,"524.455  -  5.5MM REVERE REDUCTION SCREW, 45MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.456,SUP,HCPCS C1713,,"524.456  -  5.5MM REVERE REDUCTION SCREW, 50MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.457,SUP,HCPCS C1713,,"524.457  -  5.5MM REVERE REDUCTION SCREW, 55MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.461,SUP,HCPCS C1713,,"524.461  -  6.5MM REVERE REDUCTION SCREW, 25MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.462,SUP,HCPCS C1713,,"524.462  -  6.5MM REVERE REDUCTION SCREW, 30MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.463,SUP,HCPCS C1713,,"524.463  -  6.5MM REVERE REDUCTION SCREW, 35MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.464,SUP,HCPCS C1713,,"524.464  -  6.5MM REVERE REDUCTION SCREW, 40MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.465,SUP,HCPCS C1713,,"524.465  -  6.5MM REVERE REDUCTION SCREW, 45MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.466,SUP,HCPCS C1713,,"524.466  -  6.5MM REVERE REDUCTION SCREW, 50MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.467,SUP,HCPCS C1713,,"524.467  -  6.5MM REVERE REDUCTION SCREW, 55MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.468,SUP,HCPCS C1713,,"524.468  -  6.5MM REVERE REDUCTION SCREW, 60MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.469,SUP,HCPCS C1713,,"524.469  -  6.5MM REVERE REDUCTION SCREW, 65MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.471,SUP,HCPCS C1713,,"524.471  -  7.5MM REVERE REDUCTION SCREW, 25MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.472,SUP,HCPCS C1713,,"524.472  -  7.5MM REVERE REDUCTION SCREW, 30MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.473,SUP,HCPCS C1713,,"524.473  -  7.5MM REVERE REDUCTION SCREW, 35MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.474,SUP,HCPCS C1713,,"524.474  -  7.5MM REVERE REDUCTION SCREW, 40MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.475,SUP,HCPCS C1713,,"524.475  -  7.5MM REVERE REDUCTION SCREW, 45MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.476,SUP,HCPCS C1713,,"524.476  -  7.5MM REVERE REDUCTION SCREW, 50MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.477,SUP,HCPCS C1713,,"524.477  -  7.5MM REVERE REDUCTION SCREW, 55MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.478,SUP,HCPCS C1713,,"524.478  -  7.5MM REVERE REDUCTION SCREW, 60MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.479,SUP,HCPCS C1713,,"524.479  -  7.5MM REVERE REDUCTION SCREW, 65MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.481,SUP,HCPCS C1713,,"524.481  -  8.5MM REVERE REDUCTION SCREW, 25MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.482,SUP,HCPCS C1713,,"524.482  -  8.5MM REVERE REDUCTION SCREW, 30MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.483,SUP,HCPCS C1713,,"524.483  -  8.5MM REVERE REDUCTION SCREW, 35MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.484,SUP,HCPCS C1713,,"524.484  -  8.5MM REVERE REDUCTION SCREW, 40MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.485,SUP,HCPCS C1713,,"524.485  -  8.5MM REVERE REDUCTION SCREW, 45MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.486,SUP,HCPCS C1713,,"524.486  -  8.5MM REVERE REDUCTION SCREW, 50MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.487,SUP,HCPCS C1713,,"524.487  -  8.5MM REVERE REDUCTION SCREW, 55MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.488,SUP,HCPCS C1713,,"524.488  -  8.5MM REVERE REDUCTION SCREW, 60MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.489,SUP,HCPCS C1713,,"524.489  -  8.5MM REVERE REDUCTION SCREW, 65MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.51,SUP,Custom 27803010,,"524.510  -  5.5MM STRAIGHT ROD, HEX-END, 100MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
524.512,SUP,Custom 27803010,,"524.512  -  5.5MM STRAIGHT ROD, HEX-END, 125MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
524.515,SUP,Custom 27803010,,"524.515  -  5.5MM STRAIGHT ROD, HEX-END, 150MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
524.517,SUP,Custom 27803010,,"524.517  -  5.5MM STRAIGHT ROD, HEX-END, 200MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
524.519,SUP,Custom 27803010,,"524.519  -  5.5MM STRAIGHT ROD, HEX-END, 300MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
524.52,SUP,Custom 27803010,,"524.520  -  5.5MM STRAIGHT ROD, HEX-END, 400MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
524.521,SUP,Custom 27803010,,"524.521  -  5.5MM STRAIGHT ROD, HEX-END, 500MM",$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
524.641,SUP,HCPCS C1713,,"524.641  -  REVERE 4.5MM UNIPLANAR SCREW, 25MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.642,SUP,HCPCS C1713,,"524.642  -  REVERE 4.5MM UNIPLANAR SCREW, 30MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.643,SUP,HCPCS C1713,,"524.643  -  REVERE 4.5MM UNIPLANAR SCREW, 35MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.644,SUP,HCPCS C1713,,"524.644  -  REVERE 4.5MM UNIPLANAR SCREW, 40MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.645,SUP,HCPCS C1713,,"524.645  -  REVERE 4.5MM UNIPLANAR SCREW, 45MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.646,SUP,HCPCS C1713,,"524.646  -  REVERE 4.5MM UNIPLANAR SCREW, 50MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.647,SUP,HCPCS C1713,,"524.647  -  REVERE 4.5MM UNIPLANAR SCREW, 55MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.651,SUP,HCPCS C1713,,"524.651  -  REVERE 5.0MM UNIPLANAR SCREW, 25MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.652,SUP,HCPCS C1713,,"524.652  -  REVERE 5.0MM UNIPLANAR SCREW, 30MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.653,SUP,HCPCS C1713,,"524.653  -  REVERE 5.0MM UNIPLANAR SCREW, 35MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.654,SUP,HCPCS C1713,,"524.654  -  REVERE 5.0MM UNIPLANAR SCREW, 40MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.655,SUP,HCPCS C1713,,"524.655  -  REVERE 5.0MM UNIPLANAR SCREW, 45MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.656,SUP,HCPCS C1713,,"524.656  -  REVERE 5.0MM UNIPLANAR SCREW, 50MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.657,SUP,HCPCS C1713,,"524.657  -  REVERE 5.0MM UNIPLANAR SCREW, 55MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.661,SUP,HCPCS C1713,,"524.661  -  REVERE 5.5MM UNIPLANAR SCREW, 25MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.662,SUP,HCPCS C1713,,"524.662  -  REVERE 5.5MM UNIPLANAR SCREW, 30MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.663,SUP,HCPCS C1713,,"524.663  -  REVERE 5.5MM UNIPLANAR SCREW, 35MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.664,SUP,HCPCS C1713,,"524.664  -  REVERE 5.5MM UNIPLANAR SCREW, 40MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.665,SUP,HCPCS C1713,,"524.665  -  REVERE 5.5MM UNIPLANAR SCREW, 45MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.666,SUP,HCPCS C1713,,"524.666  -  REVERE 5.5MM UNIPLANAR SCREW, 50MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.667,SUP,HCPCS C1713,,"524.667  -  REVERE 5.5MM UNIPLANAR SCREW, 55MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.671,SUP,HCPCS C1713,,"524.671  -  REVERE 6.5MM UNIPLANAR SCREW, 25MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.672,SUP,HCPCS C1713,,"524.672  -  REVERE 6.5MM UNIPLANAR SCREW, 30MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.673,SUP,HCPCS C1713,,"524.673  -  REVERE 6.5MM UNIPLANAR SCREW, 35MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.674,SUP,HCPCS C1713,,"524.674  -  REVERE 6.5MM UNIPLANAR SCREW, 40MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.675,SUP,HCPCS C1713,,"524.675  -  REVERE 6.5MM UNIPLANAR SCREW, 45MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.676,SUP,HCPCS C1713,,"524.676  -  REVERE 6.5MM UNIPLANAR SCREW, 50MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.677,SUP,HCPCS C1713,,"524.677  -  REVERE 6.5MM UNIPLANAR SCREW, 55MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.851,SUP,HCPCS C1713,,"524.851  -  5.0MM REVERE MONOAXIAL REDUCTION SCREW, 25MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.852,SUP,HCPCS C1713,,"524.852  -  5.0MM REVERE MONOAXIAL REDUCTION SCREW, 30MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.853,SUP,HCPCS C1713,,"524.853  -  5.0MM REVERE MONOAXIAL REDUCTION SCREW, 35MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.854,SUP,HCPCS C1713,,"524.854  -  5.0MM REVERE MONOAXIAL REDUCTION SCREW, 40MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.855,SUP,HCPCS C1713,,"524.855  -  5.0MM REVERE MONOAXIAL REDUCTION SCREW, 45MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.856,SUP,HCPCS C1713,,"524.856  -  5.0MM REVERE MONOAXIAL REDUCTION SCREW, 50MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.857,SUP,HCPCS C1713,,"524.857  -  5.0MM REVERE MONOAXIAL REDUCTION SCREW, 55MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.871,SUP,HCPCS C1713,,"524.871  -  7.5MM REVERE MONOAXIAL REDUCTION SCREW, 70MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.872,SUP,HCPCS C1713,,"524.872  -  7.5MM REVERE MONOAXIAL REDUCTION SCREW, 75MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.873,SUP,HCPCS C1713,,"524.873  -  7.5MM REVERE MONOAXIAL REDUCTION SCREW, 80MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.874,SUP,HCPCS C1713,,"524.874  -  7.5MM REVERE MONOAXIAL REDUCTION SCREW, 85MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.875,SUP,HCPCS C1713,,"524.875  -  7.5MM REVERE MONOAXIAL REDUCTION SCREW, 90MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.881,SUP,HCPCS C1713,,"524.881  -  8.5MM REVERE MONOAXIAL REDUCTION SCREW, 70MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.882,SUP,HCPCS C1713,,"524.882  -  8.5MM REVERE MONOAXIAL REDUCTION SCREW, 75MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.883,SUP,HCPCS C1713,,"524.883  -  8.5MM REVERE MONOAXIAL REDUCTION SCREW, 80MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.884,SUP,HCPCS C1713,,"524.884  -  8.5MM REVERE MONOAXIAL REDUCTION SCREW, 85MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
524.885,SUP,HCPCS C1713,,"524.885  -  8.5MM REVERE MONOAXIAL REDUCTION SCREW, 90MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
553,SUP,Custom 27203010,,CONTROL HGB A2 LYPHCHK LVL 2 1ML EPHRS,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
610.514,SUP,Custom 27803010,,610.514  -  BIT DRILL 4MM SM STOP,$672.50,$0.00,$672.50,$0.00,$479.96,$0.00,$0.00,$0.00,$0.00,$0.00,$672.50,$0.00,$336.25,$532.62,$538.00,$0.00,$0.00,$0.00,$0.00,$0.00
610.712,SUP,Custom 27100030,,610.712  -  BIT DRILL 12MM SPNL,$672.50,$0.00,$672.50,$0.00,$479.96,$0.00,$0.00,$0.00,$0.00,$0.00,$672.50,$0.00,$336.25,$532.62,$538.00,$0.00,$0.00,$0.00,$0.00,$0.00
610.714,SUP,Custom 27100030,,610.714  -  BIT DRILL 14MM SPNL,$672.50,$0.00,$672.50,$0.00,$479.96,$0.00,$0.00,$0.00,$0.00,$0.00,$672.50,$0.00,$336.25,$532.62,$538.00,$0.00,$0.00,$0.00,$0.00,$0.00
615.104,SUP,Custom 27100030,,615.104  -  BIT DRILL 2.4MM PRTX CT 3.5MM SCR NONSTRL,"$1,060.00",$0.00,"$1,060.00",$0.00,$756.52,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,060.00",$0.00,$530.00,$839.52,$848.00,$0.00,$0.00,$0.00,$0.00,$0.00
615.107,SUP,Custom 27100030,,615.107  -  TAP SPNL PRTX CT 3.5-4 MM SCR,$967.50,$0.00,$967.50,$0.00,$690.50,$0.00,$0.00,$0.00,$0.00,$0.00,$967.50,$0.00,$483.75,$766.26,$774.00,$0.00,$0.00,$0.00,$0.00,$0.00
615.301,SUP,HCPCS C1713,,615.301  -  TMPLT ROD 240MM,$360.00,$0.00,$360.00,$162.00,$256.93,$0.00,$62.03,$0.00,$0.00,$63.03,$360.00,$0.00,$180.00,$285.12,$288.00,$0.00,$56.34,$0.00,$57.31,$0.00
618.6,SUP,Custom 27203010,,618.60  -  LENS OPHTHALMIC GRIESHABER MACULA ASPHERIC VITREORETINAL SUR,$618.00,$0.00,$618.00,$0.00,$441.07,$0.00,$0.00,$0.00,$0.00,$0.00,$618.00,$0.00,$309.00,$489.46,$494.40,$0.00,$0.00,$0.00,$0.00,$0.00
624.214,SUP,Custom 27100030,,624.214  -  TAP 4.5MM SURG SPNL REVERE,$880.00,$0.00,$880.00,$0.00,$628.06,$0.00,$0.00,$0.00,$0.00,$0.00,$880.00,$0.00,$440.00,$696.96,$704.00,$0.00,$0.00,$0.00,$0.00,$0.00
624.215,SUP,Custom 27100030,,624.215  -  TAP 5.5MM SURG SPNL REVERE,$880.00,$0.00,$880.00,$0.00,$628.06,$0.00,$0.00,$0.00,$0.00,$0.00,$880.00,$0.00,$440.00,$696.96,$704.00,$0.00,$0.00,$0.00,$0.00,$0.00
624.216,SUP,Custom 27100030,,624.216  -  TAP 6.5MM SURG SPNL REVERE,$880.00,$0.00,$880.00,$0.00,$628.06,$0.00,$0.00,$0.00,$0.00,$0.00,$880.00,$0.00,$440.00,$696.96,$704.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.414,SUP,Custom 27803010,,"632.414  -  22MM PORT, BEVELED, 40MM",$902.50,$0.00,$902.50,$0.00,$644.11,$0.00,$0.00,$0.00,$0.00,$0.00,$902.50,$0.00,$451.25,$714.78,$722.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.415,SUP,Custom 27803010,,"632.415  -  22MM PORT, BEVELED, 50MM",$902.50,$0.00,$902.50,$0.00,$644.11,$0.00,$0.00,$0.00,$0.00,$0.00,$902.50,$0.00,$451.25,$714.78,$722.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.416,SUP,Custom 27803010,,"632.416  -  22MM PORT, BEVELED, 60MM",$902.50,$0.00,$902.50,$0.00,$644.11,$0.00,$0.00,$0.00,$0.00,$0.00,$902.50,$0.00,$451.25,$714.78,$722.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.417,SUP,Custom 27803010,,"632.417  -  22MM PORT, BEVELED, 70MM","$1,035.00",$0.00,"$1,035.00",$0.00,$738.68,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,035.00",$0.00,$517.50,$819.72,$828.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.418,SUP,Custom 27803010,,"632.418  -  22MM PORT, BEVELED, 80MM","$1,035.00",$0.00,"$1,035.00",$0.00,$738.68,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,035.00",$0.00,$517.50,$819.72,$828.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.419,SUP,Custom 27803010,,"632.419  -  22MM PORT, BEVELED, 90MM","$1,035.00",$0.00,"$1,035.00",$0.00,$738.68,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,035.00",$0.00,$517.50,$819.72,$828.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.42,SUP,Custom 27803010,,"632.420  -  22MM PORT, BEVELED, 100MM","$1,220.00",$0.00,"$1,220.00",$0.00,$870.71,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,220.00",$0.00,$610.00,$966.24,$976.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.421,SUP,Custom 27803010,,"632.421  -  22MM PORT, BEVELED, 110MM","$1,220.00",$0.00,"$1,220.00",$0.00,$870.71,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,220.00",$0.00,$610.00,$966.24,$976.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.422,SUP,Custom 27803010,,"632.422  -  22MM PORT, BEVELED, 120MM","$1,220.00",$0.00,"$1,220.00",$0.00,$870.71,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,220.00",$0.00,$610.00,$966.24,$976.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.424,SUP,Custom 27803010,,"632.424  -  22MM PORT, STRAIGHT, 40MM",$835.00,$0.00,$835.00,$0.00,$595.94,$0.00,$0.00,$0.00,$0.00,$0.00,$835.00,$0.00,$417.50,$661.32,$668.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.425,SUP,Custom 27803010,,"632.425  -  22MM PORT, STRAIGHT, 50MM",$835.00,$0.00,$835.00,$0.00,$595.94,$0.00,$0.00,$0.00,$0.00,$0.00,$835.00,$0.00,$417.50,$661.32,$668.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.426,SUP,Custom 27803010,,"632.426  -  22MM PORT, STRAIGHT, 60MM",$835.00,$0.00,$835.00,$0.00,$595.94,$0.00,$0.00,$0.00,$0.00,$0.00,$835.00,$0.00,$417.50,$661.32,$668.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.427,SUP,Custom 27803010,,"632.427  -  22MM PORT, STRAIGHT, 70MM",$942.50,$0.00,$942.50,$0.00,$672.66,$0.00,$0.00,$0.00,$0.00,$0.00,$942.50,$0.00,$471.25,$746.46,$754.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.428,SUP,Custom 27803010,,"632.428  -  22MM PORT, STRAIGHT, 80MM",$942.50,$0.00,$942.50,$0.00,$672.66,$0.00,$0.00,$0.00,$0.00,$0.00,$942.50,$0.00,$471.25,$746.46,$754.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.429,SUP,Custom 27803010,,"632.429  -  22MM PORT, STRAIGHT, 90MM",$942.50,$0.00,$942.50,$0.00,$672.66,$0.00,$0.00,$0.00,$0.00,$0.00,$942.50,$0.00,$471.25,$746.46,$754.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.43,SUP,Custom 27803010,,632.430  -  SET SPNL 22MM 100MM STRG PORT,"$1,140.00",$0.00,"$1,140.00",$0.00,$813.62,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,140.00",$0.00,$570.00,$902.88,$912.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.431,SUP,Custom 27803010,,"632.431  -  22MM PORT, STRAIGHT, 110MM","$1,140.00",$0.00,"$1,140.00",$0.00,$813.62,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,140.00",$0.00,$570.00,$902.88,$912.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.432,SUP,Custom 27803010,,"632.432  -  22MM PORT, STRAIGHT, 120MM","$1,140.00",$0.00,"$1,140.00",$0.00,$813.62,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,140.00",$0.00,$570.00,$902.88,$912.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.434,SUP,Custom 27803010,,"632.434  -  19MM PORT, BEVELED, 40MM",$902.50,$0.00,$902.50,$0.00,$644.11,$0.00,$0.00,$0.00,$0.00,$0.00,$902.50,$0.00,$451.25,$714.78,$722.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.435,SUP,Custom 27803010,,"632.435  -  19MM PORT, BEVELED, 50MM",$902.50,$0.00,$902.50,$0.00,$644.11,$0.00,$0.00,$0.00,$0.00,$0.00,$902.50,$0.00,$451.25,$714.78,$722.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.436,SUP,Custom 27803010,,632.436  -  SPACER SPNL 60MMX19MM BVL PORT PEEK INTRBD FS,$902.50,$0.00,$902.50,$0.00,$644.11,$0.00,$0.00,$0.00,$0.00,$0.00,$902.50,$0.00,$451.25,$714.78,$722.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.437,SUP,Custom 27803010,,632.437  -  SPACER SPNL 70MMX19MM BVL PORT PEEK INTRBD FS,"$1,035.00",$0.00,"$1,035.00",$0.00,$738.68,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,035.00",$0.00,$517.50,$819.72,$828.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.438,SUP,Custom 27803010,,"632.438  -  19MM PORT, BEVELED, 80MM","$1,035.00",$0.00,"$1,035.00",$0.00,$738.68,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,035.00",$0.00,$517.50,$819.72,$828.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.439,SUP,Custom 27803010,,"632.439  -  19MM PORT, BEVELED, 90MM","$1,035.00",$0.00,"$1,035.00",$0.00,$738.68,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,035.00",$0.00,$517.50,$819.72,$828.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.44,SUP,Custom 27803010,,"632.440  -  19MM PORT, BEVELED, 100MM","$1,220.00",$0.00,"$1,220.00",$0.00,$870.71,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,220.00",$0.00,$610.00,$966.24,$976.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.441,SUP,Custom 27803010,,"632.441  -  19MM PORT, BEVELED, 110MM","$1,220.00",$0.00,"$1,220.00",$0.00,$870.71,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,220.00",$0.00,$610.00,$966.24,$976.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.442,SUP,Custom 27803010,,"632.442  -  19MM PORT, BEVELED, 120MM","$1,220.00",$0.00,"$1,220.00",$0.00,$870.71,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,220.00",$0.00,$610.00,$966.24,$976.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.444,SUP,Custom 27803010,,632.444  -  SPACER SPNL 19MMX40MM PEEK INTRBD FS,$835.00,$0.00,$835.00,$0.00,$595.94,$0.00,$0.00,$0.00,$0.00,$0.00,$835.00,$0.00,$417.50,$661.32,$668.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.445,SUP,Custom 27803010,,632.445  -  SPACER SPNL 50MMX19MM STRG PORT PEEK INTRBD FS,$835.00,$0.00,$835.00,$0.00,$595.94,$0.00,$0.00,$0.00,$0.00,$0.00,$835.00,$0.00,$417.50,$661.32,$668.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.446,SUP,Custom 27803010,,"632.446  -  19MM PORT, STRAIGHT, 60MM",$835.00,$0.00,$835.00,$0.00,$595.94,$0.00,$0.00,$0.00,$0.00,$0.00,$835.00,$0.00,$417.50,$661.32,$668.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.447,SUP,Custom 27803010,,"632.447  -  19MM PORT, STRAIGHT, 70MM",$942.50,$0.00,$942.50,$0.00,$672.66,$0.00,$0.00,$0.00,$0.00,$0.00,$942.50,$0.00,$471.25,$746.46,$754.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.448,SUP,Custom 27803010,,"632.448  -  19MM PORT, STRAIGHT, 80MM",$942.50,$0.00,$942.50,$0.00,$672.66,$0.00,$0.00,$0.00,$0.00,$0.00,$942.50,$0.00,$471.25,$746.46,$754.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.449,SUP,Custom 27803010,,"632.449  -  19MM PORT, STRAIGHT, 90MM",$942.50,$0.00,$942.50,$0.00,$672.66,$0.00,$0.00,$0.00,$0.00,$0.00,$942.50,$0.00,$471.25,$746.46,$754.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.45,SUP,Custom 27803010,,"632.450  -  19MM PORT, STRAIGHT, 100MM","$1,140.00",$0.00,"$1,140.00",$0.00,$813.62,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,140.00",$0.00,$570.00,$902.88,$912.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.451,SUP,Custom 27803010,,"632.451  -  19MM PORT, STRAIGHT, 110MM","$1,140.00",$0.00,"$1,140.00",$0.00,$813.62,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,140.00",$0.00,$570.00,$902.88,$912.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.452,SUP,Custom 27803010,,"632.452  -  19MM PORT, STRAIGHT, 120MM","$1,140.00",$0.00,"$1,140.00",$0.00,$813.62,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,140.00",$0.00,$570.00,$902.88,$912.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.454,SUP,Custom 27803010,,"632.454  -  26MM PORT, BEVELED, 40MM","$1,167.50",$0.00,"$1,167.50",$0.00,$833.24,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,167.50",$0.00,$583.75,$924.66,$934.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.455,SUP,Custom 27803010,,"632.455  -  26MM PORT, BEVELED, 50MM","$1,167.50",$0.00,"$1,167.50",$0.00,$833.24,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,167.50",$0.00,$583.75,$924.66,$934.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.456,SUP,Custom 27803010,,"632.456  -  26MM PORT, BEVELED, 60MM","$1,167.50",$0.00,"$1,167.50",$0.00,$833.24,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,167.50",$0.00,$583.75,$924.66,$934.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.457,SUP,Custom 27803010,,"632.457  -  26MM PORT, BEVELED, 70MM","$1,272.50",$0.00,"$1,272.50",$0.00,$908.18,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,272.50",$0.00,$636.25,"$1,007.82","$1,018.00",$0.00,$0.00,$0.00,$0.00,$0.00
632.458,SUP,Custom 27803010,,"632.458  -  26MM PORT, BEVELED, 80MM","$1,272.50",$0.00,"$1,272.50",$0.00,$908.18,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,272.50",$0.00,$636.25,"$1,007.82","$1,018.00",$0.00,$0.00,$0.00,$0.00,$0.00
632.459,SUP,Custom 27803010,,"632.459  -  26MM PORT, BEVELED, 90MM","$1,272.50",$0.00,"$1,272.50",$0.00,$908.18,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,272.50",$0.00,$636.25,"$1,007.82","$1,018.00",$0.00,$0.00,$0.00,$0.00,$0.00
632.46,SUP,Custom 27803010,,"632.460  -  26MM PORT, BEVELED, 100MM","$1,380.00",$0.00,"$1,380.00",$0.00,$984.91,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,380.00",$0.00,$690.00,"$1,092.96","$1,104.00",$0.00,$0.00,$0.00,$0.00,$0.00
632.461,SUP,Custom 27803010,,"632.461  -  26MM PORT, BEVELED, 110MM","$1,380.00",$0.00,"$1,380.00",$0.00,$984.91,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,380.00",$0.00,$690.00,"$1,092.96","$1,104.00",$0.00,$0.00,$0.00,$0.00,$0.00
632.462,SUP,Custom 27803010,,"632.462  -  26MM PORT, BEVELED, 120MM","$1,380.00",$0.00,"$1,380.00",$0.00,$984.91,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,380.00",$0.00,$690.00,"$1,092.96","$1,104.00",$0.00,$0.00,$0.00,$0.00,$0.00
632.464,SUP,Custom 27803010,,"632.464  -  26MM PORT, STRAIGHT, 40MM","$1,140.00",$0.00,"$1,140.00",$0.00,$813.62,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,140.00",$0.00,$570.00,$902.88,$912.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.465,SUP,Custom 27803010,,"632.465  -  26MM PORT, STRAIGHT, 50MM","$1,140.00",$0.00,"$1,140.00",$0.00,$813.62,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,140.00",$0.00,$570.00,$902.88,$912.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.466,SUP,Custom 27803010,,632.466  -  SPACER SPNL TBLR 60MMX26MM PEEK INTRBD FS,"$1,140.00",$0.00,"$1,140.00",$0.00,$813.62,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,140.00",$0.00,$570.00,$902.88,$912.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.467,SUP,Custom 27803010,,632.467  -  SPACER SPNL TBLR 70MMX26MM PEEK INTRBD FS,"$1,272.50",$0.00,"$1,272.50",$0.00,$908.18,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,272.50",$0.00,$636.25,"$1,007.82","$1,018.00",$0.00,$0.00,$0.00,$0.00,$0.00
632.468,SUP,Custom 27803010,,632.468  -  SPACER SPNL TBLR 80MMX26MM PEEK INTRBD FS,"$1,272.50",$0.00,"$1,272.50",$0.00,$908.18,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,272.50",$0.00,$636.25,"$1,007.82","$1,018.00",$0.00,$0.00,$0.00,$0.00,$0.00
632.469,SUP,Custom 27803010,,"632.469  -  26MM PORT, STRAIGHT, 90MM","$1,272.50",$0.00,"$1,272.50",$0.00,$908.18,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,272.50",$0.00,$636.25,"$1,007.82","$1,018.00",$0.00,$0.00,$0.00,$0.00,$0.00
632.47,SUP,Custom 27803010,,"632.470  -  26MM PORT, STRAIGHT, 100MM","$1,380.00",$0.00,"$1,380.00",$0.00,$984.91,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,380.00",$0.00,$690.00,"$1,092.96","$1,104.00",$0.00,$0.00,$0.00,$0.00,$0.00
632.471,SUP,Custom 27803010,,"632.471  -  26MM PORT, STRAIGHT, 110MM","$1,380.00",$0.00,"$1,380.00",$0.00,$984.91,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,380.00",$0.00,$690.00,"$1,092.96","$1,104.00",$0.00,$0.00,$0.00,$0.00,$0.00
632.472,SUP,Custom 27803010,,"632.472  -  26MM PORT, STRAIGHT, 120MM","$1,380.00",$0.00,"$1,380.00",$0.00,$984.91,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,380.00",$0.00,$690.00,"$1,092.96","$1,104.00",$0.00,$0.00,$0.00,$0.00,$0.00
648.216,SUP,Custom 27203010,,648.216  -  BIT DRILL FIX 2.4MM BONE CORRIDOR,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
650.012,SUP,HCPCS C1713,,650.012  -  HOLDER IMPLANT TEMPORARY FIX SCREW SPN,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
650.112,SUP,Custom 27203010,,650.112  -  BIT DRL 12MM STRL REUSE,$672.50,$0.00,$672.50,$0.00,$479.96,$0.00,$0.00,$0.00,$0.00,$0.00,$672.50,$0.00,$336.25,$532.62,$538.00,$0.00,$0.00,$0.00,$0.00,$0.00
650.114,SUP,Custom 27100030,,650.114  -  BIT DRL 14MM STRL REUSE,$672.50,$0.00,$672.50,$0.00,$479.96,$0.00,$0.00,$0.00,$0.00,$0.00,$672.50,$0.00,$336.25,$532.62,$538.00,$0.00,$0.00,$0.00,$0.00,$0.00
650.116,SUP,Custom 27203010,,650.116  -  BIT DRL 16MM STRL REUSE,$672.50,$0.00,$672.50,$0.00,$479.96,$0.00,$0.00,$0.00,$0.00,$0.00,$672.50,$0.00,$336.25,$532.62,$538.00,$0.00,$0.00,$0.00,$0.00,$0.00
682.104,SUP,Custom 27203010,,682.104  -  BIT DRILL 2.4MM 3.5MM SCR ELLI,$950.00,$0.00,$950.00,$0.00,$678.02,$0.00,$0.00,$0.00,$0.00,$0.00,$950.00,$0.00,$475.00,$752.40,$760.00,$0.00,$0.00,$0.00,$0.00,$0.00
682.105,SUP,Custom 27203010,,682.105  -  BIT DRILL 4 MM TITANIUM SCREW,$950.00,$0.00,$950.00,$0.00,$678.02,$0.00,$0.00,$0.00,$0.00,$0.00,$950.00,$0.00,$475.00,$752.40,$760.00,$0.00,$0.00,$0.00,$0.00,$0.00
682.107,SUP,Custom 27203010,,682.107  -  TAP SURG TITANIUM SPN 4 MM SCREW,$950.00,$0.00,$950.00,$0.00,$678.02,$0.00,$0.00,$0.00,$0.00,$0.00,$950.00,$0.00,$475.00,$752.40,$760.00,$0.00,$0.00,$0.00,$0.00,$0.00
685.005,SUP,HCPCS C1769,,685.005  -  GUIDEWIRE ORTHOPEDIC 500MM BLUNT SPN,$287.50,$0.00,$287.50,$156.11,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
746,SUP,Custom 27203010,,REAGENT ANALY STA ST FNCT PRTN S CLOT BS ASY 1ML,$594.95,$0.00,$594.95,$0.00,$424.62,$0.00,$0.00,$0.00,$0.00,$0.00,$594.95,$0.00,$297.48,$471.20,$475.96,$0.00,$0.00,$0.00,$0.00,$0.00
751,SUP,Custom 27203010,,CONTROL CHM 3ML LVL 1 ASY MLANLT LQCHK,$285.00,$0.00,$285.00,$0.00,$203.40,$0.00,$0.00,$0.00,$0.00,$0.00,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$0.00,$0.00,$0.00,$0.00
752,SUP,Custom 27203010,,CONTROL CHM 3ML LVL 2 ASY MLANLT LQCHK,$285.00,$0.00,$285.00,$0.00,$203.40,$0.00,$0.00,$0.00,$0.00,$0.00,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$0.00,$0.00,$0.00,$0.00
804,SUP,HCPCS C1713,,804  -  SCREW 804 2.2MM X-DRV 4MM 6PK,$97.75,$0.00,$97.75,$43.99,$69.76,$0.00,$16.84,$0.00,$0.00,$17.12,$97.75,$0.00,$48.88,$77.42,$78.20,$0.00,$15.30,$0.00,$15.56,$0.00
805,SUP,HCPCS C1713,,805  -  SCREW 805 2.2MM X-DRV 5MM 6,$98.10,$0.00,$98.10,$44.15,$70.01,$0.00,$16.90,$0.00,$0.00,$17.18,$98.10,$0.00,$49.05,$77.70,$78.48,$0.00,$15.35,$0.00,$15.62,$0.00
807,SUP,HCPCS C1713,,807  -  SCREW 807 2.2MM X-DRV 7MM 6,$97.75,$0.00,$97.75,$43.99,$69.76,$0.00,$16.84,$0.00,$0.00,$17.12,$97.75,$0.00,$48.88,$77.42,$78.20,$0.00,$15.30,$0.00,$15.56,$0.00
835.105,SUP,Custom 27804086,,"835.105  -  MAINTAIN CERVICAL ALLOGRAFT, 5MM PARALLEL","$3,460.00",$0.00,"$3,460.00",$0.00,"$2,469.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,460.00",$0.00,"$1,730.00","$2,740.32","$2,768.00",$0.00,$0.00,$0.00,$0.00,$0.00
835.106,SUP,Custom 27804086,,"835.106  -  MAINTAIN CERVICAL ALLOGRAFT, 6MM PARALLEL","$3,460.00",$0.00,"$3,460.00",$0.00,"$2,469.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,460.00",$0.00,"$1,730.00","$2,740.32","$2,768.00",$0.00,$0.00,$0.00,$0.00,$0.00
835.107,SUP,Custom 27804086,,"835.107  -  MAINTAIN CERVICAL ALLOGRAFT, 7MM PARALLEL","$3,460.00",$0.00,"$3,460.00",$0.00,"$2,469.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,460.00",$0.00,"$1,730.00","$2,740.32","$2,768.00",$0.00,$0.00,$0.00,$0.00,$0.00
835.108,SUP,Custom 27804086,,"835.108  -  MAINTAIN CERVICAL ALLOGRAFT, 8MM PARALLEL","$3,460.00",$0.00,"$3,460.00",$0.00,"$2,469.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,460.00",$0.00,"$1,730.00","$2,740.32","$2,768.00",$0.00,$0.00,$0.00,$0.00,$0.00
835.109,SUP,Custom 27804086,,"835.109  -  MAINTAIN CERVICAL ALLOGRAFT, 9MM PARALLEL","$3,460.00",$0.00,"$3,460.00",$0.00,"$2,469.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,460.00",$0.00,"$1,730.00","$2,740.32","$2,768.00",$0.00,$0.00,$0.00,$0.00,$0.00
835.11,SUP,Custom 27804086,,"835.110  -  MAINTAIN CERVICAL ALLOGRAFT, 10MM PARALLEL","$3,460.00",$0.00,"$3,460.00",$0.00,"$2,469.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,460.00",$0.00,"$1,730.00","$2,740.32","$2,768.00",$0.00,$0.00,$0.00,$0.00,$0.00
835.111,SUP,Custom 27804086,,"835.111  -  MAINTAIN CERVICAL ALLOGRAFT, 11MM PARALLEL","$3,460.00",$0.00,"$3,460.00",$0.00,"$2,469.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,460.00",$0.00,"$1,730.00","$2,740.32","$2,768.00",$0.00,$0.00,$0.00,$0.00,$0.00
835.112,SUP,Custom 27804086,,"835.112  -  MAINTAIN CERVICAL ALLOGRAFT, 12MM PARALLEL","$3,460.00",$0.00,"$3,460.00",$0.00,"$2,469.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,460.00",$0.00,"$1,730.00","$2,740.32","$2,768.00",$0.00,$0.00,$0.00,$0.00,$0.00
835.205,SUP,Custom 27804086,,"835.205  -  MAINTAIN CERVICAL ALLOGRAFT, 5MM LORDOTIC","$3,460.00",$0.00,"$3,460.00",$0.00,"$2,469.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,460.00",$0.00,"$1,730.00","$2,740.32","$2,768.00",$0.00,$0.00,$0.00,$0.00,$0.00
835.206,SUP,Custom 27804086,,"835.206  -  MAINTAIN CERVICAL ALLOGRAFT, 6MM LORDOTIC","$3,460.00",$0.00,"$3,460.00",$0.00,"$2,469.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,460.00",$0.00,"$1,730.00","$2,740.32","$2,768.00",$0.00,$0.00,$0.00,$0.00,$0.00
835.207,SUP,Custom 27804086,,"835.207  -  MAINTAIN CERVICAL ALLOGRAFT, 7MM LORDOTIC","$3,460.00",$0.00,"$3,460.00",$0.00,"$2,469.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,460.00",$0.00,"$1,730.00","$2,740.32","$2,768.00",$0.00,$0.00,$0.00,$0.00,$0.00
835.208,SUP,Custom 27804086,,"835.208  -  MAINTAIN CERVICAL ALLOGRAFT, 8MM LORDOTIC","$3,460.00",$0.00,"$3,460.00",$0.00,"$2,469.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,460.00",$0.00,"$1,730.00","$2,740.32","$2,768.00",$0.00,$0.00,$0.00,$0.00,$0.00
835.209,SUP,Custom 27804086,,"835.209  -  MAINTAIN CERVICAL ALLOGRAFT, 9MM LORDOTIC","$3,460.00",$0.00,"$3,460.00",$0.00,"$2,469.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,460.00",$0.00,"$1,730.00","$2,740.32","$2,768.00",$0.00,$0.00,$0.00,$0.00,$0.00
835.21,SUP,Custom 27804086,,"835.210  -  MAINTAIN CERVICAL ALLOGRAFT, 10MM LORDOTIC","$3,460.00",$0.00,"$3,460.00",$0.00,"$2,469.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,460.00",$0.00,"$1,730.00","$2,740.32","$2,768.00",$0.00,$0.00,$0.00,$0.00,$0.00
835.211,SUP,Custom 27804086,,"835.211  -  MAINTAIN CERVICAL ALLOGRAFT, 11MM LORDOTIC","$3,460.00",$0.00,"$3,460.00",$0.00,"$2,469.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,460.00",$0.00,"$1,730.00","$2,740.32","$2,768.00",$0.00,$0.00,$0.00,$0.00,$0.00
835.212,SUP,Custom 27804086,,"835.212  -  MAINTAIN CERVICAL ALLOGRAFT, 12MM LORDOTIC","$3,460.00",$0.00,"$3,460.00",$0.00,"$2,469.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,460.00",$0.00,"$1,730.00","$2,740.32","$2,768.00",$0.00,$0.00,$0.00,$0.00,$0.00
846,SUP,Custom 27011340,,846  -  ELECTRODE PATIENT RETURN THK1/8IN 36X20IN 2 CORD MEGA SOFT,"$8,500.00",$0.00,"$8,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,500.00",$0.00,"$4,250.00","$6,732.00","$6,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
876,SUP,Custom 27203010,,BLANKET 64X25IN MXTHR L HPR/HPO NWVN DISP WRM,$30.93,$0.00,$30.93,$0.00,$22.07,$0.00,$0.00,$0.00,$0.00,$0.00,$30.93,$0.00,$15.46,$24.50,$24.74,$0.00,$0.00,$0.00,$0.00,$0.00
876.853,SUP,HCPCS C1713,,876.853  -  SCREW BONE 4.5MM 13MM ATLNTS TI CANC ANT CERV SPNE SLFTAP VA,"$1,202.95",$0.00,"$1,202.95",$541.33,$858.55,$0.00,$207.26,$0.00,$0.00,$210.63,"$1,202.95",$0.00,$601.48,$952.74,$962.36,$0.00,$188.26,$0.00,$191.51,$0.00
900.601,SUP,Custom 27203010,,900.601  -  GUIDEWIRE ORTHOPEDIC 1.6MM 150MM DRILL TIP NONSTRL 3.5MM,$78.45,$0.00,$78.45,$0.00,$55.99,$0.00,$0.00,$0.00,$0.00,$0.00,$78.45,$0.00,$39.23,$62.13,$62.76,$0.00,$0.00,$0.00,$0.00,$0.00
900.721,SUP,HCPCS C1769,,900.721  -  GUIDEWIRE ORTHOPEDIC 1.25MM 150MM NONTHREADED COBALT NONSTRL,$50.83,$0.00,$50.83,$27.60,$36.27,$0.00,$8.50,$0.00,$0.00,$8.90,$50.83,$0.00,$25.41,$40.26,$40.66,$0.00,$7.72,$0.00,$8.09,$0.00
900.722,SUP,HCPCS C1769,,900.722  -  GUIDEWIRE ORTHOPEDIC 1.25MM 150MM THREAD NONSTRL 3.5MM CANN,$53.90,$0.00,$53.90,$29.27,$38.47,$0.00,$9.02,$0.00,$0.00,$9.44,$53.90,$0.00,$26.95,$42.69,$43.12,$0.00,$8.19,$0.00,$8.58,$0.00
900.723,SUP,HCPCS C1769,,900.723  -  GUIDEWIRE ORTHOPEDIC SPADE 2.5MM 230MM THREAD LCP DHHS,$88.03,$0.00,$88.03,$47.80,$62.82,$0.00,$14.72,$0.00,$0.00,$15.41,$88.03,$0.00,$44.01,$69.72,$70.42,$0.00,$13.37,$0.00,$14.01,$0.00
900.726,SUP,HCPCS C1769,,900.726  -  GUIDEWIRE ORTHOPEDIC 2.8MM 450MM 300MM TROCAR POINT THREADED,$143.30,$0.00,$143.30,$77.81,$102.27,$0.00,$23.97,$0.00,$0.00,$25.09,$143.30,$0.00,$71.65,$113.49,$114.64,$0.00,$21.77,$0.00,$22.81,$0.00
910.011,SUP,HCPCS C1713,,910.011  -  ASSURE SCREW RACK INSERT FOR 4.0MM STANDARD SELF-DRILLING SC,$765.00,$0.00,$765.00,$344.25,$545.98,$0.00,$131.81,$0.00,$0.00,$133.95,$765.00,$0.00,$382.50,$605.88,$612.00,$0.00,$119.72,$0.00,$121.79,$0.00
910.012,SUP,HCPCS C1713,,910.012  -  ASSURE SCREW RACK INSERT FOR 4.5MM STANDARD SELF-DRILLING SC,$765.00,$0.00,$765.00,$344.25,$545.98,$0.00,$131.81,$0.00,$0.00,$133.95,$765.00,$0.00,$382.50,$605.88,$612.00,$0.00,$119.72,$0.00,$121.79,$0.00
910.013,SUP,HCPCS C1713,,910.013  -  ASSURE SCREW RACK INSERT FOR 4.0MM STANDARD SELF-TAPPING SCR,$765.00,$0.00,$765.00,$344.25,$545.98,$0.00,$131.81,$0.00,$0.00,$133.95,$765.00,$0.00,$382.50,$605.88,$612.00,$0.00,$119.72,$0.00,$121.79,$0.00
910.014,SUP,HCPCS C1713,,910.014  -  ASSURE SCREW RACK INSERT FOR 4.5MM STANDARD SELF-TAPPING SCR,$765.00,$0.00,$765.00,$344.25,$545.98,$0.00,$131.81,$0.00,$0.00,$133.95,$765.00,$0.00,$382.50,$605.88,$612.00,$0.00,$119.72,$0.00,$121.79,$0.00
910.021,SUP,HCPCS C1713,,910.021  -  ASSURE SCREW RACK INSERT FOR 4.0MM RIGID SELF-DRILLING SCREW,$765.00,$0.00,$765.00,$344.25,$545.98,$0.00,$131.81,$0.00,$0.00,$133.95,$765.00,$0.00,$382.50,$605.88,$612.00,$0.00,$119.72,$0.00,$121.79,$0.00
910.022,SUP,HCPCS C1713,,910.022  -  ASSURE SCREW RACK INSERT FOR 4.5MM RIGID SELF-DRILLING SCREW,$765.00,$0.00,$765.00,$344.25,$545.98,$0.00,$131.81,$0.00,$0.00,$133.95,$765.00,$0.00,$382.50,$605.88,$612.00,$0.00,$119.72,$0.00,$121.79,$0.00
910.023,SUP,HCPCS C1713,,910.023  -  ASSURE SCREW RACK INSERT FOR 4.0MM RIGID SELF-TAPPING SCREWS,$530.00,$0.00,$530.00,$238.50,$378.26,$0.00,$91.32,$0.00,$0.00,$92.80,$530.00,$0.00,$265.00,$419.76,$424.00,$0.00,$82.95,$0.00,$84.38,$0.00
910.024,SUP,HCPCS C1713,,910.024  -  ASSURE SCREW RACK INSERT FOR 4.5MM RIGID SELF-TAPPING SCREWS,$765.00,$0.00,$765.00,$344.25,$545.98,$0.00,$131.81,$0.00,$0.00,$133.95,$765.00,$0.00,$382.50,$605.88,$612.00,$0.00,$119.72,$0.00,$121.79,$0.00
910.03,SUP,HCPCS C1713,,910.030  -  ASSURE SCREW RACK INSERT FOR AUXILLARY SCREWS,$765.00,$0.00,$765.00,$344.25,$545.98,$0.00,$131.81,$0.00,$0.00,$133.95,$765.00,$0.00,$382.50,$605.88,$612.00,$0.00,$119.72,$0.00,$121.79,$0.00
910.511,SUP,HCPCS C1713,,910.511  -  ASSURE SCREW RACK INSERT FOR 4.0MM STANDARD FIXED SELF-DRILL,$765.00,$0.00,$765.00,$344.25,$545.98,$0.00,$131.81,$0.00,$0.00,$133.95,$765.00,$0.00,$382.50,$605.88,$612.00,$0.00,$119.72,$0.00,$121.79,$0.00
910.512,SUP,HCPCS C1713,,910.512  -  ASSURE SCREW RACK INSERT FOR 4.5MM STANDARD FIXED SELF-DRILL,$765.00,$0.00,$765.00,$344.25,$545.98,$0.00,$131.81,$0.00,$0.00,$133.95,$765.00,$0.00,$382.50,$605.88,$612.00,$0.00,$119.72,$0.00,$121.79,$0.00
910.513,SUP,HCPCS C1713,,910.513  -  ASSURE SCREW RACK INSERT FOR 4.0MM STANDARD FIXED SELF-TAPPI,$765.00,$0.00,$765.00,$344.25,$545.98,$0.00,$131.81,$0.00,$0.00,$133.95,$765.00,$0.00,$382.50,$605.88,$612.00,$0.00,$119.72,$0.00,$121.79,$0.00
910.514,SUP,HCPCS C1713,,910.514  -  ASSURE SCREW RACK INSERT FOR 4.5MM STANDARD FIXED SELF-TAPPI,$765.00,$0.00,$765.00,$344.25,$545.98,$0.00,$131.81,$0.00,$0.00,$133.95,$765.00,$0.00,$382.50,$605.88,$612.00,$0.00,$119.72,$0.00,$121.79,$0.00
910.521,SUP,HCPCS C1713,,910.521  -  ASSURE SCREW RACK INSERT FOR 4.0MM FIXED SELF-DRILLING SCREW,$765.00,$0.00,$765.00,$344.25,$545.98,$0.00,$131.81,$0.00,$0.00,$133.95,$765.00,$0.00,$382.50,$605.88,$612.00,$0.00,$119.72,$0.00,$121.79,$0.00
910.522,SUP,HCPCS C1713,,910.522  -  ASSURE SCREW RACK INSERT FOR 4.5MM FIXED SELF-DRILLING SCREW,$765.00,$0.00,$765.00,$344.25,$545.98,$0.00,$131.81,$0.00,$0.00,$133.95,$765.00,$0.00,$382.50,$605.88,$612.00,$0.00,$119.72,$0.00,$121.79,$0.00
910.523,SUP,HCPCS C1713,,910.523  -  ASSURE SCREW RACK INSERT FOR 4.0MM FIXED SELF-TAPPING SCREWS,$765.00,$0.00,$765.00,$344.25,$545.98,$0.00,$131.81,$0.00,$0.00,$133.95,$765.00,$0.00,$382.50,$605.88,$612.00,$0.00,$119.72,$0.00,$121.79,$0.00
910.524,SUP,HCPCS C1713,,910.524  -  ASSURE SCREW RACK INSERT FOR 4.5MM FIXED SELF-TAPPING SCREWS,$765.00,$0.00,$765.00,$344.25,$545.98,$0.00,$131.81,$0.00,$0.00,$133.95,$765.00,$0.00,$382.50,$605.88,$612.00,$0.00,$119.72,$0.00,$121.79,$0.00
910.525,SUP,HCPCS C1713,,910.525  -  ASSURE SCREW RACK INSERT FOR AUXILIARY FIXED SCREWS,$765.00,$0.00,$765.00,$344.25,$545.98,$0.00,$131.81,$0.00,$0.00,$133.95,$765.00,$0.00,$382.50,$605.88,$612.00,$0.00,$119.72,$0.00,$121.79,$0.00
917.002,SUP,HCPCS C1713,,"917.002  -  ASSURE TRANSLATIONAL CERVICAL PLATE IMPLANT MODULE FOR 1,2 A","$2,120.00",$0.00,"$2,120.00",$954.00,"$1,513.04",$0.00,$365.27,$0.00,$0.00,$371.20,"$2,120.00",$0.00,"$1,060.00","$1,679.04","$1,696.00",$0.00,$331.78,$0.00,$337.50,$0.00
917.004,SUP,HCPCS C1713,,917.004  -  ASSURE TRANSLATIONAL CERVICAL PLATE IMPLANT MODULE FOR 4-LEV,"$1,962.50",$0.00,"$1,962.50",$883.13,"$1,400.64",$0.00,$338.13,$0.00,$0.00,$343.62,"$1,962.50",$0.00,$981.25,"$1,554.30","$1,570.00",$0.00,$307.13,$0.00,$312.43,$0.00
929.007,SUP,HCPCS C1713,,929.007  -  GATEWAY/CITADEL BONE SCREW MODULE,"$3,180.00",$0.00,"$3,180.00","$1,431.00","$2,269.57",$0.00,$547.90,$0.00,$0.00,$556.79,"$3,180.00",$0.00,"$1,590.00","$2,518.56","$2,544.00",$0.00,$497.67,$0.00,$506.26,$0.00
992,SUP,HCPCS C1713,,992  -  KIT ARTHRO FIX TRNFX2 SCR CANN DILAT ROTR CUF STRL DISP,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
1001,SUP,Custom 27203010,,KIT MYCTST M TB AMPLF DIR 50 TST,"$3,090.00",$0.00,"$3,090.00",$0.00,"$2,205.33",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,090.00",$0.00,"$1,545.00","$2,447.28","$2,472.00",$0.00,$0.00,$0.00,$0.00,$0.00
1006,SUP,Custom 27203010,,1006  -  PROBE VITRTM LGC VRST ATIOP ANT OCCUTOME STRL DISP,$413.33,$0.00,$413.33,$0.00,$294.99,$0.00,$0.00,$0.00,$0.00,$0.00,$413.33,$0.00,$206.66,$327.36,$330.66,$0.00,$0.00,$0.00,$0.00,$0.00
1028,SUP,HCPCS C2628,,1028  -  CATHETER BLNOCC FLOCONTROL,"$6,987.50",$0.00,"$6,987.50",$0.00,"$4,986.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,987.50",$0.00,"$3,493.75","$5,534.10","$5,590.00",$0.00,$0.00,$0.00,$0.00,$0.00
1041,SUP,Custom 27203010,,MASK O2 VNYL ADLT ELNG UNDCHN MED CONCEN TBG 7FT,$49.00,$0.00,$49.00,$0.00,$34.97,$0.00,$0.00,$0.00,$0.00,$0.00,$49.00,$0.00,$24.50,$38.81,$39.20,$0.00,$0.00,$0.00,$0.00,$0.00
1049,SUP,Custom 27203010,,01049  -  MASK O2 VNYL ADLT UNDCHN STY MED CONCEN W/O TBG LATEX FREE,$1.04,$0.00,$1.04,$0.00,$0.74,$0.00,$0.00,$0.00,$0.00,$0.00,$1.04,$0.00,$0.52,$0.82,$0.83,$0.00,$0.00,$0.00,$0.00,$0.00
1151,SUP,Custom 27203010,,1151  -  MANIPULATOR SURG UT INJECTOR 4.5MM DISP,$51.04,$0.00,$51.04,$0.00,$36.43,$0.00,$0.00,$0.00,$0.00,$0.00,$51.04,$0.00,$25.52,$40.42,$40.83,$0.00,$0.00,$0.00,$0.00,$0.00
1201,SUP,Custom 27803010,,1201  -  CLIP INTERNAL SMALL CHEVRON TRIANGLE WIDE LIGATE CROSS,$1.05,$0.00,$4.58,$2.06,$3.27,$0.00,$0.79,$0.00,$0.00,$0.80,$4.58,$0.00,$2.29,$0.83,$3.66,$0.00,$0.72,$0.00,$0.73,$0.00
1201,SUP,HCPCS C1760,,001201  -  CLIP SM INTNL HRZN TI ENDSCP LIGAT STRL DISP LATEX FREE,$4.58,$0.00,$4.58,$2.06,$3.27,$0.00,$0.79,$0.00,$0.00,$0.80,$4.58,$0.00,$2.29,$3.63,$3.66,$0.00,$0.72,$0.00,$0.73,$0.00
1266,SUP,Custom 27203010,,REAGENT THYGL AB IMMUN,$621.35,$0.00,$621.35,$0.00,$443.46,$0.00,$0.00,$0.00,$0.00,$0.00,$621.35,$0.00,$310.68,$492.11,$497.08,$0.00,$0.00,$0.00,$0.00,$0.00
1273,SUP,Custom 27203010,,KIT IMMUN TST THR MICROSOMAL AB,$621.35,$0.00,$621.35,$0.00,$443.46,$0.00,$0.00,$0.00,$0.00,$0.00,$621.35,$0.00,$310.68,$492.11,$497.08,$0.00,$0.00,$0.00,$0.00,$0.00
1435,SUP,Custom 27203010,,1435  -  BANDAGE COMPRESSION A TUBULAR 10MR MULTPUR ELAST COMFORTABLE,$42.68,$0.00,$42.68,$0.00,$30.46,$0.00,$0.00,$0.00,$0.00,$0.00,$42.68,$0.00,$21.34,$33.80,$34.14,$0.00,$0.00,$0.00,$0.00,$0.00
1438,SUP,Custom 27203010,,1438  -  BANDAGE COMPRESSION F LARGE KNEE MEDIUM THIGH TUBULAR 10MR,$86.61,$0.00,$86.61,$0.00,$61.81,$0.00,$0.00,$0.00,$0.00,$0.00,$86.61,$0.00,$43.30,$68.60,$69.28,$0.00,$0.00,$0.00,$0.00,$0.00
1441,SUP,Custom 27203010,,1441  -  BANDAGE COMPRESSION K 10MR TUBULAR MULTPUR COMFORTABLE,$145.98,$0.00,$145.98,$0.00,$104.19,$0.00,$0.00,$0.00,$0.00,$0.00,$145.98,$0.00,$72.99,$115.62,$116.79,$0.00,$0.00,$0.00,$0.00,$0.00
1443,SUP,Custom 27203010,,1443  -  BANDAGE COMPRESSION C MEDIUM ARM SMALL ANKLE TUBULAR 10MR,$61.56,$0.00,$61.56,$0.00,$43.94,$0.00,$0.00,$0.00,$0.00,$0.00,$61.56,$0.00,$30.78,$48.76,$49.25,$0.00,$0.00,$0.00,$0.00,$0.00
1534,SUP,Custom 27203010,,1534  -  SYSTEM GSTRC LAV 34FR NS ESLV TUBE RADOPQ STRP EASI-LOK ADPR,$365.14,$0.00,$365.14,$0.00,$260.60,$0.00,$0.00,$0.00,$0.00,$0.00,$365.14,$0.00,$182.57,$289.19,$292.11,$0.00,$0.00,$0.00,$0.00,$0.00
1537,SUP,Custom 27203010,,1537  -  FORCEPS BIOPSY COLD,$34.78,$0.00,$34.78,$0.00,$24.82,$0.00,$0.00,$0.00,$0.00,$0.00,$34.78,$0.00,$17.39,$27.55,$27.82,$0.00,$0.00,$0.00,$0.00,$0.00
1651,SUP,Custom 27203010,,SENSOR NEO LNOP FNGR TOE OXM ADH OPTC PRB DISP,$641.70,$0.00,$641.70,$0.00,$457.98,$0.00,$0.00,$0.00,$0.00,$0.00,$641.70,$0.00,$320.85,$508.23,$513.36,$0.00,$0.00,$0.00,$0.00,$0.00
1791,SUP,Custom 27203010,,REAGENT CT GC AP CMB 2 DTCT KT 1200 TST ANALY,$64.38,$0.00,$64.38,$0.00,$45.94,$0.00,$0.00,$0.00,$0.00,$0.00,$64.38,$0.00,$32.19,$50.99,$51.50,$0.00,$0.00,$0.00,$0.00,$0.00
1798,SUP,Custom 27203010,,SENSOR NEO LNOP NEO-L OXM ADH DISP,$31.05,$0.00,$31.05,$0.00,$22.16,$0.00,$0.00,$0.00,$0.00,$0.00,$31.05,$0.00,$15.53,$24.59,$24.84,$0.00,$0.00,$0.00,$0.00,$0.00
1800,SUP,Custom 27203010,,SENSOR INF LNOP GRT TOE THB OXM ADH STRAP INF-L,$31.05,$0.00,$31.05,$0.00,$22.16,$0.00,$0.00,$0.00,$0.00,$0.00,$31.05,$0.00,$15.53,$24.59,$24.84,$0.00,$0.00,$0.00,$0.00,$0.00
1863,SUP,Custom 27203010,,SENSOR ADLT LNCS DCI OXM ADH CBL NSTRL LF DISP,$457.20,$0.00,$457.20,$0.00,$326.30,$0.00,$0.00,$0.00,$0.00,$0.00,$457.20,$0.00,$228.60,$362.10,$365.76,$0.00,$0.00,$0.00,$0.00,$0.00
1892,SUP,Custom 27011340,,1892  -  SET PRSS MONITR COMBITRANS,$113.75,$0.00,$113.75,$0.00,$81.18,$0.00,$0.00,$0.00,$0.00,$0.00,$113.75,$0.00,$56.88,$90.09,$91.00,$0.00,$0.00,$0.00,$0.00,$0.00
1895,SUP,Custom 27203010,,SENSOR REUSABLE TIP CLIP EAR LNOP TC-I,$457.20,$0.00,$457.20,$0.00,$326.30,$0.00,$0.00,$0.00,$0.00,$0.00,$457.20,$0.00,$228.60,$362.10,$365.76,$0.00,$0.00,$0.00,$0.00,$0.00
1896,SUP,Custom 27203010,,SENSOR REUSABLE FOREHEAD LNOP TF-I,$572.50,$0.00,$572.50,$0.00,$408.59,$0.00,$0.00,$0.00,$0.00,$0.00,$572.50,$0.00,$286.25,$453.42,$458.00,$0.00,$0.00,$0.00,$0.00,$0.00
1904,SUP,Custom 27203010,,ENFACARE LIPIL POWDER 12.8OZ,$190.00,$0.00,$190.00,$0.00,$135.60,$0.00,$0.00,$0.00,$0.00,$0.00,$190.00,$0.00,$95.00,$150.48,$152.00,$0.00,$0.00,$0.00,$0.00,$0.00
1951,SUP,Custom 27203010,,1951  -  HEMOSTAT ABSORBABLE 14X2IN ORIGINAL FLEXIBLE SHEER WEAVE,$136.04,$0.00,$136.04,$0.00,$97.09,$0.00,$0.00,$0.00,$0.00,$0.00,$136.04,$0.00,$68.02,$107.74,$108.83,$0.00,$0.00,$0.00,$0.00,$0.00
1974,SUP,Custom 27203010,,1974  -  SPONGE ABSORBABLE THK10MM 100 12.5X8CM HEMOSTAT SURGIFOAM,$91.69,$0.00,$91.69,$0.00,$65.44,$0.00,$0.00,$0.00,$0.00,$0.00,$91.69,$0.00,$45.84,$72.62,$73.35,$0.00,$0.00,$0.00,$0.00,$0.00
1985,SUP,Custom 27203010,,1985  -  AGENT HMST STRL LF INSTAT ABS MCFIB CLGN 1GM DISP,$108.73,$0.00,$86.11,$0.00,$58.58,$0.00,$0.00,$0.00,$0.00,$0.00,$82.08,$0.00,$41.04,$86.11,$65.66,$0.00,$0.00,$0.00,$0.00,$0.00
2056,SUP,Custom 27203010,,2056  -  APL BRCHTX 5-6CM VAR TRY MAMST 8MM BRST,"$6,875.00",$0.00,"$6,875.00",$0.00,"$4,906.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,875.00",$0.00,"$3,437.50","$5,445.00","$5,500.00",$0.00,$0.00,$0.00,$0.00,$0.00
2083,SUP,Custom 27203010,,2083  -  HEMOSTAT ABS 4X4IN NWVN BCTRCD SRGCL SNOW CLU FBRC,$286.01,$0.00,$286.01,$0.00,$204.13,$0.00,$0.00,$0.00,$0.00,$0.00,$286.01,$0.00,$143.01,$226.52,$228.81,$0.00,$0.00,$0.00,$0.00,$0.00
2161,SUP,Custom 27203010,,STRIP UA MLSTX 10 SG 9 PRMTR SG REAGENT 100 TST,$81.00,$0.00,$81.00,$0.00,$57.81,$0.00,$0.00,$0.00,$0.00,$0.00,$81.00,$0.00,$40.50,$64.15,$64.80,$0.00,$0.00,$0.00,$0.00,$0.00
2200,SUP,Custom 27803010,,2200  -  CLIP INTERNAL MEDIUM CHEVRON HEART TRNSVRS GROOVE LIGATE,$6.90,$0.00,$6.90,$0.00,$4.93,$0.00,$0.00,$0.00,$0.00,$0.00,$6.90,$0.00,$3.45,$5.46,$5.52,$0.00,$0.00,$0.00,$0.00,$0.00
2406,SUP,Custom 27203010,,STAIN DVD MRKNG 2OZ REFL BTL SET AST HISTOLGY,$285.00,$0.00,$285.00,$0.00,$203.40,$0.00,$0.00,$0.00,$0.00,$0.00,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$0.00,$0.00,$0.00,$0.00
2456,SUP,Custom 27203010,,2456  -  APL BRCHTX 4-5CM VAR TRY MAMST 8MM BRST,"$6,875.00",$0.00,"$6,875.00",$0.00,"$4,906.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,875.00",$0.00,"$3,437.50","$5,445.00","$5,500.00",$0.00,$0.00,$0.00,$0.00,$0.00
2550,SUP,Custom 27203010,,2550  -  BAG DRAIN INLINE SELF FILL OASIS 600ML STERILE ATRIUM ATS,$57.10,$0.00,$57.10,$0.00,$40.75,$0.00,$0.00,$0.00,$0.00,$0.00,$57.10,$0.00,$28.55,$45.22,$45.68,$0.00,$0.00,$0.00,$0.00,$0.00
2649,SUP,Custom 27203010,,CUFF CLASSIC LRG ADLT LNG 2 TB ROSE WHT SCREW CONNECTOR,$36.25,$0.00,$36.25,$0.00,$25.87,$0.00,$0.00,$0.00,$0.00,$0.00,$36.25,$0.00,$18.13,$28.71,$29.00,$0.00,$0.00,$0.00,$0.00,$0.00
2816,SUP,Custom 27203010,,RESTRAINT XTRMT PSY LMB WRST ANKL FOAM HLDR QRLSE SGL STRAP,$35.25,$0.00,$35.25,$0.00,$25.16,$0.00,$0.00,$0.00,$0.00,$0.00,$35.25,$0.00,$17.63,$27.92,$28.20,$0.00,$0.00,$0.00,$0.00,$0.00
2845,SUP,Custom 27203010,,KIT MYCTST ACPRB M AVIUM CULT ID 20 TST,$708.13,$0.00,$708.13,$0.00,$505.39,$0.00,$0.00,$0.00,$0.00,$0.00,$708.13,$0.00,$354.06,$560.84,$566.50,$0.00,$0.00,$0.00,$0.00,$0.00
2855,SUP,Custom 27203010,,KIT MYCTST ACPRB MYCB KS 2 CULT ID 20 TST,$708.33,$0.00,$708.33,$0.00,$505.53,$0.00,$0.00,$0.00,$0.00,$0.00,$708.33,$0.00,$354.16,$561.00,$566.66,$0.00,$0.00,$0.00,$0.00,$0.00
2860,SUP,Custom 27203010,,KIT MYCTST ACPRB M TB CULT ID 20 TST,$708.13,$0.00,$708.13,$0.00,$505.39,$0.00,$0.00,$0.00,$0.00,$0.00,$708.13,$0.00,$354.06,$560.84,$566.50,$0.00,$0.00,$0.00,$0.00,$0.00
2910,SUP,Custom 27203010,,KIT MYCTST ACPRB HISTOPLASMA CAPSULATUM CULT ID 20 TST,$708.33,$0.00,$708.33,$0.00,$505.53,$0.00,$0.00,$0.00,$0.00,$0.00,$708.33,$0.00,$354.16,$561.00,$566.66,$0.00,$0.00,$0.00,$0.00,$0.00
2994,SUP,Custom 27203010,,2994  -  AGENT HMST STRL SURGIFLO KT MTRX THRMB,$650.86,$0.00,$650.86,$0.00,$464.52,$0.00,$0.00,$0.00,$0.00,$0.00,$650.86,$0.00,$325.43,$515.48,$520.69,$0.00,$0.00,$0.00,$0.00,$0.00
3037,SUP,HCPCS C1787,,3037  -  PROGRAMMER NRSTM 5L 22X10X4CM INTSTM 240X640 PIXELS PT SLIM,"$2,975.00",$0.00,"$2,975.00",$0.00,"$2,123.26",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,975.00",$0.00,"$1,487.50","$2,356.20","$2,380.00",$0.00,$0.00,$0.00,$0.00,$0.00
3048,SUP,HCPCS C1729,,CATHETER IV 14GA 1.25IN RADIOPQ SFSHLD ORNG PCTV TFLN STRL,$3.88,$0.00,$3.88,$2.10,$2.77,$0.00,$0.67,$0.00,$0.00,$0.68,$3.88,$0.00,$1.94,$3.07,$3.10,$0.00,$0.61,$0.00,$0.62,$0.00
3050,SUP,HCPCS C1729,,CATHETER IV 22GA 1IN RADIOPQ SFSHLD BLUE PCTV TFLN STRL LF,$3.88,$0.00,$3.88,$2.10,$2.77,$0.00,$0.67,$0.00,$0.00,$0.68,$3.88,$0.00,$1.94,$3.07,$3.10,$0.00,$0.61,$0.00,$0.62,$0.00
3053,SUP,HCPCS C1729,,CATHETER IV 24GA .75IN RADIOPQ SFSHLD YLW PCTV TFLN STRL LF,$3.88,$0.00,$3.88,$2.10,$2.77,$0.00,$0.67,$0.00,$0.00,$0.68,$3.88,$0.00,$1.94,$3.07,$3.10,$0.00,$0.61,$0.00,$0.62,$0.00
3055,SUP,HCPCS C1729,,CATHETER IV 18GA 1.25IN RADIOPQ SFSHLD GRN PCTV TFLN STRL LF,$3.88,$0.00,$3.88,$2.10,$2.77,$0.00,$0.67,$0.00,$0.00,$0.68,$3.88,$0.00,$1.94,$3.07,$3.10,$0.00,$0.61,$0.00,$0.62,$0.00
3056,SUP,HCPCS C1729,,CATHETER IV 20GA 1.25IN RADIOPQ SFSHLD PNK PCTV+PLUS TFLN,$3.88,$0.00,$3.88,$2.10,$2.77,$0.00,$0.67,$0.00,$0.00,$0.68,$3.88,$0.00,$1.94,$3.07,$3.10,$0.00,$0.61,$0.00,$0.62,$0.00
3057,SUP,HCPCS C1729,,CATHETER IV 20GA 1IN RADIOPQ SFSHLD PNK PCTV+ TFLN STRL LF,$3.88,$0.00,$3.88,$2.10,$2.77,$0.00,$0.67,$0.00,$0.00,$0.68,$3.88,$0.00,$1.94,$3.07,$3.10,$0.00,$0.61,$0.00,$0.62,$0.00
3110,SUP,Custom 27203010,,03110  -  WRENCH SURG 5MM ALN,$317.50,$0.00,$317.50,$0.00,$226.60,$0.00,$0.00,$0.00,$0.00,$0.00,$317.50,$0.00,$158.75,$251.46,$254.00,$0.00,$0.00,$0.00,$0.00,$0.00
3125,SUP,Custom 27203010,,03125  -  WRENCH SURG T BONE SCR,$397.50,$0.00,$397.50,$0.00,$283.70,$0.00,$0.00,$0.00,$0.00,$0.00,$397.50,$0.00,$198.75,$314.82,$318.00,$0.00,$0.00,$0.00,$0.00,$0.00
3396,SUP,HCPCS C1729,,CATHETER IV 20GA 1.25IN RADIOPQ SFSHLD PNK ACV J TFLN STRL,$3.93,$0.00,$3.93,$2.13,$2.80,$0.00,$0.68,$0.00,$0.00,$0.69,$3.93,$0.00,$1.96,$3.11,$3.14,$0.00,$0.61,$0.00,$0.62,$0.00
3423,SUP,Custom 27203010,,3423  -  DRILL SRG SM SHRT 3.5MM STRL LF EVOS AO QCK CNCT OVR DISP,$258.36,$0.00,$311.10,$0.00,$222.03,$0.00,$0.00,$0.00,$0.00,$0.00,$311.10,$0.00,$155.55,$204.62,$248.88,$0.00,$0.00,$0.00,$0.00,$0.00
3570,SUP,HCPCS C1729,,CATHETER URTH KNGRD 24FR FOLEY 2W SIL 5ML LTX,$2.23,$0.00,$2.23,$1.21,$1.59,$0.00,$0.38,$0.00,$0.00,$0.39,$2.23,$0.00,$1.11,$1.77,$1.78,$0.00,$0.35,$0.00,$0.35,$0.00
3573,SUP,HCPCS C1729,,CATHETER URTH KNGRD 26FR FOLEY 2W SIL 5ML LTX,$2.20,$0.00,$2.20,$1.19,$1.57,$0.00,$0.38,$0.00,$0.00,$0.39,$2.20,$0.00,$1.10,$1.74,$1.76,$0.00,$0.34,$0.00,$0.35,$0.00
3902,SUP,Custom 27203010,,3902  -  KIT TISS CLSR 2ML EVICEL SLNT FBRN,$525.98,$0.00,$525.98,$0.00,$375.39,$0.00,$0.00,$0.00,$0.00,$0.00,$525.98,$0.00,$262.99,$416.58,$420.78,$0.00,$0.00,$0.00,$0.00,$0.00
4001,SUP,Custom 27203010,,4001  -  RETAINER INTNL ORG SURGIFISH RADOPQ,$53.75,$0.00,$53.75,$0.00,$38.36,$0.00,$0.00,$0.00,$0.00,$0.00,$53.75,$0.00,$26.88,$42.57,$43.00,$0.00,$0.00,$0.00,$0.00,$0.00
4022,SUP,Custom 27203010,,REUSABLE CLIPS,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
4030,SUP,Custom 27203010,,4030  -  DRESSING HMST 12X12IN STRL LF QUIKCLOT TRAUMAPAD CNTRL+ 3,$686.97,$0.00,$544.08,$0.00,$7.85,$0.00,$0.00,$0.00,$0.00,$0.00,$11.00,$0.00,$5.50,$544.08,$8.80,$0.00,$0.00,$0.00,$0.00,$0.00
4073,SUP,Custom 27203010,,BLADE LRNSCP 3 MCNTSH,$41.35,$0.00,$41.35,$0.00,$29.51,$0.00,$0.00,$0.00,$0.00,$0.00,$41.35,$0.00,$20.68,$32.75,$33.08,$0.00,$0.00,$0.00,$0.00,$0.00
4074,SUP,Custom 27203010,,BLADE LRNSCP 4 MCNTSH,$41.35,$0.00,$41.35,$0.00,$29.51,$0.00,$0.00,$0.00,$0.00,$0.00,$41.35,$0.00,$20.68,$32.75,$33.08,$0.00,$0.00,$0.00,$0.00,$0.00
4080,SUP,Custom 27203010,,BLADE LRNSCP 0 STD MLLR SS,$41.35,$0.00,$41.35,$0.00,$29.51,$0.00,$0.00,$0.00,$0.00,$0.00,$41.35,$0.00,$20.68,$32.75,$33.08,$0.00,$0.00,$0.00,$0.00,$0.00
4082,SUP,Custom 27203010,,BLADE LRNSCP 2 STN MLLR REUSE,$37.55,$0.00,$37.55,$0.00,$26.80,$0.00,$0.00,$0.00,$0.00,$0.00,$37.55,$0.00,$18.78,$29.74,$30.04,$0.00,$0.00,$0.00,$0.00,$0.00
4083,SUP,Custom 27203010,,BLADE LRNSCP 3 STD WINCONSIN,$41.35,$0.00,$41.35,$0.00,$29.51,$0.00,$0.00,$0.00,$0.00,$0.00,$41.35,$0.00,$20.68,$32.75,$33.08,$0.00,$0.00,$0.00,$0.00,$0.00
4200,SUP,Custom 27803010,,004200  -  CLIP INTERNAL LARGE ANGLE RIGHT RING HANDLE LIGATE,$2.36,$0.00,$2.36,$0.00,$1.69,$0.00,$0.00,$0.00,$0.00,$0.00,$2.36,$0.00,$1.18,$1.87,$1.89,$0.00,$0.00,$0.00,$0.00,$0.00
4259,SUP,Custom 27203010,,04259  -  RESERVOIR ATF XRES B BLD COL DISP,$112.50,$0.00,$112.50,$0.00,$80.29,$0.00,$0.00,$0.00,$0.00,$0.00,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$0.00,$0.00,$0.00,$0.00
4273,SUP,Custom 27203010,,04273  -  KIT ATSBWL .25IN X ANCOAG ASP LN SCT ASMB TBG PVC DISP,$50.00,$0.00,$50.00,$0.00,$35.69,$0.00,$0.00,$0.00,$0.00,$0.00,$50.00,$0.00,$25.00,$39.60,$40.00,$0.00,$0.00,$0.00,$0.00,$0.00
4275,SUP,Custom 27203010,,04275  -  RESERVOIR ATF 120UM BTM OULET GRS FLTR BLUTSAMMEL,$112.50,$0.00,$112.50,$0.00,$80.29,$0.00,$0.00,$0.00,$0.00,$0.00,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$0.00,$0.00,$0.00,$0.00
4350,SUP,HCPCS C1765,,4350  -  BRR ADH ABS PLVC INTCD 4X3IN STRL,$753.34,$0.00,$753.34,$0.00,$537.66,$0.00,$129.80,$0.00,$0.00,$131.90,$753.34,$0.00,$376.67,$596.65,$602.67,$0.00,$117.90,$0.00,$0.00,$0.00
4353,SUP,Custom 27803010,,4353  -  IMPLANT FACIAL PATIENT SPECIFIC,"$7,000.00",$0.00,"$7,000.00",$0.00,"$4,995.90",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,000.00",$0.00,"$3,500.00","$5,544.00","$5,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
4400,SUP,Custom 27803010,,4400  -  RING ANLPLS 28MM MTRL C-E CL TI,"$6,552.50",$0.00,"$6,552.50",$0.00,"$4,676.52",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,552.50",$0.00,"$3,276.25","$5,189.58","$5,242.00",$0.00,$0.00,$0.00,$0.00,$0.00
4450,SUP,Custom 27803010,,4450  -  RING ANLPLS 24-40MM MTRL C-E PH,"$3,295.00",$0.00,"$2,609.64",$0.00,$119.90,$0.00,$0.00,$0.00,$0.00,$0.00,$168.00,$0.00,$84.00,"$2,609.64",$134.40,$0.00,$0.00,$0.00,$0.00,$0.00
4672,SUP,Custom 27803010,,004672  -  DEVICE VENTRICULAR ASSIST 12FR MICROAXIAL PUMP IMPELLA 2.5L,"$62,500.00",$0.00,"$62,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$62,500.00",$0.00,"$31,250.00","$49,500.00","$50,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
4823,SUP,HCPCS C1713,,4823.000  -  BLOCKER SPNL XIA 3 TI,$459.38,$0.00,$459.38,$206.72,$327.86,$0.00,$79.15,$0.00,$0.00,$80.43,$459.38,$0.00,$229.69,$363.83,$367.50,$0.00,$71.89,$0.00,$73.13,$0.00
5065,SUP,Custom 27203010,,5065  -  COVER COMPRESSION MEDIUM 12- IN RIGID SOLE VENT HOLE DORSUM,$172.30,$0.00,$172.30,$0.00,$122.97,$0.00,$0.00,$0.00,$0.00,$0.00,$172.30,$0.00,$86.15,$136.46,$137.84,$0.00,$0.00,$0.00,$0.00,$0.00
5571,SUP,HCPCS C1887,,5571  -  HANDLE LRNSCP MED STD RUSCH DLPHN REUSE,"$1,182.50",$0.00,"$1,182.50",$642.10,$843.95,$0.00,$203.74,$0.00,$0.00,$207.05,"$1,182.50",$0.00,$591.25,$936.54,$946.00,$0.00,$185.06,$0.00,$188.25,$0.00
5897,SUP,Custom 27203010,,5897  -  CUFF CMPR REG KDL SCD EXP BLDR FT,$76.72,$0.00,$73.46,$0.00,$52.43,$0.00,$0.00,$0.00,$0.00,$0.00,$73.46,$0.00,$36.73,$60.76,$58.77,$0.00,$0.00,$0.00,$0.00,$0.00
5898,SUP,Custom 27203010,,5898  -  SLEEVE CMPR LG SCD EXP ANEMB CUF FT,$76.72,$0.00,$73.46,$0.00,$52.43,$0.00,$0.00,$0.00,$0.00,$0.00,$73.46,$0.00,$36.73,$60.76,$58.77,$0.00,$0.00,$0.00,$0.00,$0.00
6057,SUP,HCPCS C1765,,6057  -  STYLET LEAD .014IN KT BALL TIP BLUE KNOB,$100.00,$0.00,$100.00,$0.00,$71.37,$0.00,$17.23,$0.00,$0.00,$17.51,$100.00,$0.00,$50.00,$79.20,$80.00,$0.00,$15.65,$0.00,$0.00,$0.00
6081,SUP,Custom 27203010,,6081  -  FILTER LEEP SMOKE EVACUATOR PRE,$28.90,$0.00,$28.90,$0.00,$20.63,$0.00,$0.00,$0.00,$0.00,$0.00,$28.90,$0.00,$14.45,$22.89,$23.12,$0.00,$0.00,$0.00,$0.00,$0.00
6091,SUP,HCPCS C1765,,6091  -  STYLET LEAD .014IN KT JTP BALL TIP XTD TPR GRY KNOB,$100.00,$0.00,$79.20,$0.00,$27.66,$0.00,$0.00,$0.00,$0.00,$0.00,$38.76,$0.00,$19.38,$79.20,$31.01,$0.00,$0.00,$0.00,$0.00,$0.00
6092,SUP,Custom 27203010,,6092  -  PAPER RCD 110MM EKG THRM CARELINK,$250.00,$0.00,$198.00,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$198.00,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
6122,SUP,Custom 27203010,,6122  -  MOUTHWASH ORAL 1.5OZ LF RNS ANSEP 0.05% CPC CL,$86.43,$0.00,$86.43,$0.00,$61.68,$0.00,$0.00,$0.00,$0.00,$0.00,$86.43,$0.00,$43.21,$68.45,$69.14,$0.00,$0.00,$0.00,$0.00,$0.00
6177,SUP,Custom 27203010,,6177  -  SLEEVE PACEMAKER RADIO FREQUENCY HEAD WAND COVER STERILE,$23.75,$0.00,$23.75,$0.00,$16.95,$0.00,$0.00,$0.00,$0.00,$0.00,$23.75,$0.00,$11.88,$18.81,$19.00,$0.00,$0.00,$0.00,$0.00,$0.00
6196,SUP,HCPCS C1729,,6196  -  CATHETER 7FR 100CM PIGTAIL,$2.50,$0.00,$2.50,$1.36,$1.78,$0.00,$0.43,$0.00,$0.00,$0.44,$2.50,$0.00,$1.25,$1.98,$2.00,$0.00,$0.39,$0.00,$0.40,$0.00
6215,SUP,Custom 27203010,,6215  -  CATHETER GD 6FR ATN GW PU CS VNGR,$230.00,$0.00,$230.00,$0.00,$164.15,$0.00,$0.00,$0.00,$0.00,$0.00,$230.00,$0.00,$115.00,$182.16,$184.00,$0.00,$0.00,$0.00,$0.00,$0.00
6314,SUP,Custom 27803010,,6314  -  GRAFT SYNTH TISSUE 91X56X4MM SMOOTH EXTERIOR SURFACE,"$4,742.50",$0.00,"$4,742.50",$0.00,"$3,384.72",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,742.50",$0.00,"$2,371.25","$3,756.06","$3,794.00",$0.00,$0.00,$0.00,$0.00,$0.00
6316,SUP,Custom 27803010,,6316  -  IMPLANT ORBTL 14MM SPHERE BIOCOMPATIBLE POROUS MEDPOR,"$1,505.00",$0.00,"$1,505.00",$0.00,"$1,074.12",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,505.00",$0.00,$752.50,"$1,191.96","$1,204.00",$0.00,$0.00,$0.00,$0.00,$0.00
6317,SUP,Custom 27803010,,6317  -  IMPLANT ORBTL 20MM SPHERE BIOCOMPATIBLE POROUS MEDPOR,"$1,505.00",$0.00,"$1,505.00",$0.00,"$1,074.12",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,505.00",$0.00,$752.50,"$1,191.96","$1,204.00",$0.00,$0.00,$0.00,$0.00,$0.00
6322,SUP,Custom 27803010,,6322  -  SPHERE EYE 22MM THK.45MM 42MMX41MMX1MM STRL PE POR MEDPOR,"$1,505.00",$0.00,"$1,505.00",$0.00,"$1,074.12",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,505.00",$0.00,$752.50,"$1,191.96","$1,204.00",$0.00,$0.00,$0.00,$0.00,$0.00
6326,SUP,Custom 27803010,,6326  -  IMPLANT ORBTL 16MM SPHERE BIOCOMPATIBLE POROUS MEDPOR,"$1,505.00",$0.00,"$1,505.00",$0.00,"$1,074.12",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,505.00",$0.00,$752.50,"$1,191.96","$1,204.00",$0.00,$0.00,$0.00,$0.00,$0.00
6327,SUP,Custom 27803010,,6327  -  IMPLANT ORBTL ROUND 18MM SPHERE BIOCOMPATIBLE POROUS MEDPOR,"$1,505.00",$0.00,"$1,505.00",$0.00,"$1,074.12",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,505.00",$0.00,$752.50,"$1,191.96","$1,204.00",$0.00,$0.00,$0.00,$0.00,$0.00
6330,SUP,Custom 27803010,,6330  -  GRAFT SYNTH TISSUE 50X38X1.5MM SHEET POROUS MEDPOR,"$1,302.50",$0.00,"$1,302.50",$0.00,$929.59,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,302.50",$0.00,$651.25,"$1,031.58","$1,042.00",$0.00,$0.00,$0.00,$0.00,$0.00
6331,SUP,Custom 27803010,,6331  -  GRAFT SYNTH TISSUE 76X50X1.5MM SHEET POROUS MEDPOR,"$1,750.00",$0.00,"$1,386.00",$0.00,$40.68,$0.00,$0.00,$0.00,$0.00,$0.00,$57.00,$0.00,$28.50,"$1,386.00",$45.60,$0.00,$0.00,$0.00,$0.00,$0.00
6332,SUP,Custom 27803010,,6332  -  GRAFT SYNTH TISSUE 38X13X3MM BLOCK POROUS MEDPOR,"$1,310.00",$0.00,"$1,310.00",$0.00,$934.95,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,310.00",$0.00,$655.00,"$1,037.52","$1,048.00",$0.00,$0.00,$0.00,$0.00,$0.00
6333,SUP,Custom 27803010,,6333  -  GRAFT SYNTH TISSUE 38X13X6MM BLOCK POROUS MEDPOR,"$1,647.50",$0.00,"$1,647.50",$0.00,"$1,175.82",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,647.50",$0.00,$823.75,"$1,304.82","$1,318.00",$0.00,$0.00,$0.00,$0.00,$0.00
6334,SUP,Custom 27803010,,6334  -  GRAFT SYNTH TISSUE 38X13X9.5MM BLOCK POROUS MEDPOR,"$1,940.00",$0.00,"$1,940.00",$0.00,"$1,384.58",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,940.00",$0.00,$970.00,"$1,536.48","$1,552.00",$0.00,$0.00,$0.00,$0.00,$0.00
6335,SUP,Custom 27803010,,6335  -  GRAFT SYNTH TISSUE 50X25X3MM BLOCK POROUS MEDPOR,"$2,425.00",$0.00,"$2,425.00",$0.00,"$1,730.72",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,425.00",$0.00,"$1,212.50","$1,920.60","$1,940.00",$0.00,$0.00,$0.00,$0.00,$0.00
6336,SUP,Custom 27803010,,6336  -  GRAFT SYNTH TISSUE CNTOUR 25X50X6MM BLOCK MEDPOR,"$2,667.50",$0.00,"$2,667.50",$0.00,"$1,903.79",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,667.50",$0.00,"$1,333.75","$2,112.66","$2,134.00",$0.00,$0.00,$0.00,$0.00,$0.00
6337,SUP,Custom 27803010,,6337  -  GRAFT SYNTH TISSUE 50X25X9.5MM BLOCK POROUS MEDPOR,"$3,155.00",$0.00,"$3,155.00",$0.00,"$2,251.72",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,155.00",$0.00,"$1,577.50","$2,498.76","$2,524.00",$0.00,$0.00,$0.00,$0.00,$0.00
6338,SUP,Custom 27803010,,6338  -  GRAFT SYNTH TISSUE 63X38X3MM BLOCK POROUS MEDPOR POLYETHLENE,"$3,155.00",$0.00,"$3,155.00",$0.00,"$2,251.72",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,155.00",$0.00,"$1,577.50","$2,498.76","$2,524.00",$0.00,$0.00,$0.00,$0.00,$0.00
6339,SUP,Custom 27803010,,6339  -  GRAFT SYNTH TISSUE CNTOUR 38X63X6MM BLOCK MEDPOR,"$3,395.00",$0.00,"$3,395.00",$0.00,"$2,423.01",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,395.00",$0.00,"$1,697.50","$2,688.84","$2,716.00",$0.00,$0.00,$0.00,$0.00,$0.00
6340,SUP,Custom 27803010,,6340  -  GRAFT SNTH TISS CNTR 38X63X9.5MM STRL MDPR BLCK PE POR,"$3,642.50",$0.00,"$3,642.50",$0.00,"$2,599.65",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,642.50",$0.00,"$1,821.25","$2,884.86","$2,914.00",$0.00,$0.00,$0.00,$0.00,$0.00
6351,SUP,Custom 27803010,,6351  -  GRAFT SYNTH TISSUE MEDPOR 178X127MM SHEET POROUS,"$5,350.00",$0.00,"$5,350.00",$0.00,"$3,818.30",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,350.00",$0.00,"$2,675.00","$4,237.20","$4,280.00",$0.00,$0.00,$0.00,$0.00,$0.00
6550,SUP,Custom 27203010,,KIT OC TTHT SWB PRXMNT SOL MOIST LF,$13.45,$0.00,$13.45,$0.00,$9.60,$0.00,$0.00,$0.00,$0.00,$0.00,$13.45,$0.00,$6.73,$10.65,$10.76,$0.00,$0.00,$0.00,$0.00,$0.00
6640,SUP,HCPCS C1729,,6640  -  SYSTEM DRN 7FR 15ML STRL LF TLS EVACUATE TUBE RADOPQ CATH,$105.00,$0.00,$105.00,$57.02,$74.94,$0.00,$18.09,$0.00,$0.00,$18.38,$105.00,$0.00,$52.50,$83.16,$84.00,$0.00,$16.43,$0.00,$16.72,$0.00
6650,SUP,HCPCS C1729,,6650  -  SYSTEM DRAIN 10FR EVACUATE TUBE RADIOPQ RESERVOIR LATEX FREE,$105.00,$0.00,$105.00,$57.02,$74.94,$0.00,$18.09,$0.00,$0.00,$18.38,$105.00,$0.00,$52.50,$83.16,$84.00,$0.00,$16.43,$0.00,$16.72,$0.00
7120,SUP,HCPCS C1895,,7120  -  LEAD DFBR 7FR DURATA ECRDL STRD ELUT TRUE BIPOL ACT FIX,"$10,500.00",$0.00,"$10,500.00","$4,725.00","$5,158.80",$0.00,"$1,809.10",$0.00,$0.00,"$1,838.47","$10,500.00",$0.00,"$5,250.00","$8,316.00","$8,400.00",$0.00,"$1,643.25",$0.00,"$1,671.60",$0.00
7122,SUP,HCPCS C1898,,7122  -  LEAD PCNG ECRDL BIPOL ACT FIX XTD-RETRAC HLX TIP DURATA,"$10,500.00",$0.00,"$10,500.00","$4,725.00","$5,158.80",$0.00,"$1,809.10",$0.00,$0.00,"$1,838.47","$10,500.00",$0.00,"$5,250.00","$8,316.00","$8,400.00",$0.00,"$1,643.25",$0.00,"$1,671.60",$0.00
7207,SUP,Custom 27803010,,7207  -  IMPLANT ORBTL CONE FLAT 16MM MULTPUR ANTERIOR SURFACE MEDPOR,"$1,153.66",$0.00,"$1,153.66",$0.00,$823.36,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,153.66",$0.00,$576.83,$913.70,$922.92,$0.00,$0.00,$0.00,$0.00,$0.00
7208,SUP,Custom 27803010,,7208  -  SAW SURG SAGITTAL SYSTEM 7,"$1,153.66",$0.00,"$1,153.66",$0.00,$823.36,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,153.66",$0.00,$576.83,$913.70,$922.92,$0.00,$0.00,$0.00,$0.00,$0.00
7209,SUP,Custom 27803010,,7209  -  IMPLANT ORBTL CONE FLAT 20MM MULTPUR ANTERIOR SURFACE MEDPOR,"$1,153.66",$0.00,"$1,153.66",$0.00,$823.36,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,153.66",$0.00,$576.83,$913.70,$922.92,$0.00,$0.00,$0.00,$0.00,$0.00
7210,SUP,Custom 27803010,,7210  -  GRAFT SYNTH TISSUE ULTRATHIN 50X38X.85MM SHEET POROUS MEDPOR,"$1,302.50",$0.00,"$1,302.50",$0.00,$929.59,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,302.50",$0.00,$651.25,"$1,031.58","$1,042.00",$0.00,$0.00,$0.00,$0.00,$0.00
7212,SUP,Custom 27803010,,7212  -  GRAFT SYNTH TISSUE ULTRATHIN 76X50X.85MM SHEET SMOOTH,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
7214,SUP,Custom 27803010,,7214  -  GRAFT SYNTH TISSUE ULTRATHIN 127X76X.85MM SHEET SMOOTH,"$3,360.00",$0.00,"$3,360.00",$0.00,"$2,398.03",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,360.00",$0.00,"$1,680.00","$2,661.12","$2,688.00",$0.00,$0.00,$0.00,$0.00,$0.00
7216,SUP,Custom 27803010,,7216  -  MEDPOR ULTRA THIN SHEET - 127MM X 178MM X 0.85MM,"$3,710.00",$0.00,"$3,710.00",$0.00,"$2,647.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,710.00",$0.00,"$1,855.00","$2,938.32","$2,968.00",$0.00,$0.00,$0.00,$0.00,$0.00
7222,SUP,Custom 27803010,,7222  -  IMPLANT ORBTL CONICAL FLAT ANTERIOR SURFACE CHANNELS POROUS,"$1,545.00",$0.00,"$1,223.64",$0.00,$751.80,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,053.38",$0.00,$526.69,"$1,223.64",$842.70,$0.00,$0.00,$0.00,$0.00,$0.00
7223,SUP,Custom 27803010,,7223  -  IMPLANT ORBTL CONICAL FLAT ANTERIOR SURFACE CHANNELS POROUS,"$1,592.50",$0.00,"$1,592.50",$0.00,"$1,136.57",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,592.50",$0.00,$796.25,"$1,261.26","$1,274.00",$0.00,$0.00,$0.00,$0.00,$0.00
7341,SUP,Custom 27203010,,STAIN BLUING SOL SGNTR 1GL HPRFR WKG SOL HMTL,$368.78,$0.00,$368.78,$0.00,$263.19,$0.00,$0.00,$0.00,$0.00,$0.00,$368.78,$0.00,$184.39,$292.07,$295.02,$0.00,$0.00,$0.00,$0.00,$0.00
7511,SUP,Custom 27803010,,7511  -  COVER BURR HOLE 5MM 15X3MM SUPERIOR FLANGE POROUS MEDPOR,"$1,070.00",$0.00,"$1,070.00",$0.00,$763.66,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,070.00",$0.00,$535.00,$847.44,$856.00,$0.00,$0.00,$0.00,$0.00,$0.00
7512,SUP,Custom 27803010,,7512  -  COVER BURR HOLE 29X17X7MM 3PK CRANIOMAXILLOFACIAL,"$1,070.00",$0.00,"$1,070.00",$0.00,$763.66,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,070.00",$0.00,$535.00,$847.44,$856.00,$0.00,$0.00,$0.00,$0.00,$0.00
7514,SUP,Custom 27803010,,7514  -  BURR HOLE DISC - 14MM X 16MM,$340.00,$0.00,$340.00,$0.00,$242.66,$0.00,$0.00,$0.00,$0.00,$0.00,$340.00,$0.00,$170.00,$269.28,$272.00,$0.00,$0.00,$0.00,$0.00,$0.00
7516,SUP,Custom 27803010,,7516  -  GRAFT SYNTH TISSUE SMALL 53X5MM DESIGN A LATEX FREE MEDPOR,"$1,077.50",$0.00,"$1,077.50",$0.00,$769.01,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,077.50",$0.00,$538.75,$853.38,$862.00,$0.00,$0.00,$0.00,$0.00,$0.00
7517,SUP,Custom 27803010,,7517  -  GRAFT SYNTH TISSUE LARGE 66X8MM IMPLANT DESIGN A POROUS,"$1,077.50",$0.00,"$1,077.50",$0.00,$769.01,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,077.50",$0.00,$538.75,$853.38,$862.00,$0.00,$0.00,$0.00,$0.00,$0.00
7518,SUP,Custom 27803010,,7518  -  GRAFT SYNTH TISSUE LARGE 67X6.5MM IMPLANT DESIGN B POROUS,"$1,077.50",$0.00,"$1,077.50",$0.00,$769.01,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,077.50",$0.00,$538.75,$853.38,$862.00,$0.00,$0.00,$0.00,$0.00,$0.00
7520,SUP,Custom 27803010,,7520  -  GRAFT SYNTH TISSUE SMALL 65X37X5MM IMPLANT 1 PIECE DESIGN,"$1,310.00",$0.00,"$1,310.00",$0.00,$934.95,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,310.00",$0.00,$655.00,"$1,037.52","$1,048.00",$0.00,$0.00,$0.00,$0.00,$0.00
7521,SUP,Custom 27803010,,7521  -  GRAFT SYNTH TISSUE MEDIUM 65X37X7MM IMPLANT 1 PIECE DESIGN,"$1,310.00",$0.00,"$1,310.00",$0.00,$934.95,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,310.00",$0.00,$655.00,"$1,037.52","$1,048.00",$0.00,$0.00,$0.00,$0.00,$0.00
7522,SUP,Custom 27803010,,7522  -  GRAFT SYNTH TISSUE LARGE 65X37X10MM IMPLANT 1 PIECE DESIGN,"$1,310.00",$0.00,"$1,310.00",$0.00,$934.95,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,310.00",$0.00,$655.00,"$1,037.52","$1,048.00",$0.00,$0.00,$0.00,$0.00,$0.00
7525,SUP,Custom 27803010,,7525  -  EAR BASE - LEFT - 28MM X 55MM X 13MM,"$2,404.00",$0.00,"$2,404.00",$0.00,"$1,715.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,404.00",$0.00,"$1,202.00","$1,903.97","$1,923.20",$0.00,$0.00,$0.00,$0.00,$0.00
7526,SUP,Custom 27803010,,7526  -  GRAFT SYNTH TISSUE LARGE 65X32X16MM BASE RECONSTRUCTION,"$3,367.50",$0.00,"$3,367.50",$0.00,"$2,403.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,367.50",$0.00,"$1,683.75","$2,667.06","$2,694.00",$0.00,$0.00,$0.00,$0.00,$0.00
7527,SUP,Custom 27803010,,7527  -  GRAFT SYNTH TISSUE LARGE 65X32X16MM LATEX FREE EAR LEFT,"$3,367.50",$0.00,"$3,367.50",$0.00,"$2,403.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,367.50",$0.00,"$1,683.75","$2,667.06","$2,694.00",$0.00,$0.00,$0.00,$0.00,$0.00
7535,SUP,Custom 27803010,,7535  -  GRAFT SYNTH TISSUE 47X37X3MM 6.5X3X3MM LATERAL AUGMENTATION,"$1,867.50",$0.00,"$1,867.50",$0.00,"$1,332.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,867.50",$0.00,$933.75,"$1,479.06","$1,494.00",$0.00,$0.00,$0.00,$0.00,$0.00
7536,SUP,Custom 27803010,,7536  -  GRAFT SYNTH TISSUE ANGLE 47X37X3MM AUGMENTATION ONLAY MEDPOR,"$1,867.50",$0.00,"$1,479.06",$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$3.85,$22.00,$0.00,$11.00,"$1,479.06",$17.60,$0.00,$3.44,$0.00,$0.00,$0.00
7538,SUP,Custom 27803010,,7538  -  GRAFT SYNTH TISSUE ANGLE 79X32X5MM E-5 INFERIOR RIDGE MEDPOR,"$1,867.50",$0.00,"$1,867.50",$0.00,"$1,332.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,867.50",$0.00,$933.75,"$1,479.06","$1,494.00",$0.00,$0.00,$0.00,$0.00,$0.00
7539,SUP,Custom 27803010,,7539  -  GRAFT SYNTH TISSUE 79X32X10MM IMPLANT RAMUS INFERIOR RIDGE,"$1,867.50",$0.00,"$1,867.50",$0.00,"$1,332.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,867.50",$0.00,$933.75,"$1,479.06","$1,494.00",$0.00,$0.00,$0.00,$0.00,$0.00
7541,SUP,Custom 27803010,,7541  -  GRAFT SYNTH TISSUE ANGLE 79X32X4MM ES-5 INFERIOR RIDGE,"$1,867.50",$0.00,"$1,867.50",$0.00,"$1,332.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,867.50",$0.00,$933.75,"$1,479.06","$1,494.00",$0.00,$0.00,$0.00,$0.00,$0.00
7542,SUP,Custom 27803010,,7542  -  GRAFT SYNTH TISSUE ANGLE 5MM 5MM 79MMX32MM 4MMX5MM RAMUS,"$1,867.50",$0.00,"$1,867.50",$0.00,"$1,332.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,867.50",$0.00,$933.75,"$1,479.06","$1,494.00",$0.00,$0.00,$0.00,$0.00,$0.00
7543,SUP,Custom 27803010,,7543  -  GRAFT SYNTH TISSUE 79X32X10MM IMPLANT RAMUS INFERIOR RIDGE,"$1,867.50",$0.00,"$1,867.50",$0.00,"$1,332.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,867.50",$0.00,$933.75,"$1,479.06","$1,494.00",$0.00,$0.00,$0.00,$0.00,$0.00
7544,SUP,Custom 27803010,,7544  -  GRAFT SYNTH TISSUE 79X32X10MM IMPLANT RAMUS INFERIOR RIDGE,"$1,867.50",$0.00,"$1,867.50",$0.00,"$1,332.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,867.50",$0.00,$933.75,"$1,479.06","$1,494.00",$0.00,$0.00,$0.00,$0.00,$0.00
7594,SUP,Custom 27203010,,REAGENT ANTI-FYB GMA CLN 5ML MNCLN BLOOD BANK,"$1,347.50",$0.00,"$1,347.50",$0.00,$961.71,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,347.50",$0.00,$673.75,"$1,067.22","$1,078.00",$0.00,$0.00,$0.00,$0.00,$0.00
7730,SUP,Custom 27203010,,7730  -  ADHESIVE OSTOMY MEDIUM SPRAY CAN REMAIN FLEXIBLE SILICONE,$39.38,$0.00,$39.38,$0.00,$28.10,$0.00,$0.00,$0.00,$0.00,$0.00,$39.38,$0.00,$19.69,$31.19,$31.50,$0.00,$0.00,$0.00,$0.00,$0.00
7828,SUP,HCPCS C1768,,007828  -  FABRIC CARDIO 4X4IN SVG THK.61MM FLMN,$254.37,$0.00,$254.37,$114.46,$181.54,$0.00,$43.83,$0.00,$0.00,$44.54,$254.37,$0.00,$127.18,$201.46,$203.49,$0.00,$39.81,$0.00,$40.49,$0.00
7836,SUP,HCPCS C1768,,7836  -  FELT CARDIO 10X10CM THK1.65MM PTFE,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
7836,SUP,HCPCS C1768,,007836  -  FELT CARDIO THK1.65MM 4X4IN PTFE STERILE,$220.45,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$174.60,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
7837,SUP,HCPCS C1768,,007837  -  FELT CARDIO 15X15CM THK1.65MM PTFE PTCH,$295.55,$0.00,$295.55,$133.00,$210.93,$0.00,$50.92,$0.00,$0.00,$51.75,$295.55,$0.00,$147.78,$234.08,$236.44,$0.00,$46.25,$0.00,$47.05,$0.00
8101,SUP,Custom 27203010,,REAGENT METHNL ISOPRPNL FLX 100 1GL ABST DEHYDRANT BTL,$40.60,$0.00,$40.60,$0.00,$28.98,$0.00,$0.00,$0.00,$0.00,$0.00,$40.60,$0.00,$20.30,$32.16,$32.48,$0.00,$0.00,$0.00,$0.00,$0.00
8185,SUP,HCPCS C1769,,8185  -  GUIDEWIRE VASC STRG 185CM PRIMEWIRE PSTG+ PRSS,"$1,687.50",$0.00,"$1,687.50",$916.31,"$1,204.37",$0.00,$290.75,$0.00,$0.00,$295.47,"$1,687.50",$0.00,$843.75,"$1,336.50","$1,350.00",$0.00,$264.09,$0.00,$268.65,$0.00
8305,SUP,Custom 27803010,,8305  -  GRAFT SNTH TISS TRMPT 50X38X1MM STRL MDPR BRR SHT HDPE NPOR,"$2,020.00",$0.00,"$2,020.00",$0.00,"$1,441.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,020.00",$0.00,"$1,010.00","$1,599.84","$1,616.00",$0.00,$0.00,$0.00,$0.00,$0.00
8312,SUP,Custom 27803010,,8312  -  GRAFT SYNTH TISSUE REGULAR 76X50X1MM IMPLANT RECTANGULAR,"$1,777.50",$0.00,"$1,777.50",$0.00,"$1,268.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,777.50",$0.00,$888.75,"$1,407.78","$1,422.00",$0.00,$0.00,$0.00,$0.00,$0.00
8313,SUP,Custom 27803010,,8313  -  GRAFT SYNTH TISSUE SMALL ROUND 47X45X3MM 2 PIECE DESIGN,"$1,412.50",$0.00,"$1,412.50",$0.00,"$1,008.10",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,412.50",$0.00,$706.25,"$1,118.70","$1,130.00",$0.00,$0.00,$0.00,$0.00,$0.00
8314,SUP,Custom 27803010,,8314  -  GRAFT SYNTH TISSUE MEDIUM ROUND 47X45X5MM 2 PIECE DESIGN,"$1,412.50",$0.00,"$1,412.50",$0.00,"$1,008.10",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,412.50",$0.00,$706.25,"$1,118.70","$1,130.00",$0.00,$0.00,$0.00,$0.00,$0.00
8315,SUP,Custom 27803010,,8315  -  IMPLANT CHIN LG RND 47X45X7MM STRL MDPR RZ 2 PC DSGN NTCH,"$1,412.50",$0.00,"$1,412.50",$0.00,"$1,008.10",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,412.50",$0.00,$706.25,"$1,118.70","$1,130.00",$0.00,$0.00,$0.00,$0.00,$0.00
8316,SUP,Custom 27803010,,8316  -  GRAFT SYNTH TISSUE 3MM ROUND EXTEND RZ CHIN,"$1,412.50",$0.00,"$1,412.50",$0.00,"$1,008.10",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,412.50",$0.00,$706.25,"$1,118.70","$1,130.00",$0.00,$0.00,$0.00,$0.00,$0.00
8317,SUP,Custom 27803010,,8317  -  IMPLANT CHIN MED SQ 47X45X5MM STRL MDPR RZ 2 PC DSGN NTCH,"$1,412.50",$0.00,"$1,412.50",$0.00,"$1,008.10",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,412.50",$0.00,$706.25,"$1,118.70","$1,130.00",$0.00,$0.00,$0.00,$0.00,$0.00
8318,SUP,Custom 27803010,,8318  -  IMPLANT CHIN LG SQ 47X45X7MM STRL MDPR RZ 2 PC DSGN NTCH TAB,"$1,412.50",$0.00,"$1,412.50",$0.00,"$1,008.10",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,412.50",$0.00,$706.25,"$1,118.70","$1,130.00",$0.00,$0.00,$0.00,$0.00,$0.00
8319,SUP,Custom 27803010,,8319  -  IMPLANT CHIN 45X41X4MM MGG 2 PC,"$1,215.00",$0.00,"$1,215.00",$0.00,$867.15,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,215.00",$0.00,$607.50,$962.28,$972.00,$0.00,$0.00,$0.00,$0.00,$0.00
8320,SUP,Custom 27803010,,8320  -  GRAFT SNTH TISS SM 56X33X5MM STRL MDPR IMPL 2 PC PRJ TPR WNG,"$1,310.00",$0.00,"$1,310.00",$0.00,$934.95,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,310.00",$0.00,$655.00,"$1,037.52","$1,048.00",$0.00,$0.00,$0.00,$0.00,$0.00
8321,SUP,Custom 27803010,,8321  -  GRAFT SYNTH TISSUE 56X36X7MM IMPLANT 2 PIECE MEDIUM,"$1,310.00",$0.00,"$1,310.00",$0.00,$934.95,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,310.00",$0.00,$655.00,"$1,037.52","$1,048.00",$0.00,$0.00,$0.00,$0.00,$0.00
8322,SUP,Custom 27803010,,8322  -  GRAFT SYNTH TISSUE 56X36X7MM IMPLANT 2 PIECE LARGE,"$1,310.00",$0.00,"$1,310.00",$0.00,$934.95,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,310.00",$0.00,$655.00,"$1,037.52","$1,048.00",$0.00,$0.00,$0.00,$0.00,$0.00
8328,SUP,Custom 27803010,,8328  -  GRAFT SYNTH TISSUE 62X37MM IMPLANT HELICAL RIM POROUS MEDPOR,"$1,810.00",$0.00,"$1,810.00",$0.00,"$1,291.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,810.00",$0.00,$905.00,"$1,433.52","$1,448.00",$0.00,$0.00,$0.00,$0.00,$0.00
8329,SUP,Custom 27803010,,8329  -  GRAFT SYNTH TISSUE 62X37MM HELICAL RIM POROUS MEDPOR,"$1,810.00",$0.00,"$1,810.00",$0.00,"$1,291.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,810.00",$0.00,$905.00,"$1,433.52","$1,448.00",$0.00,$0.00,$0.00,$0.00,$0.00
8330,SUP,Custom 27803010,,8330  -  GRAFT SYNTH TISSUE 60X30MM IMPLANT EXTENDED BASE POROUS,"$3,317.50",$0.00,"$3,317.50",$0.00,"$2,367.70",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,317.50",$0.00,"$1,658.75","$2,627.46","$2,654.00",$0.00,$0.00,$0.00,$0.00,$0.00
8331,SUP,Custom 27803010,,8331  -  GRAFT SYNTH TISSUE 60X30MM BASE EXTENDED POROUS MEDPOR,"$3,317.50",$0.00,"$3,317.50",$0.00,"$2,367.70",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,317.50",$0.00,"$1,658.75","$2,627.46","$2,654.00",$0.00,$0.00,$0.00,$0.00,$0.00
8340,SUP,Custom 27803010,,8340  -  GRAFT SYNTH TISSUE SMALL 60X25X5MM IMPLANT GENIOPLASTY WEDGE,"$1,490.00",$0.00,"$1,490.00",$0.00,"$1,063.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,490.00",$0.00,$745.00,"$1,180.08","$1,192.00",$0.00,$0.00,$0.00,$0.00,$0.00
8341,SUP,Custom 27803010,,8341  -  GRAFT SYNTH TISSUE MEDIUM 60X25X7.5MM IMPLANT GENIOPLASTY,"$1,490.00",$0.00,"$1,490.00",$0.00,"$1,063.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,490.00",$0.00,$745.00,"$1,180.08","$1,192.00",$0.00,$0.00,$0.00,$0.00,$0.00
8342,SUP,Custom 27803010,,8342  -  GENIOPLASTY WEDGE - LARGE - 60MM X 25MM X 10MM,"$1,096.00",$0.00,"$1,096.00",$0.00,$782.22,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,096.00",$0.00,$548.00,$868.03,$876.80,$0.00,$0.00,$0.00,$0.00,$0.00
8438,SUP,Custom 27803010,,8438  -  GRAFT SYNTH TISSUE MICROTHIN 50X30X.4MM SHEET MEDPOR,"$1,302.50",$0.00,"$1,302.50",$0.00,$929.59,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,302.50",$0.00,$651.25,"$1,031.58","$1,042.00",$0.00,$0.00,$0.00,$0.00,$0.00
8536,SUP,Custom 27203010,,8536  -  NEEDLE SUT ULTHN STRL HI-FI 2 ARM SS MNSCL,$116.80,$0.00,$116.80,$0.00,$83.36,$0.00,$0.00,$0.00,$0.00,$0.00,$116.80,$0.00,$58.40,$92.51,$93.44,$0.00,$0.00,$0.00,$0.00,$0.00
8570,SUP,Custom 27203010,,8570  -  NEEDLE SUT BLU STRL ZN SPC II REPR EYLT NTNL MNSCS,$64.38,$0.00,$64.38,$0.00,$45.94,$0.00,$0.00,$0.00,$0.00,$0.00,$64.38,$0.00,$32.19,$50.99,$51.50,$0.00,$0.00,$0.00,$0.00,$0.00
8662,SUP,Custom 27803010,,8662  -  GRAFT SYNTH TISSUE MICROTHIN 76X127MM SHEET POROUS MEDPOR,"$2,962.50",$0.00,"$2,962.50",$0.00,"$2,114.34",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,962.50",$0.00,"$1,481.25","$2,346.30","$2,370.00",$0.00,$0.00,$0.00,$0.00,$0.00
8703,SUP,Custom 27803010,,8703  -  SPHERE - 21MM,"$1,071.20",$0.00,"$1,071.20",$0.00,$764.52,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,071.20",$0.00,$535.60,$848.39,$856.96,$0.00,$0.00,$0.00,$0.00,$0.00
8704,SUP,Custom 27803010,,8704  -  SPHERE - 23MM,"$1,071.20",$0.00,"$1,071.20",$0.00,$764.52,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,071.20",$0.00,$535.60,$848.39,$856.96,$0.00,$0.00,$0.00,$0.00,$0.00
8800,SUP,Custom 27203010,,8800  -  KIT ARTHRO FIX PNACL ACL STRL DISP,$319.30,$0.00,$319.30,$0.00,$227.88,$0.00,$0.00,$0.00,$0.00,$0.00,$319.30,$0.00,$159.65,$252.89,$255.44,$0.00,$0.00,$0.00,$0.00,$0.00
8814,SUP,Custom 27011340,,08814  -  BRACE ORTH 30.5- IN 17-27IN TSCP BRIDGETECH ROM HNG PRMR TRM,$203.20,$0.00,$203.20,$0.00,$145.02,$0.00,$0.00,$0.00,$0.00,$0.00,$203.20,$0.00,$101.60,$160.93,$162.56,$0.00,$0.00,$0.00,$0.00,$0.00
9019,SUP,Custom 27803010,,9019  -  VAD 9019 18MM CONVERTIBLE,$888.25,$0.00,$888.25,$0.00,$633.94,$0.00,$0.00,$0.00,$0.00,$0.00,$888.25,$0.00,$444.13,$703.49,$710.60,$0.00,$0.00,$0.00,$0.00,$0.00
9025,SUP,Custom 27803010,,9025  -  CATH 9025 VENT STD XTRA LENGTH MARK IMP,$356.25,$0.00,$356.25,$0.00,$254.26,$0.00,$0.00,$0.00,$0.00,$0.00,$356.25,$0.00,$178.13,$282.15,$285.00,$0.00,$0.00,$0.00,$0.00,$0.00
9031,SUP,Custom 27203010,,9031  -  DEVICE BRCHTX CVTY EVAL TRGT MAMST BRST,$372.50,$0.00,$372.50,$0.00,$265.85,$0.00,$0.00,$0.00,$0.00,$0.00,$372.50,$0.00,$186.25,$295.02,$298.00,$0.00,$0.00,$0.00,$0.00,$0.00
9032,SUP,Custom 27803010,,9032  -  VENT 9032 QUICK RELEASE INTRODUCER,$270.75,$0.00,$270.75,$0.00,$193.23,$0.00,$0.00,$0.00,$0.00,$0.00,$270.75,$0.00,$135.38,$214.43,$216.60,$0.00,$0.00,$0.00,$0.00,$0.00
9041,SUP,Custom 27203010,,CONNECTOR TBG FMALE LUER LOCK LOCK PLG IV,$157.50,$0.00,$157.50,$0.00,$112.41,$0.00,$0.00,$0.00,$0.00,$0.00,$157.50,$0.00,$78.75,$124.74,$126.00,$0.00,$0.00,$0.00,$0.00,$0.00
9053,SUP,Custom 27203010,,9053  -  VAD 9053 12MM CONVT W/INLET CONN,$888.25,$0.00,$888.25,$0.00,$633.94,$0.00,$0.00,$0.00,$0.00,$0.00,$888.25,$0.00,$444.13,$703.49,$710.60,$0.00,$0.00,$0.00,$0.00,$0.00
9073,SUP,Custom 27203010,,9073  -  STOCKINETTE ORTHOPEDIC 25YDX3IN HIGH ABSORBENT KNIT LATEX,$28.80,$0.00,$28.80,$0.00,$20.56,$0.00,$0.00,$0.00,$0.00,$0.00,$28.80,$0.00,$14.40,$22.81,$23.04,$0.00,$0.00,$0.00,$0.00,$0.00
9094,SUP,Custom 27203010,,9094  -  STIMULATOR NRV STRL LF CKPNT LCTR DISP,"$1,565.00",$0.00,"$1,565.00",$0.00,"$1,116.94",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,565.00",$0.00,$782.50,"$1,239.48","$1,252.00",$0.00,$0.00,$0.00,$0.00,$0.00
9207,SUP,HCPCS C1729,,CATHETER XTRN MED XTD WR MALE,$3.00,$0.00,$3.00,$1.63,$2.14,$0.00,$0.52,$0.00,$0.00,$0.53,$3.00,$0.00,$1.50,$2.38,$2.40,$0.00,$0.47,$0.00,$0.48,$0.00
9209,SUP,HCPCS C1729,,CATHETER XTRN 36MM LG XTD WR LTX MALE,$3.00,$0.00,$3.00,$1.63,$2.14,$0.00,$0.52,$0.00,$0.00,$0.53,$3.00,$0.00,$1.50,$2.38,$2.40,$0.00,$0.47,$0.00,$0.48,$0.00
9305,SUP,Custom 27803010,,9305  -  GRAFT SYNTH TISSUE TRUMPET 50X30X1.6MM SHEET BARRIER MEDPOR,"$2,020.00",$0.00,"$2,020.00",$0.00,"$1,441.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,020.00",$0.00,"$1,010.00","$1,599.84","$1,616.00",$0.00,$0.00,$0.00,$0.00,$0.00
9312,SUP,Custom 27803010,,9312  -  GRAFT SYNTH TISSUE RECTANGLE 76X50X1.6MM IMPLANT NONPOROUS,"$1,777.50",$0.00,"$1,777.50",$0.00,"$1,268.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,777.50",$0.00,$888.75,"$1,407.78","$1,422.00",$0.00,$0.00,$0.00,$0.00,$0.00
9429,SUP,Custom 27803010,,9429  -  GRAFT SYNTH TISSUE 43X18MM FLANGE MEDPOR POLYETHYLENE POROUS,"$1,310.00",$0.00,"$1,310.00",$0.00,$934.95,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,310.00",$0.00,$655.00,"$1,037.52","$1,048.00",$0.00,$0.00,$0.00,$0.00,$0.00
9430,SUP,Custom 27803010,,9430  -  GRAFT SYNTH TISSUE INFERIOR ORBTL RIM RIGHT,"$1,310.00",$0.00,"$1,037.52",$0.00,$5.40,$0.00,$0.00,$0.00,$0.00,$0.00,$7.57,$0.00,$3.79,"$1,037.52",$6.06,$0.00,$0.00,$0.00,$0.00,$0.00
9500,SUP,HCPCS C1769,,9500  -  GUIDEWIRE VASC 3CM COMBOWIRE XT FLXB SHFT DPLR PTFE HDRPHB,"$2,750.00",$0.00,"$2,178.00",$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,"$2,178.00",$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
9501,SUP,Custom 27803010,,9501  -  GRAFT SYNTH TISSUE SUPER PETITE 50X19X3MM IMPLANT TAPERED,"$1,310.00",$0.00,"$1,037.52",$0.00,$59.45,$0.00,$0.00,$0.00,$0.00,$0.00,$83.30,$0.00,$41.65,"$1,037.52",$66.64,$0.00,$0.00,$0.00,$0.00,$0.00
9502,SUP,Custom 27803010,,9502  -  GRAFT SYNTH TISSUE SUPER PETITE 50X19X3MM IMPLANT TAPERED,"$1,310.00",$0.00,"$1,037.52",$0.00,$71.94,$0.00,$0.00,$0.00,$0.00,$0.00,$100.80,$0.00,$50.40,"$1,037.52",$80.64,$0.00,$0.00,$0.00,$0.00,$0.00
9503,SUP,Custom 27803010,,9503  -  GRAFT SYNTH TISSUE PETITE 50X19X5MM IMPLANT POROUS MEDPOR,"$1,310.00",$0.00,"$1,310.00",$0.00,$934.95,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,310.00",$0.00,$655.00,"$1,037.52","$1,048.00",$0.00,$0.00,$0.00,$0.00,$0.00
9504,SUP,Custom 27803010,,9504  -  GRAFT SYNTH TISSUE PETITE 50X19X5MM IMPLANT TAPERED POROUS,"$1,310.00",$0.00,"$1,310.00",$0.00,$934.95,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,310.00",$0.00,$655.00,"$1,037.52","$1,048.00",$0.00,$0.00,$0.00,$0.00,$0.00
9513,SUP,Custom 27803010,,9513  -  GRAFT SYNTH TISSUE SMALL CNTOUR 45X24X3MM TRIM AUGMENTATION,"$1,322.50",$0.00,"$1,047.42",$0.00,$317.74,$0.00,$0.00,$0.00,$0.00,$0.00,$445.20,$0.00,$222.60,"$1,047.42",$356.16,$0.00,$0.00,$0.00,$0.00,$0.00
9514,SUP,Custom 27803010,,9514  -  GRAFT SYNTH TISSUE SMALL 45X24X3MM EXTEND DESIGN MEDPOR,"$1,322.50",$0.00,"$1,322.50",$0.00,$943.87,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,322.50",$0.00,$661.25,"$1,047.42","$1,058.00",$0.00,$0.00,$0.00,$0.00,$0.00
9515,SUP,Custom 27803010,,9515  -  GRAFT SYNTH TISSUE MEDIUM CNTOUR 50X26X4MM EXTEND MEDPOR,"$1,322.50",$0.00,"$1,322.50",$0.00,$943.87,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,322.50",$0.00,$661.25,"$1,047.42","$1,058.00",$0.00,$0.00,$0.00,$0.00,$0.00
9516,SUP,Custom 27803010,,9516  -  GRAFT SNTH TISS MED 50X26X4MM STRL LF MDPR XTD CNTR PE POR,"$1,322.50",$0.00,"$1,047.42",$0.00,$5.78,$0.00,$0.00,$0.00,$0.00,$0.00,$8.10,$0.00,$4.05,"$1,047.42",$6.48,$0.00,$0.00,$0.00,$0.00,$0.00
9517,SUP,Custom 27803010,,9517  -  GRAFT SNTH TISS LG 55X27X5MM STRL MDPR XTD CNTR POR PE,"$1,322.50",$0.00,"$1,322.50",$0.00,$943.87,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,322.50",$0.00,$661.25,"$1,047.42","$1,058.00",$0.00,$0.00,$0.00,$0.00,$0.00
9518,SUP,Custom 27803010,,9518  -  GRAFT SYNTH TISSUE LARGE 55X27X5MM EXTEND SHAPE MEDPOR,"$1,322.50",$0.00,"$1,322.50",$0.00,$943.87,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,322.50",$0.00,$661.25,"$1,047.42","$1,058.00",$0.00,$0.00,$0.00,$0.00,$0.00
9519,SUP,Custom 27803010,,9519  -  GRAFT SYNTH TISSUE PARANASAL CRESCENT PETITE 28X26X4.5MM,"$1,360.00",$0.00,"$1,360.00",$0.00,$970.63,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,360.00",$0.00,$680.00,"$1,077.12","$1,088.00",$0.00,$0.00,$0.00,$0.00,$0.00
9520,SUP,Custom 27803010,,9520  -  GRAFT SYNTH TISSUE PARANASAL CRESCENT PETITE 28X26X4.5MM,"$1,360.00",$0.00,"$1,360.00",$0.00,$970.63,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,360.00",$0.00,$680.00,"$1,077.12","$1,088.00",$0.00,$0.00,$0.00,$0.00,$0.00
9521,SUP,Custom 27803010,,9521  -  GRAFT SYNTH TISSUE SMALL 70X70X10MM SMOOTH FLEXIBLE AUGMENT,"$4,555.00",$0.00,"$4,555.00",$0.00,"$3,250.90",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,555.00",$0.00,"$2,277.50","$3,607.56","$3,644.00",$0.00,$0.00,$0.00,$0.00,$0.00
9522,SUP,Custom 27803010,,9522  -  GRAFT SYNTH TISSUE MEDIUM 88X86X15MM SMOOTH FLEXIBLE AUGMENT,"$4,742.50",$0.00,"$4,742.50",$0.00,"$3,384.72",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,742.50",$0.00,"$2,371.25","$3,756.06","$3,794.00",$0.00,$0.00,$0.00,$0.00,$0.00
9523,SUP,Custom 27803010,,9523  -  GRAFT SYNTH TISSUE LARGE 98X95X18MM SMOOTH FLEXIBLE AUGMENT,"$4,922.50",$0.00,"$3,898.62",$0.00,$54.11,$0.00,$0.00,$0.00,$0.00,$0.00,$75.81,$0.00,$37.91,"$3,898.62",$60.65,$0.00,$0.00,$0.00,$0.00,$0.00
9524,SUP,Custom 27803010,,9524  -  GRAFT SYNTH TISSUE THK6MM 107MMX97 GRID CNTOUR MEDPOR,"$11,927.50",$0.00,"$11,927.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,927.50",$0.00,"$5,963.75","$9,446.58","$9,542.00",$0.00,$0.00,$0.00,$0.00,$0.00
9525,SUP,Custom 27803010,,9525  -  GRAFT SYNTH TISSUE PARANASAL CRESCENT LARGE 30X28X7MM,"$1,360.00",$0.00,"$1,077.12",$0.00,$63.25,$0.00,$0.00,$0.00,$0.00,$0.00,$88.62,$0.00,$44.31,"$1,077.12",$70.90,$0.00,$0.00,$0.00,$0.00,$0.00
9526,SUP,Custom 27803010,,9526  -  GRAFT SYNTH TISSUE PARANASAL CRESCENT LARGE 30X28X7MM,"$1,360.00",$0.00,"$1,077.12",$0.00,$89.93,$0.00,$0.00,$0.00,$0.00,$0.00,$126.00,$0.00,$63.00,"$1,077.12",$100.80,$0.00,$0.00,$0.00,$0.00,$0.00
9527,SUP,Custom 27803010,,9527  -  GRAFT SYNTH TISSUE 38X50X.85MM 1 CHANNEL SHEET MICROPLATE,$1.00,$0.00,$1.00,$0.00,$0.71,$0.00,$0.00,$0.00,$0.00,$0.00,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.00,$0.00,$0.00,$0.00
9530,SUP,Custom 27203010,,9530  -  SLEEVE COMPRESSION MEDIUM ANTIEMBOLISM ADJUSTABLE CLOSURE,$45.71,$0.00,$43.77,$0.00,$31.24,$0.00,$0.00,$0.00,$0.00,$0.00,$43.77,$0.00,$21.89,$36.20,$35.02,$0.00,$0.00,$0.00,$0.00,$0.00
9531,SUP,Custom 27803010,,9531  -  GRAFT SYNTH TISSUE 52X40X2.3MM IMPLANT MINIPLATE CHANNEL,"$2,920.00",$0.00,"$2,920.00",$0.00,"$2,084.00",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,920.00",$0.00,"$1,460.00","$2,312.64","$2,336.00",$0.00,$0.00,$0.00,$0.00,$0.00
9532,SUP,Custom 27803010,,9532  -  GRAFT SNTH TISS 52X40X2.3MM BRR MDPR MCPLT CHNL SHT PE,"$2,920.00",$0.00,"$2,920.00",$0.00,"$2,084.00",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,920.00",$0.00,"$1,460.00","$2,312.64","$2,336.00",$0.00,$0.00,$0.00,$0.00,$0.00
9533,SUP,Custom 27803010,,9533  -  GRAFT SYNTH TISSUE 1.1MM SMALL 70X13X2MM ONLAY ARCH SHAPE,"$1,177.50",$0.00,"$1,177.50",$0.00,$840.38,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,177.50",$0.00,$588.75,$932.58,$942.00,$0.00,$0.00,$0.00,$0.00,$0.00
9534,SUP,Custom 27803010,,9534  -  GRAFT SYNTH TISSUE MEDIUM 70X15X2MM NASAL ARCH POROUS MEDPOR,"$1,177.50",$0.00,"$1,177.50",$0.00,$840.38,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,177.50",$0.00,$588.75,$932.58,$942.00,$0.00,$0.00,$0.00,$0.00,$0.00
9535,SUP,Custom 27803010,,9535  -  GRAFT SYNTH TISSUE LARGE 70X17X2MM NASAL ARCH ONLAY POROUS,"$1,177.50",$0.00,"$1,177.50",$0.00,$840.38,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,177.50",$0.00,$588.75,$932.58,$942.00,$0.00,$0.00,$0.00,$0.00,$0.00
9536,SUP,Custom 27803010,,9536  -  GRAFT SYNTH TISSUE 40X9X1.1MM NASAL SHEET POROUS MEDPOR,$562.50,$0.00,$562.50,$0.00,$401.46,$0.00,$0.00,$0.00,$0.00,$0.00,$562.50,$0.00,$281.25,$445.50,$450.00,$0.00,$0.00,$0.00,$0.00,$0.00
9537,SUP,HCPCS C1763,,9537  -  TISSUE SYNTH PE POR MEDPOR ORBTL RIM,$950.00,$0.00,$950.00,$427.50,$678.02,$0.00,$163.68,$0.00,$0.00,$166.34,$950.00,$0.00,$475.00,$752.40,$760.00,$0.00,$148.68,$0.00,$151.24,$0.00
9539,SUP,Custom 27803010,,9539  -  GRAFT SYNTH TISSUE 47X40X6.3MM EXTEND MEDPOR POLYETHYLENE,"$1,940.00",$0.00,"$1,940.00",$0.00,"$1,384.58",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,940.00",$0.00,$970.00,"$1,536.48","$1,552.00",$0.00,$0.00,$0.00,$0.00,$0.00
9540,SUP,Custom 27803010,,9540  -  GRAFT SNTH TISS 47X40X6.3MM STRL MDPR XTD PE POR CRNMXF RT,"$1,940.00",$0.00,"$1,940.00",$0.00,"$1,384.58",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,940.00",$0.00,$970.00,"$1,536.48","$1,552.00",$0.00,$0.00,$0.00,$0.00,$0.00
9541,SUP,Custom 27803010,,9541  -  GRAFT SYNTH TISSUE REGULAR 31X22X7MM ENOPHTHALMOS WEDGE,"$1,707.50",$0.00,"$1,707.50",$0.00,"$1,218.64",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,707.50",$0.00,$853.75,"$1,352.34","$1,366.00",$0.00,$0.00,$0.00,$0.00,$0.00
9542,SUP,Custom 27803010,,9542  -  GRAFT SYNTH TISSUE REGULAR 31X22X7MM WEDGE ENOPHTHALMOS,"$1,707.50",$0.00,"$1,707.50",$0.00,"$1,218.64",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,707.50",$0.00,$853.75,"$1,352.34","$1,366.00",$0.00,$0.00,$0.00,$0.00,$0.00
9543,SUP,Custom 27803010,,9543  -  GRAFT SYNTH TISSUE LARGE 40X28X7.5MM ENOPHTHALMOS WEDGE,"$1,707.50",$0.00,"$1,707.50",$0.00,"$1,218.64",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,707.50",$0.00,$853.75,"$1,352.34","$1,366.00",$0.00,$0.00,$0.00,$0.00,$0.00
9544,SUP,Custom 27803010,,9544  -  GRAFT SYNTH TISSUE LARGE 40X28X7.5MM ENOPHTHALMOS WEDGE,"$1,707.50",$0.00,"$1,707.50",$0.00,"$1,218.64",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,707.50",$0.00,$853.75,"$1,352.34","$1,366.00",$0.00,$0.00,$0.00,$0.00,$0.00
9545,SUP,Custom 27203010,,9545  -  SLEEVE SMALL SCD EXPRESS THIGH LENGTH,$99.10,$0.00,$99.10,$0.00,$70.73,$0.00,$0.00,$0.00,$0.00,$0.00,$99.10,$0.00,$49.55,$78.49,$79.28,$0.00,$0.00,$0.00,$0.00,$0.00
9548,SUP,Custom 27803010,,9548  -  CONFORMER OCULAR MEDIUM 24X21X5.3MM NONVENT LATEX FREE ACRYL,$177.50,$0.00,$177.50,$0.00,$126.68,$0.00,$0.00,$0.00,$0.00,$0.00,$177.50,$0.00,$88.75,$140.58,$142.00,$0.00,$0.00,$0.00,$0.00,$0.00
9553,SUP,Custom 27803010,,9553  -  GRAFT SYNTH TISSUE REGULAR SHELL 38X21X17MM 2 INSERT,"$1,552.50",$0.00,"$1,552.50",$0.00,"$1,108.02",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,552.50",$0.00,$776.25,"$1,229.58","$1,242.00",$0.00,$0.00,$0.00,$0.00,$0.00
9554,SUP,Custom 27803010,,9554  -  GRAFT SYNTH TISSUE LARGE 40X20X18MM NASAL SHELL 2 INSERTS,"$1,552.50",$0.00,"$1,552.50",$0.00,"$1,108.02",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,552.50",$0.00,$776.25,"$1,229.58","$1,242.00",$0.00,$0.00,$0.00,$0.00,$0.00
9555,SUP,Custom 27203010,,CURETTE 4MM FLXLP ADLT EAR FLXB OVL CUP SURG POLYPRO DISP,$2.13,$0.00,$2.13,$0.00,$1.52,$0.00,$0.00,$0.00,$0.00,$0.00,$2.13,$0.00,$1.06,$1.69,$1.70,$0.00,$0.00,$0.00,$0.00,$0.00
9562,SUP,Custom 27803010,,9562  -  SHEET SNTH 50X38X3MM MDPR NEURO,"$3,360.00",$0.00,"$3,360.00",$0.00,"$2,398.03",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,360.00",$0.00,"$1,680.00","$2,661.12","$2,688.00",$0.00,$0.00,$0.00,$0.00,$0.00
9568,SUP,Custom 27803010,,9568  -  GRAFT SNTH TISS 108X75MM STRL MDPR IMPL INFR 2/3 ORBT POR PE,"$11,410.00",$0.00,"$11,410.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,410.00",$0.00,"$5,705.00","$9,036.72","$9,128.00",$0.00,$0.00,$0.00,$0.00,$0.00
9570,SUP,Custom 27803010,,9570  -  GRAFT SNTH TISS 93X75MM STRL MDPR IMPL CMPLT POR PE CRNMXF,"$13,547.50",$0.00,"$13,547.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,547.50",$0.00,"$6,773.75","$10,729.62","$10,838.00",$0.00,$0.00,$0.00,$0.00,$0.00
9580,SUP,Custom 27203010,,09580  -  DEVICE EXFIX OPTRM ELB TRGT DISC,$572.50,$0.00,$572.50,$0.00,$408.59,$0.00,$0.00,$0.00,$0.00,$0.00,$572.50,$0.00,$286.25,$453.42,$458.00,$0.00,$0.00,$0.00,$0.00,$0.00
9595,SUP,HCPCS C1769,,09595  -  WIRE .062IN KWIRE TRGT ORTH NONSTRL,$257.50,$0.00,$257.50,$139.82,$183.78,$0.00,$44.37,$0.00,$0.00,$45.09,$257.50,$0.00,$128.75,$203.94,$206.00,$0.00,$40.30,$0.00,$40.99,$0.00
9600,SUP,Custom 27203010,,09600  -  FXTR EXFIX OPTRM PROX ELB CMPNT,"$11,645.00",$0.00,"$11,645.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,645.00",$0.00,"$5,822.50","$9,222.84","$9,316.00",$0.00,$0.00,$0.00,$0.00,$0.00
9610,SUP,Custom 27803010,,09610  -  CMPNT EXFIX OPTRM RIGHT DISTAL,"$5,727.50",$0.00,"$4,536.18",$0.00,$34.17,$0.00,$0.00,$0.00,$0.00,$0.00,$47.88,$0.00,$23.94,"$4,536.18",$38.30,$0.00,$0.00,$0.00,$0.00,$0.00
9780,SUP,Custom 27203010,,9780  -  DEVICE DRN C400LB 10-24FR STRL LF INVACARE I-FIT ATCH DEV,$51.01,$0.00,$48.85,$0.00,$34.86,$0.00,$0.00,$0.00,$0.00,$0.00,$48.85,$0.00,$24.42,$40.40,$39.08,$0.00,$0.00,$0.00,$0.00,$0.00
9857,SUP,Custom 27803010,,9857  -  SHEET SNTH SM CNTR 78X61X18MM STRL FLXBLK TF2 MDPR CRNMXF LT,"$4,542.50",$0.00,"$4,542.50",$0.00,"$3,241.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,542.50",$0.00,"$2,271.25","$3,597.66","$3,634.00",$0.00,$0.00,$0.00,$0.00,$0.00
9858,SUP,Custom 27803010,,9858  -  GRAFT SYNTH TISSUE SMALL CNTOUR 78X61X18MM FLEXBLOCK TF2,"$4,542.50",$0.00,"$4,542.50",$0.00,"$3,241.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,542.50",$0.00,"$2,271.25","$3,597.66","$3,634.00",$0.00,$0.00,$0.00,$0.00,$0.00
9859,SUP,Custom 27803010,,9859  -  GRAFT SYNTH TISSUE MEDIUM CNTOUR 93X74X20MM FLEXBLOCK MEDPOR,"$4,752.50",$0.00,"$3,763.98",$0.00,$177.18,$0.00,$0.00,$0.00,$0.00,$0.00,$248.26,$0.00,$124.13,"$3,763.98",$198.61,$0.00,$0.00,$0.00,$0.00,$0.00
9860,SUP,Custom 27803010,,9860  -  GRAFT SYNTH TISSUE MEDIUM CNTOUR 93X74X20MM FLEXBLOCK MEDPOR,"$4,752.50",$0.00,"$4,752.50",$0.00,"$3,391.86",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,752.50",$0.00,"$2,376.25","$3,763.98","$3,802.00",$0.00,$0.00,$0.00,$0.00,$0.00
9861,SUP,Custom 27803010,,9861  -  GRAFT SYNTH TISSUE LARGE IMPLANT CNTOUR POROUS MEDPOR,"$4,972.50",$0.00,"$4,972.50",$0.00,"$3,548.87",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,972.50",$0.00,"$2,486.25","$3,938.22","$3,978.00",$0.00,$0.00,$0.00,$0.00,$0.00
9862,SUP,Custom 27803010,,9862  -  GRAFT SYNTH TISSUE LARGE IMPLANT POROUS MEDPOR FLEXBLOCK TF2,"$4,972.50",$0.00,"$4,972.50",$0.00,"$3,548.87",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,972.50",$0.00,"$2,486.25","$3,938.22","$3,978.00",$0.00,$0.00,$0.00,$0.00,$0.00
9864,SUP,Custom 27803010,,9864  -  GRAFT SYNTH TISSUE 44X43X6MM MEDPOR POLYETHYLENE POROUS,"$3,515.00",$0.00,"$3,515.00",$0.00,"$2,508.66",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,515.00",$0.00,"$1,757.50","$2,783.88","$2,812.00",$0.00,$0.00,$0.00,$0.00,$0.00
9865,SUP,Custom 27803010,,9865  -  GRAFT SYNTH TISSUE 44X43X6MM MEDPOR POLYETHYLENE POROUS LEFT,"$3,515.00",$0.00,"$3,515.00",$0.00,"$2,508.66",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,515.00",$0.00,"$1,757.50","$2,783.88","$2,812.00",$0.00,$0.00,$0.00,$0.00,$0.00
9866,SUP,Custom 27803010,,9866  -  IMPLANT ORBTL 16MM SMALL ROUND MOTILITY 2 CHANNEL 4 ANTERIOR,"$1,592.50",$0.00,"$1,592.50",$0.00,"$1,136.57",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,592.50",$0.00,$796.25,"$1,261.26","$1,274.00",$0.00,$0.00,$0.00,$0.00,$0.00
9867,SUP,Custom 27803010,,9867  -  IMPLANT ORBTL 18MM MEDIUM ROUND MOTILITY 2 CHANNEL 4,"$1,592.50",$0.00,"$1,592.50",$0.00,"$1,136.57",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,592.50",$0.00,$796.25,"$1,261.26","$1,274.00",$0.00,$0.00,$0.00,$0.00,$0.00
9868,SUP,Custom 27803010,,9868  -  IMPLANT ORBTL 20MM LARGE ROUND MOTILITY 2 CHANNEL 4 ANTERIOR,"$1,592.50",$0.00,"$1,592.50",$0.00,"$1,136.57",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,592.50",$0.00,$796.25,"$1,261.26","$1,274.00",$0.00,$0.00,$0.00,$0.00,$0.00
9952,SUP,Custom 27803010,,9952  -  SET SZR MALAR,$737.50,$0.00,$737.50,$0.00,$526.35,$0.00,$0.00,$0.00,$0.00,$0.00,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$0.00,$0.00,$0.00,$0.00
9955,SUP,Custom 27803010,,9955  -  GRAFT SYNTH TISSUE SMALL 65X35X3MM IMPLANT ANGLED WRAPAROUND,"$1,915.00",$0.00,"$1,915.00",$0.00,"$1,366.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,915.00",$0.00,$957.50,"$1,516.68","$1,532.00",$0.00,$0.00,$0.00,$0.00,$0.00
9956,SUP,Custom 27803010,,9956  -  GRAFT SYNTH TISSUE SMALL ANGLE RIGHT 65X35X3MM WRAPAROUND,"$1,915.00",$0.00,"$1,915.00",$0.00,"$1,366.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,915.00",$0.00,$957.50,"$1,516.68","$1,532.00",$0.00,$0.00,$0.00,$0.00,$0.00
9957,SUP,Custom 27803010,,9957  -  GRAFT SYNTH TISSUE MEDIUM 65X35X7MM IMPLANT ANGLED,"$1,915.00",$0.00,"$1,915.00",$0.00,"$1,366.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,915.00",$0.00,$957.50,"$1,516.68","$1,532.00",$0.00,$0.00,$0.00,$0.00,$0.00
9958,SUP,Custom 27803010,,9958  -  GRAFT SYNTH TISSUE MEDIUM 65X35X7MM IMPLANT ANGLED,"$1,915.00",$0.00,"$1,915.00",$0.00,"$1,366.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,915.00",$0.00,$957.50,"$1,516.68","$1,532.00",$0.00,$0.00,$0.00,$0.00,$0.00
9959,SUP,Custom 27803010,,9959  -  GRAFT SYNTH TISSUE LARGE 65X35X11MM IMPLANT ANGLED,"$1,915.00",$0.00,"$1,915.00",$0.00,"$1,366.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,915.00",$0.00,$957.50,"$1,516.68","$1,532.00",$0.00,$0.00,$0.00,$0.00,$0.00
9960,SUP,Custom 27803010,,9960  -  GRAFT SYNTH TISSUE LARGE 65X35X11MM IMPLANT ANGLED,"$1,915.00",$0.00,"$1,915.00",$0.00,"$1,366.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,915.00",$0.00,$957.50,"$1,516.68","$1,532.00",$0.00,$0.00,$0.00,$0.00,$0.00
10004,SUP,HCPCS C1713,,010004  -  PLATE BONE 4 HOLE UTILITY SPN,$26.25,$0.00,$26.25,$11.81,$18.73,$0.00,$4.52,$0.00,$0.00,$4.60,$26.25,$0.00,$13.13,$20.79,$21.00,$0.00,$4.11,$0.00,$4.18,$0.00
10014,SUP,HCPCS C1713,,010014  -  PLATE BONE 4MM STANDARD STR 14 HOLE TIMESH TITANIUM CRANIAL,$490.88,$0.00,$388.78,$0.00,$123.65,$0.00,$0.00,$0.00,$0.00,$0.00,$173.25,$0.00,$86.63,$388.78,$138.60,$0.00,$0.00,$0.00,$78.15,$0.00
10015,SUP,HCPCS C1713,,10015  -  SPACER ALLOGRAFT 8D NARROW LORDOTIC WEDGE PYRAMIDAL TEETH,"$10,725.00",$0.00,"$10,725.00","$4,826.25","$5,158.80",$0.00,"$1,847.86",$0.00,$0.00,"$1,877.86","$10,725.00",$0.00,"$5,362.50","$8,494.20","$8,580.00",$0.00,"$1,678.46",$0.00,"$1,707.42",$0.00
10016,SUP,HCPCS C1713,,010016  -  PLATE BONE 3MM STANDARD STR 14 HOLE TIMESH TITANIUM CRANIAL,$490.88,$0.00,$490.88,$220.89,$350.34,$0.00,$84.58,$0.00,$0.00,$85.95,$490.88,$0.00,$245.44,$388.78,$392.70,$0.00,$76.82,$0.00,$78.15,$0.00
10019,SUP,HCPCS C1713,,10019  -  SPACER ALLOGRAFT 8D NARROW PYRAMID LORDOTIC WEDGE 23-27MMX19,"$10,725.00",$0.00,"$10,725.00","$4,826.25","$5,158.80",$0.00,"$1,847.86",$0.00,$0.00,"$1,877.86","$10,725.00",$0.00,"$5,362.50","$8,494.20","$8,580.00",$0.00,"$1,678.46",$0.00,"$1,707.42",$0.00
10040,SUP,HCPCS C1713,,010040  -  SCREW 010040 X-DRV 1.0MM 4MM 6,$105.19,$0.00,$105.19,$47.33,$75.07,$0.00,$18.12,$0.00,$0.00,$18.42,$105.19,$0.00,$52.59,$83.31,$84.15,$0.00,$16.46,$0.00,$16.75,$0.00
10060,SUP,HCPCS C1713,,010060  -  SCREW 010060 X-DRV 1.0MM 6MM 6,$106.60,$0.00,$106.60,$47.97,$76.08,$0.00,$18.37,$0.00,$0.00,$18.67,$106.60,$0.00,$53.30,$84.43,$85.28,$0.00,$16.68,$0.00,$16.97,$0.00
10237,SUP,Custom 27203010,,10237  -  KIT GASTROSTOMY 11 .035IN J LP 18FR 22FR INTROD NEEDLE FEED,$553.50,$0.00,$584.88,$0.00,$417.43,$0.00,$0.00,$0.00,$0.00,$0.00,$584.88,$0.00,$292.44,$438.37,$467.90,$0.00,$0.00,$0.00,$0.00,$0.00
10241,SUP,HCPCS C1713,,010241  -  CATHETER ANGIOGRAPHIC STR PIGTAIL CURVE 6FR 110CM 6 SIDEHOLE,$408.00,$0.00,$408.00,$183.60,$291.19,$0.00,$70.30,$0.00,$0.00,$71.44,$408.00,$0.00,$204.00,$323.14,$326.40,$0.00,$63.85,$0.00,$64.95,$0.00
10242,SUP,HCPCS C1713,,010242  -  CATHETER ANGIOGRAPHIC 145D VAN TASSEL ANGLED PIGTAIL CURVE 6,$388.88,$0.00,$388.88,$174.99,$277.54,$0.00,$67.00,$0.00,$0.00,$68.09,$388.88,$0.00,$194.44,$307.99,$311.10,$0.00,$60.86,$0.00,$61.91,$0.00
10250,SUP,Custom 27203010,,10250  -  KIT GASTROSTOMY 12FR INTROD LAPSCOP MIC-KEY,$584.88,$0.00,$584.88,$0.00,$417.43,$0.00,$0.00,$0.00,$0.00,$0.00,$584.88,$0.00,$292.44,$463.22,$467.90,$0.00,$0.00,$0.00,$0.00,$0.00
10354,SUP,Custom 27203010,,FUNNEL CNTRF FLTR CRD SL CAP SMPL CHMBR .4ML CYFNL CYTSPN,$207.05,$0.00,$207.05,$0.00,$147.77,$0.00,$0.00,$0.00,$0.00,$0.00,$207.05,$0.00,$103.53,$163.98,$165.64,$0.00,$0.00,$0.00,$0.00,$0.00
10355,SUP,Custom 27203010,,FUNNEL CNTRF SGL FLTR CRD SL CAP .4ML CYFNL DISP WHT,$3.00,$0.00,$3.00,$0.00,$2.14,$0.00,$0.00,$0.00,$0.00,$0.00,$3.00,$0.00,$1.50,$2.38,$2.40,$0.00,$0.00,$0.00,$0.00,$0.00
10400,SUP,Custom 27203010,,REAGENT NEIS HMPHLS API ID CRD ANALY,$9.80,$0.00,$9.80,$0.00,$6.99,$0.00,$0.00,$0.00,$0.00,$0.00,$9.80,$0.00,$4.90,$7.76,$7.84,$0.00,$0.00,$0.00,$0.00,$0.00
12110,SUP,HCPCS C1887,,12110  -  CATHETER PERFUSION 10IN VENT DLP PVC PEDIATRIC 10FR,"$1,149.45",$0.00,"$1,149.45",$624.15,$820.36,$0.00,$198.04,$0.00,$0.00,$201.26,"$1,149.45",$0.00,$574.73,$910.36,$919.56,$0.00,$179.89,$0.00,$182.99,$0.00
13030,SUP,HCPCS C1713,,013030  -  SCREW 013030 X-DRV RESCUE 3MM 6PK,$99.52,$0.00,$99.52,$44.78,$71.03,$0.00,$17.15,$0.00,$0.00,$17.43,$99.52,$0.00,$49.76,$78.82,$79.62,$0.00,$15.58,$0.00,$15.84,$0.00
13050,SUP,HCPCS C1713,,013050  -  SCREW 013050 X-DRV RESCUE 5MM 6PK,$105.19,$0.00,$105.19,$47.33,$75.07,$0.00,$18.12,$0.00,$0.00,$18.42,$105.19,$0.00,$52.59,$83.31,$84.15,$0.00,$16.46,$0.00,$16.75,$0.00
13186,SUP,HCPCS C1713,,"13186  -  ENDOBUTTON FIXATION BUTTON, 4X 12MM",$452.40,$0.00,$452.40,$203.58,$322.88,$0.00,$77.95,$0.00,$0.00,$79.21,$452.40,$0.00,$226.20,$358.30,$361.92,$0.00,$70.80,$0.00,$72.02,$0.00
14000,SUP,Custom 27203010,,14000  -  SET CRDPLG .25IN 15IN DLP MLT 4 LG ADPR SLIP CNCT,$49.48,$0.00,$49.48,$0.00,$35.31,$0.00,$0.00,$0.00,$0.00,$0.00,$49.48,$0.00,$24.74,$39.19,$39.58,$0.00,$0.00,$0.00,$0.00,$0.00
14070,SUP,Custom 27203010,,14070  -  SYSTEM 8 1/8-11.75IN OST C2000- ML MAXI DRAIN PORT,$130.02,$0.00,$130.02,$0.00,$92.80,$0.00,$0.00,$0.00,$0.00,$0.00,$130.02,$0.00,$65.01,$102.98,$104.02,$0.00,$0.00,$0.00,$0.00,$0.00
15030,SUP,HCPCS C1713,,015030  -  SCREW BN 1.5MM 3MM TIMESH XDR TI CRNM,$92.44,$0.00,$92.44,$41.60,$65.97,$0.00,$15.93,$0.00,$0.00,$16.19,$92.44,$0.00,$46.22,$73.21,$73.95,$0.00,$14.47,$0.00,$14.72,$0.00
15031,SUP,HCPCS C1713,,015031  -  SCREW 015031 SELF TAPPING 1.5X3MM 1,$104.13,$0.00,$104.13,$46.86,$74.31,$0.00,$17.94,$0.00,$0.00,$18.23,$104.13,$0.00,$52.06,$82.47,$83.30,$0.00,$16.30,$0.00,$16.58,$0.00
15040,SUP,HCPCS C1713,,015040  -  PLATE BN STRG 4MM TIMESH 1 HLE/HD 1 HL SHFT TI CRNM 1.5MM,$99.17,$0.00,$99.17,$44.63,$70.78,$0.00,$17.09,$0.00,$0.00,$17.36,$99.17,$0.00,$49.58,$78.54,$79.33,$0.00,$15.52,$0.00,$15.79,$0.00
15041,SUP,HCPCS C1713,,015041  -  SCREW 015041 SELF TAPPING 1.5X4MM 1,$106.25,$0.00,$106.25,$47.81,$75.83,$0.00,$18.31,$0.00,$0.00,$18.60,$106.25,$0.00,$53.13,$84.15,$85.00,$0.00,$16.63,$0.00,$16.92,$0.00
15050,SUP,HCPCS C1713,,015050  -  SCREW 015050 X-DRV 1.5MM 5MM 6,$97.75,$0.00,$97.75,$43.99,$69.76,$0.00,$16.84,$0.00,$0.00,$17.12,$97.75,$0.00,$48.88,$77.42,$78.20,$0.00,$15.30,$0.00,$15.56,$0.00
15051,SUP,HCPCS C1713,,015051  -  SCREW 015051 SELF TAPPING 1.5X5MM 1,$104.13,$0.00,$104.13,$46.86,$74.31,$0.00,$17.94,$0.00,$0.00,$18.23,$104.13,$0.00,$52.06,$82.47,$83.30,$0.00,$16.30,$0.00,$16.58,$0.00
15060,SUP,HCPCS C1713,,015060  -  SCREW 015060 X-DRV 1.5MM 6MM 6,$97.75,$0.00,$97.75,$43.99,$69.76,$0.00,$16.84,$0.00,$0.00,$17.12,$97.75,$0.00,$48.88,$77.42,$78.20,$0.00,$15.30,$0.00,$15.56,$0.00
15070,SUP,HCPCS C1713,,015070  -  SCREW 015070 X DRV 1.5MM 7MM 6,$99.52,$0.00,$99.52,$44.78,$71.03,$0.00,$17.15,$0.00,$0.00,$17.43,$99.52,$0.00,$49.76,$78.82,$79.62,$0.00,$15.58,$0.00,$15.84,$0.00
15080,SUP,HCPCS C1713,,015080  -  SCREW 015080 X-DRV 1.5MM 8MM 6,$97.75,$0.00,$97.75,$43.99,$69.76,$0.00,$16.84,$0.00,$0.00,$17.12,$97.75,$0.00,$48.88,$77.42,$78.20,$0.00,$15.30,$0.00,$15.56,$0.00
15090,SUP,HCPCS C1713,,015090  -  SCREW BN 1.5MM 9MM XDR,$99.52,$0.00,$99.52,$44.78,$71.03,$0.00,$17.15,$0.00,$0.00,$17.43,$99.52,$0.00,$49.76,$78.82,$79.62,$0.00,$15.58,$0.00,$15.84,$0.00
15110,SUP,HCPCS C1713,,015110  -  SCREW 015110 X-DRV 1.5MM 11MM 6,$97.75,$0.00,$97.75,$43.99,$69.76,$0.00,$16.84,$0.00,$0.00,$17.12,$97.75,$0.00,$48.88,$77.42,$78.20,$0.00,$15.30,$0.00,$15.56,$0.00
15170,SUP,Custom 27203010,,015170  -  STAPLER INTNL 57MMX.17MM LACTOMER ABS STPL SQZ,"$1,226.30",$0.00,"$1,226.30",$0.00,$875.21,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,226.30",$0.00,$613.15,$971.23,$981.04,$0.00,$0.00,$0.00,$0.00,$0.00
15850,SUP,HCPCS C1758,,0015850  -  BAG DRN 9.5IN 19OZ STRL LTX 2 ADJ BELT ADPR NTR RBR BILE,$253.80,$0.00,$253.80,$137.81,$181.14,$0.00,$43.73,$0.00,$0.00,$44.44,$253.80,$0.00,$126.90,$201.01,$203.04,$0.00,$39.72,$0.00,$40.40,$0.00
17061,SUP,Custom 27203010,,PUMP BRST 1 HND FLEXSHIELD,$55.15,$0.00,$55.15,$0.00,$39.36,$0.00,$0.00,$0.00,$0.00,$0.00,$55.15,$0.00,$27.58,$43.68,$44.12,$0.00,$0.00,$0.00,$0.00,$0.00
17130,SUP,HCPCS C1713,,017130  -  PLATE BN CRV .6MM SLVR TRAUMAONE 10 HL TI ORBT FLR 1.5MM SCR,$540.00,$0.00,$540.00,$243.00,$385.40,$0.00,$93.04,$0.00,$0.00,$94.55,$540.00,$0.00,$270.00,$427.68,$432.00,$0.00,$84.51,$0.00,$85.97,$0.00
17152,SUP,Custom 27203010,,KIT BRSTPMP 1 HND DUAL HYGIENIKIT,$92.10,$0.00,$92.10,$0.00,$65.73,$0.00,$0.00,$0.00,$0.00,$0.00,$92.10,$0.00,$46.05,$72.94,$73.68,$0.00,$0.00,$0.00,$0.00,$0.00
17207,SUP,HCPCS C1762,,017207  -  GRAFT BONE CORT CNC SPCR ANT CERV INTRBD FS 7MM,"$2,967.50",$0.00,"$2,967.50",$0.00,"$2,117.90",$0.00,$511.29,$0.00,$0.00,$0.00,"$2,967.50",$0.00,"$1,483.75","$2,350.26","$2,374.00",$0.00,$464.41,$0.00,$0.00,$0.00
17208,SUP,HCPCS C1789,,017208  -  SPACER ALGRF 5D LRDTC OVL 12X14X8MM FRZDR MNLTH LG CNTR LUM,"$2,637.50",$0.00,"$2,637.50","$1,186.88","$1,882.38",$0.00,$454.43,$0.00,$0.00,$461.81,"$2,637.50",$0.00,"$1,318.75","$2,088.90","$2,110.00",$0.00,$412.77,$0.00,$419.89,$0.00
17251,SUP,HCPCS C1769,,17251  -  PLATINUM PLUS GUIDEWIRE .014X300CM WIRE,$350.00,$0.00,$350.00,$190.05,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
17614,SUP,Custom 27203010,,17614  -  STAPLER INTNL 55X4.8MM TI ENDSCP LNR CTR SQZ HNDL STRL LF,$493.05,$0.00,$493.05,$0.00,$351.89,$0.00,$0.00,$0.00,$0.00,$0.00,$493.05,$0.00,$246.52,$390.50,$394.44,$0.00,$0.00,$0.00,$0.00,$0.00
18030,SUP,HCPCS C1713,,018030  -  SCREW 018030 X-DRV RESCUE 3MM 6PK,$91.73,$0.00,$91.73,$41.28,$65.47,$0.00,$15.80,$0.00,$0.00,$16.06,$91.73,$0.00,$45.86,$72.65,$73.38,$0.00,$14.36,$0.00,$14.60,$0.00
18031,SUP,HCPCS C1713,,018031  -  SCREW 018031 CRUCIATE RESCUE 1.8X3MM 1,$97.75,$0.00,"$1,376.26",$0.00,$982.24,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,376.26",$0.00,$688.13,$77.42,"$1,101.01",$0.00,$0.00,$0.00,$0.00,$0.00
18050,SUP,HCPCS C1713,,018050  -  SCREW 018050 X-DRV RESCUE 5MM 6PK,$91.73,$0.00,$91.73,$41.28,$65.47,$0.00,$15.80,$0.00,$0.00,$16.06,$91.73,$0.00,$45.86,$72.65,$73.38,$0.00,$14.36,$0.00,$14.60,$0.00
18051,SUP,HCPCS C1713,,018051  -  SCREW 018051 CRUCIATE RESCUE 1.8X5MM 1,$97.75,$0.00,$97.75,$43.99,$69.76,$0.00,$16.84,$0.00,$0.00,$17.12,$97.75,$0.00,$48.88,$77.42,$78.20,$0.00,$15.30,$0.00,$15.56,$0.00
19004,SUP,Custom 27203010,,19004  -  KIT COLOSTOMY/ILEOSTOMY 2.25- IN 2.75IN 12IN 2 PIECE DRAIN,$34.71,$0.00,$34.71,$0.00,$24.77,$0.00,$0.00,$0.00,$0.00,$0.00,$34.71,$0.00,$17.36,$27.49,$27.77,$0.00,$0.00,$0.00,$0.00,$0.00
19006,SUP,Custom 27203010,,19006  -  KIT OSTOMY 0-3.5IN 4IN 12IN 2 PIECE DRAIN LOCK N ROLL,$46.72,$0.00,$46.72,$0.00,$33.34,$0.00,$0.00,$0.00,$0.00,$0.00,$46.72,$0.00,$23.36,$37.00,$37.37,$0.00,$0.00,$0.00,$0.00,$0.00
19203,SUP,Custom 27203010,,19203  -  KIT UROSTOMY CUT TO FIT 1.75- IN 2.25IN 9IN 2 PIECE BELT TAB,$8.43,$0.00,$8.43,$0.00,$6.02,$0.00,$0.00,$0.00,$0.00,$0.00,$8.43,$0.00,$4.21,$6.68,$6.74,$0.00,$0.00,$0.00,$0.00,$0.00
20012,SUP,Custom 27203010,,20012  -  CANNULA PRFSN 12GA 5.5IN DLP ANTGRD STD TIP INTRO VNT LN,$2.28,$0.00,$2.28,$0.00,$1.63,$0.00,$0.00,$0.00,$0.00,$0.00,$2.28,$0.00,$1.14,$1.81,$1.83,$0.00,$0.00,$0.00,$0.00,$0.00
20028,SUP,Custom 27803010,,20028  -  VAD 20028 BH 12MM W/INT VENT 5.5CM,"$1,047.38",$0.00,"$1,047.38",$0.00,$747.51,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,047.38",$0.00,$523.69,$829.52,$837.90,$0.00,$0.00,$0.00,$0.00,$0.00
20033,SUP,HCPCS C1788,,20033  -  PORT 20033 3-WAY CONN W/O SILICONE,$565.25,$0.00,$565.25,$254.36,$403.42,$0.00,$97.39,$0.00,$0.00,$98.97,$565.25,$0.00,$282.63,$447.68,$452.20,$0.00,$88.46,$0.00,$89.99,$0.00
20034,SUP,Custom 27203010,,20034  -  KIT 20034 EDM VENTRICULAR 35CM,$712.80,$0.00,$712.80,$0.00,$508.73,$0.00,$0.00,$0.00,$0.00,$0.00,$712.80,$0.00,$356.40,$564.54,$570.24,$0.00,$0.00,$0.00,$0.00,$0.00
20046,SUP,Custom 27803010,,20046  -  CATH 20046 VENT LARGE 23CM,$427.50,$0.00,$427.50,$0.00,$305.11,$0.00,$0.00,$0.00,$0.00,$0.00,$427.50,$0.00,$213.75,$338.58,$342.00,$0.00,$0.00,$0.00,$0.00,$0.00
20116,SUP,HCPCS C1758,,020116  -  CATH URET 6FR 70CM .038IN OP-EN,$21.38,$0.00,$21.38,$11.61,$15.26,$0.00,$3.68,$0.00,$0.00,$3.74,$21.38,$0.00,$10.69,$16.93,$17.10,$0.00,$3.35,$0.00,$3.40,$0.00
20141,SUP,Custom 27203010,,20141  -  DRESSING BURN 5X4IN ANTIMICROBIAL FAST ACT BARRIER CONTROL,$39.92,$0.00,$39.92,$0.00,$28.49,$0.00,$0.00,$0.00,$0.00,$0.00,$39.92,$0.00,$19.96,$31.62,$31.94,$0.00,$0.00,$0.00,$0.00,$0.00
20201,SUP,Custom 27203010,,20201  -  DRESSING BURN ANBCTRL FAST ACT VRSTL NCRSTLN SLVR 8X4IN STRL,$121.69,$0.00,$121.69,$0.00,$86.85,$0.00,$0.00,$0.00,$0.00,$0.00,$121.69,$0.00,$60.85,$96.38,$97.35,$0.00,$0.00,$0.00,$0.00,$0.00
20230,SUP,Custom 27203010,,REAGENT .85% SAL API 5ML ANALY,$160.88,$0.00,$160.88,$0.00,$114.82,$0.00,$0.00,$0.00,$0.00,$0.00,$160.88,$0.00,$80.44,$127.42,$128.70,$0.00,$0.00,$0.00,$0.00,$0.00
20301,SUP,Custom 27203010,,FORMULA  ENFAMIL  AR  RTU,$176.40,$0.00,$176.40,$0.00,$125.90,$0.00,$0.00,$0.00,$0.00,$0.00,$176.40,$0.00,$88.20,$139.71,$141.12,$0.00,$0.00,$0.00,$0.00,$0.00
20401,SUP,Custom 27203010,,20401  -  DRESSING BRN 16X16IN STRL LF ACTCT ANBCTRL FST ACT BRR CNTRL,$158.60,$0.00,$158.60,$0.00,$113.19,$0.00,$0.00,$0.00,$0.00,$0.00,$158.60,$0.00,$79.30,$125.61,$126.88,$0.00,$0.00,$0.00,$0.00,$0.00
20421,SUP,Custom 27203010,,MATTRESS PT 16X10IN TRNWRMR PVC PORT NELCTR HEAT SRC INF,$57.78,$0.00,$57.78,$0.00,$41.23,$0.00,$0.00,$0.00,$0.00,$0.00,$57.78,$0.00,$28.89,$45.76,$46.22,$0.00,$0.00,$0.00,$0.00,$0.00
20934,SUP,Custom 27203010,,020934  -  BAG OST GTCH SNTH UNV 4IN 14-14.5IN 2 PC DRAIN SRFT FLNG TPE,$81.06,$0.00,$81.06,$0.00,$57.85,$0.00,$0.00,$0.00,$0.00,$0.00,$81.06,$0.00,$40.53,$64.20,$64.85,$0.00,$0.00,$0.00,$0.00,$0.00
21004,SUP,Custom 27803010,,21004  -  CATH 21004 PERT SML OPEN END W/SLITS,$418.00,$0.00,$418.00,$0.00,$298.33,$0.00,$0.00,$0.00,$0.00,$0.00,$418.00,$0.00,$209.00,$331.06,$334.40,$0.00,$0.00,$0.00,$0.00,$0.00
21029,SUP,Custom 27803010,,21029  -  INLET 21029 V A D 12MM W/BOTTOM INLET,$931.00,$0.00,$931.00,$0.00,$664.45,$0.00,$0.00,$0.00,$0.00,$0.00,$931.00,$0.00,$465.50,$737.35,$744.80,$0.00,$0.00,$0.00,$0.00,$0.00
21038,SUP,HCPCS C1769,,21038  -  GUIDEWIRE 21038 TEFLON COATED 100CM,$213.75,$0.00,$213.75,$116.07,$152.55,$0.00,$36.83,$0.00,$0.00,$37.43,$213.75,$0.00,$106.88,$169.29,$171.00,$0.00,$33.45,$0.00,$34.03,$0.00
21066,SUP,Custom 27803010,,21066  -  CONNECTOR 21066 LUMBOPERITONEAL STRT CSF,$178.13,$0.00,$178.13,$0.00,$127.13,$0.00,$0.00,$0.00,$0.00,$0.00,$178.13,$0.00,$89.06,$141.08,$142.50,$0.00,$0.00,$0.00,$0.00,$0.00
22013,SUP,Custom 27803010,,22013  -  CATH 22013 PER SML OPEN 90CM NO SLIT,$418.00,$0.00,$418.00,$0.00,$298.33,$0.00,$0.00,$0.00,$0.00,$0.00,$418.00,$0.00,$209.00,$331.06,$334.40,$0.00,$0.00,$0.00,$0.00,$0.00
22014,SUP,Custom 27803010,,22014  -  CATH 22014 PER STD OPEN 96CM NO SLIT,$418.00,$0.00,$418.00,$0.00,$298.33,$0.00,$0.00,$0.00,$0.00,$0.00,$418.00,$0.00,$209.00,$331.06,$334.40,$0.00,$0.00,$0.00,$0.00,$0.00
22039,SUP,Custom 27803010,,22039  -  VAD 22039 12MM,$888.25,$0.00,$888.25,$0.00,$633.94,$0.00,$0.00,$0.00,$0.00,$0.00,$888.25,$0.00,$444.13,$703.49,$710.60,$0.00,$0.00,$0.00,$0.00,$0.00
22063,SUP,Custom 27803010,,22063  -  CONNECTOR 22063 STEPDOWN W/TUBING STD,$204.25,$0.00,$204.25,$0.00,$145.77,$0.00,$0.00,$0.00,$0.00,$0.00,$204.25,$0.00,$102.13,$161.77,$163.40,$0.00,$0.00,$0.00,$0.00,$0.00
22104,SUP,Custom 27803010,,22104  -  VAD 22104 NEONATE RES W/BOTTOM INLET,$888.25,$0.00,$888.25,$0.00,$633.94,$0.00,$0.00,$0.00,$0.00,$0.00,$888.25,$0.00,$444.13,$703.49,$710.60,$0.00,$0.00,$0.00,$0.00,$0.00
22150,SUP,Custom 27203010,,22150  -  DEVICE BLWR/MSTR STRL LF CLRVW TUBE SET N180 N185,$132.00,$0.00,$132.00,$0.00,$94.21,$0.00,$0.00,$0.00,$0.00,$0.00,$132.00,$0.00,$66.00,$104.54,$105.60,$0.00,$0.00,$0.00,$0.00,$0.00
22355,SUP,HCPCS C1713,,22355  -  ROD OST 64MM STRL LF LOOP DISP SFN 70MM FLNG,$3.70,$0.00,$3.70,$1.66,$2.64,$0.00,$0.64,$0.00,$0.00,$0.65,$3.70,$0.00,$1.85,$2.93,$2.96,$0.00,$0.58,$0.00,$0.59,$0.00
22356,SUP,HCPCS C1713,,22356  -  ROD OST 90MM STRL LF SFN CNVTC LOOP DISP 4IN FLNG SKN BRR,$37.00,$0.00,$37.00,$16.65,$26.41,$0.00,$6.37,$0.00,$0.00,$6.48,$37.00,$0.00,$18.50,$29.30,$29.60,$0.00,$5.79,$0.00,$5.89,$0.00
23014,SUP,Custom 27203010,,23014  -  KIT 23014 EDM VENTRICULAR,$326.40,$0.00,$326.40,$0.00,$232.95,$0.00,$0.00,$0.00,$0.00,$0.00,$326.40,$0.00,$163.20,$258.51,$261.12,$0.00,$0.00,$0.00,$0.00,$0.00
23021,SUP,Custom 27803010,,23021  -  CONNECTOR 23021 LUERLOCK TO FIT 1.5MM ID,$153.60,$0.00,$153.60,$0.00,$109.62,$0.00,$0.00,$0.00,$0.00,$0.00,$153.60,$0.00,$76.80,$121.65,$122.88,$0.00,$0.00,$0.00,$0.00,$0.00
23045,SUP,Custom 27203010,,23045  -  EDM 23045 PATIENT LINE 91CM W/FEM LR,$177.60,$0.00,$177.60,$0.00,$126.75,$0.00,$0.00,$0.00,$0.00,$0.00,$177.60,$0.00,$88.80,$140.66,$142.08,$0.00,$0.00,$0.00,$0.00,$0.00
23047,SUP,Custom 27803010,,23047  -  CATH 23047 PERIT STD OE W/SLITS 120,$418.00,$0.00,$418.00,$0.00,$298.33,$0.00,$0.00,$0.00,$0.00,$0.00,$418.00,$0.00,$209.00,$331.06,$334.40,$0.00,$0.00,$0.00,$0.00,$0.00
23067,SUP,HCPCS C2619,,23067  -  ADAPTER 23067 PREIMPLANT TEST SNAP ASSY,$225.63,$0.00,$225.63,$0.00,$161.03,$0.00,$0.00,$0.00,$0.00,$0.00,$225.63,$0.00,$112.81,$178.70,$180.50,$0.00,$0.00,$0.00,$0.00,$0.00
23069,SUP,Custom 27803010,,23069  -  SHUNT 23069 L-P K-TUBE W/PROX TIP,"$2,272.88",$0.00,"$2,272.88",$0.00,"$1,622.15",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,272.88",$0.00,"$1,136.44","$1,800.12","$1,818.30",$0.00,$0.00,$0.00,$0.00,$0.00
23075,SUP,Custom 27803010,,23075  -  CATHETER 23075 VENTRICULAR POLYURETHANE,"$3,479.38",$0.00,"$3,479.38",$0.00,"$2,483.23",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,479.38",$0.00,"$1,739.69","$2,755.67","$2,783.50",$0.00,$0.00,$0.00,$0.00,$0.00
23076,SUP,Custom 27803010,,23076  -  CATHETER 23076 PERITITONEAL POLYURETHANE,"$2,470.00",$0.00,"$2,470.00",$0.00,"$1,762.84",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,470.00",$0.00,"$1,235.00","$1,956.24","$1,976.00",$0.00,$0.00,$0.00,$0.00,$0.00
23092,SUP,HCPCS C1750,,23092  -  CATHETER DLYS STD 120CM STRL BA IMPRG OP-EN WL SLT,$418.00,$0.00,$418.00,$188.10,$298.33,$0.00,$72.02,$0.00,$0.00,$73.19,$418.00,$0.00,$209.00,$331.06,$334.40,$0.00,$65.42,$0.00,$66.55,$0.00
23093,SUP,Custom 27803010,,23093  -  VALVE 23093 CONT. REG. LOW-LOW,"$2,147.00",$0.00,"$2,147.00",$0.00,"$1,532.31",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,147.00",$0.00,"$1,073.50","$1,700.42","$1,717.60",$0.00,$0.00,$0.00,$0.00,$0.00
24010,SUP,Custom 27803010,,24010  -  CATHETER 24010 C/P STD 120CM,$410.88,$0.00,$410.88,$0.00,$293.24,$0.00,$0.00,$0.00,$0.00,$0.00,$410.88,$0.00,$205.44,$325.42,$328.70,$0.00,$0.00,$0.00,$0.00,$0.00
24048,SUP,Custom 27803010,,24048  -  VALVE 24048 DELTA RGL PL 0.5,"$3,617.13",$0.00,"$3,617.13",$0.00,"$2,581.54",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,617.13",$0.00,"$1,808.56","$2,864.77","$2,893.70",$0.00,$0.00,$0.00,$0.00,$0.00
24052,SUP,Custom 27203010,,24052  -  KIT 24052 VENTRICULOSTOMY RES 18MM,$693.50,$0.00,$693.50,$0.00,$494.95,$0.00,$0.00,$0.00,$0.00,$0.00,$693.50,$0.00,$346.75,$549.25,$554.80,$0.00,$0.00,$0.00,$0.00,$0.00
24053,SUP,Custom 27803010,,24053  -  CHAMBER 24053 DELTA,"$2,690.88",$0.00,"$5,472.96",$0.00,"$1,920.48",$0.00,"$3,186.79",$0.00,$0.00,$0.00,"$2,690.88",$0.00,"$1,345.44","$2,131.18","$2,152.70",$0.00,"$5,472.96",$0.00,$0.00,$0.00
24084,SUP,Custom 27803010,,24084  -  RESVR 24084 12MM W INLET AND OUTLET CONN,$888.25,$0.00,$888.25,$0.00,$633.94,$0.00,$0.00,$0.00,$0.00,$0.00,$888.25,$0.00,$444.13,$703.49,$710.60,$0.00,$0.00,$0.00,$0.00,$0.00
24085,SUP,Custom 27803010,,24085  -  DOME 24085 SNAP VENTRIC W/15CM TUBE,$605.63,$0.00,$605.63,$0.00,$432.23,$0.00,$0.00,$0.00,$0.00,$0.00,$605.63,$0.00,$302.81,$479.66,$484.50,$0.00,$0.00,$0.00,$0.00,$0.00
24094,SUP,Custom 27803010,,24094  -  CATH 24094 VENT STD INCL SNAP BASE,$501.13,$0.00,$501.13,$0.00,$357.65,$0.00,$0.00,$0.00,$0.00,$0.00,$501.13,$0.00,$250.56,$396.89,$400.90,$0.00,$0.00,$0.00,$0.00,$0.00
24114,SUP,Custom 27803010,,24114  -  CONNECTOR SHNT .7MM CSF LL INTGR PLG,$187.20,$0.00,$187.20,$0.00,$133.60,$0.00,$0.00,$0.00,$0.00,$0.00,$187.20,$0.00,$93.60,$148.26,$149.76,$0.00,$0.00,$0.00,$0.00,$0.00
24146,SUP,Custom 27203010,,24146  -  EDMS 24146 BECKER NO Y-SITE,$547.20,$0.00,$547.20,$0.00,$390.54,$0.00,$0.00,$0.00,$0.00,$0.00,$547.20,$0.00,$273.60,$433.38,$437.76,$0.00,$0.00,$0.00,$0.00,$0.00
24147,SUP,Custom 27803010,,24147  -  VALVE 24147 DELTA SML PL 0.5,"$3,617.13",$0.00,"$3,617.13",$0.00,"$2,581.54",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,617.13",$0.00,"$1,808.56","$2,864.77","$2,893.70",$0.00,$0.00,$0.00,$0.00,$0.00
24148,SUP,Custom 27803010,,24148  -  CATH 24148 C/P STD 110CM NO MARKERS,$410.88,$0.00,$410.88,$0.00,$293.24,$0.00,$0.00,$0.00,$0.00,$0.00,$410.88,$0.00,$205.44,$325.42,$328.70,$0.00,$0.00,$0.00,$0.00,$0.00
24154,SUP,Custom 27803010,,24154  -  CATH 24154 VENT STD TRNS W/STRIPE,$356.25,$0.00,$356.25,$0.00,$254.26,$0.00,$0.00,$0.00,$0.00,$0.00,$356.25,$0.00,$178.13,$282.15,$285.00,$0.00,$0.00,$0.00,$0.00,$0.00
24605,SUP,HCPCS C1758,,024605  -  CATH URET 4.8FR 8FR 70CM CONE TIP MCK,$28.54,$0.00,$28.54,$15.50,$20.37,$0.00,$4.92,$0.00,$0.00,$5.00,$28.54,$0.00,$14.27,$22.60,$22.83,$0.00,$4.47,$0.00,$4.54,$0.00
24605,SUP,HCPCS C1758,,24605  -  CATH URET 4.8FR 8FR 70CM CONE TIP MCK,$29.59,$0.00,$28.54,$15.50,$20.37,$0.00,$4.92,$0.00,$0.00,$5.00,$28.54,$0.00,$14.27,$23.44,$22.83,$0.00,$4.47,$0.00,$4.54,$0.00
24712,SUP,Custom 27803010,,24712  -  TUBE VNT T FIRM FLNG 1.14MM 9.5MM 12MM GOODE SFT SIL EAR,$56.75,$0.00,$56.75,$0.00,$40.50,$0.00,$0.00,$0.00,$0.00,$0.00,$56.75,$0.00,$28.38,$44.95,$45.40,$0.00,$0.00,$0.00,$0.00,$0.00
25020,SUP,Custom 27203010,,OTOSCOPE 3.5V DX SPCLA HAL LGHT WA LEN FBROP SL SYS EXAM,$177.50,$0.00,$177.50,$0.00,$126.68,$0.00,$0.00,$0.00,$0.00,$0.00,$177.50,$0.00,$88.75,$140.58,$142.00,$0.00,$0.00,$0.00,$0.00,$0.00
25024,SUP,Custom 27803010,,25024  -  CATH 25024 PERIT STD TRNS W/STRPE,$418.00,$0.00,$418.00,$0.00,$298.33,$0.00,$0.00,$0.00,$0.00,$0.00,$418.00,$0.00,$209.00,$331.06,$334.40,$0.00,$0.00,$0.00,$0.00,$0.00
25027,SUP,Custom 27803010,,25027  -  CONNECTOR 25027 STRT STAINLESS STEEL IMP,$204.25,$0.00,$204.25,$0.00,$145.77,$0.00,$0.00,$0.00,$0.00,$0.00,$204.25,$0.00,$102.13,$161.77,$163.40,$0.00,$0.00,$0.00,$0.00,$0.00
25030,SUP,Custom 27203010,,25030  -  KIT 25030 EDM 46115 46124 46126,$513.60,$0.00,$513.60,$0.00,$366.56,$0.00,$0.00,$0.00,$0.00,$0.00,$513.60,$0.00,$256.80,$406.77,$410.88,$0.00,$0.00,$0.00,$0.00,$0.00
25068,SUP,Custom 27203010,,25068  -  KIT 25068 EDM 46124 46126,$290.40,$0.00,$290.40,$0.00,$207.26,$0.00,$0.00,$0.00,$0.00,$0.00,$290.40,$0.00,$145.20,$230.00,$232.32,$0.00,$0.00,$0.00,$0.00,$0.00
25077,SUP,Custom 27803010,,25077  -  TAB FX 1.5MM SIL,$213.75,$0.00,$213.75,$0.00,$152.55,$0.00,$0.00,$0.00,$0.00,$0.00,$213.75,$0.00,$106.88,$169.29,$171.00,$0.00,$0.00,$0.00,$0.00,$0.00
25104,SUP,Custom 27803010,,25104  -  CATHETER 25104 CP STD TRANS RAD STRP 90,$410.88,$0.00,$410.88,$0.00,$293.24,$0.00,$0.00,$0.00,$0.00,$0.00,$410.88,$0.00,$205.44,$325.42,$328.70,$0.00,$0.00,$0.00,$0.00,$0.00
25115,SUP,Custom 27203010,,REAGENT HBSAG EVOLIS BRCD ANALY,$496.25,$0.00,$496.25,$0.00,$354.17,$0.00,$0.00,$0.00,$0.00,$0.00,$496.25,$0.00,$248.13,$393.03,$397.00,$0.00,$0.00,$0.00,$0.00,$0.00
25120,SUP,Custom 27203010,,25120  -  EDMS II 25120 BECKER W/1-WAY VALVE,$595.20,$0.00,$471.40,$0.00,$20.78,$0.00,$0.00,$0.00,$0.00,$0.00,$29.11,$0.00,$14.56,$471.40,$23.29,$0.00,$0.00,$0.00,$0.00,$0.00
25123,SUP,HCPCS C1894,,25123  -  TROCAR 25123 WITH PROTECTOR SHEATH,$237.60,$0.00,$237.60,$129.02,$169.58,$0.00,$40.94,$0.00,$0.00,$41.60,$237.60,$0.00,$118.80,$188.18,$190.08,$0.00,$37.18,$0.00,$37.83,$0.00
25173,SUP,Custom 27203010,,KIT IMMUN TST MCPLT EIA RBLA IGG 96 TST,$356.13,$0.00,$356.13,$0.00,$254.17,$0.00,$0.00,$0.00,$0.00,$0.00,$356.13,$0.00,$178.06,$282.05,$284.90,$0.00,$0.00,$0.00,$0.00,$0.00
25175,SUP,Custom 27203010,,KIT IMMUN TST EIA TOXOPLASMA IGG 96 TST,$356.13,$0.00,$356.13,$0.00,$254.17,$0.00,$0.00,$0.00,$0.00,$0.00,$356.13,$0.00,$178.06,$282.05,$284.90,$0.00,$0.00,$0.00,$0.00,$0.00
25177,SUP,Custom 27203010,,REAGENT CMV IGG AXSYM EIA 96 TST ANALY,$356.93,$0.00,$356.93,$0.00,$254.74,$0.00,$0.00,$0.00,$0.00,$0.00,$356.93,$0.00,$178.46,$282.69,$285.54,$0.00,$0.00,$0.00,$0.00,$0.00
25220,SUP,Custom 27203010,,CONTROL ANTI HBS IGM MONOLISA EIA IMMUN,"$1,375.00",$0.00,"$1,375.00",$0.00,$981.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
25280,SUP,Custom 27203010,,KIT IMMUN TST MONOLISA BRCD SEQ ANTI HBS,$552.50,$0.00,$552.50,$0.00,$394.32,$0.00,$0.00,$0.00,$0.00,$0.00,$552.50,$0.00,$276.25,$437.58,$442.00,$0.00,$0.00,$0.00,$0.00,$0.00
25506,SUP,Custom 27203010,,025506  -  STENT URET 6FR 125CM 2 PGTL CURVE URTSCP SET DRETLER BLUE,$109.68,$0.00,$109.68,$0.00,$78.28,$0.00,$0.00,$0.00,$0.00,$0.00,$109.68,$0.00,$54.84,$86.87,$87.74,$0.00,$0.00,$0.00,$0.00,$0.00
26040,SUP,Custom 27203010,,26040  -  KIT 26040 BECKER EDMS II,$825.60,$0.00,$825.60,$0.00,$589.23,$0.00,$0.00,$0.00,$0.00,$0.00,$825.60,$0.00,$412.80,$653.88,$660.48,$0.00,$0.00,$0.00,$0.00,$0.00
26054,SUP,HCPCS C1726,,26054  -  DILAT VASC 4FR 20CM HYDPHI DECREASED FRCTN RADIOPQ STRL DISP,$26.25,$0.00,$26.25,$14.25,$18.73,$0.00,$4.52,$0.00,$0.00,$4.60,$26.25,$0.00,$13.13,$20.79,$21.00,$0.00,$4.11,$0.00,$4.18,$0.00
26057,SUP,Custom 27203010,,26057  -  EDM 26021 CATH VENT STD TRANS 25CM,$364.80,$0.00,$364.80,$0.00,$260.36,$0.00,$0.00,$0.00,$0.00,$0.00,$364.80,$0.00,$182.40,$288.92,$291.84,$0.00,$0.00,$0.00,$0.00,$0.00
26075,SUP,Custom 27803010,,26075  -  RES 26075 VENT BH V-CATH W/7.5MM HLS,"$1,444.00",$0.00,"$1,444.00",$0.00,"$1,030.58",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,444.00",$0.00,$722.00,"$1,143.65","$1,155.20",$0.00,$0.00,$0.00,$0.00,$0.00
26174,SUP,Custom 27203010,,CONTROL ANTI HBC IGM MONOLISA EIA IMMUN,"$1,612.50",$0.00,"$1,612.50",$0.00,"$1,150.84",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,612.50",$0.00,$806.25,"$1,277.10","$1,290.00",$0.00,$0.00,$0.00,$0.00,$0.00
26186,SUP,Custom 27203010,,CONTROL ANTI-HBC HBV MONOLISA EIA 192 TST IMMUN,"$1,387.50",$0.00,"$1,387.50",$0.00,$990.26,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,387.50",$0.00,$693.75,"$1,098.90","$1,110.00",$0.00,$0.00,$0.00,$0.00,$0.00
26189,SUP,Custom 27203010,,KIT IMMUN TST MONOLISA BRCD ANTI HAV,$496.25,$0.00,$496.25,$0.00,$354.17,$0.00,$0.00,$0.00,$0.00,$0.00,$496.25,$0.00,$248.13,$393.03,$397.00,$0.00,$0.00,$0.00,$0.00,$0.00
27010,SUP,Custom 27803010,,27010  -  CATH 27010 CSF-PERIT TRANS XTRA LM,$600.88,$0.00,$600.88,$0.00,$428.84,$0.00,$0.00,$0.00,$0.00,$0.00,$600.88,$0.00,$300.44,$475.90,$480.70,$0.00,$0.00,$0.00,$0.00,$0.00
27051,SUP,Custom 27803010,,27051  -  VAD 27051 6MM BH UNITIZED CONV.,$605.63,$0.00,$605.63,$0.00,$432.23,$0.00,$0.00,$0.00,$0.00,$0.00,$605.63,$0.00,$302.81,$479.66,$484.50,$0.00,$0.00,$0.00,$0.00,$0.00
27081,SUP,Custom 27803010,,27081  -  SHUNT 27081 DELTA ASSY RGL PL 0.5,"$3,462.75",$0.00,"$3,462.75",$0.00,"$2,471.36",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,462.75",$0.00,"$1,731.38","$2,742.50","$2,770.20",$0.00,$0.00,$0.00,$0.00,$0.00
27102,SUP,Custom 27803010,,27102  -  VALVE 27102 CONTOURED SML LOW LOW,"$2,147.00",$0.00,"$2,147.00",$0.00,"$1,532.31",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,147.00",$0.00,"$1,073.50","$1,700.42","$1,717.60",$0.00,$0.00,$0.00,$0.00,$0.00
27106,SUP,Custom 27803010,,27106  -  BASE 27106 SNAP ASSY W/LARGER ID,$275.50,$0.00,$275.50,$0.00,$196.62,$0.00,$0.00,$0.00,$0.00,$0.00,$275.50,$0.00,$137.75,$218.20,$220.40,$0.00,$0.00,$0.00,$0.00,$0.00
27156,SUP,Custom 27803010,,27156  -  CATH 27156 VENT 1.3X2.5 FXTN COLLAR,$336.00,$0.00,$336.00,$0.00,$239.80,$0.00,$0.00,$0.00,$0.00,$0.00,$336.00,$0.00,$168.00,$266.11,$268.80,$0.00,$0.00,$0.00,$0.00,$0.00
27165,SUP,Custom 27803010,,27165  -  CATH 27165 VENT INNERVISION 1.5X2.8,$505.88,$0.00,$505.88,$0.00,$361.04,$0.00,$0.00,$0.00,$0.00,$0.00,$505.88,$0.00,$252.94,$400.66,$404.70,$0.00,$0.00,$0.00,$0.00,$0.00
27211,SUP,Custom 27803010,,27211  -  CATH 27211 VENT SLOTTED 16CM,$472.63,$0.00,$472.63,$0.00,$337.31,$0.00,$0.00,$0.00,$0.00,$0.00,$472.63,$0.00,$236.31,$374.32,$378.10,$0.00,$0.00,$0.00,$0.00,$0.00
27240,SUP,Custom 27803010,,27240  -  CATHETER DRN 15CM STRL LF INNERVISION DISP,$505.88,$0.00,$505.88,$0.00,$361.04,$0.00,$0.00,$0.00,$0.00,$0.00,$505.88,$0.00,$252.94,$400.66,$404.70,$0.00,$0.00,$0.00,$0.00,$0.00
27251,SUP,Custom 27803010,,27251  -  CATH 27251 VENT SML 8MM OF HOLE,$356.25,$0.00,$356.25,$0.00,$254.26,$0.00,$0.00,$0.00,$0.00,$0.00,$356.25,$0.00,$178.13,$282.15,$285.00,$0.00,$0.00,$0.00,$0.00,$0.00
27274,SUP,Custom 27203010,,27274  -  KIT 27274 VENTRICULOSTOMY RES UNIT,$821.75,$0.00,$821.75,$0.00,$586.48,$0.00,$0.00,$0.00,$0.00,$0.00,$821.75,$0.00,$410.88,$650.83,$657.40,$0.00,$0.00,$0.00,$0.00,$0.00
27297,SUP,Custom 27203010,,27297  -  KIT 27297 EDM DRAINAG VENT CATH,$806.40,$0.00,$806.40,$0.00,$575.53,$0.00,$0.00,$0.00,$0.00,$0.00,$806.40,$0.00,$403.20,$638.67,$645.12,$0.00,$0.00,$0.00,$0.00,$0.00
27298,SUP,HCPCS C1753,,27298  -  V-CATH 27298 INNERVISION W/ SNAP BASE,$665.00,$0.00,$665.00,$361.10,$474.61,$0.00,$114.58,$0.00,$0.00,$116.44,$665.00,$0.00,$332.50,$526.68,$532.00,$0.00,$104.07,$0.00,$105.87,$0.00
27302,SUP,Custom 27203010,,27302  -  DRAIN 27302 EDM LUMBAR W/120 GRAD CH,$808.80,$0.00,$808.80,$0.00,$577.24,$0.00,$0.00,$0.00,$0.00,$0.00,$808.80,$0.00,$404.40,$640.57,$647.04,$0.00,$0.00,$0.00,$0.00,$0.00
27303,SUP,Custom 27203010,,27303  -  KIT 27303 EDM LUMBAR DRAINAGE OPEN,$705.60,$0.00,$705.60,$0.00,$503.59,$0.00,$0.00,$0.00,$0.00,$0.00,$705.60,$0.00,$352.80,$558.84,$564.48,$0.00,$0.00,$0.00,$0.00,$0.00
27304,SUP,Custom 27203010,,27304  -  KIT 27304 EDM LUMBAR DRAINAGE CLOSED,$684.00,$0.00,$684.00,$0.00,$488.17,$0.00,$0.00,$0.00,$0.00,$0.00,$684.00,$0.00,$342.00,$541.73,$547.20,$0.00,$0.00,$0.00,$0.00,$0.00
27327,SUP,Custom 27803010,,27327  -  CATH 27327 VENT STD EXTR TRANSLUC 23CM,$876.38,$0.00,$876.38,$0.00,$625.47,$0.00,$0.00,$0.00,$0.00,$0.00,$876.38,$0.00,$438.19,$694.09,$701.10,$0.00,$0.00,$0.00,$0.00,$0.00
27328,SUP,HCPCS C1750,,27328  -  PCATH 27328 EXTRACTED 90 CM,"$1,330.00",$0.00,"$1,330.00",$598.50,$949.22,$0.00,$229.15,$0.00,$0.00,$232.87,"$1,330.00",$0.00,$665.00,"$1,053.36","$1,064.00",$0.00,$208.15,$0.00,$211.74,$0.00
27384,SUP,Custom 27803010,,27384  -  CATH 27384 EDM VENT 20CM W/TROCAR,$396.00,$0.00,$396.00,$0.00,$282.63,$0.00,$0.00,$0.00,$0.00,$0.00,$396.00,$0.00,$198.00,$313.63,$316.80,$0.00,$0.00,$0.00,$0.00,$0.00
27497,SUP,Custom 27803010,,27497  -  SHUNT 27497 DELTA ASSY SMALL BG 0.5,"$4,949.50",$0.00,"$4,949.50",$0.00,"$3,532.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,949.50",$0.00,"$2,474.75","$3,920.00","$3,959.60",$0.00,$0.00,$0.00,$0.00,$0.00
27498,SUP,Custom 27803010,,27498  -  SHUNT 27498 DELTA ASSY REG BG 0.5,"$4,949.50",$0.00,"$4,949.50",$0.00,"$3,532.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,949.50",$0.00,"$2,474.75","$3,920.00","$3,959.60",$0.00,$0.00,$0.00,$0.00,$0.00
27510,SUP,Custom 27203010,,27510  -  EDMS 27510 BECKER W/ Y-SITE EURO,$520.80,$0.00,$520.80,$0.00,$371.69,$0.00,$0.00,$0.00,$0.00,$0.00,$520.80,$0.00,$260.40,$412.47,$416.64,$0.00,$0.00,$0.00,$0.00,$0.00
27536,SUP,Custom 27803010,,27536  -  CATHETER 27536 PERIT W/BIOGLIDE 8 SLITS,$543.88,$0.00,$543.88,$0.00,$388.16,$0.00,$0.00,$0.00,$0.00,$0.00,$543.88,$0.00,$271.94,$430.75,$435.10,$0.00,$0.00,$0.00,$0.00,$0.00
27548,SUP,Custom 27803010,,27548  -  CATH 27548 PERIT STD OE TRANS BS 120CM,$418.00,$0.00,$418.00,$0.00,$298.33,$0.00,$0.00,$0.00,$0.00,$0.00,$418.00,$0.00,$209.00,$331.06,$334.40,$0.00,$0.00,$0.00,$0.00,$0.00
27579,SUP,Custom 27203010,,27579  -  EDMS 27579 EXACTA W/ PATIENT LINE Y-PORT,$412.80,$0.00,$412.80,$0.00,$294.62,$0.00,$0.00,$0.00,$0.00,$0.00,$412.80,$0.00,$206.40,$326.94,$330.24,$0.00,$0.00,$0.00,$0.00,$0.00
27581,SUP,Custom 27203010,,27581  -  KIT 27581 EXACTA W/EDM VCATH 35CM,$777.60,$0.00,$777.60,$0.00,$554.97,$0.00,$0.00,$0.00,$0.00,$0.00,$777.60,$0.00,$388.80,$615.86,$622.08,$0.00,$0.00,$0.00,$0.00,$0.00
27600,SUP,Custom 27803010,,27600  -  CATH 27600 VENT INNERVISION SLOTTED 15CM,$665.00,$0.00,$665.00,$0.00,$474.61,$0.00,$0.00,$0.00,$0.00,$0.00,$665.00,$0.00,$332.50,$526.68,$532.00,$0.00,$0.00,$0.00,$0.00,$0.00
27613,SUP,Custom 27203010,,27613  -  LASER 27613 EXACTA W/SCREW ASSY,"$1,024.80",$0.00,"$1,024.80",$0.00,$731.40,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,024.80",$0.00,$512.40,$811.64,$819.84,$0.00,$0.00,$0.00,$0.00,$0.00
27617,SUP,Custom 27203010,,27617  -  TUBE 27617 TRANS W/STRPE STR CONN,$539.13,$0.00,$539.13,$0.00,$384.77,$0.00,$0.00,$0.00,$0.00,$0.00,$539.13,$0.00,$269.56,$426.99,$431.30,$0.00,$0.00,$0.00,$0.00,$0.00
27623,SUP,Custom 27803010,,27623  -  CATH 27623 INNERV15CM XTRA HOLES 2CM,$662.63,$0.00,$662.63,$0.00,$472.92,$0.00,$0.00,$0.00,$0.00,$0.00,$662.63,$0.00,$331.31,$524.80,$530.10,$0.00,$0.00,$0.00,$0.00,$0.00
27628,SUP,Custom 27203010,,27628  -  KIT 27628 CSF-VENT RES BH VCATH 15CM,$836.00,$0.00,$836.00,$0.00,$596.65,$0.00,$0.00,$0.00,$0.00,$0.00,$836.00,$0.00,$418.00,$662.11,$668.80,$0.00,$0.00,$0.00,$0.00,$0.00
27629,SUP,HCPCS C1729,,27629  -  PCATH 27629 90 TRANS W/STRIPE NO SLT,$418.00,$0.00,$418.00,$226.97,$298.33,$0.00,$72.02,$0.00,$0.00,$73.19,$418.00,$0.00,$209.00,$331.06,$334.40,$0.00,$65.42,$0.00,$66.55,$0.00
27636,SUP,Custom 27203010,,27636  -  EDM 27636 EXACTA W/BRAIDED CORD LOCK,$446.40,$0.00,$353.55,$0.00,$17.61,$0.00,$0.00,$0.00,$0.00,$0.00,$24.67,$0.00,$12.34,$353.55,$19.74,$0.00,$0.00,$0.00,$0.00,$0.00
27637,SUP,Custom 27203010,,27637  -  EDM 27637 VCATH TRANS OD 4.9MM W/TROC,$554.40,$0.00,$554.40,$0.00,$395.68,$0.00,$0.00,$0.00,$0.00,$0.00,$554.40,$0.00,$277.20,$439.08,$443.52,$0.00,$0.00,$0.00,$0.00,$0.00
27654,SUP,Custom 27203010,,27654  -  BAG 27654 EXACTA W/DRAINPORT GLUED ON,$336.00,$0.00,$336.00,$0.00,$239.80,$0.00,$0.00,$0.00,$0.00,$0.00,$336.00,$0.00,$168.00,$266.11,$268.80,$0.00,$0.00,$0.00,$0.00,$0.00
27659,SUP,Custom 27203010,,27659  -  EDM 27659 V/CATHETER 20CM LENGTH MARKER,$436.80,$0.00,$345.95,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$345.95,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
27664,SUP,Custom 27803010,,27664  -  RES 27664 CSF-VENT 12MM CONV BTTM INLET,$888.25,$0.00,$888.25,$0.00,$633.94,$0.00,$0.00,$0.00,$0.00,$0.00,$888.25,$0.00,$444.13,$703.49,$710.60,$0.00,$0.00,$0.00,$0.00,$0.00
27666,SUP,Custom 27203010,,27666  -  EDM 27666 EXCTA W GLUE STPCK GR PT LN,$400.80,$0.00,$400.80,$0.00,$286.05,$0.00,$0.00,$0.00,$0.00,$0.00,$400.80,$0.00,$200.40,$317.43,$320.64,$0.00,$0.00,$0.00,$0.00,$0.00
27673,SUP,Custom 27203010,,27673  -  KIT 27673 EXACTA W/EDM VCATH BIOGL 35CM,$859.20,$0.00,$859.20,$0.00,$613.21,$0.00,$0.00,$0.00,$0.00,$0.00,$859.20,$0.00,$429.60,$680.49,$687.36,$0.00,$0.00,$0.00,$0.00,$0.00
27695,SUP,Custom 27803010,,27695  -  CATH 27695 EDM VENT TRANS W/STRIPE 35CM,$451.20,$0.00,$357.35,$0.00,$5.51,$0.00,$0.00,$0.00,$0.00,$0.00,$7.72,$0.00,$3.86,$357.35,$6.18,$0.00,$0.00,$0.00,$0.00,$0.00
27702,SUP,Custom 27203010,,27702  -  EDMS 27702 EURO BECKER II GR PT LN,$556.80,$0.00,$556.80,$0.00,$397.39,$0.00,$0.00,$0.00,$0.00,$0.00,$556.80,$0.00,$278.40,$440.99,$445.44,$0.00,$0.00,$0.00,$0.00,$0.00
27703,SUP,HCPCS C1729,,27703  -  CATHETER DRN LG 35CM STRL LL CNCT LGTH MRKNG VNTRC,$424.80,$0.00,$424.80,$230.67,$303.18,$0.00,$73.19,$0.00,$0.00,$74.38,$424.80,$0.00,$212.40,$336.44,$339.84,$0.00,$66.48,$0.00,$67.63,$0.00
27705,SUP,Custom 27803010,,27705  -  CATH 27705 EDM NUM LNGTHMARK BIO 35CM,$460.80,$0.00,$460.80,$0.00,$328.87,$0.00,$0.00,$0.00,$0.00,$0.00,$460.80,$0.00,$230.40,$364.95,$368.64,$0.00,$0.00,$0.00,$0.00,$0.00
27710,SUP,Custom 27803010,,27710  -  CATH 27710 EDM NUM LNGTHMRK BIO 35CM,$492.00,$0.00,$492.00,$0.00,$351.14,$0.00,$0.00,$0.00,$0.00,$0.00,$492.00,$0.00,$246.00,$389.66,$393.60,$0.00,$0.00,$0.00,$0.00,$0.00
27725,SUP,Custom 27803010,,27725  -  CATH 27725 VENT 8MM HLS NUM LM 23CM,$356.25,$0.00,$356.25,$0.00,$254.26,$0.00,$0.00,$0.00,$0.00,$0.00,$356.25,$0.00,$178.13,$282.15,$285.00,$0.00,$0.00,$0.00,$0.00,$0.00
27726,SUP,Custom 27803010,,27726  -  CATH 27726 VENT 8MM HLS NUM LM 23CM BIO,$513.00,$0.00,$513.00,$0.00,$366.13,$0.00,$0.00,$0.00,$0.00,$0.00,$513.00,$0.00,$256.50,$406.30,$410.40,$0.00,$0.00,$0.00,$0.00,$0.00
27732,SUP,Custom 27203010,,27732  -  EDM 27732 EXACTA W/NDL-LS INJ. ST W/CAP,$472.80,$0.00,$472.80,$0.00,$337.44,$0.00,$0.00,$0.00,$0.00,$0.00,$472.80,$0.00,$236.40,$374.46,$378.24,$0.00,$0.00,$0.00,$0.00,$0.00
27739,SUP,Custom 27803010,,27739  -  SHUNT 27739 STRATA NSC SNAP SML 120CM,"$10,361.15",$0.00,"$10,361.15",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$10,361.15",$0.00,"$5,180.58","$8,206.03","$8,288.92",$0.00,$0.00,$0.00,$0.00,$0.00
27740,SUP,Custom 27803010,,27740  -  SHUNT 27740 STRATA NSC SNAP REG 120CM,"$10,361.15",$0.00,"$10,361.15",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$10,361.15",$0.00,"$5,180.58","$8,206.03","$8,288.92",$0.00,$0.00,$0.00,$0.00,$0.00
27771,SUP,Custom 27803010,,27771  -  CATH 27771 VENTR EDM STD W/L-MARKERS,$374.40,$0.00,$374.40,$0.00,$267.21,$0.00,$0.00,$0.00,$0.00,$0.00,$374.40,$0.00,$187.20,$296.52,$299.52,$0.00,$0.00,$0.00,$0.00,$0.00
27779,SUP,Custom 27203010,,27779  -  EDMS 27779 BECKER BC NDLESS BOND CONN,$549.60,$0.00,$549.60,$0.00,$392.25,$0.00,$0.00,$0.00,$0.00,$0.00,$549.60,$0.00,$274.80,$435.28,$439.68,$0.00,$0.00,$0.00,$0.00,$0.00
27781,SUP,Custom 27803010,,27781  -  CATH 27781 INNERV 3 SETS FLOW HLS 23CM,$840.75,$0.00,$840.75,$0.00,$600.04,$0.00,$0.00,$0.00,$0.00,$0.00,$840.75,$0.00,$420.38,$665.87,$672.60,$0.00,$0.00,$0.00,$0.00,$0.00
27785,SUP,Custom 27203010,,27785  -  EDMS 27785 EXACTA 50ML BC NDLESS INJ,$475.20,$0.00,$475.20,$0.00,$339.15,$0.00,$0.00,$0.00,$0.00,$0.00,$475.20,$0.00,$237.60,$376.36,$380.16,$0.00,$0.00,$0.00,$0.00,$0.00
27786,SUP,Custom 27803010,,27786  -  SHUNT 27786 STRATA NSC UNI-KIT SML BIOGL,"$10,114.40",$0.00,"$8,010.60",$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,136.00",$0.00,"$1,136.00","$8,010.60",$908.80,$0.00,$0.00,$0.00,$0.00,$0.00
27787,SUP,Custom 27803010,,27787  -  SHUNT 27787 STRATA NSC UNI-KIT REG BIOGL,"$10,114.40",$0.00,"$10,114.40",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$10,114.40",$0.00,"$5,057.20","$8,010.60","$8,091.52",$0.00,$0.00,$0.00,$0.00,$0.00
27788,SUP,Custom 27803010,,27788  -  SHUNT 27788 STRATA NSC SNAP ASSY SM BG,"$11,202.45",$0.00,"$11,202.45",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,202.45",$0.00,"$5,601.23","$8,872.34","$8,961.96",$0.00,$0.00,$0.00,$0.00,$0.00
27789,SUP,Custom 27803010,,27789  -  SHUNT 27789 STRATA NSC SNAP ASSY RG BG,"$11,202.45",$0.00,"$11,202.45",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,202.45",$0.00,"$5,601.23","$8,872.34","$8,961.96",$0.00,$0.00,$0.00,$0.00,$0.00
27794,SUP,Custom 27803010,,27794  -  NSC 27794 N/A STRATA SNAPSHNT NO FLANGE,"$10,361.15",$0.00,"$10,361.15",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$10,361.15",$0.00,"$5,180.58","$8,206.03","$8,288.92",$0.00,$0.00,$0.00,$0.00,$0.00
27795,SUP,Custom 27203010,,27795  -  EDMS 27795 EXACTA 100ML CATH,$775.20,$0.00,$775.20,$0.00,$553.26,$0.00,$0.00,$0.00,$0.00,$0.00,$775.20,$0.00,$387.60,$613.96,$620.16,$0.00,$0.00,$0.00,$0.00,$0.00
27811,SUP,Custom 27203010,,27811  -  EDMS 27811 BECKER GRN PL VCATH,$792.00,$0.00,$792.00,$0.00,$565.25,$0.00,$0.00,$0.00,$0.00,$0.00,$792.00,$0.00,$396.00,$627.26,$633.60,$0.00,$0.00,$0.00,$0.00,$0.00
27812,SUP,Custom 27803010,,27812  -  VALVE 27812 STRATA II SM EXTRACTED,"$10,144.95",$0.00,"$10,144.95",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$10,144.95",$0.00,"$5,072.48","$8,034.80","$8,115.96",$0.00,$0.00,$0.00,$0.00,$0.00
27814,SUP,Custom 27803010,,27814  -  SHUNT 27814 STRATA II ASSY SML,"$10,770.05",$0.00,"$10,770.05",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$10,770.05",$0.00,"$5,385.03","$8,529.88","$8,616.04",$0.00,$0.00,$0.00,$0.00,$0.00
27815,SUP,Custom 27803010,,27815  -  SHUNT 27815 STRATA II ASSY REG,"$10,770.05",$0.00,"$10,770.05",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$10,770.05",$0.00,"$5,385.03","$8,529.88","$8,616.04",$0.00,$0.00,$0.00,$0.00,$0.00
27816,SUP,Custom 27803010,,27816  -  SHUNT 27816 SNAP STRATA II SMALL,"$11,167.20",$0.00,"$11,167.20",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,167.20",$0.00,"$5,583.60","$8,844.42","$8,933.76",$0.00,$0.00,$0.00,$0.00,$0.00
27817,SUP,Custom 27803010,,27817  -  SHUNT 27817 SNAP STRATA II REG,"$11,167.20",$0.00,"$11,167.20",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,167.20",$0.00,"$5,583.60","$8,844.42","$8,933.76",$0.00,$0.00,$0.00,$0.00,$0.00
27818,SUP,Custom 27803010,,27818  -  SHUNT 27818 STRATA II SML BIO,"$11,418.65",$0.00,"$11,418.65",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,418.65",$0.00,"$5,709.33","$9,043.57","$9,134.92",$0.00,$0.00,$0.00,$0.00,$0.00
27819,SUP,Custom 27803010,,27819  -  SHUNT 27819 STRATA II REG BIO,"$11,418.65",$0.00,"$11,418.65",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,418.65",$0.00,"$5,709.33","$9,043.57","$9,134.92",$0.00,$0.00,$0.00,$0.00,$0.00
27820,SUP,Custom 27203010,,27820  -  KIT 27820 UNI STRATA II SM V 11 PCATH90,"$10,915.75",$0.00,"$10,915.75",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$10,915.75",$0.00,"$5,457.88","$8,645.27","$8,732.60",$0.00,$0.00,$0.00,$0.00,$0.00
27821,SUP,Custom 27203010,,27821  -  KIT 27821 UNI STRATA II REG V13 PCATH90,"$10,915.75",$0.00,"$10,915.75",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$10,915.75",$0.00,"$5,457.88","$8,645.27","$8,732.60",$0.00,$0.00,$0.00,$0.00,$0.00
27822,SUP,Custom 27803010,,27822  -  SHUNT 27822 STRATA II SNP ASSY SM BIO,"$12,003.80",$0.00,"$12,003.80",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$12,003.80",$0.00,"$6,001.90","$9,507.01","$9,603.04",$0.00,$0.00,$0.00,$0.00,$0.00
27823,SUP,Custom 27803010,,27823  -  SHUNT 27823 STRATA II ASSY SNP REG BIO,"$12,003.80",$0.00,"$12,003.80",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$12,003.80",$0.00,"$6,001.90","$9,507.01","$9,603.04",$0.00,$0.00,$0.00,$0.00,$0.00
27824,SUP,Custom 27803010,,27824  -  SHUNT 27824 UNI STRATA II SM BIO,"$11,385.75",$0.00,"$11,385.75",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,385.75",$0.00,"$5,692.88","$9,017.51","$9,108.60",$0.00,$0.00,$0.00,$0.00,$0.00
27825,SUP,Custom 27803010,,27825  -  SHUNT 27825 STRATA II UNI REG BIO,"$11,385.75",$0.00,"$11,385.75",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,385.75",$0.00,"$5,692.88","$9,017.51","$9,108.60",$0.00,$0.00,$0.00,$0.00,$0.00
27827,SUP,Custom 27803010,,27827  -  VALVE 27827 STRATA II REG EXTRACTED,"$10,144.95",$0.00,"$10,144.95",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$10,144.95",$0.00,"$5,072.48","$8,034.80","$8,115.96",$0.00,$0.00,$0.00,$0.00,$0.00
27828,SUP,Custom 27803010,,27828  -  VALVE 27828 STRATA II SML INLET BUTTON,"$10,953.35",$0.00,"$10,953.35",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$10,953.35",$0.00,"$5,476.68","$8,675.05","$8,762.68",$0.00,$0.00,$0.00,$0.00,$0.00
27829,SUP,Custom 27803010,,27829  -  VALVE 27829 STRATA II REG INLET BUTTON,"$10,953.35",$0.00,"$10,953.35",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$10,953.35",$0.00,"$5,476.68","$8,675.05","$8,762.68",$0.00,$0.00,$0.00,$0.00,$0.00
27830,SUP,Custom 27803010,,27830  -  SHUNT 27830 SNAP STRATA II SML BLUNT,"$11,167.20",$0.00,"$11,167.20",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,167.20",$0.00,"$5,583.60","$8,844.42","$8,933.76",$0.00,$0.00,$0.00,$0.00,$0.00
27831,SUP,Custom 27803010,,27831  -  SHUNT 27831 SNAP STRATA II REG BLUNT P/C,"$11,167.20",$0.00,"$11,167.20",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,167.20",$0.00,"$5,583.60","$8,844.42","$8,933.76",$0.00,$0.00,$0.00,$0.00,$0.00
27832,SUP,Custom 27803010,,27832  -  VALVE 27832 SNAP STRATA II REG BLUNT,"$10,156.70",$0.00,"$10,156.70",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$10,156.70",$0.00,"$5,078.35","$8,044.11","$8,125.36",$0.00,$0.00,$0.00,$0.00,$0.00
27842,SUP,Custom 27803010,,27842  -  CATHETER 27842 EDMS VENTRICULAR STD 28CM,$297.60,$0.00,$297.60,$0.00,$212.40,$0.00,$0.00,$0.00,$0.00,$0.00,$297.60,$0.00,$148.80,$235.70,$238.08,$0.00,$0.00,$0.00,$0.00,$0.00
27843,SUP,Custom 27803010,,27843  -  CATHETER 27843 VENTRICULAR STD 15CM,$410.88,$0.00,$410.88,$0.00,$293.24,$0.00,$0.00,$0.00,$0.00,$0.00,$410.88,$0.00,$205.44,$325.42,$328.70,$0.00,$0.00,$0.00,$0.00,$0.00
27848,SUP,Custom 27203010,,27848  -  KIT 27848 STRATA II SHUNT SML PCATH 90CM,"$10,770.05",$0.00,"$10,770.05",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$10,770.05",$0.00,"$5,385.03","$8,529.88","$8,616.04",$0.00,$0.00,$0.00,$0.00,$0.00
27852,SUP,Custom 27803010,,27852  -  CATHETER 27852 VENT PLIANT FIX COL 15CM,$522.50,$0.00,$522.50,$0.00,$372.91,$0.00,$0.00,$0.00,$0.00,$0.00,$522.50,$0.00,$261.25,$413.82,$418.00,$0.00,$0.00,$0.00,$0.00,$0.00
27853,SUP,Custom 27803010,,27853  -  CATHETER 27853 OPUS VENT 23CM BIOGLIDE,$605.63,$0.00,$605.63,$0.00,$432.23,$0.00,$0.00,$0.00,$0.00,$0.00,$605.63,$0.00,$302.81,$479.66,$484.50,$0.00,$0.00,$0.00,$0.00,$0.00
27855,SUP,Custom 27203010,,27855  -  EDMS 27855 EXACTA VCATH W/NLESS INJ/STES,$688.80,$0.00,"$1,369.61",$0.00,$977.49,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,369.61",$0.00,$684.81,$545.53,"$1,095.69",$0.00,$0.00,$0.00,$0.00,$0.00
27857,SUP,Custom 27803010,,27857  -  PCATH 27857 STD TRANSL NOSLIT 130CM,$418.00,$0.00,$331.06,$0.00,$11.30,$0.00,$0.00,$0.00,$0.00,$0.00,$15.83,$0.00,$7.92,$331.06,$12.66,$0.00,$0.00,$0.00,$0.00,$0.00
27861,SUP,Custom 27203010,,27861  -  EDMS 27861 EXACTA 50ML ANTIRFLUX GRNPL,$470.40,$0.00,$470.40,$0.00,$335.72,$0.00,$0.00,$0.00,$0.00,$0.00,$470.40,$0.00,$235.20,$372.56,$376.32,$0.00,$0.00,$0.00,$0.00,$0.00
27864,SUP,Custom 27803010,,27864  -  SHUNT 27864 STRATA II REGULAR 120CM,"$10,838.20",$0.00,"$10,838.20",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$10,838.20",$0.00,"$5,419.10","$8,583.85","$8,670.56",$0.00,$0.00,$0.00,$0.00,$0.00
27867,SUP,Custom 27803010,,27867  -  SHUNT 27867 STRATA II SMALL PCATH 130CM,"$10,770.05",$0.00,"$10,770.05",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$10,770.05",$0.00,"$5,385.03","$8,529.88","$8,616.04",$0.00,$0.00,$0.00,$0.00,$0.00
27868,SUP,Custom 27803010,,27868  -  SHUNT 27868 STRATA NSC SMALL PCATH 130CM,"$9,458.75",$0.00,"$9,458.75",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$9,458.75",$0.00,"$4,729.38","$7,491.33","$7,567.00",$0.00,$0.00,$0.00,$0.00,$0.00
27873,SUP,Custom 27203010,,27873  -  EDMS 27873 BECKR W/SC BLW DC W/NLESS INJ,$496.80,$0.00,$496.80,$0.00,$354.57,$0.00,$0.00,$0.00,$0.00,$0.00,$496.80,$0.00,$248.40,$393.47,$397.44,$0.00,$0.00,$0.00,$0.00,$0.00
27875,SUP,Custom 27803010,,27875  -  SHUNT 27875 CSF SNAP VCATH 15CM,$501.13,$0.00,$501.13,$0.00,$357.65,$0.00,$0.00,$0.00,$0.00,$0.00,$501.13,$0.00,$250.56,$396.89,$400.90,$0.00,$0.00,$0.00,$0.00,$0.00
27888,SUP,Custom 27803010,,27888  -  SHNT 27888 STRATA II SNAP ASSY REG PCATH,"$10,915.75",$0.00,"$10,915.75",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$10,915.75",$0.00,"$5,457.88","$8,645.27","$8,732.60",$0.00,$0.00,$0.00,$0.00,$0.00
27889,SUP,Custom 27803010,,27889  -  RESERVOIR 27889 VENT SNAP EXT FLANGE,$731.50,$0.00,$731.50,$0.00,$522.07,$0.00,$0.00,$0.00,$0.00,$0.00,$731.50,$0.00,$365.75,$579.35,$585.20,$0.00,$0.00,$0.00,$0.00,$0.00
27903,SUP,Custom 27803010,,27903  -  ASSY 27903 STRATA II SM CP CATHETER,"$9,949.90",$0.00,"$9,949.90",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$9,949.90",$0.00,"$4,974.95","$7,880.32","$7,959.92",$0.00,$0.00,$0.00,$0.00,$0.00
27922,SUP,Custom 27803010,,27922  -  SHUNT 27922 STRATA II REG W/INTEG V/RES,"$11,432.75",$0.00,"$11,432.75",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,432.75",$0.00,"$5,716.38","$9,054.74","$9,146.20",$0.00,$0.00,$0.00,$0.00,$0.00
27923,SUP,Custom 27803010,,27923  -  SHUNT 27923 STRATA II SML W/INTEG V/RES,"$11,432.75",$0.00,"$11,432.75",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,432.75",$0.00,"$5,716.38","$9,054.74","$9,146.20",$0.00,$0.00,$0.00,$0.00,$0.00
27924,SUP,Custom 27803010,,27924  -  SHUNT 27924 STRATA NSC REG W/INTG V/RES,"$10,624.35",$0.00,"$10,624.35",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$10,624.35",$0.00,"$5,312.18","$8,414.49","$8,499.48",$0.00,$0.00,$0.00,$0.00,$0.00
27925,SUP,Custom 27803010,,27925  -  SHUNT 27925 STRATA NSC SML W/INTEG V/RES,"$10,624.35",$0.00,"$10,624.35",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$10,624.35",$0.00,"$5,312.18","$8,414.49","$8,499.48",$0.00,$0.00,$0.00,$0.00,$0.00
27926,SUP,Custom 27803010,,27926  -  SHUNT 27926 STRATA II REG W/VRES INNERVN,"$11,900.40",$0.00,"$11,900.40",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,900.40",$0.00,"$5,950.20","$9,425.12","$9,520.32",$0.00,$0.00,$0.00,$0.00,$0.00
27927,SUP,Custom 27803010,,27927  -  SHUNT 27927 STRATA II SML W/VRES INNERVN,"$11,900.40",$0.00,"$11,900.40",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,900.40",$0.00,"$5,950.20","$9,425.12","$9,520.32",$0.00,$0.00,$0.00,$0.00,$0.00
27929,SUP,Custom 27803010,,27929  -  CATHETER 27929 CARDIAC PERIT SML EXTRCTD,"$1,330.00",$0.00,"$1,330.00",$0.00,$949.22,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,330.00",$0.00,$665.00,"$1,053.36","$1,064.00",$0.00,$0.00,$0.00,$0.00,$0.00
27930,SUP,Custom 27803010,,27930  -  CATHETER 27930 VENTRICULAR SML EXTRACTD,$876.38,$0.00,$876.38,$0.00,$625.47,$0.00,$0.00,$0.00,$0.00,$0.00,$876.38,$0.00,$438.19,$694.09,$701.10,$0.00,$0.00,$0.00,$0.00,$0.00
27931,SUP,Custom 27203010,,27931  -  EDMS 27931 BECKER GS TUBING SMARTSITES,$556.80,$0.00,$556.80,$0.00,$397.39,$0.00,$0.00,$0.00,$0.00,$0.00,$556.80,$0.00,$278.40,$440.99,$445.44,$0.00,$0.00,$0.00,$0.00,$0.00
27932,SUP,Custom 27803010,,27932  -  VALVE 27932 STRATA NSC SML EXTRACTED,"$8,781.95",$0.00,"$8,781.95",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,781.95",$0.00,"$4,390.98","$6,955.30","$7,025.56",$0.00,$0.00,$0.00,$0.00,$0.00
27933,SUP,Custom 27803010,,27933  -  VALVE 27933 STRATA NSC REG EXTRACTED,"$8,781.95",$0.00,"$8,781.95",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,781.95",$0.00,"$4,390.98","$6,955.30","$7,025.56",$0.00,$0.00,$0.00,$0.00,$0.00
28707,SUP,Custom 27203010,,SET RTRCTR OCTOBASE HLD INS SUTURE DISP,$137.50,$0.00,$137.50,$0.00,$98.13,$0.00,$0.00,$0.00,$0.00,$0.00,$137.50,$0.00,$68.75,$108.90,$110.00,$0.00,$0.00,$0.00,$0.00,$0.00
29400,SUP,Custom 27203010,,STABILIZER SURG OCT4 DUAL VAC TUBE REINF ARM CARD,"$2,512.50",$0.00,"$2,512.50",$0.00,"$1,793.17",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,512.50",$0.00,"$1,256.25","$1,989.90","$2,010.00",$0.00,$0.00,$0.00,$0.00,$0.00
30011,SUP,HCPCS C1776,,30011  -  STEM ULNAR 41X6.2MM PLASMA SPRAY EASE OF INSERTION REDUCE,"$7,947.50",$0.00,"$7,947.50","$3,576.38","$5,158.80",$0.00,"$1,369.31",$0.00,$0.00,"$1,391.54","$7,947.50",$0.00,"$3,973.75","$6,294.42","$6,358.00",$0.00,"$1,243.78",$0.00,"$1,265.24",$0.00
30121,SUP,HCPCS C1776,,30121  -  STEM ULNAR LATITUDE MEDIUM STANDARD LEFT ELBOW,"$7,946.75",$0.00,"$7,946.75","$3,576.04","$5,158.80",$0.00,"$1,369.19",$0.00,$0.00,"$1,391.41","$7,946.75",$0.00,"$3,973.38","$6,293.83","$6,357.40",$0.00,"$1,243.67",$0.00,"$1,265.12",$0.00
30303,SUP,HCPCS C1776,,30303  -  STEM HUMERAL 90X7.7MM LATITUDE EV 6.5MM 4MM SMALL BOW,"$8,915.00",$0.00,"$8,915.00","$4,011.75","$5,158.80",$0.00,"$1,536.01",$0.00,$0.00,"$1,560.95","$8,915.00",$0.00,"$4,457.50","$7,060.68","$7,132.00",$0.00,"$1,395.20",$0.00,"$1,419.27",$0.00
30397,SUP,Custom 27203010,,KIT C. DIFF A B ELISA MCBLTST 50ML 96 TST,$923.30,$0.00,$923.30,$0.00,$658.96,$0.00,$0.00,$0.00,$0.00,$0.00,$923.30,$0.00,$461.65,$731.25,$738.64,$0.00,$0.00,$0.00,$0.00,$0.00
30405,SUP,Custom 27203010,,KIT PARASTST G LMBLA ELISA MCPLT POS NEG CNTRL,$910.28,$0.00,$910.28,$0.00,$649.66,$0.00,$0.00,$0.00,$0.00,$0.00,$910.28,$0.00,$455.14,$720.94,$728.22,$0.00,$0.00,$0.00,$0.00,$0.00
30406,SUP,Custom 27203010,,KIT MYCTST CRPSP ELISA 96 TST,$883.75,$0.00,$883.75,$0.00,$630.73,$0.00,$0.00,$0.00,$0.00,$0.00,$883.75,$0.00,$441.88,$699.93,$707.00,$0.00,$0.00,$0.00,$0.00,$0.00
30418,SUP,Custom 27203010,,030418  -  RELOAD STPLR UNV STRG 12MM 30MMX2.5MM WHT STRL LF EGIA 6 ROW,$223.20,$0.00,$223.20,$0.00,$159.30,$0.00,$0.00,$0.00,$0.00,$0.00,$223.20,$0.00,$111.60,$176.77,$178.56,$0.00,$0.00,$0.00,$0.00,$0.00
30419,SUP,Custom 27203010,,030419  -  RELOAD STPLR UNV STRG 12MM 30MMX3.5MM BLU STRL LF EGIA 6 ROW,$223.20,$0.00,$223.20,$0.00,$159.30,$0.00,$0.00,$0.00,$0.00,$0.00,$223.20,$0.00,$111.60,$176.77,$178.56,$0.00,$0.00,$0.00,$0.00,$0.00
30422,SUP,Custom 27203010,,030422  -  RELOAD STPLR UNV STRG 12MM 45MMX3.5MM BLU STRL LF EGIA 6 ROW,$230.33,$0.00,$230.33,$0.00,$164.39,$0.00,$0.00,$0.00,$0.00,$0.00,$230.33,$0.00,$115.16,$182.42,$184.26,$0.00,$0.00,$0.00,$0.00,$0.00
30423,SUP,Custom 27203010,,030423  -  RELOAD STPLR UNV 45X4.8MM EGIA 2 TI THKTIS ENDSCP LNR CTR,$228.04,$0.00,$228.04,$0.00,$162.75,$0.00,$0.00,$0.00,$0.00,$0.00,$228.04,$0.00,$114.02,$180.61,$182.43,$0.00,$0.00,$0.00,$0.00,$0.00
30425,SUP,Custom 27203010,,030425  -  RELOAD STPLR UNV 45X2.5MM EGIA 2 TI VASC ENDSCP LNR CTR STRG,$228.04,$0.00,$228.04,$0.00,$162.75,$0.00,$0.00,$0.00,$0.00,$0.00,$228.04,$0.00,$114.02,$180.61,$182.43,$0.00,$0.00,$0.00,$0.00,$0.00
30449,SUP,Custom 27203010,,030449  -  RELOAD STPLR 12X4MM TI UNV LD UN STRL LATEX FREE DISP EGIA,$253.34,$0.00,$253.34,$0.00,$180.81,$0.00,$0.00,$0.00,$0.00,$0.00,$253.34,$0.00,$126.67,$200.65,$202.67,$0.00,$0.00,$0.00,$0.00,$0.00
30454,SUP,Custom 27203010,,030454  -  RELOAD STPLR UNV 12MM 45MMX2.5MM WHT STRL LF EGIA ROTC 6 ROW,$396.79,$0.00,$396.79,$0.00,$283.19,$0.00,$0.00,$0.00,$0.00,$0.00,$396.79,$0.00,$198.40,$314.26,$317.43,$0.00,$0.00,$0.00,$0.00,$0.00
30455,SUP,Custom 27203010,,030455  -  RELOAD STPLR UNV 12MM 45MMX3.5MM BLU STRL LF EGIA ROTC 6 ROW,$396.79,$0.00,$396.79,$0.00,$283.19,$0.00,$0.00,$0.00,$0.00,$0.00,$396.79,$0.00,$198.39,$314.26,$317.43,$0.00,$0.00,$0.00,$0.00,$0.00
30456,SUP,Custom 27203010,,030456  -  RELOAD STPLR UNV 12MM 45MMX4.8MM GRN STRL LF EGIA ROTC 6 ROW,$416.66,$0.00,$416.66,$0.00,$297.37,$0.00,$0.00,$0.00,$0.00,$0.00,$416.66,$0.00,$208.33,$329.99,$333.33,$0.00,$0.00,$0.00,$0.00,$0.00
30456,SUP,Custom 27203010,,RELOAD STPLR 45X4.8MM EGIA RT TI THKTIS LNR CTR LAPSCOP STRL,$425.65,$0.00,$416.66,$0.00,$297.37,$0.00,$0.00,$0.00,$0.00,$0.00,$416.66,$0.00,$208.33,$337.11,$333.33,$0.00,$0.00,$0.00,$0.00,$0.00
30500,SUP,HCPCS C1729,,CATHETER SCT 5FR GRAD STRG CNTRL VLV SF-T-VAC PED STRL LF,$0.88,$0.00,$0.88,$0.48,$0.62,$0.00,$0.15,$0.00,$0.00,$0.15,$0.88,$0.00,$0.44,$0.70,$0.70,$0.00,$0.14,$0.00,$0.14,$0.00
30688,SUP,HCPCS C1729,,CATHETER SCT 6FR GRAD STRG SF-T-VAC PED STRL LF,$0.88,$0.00,$0.88,$0.48,$0.62,$0.00,$0.15,$0.00,$0.00,$0.15,$0.88,$0.00,$0.44,$0.70,$0.70,$0.00,$0.14,$0.00,$0.14,$0.00
30888,SUP,HCPCS C1729,,CATHETER SCT 8FR CNTRL VLV STRG SF-T-VAC STRL LF DISP,$0.80,$0.00,$0.80,$0.43,$0.57,$0.00,$0.14,$0.00,$0.00,$0.14,$0.80,$0.00,$0.40,$0.63,$0.64,$0.00,$0.13,$0.00,$0.13,$0.00
30935,SUP,Custom 25003010,,ANTIBODY CD68/MACRPH MAB MRKR HAM56 LAB,$353.15,$0.00,$353.15,$0.00,$252.04,$0.00,$0.00,$0.00,$0.00,$0.00,$353.15,$0.00,$176.58,$279.69,$282.52,$0.00,$0.00,$0.00,$0.00,$0.00
31000,SUP,HCPCS C1729,,CATHETER SCT 10FR CNTRL VLV STRG SF-T-VAC STRL LF,$0.63,$0.00,$0.63,$0.34,$0.45,$0.00,$0.11,$0.00,$0.00,$0.11,$0.63,$0.00,$0.31,$0.50,$0.50,$0.00,$0.10,$0.00,$0.10,$0.00
31031,SUP,Custom 27203010,,31031  -  BIT DRILL 145MM 3.2MM QC NONSTRL,$152.70,$0.00,$152.70,$0.00,$108.98,$0.00,$0.00,$0.00,$0.00,$0.00,$152.70,$0.00,$76.35,$120.94,$122.16,$0.00,$0.00,$0.00,$0.00,$0.00
31035,SUP,Custom 27203010,,31035  -  BIT DRILL 110MM 3.5MM QC CANN NONSTRL,$149.30,$0.00,$149.30,$0.00,$106.56,$0.00,$0.00,$0.00,$0.00,$0.00,$149.30,$0.00,$74.65,$118.25,$119.44,$0.00,$0.00,$0.00,$0.00,$0.00
31100,SUP,Custom 27203010,,31100  -  SHUNT CV 1MM 14MM STRL CLRVW BLB TPR TIP RADOPQ SIL INTRCOR,$187.50,$0.00,$187.50,$0.00,$133.82,$0.00,$0.00,$0.00,$0.00,$0.00,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$0.00,$0.00,$0.00,$0.00
31113,SUP,Custom 27203010,,KIT ORTH HCV BRCD SEQ VIR TST 3ML,$732.50,$0.00,$732.50,$0.00,$522.79,$0.00,$0.00,$0.00,$0.00,$0.00,$732.50,$0.00,$366.25,$580.14,$586.00,$0.00,$0.00,$0.00,$0.00,$0.00
31150,SUP,Custom 27203010,,31150  -  SHUNT CV 1.5MM 14MM STRL CLRVW RADOPQ BLB TPR TIP SFT SIL,$207.50,$0.00,$207.50,$0.00,$148.09,$0.00,$0.00,$0.00,$0.00,$0.00,$207.50,$0.00,$103.75,$164.34,$166.00,$0.00,$0.00,$0.00,$0.00,$0.00
31175,SUP,Custom 27203010,,31175  -  SHUNT CV 1.75MM 14MM STRL CLRVW BLB INTRCOR ARTMY,$207.50,$0.00,$207.50,$0.00,$148.09,$0.00,$0.00,$0.00,$0.00,$0.00,$207.50,$0.00,$103.75,$164.34,$166.00,$0.00,$0.00,$0.00,$0.00,$0.00
31200,SUP,Custom 27203010,,31200  -  SHUNT CV 2MM 14MM STRL CLRVW RADOPQ BLB TPR TIP SFT SIL,$207.50,$0.00,$207.50,$0.00,$148.09,$0.00,$0.00,$0.00,$0.00,$0.00,$207.50,$0.00,$103.75,$164.34,$166.00,$0.00,$0.00,$0.00,$0.00,$0.00
31250,SUP,Custom 27203010,,31250  -  SHUNT CV 2.5MM 14MM STRL 14MM CLRVW BLB TPR TIP RADOPQ SIL,$207.50,$0.00,$207.50,$0.00,$148.09,$0.00,$0.00,$0.00,$0.00,$0.00,$207.50,$0.00,$103.75,$164.34,$166.00,$0.00,$0.00,$0.00,$0.00,$0.00
31553.91,SUP,Custom 27203010,,HANDLE SCP 3FT CORD HAL LGHT ILUM SYS ANOSCP SGSCP KLNSPC,$191.73,$0.00,$191.73,$0.00,$136.83,$0.00,$0.00,$0.00,$0.00,$0.00,$191.73,$0.00,$95.86,$151.85,$153.38,$0.00,$0.00,$0.00,$0.00,$0.00
31592,SUP,Custom 27203010,,31592  -  BIT DRILL 230MM 2.5MM 3 FLT QC NONSTRL,$451.00,$0.00,$451.00,$0.00,$321.88,$0.00,$0.00,$0.00,$0.00,$0.00,$451.00,$0.00,$225.50,$357.19,$360.80,$0.00,$0.00,$0.00,$0.00,$0.00
32508,SUP,Custom 27203010,,KIT IMMUN TST WBLOT ANTI-HIV-1 40 TST,"$3,010.00",$0.00,"$3,010.00",$0.00,"$2,148.24",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,010.00",$0.00,"$1,505.00","$2,383.92","$2,408.00",$0.00,$0.00,$0.00,$0.00,$0.00
32588,SUP,Custom 27203010,,KIT IMMUN TST EIA ANTI-HIV 1 2,"$1,527.50",$0.00,"$1,527.50",$0.00,"$1,090.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,527.50",$0.00,$763.75,"$1,209.78","$1,222.00",$0.00,$0.00,$0.00,$0.00,$0.00
32591,SUP,Custom 27203010,,KIT GN HBSAG VIR TST 480 TST,"$1,457.50",$0.00,"$1,457.50",$0.00,"$1,040.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,457.50",$0.00,$728.75,"$1,154.34","$1,166.00",$0.00,$0.00,$0.00,$0.00,$0.00
32594,SUP,Custom 27203010,,KIT IMMUN TST CNFRM ASY HBSAG 25 TST,$580.00,$0.00,$580.00,$0.00,$413.95,$0.00,$0.00,$0.00,$0.00,$0.00,$580.00,$0.00,$290.00,$459.36,$464.00,$0.00,$0.00,$0.00,$0.00,$0.00
33000,SUP,Custom 27203010,,REAGENT VIT B2 ACCES 50ML 100 TST ANALY,$175.00,$0.00,$175.00,$0.00,$124.90,$0.00,$0.00,$0.00,$0.00,$0.00,$175.00,$0.00,$87.50,$138.60,$140.00,$0.00,$0.00,$0.00,$0.00,$0.00
33005,SUP,Custom 27203010,,CALIBRATOR CHM 4ML VL VIT B2 ACCES,$264.45,$0.00,$264.45,$0.00,$188.74,$0.00,$0.00,$0.00,$0.00,$0.00,$264.45,$0.00,$132.23,$209.44,$211.56,$0.00,$0.00,$0.00,$0.00,$0.00
33020,SUP,Custom 27203010,,REAGENT FRRTN ACCES 100 TST ANALY,$175.00,$0.00,$175.00,$0.00,$124.90,$0.00,$0.00,$0.00,$0.00,$0.00,$175.00,$0.00,$87.50,$138.60,$140.00,$0.00,$0.00,$0.00,$0.00,$0.00
33025,SUP,Custom 27203010,,CALIBRATOR CHM 4ML VL FRRTN ACCES,$44.08,$0.00,$44.08,$0.00,$31.46,$0.00,$0.00,$0.00,$0.00,$0.00,$44.08,$0.00,$22.04,$34.91,$35.26,$0.00,$0.00,$0.00,$0.00,$0.00
33138,SUP,Custom 27203010,,FORMULA NUTRITIONAL ENFAMIL IRON FORTIFIED POWDER,$30.30,$0.00,$30.30,$0.00,$21.63,$0.00,$0.00,$0.00,$0.00,$0.00,$30.30,$0.00,$15.15,$24.00,$24.24,$0.00,$0.00,$0.00,$0.00,$0.00
33200,SUP,Custom 27203010,,REAGENT CEA ACCES 100 TST ANALY,$595.00,$0.00,$595.00,$0.00,$424.65,$0.00,$0.00,$0.00,$0.00,$0.00,$595.00,$0.00,$297.50,$471.24,$476.00,$0.00,$0.00,$0.00,$0.00,$0.00
33205,SUP,Custom 27203010,,CALIBRATOR CEA ACCES 50 TST IMMUN,$161.25,$0.00,$161.25,$0.00,$115.08,$0.00,$0.00,$0.00,$0.00,$0.00,$161.25,$0.00,$80.63,$127.71,$129.00,$0.00,$0.00,$0.00,$0.00,$0.00
33206,SUP,Custom 27203010,,REAGENT CEA DILU ACCES 4ML ANALY,$153.75,$0.00,$153.75,$0.00,$109.73,$0.00,$0.00,$0.00,$0.00,$0.00,$153.75,$0.00,$76.88,$121.77,$123.00,$0.00,$0.00,$0.00,$0.00,$0.00
33211,SUP,Custom 27203010,,REAGENT AFP ACCES 300 TST ANALY,"$1,597.50",$0.00,"$1,597.50",$0.00,"$1,140.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,597.50",$0.00,$798.75,"$1,265.22","$1,278.00",$0.00,$0.00,$0.00,$0.00,$0.00
33410,SUP,Custom 27203010,,REAGENT INSN ACCES SYN ULSNS 50 TST ANALY,$335.00,$0.00,$335.00,$0.00,$239.09,$0.00,$0.00,$0.00,$0.00,$0.00,$335.00,$0.00,$167.50,$265.32,$268.00,$0.00,$0.00,$0.00,$0.00,$0.00
33415,SUP,Custom 27203010,,CALIBRATOR INSN ACCES SYN SET 2ML IMMUN,$264.45,$0.00,$264.45,$0.00,$188.74,$0.00,$0.00,$0.00,$0.00,$0.00,$264.45,$0.00,$132.23,$209.44,$211.56,$0.00,$0.00,$0.00,$0.00,$0.00
33500,SUP,Custom 27203010,,REAGENT TL BHCG ACCES 100 TST ANALY,$141.88,$0.00,$141.88,$0.00,$101.26,$0.00,$0.00,$0.00,$0.00,$0.00,$141.88,$0.00,$70.94,$112.37,$113.50,$0.00,$0.00,$0.00,$0.00,$0.00
33505,SUP,Custom 27203010,,CALIBRATOR TL BHCG ACCES 4ML IMMUN,$26.88,$0.00,$26.88,$0.00,$19.18,$0.00,$0.00,$0.00,$0.00,$0.00,$26.88,$0.00,$13.44,$21.29,$21.50,$0.00,$0.00,$0.00,$0.00,$0.00
33510,SUP,Custom 27203010,,REAGENT LH ACCES 50 TST ANALY,$197.50,$0.00,$197.50,$0.00,$140.96,$0.00,$0.00,$0.00,$0.00,$0.00,$197.50,$0.00,$98.75,$156.42,$158.00,$0.00,$0.00,$0.00,$0.00,$0.00
33515,SUP,Custom 27203010,,CALIBRATOR LH ACCES 4ML IMMUN,$348.50,$0.00,$348.50,$0.00,$248.72,$0.00,$0.00,$0.00,$0.00,$0.00,$348.50,$0.00,$174.25,$276.01,$278.80,$0.00,$0.00,$0.00,$0.00,$0.00
33520,SUP,Custom 27203010,,REAGENT FSH ACCES 50 TST ANALY,$197.50,$0.00,$197.50,$0.00,$140.96,$0.00,$0.00,$0.00,$0.00,$0.00,$197.50,$0.00,$98.75,$156.42,$158.00,$0.00,$0.00,$0.00,$0.00,$0.00
33525,SUP,Custom 27203010,,CALIBRATOR FSH ACCES 4ML IMMUN,$264.45,$0.00,$264.45,$0.00,$188.74,$0.00,$0.00,$0.00,$0.00,$0.00,$264.45,$0.00,$132.23,$209.44,$211.56,$0.00,$0.00,$0.00,$0.00,$0.00
33530,SUP,Custom 27203010,,REAGENT PRLCTN ACCES 50 TST ANALY,$197.50,$0.00,$197.50,$0.00,$140.96,$0.00,$0.00,$0.00,$0.00,$0.00,$197.50,$0.00,$98.75,$156.42,$158.00,$0.00,$0.00,$0.00,$0.00,$0.00
33535,SUP,Custom 27203010,,CALIBRATOR PRLCTN ACCES 50 TST IMMUN,$264.45,$0.00,$264.45,$0.00,$188.74,$0.00,$0.00,$0.00,$0.00,$0.00,$264.45,$0.00,$132.23,$209.44,$211.56,$0.00,$0.00,$0.00,$0.00,$0.00
33540,SUP,Custom 27203010,,REAGENT E2 ACCES 100 TST ANALY,$501.25,$0.00,$501.25,$0.00,$357.74,$0.00,$0.00,$0.00,$0.00,$0.00,$501.25,$0.00,$250.63,$396.99,$401.00,$0.00,$0.00,$0.00,$0.00,$0.00
33545,SUP,Custom 27203010,,CALIBRATOR E2 ACCES 2.5ML IMMUN,$264.45,$0.00,$264.45,$0.00,$188.74,$0.00,$0.00,$0.00,$0.00,$0.00,$264.45,$0.00,$132.23,$209.44,$211.56,$0.00,$0.00,$0.00,$0.00,$0.00
33546,SUP,Custom 27203010,,REAGENT E2 DILU ACCES VL 4ML ANALY,$91.25,$0.00,$91.25,$0.00,$65.13,$0.00,$0.00,$0.00,$0.00,$0.00,$91.25,$0.00,$45.63,$72.27,$73.00,$0.00,$0.00,$0.00,$0.00,$0.00
33560,SUP,Custom 27203010,,REAGENT T ACCES 50 TST ANALY,$232.50,$0.00,$232.50,$0.00,$165.94,$0.00,$0.00,$0.00,$0.00,$0.00,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$0.00,$0.00,$0.00,$0.00
33565,SUP,Custom 27203010,,CALIBRATOR T ACCES 2.5ML IMMUN,$264.45,$0.00,$264.45,$0.00,$188.74,$0.00,$0.00,$0.00,$0.00,$0.00,$264.45,$0.00,$132.23,$209.44,$211.56,$0.00,$0.00,$0.00,$0.00,$0.00
33600,SUP,Custom 27203010,,REAGENT CORTSL ACCES 100 TST ANALY,$152.50,$0.00,$152.50,$0.00,$108.84,$0.00,$0.00,$0.00,$0.00,$0.00,$152.50,$0.00,$76.25,$120.78,$122.00,$0.00,$0.00,$0.00,$0.00,$0.00
33605,SUP,Custom 27203010,,CALIBRATOR CORTSL ACCES 50 TST IMMUN,$264.45,$0.00,$264.45,$0.00,$188.74,$0.00,$0.00,$0.00,$0.00,$0.00,$264.45,$0.00,$132.23,$209.44,$211.56,$0.00,$0.00,$0.00,$0.00,$0.00
33606,SUP,Custom 27203010,,CALIBRATOR CORTSL DILU ACCES 4ML IMMUN,$74.83,$0.00,$74.83,$0.00,$53.40,$0.00,$0.00,$0.00,$0.00,$0.00,$74.83,$0.00,$37.41,$59.27,$59.86,$0.00,$0.00,$0.00,$0.00,$0.00
33800,SUP,Custom 27203010,,REAGENT TL T4 ACCES 50 TST ANALY,$75.00,$0.00,$75.00,$0.00,$53.53,$0.00,$0.00,$0.00,$0.00,$0.00,$75.00,$0.00,$37.50,$59.40,$60.00,$0.00,$0.00,$0.00,$0.00,$0.00
33805,SUP,Custom 27203010,,CALIBRATOR TL T4 ACCES 4ML IMMUN,$264.45,$0.00,$264.45,$0.00,$188.74,$0.00,$0.00,$0.00,$0.00,$0.00,$264.45,$0.00,$132.23,$209.44,$211.56,$0.00,$0.00,$0.00,$0.00,$0.00
33815,SUP,Custom 27203010,,CALIBRATOR T UPTK ACCES 1ML IMMUN,$45.63,$0.00,$45.63,$0.00,$32.56,$0.00,$0.00,$0.00,$0.00,$0.00,$45.63,$0.00,$22.81,$36.14,$36.50,$0.00,$0.00,$0.00,$0.00,$0.00
33820,SUP,Custom 27203010,,REAGENT TSH ACCES HYPERSENSITIVE 100 TST ANALY,$1.83,$0.00,$1.83,$0.00,$1.30,$0.00,$0.00,$0.00,$0.00,$0.00,$1.83,$0.00,$0.91,$1.45,$1.46,$0.00,$0.00,$0.00,$0.00,$0.00
33821,SUP,Custom 27203010,,FORMULA NUTRITIONAL NUTRAMIGEN 1LB POWDER CAN,$56.68,$0.00,$56.68,$0.00,$40.45,$0.00,$0.00,$0.00,$0.00,$0.00,$56.68,$0.00,$28.34,$44.89,$45.34,$0.00,$0.00,$0.00,$0.00,$0.00
33825,SUP,Custom 27203010,,CALIBRATOR TSH ACCES HYPERSENSITIVE VL 4ML IMMUN,$264.45,$0.00,$264.45,$0.00,$188.74,$0.00,$0.00,$0.00,$0.00,$0.00,$264.45,$0.00,$132.23,$209.44,$211.56,$0.00,$0.00,$0.00,$0.00,$0.00
33835,SUP,Custom 27203010,,CALIBRATOR TL T3 ACCES 50 TST IMMUN,$264.45,$0.00,$264.45,$0.00,$188.74,$0.00,$0.00,$0.00,$0.00,$0.00,$264.45,$0.00,$132.23,$209.44,$211.56,$0.00,$0.00,$0.00,$0.00,$0.00
33880,SUP,Custom 27203010,,REAGENT FR T4 ACCES 100 TST ANALY,$267.50,$0.00,$267.50,$0.00,$190.91,$0.00,$0.00,$0.00,$0.00,$0.00,$267.50,$0.00,$133.75,$211.86,$214.00,$0.00,$0.00,$0.00,$0.00,$0.00
33885,SUP,Custom 27203010,,CALIBRATOR FR T4 ACCES 2.5ML IMMUN,$45.63,$0.00,$45.63,$0.00,$32.56,$0.00,$0.00,$0.00,$0.00,$0.00,$45.63,$0.00,$22.81,$36.14,$36.50,$0.00,$0.00,$0.00,$0.00,$0.00
35402,SUP,HCPCS C1729,,CATHETER SCT 14FR CNTRL VLV 2 GLOVE WO SOL MINI TRY SF-T-VAC,$1.18,$0.00,$1.18,$0.64,$0.84,$0.00,$0.20,$0.00,$0.00,$0.21,$1.18,$0.00,$0.59,$0.93,$0.94,$0.00,$0.18,$0.00,$0.19,$0.00
36179,SUP,HCPCS C1769,,36179  -  NEEDLE 5CM 18GA GUIDEWIRE PRC RNL FSCA 10MM,$82.45,$0.00,$82.45,$44.77,$58.84,$0.00,$14.21,$0.00,$0.00,$14.44,$82.45,$0.00,$41.23,$65.30,$65.96,$0.00,$12.90,$0.00,$13.13,$0.00
36721,SUP,Custom 27203010,,FORMULA NUTRITIONAL PREGESTIMIL 1LB POWDER CAN,$42.50,$0.00,$42.50,$0.00,$30.33,$0.00,$0.00,$0.00,$0.00,$0.00,$42.50,$0.00,$21.25,$33.66,$34.00,$0.00,$0.00,$0.00,$0.00,$0.00
36826,SUP,HCPCS C1729,,CATHETER SCT 8FR CNTRL VLV COIL GRAD 2 GLOVE PPUP BSIN,$1.43,$0.00,$1.43,$0.77,$1.02,$0.00,$0.25,$0.00,$0.00,$0.25,$1.43,$0.00,$0.71,$1.13,$1.14,$0.00,$0.22,$0.00,$0.23,$0.00
37024,SUP,HCPCS C1729,,CATHETER SCT 10FR CNTRL VLV COIL 2 GLOVE PPUP BSIN KT,$1.28,$0.00,$1.28,$0.69,$0.91,$0.00,$0.22,$0.00,$0.00,$0.22,$1.28,$0.00,$0.64,$1.01,$1.02,$0.00,$0.20,$0.00,$0.20,$0.00
37092,SUP,HCPCS C1787,,37092  -  PROGRAMMER NRSTM STRL ACTIVA PT ANTNA XTRN TELEM DP BRN STM,$200.00,$0.00,$200.00,$0.00,$142.74,$0.00,$0.00,$0.00,$0.00,$0.00,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$0.00,$0.00,$0.00,$0.00
37200,SUP,Custom 27203010,,REAGENT PSA ACCES HYBRITECH 100 TST ANALY,$915.00,$0.00,$915.00,$0.00,$653.04,$0.00,$0.00,$0.00,$0.00,$0.00,$915.00,$0.00,$457.50,$724.68,$732.00,$0.00,$0.00,$0.00,$0.00,$0.00
37205,SUP,Custom 27203010,,CALIBRATOR PSA ACCES HYBRITECH VL 2.5ML IMMUN,$264.45,$0.00,$264.45,$0.00,$188.74,$0.00,$0.00,$0.00,$0.00,$0.00,$264.45,$0.00,$132.23,$209.44,$211.56,$0.00,$0.00,$0.00,$0.00,$0.00
37206,SUP,Custom 27203010,,REAGENT PSA DILU ACCES HYBRITECH 14ML ANALY,$171.88,$0.00,$171.88,$0.00,$122.67,$0.00,$0.00,$0.00,$0.00,$0.00,$171.88,$0.00,$85.94,$136.13,$137.50,$0.00,$0.00,$0.00,$0.00,$0.00
37970,SUP,Custom 27203010,,0037970  -  DEVICE IRR EFL DISP,$127.50,$0.00,$127.50,$0.00,$91.00,$0.00,$0.00,$0.00,$0.00,$0.00,$127.50,$0.00,$63.75,$100.98,$102.00,$0.00,$0.00,$0.00,$0.00,$0.00
38005,SUP,Custom 27803010,,038005  -  FILLER BONE VOID DBX DEMINERALIZED BONE MATRIX .5 CC ALLOGRA,$243.25,$0.00,$243.25,$0.00,$173.61,$0.00,$0.00,$0.00,$0.00,$0.00,$243.25,$0.00,$121.63,$192.65,$194.60,$0.00,$0.00,$0.00,$0.00,$0.00
38010,SUP,HCPCS C1713,,38010  -  FILLER BONE VOID ALLOGRAFT PUTTY FREEZE DRIED DBX,$432.25,$0.00,$432.25,$194.51,$308.50,$0.00,$74.47,$0.00,$0.00,$75.68,$432.25,$0.00,$216.13,$342.34,$345.80,$0.00,$67.65,$0.00,$68.81,$0.00
38025,SUP,HCPCS C1713,,038025  -  FILLER BONE VOID ALLOGRAFT FREEZE DRY PUTTY DBX 2.5CC,$935.00,$0.00,$935.00,$420.75,$667.31,$0.00,$161.10,$0.00,$0.00,$163.71,$935.00,$0.00,$467.50,$740.52,$748.00,$0.00,$146.33,$0.00,$148.85,$0.00
38050,SUP,HCPCS C1713,,038050  -  FILLER BONE VOID ALLOGRAFT FREEZE DRY PUTTY DBX 5ML,"$1,725.50",$0.00,"$1,725.50",$776.48,"$1,231.49",$0.00,$297.30,$0.00,$0.00,$302.12,"$1,725.50",$0.00,$862.75,"$1,366.60","$1,380.40",$0.00,$270.04,$0.00,$274.70,$0.00
38100,SUP,Custom 27803010,,038100  -  FILLER BONE VOID ALLOGRAFT FREEZE DRY PUTTY DBX 10ML,"$2,652.00",$0.00,"$2,100.38",$0.00,$76.57,$0.00,$0.00,$0.00,$0.00,$0.00,$107.28,$0.00,$53.64,"$2,100.38",$85.82,$0.00,$0.00,$0.00,$0.00,$0.00
41101,SUP,HCPCS C1729,,41101  -  CATHETER DRN STD 4FR 23CM STRL LF INPT TS CSF IMPREGNATE,$356.25,$0.00,$356.25,$193.44,$254.26,$0.00,$61.38,$0.00,$0.00,$62.38,$356.25,$0.00,$178.13,$282.15,$285.00,$0.00,$55.75,$0.00,$56.72,$0.00
41103,SUP,Custom 27803010,,41103  -  CATH 41103 CSF-VENT STANDARD PLIANT,$356.25,$0.00,$356.25,$0.00,$254.26,$0.00,$0.00,$0.00,$0.00,$0.00,$356.25,$0.00,$178.13,$282.15,$285.00,$0.00,$0.00,$0.00,$0.00,$0.00
41115,SUP,Custom 27803010,,41115  -  CATH 41115 CSF-VENT STD TRANSLUCENT,$356.25,$0.00,$356.25,$0.00,$254.26,$0.00,$0.00,$0.00,$0.00,$0.00,$356.25,$0.00,$178.13,$282.15,$285.00,$0.00,$0.00,$0.00,$0.00,$0.00
41207,SUP,Custom 27803010,,41207  -  CATH 41207 CSF-VENT SMALL BAR IMP,$356.25,$0.00,$356.25,$0.00,$254.26,$0.00,$0.00,$0.00,$0.00,$0.00,$356.25,$0.00,$178.13,$282.15,$285.00,$0.00,$0.00,$0.00,$0.00,$0.00
41308,SUP,Custom 27803010,,41308  -  CATH 41308 CSF-VENT FLANGED SMALL,"$1,368.00",$0.00,"$1,368.00",$0.00,$976.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,368.00",$0.00,$684.00,"$1,083.46","$1,094.40",$0.00,$0.00,$0.00,$0.00,$0.00
41404,SUP,Custom 27803010,,41404  -  CATHETER 41404 CSF-VENT STD W/SNAP 4CM,$501.13,$0.00,$501.13,$0.00,$357.65,$0.00,$0.00,$0.00,$0.00,$0.00,$501.13,$0.00,$250.56,$396.89,$400.90,$0.00,$0.00,$0.00,$0.00,$0.00
41405,SUP,Custom 27803010,,41405  -  CATHETER 41405 CSF-VENT STD W/SNAP 5CM,$501.13,$0.00,$501.13,$0.00,$357.65,$0.00,$0.00,$0.00,$0.00,$0.00,$501.13,$0.00,$250.56,$396.89,$400.90,$0.00,$0.00,$0.00,$0.00,$0.00
41406,SUP,Custom 27803010,,41406  -  CATHETER 41406 CSF-VENT STD W/SNAP 6CM,$501.13,$0.00,$501.13,$0.00,$357.65,$0.00,$0.00,$0.00,$0.00,$0.00,$501.13,$0.00,$250.56,$396.89,$400.90,$0.00,$0.00,$0.00,$0.00,$0.00
41407,SUP,Custom 27803010,,41407  -  CATHETER 41407 CSF-VENT STD W/SNAP 7CM,$501.13,$0.00,$501.13,$0.00,$357.65,$0.00,$0.00,$0.00,$0.00,$0.00,$501.13,$0.00,$250.56,$396.89,$400.90,$0.00,$0.00,$0.00,$0.00,$0.00
41408,SUP,Custom 27803010,,41408  -  CATHETER DRN STD 8CM STRL LF CSF SNP SHNT VNTRC DISP,$501.13,$0.00,$501.13,$0.00,$357.65,$0.00,$0.00,$0.00,$0.00,$0.00,$501.13,$0.00,$250.56,$396.89,$400.90,$0.00,$0.00,$0.00,$0.00,$0.00
41409,SUP,Custom 27803010,,41409  -  CATHETER DRN STD 9CM STRL LF CSF SNP SHNT VNTRC DISP,$501.13,$0.00,$501.13,$0.00,$357.65,$0.00,$0.00,$0.00,$0.00,$0.00,$501.13,$0.00,$250.56,$396.89,$400.90,$0.00,$0.00,$0.00,$0.00,$0.00
41501,SUP,Custom 27803010,,41501  -  CATH 41501 OPUS VENTRICULAR SM 23CM,$465.50,$0.00,$465.50,$0.00,$332.23,$0.00,$0.00,$0.00,$0.00,$0.00,$465.50,$0.00,$232.75,$368.68,$372.40,$0.00,$0.00,$0.00,$0.00,$0.00
41503,SUP,Custom 27803010,,41503  -  CATH 41503 OPUS VENTRICULAR STD 23CM,$465.50,$0.00,$465.50,$0.00,$332.23,$0.00,$0.00,$0.00,$0.00,$0.00,$465.50,$0.00,$232.75,$368.68,$372.40,$0.00,$0.00,$0.00,$0.00,$0.00
41701,SUP,Custom 27803010,,41701  -  CATHETER 41701 RIVULET VENTRICULAR,$619.88,$0.00,$619.88,$0.00,$442.40,$0.00,$0.00,$0.00,$0.00,$0.00,$619.88,$0.00,$309.94,$490.94,$495.90,$0.00,$0.00,$0.00,$0.00,$0.00
41704,SUP,Custom 27803010,,41704  -  CATHETER 41704 RIVULET VENT SNAP 4CM,$790.88,$0.00,$790.88,$0.00,$564.45,$0.00,$0.00,$0.00,$0.00,$0.00,$790.88,$0.00,$395.44,$626.38,$632.70,$0.00,$0.00,$0.00,$0.00,$0.00
41705,SUP,Custom 27803010,,41705  -  CATHETER 41705 RIVULET VENT SNAP 5CM,$790.88,$0.00,$790.88,$0.00,$564.45,$0.00,$0.00,$0.00,$0.00,$0.00,$790.88,$0.00,$395.44,$626.38,$632.70,$0.00,$0.00,$0.00,$0.00,$0.00
41707,SUP,Custom 27803010,,41707  -  CATHETER 41707 RIVULET VENT SNAP 7CM,$790.88,$0.00,$790.88,$0.00,$564.45,$0.00,$0.00,$0.00,$0.00,$0.00,$790.88,$0.00,$395.44,$626.38,$632.70,$0.00,$0.00,$0.00,$0.00,$0.00
41709,SUP,Custom 27803010,,41709  -  CATHETER 41709 RIVULET VENT SNAP 9CM,$790.88,$0.00,$790.88,$0.00,$564.45,$0.00,$0.00,$0.00,$0.00,$0.00,$790.88,$0.00,$395.44,$626.38,$632.70,$0.00,$0.00,$0.00,$0.00,$0.00
42102,SUP,Custom 27803010,,42102  -  VALVE 42102 STANDARD LOW,"$2,147.00",$0.00,"$2,147.00",$0.00,"$1,532.31",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,147.00",$0.00,"$1,073.50","$1,700.42","$1,717.60",$0.00,$0.00,$0.00,$0.00,$0.00
42104,SUP,Custom 27803010,,42104  -  VALVE 42104 STANDARD MEDIUM,"$2,147.00",$0.00,"$2,147.00",$0.00,"$1,532.31",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,147.00",$0.00,"$1,073.50","$1,700.42","$1,717.60",$0.00,$0.00,$0.00,$0.00,$0.00
42106,SUP,Custom 27803010,,42106  -  VALVE 42106 STANDARD HIGH,"$1,655.38",$0.00,"$1,655.38",$0.00,"$1,181.44",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,655.38",$0.00,$827.69,"$1,311.06","$1,324.30",$0.00,$0.00,$0.00,$0.00,$0.00
42312,SUP,Custom 27803010,,42312  -  VALVE 42312 SM CONTOURED LOW PRES IMP,"$2,147.00",$0.00,"$2,147.00",$0.00,"$1,532.31",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,147.00",$0.00,"$1,073.50","$1,700.42","$1,717.60",$0.00,$0.00,$0.00,$0.00,$0.00
42314,SUP,Custom 27803010,,42314  -  VALVE 42314 SM CONTOURED MED PRESS IMP,"$2,147.00",$0.00,"$2,147.00",$0.00,"$1,532.31",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,147.00",$0.00,"$1,073.50","$1,700.42","$1,717.60",$0.00,$0.00,$0.00,$0.00,$0.00
42316,SUP,Custom 27803010,,42316  -  VALVE 42316 SM CONTOURED HIGH PRESS IMP,"$2,147.00",$0.00,"$2,147.00",$0.00,"$1,532.31",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,147.00",$0.00,"$1,073.50","$1,700.42","$1,717.60",$0.00,$0.00,$0.00,$0.00,$0.00
42322,SUP,Custom 27803010,,42322  -  VALVE SHNT REG STRL DLT CNTR LP CSF,"$2,147.00",$0.00,"$2,147.00",$0.00,"$1,532.31",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,147.00",$0.00,"$1,073.50","$1,700.42","$1,717.60",$0.00,$0.00,$0.00,$0.00,$0.00
42324,SUP,Custom 27803010,,42324  -  VALVE SHNT REG CNTR 32X18X7.5MM STRL LF 14MM DLT PS MDCL CSF,"$2,147.00",$0.00,"$2,147.00",$0.00,"$1,532.31",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,147.00",$0.00,"$1,073.50","$1,700.42","$1,717.60",$0.00,$0.00,$0.00,$0.00,$0.00
42326,SUP,Custom 27803010,,42326  -  VALVE SHNT REG STRL DLT CNTR HI-PRS IMPRG CSF,"$2,147.00",$0.00,"$2,147.00",$0.00,"$1,532.31",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,147.00",$0.00,"$1,073.50","$1,700.42","$1,717.60",$0.00,$0.00,$0.00,$0.00,$0.00
42335,SUP,Custom 27803010,,42335  -  VALVE 42335 STRATA NSC BURR HOLE,"$9,038.10",$0.00,"$9,038.10",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$9,038.10",$0.00,"$4,519.05","$7,158.18","$7,230.48",$0.00,$0.00,$0.00,$0.00,$0.00
42355,SUP,Custom 27803010,,42355  -  VALVE 42355 FP STRATA NSC SMALL,"$9,038.10",$0.00,"$9,038.10",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$9,038.10",$0.00,"$4,519.05","$7,158.18","$7,230.48",$0.00,$0.00,$0.00,$0.00,$0.00
42365,SUP,Custom 27803010,,42365  -  VALVE 42365 FP STRATA NSC REGULAR,"$9,038.10",$0.00,"$9,038.10",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$9,038.10",$0.00,"$4,519.05","$7,158.18","$7,230.48",$0.00,$0.00,$0.00,$0.00,$0.00
42410,SUP,Custom 27803010,,42410  -  VALVE 42410 ULTRA SMALL LOW-LOW,"$2,147.00",$0.00,"$2,147.00",$0.00,"$1,532.31",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,147.00",$0.00,"$1,073.50","$1,700.42","$1,717.60",$0.00,$0.00,$0.00,$0.00,$0.00
42412,SUP,Custom 27803010,,42412  -  VALVE 42412 ULTRA SMALL LOW PRESS IMP,"$2,147.00",$0.00,"$2,147.00",$0.00,"$1,532.31",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,147.00",$0.00,"$1,073.50","$1,700.42","$1,717.60",$0.00,$0.00,$0.00,$0.00,$0.00
42414,SUP,Custom 27803010,,42414  -  VALVE 42414 ULTRA SMALL MEDIUM PRESS IMP,"$2,147.00",$0.00,"$2,147.00",$0.00,"$1,532.31",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,147.00",$0.00,"$1,073.50","$1,700.42","$1,717.60",$0.00,$0.00,$0.00,$0.00,$0.00
42532,SUP,Custom 27803010,,42532  -  VALVE 42532 BURR HOLE 12MM LOW PRESS IMP,"$2,147.00",$0.00,"$2,147.00",$0.00,"$1,532.31",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,147.00",$0.00,"$1,073.50","$1,700.42","$1,717.60",$0.00,$0.00,$0.00,$0.00,$0.00
42534,SUP,Custom 27803010,,42534  -  VALVE 42534 BURR HOLE 12MM MED PRESS IMP,"$2,147.00",$0.00,"$2,147.00",$0.00,"$1,532.31",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,147.00",$0.00,"$1,073.50","$1,700.42","$1,717.60",$0.00,$0.00,$0.00,$0.00,$0.00
42536,SUP,Custom 27803010,,42536  -  VALVE 42536 BURR HOLE 12MM HI PRESS IMP,"$2,147.00",$0.00,"$2,147.00",$0.00,"$1,532.31",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,147.00",$0.00,"$1,073.50","$1,700.42","$1,717.60",$0.00,$0.00,$0.00,$0.00,$0.00
42542,SUP,Custom 27803010,,42542  -  VALVE 42542 BURR HOLE 16 MM LOW IMP,"$2,147.00",$0.00,"$2,147.00",$0.00,"$1,532.31",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,147.00",$0.00,"$1,073.50","$1,700.42","$1,717.60",$0.00,$0.00,$0.00,$0.00,$0.00
42544,SUP,Custom 27803010,,42544  -  VALVE 42544 BURR HOLE 16MM MED PRESS IMP,"$2,147.00",$0.00,"$2,147.00",$0.00,"$1,532.31",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,147.00",$0.00,"$1,073.50","$1,700.42","$1,717.60",$0.00,$0.00,$0.00,$0.00,$0.00
42546,SUP,Custom 27803010,,42546  -  VALVE 42546 BURR HOLE 16MM HI PRESS IMP,"$2,147.00",$0.00,"$2,147.00",$0.00,"$1,532.31",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,147.00",$0.00,"$1,073.50","$1,700.42","$1,717.60",$0.00,$0.00,$0.00,$0.00,$0.00
42812,SUP,Custom 27803010,,42812  -  VALVE 42812 DELTA SMALL LEVEL I,"$3,617.13",$0.00,"$3,617.13",$0.00,"$2,581.54",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,617.13",$0.00,"$1,808.56","$2,864.77","$2,893.70",$0.00,$0.00,$0.00,$0.00,$0.00
42813,SUP,Custom 27803010,,42813  -  VALVE 42813 DELTA SMALL LEVEL 1.5,"$3,617.13",$0.00,"$3,617.13",$0.00,"$2,581.54",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,617.13",$0.00,"$1,808.56","$2,864.77","$2,893.70",$0.00,$0.00,$0.00,$0.00,$0.00
42814,SUP,Custom 27803010,,42814  -  VALVE 42814 DELTA SMALL LEVEL II,"$3,617.13",$0.00,"$3,617.13",$0.00,"$2,581.54",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,617.13",$0.00,"$1,808.56","$2,864.77","$2,893.70",$0.00,$0.00,$0.00,$0.00,$0.00
42822,SUP,Custom 27803010,,42822  -  VALVE SHNT DLT REG CSF PRFRM LVL 1 STRL,"$3,617.13",$0.00,"$3,617.13",$0.00,"$2,581.54",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,617.13",$0.00,"$1,808.56","$2,864.77","$2,893.70",$0.00,$0.00,$0.00,$0.00,$0.00
42823,SUP,Custom 27803010,,42823  -  VALVE SHNT DLT REG CSF PRFRM LVL 1.5 CHRNC SYSTOLIC STRL,"$3,617.13",$0.00,"$3,617.13",$0.00,"$2,581.54",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,617.13",$0.00,"$1,808.56","$2,864.77","$2,893.70",$0.00,$0.00,$0.00,$0.00,$0.00
42824,SUP,HCPCS C1877,,42824  -  VALVE SHNT DLT REG CSF PRFRM LVL 2 STRL,"$3,617.13",$0.00,"$3,617.13","$1,627.71","$2,581.54",$0.00,$623.21,$0.00,$0.00,$633.33,"$3,617.13",$0.00,"$1,808.56","$2,864.77","$2,893.70",$0.00,$566.08,$0.00,$575.85,$0.00
42830,SUP,Custom 27803010,,42830  -  VALVE 42830 DELTA BURR HOLE 12MM LEV 0.5,"$3,617.13",$0.00,"$3,617.13",$0.00,"$2,581.54",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,617.13",$0.00,"$1,808.56","$2,864.77","$2,893.70",$0.00,$0.00,$0.00,$0.00,$0.00
42832,SUP,Custom 27803010,,42832  -  VALVE 42832 DELTA BURR HOLE 12MM LEVEL 1,"$3,617.13",$0.00,"$3,617.13",$0.00,"$2,581.54",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,617.13",$0.00,"$1,808.56","$2,864.77","$2,893.70",$0.00,$0.00,$0.00,$0.00,$0.00
42833,SUP,Custom 27803010,,42833  -  VALVE 42833DELTA BURR HOLE 12MM LEV 1.5,"$3,617.13",$0.00,"$3,617.13",$0.00,"$2,581.54",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,617.13",$0.00,"$1,808.56","$2,864.77","$2,893.70",$0.00,$0.00,$0.00,$0.00,$0.00
42834,SUP,Custom 27803010,,42834  -  VALVE 42834 DELTA BURR HOLE 12 MM LEVEL,"$3,617.13",$0.00,"$3,617.13",$0.00,"$2,581.54",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,617.13",$0.00,"$1,808.56","$2,864.77","$2,893.70",$0.00,$0.00,$0.00,$0.00,$0.00
42836,SUP,Custom 27803010,,42836  -  VALVE 42836 STRATA II BURR HOLE,"$9,839.45",$0.00,"$9,839.45",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$9,839.45",$0.00,"$4,919.73","$7,792.84","$7,871.56",$0.00,$0.00,$0.00,$0.00,$0.00
42840,SUP,Custom 27803010,,42840  -  VALVE 42840 DELTA BURR HOLE 16MM LEV 0.5,"$3,617.13",$0.00,"$3,617.13",$0.00,"$2,581.54",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,617.13",$0.00,"$1,808.56","$2,864.77","$2,893.70",$0.00,$0.00,$0.00,$0.00,$0.00
42842,SUP,Custom 27803010,,42842  -  VALVE 42842 DELTA BURR HOLE 16MM LEVEL 1,"$3,617.13",$0.00,"$3,617.13",$0.00,"$2,581.54",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,617.13",$0.00,"$1,808.56","$2,864.77","$2,893.70",$0.00,$0.00,$0.00,$0.00,$0.00
42843,SUP,Custom 27803010,,42843  -  VALVE 42843 DELTA BURR HOLE 16 MM LEV 1.,"$3,617.13",$0.00,"$3,617.13",$0.00,"$2,581.54",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,617.13",$0.00,"$1,808.56","$2,864.77","$2,893.70",$0.00,$0.00,$0.00,$0.00,$0.00
42844,SUP,Custom 27803010,,42844  -  VALVE 42844 DELTA BURR HOLE 16 MM LEVEL,"$3,617.13",$0.00,"$3,617.13",$0.00,"$2,581.54",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,617.13",$0.00,"$1,808.56","$2,864.77","$2,893.70",$0.00,$0.00,$0.00,$0.00,$0.00
42856,SUP,Custom 27803010,,42856  -  VALVE 42856 FP-STRATA 2 SMALL,"$9,839.45",$0.00,"$9,839.45",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$9,839.45",$0.00,"$4,919.73","$7,792.84","$7,871.56",$0.00,$0.00,$0.00,$0.00,$0.00
42866,SUP,Custom 27803010,,42866  -  VALVE 42866 FP-STRATA 2 REGULAR,"$9,839.45",$0.00,"$9,839.45",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$9,839.45",$0.00,"$4,919.73","$7,792.84","$7,871.56",$0.00,$0.00,$0.00,$0.00,$0.00
43103,SUP,HCPCS C1750,,43103  -  CATHETER PERITONEAL STANDARD 90CM IMPREGNATE BARIUM CARDIAC,$410.88,$0.00,$410.88,$184.89,$293.24,$0.00,$70.79,$0.00,$0.00,$71.94,$410.88,$0.00,$205.44,$325.42,$328.70,$0.00,$64.30,$0.00,$65.41,$0.00
43105,SUP,HCPCS C1713,,43105  -  SUB BNGFT GRFTN DBM PTTY JAR 5ML,"$1,400.00",$0.00,"$1,400.00",$630.00,$999.18,$0.00,$241.21,$0.00,$0.00,$245.13,"$1,400.00",$0.00,$700.00,"$1,108.80","$1,120.00",$0.00,$219.10,$0.00,$222.88,$0.00
43110,SUP,Custom 27804086,,43110  -  FILLER BN VOID 10ML GRFTN ALGRF PTTY JR DBM,"$2,418.00",$0.00,"$2,418.00",$0.00,"$1,725.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,418.00",$0.00,"$1,209.00","$1,915.06","$1,934.40",$0.00,$0.00,$0.00,$0.00,$0.00
43111,SUP,Custom 27803010,,43111  -  CATH 43111 C/P STANDARD TRANSLUCENT,$410.88,$0.00,$410.88,$0.00,$293.24,$0.00,$0.00,$0.00,$0.00,$0.00,$410.88,$0.00,$205.44,$325.42,$328.70,$0.00,$0.00,$0.00,$0.00,$0.00
43209,SUP,Custom 27803010,,43209  -  CATH 43209 C/P SMALL BAR IMP,$410.88,$0.00,$410.88,$0.00,$293.24,$0.00,$0.00,$0.00,$0.00,$0.00,$410.88,$0.00,$205.44,$325.42,$328.70,$0.00,$0.00,$0.00,$0.00,$0.00
43418,SUP,Custom 27803010,,43418  -  CATH 43418 CARDIAC CATH REDUCED TIP 58CM,$534.38,$0.00,$534.38,$0.00,$381.38,$0.00,$0.00,$0.00,$0.00,$0.00,$534.38,$0.00,$267.19,$423.23,$427.50,$0.00,$0.00,$0.00,$0.00,$0.00
43522,SUP,Custom 27803010,,43522  -  CATH 43522 C/P CATH OPEN END W/SLITS STD,$418.00,$0.00,$418.00,$0.00,$298.33,$0.00,$0.00,$0.00,$0.00,$0.00,$418.00,$0.00,$209.00,$331.06,$334.40,$0.00,$0.00,$0.00,$0.00,$0.00
43551,SUP,Custom 27803010,,43551  -  CATH 43551 C/P STD PLIANT BAR IMP,$418.00,$0.00,$418.00,$0.00,$298.33,$0.00,$0.00,$0.00,$0.00,$0.00,$418.00,$0.00,$209.00,$331.06,$334.40,$0.00,$0.00,$0.00,$0.00,$0.00
43555,SUP,Custom 27803010,,43555  -  CATHETER 43555 PERITONEAL SMALL LUMEN,$593.75,$0.00,$593.75,$0.00,$423.76,$0.00,$0.00,$0.00,$0.00,$0.00,$593.75,$0.00,$296.88,$470.25,$475.00,$0.00,$0.00,$0.00,$0.00,$0.00
11-Jan,SUP,HCPCS C1713,,JAN-11  -  PLATE BONE SM RIGHT ORBTL FLR MESH CNTOUR ANTM EZ,"$4,677.50",$0.00,"$4,677.50","$2,104.88","$3,338.33",$0.00,$805.91,$0.00,$0.00,$818.99,"$4,677.50",$0.00,"$2,338.75","$3,704.58","$3,742.00",$0.00,$732.03,$0.00,$744.66,$0.00
44000,SUP,Custom 27803010,,44000  -  INLET 44000 VENTRICULAR PORT BOTTOM,$959.50,$0.00,$959.50,$0.00,$684.80,$0.00,$0.00,$0.00,$0.00,$0.00,$959.50,$0.00,$479.75,$759.92,$767.60,$0.00,$0.00,$0.00,$0.00,$0.00
44010,SUP,Custom 27803010,,44010  -  INLET 44010 VENTRICULAR PORT SIDE,$959.50,$0.00,$959.50,$0.00,$684.80,$0.00,$0.00,$0.00,$0.00,$0.00,$959.50,$0.00,$479.75,$759.92,$767.60,$0.00,$0.00,$0.00,$0.00,$0.00
44100,SUP,Custom 27803010,,44100  -  RESERVOIR 44100 VENT. 12MM CONVERT 20MM,"$1,047.38",$0.00,"$1,047.38",$0.00,$747.51,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,047.38",$0.00,$523.69,$829.52,$837.90,$0.00,$0.00,$0.00,$0.00,$0.00
44101,SUP,Custom 27803010,,44101  -  RESERVOIR DRN SM RT ANG 2.1MM 1.2MM 3CM .1ML STRL LF 12MM,"$1,047.38",$0.00,"$1,047.38",$0.00,$747.51,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,047.38",$0.00,$523.69,$829.52,$837.90,$0.00,$0.00,$0.00,$0.00,$0.00
44103,SUP,Custom 27803010,,44103  -  RESERVOIR DRN SM 28MM 2.1MM 1.2MM 23CM 1.1ML CSF SD INLT,$931.00,$0.00,$931.00,$0.00,$664.45,$0.00,$0.00,$0.00,$0.00,$0.00,$931.00,$0.00,$465.50,$737.35,$744.80,$0.00,$0.00,$0.00,$0.00,$0.00
44104,SUP,Custom 27803010,,44104  -  RESERVOIR 44104 VENT. INLET BOTTOM,$931.00,$0.00,$931.00,$0.00,$664.45,$0.00,$0.00,$0.00,$0.00,$0.00,$931.00,$0.00,$465.50,$737.35,$744.80,$0.00,$0.00,$0.00,$0.00,$0.00
44105,SUP,Custom 27803010,,44105  -  SUB BNGFT GRFTN DBM CRNCH JAR 5ML,$931.00,$0.00,$931.00,$0.00,$664.45,$0.00,$0.00,$0.00,$0.00,$0.00,$931.00,$0.00,$465.50,$737.35,$744.80,$0.00,$0.00,$0.00,$0.00,$0.00
44108,SUP,Custom 27803010,,44108  -  RESERVOIR DRN SM 2.1MM 1.2MM 90CM 2.4ML STRL LF 30MM CSF,"$1,503.38",$0.00,"$1,503.38",$0.00,"$1,072.96",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,503.38",$0.00,$751.69,"$1,190.68","$1,202.70",$0.00,$0.00,$0.00,$0.00,$0.00
44111,SUP,Custom 27803010,,44111  -  RESERVOIR 44111 VENT. BURR HOLE,$931.00,$0.00,$931.00,$0.00,$664.45,$0.00,$0.00,$0.00,$0.00,$0.00,$931.00,$0.00,$465.50,$737.35,$744.80,$0.00,$0.00,$0.00,$0.00,$0.00
44113,SUP,Custom 27803010,,44113  -  RESERVOIR SHNT 12MM STRL DLT CSF BUR HL,$931.00,$0.00,$931.00,$0.00,$664.45,$0.00,$0.00,$0.00,$0.00,$0.00,$931.00,$0.00,$465.50,$737.35,$744.80,$0.00,$0.00,$0.00,$0.00,$0.00
44150,SUP,HCPCS C1713,,44150  -  SUB BNGFT GRFTN SM DFCT DBM OTHBLND JAR 10ML,"$3,375.00",$0.00,"$3,375.00","$1,518.75","$2,408.74",$0.00,$581.50,$0.00,$0.00,$590.94,"$3,375.00",$0.00,"$1,687.50","$2,673.00","$2,700.00",$0.00,$528.19,$0.00,$537.30,$0.00
44200,SUP,Custom 27803010,,44200  -  RES 44200 VENTRICULOSTOMY BH 6MM REG IMP,$403.75,$0.00,$403.75,$0.00,$288.16,$0.00,$0.00,$0.00,$0.00,$0.00,$403.75,$0.00,$201.88,$319.77,$323.00,$0.00,$0.00,$0.00,$0.00,$0.00
44201,SUP,Custom 27803010,,44201  -  KIT VNCLSTM REG 6MM STRL BUR HL CSF,$714.88,$0.00,$714.88,$0.00,$510.21,$0.00,$0.00,$0.00,$0.00,$0.00,$714.88,$0.00,$357.44,$566.18,$571.90,$0.00,$0.00,$0.00,$0.00,$0.00
44210,SUP,Custom 27803010,,44210  -  RESERVOIR VNCLSTM SHLW 6MM CSF BUR HL,$403.75,$0.00,$403.75,$0.00,$288.16,$0.00,$0.00,$0.00,$0.00,$0.00,$403.75,$0.00,$201.88,$319.77,$323.00,$0.00,$0.00,$0.00,$0.00,$0.00
44211,SUP,Custom 27803010,,44211  -  KIT VNCLSTM REG 6MM STRL CSF BUR HL SHLW D,$714.88,$0.00,$714.88,$0.00,$510.21,$0.00,$0.00,$0.00,$0.00,$0.00,$714.88,$0.00,$357.44,$566.18,$571.90,$0.00,$0.00,$0.00,$0.00,$0.00
Jun-21,SUP,Custom 27803010,,6-2021  -  CAGE SPNL 20MM 21MM RYTFC UNT THRD CNCT TI PLIF TLIF,"$7,813.35",$0.00,"$7,813.35",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,813.35",$0.00,"$3,906.68","$6,188.17","$6,250.68",$0.00,$0.00,$0.00,$0.00,$0.00
Jul-21,SUP,Custom 27803010,,7-2021  -  DEVICE FSN 20MM 21MM RYTFC,"$6,615.95",$0.00,"$6,615.95",$0.00,"$4,721.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,615.95",$0.00,"$3,307.98","$5,239.83","$5,292.76",$0.00,$0.00,$0.00,$0.00,$0.00
44405,SUP,Custom 27803010,,44405  -  CATHETER 44405 LUMBAR CLOSED TIP,"$1,472.50",$0.00,"$1,472.50",$0.00,"$1,050.92",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,472.50",$0.00,$736.25,"$1,166.22","$1,178.00",$0.00,$0.00,$0.00,$0.00,$0.00
44406,SUP,Custom 27803010,,44406  -  CATHETER 44406 LUMBAR OPEN TIP,"$1,472.50",$0.00,"$1,472.50",$0.00,"$1,050.92",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,472.50",$0.00,$736.25,"$1,166.22","$1,178.00",$0.00,$0.00,$0.00,$0.00,$0.00
44410,SUP,Custom 27803010,,44410  -  SYSTEM CATH C14-24CM 2O 20GA 14GA 84CM PS MDCL CNCT 3 FX TAB,"$1,686.25",$0.00,"$1,686.25",$0.00,"$1,203.48",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,686.25",$0.00,$843.13,"$1,335.51","$1,349.00",$0.00,$0.00,$0.00,$0.00,$0.00
44420,SUP,Custom 27803010,,44420  -  SHUNT 44420 STRATA KIT NSC LP,"$11,247.10",$0.00,"$11,247.10",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,247.10",$0.00,"$5,623.55","$8,907.70","$8,997.68",$0.00,$0.00,$0.00,$0.00,$0.00
44421,SUP,Custom 27203010,,44421  -  KIT 44421 STRATA NSC LP OPEN LUMBAR,"$11,247.10",$0.00,"$11,247.10",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,247.10",$0.00,"$5,623.55","$8,907.70","$8,997.68",$0.00,$0.00,$0.00,$0.00,$0.00
44430,SUP,Custom 27803010,,44430  -  SHUNT 44430 STRATA KIT NSC LP ASSY,"$11,646.60",$0.00,"$11,646.60",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,646.60",$0.00,"$5,823.30","$9,224.11","$9,317.28",$0.00,$0.00,$0.00,$0.00,$0.00
44465,SUP,Custom 27803010,,44465  -  VALVE 44465 STRATA NSC LP,"$9,677.30",$0.00,"$9,677.30",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$9,677.30",$0.00,"$4,838.65","$7,664.42","$7,741.84",$0.00,$0.00,$0.00,$0.00,$0.00
44513,SUP,Custom 27803010,,44513  -  RES 44513 CSF-LUMBOPERITONEAL 20MM,$824.13,$0.00,$824.13,$0.00,$588.18,$0.00,$0.00,$0.00,$0.00,$0.00,$824.13,$0.00,$412.06,$652.71,$659.30,$0.00,$0.00,$0.00,$0.00,$0.00
44515,SUP,Custom 27803010,,44515  -  RES 44515 CSF-LUMBOPERITONEAL 30MM,$824.13,$0.00,$824.13,$0.00,$588.18,$0.00,$0.00,$0.00,$0.00,$0.00,$824.13,$0.00,$412.06,$652.71,$659.30,$0.00,$0.00,$0.00,$0.00,$0.00
44520,SUP,Custom 27803010,,44520  -  SHUNT NS 87CM STRL LMBPRTNL CATH T CSF,"$1,835.88",$0.00,"$1,835.88",$0.00,"$1,310.26",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,835.88",$0.00,$917.94,"$1,454.02","$1,468.70",$0.00,$0.00,$0.00,$0.00,$0.00
45001,SUP,Custom 27804086,,45001  -  GRAFT BN 1ML GRFTN + PST SYR DBM,$350.00,$0.00,$350.00,$0.00,$249.80,$0.00,$0.00,$0.00,$0.00,$0.00,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$0.00,$0.00,$0.00,$0.00
45005,SUP,Custom 27804086,,45005  -  CANNULA LAPSCP 10MM DL PK DP50-0116-006,"$1,400.00",$0.00,"$1,400.00",$0.00,$999.18,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,400.00",$0.00,$700.00,"$1,108.80","$1,120.00",$0.00,$0.00,$0.00,$0.00,$0.00
45010,SUP,Custom 27804086,,45010  -  GRAFT BN 10ML GRFTN + PST SYR DBM,"$2,170.00",$0.00,"$2,170.00",$0.00,"$1,548.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,170.00",$0.00,"$1,085.00","$1,718.64","$1,736.00",$0.00,$0.00,$0.00,$0.00,$0.00
45103,SUP,Custom 27803010,,45103  -  CONNECTOR SHNT STRG STRL ACFL CSF RADOPQ CATH PLS,$178.13,$0.00,$178.13,$0.00,$127.13,$0.00,$0.00,$0.00,$0.00,$0.00,$178.13,$0.00,$89.06,$141.08,$142.50,$0.00,$0.00,$0.00,$0.00,$0.00
45104,SUP,Custom 27803010,,45104  -  CONNECTOR SHNT RT ANG STRL ACFL CSF CATH PLS,$178.13,$0.00,$178.13,$0.00,$127.13,$0.00,$0.00,$0.00,$0.00,$0.00,$178.13,$0.00,$89.06,$141.08,$142.50,$0.00,$0.00,$0.00,$0.00,$0.00
45105,SUP,Custom 27803010,,45105  -  CONNECTOR SHNT STRL ACFL CSF CATH 3W PLS,$565.25,$0.00,$565.25,$0.00,$403.42,$0.00,$0.00,$0.00,$0.00,$0.00,$565.25,$0.00,$282.63,$447.68,$452.20,$0.00,$0.00,$0.00,$0.00,$0.00
45402,SUP,Custom 27203010,,45402  -  TOOL 45402 SNAP ASSEMBLY,$729.13,$0.00,$729.13,$0.00,$520.38,$0.00,$0.00,$0.00,$0.00,$0.00,$729.13,$0.00,$364.56,$577.47,$583.30,$0.00,$0.00,$0.00,$0.00,$0.00
45792,SUP,HCPCS C1758,,45792  -  CATHETER URET 5FR 70CM .038IN TPR TIP OP-EN RT,$24.50,$0.00,$24.50,$13.30,$17.49,$0.00,$4.22,$0.00,$0.00,$4.29,$24.50,$0.00,$12.25,$19.40,$19.60,$0.00,$3.83,$0.00,$3.90,$0.00
45806,SUP,Custom 27203010,,45806  -  KIT 45806 STRATA VARIOUS,"$8,922.95",$0.00,"$8,922.95",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,922.95",$0.00,"$4,461.48","$7,066.98","$7,138.36",$0.00,$0.00,$0.00,$0.00,$0.00
45807,SUP,Custom 27203010,,45807  -  CARD 45807 SMART STRATA,$169.20,$0.00,$169.20,$0.00,$120.76,$0.00,$0.00,$0.00,$0.00,$0.00,$169.20,$0.00,$84.60,$134.01,$135.36,$0.00,$0.00,$0.00,$0.00,$0.00
45808,SUP,Custom 27203010,,45808  -  CARD 45808 SMART STRATA NSC,$232.65,$0.00,$232.65,$0.00,$166.04,$0.00,$0.00,$0.00,$0.00,$0.00,$232.65,$0.00,$116.33,$184.26,$186.12,$0.00,$0.00,$0.00,$0.00,$0.00
45809,SUP,Custom 27203010,,45809  -  TOOL 45809 STRATAVARIUS ADJUSTMENT,$491.63,$0.00,$491.63,$0.00,$350.87,$0.00,$0.00,$0.00,$0.00,$0.00,$491.63,$0.00,$245.81,$389.37,$393.30,$0.00,$0.00,$0.00,$0.00,$0.00
46012,SUP,Custom 27803010,,46012  -  KIT 46012 SHUNT UNITIZED SMALL LOW,"$3,028.13",$0.00,"$3,028.13",$0.00,"$2,161.17",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,028.13",$0.00,"$1,514.06","$2,398.28","$2,422.50",$0.00,$0.00,$0.00,$0.00,$0.00
46014,SUP,Custom 27803010,,46014  -  KIT 46014 SHUNT UNITIZED SMALL MED,"$3,028.13",$0.00,"$3,028.13",$0.00,"$2,161.17",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,028.13",$0.00,"$1,514.06","$2,398.28","$2,422.50",$0.00,$0.00,$0.00,$0.00,$0.00
46016,SUP,Custom 27803010,,46016  -  KIT 46016 SHUNT UNITIZED SMALL HIGH,"$3,028.13",$0.00,"$3,028.13",$0.00,"$2,161.17",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,028.13",$0.00,"$1,514.06","$2,398.28","$2,422.50",$0.00,$0.00,$0.00,$0.00,$0.00
46022,SUP,Custom 27803010,,46022  -  KIT 46022 SHUNT UNITIZED REG LOW,"$3,028.13",$0.00,"$3,028.13",$0.00,"$2,161.17",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,028.13",$0.00,"$1,514.06","$2,398.28","$2,422.50",$0.00,$0.00,$0.00,$0.00,$0.00
46024,SUP,Custom 27803010,,46024  -  KIT 46024 SHUNT UNITIZED REG MED,"$3,028.13",$0.00,"$3,028.13",$0.00,"$2,161.17",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,028.13",$0.00,"$1,514.06","$2,398.28","$2,422.50",$0.00,$0.00,$0.00,$0.00,$0.00
46026,SUP,Custom 27803010,,46026  -  KIT 46026 SHUNT UNITIZED REG HIGH,"$3,028.13",$0.00,"$3,028.13",$0.00,"$2,161.17",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,028.13",$0.00,"$1,514.06","$2,398.28","$2,422.50",$0.00,$0.00,$0.00,$0.00,$0.00
46070,SUP,Custom 27803010,,46070  -  SHNT 46070 FP UNI STRATA NSC SML 8CM,"$10,112.05",$0.00,"$10,112.05",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$10,112.05",$0.00,"$5,056.03","$8,008.74","$8,089.64",$0.00,$0.00,$0.00,$0.00,$0.00
46075,SUP,Custom 27803010,,46075  -  SHNT 46075 FP UNI STRATA NSC SM 11.5,"$10,112.05",$0.00,"$10,112.05",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$10,112.05",$0.00,"$5,056.03","$8,008.74","$8,089.64",$0.00,$0.00,$0.00,$0.00,$0.00
46080,SUP,Custom 27803010,,46080  -  SHNT 46080 FP UNI STRATA NSC REG 11,"$10,112.05",$0.00,"$10,112.05",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$10,112.05",$0.00,"$5,056.03","$8,008.74","$8,089.64",$0.00,$0.00,$0.00,$0.00,$0.00
46085,SUP,Custom 27803010,,46085  -  SHNT 46085 FP UNI STRATA NSC RG 13.5,"$10,112.05",$0.00,"$10,112.05",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$10,112.05",$0.00,"$5,056.03","$8,008.74","$8,089.64",$0.00,$0.00,$0.00,$0.00,$0.00
46115,SUP,HCPCS C1729,,46115  -  CATHETER DRN 20CM CLR STRL LF BCKR EDMS BA IMPRG SIL VNTRC,$268.80,$0.00,$268.80,$145.96,$191.84,$0.00,$46.31,$0.00,$0.00,$47.06,$268.80,$0.00,$134.40,$212.89,$215.04,$0.00,$42.07,$0.00,$42.79,$0.00
46118,SUP,HCPCS C1729,,46118  -  CATHETER XTRN DRN 2.8MM 1.5MM 35CM 700ML STRL LF 15CM EDM,$403.20,$0.00,$403.20,$218.94,$287.76,$0.00,$69.47,$0.00,$0.00,$70.60,$403.20,$0.00,$201.60,$319.33,$322.56,$0.00,$63.10,$0.00,$64.19,$0.00
46126,SUP,Custom 27203010,,46126  -  EDMS 46126 PATIENT CONN LINE ASSY,$168.00,$0.00,$168.00,$0.00,$119.90,$0.00,$0.00,$0.00,$0.00,$0.00,$168.00,$0.00,$84.00,$133.06,$134.40,$0.00,$0.00,$0.00,$0.00,$0.00
46129,SUP,Custom 27203010,,46129  -  EDMS III 46129 BECKER,$508.80,$0.00,$508.80,$0.00,$363.13,$0.00,$0.00,$0.00,$0.00,$0.00,$508.80,$0.00,$254.40,$402.97,$407.04,$0.00,$0.00,$0.00,$0.00,$0.00
46135,SUP,HCPCS C1713,,46135  -  CLAMP 46135 QUICK ATTACH POLE,"$1,120.80",$0.00,"$1,120.80",$504.36,$799.91,$0.00,$193.11,$0.00,$0.00,$196.24,"$1,120.80",$0.00,$560.40,$887.67,$896.64,$0.00,$175.41,$0.00,$178.43,$0.00
46137,SUP,HCPCS C1713,,46137  -  CLMP 46137 QUICK ATTACH POLE W/LAS,"$1,293.60",$0.00,"$1,293.60",$582.12,$923.24,$0.00,$222.88,$0.00,$0.00,$226.50,"$1,293.60",$0.00,$646.80,"$1,024.53","$1,034.88",$0.00,$202.45,$0.00,$205.94,$0.00
46141,SUP,Custom 27203010,,46141  -  KIT 46141 EDM VEN DRAINAGE 5PK,$751.20,$0.00,$751.20,$0.00,$536.13,$0.00,$0.00,$0.00,$0.00,$0.00,$751.20,$0.00,$375.60,$594.95,$600.96,$0.00,$0.00,$0.00,$0.00,$0.00
46154,SUP,Custom 27203010,,46154  -  KIT 46154 VNTRC EURO,$784.80,$0.00,$784.80,$0.00,$560.11,$0.00,$0.00,$0.00,$0.00,$0.00,$784.80,$0.00,$392.40,$621.56,$627.84,$0.00,$0.00,$0.00,$0.00,$0.00
Jun-26,SUP,Custom 27803010,,6-2026  -  CAGE SPNL 20MM 26MM RYTFC UNT THRD CNCT TI PLIF TLIF,"$7,813.35",$0.00,"$7,813.35",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,813.35",$0.00,"$3,906.68","$6,188.17","$6,250.68",$0.00,$0.00,$0.00,$0.00,$0.00
46220,SUP,Custom 27803010,,46220  -  KIT 46220 SHUNT ULTRA SMALL 4CM LL,"$3,028.13",$0.00,"$3,028.13",$0.00,"$2,161.17",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,028.13",$0.00,"$1,514.06","$2,398.28","$2,422.50",$0.00,$0.00,$0.00,$0.00,$0.00
46222,SUP,Custom 27803010,,46222  -  KIT 46222 SHUNT ULTRA SMALL 4CM LOW,"$3,028.13",$0.00,"$3,028.13",$0.00,"$2,161.17",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,028.13",$0.00,"$1,514.06","$2,398.28","$2,422.50",$0.00,$0.00,$0.00,$0.00,$0.00
46224,SUP,Custom 27803010,,46224  -  SHUNT 46224 KIT ULTRA SMALL 4CM MED IMP,"$3,028.13",$0.00,"$3,028.13",$0.00,"$2,161.17",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,028.13",$0.00,"$1,514.06","$2,398.28","$2,422.50",$0.00,$0.00,$0.00,$0.00,$0.00
46240,SUP,Custom 27803010,,46240  -  KIT 46240 SHUNT ULTRA SMALL 6CM LL,"$3,080.38",$0.00,"$3,080.38",$0.00,"$2,198.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,080.38",$0.00,"$1,540.19","$2,439.66","$2,464.30",$0.00,$0.00,$0.00,$0.00,$0.00
46242,SUP,Custom 27803010,,46242  -  KIT 46242 SHUNT ULTRA SMALL 6CM LOW,"$3,028.13",$0.00,"$3,028.13",$0.00,"$2,161.17",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,028.13",$0.00,"$1,514.06","$2,398.28","$2,422.50",$0.00,$0.00,$0.00,$0.00,$0.00
46244,SUP,Custom 27803010,,46244  -  KIT 46244 SHUNT ULTRA SMALL 6CM MED,"$3,028.13",$0.00,"$3,028.13",$0.00,"$2,161.17",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,028.13",$0.00,"$1,514.06","$2,398.28","$2,422.50",$0.00,$0.00,$0.00,$0.00,$0.00
46418,SUP,Custom 27803010,,46418  -  CATHETER 46418 EDM LUMBAR 24CM OPEN,$391.20,$0.00,$391.20,$0.00,$279.20,$0.00,$0.00,$0.00,$0.00,$0.00,$391.20,$0.00,$195.60,$309.83,$312.96,$0.00,$0.00,$0.00,$0.00,$0.00
46419,SUP,HCPCS C1729,,46419  -  CATHETER XTRN DRN 80CM STRL EDM CLS TIP BA IMPRG SIL LMBR,$566.40,$0.00,$566.40,$307.56,$404.24,$0.00,$97.59,$0.00,$0.00,$99.17,$566.40,$0.00,$283.20,$448.59,$453.12,$0.00,$88.64,$0.00,$90.17,$0.00
46420,SUP,Custom 27803010,,46420  -  CATH 46420 EDM LUMBAR 80CM/OPEN TIP,$544.80,$0.00,$544.80,$0.00,$388.82,$0.00,$0.00,$0.00,$0.00,$0.00,$544.80,$0.00,$272.40,$431.48,$435.84,$0.00,$0.00,$0.00,$0.00,$0.00
46430,SUP,Custom 27203010,,46430  -  BAGS 46430 EDM DRAINAGE 10-PACK BOX,$88.08,$0.00,$88.08,$0.00,$62.86,$0.00,$0.00,$0.00,$0.00,$0.00,$88.08,$0.00,$44.04,$69.76,$70.46,$0.00,$0.00,$0.00,$0.00,$0.00
46440,SUP,Custom 27203010,,46440  -  KIT XTRN DRN 35CM 700ML BE2 MNTR LMBR,$767.52,$0.00,$767.52,$0.00,$547.78,$0.00,$0.00,$0.00,$0.00,$0.00,$767.52,$0.00,$383.76,$607.88,$614.02,$0.00,$0.00,$0.00,$0.00,$0.00
46441,SUP,Custom 27203010,,46441  -  KIT 46441 EDM LUMBAR DRAINAGE 5PK,$629.76,$0.00,$629.76,$0.00,$449.46,$0.00,$0.00,$0.00,$0.00,$0.00,$629.76,$0.00,$314.88,$498.77,$503.81,$0.00,$0.00,$0.00,$0.00,$0.00
46442,SUP,Custom 27203010,,46442  -  KIT 46442 EDM LUMBAR DRN CLS TIP 5PK,$629.76,$0.00,$629.76,$0.00,$449.46,$0.00,$0.00,$0.00,$0.00,$0.00,$629.76,$0.00,$314.88,$498.77,$503.81,$0.00,$0.00,$0.00,$0.00,$0.00
46540,SUP,Custom 27803010,,46540  -  SHUNT 46540 CSF SNAP ASSY BUTTON LOW LOW,"$3,051.88",$0.00,"$3,051.88",$0.00,"$2,178.12",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,051.88",$0.00,"$1,525.94","$2,417.09","$2,441.50",$0.00,$0.00,$0.00,$0.00,$0.00
46542,SUP,Custom 27803010,,46542  -  SHUNT NS CSF ASMB SNP BTN LP,"$3,051.88",$0.00,"$3,051.88",$0.00,"$2,178.12",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,051.88",$0.00,"$1,525.94","$2,417.09","$2,441.50",$0.00,$0.00,$0.00,$0.00,$0.00
46544,SUP,Custom 27803010,,46544  -  SHUNT NS CSF ASMB SNP BTN MED PRSS,"$3,051.88",$0.00,"$3,051.88",$0.00,"$2,178.12",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,051.88",$0.00,"$1,525.94","$2,417.09","$2,441.50",$0.00,$0.00,$0.00,$0.00,$0.00
46560,SUP,Custom 27803010,,46560  -  SHUNT 46560 CSF SNAP ASSY US LOW LOW,"$3,051.88",$0.00,"$3,051.88",$0.00,"$2,178.12",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,051.88",$0.00,"$1,525.94","$2,417.09","$2,441.50",$0.00,$0.00,$0.00,$0.00,$0.00
46562,SUP,Custom 27803010,,46562  -  SHUNT 46562 CSF SNAP ASSY US LOW,"$3,051.88",$0.00,"$3,051.88",$0.00,"$2,178.12",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,051.88",$0.00,"$1,525.94","$2,417.09","$2,441.50",$0.00,$0.00,$0.00,$0.00,$0.00
46564,SUP,Custom 27803010,,46564  -  SHUNT 46564 CSF SNAP ASSY US MEDIUM,"$3,051.88",$0.00,"$3,051.88",$0.00,"$2,178.12",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,051.88",$0.00,"$1,525.94","$2,417.09","$2,441.50",$0.00,$0.00,$0.00,$0.00,$0.00
46622,SUP,Custom 27803010,,46622  -  SHUNT 46622 CSF ASSY SMALL LOW CONT C/P,"$2,498.50",$0.00,"$2,498.50",$0.00,"$1,783.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,498.50",$0.00,"$1,249.25","$1,978.81","$1,998.80",$0.00,$0.00,$0.00,$0.00,$0.00
46624,SUP,Custom 27803010,,46624  -  SHUNT 46624 CSF ASSY SMALL MED CONT C/P,"$2,498.50",$0.00,"$2,498.50",$0.00,"$1,783.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,498.50",$0.00,"$1,249.25","$1,978.81","$1,998.80",$0.00,$0.00,$0.00,$0.00,$0.00
46626,SUP,Custom 27803010,,46626  -  SHUNT 46626 CSF ASSY SMALL HIGH CONT C/P,"$2,498.50",$0.00,"$2,498.50",$0.00,"$1,783.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,498.50",$0.00,"$1,249.25","$1,978.81","$1,998.80",$0.00,$0.00,$0.00,$0.00,$0.00
46635,SUP,Custom 27803010,,46635  -  SHUNT 46635 STRATA NSC BURR HOLE,"$9,458.75",$0.00,"$9,458.75",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$9,458.75",$0.00,"$4,729.38","$7,491.33","$7,567.00",$0.00,$0.00,$0.00,$0.00,$0.00
46642,SUP,Custom 27803010,,46642  -  SHUNT 46642 ASSY REG LOW C/P-90CM,"$2,498.50",$0.00,"$2,498.50",$0.00,"$1,783.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,498.50",$0.00,"$1,249.25","$1,978.81","$1,998.80",$0.00,$0.00,$0.00,$0.00,$0.00
46644,SUP,Custom 27803010,,46644  -  SHUNT 46644 ASSY REG MED C/P-90CM,"$2,498.50",$0.00,"$2,498.50",$0.00,"$1,783.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,498.50",$0.00,"$1,249.25","$1,978.81","$1,998.80",$0.00,$0.00,$0.00,$0.00,$0.00
46646,SUP,Custom 27803010,,46646  -  SHUNT 46646 ASSY REG HIGH C/P-90CM,"$2,498.50",$0.00,"$2,498.50",$0.00,"$1,783.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,498.50",$0.00,"$1,249.25","$1,978.81","$1,998.80",$0.00,$0.00,$0.00,$0.00,$0.00
46655,SUP,Custom 27803010,,46655  -  ASSY 46655 FP SHUNT STRATA NSC SMALL,"$9,458.75",$0.00,"$9,458.75",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$9,458.75",$0.00,"$4,729.38","$7,491.33","$7,567.00",$0.00,$0.00,$0.00,$0.00,$0.00
46665,SUP,Custom 27803010,,46665  -  ASSY 46665 FP SHUNT STRATA NSC REG,"$9,458.75",$0.00,"$9,458.75",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$9,458.75",$0.00,"$4,729.38","$7,491.33","$7,567.00",$0.00,$0.00,$0.00,$0.00,$0.00
46700,SUP,Custom 27203010,,46700  -  SYSTEM 46700 EXACTA DISP. DRAINAGE,$398.40,$0.00,$398.40,$0.00,$284.34,$0.00,$0.00,$0.00,$0.00,$0.00,$398.40,$0.00,$199.20,$315.53,$318.72,$0.00,$0.00,$0.00,$0.00,$0.00
46705,SUP,Custom 27203010,,46705  -  SYSTEM 46705 EXACTA DRAINAGE 100ML,$432.00,$0.00,$432.00,$0.00,$308.32,$0.00,$0.00,$0.00,$0.00,$0.00,$432.00,$0.00,$216.00,$342.14,$345.60,$0.00,$0.00,$0.00,$0.00,$0.00
46710,SUP,Custom 27203010,,46710  -  BAG 46710 EXACTA DRAINAGE,$110.40,$0.00,$110.40,$0.00,$78.79,$0.00,$0.00,$0.00,$0.00,$0.00,$110.40,$0.00,$55.20,$87.44,$88.32,$0.00,$0.00,$0.00,$0.00,$0.00
46711,SUP,Custom 27203010,,46711  -  ASSY 46711 EXACTA POLE CLAMP W/LASER,"$1,281.60",$0.00,"$1,281.60",$0.00,$914.68,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,281.60",$0.00,$640.80,"$1,015.03","$1,025.28",$0.00,$0.00,$0.00,$0.00,$0.00
46712,SUP,Custom 27203010,,46712  -  BAG 46712 EXACTA DRAINAGE 10 PK,$88.08,$0.00,$88.08,$0.00,$62.86,$0.00,$0.00,$0.00,$0.00,$0.00,$88.08,$0.00,$44.04,$69.76,$70.46,$0.00,$0.00,$0.00,$0.00,$0.00
46713,SUP,Custom 27203010,,46713  -  ASSY 46713 EXACTA POLE CLAMP NO LASER,"$1,142.40",$0.00,"$1,142.40",$0.00,$815.33,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,142.40",$0.00,$571.20,$904.78,$913.92,$0.00,$0.00,$0.00,$0.00,$0.00
46715,SUP,HCPCS C1713,,46715  -  CLAMP 46715 EXACTA PL NEG 25CM W/LSR,"$1,399.20",$0.00,"$1,399.20",$629.64,$998.61,$0.00,$241.08,$0.00,$0.00,$244.99,"$1,399.20",$0.00,$699.60,"$1,108.17","$1,119.36",$0.00,$218.97,$0.00,$222.75,$0.00
46717,SUP,HCPCS C1713,,46717  -  CLAMP 46717 EXACTA POLE -25CM W/O LSR,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
46812,SUP,Custom 27803010,,46812  -  ASSY 46812 DELTA SHUNT SMALL PL 1,"$4,134.88",$0.00,"$4,134.88",$0.00,"$2,951.06",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,134.88",$0.00,"$2,067.44","$3,274.82","$3,307.90",$0.00,$0.00,$0.00,$0.00,$0.00
46813,SUP,Custom 27803010,,46813  -  ASSY 46813 DELTA SHUNT SM LEV 1.5,"$4,134.88",$0.00,"$4,134.88",$0.00,"$2,951.06",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,134.88",$0.00,"$2,067.44","$3,274.82","$3,307.90",$0.00,$0.00,$0.00,$0.00,$0.00
46814,SUP,Custom 27803010,,46814  -  ASSY 46814 DELTA SHUNT SMALL P/L 2,"$4,134.88",$0.00,"$4,134.88",$0.00,"$2,951.06",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,134.88",$0.00,"$2,067.44","$3,274.82","$3,307.90",$0.00,$0.00,$0.00,$0.00,$0.00
46822,SUP,Custom 27803010,,46822  -  ASSY 46822 DELTA SHUNT REG P/L 1,"$4,134.88",$0.00,"$4,134.88",$0.00,"$2,951.06",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,134.88",$0.00,"$2,067.44","$3,274.82","$3,307.90",$0.00,$0.00,$0.00,$0.00,$0.00
46823,SUP,Custom 27803010,,46823  -  ASSY 46823 DELTA SHUNT REG LEV 1.5,"$4,134.88",$0.00,"$4,134.88",$0.00,"$2,951.06",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,134.88",$0.00,"$2,067.44","$3,274.82","$3,307.90",$0.00,$0.00,$0.00,$0.00,$0.00
46824,SUP,Custom 27803010,,46824  -  ASSY 46824 DELTA SHUNT REG P/L 2,"$4,134.88",$0.00,"$4,134.88",$0.00,"$2,951.06",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,134.88",$0.00,"$2,067.44","$3,274.82","$3,307.90",$0.00,$0.00,$0.00,$0.00,$0.00
46832,SUP,Custom 27803010,,46832  -  SHUNT 46832 NEONATAL DELTA SNAP L 1,"$4,754.75",$0.00,"$4,754.75",$0.00,"$3,393.47",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,754.75",$0.00,"$2,377.38","$3,765.76","$3,803.80",$0.00,$0.00,$0.00,$0.00,$0.00
46833,SUP,Custom 27803010,,46833  -  SHUNT 46833 NEONATAL DELTA SNAP 1.5,"$4,754.75",$0.00,"$4,754.75",$0.00,"$3,393.47",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,754.75",$0.00,"$2,377.38","$3,765.76","$3,803.80",$0.00,$0.00,$0.00,$0.00,$0.00
46834,SUP,Custom 27803010,,46834  -  SHUNT 46834 NEONATAL DELTA SNAP L 2,"$5,191.75",$0.00,"$5,191.75",$0.00,"$3,705.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,191.75",$0.00,"$2,595.88","$4,111.87","$4,153.40",$0.00,$0.00,$0.00,$0.00,$0.00
46836,SUP,Custom 27803010,,46836  -  SHUNT 46836 STRATA II BURR HOLE,"$10,302.40",$0.00,"$10,302.40",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$10,302.40",$0.00,"$5,151.20","$8,159.50","$8,241.92",$0.00,$0.00,$0.00,$0.00,$0.00
46856,SUP,Custom 27803010,,46856  -  ASSY 46856 FP-STRATA 2 SHUNT SML,"$10,302.40",$0.00,"$10,302.40",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$10,302.40",$0.00,"$5,151.20","$8,159.50","$8,241.92",$0.00,$0.00,$0.00,$0.00,$0.00
46866,SUP,Custom 27803010,,46866  -  ASSY 46866 FP-STRATA 2 SHUNT REG,"$10,302.40",$0.00,"$10,302.40",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$10,302.40",$0.00,"$5,151.20","$8,159.50","$8,241.92",$0.00,$0.00,$0.00,$0.00,$0.00
46871,SUP,Custom 27803010,,46871  -  SHUNT 46871 FP-STRATA UNI SML 8,"$10,915.75",$0.00,"$10,915.75",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$10,915.75",$0.00,"$5,457.88","$8,645.27","$8,732.60",$0.00,$0.00,$0.00,$0.00,$0.00
46876,SUP,Custom 27803010,,46876  -  UNISHUNT 46876 FP STRATA SM 11.5,"$10,915.75",$0.00,"$10,915.75",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$10,915.75",$0.00,"$5,457.88","$8,645.27","$8,732.60",$0.00,$0.00,$0.00,$0.00,$0.00
46881,SUP,Custom 27803010,,46881  -  SHUNT 46881 FP-STRATA UNI REG 11,"$10,915.75",$0.00,"$10,915.75",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$10,915.75",$0.00,"$5,457.88","$8,645.27","$8,732.60",$0.00,$0.00,$0.00,$0.00,$0.00
46886,SUP,Custom 27803010,,46886  -  SHUNT 46886 FP-STRATA UNI REG 13.5,"$10,915.75",$0.00,"$10,915.75",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$10,915.75",$0.00,"$5,457.88","$8,645.27","$8,732.60",$0.00,$0.00,$0.00,$0.00,$0.00
46911,SUP,Custom 27203010,,46911  -  BAG 46911 DRAINAGE DEHP-FREE 1PK,$110.40,$0.00,$110.40,$0.00,$78.79,$0.00,$0.00,$0.00,$0.00,$0.00,$110.40,$0.00,$55.20,$87.44,$88.32,$0.00,$0.00,$0.00,$0.00,$0.00
46912,SUP,Custom 27203010,,46912  -  BAG 46912 DRAINAGE DEHP-FREE 10PK,$88.08,$0.00,$88.08,$0.00,$62.86,$0.00,$0.00,$0.00,$0.00,$0.00,$88.08,$0.00,$44.04,$69.76,$70.46,$0.00,$0.00,$0.00,$0.00,$0.00
46913,SUP,Custom 27203010,,46913  -  EDMS 46913 DUET INTERLINK SITES,$566.40,$0.00,$566.40,$0.00,$404.24,$0.00,$0.00,$0.00,$0.00,$0.00,$566.40,$0.00,$283.20,$448.59,$453.12,$0.00,$0.00,$0.00,$0.00,$0.00
46914,SUP,Custom 27203010,,46914  -  EDMS 46914 DUET BLUECORE SITES,$566.40,$0.00,$566.40,$0.00,$404.24,$0.00,$0.00,$0.00,$0.00,$0.00,$566.40,$0.00,$283.20,$448.59,$453.12,$0.00,$0.00,$0.00,$0.00,$0.00
46915,SUP,Custom 27203010,,46915  -  EDMS 46915 DUET INTERLINK WITH VCATH,$960.00,$0.00,$960.00,$0.00,$685.15,$0.00,$0.00,$0.00,$0.00,$0.00,$960.00,$0.00,$480.00,$760.32,$768.00,$0.00,$0.00,$0.00,$0.00,$0.00
46916,SUP,Custom 27203010,,46916  -  EDMS 46916 DUET BLUECORE WITH VCATH,$960.00,$0.00,$960.00,$0.00,$685.15,$0.00,$0.00,$0.00,$0.00,$0.00,$960.00,$0.00,$480.00,$760.32,$768.00,$0.00,$0.00,$0.00,$0.00,$0.00
46917,SUP,Custom 27203010,,46917  -  SYSTEM XTRN DRN 60IN DUET LCATH INTLNK CLS SYS XTRN VNTRC,"$1,104.00",$0.00,"$1,104.00",$0.00,$787.92,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,104.00",$0.00,$552.00,$874.37,$883.20,$0.00,$0.00,$0.00,$0.00,$0.00
46918,SUP,Custom 27203010,,46918  -  LEVEL LSR NS LF CLRST REUSE XTRN DRN MNTR SYS,$211.20,$0.00,$211.20,$0.00,$150.73,$0.00,$0.00,$0.00,$0.00,$0.00,$211.20,$0.00,$105.60,$167.27,$168.96,$0.00,$0.00,$0.00,$0.00,$0.00
47032,SUP,Custom 27203010,,47032  -  NEEDLE AMNIO 15CM 20GA ECHTP SDPRT DISP,$43.13,$0.00,$43.13,$0.00,$30.78,$0.00,$0.00,$0.00,$0.00,$0.00,$43.13,$0.00,$21.56,$34.16,$34.50,$0.00,$0.00,$0.00,$0.00,$0.00
48270,SUP,Custom 27203010,,0048270  -  TUBING SCT 100FT 9/32IN PLST NCDTV ECON INTGR BLSTR CONCTR,$13.52,$0.00,$13.52,$0.00,$9.65,$0.00,$0.00,$0.00,$0.00,$0.00,$13.52,$0.00,$6.76,$10.71,$10.82,$0.00,$0.00,$0.00,$0.00,$0.00
48403,SUP,Custom 27203010,,48403  -  PASSER 48403 L/P SUBCUT CATH 38CM,"$2,766.88",$0.00,"$2,766.88",$0.00,"$1,974.72",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,766.88",$0.00,"$1,383.44","$2,191.37","$2,213.50",$0.00,$0.00,$0.00,$0.00,$0.00
48405,SUP,Custom 27203010,,48405  -  PASSER 48405 CATH V/P SUBCUT 60CM,"$2,914.13",$0.00,"$2,914.13",$0.00,"$2,079.81",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,914.13",$0.00,"$1,457.06","$2,307.99","$2,331.30",$0.00,$0.00,$0.00,$0.00,$0.00
48407,SUP,Custom 27203010,,48407  -  PASSER 48407 CATHETER 38CM DISP.,$344.38,$0.00,$344.38,$0.00,$245.78,$0.00,$0.00,$0.00,$0.00,$0.00,$344.38,$0.00,$172.19,$272.75,$275.50,$0.00,$0.00,$0.00,$0.00,$0.00
48409,SUP,Custom 27203010,,48409  -  PASSER 48409 60CM DISP. CATHETER,$368.13,$0.00,$368.13,$0.00,$262.73,$0.00,$0.00,$0.00,$0.00,$0.00,$368.13,$0.00,$184.06,$291.56,$294.50,$0.00,$0.00,$0.00,$0.00,$0.00
50120,SUP,Custom 27803010,,50120  -  CLIP LGT MED LG VESOCCLUDE SMTR 6 CRTDG TI,$9.38,$0.00,$9.38,$0.00,$6.69,$0.00,$0.00,$0.00,$0.00,$0.00,$9.38,$0.00,$4.69,$7.43,$7.50,$0.00,$0.00,$0.00,$0.00,$0.00
50190,SUP,Custom 27203010,,KIT GSTRM 18FR INTROD BR-MLR TFSTNR DILAT,$414.50,$0.00,$414.50,$0.00,$295.83,$0.00,$0.00,$0.00,$0.00,$0.00,$414.50,$0.00,$207.25,$328.28,$331.60,$0.00,$0.00,$0.00,$0.00,$0.00
50318,SUP,Custom 27803010,,50318  -  CATHETER 50318 EVD ANTIBIOTIC PK 5 NCE,"$3,600.00",$0.00,"$3,600.00",$0.00,"$2,569.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,600.00",$0.00,"$1,800.00","$2,851.20","$2,880.00",$0.00,$0.00,$0.00,$0.00,$0.00
50823,SUP,Custom 27203010,,50823  -  INFLATION SYSTEM,$55.15,$0.00,$55.15,$0.00,$39.36,$0.00,$0.00,$0.00,$0.00,$0.00,$55.15,$0.00,$27.58,$43.68,$44.12,$0.00,$0.00,$0.00,$0.00,$0.00
52021,SUP,HCPCS Q4108,,52021  -  DRESSING WND 2X2IN MTRX BVN CLGN,"$1,370.36",$0.00,"$1,370.36",$0.00,$978.03,$0.00,$236.11,$0.00,$0.00,$0.00,"$1,370.36",$0.00,$685.18,"$1,085.33","$1,096.29",$0.00,$39.86,$0.00,$0.00,$0.00
53130,SUP,Custom 27203010,,53130  -  RETAINER SEPRONET 3 25YDX7/8IN ELAST TBLR NT DRSG NYL RBR,$67.92,$0.00,$67.92,$0.00,$48.48,$0.00,$0.00,$0.00,$0.00,$0.00,$67.92,$0.00,$33.96,$53.79,$54.34,$0.00,$0.00,$0.00,$0.00,$0.00
53660,SUP,HCPCS C1725,,53660  -  CATH BALDILAT .038IN 7FR 80CM 4.5CM ILC FEM POPLT ART TPR,$37.50,$0.00,$37.50,$20.36,$26.76,$0.00,$6.46,$0.00,$0.00,$6.57,$37.50,$0.00,$18.75,$29.70,$30.00,$0.00,$5.87,$0.00,$5.97,$0.00
54051,SUP,HCPCS Q4108,,54051  -  DRESSING WND 5X4IN STRL BVN CLGN GAG DISP,"$9,143.83",$0.00,"$9,143.83",$0.00,"$5,158.80",$0.00,"$1,575.44",$0.00,$0.00,$0.00,"$9,143.83",$0.00,"$4,571.91","$7,241.91","$7,315.06",$0.00,$39.86,$0.00,$0.00,$0.00
56030,SUP,HCPCS C1729,,"056030  -  URETHRAL CATHETERS, BARDEX, ROBINSON MODEL, LATEX 30FR",$7.03,$0.00,$7.03,$3.81,$5.01,$0.00,$1.21,$0.00,$0.00,$1.23,$7.03,$0.00,$3.51,$5.57,$5.62,$0.00,$1.10,$0.00,$1.12,$0.00
57760,SUP,Custom 27203010,,FORMULA NUTRITIONAL SIMILAC 24 CAL IRON FORTIFIED,$26.03,$0.00,$26.03,$0.00,$18.57,$0.00,$0.00,$0.00,$0.00,$0.00,$26.03,$0.00,$13.01,$20.62,$20.82,$0.00,$0.00,$0.00,$0.00,$0.00
58025,SUP,Custom 27803010,,58025  -  FILLER BONE VOID ALLOGRAFT FREEZE DRY MIX DBX 2.5CC,"$1,156.00",$0.00,"$1,156.00",$0.00,$825.04,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,156.00",$0.00,$578.00,$915.55,$924.80,$0.00,$0.00,$0.00,$0.00,$0.00
58050,SUP,HCPCS C1713,,58050  -  FILLER BONE VOID ALLOGRAFT FREEZE DRIED MIX DBX 5ML,"$2,091.00",$0.00,"$2,091.00",$940.95,"$1,492.35",$0.00,$360.27,$0.00,$0.00,$366.12,"$2,091.00",$0.00,"$1,045.50","$1,656.07","$1,672.80",$0.00,$327.24,$0.00,$332.89,$0.00
58200,SUP,HCPCS C1713,,58200  -  FILLER BONE VOID ALLOGRAFT MIX FREEZE DRIED DBX,"$9,475.00",$0.00,"$9,475.00","$4,263.75","$5,158.80",$0.00,"$1,632.50",$0.00,$0.00,"$1,659.00","$9,475.00",$0.00,"$4,737.50","$7,504.20","$7,580.00",$0.00,"$1,482.84",$0.00,"$1,508.42",$0.00
60011,SUP,HCPCS C2625,,60011  -  IMPLANT NASAL 370 MCG MINI 4MM 16MM STEROID RELEASE ZIP TIE,"$2,312.50",$0.00,"$2,312.50","$1,040.63","$1,650.43",$0.00,$398.43,$0.00,$0.00,$404.90,"$2,312.50",$0.00,"$1,156.25","$1,831.50","$1,850.00",$0.00,$361.91,$0.00,$368.15,$0.00
61000,SUP,Custom 27203010,,TUBING PRSS DSPL SET STPCK 45IN REST HRT DISP,$37.50,$0.00,$37.50,$0.00,$26.76,$0.00,$0.00,$0.00,$0.00,$0.00,$37.50,$0.00,$18.75,$29.70,$30.00,$0.00,$0.00,$0.00,$0.00,$0.00
61621,SUP,Custom 27803010,,61621  -  CAGE SPNL 16MM 21MM RYTFC UNT THRD CNCT TI PLIF TLIF,"$8,031.25",$0.00,"$8,031.25",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,031.25",$0.00,"$4,015.63","$6,360.75","$6,425.00",$0.00,$0.00,$0.00,$0.00,$0.00
62100,SUP,Custom 27803010,,62100  -  PATCH DURA 2X2IN STRL DUREPAIR RSRB BVN CLGN MTRX CRNL DRPLS,$996.40,$0.00,$996.40,$0.00,$711.13,$0.00,$0.00,$0.00,$0.00,$0.00,$996.40,$0.00,$498.20,$789.15,$797.12,$0.00,$0.00,$0.00,$0.00,$0.00
62105,SUP,Custom 27803010,,62105  -  PATCH DURA 3X3IN DUREPAIR CRANIAL BVN CLGN MTRX RESORB DRPLS,"$1,816.55",$0.00,"$1,816.55",$0.00,"$1,296.47",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,816.55",$0.00,$908.28,"$1,438.71","$1,453.24",$0.00,$0.00,$0.00,$0.00,$0.00
62106,SUP,Custom 27803010,,62106  -  DURA 62106 SUBSTITUTE DUREPAIR 1X3IN NCE,$822.50,$0.00,$822.50,$0.00,$587.02,$0.00,$0.00,$0.00,$0.00,$0.00,$822.50,$0.00,$411.25,$651.42,$658.00,$0.00,$0.00,$0.00,$0.00,$0.00
62110,SUP,Custom 27803010,,62110  -  PATCH DURA 5X4IN DUREPAIR CRANIAL BVN CLGN MTRX RESORB DRPLS,"$3,520.30",$0.00,"$3,520.30",$0.00,"$2,512.44",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,520.30",$0.00,"$1,760.15","$2,788.08","$2,816.24",$0.00,$0.00,$0.00,$0.00,$0.00
62111,SUP,Custom 27803010,,62111  -  DURA 62111 SUBSTITUTE DUREPAIR 1X1IN NCE,$392.45,$0.00,$392.45,$0.00,$280.09,$0.00,$0.00,$0.00,$0.00,$0.00,$392.45,$0.00,$196.23,$310.82,$313.96,$0.00,$0.00,$0.00,$0.00,$0.00
62158,SUP,Custom 27803010,,62158  -  DURA 62158 SUBSTITUTE DUREPAIR 5X8IN NCE,"$8,742.00",$0.00,"$8,742.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,742.00",$0.00,"$4,371.00","$6,923.66","$6,993.60",$0.00,$0.00,$0.00,$0.00,$0.00
64018,SUP,HCPCS C1729,,064018  -  CATHETER NEPHROSTOMY 18FR 2 EYE DRAIN LATEX PEZZER STERILE,$43.23,$0.00,$43.23,$23.47,$30.85,$0.00,$7.45,$0.00,$0.00,$7.57,$43.23,$0.00,$21.61,$34.24,$34.58,$0.00,$6.76,$0.00,$6.88,$0.00
64024,SUP,HCPCS C1729,,064024  -  CATH NPHSTM 24FR PEZ DRAIN 2 EYE STRL LATEX DISP,$43.23,$0.00,$43.23,$23.47,$30.85,$0.00,$7.45,$0.00,$0.00,$7.57,$43.23,$0.00,$21.61,$34.24,$34.58,$0.00,$6.76,$0.00,$6.88,$0.00
64026,SUP,HCPCS C1729,,064026  -  CATH NPHSTM 26FR PEZ DRAIN 2 EYE STRL LATEX DISP,$43.23,$0.00,$43.23,$23.47,$30.85,$0.00,$7.45,$0.00,$0.00,$7.57,$43.23,$0.00,$21.61,$34.24,$34.58,$0.00,$6.76,$0.00,$6.88,$0.00
64030,SUP,HCPCS C1729,,064030  -  CATHETER NEPHROSTOMY 30FR 2 EYE DRAIN LATEX PEZZER STERILE,$43.23,$0.00,$43.23,$23.47,$30.85,$0.00,$7.45,$0.00,$0.00,$7.57,$43.23,$0.00,$21.61,$34.24,$34.58,$0.00,$6.76,$0.00,$6.88,$0.00
64036,SUP,HCPCS C1729,,064036  -  CATHETER URTH 36FR STRL LTX PEZ 2 EYE DRN PROPORTIONATE HD,$2.84,$0.00,$2.84,$1.54,$2.03,$0.00,$0.49,$0.00,$0.00,$0.50,$2.84,$0.00,$1.42,$2.25,$2.27,$0.00,$0.44,$0.00,$0.45,$0.00
64331,SUP,Custom 27203010,,BRACE ORTH LEFT ANKL FT SWED AFO PE FRDM MALE,$76.88,$0.00,$76.88,$0.00,$54.87,$0.00,$0.00,$0.00,$0.00,$0.00,$76.88,$0.00,$38.44,$60.89,$61.50,$0.00,$0.00,$0.00,$0.00,$0.00
67910,SUP,Custom 27203010,,0067910  -  BRUSH FEMORAL CANAL SUCTION IRRIGATION LATEX SIMPULSE PLUS,$93.05,$0.00,$93.05,$0.00,$66.41,$0.00,$0.00,$0.00,$0.00,$0.00,$93.05,$0.00,$46.53,$73.70,$74.44,$0.00,$0.00,$0.00,$0.00,$0.00
68128,SUP,Custom 27203010,,68128  -  CANNULA PERFUSION 3/8IN CONCTR 28FR 12-15IN 1 STAGE MALBLE,$897.25,$0.00,$897.25,$0.00,$640.37,$0.00,$0.00,$0.00,$0.00,$0.00,$897.25,$0.00,$448.63,$710.62,$717.80,$0.00,$0.00,$0.00,$0.00,$0.00
68250,SUP,Custom 27803010,,68250  -  GRAFT SFT TIS 1.5X1.5CM TTPLST PRICRD ALGRF PRC STRL,$637.50,$0.00,$637.50,$0.00,$454.98,$0.00,$0.00,$0.00,$0.00,$0.00,$637.50,$0.00,$318.75,$504.90,$510.00,$0.00,$0.00,$0.00,$0.00,$0.00
68333,SUP,Custom 27803010,,68333  -  GRAFT SFT TIS .8X.5CM STRL TTPLST LOPRFL SCLR,$725.00,$0.00,$725.00,$0.00,$517.43,$0.00,$0.00,$0.00,$0.00,$0.00,$725.00,$0.00,$362.50,$574.20,$580.00,$0.00,$0.00,$0.00,$0.00,$0.00
70011,SUP,HCPCS C2625,,70011  -  STENT NSL 370 MCG PROPEL MOMETASONE FUROATE,"$2,312.50",$0.00,"$2,312.50","$1,040.63","$1,650.43",$0.00,$398.43,$0.00,$0.00,$404.90,"$2,312.50",$0.00,"$1,156.25","$1,831.50","$1,850.00",$0.00,$361.91,$0.00,$368.15,$0.00
71221,SUP,Custom 27803010,,71221  -  CAGE SPNL STD 12MM 21MM RYTFC THRD CNCT TI PLIF,"$7,087.75",$0.00,"$7,087.75",$0.00,"$5,058.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,087.75",$0.00,"$3,543.88","$5,613.50","$5,670.20",$0.00,$0.00,$0.00,$0.00,$0.00
71226,SUP,Custom 27803010,,71226  -  CAGE SPNL STD 12MM 26MM RYTFC THRD CNCT TI PLIF,"$7,087.75",$0.00,"$7,087.75",$0.00,"$5,058.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,087.75",$0.00,"$3,543.88","$5,613.50","$5,670.20",$0.00,$0.00,$0.00,$0.00,$0.00
71310,SUP,Custom 27203010,,TRAY SPCLA BLK UNV CHRGR,$69.05,$0.00,$69.05,$0.00,$49.28,$0.00,$0.00,$0.00,$0.00,$0.00,$69.05,$0.00,$34.53,$54.69,$55.24,$0.00,$0.00,$0.00,$0.00,$0.00
71421,SUP,Custom 27803010,,71421  -  CAGE SPNL STD 14MM 21MM RYTFC THRD CNCT TI PLIF,"$7,087.75",$0.00,"$7,087.75",$0.00,"$5,058.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,087.75",$0.00,"$3,543.88","$5,613.50","$5,670.20",$0.00,$0.00,$0.00,$0.00,$0.00
71426,SUP,Custom 27803010,,71426  -  CAGE SPNL STD 14MM 26MM RYTFC THRD CNCT TI PLIF,"$7,087.75",$0.00,"$7,087.75",$0.00,"$5,058.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,087.75",$0.00,"$3,543.88","$5,613.50","$5,670.20",$0.00,$0.00,$0.00,$0.00,$0.00
71621,SUP,Custom 27803010,,71621  -  CAGE SPNL STD 16MM 21MM RYTFC THRD CNCT TI PLIF,"$7,087.75",$0.00,"$7,087.75",$0.00,"$5,058.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,087.75",$0.00,"$3,543.88","$5,613.50","$5,670.20",$0.00,$0.00,$0.00,$0.00,$0.00
71626,SUP,Custom 27803010,,71626  -  CAGE SPNL STD 16MM 26MM RYTFC THRD CNCT TI PLIF,"$7,087.75",$0.00,"$7,087.75",$0.00,"$5,058.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,087.75",$0.00,"$3,543.88","$5,613.50","$5,670.20",$0.00,$0.00,$0.00,$0.00,$0.00
71821,SUP,Custom 27803010,,71821  -  CAGE SPNL STD 18MM 21MM RYTFC THRD CNCT TI PLIF,"$7,087.75",$0.00,"$7,087.75",$0.00,"$5,058.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,087.75",$0.00,"$3,543.88","$5,613.50","$5,670.20",$0.00,$0.00,$0.00,$0.00,$0.00
71826,SUP,Custom 27803010,,71826  -  CAGE SPNL STD 18MM 26MM RYTFC THRD CNCT TI PLIF,"$7,087.75",$0.00,"$7,087.75",$0.00,"$5,058.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,087.75",$0.00,"$3,543.88","$5,613.50","$5,670.20",$0.00,$0.00,$0.00,$0.00,$0.00
72026,SUP,Custom 27803010,,72026  -  CAGE SPNL STD 20MM 26MM RYTFC THRD CNCT TI PLIF,"$6,615.95",$0.00,"$6,615.95",$0.00,"$4,721.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,615.95",$0.00,"$3,307.98","$5,239.83","$5,292.76",$0.00,$0.00,$0.00,$0.00,$0.00
72228,SUP,Custom 27203010,,72228  -  DRAIN INCISION FULL FLUTE ROUND 15FR 3/16IN CHANNEL RADIOPQ,$34.44,$0.00,$34.44,$0.00,$24.58,$0.00,$0.00,$0.00,$0.00,$0.00,$34.44,$0.00,$17.22,$27.28,$27.55,$0.00,$0.00,$0.00,$0.00,$0.00
72230,SUP,Custom 27203010,,072230  -  DRAIN 19FR HUBLESS FULL FLUTED,$43.68,$0.00,$43.68,$0.00,$31.17,$0.00,$0.00,$0.00,$0.00,$0.00,$43.68,$0.00,$21.84,$34.59,$34.94,$0.00,$0.00,$0.00,$0.00,$0.00
72335,SUP,Custom 27203010,,72335  -  SPLINT ORTHOPEDIC LP 35X3IN PRECUT PAD WATER REPELLENT LATEX,$40.50,$0.00,$32.08,$0.00,$17.16,$0.00,$0.00,$0.00,$0.00,$0.00,$24.04,$0.00,$12.02,$32.08,$19.23,$0.00,$0.00,$0.00,$0.00,$0.00
72430,SUP,Custom 27203010,,72430  -  SPLINT ORTH 30X4IN CNFRM PCUT FELT PD HPOAL H2O RPLNT FBGLS,$26.74,$0.00,$26.74,$0.00,$19.08,$0.00,$0.00,$0.00,$0.00,$0.00,$26.74,$0.00,$13.37,$21.18,$21.39,$0.00,$0.00,$0.00,$0.00,$0.00
72495,SUP,Custom 27203010,,CONTROL ANTI HAV IGM MONOLISA EIA IMMUN,"$1,612.50",$0.00,"$1,612.50",$0.00,"$1,150.84",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,612.50",$0.00,$806.25,"$1,277.10","$1,290.00",$0.00,$0.00,$0.00,$0.00,$0.00
72496,SUP,Custom 27203010,,CONTROL ANTI-HAV IGM IGG HAV MONOLISA EIA 192 TST IMMUN,"$1,387.50",$0.00,"$1,387.50",$0.00,$990.26,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,387.50",$0.00,$693.75,"$1,098.90","$1,110.00",$0.00,$0.00,$0.00,$0.00,$0.00
72530,SUP,Custom 27203010,,72530  -  SPLINT ORTH 30X5IN PCUT FELT PD FBGLS SCTCHCST CNFRM,$31.37,$0.00,$31.37,$0.00,$22.39,$0.00,$0.00,$0.00,$0.00,$0.00,$31.37,$0.00,$15.69,$24.85,$25.10,$0.00,$0.00,$0.00,$0.00,$0.00
75000,SUP,HCPCS C1726,,075000  -  SET DILAT 30CM 6-30FR AMPTZ RNL TFE 16CM,$495.85,$0.00,$495.85,$269.25,$353.89,$0.00,$85.43,$0.00,$0.00,$86.82,$495.85,$0.00,$247.93,$392.71,$396.68,$0.00,$77.60,$0.00,$78.94,$0.00
76430,SUP,Custom 27203010,,76430  -  SPLINT ORTHOPEDIC 30X4IN CONFORMABLE MOLDABLE LIGHTWEIGHT 3M,$47.30,$0.00,$37.46,$0.00,$20.14,$0.00,$0.00,$0.00,$0.00,$0.00,$28.22,$0.00,$14.11,$37.46,$22.58,$0.00,$0.00,$0.00,$0.00,$0.00
78710,SUP,HCPCS C1713,,SPACER MDI ARCHB+ MED VLV HLD CHMBR HNDHLD CMFSL MASK PED,$41.80,$0.00,$41.80,$18.81,$29.83,$0.00,$7.20,$0.00,$0.00,$7.32,$41.80,$0.00,$20.90,$33.11,$33.44,$0.00,$6.54,$0.00,$6.65,$0.00
78810,SUP,Custom 27203010,,TRANSILLUMINATOR EXAM TRNSFM ON/OFF SWH LF DISP KLNSPC VAG,$326.83,$0.00,$326.83,$0.00,$233.26,$0.00,$0.00,$0.00,$0.00,$0.00,$326.83,$0.00,$163.41,$258.85,$261.46,$0.00,$0.00,$0.00,$0.00,$0.00
79910,SUP,Custom 27203010,,TRANSILLUMINATOR EXAM CRDLS CHRG STTN DISP KLNSPC VAG SPCLM,$461.70,$0.00,$461.70,$0.00,$329.52,$0.00,$0.00,$0.00,$0.00,$0.00,$461.70,$0.00,$230.85,$365.67,$369.36,$0.00,$0.00,$0.00,$0.00,$0.00
80010,SUP,Custom 27803010,,80010  -  IMPLANT ORBTL 18MM SPHERE SMOOTH SUTURE TUNNELS POROUS,"$1,942.50",$0.00,"$1,942.50",$0.00,"$1,386.36",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,942.50",$0.00,$971.25,"$1,538.46","$1,554.00",$0.00,$0.00,$0.00,$0.00,$0.00
80018,SUP,Custom 27203010,,80018  -  IMPLANT ORBTL 18MM CONICAL MULTPUR SMOOTH SUTURE TUNNELS,"$1,912.50",$0.00,"$1,912.50",$0.00,"$1,364.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,912.50",$0.00,$956.25,"$1,514.70","$1,530.00",$0.00,$0.00,$0.00,$0.00,$0.00
80022,SUP,Custom 27803010,,80022  -  QUAD MOTILITY IMPLANT - EXTRA LARGE (APPROX. 22MM VOLUME),"$1,188.06",$0.00,"$1,188.06",$0.00,$847.92,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,188.06",$0.00,$594.03,$940.94,$950.45,$0.00,$0.00,$0.00,$0.00,$0.00
80026,SUP,Custom 27803010,,80026  -  IMPLANT ORBTL CONICAL CONICAL FLAT ANTERIOR SURFACE CHANNELS,"$1,188.06",$0.00,"$1,188.06",$0.00,$847.92,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,188.06",$0.00,$594.03,$940.94,$950.45,$0.00,$0.00,$0.00,$0.00,$0.00
80036,SUP,Custom 27803010,,80036  -  SPHERE EYE 16MM MDPR+,"$1,277.20",$0.00,"$1,277.20",$0.00,$911.54,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,277.20",$0.00,$638.60,"$1,011.54","$1,021.76",$0.00,$0.00,$0.00,$0.00,$0.00
80038,SUP,Custom 27803010,,80038  -  IMPLANT ORBTL STANDARD SPHERE 18MM MEDPOR PLUS BIOACTIVE,"$1,742.50",$0.00,"$1,742.50",$0.00,"$1,243.62",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,742.50",$0.00,$871.25,"$1,380.06","$1,394.00",$0.00,$0.00,$0.00,$0.00,$0.00
80040,SUP,Custom 27803010,,80040  -  SPHERE EYE 20MM MDPR+,"$1,277.20",$0.00,"$1,277.20",$0.00,$911.54,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,277.20",$0.00,$638.60,"$1,011.54","$1,021.76",$0.00,$0.00,$0.00,$0.00,$0.00
80042,SUP,Custom 27803010,,80042  -  MEDPOR PLUS - 22MM,"$1,277.20",$0.00,"$1,277.20",$0.00,$911.54,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,277.20",$0.00,$638.60,"$1,011.54","$1,021.76",$0.00,$0.00,$0.00,$0.00,$0.00
80046,SUP,Custom 27803010,,80046  -  MEDPOR PLUS SST - 16MM,"$1,483.20",$0.00,"$1,483.20",$0.00,"$1,058.56",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,483.20",$0.00,$741.60,"$1,174.69","$1,186.56",$0.00,$0.00,$0.00,$0.00,$0.00
80048,SUP,Custom 27803010,,80048  -  MEDPOR PLUS SST - 18MM,"$1,483.20",$0.00,"$1,174.69",$15.07,$12.36,$11.51,$0.00,$12.36,$12.36,$12.52,$30.00,$8.88,$23.66,"$1,174.69",$24.00,$12.27,$0.00,$8.46,$9.34,$8.46
80050,SUP,Custom 27803010,,80050  -  MEDPOR PLUS SST - 20MM,"$1,483.20",$0.00,"$1,483.20",$0.00,"$1,058.56",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,483.20",$0.00,$741.60,"$1,174.69","$1,186.56",$0.00,$0.00,$0.00,$0.00,$0.00
80052,SUP,Custom 27803010,,80052  -  KIT RETRIEVER 18MM 20X4MM 32MM MICROCATHETER FLEXCELL TREVO,"$13,641.25",$0.00,"$13,641.25",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,641.25",$0.00,"$6,820.63","$10,803.87","$10,913.00",$0.00,$0.00,$0.00,$0.00,$0.00
80056,SUP,Custom 27803010,,80056  -  MEDPOR PLUS SST EZ - 16MM,"$1,483.20",$0.00,"$1,483.20",$0.00,"$1,058.56",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,483.20",$0.00,$741.60,"$1,174.69","$1,186.56",$0.00,$0.00,$0.00,$0.00,$0.00
80058,SUP,Custom 27803010,,80058  -  SPHERE EYE 18MM SST EZ,"$1,483.20",$0.00,"$1,483.20",$0.00,"$1,058.56",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,483.20",$0.00,$741.60,"$1,174.69","$1,186.56",$0.00,$0.00,$0.00,$0.00,$0.00
80060,SUP,Custom 27803010,,80060  -  MEDPOR PLUS SST EZ - 20MM,"$1,483.20",$0.00,"$1,483.20",$0.00,"$1,058.56",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,483.20",$0.00,$741.60,"$1,174.69","$1,186.56",$0.00,$0.00,$0.00,$0.00,$0.00
80062,SUP,Custom 27803010,,80062  -  IMPLANT ORBTL ROUND 22MM SPHERE SMOOTH SURFACE SUTURE,"$2,052.50",$0.00,"$2,052.50",$0.00,"$1,464.87",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,052.50",$0.00,"$1,026.25","$1,625.58","$1,642.00",$0.00,$0.00,$0.00,$0.00,$0.00
80400,SUP,HCPCS C1751,,0080400  -  DRAIN INCISION 15X5/8IN 3 LUMEN ANTIBACTERIAL FILTER SUMP,$55.90,$0.00,$55.90,$30.35,$39.90,$0.00,$9.63,$0.00,$0.00,$9.79,$55.90,$0.00,$27.95,$44.27,$44.72,$0.00,$8.75,$0.00,$8.90,$0.00
80710,SUP,HCPCS C1713,,SPACER MDI ARCHB+ LG VLV HLD CHMBR HNDHLD CMFSL MASK PED,$32.50,$0.00,$32.50,$14.63,$23.20,$0.00,$5.60,$0.00,$0.00,$5.69,$32.50,$0.00,$16.25,$25.74,$26.00,$0.00,$5.09,$0.00,$5.17,$0.00
81001,SUP,Custom 27803010,,81001  -  IMPLANT ORBT 40X40X8.45MM STRL MDPR ONLAY PE POR LT CRNMXF,"$1,940.00",$1.77,"$1,536.48",$5.65,$4.63,$4.31,$1.77,$4.63,$4.63,$4.68,$11.00,$3.33,$8.86,"$1,536.48",$8.80,$4.60,$4.99,$3.17,$3.49,$3.17
81002,SUP,Custom 27803010,,81002  -  GRAFT SYNTH TISSUE 40X40MM ONLAY MEDPOR POLYETHYLENE POROUS,"$1,940.00",$0.00,"$1,940.00",$0.00,"$1,384.58",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,940.00",$0.00,$970.00,"$1,536.48","$1,552.00",$0.00,$0.00,$0.00,$0.00,$0.00
81007,SUP,Custom 27803010,,81007  -  GRAFT SYNTH TISSUE 33X45MM IMPLANT POROUS MEDPOR,"$1,387.50",$0.00,"$1,387.50",$0.00,$990.26,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,387.50",$0.00,$693.75,"$1,098.90","$1,110.00",$0.00,$0.00,$0.00,$0.00,$0.00
81008,SUP,Custom 27803010,,81008  -  GRAFT SYNTH TISSUE 45X33MM IMPLANT POROUS MEDPOR,"$1,387.50",$0.00,"$1,387.50",$0.00,$990.26,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,387.50",$0.00,$693.75,"$1,098.90","$1,110.00",$0.00,$0.00,$0.00,$0.00,$0.00
81013,SUP,Custom 27803010,,81013  -  GRAFT SYNTH TISSUE 30MM 38X33X.8MM IMPLANT ORBITO-ZYGOMATIC,"$3,040.00",$0.00,"$3,040.00",$0.00,"$2,169.65",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,040.00",$0.00,"$1,520.00","$2,407.68","$2,432.00",$0.00,$0.00,$0.00,$0.00,$0.00
81014,SUP,Custom 27803010,,81014  -  IMPLANT ORBT 38X33X.8MM TRM OFF THE SHLF MDPR RT,"$3,040.00",$0.00,"$3,040.00",$0.00,"$2,169.65",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,040.00",$0.00,"$1,520.00","$2,407.68","$2,432.00",$0.00,$0.00,$0.00,$0.00,$0.00
81020,SUP,Custom 27803010,,81020  -  MESH CRANIAL 76X50X.85MM EMBED SHEET MEDPOR TITAN MEDPOR,"$3,702.50",$0.00,"$3,702.50",$0.00,"$2,642.47",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,702.50",$0.00,"$1,851.25","$2,932.38","$2,962.00",$0.00,$0.00,$0.00,$0.00,$0.00
81021,SUP,Custom 27803010,,81021  -  PLATE BONE 38X50X.85MM MESH EMBEDDED POROUS MEDPOR TITAN MTM,"$2,962.50",$0.00,"$2,962.50",$0.00,"$2,114.34",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,962.50",$0.00,"$1,481.25","$2,346.30","$2,370.00",$0.00,$0.00,$0.00,$0.00,$0.00
81022,SUP,Custom 27803010,,81022  -  PLATE BONE 38X50X1.5MM MESH EMBEDDED POROUS MEDPOR TITAN MTM,"$2,962.50",$0.00,"$2,962.50",$0.00,"$2,114.34",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,962.50",$0.00,"$1,481.25","$2,346.30","$2,370.00",$0.00,$0.00,$0.00,$0.00,$0.00
81023,SUP,Custom 27803010,,81023  -  PLATE BONE 76X50X1.5MM MESH EMBEDDED POROUS MEDPOR TITAN MTM,"$3,702.50",$0.00,"$3,702.50",$0.00,"$2,642.47",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,702.50",$0.00,"$1,851.25","$2,932.38","$2,962.00",$0.00,$0.00,$0.00,$0.00,$0.00
81024,SUP,Custom 27803010,,81024  -  PLATE BONE 38X50X.6MM MESH EMBEDDED NONPOROUS BARRIER,"$3,487.50",$0.00,"$3,487.50",$0.00,"$2,489.03",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,487.50",$0.00,"$1,743.75","$2,762.10","$2,790.00",$0.00,$0.00,$0.00,$0.00,$0.00
81025,SUP,Custom 27803010,,81025  -  MESH CRANIAL 76X50X.6MM EMBED SHEET MEDPOR TITAN BARRIER,"$4,225.00",$4.33,"$3,346.20",$11.26,$9.24,$8.61,$4.33,$9.24,$9.24,$9.36,$30.00,$9.04,$17.68,"$3,346.20",$24.00,$12.48,$9.97,$8.61,$6.98,$8.61
81026,SUP,Custom 27803010,,81026  -  MESH CRANIAL 38X50X1MM EMBED SHEET SOLID MEDPOR TITAN DOUBLE,"$3,487.50",$0.00,"$3,487.50",$0.00,"$2,489.03",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,487.50",$0.00,"$1,743.75","$2,762.10","$2,790.00",$0.00,$0.00,$0.00,$0.00,$0.00
81027,SUP,Custom 27803010,,81027  -  MESH CRANIAL 76X50X1MM EMBED SHEET SOLID MEDPOR TITAN DOUBLE,"$4,225.00",$0.00,"$4,225.00",$0.00,"$3,015.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,225.00",$0.00,"$2,112.50","$3,346.20","$3,380.00",$0.00,$0.00,$0.00,$0.00,$0.00
81028,SUP,Custom 27803010,,81028  -  PLATE BONE 50X38X1.6MM SHEET SOLID SURFACE MTB POLYETHYLENE,"$3,487.50",$0.00,"$3,487.50",$0.00,"$2,489.03",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,487.50",$0.00,"$1,743.75","$2,762.10","$2,790.00",$0.00,$0.00,$0.00,$0.00,$0.00
81029,SUP,Custom 27803010,,81029  -  PLATE BONE 76X50X1.6MM MESH EMBEDDED NONPOROUS BARRIER,"$4,225.00",$0.00,"$4,225.00",$0.00,"$3,015.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,225.00",$0.00,"$2,112.50","$3,346.20","$3,380.00",$0.00,$0.00,$0.00,$0.00,$0.00
81030,SUP,Custom 27803010,,81030  -  GRAFT SYNTH TISSUE 41X42X.85MM MESH EMBED MEDPOR TITAN,"$2,905.00",$0.00,"$2,905.00",$0.00,"$2,073.30",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,905.00",$0.00,"$1,452.50","$2,300.76","$2,324.00",$0.00,$0.00,$0.00,$0.00,$0.00
81031,SUP,Custom 27803010,,81031  -  PLATE BN 42X41X1MM STRL MDPR TN MTB MESH EMBED XTN TI PE,"$3,417.50",$0.00,"$3,417.50",$0.00,"$2,439.07",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,417.50",$0.00,"$1,708.75","$2,706.66","$2,734.00",$0.00,$0.00,$0.00,$0.00,$0.00
81032,SUP,Custom 27803010,,81032  -  PLATE BONE 42X41X1MM MESH EMBED EXTN MEDPOR TITAN MTB,"$3,417.50",$0.00,"$3,417.50",$0.00,"$2,439.07",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,417.50",$0.00,"$1,708.75","$2,706.66","$2,734.00",$0.00,$0.00,$0.00,$0.00,$0.00
81033,SUP,Custom 27803010,,81033  -  PLATE BONE 42X41X.6MM MESH EMBED EXTN MEDPOR TITAN DOUBLE,"$3,417.50",$0.00,"$3,417.50",$0.00,"$2,439.07",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,417.50",$0.00,"$1,708.75","$2,706.66","$2,734.00",$0.00,$0.00,$0.00,$0.00,$0.00
81034,SUP,Custom 27803010,,81034  -  GRAFT SYNTH TISSUE 41X42X.85MM MESH EMBED MEDPOR TITAN MAX,"$2,905.00",$0.00,"$2,905.00",$0.00,"$2,073.30",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,905.00",$0.00,"$1,452.50","$2,300.76","$2,324.00",$0.00,$0.00,$0.00,$0.00,$0.00
81035,SUP,Custom 27803010,,81035  -  PLATE BONE 42X41X1MM MESH EMBED EXTN MEDPOR TITAN BARRIER,"$3,417.50",$0.00,"$3,417.50",$0.00,"$2,439.07",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,417.50",$0.00,"$1,708.75","$2,706.66","$2,734.00",$0.00,$0.00,$0.00,$0.00,$0.00
81036,SUP,Custom 27803010,,81036  -  PLATE BONE THK1MM 42X41X1MM MESH EMBEDDED EXTENSIONS POROUS,"$3,417.50",$0.00,"$3,417.50",$0.00,"$2,439.07",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,417.50",$0.00,"$1,708.75","$2,706.66","$2,734.00",$0.00,$0.00,$0.00,$0.00,$0.00
81037,SUP,Custom 27803010,,81037  -  PLATE BONE THIN PROFILE 130X130X3MM RADIOPQ MEDPOR TITANIUM,"$25,372.50",$0.00,"$25,372.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$25,372.50",$0.00,"$12,686.25","$20,095.02","$20,298.00",$0.00,$0.00,$0.00,$0.00,$0.00
81038,SUP,Custom 27803010,,81038  -  PLATE BONE 130X130X3MM MESH EMBEDDED POROUS MEDPOR TITAN,"$25,372.50",$0.00,"$25,372.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$25,372.50",$0.00,"$12,686.25","$20,095.02","$20,298.00",$0.00,$0.00,$0.00,$0.00,$0.00
81040,SUP,Custom 27803010,,81040  -  PLATE BONE 76X100X1.5MM MESH EMBEDDED SHEET POROUS MEDPOR,"$8,142.50",$0.00,"$8,142.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,142.50",$0.00,"$4,071.25","$6,448.86","$6,514.00",$0.00,$0.00,$0.00,$0.00,$0.00
81050,SUP,HCPCS C1713,,81050  -  PLATE BONE FAN MTB CRANFCL,"$3,592.50",$0.00,"$3,592.50","$1,616.63","$2,563.97",$0.00,$618.97,$0.00,$0.00,$629.02,"$3,592.50",$0.00,"$1,796.25","$2,845.26","$2,874.00",$0.00,$562.23,$0.00,$571.93,$0.00
81060,SUP,Custom 27803010,,81060  -  IMPLANT MANDIB 30X15X.25MM BIOCOMPATIBLE SPACE MAINTENANCE,$477.50,$0.00,$477.50,$0.00,$340.79,$0.00,$0.00,$0.00,$0.00,$0.00,$477.50,$0.00,$238.75,$378.18,$382.00,$0.00,$0.00,$0.00,$0.00,$0.00
81061,SUP,Custom 27803010,,81061  -  IMPLANT MANDIB 30X25X.25MM BIOCOMPATIBLE SPACE MAINTENANCE,$720.00,$0.00,$720.00,$0.00,$513.86,$0.00,$0.00,$0.00,$0.00,$0.00,$720.00,$0.00,$360.00,$570.24,$576.00,$0.00,$0.00,$0.00,$0.00,$0.00
81062,SUP,Custom 27803010,,81062  -  GRAFT SYNTH TISSUE ULTRATHIN 35X45X.25IN SHEET CONTAINMENT,$957.50,$0.00,$957.50,$0.00,$683.37,$0.00,$0.00,$0.00,$0.00,$0.00,$957.50,$0.00,$478.75,$758.34,$766.00,$0.00,$0.00,$0.00,$0.00,$0.00
81063,SUP,Custom 27803010,,81063  -  IMPLANT MANDIB 30X15X.35MM BIOCOMPATIBLE SPACE MAINTENANCE,$477.50,$0.00,$477.50,$0.00,$340.79,$0.00,$0.00,$0.00,$0.00,$0.00,$477.50,$0.00,$238.75,$378.18,$382.00,$0.00,$0.00,$0.00,$0.00,$0.00
81064,SUP,Custom 27803010,,81064  -  IMPLANT MANDIB 30X25X.35MM BIOCOMPATIBLE SPACE MAINTENANCE,$720.00,$0.00,$720.00,$0.00,$513.86,$0.00,$0.00,$0.00,$0.00,$0.00,$720.00,$0.00,$360.00,$570.24,$576.00,$0.00,$0.00,$0.00,$0.00,$0.00
81065,SUP,Custom 27803010,,81065  -  IMPLANT MANDIB 45X35X.35MM BIOCOMPATIBLE SPACE MAINTENANCE,$957.50,$0.00,$957.50,$0.00,$683.37,$0.00,$0.00,$0.00,$0.00,$0.00,$957.50,$0.00,$478.75,$758.34,$766.00,$0.00,$0.00,$0.00,$0.00,$0.00
81066,SUP,Custom 27803010,,81066  -  IMPLANT MANDIB 30X15X.45MM BIOCOMPATIBLE SPACE MAINTENANCE,$477.50,$0.00,$477.50,$0.00,$340.79,$0.00,$0.00,$0.00,$0.00,$0.00,$477.50,$0.00,$238.75,$378.18,$382.00,$0.00,$0.00,$0.00,$0.00,$0.00
81067,SUP,Custom 27803010,,81067  -  IMPLANT MANDIB 30X25X.45MM BIOCOMPATIBLE SPACE MAINTENANCE,$720.00,$0.00,$720.00,$0.00,$513.86,$0.00,$0.00,$0.00,$0.00,$0.00,$720.00,$0.00,$360.00,$570.24,$576.00,$0.00,$0.00,$0.00,$0.00,$0.00
81068,SUP,Custom 27803010,,81068  -  IMPLANT MANDIB 35X45X.45MM BIOCOMPATIBLE SPACE MAINTENANCE,$957.50,$0.00,$957.50,$0.00,$683.37,$0.00,$0.00,$0.00,$0.00,$0.00,$957.50,$0.00,$478.75,$758.34,$766.00,$0.00,$0.00,$0.00,$0.00,$0.00
81200,SUP,Custom 27803010,,81200  -  ROD SPNL 5.5MM 50MM SPRL R90D HEX END TI,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
81201,SUP,Custom 27803010,,81201  -  ROD SPNL 5.5MM 60MM SPRL R90D HEX END TI,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
81202,SUP,Custom 27803010,,81202  -  ROD SPNL 5.5MM 70MM SPRL R90D HEX END TI,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
81203,SUP,Custom 27803010,,81203  -  ROD SPNL 5.5MM 80MM SPRL R90D HEX END TI,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
81204,SUP,Custom 27803010,,81204  -  ROD SPNL 5.5MM 90MM SPRL R90D HEX END TI,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
81205,SUP,Custom 27803010,,81205  -  ROD SPNL 5.5MM 100MM SPRL R90D HEX END TI,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
81206,SUP,Custom 27803010,,81206  -  ROD SPNL 5.5MM 110MM SPRL R90D HEX END TI,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
81207,SUP,Custom 27803010,,81207  -  ROD SPNL 5.5MM 120MM SPRL R90D HEX END TI,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
81208,SUP,Custom 27803010,,81208  -  ROD SPNL 5.5MM 140MM SPRL R90D HEX END TI,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
81210,SUP,Custom 27803010,,81210  -  ROD SPNL 5.5MM 160MM SPRL R90D HEX END TI,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
81211,SUP,Custom 27803010,,81211  -  ROD SPNL 5.5MM 180MM SPRL R90D HEX END TI,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
81212,SUP,Custom 27803010,,81212  -  ROD SPNL 5.5MM 220MM SPRL R90D HEX END TI,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
81213,SUP,Custom 27803010,,81213  -  ROD SPNL 5.5MM 240MM SPRL R90D HEX END TI,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
81214,SUP,Custom 27803010,,81214  -  ROD SPNL 5.5MM 260MM SPRL R90D HEX END TI,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
81215,SUP,Custom 27803010,,81215  -  ROD SPNL 5.5MM 280MM SPRL R90D HEX END TI,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
81216,SUP,Custom 27803010,,81216  -  ROD SPNL 5.5MM 300MM SPRL R90D HEX END TI,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
81217,SUP,Custom 27803010,,81217  -  ROD SPNL 5.5MM 320MM SPRL R90D HEX END TI,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
81218,SUP,Custom 27803010,,81218  -  ROD SPNL 5.5MM 340MM SPRL R90D HEX END TI,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
81219,SUP,Custom 27803010,,81219  -  ROD SPNL 5.5MM 360MM SPRL R90D HEX END TI,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
81220,SUP,Custom 27803010,,81220  -  ROD SPNL 5.5MM 380MM SPRL R90D HEX END TI,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
81906,SUP,Custom 27203010,,REAGENT SBSTR ACCES 130ML ANALY,$461.25,$0.00,$461.25,$0.00,$329.19,$0.00,$0.00,$0.00,$0.00,$0.00,$461.25,$0.00,$230.63,$365.31,$369.00,$0.00,$0.00,$0.00,$0.00,$0.00
81908,SUP,Custom 27203010,,REAGENT SMPL DILU A ANALY,$74.83,$0.00,$74.83,$0.00,$53.40,$0.00,$0.00,$0.00,$0.00,$0.00,$74.83,$0.00,$37.41,$59.27,$59.86,$0.00,$0.00,$0.00,$0.00,$0.00
81910,SUP,Custom 27203010,,REAGENT SYS CHK SOL ACCES 4ML ANALY,$95.33,$0.00,$95.33,$0.00,$68.03,$0.00,$0.00,$0.00,$0.00,$0.00,$95.33,$0.00,$47.66,$75.50,$76.26,$0.00,$0.00,$0.00,$0.00,$0.00
82000,SUP,Custom 27803010,,82000  -  GRAFT SYNTH TISSUE THK4MM HEMISPHERE CNTOUR POROUS MEDPOR,"$14,542.50",$0.00,"$14,542.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$14,542.50",$0.00,"$7,271.25","$11,517.66","$11,634.00",$0.00,$0.00,$0.00,$0.00,$0.00
82001,SUP,Custom 27803010,,82001  -  GRAFT SYNTH TISSUE HEMISPHERE 170X124X4.5MM OFF THE SHELF,"$14,542.50",$0.00,"$14,542.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$14,542.50",$0.00,"$7,271.25","$11,517.66","$11,634.00",$0.00,$0.00,$0.00,$0.00,$0.00
82006,SUP,Custom 27803010,,82006  -  GRAFT SYNTH TISSUE DOME 180X150X6MM PRESHAPED POROUS MEDPOR,"$15,460.00",$0.00,"$15,460.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$15,460.00",$0.00,"$7,730.00","$12,244.32","$12,368.00",$0.00,$0.00,$0.00,$0.00,$0.00
82007,SUP,Custom 27803010,,82007  -  GRAFT SNTH TISS LG 20X2.5X2.5MM STRL MDPR TSI TAB NPOR POST,"$1,800.00",$0.00,"$1,800.00",$0.00,"$1,284.66",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,800.00",$0.00,$900.00,"$1,425.60","$1,440.00",$0.00,$0.00,$0.00,$0.00,$0.00
82008,SUP,Custom 27803010,,82008  -  GRAFT SYNTH TISSUE LARGE 40X40X2.5MM .73MM 3 TABS NONPOROUS,"$1,972.50",$0.00,"$1,972.50",$0.00,"$1,407.77",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,972.50",$0.00,$986.25,"$1,562.22","$1,578.00",$0.00,$0.00,$0.00,$0.00,$0.00
82011,SUP,Custom 27803010,,82011  -  GRAFT SYNTH TISSUE TRIANGLE 102X3.6X4MM 102X10X6MM IMPLANT,"$1,012.50",$0.00,"$1,012.50",$0.00,$722.62,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,012.50",$0.00,$506.25,$801.90,$810.00,$0.00,$0.00,$0.00,$0.00,$0.00
82013,SUP,Custom 27803010,,82013  -  GRAFT SYNTH TISSUE .6MM V SHAPE 30X10X6MM IMPLANT CRANIOTOMY,"$1,012.50",$0.00,"$1,012.50",$0.00,$722.62,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,012.50",$0.00,$506.25,$801.90,$810.00,$0.00,$0.00,$0.00,$0.00,$0.00
82014,SUP,Custom 27803010,,82014  -  GRAFT SYNTH TISSUE SMALL 36X45X1MM IMPLANT POROUS MEDPOR,"$2,320.00",$0.00,"$2,320.00",$0.00,"$1,655.78",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,320.00",$0.00,"$1,160.00","$1,837.44","$1,856.00",$0.00,$0.00,$0.00,$0.00,$0.00
82015,SUP,Custom 27803010,,82015  -  GRAFT SYNTH TISSUE 58X56X1.5MM IMPLANT POROUS MEDPOR,"$3,207.50",$0.00,"$3,207.50",$0.00,"$2,289.19",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,207.50",$0.00,"$1,603.75","$2,540.34","$2,566.00",$0.00,$0.00,$0.00,$0.00,$0.00
82016,SUP,Custom 27803010,,82016  -  GRAFT SYNTH TISSUE 58X56X1.5MM IMPLANT POROUS MEDPOR,"$3,207.50",$0.00,"$3,207.50",$0.00,"$2,289.19",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,207.50",$0.00,"$1,603.75","$2,540.34","$2,566.00",$0.00,$0.00,$0.00,$0.00,$0.00
82019,SUP,Custom 27803010,,82019  -  PLATE BONE CURVE 48X38X.85MM MESH EMBED PRESHAPE MEDPOR,"$4,430.00",$0.00,"$4,430.00",$0.00,"$3,161.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,430.00",$0.00,"$2,215.00","$3,508.56","$3,544.00",$0.00,$0.00,$0.00,$0.00,$0.00
82020,SUP,Custom 27803010,,82020  -  PLATE BONE CURVE 48X38X1MM MESH EMBEDDED PCVD NONPOROUS,"$5,015.00",$0.00,"$5,015.00",$0.00,"$3,579.21",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,015.00",$0.00,"$2,507.50","$3,971.88","$4,012.00",$0.00,$0.00,$0.00,$0.00,$0.00
82022,SUP,Custom 27803010,,82022  -  FLEXBLOCK IMPLANT - BARRIER 56MM X 91MM X 4MM,"$3,712.00",$0.00,"$3,712.00",$0.00,"$2,649.25",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,712.00",$0.00,"$1,856.00","$2,939.90","$2,969.60",$0.00,$0.00,$0.00,$0.00,$0.00
82030,SUP,Custom 27803010,,82030  -  PLATE BONE 96X61X1.5MM IMPLANT POROUS MEDPOR TITAN TITANIUM,"$8,702.50",$0.00,"$8,702.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,702.50",$0.00,"$4,351.25","$6,892.38","$6,962.00",$0.00,$0.00,$0.00,$0.00,$0.00
82301,SUP,HCPCS B4088,,082301  -  TUBE JJNSTM 60IN 9-18FR PU COMPAT STPT FEED NSL STRL,$466.09,$0.00,$369.14,$9.90,$15.70,$3.92,$7.07,$0.00,$0.00,$3.29,$22.00,$0.00,$11.00,$369.14,$17.60,$13.20,$3.29,$0.00,$3.13,$0.00
83003,SUP,Custom 27803010,,83003  -  GRAFT SYNTH TISSUE 47X28X3MM MEDPOR POLYETHYLENE POROUS,"$1,407.50",$0.00,"$1,407.50",$0.00,"$1,004.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,407.50",$0.00,$703.75,"$1,114.74","$1,126.00",$0.00,$0.00,$0.00,$0.00,$0.00
83004,SUP,Custom 27803010,,83004  -  GRAFT SYNTH TISSUE 47X28X3MM MEDPOR POLYETHYLENE POROUS,"$1,407.50",$0.00,"$1,407.50",$0.00,"$1,004.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,407.50",$0.00,$703.75,"$1,114.74","$1,126.00",$0.00,$0.00,$0.00,$0.00,$0.00
83007,SUP,Custom 27803010,,83007  -  GRAFT SNTH TISS 60X40X4MM STRL MDPR IMPL CNTR SHL-TY DSGN,"$1,407.50",$0.00,"$1,407.50",$0.00,"$1,004.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,407.50",$0.00,$703.75,"$1,114.74","$1,126.00",$0.00,$0.00,$0.00,$0.00,$0.00
83008,SUP,Custom 27803010,,83008  -  GRAFT SNTH TISS 60X40MM STRL MDPR IMPL CNTR SHL-TY DSGN POR,"$1,407.50",$0.00,"$1,407.50",$0.00,"$1,004.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,407.50",$0.00,$703.75,"$1,114.74","$1,126.00",$0.00,$0.00,$0.00,$0.00,$0.00
83020,SUP,Custom 27803010,,83020  -  GRAFT SYNTH TISSUE MICROTHIN 38X50X.25MM SHEET POROUS MEDPOR,"$1,320.00",$0.00,"$1,320.00",$0.00,$942.08,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,320.00",$0.00,$660.00,"$1,045.44","$1,056.00",$0.00,$0.00,$0.00,$0.00,$0.00
83021,SUP,Custom 27803010,,83021  -  GRAFT SYNTH TISSUE MICROTHIN 76X50X.25MM SHEET POROUS MEDPOR,"$1,777.50",$0.00,"$1,777.50",$0.00,"$1,268.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,777.50",$0.00,$888.75,"$1,407.78","$1,422.00",$0.00,$0.00,$0.00,$0.00,$0.00
83022,SUP,Custom 27803010,,83022  -  GRAFT SNTH 38X50X.35MM STRL OFF THE SHLF FTHR EDG SMTH TRNS,"$1,320.00",$0.00,"$1,320.00",$0.00,$942.08,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,320.00",$0.00,$660.00,"$1,045.44","$1,056.00",$0.00,$0.00,$0.00,$0.00,$0.00
83023,SUP,Custom 27803010,,83023  -  GRAFT SYNTH TISSUE MICROTHIN 76X50X.35MM SHEET POROUS MEDPOR,"$1,777.50",$0.00,"$1,777.50",$0.00,"$1,268.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,777.50",$0.00,$888.75,"$1,407.78","$1,422.00",$0.00,$0.00,$0.00,$0.00,$0.00
83029,SUP,Custom 27803010,,83029  -  GRAFT SYNTH TISSUE MICROTHIN 50X38X.45MM SHEET POROUS MEDPOR,"$1,320.00",$0.00,"$1,320.00",$0.00,$942.08,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,320.00",$0.00,$660.00,"$1,045.44","$1,056.00",$0.00,$0.00,$0.00,$0.00,$0.00
83030,SUP,Custom 27803010,,83030  -  GRAFT SYNTH TISSUE MICROTHIN 76X50X.45MM SHEET MEDPOR POROUS,"$1,777.50",$0.00,"$1,777.50",$0.00,"$1,268.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,777.50",$0.00,$888.75,"$1,407.78","$1,422.00",$0.00,$0.00,$0.00,$0.00,$0.00
84000,SUP,Custom 27803010,,84000  -  GRAFT SYNTH TISSUE PETITE 45X4X4MM IMPLANT TAPERED PROFILE,$937.50,$0.00,$937.50,$0.00,$669.09,$0.00,$0.00,$0.00,$0.00,$0.00,$937.50,$0.00,$468.75,$742.50,$750.00,$0.00,$0.00,$0.00,$0.00,$0.00
84001,SUP,Custom 27803010,,84001  -  GRAFT SYNTH TISSUE PETITE 55X4X4MM IMPLANT TAPERED PROFILE,$937.50,$0.00,$937.50,$0.00,$669.09,$0.00,$0.00,$0.00,$0.00,$0.00,$937.50,$0.00,$468.75,$742.50,$750.00,$0.00,$0.00,$0.00,$0.00,$0.00
84002,SUP,Custom 27803010,,84002  -  GRAFT SYNTH TISSUE PETITE 45X5X5MM IMPLANT TAPERED PROFILE,$937.50,$0.00,$937.50,$0.00,$669.09,$0.00,$0.00,$0.00,$0.00,$0.00,$937.50,$0.00,$468.75,$742.50,$750.00,$0.00,$0.00,$0.00,$0.00,$0.00
84003,SUP,Custom 27803010,,84003  -  GRAFT SYNTH TISSUE PETITE 55X5X5MM IMPLANT TAPERED PROFILE,$937.50,$0.00,$937.50,$0.00,$669.09,$0.00,$0.00,$0.00,$0.00,$0.00,$937.50,$0.00,$468.75,$742.50,$750.00,$0.00,$0.00,$0.00,$0.00,$0.00
84004,SUP,Custom 27803010,,84004  -  GRAFT SYNTH TISSUE PETITE 55X9X6MM IMPLANT TAPERED PROFILE,$937.50,$0.00,$937.50,$0.00,$669.09,$0.00,$0.00,$0.00,$0.00,$0.00,$937.50,$0.00,$468.75,$742.50,$750.00,$0.00,$0.00,$0.00,$0.00,$0.00
84006,SUP,Custom 27803010,,84006  -  IMPLANT FACIAL THIN SHELL NASAL DORSAL,"$1,552.50",$0.00,"$1,552.50",$0.00,"$1,108.02",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,552.50",$0.00,$776.25,"$1,229.58","$1,242.00",$0.00,$0.00,$0.00,$0.00,$0.00
84008,SUP,Custom 27803010,,84008  -  NASAL DARTT IMPLANT - 40M X 4MM X 1.4MM,$884.00,$0.00,$884.00,$0.00,$630.91,$0.00,$0.00,$0.00,$0.00,$0.00,$884.00,$0.00,$442.00,$700.13,$707.20,$0.00,$0.00,$0.00,$0.00,$0.00
84010,SUP,Custom 27803010,,84010  -  IMPLANT FACIAL 37X22X.5MM TIP TOP MEDPOR NASAL,"$1,227.50",$0.00,"$1,227.50",$0.00,$876.07,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,227.50",$0.00,$613.75,$972.18,$982.00,$0.00,$0.00,$0.00,$0.00,$0.00
84012,SUP,Custom 27803010,,84012  -  GRAFT SYNTH TISSUE 41X9X3MM ONLAY POROUS MEDPOR POLYETHYLENE,"$1,077.50",$0.00,"$1,077.50",$0.00,$769.01,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,077.50",$0.00,$538.75,$853.38,$862.00,$0.00,$0.00,$0.00,$0.00,$0.00
84129,SUP,Custom 27803010,,84129  -  GRAFT SYNTH TISSUE SMALL 59X34X19.5MM IMPLANT S-SHAPE 1,"$5,277.50",$0.00,"$5,277.50",$0.00,"$3,766.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,277.50",$0.00,"$2,638.75","$4,179.78","$4,222.00",$0.00,$0.00,$0.00,$0.00,$0.00
84130,SUP,Custom 27803010,,84130  -  S EAR - SMALL - RIGHT - 59MM X 34MM X 19.5,"$3,886.00",$0.00,"$3,886.00",$0.00,"$2,773.44",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,886.00",$0.00,"$1,943.00","$3,077.71","$3,108.80",$0.00,$0.00,$0.00,$0.00,$0.00
84131,SUP,Custom 27803010,,84131  -  PROS OSS MED 62X36X20.5MM LEFT EAR S,"$3,886.00",$0.00,"$3,886.00",$0.00,"$2,773.44",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,886.00",$0.00,"$1,943.00","$3,077.71","$3,108.80",$0.00,$0.00,$0.00,$0.00,$0.00
84132,SUP,Custom 27803010,,84132  -  S EAR - MEDIUM - RIGHT - 62MM X 36MM X 20.5MM,"$3,886.00",$0.00,"$3,886.00",$0.00,"$2,773.44",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,886.00",$0.00,"$1,943.00","$3,077.71","$3,108.80",$0.00,$0.00,$0.00,$0.00,$0.00
84133,SUP,Custom 27803010,,84133  -  S EAR - LARGE - LEFT - 65MM X 37MM X 21.5MM,"$3,886.00",$0.00,"$3,886.00",$0.00,"$2,773.44",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,886.00",$0.00,"$1,943.00","$3,077.71","$3,108.80",$0.00,$0.00,$0.00,$0.00,$0.00
84134,SUP,Custom 27803010,,84134  -  S EAR - LARGE - RIGHT - 65MM X 37MM X 21.5MM,"$4,004.00",$0.00,"$4,004.00",$0.00,"$2,857.65",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,004.00",$0.00,"$2,002.00","$3,171.17","$3,203.20",$0.00,$0.00,$0.00,$0.00,$0.00
84505,SUP,Custom 27803010,,84505  -  CONNECTOR 84505 CD CL DOM 7.7MM,"$1,991.25",$0.00,"$1,991.25",$0.00,"$1,421.16",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,991.25",$0.00,$995.63,"$1,577.07","$1,593.00",$0.00,$0.00,$0.00,$0.00,$0.00
85040,SUP,Custom 27203010,,85040  -  APPLICATOR FBRTP 6IN FOAM CTTN POLYPRO CSTM OVR 1IN 3/8IN,$151.63,$0.00,$151.63,$0.00,$108.21,$0.00,$0.00,$0.00,$0.00,$0.00,$151.63,$0.00,$75.81,$120.09,$121.30,$0.00,$0.00,$0.00,$0.00,$0.00
85201,SUP,HCPCS C1768,,85201  -  GRAFT HEMASHIELD GRAFT? 20X10MM X 40L962.45,"$1,688.05",$0.00,"$1,688.05",$759.62,"$1,204.76",$0.00,$290.84,$0.00,$0.00,$295.56,"$1,688.05",$0.00,$844.03,"$1,336.94","$1,350.44",$0.00,$264.18,$0.00,$268.74,$0.00
85412,SUP,HCPCS C1876,,85412  -  STENT TRCHBR 6MM 7FR 38MM STRL 120CM ICAST CVR CATH INTRO,"$6,125.00",$0.00,"$6,125.00","$2,756.25","$4,371.41",$0.00,"$1,055.31",$0.00,$0.00,"$1,072.44","$6,125.00",$0.00,"$3,062.50","$4,851.00","$4,900.00",$0.00,$958.56,$0.00,$975.10,$0.00
85414,SUP,HCPCS C1876,,85414  -  STENT TRCHBR 7MM 7FR 38MM STRL 120CM ICAST CVR CATH INTRO,"$6,115.63",$0.00,"$6,115.63","$2,752.03","$4,364.72",$0.00,"$1,053.69",$0.00,$0.00,"$1,070.80","$6,115.63",$0.00,"$3,057.81","$4,843.58","$4,892.50",$0.00,$957.10,$0.00,$973.61,$0.00
85415,SUP,HCPCS C1876,,85415  -  STENT TRCHBR 7MM 7FR 59MM STRL 120CM ICAST CVR CATH INTRO SS,"$6,590.63",$0.00,"$6,590.63","$2,965.78","$4,703.73",$0.00,"$1,135.53",$0.00,$0.00,"$1,153.97","$6,590.63",$0.00,"$3,295.31","$5,219.78","$5,272.50",$0.00,"$1,031.43",$0.00,"$1,049.23",$0.00
85416,SUP,HCPCS C1876,,85416  -  STENT TRCHBR 8MM 7FR 38MM STRL 120CM ICAST CVR CATH INTRO SS,"$6,115.63",$0.00,"$6,115.63","$2,752.03","$4,364.72",$0.00,"$1,053.69",$0.00,$0.00,"$1,070.80","$6,115.63",$0.00,"$3,057.81","$4,843.58","$4,892.50",$0.00,$957.10,$0.00,$973.61,$0.00
85417,SUP,HCPCS C1876,,85417  -  STENT TRCHBR 8MM 7FR 59MM STRL 120CM ICAST CVR CATH INTRO SS,"$6,590.63",$0.00,"$6,590.63","$2,965.78","$4,703.73",$0.00,"$1,135.53",$0.00,$0.00,"$1,153.97","$6,590.63",$0.00,"$3,295.31","$5,219.78","$5,272.50",$0.00,"$1,031.43",$0.00,"$1,049.23",$0.00
85418,SUP,HCPCS C1876,,85418  -  STENT TRCHBR 9MM 7FR 38MM STRL 120CM ICAST CVR CATH INTRO,"$6,115.63",$0.00,"$6,115.63","$2,752.03","$4,364.72",$0.00,"$1,053.69",$0.00,$0.00,"$1,070.80","$6,115.63",$0.00,"$3,057.81","$4,843.58","$4,892.50",$0.00,$957.10,$0.00,$973.61,$0.00
85419,SUP,HCPCS C1876,,85419  -  STENT TRCHBR 9MM 7FR 59MM STRL 120CM ICAST CVR CATH INTRO SS,"$6,590.63",$0.00,"$6,590.63","$2,965.78","$4,703.73",$0.00,"$1,135.53",$0.00,$0.00,"$1,153.97","$6,590.63",$0.00,"$3,295.31","$5,219.78","$5,272.50",$0.00,"$1,031.43",$0.00,"$1,049.23",$0.00
85424,SUP,HCPCS C1876,,85424  -  STENT TRCHBR 10MM 7FR 38MM STRL 120CM ICAST CVR CATH INTRO,"$6,115.63",$0.00,"$6,115.63","$2,752.03","$4,364.72",$0.00,"$1,053.69",$0.00,$0.00,"$1,070.80","$6,115.63",$0.00,"$3,057.81","$4,843.58","$4,892.50",$0.00,$957.10,$0.00,$973.61,$0.00
85426,SUP,HCPCS C1768,,85426  -  STENT COVERED  12MMX38MMX120CM,"$6,125.00",$0.00,"$6,125.00","$2,756.25","$4,371.41",$0.00,"$1,055.31",$0.00,$0.00,"$1,072.44","$6,125.00",$0.00,"$3,062.50","$4,851.00","$4,900.00",$0.00,$958.56,$0.00,$975.10,$0.00
85450,SUP,HCPCS C1876,,85450  -  STENT TRCHBR 5MM 6FR 16MM 120CM ICAST CVR ULT LO CX PRFL PWR,"$5,723.75",$0.00,"$5,723.75","$2,575.69","$4,085.04",$0.00,$986.17,$0.00,$0.00,"$1,002.18","$5,723.75",$0.00,"$2,861.88","$4,533.21","$4,579.00",$0.00,$895.77,$0.00,$911.22,$0.00
85451,SUP,HCPCS C1876,,85451  -  STENT TRCHBR 5MM 6FR 22MM STRL 120CM ICAST CVR CATH INTRO SS,"$6,287.50",$0.00,"$6,287.50","$2,829.38","$4,487.39",$0.00,"$1,083.30",$0.00,$0.00,"$1,100.89","$6,287.50",$0.00,"$3,143.75","$4,979.70","$5,030.00",$0.00,$983.99,$0.00,"$1,000.97",$0.00
85785,SUP,HCPCS C1733,,85785  -  SET TBG 260CM CL PNT 2W CMUNC IRR PMP CATH,$125.00,$0.00,$125.00,$67.88,$89.21,$0.00,$21.54,$0.00,$0.00,$21.89,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$19.56,$0.00,$19.90,$0.00
86000,SUP,Custom 27803010,,86000  -  IMPLANT CHIN CNTR LF 2 PC,"$1,407.50",$0.00,"$1,407.50",$0.00,"$1,004.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,407.50",$0.00,$703.75,"$1,114.74","$1,126.00",$0.00,$0.00,$0.00,$0.00,$0.00
86001,SUP,Custom 27803010,,86001  -  GRAFT SYNTH TISSUE CNTOUR CONCAVE TAPER 74X42X5MM 2 PIECE,"$1,407.50",$0.00,"$1,407.50",$0.00,"$1,004.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,407.50",$0.00,$703.75,"$1,114.74","$1,126.00",$0.00,$0.00,$0.00,$0.00,$0.00
86002,SUP,Custom 27803010,,86002  -  IMPLANT CHIN CNTR TPR 78X50X7MM STRL MDPR 2 PC PE POR,"$1,407.50",$0.00,"$1,407.50",$0.00,"$1,004.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,407.50",$0.00,$703.75,"$1,114.74","$1,126.00",$0.00,$0.00,$0.00,$0.00,$0.00
86003,SUP,Custom 27803010,,86003  -  GRAFT SYNTH TISSUE CNTOUR TAPER 80X55X9MM 2 PIECE GRADUAL,"$1,407.50",$0.00,"$1,407.50",$0.00,"$1,004.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,407.50",$0.00,$703.75,"$1,114.74","$1,126.00",$0.00,$0.00,$0.00,$0.00,$0.00
86010,SUP,Custom 27803010,,86010  -  GRAFT SNTH TISS SM 3D 40X25X4MM STRL MDPR BTN MXLFCL CHIN,"$1,177.50",$0.00,"$1,177.50",$0.00,$840.38,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,177.50",$0.00,$588.75,$932.58,$942.00,$0.00,$0.00,$0.00,$0.00,$0.00
86011,SUP,Custom 27803010,,86011  -  GRAFT SNTH TISS MED 3D 47.5X37.5X5.5MM STRL MDPR BTN MXLFCL,"$1,177.50",$0.00,"$1,177.50",$0.00,$840.38,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,177.50",$0.00,$588.75,$932.58,$942.00,$0.00,$0.00,$0.00,$0.00,$0.00
86012,SUP,HCPCS C2627,,CATHETER SPBC MLCT 12FR 4 WNG DRAIN STRL LTX DISP AMBR,$38.19,$0.00,$38.19,$20.73,$27.25,$0.00,$6.58,$0.00,$0.00,$6.69,$38.19,$0.00,$19.09,$30.25,$30.55,$0.00,$5.98,$0.00,$6.08,$0.00
86014,SUP,HCPCS C1729,,086014  -  CATHETER SUPRAPUBIC 14FR 4 WING DRAIN LATEX MALECOT STERILE,$24.90,$0.00,$24.90,$13.52,$17.77,$0.00,$4.29,$0.00,$0.00,$4.36,$24.90,$0.00,$12.45,$19.72,$19.92,$0.00,$3.90,$0.00,$3.96,$0.00
86016,SUP,HCPCS C1729,,086016  -  CATHETER NPHSTM 16FR STRL LTX MLCT 4 WNG DRN NTR RBR DISP,$24.90,$0.00,$24.90,$13.52,$17.77,$0.00,$4.29,$0.00,$0.00,$4.36,$24.90,$0.00,$12.45,$19.72,$19.92,$0.00,$3.90,$0.00,$3.96,$0.00
86018,SUP,HCPCS C1751,,086018  -  CATHETER NPHSTM 18FR STRL LTX MLCT 4 WNG DRN NTR RBR DISP,$24.90,$0.00,$24.90,$13.52,$17.77,$0.00,$4.29,$0.00,$0.00,$4.36,$24.90,$0.00,$12.45,$19.72,$19.92,$0.00,$3.90,$0.00,$3.96,$0.00
86020,SUP,HCPCS C1729,,086020  -  CATH NPHSTM AMBR 20FR MLCT DRAIN 4 WNG STRL LATEX DISP,$368.10,$0.00,$368.10,$199.88,$262.71,$0.00,$63.42,$0.00,$0.00,$64.45,$368.10,$0.00,$184.05,$291.54,$294.48,$0.00,$57.61,$0.00,$58.60,$0.00
86022,SUP,HCPCS C1729,,086022  -  CATHETER NPHSTM 22FR STRL LTX MLCT 4 WNG DRN NTR RBR DISP,$24.90,$0.00,$24.90,$13.52,$17.77,$0.00,$4.29,$0.00,$0.00,$4.36,$24.90,$0.00,$12.45,$19.72,$19.92,$0.00,$3.90,$0.00,$3.96,$0.00
86024,SUP,HCPCS C1729,,086024  -  CATHETER NPHSTM 24FR STRL LTX MLCT 4 WNG DRN NTR RBR DISP,$24.90,$0.00,$24.90,$13.52,$17.77,$0.00,$4.29,$0.00,$0.00,$4.36,$24.90,$0.00,$12.45,$19.72,$19.92,$0.00,$3.90,$0.00,$3.96,$0.00
86026,SUP,HCPCS C1729,,086026  -  CATHETER NPHSTM 26FR STRL LTX MLCT 4 WNG DRN NTR RBR DISP,$24.90,$0.00,$24.90,$13.52,$17.77,$0.00,$4.29,$0.00,$0.00,$4.36,$24.90,$0.00,$12.45,$19.72,$19.92,$0.00,$3.90,$0.00,$3.96,$0.00
86028,SUP,HCPCS C1729,,086028  -  CATHETER NPHSTM 28FR STRL LTX MLCT 4 WNG DRN NTR RBR DISP,$24.90,$0.00,$24.90,$13.52,$17.77,$0.00,$4.29,$0.00,$0.00,$4.36,$24.90,$0.00,$12.45,$19.72,$19.92,$0.00,$3.90,$0.00,$3.96,$0.00
86030,SUP,HCPCS C1729,,086030  -  CATHETER NPHSTM 30FR STRL LTX MLCT 4 WNG DRN NTR RBR DISP,$24.90,$0.00,$24.90,$13.52,$17.77,$0.00,$4.29,$0.00,$0.00,$4.36,$24.90,$0.00,$12.45,$19.72,$19.92,$0.00,$3.90,$0.00,$3.96,$0.00
86032,SUP,HCPCS C1729,,086032  -  CATHETER NPHSTM 32FR STRL LTX MLCT 4 WNG DRN NTR RBR DISP,$24.90,$0.00,$24.90,$13.52,$17.77,$0.00,$4.29,$0.00,$0.00,$4.36,$24.90,$0.00,$12.45,$19.72,$19.92,$0.00,$3.90,$0.00,$3.96,$0.00
86034,SUP,HCPCS C1729,,086034  -  CATHETER NPHSTM 34FR STRL LTX MLCT 4 WNG DRN NTR RBR DISP,$24.90,$0.00,$24.90,$13.52,$17.77,$0.00,$4.29,$0.00,$0.00,$4.36,$24.90,$0.00,$12.45,$19.72,$19.92,$0.00,$3.90,$0.00,$3.96,$0.00
86036,SUP,HCPCS C1729,,086036  -  CATHETER NPHSTM 36FR STRL LTX MLCT 4 WNG DRN NTR RBR DISP,$4.15,$0.00,$4.15,$2.25,$2.96,$0.00,$0.72,$0.00,$0.00,$0.73,$4.15,$0.00,$2.08,$3.29,$3.32,$0.00,$0.65,$0.00,$0.66,$0.00
86038,SUP,HCPCS C1751,,086038  -  CATHETER NPHSTM 38FR STRL LTX MLCT 4 WNG DRN NTR RBR DISP,$61.35,$0.00,$61.35,$33.31,$43.79,$0.00,$10.57,$0.00,$0.00,$10.74,$61.35,$0.00,$30.68,$48.59,$49.08,$0.00,$9.60,$0.00,$9.77,$0.00
86202,SUP,Custom 27203010,,86202  -  TUBE ENDOTRAC 6MM CUF MRPH EYE OR R STRL LATEX FREE DISP,$12.26,$0.00,$12.26,$0.00,$8.75,$0.00,$0.00,$0.00,$0.00,$0.00,$12.26,$0.00,$6.13,$9.71,$9.81,$0.00,$0.00,$0.00,$0.00,$0.00
86203,SUP,Custom 27203010,,86203  -  TUBE ENDOTRAC 6.5MM CUF MRPH EYE PREFRM CURVE OR R STRL,$12.26,$0.00,$12.26,$0.00,$8.75,$0.00,$0.00,$0.00,$0.00,$0.00,$12.26,$0.00,$6.13,$9.71,$9.81,$0.00,$0.00,$0.00,$0.00,$0.00
86207,SUP,Custom 27203010,,86207  -  TUBE ORAL/TRACHEAL RAE 8.5MM CUFFED MURPHY TIP PREFORMED PVC,$14.41,$0.00,$14.41,$0.00,$10.29,$0.00,$0.00,$0.00,$0.00,$0.00,$14.41,$0.00,$7.21,$11.41,$11.53,$0.00,$0.00,$0.00,$0.00,$0.00
86207,SUP,Custom 27203010,,086207  -  TUBE ORAL/TRACHEAL RAE 8.5MM CUFFED MURPHY TIP PREFORMED PVC,$14.41,$0.00,$14.41,$0.00,$10.29,$0.00,$0.00,$0.00,$0.00,$0.00,$14.41,$0.00,$7.21,$11.41,$11.53,$0.00,$0.00,$0.00,$0.00,$0.00
86228,SUP,Custom 27203010,,86228  -  TUBE ENDOTRAC 22FR 5.5MM STD NSL/ORL UNCUF MRPH EYE RADIOPQ,$32.66,$0.00,$32.66,$0.00,$23.31,$0.00,$0.00,$0.00,$0.00,$0.00,$32.66,$0.00,$16.33,$25.87,$26.12,$0.00,$0.00,$0.00,$0.00,$0.00
86266,SUP,Custom 27203010,,86266  -  TUBE ENDOTRAC 4.5MM UNCUF MRPH EYE OR R,$87.85,$0.00,$87.85,$0.00,$62.69,$0.00,$0.00,$0.00,$0.00,$0.00,$87.85,$0.00,$43.92,$69.58,$70.28,$0.00,$0.00,$0.00,$0.00,$0.00
86287,SUP,Custom 27203010,,86287  -  TUBE NASOTRACHEAL RAE 21FR 5MM UNCUFFED MURPHY EYE,$8.49,$0.00,$8.49,$0.00,$6.06,$0.00,$0.00,$0.00,$0.00,$0.00,$8.49,$0.00,$4.24,$6.72,$6.79,$0.00,$0.00,$0.00,$0.00,$0.00
86311,SUP,HCPCS C1757,,86311  -  CATHETER  THROMBECTOMY PROGREAT PRELUMEN,"$1,487.50",$0.00,"$1,487.50",$0.00,"$1,061.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,487.50",$0.00,$743.75,"$1,178.10","$1,190.00",$0.00,$0.00,$0.00,$0.00,$0.00
86395,SUP,Custom 27203010,,86395  -  TUBE ET 7.9MM 5.5MM STRL SHLY LSRFLX 2 CUF MRPH EYE SS,$114.75,$0.00,$114.75,$0.00,$81.90,$0.00,$0.00,$0.00,$0.00,$0.00,$114.75,$0.00,$57.38,$90.88,$91.80,$0.00,$0.00,$0.00,$0.00,$0.00
86397,SUP,Custom 27203010,,86397  -  TUBE ET MGL CRV 7MM 4.5MM STRL LF LSRFLX MALLINCKRODT 2 CUF,$114.75,$0.00,$114.75,$0.00,$81.90,$0.00,$0.00,$0.00,$0.00,$0.00,$114.75,$0.00,$57.38,$90.88,$91.80,$0.00,$0.00,$0.00,$0.00,$0.00
86548,SUP,Custom 27203010,,86548  -  TUBE ENDOTRAC 6MM CUFF REINFORCE MURPHY EYE PVC SILICONE,$45.30,$0.00,$45.30,$0.00,$32.33,$0.00,$0.00,$0.00,$0.00,$0.00,$45.30,$0.00,$22.65,$35.88,$36.24,$0.00,$0.00,$0.00,$0.00,$0.00
86551,SUP,Custom 27203010,,86551  -  TUBE ENDOTRAC 7.5MM NSL/ORL CUF MRPH EYE REINF SIL SS STRL,$50.59,$0.00,$50.59,$0.00,$36.10,$0.00,$0.00,$0.00,$0.00,$0.00,$50.59,$0.00,$25.29,$40.07,$40.47,$0.00,$0.00,$0.00,$0.00,$0.00
86552,SUP,Custom 27203010,,86552  -  TUBE ENDOTRAC 8MM CUF REINF STRL,$312.93,$0.00,$312.93,$0.00,$223.34,$0.00,$0.00,$0.00,$0.00,$0.00,$312.93,$0.00,$156.47,$247.84,$250.35,$0.00,$0.00,$0.00,$0.00,$0.00
86700,SUP,HCPCS C1753,,86700  -  CATH US .018IN 3.4FR 135CM INTVASC NONUNIFORM ROT DSTRTN VSN,"$1,687.50",$0.00,"$1,687.50",$916.31,"$1,204.37",$0.00,$290.75,$0.00,$0.00,$295.47,"$1,687.50",$0.00,$843.75,"$1,336.50","$1,350.00",$0.00,$264.09,$0.00,$268.65,$0.00
87003,SUP,Custom 27803010,,87003  -  GRAFT SYNTH TISSUE 26X25X2.5MM IMPLANT POROUS MEDPOR IMORI,"$1,310.00",$0.00,"$1,310.00",$0.00,$934.95,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,310.00",$0.00,$655.00,"$1,037.52","$1,048.00",$0.00,$0.00,$0.00,$0.00,$0.00
87004,SUP,Custom 27803010,,87004  -  GRAFT SYNTH TISSUE 26X25X2.5MM IMPLANT POROUS MEDPOR IMORI,"$1,310.00",$0.00,"$1,310.00",$0.00,$934.95,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,310.00",$0.00,$655.00,"$1,037.52","$1,048.00",$0.00,$0.00,$0.00,$0.00,$0.00
87118,SUP,Custom 27203010,,SLIDE KOVA 2 GLSTC 4 WELL WO GRID UA,$241.95,$0.00,$241.95,$0.00,$172.68,$0.00,$0.00,$0.00,$0.00,$0.00,$241.95,$0.00,$120.98,$191.62,$193.56,$0.00,$0.00,$0.00,$0.00,$0.00
88000,SUP,HCPCS B4088,,88000  -  TUBE JJNSTM 55IN 28FR 12FR SIL CMPCT BLN RADIOPQ STRP ADPR,$263.90,$0.00,$263.90,$0.00,$188.35,$0.00,$0.00,$0.00,$0.00,$0.00,$263.90,$0.00,$131.95,$209.01,$211.12,$0.00,$0.00,$0.00,$0.00,$0.00
88037,SUP,Custom 27803010,,88037  -  GRAFT SYNTH TISSUE 59X29X7MM IMPLANT CNTOUR ANGLED POROUS,"$1,897.50",$0.00,"$1,897.50",$0.00,"$1,354.25",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,897.50",$0.00,$948.75,"$1,502.82","$1,518.00",$0.00,$0.00,$0.00,$0.00,$0.00
88038,SUP,Custom 27803010,,88038  -  GRAFT SYNTH TISSUE 59X29X7MM IMPLANT CNTOUR ANGLED POROUS,"$1,897.50",$0.00,"$1,897.50",$0.00,"$1,354.25",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,897.50",$0.00,$948.75,"$1,502.82","$1,518.00",$0.00,$0.00,$0.00,$0.00,$0.00
88051,SUP,Custom 27803010,,88051  -  GRAFT SYNTH TISSUE 79X37X5MM IMPLANT RAMUS INFERIOR RIDGE,"$1,867.50",$0.00,"$1,867.50",$0.00,"$1,332.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,867.50",$0.00,$933.75,"$1,479.06","$1,494.00",$0.00,$0.00,$0.00,$0.00,$0.00
88052,SUP,Custom 27803010,,88052  -  GRAFT SYNTH TISSUE 79X37X5MM IMPLANT RAMUS INFERIOR RIDGE,"$1,867.50",$0.00,"$1,867.50",$0.00,"$1,332.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,867.50",$0.00,$933.75,"$1,479.06","$1,494.00",$0.00,$0.00,$0.00,$0.00,$0.00
88053,SUP,Custom 27803010,,88053  -  GRAFT SYNTH TISSUE ANGLE LARGE 57X40X4MM AUGMENTATION,"$1,867.50",$0.00,"$1,867.50",$0.00,"$1,332.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,867.50",$0.00,$933.75,"$1,479.06","$1,494.00",$0.00,$0.00,$0.00,$0.00,$0.00
88054,SUP,Custom 27803010,,88054  -  MANDIBLE ANGLE LARGE - RIGHT-57MM X 40MM X 4MM X 10MM X 4MM,"$1,380.00",$0.00,"$1,380.00",$0.00,$984.91,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,380.00",$0.00,$690.00,"$1,092.96","$1,104.00",$0.00,$0.00,$0.00,$0.00,$0.00
88710,SUP,HCPCS C1713,,SPACER MDI ARCHB+ SM VLV HLD CHMBR HNDHLD CMFSL MASK PED,$41.80,$0.00,$41.80,$18.81,$29.83,$0.00,$7.20,$0.00,$0.00,$7.32,$41.80,$0.00,$20.90,$33.11,$33.44,$0.00,$6.54,$0.00,$6.65,$0.00
88900,SUP,HCPCS C1725,,88900  -  CATH US .038IN 8.2FR 90CM INTVASC PULBCK SLED REV,"$2,125.00",$0.00,"$2,125.00","$1,153.88","$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
88901,SUP,HCPCS C1753,,88901  -  CATHETER ULTRASOUND .035IN 8.5FR 90CM 100CM OTW RADIOPQ,"$2,500.00",$0.00,"$2,500.00","$1,357.50","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
89007,SUP,HCPCS C2617,,089007  -  STENT URETERAL 7FR 90CM LUBRICIOUS GWIRE LATEX FREE STERILE,$213.05,$0.00,$213.05,$95.87,$152.05,$0.00,$36.71,$0.00,$0.00,$37.30,$213.05,$0.00,$106.53,$168.74,$170.44,$0.00,$33.34,$0.00,$33.92,$0.00
89008,SUP,HCPCS C2617,,089008  -  STENT URETERAL 8FR 90CM LUBRICIOUS GWIRE LATEX FREE STERILE,$213.05,$0.00,$213.05,$95.87,$152.05,$0.00,$36.71,$0.00,$0.00,$37.30,$213.05,$0.00,$106.53,$168.74,$170.44,$0.00,$33.34,$0.00,$33.92,$0.00
89020,SUP,HCPCS C1763,,89020  -  TISSUE SYNTH PE POR MEDPOR IMPL CSTM CRANIAL,"$4,500.00",$0.00,"$4,500.00","$2,025.00","$3,211.65",$0.00,$775.33,$0.00,$0.00,$787.91,"$4,500.00",$0.00,"$2,250.00","$3,564.00","$3,600.00",$0.00,$704.25,$0.00,$716.40,$0.00
89104,SUP,HCPCS C1713,,89104  -  SCREW 89104 CD THR PLUG,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
89223,SUP,Custom 27803010,,89223  -  IMPLANT SOFT TISSUE FLAT 4X1X1CM MOIST TOUGH FLEXIBLE SHEET,"$1,120.00",$0.00,"$1,120.00",$0.00,$799.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,120.00",$0.00,$560.00,$887.04,$896.00,$0.00,$0.00,$0.00,$0.00,$0.00
89224,SUP,Custom 27803010,,89224  -  IMPLANT SOFT TISSUE THK1MM FLAT 5X2CM MOIST TOUGH FLEXIBLE,"$2,267.50",$0.00,"$2,267.50",$0.00,"$1,618.31",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,267.50",$0.00,"$1,133.75","$1,795.86","$1,814.00",$0.00,$0.00,$0.00,$0.00,$0.00
89225,SUP,Custom 27803010,,89225  -  IMPLANT SOFT TISSUE 8X3X1CM MOIST TOUGH FLEXIBLE FLAT SHEET,"$2,742.50",$0.00,"$2,742.50",$0.00,"$1,957.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,742.50",$0.00,"$1,371.25","$2,172.06","$2,194.00",$0.00,$0.00,$0.00,$0.00,$0.00
89612,SUP,Custom 27203010,,TIP PIP 1100UL EPNDF CNDCT,"$3,545.00",$0.00,"$3,545.00",$0.00,"$2,530.07",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,545.00",$0.00,"$1,772.50","$2,807.64","$2,836.00",$0.00,$0.00,$0.00,$0.00,$0.00
89894,SUP,Custom 27203010,,WASHER PIP KT,$547.50,$0.00,$547.50,$0.00,$390.75,$0.00,$0.00,$0.00,$0.00,$0.00,$547.50,$0.00,$273.75,$433.62,$438.00,$0.00,$0.00,$0.00,$0.00,$0.00
90001,SUP,Custom 27203010,,090001  -  NEEDLE ENDSCP 35CM 23GA 8MM URTH CSCP INJEC PRC WMS,$48.50,$0.00,$48.50,$0.00,$34.61,$0.00,$0.00,$0.00,$0.00,$0.00,$48.50,$0.00,$24.25,$38.41,$38.80,$0.00,$0.00,$0.00,$0.00,$0.00
90044,SUP,HCPCS C1887,,90044  -  CATHETER ANGIO 3-2.4FR 150CM MRC 1 LUM RADOPQ,"$1,187.50",$0.00,"$1,187.50",$644.81,$847.52,$0.00,$204.60,$0.00,$0.00,$207.92,"$1,187.50",$0.00,$593.75,$940.50,$950.00,$0.00,$185.84,$0.00,$189.05,$0.00
90051,SUP,Custom 27203010,,90051  -  CATHETER URETHRAL 16FR FOLEY TEMPERATURE SENSOR LATEX FREE,$3.93,$0.00,$25.75,$0.00,$18.38,$0.00,$0.00,$0.00,$0.00,$0.00,$25.75,$0.00,$12.88,$3.11,$20.60,$0.00,$0.00,$0.00,$0.00,$0.00
90071,SUP,Custom 27203010,,090071  -  NEEDLE FASCIAL INCISING 10MM,$76.95,$0.00,$76.95,$0.00,$54.92,$0.00,$0.00,$0.00,$0.00,$0.00,$76.95,$0.00,$38.48,$60.94,$61.56,$0.00,$0.00,$0.00,$0.00,$0.00
90071,SUP,Custom 27203010,,90071  -  NEEDLE 5CM 18GA GWIRE PRC RNL FSCA 10MM,$82.45,$0.00,$76.95,$0.00,$54.92,$0.00,$0.00,$0.00,$0.00,$0.00,$76.95,$0.00,$38.48,$65.30,$61.56,$0.00,$0.00,$0.00,$0.00,$0.00
90073,SUP,HCPCS C1887,,CATHETER GUID .038IN 8FR 5.9FR 95CM BLN SIL MRC,"$2,187.50",$0.00,"$2,187.50","$1,187.81","$1,561.22",$0.00,$376.90,$0.00,$0.00,$383.01,"$2,187.50",$0.00,"$1,093.75","$1,732.50","$1,750.00",$0.00,$342.34,$0.00,$348.25,$0.00
90074,SUP,HCPCS C1887,,CATHETER BALLOON GUIDE CONCENTRIC 9F 95CM,"$2,187.50",$0.00,"$2,187.50","$1,187.81","$1,561.22",$0.00,$376.90,$0.00,$0.00,$383.01,"$2,187.50",$0.00,"$1,093.75","$1,732.50","$1,750.00",$0.00,$342.34,$0.00,$348.25,$0.00
90076,SUP,HCPCS C1887,,CATHETER BALLOON GUIDE CONCENTRIC 8F 80CM,"$2,187.50",$0.00,"$2,187.50","$1,187.81","$1,561.22",$0.00,$376.90,$0.00,$0.00,$383.01,"$2,187.50",$0.00,"$1,093.75","$1,732.50","$1,750.00",$0.00,$342.34,$0.00,$348.25,$0.00
90077,SUP,HCPCS C1887,,CATHETER BALLOON GUIDE 9F 80CM,"$2,187.50",$0.00,"$2,187.50","$1,187.81","$1,561.22",$0.00,$376.90,$0.00,$0.00,$383.01,"$2,187.50",$0.00,"$1,093.75","$1,732.50","$1,750.00",$0.00,$342.34,$0.00,$348.25,$0.00
90110,SUP,HCPCS C1757,,90110  -  CATHETER THRMB CRKSCR 2MM 180CM 5MM MRC V RTRV V2 FIRM NTNL,"$7,987.50",$0.00,"$7,987.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,987.50",$0.00,"$3,993.75","$6,326.10","$6,390.00",$0.00,$0.00,$0.00,$0.00,$0.00
90111,SUP,HCPCS C1757,,90111  -  CATHETER THRMB CRKSCR 2.5MM 180CM 6MM MRC V RETREIEVER V2.5,"$7,987.50",$0.00,"$7,987.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,987.50",$0.00,"$3,993.75","$6,326.10","$6,390.00",$0.00,$0.00,$0.00,$0.00,$0.00
90112,SUP,HCPCS C1757,,90112  -  CATHETER THRMB CRKSCR 2.5MM 180CM 6MM MRC V RETREIVER V2.5,"$7,987.50",$0.00,"$7,987.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,987.50",$0.00,"$3,993.75","$6,326.10","$6,390.00",$0.00,$0.00,$0.00,$0.00,$0.00
90113,SUP,HCPCS C1757,,90113  -  CATHETER THRMB CRKSCR 3MM 180CM 7MM MRC V RTRV V3 SFT NTNL,"$7,987.50",$0.00,"$7,987.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,987.50",$0.00,"$3,993.75","$6,326.10","$6,390.00",$0.00,$0.00,$0.00,$0.00,$0.00
90120,SUP,HCPCS C1757,,90120  -  CATHETER THRMB 3.9FR .038IN 125CM DAC 1 LUM BRAID RADOPQ LL,"$2,700.15",$0.00,"$2,700.15",$0.00,"$1,927.10",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,700.15",$0.00,"$1,350.08","$2,138.52","$2,160.12",$0.00,$0.00,$0.00,$0.00,$0.00
90121,SUP,HCPCS C1887,,CATHETER THROMBECTOMY DAC 038 - 136CM,"$2,487.50",$0.00,"$2,487.50","$1,350.71","$1,775.33",$0.00,$428.58,$0.00,$0.00,$435.54,"$2,487.50",$0.00,"$1,243.75","$1,970.10","$1,990.00",$0.00,$389.29,$0.00,$396.01,$0.00
90131,SUP,HCPCS C1887,,CATHETER DISTAL ACCESS DAC 057 - 125CM,"$2,487.50",$0.00,"$2,487.50","$1,350.71","$1,775.33",$0.00,$428.58,$0.00,$0.00,$435.54,"$2,487.50",$0.00,"$1,243.75","$1,970.10","$1,990.00",$0.00,$389.29,$0.00,$396.01,$0.00
90160,SUP,HCPCS C1757,,90160  -  CATHETER THRMB 4.3FR .044IN 115CM DAC 1 LUM BRAID RADOPQ LL,"$2,700.15",$0.00,"$2,700.15",$0.00,"$1,927.10",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,700.15",$0.00,"$1,350.08","$2,138.52","$2,160.12",$0.00,$0.00,$0.00,$0.00,$0.00
90161,SUP,HCPCS C1757,,90161  -  CATHETER THROMBECTOMY DAC® 044 0.044IN / 130CM RADIOPQ SHAFT,"$2,573.25",$0.00,"$2,573.25",$0.00,"$1,836.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,573.25",$0.00,"$1,286.63","$2,038.01","$2,058.60",$0.00,$0.00,$0.00,$0.00,$0.00
90162,SUP,HCPCS C1757,,90162  -  CATHETER THRMB 4.3FR .044IN 136CM DAC 1 LUM BRAID RADOPQ LL,"$2,700.15",$0.00,"$2,700.15",$0.00,"$1,927.10",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,700.15",$0.00,"$1,350.08","$2,138.52","$2,160.12",$0.00,$0.00,$0.00,$0.00,$0.00
90170,SUP,HCPCS C1757,,90170  -  CATHETER THRMB 6.3FR .07IN 105CM DAC 1 LUM BRD RADOPQ LL HUB,"$2,700.15",$0.00,"$2,700.15",$0.00,"$1,927.10",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,700.15",$0.00,"$1,350.08","$2,138.52","$2,160.12",$0.00,$0.00,$0.00,$0.00,$0.00
90171,SUP,HCPCS C1757,,90171  -  CATHETER THRMB 6.3FR .07IN 120CM DAC 1 LUM BRD RADOPQ LL HUB,"$2,700.15",$0.00,"$2,700.15",$0.00,"$1,927.10",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,700.15",$0.00,"$1,350.08","$2,138.52","$2,160.12",$0.00,$0.00,$0.00,$0.00,$0.00
90182,SUP,Custom 27203010,,90182  -  RETRIEVER ESCP 4MM 20MM TREVO XP PROVUE,"$13,116.25",$0.00,"$13,116.25",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,116.25",$0.00,"$6,558.13","$10,388.07","$10,493.00",$0.00,$0.00,$0.00,$0.00,$0.00
90183,SUP,Custom 27203010,,90183  -  RETRIEVER ESCP 3MM 20MM TREVO XP PROVUE,"$13,116.25",$0.00,"$13,116.25",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,116.25",$0.00,"$6,558.13","$10,388.07","$10,493.00",$0.00,$0.00,$0.00,$0.00,$0.00
90231,SUP,HCPCS C1757,,90231  -  CATHETER INFS MIC 18FR TREVO PRO NRVSC,"$1,703.75",$0.00,"$1,703.75",$0.00,"$1,215.97",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,703.75",$0.00,$851.88,"$1,349.37","$1,363.00",$0.00,$0.00,$0.00,$0.00,$0.00
90603,SUP,Custom 27203010,,90603  -  DRESSING TRANSPARENT 8X8IN ABSORBENT NONADHESIVE,$28.88,$0.00,$28.88,$0.00,$20.61,$0.00,$0.00,$0.00,$0.00,$0.00,$28.88,$0.00,$14.44,$22.87,$23.11,$0.00,$0.00,$0.00,$0.00,$0.00
90605,SUP,Custom 27203010,,90605  -  DRESSING FOAM 24X4IN NONADHESIVE HIGH FLUID HANDLE,$49.61,$0.00,$49.61,$0.00,$35.41,$0.00,$0.00,$0.00,$0.00,$0.00,$49.61,$0.00,$24.80,$39.29,$39.69,$0.00,$0.00,$0.00,$0.00,$0.00
90730,SUP,HCPCS C1757,,90730  -  CATHETER THRMB 5.2FR .057IN 115CM DAC 1 LUM BRAID RADOPQ LL,"$2,700.15",$0.00,"$2,700.15",$0.00,"$1,927.10",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,700.15",$0.00,"$1,350.08","$2,138.52","$2,160.12",$0.00,$0.00,$0.00,$0.00,$0.00
90760,SUP,HCPCS C1757,,90760  -  CATHETER THRMB 4.3FR .044IN 130CM DAC 1 LUM BRAID RADOPQ LL,"$2,573.25",$0.00,"$2,573.25",$0.00,"$1,836.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,573.25",$0.00,"$1,286.63","$2,038.01","$2,058.60",$0.00,$0.00,$0.00,$0.00,$0.00
90805,SUP,Custom 27203010,,90805  -  DRESSING TRANSPARENT LARGE SQUARE 8INX7 7/8IN 6INX5 7/8IN,$24.44,$0.00,$24.44,$0.00,$17.44,$0.00,$0.00,$0.00,$0.00,$0.00,$24.44,$0.00,$12.22,$19.36,$19.55,$0.00,$0.00,$0.00,$0.00,$0.00
91101,SUP,Custom 27203010,,91101  -  CATHETER NEUROSURGICAL ANTIBIOTIC IMPREGNATED ARES VENTRICLE,$770.00,$0.00,$770.00,$0.00,$549.55,$0.00,$0.00,$0.00,$0.00,$0.00,$770.00,$0.00,$385.00,$609.84,$616.00,$0.00,$0.00,$0.00,$0.00,$0.00
91265,SUP,Custom 27203010,,91265  -  FLAT VENOUS 2 STAGE CANNULA MC2,$86.09,$0.00,$86.09,$0.00,$61.44,$0.00,$0.00,$0.00,$0.00,$0.00,$86.09,$0.00,$43.04,$68.18,$68.87,$0.00,$0.00,$0.00,$0.00,$0.00
91503,SUP,Custom 27803010,,91503  -  CATH 91503 BIOGLIDE VENT 23CM CLOSED IMP,$513.00,$0.00,$513.00,$0.00,$366.13,$0.00,$0.00,$0.00,$0.00,$0.00,$513.00,$0.00,$256.50,$406.30,$410.40,$0.00,$0.00,$0.00,$0.00,$0.00
92001,SUP,Custom 27203010,,092001  -  CLIP INTNL ANG RT 15MM STRL LF LDS LNR CTR PWR SF LKOUT,$387.15,$0.00,$387.15,$0.00,$276.31,$0.00,$0.00,$0.00,$0.00,$0.00,$387.15,$0.00,$193.58,$306.62,$309.72,$0.00,$0.00,$0.00,$0.00,$0.00
92100,SUP,Custom 27203010,,0092100  -  TUBE ESPH 20FR 8IN NS LTX 1.5IN BLKMR BLN SPCL NTR RBR ADLT,$365.88,$0.00,$365.88,$0.00,$261.13,$0.00,$0.00,$0.00,$0.00,$0.00,$365.88,$0.00,$182.94,$289.78,$292.71,$0.00,$0.00,$0.00,$0.00,$0.00
92100,SUP,Custom 27203010,,TUBE NG 8IN 20FR 3 LUM BLN RADIOPQ STRP BLKMR ADLT NSTRL LTX,$889.18,$0.00,$704.23,$0.00,$261.13,$0.00,$0.00,$0.00,$0.00,$0.00,$365.88,$0.00,$182.94,$704.23,$292.71,$0.00,$0.00,$0.00,$0.00,$0.00
92312,SUP,Custom 27803010,,92312  -  VALVE 92312 CSF CONTRD SML LOW BIO,"$2,681.38",$0.00,"$2,681.38",$0.00,"$1,913.70",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,681.38",$0.00,"$1,340.69","$2,123.65","$2,145.10",$0.00,$0.00,$0.00,$0.00,$0.00
92314,SUP,Custom 27803010,,92314  -  VALVE 92314 CSF CONT SML MED BIO,"$2,681.38",$0.00,"$2,681.38",$0.00,"$1,913.70",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,681.38",$0.00,"$1,340.69","$2,123.65","$2,145.10",$0.00,$0.00,$0.00,$0.00,$0.00
92316,SUP,Custom 27803010,,92316  -  VALVE 92316 CSF CONT SML HIGH BIO,"$3,018.63",$0.00,"$3,018.63",$0.00,"$2,154.39",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,018.63",$0.00,"$1,509.31","$2,390.75","$2,414.90",$0.00,$0.00,$0.00,$0.00,$0.00
92322,SUP,Custom 27803010,,92322  -  VALVE 92322 CSF CONT REG LOW BIO,"$2,681.38",$0.00,"$2,681.38",$0.00,"$1,913.70",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,681.38",$0.00,"$1,340.69","$2,123.65","$2,145.10",$0.00,$0.00,$0.00,$0.00,$0.00
92324,SUP,Custom 27803010,,92324  -  VALVE 92324 CSF CONT REG MED BIO,"$2,681.38",$0.00,"$2,681.38",$0.00,"$1,913.70",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,681.38",$0.00,"$1,340.69","$2,123.65","$2,145.10",$0.00,$0.00,$0.00,$0.00,$0.00
92326,SUP,Custom 27803010,,92326  -  VALVE 92326 CSF CONT REG HIGH BIO,"$2,681.38",$0.00,"$2,681.38",$0.00,"$1,913.70",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,681.38",$0.00,"$1,340.69","$2,123.65","$2,145.10",$0.00,$0.00,$0.00,$0.00,$0.00
92355,SUP,Custom 27803010,,92355  -  VALVE 92355 STRATA NSC SML BIOGLIDE,"$9,501.05",$0.00,"$9,501.05",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$9,501.05",$0.00,"$4,750.53","$7,524.83","$7,600.84",$0.00,$0.00,$0.00,$0.00,$0.00
92365,SUP,Custom 27803010,,92365  -  VALVE 92365 STRATA NSC REG BIOGLIDE,"$9,501.05",$0.00,"$9,501.05",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$9,501.05",$0.00,"$4,750.53","$7,524.83","$7,600.84",$0.00,$0.00,$0.00,$0.00,$0.00
92812,SUP,Custom 27803010,,92812  -  VALVE 92812 BIOGLIDE DELTA SM 1.0,"$4,358.13",$0.00,"$4,358.13",$0.00,"$3,110.39",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,358.13",$0.00,"$2,179.06","$3,451.64","$3,486.50",$0.00,$0.00,$0.00,$0.00,$0.00
92813,SUP,Custom 27803010,,92813  -  VALVE 92813 BIOGLIDE DELTA SM 1.5,"$4,358.13",$0.00,"$4,358.13",$0.00,"$3,110.39",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,358.13",$0.00,"$2,179.06","$3,451.64","$3,486.50",$0.00,$0.00,$0.00,$0.00,$0.00
92814,SUP,Custom 27803010,,92814  -  VALVE 92814 BIOGLIDE DELTA SM 2.0,"$4,358.13",$0.00,"$4,358.13",$0.00,"$3,110.39",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,358.13",$0.00,"$2,179.06","$3,451.64","$3,486.50",$0.00,$0.00,$0.00,$0.00,$0.00
92822,SUP,Custom 27803010,,92822  -  VALVE 92822 BIOGLIDE DELTA REG. 1.0,"$4,358.13",$0.00,"$4,358.13",$0.00,"$3,110.39",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,358.13",$0.00,"$2,179.06","$3,451.64","$3,486.50",$0.00,$0.00,$0.00,$0.00,$0.00
92823,SUP,Custom 27803010,,92823  -  VALVE 92823 BIOGLIDE DELTA REG. 1.5,"$4,358.13",$0.00,"$4,358.13",$0.00,"$3,110.39",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,358.13",$0.00,"$2,179.06","$3,451.64","$3,486.50",$0.00,$0.00,$0.00,$0.00,$0.00
92824,SUP,Custom 27803010,,92824  -  VALVE 92824 BIOGLIDE DELTA REG. 2.0,"$4,358.13",$0.00,"$4,358.13",$0.00,"$3,110.39",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,358.13",$0.00,"$2,179.06","$3,451.64","$3,486.50",$0.00,$0.00,$0.00,$0.00,$0.00
92830,SUP,Custom 27803010,,92830  -  VALVE 92830 DELTA BH 12MM PL 0.5 BIOGLID,"$4,612.25",$0.00,"$4,612.25",$0.00,"$3,291.76",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,612.25",$0.00,"$2,306.13","$3,652.90","$3,689.80",$0.00,$0.00,$0.00,$0.00,$0.00
92833,SUP,Custom 27803010,,92833  -  VALVE 92833 BIOGLIDE DELTA BH 12 1.5,"$3,904.50",$0.00,"$3,904.50",$0.00,"$2,786.64",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,904.50",$0.00,"$1,952.25","$3,092.36","$3,123.60",$0.00,$0.00,$0.00,$0.00,$0.00
92834,SUP,Custom 27803010,,92834  -  VALVE 92834 BIOGLIDE DELTA BH 12 2.0,"$4,612.25",$0.00,"$4,612.25",$0.00,"$3,291.76",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,612.25",$0.00,"$2,306.13","$3,652.90","$3,689.80",$0.00,$0.00,$0.00,$0.00,$0.00
92840,SUP,Custom 27803010,,92840  -  VALVE 92840 DELTA BH 16MM PL 0.5 BIOGLID,"$3,904.50",$0.00,"$3,904.50",$0.00,"$2,786.64",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,904.50",$0.00,"$1,952.25","$3,092.36","$3,123.60",$0.00,$0.00,$0.00,$0.00,$0.00
92842,SUP,Custom 27803010,,92842  -  VALVE 92842 BIOGLIDE DELTA BH 16 1.0,"$3,904.50",$0.00,"$3,904.50",$0.00,"$2,786.64",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,904.50",$0.00,"$1,952.25","$3,092.36","$3,123.60",$0.00,$0.00,$0.00,$0.00,$0.00
92843,SUP,Custom 27803010,,92843  -  VALVE 92843 BIOGLIDE DELTA BH 16 1.5,"$3,904.50",$0.00,"$3,904.50",$0.00,"$2,786.64",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,904.50",$0.00,"$1,952.25","$3,092.36","$3,123.60",$0.00,$0.00,$0.00,$0.00,$0.00
92844,SUP,Custom 27803010,,92844  -  VALVE 92844 BIOGLIDE DELTA BH 16 2.0,"$3,904.50",$0.00,"$3,904.50",$0.00,"$2,786.64",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,904.50",$0.00,"$1,952.25","$3,092.36","$3,123.60",$0.00,$0.00,$0.00,$0.00,$0.00
92856,SUP,Custom 27803010,,92856  -  VALVE 92856 FP STRATA 2 SML BG,"$10,337.65",$0.00,"$10,337.65",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$10,337.65",$0.00,"$5,168.83","$8,187.42","$8,270.12",$0.00,$0.00,$0.00,$0.00,$0.00
92866,SUP,Custom 27803010,,92866  -  VALVE 92866 FP STRATA 2 REG BG,"$10,337.65",$0.00,"$10,337.65",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$10,337.65",$0.00,"$5,168.83","$8,187.42","$8,270.12",$0.00,$0.00,$0.00,$0.00,$0.00
93092,SUP,Custom 27203010,,93092  -  CATHETER NEUROSURGICAL 120CM ANTIBIOTIC IMPREGNATED ARES,$770.00,$0.00,$770.00,$0.00,$549.55,$0.00,$0.00,$0.00,$0.00,$0.00,$770.00,$0.00,$385.00,$609.84,$616.00,$0.00,$0.00,$0.00,$0.00,$0.00
93320,SUP,HCPCS C1769,,93320  -  WIRE 35-180 COONS,$60.75,$0.00,$60.75,$32.99,$43.36,$0.00,$10.47,$0.00,$0.00,$10.64,$60.75,$0.00,$30.38,$48.11,$48.60,$0.00,$9.51,$0.00,$9.67,$0.00
93522,SUP,Custom 27803010,,93522  -  CATHETER 93522 BIOGLIDE PERITONEAL,$543.88,$0.00,$543.88,$0.00,$388.16,$0.00,$0.00,$0.00,$0.00,$0.00,$543.88,$0.00,$271.94,$430.75,$435.10,$0.00,$0.00,$0.00,$0.00,$0.00
94965,SUP,Custom 27203010,,94965  -  DLP RETROGRADE CORONARY PERFUSION CANNULA 15 FR,$218.25,$0.00,$218.25,$0.00,$155.77,$0.00,$0.00,$0.00,$0.00,$0.00,$218.25,$0.00,$109.13,$172.85,$174.60,$0.00,$0.00,$0.00,$0.00,$0.00
95001,SUP,Custom 27203010,,95001  -  KIT CATH STRL LF ARES ANBTC,"$1,350.00",$0.00,"$1,350.00",$0.00,$963.50,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,350.00",$0.00,$675.00,"$1,069.20","$1,080.00",$0.00,$0.00,$0.00,$0.00,$0.00
95201,SUP,Custom 27203010,,PUMP CNTRF BPMP BPX80 STRL,$425.00,$0.00,$425.00,$0.00,$303.32,$0.00,$0.00,$0.00,$0.00,$0.00,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$0.00,$0.00,$0.00,$0.00
96115,SUP,Custom 27803010,,96115  -  CATH 96115 BIOGLIDE EDM VENT 20 CM,$458.40,$0.00,$458.40,$0.00,$327.16,$0.00,$0.00,$0.00,$0.00,$0.00,$458.40,$0.00,$229.20,$363.05,$366.72,$0.00,$0.00,$0.00,$0.00,$0.00
96118,SUP,Custom 27803010,,96118  -  CATH 96118 BIOGLIDE EDM VENT 35 CM,$549.60,$0.00,$549.60,$0.00,$392.25,$0.00,$0.00,$0.00,$0.00,$0.00,$549.60,$0.00,$274.80,$435.28,$439.68,$0.00,$0.00,$0.00,$0.00,$0.00
96655,SUP,Custom 27803010,,96655  -  SHUNT 96655 STRATA NSC ASSY SML BIOGLIDE,"$9,921.70",$0.00,"$9,921.70",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$9,921.70",$0.00,"$4,960.85","$7,857.99","$7,937.36",$0.00,$0.00,$0.00,$0.00,$0.00
96665,SUP,Custom 27803010,,96665  -  SHUNT 96665 STRATA NSC ASSY REG BIOGLIDE,"$9,921.70",$0.00,"$9,921.70",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$9,921.70",$0.00,"$4,960.85","$7,857.99","$7,937.36",$0.00,$0.00,$0.00,$0.00,$0.00
96812,SUP,Custom 27803010,,96812  -  SHUNT 96812 DELTA ASSY SMALL P/L 1.0 BIO,"$4,949.50",$0.00,"$4,949.50",$0.00,"$3,532.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,949.50",$0.00,"$2,474.75","$3,920.00","$3,959.60",$0.00,$0.00,$0.00,$0.00,$0.00
96813,SUP,Custom 27803010,,96813  -  SHUNT 96813 DELTA ASSY SMALL P/L 1.5 BIO,"$4,949.50",$0.00,"$4,949.50",$0.00,"$3,532.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,949.50",$0.00,"$2,474.75","$3,920.00","$3,959.60",$0.00,$0.00,$0.00,$0.00,$0.00
96814,SUP,Custom 27803010,,96814  -  SHUNT 96814 DELTA ASSY SMALL P/L 2.0 BIO,"$4,949.50",$0.00,"$4,949.50",$0.00,"$3,532.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,949.50",$0.00,"$2,474.75","$3,920.00","$3,959.60",$0.00,$0.00,$0.00,$0.00,$0.00
96822,SUP,Custom 27803010,,96822  -  SHUNT 96822 DELTA ASSY REG P/L 1.0 BIO,"$4,949.50",$0.00,"$4,949.50",$0.00,"$3,532.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,949.50",$0.00,"$2,474.75","$3,920.00","$3,959.60",$0.00,$0.00,$0.00,$0.00,$0.00
96823,SUP,Custom 27803010,,96823  -  SHUNT 96823 DELTA ASSY REG P/L 1.5 BIO,"$4,949.50",$0.00,"$4,949.50",$0.00,"$3,532.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,949.50",$0.00,"$2,474.75","$3,920.00","$3,959.60",$0.00,$0.00,$0.00,$0.00,$0.00
96824,SUP,Custom 27803010,,96824  -  SHUNT 96824 DELTA ASSY REG P/L 2.0 BIO,"$5,569.38",$0.00,"$5,569.38",$0.00,"$3,974.86",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,569.38",$0.00,"$2,784.69","$4,410.95","$4,455.50",$0.00,$0.00,$0.00,$0.00,$0.00
97021,SUP,Custom 27203010,,KIT OC KIMVENT SLF CLEAN Y CONNCTR SCT HNDL,$38.04,$0.00,$38.04,$0.00,$27.15,$0.00,$0.00,$0.00,$0.00,$0.00,$38.04,$0.00,$19.02,$30.13,$30.43,$0.00,$0.00,$0.00,$0.00,$0.00
98200,SUP,Custom 27203010,,TRIAGE BIOSITE BNP REAGENT 2/PK,"$3,000.00",$0.00,"$3,000.00",$0.00,"$2,141.10",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
98201,SUP,Custom 27203010,,CONTROL BNP TRG BKMN SYS IMMUN,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
98202,SUP,Custom 27203010,,CALIBRATOR CHM BKMN SYS VRFR BNP TRG 98202,$200.00,$0.00,$200.00,$0.00,$142.74,$0.00,$0.00,$0.00,$0.00,$0.00,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$0.00,$0.00,$0.00,$0.00
98433,SUP,HCPCS C1894,,98433  -  KIT GASTROSTOMY 22FR 18GA DILAT INTROD NEEDLE HEMOSTAT LATEX,$531.70,$0.00,$531.70,$288.71,$379.47,$0.00,$91.61,$0.00,$0.00,$93.10,$531.70,$0.00,$265.85,$421.11,$425.36,$0.00,$83.21,$0.00,$84.65,$0.00
99102,SUP,Custom 27803010,,99102  -  CATH 99102 INNERVISION BIOGLIDE,$729.13,$0.00,$729.13,$0.00,$520.38,$0.00,$0.00,$0.00,$0.00,$0.00,$729.13,$0.00,$364.56,$577.47,$583.30,$0.00,$0.00,$0.00,$0.00,$0.00
99800,SUP,Custom 27203010,,0099800  -  DRAIN INCS 10FR 12IN DEAVER RBR BIL 5IN T-TB STM XBAR GRVTY,$34.88,$0.00,$34.88,$0.00,$24.89,$0.00,$0.00,$0.00,$0.00,$0.00,$34.88,$0.00,$17.44,$27.62,$27.90,$0.00,$0.00,$0.00,$0.00,$0.00
99810,SUP,HCPCS C1729,,0099810  -  DRAIN INCS 12FR 12IN DEAVER RBR BIL 5IN T-TB STM XBAR GRVTY,$28.78,$0.00,$28.78,$15.62,$20.54,$0.00,$4.96,$0.00,$0.00,$5.04,$28.78,$0.00,$14.39,$22.79,$23.02,$0.00,$4.50,$0.00,$4.58,$0.00
99820,SUP,Custom 27203010,,99820  -  TUBES T 14FR,$31.68,$0.00,$31.68,$0.00,$22.61,$0.00,$0.00,$0.00,$0.00,$0.00,$31.68,$0.00,$15.84,$25.09,$25.35,$0.00,$0.00,$0.00,$0.00,$0.00
99830,SUP,Custom 27203010,,99830  -  DRAIN INCS 16FR 12IN DEAVER RBR BIL 5IN T-TB STM XBAR GRVTY,$173.25,$0.00,$173.25,$0.00,$123.65,$0.00,$0.00,$0.00,$0.00,$0.00,$173.25,$0.00,$86.63,$137.21,$138.60,$0.00,$0.00,$0.00,$0.00,$0.00
99840,SUP,HCPCS C1729,,0099840  -  DRAIN INCS 18FR 12IN DEAVER RBR BIL 5IN T-TB STM XBAR GRVTY,$28.78,$0.00,$28.78,$15.62,$20.54,$0.00,$4.96,$0.00,$0.00,$5.04,$28.78,$0.00,$14.39,$22.79,$23.02,$0.00,$4.50,$0.00,$4.58,$0.00
100100,SUP,Custom 27011340,,100100  -  ROD XTRNFX LG 100MM ILZ TLSCP BSC SET SS AL PED FEM,"$1,686.40",$0.00,"$1,686.40",$0.00,"$1,203.58",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,686.40",$0.00,$843.20,"$1,335.63","$1,349.12",$0.00,$0.00,$0.00,$0.00,$0.00
100101,SUP,Custom 27011340,,100101  -  ROD XTRNFX LG 150MM ILZ TLSCP SYS,"$1,686.40",$0.00,"$1,686.40",$0.00,"$1,203.58",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,686.40",$0.00,$843.20,"$1,335.63","$1,349.12",$0.00,$0.00,$0.00,$0.00,$0.00
100102,SUP,Custom 27011340,,100102  -  ROD XTRNFX LG 200MM ILZ TLSCP,"$2,048.50",$0.00,"$2,048.50",$0.00,"$1,462.01",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,048.50",$0.00,"$1,024.25","$1,622.41","$1,638.80",$0.00,$0.00,$0.00,$0.00,$0.00
100103,SUP,Custom 27011340,,100103  -  ROD XTRNFX LG 250MM ILZ CIRC TLSCP SS AL,"$2,048.50",$0.00,"$2,048.50",$0.00,"$1,462.01",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,048.50",$0.00,"$1,024.25","$1,622.41","$1,638.80",$0.00,$0.00,$0.00,$0.00,$0.00
100104,SUP,Custom 27011340,,100104  -  ROD XTRNFX 60MM ILZ GRAD TLSCP SYS SS AL,"$3,145.00",$0.00,"$3,145.00",$0.00,"$2,244.59",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,145.00",$0.00,"$1,572.50","$2,490.84","$2,516.00",$0.00,$0.00,$0.00,$0.00,$0.00
100105,SUP,Custom 27011340,,100105  -  ROD XTRNFX LG 100MM ILZ TLSCP GRAD DLX SET ADLT TIB,"$3,145.00",$0.00,"$3,145.00",$0.00,"$2,244.59",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,145.00",$0.00,"$1,572.50","$2,490.84","$2,516.00",$0.00,$0.00,$0.00,$0.00,$0.00
100106,SUP,Custom 27011340,,100106  -  ROD XTRNFX 150MM ILZ GRAD TLSCP SYS SS AL,"$4,615.50",$0.00,"$4,615.50",$0.00,"$3,294.08",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,615.50",$0.00,"$2,307.75","$3,655.48","$3,692.40",$0.00,$0.00,$0.00,$0.00,$0.00
100107,SUP,Custom 27011340,,100107  -  ROD XTRNFX 200MM ILZ GRAD TLSCP SYS SS AL,"$4,615.50",$0.00,"$4,615.50",$0.00,"$3,294.08",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,615.50",$0.00,"$2,307.75","$3,655.48","$3,692.40",$0.00,$0.00,$0.00,$0.00,$0.00
100108,SUP,Custom 27011340,,100108  -  ROD XTRNFX 250MM ILZ GRAD TLSCP AL SS,"$4,615.50",$0.00,"$4,615.50",$0.00,"$3,294.08",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,615.50",$0.00,"$2,307.75","$3,655.48","$3,692.40",$0.00,$0.00,$0.00,$0.00,$0.00
100200,SUP,Custom 27011340,,100200  -  WIRE XTRNFX ILZ BSC SET BCKL DTCH ADLT FEM SS RING,$826.20,$0.00,$826.20,$0.00,$589.66,$0.00,$0.00,$0.00,$0.00,$0.00,$826.20,$0.00,$413.10,$654.35,$660.96,$0.00,$0.00,$0.00,$0.00,$0.00
100241,SUP,Custom 27011340,,100241  -  DEVICE XTRNFX ILZ WRE FX BCKL CIRC SM BN FXTR,"$1,768.00",$0.00,"$1,768.00",$0.00,"$1,261.82",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,768.00",$0.00,$884.00,"$1,400.26","$1,414.40",$0.00,$0.00,$0.00,$0.00,$0.00
100250,SUP,Custom 27203010,,100250  -  DEVICE XTRNFX ILZ WRE FX BCKL CIRC COMP RING,$911.20,$0.00,$911.20,$0.00,$650.32,$0.00,$0.00,$0.00,$0.00,$0.00,$911.20,$0.00,$455.60,$721.67,$728.96,$0.00,$0.00,$0.00,$0.00,$0.00
100301,SUP,Custom 27011340,,100301  -  CLAMP XTRNFX ILZ 1 HL PIN,$892.50,$0.00,$892.50,$0.00,$636.98,$0.00,$0.00,$0.00,$0.00,$0.00,$892.50,$0.00,$446.25,$706.86,$714.00,$0.00,$0.00,$0.00,$0.00,$0.00
100302,SUP,Custom 27011340,,100302  -  CLAMP XTRNFX ILZ 2 HL PIN,$892.50,$0.00,$892.50,$0.00,$636.98,$0.00,$0.00,$0.00,$0.00,$0.00,$892.50,$0.00,$446.25,$706.86,$714.00,$0.00,$0.00,$0.00,$0.00,$0.00
100303,SUP,Custom 27011340,,100303  -  CLAMP XTRNFX ILZ 3 HL PIN,$892.50,$0.00,$892.50,$0.00,$636.98,$0.00,$0.00,$0.00,$0.00,$0.00,$892.50,$0.00,$446.25,$706.86,$714.00,$0.00,$0.00,$0.00,$0.00,$0.00
100304,SUP,Custom 27011340,,100304  -  CLAMP XTRNFX ILZ 4 HL PIN,"$1,251.20",$0.00,"$1,251.20",$0.00,$892.98,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,251.20",$0.00,$625.60,$990.95,"$1,000.96",$0.00,$0.00,$0.00,$0.00,$0.00
100305,SUP,Custom 27011340,,100305  -  CLAMP XTRNFX ILZ 5 HL PIN,"$1,251.20",$0.00,"$1,251.20",$0.00,$892.98,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,251.20",$0.00,$625.60,$990.95,"$1,000.96",$0.00,$0.00,$0.00,$0.00,$0.00
100400,SUP,Custom 27011340,,100400  -  PLATE XTRNFX LNG 155MM 8 HL CNCT,$974.10,$0.00,$974.10,$0.00,$695.22,$0.00,$0.00,$0.00,$0.00,$0.00,$974.10,$0.00,$487.05,$771.49,$779.28,$0.00,$0.00,$0.00,$0.00,$0.00
100401,SUP,Custom 27011340,,100401  -  PLATE XTRNFX LNG 235MM ILZ 12 HL CNCT,$974.10,$0.00,$974.10,$0.00,$695.22,$0.00,$0.00,$0.00,$0.00,$0.00,$974.10,$0.00,$487.05,$771.49,$779.28,$0.00,$0.00,$0.00,$0.00,$0.00
100402,SUP,Custom 27011340,,100402  -  PLATE XTRNFX LNG 355MM ILZ 17 HL CNCT SYS,"$1,184.90",$0.00,"$1,184.90",$0.00,$845.66,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,184.90",$0.00,$592.45,$938.44,$947.92,$0.00,$0.00,$0.00,$0.00,$0.00
100409,SUP,Custom 27011340,,100409  -  PLATE XTRNFX LNG 72MM ILZ 5 HL SM BN FXTR SET,$873.80,$0.00,$873.80,$0.00,$623.63,$0.00,$0.00,$0.00,$0.00,$0.00,$873.80,$0.00,$436.90,$692.05,$699.04,$0.00,$0.00,$0.00,$0.00,$0.00
100412,SUP,Custom 27011340,,100412  -  PLATE XTRNFX LNG 102MM ILZ 7 HL SM BN FXTR SET,$958.80,$0.00,$958.80,$0.00,$684.30,$0.00,$0.00,$0.00,$0.00,$0.00,$958.80,$0.00,$479.40,$759.37,$767.04,$0.00,$0.00,$0.00,$0.00,$0.00
100415,SUP,Custom 27011340,,100415  -  PLATE XTRNFX LNG 72MM ILZ 9 HL SM BN FXTR SET,"$1,014.90",$0.00,"$1,014.90",$0.00,$724.33,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,014.90",$0.00,$507.45,$803.80,$811.92,$0.00,$0.00,$0.00,$0.00,$0.00
100418,SUP,Custom 27011340,,100418  -  PLATE XTRNFX LNG 162MM ILZ 11 HL SM BN FXTR SET,"$1,100.00",$0.00,"$1,100.00",$0.00,$785.07,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,100.00",$0.00,$550.00,$871.20,$880.00,$0.00,$0.00,$0.00,$0.00,$0.00
100420,SUP,Custom 27011340,,100420  -  PLATE XTRNFX LNG 155MM ILZ 8 HL CNCT CIRC COMP CFBR EPOXY,"$1,214.00",$0.00,"$1,214.00",$0.00,$866.43,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,214.00",$0.00,$607.00,$961.49,$971.20,$0.00,$0.00,$0.00,$0.00,$0.00
100421,SUP,Custom 27011340,,100421  -  PLATE XTRNFX LNG 235MM ILZ 12 HL CNCT CIRC COMP CFBR EPOXY,"$1,214.00",$0.00,"$1,214.00",$0.00,$866.43,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,214.00",$0.00,$607.00,$961.49,$971.20,$0.00,$0.00,$0.00,$0.00,$0.00
100422,SUP,Custom 27011340,,100422  -  PLATE XTRNFX LNG 335MM ILZ 17 HL CNCT CIRC COMP CFBR EPOXY,"$1,354.00",$0.00,"$1,354.00",$0.00,$966.35,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,354.00",$0.00,$677.00,"$1,072.37","$1,083.20",$0.00,$0.00,$0.00,$0.00,$0.00
100500,SUP,Custom 27011340,,100500  -  PLATE XTRNFX 135MM ILZ 5 HL CNCT THRD END,"$1,079.50",$0.00,"$1,079.50",$0.00,$770.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,079.50",$0.00,$539.75,$854.96,$863.60,$0.00,$0.00,$0.00,$0.00,$0.00
100501,SUP,Custom 27011340,,100501  -  PLATE XTRNFX 175MM ILZ 7 HL CNCT SYS THRD END,"$1,079.50",$0.00,"$1,079.50",$0.00,$770.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,079.50",$0.00,$539.75,$854.96,$863.60,$0.00,$0.00,$0.00,$0.00,$0.00
100502,SUP,Custom 27011340,,100502  -  PLATE XTRNFX 215MM ILZ 9 HL CNCT CIRC THRD END,"$1,380.40",$0.00,"$1,380.40",$0.00,$985.19,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,380.40",$0.00,$690.20,"$1,093.28","$1,104.32",$0.00,$0.00,$0.00,$0.00,$0.00
100503,SUP,Custom 27011340,,100503  -  PLATE XTRNFX 255MM ILZ 11 HL CNCT THRD END SS ADLT TIB,"$1,416.00",$0.00,"$1,416.00",$0.00,"$1,010.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,416.00",$0.00,$708.00,"$1,121.47","$1,132.80",$0.00,$0.00,$0.00,$0.00,$0.00
100550,SUP,HCPCS C1713,,100550  -  BOLT XTRNFX 8MM ILZ CNCT SS ADLT,$16.15,$0.00,$16.15,$7.27,$11.53,$0.00,$2.78,$0.00,$0.00,$2.83,$16.15,$0.00,$8.08,$12.79,$12.92,$0.00,$2.53,$0.00,$2.57,$0.00
100600,SUP,Custom 27203010,,100600  -  BOLT XTRNFX ILZ CNN WRE FEM,$143.83,$0.00,$143.83,$0.00,$102.65,$0.00,$0.00,$0.00,$0.00,$0.00,$143.83,$0.00,$71.91,$113.91,$115.06,$0.00,$0.00,$0.00,$0.00,$0.00
100601,SUP,Custom 27011340,,100601  -  BOLT XTRNFX ILZ CNN WRE CIRC THRD HD,$223.20,$0.00,$223.20,$0.00,$159.30,$0.00,$0.00,$0.00,$0.00,$0.00,$223.20,$0.00,$111.60,$176.77,$178.56,$0.00,$0.00,$0.00,$0.00,$0.00
100613,SUP,Custom 27011340,,100613  -  BOLT XTRNFX 3MM ILZ .5 PIN CIRC,$740.00,$0.00,$740.00,$0.00,$528.14,$0.00,$0.00,$0.00,$0.00,$0.00,$740.00,$0.00,$370.00,$586.08,$592.00,$0.00,$0.00,$0.00,$0.00,$0.00
100614,SUP,Custom 27011340,,100614  -  BOLT XTRNFX 4MM ILZ .5 PIN CIRC,$740.00,$0.00,$740.00,$0.00,$528.14,$0.00,$0.00,$0.00,$0.00,$0.00,$740.00,$0.00,$370.00,$586.08,$592.00,$0.00,$0.00,$0.00,$0.00,$0.00
100615,SUP,Custom 27011340,,100615  -  BOLT XTRNFX CRC 5MM ILZ HLF PIN,$672.00,$0.00,$672.00,$0.00,$479.61,$0.00,$0.00,$0.00,$0.00,$0.00,$672.00,$0.00,$336.00,$532.22,$537.60,$0.00,$0.00,$0.00,$0.00,$0.00
100616,SUP,Custom 27011340,,100616  -  BOLT XTRNFX CRC 6MM ILZ HLF PIN,$740.00,$0.00,$740.00,$0.00,$528.14,$0.00,$0.00,$0.00,$0.00,$0.00,$740.00,$0.00,$370.00,$586.08,$592.00,$0.00,$0.00,$0.00,$0.00,$0.00
100700,SUP,HCPCS C1713,,100700  -  BOLT XTRNFX ILZ SLOT WRE BSC SET FEM,$161.85,$0.00,$161.85,$72.83,$115.51,$0.00,$27.89,$0.00,$0.00,$28.34,$161.85,$0.00,$80.93,$128.19,$129.48,$0.00,$25.33,$0.00,$25.77,$0.00
100819,SUP,HCPCS C1713,,100819  -  PLATE XTRNFX SHRT 27MM 2 HL CNCT CIRC SM BN,$484.50,$0.00,$484.50,$218.03,$345.79,$0.00,$83.48,$0.00,$0.00,$84.83,$484.50,$0.00,$242.25,$383.72,$387.60,$0.00,$75.82,$0.00,$77.13,$0.00
100822,SUP,HCPCS C1713,,100822  -  PLATE XTRNFX SHRT 37MM 3 HL CNCT CIRC SM BN,$564.40,$0.00,$564.40,$253.98,$402.81,$0.00,$97.24,$0.00,$0.00,$98.82,$564.40,$0.00,$282.20,$447.00,$451.52,$0.00,$88.33,$0.00,$89.85,$0.00
100825,SUP,HCPCS C1713,,100825  -  PLATE XTRNFX SHRT 47MM 4 HL CNCT CIRC SM BN,$600.10,$0.00,$600.10,$270.05,$428.29,$0.00,$103.39,$0.00,$0.00,$105.07,$600.10,$0.00,$300.05,$475.28,$480.08,$0.00,$93.92,$0.00,$95.54,$0.00
100882,SUP,HCPCS C1713,,100882  -  SPACER XTRNFX 20MM SM BN FXTR,$511.70,$0.00,$511.70,$230.27,$365.20,$0.00,$88.16,$0.00,$0.00,$89.59,$511.70,$0.00,$255.85,$405.27,$409.36,$0.00,$80.08,$0.00,$81.46,$0.00
100883,SUP,HCPCS C1713,,100883  -  SPACER XTRNFX 30MM SM BN FXTR,$511.70,$0.00,$511.70,$230.27,$365.20,$0.00,$88.16,$0.00,$0.00,$89.59,$511.70,$0.00,$255.85,$405.27,$409.36,$0.00,$80.08,$0.00,$81.46,$0.00
101010,SUP,HCPCS Q4116,,101010  -  GRAFT SKIN 14X5CM ALLOGRAFT NON MESHED ALLODERM ACELLULAR,$1.39,$0.00,$1.39,$0.63,$0.99,$0.00,$0.24,$0.00,$0.00,$0.24,$1.39,$0.00,$0.70,$1.10,$1.11,$0.00,$0.22,$0.00,$0.22,$0.00
101020,SUP,HCPCS Q4116,,101020  -  GRAFT SKIN 12X5CM ALLOGRAFT NON MESHED ALLODERM ACELLULAR,$1.63,$0.00,$1.63,$0.73,$1.16,$0.00,$0.28,$0.00,$0.00,$0.28,$1.63,$0.00,$0.81,$1.29,$1.30,$0.00,$0.25,$0.00,$0.26,$0.00
101400,SUP,Custom 27011340,,101400  -  POST EXFIX ILZ SS 2 HOLE MALE,$409.70,$0.00,$409.70,$0.00,$292.40,$0.00,$0.00,$0.00,$0.00,$0.00,$409.70,$0.00,$204.85,$324.48,$327.76,$0.00,$0.00,$0.00,$0.00,$0.00
101401,SUP,Custom 27011340,,101401  -  POST EXFIX ILZ TIB 3 HOLE MALE PED,$428.40,$0.00,$428.40,$0.00,$305.75,$0.00,$0.00,$0.00,$0.00,$0.00,$428.40,$0.00,$214.20,$339.29,$342.72,$0.00,$0.00,$0.00,$0.00,$0.00
101510,SUP,HCPCS Q4116,,101510  -  GRAFT SKIN 36X5MM ALLOGRAFT MESHED ALLODERM ACELLULAR DERMIS,$0.54,$0.00,$0.54,$0.24,$0.39,$0.00,$0.09,$0.00,$0.00,$0.09,$0.54,$0.00,$0.27,$0.43,$0.43,$0.00,$0.08,$0.00,$0.09,$0.00
101520,SUP,HCPCS Q4116,,101520  -  GRAFT SKIN 14.5X4CM ALLOGRAFT MESHED ALLODERM ACELLULAR,$1.68,$0.00,$1.68,$0.76,$1.20,$0.00,$0.29,$0.00,$0.00,$0.29,$1.68,$0.00,$0.84,$1.33,$1.34,$0.00,$0.26,$0.00,$0.27,$0.00
101602,SUP,Custom 27011340,,101602  -  HINGE XTRNFX ILZ M CNCT LOPRFL SS TIB,$367.20,$0.00,$367.20,$0.00,$262.07,$0.00,$0.00,$0.00,$0.00,$0.00,$367.20,$0.00,$183.60,$290.82,$293.76,$0.00,$0.00,$0.00,$0.00,$0.00
101804,SUP,HCPCS C1713,,101804  -  PLATE XTRNFX SHRT 85MM ILZ 7 HL CNCT TIB,$535.50,$0.00,$535.50,$240.98,$382.19,$0.00,$92.26,$0.00,$0.00,$93.76,$535.50,$0.00,$267.75,$424.12,$428.40,$0.00,$83.81,$0.00,$85.25,$0.00
101805,SUP,HCPCS C1713,,101805  -  PLATE XTRNFX SHRT 95MM ILZ 8 HL CNCT TIB,$535.50,$0.00,$535.50,$240.98,$382.19,$0.00,$92.26,$0.00,$0.00,$93.76,$535.50,$0.00,$267.75,$424.12,$428.40,$0.00,$83.81,$0.00,$85.25,$0.00
101806,SUP,HCPCS C1713,,101806  -  PLATE XTRNFX SHRT 105MM ILZ 9 HL CNCT  TIB,$535.50,$0.00,$535.50,$240.98,$382.19,$0.00,$92.26,$0.00,$0.00,$93.76,$535.50,$0.00,$267.75,$424.12,$428.40,$0.00,$83.81,$0.00,$85.25,$0.00
101807,SUP,HCPCS C1713,,101807  -  PLATE XTRNFX SHRT 115MM ILZ 10 HL CNCT CIRC,$642.60,$0.00,$642.60,$289.17,$458.62,$0.00,$110.72,$0.00,$0.00,$112.51,$642.60,$0.00,$321.30,$508.94,$514.08,$0.00,$100.57,$0.00,$102.30,$0.00
101900,SUP,HCPCS C1713,,101900  -  PLATE BN 45MM 2 HL TWST ORTH,$364.00,$0.00,$364.00,$163.80,$259.79,$0.00,$62.72,$0.00,$0.00,$63.73,$364.00,$0.00,$182.00,$288.29,$291.20,$0.00,$56.97,$0.00,$57.95,$0.00
101901,SUP,HCPCS C1713,,101901  -  PLATE XTRNFX 65MM ILZ 3 HL TWST DLX SET ADLT TIB,$535.50,$0.00,$535.50,$240.98,$382.19,$0.00,$92.26,$0.00,$0.00,$93.76,$535.50,$0.00,$267.75,$424.12,$428.40,$0.00,$83.81,$0.00,$85.25,$0.00
101902,SUP,HCPCS C1713,,101902  -  PLATE XTRNFX 85MM ILZ 3 HL TWST DLX SET ADLT,$535.50,$0.00,$535.50,$240.98,$382.19,$0.00,$92.26,$0.00,$0.00,$93.76,$535.50,$0.00,$267.75,$424.12,$428.40,$0.00,$83.81,$0.00,$85.25,$0.00
102000,SUP,HCPCS C1713,,102000  -  PLATE XTRNFX ILZ 3 HL CRV CIRC,$623.90,$0.00,$623.90,$280.76,$445.28,$0.00,$107.49,$0.00,$0.00,$109.24,$623.90,$0.00,$311.95,$494.13,$499.12,$0.00,$97.64,$0.00,$99.32,$0.00
102003,SUP,HCPCS Q4116,,102003  -  MATRIX TISSUE THICK 2X1CM ALLOGRAFT REGENERATIVE FREEZE,$273.75,$0.00,$273.75,$123.19,$195.38,$0.00,$47.17,$0.00,$0.00,$47.93,$273.75,$0.00,$136.88,$216.81,$219.00,$0.00,$42.84,$0.00,$43.58,$0.00
102007,SUP,HCPCS Q4116,,102007  -  MATRIX TISSUE THIN 4X1CM ALLOGRAFT REGENERATIVE FREEZE DRIED,$230.00,$0.00,$230.00,$103.50,$164.15,$0.00,$39.63,$0.00,$0.00,$40.27,$230.00,$0.00,$115.00,$182.16,$184.00,$0.00,$36.00,$0.00,$36.62,$0.00
102009,SUP,HCPCS Q4116,,102009  -  GRAFT SKIN 4X2CM ALLOGRAFT ALLODERM ACELLULAR DERMIS,$100.94,$0.00,$100.94,$45.42,$72.04,$0.00,$17.39,$0.00,$0.00,$17.67,$100.94,$0.00,$50.47,$79.94,$80.75,$0.00,$15.80,$0.00,$16.07,$0.00
102010,SUP,HCPCS Q4116,,102010  -  MATRIX TISSUE THIN 4X2CM ALLOGRAFT REGENERATIVE FREEZE DRIED,"$1,600.00",$0.00,"$1,600.00",$720.00,"$1,141.92",$0.00,$275.67,$0.00,$0.00,$280.15,"$1,600.00",$0.00,$800.00,"$1,267.20","$1,280.00",$0.00,$250.40,$0.00,$254.72,$0.00
102012,SUP,HCPCS Q4116,,102012  -  MATRIX TISSUE THICK 4X2CM ALLOGRAFT REGENERATIVE FREEZE,$200.00,$0.00,$200.00,$90.00,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
102016,SUP,HCPCS Q4116,,102016  -  ALLODERM IMPLANTABLE,"$12,497.50",$0.00,"$12,497.50","$5,623.88","$5,158.80",$0.00,"$2,153.26",$0.00,$0.00,"$2,188.21","$12,497.50",$0.00,"$6,248.75","$9,898.02","$9,998.00",$0.00,"$1,955.86",$0.00,"$1,989.60",$0.00
102020,SUP,HCPCS Q4116,,102020  -  MATRIX TISSUE MEDIUM 7X3CM ALLOGRAFT REGENERATIVE FREEZE,$129.40,$0.00,$129.40,$58.23,$92.36,$0.00,$22.30,$0.00,$0.00,$22.66,$129.40,$0.00,$64.70,$102.48,$103.52,$0.00,$20.25,$0.00,$20.60,$0.00
102021,SUP,HCPCS Q4116,,102021  -  MATRIX TISSUE THICK 7X3CM ALLOGRAFT REGENERATIVE FREEZE,$129.40,$0.00,$129.40,$58.23,$92.36,$0.00,$22.30,$0.00,$0.00,$22.66,$129.40,$0.00,$64.70,$102.48,$103.52,$0.00,$20.25,$0.00,$20.60,$0.00
102031,SUP,HCPCS Q4116,,102031  -  MATRIX TISSUE THIN 7X4CM ALLOGRAFT REGENERATIVE FREEZE DRIED,$50.63,$0.00,$50.63,$22.78,$36.13,$0.00,$8.72,$0.00,$0.00,$8.86,$50.63,$0.00,$25.31,$40.10,$40.50,$0.00,$7.92,$0.00,$8.06,$0.00
102033,SUP,HCPCS Q4116,,102033  -  MATRIX TISSUE MEDIUM 7X4CM ALLOGRAFT REGENERATIVE FREEZE,$100.54,$0.00,$100.54,$45.24,$71.75,$0.00,$17.32,$0.00,$0.00,$17.60,$100.54,$0.00,$50.27,$79.63,$80.43,$0.00,$15.73,$0.00,$16.01,$0.00
102034,SUP,HCPCS Q4116,,102034  -  MATRIX TISSUE THICK 7X4CM ALLOGRAFT REGENERATIVE FREEZE,$100.54,$0.00,$100.54,$45.24,$71.75,$0.00,$17.32,$0.00,$0.00,$17.60,$100.54,$0.00,$50.27,$79.63,$80.43,$0.00,$15.73,$0.00,$16.01,$0.00
102049,SUP,HCPCS Q4116,,102049  -  MATRIX TISSUE MEDIUM 12X4CM ALLOGRAFT REGENERATIVE FREEZE,$104.11,$0.00,$104.11,$46.85,$74.31,$0.00,$17.94,$0.00,$0.00,$18.23,$104.11,$0.00,$52.06,$82.46,$83.29,$0.00,$16.29,$0.00,$16.58,$0.00
102050,SUP,HCPCS Q4116,,102050  -  MATRIX TISSUE THICK 12X4CM ALLOGRAFT REGENERATIVE FREEZE,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
102061,SUP,HCPCS Q4116,,102061  -  MATRIX TISSUE MEDIUM 10X5CM ALLOGRAFT REGENERATIVE FREEZE,$100.20,$0.00,$100.20,$45.09,$71.51,$0.00,$17.26,$0.00,$0.00,$17.54,$100.20,$0.00,$50.10,$79.36,$80.16,$0.00,$15.68,$0.00,$15.95,$0.00
102062,SUP,HCPCS Q4116,,102062  -  MATRIX TISSUE THICK 10X5CM ALLOGRAFT REGENERATIVE FREEZE,"$5,010.00",$0.00,"$5,010.00","$2,254.50","$3,575.64",$0.00,$863.20,$0.00,$0.00,$877.21,"$5,010.00",$0.00,"$2,505.00","$3,967.92","$4,008.00",$0.00,$784.07,$0.00,$797.59,$0.00
102071,SUP,HCPCS Q4116,,102071  -  MATRIX TISSUE MEDIUM 12X6CM ALLOGRAFT REGENERATIVE FREEZE,$70.80,$0.00,$70.80,$31.86,$50.53,$0.00,$12.20,$0.00,$0.00,$12.40,$70.80,$0.00,$35.40,$56.07,$56.64,$0.00,$11.08,$0.00,$11.27,$0.00
102072,SUP,HCPCS Q4116,,102072  -  MATRIX TISSUE THICK 12X6CM ALLOGRAFT REGENERATIVE FREEZE,$70.80,$0.00,$70.80,$31.86,$50.53,$0.00,$12.20,$0.00,$0.00,$12.40,$70.80,$0.00,$35.40,$56.07,$56.64,$0.00,$11.08,$0.00,$11.27,$0.00
102081,SUP,HCPCS Q4116,,102081  -  MATRIX TISSUE MEDIUM 16X4CM ALLOGRAFT REGENERATIVE FREEZE,$78.09,$0.00,$78.09,$35.14,$55.73,$0.00,$13.45,$0.00,$0.00,$13.67,$78.09,$0.00,$39.04,$61.85,$62.47,$0.00,$12.22,$0.00,$12.43,$0.00
102082,SUP,HCPCS Q4116,,102082  -  MATRIX TISSUE THICK 16X4CM ALLOGRAFT REGENERATIVE FREEZE,$78.09,$0.00,$78.09,$35.14,$55.73,$0.00,$13.45,$0.00,$0.00,$13.67,$78.09,$0.00,$39.04,$61.85,$62.47,$0.00,$12.22,$0.00,$12.43,$0.00
102096,SUP,HCPCS Q4116,,102096  -  MATRIX TISSUE THICK 12X8CM ALLOGRAFT REGENERATIVE FREEZE,$78.10,$0.00,$78.10,$35.14,$55.74,$0.00,$13.46,$0.00,$0.00,$13.67,$78.10,$0.00,$39.05,$61.86,$62.48,$0.00,$12.22,$0.00,$12.43,$0.00
102102,SUP,Custom 27203010,,102102 - WIRE XTRNFX 1.8MM 370MM NS ILZ BYNT PNT DLX SET SS TIB,$208.50,$0.00,$208.50,$0.00,$148.81,$0.00,$0.00,$0.00,$0.00,$0.00,$208.50,$0.00,$104.25,$165.13,$166.80,$0.00,$0.00,$0.00,$0.00,$0.00
102128,SUP,HCPCS Q4116,,102128  -  MATRIX TISSUE THICK 16X8CM ALLOGRAFT REGENERATIVE FREEZE,$78.11,$0.00,$78.11,$35.15,$55.74,$0.00,$13.46,$0.00,$0.00,$13.68,$78.11,$0.00,$39.05,$61.86,$62.48,$0.00,$12.22,$0.00,$12.43,$0.00
102132,SUP,HCPCS C1760,,CLIP HLF PIN CIRC DISC ILZ EXFIXA 4,$4.65,$0.00,$4.65,$2.09,$3.32,$0.00,$0.80,$0.00,$0.00,$0.81,$4.65,$0.00,$2.33,$3.68,$3.72,$0.00,$0.73,$0.00,$0.74,$0.00
102144,SUP,HCPCS Q4116,,102144  -  MATRIX TISSUE THICK 12X12CM ALLOGRAFT REGENERATIVE FREEZE,$105.87,$0.00,$105.87,$47.64,$75.56,$0.00,$18.24,$0.00,$0.00,$18.54,$105.87,$0.00,$52.93,$83.85,$84.69,$0.00,$16.57,$0.00,$16.85,$0.00
102196,SUP,HCPCS Q4116,,102196  -  MATRIX TISSUE THICK 16X6CM ALLOGRAFT REGENERATIVE FREEZE,$78.10,$0.00,$78.10,$35.14,$55.74,$0.00,$13.46,$0.00,$0.00,$13.67,$78.10,$0.00,$39.05,$61.86,$62.48,$0.00,$12.22,$0.00,$12.43,$0.00
102302,SUP,HCPCS C1713,,102302  -  SET XTRNFX 100MM ILZ THRD ROD ADLT TIB,$109.60,$0.00,$109.60,$49.32,$78.22,$0.00,$18.88,$0.00,$0.00,$19.19,$109.60,$0.00,$54.80,$86.80,$87.68,$0.00,$17.15,$0.00,$17.45,$0.00
102303,SUP,HCPCS C1713,,102303  -  ROD EXFIX 120MM ILZ TIB THRD DLX SET ADLT,$109.60,$0.00,$109.60,$49.32,$78.22,$0.00,$18.88,$0.00,$0.00,$19.19,$109.60,$0.00,$54.80,$86.80,$87.68,$0.00,$17.15,$0.00,$17.45,$0.00
102304,SUP,HCPCS C1713,,102304  -  ROD XTRNFX 150MM ILZ THRD DLX SET SS ADLT TIB,$109.60,$0.00,$109.60,$49.32,$78.22,$0.00,$18.88,$0.00,$0.00,$19.19,$109.60,$0.00,$54.80,$86.80,$87.68,$0.00,$17.15,$0.00,$17.45,$0.00
102320,SUP,HCPCS Q4116,,102320  -  MATRIX TISSUE THICK 20X16CM ALLOGRAFT REGENERATIVE FREEZE,$78.12,$0.00,$78.12,$35.15,$55.75,$0.00,$13.46,$0.00,$0.00,$13.68,$78.12,$0.00,$39.06,$61.87,$62.49,$0.00,$12.23,$0.00,$12.44,$0.00
102600,SUP,HCPCS C1713,,102600  -  WASHER XTRNFX THK3MM 14MM ILZ SLT BSC SET ADLT FEM,$65.40,$0.00,$65.40,$29.43,$46.68,$0.00,$11.27,$0.00,$0.00,$11.45,$65.40,$0.00,$32.70,$51.80,$52.32,$0.00,$10.24,$0.00,$10.41,$0.00
102701,SUP,HCPCS C1713,,102701  -  WASHER XTRNFX 2MM 14MM ILZ BSC SET ADLT TIB,$30.00,$0.00,$30.00,$13.50,$21.41,$0.00,$5.17,$0.00,$0.00,$5.25,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$4.70,$0.00,$4.78,$0.00
102706,SUP,HCPCS C1713,,102706  -  WASHER XTRNFX THK2MM ILZ BOLT,$65.40,$0.00,$65.40,$29.43,$46.68,$0.00,$11.27,$0.00,$0.00,$11.45,$65.40,$0.00,$32.70,$51.80,$52.32,$0.00,$10.24,$0.00,$10.41,$0.00
102707,SUP,HCPCS C1713,,102707  -  WASHER XTRNFX THK4MM ILZ BOLT,$65.40,$0.00,$65.40,$29.43,$46.68,$0.00,$11.27,$0.00,$0.00,$11.45,$65.40,$0.00,$32.70,$51.80,$52.32,$0.00,$10.24,$0.00,$10.41,$0.00
102715,SUP,HCPCS C1713,,102715  -  WASHER XTRNFX THK1MM 1MM CIRC SM BN FXTR,$45.90,$0.00,$45.90,$20.66,$32.76,$0.00,$7.91,$0.00,$0.00,$8.04,$45.90,$0.00,$22.95,$36.35,$36.72,$0.00,$7.18,$0.00,$7.31,$0.00
102718,SUP,HCPCS C1713,,102718  -  WASHER XTRNFX THK1.5MM 1.5MM CIRC SM BN FXTR,$45.90,$0.00,$45.90,$20.66,$32.76,$0.00,$7.91,$0.00,$0.00,$8.04,$45.90,$0.00,$22.95,$36.35,$36.72,$0.00,$7.18,$0.00,$7.31,$0.00
102721,SUP,HCPCS C1713,,102721  -  WASHER XTRNFX THK3MM SLT SM BN FXTR,$86.30,$0.00,$86.30,$38.84,$61.59,$0.00,$14.87,$0.00,$0.00,$15.11,$86.30,$0.00,$43.15,$68.35,$69.04,$0.00,$13.51,$0.00,$13.74,$0.00
103044,SUP,Custom 27203010,,103044  -  BIT DRL 2.7MM STRL ILZ SHNK CMPNT SET DISP RNCH SYS,"$1,023.40",$0.00,"$1,023.40",$0.00,$730.40,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,023.40",$0.00,$511.70,$810.53,$818.72,$0.00,$0.00,$0.00,$0.00,$0.00
103045,SUP,Custom 27203010,,103045  -  BIT DRL 3.8MM STRL ILZ SHNK CMPNT SET DISP RNCH SYS,"$1,023.40",$0.00,"$1,023.40",$0.00,$730.40,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,023.40",$0.00,$511.70,$810.53,$818.72,$0.00,$0.00,$0.00,$0.00,$0.00
103201,SUP,HCPCS C1713,,103201  -  BOLT XTRNFX UNV 16MM ILZ CMPS BSC SET CIRC CNCT HNG SS ADLT,$16.15,$0.00,$16.15,$7.27,$11.53,$0.00,$2.78,$0.00,$0.00,$2.83,$16.15,$0.00,$8.08,$12.79,$12.92,$0.00,$2.53,$0.00,$2.57,$0.00
103301,SUP,HCPCS C1713,,103301  -  NUT XTRNFX THK5MM 10MM 6MM ILZ THRD INS HEX SS NYL,$77.20,$0.00,$77.20,$34.74,$55.10,$0.00,$13.30,$0.00,$0.00,$13.52,$77.20,$0.00,$38.60,$61.14,$61.76,$0.00,$12.08,$0.00,$12.29,$0.00
103313,SUP,HCPCS C1713,,103313  -  NUT XTRNFX 3ANG SM BN FXTR,$409.70,$0.00,$409.70,$184.37,$292.40,$0.00,$70.59,$0.00,$0.00,$71.74,$409.70,$0.00,$204.85,$324.48,$327.76,$0.00,$64.12,$0.00,$65.22,$0.00
103406,SUP,HCPCS C1776,,103406  -  SLEEVE XTRNFX 6MM ILZ CENTERING,$406.30,$0.00,$406.30,$182.84,$289.98,$0.00,$70.00,$0.00,$0.00,$71.14,$406.30,$0.00,$203.15,$321.79,$325.04,$0.00,$63.59,$0.00,$64.68,$0.00
103452,SUP,HCPCS C1713,,103452  -  CUBE XTRNFX ILZ 2 HL SS RNCH SYS,$578.00,$0.00,$578.00,$260.10,$412.52,$0.00,$99.59,$0.00,$0.00,$101.20,$578.00,$0.00,$289.00,$457.78,$462.40,$0.00,$90.46,$0.00,$92.02,$0.00
103453,SUP,HCPCS C1713,,103453  -  CUBE EXFIX UNIVERSAL 3 HOLE COMPONENT SET HINGE COMPASS,$668.00,$0.00,$668.00,$300.60,$476.75,$0.00,$115.09,$0.00,$0.00,$116.96,$668.00,$0.00,$334.00,$529.06,$534.40,$0.00,$104.54,$0.00,$106.35,$0.00
103454,SUP,Custom 27203010,,103454  -  CUBE XTRNFX ILZ 4 HL SS RNCH SYS,$686.80,$0.00,$686.80,$0.00,$490.17,$0.00,$0.00,$0.00,$0.00,$0.00,$686.80,$0.00,$343.40,$543.95,$549.44,$0.00,$0.00,$0.00,$0.00,$0.00
103455,SUP,HCPCS C1713,,CUBE 5 HOLE CIRC EXFIXA RNCH SYS,$482.43,$0.00,$482.43,$217.09,$344.31,$0.00,$83.12,$0.00,$0.00,$84.47,$482.43,$0.00,$241.21,$382.08,$385.94,$0.00,$75.50,$0.00,$76.80,$0.00
106132,SUP,HCPCS C1713,,106132  -  BLADE SW DMD 800X.64X.54MM,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
106133,SUP,HCPCS C1713,,106133  -  SAW 0106133 DIAMOND 0.81 0.91MM X 800MM,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
108280,SUP,Custom 27203010,,108280  -  DOPPLER VASC 8MHZ STRL PRB DISP,$374.38,$0.00,$374.38,$0.00,$267.19,$0.00,$0.00,$0.00,$0.00,$0.00,$374.38,$0.00,$187.19,$296.51,$299.50,$0.00,$0.00,$0.00,$0.00,$0.00
Jan-00,SUP,Custom 27803010,,01-2200  -  HEAD FEMORAL MORSE TAPER LFIT HIP,"$1,795.00",$0.00,"$1,795.00",$0.00,"$1,281.09",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,795.00",$0.00,$897.50,"$1,421.64","$1,436.00",$0.00,$0.00,$0.00,$0.00,$0.00
Jun-00,SUP,Custom 27803010,,06-2200  -  HEAD FEM +0MM OFST CTPR 22MM STRL LFIT COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
110021,SUP,Custom 27203010,,110021  -  BIT DRL 6.3MM AMBI PRFR,$200.55,$0.00,$200.55,$0.00,$143.13,$0.00,$0.00,$0.00,$0.00,$0.00,$200.55,$0.00,$100.28,$158.84,$160.44,$0.00,$0.00,$0.00,$0.00,$0.00
110107,SUP,HCPCS C1713,,110107  -  SCREW SET CLLS FRM,$111.00,$0.00,$111.00,$49.95,$79.22,$0.00,$19.12,$0.00,$0.00,$19.44,$111.00,$0.00,$55.50,$87.91,$88.80,$0.00,$17.37,$0.00,$17.67,$0.00
110242,SUP,Custom 27203010,,110242  -  BIT DRL 2.7MM STRL COLE TWST RDLCNT,$635.63,$0.00,$635.63,$0.00,$453.65,$0.00,$0.00,$0.00,$0.00,$0.00,$635.63,$0.00,$317.81,$503.42,$508.50,$0.00,$0.00,$0.00,$0.00,$0.00
110244,SUP,Custom 27203010,,110244  -  BIT DRL 3.5MM STRL COLE TWST RDLCNT,$635.63,$0.00,$635.63,$0.00,$453.65,$0.00,$0.00,$0.00,$0.00,$0.00,$635.63,$0.00,$317.81,$503.42,$508.50,$0.00,$0.00,$0.00,$0.00,$0.00
110245,SUP,Custom 27203010,,110245  -  BIT DRL 4MM COLE RDLCNT,$635.63,$0.00,$635.63,$0.00,$453.65,$0.00,$0.00,$0.00,$0.00,$0.00,$635.63,$0.00,$317.81,$503.42,$508.50,$0.00,$0.00,$0.00,$0.00,$0.00
110246,SUP,Custom 27203010,,110246  -  BIT DRL 4.8MM COLE RDLCNT,$635.63,$0.00,$635.63,$0.00,$453.65,$0.00,$0.00,$0.00,$0.00,$0.00,$635.63,$0.00,$317.81,$503.42,$508.50,$0.00,$0.00,$0.00,$0.00,$0.00
110300,SUP,HCPCS C1713,,110300  -  SCREW 110300  BABY CD SELF BRKNG,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
110675,SUP,Custom 27203010,,110675  -  PASSER SUT 6.1IN BLK STRL LF 3.6CM SWNSN WIRELOOP ATCL SS,$199.70,$0.00,$199.70,$0.00,$142.53,$0.00,$0.00,$0.00,$0.00,$0.00,$199.70,$0.00,$99.85,$158.16,$159.76,$0.00,$0.00,$0.00,$0.00,$0.00
111250,SUP,HCPCS C1762,,111250  -  GRAFT SOFT TISSUE 1-2MM 50MM ALLOGRAFT AXONAL REGENERATION,"$10,125.00",$0.00,"$10,125.00",$0.00,"$5,158.80",$0.00,"$1,744.49",$0.00,$0.00,$0.00,"$10,125.00",$0.00,"$5,062.50","$8,019.00","$8,100.00",$0.00,"$1,584.56",$0.00,$0.00,$0.00
Jan-05,SUP,Custom 27803010,,01-2205  -  HEAD FEMORAL +5MM 22MM MORSE TAPERED LFIT COCR HIP,"$1,795.00",$0.00,"$1,795.00",$0.00,"$1,281.09",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,795.00",$0.00,$897.50,"$1,421.64","$1,436.00",$0.00,$0.00,$0.00,$0.00,$0.00
Jun-05,SUP,Custom 27803010,,06-2205  -  HEAD FEM +5MM OFST CTPR 22MM STRL LFIT COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
111630,SUP,HCPCS C1713,,111630  -  PIN FX SM DUNN-DAUTREY STRPR UNCMP,$302.50,$0.00,$302.50,$136.13,$215.89,$0.00,$52.12,$0.00,$0.00,$52.97,$302.50,$0.00,$151.25,$239.58,$242.00,$0.00,$47.34,$0.00,$48.16,$0.00
111640,SUP,HCPCS C1713,,111640  -  PIN FX 4MM 170MM STRL KN,$302.50,$0.00,$302.50,$136.13,$215.89,$0.00,$52.12,$0.00,$0.00,$52.97,$302.50,$0.00,$151.25,$239.58,$242.00,$0.00,$47.34,$0.00,$48.16,$0.00
111650,SUP,HCPCS C1776,,111650  -  KIT THR STRL FEM/TIB CKPNT KT KN,$387.50,$0.00,$387.50,$174.38,$276.56,$0.00,$66.76,$0.00,$0.00,$67.85,$387.50,$0.00,$193.75,$306.90,$310.00,$0.00,$60.64,$0.00,$61.69,$0.00
111651,SUP,HCPCS C1776,,111651  -  COMPONENT FEM STRL TIB CKPNT KN,$120.00,$0.00,$120.00,$54.00,$85.64,$0.00,$20.68,$0.00,$0.00,$21.01,$120.00,$0.00,$60.00,$95.04,$96.00,$0.00,$18.78,$0.00,$19.10,$0.00
111652,SUP,HCPCS C1776,,111652  -  COMPONENT FEM STRL FEM CKPNT KN,$205.00,$0.00,$205.00,$92.25,$146.31,$0.00,$35.32,$0.00,$0.00,$35.89,$205.00,$0.00,$102.50,$162.36,$164.00,$0.00,$32.08,$0.00,$32.64,$0.00
111655,SUP,HCPCS C1713,,111655  -  SCREW BN STRL VA CORT,$662.50,$0.00,$662.50,$298.13,$472.83,$0.00,$114.15,$0.00,$0.00,$116.00,$662.50,$0.00,$331.25,$524.70,$530.00,$0.00,$103.68,$0.00,$105.47,$0.00
111670,SUP,HCPCS C1713,,111670  -  PIN ORTH 3.2MM 80MM STRL KN,$302.50,$0.00,$302.50,$136.13,$215.89,$0.00,$52.12,$0.00,$0.00,$52.97,$302.50,$0.00,$151.25,$239.58,$242.00,$0.00,$47.34,$0.00,$48.16,$0.00
111680,SUP,HCPCS C1713,,111680  -  PIN FX 4MM 80MM STRL KN,$302.50,$0.00,$302.50,$136.13,$215.89,$0.00,$52.12,$0.00,$0.00,$52.97,$302.50,$0.00,$151.25,$239.58,$242.00,$0.00,$47.34,$0.00,$48.16,$0.00
Jan-06,SUP,HCPCS C1713,,1-2206  -  SPACER SPNL 6MM X-STP TI LMBR INTERSPINOUS PRC DCMPRS,"$7,632.00",$0.00,"$7,632.00","$3,434.40","$5,158.80",$0.00,"$1,314.96",$0.00,$0.00,"$1,336.30","$7,632.00",$0.00,"$3,816.00","$6,044.54","$6,105.60",$0.00,"$1,194.41",$0.00,"$1,215.01",$0.00
Jan-08,SUP,HCPCS C1713,,1-2208  -  SPACER SPNL 8MM X-STP TI LMBR INTERSPINOUS PRC DCMPRS,"$7,632.00",$0.00,"$7,632.00","$3,434.40","$5,158.80",$0.00,"$1,314.96",$0.00,$0.00,"$1,336.30","$7,632.00",$0.00,"$3,816.00","$6,044.54","$6,105.60",$0.00,"$1,194.41",$0.00,"$1,215.01",$0.00
112640,SUP,HCPCS C1781,,0112640  -  MESH SURG 4X1IN PATCH FLAT SHEET KNIT MARLEX GROIN HERN,$118.25,$0.00,$118.25,$53.21,$84.40,$0.00,$20.37,$0.00,$0.00,$20.70,$118.25,$0.00,$59.13,$93.65,$94.60,$0.00,$18.51,$0.00,$18.83,$0.00
112660,SUP,HCPCS C1781,,112660  -  MESH HERN GROIN POLYPRO 14X10IN FLAT PTCH KNTD MRLX STRL,"$1,350.00",$0.00,"$1,350.00",$607.50,$963.50,$0.00,$232.60,$0.00,$0.00,$236.37,"$1,350.00",$0.00,$675.00,"$1,069.20","$1,080.00",$0.00,$211.28,$0.00,$214.92,$0.00
112727,SUP,Custom 27203010,,112727  -  SCREW XTRNFX SPTL FRM HXFX SET SS,$33.83,$0.00,$33.83,$0.00,$24.14,$0.00,$0.00,$0.00,$0.00,$0.00,$33.83,$0.00,$16.91,$26.79,$27.06,$0.00,$0.00,$0.00,$0.00,$0.00
112960,SUP,HCPCS C1781,,0112960  -  PLUG SURG MEDIUM TAPER 1.55X1.3IN MONOFILAMENT NONABSORBABLE,$736.64,$0.00,$736.64,$331.49,$525.74,$0.00,$126.92,$0.00,$0.00,$128.98,$736.64,$0.00,$368.32,$583.42,$589.31,$0.00,$115.28,$0.00,$117.27,$0.00
112970,SUP,HCPCS C1781,,0112970  -  MESH SRG LG 1.9IN 1.6IN STRL BARD PRFX PLG MFL PLT EDG PP,$743.23,$0.00,$743.23,$334.46,$530.45,$0.00,$128.06,$0.00,$0.00,$130.13,$743.23,$0.00,$371.62,$588.64,$594.59,$0.00,$116.32,$0.00,$118.32,$0.00
112970,SUP,HCPCS C1781,,112970  -  MESH SURG LARGE 1.9IN 1.6IN PLUG MONOFILAMENT PERFIX POLYPRO,"$3,417.75",$0.00,"$2,706.86",$334.46,$530.45,$0.00,$128.06,$0.00,$0.00,$130.13,$743.23,$0.00,$371.62,"$2,706.86",$594.59,$0.00,$116.32,$0.00,$118.32,$0.00
112980,SUP,HCPCS C1781,,0112980  -  MESH SURG XL 2X1.6IN NONABSORBABLE PLUG TAPERED MARLEX,$849.25,$0.00,$849.25,$382.16,$606.11,$0.00,$146.32,$0.00,$0.00,$148.70,$849.25,$0.00,$424.63,$672.61,$679.40,$0.00,$132.91,$0.00,$135.20,$0.00
Jan-10,SUP,HCPCS C1713,,1-2210  -  SPACER SPNL 10MM X-STP TI LMBR INTERSPINOUS PRC DCMPRS,"$7,632.00",$0.00,"$7,632.00","$3,434.40","$5,158.80",$0.00,"$1,314.96",$0.00,$0.00,"$1,336.30","$7,632.00",$0.00,"$3,816.00","$6,044.54","$6,105.60",$0.00,"$1,194.41",$0.00,"$1,215.01",$0.00
Jun-10,SUP,Custom 27803010,,06-2210  -  HEAD FEM +10MM OFST CTPR 22MM STRL LFIT COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
Jan-12,SUP,HCPCS C1713,,1-2212  -  SPACER SPNL 12MM X-STP TI LMBR INTERSPINOUS PRC DCMPRS,"$7,632.00",$0.00,"$7,632.00","$3,434.40","$5,158.80",$0.00,"$1,314.96",$0.00,$0.00,"$1,336.30","$7,632.00",$0.00,"$3,816.00","$6,044.54","$6,105.60",$0.00,"$1,194.41",$0.00,"$1,215.01",$0.00
114153,SUP,HCPCS C1880,,114153  -  CATHETER SCT KT 2 LUM COIL XTD LGTH,$200.00,$0.00,$200.00,$90.00,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
114156,SUP,HCPCS C1788,,114156  -  SET HMDIAL 33ML LF AQDX BLD CRCT UF-500,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
Jan-14,SUP,HCPCS C1713,,1-2214  -  SPACER SPNL 14MM X-STP TI LMBR INTERSPINOUS PRC DCMPRS,"$7,632.00",$0.00,"$7,632.00","$3,434.40","$5,158.80",$0.00,"$1,314.96",$0.00,$0.00,"$1,336.30","$7,632.00",$0.00,"$3,816.00","$6,044.54","$6,105.60",$0.00,"$1,194.41",$0.00,"$1,215.01",$0.00
116240,SUP,HCPCS C1713,,116240  -  SCREW BN STRL CORT,$662.50,$0.00,$662.50,$298.13,$472.83,$0.00,$114.15,$0.00,$0.00,$116.00,$662.50,$0.00,$331.25,$524.70,$530.00,$0.00,$103.68,$0.00,$105.47,$0.00
120019,SUP,HCPCS C1713,,120019  -  BUTTON SUT 19MM STRL LF HWSN 4 HL HD PE LGMNT DISP,$310.40,$0.00,$310.40,$139.68,$221.53,$0.00,$53.48,$0.00,$0.00,$54.35,$310.40,$0.00,$155.20,$245.84,$248.32,$0.00,$48.58,$0.00,$49.42,$0.00
121100,SUP,HCPCS C1713,,121100  -  SCREW BN STD 12.7MM 9MM 55MM STRL 21MM AMBI CLS LG CMPR SS,$726.60,$0.00,$726.60,$326.97,$518.57,$0.00,$125.19,$0.00,$0.00,$127.22,$726.60,$0.00,$363.30,$575.47,$581.28,$0.00,$113.71,$0.00,$115.67,$0.00
121101,SUP,HCPCS C1713,,121101  -  SCREW BN STD 9MM .5MM 60MM CLS AMBI IMHS LG THRD HIP,$726.60,$0.00,$726.60,$326.97,$518.57,$0.00,$125.19,$0.00,$0.00,$127.22,$726.60,$0.00,$363.30,$575.47,$581.28,$0.00,$113.71,$0.00,$115.67,$0.00
121102,SUP,HCPCS C1713,,121102  -  SCREW BN STD 12.7MM 9MM 65MM STRL 21MM AMBI CLS LG CMPR SS,$726.60,$0.00,$726.60,$326.97,$518.57,$0.00,$125.19,$0.00,$0.00,$127.22,$726.60,$0.00,$363.30,$575.47,$581.28,$0.00,$113.71,$0.00,$115.67,$0.00
121103,SUP,HCPCS C1713,,121103  -  SCREW BN STD 9MM .5MM 70MM CLS AMBI IMHS LG THRD HIP,$726.60,$0.00,$726.60,$326.97,$518.57,$0.00,$125.19,$0.00,$0.00,$127.22,$726.60,$0.00,$363.30,$575.47,$581.28,$0.00,$113.71,$0.00,$115.67,$0.00
121104,SUP,HCPCS C1713,,121104  -  SCREW BN STD 12.7MM 9MM 75MM STRL 21MM AMBI IMHS CLS LG CMPR,$726.60,$0.00,$726.60,$326.97,$518.57,$0.00,$125.19,$0.00,$0.00,$127.22,$726.60,$0.00,$363.30,$575.47,$581.28,$0.00,$113.71,$0.00,$115.67,$0.00
121105,SUP,HCPCS C1713,,121105  -  SCREW BN STD 12.7MM 9MM 80MM STRL 21MM AMBI IMHS CLS LG CMPR,$726.60,$0.00,$726.60,$326.97,$518.57,$0.00,$125.19,$0.00,$0.00,$127.22,$726.60,$0.00,$363.30,$575.47,$581.28,$0.00,$113.71,$0.00,$115.67,$0.00
121106,SUP,HCPCS C1713,,121106  -  SCREW BN P/T 12.7MM 9MM 85MM 21MM AMBI CHS IMHS STD LG HIP,$726.60,$0.00,$726.60,$326.97,$518.57,$0.00,$125.19,$0.00,$0.00,$127.22,$726.60,$0.00,$363.30,$575.47,$581.28,$0.00,$113.71,$0.00,$115.67,$0.00
121107,SUP,HCPCS C1713,,121107  -  SCREW BN P/T 12.7MM 9MM 90MM 21MM AMBI CHS IMHS STD LG HIP,$726.60,$0.00,$726.60,$326.97,$518.57,$0.00,$125.19,$0.00,$0.00,$127.22,$726.60,$0.00,$363.30,$575.47,$581.28,$0.00,$113.71,$0.00,$115.67,$0.00
121108,SUP,HCPCS C1713,,121108  -  SCREW BN 12.7MM 9MM 95MM 21MM AMBI CHS STD LG SS HIP,$726.60,$0.00,$726.60,$326.97,$518.57,$0.00,$125.19,$0.00,$0.00,$127.22,$726.60,$0.00,$363.30,$575.47,$581.28,$0.00,$113.71,$0.00,$115.67,$0.00
121109,SUP,HCPCS C1713,,121109  -  SCREW BN STD 12.7MM 9MM 100MM STRL 21MM AMBI IMHS CLS LG,$726.60,$0.00,$726.60,$326.97,$518.57,$0.00,$125.19,$0.00,$0.00,$127.22,$726.60,$0.00,$363.30,$575.47,$581.28,$0.00,$113.71,$0.00,$115.67,$0.00
121110,SUP,HCPCS C1713,,121110  -  SCREW BN 12.7MM 9MM 105MM 21MM AMBI CHS STD LG SS HIP,$726.60,$0.00,$726.60,$326.97,$518.57,$0.00,$125.19,$0.00,$0.00,$127.22,$726.60,$0.00,$363.30,$575.47,$581.28,$0.00,$113.71,$0.00,$115.67,$0.00
121111,SUP,HCPCS C1713,,121111  -  SCREW BN STD .5IN 9MM 110MM 21MM IMHS LG HIP SP CNDL PLT,$726.60,$0.00,$726.60,$326.97,$518.57,$0.00,$125.19,$0.00,$0.00,$127.22,$726.60,$0.00,$363.30,$575.47,$581.28,$0.00,$113.71,$0.00,$115.67,$0.00
121112,SUP,HCPCS C1713,,121112  -  SCREW BN STD .5IN 9MM 115MM 21MM AMBI CLS IMHS LG,$726.60,$0.00,$726.60,$326.97,$518.57,$0.00,$125.19,$0.00,$0.00,$127.22,$726.60,$0.00,$363.30,$575.47,$581.28,$0.00,$113.71,$0.00,$115.67,$0.00
121116,SUP,HCPCS C1713,,121116  -  SCREW BN HEX 3.5MM 19MM AMBI IMHS CLS CMPR SS HIP SP CNDL IM,$199.40,$0.00,$199.40,$89.73,$142.31,$0.00,$34.36,$0.00,$0.00,$34.91,$199.40,$0.00,$99.70,$157.92,$159.52,$0.00,$31.21,$0.00,$31.74,$0.00
121117,SUP,HCPCS C1713,,121117  -  SCREW BN HEX 3.5MM 28.5MM AMBI IMHS CLS CMPR SS HIP SP CNDL,$199.40,$0.00,$199.40,$89.73,$142.31,$0.00,$34.36,$0.00,$0.00,$34.91,$199.40,$0.00,$99.70,$157.92,$159.52,$0.00,$31.21,$0.00,$31.74,$0.00
121120,SUP,HCPCS C1713,,121120  -  PLATE BN 130D STD BRL 60MM 38.1MM AMBI 2 HL SS HIP,"$1,081.50",$0.00,"$1,081.50",$486.68,$771.87,$0.00,$186.34,$0.00,$0.00,$189.36,"$1,081.50",$0.00,$540.75,$856.55,$865.20,$0.00,$169.25,$0.00,$172.17,$0.00
121121,SUP,HCPCS C1713,,121121  -  PLATE BN 135D STD BRL 60MM 38.1MM AMBI 2 HL CMPR SS HIP,"$1,081.50",$0.00,"$1,081.50",$486.68,$771.87,$0.00,$186.34,$0.00,$0.00,$189.36,"$1,081.50",$0.00,$540.75,$856.55,$865.20,$0.00,$169.25,$0.00,$172.17,$0.00
121122,SUP,HCPCS C1713,,121122  -  PLATE BN 140D STD BRL 60MM 38.1MM AMBI 2 HL CMPR SS HIP,"$1,081.50",$0.00,"$1,081.50",$486.68,$771.87,$0.00,$186.34,$0.00,$0.00,$189.36,"$1,081.50",$0.00,$540.75,$856.55,$865.20,$0.00,$169.25,$0.00,$172.17,$0.00
121123,SUP,HCPCS C1713,,121123  -  PLATE BN 145D STD BRL 60MM 38.1MM AMBI 2 HL SS HIP,"$1,081.50",$0.00,"$1,081.50",$486.68,$771.87,$0.00,$186.34,$0.00,$0.00,$189.36,"$1,081.50",$0.00,$540.75,$856.55,$865.20,$0.00,$169.25,$0.00,$172.17,$0.00
121124,SUP,HCPCS C1713,,121124  -  PLATE BN 150D STD BRL 60MM 38.1MM AMBI 2 HL CMPR SS HIP,"$1,081.50",$0.00,"$1,081.50",$486.68,$771.87,$0.00,$186.34,$0.00,$0.00,$189.36,"$1,081.50",$0.00,$540.75,$856.55,$865.20,$0.00,$169.25,$0.00,$172.17,$0.00
121125,SUP,HCPCS C1713,,121125  -  PLATE BN 130D STD BRL 80MM 38.1MM AMBI 3 HL CMPR SS HIP,"$1,113.00",$0.00,"$1,113.00",$500.85,$794.35,$0.00,$191.76,$0.00,$0.00,$194.88,"$1,113.00",$0.00,$556.50,$881.50,$890.40,$0.00,$174.18,$0.00,$177.19,$0.00
121126,SUP,HCPCS C1713,,121126  -  PLATE BN 135D STD BRL 80MM 38.1MM AMBI 3 HL CMPR SS HIP,"$1,113.00",$0.00,"$1,113.00",$500.85,$794.35,$0.00,$191.76,$0.00,$0.00,$194.88,"$1,113.00",$0.00,$556.50,$881.50,$890.40,$0.00,$174.18,$0.00,$177.19,$0.00
121127,SUP,HCPCS C1713,,121127  -  PLATE BN 140D STD BRL 80MM 38.1MM AMBI 3 HL CMPR HIP,"$1,113.00",$0.00,"$1,113.00",$500.85,$794.35,$0.00,$191.76,$0.00,$0.00,$194.88,"$1,113.00",$0.00,$556.50,$881.50,$890.40,$0.00,$174.18,$0.00,$177.19,$0.00
121128,SUP,HCPCS C1713,,121128  -  PLATE BN 145D STD BRL 80MM 38.1MM AMBI 3 HL CMPR HIP,"$1,113.00",$0.00,"$1,113.00",$500.85,$794.35,$0.00,$191.76,$0.00,$0.00,$194.88,"$1,113.00",$0.00,$556.50,$881.50,$890.40,$0.00,$174.18,$0.00,$177.19,$0.00
121130,SUP,HCPCS C1713,,121130  -  PLATE BN 130D STD BRL 100MM 38.1MM AMBI 4 HL CMPR SS HIP,"$1,113.00",$0.00,"$1,113.00",$500.85,$794.35,$0.00,$191.76,$0.00,$0.00,$194.88,"$1,113.00",$0.00,$556.50,$881.50,$890.40,$0.00,$174.18,$0.00,$177.19,$0.00
121131,SUP,HCPCS C1713,,121131  -  PLATE BN 135D STD BRL 135MM 38.1MM AMBI 4 HL CMPR SS HIP,"$1,113.00",$0.00,"$1,113.00",$500.85,$794.35,$0.00,$191.76,$0.00,$0.00,$194.88,"$1,113.00",$0.00,$556.50,$881.50,$890.40,$0.00,$174.18,$0.00,$177.19,$0.00
121135,SUP,HCPCS C1713,,121135  -  PLATE BN 130D STD BRL 120MM 38.1MM AMBI CHS 5 HL SS HIP,"$1,191.75",$0.00,"$1,191.75",$536.29,$850.55,$0.00,$205.33,$0.00,$0.00,$208.67,"$1,191.75",$0.00,$595.88,$943.87,$953.40,$0.00,$186.51,$0.00,$189.73,$0.00
121137,SUP,HCPCS C1713,,121137  -  PLATE BN 140D STD BRL 120MM 38.1MM AMBI 5 HL HIP,"$1,191.75",$0.00,"$1,191.75",$536.29,$850.55,$0.00,$205.33,$0.00,$0.00,$208.67,"$1,191.75",$0.00,$595.88,$943.87,$953.40,$0.00,$186.51,$0.00,$189.73,$0.00
121138,SUP,HCPCS C1713,,121138  -  PLATE BN 145D STD BRL 120MM 38.1MM AMBI 5 HL CMPR SS HIP,"$1,191.75",$0.00,"$1,191.75",$536.29,$850.55,$0.00,$205.33,$0.00,$0.00,$208.67,"$1,191.75",$0.00,$595.88,$943.87,$953.40,$0.00,$186.51,$0.00,$189.73,$0.00
121139,SUP,HCPCS C1713,,121139  -  PLATE BN 150D STD BRL 120MM 38.1MM AMBI 5 HL CMPR SS HIP,"$1,191.75",$0.00,"$1,191.75",$536.29,$850.55,$0.00,$205.33,$0.00,$0.00,$208.67,"$1,191.75",$0.00,$595.88,$943.87,$953.40,$0.00,$186.51,$0.00,$189.73,$0.00
121141,SUP,HCPCS C1713,,121141  -  PLATE BN 135D STD BRL 140MM 38.1MM AMBI 6 HL CMPR SS HIP,"$1,239.00",$0.00,"$1,239.00",$557.55,$884.27,$0.00,$213.47,$0.00,$0.00,$216.94,"$1,239.00",$0.00,$619.50,$981.29,$991.20,$0.00,$193.90,$0.00,$197.25,$0.00
121143,SUP,HCPCS C1713,,121143  -  PLATE BN 145D STD BRL 140MM 38.1MM AMBI 6 HL CMPR SS HIP,"$1,239.00",$0.00,"$1,239.00",$557.55,$884.27,$0.00,$213.47,$0.00,$0.00,$216.94,"$1,239.00",$0.00,$619.50,$981.29,$991.20,$0.00,$193.90,$0.00,$197.25,$0.00
121144,SUP,HCPCS C1713,,121144  -  PLATE BN 150D STD BRL 140MM 38.1MM AMBI 6 HL CMPR SS HIP,"$1,239.00",$0.00,"$1,239.00",$557.55,$884.27,$0.00,$213.47,$0.00,$0.00,$216.94,"$1,239.00",$0.00,$619.50,$981.29,$991.20,$0.00,$193.90,$0.00,$197.25,$0.00
121145,SUP,HCPCS C1713,,121145  -  PLATE BN 130D STD BRL 180MM 38.1MM AMBI 8 HL CMPR SS HIP,"$1,501.50",$0.00,"$1,501.50",$675.68,"$1,071.62",$0.00,$258.70,$0.00,$0.00,$262.90,"$1,501.50",$0.00,$750.75,"$1,189.19","$1,201.20",$0.00,$234.98,$0.00,$239.04,$0.00
121147,SUP,HCPCS C1713,,121147  -  PLATE BN 140D STD BRL 180MM 38.1MM AMBI 8 HL CMPR SS HIP,"$1,501.50",$0.00,"$1,501.50",$675.68,"$1,071.62",$0.00,$258.70,$0.00,$0.00,$262.90,"$1,501.50",$0.00,$750.75,"$1,189.19","$1,201.20",$0.00,$234.98,$0.00,$239.04,$0.00
121148,SUP,HCPCS C1713,,121148  -  PLATE BN 145D STD BRL 180MM 38.1MM AMBI 8 HL CMPR SS HIP,"$1,501.50",$0.00,"$1,501.50",$675.68,"$1,071.62",$0.00,$258.70,$0.00,$0.00,$262.90,"$1,501.50",$0.00,$750.75,"$1,189.19","$1,201.20",$0.00,$234.98,$0.00,$239.04,$0.00
121149,SUP,HCPCS C1713,,121149  -  PLATE BN 150D STD BRL 180MM 38.1MM AMBI 8 HL CMPR SS HIP,"$1,501.50",$0.00,"$1,501.50",$675.68,"$1,071.62",$0.00,$258.70,$0.00,$0.00,$262.90,"$1,501.50",$0.00,$750.75,"$1,189.19","$1,201.20",$0.00,$234.98,$0.00,$239.04,$0.00
121150,SUP,HCPCS C1713,,121150  -  PLATE BN 130D STD BRL 220MM 38.1MM AMBI 10 HL SS HIP,"$1,758.75",$0.00,"$1,758.75",$791.44,"$1,255.22",$0.00,$303.02,$0.00,$0.00,$307.94,"$1,758.75",$0.00,$879.38,"$1,392.93","$1,407.00",$0.00,$275.24,$0.00,$279.99,$0.00
121152,SUP,HCPCS C1713,,121152  -  PLATE BN 140D STD BRL 220MM 1.5IN AMBI 10 HL SS HIP,"$1,758.75",$0.00,"$1,758.75",$791.44,"$1,255.22",$0.00,$303.02,$0.00,$0.00,$307.94,"$1,758.75",$0.00,$879.38,"$1,392.93","$1,407.00",$0.00,$275.24,$0.00,$279.99,$0.00
121153,SUP,HCPCS C1713,,121153  -  PLATE BN 145D STD BRL 180MM 38.1MM AMBI 10 HL CMPR SS HIP,"$1,758.75",$0.00,"$1,758.75",$791.44,"$1,255.22",$0.00,$303.02,$0.00,$0.00,$307.94,"$1,758.75",$0.00,$879.38,"$1,392.93","$1,407.00",$0.00,$275.24,$0.00,$279.99,$0.00
121154,SUP,HCPCS C1713,,121154  -  PLATE BN 150D STD BRL 220MM 38.1MM AMBI 10 HL CMPR SS HIP,"$1,758.75",$0.00,"$1,758.75",$791.44,"$1,255.22",$0.00,$303.02,$0.00,$0.00,$307.94,"$1,758.75",$0.00,$879.38,"$1,392.93","$1,407.00",$0.00,$275.24,$0.00,$279.99,$0.00
121156,SUP,HCPCS C1713,,121156  -  PLATE BN 135D STD BRL 260MM 38.1MM AMBI 12 HL CMPR SS HIP,"$1,879.50",$0.00,"$1,879.50",$845.78,"$1,341.40",$0.00,$323.83,$0.00,$0.00,$329.09,"$1,879.50",$0.00,$939.75,"$1,488.56","$1,503.60",$0.00,$294.14,$0.00,$299.22,$0.00
121158,SUP,HCPCS C1713,,121158  -  PLATE BN 145D STD BRL 260MM 38.1MM AMBI 12 HL CMPR SS HIP,"$1,879.50",$0.00,"$1,879.50",$845.78,"$1,341.40",$0.00,$323.83,$0.00,$0.00,$329.09,"$1,879.50",$0.00,$939.75,"$1,488.56","$1,503.60",$0.00,$294.14,$0.00,$299.22,$0.00
121159,SUP,HCPCS C1713,,121159  -  PLATE BN 150D STD BRL 260MM 38.1MM AMBI 12 HL CMPR HIP,$889.35,$0.00,$889.35,$400.21,$634.73,$0.00,$153.23,$0.00,$0.00,$155.72,$889.35,$0.00,$444.68,$704.37,$711.48,$0.00,$139.18,$0.00,$141.58,$0.00
121161,SUP,HCPCS C1713,,121161  -  PLATE BN 135D STD BRL 300MM 38.1MM AMBI 14 SLOT SS HIP,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
121165,SUP,HCPCS C1713,,121165  -  PLATE BN 130D SHRT BRL 120MM 25.4MM AMBI CHS 5 HL SS HIP,"$1,212.75",$0.00,"$1,212.75",$545.74,$865.54,$0.00,$208.95,$0.00,$0.00,$212.34,"$1,212.75",$0.00,$606.38,$960.50,$970.20,$0.00,$189.80,$0.00,$193.07,$0.00
121166,SUP,HCPCS C1713,,121166  -  PLATE BN 135D SHRT BRL 120MM 25.4MM AMBI CHS 5 HL SS HIP,"$1,212.75",$0.00,"$1,212.75",$545.74,$865.54,$0.00,$208.95,$0.00,$0.00,$212.34,"$1,212.75",$0.00,$606.38,$960.50,$970.20,$0.00,$189.80,$0.00,$193.07,$0.00
121167,SUP,HCPCS C1713,,121167  -  PLATE BN 140D SHRT BRL 120MM 25.4MM AMBI CHS 5 HL SS HIP,"$1,212.75",$0.00,"$1,212.75",$545.74,$865.54,$0.00,$208.95,$0.00,$0.00,$212.34,"$1,212.75",$0.00,$606.38,$960.50,$970.20,$0.00,$189.80,$0.00,$193.07,$0.00
121168,SUP,HCPCS C1713,,121168  -  PLATE BN 145D SHRT BRL 120MM 25.4MM AMBI CHS 5 HL SS HIP,"$1,212.75",$0.00,"$1,212.75",$545.74,$865.54,$0.00,$208.95,$0.00,$0.00,$212.34,"$1,212.75",$0.00,$606.38,$960.50,$970.20,$0.00,$189.80,$0.00,$193.07,$0.00
121169,SUP,HCPCS C1713,,121169  -  PLATE BN 150D SHRT BRL 120MM 25.4MM AMBI CHS 5 HL SS HIP,"$1,212.75",$0.00,"$1,212.75",$545.74,$865.54,$0.00,$208.95,$0.00,$0.00,$212.34,"$1,212.75",$0.00,$606.38,$960.50,$970.20,$0.00,$189.80,$0.00,$193.07,$0.00
121176,SUP,HCPCS C1713,,121176  -  SCREW BN STD .5IN 9MM 130MM 21MM AMBI CLS IMHS LG,$726.60,$0.00,$726.60,$326.97,$518.57,$0.00,$125.19,$0.00,$0.00,$127.22,$726.60,$0.00,$363.30,$575.47,$581.28,$0.00,$113.71,$0.00,$115.67,$0.00
121177,SUP,HCPCS C1713,,121177  -  SCREW BN 12.7MM 9MM 135MM 21MM IMHS CP STD LG SS HIP IM NL,$726.60,$0.00,$726.60,$326.97,$518.57,$0.00,$125.19,$0.00,$0.00,$127.22,$726.60,$0.00,$363.30,$575.47,$581.28,$0.00,$113.71,$0.00,$115.67,$0.00
121178,SUP,HCPCS C1713,,121178  -  SCREW BN 12.7MM 9MM 140MM 21MM IMHS CP STD LG SS HIP IM NL,$726.60,$0.00,$726.60,$326.97,$518.57,$0.00,$125.19,$0.00,$0.00,$127.22,$726.60,$0.00,$363.30,$575.47,$581.28,$0.00,$113.71,$0.00,$115.67,$0.00
121181,SUP,HCPCS C1713,,121181  -  SCREW BN 14.3MM 9MM 60MM 21MM SPLG HIP,$774.90,$0.00,$774.90,$348.71,$553.05,$0.00,$133.51,$0.00,$0.00,$135.68,$774.90,$0.00,$387.45,$613.72,$619.92,$0.00,$121.27,$0.00,$123.36,$0.00
121191,SUP,HCPCS C1713,,121191  -  SCREW BN 9/16IN 9MM 110MM 21MM AMBI CLS SPLG,$774.90,$0.00,$774.90,$348.71,$553.05,$0.00,$133.51,$0.00,$0.00,$135.68,$774.90,$0.00,$387.45,$613.72,$619.92,$0.00,$121.27,$0.00,$123.36,$0.00
121192,SUP,HCPCS C1713,,121192  -  SCREW BN 14.3MM 9MM 115MM STRL 21MM AMBI CLS SPLG CMPR SS,$774.90,$0.00,$774.90,$348.71,$553.05,$0.00,$133.51,$0.00,$0.00,$135.68,$774.90,$0.00,$387.45,$613.72,$619.92,$0.00,$121.27,$0.00,$123.36,$0.00
121193,SUP,HCPCS C1713,,121193  -  SCREW BN 14.3MM 9MM 120MM STRL 21MM AMBI CLS SPLG CMPR SS,$774.90,$0.00,$774.90,$348.71,$553.05,$0.00,$133.51,$0.00,$0.00,$135.68,$774.90,$0.00,$387.45,$613.72,$619.92,$0.00,$121.27,$0.00,$123.36,$0.00
121194,SUP,HCPCS C1713,,121194  -  SCREW BN 14.3MM 9MM 125MM STRL 21MM AMBI CLS SPLG CMPR SS,$774.90,$0.00,$774.90,$348.71,$553.05,$0.00,$133.51,$0.00,$0.00,$135.68,$774.90,$0.00,$387.45,$613.72,$619.92,$0.00,$121.27,$0.00,$123.36,$0.00
121195,SUP,HCPCS C1713,,121195  -  SCREW BN 14.3MM 9MM 130MM 21MM CHS SPLG SS HIP,$774.90,$0.00,$774.90,$348.71,$553.05,$0.00,$133.51,$0.00,$0.00,$135.68,$774.90,$0.00,$387.45,$613.72,$619.92,$0.00,$121.27,$0.00,$123.36,$0.00
121196,SUP,HCPCS C1713,,121196  -  SCREW BN 14.3MM 9MM 135MM 21MM CHS SPLG SS HIP,$774.90,$0.00,$774.90,$348.71,$553.05,$0.00,$133.51,$0.00,$0.00,$135.68,$774.90,$0.00,$387.45,$613.72,$619.92,$0.00,$121.27,$0.00,$123.36,$0.00
121197,SUP,HCPCS C1713,,121197  -  SCREW BN 14.3MM 9MM 140MM 21MM CHS SPLG SS HIP,$774.90,$0.00,$774.90,$348.71,$553.05,$0.00,$133.51,$0.00,$0.00,$135.68,$774.90,$0.00,$387.45,$613.72,$619.92,$0.00,$121.27,$0.00,$123.36,$0.00
121198,SUP,HCPCS C1713,,121198  -  PLATE BN 130D SHRT BRL 100MM 25.4MM AMBI CHS 4 HL SS HIP,"$1,165.50",$0.00,"$1,165.50",$524.48,$831.82,$0.00,$200.81,$0.00,$0.00,$204.07,"$1,165.50",$0.00,$582.75,$923.08,$932.40,$0.00,$182.40,$0.00,$185.55,$0.00
121199,SUP,HCPCS C1713,,121199  -  PLATE BN 135D SHRT BRL 100MM 25.4MM AMBI CHS 4 HL SS HIP,"$1,165.50",$0.00,"$1,165.50",$524.48,$831.82,$0.00,$200.81,$0.00,$0.00,$204.07,"$1,165.50",$0.00,$582.75,$923.08,$932.40,$0.00,$182.40,$0.00,$185.55,$0.00
121200,SUP,HCPCS C1713,,121200  -  PLATE BN 140D SHRT BRL 100MM 25.4MM AMBI CHS 4 HL SS HIP,"$1,165.50",$0.00,"$1,165.50",$524.48,$831.82,$0.00,$200.81,$0.00,$0.00,$204.07,"$1,165.50",$0.00,$582.75,$923.08,$932.40,$0.00,$182.40,$0.00,$185.55,$0.00
121201,SUP,HCPCS C1713,,121201  -  PLATE BN 145D SHRT BRL 100MM 25.4MM AMBI CHS 4 HL SS HIP,"$1,165.50",$0.00,"$1,165.50",$524.48,$831.82,$0.00,$200.81,$0.00,$0.00,$204.07,"$1,165.50",$0.00,$582.75,$923.08,$932.40,$0.00,$182.40,$0.00,$185.55,$0.00
121202,SUP,HCPCS C1713,,121202  -  PLATE BN 150D SHRT BRL 100MM 25.4MM AMBI CHS 4 HL SS HIP,"$1,165.50",$0.00,"$1,165.50",$524.48,$831.82,$0.00,$200.81,$0.00,$0.00,$204.07,"$1,165.50",$0.00,$582.75,$923.08,$932.40,$0.00,$182.40,$0.00,$185.55,$0.00
121410,SUP,Custom 27203010,,121410  -  DEVICE BIOP 10CM 14GA MNPTY 22MM INSTR AUTO STRL DISP,$176.32,$0.00,$176.32,$0.00,$125.84,$0.00,$0.00,$0.00,$0.00,$0.00,$176.32,$0.00,$88.16,$139.65,$141.05,$0.00,$0.00,$0.00,$0.00,$0.00
121625,SUP,HCPCS C1713,,121625  -  SCREW BN 6.5MM 25MM STRL 16MM IMSC CNN SS SP CNDL,$531.30,$0.00,$531.30,$239.09,$379.19,$0.00,$91.54,$0.00,$0.00,$93.03,$531.30,$0.00,$265.65,$420.79,$425.04,$0.00,$83.15,$0.00,$84.58,$0.00
121626,SUP,HCPCS C1713,,121626  -  SCREW BN UNV 6.5MM 30MM STRL 20MM IMSC CNN CMPR SS HIP SP,$531.30,$0.00,$531.30,$239.09,$379.19,$0.00,$91.54,$0.00,$0.00,$93.03,$531.30,$0.00,$265.65,$420.79,$425.04,$0.00,$83.15,$0.00,$84.58,$0.00
121627,SUP,HCPCS C1713,,121627  -  SCREW BN UNV 6.5MM 35MM STRL 20MM IMSC CNN CMPR SS HIP SP,$531.30,$0.00,$531.30,$239.09,$379.19,$0.00,$91.54,$0.00,$0.00,$93.03,$531.30,$0.00,$265.65,$420.79,$425.04,$0.00,$83.15,$0.00,$84.58,$0.00
121628,SUP,HCPCS C1713,,121628  -  SCREW BN UNV 6.5MM 40MM STRL 20MM IMSC CNN CMPR SS HIP SP,$531.30,$0.00,$531.30,$239.09,$379.19,$0.00,$91.54,$0.00,$0.00,$93.03,$531.30,$0.00,$265.65,$420.79,$425.04,$0.00,$83.15,$0.00,$84.58,$0.00
121629,SUP,HCPCS C1713,,121629  -  SCREW BN UNV 6.5MM 45MM STRL 20MM IMSC CNN CMPR SS HIP SP,$531.30,$0.00,$531.30,$239.09,$379.19,$0.00,$91.54,$0.00,$0.00,$93.03,$531.30,$0.00,$265.65,$420.79,$425.04,$0.00,$83.15,$0.00,$84.58,$0.00
121630,SUP,HCPCS C1713,,121630  -  SCREW BN UNV 6.5MM 50MM STRL 20MM IMSC CNN CMPR SS HIP SP,$531.30,$0.00,$531.30,$239.09,$379.19,$0.00,$91.54,$0.00,$0.00,$93.03,$531.30,$0.00,$265.65,$420.79,$425.04,$0.00,$83.15,$0.00,$84.58,$0.00
121631,SUP,HCPCS C1713,,121631  -  SCREW BN UNV 6.5MM 55MM STRL 20MM IMSC CNN CMPR SS HIP SP,$531.30,$0.00,$531.30,$239.09,$379.19,$0.00,$91.54,$0.00,$0.00,$93.03,$531.30,$0.00,$265.65,$420.79,$425.04,$0.00,$83.15,$0.00,$84.58,$0.00
121632,SUP,HCPCS C1713,,121632  -  SCREW BN UNV 6.5MM 60MM STRL 20MM IMSC CNN CMPR SS HIP SP,$531.30,$0.00,$531.30,$239.09,$379.19,$0.00,$91.54,$0.00,$0.00,$93.03,$531.30,$0.00,$265.65,$420.79,$425.04,$0.00,$83.15,$0.00,$84.58,$0.00
121633,SUP,HCPCS C1713,,121633  -  SCREW BN UNV 6.5MM 65MM STRL 20MM IMSC CNN CMPR SS HIP SP,$531.30,$0.00,$531.30,$239.09,$379.19,$0.00,$91.54,$0.00,$0.00,$93.03,$531.30,$0.00,$265.65,$420.79,$425.04,$0.00,$83.15,$0.00,$84.58,$0.00
121634,SUP,HCPCS C1713,,121634  -  SCREW BN UNV 6.5MM 70MM STRL 20MM IMSC CNN CMPR SS HIP SP,$531.30,$0.00,$531.30,$239.09,$379.19,$0.00,$91.54,$0.00,$0.00,$93.03,$531.30,$0.00,$265.65,$420.79,$425.04,$0.00,$83.15,$0.00,$84.58,$0.00
121635,SUP,HCPCS C1713,,121635  -  SCREW BN UNV 6.5MM 75MM STRL 20MM IMSC CNN CMPR SS HIP SP,$531.30,$0.00,$531.30,$239.09,$379.19,$0.00,$91.54,$0.00,$0.00,$93.03,$531.30,$0.00,$265.65,$420.79,$425.04,$0.00,$83.15,$0.00,$84.58,$0.00
121636,SUP,HCPCS C1713,,121636  -  SCREW BN P/T 6.5MM 4.5MM 80MM STRL 20MM CNN SS HIP,$531.30,$0.00,$531.30,$239.09,$379.19,$0.00,$91.54,$0.00,$0.00,$93.03,$531.30,$0.00,$265.65,$420.79,$425.04,$0.00,$83.15,$0.00,$84.58,$0.00
121637,SUP,HCPCS C1713,,121637  -  SCREW BN UNV 6.5MM 85MM STRL 20MM IMSC CNN CMPR SS HIP SP,$531.30,$0.00,$531.30,$239.09,$379.19,$0.00,$91.54,$0.00,$0.00,$93.03,$531.30,$0.00,$265.65,$420.79,$425.04,$0.00,$83.15,$0.00,$84.58,$0.00
121638,SUP,HCPCS C1713,,121638  -  SCREW BN 6.5MM 90MM CNN MTPHSL,$531.30,$0.00,$531.30,$239.09,$379.19,$0.00,$91.54,$0.00,$0.00,$93.03,$531.30,$0.00,$265.65,$420.79,$425.04,$0.00,$83.15,$0.00,$84.58,$0.00
121639,SUP,HCPCS C1713,,121639  -  SCREW BN UNV 6.5MM 95MM STRL 20MM IMSC CNN CMPR SS HIP SP,$531.30,$0.00,$531.30,$239.09,$379.19,$0.00,$91.54,$0.00,$0.00,$93.03,$531.30,$0.00,$265.65,$420.79,$425.04,$0.00,$83.15,$0.00,$84.58,$0.00
121640,SUP,HCPCS C1713,,121640  -  SCREW BN 6.5MM 100MM CNN SP CNDL,$531.30,$0.00,$531.30,$239.09,$379.19,$0.00,$91.54,$0.00,$0.00,$93.03,$531.30,$0.00,$265.65,$420.79,$425.04,$0.00,$83.15,$0.00,$84.58,$0.00
121641,SUP,HCPCS C1713,,121641  -  SCREW BN UNV 6.5MM 105MM STRL 20MM IMSC CNN CMPR SS HIP SP,$531.30,$0.00,$531.30,$239.09,$379.19,$0.00,$91.54,$0.00,$0.00,$93.03,$531.30,$0.00,$265.65,$420.79,$425.04,$0.00,$83.15,$0.00,$84.58,$0.00
121642,SUP,HCPCS C1713,,121642  -  SCREW BN UNV 6.5MM 110MM STRL 20MM IMSC CNN CMPR SS HIP SP,$531.30,$0.00,$531.30,$239.09,$379.19,$0.00,$91.54,$0.00,$0.00,$93.03,$531.30,$0.00,$265.65,$420.79,$425.04,$0.00,$83.15,$0.00,$84.58,$0.00
121643,SUP,HCPCS C1713,,121643  -  SCREW BN UNV 6.5MM 115MM STRL 20MM IMSC CNN CMPR SS HIP SP,$531.30,$0.00,$531.30,$239.09,$379.19,$0.00,$91.54,$0.00,$0.00,$93.03,$531.30,$0.00,$265.65,$420.79,$425.04,$0.00,$83.15,$0.00,$84.58,$0.00
121644,SUP,HCPCS C1713,,121644  -  SCREW BN UNV 6.5MM 120MM STRL 20MM IMSC CNN CMPR SS HIP SP,$531.30,$0.00,$531.30,$239.09,$379.19,$0.00,$91.54,$0.00,$0.00,$93.03,$531.30,$0.00,$265.65,$420.79,$425.04,$0.00,$83.15,$0.00,$84.58,$0.00
121654,SUP,HCPCS C1713,,121654  -  PIN FX 30MM CNN HIP,$761.25,$0.00,$761.25,$342.56,$543.30,$0.00,$131.16,$0.00,$0.00,$133.29,$761.25,$0.00,$380.63,$602.91,$609.00,$0.00,$119.14,$0.00,$121.19,$0.00
121655,SUP,HCPCS C1713,,121655  -  PIN FX 35MM CNN HIP,$761.25,$0.00,$761.25,$342.56,$543.30,$0.00,$131.16,$0.00,$0.00,$133.29,$761.25,$0.00,$380.63,$602.91,$609.00,$0.00,$119.14,$0.00,$121.19,$0.00
121656,SUP,HCPCS C1713,,121656  -  PIN FX 40MM CNN HIP,$761.25,$0.00,$761.25,$342.56,$543.30,$0.00,$131.16,$0.00,$0.00,$133.29,$761.25,$0.00,$380.63,$602.91,$609.00,$0.00,$119.14,$0.00,$121.19,$0.00
121657,SUP,HCPCS C1713,,121657  -  PIN FX 45MM CNN HIP,$761.25,$0.00,$761.25,$342.56,$543.30,$0.00,$131.16,$0.00,$0.00,$133.29,$761.25,$0.00,$380.63,$602.91,$609.00,$0.00,$119.14,$0.00,$121.19,$0.00
121658,SUP,HCPCS C1713,,121658  -  PIN FX 50MM CNN HIP,$761.25,$0.00,$761.25,$342.56,$543.30,$0.00,$131.16,$0.00,$0.00,$133.29,$761.25,$0.00,$380.63,$602.91,$609.00,$0.00,$119.14,$0.00,$121.19,$0.00
121659,SUP,HCPCS C1713,,121659  -  PIN FX 55MM CNN HIP,$761.25,$0.00,$761.25,$342.56,$543.30,$0.00,$131.16,$0.00,$0.00,$133.29,$761.25,$0.00,$380.63,$602.91,$609.00,$0.00,$119.14,$0.00,$121.19,$0.00
121660,SUP,HCPCS C1713,,121660  -  PIN FX 60MM CNN HIP,$700.35,$0.00,$700.35,$315.16,$499.84,$0.00,$120.67,$0.00,$0.00,$122.63,$700.35,$0.00,$350.18,$554.68,$560.28,$0.00,$109.60,$0.00,$111.50,$0.00
121661,SUP,HCPCS C1713,,121661  -  PIN FX 65MM CNN HIP,$700.35,$0.00,$700.35,$315.16,$499.84,$0.00,$120.67,$0.00,$0.00,$122.63,$700.35,$0.00,$350.18,$554.68,$560.28,$0.00,$109.60,$0.00,$111.50,$0.00
121662,SUP,HCPCS C1713,,121662  -  PIN FX 6.35MM 70MM 16MM CNN HIP,$700.35,$0.00,$700.35,$315.16,$499.84,$0.00,$120.67,$0.00,$0.00,$122.63,$700.35,$0.00,$350.18,$554.68,$560.28,$0.00,$109.60,$0.00,$111.50,$0.00
121663,SUP,HCPCS C1713,,121663  -  PIN FX 75MM CNN HIP,$700.35,$0.00,$700.35,$315.16,$499.84,$0.00,$120.67,$0.00,$0.00,$122.63,$700.35,$0.00,$350.18,$554.68,$560.28,$0.00,$109.60,$0.00,$111.50,$0.00
121664,SUP,HCPCS C1713,,121664  -  PIN FX 6.35MM 80MM 16MM CNN HIP,$700.35,$0.00,$700.35,$315.16,$499.84,$0.00,$120.67,$0.00,$0.00,$122.63,$700.35,$0.00,$350.18,$554.68,$560.28,$0.00,$109.60,$0.00,$111.50,$0.00
121665,SUP,HCPCS C1713,,121665  -  PIN FX 6.35MM 85MM 16MM CNN HIP,$700.35,$0.00,$700.35,$315.16,$499.84,$0.00,$120.67,$0.00,$0.00,$122.63,$700.35,$0.00,$350.18,$554.68,$560.28,$0.00,$109.60,$0.00,$111.50,$0.00
121666,SUP,HCPCS C1713,,121666  -  PIN FX 6.35MM 90MM 16MM CNN HIP,$700.35,$0.00,$700.35,$315.16,$499.84,$0.00,$120.67,$0.00,$0.00,$122.63,$700.35,$0.00,$350.18,$554.68,$560.28,$0.00,$109.60,$0.00,$111.50,$0.00
121667,SUP,HCPCS C1713,,121667  -  PIN FX 6.35MM 95MM 16MM CNN HIP,$700.35,$0.00,$700.35,$315.16,$499.84,$0.00,$120.67,$0.00,$0.00,$122.63,$700.35,$0.00,$350.18,$554.68,$560.28,$0.00,$109.60,$0.00,$111.50,$0.00
121668,SUP,HCPCS C1713,,121668  -  PIN FX 6.35MM 100MM 16MM CNN HIP,$700.35,$0.00,$700.35,$315.16,$499.84,$0.00,$120.67,$0.00,$0.00,$122.63,$700.35,$0.00,$350.18,$554.68,$560.28,$0.00,$109.60,$0.00,$111.50,$0.00
121669,SUP,HCPCS C1713,,121669  -  PIN FX 105MM CNN HIP,$700.35,$0.00,$700.35,$315.16,$499.84,$0.00,$120.67,$0.00,$0.00,$122.63,$700.35,$0.00,$350.18,$554.68,$560.28,$0.00,$109.60,$0.00,$111.50,$0.00
121670,SUP,HCPCS C1713,,121670  -  PIN FX 6.35MM 110MM 16MM CNN HIP,$700.35,$0.00,$700.35,$315.16,$499.84,$0.00,$120.67,$0.00,$0.00,$122.63,$700.35,$0.00,$350.18,$554.68,$560.28,$0.00,$109.60,$0.00,$111.50,$0.00
121671,SUP,HCPCS C1713,,121671  -  PIN FX 6.35MM 115MM 16MM CNN HIP,$700.35,$0.00,$700.35,$315.16,$499.84,$0.00,$120.67,$0.00,$0.00,$122.63,$700.35,$0.00,$350.18,$554.68,$560.28,$0.00,$109.60,$0.00,$111.50,$0.00
121672,SUP,HCPCS C1713,,121672  -  PIN FX 6.86MM 115MM STRL 16MM CNN HEX HD SS HIP,$761.25,$0.00,$761.25,$342.56,$543.30,$0.00,$131.16,$0.00,$0.00,$133.29,$761.25,$0.00,$380.63,$602.91,$609.00,$0.00,$119.14,$0.00,$121.19,$0.00
121673,SUP,HCPCS C1713,,121673  -  PIN FX 125MM CNN HIP,$761.25,$0.00,$761.25,$342.56,$543.30,$0.00,$131.16,$0.00,$0.00,$133.29,$761.25,$0.00,$380.63,$602.91,$609.00,$0.00,$119.14,$0.00,$121.19,$0.00
121674,SUP,HCPCS C1713,,121674  -  PIN FX 130MM CNN HIP,$761.25,$0.00,$761.25,$342.56,$543.30,$0.00,$131.16,$0.00,$0.00,$133.29,$761.25,$0.00,$380.63,$602.91,$609.00,$0.00,$119.14,$0.00,$121.19,$0.00
121675,SUP,HCPCS C1713,,121675  -  PIN FX 135MM CNN HIP,$761.25,$0.00,$761.25,$342.56,$543.30,$0.00,$131.16,$0.00,$0.00,$133.29,$761.25,$0.00,$380.63,$602.91,$609.00,$0.00,$119.14,$0.00,$121.19,$0.00
121680,SUP,HCPCS C1713,,121680  -  WASHER ORTH UNV 12.7MM 6.5MM 1MM STRL SET SS 6.5MM CNN SCR,$158.00,$0.00,$158.00,$71.10,$112.76,$0.00,$27.22,$0.00,$0.00,$27.66,$158.00,$0.00,$79.00,$125.14,$126.40,$0.00,$24.73,$0.00,$25.15,$0.00
121810,SUP,HCPCS C1713,,121810  -  SCREW BN 2.5MM FLUT 4MM 6MM 10MM STRL 5MM PRLC ST CNN TROC,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
121812,SUP,HCPCS C1713,,121812  -  SCREW BN 2.5MM FLUT 4MM 6MM 12MM STRL 5MM PRLC ST CNN TROC,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
121814,SUP,HCPCS C1713,,121814  -  SCREW BN 2.5MM FLUT 4MM 6MM 14MM STRL 5MM PRLC ST CNN TROC,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
121816,SUP,HCPCS C1713,,121816  -  SCREW BN 2.5MM FLUT 4MM 6MM 16MM STRL 6MM PRLC ST CNN TROC,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
121818,SUP,HCPCS C1713,,121818  -  SCREW BN 2.5MM FLUT 4MM 6MM 18MM STRL 7MM PRLC ST CNN TROC,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
121820,SUP,HCPCS C1713,,121820  -  SCREW BN 2.5MM FLUT 4MM 6MM 20MM STRL 8MM PRLC ST CNN TROC,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
121822,SUP,HCPCS C1713,,121822  -  SCREW BN 2.5MM FLUT 4MM 6MM 22MM STRL 9MM PRLC ST CNN TROC,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
121824,SUP,HCPCS C1713,,121824  -  SCREW BN 2.5MM FLUT 4MM 6MM 24MM STRL 10MM PRLC ST CNN TROC,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
121826,SUP,HCPCS C1713,,121826  -  SCREW BN 2.5MM FLUT 4MM 6MM 26MM STRL 12MM PRLC ST CNN TROC,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
121828,SUP,HCPCS C1713,,121828  -  SCREW BN 2.5MM FLUT 4MM 6MM 28MM STRL 14MM PRLC ST CNN TROC,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
121830,SUP,HCPCS C1713,,121830  -  SCREW BN 2.5MM FLUT 4MM 6MM 30MM STRL 14MM PRLC ST CNN TROC,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
121832,SUP,HCPCS C1713,,121832  -  SCREW BN 2.5MM FLUT 4MM 6MM 32MM STRL 14MM PRLC ST CNN TROC,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
121834,SUP,HCPCS C1713,,121834  -  SCREW BN 2.5MM FLUT 4MM 6MM 34MM STRL 14MM PRLC ST CNN TROC,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
121836,SUP,HCPCS C1713,,121836  -  SCREW BN 2.5MM FLUT 4MM 6MM 36MM STRL 14MM PRLC ST CNN TROC,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
121838,SUP,HCPCS C1713,,121838  -  SCREW BN 2.5MM FLUT 4MM 6MM 38MM STRL 14MM PRLC ST CNN TROC,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
121840,SUP,HCPCS C1713,,121840  -  SCREW BN 2.5MM FLUT 4MM 6MM 40MM STRL 14MM PRLC ST CNN TROC,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
121842,SUP,HCPCS C1713,,121842  -  SCREW BN 2.5MM FLUT 4MM 6MM 42MM STRL 14MM PRLC ST CNN TROC,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
121844,SUP,HCPCS C1713,,121844  -  SCREW BN P/T 4MM 6MM 1.3MM 44MM STRL 2.9MM CNN ST SLF DRL,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
121846,SUP,HCPCS C1713,,121846  -  SCREW BN 2.5MM FLUT 4MM 6MM 46MM STRL 15MM PRLC ST CNN TROC,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
121848,SUP,HCPCS C1713,,121848  -  SCREW BN 2.5MM FLUT P/T 4MM 6MM 48MM STRL 15MM PRLC ST CNN,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
121850,SUP,HCPCS C1713,,121850  -  SCREW BN 2.5MM FLUT 4MM 6MM 50MM STRL 15MM PRLC ST CNN TROC,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
121852,SUP,HCPCS C1713,,121852  -  SCREW BN 2.5MM FLUT 4MM 6MM 52MM STRL 15MM PRLC ST CNN TROC,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
121854,SUP,HCPCS C1713,,121854  -  SCREW BN 2.5MM FLUT 4MM 6MM 54MM STRL 15MM PRLC ST CNN TROC,$399.00,$0.00,$316.01,$0.00,$115.41,$0.00,$0.00,$0.00,$0.00,$0.00,$161.71,$0.00,$80.86,$316.01,$129.37,$0.00,$0.00,$0.00,$0.00,$0.00
121856,SUP,HCPCS C1713,,121856  -  SCREW BN 2.5MM FLUT 4MM 6MM 56MM STRL 15MM PRLC ST CNN TROC,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
121858,SUP,HCPCS C1713,,121858  -  SCREW BN 2.5MM FLUT 4MM 6MM 58MM STRL 15MM PRLC ST CNN TROC,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
121860,SUP,HCPCS C1713,,121860  -  SCREW BN 2.5MM FLUT 4MM 6MM 60MM STRL 15MM PRLC ST CNN TROC,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
121865,SUP,HCPCS C1713,,121865  -  SCREW BN 2.5MM FLUT 4MM 6MM 65MM STRL 15MM PRLC ST CNN TROC,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
121870,SUP,HCPCS C1713,,121870  -  SCREW BN 2.5MM FLUT 4MM 6MM 70MM STRL 15MM PRLC ST CNN TROC,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
121905,SUP,HCPCS C1713,,121905  -  NAIL IM 8MM 32CM RUS-TYLR DLT SS FEM,"$1,704.38",$0.00,"$1,704.38",$766.97,"$1,216.41",$0.00,$293.66,$0.00,$0.00,$298.42,"$1,704.38",$0.00,$852.19,"$1,349.87","$1,363.50",$0.00,$266.73,$0.00,$271.34,$0.00
121906,SUP,HCPCS C1713,,121906  -  NAIL IM 8MM 34CM RUS-TYLR DLT II FEM,"$1,704.38",$0.00,"$1,704.38",$766.97,"$1,216.41",$0.00,$293.66,$0.00,$0.00,$298.42,"$1,704.38",$0.00,$852.19,"$1,349.87","$1,363.50",$0.00,$266.73,$0.00,$271.34,$0.00
121907,SUP,HCPCS C1713,,121907  -  NAIL IM 8MM 36CM RUS-TYLR DLT II FEM,"$1,704.38",$0.00,"$1,704.38",$766.97,"$1,216.41",$0.00,$293.66,$0.00,$0.00,$298.42,"$1,704.38",$0.00,$852.19,"$1,349.87","$1,363.50",$0.00,$266.73,$0.00,$271.34,$0.00
122034,SUP,HCPCS C1713,,122034  -  NAIL IM 11MM 44CM RUS-TYLR DLT SS FEM,"$1,563.75",$0.00,"$1,563.75",$703.69,"$1,116.05",$0.00,$269.43,$0.00,$0.00,$273.80,"$1,563.75",$0.00,$781.88,"$1,238.49","$1,251.00",$0.00,$244.73,$0.00,$248.95,$0.00
122153,SUP,HCPCS C1713,,122153  -  NAIL IM 15MM 42CM RUS-TYLR INTLK SS FEM,"$2,711.25",$0.00,"$2,711.25","$1,220.06","$1,935.02",$0.00,$467.13,$0.00,$0.00,$474.72,"$2,711.25",$0.00,"$1,355.63","$2,147.31","$2,169.00",$0.00,$424.31,$0.00,$431.63,$0.00
122159,SUP,HCPCS C1713,,122159  -  NAIL IM 16MM 40CM RUS-TYLR INTLK SS FEM,"$2,711.25",$0.00,"$2,711.25","$1,220.06","$1,935.02",$0.00,$467.13,$0.00,$0.00,$474.72,"$2,711.25",$0.00,"$1,355.63","$2,147.31","$2,169.00",$0.00,$424.31,$0.00,$431.63,$0.00
122202,SUP,HCPCS C1713,,122202  -  NAIL IM 13MM 36CM RUS-TYLR INTLK SS TIB,"$3,150.00",$0.00,"$3,150.00","$1,417.50","$2,248.16",$0.00,$542.73,$0.00,$0.00,$551.54,"$3,150.00",$0.00,"$1,575.00","$2,494.80","$2,520.00",$0.00,$492.98,$0.00,$501.48,$0.00
122341,SUP,HCPCS C1713,,122341  -  NAIL IM 10MM 38CM RUS-TYLR DLT INTLK RECON SS FEM RT,"$8,375.63",$0.00,"$8,375.63","$3,769.03","$5,158.80",$0.00,"$1,443.08",$0.00,$0.00,"$1,466.50","$8,375.63",$0.00,"$4,187.81","$6,633.50","$6,700.50",$0.00,"$1,310.79",$0.00,"$1,333.40",$0.00
122466,SUP,HCPCS C1713,,122466  -  NAIL IM 8MM 30CM RUS-TYLR INTLK SS HUM,"$6,519.38",$0.00,"$6,519.38","$2,933.72","$4,652.88",$0.00,"$1,123.26",$0.00,$0.00,"$1,141.49","$6,519.38",$0.00,"$3,259.69","$5,163.35","$5,215.50",$0.00,"$1,020.28",$0.00,"$1,037.88",$0.00
122670,SUP,HCPCS C1713,,122670  -  CAP END RECON FEM,$70.10,$0.00,$70.10,$31.55,$50.03,$0.00,$12.08,$0.00,$0.00,$12.27,$70.10,$0.00,$35.05,$55.52,$56.08,$0.00,$10.97,$0.00,$11.16,$0.00
122671,SUP,HCPCS C1713,,122671  -  CAP END RUS-TYLR RUS-TYLR RECON NL,$66.83,$0.00,$66.83,$30.07,$47.69,$0.00,$11.51,$0.00,$0.00,$11.70,$66.83,$0.00,$33.41,$52.93,$53.46,$0.00,$10.46,$0.00,$10.64,$0.00
122700,SUP,HCPCS C1713,,122700  -  PIN HLF UNV 4MM 20MM 20MM HXFX RN HNG KT CMPS TI ORTH XTRNFX,$780.30,$0.00,$780.30,$351.14,$556.90,$0.00,$134.44,$0.00,$0.00,$136.62,$780.30,$0.00,$390.15,$618.00,$624.24,$0.00,$122.12,$0.00,$124.22,$0.00
122701,SUP,HCPCS C1713,,122701  -  PIN HLF 4MM 25MM HXFX RN UNLAT TI ORTH XTRNFX SYS,$780.30,$0.00,$780.30,$351.14,$556.90,$0.00,$134.44,$0.00,$0.00,$136.62,$780.30,$0.00,$390.15,$618.00,$624.24,$0.00,$122.12,$0.00,$124.22,$0.00
122703,SUP,HCPCS C1713,,122703  -  PIN HLF 4MM 35MM HXFX TI ORTH,$780.30,$0.00,$780.30,$351.14,$556.90,$0.00,$134.44,$0.00,$0.00,$136.62,$780.30,$0.00,$390.15,$618.00,$624.24,$0.00,$122.12,$0.00,$124.22,$0.00
122704,SUP,HCPCS C1713,,122704  -  PIN HLF 4MM 40MM HXFX RN UNLAT TI ORTH XTRNFX SYS,$780.30,$0.00,$780.30,$351.14,$556.90,$0.00,$134.44,$0.00,$0.00,$136.62,$780.30,$0.00,$390.15,$618.00,$624.24,$0.00,$122.12,$0.00,$124.22,$0.00
122705,SUP,HCPCS C1713,,122705  -  PIN HLF 4MM 45MM HXFX TI ORTH,$469.20,$0.00,$469.20,$211.14,$334.87,$0.00,$80.84,$0.00,$0.00,$82.15,$469.20,$0.00,$234.60,$371.61,$375.36,$0.00,$73.43,$0.00,$74.70,$0.00
122706,SUP,HCPCS C1713,,122706  -  PIN HLF 4MM 50MM HXFX TI,$561.00,$0.00,$561.00,$252.45,$400.39,$0.00,$96.66,$0.00,$0.00,$98.23,$561.00,$0.00,$280.50,$444.31,$448.80,$0.00,$87.80,$0.00,$89.31,$0.00
122707,SUP,HCPCS C1713,,122707  -  PIN HLF P/T 5MM 20MM HXFX SET TI ORTH XTRNFX SYS,$780.30,$0.00,$780.30,$351.14,$556.90,$0.00,$134.44,$0.00,$0.00,$136.62,$780.30,$0.00,$390.15,$618.00,$624.24,$0.00,$122.12,$0.00,$124.22,$0.00
122708,SUP,HCPCS C1713,,122708  -  PIN HLF P/T 5MM 25MM 25MM HXFX TI ORTH XTRNFX SYS,$780.30,$0.00,$780.30,$351.14,$556.90,$0.00,$134.44,$0.00,$0.00,$136.62,$780.30,$0.00,$390.15,$618.00,$624.24,$0.00,$122.12,$0.00,$124.22,$0.00
122709,SUP,HCPCS C1713,,122709  -  PIN HLF P/T 5MM 30MM HXFX TI,$780.30,$0.00,$780.30,$351.14,$556.90,$0.00,$134.44,$0.00,$0.00,$136.62,$780.30,$0.00,$390.15,$618.00,$624.24,$0.00,$122.12,$0.00,$124.22,$0.00
122710,SUP,HCPCS C1713,,122710  -  PIN HLF P/T 5MM 35MM HXFX TI XTRNFX SYS,$780.30,$0.00,$780.30,$351.14,$556.90,$0.00,$134.44,$0.00,$0.00,$136.62,$780.30,$0.00,$390.15,$618.00,$624.24,$0.00,$122.12,$0.00,$124.22,$0.00
122711,SUP,HCPCS C1713,,122711  -  PIN HLF P/T 5MM 40MM HXFX TI XTRNFX SYS,$780.30,$0.00,$780.30,$351.14,$556.90,$0.00,$134.44,$0.00,$0.00,$136.62,$780.30,$0.00,$390.15,$618.00,$624.24,$0.00,$122.12,$0.00,$124.22,$0.00
122712,SUP,HCPCS C1713,,122712  -  PIN HLF 5MM 45MM HXFX RN TI ORTH XTRNFX SYS,$780.30,$0.00,$780.30,$351.14,$556.90,$0.00,$134.44,$0.00,$0.00,$136.62,$780.30,$0.00,$390.15,$618.00,$624.24,$0.00,$122.12,$0.00,$124.22,$0.00
122714,SUP,HCPCS C1713,,122714  -  PIN HLF 5MM 55MM HXFX RN UNLAT TI ORTH XTRNFX SYS,$780.30,$0.00,$780.30,$351.14,$556.90,$0.00,$134.44,$0.00,$0.00,$136.62,$780.30,$0.00,$390.15,$618.00,$624.24,$0.00,$122.12,$0.00,$124.22,$0.00
122715,SUP,HCPCS C1713,,122715  -  PIN HLF 5MM 60MM HXFX RN UNLAT TI ORTH XTRNFX SYS,$780.30,$0.00,$780.30,$351.14,$556.90,$0.00,$134.44,$0.00,$0.00,$136.62,$780.30,$0.00,$390.15,$618.00,$624.24,$0.00,$122.12,$0.00,$124.22,$0.00
122716,SUP,HCPCS C1713,,122716  -  PIN HLF 5MM 65MM HXFX RN UNLAT TI ORTH XTRNFX SYS,$533.80,$0.00,$533.80,$240.21,$380.97,$0.00,$91.97,$0.00,$0.00,$93.46,$533.80,$0.00,$266.90,$422.77,$427.04,$0.00,$83.54,$0.00,$84.98,$0.00
122717,SUP,HCPCS C1713,,122717  -  PIN HLF 5MM 70MM HXFX TI ORTH,$394.40,$0.00,$394.40,$177.48,$281.48,$0.00,$67.95,$0.00,$0.00,$69.06,$394.40,$0.00,$197.20,$312.36,$315.52,$0.00,$61.72,$0.00,$62.79,$0.00
122718,SUP,HCPCS C1713,,122718  -  PIN HLF 5MM 75MM HXFX TI ORTH,$561.00,$0.00,$561.00,$252.45,$400.39,$0.00,$96.66,$0.00,$0.00,$98.23,$561.00,$0.00,$280.50,$444.31,$448.80,$0.00,$87.80,$0.00,$89.31,$0.00
122719,SUP,HCPCS C1713,,122719  -  PIN HLF 5MM 80MM HXFX TI,$561.00,$0.00,$561.00,$252.45,$400.39,$0.00,$96.66,$0.00,$0.00,$98.23,$561.00,$0.00,$280.50,$444.31,$448.80,$0.00,$87.80,$0.00,$89.31,$0.00
122720,SUP,HCPCS C1713,,122720  -  PIN HLF 5MM 85MM HXFX TI ORTH,$472.60,$0.00,$472.60,$212.67,$337.29,$0.00,$81.43,$0.00,$0.00,$82.75,$472.60,$0.00,$236.30,$374.30,$378.08,$0.00,$73.96,$0.00,$75.24,$0.00
122721,SUP,HCPCS C1713,,122721  -  PIN HLF 5MM 90MM HXFX TI ORTH,$561.00,$0.00,$561.00,$252.45,$400.39,$0.00,$96.66,$0.00,$0.00,$98.23,$561.00,$0.00,$280.50,$444.31,$448.80,$0.00,$87.80,$0.00,$89.31,$0.00
122725,SUP,HCPCS C1713,,122725  -  PIN HLF 6MM 40MM 40MM HXFX RN UNLAT THRD TI ORTH XTRNFX SYS,$780.30,$0.00,$780.30,$351.14,$556.90,$0.00,$134.44,$0.00,$0.00,$136.62,$780.30,$0.00,$390.15,$618.00,$624.24,$0.00,$122.12,$0.00,$124.22,$0.00
122727,SUP,HCPCS C1713,,122727  -  PIN HLF 6MM 50MM HXFX RN UNLAT TI ORTH XTRNFX SYS,$780.30,$0.00,$780.30,$351.14,$556.90,$0.00,$134.44,$0.00,$0.00,$136.62,$780.30,$0.00,$390.15,$618.00,$624.24,$0.00,$122.12,$0.00,$124.22,$0.00
122729,SUP,HCPCS C1713,,122729  -  PIN HLF 6MM 60MM HXFX RN UNLAT TI ORTH XTRNFX SYS,$780.30,$0.00,$780.30,$351.14,$556.90,$0.00,$134.44,$0.00,$0.00,$136.62,$780.30,$0.00,$390.15,$618.00,$624.24,$0.00,$122.12,$0.00,$124.22,$0.00
122733,SUP,HCPCS C1713,,122733  -  PIN HLF 6MM 80MM HXFX TI,$472.60,$0.00,$472.60,$212.67,$337.29,$0.00,$81.43,$0.00,$0.00,$82.75,$472.60,$0.00,$236.30,$374.30,$378.08,$0.00,$73.96,$0.00,$75.24,$0.00
122735,SUP,HCPCS C1713,,122735  -  PIN FX HLF 6MM 90MM,$561.00,$0.00,$561.00,$252.45,$400.39,$0.00,$96.66,$0.00,$0.00,$98.23,$561.00,$0.00,$280.50,$444.31,$448.80,$0.00,$87.80,$0.00,$89.31,$0.00
122741,SUP,HCPCS C1713,,122741  -  PIN HLF 4MM 25MM HXFX UNLAT SS ORTH XTRNFX SYS,$499.80,$0.00,$499.80,$224.91,$356.71,$0.00,$86.11,$0.00,$0.00,$87.51,$499.80,$0.00,$249.90,$395.84,$399.84,$0.00,$78.22,$0.00,$79.57,$0.00
122742,SUP,HCPCS C1713,,122742  -  PIN HLF 4MM 30MM HXFX SS ORTH,$282.20,$0.00,$282.20,$126.99,$201.41,$0.00,$48.62,$0.00,$0.00,$49.41,$282.20,$0.00,$141.10,$223.50,$225.76,$0.00,$44.16,$0.00,$44.93,$0.00
122743,SUP,HCPCS C1713,,122743  -  PIN HLF 4MM 35MM HXFX SS ORTH,$282.20,$0.00,$282.20,$126.99,$201.41,$0.00,$48.62,$0.00,$0.00,$49.41,$282.20,$0.00,$141.10,$223.50,$225.76,$0.00,$44.16,$0.00,$44.93,$0.00
122744,SUP,HCPCS C1713,,122744  -  PIN HLF 4MM 40MM HXFX UNLAT SS ORTH XTRNFX SYS,$499.80,$0.00,$499.80,$224.91,$356.71,$0.00,$86.11,$0.00,$0.00,$87.51,$499.80,$0.00,$249.90,$395.84,$399.84,$0.00,$78.22,$0.00,$79.57,$0.00
122745,SUP,HCPCS C1713,,122745  -  PIN HLF 4MM 45MM HXFX UNLAT SS ORTH XTRNFX SYS,$499.80,$0.00,$499.80,$224.91,$356.71,$0.00,$86.11,$0.00,$0.00,$87.51,$499.80,$0.00,$249.90,$395.84,$399.84,$0.00,$78.22,$0.00,$79.57,$0.00
122746,SUP,HCPCS C1713,,122746  -  PIN HLF 4MM 50MM HXFX UNLAT SS ORTH XTRNFX SYS,$499.80,$0.00,$499.80,$224.91,$356.71,$0.00,$86.11,$0.00,$0.00,$87.51,$499.80,$0.00,$249.90,$395.84,$399.84,$0.00,$78.22,$0.00,$79.57,$0.00
122747,SUP,HCPCS C1713,,122747  -  PIN HLF 5MM 20MM HXFX UNLAT SS ORTH XTRNFX SYS,$567.80,$0.00,$567.80,$255.51,$405.24,$0.00,$97.83,$0.00,$0.00,$99.42,$567.80,$0.00,$283.90,$449.70,$454.24,$0.00,$88.86,$0.00,$90.39,$0.00
122748,SUP,HCPCS C1713,,122748  -  PIN HLF 5MM 25MM 25MM HXFX UNLAT SS ORTH XTRNFX SYS,$567.80,$0.00,$567.80,$255.51,$405.24,$0.00,$97.83,$0.00,$0.00,$99.42,$567.80,$0.00,$283.90,$449.70,$454.24,$0.00,$88.86,$0.00,$90.39,$0.00
122749,SUP,HCPCS C1713,,122749  -  PIN HLF 5MM 30MM HXFX UNLAT SS ORTH XTRNFX SYS,$567.80,$0.00,$567.80,$255.51,$405.24,$0.00,$97.83,$0.00,$0.00,$99.42,$567.80,$0.00,$283.90,$449.70,$454.24,$0.00,$88.86,$0.00,$90.39,$0.00
122750,SUP,HCPCS C1713,,122750  -  PIN HLF 5MM 35MM HXFX UNLAT SS ORTH XTRNFX SYS,$567.80,$0.00,$567.80,$255.51,$405.24,$0.00,$97.83,$0.00,$0.00,$99.42,$567.80,$0.00,$283.90,$449.70,$454.24,$0.00,$88.86,$0.00,$90.39,$0.00
122751,SUP,HCPCS C1713,,122751  -  PIN HLF 5MM 40MM 40MM HXFX UNLAT SS ORTH XTRNFX SYS,$567.80,$0.00,$567.80,$255.51,$405.24,$0.00,$97.83,$0.00,$0.00,$99.42,$567.80,$0.00,$283.90,$449.70,$454.24,$0.00,$88.86,$0.00,$90.39,$0.00
122752,SUP,HCPCS C1713,,122752  -  PIN HLF 5MM 45MM 45MM HXFX UNLAT SS ORTH XTRNFX SYS,$567.80,$0.00,$567.80,$255.51,$405.24,$0.00,$97.83,$0.00,$0.00,$99.42,$567.80,$0.00,$283.90,$449.70,$454.24,$0.00,$88.86,$0.00,$90.39,$0.00
122753,SUP,HCPCS C1713,,122753  -  PIN HLF 5MM 50MM HXFX UNLAT SS ORTH XTRNFX SYS,$567.80,$0.00,$567.80,$255.51,$405.24,$0.00,$97.83,$0.00,$0.00,$99.42,$567.80,$0.00,$283.90,$449.70,$454.24,$0.00,$88.86,$0.00,$90.39,$0.00
122754,SUP,HCPCS C1713,,122754  -  PIN HLF 5MM 55MM HXFX SS ORTH,$340.00,$0.00,$340.00,$153.00,$242.66,$0.00,$58.58,$0.00,$0.00,$59.53,$340.00,$0.00,$170.00,$269.28,$272.00,$0.00,$53.21,$0.00,$54.13,$0.00
122755,SUP,HCPCS C1713,,122755  -  PIN HLF 5MM 60MM HXFX UNLAT SS ORTH XTRNFX SYS,$209.10,$0.00,$209.10,$94.10,$149.23,$0.00,$36.03,$0.00,$0.00,$36.61,$209.10,$0.00,$104.55,$165.61,$167.28,$0.00,$32.72,$0.00,$33.29,$0.00
122756,SUP,HCPCS C1713,,122756  -  PIN HLF 5MM 65MM HXFX UNLAT SS ORTH XTRNFX SYS,$499.80,$0.00,$499.80,$224.91,$356.71,$0.00,$86.11,$0.00,$0.00,$87.51,$499.80,$0.00,$249.90,$395.84,$399.84,$0.00,$78.22,$0.00,$79.57,$0.00
122757,SUP,HCPCS C1713,,122757  -  PIN HLF 5MM 70MM HXFX UNLAT SS ORTH XTRNFX SYS,$209.10,$0.00,$209.10,$94.10,$149.23,$0.00,$36.03,$0.00,$0.00,$36.61,$209.10,$0.00,$104.55,$165.61,$167.28,$0.00,$32.72,$0.00,$33.29,$0.00
122758,SUP,HCPCS C1713,,122758  -  PIN HLF 5MM 75MM HXFX SS ORTH,$340.00,$0.00,$340.00,$153.00,$242.66,$0.00,$58.58,$0.00,$0.00,$59.53,$340.00,$0.00,$170.00,$269.28,$272.00,$0.00,$53.21,$0.00,$54.13,$0.00
122759,SUP,HCPCS C1713,,122759  -  PIN HLF 5MM 80MM HXFX SS ORTH,$340.00,$0.00,$340.00,$153.00,$242.66,$0.00,$58.58,$0.00,$0.00,$59.53,$340.00,$0.00,$170.00,$269.28,$272.00,$0.00,$53.21,$0.00,$54.13,$0.00
122760,SUP,HCPCS C1713,,122760  -  PIN HLF 5MM 85MM HXFX SS ORTH,$340.00,$0.00,$340.00,$153.00,$242.66,$0.00,$58.58,$0.00,$0.00,$59.53,$340.00,$0.00,$170.00,$269.28,$272.00,$0.00,$53.21,$0.00,$54.13,$0.00
122761,SUP,HCPCS C1713,,122761  -  PIN HLF 5MM 90MM HXFX UNLAT SS ORTH XTRNFX SYS,$209.10,$0.00,$209.10,$94.10,$149.23,$0.00,$36.03,$0.00,$0.00,$36.61,$209.10,$0.00,$104.55,$165.61,$167.28,$0.00,$32.72,$0.00,$33.29,$0.00
122765,SUP,HCPCS C1713,,122765  -  PIN HLF 6MM 40MM HXFX UNLAT SS ORTH XTRNFX SYS,$567.80,$0.00,$567.80,$255.51,$405.24,$0.00,$97.83,$0.00,$0.00,$99.42,$567.80,$0.00,$283.90,$449.70,$454.24,$0.00,$88.86,$0.00,$90.39,$0.00
122767,SUP,HCPCS C1713,,122767  -  PIN HLF 6MM 50MM HXFX UNLAT SS ORTH XTRNFX SYS,$567.80,$0.00,$567.80,$255.51,$405.24,$0.00,$97.83,$0.00,$0.00,$99.42,$567.80,$0.00,$283.90,$449.70,$454.24,$0.00,$88.86,$0.00,$90.39,$0.00
122769,SUP,HCPCS C1713,,122769  -  PIN HLF 6MM 60MM HXFX UNLAT SS ORTH XTRNFX SYS,$567.80,$0.00,$567.80,$255.51,$405.24,$0.00,$97.83,$0.00,$0.00,$99.42,$567.80,$0.00,$283.90,$449.70,$454.24,$0.00,$88.86,$0.00,$90.39,$0.00
122771,SUP,HCPCS C1713,,122771  -  PIN HLF 6MM 70MM HXFX UNLAT SS ORTH XTRNFX SYS,$499.80,$0.00,$499.80,$224.91,$356.71,$0.00,$86.11,$0.00,$0.00,$87.51,$499.80,$0.00,$249.90,$395.84,$399.84,$0.00,$78.22,$0.00,$79.57,$0.00
122773,SUP,HCPCS C1713,,122773  -  PIN HLF 6MM 80MM HXFX SS ORTH,$282.20,$0.00,$282.20,$126.99,$201.41,$0.00,$48.62,$0.00,$0.00,$49.41,$282.20,$0.00,$141.10,$223.50,$225.76,$0.00,$44.16,$0.00,$44.93,$0.00
122775,SUP,HCPCS C1713,,122775  -  PIN HLF 6MM 90MM HXFX UNLAT SS ORTH XTRNFX SYS,$499.80,$0.00,$499.80,$224.91,$356.71,$0.00,$86.11,$0.00,$0.00,$87.51,$499.80,$0.00,$249.90,$395.84,$399.84,$0.00,$78.22,$0.00,$79.57,$0.00
124120,SUP,HCPCS C1713,,124120  -  PLATE BN 130D STD BRL 60MM 38.1MM CLS CHS 2 HL SS HIP,"$1,107.75",$0.00,"$1,107.75",$498.49,$790.60,$0.00,$190.86,$0.00,$0.00,$193.96,"$1,107.75",$0.00,$553.88,$877.34,$886.20,$0.00,$173.36,$0.00,$176.35,$0.00
124121,SUP,HCPCS C1713,,124121  -  PLATE BN 135D STD BRL 60MM 38.1MM CLS CHS 2 HL CMPR HIP,"$1,107.75",$0.00,"$1,107.75",$498.49,$790.60,$0.00,$190.86,$0.00,$0.00,$193.96,"$1,107.75",$0.00,$553.88,$877.34,$886.20,$0.00,$173.36,$0.00,$176.35,$0.00
124122,SUP,HCPCS C1713,,124122  -  PLATE BN 140D STD BRL 60MM 38.1MM CLS CHS 2 HL CMPR HIP,"$1,107.75",$0.00,"$1,107.75",$498.49,$790.60,$0.00,$190.86,$0.00,$0.00,$193.96,"$1,107.75",$0.00,$553.88,$877.34,$886.20,$0.00,$173.36,$0.00,$176.35,$0.00
124123,SUP,HCPCS C1713,,124123  -  PLATE BN 145D STD BRL 60MM 38.1MM CLS CHS 2 HL CMPR HIP,"$1,107.75",$0.00,"$1,107.75",$498.49,$790.60,$0.00,$190.86,$0.00,$0.00,$193.96,"$1,107.75",$0.00,$553.88,$877.34,$886.20,$0.00,$173.36,$0.00,$176.35,$0.00
124124,SUP,HCPCS C1713,,124124  -  PLATE BN 150D STD BRL 60MM 38.1MM CLS CHS 2 HL CMPR HIP,"$1,107.75",$0.00,"$1,107.75",$498.49,$790.60,$0.00,$190.86,$0.00,$0.00,$193.96,"$1,107.75",$0.00,$553.88,$877.34,$886.20,$0.00,$173.36,$0.00,$176.35,$0.00
124125,SUP,HCPCS C1713,,124125  -  PLATE BN 130D STD BRL 80MM 38.1MM CLS CHS 3 HL CMPR HIP,"$1,144.50",$0.00,"$1,144.50",$515.03,$816.83,$0.00,$197.19,$0.00,$0.00,$200.39,"$1,144.50",$0.00,$572.25,$906.44,$915.60,$0.00,$179.11,$0.00,$182.20,$0.00
124126,SUP,HCPCS C1713,,124126  -  PLATE BN 135D STD BRL 80MM 38.1MM CLS CHS 3 HL CMPR SS HIP,"$1,144.50",$0.00,"$1,144.50",$515.03,$816.83,$0.00,$197.19,$0.00,$0.00,$200.39,"$1,144.50",$0.00,$572.25,$906.44,$915.60,$0.00,$179.11,$0.00,$182.20,$0.00
124127,SUP,HCPCS C1713,,124127  -  PLATE BN 140D STD BRL 80MM 38.1MM CLS CHS 3 HL CMPR SS HIP,"$1,144.50",$0.00,"$1,144.50",$515.03,$816.83,$0.00,$197.19,$0.00,$0.00,$200.39,"$1,144.50",$0.00,$572.25,$906.44,$915.60,$0.00,$179.11,$0.00,$182.20,$0.00
124128,SUP,HCPCS C1713,,124128  -  PLATE BN 145D STD BRL 80MM 38.1MM CLS CHS 3 HL SS HIP,"$1,144.50",$0.00,"$1,144.50",$515.03,$816.83,$0.00,$197.19,$0.00,$0.00,$200.39,"$1,144.50",$0.00,$572.25,$906.44,$915.60,$0.00,$179.11,$0.00,$182.20,$0.00
124129,SUP,HCPCS C1713,,124129  -  PLATE BN 150D STD BRL 80MM 38.1MM CLS CHS 3 HL SS HIP,"$1,144.50",$0.00,"$1,144.50",$515.03,$816.83,$0.00,$197.19,$0.00,$0.00,$200.39,"$1,144.50",$0.00,$572.25,$906.44,$915.60,$0.00,$179.11,$0.00,$182.20,$0.00
124130,SUP,HCPCS C1713,,124130  -  PLATE BN 130D STD BRL 100MM 38.1MM CLS CHS 4 HL CMPR HIP,"$1,144.50",$0.00,"$1,144.50",$515.03,$816.83,$0.00,$197.19,$0.00,$0.00,$200.39,"$1,144.50",$0.00,$572.25,$906.44,$915.60,$0.00,$179.11,$0.00,$182.20,$0.00
124131,SUP,HCPCS C1713,,124131  -  PLATE BN 135D STD BRL 100MM 1.5MM CLS 4 HL HIP,"$1,144.50",$0.00,"$1,144.50",$515.03,$816.83,$0.00,$197.19,$0.00,$0.00,$200.39,"$1,144.50",$0.00,$572.25,$906.44,$915.60,$0.00,$179.11,$0.00,$182.20,$0.00
124132,SUP,HCPCS C1713,,124132  -  PLATE BN 140D STD BRL 100MM 38.1MM CLS CHS 4 HL CMPR HIP,"$1,144.50",$0.00,"$1,144.50",$515.03,$816.83,$0.00,$197.19,$0.00,$0.00,$200.39,"$1,144.50",$0.00,$572.25,$906.44,$915.60,$0.00,$179.11,$0.00,$182.20,$0.00
124133,SUP,HCPCS C1713,,124133  -  PLATE BN 145D STD BRL 100MM 38.1MM CLS CHS 4 HL CMPR HIP,"$1,144.50",$0.00,"$1,144.50",$515.03,$816.83,$0.00,$197.19,$0.00,$0.00,$200.39,"$1,144.50",$0.00,$572.25,$906.44,$915.60,$0.00,$179.11,$0.00,$182.20,$0.00
124134,SUP,HCPCS C1713,,124134  -  PLATE BN 150D STD BRL 100MM 38.1MM CLS CHS 4 HL SS HIP,"$1,144.50",$0.00,"$1,144.50",$515.03,$816.83,$0.00,$197.19,$0.00,$0.00,$200.39,"$1,144.50",$0.00,$572.25,$906.44,$915.60,$0.00,$179.11,$0.00,$182.20,$0.00
124135,SUP,HCPCS C1713,,124135  -  PLATE BN 130D STD BRL 120MM 38.1MM CLS CHS 5 HL CMPR SS HIP,"$1,223.25",$0.00,"$1,223.25",$550.46,$873.03,$0.00,$210.76,$0.00,$0.00,$214.18,"$1,223.25",$0.00,$611.63,$968.81,$978.60,$0.00,$191.44,$0.00,$194.74,$0.00
124136,SUP,HCPCS C1713,,124136  -  PLATE BN 135D STD BRL 120MM 1.5MM CLS 5 HL HIP,"$1,223.25",$0.00,"$1,223.25",$550.46,$873.03,$0.00,$210.76,$0.00,$0.00,$214.18,"$1,223.25",$0.00,$611.63,$968.81,$978.60,$0.00,$191.44,$0.00,$194.74,$0.00
124137,SUP,HCPCS C1713,,124137  -  PLATE BN 140D STD BRL 120MM 38.1MM CHS 5 HL CMPR SS HIP,"$1,223.25",$0.00,"$1,223.25",$550.46,$873.03,$0.00,$210.76,$0.00,$0.00,$214.18,"$1,223.25",$0.00,$611.63,$968.81,$978.60,$0.00,$191.44,$0.00,$194.74,$0.00
124138,SUP,HCPCS C1713,,124138  -  PLATE BN 145D STD BRL 120MM 38.1MM CLS CHS 5 HL SS HIP,"$1,223.25",$0.00,"$1,223.25",$550.46,$873.03,$0.00,$210.76,$0.00,$0.00,$214.18,"$1,223.25",$0.00,$611.63,$968.81,$978.60,$0.00,$191.44,$0.00,$194.74,$0.00
124139,SUP,HCPCS C1713,,124139  -  PLATE BN 150D STD BRL 120MM 38.1MM CLS CHS 5 HL SS HIP,"$1,223.25",$0.00,"$1,223.25",$550.46,$873.03,$0.00,$210.76,$0.00,$0.00,$214.18,"$1,223.25",$0.00,$611.63,$968.81,$978.60,$0.00,$191.44,$0.00,$194.74,$0.00
124140,SUP,HCPCS C1713,,124140  -  PLATE BN 130D STD BRL 140MM 38.1MM CLS CHS 6 HL SS HIP,"$1,260.00",$0.00,"$1,260.00",$567.00,$899.26,$0.00,$217.09,$0.00,$0.00,$220.62,"$1,260.00",$0.00,$630.00,$997.92,"$1,008.00",$0.00,$197.19,$0.00,$200.59,$0.00
124141,SUP,HCPCS C1713,,124141  -  PLATE BN 135D STD BRL 140MM 38.1MM CLS CHS 6 HL SS HIP,"$1,260.00",$0.00,"$1,260.00",$567.00,$899.26,$0.00,$217.09,$0.00,$0.00,$220.62,"$1,260.00",$0.00,$630.00,$997.92,"$1,008.00",$0.00,$197.19,$0.00,$200.59,$0.00
124142,SUP,HCPCS C1713,,124142  -  PLATE BN 140D STD BRL 140MM 38.1MM CLS CHS 6 HL SS HIP,"$1,260.00",$0.00,"$1,260.00",$567.00,$899.26,$0.00,$217.09,$0.00,$0.00,$220.62,"$1,260.00",$0.00,$630.00,$997.92,"$1,008.00",$0.00,$197.19,$0.00,$200.59,$0.00
124143,SUP,HCPCS C1713,,124143  -  PLATE BN 145D STD BRL 140MM 38.1MM CLS CHS 6 HL SS HIP,"$1,260.00",$0.00,"$1,260.00",$567.00,$899.26,$0.00,$217.09,$0.00,$0.00,$220.62,"$1,260.00",$0.00,$630.00,$997.92,"$1,008.00",$0.00,$197.19,$0.00,$200.59,$0.00
124144,SUP,HCPCS C1713,,124144  -  PLATE BN 150D STD BRL 140MM 38.1MM CLS CHS 6 HL SS HIP,"$1,260.00",$0.00,"$1,260.00",$567.00,$899.26,$0.00,$217.09,$0.00,$0.00,$220.62,"$1,260.00",$0.00,$630.00,$997.92,"$1,008.00",$0.00,$197.19,$0.00,$200.59,$0.00
124145,SUP,HCPCS C1713,,124145  -  PLATE BN 130D STD BRL 180MM 38.1MM CLS CHS 8 HL CMPR HIP,"$1,554.00",$0.00,"$1,554.00",$699.30,"$1,109.09",$0.00,$267.75,$0.00,$0.00,$272.09,"$1,554.00",$0.00,$777.00,"$1,230.77","$1,243.20",$0.00,$243.20,$0.00,$247.40,$0.00
124146,SUP,HCPCS C1713,,124146  -  PLATE BN 135D STD BRL 180MM 38.1MM CLS CHS 8 HL CMPR HIP,"$1,554.00",$0.00,"$1,554.00",$699.30,"$1,109.09",$0.00,$267.75,$0.00,$0.00,$272.09,"$1,554.00",$0.00,$777.00,"$1,230.77","$1,243.20",$0.00,$243.20,$0.00,$247.40,$0.00
124147,SUP,HCPCS C1713,,124147  -  PLATE BN 140D STD BRL 180MM 38.1MM CLS CHS 8 HL CMPR HIP,"$1,554.00",$0.00,"$1,554.00",$699.30,"$1,109.09",$0.00,$267.75,$0.00,$0.00,$272.09,"$1,554.00",$0.00,$777.00,"$1,230.77","$1,243.20",$0.00,$243.20,$0.00,$247.40,$0.00
124148,SUP,HCPCS C1713,,124148  -  PLATE BN 145D STD BRL 180MM 38.1MM CLS CHS 8 HL CMPR HIP,"$1,554.00",$0.00,"$1,554.00",$699.30,"$1,109.09",$0.00,$267.75,$0.00,$0.00,$272.09,"$1,554.00",$0.00,$777.00,"$1,230.77","$1,243.20",$0.00,$243.20,$0.00,$247.40,$0.00
124149,SUP,HCPCS C1713,,124149  -  PLATE BN 150D STD BRL 180MM 38.1MM CLS CHS 8 HL CMPR HIP,"$1,554.00",$0.00,"$1,554.00",$699.30,"$1,109.09",$0.00,$267.75,$0.00,$0.00,$272.09,"$1,554.00",$0.00,$777.00,"$1,230.77","$1,243.20",$0.00,$243.20,$0.00,$247.40,$0.00
124150,SUP,HCPCS C1713,,124150  -  PLATE BN 130D STD BRL 220MM 38.1MM CLS CHS 10 HL CMPR HIP,"$1,811.25",$0.00,"$1,811.25",$815.06,"$1,292.69",$0.00,$312.07,$0.00,$0.00,$317.14,"$1,811.25",$0.00,$905.63,"$1,434.51","$1,449.00",$0.00,$283.46,$0.00,$288.35,$0.00
124151,SUP,HCPCS C1713,,124151  -  PLATE BN 135D STD BRL 220MM 38.1MM CHS 10 HL SS HIP,"$1,811.25",$0.00,"$1,811.25",$815.06,"$1,292.69",$0.00,$312.07,$0.00,$0.00,$317.14,"$1,811.25",$0.00,$905.63,"$1,434.51","$1,449.00",$0.00,$283.46,$0.00,$288.35,$0.00
124152,SUP,HCPCS C1713,,124152  -  PLATE BN 140D STD BRL 220MM 38.1MM CLS CHS 10 HL CMPR HIP,"$1,811.25",$0.00,"$1,811.25",$815.06,"$1,292.69",$0.00,$312.07,$0.00,$0.00,$317.14,"$1,811.25",$0.00,$905.63,"$1,434.51","$1,449.00",$0.00,$283.46,$0.00,$288.35,$0.00
124153,SUP,HCPCS C1713,,124153  -  PLATE BN 145D STD BRL 220MM 38.1MM CLS CHS 10 HL CMPR HIP,"$1,811.25",$0.00,"$1,811.25",$815.06,"$1,292.69",$0.00,$312.07,$0.00,$0.00,$317.14,"$1,811.25",$0.00,$905.63,"$1,434.51","$1,449.00",$0.00,$283.46,$0.00,$288.35,$0.00
124154,SUP,HCPCS C1713,,124154  -  PLATE BN 150D STD BRL 220MM 38.1MM CLS CHS 10 HL CMPR HIP,"$1,811.25",$0.00,"$1,811.25",$815.06,"$1,292.69",$0.00,$312.07,$0.00,$0.00,$317.14,"$1,811.25",$0.00,$905.63,"$1,434.51","$1,449.00",$0.00,$283.46,$0.00,$288.35,$0.00
124156,SUP,HCPCS C1713,,124156  -  PLATE BN 135D STD BRL 260MM 38.1MM CLS CHS 12 HL CMPR HIP,"$1,937.25",$0.00,"$1,937.25",$871.76,"$1,382.62",$0.00,$333.78,$0.00,$0.00,$339.20,"$1,937.25",$0.00,$968.63,"$1,534.30","$1,549.80",$0.00,$303.18,$0.00,$308.41,$0.00
124158,SUP,HCPCS C1713,,124158  -  PLATE BN 145D STD BRL 260MM 38.1MM CLS CHS 12 HL SS HIP,"$1,937.25",$0.00,"$1,937.25",$871.76,"$1,382.62",$0.00,$333.78,$0.00,$0.00,$339.20,"$1,937.25",$0.00,$968.63,"$1,534.30","$1,549.80",$0.00,$303.18,$0.00,$308.41,$0.00
124161,SUP,HCPCS C1713,,124161  -  PLATE BN 135D STD BRL 300MM 38.1MM CLS CHS 14 HL CMPR HIP,"$2,294.25",$0.00,"$2,294.25","$1,032.41","$1,637.41",$0.00,$395.29,$0.00,$0.00,$401.70,"$2,294.25",$0.00,"$1,147.13","$1,817.05","$1,835.40",$0.00,$359.05,$0.00,$365.24,$0.00
124162,SUP,HCPCS C1713,,124162  -  PLATE BN 140D STD BRL 300MM 38.1MM CLS CHS 14 HL SS HIP,"$2,160.00",$0.00,"$2,160.00",$972.00,"$1,541.59",$0.00,$372.16,$0.00,$0.00,$378.20,"$2,160.00",$0.00,"$1,080.00","$1,710.72","$1,728.00",$0.00,$338.04,$0.00,$343.87,$0.00
124163,SUP,HCPCS C1713,,124163  -  PLATE BN 145D STD BRL 300MM 38.1MM CLS CHS 14 HL SS HIP,"$2,294.25",$0.00,"$2,294.25","$1,032.41","$1,637.41",$0.00,$395.29,$0.00,$0.00,$401.70,"$2,294.25",$0.00,"$1,147.13","$1,817.05","$1,835.40",$0.00,$359.05,$0.00,$365.24,$0.00
124164,SUP,HCPCS C1713,,124164  -  PLATE BN 150D STD BRL 300MM 38.1MM CLS CHS 14 HL SS HIP,"$1,386.00",$0.00,"$1,386.00",$623.70,$989.19,$0.00,$238.80,$0.00,$0.00,$242.68,"$1,386.00",$0.00,$693.00,"$1,097.71","$1,108.80",$0.00,$216.91,$0.00,$220.65,$0.00
124165,SUP,HCPCS C1713,,124165  -  PLATE BN 130D SHRT BRL 120MM 25.4MM CLS CHS 5 HL CMPR SS HIP,"$1,249.50",$0.00,"$1,249.50",$562.28,$891.77,$0.00,$215.28,$0.00,$0.00,$218.78,"$1,249.50",$0.00,$624.75,$989.60,$999.60,$0.00,$195.55,$0.00,$198.92,$0.00
124166,SUP,HCPCS C1713,,124166  -  PLATE BN 135D SHRT BRL 120MM 25.9MM CLS CHS 5 HL CMPR SS HIP,"$1,249.50",$0.00,"$1,249.50",$562.28,$891.77,$0.00,$215.28,$0.00,$0.00,$218.78,"$1,249.50",$0.00,$624.75,$989.60,$999.60,$0.00,$195.55,$0.00,$198.92,$0.00
124167,SUP,HCPCS C1713,,124167  -  PLATE BN 140D SHRT BRL 120MM 25.4MM CLS CHS 5 HL CMPR SS HIP,"$1,249.50",$0.00,"$1,249.50",$562.28,$891.77,$0.00,$215.28,$0.00,$0.00,$218.78,"$1,249.50",$0.00,$624.75,$989.60,$999.60,$0.00,$195.55,$0.00,$198.92,$0.00
124168,SUP,HCPCS C1713,,124168  -  PLATE BN 145D SHRT BRL 120MM 25.4MM CLS CHS 5 HL CMPR SS HIP,"$1,249.50",$0.00,"$1,249.50",$562.28,$891.77,$0.00,$215.28,$0.00,$0.00,$218.78,"$1,249.50",$0.00,$624.75,$989.60,$999.60,$0.00,$195.55,$0.00,$198.92,$0.00
124169,SUP,HCPCS C1713,,124169  -  PLATE BN 150D SHRT BRL 120MM 25.4MM CLS CHS 5 HL CMPR SS HIP,"$1,249.50",$0.00,"$1,249.50",$562.28,$891.77,$0.00,$215.28,$0.00,$0.00,$218.78,"$1,249.50",$0.00,$624.75,$989.60,$999.60,$0.00,$195.55,$0.00,$198.92,$0.00
124176,SUP,HCPCS C1713,,124176  -  PLATE BN 130D SHRT BRL 100MM 25.4MM CLS CHS 4 HL CMPR HIP SP,"$1,197.00",$0.00,"$1,197.00",$538.65,$854.30,$0.00,$206.24,$0.00,$0.00,$209.59,"$1,197.00",$0.00,$598.50,$948.02,$957.60,$0.00,$187.33,$0.00,$190.56,$0.00
124177,SUP,HCPCS C1713,,124177  -  PLATE BN 135D SHRT BRL 100MM 1MM CLS 4 HL HIP,"$1,197.00",$0.00,"$1,197.00",$538.65,$854.30,$0.00,$206.24,$0.00,$0.00,$209.59,"$1,197.00",$0.00,$598.50,$948.02,$957.60,$0.00,$187.33,$0.00,$190.56,$0.00
124178,SUP,HCPCS C1713,,124178  -  PLATE BN 140D SHRT BRL 100MM CLS 4 SLOT CMPR,"$1,197.00",$0.00,"$1,197.00",$538.65,$854.30,$0.00,$206.24,$0.00,$0.00,$209.59,"$1,197.00",$0.00,$598.50,$948.02,$957.60,$0.00,$187.33,$0.00,$190.56,$0.00
124179,SUP,HCPCS C1713,,124179  -  PLATE BN 145D SHRT BRL 100MM 25.4MM CLS CHS 4 HL CMPR HIP SP,"$1,197.00",$0.00,"$1,197.00",$538.65,$854.30,$0.00,$206.24,$0.00,$0.00,$209.59,"$1,197.00",$0.00,$598.50,$948.02,$957.60,$0.00,$187.33,$0.00,$190.56,$0.00
124180,SUP,HCPCS C1713,,124180  -  PLATE BN 150D SHRT BRL 100MM 25.4MM CLS CHS 4 HL CMPR HIP SP,"$1,197.00",$0.00,"$1,197.00",$538.65,$854.30,$0.00,$206.24,$0.00,$0.00,$209.59,"$1,197.00",$0.00,$598.50,$948.02,$957.60,$0.00,$187.33,$0.00,$190.56,$0.00
124810,SUP,HCPCS C1713,,124810  -  PIN TRC 4MM 250MM 50MM FULL COVE PNT ORTH,$894.50,$0.00,$708.44,$0.00,$4.28,$0.00,$0.00,$0.00,$0.00,$0.00,$6.00,$0.00,$3.00,$708.44,$4.80,$0.00,$0.00,$0.00,$0.00,$0.00
124811,SUP,HCPCS C1713,,124811  -  PIN TRC 4MM 150MM 60MM FULL COVE PNT ORTH,$894.50,$0.00,$894.50,$402.53,$638.40,$0.00,$154.12,$0.00,$0.00,$156.62,$894.50,$0.00,$447.25,$708.44,$715.60,$0.00,$139.99,$0.00,$142.40,$0.00
124820,SUP,HCPCS C1713,,124820  -  PIN TRC 4MM 250MM 40MM FULL COVE PNT ORTH,$894.50,$0.00,$894.50,$402.53,$638.40,$0.00,$154.12,$0.00,$0.00,$156.62,$894.50,$0.00,$447.25,$708.44,$715.60,$0.00,$139.99,$0.00,$142.40,$0.00
124823,SUP,HCPCS C1713,,124823  -  PIN TRC 4MM 300MM 40MM FULL COVE PNT ORTH,$894.50,$0.00,$894.50,$402.53,$638.40,$0.00,$154.12,$0.00,$0.00,$156.62,$894.50,$0.00,$447.25,$708.44,$715.60,$0.00,$139.99,$0.00,$142.40,$0.00
124824,SUP,HCPCS C1713,,124824  -  PIN TRC 4MM 300MM 50MM FULL COVE PNT ORTH,$894.50,$0.00,$894.50,$402.53,$638.40,$0.00,$154.12,$0.00,$0.00,$156.62,$894.50,$0.00,$447.25,$708.44,$715.60,$0.00,$139.99,$0.00,$142.40,$0.00
124825,SUP,HCPCS C1713,,124825  -  PIN TRC 4MM 250MM 40MM FULL COVE PNT ORTH,$894.50,$0.00,$894.50,$402.53,$638.40,$0.00,$154.12,$0.00,$0.00,$156.62,$894.50,$0.00,$447.25,$708.44,$715.60,$0.00,$139.99,$0.00,$142.40,$0.00
124826,SUP,HCPCS C1713,,124826  -  PIN TRC 5MM 250MM 50MM FULL COVE PNT ORTH,$894.50,$0.00,$894.50,$402.53,$638.40,$0.00,$154.12,$0.00,$0.00,$156.62,$894.50,$0.00,$447.25,$708.44,$715.60,$0.00,$139.99,$0.00,$142.40,$0.00
124827,SUP,HCPCS C1713,,124827  -  PIN TRC 5MM 250MM 60MM FULL COVE PNT ORTH,$894.50,$0.00,$894.50,$402.53,$638.40,$0.00,$154.12,$0.00,$0.00,$156.62,$894.50,$0.00,$447.25,$708.44,$715.60,$0.00,$139.99,$0.00,$142.40,$0.00
124828,SUP,HCPCS C1713,,124828  -  PIN TRC 3MM 60MM 16MM HLF COVE PNT ORTH,$558.00,$0.00,$558.00,$251.10,$398.24,$0.00,$96.14,$0.00,$0.00,$97.70,$558.00,$0.00,$279.00,$441.94,$446.40,$0.00,$87.33,$0.00,$88.83,$0.00
124829,SUP,HCPCS C1713,,124829  -  PIN TRC 3MM 60MM 22MM HLF COVE PNT,$558.00,$0.00,$558.00,$251.10,$398.24,$0.00,$96.14,$0.00,$0.00,$97.70,$558.00,$0.00,$279.00,$441.94,$446.40,$0.00,$87.33,$0.00,$88.83,$0.00
124830,SUP,HCPCS C1713,,124830  -  PIN TRC 3MM 75MM 28MM HLF COVE PNT ORTH,$558.00,$0.00,$558.00,$251.10,$398.24,$0.00,$96.14,$0.00,$0.00,$97.70,$558.00,$0.00,$279.00,$441.94,$446.40,$0.00,$87.33,$0.00,$88.83,$0.00
124831,SUP,HCPCS C1713,,124831  -  PIN TRC 4MM 150MM 50MM HLF COVE PNT ORTH,$770.00,$0.00,$770.00,$346.50,$549.55,$0.00,$132.67,$0.00,$0.00,$134.82,$770.00,$0.00,$385.00,$609.84,$616.00,$0.00,$120.51,$0.00,$122.58,$0.00
124833,SUP,HCPCS C1713,,124833  -  PIN TRC 5MM 150MM 50MM HLF COVE PNT ORTH,$770.00,$0.00,$770.00,$346.50,$549.55,$0.00,$132.67,$0.00,$0.00,$134.82,$770.00,$0.00,$385.00,$609.84,$616.00,$0.00,$120.51,$0.00,$122.58,$0.00
124834,SUP,HCPCS C1713,,124834  -  PIN TRC 5MM 200MM 35MM HLF COVE PNT ORTH,$614.00,$0.00,$614.00,$276.30,$438.21,$0.00,$105.79,$0.00,$0.00,$107.51,$614.00,$0.00,$307.00,$486.29,$491.20,$0.00,$96.09,$0.00,$97.75,$0.00
124835,SUP,HCPCS C1713,,124835  -  PIN TRC 3MM 250MM 50MM HLF COVE PNT ORTH,$894.50,$0.00,$894.50,$402.53,$638.40,$0.00,$154.12,$0.00,$0.00,$156.62,$894.50,$0.00,$447.25,$708.44,$715.60,$0.00,$139.99,$0.00,$142.40,$0.00
124839,SUP,HCPCS C1713,,124839  -  PIN HLF 5MM 150MM 40MM PDRLL ORTH,$614.00,$0.00,$614.00,$276.30,$438.21,$0.00,$105.79,$0.00,$0.00,$107.51,$614.00,$0.00,$307.00,$486.29,$491.20,$0.00,$96.09,$0.00,$97.75,$0.00
124840,SUP,HCPCS C1713,,124840  -  PIN HLF 5MM 150MM 45MM PDRLL ORTH,$493.00,$0.00,$493.00,$221.85,$351.85,$0.00,$84.94,$0.00,$0.00,$86.32,$493.00,$0.00,$246.50,$390.46,$394.40,$0.00,$77.15,$0.00,$78.49,$0.00
124841,SUP,HCPCS C1713,,124841  -  PIN HLF 5MM 150MM 50MM PDRLL ORTH,$493.00,$0.00,$493.00,$221.85,$351.85,$0.00,$84.94,$0.00,$0.00,$86.32,$493.00,$0.00,$246.50,$390.46,$394.40,$0.00,$77.15,$0.00,$78.49,$0.00
125037,SUP,Custom 27203010,,125037  -  TUBE ENDBR 37FR 5.1MM BLU CLR SHLY B-CTH LT CUF RADOPQ SLT,$126.83,$0.00,$126.83,$0.00,$90.52,$0.00,$0.00,$0.00,$0.00,$0.00,$126.83,$0.00,$63.41,$100.45,$101.46,$0.00,$0.00,$0.00,$0.00,$0.00
125039,SUP,Custom 27203010,,125039  -  TUBE ENDBR 39FR 5.3MM BLU CLR SHLY B-CTH LT CUF RADOPQ SLT,$126.83,$0.00,$126.83,$0.00,$90.52,$0.00,$0.00,$0.00,$0.00,$0.00,$126.83,$0.00,$63.41,$100.45,$101.46,$0.00,$0.00,$0.00,$0.00,$0.00
125195,SUP,HCPCS C1713,,125195  -  SCREW BN SLT HD CMPR PED,$183.75,$0.00,$183.75,$82.69,$131.14,$0.00,$31.66,$0.00,$0.00,$32.17,$183.75,$0.00,$91.88,$145.53,$147.00,$0.00,$28.76,$0.00,$29.25,$0.00
125292,SUP,HCPCS C1713,,125292  -  PLATE BN 100D 3 HL BRL INTMD SS HIP,$601.65,$0.00,$601.65,$270.74,$429.40,$0.00,$103.66,$0.00,$0.00,$105.34,$601.65,$0.00,$300.83,$476.51,$481.32,$0.00,$94.16,$0.00,$95.78,$0.00
125294,SUP,HCPCS C1713,,125294  -  PLATE BN 130D 76.2MM 3 HL BRL INTMD SS HIP KY-LOK,$558.60,$0.00,$558.60,$251.37,$398.67,$0.00,$96.24,$0.00,$0.00,$97.81,$558.60,$0.00,$279.30,$442.41,$446.88,$0.00,$87.42,$0.00,$88.93,$0.00
125800,SUP,HCPCS C1713,,125800  -  PIN HLF 4MM 150MM 35MM SKL TRX COVE PNT,$383.50,$0.00,$383.50,$172.58,$273.70,$0.00,$66.08,$0.00,$0.00,$67.15,$383.50,$0.00,$191.75,$303.73,$306.80,$0.00,$60.02,$0.00,$61.05,$0.00
125900,SUP,HCPCS C1713,,125900  -  PIN TRC 4MM 300MM 60MM FULL COVE PNT ORTH,$894.50,$0.00,$894.50,$402.53,$638.40,$0.00,$154.12,$0.00,$0.00,$156.62,$894.50,$0.00,$447.25,$708.44,$715.60,$0.00,$139.99,$0.00,$142.40,$0.00
127016,SUP,HCPCS C1713,,127016  -  SCREW BN 4.5MM 16MM IMHS ST HIP,$36.50,$0.00,$36.50,$16.43,$26.05,$0.00,$6.29,$0.00,$0.00,$6.39,$36.50,$0.00,$18.25,$28.91,$29.20,$0.00,$5.71,$0.00,$5.81,$0.00
127018,SUP,HCPCS C1713,,127018  -  SCREW BN 4.5MM 18MM IMHS ST HIP,$36.50,$0.00,$36.50,$16.43,$26.05,$0.00,$6.29,$0.00,$0.00,$6.39,$36.50,$0.00,$18.25,$28.91,$29.20,$0.00,$5.71,$0.00,$5.81,$0.00
127020,SUP,HCPCS C1713,,127020  -  SCREW BN 4.5MM 20MM IMHS ST HIP,$36.50,$0.00,$36.50,$16.43,$26.05,$0.00,$6.29,$0.00,$0.00,$6.39,$36.50,$0.00,$18.25,$28.91,$29.20,$0.00,$5.71,$0.00,$5.81,$0.00
127026,SUP,HCPCS C1713,,127026  -  SCREW BN 4.5MM 26MM IMHS ST HIP,$36.50,$0.00,$36.50,$16.43,$26.05,$0.00,$6.29,$0.00,$0.00,$6.39,$36.50,$0.00,$18.25,$28.91,$29.20,$0.00,$5.71,$0.00,$5.81,$0.00
127032,SUP,HCPCS C1713,,127032  -  SCREW BN 4.5MM 32MM IMHS ST HIP,$39.00,$0.00,$39.00,$17.55,$27.83,$0.00,$6.72,$0.00,$0.00,$6.83,$39.00,$0.00,$19.50,$30.89,$31.20,$0.00,$6.10,$0.00,$6.21,$0.00
127042,SUP,HCPCS C1713,,127042  -  SCREW BN 4.5MM 8MM 42MM IMHS ST THRD HD CORT,$32.10,$0.00,$32.10,$14.45,$22.91,$0.00,$5.53,$0.00,$0.00,$5.62,$32.10,$0.00,$16.05,$25.42,$25.68,$0.00,$5.02,$0.00,$5.11,$0.00
127056,SUP,HCPCS C1713,,127056  -  SCREW BN 4.5MM 56MM IMHS ST HIP,$39.00,$0.00,$39.00,$17.55,$27.83,$0.00,$6.72,$0.00,$0.00,$6.83,$39.00,$0.00,$19.50,$30.89,$31.20,$0.00,$6.10,$0.00,$6.21,$0.00
127060,SUP,HCPCS C1713,,127060  -  SCREW BN 4.5MM 60MM IMHS ST SS HIP,$36.50,$0.00,$36.50,$16.43,$26.05,$0.00,$6.29,$0.00,$0.00,$6.39,$36.50,$0.00,$18.25,$28.91,$29.20,$0.00,$5.71,$0.00,$5.81,$0.00
127062,SUP,HCPCS C1713,,127062  -  SCREW BN 4.5MM 62MM ST CORT,$41.80,$0.00,$41.80,$18.81,$29.83,$0.00,$7.20,$0.00,$0.00,$7.32,$41.80,$0.00,$20.90,$33.11,$33.44,$0.00,$6.54,$0.00,$6.65,$0.00
127820,SUP,HCPCS C1769,,127820  -  WIRE FX .85MM 9IN NS KRSH THRD DMD PT 1 END RND TY E SS ORTH,$164.70,$0.00,$164.70,$89.43,$117.55,$0.00,$28.38,$0.00,$0.00,$28.84,$164.70,$0.00,$82.35,$130.44,$131.76,$0.00,$25.78,$0.00,$26.22,$0.00
127821,SUP,HCPCS C1769,,127821  -  WIRE FX .035MM 9IN NS KRSH THRD DMD PT BOTH ENDS TY F SS,$164.70,$0.00,$164.70,$89.43,$117.55,$0.00,$28.38,$0.00,$0.00,$28.84,$164.70,$0.00,$82.35,$130.44,$131.76,$0.00,$25.78,$0.00,$26.22,$0.00
127840,SUP,HCPCS C1769,,127840  -  WIRE FX 1.1MM 9IN NS KRSH THRD DMD PT 1 END RND TY E SS ORTH,$164.70,$0.00,$164.70,$89.43,$117.55,$0.00,$28.38,$0.00,$0.00,$28.84,$164.70,$0.00,$82.35,$130.44,$131.76,$0.00,$25.78,$0.00,$26.22,$0.00
127841,SUP,HCPCS C1769,,127841  -  WIRE FX 1.1MM 9IN NS KRSH THRD DMD PT BOTH ENDS TY F SS,$164.70,$0.00,$164.70,$89.43,$117.55,$0.00,$28.38,$0.00,$0.00,$28.84,$164.70,$0.00,$82.35,$130.44,$131.76,$0.00,$25.78,$0.00,$26.22,$0.00
127860,SUP,HCPCS C1769,,127860  -  WIRE FX 1.5MM 9IN NS KRSH THRD DMD PT 1 END RND TY E SS ORTH,$164.70,$0.00,$164.70,$89.43,$117.55,$0.00,$28.38,$0.00,$0.00,$28.84,$164.70,$0.00,$82.35,$130.44,$131.76,$0.00,$25.78,$0.00,$26.22,$0.00
127861,SUP,HCPCS C1769,,127861  -  WIRE FX 1.5IN 9IN NS KRSH THRD F TY PNT SS ORTH,$164.70,$0.00,$164.70,$89.43,$117.55,$0.00,$28.38,$0.00,$0.00,$28.84,$164.70,$0.00,$82.35,$130.44,$131.76,$0.00,$25.78,$0.00,$26.22,$0.00
127874,SUP,HCPCS C1713,,127874  -  PIN FX 1.9MM 9IN NS STNM THRD TROC PNT BOTH ENDS TY A SS,$170.40,$0.00,$170.40,$76.68,$121.61,$0.00,$29.36,$0.00,$0.00,$29.84,$170.40,$0.00,$85.20,$134.96,$136.32,$0.00,$26.67,$0.00,$27.13,$0.00
127877,SUP,HCPCS C1713,,127877  -  PIN FX 1.9IN 9IN NS STNM SMTH TY D THRD SS ORTH,$170.40,$0.00,$170.40,$76.68,$121.61,$0.00,$29.36,$0.00,$0.00,$29.84,$170.40,$0.00,$85.20,$134.96,$136.32,$0.00,$26.67,$0.00,$27.13,$0.00
127880,SUP,HCPCS C1713,,127880  -  PIN FX 5/64IN 9IN NS STNM THRD SS ORTH,$170.40,$0.00,$170.40,$76.68,$121.61,$0.00,$29.36,$0.00,$0.00,$29.84,$170.40,$0.00,$85.20,$134.96,$136.32,$0.00,$26.67,$0.00,$27.13,$0.00
127881,SUP,HCPCS C1713,,127881  -  PIN FX 1.9IN 9IN NS STNM F PLN THRD SS ORTH,$170.40,$0.00,$170.40,$76.68,$121.61,$0.00,$29.36,$0.00,$0.00,$29.84,$170.40,$0.00,$85.20,$134.96,$136.32,$0.00,$26.67,$0.00,$27.13,$0.00
127894,SUP,HCPCS C1713,,127894  -  PIN FX 2.3MM 9IN NS STNM THRD TROC PNT BOTH ENDS TY A SS,$170.40,$0.00,$170.40,$76.68,$121.61,$0.00,$29.36,$0.00,$0.00,$29.84,$170.40,$0.00,$85.20,$134.96,$136.32,$0.00,$26.67,$0.00,$27.13,$0.00
127900,SUP,HCPCS C1713,,127900  -  PIN FX 2.3IN 9IN NS STNM THRD TY E SS ORTH,$170.40,$0.00,$170.40,$76.68,$121.61,$0.00,$29.36,$0.00,$0.00,$29.84,$170.40,$0.00,$85.20,$134.96,$136.32,$0.00,$26.67,$0.00,$27.13,$0.00
127901,SUP,HCPCS C1713,,127901  -  PIN FX 2.3MM 9IN NS STNM 2 END DMD PT TY F SS,$170.40,$0.00,$170.40,$76.68,$121.61,$0.00,$29.36,$0.00,$0.00,$29.84,$170.40,$0.00,$85.20,$134.96,$136.32,$0.00,$26.67,$0.00,$27.13,$0.00
127914,SUP,HCPCS C1713,,127914  -  PIN FX 2.7MM 9IN NS STNM THRD TROC PNT BOTH ENDS TY A SS,$170.40,$0.00,$170.40,$76.68,$121.61,$0.00,$29.36,$0.00,$0.00,$29.84,$170.40,$0.00,$85.20,$134.96,$136.32,$0.00,$26.67,$0.00,$27.13,$0.00
127917,SUP,HCPCS C1713,,127917  -  PIN FX 2.7MM 9IN NS STNM THRD TROC PNT 1 END RND TY D SS,$170.40,$0.00,$170.40,$76.68,$121.61,$0.00,$29.36,$0.00,$0.00,$29.84,$170.40,$0.00,$85.20,$134.96,$136.32,$0.00,$26.67,$0.00,$27.13,$0.00
127920,SUP,HCPCS C1713,,127920  -  PIN FX 7/64IN 9IN NS STNM THRD SS ORTH,$170.40,$0.00,$170.40,$76.68,$121.61,$0.00,$29.36,$0.00,$0.00,$29.84,$170.40,$0.00,$85.20,$134.96,$136.32,$0.00,$26.67,$0.00,$27.13,$0.00
127921,SUP,HCPCS C1713,,127921  -  PIN FX 2.7IN 9IN NS STNM F PLN THRD SS ORTH,$170.40,$0.00,$170.40,$76.68,$121.61,$0.00,$29.36,$0.00,$0.00,$29.84,$170.40,$0.00,$85.20,$134.96,$136.32,$0.00,$26.67,$0.00,$27.13,$0.00
127934,SUP,HCPCS C1713,,127934  -  PIN FX 3.1MM 9IN NS STNM THRD TROC PNT BOTH ENDS TY A SS,$170.40,$0.00,$170.40,$76.68,$121.61,$0.00,$29.36,$0.00,$0.00,$29.84,$170.40,$0.00,$85.20,$134.96,$136.32,$0.00,$26.67,$0.00,$27.13,$0.00
127937,SUP,HCPCS C1713,,127937  -  PIN FX 3.1MM 9IN NS STNM THRD TROC PNT 1 END RND TY D SS,$170.40,$0.00,$170.40,$76.68,$121.61,$0.00,$29.36,$0.00,$0.00,$29.84,$170.40,$0.00,$85.20,$134.96,$136.32,$0.00,$26.67,$0.00,$27.13,$0.00
127940,SUP,HCPCS C1713,,127940  -  PIN FX 1/8IN 9IN NS STNM THRD SS ORTH,$170.40,$0.00,$170.40,$76.68,$121.61,$0.00,$29.36,$0.00,$0.00,$29.84,$170.40,$0.00,$85.20,$134.96,$136.32,$0.00,$26.67,$0.00,$27.13,$0.00
127941,SUP,HCPCS C1713,,127941  -  PIN FX 3.1IN 9IN NS STNM F PLN THRD SS ORTH,$170.40,$0.00,$170.40,$76.68,$121.61,$0.00,$29.36,$0.00,$0.00,$29.84,$170.40,$0.00,$85.20,$134.96,$136.32,$0.00,$26.67,$0.00,$27.13,$0.00
127954,SUP,HCPCS C1713,,127954  -  PIN FX 3.5MM 9IN NS STNM THRD TROC PNT BOTH ENDS TY A SS,$170.40,$0.00,$170.40,$76.68,$121.61,$0.00,$29.36,$0.00,$0.00,$29.84,$170.40,$0.00,$85.20,$134.96,$136.32,$0.00,$26.67,$0.00,$27.13,$0.00
127957,SUP,HCPCS C1713,,127957  -  PIN FX 3.5MM 9IN NS STNM THRD TROC PNT 1 END RND TY D SS,$170.40,$0.00,$170.40,$76.68,$121.61,$0.00,$29.36,$0.00,$0.00,$29.84,$170.40,$0.00,$85.20,$134.96,$136.32,$0.00,$26.67,$0.00,$27.13,$0.00
127960,SUP,HCPCS C1713,,127960  -  PIN FX 9/64IN 9IN NS STNM THRD SS ORTH,$170.40,$0.00,$170.40,$76.68,$121.61,$0.00,$29.36,$0.00,$0.00,$29.84,$170.40,$0.00,$85.20,$134.96,$136.32,$0.00,$26.67,$0.00,$27.13,$0.00
127961,SUP,HCPCS C1713,,127961  -  PIN FX 3.5MM 9IN NS STNM THRD DMD PT BOTH ENDS TY F SS ORTH,$170.40,$0.00,$170.40,$76.68,$121.61,$0.00,$29.36,$0.00,$0.00,$29.84,$170.40,$0.00,$85.20,$134.96,$136.32,$0.00,$26.67,$0.00,$27.13,$0.00
127974,SUP,HCPCS C1713,,127974  -  PIN FX 3.9MM 9IN NS STNM THRD TROC PNT BOTH ENDS TY A SS,$170.40,$0.00,$170.40,$76.68,$121.61,$0.00,$29.36,$0.00,$0.00,$29.84,$170.40,$0.00,$85.20,$134.96,$136.32,$0.00,$26.67,$0.00,$27.13,$0.00
127977,SUP,HCPCS C1713,,127977  -  PIN FX 3.9MM 9IN NS STNM THRD TROC PNT 1 END RND TY D SS,$170.40,$0.00,$170.40,$76.68,$121.61,$0.00,$29.36,$0.00,$0.00,$29.84,$170.40,$0.00,$85.20,$134.96,$136.32,$0.00,$26.67,$0.00,$27.13,$0.00
127980,SUP,HCPCS C1713,,127980  -  PIN FX 5/32IN 9IN NS STNM THRD SS ORTH,$170.40,$0.00,$170.40,$76.68,$121.61,$0.00,$29.36,$0.00,$0.00,$29.84,$170.40,$0.00,$85.20,$134.96,$136.32,$0.00,$26.67,$0.00,$27.13,$0.00
127981,SUP,HCPCS C1713,,127981  -  PIN FX 3.9IN 9IN NS STNM THRD TY F SS ORTH,$170.40,$0.00,$170.40,$76.68,$121.61,$0.00,$29.36,$0.00,$0.00,$29.84,$170.40,$0.00,$85.20,$134.96,$136.32,$0.00,$26.67,$0.00,$27.13,$0.00
127994,SUP,HCPCS C1713,,127994  -  PIN FX 4.7MM 9IN NS STNM THRD TROC PNT BOTH ENDS TY A SS,$170.40,$0.00,$170.40,$76.68,$121.61,$0.00,$29.36,$0.00,$0.00,$29.84,$170.40,$0.00,$85.20,$134.96,$136.32,$0.00,$26.67,$0.00,$27.13,$0.00
127997,SUP,HCPCS C1713,,127997  -  PIN FX 4.7MM 9IN NS STNM THRD TROC PNT 1 END RND TY D SS,$170.40,$0.00,$170.40,$76.68,$121.61,$0.00,$29.36,$0.00,$0.00,$29.84,$170.40,$0.00,$85.20,$134.96,$136.32,$0.00,$26.67,$0.00,$27.13,$0.00
128000,SUP,HCPCS C1713,,128000  -  PIN FX 3/16IN 9IN NS STNM THRD SS ORTH,$170.40,$0.00,$170.40,$76.68,$121.61,$0.00,$29.36,$0.00,$0.00,$29.84,$170.40,$0.00,$85.20,$134.96,$136.32,$0.00,$26.67,$0.00,$27.13,$0.00
128001,SUP,HCPCS C1713,,128001  -  PIN FX 4.7MM 9IN NS STNM THRD DMD PT BOTH ENDS TY F SS ORTH,$170.40,$0.00,$170.40,$76.68,$121.61,$0.00,$29.36,$0.00,$0.00,$29.84,$170.40,$0.00,$85.20,$134.96,$136.32,$0.00,$26.67,$0.00,$27.13,$0.00
128005,SUP,HCPCS C1769,,128005  -  WIRE FX .028MM 4MM NS KRSH SMTH TROC PNT BOTH END TY A SS,$78.70,$0.00,$78.70,$42.73,$56.17,$0.00,$13.56,$0.00,$0.00,$13.78,$78.70,$0.00,$39.35,$62.33,$62.96,$0.00,$12.32,$0.00,$12.53,$0.00
128007,SUP,HCPCS C1769,,128007  -  WIRE FX .76IN 4IN NS KRSH PLN PNT TY A SS ORTH,$78.70,$0.00,$78.70,$42.73,$56.17,$0.00,$13.56,$0.00,$0.00,$13.78,$78.70,$0.00,$39.35,$62.33,$62.96,$0.00,$12.32,$0.00,$12.53,$0.00
128010,SUP,HCPCS C1769,,128010  -  WIRE FX .035IN 4IN STRL KRSH PLN 2 PNT TY A TROC SS,$78.70,$0.00,$78.70,$42.73,$56.17,$0.00,$13.56,$0.00,$0.00,$13.78,$78.70,$0.00,$39.35,$62.33,$62.96,$0.00,$12.32,$0.00,$12.53,$0.00
128011,SUP,HCPCS C1769,,128011  -  WIRE FX .85MM 4IN NS KRSH SMTH TROC PNT 1 END RND TY D SS,$78.70,$0.00,$78.70,$42.73,$56.17,$0.00,$13.56,$0.00,$0.00,$13.78,$78.70,$0.00,$39.35,$62.33,$62.96,$0.00,$12.32,$0.00,$12.53,$0.00
128012,SUP,HCPCS C1769,,128012  -  WIRE FX .035IN 9IN NS KRSH 1 DMD PT SS,$78.70,$0.00,$78.70,$42.73,$56.17,$0.00,$13.56,$0.00,$0.00,$13.78,$78.70,$0.00,$39.35,$62.33,$62.96,$0.00,$12.32,$0.00,$12.53,$0.00
128017,SUP,HCPCS C1769,,128017  -  WIRE FX .85IN 4IN NS KRSH PLN PNT TY A SS ORTH,$78.70,$0.00,$78.70,$42.73,$56.17,$0.00,$13.56,$0.00,$0.00,$13.78,$78.70,$0.00,$39.35,$62.33,$62.96,$0.00,$12.32,$0.00,$12.53,$0.00
128020,SUP,HCPCS C1769,,128020  -  WIRE FX .85MM 5IN NS KRSH SMTH DMD PT BOTH ENDS TY F SS ORTH,$78.70,$0.00,$78.70,$42.73,$56.17,$0.00,$13.56,$0.00,$0.00,$13.78,$78.70,$0.00,$39.35,$62.33,$62.96,$0.00,$12.32,$0.00,$12.53,$0.00
128021,SUP,HCPCS C1769,,128021  -  WIRE FX .035IN 7IN NS KRSH PLN PNT TY F SS ORTH,$78.70,$0.00,$78.70,$42.73,$56.17,$0.00,$13.56,$0.00,$0.00,$13.78,$78.70,$0.00,$39.35,$62.33,$62.96,$0.00,$12.32,$0.00,$12.53,$0.00
128022,SUP,HCPCS C1769,,128022  -  WIRE FX .85IN 9IN NS KRSH PLN PNT TY F SS,$78.70,$0.00,$78.70,$42.73,$56.17,$0.00,$13.56,$0.00,$0.00,$13.78,$78.70,$0.00,$39.35,$62.33,$62.96,$0.00,$12.32,$0.00,$12.53,$0.00
128030,SUP,HCPCS C1769,,128030  -  WIRE FX .045MM 4MM STRL KRSH TROC PNT BOTH END TY A SS,$78.70,$0.00,$78.70,$42.73,$56.17,$0.00,$13.56,$0.00,$0.00,$13.78,$78.70,$0.00,$39.35,$62.33,$62.96,$0.00,$12.32,$0.00,$12.53,$0.00
128031,SUP,HCPCS C1769,,128031  -  WIRE FX 1.1MM 4IN NS KRSH SMTH TROC PNT 1 END RND TY D SS,$78.70,$0.00,$78.70,$42.73,$56.17,$0.00,$13.56,$0.00,$0.00,$13.78,$78.70,$0.00,$39.35,$62.33,$62.96,$0.00,$12.32,$0.00,$12.53,$0.00
128032,SUP,HCPCS C1769,,128032  -  WIRE FX .045IN 9IN NS KRSH PLN PNT TY E SS ORTH,$78.70,$0.00,$78.70,$42.73,$56.17,$0.00,$13.56,$0.00,$0.00,$13.78,$78.70,$0.00,$39.35,$62.33,$62.96,$0.00,$12.32,$0.00,$12.53,$0.00
128034,SUP,HCPCS C1769,,128034  -  WIRE FX 1.1MM 12IN NS KRSH SMTH DMD PT 1 END RND TY E SS,$78.70,$0.00,$78.70,$42.73,$56.17,$0.00,$13.56,$0.00,$0.00,$13.78,$78.70,$0.00,$39.35,$62.33,$62.96,$0.00,$12.32,$0.00,$12.53,$0.00
128037,SUP,HCPCS C1769,,128037  -  WIRE FX .045IN 4IN NS KRSH SMTH TY A SS ORTH,$78.70,$0.00,$78.70,$42.73,$56.17,$0.00,$13.56,$0.00,$0.00,$13.78,$78.70,$0.00,$39.35,$62.33,$62.96,$0.00,$12.32,$0.00,$12.53,$0.00
128040,SUP,HCPCS C1769,,128040  -  WIRE FX 1.1MM 5IN NS KRSH SMTH DMD PT BOTH ENDS TY F SS ORTH,$78.70,$0.00,$78.70,$42.73,$56.17,$0.00,$13.56,$0.00,$0.00,$13.78,$78.70,$0.00,$39.35,$62.33,$62.96,$0.00,$12.32,$0.00,$12.53,$0.00
128041,SUP,HCPCS C1769,,128041  -  WIRE FX .045IN 7IN NS KRSH PLN PNT TY F SS ORTH,$78.70,$0.00,$78.70,$42.73,$56.17,$0.00,$13.56,$0.00,$0.00,$13.78,$78.70,$0.00,$39.35,$62.33,$62.96,$0.00,$12.32,$0.00,$12.53,$0.00
128042,SUP,HCPCS C1769,,128042  -  WIRE FX .045IN 9IN NS KRSH DMD PT 2 END SS,$78.70,$0.00,$78.70,$42.73,$56.17,$0.00,$13.56,$0.00,$0.00,$13.78,$78.70,$0.00,$39.35,$62.33,$62.96,$0.00,$12.32,$0.00,$12.53,$0.00
128044,SUP,HCPCS C1769,,128044  -  WIRE FX 1.1MM 12IN NS KRSH SMTH DMD PT BOTH ENDS TY F SS,$49.40,$0.00,$49.40,$26.82,$35.26,$0.00,$8.51,$0.00,$0.00,$8.65,$49.40,$0.00,$24.70,$39.12,$39.52,$0.00,$7.73,$0.00,$7.86,$0.00
128050,SUP,HCPCS C1769,,128050  -  WIRE FX .062IN 4IN NS KRSH PLN 2 PNT TY A TROC SS ORTH,$78.70,$0.00,$78.70,$42.73,$56.17,$0.00,$13.56,$0.00,$0.00,$13.78,$78.70,$0.00,$39.35,$62.33,$62.96,$0.00,$12.32,$0.00,$12.53,$0.00
128051,SUP,HCPCS C1769,,128051  -  WIRE FX 1.5MM 4IN NS KRSH SMTH TROC PNT 1 END RND TY D SS,$78.70,$0.00,$78.70,$42.73,$56.17,$0.00,$13.56,$0.00,$0.00,$13.78,$78.70,$0.00,$39.35,$62.33,$62.96,$0.00,$12.32,$0.00,$12.53,$0.00
128052,SUP,HCPCS C1769,,128052  -  WIRE FX .062IN 9IN NS KRSH PLN PNT TY E SS ORTH,$78.70,$0.00,$78.70,$42.73,$56.17,$0.00,$13.56,$0.00,$0.00,$13.78,$78.70,$0.00,$39.35,$62.33,$62.96,$0.00,$12.32,$0.00,$12.53,$0.00
128054,SUP,HCPCS C1769,,128054  -  WIRE FX 1.5MM 12IN NS KRSH SMTH DMD PT 1 END RND TY E SS,$78.70,$0.00,$78.70,$42.73,$56.17,$0.00,$13.56,$0.00,$0.00,$13.78,$78.70,$0.00,$39.35,$62.33,$62.96,$0.00,$12.32,$0.00,$12.53,$0.00
128057,SUP,HCPCS C1769,,128057  -  WIRE FX 1.5IN 4IN NS KRSH PLN PNT TY A SS ORTH,$78.70,$0.00,$78.70,$42.73,$56.17,$0.00,$13.56,$0.00,$0.00,$13.78,$78.70,$0.00,$39.35,$62.33,$62.96,$0.00,$12.32,$0.00,$12.53,$0.00
128060,SUP,HCPCS C1769,,128060  -  WIRE FX 1.5MM 5IN NS KRSH SMTH DMD PT BOTH ENDS TY F SS ORTH,$78.70,$0.00,$78.70,$42.73,$56.17,$0.00,$13.56,$0.00,$0.00,$13.78,$78.70,$0.00,$39.35,$62.33,$62.96,$0.00,$12.32,$0.00,$12.53,$0.00
128061,SUP,HCPCS C1769,,128061  -  WIRE FX .062IN 7IN NS KRSH PLN PNT TY F SS ORTH,$78.70,$0.00,$78.70,$42.73,$56.17,$0.00,$13.56,$0.00,$0.00,$13.78,$78.70,$0.00,$39.35,$62.33,$62.96,$0.00,$12.32,$0.00,$12.53,$0.00
128062,SUP,HCPCS C1769,,128062  -  WIRE FX 1.5IN 9IN NS KRSH PLN TY F SS,$78.70,$0.00,$78.70,$42.73,$56.17,$0.00,$13.56,$0.00,$0.00,$13.78,$78.70,$0.00,$39.35,$62.33,$62.96,$0.00,$12.32,$0.00,$12.53,$0.00
128064,SUP,HCPCS C1769,,128064  -  WIRE FX 1.5MM 12IN NS KRSH SMTH DMD PT BOTH ENDS TY F SS,$78.70,$0.00,$78.70,$42.73,$56.17,$0.00,$13.56,$0.00,$0.00,$13.78,$78.70,$0.00,$39.35,$62.33,$62.96,$0.00,$12.32,$0.00,$12.53,$0.00
128076,SUP,HCPCS C1713,,128076  -  PIN FX 1.9IN 9IN NS STNM 2 END DMD PT PLN TY A SS ORTH,$87.40,$0.00,$87.40,$39.33,$62.38,$0.00,$15.06,$0.00,$0.00,$15.30,$87.40,$0.00,$43.70,$69.22,$69.92,$0.00,$13.68,$0.00,$13.91,$0.00
128077,SUP,HCPCS C1713,,128077  -  PIN FX 1.9MM 9IN NS STNM SMTH TROC PNT 1 END CHK TY B SS,$87.40,$0.00,$87.40,$39.33,$62.38,$0.00,$15.06,$0.00,$0.00,$15.30,$87.40,$0.00,$43.70,$69.22,$69.92,$0.00,$13.68,$0.00,$13.91,$0.00
128078,SUP,HCPCS C1713,,128078  -  PIN FX 1.9MM 9IN NS STNM SMTH DMD PT 1 END CHK TY C SS ORTH,$87.40,$0.00,$87.40,$39.33,$62.38,$0.00,$15.06,$0.00,$0.00,$15.30,$87.40,$0.00,$43.70,$69.22,$69.92,$0.00,$13.68,$0.00,$13.91,$0.00
128079,SUP,HCPCS C1713,,128079  -  PIN FX 1.9MM 9IN NS STNM SMTH TROC PNT 1 END RND TY D SS,$87.40,$0.00,$87.40,$39.33,$62.38,$0.00,$15.06,$0.00,$0.00,$15.30,$87.40,$0.00,$43.70,$69.22,$69.92,$0.00,$13.68,$0.00,$13.91,$0.00
128080,SUP,HCPCS C1713,,128080  -  PIN FX 1.9IN 9IN NS STNM SMTH TY E SS ORTH,$87.40,$0.00,$87.40,$39.33,$62.38,$0.00,$15.06,$0.00,$0.00,$15.30,$87.40,$0.00,$43.70,$69.22,$69.92,$0.00,$13.68,$0.00,$13.91,$0.00
128081,SUP,HCPCS C1713,,128081  -  PIN FX 1.9IN 9IN NS STNM 2 END DMD PT TY F SS,$87.40,$0.00,$87.40,$39.33,$62.38,$0.00,$15.06,$0.00,$0.00,$15.30,$87.40,$0.00,$43.70,$69.22,$69.92,$0.00,$13.68,$0.00,$13.91,$0.00
128086,SUP,HCPCS C1713,,128086  -  PIN FX 2.3IN 9IN NS STNM A PLN SS ORTH,$95.00,$0.00,$95.00,$42.75,$67.80,$0.00,$16.37,$0.00,$0.00,$16.63,$95.00,$0.00,$47.50,$75.24,$76.00,$0.00,$14.87,$0.00,$15.12,$0.00
128087,SUP,HCPCS C1713,,128087  -  PIN FX 2.3MM 9IN NS STNM SMTH TROC PNT 1 END CHK TY B SS,$95.00,$0.00,$95.00,$42.75,$67.80,$0.00,$16.37,$0.00,$0.00,$16.63,$95.00,$0.00,$47.50,$75.24,$76.00,$0.00,$14.87,$0.00,$15.12,$0.00
128088,SUP,HCPCS C1713,,128088  -  PIN FX 2.3MM 9IN NS STNM SMTH DMD PT 1 END CHK TY C SS ORTH,$95.00,$0.00,$95.00,$42.75,$67.80,$0.00,$16.37,$0.00,$0.00,$16.63,$95.00,$0.00,$47.50,$75.24,$76.00,$0.00,$14.87,$0.00,$15.12,$0.00
128089,SUP,HCPCS C1713,,128089  -  PIN FX 3/32IN 9IN NS STNM TY D SS ORTH,$95.00,$0.00,$95.00,$42.75,$67.80,$0.00,$16.37,$0.00,$0.00,$16.63,$95.00,$0.00,$47.50,$75.24,$76.00,$0.00,$14.87,$0.00,$15.12,$0.00
128090,SUP,HCPCS C1713,,128090  -  PIN FX 2.3IN 9IN NS STNM SMTH TY E SS ORTH,$95.00,$0.00,$95.00,$42.75,$67.80,$0.00,$16.37,$0.00,$0.00,$16.63,$95.00,$0.00,$47.50,$75.24,$76.00,$0.00,$14.87,$0.00,$15.12,$0.00
128091,SUP,HCPCS C1713,,128091  -  PIN FX 2.3MM 9IN NS STNM 2 END DMD PT SMTH TY F SS,$95.00,$0.00,$95.00,$42.75,$67.80,$0.00,$16.37,$0.00,$0.00,$16.63,$95.00,$0.00,$47.50,$75.24,$76.00,$0.00,$14.87,$0.00,$15.12,$0.00
128097,SUP,HCPCS C1713,,128097  -  PIN FX 2.7MM 9IN NS STNM SMTH TROC PNT 1 END CHK TY B SS,$95.00,$0.00,$95.00,$42.75,$67.80,$0.00,$16.37,$0.00,$0.00,$16.63,$95.00,$0.00,$47.50,$75.24,$76.00,$0.00,$14.87,$0.00,$15.12,$0.00
128098,SUP,HCPCS C1713,,128098  -  PIN FX 2.7MM 9IN NS STNM SMTH DMD PT 1 END CHK TY C SS ORTH,$95.00,$0.00,$95.00,$42.75,$67.80,$0.00,$16.37,$0.00,$0.00,$16.63,$95.00,$0.00,$47.50,$75.24,$76.00,$0.00,$14.87,$0.00,$15.12,$0.00
128099,SUP,HCPCS C1713,,128099  -  PIN FX 2.7MM 9IN NS STNM SMTH TROC PNT 1 END RND TY D SS,$95.00,$0.00,$95.00,$42.75,$67.80,$0.00,$16.37,$0.00,$0.00,$16.63,$95.00,$0.00,$47.50,$75.24,$76.00,$0.00,$14.87,$0.00,$15.12,$0.00
128100,SUP,HCPCS C1713,,128100  -  PIN FX 2.7IN 9IN NS STNM SMTH DMD PT RND END TY E SS ORTH,$95.00,$0.00,$95.00,$42.75,$67.80,$0.00,$16.37,$0.00,$0.00,$16.63,$95.00,$0.00,$47.50,$75.24,$76.00,$0.00,$14.87,$0.00,$15.12,$0.00
128101,SUP,HCPCS C1713,,128101  -  PIN FX 7/64IN 9IN NS STNM SMTH DMD PT BOTH ENDS TY F SS,$95.00,$0.00,$95.00,$42.75,$67.80,$0.00,$16.37,$0.00,$0.00,$16.63,$95.00,$0.00,$47.50,$75.24,$76.00,$0.00,$14.87,$0.00,$15.12,$0.00
128106,SUP,HCPCS C1713,,128106  -  PIN FX 3.1IN 9IN NS STNM A PLN SS ORTH,$95.00,$0.00,$95.00,$42.75,$67.80,$0.00,$16.37,$0.00,$0.00,$16.63,$95.00,$0.00,$47.50,$75.24,$76.00,$0.00,$14.87,$0.00,$15.12,$0.00
128107,SUP,HCPCS C1713,,128107  -  PIN FX 3.1MM 9IN NS STNM SMTH TROC PNT 1 END CHK TY B SS,$102.70,$0.00,$102.70,$46.22,$73.30,$0.00,$17.69,$0.00,$0.00,$17.98,$102.70,$0.00,$51.35,$81.34,$82.16,$0.00,$16.07,$0.00,$16.35,$0.00
128108,SUP,HCPCS C1713,,128108  -  PIN FX 3.1MM 9IN NS STNM SMTH DMD PT 1 END CHK TY C SS ORTH,$102.70,$0.00,$102.70,$46.22,$73.30,$0.00,$17.69,$0.00,$0.00,$17.98,$102.70,$0.00,$51.35,$81.34,$82.16,$0.00,$16.07,$0.00,$16.35,$0.00
128109,SUP,HCPCS C1713,,128109  -  PIN FX 3.1IN 9IN NS STNM PLN PNT TY D TROC RND END SS,$102.70,$0.00,$102.70,$46.22,$73.30,$0.00,$17.69,$0.00,$0.00,$17.98,$102.70,$0.00,$51.35,$81.34,$82.16,$0.00,$16.07,$0.00,$16.35,$0.00
128110,SUP,HCPCS C1713,,128110  -  PIN FX 3.1IN 9IN NS STNM SMTH TY E SS ORTH,$102.70,$0.00,$102.70,$46.22,$73.30,$0.00,$17.69,$0.00,$0.00,$17.98,$102.70,$0.00,$51.35,$81.34,$82.16,$0.00,$16.07,$0.00,$16.35,$0.00
128111,SUP,HCPCS C1713,,128111  -  PIN FX 3.1IN 9IN NS STNM F PLN SS,$102.70,$0.00,$102.70,$46.22,$73.30,$0.00,$17.69,$0.00,$0.00,$17.98,$102.70,$0.00,$51.35,$81.34,$82.16,$0.00,$16.07,$0.00,$16.35,$0.00
128116,SUP,HCPCS C1713,,128116  -  PIN FX 3.5IN 9IN NS STNM A PLN SS ORTH,$111.00,$0.00,$111.00,$49.95,$79.22,$0.00,$19.12,$0.00,$0.00,$19.44,$111.00,$0.00,$55.50,$87.91,$88.80,$0.00,$17.37,$0.00,$17.67,$0.00
128117,SUP,HCPCS C1713,,128117  -  PIN FX 3.5IN 9IN NS STNM PLN PNT TY A SS,$111.00,$0.00,$111.00,$49.95,$79.22,$0.00,$19.12,$0.00,$0.00,$19.44,$111.00,$0.00,$55.50,$87.91,$88.80,$0.00,$17.37,$0.00,$17.67,$0.00
128118,SUP,HCPCS C1713,,128118  -  PIN FX 3.5MM 9IN NS STNM SMTH DMD PT 1 END CHK TY C SS ORTH,$111.00,$0.00,$111.00,$49.95,$79.22,$0.00,$19.12,$0.00,$0.00,$19.44,$111.00,$0.00,$55.50,$87.91,$88.80,$0.00,$17.37,$0.00,$17.67,$0.00
128119,SUP,HCPCS C1713,,128119  -  PIN FX 3.5IN 9IN NS STNM PLN PNT TY D TROC RND END SS,$111.00,$0.00,$111.00,$49.95,$79.22,$0.00,$19.12,$0.00,$0.00,$19.44,$111.00,$0.00,$55.50,$87.91,$88.80,$0.00,$17.37,$0.00,$17.67,$0.00
128120,SUP,HCPCS C1713,,128120  -  PIN FX 3.5MM 9IN NS STNM SMTH DMD PT 1 END RND TY E SS ORTH,$111.00,$0.00,$111.00,$49.95,$79.22,$0.00,$19.12,$0.00,$0.00,$19.44,$111.00,$0.00,$55.50,$87.91,$88.80,$0.00,$17.37,$0.00,$17.67,$0.00
128121,SUP,HCPCS C1713,,128121  -  PIN FX 3.5IN 9IN NS STNM F PLN SS,$111.00,$0.00,$111.00,$49.95,$79.22,$0.00,$19.12,$0.00,$0.00,$19.44,$111.00,$0.00,$55.50,$87.91,$88.80,$0.00,$17.37,$0.00,$17.67,$0.00
128126,SUP,HCPCS C1713,,128126  -  PIN FX 3.9IN 9IN NS STNM A PLN SS ORTH,$124.00,$0.00,$124.00,$55.80,$88.50,$0.00,$21.36,$0.00,$0.00,$21.71,$124.00,$0.00,$62.00,$98.21,$99.20,$0.00,$19.41,$0.00,$19.74,$0.00
128127,SUP,HCPCS C1713,,128127  -  PIN FX 3.9MM 9IN NS STNM SMTH TROC PNT 1 END CHK TY B SS,$124.00,$0.00,$124.00,$55.80,$88.50,$0.00,$21.36,$0.00,$0.00,$21.71,$124.00,$0.00,$62.00,$98.21,$99.20,$0.00,$19.41,$0.00,$19.74,$0.00
128128,SUP,HCPCS C1713,,128128  -  PIN FX 3.9MM 9IN NS STNM SMTH DMD PT 1 END CHK TY C SS ORTH,$124.00,$0.00,$124.00,$55.80,$88.50,$0.00,$21.36,$0.00,$0.00,$21.71,$124.00,$0.00,$62.00,$98.21,$99.20,$0.00,$19.41,$0.00,$19.74,$0.00
128129,SUP,HCPCS C1713,,128129  -  PIN FX 5/32IN 9IN NS STNM TY D SS ORTH,$124.00,$0.00,$124.00,$55.80,$88.50,$0.00,$21.36,$0.00,$0.00,$21.71,$124.00,$0.00,$62.00,$98.21,$99.20,$0.00,$19.41,$0.00,$19.74,$0.00
128130,SUP,HCPCS C1713,,128130  -  PIN FX 3.9MM 9IN NS STNM SMTH DMD PT 1 END RND TY E SS ORTH,$124.00,$0.00,$124.00,$55.80,$88.50,$0.00,$21.36,$0.00,$0.00,$21.71,$124.00,$0.00,$62.00,$98.21,$99.20,$0.00,$19.41,$0.00,$19.74,$0.00
128131,SUP,HCPCS C1713,,128131  -  PIN FX 3.9IN 9IN NS STNM F PLN SS,$124.00,$0.00,$124.00,$55.80,$88.50,$0.00,$21.36,$0.00,$0.00,$21.71,$124.00,$0.00,$62.00,$98.21,$99.20,$0.00,$19.41,$0.00,$19.74,$0.00
128136,SUP,HCPCS C1713,,128136  -  PIN FX 4.7IN 9IN NS STNM PLN TY A SS ORTH,$124.00,$0.00,$124.00,$55.80,$88.50,$0.00,$21.36,$0.00,$0.00,$21.71,$124.00,$0.00,$62.00,$98.21,$99.20,$0.00,$19.41,$0.00,$19.74,$0.00
128137,SUP,HCPCS C1713,,128137  -  PIN FX 4.7IN 9IN NS STNM SMTH TROC PNT 1 END TY B SS ORTH,$124.00,$0.00,$124.00,$55.80,$88.50,$0.00,$21.36,$0.00,$0.00,$21.71,$124.00,$0.00,$62.00,$98.21,$99.20,$0.00,$19.41,$0.00,$19.74,$0.00
128138,SUP,HCPCS C1713,,128138  -  PIN FX 4.7MM 9IN NS STNM SMTH DMD PT 1 END CHK TY C SS ORTH,$124.00,$0.00,$124.00,$55.80,$88.50,$0.00,$21.36,$0.00,$0.00,$21.71,$124.00,$0.00,$62.00,$98.21,$99.20,$0.00,$19.41,$0.00,$19.74,$0.00
128139,SUP,HCPCS C1713,,128139  -  PIN FX 4.7MM 9IN NS STNM SMTH TROC PNT 1 END RND TY D SS,$124.00,$0.00,$124.00,$55.80,$88.50,$0.00,$21.36,$0.00,$0.00,$21.71,$124.00,$0.00,$62.00,$98.21,$99.20,$0.00,$19.41,$0.00,$19.74,$0.00
128140,SUP,HCPCS C1713,,128140  -  PIN FX 4.7IN 9IN NS STNM SMTH DMD PT BOTH ENDS TY E SS ORTH,$124.00,$0.00,$124.00,$55.80,$88.50,$0.00,$21.36,$0.00,$0.00,$21.71,$124.00,$0.00,$62.00,$98.21,$99.20,$0.00,$19.41,$0.00,$19.74,$0.00
128141,SUP,HCPCS C1713,,128141  -  PIN FX 4.7IN 9IN NS STNM F PLN SS,$124.00,$0.00,$124.00,$55.80,$88.50,$0.00,$21.36,$0.00,$0.00,$21.71,$124.00,$0.00,$62.00,$98.21,$99.20,$0.00,$19.41,$0.00,$19.74,$0.00
128146,SUP,HCPCS C1713,,128146  -  PIN FX 1.14MM 5IN SWNSN SS FNGR XTRNFX SYS,$76.00,$0.00,$76.00,$34.20,$54.24,$0.00,$13.09,$0.00,$0.00,$13.31,$76.00,$0.00,$38.00,$60.19,$60.80,$0.00,$11.89,$0.00,$12.10,$0.00
128162,SUP,HCPCS C1713,,128162  -  PIN FX 5/32IN 11.5IN THRD ORTH K-DONK,$452.20,$0.00,$452.20,$203.49,$322.74,$0.00,$77.91,$0.00,$0.00,$79.18,$452.20,$0.00,$226.10,$358.14,$361.76,$0.00,$70.77,$0.00,$71.99,$0.00
128175,SUP,HCPCS C1713,,128175  -  PIN FX TROC PNT 1 END ORTH K-DONK,$452.20,$0.00,$452.20,$203.49,$322.74,$0.00,$77.91,$0.00,$0.00,$79.18,$452.20,$0.00,$226.10,$358.14,$361.76,$0.00,$70.77,$0.00,$71.99,$0.00
128177,SUP,HCPCS C1713,,128177  -  PIN FX 7/64IN 9IN TROC PNT 1 END ORTH K-DONK,$598.40,$0.00,$598.40,$269.28,$427.08,$0.00,$103.10,$0.00,$0.00,$104.78,$598.40,$0.00,$299.20,$473.93,$478.72,$0.00,$93.65,$0.00,$95.27,$0.00
128307,SUP,HCPCS C1713,,128307  -  PIN FX .15IN 2.25IN KNWL SS ORTH,$418.95,$0.00,$418.95,$188.53,$299.00,$0.00,$72.18,$0.00,$0.00,$73.35,$418.95,$0.00,$209.48,$331.81,$335.16,$0.00,$65.57,$0.00,$66.70,$0.00
128310,SUP,HCPCS C1713,,128310  -  PIN FX 5/32IN 3IN KNWL SS,$418.95,$0.00,$418.95,$188.53,$299.00,$0.00,$72.18,$0.00,$0.00,$73.35,$418.95,$0.00,$209.48,$331.81,$335.16,$0.00,$65.57,$0.00,$66.70,$0.00
128314,SUP,HCPCS C1713,,128314  -  PIN FX 5/32IN 4IN KNWL SS,$418.95,$0.00,$418.95,$188.53,$299.00,$0.00,$72.18,$0.00,$0.00,$73.35,$418.95,$0.00,$209.48,$331.81,$335.16,$0.00,$65.57,$0.00,$66.70,$0.00
128408,SUP,HCPCS C1713,,128408  -  PIN FX 5/32IN 6IN 1.5IN HAGIE ORTH,$319.20,$0.00,$319.20,$143.64,$227.81,$0.00,$55.00,$0.00,$0.00,$55.89,$319.20,$0.00,$159.60,$252.81,$255.36,$0.00,$49.95,$0.00,$50.82,$0.00
128416,SUP,HCPCS C1713,,128416  -  PIN FX 3/16IN 6IN 1.25IN HAGIE ORTH,$319.20,$0.00,$319.20,$143.64,$227.81,$0.00,$55.00,$0.00,$0.00,$55.89,$319.20,$0.00,$159.60,$252.81,$255.36,$0.00,$49.95,$0.00,$50.82,$0.00
128418,SUP,HCPCS C1713,,128418  -  PIN FX 3/16IN 6IN 1.5IN HAGIE ORTH,$319.20,$0.00,$319.20,$143.64,$227.81,$0.00,$55.00,$0.00,$0.00,$55.89,$319.20,$0.00,$159.60,$252.81,$255.36,$0.00,$49.95,$0.00,$50.82,$0.00
128436,SUP,HCPCS C1713,,128436  -  PIN FX .25IN 6IN 1.25IN HAGIE ORTH,$319.20,$0.00,$319.20,$143.64,$227.81,$0.00,$55.00,$0.00,$0.00,$55.89,$319.20,$0.00,$159.60,$252.81,$255.36,$0.00,$49.95,$0.00,$50.82,$0.00
128518,SUP,HCPCS C1713,,128518  -  PIN FX .89MM 2IN STRL INSTR ORTH XTRNFX SYS,$124.00,$0.00,$124.00,$55.80,$88.50,$0.00,$21.36,$0.00,$0.00,$21.71,$124.00,$0.00,$62.00,$98.21,$99.20,$0.00,$19.41,$0.00,$19.74,$0.00
128520,SUP,HCPCS C1713,,128520  -  PIN FX 1.1MM 2IN STRL INSTR ORTH XTRNFX SYS,$102.70,$0.00,$102.70,$46.22,$73.30,$0.00,$17.69,$0.00,$0.00,$17.98,$102.70,$0.00,$51.35,$81.34,$82.16,$0.00,$16.07,$0.00,$16.35,$0.00
128522,SUP,HCPCS C1713,,128522  -  PIN FX 1.5MM 2IN STRL INSTR ORTH XTRNFX SYS,$124.00,$0.00,$124.00,$55.80,$88.50,$0.00,$21.36,$0.00,$0.00,$21.71,$124.00,$0.00,$62.00,$98.21,$99.20,$0.00,$19.41,$0.00,$19.74,$0.00
128551,SUP,HCPCS C1713,,128551  -  PIN FX .062IN 5.8IN SML SS ORTH,$149.00,$0.00,$149.00,$67.05,$106.34,$0.00,$25.67,$0.00,$0.00,$26.09,$149.00,$0.00,$74.50,$118.01,$119.20,$0.00,$23.32,$0.00,$23.72,$0.00
128552,SUP,HCPCS C1713,,128552  -  PIN FX .062IN 7.8IN SML SS ORTH,$119.00,$0.00,$119.00,$53.55,$84.93,$0.00,$20.50,$0.00,$0.00,$20.84,$119.00,$0.00,$59.50,$94.25,$95.20,$0.00,$18.62,$0.00,$18.94,$0.00
128553,SUP,HCPCS C1713,,128553  -  PIN FX .062IN 1IN SML SS ORTH,$119.00,$0.00,$119.00,$53.55,$84.93,$0.00,$20.50,$0.00,$0.00,$20.84,$119.00,$0.00,$59.50,$94.25,$95.20,$0.00,$18.62,$0.00,$18.94,$0.00
128555,SUP,HCPCS C1713,,128555  -  PIN FX .062IN 1.25IN SML SS ORTH,$119.00,$0.00,$119.00,$53.55,$84.93,$0.00,$20.50,$0.00,$0.00,$20.84,$119.00,$0.00,$59.50,$94.25,$95.20,$0.00,$18.62,$0.00,$18.94,$0.00
128607,SUP,HCPCS C1713,,128607  -  STAPLE BN 12MM 12MM KRCKW HTO OFST COCR TIB LAT BLDE,$852.60,$0.00,$852.60,$383.67,$608.50,$0.00,$146.90,$0.00,$0.00,$149.28,$852.60,$0.00,$426.30,$675.26,$682.08,$0.00,$133.43,$0.00,$135.73,$0.00
128608,SUP,HCPCS C1713,,128608  -  STAPLE BN 14MM 14MM KRCKW HTO OFST COCR TIB LAT BLDE,$852.60,$0.00,$852.60,$383.67,$608.50,$0.00,$146.90,$0.00,$0.00,$149.28,$852.60,$0.00,$426.30,$675.26,$682.08,$0.00,$133.43,$0.00,$135.73,$0.00
128609,SUP,HCPCS C1713,,128609  -  STAPLE BN 16MM 16MM KRCKW HTO OFST COCR TIB LAT BLDE,$852.60,$0.00,$852.60,$383.67,$608.50,$0.00,$146.90,$0.00,$0.00,$149.28,$852.60,$0.00,$426.30,$675.26,$682.08,$0.00,$133.43,$0.00,$135.73,$0.00
128610,SUP,HCPCS C1713,,128610  -  STAPLE BN 25X25MM BLK KRCKW HTO COCR TIB MDL MEDAL,$852.60,$0.00,$852.60,$383.67,$608.50,$0.00,$146.90,$0.00,$0.00,$149.28,$852.60,$0.00,$426.30,$675.26,$682.08,$0.00,$133.43,$0.00,$135.73,$0.00
128673,SUP,HCPCS C1713,,128673  -  STAPLE BN 5MM OFST 26.5X23MM FX COCR OSTM,$680.40,$0.00,$680.40,$306.18,$485.60,$0.00,$117.23,$0.00,$0.00,$119.13,$680.40,$0.00,$340.20,$538.88,$544.32,$0.00,$106.48,$0.00,$108.32,$0.00
128674,SUP,HCPCS C1713,,128674  -  STAPLE BN 10MM 21.5X23MM FX OFST COCR ORTH OSTM,$680.40,$0.00,$680.40,$306.18,$485.60,$0.00,$117.23,$0.00,$0.00,$119.13,$680.40,$0.00,$340.20,$538.88,$544.32,$0.00,$106.48,$0.00,$108.32,$0.00
128675,SUP,HCPCS C1713,,128675  -  STAPLE BN 14MM 17.5X23MM FX COCR ORTH OSTM,$680.40,$0.00,$680.40,$306.18,$485.60,$0.00,$117.23,$0.00,$0.00,$119.13,$680.40,$0.00,$340.20,$538.88,$544.32,$0.00,$106.48,$0.00,$108.32,$0.00
128690,SUP,HCPCS C1713,,128690  -  STAPLE BN XS 23.22X6.35MM SPK FX COCR,$507.15,$0.00,$507.15,$228.22,$361.95,$0.00,$87.38,$0.00,$0.00,$88.80,$507.15,$0.00,$253.58,$401.66,$405.72,$0.00,$79.37,$0.00,$80.74,$0.00
128691,SUP,HCPCS C1713,,128691  -  STAPLE BN XS 23.22X6.35MM WO SPK COCR ORTH,$507.15,$0.00,$507.15,$228.22,$361.95,$0.00,$87.38,$0.00,$0.00,$88.80,$507.15,$0.00,$253.58,$401.66,$405.72,$0.00,$79.37,$0.00,$80.74,$0.00
128692,SUP,HCPCS C1713,,128692  -  STAPLE BN SM SPK 23X12MM FX COCR,$507.15,$0.00,$507.15,$228.22,$361.95,$0.00,$87.38,$0.00,$0.00,$88.80,$507.15,$0.00,$253.58,$401.66,$405.72,$0.00,$79.37,$0.00,$80.74,$0.00
128693,SUP,HCPCS C1713,,128693  -  STAPLE BN SM REG 23.22X7.94MM FX COCR OSTM,$507.15,$0.00,$507.15,$228.22,$361.95,$0.00,$87.38,$0.00,$0.00,$88.80,$507.15,$0.00,$253.58,$401.66,$405.72,$0.00,$79.37,$0.00,$80.74,$0.00
128695,SUP,HCPCS C1713,,128695  -  STAPLE BN MED 23.22X11.11MM SPK COCR ORTH,$507.15,$0.00,$507.15,$228.22,$361.95,$0.00,$87.38,$0.00,$0.00,$88.80,$507.15,$0.00,$253.58,$401.66,$405.72,$0.00,$79.37,$0.00,$80.74,$0.00
128696,SUP,HCPCS C1713,,128696  -  STAPLE BN LG REG 23.22X14.29MM SPK COCR ORTH OSTM,$507.15,$0.00,$507.15,$228.22,$361.95,$0.00,$87.38,$0.00,$0.00,$88.80,$507.15,$0.00,$253.58,$401.66,$405.72,$0.00,$79.37,$0.00,$80.74,$0.00
128697,SUP,HCPCS C1713,,128697  -  STAPLE BN LG 23.22X14.29MM FX COCR OSTM,$507.15,$0.00,$507.15,$228.22,$361.95,$0.00,$87.38,$0.00,$0.00,$88.80,$507.15,$0.00,$253.58,$401.66,$405.72,$0.00,$79.37,$0.00,$80.74,$0.00
128698,SUP,HCPCS C1713,,128698  -  STAPLE BN SM 16X13MM TBL FX COCR,$655.20,$0.00,$655.20,$294.84,$467.62,$0.00,$112.89,$0.00,$0.00,$114.72,$655.20,$0.00,$327.60,$518.92,$524.16,$0.00,$102.54,$0.00,$104.31,$0.00
128699,SUP,HCPCS C1713,,128699  -  STAPLE BN 16 MED 22X16MM TBL FX RTRCT COCR ORTH,$655.20,$0.00,$655.20,$294.84,$467.62,$0.00,$112.89,$0.00,$0.00,$114.72,$655.20,$0.00,$327.60,$518.92,$524.16,$0.00,$102.54,$0.00,$104.31,$0.00
128720,SUP,HCPCS C1713,,128720  -  STAPLE BN XS 15X6.35MM FX SPK SHRT LG COCR,$507.15,$0.00,$507.15,$228.22,$361.95,$0.00,$87.38,$0.00,$0.00,$88.80,$507.15,$0.00,$253.58,$401.66,$405.72,$0.00,$79.37,$0.00,$80.74,$0.00
128721,SUP,HCPCS C1713,,128721  -  STAPLE BN XS 15X6.35MM WO SPK SHRT LG COCR ORTH,$507.15,$0.00,$507.15,$228.22,$361.95,$0.00,$87.38,$0.00,$0.00,$88.80,$507.15,$0.00,$253.58,$401.66,$405.72,$0.00,$79.37,$0.00,$80.74,$0.00
128722,SUP,HCPCS C1713,,128722  -  STAPLE BN SM 15X7.94MM SPK SHRT LG FX COCR,$507.15,$0.00,$507.15,$228.22,$361.95,$0.00,$87.38,$0.00,$0.00,$88.80,$507.15,$0.00,$253.58,$401.66,$405.72,$0.00,$79.37,$0.00,$80.74,$0.00
128723,SUP,HCPCS C1713,,128723  -  STAPLE BN SM 15X7.94MM WO SPK SHRT LG COCR ORTH,$507.15,$0.00,$507.15,$228.22,$361.95,$0.00,$87.38,$0.00,$0.00,$88.80,$507.15,$0.00,$253.58,$401.66,$405.72,$0.00,$79.37,$0.00,$80.74,$0.00
128724,SUP,HCPCS C1713,,128724  -  STAPLE BN MED 15X11.11MM SPK SHRT LG FX COCR,$507.15,$0.00,$507.15,$228.22,$361.95,$0.00,$87.38,$0.00,$0.00,$88.80,$507.15,$0.00,$253.58,$401.66,$405.72,$0.00,$79.37,$0.00,$80.74,$0.00
128725,SUP,HCPCS C1713,,128725  -  STAPLE BN MED 15X11.11MM WO SPK SHRT LG COCR ORTH,$507.15,$0.00,$507.15,$228.22,$361.95,$0.00,$87.38,$0.00,$0.00,$88.80,$507.15,$0.00,$253.58,$401.66,$405.72,$0.00,$79.37,$0.00,$80.74,$0.00
128726,SUP,HCPCS C1713,,128726  -  STAPLE BN LG 15X14.29MM SPK SHRT LG FX COCR,$507.15,$0.00,$507.15,$228.22,$361.95,$0.00,$87.38,$0.00,$0.00,$88.80,$507.15,$0.00,$253.58,$401.66,$405.72,$0.00,$79.37,$0.00,$80.74,$0.00
128727,SUP,HCPCS C1713,,128727  -  STAPLE BN LG 15X14.29MM WO SPK SHRT LG COCR ORTH,$507.15,$0.00,$507.15,$228.22,$361.95,$0.00,$87.38,$0.00,$0.00,$88.80,$507.15,$0.00,$253.58,$401.66,$405.72,$0.00,$79.37,$0.00,$80.74,$0.00
131710,SUP,HCPCS Q4130,,131710  -  DRESSING BIO 48X3IN EZ DERM MSH PRFR PRCN XENOGRAFT,$973.95,$0.00,$973.95,$0.00,$695.10,$0.00,$0.00,$0.00,$0.00,$0.00,$973.95,$0.00,$486.97,$771.37,$779.16,$0.00,$0.00,$0.00,$0.00,$0.00
140100,SUP,Custom 27203010,,KIT IMMUN TST AGLT SYS CRPTCOC NFRMNS AG LTX,$950.70,$0.00,$950.70,$0.00,$678.51,$0.00,$0.00,$0.00,$0.00,$0.00,$950.70,$0.00,$475.35,$752.95,$760.56,$0.00,$0.00,$0.00,$0.00,$0.00
143080,SUP,HCPCS C1713,,143080  -  PIN FX 3.2MM 80MM STRL,$302.50,$0.00,$302.50,$136.13,$215.89,$0.00,$52.12,$0.00,$0.00,$52.97,$302.50,$0.00,$151.25,$239.58,$242.00,$0.00,$47.34,$0.00,$48.16,$0.00
143090,SUP,HCPCS C1713,,143090  -  PIN FX 3.2MM 90MM STRL PRM KN,$302.50,$0.00,$302.50,$136.13,$215.89,$0.00,$52.12,$0.00,$0.00,$52.97,$302.50,$0.00,$151.25,$239.58,$242.00,$0.00,$47.34,$0.00,$48.16,$0.00
143100,SUP,HCPCS C1713,,143100  -  PIN FX 3.2MM 100MM STRL PRM KN,$302.50,$0.00,$302.50,$136.13,$215.89,$0.00,$52.12,$0.00,$0.00,$52.97,$302.50,$0.00,$151.25,$239.58,$242.00,$0.00,$47.34,$0.00,$48.16,$0.00
143110,SUP,HCPCS C1713,,143110  -  PIN FX 3.2MM 110MM STRL,$302.50,$0.00,$302.50,$136.13,$215.89,$0.00,$52.12,$0.00,$0.00,$52.97,$302.50,$0.00,$151.25,$239.58,$242.00,$0.00,$47.34,$0.00,$48.16,$0.00
143120,SUP,HCPCS C1713,,143120  -  PIN FX 3.2MM 120MM STRL PRM KN,$302.50,$0.00,"$1,352.93",$0.00,$965.59,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,352.93",$0.00,$676.47,$239.58,"$1,082.34",$0.00,$0.00,$0.00,$48.16,$0.00
143130,SUP,HCPCS C1713,,143130  -  PIN FX 3.2MM 130MM STRL PRM KN,$302.50,$0.00,$302.50,$136.13,$215.89,$0.00,$52.12,$0.00,$0.00,$52.97,$302.50,$0.00,$151.25,$239.58,$242.00,$0.00,$47.34,$0.00,$48.16,$0.00
143140,SUP,HCPCS C1713,,143140  -  PIN FX 3.2MM 140MM STRL,$302.50,$0.00,$239.58,$0.00,$15.70,$0.00,$0.00,$0.00,$0.00,$0.00,$22.00,$0.00,$11.00,$239.58,$17.60,$0.00,$0.00,$0.00,$0.00,$0.00
144080,SUP,HCPCS C1713,,144080  -  PIN FX 4MM 80MM NS KN,$302.50,$0.00,$302.50,$136.13,$215.89,$0.00,$52.12,$0.00,$0.00,$52.97,$302.50,$0.00,$151.25,$239.58,$242.00,$0.00,$47.34,$0.00,$48.16,$0.00
144090,SUP,HCPCS C1713,,144090  -  PIN FX 4MM 90MM STRL PRM KN,$302.50,$0.00,$302.50,$136.13,$215.89,$0.00,$52.12,$0.00,$0.00,$52.97,$302.50,$0.00,$151.25,$239.58,$242.00,$0.00,$47.34,$0.00,$48.16,$0.00
144100,SUP,HCPCS C1713,,144100  -  PIN FX 4MM 100MM STRL PRM KN,$302.50,$0.00,$302.50,$136.13,$215.89,$0.00,$52.12,$0.00,$0.00,$52.97,$302.50,$0.00,$151.25,$239.58,$242.00,$0.00,$47.34,$0.00,$48.16,$0.00
144110,SUP,HCPCS C1713,,144110  -  PIN FX 4MM 110MM STRL,$302.50,$0.00,$302.50,$136.13,$215.89,$0.00,$52.12,$0.00,$0.00,$52.97,$302.50,$0.00,$151.25,$239.58,$242.00,$0.00,$47.34,$0.00,$48.16,$0.00
144120,SUP,HCPCS C1713,,144120  -  PIN FX 4MM 1200MM STRL PRM KN,$302.50,$0.00,$302.50,$136.13,$215.89,$0.00,$52.12,$0.00,$0.00,$52.97,$302.50,$0.00,$151.25,$239.58,$242.00,$0.00,$47.34,$0.00,$48.16,$0.00
144130,SUP,HCPCS C1713,,144130  -  PIN FX 4MM 130MM STRL PRM KN,$302.50,$0.00,$302.50,$136.13,$215.89,$0.00,$52.12,$0.00,$0.00,$52.97,$302.50,$0.00,$151.25,$239.58,$242.00,$0.00,$47.34,$0.00,$48.16,$0.00
144140,SUP,HCPCS C1713,,144140  -  PIN FX 4MM 140MM STRL KN,$302.50,$0.00,$302.50,$136.13,$215.89,$0.00,$52.12,$0.00,$0.00,$52.97,$302.50,$0.00,$151.25,$239.58,$242.00,$0.00,$47.34,$0.00,$48.16,$0.00
144150,SUP,HCPCS C1713,,144150  -  PIN FX 4MM 150MM STRL PRM KN,$302.50,$0.00,$302.50,$136.13,$215.89,$0.00,$52.12,$0.00,$0.00,$52.97,$302.50,$0.00,$151.25,$239.58,$242.00,$0.00,$47.34,$0.00,$48.16,$0.00
144160,SUP,HCPCS C1713,,144160  -  PIN FX 4MM 160MM STRL PRM KN,$302.50,$0.00,$302.50,$136.13,$215.89,$0.00,$52.12,$0.00,$0.00,$52.97,$302.50,$0.00,$151.25,$239.58,$242.00,$0.00,$47.34,$0.00,$48.16,$0.00
144170,SUP,HCPCS C1713,,144170  -  PIN FX 4MM 170MM STRL KN,$302.50,$0.00,$302.50,$136.13,$215.89,$0.00,$52.12,$0.00,$0.00,$52.97,$302.50,$0.00,$151.25,$239.58,$242.00,$0.00,$47.34,$0.00,$48.16,$0.00
151435,SUP,Custom 27203010,,RETAINER TBGRP A 33FTX1.5IN NTR ELAST TBLR DRSG LTX,$40.13,$0.00,$40.13,$0.00,$28.64,$0.00,$0.00,$0.00,$0.00,$0.00,$40.13,$0.00,$20.06,$31.78,$32.10,$0.00,$0.00,$0.00,$0.00,$0.00
151436,SUP,Custom 27203010,,151436  -  RETAINER TBGRP B 33FTX2.5IN NTR ELAST TBLR DRSG LF,$52.92,$0.00,$52.92,$0.00,$37.77,$0.00,$0.00,$0.00,$0.00,$0.00,$52.92,$0.00,$26.46,$41.91,$42.33,$0.00,$0.00,$0.00,$0.00,$0.00
151437,SUP,Custom 27203010,,151437  -  RETAINER DRSG D 33FTX3IN NTR LF TBGRP ELC TBLR,$73.13,$0.00,$73.13,$0.00,$52.19,$0.00,$0.00,$0.00,$0.00,$0.00,$73.13,$0.00,$36.57,$57.92,$58.50,$0.00,$0.00,$0.00,$0.00,$0.00
151440,SUP,Custom 27203010,,151440  -  RETAINER TBGRP J 33FTX6.75IN NTR ELAST TBLR DRSG LTX,$55.61,$0.00,$55.61,$0.00,$39.69,$0.00,$0.00,$0.00,$0.00,$0.00,$55.61,$0.00,$27.80,$44.04,$44.48,$0.00,$0.00,$0.00,$0.00,$0.00
151442,SUP,Custom 27203010,,151442  -  RTNR TBGRP LG 10MR NTR ELAST TBLR DRSG LATEX,$605.00,$0.00,$605.00,$0.00,$431.79,$0.00,$0.00,$0.00,$0.00,$0.00,$605.00,$0.00,$302.50,$479.16,$484.00,$0.00,$0.00,$0.00,$0.00,$0.00
160821,SUP,Custom 27203010,,160821  -  BURR SURG MICRO 14 FLUTE BARREL .24IN 2.13IN .41IN STAINLESS,$137.50,$0.00,$137.50,$0.00,$98.13,$0.00,$0.00,$0.00,$0.00,$0.00,$137.50,$0.00,$68.75,$108.90,$110.00,$0.00,$0.00,$0.00,$0.00,$0.00
163663,SUP,HCPCS C1776,,163663  -  HEAD FEMORAL +3MM 28MM MODULAR TYPE 1 COCR HIP,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
165808,SUP,Custom 27203010,,165808  -  CATHETER URETHRAL 8FR 2 WAY FOLEY LATEX FREE BARD SILICONE 3,$8.13,$0.00,$8.13,$0.00,$5.80,$0.00,$0.00,$0.00,$0.00,$0.00,$8.13,$0.00,$4.06,$6.44,$6.50,$0.00,$0.00,$0.00,$0.00,$0.00
165810,SUP,Custom 27203010,,165810  -  CATHETER URETHRAL 10FR 2 WAY FOLEY LATEX FREE BARD SILICONE,$8.13,$0.00,$8.13,$0.00,$5.80,$0.00,$0.00,$0.00,$0.00,$0.00,$8.13,$0.00,$4.06,$6.44,$6.50,$0.00,$0.00,$0.00,$0.00,$0.00
165814,SUP,Custom 27203010,,165814  -  CATHETER URTH 14FR 5CC STRL LF BARD 2W FL BLN UNCOAT SIL,$7.83,$0.00,$7.83,$0.00,$5.58,$0.00,$0.00,$0.00,$0.00,$0.00,$7.83,$0.00,$3.91,$6.20,$6.26,$0.00,$0.00,$0.00,$0.00,$0.00
165816,SUP,Custom 27203010,,165816  -  CATHETER URTH 16FR 5CC STRL LF BARD 2W FL BLN UNCOAT SIL,$7.83,$0.00,$7.83,$0.00,$5.58,$0.00,$0.00,$0.00,$0.00,$0.00,$7.83,$0.00,$3.91,$6.20,$6.26,$0.00,$0.00,$0.00,$0.00,$0.00
165818,SUP,Custom 27203010,,165818  -  CATHETER URTH 18FR 5CC STRL LF BARD 2W FL BLN UNCOAT SIL,$7.83,$0.00,$7.83,$0.00,$5.58,$0.00,$0.00,$0.00,$0.00,$0.00,$7.83,$0.00,$3.91,$6.20,$6.26,$0.00,$0.00,$0.00,$0.00,$0.00
165822,SUP,Custom 27203010,,165822  -  CATHETER URETHRAL 22FR 2 WAY FOLEY LATEX FREE BARD SILICONE,$7.83,$0.00,$7.83,$0.00,$5.58,$0.00,$0.00,$0.00,$0.00,$0.00,$7.83,$0.00,$3.91,$6.20,$6.26,$0.00,$0.00,$0.00,$0.00,$0.00
170057,SUP,Custom 27803010,,170057  -  RELOAD SUT AS 2-0 ES-9 48IN UD E STCH PLSRB 1 STCH LACTOMER,$620.10,$0.00,$620.10,$0.00,$442.57,$0.00,$0.00,$0.00,$0.00,$0.00,$620.10,$0.00,$310.05,$491.12,$496.08,$0.00,$0.00,$0.00,$0.00,$0.00
173016,SUP,Custom 27203010,,173016  -  DEVICE SUTURING 10MM 15IN PUSH BUTTON GRIP HANDLE LATEX FREE,$288.67,$0.00,$288.67,$0.00,$206.02,$0.00,$0.00,$0.00,$0.00,$0.00,$288.67,$0.00,$144.33,$228.63,$230.93,$0.00,$0.00,$0.00,$0.00,$0.00
173019,SUP,Custom 27203010,,173019  -  RETRACTOR LAPSCOP STANDARD LENGTH 5MM 45CM TROCAR ADAPTER,$51.18,$0.00,$51.18,$0.00,$36.53,$0.00,$0.00,$0.00,$0.00,$0.00,$51.18,$0.00,$25.59,$40.53,$40.95,$0.00,$0.00,$0.00,$0.00,$0.00
174001,SUP,Custom 27203010,,174001  -  CLAMP LAPSCP STD 10MM 31CM GRN STRL E-BBCK ON OFF SWH RCHT,$176.91,$0.00,$176.91,$0.00,$126.26,$0.00,$0.00,$0.00,$0.00,$0.00,$176.91,$0.00,$88.46,$140.11,$141.53,$0.00,$0.00,$0.00,$0.00,$0.00
174006,SUP,Custom 27203010,,174006  -  STAPLER INTERNAL 35.5X5MM 30 HELICAL FASTENER LATEX FREE,$593.72,$0.00,$593.72,$0.00,$423.74,$0.00,$0.00,$0.00,$0.00,$0.00,$593.72,$0.00,$296.86,$470.23,$474.98,$0.00,$0.00,$0.00,$0.00,$0.00
175424,SUP,HCPCS C1768,,175424  -  GRAFT CV 24MM 30CM HMSH PL WVN STRG,"$1,236.58",$0.00,"$1,236.58",$556.46,$882.54,$0.00,$213.06,$0.00,$0.00,$216.51,"$1,236.58",$0.00,$618.29,$979.37,$989.26,$0.00,$193.52,$0.00,$196.86,$0.00
175428,SUP,HCPCS C1768,,175428  -  GRAFT VASC 30CM 28MM HMSH GMCVL WVN STR,"$1,317.40",$0.00,"$1,317.40",$592.83,$940.23,$0.00,$226.98,$0.00,$0.00,$230.67,"$1,317.40",$0.00,$658.70,"$1,043.38","$1,053.92",$0.00,$206.17,$0.00,$209.73,$0.00
175432,SUP,HCPCS C1768,,175432  -  GRAFT CV 32MM 30CM HMSH GMCVL WVN STRG,"$1,317.40",$0.00,"$1,317.40",$592.83,$940.23,$0.00,$226.98,$0.00,$0.00,$230.67,"$1,317.40",$0.00,$658.70,"$1,043.38","$1,053.92",$0.00,$206.17,$0.00,$209.73,$0.00
176605,SUP,Custom 27203010,,176605  -  SCISSORS LAPSCP 5MM 31CM E SCZ MNPLR CAUT ADPR HK CRV JAW,$187.02,$0.00,$187.02,$0.00,$133.47,$0.00,$0.00,$0.00,$0.00,$0.00,$187.02,$0.00,$93.51,$148.12,$149.61,$0.00,$0.00,$0.00,$0.00,$0.00
176620,SUP,Custom 27203010,,176620  -  APPLIER INTERNAL CLIP LARGE 5MM 11IN TROCAR SLEEVE ENDO CLIP,$373.88,$0.00,$373.88,$0.00,$266.83,$0.00,$0.00,$0.00,$0.00,$0.00,$373.88,$0.00,$186.94,$296.11,$299.10,$0.00,$0.00,$0.00,$0.00,$0.00
176643,SUP,Custom 27203010,,176643  -  SHEARS MONOPOLAR STANDARD CURVE 5MM 31CM MONOPOLAR CAUTERY,$153.37,$0.00,$153.37,$0.00,$109.46,$0.00,$0.00,$0.00,$0.00,$0.00,$153.37,$0.00,$76.68,$121.47,$122.69,$0.00,$0.00,$0.00,$0.00,$0.00
176657,SUP,Custom 27203010,,176657  -  APPLIER INTERNAL CLIP MEDIUM LARGE 10MM 10MM PISTOL GRIP,$209.17,$0.00,$209.17,$0.00,$149.28,$0.00,$0.00,$0.00,$0.00,$0.00,$209.17,$0.00,$104.58,$165.66,$167.33,$0.00,$0.00,$0.00,$0.00,$0.00
176816,SUP,Custom 27203010,,176816  -  CATHETER URTH 16FR 30ML STRL LF BARD LBRSL 2W FL BLN SIL,$18.70,$0.00,$18.70,$0.00,$13.35,$0.00,$0.00,$0.00,$0.00,$0.00,$18.70,$0.00,$9.35,$14.81,$14.96,$0.00,$0.00,$0.00,$0.00,$0.00
177017,SUP,Custom 27203010,,REAGENT ANALY QUICKCOMP FLUOROCHROME MNCLN LQ 50 TST,"$1,849.53",$0.00,"$1,849.53",$0.00,"$1,320.01",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,849.53",$0.00,$924.76,"$1,464.83","$1,479.62",$0.00,$0.00,$0.00,$0.00,$0.00
179301,SUP,Custom 27203010,,179301  -  TROCAR ENDSCP 10.5MM NONCONDUCTIVE SLEEVE THORACOPORT TEAL,$38.82,$0.00,$38.82,$0.00,$27.71,$0.00,$0.00,$0.00,$0.00,$0.00,$38.82,$0.00,$19.41,$30.75,$31.06,$0.00,$0.00,$0.00,$0.00,$0.00
179309,SUP,Custom 27203010,,179309  -  TROCAR ENDSCP 12MM SOFT CONDUCTIVE SLEEVE OBTURATOR,$38.82,$0.00,$38.82,$0.00,$27.71,$0.00,$0.00,$0.00,$0.00,$0.00,$38.82,$0.00,$19.41,$30.75,$31.06,$0.00,$0.00,$0.00,$0.00,$0.00
180402,SUP,HCPCS C1776,,180402  -  COMPONENT FEM 2 KN LT PTLFEM MULTICOMPARTMENTAL KN SYS,"$9,780.00",$0.00,"$9,780.00","$4,401.00","$5,158.80",$0.00,"$1,685.05",$0.00,$0.00,"$1,712.40","$9,780.00",$0.00,"$4,890.00","$7,745.76","$7,824.00",$0.00,"$1,530.57",$0.00,"$1,556.98",$0.00
180403,SUP,HCPCS C1776,,180403  -  COMPONENT FEM 3 KN PTLFEM LT MCK SYS,"$9,780.00",$0.00,"$9,780.00","$4,401.00","$5,158.80",$0.00,"$1,685.05",$0.00,$0.00,"$1,712.40","$9,780.00",$0.00,"$4,890.00","$7,745.76","$7,824.00",$0.00,"$1,530.57",$0.00,"$1,556.98",$0.00
180404,SUP,HCPCS C1776,,180404  -  COMPONENT FEM 4 KN PTLFEM LT MCK SYS,"$9,780.00",$0.00,"$9,780.00","$4,401.00","$5,158.80",$0.00,"$1,685.05",$0.00,$0.00,"$1,712.40","$9,780.00",$0.00,"$4,890.00","$7,745.76","$7,824.00",$0.00,"$1,530.57",$0.00,"$1,556.98",$0.00
180405,SUP,HCPCS C1776,,180405  -  COMPONENT FEM 5 KN PTLFEM LT MCK SYS,"$9,780.00",$0.00,"$9,780.00","$4,401.00","$5,158.80",$0.00,"$1,685.05",$0.00,$0.00,"$1,712.40","$9,780.00",$0.00,"$4,890.00","$7,745.76","$7,824.00",$0.00,"$1,530.57",$0.00,"$1,556.98",$0.00
180406,SUP,HCPCS C1776,,180406  -  COMPONENT FEM 6 KN LT PTLFEM MULTICOMPARTMENTAL KN SYS,"$9,780.00",$0.00,"$9,780.00","$4,401.00","$5,158.80",$0.00,"$1,685.05",$0.00,$0.00,"$1,712.40","$9,780.00",$0.00,"$4,890.00","$7,745.76","$7,824.00",$0.00,"$1,530.57",$0.00,"$1,556.98",$0.00
180407,SUP,HCPCS C1776,,180407  -  COMPONENT FEM 7 KN PTLFEM LT MCK SYS,"$9,780.00",$0.00,"$9,780.00","$4,401.00","$5,158.80",$0.00,"$1,685.05",$0.00,$0.00,"$1,712.40","$9,780.00",$0.00,"$4,890.00","$7,745.76","$7,824.00",$0.00,"$1,530.57",$0.00,"$1,556.98",$0.00
180412,SUP,HCPCS C1776,,180412  -  COMPONENT FEM 2 KN PTLFEM RT MCK SYS,"$9,780.00",$0.00,"$9,780.00","$4,401.00","$5,158.80",$0.00,"$1,685.05",$0.00,$0.00,"$1,712.40","$9,780.00",$0.00,"$4,890.00","$7,745.76","$7,824.00",$0.00,"$1,530.57",$0.00,"$1,556.98",$0.00
180413,SUP,HCPCS C1776,,180413  -  COMPONENT FEM 3 KN RT PTLFEM MULTICOMPARTMENTAL KN SYS,"$9,780.00",$0.00,"$9,780.00","$4,401.00","$5,158.80",$0.00,"$1,685.05",$0.00,$0.00,"$1,712.40","$9,780.00",$0.00,"$4,890.00","$7,745.76","$7,824.00",$0.00,"$1,530.57",$0.00,"$1,556.98",$0.00
180414,SUP,HCPCS C1776,,180414  -  COMPONENT FEM 4 KN PTLFEM RT MCK SYS,"$9,780.00",$0.00,"$9,780.00","$4,401.00","$5,158.80",$0.00,"$1,685.05",$0.00,$0.00,"$1,712.40","$9,780.00",$0.00,"$4,890.00","$7,745.76","$7,824.00",$0.00,"$1,530.57",$0.00,"$1,556.98",$0.00
180415,SUP,HCPCS C1776,,180415  -  COMPONENT FEM 5 KN PTLFEM RT MCK SYS,"$9,780.00",$0.00,"$9,780.00","$4,401.00","$5,158.80",$0.00,"$1,685.05",$0.00,$0.00,"$1,712.40","$9,780.00",$0.00,"$4,890.00","$7,745.76","$7,824.00",$0.00,"$1,530.57",$0.00,"$1,556.98",$0.00
180416,SUP,HCPCS C1776,,180416  -  COMPONENT FEM 6 KN PTLFEM RT MCK SYS,"$9,780.00",$0.00,"$9,780.00","$4,401.00","$5,158.80",$0.00,"$1,685.05",$0.00,$0.00,"$1,712.40","$9,780.00",$0.00,"$4,890.00","$7,745.76","$7,824.00",$0.00,"$1,530.57",$0.00,"$1,556.98",$0.00
180417,SUP,HCPCS C1776,,180417  -  COMPONENT FEM 7 STD KN PTLFEM RT,"$9,780.00",$0.00,"$9,780.00","$4,401.00","$5,158.80",$0.00,"$1,685.05",$0.00,$0.00,"$1,712.40","$9,780.00",$0.00,"$4,890.00","$7,745.76","$7,824.00",$0.00,"$1,530.57",$0.00,"$1,556.98",$0.00
180502,SUP,HCPCS C1776,,180502  -  COMPONENT FEM 2 KN LT MDL RL MCK SYS,"$3,302.50",$0.00,"$3,302.50","$1,486.13","$2,356.99",$0.00,$569.00,$0.00,$0.00,$578.24,"$3,302.50",$0.00,"$1,651.25","$2,615.58","$2,642.00",$0.00,$516.84,$0.00,$525.76,$0.00
180503,SUP,HCPCS C1776,,180503  -  COMPONENT FEM 3 KN LT MDL RL MCK SYS,"$3,302.50",$0.00,"$3,302.50","$1,486.13","$2,356.99",$0.00,$569.00,$0.00,$0.00,$578.24,"$3,302.50",$0.00,"$1,651.25","$2,615.58","$2,642.00",$0.00,$516.84,$0.00,$525.76,$0.00
180504,SUP,HCPCS C1776,,180504  -  COMPONENT FEM 4 KN LT MDL RL MCK SYS,"$3,302.50",$0.00,"$3,302.50","$1,486.13","$2,356.99",$0.00,$569.00,$0.00,$0.00,$578.24,"$3,302.50",$0.00,"$1,651.25","$2,615.58","$2,642.00",$0.00,$516.84,$0.00,$525.76,$0.00
180505,SUP,HCPCS C1776,,180505  -  COMPONENT FEM 5 KN LT MDL RL MCK SYS,"$3,302.50",$0.00,"$3,302.50","$1,486.13","$2,356.99",$0.00,$569.00,$0.00,$0.00,$578.24,"$3,302.50",$0.00,"$1,651.25","$2,615.58","$2,642.00",$0.00,$516.84,$0.00,$525.76,$0.00
180506,SUP,HCPCS C1776,,180506  -  COMPONENT FEM 6 KN LT MDL RL MCK SYS,"$3,302.50",$0.00,"$3,302.50","$1,486.13","$2,356.99",$0.00,$569.00,$0.00,$0.00,$578.24,"$3,302.50",$0.00,"$1,651.25","$2,615.58","$2,642.00",$0.00,$516.84,$0.00,$525.76,$0.00
180507,SUP,HCPCS C1776,,180507  -  COMPONENT FEM 7 KN LT MDL RL MCK SYS,"$3,302.50",$0.00,"$3,302.50","$1,486.13","$2,356.99",$0.00,$569.00,$0.00,$0.00,$578.24,"$3,302.50",$0.00,"$1,651.25","$2,615.58","$2,642.00",$0.00,$516.84,$0.00,$525.76,$0.00
180512,SUP,HCPCS C1776,,180512  -  COMPONENT FEM 2 KN RMLL MCK SYS,"$3,302.50",$0.00,"$3,302.50","$1,486.13","$2,356.99",$0.00,$569.00,$0.00,$0.00,$578.24,"$3,302.50",$0.00,"$1,651.25","$2,615.58","$2,642.00",$0.00,$516.84,$0.00,$525.76,$0.00
180513,SUP,HCPCS C1776,,180513  -  COMPONENT FEM 3 KN RMLL MCK SYS,"$3,302.50",$0.00,"$3,302.50","$1,486.13","$2,356.99",$0.00,$569.00,$0.00,$0.00,$578.24,"$3,302.50",$0.00,"$1,651.25","$2,615.58","$2,642.00",$0.00,$516.84,$0.00,$525.76,$0.00
180514,SUP,HCPCS C1776,,180514  -  COMPONENT FEM 4 KN RMLL MCK SYS,"$3,302.50",$0.00,"$3,302.50","$1,486.13","$2,356.99",$0.00,$569.00,$0.00,$0.00,$578.24,"$3,302.50",$0.00,"$1,651.25","$2,615.58","$2,642.00",$0.00,$516.84,$0.00,$525.76,$0.00
180515,SUP,HCPCS C1776,,180515  -  COMPONENT FEM 5 KN RMLL MCK SYS,"$3,302.50",$0.00,"$3,302.50","$1,486.13","$2,356.99",$0.00,$569.00,$0.00,$0.00,$578.24,"$3,302.50",$0.00,"$1,651.25","$2,615.58","$2,642.00",$0.00,$516.84,$0.00,$525.76,$0.00
180516,SUP,HCPCS C1776,,180516  -  COMPONENT FEM 6 KN RMLL MCK SYS,"$3,302.50",$0.00,"$3,302.50","$1,486.13","$2,356.99",$0.00,$569.00,$0.00,$0.00,$578.24,"$3,302.50",$0.00,"$1,651.25","$2,615.58","$2,642.00",$0.00,$516.84,$0.00,$525.76,$0.00
180517,SUP,HCPCS C1776,,180517  -  COMPONENT FEM 7 STRL RESTORIS MULTICOMPARTMENTAL KN RMLL,"$3,302.50",$0.00,"$3,302.50","$1,486.13","$2,356.99",$0.00,$569.00,$0.00,$0.00,$578.24,"$3,302.50",$0.00,"$1,651.25","$2,615.58","$2,642.00",$0.00,$516.84,$0.00,$525.76,$0.00
180518,SUP,HCPCS C1776,,180518  -  COMPONENT FEM 8 STRL RESTORIS MULTICOMPARTMENTAL KN RMLL,"$3,302.50",$0.00,"$3,302.50","$1,486.13","$2,356.99",$0.00,$569.00,$0.00,$0.00,$578.24,"$3,302.50",$0.00,"$1,651.25","$2,615.58","$2,642.00",$0.00,$516.84,$0.00,$525.76,$0.00
180601,SUP,HCPCS C1776,,180601  -  BASEPLATE TIB 1 STRL RESTORIS ONLAY MULTICOMPARTMENTAL KN LT,"$2,402.50",$0.00,"$2,402.50","$1,081.13","$1,714.66",$0.00,$413.94,$0.00,$0.00,$420.66,"$2,402.50",$0.00,"$1,201.25","$1,902.78","$1,922.00",$0.00,$375.99,$0.00,$382.48,$0.00
180602,SUP,HCPCS C1776,,180602  -  BASEPLATE TIB 2 KN LT MDL RL MCK SYS,"$2,402.50",$0.00,"$2,402.50","$1,081.13","$1,714.66",$0.00,$413.94,$0.00,$0.00,$420.66,"$2,402.50",$0.00,"$1,201.25","$1,902.78","$1,922.00",$0.00,$375.99,$0.00,$382.48,$0.00
180603,SUP,HCPCS C1776,,180603  -  BASEPLATE TIB 3 KN LT MDL RL MCK SYS,"$2,402.50",$0.00,"$2,402.50","$1,081.13","$1,714.66",$0.00,$413.94,$0.00,$0.00,$420.66,"$2,402.50",$0.00,"$1,201.25","$1,902.78","$1,922.00",$0.00,$375.99,$0.00,$382.48,$0.00
180604,SUP,HCPCS C1776,,180604  -  BASEPLATE TIB 4 KN LT MDL RL MCK SYS,"$2,402.50",$0.00,"$2,402.50","$1,081.13","$1,714.66",$0.00,$413.94,$0.00,$0.00,$420.66,"$2,402.50",$0.00,"$1,201.25","$1,902.78","$1,922.00",$0.00,$375.99,$0.00,$382.48,$0.00
180605,SUP,HCPCS C1776,,180605  -  BASEPLATE TIB 5 KN LT MDL RL MCK SYS,"$2,402.50",$0.00,"$2,402.50","$1,081.13","$1,714.66",$0.00,$413.94,$0.00,$0.00,$420.66,"$2,402.50",$0.00,"$1,201.25","$1,902.78","$1,922.00",$0.00,$375.99,$0.00,$382.48,$0.00
180606,SUP,HCPCS C1776,,180606  -  BASEPLATE TIB 6 KN LT MDL RL MCK SYS,"$2,402.50",$0.00,"$2,402.50","$1,081.13","$1,714.66",$0.00,$413.94,$0.00,$0.00,$420.66,"$2,402.50",$0.00,"$1,201.25","$1,902.78","$1,922.00",$0.00,$375.99,$0.00,$382.48,$0.00
180607,SUP,HCPCS C1776,,180607  -  BASEPLATE TIB 7 KN LT MDL RL MCK SYS,"$2,402.50",$0.00,"$2,402.50","$1,081.13","$1,714.66",$0.00,$413.94,$0.00,$0.00,$420.66,"$2,402.50",$0.00,"$1,201.25","$1,902.78","$1,922.00",$0.00,$375.99,$0.00,$382.48,$0.00
180608,SUP,HCPCS C1776,,180608  -  BASEPLATE TIB 8 STRL RESTORIS ONLAY MULTICOMPARTMENTAL KN LT,"$2,402.50",$0.00,"$2,402.50","$1,081.13","$1,714.66",$0.00,$413.94,$0.00,$0.00,$420.66,"$2,402.50",$0.00,"$1,201.25","$1,902.78","$1,922.00",$0.00,$375.99,$0.00,$382.48,$0.00
180612,SUP,HCPCS C1776,,180612  -  BASEPLATE TIB 2 KN RMLL MCK SYS,"$2,402.50",$0.00,"$2,402.50","$1,081.13","$1,714.66",$0.00,$413.94,$0.00,$0.00,$420.66,"$2,402.50",$0.00,"$1,201.25","$1,902.78","$1,922.00",$0.00,$375.99,$0.00,$382.48,$0.00
180613,SUP,HCPCS C1776,,180613  -  BASEPLATE TIB 3 KN RMLL MCK SYS,"$2,402.50",$0.00,"$2,402.50","$1,081.13","$1,714.66",$0.00,$413.94,$0.00,$0.00,$420.66,"$2,402.50",$0.00,"$1,201.25","$1,902.78","$1,922.00",$0.00,$375.99,$0.00,$382.48,$0.00
180614,SUP,HCPCS C1776,,180614  -  BASEPLATE TIB 4 STRL RESTORIS KN RMLL MCK SYS,"$2,402.50",$0.00,"$2,402.50","$1,081.13","$1,714.66",$0.00,$413.94,$0.00,$0.00,$420.66,"$2,402.50",$0.00,"$1,201.25","$1,902.78","$1,922.00",$0.00,$375.99,$0.00,$382.48,$0.00
180615,SUP,HCPCS C1776,,180615  -  BASEPLATE TIB 5 STRL RESTORIS KN RMLL MCK SYS,"$2,402.50",$0.00,"$2,402.50","$1,081.13","$1,714.66",$0.00,$413.94,$0.00,$0.00,$420.66,"$2,402.50",$0.00,"$1,201.25","$1,902.78","$1,922.00",$0.00,$375.99,$0.00,$382.48,$0.00
180616,SUP,HCPCS C1776,,180616  -  BASEPLATE TIB 6 KN RMLL MCK SYS,"$2,402.50",$0.00,"$2,402.50","$1,081.13","$1,714.66",$0.00,$413.94,$0.00,$0.00,$420.66,"$2,402.50",$0.00,"$1,201.25","$1,902.78","$1,922.00",$0.00,$375.99,$0.00,$382.48,$0.00
180617,SUP,HCPCS C1776,,180617  -  BASEPLATE TIB 7 KN RMLL MCK SYS,"$2,402.50",$0.00,"$2,402.50","$1,081.13","$1,714.66",$0.00,$413.94,$0.00,$0.00,$420.66,"$2,402.50",$0.00,"$1,201.25","$1,902.78","$1,922.00",$0.00,$375.99,$0.00,$382.48,$0.00
180618,SUP,HCPCS C1776,,180618  -  BASEPLATE TIB 8 STRL RESTORIS ONLAY MULTICOMPARTMENTAL KN,"$2,402.50",$0.00,"$2,402.50","$1,081.13","$1,714.66",$0.00,$413.94,$0.00,$0.00,$420.66,"$2,402.50",$0.00,"$1,201.25","$1,902.78","$1,922.00",$0.00,$375.99,$0.00,$382.48,$0.00
186140,SUP,HCPCS C1776,,186140  -  LINER ACTB NTRL RESTORIS XLVE HIP,"$1,440.00",$0.00,"$1,440.00",$648.00,"$1,027.73",$0.00,$248.10,$0.00,$0.00,$252.13,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$225.36,$0.00,$229.25,$0.00
186240,SUP,HCPCS C1776,,186240  -  LINER ACTB RESTORIS HW XLVE HIP,"$1,440.00",$0.00,"$1,440.00",$648.00,"$1,027.73",$0.00,$248.10,$0.00,$0.00,$252.13,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$225.36,$0.00,$229.25,$0.00
200641,SUP,Custom 27805411,,200641  -  GRAFT BONE CORNERSTONE CORTICAL L14 MM X W11 MM X H6 MM BLOC,"$2,875.00",$0.00,"$2,875.00",$0.00,"$2,051.89",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,875.00",$0.00,"$1,437.50","$2,277.00","$2,300.00",$0.00,$0.00,$0.00,$0.00,$0.00
200741,SUP,HCPCS C1713,,200741  -  GRAFT BONE CRSTN SR CORT BLCK 14X11X7MM CERV SPNE,"$2,875.00",$0.00,"$2,875.00","$1,293.75","$2,051.89",$0.00,$495.35,$0.00,$0.00,$503.39,"$2,875.00",$0.00,"$1,437.50","$2,277.00","$2,300.00",$0.00,$449.94,$0.00,$457.70,$0.00
200744,SUP,Custom 27804086,,200744  -  GRAFT BONE 14X14X7MM BLOCK CORNERSTONE SR CORTICAL CERV SPN,"$2,875.00",$0.00,"$2,875.00",$0.00,"$2,051.89",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,875.00",$0.00,"$1,437.50","$2,277.00","$2,300.00",$0.00,$0.00,$0.00,$0.00,$0.00
200841,SUP,HCPCS C1713,,200841  -  GRAFT BONE CRSTN PSR CORT BLOCK 14X11X8MM CERV SPN,"$2,875.00",$0.00,"$2,875.00","$1,293.75","$2,051.89",$0.00,$495.35,$0.00,$0.00,$503.39,"$2,875.00",$0.00,"$1,437.50","$2,277.00","$2,300.00",$0.00,$449.94,$0.00,$457.70,$0.00
200941,SUP,Custom 27804086,,200941  -  GRAFT BONE 14X11X9MM BLOCK FREEZE DRIED CORNERSTONE CORTICAL,"$2,875.00",$0.00,"$2,875.00",$0.00,"$2,051.89",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,875.00",$0.00,"$1,437.50","$2,277.00","$2,300.00",$0.00,$0.00,$0.00,$0.00,$0.00
201400,SUP,HCPCS C1713,,201400  -  PIN HLF 4MM 120MM 30MM ILZ THRD ORTH,$422.00,$0.00,$422.00,$189.90,$301.18,$0.00,$72.71,$0.00,$0.00,$73.89,$422.00,$0.00,$211.00,$334.22,$337.60,$0.00,$66.04,$0.00,$67.18,$0.00
201401,SUP,HCPCS C1713,,201401  -  PIN HLF 4MM 150MM 35MM ILZ THRD ORTH,$428.00,$0.00,$428.00,$192.60,$305.46,$0.00,$73.74,$0.00,$0.00,$74.94,$428.00,$0.00,$214.00,$338.98,$342.40,$0.00,$66.98,$0.00,$68.14,$0.00
201402,SUP,HCPCS C1713,,201402  -  PIN HLF 4MM 180MM 40MM ILZ THRD ORTH,$448.00,$0.00,$448.00,$201.60,$319.74,$0.00,$77.19,$0.00,$0.00,$78.44,$448.00,$0.00,$224.00,$354.82,$358.40,$0.00,$70.11,$0.00,$71.32,$0.00
201502,SUP,HCPCS C1713,,201502  -  PIN HLF 5MM 180MM 50MM ILZ THRD CNCL ORTH,$480.00,$0.00,$480.00,$216.00,$342.58,$0.00,$82.70,$0.00,$0.00,$84.04,$480.00,$0.00,$240.00,$380.16,$384.00,$0.00,$75.12,$0.00,$76.42,$0.00
201700,SUP,HCPCS C1713,,201700  -  WASHER ORTH ILZ CNCL CPL,$128.80,$0.00,$128.80,$57.96,$91.92,$0.00,$22.19,$0.00,$0.00,$22.55,$128.80,$0.00,$64.40,$102.01,$103.04,$0.00,$20.16,$0.00,$20.50,$0.00
202050,SUP,Custom 27203010,,202050  -  SEALANT DURA 5ML DURASEAL PG TRILYSINE AMINE,"$2,760.94",$0.00,"$2,760.94",$0.00,"$1,970.48",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,760.94",$0.00,"$1,380.47","$2,186.66","$2,208.75",$0.00,$0.00,$0.00,$0.00,$0.00
204002,SUP,HCPCS Q4116,,204002  -  GRAFT SKN STRATTICE 20 X 40,"$50,720.00",$0.00,"$50,720.00","$22,824.00","$5,158.80",$0.00,"$8,138.89",$0.00,$0.00,"$8,138.89","$50,720.00",$0.00,"$25,360.00","$40,170.24","$40,576.00",$0.00,"$7,751.33",$0.00,"$8,074.62",$0.00
205108,SUP,Custom 27203010,,205108  -  DEVICE TISSUE CLOSURE 8CM EXTEND TIP APPLICATOR,"$2,830.10",$0.00,"$2,830.10",$0.00,"$2,019.84",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,830.10",$0.00,"$1,415.05","$2,241.44","$2,264.08",$0.00,$0.00,$0.00,$0.00,$0.00
206010,SUP,Custom 27203010,,206010  -  STONE BREAKER,"$1,687.50",$0.00,"$1,687.50",$0.00,"$1,204.37",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,687.50",$0.00,$843.75,"$1,336.50","$1,350.00",$0.00,$0.00,$0.00,$0.00,$0.00
206020,SUP,Custom 27203010,,206020  -  STONE BRAKER PROBE 20 MM,"$1,687.50",$0.00,"$1,687.50",$0.00,"$1,204.37",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,687.50",$0.00,$843.75,"$1,336.50","$1,350.00",$0.00,$0.00,$0.00,$0.00,$0.00
206520,SUP,Custom 27203010,,206520  -  SEALANT TISS CLSR 5ML STRL LF DURASEAL EXACT SPNE DISP,"$14,296.10",$0.00,"$14,296.10",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$14,296.10",$0.00,"$7,148.05","$11,322.51","$11,436.88",$0.00,$0.00,$0.00,$0.00,$0.00
208058,SUP,Custom 27203010,,FORMULA 1QT MCT OIL SUPPL GLS BTL ADLT 7.7 CAL,$375.20,$0.00,$375.20,$0.00,$267.78,$0.00,$0.00,$0.00,$0.00,$0.00,$375.20,$0.00,$187.60,$297.16,$300.16,$0.00,$0.00,$0.00,$0.00,$0.00
210439,SUP,Custom 27203010,,210439  -  BIT DRL LNG 2MM 127MM STRL TWST SS,$175.40,$0.00,$175.40,$0.00,$125.18,$0.00,$0.00,$0.00,$0.00,$0.00,$175.40,$0.00,$87.70,$138.92,$140.32,$0.00,$0.00,$0.00,$0.00,$0.00
210440,SUP,Custom 27203010,,210440  -  BIT DRL LNG 2.4MM 127MM STRL CUT SS,$175.40,$0.00,$175.40,$0.00,$125.18,$0.00,$0.00,$0.00,$0.00,$0.00,$175.40,$0.00,$87.70,$138.92,$140.32,$0.00,$0.00,$0.00,$0.00,$0.00
210441,SUP,Custom 27203010,,210441  -  BIT DRL LNG 2.7MM 127MM STRL TWST SS,$175.40,$0.00,$175.40,$0.00,$125.18,$0.00,$0.00,$0.00,$0.00,$0.00,$175.40,$0.00,$87.70,$138.92,$140.32,$0.00,$0.00,$0.00,$0.00,$0.00
210442,SUP,Custom 27203010,,210442  -  BIT DRL 3.2MM 127MM STRL TWST SS,$175.40,$0.00,$175.40,$0.00,$125.18,$0.00,$0.00,$0.00,$0.00,$0.00,$175.40,$0.00,$87.70,$138.92,$140.32,$0.00,$0.00,$0.00,$0.00,$0.00
210444,SUP,Custom 27203010,,210444  -  BIT DRL LNG 4MM 127MM STRL TWST SS,$132.30,$0.00,$132.30,$0.00,$94.42,$0.00,$0.00,$0.00,$0.00,$0.00,$132.30,$0.00,$66.15,$104.78,$105.84,$0.00,$0.00,$0.00,$0.00,$0.00
210445,SUP,Custom 27203010,,210445  -  BIT DRL LNG 4.3MM 127MM STRL CUT SS,$132.30,$0.00,$132.30,$0.00,$94.42,$0.00,$0.00,$0.00,$0.00,$0.00,$132.30,$0.00,$66.15,$104.78,$105.84,$0.00,$0.00,$0.00,$0.00,$0.00
210446,SUP,Custom 27203010,,210446  -  BIT DRL LNG 4.7MM 127MM TWST SS,$132.30,$0.00,$132.30,$0.00,$94.42,$0.00,$0.00,$0.00,$0.00,$0.00,$132.30,$0.00,$66.15,$104.78,$105.84,$0.00,$0.00,$0.00,$0.00,$0.00
210447,SUP,Custom 27203010,,210447  -  BIT DRL 5.5MM 127MM STRL TWST SS,$140.70,$0.00,$140.70,$0.00,$100.42,$0.00,$0.00,$0.00,$0.00,$0.00,$140.70,$0.00,$70.35,$111.43,$112.56,$0.00,$0.00,$0.00,$0.00,$0.00
210448,SUP,Custom 27203010,,210448  -  BIT DRL LNG 6.4MM 127MM STRL CUT SS,$132.30,$0.00,$132.30,$0.00,$94.42,$0.00,$0.00,$0.00,$0.00,$0.00,$132.30,$0.00,$66.15,$104.78,$105.84,$0.00,$0.00,$0.00,$0.00,$0.00
210450,SUP,Custom 27203010,,210450  -  BIT DRL 2.7MM 152.4MM STRL TWST SS,$157.50,$0.00,$157.50,$0.00,$112.41,$0.00,$0.00,$0.00,$0.00,$0.00,$157.50,$0.00,$78.75,$124.74,$126.00,$0.00,$0.00,$0.00,$0.00,$0.00
210451,SUP,Custom 27203010,,210451  -  BIT DRL LNG 3.5MM 152.4MM STRL TWST SS,$230.00,$0.00,$230.00,$0.00,$164.15,$0.00,$0.00,$0.00,$0.00,$0.00,$230.00,$0.00,$115.00,$182.16,$184.00,$0.00,$0.00,$0.00,$0.00,$0.00
210454,SUP,Custom 27203010,,210454  -  BIT DRL 5/16MM STRL TWST SS,$507.15,$0.00,$507.15,$0.00,$361.95,$0.00,$0.00,$0.00,$0.00,$0.00,$507.15,$0.00,$253.58,$401.66,$405.72,$0.00,$0.00,$0.00,$0.00,$0.00
210455,SUP,Custom 27203010,,210455  -  BIT DRL LG 9.5MM 127MM STRL TWST SS,$632.10,$0.00,$632.10,$0.00,$451.13,$0.00,$0.00,$0.00,$0.00,$0.00,$632.10,$0.00,$316.05,$500.62,$505.68,$0.00,$0.00,$0.00,$0.00,$0.00
210458,SUP,Custom 27203010,,210458  -  BIT DRL LG 11.1MM 127MM STRL TWST SS,$679.35,$0.00,$679.35,$0.00,$484.85,$0.00,$0.00,$0.00,$0.00,$0.00,$679.35,$0.00,$339.68,$538.05,$543.48,$0.00,$0.00,$0.00,$0.00,$0.00
210461,SUP,Custom 27203010,,210461  -  BIT DRL LG 12.7MM 127MM TWST,$679.35,$0.00,$679.35,$0.00,$484.85,$0.00,$0.00,$0.00,$0.00,$0.00,$679.35,$0.00,$339.68,$538.05,$543.48,$0.00,$0.00,$0.00,$0.00,$0.00
210465,SUP,Custom 27203010,,210465  -  BIT DRL 3.6MM 152.4MM STRL TWST SS,$217.35,$0.00,$217.35,$0.00,$155.12,$0.00,$0.00,$0.00,$0.00,$0.00,$217.35,$0.00,$108.68,$172.14,$173.88,$0.00,$0.00,$0.00,$0.00,$0.00
210521,SUP,Custom 27203010,,210521  -  FORCEP SPEC RTRVL 65CM 5.2FR 1 JAW ALGTR TOOTH FLXB SHFT,$707.35,$0.00,$707.35,$0.00,$504.84,$0.00,$0.00,$0.00,$0.00,$0.00,$707.35,$0.00,$353.68,$560.22,$565.88,$0.00,$0.00,$0.00,$0.00,$0.00
210550,SUP,Custom 27203010,,210550  -  BIT DRL 2.4MM 127MM STRL TWST SUT HL SS,$166.95,$0.00,$166.95,$0.00,$119.15,$0.00,$0.00,$0.00,$0.00,$0.00,$166.95,$0.00,$83.48,$132.22,$133.56,$0.00,$0.00,$0.00,$0.00,$0.00
210551,SUP,Custom 27203010,,210551  -  BIT DRL 2.7MM 127MM STRL TWST SUT HL SS,$166.95,$0.00,$166.95,$0.00,$119.15,$0.00,$0.00,$0.00,$0.00,$0.00,$166.95,$0.00,$83.48,$132.22,$133.56,$0.00,$0.00,$0.00,$0.00,$0.00
210552,SUP,Custom 27203010,,210552  -  BIT DRL 3.1MM 127MM STRL TWST SUT HL SS,$164.85,$0.00,$164.85,$0.00,$117.65,$0.00,$0.00,$0.00,$0.00,$0.00,$164.85,$0.00,$82.43,$130.56,$131.88,$0.00,$0.00,$0.00,$0.00,$0.00
210554,SUP,Custom 27203010,,210554  -  BIT DRL 3.9MM 127MM STRL TWST SUT HL,$164.85,$0.00,$164.85,$0.00,$117.65,$0.00,$0.00,$0.00,$0.00,$0.00,$164.85,$0.00,$82.43,$130.56,$131.88,$0.00,$0.00,$0.00,$0.00,$0.00
211250,SUP,HCPCS C1763,,211250  -  GRAFT SOFT TISSUE 2-3MM 50MM ALLOGRAFT MULTIPLE CLEAN AVANCE,"$10,125.00",$0.00,"$10,125.00","$4,556.25","$5,158.80",$0.00,"$1,744.49",$0.00,$0.00,"$1,772.81","$10,125.00",$0.00,"$5,062.50","$8,019.00","$8,100.00",$0.00,"$1,584.56",$0.00,"$1,611.90",$0.00
212038,SUP,HCPCS C1713,,212038  -  ANCHOR SUTURE OTHCRD,"$1,027.50",$0.00,"$1,027.50",$462.38,$733.33,$0.00,$177.03,$0.00,$0.00,$179.91,"$1,027.50",$0.00,$513.75,$813.78,$822.00,$0.00,$160.80,$0.00,$163.58,$0.00
212133,SUP,HCPCS C1713,,212133  -  ANCHOR SUTURE 0 OS-2 MINI QANCHR+ SFT TIS SHLDR ARTHRO TI,"$1,000.00",$0.00,"$1,000.00",$450.00,$713.70,$0.00,$172.30,$0.00,$0.00,$175.09,"$1,000.00",$0.00,$500.00,$792.00,$800.00,$0.00,$156.50,$0.00,$159.20,$0.00
212525,SUP,Custom 27203010,,STAIN MCBL GM CRYS VIOL WKG SOL BBL 250ML,$17.55,$0.00,$17.55,$0.00,$12.53,$0.00,$0.00,$0.00,$0.00,$0.00,$17.55,$0.00,$8.78,$13.90,$14.04,$0.00,$0.00,$0.00,$0.00,$0.00
212843,SUP,HCPCS C1713,,212843  -  ANCHOR SUT 3-0 V-4 MIC 1.3MM STRL LF QANCHR+ OTHCRD BABSR,"$1,000.00",$0.00,"$1,000.00",$450.00,$713.70,$0.00,$172.30,$0.00,$0.00,$175.09,"$1,000.00",$0.00,$500.00,$792.00,$800.00,$0.00,$156.50,$0.00,$159.20,$0.00
212865,SUP,HCPCS C1713,,212865  -  ANCHOR SUT 3-0 V-4 MIC QAN+ ETH BIT,$740.00,$0.00,$740.00,$333.00,$528.14,$0.00,$127.50,$0.00,$0.00,$129.57,$740.00,$0.00,$370.00,$586.08,$592.00,$0.00,$115.81,$0.00,$117.81,$0.00
213352,SUP,Custom 27203010,,REAGENT FLW CYMTR CTCHX FIXAT TRNSPT STOR 1ML,$462.50,$0.00,$462.50,$0.00,$330.09,$0.00,$0.00,$0.00,$0.00,$0.00,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$0.00,$0.00,$0.00,$0.00
213524,SUP,HCPCS C1713,,213524  -  PIN FX 3.2MM 110MM STRL LF BN,$302.50,$0.00,$302.50,$136.13,$215.89,$0.00,$52.12,$0.00,$0.00,$52.97,$302.50,$0.00,$151.25,$239.58,$242.00,$0.00,$47.34,$0.00,$48.16,$0.00
213527,SUP,HCPCS C1713,,213527  -  PIN FX 3.2MM 140MM STRL LF BN,$302.50,$0.00,$302.50,$136.13,$215.89,$0.00,$52.12,$0.00,$0.00,$52.97,$302.50,$0.00,$151.25,$239.58,$242.00,$0.00,$47.34,$0.00,$48.16,$0.00
219791,SUP,Custom 27203010,,219791  -  MONTEFIORE 7FR X 100CM,$39.38,$0.00,$39.38,$0.00,$28.10,$0.00,$0.00,$0.00,$0.00,$0.00,$39.38,$0.00,$19.69,$31.19,$31.50,$0.00,$0.00,$0.00,$0.00,$0.00
221716,SUP,Custom 27203010,,MEDIA CULT TSB TUBE MCFLS 5ML,$75.88,$0.00,$75.88,$0.00,$54.15,$0.00,$0.00,$0.00,$0.00,$0.00,$75.88,$0.00,$37.94,$60.10,$60.70,$0.00,$0.00,$0.00,$0.00,$0.00
222000,SUP,Custom 27203010,,222000  -  IMMOBILIZER ORTH UNV 18-24IN KNEE 2 CUF SLD TO  ADJ EXOFORM,$42.59,$0.00,$42.59,$0.00,$30.39,$0.00,$0.00,$0.00,$0.00,$0.00,$42.59,$0.00,$21.29,$33.73,$34.07,$0.00,$0.00,$0.00,$0.00,$0.00
222228,SUP,Custom 27203010,,MEDIA CULT C DFC SLCT AGAR PLT BBL,$26.43,$0.00,$26.43,$0.00,$18.86,$0.00,$0.00,$0.00,$0.00,$0.00,$26.43,$0.00,$13.21,$20.93,$21.14,$0.00,$0.00,$0.00,$0.00,$0.00
222820,SUP,HCPCS C1713,,222820  -  SCREW BN 6MM FT 4MM 2.7MM 1.3MM 20MM STRL EXCEL ST FLUT CNN,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
222822,SUP,HCPCS C1713,,222822  -  SCREW BN FT FLUT 4MM 22MM STRL EXCEL ST CNN TROC SS HIP,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
222824,SUP,HCPCS C1713,,222824  -  SCREW BN 6MM FT 4MM 2.7MM 1.3MM 24MM STRL EXCEL ST FLUT CNN,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
222826,SUP,HCPCS C1713,,222826  -  SCREW BN FT FLUT 4MM 26MM STRL EXCEL ST CNN TROC SS HIP,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
222828,SUP,HCPCS C1713,,222828  -  SCREW BN FT FLUT 4MM 28MM STRL EXCEL ST CNN TROC SS HIP,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
222830,SUP,HCPCS C1713,,222830  -  SCREW BN FT FLUT 4MM 30MM STRL EXCEL ST CNN TROC SS HIP,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
222835,SUP,HCPCS C1713,,222835  -  SCREW BN FT FLUT 4MM 35MM STRL EXCEL ST CNN TROC SS HIP,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
222840,SUP,HCPCS C1713,,222840  -  SCREW BN 6MM FT 4MM 2.7MM 1.3MM 40MM STRL EXCEL ST FLUT CNN,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
222845,SUP,HCPCS C1713,,222845  -  SCREW BN FT FLUT 4MM 45MM STRL EXCEL ST CNN TROC SS HIP,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
222850,SUP,HCPCS C1713,,222850  -  SCREW BN FT FLUT 4MM 50MM STRL EXCEL ST CNN TROC SS HIP,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
222855,SUP,HCPCS C1713,,222855  -  SCREW BN FT FLUT 4MM 55MM STRL EXCEL ST CNN TROC SS HIP,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
222860,SUP,HCPCS C1713,,222860  -  SCREW BN FT FLUT 4MM 60MM STRL EXCEL ST CNN TROC SS HIP,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
222865,SUP,HCPCS C1713,,222865  -  SCREW BN FT FLUT 4MM 65MM STRL EXCEL ST CNN TROC SS HIP,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
222870,SUP,HCPCS C1713,,222870  -  SCREW BN FT FLUT 4MM 70MM STRL EXCEL ST CNN TROC SS HIP,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
222983,SUP,HCPCS C1713,,222983  -  ANCHOR SUT 2 CP-2 2.4MM 8.8MM STRL G2QKAN + OTHCRD NDL NTNL,"$1,030.00",$0.00,"$1,030.00",$463.50,$735.11,$0.00,$177.46,$0.00,$0.00,$180.34,"$1,030.00",$0.00,$515.00,$815.76,$824.00,$0.00,$161.20,$0.00,$163.98,$0.00
222984,SUP,HCPCS C1713,,222984  -  ANCHOR SUT 2 CP-2 2.8MM 11.4MM STRL QANCHR+ OTHCRD NDL NTNL,"$1,045.00",$0.00,"$1,045.00",$470.25,$745.82,$0.00,$180.05,$0.00,$0.00,$182.97,"$1,045.00",$0.00,$522.50,$827.64,$836.00,$0.00,$163.54,$0.00,$166.36,$0.00
223522,SUP,HCPCS C1713,,223522  -  NAIL IM 3.5MM 22CM ENDR HUM TIB,"$1,092.38",$0.00,"$1,092.38",$491.57,$779.63,$0.00,$188.21,$0.00,$0.00,$191.27,"$1,092.38",$0.00,$546.19,$865.16,$873.90,$0.00,$170.96,$0.00,$173.91,$0.00
223524,SUP,HCPCS C1713,,223524  -  NAIL IM 3.5MM 24CM ENDR HUM TIB,"$1,092.38",$0.00,"$1,092.38",$491.57,$779.63,$0.00,$188.21,$0.00,$0.00,$191.27,"$1,092.38",$0.00,$546.19,$865.16,$873.90,$0.00,$170.96,$0.00,$173.91,$0.00
223525,SUP,HCPCS C1713,,223525  -  NAIL IM 3.5MM 25CM ENDR HUM TIB,"$1,092.38",$0.00,"$1,092.38",$491.57,$779.63,$0.00,$188.21,$0.00,$0.00,$191.27,"$1,092.38",$0.00,$546.19,$865.16,$873.90,$0.00,$170.96,$0.00,$173.91,$0.00
223526,SUP,HCPCS C1713,,223526  -  NAIL IM 3.5MM 26CM ENDR HUM TIB,"$1,092.38",$0.00,"$1,092.38",$491.57,$779.63,$0.00,$188.21,$0.00,$0.00,$191.27,"$1,092.38",$0.00,$546.19,$865.16,$873.90,$0.00,$170.96,$0.00,$173.91,$0.00
223527,SUP,HCPCS C1713,,223527  -  NAIL IM 3.5MM 27CM ENDR HUM TIB,"$1,092.38",$0.00,"$1,092.38",$491.57,$779.63,$0.00,$188.21,$0.00,$0.00,$191.27,"$1,092.38",$0.00,$546.19,$865.16,$873.90,$0.00,$170.96,$0.00,$173.91,$0.00
223528,SUP,HCPCS C1713,,223528  -  NAIL IM 3.5MM 28CM ENDR ORTH,"$1,092.38",$0.00,"$1,092.38",$491.57,$779.63,$0.00,$188.21,$0.00,$0.00,$191.27,"$1,092.38",$0.00,$546.19,$865.16,$873.90,$0.00,$170.96,$0.00,$173.91,$0.00
223529,SUP,HCPCS C1713,,223529  -  NAIL IM 3.5MM 29CM ENDR HUM TIB,"$1,092.38",$0.00,"$1,092.38",$491.57,$779.63,$0.00,$188.21,$0.00,$0.00,$191.27,"$1,092.38",$0.00,$546.19,$865.16,$873.90,$0.00,$170.96,$0.00,$173.91,$0.00
223530,SUP,HCPCS C1713,,223530  -  NAIL IM 3.5MM 30CM ENDR HUM TIB,"$1,092.38",$0.00,"$1,092.38",$491.57,$779.63,$0.00,$188.21,$0.00,$0.00,$191.27,"$1,092.38",$0.00,$546.19,$865.16,$873.90,$0.00,$170.96,$0.00,$173.91,$0.00
223531,SUP,HCPCS C1713,,223531  -  NAIL IM 3.5MM 31CM ENDR HUM TIB,"$1,092.38",$0.00,"$1,092.38",$491.57,$779.63,$0.00,$188.21,$0.00,$0.00,$191.27,"$1,092.38",$0.00,$546.19,$865.16,$873.90,$0.00,$170.96,$0.00,$173.91,$0.00
223532,SUP,HCPCS C1713,,223532  -  NAIL IM 3.5MM 32CM ENDR HUM TIB,"$1,092.38",$0.00,"$1,092.38",$491.57,$779.63,$0.00,$188.21,$0.00,$0.00,$191.27,"$1,092.38",$0.00,$546.19,$865.16,$873.90,$0.00,$170.96,$0.00,$173.91,$0.00
223533,SUP,HCPCS C1713,,223533  -  NAIL IM 3.5MM 33CM ENDR HUM TIB,"$1,092.38",$0.00,"$1,092.38",$491.57,$779.63,$0.00,$188.21,$0.00,$0.00,$191.27,"$1,092.38",$0.00,$546.19,$865.16,$873.90,$0.00,$170.96,$0.00,$173.91,$0.00
223534,SUP,HCPCS C1713,,223534  -  NAIL IM 3.5MM 34CM ENDR ADLT ORTH,"$1,092.38",$0.00,"$1,092.38",$491.57,$779.63,$0.00,$188.21,$0.00,$0.00,$191.27,"$1,092.38",$0.00,$546.19,$865.16,$873.90,$0.00,$170.96,$0.00,$173.91,$0.00
223535,SUP,HCPCS C1713,,223535  -  NAIL IM 3.5MM 35CM ENDR ORTH,"$1,092.38",$0.00,"$1,092.38",$491.57,$779.63,$0.00,$188.21,$0.00,$0.00,$191.27,"$1,092.38",$0.00,$546.19,$865.16,$873.90,$0.00,$170.96,$0.00,$173.91,$0.00
223536,SUP,HCPCS C1713,,223536  -  NAIL IM 3.5MM 36CM ENDR HUM TIB,"$1,092.38",$0.00,"$1,092.38",$491.57,$779.63,$0.00,$188.21,$0.00,$0.00,$191.27,"$1,092.38",$0.00,$546.19,$865.16,$873.90,$0.00,$170.96,$0.00,$173.91,$0.00
223537,SUP,HCPCS C1713,,223537  -  NAIL IM 3.5MM 37CM ENDR HUM TIB,"$1,092.38",$0.00,"$1,092.38",$491.57,$779.63,$0.00,$188.21,$0.00,$0.00,$191.27,"$1,092.38",$0.00,$546.19,$865.16,$873.90,$0.00,$170.96,$0.00,$173.91,$0.00
223538,SUP,HCPCS C1713,,223538  -  NAIL IM 3.5MM 38CM ENDR HUM TIB,"$1,092.38",$0.00,"$1,092.38",$491.57,$779.63,$0.00,$188.21,$0.00,$0.00,$191.27,"$1,092.38",$0.00,$546.19,$865.16,$873.90,$0.00,$170.96,$0.00,$173.91,$0.00
224022,SUP,HCPCS C1713,,224022  -  NAIL IM 4MM 22CM ENDR HUM TIB,"$1,092.38",$0.00,"$1,092.38",$491.57,$779.63,$0.00,$188.21,$0.00,$0.00,$191.27,"$1,092.38",$0.00,$546.19,$865.16,$873.90,$0.00,$170.96,$0.00,$173.91,$0.00
224023,SUP,HCPCS C1713,,224023  -  NAIL IM 4MM 23CM ENDR HUM TIB,"$1,092.38",$0.00,"$1,092.38",$491.57,$779.63,$0.00,$188.21,$0.00,$0.00,$191.27,"$1,092.38",$0.00,$546.19,$865.16,$873.90,$0.00,$170.96,$0.00,$173.91,$0.00
224024,SUP,HCPCS C1713,,224024  -  NAIL IM 4MM 24CM ENDR HUM TIB,"$1,092.38",$0.00,"$1,092.38",$491.57,$779.63,$0.00,$188.21,$0.00,$0.00,$191.27,"$1,092.38",$0.00,$546.19,$865.16,$873.90,$0.00,$170.96,$0.00,$173.91,$0.00
224025,SUP,HCPCS C1713,,224025  -  NAIL IM 4MM 25CM ENDR HUM TIB,"$1,092.38",$0.00,"$1,092.38",$491.57,$779.63,$0.00,$188.21,$0.00,$0.00,$191.27,"$1,092.38",$0.00,$546.19,$865.16,$873.90,$0.00,$170.96,$0.00,$173.91,$0.00
224026,SUP,HCPCS C1713,,224026  -  NAIL IM 4MM 26CM ENDR HUM TIB,"$1,092.38",$0.00,"$1,092.38",$491.57,$779.63,$0.00,$188.21,$0.00,$0.00,$191.27,"$1,092.38",$0.00,$546.19,$865.16,$873.90,$0.00,$170.96,$0.00,$173.91,$0.00
224027,SUP,HCPCS C1713,,224027  -  NAIL IM 4MM 27CM ENDR HUM TIB,"$1,092.38",$0.00,"$1,092.38",$491.57,$779.63,$0.00,$188.21,$0.00,$0.00,$191.27,"$1,092.38",$0.00,$546.19,$865.16,$873.90,$0.00,$170.96,$0.00,$173.91,$0.00
224028,SUP,HCPCS C1713,,224028  -  NAIL IM 4MM 28CM ENDR HUM TIB,"$1,092.38",$0.00,"$1,092.38",$491.57,$779.63,$0.00,$188.21,$0.00,$0.00,$191.27,"$1,092.38",$0.00,$546.19,$865.16,$873.90,$0.00,$170.96,$0.00,$173.91,$0.00
224029,SUP,HCPCS C1713,,224029  -  NAIL IM 4MM 29CM ENDR HUM TIB,"$1,092.38",$0.00,"$1,092.38",$491.57,$779.63,$0.00,$188.21,$0.00,$0.00,$191.27,"$1,092.38",$0.00,$546.19,$865.16,$873.90,$0.00,$170.96,$0.00,$173.91,$0.00
224030,SUP,HCPCS C1713,,224030  -  NAIL IM 4MM 30CM ENDR HUM TIB,"$1,092.38",$0.00,"$1,092.38",$491.57,$779.63,$0.00,$188.21,$0.00,$0.00,$191.27,"$1,092.38",$0.00,$546.19,$865.16,$873.90,$0.00,$170.96,$0.00,$173.91,$0.00
224031,SUP,HCPCS C1713,,224031  -  NAIL IM 4MM 31CM ENDR HUM TIB,"$1,092.38",$0.00,"$1,092.38",$491.57,$779.63,$0.00,$188.21,$0.00,$0.00,$191.27,"$1,092.38",$0.00,$546.19,$865.16,$873.90,$0.00,$170.96,$0.00,$173.91,$0.00
224032,SUP,HCPCS C1713,,224032  -  NAIL IM 4MM 32CM ENDR HUM TIB,"$1,092.38",$0.00,"$1,092.38",$491.57,$779.63,$0.00,$188.21,$0.00,$0.00,$191.27,"$1,092.38",$0.00,$546.19,$865.16,$873.90,$0.00,$170.96,$0.00,$173.91,$0.00
224033,SUP,HCPCS C1713,,224033  -  NAIL IM 4MM 33CM ENDR HUM TIB,"$1,092.38",$0.00,"$1,092.38",$491.57,$779.63,$0.00,$188.21,$0.00,$0.00,$191.27,"$1,092.38",$0.00,$546.19,$865.16,$873.90,$0.00,$170.96,$0.00,$173.91,$0.00
224034,SUP,HCPCS C1713,,224034  -  NAIL IM 4MM 34CM ENDR HUM TIB,"$1,092.38",$0.00,"$1,092.38",$491.57,$779.63,$0.00,$188.21,$0.00,$0.00,$191.27,"$1,092.38",$0.00,$546.19,$865.16,$873.90,$0.00,$170.96,$0.00,$173.91,$0.00
224035,SUP,HCPCS C1713,,224035  -  NAIL IM 4MM 35CM ENDR SS HUM TIB,"$1,092.38",$0.00,"$1,092.38",$491.57,$779.63,$0.00,$188.21,$0.00,$0.00,$191.27,"$1,092.38",$0.00,$546.19,$865.16,$873.90,$0.00,$170.96,$0.00,$173.91,$0.00
224037,SUP,HCPCS C1713,,224037  -  NAIL IM 4MM 37CM ENDR HUM TIB,"$1,092.38",$0.00,"$1,092.38",$491.57,$779.63,$0.00,$188.21,$0.00,$0.00,$191.27,"$1,092.38",$0.00,$546.19,$865.16,$873.90,$0.00,$170.96,$0.00,$173.91,$0.00
224527,SUP,HCPCS C1713,,224527  -  NAIL IM 4.5MM 27CM ENDR HUM TIB,"$1,092.38",$0.00,"$1,092.38",$491.57,$779.63,$0.00,$188.21,$0.00,$0.00,$191.27,"$1,092.38",$0.00,$546.19,$865.16,$873.90,$0.00,$170.96,$0.00,$173.91,$0.00
224532,SUP,HCPCS C1713,,224532  -  NAIL IM 4.5MM 32CM ENDR HUM TIB,"$1,092.38",$0.00,"$1,092.38",$491.57,$779.63,$0.00,$188.21,$0.00,$0.00,$191.27,"$1,092.38",$0.00,$546.19,$865.16,$873.90,$0.00,$170.96,$0.00,$173.91,$0.00
224533,SUP,HCPCS C1713,,224533  -  NAIL IM 4.5MM 33CM ENDR,"$1,092.38",$0.00,"$1,092.38",$491.57,$779.63,$0.00,$188.21,$0.00,$0.00,$191.27,"$1,092.38",$0.00,$546.19,$865.16,$873.90,$0.00,$170.96,$0.00,$173.91,$0.00
224534,SUP,HCPCS C1713,,224534  -  NAIL IM 4.5MM 34CM ENDR HUM TIB,"$1,092.38",$0.00,"$1,092.38",$491.57,$779.63,$0.00,$188.21,$0.00,$0.00,$191.27,"$1,092.38",$0.00,$546.19,$865.16,$873.90,$0.00,$170.96,$0.00,$173.91,$0.00
224535,SUP,HCPCS C1713,,224535  -  NAIL IM 4.5MM 35CM ENDR HUM TIB,"$1,092.38",$0.00,"$1,092.38",$491.57,$779.63,$0.00,$188.21,$0.00,$0.00,$191.27,"$1,092.38",$0.00,$546.19,$865.16,$873.90,$0.00,$170.96,$0.00,$173.91,$0.00
224536,SUP,HCPCS C1713,,224536  -  NAIL IM 4.5MM 36CM ENDR HUM TIB,"$1,092.38",$0.00,"$1,092.38",$491.57,$779.63,$0.00,$188.21,$0.00,$0.00,$191.27,"$1,092.38",$0.00,$546.19,$865.16,$873.90,$0.00,$170.96,$0.00,$173.91,$0.00
224537,SUP,HCPCS C1713,,224537  -  NAIL IM 4.5MM 37CM ENDR HUM TIB,"$1,092.38",$0.00,"$1,092.38",$491.57,$779.63,$0.00,$188.21,$0.00,$0.00,$191.27,"$1,092.38",$0.00,$546.19,$865.16,$873.90,$0.00,$170.96,$0.00,$173.91,$0.00
224538,SUP,HCPCS C1713,,224538  -  NAIL IM 4.5MM 38CM ENDR HUM TIB,"$1,092.38",$0.00,"$1,092.38",$491.57,$779.63,$0.00,$188.21,$0.00,$0.00,$191.27,"$1,092.38",$0.00,$546.19,$865.16,$873.90,$0.00,$170.96,$0.00,$173.91,$0.00
224539,SUP,HCPCS C1713,,224539  -  NAIL IM 4.5MM 39CM ENDR HUM TIB,"$1,092.38",$0.00,"$1,092.38",$491.57,$779.63,$0.00,$188.21,$0.00,$0.00,$191.27,"$1,092.38",$0.00,$546.19,$865.16,$873.90,$0.00,$170.96,$0.00,$173.91,$0.00
224540,SUP,HCPCS C1713,,224540  -  NAIL IM 4.5MM 40CM ENDR HUM TIB,"$1,092.38",$0.00,"$1,092.38",$491.57,$779.63,$0.00,$188.21,$0.00,$0.00,$191.27,"$1,092.38",$0.00,$546.19,$865.16,$873.90,$0.00,$170.96,$0.00,$173.91,$0.00
224541,SUP,HCPCS C1713,,224541  -  NAIL IM 4.5MM 41CM ENDR HUM TIB,"$1,092.38",$0.00,"$1,092.38",$491.57,$779.63,$0.00,$188.21,$0.00,$0.00,$191.27,"$1,092.38",$0.00,$546.19,$865.16,$873.90,$0.00,$170.96,$0.00,$173.91,$0.00
224542,SUP,HCPCS C1713,,224542  -  NAIL IM 4.5MM 42CM ENDR HUM TIB,"$1,092.38",$0.00,"$1,092.38",$491.57,$779.63,$0.00,$188.21,$0.00,$0.00,$191.27,"$1,092.38",$0.00,$546.19,$865.16,$873.90,$0.00,$170.96,$0.00,$173.91,$0.00
224543,SUP,HCPCS C1713,,224543  -  NAIL IM 4.5MM 43CM ENDR HUM TIB,"$1,092.38",$0.00,"$1,092.38",$491.57,$779.63,$0.00,$188.21,$0.00,$0.00,$191.27,"$1,092.38",$0.00,$546.19,$865.16,$873.90,$0.00,$170.96,$0.00,$173.91,$0.00
224544,SUP,HCPCS C1713,,224544  -  NAIL IM 4.5MM 44CM ENDR HUM TIB,"$1,092.38",$0.00,"$1,092.38",$491.57,$779.63,$0.00,$188.21,$0.00,$0.00,$191.27,"$1,092.38",$0.00,$546.19,$865.16,$873.90,$0.00,$170.96,$0.00,$173.91,$0.00
224545,SUP,HCPCS C1713,,224545  -  NAIL IM 4.5MM 45CM ENDR HUM TIB,"$1,092.38",$0.00,"$1,092.38",$491.57,$779.63,$0.00,$188.21,$0.00,$0.00,$191.27,"$1,092.38",$0.00,$546.19,$865.16,$873.90,$0.00,$170.96,$0.00,$173.91,$0.00
224546,SUP,HCPCS C1713,,224546  -  NAIL IM 4.5MM 46CM ENDR HUM TIB,"$1,092.38",$0.00,"$1,092.38",$491.57,$779.63,$0.00,$188.21,$0.00,$0.00,$191.27,"$1,092.38",$0.00,$546.19,$865.16,$873.90,$0.00,$170.96,$0.00,$173.91,$0.00
224547,SUP,HCPCS C1713,,224547  -  NAIL IM 4.5MM 47CM ENDR HUM TIB,"$1,092.38",$0.00,"$1,092.38",$491.57,$779.63,$0.00,$188.21,$0.00,$0.00,$191.27,"$1,092.38",$0.00,$546.19,$865.16,$873.90,$0.00,$170.96,$0.00,$173.91,$0.00
224548,SUP,HCPCS C1713,,224548  -  NAIL IM 4.5MM 48CM ENDR HUM TIB,"$1,092.38",$0.00,"$1,092.38",$491.57,$779.63,$0.00,$188.21,$0.00,$0.00,$191.27,"$1,092.38",$0.00,$546.19,$865.16,$873.90,$0.00,$170.96,$0.00,$173.91,$0.00
224549,SUP,HCPCS C1713,,224549  -  NAIL IM 4.5MM 49CM ENDR HUM TIB,"$1,092.38",$0.00,"$1,092.38",$491.57,$779.63,$0.00,$188.21,$0.00,$0.00,$191.27,"$1,092.38",$0.00,$546.19,$865.16,$873.90,$0.00,$170.96,$0.00,$173.91,$0.00
231554,SUP,Custom 25003010,,DISK OPTOCHIN PNMC DIFF BD TXO SNS,$91.08,$0.00,$91.08,$0.00,$65.00,$0.00,$0.00,$0.00,$0.00,$0.00,$91.08,$0.00,$45.54,$72.14,$72.86,$0.00,$0.00,$0.00,$0.00,$0.00
232447,SUP,HCPCS C1713,,232447  -  SYSTEM FX STD RIGIDLOOP ADJ CORT,$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
240765,SUP,Custom 27203010,,REAGENT VDRL CRDLPN AG BUFF SAL DFC .5ML 60ML NTRPN VL SERO,$127.95,$0.00,$127.95,$0.00,$91.32,$0.00,$0.00,$0.00,$0.00,$0.00,$127.95,$0.00,$63.98,$101.34,$102.36,$0.00,$0.00,$0.00,$0.00,$0.00
Jan-00,SUP,Custom 27803010,,01-2600  -  HEAD FEMORAL MORSE TAPERED LFIT HIP,"$1,795.00",$0.00,"$1,795.00",$0.00,"$1,281.09",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,795.00",$0.00,$897.50,"$1,421.64","$1,436.00",$0.00,$0.00,$0.00,$0.00,$0.00
Jun-00,SUP,Custom 27803010,,06-2600  -  HEAD FEMORAL 0 26MM C TAPER LFIT COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
Jan-05,SUP,Custom 27803010,,01-2605  -  HEAD FEMORAL +5MM 26MM MORSE TAPERED LFIT COCR HIP,"$1,795.00",$0.00,"$1,795.00",$0.00,"$1,281.09",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,795.00",$0.00,$897.50,"$1,421.64","$1,436.00",$0.00,$0.00,$0.00,$0.00,$0.00
Jun-05,SUP,Custom 27803010,,06-2605  -  HEAD FEMORAL +5MM 26MM C TAPER OFFST LFIT COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
258962,SUP,HCPCS C1769,,258962  -  INTROD TUBE 24-28FR CGL BRHN 8 PERC HYDPHI INTROD SHLY DILAT,$843.75,$0.00,$843.75,$458.16,$602.18,$0.00,$145.37,$0.00,$0.00,$147.73,$843.75,$0.00,$421.88,$668.25,$675.00,$0.00,$132.05,$0.00,$134.33,$0.00
Jan-10,SUP,Custom 27803010,,01-2610  -  HEAD FEMORAL +10MM 26MM MORSE TAPERED LFIT COCR,"$1,795.00",$0.00,"$1,795.00",$0.00,"$1,281.09",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,795.00",$0.00,$897.50,"$1,421.64","$1,436.00",$0.00,$0.00,$0.00,$0.00,$0.00
Jun-10,SUP,Custom 27803010,,06-2610  -  HEAD FEMORAL +10MM 26MM C TAPER LFIT COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
261187,SUP,Custom 27203010,,REAGENT MCBL DMACA INDL DRPR BBL .5ML,$1.33,$0.00,$1.33,$0.00,$0.95,$0.00,$0.00,$0.00,$0.00,$0.00,$1.33,$0.00,$0.66,$1.05,$1.06,$0.00,$0.00,$0.00,$0.00,$0.00
261221,SUP,Custom 27203010,,261221  -  PERFORATOR SURG 14MM 11MM 14X11MM CRANIUM ADULT STERILE,$735.05,$0.00,$735.05,$0.00,$524.61,$0.00,$0.00,$0.00,$0.00,$0.00,$735.05,$0.00,$367.53,$582.16,$588.04,$0.00,$0.00,$0.00,$0.00,$0.00
263567,SUP,HCPCS C1769,,263567  -  SET INTROD 24-26-28FR CGL BRHN 6 PERC EZ-PASS HYDPHI COAT,$905.05,$0.00,$905.05,$491.44,$645.93,$0.00,$155.94,$0.00,$0.00,$158.47,$905.05,$0.00,$452.53,$716.80,$724.04,$0.00,$141.64,$0.00,$144.08,$0.00
265724,SUP,Custom 27203010,,265724  -  CATHETER FOLEY 5CC 24FR,$4.89,$0.00,$4.89,$0.00,$3.49,$0.00,$0.00,$0.00,$0.00,$0.00,$4.89,$0.00,$2.45,$3.87,$3.91,$0.00,$0.00,$0.00,$0.00,$0.00
266720,SUP,Custom 27203010,,266720  -  CATHETER URTH 20FR 30CC STRL LTX BARD 2W FL 2 OPPS EYE,$5.73,$0.00,$5.73,$0.00,$4.09,$0.00,$0.00,$0.00,$0.00,$0.00,$5.73,$0.00,$2.86,$4.54,$4.58,$0.00,$0.00,$0.00,$0.00,$0.00
266722,SUP,Custom 27203010,,266722  -  CATHETER URTH 22FR 30CC STRL LTX BARD 2W FL 2 OPPS EYE,$5.73,$0.00,$5.73,$0.00,$4.09,$0.00,$0.00,$0.00,$0.00,$0.00,$5.73,$0.00,$2.86,$4.54,$4.58,$0.00,$0.00,$0.00,$0.00,$0.00
266728,SUP,Custom 27203010,,266728  -  CATH URTH 28FR 2W 2 OPPS EYE FOLEY RND TIP SIL-EL 30ML STRL,$6.18,$0.00,$6.18,$0.00,$4.41,$0.00,$0.00,$0.00,$0.00,$0.00,$6.18,$0.00,$3.09,$4.89,$4.94,$0.00,$0.00,$0.00,$0.00,$0.00
268877,SUP,Custom 27203010,,TUBE ACD SOL B 3ML YLW VCTNR CNV CLSR COLLECT,$0.65,$0.00,$0.65,$0.00,$0.46,$0.00,$0.00,$0.00,$0.00,$0.00,$0.65,$0.00,$0.33,$0.51,$0.52,$0.00,$0.00,$0.00,$0.00,$0.00
272905,SUP,Custom 27203010,,DEVICE MACV DISPENSTIRS RPR VDRL KT SERTST .05ML,$183.63,$0.00,$183.63,$0.00,$131.05,$0.00,$0.00,$0.00,$0.00,$0.00,$183.63,$0.00,$91.81,$145.43,$146.90,$0.00,$0.00,$0.00,$0.00,$0.00
276081,SUP,Custom 27803010,,276081  -  SHUNT 276081 UNI DSM VCATH23CM PCTH120CM,"$4,723.88",$0.00,"$4,723.88",$0.00,"$3,371.43",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,723.88",$0.00,"$2,361.94","$3,741.31","$3,779.10",$0.00,$0.00,$0.00,$0.00,$0.00
276082,SUP,Custom 27803010,,276082  -  SHUNT 276082 UNI DSM VCATH23CM PCTH120CM,"$4,723.88",$0.00,"$4,723.88",$0.00,"$3,371.43",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,723.88",$0.00,"$2,361.94","$3,741.31","$3,779.10",$0.00,$0.00,$0.00,$0.00,$0.00
276084,SUP,Custom 27803010,,276084  -  SHUNT 276084 UNI DSM VCATH23CM PCTH120CM,"$4,723.88",$0.00,"$4,723.88",$0.00,"$3,371.43",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,723.88",$0.00,"$2,361.94","$3,741.31","$3,779.10",$0.00,$0.00,$0.00,$0.00,$0.00
276085,SUP,Custom 27803010,,276085  -  SHUNT 276085 UNI DSM VCATH23CM PCTH120CM,"$4,723.88",$0.00,"$4,723.88",$0.00,"$3,371.43",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,723.88",$0.00,"$2,361.94","$3,741.31","$3,779.10",$0.00,$0.00,$0.00,$0.00,$0.00
276124,SUP,Custom 27803010,,276124  -  SHUNT 276124 UNIDLTA VCATH11 PCATH90 38+,"$4,251.25",$0.00,"$4,251.25",$0.00,"$3,034.12",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,251.25",$0.00,"$2,125.63","$3,366.99","$3,401.00",$0.00,$0.00,$0.00,$0.00,$0.00
276125,SUP,Custom 27803010,,276125  -  SHUNT 276125 UNIDLTA VCATH11 PCATH90 38+,"$4,251.25",$0.00,"$4,251.25",$0.00,"$3,034.12",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,251.25",$0.00,"$2,125.63","$3,366.99","$3,401.00",$0.00,$0.00,$0.00,$0.00,$0.00
276201,SUP,Custom 27203010,,276201  -  KIT 276201 SHNT SM BIO PCATH 90 VCATH 15,"$5,804.50",$0.00,"$5,804.50",$0.00,"$4,142.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,804.50",$0.00,"$2,902.25","$4,597.16","$4,643.60",$0.00,$0.00,$0.00,$0.00,$0.00
276391,SUP,Custom 27203010,,276391  -  KIT 276391 DREG VRES PCATH120 VCATH15,"$4,970.88",$0.00,"$4,970.88",$0.00,"$3,547.71",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,970.88",$0.00,"$2,485.44","$3,936.94","$3,976.70",$0.00,$0.00,$0.00,$0.00,$0.00
276412,SUP,Custom 27803010,,276412  -  SHUNT 276412 DSM PCATH130 STRP NOSLT,"$4,134.88",$0.00,"$4,134.88",$0.00,"$2,951.06",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,134.88",$0.00,"$2,067.44","$3,274.82","$3,307.90",$0.00,$0.00,$0.00,$0.00,$0.00
276421,SUP,Custom 27803010,,276421  -  SHUNT 276421 DREG PCATH130 STRP P/L 1.0,"$4,134.88",$0.00,"$4,134.88",$0.00,"$2,951.06",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,134.88",$0.00,"$2,067.44","$3,274.82","$3,307.90",$0.00,$0.00,$0.00,$0.00,$0.00
276709,SUP,Custom 27203010,,CONTROL RPR BBL MACV CRD 1.5ML IMMUN,$105.93,$0.00,$105.93,$0.00,$75.60,$0.00,$0.00,$0.00,$0.00,$0.00,$105.93,$0.00,$52.96,$83.90,$84.74,$0.00,$0.00,$0.00,$0.00,$0.00
278801,SUP,Custom 27803010,,278801  -  SHUNT 278801 DELTA SNP ASY BG SML PL 1.0,"$2,983.00",$0.00,"$2,983.00",$0.00,"$2,128.97",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,983.00",$0.00,"$1,491.50","$2,362.54","$2,386.40",$0.00,$0.00,$0.00,$0.00,$0.00
278802,SUP,Custom 27803010,,278802  -  SHUNT 278802 DELTA SNP ASY BG SML PL 2.0,"$2,983.00",$0.00,"$2,983.00",$0.00,"$2,128.97",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,983.00",$0.00,"$1,491.50","$2,362.54","$2,386.40",$0.00,$0.00,$0.00,$0.00,$0.00
278805,SUP,Custom 27803010,,278805  -  SHUNT 278805 DELTA SNP ASY BG SML PL 1.5,"$2,983.00",$0.00,"$2,983.00",$0.00,"$2,128.97",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,983.00",$0.00,"$1,491.50","$2,362.54","$2,386.40",$0.00,$0.00,$0.00,$0.00,$0.00
281000,SUP,Custom 27203010,,281000  -  DRESSING FOAM THIN 2X1.6IN SELF ADHERENT MOISTURE PROOF,$266.72,$0.00,$266.72,$0.00,$190.36,$0.00,$0.00,$0.00,$0.00,$0.00,$266.72,$0.00,$133.36,$211.24,$213.37,$0.00,$0.00,$0.00,$0.00,$0.00
282400,SUP,Custom 27203010,,282400  -  DRESSING FM 9.2X9.2IN MPLX BR ADH SAFETAC SIL SCRM,$26.69,$0.00,$26.69,$0.00,$19.05,$0.00,$0.00,$0.00,$0.00,$0.00,$26.69,$0.00,$13.34,$21.14,$21.35,$0.00,$0.00,$0.00,$0.00,$0.00
287300,SUP,Custom 27203010,,287300  -  DRESSING FOAM 6X6IN ABSORBENT SELF ADHERENT WATERPROOF,$42.48,$0.00,$42.48,$0.00,$30.32,$0.00,$0.00,$0.00,$0.00,$0.00,$42.48,$0.00,$21.24,$33.64,$33.98,$0.00,$0.00,$0.00,$0.00,$0.00
287500,SUP,Custom 27203010,,287500  -  DRESSING FOAM 20X8IN GENTLE ADHERENCE POLYURETHANE FOAM PAD,$167.05,$0.00,$167.05,$0.00,$119.22,$0.00,$0.00,$0.00,$0.00,$0.00,$167.05,$0.00,$83.52,$132.30,$133.64,$0.00,$0.00,$0.00,$0.00,$0.00
Jan-91,SUP,HCPCS C1713,,01-2691  -  PLATE BONE RECONSTRUCTION ADD ON LEFT CNDYLR HEAD MANDIB 2.4,"$7,577.50",$0.00,"$7,577.50","$3,409.88","$5,158.80",$0.00,"$1,305.57",$0.00,$0.00,"$1,326.76","$7,577.50",$0.00,"$3,788.75","$6,001.38","$6,062.00",$0.00,"$1,185.88",$0.00,"$1,206.34",$0.00
Jan-92,SUP,HCPCS C1713,,01-2692  -  PLATE BONE RECONSTRUCTION ADD ON RIGHT CNDYLR HEAD MANDIB,"$7,577.50",$0.00,"$7,577.50","$3,409.88","$5,158.80",$0.00,"$1,305.57",$0.00,$0.00,"$1,326.76","$7,577.50",$0.00,"$3,788.75","$6,001.38","$6,062.00",$0.00,"$1,185.88",$0.00,"$1,206.34",$0.00
290058,SUP,HCPCS C1713,,290058  -  CAP PCTV 4MM RD STRL,$84.30,$0.00,$84.30,$37.94,$60.16,$0.00,$14.52,$0.00,$0.00,$14.76,$84.30,$0.00,$42.15,$66.77,$67.44,$0.00,$13.19,$0.00,$13.42,$0.00
290060,SUP,HCPCS C1713,,290060  -  CAP PCTV 3MM GRN STRL,$83.70,$0.00,$83.70,$37.67,$59.74,$0.00,$14.42,$0.00,$0.00,$14.66,$83.70,$0.00,$41.85,$66.29,$66.96,$0.00,$13.10,$0.00,$13.33,$0.00
290061,SUP,HCPCS C1713,,290061  -  CAP PROTECTIVE 5MM BLACK STERILE,$78.20,$0.00,$78.20,$35.19,$55.81,$0.00,$13.47,$0.00,$0.00,$13.69,$78.20,$0.00,$39.10,$61.93,$62.56,$0.00,$12.24,$0.00,$12.45,$0.00
293400,SUP,Custom 27203010,,293400  -  DRESSING MPFRM THN 7X4IN ADH FLXB WTPRF SAFETAC TCH WND SIL,$17.62,$0.00,$17.62,$0.00,$12.58,$0.00,$0.00,$0.00,$0.00,$0.00,$17.62,$0.00,$8.81,$13.96,$14.10,$0.00,$0.00,$0.00,$0.00,$0.00
295900,SUP,Custom 27203010,,295900  -  DRESSING FOAM 12X4IN ABSORBENT NONADHERENT WATERPROOF,$376.13,$0.00,$376.13,$0.00,$268.45,$0.00,$0.00,$0.00,$0.00,$0.00,$376.13,$0.00,$188.07,$297.89,$300.91,$0.00,$0.00,$0.00,$0.00,$0.00
296348,SUP,Custom 27203010,,MEDIA MYCL SAB-DEX EMNS AGAR GNTA BBL PLT DP FILL,$57.80,$0.00,$57.80,$0.00,$41.25,$0.00,$0.00,$0.00,$0.00,$0.00,$57.80,$0.00,$28.90,$45.78,$46.24,$0.00,$0.00,$0.00,$0.00,$0.00
304206,SUP,HCPCS C1729,,CATHETER IV 16GA 1.25IN RADIOPQ SFSHLD GRY PCTV TFLN STRL LF,$3.88,$0.00,$3.88,$2.10,$2.77,$0.00,$0.67,$0.00,$0.00,$0.68,$3.88,$0.00,$1.94,$3.07,$3.10,$0.00,$0.61,$0.00,$0.62,$0.00
310431,SUP,Custom 27203010,,310431  -  BIT DRILL 180MM 4.3MM QC 5MM LCK SCR NONSTRL,$260.10,$0.00,$260.10,$0.00,$185.63,$0.00,$0.00,$0.00,$0.00,$0.00,$260.10,$0.00,$130.05,$206.00,$208.08,$0.00,$0.00,$0.00,$0.00,$0.00
311270,SUP,HCPCS C1768,,"311270  -  GRAFT, AVANCE NERVE, 3-4MM X 70MM","$14,750.00",$0.00,"$14,750.00","$6,637.50","$5,158.80",$0.00,"$2,541.35",$0.00,$0.00,"$2,582.61","$14,750.00",$0.00,"$7,375.00","$11,682.00","$11,800.00",$0.00,"$2,308.38",$0.00,"$2,348.20",$0.00
315804,SUP,Custom 27203010,,315804  -  CANNU PRFSN 11.4IN 4MM CORON ART STR SLF INFL BLN LATEX FREE,$163.75,$0.00,$163.75,$0.00,$116.87,$0.00,$0.00,$0.00,$0.00,$0.00,$163.75,$0.00,$81.88,$129.69,$131.00,$0.00,$0.00,$0.00,$0.00,$0.00
315805,SUP,Custom 27203010,,315805  -  CANNULA PERFUSION 2.1MM STR 5MM 11.4IN SELF INFLATING,$205.00,$0.00,$205.00,$0.00,$146.31,$0.00,$0.00,$0.00,$0.00,$0.00,$205.00,$0.00,$102.50,$162.36,$164.00,$0.00,$0.00,$0.00,$0.00,$0.00
315806,SUP,Custom 27203010,,315806  -  CANNU PRFSN 11.4IN 6MM CORON ART 3MM STR SLF INFL BLN FMALE,$196.50,$0.00,$196.50,$0.00,$140.24,$0.00,$0.00,$0.00,$0.00,$0.00,$196.50,$0.00,$98.25,$155.63,$157.20,$0.00,$0.00,$0.00,$0.00,$0.00
315807,SUP,Custom 27203010,,315807  -  CANNU PRFSN 11.4IN 7MM CORON ART 3MM STR SLF INFL BLN FMALE,$163.75,$0.00,$163.75,$0.00,$116.87,$0.00,$0.00,$0.00,$0.00,$0.00,$163.75,$0.00,$81.88,$129.69,$131.00,$0.00,$0.00,$0.00,$0.00,$0.00
323020,SUP,Custom 27803010,,323020  -  STENT LARYNGEAL SMALL 2 SUTURE BUTTON FLEXIBLE NONADHERENT,$262.50,$0.00,$262.50,$0.00,$187.35,$0.00,$0.00,$0.00,$0.00,$0.00,$262.50,$0.00,$131.25,$207.90,$210.00,$0.00,$0.00,$0.00,$0.00,$0.00
323025,SUP,Custom 27803010,,323025  -  STENT LARYNGEAL MEDIUM FLEXIBLE NONADHERENT INTEGRAL,$287.50,$0.00,$287.50,$0.00,$205.19,$0.00,$0.00,$0.00,$0.00,$0.00,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$0.00,$0.00,$0.00,$0.00
323030,SUP,Custom 27803010,,323030  -  STENT LARYNGEAL LARGE FLEXIBLE NONADHERENT INTEGRAL,$287.50,$0.00,$287.50,$0.00,$205.19,$0.00,$0.00,$0.00,$0.00,$0.00,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$0.00,$0.00,$0.00,$0.00
325014,SUP,HCPCS C1713,,325014  -  SCREW BN 4MM 14MM NS ASNS III P/T CNN SS,$206.25,$0.00,$206.25,$92.81,$147.20,$0.00,$35.54,$0.00,$0.00,$36.11,$206.25,$0.00,$103.13,$163.35,$165.00,$0.00,$32.28,$0.00,$32.84,$0.00
325016,SUP,HCPCS C1713,,325016  -  SCREW BONE 4MM 16MM ASNS 3 SS PTHRD FRARM CANN NONSTRL,$192.50,$0.00,$192.50,$86.63,$137.39,$0.00,$33.17,$0.00,$0.00,$33.71,$192.50,$0.00,$96.25,$152.46,$154.00,$0.00,$30.13,$0.00,$30.65,$0.00
325018,SUP,HCPCS C1713,,325018  -  SCREW BN 4MM 18MM STRL ASNS III P/T IMPL SS,$206.25,$0.00,$206.25,$92.81,$147.20,$0.00,$35.54,$0.00,$0.00,$36.11,$206.25,$0.00,$103.13,$163.35,$165.00,$0.00,$32.28,$0.00,$32.84,$0.00
325020,SUP,HCPCS C1713,,325020  -  SCREW BONE 4MM 20MM ASNS 3 SS CANN NONSTRL,$206.25,$0.00,$206.25,$92.81,$147.20,$0.00,$35.54,$0.00,$0.00,$36.11,$206.25,$0.00,$103.13,$163.35,$165.00,$0.00,$32.28,$0.00,$32.84,$0.00
325022,SUP,HCPCS C1713,,325022  -  SCREW BONE 4MM 22MM ASNS 3 SS CANN NONSTRL,$206.25,$0.00,$206.25,$92.81,$147.20,$0.00,$35.54,$0.00,$0.00,$36.11,$206.25,$0.00,$103.13,$163.35,$165.00,$0.00,$32.28,$0.00,$32.84,$0.00
325024,SUP,HCPCS C1713,,325024  -  SCREW BONE 4MM 24MM ASNS 3 SS PTHRD FRARM CANN NONSTRL,$192.50,$0.00,$192.50,$86.63,$137.39,$0.00,$33.17,$0.00,$0.00,$33.71,$192.50,$0.00,$96.25,$152.46,$154.00,$0.00,$30.13,$0.00,$30.65,$0.00
325026,SUP,HCPCS C1713,,325026  -  SCREW BN P/T 4MM 26MM STRL 9MM ASNS III ST SLF DRL CNN SS,$206.25,$0.00,$206.25,$92.81,$147.20,$0.00,$35.54,$0.00,$0.00,$36.11,$206.25,$0.00,$103.13,$163.35,$165.00,$0.00,$32.28,$0.00,$32.84,$0.00
325028,SUP,HCPCS C1713,,325028  -  SCREW BN 4MM 28MM STRL 9.5MM ASNS III CNN SS,$206.25,$0.00,$206.25,$92.81,$147.20,$0.00,$35.54,$0.00,$0.00,$36.11,$206.25,$0.00,$103.13,$163.35,$165.00,$0.00,$32.28,$0.00,$32.84,$0.00
325030,SUP,HCPCS C1713,,325030  -  SCREW BN P/T 4MM 30MM STRL ASNS III ST SLF DRL CNN SS HIP,$206.25,$0.00,$206.25,$92.81,$147.20,$0.00,$35.54,$0.00,$0.00,$36.11,$206.25,$0.00,$103.13,$163.35,$165.00,$0.00,$32.28,$0.00,$32.84,$0.00
325032,SUP,HCPCS C1713,,325032  -  SCREW BONE 4MM 32MM SS PTTHRD IMPL STRL,$206.25,$0.00,$206.25,$92.81,$147.20,$0.00,$35.54,$0.00,$0.00,$36.11,$206.25,$0.00,$103.13,$163.35,$165.00,$0.00,$32.28,$0.00,$32.84,$0.00
325034,SUP,HCPCS C1713,,325034  -  SCREW BONE 4MM 34MM SS PTTHRD IMPL STRL,$206.25,$0.00,$206.25,$92.81,$147.20,$0.00,$35.54,$0.00,$0.00,$36.11,$206.25,$0.00,$103.13,$163.35,$165.00,$0.00,$32.28,$0.00,$32.84,$0.00
325036,SUP,HCPCS C1713,,325036  -  SCREW BONE 4MM 36MM ASNS 3 SS PTHRD FEM HIP STRL,$272.25,$0.00,$272.25,$122.51,$194.30,$0.00,$46.91,$0.00,$0.00,$47.67,$272.25,$0.00,$136.13,$215.62,$217.80,$0.00,$42.61,$0.00,$43.34,$0.00
325038,SUP,HCPCS C1713,,325038  -  SCREW BN P/T 4MM 38MM NS ASNS III ST SLF DRL LOPRFL HD CNN,$272.25,$0.00,$272.25,$122.51,$194.30,$0.00,$46.91,$0.00,$0.00,$47.67,$272.25,$0.00,$136.13,$215.62,$217.80,$0.00,$42.61,$0.00,$43.34,$0.00
325040,SUP,HCPCS C1713,,325040  -  SCREW BONE 4MM 40MM ASNS 3 SS PTHRD HIP CANN SYS SLFTAP CUT,$272.25,$0.00,$272.25,$122.51,$194.30,$0.00,$46.91,$0.00,$0.00,$47.67,$272.25,$0.00,$136.13,$215.62,$217.80,$0.00,$42.61,$0.00,$43.34,$0.00
325042,SUP,HCPCS C1713,,325042  -  SCREW BONE 4MM 42MM ASNS 3 SS ORTH CANN,$272.25,$0.00,$272.25,$122.51,$194.30,$0.00,$46.91,$0.00,$0.00,$47.67,$272.25,$0.00,$136.13,$215.62,$217.80,$0.00,$42.61,$0.00,$43.34,$0.00
325044,SUP,HCPCS C1713,,325044  -  SCREW BONE 4MM 44MM ASNS 3 SS HIP SLFTAP SLFDRILL CANN PTHRD,$254.38,$0.00,$254.38,$114.47,$181.55,$0.00,$43.83,$0.00,$0.00,$44.54,$254.38,$0.00,$127.19,$201.47,$203.50,$0.00,$39.81,$0.00,$40.50,$0.00
325046,SUP,HCPCS C1713,,325046  -  SCREW BONE 4MM 46MM ASNS 3 SS HIP SLFTAP SLFDRILL CANN PTHRD,$272.25,$0.00,$272.25,$122.51,$194.30,$0.00,$46.91,$0.00,$0.00,$47.67,$272.25,$0.00,$136.13,$215.62,$217.80,$0.00,$42.61,$0.00,$43.34,$0.00
325048,SUP,HCPCS C1713,,325048  -  SCREW BN P/T 4MM 48MM NS ASNS III ST SLF DRL LOPRFL HD CNN,$272.25,$0.00,$272.25,$122.51,$194.30,$0.00,$46.91,$0.00,$0.00,$47.67,$272.25,$0.00,$136.13,$215.62,$217.80,$0.00,$42.61,$0.00,$43.34,$0.00
325050,SUP,HCPCS C1713,,325050  -  SCREW BONE 4MM 50MM ASNS 3 SS PTHRD HIP CANN SLFTAP SLFDRILL,$272.25,$0.00,$272.25,$122.51,$194.30,$0.00,$46.91,$0.00,$0.00,$47.67,$272.25,$0.00,$136.13,$215.62,$217.80,$0.00,$42.61,$0.00,$43.34,$0.00
325055,SUP,HCPCS C1713,,325055  -  SCREW BONE 4MM 55MM ASNS 3 SS PTHRD HIP CANN SLFTAP CUT STRL,$272.25,$0.00,$272.25,$122.51,$194.30,$0.00,$46.91,$0.00,$0.00,$47.67,$272.25,$0.00,$136.13,$215.62,$217.80,$0.00,$42.61,$0.00,$43.34,$0.00
325060,SUP,HCPCS C1713,,325060  -  SCREW BONE 4MM 60MM ASNS 3 SS CANN NONSTRL,$272.25,$0.00,$272.25,$122.51,$194.30,$0.00,$46.91,$0.00,$0.00,$47.67,$272.25,$0.00,$136.13,$215.62,$217.80,$0.00,$42.61,$0.00,$43.34,$0.00
325065,SUP,HCPCS C1713,,325065  -  SCREW BONE 4MM 65MM ASNS 3 SS HIP CANN NONSTRL,$286.00,$0.00,$286.00,$128.70,$204.12,$0.00,$49.28,$0.00,$0.00,$50.08,$286.00,$0.00,$143.00,$226.51,$228.80,$0.00,$44.76,$0.00,$45.53,$0.00
325070,SUP,HCPCS C1713,,325070  -  SCREW BONE 4MM 70MM ASNS 3 SS PTHRD HIP CANN STRL,$286.00,$0.00,$286.00,$128.70,$204.12,$0.00,$49.28,$0.00,$0.00,$50.08,$286.00,$0.00,$143.00,$226.51,$228.80,$0.00,$44.76,$0.00,$45.53,$0.00
325420,SUP,HCPCS C1713,,325420  -  SCREW BONE 5MM 20MM ASNS 3 SS ORTH CANN PTHRD STRL,$166.38,$0.00,$166.38,$74.87,$118.74,$0.00,$28.67,$0.00,$0.00,$29.13,$166.38,$0.00,$83.19,$131.77,$133.10,$0.00,$26.04,$0.00,$26.49,$0.00
326260,SUP,HCPCS C1713,,326260  -  SCREW BONE 6.5MM 60MM 40MM ASNS 3 SS ORTH CANN STRL,$391.88,$0.00,$391.88,$176.34,$279.68,$0.00,$67.52,$0.00,$0.00,$68.61,$391.88,$0.00,$195.94,$310.37,$313.50,$0.00,$61.33,$0.00,$62.39,$0.00
Jan-00,SUP,Custom 27803010,,01-2800  -  HEAD FEM +0MM OFST MRS TPR 28MM STRL HIP,"$1,795.00",$0.00,"$1,795.00",$0.00,"$1,281.09",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,795.00",$0.00,$897.50,"$1,421.64","$1,436.00",$0.00,$0.00,$0.00,$0.00,$0.00
Jun-00,SUP,Custom 27803010,,06-2800  -  HEAD FEM +0MM OFST CTPR 28MM LFIT COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
330046,SUP,Custom 27203010,,ADAPTER TBG Y 2 FMALE SCR TO 1 MALE BYNT,$29.70,$0.00,$29.70,$0.00,$21.20,$0.00,$0.00,$0.00,$0.00,$0.00,$29.70,$0.00,$14.85,$23.52,$23.76,$0.00,$0.00,$0.00,$0.00,$0.00
Jan-05,SUP,HCPCS C1776,,01-2805  -  HEAD FEM +5MM 28MM LFIT MRS TPR COCR HIP,"$1,795.00",$0.00,"$1,795.00",$807.75,"$1,281.09",$0.00,$309.27,$0.00,$0.00,$314.29,"$1,795.00",$0.00,$897.50,"$1,421.64","$1,436.00",$0.00,$280.92,$0.00,$285.76,$0.00
Jun-05,SUP,Custom 27803010,,06-2805  -  HEAD FEM +5MM OFST CTPR 28MM LFIT COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
331822,SUP,HCPCS C1729,,CATHETER CONTAMINATING GUARD AG-2000,$30.00,$0.00,$30.00,$16.29,$21.41,$0.00,$5.17,$0.00,$0.00,$5.25,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$4.70,$0.00,$4.78,$0.00
332079,SUP,Custom 27203010,,TRAY EPDRL 17GA 3.5IN NDL MTL TIP SYR FLTR PRFX TH SCHF,$720.00,$0.00,$720.00,$0.00,$513.86,$0.00,$0.00,$0.00,$0.00,$0.00,$720.00,$0.00,$360.00,$570.24,$576.00,$0.00,$0.00,$0.00,$0.00,$0.00
Jan-10,SUP,Custom 27803010,,01-2810  -  HEAD FEM LFIT MRS TPR,"$1,795.00",$0.00,"$1,795.00",$0.00,"$1,281.09",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,795.00",$0.00,$897.50,"$1,421.64","$1,436.00",$0.00,$0.00,$0.00,$0.00,$0.00
Jun-10,SUP,Custom 27803010,,06-2810  -  HEAD FEM +10MM OFST CTPR 28MM LFIT COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
333676,SUP,Custom 27203010,,NEEDLE NS STPLX D BVL INSL EXTN SET 15D 4.75IN 22GA,$127.50,$0.00,$127.50,$0.00,$91.00,$0.00,$0.00,$0.00,$0.00,$0.00,$127.50,$0.00,$63.75,$100.98,$102.00,$0.00,$0.00,$0.00,$0.00,$0.00
333690,SUP,Custom 27203010,,NEEDLE NS STPLX A INSL EXTN SET BVL 30D DIG/HNS11 STM 2IN 22,$23.45,$0.00,$23.45,$0.00,$16.74,$0.00,$0.00,$0.00,$0.00,$0.00,$23.45,$0.00,$11.73,$18.57,$18.76,$0.00,$0.00,$0.00,$0.00,$0.00
334050,SUP,HCPCS C1900,,334050  -  PHILOS DR SYSTEM,"$8,500.00",$0.00,"$8,500.00",$0.00,"$5,158.80",$0.00,"$1,464.51",$0.00,$0.00,$0.00,"$8,500.00",$0.00,"$4,250.00","$6,732.00","$6,800.00",$0.00,"$1,330.25",$0.00,$0.00,$0.00
335903,SUP,HCPCS C1729,,CATHETER IV 20GA 1.75IN RADIOPQ SFSHLD PNK ACV+ OCRILON STRL,$3.98,$0.00,$3.98,$2.16,$2.84,$0.00,$0.68,$0.00,$0.00,$0.70,$3.98,$0.00,$1.99,$3.15,$3.18,$0.00,$0.62,$0.00,$0.63,$0.00
338001,SUP,HCPCS C1729,,CATHETER IV 22GA 1IN RADIOPQ SFSHLD BLUE ACV J TFLN STRL LF,$3.80,$0.00,$3.80,$2.06,$2.71,$0.00,$0.65,$0.00,$0.00,$0.67,$3.80,$0.00,$1.90,$3.01,$3.04,$0.00,$0.59,$0.00,$0.60,$0.00
338610,SUP,HCPCS C1713,,338610  -  SCREW BONE 3.5MM 10MM AXSOS SS FULTHD CORT SLFTAP,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
338612,SUP,HCPCS C1713,,338612  -  SCREW BONE 3.5MM 12MM SS CORT SLFTAP,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
338614,SUP,HCPCS C1713,,338614  -  SCREW BONE 3.5MM 14MM AXSOS SS FULTHD CORT HUM HEX DRV,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
338616,SUP,HCPCS C1713,,338616  -  SCREW BONE 3.5MM 16MM SS CORT SLFTAP,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
338618,SUP,HCPCS C1713,,338618  -  SCREW BONE 3.5MM 2.5MM 18MM AXSOS SS CORT PROX HUM HEX DRV,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
338620,SUP,HCPCS C1713,,338620  -  SCREW BN 2.5MM 3.5MM 20MM NS ST HEX SS CORT AXSOS SM FRAG,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
338622,SUP,HCPCS C1713,,338622  -  SCREW BN 2.5MM 3.5MM 22MM NS ST HEX SS CORT AXSOS SM FRAG,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
338624,SUP,HCPCS C1713,,338624  -  SCREW BN 2.5MM 3.5MM 24MM NS ST HEX SS CORT AXSOS SM FRAG,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
338626,SUP,HCPCS C1713,,338626  -  SCREW BN 2.5MM 3.5MM 26MM NS ST HEX SS CORT AXSOS SM FRAG,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
338628,SUP,HCPCS C1713,,338628  -  SCREW BN 2.5MM 3.5MM 28MM NS ST HEX SS CORT AXSOS SM FRAG,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
338630,SUP,HCPCS C1713,,338630  -  SCREW BN 2.5MM 3.5MM 30MM NS ST HEX SS CORT AXSOS SM FRAG,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
338632,SUP,HCPCS C1713,,338632  -  SCREW BONE 3.5MM 32MM AXSOS SS 2.5MM PROX CORT HUM SLFTAP,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
338634,SUP,HCPCS C1713,,338634  -  SCREW BN 2.5MM 3.5MM 34MM NS ST HEX SS CORT AXSOS SM FRAG,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
338636,SUP,HCPCS C1713,,338636  -  SCREW BONE 3.5MM 36MM AXSOS SS FULTHD CORT HUM HEX DRV,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
338638,SUP,HCPCS C1713,,338638  -  SCREW BN 2.5MM 3.5MM 38MM NS ST HEX SS CORT AXSOS SM FRAG,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
338640,SUP,HCPCS C1713,,338640  -  SCREW BN 2.5MM 3.5MM 40MM NS ST HEX SS CORT AXSOS SM FRAG,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
338642,SUP,HCPCS C1713,,338642  -  SCREW BONE 3.5MM 40MM AXSOS SS FULTHD CORT SLFTAP,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
338644,SUP,HCPCS C1713,,338644  -  SCREW BONE 3.5MM 44MM AXSOS SS FULTHD CORT HUM HEX DRV,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
338645,SUP,HCPCS C1713,,338645  -  SCREW BN 2.5MM 3.5MM 45MM NS ST HEX SS CORT AXSOS SM FRAG,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
338646,SUP,HCPCS C1713,,338646  -  SCREW BONE 3.5MM 46MM SS CORT SLFTAP,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
338648,SUP,HCPCS C1713,,338648  -  SCREW BONE 3.5MM 48MM AXSOS SS FULTHD CORT HUM HEX DRV,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
338650,SUP,HCPCS C1713,,338650  -  SCREW BN 2.5MM 3.5MM 50MM NS ST HEX SS CORT AXSOS SM FRAG,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
338655,SUP,HCPCS C1713,,338655  -  SCREW BN 2.5MM 3.5MM 55MM NS ST HEX SS CORT AXSOS SM FRAG,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
338660,SUP,HCPCS C1713,,338660  -  SCREW BN 2.5MM 3.5MM 60MM NS ST HEX SS CORT AXSOS SM FRAG,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
338665,SUP,HCPCS C1713,,338665  -  SCREW BN 2.5MM 3.5MM 65MM NS ST HEX SS CORT AXSOS SM FRAG,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
338670,SUP,HCPCS C1713,,338670  -  SCREW BN 2.5MM 3.5MM 70MM NS ST HEX SS CORT AXSOS SM FRAG,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
338675,SUP,HCPCS C1713,,338675  -  SCREW BN 2.5MM 3.5MM 75MM NS ST HEX SS CORT AXSOS SM FRAG,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
338680,SUP,HCPCS C1713,,338680  -  SCREW BN 2.5MM 3.5MM 80MM NS ST HEX SS CORT AXSOS SM FRAG,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
338685,SUP,HCPCS C1713,,338685  -  SCREW BN 2.5MM 3.5MM 85MM NS ST HEX SS CORT AXSOS SM FRAG,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
338690,SUP,HCPCS C1713,,338690  -  SCREW BN 2.5MM 3.5MM 90MM NS ST HEX SS CORT AXSOS SM FRAG,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
338695,SUP,HCPCS C1713,,338695  -  SCREW BONE 3.5MM 95MM CORT SLFTAP,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
338700,SUP,HCPCS C1713,,338700  -  SCREW BN FT 3.5MM 100MM ST HEX SS CORT AXSOS SM FRAG SET,$46.75,$0.00,$46.75,$21.04,$33.37,$0.00,$8.05,$0.00,$0.00,$8.19,$46.75,$0.00,$23.38,$37.03,$37.40,$0.00,$7.32,$0.00,$7.44,$0.00
338705,SUP,HCPCS C1713,,338705  -  SCREW BONE 3.5MM 105MM CORT SLFTAP,$46.75,$0.00,$46.75,$21.04,$33.37,$0.00,$8.05,$0.00,$0.00,$8.19,$46.75,$0.00,$23.38,$37.03,$37.40,$0.00,$7.32,$0.00,$7.44,$0.00
338710,SUP,HCPCS C1713,,338710  -  SCREW BONE 3.5MM 110MM CORT SLFTAP,$46.75,$0.00,$46.75,$21.04,$33.37,$0.00,$8.05,$0.00,$0.00,$8.19,$46.75,$0.00,$23.38,$37.03,$37.40,$0.00,$7.32,$0.00,$7.44,$0.00
338715,SUP,HCPCS C1713,,338715  -  SCREW BONE 3.5MM 115MM SS CORT SLFTAP,$46.75,$0.00,$46.75,$21.04,$33.37,$0.00,$8.05,$0.00,$0.00,$8.19,$46.75,$0.00,$23.38,$37.03,$37.40,$0.00,$7.32,$0.00,$7.44,$0.00
338720,SUP,HCPCS C1713,,338720  -  SCREW BONE 3.5MM 120MM SS CORT SLFTAP,$46.75,$0.00,$46.75,$21.04,$33.37,$0.00,$8.05,$0.00,$0.00,$8.19,$46.75,$0.00,$23.38,$37.03,$37.40,$0.00,$7.32,$0.00,$7.44,$0.00
340612,SUP,HCPCS C1713,,340612  -  SCREW BONE 4.5MM 12MM CORT SLFTAP,$28.88,$0.00,$28.88,$12.99,$20.61,$0.00,$4.98,$0.00,$0.00,$5.06,$28.88,$0.00,$14.44,$22.87,$23.10,$0.00,$4.52,$0.00,$4.60,$0.00
340614,SUP,HCPCS C1713,,340614  -  SCREW BONE 4.5MM 14MM CORT SLFTAP,$33.00,$0.00,$33.00,$14.85,$23.55,$0.00,$5.69,$0.00,$0.00,$5.78,$33.00,$0.00,$16.50,$26.14,$26.40,$0.00,$5.16,$0.00,$5.25,$0.00
340616,SUP,HCPCS C1713,,340616  -  SCREW BONE 4.5MM 16MM ISO SS FULTHD CORT SLFTAP NONSTRL,$33.00,$0.00,$33.00,$14.85,$23.55,$0.00,$5.69,$0.00,$0.00,$5.78,$33.00,$0.00,$16.50,$26.14,$26.40,$0.00,$5.16,$0.00,$5.25,$0.00
340618,SUP,HCPCS C1713,,340618  -  SCREW BONE 4.5MM 18MM AXSOS SS CORT SLFTAP LCK HEX DRV,$33.00,$0.00,$33.00,$14.85,$23.55,$0.00,$5.69,$0.00,$0.00,$5.78,$33.00,$0.00,$16.50,$26.14,$26.40,$0.00,$5.16,$0.00,$5.25,$0.00
340620,SUP,HCPCS C1713,,340620  -  SCREW BONE 4.5MM 20MM SS CORT SLFTAP,$33.00,$0.00,$33.00,$14.85,$23.55,$0.00,$5.69,$0.00,$0.00,$5.78,$33.00,$0.00,$16.50,$26.14,$26.40,$0.00,$5.16,$0.00,$5.25,$0.00
340622,SUP,HCPCS C1713,,340622  -  SCREW BONE 4.5MM 22MM SS CORT SLFTAP,$33.00,$0.00,$33.00,$14.85,$23.55,$0.00,$5.69,$0.00,$0.00,$5.78,$33.00,$0.00,$16.50,$26.14,$26.40,$0.00,$5.16,$0.00,$5.25,$0.00
340624,SUP,HCPCS C1713,,340624  -  SCREW BONE 4.5MM 24MM AXSOS SS CORT SLFTAP,$33.00,$0.00,$33.00,$14.85,$23.55,$0.00,$5.69,$0.00,$0.00,$5.78,$33.00,$0.00,$16.50,$26.14,$26.40,$0.00,$5.16,$0.00,$5.25,$0.00
340626,SUP,HCPCS C1713,,340626  -  SCREW BONE 4.5MM 26MM AXSOS SS CORT SLFTAP LCK HEX DRV,$33.00,$0.00,$33.00,$14.85,$23.55,$0.00,$5.69,$0.00,$0.00,$5.78,$33.00,$0.00,$16.50,$26.14,$26.40,$0.00,$5.16,$0.00,$5.25,$0.00
340628,SUP,HCPCS C1713,,340628  -  SCREW BONE 4.5MM 28MM AXSOS SS CORT SLFTAP,$33.00,$0.00,$33.00,$14.85,$23.55,$0.00,$5.69,$0.00,$0.00,$5.78,$33.00,$0.00,$16.50,$26.14,$26.40,$0.00,$5.16,$0.00,$5.25,$0.00
340630,SUP,HCPCS C1713,,340630  -  SCREW BONE 4.5MM 30MM AXSOS SS CORT SLFTAP LCK HEX DRV,$33.00,$0.00,$33.00,$14.85,$23.55,$0.00,$5.69,$0.00,$0.00,$5.78,$33.00,$0.00,$16.50,$26.14,$26.40,$0.00,$5.16,$0.00,$5.25,$0.00
340632,SUP,HCPCS C1713,,340632  -  SCREW BONE 4.5MM 32MM AXSOS SS CORT SLFTAP,$33.00,$0.00,$33.00,$14.85,$23.55,$0.00,$5.69,$0.00,$0.00,$5.78,$33.00,$0.00,$16.50,$26.14,$26.40,$0.00,$5.16,$0.00,$5.25,$0.00
340634,SUP,HCPCS C1713,,340634  -  SCREW BONE 4.5MM 34MM SPS SS CORT SLFTAP BASIC FRAG SET,$33.00,$0.00,$33.00,$14.85,$23.55,$0.00,$5.69,$0.00,$0.00,$5.78,$33.00,$0.00,$16.50,$26.14,$26.40,$0.00,$5.16,$0.00,$5.25,$0.00
340636,SUP,HCPCS C1713,,340636  -  SCREW BONE 4.5MM 36MM AXSOS SS 3.5MM LAT DISTAL CORT FEM,$33.00,$0.00,$33.00,$14.85,$23.55,$0.00,$5.69,$0.00,$0.00,$5.78,$33.00,$0.00,$16.50,$26.14,$26.40,$0.00,$5.16,$0.00,$5.25,$0.00
340638,SUP,HCPCS C1713,,340638  -  SCREW BONE 4.5MM 38MM AXSOS SS 3.5MM LAT DISTAL CORT FEM,$33.00,$0.00,$33.00,$14.85,$23.55,$0.00,$5.69,$0.00,$0.00,$5.78,$33.00,$0.00,$16.50,$26.14,$26.40,$0.00,$5.16,$0.00,$5.25,$0.00
340640,SUP,HCPCS C1713,,340640  -  SCREW BONE 4.5MM 40MM AXSOS SS 3.5MM LAT DISTAL CORT FEM,$33.00,$0.00,$33.00,$14.85,$23.55,$0.00,$5.69,$0.00,$0.00,$5.78,$33.00,$0.00,$16.50,$26.14,$26.40,$0.00,$5.16,$0.00,$5.25,$0.00
340642,SUP,HCPCS C1713,,340642  -  SCREW BONE 4.5MM 42MM AXSOS SS CORT SLFTAP LCK HEX DRV,$33.00,$0.00,$33.00,$14.85,$23.55,$0.00,$5.69,$0.00,$0.00,$5.78,$33.00,$0.00,$16.50,$26.14,$26.40,$0.00,$5.16,$0.00,$5.25,$0.00
340644,SUP,HCPCS C1713,,340644  -  SCREW BONE 4.5MM 44MM AXSOS SS CORT SLFTAP LCK HEX DRV,$33.00,$0.00,$33.00,$14.85,$23.55,$0.00,$5.69,$0.00,$0.00,$5.78,$33.00,$0.00,$16.50,$26.14,$26.40,$0.00,$5.16,$0.00,$5.25,$0.00
340646,SUP,HCPCS C1713,,340646  -  SCREW BONE 4.5MM 46MM AXSOS SS CORT SLFTAP LCK HEX DRV,$33.00,$0.00,$33.00,$14.85,$23.55,$0.00,$5.69,$0.00,$0.00,$5.78,$33.00,$0.00,$16.50,$26.14,$26.40,$0.00,$5.16,$0.00,$5.25,$0.00
340648,SUP,HCPCS C1713,,340648  -  SCREW BONE 4.5MM 48MM AXSOS SS CORT SLFTAP LCK HEX DRV,$33.00,$0.00,$33.00,$14.85,$23.55,$0.00,$5.69,$0.00,$0.00,$5.78,$33.00,$0.00,$16.50,$26.14,$26.40,$0.00,$5.16,$0.00,$5.25,$0.00
340650,SUP,HCPCS C1713,,340650  -  SCREW BONE 4.5MM 50MM AXSOS SS CORT SLFTAP LCK HEX DRV,$33.00,$0.00,$33.00,$14.85,$23.55,$0.00,$5.69,$0.00,$0.00,$5.78,$33.00,$0.00,$16.50,$26.14,$26.40,$0.00,$5.16,$0.00,$5.25,$0.00
340652,SUP,HCPCS C1713,,340652  -  SCREW BONE 4.5MM 52MM AXSOS SS CORT SLFTAP LCK HEX DRV,$33.00,$0.00,$33.00,$14.85,$23.55,$0.00,$5.69,$0.00,$0.00,$5.78,$33.00,$0.00,$16.50,$26.14,$26.40,$0.00,$5.16,$0.00,$5.25,$0.00
340654,SUP,HCPCS C1713,,340654  -  SCREW BONE 4.5MM 54MM AXSOS SS CORT SLFTAP,$33.00,$0.00,$33.00,$14.85,$23.55,$0.00,$5.69,$0.00,$0.00,$5.78,$33.00,$0.00,$16.50,$26.14,$26.40,$0.00,$5.16,$0.00,$5.25,$0.00
340656,SUP,HCPCS C1713,,340656  -  SCREW BONE 4.5MM 56MM AXSOS SS CORT SLFTAP,$33.00,$0.00,$33.00,$14.85,$23.55,$0.00,$5.69,$0.00,$0.00,$5.78,$33.00,$0.00,$16.50,$26.14,$26.40,$0.00,$5.16,$0.00,$5.25,$0.00
340658,SUP,HCPCS C1713,,340658  -  SCREW BONE 4.5MM 58MM AXSOS SS CORT SLFTAP,$33.00,$0.00,$33.00,$14.85,$23.55,$0.00,$5.69,$0.00,$0.00,$5.78,$33.00,$0.00,$16.50,$26.14,$26.40,$0.00,$5.16,$0.00,$5.25,$0.00
340660,SUP,HCPCS C1713,,340660  -  SCREW BONE 4.5MM 60MM AXSOS SS CORT SLFTAP LCK HEX DRV,$33.00,$0.00,$33.00,$14.85,$23.55,$0.00,$5.69,$0.00,$0.00,$5.78,$33.00,$0.00,$16.50,$26.14,$26.40,$0.00,$5.16,$0.00,$5.25,$0.00
340665,SUP,HCPCS C1713,,340665  -  SCREW BONE 4.5MM 3.5MM 65MM AXSOS SS CORT HEX DRV SLFTAP LCK,$33.00,$0.00,$33.00,$14.85,$23.55,$0.00,$5.69,$0.00,$0.00,$5.78,$33.00,$0.00,$16.50,$26.14,$26.40,$0.00,$5.16,$0.00,$5.25,$0.00
340670,SUP,HCPCS C1713,,340670  -  SCREW BONE 4.5MM 70MM AXSOS SS CORT SLFTAP,$33.00,$0.00,$33.00,$14.85,$23.55,$0.00,$5.69,$0.00,$0.00,$5.78,$33.00,$0.00,$16.50,$26.14,$26.40,$0.00,$5.16,$0.00,$5.25,$0.00
340675,SUP,HCPCS C1713,,340675  -  SCREW BONE 4.5MM 75MM AXSOS SS CORT SLFTAP,$33.00,$0.00,$33.00,$14.85,$23.55,$0.00,$5.69,$0.00,$0.00,$5.78,$33.00,$0.00,$16.50,$26.14,$26.40,$0.00,$5.16,$0.00,$5.25,$0.00
340680,SUP,HCPCS C1713,,340680  -  SCREW BONE 4.5MM 80MM AXSOS SS CORT SLFTAP,$33.00,$0.00,$33.00,$14.85,$23.55,$0.00,$5.69,$0.00,$0.00,$5.78,$33.00,$0.00,$16.50,$26.14,$26.40,$0.00,$5.16,$0.00,$5.25,$0.00
340685,SUP,HCPCS C1713,,340685  -  SCREW BONE 4.5MM 85MM AXSOS SS CORT SLFTAP,$33.00,$0.00,$33.00,$14.85,$23.55,$0.00,$5.69,$0.00,$0.00,$5.78,$33.00,$0.00,$16.50,$26.14,$26.40,$0.00,$5.16,$0.00,$5.25,$0.00
340690,SUP,HCPCS C1713,,340690  -  SCREW BONE 4.5MM 90MM AXSOS SS CORT SLFTAP,$33.00,$0.00,$33.00,$14.85,$23.55,$0.00,$5.69,$0.00,$0.00,$5.78,$33.00,$0.00,$16.50,$26.14,$26.40,$0.00,$5.16,$0.00,$5.25,$0.00
340695,SUP,HCPCS C1713,,340695  -  SCREW BONE 4.5MM 95MM AXSOS SS CORT SLFTAP,$33.00,$0.00,$33.00,$14.85,$23.55,$0.00,$5.69,$0.00,$0.00,$5.78,$33.00,$0.00,$16.50,$26.14,$26.40,$0.00,$5.16,$0.00,$5.25,$0.00
340700,SUP,HCPCS C1713,,340700  -  SCREW BONE 4.5MM 100MM AXSOS SS CORT SLFTAP,$48.13,$0.00,$48.13,$21.66,$34.35,$0.00,$8.29,$0.00,$0.00,$8.43,$48.13,$0.00,$24.06,$38.12,$38.50,$0.00,$7.53,$0.00,$7.66,$0.00
340705,SUP,HCPCS C1713,,340705  -  SCREW BONE 4.5MM 105MM AXSOS SS CORT SLFTAP,$48.13,$0.00,$48.13,$21.66,$34.35,$0.00,$8.29,$0.00,$0.00,$8.43,$48.13,$0.00,$24.06,$38.12,$38.50,$0.00,$7.53,$0.00,$7.66,$0.00
340710,SUP,HCPCS C1713,,340710  -  SCREW BONE 4.5MM 100MM AXSOS SS CORT SLFTAP,$48.13,$0.00,$48.13,$21.66,$34.35,$0.00,$8.29,$0.00,$0.00,$8.43,$48.13,$0.00,$24.06,$38.12,$38.50,$0.00,$7.53,$0.00,$7.66,$0.00
340715,SUP,HCPCS C1713,,340715  -  SCREW BONE 4.5MM 115MM SS CORT SLFTAP,$48.13,$0.00,$48.13,$21.66,$34.35,$0.00,$8.29,$0.00,$0.00,$8.43,$48.13,$0.00,$24.06,$38.12,$38.50,$0.00,$7.53,$0.00,$7.66,$0.00
340720,SUP,HCPCS C1713,,340720  -  SCREW BONE 4.5MM 120MM CORT,$48.13,$0.00,$48.13,$21.66,$34.35,$0.00,$8.29,$0.00,$0.00,$8.43,$48.13,$0.00,$24.06,$38.12,$38.50,$0.00,$7.53,$0.00,$7.66,$0.00
340725,SUP,HCPCS C1713,,340725  -  SCREW BONE 4.5MM 125MM ISO SS FULTHD CORT SLFTAP,$48.13,$0.00,$48.13,$21.66,$34.35,$0.00,$8.29,$0.00,$0.00,$8.43,$48.13,$0.00,$24.06,$38.12,$38.50,$0.00,$7.53,$0.00,$7.66,$0.00
340730,SUP,HCPCS C1713,,340730  -  SCREW BONE 4.5MM 130MM ISO SS FULTHD CORT SLFTAP,$48.13,$0.00,$48.13,$21.66,$34.35,$0.00,$8.29,$0.00,$0.00,$8.43,$48.13,$0.00,$24.06,$38.12,$38.50,$0.00,$7.53,$0.00,$7.66,$0.00
340735,SUP,HCPCS C1713,,340735  -  SCREW BONE 4.5MM 135MM ISO SS FULTHD CORT SLFTAP,$48.13,$0.00,$48.13,$21.66,$34.35,$0.00,$8.29,$0.00,$0.00,$8.43,$48.13,$0.00,$24.06,$38.12,$38.50,$0.00,$7.53,$0.00,$7.66,$0.00
340740,SUP,HCPCS C1713,,340740  -  SCREW BONE 4.5MM 140MM ISO SS FULTHD CORT SLFTAP,$48.13,$0.00,$48.13,$21.66,$34.35,$0.00,$8.29,$0.00,$0.00,$8.43,$48.13,$0.00,$24.06,$38.12,$38.50,$0.00,$7.53,$0.00,$7.66,$0.00
340745,SUP,HCPCS C1713,,340745  -  SCREW BONE 4.5MM 145MM ISO SS FULTHD CORT SLFTAP,$48.13,$0.00,$48.13,$21.66,$34.35,$0.00,$8.29,$0.00,$0.00,$8.43,$48.13,$0.00,$24.06,$38.12,$38.50,$0.00,$7.53,$0.00,$7.66,$0.00
340750,SUP,HCPCS C1713,,340750  -  SCREW BONE 4.5MM 150MM ISO SS CORT SLFTAP FULTHD,$48.13,$0.00,$48.13,$21.66,$34.35,$0.00,$8.29,$0.00,$0.00,$8.43,$48.13,$0.00,$24.06,$38.12,$38.50,$0.00,$7.53,$0.00,$7.66,$0.00
341025,SUP,HCPCS C1713,,341025  -  SCREW BN 6.5MM 25MM 16MM P/T CANC,$52.25,$0.00,$52.25,$23.51,$37.29,$0.00,$9.00,$0.00,$0.00,$9.15,$52.25,$0.00,$26.13,$41.38,$41.80,$0.00,$8.18,$0.00,$8.32,$0.00
341030,SUP,HCPCS C1713,,341030  -  SCREW BONE 6.5MM 30MM 16MM SS CANC,$52.25,$0.00,$52.25,$23.51,$37.29,$0.00,$9.00,$0.00,$0.00,$9.15,$52.25,$0.00,$26.13,$41.38,$41.80,$0.00,$8.18,$0.00,$8.32,$0.00
341035,SUP,HCPCS C1713,,341035  -  SCREW BONE 6.5MM 35MM 16MM SS CANC,$52.25,$0.00,$52.25,$23.51,$37.29,$0.00,$9.00,$0.00,$0.00,$9.15,$52.25,$0.00,$26.13,$41.38,$41.80,$0.00,$8.18,$0.00,$8.32,$0.00
341040,SUP,HCPCS C1713,,341040  -  SCREW BONE 6.5MM 40MM 16MM CANC PTHRD,$52.25,$0.00,$52.25,$23.51,$37.29,$0.00,$9.00,$0.00,$0.00,$9.15,$52.25,$0.00,$26.13,$41.38,$41.80,$0.00,$8.18,$0.00,$8.32,$0.00
341045,SUP,HCPCS C1713,,341045  -  SCREW BONE 6.5MM 45MM 16MM SS CANC,$52.25,$0.00,$52.25,$23.51,$37.29,$0.00,$9.00,$0.00,$0.00,$9.15,$52.25,$0.00,$26.13,$41.38,$41.80,$0.00,$8.18,$0.00,$8.32,$0.00
341050,SUP,HCPCS C1713,,341050  -  SCREW BONE 6.5MM 50MM 16MM SS CANC,$52.25,$0.00,$52.25,$23.51,$37.29,$0.00,$9.00,$0.00,$0.00,$9.15,$52.25,$0.00,$26.13,$41.38,$41.80,$0.00,$8.18,$0.00,$8.32,$0.00
341055,SUP,HCPCS C1713,,341055  -  SCREW BONE 6.5MM 55MM 16MM SS CANC,$52.25,$0.00,$52.25,$23.51,$37.29,$0.00,$9.00,$0.00,$0.00,$9.15,$52.25,$0.00,$26.13,$41.38,$41.80,$0.00,$8.18,$0.00,$8.32,$0.00
341060,SUP,HCPCS C1713,,341060  -  SCREW BONE 6.5MM 60MM 16MM SS CANC,$52.25,$0.00,$52.25,$23.51,$37.29,$0.00,$9.00,$0.00,$0.00,$9.15,$52.25,$0.00,$26.13,$41.38,$41.80,$0.00,$8.18,$0.00,$8.32,$0.00
341065,SUP,HCPCS C1713,,341065  -  SCREW BONE 6.5MM 65MM 16MM SS CANC,$52.25,$0.00,$52.25,$23.51,$37.29,$0.00,$9.00,$0.00,$0.00,$9.15,$52.25,$0.00,$26.13,$41.38,$41.80,$0.00,$8.18,$0.00,$8.32,$0.00
341070,SUP,HCPCS C1713,,341070  -  SCREW BONE 6.5MM 70MM 16MM SS CANC,$52.25,$0.00,$52.25,$23.51,$37.29,$0.00,$9.00,$0.00,$0.00,$9.15,$52.25,$0.00,$26.13,$41.38,$41.80,$0.00,$8.18,$0.00,$8.32,$0.00
341075,SUP,HCPCS C1713,,341075  -  SCREW BONE 6.5MM 75MM 16MM SS CANC,$52.25,$0.00,$52.25,$23.51,$37.29,$0.00,$9.00,$0.00,$0.00,$9.15,$52.25,$0.00,$26.13,$41.38,$41.80,$0.00,$8.18,$0.00,$8.32,$0.00
341080,SUP,HCPCS C1713,,341080  -  SCREW BONE 6.5MM 80MM 16MM SS CANC,$52.25,$0.00,$52.25,$23.51,$37.29,$0.00,$9.00,$0.00,$0.00,$9.15,$52.25,$0.00,$26.13,$41.38,$41.80,$0.00,$8.18,$0.00,$8.32,$0.00
341085,SUP,HCPCS C1713,,341085  -  SCREW BONE 6.5MM 85MM 16MM SS CANC,$52.25,$0.00,$52.25,$23.51,$37.29,$0.00,$9.00,$0.00,$0.00,$9.15,$52.25,$0.00,$26.13,$41.38,$41.80,$0.00,$8.18,$0.00,$8.32,$0.00
341090,SUP,HCPCS C1713,,341090  -  SCREW BONE 6.5MM 90MM 16MM SS CANC,$52.25,$0.00,$52.25,$23.51,$37.29,$0.00,$9.00,$0.00,$0.00,$9.15,$52.25,$0.00,$26.13,$41.38,$41.80,$0.00,$8.18,$0.00,$8.32,$0.00
341095,SUP,HCPCS C1713,,341095  -  SCREW BONE 6.5MM 95MM 16MM SS CANC,$52.25,$0.00,$52.25,$23.51,$37.29,$0.00,$9.00,$0.00,$0.00,$9.15,$52.25,$0.00,$26.13,$41.38,$41.80,$0.00,$8.18,$0.00,$8.32,$0.00
341100,SUP,HCPCS C1713,,341100  -  SCREW BONE 6.5MM 100MM 16MM SS CANC,$61.88,$0.00,$61.88,$27.84,$44.16,$0.00,$10.66,$0.00,$0.00,$10.83,$61.88,$0.00,$30.94,$49.01,$49.50,$0.00,$9.68,$0.00,$9.85,$0.00
341105,SUP,HCPCS C1713,,341105  -  SCREW BONE 6.5MM 105MM 16MM SS CANC,$61.88,$0.00,$61.88,$27.84,$44.16,$0.00,$10.66,$0.00,$0.00,$10.83,$61.88,$0.00,$30.94,$49.01,$49.50,$0.00,$9.68,$0.00,$9.85,$0.00
341110,SUP,HCPCS C1713,,341110  -  SCREW BONE 6.5MM 110MM 16MM SS CANC,$61.88,$0.00,$61.88,$27.84,$44.16,$0.00,$10.66,$0.00,$0.00,$10.83,$61.88,$0.00,$30.94,$49.01,$49.50,$0.00,$9.68,$0.00,$9.85,$0.00
341115,SUP,HCPCS C1713,,341115  -  SCREW BONE 6.5MM 115MM 16MM SS CANC,$61.88,$0.00,$61.88,$27.84,$44.16,$0.00,$10.66,$0.00,$0.00,$10.83,$61.88,$0.00,$30.94,$49.01,$49.50,$0.00,$9.68,$0.00,$9.85,$0.00
341120,SUP,HCPCS C1713,,341120  -  SCREW BONE 6.5MM 120MM 16MM SS CANC,$61.88,$0.00,$61.88,$27.84,$44.16,$0.00,$10.66,$0.00,$0.00,$10.83,$61.88,$0.00,$30.94,$49.01,$49.50,$0.00,$9.68,$0.00,$9.85,$0.00
341125,SUP,HCPCS C1713,,341125  -  SCREW BONE 6.5MM 125MM 16MM SS CANC,$61.88,$0.00,$61.88,$27.84,$44.16,$0.00,$10.66,$0.00,$0.00,$10.83,$61.88,$0.00,$30.94,$49.01,$49.50,$0.00,$9.68,$0.00,$9.85,$0.00
341130,SUP,HCPCS C1713,,341130  -  SCREW BONE 6.5MM 130MM 16MM SS CANC,$61.88,$0.00,$61.88,$27.84,$44.16,$0.00,$10.66,$0.00,$0.00,$10.83,$61.88,$0.00,$30.94,$49.01,$49.50,$0.00,$9.68,$0.00,$9.85,$0.00
341140,SUP,HCPCS C1713,,341140  -  SCREW BONE 6.5MM 140MM 16MM SS CANC SLFTAP FULTHD ISO,$61.88,$0.00,$61.88,$27.84,$44.16,$0.00,$10.66,$0.00,$0.00,$10.83,$61.88,$0.00,$30.94,$49.01,$49.50,$0.00,$9.68,$0.00,$9.85,$0.00
341824,SUP,HCPCS C1786,,341824  -  PACEMAKER CRD THK6MM 53X39MM 11ML PH2 SR IMPL 1 CHMBR RR,"$8,000.00",$0.00,"$8,000.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,000.00",$0.00,"$4,000.00","$6,336.00","$6,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
342040,SUP,HCPCS C1713,,342040  -  SCREW BONE 6.5MM 40MM 32MM SS CANC,$52.25,$0.00,$52.25,$23.51,$37.29,$0.00,$9.00,$0.00,$0.00,$9.15,$52.25,$0.00,$26.13,$41.38,$41.80,$0.00,$8.18,$0.00,$8.32,$0.00
342045,SUP,HCPCS C1713,,342045  -  SCREW BONE 6.5MM 45MM 32MM SS CANC,$52.25,$0.00,$52.25,$23.51,$37.29,$0.00,$9.00,$0.00,$0.00,$9.15,$52.25,$0.00,$26.13,$41.38,$41.80,$0.00,$8.18,$0.00,$8.32,$0.00
342050,SUP,HCPCS C1713,,342050  -  SCREW BONE 6.5MM 50MM SS CANC PTTHRD,$52.25,$0.00,$52.25,$23.51,$37.29,$0.00,$9.00,$0.00,$0.00,$9.15,$52.25,$0.00,$26.13,$41.38,$41.80,$0.00,$8.18,$0.00,$8.32,$0.00
342055,SUP,HCPCS C1713,,342055  -  SCREW BONE 6.5MM 55MM 32MM SS CANC,$52.25,$0.00,$52.25,$23.51,$37.29,$0.00,$9.00,$0.00,$0.00,$9.15,$52.25,$0.00,$26.13,$41.38,$41.80,$0.00,$8.18,$0.00,$8.32,$0.00
342060,SUP,HCPCS C1713,,342060  -  SCREW BONE 6.5MM 60MM 32MM SS CANC,$52.25,$0.00,$52.25,$23.51,$37.29,$0.00,$9.00,$0.00,$0.00,$9.15,$52.25,$0.00,$26.13,$41.38,$41.80,$0.00,$8.18,$0.00,$8.32,$0.00
342065,SUP,HCPCS C1713,,342065  -  SCREW BONE 6.5MM 65MM 32MM SS CANC,$52.25,$0.00,$52.25,$23.51,$37.29,$0.00,$9.00,$0.00,$0.00,$9.15,$52.25,$0.00,$26.13,$41.38,$41.80,$0.00,$8.18,$0.00,$8.32,$0.00
342070,SUP,HCPCS C1713,,342070  -  SCREW BONE 6.5MM 70MM 32MM SS CANC,$52.25,$0.00,$52.25,$23.51,$37.29,$0.00,$9.00,$0.00,$0.00,$9.15,$52.25,$0.00,$26.13,$41.38,$41.80,$0.00,$8.18,$0.00,$8.32,$0.00
342075,SUP,HCPCS C1713,,342075  -  SCREW BONE 6.5MM 75MM 32MM SS CANC,$52.25,$0.00,$52.25,$23.51,$37.29,$0.00,$9.00,$0.00,$0.00,$9.15,$52.25,$0.00,$26.13,$41.38,$41.80,$0.00,$8.18,$0.00,$8.32,$0.00
342080,SUP,HCPCS C1713,,342080  -  SCREW BONE 6.5MM 80MM 32MM SS CANC,$52.25,$0.00,$52.25,$23.51,$37.29,$0.00,$9.00,$0.00,$0.00,$9.15,$52.25,$0.00,$26.13,$41.38,$41.80,$0.00,$8.18,$0.00,$8.32,$0.00
342085,SUP,HCPCS C1713,,342085  -  SCREW BONE 6.5MM 85MM 32MM SS CANC,$52.25,$0.00,$52.25,$23.51,$37.29,$0.00,$9.00,$0.00,$0.00,$9.15,$52.25,$0.00,$26.13,$41.38,$41.80,$0.00,$8.18,$0.00,$8.32,$0.00
342090,SUP,HCPCS C1713,,342090  -  SCREW BONE 6.5MM 90MM 32MM SS CANC,$52.25,$0.00,$52.25,$23.51,$37.29,$0.00,$9.00,$0.00,$0.00,$9.15,$52.25,$0.00,$26.13,$41.38,$41.80,$0.00,$8.18,$0.00,$8.32,$0.00
342095,SUP,HCPCS C1713,,342095  -  SCREW BONE 6.5MM 95MM 32MM SS CANC,$52.25,$0.00,$52.25,$23.51,$37.29,$0.00,$9.00,$0.00,$0.00,$9.15,$52.25,$0.00,$26.13,$41.38,$41.80,$0.00,$8.18,$0.00,$8.32,$0.00
342100,SUP,HCPCS C1713,,342100  -  SCREW BONE 6.5MM 100MM 32MM SS CANC,$61.88,$0.00,$61.88,$27.84,$44.16,$0.00,$10.66,$0.00,$0.00,$10.83,$61.88,$0.00,$30.94,$49.01,$49.50,$0.00,$9.68,$0.00,$9.85,$0.00
342105,SUP,HCPCS C1713,,342105  -  SCREW BONE 6.5MM 105MM 32MM SS CANC,$61.88,$0.00,$61.88,$27.84,$44.16,$0.00,$10.66,$0.00,$0.00,$10.83,$61.88,$0.00,$30.94,$49.01,$49.50,$0.00,$9.68,$0.00,$9.85,$0.00
342110,SUP,HCPCS C1713,,342110  -  SCREW BONE 6.5MM 110MM 32MM SS CANC,$61.88,$0.00,$61.88,$27.84,$44.16,$0.00,$10.66,$0.00,$0.00,$10.83,$61.88,$0.00,$30.94,$49.01,$49.50,$0.00,$9.68,$0.00,$9.85,$0.00
342115,SUP,HCPCS C1713,,342115  -  SCREW BONE 6.5MM 115MM 32MM SS CANC,$61.88,$0.00,$61.88,$27.84,$44.16,$0.00,$10.66,$0.00,$0.00,$10.83,$61.88,$0.00,$30.94,$49.01,$49.50,$0.00,$9.68,$0.00,$9.85,$0.00
342120,SUP,HCPCS C1713,,342120  -  SCREW BONE 6.5MM 120MM 32MM SS CANC,$61.88,$0.00,$61.88,$27.84,$44.16,$0.00,$10.66,$0.00,$0.00,$10.83,$61.88,$0.00,$30.94,$49.01,$49.50,$0.00,$9.68,$0.00,$9.85,$0.00
342125,SUP,HCPCS C1713,,342125  -  SCREW BONE 6.5MM 125MM 32MM SS CANC,$61.88,$0.00,$61.88,$27.84,$44.16,$0.00,$10.66,$0.00,$0.00,$10.83,$61.88,$0.00,$30.94,$49.01,$49.50,$0.00,$9.68,$0.00,$9.85,$0.00
342130,SUP,HCPCS C1713,,342130  -  SCREW BONE 6.5MM 130MM 32MM SS CANC,$61.88,$0.00,$61.88,$27.84,$44.16,$0.00,$10.66,$0.00,$0.00,$10.83,$61.88,$0.00,$30.94,$49.01,$49.50,$0.00,$9.68,$0.00,$9.85,$0.00
342140,SUP,HCPCS C1713,,342140  -  SCREW BONE 6.5MM 140MM 32MM SS CANC,$61.88,$0.00,$61.88,$27.84,$44.16,$0.00,$10.66,$0.00,$0.00,$10.83,$61.88,$0.00,$30.94,$49.01,$49.50,$0.00,$9.68,$0.00,$9.85,$0.00
343020,SUP,HCPCS C1713,,343020  -  SCREW BONE 6.5MM 20MM SS FULTHD CANC,$61.88,$0.00,$61.88,$27.84,$44.16,$0.00,$10.66,$0.00,$0.00,$10.83,$61.88,$0.00,$30.94,$49.01,$49.50,$0.00,$9.68,$0.00,$9.85,$0.00
343025,SUP,HCPCS C1713,,343025  -  SCREW BONE 6.5MM 25MM SS FULTHD CANC,$52.25,$0.00,$52.25,$23.51,$37.29,$0.00,$9.00,$0.00,$0.00,$9.15,$52.25,$0.00,$26.13,$41.38,$41.80,$0.00,$8.18,$0.00,$8.32,$0.00
343030,SUP,HCPCS C1713,,343030  -  SCREW BONE 6.5MM 30MM SS FULTHD CANC,$52.25,$0.00,$52.25,$23.51,$37.29,$0.00,$9.00,$0.00,$0.00,$9.15,$52.25,$0.00,$26.13,$41.38,$41.80,$0.00,$8.18,$0.00,$8.32,$0.00
343035,SUP,HCPCS C1713,,343035  -  SCREW BONE 6.5MM 35MM SS FULTHD CANC LCK HEX DRV,$52.25,$0.00,$52.25,$23.51,$37.29,$0.00,$9.00,$0.00,$0.00,$9.15,$52.25,$0.00,$26.13,$41.38,$41.80,$0.00,$8.18,$0.00,$8.32,$0.00
343040,SUP,HCPCS C1713,,343040  -  SCREW BONE 6.5MM 40MM ISO TI FULTHD CANC NONSTRL,$52.25,$0.00,$52.25,$23.51,$37.29,$0.00,$9.00,$0.00,$0.00,$9.15,$52.25,$0.00,$26.13,$41.38,$41.80,$0.00,$8.18,$0.00,$8.32,$0.00
343045,SUP,HCPCS C1713,,343045  -  SCREW BONE 6.5MM 45MM SS FULTHD CANC,$52.25,$0.00,$52.25,$23.51,$37.29,$0.00,$9.00,$0.00,$0.00,$9.15,$52.25,$0.00,$26.13,$41.38,$41.80,$0.00,$8.18,$0.00,$8.32,$0.00
343050,SUP,HCPCS C1713,,343050  -  SCREW BONE 6.5MM 50MM SS FULTHD CANC,$52.25,$0.00,$52.25,$23.51,$37.29,$0.00,$9.00,$0.00,$0.00,$9.15,$52.25,$0.00,$26.13,$41.38,$41.80,$0.00,$8.18,$0.00,$8.32,$0.00
343055,SUP,HCPCS C1713,,343055  -  SCREW BONE 6.5MM 55MM SS FULTHD CANC,$52.25,$0.00,$52.25,$23.51,$37.29,$0.00,$9.00,$0.00,$0.00,$9.15,$52.25,$0.00,$26.13,$41.38,$41.80,$0.00,$8.18,$0.00,$8.32,$0.00
343060,SUP,HCPCS C1713,,343060  -  SCREW BONE 6.5MM 60MM SS FULTHD CANC,$52.25,$0.00,$52.25,$23.51,$37.29,$0.00,$9.00,$0.00,$0.00,$9.15,$52.25,$0.00,$26.13,$41.38,$41.80,$0.00,$8.18,$0.00,$8.32,$0.00
343065,SUP,HCPCS C1713,,343065  -  SCREW BONE 6.5MM 65MM SS FULTHD CANC,$52.25,$0.00,$52.25,$23.51,$37.29,$0.00,$9.00,$0.00,$0.00,$9.15,$52.25,$0.00,$26.13,$41.38,$41.80,$0.00,$8.18,$0.00,$8.32,$0.00
343070,SUP,HCPCS C1713,,343070  -  SCREW BONE 6.5MM 70MM SS FULTHD CANC LCK HEX DRV,$52.25,$0.00,$52.25,$23.51,$37.29,$0.00,$9.00,$0.00,$0.00,$9.15,$52.25,$0.00,$26.13,$41.38,$41.80,$0.00,$8.18,$0.00,$8.32,$0.00
343075,SUP,HCPCS C1713,,343075  -  SCREW BONE 6.5MM 75MM SS FULTHD CANC LCK HEX DRV,$52.25,$0.00,$52.25,$23.51,$37.29,$0.00,$9.00,$0.00,$0.00,$9.15,$52.25,$0.00,$26.13,$41.38,$41.80,$0.00,$8.18,$0.00,$8.32,$0.00
343080,SUP,HCPCS C1713,,343080  -  SCREW BONE 6.5MM 80MM SS FULTHD CANC LCK HEX DRV,$52.25,$0.00,$52.25,$23.51,$37.29,$0.00,$9.00,$0.00,$0.00,$9.15,$52.25,$0.00,$26.13,$41.38,$41.80,$0.00,$8.18,$0.00,$8.32,$0.00
343085,SUP,HCPCS C1713,,343085  -  SCREW BONE 6.5MM 85MM SS FULTHD CANC,$52.25,$0.00,$52.25,$23.51,$37.29,$0.00,$9.00,$0.00,$0.00,$9.15,$52.25,$0.00,$26.13,$41.38,$41.80,$0.00,$8.18,$0.00,$8.32,$0.00
343090,SUP,HCPCS C1713,,343090  -  SCREW BONE 6.5MM 90MM SS FULTHD CANC,$52.25,$0.00,$52.25,$23.51,$37.29,$0.00,$9.00,$0.00,$0.00,$9.15,$52.25,$0.00,$26.13,$41.38,$41.80,$0.00,$8.18,$0.00,$8.32,$0.00
343095,SUP,HCPCS C1713,,343095  -  SCREW BONE 6.5MM 95MM SS FULTHD CANC,$52.25,$0.00,$52.25,$23.51,$37.29,$0.00,$9.00,$0.00,$0.00,$9.15,$52.25,$0.00,$26.13,$41.38,$41.80,$0.00,$8.18,$0.00,$8.32,$0.00
343100,SUP,HCPCS C1713,,343100  -  SCREW BONE 6.5MM 100MM SS FULTHD CANC,$61.88,$0.00,$61.88,$27.84,$44.16,$0.00,$10.66,$0.00,$0.00,$10.83,$61.88,$0.00,$30.94,$49.01,$49.50,$0.00,$9.68,$0.00,$9.85,$0.00
343105,SUP,HCPCS C1713,,343105  -  SCREW BONE 6.5MM 105MM SS CANC FULTHRD,$61.88,$0.00,$61.88,$27.84,$44.16,$0.00,$10.66,$0.00,$0.00,$10.83,$61.88,$0.00,$30.94,$49.01,$49.50,$0.00,$9.68,$0.00,$9.85,$0.00
343110,SUP,HCPCS C1713,,343110  -  SCREW BONE 6.5MM 110MM SS CANC FULTHRD,$61.88,$0.00,$61.88,$27.84,$44.16,$0.00,$10.66,$0.00,$0.00,$10.83,$61.88,$0.00,$30.94,$49.01,$49.50,$0.00,$9.68,$0.00,$9.85,$0.00
343115,SUP,HCPCS C1713,,343115  -  SCREW BONE 6.5MM 115MM SS CANC FULTHRD,$61.88,$0.00,$61.88,$27.84,$44.16,$0.00,$10.66,$0.00,$0.00,$10.83,$61.88,$0.00,$30.94,$49.01,$49.50,$0.00,$9.68,$0.00,$9.85,$0.00
343120,SUP,HCPCS C1713,,343120  -  SCREW BONE 6.5MM 120MM ISO SS CANC FULTHRD,$61.88,$0.00,$61.88,$27.84,$44.16,$0.00,$10.66,$0.00,$0.00,$10.83,$61.88,$0.00,$30.94,$49.01,$49.50,$0.00,$9.68,$0.00,$9.85,$0.00
343125,SUP,HCPCS C1713,,343125  -  SCREW BONE 6.5MM 125MM ISO SS FULTHD CANC HIP NONSTRL,$61.88,$0.00,$61.88,$27.84,$44.16,$0.00,$10.66,$0.00,$0.00,$10.83,$61.88,$0.00,$30.94,$49.01,$49.50,$0.00,$9.68,$0.00,$9.85,$0.00
343130,SUP,HCPCS C1713,,343130  -  SCREW BONE 6.5MM 130MM ISO SS FULTHD CANC HIP NONSTRL,$61.88,$0.00,$61.88,$27.84,$44.16,$0.00,$10.66,$0.00,$0.00,$10.83,$61.88,$0.00,$30.94,$49.01,$49.50,$0.00,$9.68,$0.00,$9.85,$0.00
345410,SUP,HCPCS C1713,,345410  -  SCREW BONE 4MM 10MM UNIFLEX SS FULTHD CANC PROX HUM HEX DRV,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
345412,SUP,HCPCS C1713,,345412  -  SCREW BONE 4MM 12MM UNIFLEX SS FULTHD CANC PROX HUM HEX DRV,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
345414,SUP,HCPCS C1713,,345414  -  SCREW BONE 4MM 14MM UNIFLEX SS FULTHD CANC PROX HUM HEX DRV,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
345416,SUP,HCPCS C1713,,345416  -  SCREW BONE 4MM 16MM SS FULTHD CANC,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
345418,SUP,HCPCS C1713,,345418  -  SCREW BONE 4MM 18MM SS FULTHD CANC,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
345420,SUP,HCPCS C1713,,345420  -  SCREW BONE 4MM 20MM UNIFLEX SS FULTHD CANC PROX HUM HEX DRV,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
345422,SUP,HCPCS C1713,,345422  -  SCREW BONE 4MM 22MM UNIFLEX SS FULTHD CANC PROX HUM HEX DRV,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
345424,SUP,HCPCS C1713,,345424  -  SCREW BONE 4MM 24MM UNIFLEX SS FULTHD CANC IM NAIL,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
345426,SUP,HCPCS C1713,,345426  -  SCREW BONE 4MM 26MM UNIFLEX SS FULTHD CANC IM NAIL,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
345428,SUP,HCPCS C1713,,345428  -  SCREW BONE 4MM 28MM ISO SS FULTHD CANC NONSTRL,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
345430,SUP,HCPCS C1713,,345430  -  SCREW BONE 4MM 30MM UNIFLEX SS FULTHD CANC PROX HUM HEX DRV,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
345432,SUP,HCPCS C1713,,345432  -  SCREW BONE 4MM 32MM UNIFLEX SS FULTHD CANC PROX HUM HEX DRV,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
345434,SUP,HCPCS C1713,,345434  -  SCREW BONE 4MM 34MM UNIFLEX SS FULTHD CANC IM NAIL,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
345436,SUP,HCPCS C1713,,345436  -  SCREW BONE 4MM 36MM UNIFLEX SS FULTHD CANC PROX HUM HEX DRV,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
345438,SUP,HCPCS C1713,,345438  -  SCREW BONE 4MM 38MM UNIFLEX SS FULTHD CANC PROX HUM HEX DRV,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
345440,SUP,HCPCS C1713,,345440  -  SCREW BONE 4MM 40MM SS FULTHD CANC,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
345445,SUP,HCPCS C1713,,345445  -  SCREW BONE 4MM 45MM AXSOS SS 2.5MM FULTHD PROX CANC HUM LCK,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
345450,SUP,HCPCS C1713,,345450  -  SCREW BONE 4MM 50MM SS FULTHD CANC,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
345455,SUP,HCPCS C1713,,345455  -  SCREW BONE 4MM 55MM UNIFLEX SS FULTHD CANC PROX HUM HEX DRV,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
345460,SUP,HCPCS C1713,,345460  -  SCREW BONE 4MM 60MM UNIFLEX SS FULTHD CANC IM NAIL,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
345465,SUP,HCPCS C1713,,345465  -  SCREW BONE 4MM 65MM AXSOS SS FULTHD CANC HEX DRV LCK,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
345470,SUP,HCPCS C1713,,345470  -  SCREW BONE 4MM 70MM ISO SS FULTHD CANC,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
345475,SUP,HCPCS C1713,,345475  -  SCREW BONE 4MM 75MM SS FULTHD CANC,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
345480,SUP,HCPCS C1713,,345480  -  SCREW BONE 4MM 80MM UNIFLEX SS FULTHD CANC PROX HUM HEX DRV,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
345485,SUP,HCPCS C1713,,345485  -  SCREW BONE 4MM 85MM SS FULTHD CANC,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
345490,SUP,HCPCS C1713,,345490  -  SCREW BONE 4MM 90MM SS FULTHD CANC,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
345495,SUP,HCPCS C1713,,345495  -  SCREW BONE 4MM 95MM ISO SS FULTHD CANC,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
345500,SUP,HCPCS C1713,,345500  -  SCREW BONE 4MM 100MM ISO SS FULTHD CANC,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
345510,SUP,HCPCS C1713,,345510  -  SCREW BONE 4MM 10MM 5MM SS CANC,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
345512,SUP,HCPCS C1713,,345512  -  SCREW BONE 4MM 12MM AXSOS SS PTHRD CANC HUM HEX DRV SM FRAG,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
345514,SUP,HCPCS C1713,,345514  -  SCREW BONE 4MM 14MM AXSOS SS PTHRD CANC HUM HEX DRV SM FRAG,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
345516,SUP,HCPCS C1713,,345516  -  SCREW BONE 4MM 16MM AXSOS SS PTHRD CANC HUM HEX DRV SM FRAG,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
345518,SUP,HCPCS C1758,,345518  -  SCREW BONE 4MM 18MM UNIFLEX SS CANC PTTHRD IM NAIL,$31.63,$0.00,$31.63,$17.17,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
345520,SUP,HCPCS C1713,,345520  -  SCREW BONE 4MM 20MM AXSOS SS PTHRD CANC HUM HEX DRV SM FRAG,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
345522,SUP,HCPCS C1713,,345522  -  SCREW BONE 4MM 22MM AXSOS SS PTHRD CANC HUM HEX DRV SM FRAG,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
345524,SUP,HCPCS C1713,,345524  -  SCREW BONE 4MM 24MM ISO SS PTHRD CANC PARTIL THRD SM FRAG,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
345526,SUP,HCPCS C1713,,345526  -  SCREW BONE 4MM 26MM SS CANC,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
345528,SUP,HCPCS C1713,,345528  -  SCREW BONE 4MM 28MM UNIFLEX SS CANC PTHRD IM NAIL,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
345530,SUP,HCPCS C1713,,345530  -  SCREW BONE 4MM 30MM AXSOS SS PTHRD CANC PTHRD SM FRAG SET,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
345532,SUP,HCPCS C1713,,345532  -  SCREW BONE 4MM 32MM 14MM SS CANC,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
345534,SUP,HCPCS C1713,,345534  -  SCREW BONE 4MM 34MM 14MM SS CANC,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
345536,SUP,HCPCS C1713,,345536  -  SCREW BONE 4MM 36MM 14MM SS CANC PTHRD,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
345538,SUP,HCPCS C1713,,345538  -  SCREW BONE 4MM 38MM 14MM SS CANC,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
345540,SUP,HCPCS C1713,,345540  -  SCREW BONE 4MM 40MM AXSOS SS PTHRD CANC HUM HEX DRV SM FRAG,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
345545,SUP,HCPCS C1713,,345545  -  SCREW BN 2.5MM P/T 4MM 45MM NS HEX SS CANC AXSOS SM FRAG SET,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
345550,SUP,HCPCS C1713,,345550  -  SCREW BONE 4MM 50MM AXSOS SS PTHRD CANC PTHRD SM FRAG SET,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
345555,SUP,HCPCS C1713,,345555  -  SCREW BONE 4MM 55MM AXSOS SS PTHRD CANC HUM HEX DRV SM FRAG,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
345560,SUP,HCPCS C1713,,345560  -  SCREW BONE 4MM 60MM 16MM SS CANC,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
345565,SUP,HCPCS C1713,,345565  -  SCREW BONE 4MM 65MM SS CANC,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
345570,SUP,HCPCS C1713,,345570  -  SCREW BONE 4MM 70MM 14MM SS CANC,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
345575,SUP,HCPCS C1713,,345575  -  SCREW BONE 4MM 75MM SS CANC,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
345580,SUP,HCPCS C1713,,345580  -  SCREW BONE 4MM 80MM SS CANC,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
345585,SUP,HCPCS C1713,,345585  -  SCREW BONE 4MM 85MM 16MM ISO SS CANC,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
345590,SUP,HCPCS C1713,,345590  -  SCREW BONE 4MM 90MM 16MM ISO SS CANC,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
345595,SUP,HCPCS C1713,,345595  -  SCREW BONE 4MM 95MM AXSOS SS CANC LCK PTHRD,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
345600,SUP,HCPCS C1713,,345600  -  SCREW BONE 4MM 100MM 16MM ISO SS CANC,$31.63,$0.00,$31.63,$14.23,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
348446,SUP,HCPCS C1900,,348446  -  PHILOS II DR SYSTEM,"$10,000.00",$0.00,"$10,000.00",$0.00,"$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,$0.00,"$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,$0.00,$0.00
350974,SUP,HCPCS C1895,,350974  -  SETROX S 53 LEAD,"$1,125.00",$0.00,"$1,125.00",$506.25,$802.91,$0.00,$193.83,$0.00,$0.00,$196.98,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$176.06,$0.00,$179.10,$0.00
353440,SUP,Custom 27203010,,PUNCH 7IN 4MM STD TIP STRL LF DISP AOR,$465.00,$0.00,$465.00,$0.00,$331.87,$0.00,$0.00,$0.00,$0.00,$0.00,$465.00,$0.00,$232.50,$368.28,$372.00,$0.00,$0.00,$0.00,$0.00,$0.00
355149,SUP,HCPCS C1900,,355149  -  COROX OTW 85 BP-S LEAD,"$5,000.00",$0.00,"$5,000.00",$0.00,"$3,568.50",$0.00,$861.48,$0.00,$0.00,$0.00,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$782.50,$0.00,$0.00,$0.00
356053,SUP,HCPCS C1900,,356053  -  CYLOS VR SYSTEM WITH CLS AUTONOMIC RESPONSE,"$9,500.00",$0.00,"$9,500.00",$0.00,"$5,158.80",$0.00,"$1,636.80",$0.00,$0.00,$0.00,"$9,500.00",$0.00,"$4,750.00","$7,524.00","$7,600.00",$0.00,"$1,486.75",$0.00,$0.00,$0.00
359654,SUP,HCPCS C1721,,359654  -  LUMAX 340 DR-T HIGH ENERGY WITH HM MOBILE GSM,"$46,450.00",$0.00,"$46,450.00","$20,902.50","$5,158.80",$0.00,"$8,003.10",$0.00,$0.00,"$8,133.02","$46,450.00",$0.00,"$23,225.00","$36,788.40","$37,160.00",$0.00,"$7,269.43",$0.00,"$7,394.84",$0.00
359655,SUP,HCPCS C1721,,359655  -  LUMAX 340 DR-T HIGH ENERGY SYSTEM WITH HM MOBILE GSM,"$56,450.00",$0.00,"$56,450.00","$25,402.50","$5,158.80",$0.00,"$8,138.89",$0.00,$0.00,"$8,138.89","$56,450.00",$0.00,"$28,225.00","$44,708.40","$45,160.00",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
359656,SUP,HCPCS C1721,,359656  -  LUMAX 340 DR-T HIGH ENERGY SYSTEM WITH HM LANDLINE,"$51,450.00",$0.00,"$51,450.00","$23,152.50","$5,158.80",$0.00,"$8,138.89",$0.00,$0.00,"$8,138.89","$51,450.00",$0.00,"$25,725.00","$40,748.40","$41,160.00",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
359659,SUP,HCPCS C1882,,359659  -  LUMAX 340 HF-T HIGH ENERGY SYSTEM WITH HM MOBILE GSM,"$72,600.00",$0.00,"$72,600.00","$32,670.00","$5,158.80",$0.00,"$8,138.89",$0.00,$0.00,"$8,138.89","$72,600.00",$0.00,"$36,300.00","$57,499.20","$58,080.00",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
359662,SUP,HCPCS C1882,,359662  -  LUMAX 340 HF-T HIGH ENERGY SYSTEM WITH HM LANDLINE,"$67,600.00",$0.00,"$67,600.00","$30,420.00","$5,158.80",$0.00,"$8,138.89",$0.00,$0.00,"$8,138.89","$67,600.00",$0.00,"$33,800.00","$53,539.20","$54,080.00",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
359664,SUP,HCPCS C1786,,359664  -  LUMAX 340 VR-T HIGH ENERGY WITH HM MOBILE GSM,"$42,700.00",$0.00,"$42,700.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$42,700.00",$0.00,"$21,350.00","$33,818.40","$34,160.00",$0.00,$0.00,$0.00,$0.00,$0.00
359665,SUP,HCPCS C1786,,359665  -  LUMAX 340 VR-T HIGH ENERGY SYSTEM WITH HM MOBILE GSM,"$52,700.00",$0.00,"$52,700.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$52,700.00",$0.00,"$26,350.00","$41,738.40","$42,160.00",$0.00,$0.00,$0.00,$0.00,$0.00
359666,SUP,HCPCS C1874,,359666  -  DFBR CRD LUMAX 340 VR-T AV 1 CHMBR RSYN THRP IMPLTABLE,"$47,700.00",$0.00,"$47,700.00","$21,465.00","$5,158.80",$0.00,"$8,138.89",$0.00,$0.00,"$8,138.89","$47,700.00",$0.00,"$23,850.00","$37,778.40","$38,160.00",$0.00,"$7,465.05",$0.00,"$7,593.84",$0.00
360101,SUP,Custom 27203010,,360101  -  DEVICE SPEC RTRVL .018IN 10MM 10CM INTLK DTCH COIL,$455.50,$0.00,$455.50,$0.00,$325.09,$0.00,$0.00,$0.00,$0.00,$0.00,$455.50,$0.00,$227.75,$360.76,$364.40,$0.00,$0.00,$0.00,$0.00,$0.00
Jun-98,SUP,Custom 27803010,,06-2898  -  HEAD FEM -3MM OFST CTPR 28MM LFIT COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
370001,SUP,Custom 27803010,,370001  -  INSERT ACETAB 3MM HIP LCK,$74.25,$0.00,$74.25,$0.00,$52.99,$0.00,$0.00,$0.00,$0.00,$0.00,$74.25,$0.00,$37.13,$58.81,$59.40,$0.00,$0.00,$0.00,$0.00,$0.00
370002,SUP,Custom 27803010,,370002  -  INSERT ACETAB 4MM SM BONE SS AXSOS PLT SYS,$74.25,$0.00,$74.25,$0.00,$52.99,$0.00,$0.00,$0.00,$0.00,$0.00,$74.25,$0.00,$37.13,$58.81,$59.40,$0.00,$0.00,$0.00,$0.00,$0.00
370003,SUP,Custom 27803010,,370003  -  INSERT TIB LAT DISTAL FEM SS LCK AXSOS 5MM NONSTRL BASIC,$96.25,$0.00,$96.25,$0.00,$68.69,$0.00,$0.00,$0.00,$0.00,$0.00,$96.25,$0.00,$48.13,$76.23,$77.00,$0.00,$0.00,$0.00,$0.00,$0.00
370004,SUP,HCPCS C1713,,370004  -  PLUG CABLE 4MM AXSOS SS SM FRAG,$74.25,$0.00,$74.25,$33.41,$52.99,$0.00,$12.79,$0.00,$0.00,$13.00,$74.25,$0.00,$37.13,$58.81,$59.40,$0.00,$11.62,$0.00,$11.82,$0.00
370005,SUP,HCPCS C1713,,370005  -  PLUG CABLE 5MM AXSOS LAT DISTAL FEM SS NONSTRL,$89.38,$0.00,$89.38,$40.22,$63.79,$0.00,$15.40,$0.00,$0.00,$15.65,$89.38,$0.00,$44.69,$70.79,$71.50,$0.00,$13.99,$0.00,$14.23,$0.00
370008,SUP,HCPCS C1713,,370008  -  SCREW BONE 3MM 8MM ORTH LCK,$132.00,$0.00,$132.00,$59.40,$94.21,$0.00,$22.74,$0.00,$0.00,$23.11,$132.00,$0.00,$66.00,$104.54,$105.60,$0.00,$20.66,$0.00,$21.01,$0.00
370010,SUP,HCPCS C1713,,370010  -  SCREW BONE 3MM 10MM ORTH LCK,$132.00,$0.00,$132.00,$59.40,$94.21,$0.00,$22.74,$0.00,$0.00,$23.11,$132.00,$0.00,$66.00,$104.54,$105.60,$0.00,$20.66,$0.00,$21.01,$0.00
370012,SUP,HCPCS C1713,,370012  -  SCREW BONE 3MM 12MM AXSOS SS CORT T8 DRV LCK SLFTAP,$132.00,$0.00,$132.00,$59.40,$94.21,$0.00,$22.74,$0.00,$0.00,$23.11,$132.00,$0.00,$66.00,$104.54,$105.60,$0.00,$20.66,$0.00,$21.01,$0.00
370014,SUP,HCPCS C1713,,370014  -  SCREW BONE 3MM 14MM AXSOS SS CORT T8 DRV LCK SLFTAP,$132.00,$0.00,$132.00,$59.40,$94.21,$0.00,$22.74,$0.00,$0.00,$23.11,$132.00,$0.00,$66.00,$104.54,$105.60,$0.00,$20.66,$0.00,$21.01,$0.00
370016,SUP,HCPCS C1713,,370016  -  SCREW BONE 3MM 16MM AXSOS SS CORT T8 DRV LCK SLFTAP,$132.00,$0.00,$132.00,$59.40,$94.21,$0.00,$22.74,$0.00,$0.00,$23.11,$132.00,$0.00,$66.00,$104.54,$105.60,$0.00,$20.66,$0.00,$21.01,$0.00
370018,SUP,HCPCS C1713,,370018  -  SCREW BONE 3MM 18MM AXSOS SS HUM FEM/TIB T8 DRV LCK SLFTAP,$132.00,$0.00,$132.00,$59.40,$94.21,$0.00,$22.74,$0.00,$0.00,$23.11,$132.00,$0.00,$66.00,$104.54,$105.60,$0.00,$20.66,$0.00,$21.01,$0.00
370020,SUP,HCPCS C1713,,370020  -  SCREW BONE 3MM 20MM ORTH LCK,$132.00,$0.00,$132.00,$59.40,$94.21,$0.00,$22.74,$0.00,$0.00,$23.11,$132.00,$0.00,$66.00,$104.54,$105.60,$0.00,$20.66,$0.00,$21.01,$0.00
370022,SUP,HCPCS C1713,,370022  -  SCREW BONE 3MM 22MM ORTH LCK,$132.00,$0.00,$132.00,$59.40,$94.21,$0.00,$22.74,$0.00,$0.00,$23.11,$132.00,$0.00,$66.00,$104.54,$105.60,$0.00,$20.66,$0.00,$21.01,$0.00
370024,SUP,HCPCS C1713,,370024  -  SCREW BONE 3MM 24MM AXSOS SS CORT T8 DRV LCK SLFTAP,$132.00,$0.00,$132.00,$59.40,$94.21,$0.00,$22.74,$0.00,$0.00,$23.11,$132.00,$0.00,$66.00,$104.54,$105.60,$0.00,$20.66,$0.00,$21.01,$0.00
370026,SUP,HCPCS C1713,,370026  -  SCREW BONE 3MM 26MM ORTH LCK,$132.00,$0.00,$132.00,$59.40,$94.21,$0.00,$22.74,$0.00,$0.00,$23.11,$132.00,$0.00,$66.00,$104.54,$105.60,$0.00,$20.66,$0.00,$21.01,$0.00
370028,SUP,HCPCS C1713,,370028  -  SCREW BONE 3MM 28MM ORTH LCK,$132.00,$0.00,$132.00,$59.40,$94.21,$0.00,$22.74,$0.00,$0.00,$23.11,$132.00,$0.00,$66.00,$104.54,$105.60,$0.00,$20.66,$0.00,$21.01,$0.00
370030,SUP,HCPCS C1713,,370030  -  SCREW BONE 3MM 30MM AXSOS SS CORT T8 DRV LCK SLFTAP,$132.00,$0.00,$132.00,$59.40,$94.21,$0.00,$22.74,$0.00,$0.00,$23.11,$132.00,$0.00,$66.00,$104.54,$105.60,$0.00,$20.66,$0.00,$21.01,$0.00
370110,SUP,HCPCS C1713,,370110  -  SCREW BONE 5MM 10MM AXSOS SS HUM FEM/TIB SLFTAP LCK,$268.13,$0.00,$268.13,$120.66,$191.36,$0.00,$46.20,$0.00,$0.00,$46.95,$268.13,$0.00,$134.06,$212.36,$214.50,$0.00,$41.96,$0.00,$42.69,$0.00
370112,SUP,HCPCS C1713,,370112  -  SCREW BONE 5MM 12MM AXSOS SS HUM FEM/TIB SLFTAP LCK T15 DRV,$268.13,$0.00,$268.13,$120.66,$191.36,$0.00,$46.20,$0.00,$0.00,$46.95,$268.13,$0.00,$134.06,$212.36,$214.50,$0.00,$41.96,$0.00,$42.69,$0.00
370114,SUP,HCPCS C1713,,370114  -  SCREW BONE 5MM 14MM AXSOS DISTAL LAT FEM SLFTAP LCK T20 DRV,$268.13,$0.00,$268.13,$120.66,$191.36,$0.00,$46.20,$0.00,$0.00,$46.95,$268.13,$0.00,$134.06,$212.36,$214.50,$0.00,$41.96,$0.00,$42.69,$0.00
370116,SUP,HCPCS C1713,,370116  -  SCREW BONE 5MM 16MM AXSOS SS HUM FEM/TIB SLFTAP LCK T20 DRV,$268.13,$0.00,$268.13,$120.66,$191.36,$0.00,$46.20,$0.00,$0.00,$46.95,$268.13,$0.00,$134.06,$212.36,$214.50,$0.00,$41.96,$0.00,$42.69,$0.00
370118,SUP,HCPCS C1713,,370118  -  SCREW BONE 5MM 18MM AXSOS SS HUM FEM/TIB SLFTAP LCK,$268.13,$0.00,$268.13,$120.66,$191.36,$0.00,$46.20,$0.00,$0.00,$46.95,$268.13,$0.00,$134.06,$212.36,$214.50,$0.00,$41.96,$0.00,$42.69,$0.00
370120,SUP,HCPCS C1713,,370120  -  SCREW BONE 5MM 20MM AXSOS SS HUM FEM/TIB SLFTAP LCK,$268.13,$0.00,$268.13,$120.66,$191.36,$0.00,$46.20,$0.00,$0.00,$46.95,$268.13,$0.00,$134.06,$212.36,$214.50,$0.00,$41.96,$0.00,$42.69,$0.00
370314,SUP,HCPCS C1713,,370314  -  SCREW BONE 5MM 14MM ORTH LCK,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
370316,SUP,HCPCS C1713,,370316  -  SCREW BONE 5MM 16MM ORTH LCK,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
370318,SUP,HCPCS C1713,,370318  -  SCREW BONE 5MM 18MM AXSOS SS HUM FEM/TIB SLFTAP LCK T20 DRV,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
370320,SUP,HCPCS C1713,,370320  -  SCREW BONE 5MM 20MM AXSOS SS HUM FEM/TIB SLFTAP LCK,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
370322,SUP,HCPCS C1713,,370322  -  SCREW BONE 5MM 22MM ORTH LCK,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
370324,SUP,HCPCS C1713,,370324  -  SCREW BONE 5MM 24MM ORTH LCK,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
370326,SUP,HCPCS C1713,,370326  -  SCREW BONE 5MM 26MM AXSOS SS HUM FEM/TIB SLFTAP LCK,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
370328,SUP,HCPCS C1713,,370328  -  SCREW BONE 5MM 28MM AXSOS SS LCK SLFTAP T20 DRV PLT SYS,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
370330,SUP,HCPCS C1713,,370330  -  SCREW BONE 5MM 30MM AXSOS SS HUM FEM/TIB SLFTAP LCK,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
370332,SUP,HCPCS C1713,,370332  -  SCREW BONE 5MM 32MM AXSOS SS HUM FEM/TIB SLFTAP LCK,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
370334,SUP,HCPCS C1713,,370334  -  SCREW BONE 5MM 34MM AXSOS SS HUM FEM/TIB SLFTAP LCK,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
370336,SUP,HCPCS C1713,,370336  -  SCREW BONE 5MM 36MM AXSOS SS HUM FEM/TIB T20 DRV SLFTAP LCK,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
370338,SUP,HCPCS C1713,,370338  -  SCREW BONE 5MM 38MM AXSOS SS HUM FEM/TIB SLFTAP LCK,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
370340,SUP,HCPCS C1713,,370340  -  SCREW BONE 5MM 40MM AXSOS SS DISTAL LAT FEM LCK SLFTAP T20,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
370342,SUP,HCPCS C1713,,370342  -  SCREW BONE 5MM 42MM AXSOS SS HUM FEM/TIB SLFTAP LCK,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
370344,SUP,HCPCS C1713,,370344  -  SCREW BONE 5MM 44MM AXSOS SS HUM FEM/TIB SLFTAP LCK,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
370346,SUP,HCPCS C1713,,370346  -  SCREW BONE 5MM 46MM AXSOS SS HUM FEM/TIB SLFTAP LCK,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
370348,SUP,HCPCS C1713,,370348  -  SCREW BONE 5MM 48MM AXSOS SS HUM FEM/TIB SLFTAP LCK,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
370350,SUP,HCPCS C1713,,370350  -  SCREW BONE 5MM 50MM AXSOS SS HUM FEM/TIB SLFTAP LCK,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
370355,SUP,HCPCS C1713,,370355  -  SCREW BONE 5MM 55MM AXSOS SS HUM FEM/TIB SLFTAP LCK,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
370360,SUP,HCPCS C1713,,370360  -  SCREW BONE 5MM 60MM AXSOS SS HUM FEM/TIB SLFTAP LCK,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
370365,SUP,HCPCS C1713,,370365  -  SCREW BONE 5MM 65MM AXSOS SS HUM FEM/TIB SLFTAP LCK,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
370370,SUP,HCPCS C1713,,370370  -  SCREW BONE 5MM 70MM AXSOS SS HUM FEM/TIB SLFTAP LCK,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
370375,SUP,HCPCS C1713,,370375  -  SCREW BONE 5MM 75MM AXSOS SS HUM FEM/TIB SLFTAP LCK,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
370380,SUP,HCPCS C1713,,370380  -  SCREW BONE 5MM 80MM AXSOS SS HUM FEM/TIB SLFTAP LCK,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
370385,SUP,HCPCS C1713,,370385  -  SCREW BONE 5MM 85MM AXSOS SS HUM FEM/TIB SLFTAP LCK,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
370390,SUP,HCPCS C1713,,370390  -  SCREW BONE 5MM 90MM AXSOS SS HUM FEM/TIB SLFTAP LCK,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
370395,SUP,HCPCS C1713,,370395  -  SCREW BONE 5MM 95MM AXSOS SS HUM FEM/TIB SLFTAP LCK,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
370400,SUP,HCPCS C1713,,370400  -  SCREW BONE 5MM 100MM ORTH LCK,$196.63,$0.00,$196.63,$88.48,$140.33,$0.00,$33.88,$0.00,$0.00,$34.43,$196.63,$0.00,$98.31,$155.73,$157.30,$0.00,$30.77,$0.00,$31.30,$0.00
370405,SUP,HCPCS C1713,,370405  -  SCREW BONE 5MM 105MM ORTH LCK,$196.63,$0.00,$196.63,$88.48,$140.33,$0.00,$33.88,$0.00,$0.00,$34.43,$196.63,$0.00,$98.31,$155.73,$157.30,$0.00,$30.77,$0.00,$31.30,$0.00
370410,SUP,HCPCS C1713,,370410  -  SCREW BONE 5MM 110MM AXSOS SS HUM FEM/TIB SLFTAP LCK,$196.63,$0.00,$196.63,$88.48,$140.33,$0.00,$33.88,$0.00,$0.00,$34.43,$196.63,$0.00,$98.31,$155.73,$157.30,$0.00,$30.77,$0.00,$31.30,$0.00
370415,SUP,HCPCS C1713,,370415  -  SCREW BONE 5MM 115MM ORTH LCK,$196.63,$0.00,$196.63,$88.48,$140.33,$0.00,$33.88,$0.00,$0.00,$34.43,$196.63,$0.00,$98.31,$155.73,$157.30,$0.00,$30.77,$0.00,$31.30,$0.00
370420,SUP,HCPCS C1713,,370420  -  SCREW BONE 5MM 120MM AXSOS SS HUM FEM/TIB SLFTAP LCK,$196.63,$0.00,$196.63,$88.48,$140.33,$0.00,$33.88,$0.00,$0.00,$34.43,$196.63,$0.00,$98.31,$155.73,$157.30,$0.00,$30.77,$0.00,$31.30,$0.00
370514,SUP,HCPCS C1713,,370514  -  SCREW BONE 4MM 14MM AXSOS SS HUM FEM/TIB T15 DRV LCK SLFTAP,$185.63,$0.00,$185.63,$83.53,$132.48,$0.00,$31.98,$0.00,$0.00,$32.50,$185.63,$0.00,$92.81,$147.02,$148.50,$0.00,$29.05,$0.00,$29.55,$0.00
370516,SUP,HCPCS C1713,,370516  -  SCREW BONE 4MM 16MM AXSOS SS HUM FEM/TIB T15 DRV LCK SLFTAP,$185.63,$0.00,$185.63,$83.53,$132.48,$0.00,$31.98,$0.00,$0.00,$32.50,$185.63,$0.00,$92.81,$147.02,$148.50,$0.00,$29.05,$0.00,$29.55,$0.00
370518,SUP,HCPCS C1713,,370518  -  SCREW BONE 4MM 18MM AXSOS SS HUM FEM/TIB T15 DRV LCK SLFTAP,$185.63,$0.00,$185.63,$83.53,$132.48,$0.00,$31.98,$0.00,$0.00,$32.50,$185.63,$0.00,$92.81,$147.02,$148.50,$0.00,$29.05,$0.00,$29.55,$0.00
370520,SUP,HCPCS C1713,,370520  -  SCREW BONE 4MM 20MM AXSOS SS HUM FEM/TIB T15 DRV LCK SLFTAP,$185.63,$0.00,$185.63,$83.53,$132.48,$0.00,$31.98,$0.00,$0.00,$32.50,$185.63,$0.00,$92.81,$147.02,$148.50,$0.00,$29.05,$0.00,$29.55,$0.00
370522,SUP,HCPCS C1713,,370522  -  SCREW BONE 4MM 22MM AXSOS SS HUM FEM/TIB T15 DRV LCK SLFTAP,$185.63,$0.00,$185.63,$83.53,$132.48,$0.00,$31.98,$0.00,$0.00,$32.50,$185.63,$0.00,$92.81,$147.02,$148.50,$0.00,$29.05,$0.00,$29.55,$0.00
370524,SUP,HCPCS C1713,,370524  -  SCREW BONE 4MM 24MM AXSOS SS HUM FEM/TIB SLFTAP LCK T15 DRV,$185.63,$0.00,$185.63,$83.53,$132.48,$0.00,$31.98,$0.00,$0.00,$32.50,$185.63,$0.00,$92.81,$147.02,$148.50,$0.00,$29.05,$0.00,$29.55,$0.00
370526,SUP,HCPCS C1713,,370526  -  SCREW BONE 4MM 26MM AXSOS SS HUM FEM/TIB SLFTAP LCK T15 DRV,$185.63,$0.00,$185.63,$83.53,$132.48,$0.00,$31.98,$0.00,$0.00,$32.50,$185.63,$0.00,$92.81,$147.02,$148.50,$0.00,$29.05,$0.00,$29.55,$0.00
370528,SUP,HCPCS C1713,,370528  -  SCREW BONE 4MM 28MM AXSOS SS LCK SLFTAP T15 DRV,$185.63,$0.00,$185.63,$83.53,$132.48,$0.00,$31.98,$0.00,$0.00,$32.50,$185.63,$0.00,$92.81,$147.02,$148.50,$0.00,$29.05,$0.00,$29.55,$0.00
370530,SUP,HCPCS C1713,,370530  -  SCREW BONE 4MM 30MM AXSOS SS HUM FEM/TIB SLFTAP LCK,$185.63,$0.00,$185.63,$83.53,$132.48,$0.00,$31.98,$0.00,$0.00,$32.50,$185.63,$0.00,$92.81,$147.02,$148.50,$0.00,$29.05,$0.00,$29.55,$0.00
370532,SUP,HCPCS C1713,,370532  -  SCREW BONE 4MM 32MM AXSOS SS HUM FEM/TIB SLFTAP LCK,$185.63,$0.00,$185.63,$83.53,$132.48,$0.00,$31.98,$0.00,$0.00,$32.50,$185.63,$0.00,$92.81,$147.02,$148.50,$0.00,$29.05,$0.00,$29.55,$0.00
370534,SUP,HCPCS C1713,,370534  -  SCREW BONE 4MM 34MM AXSOS SS HUM FEM/TIB SLFTAP LCK,$185.63,$0.00,$185.63,$83.53,$132.48,$0.00,$31.98,$0.00,$0.00,$32.50,$185.63,$0.00,$92.81,$147.02,$148.50,$0.00,$29.05,$0.00,$29.55,$0.00
370536,SUP,HCPCS C1713,,370536  -  SCREW BONE 4MM 36MM AXSOS SS HUM FEM/TIB SLFTAP LCK T20 DRV,$185.63,$0.00,$185.63,$83.53,$132.48,$0.00,$31.98,$0.00,$0.00,$32.50,$185.63,$0.00,$92.81,$147.02,$148.50,$0.00,$29.05,$0.00,$29.55,$0.00
370538,SUP,HCPCS C1713,,370538  -  SCREW BONE 4MM 38MM AXSOS SS HUM FEM/TIB SLFTAP LCK,$185.63,$0.00,$185.63,$83.53,$132.48,$0.00,$31.98,$0.00,$0.00,$32.50,$185.63,$0.00,$92.81,$147.02,$148.50,$0.00,$29.05,$0.00,$29.55,$0.00
370540,SUP,HCPCS C1713,,370540  -  SCREW BONE 4MM 40MM AXSOS SS HUM FEM/TIB SLFTAP LCK,$185.63,$0.00,$185.63,$83.53,$132.48,$0.00,$31.98,$0.00,$0.00,$32.50,$185.63,$0.00,$92.81,$147.02,$148.50,$0.00,$29.05,$0.00,$29.55,$0.00
370542,SUP,HCPCS C1713,,370542  -  SCREW BONE 4MM 42MM AXSOS SS LCK SLFTAP T15 DRV,$185.63,$0.00,$185.63,$83.53,$132.48,$0.00,$31.98,$0.00,$0.00,$32.50,$185.63,$0.00,$92.81,$147.02,$148.50,$0.00,$29.05,$0.00,$29.55,$0.00
370544,SUP,HCPCS C1713,,370544  -  SCREW BONE 4MM 44MM AXSOS SS HUM FEM/TIB SLFTAP LCK T15 DRV,$185.63,$0.00,$185.63,$83.53,$132.48,$0.00,$31.98,$0.00,$0.00,$32.50,$185.63,$0.00,$92.81,$147.02,$148.50,$0.00,$29.05,$0.00,$29.55,$0.00
370546,SUP,HCPCS C1713,,370546  -  SCREW BONE 4MM 46MM AXSOS SS LCK SLFTAP T15 DRV,$185.63,$0.00,$185.63,$83.53,$132.48,$0.00,$31.98,$0.00,$0.00,$32.50,$185.63,$0.00,$92.81,$147.02,$148.50,$0.00,$29.05,$0.00,$29.55,$0.00
370548,SUP,HCPCS C1713,,370548  -  SCREW BONE 4MM 48MM AXSOS SS HUM FEM/TIB LCK,$185.63,$0.00,$185.63,$83.53,$132.48,$0.00,$31.98,$0.00,$0.00,$32.50,$185.63,$0.00,$92.81,$147.02,$148.50,$0.00,$29.05,$0.00,$29.55,$0.00
370550,SUP,HCPCS C1713,,370550  -  SCREW BONE 4MM 50MM AXSOS SS LCK SLFTAP T15 DRV,$185.63,$0.00,$185.63,$83.53,$132.48,$0.00,$31.98,$0.00,$0.00,$32.50,$185.63,$0.00,$92.81,$147.02,$148.50,$0.00,$29.05,$0.00,$29.55,$0.00
370555,SUP,HCPCS C1713,,370555  -  SCREW BONE 4MM 55MM AXSOS SS HUM FEM/TIB SLFTAP LCK,$185.63,$0.00,$185.63,$83.53,$132.48,$0.00,$31.98,$0.00,$0.00,$32.50,$185.63,$0.00,$92.81,$147.02,$148.50,$0.00,$29.05,$0.00,$29.55,$0.00
370560,SUP,HCPCS C1713,,370560  -  SCREW BONE 4MM 60MM AXSOS SS HUM FEM/TIB SLFTAP LCK,$185.63,$0.00,$185.63,$83.53,$132.48,$0.00,$31.98,$0.00,$0.00,$32.50,$185.63,$0.00,$92.81,$147.02,$148.50,$0.00,$29.05,$0.00,$29.55,$0.00
370565,SUP,HCPCS C1713,,370565  -  SCREW BONE 4MM 65MM AXSOS SS HUM FEM/TIB SLFTAP LCK,$185.63,$0.00,$185.63,$83.53,$132.48,$0.00,$31.98,$0.00,$0.00,$32.50,$185.63,$0.00,$92.81,$147.02,$148.50,$0.00,$29.05,$0.00,$29.55,$0.00
370570,SUP,HCPCS C1713,,370570  -  SCREW BONE 4MM 70MM AXSOS SS SLFTAP LCK T15 DRV NONSTRL,$185.63,$0.00,$185.63,$83.53,$132.48,$0.00,$31.98,$0.00,$0.00,$32.50,$185.63,$0.00,$92.81,$147.02,$148.50,$0.00,$29.05,$0.00,$29.55,$0.00
370575,SUP,HCPCS C1713,,370575  -  SCREW BONE 4MM 75MM AXSOS SS HUM FEM/TIB SLFTAP LCK T15 DRV,$185.63,$0.00,$185.63,$83.53,$132.48,$0.00,$31.98,$0.00,$0.00,$32.50,$185.63,$0.00,$92.81,$147.02,$148.50,$0.00,$29.05,$0.00,$29.55,$0.00
370580,SUP,HCPCS C1713,,370580  -  SCREW BONE 4MM 80MM AXSOS SS HUM FEM/TIB SLFTAP LCK T15 DRV,$185.63,$0.00,$185.63,$83.53,$132.48,$0.00,$31.98,$0.00,$0.00,$32.50,$185.63,$0.00,$92.81,$147.02,$148.50,$0.00,$29.05,$0.00,$29.55,$0.00
370585,SUP,HCPCS C1713,,370585  -  SCREW BONE 4MM 85MM AXSOS SS HUM FEM/TIB SLFTAP LCK T20 DRV,$185.63,$0.00,$185.63,$83.53,$132.48,$0.00,$31.98,$0.00,$0.00,$32.50,$185.63,$0.00,$92.81,$147.02,$148.50,$0.00,$29.05,$0.00,$29.55,$0.00
370590,SUP,HCPCS C1713,,370590  -  SCREW BONE 4MM 90MM AXSOS SS HUM FEM/TIB SLFTAP LCK T15 DRV,$185.63,$0.00,$185.63,$83.53,$132.48,$0.00,$31.98,$0.00,$0.00,$32.50,$185.63,$0.00,$92.81,$147.02,$148.50,$0.00,$29.05,$0.00,$29.55,$0.00
370595,SUP,HCPCS C1713,,370595  -  SCREW BONE 3.5MM 95MM AXSOS SS HUM FEM/TIB ST LCK,$185.63,$0.00,$185.63,$83.53,$132.48,$0.00,$31.98,$0.00,$0.00,$32.50,$185.63,$0.00,$92.81,$147.02,$148.50,$0.00,$29.05,$0.00,$29.55,$0.00
370600,SUP,HCPCS C1713,,370600  -  SCREW BONE 4MM 100MM ORTH LCK,$185.63,$0.00,$185.63,$83.53,$132.48,$0.00,$31.98,$0.00,$0.00,$32.50,$185.63,$0.00,$92.81,$147.02,$148.50,$0.00,$29.05,$0.00,$29.55,$0.00
370605,SUP,HCPCS C1713,,370605  -  SCREW BONE 4MM 105MM ORTH LCK,$185.63,$0.00,$185.63,$83.53,$132.48,$0.00,$31.98,$0.00,$0.00,$32.50,$185.63,$0.00,$92.81,$147.02,$148.50,$0.00,$29.05,$0.00,$29.55,$0.00
370610,SUP,HCPCS C1713,,370610  -  SCREW BONE 4MM 110MM ORTH LCK,$185.63,$0.00,$185.63,$83.53,$132.48,$0.00,$31.98,$0.00,$0.00,$32.50,$185.63,$0.00,$92.81,$147.02,$148.50,$0.00,$29.05,$0.00,$29.55,$0.00
370615,SUP,HCPCS C1713,,370615  -  SCREW BONE 4MM 115MM ORTH LCK,$185.63,$0.00,$185.63,$83.53,$132.48,$0.00,$31.98,$0.00,$0.00,$32.50,$185.63,$0.00,$92.81,$147.02,$148.50,$0.00,$29.05,$0.00,$29.55,$0.00
370620,SUP,HCPCS C1713,,370620  -  SCREW BONE 4MM 120MM ORTH LCK,$185.63,$0.00,$185.63,$83.53,$132.48,$0.00,$31.98,$0.00,$0.00,$32.50,$185.63,$0.00,$92.81,$147.02,$148.50,$0.00,$29.05,$0.00,$29.55,$0.00
371008,SUP,HCPCS C1713,,371008  -  SCREW BONE 3MM 8MM AXSOS T8 DRV LCK SLFTAP,$132.00,$0.00,$132.00,$59.40,$94.21,$0.00,$22.74,$0.00,$0.00,$23.11,$132.00,$0.00,$66.00,$104.54,$105.60,$0.00,$20.66,$0.00,$21.01,$0.00
371010,SUP,HCPCS C1713,,371010  -  SCREW BONE 3MM 10MM AXSOS SS LCK SLFTAP T8 DRV,$132.00,$0.00,$132.00,$59.40,$94.21,$0.00,$22.74,$0.00,$0.00,$23.11,$132.00,$0.00,$66.00,$104.54,$105.60,$0.00,$20.66,$0.00,$21.01,$0.00
371012,SUP,HCPCS C1713,,371012  -  SCREW BONE 3MM 12MM AXSOS LCK,$132.00,$0.00,$132.00,$59.40,$94.21,$0.00,$22.74,$0.00,$0.00,$23.11,$132.00,$0.00,$66.00,$104.54,$105.60,$0.00,$20.66,$0.00,$21.01,$0.00
371014,SUP,HCPCS C1713,,371014  -  SCREW BONE 3MM 14MM AXSOS SS PERIART LCK SLFTAP T8 DRV,$132.00,$0.00,$132.00,$59.40,$94.21,$0.00,$22.74,$0.00,$0.00,$23.11,$132.00,$0.00,$66.00,$104.54,$105.60,$0.00,$20.66,$0.00,$21.01,$0.00
371016,SUP,HCPCS C1713,,371016  -  SCREW BONE 3MM 16MM AXSOS SS PERIART LCK SLFTAP T8 DRV,$132.00,$0.00,$132.00,$59.40,$94.21,$0.00,$22.74,$0.00,$0.00,$23.11,$132.00,$0.00,$66.00,$104.54,$105.60,$0.00,$20.66,$0.00,$21.01,$0.00
371018,SUP,HCPCS C1713,,371018  -  SCREW BONE 3MM 18MM AXSOS SS PERIART LCK SLFTAP T8 DRV,$132.00,$0.00,$132.00,$59.40,$94.21,$0.00,$22.74,$0.00,$0.00,$23.11,$132.00,$0.00,$66.00,$104.54,$105.60,$0.00,$20.66,$0.00,$21.01,$0.00
371020,SUP,HCPCS C1713,,371020  -  SCREW BONE 3MM 20MM AXSOS SS PERIART T8 DRV LCK SLFTAP,$132.00,$0.00,$132.00,$59.40,$94.21,$0.00,$22.74,$0.00,$0.00,$23.11,$132.00,$0.00,$66.00,$104.54,$105.60,$0.00,$20.66,$0.00,$21.01,$0.00
371022,SUP,HCPCS C1713,,371022  -  SCREW BONE 3MM 22MM AXSOS SS LCK SLFTAP T8 DRV,$132.00,$0.00,$132.00,$59.40,$94.21,$0.00,$22.74,$0.00,$0.00,$23.11,$132.00,$0.00,$66.00,$104.54,$105.60,$0.00,$20.66,$0.00,$21.01,$0.00
371024,SUP,HCPCS C1713,,371024  -  SCREW BONE 3MM 24MM AXSOS T8 DRV LCK SLFTAP,$132.00,$0.00,$132.00,$59.40,$94.21,$0.00,$22.74,$0.00,$0.00,$23.11,$132.00,$0.00,$66.00,$104.54,$105.60,$0.00,$20.66,$0.00,$21.01,$0.00
371026,SUP,HCPCS C1713,,371026  -  SCREW BONE 3MM 26MM AXSOS T8 DRV LCK SLFTAP,$132.00,$0.00,$132.00,$59.40,$94.21,$0.00,$22.74,$0.00,$0.00,$23.11,$132.00,$0.00,$66.00,$104.54,$105.60,$0.00,$20.66,$0.00,$21.01,$0.00
371028,SUP,HCPCS C1713,,371028  -  SCREW BONE 3MM 28MM AXSOS T8 DRV LCK SLFTAP,$132.00,$0.00,$132.00,$59.40,$94.21,$0.00,$22.74,$0.00,$0.00,$23.11,$132.00,$0.00,$66.00,$104.54,$105.60,$0.00,$20.66,$0.00,$21.01,$0.00
371030,SUP,HCPCS C1713,,371030  -  SCREW BONE 3MM 30MM AXSOS SS PERIART LCK SLFTAP T8 DRV,$132.00,$0.00,$132.00,$59.40,$94.21,$0.00,$22.74,$0.00,$0.00,$23.11,$132.00,$0.00,$66.00,$104.54,$105.60,$0.00,$20.66,$0.00,$21.01,$0.00
371314,SUP,HCPCS C1713,,371314  -  LOCKING SCREW AXSOS 5.0MM / L14MM,$209.00,$0.00,$209.00,$94.05,$149.16,$0.00,$36.01,$0.00,$0.00,$36.59,$209.00,$0.00,$104.50,$165.53,$167.20,$0.00,$32.71,$0.00,$33.27,$0.00
371316,SUP,HCPCS C1713,,371316  -  LOCKING SCREW AXSOS 5.0MM / L16MM,$209.00,$0.00,$209.00,$94.05,$149.16,$0.00,$36.01,$0.00,$0.00,$36.59,$209.00,$0.00,$104.50,$165.53,$167.20,$0.00,$32.71,$0.00,$33.27,$0.00
371318,SUP,HCPCS C1713,,371318  -  SCREW BONE 5MM 18MM AXSOS SS LCK SLFTAP T20 DRV,$209.00,$0.00,$209.00,$94.05,$149.16,$0.00,$36.01,$0.00,$0.00,$36.59,$209.00,$0.00,$104.50,$165.53,$167.20,$0.00,$32.71,$0.00,$33.27,$0.00
371320,SUP,HCPCS C1713,,371320  -  SCREW BONE 5MM 20MM AXSOS SS PERIART LCK SLFTAP T20 DRV,$209.00,$0.00,$209.00,$94.05,$149.16,$0.00,$36.01,$0.00,$0.00,$36.59,$209.00,$0.00,$104.50,$165.53,$167.20,$0.00,$32.71,$0.00,$33.27,$0.00
371322,SUP,HCPCS C1713,,371322  -  LOCKING SCREW AXSOS 5.0MM / L22MM,$209.00,$0.00,$209.00,$94.05,$149.16,$0.00,$36.01,$0.00,$0.00,$36.59,$209.00,$0.00,$104.50,$165.53,$167.20,$0.00,$32.71,$0.00,$33.27,$0.00
371324,SUP,HCPCS C1713,,371324  -  SCREW BONE 5MM 24MM AXSOS SS PERIART LCK SLFTAP T20 DRV,$209.00,$0.00,$209.00,$94.05,$149.16,$0.00,$36.01,$0.00,$0.00,$36.59,$209.00,$0.00,$104.50,$165.53,$167.20,$0.00,$32.71,$0.00,$33.27,$0.00
371326,SUP,HCPCS C1713,,371326  -  SCREW BONE 5MM 26MM AXSOS SS LCK SLFTAP T20 DRV,$209.00,$0.00,$209.00,$94.05,$149.16,$0.00,$36.01,$0.00,$0.00,$36.59,$209.00,$0.00,$104.50,$165.53,$167.20,$0.00,$32.71,$0.00,$33.27,$0.00
371328,SUP,HCPCS C1713,,371328  -  SCREW BONE 5MM 28MM AXOS SS T20 DRV LCK SLFTAP NONSTRL,$209.00,$0.00,$209.00,$94.05,$149.16,$0.00,$36.01,$0.00,$0.00,$36.59,$209.00,$0.00,$104.50,$165.53,$167.20,$0.00,$32.71,$0.00,$33.27,$0.00
371330,SUP,HCPCS C1713,,371330  -  SCREW BONE 5MM 30MM AXSOS SS HUM FEM/TIB LCK SLFTAP T20 DRV,$209.00,$0.00,$209.00,$94.05,$149.16,$0.00,$36.01,$0.00,$0.00,$36.59,$209.00,$0.00,$104.50,$165.53,$167.20,$0.00,$32.71,$0.00,$33.27,$0.00
371332,SUP,HCPCS C1713,,371332  -  SCREW BONE 5MM 32MM AXSOS SS HUM FEM/TIB LCK SLFTAP T20 DRV,$209.00,$0.00,$209.00,$94.05,$149.16,$0.00,$36.01,$0.00,$0.00,$36.59,$209.00,$0.00,$104.50,$165.53,$167.20,$0.00,$32.71,$0.00,$33.27,$0.00
371334,SUP,HCPCS C1713,,371334  -  SCREW BONE 5MM 34MM AXSOS SS PERIART LCK SLFTAP T20 DRV,$209.00,$0.00,$209.00,$94.05,$149.16,$0.00,$36.01,$0.00,$0.00,$36.59,$209.00,$0.00,$104.50,$165.53,$167.20,$0.00,$32.71,$0.00,$33.27,$0.00
371336,SUP,HCPCS C1713,,371336  -  LOCKING SCREW AXSOS 5.0MM / L36MM,$209.00,$0.00,$209.00,$94.05,$149.16,$0.00,$36.01,$0.00,$0.00,$36.59,$209.00,$0.00,$104.50,$165.53,$167.20,$0.00,$32.71,$0.00,$33.27,$0.00
371338,SUP,HCPCS C1713,,371338  -  SCREW BONE 5MM 38MM AXSOS SS PERIART LCK SLFTAP T20 DRV,$209.00,$0.00,$209.00,$94.05,$149.16,$0.00,$36.01,$0.00,$0.00,$36.59,$209.00,$0.00,$104.50,$165.53,$167.20,$0.00,$32.71,$0.00,$33.27,$0.00
371340,SUP,HCPCS C1713,,371340  -  SCREW BONE 5MM 40MM AXSOS SS PERIART LCK SLFTAP T20 DRV,$209.00,$0.00,$209.00,$94.05,$149.16,$0.00,$36.01,$0.00,$0.00,$36.59,$209.00,$0.00,$104.50,$165.53,$167.20,$0.00,$32.71,$0.00,$33.27,$0.00
371342,SUP,HCPCS C1713,,371342  -  SCREW BONE 5MM 42MM AXSOS SS HUM FEM/TIB LCK SLFTAP T20 DRV,$209.00,$0.00,$209.00,$94.05,$149.16,$0.00,$36.01,$0.00,$0.00,$36.59,$209.00,$0.00,$104.50,$165.53,$167.20,$0.00,$32.71,$0.00,$33.27,$0.00
371344,SUP,HCPCS C1713,,371344  -  SCREW BONE 5MM 44MM AXSOS SS LCK SLFTAP T20 DRV,$209.00,$0.00,$209.00,$94.05,$149.16,$0.00,$36.01,$0.00,$0.00,$36.59,$209.00,$0.00,$104.50,$165.53,$167.20,$0.00,$32.71,$0.00,$33.27,$0.00
371346,SUP,HCPCS C1713,,371346  -  SCREW BONE 5MM 46MM AXSOS SS LCK SLFTAP T20 DRV,$209.00,$0.00,$209.00,$94.05,$149.16,$0.00,$36.01,$0.00,$0.00,$36.59,$209.00,$0.00,$104.50,$165.53,$167.20,$0.00,$32.71,$0.00,$33.27,$0.00
371348,SUP,HCPCS C1713,,371348  -  SCREW BONE 5MM 48MM AXSOS SS LCK SLFTAP T20 DRV,$209.00,$0.00,$209.00,$94.05,$149.16,$0.00,$36.01,$0.00,$0.00,$36.59,$209.00,$0.00,$104.50,$165.53,$167.20,$0.00,$32.71,$0.00,$33.27,$0.00
371350,SUP,HCPCS C1713,,371350  -  SCREW BONE 5MM 50MM AXSOS SS PERIART LCK SLFTAP T20 DRV,$209.00,$0.00,$209.00,$94.05,$149.16,$0.00,$36.01,$0.00,$0.00,$36.59,$209.00,$0.00,$104.50,$165.53,$167.20,$0.00,$32.71,$0.00,$33.27,$0.00
371355,SUP,HCPCS C1713,,371355  -  SCREW BONE 5MM 55MM AXSOS SS LCK SLFTAP T20 DRV,$209.00,$0.00,$209.00,$94.05,$149.16,$0.00,$36.01,$0.00,$0.00,$36.59,$209.00,$0.00,$104.50,$165.53,$167.20,$0.00,$32.71,$0.00,$33.27,$0.00
371360,SUP,HCPCS C1713,,371360  -  SCREW BONE 5MM 60MM AXSOS SS PERIART LCK SLFTAP T20 DRV,$209.00,$0.00,$209.00,$94.05,$149.16,$0.00,$36.01,$0.00,$0.00,$36.59,$209.00,$0.00,$104.50,$165.53,$167.20,$0.00,$32.71,$0.00,$33.27,$0.00
371365,SUP,HCPCS C1713,,371365  -  SCREW BONE 5MM 65MM AXSOS SS PERIART LCK SLFTAP T20 DRV,$209.00,$0.00,$209.00,$94.05,$149.16,$0.00,$36.01,$0.00,$0.00,$36.59,$209.00,$0.00,$104.50,$165.53,$167.20,$0.00,$32.71,$0.00,$33.27,$0.00
371370,SUP,HCPCS C1713,,371370  -  SCREW BONE 5MM 70MM AXSOS SS PERIART LCK SLFTAP T20 DRV,$209.00,$0.00,$209.00,$94.05,$149.16,$0.00,$36.01,$0.00,$0.00,$36.59,$209.00,$0.00,$104.50,$165.53,$167.20,$0.00,$32.71,$0.00,$33.27,$0.00
371375,SUP,HCPCS C1713,,371375  -  SCREW BONE 5MM 75MM AXSOS SS PERIART LCK SLFTAP T20 DRV,$209.00,$0.00,$209.00,$94.05,$149.16,$0.00,$36.01,$0.00,$0.00,$36.59,$209.00,$0.00,$104.50,$165.53,$167.20,$0.00,$32.71,$0.00,$33.27,$0.00
371380,SUP,HCPCS C1713,,371380  -  SCREW BONE 5MM 80MM AXSOS SS PERIART LCK SLFTAP T20 DRV,$209.00,$0.00,$209.00,$94.05,$149.16,$0.00,$36.01,$0.00,$0.00,$36.59,$209.00,$0.00,$104.50,$165.53,$167.20,$0.00,$32.71,$0.00,$33.27,$0.00
371385,SUP,HCPCS C1713,,371385  -  SCREW BONE 5MM 85MM AXSOS SS LCK,$209.00,$0.00,$209.00,$94.05,$149.16,$0.00,$36.01,$0.00,$0.00,$36.59,$209.00,$0.00,$104.50,$165.53,$167.20,$0.00,$32.71,$0.00,$33.27,$0.00
371390,SUP,HCPCS C1713,,371390  -  SCREW BONE 5MM 90MM AXSOS SS LCK SLFTAP T20 DRV,$209.00,$0.00,$209.00,$94.05,$149.16,$0.00,$36.01,$0.00,$0.00,$36.59,$209.00,$0.00,$104.50,$165.53,$167.20,$0.00,$32.71,$0.00,$33.27,$0.00
371395,SUP,HCPCS C1713,,371395  -  SCREW BONE 5MM 95MM AXSOS SS PERIART LCK SLFTAP T20 DRV,$209.00,$0.00,$209.00,$94.05,$149.16,$0.00,$36.01,$0.00,$0.00,$36.59,$209.00,$0.00,$104.50,$165.53,$167.20,$0.00,$32.71,$0.00,$33.27,$0.00
371514,SUP,HCPCS C1713,,371514  -  SCREW BONE 4MM 14MM SS T15 SLFTAP LCK DRV,$195.25,$0.00,$195.25,$87.86,$139.35,$0.00,$33.64,$0.00,$0.00,$34.19,$195.25,$0.00,$97.63,$154.64,$156.20,$0.00,$30.56,$0.00,$31.08,$0.00
371516,SUP,HCPCS C1713,,371516  -  SCREW BONE 4MM 16MM SS LCK SLFTAP T15 DRV NONSTRL,$195.25,$0.00,$195.25,$87.86,$139.35,$0.00,$33.64,$0.00,$0.00,$34.19,$195.25,$0.00,$97.63,$154.64,$156.20,$0.00,$30.56,$0.00,$31.08,$0.00
371518,SUP,HCPCS C1713,,371518  -  SCREW BONE 4MM 18MM AXSOS SS LCK SLFTAP T15 DRV NONSTRL,$195.25,$0.00,$195.25,$87.86,$139.35,$0.00,$33.64,$0.00,$0.00,$34.19,$195.25,$0.00,$97.63,$154.64,$156.20,$0.00,$30.56,$0.00,$31.08,$0.00
371520,SUP,HCPCS C1713,,371520  -  SCREW BN T15 4MM 20MM NS ST LCK SS AXSOS SM FRAG SET XTRMT,$195.25,$0.00,$195.25,$87.86,$139.35,$0.00,$33.64,$0.00,$0.00,$34.19,$195.25,$0.00,$97.63,$154.64,$156.20,$0.00,$30.56,$0.00,$31.08,$0.00
371522,SUP,HCPCS C1713,,371522  -  SCREW BN T15 4MM 22MM NS ST LCK SS AXSOS SM FRAG SET XTRMT,$195.25,$0.00,$195.25,$87.86,$139.35,$0.00,$33.64,$0.00,$0.00,$34.19,$195.25,$0.00,$97.63,$154.64,$156.20,$0.00,$30.56,$0.00,$31.08,$0.00
371524,SUP,HCPCS C1713,,371524  -  SCREW BN T15 4MM 24MM NS ST LCK SS AXSOS SM FRAG SET XTRMT,$195.25,$0.00,$195.25,$87.86,$139.35,$0.00,$33.64,$0.00,$0.00,$34.19,$195.25,$0.00,$97.63,$154.64,$156.20,$0.00,$30.56,$0.00,$31.08,$0.00
371526,SUP,HCPCS C1713,,371526  -  SCREW BN T15 4MM 26MM NS ST LCK SS AXSOS SM FRAG SET XTRMT,$195.25,$0.00,$195.25,$87.86,$139.35,$0.00,$33.64,$0.00,$0.00,$34.19,$195.25,$0.00,$97.63,$154.64,$156.20,$0.00,$30.56,$0.00,$31.08,$0.00
371528,SUP,HCPCS C1713,,371528  -  SCREW BN T15 4MM 28MM NS ST LCK SS AXSOS SM FRAG SET XTRMT,$195.25,$0.00,$195.25,$87.86,$139.35,$0.00,$33.64,$0.00,$0.00,$34.19,$195.25,$0.00,$97.63,$154.64,$156.20,$0.00,$30.56,$0.00,$31.08,$0.00
371530,SUP,HCPCS C1713,,371530  -  SCREW BN T15 4MM 30MM NS ST LCK SS AXSOS SM FRAG SET XTRMT,$195.25,$0.00,$195.25,$87.86,$139.35,$0.00,$33.64,$0.00,$0.00,$34.19,$195.25,$0.00,$97.63,$154.64,$156.20,$0.00,$30.56,$0.00,$31.08,$0.00
371532,SUP,HCPCS C1713,,371532  -  SCREW BN T15 4MM 32MM NS ST LCK SS AXSOS SM FRAG SET XTRMT,$195.25,$0.00,$195.25,$87.86,$139.35,$0.00,$33.64,$0.00,$0.00,$34.19,$195.25,$0.00,$97.63,$154.64,$156.20,$0.00,$30.56,$0.00,$31.08,$0.00
371534,SUP,HCPCS C1713,,371534  -  SCREW BN T15 4MM 34MM NS ST LCK SS AXSOS SM FRAG SET XTRMT,$195.25,$0.00,$195.25,$87.86,$139.35,$0.00,$33.64,$0.00,$0.00,$34.19,$195.25,$0.00,$97.63,$154.64,$156.20,$0.00,$30.56,$0.00,$31.08,$0.00
371536,SUP,HCPCS C1713,,371536  -  SCREW BN T15 4MM 36MM NS ST LCK SS AXSOS SM FRAG SET XTRMT,$195.25,$0.00,$195.25,$87.86,$139.35,$0.00,$33.64,$0.00,$0.00,$34.19,$195.25,$0.00,$97.63,$154.64,$156.20,$0.00,$30.56,$0.00,$31.08,$0.00
371538,SUP,HCPCS C1713,,371538  -  SCREW BN T15 4MM 38MM NS ST LCK SS AXSOS SM FRAG SET XTRMT,$195.25,$0.00,$195.25,$87.86,$139.35,$0.00,$33.64,$0.00,$0.00,$34.19,$195.25,$0.00,$97.63,$154.64,$156.20,$0.00,$30.56,$0.00,$31.08,$0.00
371540,SUP,HCPCS C1713,,371540  -  SCREW BONE 4MM 40MM AXSOS SS PERIART LCK SLFTAP T15 DRV,$195.25,$0.00,$195.25,$87.86,$139.35,$0.00,$33.64,$0.00,$0.00,$34.19,$195.25,$0.00,$97.63,$154.64,$156.20,$0.00,$30.56,$0.00,$31.08,$0.00
371542,SUP,HCPCS C1713,,371542  -  SCREW BONE 4MM 42MM AXSOS SS PERIART LCK SLFTAP T15 DRV,$195.25,$0.00,$195.25,$87.86,$139.35,$0.00,$33.64,$0.00,$0.00,$34.19,$195.25,$0.00,$97.63,$154.64,$156.20,$0.00,$30.56,$0.00,$31.08,$0.00
371544,SUP,HCPCS C1713,,371544  -  SCREW BONE 4MM 44MM AXSOS SS PERIART LCK SLFTAP T15 DRV,$195.25,$0.00,$195.25,$87.86,$139.35,$0.00,$33.64,$0.00,$0.00,$34.19,$195.25,$0.00,$97.63,$154.64,$156.20,$0.00,$30.56,$0.00,$31.08,$0.00
371546,SUP,HCPCS C1713,,371546  -  SCREW BONE 4MM 46MM AXSOS SS PERIART LCK SLFTAP T15 DRV,$195.25,$0.00,$195.25,$87.86,$139.35,$0.00,$33.64,$0.00,$0.00,$34.19,$195.25,$0.00,$97.63,$154.64,$156.20,$0.00,$30.56,$0.00,$31.08,$0.00
371548,SUP,HCPCS C1713,,371548  -  SCREW BN T15 4MM 48MM NS ST LCK SS AXSOS SM FRAG SET XTRMT,$195.25,$0.00,$195.25,$87.86,$139.35,$0.00,$33.64,$0.00,$0.00,$34.19,$195.25,$0.00,$97.63,$154.64,$156.20,$0.00,$30.56,$0.00,$31.08,$0.00
371550,SUP,HCPCS C1713,,371550  -  SCREW BONE 4MM 50MM AXSOS SS HUM FEM/TIB LCK SLFTAP T15 DRV,$195.25,$0.00,$195.25,$87.86,$139.35,$0.00,$33.64,$0.00,$0.00,$34.19,$195.25,$0.00,$97.63,$154.64,$156.20,$0.00,$30.56,$0.00,$31.08,$0.00
371555,SUP,HCPCS C1713,,371555  -  SCREW BONE 4MM 55MM AXSOS SS PERIART LCK SLFTAP T15 DRV,$195.25,$0.00,$195.25,$87.86,$139.35,$0.00,$33.64,$0.00,$0.00,$34.19,$195.25,$0.00,$97.63,$154.64,$156.20,$0.00,$30.56,$0.00,$31.08,$0.00
371560,SUP,HCPCS C1713,,371560  -  SCREW BONE 4MM 60MM AXSOS SS PERIART LCK SLFTAP T15 DRV,$195.25,$0.00,$195.25,$87.86,$139.35,$0.00,$33.64,$0.00,$0.00,$34.19,$195.25,$0.00,$97.63,$154.64,$156.20,$0.00,$30.56,$0.00,$31.08,$0.00
371565,SUP,HCPCS C1713,,371565  -  SCREW BONE 4MM 65MM AXSOS SS LCK SLFTAP T15 DRV,$195.25,$0.00,$195.25,$87.86,$139.35,$0.00,$33.64,$0.00,$0.00,$34.19,$195.25,$0.00,$97.63,$154.64,$156.20,$0.00,$30.56,$0.00,$31.08,$0.00
371570,SUP,HCPCS C1713,,371570  -  SCREW BONE T15 4MM 70MM SELF TAP LOCK AXSOS STAINLESS STEEL,$195.25,$0.00,$195.25,$87.86,$139.35,$0.00,$33.64,$0.00,$0.00,$34.19,$195.25,$0.00,$97.63,$154.64,$156.20,$0.00,$30.56,$0.00,$31.08,$0.00
371575,SUP,HCPCS C1713,,371575  -  SCREW BONE 4MM 75MM AXSOS SS LCK SLFTAP T15 DRV,$195.25,$0.00,$195.25,$87.86,$139.35,$0.00,$33.64,$0.00,$0.00,$34.19,$195.25,$0.00,$97.63,$154.64,$156.20,$0.00,$30.56,$0.00,$31.08,$0.00
371580,SUP,HCPCS C1713,,371580  -  SCREW BONE 4MM 80MM AXSOS LCK,$195.25,$0.00,$195.25,$87.86,$139.35,$0.00,$33.64,$0.00,$0.00,$34.19,$195.25,$0.00,$97.63,$154.64,$156.20,$0.00,$30.56,$0.00,$31.08,$0.00
371585,SUP,HCPCS C1713,,371585  -  SCREW BONE 4MM 85MM AXSOS SS T15 SLFTAP LCK DRV,$195.25,$0.00,$195.25,$87.86,$139.35,$0.00,$33.64,$0.00,$0.00,$34.19,$195.25,$0.00,$97.63,$154.64,$156.20,$0.00,$30.56,$0.00,$31.08,$0.00
371590,SUP,HCPCS C1713,,371590  -  SCREW BONE 4MM 90MM AXSOS SS T15 DRV SLFTAP LCK,$195.25,$0.00,$195.25,$87.86,$139.35,$0.00,$33.64,$0.00,$0.00,$34.19,$195.25,$0.00,$97.63,$154.64,$156.20,$0.00,$30.56,$0.00,$31.08,$0.00
371595,SUP,HCPCS C1713,,371595  -  LOCKING SCREW AXSOS 4.0MM / L95MM,$195.25,$0.00,$195.25,$87.86,$139.35,$0.00,$33.64,$0.00,$0.00,$34.19,$195.25,$0.00,$97.63,$154.64,$156.20,$0.00,$30.56,$0.00,$31.08,$0.00
372615,SUP,HCPCS C1713,,372615  -  SCALPEL SURG 15 1 HAND ACTIVATION LOCK RETRACTABLE SHIELD,$37.02,$0.00,$37.02,$16.66,$26.42,$0.00,$6.38,$0.00,$0.00,$6.48,$37.02,$0.00,$18.51,$29.32,$29.62,$0.00,$5.79,$0.00,$5.89,$0.00
373741,SUP,Custom 27203010,,373741  -  KNIFE OPHTHALMIC 45D ANGLED 4.1MM BEVEL UP PHACO SLIT MATTE,$30.07,$0.00,$30.07,$0.00,$21.46,$0.00,$0.00,$0.00,$0.00,$0.00,$30.07,$0.00,$15.03,$23.82,$24.06,$0.00,$0.00,$0.00,$0.00,$0.00
373808,SUP,Custom 27203010,,373808  -  SCALPEL SURG 2.5MM 2.5MM STR ROUND TIP CRESCENT OPHTHALMIC,$87.68,$0.00,$69.44,$0.00,$24.12,$0.00,$0.00,$0.00,$0.00,$0.00,$33.80,$0.00,$16.90,$69.44,$27.04,$0.00,$0.00,$0.00,$0.00,$0.00
378227,SUP,Custom 27203010,,378227  -  KNIFE OPHTHALMIC 45D BEVEL 2.75MM BLADE MATTE FINISH SLIT BD,$35.63,$0.00,$35.63,$0.00,$25.43,$0.00,$0.00,$0.00,$0.00,$0.00,$35.63,$0.00,$17.81,$28.22,$28.50,$0.00,$0.00,$0.00,$0.00,$0.00
378230,SUP,Custom 27203010,,378230  -  KNIFE OPHTHALMIC 45D BEVEL 3MM PHACO SLIT SAFETY MATTE,$35.63,$0.00,$35.63,$0.00,$25.43,$0.00,$0.00,$0.00,$0.00,$0.00,$35.63,$0.00,$17.81,$28.22,$28.50,$0.00,$0.00,$0.00,$0.00,$0.00
378231,SUP,Custom 27203010,,378231  -  KNIFE OPHTHALMIC 20D .9MM 3MM SAFETY SIDEPORT RETRACTABLE,$128.88,$0.00,$128.88,$0.00,$91.98,$0.00,$0.00,$0.00,$0.00,$0.00,$128.88,$0.00,$64.44,$102.07,$103.11,$0.00,$0.00,$0.00,$0.00,$0.00
381112,SUP,HCPCS C1729,,CATHETER IV 24GA .75IN RADIOPQ YLW ANGCTH TFLN STRL LF,$4.45,$0.00,$4.45,$2.42,$3.18,$0.00,$0.77,$0.00,$0.00,$0.78,$4.45,$0.00,$2.23,$3.52,$3.56,$0.00,$0.70,$0.00,$0.71,$0.00
381137,SUP,HCPCS C1729,,CATHETER IV 20GA 1.88IN RADIOPQ PNK ANGCTH TFLN STRL LF,$9.18,$0.00,$9.18,$4.98,$6.55,$0.00,$1.58,$0.00,$0.00,$1.61,$9.18,$0.00,$4.59,$7.27,$7.34,$0.00,$1.44,$0.00,$1.46,$0.00
381144,SUP,HCPCS C1729,,CATHETER IV 18GA 1.16IN RADIOPQ GRN ANGCTH TFLN STRL LF,$9.93,$0.00,$9.93,$5.39,$7.08,$0.00,$1.71,$0.00,$0.00,$1.74,$9.93,$0.00,$4.96,$7.86,$7.94,$0.00,$1.55,$0.00,$1.58,$0.00
381511,SUP,HCPCS C1729,,CATHETER IV 24GA .56IN RADIOPQ SFSHLD WNG YLW INST-N ATGRD,$6.65,$0.00,$6.65,$3.61,$4.75,$0.00,$1.15,$0.00,$0.00,$1.16,$6.65,$0.00,$3.33,$5.27,$5.32,$0.00,$1.04,$0.00,$1.06,$0.00
381512,SUP,HCPCS C1729,,CATHETER IV 24GA .75IN RADIOPQ SFSHLD WNG YLW INST-N ATGRD,$4.93,$0.00,$4.93,$2.67,$3.51,$0.00,$0.85,$0.00,$0.00,$0.86,$4.93,$0.00,$2.46,$3.90,$3.94,$0.00,$0.77,$0.00,$0.78,$0.00
381523,SUP,HCPCS C1729,,CATHETER IV 22GA 1IN RADIOPQ SFSHLD WNG BLUE INST-N ATGRD,$4.78,$0.00,$4.78,$2.59,$3.41,$0.00,$0.82,$0.00,$0.00,$0.84,$4.78,$0.00,$2.39,$3.79,$3.82,$0.00,$0.75,$0.00,$0.76,$0.00
381533,SUP,HCPCS C1729,,CATHETER IV 20GA 1IN RADIOPQ SFSHLD WNG PNK INST AGRD VLN,$4.53,$0.00,$4.53,$2.46,$3.23,$0.00,$0.78,$0.00,$0.00,$0.79,$4.53,$0.00,$2.26,$3.59,$3.62,$0.00,$0.71,$0.00,$0.72,$0.00
382259,SUP,HCPCS C1729,,CATHETER IV 16GA 5.25IN RADIOPQ YLW ANGCTH TFLN STRL LF,$28.48,$0.00,$28.48,$15.46,$20.32,$0.00,$4.91,$0.00,$0.00,$4.99,$28.48,$0.00,$14.24,$22.56,$22.78,$0.00,$4.46,$0.00,$4.53,$0.00
382269,SUP,HCPCS C1729,,CATHETER IV 14GA 5.25IN RADIOPQ SFSHLD ORNG ANGCTH TFLN STRL,$28.48,$0.00,$28.48,$15.46,$20.32,$0.00,$4.91,$0.00,$0.00,$4.99,$28.48,$0.00,$14.24,$22.56,$22.78,$0.00,$4.46,$0.00,$4.53,$0.00
382861,SUP,HCPCS C1898,,"382861  -  PASSIVE FIXATION PACING LEAD, J-SHAPE, SILICONE INSULATION,","$1,125.00",$0.00,"$1,125.00",$506.25,$802.91,$0.00,$193.83,$0.00,$0.00,$196.98,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$176.06,$0.00,$179.10,$0.00
382866,SUP,HCPCS C1898,,"382866  -  PASSIVE FIXATION PACING LEAD, J-SHAPE, SILICONE INSULATION,","$1,125.00",$0.00,"$1,125.00",$506.25,$802.91,$0.00,$193.83,$0.00,$0.00,$196.98,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$176.06,$0.00,$179.10,$0.00
382872,SUP,HCPCS C1898,,"382872  -  PASSIVE FIXATION PACING LEAD, STRAIGHT, SILICONE INSULATION,","$1,125.00",$0.00,"$1,125.00",$506.25,$802.91,$0.00,$193.83,$0.00,$0.00,$196.98,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$176.06,$0.00,$179.10,$0.00
382878,SUP,HCPCS C1898,,"382878  -  PASSIVE FIXATION PACING LEAD, STRAIGHT, SILICONE INSULATION,","$1,125.00",$0.00,"$1,125.00",$506.25,$802.91,$0.00,$193.83,$0.00,$0.00,$196.98,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$176.06,$0.00,$179.10,$0.00
382884,SUP,HCPCS C1898,,382884  -  LEAD PCNG HLX 45CM SIL ATR TILDA,"$1,125.00",$0.00,"$1,125.00",$506.25,$802.91,$0.00,$193.83,$0.00,$0.00,$196.98,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$176.06,$0.00,$179.10,$0.00
382889,SUP,HCPCS C1895,,382889  -  LEAD PCNG HLX 53CM SIL ATR TILDA,"$1,125.00",$0.00,"$1,125.00",$506.25,$802.91,$0.00,$193.83,$0.00,$0.00,$196.98,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$176.06,$0.00,$179.10,$0.00
382895,SUP,HCPCS C1895,,382895  -  LEAD PCNG HLX 60CM SIL VNTRC TILDA,"$1,125.00",$0.00,"$1,125.00",$506.25,$802.91,$0.00,$193.83,$0.00,$0.00,$196.98,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$176.06,$0.00,$179.10,$0.00
382903,SUP,HCPCS C1777,,382903  -  LEAD PCNG 65CM VIGILA,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
382918,SUP,HCPCS C1721,,"382918  -  PASSIVE FIXATION, DUAL COIL, SILICONE INSULATION, 65 CM, 18","$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
382924,SUP,HCPCS C1721,,"382924  -  ACTIVE FIXATION, DUAL COIL, SILICONE INSULATION, 60 CM, 16 C","$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
382936,SUP,HCPCS C1721,,"382936  -  ACTIVE FIXATION, DUAL COIL, SILICONE INSULATION, 65 CM, 18 C","$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
382961,SUP,HCPCS C1900,,382961  -  LEFT VENTRICULAR LEAD WITH 3D PRE-SHAPED HELIX AT DISTAL END,"$5,000.00",$0.00,"$5,000.00",$0.00,"$3,568.50",$0.00,$861.48,$0.00,$0.00,$0.00,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$782.50,$0.00,$0.00,$0.00
382972,SUP,HCPCS C1900,,382972  -  LEFT VENTRICULAR LEAD WITH PRE-SHAPED BEND AND THREAD FIXATI,"$5,000.00",$0.00,"$5,000.00",$0.00,"$3,568.50",$0.00,$861.48,$0.00,$0.00,$0.00,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$782.50,$0.00,$0.00,$0.00
383395,SUP,HCPCS C1900,,"383395  -  LEFT VENTRICULAR LEAD WITH 2D PRE-SHAPED BEND AT DISTAL END,","$5,000.00",$0.00,"$5,000.00",$0.00,"$3,568.50",$0.00,$861.48,$0.00,$0.00,$0.00,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$782.50,$0.00,$0.00,$0.00
384021,SUP,HCPCS C1887,,INTRODUCER CATH 26GA 1.9FR INTRST-N NEO,$96.18,$0.00,$96.18,$52.22,$68.64,$0.00,$16.57,$0.00,$0.00,$16.84,$96.18,$0.00,$48.09,$76.17,$76.94,$0.00,$15.05,$0.00,$15.31,$0.00
384232,SUP,HCPCS C1729,,CATHETER CEN VEN 1.9FR 50CM 1 LUM PICC 1ST PICC SIL,$143.63,$0.00,$143.63,$77.99,$102.51,$0.00,$24.75,$0.00,$0.00,$25.15,$143.63,$0.00,$71.81,$113.75,$114.90,$0.00,$22.48,$0.00,$22.87,$0.00
384825,SUP,Custom 27203010,,TRAY PRC DRSG SCSR TRNQT NEO,$110.10,$0.00,$110.10,$0.00,$78.58,$0.00,$0.00,$0.00,$0.00,$0.00,$110.10,$0.00,$55.05,$87.20,$88.08,$0.00,$0.00,$0.00,$0.00,$0.00
386358,SUP,Custom 27203010,,CALIBRATOR CA 125 ACCES OV MONITR VL 2.5ML IMMUN,$348.50,$0.00,$348.50,$0.00,$248.72,$0.00,$0.00,$0.00,$0.00,$0.00,$348.50,$0.00,$174.25,$276.01,$278.80,$0.00,$0.00,$0.00,$0.00,$0.00
386371,SUP,Custom 27203010,,REAGENT CKMB ACCES 100 TST ANALY,$315.00,$0.00,$315.00,$0.00,$224.82,$0.00,$0.00,$0.00,$0.00,$0.00,$315.00,$0.00,$157.50,$249.48,$252.00,$0.00,$0.00,$0.00,$0.00,$0.00
386372,SUP,Custom 27203010,,CALIBRATOR CHM SET CK-MB ACCES 6X2ML,$264.45,$0.00,$264.45,$0.00,$188.74,$0.00,$0.00,$0.00,$0.00,$0.00,$264.45,$0.00,$132.23,$209.44,$211.56,$0.00,$0.00,$0.00,$0.00,$0.00
390016,SUP,HCPCS C1713,,390016  -  WASHER 6.6MM CANN ASNS 3 ORTH SS 8IN 6.5/8MM SCR,$59.13,$0.00,$59.13,$26.61,$42.20,$0.00,$10.19,$0.00,$0.00,$10.35,$59.13,$0.00,$29.56,$46.83,$47.30,$0.00,$9.25,$0.00,$9.41,$0.00
390017,SUP,HCPCS C1713,,390017  -  WASHER 5MM ASNS 3 ORTH SS 7MM CANN SCR,$46.75,$0.00,$46.75,$21.04,$33.37,$0.00,$8.05,$0.00,$0.00,$8.19,$46.75,$0.00,$23.38,$37.03,$37.40,$0.00,$7.32,$0.00,$7.44,$0.00
390018,SUP,HCPCS C1713,,390018  -  WASHER 8MM ASNS 3 ORTH SS 7MM CANN SCR,$49.50,$0.00,$49.50,$22.28,$35.33,$0.00,$8.53,$0.00,$0.00,$8.67,$49.50,$0.00,$24.75,$39.20,$39.60,$0.00,$7.75,$0.00,$7.88,$0.00
390019,SUP,HCPCS C1713,,390019  -  WASHER 9MM ASNS 3 ORTH SS 8IN 3.5MM CANN SCR,$50.88,$0.00,$50.88,$22.89,$36.31,$0.00,$8.77,$0.00,$0.00,$8.91,$50.88,$0.00,$25.44,$40.30,$40.70,$0.00,$7.96,$0.00,$8.10,$0.00
390083,SUP,HCPCS C1713,,390083  -  PIN HLD 5MM ORTH REDX 150MM,$247.50,$0.00,$247.50,$111.38,$176.64,$0.00,$42.64,$0.00,$0.00,$43.34,$247.50,$0.00,$123.75,$196.02,$198.00,$0.00,$38.73,$0.00,$39.40,$0.00
390084,SUP,HCPCS C1713,,390084  -  PIN HLD 5MM ORTH REDX SS 180MM,$247.50,$0.00,$247.50,$111.38,$176.64,$0.00,$42.64,$0.00,$0.00,$43.34,$247.50,$0.00,$123.75,$196.02,$198.00,$0.00,$38.73,$0.00,$39.40,$0.00
390086,SUP,HCPCS C1713,,390086  -  PIN HALF 150MM 6MM PLVC SS SLF CUT REDX,$247.50,$0.00,$247.50,$111.38,$176.64,$0.00,$42.64,$0.00,$0.00,$43.34,$247.50,$0.00,$123.75,$196.02,$198.00,$0.00,$38.73,$0.00,$39.40,$0.00
390087,SUP,HCPCS C1713,,390087  -  PIN HLD 6MM ORTH REDX 180MM,$247.50,$0.00,$247.50,$111.38,$176.64,$0.00,$42.64,$0.00,$0.00,$43.34,$247.50,$0.00,$123.75,$196.02,$198.00,$0.00,$38.73,$0.00,$39.40,$0.00
390181,SUP,HCPCS C1713,,390181  -  WIRE FX 2.5MM 285MM NS KRSH TROC PNT SS,$140.25,$0.00,$140.25,$63.11,$100.10,$0.00,$24.16,$0.00,$0.00,$24.56,$140.25,$0.00,$70.13,$111.08,$112.20,$0.00,$21.95,$0.00,$22.33,$0.00
390195,SUP,HCPCS C1713,,390195  -  WIRE FX 3MM 285MM NS KRSH TROC PNT SS,$129.25,$0.00,$129.25,$58.16,$92.25,$0.00,$22.27,$0.00,$0.00,$22.63,$129.25,$0.00,$64.63,$102.37,$103.40,$0.00,$20.23,$0.00,$20.58,$0.00
397003,SUP,HCPCS C1713,,397003  -  CEMENT BONE SLF SET INJ OSTCNDC HYDROSET BONE SUB VOID FILR,"$2,522.63",$0.00,"$2,522.63","$1,135.18","$1,800.40",$0.00,$434.64,$0.00,$0.00,$441.69,"$2,522.63",$0.00,"$1,261.31","$1,997.92","$2,018.10",$0.00,$394.79,$0.00,$401.60,$0.00
397005,SUP,HCPCS C1713,,397005  -  CEMENT BONE HYDROSET CALCIUM PHOS 5ML INJ SLF SET VOID FILR,"$4,045.50",$0.00,"$4,045.50","$1,820.48","$2,887.27",$0.00,$697.02,$0.00,$0.00,$708.33,"$4,045.50",$0.00,"$2,022.75","$3,204.04","$3,236.40",$0.00,$633.12,$0.00,$644.04,$0.00
397010,SUP,HCPCS C1713,,397010  -  CEMENT BONE SLF SET INJ OSTCNDC HYDROSET BONE SUB VOID FILR,"$7,777.13",$0.00,"$7,777.13","$3,499.71","$5,158.80",$0.00,"$1,339.96",$0.00,$0.00,"$1,361.71","$7,777.13",$0.00,"$3,888.56","$6,159.49","$6,221.70",$0.00,"$1,217.12",$0.00,"$1,238.12",$0.00
397015,SUP,HCPCS C1713,,397015  -  CEMENT BONE HYDROSET BONE SUB VOID FILR CALCIUM PHOS 15ML,"$11,160.00",$0.00,"$11,160.00","$5,022.00","$5,158.80",$0.00,"$1,922.81",$0.00,$0.00,"$1,954.03","$11,160.00",$0.00,"$5,580.00","$8,838.72","$8,928.00",$0.00,"$1,746.54",$0.00,"$1,776.67",$0.00
400077,SUP,Custom 27203010,,400077  -  SEAL CNN 8MM DVNC EWRST DISP,$3.75,$0.00,$3.75,$0.00,$2.68,$0.00,$0.00,$0.00,$0.00,$0.00,$3.75,$0.00,$1.88,$2.97,$3.00,$0.00,$0.00,$0.00,$0.00,$0.00
400180,SUP,Custom 27203010,,400180  -  COVER ESCP TIP 8MM STD HOT SHR DVNC EWRST CAUT MNPLR DISP,$50.00,$0.00,$50.00,$0.00,$35.69,$0.00,$0.00,$0.00,$0.00,$0.00,$50.00,$0.00,$25.00,$39.60,$40.00,$0.00,$0.00,$0.00,$0.00,$0.00
400427,SUP,Custom 27203010,,400427  -  PACKING NSL 2.5X.9X2CM MRCL BRN SIN-PK STNG SLIM PRFL,$18.98,$0.00,$18.98,$0.00,$13.54,$0.00,$0.00,$0.00,$0.00,$0.00,$18.98,$0.00,$9.49,$15.03,$15.18,$0.00,$0.00,$0.00,$0.00,$0.00
401531,SUP,Custom 27203010,,401531  -  BAG OST SFN MINI 1.75IN 5IN 2 SIDE COROVIN LATEX FREE DISP,$1.50,$0.00,$1.50,$0.00,$1.07,$0.00,$0.00,$0.00,$0.00,$0.00,$1.50,$0.00,$0.75,$1.19,$1.20,$0.00,$0.00,$0.00,$0.00,$0.00
401552,SUP,Custom 27203010,,KIT 1.5IN UROS STD SRFT,$4.00,$0.00,$4.00,$0.00,$2.85,$0.00,$0.00,$0.00,$0.00,$0.00,$4.00,$0.00,$2.00,$3.17,$3.20,$0.00,$0.00,$0.00,$0.00,$0.00
402025,SUP,HCPCS Q4116,,402025  -  MATRIX TISSUE THIN 7X4CM ALLOGRAFT REGENERATIVE FREEZE DRIED,$100.54,$0.00,$100.54,$45.24,$71.75,$0.00,$17.32,$0.00,$0.00,$17.60,$100.54,$0.00,$50.27,$79.63,$80.43,$0.00,$15.73,$0.00,$16.01,$0.00
402045,SUP,HCPCS Q4116,,402045  -  MATRIX TISSUE THIN 12X4CM ALLOGRAFT REGENERATIVE FREEZE,$100.16,$0.00,$100.16,$45.07,$71.48,$0.00,$17.26,$0.00,$0.00,$17.54,$100.16,$0.00,$50.08,$79.33,$80.13,$0.00,$15.67,$0.00,$15.94,$0.00
402432,SUP,Custom 27803010,,402432  -  CEMENT BONE CO HV LG 40GM HVISC STRL,$292.50,$0.00,$292.50,$0.00,$208.76,$0.00,$0.00,$0.00,$0.00,$0.00,$292.50,$0.00,$146.25,$231.66,$234.00,$0.00,$0.00,$0.00,$0.00,$0.00
402433,SUP,Custom 27803010,,402433  -  CEMENT BONE CBLT G-HV 40GM HVISC GNTA STRL,"$1,057.50",$0.00,"$1,057.50",$0.00,$754.74,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,057.50",$0.00,$528.75,$837.54,$846.00,$0.00,$0.00,$0.00,$0.00,$0.00
403326,SUP,Custom 27203010,,DRESSING DUODERM 4X4 SIGNAL,$6.60,$0.00,$6.60,$0.00,$4.71,$0.00,$0.00,$0.00,$0.00,$0.00,$6.60,$0.00,$3.30,$5.23,$5.28,$0.00,$0.00,$0.00,$0.00,$0.00
403711,SUP,Custom 27203010,,403711  -  DRESSING WOUND RECTANGLE 10X8IN STRONGER GREATER ABSORBENCY,$82.33,$0.00,$82.33,$0.00,$58.76,$0.00,$0.00,$0.00,$0.00,$0.00,$82.33,$0.00,$41.16,$65.21,$65.86,$0.00,$0.00,$0.00,$0.00,$0.00
403771,SUP,Custom 27203010,,403771  -  DRESSING HYDROCOLLOID RIBBON 18X.75IN STITCHBOND LATEX FREE,$29.96,$0.00,$29.96,$0.00,$21.38,$0.00,$0.00,$0.00,$0.00,$0.00,$29.96,$0.00,$14.98,$23.73,$23.97,$0.00,$0.00,$0.00,$0.00,$0.00
405416,SUP,HCPCS C1892,,405416  -  INTROD SHTH 9FR 14CM HMSTS GWIRE PLWY .038IN TRNSPT,$8.00,$0.00,$8.00,$4.34,$5.71,$0.00,$1.38,$0.00,$0.00,$1.40,$8.00,$0.00,$4.00,$6.34,$6.40,$0.00,$1.25,$0.00,$1.27,$0.00
406136,SUP,HCPCS C1894,,406136  -  INTROD CATH 12CM 14FR .038IN TRNSPT FSTCTH HMSTS,$42.75,$0.00,$42.75,$23.21,$30.51,$0.00,$7.37,$0.00,$0.00,$7.49,$42.75,$0.00,$21.38,$33.86,$34.20,$0.00,$6.69,$0.00,$6.81,$0.00
406701,SUP,HCPCS C1894,,406701  -  INTRODUCER SHEATH .038IN STANDARD 6FR 12CM 50CM 2 DISTAL,$2.75,$0.00,$2.75,$1.49,$1.96,$0.00,$0.47,$0.00,$0.00,$0.48,$2.75,$0.00,$1.38,$2.18,$2.20,$0.00,$0.43,$0.00,$0.44,$0.00
407145,SUP,HCPCS C1785,,407145  -  PACEMAKER CRD SM 48X40X6.5MM 10CC EDORA PROMRI 1 CHMBR RT,"$15,250.00",$0.00,"$15,250.00","$6,862.50","$5,158.80",$0.00,"$2,627.50",$0.00,$0.00,"$2,670.15","$15,250.00",$0.00,"$7,625.00","$12,078.00","$12,200.00",$0.00,"$2,386.63",$0.00,"$2,427.80",$0.00
407157,SUP,HCPCS C1786,,407157  -  PACEMAKER CRD SM 48X40X6.5MM 10CC EDORA PROMRI 1 CHMBR RT,"$13,375.00",$0.00,"$13,375.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,375.00",$0.00,"$6,687.50","$10,593.00","$10,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
410298,SUP,Custom 27803010,,410298  -  STAPLER INTNL 14MM 45MM NS LF DVNC SI EWRST RPSB 50 FRNG,"$17,500.00",$0.00,"$17,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$17,500.00",$0.00,"$8,750.00","$13,860.00","$14,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
410322,SUP,Custom 27203010,,410322  -  TIP CAUT 8MM 1 DVNC SI EWRST VSL SLR DISP,"$8,925.00",$0.00,"$8,925.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,925.00",$0.00,"$4,462.50","$7,068.60","$7,140.00",$0.00,$0.00,$0.00,$0.00,$0.00
410370,SUP,Custom 27203010,,410370  -  SHEATH LAPSCP 45MM STPLR,$50.00,$0.00,$50.00,$0.00,$35.69,$0.00,$0.00,$0.00,$0.00,$0.00,$50.00,$0.00,$25.00,$39.60,$40.00,$0.00,$0.00,$0.00,$0.00,$0.00
410500,SUP,Custom 27203010,,410500  -  DRESSING HYDROCOLLOID TAPER 7.8X7.5IN ABSORBENT FLEXIBLE,$29.75,$0.00,$29.75,$0.00,$21.24,$0.00,$0.00,$0.00,$0.00,$0.00,$29.75,$0.00,$14.88,$23.56,$23.80,$0.00,$0.00,$0.00,$0.00,$0.00
410501,SUP,Custom 27203010,,SACRAL DUODERM SIGNAL 7.8X8.77,$28.28,$0.00,$28.28,$0.00,$20.18,$0.00,$0.00,$0.00,$0.00,$0.00,$28.28,$0.00,$14.14,$22.40,$22.62,$0.00,$0.00,$0.00,$0.00,$0.00
410614,SUP,Custom 27203010,,410614  -  DRESSING FOAM 8X8IN GELLING LATEX FREE VERSIVA XC,$33.99,$0.00,$33.99,$0.00,$24.26,$0.00,$0.00,$0.00,$0.00,$0.00,$33.99,$0.00,$16.99,$26.92,$27.19,$0.00,$0.00,$0.00,$0.00,$0.00
411250,SUP,HCPCS C1762,,411250  -  GRAFT SOFT TISSUE 4-5MM 50MM ALLOGRAFT NATURAL CONNECT,"$10,437.50",$0.00,"$10,437.50",$0.00,"$5,158.80",$0.00,"$1,798.33",$0.00,$0.00,$0.00,"$10,437.50",$0.00,"$5,218.75","$8,266.50","$8,350.00",$0.00,"$1,633.47",$0.00,$0.00,$0.00
411270,SUP,HCPCS C1768,,"411270  -  GRAFT, AVANCE NERVE, 4-5MM X 70MM","$14,750.00",$0.00,"$14,750.00","$6,637.50","$5,158.80",$0.00,"$2,541.35",$0.00,$0.00,"$2,582.61","$14,750.00",$0.00,"$7,375.00","$11,682.00","$11,800.00",$0.00,"$2,308.38",$0.00,"$2,348.20",$0.00
415807,SUP,Custom 27203010,,415807  -  CANNULA PERFUSION 7MM 3MM 11.4IN BALLOON RIGHT ANGLED LATEX,$982.50,$0.00,$982.50,$0.00,$701.21,$0.00,$0.00,$0.00,$0.00,$0.00,$982.50,$0.00,$491.25,$778.14,$786.00,$0.00,$0.00,$0.00,$0.00,$0.00
417300,SUP,Custom 27803010,,417300  -  SYSTEM BONE CMNT TRPL MX KIT 120GM OPTVC,$487.50,$0.00,$487.50,$0.00,$347.93,$0.00,$0.00,$0.00,$0.00,$0.00,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$0.00,$0.00,$0.00,$0.00
419588,SUP,HCPCS C1898,,419588  -  LEAD PACING 5FR 88CM UNIPOLAR DEPLOYABLE LOBES FIX IS-1,"$3,562.50",$0.00,"$3,562.50","$1,603.13","$2,542.56",$0.00,$613.80,$0.00,$0.00,$623.77,"$3,562.50",$0.00,"$1,781.25","$2,821.50","$2,850.00",$0.00,$557.53,$0.00,$567.15,$0.00
419678,SUP,HCPCS C1898,,419678  -  LEAD PACING 2 CURVE 4FR 78CM BIPOL IS-1 ATTAIN ABILITY,"$3,562.50",$0.00,"$3,562.50","$1,603.13","$2,542.56",$0.00,$613.80,$0.00,$0.00,$623.77,"$3,562.50",$0.00,"$1,781.25","$2,821.50","$2,850.00",$0.00,$557.53,$0.00,$567.15,$0.00
419688,SUP,HCPCS C1898,,419688  -  LEAD PACING 4FR 88CM OTW TRACKABILITY STEERABLE BIPOL,"$3,562.50",$0.00,"$3,562.50","$1,603.13","$2,542.56",$0.00,$613.80,$0.00,$0.00,$623.77,"$3,562.50",$0.00,"$1,781.25","$2,821.50","$2,850.00",$0.00,$557.53,$0.00,$567.15,$0.00
420006,SUP,Custom 27203010,,420006  -  DRIVER NDL 0-30D LG 8MM 54.4CM 1CM S/SI EWRST,"$5,500.00",$0.00,"$5,500.00",$0.00,"$3,925.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,500.00",$0.00,"$2,750.00","$4,356.00","$4,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
420024,SUP,Custom 27203010,,420024  -  OBTURATOR LAPSCP LNG 8MM STRL DVNC S/SI EWRST DISP,$62.50,$0.00,$62.50,$0.00,$44.61,$0.00,$0.00,$0.00,$0.00,$0.00,$62.50,$0.00,$31.25,$49.50,$50.00,$0.00,$0.00,$0.00,$0.00,$0.00
420206,SUP,Custom 27203010,,420206  -  SEAL ENDSCP INSTR 8.5-13MM S/SI EWRST CANNU HD SD,"$1,000.00",$0.00,"$1,000.00",$0.00,$713.70,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,000.00",$0.00,$500.00,$792.00,$800.00,$0.00,$0.00,$0.00,$0.00,$0.00
420290,SUP,Custom 27203010,,420290  -  KIT ACC 8MM DVNC SI 3 ARM CAM CNN SL INST DRP DISP,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
420291,SUP,Custom 27203010,,420291  -  KIT 8MM 4 ARM CAM CANNU SL INSTR DRP ACC DVNC SI,"$3,250.00",$0.00,"$3,250.00",$0.00,"$2,319.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
425304,SUP,HCPCS C1713,,425304  -  PLATE  PELVIS  108MM RADIUS,$284.63,$0.00,$284.63,$128.08,$203.14,$0.00,$49.04,$0.00,$0.00,$49.84,$284.63,$0.00,$142.31,$225.43,$227.70,$0.00,$44.54,$0.00,$45.31,$0.00
425306,SUP,HCPCS C1713,,425306  -  PLATE  PELVIS  108MM RADIUS,$361.63,$0.00,$361.63,$162.73,$258.09,$0.00,$62.31,$0.00,$0.00,$63.32,$361.63,$0.00,$180.81,$286.41,$289.30,$0.00,$56.59,$0.00,$57.57,$0.00
425308,SUP,HCPCS C1713,,425308  -  PLATE  PELVIS  108MM RADIUS,$354.75,$0.00,$354.75,$159.64,$253.19,$0.00,$61.12,$0.00,$0.00,$62.11,$354.75,$0.00,$177.38,$280.96,$283.80,$0.00,$55.52,$0.00,$56.48,$0.00
425310,SUP,HCPCS C1713,,425310  -  PLATE  PELVIS  108MM RADIUS,$391.88,$0.00,$391.88,$176.34,$279.68,$0.00,$67.52,$0.00,$0.00,$68.61,$391.88,$0.00,$195.94,$310.37,$313.50,$0.00,$61.33,$0.00,$62.39,$0.00
425312,SUP,HCPCS C1713,,425312  -  PLATE  PELVIS  108MM RADIUS,$419.38,$0.00,$419.38,$188.72,$299.31,$0.00,$72.26,$0.00,$0.00,$73.43,$419.38,$0.00,$209.69,$332.15,$335.50,$0.00,$65.63,$0.00,$66.76,$0.00
425406,SUP,HCPCS C1713,,425406  -  PLATE  PELVIS  88MM RADIUS,$328.63,$0.00,$328.63,$147.88,$234.54,$0.00,$56.62,$0.00,$0.00,$57.54,$328.63,$0.00,$164.31,$260.27,$262.90,$0.00,$51.43,$0.00,$52.32,$0.00
425408,SUP,HCPCS C1713,,425408  -  PLATE  PELVIS  88MM RADIUS,$349.25,$0.00,$349.25,$157.16,$249.26,$0.00,$60.17,$0.00,$0.00,$61.15,$349.25,$0.00,$174.63,$276.61,$279.40,$0.00,$54.66,$0.00,$55.60,$0.00
425410,SUP,HCPCS C1713,,425410  -  PLATE  PELVIS  88MM RADIUS,$389.13,$0.00,$389.13,$175.11,$277.72,$0.00,$67.04,$0.00,$0.00,$68.13,$389.13,$0.00,$194.56,$308.19,$311.30,$0.00,$60.90,$0.00,$61.95,$0.00
425412,SUP,HCPCS C1713,,425412  -  PLATE  PELVIS  88MM RADIUS,$419.38,$0.00,$419.38,$188.72,$299.31,$0.00,$72.26,$0.00,$0.00,$73.43,$419.38,$0.00,$209.69,$332.15,$335.50,$0.00,$65.63,$0.00,$66.76,$0.00
425504,SUP,HCPCS C1713,,425504  -  PELVIC PLATE STRAIGHT 4H/64MM,$233.75,$0.00,$233.75,$105.19,$166.83,$0.00,$40.27,$0.00,$0.00,$40.93,$233.75,$0.00,$116.88,$185.13,$187.00,$0.00,$36.58,$0.00,$37.21,$0.00
425506,SUP,HCPCS C1713,,425506  -  PLATE  PELVIS  STRAIGHT,$268.13,$0.00,$268.13,$120.66,$191.36,$0.00,$46.20,$0.00,$0.00,$46.95,$268.13,$0.00,$134.06,$212.36,$214.50,$0.00,$41.96,$0.00,$42.69,$0.00
425509,SUP,HCPCS C1713,,425509  -  PELVIC PLATE STRAIGHT 9H/154MM,$338.25,$0.00,$338.25,$152.21,$241.41,$0.00,$58.28,$0.00,$0.00,$59.22,$338.25,$0.00,$169.13,$267.89,$270.60,$0.00,$52.94,$0.00,$53.85,$0.00
425512,SUP,HCPCS C1713,,425512  -  PLATE. PELVIS. STRAIGHT,$398.75,$0.00,$398.75,$179.44,$284.59,$0.00,$68.70,$0.00,$0.00,$69.82,$398.75,$0.00,$199.38,$315.81,$319.00,$0.00,$62.40,$0.00,$63.48,$0.00
425602,SUP,HCPCS C1713,,425602  -  PLATE 108MM RAD 26.5MM 2 HOLE CVD MATTA BONE PLVC,$383.63,$0.00,$383.63,$172.63,$273.79,$0.00,$66.10,$0.00,$0.00,$67.17,$383.63,$0.00,$191.81,$303.83,$306.90,$0.00,$60.04,$0.00,$61.07,$0.00
425603,SUP,HCPCS C1713,,425603  -  PLATE 108MM RAD 42.5MM 3 HOLE CVD MATTA BONE PLVC,$426.25,$0.00,$426.25,$191.81,$304.21,$0.00,$73.44,$0.00,$0.00,$74.63,$426.25,$0.00,$213.13,$337.59,$341.00,$0.00,$66.71,$0.00,$67.86,$0.00
425604,SUP,HCPCS C1713,,425604  -  PLATE 108MM RAD 58.5MM SS R108 4 HOLE CVD MATTA BONE PLVC,$468.88,$0.00,$468.88,$210.99,$334.64,$0.00,$80.78,$0.00,$0.00,$82.10,$468.88,$0.00,$234.44,$371.35,$375.10,$0.00,$73.38,$0.00,$74.64,$0.00
425605,SUP,HCPCS C1713,,425605  -  PLATE 108MM 74.5MM 5 HOLE CVD BONE PLVC,$512.88,$0.00,$512.88,$230.79,$366.04,$0.00,$88.37,$0.00,$0.00,$89.80,$512.88,$0.00,$256.44,$406.20,$410.30,$0.00,$80.26,$0.00,$81.65,$0.00
425606,SUP,HCPCS C1713,,425606  -  PLATE 108MM RAD 90.5MM SS 6 HOLE CVD MPS BONE PLVC,$554.13,$0.00,$554.13,$249.36,$395.48,$0.00,$95.47,$0.00,$0.00,$97.02,$554.13,$0.00,$277.06,$438.87,$443.30,$0.00,$86.72,$0.00,$88.22,$0.00
425607,SUP,HCPCS C1713,,425607  -  PLATE 108MM 106.5MM 5 HOLE CVD BONE PLVC,$577.50,$0.00,$577.50,$259.88,$412.16,$0.00,$99.50,$0.00,$0.00,$101.12,$577.50,$0.00,$288.75,$457.38,$462.00,$0.00,$90.38,$0.00,$91.94,$0.00
425608,SUP,HCPCS C1713,,425608  -  PLATE 108MM RAD 122.5MM SS 8 HOLE CVD MPS BONE PLVC,$607.75,$0.00,$607.75,$273.49,$433.75,$0.00,$104.71,$0.00,$0.00,$106.41,$607.75,$0.00,$303.88,$481.34,$486.20,$0.00,$95.11,$0.00,$96.75,$0.00
425609,SUP,HCPCS C1713,,425609  -  PLATE 108MM RAD 138.5X10.5X2.5MM 9 HL SHFT CVD MATTA BONE,$618.75,$0.00,$618.75,$278.44,$441.60,$0.00,$106.61,$0.00,$0.00,$108.34,$618.75,$0.00,$309.38,$490.05,$495.00,$0.00,$96.83,$0.00,$98.51,$0.00
425610,SUP,HCPCS C1713,,425610  -  PLATE BN CRV 154.5MM MPS 10 HL SS R108,$640.75,$0.00,$640.75,$288.34,$457.30,$0.00,$110.40,$0.00,$0.00,$112.19,$640.75,$0.00,$320.38,$507.47,$512.60,$0.00,$100.28,$0.00,$102.01,$0.00
425611,SUP,HCPCS C1713,,425611  -  PLATE 108MM RAD 170.5X10.5X2.5MM 11 HL SHFT CVD MATTA BONE,$649.00,$0.00,$649.00,$292.05,$463.19,$0.00,$111.82,$0.00,$0.00,$113.63,$649.00,$0.00,$324.50,$514.01,$519.20,$0.00,$101.57,$0.00,$103.32,$0.00
425612,SUP,HCPCS C1713,,425612  -  PLATE 186.5MM SS 12 HOLE CVD MPS BONE 108MM PLVC,$671.00,$0.00,$671.00,$301.95,$478.89,$0.00,$115.61,$0.00,$0.00,$117.49,$671.00,$0.00,$335.50,$531.43,$536.80,$0.00,$105.01,$0.00,$106.82,$0.00
425613,SUP,HCPCS C1713,,425613  -  PLATE 108MM RAD 202.5X10.5X2.5MM 13 HL SHFT CVD MATTA BONE,$694.38,$0.00,$694.38,$312.47,$495.58,$0.00,$119.64,$0.00,$0.00,$121.58,$694.38,$0.00,$347.19,$549.95,$555.50,$0.00,$108.67,$0.00,$110.54,$0.00
425614,SUP,HCPCS C1713,,425614  -  PLATE 218.5MM SS 14 HOLE CVD MPS BONE 108MM PLVC,$746.63,$0.00,$746.63,$335.98,$532.87,$0.00,$128.64,$0.00,$0.00,$130.73,$746.63,$0.00,$373.31,$591.33,$597.30,$0.00,$116.85,$0.00,$118.86,$0.00
425615,SUP,HCPCS C1713,,425615  -  PLATE 108MM RAD 234.5X10.5X2.5MM 15 HL SHFT CVD MATTA BONE,$778.25,$0.00,$778.25,$350.21,$555.44,$0.00,$134.09,$0.00,$0.00,$136.27,$778.25,$0.00,$389.13,$616.37,$622.60,$0.00,$121.80,$0.00,$123.90,$0.00
425616,SUP,HCPCS C1713,,425616  -  PLATE 108MM RAD 250.5MM 16 HOLE CVD MATTA BONE PLVC,$800.25,$0.00,$800.25,$360.11,$571.14,$0.00,$137.88,$0.00,$0.00,$140.12,$800.25,$0.00,$400.13,$633.80,$640.20,$0.00,$125.24,$0.00,$127.40,$0.00
425618,SUP,HCPCS C1713,,425618  -  PLATE 108MM RAD 282.5X10.5X2.5MM 18 HL SHFT CVD MATTA BONE,$864.88,$0.00,$864.88,$389.19,$617.26,$0.00,$149.01,$0.00,$0.00,$151.43,$864.88,$0.00,$432.44,$684.98,$691.90,$0.00,$135.35,$0.00,$137.69,$0.00
425620,SUP,HCPCS C1713,,425620  -  PLATE 108MM RAD 314.5X10.5X2.5MM 20 HL SHFT CVD MATTA BONE,"$1,012.00",$0.00,"$1,012.00",$455.40,$722.26,$0.00,$174.36,$0.00,$0.00,$177.19,"$1,012.00",$0.00,$506.00,$801.50,$809.60,$0.00,$158.38,$0.00,$161.11,$0.00
425653,SUP,HCPCS C1713,,425653  -  PLATE 88MM RAD 42.5MM 3 HOLE CVD MATTA BONE PLVC,$426.25,$0.00,$426.25,$191.81,$304.21,$0.00,$73.44,$0.00,$0.00,$74.63,$426.25,$0.00,$213.13,$337.59,$341.00,$0.00,$66.71,$0.00,$67.86,$0.00
425654,SUP,HCPCS C1713,,425654  -  PLATE 88MM RAD 58.8MM SS 4 HOLE CVD MPS BONE PLVC,$468.88,$0.00,$468.88,$210.99,$334.64,$0.00,$80.78,$0.00,$0.00,$82.10,$468.88,$0.00,$234.44,$371.35,$375.10,$0.00,$73.38,$0.00,$74.64,$0.00
425655,SUP,HCPCS C1713,,425655  -  PLATE BN 88MM RDS CRV 74.5MM NS MATTA 5 HL SS PLV,$512.88,$0.00,$512.88,$230.79,$366.04,$0.00,$88.37,$0.00,$0.00,$89.80,$512.88,$0.00,$256.44,$406.20,$410.30,$0.00,$80.26,$0.00,$81.65,$0.00
425656,SUP,HCPCS C1713,,425656  -  PLATE 88MM RAD 90.5MM SS 6 HOLE CVD MPS BONE PLVC,$554.13,$0.00,$554.13,$249.36,$395.48,$0.00,$95.47,$0.00,$0.00,$97.02,$554.13,$0.00,$277.06,$438.87,$443.30,$0.00,$86.72,$0.00,$88.22,$0.00
425657,SUP,HCPCS C1713,,425657  -  PLATE 88MM 106.5MM 7 HOLE CVD BONE PLVC,$577.50,$0.00,$577.50,$259.88,$412.16,$0.00,$99.50,$0.00,$0.00,$101.12,$577.50,$0.00,$288.75,$457.38,$462.00,$0.00,$90.38,$0.00,$91.94,$0.00
425658,SUP,HCPCS C1713,,425658  -  PLATE 122.5MM SS 8 HOLE CVD BONE 88MM PLVC,$607.75,$0.00,$607.75,$273.49,$433.75,$0.00,$104.71,$0.00,$0.00,$106.41,$607.75,$0.00,$303.88,$481.34,$486.20,$0.00,$95.11,$0.00,$96.75,$0.00
425659,SUP,HCPCS C1713,,425659  -  PLATE 88MM RAD 138.5MM 9 HOLE CVD MATTA BONE PLVC,$618.75,$0.00,$618.75,$278.44,$441.60,$0.00,$106.61,$0.00,$0.00,$108.34,$618.75,$0.00,$309.38,$490.05,$495.00,$0.00,$96.83,$0.00,$98.51,$0.00
425660,SUP,HCPCS C1713,,425660  -  PLATE 154.5MM SS 10 HOLE CVD MPS BONE 88MM PLVC,$640.75,$0.00,$640.75,$288.34,$457.30,$0.00,$110.40,$0.00,$0.00,$112.19,$640.75,$0.00,$320.38,$507.47,$512.60,$0.00,$100.28,$0.00,$102.01,$0.00
425661,SUP,HCPCS C1713,,425661  -  PLATE 88MM RAD 170.5MM 11 HOLE CVD MATTA BONE PLVC,$649.00,$0.00,$649.00,$292.05,$463.19,$0.00,$111.82,$0.00,$0.00,$113.63,$649.00,$0.00,$324.50,$514.01,$519.20,$0.00,$101.57,$0.00,$103.32,$0.00
425662,SUP,HCPCS C1713,,425662  -  PLATE 186.5MM SS 12 HOLE CVD MPS BONE 88MM PLVC,$671.00,$0.00,$671.00,$301.95,$478.89,$0.00,$115.61,$0.00,$0.00,$117.49,$671.00,$0.00,$335.50,$531.43,$536.80,$0.00,$105.01,$0.00,$106.82,$0.00
425663,SUP,HCPCS C1713,,425663  -  PLATE 88MM RAD 202.5MM 13 HOLE CVD MATTA BONE PLVC,$694.38,$0.00,$694.38,$312.47,$495.58,$0.00,$119.64,$0.00,$0.00,$121.58,$694.38,$0.00,$347.19,$549.95,$555.50,$0.00,$108.67,$0.00,$110.54,$0.00
425664,SUP,HCPCS C1713,,425664  -  PLATE 218.5MM SS 14 HOLE CVD MPS BONE 88MM PLVC,$746.63,$0.00,$746.63,$335.98,$532.87,$0.00,$128.64,$0.00,$0.00,$130.73,$746.63,$0.00,$373.31,$591.33,$597.30,$0.00,$116.85,$0.00,$118.86,$0.00
425665,SUP,HCPCS C1713,,425665  -  PLATE 88MM RAD 234.5MM 15 HOLE CVD MATTA BONE PLVC,$778.25,$0.00,$778.25,$350.21,$555.44,$0.00,$134.09,$0.00,$0.00,$136.27,$778.25,$0.00,$389.13,$616.37,$622.60,$0.00,$121.80,$0.00,$123.90,$0.00
425666,SUP,HCPCS C1713,,425666  -  PLATE 88MM RAD 250.5MM 16 HOLE CVD MATTA BONE PLVC,$800.25,$0.00,$800.25,$360.11,$571.14,$0.00,$137.88,$0.00,$0.00,$140.12,$800.25,$0.00,$400.13,$633.80,$640.20,$0.00,$125.24,$0.00,$127.40,$0.00
425667,SUP,HCPCS C1713,,425667  -  PLATE 88MM RAD 266.5MM 17 HOLE CVD MATTA BONE PLVC,$833.25,$0.00,$833.25,$374.96,$594.69,$0.00,$143.56,$0.00,$0.00,$145.90,$833.25,$0.00,$416.63,$659.93,$666.60,$0.00,$130.40,$0.00,$132.65,$0.00
425668,SUP,HCPCS C1713,,425668  -  PLATE 88MM RAD 282.5MM 18 HOLE CVD MATTA BONE PLVC,$864.88,$0.00,$864.88,$389.19,$617.26,$0.00,$149.01,$0.00,$0.00,$151.43,$864.88,$0.00,$432.44,$684.98,$691.90,$0.00,$135.35,$0.00,$137.69,$0.00
425670,SUP,HCPCS C1713,,425670  -  PLATE 88MM RAD 314.5MM 20 HOLE CVD MATTA BONE PLVC,"$1,012.00",$0.00,"$1,012.00",$455.40,$722.26,$0.00,$174.36,$0.00,$0.00,$177.19,"$1,012.00",$0.00,$506.00,$801.50,$809.60,$0.00,$158.38,$0.00,$161.11,$0.00
425672,SUP,HCPCS C1713,,425672  -  PLATE 88MM RAD 346.5MM 22 HOLE CVD MATTA BONE PLVC,"$1,012.00",$0.00,"$1,012.00",$455.40,$722.26,$0.00,$174.36,$0.00,$0.00,$177.19,"$1,012.00",$0.00,$506.00,$801.50,$809.60,$0.00,$158.38,$0.00,$161.11,$0.00
425674,SUP,HCPCS C1713,,425674  -  PLATE 88MM RAD 378.5MM 24 HOLE CVD MATTA BONE PLVC,"$1,012.00",$0.00,"$1,012.00",$455.40,$722.26,$0.00,$174.36,$0.00,$0.00,$177.19,"$1,012.00",$0.00,$506.00,$801.50,$809.60,$0.00,$158.38,$0.00,$161.11,$0.00
425676,SUP,HCPCS C1713,,425676  -  PLATE 88MM RAD 410.5MM 26 HOLE CVD MATTA BONE PLVC,"$1,067.00",$0.00,"$1,067.00",$480.15,$761.52,$0.00,$183.84,$0.00,$0.00,$186.82,"$1,067.00",$0.00,$533.50,$845.06,$853.60,$0.00,$166.99,$0.00,$169.87,$0.00
425678,SUP,HCPCS C1713,,425678  -  PLATE 442.5MM 28 HOLE CVD BONE 88MM PLVC,"$1,067.00",$0.00,"$1,067.00",$480.15,$761.52,$0.00,$183.84,$0.00,$0.00,$186.82,"$1,067.00",$0.00,$533.50,$845.06,$853.60,$0.00,$166.99,$0.00,$169.87,$0.00
425680,SUP,HCPCS C1713,,425680  -  PLATE 88MM RAD 474.5MM 30 HOLE CVD MATTA BONE PLVC,"$1,067.00",$0.00,"$1,067.00",$480.15,$761.52,$0.00,$183.84,$0.00,$0.00,$186.82,"$1,067.00",$0.00,$533.50,$845.06,$853.60,$0.00,$166.99,$0.00,$169.87,$0.00
425702,SUP,HCPCS C1713,,425702  -  PLATE 26.5MMX10.5MMX2.5M SS 2 HOLE STR MATTA BONE PLVC,$349.25,$0.00,$349.25,$157.16,$249.26,$0.00,$60.17,$0.00,$0.00,$61.15,$349.25,$0.00,$174.63,$276.61,$279.40,$0.00,$54.66,$0.00,$55.60,$0.00
425703,SUP,HCPCS C1713,,425703  -  PLATE 42.5MM SS 3 HOLE STR BONE PLVC,$401.50,$0.00,$401.50,$180.68,$286.55,$0.00,$69.18,$0.00,$0.00,$70.30,$401.50,$0.00,$200.75,$317.99,$321.20,$0.00,$62.83,$0.00,$63.92,$0.00
425704,SUP,HCPCS C1713,,425704  -  PLATE 58.5MM SS 4 HOLE STR MPS BONE PLVC,$422.13,$0.00,$422.13,$189.96,$301.27,$0.00,$72.73,$0.00,$0.00,$73.91,$422.13,$0.00,$211.06,$334.33,$337.70,$0.00,$66.06,$0.00,$67.20,$0.00
425705,SUP,HCPCS C1713,,425705  -  PLATE 74.5MM 5 HL SHFT STR MATTA BONE PLVC,$441.38,$0.00,$441.38,$198.62,$315.01,$0.00,$76.05,$0.00,$0.00,$77.28,$441.38,$0.00,$220.69,$349.57,$353.10,$0.00,$69.08,$0.00,$70.27,$0.00
425706,SUP,HCPCS C1713,,425706  -  PLATE 90.5MM SS 6 HOLE STR MPS BONE PLVC,$479.88,$0.00,$479.88,$215.94,$342.49,$0.00,$82.68,$0.00,$0.00,$84.02,$479.88,$0.00,$239.94,$380.06,$383.90,$0.00,$75.10,$0.00,$76.40,$0.00
425707,SUP,HCPCS C1713,,425707  -  PLATE 106.5MM 7 HL SHFT STR MATTA BONE PLVC,$510.13,$0.00,$510.13,$229.56,$364.08,$0.00,$87.89,$0.00,$0.00,$89.32,$510.13,$0.00,$255.06,$404.02,$408.10,$0.00,$79.83,$0.00,$81.21,$0.00
425708,SUP,HCPCS C1713,,425708  -  PLATE 122.5MM SS 8 HOLE STR MPS BONE PLVC,$541.75,$0.00,$541.75,$243.79,$386.65,$0.00,$93.34,$0.00,$0.00,$94.86,$541.75,$0.00,$270.88,$429.07,$433.40,$0.00,$84.78,$0.00,$86.25,$0.00
425709,SUP,HCPCS C1713,,425709  -  PLATE 138.5MM 9 HL SHFT STR MATTA BONE PLVC,$561.00,$0.00,$561.00,$252.45,$400.39,$0.00,$96.66,$0.00,$0.00,$98.23,$561.00,$0.00,$280.50,$444.31,$448.80,$0.00,$87.80,$0.00,$89.31,$0.00
425710,SUP,HCPCS C1713,,425710  -  PLATE 154.5MM SS 10 HOLE STR MPS BONE PLVC,$580.25,$0.00,$580.25,$261.11,$414.12,$0.00,$99.97,$0.00,$0.00,$101.60,$580.25,$0.00,$290.13,$459.56,$464.20,$0.00,$90.81,$0.00,$92.38,$0.00
425711,SUP,HCPCS C1713,,425711  -  PLATE 170.5MM 11 HL SHFT STR MATTA BONE PLVC,$600.88,$0.00,$600.88,$270.39,$428.84,$0.00,$103.53,$0.00,$0.00,$105.21,$600.88,$0.00,$300.44,$475.90,$480.70,$0.00,$94.04,$0.00,$95.66,$0.00
425712,SUP,HCPCS C1713,,425712  -  PLATE 186.5MM SS 12 HOLE STR MATTA MPS BONE PLVC,$621.50,$0.00,$621.50,$279.68,$443.56,$0.00,$107.08,$0.00,$0.00,$108.82,$621.50,$0.00,$310.75,$492.23,$497.20,$0.00,$97.26,$0.00,$98.94,$0.00
425713,SUP,HCPCS C1713,,425713  -  PLATE 202.5MM 13 HL SHFT STR MATTA BONE PLVC,$642.13,$0.00,$642.13,$288.96,$458.28,$0.00,$110.63,$0.00,$0.00,$112.43,$642.13,$0.00,$321.06,$508.57,$513.70,$0.00,$100.49,$0.00,$102.23,$0.00
425714,SUP,HCPCS C1713,,425714  -  PLATE 218.5MM SS 14 HOLE STR MATTA BONE PLVC,$661.38,$0.00,$661.38,$297.62,$472.02,$0.00,$113.95,$0.00,$0.00,$115.80,$661.38,$0.00,$330.69,$523.81,$529.10,$0.00,$103.51,$0.00,$105.29,$0.00
425715,SUP,HCPCS C1713,,425715  -  PLATE 234.5MM 15 HL SHFT STR MATTA BONE PLVC,$680.63,$0.00,$680.63,$306.28,$485.76,$0.00,$117.27,$0.00,$0.00,$119.17,$680.63,$0.00,$340.31,$539.06,$544.50,$0.00,$106.52,$0.00,$108.36,$0.00
425716,SUP,HCPCS C1713,,425716  -  PLATE 250.5MMX10.5MMX2.5M SS 16 HOLE STR MATTA BONE PLVC,$720.50,$0.00,$720.50,$324.23,$514.22,$0.00,$124.14,$0.00,$0.00,$126.15,$720.50,$0.00,$360.25,$570.64,$576.40,$0.00,$112.76,$0.00,$114.70,$0.00
425718,SUP,HCPCS C1713,,425718  -  PLATE 282.5MM 18 HL SHFT STR MATTA BONE PLVC,$801.63,$0.00,$801.63,$360.73,$572.12,$0.00,$138.12,$0.00,$0.00,$140.36,$801.63,$0.00,$400.81,$634.89,$641.30,$0.00,$125.45,$0.00,$127.62,$0.00
425720,SUP,HCPCS C1713,,425720  -  PLATE 314.5MM 20 HL SHFT STR MATTA BONE PLVC,$902.00,$0.00,$902.00,$405.90,$643.76,$0.00,$155.41,$0.00,$0.00,$157.93,$902.00,$0.00,$451.00,$714.38,$721.60,$0.00,$141.16,$0.00,$143.60,$0.00
425752,SUP,HCPCS C1713,,425752  -  PLATE 22.5MM 2 HOLE STR BONE ACETAB,$374.00,$0.00,$374.00,$168.30,$266.92,$0.00,$64.44,$0.00,$0.00,$65.48,$374.00,$0.00,$187.00,$296.21,$299.20,$0.00,$58.53,$0.00,$59.54,$0.00
425753,SUP,HCPCS C1713,,425753  -  PLATE 34.5MM 3 HOLE STR BONE ACETAB,$426.25,$0.00,$426.25,$191.81,$304.21,$0.00,$73.44,$0.00,$0.00,$74.63,$426.25,$0.00,$213.13,$337.59,$341.00,$0.00,$66.71,$0.00,$67.86,$0.00
425754,SUP,HCPCS C1713,,425754  -  PLATE 46.5MM SS 4 HOLE STR MPS BONE ACETAB,$448.25,$0.00,$448.25,$201.71,$319.92,$0.00,$77.23,$0.00,$0.00,$78.48,$448.25,$0.00,$224.13,$355.01,$358.60,$0.00,$70.15,$0.00,$71.36,$0.00
425755,SUP,HCPCS C1713,,425755  -  PLATE 58.5MM 5 HOLE STR BONE ACETAB,$468.88,$0.00,$468.88,$210.99,$334.64,$0.00,$80.78,$0.00,$0.00,$82.10,$468.88,$0.00,$234.44,$371.35,$375.10,$0.00,$73.38,$0.00,$74.64,$0.00
425756,SUP,HCPCS C1713,,425756  -  PLATE 70.5MM SS 6 HOLE STR MPS BONE ACETAB,$512.88,$0.00,$512.88,$230.79,$366.04,$0.00,$88.37,$0.00,$0.00,$89.80,$512.88,$0.00,$256.44,$406.20,$410.30,$0.00,$80.26,$0.00,$81.65,$0.00
425757,SUP,HCPCS C1713,,425757  -  PLATE 82.5MM 7 HOLE STR BONE ACETAB,$543.13,$0.00,$543.13,$244.41,$387.63,$0.00,$93.58,$0.00,$0.00,$95.10,$543.13,$0.00,$271.56,$430.16,$434.50,$0.00,$85.00,$0.00,$86.47,$0.00
425758,SUP,HCPCS C1713,,425758  -  PLATE 94.5MM SS 8 HOLE STR MPS BONE ACETAB,$577.50,$0.00,$577.50,$259.88,$412.16,$0.00,$99.50,$0.00,$0.00,$101.12,$577.50,$0.00,$288.75,$457.38,$462.00,$0.00,$90.38,$0.00,$91.94,$0.00
425759,SUP,HCPCS C1713,,425759  -  PLATE 106.5MM 9 HOLE STR BONE ACETAB,$598.13,$0.00,$598.13,$269.16,$426.88,$0.00,$103.05,$0.00,$0.00,$104.73,$598.13,$0.00,$299.06,$473.72,$478.50,$0.00,$93.61,$0.00,$95.22,$0.00
425760,SUP,HCPCS C1713,,425760  -  PLATE 118.5MM SS 10 HOLE STR MPS BONE ACETAB,$618.75,$0.00,$618.75,$278.44,$441.60,$0.00,$106.61,$0.00,$0.00,$108.34,$618.75,$0.00,$309.38,$490.05,$495.00,$0.00,$96.83,$0.00,$98.51,$0.00
425761,SUP,HCPCS C1713,,425761  -  PLATE 130.5MM 11 HOLE STR BONE ACETAB,$640.75,$0.00,$640.75,$288.34,$457.30,$0.00,$110.40,$0.00,$0.00,$112.19,$640.75,$0.00,$320.38,$507.47,$512.60,$0.00,$100.28,$0.00,$102.01,$0.00
425762,SUP,HCPCS C1713,,425762  -  PLATE 142.5MM SS 12 HOLE STR MATTA MPS BONE ACETAB,$662.75,$0.00,$662.75,$298.24,$473.00,$0.00,$114.19,$0.00,$0.00,$116.04,$662.75,$0.00,$331.38,$524.90,$530.20,$0.00,$103.72,$0.00,$105.51,$0.00
425763,SUP,HCPCS C1713,,425763  -  PLATE 154.5MM 13 HOLE STR BONE ACETAB,$682.00,$0.00,$682.00,$306.90,$486.74,$0.00,$117.51,$0.00,$0.00,$119.41,$682.00,$0.00,$341.00,$540.14,$545.60,$0.00,$106.73,$0.00,$108.57,$0.00
425764,SUP,HCPCS C1713,,425764  -  PLATE 166.5MM SS 14 HOLE STR MATTA MPS BONE ACETAB,$704.00,$0.00,$704.00,$316.80,$502.44,$0.00,$121.30,$0.00,$0.00,$123.26,$704.00,$0.00,$352.00,$557.57,$563.20,$0.00,$110.18,$0.00,$112.08,$0.00
425765,SUP,HCPCS C1713,,425765  -  PLATE 178.5MM 15 HOLE STR BONE ACETAB,$726.00,$0.00,$726.00,$326.70,$518.15,$0.00,$125.09,$0.00,$0.00,$127.12,$726.00,$0.00,$363.00,$574.99,$580.80,$0.00,$113.62,$0.00,$115.58,$0.00
425766,SUP,HCPCS C1713,,425766  -  PLATE 190.5MM SS 16 HOLE STR BONE ACETAB,$767.25,$0.00,$767.25,$345.26,$547.59,$0.00,$132.19,$0.00,$0.00,$134.34,$767.25,$0.00,$383.63,$607.66,$613.80,$0.00,$120.07,$0.00,$122.15,$0.00
425767,SUP,HCPCS C1713,,425767  -  PLATE 202.5MM 17 HOLE STR BONE ACETAB,$809.88,$0.00,$809.88,$364.44,$578.01,$0.00,$139.54,$0.00,$0.00,$141.80,$809.88,$0.00,$404.94,$641.42,$647.90,$0.00,$126.75,$0.00,$128.93,$0.00
425768,SUP,HCPCS C1713,,425768  -  PLATE 214.5MM 18 HOLE STR BONE ACETAB,$851.13,$0.00,$851.13,$383.01,$607.45,$0.00,$146.64,$0.00,$0.00,$149.03,$851.13,$0.00,$425.56,$674.09,$680.90,$0.00,$133.20,$0.00,$135.50,$0.00
425769,SUP,HCPCS C1713,,425769  -  PLATE 226.5MM 19 HOLE STR BONE ACETAB,$961.13,$0.00,$961.13,$432.51,$685.95,$0.00,$165.60,$0.00,$0.00,$168.29,$961.13,$0.00,$480.56,$761.21,$768.90,$0.00,$150.42,$0.00,$153.01,$0.00
425770,SUP,HCPCS C1713,,425770  -  PLATE 238.5MM 20 HOLE STR BONE ACETAB,$961.13,$0.00,$961.13,$432.51,$685.95,$0.00,$165.60,$0.00,$0.00,$168.29,$961.13,$0.00,$480.56,$761.21,$768.90,$0.00,$150.42,$0.00,$153.01,$0.00
425772,SUP,HCPCS C1713,,425772  -  PLATE 262.5MM 22 HOLE STR BONE ACETAB,$961.13,$0.00,$961.13,$432.51,$685.95,$0.00,$165.60,$0.00,$0.00,$168.29,$961.13,$0.00,$480.56,$761.21,$768.90,$0.00,$150.42,$0.00,$153.01,$0.00
425774,SUP,HCPCS C1713,,425774  -  PLATE 286.5MM 24 HOLE STR BONE ACETAB,$961.13,$0.00,$961.13,$432.51,$685.95,$0.00,$165.60,$0.00,$0.00,$168.29,$961.13,$0.00,$480.56,$761.21,$768.90,$0.00,$150.42,$0.00,$153.01,$0.00
425776,SUP,HCPCS C1713,,425776  -  PLATE 310.5MM 26 HOLE STR BONE ACETAB,$961.13,$0.00,$961.13,$432.51,$685.95,$0.00,$165.60,$0.00,$0.00,$168.29,$961.13,$0.00,$480.56,$761.21,$768.90,$0.00,$150.42,$0.00,$153.01,$0.00
425778,SUP,HCPCS C1713,,425778  -  PLATE 334.5MM 28 HOLE STR BONE ACETAB,$961.13,$0.00,$961.13,$432.51,$685.95,$0.00,$165.60,$0.00,$0.00,$168.29,$961.13,$0.00,$480.56,$761.21,$768.90,$0.00,$150.42,$0.00,$153.01,$0.00
425780,SUP,HCPCS C1713,,425780  -  PLATE 358.5MM 30 HOLE STR BONE ACETAB,$961.13,$0.00,$961.13,$432.51,$685.95,$0.00,$165.60,$0.00,$0.00,$168.29,$961.13,$0.00,$480.56,$761.21,$768.90,$0.00,$150.42,$0.00,$153.01,$0.00
425794,SUP,HCPCS C1713,,425794  -  PLATE BN 60.5MM MPS 4 HL SS R75,"$1,018.88",$0.00,"$1,018.88",$458.49,$727.17,$0.00,$175.55,$0.00,$0.00,$178.40,"$1,018.88",$0.00,$509.44,$806.95,$815.10,$0.00,$159.45,$0.00,$162.20,$0.00
425796,SUP,HCPCS C1713,,425796  -  PLATE BN 92.5MM MPS 6 HL SS R75,"$1,071.13",$0.00,"$1,071.13",$482.01,$764.46,$0.00,$184.55,$0.00,$0.00,$187.55,"$1,071.13",$0.00,$535.56,$848.33,$856.90,$0.00,$167.63,$0.00,$170.52,$0.00
425798,SUP,HCPCS C1713,,425798  -  PLATE 75MM RAD 124.5MM 8 HOLE BONE PUBIS SYMPHYSIS,"$1,122.00",$0.00,"$1,122.00",$504.90,$800.77,$0.00,$193.31,$0.00,$0.00,$196.45,"$1,122.00",$0.00,$561.00,$888.62,$897.60,$0.00,$175.59,$0.00,$178.62,$0.00
427002,SUP,HCPCS C1713,,427002  -  PLATE 32MM SS 4MM SCR SM FRAG 2 HOLE WST CMPR LCK AXSOS BONE,$178.75,$0.00,$178.75,$80.44,$127.57,$0.00,$30.80,$0.00,$0.00,$31.30,$178.75,$0.00,$89.38,$141.57,$143.00,$0.00,$27.97,$0.00,$28.46,$0.00
427003,SUP,HCPCS C1713,,427003  -  PLATE 45MM SS 3 HOLE WST CMPR SM FRAG IMPL AXSOS BONE 4MM,$178.75,$0.00,$178.75,$80.44,$127.57,$0.00,$30.80,$0.00,$0.00,$31.30,$178.75,$0.00,$89.38,$141.57,$143.00,$0.00,$27.97,$0.00,$28.46,$0.00
427004,SUP,HCPCS C1713,,427004  -  PLATE 58MM SS 4MM SCR SM FRAG 4 HOLE WST CMPR LCK AXSOS BONE,$192.50,$0.00,$192.50,$86.63,$137.39,$0.00,$33.17,$0.00,$0.00,$33.71,$192.50,$0.00,$96.25,$152.46,$154.00,$0.00,$30.13,$0.00,$30.65,$0.00
427005,SUP,HCPCS C1713,,427005  -  PLATE BN 71MM NS AXSOS 5 HL LCK CMPR SS WST 4MM SCR SM FRAG,$226.88,$0.00,$226.88,$102.09,$161.92,$0.00,$39.09,$0.00,$0.00,$39.72,$226.88,$0.00,$113.44,$179.69,$181.50,$0.00,$35.51,$0.00,$36.12,$0.00
427006,SUP,HCPCS C1713,,427006  -  PLATE BN 84MM NS AXSOS 6 HL LCK CMPR SS WST 4MM SCR SM FRAG,$226.88,$0.00,$226.88,$102.09,$161.92,$0.00,$39.09,$0.00,$0.00,$39.72,$226.88,$0.00,$113.44,$179.69,$181.50,$0.00,$35.51,$0.00,$36.12,$0.00
427007,SUP,HCPCS C1713,,427007  -  PLATE BN 97MM NS AXSOS 7 HL LCK CMPR SS WST 4MM SCR SM FRAG,$226.88,$0.00,$226.88,$102.09,$161.92,$0.00,$39.09,$0.00,$0.00,$39.72,$226.88,$0.00,$113.44,$179.69,$181.50,$0.00,$35.51,$0.00,$36.12,$0.00
427008,SUP,HCPCS C1713,,427008  -  PLATE 110MM SS 4MM SCR 8 HOLE WST CMPR SM FRAG IMPL AXSOS,$268.13,$0.00,$268.13,$120.66,$191.36,$0.00,$46.20,$0.00,$0.00,$46.95,$268.13,$0.00,$134.06,$212.36,$214.50,$0.00,$41.96,$0.00,$42.69,$0.00
427009,SUP,HCPCS C1713,,427009  -  PLATE 123MM SS 4MM SCR SM FRAG 29 HOLE WST CMPR LCK AXSOS,$268.13,$0.00,$268.13,$120.66,$191.36,$0.00,$46.20,$0.00,$0.00,$46.95,$268.13,$0.00,$134.06,$212.36,$214.50,$0.00,$41.96,$0.00,$42.69,$0.00
427010,SUP,HCPCS C1713,,427010  -  PLATE 4MM SCR NONSTRL 136MM SS 10 HOLE LCK CMPR WST SM FRAG,$268.13,$0.00,$268.13,$120.66,$191.36,$0.00,$46.20,$0.00,$0.00,$46.95,$268.13,$0.00,$134.06,$212.36,$214.50,$0.00,$41.96,$0.00,$42.69,$0.00
427011,SUP,HCPCS C1713,,427011  -  PLATE 149MM SS 4MM SCR SM FRAG 11 HOLE WST CMPR LCK AXSOS,$268.13,$0.00,$268.13,$120.66,$191.36,$0.00,$46.20,$0.00,$0.00,$46.95,$268.13,$0.00,$134.06,$212.36,$214.50,$0.00,$41.96,$0.00,$42.69,$0.00
427012,SUP,HCPCS C1713,,427012  -  PLATE BN 162MM NS AXSOS 12 HL LCK CMPR SS WST 4MM SCR SM,$268.13,$0.00,$268.13,$120.66,$191.36,$0.00,$46.20,$0.00,$0.00,$46.95,$268.13,$0.00,$134.06,$212.36,$214.50,$0.00,$41.96,$0.00,$42.69,$0.00
427014,SUP,HCPCS C1713,,427014  -  PLATE 188MM 14 HOLE CMPR WST LCK AXSOS BONE 4MM,$295.63,$0.00,$295.63,$133.03,$210.99,$0.00,$50.93,$0.00,$0.00,$51.76,$295.63,$0.00,$147.81,$234.14,$236.50,$0.00,$46.27,$0.00,$47.06,$0.00
427016,SUP,HCPCS C1713,,427016  -  PLATE 241MM SS 16 HOLE WST CMPR BONE 4MM STRL,$336.88,$0.00,$336.88,$151.59,$240.43,$0.00,$58.04,$0.00,$0.00,$58.98,$336.88,$0.00,$168.44,$266.81,$269.50,$0.00,$52.72,$0.00,$53.63,$0.00
427018,SUP,HCPCS C1713,,427018  -  PLATE 240MM SS 4MM SCR SM FRAG 18 HOLE WST CMPR LCK AXSOS,$378.13,$0.00,$378.13,$170.16,$269.87,$0.00,$65.15,$0.00,$0.00,$66.21,$378.13,$0.00,$189.06,$299.48,$302.50,$0.00,$59.18,$0.00,$60.20,$0.00
427020,SUP,HCPCS C1713,,427020  -  PLATE 266MM SS 4MM SCR SM FRAG 20 HOLE WST CMPR LCK AXSOS,$378.13,$0.00,$378.13,$170.16,$269.87,$0.00,$65.15,$0.00,$0.00,$66.21,$378.13,$0.00,$189.06,$299.48,$302.50,$0.00,$59.18,$0.00,$60.20,$0.00
427062,SUP,HCPCS C1713,,427062  -  PLATE 24MM SS 3MM SCR SM FRAG 2 HOLE 1/3 TBLR LCK SYS AXSOS,$180.13,$0.00,$180.13,$81.06,$128.56,$0.00,$31.03,$0.00,$0.00,$31.54,$180.13,$0.00,$90.06,$142.66,$144.10,$0.00,$28.19,$0.00,$28.68,$0.00
427063,SUP,HCPCS C1713,,427063  -  PLATE 37MM SS 3 HOLE 1/3 TBLR BONE 3MM,$189.75,$0.00,$189.75,$85.39,$135.42,$0.00,$32.69,$0.00,$0.00,$33.22,$189.75,$0.00,$94.88,$150.28,$151.80,$0.00,$29.70,$0.00,$30.21,$0.00
427064,SUP,HCPCS C1713,,427064  -  PLATE 50MM SS 3MM SCR SM FRAG SET 4 HOLE 1/3 TBLR LCK AXSOS,$218.63,$0.00,$218.63,$98.38,$156.03,$0.00,$37.67,$0.00,$0.00,$38.28,$218.63,$0.00,$109.31,$173.15,$174.90,$0.00,$34.21,$0.00,$34.81,$0.00
427065,SUP,HCPCS C1713,,427065  -  PLATE 3MM 63MM SS 5 HOLE 1/3 TBLR SM FRAG AXSOS BONE,$218.63,$0.00,$218.63,$98.38,$156.03,$0.00,$37.67,$0.00,$0.00,$38.28,$218.63,$0.00,$109.31,$173.15,$174.90,$0.00,$34.21,$0.00,$34.81,$0.00
427066,SUP,HCPCS C1713,,427066  -  PLATE BN 1/3 TBLR 76MM NS AXSOS 6 HL LCK SS 3MM SCR SM FRAG,$88.00,$0.00,$88.00,$39.60,$62.81,$0.00,$15.16,$0.00,$0.00,$15.41,$88.00,$0.00,$44.00,$69.70,$70.40,$0.00,$13.77,$0.00,$14.01,$0.00
427067,SUP,HCPCS C1713,,427067  -  PLATE 89MM SS 3MM SCR SM FRAG 7 HOLE 1/3 TBLR LCK AXSOS BONE,$224.13,$0.00,$224.13,$100.86,$159.96,$0.00,$38.62,$0.00,$0.00,$39.24,$224.13,$0.00,$112.06,$177.51,$179.30,$0.00,$35.08,$0.00,$35.68,$0.00
427068,SUP,HCPCS C1713,,427068  -  PLATE BN 1/3 TBLR 102MM NS AXSOS 8 HL LCK SS 3MM SCR SM FRAG,$236.50,$0.00,$236.50,$106.43,$168.79,$0.00,$40.75,$0.00,$0.00,$41.41,$236.50,$0.00,$118.25,$187.31,$189.20,$0.00,$37.01,$0.00,$37.65,$0.00
427070,SUP,HCPCS C1713,,427070  -  PLATE 3MM 128MM SS 10 HOLE 1/3 TBLR SM FRAG IMPL AXSOS BONE,$236.50,$0.00,$236.50,$106.43,$168.79,$0.00,$40.75,$0.00,$0.00,$41.41,$236.50,$0.00,$118.25,$187.31,$189.20,$0.00,$37.01,$0.00,$37.65,$0.00
427072,SUP,HCPCS C1713,,427072  -  PLATE 154MM SS 3MM SCR SM FRAG 12 HOLE 1/3 TBLR LCK AXSOS,$243.38,$0.00,$243.38,$109.52,$173.70,$0.00,$41.93,$0.00,$0.00,$42.61,$243.38,$0.00,$121.69,$192.76,$194.70,$0.00,$38.09,$0.00,$38.75,$0.00
427074,SUP,HCPCS C1713,,427074  -  PLATE 180MM SS 3MM SCR SM FRAG 14 HOLE 1/3 TBLR LCK AXSOS,$246.13,$0.00,$246.13,$110.76,$175.66,$0.00,$42.41,$0.00,$0.00,$43.09,$246.13,$0.00,$123.06,$194.93,$196.90,$0.00,$38.52,$0.00,$39.18,$0.00
427102,SUP,HCPCS C1713,,427102  -  PLATE NAR 43MM SS 5MM SCR BASIC FRAG 2 HOLE WST CMPR LCK,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
427103,SUP,HCPCS C1713,,427103  -  PLATE NAR 61MM SS 5MM SCR BASIC FRAG 3 HOLE WST CMPR LCK,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
427104,SUP,HCPCS C1713,,427104  -  PLATE NAR 79MM SS 5MM SCR BASIC FRAG 4 HOLE WST CMPR LCK,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
427105,SUP,HCPCS C1713,,427105  -  PLATE NAR 97MM SS 5MM SCR BASIC FRAG 5 HOLE WST CMPR LCK,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
427106,SUP,HCPCS C1713,,427106  -  PLATE NAR 115MM SS WST CMPR 6 HOLE BONE 5MM,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
427107,SUP,HCPCS C1713,,427107  -  PLATE NAR 133MM SS 7 HL SHFT CMPR WST BONE 5MM,$254.38,$0.00,$254.38,$114.47,$181.55,$0.00,$43.83,$0.00,$0.00,$44.54,$254.38,$0.00,$127.19,$201.47,$203.50,$0.00,$39.81,$0.00,$40.50,$0.00
427108,SUP,HCPCS C1713,,427108  -  PLATE BN NAR 151MM NS AXSOS 8 HL LCK CMPR SS WST 5MM SCR BSC,$254.38,$0.00,$254.38,$114.47,$181.55,$0.00,$43.83,$0.00,$0.00,$44.54,$254.38,$0.00,$127.19,$201.47,$203.50,$0.00,$39.81,$0.00,$40.50,$0.00
427109,SUP,HCPCS C1713,,427109  -  PLATE NAR 169MM SS BASIC FRAG SET 9 HOLE LCK CMPR AXSOS BONE,$254.38,$0.00,$254.38,$114.47,$181.55,$0.00,$43.83,$0.00,$0.00,$44.54,$254.38,$0.00,$127.19,$201.47,$203.50,$0.00,$39.81,$0.00,$40.50,$0.00
427110,SUP,HCPCS C1713,,427110  -  PLATE NAR 187MM SS 5MM SCR BASIC FRAG 10 HOLE WST CMPR LCK,$254.38,$0.00,$254.38,$114.47,$181.55,$0.00,$43.83,$0.00,$0.00,$44.54,$254.38,$0.00,$127.19,$201.47,$203.50,$0.00,$39.81,$0.00,$40.50,$0.00
427112,SUP,HCPCS C1713,,427112  -  PLATE NAR 223MM SS 5MM SCR BASIC FRAG 12 HOLE WST CMPR LCK,$316.25,$0.00,$316.25,$142.31,$225.71,$0.00,$54.49,$0.00,$0.00,$55.37,$316.25,$0.00,$158.13,$250.47,$253.00,$0.00,$49.49,$0.00,$50.35,$0.00
427114,SUP,HCPCS C1713,,427114  -  PLATE BN NAR 259MM NS AXSOS 14 HL LCK CMPR SS WST 5MM SCR,$316.25,$0.00,$316.25,$142.31,$225.71,$0.00,$54.49,$0.00,$0.00,$55.37,$316.25,$0.00,$158.13,$250.47,$253.00,$0.00,$49.49,$0.00,$50.35,$0.00
427116,SUP,HCPCS C1713,,427116  -  PLATE NAR NONSTRL 295MM SS 5MM SCR BASIC FRAG 16 HOLE WST,$371.25,$0.00,$371.25,$167.06,$264.96,$0.00,$63.96,$0.00,$0.00,$65.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$58.10,$0.00,$59.10,$0.00
427118,SUP,HCPCS C1713,,427118  -  PLATE NAR NONSTRL 331MM SS 5MM SCR BASIC FRAG 18 HOLE WST,$446.88,$0.00,$446.88,$201.09,$318.93,$0.00,$76.99,$0.00,$0.00,$78.24,$446.88,$0.00,$223.44,$353.93,$357.50,$0.00,$69.94,$0.00,$71.14,$0.00
427120,SUP,HCPCS C1713,,427120  -  PLATE NAR 367MM SS 5MM SCR BASIC FRAG 20 HOLE WST CMPR LCK,$501.88,$0.00,$501.88,$225.84,$358.19,$0.00,$86.47,$0.00,$0.00,$87.87,$501.88,$0.00,$250.94,$397.49,$401.50,$0.00,$78.54,$0.00,$79.90,$0.00
427122,SUP,HCPCS C1713,,427122  -  PLATE NAR NONSTRL 403MM SS 5MM SCR BASIC FRAG 22 HOLE WST,$563.75,$0.00,$563.75,$253.69,$402.35,$0.00,$97.13,$0.00,$0.00,$98.71,$563.75,$0.00,$281.88,$446.49,$451.00,$0.00,$88.23,$0.00,$89.75,$0.00
427136,SUP,HCPCS C1713,,427136  -  PLATE BRD 119MM SS 5MM SCR BASIC FRAG SET 6 HOLE LCK CMPR,$297.00,$0.00,$297.00,$133.65,$211.97,$0.00,$51.17,$0.00,$0.00,$52.00,$297.00,$0.00,$148.50,$235.22,$237.60,$0.00,$46.48,$0.00,$47.28,$0.00
427137,SUP,HCPCS C1713,,427137  -  PLATE BRD 137MM SS 7 HL SHFT CMPR WST BONE 5MM,$332.75,$0.00,$332.75,$149.74,$237.48,$0.00,$57.33,$0.00,$0.00,$58.26,$332.75,$0.00,$166.38,$263.54,$266.20,$0.00,$52.08,$0.00,$52.97,$0.00
427138,SUP,HCPCS C1713,,427138  -  PLATE BN BRD 155MM NS AXSOS 8 HL LCK CMPR SS WST 5MM SCR BSC,$332.75,$0.00,$332.75,$149.74,$237.48,$0.00,$57.33,$0.00,$0.00,$58.26,$332.75,$0.00,$166.38,$263.54,$266.20,$0.00,$52.08,$0.00,$52.97,$0.00
427139,SUP,HCPCS C1713,,427139  -  PLATE BRD 173MM SS 5MM SCR BASIC FRAG 9 HOLE WST CMPR LCK,$332.75,$0.00,$332.75,$149.74,$237.48,$0.00,$57.33,$0.00,$0.00,$58.26,$332.75,$0.00,$166.38,$263.54,$266.20,$0.00,$52.08,$0.00,$52.97,$0.00
427140,SUP,HCPCS C1713,,427140  -  PLATE BN BRD 191MM NS AXSOS 10 HL LCK CMPR SS WST 5MM SCR,$332.75,$0.00,$332.75,$149.74,$237.48,$0.00,$57.33,$0.00,$0.00,$58.26,$332.75,$0.00,$166.38,$263.54,$266.20,$0.00,$52.08,$0.00,$52.97,$0.00
427141,SUP,HCPCS C1713,,427141  -  PLATE BRD 209MM SS 5MM SCR BASIC FRAG 11 HOLE WST CMPR LCK,$371.25,$0.00,$371.25,$167.06,$264.96,$0.00,$63.96,$0.00,$0.00,$65.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$58.10,$0.00,$59.10,$0.00
427142,SUP,HCPCS C1713,,427142  -  PLATE BRD 227MM SS BASIC FRAG SET 12 HOLE LCK CMPR AXSOS,$371.25,$0.00,$371.25,$167.06,$264.96,$0.00,$63.96,$0.00,$0.00,$65.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$58.10,$0.00,$59.10,$0.00
427143,SUP,HCPCS C1713,,427143  -  PLATE BRD 245MM SS 5MM SCR BASIC FRAG 13 HOLE WST CMPR LCK,$371.25,$0.00,$371.25,$167.06,$264.96,$0.00,$63.96,$0.00,$0.00,$65.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$58.10,$0.00,$59.10,$0.00
427144,SUP,HCPCS C1713,,427144  -  PLATE BRD 263MM SS 5MM SCR BASIC FRAG 14 HOLE WST CMPR LCK,$371.25,$0.00,$371.25,$167.06,$264.96,$0.00,$63.96,$0.00,$0.00,$65.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$58.10,$0.00,$59.10,$0.00
427146,SUP,HCPCS C1713,,427146  -  PLATE BRD 299MM SS 5MM SCR BASIC FRAG 16 HOLE WST CMPR LCK,$407.00,$0.00,$407.00,$183.15,$290.48,$0.00,$70.12,$0.00,$0.00,$71.26,$407.00,$0.00,$203.50,$322.34,$325.60,$0.00,$63.70,$0.00,$64.79,$0.00
427148,SUP,HCPCS C1713,,427148  -  PLATE BRD 335MM SS 5MM SCR BASIC FRAG 18 HOLE WST CMPR LCK,$500.50,$0.00,$500.50,$225.23,$357.21,$0.00,$86.23,$0.00,$0.00,$87.63,$500.50,$0.00,$250.25,$396.40,$400.40,$0.00,$78.33,$0.00,$79.68,$0.00
427150,SUP,HCPCS C1713,,427150  -  PLATE BRD 371MM SS 5MM SCR BASIC FRAG 20 HOLE WST CMPR LCK,$559.63,$0.00,$559.63,$251.83,$399.40,$0.00,$96.42,$0.00,$0.00,$97.99,$559.63,$0.00,$279.81,$443.23,$447.70,$0.00,$87.58,$0.00,$89.09,$0.00
427152,SUP,HCPCS C1713,,427152  -  PLATE BRD 407MM SS 5MM SCR BASIC FRAG 22 HOLE WST CMPR LCK,$618.75,$0.00,$618.75,$278.44,$441.60,$0.00,$106.61,$0.00,$0.00,$108.34,$618.75,$0.00,$309.38,$490.05,$495.00,$0.00,$96.83,$0.00,$98.51,$0.00
429688,SUP,HCPCS C1900,,429688  -  LEAD PACING 2 CURVE 5.3FR 88CM BIPOL 2 ELECTRODE 2 FIX IS-1,"$3,562.50",$0.00,"$3,562.50",$0.00,"$2,542.56",$0.00,$613.80,$0.00,$0.00,$0.00,"$3,562.50",$0.00,"$1,781.25","$2,821.50","$2,850.00",$0.00,$557.53,$0.00,$0.00,$0.00
430009,SUP,HCPCS C1713,,430009  -  PLATE 117MM SS SM FRAG SET 9 HOLE WST CMPR SPS BONE ORTH,$225.50,$0.00,$225.50,$101.48,$160.94,$0.00,$38.85,$0.00,$0.00,$39.48,$225.50,$0.00,$112.75,$178.60,$180.40,$0.00,$35.29,$0.00,$35.90,$0.00
430012,SUP,HCPCS C1713,,430012  -  PLATE 156X10.3X3.2MM SS 12 HOLE CMPR WST BONE ORTH,$243.38,$0.00,$243.38,$109.52,$173.70,$0.00,$41.93,$0.00,$0.00,$42.61,$243.38,$0.00,$121.69,$192.76,$194.70,$0.00,$38.09,$0.00,$38.75,$0.00
430014,SUP,HCPCS C1713,,430014  -  PLATE 182MM SS SM FRAG SET 14 HOLE WST CMPR SPS BONE ORTH,$389.13,$0.00,$389.13,$175.11,$277.72,$0.00,$67.04,$0.00,$0.00,$68.13,$389.13,$0.00,$194.56,$308.19,$311.30,$0.00,$60.90,$0.00,$61.95,$0.00
430016,SUP,HCPCS C1713,,430016  -  PLATE 208MM SS SM FRAG SET 16 HOLE WST CMPR SPS BONE ORTH,$606.38,$0.00,$606.38,$272.87,$432.77,$0.00,$104.48,$0.00,$0.00,$106.17,$606.38,$0.00,$303.19,$480.25,$485.10,$0.00,$94.90,$0.00,$96.53,$0.00
430018,SUP,HCPCS C1713,,430018  -  PLATE 234X10.3X3.2MM SS 18 HOLE CMPR WST BONE ORTH,$691.63,$0.00,$691.63,$311.23,$493.61,$0.00,$119.16,$0.00,$0.00,$121.10,$691.63,$0.00,$345.81,$547.77,$553.30,$0.00,$108.24,$0.00,$110.11,$0.00
430055,SUP,HCPCS C1713,,430055  -  PLATE STD 65MM SS 5 HOLE CMPR SPS BONE DISTAL ULN NONSTRL,$191.13,$0.00,$191.13,$86.01,$136.41,$0.00,$32.93,$0.00,$0.00,$33.46,$191.13,$0.00,$95.56,$151.37,$152.90,$0.00,$29.91,$0.00,$30.43,$0.00
430056,SUP,HCPCS C1713,,430056  -  PLATE STD 78MM SS 6 HOLE CMPR BONE,$159.50,$0.00,$159.50,$71.78,$113.84,$0.00,$27.48,$0.00,$0.00,$27.93,$159.50,$0.00,$79.75,$126.32,$127.60,$0.00,$24.96,$0.00,$25.39,$0.00
430060,SUP,HCPCS C1713,,430060  -  PLATE STD 130MM SS 10 HOLE CMPR SPS BONE DISTAL ULN NONSTRL,$165.00,$0.00,$165.00,$74.25,$117.76,$0.00,$28.43,$0.00,$0.00,$28.89,$165.00,$0.00,$82.50,$130.68,$132.00,$0.00,$25.82,$0.00,$26.27,$0.00
431748,SUP,HCPCS C1785,,431748  -  PACEMAKER CRD EDORA PROMRI CLS HOME MNTR DR-T,"$17,750.00",$0.00,"$17,750.00","$7,987.50","$5,158.80",$0.00,"$3,058.24",$0.00,$0.00,"$3,107.88","$17,750.00",$0.00,"$8,875.00","$14,058.00","$14,200.00",$0.00,"$2,777.88",$0.00,"$2,825.80",$0.00
431749,SUP,HCPCS C1786,,431749  -  PACEMAKER CRD EDORA PROMRI CLS HOME MNTR SR-T,"$14,500.00",$0.00,"$14,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$14,500.00",$0.00,"$7,250.00","$11,484.00","$11,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
432203,SUP,HCPCS C1713,,432203  -  PLATE 46MM SS 4.5MM SCR 3 HOLE RECON SPS BONE DISTAL TIB,$324.50,$0.00,$324.50,$146.03,$231.60,$0.00,$55.91,$0.00,$0.00,$56.82,$324.50,$0.00,$162.25,$257.00,$259.60,$0.00,$50.78,$0.00,$51.66,$0.00
432204,SUP,HCPCS C1713,,432204  -  PLATE 62MM SS 4.5MM SCR 4 HL SHFT RECON BONE,$374.00,$0.00,$374.00,$168.30,$266.92,$0.00,$64.44,$0.00,$0.00,$65.48,$374.00,$0.00,$187.00,$296.21,$299.20,$0.00,$58.53,$0.00,$59.54,$0.00
432205,SUP,HCPCS C1713,,432205  -  PLATE 78MM SS 4.5MM SCR 5 HOLE RECON SPS BONE DISTAL TIB,$409.75,$0.00,$409.75,$184.39,$292.44,$0.00,$70.60,$0.00,$0.00,$71.74,$409.75,$0.00,$204.88,$324.52,$327.80,$0.00,$64.13,$0.00,$65.23,$0.00
432206,SUP,HCPCS C1713,,432206  -  PLATE 94MM SS 4.5MM SCR 6 HL SHFT RECON BONE,$437.25,$0.00,$437.25,$196.76,$312.07,$0.00,$75.34,$0.00,$0.00,$76.56,$437.25,$0.00,$218.63,$346.30,$349.80,$0.00,$68.43,$0.00,$69.61,$0.00
432207,SUP,HCPCS C1713,,432207  -  PLATE 110MM SS 4.5MM SCR 7 HOLE RECON SPS BONE DISTAL TIB,$455.13,$0.00,$455.13,$204.81,$324.82,$0.00,$78.42,$0.00,$0.00,$79.69,$455.13,$0.00,$227.56,$360.46,$364.10,$0.00,$71.23,$0.00,$72.46,$0.00
432208,SUP,HCPCS C1713,,432208  -  PLATE 126MM SS 4.5MM SCR 8 HL SHFT RECON BONE,$481.25,$0.00,$481.25,$216.56,$343.47,$0.00,$82.92,$0.00,$0.00,$84.26,$481.25,$0.00,$240.63,$381.15,$385.00,$0.00,$75.32,$0.00,$76.62,$0.00
432209,SUP,HCPCS C1713,,432209  -  PLATE 142MM SS 4.5MM SCR 9 HOLE RECON SPS BONE DISTAL TIB,$517.00,$0.00,$517.00,$232.65,$368.98,$0.00,$89.08,$0.00,$0.00,$90.52,$517.00,$0.00,$258.50,$409.46,$413.60,$0.00,$80.91,$0.00,$82.31,$0.00
432210,SUP,HCPCS C1713,,432210  -  PLATE 158MM SS 4.5MM SCR 10 HOLE RECON BONE,$534.88,$0.00,$534.88,$240.69,$381.74,$0.00,$92.16,$0.00,$0.00,$93.65,$534.88,$0.00,$267.44,$423.62,$427.90,$0.00,$83.71,$0.00,$85.15,$0.00
432211,SUP,HCPCS C1713,,432211  -  PLATE 174MM SS 4.5MM SCR 11 HOLE RECON SPS BONE DISTAL TIB,$511.50,$0.00,$511.50,$230.18,$365.06,$0.00,$88.13,$0.00,$0.00,$89.56,$511.50,$0.00,$255.75,$405.11,$409.20,$0.00,$80.05,$0.00,$81.43,$0.00
432212,SUP,HCPCS C1713,,432212  -  PLATE 190MM SS 4.5MM SCR 12 HOLE RECON BONE,$587.13,$0.00,$587.13,$264.21,$419.03,$0.00,$101.16,$0.00,$0.00,$102.80,$587.13,$0.00,$293.56,$465.01,$469.70,$0.00,$91.89,$0.00,$93.47,$0.00
432213,SUP,HCPCS C1713,,432213  -  PLATE 206MM SS 4.5MM SCR 13 HOLE RECON SPS BONE DISTAL TIB,$624.25,$0.00,$624.25,$280.91,$445.53,$0.00,$107.56,$0.00,$0.00,$109.30,$624.25,$0.00,$312.13,$494.41,$499.40,$0.00,$97.70,$0.00,$99.38,$0.00
432214,SUP,HCPCS C1713,,432214  -  PLATE 222MM SS 4.5MM SCR 14 HL SHFT RECON BONE,$642.13,$0.00,$642.13,$288.96,$458.28,$0.00,$110.63,$0.00,$0.00,$112.43,$642.13,$0.00,$321.06,$508.57,$513.70,$0.00,$100.49,$0.00,$102.23,$0.00
432215,SUP,HCPCS C1713,,432215  -  PLATE 238MM SS 4.5MM SCR 15 HOLE RECON SPS BONE DISTAL TIB,$607.75,$0.00,$607.75,$273.49,$433.75,$0.00,$104.71,$0.00,$0.00,$106.41,$607.75,$0.00,$303.88,$481.34,$486.20,$0.00,$95.11,$0.00,$96.75,$0.00
432216,SUP,HCPCS C1713,,432216  -  PLATE 254MM SS 4.5MM SCR 16 HL SHFT RECON BONE,$686.13,$0.00,$686.13,$308.76,$489.69,$0.00,$118.22,$0.00,$0.00,$120.13,$686.13,$0.00,$343.06,$543.41,$548.90,$0.00,$107.38,$0.00,$109.23,$0.00
433165,SUP,Custom 27803010,,433165  -  CEMENT BONE SIL 65MM 40GM TIB KNEE SPCR MLD STRL DISP,"$2,330.00",$0.00,"$2,330.00",$0.00,"$1,662.92",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,330.00",$0.00,"$1,165.00","$1,845.36","$1,864.00",$0.00,$0.00,$0.00,$0.00,$0.00
436003,SUP,HCPCS C1713,,436003  -  PLATE 3 HOLE BONE LEFT DISTAL VOLR RADL,"$1,031.25",$0.00,"$1,031.25",$464.06,$736.00,$0.00,$177.68,$0.00,$0.00,$180.56,"$1,031.25",$0.00,$515.63,$816.75,$825.00,$0.00,$161.39,$0.00,$164.18,$0.00
436004,SUP,HCPCS C1713,,436004  -  PLATE 4 HOLE BONE LEFT DISTAL VOLR RAD,"$1,031.25",$0.00,"$1,031.25",$464.06,$736.00,$0.00,$177.68,$0.00,$0.00,$180.56,"$1,031.25",$0.00,$515.63,$816.75,$825.00,$0.00,$161.39,$0.00,$164.18,$0.00
436006,SUP,HCPCS C1713,,436006  -  PLATE 6 HOLE BONE LEFT DISTAL VOLR RAD,"$1,031.25",$0.00,"$1,031.25",$464.06,$736.00,$0.00,$177.68,$0.00,$0.00,$180.56,"$1,031.25",$0.00,$515.63,$816.75,$825.00,$0.00,$161.39,$0.00,$164.18,$0.00
436008,SUP,HCPCS C1713,,436008  -  DISTAL VOLAR RADIUS  8 HOLE LT,"$1,031.25",$0.00,"$1,031.25",$464.06,$736.00,$0.00,$177.68,$0.00,$0.00,$180.56,"$1,031.25",$0.00,$515.63,$816.75,$825.00,$0.00,$161.39,$0.00,$164.18,$0.00
436010,SUP,HCPCS C1713,,436010  -  PLATE 10 HOLE BONE LEFT DISTAL VOLR RADL,"$1,031.25",$0.00,"$1,031.25",$464.06,$736.00,$0.00,$177.68,$0.00,$0.00,$180.56,"$1,031.25",$0.00,$515.63,$816.75,$825.00,$0.00,$161.39,$0.00,$164.18,$0.00
436023,SUP,HCPCS C1713,,436023  -  PLATE 3 HOLE BONE RIGHT DISTAL VOLR RAD,"$1,031.25",$0.00,"$1,031.25",$464.06,$736.00,$0.00,$177.68,$0.00,$0.00,$180.56,"$1,031.25",$0.00,$515.63,$816.75,$825.00,$0.00,$161.39,$0.00,$164.18,$0.00
436024,SUP,HCPCS C1713,,436024  -  PLATE 4 HOLE BONE RIGHT DISTAL VOLR RAD,"$1,031.25",$0.00,"$1,031.25",$464.06,$736.00,$0.00,$177.68,$0.00,$0.00,$180.56,"$1,031.25",$0.00,$515.63,$816.75,$825.00,$0.00,$161.39,$0.00,$164.18,$0.00
436026,SUP,HCPCS C1713,,436026  -  PLATE 6 HOLE BONE RIGHT DISTAL VOLR RAD,"$1,031.25",$0.00,"$1,031.25",$464.06,$736.00,$0.00,$177.68,$0.00,$0.00,$180.56,"$1,031.25",$0.00,$515.63,$816.75,$825.00,$0.00,$161.39,$0.00,$164.18,$0.00
436028,SUP,HCPCS C1713,,436028  -  PLATE 8 HOLE BONE RIGHT DISTAL VOLR RADL,"$1,031.25",$0.00,"$1,031.25",$464.06,$736.00,$0.00,$177.68,$0.00,$0.00,$180.56,"$1,031.25",$0.00,$515.63,$816.75,$825.00,$0.00,$161.39,$0.00,$164.18,$0.00
436030,SUP,HCPCS C1713,,436030  -  PLATE 10 HOLE BONE RIGHT DISTAL VOLR RADL,"$1,031.25",$0.00,"$1,031.25",$464.06,$736.00,$0.00,$177.68,$0.00,$0.00,$180.56,"$1,031.25",$0.00,$515.63,$816.75,$825.00,$0.00,$161.39,$0.00,$164.18,$0.00
436103,SUP,HCPCS C1713,,436103  -  PLATE 86MM SS 5 HOLE BONE LEFT PROX LAT HUM,"$1,980.00",$0.00,"$1,980.00",$891.00,"$1,413.13",$0.00,$341.14,$0.00,$0.00,$346.68,"$1,980.00",$0.00,$990.00,"$1,568.16","$1,584.00",$0.00,$309.87,$0.00,$315.22,$0.00
436105,SUP,HCPCS C1713,,436105  -  PLATE 5 HOLE BONE LEFT PROX LAT HUM,"$1,980.00",$0.00,"$1,980.00",$891.00,"$1,413.13",$0.00,$341.14,$0.00,$0.00,$346.68,"$1,980.00",$0.00,$990.00,"$1,568.16","$1,584.00",$0.00,$309.87,$0.00,$315.22,$0.00
436108,SUP,HCPCS C1713,,436108  -  PLATE 150MM SS 8 HOLE BONE LEFT PROX LAT HUM,"$1,980.00",$0.00,"$1,980.00",$891.00,"$1,413.13",$0.00,$341.14,$0.00,$0.00,$346.68,"$1,980.00",$0.00,$990.00,"$1,568.16","$1,584.00",$0.00,$309.87,$0.00,$315.22,$0.00
436123,SUP,HCPCS C1713,,436123  -  PLATE 86MM SS 5 HOLE BONE RIGHT PROX LAT HUM,"$1,980.00",$0.00,"$1,980.00",$891.00,"$1,413.13",$0.00,$341.14,$0.00,$0.00,$346.68,"$1,980.00",$0.00,$990.00,"$1,568.16","$1,584.00",$0.00,$309.87,$0.00,$315.22,$0.00
436125,SUP,HCPCS C1713,,436125  -  PLATE 112MM SS 5 HOLE BONE RIGHT PROX LAT HUM,"$1,980.00",$0.00,"$1,980.00",$891.00,"$1,413.13",$0.00,$341.14,$0.00,$0.00,$346.68,"$1,980.00",$0.00,$990.00,"$1,568.16","$1,584.00",$0.00,$309.87,$0.00,$315.22,$0.00
436128,SUP,HCPCS C1713,,436128  -  PLATE 112MM 8 HOLE LCK BONE 4MM RIGHT PROX HUM PERIART TIB,"$1,980.00",$0.00,"$1,980.00",$891.00,"$1,413.13",$0.00,$341.14,$0.00,$0.00,$346.68,"$1,980.00",$0.00,$990.00,"$1,568.16","$1,584.00",$0.00,$309.87,$0.00,$315.22,$0.00
436204,SUP,HCPCS C1713,,436204  -  PLATE 94MM SS 4MM 3.5MM STD LCK SCR 4 SHFT HOLE AXSOS BONE,"$1,813.63",$0.00,"$1,813.63",$816.13,"$1,294.38",$0.00,$312.48,$0.00,$0.00,$317.55,"$1,813.63",$0.00,$906.81,"$1,436.39","$1,450.90",$0.00,$283.83,$0.00,$288.73,$0.00
436206,SUP,HCPCS C1713,,436206  -  PLATE 6 HOLE BONE LEFT DISTAL MDL TIB,"$1,813.63",$0.00,"$1,813.63",$816.13,"$1,294.38",$0.00,$312.48,$0.00,$0.00,$317.55,"$1,813.63",$0.00,$906.81,"$1,436.39","$1,450.90",$0.00,$283.83,$0.00,$288.73,$0.00
436208,SUP,HCPCS C1713,,436208  -  PLATE 8 HOLE BONE LEFT DISTAL MDL TIB,"$1,813.63",$0.00,"$1,813.63",$816.13,"$1,294.38",$0.00,$312.48,$0.00,$0.00,$317.55,"$1,813.63",$0.00,$906.81,"$1,436.39","$1,450.90",$0.00,$283.83,$0.00,$288.73,$0.00
436210,SUP,HCPCS C1713,,436210  -  PLATE 172MM SS 10 HOLE BONE LEFT DISTAL MDL TIB,"$1,813.63",$0.00,"$1,813.63",$816.13,"$1,294.38",$0.00,$312.48,$0.00,$0.00,$317.55,"$1,813.63",$0.00,$906.81,"$1,436.39","$1,450.90",$0.00,$283.83,$0.00,$288.73,$0.00
436212,SUP,HCPCS C1713,,436212  -  PLATE 198MM SS 12 HOLE BONE LEFT DISTAL MDL TIB,"$2,143.63",$0.00,"$2,143.63",$964.63,"$1,529.91",$0.00,$369.34,$0.00,$0.00,$375.33,"$2,143.63",$0.00,"$1,071.81","$1,697.75","$1,714.90",$0.00,$335.48,$0.00,$341.27,$0.00
436214,SUP,HCPCS C1713,,436214  -  PLATE 224MM SS 14 SHFT HOLE LCK BONE 4MM 3.5MM DISTAL MDL,"$2,143.63",$0.00,"$2,143.63",$964.63,"$1,529.91",$0.00,$369.34,$0.00,$0.00,$375.33,"$2,143.63",$0.00,"$1,071.81","$1,697.75","$1,714.90",$0.00,$335.48,$0.00,$341.27,$0.00
436216,SUP,HCPCS C1713,,436216  -  PLATE 250MM SS 16 HOLE BONE LEFT DISTAL MDL TIB,"$2,143.63",$0.00,"$2,143.63",$964.63,"$1,529.91",$0.00,$369.34,$0.00,$0.00,$375.33,"$2,143.63",$0.00,"$1,071.81","$1,697.75","$1,714.90",$0.00,$335.48,$0.00,$341.27,$0.00
436224,SUP,HCPCS C1713,,436224  -  PLATE 4 HOLE BONE RIGHT DISTAL MDL TIB,"$1,813.63",$0.00,"$1,813.63",$816.13,"$1,294.38",$0.00,$312.48,$0.00,$0.00,$317.55,"$1,813.63",$0.00,$906.81,"$1,436.39","$1,450.90",$0.00,$283.83,$0.00,$288.73,$0.00
436226,SUP,HCPCS C1713,,436226  -  PLATE 120MM SS 4MM 3.5MM STD LCK SCR 6 SHFT HOLE AXSOS BONE,"$1,813.63",$0.00,"$1,813.63",$816.13,"$1,294.38",$0.00,$312.48,$0.00,$0.00,$317.55,"$1,813.63",$0.00,$906.81,"$1,436.39","$1,450.90",$0.00,$283.83,$0.00,$288.73,$0.00
436228,SUP,HCPCS C1713,,436228  -  PLATE 8 HOLE BONE RIGHT DISTAL MDL TIB,"$1,813.63",$0.00,"$1,813.63",$816.13,"$1,294.38",$0.00,$312.48,$0.00,$0.00,$317.55,"$1,813.63",$0.00,$906.81,"$1,436.39","$1,450.90",$0.00,$283.83,$0.00,$288.73,$0.00
436230,SUP,HCPCS C1713,,436230  -  PLATE 172MM SS 10 HOLE BONE RIGHT DISTAL MDL TIB,"$1,813.63",$0.00,"$1,813.63",$816.13,"$1,294.38",$0.00,$312.48,$0.00,$0.00,$317.55,"$1,813.63",$0.00,$906.81,"$1,436.39","$1,450.90",$0.00,$283.83,$0.00,$288.73,$0.00
436232,SUP,HCPCS C1713,,436232  -  PLATE 198MM SS 12 SHFT HOLE LCK BONE 4MM 3.5MM DISTAL MDL,"$2,143.63",$0.00,"$2,143.63",$964.63,"$1,529.91",$0.00,$369.34,$0.00,$0.00,$375.33,"$2,143.63",$0.00,"$1,071.81","$1,697.75","$1,714.90",$0.00,$335.48,$0.00,$341.27,$0.00
436234,SUP,HCPCS C1713,,436234  -  PLATE 224MM SS 14 HL SHFT LCK IMPL AXSOS BONE RIGHT DISTAL,"$2,143.63",$0.00,"$2,143.63",$964.63,"$1,529.91",$0.00,$369.34,$0.00,$0.00,$375.33,"$2,143.63",$0.00,"$1,071.81","$1,697.75","$1,714.90",$0.00,$335.48,$0.00,$341.27,$0.00
436236,SUP,HCPCS C1713,,436236  -  PLATE 250MM SS 16 HL SHFT LCK IMPL AXSOS BONE RIGHT DISTAL,"$2,143.63",$0.00,"$2,143.63",$964.63,"$1,529.91",$0.00,$369.34,$0.00,$0.00,$375.33,"$2,143.63",$0.00,"$1,071.81","$1,697.75","$1,714.90",$0.00,$335.48,$0.00,$341.27,$0.00
436302,SUP,HCPCS C1713,,436302  -  PLATE 2 HOLE BONE LEFT PROX LAT TIB,"$1,731.13",$0.00,"$1,731.13",$779.01,"$1,235.50",$0.00,$298.26,$0.00,$0.00,$303.11,"$1,731.13",$0.00,$865.56,"$1,371.05","$1,384.90",$0.00,$270.92,$0.00,$275.60,$0.00
436304,SUP,HCPCS C1713,,436304  -  PLATE 4 HOLE BONE LEFT PROX LAT TIB,"$1,731.13",$0.00,"$1,731.13",$779.01,"$1,235.50",$0.00,$298.26,$0.00,$0.00,$303.11,"$1,731.13",$0.00,$865.56,"$1,371.05","$1,384.90",$0.00,$270.92,$0.00,$275.60,$0.00
436306,SUP,HCPCS C1713,,436306  -  PLATE 6 HOLE BONE LEFT PROX LAT TIB,"$1,731.13",$0.00,"$1,731.13",$779.01,"$1,235.50",$0.00,$298.26,$0.00,$0.00,$303.11,"$1,731.13",$0.00,$865.56,"$1,371.05","$1,384.90",$0.00,$270.92,$0.00,$275.60,$0.00
436308,SUP,HCPCS C1713,,436308  -  PLATE 8 HOLE BONE LEFT PROX LAT TIB,"$1,731.13",$0.00,"$1,731.13",$779.01,"$1,235.50",$0.00,$298.26,$0.00,$0.00,$303.11,"$1,731.13",$0.00,$865.56,"$1,371.05","$1,384.90",$0.00,$270.92,$0.00,$275.60,$0.00
436310,SUP,HCPCS C1713,,436310  -  PLATE 10 HOLE BONE LEFT PROX LAT TIB,"$1,731.13",$0.00,"$1,731.13",$779.01,"$1,235.50",$0.00,$298.26,$0.00,$0.00,$303.11,"$1,731.13",$0.00,$865.56,"$1,371.05","$1,384.90",$0.00,$270.92,$0.00,$275.60,$0.00
436312,SUP,HCPCS C1713,,436312  -  PLATE 12 HOLE BONE LEFT PROX LAT TIB,"$1,874.13",$0.00,"$1,874.13",$843.36,"$1,337.56",$0.00,$322.90,$0.00,$0.00,$328.14,"$1,874.13",$0.00,$937.06,"$1,484.31","$1,499.30",$0.00,$293.30,$0.00,$298.36,$0.00
436314,SUP,HCPCS C1713,,436314  -  PLATE 14 HOLE BONE LEFT PROX LAT TIB,"$2,061.13",$0.00,"$2,061.13",$927.51,"$1,471.02",$0.00,$355.12,$0.00,$0.00,$360.89,"$2,061.13",$0.00,"$1,030.56","$1,632.41","$1,648.90",$0.00,$322.57,$0.00,$328.13,$0.00
436322,SUP,HCPCS C1713,,436322  -  PLATE 2 HOLE BONE RIGHT PROX LAT TIB,"$1,731.13",$0.00,"$1,731.13",$779.01,"$1,235.50",$0.00,$298.26,$0.00,$0.00,$303.11,"$1,731.13",$0.00,$865.56,"$1,371.05","$1,384.90",$0.00,$270.92,$0.00,$275.60,$0.00
436324,SUP,HCPCS C1713,,436324  -  PLATE 4 HOLE BONE RIGHT PROX LAT TIB,"$1,731.13",$0.00,"$1,731.13",$779.01,"$1,235.50",$0.00,$298.26,$0.00,$0.00,$303.11,"$1,731.13",$0.00,$865.56,"$1,371.05","$1,384.90",$0.00,$270.92,$0.00,$275.60,$0.00
436326,SUP,HCPCS C1713,,436326  -  PLATE 6 HOLE BONE RIGHT PROX LAT TIB,"$1,731.13",$0.00,"$1,731.13",$779.01,"$1,235.50",$0.00,$298.26,$0.00,$0.00,$303.11,"$1,731.13",$0.00,$865.56,"$1,371.05","$1,384.90",$0.00,$270.92,$0.00,$275.60,$0.00
436328,SUP,HCPCS C1713,,436328  -  PLATE 8 HOLE BONE RIGHT PROX LAT TIB,"$1,731.13",$0.00,"$1,731.13",$779.01,"$1,235.50",$0.00,$298.26,$0.00,$0.00,$303.11,"$1,731.13",$0.00,$865.56,"$1,371.05","$1,384.90",$0.00,$270.92,$0.00,$275.60,$0.00
436330,SUP,HCPCS C1713,,436330  -  PLATE 10 HOLE BONE RIGHT PROX LAT TIB,"$1,731.13",$0.00,"$1,731.13",$779.01,"$1,235.50",$0.00,$298.26,$0.00,$0.00,$303.11,"$1,731.13",$0.00,$865.56,"$1,371.05","$1,384.90",$0.00,$270.92,$0.00,$275.60,$0.00
436332,SUP,HCPCS C1713,,436332  -  PLATE 12 HOLE BONE RIGHT PROX LAT TIB,"$2,061.13",$0.00,"$2,061.13",$927.51,"$1,471.02",$0.00,$355.12,$0.00,$0.00,$360.89,"$2,061.13",$0.00,"$1,030.56","$1,632.41","$1,648.90",$0.00,$322.57,$0.00,$328.13,$0.00
436334,SUP,HCPCS C1713,,436334  -  PLATE 14 HOLE BONE RIGHT PROX LAT TIB,"$1,874.13",$0.00,"$1,874.13",$843.36,"$1,337.56",$0.00,$322.90,$0.00,$0.00,$328.14,"$1,874.13",$0.00,$937.06,"$1,484.31","$1,499.30",$0.00,$293.30,$0.00,$298.36,$0.00
436342,SUP,HCPCS C1713,,436342  -  PLATE 95MM SS 3.5MM 4MM STD SCR 2 SHFT HOLE 5 LCK HOLE BONE,"$1,731.13",$0.00,"$1,731.13",$779.01,"$1,235.50",$0.00,$298.26,$0.00,$0.00,$303.11,"$1,731.13",$0.00,$865.56,"$1,371.05","$1,384.90",$0.00,$270.92,$0.00,$275.60,$0.00
436344,SUP,HCPCS C1713,,436344  -  PLATE 121MM 4MM SCR 4 HOLE LCK AXSOS BONE LEFT PROX LAT,"$1,731.13",$0.00,"$1,731.13",$779.01,"$1,235.50",$0.00,$298.26,$0.00,$0.00,$303.11,"$1,731.13",$0.00,$865.56,"$1,371.05","$1,384.90",$0.00,$270.92,$0.00,$275.60,$0.00
436346,SUP,HCPCS C1713,,436346  -  PLATE 147MM 6 HL SHFT LCK BONE LEFT PROX LAT TIB,"$1,731.13",$0.00,"$1,731.13",$779.01,"$1,235.50",$0.00,$298.26,$0.00,$0.00,$303.11,"$1,731.13",$0.00,$865.56,"$1,371.05","$1,384.90",$0.00,$270.92,$0.00,$275.60,$0.00
436348,SUP,HCPCS C1713,,436348  -  PLATE 173MM SS 3.5MM 4MM STD SCR 8 SHFT HOLE 5 LCK HOLE BONE,"$1,731.13",$0.00,"$1,731.13",$779.01,"$1,235.50",$0.00,$298.26,$0.00,$0.00,$303.11,"$1,731.13",$0.00,$865.56,"$1,371.05","$1,384.90",$0.00,$270.92,$0.00,$275.60,$0.00
436350,SUP,HCPCS C1713,,436350  -  PLATE 199MM 4MM SCR 10X5 HOLE LCK AXSOS BONE LEFT PROX LAT,"$1,731.13",$0.00,"$1,731.13",$779.01,"$1,235.50",$0.00,$298.26,$0.00,$0.00,$303.11,"$1,731.13",$0.00,$865.56,"$1,371.05","$1,384.90",$0.00,$270.92,$0.00,$275.60,$0.00
436352,SUP,HCPCS C1713,,436352  -  PLATE 225MM 4MM SCR 12X5 HOLE LCK AXSOS BONE LEFT PROX LAT,"$2,061.13",$0.00,"$2,061.13",$927.51,"$1,471.02",$0.00,$355.12,$0.00,$0.00,$360.89,"$2,061.13",$0.00,"$1,030.56","$1,632.41","$1,648.90",$0.00,$322.57,$0.00,$328.13,$0.00
436354,SUP,HCPCS C1713,,436354  -  PLATE 251MM 15 HOLE LCK BONE 4MM RIGHT PROX LAT PERIART TIB,"$1,874.13",$0.00,"$1,874.13",$843.36,"$1,337.56",$0.00,$322.90,$0.00,$0.00,$328.14,"$1,874.13",$0.00,$937.06,"$1,484.31","$1,499.30",$0.00,$293.30,$0.00,$298.36,$0.00
436362,SUP,HCPCS C1713,,436362  -  PLATE 2 HOLE BONE RIGHT PROX TIB,"$1,731.13",$0.00,"$1,731.13",$779.01,"$1,235.50",$0.00,$298.26,$0.00,$0.00,$303.11,"$1,731.13",$0.00,$865.56,"$1,371.05","$1,384.90",$0.00,$270.92,$0.00,$275.60,$0.00
436364,SUP,HCPCS C1713,,436364  -  PLATE 121MM 4MM SCR 4X5 HOLE LCK AXSOS BONE RIGHT PROX LAT,"$1,574.38",$0.00,"$1,574.38",$708.47,"$1,123.63",$0.00,$271.26,$0.00,$0.00,$275.66,"$1,574.38",$0.00,$787.19,"$1,246.91","$1,259.50",$0.00,$246.39,$0.00,$250.64,$0.00
436366,SUP,HCPCS C1713,,436366  -  PLATE 147MM 4MM SCR 6X5 HOLE LCK AXSOS BONE RIGHT PROX LAT,"$1,731.13",$0.00,"$1,731.13",$779.01,"$1,235.50",$0.00,$298.26,$0.00,$0.00,$303.11,"$1,731.13",$0.00,$865.56,"$1,371.05","$1,384.90",$0.00,$270.92,$0.00,$275.60,$0.00
436368,SUP,HCPCS C1713,,436368  -  PLATE 173MM 4MM SCR 8X5 HOLE LCK AXSOS BONE RIGHT PROX LAT,"$1,574.38",$0.00,"$1,574.38",$708.47,"$1,123.63",$0.00,$271.26,$0.00,$0.00,$275.66,"$1,574.38",$0.00,$787.19,"$1,246.91","$1,259.50",$0.00,$246.39,$0.00,$250.64,$0.00
436370,SUP,HCPCS C1713,,436370  -  PLATE 199MM 4MM SCR 10X5 HOLE LCK AXSOS BONE RIGHT PROX LAT,"$1,574.38",$0.00,"$1,574.38",$708.47,"$1,123.63",$0.00,$271.26,$0.00,$0.00,$275.66,"$1,574.38",$0.00,$787.19,"$1,246.91","$1,259.50",$0.00,$246.39,$0.00,$250.64,$0.00
436372,SUP,HCPCS C1713,,436372  -  PLATE 225MM 4MM SCR 12X5 HOLE LCK AXSOS BONE RIGHT PROX LAT,"$1,874.13",$0.00,"$1,874.13",$843.36,"$1,337.56",$0.00,$322.90,$0.00,$0.00,$328.14,"$1,874.13",$0.00,$937.06,"$1,484.31","$1,499.30",$0.00,$293.30,$0.00,$298.36,$0.00
436374,SUP,HCPCS C1713,,436374  -  PLATE 251MM 14 HL SHFT LCK BONE RIGHT PROX LAT MTPHSL TIB,"$1,874.13",$0.00,"$1,874.13",$843.36,"$1,337.56",$0.00,$322.90,$0.00,$0.00,$328.14,"$1,874.13",$0.00,$937.06,"$1,484.31","$1,499.30",$0.00,$293.30,$0.00,$298.36,$0.00
436404,SUP,HCPCS C1713,,436404  -  PLATE 4 HOLE BONE LEFT DISTAL ANT LAT TIB,"$2,308.63",$0.00,"$2,308.63","$1,038.88","$1,647.67",$0.00,$397.76,$0.00,$0.00,$404.22,"$2,308.63",$0.00,"$1,154.31","$1,828.43","$1,846.90",$0.00,$361.30,$0.00,$367.53,$0.00
436406,SUP,HCPCS C1713,,436406  -  PLATE 123MM SS 6 HL SHFT LCK IMPL AXSOS BONE LEFT DISTAL,"$2,308.63",$0.00,"$2,308.63","$1,038.88","$1,647.67",$0.00,$397.76,$0.00,$0.00,$404.22,"$2,308.63",$0.00,"$1,154.31","$1,828.43","$1,846.90",$0.00,$361.30,$0.00,$367.53,$0.00
436408,SUP,HCPCS C1713,,436408  -  PLATE 149MM SS 8 HL SHFT LCK IMPL AXSOS BONE LEFT DISTAL,"$2,308.63",$0.00,"$2,308.63","$1,038.88","$1,647.67",$0.00,$397.76,$0.00,$0.00,$404.22,"$2,308.63",$0.00,"$1,154.31","$1,828.43","$1,846.90",$0.00,$361.30,$0.00,$367.53,$0.00
436410,SUP,HCPCS C1713,,436410  -  PLATE 10 HOLE BONE LEFT DISTAL ANTLAT TIB,"$2,308.63",$0.00,"$2,308.63","$1,038.88","$1,647.67",$0.00,$397.76,$0.00,$0.00,$404.22,"$2,308.63",$0.00,"$1,154.31","$1,828.43","$1,846.90",$0.00,$361.30,$0.00,$367.53,$0.00
436412,SUP,HCPCS C1713,,436412  -  PLATE 12 HOLE BONE LEFT DISTAL ANTLAT TIB,"$2,638.63",$0.00,"$2,638.63","$1,187.38","$1,883.19",$0.00,$454.62,$0.00,$0.00,$462.00,"$2,638.63",$0.00,"$1,319.31","$2,089.79","$2,110.90",$0.00,$412.94,$0.00,$420.07,$0.00
436414,SUP,HCPCS C1713,,436414  -  PLATE 14 HOLE BONE LEFT DISTAL ANT LAT TIB,"$2,638.63",$0.00,"$2,638.63","$1,187.38","$1,883.19",$0.00,$454.62,$0.00,$0.00,$462.00,"$2,638.63",$0.00,"$1,319.31","$2,089.79","$2,110.90",$0.00,$412.94,$0.00,$420.07,$0.00
436416,SUP,HCPCS C1713,,436416  -  PLATE 16 HOLE BONE LEFT DISTAL ANTLAT TIB,"$2,638.63",$0.00,"$2,638.63","$1,187.38","$1,883.19",$0.00,$454.62,$0.00,$0.00,$462.00,"$2,638.63",$0.00,"$1,319.31","$2,089.79","$2,110.90",$0.00,$412.94,$0.00,$420.07,$0.00
436424,SUP,HCPCS C1713,,436424  -  PLATE 4 HOLE BONE RIGHT DISTAL ANT LAT TIB,"$2,308.63",$0.00,"$2,308.63","$1,038.88","$1,647.67",$0.00,$397.76,$0.00,$0.00,$404.22,"$2,308.63",$0.00,"$1,154.31","$1,828.43","$1,846.90",$0.00,$361.30,$0.00,$367.53,$0.00
436426,SUP,HCPCS C1713,,436426  -  PLATE 123MM SS 6 HL SHFT LCK IMPL AXSOS BONE RIGHT DISTAL,"$2,308.63",$0.00,"$2,308.63","$1,038.88","$1,647.67",$0.00,$397.76,$0.00,$0.00,$404.22,"$2,308.63",$0.00,"$1,154.31","$1,828.43","$1,846.90",$0.00,$361.30,$0.00,$367.53,$0.00
436428,SUP,HCPCS C1713,,436428  -  PLATE 149MM SS 8 HL SHFT LCK IMPL AXSOS BONE RIGHT DISTAL,"$2,308.63",$0.00,"$2,308.63","$1,038.88","$1,647.67",$0.00,$397.76,$0.00,$0.00,$404.22,"$2,308.63",$0.00,"$1,154.31","$1,828.43","$1,846.90",$0.00,$361.30,$0.00,$367.53,$0.00
436430,SUP,HCPCS C1713,,436430  -  PLATE 4 HOLE BONE RIGHT DISTAL ANT LAT TIB,"$2,308.63",$0.00,"$2,308.63","$1,038.88","$1,647.67",$0.00,$397.76,$0.00,$0.00,$404.22,"$2,308.63",$0.00,"$1,154.31","$1,828.43","$1,846.90",$0.00,$361.30,$0.00,$367.53,$0.00
436432,SUP,HCPCS C1713,,436432  -  PLATE 12 HOLE BONE RIGHT DISTAL ANT LAT TIB,"$2,638.63",$0.00,"$2,638.63","$1,187.38","$1,883.19",$0.00,$454.62,$0.00,$0.00,$462.00,"$2,638.63",$0.00,"$1,319.31","$2,089.79","$2,110.90",$0.00,$412.94,$0.00,$420.07,$0.00
436434,SUP,HCPCS C1713,,436434  -  PLATE 14 HOLE BONE RIGHT DISTAL ANT LAT TIB,"$2,638.63",$0.00,"$2,638.63","$1,187.38","$1,883.19",$0.00,$454.62,$0.00,$0.00,$462.00,"$2,638.63",$0.00,"$1,319.31","$2,089.79","$2,110.90",$0.00,$412.94,$0.00,$420.07,$0.00
436436,SUP,HCPCS C1713,,436436  -  PLATE 16 HOLE BONE RIGHT DISTAL ANT LAT TIB,"$2,638.63",$0.00,"$2,638.63","$1,187.38","$1,883.19",$0.00,$454.62,$0.00,$0.00,$462.00,"$2,638.63",$0.00,"$1,319.31","$2,089.79","$2,110.90",$0.00,$412.94,$0.00,$420.07,$0.00
436504,SUP,HCPCS C1713,,436504  -  PLATE 130MM SS 5MM SCR 4 HOLE LCK AXSOS BONE LEFT DISTAL LAT,"$1,930.50",$0.00,"$1,930.50",$868.73,"$1,377.80",$0.00,$332.62,$0.00,$0.00,$338.02,"$1,930.50",$0.00,$965.25,"$1,528.96","$1,544.40",$0.00,$302.12,$0.00,$307.34,$0.00
436506,SUP,HCPCS C1713,,436506  -  PLATE 6 HOLE BONE LEFT DISTAL LAT FEM,"$1,930.50",$0.00,"$1,930.50",$868.73,"$1,377.80",$0.00,$332.62,$0.00,$0.00,$338.02,"$1,930.50",$0.00,$965.25,"$1,528.96","$1,544.40",$0.00,$302.12,$0.00,$307.34,$0.00
436508,SUP,HCPCS C1713,,436508  -  PLATE 202MM SS 8 HL SHFT LCK IMPL AXSOS BONE LEFT DISTAL LAT,"$1,930.50",$0.00,"$1,930.50",$868.73,"$1,377.80",$0.00,$332.62,$0.00,$0.00,$338.02,"$1,930.50",$0.00,$965.25,"$1,528.96","$1,544.40",$0.00,$302.12,$0.00,$307.34,$0.00
436510,SUP,HCPCS C1713,,436510  -  PLATE 238MM SS 5MM SCR 10 HOLE LCK AXSOS BONE LEFT DISTAL,"$1,930.50",$0.00,"$1,930.50",$868.73,"$1,377.80",$0.00,$332.62,$0.00,$0.00,$338.02,"$1,930.50",$0.00,$965.25,"$1,528.96","$1,544.40",$0.00,$302.12,$0.00,$307.34,$0.00
436512,SUP,HCPCS C1713,,436512  -  PLATE 274MM SS 12 HL SHFT LCK AXSOS BONE LEFT DISTAL LAT FEM,"$1,930.50",$0.00,"$1,930.50",$868.73,"$1,377.80",$0.00,$332.62,$0.00,$0.00,$338.02,"$1,930.50",$0.00,$965.25,"$1,528.96","$1,544.40",$0.00,$302.12,$0.00,$307.34,$0.00
436514,SUP,HCPCS C1713,,436514  -  PLATE 310MM SS 14 HL SHFT LCK IMPL AXSOS BONE LEFT DISTAL,"$1,930.50",$0.00,"$1,930.50",$868.73,"$1,377.80",$0.00,$332.62,$0.00,$0.00,$338.02,"$1,930.50",$0.00,$965.25,"$1,528.96","$1,544.40",$0.00,$302.12,$0.00,$307.34,$0.00
436516,SUP,HCPCS C1713,,436516  -  PLATE 343MM SS 16 HL SHFT LCK AXSOS BONE LEFT DISTAL LAT FEM,"$1,930.50",$0.00,"$1,930.50",$868.73,"$1,377.80",$0.00,$332.62,$0.00,$0.00,$338.02,"$1,930.50",$0.00,$965.25,"$1,528.96","$1,544.40",$0.00,$302.12,$0.00,$307.34,$0.00
436524,SUP,HCPCS C1713,,436524  -  PLATE 130MM SS 5MM/4.5MM/6.5MM SCR 4X5 HOLE LCK AXSOS BONE,"$1,930.50",$0.00,"$1,930.50",$868.73,"$1,377.80",$0.00,$332.62,$0.00,$0.00,$338.02,"$1,930.50",$0.00,$965.25,"$1,528.96","$1,544.40",$0.00,$302.12,$0.00,$307.34,$0.00
436526,SUP,HCPCS C1713,,436526  -  PLATE 166MM SS 5MM/4.5MM/6.5MM SCR 6X5 HOLE LCK AXSOS BONE,"$1,930.50",$0.00,"$1,930.50",$868.73,"$1,377.80",$0.00,$332.62,$0.00,$0.00,$338.02,"$1,930.50",$0.00,$965.25,"$1,528.96","$1,544.40",$0.00,$302.12,$0.00,$307.34,$0.00
436528,SUP,HCPCS C1713,,436528  -  PLATE 8 HOLE BONE RIGHT DISTAL LAT FEM,"$1,930.50",$0.00,"$1,930.50",$868.73,"$1,377.80",$0.00,$332.62,$0.00,$0.00,$338.02,"$1,930.50",$0.00,$965.25,"$1,528.96","$1,544.40",$0.00,$302.12,$0.00,$307.34,$0.00
436530,SUP,HCPCS C1713,,436530  -  PLATE SS 10 SHFT HOLE 5 LCK HOLE BONE,"$1,930.50",$0.00,"$1,930.50",$868.73,"$1,377.80",$0.00,$332.62,$0.00,$0.00,$338.02,"$1,930.50",$0.00,$965.25,"$1,528.96","$1,544.40",$0.00,$302.12,$0.00,$307.34,$0.00
436532,SUP,HCPCS C1713,,436532  -  PLATE 274MM SS 12X5 HOLE LCK AXSOS BONE RIGHT DISTAL LAT FEM,"$1,930.50",$0.00,"$1,930.50",$868.73,"$1,377.80",$0.00,$332.62,$0.00,$0.00,$338.02,"$1,930.50",$0.00,$965.25,"$1,528.96","$1,544.40",$0.00,$302.12,$0.00,$307.34,$0.00
436534,SUP,HCPCS C1713,,436534  -  PLATE 14 HOLE BONE RIGHT DISTAL LAT FEM,"$1,930.50",$0.00,"$1,930.50",$868.73,"$1,377.80",$0.00,$332.62,$0.00,$0.00,$338.02,"$1,930.50",$0.00,$965.25,"$1,528.96","$1,544.40",$0.00,$302.12,$0.00,$307.34,$0.00
436536,SUP,HCPCS C1713,,436536  -  PLATE 343MM SS 16X5 HOLE LCK AXSOS BONE RIGHT DISTAL LAT FEM,"$1,930.50",$0.00,"$1,930.50",$868.73,"$1,377.80",$0.00,$332.62,$0.00,$0.00,$338.02,"$1,930.50",$0.00,$965.25,"$1,528.96","$1,544.40",$0.00,$302.12,$0.00,$307.34,$0.00
437103,SUP,HCPCS C1713,,437103  -  PLATE BN 86MM NS AXSOS 3X7X 1 HL LCK SS HUM LT PROX 3.5/4MM,"$2,145.00",$0.00,"$2,145.00",$965.25,"$1,530.89",$0.00,$369.57,$0.00,$0.00,$375.57,"$2,145.00",$0.00,"$1,072.50","$1,698.84","$1,716.00",$0.00,$335.69,$0.00,$341.48,$0.00
437105,SUP,HCPCS C1713,,437105  -  PLATE BN 112MM NS AXSOS 5X7X 2 HL LCK SS HUM LT PROX 3.5/4MM,"$2,145.00",$0.00,"$2,145.00",$965.25,"$1,530.89",$0.00,$369.57,$0.00,$0.00,$375.57,"$2,145.00",$0.00,"$1,072.50","$1,698.84","$1,716.00",$0.00,$335.69,$0.00,$341.48,$0.00
437108,SUP,HCPCS C1713,,437108  -  PLATE 150MM 4MM SCR 8 SHFT HOLE LCK THRD BONE LEFT PROX,"$2,145.00",$0.00,"$2,145.00",$965.25,"$1,530.89",$0.00,$369.57,$0.00,$0.00,$375.57,"$2,145.00",$0.00,"$1,072.50","$1,698.84","$1,716.00",$0.00,$335.69,$0.00,$341.48,$0.00
437123,SUP,HCPCS C1713,,437123  -  PLATE BN 86MM NS AXSOS 3X7X 1 HL LCK SS HUM RT PROX 3.5/4MM,"$2,145.00",$0.00,"$2,145.00",$965.25,"$1,530.89",$0.00,$369.57,$0.00,$0.00,$375.57,"$2,145.00",$0.00,"$1,072.50","$1,698.84","$1,716.00",$0.00,$335.69,$0.00,$341.48,$0.00
437125,SUP,HCPCS C1713,,437125  -  PLATE BN 112MM NS AXSOS 5X7X 2 HL LCK SS HUM RT PROX 3.5/4MM,"$2,145.00",$0.00,"$2,145.00",$965.25,"$1,530.89",$0.00,$369.57,$0.00,$0.00,$375.57,"$2,145.00",$0.00,"$1,072.50","$1,698.84","$1,716.00",$0.00,$335.69,$0.00,$341.48,$0.00
437128,SUP,HCPCS C1713,,437128  -  PLATE BN 150MM NS AXSOS 8X7X 4 HL LCK SS HUM RT PROX 3.5/4MM,"$2,145.00",$0.00,"$2,145.00",$965.25,"$1,530.89",$0.00,$369.57,$0.00,$0.00,$375.57,"$2,145.00",$0.00,"$1,072.50","$1,698.84","$1,716.00",$0.00,$335.69,$0.00,$341.48,$0.00
437204,SUP,HCPCS C1713,,437204  -  PLATE BN 94MM NS AXSOS 4X4X 2 HL LCK SS TIB LT DIST MDL,"$2,063.88",$0.00,"$2,063.88",$928.74,"$1,472.99",$0.00,$355.60,$0.00,$0.00,$361.37,"$2,063.88",$0.00,"$1,031.94","$1,634.59","$1,651.10",$0.00,$323.00,$0.00,$328.57,$0.00
437206,SUP,HCPCS C1713,,437206  -  PLATE BN 120MM NS AXSOS 6X4X 3 HL LCK SS TIB LT DIST MDL,"$2,063.88",$0.00,"$2,063.88",$928.74,"$1,472.99",$0.00,$355.60,$0.00,$0.00,$361.37,"$2,063.88",$0.00,"$1,031.94","$1,634.59","$1,651.10",$0.00,$323.00,$0.00,$328.57,$0.00
437208,SUP,HCPCS C1713,,437208  -  PLATE BN 146MM NS AXSOS 8X4X 4 HL LCK SS TIB LT DIST MDL,"$2,063.88",$0.00,"$2,063.88",$928.74,"$1,472.99",$0.00,$355.60,$0.00,$0.00,$361.37,"$2,063.88",$0.00,"$1,031.94","$1,634.59","$1,651.10",$0.00,$323.00,$0.00,$328.57,$0.00
437210,SUP,HCPCS C1713,,437210  -  PLATE 172MM 10X4X 5 HOLE LCK THRD SHFT HOLE SYS AXSOS BONE,"$2,063.88",$0.00,"$2,063.88",$928.74,"$1,472.99",$0.00,$355.60,$0.00,$0.00,$361.37,"$2,063.88",$0.00,"$1,031.94","$1,634.59","$1,651.10",$0.00,$323.00,$0.00,$328.57,$0.00
437212,SUP,HCPCS C1713,,437212  -  PLATE 198MM 4MM SCR 12 SHFT HOLE LCK THRD BONE LEFT DISTAL,"$2,063.88",$0.00,"$2,063.88",$928.74,"$1,472.99",$0.00,$355.60,$0.00,$0.00,$361.37,"$2,063.88",$0.00,"$1,031.94","$1,634.59","$1,651.10",$0.00,$323.00,$0.00,$328.57,$0.00
437214,SUP,HCPCS C1713,,437214  -  PLATE BN 224MM NS AXSOS 14X4X 7 HL LCK SS TIB LT DIST MDL,"$2,063.88",$0.00,"$2,063.88",$928.74,"$1,472.99",$0.00,$355.60,$0.00,$0.00,$361.37,"$2,063.88",$0.00,"$1,031.94","$1,634.59","$1,651.10",$0.00,$323.00,$0.00,$328.57,$0.00
437216,SUP,HCPCS C1713,,437216  -  PLATE 16 HL SHFT BONE DISTAL MDL TIB,"$2,063.88",$0.00,"$2,063.88",$928.74,"$1,472.99",$0.00,$355.60,$0.00,$0.00,$361.37,"$2,063.88",$0.00,"$1,031.94","$1,634.59","$1,651.10",$0.00,$323.00,$0.00,$328.57,$0.00
437224,SUP,HCPCS C1713,,437224  -  PLATE BN 94MM NS AXSOS 4X4X 2 HL LCK SS TIB RT DIST MDL,"$2,063.88",$0.00,"$2,063.88",$928.74,"$1,472.99",$0.00,$355.60,$0.00,$0.00,$361.37,"$2,063.88",$0.00,"$1,031.94","$1,634.59","$1,651.10",$0.00,$323.00,$0.00,$328.57,$0.00
437226,SUP,HCPCS C1713,,437226  -  PLATE BN 120MM NS AXSOS 6X4X 3 HL LCK SS TIB RT DIST MDL,"$2,063.88",$0.00,"$2,063.88",$928.74,"$1,472.99",$0.00,$355.60,$0.00,$0.00,$361.37,"$2,063.88",$0.00,"$1,031.94","$1,634.59","$1,651.10",$0.00,$323.00,$0.00,$328.57,$0.00
437228,SUP,HCPCS C1713,,437228  -  PLATE BN 146MM NS AXSOS 8X4X 4 HL SS TIB RT DIST MDL 4/3.5MM,"$2,063.88",$0.00,"$2,063.88",$928.74,"$1,472.99",$0.00,$355.60,$0.00,$0.00,$361.37,"$2,063.88",$0.00,"$1,031.94","$1,634.59","$1,651.10",$0.00,$323.00,$0.00,$328.57,$0.00
437230,SUP,HCPCS C1713,,437230  -  PLATE BN 172MM NS AXSOS 10X4X 5 HL LCK SS TIB RT DIST MDL,"$2,063.88",$0.00,"$2,063.88",$928.74,"$1,472.99",$0.00,$355.60,$0.00,$0.00,$361.37,"$2,063.88",$0.00,"$1,031.94","$1,634.59","$1,651.10",$0.00,$323.00,$0.00,$328.57,$0.00
437232,SUP,HCPCS C1713,,437232  -  PLATE BN 198MM NS AXSOS 12X4X 6 HL LCK SS TIB RT DIST MDL,"$2,063.88",$0.00,"$2,063.88",$928.74,"$1,472.99",$0.00,$355.60,$0.00,$0.00,$361.37,"$2,063.88",$0.00,"$1,031.94","$1,634.59","$1,651.10",$0.00,$323.00,$0.00,$328.57,$0.00
437234,SUP,HCPCS C1713,,437234  -  PLATE SS 14 HOLE TOT STAB AXSOS BONE DISTAL MDL TIB,"$2,063.88",$0.00,"$2,063.88",$928.74,"$1,472.99",$0.00,$355.60,$0.00,$0.00,$361.37,"$2,063.88",$0.00,"$1,031.94","$1,634.59","$1,651.10",$0.00,$323.00,$0.00,$328.57,$0.00
437236,SUP,HCPCS C1713,,437236  -  PLATE 250MM BONE RIGHT DISTAL MDL TIB,"$2,063.88",$0.00,"$2,063.88",$928.74,"$1,472.99",$0.00,$355.60,$0.00,$0.00,$361.37,"$2,063.88",$0.00,"$1,031.94","$1,634.59","$1,651.10",$0.00,$323.00,$0.00,$328.57,$0.00
437302,SUP,HCPCS C1713,,437302  -  PLATE BN 95MM NS AXSOS 2X5X 1 HL SS TIB LT PROX LAT 3.5/4MM,"$1,874.13",$0.00,"$1,874.13",$843.36,"$1,337.56",$0.00,$322.90,$0.00,$0.00,$328.14,"$1,874.13",$0.00,$937.06,"$1,484.31","$1,499.30",$0.00,$293.30,$0.00,$298.36,$0.00
437304,SUP,HCPCS C1713,,437304  -  PLATE BN 121MM NS AXSOS 4X5X 2 HL SS TIB LT PROX LAT 3.5/4MM,"$1,874.13",$0.00,"$1,874.13",$843.36,"$1,337.56",$0.00,$322.90,$0.00,$0.00,$328.14,"$1,874.13",$0.00,$937.06,"$1,484.31","$1,499.30",$0.00,$293.30,$0.00,$298.36,$0.00
437306,SUP,HCPCS C1713,,437306  -  PLATE BN 147MM NS AXSOS 6X5X 3 HL SS TIB LT PROX LAT 3.5/4MM,"$1,874.13",$0.00,"$1,874.13",$843.36,"$1,337.56",$0.00,$322.90,$0.00,$0.00,$328.14,"$1,874.13",$0.00,$937.06,"$1,484.31","$1,499.30",$0.00,$293.30,$0.00,$298.36,$0.00
437308,SUP,HCPCS C1713,,437308  -  PLATE BN 173MM NS AXSOS 8X5X 4 HL SS TIB LT PROX LAT 3.5/4MM,"$1,874.13",$0.00,"$1,874.13",$843.36,"$1,337.56",$0.00,$322.90,$0.00,$0.00,$328.14,"$1,874.13",$0.00,$937.06,"$1,484.31","$1,499.30",$0.00,$293.30,$0.00,$298.36,$0.00
437310,SUP,HCPCS C1713,,437310  -  PLATE BN 199MM NS AXSOS 10X5X 5 HL SS TIB LT PROX LAT 3.5/4,"$1,874.13",$0.00,"$1,874.13",$843.36,"$1,337.56",$0.00,$322.90,$0.00,$0.00,$328.14,"$1,874.13",$0.00,$937.06,"$1,484.31","$1,499.30",$0.00,$293.30,$0.00,$298.36,$0.00
437312,SUP,HCPCS C1713,,437312  -  PLATE BN 225MM NS AXSOS 12X5X 6 HL SS TIB LT PROX LAT 3.5/4,"$1,874.13",$0.00,"$1,874.13",$843.36,"$1,337.56",$0.00,$322.90,$0.00,$0.00,$328.14,"$1,874.13",$0.00,$937.06,"$1,484.31","$1,499.30",$0.00,$293.30,$0.00,$298.36,$0.00
437314,SUP,HCPCS C1713,,437314  -  PLATE 251MM 4MM SCR 14 SHFT HOLE LCK THRD BONE LEFT PROX LAT,"$1,874.13",$0.00,"$1,874.13",$843.36,"$1,337.56",$0.00,$322.90,$0.00,$0.00,$328.14,"$1,874.13",$0.00,$937.06,"$1,484.31","$1,499.30",$0.00,$293.30,$0.00,$298.36,$0.00
437322,SUP,HCPCS C1713,,437322  -  PLATE BN 95MM NS AXSOS 2X5X 1 HL SS TIB RT PROX LAT 3.5/4MM,"$1,874.13",$0.00,"$1,874.13",$843.36,"$1,337.56",$0.00,$322.90,$0.00,$0.00,$328.14,"$1,874.13",$0.00,$937.06,"$1,484.31","$1,499.30",$0.00,$293.30,$0.00,$298.36,$0.00
437324,SUP,HCPCS C1713,,437324  -  PLATE BN 121MM NS AXSOS 4X5X 2 HL SS TIB RT PROX LAT 3.5/4MM,"$1,874.13",$0.00,"$1,874.13",$843.36,"$1,337.56",$0.00,$322.90,$0.00,$0.00,$328.14,"$1,874.13",$0.00,$937.06,"$1,484.31","$1,499.30",$0.00,$293.30,$0.00,$298.36,$0.00
437326,SUP,HCPCS C1713,,437326  -  PLATE BN 147MM NS AXSOS 6X5X 3 HL SS TIB RT PROX LAT 3.5/4MM,"$1,874.13",$0.00,"$1,874.13",$843.36,"$1,337.56",$0.00,$322.90,$0.00,$0.00,$328.14,"$1,874.13",$0.00,$937.06,"$1,484.31","$1,499.30",$0.00,$293.30,$0.00,$298.36,$0.00
437328,SUP,HCPCS C1713,,437328  -  PLATE BN 173MM NS AXSOS 8X5X 4 HL SS TIB RT PROX LAT 3.5/4MM,"$1,874.13",$0.00,"$1,874.13",$843.36,"$1,337.56",$0.00,$322.90,$0.00,$0.00,$328.14,"$1,874.13",$0.00,$937.06,"$1,484.31","$1,499.30",$0.00,$293.30,$0.00,$298.36,$0.00
437330,SUP,HCPCS C1713,,437330  -  PLATE BN 199MM NS AXSOS 10X5X 5 HL SS TIB RT PROX LAT 3.5/4,"$1,874.13",$0.00,"$1,874.13",$843.36,"$1,337.56",$0.00,$322.90,$0.00,$0.00,$328.14,"$1,874.13",$0.00,$937.06,"$1,484.31","$1,499.30",$0.00,$293.30,$0.00,$298.36,$0.00
437332,SUP,HCPCS C1713,,437332  -  PLATE BN 225MM NS AXSOS 12X5X 6 HL SS TIB RT PROX LAT 3.5/4,"$1,874.13",$0.00,"$1,874.13",$843.36,"$1,337.56",$0.00,$322.90,$0.00,$0.00,$328.14,"$1,874.13",$0.00,$937.06,"$1,484.31","$1,499.30",$0.00,$293.30,$0.00,$298.36,$0.00
437334,SUP,HCPCS C1713,,437334  -  PLATE 251MM 4MM SCR 14 SHFT HOLE LCK THRD BONE RIGHT PROX,"$1,874.13",$0.00,"$1,874.13",$843.36,"$1,337.56",$0.00,$322.90,$0.00,$0.00,$328.14,"$1,874.13",$0.00,$937.06,"$1,484.31","$1,499.30",$0.00,$293.30,$0.00,$298.36,$0.00
437404,SUP,HCPCS C1713,,437404  -  PLATE BN 95MM NS AXSOS 4X3X 2 HL SS TIB LT DIST ALAT 3.5/4MM,"$2,061.13",$0.00,"$2,061.13",$927.51,"$1,471.02",$0.00,$355.12,$0.00,$0.00,$360.89,"$2,061.13",$0.00,"$1,030.56","$1,632.41","$1,648.90",$0.00,$322.57,$0.00,$328.13,$0.00
437406,SUP,HCPCS C1713,,437406  -  PLATE BN 123MM NS AXSOS 6X3X 3 HL SS TIB LT DIST ALAT 3.5/4,"$2,061.13",$0.00,"$2,061.13",$927.51,"$1,471.02",$0.00,$355.12,$0.00,$0.00,$360.89,"$2,061.13",$0.00,"$1,030.56","$1,632.41","$1,648.90",$0.00,$322.57,$0.00,$328.13,$0.00
437408,SUP,HCPCS C1713,,437408  -  PLATE BN 149MM NS AXSOS 8X3X 4 HL SS TIB LT DIST ALAT 3.5/4,"$2,061.13",$0.00,"$2,061.13",$927.51,"$1,471.02",$0.00,$355.12,$0.00,$0.00,$360.89,"$2,061.13",$0.00,"$1,030.56","$1,632.41","$1,648.90",$0.00,$322.57,$0.00,$328.13,$0.00
437410,SUP,HCPCS C1713,,437410  -  PLATE BN 175MM NS AXSOS 10X3X 5 HL SS TIB LT DIST ALAT 3.5/4,"$2,061.13",$0.00,"$2,061.13",$927.51,"$1,471.02",$0.00,$355.12,$0.00,$0.00,$360.89,"$2,061.13",$0.00,"$1,030.56","$1,632.41","$1,648.90",$0.00,$322.57,$0.00,$328.13,$0.00
437412,SUP,HCPCS C1713,,437412  -  PLATE 12 HL SHFT BONE DISTAL ANTLAT TIB,"$2,356.75",$0.00,"$2,356.75","$1,060.54","$1,682.01",$0.00,$406.06,$0.00,$0.00,$412.65,"$2,356.75",$0.00,"$1,178.38","$1,866.55","$1,885.40",$0.00,$368.83,$0.00,$375.19,$0.00
437414,SUP,HCPCS C1713,,437414  -  PLATE 14 HL SHFT BONE DISTAL ANTLAT TIB,"$2,356.75",$0.00,"$2,356.75","$1,060.54","$1,682.01",$0.00,$406.06,$0.00,$0.00,$412.65,"$2,356.75",$0.00,"$1,178.38","$1,866.55","$1,885.40",$0.00,$368.83,$0.00,$375.19,$0.00
437416,SUP,HCPCS C1713,,437416  -  PLATE 16 HL SHFT BONE DISTAL ANTLAT TIB,"$2,356.75",$0.00,"$2,356.75","$1,060.54","$1,682.01",$0.00,$406.06,$0.00,$0.00,$412.65,"$2,356.75",$0.00,"$1,178.38","$1,866.55","$1,885.40",$0.00,$368.83,$0.00,$375.19,$0.00
437424,SUP,HCPCS C1713,,437424  -  PLATE BN 95MM NS AXSOS 4X3X 2 HL SS TIB RT DIST ALAT 3.5/4MM,"$2,061.13",$0.00,"$2,061.13",$927.51,"$1,471.02",$0.00,$355.12,$0.00,$0.00,$360.89,"$2,061.13",$0.00,"$1,030.56","$1,632.41","$1,648.90",$0.00,$322.57,$0.00,$328.13,$0.00
437426,SUP,HCPCS C1713,,437426  -  PLATE 123MM SS RFLX BONE RIGHT ANTLAT TIB,"$2,061.13",$0.00,"$2,061.13",$927.51,"$1,471.02",$0.00,$355.12,$0.00,$0.00,$360.89,"$2,061.13",$0.00,"$1,030.56","$1,632.41","$1,648.90",$0.00,$322.57,$0.00,$328.13,$0.00
437428,SUP,HCPCS C1713,,437428  -  PLATE BN 149MM NS AXSOS 8X3X 4 HL SS TIB RT DIST ALAT 4/3.5,"$2,061.13",$0.00,"$2,061.13",$927.51,"$1,471.02",$0.00,$355.12,$0.00,$0.00,$360.89,"$2,061.13",$0.00,"$1,030.56","$1,632.41","$1,648.90",$0.00,$322.57,$0.00,$328.13,$0.00
437430,SUP,HCPCS C1713,,437430  -  PLATE 10 HL SHFT BONE DISTAL ANTLAT TIB,"$2,061.13",$0.00,"$2,061.13",$927.51,"$1,471.02",$0.00,$355.12,$0.00,$0.00,$360.89,"$2,061.13",$0.00,"$1,030.56","$1,632.41","$1,648.90",$0.00,$322.57,$0.00,$328.13,$0.00
437432,SUP,HCPCS C1713,,437432  -  PLATE 12 HL SHFT BONE DISTAL ANTLAT TIB,"$2,356.75",$0.00,"$2,356.75","$1,060.54","$1,682.01",$0.00,$406.06,$0.00,$0.00,$412.65,"$2,356.75",$0.00,"$1,178.38","$1,866.55","$1,885.40",$0.00,$368.83,$0.00,$375.19,$0.00
437434,SUP,HCPCS C1713,,437434  -  PLATE BN 14 HL SHFT TIB RT ALAT DIST,"$2,356.75",$0.00,"$2,356.75","$1,060.54","$1,682.01",$0.00,$406.06,$0.00,$0.00,$412.65,"$2,356.75",$0.00,"$1,178.38","$1,866.55","$1,885.40",$0.00,$368.83,$0.00,$375.19,$0.00
437436,SUP,HCPCS C1713,,437436  -  PLATE 16 HL SHFT BONE DISTAL ANTLAT TIB,"$2,356.75",$0.00,"$2,356.75","$1,060.54","$1,682.01",$0.00,$406.06,$0.00,$0.00,$412.65,"$2,356.75",$0.00,"$1,178.38","$1,866.55","$1,885.40",$0.00,$368.83,$0.00,$375.19,$0.00
437504,SUP,HCPCS C1713,,437504  -  PLATE BN 130MM NS AXSOS 4X5X 2 HL SS FEM LT DIST LAT,"$2,356.75",$0.00,"$2,356.75","$1,060.54","$1,682.01",$0.00,$406.06,$0.00,$0.00,$412.65,"$2,356.75",$0.00,"$1,178.38","$1,866.55","$1,885.40",$0.00,$368.83,$0.00,$375.19,$0.00
437506,SUP,HCPCS C1713,,437506  -  PLATE BN 166MM NS AXSOS 6X5X 3 HL SS FEM LT DIST LAT,"$2,356.75",$0.00,"$2,356.75","$1,060.54","$1,682.01",$0.00,$406.06,$0.00,$0.00,$412.65,"$2,356.75",$0.00,"$1,178.38","$1,866.55","$1,885.40",$0.00,$368.83,$0.00,$375.19,$0.00
437508,SUP,HCPCS C1713,,437508  -  PLATE BN 202MM NS AXSOS 8X5X 4 HL SS FEM LT DIST LAT,"$2,356.75",$0.00,"$2,356.75","$1,060.54","$1,682.01",$0.00,$406.06,$0.00,$0.00,$412.65,"$2,356.75",$0.00,"$1,178.38","$1,866.55","$1,885.40",$0.00,$368.83,$0.00,$375.19,$0.00
437510,SUP,HCPCS C1713,,437510  -  PLATE BN 238MM NS AXSOS 10X5X 5 HL SS FEM LT DIST LAT,"$2,356.75",$0.00,"$2,356.75","$1,060.54","$1,682.01",$0.00,$406.06,$0.00,$0.00,$412.65,"$2,356.75",$0.00,"$1,178.38","$1,866.55","$1,885.40",$0.00,$368.83,$0.00,$375.19,$0.00
437512,SUP,HCPCS C1713,,437512  -  PLATE 12 HL SHFT BONE DISTAL LAT FEM,"$2,356.75",$0.00,"$2,356.75","$1,060.54","$1,682.01",$0.00,$406.06,$0.00,$0.00,$412.65,"$2,356.75",$0.00,"$1,178.38","$1,866.55","$1,885.40",$0.00,$368.83,$0.00,$375.19,$0.00
437514,SUP,HCPCS C1713,,437514  -  PLATE BN 310MM NS AXSOS 10X5X 7 HL SS FEM LT DIST LAT,"$2,356.75",$0.00,"$2,356.75","$1,060.54","$1,682.01",$0.00,$406.06,$0.00,$0.00,$412.65,"$2,356.75",$0.00,"$1,178.38","$1,866.55","$1,885.40",$0.00,$368.83,$0.00,$375.19,$0.00
437516,SUP,HCPCS C1713,,437516  -  PLATE BN 343MM NS AXSOS 16X5X 8 HL SS FEM LT DIST LAT,"$2,356.75",$0.00,"$2,356.75","$1,060.54","$1,682.01",$0.00,$406.06,$0.00,$0.00,$412.65,"$2,356.75",$0.00,"$1,178.38","$1,866.55","$1,885.40",$0.00,$368.83,$0.00,$375.19,$0.00
437524,SUP,HCPCS C1713,,437524  -  PLATE BN 130MM NS AXSOS 4X5X 2 HL SS FEM RT DIST LAT,"$2,356.75",$0.00,"$2,356.75","$1,060.54","$1,682.01",$0.00,$406.06,$0.00,$0.00,$412.65,"$2,356.75",$0.00,"$1,178.38","$1,866.55","$1,885.40",$0.00,$368.83,$0.00,$375.19,$0.00
437526,SUP,HCPCS C1713,,437526  -  PLATE BN 166MM NS AXSOS 6X5X 3 HL SS FEM RT DIST LAT,"$2,356.75",$0.00,"$2,356.75","$1,060.54","$1,682.01",$0.00,$406.06,$0.00,$0.00,$412.65,"$2,356.75",$0.00,"$1,178.38","$1,866.55","$1,885.40",$0.00,$368.83,$0.00,$375.19,$0.00
437528,SUP,HCPCS C1713,,437528  -  PLATE BN 202MM NS AXSOS 8X5X 4 HL SS FEM RT DIST LAT,"$2,356.75",$0.00,"$2,356.75","$1,060.54","$1,682.01",$0.00,$406.06,$0.00,$0.00,$412.65,"$2,356.75",$0.00,"$1,178.38","$1,866.55","$1,885.40",$0.00,$368.83,$0.00,$375.19,$0.00
437530,SUP,HCPCS C1713,,437530  -  PLATE BN 238MM NS AXSOS 10X5X 5 HL SS FEM RT DIST LAT,"$2,356.75",$0.00,"$2,356.75","$1,060.54","$1,682.01",$0.00,$406.06,$0.00,$0.00,$412.65,"$2,356.75",$0.00,"$1,178.38","$1,866.55","$1,885.40",$0.00,$368.83,$0.00,$375.19,$0.00
437532,SUP,HCPCS C1713,,437532  -  PLATE BN 274MM NS AXSOS 12X5X 6 HL SS FEM RT DIST LAT,"$2,356.75",$0.00,"$2,356.75","$1,060.54","$1,682.01",$0.00,$406.06,$0.00,$0.00,$412.65,"$2,356.75",$0.00,"$1,178.38","$1,866.55","$1,885.40",$0.00,$368.83,$0.00,$375.19,$0.00
437534,SUP,HCPCS C1713,,437534  -  PLATE 310MM 14 HL SHFT BONE RIGHT DISTAL LAT PERIART FEM,"$2,356.75",$0.00,"$2,356.75","$1,060.54","$1,682.01",$0.00,$406.06,$0.00,$0.00,$412.65,"$2,356.75",$0.00,"$1,178.38","$1,866.55","$1,885.40",$0.00,$368.83,$0.00,$375.19,$0.00
437536,SUP,HCPCS C1713,,437536  -  PLATE BN 343MM NS AXSOS 16X5X 8 HL SS FEM RT DIST LAT,"$2,356.75",$0.00,"$2,356.75","$1,060.54","$1,682.01",$0.00,$406.06,$0.00,$0.00,$412.65,"$2,356.75",$0.00,"$1,178.38","$1,866.55","$1,885.40",$0.00,$368.83,$0.00,$375.19,$0.00
439678,SUP,HCPCS C1900,,439678  -  LEAD PACING STR 4FR 78CM 2 ELECTRODE TINES IS-1 ATTAIN,"$3,562.50",$0.00,"$3,562.50",$0.00,"$2,542.56",$0.00,$613.80,$0.00,$0.00,$0.00,"$3,562.50",$0.00,"$1,781.25","$2,821.50","$2,850.00",$0.00,$557.53,$0.00,$0.00,$0.00
439688,SUP,HCPCS C1900,,439688  -  LEAD PACING STR 4FR 88CM 2 ELECTRODE TINES IS-1 ATTAIN,"$3,562.50",$0.00,"$3,562.50",$0.00,"$2,542.56",$0.00,$613.80,$0.00,$0.00,$0.00,"$3,562.50",$0.00,"$1,781.25","$2,821.50","$2,850.00",$0.00,$557.53,$0.00,$0.00,$0.00
440400,SUP,Custom 27203010,,440400  -  DRESSING NSL THK1.5CM STD 4.5CM WHT STRL LF MRCL TMPN SPT,$237.50,$0.00,$237.50,$0.00,$169.50,$0.00,$0.00,$0.00,$0.00,$0.00,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$0.00,$0.00,$0.00,$0.00
446400,SUP,Custom 27203010,,REAGENT IGG IMMAGE 300 TST ANALY,"$1,608.75",$0.00,"$1,608.75",$0.00,"$1,148.16",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,608.75",$0.00,$804.38,"$1,274.13","$1,287.00",$0.00,$0.00,$0.00,$0.00,$0.00
447060,SUP,Custom 27203010,,REAGENT WSH SOL IMMAGE 10L ANALY,$318.75,$0.00,$318.75,$0.00,$227.49,$0.00,$0.00,$0.00,$0.00,$0.00,$318.75,$0.00,$159.38,$252.45,$255.00,$0.00,$0.00,$0.00,$0.00,$0.00
447600,SUP,Custom 27203010,,REAGENT ALBM IMMAGE 150 TST ANALY,$811.25,$0.00,$811.25,$0.00,$578.99,$0.00,$0.00,$0.00,$0.00,$0.00,$811.25,$0.00,$405.63,$642.51,$649.00,$0.00,$0.00,$0.00,$0.00,$0.00
447640,SUP,Custom 27203010,,REAGENT DILU 1 IMMAGE 120ML ANALY,$328.13,$0.00,$328.13,$0.00,$234.18,$0.00,$0.00,$0.00,$0.00,$0.00,$328.13,$0.00,$164.06,$259.88,$262.50,$0.00,$0.00,$0.00,$0.00,$0.00
447650,SUP,Custom 27203010,,REAGENT BUFF 1 IMMAGE 120ML ANALY,$328.13,$0.00,$328.13,$0.00,$234.18,$0.00,$0.00,$0.00,$0.00,$0.00,$328.13,$0.00,$164.06,$259.88,$262.50,$0.00,$0.00,$0.00,$0.00,$0.00
449560,SUP,Custom 27203010,,CALIBRATOR ARY CHM SYS IMMUN,$806.25,$0.00,$806.25,$0.00,$575.42,$0.00,$0.00,$0.00,$0.00,$0.00,$806.25,$0.00,$403.13,$638.55,$645.00,$0.00,$0.00,$0.00,$0.00,$0.00
449730,SUP,Custom 27203010,,CALIBRATOR TRNFRN IMMAGE ARY LVL 3 3ML 360 SER IMMUN,$534.38,$0.00,$534.38,$0.00,$381.38,$0.00,$0.00,$0.00,$0.00,$0.00,$534.38,$0.00,$267.19,$423.23,$427.50,$0.00,$0.00,$0.00,$0.00,$0.00
453547,SUP,HCPCS C1751,,453547  -  CATHETER IV 26GA .75IN STRL LF ABCTH-T ISO CLR CD TFLN,$8.68,$0.00,$8.68,$3.90,$6.19,$0.00,$1.49,$0.00,$0.00,$1.52,$8.68,$0.00,$4.34,$6.87,$6.94,$0.00,$1.36,$0.00,$1.38,$0.00
465990,SUP,Custom 27203010,,CONTROL NH3 ALC SYN LVL 1 4ML CX7/LX SER TOX,$107.50,$0.00,$107.50,$0.00,$76.72,$0.00,$0.00,$0.00,$0.00,$0.00,$107.50,$0.00,$53.75,$85.14,$86.00,$0.00,$0.00,$0.00,$0.00,$0.00
465993,SUP,Custom 27203010,,CONTROL NH3 ALC SYN LVL 2 4ML CX7/LX SER TOX,$107.50,$0.00,$107.50,$0.00,$76.72,$0.00,$0.00,$0.00,$0.00,$0.00,$107.50,$0.00,$53.75,$85.14,$86.00,$0.00,$0.00,$0.00,$0.00,$0.00
465996,SUP,Custom 27203010,,CONTROL NH3 ALC SYN LVL 3 4ML CX7/LX SER TOX,$430.00,$0.00,$430.00,$0.00,$306.89,$0.00,$0.00,$0.00,$0.00,$0.00,$430.00,$0.00,$215.00,$340.56,$344.00,$0.00,$0.00,$0.00,$0.00,$0.00
472620,SUP,CPT® Q4128,,472620  -  GRAFT SKIN THK1.8+ MM ULTRATHICK 20X16CM ALLOGRAFT HYDRATE,"$21,021.00",$0.00,"$21,021.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,021.00",$0.00,"$10,510.50","$16,648.63","$16,816.80",$0.00,$0.00,$0.00,$0.00,$0.00
Jan-00,SUP,Custom 27803010,,01-3200  -  HEAD FEMORAL +0MM 32MM MORSE TAPER LFIT COCR HIP,"$1,795.00",$0.00,"$1,795.00",$0.00,"$1,281.09",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,795.00",$0.00,$897.50,"$1,421.64","$1,436.00",$0.00,$0.00,$0.00,$0.00,$0.00
Jun-00,SUP,Custom 27803010,,06-3200  -  HEAD FEMORAL 0 32MM C TAPER LFIT COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
474976,SUP,Custom 27203010,,CONTROL MUL-DRUG SYN LOW 10ML CX/LX SER TOX,$280.00,$0.00,$280.00,$0.00,$199.84,$0.00,$0.00,$0.00,$0.00,$0.00,$280.00,$0.00,$140.00,$221.76,$224.00,$0.00,$0.00,$0.00,$0.00,$0.00
Jan-05,SUP,Custom 27803010,,01-3205  -  HEAD FEMORAL +5MM MORSE TAPER 32MM LFIT COCR HIP,"$1,795.00",$0.00,"$1,795.00",$0.00,"$1,281.09",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,795.00",$0.00,$897.50,"$1,421.64","$1,436.00",$0.00,$0.00,$0.00,$0.00,$0.00
Jan-06,SUP,HCPCS C1713,,1-3206  -  SPACER SPNL 6MM X-STP PEEK LMBR INTERSPINOUS PRC DCMPRS,"$8,407.50",$0.00,"$8,407.50","$3,783.38","$5,158.80",$0.00,"$1,448.57",$0.00,$0.00,"$1,472.09","$8,407.50",$0.00,"$4,203.75","$6,658.74","$6,726.00",$0.00,"$1,315.77",$0.00,"$1,338.47",$0.00
Jan-08,SUP,HCPCS C1713,,1-3208  -  SPACER SPNL 8MM X-STP PEEK LMBR INTERSPINOUS PRC DCMPRS,"$8,407.50",$0.00,"$8,407.50","$3,783.38","$5,158.80",$0.00,"$1,448.57",$0.00,$0.00,"$1,472.09","$8,407.50",$0.00,"$4,203.75","$6,658.74","$6,726.00",$0.00,"$1,315.77",$0.00,"$1,338.47",$0.00
Jan-10,SUP,Custom 27803010,,01-3210  -  HEAD FEMORAL 10MM MORSE TAPER 32MM MORSE TAPER LFIT HIP,"$1,795.00",$0.00,"$1,795.00",$0.00,"$1,281.09",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,795.00",$0.00,$897.50,"$1,421.64","$1,436.00",$0.00,$0.00,$0.00,$0.00,$0.00
Jan-10,SUP,HCPCS C1713,,1-3210  -  SPACER SPNL 10MM X-STP PEEK LMBR INTERSPINOUS PRC DCMPRS,"$8,407.50",$0.00,"$6,658.74",$0.00,"$1,281.09",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,795.00",$0.00,$897.50,"$6,658.74","$1,436.00",$0.00,$0.00,$0.00,$0.00,$0.00
Jun-10,SUP,Custom 27803010,,06-3210  -  HEAD FEM +10MM OFST CTPR 32MM STRL LFIT COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
Jan-12,SUP,HCPCS C1713,,1-3212  -  SPACER SPNL 12MM X-STP PEEK LMBR INTERSPINOUS PRC DCMPRS,"$8,407.50",$0.00,"$8,407.50","$3,783.38","$5,158.80",$0.00,"$1,448.57",$0.00,$0.00,"$1,472.09","$8,407.50",$0.00,"$4,203.75","$6,658.74","$6,726.00",$0.00,"$1,315.77",$0.00,"$1,338.47",$0.00
Jan-14,SUP,HCPCS C1713,,1-3214  -  SPACER SPNL 14MM X-STP PEEK LMBR INTERSPINOUS PRC DCMPRS,"$8,407.50",$0.00,"$8,407.50","$3,783.38","$5,158.80",$0.00,"$1,448.57",$0.00,$0.00,"$1,472.09","$8,407.50",$0.00,"$4,203.75","$6,658.74","$6,726.00",$0.00,"$1,315.77",$0.00,"$1,338.47",$0.00
Jan-16,SUP,HCPCS C1713,,1-3216  -  SPACER SPNL 16MM X-STP PEEK LMBR INTERSPINOUS PRC DCMPRS,"$8,407.50",$0.00,"$8,407.50","$3,783.38","$5,158.80",$0.00,"$1,448.57",$0.00,$0.00,"$1,472.09","$8,407.50",$0.00,"$4,203.75","$6,658.74","$6,726.00",$0.00,"$1,315.77",$0.00,"$1,338.47",$0.00
482047,SUP,HCPCS C1763,,482047  -  IMPL URO PLVCL BCMPT VERSATILITY DRBLTY STRTH ACLR CLGN MTRX,"$1,125.00",$0.00,"$1,125.00",$506.25,$802.91,$0.00,$193.83,$0.00,$0.00,$196.98,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$176.06,$0.00,$179.10,$0.00
502452,SUP,HCPCS C1769,,502452  -  GUIDEWIRE VASC 3MM RDS J .025IN 260CM STRL LF 7CM CRDS EMRLD,$22.58,$0.00,$22.58,$12.26,$16.11,$0.00,$3.89,$0.00,$0.00,$3.95,$22.58,$0.00,$11.29,$17.88,$18.06,$0.00,$3.53,$0.00,$3.59,$0.00
502455,SUP,HCPCS C1769,,502455  -  GUIDEWIRE VASC 3MM RDS J .035IN 260CM STRL LF 7CM CRDS EMRLD,$22.58,$0.00,$22.58,$12.26,$16.11,$0.00,$3.89,$0.00,$0.00,$3.95,$22.58,$0.00,$11.29,$17.88,$18.06,$0.00,$3.53,$0.00,$3.59,$0.00
502521,SUP,HCPCS C1769,,502521  -  GUIDEWIRE VASC 3MM RDS J .035IN 150CM STRL LF 7CM CRDS EMRLD,$14.45,$0.00,$14.45,$7.85,$10.31,$0.00,$2.49,$0.00,$0.00,$2.53,$14.45,$0.00,$7.23,$11.44,$11.56,$0.00,$2.26,$0.00,$2.30,$0.00
502542,SUP,HCPCS C1769,,502542  -  GUIDEWIRE VASC STRG .035IN 150CM STRL LF 7CM CRDS EMRLD FLXB,$14.45,$0.00,$14.45,$7.85,$10.31,$0.00,$2.49,$0.00,$0.00,$2.53,$14.45,$0.00,$7.23,$11.44,$11.56,$0.00,$2.26,$0.00,$2.30,$0.00
509748,SUP,Custom 27203010,,DRUG ANBTC VITEK2 ETST DXYCL DC 256 B100,$690.00,$0.00,$690.00,$0.00,$492.45,$0.00,$0.00,$0.00,$0.00,$0.00,$690.00,$0.00,$345.00,$546.48,$552.00,$0.00,$0.00,$0.00,$0.00,$0.00
510422,SUP,HCPCS A4351,,510422  -  CATHETER URETHRAL 22FR 16IN 2 STAGGERED EYE RADIOPQ LATEX,$10.58,$0.00,$10.58,$0.00,$7.55,$0.00,$0.00,$0.00,$0.00,$0.00,$10.58,$0.00,$5.29,$8.38,$8.46,$0.00,$0.00,$0.00,$0.00,$0.00
510426,SUP,HCPCS C1729,,510426  -  CATHETER URTH RBNSN 26FR RBR STRL LTX RD,$203.45,$0.00,$203.45,$110.47,$145.20,$0.00,$35.05,$0.00,$0.00,$35.62,$203.45,$0.00,$101.73,$161.13,$162.76,$0.00,$31.84,$0.00,$32.39,$0.00
510428,SUP,HCPCS C1758,,510428  -  CATHETER URTH 28FR 16IN RD STRL LTX 2 STGR EYE RADOPQ RBR,$10.58,$0.00,$10.58,$5.74,$7.55,$0.00,$1.82,$0.00,$0.00,$1.85,$10.58,$0.00,$5.29,$8.38,$8.46,$0.00,$1.65,$0.00,$1.68,$0.00
Jan-99,SUP,Custom 27803010,,01-3299  -  HEAD FEMORAL -5MM 32MM MORSE TAPER LFIT COCR HIP,"$1,795.00",$0.00,"$1,795.00",$0.00,"$1,281.09",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,795.00",$0.00,$897.50,"$1,421.64","$1,436.00",$0.00,$0.00,$0.00,$0.00,$0.00
Jun-99,SUP,Custom 27203010,,06-3299  -  HEAD FEM -5MM OFST CTPR 32MM STRL LFIT COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
511212,SUP,HCPCS C1898,,"511212  -  IS-1, SILICONE, 54CM, V PLACEMENT","$1,125.00",$0.00,"$1,125.00",$506.25,$802.91,$0.00,$193.83,$0.00,$0.00,$196.98,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$176.06,$0.00,$179.10,$0.00
513658,SUP,Custom 27203010,,STRIP IMPNM .002-32 MCG SNS,$690.00,$0.00,$690.00,$0.00,$492.45,$0.00,$0.00,$0.00,$0.00,$0.00,$690.00,$0.00,$345.00,$546.48,$552.00,$0.00,$0.00,$0.00,$0.00,$0.00
516001,SUP,HCPCS Q4130,,0516001  -  MATRIX TISSUE 16X5CM RECONSTRUCTIVE STRATTICE PIG DERMIS,"$24,997.50",$0.00,"$24,997.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$24,997.50",$0.00,"$12,498.75","$19,798.02","$19,998.00",$0.00,$0.00,$0.00,$0.00,$0.00
520368,SUP,HCPCS C1713,,520368  -  SCREW BN 2MM CMPR HEX SCKT,$38.40,$0.00,$38.40,$17.28,$27.41,$0.00,$6.62,$0.00,$0.00,$6.72,$38.40,$0.00,$19.20,$30.41,$30.72,$0.00,$6.01,$0.00,$6.11,$0.00
522022,SUP,HCPCS C1776,,522022  -  HEAD FEM +0MM 11/13 TPR 22MM STRL SR COCR HIP MDLR SYS,"$3,187.50",$0.00,"$3,187.50","$1,434.38","$2,274.92",$0.00,$549.19,$0.00,$0.00,$558.11,"$3,187.50",$0.00,"$1,593.75","$2,524.50","$2,550.00",$0.00,$498.84,$0.00,$507.45,$0.00
525558,SUP,Custom 27203010,,STRIP VNCMCN ETST SNS,$690.00,$0.00,$690.00,$0.00,$492.45,$0.00,$0.00,$0.00,$0.00,$0.00,$690.00,$0.00,$345.00,$546.48,$552.00,$0.00,$0.00,$0.00,$0.00,$0.00
528341,SUP,Custom 27203010,,528341  -  PILLING SURGILUX H/L VAR. 10-75 MM,"$2,400.00",$0.00,"$2,400.00",$0.00,"$1,712.88",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,400.00",$0.00,"$1,200.00","$1,900.80","$1,920.00",$0.00,$0.00,$0.00,$0.00,$0.00
531658,SUP,Custom 27203010,,DISK ERTAPENEM SNS,$690.00,$0.00,$690.00,$0.00,$492.45,$0.00,$0.00,$0.00,$0.00,$0.00,$690.00,$0.00,$345.00,$546.48,$552.00,$0.00,$0.00,$0.00,$0.00,$0.00
532644,SUP,HCPCS C1725,,532644  -  CATHETER ANGIO MP A2 CRV 6FR 125CM ST BRD ATRM SLCT 2 SH PU,$21.13,$0.00,$21.13,$11.47,$15.08,$0.00,$3.64,$0.00,$0.00,$3.70,$21.13,$0.00,$10.56,$16.73,$16.90,$0.00,$3.31,$0.00,$3.36,$0.00
533448,SUP,Custom 27203010,,STRIP PLMXN ETST SNS,$785.00,$0.00,$785.00,$0.00,$560.25,$0.00,$0.00,$0.00,$0.00,$0.00,$785.00,$0.00,$392.50,$621.72,$628.00,$0.00,$0.00,$0.00,$0.00,$0.00
533558,SUP,Custom 27203010,,STRIP TIGECYCLINE 256 MCG ETST VK2 SNS F100,$690.00,$0.00,$690.00,$0.00,$492.45,$0.00,$0.00,$0.00,$0.00,$0.00,$690.00,$0.00,$345.00,$546.48,$552.00,$0.00,$0.00,$0.00,$0.00,$0.00
535058,SUP,Custom 27203010,,STRIP DAPTOMYCIN .016-256 MCG ETST SNS,$690.00,$0.00,$690.00,$0.00,$492.45,$0.00,$0.00,$0.00,$0.00,$0.00,$690.00,$0.00,$345.00,$546.48,$552.00,$0.00,$0.00,$0.00,$0.00,$0.00
535070,SUP,Custom 27203010,,535070  -  KIT TRACHEOSTOMY 9.6MM 7MM 82MM 2 DECK TRAY DILAT OBTURATOR,$627.63,$0.00,$627.63,$0.00,$447.94,$0.00,$0.00,$0.00,$0.00,$0.00,$627.63,$0.00,$313.81,$497.08,$502.10,$0.00,$0.00,$0.00,$0.00,$0.00
535080,SUP,Custom 27203010,,535080  -  KIT TRCH 10.9MM 8MM 86MM STRL LTX PRFT PRTX 2 DECK TRY DIL,$627.63,$0.00,$627.63,$0.00,$447.94,$0.00,$0.00,$0.00,$0.00,$0.00,$627.63,$0.00,$313.81,$497.08,$502.10,$0.00,$0.00,$0.00,$0.00,$0.00
535090,SUP,Custom 27203010,,535090  -  KIT TRACHEOSTOMY 12.3MM 9MM COMPLETE SET INNER CANNU,$627.63,$0.00,$627.63,$0.00,$447.94,$0.00,$0.00,$0.00,$0.00,$0.00,$627.63,$0.00,$313.81,$497.08,$502.10,$0.00,$0.00,$0.00,$0.00,$0.00
540015,SUP,Custom 27203010,,540015  -  DRILL SURG MICRO CORE,"$13,025.75",$0.00,"$13,025.75",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,025.75",$0.00,"$6,512.88","$10,316.39","$10,420.60",$0.00,$0.00,$0.00,$0.00,$0.00
544230,SUP,Custom 27803010,,544230  -  CLIP INTNL MED LG CHEVRON HRT GRN STRL LF WECK HEM-O-LOK LGT,$86.61,$0.00,$86.61,$0.00,$61.81,$0.00,$0.00,$0.00,$0.00,$0.00,$86.61,$0.00,$43.30,$68.60,$69.29,$0.00,$0.00,$0.00,$0.00,$0.00
544240,SUP,Custom 27803010,,544240  -  CLIP INTERNAL LARGE LIGATE CARTRIDGE LATEX FREE WECK,$86.61,$0.00,$86.61,$0.00,$61.81,$0.00,$0.00,$0.00,$0.00,$0.00,$86.61,$0.00,$43.30,$68.60,$69.29,$0.00,$0.00,$0.00,$0.00,$0.00
544250,SUP,Custom 27803010,,544250  -  CLIP XL INTNL HEM-O-LOK PLMR LAPSCOP STRL DISP LATEX FREE,$81.75,$0.00,$81.75,$0.00,$58.34,$0.00,$0.00,$0.00,$0.00,$0.00,$81.75,$0.00,$40.88,$64.75,$65.40,$0.00,$0.00,$0.00,$0.00,$0.00
570624,SUP,HCPCS C1729,,570624  -  CATH URTH SMPLS 24FR 16IN FOLEY 3W CVLR TIP 30ML STRL LATEX,$84.50,$0.00,$84.50,$45.88,$60.31,$0.00,$14.56,$0.00,$0.00,$14.80,$84.50,$0.00,$42.25,$66.92,$67.60,$0.00,$13.22,$0.00,$13.45,$0.00
573030,SUP,HCPCS C1725,,573030  -  CATH BALDILAT .014IN 3MM 145CM 10MM OTW NC DRLN NC RPTR,$597.55,$0.00,$597.55,$324.47,$426.47,$0.00,$102.95,$0.00,$0.00,$104.63,$597.55,$0.00,$298.78,$473.26,$478.04,$0.00,$93.52,$0.00,$95.13,$0.00
585040,SUP,Custom 27203010,,585040  -  CANNULA OPHTHALMIC 40D 1.1MM 25MM 8MM SMOOTH TIP AIR INJEC,$193.03,$0.00,$193.03,$0.00,$137.76,$0.00,$0.00,$0.00,$0.00,$0.00,$193.03,$0.00,$96.51,$152.88,$154.42,$0.00,$0.00,$0.00,$0.00,$0.00
585047,SUP,Custom 27203010,,585047  -  CANNULA IRR 23GA .8IN .4IN .3MM STRL LF SMC ASP PORT THNWL,$135.00,$0.00,$135.00,$0.00,$96.35,$0.00,$0.00,$0.00,$0.00,$0.00,$135.00,$0.00,$67.50,$106.92,$108.00,$0.00,$0.00,$0.00,$0.00,$0.00
585119,SUP,Custom 27203010,,585119  -  CANNULA OPHTHALMIC 45D ULTRATHIN WALL BEVEL 20GA 4MM INFUS,$256.00,$0.00,$256.00,$0.00,$182.71,$0.00,$0.00,$0.00,$0.00,$0.00,$256.00,$0.00,$128.00,$202.75,$204.80,$0.00,$0.00,$0.00,$0.00,$0.00
585233,SUP,Custom 27203010,,585233  -  UNIT IRRIGATION 14MM SQUEEGEE LASIK FLAP ROLLER SLEEVE BD,$59.80,$0.00,$59.80,$0.00,$42.68,$0.00,$0.00,$0.00,$0.00,$0.00,$59.80,$0.00,$29.90,$47.36,$47.84,$0.00,$0.00,$0.00,$0.00,$0.00
600040,SUP,HCPCS C1751,,0600040  -  CATHETER CV 2 BRCH 2.7FR .9MM .5MM 71CM STRL LTX BRVC 1 LUM,$195.50,$0.00,$169.81,$0.00,$121.19,$0.00,$0.00,$0.00,$0.00,$0.00,$169.81,$0.00,$84.91,$154.84,$135.85,$0.00,$0.00,$0.00,$0.00,$0.00
600125,SUP,Custom 27203010,,0600125  -  APPLICATOR ENDSCP FLSL BXTR NRFL COMP CANNU COMP,$166.33,$0.00,$166.33,$0.00,$118.71,$0.00,$0.00,$0.00,$0.00,$0.00,$166.33,$0.00,$83.17,$131.73,$133.07,$0.00,$0.00,$0.00,$0.00,$0.00
600160,SUP,HCPCS C1751,,0600160  -  CATHETER 9FR SINGLE LUMEN HICKMAN,$61.35,$0.00,$61.35,$33.31,$43.79,$0.00,$10.57,$0.00,$0.00,$10.74,$61.35,$0.00,$30.68,$48.59,$49.08,$0.00,$9.60,$0.00,$9.77,$0.00
600544,SUP,HCPCS C1751,,0600544  -  KIT CATH 6.6FR 57CM STRL LF BRVC 1 LUM LOPRFL ADPR SIL PED,$371.13,$0.00,$293.93,$0.00,$13.29,$0.00,$0.00,$0.00,$0.00,$0.00,$18.62,$0.00,$9.31,$293.93,$14.90,$0.00,$0.00,$0.00,$0.00,$0.00
600560,SUP,HCPCS C1751,,0600560  -  CATHETER CEN VEN 9.6FR 3.2MM 1.6MM 90CM 1 LUMEN TISSUE,$395.00,$0.00,$312.84,$23.40,$37.11,$0.00,$1.05,$0.00,$0.00,$3.91,$52.00,$0.00,$26.00,$312.84,$41.60,$0.00,$3.91,$0.00,$3.73,$0.00
600600,SUP,HCPCS C1751,,0600600  -  KIT CATH 9FR 54CM STRL LF HKMN PEEL-APART 2 LUM LOPRFL ADPR,$355.00,$0.00,$355.00,$192.77,$253.36,$0.00,$61.16,$0.00,$0.00,$62.16,$355.00,$0.00,$177.50,$281.16,$284.00,$0.00,$55.56,$0.00,$56.52,$0.00
601600,SUP,HCPCS C1751,,0601600  -  KIT CATH REPR 2.7FR .9MM .5MM 71CM .15ML WHT STRL LTX BRVC 1,$375.00,$0.00,$375.00,$203.63,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
601610,SUP,HCPCS C1751,,0601610  -  KIT CATH REPR 4.2FR 1.4MM .7MM 71CM .3ML WHT STRL LF BRVC 1,$375.00,$0.00,$375.00,$203.63,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
601648,SUP,HCPCS C1713,,601648  -  SCREW BONE PTHRD 5MM 48MM CANN LP HEAD REVERSE CUTTING FLUTE,$510.23,$0.00,$510.23,$229.60,$364.15,$0.00,$87.91,$0.00,$0.00,$89.34,$510.23,$0.00,$255.11,$404.10,$408.18,$0.00,$79.85,$0.00,$81.23,$0.00
602230,SUP,HCPCS C1788,,0602230  -  PORT IMPLTABLE INFUS SBQ TI 9.6FR 1 LUM ATCH CATH PLAPRT,"$2,108.70",$0.00,"$2,108.70",$948.92,"$1,504.98",$0.00,$363.32,$0.00,$0.00,$369.22,"$2,108.70",$0.00,"$1,054.35","$1,670.09","$1,686.96",$0.00,$330.01,$0.00,$335.71,$0.00
602645,SUP,HCPCS C1713,,602645  -  SCREW BN 6.5MM 45MM STRL 20MM ASNS III ST SLFDRL CNN TI ORTH,$391.88,$0.00,$391.88,$176.34,$279.68,$0.00,$67.52,$0.00,$0.00,$68.61,$391.88,$0.00,$195.94,$310.37,$313.50,$0.00,$61.33,$0.00,$62.39,$0.00
602650,SUP,HCPCS C1713,,602650  -  SCREW BN 6.5MM 50MM STRL 20MM ASNS III ST SLF DRL CNN TI HIP,$391.88,$0.00,$391.88,$176.34,$279.68,$0.00,$67.52,$0.00,$0.00,$68.61,$391.88,$0.00,$195.94,$310.37,$313.50,$0.00,$61.33,$0.00,$62.39,$0.00
602660,SUP,HCPCS C1713,,602660  -  SCREW BN 6.5MM 60MM STRL 20MM ASNS III SLF DRL ST CNN TI LNG,$391.88,$0.00,$391.88,$176.34,$279.68,$0.00,$67.52,$0.00,$0.00,$68.61,$391.88,$0.00,$195.94,$310.37,$313.50,$0.00,$61.33,$0.00,$62.39,$0.00
602885,SUP,HCPCS C1713,,602885  -  SCREW BN LOPRFL REVCT FLUT 6.5MM 85MM NS 40MM ASNS III CNN,$391.88,$0.00,$391.88,$176.34,$279.68,$0.00,$67.52,$0.00,$0.00,$68.61,$391.88,$0.00,$195.94,$310.37,$313.50,$0.00,$61.33,$0.00,$62.39,$0.00
603020,SUP,HCPCS Q4116,,603020  -  MATRIX TISSUE INJECTABLE CYMETRA MAT ACELLULAR DERMIS 2ML,$373.75,$0.00,$373.75,$168.19,$266.75,$0.00,$64.40,$0.00,$0.00,$65.44,$373.75,$0.00,$186.88,$296.01,$299.00,$0.00,$58.49,$0.00,$59.50,$0.00
606008,SUP,HCPCS Q4130,,0606008  -  MESH SURG 6X6MM STMA TISS HERN PTCH,"$2,512.50",$0.00,"$2,512.50",$0.00,"$1,793.17",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,512.50",$0.00,"$1,256.25","$1,989.90","$2,010.00",$0.00,$0.00,$0.00,$0.00,$0.00
606096,SUP,Custom 27203010,,KIT IMMUN TST PRMR POS NEG CNTRL H PYLR IGG 96 TST,"$1,619.25",$0.00,"$1,619.25",$0.00,"$1,155.66",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,619.25",$0.00,$809.63,"$1,282.45","$1,295.40",$0.00,$0.00,$0.00,$0.00,$0.00
606560,SUP,HCPCS C1751,,0606560  -  KIT CATH 10FR 59CM STRL LF HKMN 3 LUM LOPRFL ADPR PLAPRT,$455.05,$0.00,$455.05,$247.09,$324.77,$0.00,$78.40,$0.00,$0.00,$79.68,$455.05,$0.00,$227.53,$360.40,$364.04,$0.00,$71.22,$0.00,$72.44,$0.00
608001,SUP,HCPCS Q4130,,0608001  -  MATRIX TISS 8X6CM STRL STRATTICE RECON PRCN DERM,"$4,270.00",$0.00,"$4,270.00",$0.00,"$3,047.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,270.00",$0.00,"$2,135.00","$3,381.84","$3,416.00",$0.00,$0.00,$0.00,$0.00,$0.00
609002,SUP,Custom 27803010,,609002  -  TISSUE 609002 2MM FACET SHIM,"$1,375.00",$0.00,"$1,375.00",$0.00,$981.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
609003,SUP,Custom 27803010,,609003  -  TISSUE 609003 3MM FACET SHIM,"$1,500.00",$0.00,"$1,500.00",$0.00,"$1,070.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
609004,SUP,HCPCS C1763,,609004  -  GRAFT SFT SHIM 4 MM,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
609404,SUP,HCPCS C1763,,609404  -  GRAFT SFT TIS 10X8X4MM FACET,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
609604,SUP,HCPCS C1763,,609604  -  GRAFT SFT TIS WDG 8X8X4MM LF,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
610008,SUP,HCPCS Q4130,,0610008  -  MATRIX TISSUE 10X6CM RECONSTRUCTIVE STRATTICE PIG DERMIS,"$5,720.00",$0.00,"$5,720.00",$0.00,"$4,082.36",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,720.00",$0.00,"$2,860.00","$4,530.24","$4,576.00",$0.00,$0.00,$0.00,$0.00,$0.00
610102,SUP,HCPCS C1894,,INTRODUCER SHTH 6FR 16CM TRAW ADPR DILAT SET INDN SPNLK .038,$67.10,$0.00,$67.10,$36.44,$47.89,$0.00,$11.56,$0.00,$0.00,$11.75,$67.10,$0.00,$33.55,$53.14,$53.68,$0.00,$10.50,$0.00,$10.68,$0.00
610104,SUP,HCPCS C1894,,INTRODUCER 8 FR TEAR AWAY,$70.40,$0.00,$70.40,$38.23,$50.24,$0.00,$12.13,$0.00,$0.00,$12.33,$70.40,$0.00,$35.20,$55.76,$56.32,$0.00,$11.02,$0.00,$11.21,$0.00
610106,SUP,HCPCS C1892,,INTRODUCER SHTH 10FR 16CM TRAW DILAT SET ADPR INTRDN .038IN,$69.35,$0.00,$69.35,$37.66,$49.50,$0.00,$11.95,$0.00,$0.00,$12.14,$69.35,$0.00,$34.68,$54.93,$55.48,$0.00,$10.85,$0.00,$11.04,$0.00
610130,SUP,HCPCS C1760,,610130  -  DEVICE CLSR 6FR .035IN 70CM STRL LF ANGSL VIP BONDEK-+ HMST,$525.00,$0.00,$525.00,$236.25,$374.69,$0.00,$90.45,$0.00,$0.00,$91.92,$525.00,$0.00,$262.50,$415.80,$420.00,$0.00,$82.16,$0.00,$83.58,$0.00
610131,SUP,HCPCS C1760,,610131  -  DEVICE CLSR 8FR ANGSL VIP VASC HMST STRL LATEX FREE DISP,$525.00,$0.00,$525.00,$236.25,$374.69,$0.00,$90.45,$0.00,$0.00,$91.92,$525.00,$0.00,$262.50,$415.80,$420.00,$0.00,$82.16,$0.00,$83.58,$0.00
610400,SUP,Custom 27203010,,CONNECTOR CATH 9.5FR Y SWVL LUER LOCK SDPRT SGL,$65.65,$0.00,$65.65,$0.00,$46.85,$0.00,$0.00,$0.00,$0.00,$0.00,$65.65,$0.00,$32.83,$51.99,$52.52,$0.00,$0.00,$0.00,$0.00,$0.00
611125,SUP,HCPCS C1713,,611125  -  SCREW BONE 8MM 125MM 25MM ASNS 3 TI ORTH SLFTAP SLFDRILL,$385.00,$0.00,$385.00,$173.25,$274.77,$0.00,$66.33,$0.00,$0.00,$67.41,$385.00,$0.00,$192.50,$304.92,$308.00,$0.00,$60.25,$0.00,$61.29,$0.00
611130,SUP,HCPCS C1713,,611130  -  SCREW BONE 8MM 130MM 25MM ASNS 3 TI ORTH SLFTAP SLFDRILL,$385.00,$0.00,$385.00,$173.25,$274.77,$0.00,$66.33,$0.00,$0.00,$67.41,$385.00,$0.00,$192.50,$304.92,$308.00,$0.00,$60.25,$0.00,$61.29,$0.00
611335,SUP,HCPCS C1713,,611335  -  SCREW BONE 8MM 135MM ASNS 3 TI FULTHRD CANN NONSTRL,$391.88,$0.00,$391.88,$176.34,$279.68,$0.00,$67.52,$0.00,$0.00,$68.61,$391.88,$0.00,$195.94,$310.37,$313.50,$0.00,$61.33,$0.00,$62.39,$0.00
611340,SUP,HCPCS C1713,,611340  -  SCREW BONE 8MM 140MM ASNS 3 TI FULTHRD CANN NONSTRL,$391.88,$0.00,$391.88,$176.34,$279.68,$0.00,$67.52,$0.00,$0.00,$68.61,$391.88,$0.00,$195.94,$310.37,$313.50,$0.00,$61.33,$0.00,$62.39,$0.00
611345,SUP,HCPCS C1713,,611345  -  SCREW BONE 8MM 145MM ASNS 3 TI FULTHRD CANN NONSTRL,$391.88,$0.00,$391.88,$176.34,$279.68,$0.00,$67.52,$0.00,$0.00,$68.61,$391.88,$0.00,$195.94,$310.37,$313.50,$0.00,$61.33,$0.00,$62.39,$0.00
611350,SUP,HCPCS C1713,,611350  -  SCREW BONE 8MM 150MM ASNS 3 TI FULTHRD CANN NONSTRL,$391.88,$0.00,$391.88,$176.34,$279.68,$0.00,$67.52,$0.00,$0.00,$68.61,$391.88,$0.00,$195.94,$310.37,$313.50,$0.00,$61.33,$0.00,$62.39,$0.00
612601,SUP,HCPCS C1892,,612601 - INTRODUCER SHTH 5FR 19CM 16CM TRAW ADPR DILAT SET INDN SPNLK,$60.88,$0.00,$60.88,$33.06,$43.45,$0.00,$10.49,$0.00,$0.00,$10.66,$60.88,$0.00,$30.44,$48.22,$48.70,$0.00,$9.53,$0.00,$9.69,$0.00
614508,SUP,HCPCS C1713,,614508  -  SCREW BONE 2.7MM 8MM VARIAX TI ELB LCK SLFTAP PLT SYS,$247.50,$0.00,$247.50,$111.38,$176.64,$0.00,$42.64,$0.00,$0.00,$43.34,$247.50,$0.00,$123.75,$196.02,$198.00,$0.00,$38.73,$0.00,$39.40,$0.00
614510,SUP,HCPCS C1713,,614510  -  SCREW BONE 2.7MM 10MM VARIAX TI ELB LCK SLFTAP PLT SYS,$247.50,$0.00,$247.50,$111.38,$176.64,$0.00,$42.64,$0.00,$0.00,$43.34,$247.50,$0.00,$123.75,$196.02,$198.00,$0.00,$38.73,$0.00,$39.40,$0.00
614512,SUP,HCPCS C1713,,614512  -  SCREW BONE 2.7MM 12MM VARIAX TI ELB LCK SLFTAP PLT SYS,$247.50,$0.00,$247.50,$111.38,$176.64,$0.00,$42.64,$0.00,$0.00,$43.34,$247.50,$0.00,$123.75,$196.02,$198.00,$0.00,$38.73,$0.00,$39.40,$0.00
614514,SUP,HCPCS C1713,,614514  -  SCREW BONE 2.7MM 14MM VARIAX TI ELB LCK SLFTAP PLT SYS,$247.50,$0.00,$247.50,$111.38,$176.64,$0.00,$42.64,$0.00,$0.00,$43.34,$247.50,$0.00,$123.75,$196.02,$198.00,$0.00,$38.73,$0.00,$39.40,$0.00
614516,SUP,HCPCS C1713,,614516  -  SCREW BONE 2.7MM 16MM LCK STRL,$247.50,$0.00,$247.50,$111.38,$176.64,$0.00,$42.64,$0.00,$0.00,$43.34,$247.50,$0.00,$123.75,$196.02,$198.00,$0.00,$38.73,$0.00,$39.40,$0.00
614518,SUP,HCPCS C1713,,614518  -  SCREW BONE 2.7MM 18MM LCK STRL,$247.50,$0.00,$247.50,$111.38,$176.64,$0.00,$42.64,$0.00,$0.00,$43.34,$247.50,$0.00,$123.75,$196.02,$198.00,$0.00,$38.73,$0.00,$39.40,$0.00
614520,SUP,HCPCS C1713,,614520  -  SCREW BONE 2.7MM 20MM VARIAX TI ELB LCK SLFTAP PLT SYS,$247.50,$0.00,$247.50,$111.38,$176.64,$0.00,$42.64,$0.00,$0.00,$43.34,$247.50,$0.00,$123.75,$196.02,$198.00,$0.00,$38.73,$0.00,$39.40,$0.00
614522,SUP,HCPCS C1713,,614522  -  SCREW BONE 2.7MM 22MM VARIAX TI ELB LCK SLFTAP PLT SYS,$247.50,$0.00,$247.50,$111.38,$176.64,$0.00,$42.64,$0.00,$0.00,$43.34,$247.50,$0.00,$123.75,$196.02,$198.00,$0.00,$38.73,$0.00,$39.40,$0.00
614524,SUP,HCPCS C1713,,614524  -  SCREW BONE 2.7MM 24MM VARIAX TI ELB LCK SLFTAP PLT SYS,$247.50,$0.00,$247.50,$111.38,$176.64,$0.00,$42.64,$0.00,$0.00,$43.34,$247.50,$0.00,$123.75,$196.02,$198.00,$0.00,$38.73,$0.00,$39.40,$0.00
614526,SUP,HCPCS C1713,,614526  -  SCREW BONE 2.7MM 26MM VARIAX TI ELB LCK SLFTAP PLT SYS,$247.50,$0.00,$247.50,$111.38,$176.64,$0.00,$42.64,$0.00,$0.00,$43.34,$247.50,$0.00,$123.75,$196.02,$198.00,$0.00,$38.73,$0.00,$39.40,$0.00
614528,SUP,HCPCS C1713,,614528  -  SCREW BONE 2.7MM 28MM VARIAX TI ELB LCK SLFTAP PLT SYS,$247.50,$0.00,$247.50,$111.38,$176.64,$0.00,$42.64,$0.00,$0.00,$43.34,$247.50,$0.00,$123.75,$196.02,$198.00,$0.00,$38.73,$0.00,$39.40,$0.00
614530,SUP,HCPCS C1713,,614530  -  SCREW BONE 2.7MM 30MM VARIAX TI ELB LCK SLFTAP PLT SYS,$247.50,$0.00,$247.50,$111.38,$176.64,$0.00,$42.64,$0.00,$0.00,$43.34,$247.50,$0.00,$123.75,$196.02,$198.00,$0.00,$38.73,$0.00,$39.40,$0.00
614532,SUP,HCPCS C1713,,614532  -  SCREW BONE 2.7MM 32MM VARIAX TI ELB LCK SLFTAP PLT SYS,$247.50,$0.00,$247.50,$111.38,$176.64,$0.00,$42.64,$0.00,$0.00,$43.34,$247.50,$0.00,$123.75,$196.02,$198.00,$0.00,$38.73,$0.00,$39.40,$0.00
614534,SUP,HCPCS C1713,,614534  -  SCREW BONE 2.7MM 34MM VARIAX TI ELB LCK SLFTAP PLT SYS,$247.50,$0.00,$247.50,$111.38,$176.64,$0.00,$42.64,$0.00,$0.00,$43.34,$247.50,$0.00,$123.75,$196.02,$198.00,$0.00,$38.73,$0.00,$39.40,$0.00
614536,SUP,HCPCS C1713,,614536  -  SCREW BONE 2.7MM 36MM VARIAX TI ELB LCK SLFTAP PLT SYS,$247.50,$0.00,$247.50,$111.38,$176.64,$0.00,$42.64,$0.00,$0.00,$43.34,$247.50,$0.00,$123.75,$196.02,$198.00,$0.00,$38.73,$0.00,$39.40,$0.00
614538,SUP,HCPCS C1713,,614538  -  SCREW BONE 2.7MM 38MM VARIAX TI ELB LCK SLFTAP PLT SYS,$247.50,$0.00,$247.50,$111.38,$176.64,$0.00,$42.64,$0.00,$0.00,$43.34,$247.50,$0.00,$123.75,$196.02,$198.00,$0.00,$38.73,$0.00,$39.40,$0.00
614540,SUP,HCPCS C1713,,614540  -  SCREW BONE 2.7MM 40MM VARIAX TI ELB LCK SLFTAP PLT SYS,$247.50,$0.00,$247.50,$111.38,$176.64,$0.00,$42.64,$0.00,$0.00,$43.34,$247.50,$0.00,$123.75,$196.02,$198.00,$0.00,$38.73,$0.00,$39.40,$0.00
614542,SUP,HCPCS C1713,,614542  -  SCREW BONE 2.7MM 42MM VARIAX TI ELB LCK SLFTAP PLT SYS,$247.50,$0.00,$247.50,$111.38,$176.64,$0.00,$42.64,$0.00,$0.00,$43.34,$247.50,$0.00,$123.75,$196.02,$198.00,$0.00,$38.73,$0.00,$39.40,$0.00
614544,SUP,HCPCS C1713,,614544  -  SCREW BONE 2.7MM 44MM VARIAX TI ELB LCK SLFTAP PLT SYS,$247.50,$0.00,$247.50,$111.38,$176.64,$0.00,$42.64,$0.00,$0.00,$43.34,$247.50,$0.00,$123.75,$196.02,$198.00,$0.00,$38.73,$0.00,$39.40,$0.00
614546,SUP,HCPCS C1713,,614546  -  SCREW BONE 2.7MM 46MM VARIAX TI ELB LCK SLFTAP PLT SYS,$247.50,$0.00,$247.50,$111.38,$176.64,$0.00,$42.64,$0.00,$0.00,$43.34,$247.50,$0.00,$123.75,$196.02,$198.00,$0.00,$38.73,$0.00,$39.40,$0.00
614548,SUP,HCPCS C1713,,614548  -  SCREW BONE 2.7MM 48MM VARIAX TI ELB LCK SLFTAP PLT SYS,$247.50,$0.00,$247.50,$111.38,$176.64,$0.00,$42.64,$0.00,$0.00,$43.34,$247.50,$0.00,$123.75,$196.02,$198.00,$0.00,$38.73,$0.00,$39.40,$0.00
614550,SUP,HCPCS C1713,,614550  -  SCREW BONE 2.7MM 50MM VARIAX TI ELB LCK SLFTAP PLT SYS,$247.50,$0.00,$247.50,$111.38,$176.64,$0.00,$42.64,$0.00,$0.00,$43.34,$247.50,$0.00,$123.75,$196.02,$198.00,$0.00,$38.73,$0.00,$39.40,$0.00
614555,SUP,HCPCS C1713,,614555  -  SCREW BONE 2.7MM 55MM VARIAX TI ELB LCK SLFTAP PLT SYS,$247.50,$0.00,$247.50,$111.38,$176.64,$0.00,$42.64,$0.00,$0.00,$43.34,$247.50,$0.00,$123.75,$196.02,$198.00,$0.00,$38.73,$0.00,$39.40,$0.00
614560,SUP,HCPCS C1713,,614560  -  SCREW BONE 2.7MM 60MM VARIAX TI ELB LCK SLFTAP PLT SYS,$247.50,$0.00,$247.50,$111.38,$176.64,$0.00,$42.64,$0.00,$0.00,$43.34,$247.50,$0.00,$123.75,$196.02,$198.00,$0.00,$38.73,$0.00,$39.40,$0.00
614565,SUP,HCPCS C1713,,614565  -  SCREW BONE 2.7MM 65MM VARIAX TI ELB LCK SLFTAP PLT SYS,$247.50,$0.00,$247.50,$111.38,$176.64,$0.00,$42.64,$0.00,$0.00,$43.34,$247.50,$0.00,$123.75,$196.02,$198.00,$0.00,$38.73,$0.00,$39.40,$0.00
614570,SUP,HCPCS C1713,,614570  -  SCREW BONE 2.7MM 70MM VARIAX TI ELB LCK SLFTAP PLT SYS,$247.50,$0.00,$247.50,$111.38,$176.64,$0.00,$42.64,$0.00,$0.00,$43.34,$247.50,$0.00,$123.75,$196.02,$198.00,$0.00,$38.73,$0.00,$39.40,$0.00
614608,SUP,HCPCS C1713,,614608  -  SCREW BONE 3.5MM 8MM VARIAX TI ELB SLFTAP LCK PLT SYS,$251.63,$0.00,$251.63,$113.23,$179.58,$0.00,$43.35,$0.00,$0.00,$44.06,$251.63,$0.00,$125.81,$199.29,$201.30,$0.00,$39.38,$0.00,$40.06,$0.00
614610,SUP,HCPCS C1713,,614610  -  SCREW BONE 3.5MM 10MM VARIAX TI ELB SLFTAP LCK PLT SYS,$251.63,$0.00,$251.63,$113.23,$179.58,$0.00,$43.35,$0.00,$0.00,$44.06,$251.63,$0.00,$125.81,$199.29,$201.30,$0.00,$39.38,$0.00,$40.06,$0.00
614612,SUP,HCPCS C1713,,614612  -  SCREW BONE 3.5MM 12MM VARIAX SS ELB SLFTAP LCK,$251.63,$0.00,$251.63,$113.23,$179.58,$0.00,$43.35,$0.00,$0.00,$44.06,$251.63,$0.00,$125.81,$199.29,$201.30,$0.00,$39.38,$0.00,$40.06,$0.00
614614,SUP,HCPCS C1713,,614614  -  SCREW BONE 3.5MM 14MM VARIAX SS ELB SLFTAP LCK,$251.63,$0.00,$251.63,$113.23,$179.58,$0.00,$43.35,$0.00,$0.00,$44.06,$251.63,$0.00,$125.81,$199.29,$201.30,$0.00,$39.38,$0.00,$40.06,$0.00
614616,SUP,HCPCS C1713,,614616  -  SCREW BONE 3.5MM 16MM VARIAX SS ELB SLFTAP LCK,$251.63,$0.00,$251.63,$113.23,$179.58,$0.00,$43.35,$0.00,$0.00,$44.06,$251.63,$0.00,$125.81,$199.29,$201.30,$0.00,$39.38,$0.00,$40.06,$0.00
614618,SUP,HCPCS C1713,,614618  -  SCREW BONE 3.5MM 18MM VARIAX SS ELB SLFTAP LCK,$251.63,$0.00,$251.63,$113.23,$179.58,$0.00,$43.35,$0.00,$0.00,$44.06,$251.63,$0.00,$125.81,$199.29,$201.30,$0.00,$39.38,$0.00,$40.06,$0.00
614620,SUP,HCPCS C1713,,614620  -  SCREW BONE 3.5MM 20MM VARIAX SS ELB SLFTAP LCK,$251.63,$0.00,$251.63,$113.23,$179.58,$0.00,$43.35,$0.00,$0.00,$44.06,$251.63,$0.00,$125.81,$199.29,$201.30,$0.00,$39.38,$0.00,$40.06,$0.00
614622,SUP,HCPCS C1713,,614622  -  SCREW BONE 3.5MM 22MM VARIAX SS ELB SLFTAP LCK,$251.63,$0.00,$251.63,$113.23,$179.58,$0.00,$43.35,$0.00,$0.00,$44.06,$251.63,$0.00,$125.81,$199.29,$201.30,$0.00,$39.38,$0.00,$40.06,$0.00
614624,SUP,HCPCS C1713,,614624  -  SCREW BONE 3.5MM 24MM VARIAX SS ELB SLFTAP LCK,$251.63,$0.00,$251.63,$113.23,$179.58,$0.00,$43.35,$0.00,$0.00,$44.06,$251.63,$0.00,$125.81,$199.29,$201.30,$0.00,$39.38,$0.00,$40.06,$0.00
614626,SUP,HCPCS C1713,,614626  -  SCREW BONE 3.5MM 26MM VARIAX TI ELB LCK SLFTAP PLT SYS,$251.63,$0.00,$251.63,$113.23,$179.58,$0.00,$43.35,$0.00,$0.00,$44.06,$251.63,$0.00,$125.81,$199.29,$201.30,$0.00,$39.38,$0.00,$40.06,$0.00
614628,SUP,HCPCS C1713,,614628  -  SCREW BONE 3.5MM 28MM VARIAX SS ELB SLFTAP LCK,$251.63,$0.00,$251.63,$113.23,$179.58,$0.00,$43.35,$0.00,$0.00,$44.06,$251.63,$0.00,$125.81,$199.29,$201.30,$0.00,$39.38,$0.00,$40.06,$0.00
614630,SUP,HCPCS C1713,,614630  -  SCREW BONE 3.5MM 30MM VARIAX TI ELB LCK SLFTAP PLT SYS,$251.63,$0.00,$251.63,$113.23,$179.58,$0.00,$43.35,$0.00,$0.00,$44.06,$251.63,$0.00,$125.81,$199.29,$201.30,$0.00,$39.38,$0.00,$40.06,$0.00
614632,SUP,HCPCS C1713,,614632  -  SCREW BONE 3.5MM 32MM VARIAX TI ELB LCK SLFTAP PLT SYS,$251.63,$0.00,$251.63,$113.23,$179.58,$0.00,$43.35,$0.00,$0.00,$44.06,$251.63,$0.00,$125.81,$199.29,$201.30,$0.00,$39.38,$0.00,$40.06,$0.00
614634,SUP,HCPCS C1713,,614634  -  SCREW BONE 3.5MM 42MM VARIAX TI ELB SLFTAP LCK NONSTRL,$251.63,$0.00,$251.63,$113.23,$179.58,$0.00,$43.35,$0.00,$0.00,$44.06,$251.63,$0.00,$125.81,$199.29,$201.30,$0.00,$39.38,$0.00,$40.06,$0.00
614636,SUP,HCPCS C1713,,614636  -  SCREW BONE 3.5MM 36MM VARIAX TI ELB LCK SLFTAP PLT SYS,$251.63,$0.00,$251.63,$113.23,$179.58,$0.00,$43.35,$0.00,$0.00,$44.06,$251.63,$0.00,$125.81,$199.29,$201.30,$0.00,$39.38,$0.00,$40.06,$0.00
614638,SUP,HCPCS C1713,,614638  -  SCREW BONE 3.5MM 38MM VARIAX TI ELB LCK SLFTAP PLT SYS,$251.63,$0.00,$251.63,$113.23,$179.58,$0.00,$43.35,$0.00,$0.00,$44.06,$251.63,$0.00,$125.81,$199.29,$201.30,$0.00,$39.38,$0.00,$40.06,$0.00
614640,SUP,HCPCS C1713,,614640  -  SCREW BONE 3.5MM 40MM VARIAX TI ELB LCK SLFTAP PLT SYS,$251.63,$0.00,$251.63,$113.23,$179.58,$0.00,$43.35,$0.00,$0.00,$44.06,$251.63,$0.00,$125.81,$199.29,$201.30,$0.00,$39.38,$0.00,$40.06,$0.00
614642,SUP,HCPCS C1713,,614642  -  SCREW BONE 3.5MM 42MM VARIAX SS ELB SLFTAP LCK,$251.63,$0.00,$251.63,$113.23,$179.58,$0.00,$43.35,$0.00,$0.00,$44.06,$251.63,$0.00,$125.81,$199.29,$201.30,$0.00,$39.38,$0.00,$40.06,$0.00
614644,SUP,HCPCS C1713,,614644  -  SCREW BONE 3.5MM 44MM VARIAX TI ELB SLFTAP LCK PLT SYS,$251.63,$0.00,$251.63,$113.23,$179.58,$0.00,$43.35,$0.00,$0.00,$44.06,$251.63,$0.00,$125.81,$199.29,$201.30,$0.00,$39.38,$0.00,$40.06,$0.00
614646,SUP,HCPCS C1713,,614646  -  SCREW BONE 3.5MM 46MM VARIAX TI ELB SLFTAP LCK PLT SYS,$251.63,$0.00,$251.63,$113.23,$179.58,$0.00,$43.35,$0.00,$0.00,$44.06,$251.63,$0.00,$125.81,$199.29,$201.30,$0.00,$39.38,$0.00,$40.06,$0.00
614648,SUP,HCPCS C1713,,614648  -  SCREW BONE 3.5MM 48MM VARIAX TI ELB SLFTAP LCK PLT SYS,$251.63,$0.00,$251.63,$113.23,$179.58,$0.00,$43.35,$0.00,$0.00,$44.06,$251.63,$0.00,$125.81,$199.29,$201.30,$0.00,$39.38,$0.00,$40.06,$0.00
614650,SUP,HCPCS C1713,,614650  -  SCREW BONE 3.5MM 50MM VARIAX TI ELB SLFTAP LCK PLT SYS,$251.63,$0.00,$251.63,$113.23,$179.58,$0.00,$43.35,$0.00,$0.00,$44.06,$251.63,$0.00,$125.81,$199.29,$201.30,$0.00,$39.38,$0.00,$40.06,$0.00
614655,SUP,HCPCS C1713,,614655  -  SCREW BONE 3.5MM 55MM VARIAX LCK,$251.63,$0.00,$251.63,$113.23,$179.58,$0.00,$43.35,$0.00,$0.00,$44.06,$251.63,$0.00,$125.81,$199.29,$201.30,$0.00,$39.38,$0.00,$40.06,$0.00
614660,SUP,HCPCS C1713,,614660  -  SCREW BONE 3.5MM 60MM VARIAX SS ELB SLFTAP LCK,$251.63,$0.00,$251.63,$113.23,$179.58,$0.00,$43.35,$0.00,$0.00,$44.06,$251.63,$0.00,$125.81,$199.29,$201.30,$0.00,$39.38,$0.00,$40.06,$0.00
614665,SUP,HCPCS C1713,,614665  -  SCREW BONE 3.5MM 65MM VARIAX TI ELB SLFTAP LCK PLT SYS,$251.63,$0.00,$251.63,$113.23,$179.58,$0.00,$43.35,$0.00,$0.00,$44.06,$251.63,$0.00,$125.81,$199.29,$201.30,$0.00,$39.38,$0.00,$40.06,$0.00
614670,SUP,HCPCS C1713,,614670  -  SCREW BONE 3.5MM 70MM VARIAX TI ELB SLFTAP LCK PLT SYS,$251.63,$0.00,$251.63,$113.23,$179.58,$0.00,$43.35,$0.00,$0.00,$44.06,$251.63,$0.00,$125.81,$199.29,$201.30,$0.00,$39.38,$0.00,$40.06,$0.00
614708,SUP,HCPCS C1713,,614708  -  SCREW BONE 2.7MM 8MM VARIAX TI ELB SLFTAP PLT SYS,$107.25,$0.00,$107.25,$48.26,$76.54,$0.00,$18.48,$0.00,$0.00,$18.78,$107.25,$0.00,$53.63,$84.94,$85.80,$0.00,$16.78,$0.00,$17.07,$0.00
614710,SUP,HCPCS C1713,,614710  -  SCREW BONE 2.7MM 10MM VARIAX TI ELB SLFTAP PLT SYS,$107.25,$0.00,$107.25,$48.26,$76.54,$0.00,$18.48,$0.00,$0.00,$18.78,$107.25,$0.00,$53.63,$84.94,$85.80,$0.00,$16.78,$0.00,$17.07,$0.00
614712,SUP,HCPCS C1713,,614712  -  SCREW BONE 2.7MM 12MM VARIAX TI ELB SLFTAP PLT SYS,$107.25,$0.00,$107.25,$48.26,$76.54,$0.00,$18.48,$0.00,$0.00,$18.78,$107.25,$0.00,$53.63,$84.94,$85.80,$0.00,$16.78,$0.00,$17.07,$0.00
614714,SUP,HCPCS C1713,,614714  -  SCREW BONE 2.7MM 14MM VARIAX TI ELB SLFTAP PLT SYS,$107.25,$0.00,$107.25,$48.26,$76.54,$0.00,$18.48,$0.00,$0.00,$18.78,$107.25,$0.00,$53.63,$84.94,$85.80,$0.00,$16.78,$0.00,$17.07,$0.00
614716,SUP,HCPCS C1713,,614716  -  SCREW BONE 2.7MM 16MM VARIAX TI ELB SLFTAP PLT SYS,$107.25,$0.00,$107.25,$48.26,$76.54,$0.00,$18.48,$0.00,$0.00,$18.78,$107.25,$0.00,$53.63,$84.94,$85.80,$0.00,$16.78,$0.00,$17.07,$0.00
614718,SUP,HCPCS C1713,,614718  -  SCREW BONE 2.7MM 18MM VARIAX SLFTAP,$107.25,$0.00,$107.25,$48.26,$76.54,$0.00,$18.48,$0.00,$0.00,$18.78,$107.25,$0.00,$53.63,$84.94,$85.80,$0.00,$16.78,$0.00,$17.07,$0.00
614720,SUP,HCPCS C1713,,614720  -  SCREW BONE 2.7MM 20MM VARIAX TI ELB SLFTAP PLT SYS,$107.25,$0.00,$107.25,$48.26,$76.54,$0.00,$18.48,$0.00,$0.00,$18.78,$107.25,$0.00,$53.63,$84.94,$85.80,$0.00,$16.78,$0.00,$17.07,$0.00
614722,SUP,HCPCS C1713,,614722  -  SCREW BONE 2.7MM 22MM VARIAX TI ELB SLFTAP PLT SYS,$107.25,$0.00,$107.25,$48.26,$76.54,$0.00,$18.48,$0.00,$0.00,$18.78,$107.25,$0.00,$53.63,$84.94,$85.80,$0.00,$16.78,$0.00,$17.07,$0.00
614724,SUP,HCPCS C1713,,614724  -  SCREW BONE 2.7MM 24MM VARIAX SLFTAP,$107.25,$0.00,$107.25,$48.26,$76.54,$0.00,$18.48,$0.00,$0.00,$18.78,$107.25,$0.00,$53.63,$84.94,$85.80,$0.00,$16.78,$0.00,$17.07,$0.00
614726,SUP,HCPCS C1713,,614726  -  SCREW BONE 2.7MM 26MM VARIAX TI ELB SLFTAP PLT SYS,$107.25,$0.00,$107.25,$48.26,$76.54,$0.00,$18.48,$0.00,$0.00,$18.78,$107.25,$0.00,$53.63,$84.94,$85.80,$0.00,$16.78,$0.00,$17.07,$0.00
614728,SUP,HCPCS C1713,,614728  -  SCREW BONE 2.7MM 28MM VARIAX TI ELB SLFTAP PLT SYS,$107.25,$0.00,$107.25,$48.26,$76.54,$0.00,$18.48,$0.00,$0.00,$18.78,$107.25,$0.00,$53.63,$84.94,$85.80,$0.00,$16.78,$0.00,$17.07,$0.00
614730,SUP,HCPCS C1713,,614730  -  SCREW BONE 2.7MM 30MM VARIAX TI ELB SLFTAP PLT SYS,$107.25,$0.00,$107.25,$48.26,$76.54,$0.00,$18.48,$0.00,$0.00,$18.78,$107.25,$0.00,$53.63,$84.94,$85.80,$0.00,$16.78,$0.00,$17.07,$0.00
614732,SUP,HCPCS C1713,,614732  -  SCREW BONE 2.7MM 32MM VARIAX TI ELB SLFTAP PLT SYS,$107.25,$0.00,$107.25,$48.26,$76.54,$0.00,$18.48,$0.00,$0.00,$18.78,$107.25,$0.00,$53.63,$84.94,$85.80,$0.00,$16.78,$0.00,$17.07,$0.00
614734,SUP,HCPCS C1713,,614734  -  SCREW BONE 2.7MM 34MM VARIAX TI ELB LCK SLFTAP PLT SYS,$107.25,$0.00,$107.25,$48.26,$76.54,$0.00,$18.48,$0.00,$0.00,$18.78,$107.25,$0.00,$53.63,$84.94,$85.80,$0.00,$16.78,$0.00,$17.07,$0.00
614736,SUP,HCPCS C1713,,614736  -  SCREW BONE 2.7MM 36MM VARIAX TI ELB LCK SLFTAP PLT SYS,$107.25,$0.00,$107.25,$48.26,$76.54,$0.00,$18.48,$0.00,$0.00,$18.78,$107.25,$0.00,$53.63,$84.94,$85.80,$0.00,$16.78,$0.00,$17.07,$0.00
614738,SUP,HCPCS C1713,,614738  -  SCREW BONE 2.7MM 38MM VARIAX TI ELB LCK SLFTAP PLT SYS,$107.25,$0.00,$107.25,$48.26,$76.54,$0.00,$18.48,$0.00,$0.00,$18.78,$107.25,$0.00,$53.63,$84.94,$85.80,$0.00,$16.78,$0.00,$17.07,$0.00
614740,SUP,HCPCS C1713,,614740  -  SCREW BONE 2.7MM 40MM VARIAX TI ELB LCK SLFTAP PLT SYS,$107.25,$0.00,$107.25,$48.26,$76.54,$0.00,$18.48,$0.00,$0.00,$18.78,$107.25,$0.00,$53.63,$84.94,$85.80,$0.00,$16.78,$0.00,$17.07,$0.00
614742,SUP,HCPCS C1713,,614742  -  SCREW BONE 2.7MM 42MM VARIAX TI ELB LCK SLFTAP PLT SYS,$107.25,$0.00,$107.25,$48.26,$76.54,$0.00,$18.48,$0.00,$0.00,$18.78,$107.25,$0.00,$53.63,$84.94,$85.80,$0.00,$16.78,$0.00,$17.07,$0.00
614744,SUP,HCPCS C1713,,614744  -  SCREW BONE 2.7MM 44MM VARIAX TI ELB LCK SLFTAP PLT SYS,$107.25,$0.00,$107.25,$48.26,$76.54,$0.00,$18.48,$0.00,$0.00,$18.78,$107.25,$0.00,$53.63,$84.94,$85.80,$0.00,$16.78,$0.00,$17.07,$0.00
614746,SUP,HCPCS C1713,,614746  -  SCREW BONE 2.7MM 46MM VARIAX TI ELB LCK SLFTAP PLT SYS,$107.25,$0.00,$107.25,$48.26,$76.54,$0.00,$18.48,$0.00,$0.00,$18.78,$107.25,$0.00,$53.63,$84.94,$85.80,$0.00,$16.78,$0.00,$17.07,$0.00
614748,SUP,HCPCS C1713,,614748  -  SCREW BONE 2.7MM 48MM VARIAX TI ELB LCK SLFTAP PLT SYS,$107.25,$0.00,$107.25,$48.26,$76.54,$0.00,$18.48,$0.00,$0.00,$18.78,$107.25,$0.00,$53.63,$84.94,$85.80,$0.00,$16.78,$0.00,$17.07,$0.00
614750,SUP,HCPCS C1713,,614750  -  SCREW BONE 2.7MM 50MM VARIAX TI ELB LCK SLFTAP PLT SYS,$107.25,$0.00,$107.25,$48.26,$76.54,$0.00,$18.48,$0.00,$0.00,$18.78,$107.25,$0.00,$53.63,$84.94,$85.80,$0.00,$16.78,$0.00,$17.07,$0.00
614755,SUP,HCPCS C1713,,614755  -  SCREW BONE 2.7MM 55MM VARIAX TI ELB LCK SLFTAP PLT SYS,$107.25,$0.00,$107.25,$48.26,$76.54,$0.00,$18.48,$0.00,$0.00,$18.78,$107.25,$0.00,$53.63,$84.94,$85.80,$0.00,$16.78,$0.00,$17.07,$0.00
614760,SUP,HCPCS C1713,,614760  -  SCREW BONE 2.7MM 60MM VARIAX TI ELB LCK SLFTAP PLT SYS,$107.25,$0.00,$107.25,$48.26,$76.54,$0.00,$18.48,$0.00,$0.00,$18.78,$107.25,$0.00,$53.63,$84.94,$85.80,$0.00,$16.78,$0.00,$17.07,$0.00
614765,SUP,HCPCS C1713,,614765  -  SCREW BONE 2.7MM 65MM VARIAX TI ELB LCK SLFTAP PLT SYS,$107.25,$0.00,$107.25,$48.26,$76.54,$0.00,$18.48,$0.00,$0.00,$18.78,$107.25,$0.00,$53.63,$84.94,$85.80,$0.00,$16.78,$0.00,$17.07,$0.00
614770,SUP,HCPCS C1713,,614770  -  SCREW BONE 2.7MM 70MM VARIAX TI ELB LCK SLFTAP PLT SYS,$107.25,$0.00,$107.25,$48.26,$76.54,$0.00,$18.48,$0.00,$0.00,$18.78,$107.25,$0.00,$53.63,$84.94,$85.80,$0.00,$16.78,$0.00,$17.07,$0.00
614808,SUP,HCPCS C1713,,614808  -  SCREW BONE 3.5MM 8MM VARIAX TI ELB LCK SLFTAP PLT SYS,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
614810,SUP,HCPCS C1713,,614810  -  SCREW BONE 3.5MM 10MM VARIAX TI ELB LCK SLFTAP PLT SYS,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
614812,SUP,HCPCS C1713,,614812  -  SCREW BONE 3.5MM 12MM VARIAX TI ELB LCK SLFTAP PLT SYS,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
614814,SUP,HCPCS C1713,,614814  -  SCREW BONE 3.5MM 14MM VARIAX SS,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
614816,SUP,HCPCS C1713,,614816  -  SCREW BONE 3.5MM 16MM VARIAX SS NLCKG,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
614818,SUP,HCPCS C1713,,614818  -  SCREW BONE 3.5MM 18MM VARIAX SS ELB SLFTAP LCK,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
614820,SUP,HCPCS C1713,,614820  -  SCREW BONE 3.5MM 20MM VARIAX SS ELB SLFTAP LCK,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
614822,SUP,HCPCS C1713,,614822  -  SCREW BONE 3.5MM 22MM VARIAX TI ELB SLFTAP LCK,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
614824,SUP,HCPCS C1713,,614824  -  SCREW BONE 3.5MM 24MM VARIAX TI ELB SLFTAP LCK,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
614826,SUP,HCPCS C1713,,614826  -  SCREW BONE 3.5MM 26MM VARIAX TI,"$1,941.50",$0.00,"$1,941.50",$873.68,"$1,385.65",$0.00,$334.51,$0.00,$0.00,$339.94,"$1,941.50",$0.00,$970.75,"$1,537.67","$1,553.20",$0.00,$303.84,$0.00,$309.09,$0.00
614828,SUP,HCPCS C1713,,614828  -  SCREW BONE 3.5MM 28MM VARIAX TI,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
614830,SUP,HCPCS C1713,,614830  -  SCREW BONE 3.5MM 30MM VARIAX TI ELB SLFTAP LCK PLT SYS,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
614832,SUP,HCPCS C1713,,614832  -  SCREW BONE 3.5MM 32MM VARIAX TI ELB SLFTAP LCK,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
614834,SUP,HCPCS C1713,,614834  -  SCREW BONE 3.5MM 34MM VARIAX TI ELB SLFTAP LCK PLT SYS,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
614836,SUP,HCPCS C1713,,614836  -  SCREW BONE 3.5MM 36MM VARIAX TI ELB SLFTAP LCK PLT SYS,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
614838,SUP,HCPCS C1713,,614838  -  SCREW BONE 3.5MM 38MM VARIAX TI ELB SLFTAP LCK PLT SYS,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
614840,SUP,HCPCS C1713,,614840  -  SCREW BONE 3.5MM 40MM VARIAX TI ELB SLFTAP LCK PLT SYS,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
614842,SUP,HCPCS C1713,,614842  -  SCREW BONE 3.5MM 42MM VARIAX TI ELB SLFTAP LCK PLT SYS,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
614844,SUP,HCPCS C1713,,614844  -  SCREW BONE 3.5MM 44MM VARIAX TI ELB SLFTAP LCK PLT SYS,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
614846,SUP,HCPCS C1713,,614846  -  SCREW BONE 3.5MM 46MM VARIAX TI ELB SLFTAP LCK PLT SYS,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
614848,SUP,HCPCS C1713,,614848  -  SCREW BONE 3.5MM 48MM VARIAX TI ELB SLFTAP LCK PLT SYS,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
614850,SUP,HCPCS C1713,,614850  -  SCREW BONE 3.5MM 50MM VARIAX NLCKG,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
614855,SUP,HCPCS C1713,,614855  -  SCREW BONE 3.5MM 55MM VARIAX TI ELB SLFTAP LCK PLT SYS,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
614860,SUP,HCPCS C1713,,614860  -  SCREW BONE 3.5MM 60MM VARIAX TI ELB SLFTAP LCK PLT SYS,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
614865,SUP,HCPCS C1713,,614865  -  SCREW BONE 3.5MM 65MM VARIAX TI ELB SLFTAP LCK PLT SYS,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
614870,SUP,HCPCS C1713,,614870  -  SCREW BONE 3.5MM 70MM VARIAX TI ELB SLFTAP LCK PLT SYS,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
616002,SUP,HCPCS Q4130,,0616002  -  MATRIX TISSUE 16X6CM RECONSTRUCTIVE STRATTICE PIG DERMIS,$88.98,$0.00,$88.98,$0.00,$63.51,$0.00,$0.00,$0.00,$0.00,$0.00,$88.98,$0.00,$44.49,$70.47,$71.19,$0.00,$0.00,$0.00,$0.00,$0.00
Jun-00,SUP,Custom 27803010,,06-3600  -  HEAD FEM +0MM OFST CTPR 36MM STRL LFIT ANTM COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
621552,SUP,HCPCS C1713,,621552  -  PLATE LNG 50MM TI BONE CALCANEUS,$705.38,$0.00,$705.38,$317.42,$503.43,$0.00,$121.53,$0.00,$0.00,$123.51,$705.38,$0.00,$352.69,$558.66,$564.30,$0.00,$110.39,$0.00,$112.30,$0.00
621553,SUP,HCPCS C1713,,621553  -  PLATE LNG 60MM TI BONE CALCANEUS,$705.38,$0.00,$705.38,$317.42,$503.43,$0.00,$121.53,$0.00,$0.00,$123.51,$705.38,$0.00,$352.69,$558.66,$564.30,$0.00,$110.39,$0.00,$112.30,$0.00
621554,SUP,HCPCS C1713,,621554  -  PLATE LNG 70MM TI BONE CALCANEUS,$705.38,$0.00,$705.38,$317.42,$503.43,$0.00,$121.53,$0.00,$0.00,$123.51,$705.38,$0.00,$352.69,$558.66,$564.30,$0.00,$110.39,$0.00,$112.30,$0.00
621555,SUP,HCPCS C1713,,621555  -  PLATE LNG 80MM TI BONE CALCANEUS,$541.75,$0.00,$541.75,$243.79,$386.65,$0.00,$93.34,$0.00,$0.00,$94.86,$541.75,$0.00,$270.88,$429.07,$433.40,$0.00,$84.78,$0.00,$86.25,$0.00
624519,SUP,Custom 27203010,,CALIBRATOR CL S-CL KT 4.2ML HMTL,$78.85,$0.00,$78.85,$0.00,$56.28,$0.00,$0.00,$0.00,$0.00,$0.00,$78.85,$0.00,$39.43,$62.45,$63.08,$0.00,$0.00,$0.00,$0.00,$0.00
626001,SUP,HCPCS C1713,,626001  -  PLATE LNG 1 LVL RPS BONE SPNL,"$2,830.60",$0.00,"$2,830.60","$1,273.77","$2,020.20",$0.00,$487.70,$0.00,$0.00,$495.62,"$2,830.60",$0.00,"$1,415.30","$2,241.84","$2,264.48",$0.00,$442.99,$0.00,$450.63,$0.00
626002,SUP,HCPCS C1713,,626002  -  PLATE LNG TI 2 LVL BONE ORTH,"$3,124.90",$0.00,"$3,124.90","$1,406.21","$2,230.24",$0.00,$538.40,$0.00,$0.00,$547.14,"$3,124.90",$0.00,"$1,562.45","$2,474.92","$2,499.92",$0.00,$489.05,$0.00,$497.48,$0.00
626011,SUP,HCPCS C1713,,626011  -  PLATE SHRT 1 LVL RPS BONE SPNL,"$2,830.60",$0.00,"$2,830.60","$1,273.77","$2,020.20",$0.00,$487.70,$0.00,$0.00,$495.62,"$2,830.60",$0.00,"$1,415.30","$2,241.84","$2,264.48",$0.00,$442.99,$0.00,$450.63,$0.00
626300,SUP,Custom 27803010,,626300  -  CONCTR ROD RPS FIX SPNL,"$2,122.93",$0.00,"$2,122.93",$0.00,"$1,515.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,122.93",$0.00,"$1,061.46","$1,681.36","$1,698.34",$0.00,$0.00,$0.00,$0.00,$0.00
629004,SUP,HCPCS C1713,,629004  -  PLATE BN 4 HL HUM DIST LAT,"$1,485.00",$0.00,"$1,485.00",$668.25,"$1,059.84",$0.00,$255.86,$0.00,$0.00,$260.01,"$1,485.00",$0.00,$742.50,"$1,176.12","$1,188.00",$0.00,$232.40,$0.00,$236.41,$0.00
629006,SUP,HCPCS C1713,,629006  -  PLATE BN 6 HL HUM LT DIST LAT,"$1,650.00",$0.00,"$1,650.00",$742.50,"$1,177.61",$0.00,$284.29,$0.00,$0.00,$288.90,"$1,650.00",$0.00,$825.00,"$1,306.80","$1,320.00",$0.00,$258.23,$0.00,$262.68,$0.00
629008,SUP,HCPCS C1713,,629008  -  PLATE BN 8 HL HUM LT DIST LAT,"$1,815.00",$0.00,"$1,815.00",$816.75,"$1,295.37",$0.00,$312.72,$0.00,$0.00,$317.79,"$1,815.00",$0.00,$907.50,"$1,437.48","$1,452.00",$0.00,$284.05,$0.00,$288.95,$0.00
629024,SUP,HCPCS C1713,,629024  -  PLATE BN 4 HL HUM RT DIST LAT,"$1,485.00",$0.00,"$1,485.00",$668.25,"$1,059.84",$0.00,$255.86,$0.00,$0.00,$260.01,"$1,485.00",$0.00,$742.50,"$1,176.12","$1,188.00",$0.00,$232.40,$0.00,$236.41,$0.00
629026,SUP,HCPCS C1713,,629026  -  PLATE BN 6 HL HUM RT DIST LAT,"$1,650.00",$0.00,"$1,650.00",$742.50,"$1,177.61",$0.00,$284.29,$0.00,$0.00,$288.90,"$1,650.00",$0.00,$825.00,"$1,306.80","$1,320.00",$0.00,$258.23,$0.00,$262.68,$0.00
629028,SUP,HCPCS C1713,,629028  -  PLATE BN 8 HL HUM RT DIST LAT,"$1,815.00",$0.00,"$1,815.00",$816.75,"$1,295.37",$0.00,$312.72,$0.00,$0.00,$317.79,"$1,815.00",$0.00,$907.50,"$1,437.48","$1,452.00",$0.00,$284.05,$0.00,$288.95,$0.00
629044,SUP,HCPCS C1713,,629044  -  PLATE BN 4 HL HUM DP LAT,"$1,485.00",$0.00,"$1,485.00",$668.25,"$1,059.84",$0.00,$255.86,$0.00,$0.00,$260.01,"$1,485.00",$0.00,$742.50,"$1,176.12","$1,188.00",$0.00,$232.40,$0.00,$236.41,$0.00
629046,SUP,HCPCS C1713,,629046  -  PLATE BN 6 HL HUM L/L POST DIST,"$1,650.00",$0.00,"$1,650.00",$742.50,"$1,177.61",$0.00,$284.29,$0.00,$0.00,$288.90,"$1,650.00",$0.00,$825.00,"$1,306.80","$1,320.00",$0.00,$258.23,$0.00,$262.68,$0.00
629048,SUP,HCPCS C1713,,629048  -  PLATE BN 8 HL HUM L/L POST DIST,"$1,815.00",$0.00,"$1,815.00",$816.75,"$1,295.37",$0.00,$312.72,$0.00,$0.00,$317.79,"$1,815.00",$0.00,$907.50,"$1,437.48","$1,452.00",$0.00,$284.05,$0.00,$288.95,$0.00
629064,SUP,HCPCS C1713,,629064  -  PLATE BN 4 HL HUM RL POST DIST,"$1,485.00",$0.00,"$1,485.00",$668.25,"$1,059.84",$0.00,$255.86,$0.00,$0.00,$260.01,"$1,485.00",$0.00,$742.50,"$1,176.12","$1,188.00",$0.00,$232.40,$0.00,$236.41,$0.00
629066,SUP,HCPCS C1713,,629066  -  PLATE BN 6 HL HUM RL POST DIST,"$1,650.00",$0.00,"$1,650.00",$742.50,"$1,177.61",$0.00,$284.29,$0.00,$0.00,$288.90,"$1,650.00",$0.00,$825.00,"$1,306.80","$1,320.00",$0.00,$258.23,$0.00,$262.68,$0.00
629068,SUP,HCPCS C1713,,629068  -  PLATE BN 8 HL HUM DP LAT,"$1,815.00",$0.00,"$1,815.00",$816.75,"$1,295.37",$0.00,$312.72,$0.00,$0.00,$317.79,"$1,815.00",$0.00,$907.50,"$1,437.48","$1,452.00",$0.00,$284.05,$0.00,$288.95,$0.00
629084,SUP,HCPCS C1713,,629084  -  PLATE BN XTD HUM DIST MDL,"$1,485.00",$0.00,"$1,485.00",$668.25,"$1,059.84",$0.00,$255.86,$0.00,$0.00,$260.01,"$1,485.00",$0.00,$742.50,"$1,176.12","$1,188.00",$0.00,$232.40,$0.00,$236.41,$0.00
629086,SUP,HCPCS C1713,,629086  -  PLATE BN 6 HL XTD HUM DIST MDL,"$1,650.00",$0.00,"$1,650.00",$742.50,"$1,177.61",$0.00,$284.29,$0.00,$0.00,$288.90,"$1,650.00",$0.00,$825.00,"$1,306.80","$1,320.00",$0.00,$258.23,$0.00,$262.68,$0.00
629088,SUP,HCPCS C1713,,629088  -  PLATE BN XTD HUM DIST MDL,"$1,815.00",$0.00,"$1,815.00",$816.75,"$1,295.37",$0.00,$312.72,$0.00,$0.00,$317.79,"$1,815.00",$0.00,$907.50,"$1,437.48","$1,452.00",$0.00,$284.05,$0.00,$288.95,$0.00
629104,SUP,HCPCS C1713,,629104  -  PLATE BN 4 HL HUM MDL POST DIST,"$1,485.00",$0.00,"$1,485.00",$668.25,"$1,059.84",$0.00,$255.86,$0.00,$0.00,$260.01,"$1,485.00",$0.00,$742.50,"$1,176.12","$1,188.00",$0.00,$232.40,$0.00,$236.41,$0.00
629106,SUP,HCPCS C1713,,629106  -  DIST. POST. MED. HUM. PL. 6 HOLE / LEFT,"$1,650.00",$0.00,"$1,650.00",$742.50,"$1,177.61",$0.00,$284.29,$0.00,$0.00,$288.90,"$1,650.00",$0.00,$825.00,"$1,306.80","$1,320.00",$0.00,$258.23,$0.00,$262.68,$0.00
629108,SUP,HCPCS C1713,,629108  -  PLATE BN 8 HL HUM MDL POST DIST,"$1,815.00",$0.00,"$1,815.00",$816.75,"$1,295.37",$0.00,$312.72,$0.00,$0.00,$317.79,"$1,815.00",$0.00,$907.50,"$1,437.48","$1,452.00",$0.00,$284.05,$0.00,$288.95,$0.00
629124,SUP,HCPCS C1713,,629124  -  PLATE BN 4 HL HUM MDL POST DIST,"$1,485.00",$0.00,"$1,485.00",$668.25,"$1,059.84",$0.00,$255.86,$0.00,$0.00,$260.01,"$1,485.00",$0.00,$742.50,"$1,176.12","$1,188.00",$0.00,$232.40,$0.00,$236.41,$0.00
629126,SUP,HCPCS C1713,,629126  -  PLATE BN 6 HL HUM MDL POST DIST,"$1,650.00",$0.00,"$1,650.00",$742.50,"$1,177.61",$0.00,$284.29,$0.00,$0.00,$288.90,"$1,650.00",$0.00,$825.00,"$1,306.80","$1,320.00",$0.00,$258.23,$0.00,$262.68,$0.00
629128,SUP,HCPCS C1713,,629128  -  PLATE BN 8 HL HUM MDL POST DIST,"$1,815.00",$0.00,"$1,815.00",$816.75,"$1,295.37",$0.00,$312.72,$0.00,$0.00,$317.79,"$1,815.00",$0.00,$907.50,"$1,437.48","$1,452.00",$0.00,$284.05,$0.00,$288.95,$0.00
629144,SUP,HCPCS C1713,,629144  -  PLATE BN 4 HL LT OLCRN,"$1,485.00",$0.00,"$1,485.00",$668.25,"$1,059.84",$0.00,$255.86,$0.00,$0.00,$260.01,"$1,485.00",$0.00,$742.50,"$1,176.12","$1,188.00",$0.00,$232.40,$0.00,$236.41,$0.00
629146,SUP,HCPCS C1713,,629146  -  PLATE BN 6 HL LT OLCRN,"$1,567.50",$0.00,"$1,567.50",$705.38,"$1,118.72",$0.00,$270.07,$0.00,$0.00,$274.46,"$1,567.50",$0.00,$783.75,"$1,241.46","$1,254.00",$0.00,$245.31,$0.00,$249.55,$0.00
629148,SUP,HCPCS C1713,,629148  -  PLATE BN 8 HL LT OLCRN,"$1,650.00",$0.00,"$1,650.00",$742.50,"$1,177.61",$0.00,$284.29,$0.00,$0.00,$288.90,"$1,650.00",$0.00,$825.00,"$1,306.80","$1,320.00",$0.00,$258.23,$0.00,$262.68,$0.00
629164,SUP,HCPCS C1713,,629164  -  OLECRANON PLATE 4 HOLE / RIGHT,"$1,485.00",$0.00,"$1,485.00",$668.25,"$1,059.84",$0.00,$255.86,$0.00,$0.00,$260.01,"$1,485.00",$0.00,$742.50,"$1,176.12","$1,188.00",$0.00,$232.40,$0.00,$236.41,$0.00
629166,SUP,HCPCS C1713,,629166  -  PLATE SS 6 HOLE LCK BONE OLCRN,"$1,567.50",$0.00,"$1,567.50",$705.38,"$1,118.72",$0.00,$270.07,$0.00,$0.00,$274.46,"$1,567.50",$0.00,$783.75,"$1,241.46","$1,254.00",$0.00,$245.31,$0.00,$249.55,$0.00
629168,SUP,HCPCS C1713,,629168  -  PLATE BN 8 HL RT OLCRN,"$1,650.00",$0.00,"$1,650.00",$742.50,"$1,177.61",$0.00,$284.29,$0.00,$0.00,$288.90,"$1,650.00",$0.00,$825.00,"$1,306.80","$1,320.00",$0.00,$258.23,$0.00,$262.68,$0.00
629184,SUP,HCPCS C1713,,629184  -  PLATE BN 4 HL HUM DIST MDL,"$1,485.00",$0.00,"$1,485.00",$668.25,"$1,059.84",$0.00,$255.86,$0.00,$0.00,$260.01,"$1,485.00",$0.00,$742.50,"$1,176.12","$1,188.00",$0.00,$232.40,$0.00,$236.41,$0.00
629186,SUP,HCPCS C1713,,629186  -  DIST. MED. HUM. PLATE 6 HOLE,"$1,650.00",$0.00,"$1,650.00",$742.50,"$1,177.61",$0.00,$284.29,$0.00,$0.00,$288.90,"$1,650.00",$0.00,$825.00,"$1,306.80","$1,320.00",$0.00,$258.23,$0.00,$262.68,$0.00
629188,SUP,HCPCS C1713,,629188  -  PLATE BN 8 HL HUM DIST MDL,"$1,815.00",$0.00,"$1,815.00",$816.75,"$1,295.37",$0.00,$312.72,$0.00,$0.00,$317.79,"$1,815.00",$0.00,$907.50,"$1,437.48","$1,452.00",$0.00,$284.05,$0.00,$288.95,$0.00
629204,SUP,HCPCS C1713,,629204  -  PLATE BN 109MM NS VARIAX 4 HL TI HUM LT DIST LAT,"$1,589.50",$0.00,"$1,589.50",$715.28,"$1,134.43",$0.00,$273.86,$0.00,$0.00,$278.31,"$1,589.50",$0.00,$794.75,"$1,258.88","$1,271.60",$0.00,$248.76,$0.00,$253.05,$0.00
629206,SUP,HCPCS C1713,,629206  -  PLATE BN 132MM NS VARIAX 6 HL TI HUM LT DIST LAT,"$1,765.50",$0.00,"$1,765.50",$794.48,"$1,260.04",$0.00,$304.19,$0.00,$0.00,$309.12,"$1,765.50",$0.00,$882.75,"$1,398.28","$1,412.40",$0.00,$276.30,$0.00,$281.07,$0.00
629208,SUP,HCPCS C1713,,629208  -  PLATE BN 156MM NS VARIAX 8 HL TI HUM LT DIST LAT,"$1,941.50",$0.00,"$1,941.50",$873.68,"$1,385.65",$0.00,$334.51,$0.00,$0.00,$339.94,"$1,941.50",$0.00,$970.75,"$1,537.67","$1,553.20",$0.00,$303.84,$0.00,$309.09,$0.00
629224,SUP,HCPCS C1713,,629224  -  PLATE BN 109MM NS VARIAX 4 HL TI HUM RT DIST LAT,"$1,589.50",$0.00,"$1,589.50",$715.28,"$1,134.43",$0.00,$273.86,$0.00,$0.00,$278.31,"$1,589.50",$0.00,$794.75,"$1,258.88","$1,271.60",$0.00,$248.76,$0.00,$253.05,$0.00
629226,SUP,HCPCS C1713,,629226  -  PLATE BN 132MM NS VARIAX 6 HL TI HUM RT DIST LAT,"$1,765.50",$0.00,"$1,765.50",$794.48,"$1,260.04",$0.00,$304.19,$0.00,$0.00,$309.12,"$1,765.50",$0.00,$882.75,"$1,398.28","$1,412.40",$0.00,$276.30,$0.00,$281.07,$0.00
629228,SUP,HCPCS C1713,,629228  -  PLATE BN 156MM NS VARIAX 8 HL TI HUM RT DIST LAT,"$1,941.50",$0.00,"$1,941.50",$873.68,"$1,385.65",$0.00,$334.51,$0.00,$0.00,$339.94,"$1,941.50",$0.00,$970.75,"$1,537.67","$1,553.20",$0.00,$303.84,$0.00,$309.09,$0.00
629244,SUP,HCPCS C1713,,629244  -  PLATE BN 105MM NS VARIAX 4 HL TI HUM LT P/L,"$1,589.50",$0.00,"$1,589.50",$715.28,"$1,134.43",$0.00,$273.86,$0.00,$0.00,$278.31,"$1,589.50",$0.00,$794.75,"$1,258.88","$1,271.60",$0.00,$248.76,$0.00,$253.05,$0.00
629246,SUP,HCPCS C1713,,629246  -  PLATE BN 128MM NS VARIAX 6 HL TI HUM LT P/L,"$1,765.50",$0.00,"$1,765.50",$794.48,"$1,260.04",$0.00,$304.19,$0.00,$0.00,$309.12,"$1,765.50",$0.00,$882.75,"$1,398.28","$1,412.40",$0.00,$276.30,$0.00,$281.07,$0.00
629248,SUP,HCPCS C1713,,629248  -  PLATE BN 150MM NS VARIAX 8 HL TI HUM LT P/L,"$1,941.50",$0.00,"$1,941.50",$873.68,"$1,385.65",$0.00,$334.51,$0.00,$0.00,$339.94,"$1,941.50",$0.00,$970.75,"$1,537.67","$1,553.20",$0.00,$303.84,$0.00,$309.09,$0.00
629264,SUP,HCPCS C1713,,629264  -  PLATE BN 105MM NS VARIAX 4 HL TI HUM RT P/L,"$1,589.50",$0.00,"$1,589.50",$715.28,"$1,134.43",$0.00,$273.86,$0.00,$0.00,$278.31,"$1,589.50",$0.00,$794.75,"$1,258.88","$1,271.60",$0.00,$248.76,$0.00,$253.05,$0.00
629266,SUP,HCPCS C1713,,629266  -  PLATE BN 128MM NS VARIAX 6 HL TI HUM RT P/L,"$1,765.50",$0.00,"$1,765.50",$794.48,"$1,260.04",$0.00,$304.19,$0.00,$0.00,$309.12,"$1,765.50",$0.00,$882.75,"$1,398.28","$1,412.40",$0.00,$276.30,$0.00,$281.07,$0.00
629268,SUP,HCPCS C1713,,629268  -  PLATE BN 150MM NS VARIAX 8 HL TI HUM RT P/L,"$1,941.50",$0.00,"$1,941.50",$873.68,"$1,385.65",$0.00,$334.51,$0.00,$0.00,$339.94,"$1,941.50",$0.00,$970.75,"$1,537.67","$1,553.20",$0.00,$303.84,$0.00,$309.09,$0.00
629284,SUP,HCPCS C1713,,629284  -  PLATE BN 96MM NS VARIAX 4 HL XTD TI HUM DIST MDL,"$1,589.50",$0.00,"$1,589.50",$715.28,"$1,134.43",$0.00,$273.86,$0.00,$0.00,$278.31,"$1,589.50",$0.00,$794.75,"$1,258.88","$1,271.60",$0.00,$248.76,$0.00,$253.05,$0.00
629286,SUP,HCPCS C1713,,629286  -  PLATE BN 120MM NS VARIAX 6 HL XTD TI HUM DIST MDL,"$1,765.50",$0.00,"$1,765.50",$794.48,"$1,260.04",$0.00,$304.19,$0.00,$0.00,$309.12,"$1,765.50",$0.00,$882.75,"$1,398.28","$1,412.40",$0.00,$276.30,$0.00,$281.07,$0.00
629288,SUP,HCPCS C1713,,629288  -  PLATE BN 143MM NS VARIAX 8 HL XTD TI HUM DIST MDL,"$1,941.50",$0.00,"$1,941.50",$873.68,"$1,385.65",$0.00,$334.51,$0.00,$0.00,$339.94,"$1,941.50",$0.00,$970.75,"$1,537.67","$1,553.20",$0.00,$303.84,$0.00,$309.09,$0.00
629304,SUP,HCPCS C1713,,629304  -  PLATE 104MM TI 4 SHFT HOLE VARIAX BONE LEFT POST MDL ELB,"$1,589.50",$0.00,"$1,589.50",$715.28,"$1,134.43",$0.00,$273.86,$0.00,$0.00,$278.31,"$1,589.50",$0.00,$794.75,"$1,258.88","$1,271.60",$0.00,$248.76,$0.00,$253.05,$0.00
629306,SUP,HCPCS C1713,,629306  -  PLATE 128MM TI 6 SHFT HOLE VARIAX BONE LEFT POST MDL ELB,"$1,765.50",$0.00,"$1,765.50",$794.48,"$1,260.04",$0.00,$304.19,$0.00,$0.00,$309.12,"$1,765.50",$0.00,$882.75,"$1,398.28","$1,412.40",$0.00,$276.30,$0.00,$281.07,$0.00
629308,SUP,HCPCS C1713,,629308  -  PLATE 151MM TI 8 SHFT HOLE VARIAX BONE LEFT POST MDL ELB,"$1,941.50",$0.00,"$1,941.50",$873.68,"$1,385.65",$0.00,$334.51,$0.00,$0.00,$339.94,"$1,941.50",$0.00,$970.75,"$1,537.67","$1,553.20",$0.00,$303.84,$0.00,$309.09,$0.00
629324,SUP,HCPCS C1713,,629324  -  PLATE 104MM TI 4 SHFT HOLE VARIAX BONE RIGHT POST MDL ELB,"$1,589.50",$0.00,"$1,589.50",$715.28,"$1,134.43",$0.00,$273.86,$0.00,$0.00,$278.31,"$1,589.50",$0.00,$794.75,"$1,258.88","$1,271.60",$0.00,$248.76,$0.00,$253.05,$0.00
629326,SUP,HCPCS C1713,,629326  -  PLATE 128MM TI 6 SHFT HOLE VARIAX BONE RIGHT POST MDL ELB,"$1,765.50",$0.00,"$1,765.50",$794.48,"$1,260.04",$0.00,$304.19,$0.00,$0.00,$309.12,"$1,765.50",$0.00,$882.75,"$1,398.28","$1,412.40",$0.00,$276.30,$0.00,$281.07,$0.00
629328,SUP,HCPCS C1713,,629328  -  PLATE 151MM TI 8 SHFT HOLE VARIAX BONE RIGHT POST MDL ELB,"$1,941.50",$0.00,"$1,941.50",$873.68,"$1,385.65",$0.00,$334.51,$0.00,$0.00,$339.94,"$1,941.50",$0.00,$970.75,"$1,537.67","$1,553.20",$0.00,$303.84,$0.00,$309.09,$0.00
629344,SUP,HCPCS C1713,,629344  -  PLATE BN 89MM NS VARIAX 4 HL TI OLCRN LT,"$1,589.50",$0.00,"$1,589.50",$715.28,"$1,134.43",$0.00,$273.86,$0.00,$0.00,$278.31,"$1,589.50",$0.00,$794.75,"$1,258.88","$1,271.60",$0.00,$248.76,$0.00,$253.05,$0.00
629346,SUP,HCPCS C1713,,629346  -  PLATE BN 113MM NS VARIAX 6 HL TI OLCRN LT,"$1,677.50",$0.00,"$1,677.50",$754.88,"$1,197.23",$0.00,$289.02,$0.00,$0.00,$293.72,"$1,677.50",$0.00,$838.75,"$1,328.58","$1,342.00",$0.00,$262.53,$0.00,$267.06,$0.00
629348,SUP,HCPCS C1713,,629348  -  PLATE BN 137MM NS VARIAX 8 HL TI OLCRN LT,"$1,765.50",$0.00,"$1,765.50",$794.48,"$1,260.04",$0.00,$304.19,$0.00,$0.00,$309.12,"$1,765.50",$0.00,$882.75,"$1,398.28","$1,412.40",$0.00,$276.30,$0.00,$281.07,$0.00
629364,SUP,HCPCS C1713,,629364  -  PLATE BN 89MM NS VARIAX 4 HL TI OLCRN RT,"$1,589.50",$0.00,"$1,589.50",$715.28,"$1,134.43",$0.00,$273.86,$0.00,$0.00,$278.31,"$1,589.50",$0.00,$794.75,"$1,258.88","$1,271.60",$0.00,$248.76,$0.00,$253.05,$0.00
629366,SUP,HCPCS C1713,,629366  -  PLATE BN 113MM NS VARIAX 6 HL TI OLCRN RT,"$1,677.50",$0.00,"$1,677.50",$754.88,"$1,197.23",$0.00,$289.02,$0.00,$0.00,$293.72,"$1,677.50",$0.00,$838.75,"$1,328.58","$1,342.00",$0.00,$262.53,$0.00,$267.06,$0.00
629368,SUP,HCPCS C1713,,629368  -  PLATE BN 137MM NS VARIAX 8 HL TI OLCRN RT,"$1,765.50",$0.00,"$1,765.50",$794.48,"$1,260.04",$0.00,$304.19,$0.00,$0.00,$309.12,"$1,765.50",$0.00,$882.75,"$1,398.28","$1,412.40",$0.00,$276.30,$0.00,$281.07,$0.00
629384,SUP,HCPCS C1713,,629384  -  PLATE BN 92MM NS VARIAX 4 HL TI HUM DIST MDL,"$1,589.50",$0.00,"$1,589.50",$715.28,"$1,134.43",$0.00,$273.86,$0.00,$0.00,$278.31,"$1,589.50",$0.00,$794.75,"$1,258.88","$1,271.60",$0.00,$248.76,$0.00,$253.05,$0.00
629385,SUP,Custom 27203010,,629385  -  STYLET LEAD STR BALL TAPER .016IN 85CM KIT EXTEND KNOB,$16.00,$0.00,$16.00,$0.00,$11.42,$0.00,$0.00,$0.00,$0.00,$0.00,$16.00,$0.00,$8.00,$12.67,$12.80,$0.00,$0.00,$0.00,$0.00,$0.00
629386,SUP,HCPCS C1713,,629386  -  PLATE BN 116MM NS VARIAX 6 HL TI HUM DIST MDL,"$1,765.50",$0.00,"$1,765.50",$794.48,"$1,260.04",$0.00,$304.19,$0.00,$0.00,$309.12,"$1,765.50",$0.00,$882.75,"$1,398.28","$1,412.40",$0.00,$276.30,$0.00,$281.07,$0.00
629388,SUP,HCPCS C1713,,629388  -  PLATE BN 139MM NS VARIAX 8 HL TI HUM DIST MDL,"$1,941.50",$0.00,"$1,941.50",$873.68,"$1,385.65",$0.00,$334.51,$0.00,$0.00,$339.94,"$1,941.50",$0.00,$970.75,"$1,537.67","$1,553.20",$0.00,$303.84,$0.00,$309.09,$0.00
Jun-25,SUP,Custom 27803010,,06-3625  -  HEAD FEM +2.5MM OFST CTPR 36MM STRL LFIT ANTM COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
631400,SUP,Custom 27203010,,631400  -  PARTICLES EMBL TRFL KT LQ SYS NBCA 2GM,"$10,375.00",$0.00,"$10,375.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$10,375.00",$0.00,"$5,187.50","$8,217.00","$8,300.00",$0.00,$0.00,$0.00,$0.00,$0.00
631500,SUP,Custom 27203010,,631500  -  PARTICLES EMBL TRFL KT LQ SYS NBCA 1GM,"$8,099.68",$0.00,"$8,099.68",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,099.68",$0.00,"$4,049.84","$6,414.95","$6,479.74",$0.00,$0.00,$0.00,$0.00,$0.00
633000,SUP,HCPCS C1884,,COIL EMBL 2MM .014IN TRFL STRG PSH 2CM PLTN NRVSC,$172.50,$0.00,$172.50,$77.63,$123.11,$0.00,$29.72,$0.00,$0.00,$30.20,$172.50,$0.00,$86.25,$136.62,$138.00,$0.00,$27.00,$0.00,$27.46,$0.00
633340,SUP,HCPCS C1884,,COIL EMBL 5MM TRFL PSH CMPLX SHP,$389.50,$0.00,$389.50,$175.28,$277.99,$0.00,$67.11,$0.00,$0.00,$68.20,$389.50,$0.00,$194.75,$308.48,$311.60,$0.00,$60.96,$0.00,$62.01,$0.00
633360,SUP,HCPCS C1884,,COIL EMBL 60MM 7MM TRFL OCL PSH CMPLX SHP NYL,$389.50,$0.00,$389.50,$175.28,$277.99,$0.00,$67.11,$0.00,$0.00,$68.20,$389.50,$0.00,$194.75,$308.48,$311.60,$0.00,$60.96,$0.00,$62.01,$0.00
635002,SUP,Custom 27803010,,635002  -  SYRINGE INFLAT/DEFLATION INDEFLATOR TRUFILL DCS II PLATINUM,$674.40,$0.00,$674.40,$0.00,$481.32,$0.00,$0.00,$0.00,$0.00,$0.00,$674.40,$0.00,$337.20,$534.12,$539.52,$0.00,$0.00,$0.00,$0.00,$0.00
636032,SUP,HCPCS C1713,,636032  -  SPACER 636032 PERIMETER XS 10X13X12MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
636053,SUP,HCPCS C1713,,636053  -  SPACER 636053 PERIMETER XS 10X15X13MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
636132,SUP,HCPCS C1713,,636132  -  SPACER 636132 PERIMETER XS 11X13X12MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
636153,SUP,HCPCS C1713,,636153  -  SPACER 636153 PERIMETER XS 11X15X13MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
636232,SUP,HCPCS C1713,,636232  -  SPACER 636232 PERIMETER XS 12X13X12MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
636253,SUP,HCPCS C1713,,636253  -  SPACER 636253 PERIMETER XS 12X15X13MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
636532,SUP,HCPCS C1713,,636532  -  SPACER 636532 PERIMETER XS 5X13X12MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
636553,SUP,HCPCS C1713,,636553  -  SPACER 636553 PERIMETER XS 5X15X13MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
636632,SUP,HCPCS C1713,,636632  -  SPACER 636632 PERIMETER XS 6X13X12MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
636653,SUP,HCPCS C1713,,636653  -  SPACER 636653 PERIMETER XS 6X15X13MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
636732,SUP,HCPCS C1713,,636732  -  SPACER 636732 PERIMETER XS 7X13X12MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
636753,SUP,HCPCS C1713,,636753  -  SPACER 636753 PERIMETER XS 7X15X13MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
636832,SUP,HCPCS C1713,,636832  -  SPACER 636832 PERIMETER XS 8X13X12MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
636853,SUP,HCPCS C1713,,636853  -  SPACER 636853 PERIMETER XS 8X15X13MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
636932,SUP,HCPCS C1713,,636932  -  SPACER 636932 PERIMETER XS 9X13X12MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
636953,SUP,HCPCS C1713,,636953  -  SPACER SPNL XS 15X13X9MM PRIMTR PEEK-OPTM LMBR INTRBD FS,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
Jun-75,SUP,Custom 27803010,,06-3675  -  HEAD FEM +7.5MM OFST CTPR 36MM STRL LFIT ANTM COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
650038,SUP,Custom 27203010,,CONTROL CHM LX SER LVL 1 2 HBA1C SYN VIGIL,$60.50,$0.00,$60.50,$0.00,$43.18,$0.00,$0.00,$0.00,$0.00,$0.00,$60.50,$0.00,$30.25,$47.92,$48.40,$0.00,$0.00,$0.00,$0.00,$0.00
653050,SUP,HCPCS C1762,,653050  -  GRAFT BONE SHORT 5X2.5CM DEMINERALIZED BONE MATRIX,"$6,800.00",$0.00,"$6,800.00",$0.00,"$4,853.16",$0.00,"$1,171.61",$0.00,$0.00,$0.00,"$6,800.00",$0.00,"$3,400.00","$5,385.60","$5,440.00",$0.00,"$1,064.20",$0.00,$0.00,$0.00
653100,SUP,HCPCS C1762,,653100  -  GRAFT BONE BIO BOAT ALLOGRAFT DEMINERALIZED BONE MATRIX 20ML,"$10,975.00",$0.00,"$10,975.00",$0.00,"$5,158.80",$0.00,"$1,890.94",$0.00,$0.00,$0.00,"$10,975.00",$0.00,"$5,487.50","$8,692.20","$8,780.00",$0.00,"$1,717.59",$0.00,$0.00,$0.00
Jun-97,SUP,Custom 27803010,,06-3697  -  HEAD FEMORAL C TAPER LOW FRICTION HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
Jun-99,SUP,Custom 27803010,,06-3699  -  HEAD FEMORAL -5 36MM C TAPER ANATOMIC LFIT COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
663940,SUP,Custom 27203010,,CALIBRATOR MLANLT IMMAGE ARY 1ML IMMUN,$543.75,$0.00,$543.75,$0.00,$388.07,$0.00,$0.00,$0.00,$0.00,$0.00,$543.75,$0.00,$271.88,$430.65,$435.00,$0.00,$0.00,$0.00,$0.00,$0.00
665040,SUP,Custom 27803010,,665040  -  ROD SPINAL 6MM 40MM UNION DIAPASON TITANIUM THORACOLUMBAR,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
665050,SUP,Custom 27803010,,665050  -  ROD SPINAL 6MM 50MM UNION DIAPASON TITANIUM THORACOLUMBAR,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
665060,SUP,Custom 27803010,,665060  -  ROD SPINAL 6MM 60MM UNION DIAPASON TITANIUM THORACOLUMBAR,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
665070,SUP,Custom 27803010,,665070  -  ROD SPINAL 6MM 70MM UNION TRIO THORACOLUMBAR,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
665080,SUP,Custom 27803010,,665080  -  ROD SPINAL 6MM 80MM UNION DIAPASON TITANIUM THORACOLUMBAR,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
665090,SUP,Custom 27803010,,665090  -  ROD SPINAL 6MM 90MM UNION TRIO THORACOLUMBAR,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
665100,SUP,Custom 27803010,,665100  -  ROD SPINAL 6MM 100MM UNION DIAPASON TITANIUM THORACOLUMBAR,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
665110,SUP,Custom 27803010,,665110  -  ROD SPINAL 6MM 110MM UNION DIAPASON TITANIUM THORACOLUMBAR,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
665120,SUP,Custom 27803010,,665120  -  ROD SPINAL 6MM 120MM UNION DIAPASON OSS TITANIUM,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
665130,SUP,Custom 27803010,,665130  -  ROD SPINAL 6MM 130MM UNION DIAPASON TITANIUM THORACOLUMBAR,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
665140,SUP,Custom 27803010,,665140  -  ROD SPINAL 6MM 140MM UNION TOP LOADING TRIO THORACOLUMBAR,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
665150,SUP,Custom 27803010,,665150  -  ROD SPINAL 6MM 150MM UNION DIAPASON TITANIUM THORACOLUMBAR,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
665160,SUP,Custom 27803010,,665160  -  ROD SPINAL 6MM 160MM UNION DIAPASON OSS TITANIUM,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
665170,SUP,Custom 27803010,,665170  -  ROD SPINAL 6MM 170MM UNION DIAPASON TITANIUM THORACOLUMBAR,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
665180,SUP,Custom 27803010,,665180  -  ROD SPINAL 6MM 180MM UNION DIAPASON OSS TITANIUM,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
665190,SUP,Custom 27803010,,665190  -  ROD SPINAL 190MM UNION DIAPASON TITANIUM,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
665200,SUP,Custom 27803010,,665200  -  ROD SPINAL 6MM 200MM UNION DIAPASON TITANIUM PEDICLE,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
665210,SUP,Custom 27803010,,665210  -  ROD SPINAL 210MM UNION DIAPASON OSS TITANIUM,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
665250,SUP,Custom 27803010,,665250  -  ROD SPINAL 250MM UNION DIAPASON OSS TITANIUM,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
665270,SUP,Custom 27803010,,665270  -  ROD SPINAL 270MM UNION DIAPASON OSS TITANIUM,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
665300,SUP,Custom 27803010,,665300  -  ROD SPINAL 300MM UNION DIAPASON OSS TITANIUM,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
665350,SUP,Custom 27803010,,665350  -  ROD SPINAL 6MM 350MM UNION TRIO THORACOLUMBAR,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
665400,SUP,Custom 27803010,,665400  -  ROD SPINAL 6MM 400MM UNION DIAPASON TITANIUM PEDICLE,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
665480,SUP,Custom 27803010,,665480  -  ROD SPINAL 6MM 480MM UNION DIAPASON TITANIUM,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
670001,SUP,HCPCS C1713,,670001  -  SCREW BONE 6.7MM 35MM OPUS SPNL CONICAL,"$1,675.90",$0.00,"$1,675.90",$754.16,"$1,196.09",$0.00,$288.75,$0.00,$0.00,$293.44,"$1,675.90",$0.00,$837.95,"$1,327.31","$1,340.72",$0.00,$262.28,$0.00,$266.80,$0.00
670002,SUP,HCPCS C1713,,670002  -  SCREW BONE 6.7MM 40MM OPUS SPNL CONICAL,"$1,675.90",$0.00,"$1,675.90",$754.16,"$1,196.09",$0.00,$288.75,$0.00,$0.00,$293.44,"$1,675.90",$0.00,$837.95,"$1,327.31","$1,340.72",$0.00,$262.28,$0.00,$266.80,$0.00
670003,SUP,HCPCS C1713,,670003  -  SCREW BONE 6.7MM 45MM OPUS SPNL CONICAL,"$1,675.90",$0.00,"$1,675.90",$754.16,"$1,196.09",$0.00,$288.75,$0.00,$0.00,$293.44,"$1,675.90",$0.00,$837.95,"$1,327.31","$1,340.72",$0.00,$262.28,$0.00,$266.80,$0.00
670004,SUP,HCPCS C1713,,670004  -  SCREW BONE 6.5MM 50MM OPUS SPNL CONICAL,"$1,675.90",$0.00,"$1,675.90",$754.16,"$1,196.09",$0.00,$288.75,$0.00,$0.00,$293.44,"$1,675.90",$0.00,$837.95,"$1,327.31","$1,340.72",$0.00,$262.28,$0.00,$266.80,$0.00
670005,SUP,HCPCS C1713,,670005  -  SCREW BONE 7.5MM 35MM OPUS SPNL CONICAL,"$1,675.90",$0.00,"$1,675.90",$754.16,"$1,196.09",$0.00,$288.75,$0.00,$0.00,$293.44,"$1,675.90",$0.00,$837.95,"$1,327.31","$1,340.72",$0.00,$262.28,$0.00,$266.80,$0.00
670006,SUP,HCPCS C1713,,670006  -  SCREW BONE 7.5MM 40MM OPUS SPNL CONICAL,"$1,675.90",$0.00,"$1,675.90",$754.16,"$1,196.09",$0.00,$288.75,$0.00,$0.00,$293.44,"$1,675.90",$0.00,$837.95,"$1,327.31","$1,340.72",$0.00,$262.28,$0.00,$266.80,$0.00
670007,SUP,HCPCS C1713,,670007  -  SCREW BONE 7.5MM 45MM OPUS SPNL CONICAL,"$1,675.90",$0.00,"$1,675.90",$754.16,"$1,196.09",$0.00,$288.75,$0.00,$0.00,$293.44,"$1,675.90",$0.00,$837.95,"$1,327.31","$1,340.72",$0.00,$262.28,$0.00,$266.80,$0.00
670008,SUP,HCPCS C1713,,670008  -  SCREW BONE 7.5MM 50MM OPUS SPNL CONICAL,"$1,675.90",$0.00,"$1,675.90",$754.16,"$1,196.09",$0.00,$288.75,$0.00,$0.00,$293.44,"$1,675.90",$0.00,$837.95,"$1,327.31","$1,340.72",$0.00,$262.28,$0.00,$266.80,$0.00
670009,SUP,HCPCS C1713,,670009  -  SCREW BONE 7.5MM 55MM OPUS SPNL CONICAL,"$1,675.90",$0.00,"$1,675.90",$754.16,"$1,196.09",$0.00,$288.75,$0.00,$0.00,$293.44,"$1,675.90",$0.00,$837.95,"$1,327.31","$1,340.72",$0.00,$262.28,$0.00,$266.80,$0.00
670015,SUP,HCPCS C1713,,670015  -  SCREW BONE 6.5MM 55MM OPUS SPNL CYLND,"$1,505.15",$0.00,"$1,505.15",$677.32,"$1,074.23",$0.00,$259.33,$0.00,$0.00,$263.54,"$1,505.15",$0.00,$752.58,"$1,192.08","$1,204.12",$0.00,$235.56,$0.00,$239.62,$0.00
670062,SUP,HCPCS C1713,,670062  -  SCREW BONE 5.5MM 35MM OPUS LNG SPNL HEX CONICAL,"$1,073.85",$0.00,"$1,073.85",$483.23,$766.41,$0.00,$185.02,$0.00,$0.00,$188.02,"$1,073.85",$0.00,$536.93,$850.49,$859.08,$0.00,$168.06,$0.00,$170.96,$0.00
670063,SUP,HCPCS C1713,,670063  -  SCREW BONE 5.5MM 40MM OPUS LNG SPNL HEX CONICAL,"$1,073.85",$0.00,"$1,073.85",$483.23,$766.41,$0.00,$185.02,$0.00,$0.00,$188.02,"$1,073.85",$0.00,$536.93,$850.49,$859.08,$0.00,$168.06,$0.00,$170.96,$0.00
670071,SUP,HCPCS C1713,,670071  -  SCREW BONE 6.5MM 35MM OPUS LNG SPNL HEX CONICAL,"$1,565.80",$0.00,"$1,565.80",$704.61,"$1,117.51",$0.00,$269.78,$0.00,$0.00,$274.16,"$1,565.80",$0.00,$782.90,"$1,240.11","$1,252.64",$0.00,$245.05,$0.00,$249.28,$0.00
670072,SUP,HCPCS C1713,,670072  -  SCREW BONE 6.5MM 40MM OPUS LNG SPNL HEX CONICAL,"$1,565.80",$0.00,"$1,565.80",$704.61,"$1,117.51",$0.00,$269.78,$0.00,$0.00,$274.16,"$1,565.80",$0.00,$782.90,"$1,240.11","$1,252.64",$0.00,$245.05,$0.00,$249.28,$0.00
670073,SUP,HCPCS C1713,,670073  -  SCREW BONE 6.5MM 45MM OPUS LNG SPNL HEX CONICAL,"$1,644.45",$0.00,"$1,644.45",$740.00,"$1,173.64",$0.00,$283.33,$0.00,$0.00,$287.93,"$1,644.45",$0.00,$822.23,"$1,302.40","$1,315.56",$0.00,$257.36,$0.00,$261.80,$0.00
670074,SUP,HCPCS C1713,,670074  -  SCREW BONE 6.5MM 50MM OPUS LNG SPNL HEX CONICAL,"$1,565.80",$0.00,"$1,565.80",$704.61,"$1,117.51",$0.00,$269.78,$0.00,$0.00,$274.16,"$1,565.80",$0.00,$782.90,"$1,240.11","$1,252.64",$0.00,$245.05,$0.00,$249.28,$0.00
670075,SUP,HCPCS C1713,,670075  -  SCREW BONE 6.5MM 55MM OPUS LNG SPNL HEX CONICAL,"$1,565.80",$0.00,"$1,565.80",$704.61,"$1,117.51",$0.00,$269.78,$0.00,$0.00,$274.16,"$1,565.80",$0.00,$782.90,"$1,240.11","$1,252.64",$0.00,$245.05,$0.00,$249.28,$0.00
670081,SUP,HCPCS C1713,,670081  -  SCREW BONE 7.5MM 35MM OPUS LNG SPNL HEX CONICAL,"$1,565.80",$0.00,"$1,565.80",$704.61,"$1,117.51",$0.00,$269.78,$0.00,$0.00,$274.16,"$1,565.80",$0.00,$782.90,"$1,240.11","$1,252.64",$0.00,$245.05,$0.00,$249.28,$0.00
670082,SUP,HCPCS C1713,,670082  -  SCREW BONE 7.5MM 40MM OPUS LNG SPNL HEX CONICAL,"$1,565.80",$0.00,"$1,565.80",$704.61,"$1,117.51",$0.00,$269.78,$0.00,$0.00,$274.16,"$1,565.80",$0.00,$782.90,"$1,240.11","$1,252.64",$0.00,$245.05,$0.00,$249.28,$0.00
670083,SUP,HCPCS C1713,,670083  -  SCREW BONE 7.5MM 45MM OPUS LNG SPNL HEX CONICAL,"$1,565.80",$0.00,"$1,565.80",$704.61,"$1,117.51",$0.00,$269.78,$0.00,$0.00,$274.16,"$1,565.80",$0.00,$782.90,"$1,240.11","$1,252.64",$0.00,$245.05,$0.00,$249.28,$0.00
670084,SUP,HCPCS C1713,,670084  -  SCREW BONE 7.5MM 50MM OPUS LNG SPNL HEX CONICAL,"$1,565.80",$0.00,"$1,565.80",$704.61,"$1,117.51",$0.00,$269.78,$0.00,$0.00,$274.16,"$1,565.80",$0.00,$782.90,"$1,240.11","$1,252.64",$0.00,$245.05,$0.00,$249.28,$0.00
670086,SUP,HCPCS C1713,,670086  -  SCREW BONE 7.5MM 55MM OPUS LNG SPNL HEX CONICAL,"$1,565.80",$0.00,"$1,565.80",$704.61,"$1,117.51",$0.00,$269.78,$0.00,$0.00,$274.16,"$1,565.80",$0.00,$782.90,"$1,240.11","$1,252.64",$0.00,$245.05,$0.00,$249.28,$0.00
670102,SUP,HCPCS C1713,,670102  -  SCREW BONE 8MM 40MM OPUS SPNL CONICAL,"$1,026.65",$0.00,"$1,026.65",$461.99,$732.72,$0.00,$176.89,$0.00,$0.00,$179.76,"$1,026.65",$0.00,$513.33,$813.11,$821.32,$0.00,$160.67,$0.00,$163.44,$0.00
670103,SUP,HCPCS C1713,,670103  -  SCREW BONE 8MM 45MM OPUS SPNL CONICAL,"$1,026.65",$0.00,"$1,026.65",$461.99,$732.72,$0.00,$176.89,$0.00,$0.00,$179.76,"$1,026.65",$0.00,$513.33,$813.11,$821.32,$0.00,$160.67,$0.00,$163.44,$0.00
670111,SUP,HCPCS C1713,,670111  -  SCREW BONE 9MM 35MM OPUS SPNL CONICAL,"$1,062.58",$0.00,"$1,062.58",$478.16,$758.36,$0.00,$183.08,$0.00,$0.00,$186.05,"$1,062.58",$0.00,$531.29,$841.56,$850.06,$0.00,$166.29,$0.00,$169.16,$0.00
670112,SUP,HCPCS C1713,,670112  -  SCREW BONE 9MM 40MM OPUS SPNL CONICAL,"$1,062.58",$0.00,"$1,062.58",$478.16,$758.36,$0.00,$183.08,$0.00,$0.00,$186.05,"$1,062.58",$0.00,$531.29,$841.56,$850.06,$0.00,$166.29,$0.00,$169.16,$0.00
670113,SUP,HCPCS C1713,,670113  -  SCREW BONE 9MM 45MM OPUS SPNL CONICAL,"$1,062.58",$0.00,"$1,062.58",$478.16,$758.36,$0.00,$183.08,$0.00,$0.00,$186.05,"$1,062.58",$0.00,$531.29,$841.56,$850.06,$0.00,$166.29,$0.00,$169.16,$0.00
670114,SUP,HCPCS C1713,,670114  -  SCREW BONE 9MM 50MM OPUS SPNL CONICAL,"$1,062.58",$0.00,"$1,062.58",$478.16,$758.36,$0.00,$183.08,$0.00,$0.00,$186.05,"$1,062.58",$0.00,$531.29,$841.56,$850.06,$0.00,$166.29,$0.00,$169.16,$0.00
670115,SUP,HCPCS C1713,,670115  -  SCREW BONE 9MM 55MM OPUS SPNL CONICAL,"$1,062.58",$0.00,"$1,062.58",$478.16,$758.36,$0.00,$183.08,$0.00,$0.00,$186.05,"$1,062.58",$0.00,$531.29,$841.56,$850.06,$0.00,$166.29,$0.00,$169.16,$0.00
670213,SUP,HCPCS C1713,,670213  -  SCREW BONE 5.5MM 35MM OPUS SPNL SGTL DUAL CUT,"$1,505.15",$0.00,"$1,505.15",$677.32,"$1,074.23",$0.00,$259.33,$0.00,$0.00,$263.54,"$1,505.15",$0.00,$752.58,"$1,192.08","$1,204.12",$0.00,$235.56,$0.00,$239.62,$0.00
670214,SUP,HCPCS C1713,,670214  -  SCREW BONE 5.5MM 40MM OPUS SPNL CONICAL,"$1,675.90",$0.00,"$1,675.90",$754.16,"$1,196.09",$0.00,$288.75,$0.00,$0.00,$293.44,"$1,675.90",$0.00,$837.95,"$1,327.31","$1,340.72",$0.00,$262.28,$0.00,$266.80,$0.00
670221,SUP,HCPCS C1713,,670221  -  PLATE LNG 35MM 2 HOLE OPUS BONE SPNL,"$2,619.45",$0.00,"$2,619.45","$1,178.75","$1,869.50",$0.00,$451.32,$0.00,$0.00,$458.64,"$2,619.45",$0.00,"$1,309.73","$2,074.60","$2,095.56",$0.00,$409.94,$0.00,$417.02,$0.00
670222,SUP,HCPCS C1713,,670222  -  PLATE SHRT 2 HOLE OPUS BONE SPNL,"$2,619.45",$0.00,"$2,619.45","$1,178.75","$1,869.50",$0.00,$451.32,$0.00,$0.00,$458.64,"$2,619.45",$0.00,"$1,309.73","$2,074.60","$2,095.56",$0.00,$409.94,$0.00,$417.02,$0.00
670223,SUP,HCPCS C1713,,670223  -  PLATE LNG 3 HOLE OPUS BONE SPNL,"$2,772.18",$0.00,"$2,772.18","$1,247.48","$1,978.50",$0.00,$477.63,$0.00,$0.00,$485.39,"$2,772.18",$0.00,"$1,386.09","$2,195.57","$2,217.74",$0.00,$433.85,$0.00,$441.33,$0.00
670224,SUP,HCPCS C1713,,670224  -  PLATE 90MM OPUS BONE SPNL,"$2,621.70",$0.00,"$2,621.70","$1,179.77","$1,871.11",$0.00,$451.71,$0.00,$0.00,$459.04,"$2,621.70",$0.00,"$1,310.85","$2,076.39","$2,097.36",$0.00,$410.30,$0.00,$417.37,$0.00
670225,SUP,HCPCS C1713,,670225  -  PLATE 105MM OPUS BONE SPNL,"$2,495.88",$0.00,"$2,495.88","$1,123.14","$1,781.31",$0.00,$430.03,$0.00,$0.00,$437.01,"$2,495.88",$0.00,"$1,247.94","$1,976.74","$1,996.70",$0.00,$390.60,$0.00,$397.34,$0.00
670226,SUP,HCPCS C1713,,670226  -  PLATE 120MM OPUS BONE SPNL,"$2,495.88",$0.00,"$2,495.88","$1,123.14","$1,781.31",$0.00,$430.03,$0.00,$0.00,$437.01,"$2,495.88",$0.00,"$1,247.94","$1,976.74","$1,996.70",$0.00,$390.60,$0.00,$397.34,$0.00
670282,SUP,Custom 27803010,,670282  -  CONCTR ROD 35MM 5.5MM OPUS LONGTOP SPNL,"$1,121.03",$0.00,"$1,121.03",$0.00,$800.08,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,121.03",$0.00,$560.51,$887.86,$896.82,$0.00,$0.00,$0.00,$0.00,$0.00
670283,SUP,Custom 27803010,,670283  -  CONCTR ROD 40MM 5.5MM OPUS LONGTOP SPNL,"$1,121.03",$0.00,"$1,121.03",$0.00,$800.08,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,121.03",$0.00,$560.51,$887.86,$896.82,$0.00,$0.00,$0.00,$0.00,$0.00
670301,SUP,HCPCS C1713,,670301  -  SCREW BONE 6.5MM 35MM OPUS SPNL LNG TOP CONICAL,"$1,565.80",$0.00,"$1,565.80",$704.61,"$1,117.51",$0.00,$269.78,$0.00,$0.00,$274.16,"$1,565.80",$0.00,$782.90,"$1,240.11","$1,252.64",$0.00,$245.05,$0.00,$249.28,$0.00
670302,SUP,HCPCS C1713,,670302  -  SCREW BONE 6.5MM 40MM OPUS SPNL LNG TOP CONICAL,"$1,565.80",$0.00,"$1,565.80",$704.61,"$1,117.51",$0.00,$269.78,$0.00,$0.00,$274.16,"$1,565.80",$0.00,$782.90,"$1,240.11","$1,252.64",$0.00,$245.05,$0.00,$249.28,$0.00
670303,SUP,HCPCS C1713,,670303  -  SCREW BONE 6.5MM 45MM OPUS SPNL LNG TOP CONICAL,"$1,644.45",$0.00,"$1,644.45",$740.00,"$1,173.64",$0.00,$283.33,$0.00,$0.00,$287.93,"$1,644.45",$0.00,$822.23,"$1,302.40","$1,315.56",$0.00,$257.36,$0.00,$261.80,$0.00
670304,SUP,HCPCS C1713,,670304  -  SCREW BONE 6.5MM 50MM OPUS SPNL LNG TOP CONICAL,"$1,565.80",$0.00,"$1,565.80",$704.61,"$1,117.51",$0.00,$269.78,$0.00,$0.00,$274.16,"$1,565.80",$0.00,$782.90,"$1,240.11","$1,252.64",$0.00,$245.05,$0.00,$249.28,$0.00
670305,SUP,HCPCS C1713,,670305  -  SCREW BONE 6.5MM 55MM OPUS SPNL LNG TOP CONICAL,"$1,565.80",$0.00,"$1,565.80",$704.61,"$1,117.51",$0.00,$269.78,$0.00,$0.00,$274.16,"$1,565.80",$0.00,$782.90,"$1,240.11","$1,252.64",$0.00,$245.05,$0.00,$249.28,$0.00
670311,SUP,HCPCS C1713,,670311  -  SCREW BONE 7.5MM 35MM OPUS SPNL LNG TOP CONICAL,"$1,565.80",$0.00,"$1,565.80",$704.61,"$1,117.51",$0.00,$269.78,$0.00,$0.00,$274.16,"$1,565.80",$0.00,$782.90,"$1,240.11","$1,252.64",$0.00,$245.05,$0.00,$249.28,$0.00
670312,SUP,HCPCS C1713,,670312  -  SCREW BONE 7.5MM 40MM OPUS SPNL LNG TOP CONICAL,"$1,565.80",$0.00,"$1,565.80",$704.61,"$1,117.51",$0.00,$269.78,$0.00,$0.00,$274.16,"$1,565.80",$0.00,$782.90,"$1,240.11","$1,252.64",$0.00,$245.05,$0.00,$249.28,$0.00
670313,SUP,HCPCS C1713,,670313  -  SCREW BONE 7.5MM 45MM OPUS SPNL LNG TOP CONICAL,"$1,565.80",$0.00,"$1,565.80",$704.61,"$1,117.51",$0.00,$269.78,$0.00,$0.00,$274.16,"$1,565.80",$0.00,$782.90,"$1,240.11","$1,252.64",$0.00,$245.05,$0.00,$249.28,$0.00
670314,SUP,HCPCS C1713,,670314  -  SCREW BONE 7.5MM 50MM OPUS SPNL LNG TOP CONICAL,"$1,565.80",$0.00,"$1,565.80",$704.61,"$1,117.51",$0.00,$269.78,$0.00,$0.00,$274.16,"$1,565.80",$0.00,$782.90,"$1,240.11","$1,252.64",$0.00,$245.05,$0.00,$249.28,$0.00
670315,SUP,HCPCS C1713,,670315  -  SCREW BONE 7.5MM 55MM OPUS SPNL LNG TOP CONICAL,"$1,565.80",$0.00,"$1,565.80",$704.61,"$1,117.51",$0.00,$269.78,$0.00,$0.00,$274.16,"$1,565.80",$0.00,$782.90,"$1,240.11","$1,252.64",$0.00,$245.05,$0.00,$249.28,$0.00
670371,SUP,HCPCS C1713,,670371  -  SCREW BONE 6.5MM 35MM OPUS SPNL LNG TOP LNG HEX CONICAL,"$1,073.85",$0.00,"$1,073.85",$483.23,$766.41,$0.00,$185.02,$0.00,$0.00,$188.02,"$1,073.85",$0.00,$536.93,$850.49,$859.08,$0.00,$168.06,$0.00,$170.96,$0.00
670372,SUP,HCPCS C1713,,670372  -  SCREW BONE 6.5MM 40MM OPUS SPNL LNG TOP LNG HEX CONICAL,"$1,073.85",$0.00,"$1,073.85",$483.23,$766.41,$0.00,$185.02,$0.00,$0.00,$188.02,"$1,073.85",$0.00,$536.93,$850.49,$859.08,$0.00,$168.06,$0.00,$170.96,$0.00
670373,SUP,HCPCS C1713,,670373  -  SCREW BONE 6.5MM 45MM OPUS SPNL LNG TOP LNG HEX CONICAL,"$1,073.85",$0.00,"$1,073.85",$483.23,$766.41,$0.00,$185.02,$0.00,$0.00,$188.02,"$1,073.85",$0.00,$536.93,$850.49,$859.08,$0.00,$168.06,$0.00,$170.96,$0.00
670374,SUP,HCPCS C1713,,670374  -  SCREW BONE 6.5MM 50MM OPUS SPNL LNG TOP LNG HEX CONICAL,"$1,073.85",$0.00,"$1,073.85",$483.23,$766.41,$0.00,$185.02,$0.00,$0.00,$188.02,"$1,073.85",$0.00,$536.93,$850.49,$859.08,$0.00,$168.06,$0.00,$170.96,$0.00
670381,SUP,HCPCS C1713,,670381  -  SCREW BONE 7.5MM 35MM OPUS SPNL LNG TOP LNG HEX CONICAL,"$1,073.85",$0.00,"$1,073.85",$483.23,$766.41,$0.00,$185.02,$0.00,$0.00,$188.02,"$1,073.85",$0.00,$536.93,$850.49,$859.08,$0.00,$168.06,$0.00,$170.96,$0.00
670382,SUP,HCPCS C1713,,670382  -  SCREW BONE 7.5MM 40MM OPUS SPNL LNG TOP LNG HEX CONICAL,"$1,073.85",$0.00,"$1,073.85",$483.23,$766.41,$0.00,$185.02,$0.00,$0.00,$188.02,"$1,073.85",$0.00,$536.93,$850.49,$859.08,$0.00,$168.06,$0.00,$170.96,$0.00
670383,SUP,HCPCS C1713,,670383  -  SCREW BONE 7.5MM 45MM OPUS SPNL LNG TOP LNG HEX CONICAL,"$1,073.85",$0.00,"$1,073.85",$483.23,$766.41,$0.00,$185.02,$0.00,$0.00,$188.02,"$1,073.85",$0.00,$536.93,$850.49,$859.08,$0.00,$168.06,$0.00,$170.96,$0.00
670384,SUP,HCPCS C1713,,670384  -  SCREW BONE 7.5MM 50MM OPUS SPNL LNG TOP LNG HEX CONICAL,"$1,073.85",$0.00,"$1,073.85",$483.23,$766.41,$0.00,$185.02,$0.00,$0.00,$188.02,"$1,073.85",$0.00,$536.93,$850.49,$859.08,$0.00,$168.06,$0.00,$170.96,$0.00
670501,SUP,HCPCS C1713,,670501  -  OPUS WASHER,$141.55,$0.00,$141.55,$63.70,$101.02,$0.00,$24.39,$0.00,$0.00,$24.78,$141.55,$0.00,$70.78,$112.11,$113.24,$0.00,$22.15,$0.00,$22.53,$0.00
670504,SUP,HCPCS C1713,,670504  -  OPUS PLATE NUT,$141.55,$0.00,$141.55,$63.70,$101.02,$0.00,$24.39,$0.00,$0.00,$24.78,$141.55,$0.00,$70.78,$112.11,$113.24,$0.00,$22.15,$0.00,$22.53,$0.00
670600,SUP,Custom 27803010,,670600  -  CONCTR ROD OPUS SPNL,"$1,062.58",$0.00,"$1,062.58",$0.00,$758.36,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,062.58",$0.00,$531.29,$841.56,$850.06,$0.00,$0.00,$0.00,$0.00,$0.00
670604,SUP,HCPCS C1713,,670604  -  OPUS ROD NUT,$199.95,$0.00,$199.95,$89.98,$142.70,$0.00,$34.45,$0.00,$0.00,$35.01,$199.95,$0.00,$99.98,$158.36,$159.96,$0.00,$31.29,$0.00,$31.83,$0.00
670610,SUP,Custom 27803010,,670610  -  CONCTR ROD OPUS OFFST SPNL,"$1,251.28",$0.00,"$1,251.28",$0.00,$893.03,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,251.28",$0.00,$625.64,$991.01,"$1,001.02",$0.00,$0.00,$0.00,$0.00,$0.00
671040,SUP,Custom 27803010,,671040  -  ROD SPNL 40MM OPUS,$707.65,$0.00,$707.65,$0.00,$505.05,$0.00,$0.00,$0.00,$0.00,$0.00,$707.65,$0.00,$353.83,$560.46,$566.12,$0.00,$0.00,$0.00,$0.00,$0.00
671050,SUP,Custom 27803010,,671050  -  ROD SPNL 50MM OPUS,$707.65,$0.00,$707.65,$0.00,$505.05,$0.00,$0.00,$0.00,$0.00,$0.00,$707.65,$0.00,$353.83,$560.46,$566.12,$0.00,$0.00,$0.00,$0.00,$0.00
671060,SUP,Custom 27803010,,671060  -  ROD SPNL 60MM OPUS,$707.65,$0.00,$707.65,$0.00,$505.05,$0.00,$0.00,$0.00,$0.00,$0.00,$707.65,$0.00,$353.83,$560.46,$566.12,$0.00,$0.00,$0.00,$0.00,$0.00
671070,SUP,Custom 27803010,,671070  -  ROD SPNL 70MM OPUS,$707.65,$0.00,$707.65,$0.00,$505.05,$0.00,$0.00,$0.00,$0.00,$0.00,$707.65,$0.00,$353.83,$560.46,$566.12,$0.00,$0.00,$0.00,$0.00,$0.00
671080,SUP,Custom 27803010,,671080  -  ROD SPNL 80MM OPUS,$707.65,$0.00,$707.65,$0.00,$505.05,$0.00,$0.00,$0.00,$0.00,$0.00,$707.65,$0.00,$353.83,$560.46,$566.12,$0.00,$0.00,$0.00,$0.00,$0.00
671090,SUP,Custom 27803010,,671090  -  ROD SPNL 90MM OPUS,$707.65,$0.00,$707.65,$0.00,$505.05,$0.00,$0.00,$0.00,$0.00,$0.00,$707.65,$0.00,$353.83,$560.46,$566.12,$0.00,$0.00,$0.00,$0.00,$0.00
671100,SUP,Custom 27803010,,671100  -  ROD SPNL 100MM OPUS,$707.65,$0.00,$707.65,$0.00,$505.05,$0.00,$0.00,$0.00,$0.00,$0.00,$707.65,$0.00,$353.83,$560.46,$566.12,$0.00,$0.00,$0.00,$0.00,$0.00
671110,SUP,Custom 27803010,,671110  -  ROD SPNL 110MM OPUS,$707.65,$0.00,$707.65,$0.00,$505.05,$0.00,$0.00,$0.00,$0.00,$0.00,$707.65,$0.00,$353.83,$560.46,$566.12,$0.00,$0.00,$0.00,$0.00,$0.00
671120,SUP,Custom 27803010,,671120  -  ROD SPNL 120MM OPUS,$707.65,$0.00,$707.65,$0.00,$505.05,$0.00,$0.00,$0.00,$0.00,$0.00,$707.65,$0.00,$353.83,$560.46,$566.12,$0.00,$0.00,$0.00,$0.00,$0.00
671140,SUP,Custom 27803010,,671140  -  ROD SPNL 140MM OPUS,$458.30,$0.00,$458.30,$0.00,$327.09,$0.00,$0.00,$0.00,$0.00,$0.00,$458.30,$0.00,$229.15,$362.97,$366.64,$0.00,$0.00,$0.00,$0.00,$0.00
671150,SUP,Custom 27803010,,671150  -  ROD SPNL 150MM OPUS,$707.65,$0.00,$707.65,$0.00,$505.05,$0.00,$0.00,$0.00,$0.00,$0.00,$707.65,$0.00,$353.83,$560.46,$566.12,$0.00,$0.00,$0.00,$0.00,$0.00
671180,SUP,Custom 27803010,,671180  -  ROD SPNL 180MM OPUS,$707.65,$0.00,$707.65,$0.00,$505.05,$0.00,$0.00,$0.00,$0.00,$0.00,$707.65,$0.00,$353.83,$560.46,$566.12,$0.00,$0.00,$0.00,$0.00,$0.00
671190,SUP,Custom 27803010,,671190  -  ROD SPNL 190MM OPUS TI,$707.65,$0.00,$707.65,$0.00,$505.05,$0.00,$0.00,$0.00,$0.00,$0.00,$707.65,$0.00,$353.83,$560.46,$566.12,$0.00,$0.00,$0.00,$0.00,$0.00
671210,SUP,Custom 27803010,,671210  -  ROD SPNL 210MM OPUS,$669.48,$0.00,$669.48,$0.00,$477.80,$0.00,$0.00,$0.00,$0.00,$0.00,$669.48,$0.00,$334.74,$530.23,$535.58,$0.00,$0.00,$0.00,$0.00,$0.00
671240,SUP,Custom 27803010,,671240  -  ROD SPNL 240MM OPUS,$638.03,$0.00,$638.03,$0.00,$455.36,$0.00,$0.00,$0.00,$0.00,$0.00,$638.03,$0.00,$319.01,$505.32,$510.42,$0.00,$0.00,$0.00,$0.00,$0.00
671270,SUP,Custom 27803010,,671270  -  ROD SPNL 270MM OPUS,$638.03,$0.00,$638.03,$0.00,$455.36,$0.00,$0.00,$0.00,$0.00,$0.00,$638.03,$0.00,$319.01,$505.32,$510.42,$0.00,$0.00,$0.00,$0.00,$0.00
671300,SUP,Custom 27803010,,671300  -  ROD SPNL 300MM OPUS,$638.03,$0.00,$638.03,$0.00,$455.36,$0.00,$0.00,$0.00,$0.00,$0.00,$638.03,$0.00,$319.01,$505.32,$510.42,$0.00,$0.00,$0.00,$0.00,$0.00
671600,SUP,Custom 27803010,,671600  -  ROD SPNL 600MM OPUS,$435.83,$0.00,$435.83,$0.00,$311.05,$0.00,$0.00,$0.00,$0.00,$0.00,$435.83,$0.00,$217.91,$345.18,$348.66,$0.00,$0.00,$0.00,$0.00,$0.00
695305,SUP,Custom 27803010,,695305  -  CONCTR ROD DIAPASON OSS OFFST SPNL,$660.48,$0.00,$660.48,$0.00,$471.38,$0.00,$0.00,$0.00,$0.00,$0.00,$660.48,$0.00,$330.24,$523.10,$528.38,$0.00,$0.00,$0.00,$0.00,$0.00
700351,SUP,Custom 27203010,,700351  -  BIT DRILL 180MM 2.5MM CLBRT AO FIT STRL,$287.38,$0.00,$287.38,$0.00,$205.10,$0.00,$0.00,$0.00,$0.00,$0.00,$287.38,$0.00,$143.69,$227.60,$229.90,$0.00,$0.00,$0.00,$0.00,$0.00
700353,SUP,Custom 27203010,,700353  -  BIT DRILL 195MM 3.5MM SPS TWST CLBRT AO FIT NONSTRL,$287.38,$0.00,$287.38,$0.00,$205.10,$0.00,$0.00,$0.00,$0.00,$0.00,$287.38,$0.00,$143.69,$227.60,$229.90,$0.00,$0.00,$0.00,$0.00,$0.00
700354,SUP,Custom 27203010,,700354  -  DRILL TWST LNG 4.5MM 195MM STRL AO FIT,$287.38,$0.00,$287.38,$0.00,$205.10,$0.00,$0.00,$0.00,$0.00,$0.00,$287.38,$0.00,$143.69,$227.60,$229.90,$0.00,$0.00,$0.00,$0.00,$0.00
700355,SUP,Custom 27203010,,700355  -  BIT DRILL 230MM 2.5MM SPS TWST CLBRT AO FIT NONSTRL,$287.38,$0.00,$287.38,$0.00,$205.10,$0.00,$0.00,$0.00,$0.00,$0.00,$287.38,$0.00,$143.69,$227.60,$229.90,$0.00,$0.00,$0.00,$0.00,$0.00
700356,SUP,Custom 27203010,,700356  -  BIT DRILL 180MM 3.2MM CLBRT AO FIT NONSTRL,$287.38,$0.00,$287.38,$0.00,$205.10,$0.00,$0.00,$0.00,$0.00,$0.00,$287.38,$0.00,$143.69,$227.60,$229.90,$0.00,$0.00,$0.00,$0.00,$0.00
700357,SUP,Custom 27203010,,700357  -  BIT DRILL 230MM 3.2MM AXSOS STD TWST CLBRT AO FIT STRL,$287.38,$0.00,$287.38,$0.00,$205.10,$0.00,$0.00,$0.00,$0.00,$0.00,$287.38,$0.00,$143.69,$227.60,$229.90,$0.00,$0.00,$0.00,$0.00,$0.00
700371,SUP,Custom 27203010,,700371  -  BIT DRILL 2MM TWST AO FIT,$220.00,$0.00,$220.00,$0.00,$157.01,$0.00,$0.00,$0.00,$0.00,$0.00,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$0.00,$0.00,$0.00,$0.00
700373,SUP,Custom 27203010,,700373  -  BIT DRL 2.7MM OSTN TWST AO FIT,$196.63,$0.00,$196.63,$0.00,$140.33,$0.00,$0.00,$0.00,$0.00,$0.00,$196.63,$0.00,$98.31,$155.73,$157.30,$0.00,$0.00,$0.00,$0.00,$0.00
700374,SUP,Custom 27203010,,700374  -  3.2MM AO FIT.TWIST DRILL BIT,$162.25,$0.00,$162.25,$0.00,$115.80,$0.00,$0.00,$0.00,$0.00,$0.00,$162.25,$0.00,$81.13,$128.50,$129.80,$0.00,$0.00,$0.00,$0.00,$0.00
700375,SUP,Custom 27203010,,700375  -  BIT DRILL 3.5MM TWST AO FIT,$220.00,$0.00,$220.00,$0.00,$157.01,$0.00,$0.00,$0.00,$0.00,$0.00,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$0.00,$0.00,$0.00,$0.00
700436,SUP,Custom 27203010,,700436  -  TAP SRG OD2.7 MM CORT SCR,$178.75,$0.00,$178.75,$0.00,$127.57,$0.00,$0.00,$0.00,$0.00,$0.00,$178.75,$0.00,$89.38,$141.57,$143.00,$0.00,$0.00,$0.00,$0.00,$0.00
700438,SUP,Custom 27203010,,700438  -  TAP SRG OD4.5 MM CANC SCR,$178.75,$0.00,$178.75,$0.00,$127.57,$0.00,$0.00,$0.00,$0.00,$0.00,$178.75,$0.00,$89.38,$141.57,$143.00,$0.00,$0.00,$0.00,$0.00,$0.00
700443,SUP,Custom 27203010,,700443  -  TAP SRG OSTEO FIT OD4.5 MM SCR,$342.38,$0.00,$342.38,$0.00,$244.35,$0.00,$0.00,$0.00,$0.00,$0.00,$342.38,$0.00,$171.19,$271.16,$273.90,$0.00,$0.00,$0.00,$0.00,$0.00
700447,SUP,Custom 27203010,,700447  -  TAP FIT SURG 6.5 MM SCR,$515.63,$0.00,$515.63,$0.00,$368.00,$0.00,$0.00,$0.00,$0.00,$0.00,$515.63,$0.00,$257.81,$408.38,$412.50,$0.00,$0.00,$0.00,$0.00,$0.00
700448,SUP,Custom 27203010,,700448  -  TAP FIT SURG 6.5 MM SCR,$618.75,$0.00,$618.75,$0.00,$441.60,$0.00,$0.00,$0.00,$0.00,$0.00,$618.75,$0.00,$309.38,$490.05,$495.00,$0.00,$0.00,$0.00,$0.00,$0.00
700708,SUP,Custom 27203010,,700708  -  TAP LAG SCR SURG HIP OHS,"$2,014.38",$0.00,"$2,014.38",$0.00,"$1,437.66",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,014.38",$0.00,"$1,007.19","$1,595.39","$1,611.50",$0.00,$0.00,$0.00,$0.00,$0.00
700721,SUP,Custom 27203010,,700721  -  TAP SURG OCS LAG SCR,"$1,560.63",$0.00,"$1,560.63",$0.00,"$1,113.82",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,560.63",$0.00,$780.31,"$1,236.02","$1,248.50",$0.00,$0.00,$0.00,$0.00,$0.00
702346,SUP,Custom 27203010,,702346  -  BIT DRL 3.5MM,$243.38,$0.00,$243.38,$0.00,$173.70,$0.00,$0.00,$0.00,$0.00,$0.00,$243.38,$0.00,$121.69,$192.76,$194.70,$0.00,$0.00,$0.00,$0.00,$0.00
702347,SUP,Custom 27203010,,702347  -  BIT DRILL 220MM 5MM TWST AO FIT STRL,$231.00,$0.00,$231.00,$0.00,$164.86,$0.00,$0.00,$0.00,$0.00,$0.00,$231.00,$0.00,$115.50,$182.95,$184.80,$0.00,$0.00,$0.00,$0.00,$0.00
702348,SUP,Custom 27203010,,702348  -  DRILL TWST 1.5MM 3.5MM AO FIT,$220.00,$0.00,$220.00,$0.00,$157.01,$0.00,$0.00,$0.00,$0.00,$0.00,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$0.00,$0.00,$0.00,$0.00
702350,SUP,Custom 27203010,,702350  -  BIT DRILL 235MM 4.2MM STRL,$243.38,$0.00,$243.38,$0.00,$173.70,$0.00,$0.00,$0.00,$0.00,$0.00,$243.38,$0.00,$121.69,$192.76,$194.70,$0.00,$0.00,$0.00,$0.00,$0.00
702446,SUP,Custom 27203010,,702446  -  DRILL SRG 4MM NS CNN AO CPLNG TWST,$512.88,$0.00,$512.88,$0.00,$366.04,$0.00,$0.00,$0.00,$0.00,$0.00,$512.88,$0.00,$256.44,$406.20,$410.30,$0.00,$0.00,$0.00,$0.00,$0.00
702447,SUP,Custom 27203010,,702447  -  BIT DRILL 5MM CANN TWST AO,$551.38,$0.00,$551.38,$0.00,$393.52,$0.00,$0.00,$0.00,$0.00,$0.00,$551.38,$0.00,$275.69,$436.69,$441.10,$0.00,$0.00,$0.00,$0.00,$0.00
702448,SUP,Custom 27203010,,702448  -  BIT DRILL 150MM 1.4MM NONSTRL DISP,$305.25,$0.00,$305.25,$0.00,$217.86,$0.00,$0.00,$0.00,$0.00,$0.00,$305.25,$0.00,$152.63,$241.76,$244.20,$0.00,$0.00,$0.00,$0.00,$0.00
702453,SUP,Custom 27203010,,702453  -  BIT DRILL 150MM 2MM ASNS CANN STRL,$272.25,$0.00,$272.25,$0.00,$194.30,$0.00,$0.00,$0.00,$0.00,$0.00,$272.25,$0.00,$136.13,$215.62,$217.80,$0.00,$0.00,$0.00,$0.00,$0.00
702459,SUP,HCPCS C1769,,702459  -  GWIRE ORTH 150MM 1.4MM ASNS 3 FEM HIP THRD STRL,$63.25,$0.00,$63.25,$34.34,$45.14,$0.00,$10.90,$0.00,$0.00,$11.07,$63.25,$0.00,$31.63,$50.09,$50.60,$0.00,$9.90,$0.00,$10.07,$0.00
702460,SUP,HCPCS C1769,,702460  -  GWIRE ORTH 150MM 2MM ASNS 3 FEM HIP THRD 5MM NONSTRL DISP,$61.88,$0.00,$61.88,$33.60,$44.16,$0.00,$10.66,$0.00,$0.00,$10.83,$61.88,$0.00,$30.94,$49.01,$49.50,$0.00,$9.68,$0.00,$9.85,$0.00
702461,SUP,HCPCS C1769,,702461  -  GWIRE ORTH 300MM 3MM ASNS 3 FEM HIP THRD DISP,$61.88,$0.00,$61.88,$33.60,$44.16,$0.00,$10.66,$0.00,$0.00,$10.83,$61.88,$0.00,$30.94,$49.01,$49.50,$0.00,$9.68,$0.00,$9.85,$0.00
702462,SUP,HCPCS C1769,,702462  -  GWIRE ORTH 300MM 3.2MM ASNS 3 FEM HIP THRD CANN SCR SYS STRL,$75.63,$0.00,$75.63,$41.06,$53.97,$0.00,$13.03,$0.00,$0.00,$13.24,$75.63,$0.00,$37.81,$59.90,$60.50,$0.00,$11.84,$0.00,$12.04,$0.00
702463,SUP,HCPCS C1769,,702463  -  GWIRE ORTH 300MM 3.2MM ASNS 3 FEM HIP THRD 5MM STRL DISP,$75.63,$0.00,$75.63,$41.06,$53.97,$0.00,$13.03,$0.00,$0.00,$13.24,$75.63,$0.00,$37.81,$59.90,$60.50,$0.00,$11.84,$0.00,$12.04,$0.00
702739,SUP,Custom 27203010,,702739  -  BIT DRL 4MM 180MM AO FIT,$728.75,$0.00,$728.75,$0.00,$520.11,$0.00,$0.00,$0.00,$0.00,$0.00,$728.75,$0.00,$364.38,$577.17,$583.00,$0.00,$0.00,$0.00,$0.00,$0.00
702741,SUP,Custom 27203010,,702741  -  BIT DRILL 125MM 2.3MM AXSOS CLBRT NONSTRL,$174.63,$0.00,$174.63,$0.00,$124.63,$0.00,$0.00,$0.00,$0.00,$0.00,$174.63,$0.00,$87.31,$138.31,$139.70,$0.00,$0.00,$0.00,$0.00,$0.00
702742,SUP,Custom 27203010,,702742  -  BIT DRILL 289MM 4.3MM AXSOS CLBRT NONSTRL,$167.75,$0.00,$167.75,$0.00,$119.72,$0.00,$0.00,$0.00,$0.00,$0.00,$167.75,$0.00,$83.88,$132.86,$134.20,$0.00,$0.00,$0.00,$0.00,$0.00
702743,SUP,Custom 27203010,,702743  -  BIT DRILL 289MM 4.3MM AXSOS CLBRT STRL,$214.50,$0.00,$214.50,$0.00,$153.09,$0.00,$0.00,$0.00,$0.00,$0.00,$214.50,$0.00,$107.25,$169.88,$171.60,$0.00,$0.00,$0.00,$0.00,$0.00
702771,SUP,Custom 27803010,,702771  -  TAP 3MM 130MM SURG,$174.63,$0.00,$174.63,$0.00,$124.63,$0.00,$0.00,$0.00,$0.00,$0.00,$174.63,$0.00,$87.31,$138.31,$139.70,$0.00,$0.00,$0.00,$0.00,$0.00
702772,SUP,Custom 27803010,,702772  -  TAP 4MM 140MM LCK SURG,$207.63,$0.00,$207.63,$0.00,$148.18,$0.00,$0.00,$0.00,$0.00,$0.00,$207.63,$0.00,$103.81,$164.44,$166.10,$0.00,$0.00,$0.00,$0.00,$0.00
702773,SUP,Custom 27803010,,702773  -  TAP 5MM 140MM LCK SURG AXSOS,$236.50,$0.00,$236.50,$0.00,$168.79,$0.00,$0.00,$0.00,$0.00,$0.00,$236.50,$0.00,$118.25,$187.31,$189.20,$0.00,$0.00,$0.00,$0.00,$0.00
702804,SUP,Custom 27803010,,702804  -  TAP 3.5MM SURG AXSOS,$280.50,$0.00,$280.50,$0.00,$200.19,$0.00,$0.00,$0.00,$0.00,$0.00,$280.50,$0.00,$140.25,$222.16,$224.40,$0.00,$0.00,$0.00,$0.00,$0.00
702806,SUP,Custom 27803010,,702806  -  TAP 4.5MM 180MM AO FIT SURG,$254.38,$0.00,$254.38,$0.00,$181.55,$0.00,$0.00,$0.00,$0.00,$0.00,$254.38,$0.00,$127.19,$201.47,$203.50,$0.00,$0.00,$0.00,$0.00,$0.00
702807,SUP,Custom 27803010,,702807  -  TAP 6.5MM 180MM AO FIT SURG CORT,$280.50,$0.00,$280.50,$0.00,$200.19,$0.00,$0.00,$0.00,$0.00,$0.00,$280.50,$0.00,$140.25,$222.16,$224.40,$0.00,$0.00,$0.00,$0.00,$0.00
702808,SUP,Custom 27803010,,702808  -  TAP 4.5MM SHRT 145MM AO FIT SURG CORT,$247.50,$0.00,$247.50,$0.00,$176.64,$0.00,$0.00,$0.00,$0.00,$0.00,$247.50,$0.00,$123.75,$196.02,$198.00,$0.00,$0.00,$0.00,$0.00,$0.00
702809,SUP,Custom 27803010,,702809  -  TAP 6.5MM SHRT 145MM AO FIT SURG CANC,$272.25,$0.00,$272.25,$0.00,$194.30,$0.00,$0.00,$0.00,$0.00,$0.00,$272.25,$0.00,$136.13,$215.62,$217.80,$0.00,$0.00,$0.00,$0.00,$0.00
702930,SUP,Custom 27203010,,702930  -  FORCEP SURG PLVC REPST 2X1 JAW,"$2,457.13",$0.00,"$2,457.13",$0.00,"$1,753.65",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,457.13",$0.00,"$1,228.56","$1,946.05","$1,965.70",$0.00,$0.00,$0.00,$0.00,$0.00
702996,SUP,Custom 27203010,,702996  -  BIT DRL 2.5MM 285MM AO CLBRT,$152.63,$0.00,$152.63,$0.00,$108.93,$0.00,$0.00,$0.00,$0.00,$0.00,$152.63,$0.00,$76.31,$120.88,$122.10,$0.00,$0.00,$0.00,$0.00,$0.00
702997,SUP,Custom 27203010,,702997  -  BIT DRILL 285MM 3.1MM CLBRT,$176.00,$0.00,$176.00,$0.00,$125.61,$0.00,$0.00,$0.00,$0.00,$0.00,$176.00,$0.00,$88.00,$139.39,$140.80,$0.00,$0.00,$0.00,$0.00,$0.00
703176,SUP,Custom 27203010,,703176  -  BIT DRILL 325MM 4.2MM AO STRL,$243.38,$0.00,$243.38,$0.00,$173.70,$0.00,$0.00,$0.00,$0.00,$0.00,$243.38,$0.00,$121.69,$192.76,$194.70,$0.00,$0.00,$0.00,$0.00,$0.00
703178,SUP,Custom 27203010,,703178  -  BIT DRILL 4.2MM TROCAR PNT AO STRL,$243.38,$0.00,$243.38,$0.00,$173.70,$0.00,$0.00,$0.00,$0.00,$0.00,$243.38,$0.00,$121.69,$192.76,$194.70,$0.00,$0.00,$0.00,$0.00,$0.00
703541,SUP,Custom 27203010,,703541  -  BIT DRILL 310MM 4.3MM CLBRT AO FIT,$331.38,$0.00,$331.38,$0.00,$236.50,$0.00,$0.00,$0.00,$0.00,$0.00,$331.38,$0.00,$165.69,$262.45,$265.10,$0.00,$0.00,$0.00,$0.00,$0.00
703542,SUP,Custom 27203010,,703542  -  BIT DRILL 310MM 3.2MM CLBRT AO FIT,$320.38,$0.00,$320.38,$0.00,$228.65,$0.00,$0.00,$0.00,$0.00,$0.00,$320.38,$0.00,$160.19,$253.74,$256.30,$0.00,$0.00,$0.00,$0.00,$0.00
703543,SUP,Custom 27203010,,703543  -  SET ORTH 4.5MM AO,$336.88,$0.00,$336.88,$0.00,$240.43,$0.00,$0.00,$0.00,$0.00,$0.00,$336.88,$0.00,$168.44,$266.81,$269.50,$0.00,$0.00,$0.00,$0.00,$0.00
703551,SUP,Custom 27803010,,703551  -  TAP 4.5MM 295MM AO FIT SURG CORT AXSOS,$475.75,$0.00,$475.75,$0.00,$339.54,$0.00,$0.00,$0.00,$0.00,$0.00,$475.75,$0.00,$237.88,$376.79,$380.60,$0.00,$0.00,$0.00,$0.00,$0.00
703553,SUP,Custom 27803010,,703553  -  TAP 6.5MM 295MM AO FIT SURG CANC AXSOS,$490.88,$0.00,$490.88,$0.00,$350.34,$0.00,$0.00,$0.00,$0.00,$0.00,$490.88,$0.00,$245.44,$388.78,$392.70,$0.00,$0.00,$0.00,$0.00,$0.00
703554,SUP,Custom 27803010,,703554  -  TAP 5MM 295MM LCK SURG,$489.50,$0.00,$489.50,$0.00,$349.36,$0.00,$0.00,$0.00,$0.00,$0.00,$489.50,$0.00,$244.75,$387.68,$391.60,$0.00,$0.00,$0.00,$0.00,$0.00
703561,SUP,HCPCS C1713,,703561  -  WIRE FX 2MM 315MM KRSH DRL TIP,$108.63,$0.00,$108.63,$48.88,$77.53,$0.00,$18.72,$0.00,$0.00,$19.02,$108.63,$0.00,$54.31,$86.03,$86.90,$0.00,$17.00,$0.00,$17.29,$0.00
703574,SUP,HCPCS C1713,,703574  -  TAP BN LCK SPHRCL TIP 4 MM SCR,$606.38,$0.00,$606.38,$272.87,$432.77,$0.00,$104.48,$0.00,$0.00,$106.17,$606.38,$0.00,$303.19,$480.25,$485.10,$0.00,$94.90,$0.00,$96.53,$0.00
703583,SUP,HCPCS C1713,,703583  -  WIRE FX 2MM 285MM KRSH DRL TIP,$173.25,$0.00,$173.25,$77.96,$123.65,$0.00,$29.85,$0.00,$0.00,$30.33,$173.25,$0.00,$86.63,$137.21,$138.60,$0.00,$27.11,$0.00,$27.58,$0.00
703585,SUP,Custom 27203010,,703585  -  BIT DRILL 3.1MM,$323.13,$0.00,$323.13,$0.00,$230.61,$0.00,$0.00,$0.00,$0.00,$0.00,$323.13,$0.00,$161.56,$255.92,$258.50,$0.00,$0.00,$0.00,$0.00,$0.00
703586,SUP,Custom 27203010,,703586  -  BIT DRL 2.5MM CLBRT AO,$323.13,$0.00,$323.13,$0.00,$230.61,$0.00,$0.00,$0.00,$0.00,$0.00,$323.13,$0.00,$161.56,$255.92,$258.50,$0.00,$0.00,$0.00,$0.00,$0.00
703588,SUP,Custom 27803010,,703588  -  TAP 3.5MM SURG CORT AXSOS,$576.13,$0.00,$576.13,$0.00,$411.18,$0.00,$0.00,$0.00,$0.00,$0.00,$576.13,$0.00,$288.06,$456.29,$460.90,$0.00,$0.00,$0.00,$0.00,$0.00
703589,SUP,Custom 27803010,,703589  -  TAP SURG AXSOS 4 MM CANC SCR,$576.13,$0.00,$576.13,$0.00,$411.18,$0.00,$0.00,$0.00,$0.00,$0.00,$576.13,$0.00,$288.06,$456.29,$460.90,$0.00,$0.00,$0.00,$0.00,$0.00
703590,SUP,Custom 27203010,,703590  -  DRILL SURG SM AO 3.5MM,$288.75,$0.00,$288.75,$0.00,$206.08,$0.00,$0.00,$0.00,$0.00,$0.00,$288.75,$0.00,$144.38,$228.69,$231.00,$0.00,$0.00,$0.00,$0.00,$0.00
703615,SUP,Custom 27203010,,703615  -  BIT DRL 4.3MM 264MM CLBRT,$251.63,$0.00,$251.63,$0.00,$179.58,$0.00,$0.00,$0.00,$0.00,$0.00,$251.63,$0.00,$125.81,$199.29,$201.30,$0.00,$0.00,$0.00,$0.00,$0.00
703616,SUP,Custom 27203010,,703616  -  BIT DRL 3.1MM 205MM CLBRT,$198.00,$0.00,$198.00,$0.00,$141.31,$0.00,$0.00,$0.00,$0.00,$0.00,$198.00,$0.00,$99.00,$156.82,$158.40,$0.00,$0.00,$0.00,$0.00,$0.00
703617,SUP,Custom 27203010,,703617  -  CALIBRATED DRILL BIT 03.1 X 285MM,$207.63,$0.00,$207.63,$0.00,$148.18,$0.00,$0.00,$0.00,$0.00,$0.00,$207.63,$0.00,$103.81,$164.44,$166.10,$0.00,$0.00,$0.00,$0.00,$0.00
703618,SUP,Custom 27203010,,703618  -  CALIBRATED DRILL BIT 04.3 X 315MM,$389.13,$0.00,$389.13,$0.00,$277.72,$0.00,$0.00,$0.00,$0.00,$0.00,$389.13,$0.00,$194.56,$308.19,$311.30,$0.00,$0.00,$0.00,$0.00,$0.00
703701,SUP,Custom 27203010,,703701  -  DRILL SURG AO CONNECT 2MM 2.7MM SCR,$220.00,$0.00,$220.00,$0.00,$157.01,$0.00,$0.00,$0.00,$0.00,$0.00,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$0.00,$0.00,$0.00,$0.00
703702,SUP,Custom 27203010,,703702  -  DRILL SURG AO CONNECT 2.6MM 3.5MM SCR,$220.00,$0.00,$220.00,$0.00,$157.01,$0.00,$0.00,$0.00,$0.00,$0.00,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$0.00,$0.00,$0.00,$0.00
703703,SUP,Custom 27203010,,703703  -  DRILL SURG OVR AO CONNECT 2.7 MM SCR,$233.75,$0.00,$233.75,$0.00,$166.83,$0.00,$0.00,$0.00,$0.00,$0.00,$233.75,$0.00,$116.88,$185.13,$187.00,$0.00,$0.00,$0.00,$0.00,$0.00
703704,SUP,Custom 27203010,,703704  -  BIT DRL 3.5MM STRL DISP,$233.75,$0.00,$233.75,$0.00,$166.83,$0.00,$0.00,$0.00,$0.00,$0.00,$233.75,$0.00,$116.88,$185.13,$187.00,$0.00,$0.00,$0.00,$0.00,$0.00
703705,SUP,Custom 27803010,,703705  -  TAP AO CONNECT SURG VARIAX 2.7 MM SCR NONSTRL,$288.75,$0.00,$288.75,$0.00,$206.08,$0.00,$0.00,$0.00,$0.00,$0.00,$288.75,$0.00,$144.38,$228.69,$231.00,$0.00,$0.00,$0.00,$0.00,$0.00
703706,SUP,Custom 27803010,,703706  -  TAP AO CONNECT SURG 3.5 MM SCR,$288.75,$0.00,$288.75,$0.00,$206.08,$0.00,$0.00,$0.00,$0.00,$0.00,$288.75,$0.00,$144.38,$228.69,$231.00,$0.00,$0.00,$0.00,$0.00,$0.00
704501,SUP,Custom 27203010,,704501  -  DRILL SURG SHRT 246MM CANN JCB FIT HANSSON ADLT 6.7MM,$680.63,$0.00,$680.63,$0.00,$485.76,$0.00,$0.00,$0.00,$0.00,$0.00,$680.63,$0.00,$340.31,$539.06,$544.50,$0.00,$0.00,$0.00,$0.00,$0.00
704502,SUP,Custom 27203010,,704502  -  DRILL SURG LNG 276MM CANN JCB FIT HANSSON ADLT 6.7MM,$680.63,$0.00,$680.63,$0.00,$485.76,$0.00,$0.00,$0.00,$0.00,$0.00,$680.63,$0.00,$340.31,$539.06,$544.50,$0.00,$0.00,$0.00,$0.00,$0.00
711050,SUP,Custom 27203010,,00711050  -  DEVICE SPECIMEN RETRIEVAL STANDARD 2.5MM 230CM 6X3CM STRONG,$222.50,$0.00,$222.50,$0.00,$158.80,$0.00,$0.00,$0.00,$0.00,$0.00,$222.50,$0.00,$111.25,$176.22,$178.00,$0.00,$0.00,$0.00,$0.00,$0.00
712001,SUP,Custom 27203010,,712001  -  CLIP PMP IRR MDNXT,$140.00,$0.00,$140.00,$0.00,$99.92,$0.00,$0.00,$0.00,$0.00,$0.00,$140.00,$0.00,$70.00,$110.88,$112.00,$0.00,$0.00,$0.00,$0.00,$0.00
714080,SUP,Custom 27203010,,REAGENT ANTI-LTTL C RH 4 BCLN 5ML MNCLN TUBE MCPLT BLOOD,$470.23,$0.00,$470.23,$0.00,$335.60,$0.00,$0.00,$0.00,$0.00,$0.00,$470.23,$0.00,$235.11,$372.42,$376.18,$0.00,$0.00,$0.00,$0.00,$0.00
719101,SUP,Custom 27203010,,REAGENT .8% RBC SRGSCRN 10ML AB SCRN BLOOD BANK,$80.35,$0.00,$80.35,$0.00,$57.35,$0.00,$0.00,$0.00,$0.00,$0.00,$80.35,$0.00,$40.18,$63.64,$64.28,$0.00,$0.00,$0.00,$0.00,$0.00
721543,SUP,Custom 27203010,,REAGENT ANALY CLTR CLEAN SOL 10L LH SER,$106.15,$0.00,$106.15,$0.00,$75.76,$0.00,$0.00,$0.00,$0.00,$0.00,$106.15,$0.00,$53.08,$84.07,$84.92,$0.00,$0.00,$0.00,$0.00,$0.00
725230,SUP,Custom 27203010,,REAGENT ANTI-FY LTTL B BLOOD BANK,"$1,350.63",$0.00,"$1,350.63",$0.00,$963.94,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,350.63",$0.00,$675.31,"$1,069.70","$1,080.50",$0.00,$0.00,$0.00,$0.00,$0.00
732420,SUP,HCPCS C1713,,732420  -  SCREW BN 2.4MM 20MM AU STERNALOCK BLU SLF DRL LCK STRNM CANC,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
733008,SUP,HCPCS C1768,,733008  -  GRAFT CARDIO STR 8MM 30CM SUTURE RETENTION UNIQUE,"$1,800.00",$0.00,"$1,800.00",$810.00,"$1,284.66",$0.00,$310.13,$0.00,$0.00,$315.17,"$1,800.00",$0.00,$900.00,"$1,425.60","$1,440.00",$0.00,$281.70,$0.00,$286.56,$0.00
733010,SUP,HCPCS C1768,,733010  -  GRAFT CV STRG 10MM 30CM GLWV SUT RTNT UNQ HYDROLYZABLE GELTN,"$1,202.25",$0.00,"$1,202.25",$541.01,$858.05,$0.00,$207.14,$0.00,$0.00,$210.50,"$1,202.25",$0.00,$601.13,$952.18,$961.80,$0.00,$188.15,$0.00,$191.40,$0.00
733026,SUP,HCPCS C1768,,733026  -  GRAFT CARDIO STR 26MM 30CM WOVEN VASCUTEK GELWEAVE THORAX,"$1,800.00",$0.00,"$1,800.00",$810.00,"$1,284.66",$0.00,$310.13,$0.00,$0.00,$315.17,"$1,800.00",$0.00,$900.00,"$1,425.60","$1,440.00",$0.00,$281.70,$0.00,$286.56,$0.00
733028,SUP,HCPCS C1768,,733028  -  GRAFT CARDIO STR 28MM 30CM SUTURE RETENTION UNIQUE,"$1,800.00",$0.00,"$1,800.00",$810.00,"$1,284.66",$0.00,$310.13,$0.00,$0.00,$315.17,"$1,800.00",$0.00,$900.00,"$1,425.60","$1,440.00",$0.00,$281.70,$0.00,$286.56,$0.00
733030,SUP,HCPCS C1768,,733030  -  GRAFT CARDIO STR 30MM 30CM SUTURE RETENTION UNIQUE,"$1,800.00",$0.00,"$1,800.00",$810.00,"$1,284.66",$0.00,$310.13,$0.00,$0.00,$315.17,"$1,800.00",$0.00,$900.00,"$1,425.60","$1,440.00",$0.00,$281.70,$0.00,$286.56,$0.00
733032,SUP,HCPCS C1768,,733032  -  GRAFT CARDIO STR 32MM 30CM SUTURE RETENTION UNIQUE,"$1,800.00",$0.00,"$1,800.00",$810.00,"$1,284.66",$0.00,$310.13,$0.00,$0.00,$315.17,"$1,800.00",$0.00,$900.00,"$1,425.60","$1,440.00",$0.00,$281.70,$0.00,$286.56,$0.00
740026,SUP,Custom 27203010,,740026  -  DEVICE PSTN STRL THE SEC AST 2 ADJ CLP BT FTBRD PLS KN DISP,$497.50,$0.00,$497.50,$0.00,$355.07,$0.00,$0.00,$0.00,$0.00,$0.00,$497.50,$0.00,$248.75,$394.02,$398.00,$0.00,$0.00,$0.00,$0.00,$0.00
Jun-00,SUP,Custom 27803010,,06-4000  -  HEAD FEM +0MM OFST CTPR 40MM STRL LFIT ANTM COCR HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
Jun-05,SUP,Custom 27803010,,06-4005  -  HEAD FEM +5MM OFST CTPR 40MM STRL LFIT ANTM COCR HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
3/11/4010,SUP,HCPCS C1713,,03-11-4010  -  SCREW BONE 4MM 10MM FIX ANGLE TITANIUM SPN CERV ANTERIOR,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3/12/4010,SUP,HCPCS C1713,,03-12-4010  -  SCREW BONE 4MM 10MM VAR ANG TITANIUM SPN CERV ANTERIOR,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
Jun-10,SUP,Custom 27803010,,06-4010  -  HEAD FEMORAL +10 40MM C TAPER ANATOMIC OFFST LFIT COCR HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
3/11/4011,SUP,HCPCS C1713,,03-11-4011  -  SCREW BONE 4MM 11MM FIX ANGLE TITANIUM SPN CERV ANTERIOR,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3/12/4011,SUP,HCPCS C1713,,03-12-4011  -  SCREW BONE 4MM 11MM VAR ANG TITANIUM SPN CERV ANTERIOR,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3/11/4012,SUP,HCPCS C1713,,03-11-4012  -  SCREW BONE 4MM 12MM FIX ANGLE TITANIUM SPN CERV ANTERIOR,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3/12/4012,SUP,HCPCS C1713,,03-12-4012  -  SCREW BONE 4MM 12MM VAR ANG TITANIUM SPN CERV ANTERIOR,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3/11/4013,SUP,HCPCS C1713,,03-11-4013  -  SCREW BONE 4MM 13MM FIX ANGLE TITANIUM SPN CERV ANTERIOR,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3/12/4013,SUP,HCPCS C1713,,03-12-4013  -  SCREW BONE 4MM 13MM VAR ANG TITANIUM SPN CERV ANTERIOR,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3/11/4014,SUP,HCPCS C1713,,03-11-4014  -  SCREW BONE 4MM 14MM FIX ANGLE TITANIUM SPN CERV ANTERIOR,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3/12/4014,SUP,HCPCS C1713,,03-12-4014  -  SCREW BONE 4MM 14MM VAR ANG TITANIUM SPN CERV ANTERIOR,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3/11/4015,SUP,HCPCS C1713,,03-11-4015  -  SCREW BONE 4MM 15MM FIX ANGLE TITANIUM SPN CERV ANTERIOR,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3/12/4015,SUP,HCPCS C1713,,03-12-4015  -  SCREW BONE 4MM 15MM VAR ANG TITANIUM SPN CERV ANTERIOR,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3/11/4016,SUP,HCPCS C1713,,03-11-4016  -  SCREW BONE 4MM 16MM FIX ANGLE TITANIUM SPN CERV ANTERIOR,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3/12/4016,SUP,HCPCS C1713,,03-12-4016  -  SCREW BONE 4MM 16MM VAR ANG TITANIUM SPN CERV ANTERIOR,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3/11/4017,SUP,HCPCS C1713,,03-11-4017  -  SCREW BONE 4MM 17MM FIX ANGLE TITANIUM SPN CERV ANTERIOR,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3/12/4017,SUP,HCPCS C1713,,03-12-4017  -  SCREW BONE 4MM 17MM VAR ANG TITANIUM SPN CERV ANTERIOR,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3/11/4018,SUP,HCPCS C1713,,03-11-4018  -  SCREW BONE 4MM 18MM FIX ANGLE TITANIUM SPN CERV ANTERIOR,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3/12/4018,SUP,HCPCS C1713,,03-12-4018  -  SCREW BONE 4MM 18MM VAR ANG TITANIUM SPN CERV ANTERIOR,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
773997,SUP,Custom 27203010,,CIRCUIT BRTHG HEAT WIRE 38IN,$299.35,$0.00,$299.35,$0.00,$213.65,$0.00,$0.00,$0.00,$0.00,$0.00,$299.35,$0.00,$149.68,$237.09,$239.48,$0.00,$0.00,$0.00,$0.00,$0.00
3/11/4019,SUP,HCPCS C1713,,03-11-4019  -  SCREW BONE 4MM 19MM FIX ANGLE TITANIUM SPN CERV ANTERIOR,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3/12/4019,SUP,HCPCS C1713,,03-12-4019  -  SCREW BONE 4MM 19MM VAR ANG TITANIUM SPN CERV ANTERIOR,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3/11/4020,SUP,HCPCS C1713,,03-11-4020  -  SCREW BONE 4MM 20MM FIX ANGLE TITANIUM SPN CERV ANTERIOR,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3/12/4020,SUP,HCPCS C1713,,03-12-4020  -  SCREW BONE 4MM 20MM VAR ANG TITANIUM SPN CERV ANTERIOR,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
775856,SUP,Custom 27203010,,CIRCUIT BRTHG 3100B F AND P 850 VIASYS,$329.58,$0.00,$329.58,$0.00,$235.22,$0.00,$0.00,$0.00,$0.00,$0.00,$329.58,$0.00,$164.79,$261.03,$263.66,$0.00,$0.00,$0.00,$0.00,$0.00
Jun-25,SUP,Custom 27803010,,06-4025  -  HEAD FEM +2.5MM OFST CTPR 40MM STRL LFIT ANTM COCR HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
Jun-75,SUP,Custom 27803010,,06-4075  -  HEAD FEM +7.5MM OFST CTPR 40MM STRL LFIT ANTM COCR HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
800070,SUP,Custom 27203010,,800070  -  SLIDE INSTRUCTIONAL HMRHD THD SYS,"$1,307.50",$0.00,"$1,307.50",$0.00,$933.16,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,307.50",$0.00,$653.75,"$1,035.54","$1,046.00",$0.00,$0.00,$0.00,$0.00,$0.00
800257,SUP,Custom 27203010,,TIP ANALY PIP ALQ,$382.50,$0.00,$382.50,$0.00,$272.99,$0.00,$0.00,$0.00,$0.00,$0.00,$382.50,$0.00,$191.25,$302.94,$306.00,$0.00,$0.00,$0.00,$0.00,$0.00
Jun-97,SUP,Custom 27803010,,06-4097  -  HEAD FEM -2.5MM OFST CTPR 40MM STRL LFIT ANTM COCR HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
Jun-99,SUP,Custom 27803010,,06-4099  -  HEAD FEM -5MM OFST CTPR 40MM STRL LFIT ANTM COCR HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
807603,SUP,Custom 27203010,,807603  -  FORCEPS BIPOL .5MM SMALL 8IN IRRIGATION DISPOSABLE,"$1,088.00",$0.00,"$1,088.00",$0.00,$776.51,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,088.00",$0.00,$544.00,$861.70,$870.40,$0.00,$0.00,$0.00,$0.00,$0.00
808006,SUP,HCPCS Q4130,,0808006  -  MATRIX TISSUE 8X8CM RECONSTRUCTIVE STRATTICE PIG DERMIS,"$4,617.50",$0.00,"$4,617.50",$0.00,"$3,295.51",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,617.50",$0.00,"$2,308.75","$3,657.06","$3,694.00",$0.00,$0.00,$0.00,$0.00,$0.00
810051,SUP,HCPCS C1771,,810051  -  SLING GYN GNCR TVT OBT INTROD SYS DEV FMALE STRS URN INCNT,"$1,362.50",$0.00,"$1,362.50",$613.13,$972.42,$0.00,$234.75,$0.00,$0.00,$238.56,"$1,362.50",$0.00,$681.25,"$1,079.10","$1,090.00",$0.00,$213.23,$0.00,$216.91,$0.00
810061,SUP,HCPCS C1769,,810061  -  GUIDE CATHETER 7FR 100CM RIGID TAPE TVT FMALE VAGINA,$347.63,$0.00,$347.63,$188.76,$248.10,$0.00,$59.89,$0.00,$0.00,$60.87,$347.63,$0.00,$173.81,$275.32,$278.10,$0.00,$54.40,$0.00,$55.34,$0.00
811558,SUP,Custom 27803010,,811558  -  X-10 CROSSLINK,"$4,640.30",$0.00,"$4,640.30",$0.00,"$3,311.78",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,640.30",$0.00,"$2,320.15","$3,675.12","$3,712.24",$0.00,$0.00,$0.00,$0.00,$0.00
815009,SUP,HCPCS Q4130,,815009  -  MATRIX TISSUE 15X8CM RECONSTRUCTIVE STRATTICE PIG DERMIS,"$7,235.00",$0.00,"$7,235.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,235.00",$0.00,"$3,617.50","$5,730.12","$5,788.00",$0.00,$0.00,$0.00,$0.00,$0.00
816001,SUP,HCPCS Q4130,,0816001  -  MATRIX TISSUE 16X8CM RECONSTRUCTIVE PLIABLE STRATTICE PIG,"$8,120.00",$0.00,"$8,120.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,120.00",$0.00,"$4,060.00","$6,431.04","$6,496.00",$0.00,$0.00,$0.00,$0.00,$0.00
816458,SUP,HCPCS C1713,,816458  -  CROSSLINK X-10/58MM,"$4,640.30",$0.00,"$4,640.30","$2,088.14","$3,311.78",$0.00,$799.50,$0.00,$0.00,$812.48,"$4,640.30",$0.00,"$2,320.15","$3,675.12","$3,712.24",$0.00,$726.21,$0.00,$738.74,$0.00
821707,SUP,Custom 27203010,,821707  -  KIT XTRN DRN CDMN CATH LMBR,$527.05,$0.00,$527.05,$0.00,$376.16,$0.00,$0.00,$0.00,$0.00,$0.00,$527.05,$0.00,$263.53,$417.42,$421.64,$0.00,$0.00,$0.00,$0.00,$0.00
821739,SUP,Custom 27803010,,821739  -  SET VENTRICULAR DRAINAGE TRAUMACATH L35 CM OD10 FR ODSEC3.3,$271.95,$0.00,$271.95,$0.00,$194.09,$0.00,$0.00,$0.00,$0.00,$0.00,$271.95,$0.00,$135.98,$215.38,$217.56,$0.00,$0.00,$0.00,$0.00,$0.00
821750,SUP,HCPCS C1729,,821750  -  CATHETER EXTERNAL DRAIN LARGE 1.9MM LATEX FREE BACTISEAL EVD,"$1,228.85",$0.00,"$1,228.85",$667.27,$877.03,$0.00,$211.72,$0.00,$0.00,$215.16,"$1,228.85",$0.00,$614.43,$973.25,$983.08,$0.00,$192.32,$0.00,$195.63,$0.00
858445,SUP,HCPCS C1713,,858445  -  SCREW BONE 4.5MM 45MM FIX ANGLE CD HORIZON M8 STAINLESS,"$1,659.00",$0.00,"$1,659.00",$746.55,"$1,184.03",$0.00,$285.84,$0.00,$0.00,$290.48,"$1,659.00",$0.00,$829.50,"$1,313.93","$1,327.20",$0.00,$259.63,$0.00,$264.11,$0.00
858450,SUP,HCPCS C1713,,858450  -  SCREW BONE 4.5MM 50MM FIX ANGLE CD HORIZON M8 STAINLESS,"$1,659.00",$0.00,"$1,659.00",$746.55,"$1,184.03",$0.00,$285.84,$0.00,$0.00,$290.48,"$1,659.00",$0.00,$829.50,"$1,313.93","$1,327.20",$0.00,$259.63,$0.00,$264.11,$0.00
862309,SUP,Custom 27203010,,862309  -  ELECTRODE MONOPOLAR 24.5FR 26FR HOOK BIPOL,$724.75,$0.00,$724.75,$0.00,$517.25,$0.00,$0.00,$0.00,$0.00,$0.00,$724.75,$0.00,$362.38,$574.00,$579.80,$0.00,$0.00,$0.00,$0.00,$0.00
873011,SUP,Custom 27203010,,873011  -  SPRDR SURG DURA MATER,$398.08,$0.00,$398.08,$0.00,$284.11,$0.00,$0.00,$0.00,$0.00,$0.00,$398.08,$0.00,$199.04,$315.28,$318.46,$0.00,$0.00,$0.00,$0.00,$0.00
874002,SUP,Custom 27803010,,874002  -  PIN DISTRACTION 10MM RELIANCE STERILE C,$825.00,$0.00,$825.00,$0.00,$588.80,$0.00,$0.00,$0.00,$0.00,$0.00,$825.00,$0.00,$412.50,$653.40,$660.00,$0.00,$0.00,$0.00,$0.00,$0.00
898716,SUP,Custom 27203010,,898716  -  TRAY CATH 16FR 350ML FOLEY URMTR LATEX,$40.06,$0.00,$40.06,$0.00,$28.59,$0.00,$0.00,$0.00,$0.00,$0.00,$40.06,$0.00,$20.03,$31.73,$32.04,$0.00,$0.00,$0.00,$0.00,$0.00
900284,SUP,Custom 27203010,,900284  -  SUTURE NABSB 2 KHC-5 BLU MXBRD BRAID,$65.00,$0.00,$65.00,$0.00,$46.39,$0.00,$0.00,$0.00,$0.00,$0.00,$65.00,$0.00,$32.50,$51.48,$52.00,$0.00,$0.00,$0.00,$0.00,$0.00
900334,SUP,Custom 27203010,,900334  -  SUTURE NABSB 2 C-2 BLU MXBRD BRAID,$65.00,$0.00,$65.00,$0.00,$46.39,$0.00,$0.00,$0.00,$0.00,$0.00,$65.00,$0.00,$32.50,$51.48,$52.00,$0.00,$0.00,$0.00,$0.00,$0.00
900339,SUP,Custom 27203010,,900339  -  DEVICE FX MAXFIRE REPR ZIPLOOP TCH MNSCS,"$1,085.00",$0.00,"$1,085.00",$0.00,$774.36,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,085.00",$0.00,$542.50,$859.32,$868.00,$0.00,$0.00,$0.00,$0.00,$0.00
901124,SUP,HCPCS C1894,,901124  -  INTRO SHTH PRTNL,$777.50,$0.00,$777.50,$422.18,$554.90,$0.00,$133.96,$0.00,$0.00,$136.13,$777.50,$0.00,$388.75,$615.78,$622.00,$0.00,$121.68,$0.00,$123.78,$0.00
902916,SUP,Custom 27203010,,902916  -  TRAY CATHETERIZATION 16FR URINE METER FOLEY STATLOCK LATEX,$38.29,$0.00,$38.29,$0.00,$27.33,$0.00,$0.00,$0.00,$0.00,$0.00,$38.29,$0.00,$19.15,$30.33,$30.63,$0.00,$0.00,$0.00,$0.00,$0.00
904754,SUP,Custom 27803010,,904754  -  DEVICE FX 7 50IN TOGGLELOC ZIPLOOP LNG LOOP XTD PE FEM,"$1,452.50",$0.00,"$1,452.50",$0.00,"$1,036.65",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,452.50",$0.00,$726.25,"$1,150.38","$1,162.00",$0.00,$0.00,$0.00,$0.00,$0.00
905256,SUP,HCPCS C1713,,905256  -  SCREW INTFR 9MM 25MM COMPOSITCP RND HD,"$1,122.50",$0.00,"$1,122.50",$505.13,$801.13,$0.00,$193.40,$0.00,$0.00,$196.54,"$1,122.50",$0.00,$561.25,$889.02,$898.00,$0.00,$175.67,$0.00,$178.70,$0.00
905257,SUP,HCPCS C1713,,905257  -  SCREW BABSR 9MM 30MM COMPOSITCP RND HD,"$1,122.50",$0.00,"$1,122.50",$505.13,$801.13,$0.00,$193.40,$0.00,$0.00,$196.54,"$1,122.50",$0.00,$561.25,$889.02,$898.00,$0.00,$175.67,$0.00,$178.70,$0.00
905261,SUP,HCPCS C1713,,905261  -  SCREW INTFR FT 10MM 30MM COMPOSITCP,"$1,122.50",$0.00,"$1,122.50",$505.13,$801.13,$0.00,$193.40,$0.00,$0.00,$196.54,"$1,122.50",$0.00,$561.25,$889.02,$898.00,$0.00,$175.67,$0.00,$178.70,$0.00
905263,SUP,HCPCS C1713,,905263  -  SCREW INTFR FT 11MM 30MM COMPOSITCP,"$1,122.50",$0.00,"$1,122.50",$505.13,$801.13,$0.00,$193.40,$0.00,$0.00,$196.54,"$1,122.50",$0.00,$561.25,$889.02,$898.00,$0.00,$175.67,$0.00,$178.70,$0.00
905732,SUP,Custom 27203010,,905732  -  CUTTER SRG 203MM MAXFIRE DISP,$460.00,$0.00,$460.00,$0.00,$328.30,$0.00,$0.00,$0.00,$0.00,$0.00,$460.00,$0.00,$230.00,$364.32,$368.00,$0.00,$0.00,$0.00,$0.00,$0.00
906520,SUP,Custom 27203010,,BAG PPR THK1/6IN C50LB LG KRAFT BRL,$0.35,$0.00,$0.35,$0.00,$0.25,$0.00,$0.00,$0.00,$0.00,$0.00,$0.35,$0.00,$0.18,$0.28,$0.28,$0.00,$0.00,$0.00,$0.00,$0.00
908469,SUP,HCPCS C1713,,908469  -  WASHER ORTH SPK 16MM WSHRLC XTD TIP TI TIB,"$1,450.00",$0.00,"$1,450.00",$652.50,"$1,034.87",$0.00,$249.83,$0.00,$0.00,$253.88,"$1,450.00",$0.00,$725.00,"$1,148.40","$1,160.00",$0.00,$226.93,$0.00,$230.84,$0.00
908846,SUP,HCPCS C1713,,908846  -  SCREW BN 6MM 46MM STRL WSHRLC TI ACL/PCL CANC ASCP,$502.50,$0.00,$502.50,$226.13,$358.63,$0.00,$86.58,$0.00,$0.00,$87.98,$502.50,$0.00,$251.25,$397.98,$402.00,$0.00,$78.64,$0.00,$80.00,$0.00
908850,SUP,HCPCS C1713,,908850  -  SCREW BN 6MM 50MM STRL WSHRLC TI ACL/PCL CANC ASCP,$502.50,$0.00,$502.50,$226.13,$358.63,$0.00,$86.58,$0.00,$0.00,$87.98,$502.50,$0.00,$251.25,$397.98,$402.00,$0.00,$78.64,$0.00,$80.00,$0.00
908860,SUP,HCPCS C1713,,908860  -  SCREW BN 6MM 60MM STRL WSHRLC TI ACL/PCL CANC ASCP,$502.50,$0.00,$502.50,$226.13,$358.63,$0.00,$86.58,$0.00,$0.00,$87.98,$502.50,$0.00,$251.25,$397.98,$402.00,$0.00,$78.64,$0.00,$80.00,$0.00
909848,SUP,Custom 27203010,,909848  -  KIT ASCP FX TOGGLELOC ZIPLOOP,"$3,657.50",$0.00,"$3,657.50",$0.00,"$2,610.36",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,657.50",$0.00,"$1,828.75","$2,896.74","$2,926.00",$0.00,$0.00,$0.00,$0.00,$0.00
912076,SUP,HCPCS C1713,,912076  -  ANCHOR SUT JUGGERKNOT SFT TIS,$990.00,$0.00,$990.00,$445.50,$706.56,$0.00,$170.57,$0.00,$0.00,$173.34,$990.00,$0.00,$495.00,$784.08,$792.00,$0.00,$154.94,$0.00,$157.61,$0.00
Jun-00,SUP,Custom 27803010,,06-4400  -  HEAD FEM +0MM OFST CTPR 44MM STRL LFIT ANTM COCR HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
Jun-05,SUP,Custom 27803010,,06-4405  -  HEAD FEM +5MM OFST CTPR 44MM STRL LFIT ANTM COCR HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
Jun-10,SUP,Custom 27803010,,06-4410  -  HEAD FEMORAL +10MM 44MM C TAPER LFIT COCR HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
921031,SUP,HCPCS C9250,,921031  -  SET SPRY 2 SPRY TIP CONCTR HOSE STRL FLTR TSMT DISP,$131.66,$0.00,$173.09,$59.25,$93.97,$164.85,$22.68,$0.00,$0.00,$23.05,$131.66,$173.09,$65.83,$104.27,$105.33,$131.66,$20.60,$0.00,$20.96,$164.85
Jun-25,SUP,Custom 27803010,,06-4425  -  HEAD FEMORAL +2.5MM 44MM C TAPER LFIT COCR HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
928950,SUP,HCPCS C1894,,0928950  -  MICROMICROINTRUDUCER 7CM 5.0FR FLECURA GUIDEWIRE,$78.50,$0.00,$78.50,$42.63,$56.03,$0.00,$13.53,$0.00,$0.00,$13.74,$78.50,$0.00,$39.25,$62.17,$62.80,$0.00,$12.29,$0.00,$12.50,$0.00
930740,SUP,Custom 27203010,,KIT IMMUN TST ELISA ANTI-HCV 480 TST,"$7,582.50",$0.00,"$7,582.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,582.50",$0.00,"$3,791.25","$6,005.34","$6,066.00",$0.00,$0.00,$0.00,$0.00,$0.00
933040,SUP,Custom 27203010,,REAGENT ANTI-HCV ELISA STOP SOL 500ML ANALY,$330.00,$0.00,$330.00,$0.00,$235.52,$0.00,$0.00,$0.00,$0.00,$0.00,$330.00,$0.00,$165.00,$261.36,$264.00,$0.00,$0.00,$0.00,$0.00,$0.00
Jun-75,SUP,Custom 27803010,,06-4475  -  HEAD FEMORAL +7.5MM 44MM C TAPER LFIT COCR HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
Jun-97,SUP,Custom 27803010,,06-4497  -  HEAD FEMORAL -2.5MM 44MM C TAPER LFIT COCR HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
Jun-99,SUP,Custom 27803010,,06-4499  -  HEAD FEMORAL -5MM 44MM C TAPER ANATOMIC LFIT V40 COCR,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
3/11/4513,SUP,HCPCS C1713,,03-11-4513  -  SCREW BONE 4.5MM 13MM FIX ANGLE TITANIUM SPN CERV ANTERIOR,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3/12/4513,SUP,HCPCS C1713,,03-12-4513  -  SCREW BONE 4.5MM 13MM VAR ANG TITANIUM SPN CERV ANTERIOR,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3/11/4515,SUP,HCPCS C1713,,03-11-4515  -  SCREW BONE 4.5MM 15MM FIX ANGLE TITANIUM SPN CERV ANTERIOR,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3/12/4515,SUP,HCPCS C1713,,03-12-4515  -  SCREW BONE 4.5MM 15MM VAR ANG TITANIUM SPN CERV ANTERIOR,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3/11/4517,SUP,HCPCS C1713,,03-11-4517  -  SCREW BONE 4.5MM 17MM FIX ANGLE TITANIUM SPN CERV ANTERIOR,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3/12/4517,SUP,HCPCS C1713,,03-12-4517  -  SCREW BONE 4.5MM 17MM VAR ANG TITANIUM SPN CERV ANTERIOR,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
982001,SUP,HCPCS Q4116,,982001  -  GRAFT SKN XTHICK 1X1CM ALDRM,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
982003,SUP,HCPCS Q4116,,982003  -  GRAFT SKN 2X1CM ALDRM RGNRT ACLR DRML MTRX,$547.50,$0.00,$547.50,$246.38,$390.75,$0.00,$94.33,$0.00,$0.00,$95.86,$547.50,$0.00,$273.75,$433.62,$438.00,$0.00,$85.68,$0.00,$87.16,$0.00
982007,SUP,HCPCS Q4116,,982007  -  MATRIX TISSUE XTHICK 4X1CM ALLOGRAFT REGENERATIVE FREEZE,$230.00,$0.00,$230.00,$103.50,$164.15,$0.00,$39.63,$0.00,$0.00,$40.27,$230.00,$0.00,$115.00,$182.16,$184.00,$0.00,$36.00,$0.00,$36.62,$0.00
982011,SUP,HCPCS Q4116,,982011  -  MATRIX TISSUE XTHICK 4X2CM ALLOGRAFT REGENERATIVE FREEZE,"$1,600.00",$0.00,"$1,600.00",$720.00,"$1,141.92",$0.00,$275.67,$0.00,$0.00,$280.15,"$1,600.00",$0.00,$800.00,"$1,267.20","$1,280.00",$0.00,$250.40,$0.00,$254.72,$0.00
982021,SUP,HCPCS Q4116,,982021  -  MATRIX TISSUE XTHICK 7X3CM ALLOGRAFT REGENERATIVE FREEZE,$129.40,$0.00,$129.40,$58.23,$92.36,$0.00,$22.30,$0.00,$0.00,$22.66,$129.40,$0.00,$64.70,$102.48,$103.52,$0.00,$20.25,$0.00,$20.60,$0.00
982024,SUP,HCPCS Q4116,,982024  -  GRAFT SKN XTHICK 12X2CM ALDRM,"$2,337.50",$0.00,"$2,337.50","$1,051.88","$1,668.27",$0.00,$402.74,$0.00,$0.00,$409.28,"$2,337.50",$0.00,"$1,168.75","$1,851.30","$1,870.00",$0.00,$365.82,$0.00,$372.13,$0.00
982028,SUP,HCPCS Q4116,,982028  -  MATRIX TISSUE XTHICK 7X4CM ALLOGRAFT REGENERATIVE FREEZE,$100.54,$0.00,$100.54,$45.24,$71.75,$0.00,$17.32,$0.00,$0.00,$17.60,$100.54,$0.00,$50.27,$79.63,$80.43,$0.00,$15.73,$0.00,$16.01,$0.00
982048,SUP,HCPCS Q4116,,982048  -  MATRIX TISSUE XTHICK 12X4CM ALLOGRAFT REGENERATIVE FREEZE,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
982060,SUP,HCPCS Q4116,,982060  -  MATRIX TISSUE XTHICK 10CMX5CMX2.3-3.3MM ALLOGRAFT,$100.20,$0.00,$100.20,$45.09,$71.51,$0.00,$17.26,$0.00,$0.00,$17.54,$100.20,$0.00,$50.10,$79.36,$80.16,$0.00,$15.68,$0.00,$15.95,$0.00
982070,SUP,HCPCS Q4116,,982070  -  MATRIX TISSUE XTHICK 12X6CM ALLOGRAFT REGENERATIVE FREEZE,$70.80,$0.00,$70.80,$31.86,$50.53,$0.00,$12.20,$0.00,$0.00,$12.40,$70.80,$0.00,$35.40,$56.07,$56.64,$0.00,$11.08,$0.00,$11.27,$0.00
982080,SUP,HCPCS Q4116,,982080  -  MATRIX TISSUE XTHICK 16X4CM ALLOGRAFT REGENERATIVE FREEZE,$78.09,$0.00,$78.09,$35.14,$55.73,$0.00,$13.45,$0.00,$0.00,$13.67,$78.09,$0.00,$39.04,$61.85,$62.47,$0.00,$12.22,$0.00,$12.43,$0.00
982096,SUP,HCPCS Q4116,,982096  -  MATRIX TISSUE XTHICK 12X8CM ALLOGRAFT REGENERATIVE FREEZE,$78.10,$0.00,$78.10,$35.14,$55.74,$0.00,$13.46,$0.00,$0.00,$13.67,$78.10,$0.00,$39.05,$61.86,$62.48,$0.00,$12.22,$0.00,$12.43,$0.00
982108,SUP,HCPCS Q4116,,982108  -  MATRIX TISSUE XTHICK 18X6CM ALLOGRAFT REGENERATIVE FREEZE,$92.57,$0.00,$92.57,$41.66,$66.07,$0.00,$15.95,$0.00,$0.00,$16.21,$92.57,$0.00,$46.28,$73.32,$74.06,$0.00,$14.49,$0.00,$14.74,$0.00
982128,SUP,HCPCS Q4116,,982128  -  MATRIX TISSUE XTHICK 16X8CM ALLOGRAFT REGENERATIVE FREEZE,$78.11,$0.00,$78.11,$35.15,$55.74,$0.00,$13.46,$0.00,$0.00,$13.68,$78.11,$0.00,$39.05,$61.86,$62.48,$0.00,$12.22,$0.00,$12.43,$0.00
982144,SUP,HCPCS Q4116,,982144  -  MATRIX TISSUE XTHICK 12X12CM ALLOGRAFT REGENERATIVE FREEZE,$105.87,$0.00,$105.87,$47.64,$75.56,$0.00,$18.24,$0.00,$0.00,$18.54,$105.87,$0.00,$52.93,$83.85,$84.69,$0.00,$16.57,$0.00,$16.85,$0.00
982196,SUP,HCPCS Q4116,,982196  -  MATRIX TISSUE XTHICK 16X6CM ALLOGRAFT REGENERATIVE FREEZE,$78.10,$0.00,$78.10,$35.14,$55.74,$0.00,$13.46,$0.00,$0.00,$13.67,$78.10,$0.00,$39.05,$61.86,$62.48,$0.00,$12.22,$0.00,$12.43,$0.00
982320,SUP,HCPCS Q4116,,982320  -  MATRIX TISSUE XTHICK 20X16CM ALLOGRAFT REGENERATIVE FREEZE,$78.12,$0.00,$78.12,$35.15,$55.75,$0.00,$13.46,$0.00,$0.00,$13.68,$78.12,$0.00,$39.06,$61.87,$62.49,$0.00,$12.23,$0.00,$12.44,$0.00
983102,SUP,Custom 27203010,,983102  -  COLLAR CERV CHLD SHRT CHIN REST TRCH OPN ADJ STRAP CNTCT,$67.45,$0.00,$67.45,$0.00,$48.14,$0.00,$0.00,$0.00,$0.00,$0.00,$67.45,$0.00,$33.73,$53.42,$53.96,$0.00,$0.00,$0.00,$0.00,$0.00
983104,SUP,Custom 27203010,,983104  -  COLLAR CERV CHLD REG ASPN CHIN REST TRCH OPN ADJ STRAP CNTCT,$75.97,$0.00,$75.97,$0.00,$54.22,$0.00,$0.00,$0.00,$0.00,$0.00,$75.97,$0.00,$37.98,$60.17,$60.77,$0.00,$0.00,$0.00,$0.00,$0.00
983106,SUP,Custom 27203010,,983106  -  COLLAR CERV CHLD TOT CHIN REST TRCH OPN ADJ STRAP CNTCT CLSR,$72.63,$0.00,$72.63,$0.00,$51.83,$0.00,$0.00,$0.00,$0.00,$0.00,$72.63,$0.00,$36.31,$57.52,$58.10,$0.00,$0.00,$0.00,$0.00,$0.00
983112,SUP,Custom 27203010,,983112  -  COLLAR CERV ADLT TLL CHIN REST TRCH OPN ADJ STRAP CNTCT CLSR,$65.80,$0.00,$65.80,$0.00,$46.96,$0.00,$0.00,$0.00,$0.00,$0.00,$65.80,$0.00,$32.90,$52.11,$52.64,$0.00,$0.00,$0.00,$0.00,$0.00
983114,SUP,Custom 27203010,,983114  -  COLLAR CERV ADLT XTALL CHIN REST TRCH OPN ADJ STRAP CNTCT,$65.80,$0.00,$65.80,$0.00,$46.96,$0.00,$0.00,$0.00,$0.00,$0.00,$65.80,$0.00,$32.90,$52.11,$52.64,$0.00,$0.00,$0.00,$0.00,$0.00
983119,SUP,Custom 27203010,,983119  -  COLLAR CERV ADLT LG BACK PNL PLST,$36.85,$0.00,$36.85,$0.00,$26.30,$0.00,$0.00,$0.00,$0.00,$0.00,$36.85,$0.00,$18.42,$29.19,$29.48,$0.00,$0.00,$0.00,$0.00,$0.00
983190,SUP,Custom 27203010,,983190  -  COLLAR IMMOB CERVICAL INFANT FOAM PAD TRACH OPEN FLEXIBLE TA,$65.80,$0.00,$65.80,$0.00,$46.96,$0.00,$0.00,$0.00,$0.00,$0.00,$65.80,$0.00,$32.90,$52.11,$52.64,$0.00,$0.00,$0.00,$0.00,$0.00
983195,SUP,Custom 27203010,,983195  -  COLLAR CERV INF REG CHIN REST TRCH OPN ADJ STRAP CNTCT CLSR,$72.28,$0.00,$72.28,$0.00,$51.59,$0.00,$0.00,$0.00,$0.00,$0.00,$72.28,$0.00,$36.14,$57.25,$57.82,$0.00,$0.00,$0.00,$0.00,$0.00
992003,SUP,HCPCS Q4116,,992003  -  MATRIX TISSUE THIN 2X1CM ALLOGRAFT REGENERATIVE FREEZE DRIED,$262.50,$0.00,$262.50,$118.13,$187.35,$0.00,$45.23,$0.00,$0.00,$45.96,$262.50,$0.00,$131.25,$207.90,$210.00,$0.00,$41.08,$0.00,$41.79,$0.00
992128,SUP,HCPCS Q4116,,992128  -  MATRIX TISSUE MEDIUM 16X8CM ALLOGRAFT REGENERATIVE FREEZE,$78.11,$0.00,$78.11,$35.15,$55.74,$0.00,$13.46,$0.00,$0.00,$13.68,$78.11,$0.00,$39.05,$61.86,$62.48,$0.00,$12.22,$0.00,$12.43,$0.00
992196,SUP,HCPCS Q4116,,992196  -  MATRIX TISSUE THIN 16X6CM ALLOGRAFT REGENERATIVE FREEZE,$78.10,$0.00,$78.10,$35.14,$55.74,$0.00,$13.46,$0.00,$0.00,$13.67,$78.10,$0.00,$39.05,$61.86,$62.48,$0.00,$12.22,$0.00,$12.43,$0.00
1001740,SUP,HCPCS C1769,,1001740  -  GUIDEWIRE VASCULAR STR .014IN 190CM 3CM RADIOPQ HI-TORQUE,$177.50,$0.00,$177.50,$96.38,$126.68,$0.00,$30.58,$0.00,$0.00,$31.08,$177.50,$0.00,$88.75,$140.58,$142.00,$0.00,$27.78,$0.00,$28.26,$0.00
1001741,SUP,HCPCS C1769,,1001741  -  GUIDEWIRE VASCULAR STR .014IN 300CM 3CM HI-TORQUE ALL STAR,$177.50,$0.00,$177.50,$96.38,$126.68,$0.00,$30.58,$0.00,$0.00,$31.08,$177.50,$0.00,$88.75,$140.58,$142.00,$0.00,$27.78,$0.00,$28.26,$0.00
1002005,SUP,Custom 27203010,,1002005  -  NON STERILE DISPOSABLE DRILL BIT,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
1004722,SUP,Custom 27804086,,1004722  -  GRAFT BN 11X11X5MM TRD CSPN,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
1004723,SUP,Custom 27804086,,1004723  -  GRAFT BN 11X11X6MM TRD CSPN,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
1004724,SUP,Custom 27804086,,1004724  -  GRAFT BN 11X11X7MM TRD CSPN,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
1004725,SUP,Custom 27804086,,1004725  -  GRAFT BN 11X11X8MM TRD CSPN,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
1004726,SUP,Custom 27804086,,1004726  -  GRAFT BN 11X11X9MM TRD CSPN,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
1004727,SUP,Custom 27804086,,1004727  -  GRAFT BN 11X11X10MM TRD CSPN,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
1004728,SUP,Custom 27804086,,1004728  -  GRAFT BN 11X11X11IN ALGRF SPNE,"$2,342.50",$0.00,"$2,342.50",$0.00,"$1,671.84",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,342.50",$0.00,"$1,171.25","$1,855.26","$1,874.00",$0.00,$0.00,$0.00,$0.00,$0.00
1004732,SUP,Custom 27804086,,1004732  -  GRAFT BN 14X11X5MM TRD CSPN,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
1004733,SUP,Custom 27804086,,1004733  -  GRAFT BN 14X11X6MM TRD CSPN,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
1004734,SUP,Custom 27804086,,1004734  -  GRAFT BN 7X11X14MM TRD CSPN,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
1004735,SUP,Custom 27804086,,1004735  -  GRAFT BN 14X11X8MM TRD CSPN,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
1004736,SUP,Custom 27804086,,1004736  -  GRAFT BN 14X11X9MM TRD CSPN,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
1004737,SUP,Custom 27804086,,1004737  -  GRAFT BN 14X11X10MM TRD CSPN,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
1004772,SUP,Custom 27804086,,1004772  -  GRAFT BN 20X9X8MM TRD PLIF,"$5,257.50",$0.00,"$5,257.50",$0.00,"$3,752.28",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,257.50",$0.00,"$2,628.75","$4,163.94","$4,206.00",$0.00,$0.00,$0.00,$0.00,$0.00
1004773,SUP,Custom 27804086,,1004773  -  GRAFT BN 20X9X10MM TRD PLIF ALGRF,"$5,257.50",$0.00,"$5,257.50",$0.00,"$3,752.28",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,257.50",$0.00,"$2,628.75","$4,163.94","$4,206.00",$0.00,$0.00,$0.00,$0.00,$0.00
1004774,SUP,Custom 27804086,,1004774  -  GRAFT BN 20X9X12MM TRD PLIF ALGRF,"$5,257.50",$0.00,"$5,257.50",$0.00,"$3,752.28",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,257.50",$0.00,"$2,628.75","$4,163.94","$4,206.00",$0.00,$0.00,$0.00,$0.00,$0.00
1004775,SUP,Custom 27804086,,1004775  -  GRAFT BN 20X9X14MM TRD PLIF,"$5,257.50",$0.00,"$5,257.50",$0.00,"$3,752.28",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,257.50",$0.00,"$2,628.75","$4,163.94","$4,206.00",$0.00,$0.00,$0.00,$0.00,$0.00
1004782,SUP,Custom 27804086,,1004782  -  GRAFT BN 20X11X8MM TRD TLIF,"$7,017.50",$0.00,"$7,017.50",$0.00,"$5,008.39",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,017.50",$0.00,"$3,508.75","$5,557.86","$5,614.00",$0.00,$0.00,$0.00,$0.00,$0.00
1004783,SUP,Custom 27804086,,1004783  -  GRAFT BN 20X11X10MM TRD TLIF,"$7,017.50",$0.00,"$7,017.50",$0.00,"$5,008.39",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,017.50",$0.00,"$3,508.75","$5,557.86","$5,614.00",$0.00,$0.00,$0.00,$0.00,$0.00
1004784,SUP,Custom 27804086,,1004784  -  GRAFT BN 20X11X12MM TRD TLIF,"$7,017.50",$0.00,"$7,017.50",$0.00,"$5,008.39",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,017.50",$0.00,"$3,508.75","$5,557.86","$5,614.00",$0.00,$0.00,$0.00,$0.00,$0.00
1004785,SUP,Custom 27804086,,1004785  -  GRAFT BN 20X11X14MM TRD TLIF,"$7,017.50",$0.00,"$7,017.50",$0.00,"$5,008.39",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,017.50",$0.00,"$3,508.75","$5,557.86","$5,614.00",$0.00,$0.00,$0.00,$0.00,$0.00
1004792,SUP,Custom 27804086,,1004792  -  GRAFT BN 25X9X8MM TRD PLIF ALGRF,"$5,257.50",$0.00,"$5,257.50",$0.00,"$3,752.28",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,257.50",$0.00,"$2,628.75","$4,163.94","$4,206.00",$0.00,$0.00,$0.00,$0.00,$0.00
1004793,SUP,Custom 27804086,,1004793  -  GRAFT BN 25X9X10MM TRD PLIF ALGRF,"$5,257.50",$0.00,"$5,257.50",$0.00,"$3,752.28",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,257.50",$0.00,"$2,628.75","$4,163.94","$4,206.00",$0.00,$0.00,$0.00,$0.00,$0.00
1004794,SUP,Custom 27804086,,1004794  -  GRAFT BN 25X9X12MM TRD PLIF,"$5,257.50",$0.00,"$5,257.50",$0.00,"$3,752.28",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,257.50",$0.00,"$2,628.75","$4,163.94","$4,206.00",$0.00,$0.00,$0.00,$0.00,$0.00
1004795,SUP,Custom 27804086,,1004795  -  GRAFT BN 25X9X14MM TRD PLIF,"$5,257.50",$0.00,"$5,257.50",$0.00,"$3,752.28",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,257.50",$0.00,"$2,628.75","$4,163.94","$4,206.00",$0.00,$0.00,$0.00,$0.00,$0.00
1004802,SUP,Custom 27804086,,1004802  -  GRAFT BN 25X11X8MM TRD TLIF,"$7,017.50",$0.00,"$7,017.50",$0.00,"$5,008.39",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,017.50",$0.00,"$3,508.75","$5,557.86","$5,614.00",$0.00,$0.00,$0.00,$0.00,$0.00
1004803,SUP,Custom 27804086,,1004803  -  GRAFT BN 25X11X10MM TLIF,"$7,017.50",$0.00,"$7,017.50",$0.00,"$5,008.39",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,017.50",$0.00,"$3,508.75","$5,557.86","$5,614.00",$0.00,$0.00,$0.00,$0.00,$0.00
1004804,SUP,Custom 27804086,,1004804  -  GRAFT BN 25X11X12MM TRD TLIF ALGRF,"$7,017.50",$0.00,"$7,017.50",$0.00,"$5,008.39",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,017.50",$0.00,"$3,508.75","$5,557.86","$5,614.00",$0.00,$0.00,$0.00,$0.00,$0.00
1004805,SUP,Custom 27804086,,1004805  -  GRAFT BN 25X11X14MM TLIF,"$7,017.50",$0.00,"$7,017.50",$0.00,"$5,008.39",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,017.50",$0.00,"$3,508.75","$5,557.86","$5,614.00",$0.00,$0.00,$0.00,$0.00,$0.00
1005203,SUP,HCPCS C1769,,1005203  -  GUIDEWIRE VASCULAR STR .014IN 300CM 5CM STEERABLE CORE TO,$207.50,$0.00,$207.50,$112.67,$148.09,$0.00,$35.75,$0.00,$0.00,$36.33,$207.50,$0.00,$103.75,$164.34,$166.00,$0.00,$32.47,$0.00,$33.03,$0.00
1005987,SUP,Custom 27203010,,MASK F/F DISP W/HEADSTRP PED,$58.40,$0.00,$58.40,$0.00,$41.68,$0.00,$0.00,$0.00,$0.00,$0.00,$58.40,$0.00,$29.20,$46.25,$46.72,$0.00,$0.00,$0.00,$0.00,$0.00
1007633,SUP,HCPCS C1713,,1007633  -  MESH SRG 10X6MM SPNE,"$2,617.50",$0.00,"$2,617.50","$1,177.88","$1,868.11",$0.00,$450.98,$0.00,$0.00,$458.30,"$2,617.50",$0.00,"$1,308.75","$2,073.06","$2,094.00",$0.00,$409.64,$0.00,$416.71,$0.00
1007634,SUP,HCPCS C1713,,1007634  -  MESH SRG 10X7MM SPNE,"$2,617.50",$0.00,"$2,617.50","$1,177.88","$1,868.11",$0.00,$450.98,$0.00,$0.00,$458.30,"$2,617.50",$0.00,"$1,308.75","$2,073.06","$2,094.00",$0.00,$409.64,$0.00,$416.71,$0.00
1007635,SUP,HCPCS C1713,,1007635  -  MESH SRG 10X8MM SPNE,"$2,617.50",$0.00,"$2,617.50","$1,177.88","$1,868.11",$0.00,$450.98,$0.00,$0.00,$458.30,"$2,617.50",$0.00,"$1,308.75","$2,073.06","$2,094.00",$0.00,$409.64,$0.00,$416.71,$0.00
1007636,SUP,HCPCS C1713,,1007636  -  MESH SRG 10X9MM SPNE,"$2,617.50",$0.00,"$2,617.50","$1,177.88","$1,868.11",$0.00,$450.98,$0.00,$0.00,$458.30,"$2,617.50",$0.00,"$1,308.75","$2,073.06","$2,094.00",$0.00,$409.64,$0.00,$416.71,$0.00
1007637,SUP,HCPCS C1713,,1007637  -  MESH SRG 10X10MM SPNE,"$2,617.50",$0.00,"$2,617.50","$1,177.88","$1,868.11",$0.00,$450.98,$0.00,$0.00,$458.30,"$2,617.50",$0.00,"$1,308.75","$2,073.06","$2,094.00",$0.00,$409.64,$0.00,$416.71,$0.00
1007639,SUP,HCPCS C1713,,1007639  -  MESH SRG 12X10MM SPNE,"$2,617.50",$0.00,"$2,617.50","$1,177.88","$1,868.11",$0.00,$450.98,$0.00,$0.00,$458.30,"$2,617.50",$0.00,"$1,308.75","$2,073.06","$2,094.00",$0.00,$409.64,$0.00,$416.71,$0.00
1007640,SUP,HCPCS C1713,,1007640  -  MESH SRG 10X14MM SPNE,"$2,617.50",$0.00,"$2,617.50","$1,177.88","$1,868.11",$0.00,$450.98,$0.00,$0.00,$458.30,"$2,617.50",$0.00,"$1,308.75","$2,073.06","$2,094.00",$0.00,$409.64,$0.00,$416.71,$0.00
1007643,SUP,HCPCS C1713,,1007643  -  MESH SRG 50X10MM SPNE,"$6,322.50",$0.00,"$6,322.50","$2,845.13","$4,512.37",$0.00,"$1,089.34",$0.00,$0.00,"$1,107.02","$6,322.50",$0.00,"$3,161.25","$5,007.42","$5,058.00",$0.00,$989.47,$0.00,"$1,006.54",$0.00
1007653,SUP,HCPCS C1713,,1007653  -  MESH SRG 12X6MM SPNE,"$2,617.50",$0.00,"$2,617.50","$1,177.88","$1,868.11",$0.00,$450.98,$0.00,$0.00,$458.30,"$2,617.50",$0.00,"$1,308.75","$2,073.06","$2,094.00",$0.00,$409.64,$0.00,$416.71,$0.00
1007654,SUP,HCPCS C1713,,1007654  -  MESH SRG 12X7MM SPNE,"$2,617.50",$0.00,"$2,617.50","$1,177.88","$1,868.11",$0.00,$450.98,$0.00,$0.00,$458.30,"$2,617.50",$0.00,"$1,308.75","$2,073.06","$2,094.00",$0.00,$409.64,$0.00,$416.71,$0.00
1007655,SUP,HCPCS C1713,,1007655  -  MESH SRG 12X8MM SPNE,"$2,617.50",$0.00,"$2,617.50","$1,177.88","$1,868.11",$0.00,$450.98,$0.00,$0.00,$458.30,"$2,617.50",$0.00,"$1,308.75","$2,073.06","$2,094.00",$0.00,$409.64,$0.00,$416.71,$0.00
1007656,SUP,HCPCS C1713,,1007656  -  MESH SRG 12X9MM SPNE,"$2,617.50",$0.00,"$2,617.50","$1,177.88","$1,868.11",$0.00,$450.98,$0.00,$0.00,$458.30,"$2,617.50",$0.00,"$1,308.75","$2,073.06","$2,094.00",$0.00,$409.64,$0.00,$416.71,$0.00
1007657,SUP,HCPCS C1713,,1007657  -  MESH SRG 10X12MM SPNE,"$2,617.50",$0.00,"$2,617.50","$1,177.88","$1,868.11",$0.00,$450.98,$0.00,$0.00,$458.30,"$2,617.50",$0.00,"$1,308.75","$2,073.06","$2,094.00",$0.00,$409.64,$0.00,$416.71,$0.00
1007659,SUP,HCPCS C1713,,1007659  -  MESH SRG 12X12MM SPNE,"$2,617.50",$0.00,"$2,617.50","$1,177.88","$1,868.11",$0.00,$450.98,$0.00,$0.00,$458.30,"$2,617.50",$0.00,"$1,308.75","$2,073.06","$2,094.00",$0.00,$409.64,$0.00,$416.71,$0.00
1007660,SUP,HCPCS C1713,,1007660  -  MESH SRG 12X14MM SPNE,"$2,617.50",$0.00,"$2,617.50","$1,177.88","$1,868.11",$0.00,$450.98,$0.00,$0.00,$458.30,"$2,617.50",$0.00,"$1,308.75","$2,073.06","$2,094.00",$0.00,$409.64,$0.00,$416.71,$0.00
1007663,SUP,HCPCS C1713,,1007663  -  MESH SRG 50X12MM SPNE,"$7,227.50",$0.00,"$7,227.50","$3,252.38","$5,158.27",$0.00,"$1,245.26",$0.00,$0.00,"$1,265.48","$7,227.50",$0.00,"$3,613.75","$5,724.18","$5,782.00",$0.00,"$1,131.10",$0.00,"$1,150.62",$0.00
1007673,SUP,HCPCS C1713,,1007673  -  MESH SRG 14X6MM SPNE,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,$0.00,$0.00,$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
1007674,SUP,HCPCS C1713,,1007674  -  MESH SRG 14X7MM SPNE,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,$0.00,$0.00,$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
1007675,SUP,HCPCS C1713,,1007675  -  MESH SRG 14X8MM SPNE,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,$0.00,$0.00,$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
1007676,SUP,HCPCS C1713,,1007676  -  MESH SRG 14X9MM SPNE,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,$0.00,$0.00,$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
1007677,SUP,HCPCS C1713,,1007677  -  MESH SRG 14X10MM SPNE,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,$0.00,$0.00,$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
1007679,SUP,HCPCS C1713,,1007679  -  MESH SRG 14X12MM SPNE,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,$0.00,$0.00,$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
1007680,SUP,HCPCS C1713,,1007680  -  MESH SRG 14X14MM SPNE,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,$0.00,$0.00,$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
1007683,SUP,HCPCS C1713,,1007683  -  MESH SRG 50X14MM TI SPNE,"$8,132.50",$0.00,"$8,132.50","$3,659.63","$5,158.80",$0.00,"$1,401.19",$0.00,$0.00,"$1,423.94","$8,132.50",$0.00,"$4,066.25","$6,440.94","$6,506.00",$0.00,"$1,272.74",$0.00,"$1,294.69",$0.00
1007693,SUP,HCPCS C1713,,1007693  -  MESH SRG 16X6MM SPNE,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,$0.00,$0.00,$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
1007694,SUP,HCPCS C1713,,1007694  -  MESH SRG 16X7MM SPNE,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,$0.00,$0.00,$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
1007695,SUP,HCPCS C1713,,1007695  -  MESH SRG 16X8MM SPNE,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,$0.00,$0.00,$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
1007696,SUP,HCPCS C1713,,1007696  -  MESH SRG 16X9MM SPNE,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,$0.00,$0.00,$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
1007697,SUP,HCPCS C1713,,1007697  -  MESH SRG 16X10MM SPNE,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,$0.00,$0.00,$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
1007699,SUP,HCPCS C1713,,1007699  -  MESH SRG 16X12MM SPNE,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,$0.00,$0.00,$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
1007700,SUP,HCPCS C1713,,1007700  -  MESH SRG 16X14MM SPNE,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,$0.00,$0.00,$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
1007703,SUP,HCPCS C1713,,1007703  -  CAGE SPNL 16MM 50MM MESH,"$8,132.50",$0.00,"$8,132.50","$3,659.63","$5,158.80",$0.00,"$1,401.19",$0.00,$0.00,"$1,423.94","$8,132.50",$0.00,"$4,066.25","$6,440.94","$6,506.00",$0.00,"$1,272.74",$0.00,"$1,294.69",$0.00
1007704,SUP,HCPCS C1713,,1007704  -  MESH SRG 90X16MM SPNE,"$10,122.50",$0.00,"$10,122.50","$4,555.13","$5,158.80",$0.00,"$1,744.06",$0.00,$0.00,"$1,772.37","$10,122.50",$0.00,"$5,061.25","$8,017.02","$8,098.00",$0.00,"$1,584.17",$0.00,"$1,611.50",$0.00
1010008,SUP,HCPCS Q4130,,1010008  -  SUBSTITUTE TISS 10X10CM STRATTICE MESH RECON TISS MTRX PRCN,"$6,825.00",$0.00,"$6,825.00",$0.00,"$4,871.00",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,825.00",$0.00,"$3,412.50","$5,405.40","$5,460.00",$0.00,$0.00,$0.00,$0.00,$0.00
1010020,SUP,Custom 27203010,,1010020  -  AGENT HMST AVTN CLGN MCFIB FLUR 1GM STRL LATEX FREE DISP,$256.15,$0.00,$256.15,$0.00,$182.81,$0.00,$0.00,$0.00,$0.00,$0.00,$256.15,$0.00,$128.08,$202.87,$204.92,$0.00,$0.00,$0.00,$0.00,$0.00
1010150,SUP,Custom 27203010,,1010150  -  AGENT HEMOSTATIC 10MM 42CM 50X15X1MM PRELOAD APPLICATOR,$245.25,$0.00,$245.25,$0.00,$175.03,$0.00,$0.00,$0.00,$0.00,$0.00,$245.25,$0.00,$122.63,$194.24,$196.20,$0.00,$0.00,$0.00,$0.00,$0.00
1011132,SUP,HCPCS C1713,,1011132  -  MESH SRG 30X20MM SPNE,"$6,012.50",$0.00,"$6,012.50","$2,705.63","$4,291.12",$0.00,"$1,035.92",$0.00,$0.00,"$1,052.74","$6,012.50",$0.00,"$3,006.25","$4,761.90","$4,810.00",$0.00,$940.96,$0.00,$957.19,$0.00
1011134,SUP,HCPCS C1713,,1011134  -  MESH SRG 60X20MM SPNE,"$8,495.00",$0.00,"$8,495.00","$3,822.75","$5,158.80",$0.00,"$1,463.65",$0.00,$0.00,"$1,487.41","$8,495.00",$0.00,"$4,247.50","$6,728.04","$6,796.00",$0.00,"$1,329.47",$0.00,"$1,352.40",$0.00
1011135,SUP,HCPCS C1713,,1011135  -  MESH SRG 90X20MM SPNE,"$10,662.50",$0.00,"$10,662.50","$4,798.13","$5,158.80",$0.00,"$1,837.10",$0.00,$0.00,"$1,866.92","$10,662.50",$0.00,"$5,331.25","$8,444.70","$8,530.00",$0.00,"$1,668.68",$0.00,"$1,697.47",$0.00
1011152,SUP,HCPCS C1713,,1011152  -  MESH SRG 30X24MM SPNE,"$6,012.50",$0.00,"$6,012.50","$2,705.63","$4,291.12",$0.00,"$1,035.92",$0.00,$0.00,"$1,052.74","$6,012.50",$0.00,"$3,006.25","$4,761.90","$4,810.00",$0.00,$940.96,$0.00,$957.19,$0.00
1011154,SUP,HCPCS C1713,,1011154  -  MESH SRG 60X24MM SPNE,"$9,035.00",$0.00,"$9,035.00","$4,065.75","$5,158.80",$0.00,"$1,556.69",$0.00,$0.00,"$1,581.96","$9,035.00",$0.00,"$4,517.50","$7,155.72","$7,228.00",$0.00,"$1,413.98",$0.00,"$1,438.37",$0.00
1011155,SUP,HCPCS C1713,,1011155  -  MESH SRG 90X24MM SPNE,"$11,207.50",$0.00,"$11,207.50","$5,043.38","$5,158.80",$0.00,"$1,931.00",$0.00,$0.00,"$1,962.34","$11,207.50",$0.00,"$5,603.75","$8,876.34","$8,966.00",$0.00,"$1,753.97",$0.00,"$1,784.23",$0.00
1012572,SUP,Custom 27203010,,MASK CPAP LG ADLT HDGR FULL ADJ STRAP FRHD CLIP PRFMTRK LF,$65.20,$0.00,$65.20,$0.00,$46.53,$0.00,$0.00,$0.00,$0.00,$0.00,$65.20,$0.00,$32.60,$51.64,$52.16,$0.00,$0.00,$0.00,$0.00,$0.00
1012624,SUP,Custom 27203010,,MASK CPAP MED ADLT HDGR FULL ADJ STRAP FRHD CLIP PRFMTRK LF,$65.20,$0.00,$65.20,$0.00,$46.53,$0.00,$0.00,$0.00,$0.00,$0.00,$65.20,$0.00,$32.60,$51.64,$52.16,$0.00,$0.00,$0.00,$0.00,$0.00
1016002,SUP,HCPCS Q4130,,1016002  -  MATRIX TISSUE 16X10CM RECONSTRUCTIVE STRATTICE PIG DERMIS,$88.98,$0.00,$88.98,$0.00,$63.51,$0.00,$0.00,$0.00,$0.00,$0.00,$88.98,$0.00,$44.49,$70.47,$71.19,$0.00,$0.00,$0.00,$0.00,$0.00
1016692,SUP,Custom 27203010,,MASK CPAP MED LG 2 FLP CSHN HDSTRP SIL CNTOUR DLX LF DISP,$37.53,$0.00,$37.53,$0.00,$26.78,$0.00,$0.00,$0.00,$0.00,$0.00,$37.53,$0.00,$18.76,$29.72,$30.02,$0.00,$0.00,$0.00,$0.00,$0.00
1025002,SUP,HCPCS Q4130,,1025002  -  MATRIX TISSUE 25X10CM RECONSTRUCTIVE STRATTICE PIG DERMIS,"$22,245.00",$0.00,"$22,245.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$22,245.00",$0.00,"$11,122.50","$17,618.04","$17,796.00",$0.00,$0.00,$0.00,$0.00,$0.00
1040014,SUP,Custom 27803010,,1040014  -  TUBE VNT 1.14MM 3.6MM 1.3MM GRN POPE GRMT BVL FLRPLAS EAR,$44.25,$0.00,$44.25,$0.00,$31.58,$0.00,$0.00,$0.00,$0.00,$0.00,$44.25,$0.00,$22.13,$35.05,$35.40,$0.00,$0.00,$0.00,$0.00,$0.00
1046742,SUP,Custom 27203010,,PACIFIER NBN WTHMB PRMTR PUR,$7.40,$0.00,$7.40,$0.00,$5.28,$0.00,$0.00,$0.00,$0.00,$0.00,$7.40,$0.00,$3.70,$5.86,$5.92,$0.00,$0.00,$0.00,$0.00,$0.00
1050044,SUP,Custom 27203010,,1050044  -  HYSTOCRYL BLUE FOIL POUCH 10X0.5ML,$48.75,$0.00,$48.75,$0.00,$34.79,$0.00,$0.00,$0.00,$0.00,$0.00,$48.75,$0.00,$24.38,$38.61,$39.00,$0.00,$0.00,$0.00,$0.00,$0.00
1112095,SUP,HCPCS C1713,,1112095  -  PROSTHESIS OSS 90D RND 4MM 1.1MM 5MM FULL CNN SHFT OFF CNTR,$442.50,$0.00,$442.50,$199.13,$315.81,$0.00,$76.24,$0.00,$0.00,$77.48,$442.50,$0.00,$221.25,$350.46,$354.00,$0.00,$69.25,$0.00,$70.45,$0.00
1135510,SUP,HCPCS C1713,,"1135510  -  RELINE MAS ROD, 100MM",$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1151015,SUP,HCPCS C1781,,1151015  -  GRAFT PRCN RECT 5.9X3.9IN STRL XENMATRIX AB NONCROSSLINK,"$11,445.00",$0.00,"$11,445.00","$5,150.25","$5,158.80",$0.00,"$1,971.92",$0.00,$0.00,"$2,003.93","$11,445.00",$0.00,"$5,722.50","$9,064.44","$9,156.00",$0.00,"$1,791.14",$0.00,"$1,822.04",$0.00
1151928,SUP,HCPCS C1781,,1151928  -  GRAFT PRCN RECT 11X7.5IN STRL XENMATRIX AB RGNRT,"$22,877.00",$0.00,"$22,877.00","$10,294.65","$5,158.80",$0.00,"$3,941.59",$0.00,$0.00,"$4,005.58","$22,877.00",$0.00,"$11,438.50","$18,118.58","$18,301.60",$0.00,"$3,580.25",$0.00,"$3,642.02",$0.00
1161015,SUP,HCPCS C1781,,1161015  -  GRAFT PIG THK1.8-2.5MM 5.9X3.9IN REGENERATIVE XENMATRIX,"$10,374.00",$0.00,"$10,374.00","$4,668.30","$5,158.80",$0.00,"$1,787.39",$0.00,$0.00,"$1,816.40","$10,374.00",$0.00,"$5,187.00","$8,216.21","$8,299.20",$0.00,"$1,623.53",$0.00,"$1,651.54",$0.00
1161520,SUP,HCPCS C1781,,1161520  -  GRAFT PIG THK1.8-2.5MM 7.9X5.9IN REGENERATIVE XENMATRIX,"$20,748.00",$0.00,"$20,748.00","$9,336.60","$5,158.80",$0.00,"$3,574.78",$0.00,$0.00,"$3,632.81","$20,748.00",$0.00,"$10,374.00","$16,432.42","$16,598.40",$0.00,"$3,247.06",$0.00,"$3,303.08",$0.00
1161928,SUP,HCPCS C1781,,1161928  -  GRAFT SURG 11X7.5IN REGENERATIVE XENMATRIX COLLAGEN MATRIX,"$35,479.60",$0.00,"$35,479.60","$15,965.82","$5,158.80",$0.00,"$6,112.96",$0.00,$0.00,"$6,212.19","$35,479.60",$0.00,"$17,739.80","$28,099.84","$28,383.68",$0.00,"$5,552.56",$0.00,"$5,648.35",$0.00
1190602,SUP,HCPCS C1781,,1190602  -  PLUG SURG LARGE 1.9X1.5IN MONOFILAMENT MESH PLEATED EDGE,"$1,572.25",$0.00,"$1,572.25",$707.51,"$1,122.11",$0.00,$270.89,$0.00,$0.00,$275.29,"$1,572.25",$0.00,$786.13,"$1,245.22","$1,257.80",$0.00,$246.06,$0.00,$250.30,$0.00
1190603,SUP,HCPCS C1781,,1190603  -  PLUG SURG XL 1.6X1.3IN MESH MULTILAYER PHASIX,"$1,585.75",$0.00,"$1,585.75",$713.59,"$1,131.75",$0.00,$273.22,$0.00,$0.00,$277.65,"$1,585.75",$0.00,$792.88,"$1,255.91","$1,268.60",$0.00,$248.17,$0.00,$252.45,$0.00
1203105,SUP,Custom 27203010,,1203105  -  TUBE ENDBR 9FR STRL UNIBLOCKER ADLT,$347.50,$0.00,$347.50,$0.00,$248.01,$0.00,$0.00,$0.00,$0.00,$0.00,$347.50,$0.00,$173.75,$275.22,$278.00,$0.00,$0.00,$0.00,$0.00,$0.00
1303346,SUP,Custom 27203010,,1303346  -  SPONGE ABS HMST AGNT PWDR GELTN GLFM 50 STRL,$288.43,$0.00,$288.43,$0.00,$205.85,$0.00,$0.00,$0.00,$0.00,$0.00,$288.43,$0.00,$144.21,$228.44,$230.74,$0.00,$0.00,$0.00,$0.00,$0.00
Oct-10,SUP,Custom 27203010,,10-5510  -  DRESSING GZE 36X36IN STRL LF 1-+ 17 PLY W MESH 1 LYR,$33.69,$0.00,$33.69,$0.00,$24.05,$0.00,$0.00,$0.00,$0.00,$0.00,$33.69,$0.00,$16.85,$26.68,$26.95,$0.00,$0.00,$0.00,$0.00,$0.00
6/11/5537,SUP,HCPCS C1776,,5537-6/11  -  STEM HUMERAL 6 135MM PRESS FIT ANATOMIC TITANIUM NONSTRL,"$6,566.70",$0.00,"$6,566.70","$2,955.02","$4,686.65",$0.00,"$1,131.41",$0.00,$0.00,"$1,149.78","$6,566.70",$0.00,"$3,283.35","$5,200.83","$5,253.36",$0.00,"$1,027.69",$0.00,"$1,045.42",$0.00
8/12/5537,SUP,HCPCS C1776,,5537-8/12  -  STEM HUMERAL 8 120MM PRESS FIT ANATOMIC SELF CENTERING EPOCA,"$6,566.70",$0.00,"$6,566.70","$2,955.02","$4,686.65",$0.00,"$1,131.41",$0.00,$0.00,"$1,149.78","$6,566.70",$0.00,"$3,283.35","$5,200.83","$5,253.36",$0.00,"$1,027.69",$0.00,"$1,045.42",$0.00
10/12/5537,SUP,HCPCS C1776,,5537-10/12  -  STEM HUMERAL 10 125MM PRESS FIT ANATOMIC SELF CENTERING,"$6,566.70",$0.00,"$6,566.70","$2,955.02","$4,686.65",$0.00,"$1,131.41",$0.00,$0.00,"$1,149.78","$6,566.70",$0.00,"$3,283.35","$5,200.83","$5,253.36",$0.00,"$1,027.69",$0.00,"$1,045.42",$0.00
12/13/5537,SUP,HCPCS C1776,,5537-12/13  -  STEM HUMERAL 12MM 130MM PRESS FIT TITANIUM NONSTRL,"$6,566.70",$0.00,"$6,566.70","$2,955.02","$4,686.65",$0.00,"$1,131.41",$0.00,$0.00,"$1,149.78","$6,566.70",$0.00,"$3,283.35","$5,200.83","$5,253.36",$0.00,"$1,027.69",$0.00,"$1,045.42",$0.00
6/11/5540,SUP,HCPCS C1776,,5540-6/11  -  STEM HUMERAL 6MM 115MM PRESS FIT TITANIUM HA STERILE,"$6,943.00",$0.00,"$6,943.00","$3,124.35","$4,955.22",$0.00,"$1,196.24",$0.00,$0.00,"$1,215.66","$6,943.00",$0.00,"$3,471.50","$5,498.86","$5,554.40",$0.00,"$1,086.58",$0.00,"$1,105.33",$0.00
8/12/5540,SUP,HCPCS C1776,,5540-8/12  -  STEM HUMERAL 8MM 120MM PRESS FIT EPOCA TITANIUM HA SHOULDER,"$6,943.00",$0.00,"$6,943.00","$3,124.35","$4,955.22",$0.00,"$1,196.24",$0.00,$0.00,"$1,215.66","$6,943.00",$0.00,"$3,471.50","$5,498.86","$5,554.40",$0.00,"$1,086.58",$0.00,"$1,105.33",$0.00
10/12/5540,SUP,HCPCS C1776,,5540-10/12  -  STEM HUMERAL 10 125MM PRESS FIT IMPLANT TITANIUM HA SHOULDER,"$6,943.00",$0.00,"$6,943.00","$3,124.35","$4,955.22",$0.00,"$1,196.24",$0.00,$0.00,"$1,215.66","$6,943.00",$0.00,"$3,471.50","$5,498.86","$5,554.40",$0.00,"$1,086.58",$0.00,"$1,105.33",$0.00
12/13/5540,SUP,HCPCS C1776,,5540-12/13  -  STEM HUMERAL 12MM 130MM PRESS FIT TITANIUM HA STERILE,"$6,943.00",$0.00,"$6,943.00","$3,124.35","$4,955.22",$0.00,"$1,196.24",$0.00,$0.00,"$1,215.66","$6,943.00",$0.00,"$3,471.50","$5,498.86","$5,554.40",$0.00,"$1,086.58",$0.00,"$1,105.33",$0.00
6/11/5624,SUP,HCPCS C1776,,5624-6/11  -  STEM HUMERAL 8MM 115MM CEMENT EPOCA COCR SHOULDER STERILE,"$5,769.05",$0.00,"$5,769.05","$2,596.07","$4,117.37",$0.00,$993.98,$0.00,$0.00,"$1,010.11","$5,769.05",$0.00,"$2,884.53","$4,569.09","$4,615.24",$0.00,$902.86,$0.00,$918.43,$0.00
8/12/5624,SUP,HCPCS C1776,,5624-8/12  -  STEM HUMERAL 8MM 120MM CEMENTED ANATOMIC SELF CENTERING,"$5,769.05",$0.00,"$5,769.05","$2,596.07","$4,117.37",$0.00,$993.98,$0.00,$0.00,"$1,010.11","$5,769.05",$0.00,"$2,884.53","$4,569.09","$4,615.24",$0.00,$902.86,$0.00,$918.43,$0.00
10/12/5624,SUP,HCPCS C1776,,5624-10/12  -  STEM HUMERAL 10 125MM CEMENTED ANATOMIC COCR STERILE,"$5,769.05",$0.00,"$5,769.05","$2,596.07","$4,117.37",$0.00,$993.98,$0.00,$0.00,"$1,010.11","$5,769.05",$0.00,"$2,884.53","$4,569.09","$4,615.24",$0.00,$902.86,$0.00,$918.43,$0.00
12/13/5624,SUP,HCPCS C1776,,5624-12/13  -  STEM HUMERAL 12 130MM CEMENTED ANATOMIC COCR STERILE,"$5,769.05",$0.00,"$5,769.05","$2,596.07","$4,117.37",$0.00,$993.98,$0.00,$0.00,"$1,010.11","$5,769.05",$0.00,"$2,884.53","$4,569.09","$4,615.24",$0.00,$902.86,$0.00,$918.43,$0.00
1371120,SUP,Custom 27203010,,PIPETTE TRNSF PE 6IN 5.8ML GRAD STRL,$0.30,$0.00,$0.30,$0.00,$0.21,$0.00,$0.00,$0.00,$0.00,$0.00,$0.30,$0.00,$0.15,$0.24,$0.24,$0.00,$0.00,$0.00,$0.00,$0.00
1372301,SUP,Custom 27203010,,1372301  -  SET ADM 110IN 0.2 MH NVNT ADON,$38.38,$0.00,$38.38,$0.00,$27.39,$0.00,$0.00,$0.00,$0.00,$0.00,$38.38,$0.00,$19.19,$30.40,$30.70,$0.00,$0.00,$0.00,$0.00,$0.00
1424571,SUP,HCPCS C1713,,PLATE MCWL 96 WELL UBTM RGD PS DISP,$4.48,$0.00,$4.48,$2.01,$3.19,$0.00,$0.77,$0.00,$0.00,$0.78,$4.48,$0.00,$2.24,$3.55,$3.58,$0.00,$0.70,$0.00,$0.71,$0.00
1437374,SUP,Custom 27203010,,BLADE HISTOLGY 130MM ACED SHRT SS TRM DISP,$539.75,$0.00,$539.75,$0.00,$385.22,$0.00,$0.00,$0.00,$0.00,$0.00,$539.75,$0.00,$269.88,$427.48,$431.80,$0.00,$0.00,$0.00,$0.00,$0.00
1500181,SUP,Custom 27203010,,1500181  -  APL ENDSCP FLSL STRL DISP,$147.78,$0.00,$147.78,$0.00,$105.47,$0.00,$0.00,$0.00,$0.00,$0.00,$147.78,$0.00,$73.89,$117.04,$118.23,$0.00,$0.00,$0.00,$0.00,$0.00
1501262,SUP,HCPCS C9250,,1501262  -  KIT TISSUE CLOSURE 1 PREFILL SYRINGE PLUNGER 2 PULL STRAP,$601.60,$0.00,$601.60,$270.72,$429.36,$164.85,$103.65,$0.00,$0.00,$105.33,$601.60,$173.09,$300.80,$476.47,$481.28,$239.03,$94.15,$0.00,$95.77,$164.85
1501263,SUP,HCPCS C9250,,1501263  -  KIT TISS CLSR 10ML 2 PCH FRZN SLNT SYRPLNG Y PC CONCTR TSSL,"$1,391.58",$0.00,"$1,391.58",$626.21,$993.17,$164.85,$239.76,$0.00,$0.00,$243.65,"$1,391.58",$173.09,$695.79,"$1,102.13","$1,113.26",$239.03,$217.78,$0.00,$221.54,$164.85
1518128,SUP,HCPCS Q4116,,1518128  -  MATRIX TISS THK.4-1.6MM 128SQ CM MED RECT 16X8CM ALDRM SLCT,"$13,550.00",$0.00,"$13,550.00","$6,097.50","$5,158.80",$0.00,"$2,334.60",$0.00,$0.00,"$2,372.50","$13,550.00",$0.00,"$6,775.00","$10,731.60","$10,840.00",$0.00,"$2,120.58",$0.00,"$2,157.16",$0.00
1518320,SUP,HCPCS Q4116,,1518320  -  MATRIX TISS THK.4-1.6MM 320SQ CM MED RECT 20X16CM ALDRM SLCT,"$33,875.00",$0.00,"$33,875.00","$15,243.75","$5,158.80",$0.00,"$5,836.49",$0.00,$0.00,"$5,931.24","$33,875.00",$0.00,"$16,937.50","$26,829.00","$27,100.00",$0.00,"$5,301.44",$0.00,"$5,392.90",$0.00
1518616,SUP,HCPCS Q4116,,1518616  -  MATRIX TISSUE THICK 16X6CM ALLOGRAFT REGENERATIVE FREEZE,"$7,497.50",$0.00,"$7,497.50","$3,373.88","$5,158.80",$0.00,"$1,291.78",$0.00,$0.00,"$1,312.75","$7,497.50",$0.00,"$3,748.75","$5,938.02","$5,998.00",$0.00,"$1,173.36",$0.00,"$1,193.60",$0.00
1520616,SUP,HCPCS Q4116,,1520616  -  MATRIX TISS THK.4-1.6MM MED 16X6CM ALDRM SLCT ALGRF RGNRT,"$10,162.50",$0.00,"$10,162.50","$4,573.13","$5,158.80",$0.00,"$1,750.95",$0.00,$0.00,"$1,779.37","$10,162.50",$0.00,"$5,081.25","$8,048.70","$8,130.00",$0.00,"$1,590.43",$0.00,"$1,617.87",$0.00
1523901,SUP,Custom 27203010,,1523901  -  SET IRRIGATION .28IN 85IN 4 LEAD 3Y CONCTR SIGHT CHAMBER,$385.75,$0.00,$385.75,$0.00,$275.31,$0.00,$0.00,$0.00,$0.00,$0.00,$385.75,$0.00,$192.88,$305.51,$308.60,$0.00,$0.00,$0.00,$0.00,$0.00
1524055,SUP,Custom 27203010,,1524055  -  SPLINT NSL WHT STRL LF DYLE II CMPR ANT TIP INTGR ARWY SIL,$122.50,$0.00,$122.50,$0.00,$87.43,$0.00,$0.00,$0.00,$0.00,$0.00,$122.50,$0.00,$61.25,$97.02,$98.00,$0.00,$0.00,$0.00,$0.00,$0.00
1525002,SUP,HCPCS Q4130,,1525002  -  MATRIX TISSUE 25X15CM RECONSTRUCTIVE STRATTICE PIG DERMIS,"$33,367.50",$0.00,"$33,367.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$33,367.50",$0.00,"$16,683.75","$26,427.06","$26,694.00",$0.00,$0.00,$0.00,$0.00,$0.00
1527005,SUP,Custom 27803010,,1527005  -  SPLINT NSL THK.5MM STD REUT PREPUNCH HL FLRPLAS SPT,$74.50,$0.00,$74.50,$0.00,$53.17,$0.00,$0.00,$0.00,$0.00,$0.00,$74.50,$0.00,$37.25,$59.00,$59.60,$0.00,$0.00,$0.00,$0.00,$0.00
1527010,SUP,HCPCS C1713,,1527010  -  SPLINT 1527010 10PK PAIR REUTER LRG THIN,$74.50,$0.00,$74.50,$33.53,$53.17,$0.00,$12.84,$0.00,$0.00,$13.04,$74.50,$0.00,$37.25,$59.00,$59.60,$0.00,$11.66,$0.00,$11.86,$0.00
1527020,SUP,Custom 27803010,,1527020  -  SPLINT 1527020 10PK PAIR REUTER LRG THK,$74.50,$0.00,$74.50,$0.00,$53.17,$0.00,$0.00,$0.00,$0.00,$0.00,$74.50,$0.00,$37.25,$59.00,$59.60,$0.00,$0.00,$0.00,$0.00,$0.00
1528120,SUP,Custom 27203010,,1528120  -  SPLINT NASAL MEDIUM REGULAR 2.38X1.53IN EXTERNAL RUBBER FOAM,"$2,912.50",$0.00,"$2,912.50",$0.00,"$2,078.65",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,912.50",$0.00,"$1,456.25","$2,306.70","$2,330.00",$0.00,$0.00,$0.00,$0.00,$0.00
1528126,SUP,Custom 27203010,,1528126  -  SPLINT NSL MED 2.38X1.53IN WHT STRL LF XTRN KT FM RBR SPT,$93.50,$0.00,$93.50,$0.00,$66.73,$0.00,$0.00,$0.00,$0.00,$0.00,$93.50,$0.00,$46.75,$74.05,$74.80,$0.00,$0.00,$0.00,$0.00,$0.00
1528136,SUP,Custom 27203010,,1528136  -  SPLINT NSL LG KT XTRN LTWT STRNG WTR RS ADH FM AL SPT,$125.00,$0.00,$125.00,$0.00,$89.21,$0.00,$0.00,$0.00,$0.00,$0.00,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$0.00,$0.00,$0.00,$0.00
1528137,SUP,Custom 27203010,,1528137  -  SPLINT NASAL LARGE 2.63INX1.73IN ADHERENT EXTERNAL STRONG,"$2,877.50",$0.00,"$2,877.50",$0.00,"$2,053.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,877.50",$0.00,"$1,438.75","$2,278.98","$2,302.00",$0.00,$0.00,$0.00,$0.00,$0.00
1529010,SUP,Custom 27803010,,1529010  -  SPLINT NSL MED 2.38X1.53IN WHT STRL LF THRMSPLNT KT XTRN,$577.50,$0.00,$577.50,$0.00,$412.16,$0.00,$0.00,$0.00,$0.00,$0.00,$577.50,$0.00,$288.75,$457.38,$462.00,$0.00,$0.00,$0.00,$0.00,$0.00
1529020,SUP,Custom 27203010,,1529020  -  SPLINT NSL LG 2.63INX1.73IN WHT STRL LF THRMSPLNT KT XTRN,$56.75,$0.00,$56.75,$0.00,$40.50,$0.00,$0.00,$0.00,$0.00,$0.00,$56.75,$0.00,$28.38,$44.95,$45.40,$0.00,$0.00,$0.00,$0.00,$0.00
1608695,SUP,Custom 27203010,,1608695  -  BURR SURG ROUND .157MM 2.13IN DIAMOND MEDIUM GRIT,$210.00,$0.00,$210.00,$0.00,$149.88,$0.00,$0.00,$0.00,$0.00,$0.00,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$0.00,$0.00,$0.00,$0.00
1620002,SUP,HCPCS Q4130,,1620002  -  MATRIX TISSUE 20X16CM RECONSTRUCTIVE STRATTICE PIG DERMIS,$88.98,$0.00,$88.98,$0.00,$63.51,$0.00,$0.00,$0.00,$0.00,$0.00,$88.98,$0.00,$44.49,$70.47,$71.19,$0.00,$0.00,$0.00,$0.00,$0.00
1664017,SUP,HCPCS C1713,,1664017  -  SET SCREW 1664017 4.75 SOL PERC MULTI S,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
1677545,SUP,HCPCS C1713,,1677545  -  SCREW BN 7.5MM 45MM NS PRCPT PA CR SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
1677550,SUP,HCPCS C1713,,1677550  -  SCREW BN 7.5MM 50MM NS PRCPT PA CR SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
1801303,SUP,HCPCS C1713,,1801303  -  ENDPLATE SPNL 3D MED NS INFIX TI THORLMBR ALIF,"$5,000.00",$0.00,"$5,000.00","$2,250.00","$3,568.50",$0.00,$861.48,$0.00,$0.00,$875.46,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$782.50,$0.00,$796.00,$0.00
1801306,SUP,HCPCS C1713,,1801306  -  ENDPLATE SPNL 6D MED NS INFIX TI THORLMBR ALIF,"$5,000.00",$0.00,"$5,000.00","$2,250.00","$3,568.50",$0.00,$861.48,$0.00,$0.00,$875.46,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$782.50,$0.00,$796.00,$0.00
1803205,SUP,HCPCS C1776,,1803205  -  DOME PTLR RND 38MM RSRFC KN MCK SYS,"$2,192.50",$0.00,"$2,192.50",$986.63,"$1,564.79",$0.00,$377.76,$0.00,$0.00,$383.89,"$2,192.50",$0.00,"$1,096.25","$1,736.46","$1,754.00",$0.00,$343.13,$0.00,$349.05,$0.00
1804308,SUP,HCPCS C1713,,1804308  -  STRUT SPNL MED 8MM BLU NS INFIX TI THORLMBR ALIF,"$5,000.00",$0.00,"$5,000.00","$2,250.00","$3,568.50",$0.00,$861.48,$0.00,$0.00,$875.46,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$782.50,$0.00,$796.00,$0.00
1807052,SUP,HCPCS C1776,,1807052  -  INSERT TIB 5 9MM ONLAY KN MCK SYS,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
1807081,SUP,HCPCS C1776,,1807081  -  INSERT TIB 8 8MM STRL RESTORIS ONLAY MULTICOMPARTMENTAL KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
1850300,SUP,HCPCS C1894,,1850300  -  SHEATH ENDSCP CLEAN 170MM 4MM ESCRB 25D SIN LEN SYS STRL,$502.50,$0.00,$502.50,$272.86,$358.63,$0.00,$86.58,$0.00,$0.00,$87.98,$502.50,$0.00,$251.25,$397.98,$402.00,$0.00,$78.64,$0.00,$80.00,$0.00
Jan-33,SUP,HCPCS C1713,,01-7033  -  PLATE 100D MED RIGHT MIDFAC 3X3 HOLE L 1.5MM SCR BONE TI,$467.50,$0.00,$467.50,$210.38,$333.65,$0.00,$80.55,$0.00,$0.00,$81.86,$467.50,$0.00,$233.75,$370.26,$374.00,$0.00,$73.16,$0.00,$74.43,$0.00
Jan-38,SUP,HCPCS C1713,,01-7038  -  PLATE BONE 1.5MM REGULAR L SILVER LEFT MIDFAC,$910.00,$0.00,$910.00,$409.50,$649.47,$0.00,$156.79,$0.00,$0.00,$159.33,$910.00,$0.00,$455.00,$720.72,$728.00,$0.00,$142.42,$0.00,$144.87,$0.00
Jan-40,SUP,HCPCS C1713,,01-7040  -  PLATE BONE REGULAR STR 16MMX.6MM 4 HOLE TRAUMAONE LORENZ,$295.00,$0.00,$295.00,$132.75,$210.54,$0.00,$50.83,$0.00,$0.00,$51.65,$295.00,$0.00,$147.50,$233.64,$236.00,$0.00,$46.17,$0.00,$46.96,$0.00
Jan-45,SUP,HCPCS C1713,,01-7045  -  PLATE BONE MEDIUM STR 17MMX.6MM 4 HOLE SILVER TITANIUM,$295.00,$0.00,$295.00,$132.75,$210.54,$0.00,$50.83,$0.00,$0.00,$51.65,$295.00,$0.00,$147.50,$233.64,$236.00,$0.00,$46.17,$0.00,$46.96,$0.00
Jan-47,SUP,HCPCS C1713,,01-7047  -  PLATE BONE LONG STR 4 HOLE GRADE II TRAUMAONE LORENZ SILVER,$295.00,$0.00,$295.00,$132.75,$210.54,$0.00,$50.83,$0.00,$0.00,$51.65,$295.00,$0.00,$147.50,$233.64,$236.00,$0.00,$46.17,$0.00,$46.96,$0.00
Jan-50,SUP,HCPCS C1713,,01-7050  -  PLATE BONE REGULAR STR 6 HOLE TRAUMAONE LORENZ SILVER,$447.50,$0.00,$447.50,$201.38,$319.38,$0.00,$77.10,$0.00,$0.00,$78.35,$447.50,$0.00,$223.75,$354.42,$358.00,$0.00,$70.03,$0.00,$71.24,$0.00
Jan-65,SUP,HCPCS C1713,,01-7065  -  PLATE BONE MESH SIDE PROFILE PRECONTOUR 163X115X.3MM ULTRA,"$10,742.50",$0.00,"$10,742.50","$4,834.13","$5,158.80",$0.00,"$1,850.88",$0.00,$0.00,"$1,880.93","$10,742.50",$0.00,"$5,371.25","$8,508.06","$8,594.00",$0.00,"$1,681.20",$0.00,"$1,710.21",$0.00
Jan-66,SUP,HCPCS C1713,,01-7066  -  PLATE BONE 16 HOLE STR LORENZ TITANIUM CRANIOMAXILLOFACIAL,"$1,057.50",$0.00,"$1,057.50",$475.88,$754.74,$0.00,$182.20,$0.00,$0.00,$185.16,"$1,057.50",$0.00,$528.75,$837.54,$846.00,$0.00,$165.50,$0.00,$168.35,$0.00
Jan-92,SUP,HCPCS C1713,,01-7092  -  PLATE BONE MED 2T CRNMXF TI 1.5MM SCR,$710.00,$0.00,$710.00,$319.50,$506.73,$0.00,$122.33,$0.00,$0.00,$124.32,$710.00,$0.00,$355.00,$562.32,$568.00,$0.00,$111.12,$0.00,$113.03,$0.00
Jan-02,SUP,HCPCS C1713,,01-7102  -  PLATE BONE LONG REGULAR Y 5 HOLE TRAUMAONE LORENZ SILVER,$840.00,$0.00,$840.00,$378.00,$599.51,$0.00,$144.73,$0.00,$0.00,$147.08,$840.00,$0.00,$420.00,$665.28,$672.00,$0.00,$131.46,$0.00,$133.73,$0.00
1900233,SUP,Custom 27203010,,REAGENT XYLN SHDN 120ML SUB MOUNTANT HISTOLGY,$54.45,$0.00,$54.45,$0.00,$38.86,$0.00,$0.00,$0.00,$0.00,$0.00,$54.45,$0.00,$27.23,$43.12,$43.56,$0.00,$0.00,$0.00,$0.00,$0.00
Jan-04,SUP,HCPCS C1713,,01-7104  -  PLATE BONE XL Y 19MMX.6MM 5 HOLE LORENZ SILVER TITANIUM,$710.00,$0.00,$710.00,$319.50,$506.73,$0.00,$122.33,$0.00,$0.00,$124.32,$710.00,$0.00,$355.00,$562.32,$568.00,$0.00,$111.12,$0.00,$113.03,$0.00
Jan-06,SUP,HCPCS C1713,,01-7106  -  PLATE BONE SMALL PREFORM TITANIUM ORBTL FLOOR,"$3,112.50",$0.00,"$3,112.50","$1,400.63","$2,221.39",$0.00,$536.27,$0.00,$0.00,$544.97,"$3,112.50",$0.00,"$1,556.25","$2,465.10","$2,490.00",$0.00,$487.11,$0.00,$495.51,$0.00
Jan-07,SUP,HCPCS C1713,,01-7107  -  PLATE BONE MEDIUM .3MM PREFORM TRAUMAONE LORENZ GOLD,"$3,112.50",$0.00,"$3,112.50","$1,400.63","$2,221.39",$0.00,$536.27,$0.00,$0.00,$544.97,"$3,112.50",$0.00,"$1,556.25","$2,465.10","$2,490.00",$0.00,$487.11,$0.00,$495.51,$0.00
1901819,SUP,HCPCS C1713,,1901819  -  PLATE BONE MED ORBTL FLR TI MESH,"$2,500,000.00",$0.00,"$1,980,000.00","$1,400.63","$2,221.39",$0.00,$536.27,$0.00,$0.00,$544.97,"$3,112.50",$0.00,"$1,556.25","$1,980,000.00","$2,490.00",$0.00,$487.11,$0.00,$495.51,$0.00
Jan-08,SUP,HCPCS C1713,,01-7108  -  PLATE BONE LARGE .3MM PREFORM TITANIUM ORBTL FLOOR STERILE,"$3,242.50",$0.00,"$3,242.50","$1,459.13","$2,314.17",$0.00,$558.67,$0.00,$0.00,$567.74,"$3,242.50",$0.00,"$1,621.25","$2,568.06","$2,594.00",$0.00,$507.45,$0.00,$516.21,$0.00
Jan-09,SUP,HCPCS C1713,,01-7109  -  PLATE BONE .3MM GRADE IV PREFORME TRAUMAONE LORENZ GOLD,"$2,835.00",$0.00,"$2,835.00","$1,275.75","$2,023.34",$0.00,$488.46,$0.00,$0.00,$496.39,"$2,835.00",$0.00,"$1,417.50","$2,245.32","$2,268.00",$0.00,$443.68,$0.00,$451.33,$0.00
Jan-10,SUP,HCPCS C1713,,01-7110  -  PLATE BN REG 2Y 6 HL TI MDFC 1.5MM SCR,$760.00,$0.00,$760.00,$342.00,$542.41,$0.00,$130.94,$0.00,$0.00,$133.07,$760.00,$0.00,$380.00,$601.92,$608.00,$0.00,$118.94,$0.00,$120.99,$0.00
Jan-12,SUP,HCPCS C1713,,01-7112  -  PLATE BONE LONG 6 HOLE 2Y TITANIUM MIDFAC 1.5MM SCREWS,$850.00,$0.00,$850.00,$382.50,$606.65,$0.00,$146.45,$0.00,$0.00,$148.83,$850.00,$0.00,$425.00,$673.20,$680.00,$0.00,$133.03,$0.00,$135.32,$0.00
Jan-14,SUP,HCPCS C1713,,01-7114  -  PLATE BONE XLONG 2Y TITANIUM CRANIOMAXILLOFACIAL 1.5MM SCREW,$745.00,$0.00,$745.00,$335.25,$531.71,$0.00,$128.36,$0.00,$0.00,$130.44,$745.00,$0.00,$372.50,$590.04,$596.00,$0.00,$116.59,$0.00,$118.60,$0.00
Jan-20,SUP,HCPCS C1713,,01-7120  -  PLATE BONE REGULAR X TITANIUM CRANIOMAXILLOFACIAL STERILE,$840.00,$0.00,$840.00,$378.00,$599.51,$0.00,$144.73,$0.00,$0.00,$147.08,$840.00,$0.00,$420.00,$665.28,$672.00,$0.00,$131.46,$0.00,$133.73,$0.00
Jan-21,SUP,HCPCS C1713,,01-7121  -  PLATE BONE 6 HOLE CVD TRAUMAONE GREEN ORBTL MIDFAC,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
Jan-22,SUP,HCPCS C1713,,01-7122  -  PLATE BONE 18 HOLE CVD TRAUMAONE GREEN ORBTL MIDFAC,"$1,570.00",$0.00,"$1,570.00",$706.50,"$1,120.51",$0.00,$270.50,$0.00,$0.00,$274.89,"$1,570.00",$0.00,$785.00,"$1,243.44","$1,256.00",$0.00,$245.71,$0.00,$249.94,$0.00
Jan-23,SUP,HCPCS C1713,,01-7123  -  PLATE BONE 4 HOLE CVD TRAUMAONE GREEN ORBTL MIDFAC,$932.50,$0.00,$932.50,$419.63,$665.53,$0.00,$160.67,$0.00,$0.00,$163.27,$932.50,$0.00,$466.25,$738.54,$746.00,$0.00,$145.94,$0.00,$148.45,$0.00
Jan-26,SUP,HCPCS C1713,,01-7126  -  PLATE BONE REGULAR CURVE 6 HOLE GRADE II TRAUMAONE LORENZ,$857.50,$0.00,$857.50,$385.88,$612.00,$0.00,$147.74,$0.00,$0.00,$150.14,$857.50,$0.00,$428.75,$679.14,$686.00,$0.00,$134.20,$0.00,$136.51,$0.00
Jan-28,SUP,HCPCS C1713,,01-7128  -  PLATE BONE REGULAR CURVE .6MM 8 HOLE TRAUMAONE LORENZ SILVER,$540.00,$0.00,$540.00,$243.00,$385.40,$0.00,$93.04,$0.00,$0.00,$94.55,$540.00,$0.00,$270.00,$427.68,$432.00,$0.00,$84.51,$0.00,$85.97,$0.00
Jan-30,SUP,HCPCS C1713,,01-7130  -  PLATE BN CRV .6MM SLVR TRAUMAONE 10 HL TI ORBT FLR 1.5MM SCR,$540.00,$0.00,$540.00,$243.00,$385.40,$0.00,$93.04,$0.00,$0.00,$94.55,$540.00,$0.00,$270.00,$427.68,$432.00,$0.00,$84.51,$0.00,$85.97,$0.00
Jan-31,SUP,HCPCS C1713,,01-7131  -  PLATE BN SQ 12MM LORENZ 4 HL NEURO 1.5MM SCR,$760.00,$0.00,$760.00,$342.00,$542.41,$0.00,$130.94,$0.00,$0.00,$133.07,$760.00,$0.00,$380.00,$601.92,$608.00,$0.00,$118.94,$0.00,$120.99,$0.00
1912000,SUP,HCPCS C1894,,1912000  -  SHEATH ENDSCP CLEAN 0D 4MM LENS SOFTWARE CONTROL ENDO-SCRUB,$32.80,$0.00,$32.80,$17.81,$23.41,$0.00,$5.65,$0.00,$0.00,$5.74,$32.80,$0.00,$16.40,$25.98,$26.24,$0.00,$5.13,$0.00,$5.22,$0.00
1912010,SUP,HCPCS C1892,,1912010  -  SHEATH ENDSCP CLEAN 4MM ESCRB2 30D SIN LEN STRL LATEX FREE,$27.50,$0.00,$27.50,$14.93,$19.63,$0.00,$4.74,$0.00,$0.00,$4.82,$27.50,$0.00,$13.75,$21.78,$22.00,$0.00,$4.30,$0.00,$4.38,$0.00
Jan-36,SUP,HCPCS C1713,,01-7136  -  PLATE BONE RECTANGLE 2X3 HOLE TRAUMAONE MATRIX SILVER,$950.00,$0.00,$950.00,$427.50,$678.02,$0.00,$163.68,$0.00,$0.00,$166.34,$950.00,$0.00,$475.00,$752.40,$760.00,$0.00,$148.68,$0.00,$151.24,$0.00
Jan-37,SUP,HCPCS C1713,,01-7137  -  PLATE BONE 2X4 HOLE RECTANGULAR LORENZ TITANIUM,$950.00,$0.00,$950.00,$427.50,$678.02,$0.00,$163.68,$0.00,$0.00,$166.34,$950.00,$0.00,$475.00,$752.40,$760.00,$0.00,$148.68,$0.00,$151.24,$0.00
Jan-42,SUP,Custom 27203010,,01-7142  -  DRILL TWIST 5MM STOP 1MM 50MM LORENZ MANDIB,$447.50,$0.00,$447.50,$0.00,$319.38,$0.00,$0.00,$0.00,$0.00,$0.00,$447.50,$0.00,$223.75,$354.42,$358.00,$0.00,$0.00,$0.00,$0.00,$0.00
Jan-44,SUP,Custom 27203010,,01-7144  -  DRILL TWIST 1.1MM 50MM 7MM STOP LORENZ 1.5MM SCREW MIDAS REX,$447.50,$0.00,$447.50,$0.00,$319.38,$0.00,$0.00,$0.00,$0.00,$0.00,$447.50,$0.00,$223.75,$354.42,$358.00,$0.00,$0.00,$0.00,$0.00,$0.00
Jan-46,SUP,Custom 27203010,,01-7146  -  DRILL TWIST 1.1MM 50MM 9MM STOP,$447.50,$0.00,$447.50,$0.00,$319.38,$0.00,$0.00,$0.00,$0.00,$0.00,$447.50,$0.00,$223.75,$354.42,$358.00,$0.00,$0.00,$0.00,$0.00,$0.00
Jan-48,SUP,Custom 27203010,,01-7148  -  DRILL TWIST 1.1MM 50MM 15MM STOP,$447.50,$0.00,$447.50,$0.00,$319.38,$0.00,$0.00,$0.00,$0.00,$0.00,$447.50,$0.00,$223.75,$354.42,$358.00,$0.00,$0.00,$0.00,$0.00,$0.00
1924542,SUP,Custom 27803010,,1924542  -  ROD SPNL 5.5MM 200MM SPRL R90D HEX END TI,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
1924543,SUP,Custom 27803010,,1924543  -  ROD SPNL 5.5MM 400MM SPRL R90D HEX END,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
1924547,SUP,HCPCS C1713,,1924547  -  SCREW BN 6.75MM 30MM SPRL R90D LCK TI SPNE THORLMBR,"$1,345.68",$0.00,"$1,345.68",$605.55,$960.41,$0.00,$231.85,$0.00,$0.00,$235.62,"$1,345.68",$0.00,$672.84,"$1,065.78","$1,076.54",$0.00,$210.60,$0.00,$214.23,$0.00
1924548,SUP,HCPCS C1713,,1924548  -  SCREW BN 6.75MM 35MM SPRL R90D LCK TI SPNE THORLMBR,"$1,345.68",$0.00,"$1,345.68",$605.55,$960.41,$0.00,$231.85,$0.00,$0.00,$235.62,"$1,345.68",$0.00,$672.84,"$1,065.78","$1,076.54",$0.00,$210.60,$0.00,$214.23,$0.00
1924549,SUP,HCPCS C1713,,1924549  -  SCREW BN 6.75MM 40MM SPRL R90D LCK TI SPNE THORLMBR,"$1,345.68",$0.00,"$1,345.68",$605.55,$960.41,$0.00,$231.85,$0.00,$0.00,$235.62,"$1,345.68",$0.00,$672.84,"$1,065.78","$1,076.54",$0.00,$210.60,$0.00,$214.23,$0.00
1924550,SUP,HCPCS C1713,,1924550  -  SCREW BN 6.75MM 45MM SPRL R90D LCK TI SPNE THORLMBR,"$1,345.68",$0.00,"$1,345.68",$605.55,$960.41,$0.00,$231.85,$0.00,$0.00,$235.62,"$1,345.68",$0.00,$672.84,"$1,065.78","$1,076.54",$0.00,$210.60,$0.00,$214.23,$0.00
1924551,SUP,HCPCS C1713,,1924551  -  SCREW BN 6.75MM 50MM SPRL R90D LCK TI SPNE THORLMBR,"$1,345.68",$0.00,"$1,345.68",$605.55,$960.41,$0.00,$231.85,$0.00,$0.00,$235.62,"$1,345.68",$0.00,$672.84,"$1,065.78","$1,076.54",$0.00,$210.60,$0.00,$214.23,$0.00
1924552,SUP,Custom 27803010,,1924552  -  ROD SPNL 5.5MM 200MM SPRL R90D SCRL EYE TI,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
1924553,SUP,Custom 27803010,,1924553  -  ROD SPNL 5.5MM 400MM SPRL R90D SCRL EYE TI,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
1924900,SUP,Custom 27803010,,1924900  -  ROD SPNL 5.5MM 40MM SPRL R90D NONHEXAGONAL TI,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
1924901,SUP,Custom 27803010,,1924901  -  ROD SPNL 5.5MM 50MM SPRL R90D NONHEXAGONAL TI,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
1924902,SUP,Custom 27803010,,1924902  -  ROD SPNL 5.5MM 60MM SPRL R90D TI,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
1924903,SUP,Custom 27803010,,1924903  -  ROD SPNL 5.5MM 70MM SPRL R90D NONHEXAGONAL TI,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
1924904,SUP,Custom 27803010,,1924904  -  ROD SPNL 5.5MM 80MM SPRL R90D NONHEXAGONAL TI SPNE,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
1924905,SUP,Custom 27803010,,1924905  -  ROD SPNL 5.5MM 90MM SPRL R90D NONHEXAGONAL,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
1924906,SUP,Custom 27803010,,1924906  -  ROD SPNL 5.5MM 100MM SPRL R90D NONHEXAGONAL TI,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
1924907,SUP,Custom 27803010,,1924907  -  ROD SPNL 5.5MM 110MM SPRL R90D NONHEXAGONAL TI,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
1924908,SUP,Custom 27803010,,1924908  -  ROD SPNL 5.5MM 120MM SPRL R90D NONHEXAGONAL TI,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
1924909,SUP,Custom 27803010,,1924909  -  ROD SPNL 5.5MM 600MM SPRL R90D HEX TI,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
Jan-80,SUP,HCPCS C1713,,01-7180  -  PLATE BN REG 80X53X.6MM SLVR LORENZ GRID MESH PNL TI CRNMXF,"$4,182.50",$0.00,"$4,182.50","$1,882.13","$2,985.05",$0.00,$720.62,$0.00,$0.00,$732.32,"$4,182.50",$0.00,"$2,091.25","$3,312.54","$3,346.00",$0.00,$654.56,$0.00,$665.85,$0.00
Jan-82,SUP,HCPCS C1713,,01-7182  -  PLATE BONE SMALL 85X53X.6MM GRID MESH PANEL LORENZ SILVER,"$4,125.00",$0.00,"$4,125.00","$1,856.25","$2,944.01",$0.00,$710.72,$0.00,$0.00,$722.25,"$4,125.00",$0.00,"$2,062.50","$3,267.00","$3,300.00",$0.00,$645.56,$0.00,$656.70,$0.00
Jan-85,SUP,HCPCS C1713,,01-7185  -  PLATE BONE SMALL 85X53X.3MM GRID MESH PANEL LORENZ SILVER,"$4,125.00",$0.00,"$4,125.00","$1,856.25","$2,944.01",$0.00,$710.72,$0.00,$0.00,$722.25,"$4,125.00",$0.00,"$2,062.50","$3,267.00","$3,300.00",$0.00,$645.56,$0.00,$656.70,$0.00
Jan-49,SUP,HCPCS C1713,,01-7249  -  PLATE BONE 100X100X.6MM CONTUR MESH LORENZ STERILE 1.5MM,"$6,692.50",$0.00,"$6,692.50","$3,011.63","$4,776.44",$0.00,"$1,153.08",$0.00,$0.00,"$1,171.80","$6,692.50",$0.00,"$3,346.25","$5,300.46","$5,354.00",$0.00,"$1,047.38",$0.00,"$1,065.45",$0.00
Jan-05,SUP,HCPCS C1713,,01-7305  -  PLATE BONE LORENZ TITANIUM H.5 MM OD18.5 MM CRANIOMAXILLOFAC,$800.00,$0.00,$800.00,$360.00,$570.96,$0.00,$137.84,$0.00,$0.00,$140.07,$800.00,$0.00,$400.00,$633.60,$640.00,$0.00,$125.20,$0.00,$127.36,$0.00
Jan-06,SUP,HCPCS C1713,,01-7306  -  PLATE BONE 18.5MM .5MM BURR HOLE LORENZ TITANIUM,$800.00,$0.00,$800.00,$360.00,$570.96,$0.00,$137.84,$0.00,$0.00,$140.07,$800.00,$0.00,$400.00,$633.60,$640.00,$0.00,$125.20,$0.00,$127.36,$0.00
Jan-08,SUP,HCPCS C1713,,01-7308  -  PLATE BONE 18.5MM BURR HOLE TITANIUM MIDFAC 1.5MM SCREWS,$800.00,$0.00,$800.00,$360.00,$570.96,$0.00,$137.84,$0.00,$0.00,$140.07,$800.00,$0.00,$400.00,$633.60,$640.00,$0.00,$125.20,$0.00,$127.36,$0.00
Jan-09,SUP,HCPCS C1713,,01-7309  -  PLATE BONE 22MM .5MM BURR HOLE LORENZ TITANIUM,$800.00,$0.00,$800.00,$360.00,$570.96,$0.00,$137.84,$0.00,$0.00,$140.07,$800.00,$0.00,$400.00,$633.60,$640.00,$0.00,$125.20,$0.00,$127.36,$0.00
Jan-40,SUP,HCPCS C1713,,01-7340  -  PLATE BONE 1/1.5MM 85X50X.2MM HEXAGONAL PANEL LORENZ,"$4,022.50",$0.00,"$4,022.50","$1,810.13","$2,870.86",$0.00,$693.06,$0.00,$0.00,$704.31,"$4,022.50",$0.00,"$2,011.25","$3,185.82","$3,218.00",$0.00,$629.52,$0.00,$640.38,$0.00
Jan-45,SUP,HCPCS C1713,,01-7345  -  PLATE BONE MEDIUM 2 HOLE STR TITANIUM MIDFAC 1.5MM SCREWS,$165.00,$0.00,$165.00,$74.25,$117.76,$0.00,$28.43,$0.00,$0.00,$28.89,$165.00,$0.00,$82.50,$130.68,$132.00,$0.00,$25.82,$0.00,$26.27,$0.00
Jan-47,SUP,HCPCS C1713,,01-7347  -  PLATE BONE LONG STR .6MM 2 HOLE TRAUMAONE LORENZ SILVER,$165.00,$0.00,$165.00,$74.25,$117.76,$0.00,$28.43,$0.00,$0.00,$28.89,$165.00,$0.00,$82.50,$130.68,$132.00,$0.00,$25.82,$0.00,$26.27,$0.00
Jan-51,SUP,HCPCS C1713,,01-7351  -  PLATE BN 25MM LORENZ 6 HL GAP NEURO 1.5MM SCR,"$1,062.50",$0.00,"$1,062.50",$478.13,$758.31,$0.00,$183.06,$0.00,$0.00,$186.04,"$1,062.50",$0.00,$531.25,$841.50,$850.00,$0.00,$166.28,$0.00,$169.15,$0.00
Jan-53,SUP,HCPCS C1713,,01-7353  -  PLATE BONE MEDIUM 35MMX.5MM 6 HOLE GAP LORENZ TITANIUM,"$1,062.50",$0.00,"$1,062.50",$478.13,$758.31,$0.00,$183.06,$0.00,$0.00,$186.04,"$1,062.50",$0.00,$531.25,$841.50,$850.00,$0.00,$166.28,$0.00,$169.15,$0.00
Jan-55,SUP,HCPCS C1713,,01-7355  -  PLATE BN 45MMX.5MM LORENZ 6 HL GAP TI CRNM 1.5MM SCR,"$1,062.50",$0.00,"$1,062.50",$478.13,$758.31,$0.00,$183.06,$0.00,$0.00,$186.04,"$1,062.50",$0.00,$531.25,$841.50,$850.00,$0.00,$166.28,$0.00,$169.15,$0.00
2010027,SUP,Custom 27203010,,2010027  -  ELECTRODE EMG DMD STRL LF I-PAS III SPRINGLESS DISP,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
2010028,SUP,Custom 27203010,,2010028  -  SET SPINAL INSULATED PEDICLE ACCES SYSTEM DIAMOND TIP I-PAS,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
2010029,SUP,Custom 27203010,,2010029  -  SET SPINAL INSULATED PEDICLE ACCES SYSTEM BEVELED TIP I-PAS,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
2010036,SUP,Custom 27011340,,2010036  -  STIMULATOR NRV STRL LF NVJJB DYNMC DISP,$182.50,$0.00,$182.50,$0.00,$130.25,$0.00,$0.00,$0.00,$0.00,$0.00,$182.50,$0.00,$91.25,$144.54,$146.00,$0.00,$0.00,$0.00,$0.00,$0.00
2010037,SUP,Custom 27203010,,2010037  -  ELECTRODE EMG BVL STRL LF I-PAS III SPRINGLESS DISP,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
2011202,SUP,Custom 27203010,,2011202  -  RETRACTOR SRG SHTH NRV ROOT,"$1,205.00",$0.00,"$1,205.00",$0.00,$860.01,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,205.00",$0.00,$602.50,$954.36,$964.00,$0.00,$0.00,$0.00,$0.00,$0.00
2012021,SUP,Custom 27011340,,2012021  -  PROBE EMG STM HNDPC NV M5,$712.50,$0.00,$712.50,$0.00,$508.51,$0.00,$0.00,$0.00,$0.00,$0.00,$712.50,$0.00,$356.25,$564.30,$570.00,$0.00,$0.00,$0.00,$0.00,$0.00
Oct-08,SUP,Custom 27203010,,10-7408  -  BANDAGE COMPRESSION 7 TUBULAR 42-52IN 10YD ELAST DRESSING,$29.31,$0.00,$29.31,$0.00,$20.92,$0.00,$0.00,$0.00,$0.00,$0.00,$29.31,$0.00,$14.65,$23.21,$23.45,$0.00,$0.00,$0.00,$0.00,$0.00
Oct-09,SUP,Custom 27203010,,10-7409  -  RETAINER DRESSING 8 TUBULAR 52-58IN 10YD ELAST LATEX SAFE,$39.97,$0.00,$39.97,$0.00,$28.52,$0.00,$0.00,$0.00,$0.00,$0.00,$39.97,$0.00,$19.98,$31.66,$31.97,$0.00,$0.00,$0.00,$0.00,$0.00
Oct-13,SUP,Custom 27203010,,10-7413  -  RETAINER DRESSING 12 10YD ELAST LATEX SAFE STRETCHED TUBULAR,$65.24,$0.00,$65.24,$0.00,$46.56,$0.00,$0.00,$0.00,$0.00,$0.00,$65.24,$0.00,$32.62,$51.67,$52.19,$0.00,$0.00,$0.00,$0.00,$0.00
2020000,SUP,HCPCS Q4130,,2020000  -  SUB TISS 20X20CM STRATTICE PIG DRML MTRX FIRM PTCH RECON,$65.23,$0.00,$65.23,$0.00,$46.55,$0.00,$0.00,$0.00,$0.00,$0.00,$65.23,$0.00,$32.61,$51.66,$52.18,$0.00,$0.00,$0.00,$0.00,$0.00
2020002,SUP,HCPCS Q4130,,2020002  -  MATRIX TISSUE 20X20CM RECONSTRUCTIVE STRATTICE PIG DERMIS,"$35,592.50",$0.00,"$35,592.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$35,592.50",$0.00,"$17,796.25","$28,189.26","$28,474.00",$0.00,$0.00,$0.00,$0.00,$0.00
2025002,SUP,HCPCS Q4130,,2025002  -  MATRIX TISSUE 25X20CM RECONSTRUCTIVE STRATTICE PIG DERMIS,"$44,490.00",$0.00,"$44,490.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$44,490.00",$0.00,"$22,245.00","$35,236.08","$35,592.00",$0.00,$0.00,$0.00,$0.00,$0.00
2029950,SUP,Custom 27803010,,2029950  -  KIT SPINAL DILAT XLIF NEUROVISION DISPOSABLE M5,"$2,000.00",$0.00,"$2,000.00",$0.00,"$1,427.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
2030365,SUP,Custom 27203010,,STRIP ACCK CMFCRV GLUC CHMTEST,$60.20,$0.00,$60.20,$0.00,$42.96,$0.00,$0.00,$0.00,$0.00,$0.00,$60.20,$0.00,$30.10,$47.68,$48.16,$0.00,$0.00,$0.00,$0.00,$0.00
2040001,SUP,HCPCS C1713,,2040001  -  DIGITIZER INST BENDINI ROD BNDRG ARY,"$5,660.00",$0.00,"$5,660.00","$2,547.00","$4,039.54",$0.00,$975.19,$0.00,$0.00,$991.02,"$5,660.00",$0.00,"$2,830.00","$4,482.72","$4,528.00",$0.00,$885.79,$0.00,$901.07,$0.00
2078175,SUP,HCPCS C1769,,2078175  -  GUIDEWIRE VASCULAR .014IN 300CM 3CM SHAPEABLE TIP STEERABLE,$375.00,$0.00,$375.00,$203.63,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
2110140,SUP,HCPCS C1713,,2110140  -  SPACER SPNL 0D 40X20X8MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2110145,SUP,HCPCS C1713,,2110145  -  SPACER SPNL 0D 45X20X8MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2110150,SUP,HCPCS C1713,,2110150  -  SPACER SPNL 0D 50X20X8MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2110155,SUP,HCPCS C1713,,2110155  -  SPACER SPNL 0D 55X20X8MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2110160,SUP,HCPCS C1713,,2110160  -  SPACER SPNL 0D 60X20X8MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2110240,SUP,HCPCS C1713,,2110240  -  SPACER SPNL 0D 40X20X10MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2110245,SUP,HCPCS C1713,,2110245  -  SPACER SPNL 0D 45X20X10MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2110250,SUP,HCPCS C1713,,2110250  -  SPACER SPNL 0D 50X20X10MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2110255,SUP,HCPCS C1713,,2110255  -  SPACER SPNL 0D 55X20X10MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2110260,SUP,HCPCS C1713,,2110260  -  SPACER SPNL 0D 60X20X10MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2110340,SUP,HCPCS C1713,,2110340  -  SPACER SPNL 0D 40X20X12MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2110345,SUP,HCPCS C1713,,2110345  -  SPACER SPNL 0D 45X20X12MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2110350,SUP,HCPCS C1713,,2110350  -  SPACER SPNL 0D 50X20X12MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2110355,SUP,HCPCS C1713,,2110355  -  SPACER SPNL 0D 55X20X12MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2110360,SUP,HCPCS C1713,,2110360  -  SPACER SPNL 0D 60X20X12MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2110440,SUP,HCPCS C1713,,2110440  -  SPACER SPNL 0D 40X20X14MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2110445,SUP,HCPCS C1713,,2110445  -  SPACER SPNL 0D 45X20X14MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2110450,SUP,HCPCS C1713,,2110450  -  SPACER SPNL 0D 50X20X14MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2110455,SUP,HCPCS C1713,,2110455  -  SPACER SPNL 0D 55X20X14MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2110460,SUP,HCPCS C1713,,2110460  -  SPACER SPNL 0D 60X20X14MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2110540,SUP,HCPCS C1713,,2110540  -  SPACER SPNL 0D 40X20X16MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2110545,SUP,HCPCS C1713,,2110545  -  SPACER SPNL 0D 45X20X16MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2110550,SUP,HCPCS C1713,,2110550  -  SPACER SPNL 0D 50X20X16MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2110555,SUP,HCPCS C1713,,2110555  -  SPACER SPNL 0D 55X20X16MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2110560,SUP,HCPCS C1713,,2110560  -  SPACER SPNL 0D 60X20X16MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2111140,SUP,HCPCS C1713,,2111140  -  SPACER SPNL 6D 40X20X8MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2111145,SUP,HCPCS C1713,,2111145  -  SPACER SPNL 6D 45X20X8MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2111150,SUP,HCPCS C1713,,2111150  -  SPACER SPNL 6D 50X20X8MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2111155,SUP,HCPCS C1713,,2111155  -  SPACER SPNL 6D 55X20X8MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2111160,SUP,HCPCS C1713,,2111160  -  SPACER SPNL 6D 60X20X8MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2111240,SUP,HCPCS C1713,,2111240  -  SPACER SPNL 6D 40X20X10MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2111245,SUP,HCPCS C1713,,2111245  -  SPACER SPNL 6D 45X20X10MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2111250,SUP,HCPCS C1713,,2111250  -  SPACER SPNL 6D 50X20X10MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2111255,SUP,HCPCS C1713,,2111255  -  SPACER SPNL 6D 55X20X10MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2111260,SUP,HCPCS C1713,,2111260  -  SPACER SPNL 6D 60X20X10MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2111340,SUP,HCPCS C1713,,2111340  -  SPACER SPNL 6D 40X20X12MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2111345,SUP,HCPCS C1713,,2111345  -  SPACER SPNL 6D 45X20X12MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2111350,SUP,HCPCS C1713,,2111350  -  SPACER SPNL 6D 50X20X12MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2111355,SUP,HCPCS C1713,,2111355  -  SPACER SPNL 6D 55X20X12MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2111360,SUP,HCPCS C1713,,2111360  -  SPACER SPNL 6D 60X20X12MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2111440,SUP,HCPCS C1713,,2111440  -  SPACER SPNL 6D 40X20X14MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2111445,SUP,HCPCS C1713,,2111445  -  SPACER SPNL 6D 45X20X14MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2111450,SUP,HCPCS C1713,,2111450  -  SPACER SPNL 6D 50X20X14MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2111455,SUP,HCPCS C1713,,2111455  -  SPACER SPNL 6D 55X20X14MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2111460,SUP,HCPCS C1713,,2111460  -  SPACER SPNL 6D 60X20X14MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2111540,SUP,HCPCS C1713,,2111540  -  SPACER SPNL 6D 40X20X16MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2111545,SUP,HCPCS C1713,,2111545  -  SPACER SPNL 6D 45X20X16MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2111550,SUP,HCPCS C1713,,2111550  -  SPACER SPNL 6D 50X20X16MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2111555,SUP,HCPCS C1713,,2111555  -  SPACER SPNL 6D 55X20X16MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2111560,SUP,HCPCS C1713,,2111560  -  SPACER SPNL 6D 60X20X16MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2112240,SUP,HCPCS C1713,,2112240  -  SPACER SPNL 12D 40X20X10MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2112245,SUP,HCPCS C1713,,2112245  -  SPACER SPNL 12D 45X20X10MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2112250,SUP,HCPCS C1713,,2112250  -  SPACER SPNL 12D 50X20X10MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2112255,SUP,HCPCS C1713,,2112255  -  SPACER SPNL 12D 55X20X10MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2112260,SUP,HCPCS C1713,,2112260  -  SPACER SPNL 12D 60X20X10MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2112340,SUP,HCPCS C1713,,2112340  -  SPACER SPNL 12D 40X20X12MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2112345,SUP,HCPCS C1713,,2112345  -  SPACER SPNL 12D 45X20X12MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2112350,SUP,HCPCS C1713,,2112350  -  SPACER SPNL 12D 50X20X12MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2112355,SUP,HCPCS C1713,,2112355  -  SPACER SPNL 12D 55X20X12MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2112360,SUP,HCPCS C1713,,2112360  -  SPACER SPNL 12D 60X20X12MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2112440,SUP,HCPCS C1713,,2112440  -  SPACER SPNL 12D 40X20X14MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2112445,SUP,HCPCS C1713,,2112445  -  SPACER SPNL 12D 45X20X14MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2112450,SUP,HCPCS C1713,,2112450  -  SPACER SPNL 12D 50X20X14MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2112455,SUP,HCPCS C1713,,2112455  -  SPACER SPNL 12D 55X20X14MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2112460,SUP,HCPCS C1713,,2112460  -  SPACER SPNL 12D 60X20X14MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2112540,SUP,HCPCS C1713,,2112540  -  SPACER SPNL 12D 40X20X16MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2112545,SUP,HCPCS C1713,,2112545  -  SPACER SPNL 12D 45X20X16MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2112550,SUP,HCPCS C1713,,2112550  -  SPACER SPNL 12D 50X20X16MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2112555,SUP,HCPCS C1713,,2112555  -  SPACER SPNL 12D 55X20X16MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2112560,SUP,HCPCS C1713,,2112560  -  SPACER SPNL 12D 60X20X16MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2112640,SUP,HCPCS C1713,,2112640  -  SPACER SPNL 12D 40X20X18MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2112645,SUP,HCPCS C1713,,2112645  -  SPACER SPNL 12D 45X20X18MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2112650,SUP,HCPCS C1713,,2112650  -  SPACER SPNL 12D 50X20X18MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2112655,SUP,HCPCS C1713,,2112655  -  SPACER SPNL 12D 55X20X18MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2112660,SUP,HCPCS C1713,,2112660  -  SPACER SPNL 12D 60X20X18MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2113340,SUP,HCPCS C1713,,2113340  -  SPACER SPNL 18D 40X20X12MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2113345,SUP,HCPCS C1713,,2113345  -  SPACER SPNL 18D 45X20X12MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2113350,SUP,HCPCS C1713,,2113350  -  SPACER SPNL 18D 50X20X12MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2113355,SUP,HCPCS C1713,,2113355  -  SPACER SPNL 18D 55X20X12MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2113360,SUP,HCPCS C1713,,2113360  -  SPACER SPNL 18D 60X20X12MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2113440,SUP,HCPCS C1713,,2113440  -  SPACER SPNL 18D 40X20X14MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2113445,SUP,HCPCS C1713,,2113445  -  SPACER SPNL 18D 45X20X14MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2113450,SUP,HCPCS C1713,,2113450  -  SPACER SPNL 18D 50X20X14MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2113455,SUP,HCPCS C1713,,2113455  -  SPACER SPNL 18D 55X20X14MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2113460,SUP,HCPCS C1713,,2113460  -  SPACER SPNL 18D 60X20X14MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2113540,SUP,HCPCS C1713,,2113540  -  SPACER SPNL 18D 40X20X16MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2113545,SUP,HCPCS C1713,,2113545  -  SPACER SPNL 18D 45X20X16MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2113550,SUP,HCPCS C1713,,2113550  -  SPACER SPNL 18D 50X20X16MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2113555,SUP,HCPCS C1713,,2113555  -  SPACER SPNL 18D 55X20X16MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2113560,SUP,HCPCS C1713,,2113560  -  SPACER SPNL 18D 60X20X16MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2113640,SUP,HCPCS C1713,,2113640  -  SPACER SPNL 18D 40X20X18MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2113645,SUP,HCPCS C1713,,2113645  -  SPACER SPNL 18D 45X20X18MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2113650,SUP,HCPCS C1713,,2113650  -  SPACER SPNL 18D 50X20X18MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2113655,SUP,HCPCS C1713,,2113655  -  SPACER SPNL 18D 55X20X18MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2113660,SUP,HCPCS C1713,,2113660  -  SPACER SPNL 18D 60X20X18MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2131240,SUP,HCPCS C1713,,2131240  -  SPACER SPNL 6D 40X27X10MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2131245,SUP,HCPCS C1713,,2131245  -  SPACER SPNL 6D 45X27X10MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2131250,SUP,HCPCS C1713,,2131250  -  SPACER SPNL 6D 50X27X10MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2131255,SUP,HCPCS C1713,,2131255  -  SPACER SPNL 6D 55X27X10MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2131260,SUP,HCPCS C1713,,2131260  -  SPACER SPNL 6D 60X27X10MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2131340,SUP,HCPCS C1713,,2131340  -  SPACER SPNL 6D 40X27X12MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2131345,SUP,HCPCS C1713,,2131345  -  SPACER SPNL 6D 45X27X12MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2131350,SUP,HCPCS C1713,,2131350  -  SPACER SPNL 6D 50X27X12MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2131355,SUP,HCPCS C1713,,2131355  -  SPACER SPNL 6D 55X27X12MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2131360,SUP,HCPCS C1713,,2131360  -  SPACER SPNL 6D 60X27X12MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2131440,SUP,HCPCS C1713,,2131440  -  SPACER SPNL 6D 40X27X14MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2131445,SUP,HCPCS C1713,,2131445  -  SPACER SPNL 6D 45X27X14MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2131450,SUP,HCPCS C1713,,2131450  -  SPACER SPNL 6D 50X27X14MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2131455,SUP,HCPCS C1713,,2131455  -  SPACER SPNL 6D 55X27X14MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2131460,SUP,HCPCS C1713,,2131460  -  SPACER SPNL 6D 60X27X14MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2131540,SUP,HCPCS C1713,,2131540  -  SPACER SPNL 6D 40X27X16MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2131545,SUP,HCPCS C1713,,2131545  -  SPACER SPNL 6D 45X27X16MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2131550,SUP,HCPCS C1713,,2131550  -  SPACER SPNL 6D 50X27X16MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2131555,SUP,HCPCS C1713,,2131555  -  SPACER SPNL 6D 55X27X16MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2131560,SUP,HCPCS C1713,,2131560  -  SPACER SPNL 6D 60X27X16MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2132340,SUP,HCPCS C1713,,2132340  -  SPACER SPNL 12D 40X27X12MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2132345,SUP,HCPCS C1713,,2132345  -  SPACER SPNL 12D 45X27X12MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2132350,SUP,HCPCS C1713,,2132350  -  SPACER SPNL 12D 50X27X12MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2132355,SUP,HCPCS C1713,,2132355  -  SPACER SPNL 12D 55X27X12MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2132360,SUP,HCPCS C1713,,2132360  -  SPACER SPNL 12D 60X27X12MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2132440,SUP,HCPCS C1713,,2132440  -  SPACER SPNL 12D 40X27X14MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2132445,SUP,HCPCS C1713,,2132445  -  SPACER SPNL 12D 45X27X14MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2132450,SUP,HCPCS C1713,,2132450  -  SPACER SPNL 12D 50X27X14MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2132455,SUP,HCPCS C1713,,2132455  -  SPACER SPNL 12D 55X27X14MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2132460,SUP,HCPCS C1713,,2132460  -  SPACER SPNL 12D 60X27X14MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2132540,SUP,HCPCS C1713,,2132540  -  SPACER SPNL 12D 40X27X16MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2132545,SUP,HCPCS C1713,,2132545  -  SPACER SPNL 12D 45X27X16MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2132550,SUP,HCPCS C1713,,2132550  -  SPACER SPNL 12D 50X27X16MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2132555,SUP,HCPCS C1713,,2132555  -  SPACER SPNL 12D 55X27X16MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2132560,SUP,HCPCS C1713,,2132560  -  SPACER SPNL 12D 60X27X16MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2132640,SUP,HCPCS C1713,,2132640  -  SPACER SPNL 12D 40X27X18MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2132645,SUP,HCPCS C1713,,2132645  -  SPACER SPNL 12D 45X27X18MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2132650,SUP,HCPCS C1713,,2132650  -  SPACER SPNL 12D 50X27X18MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2132655,SUP,HCPCS C1713,,2132655  -  SPACER SPNL 12D 55X27X18MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2132660,SUP,HCPCS C1713,,2132660  -  SPACER SPNL 12D 60X27X18MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2133440,SUP,HCPCS C1713,,2133440  -  SPACER SPNL 18D 40X27X14MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2133445,SUP,HCPCS C1713,,2133445  -  SPACER SPNL 18D 45X27X14MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2133450,SUP,HCPCS C1713,,2133450  -  SPACER SPNL 18D 50X27X14MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2133455,SUP,HCPCS C1713,,2133455  -  SPACER SPNL 18D 55X27X14MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2133460,SUP,HCPCS C1713,,2133460  -  SPACER SPNL 18D 60X27X14MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2133540,SUP,HCPCS C1713,,2133540  -  SPACER SPNL 18D 40X27X16MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2133545,SUP,HCPCS C1713,,2133545  -  SPACER SPNL 18D 45X27X16MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2133550,SUP,HCPCS C1713,,2133550  -  SPACER SPNL 18D 50X27X16MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2133555,SUP,HCPCS C1713,,2133555  -  SPACER SPNL 18D 55X27X16MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2133560,SUP,HCPCS C1713,,2133560  -  SPACER SPNL 18D 60X27X16MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2133640,SUP,HCPCS C1713,,2133640  -  SPACER SPNL 18D 40X27X18MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2133645,SUP,HCPCS C1713,,2133645  -  SPACER SPNL 18D 45X27X18MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2133650,SUP,HCPCS C1713,,2133650  -  SPACER SPNL 18D 50X27X18MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2133655,SUP,HCPCS C1713,,2133655  -  SPACER SPNL 18D 55X27X18MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2133660,SUP,HCPCS C1713,,2133660  -  SPACER SPNL 18D 60X27X18MM PIVOX LAT OLIF25,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2140001,SUP,HCPCS C1713,,2140001  -  PLATE SPNL SM 2 HOLE OLIF25 STRL,"$9,487.50",$0.00,"$9,487.50","$4,269.38","$5,158.80",$0.00,"$1,634.65",$0.00,$0.00,"$1,661.19","$9,487.50",$0.00,"$4,743.75","$7,514.10","$7,590.00",$0.00,"$1,484.79",$0.00,"$1,510.41",$0.00
2140002,SUP,HCPCS C1713,,2140002  -  PLATE SPNL LG 2 HOLE OLIF25 STRL,"$9,487.50",$0.00,"$9,487.50","$4,269.38","$5,158.80",$0.00,"$1,634.65",$0.00,$0.00,"$1,661.19","$9,487.50",$0.00,"$4,743.75","$7,514.10","$7,590.00",$0.00,"$1,484.79",$0.00,"$1,510.41",$0.00
2140120,SUP,HCPCS C1713,,2140120  -  SCREW BONE 5.5MM 20MM LMBR SPN STRL,"$1,209.00",$0.00,"$1,209.00",$544.05,$862.86,$0.00,$208.30,$0.00,$0.00,$211.69,"$1,209.00",$0.00,$604.50,$957.53,$967.20,$0.00,$189.21,$0.00,$192.47,$0.00
2140125,SUP,HCPCS C1713,,2140125  -  SCREW BONE 5.5MM 25MM LMBR SPN STRL,"$1,209.00",$0.00,"$1,209.00",$544.05,$862.86,$0.00,$208.30,$0.00,$0.00,$211.69,"$1,209.00",$0.00,$604.50,$957.53,$967.20,$0.00,$189.21,$0.00,$192.47,$0.00
2140130,SUP,HCPCS C1713,,2140130  -  SCREW BONE 5.5MM 30MM LMBR SPN STRL,"$1,209.00",$0.00,"$1,209.00",$544.05,$862.86,$0.00,$208.30,$0.00,$0.00,$211.69,"$1,209.00",$0.00,$604.50,$957.53,$967.20,$0.00,$189.21,$0.00,$192.47,$0.00
2140135,SUP,HCPCS C1713,,2140135  -  SCREW BONE 5.5MM 35MM LMBR SPN STRL,"$1,209.00",$0.00,"$1,209.00",$544.05,$862.86,$0.00,$208.30,$0.00,$0.00,$211.69,"$1,209.00",$0.00,$604.50,$957.53,$967.20,$0.00,$189.21,$0.00,$192.47,$0.00
2140140,SUP,HCPCS C1713,,2140140  -  SCREW BONE 5.5MM 40MM LMBR SPN STRL,"$1,209.00",$0.00,"$1,209.00",$544.05,$862.86,$0.00,$208.30,$0.00,$0.00,$211.69,"$1,209.00",$0.00,$604.50,$957.53,$967.20,$0.00,$189.21,$0.00,$192.47,$0.00
2140145,SUP,HCPCS C1713,,2140145  -  SCREW BONE 5.5MM 45MM LMBR SPN STRL,"$1,209.00",$0.00,"$1,209.00",$544.05,$862.86,$0.00,$208.30,$0.00,$0.00,$211.69,"$1,209.00",$0.00,$604.50,$957.53,$967.20,$0.00,$189.21,$0.00,$192.47,$0.00
2140150,SUP,HCPCS C1713,,2140150  -  SCREW BONE 5.5MM 50MM LMBR SPN STRL,"$1,209.00",$0.00,"$1,209.00",$544.05,$862.86,$0.00,$208.30,$0.00,$0.00,$211.69,"$1,209.00",$0.00,$604.50,$957.53,$967.20,$0.00,$189.21,$0.00,$192.47,$0.00
2150010,SUP,HCPCS C1713,,2150010  -  PLATE SPNL 10MM DIVERGENCE-L OLIF51,"$9,487.50",$0.00,"$9,487.50","$4,269.38","$5,158.80",$0.00,"$1,634.65",$0.00,$0.00,"$1,661.19","$9,487.50",$0.00,"$4,743.75","$7,514.10","$7,590.00",$0.00,"$1,484.79",$0.00,"$1,510.41",$0.00
2150012,SUP,HCPCS C1713,,2150012  -  PLATE SPNL 12MM DIVERGENCE-L OLIF51,"$9,487.50",$0.00,"$9,487.50","$4,269.38","$5,158.80",$0.00,"$1,634.65",$0.00,$0.00,"$1,661.19","$9,487.50",$0.00,"$4,743.75","$7,514.10","$7,590.00",$0.00,"$1,484.79",$0.00,"$1,510.41",$0.00
2150014,SUP,HCPCS C1713,,2150014  -  PLATE SPNL 14MM DIVERGENCE-L OLIF51,"$9,487.50",$0.00,"$9,487.50","$4,269.38","$5,158.80",$0.00,"$1,634.65",$0.00,$0.00,"$1,661.19","$9,487.50",$0.00,"$4,743.75","$7,514.10","$7,590.00",$0.00,"$1,484.79",$0.00,"$1,510.41",$0.00
2150016,SUP,HCPCS C1713,,2150016  -  PLATE SPNL 16MM DIVERGENCE-L OLIF51,"$9,487.50",$0.00,"$9,487.50","$4,269.38","$5,158.80",$0.00,"$1,634.65",$0.00,$0.00,"$1,661.19","$9,487.50",$0.00,"$4,743.75","$7,514.10","$7,590.00",$0.00,"$1,484.79",$0.00,"$1,510.41",$0.00
2150018,SUP,HCPCS C1713,,2150018  -  PLATE SPNL 18MM DIVERGENCE-L OLIF51,"$9,487.50",$0.00,"$9,487.50","$4,269.38","$5,158.80",$0.00,"$1,634.65",$0.00,$0.00,"$1,661.19","$9,487.50",$0.00,"$4,743.75","$7,514.10","$7,590.00",$0.00,"$1,484.79",$0.00,"$1,510.41",$0.00
2150020,SUP,HCPCS C1713,,2150020  -  PLATE SPNL 20MM DIVERGENCE-L OLIF51,"$9,487.50",$0.00,"$9,487.50","$4,269.38","$5,158.80",$0.00,"$1,634.65",$0.00,$0.00,"$1,661.19","$9,487.50",$0.00,"$4,743.75","$7,514.10","$7,590.00",$0.00,"$1,484.79",$0.00,"$1,510.41",$0.00
2150120,SUP,HCPCS C1713,,2150120  -  SCREW BONE 20MM DIVERGENCE-L SPN,"$1,209.00",$0.00,"$1,209.00",$544.05,$862.86,$0.00,$208.30,$0.00,$0.00,$211.69,"$1,209.00",$0.00,$604.50,$957.53,$967.20,$0.00,$189.21,$0.00,$192.47,$0.00
2150125,SUP,HCPCS C1713,,2150125  -  SCREW BONE 25MM DIVERGENCE-L SPN,"$1,209.00",$0.00,"$1,209.00",$544.05,$862.86,$0.00,$208.30,$0.00,$0.00,$211.69,"$1,209.00",$0.00,$604.50,$957.53,$967.20,$0.00,$189.21,$0.00,$192.47,$0.00
2150130,SUP,HCPCS C1713,,2150130  -  SCREW BONE 6.5MM 30MM DIVERGENCE-L SPN,"$1,209.00",$0.00,"$1,209.00",$544.05,$862.86,$0.00,$208.30,$0.00,$0.00,$211.69,"$1,209.00",$0.00,$604.50,$957.53,$967.20,$0.00,$189.21,$0.00,$192.47,$0.00
2150135,SUP,HCPCS C1713,,2150135  -  SCREW BONE 6.5MM 35MM DIVERGENCE-L SPN,"$1,209.00",$0.00,"$1,209.00",$544.05,$862.86,$0.00,$208.30,$0.00,$0.00,$211.69,"$1,209.00",$0.00,$604.50,$957.53,$967.20,$0.00,$189.21,$0.00,$192.47,$0.00
2150140,SUP,HCPCS C1713,,2150140  -  SCREW BONE 6.5MM 40MM DIVERGENCE-L SPN,"$1,209.00",$0.00,"$1,209.00",$544.05,$862.86,$0.00,$208.30,$0.00,$0.00,$211.69,"$1,209.00",$0.00,$604.50,$957.53,$967.20,$0.00,$189.21,$0.00,$192.47,$0.00
2151110,SUP,HCPCS C1713,,2151110  -  CAGE SPNL 6D SM 32X25X10MM DIVERGENCE-L ANT OBLQ LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2151112,SUP,HCPCS C1713,,2151112  -  CAGE SPNL 32X25X12MM DIVERGENCE-L 6D SM,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2151114,SUP,HCPCS C1713,,2151114  -  CAGE SPNL 6D SM 32X25X14MM DIVERGENCE-L ANT OBLQ LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2151116,SUP,HCPCS C1713,,2151116  -  CAGE SPNL 6D SM 32X25X16MM DIVERGENCE-L ANT OBLQ LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2151118,SUP,HCPCS C1713,,2151118  -  CAGE SPNL 6D SM 32X25X18MM DIVERGENCE-L ANT OBLQ LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2151120,SUP,HCPCS C1713,,2151120  -  CAGE SPNL 6D SM 32X25X20MM DIVERGENCE-L ANT OBLQ LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2151210,SUP,HCPCS C1713,,2151210  -  CAGE SPNL 6D MED 37X29X10MM DIVERGENCE-L ANT OBLQ LMBR,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2151212,SUP,HCPCS C1713,,2151212  -  CAGE SPNL 6D MED 37X29X12MM DIVERGENCE-L ANT OBLQ LMBR,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2151214,SUP,HCPCS C1713,,2151214  -  CAGE SPNL 6D MED 37X29X14MM DIVERGENCE-L ANT OBLQ LMBR,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2151216,SUP,HCPCS C1713,,2151216  -  CAGE SPNL 6D MED 37X29X16MM DIVERGENCE-L ANT OBLQ LMBR,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2151218,SUP,HCPCS C1713,,2151218  -  CAGE SPNL 6D MED 37X29X18MM DIVERGENCE-L ANT OBLQ LMBR,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2151220,SUP,HCPCS C1713,,2151220  -  CAGE SPNL 6D MED 37X29X20MM DIVERGENCE-L ANT OBLQ LMBR,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2151310,SUP,HCPCS C1713,,2151310  -  CAGE SPNL 6D LG 42X32X10MM DIVERGENCE-L ANT OBLQ LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2151312,SUP,HCPCS C1713,,2151312  -  CAGE SPNL 6D LG 42X32X12MM DIVERGENCE-L ANT OBLQ LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2151314,SUP,HCPCS C1713,,2151314  -  CAGE SPNL 6D LG 42X32X14MM DIVERGENCE-L ANT OBLQ LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2151316,SUP,HCPCS C1713,,2151316  -  CAGE SPNL 6D LG 42X32X16MM DIVERGENCE-L ANT OBLQ LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2151318,SUP,HCPCS C1713,,2151318  -  CAGE SPNL 6D LG 42X32X18MM DIVERGENCE-L ANT OBLQ LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2151320,SUP,HCPCS C1713,,2151320  -  CAGE SPNL 6D LG 42X32X20MM DIVERGENCE-L ANT OBLQ LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2152110,SUP,HCPCS C1713,,2152110  -  CAGE SPNL 12D SM 32X25X10MM DIVERGENCE-L ANT OBLQ LMBR,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2152112,SUP,HCPCS C1713,,2152112  -  CAGE SPNL 12D SM 32X25X12MM DIVERGENCE-L ANT OBLQ LMBR,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2152114,SUP,HCPCS C1713,,2152114  -  CAGE SPNL 12D SM 32X25X14MM DIVERGENCE-L ANT OBLQ LMBR,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2152116,SUP,HCPCS C1713,,2152116  -  CAGE SPNL 12D SM 32X25X16MM DIVERGENCE-L ANT OBLQ LMBR,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2152118,SUP,HCPCS C1713,,2152118  -  CAGE SPNL 12D SM 32X25X18MM DIVERGENCE-L ANT OBLQ LMBR,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2152120,SUP,HCPCS C1713,,2152120  -  CAGE SPNL 12D SM 32X25X20MM DIVERGENCE-L ANT OBLQ LMBR,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2152210,SUP,HCPCS C1713,,2152210  -  CAGE SPNL 12D MED 37X29X10MM DIVERGENCE-L ANT OBLQ LMBR,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2152212,SUP,HCPCS C1713,,2152212  -  CAGE SPNL 12D MED 37X29X12MM DIVERGENCE-L ANT OBLQ LMBR,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2152214,SUP,HCPCS C1713,,2152214  -  CAGE SPNL 12D MED 37X29X14MM DIVERGENCE-L ANT OBLQ LMBR,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2152216,SUP,HCPCS C1713,,2152216  -  CAGE SPNL 12D MED 37X29X16MM DIVERGENCE-L ANT OBLQ LMBR,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2152218,SUP,HCPCS C1713,,2152218  -  CAGE SPNL 12D MED 37X29X18MM DIVERGENCE-L ANT OBLQ LMBR,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2152220,SUP,HCPCS C1713,,2152220  -  CAGE SPNL 12D MED 37X29X20MM DIVERGENCE-L ANT OBLQ LMBR,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2152312,SUP,HCPCS C1713,,2152312  -  CAGE SPNL 12D LG 42X32X12MM DIVERGENCE-L ANT OBLQ LMBR,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2152314,SUP,HCPCS C1713,,2152314  -  CAGE SPNL 12D LG 42X32X14MM DIVERGENCE-L ANT OBLQ LMBR,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2152316,SUP,HCPCS C1713,,2152316  -  CAGE SPNL 12D LG 42X32X16MM DIVERGENCE-L ANT OBLQ LMBR,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2152318,SUP,HCPCS C1713,,2152318  -  CAGE SPNL 12D LG 42X32X18MM DIVERGENCE-L ANT OBLQ LMBR,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2152320,SUP,HCPCS C1713,,2152320  -  CAGE SPNL 12D LG 42X32X20MM DIVERGENCE-L ANT OBLQ LMBR,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2153112,SUP,HCPCS C1713,,2153112  -  CAGE SPNL 18D SM 32X25X12MM DIVERGENCE-L ANT OBLQ LMBR,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2153114,SUP,HCPCS C1713,,2153114  -  CAGE SPNL 18D SM 32X25X14MM DIVERGENCE-L ANT OBLQ LMBR,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2153116,SUP,HCPCS C1713,,2153116  -  CAGE SPNL 18D SM 32X25X16MM DIVERGENCE-L ANT OBLQ LMBR,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2153118,SUP,HCPCS C1713,,2153118  -  CAGE SPNL 18D SM 32X25X18MM DIVERGENCE-L ANT OBLQ LMBR,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2153120,SUP,HCPCS C1713,,2153120  -  CAGE SPNL 18D SM 32X25X20MM DIVERGENCE-L ANT OBLQ LMBR,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2153214,SUP,HCPCS C1713,,2153214  -  CAGE SPNL 18D MED 37X29X14MM DIVERGENCE-L ANT OBLQ LMBR,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2153216,SUP,HCPCS C1713,,2153216  -  CAGE SPNL 18D MED 37X29X16MM DIVERGENCE-L ANT OBLQ LMBR,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2153218,SUP,HCPCS C1713,,2153218  -  CAGE SPNL 18D MED 37X29X18MM DIVERGENCE-L ANT OBLQ LMBR,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2153220,SUP,HCPCS C1713,,2153220  -  CAGE SPNL 18D MED 37X29X20MM DIVERGENCE-L ANT OBLQ LMBR,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2153316,SUP,HCPCS C1713,,2153316  -  CAGE SPNL 18D LG 42X32X16MM DIVERGENCE-L ANT OBLQ LMBR,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2153318,SUP,HCPCS C1713,,2153318  -  CAGE SPNL 18D LG 42X32X18MM DIVERGENCE-L ANT OBLQ LMBR,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2153320,SUP,HCPCS C1713,,2153320  -  CAGE SPNL 18D LG 42X32X20MM DIVERGENCE-L ANT OBLQ LMBR,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2154116,SUP,HCPCS C1713,,2154116  -  CAGE SPNL 24D SM 32X25X16MM DIVERGENCE-L ANT OBLQ LMBR,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2154118,SUP,HCPCS C1713,,2154118  -  CAGE SPNL 24D SM 32X25X18MM DIVERGENCE-L ANT OBLQ LMBR,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2154120,SUP,HCPCS C1713,,2154120  -  CAGE SPNL 24D SM 32X25X20MM DIVERGENCE-L ANT OBLQ LMBR,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2154216,SUP,HCPCS C1713,,2154216  -  CAGE SPNL 24D MED 37X29X16MM DIVERGENCE-L ANT OBLQ LMBR,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2154218,SUP,HCPCS C1713,,2154218  -  CAGE SPNL 24D MED 37X29X18MM DIVERGENCE-L ANT OBLQ LMBR,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2154220,SUP,HCPCS C1713,,2154220  -  CAGE SPNL 24D MED 37X29X20MM DIVERGENCE-L ANT OBLQ LMBR,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2154318,SUP,HCPCS C1713,,2154318  -  CAGE SPNL 24D LG 42X32X18MM DIVERGENCE-L ANT OBLQ LMBR,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2154320,SUP,HCPCS C1713,,2154320  -  CAGE SPNL 24D LG 42X32X20MM DIVERGENCE-L ANT OBLQ LMBR,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2160010,SUP,HCPCS C1713,,2160010  -  PLATE SPNL 10MM DIVERGENCE-L ALIF,"$9,487.50",$0.00,"$9,487.50","$4,269.38","$5,158.80",$0.00,"$1,634.65",$0.00,$0.00,"$1,661.19","$9,487.50",$0.00,"$4,743.75","$7,514.10","$7,590.00",$0.00,"$1,484.79",$0.00,"$1,510.41",$0.00
2160012,SUP,HCPCS C1713,,2160012  -  PLATE SPNL 12MM DIVERGENCE-L ALIF,"$9,487.50",$0.00,"$9,487.50","$4,269.38","$5,158.80",$0.00,"$1,634.65",$0.00,$0.00,"$1,661.19","$9,487.50",$0.00,"$4,743.75","$7,514.10","$7,590.00",$0.00,"$1,484.79",$0.00,"$1,510.41",$0.00
Jan-11,SUP,HCPCS C1713,,01-8611  -  PLATE BN SM MESH CNTR ANTM EZ MODIFICATION MN SHRP EDG RT,"$4,677.50",$0.00,"$4,677.50","$2,104.88","$3,338.33",$0.00,$805.91,$0.00,$0.00,$818.99,"$4,677.50",$0.00,"$2,338.75","$3,704.58","$3,742.00",$0.00,$732.03,$0.00,$744.66,$0.00
Jan-12,SUP,HCPCS C1713,,01-8612  -  PLATE BN LG MESH CNTR ANTM EZ MODIFICATION MN SHRP EDG LT,"$4,837.50",$0.00,"$4,837.50","$2,176.88","$3,452.52",$0.00,$833.48,$0.00,$0.00,$847.01,"$4,837.50",$0.00,"$2,418.75","$3,831.30","$3,870.00",$0.00,$757.07,$0.00,$770.13,$0.00
Jan-36,SUP,HCPCS C1713,,01-8636  -  PLATE BONE LONG 3X3 HOLE L RIGID DELTA GOLD LEFT,$485.00,$0.00,$485.00,$218.25,$346.14,$0.00,$83.56,$0.00,$0.00,$84.92,$485.00,$0.00,$242.50,$384.12,$388.00,$0.00,$75.90,$0.00,$77.21,$0.00
Jan-62,SUP,HCPCS C1713,,01-8662  -  PLATE BONE 8 HOLE STR RIGID TRAUMAONE GOLD TITANIUM MIDFAC,$872.50,$0.00,$872.50,$392.63,$622.70,$0.00,$150.33,$0.00,$0.00,$152.77,$872.50,$0.00,$436.25,$691.02,$698.00,$0.00,$136.55,$0.00,$138.90,$0.00
Jan-64,SUP,HCPCS C1713,,01-8664  -  PLATE BONE 4 HOLE STR RIGID TRAUMAONE GOLD TITANIUM MIDFAC,$872.50,$0.00,$872.50,$392.63,$622.70,$0.00,$150.33,$0.00,$0.00,$152.77,$872.50,$0.00,$436.25,$691.02,$698.00,$0.00,$136.55,$0.00,$138.90,$0.00
Jan-70,SUP,HCPCS C1713,,01-8670  -  PLATE BONE LONG STR 20 HOLE RIGID SYSTEM LORENZ TRAUMAONE,"$1,510.00",$0.00,"$1,510.00",$679.50,"$1,077.69",$0.00,$260.17,$0.00,$0.00,$264.39,"$1,510.00",$0.00,$755.00,"$1,195.92","$1,208.00",$0.00,$236.32,$0.00,$240.39,$0.00
Jan-78,SUP,HCPCS C1713,,01-8678  -  PLATE LEFT MIDFAC 2X2 HOLE L RGD 1.5MM SCR BONE LORENZ,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
Jan-79,SUP,HCPCS C1713,,01-8679  -  PLATE RIGHT MIDFAC 2X2 HOLE L RGD 1.5MM SCR BONE LORENZ,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
Jan-80,SUP,HCPCS C1713,,01-8680  -  PLATE BONE LONG 4X6 HOLE L RIGID TRAUMAONE GOLD TITANIUM,"$1,015.00",$0.00,"$1,015.00",$456.75,$724.41,$0.00,$174.88,$0.00,$0.00,$177.72,"$1,015.00",$0.00,$507.50,$803.88,$812.00,$0.00,$158.85,$0.00,$161.59,$0.00
Jan-81,SUP,HCPCS C1713,,01-8681  -  PLATE BONE LONG 4X6 HOLE L RIGID TRAUMAONE GOLD TITANIUM,"$1,015.00",$0.00,"$1,015.00",$456.75,$724.41,$0.00,$174.88,$0.00,$0.00,$177.72,"$1,015.00",$0.00,$507.50,$803.88,$812.00,$0.00,$158.85,$0.00,$161.59,$0.00
Jan-89,SUP,HCPCS C1713,,01-8689  -  PLATE BONE LONG 14 HOLE CVD RIGID TRAUMAONE GOLD TITANIUM,"$1,102.50",$0.00,"$1,102.50",$496.13,$786.85,$0.00,$189.96,$0.00,$0.00,$193.04,"$1,102.50",$0.00,$551.25,$873.18,$882.00,$0.00,$172.54,$0.00,$175.52,$0.00
Jan-92,SUP,Custom 27203010,,01-9192  -  TW DRILL 1.5X50MM 5MM STP W/NT,$435.00,$0.00,$435.00,$0.00,$310.46,$0.00,$0.00,$0.00,$0.00,$0.00,$435.00,$0.00,$217.50,$344.52,$348.00,$0.00,$0.00,$0.00,$0.00,$0.00
Jan-93,SUP,Custom 27203010,,01-9193  -  DRILL TWIST 1.5MM 50MM 7MM STOP TRAUMAONE,$435.00,$0.00,$435.00,$0.00,$310.46,$0.00,$0.00,$0.00,$0.00,$0.00,$435.00,$0.00,$217.50,$344.52,$348.00,$0.00,$0.00,$0.00,$0.00,$0.00
Jan-20,SUP,HCPCS C1781,,01-9520  -  MESH SURG SMALL .6MM ETCHED LABEL ANATOMIC AESTHETIC,"$16,200.00",$0.00,"$16,200.00","$7,290.00","$5,158.80",$0.00,"$2,791.18",$0.00,$0.00,"$2,836.49","$16,200.00",$0.00,"$8,100.00","$12,830.40","$12,960.00",$0.00,"$2,535.30",$0.00,"$2,579.04",$0.00
Jan-21,SUP,HCPCS C1781,,01-9521  -  MESH SURG SMALL .6MM ETCHED LABEL ANATOMIC AESTHETIC,"$18,900.00",$0.00,"$18,900.00","$8,505.00","$5,158.80",$0.00,"$3,256.38",$0.00,$0.00,"$3,309.24","$18,900.00",$0.00,"$9,450.00","$14,968.80","$15,120.00",$0.00,"$2,957.85",$0.00,"$3,008.88",$0.00
Jan-22,SUP,HCPCS C1781,,01-9522  -  MESH SURG SMALL .6MM ETCHED LABEL ANATOMIC AESTHETIC,"$18,900.00",$0.00,"$18,900.00","$8,505.00","$5,158.80",$0.00,"$3,256.38",$0.00,$0.00,"$3,309.24","$18,900.00",$0.00,"$9,450.00","$14,968.80","$15,120.00",$0.00,"$2,957.85",$0.00,"$3,008.88",$0.00
Jan-23,SUP,HCPCS C1781,,01-9523  -  MESH SURG LARGE .6MM ETCHED LABEL ANATOMIC AESTHETIC,"$21,060.00",$0.00,"$21,060.00","$9,477.00","$5,158.80",$0.00,"$3,628.53",$0.00,$0.00,"$3,687.44","$21,060.00",$0.00,"$10,530.00","$16,679.52","$16,848.00",$0.00,"$3,295.89",$0.00,"$3,352.75",$0.00
Jan-24,SUP,HCPCS C1781,,01-9524  -  MESH SURG LARGE .6MM ETCHED LABEL ANATOMIC AESTHETIC,"$21,060.00",$0.00,"$21,060.00","$9,477.00","$5,158.80",$0.00,"$3,628.53",$0.00,$0.00,"$3,687.44","$21,060.00",$0.00,"$10,530.00","$16,679.52","$16,848.00",$0.00,"$3,295.89",$0.00,"$3,352.75",$0.00
2800724,SUP,HCPCS C1713,,2800724  -  CAGE SPNL 0D 24MMX7MM STRL FUSE TI,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2800824,SUP,HCPCS C1713,,2800824  -  CAGE SPNL 0D 24MMX8MM STRL FUSE TI,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2840924,SUP,HCPCS C1713,,2840924  -  CAGE SPNL 4D 24MMX9MM STRL FUSE TI,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2841024,SUP,HCPCS C1713,,2841024  -  CAGE SPNL 4D 24MMX10MM STRL FUSE TI,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2841124,SUP,HCPCS C1713,,2841124  -  CAGE SPNL 4D 24MMX11MM STRL FUSE TI,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2841224,SUP,HCPCS C1713,,2841224  -  CAGE SPNL 4D 24MMX12MM STRL FUSE TI,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2841324,SUP,HCPCS C1713,,2841324  -  CAGE SPNL 4D 24MMX13MM STRL FUSE TI,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2841424,SUP,HCPCS C1713,,2841424  -  CAGE SPNL 4D 24MMX14MM STRL FUSE TI,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2880924,SUP,HCPCS C1713,,2880924  -  CAGE SPNL 8D 24MMX9MM FUSE TI,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2881024,SUP,HCPCS C1713,,2881024  -  CAGE SPNL 8D 24MMX10MM FUSE TI,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2881124,SUP,HCPCS C1713,,2881124  -  CAGE SPNL 8D 24MMX11MM FUSE TI,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2881224,SUP,HCPCS C1713,,2881224  -  CAGE SPNL 8D 24MMX12MM FUSE TI,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2881324,SUP,HCPCS C1713,,2881324  -  CAGE SPNL 8D 24MMX13MM FUSE TI,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2881424,SUP,HCPCS C1713,,2881424  -  CAGE SPNL 8D 24MMX14MM FUSE TI,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
2920040,SUP,Custom 27803010,,2920040  -  CAGE SPNL 0D 40X22X10MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2920045,SUP,Custom 27803010,,2920045  -  CAGE SPNL 0D 45X22X10MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2920050,SUP,Custom 27803010,,2920050  -  CAGE SPNL 0D 50X22X10MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2920055,SUP,Custom 27803010,,2920055  -  CAGE SPNL 0D 55X22X10MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2920060,SUP,Custom 27803010,,2920060  -  CAGE SPNL 0D 60X22X10MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2920240,SUP,Custom 27803010,,2920240  -  CAGE SPNL 0D 40X22X12MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2920245,SUP,Custom 27803010,,2920245  -  CAGE SPNL 0D 45X22X12MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2920250,SUP,Custom 27803010,,2920250  -  CAGE SPNL 0D 50X22X12MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2920255,SUP,Custom 27803010,,2920255  -  CAGE SPNL 0D 55X22X12MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2920260,SUP,Custom 27803010,,2920260  -  CAGE SPNL 0D 60X22X12MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2920440,SUP,Custom 27803010,,2920440  -  CAGE SPNL 0D 40X22X14MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2920445,SUP,Custom 27803010,,2920445  -  CAGE SPNL 0D 45X22X14MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2920450,SUP,Custom 27803010,,2920450  -  CAGE SPNL 0D 50X22X14MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2920455,SUP,Custom 27803010,,2920455  -  CAGE SPNL 0D 55X22X14MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2920460,SUP,Custom 27803010,,2920460  -  CAGE SPNL 0D 60X22X14MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2920640,SUP,Custom 27803010,,2920640  -  CAGE SPNL 0D 40X22X16MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2920645,SUP,Custom 27803010,,2920645  -  CAGE SPNL 0D 45X22X16MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2920650,SUP,Custom 27803010,,2920650  -  CAGE SPNL 0D 50X22X16MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2920655,SUP,Custom 27803010,,2920655  -  CAGE SPNL 0D 55X22X16MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2920660,SUP,Custom 27803010,,2920660  -  CAGE SPNL 0D 60X22X16MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2920840,SUP,Custom 27803010,,2920840  -  CAGE SPNL 0D 40X22X8MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2920845,SUP,Custom 27803010,,2920845  -  CAGE SPNL 0D 45X22X8MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2920850,SUP,Custom 27803010,,2920850  -  CAGE SPNL 0D 50X22X8MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2920855,SUP,Custom 27803010,,2920855  -  CAGE SPNL 0D 55X22X8MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2920860,SUP,Custom 27803010,,2920860  -  CAGE SPNL 0D 60X22X8MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2922040,SUP,Custom 27803010,,2922040  -  CAGE SPNL 12D 40X22X10MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2922045,SUP,Custom 27803010,,2922045  -  CAGE SPNL 12D 45X22X10MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2922050,SUP,Custom 27803010,,2922050  -  CAGE SPNL 12D 50X22X10MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2922055,SUP,Custom 27803010,,2922055  -  CAGE SPNL 12D 55X22X10MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2922060,SUP,Custom 27803010,,2922060  -  CAGE SPNL 12D 60X22X10MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2922240,SUP,Custom 27803010,,2922240  -  CAGE SPNL 12D 40X22X12MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2922245,SUP,Custom 27803010,,2922245  -  CAGE SPNL 12D 45X22X12MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2922250,SUP,Custom 27803010,,2922250  -  CAGE SPNL 12D 50X22X12MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2922255,SUP,Custom 27803010,,2922255  -  CAGE SPNL 12D 55X22X12MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2922260,SUP,Custom 27803010,,2922260  -  CAGE SPNL 12D 60X22X12MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2922440,SUP,Custom 27803010,,2922440  -  CAGE SPNL 12D 40X22X14MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2922445,SUP,Custom 27803010,,2922445  -  CAGE SPNL 12D 45X22X14MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2922450,SUP,Custom 27803010,,2922450  -  CAGE SPNL 12D 50X22X14MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2922455,SUP,Custom 27803010,,2922455  -  CAGE SPNL 12D 55X22X14MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2922460,SUP,Custom 27803010,,2922460  -  CAGE SPNL 12D 60X22X14MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2922640,SUP,Custom 27803010,,2922640  -  CAGE SPNL 12D 40X22X16MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2922645,SUP,Custom 27803010,,2922645  -  CAGE SPNL 12D 45X22X16MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2922650,SUP,Custom 27803010,,2922650  -  CAGE SPNL 12D 50X22X16MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2922655,SUP,Custom 27803010,,2922655  -  CAGE SPNL 12D 55X22X16MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2922660,SUP,Custom 27803010,,2922660  -  CAGE SPNL 12D 60X22X16MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2926040,SUP,Custom 27803010,,2926040  -  CAGE SPNL 6D 40X22X10MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2926045,SUP,Custom 27803010,,2926045  -  CAGE SPNL 6D 45X22X10MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2926050,SUP,Custom 27803010,,2926050  -  CAGE SPNL 6D 50X22X10MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2926055,SUP,Custom 27803010,,2926055  -  CAGE SPNL 6D 55X22X10MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2926060,SUP,Custom 27803010,,2926060  -  CAGE SPNL 6D 60X22X10MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2926240,SUP,Custom 27803010,,2926240  -  CAGE SPNL 6D 40X22X12MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2926245,SUP,Custom 27803010,,2926245  -  CAGE SPNL 6D 45X22X12MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2926250,SUP,Custom 27803010,,2926250  -  CAGE SPNL 6D 50X22X12MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2926255,SUP,Custom 27803010,,2926255  -  CAGE SPNL 6D 22X12X55MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2926260,SUP,Custom 27803010,,2926260  -  CAGE SPNL 6D 60X12X22MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2926440,SUP,Custom 27803010,,2926440  -  CAGE SPNL 6D 40X22X14MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2926445,SUP,Custom 27803010,,2926445  -  CAGE SPNL 6D 45X22X14MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2926450,SUP,Custom 27803010,,2926450  -  CAGE SPNL 6D 50X22X14MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2926455,SUP,Custom 27803010,,2926455  -  CAGE SPNL 6D 55X22X14MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2926460,SUP,Custom 27803010,,2926460  -  CAGE SPNL 6D 60X22X14MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2926640,SUP,Custom 27803010,,2926640  -  CAGE SPNL 6D 40X22X16MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2926645,SUP,Custom 27803010,,2926645  -  CAGE SPNL 6D 45X22X16MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2926650,SUP,Custom 27803010,,2926650  -  CAGE SPNL 6D 50X22X16MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2926655,SUP,Custom 27803010,,2926655  -  CAGE SPNL 6D 55X22X16MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2926660,SUP,Custom 27803010,,2926660  -  CAGE SPNL 6D 60X22X16MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2926840,SUP,Custom 27803010,,2926840  -  CAGE SPNL 6D 40X22X8MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2926845,SUP,Custom 27803010,,2926845  -  CAGE SPNL 6D 45X22X8MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2926850,SUP,Custom 27803010,,2926850  -  CAGE SPNL 6D 50X22X8MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2926855,SUP,Custom 27803010,,2926855  -  CAGE SPNL 6D 55X22X8MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2926860,SUP,Custom 27803010,,2926860  -  CAGE SPNL 6D 60X22X8MM STRL CLYDESDALE RADOPQ PEEK LMBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2960822,SUP,Custom 27803010,,2960822  -  SPACER SPNL 22MMX8MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2960826,SUP,HCPCS C1713,,2960826  -  SPACER SPNL 26MMX8MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
2960832,SUP,Custom 27803010,,2960832  -  SPACER SPNL 32MMX8MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2960836,SUP,Custom 27803010,,2960836  -  SPACER SPNL 36MMX8MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2961022,SUP,Custom 27803010,,2961022  -  SPACER SPNL 22MMX10MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2961026,SUP,HCPCS C1713,,2961026  -  SPACER SPNL 26MMX10MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
2961032,SUP,Custom 27803010,,2961032  -  SPACER SPNL 32MMX10MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2961036,SUP,Custom 27803010,,2961036  -  SPACER SPNL 36MMX10MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2961222,SUP,Custom 27803010,,2961222  -  SPACER SPNL 22MMX12MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2961226,SUP,Custom 27803010,,2961226  -  SPACER SPNL 26MMX12MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2961232,SUP,Custom 27803010,,2961232  -  SPACER SPNL 32MMX12MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2961236,SUP,Custom 27803010,,2961236  -  SPACER SPNL 36MMX12MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2961422,SUP,Custom 27803010,,2961422  -  SPACER SPNL 22MMX14MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2961426,SUP,Custom 27803010,,2961426  -  SPACER SPNL 26X14MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2961432,SUP,Custom 27803010,,2961432  -  SPACER SPNL 32MMX14MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2961436,SUP,Custom 27803010,,2961436  -  SPACER SPNL 36X14MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2962036,SUP,HCPCS C1713,,2962036  -  SPACER SPNL 36MMX10MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2962040,SUP,HCPCS C1713,,2962040  -  SPACER SPNL 40MMX10MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2962044,SUP,HCPCS C1713,,2962044  -  SPACER SPNL 44MMX10MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2962236,SUP,HCPCS C1713,,2962236  -  SPACER SPNL 36MMX12MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2962240,SUP,HCPCS C1713,,2962240  -  SPACER SPNL 40MMX12MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2962244,SUP,HCPCS C1713,,2962244  -  SPACER SPNL 44MMX12MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2962436,SUP,HCPCS C1713,,2962436  -  SPACER SPNL 36MMX14MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2962440,SUP,HCPCS C1713,,2962440  -  SPACER SPNL 40MMX14MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2962444,SUP,HCPCS C1713,,2962444  -  SPACER SPNL 44MMX14MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2962836,SUP,HCPCS C1713,,2962836  -  SPACER SPNL 36MMX8MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2962840,SUP,HCPCS C1713,,2962840  -  SPACER SPNL 40MMX8MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2962844,SUP,HCPCS C1713,,2962844  -  SPACER SPNL 44MMX8MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
2968040,SUP,Custom 27803010,,2968040  -  CAGE SPNL 6D 40MMX10MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2968045,SUP,Custom 27803010,,2968045  -  CAGE SPNL 6D 45MMX10MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2968050,SUP,Custom 27803010,,2968050  -  CAGE SPNL 6D 50MMX10MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2968055,SUP,Custom 27803010,,2968055  -  CAGE SPNL 6D 55MMX10MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2968060,SUP,Custom 27803010,,2968060  -  CAGE SPNL 6D 60MMX10MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2968240,SUP,Custom 27803010,,2968240  -  CAGE SPNL 6D 40MMX12MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2968245,SUP,Custom 27803010,,2968245  -  CAGE SPNL 6D 45MMX12MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2968250,SUP,Custom 27803010,,2968250  -  CAGE SPNL 6D 50MMX12MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2968255,SUP,Custom 27803010,,2968255  -  CAGE SPNL 6D 55MMX12MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2968260,SUP,Custom 27803010,,2968260  -  CAGE SPNL 6D 60MMX12MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2968440,SUP,Custom 27803010,,2968440  -  CAGE SPNL 6D 40MMX14MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2968445,SUP,Custom 27803010,,2968445  -  CAGE SPNL 6D 45MMX14MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2968450,SUP,Custom 27803010,,2968450  -  CAGE SPNL 6D 50MMX14MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2968455,SUP,Custom 27803010,,2968455  -  CAGE SPNL 6D 55MMX14MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2968460,SUP,Custom 27803010,,2968460  -  CAGE SPNL 6D 60MMX14MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2968640,SUP,Custom 27803010,,2968640  -  CAGE SPNL 6D 40MMX16MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2968645,SUP,Custom 27803010,,2968645  -  CAGE SPNL 6D 45MMX16MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2968650,SUP,Custom 27803010,,2968650  -  CAGE SPNL 6D 50MMX16MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2968655,SUP,Custom 27803010,,2968655  -  CAGE SPNL 6D 55MMX16MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2968660,SUP,Custom 27803010,,2968660  -  CAGE SPNL 6D 60MMX16MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2968840,SUP,Custom 27803010,,2968840  -  CAGE SPNL 6D 40MMX8MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2968845,SUP,Custom 27803010,,2968845  -  CAGE SPNL 6D 45MMX8MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2968850,SUP,Custom 27803010,,2968850  -  CAGE SPNL 6D 50MMX8MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2968855,SUP,Custom 27803010,,2968855  -  CAGE SPNL 6D 55MMX8MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2968860,SUP,Custom 27803010,,2968860  -  CAGE SPNL 6D 60MMX8MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2969040,SUP,Custom 27803010,,2969040  -  CAGE SPNL 0D 40MMX10MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2969045,SUP,Custom 27803010,,2969045  -  CAGE SPNL 0D 45MMX10MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2969050,SUP,Custom 27803010,,2969050  -  CAGE SPNL 0D 50MMX10MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2969055,SUP,Custom 27803010,,2969055  -  CAGE SPNL 0D 55MMX10MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2969240,SUP,Custom 27803010,,2969240  -  CAGE SPNL 0D 40MMX12MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2969245,SUP,Custom 27803010,,2969245  -  CAGE SPNL 0D 45MMX12MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2969250,SUP,Custom 27803010,,2969250  -  CAGE SPNL 0D 50MMX12MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2969255,SUP,Custom 27803010,,2969255  -  CAGE SPNL 0D 55MMX12MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2969440,SUP,Custom 27803010,,2969440  -  CAGE SPNL 0D 40MMX14MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2969445,SUP,Custom 27803010,,2969445  -  CAGE SPNL 0D 45MMX14MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2969450,SUP,Custom 27803010,,2969450  -  CAGE SPNL 0D 50MMX14MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2969455,SUP,Custom 27803010,,2969455  -  CAGE SPNL 0D 55MMX14MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2969640,SUP,Custom 27803010,,2969640  -  CAGE SPNL 0D 40MMX16MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2969645,SUP,Custom 27803010,,2969645  -  CAGE SPNL 0D 45MMX16MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2969650,SUP,Custom 27803010,,2969650  -  CAGE SPNL 0D 50MMX16MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2969655,SUP,Custom 27803010,,2969655  -  CAGE SPNL 0D 55MMX16MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2969840,SUP,Custom 27803010,,2969840  -  CAGE SPNL 0D 40MMX8MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2969845,SUP,Custom 27803010,,2969845  -  CAGE SPNL 0D 45MMX8MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2969850,SUP,Custom 27803010,,2969850  -  CAGE SPNL 0D 50MMX8MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2969855,SUP,Custom 27803010,,2969855  -  CAGE SPNL 0D 55MMX8MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2990622,SUP,HCPCS C1713,,2990622  -  SPACER SPNL 22MMX6MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM LMBR,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
2990626,SUP,HCPCS C1713,,2990626  -  SPACER SPNL 26MMX6MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM LMBR,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
2990722,SUP,HCPCS C1713,,2990722  -  SPACER SPNL 22MMX7MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM LMBR,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
2990726,SUP,HCPCS C1713,,2990726  -  SPACER SPNL 26MMX7MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM LMBR,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
2990732,SUP,HCPCS C1713,,2990732  -  SPACER SPNL 32MMX7MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM LMBR,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
2990736,SUP,HCPCS C1713,,2990736  -  SPACER SPNL 36MMX7MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM LMBR,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
2990822,SUP,Custom 27803010,,2990822  -  SPACER SPNL 22MMX8MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM LMBR,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2990826,SUP,Custom 27803010,,2990826  -  SPACER SPNL 26MMX8MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM LMBR,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2990832,SUP,Custom 27803010,,2990832  -  SPACER SPNL 32MMX8MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM LMBR,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2990836,SUP,Custom 27803010,,2990836  -  SPACER SPNL 36MMX8MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM LMBR,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2990922,SUP,HCPCS C1713,,2990922  -  SPACER SPNL 22MMX9MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM LMBR,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
2990926,SUP,HCPCS C1713,,2990926  -  SPACER SPNL 26MMX9MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM LMBR,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
2990932,SUP,HCPCS C1713,,2990932  -  SPACER SPNL 32MMX9MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM LMBR,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
2990936,SUP,HCPCS C1713,,2990936  -  SPACER SPNL 36MMX9MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM LMBR,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
2991022,SUP,Custom 27803010,,2991022  -  SPACER SPNL 22MMX10MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2991026,SUP,Custom 27803010,,2991026  -  SPACER SPNL 26MMX10MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2991032,SUP,Custom 27803010,,2991032  -  SPACER SPNL 32MMX10MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2991036,SUP,Custom 27803010,,2991036  -  SPACER SPNL 36MMX10MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2991122,SUP,HCPCS C1713,,2991122  -  SPACER SPNL 22MMX11MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
2991126,SUP,HCPCS C1713,,2991126  -  SPACER SPNL 26MMX11MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
2991132,SUP,HCPCS C1713,,2991132  -  SPACER SPNL 32MMX11MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
2991136,SUP,HCPCS C1713,,2991136  -  SPACER SPNL 36MMX11MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
2991222,SUP,Custom 27803010,,2991222  -  SPACER SPNL 22MMX12MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2991226,SUP,Custom 27803010,,2991226  -  SPACER SPNL 26MMX12MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2991232,SUP,Custom 27803010,,2991232  -  SPACER SPNL 32MMX12MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2991236,SUP,Custom 27803010,,2991236  -  SPACER SPNL 36MMX12MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2991322,SUP,HCPCS C1713,,2991322  -  SPACER SPNL 22MMX13MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
2991326,SUP,HCPCS C1713,,2991326  -  SPACER SPNL 26MMX13MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
2991332,SUP,HCPCS C1713,,2991332  -  SPACER SPNL 32MMX13MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
2991336,SUP,HCPCS C1713,,2991336  -  SPACER SPNL 36MMX13MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
2991422,SUP,Custom 27803010,,2991422  -  SPACER SPNL 22MMX14MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2991426,SUP,Custom 27803010,,2991426  -  SPACER SPNL 26MMX14MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2991432,SUP,Custom 27803010,,2991432  -  SPACER SPNL 32MMX14MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2991436,SUP,Custom 27803010,,2991436  -  SPACER SPNL 36MMX14MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2991522,SUP,HCPCS C1713,,2991522  -  SPACER SPNL 22MMX15MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
2991526,SUP,HCPCS C1713,,2991526  -  SPACER SPNL 26MMX15MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
2991532,SUP,HCPCS C1713,,2991532  -  SPACER SPNL 32MMX15MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
2991536,SUP,HCPCS C1713,,2991536  -  SPACER SPNL 36MMX15MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
2991622,SUP,Custom 27803010,,2991622  -  SPACER SPNL 22MMX16MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2991626,SUP,Custom 27803010,,2991626  -  SPACER SPNL 26MMX16MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2991632,SUP,Custom 27803010,,2991632  -  SPACER SPNL 32MMX16MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2991636,SUP,Custom 27803010,,2991636  -  SPACER SPNL 36MMX16MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
3001015,SUP,HCPCS C1713,,3001015  -  PLATE BN 15MM ZEVO 1 LVL TI SPNE CRV ANT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
3001017,SUP,HCPCS C1713,,3001017  -  PLATE BN 17MM ZEVO 1 LVL TI SPNE CRV ANT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
3001019,SUP,HCPCS C1713,,3001019  -  PLATE BN 19MM ZEVO 1 LVL TI SPNE CRV ANT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
3001021,SUP,HCPCS C1713,,3001021  -  PLATE BN 21MM ZEVO 1 LVL TI SPNE CRV ANT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
3001023,SUP,HCPCS C1713,,3001023  -  PLATE BN 23MM ZEVO 1 LVL TI SPNE CRV ANT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
3001027,SUP,HCPCS C1713,,3001027  -  PLATE 27MM TI LVL 1 ZEVO BONE SPN CERV ANT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
3001029,SUP,HCPCS C1713,,3001029  -  PLATE 29MM TI LVL 1 ZEVO BONE SPN CERV ANT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
3001031,SUP,HCPCS C1713,,3001031  -  PLATE 31MM TI LVL 1 ZEVO BONE SPN CERV ANT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
3002035,SUP,HCPCS C1713,,3002035  -  PLATE BN 35MM ZEVO 2 LVL TI SPNE CRV ANT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
3002039,SUP,HCPCS C1713,,3002039  -  PLATE BN 39MM ZEVO 2 LVL TI SPNE CRV ANT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
3002043,SUP,HCPCS C1713,,3002043  -  PLATE 43MM TI LVL 2 ZEVO BONE SPN CERV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
3002045,SUP,HCPCS C1713,,3002045  -  PLATE BN 45MM ZEVO 2 LVL TI SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
3002047,SUP,HCPCS C1713,,3002047  -  PLATE 47MM TI LVL 2 ZEVO BONE SPN CERV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
3002048,SUP,HCPCS C1713,,3002048  -  PLATE BN 48MM ZEVO 2 LVL TI SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
3002049,SUP,HCPCS C1713,,3002049  -  PLATE 49MM TI LVL 2 ZEVO BONE SPN CERV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
3002051,SUP,HCPCS C1713,,3002051  -  PLATE BN 51MM ZEVO 2 LVL TI SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
3002053,SUP,HCPCS C1713,,3002053  -  PLATE 53MM TI LVL 2 ZEVO BONE SPN CERV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
3003047,SUP,HCPCS C1713,,3003047  -  PLATE BN 47MM ZEVO 3 LVL TI SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
3003049,SUP,HCPCS C1713,,3003049  -  PLATE 49MM TI LVL 3 ZEVO BONE SPN CERV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
3003055,SUP,HCPCS C1713,,3003055  -  PLATE BN 55MM ZEVO LVL 3 TI SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
3003063,SUP,HCPCS C1713,,3003063  -  PLATE BN 63MM ZEVO LVL 3 TI SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
3003065,SUP,HCPCS C1713,,3003065  -  PLATE 65MM TI LVL 3 ZEVO BONE SPN CERV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
3003067,SUP,HCPCS C1713,,3003067  -  PLATE 67MM TI LVL 3 ZEVO BONE SPN CERV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
3003068,SUP,HCPCS C1713,,3003068  -  PLATE 68MM TI LVL 3 ZEVO BONE SPN CERV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
3003069,SUP,HCPCS C1713,,3003069  -  PLATE 69MM TI LVL 3 ZEVO BONE SPN CERV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
3003071,SUP,HCPCS C1713,,3003071  -  PLATE 71MM TI LVL 3 ZEVO BONE SPN CERV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
3003248,SUP,Custom 27203010,,REAGENT PCR HOT SRT REAC MX LTCYCLR 96 TST,$597.50,$0.00,$597.50,$0.00,$426.44,$0.00,$0.00,$0.00,$0.00,$0.00,$597.50,$0.00,$298.75,$473.22,$478.00,$0.00,$0.00,$0.00,$0.00,$0.00
3004071,SUP,HCPCS C1713,,3004071  -  PLATE 71MM TI LVL 4 ZEVO BONE SPN CERV ANT,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
3004073,SUP,HCPCS C1713,,3004073  -  PLATE BN 73MM ZEVO 4 LVL TI SPNE CRV ANT,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
3004075,SUP,HCPCS C1713,,3004075  -  PLATE BN 75MM ZEVO 4 LVL TI SPNE CRV ANT,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
3004077,SUP,HCPCS C1713,,3004077  -  PLATE 77MM TI LVL 4 ZEVO BONE SPN CERV ANT,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
3004078,SUP,HCPCS C1713,,3004078  -  PLATE BN 78MM ZEVO 4 LVL TI SPNE CRV ANT,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
3004079,SUP,HCPCS C1713,,3004079  -  PLATE 79MM TI LVL 4 ZEVO BONE SPN CERV ANT,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
3004081,SUP,HCPCS C1713,,3004081  -  PLATE 81MM TI LVL 4 ZEVO BONE SPN CERV ANT,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
3004083,SUP,HCPCS C1713,,3004083  -  PLATE 83MM TI LVL 4 ZEVO BONE SPN CERV ANT,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
3004085,SUP,HCPCS C1713,,3004085  -  PLATE 85MM TI LVL 4 ZEVO BONE SPN CERV ANT,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
3004086,SUP,HCPCS C1713,,3004086  -  PLATE 86MM TI LVL 4 ZEVO BONE SPN CERV ANT,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
3004087,SUP,HCPCS C1713,,3004087  -  PLATE 87MM TI LVL 4 ZEVO BONE SPN CERV ANT,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
3004089,SUP,HCPCS C1713,,3004089  -  PLATE 89MM TI LVL 4 ZEVO BONE SPN CERV ANT,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
3005075,SUP,HCPCS C1713,,3005075  -  PLATE 75MM TI LVL 5 ZEVO BONE SPN CERV ANT,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,$0.00,$0.00,$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
3005077,SUP,HCPCS C1713,,3005077  -  PLATE 77MM TI LVL 5 ZEVO BONE SPN CERV ANT,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,$0.00,$0.00,$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
3005079,SUP,HCPCS C1713,,3005079  -  PLATE 79MM TI LVL 5 ZEVO BONE SPN CERV ANT,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,$0.00,$0.00,$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
3005081,SUP,HCPCS C1713,,3005081  -  PLATE 81MM TI LVL 5 ZEVO BONE SPN CERV ANT,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,$0.00,$0.00,$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
3005085,SUP,HCPCS C1713,,3005085  -  PLATE 85MM TI LVL 5 ZEVO BONE SPN CERV ANT,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,$0.00,$0.00,$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
3005090,SUP,HCPCS C1713,,3005090  -  PLATE 90MM TI LVL 5 ZEVO BONE SPN CERV ANT,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,$0.00,$0.00,$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
3005095,SUP,HCPCS C1713,,3005095  -  PLATE 95MM TI LVL 5 ZEVO BONE SPN CERV ANT,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,$0.00,$0.00,$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
3005100,SUP,HCPCS C1713,,3005100  -  PLATE 100MM TI LVL 5 ZEVO BONE SPN CERV ANT,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,$0.00,$0.00,$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
3005105,SUP,HCPCS C1713,,3005105  -  PLATE 105MM TI LVL 5 ZEVO BONE SPN CERV ANT,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,$0.00,$0.00,$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
3005108,SUP,HCPCS C1713,,3005108  -  PLATE 108MM TI LVL 5 ZEVO BONE SPN CERV ANT,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,$0.00,$0.00,$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
3034001,SUP,Custom 27203010,,3034001  -  DRILL BIT 3034001 ADJUSTABLE STERILE,$501.00,$0.00,$501.00,$0.00,$357.56,$0.00,$0.00,$0.00,$0.00,$0.00,$501.00,$0.00,$250.50,$396.79,$400.80,$0.00,$0.00,$0.00,$0.00,$0.00
3101001,SUP,Custom 27203010,,EARPLUG FOAM EAR NSE RDC BRL SHP PCTV EAR,$0.18,$0.00,$0.18,$0.00,$0.12,$0.00,$0.00,$0.00,$0.00,$0.00,$0.18,$0.00,$0.09,$0.14,$0.14,$0.00,$0.00,$0.00,$0.00,$0.00
3120211,SUP,HCPCS C1713,,3120211  -  SCREW BN 4MM 11MM NS ATLNTS ST FX ANG TI SPNE CRV ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3120212,SUP,HCPCS C1713,,3120212  -  SCREW 3120212 4.0 X 12 SELF TAP FIX,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3120213,SUP,HCPCS C1713,,3120213  -  SCREW 3120213 4.0 X 13 SELF TAP FIX,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3120214,SUP,HCPCS C1713,,3120214  -  SCREW BONE 4MM 14MM ATLNTS TI ANT CERV SPN SLFTAP FIXANG,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3120215,SUP,HCPCS C1713,,3120215  -  SCREW BN 4MM 15MM NS ATLNTS ST FX ANG TI SPNE CRV ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3120216,SUP,HCPCS C1713,,3120216  -  SCREW 3120216 4.0 X 16 SELF TAP FIX,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3120217,SUP,HCPCS C1713,,3120217  -  SCREW BN 4MM 17MM NS ATLNTS ST FX ANG TI SPNE CRV ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3120218,SUP,HCPCS C1713,,3120218  -  SCREW 3120218 4.0 X 18 SELF TAP FIX,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3120219,SUP,HCPCS C1713,,3120219  -  SCREW 3120219 4.0 X 19 SELF TAP FIX,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3120220,SUP,HCPCS C1713,,3120220  -  SCREW 3120220 4.0 X 20 SELF TAP FIX,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3120311,SUP,HCPCS C1713,,3120311  -  SCREW BN 4MM 11MM NS ATLNTS ST VA TI SPNE CRV ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3120312,SUP,HCPCS C1713,,3120312  -  SCREW 3120312 4.0 X 12 SELF TAP VAR,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3120313,SUP,HCPCS C1713,,3120313  -  SCREW 3120313 4.0 X 13 SELF TAP VAR,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3120314,SUP,HCPCS C1713,,3120314  -  SCREW BN 4MM 14MM NS ATLNTS ST VA TI SPNE CRV ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3120315,SUP,HCPCS C1713,,3120315  -  SCREW BN 4MM 15MM NS ATLNTS ST VA TI SPNE CRV ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3120316,SUP,HCPCS C1713,,3120316  -  SCREW BN 4MM 16MM NS ATLNTS ST VA TI SPNE CRV ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3120317,SUP,HCPCS C1713,,3120317  -  SCREW BN 4MM 17MM NS ATLNTS ST VA TI SPNE CRV ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3120318,SUP,HCPCS C1713,,3120318  -  SCREW 3120318 4.0 X 18 SELF TAP VAR,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3120319,SUP,HCPCS C1713,,3120319  -  SCREW 3120319 4.0 X 19 SELF TAP VAR,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3120320,SUP,HCPCS C1713,,3120320  -  SCREW 3120320 4.0 X 20 SELF TAP VAR,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3120411,SUP,HCPCS C1713,,3120411  -  SCREW 3120411 4.0 X 11 SELF DRILL FIX,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3120412,SUP,HCPCS C1713,,3120412  -  SCREW BN 4MM 12MM NS ATLNTS SLF DRL FX ANG TI SPNE CRV ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3120413,SUP,HCPCS C1713,,3120413  -  SCREW BN 4MM 13MM NS ATLNTS SLF DRL FX ANG TI SPNE CRV ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3120414,SUP,HCPCS C1713,,3120414  -  SCREW BN 4MM 14MM NS ATLNTS SLF DRL FX ANG TI SPNE CRV ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3120415,SUP,HCPCS C1713,,3120415  -  SCREW BN 4MM 15MM NS ATLNTS SLF DRL FX ANG TI SPNE CRV ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3120416,SUP,HCPCS C1713,,3120416  -  SCREW BN 4MM 16MM NS ATLNTS SLF DRL FX ANG TI SPNE CRV ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3120417,SUP,HCPCS C1713,,3120417  -  SCREW 3120417 4.0 X 17 SELF DRILL FIX,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3120419,SUP,HCPCS C1713,,3120419  -  SCREW 3120419 4.0 X 19 SELF DRILL FIX,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3120420,SUP,HCPCS C1713,,3120420  -  SCREW 3120420 4.0 X 20 SELF DRILL FIX,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3120511,SUP,HCPCS C1713,,3120511  -  SCREW BN 4MM 11MM NS ATLNTS SLF DRL VA TI SPNE CRV ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3120512,SUP,HCPCS C1713,,3120512  -  SCREW BN 4MM 12MM NS ATLNTS SLF DRL VA TI SPNE CRV ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3120513,SUP,HCPCS C1713,,3120513  -  SCREW BN 4MM 13MM NS ATLNTS SLF DRL VA TI SPNE CRV ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3120514,SUP,HCPCS C1713,,3120514  -  SCREW BN 4MM 14MM NS ATLNTS SLF DRL VA TI SPNE CRV ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3120515,SUP,HCPCS C1713,,3120515  -  SCREW BN 4MM 15MM NS ATLNTS SLF DRL VA TI SPNE CRV ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3120516,SUP,HCPCS C1713,,3120516  -  SCREW BN 4MM 16MM NS ATLNTS SLF DRL VA TI SPNE CRV ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3120517,SUP,HCPCS C1713,,3120517  -  SCREW BN 4MM 17MM NS ATLNTS SLF DRL VA TI SPNE CRV ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3120518,SUP,HCPCS C1713,,3120518  -  SCREW 3120518 4.0 X 18 SELF DRILL VAR,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3120519,SUP,HCPCS C1713,,3120519  -  SCREW 3120519 4.0 X 19 SELF DRILL VAR,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3120520,SUP,HCPCS C1713,,3120520  -  SCREW 3120520 4.0 X 20 SELF DRILL VAR,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3125211,SUP,HCPCS C1713,,3125211  -  SCREW 3125211 4.5 X 11 SELF TAP FIX,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3125213,SUP,HCPCS C1713,,3125213  -  SCREW 3125213 4.5 X 13 SELF TAP FIX,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3125215,SUP,HCPCS C1713,,3125215  -  SCREW 3125215 4.5 X 15 SELF TAP FIX,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3125217,SUP,HCPCS C1713,,3125217  -  SCREW BN 4.5MM 17MM NS ATLNTS ST FX ANG TI SPNE CRV ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3125311,SUP,HCPCS C1713,,3125311  -  SCREW 3125311 4.5 X 11 SELF TAP VAR,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3125313,SUP,HCPCS C1713,,3125313  -  SCREW 3125313 4.5 X 13 SELF TAP VAR,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3125315,SUP,HCPCS C1713,,3125315  -  SCREW 3125315 4.5 X 15 SELF TAP VAR,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3125317,SUP,HCPCS C1713,,3125317  -  SCREW 3125317 4.5 X 17 SELF TAP VAR,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3125411,SUP,HCPCS C1713,,3125411  -  SCREW 3125411 4.5 X 11 SELF DRILL FIX,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3125413,SUP,HCPCS C1713,,3125413  -  SCREW BN 4.5MM 13MM NS ATLNTS SLF DRL FX ANG TI SPNE CRV ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3125415,SUP,HCPCS C1713,,3125415  -  SCREW BN 4.5MM 15MM NS ATLNTS SLF DRL FX ANG TI SPNE CRV ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3125417,SUP,HCPCS C1713,,3125417  -  SCREW BN 4.5MM 17MM NS ATLNTS SLF DRL FX ANG TI SPNE CRV ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3125511,SUP,HCPCS C1713,,3125511  -  SCREW 3125511 4.5 X 11 SELF DRILL VAR,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3125513,SUP,HCPCS C1713,,3125513  -  SCREW BN 4.5MM 13MM NS ATLNTS SLF DRL VA TI SPNE CRV ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3125515,SUP,HCPCS C1713,,3125515  -  SCREW BN 4.5MM 15MM NS ATLNTS SLF DRL VA TI SPNE CRV ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3125517,SUP,HCPCS C1713,,3125517  -  SCREW BN 4.5MM 17MM NS ATLNTS SLF DRL VA TI SPNE CRV ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3125520,SUP,HCPCS C1713,,3125520  -  SCREW 3125520 4.5 X 20 SELF DRILL VAR,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
3155648,SUP,Custom 27203010,,3155648  -  BURR SURG .8MM LOW FRICTION SLEEVE BEARING OTO-FLEX SKEETER,$507.50,$0.00,$507.50,$0.00,$362.20,$0.00,$0.00,$0.00,$0.00,$0.00,$507.50,$0.00,$253.75,$401.94,$406.00,$0.00,$0.00,$0.00,$0.00,$0.00
3200028,SUP,Custom 27203010,,3200028  -  KIT SPNL MAXCESS SHIM FX,$920.00,$0.00,$920.00,$0.00,$656.60,$0.00,$0.00,$0.00,$0.00,$0.00,$920.00,$0.00,$460.00,$728.64,$736.00,$0.00,$0.00,$0.00,$0.00,$0.00
3200060,SUP,Custom 27203010,,3200060  -  KIT SPNL MAXCESS MOD STRL DISP,"$3,765.00",$0.00,"$3,765.00",$0.00,"$2,687.08",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,765.00",$0.00,"$1,882.50","$2,981.88","$3,012.00",$0.00,$0.00,$0.00,$0.00,$0.00
3230101,SUP,HCPCS C1713,,3230101  -  WIRE FIX 13.5IN KWIRE SPN,$122.50,$0.00,$122.50,$55.13,$87.43,$0.00,$21.11,$0.00,$0.00,$21.45,$122.50,$0.00,$61.25,$97.02,$98.00,$0.00,$19.17,$0.00,$19.50,$0.00
3240060,SUP,Custom 27803010,,3240060  -  RETRACTOR SURG MAXCESS 4 DISPOSABLE,"$4,000.00",$0.00,"$4,000.00",$0.00,"$2,854.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,000.00",$0.00,"$2,000.00","$3,168.00","$3,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
3240061,SUP,Custom 27203010,,3240061  -  KIT SPNL MAXCESS4 SHIM DISP,"$2,957.50",$0.00,"$2,957.50",$0.00,"$2,110.77",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,957.50",$0.00,"$1,478.75","$2,342.34","$2,366.00",$0.00,$0.00,$0.00,$0.00,$0.00
3391208,SUP,HCPCS C1713,,3391208  -  SPACER SPNL 4D SM 8MM PRIMTR ADON PEEK-OPTM ALIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3391210,SUP,HCPCS C1713,,3391210  -  SPACER SPNL 4D SM 10MM PRIMTR ADON PEEK-OPTM ALIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3391212,SUP,HCPCS C1713,,3391212  -  SPACER SPNL 4D SM 12MM PRIMTR ADON PEEK-OPTM ALIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3391214,SUP,HCPCS C1713,,3391214  -  SPACER SPNL 4D SM 14MM PRIMTR ADON PEEK-OPTM ALIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3392308,SUP,Custom 27803010,,3392308  -  SPACER SPNL 8D MED 8MM PRIMTR ADON PEEK-OPTM ALIF,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
3392310,SUP,Custom 27803010,,3392310  -  SPACER SPNL 8D MED 10MM PRIMTR ADON PEEK-OPTM ALIF,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
3392312,SUP,Custom 27803010,,3392312  -  SPACER SPNL 8D MED 12MM PRIMTR ADON PEEK-OPTM ALIF,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
3392314,SUP,Custom 27803010,,3392314  -  SPACER SPNL 8D MED 14MM PRIMTR ADON PEEK-OPTM ALIF,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
3392316,SUP,Custom 27803010,,3392316  -  SPACER SPNL 8D MED 16MM PRIMTR ADON PEEK-OPTM ALIF,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
3392318,SUP,HCPCS C1713,,3392318  -  SPACER SPNL 8D MED 18MM PRIMTR ADON PEEK-OPTM ALIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3392320,SUP,HCPCS C1713,,3392320  -  SPACER SPNL 8D MED 20MM PRIMTR ADON PEEK-OPTM ALIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3393308,SUP,Custom 27803010,,3393308  -  SPACER SPNL 8D LG 8MM PRIMTR ADON PEEK-OPTM ALIF,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
3393310,SUP,Custom 27803010,,3393310  -  SPACER SPNL 8D LG 10MM PRIMTR ADON PEEK-OPTM ALIF,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
3393312,SUP,Custom 27803010,,3393312  -  SPACER SPNL 8D LG 12MM PRIMTR ADON PEEK-OPTM ALIF,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
3393314,SUP,Custom 27803010,,3393314  -  SPACER SPNL 8D LG 14MM PRIMTR ADON PEEK-OPTM ALIF,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
3393316,SUP,Custom 27803010,,3393316  -  SPACER SPNL 8D LG 16MM PRIMTR ADON PEEK-OPTM ALIF,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
3393318,SUP,HCPCS C1713,,3393318  -  SPACER SPNL 8D LG 18MM PRIMTR ADON PEEK-OPTM ALIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3393320,SUP,HCPCS C1713,,3393320  -  SPACER SPNL 8D LG 20MM PRIMTR ADON PEEK-OPTM ALIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3393412,SUP,Custom 27803010,,3393412  -  SPACER SPNL 12D LG 12MM PRIMTR ADON PEEK-OPTM ALIF,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
3393414,SUP,Custom 27803010,,3393414  -  SPACER SPNL 12D LG 14MM PRIMTR ADON PEEK-OPTM ALIF,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
3393416,SUP,Custom 27803010,,3393416  -  SPACER SPNL 12D LG 16MM PRIMTR ADON PEEK-OPTM ALIF,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
3393418,SUP,HCPCS C1713,,3393418  -  SPACER SPNL 12D LG 18MM PRIMTR ADON PEEK-OPTM ALIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3393420,SUP,HCPCS C1713,,3393420  -  SPACER SPNL 12D LG 20MM PRIMTR ADON PEEK-OPTM ALIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3394310,SUP,HCPCS C1713,,3394310  -  SPACER SPNL 8D XL 8MM PRIMTR ADON PEEK-OPTM ALIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3394312,SUP,HCPCS C1713,,3394312  -  SPACER SPNL 8D XL 12MM PRIMTR ADON PEEK-OPTM ALIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3394314,SUP,HCPCS C1713,,3394314  -  SPACER SPNL 8D XL 14MM PRIMTR ADON PEEK-OPTM ALIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3400014,SUP,HCPCS C1713,,3400014  -  SPACER SPNL TLIF HOOD SHIM,$920.00,$0.00,$920.00,$414.00,$656.60,$0.00,$158.51,$0.00,$0.00,$161.08,$920.00,$0.00,$460.00,$728.64,$736.00,$0.00,$143.98,$0.00,$146.46,$0.00
3400033,SUP,Custom 27203010,,3400033  -  KIT SPNL MAS LGHT CBL SLFRET TLIF,"$1,087.50",$0.00,"$1,087.50",$0.00,$776.15,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,087.50",$0.00,$543.75,$861.30,$870.00,$0.00,$0.00,$0.00,$0.00,$0.00
3491208,SUP,HCPCS C1713,,3491208  -  SPACER SPNL 4D LRDTC SM 8MM PRIMTR VERT BD REPL,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3491210,SUP,HCPCS C1713,,3491210  -  SPACER SPNL 4D LRDTC SM 10MM PRIMTR VERT BD REPL,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3491212,SUP,HCPCS C1713,,3491212  -  SPACER SPNL 4D LRDTC SM 12MM PRIMTR VERT BD REPL,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3491214,SUP,HCPCS C1713,,3491214  -  SPACER SPNL 4D LRDTC SM 14MM PRIMTR VERT BD REPL,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3491216,SUP,HCPCS C1713,,3491216  -  SPACER SPNL 4D LRDTC SM 16MM PRIMTR VERT BD REPL,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3491218,SUP,HCPCS C1713,,3491218  -  SPACER SPNL 4D LRDTC SM 18MM PRIMTR VERT BD REPL,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3491220,SUP,HCPCS C1713,,3491220  -  SPACER SPNL 4D LRDTC SM 20MM PRIMTR VERT BD REPL,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3492308,SUP,HCPCS C1713,,3492308  -  SPACER SPNL 8D LRDTC MED 8MM PRIMTR VERT BD REPL,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3492310,SUP,HCPCS C1713,,3492310  -  SPACER SPNL 8D LRDTC MED 10MM PRIMTR VERT BD REPL,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3492312,SUP,HCPCS C1713,,3492312  -  SPACER SPNL 8D LRDTC MED 12MM PRIMTR VERT BD REPL,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3492314,SUP,HCPCS C1713,,3492314  -  SPACER SPNL 8D LRDTC MED 14MM PRIMTR VERT BD REPL,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3492316,SUP,HCPCS C1713,,3492316  -  SPACER SPNL 8D LRDTC MED 16MM PRIMTR VERT BD REPL,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3492318,SUP,HCPCS C1713,,3492318  -  SPACER SPNL 8D LRDTC MED 18MM PRIMTR VERT BD REPL,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3492320,SUP,HCPCS C1713,,3492320  -  SPACER SPNL 8D LRDTC MED 20MM PRIMTR VERT BD REPL,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3493308,SUP,HCPCS C1713,,3493308  -  SPACER SPNL 8D LRDTC LG 8MM PRIMTR VERT BD REPL,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3493310,SUP,HCPCS C1713,,3493310  -  SPACER SPNL 8D LRDTC LG 10MM PRIMTR VERT BD REPL,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3493312,SUP,HCPCS C1713,,3493312  -  SPACER SPNL 8D LRDTC LG 12MM PRIMTR VERT BD REPL,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3493314,SUP,HCPCS C1713,,3493314  -  SPACER SPNL 8D LRDTC LG 14MM PRIMTR VERT BD REPL,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3493316,SUP,HCPCS C1713,,3493316  -  SPACER SPNL 8D LRDTC LG 16MM PRIMTR VERT BD REPL,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3493318,SUP,HCPCS C1713,,3493318  -  SPACER SPNL 8D LRDTC LG 18MM PRIMTR VERT BD REPL,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3493320,SUP,HCPCS C1713,,3493320  -  SPACER SPNL 8D LRDTC LG 20MM PRIMTR VERT BD REPL,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3493412,SUP,HCPCS C1713,,3493412  -  SPACER SPNL 12D LRDTC LG 12MM PRIMTR VERT BD REPL,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3493414,SUP,HCPCS C1713,,3493414  -  SPACER SPNL 12D LRDTC LG 14MM PRIMTR VERT BD REPL,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3493416,SUP,HCPCS C1713,,3493416  -  SPACER SPNL 12D LRDTC LG 16MM PRIMTR VERT BD REPL,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3493418,SUP,HCPCS C1713,,3493418  -  SPACER SPNL 12D LRDTC LG 18MM PRIMTR VERT BD REPL,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3493420,SUP,HCPCS C1713,,3493420  -  SPACER SPNL 12D LRDTC LG 20MM PRIMTR VERT BD REPL,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3493512,SUP,HCPCS C1713,,3493512  -  SPACER SPNL 15D LRDTC LG 12MM PRIMTR VERT BD REPL,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3493514,SUP,HCPCS C1713,,3493514  -  SPACER SPNL 15D LRDTC LG 14MM PRIMTR VERT BD REPL,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3493516,SUP,HCPCS C1713,,3493516  -  SPACER SPNL 15D LRDTC LG 16MM PRIMTR VERT BD REPL,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3493518,SUP,HCPCS C1713,,3493518  -  SPACER SPNL 15D LRDTC LG 18MM PRIMTR VERT BD REPL,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3493520,SUP,HCPCS C1713,,3493520  -  SPACER SPNL 15D LRDTC LG 20MM PRIMTR VERT BD REPL,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3494310,SUP,HCPCS C1713,,3494310  -  SPACER SPNL 8D LRDTC XL 10MM PRIMTR VERT BD REPL,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3494312,SUP,HCPCS C1713,,3494312  -  SPACER SPNL 8D LRDTC XL 12MM PRIMTR VERT BD REPL,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3494314,SUP,HCPCS C1713,,3494314  -  SPACER SPNL 8D LRDTC XL 14MM PRIMTR VERT BD REPL,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3494316,SUP,HCPCS C1713,,3494316  -  SPACER SPNL 8D LRDTC XL 16MM PRIMTR VERT BD REPL,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3494318,SUP,HCPCS C1713,,3494318  -  SPACER SPNL 8D LRDTC XL 18MM PRIMTR VERT BD REPL,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3494320,SUP,HCPCS C1713,,3494320  -  SPACER SPNL 8D LRDTC XL 20MM PRIMTR VERT BD REPL,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3547213,SUP,HCPCS C1789,,3547213  -  EXPANDER TISS 450ML TAB MED HT STY 7200 CPX3 SLTX CNTOUR,"$3,312.50",$0.00,"$3,312.50","$1,490.63","$2,364.13",$0.00,$570.73,$0.00,$0.00,$579.99,"$3,312.50",$0.00,"$1,656.25","$2,623.50","$2,650.00",$0.00,$518.41,$0.00,$527.35,$0.00
3549213,SUP,HCPCS C1789,,3549213  -  EXPANDER TISS P7CM CNTR PRFL MED HT 12.7X10.8CM 450ML CPX4,"$2,937.50",$0.00,"$2,937.50","$1,321.88","$2,096.49",$0.00,$506.12,$0.00,$0.00,$514.33,"$2,937.50",$0.00,"$1,468.75","$2,326.50","$2,350.00",$0.00,$459.72,$0.00,$467.65,$0.00
3549214,SUP,HCPCS C1789,,3549214  -  EXPANDER TISS P7.4CM CNTR PRFL MED HT 13.5X11.7CM 550ML CPX4,"$2,937.50",$0.00,"$2,937.50","$1,321.88","$2,096.49",$0.00,$506.12,$0.00,$0.00,$514.33,"$2,937.50",$0.00,"$1,468.75","$2,326.50","$2,350.00",$0.00,$459.72,$0.00,$467.65,$0.00
3549215,SUP,HCPCS C1789,,3549215  -  EXPANDER TISS P7.6CM CNTR PRFL MED HT 14.6X12.6CM 650ML CPX4,"$2,937.50",$0.00,"$2,937.50","$1,321.88","$2,096.49",$0.00,$506.12,$0.00,$0.00,$514.33,"$2,937.50",$0.00,"$1,468.75","$2,326.50","$2,350.00",$0.00,$459.72,$0.00,$467.65,$0.00
3549216,SUP,HCPCS C1789,,3549216  -  EXPANDER TISS P8CM CNTR PRFL MED HT 15.6X13.3CM 800ML CPX4,"$2,937.50",$0.00,"$2,937.50","$1,321.88","$2,096.49",$0.00,$506.12,$0.00,$0.00,$514.33,"$2,937.50",$0.00,"$1,468.75","$2,326.50","$2,350.00",$0.00,$459.72,$0.00,$467.65,$0.00
3712039,SUP,Custom 27203010,,PUNCH SURG 3.5MM UP BITE ANG CIRC CUT 160MM 45D,"$2,515.00",$0.00,"$2,515.00",$0.00,"$1,794.96",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,515.00",$0.00,"$1,257.50","$1,991.88","$2,012.00",$0.00,$0.00,$0.00,$0.00,$0.00
3714231,SUP,Custom 27203010,,PROBE SURG 208MM FRNTL OSTM SKR RT ANG 2 END BALL TIP,$427.50,$0.00,$427.50,$0.00,$305.11,$0.00,$0.00,$0.00,$0.00,$0.00,$427.50,$0.00,$213.75,$338.58,$342.00,$0.00,$0.00,$0.00,$0.00,$0.00
3714284,SUP,Custom 27203010,,CURETTE 5MM 2MM 75D CURVE CUP SURG,$460.00,$0.00,$460.00,$0.00,$328.30,$0.00,$0.00,$0.00,$0.00,$0.00,$460.00,$0.00,$230.00,$364.32,$368.00,$0.00,$0.00,$0.00,$0.00,$0.00
3756230,SUP,HCPCS C1713,,03756230  -  SCREW SET BUTTRESS BLOCKER XIA TITANIUM THORACOLUMBAR SPN,"$1,087.50",$0.00,"$1,087.50",$489.38,$776.15,$0.00,$187.37,$0.00,$0.00,$190.41,"$1,087.50",$0.00,$543.75,$861.30,$870.00,$0.00,$170.19,$0.00,$173.13,$0.00
3800750,SUP,HCPCS C1713,,03800750  -  SCREW BONE 7.5MM 50MM MNOAX XIA TITANIUM SPN THORACOLUMBAR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
3801530,SUP,HCPCS C1713,,03801530  -  SCREW BONE 5.5MM 30MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
3801535,SUP,HCPCS C1713,,03801535  -  SCREW BONE 5.5MM 35MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
3801540,SUP,HCPCS C1713,,03801540  -  SCREW BONE 5.5MM 40MM POLYAX XIA TITANIUM THORACOLUMBAR SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
3801545,SUP,HCPCS C1713,,03801545  -  SCREW BONE 5.5MM 45MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
3801550,SUP,HCPCS C1713,,03801550  -  SCREW BONE 5.5MM 50MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
3801555,SUP,HCPCS C1713,,03801555  -  SCREW BONE 5.5MM 55MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
3801630,SUP,HCPCS C1713,,03801630  -  SCREW BONE 6.5MM 30MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
3801635,SUP,HCPCS C1713,,03801635  -  SCREW BONE 6.5MM 35MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
3801640,SUP,HCPCS C1713,,03801640  -  SCREW BONE 6.5MM 40MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
3801645,SUP,HCPCS C1713,,03801645  -  SCREW BONE 6.5MM 45MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
3801650,SUP,HCPCS C1713,,03801650  -  SCREW BONE 6.5MM 50MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
3801655,SUP,HCPCS C1713,,03801655  -  SCREW BONE 6.5MM 55MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
3801660,SUP,HCPCS C1713,,03801660  -  SCREW BONE 6.5MM 60MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
3801730,SUP,HCPCS C1713,,03801730  -  SCREW BONE 7.5MM 30MM POLYAX XIA SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
3801735,SUP,HCPCS C1713,,03801735  -  SCREW BONE 7.5MM 35MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
3801740,SUP,HCPCS C1713,,03801740  -  SCREW BONE 7.5MM 40MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
3801745,SUP,HCPCS C1713,,03801745  -  SCREW BONE 7.5MM 45MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
3801750,SUP,HCPCS C1713,,03801750  -  SCREW BONE 7.5MM 50MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
3801755,SUP,HCPCS C1713,,03801755  -  SCREW BONE 7.5MM 55MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
3801760,SUP,HCPCS C1713,,03801760  -  SCREW BONE 7.5MM 60MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
3801800,SUP,HCPCS C1713,,03801800  -  SCREW BONE 8.5MM 100MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3801830,SUP,HCPCS C1713,,03801830  -  SCREW BONE 8.5MM 30MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3801835,SUP,HCPCS C1713,,03801835  -  SCREW BONE 8.5MM 35MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3801840,SUP,HCPCS C1713,,03801840  -  SCREW BONE 8.5MM 40MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3801845,SUP,HCPCS C1713,,03801845  -  SCREW BONE 8.5MM 45MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3801850,SUP,HCPCS C1713,,03801850  -  SCREW BONE 8.5MM 50MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3801855,SUP,HCPCS C1713,,03801855  -  SCREW BONE 8.5MM 55MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3801860,SUP,HCPCS C1713,,03801860  -  SCREW BONE 8.5MM 60MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3801870,SUP,HCPCS C1713,,03801870  -  SCREW BONE 8.5MM 70MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3801880,SUP,HCPCS C1713,,03801880  -  SCREW BONE 8.5MM 80MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3801890,SUP,HCPCS C1713,,03801890  -  SCREW BONE 8.5MM 90MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3801900,SUP,HCPCS C1713,,03801900  -  SCREW BONE 9.5MM 100MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$1,162.50",$0.00,"$1,162.50",$523.13,$829.68,$0.00,$200.29,$0.00,$0.00,$203.54,"$1,162.50",$0.00,$581.25,$920.70,$930.00,$0.00,$181.93,$0.00,$185.07,$0.00
3801960,SUP,HCPCS C1713,,03801960  -  SCREW BONE 9.5MM 60MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$1,162.50",$0.00,"$1,162.50",$523.13,$829.68,$0.00,$200.29,$0.00,$0.00,$203.54,"$1,162.50",$0.00,$581.25,$920.70,$930.00,$0.00,$181.93,$0.00,$185.07,$0.00
3801970,SUP,HCPCS C1713,,03801970  -  SCREW BONE 9.5MM 70MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
3801980,SUP,HCPCS C1713,,03801980  -  SCREW BONE 9.5MM 80MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$4,437.50",$0.00,"$4,437.50","$1,996.88","$3,167.04",$0.00,$764.56,$0.00,$0.00,$776.97,"$4,437.50",$0.00,"$2,218.75","$3,514.50","$3,550.00",$0.00,$694.47,$0.00,$706.45,$0.00
3801990,SUP,HCPCS C1713,,03801990  -  SCREW BONE 9.5MM 90MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
3802070,SUP,Custom 27803010,,03802070  -  ROD SPNL 70MM 6MM XIA TI CENTRL POST,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
3802110,SUP,Custom 27803010,,03802110  -  ROD SPNL 110MM 6MM XIA TI CENTRL POST,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
3802480,SUP,Custom 27803010,,03802480  -  ROD SPNL 480MM 6MM XIA TI CENTRL POST,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
3804025,SUP,Custom 27803010,,03804025  -  CONNECTOR ROD XIA SPN I,$991.68,$0.00,$991.68,$0.00,$707.76,$0.00,$0.00,$0.00,$0.00,$0.00,$991.68,$0.00,$495.84,$785.41,$793.34,$0.00,$0.00,$0.00,$0.00,$0.00
3804120,SUP,Custom 27803010,,03804120  -  CONNECTOR ROD ADAPTER XIA SPN,$991.68,$0.00,$991.68,$0.00,$707.76,$0.00,$0.00,$0.00,$0.00,$0.00,$991.68,$0.00,$495.84,$785.41,$793.34,$0.00,$0.00,$0.00,$0.00,$0.00
3805000,SUP,Custom 27803010,,03805000  -  BLOCK SPINAL XIA TITANIUM SACRAL,"$4,082.50",$0.00,"$4,082.50",$0.00,"$2,913.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,082.50",$0.00,"$2,041.25","$3,233.34","$3,266.00",$0.00,$0.00,$0.00,$0.00,$0.00
3805001,SUP,Custom 27803010,,03805001  -  CLAMP SPINAL ROD TO ROD PARALLEL XIA TITANIUM,"$5,737.50",$0.00,"$5,737.50",$0.00,"$4,094.85",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,737.50",$0.00,"$2,868.75","$4,544.10","$4,590.00",$0.00,$0.00,$0.00,$0.00,$0.00
3805002,SUP,Custom 27803010,,03805002  -  CLAMP SPINAL AXIAL XIA TITANIUM,"$5,737.50",$0.00,"$5,737.50",$0.00,"$4,094.85",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,737.50",$0.00,"$2,868.75","$4,544.10","$4,590.00",$0.00,$0.00,$0.00,$0.00,$0.00
3805025,SUP,HCPCS C1713,,03805025  -  SCREW BONE 6.5MM 25MM XIA TITANIUM SPN THORACOLUMBAR,"$2,400.00",$0.00,"$2,400.00","$1,080.00","$1,712.88",$0.00,$413.51,$0.00,$0.00,$420.22,"$2,400.00",$0.00,"$1,200.00","$1,900.80","$1,920.00",$0.00,$375.60,$0.00,$382.08,$0.00
3805030,SUP,HCPCS C1713,,03805030  -  SCREW BONE 6.5MM 30MM XIA TITANIUM SPN THORACOLUMBAR,"$2,400.00",$0.00,"$2,400.00","$1,080.00","$1,712.88",$0.00,$413.51,$0.00,$0.00,$420.22,"$2,400.00",$0.00,"$1,200.00","$1,900.80","$1,920.00",$0.00,$375.60,$0.00,$382.08,$0.00
3805035,SUP,HCPCS C1713,,03805035  -  SCREW BONE 6.5MM 35MM XIA TITANIUM SPN THORACOLUMBAR,"$5,000.00",$0.00,"$5,000.00","$2,250.00","$3,568.50",$0.00,$861.48,$0.00,$0.00,$875.46,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$782.50,$0.00,$796.00,$0.00
3806001,SUP,Custom 27803010,,03806001  -  HOOK SPINAL LARGE XIA TITANIUM LAMINA,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
3806002,SUP,Custom 27803010,,03806002  -  HOOK SPINAL MEDIUM XIA TITANIUM LAMINA,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
3806003,SUP,Custom 27803010,,03806003  -  HOOK SPINAL SMALL XIA TITANIUM LMNR,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
3806006,SUP,Custom 27803010,,03806006  -  HOOK SPINAL LEFT EXTEND BODY XIA TITANIUM LAMINA,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
3806007,SUP,Custom 27803010,,03806007  -  HOOK SPINAL RIGHT EXTEND BODY XIA TITANIUM LAMINA,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
3806009,SUP,Custom 27803010,,03806009  -  HOOK SPINAL LARGE ANGLE LEFT XIA TITANIUM LAMINA,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
3806012,SUP,Custom 27803010,,03806012  -  HOOK SPINAL SMALL XIA GOLD TITANIUM PEDICLE,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
3820100,SUP,HCPCS C1713,,03820100  -  WASHER SPINAL LP XIA II TITANIUM,"$1,087.50",$0.00,"$1,087.50",$489.38,$776.15,$0.00,$187.37,$0.00,$0.00,$190.41,"$1,087.50",$0.00,$543.75,$861.30,$870.00,$0.00,$170.19,$0.00,$173.13,$0.00
3820101,SUP,Custom 27803010,,03820101  -  CONCTR ROD XIA OFFST SCR TI THORLMBR SPN,"$5,737.50",$0.00,"$5,737.50",$0.00,"$4,094.85",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,737.50",$0.00,"$2,868.75","$4,544.10","$4,590.00",$0.00,$0.00,$0.00,$0.00,$0.00
3820104,SUP,HCPCS C1713,,03820104  -  STAPLE BONE 1 HOLE XIA TITANIUM SPN ANTERIOR,"$1,087.50",$0.00,"$1,087.50",$489.38,$776.15,$0.00,$187.37,$0.00,$0.00,$190.41,"$1,087.50",$0.00,$543.75,$861.30,$870.00,$0.00,$170.19,$0.00,$173.13,$0.00
3820110,SUP,HCPCS C1713,,03820110  -  STAPLE BONE SMALL 2 DIAPASON OSS XIA TITANIUM SPN CAUDAL,"$4,750.00",$0.00,"$4,750.00","$2,137.50","$3,390.08",$0.00,$818.40,$0.00,$0.00,$831.69,"$4,750.00",$0.00,"$2,375.00","$3,762.00","$3,800.00",$0.00,$743.38,$0.00,$756.20,$0.00
3820111,SUP,HCPCS C1713,,03820111  -  STAPLE BONE SMALL 2 DIAPASON OSS XIA TITANIUM SPN ROSTRAL,"$4,750.00",$0.00,"$4,750.00","$2,137.50","$3,390.08",$0.00,$818.40,$0.00,$0.00,$831.69,"$4,750.00",$0.00,"$2,375.00","$3,762.00","$3,800.00",$0.00,$743.38,$0.00,$756.20,$0.00
3820112,SUP,HCPCS C1713,,03820112  -  STAPLE BONE MEDIUM 2 DIAPASON OSS XIA TITANIUM SPN CAUDAL,"$4,750.00",$0.00,"$4,750.00","$2,137.50","$3,390.08",$0.00,$818.40,$0.00,$0.00,$831.69,"$4,750.00",$0.00,"$2,375.00","$3,762.00","$3,800.00",$0.00,$743.38,$0.00,$756.20,$0.00
3820113,SUP,HCPCS C1713,,03820113  -  STAPLE BONE MEDIUM 2 DIAPASON OSS XIA TITANIUM SPN ROSTRAL,"$4,750.00",$0.00,"$4,750.00","$2,137.50","$3,390.08",$0.00,$818.40,$0.00,$0.00,$831.69,"$4,750.00",$0.00,"$2,375.00","$3,762.00","$3,800.00",$0.00,$743.38,$0.00,$756.20,$0.00
3820114,SUP,HCPCS C1713,,03820114  -  STAPLE BONE LARGE 2 DIAPASON OSS XIA TITANIUM SPN CAUDAL,"$4,750.00",$0.00,"$4,750.00","$2,137.50","$3,390.08",$0.00,$818.40,$0.00,$0.00,$831.69,"$4,750.00",$0.00,"$2,375.00","$3,762.00","$3,800.00",$0.00,$743.38,$0.00,$756.20,$0.00
3820115,SUP,HCPCS C1713,,03820115  -  STAPLE BONE LARGE 2 DIAPASON OSS XIA TITANIUM SPN ROSTRAL,"$4,750.00",$0.00,"$4,750.00","$2,137.50","$3,390.08",$0.00,$818.40,$0.00,$0.00,$831.69,"$4,750.00",$0.00,"$2,375.00","$3,762.00","$3,800.00",$0.00,$743.38,$0.00,$756.20,$0.00
3820120,SUP,HCPCS C1713,,03820120  -  WASHER SPINAL 4.5MM LP XIA TITANIUM,$223.38,$0.00,$223.38,$100.52,$159.42,$0.00,$38.49,$0.00,$0.00,$39.11,$223.38,$0.00,$111.69,$176.92,$178.70,$0.00,$34.96,$0.00,$35.56,$0.00
3820124,SUP,HCPCS C1713,,03820124  -  WASHER SPINAL 8.5MM LP XIA TITANIUM,$223.38,$0.00,$223.38,$100.52,$159.42,$0.00,$38.49,$0.00,$0.00,$39.11,$223.38,$0.00,$111.69,$176.92,$178.70,$0.00,$34.96,$0.00,$35.56,$0.00
3820130,SUP,Custom 27803010,,03820130  -  CONNECTOR ROD 75D XIA TITANIUM THORACOLUMBAR SPN,"$5,737.50",$0.00,"$5,737.50",$0.00,"$4,094.85",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,737.50",$0.00,"$2,868.75","$4,544.10","$4,590.00",$0.00,$0.00,$0.00,$0.00,$0.00
3820131,SUP,Custom 27803010,,03820131  -  CONNECTOR ROD 0D PLATE XIA TITANIUM THORACOLUMBAR SPN,"$5,737.50",$0.00,"$5,737.50",$0.00,"$4,094.85",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,737.50",$0.00,"$2,868.75","$4,544.10","$4,590.00",$0.00,$0.00,$0.00,$0.00,$0.00
3820132,SUP,Custom 27803010,,03820132  -  CONNECTOR ROD 105D OFFST PLATE XIA TITANIUM SPN,"$5,737.50",$0.00,"$5,737.50",$0.00,"$4,094.85",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,737.50",$0.00,"$2,868.75","$4,544.10","$4,590.00",$0.00,$0.00,$0.00,$0.00,$0.00
3820133,SUP,Custom 27803010,,03820133  -  CONNECTOR ROD NEUTRAL 80MM OFFST XIA 3 TITANIUM STAINLESS,"$5,737.50",$0.00,"$5,737.50",$0.00,"$4,094.85",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,737.50",$0.00,"$2,868.75","$4,544.10","$4,590.00",$0.00,$0.00,$0.00,$0.00,$0.00
3820134,SUP,Custom 27803010,,03820134  -  CONNECTOR ROD 0D SMALL XIA TITANIUM SPN,"$5,737.50",$0.00,"$5,737.50",$0.00,"$4,094.85",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,737.50",$0.00,"$2,868.75","$4,544.10","$4,590.00",$0.00,$0.00,$0.00,$0.00,$0.00
3820135,SUP,Custom 27803010,,03820135  -  CONNECTOR ROD 30D SMALL XIA TITANIUM SPN,"$5,737.50",$0.00,"$5,737.50",$0.00,"$4,094.85",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,737.50",$0.00,"$2,868.75","$4,544.10","$4,590.00",$0.00,$0.00,$0.00,$0.00,$0.00
3820136,SUP,Custom 27803010,,03820136  -  CONNECTOR ROD 0D LARGE XIA TITANIUM SPN,"$5,737.50",$0.00,"$5,737.50",$0.00,"$4,094.85",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,737.50",$0.00,"$2,868.75","$4,544.10","$4,590.00",$0.00,$0.00,$0.00,$0.00,$0.00
3820137,SUP,Custom 27803010,,03820137  -  CONNECTOR ROD 30D LARGE XIA TITANIUM SPN,"$5,737.50",$0.00,"$5,737.50",$0.00,"$4,094.85",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,737.50",$0.00,"$2,868.75","$4,544.10","$4,590.00",$0.00,$0.00,$0.00,$0.00,$0.00
3820200,SUP,Custom 27803010,,03820200  -  HOOK SPINAL SMALL STANDARD BLADE XIA TITANIUM LAMINA,"$5,287.50",$0.00,"$5,287.50",$0.00,"$3,773.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,287.50",$0.00,"$2,643.75","$4,187.70","$4,230.00",$0.00,$0.00,$0.00,$0.00,$0.00
3820201,SUP,Custom 27803010,,03820201  -  HOOK SPINAL SMALL NARROW XIA TITANIUM LAMINA,"$5,287.50",$0.00,"$5,287.50",$0.00,"$3,773.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,287.50",$0.00,"$2,643.75","$4,187.70","$4,230.00",$0.00,$0.00,$0.00,$0.00,$0.00
3820202,SUP,Custom 27803010,,03820202  -  HOOK SPINAL LARGE STANDARD BLADE XIA TITANIUM LAMINA,"$5,287.50",$0.00,"$5,287.50",$0.00,"$3,773.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,287.50",$0.00,"$2,643.75","$4,187.70","$4,230.00",$0.00,$0.00,$0.00,$0.00,$0.00
3820203,SUP,Custom 27803010,,03820203  -  HOOK SPINAL LARGE LEGENDARY BLADE XIA II TITANIUM LAMINA,"$5,287.50",$0.00,"$5,287.50",$0.00,"$3,773.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,287.50",$0.00,"$2,643.75","$4,187.70","$4,230.00",$0.00,$0.00,$0.00,$0.00,$0.00
3820204,SUP,Custom 27803010,,03820204  -  HOOK SPINAL EXTEND XIA TITANIUM LAMINA,"$5,287.50",$0.00,"$5,287.50",$0.00,"$3,773.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,287.50",$0.00,"$2,643.75","$4,187.70","$4,230.00",$0.00,$0.00,$0.00,$0.00,$0.00
3820206,SUP,Custom 27803010,,03820206  -  HOOK SPINAL RIGHT OFFST XIA TITANIUM LAMINA,"$5,287.50",$0.00,"$5,287.50",$0.00,"$3,773.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,287.50",$0.00,"$2,643.75","$4,187.70","$4,230.00",$0.00,$0.00,$0.00,$0.00,$0.00
3820207,SUP,Custom 27803010,,03820207  -  HOOK SPINAL LEFT OFFST XIA TITANIUM LAMINA,"$5,287.50",$0.00,"$5,287.50",$0.00,"$3,773.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,287.50",$0.00,"$2,643.75","$4,187.70","$4,230.00",$0.00,$0.00,$0.00,$0.00,$0.00
3820208,SUP,Custom 27803010,,03820208  -  HOOK SPINAL ANGLE BLADE XIA TITANIUM LAMINA,"$5,287.50",$0.00,"$5,287.50",$0.00,"$3,773.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,287.50",$0.00,"$2,643.75","$4,187.70","$4,230.00",$0.00,$0.00,$0.00,$0.00,$0.00
3820210,SUP,Custom 27803010,,03820210  -  HOOK SPINAL STANDARD BLADE XIA TITANIUM LMNR THORACIC,"$5,287.50",$0.00,"$5,287.50",$0.00,"$3,773.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,287.50",$0.00,"$2,643.75","$4,187.70","$4,230.00",$0.00,$0.00,$0.00,$0.00,$0.00
3820211,SUP,Custom 27803010,,03820211  -  HOOK SPINAL SMALL NARROW BLADE XIA TITANIUM THORAX LAMINA,"$5,287.50",$0.00,"$5,287.50",$0.00,"$3,773.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,287.50",$0.00,"$2,643.75","$4,187.70","$4,230.00",$0.00,$0.00,$0.00,$0.00,$0.00
3820212,SUP,Custom 27803010,,03820212  -  HOOK SPINAL SMALL RIGHT OFFST XIA TITANIUM THORACOLUMBAR,"$5,287.50",$0.00,"$5,287.50",$0.00,"$3,773.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,287.50",$0.00,"$2,643.75","$4,187.70","$4,230.00",$0.00,$0.00,$0.00,$0.00,$0.00
3820213,SUP,Custom 27803010,,03820213  -  HOOK SPINAL SMALL LEFT OFFST XIA TITANIUM THORACOLUMBAR,"$5,287.50",$0.00,"$5,287.50",$0.00,"$3,773.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,287.50",$0.00,"$2,643.75","$4,187.70","$4,230.00",$0.00,$0.00,$0.00,$0.00,$0.00
3820214,SUP,Custom 27803010,,03820214  -  HOOK SPINAL LARGE RIGHT OFFST XIA TITANIUM THORAX LAMINA,"$5,287.50",$0.00,"$5,287.50",$0.00,"$3,773.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,287.50",$0.00,"$2,643.75","$4,187.70","$4,230.00",$0.00,$0.00,$0.00,$0.00,$0.00
3820215,SUP,Custom 27803010,,03820215  -  HOOK SPINAL LARGE LEFT OFFST XIA TITANIUM THORAX LAMINA,"$5,287.50",$0.00,"$5,287.50",$0.00,"$3,773.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,287.50",$0.00,"$2,643.75","$4,187.70","$4,230.00",$0.00,$0.00,$0.00,$0.00,$0.00
3820220,SUP,Custom 27803010,,03820220  -  HOOK SPINAL SMALL LOCK XIA TITANIUM PEDICLE,"$5,287.50",$0.00,"$5,287.50",$0.00,"$3,773.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,287.50",$0.00,"$2,643.75","$4,187.70","$4,230.00",$0.00,$0.00,$0.00,$0.00,$0.00
3820221,SUP,Custom 27803010,,03820221  -  HOOK SPINAL LARGE XIA TITANIUM PEDICLE,"$5,287.50",$0.00,"$5,287.50",$0.00,"$3,773.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,287.50",$0.00,"$2,643.75","$4,187.70","$4,230.00",$0.00,$0.00,$0.00,$0.00,$0.00
3820230,SUP,Custom 27803010,,03820230  -  HOOK SPINAL RIGHT OFFST XIA TITANIUM TRNSVRS PROCESS,"$5,287.50",$0.00,"$5,287.50",$0.00,"$3,773.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,287.50",$0.00,"$2,643.75","$4,187.70","$4,230.00",$0.00,$0.00,$0.00,$0.00,$0.00
3820231,SUP,Custom 27803010,,03820231  -  HOOK SPINAL LEFT OFFST XIA II TITANIUM TRNSVRS PROCESS,"$5,287.50",$0.00,"$5,287.50",$0.00,"$3,773.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,287.50",$0.00,"$2,643.75","$4,187.70","$4,230.00",$0.00,$0.00,$0.00,$0.00,$0.00
3820240,SUP,Custom 27803010,,03820240  -  HOOK SPINAL NARROW ANGLE REDUCE BLADE XIA TITANIUM LAMINA,"$5,287.50",$0.00,"$5,287.50",$0.00,"$3,773.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,287.50",$0.00,"$2,643.75","$4,187.70","$4,230.00",$0.00,$0.00,$0.00,$0.00,$0.00
3820241,SUP,Custom 27803010,,03820241  -  HOOK SPINAL WIDE ANGLE REDUCE BLADE XIA TITANIUM LAMINA,"$5,287.50",$0.00,"$5,287.50",$0.00,"$3,773.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,287.50",$0.00,"$2,643.75","$4,187.70","$4,230.00",$0.00,$0.00,$0.00,$0.00,$0.00
3820242,SUP,Custom 27803010,,03820242  -  HOOK SPINAL ANGLE REDUCE XIA TITANIUM LAMINA,"$5,287.50",$0.00,"$5,287.50",$0.00,"$3,773.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,287.50",$0.00,"$2,643.75","$4,187.70","$4,230.00",$0.00,$0.00,$0.00,$0.00,$0.00
3820243,SUP,Custom 27803010,,03820243  -  HOOK SPINAL NARROW ANGLE REDUCE BLADE XIA TITANIUM THORAX,"$5,287.50",$0.00,"$5,287.50",$0.00,"$3,773.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,287.50",$0.00,"$2,643.75","$4,187.70","$4,230.00",$0.00,$0.00,$0.00,$0.00,$0.00
3820244,SUP,Custom 27803010,,03820244  -  HOOK SPINAL LP RED BLADE XIA TITANIUM PEDIATRIC PEDICLE,"$5,287.50",$0.00,"$5,287.50",$0.00,"$3,773.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,287.50",$0.00,"$2,643.75","$4,187.70","$4,230.00",$0.00,$0.00,$0.00,$0.00,$0.00
3820425,SUP,HCPCS C1713,,03820425  -  SCREW BONE 4.5MM 25MM MNOAX XIA II TITANIUM SPN,"$5,000.00",$0.00,"$5,000.00","$2,250.00","$3,568.50",$0.00,$861.48,$0.00,$0.00,$875.46,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$782.50,$0.00,$796.00,$0.00
3820430,SUP,HCPCS C1713,,03820430  -  SCREW BONE 4.5MM 30MM MNOAX XIA II TITANIUM SPN,"$5,000.00",$0.00,"$5,000.00","$2,250.00","$3,568.50",$0.00,$861.48,$0.00,$0.00,$875.46,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$782.50,$0.00,$796.00,$0.00
3820435,SUP,HCPCS C1713,,03820435  -  SCREW BONE 4.5MM 35MM MNOAX XIA TITANIUM THORACOLUMBAR SPN,"$5,000.00",$0.00,"$5,000.00","$2,250.00","$3,568.50",$0.00,$861.48,$0.00,$0.00,$875.46,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$782.50,$0.00,$796.00,$0.00
3820440,SUP,HCPCS C1713,,03820440  -  SCREW BONE 4.5MM 40MM MNOAX XIA II TITANIUM SPN,"$5,000.00",$0.00,"$5,000.00","$2,250.00","$3,568.50",$0.00,$861.48,$0.00,$0.00,$875.46,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$782.50,$0.00,$796.00,$0.00
3820445,SUP,HCPCS C1713,,03820445  -  SCREW BONE 4.5MM 45MM MNOAX XIA II TITANIUM SPN,"$5,000.00",$0.00,"$5,000.00","$2,250.00","$3,568.50",$0.00,$861.48,$0.00,$0.00,$875.46,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$782.50,$0.00,$796.00,$0.00
3820525,SUP,HCPCS C1713,,03820525  -  SCREW BONE 5.5MM 25MM MNOAX XIA II TITANIUM SPN,"$5,000.00",$0.00,"$5,000.00","$2,250.00","$3,568.50",$0.00,$861.48,$0.00,$0.00,$875.46,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$782.50,$0.00,$796.00,$0.00
3820530,SUP,HCPCS C1713,,03820530  -  SCREW BONE 5.5MM 30MM MNOAX XIA II TITANIUM SPN,"$5,000.00",$0.00,"$5,000.00","$2,250.00","$3,568.50",$0.00,$861.48,$0.00,$0.00,$875.46,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$782.50,$0.00,$796.00,$0.00
3820535,SUP,HCPCS C1713,,03820535  -  SCREW BONE 5.5MM 35MM MNOAX XIA II TITANIUM SPN,"$5,000.00",$0.00,"$5,000.00","$2,250.00","$3,568.50",$0.00,$861.48,$0.00,$0.00,$875.46,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$782.50,$0.00,$796.00,$0.00
3820540,SUP,HCPCS C1713,,03820540  -  SCREW BONE 5.5MM 40MM MNOAX XIA II TITANIUM SPN,"$5,000.00",$0.00,"$5,000.00","$2,250.00","$3,568.50",$0.00,$861.48,$0.00,$0.00,$875.46,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$782.50,$0.00,$796.00,$0.00
3820545,SUP,HCPCS C1713,,03820545  -  SCREW BONE 5.5MM 45MM XIA SPNL MNOAX,"$5,000.00",$0.00,"$5,000.00","$2,250.00","$3,568.50",$0.00,$861.48,$0.00,$0.00,$875.46,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$782.50,$0.00,$796.00,$0.00
3820550,SUP,HCPCS C1713,,03820550  -  SCREW BONE 5.5MM 50MM MNOAX XIA II TITANIUM SPN,"$5,000.00",$0.00,"$5,000.00","$2,250.00","$3,568.50",$0.00,$861.48,$0.00,$0.00,$875.46,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$782.50,$0.00,$796.00,$0.00
3820555,SUP,HCPCS C1713,,03820555  -  SCREW BONE 5.5MM 55MM MNOAX XIA II TITANIUM SPN,"$5,000.00",$0.00,"$5,000.00","$2,250.00","$3,568.50",$0.00,$861.48,$0.00,$0.00,$875.46,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$782.50,$0.00,$796.00,$0.00
3820600,SUP,HCPCS C1713,,03820600  -  SCREW BONE 6.5MM 100MM MNOAX XIA II TITANIUM SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
3820630,SUP,HCPCS C1713,,03820630  -  SCREW BONE 6.5MM 30MM MNOAX XIA II TITANIUM SPN,"$5,000.00",$0.00,"$5,000.00","$2,250.00","$3,568.50",$0.00,$861.48,$0.00,$0.00,$875.46,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$782.50,$0.00,$796.00,$0.00
3820635,SUP,HCPCS C1713,,03820635  -  SCREW BONE 6.5MM 35MM MNOAX XIA II TITANIUM SPN,"$5,000.00",$0.00,"$5,000.00","$2,250.00","$3,568.50",$0.00,$861.48,$0.00,$0.00,$875.46,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$782.50,$0.00,$796.00,$0.00
3820640,SUP,HCPCS C1713,,03820640  -  SCREW BONE 6.5MM 40MM MNOAX XIA II TITANIUM SPN,"$5,000.00",$0.00,"$5,000.00","$2,250.00","$3,568.50",$0.00,$861.48,$0.00,$0.00,$875.46,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$782.50,$0.00,$796.00,$0.00
3820645,SUP,HCPCS C1713,,03820645  -  SCREW BONE 6.5MM 45MM MNOAX XIA II TITANIUM SPN,"$5,000.00",$0.00,"$5,000.00","$2,250.00","$3,568.50",$0.00,$861.48,$0.00,$0.00,$875.46,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$782.50,$0.00,$796.00,$0.00
3820650,SUP,HCPCS C1713,,03820650  -  SCREW BONE 6.5MM 50MM MNOAX XIA II TITANIUM SPN,"$5,000.00",$0.00,"$5,000.00","$2,250.00","$3,568.50",$0.00,$861.48,$0.00,$0.00,$875.46,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$782.50,$0.00,$796.00,$0.00
3820655,SUP,HCPCS C1713,,03820655  -  SCREW BONE 6.5MM 55MM MNOAX XIA II TITANIUM SPN,"$5,000.00",$0.00,"$5,000.00","$2,250.00","$3,568.50",$0.00,$861.48,$0.00,$0.00,$875.46,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$782.50,$0.00,$796.00,$0.00
3820660,SUP,HCPCS C1713,,03820660  -  SCREW BONE 6.5MM 60MM MNOAX XIA II TITANIUM SPN,"$5,000.00",$0.00,"$5,000.00","$2,250.00","$3,568.50",$0.00,$861.48,$0.00,$0.00,$875.46,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$782.50,$0.00,$796.00,$0.00
3820670,SUP,HCPCS C1713,,03820670  -  SCREW BONE 6.5MM 70MM MNOAX XIA II TITANIUM SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
3820680,SUP,HCPCS C1713,,03820680  -  SCREW BONE 6.5MM 80MM MNOAX XIA II TITANIUM SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
3820690,SUP,HCPCS C1713,,03820690  -  SCREW BONE 6.5MM 90MM MNOAX XIA II TITANIUM SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
3820700,SUP,HCPCS C1713,,03820700  -  SCREW BONE 7.5MM 100MM MNOAX XIA II TITANIUM SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
3820730,SUP,HCPCS C1713,,03820730  -  SCREW BONE 7.5MM 30MM MNOAX XIA II TITANIUM SPN,"$5,000.00",$0.00,"$5,000.00","$2,250.00","$3,568.50",$0.00,$861.48,$0.00,$0.00,$875.46,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$782.50,$0.00,$796.00,$0.00
3820735,SUP,HCPCS C1713,,03820735  -  SCREW BONE 7.5MM 35MM MNOAX XIA II TITANIUM SPN,"$5,000.00",$0.00,"$5,000.00","$2,250.00","$3,568.50",$0.00,$861.48,$0.00,$0.00,$875.46,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$782.50,$0.00,$796.00,$0.00
3820740,SUP,HCPCS C1713,,03820740  -  SCREW BONE 7.5MM 40MM MNOAX XIA II TITANIUM SPN,"$5,000.00",$0.00,"$5,000.00","$2,250.00","$3,568.50",$0.00,$861.48,$0.00,$0.00,$875.46,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$782.50,$0.00,$796.00,$0.00
3820745,SUP,HCPCS C1713,,03820745  -  SCREW BONE 7.5MM 45MM MNOAX XIA II TITANIUM SPN,"$5,000.00",$0.00,"$5,000.00","$2,250.00","$3,568.50",$0.00,$861.48,$0.00,$0.00,$875.46,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$782.50,$0.00,$796.00,$0.00
3820750,SUP,HCPCS C1713,,03820750  -  SCREW BONE 7.5MM 50MM MNOAX XIA II TITANIUM SPN,"$5,000.00",$0.00,"$5,000.00","$2,250.00","$3,568.50",$0.00,$861.48,$0.00,$0.00,$875.46,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$782.50,$0.00,$796.00,$0.00
3820755,SUP,HCPCS C1713,,03820755  -  SCREW BONE 7.5MM 55MM XIA TI SPNL MNOAX,"$5,000.00",$0.00,"$5,000.00","$2,250.00","$3,568.50",$0.00,$861.48,$0.00,$0.00,$875.46,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$782.50,$0.00,$796.00,$0.00
3820760,SUP,HCPCS C1713,,03820760  -  SCREW BONE 7.5MM 60MM MNOAX XIA II TITANIUM SPN,"$5,000.00",$0.00,"$5,000.00","$2,250.00","$3,568.50",$0.00,$861.48,$0.00,$0.00,$875.46,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$782.50,$0.00,$796.00,$0.00
3820770,SUP,HCPCS C1713,,03820770  -  SCREW BONE 7.5MM 70MM MNOAX XIA II TITANIUM SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
3820780,SUP,HCPCS C1713,,03820780  -  SCREW BONE 7.5MM 80MM MNOAX XIA II TITANIUM SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
3820790,SUP,HCPCS C1713,,03820790  -  SCREW BONE 7.5MM 90MM MNOAX XIA II TITANIUM SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
3820800,SUP,HCPCS C1713,,03820800  -  SCREW BONE 8.5MM 100MM MNOAX XIA II TITANIUM SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
3820830,SUP,HCPCS C1713,,03820830  -  SCREW BONE 8.5MM 30MM MNOAX XIA II TITANIUM SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
3820835,SUP,HCPCS C1713,,03820835  -  SCREW BONE 8.5MM 35MM MNOAX XIA II TITANIUM SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
3820840,SUP,HCPCS C1713,,03820840  -  SCREW BONE 8.5MM 40MM MNOAX XIA II TITANIUM SPN,"$5,000.00",$0.00,"$5,000.00","$2,250.00","$3,568.50",$0.00,$861.48,$0.00,$0.00,$875.46,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$782.50,$0.00,$796.00,$0.00
3820845,SUP,HCPCS C1713,,03820845  -  SCREW BONE 8.5MM 45MM MNOAX XIA II TITANIUM SPN,"$5,000.00",$0.00,"$5,000.00","$2,250.00","$3,568.50",$0.00,$861.48,$0.00,$0.00,$875.46,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$782.50,$0.00,$796.00,$0.00
3820850,SUP,HCPCS C1713,,03820850  -  SCREW BONE 8.5MM 50MM MNOAX XIA II TITANIUM SPN,"$5,000.00",$0.00,"$5,000.00","$2,250.00","$3,568.50",$0.00,$861.48,$0.00,$0.00,$875.46,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$782.50,$0.00,$796.00,$0.00
3820855,SUP,HCPCS C1713,,03820855  -  SCREW BONE 8.5MM 55MM MNOAX XIA II TITANIUM SPN,"$5,000.00",$0.00,"$5,000.00","$2,250.00","$3,568.50",$0.00,$861.48,$0.00,$0.00,$875.46,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$782.50,$0.00,$796.00,$0.00
3820860,SUP,HCPCS C1713,,03820860  -  SCREW BONE 8.5MM 60MM MNOAX XIA II TITANIUM SPN,"$5,000.00",$0.00,"$5,000.00","$2,250.00","$3,568.50",$0.00,$861.48,$0.00,$0.00,$875.46,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$782.50,$0.00,$796.00,$0.00
3820870,SUP,HCPCS C1713,,03820870  -  SCREW BONE 8.5MM 70MM MNOAX XIA II TITANIUM SPN,"$5,000.00",$0.00,"$5,000.00","$2,250.00","$3,568.50",$0.00,$861.48,$0.00,$0.00,$875.46,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$782.50,$0.00,$796.00,$0.00
3820880,SUP,HCPCS C1713,,03820880  -  SCREW BONE 8.5MM 80MM MNOAX XIA II TITANIUM SPN,"$6,300.00",$0.00,"$6,300.00","$2,835.00","$4,496.31",$0.00,"$1,085.46",$0.00,$0.00,"$1,103.08","$6,300.00",$0.00,"$3,150.00","$4,989.60","$5,040.00",$0.00,$985.95,$0.00,"$1,002.96",$0.00
3820890,SUP,HCPCS C1713,,03820890  -  SCREW BONE 8.5MM 90MM MNOAX XIA II TITANIUM SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
3820900,SUP,HCPCS C1713,,03820900  -  SCREW BONE 9.5MM 100MM MNOAX XIA II TITANIUM SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
3820960,SUP,HCPCS C1713,,03820960  -  SCREW BONE 9.5MM 60MM MNOAX XIA II TITANIUM SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
3820970,SUP,HCPCS C1713,,03820970  -  SCREW BONE 9.5MM 70MM MNOAX XIA II TITANIUM SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
3820980,SUP,HCPCS C1713,,03820980  -  SCREW BONE 9.5MM 80MM MNOAX XIA II TITANIUM SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
3820990,SUP,HCPCS C1713,,03820990  -  SCREW BONE 9.5MM 90MM MNOAX XIA II TITANIUM SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
3821015,SUP,Custom 27803010,,03821015  -  CONNECTOR ROD 15MM CROSSLINK XIA MAC TITANIUM THORACOLUMBAR,"$5,875.00",$0.00,"$5,875.00",$0.00,"$4,192.99",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,875.00",$0.00,"$2,937.50","$4,653.00","$4,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
3821016,SUP,Custom 27803010,,03821016  -  CONNECTOR ROD 16MM MULTIAX CROSSLINK XIA MAC TITANIUM,"$5,875.00",$0.00,"$5,875.00",$0.00,"$4,192.99",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,875.00",$0.00,"$2,937.50","$4,653.00","$4,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
3821017,SUP,Custom 27803010,,03821017  -  CONNECTOR ROD 17MM MULTIAX CROSSLINK XIA MAC TITANIUM,"$5,875.00",$0.00,"$5,875.00",$0.00,"$4,192.99",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,875.00",$0.00,"$2,937.50","$4,653.00","$4,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
3821018,SUP,Custom 27803010,,03821018  -  CONNECTOR ROD 18MM MULTIAX CROSSLINK XIA MAC TITANIUM,"$5,875.00",$0.00,"$5,875.00",$0.00,"$4,192.99",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,875.00",$0.00,"$2,937.50","$4,653.00","$4,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
3821019,SUP,Custom 27803010,,03821019  -  CONNECTOR ROD 19MM MULTIAX CROSSLINK XIA MAC TITANIUM,"$5,875.00",$0.00,"$5,875.00",$0.00,"$4,192.99",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,875.00",$0.00,"$2,937.50","$4,653.00","$4,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
3821020,SUP,Custom 27803010,,03821020  -  CONNECTOR ROD 20MM MULTIAX CROSSLINK XIA MAC TITANIUM,"$5,875.00",$0.00,"$5,875.00",$0.00,"$4,192.99",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,875.00",$0.00,"$2,937.50","$4,653.00","$4,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
3821425,SUP,HCPCS C1713,,03821425  -  SCREW BONE 4.5MM 25MM XIA TI THORLMBR SPN POLYAX,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
3821430,SUP,HCPCS C1713,,03821430  -  SCREW BONE 4.5MM 30MM XIA TI THORLMBR SPN POLYAX,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
3821435,SUP,HCPCS C1713,,03821435  -  SCREW BONE 4.5MM 35MM POLYAX XIA II TITANIUM SPN,"$6,212.50",$0.00,"$6,212.50","$2,795.63","$4,433.86",$0.00,"$1,070.38",$0.00,$0.00,"$1,087.76","$6,212.50",$0.00,"$3,106.25","$4,920.30","$4,970.00",$0.00,$972.26,$0.00,$989.03,$0.00
3821440,SUP,HCPCS C1713,,03821440  -  SCREW BONE 4.5MM 40MM POLYAX XIA II TITANIUM SPN,"$6,212.50",$0.00,"$6,212.50","$2,795.63","$4,433.86",$0.00,"$1,070.38",$0.00,$0.00,"$1,087.76","$6,212.50",$0.00,"$3,106.25","$4,920.30","$4,970.00",$0.00,$972.26,$0.00,$989.03,$0.00
3821445,SUP,HCPCS C1713,,03821445  -  SCREW BONE 4.5MM 45MM FIX XIA TITANIUM SPN,"$6,212.50",$0.00,"$6,212.50","$2,795.63","$4,433.86",$0.00,"$1,070.38",$0.00,$0.00,"$1,087.76","$6,212.50",$0.00,"$3,106.25","$4,920.30","$4,970.00",$0.00,$972.26,$0.00,$989.03,$0.00
3821525,SUP,HCPCS C1713,,03821525  -  SCREW BONE 5.5MM 25MM XIA TI SPNL POLYAX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
3821530,SUP,HCPCS C1713,,03821530  -  SCREW BONE 5.5MM 30MM POLYAX XIA II TITANIUM SPN,"$6,212.50",$0.00,"$6,212.50","$2,795.63","$4,433.86",$0.00,"$1,070.38",$0.00,$0.00,"$1,087.76","$6,212.50",$0.00,"$3,106.25","$4,920.30","$4,970.00",$0.00,$972.26,$0.00,$989.03,$0.00
3821535,SUP,HCPCS C1713,,03821535  -  SCREW BONE 5.5MM 30MM XIA TI SPNL POLYAX LP,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
3821540,SUP,HCPCS C1713,,03821540  -  SCREW BONE 5.5MM 40MM POLYAX XIA II TITANIUM SPN,"$6,212.50",$0.00,"$6,212.50","$2,795.63","$4,433.86",$0.00,"$1,070.38",$0.00,$0.00,"$1,087.76","$6,212.50",$0.00,"$3,106.25","$4,920.30","$4,970.00",$0.00,$972.26,$0.00,$989.03,$0.00
3821545,SUP,HCPCS C1713,,03821545  -  SCREW BONE 5.5MM 45MM POLYAX XIA II TITANIUM SPN,"$6,212.50",$0.00,"$6,212.50","$2,795.63","$4,433.86",$0.00,"$1,070.38",$0.00,$0.00,"$1,087.76","$6,212.50",$0.00,"$3,106.25","$4,920.30","$4,970.00",$0.00,$972.26,$0.00,$989.03,$0.00
3821550,SUP,HCPCS C1713,,03821550  -  SCREW BONE 5.5MM 50MM POLYAX XIA II TITANIUM SPN,"$6,212.50",$0.00,"$6,212.50","$2,795.63","$4,433.86",$0.00,"$1,070.38",$0.00,$0.00,"$1,087.76","$6,212.50",$0.00,"$3,106.25","$4,920.30","$4,970.00",$0.00,$972.26,$0.00,$989.03,$0.00
3821555,SUP,HCPCS C1713,,03821555  -  SCREW BONE 5.5MM 55MM POLYAX XIA II TITANIUM SPN,"$6,212.50",$0.00,"$6,212.50","$2,795.63","$4,433.86",$0.00,"$1,070.38",$0.00,$0.00,"$1,087.76","$6,212.50",$0.00,"$3,106.25","$4,920.30","$4,970.00",$0.00,$972.26,$0.00,$989.03,$0.00
3821600,SUP,HCPCS C1713,,03821600  -  SCREW BONE 6.5MM 100MM POLYAX XIA II TITANIUM SPN,"$6,212.50",$0.00,"$6,212.50","$2,795.63","$4,433.86",$0.00,"$1,070.38",$0.00,$0.00,"$1,087.76","$6,212.50",$0.00,"$3,106.25","$4,920.30","$4,970.00",$0.00,$972.26,$0.00,$989.03,$0.00
3821630,SUP,HCPCS C1713,,03821630  -  SCREW BONE 6.5MM 30MM POLYAX XIA II TITANIUM SPN,"$6,212.50",$0.00,"$6,212.50","$2,795.63","$4,433.86",$0.00,"$1,070.38",$0.00,$0.00,"$1,087.76","$6,212.50",$0.00,"$3,106.25","$4,920.30","$4,970.00",$0.00,$972.26,$0.00,$989.03,$0.00
3821635,SUP,HCPCS C1713,,03821635  -  SCREW BONE 6.5MM 35MM POLYAX XIA II TITANIUM SPN,"$6,212.50",$0.00,"$6,212.50","$2,795.63","$4,433.86",$0.00,"$1,070.38",$0.00,$0.00,"$1,087.76","$6,212.50",$0.00,"$3,106.25","$4,920.30","$4,970.00",$0.00,$972.26,$0.00,$989.03,$0.00
3821640,SUP,HCPCS C1713,,03821640  -  SCREW BONE 6.5MM 40MM POLYAX XIA II TITANIUM SPN,"$6,212.50",$0.00,"$6,212.50","$2,795.63","$4,433.86",$0.00,"$1,070.38",$0.00,$0.00,"$1,087.76","$6,212.50",$0.00,"$3,106.25","$4,920.30","$4,970.00",$0.00,$972.26,$0.00,$989.03,$0.00
3821645,SUP,HCPCS C1713,,03821645  -  SCREW BONE 6.5MM 45MM POLYAX XIA II TITANIUM SPN,"$6,212.50",$0.00,"$6,212.50","$2,795.63","$4,433.86",$0.00,"$1,070.38",$0.00,$0.00,"$1,087.76","$6,212.50",$0.00,"$3,106.25","$4,920.30","$4,970.00",$0.00,$972.26,$0.00,$989.03,$0.00
3821650,SUP,HCPCS C1713,,03821650  -  SCREW BONE 6.5MM 50MM XIA TI THORLMBR SPN POLYAX,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
3821650,SUP,HCPCS C1713,,03821650  -  SCREW BONE 6.5MM 50MM XIA TI THORLMBR SPN POLYAX,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
3821655,SUP,HCPCS C1713,,03821655  -  SCREW BONE 6.5MM 55MM POLYAX XIA II TITANIUM SPN,"$6,212.50",$0.00,"$6,212.50","$2,795.63","$4,433.86",$0.00,"$1,070.38",$0.00,$0.00,"$1,087.76","$6,212.50",$0.00,"$3,106.25","$4,920.30","$4,970.00",$0.00,$972.26,$0.00,$989.03,$0.00
3821660,SUP,HCPCS C1713,,03821660  -  SCREW BONE 6.5MM 60MM POLYAX XIA II TITANIUM SPN,"$6,212.50",$0.00,"$6,212.50","$2,795.63","$4,433.86",$0.00,"$1,070.38",$0.00,$0.00,"$1,087.76","$6,212.50",$0.00,"$3,106.25","$4,920.30","$4,970.00",$0.00,$972.26,$0.00,$989.03,$0.00
3821670,SUP,HCPCS C1713,,03821670  -  SCREW BONE 6.5MM 70MM POLYAX XIA II TITANIUM SPN,"$6,212.50",$0.00,"$6,212.50","$2,795.63","$4,433.86",$0.00,"$1,070.38",$0.00,$0.00,"$1,087.76","$6,212.50",$0.00,"$3,106.25","$4,920.30","$4,970.00",$0.00,$972.26,$0.00,$989.03,$0.00
3821680,SUP,HCPCS C1713,,03821680  -  SCREW BONE 6.5MM 80MM POLYAX XIA II TITANIUM SPN,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3821690,SUP,HCPCS C1713,,03821690  -  SCREW BONE 6.5MM 90MM POLYAX XIA II TITANIUM SPN,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3821700,SUP,HCPCS C1713,,03821700  -  SCREW BONE 7.5MM 100MM POLYAX XIA II TITANIUM SPN,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3821730,SUP,HCPCS C1713,,03821730  -  SCREW BONE 7.5MM 30MM POLYAX XIA SPN,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3821735,SUP,HCPCS C1713,,03821735  -  SCREW BONE 7.5MM 35MM POLYAX XIA II TITANIUM SPN,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3821740,SUP,HCPCS C1713,,03821740  -  SCREW BONE 7.5MM 40MM POLYAX XIA II TITANIUM SPN,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3821745,SUP,HCPCS C1713,,03821745  -  SCREW BONE 7.5MM 45MM POLYAX XIA II TITANIUM SPN,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3821750,SUP,HCPCS C1713,,03821750  -  SCREW BONE 7.5MM 50MM POLYAX XIA II TITANIUM SPN,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3821755,SUP,HCPCS C1713,,03821755  -  SCREW BONE 7.5MM 55MM POLYAX XIA II TITANIUM SPN,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3821760,SUP,HCPCS C1713,,03821760  -  SCREW BONE 7.5MM 60MM POLYAX XIA II TITANIUM SPN,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3821770,SUP,HCPCS C1713,,03821770  -  SCREW BONE 7.5MM 70MM POLYAX XIA II SPN,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3821780,SUP,HCPCS C1713,,03821780  -  SCREW BONE 7.5MM 80MM POLYAX XIA II TITANIUM SPN,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3821790,SUP,HCPCS C1713,,03821790  -  SCREW BONE 7.5MM 90MM POLYAX XIA II TITANIUM SPN,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3822601,SUP,Custom 27803010,,03822601  -  ROD SPINAL 6MM 600MM XIA VITALLIUM,"$2,356.58",$0.00,"$2,356.58",$0.00,"$1,681.89",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,356.58",$0.00,"$1,178.29","$1,866.41","$1,885.26",$0.00,$0.00,$0.00,$0.00,$0.00
3827201,SUP,Custom 27803010,,03827201  -  HOOK SPINAL SMALL NARROW BLADE LMNR,"$5,287.50",$0.00,"$5,287.50",$0.00,"$3,773.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,287.50",$0.00,"$2,643.75","$4,187.70","$4,230.00",$0.00,$0.00,$0.00,$0.00,$0.00
3827202,SUP,Custom 27803010,,03827202  -  HOOK SPINAL LARGE STANDARD BLADE LMNR,"$5,287.50",$0.00,"$5,287.50",$0.00,"$3,773.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,287.50",$0.00,"$2,643.75","$4,187.70","$4,230.00",$0.00,$0.00,$0.00,$0.00,$0.00
3827203,SUP,Custom 27803010,,03827203  -  HOOK SPINAL LARGE NARROW BLADE LMNR,"$5,287.50",$0.00,"$5,287.50",$0.00,"$3,773.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,287.50",$0.00,"$2,643.75","$4,187.70","$4,230.00",$0.00,$0.00,$0.00,$0.00,$0.00
3827211,SUP,Custom 27803010,,03827211  -  HOOK SPINAL STANDARD BLADE LMNR,"$5,287.50",$0.00,"$5,287.50",$0.00,"$3,773.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,287.50",$0.00,"$2,643.75","$4,187.70","$4,230.00",$0.00,$0.00,$0.00,$0.00,$0.00
3827220,SUP,Custom 27803010,,03827220  -  HOOK SPINAL SMALL LONG ARM PEDICLE,"$5,287.50",$0.00,"$5,287.50",$0.00,"$3,773.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,287.50",$0.00,"$2,643.75","$4,187.70","$4,230.00",$0.00,$0.00,$0.00,$0.00,$0.00
3828425,SUP,HCPCS C1713,,03828425  -  SCREW BONE LONG ARM 4.5MM 25MM MNOAX XIA TITANIUM SPN,"$6,212.50",$0.00,"$6,212.50","$2,795.63","$4,433.86",$0.00,"$1,070.38",$0.00,$0.00,"$1,087.76","$6,212.50",$0.00,"$3,106.25","$4,920.30","$4,970.00",$0.00,$972.26,$0.00,$989.03,$0.00
3828430,SUP,HCPCS C1713,,03828430  -  SCREW BONE LONG ARM 4.5MM 30MM MNOAX XIA TITANIUM SPN,"$6,212.50",$0.00,"$6,212.50","$2,795.63","$4,433.86",$0.00,"$1,070.38",$0.00,$0.00,"$1,087.76","$6,212.50",$0.00,"$3,106.25","$4,920.30","$4,970.00",$0.00,$972.26,$0.00,$989.03,$0.00
3828435,SUP,HCPCS C1713,,03828435  -  SCREW BONE LONG ARM 4.5MM 35MM MNOAX XIA TITANIUM SPN,"$6,212.50",$0.00,"$6,212.50","$2,795.63","$4,433.86",$0.00,"$1,070.38",$0.00,$0.00,"$1,087.76","$6,212.50",$0.00,"$3,106.25","$4,920.30","$4,970.00",$0.00,$972.26,$0.00,$989.03,$0.00
3828440,SUP,HCPCS C1713,,03828440  -  SCREW BONE LONG ARM 4.5MM 40MM MNOAX XIA TITANIUM SPN,"$6,212.50",$0.00,"$6,212.50","$2,795.63","$4,433.86",$0.00,"$1,070.38",$0.00,$0.00,"$1,087.76","$6,212.50",$0.00,"$3,106.25","$4,920.30","$4,970.00",$0.00,$972.26,$0.00,$989.03,$0.00
3828445,SUP,HCPCS C1713,,03828445  -  SCREW BONE LONG ARM 4.5MM 45MM MNOAX XIA TITANIUM SPN,"$6,212.50",$0.00,"$6,212.50","$2,795.63","$4,433.86",$0.00,"$1,070.38",$0.00,$0.00,"$1,087.76","$6,212.50",$0.00,"$3,106.25","$4,920.30","$4,970.00",$0.00,$972.26,$0.00,$989.03,$0.00
3828530,SUP,HCPCS C1713,,03828530  -  SCREW BONE 5.5MM 30MM MNOAX LONG ARM XIA TITANIUM SPN,"$6,212.50",$0.00,"$6,212.50","$2,795.63","$4,433.86",$0.00,"$1,070.38",$0.00,$0.00,"$1,087.76","$6,212.50",$0.00,"$3,106.25","$4,920.30","$4,970.00",$0.00,$972.26,$0.00,$989.03,$0.00
3828535,SUP,HCPCS C1713,,03828535  -  SCREW BONE 5.5MM 35MM MNOAX LONG ARM XIA TITANIUM SPN,"$6,212.50",$0.00,"$6,212.50","$2,795.63","$4,433.86",$0.00,"$1,070.38",$0.00,$0.00,"$1,087.76","$6,212.50",$0.00,"$3,106.25","$4,920.30","$4,970.00",$0.00,$972.26,$0.00,$989.03,$0.00
3828540,SUP,HCPCS C1713,,03828540  -  SCREW BONE 5.5MM 40MM MNOAX LONG ARM XIA TITANIUM SPN,"$6,212.50",$0.00,"$6,212.50","$2,795.63","$4,433.86",$0.00,"$1,070.38",$0.00,$0.00,"$1,087.76","$6,212.50",$0.00,"$3,106.25","$4,920.30","$4,970.00",$0.00,$972.26,$0.00,$989.03,$0.00
3828545,SUP,HCPCS C1713,,03828545  -  SCREW BONE 5.5MM 45MM MNOAX LONG ARM XIA TITANIUM SPN,"$6,212.50",$0.00,"$6,212.50","$2,795.63","$4,433.86",$0.00,"$1,070.38",$0.00,$0.00,"$1,087.76","$6,212.50",$0.00,"$3,106.25","$4,920.30","$4,970.00",$0.00,$972.26,$0.00,$989.03,$0.00
3828550,SUP,HCPCS C1713,,03828550  -  SCREW BONE LONG ARM 5.5MM 50MM MNOAX XIA TITANIUM SPN,"$6,212.50",$0.00,"$6,212.50","$2,795.63","$4,433.86",$0.00,"$1,070.38",$0.00,$0.00,"$1,087.76","$6,212.50",$0.00,"$3,106.25","$4,920.30","$4,970.00",$0.00,$972.26,$0.00,$989.03,$0.00
3828555,SUP,HCPCS C1713,,03828555  -  SCREW BONE LONG ARM 5.5MM 55MM MNOAX XIA TITANIUM SPN,"$6,212.50",$0.00,"$6,212.50","$2,795.63","$4,433.86",$0.00,"$1,070.38",$0.00,$0.00,"$1,087.76","$6,212.50",$0.00,"$3,106.25","$4,920.30","$4,970.00",$0.00,$972.26,$0.00,$989.03,$0.00
3828630,SUP,HCPCS C1713,,03828630  -  SCREW BONE 6.5MM 30MM MNOAX LONG ARM XIA TITANIUM SPN,"$6,212.50",$0.00,"$6,212.50","$2,795.63","$4,433.86",$0.00,"$1,070.38",$0.00,$0.00,"$1,087.76","$6,212.50",$0.00,"$3,106.25","$4,920.30","$4,970.00",$0.00,$972.26,$0.00,$989.03,$0.00
3828635,SUP,HCPCS C1713,,03828635  -  SCREW BONE 6.5MM 35MM MNOAX LONG ARM XIA TITANIUM SPN,"$6,212.50",$0.00,"$6,212.50","$2,795.63","$4,433.86",$0.00,"$1,070.38",$0.00,$0.00,"$1,087.76","$6,212.50",$0.00,"$3,106.25","$4,920.30","$4,970.00",$0.00,$972.26,$0.00,$989.03,$0.00
3828640,SUP,HCPCS C1713,,03828640  -  SCREW BONE 6.5MM 40MM MNOAX LONG ARM XIA TITANIUM SPN,"$6,212.50",$0.00,"$6,212.50","$2,795.63","$4,433.86",$0.00,"$1,070.38",$0.00,$0.00,"$1,087.76","$6,212.50",$0.00,"$3,106.25","$4,920.30","$4,970.00",$0.00,$972.26,$0.00,$989.03,$0.00
3828645,SUP,HCPCS C1713,,03828645  -  SCREW BONE 6.5MM 45MM MNOAX LONG ARM XIA TITANIUM SPN,"$6,212.50",$0.00,"$6,212.50","$2,795.63","$4,433.86",$0.00,"$1,070.38",$0.00,$0.00,"$1,087.76","$6,212.50",$0.00,"$3,106.25","$4,920.30","$4,970.00",$0.00,$972.26,$0.00,$989.03,$0.00
3828650,SUP,HCPCS C1713,,03828650  -  SCREW BONE 6.5MM 50MM MNOAX LONG ARM XIA TITANIUM SPN,"$6,212.50",$0.00,"$6,212.50","$2,795.63","$4,433.86",$0.00,"$1,070.38",$0.00,$0.00,"$1,087.76","$6,212.50",$0.00,"$3,106.25","$4,920.30","$4,970.00",$0.00,$972.26,$0.00,$989.03,$0.00
3828655,SUP,HCPCS C1713,,03828655  -  SCREW BONE 6.5MM 55MM MNOAX LONG ARM XIA TITANIUM SPN,"$6,212.50",$0.00,"$6,212.50","$2,795.63","$4,433.86",$0.00,"$1,070.38",$0.00,$0.00,"$1,087.76","$6,212.50",$0.00,"$3,106.25","$4,920.30","$4,970.00",$0.00,$972.26,$0.00,$989.03,$0.00
3828660,SUP,HCPCS C1713,,03828660  -  SCREW BONE LONG ARM 6.5MM 60MM MNOAX XIA TITANIUM SPN,"$6,212.50",$0.00,"$6,212.50","$2,795.63","$4,433.86",$0.00,"$1,070.38",$0.00,$0.00,"$1,087.76","$6,212.50",$0.00,"$3,106.25","$4,920.30","$4,970.00",$0.00,$972.26,$0.00,$989.03,$0.00
3828730,SUP,HCPCS C1713,,03828730  -  SCREW BONE 7.5MM 30MM MNOAX LONG ARM XIA TITANIUM SPN,"$6,212.50",$0.00,"$6,212.50","$2,795.63","$4,433.86",$0.00,"$1,070.38",$0.00,$0.00,"$1,087.76","$6,212.50",$0.00,"$3,106.25","$4,920.30","$4,970.00",$0.00,$972.26,$0.00,$989.03,$0.00
3828735,SUP,HCPCS C1713,,03828735  -  SCREW BONE 7.5MM 35MM MNOAX LONG ARM XIA TITANIUM SPN,"$6,212.50",$0.00,"$6,212.50","$2,795.63","$4,433.86",$0.00,"$1,070.38",$0.00,$0.00,"$1,087.76","$6,212.50",$0.00,"$3,106.25","$4,920.30","$4,970.00",$0.00,$972.26,$0.00,$989.03,$0.00
3828740,SUP,HCPCS C1713,,03828740  -  SCREW BONE 7.5MM 40MM MNOAX LONG ARM XIA TITANIUM SPN,"$6,212.50",$0.00,"$6,212.50","$2,795.63","$4,433.86",$0.00,"$1,070.38",$0.00,$0.00,"$1,087.76","$6,212.50",$0.00,"$3,106.25","$4,920.30","$4,970.00",$0.00,$972.26,$0.00,$989.03,$0.00
3828745,SUP,HCPCS C1713,,03828745  -  SCREW BONE 7.5MM 45MM MNOAX REDX XIA TITANIUM SPN,"$6,212.50",$0.00,"$6,212.50","$2,795.63","$4,433.86",$0.00,"$1,070.38",$0.00,$0.00,"$1,087.76","$6,212.50",$0.00,"$3,106.25","$4,920.30","$4,970.00",$0.00,$972.26,$0.00,$989.03,$0.00
3828750,SUP,HCPCS C1713,,03828750  -  SCREW BONE 7.5MM 50MM MULTIAX LONG ARM XIA TITANIUM SPN,"$6,212.50",$0.00,"$6,212.50","$2,795.63","$4,433.86",$0.00,"$1,070.38",$0.00,$0.00,"$1,087.76","$6,212.50",$0.00,"$3,106.25","$4,920.30","$4,970.00",$0.00,$972.26,$0.00,$989.03,$0.00
3828755,SUP,HCPCS C1713,,03828755  -  SCREW BONE LONG ARM 7.5MM 55MM MNOAX XIA TITANIUM SPN,"$6,212.50",$0.00,"$6,212.50","$2,795.63","$4,433.86",$0.00,"$1,070.38",$0.00,$0.00,"$1,087.76","$6,212.50",$0.00,"$3,106.25","$4,920.30","$4,970.00",$0.00,$972.26,$0.00,$989.03,$0.00
3828760,SUP,HCPCS C1713,,03828760  -  SCREW BONE LONG ARM 7.5MM 60MM MNOAX XIA TITANIUM SPN,"$6,212.50",$0.00,"$6,212.50","$2,795.63","$4,433.86",$0.00,"$1,070.38",$0.00,$0.00,"$1,087.76","$6,212.50",$0.00,"$3,106.25","$4,920.30","$4,970.00",$0.00,$972.26,$0.00,$989.03,$0.00
3829425,SUP,HCPCS C1713,,03829425  -  SCREW BONE LONG ARM 4.5MM 25MM POLYAX XIA TITANIUM SPN,"$4,750.00",$0.00,"$4,750.00","$2,137.50","$3,390.08",$0.00,$818.40,$0.00,$0.00,$831.69,"$4,750.00",$0.00,"$2,375.00","$3,762.00","$3,800.00",$0.00,$743.38,$0.00,$756.20,$0.00
3829430,SUP,HCPCS C1713,,03829430  -  SCREW BONE LONG ARM 4.5MM 30MM POLYAX XIA TITANIUM SPN,"$4,750.00",$0.00,"$4,750.00","$2,137.50","$3,390.08",$0.00,$818.40,$0.00,$0.00,$831.69,"$4,750.00",$0.00,"$2,375.00","$3,762.00","$3,800.00",$0.00,$743.38,$0.00,$756.20,$0.00
3829435,SUP,HCPCS C1713,,03829435  -  SCREW BONE LONG ARM 4.5MM 35MM POLYAX XIA TITANIUM SPN,"$4,750.00",$0.00,"$4,750.00","$2,137.50","$3,390.08",$0.00,$818.40,$0.00,$0.00,$831.69,"$4,750.00",$0.00,"$2,375.00","$3,762.00","$3,800.00",$0.00,$743.38,$0.00,$756.20,$0.00
3829440,SUP,HCPCS C1713,,03829440  -  SCREW BONE LONG ARM 4.5MM 40MM POLYAX XIA TITANIUM SPN,"$4,750.00",$0.00,"$4,750.00","$2,137.50","$3,390.08",$0.00,$818.40,$0.00,$0.00,$831.69,"$4,750.00",$0.00,"$2,375.00","$3,762.00","$3,800.00",$0.00,$743.38,$0.00,$756.20,$0.00
3829445,SUP,HCPCS C1713,,03829445  -  SCREW BONE LONG ARM 4.5MM 45MM POLYAX XIA TITANIUM SPN,"$1,087.50",$0.00,"$1,087.50",$489.38,$776.15,$0.00,$187.37,$0.00,$0.00,$190.41,"$1,087.50",$0.00,$543.75,$861.30,$870.00,$0.00,$170.19,$0.00,$173.13,$0.00
3829530,SUP,HCPCS C1713,,03829530  -  SCREW BONE 5.5MM 30MM POLYAX LONG ARM XIA TITANIUM SPN,"$1,087.50",$0.00,"$1,087.50",$489.38,$776.15,$0.00,$187.37,$0.00,$0.00,$190.41,"$1,087.50",$0.00,$543.75,$861.30,$870.00,$0.00,$170.19,$0.00,$173.13,$0.00
3829535,SUP,HCPCS C1713,,03829535  -  SCREW BONE 5.5MM 35MM POLYAX LONG ARM XIA TITANIUM SPN,$825.00,$0.00,$825.00,$371.25,$588.80,$0.00,$142.14,$0.00,$0.00,$144.45,$825.00,$0.00,$412.50,$653.40,$660.00,$0.00,$129.11,$0.00,$131.34,$0.00
3829540,SUP,HCPCS C1713,,03829540  -  SCREW BONE 5.5MM 40MM POLYAX LONG ARM XIA TITANIUM SPN,"$6,675.00",$0.00,"$6,675.00","$3,003.75","$4,763.95",$0.00,"$1,150.07",$0.00,$0.00,"$1,168.74","$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,"$1,044.64",$0.00,"$1,062.66",$0.00
3829550,SUP,HCPCS C1713,,03829550  -  SCREW BONE 5.5MM 50MM POLYAX LONG ARM XIA TITANIUM SPN,"$6,675.00",$0.00,"$6,675.00","$3,003.75","$4,763.95",$0.00,"$1,150.07",$0.00,$0.00,"$1,168.74","$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,"$1,044.64",$0.00,"$1,062.66",$0.00
3829555,SUP,HCPCS C1713,,03829555  -  SCREW BONE LONG ARM 5.5MM 55MM POLYAX XIA TITANIUM SPN,"$6,675.00",$0.00,"$6,675.00","$3,003.75","$4,763.95",$0.00,"$1,150.07",$0.00,$0.00,"$1,168.74","$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,"$1,044.64",$0.00,"$1,062.66",$0.00
3829630,SUP,HCPCS C1713,,03829630  -  SCREW BONE 6.5MM 30MM POLYAX LONG ARM XIA TITANIUM SPN,"$6,675.00",$0.00,"$6,675.00","$3,003.75","$4,763.95",$0.00,"$1,150.07",$0.00,$0.00,"$1,168.74","$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,"$1,044.64",$0.00,"$1,062.66",$0.00
3829635,SUP,HCPCS C1713,,03829635  -  SCREW BONE 6.5MM 35MM POLYAX LONG ARM XIA TITANIUM SPN,"$6,675.00",$0.00,"$6,675.00","$3,003.75","$4,763.95",$0.00,"$1,150.07",$0.00,$0.00,"$1,168.74","$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,"$1,044.64",$0.00,"$1,062.66",$0.00
3829640,SUP,HCPCS C1713,,03829640  -  SCREW BONE 6.5MM 40MM POLYAX LONG ARM XIA TITANIUM SPN,"$6,675.00",$0.00,"$6,675.00","$3,003.75","$4,763.95",$0.00,"$1,150.07",$0.00,$0.00,"$1,168.74","$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,"$1,044.64",$0.00,"$1,062.66",$0.00
3829645,SUP,HCPCS C1713,,03829645  -  SCREW BONE 6.5MM 45MM POLYAX LONG ARM XIA TITANIUM SPN,"$6,675.00",$0.00,"$6,675.00","$3,003.75","$4,763.95",$0.00,"$1,150.07",$0.00,$0.00,"$1,168.74","$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,"$1,044.64",$0.00,"$1,062.66",$0.00
3829650,SUP,HCPCS C1713,,03829650  -  SCREW BONE 6.5MM 50MM POLYAX LONG ARM XIA TITANIUM SPN,"$6,675.00",$0.00,"$6,675.00","$3,003.75","$4,763.95",$0.00,"$1,150.07",$0.00,$0.00,"$1,168.74","$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,"$1,044.64",$0.00,"$1,062.66",$0.00
3829655,SUP,HCPCS C1713,,03829655  -  SCREW BONE 6.5MM 55MM POLYAX LONG ARM XIA TITANIUM SPN,"$6,675.00",$0.00,"$6,675.00","$3,003.75","$4,763.95",$0.00,"$1,150.07",$0.00,$0.00,"$1,168.74","$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,"$1,044.64",$0.00,"$1,062.66",$0.00
3829660,SUP,HCPCS C1713,,03829660  -  SCREW BONE LONG ARM 6.5MM 60MM POLYAX XIA TITANIUM SPN,"$6,675.00",$0.00,"$6,675.00","$3,003.75","$4,763.95",$0.00,"$1,150.07",$0.00,$0.00,"$1,168.74","$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,"$1,044.64",$0.00,"$1,062.66",$0.00
3829730,SUP,HCPCS C1713,,03829730  -  SCREW BONE 7.5MM 30MM POLYAX LONG ARM XIA TITANIUM SPN,"$6,675.00",$0.00,"$6,675.00","$3,003.75","$4,763.95",$0.00,"$1,150.07",$0.00,$0.00,"$1,168.74","$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,"$1,044.64",$0.00,"$1,062.66",$0.00
3829735,SUP,HCPCS C1713,,03829735  -  SCREW BONE 7.5MM 35MM POLYAX LONG ARM XIA TITANIUM SPN,"$6,675.00",$0.00,"$6,675.00","$3,003.75","$4,763.95",$0.00,"$1,150.07",$0.00,$0.00,"$1,168.74","$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,"$1,044.64",$0.00,"$1,062.66",$0.00
3829740,SUP,HCPCS C1713,,03829740  -  SCREW BONE 7.5MM 40MM POLYAX LONG ARM XIA TITANIUM SPN,"$6,675.00",$0.00,"$6,675.00","$3,003.75","$4,763.95",$0.00,"$1,150.07",$0.00,$0.00,"$1,168.74","$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,"$1,044.64",$0.00,"$1,062.66",$0.00
3829745,SUP,HCPCS C1713,,03829745  -  SCREW BONE 7.5MM 45MM POLYAX LONG ARM XIA TITANIUM SPN,"$6,675.00",$0.00,"$6,675.00","$3,003.75","$4,763.95",$0.00,"$1,150.07",$0.00,$0.00,"$1,168.74","$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,"$1,044.64",$0.00,"$1,062.66",$0.00
3829750,SUP,HCPCS C1713,,03829750  -  SCREW BONE 7.5MM 50MM POLYAX LONG ARM XIA TITANIUM SPN,"$6,675.00",$0.00,"$6,675.00","$3,003.75","$4,763.95",$0.00,"$1,150.07",$0.00,$0.00,"$1,168.74","$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,"$1,044.64",$0.00,"$1,062.66",$0.00
3829755,SUP,HCPCS C1713,,03829755  -  SCREW BONE LONG ARM 7.5MM 55MM POLYAX XIA TITANIUM SPN,"$6,675.00",$0.00,"$6,675.00","$3,003.75","$4,763.95",$0.00,"$1,150.07",$0.00,$0.00,"$1,168.74","$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,"$1,044.64",$0.00,"$1,062.66",$0.00
3829760,SUP,HCPCS C1713,,03829760  -  SCREW BONE LONG ARM 7.5MM 60MM POLYAX XIA TITANIUM SPN,"$6,675.00",$0.00,"$6,675.00","$3,003.75","$4,763.95",$0.00,"$1,150.07",$0.00,$0.00,"$1,168.74","$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,"$1,044.64",$0.00,"$1,062.66",$0.00
3992206,SUP,HCPCS C1713,,3992206  -  SPACER SPNL 0D 27MMX6MM STRL LF CPSTN CNTRL PEEK INTRBD FS,"$5,000.00",$0.00,"$5,000.00","$2,250.00","$3,568.50",$0.00,$861.48,$0.00,$0.00,$875.46,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$782.50,$0.00,$796.00,$0.00
3992207,SUP,HCPCS C1713,,3992207  -  SPACER SPNL 22MMX7MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS,"$5,000.00",$0.00,"$5,000.00","$2,250.00","$3,568.50",$0.00,$861.48,$0.00,$0.00,$875.46,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$782.50,$0.00,$796.00,$0.00
3992208,SUP,HCPCS C1713,,3992208  -  SPACER SPNL 22MMX8MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS,"$5,000.00",$0.00,"$5,000.00","$2,250.00","$3,568.50",$0.00,$861.48,$0.00,$0.00,$875.46,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$782.50,$0.00,$796.00,$0.00
3992209,SUP,HCPCS C1713,,3992209  -  SPACER SPNL 22MMX9MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS,"$5,000.00",$0.00,"$5,000.00","$2,250.00","$3,568.50",$0.00,$861.48,$0.00,$0.00,$875.46,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$782.50,$0.00,$796.00,$0.00
3992210,SUP,HCPCS C1713,,3992210  -  SPACER SPNL 22MMX10MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS,"$5,000.00",$0.00,"$5,000.00","$2,250.00","$3,568.50",$0.00,$861.48,$0.00,$0.00,$875.46,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$782.50,$0.00,$796.00,$0.00
3992211,SUP,HCPCS C1713,,3992211  -  SPACER SPNL 22MMX11MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS,"$5,000.00",$0.00,"$5,000.00","$2,250.00","$3,568.50",$0.00,$861.48,$0.00,$0.00,$875.46,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$782.50,$0.00,$796.00,$0.00
3992212,SUP,HCPCS C1713,,3992212  -  SPACER SPNL 22MMX12MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS,"$5,000.00",$0.00,"$5,000.00","$2,250.00","$3,568.50",$0.00,$861.48,$0.00,$0.00,$875.46,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$782.50,$0.00,$796.00,$0.00
3992213,SUP,HCPCS C1713,,3992213  -  SPACER SPNL 22MMX13MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS,"$5,000.00",$0.00,"$5,000.00","$2,250.00","$3,568.50",$0.00,$861.48,$0.00,$0.00,$875.46,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$782.50,$0.00,$796.00,$0.00
3992214,SUP,HCPCS C1713,,3992214  -  SPACER SPNL 22MMX14MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS,"$5,000.00",$0.00,"$5,000.00","$2,250.00","$3,568.50",$0.00,$861.48,$0.00,$0.00,$875.46,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$782.50,$0.00,$796.00,$0.00
3992215,SUP,HCPCS C1713,,3992215  -  SPACER SPNL 22MMX15MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS,"$5,000.00",$0.00,"$5,000.00","$2,250.00","$3,568.50",$0.00,$861.48,$0.00,$0.00,$875.46,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$782.50,$0.00,$796.00,$0.00
3992216,SUP,HCPCS C1713,,3992216  -  SPACER SPNL 22MMX16MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS,"$5,000.00",$0.00,"$5,000.00","$2,250.00","$3,568.50",$0.00,$861.48,$0.00,$0.00,$875.46,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$782.50,$0.00,$796.00,$0.00
3992606,SUP,HCPCS C1713,,3992606  -  SPACER SPNL 26MMX6MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3992607,SUP,HCPCS C1713,,3992607  -  SPACER SPNL 26MMX7MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3992608,SUP,HCPCS C1713,,3992608  -  SPACER SPNL 26MMX8MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3992609,SUP,HCPCS C1713,,3992609  -  SPACER SPNL 26MMX9MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3992610,SUP,HCPCS C1713,,3992610  -  SPACER SPNL 26MMX10MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3992611,SUP,HCPCS C1713,,3992611  -  SPACER SPNL 26MMX11MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3992612,SUP,HCPCS C1713,,3992612  -  SPACER SPNL 26MMX12MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3992613,SUP,HCPCS C1713,,3992613  -  SPACER SPNL 26MMX13MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3992614,SUP,HCPCS C1713,,3992614  -  SPACER SPNL 26X14MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3992615,SUP,HCPCS C1713,,3992615  -  SPACER SPNL 26MMX15MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3992616,SUP,HCPCS C1713,,3992616  -  SPACER SPNL 26MMX16MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3993207,SUP,HCPCS C1713,,3993207  -  SPACER SPNL 32MMX7MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3993208,SUP,HCPCS C1713,,3993208  -  SPACER SPNL 32MMX8MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3993209,SUP,HCPCS C1713,,3993209  -  SPACER SPNL 32MMX9MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3993210,SUP,HCPCS C1713,,3993210  -  SPACER SPNL 32MMX10MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3993211,SUP,HCPCS C1713,,3993211  -  SPACER SPNL 32MMX11MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3993212,SUP,HCPCS C1713,,3993212  -  SPACER SPNL 32MMX12MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3993213,SUP,HCPCS C1713,,3993213  -  SPACER SPNL 32MMX13MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3993214,SUP,HCPCS C1713,,3993214  -  SPACER SPNL 32MMX14MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3993215,SUP,HCPCS C1713,,3993215  -  SPACER SPNL 32MMX15MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3993216,SUP,HCPCS C1713,,3993216  -  SPACER SPNL 32MMX16MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
3993616,SUP,HCPCS C1713,,3993616  -  SPACER SPNL 36MMX16MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
4001122,SUP,HCPCS C1713,,4001122  -  SPACER SPNL 6D 22MMX11MM STRL LF CPSTN CNTRL PEEK INTRBD FS,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
4001227,SUP,HCPCS C1713,,4001227  -  SPACER SPNL 6D 27MMX12MM STRL LF CPSTN CNTRL PEEK INTRBD FS,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
4001322,SUP,HCPCS C1713,,4001322  -  SPACER SPNL 6D 22MMX13MM STRL LF CPSTN CNTRL PEEK INTRBD FS,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
4011022,SUP,HCPCS C1713,,4011022  -  SPACER SPNL 12D 22MMX10MM STRL LF CPSTN CNTRL PEEK INTRBD FS,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
4011222,SUP,HCPCS C1713,,4011222  -  SPACER SPNL 12D 22MMX12MM CPSTN CNTRL,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
4025900,SUP,Custom 27203010,,VIAL ANALY CODA POLYPRO 5 REAGENT 23ML,$25.75,$0.00,$25.75,$0.00,$18.38,$0.00,$0.00,$0.00,$0.00,$0.00,$25.75,$0.00,$12.88,$20.39,$20.60,$0.00,$0.00,$0.00,$0.00,$0.00
4098545,SUP,HCPCS C1713,,4098545  -  SCREW BONE CYLINDER 8.5MM 45MM OSS SPN,"$1,213.13",$0.00,"$1,213.13",$545.91,$865.81,$0.00,$209.02,$0.00,$0.00,$212.41,"$1,213.13",$0.00,$606.56,$960.80,$970.50,$0.00,$189.85,$0.00,$193.13,$0.00
4098550,SUP,HCPCS C1713,,4098550  -  SCREW BONE CYLINDER 8.5MM 50MM OSS SPN,"$1,213.13",$0.00,"$1,213.13",$545.91,$865.81,$0.00,$209.02,$0.00,$0.00,$212.41,"$1,213.13",$0.00,$606.56,$960.80,$970.50,$0.00,$189.85,$0.00,$193.13,$0.00
4105535,SUP,HCPCS C1713,,4105535  -  SCREW BONE 5.5MM 35MM OSS SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
4105540,SUP,HCPCS C1713,,4105540  -  SCREW BONE 5.5MM 40MM OSS SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
4105545,SUP,HCPCS C1713,,4105545  -  SCREW BONE 5.5MM 45MM OSS SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
4106535,SUP,HCPCS C1713,,4106535  -  SCREW BONE 6.5MM 35MM OSS SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
4106540,SUP,HCPCS C1713,,4106540  -  SCREW BONE 6.5MM 40MM OSS SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
4106550,SUP,HCPCS C1713,,4106550  -  SCREW BONE 6.5MM 50MM OSS SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
4106555,SUP,HCPCS C1713,,4106555  -  SCREW BONE 6.5MM 55MM OSS SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
4106560,SUP,HCPCS C1713,,4106560  -  SCREW BONE 6.5MM 60MM OSS SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
4107017,SUP,Custom 27803010,,4107017  -  CONNECTOR ROD 17MM MULTIAX CROSS XIA CROSSLINK TITANIUM,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
4107020,SUP,Custom 27803010,,4107020  -  CONNECTOR ROD 20MM MULTIAX CROSS XIA CROSSLINK TITANIUM,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
4107023,SUP,Custom 27803010,,4107023  -  CONNECTOR ROD 23MM CROSSLINK XIA TITANIUM THORACOLUMBAR SPN,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
4107026,SUP,Custom 27803010,,4107026  -  CONNECTOR ROD 26MM CROSSLINK XIA TITANIUM THORACOLUMBAR SPN,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
4107029,SUP,Custom 27803010,,4107029  -  CONNECTOR ROD 29-31MM MULTIAX CROSS XIA SPN,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
4107031,SUP,Custom 27803010,,4107031  -  CONNECTOR ROD 31-34MM MULTIAX MAC CROSSLINK TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
4107035,SUP,Custom 27803010,,4107035  -  CONNECTOR ROD 35MM CROSSLINK XIA TITANIUM THORACOLUMBAR SPN,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
4107038,SUP,Custom 27803010,,4107038  -  CONNECTOR ROD 38-43MM MULTIAX CROSSLINK XIA TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
4107042,SUP,Custom 27803010,,4107042  -  CONNECTOR ROD 42-51MM MULTIAX CROSSLINK MAC SPN,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
4107050,SUP,Custom 27803010,,4107050  -  CONNECTOR ROD 50-67MM MULTIAX CROSSLINK XIA TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
4107066,SUP,Custom 27803010,,4107066  -  CONNECTOR ROD 66-99MM MULTIAX CROSS XIA MAC TITANIUM,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
4107535,SUP,HCPCS C1713,,4107535  -  SCREW BONE 7.5MM 35MM OSS SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
4107545,SUP,HCPCS C1713,,4107545  -  SCREW BONE 7.5MM 45MM OSS SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
4107555,SUP,HCPCS C1713,,4107555  -  SCREW BONE 7.5MM 55MM OSS SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
4107560,SUP,HCPCS C1713,,4107560  -  SCREW BONE 7.5MM 60MM OSS SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
4108535,SUP,HCPCS C1713,,4108535  -  SCREW BONE 8.5MM 35MM OSS SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
4108540,SUP,HCPCS C1713,,4108540  -  SCREW BONE 8.5MM 40MM OSS SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
4108560,SUP,HCPCS C1713,,4108560  -  SCREW BONE 8.5MM 60MM OSS SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
4109040,SUP,HCPCS C1713,,4109040  -  SCREW BONE 9MM 40MM OSS SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
4109045,SUP,HCPCS C1713,,4109045  -  SCREW BONE 9MM 45MM OSS SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
4110101,SUP,Custom 27803010,,4110101  -  HOOK SPINAL OSS LMNR THORACIC,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
4110102,SUP,Custom 27803010,,4110102  -  HOOK SPINAL LONG OSS LMNR THORACIC,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
4110113,SUP,Custom 27803010,,4110113  -  HOOK SPINAL SMALL OSS LMNR THORACIC,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
4110118,SUP,Custom 27803010,,4110118  -  HOOK SPINAL LARGE OSS LMNR THORACIC,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
4110201,SUP,Custom 27803010,,4110201  -  HOOK SPINAL CENTERED OSS TITANIUM LMNR LUMBAR,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
4110202,SUP,Custom 27803010,,4110202  -  HOOK SPINAL LARGE OSS LMNR LUMBAR,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
4110203,SUP,Custom 27803010,,4110203  -  HOOK SPINAL OSS RIGHT LMNR LUMBAR,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
4110204,SUP,Custom 27803010,,4110204  -  HOOK SPINAL CENTERING OSS LEFT LMNR,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
4110223,SUP,Custom 27803010,,4110223  -  HOOK SPINAL OSS RIGHT INFERIOR LMNR LUMBAR,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
4110224,SUP,Custom 27803010,,4110224  -  HOOK SPINAL OSS LEFT INFERIOR LMNR,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
4110231,SUP,Custom 27803010,,4110231  -  HOOK SPINAL SMALL LOWER RIGHT OFFST OSS,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
4110232,SUP,Custom 27803010,,4110232  -  HOOK SPINAL SMALL LOWER LEFT OFFST OSS,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
4110302,SUP,Custom 27803010,,4110302  -  HOOK SPINAL LONG BLADE OSS TITANIUM PEDICLE,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
4123010,SUP,Custom 27803010,,4123010  -  RING SPNL OSS,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
4123021,SUP,HCPCS C1713,,4123021  -  CAP SCR SPNL OSS,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
4125303,SUP,Custom 27803010,,4125303  -  RING SPNL OSS XL,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
4195103,SUP,HCPCS C1898,,4195103  -  LEAD PACING 5FR 103CM UNIPOLAR DEPLOYABLE LOBES FIX IS-1,"$3,562.50",$0.00,"$3,562.50","$1,603.13","$2,542.56",$0.00,$613.80,$0.00,$0.00,$623.77,"$3,562.50",$0.00,"$1,781.25","$2,821.50","$2,850.00",$0.00,$557.53,$0.00,$567.15,$0.00
4200015,SUP,HCPCS C1762,,4200015  -  GRAFT SOFT TISSUE DELIVERY UNCRIMPED,"$1,415.30",$0.00,"$1,415.30",$0.00,"$1,010.10",$0.00,$243.85,$0.00,$0.00,$0.00,"$1,415.30",$0.00,$707.65,"$1,120.92","$1,132.24",$0.00,$221.49,$0.00,$0.00,$0.00
4210564,SUP,Custom 27803010,,4210564  -  SPACER SPNL 14MM 16X5MM STRL PRVL STNDALN PEEK-OPTM CRV,"$5,775.00",$0.00,"$5,775.00",$0.00,"$4,121.62",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,775.00",$0.00,"$2,887.50","$4,573.80","$4,620.00",$0.00,$0.00,$0.00,$0.00,$0.00
4210664,SUP,Custom 27803010,,4210664  -  SPACER SPNL 14MM 16X6MM STRL PRVL STNDALN PEEK-OPTM CRV,"$5,775.00",$0.00,"$5,775.00",$0.00,"$4,121.62",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,775.00",$0.00,"$2,887.50","$4,573.80","$4,620.00",$0.00,$0.00,$0.00,$0.00,$0.00
4210764,SUP,Custom 27803010,,4210764  -  SPACER SPNL 14MM 16X7MM STRL PRVL STNDALN PEEK-OPTM CRV,"$5,775.00",$0.00,"$5,775.00",$0.00,"$4,121.62",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,775.00",$0.00,"$2,887.50","$4,573.80","$4,620.00",$0.00,$0.00,$0.00,$0.00,$0.00
4210864,SUP,Custom 27803010,,4210864  -  SPACER SPNL 14MM 16X8MM STRL PRVL STNDALN PEEK-OPTM CRV,"$5,775.00",$0.00,"$5,775.00",$0.00,"$4,121.62",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,775.00",$0.00,"$2,887.50","$4,573.80","$4,620.00",$0.00,$0.00,$0.00,$0.00,$0.00
4210964,SUP,Custom 27803010,,4210964  -  SPACER SPNL 14MM 16X9MM STRL PRVL STNDALN PEEK-OPTM CRV,"$5,775.00",$0.00,"$5,775.00",$0.00,"$4,121.62",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,775.00",$0.00,"$2,887.50","$4,573.80","$4,620.00",$0.00,$0.00,$0.00,$0.00,$0.00
4240041,SUP,Custom 27803010,,4240041  -  CAGE SPNL 11MM 14X10MM STRL ANTM RADOPQ PEEK CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
4240064,SUP,Custom 27803010,,4240064  -  CAGE SPNL 14MM 16X10MM STRL ANTM RADOPQ PEEK CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
4240086,SUP,Custom 27803010,,4240086  -  CAGE SPNL 16MM 18X10MM STRL ANTM RADOPQ PEEK CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
4240141,SUP,Custom 27803010,,4240141  -  CAGE SPNL 11MM 14X11MM STRL ANTM RADOPQ PEEK CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
4240164,SUP,Custom 27803010,,4240164  -  CAGE SPNL 14MM 16X11MM STRL ANTM RADOPQ PEEK CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
4240186,SUP,Custom 27803010,,4240186  -  CAGE SPNL 16MM 18X11MM STRL ANTM RADOPQ PEEK CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
4240241,SUP,Custom 27803010,,4240241  -  CAGE SPNL 11MM 14X12MM STRL ANTM RADOPQ PEEK CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
4240264,SUP,Custom 27803010,,4240264  -  CAGE SPNL 14MM 16X12MM STRL ANTM RADOPQ PEEK CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
4240286,SUP,Custom 27803010,,4240286  -  CAGE SPNL 16MM 18X12MM STRL ANTM RADOPQ PEEK CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
4240341,SUP,Custom 27803010,,4240341  -  CAGE SPNL 11MM 14X13MM STRL ANTM RADOPQ PEEK CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
4240364,SUP,Custom 27803010,,4240364  -  CAGE SPNL 14MM 16X13MM STRL ANTM RADOPQ PEEK CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
4240386,SUP,Custom 27803010,,4240386  -  CAGE SPNL 16MM 18X13MM STRL ANTM RADOPQ PEEK CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
4240441,SUP,Custom 27803010,,4240441  -  CAGE SPNL 11MM 14X14MM STRL ANTM RADOPQ PEEK CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
4240464,SUP,Custom 27803010,,4240464  -  CAGE SPNL 14MM 16X14MM STRL ANTM RADOPQ PEEK CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
4240486,SUP,Custom 27803010,,4240486  -  CAGE SPNL 16MM 18X14MM STRL ANTM RADOPQ PEEK CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
4240541,SUP,Custom 27803010,,4240541  -  CAGE SPNL 11MM 14X5MM STRL ANTM RADOPQ PEEK CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
4240564,SUP,Custom 27803010,,4240564  -  CAGE SPNL 14MM 16X5MM STRL ANTM RADOPQ PEEK CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
4240586,SUP,Custom 27803010,,4240586  -  CAGE SPNL 16MM 18X5MM STRL ANTM RADOPQ PEEK CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
4240641,SUP,Custom 27803010,,4240641  -  CAGE SPNL 11MM 14X6MM STRL ANTM RADOPQ PEEK CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
4240664,SUP,Custom 27803010,,4240664  -  CAGE SPNL 14MM 16X6MM STRL ANTM RADOPQ PEEK CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
4240686,SUP,Custom 27803010,,4240686  -  CAGE SPNL 16MM 18X6MM STRL ANTM RADOPQ PEEK CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
4240741,SUP,Custom 27803010,,4240741  -  CAGE SPNL 11MM 14X7MM STRL ANTM RADOPQ PEEK CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
4240764,SUP,Custom 27803010,,4240764  -  CAGE SPNL 14MM 16X7MM STRL ANTM RADOPQ PEEK CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
4240786,SUP,Custom 27803010,,4240786  -  CAGE SPNL 16MM 18X7MM STRL ANTM RADOPQ PEEK CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
4240841,SUP,Custom 27803010,,4240841  -  CAGE SPNL 11MM 14X8MM STRL ANTM RADOPQ PEEK CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
4240864,SUP,Custom 27803010,,4240864  -  CAGE SPNL 14MM 16X8MM STRL ANTM RADOPQ PEEK CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
4240886,SUP,Custom 27803010,,4240886  -  CAGE SPNL 16MM 18X8MM STRL ANTM RADOPQ PEEK CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
4240941,SUP,Custom 27803010,,4240941  -  CAGE SPNL 11MM 14X9MM STRL ANTM RADOPQ PEEK CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
4240964,SUP,Custom 27803010,,4240964  -  CAGE SPNL 14MM 16X9MM STRL ANTM RADOPQ PEEK CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
4240986,SUP,Custom 27803010,,4240986  -  CAGE SPNL 16MM 18X9MM STRL ANTM RADOPQ PEEK CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
4264606,SUP,Custom 27203010,,4264606  -  KIT PRSS MONITR 84IN SFST 2 INLN BLD SMPL PORT TRNDCR KIT AN,$41.40,$0.00,$41.40,$0.00,$29.55,$0.00,$0.00,$0.00,$0.00,$0.00,$41.40,$0.00,$20.70,$32.79,$33.12,$0.00,$0.00,$0.00,$0.00,$0.00
4302208,SUP,HCPCS C1713,,4302208  -  SPACER 4302208 TELAMON P VBS 0 22X8MM,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
4302210,SUP,HCPCS C1713,,4302210  -  SPACER 4302210 TELAMON P VBS 0 22X10MM,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
4302212,SUP,HCPCS C1713,,4302212  -  SPACER 4302212 TELAMON P VBS 0 22X12MM,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
4302214,SUP,HCPCS C1713,,4302214  -  SPACER 4302214 TELAMON P VBS 0 22X14MM,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
4302608,SUP,HCPCS C1713,,4302608  -  SPACER 4302608 TELAMON P VBS 0 26X8MM,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
4302610,SUP,HCPCS C1713,,4302610  -  SPACER 4302610 TELAMON P VBS 0 26X10MM,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
4302612,SUP,HCPCS C1713,,4302612  -  SPACER 4302612 TELAMON P VBS 0 26X12MM,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
4302614,SUP,Custom 27803010,,4302614  -  TELAMON-P 4302614 VBS 0 26 X 14MM,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
4312513,SUP,Custom 27203010,,STAIN MYCL DFC TB KMNO4 PK 250ML,$79.45,$0.00,$79.45,$0.00,$56.70,$0.00,$0.00,$0.00,$0.00,$0.00,$79.45,$0.00,$39.73,$62.92,$63.56,$0.00,$0.00,$0.00,$0.00,$0.00
4312514,SUP,Custom 27203010,,STAIN MYCL DFC TB ARMN M BTL 250ML,$137.50,$0.00,$137.50,$0.00,$98.13,$0.00,$0.00,$0.00,$0.00,$0.00,$137.50,$0.00,$68.75,$108.90,$110.00,$0.00,$0.00,$0.00,$0.00,$0.00
4312518,SUP,Custom 27203010,,STAIN MYCL BBL TB CRBL FCHSN WKG SOL 250ML,$224.40,$0.00,$224.40,$0.00,$160.15,$0.00,$0.00,$0.00,$0.00,$0.00,$224.40,$0.00,$112.20,$177.72,$179.52,$0.00,$0.00,$0.00,$0.00,$0.00
4312526,SUP,Custom 27203010,,STAIN MCBL GM CRYS VIOL WKG SOL BBL 1GL,$132.05,$0.00,$132.05,$0.00,$94.24,$0.00,$0.00,$0.00,$0.00,$0.00,$132.05,$0.00,$66.03,$104.58,$105.64,$0.00,$0.00,$0.00,$0.00,$0.00
4312531,SUP,Custom 27203010,,STAIN MCBL GM SFRN WKG SOL DFC 250ML,$53.95,$0.00,$53.95,$0.00,$38.50,$0.00,$0.00,$0.00,$0.00,$0.00,$53.95,$0.00,$26.98,$42.73,$43.16,$0.00,$0.00,$0.00,$0.00,$0.00
4312532,SUP,Custom 27203010,,STAIN MCBL GM SFRN REPL REAGENT BBL 1GL,$122.30,$0.00,$122.30,$0.00,$87.29,$0.00,$0.00,$0.00,$0.00,$0.00,$122.30,$0.00,$61.15,$96.86,$97.84,$0.00,$0.00,$0.00,$0.00,$0.00
4312542,SUP,Custom 27203010,,STAIN MCBL GM IOD STAB DFC 250ML,$60.45,$0.00,$60.45,$0.00,$43.14,$0.00,$0.00,$0.00,$0.00,$0.00,$60.45,$0.00,$30.23,$47.88,$48.36,$0.00,$0.00,$0.00,$0.00,$0.00
4321039,SUP,Custom 27203010,,MEDIA CULT TSI SLANT MCFLS,$121.63,$0.00,$121.63,$0.00,$86.80,$0.00,$0.00,$0.00,$0.00,$0.00,$121.63,$0.00,$60.81,$96.33,$97.30,$0.00,$0.00,$0.00,$0.00,$0.00
4321087,SUP,Custom 27203010,,MEDIA CULT TSA SLANT BBL,$115.03,$0.00,$115.03,$0.00,$82.09,$0.00,$0.00,$0.00,$0.00,$0.00,$115.03,$0.00,$57.51,$91.10,$92.02,$0.00,$0.00,$0.00,$0.00,$0.00
4321283,SUP,Custom 27203010,,MEDIA CULT TSA PLT BBL,$104.93,$0.00,$104.93,$0.00,$74.88,$0.00,$0.00,$0.00,$0.00,$0.00,$104.93,$0.00,$52.46,$83.10,$83.94,$0.00,$0.00,$0.00,$0.00,$0.00
4321326,SUP,Custom 27203010,,MEDIA CULT OF BSL MED TUBE BBL 5ML,$39.93,$0.00,$39.93,$0.00,$28.49,$0.00,$0.00,$0.00,$0.00,$0.00,$39.93,$0.00,$19.96,$31.62,$31.94,$0.00,$0.00,$0.00,$0.00,$0.00
4321328,SUP,Custom 27203010,,MEDIA CULT OF MED DEX TUBE BBL 5ML,$39.93,$0.00,$39.93,$0.00,$28.49,$0.00,$0.00,$0.00,$0.00,$0.00,$39.93,$0.00,$19.96,$31.62,$31.94,$0.00,$0.00,$0.00,$0.00,$0.00
4321388,SUP,Custom 27203010,,MEDIA MYCL L-J MED BBL SLANT,$156.83,$0.00,$156.83,$0.00,$111.93,$0.00,$0.00,$0.00,$0.00,$0.00,$156.83,$0.00,$78.41,$124.21,$125.46,$0.00,$0.00,$0.00,$0.00,$0.00
4321739,SUP,Custom 27203010,,MEDIA CULT CDC ANAER AGAR PEA 5% SB PLT BBL,$25.93,$0.00,$25.93,$0.00,$18.50,$0.00,$0.00,$0.00,$0.00,$0.00,$25.93,$0.00,$12.96,$20.54,$20.74,$0.00,$0.00,$0.00,$0.00,$0.00
4321826,SUP,Custom 27203010,,MEDIA MYCL SAB EMNS DEX AGAR BBL SLANT,$1.78,$0.00,$1.78,$0.00,$1.27,$0.00,$0.00,$0.00,$0.00,$0.00,$1.78,$0.00,$0.89,$1.41,$1.42,$0.00,$0.00,$0.00,$0.00,$0.00
4328351,SUP,Custom 27203010,,REAGENT MCBL ANSR SHIG FLEXNERI GRP B TYPE 1-6 LYPH 3ML,$272.00,$0.00,$272.00,$0.00,$194.13,$0.00,$0.00,$0.00,$0.00,$0.00,$272.00,$0.00,$136.00,$215.42,$217.60,$0.00,$0.00,$0.00,$0.00,$0.00
4331107,SUP,Custom 27203010,,STRIP X FCTR HMPHLS DIFF TAXO ID,$314.40,$0.00,$314.40,$0.00,$224.39,$0.00,$0.00,$0.00,$0.00,$0.00,$314.40,$0.00,$157.20,$249.00,$251.52,$0.00,$0.00,$0.00,$0.00,$0.00
4331109,SUP,Custom 27203010,,STRIP FCTR 5 DIFF TAXO ID,$278.90,$0.00,$278.90,$0.00,$199.05,$0.00,$0.00,$0.00,$0.00,$0.00,$278.90,$0.00,$139.45,$220.89,$223.12,$0.00,$0.00,$0.00,$0.00,$0.00
4331264,SUP,Custom 25003010,,DISK AMPCLN 10 MCG BD SNS DS SNS,$6.80,$0.00,$6.80,$0.00,$4.85,$0.00,$0.00,$0.00,$0.00,$0.00,$6.80,$0.00,$3.40,$5.39,$5.44,$0.00,$0.00,$0.00,$0.00,$0.00
4331275,SUP,Custom 25003010,,DISK CLNDMCN 2 MCG BD SNS DS SNS,$66.78,$0.00,$66.78,$0.00,$47.66,$0.00,$0.00,$0.00,$0.00,$0.00,$66.78,$0.00,$33.39,$52.89,$53.42,$0.00,$0.00,$0.00,$0.00,$0.00
4331286,SUP,Custom 25003010,,DISK DXYCL 30 MCG BD SNS DS SNS,$1.58,$0.00,$1.58,$0.00,$1.12,$0.00,$0.00,$0.00,$0.00,$0.00,$1.58,$0.00,$0.79,$1.25,$1.26,$0.00,$0.00,$0.00,$0.00,$0.00
4331290,SUP,Custom 25003010,,DISK EMYCIN 15 MCG SNSDC SNS,$6.80,$0.00,$6.80,$0.00,$4.85,$0.00,$0.00,$0.00,$0.00,$0.00,$6.80,$0.00,$3.40,$5.39,$5.44,$0.00,$0.00,$0.00,$0.00,$0.00
4331299,SUP,Custom 25003010,,DISK GNTA 10 MCG BD SNS DS SNS,$0.68,$0.00,$0.68,$0.00,$0.48,$0.00,$0.00,$0.00,$0.00,$0.00,$0.68,$0.00,$0.34,$0.54,$0.54,$0.00,$0.00,$0.00,$0.00,$0.00
4331321,SUP,Custom 25003010,,DISK PEN 10 UN SNSDC SNS,$6.80,$0.00,$6.80,$0.00,$4.85,$0.00,$0.00,$0.00,$0.00,$0.00,$6.80,$0.00,$3.40,$5.39,$5.44,$0.00,$0.00,$0.00,$0.00,$0.00
4331344,SUP,Custom 25003010,,DISK TTRCLN 30 MCG SNSDC SNS,$64.70,$0.00,$64.70,$0.00,$46.18,$0.00,$0.00,$0.00,$0.00,$0.00,$64.70,$0.00,$32.35,$51.24,$51.76,$0.00,$0.00,$0.00,$0.00,$0.00
4331539,SUP,Custom 25003010,,DISK SXT 23.75 MCG 1.25 MCG SNSDC SNS,$6.80,$0.00,$6.80,$0.00,$4.85,$0.00,$0.00,$0.00,$0.00,$0.00,$6.80,$0.00,$3.40,$5.39,$5.44,$0.00,$0.00,$0.00,$0.00,$0.00
4331569,SUP,Custom 25003010,,DISK TBR 10 MCG BD SNS DS SNS,$6.80,$0.00,$6.80,$0.00,$4.85,$0.00,$0.00,$0.00,$0.00,$0.00,$6.80,$0.00,$3.40,$5.39,$5.44,$0.00,$0.00,$0.00,$0.00,$0.00
4331593,SUP,Custom 25003010,,DISK CFZLN 30 MCG SNSDC SNS,$67.93,$0.00,$67.93,$0.00,$48.48,$0.00,$0.00,$0.00,$0.00,$0.00,$67.93,$0.00,$33.96,$53.80,$54.34,$0.00,$0.00,$0.00,$0.00,$0.00
4331597,SUP,Custom 27203010,,DISK AMK 30 MCG BD SNS DS SNS,$67.93,$0.00,$67.93,$0.00,$48.48,$0.00,$0.00,$0.00,$0.00,$0.00,$67.93,$0.00,$33.96,$53.80,$54.34,$0.00,$0.00,$0.00,$0.00,$0.00
4331609,SUP,Custom 25003010,,DISK PIPRCLN 100 MCG SNSDC SNS,$60.13,$0.00,$60.13,$0.00,$42.91,$0.00,$0.00,$0.00,$0.00,$0.00,$60.13,$0.00,$30.06,$47.62,$48.10,$0.00,$0.00,$0.00,$0.00,$0.00
4331621,SUP,Custom 25003010,,DISK CEFRXM 30 MCG BD SNS DS SNS,$60.13,$0.00,$60.13,$0.00,$42.91,$0.00,$0.00,$0.00,$0.00,$0.00,$60.13,$0.00,$30.06,$47.62,$48.10,$0.00,$0.00,$0.00,$0.00,$0.00
4331633,SUP,Custom 25003010,,DISK CFTZDM 30 MCG BD SNS DS SNS,$6.55,$0.00,$6.55,$0.00,$4.67,$0.00,$0.00,$0.00,$0.00,$0.00,$6.55,$0.00,$3.28,$5.19,$5.24,$0.00,$0.00,$0.00,$0.00,$0.00
4331635,SUP,Custom 25003010,,DISK CEFTRXN 30 MCG SNSDC SNS,$60.13,$0.00,$60.13,$0.00,$42.91,$0.00,$0.00,$0.00,$0.00,$0.00,$60.13,$0.00,$30.06,$47.62,$48.10,$0.00,$0.00,$0.00,$0.00,$0.00
4331649,SUP,Custom 25003010,,DISK TCR CLVLN 75 10 MCG SNSDC SNS,$66.78,$0.00,$66.78,$0.00,$47.66,$0.00,$0.00,$0.00,$0.00,$0.00,$66.78,$0.00,$33.39,$52.89,$53.42,$0.00,$0.00,$0.00,$0.00,$0.00
4331658,SUP,Custom 25003010,,DISK CIPRO 5 MCG BD SNS DS SNS,$6.80,$0.00,$6.80,$0.00,$4.85,$0.00,$0.00,$0.00,$0.00,$0.00,$6.80,$0.00,$3.40,$5.39,$5.44,$0.00,$0.00,$0.00,$0.00,$0.00
4331696,SUP,Custom 25003010,,DISK CEFEPIME 30 MCG BD SNS DS SNS,$6.80,$0.00,$6.80,$0.00,$4.85,$0.00,$0.00,$0.00,$0.00,$0.00,$6.80,$0.00,$3.40,$5.39,$5.44,$0.00,$0.00,$0.00,$0.00,$0.00
4331704,SUP,Custom 25003010,,DISK MRPNM 10 MCG BD SNS DS SNS,$0.68,$0.00,$0.68,$0.00,$0.48,$0.00,$0.00,$0.00,$0.00,$0.00,$0.68,$0.00,$0.34,$0.54,$0.54,$0.00,$0.00,$0.00,$0.00,$0.00
4331752,SUP,Custom 25003010,,DISK CFTXM CLVLN 30 10 MCG BD SNS DS SNS,$216.88,$0.00,$216.88,$0.00,$154.78,$0.00,$0.00,$0.00,$0.00,$0.00,$216.88,$0.00,$108.44,$171.77,$173.50,$0.00,$0.00,$0.00,$0.00,$0.00
4331754,SUP,Custom 25003010,,DISK CFTZDM CLVLN 30 10 MCG BD SNS DS SNS,$56.13,$0.00,$56.13,$0.00,$40.06,$0.00,$0.00,$0.00,$0.00,$0.00,$56.13,$0.00,$28.06,$44.45,$44.90,$0.00,$0.00,$0.00,$0.00,$0.00
4332208,SUP,HCPCS C1713,,4332208  -  SPACER SPNL 3D 22MMX8MM TLMN-PPEEK-OPTM END PC VERT BD REPL,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
4332210,SUP,HCPCS C1713,,4332210  -  SPACER SPNL 3D 22MMX10MM TLMN-PPEEK-OPTM END PC VERT BD REPL,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
4332212,SUP,HCPCS C1713,,4332212  -  SPACER 4332212 TELAMON P VBS 3 22X12MM,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
4332214,SUP,HCPCS C1713,,4332214  -  SPACER 4332214 TELAMON P VBS 3 22X14MM,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
4332608,SUP,HCPCS C1713,,4332608  -  SPACER 4332608 TELAMON P VBS 3 26X8MM,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
4332610,SUP,HCPCS C1713,,4332610  -  SPACER 4332610 TELAMON P VBS 3 26X10MM,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
4332612,SUP,HCPCS C1713,,4332612  -  SPACER SPNL 3D 26MMX12MM TLMN-PPEEK-OPTM END PC VERT BD REPL,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
4332614,SUP,HCPCS C1713,,4332614  -  SPACER 4332614 TELAMON P VBS 3 26X14MM,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
4340765,SUP,Custom 27203010,,REAGENT VDRL AG BUFF SAL BBL .5ML 60ML SERO,$183.70,$0.00,$183.70,$0.00,$131.11,$0.00,$0.00,$0.00,$0.00,$0.00,$183.70,$0.00,$91.85,$145.49,$146.96,$0.00,$0.00,$0.00,$0.00,$0.00
4340826,SUP,Custom 27203010,,REAGENT MCBL COAG PLSM EDTA LYPH RBT BBL 15ML,$301.25,$0.00,$301.25,$0.00,$215.00,$0.00,$0.00,$0.00,$0.00,$0.00,$301.25,$0.00,$150.63,$238.59,$241.00,$0.00,$0.00,$0.00,$0.00,$0.00
4340983,SUP,Custom 27203010,,REAGENT MCBL ANSR SLMNLA O GRP A GLYCERINATED DFC 3ML,$291.48,$0.00,$291.48,$0.00,$208.03,$0.00,$0.00,$0.00,$0.00,$0.00,$291.48,$0.00,$145.74,$230.85,$233.18,$0.00,$0.00,$0.00,$0.00,$0.00
4340984,SUP,Custom 27203010,,REAGENT MCBL ANSR SLMNLA O GRP B GLYCERINATED DFC 3ML,$194.85,$0.00,$194.85,$0.00,$139.06,$0.00,$0.00,$0.00,$0.00,$0.00,$194.85,$0.00,$97.43,$154.32,$155.88,$0.00,$0.00,$0.00,$0.00,$0.00
4340985,SUP,Custom 27203010,,REAGENT MCBL ANSR SLMNLA O GRP C1 GLYCERINATED DFC 3ML,$363.13,$0.00,$363.13,$0.00,$259.16,$0.00,$0.00,$0.00,$0.00,$0.00,$363.13,$0.00,$181.56,$287.60,$290.50,$0.00,$0.00,$0.00,$0.00,$0.00
4340986,SUP,Custom 27203010,,REAGENT MCBL ANSR SLMNLA O GRP C2 GLYCERINATED DFC 3ML,$306.63,$0.00,$306.63,$0.00,$218.84,$0.00,$0.00,$0.00,$0.00,$0.00,$306.63,$0.00,$153.31,$242.85,$245.30,$0.00,$0.00,$0.00,$0.00,$0.00
4340987,SUP,Custom 27203010,,REAGENT MCBL ANSR SLMNLA O GRP D GLYCERINATED DFC 3ML,$133.28,$0.00,$133.28,$0.00,$95.12,$0.00,$0.00,$0.00,$0.00,$0.00,$133.28,$0.00,$66.64,$105.56,$106.62,$0.00,$0.00,$0.00,$0.00,$0.00
4340988,SUP,Custom 27203010,,REAGENT MCBL ANSR SLMNLA O GRP E GLYCERINATED DFC 3ML,$240.65,$0.00,$240.65,$0.00,$171.75,$0.00,$0.00,$0.00,$0.00,$0.00,$240.65,$0.00,$120.33,$190.59,$192.52,$0.00,$0.00,$0.00,$0.00,$0.00
4340993,SUP,Custom 27203010,,REAGENT MCBL ANSR SLMNLA O PLVLNT A-1 6 GLYCERINATED DFC 3ML,$234.25,$0.00,$234.25,$0.00,$167.18,$0.00,$0.00,$0.00,$0.00,$0.00,$234.25,$0.00,$117.13,$185.53,$187.40,$0.00,$0.00,$0.00,$0.00,$0.00
4340994,SUP,Custom 27203010,,REAGENT MCBL ANSR SLMNLA 6 GLYCERINATED DFC 3ML,$228.23,$0.00,$228.23,$0.00,$162.88,$0.00,$0.00,$0.00,$0.00,$0.00,$228.23,$0.00,$114.11,$180.76,$182.58,$0.00,$0.00,$0.00,$0.00,$0.00
4360130,SUP,HCPCS C1713,,4360130  -  ENDCAP 4360130 13MM 0 DEGREE,$907.50,$0.00,$907.50,$408.38,$647.68,$0.00,$156.36,$0.00,$0.00,$158.90,$907.50,$0.00,$453.75,$718.74,$726.00,$0.00,$142.02,$0.00,$144.47,$0.00
4360135,SUP,HCPCS C1713,,4360135  -  ENDCAP 4360135 13MM 15 DEGREE,$907.50,$0.00,$907.50,$408.38,$647.68,$0.00,$156.36,$0.00,$0.00,$158.90,$907.50,$0.00,$453.75,$718.74,$726.00,$0.00,$142.02,$0.00,$144.47,$0.00
4360138,SUP,HCPCS C1713,,4360138  -  ENDCAP 4360138 13MM 8 DEGREE,$907.50,$0.00,$907.50,$408.38,$647.68,$0.00,$156.36,$0.00,$0.00,$158.90,$907.50,$0.00,$453.75,$718.74,$726.00,$0.00,$142.02,$0.00,$144.47,$0.00
4360160,SUP,HCPCS C1713,,4360160  -  ENDCAP 4360160 16MM 0 DEGREE,$907.50,$0.00,$907.50,$408.38,$647.68,$0.00,$156.36,$0.00,$0.00,$158.90,$907.50,$0.00,$453.75,$718.74,$726.00,$0.00,$142.02,$0.00,$144.47,$0.00
4360165,SUP,HCPCS C1713,,4360165  -  ENDCAP 4360165 16MM 15 DEGREE,$907.50,$0.00,$907.50,$408.38,$647.68,$0.00,$156.36,$0.00,$0.00,$158.90,$907.50,$0.00,$453.75,$718.74,$726.00,$0.00,$142.02,$0.00,$144.47,$0.00
4360168,SUP,HCPCS C1713,,4360168  -  ENDCAP 4360168 16MM 8 DEGREE,$907.50,$0.00,$907.50,$408.38,$647.68,$0.00,$156.36,$0.00,$0.00,$158.90,$907.50,$0.00,$453.75,$718.74,$726.00,$0.00,$142.02,$0.00,$144.47,$0.00
4360200,SUP,HCPCS C1713,,4360200  -  ENDCAP 4360200 20MM 0 DEGREE,$907.50,$0.00,$907.50,$408.38,$647.68,$0.00,$156.36,$0.00,$0.00,$158.90,$907.50,$0.00,$453.75,$718.74,$726.00,$0.00,$142.02,$0.00,$144.47,$0.00
4360205,SUP,HCPCS C1713,,4360205  -  ENDCAP 4360205 20MM 15 DEGREE,$907.50,$0.00,$907.50,$408.38,$647.68,$0.00,$156.36,$0.00,$0.00,$158.90,$907.50,$0.00,$453.75,$718.74,$726.00,$0.00,$142.02,$0.00,$144.47,$0.00
4360208,SUP,HCPCS C1713,,4360208  -  ENDCAP 4360208 20MM 8 DEGREE,$907.50,$0.00,$907.50,$408.38,$647.68,$0.00,$156.36,$0.00,$0.00,$158.90,$907.50,$0.00,$453.75,$718.74,$726.00,$0.00,$142.02,$0.00,$144.47,$0.00
4360220,SUP,HCPCS C1713,,4360220  -  ENDCAP 4360220 22MM 0 DEGREE,$907.50,$0.00,$907.50,$408.38,$647.68,$0.00,$156.36,$0.00,$0.00,$158.90,$907.50,$0.00,$453.75,$718.74,$726.00,$0.00,$142.02,$0.00,$144.47,$0.00
4360225,SUP,HCPCS C1713,,4360225  -  ENDCAP 4360225 22MM 15 DEGREE,$907.50,$0.00,$907.50,$408.38,$647.68,$0.00,$156.36,$0.00,$0.00,$158.90,$907.50,$0.00,$453.75,$718.74,$726.00,$0.00,$142.02,$0.00,$144.47,$0.00
4360228,SUP,HCPCS C1713,,4360228  -  ENDCAP 4360228 22MM 8 DEGREE,$907.50,$0.00,$907.50,$408.38,$647.68,$0.00,$156.36,$0.00,$0.00,$158.90,$907.50,$0.00,$453.75,$718.74,$726.00,$0.00,$142.02,$0.00,$144.47,$0.00
4360250,SUP,HCPCS C1713,,4360250  -  ENDCAP 4360250 25MM 0 DEGREE,$907.50,$0.00,$907.50,$408.38,$647.68,$0.00,$156.36,$0.00,$0.00,$158.90,$907.50,$0.00,$453.75,$718.74,$726.00,$0.00,$142.02,$0.00,$144.47,$0.00
4360255,SUP,HCPCS C1713,,4360255  -  ENDCAP 4360255 25MM 15 DEGREE,$907.50,$0.00,$907.50,$408.38,$647.68,$0.00,$156.36,$0.00,$0.00,$158.90,$907.50,$0.00,$453.75,$718.74,$726.00,$0.00,$142.02,$0.00,$144.47,$0.00
4360258,SUP,HCPCS C1713,,4360258  -  ENDCAP 4360258 25MM 8 DEGREE,$907.50,$0.00,$907.50,$408.38,$647.68,$0.00,$156.36,$0.00,$0.00,$158.90,$907.50,$0.00,$453.75,$718.74,$726.00,$0.00,$142.02,$0.00,$144.47,$0.00
4360300,SUP,HCPCS C1713,,4360300  -  ENDCAP 4360300 30MM 0 DEGREE,$907.50,$0.00,$907.50,$408.38,$647.68,$0.00,$156.36,$0.00,$0.00,$158.90,$907.50,$0.00,$453.75,$718.74,$726.00,$0.00,$142.02,$0.00,$144.47,$0.00
4360305,SUP,HCPCS C1713,,4360305  -  ENDCAP 4360305 30MM 15 DEGREE,$907.50,$0.00,$907.50,$408.38,$647.68,$0.00,$156.36,$0.00,$0.00,$158.90,$907.50,$0.00,$453.75,$718.74,$726.00,$0.00,$142.02,$0.00,$144.47,$0.00
4360308,SUP,HCPCS C1713,,4360308  -  ENDCAP 4360308 30MM 8 DEGREE,$907.50,$0.00,$907.50,$408.38,$647.68,$0.00,$156.36,$0.00,$0.00,$158.90,$907.50,$0.00,$453.75,$718.74,$726.00,$0.00,$142.02,$0.00,$144.47,$0.00
4360678,SUP,Custom 27203010,,4360678  -  SYSTEM CULT SCHT GSPK EZ,$82.23,$0.00,$82.23,$0.00,$58.69,$0.00,$0.00,$0.00,$0.00,$0.00,$82.23,$0.00,$41.12,$65.13,$65.78,$0.00,$0.00,$0.00,$0.00,$0.00
4361130,SUP,HCPCS C1713,,4361130  -  ENDCAP 4361130 13MM 0 DEGREE STERILE,$907.50,$0.00,$907.50,$408.38,$647.68,$0.00,$156.36,$0.00,$0.00,$158.90,$907.50,$0.00,$453.75,$718.74,$726.00,$0.00,$142.02,$0.00,$144.47,$0.00
4361135,SUP,HCPCS C1713,,4361135  -  ENDCAP 4361135 13MM 15 DEGREE STERILE,$907.50,$0.00,$907.50,$408.38,$647.68,$0.00,$156.36,$0.00,$0.00,$158.90,$907.50,$0.00,$453.75,$718.74,$726.00,$0.00,$142.02,$0.00,$144.47,$0.00
4361138,SUP,HCPCS C1713,,4361138  -  ENDCAP 4361138 13MM 8 DEGREE STERILE,$907.50,$0.00,$907.50,$408.38,$647.68,$0.00,$156.36,$0.00,$0.00,$158.90,$907.50,$0.00,$453.75,$718.74,$726.00,$0.00,$142.02,$0.00,$144.47,$0.00
4361160,SUP,HCPCS C1713,,4361160  -  ENDCAP 4361160 16MM 0 DEGREE STERILE,$907.50,$0.00,$907.50,$408.38,$647.68,$0.00,$156.36,$0.00,$0.00,$158.90,$907.50,$0.00,$453.75,$718.74,$726.00,$0.00,$142.02,$0.00,$144.47,$0.00
4361165,SUP,HCPCS C1713,,4361165  -  ENDCAP 4361165 16MM 15 DEGREE STERILE,$907.50,$0.00,$907.50,$408.38,$647.68,$0.00,$156.36,$0.00,$0.00,$158.90,$907.50,$0.00,$453.75,$718.74,$726.00,$0.00,$142.02,$0.00,$144.47,$0.00
4361168,SUP,HCPCS C1713,,4361168  -  ENDCAP 4361168 16MM 8 DEGREE STERILE,$907.50,$0.00,$907.50,$408.38,$647.68,$0.00,$156.36,$0.00,$0.00,$158.90,$907.50,$0.00,$453.75,$718.74,$726.00,$0.00,$142.02,$0.00,$144.47,$0.00
4361200,SUP,HCPCS C1713,,4361200  -  ENDCAP 4361200 20MM 0 DEGREE STERILE,$907.50,$0.00,$907.50,$408.38,$647.68,$0.00,$156.36,$0.00,$0.00,$158.90,$907.50,$0.00,$453.75,$718.74,$726.00,$0.00,$142.02,$0.00,$144.47,$0.00
4361205,SUP,HCPCS C1713,,4361205  -  ENDCAP 4361205 20MM 15 DEGREE STERILE,$907.50,$0.00,$907.50,$408.38,$647.68,$0.00,$156.36,$0.00,$0.00,$158.90,$907.50,$0.00,$453.75,$718.74,$726.00,$0.00,$142.02,$0.00,$144.47,$0.00
4361208,SUP,HCPCS C1713,,4361208  -  ENDCAP 4361208 20MM 8 DEGREE STERILE,$907.50,$0.00,$907.50,$408.38,$647.68,$0.00,$156.36,$0.00,$0.00,$158.90,$907.50,$0.00,$453.75,$718.74,$726.00,$0.00,$142.02,$0.00,$144.47,$0.00
4361220,SUP,HCPCS C1713,,4361220  -  ENDCAP 4361220 22MM 0 DEGREE STERILE,$907.50,$0.00,$907.50,$408.38,$647.68,$0.00,$156.36,$0.00,$0.00,$158.90,$907.50,$0.00,$453.75,$718.74,$726.00,$0.00,$142.02,$0.00,$144.47,$0.00
4361225,SUP,HCPCS C1713,,4361225  -  ENDCAP 4361225 22MM 15 DEGREE STERILE,$907.50,$0.00,$907.50,$408.38,$647.68,$0.00,$156.36,$0.00,$0.00,$158.90,$907.50,$0.00,$453.75,$718.74,$726.00,$0.00,$142.02,$0.00,$144.47,$0.00
4361228,SUP,HCPCS C1713,,4361228  -  ENDCAP 4361228 22MM 8 DEGREE STERILE,$907.50,$0.00,$907.50,$408.38,$647.68,$0.00,$156.36,$0.00,$0.00,$158.90,$907.50,$0.00,$453.75,$718.74,$726.00,$0.00,$142.02,$0.00,$144.47,$0.00
4361250,SUP,HCPCS C1713,,4361250  -  ENDCAP 4361250 25MM 0 DEGREE STERILE,$907.50,$0.00,$907.50,$408.38,$647.68,$0.00,$156.36,$0.00,$0.00,$158.90,$907.50,$0.00,$453.75,$718.74,$726.00,$0.00,$142.02,$0.00,$144.47,$0.00
4361255,SUP,HCPCS C1713,,4361255  -  ENDCAP 4361255 25MM 15 DEGREE STERILE,$907.50,$0.00,$907.50,$408.38,$647.68,$0.00,$156.36,$0.00,$0.00,$158.90,$907.50,$0.00,$453.75,$718.74,$726.00,$0.00,$142.02,$0.00,$144.47,$0.00
4361258,SUP,HCPCS C1713,,4361258  -  ENDCAP 4361258 25MM 8 DEGREE STERILE,$907.50,$0.00,$907.50,$408.38,$647.68,$0.00,$156.36,$0.00,$0.00,$158.90,$907.50,$0.00,$453.75,$718.74,$726.00,$0.00,$142.02,$0.00,$144.47,$0.00
4361300,SUP,HCPCS C1713,,4361300  -  ENDCAP 4361300 30MM 0 DEGREE STERILE,$907.50,$0.00,$907.50,$408.38,$647.68,$0.00,$156.36,$0.00,$0.00,$158.90,$907.50,$0.00,$453.75,$718.74,$726.00,$0.00,$142.02,$0.00,$144.47,$0.00
4361305,SUP,HCPCS C1713,,4361305  -  ENDCAP 4361305 30MM 15 DEGREE STERILE,$907.50,$0.00,$907.50,$408.38,$647.68,$0.00,$156.36,$0.00,$0.00,$158.90,$907.50,$0.00,$453.75,$718.74,$726.00,$0.00,$142.02,$0.00,$144.47,$0.00
4361308,SUP,HCPCS C1713,,4361308  -  ENDCAP 4361308 30MM 8 DEGREE STERILE,$907.50,$0.00,$907.50,$408.38,$647.68,$0.00,$156.36,$0.00,$0.00,$158.90,$907.50,$0.00,$453.75,$718.74,$726.00,$0.00,$142.02,$0.00,$144.47,$0.00
4395872,SUP,Custom 27203010,,MEDIA CULT CHOC AGAR SLANT MCFLS,$49.63,$0.00,$49.63,$0.00,$35.42,$0.00,$0.00,$0.00,$0.00,$0.00,$49.63,$0.00,$24.81,$39.31,$39.70,$0.00,$0.00,$0.00,$0.00,$0.00
4396266,SUP,Custom 27203010,,MEDIA CULT T-H BROTH TUBE MYCFLS 5ML,$176.30,$0.00,$176.30,$0.00,$125.83,$0.00,$0.00,$0.00,$0.00,$0.00,$176.30,$0.00,$88.15,$139.63,$141.04,$0.00,$0.00,$0.00,$0.00,$0.00
4396348,SUP,Custom 27203010,,MEDIA MYCL SAB-DEX EMNS AGAR GNTA BBL PLT DP FILL,$62.88,$0.00,$62.88,$0.00,$44.87,$0.00,$0.00,$0.00,$0.00,$0.00,$62.88,$0.00,$31.44,$49.80,$50.30,$0.00,$0.00,$0.00,$0.00,$0.00
4397222,SUP,Custom 27203010,,MEDIA CULT TRSN AGAR PR TUBE BBL 20ML,$55.08,$0.00,$55.08,$0.00,$39.31,$0.00,$0.00,$0.00,$0.00,$0.00,$55.08,$0.00,$27.54,$43.62,$44.06,$0.00,$0.00,$0.00,$0.00,$0.00
4397224,SUP,Custom 27203010,,MEDIA CULT XANTHINE AGAR PR TUBE BBL 20ML,$55.08,$0.00,$55.08,$0.00,$39.31,$0.00,$0.00,$0.00,$0.00,$0.00,$55.08,$0.00,$27.54,$43.62,$44.06,$0.00,$0.00,$0.00,$0.00,$0.00
4397231,SUP,Custom 27203010,,MEDIA CULT LYSOZYME BROTH TUBE MCFLS 5ML,$62.83,$0.00,$62.83,$0.00,$44.84,$0.00,$0.00,$0.00,$0.00,$0.00,$62.83,$0.00,$31.41,$49.76,$50.26,$0.00,$0.00,$0.00,$0.00,$0.00
4397232,SUP,Custom 27203010,,MEDIA CULT LYSOZYME CNTRL BROTH TUBE MCFLS 5ML,$56.98,$0.00,$56.98,$0.00,$40.66,$0.00,$0.00,$0.00,$0.00,$0.00,$56.98,$0.00,$28.49,$45.13,$45.58,$0.00,$0.00,$0.00,$0.00,$0.00
4397448,SUP,Custom 27203010,,MEDIA MYCL MDBRK COHN 7H10 AGAR MCFLS SLANT,$53.98,$0.00,$53.98,$0.00,$38.52,$0.00,$0.00,$0.00,$0.00,$0.00,$53.98,$0.00,$26.99,$42.75,$43.18,$0.00,$0.00,$0.00,$0.00,$0.00
4397770,SUP,Custom 27203010,,MEDIA MYCL SAB EMNS DEX AGAR GNTA SLANT,$759.05,$0.00,$759.05,$0.00,$541.73,$0.00,$0.00,$0.00,$0.00,$0.00,$759.05,$0.00,$379.53,$601.17,$607.24,$0.00,$0.00,$0.00,$0.00,$0.00
4397793,SUP,Custom 27203010,,MEDIA CULT SKIRROWS MED PLT BBL,$60.70,$0.00,$60.70,$0.00,$43.32,$0.00,$0.00,$0.00,$0.00,$0.00,$60.70,$0.00,$30.35,$48.07,$48.56,$0.00,$0.00,$0.00,$0.00,$0.00
4397875,SUP,Custom 27203010,,MEDIA MYCL BIRD SEED AGAR BBL PLT,$45.85,$0.00,$45.85,$0.00,$32.72,$0.00,$0.00,$0.00,$0.00,$0.00,$45.85,$0.00,$22.93,$36.31,$36.68,$0.00,$0.00,$0.00,$0.00,$0.00
4397880,SUP,Custom 27203010,,MEDIA CULT BCYE SLCT AGAR PAV PLT BBL,$37.03,$0.00,$37.03,$0.00,$26.42,$0.00,$0.00,$0.00,$0.00,$0.00,$37.03,$0.00,$18.51,$29.33,$29.62,$0.00,$0.00,$0.00,$0.00,$0.00
4397886,SUP,Custom 27203010,,MEDIA MYCL YST XTRT PHOS AGAR BBL PLT DP FILL,$26.43,$0.00,$26.43,$0.00,$18.86,$0.00,$0.00,$0.00,$0.00,$0.00,$26.43,$0.00,$13.21,$20.93,$21.14,$0.00,$0.00,$0.00,$0.00,$0.00
4484525,SUP,HCPCS C1713,,4484525  -  SCREW BN 4.5MM 25MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4484530,SUP,HCPCS C1713,,4484530  -  SCREW BN 4.5MM 30MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4484535,SUP,HCPCS C1713,,4484535  -  SCREW BN 4.5MM 35MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4484540,SUP,HCPCS C1713,,4484540  -  SCREW BN 4.5MM 40MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4484545,SUP,HCPCS C1713,,4484545  -  SCREW BN 4.5MM 45MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4484550,SUP,HCPCS C1713,,4484550  -  SCREW BN 4.5MM 50MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4484555,SUP,HCPCS C1713,,4484555  -  SCREW BN 4.5MM 55MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4484560,SUP,HCPCS C1713,,4484560  -  SCREW BN 4.5MM 60MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4484565,SUP,HCPCS C1713,,4484565  -  SCREW BN 4.5MM 65MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4484570,SUP,HCPCS C1713,,4484570  -  SCREW BN 4.5MM 70MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4484575,SUP,HCPCS C1713,,4484575  -  SCREW BN 4.5MM 75MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4484580,SUP,HCPCS C1713,,4484580  -  SCREW BN 4.5MM 80MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4485525,SUP,HCPCS C1713,,4485525  -  SCREW BN 5.5MM 25MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4485530,SUP,HCPCS C1713,,4485530  -  SCREW BN 5.5MM 30MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4485535,SUP,HCPCS C1713,,4485535  -  SCREW BN 5.5MM 35MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4485540,SUP,HCPCS C1713,,4485540  -  SCREW BN 5.5MM 40MM NS DBR III SPHERX CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4485545,SUP,HCPCS C1713,,4485545  -  SCREW BN 5.5MM 45MM NS DBR III SPHERX CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4485550,SUP,HCPCS C1713,,4485550  -  SCREW BN 5.5MM 50MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4485555,SUP,HCPCS C1713,,4485555  -  SCREW BN 5.5MM 55MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4485560,SUP,HCPCS C1713,,4485560  -  SCREW BN 5.5MM 60MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4485565,SUP,HCPCS C1713,,4485565  -  SCREW BN 5.5MM 65MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4485570,SUP,HCPCS C1713,,4485570  -  SCREW BN 5.5MM 70MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4485575,SUP,HCPCS C1713,,4485575  -  SCREW BN 5.5MM 75MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4485580,SUP,HCPCS C1713,,4485580  -  SCREW BN 5.5MM 80MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4486510,SUP,HCPCS C1713,,4486510  -  SCREW BN 6.5MM 100MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4486511,SUP,HCPCS C1713,,4486511  -  SCREW BN 6.5MM 105MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4486512,SUP,HCPCS C1713,,4486512  -  SCREW BN 6.5MM 110MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4486513,SUP,HCPCS C1713,,4486513  -  SCREW BN 6.5MM 115MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4486514,SUP,HCPCS C1713,,4486514  -  SCREW BN 6.5MM 120MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4486525,SUP,HCPCS C1713,,4486525  -  SCREW BN 6.5MM 25MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4486530,SUP,HCPCS C1713,,4486530  -  SCREW BN 6.5MM 30MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4486535,SUP,HCPCS C1713,,4486535  -  SCREW BN 6.5MM 35MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4486540,SUP,HCPCS C1713,,4486540  -  SCREW BN 6.5MM 40MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4486545,SUP,HCPCS C1713,,4486545  -  SCREW BN 6.5MM 45MM NS DBR III SPHERX CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4486550,SUP,HCPCS C1713,,4486550  -  SCREW BN 6.5MM 50MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4486555,SUP,HCPCS C1713,,4486555  -  SCREW BN 6.5MM 55MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4486560,SUP,HCPCS C1713,,4486560  -  SCREW BN 6.5MM 60MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4486565,SUP,HCPCS C1713,,4486565  -  SCREW BN 6.5MM 65MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4486570,SUP,HCPCS C1713,,4486570  -  SCREW BN 6.5MM 70MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4486575,SUP,HCPCS C1713,,4486575  -  SCREW BN 6.5MM 75MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4486580,SUP,HCPCS C1713,,4486580  -  SCREW BN 6.5MM 80MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4486585,SUP,HCPCS C1713,,4486585  -  SCREW BN 6.5MM 85MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4486590,SUP,HCPCS C1713,,4486590  -  SCREW BN 6.5MM 90MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4486595,SUP,HCPCS C1713,,4486595  -  SCREW BN 6.5MM 95MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4487510,SUP,HCPCS C1713,,4487510  -  SCREW BN 7.5MM 100MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4487511,SUP,HCPCS C1713,,4487511  -  SCREW BN 7.5MM 105MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4487512,SUP,HCPCS C1713,,4487512  -  SCREW BN 7.5MM 110MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4487513,SUP,HCPCS C1713,,4487513  -  SCREW BN 7.5MM 115MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4487514,SUP,HCPCS C1713,,4487514  -  SCREW BN 7.5MM 120MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4487525,SUP,HCPCS C1713,,4487525  -  SCREW BN 7.5MM 25MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4487530,SUP,HCPCS C1713,,4487530  -  SCREW BN 7.5MM 30MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4487535,SUP,HCPCS C1713,,4487535  -  SCREW BN 7.5MM 35MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4487540,SUP,HCPCS C1713,,4487540  -  SCREW BN 7.5MM 40MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4487545,SUP,HCPCS C1713,,4487545  -  SCREW BN 7.5MM 45MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4487550,SUP,HCPCS C1713,,4487550  -  SCREW BN 7.5MM 50MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4487555,SUP,HCPCS C1713,,4487555  -  SCREW BN 7.5MM 55MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4487560,SUP,HCPCS C1713,,4487560  -  SCREW BN 7.5MM 60MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4487565,SUP,HCPCS C1713,,4487565  -  SCREW BN 7.5MM 65MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4487570,SUP,HCPCS C1713,,4487570  -  SCREW BN 7.5MM 70MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4487575,SUP,HCPCS C1713,,4487575  -  SCREW BN 7.5MM 75MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4487580,SUP,HCPCS C1713,,4487580  -  SCREW BN 7.5MM 80MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4487585,SUP,HCPCS C1713,,4487585  -  SCREW BN 7.5MM 85MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4487590,SUP,HCPCS C1713,,4487590  -  SCREW BN 7.5MM 90MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4487595,SUP,HCPCS C1713,,4487595  -  SCREW BN 7.5MM 95MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4488510,SUP,HCPCS C1713,,4488510  -  SCREW BN 8.5MM 100MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4488511,SUP,HCPCS C1713,,4488511  -  SCREW BN 8.5MM 105MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4488512,SUP,HCPCS C1713,,4488512  -  SCREW BN 8.5MM 110MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4488513,SUP,HCPCS C1713,,4488513  -  SCREW BN 8.5MM 115MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4488514,SUP,HCPCS C1713,,4488514  -  SCREW BN 8.5MM 120MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4488525,SUP,HCPCS C1713,,4488525  -  SCREW BN 8.5MM 25MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4488530,SUP,HCPCS C1713,,4488530  -  SCREW BN 8.5MM 30MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4488535,SUP,HCPCS C1713,,4488535  -  SCREW BN 8.5MM 35MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4488540,SUP,HCPCS C1713,,4488540  -  SCREW BN 8.5MM 40MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4488545,SUP,HCPCS C1713,,4488545  -  SCREW BN 8.5MM 45MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4488550,SUP,HCPCS C1713,,4488550  -  SCREW BN 8.5MM 50MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4488555,SUP,HCPCS C1713,,4488555  -  SCREW BN 8.5MM 55MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4488560,SUP,HCPCS C1713,,4488560  -  SCREW BN 8.5MM 60MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4488565,SUP,HCPCS C1713,,4488565  -  SCREW BN 8.5MM 65MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4488570,SUP,HCPCS C1713,,4488570  -  SCREW BN 8.5MM 70MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4488575,SUP,HCPCS C1713,,4488575  -  SCREW BN 8.5MM 75MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4488580,SUP,HCPCS C1713,,4488580  -  SCREW BN 8.5MM 80MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4488585,SUP,HCPCS C1713,,4488585  -  SCREW BN 8.5MM 85MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4488590,SUP,HCPCS C1713,,4488590  -  SCREW BN 8.5MM 90MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4488595,SUP,HCPCS C1713,,4488595  -  SCREW BN 8.5MM 95MM DBR III CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
4527020,SUP,Custom 27203010,,4527020  -  BIT DRILL 2MM 102MM AO SHAFT,$306.30,$0.00,$306.30,$0.00,$218.61,$0.00,$0.00,$0.00,$0.00,$0.00,$306.30,$0.00,$153.15,$242.59,$245.04,$0.00,$0.00,$0.00,$0.00,$0.00
4535020,SUP,Custom 27203010,,4535020  -  BIT DRL 3.6MM RD YLW AO FIT 3.5MM VARIAX LCK PLT SYSTE,$306.30,$0.00,$306.30,$0.00,$218.61,$0.00,$0.00,$0.00,$0.00,$0.00,$306.30,$0.00,$153.15,$242.59,$245.04,$0.00,$0.00,$0.00,$0.00,$0.00
4622801,SUP,Custom 27203010,,MATTRESS HEAD SECTION /FA,"$1,264.83",$0.00,"$1,264.83",$0.00,$902.71,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,264.83",$0.00,$632.41,"$1,001.75","$1,011.86",$0.00,$0.00,$0.00,$0.00,$0.00
4623002,SUP,Custom 27203010,,MATTRESS FOOT SECTION /FA,"$1,015.35",$0.00,"$1,015.35",$0.00,$724.66,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,015.35",$0.00,$507.68,$804.16,$812.28,$0.00,$0.00,$0.00,$0.00,$0.00
4920040,SUP,HCPCS C1713,,4920040  -  CAGE SPNL 0D 40X22X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4920045,SUP,HCPCS C1713,,4920045  -  CAGE SPNL 0D 45X22X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4920050,SUP,HCPCS C1713,,4920050  -  CAGE SPNL 0D 50X22X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4920055,SUP,HCPCS C1713,,4920055  -  CAGE SPNL 0D 55X22X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4920060,SUP,HCPCS C1713,,4920060  -  CAGE SPNL 0D 60X22X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4920240,SUP,HCPCS C1713,,4920240  -  CAGE SPNL 0D 40X22X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4920245,SUP,HCPCS C1713,,4920245  -  CAGE SPNL 0D 45X22X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4920250,SUP,HCPCS C1713,,4920250  -  CAGE SPNL 0D 50X22X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4920255,SUP,HCPCS C1713,,4920255  -  CAGE SPNL 0D 55X22X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4920260,SUP,HCPCS C1713,,4920260  -  CAGE SPNL 0D 60X22X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4920440,SUP,HCPCS C1713,,4920440  -  CAGE SPNL 0D 40X22X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4920445,SUP,HCPCS C1713,,4920445  -  CAGE SPNL 0D 45X22X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4920450,SUP,HCPCS C1713,,4920450  -  CAGE SPNL 0D 50X22X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4920455,SUP,HCPCS C1713,,4920455  -  CAGE SPNL 0D 55X22X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4920460,SUP,HCPCS C1713,,4920460  -  CAGE SPNL 0D 60X22X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4920640,SUP,HCPCS C1713,,4920640  -  CAGE SPNL 0D 40X22X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4920645,SUP,HCPCS C1713,,4920645  -  CAGE SPNL 0D 45X22X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4920650,SUP,HCPCS C1713,,4920650  -  CAGE SPNL 0D 50X22X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4920655,SUP,HCPCS C1713,,4920655  -  CAGE SPNL 0D 55X22X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4920660,SUP,HCPCS C1713,,4920660  -  CAGE SPNL 0D 60X22X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4920840,SUP,HCPCS C1713,,4920840  -  CAGE SPNL 0D 40X22X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4920845,SUP,HCPCS C1713,,4920845  -  CAGE SPNL 0D 45X22X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4920850,SUP,HCPCS C1713,,4920850  -  CAGE SPNL 0D 50X22X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4920855,SUP,HCPCS C1713,,4920855  -  CAGE SPNL 0D 55X22X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4920860,SUP,HCPCS C1713,,4920860  -  CAGE SPNL 0D 60X22X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4922040,SUP,HCPCS C1713,,4922040  -  CAGE SPNL 12D 40X22X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4922045,SUP,HCPCS C1713,,4922045  -  CAGE SPNL 12D 45X22X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4922050,SUP,HCPCS C1713,,4922050  -  CAGE SPNL 12D 50X22X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4922055,SUP,HCPCS C1713,,4922055  -  CAGE SPNL 12D 55X22X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4922060,SUP,HCPCS C1713,,4922060  -  CAGE SPNL 12D 60X22X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4922240,SUP,HCPCS C1713,,4922240  -  CAGE SPNL 12D 40X22X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4922245,SUP,HCPCS C1713,,4922245  -  CAGE SPNL 12D 45X22X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4922250,SUP,HCPCS C1713,,4922250  -  CAGE SPNL 12D 50X22X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4922255,SUP,HCPCS C1713,,4922255  -  CAGE SPNL 12D 55X22X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4922260,SUP,HCPCS C1713,,4922260  -  CAGE SPNL 12D 60X22X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4922440,SUP,HCPCS C1713,,4922440  -  CAGE SPNL 12D 40X22X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4922445,SUP,HCPCS C1713,,4922445  -  CAGE SPNL 12D 45X22X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4922450,SUP,HCPCS C1713,,4922450  -  CAGE SPNL 12D 50X22X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4922455,SUP,HCPCS C1713,,4922455  -  CAGE SPNL 12D 55X22X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4922460,SUP,HCPCS C1713,,4922460  -  CAGE SPNL 12D 60X22X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4922640,SUP,HCPCS C1713,,4922640  -  CAGE SPNL 12D 40X22X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4922645,SUP,HCPCS C1713,,4922645  -  CAGE SPNL 12D 45X22X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4922650,SUP,HCPCS C1713,,4922650  -  CAGE SPNL 12D 50X22X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4922655,SUP,HCPCS C1713,,4922655  -  CAGE SPNL 12D 55X22X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4922660,SUP,HCPCS C1713,,4922660  -  CAGE SPNL 12D 60X22X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4926040,SUP,HCPCS C1713,,4926040  -  CAGE SPNL 6D 40X22X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4926045,SUP,HCPCS C1713,,4926045  -  CAGE SPNL 6D 45X22X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4926050,SUP,HCPCS C1713,,4926050  -  CAGE SPNL 6D 50X22X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4926055,SUP,HCPCS C1713,,4926055  -  CAGE SPNL 6D 55X22X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4926060,SUP,HCPCS C1713,,4926060  -  CAGE SPNL 6D 60X22X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4926240,SUP,HCPCS C1713,,4926240  -  CAGE SPNL 6D 40X22X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4926245,SUP,HCPCS C1713,,4926245  -  CAGE SPNL 6D 45X22X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4926250,SUP,HCPCS C1713,,4926250  -  CAGE SPNL 6D 50X22X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4926255,SUP,HCPCS C1713,,4926255  -  CAGE SPNL 6D 55X22X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4926260,SUP,HCPCS C1713,,4926260  -  CAGE SPNL 6D 60X22X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4926440,SUP,HCPCS C1713,,4926440  -  CAGE SPNL 6D 40X22X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4926445,SUP,HCPCS C1713,,4926445  -  CAGE SPNL 6D 45X22X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4926450,SUP,HCPCS C1713,,4926450  -  CAGE SPNL 6D 50X22X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4926455,SUP,HCPCS C1713,,4926455  -  CAGE SPNL 6D 55X22X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4926460,SUP,HCPCS C1713,,4926460  -  CAGE SPNL 6D 60X22X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4926640,SUP,HCPCS C1713,,4926640  -  CAGE SPNL 6D 40X22X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4926645,SUP,HCPCS C1713,,4926645  -  CAGE SPNL 6D 45X22X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4926650,SUP,HCPCS C1713,,4926650  -  CAGE SPNL 6D 50X22X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4926655,SUP,HCPCS C1713,,4926655  -  CAGE SPNL 6D 55X22X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4926660,SUP,HCPCS C1713,,4926660  -  CAGE SPNL 6D 60X22X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4926840,SUP,HCPCS C1713,,4926840  -  CAGE SPNL 6D 40X22X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4926845,SUP,HCPCS C1713,,4926845  -  CAGE SPNL 6D 45X22X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4926850,SUP,HCPCS C1713,,4926850  -  CAGE SPNL 6D 50X22X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4926855,SUP,HCPCS C1713,,4926855  -  CAGE SPNL 6D 55X22X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4926860,SUP,HCPCS C1713,,4926860  -  CAGE SPNL 6D 60X22X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4980040,SUP,HCPCS C1713,,4980040  -  CAGE SPNL 0D 40X18X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4980045,SUP,HCPCS C1713,,4980045  -  CAGE SPNL 0D 45X18X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4980050,SUP,HCPCS C1713,,4980050  -  CAGE SPNL 0D 50X18X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4980055,SUP,HCPCS C1713,,4980055  -  CAGE SPNL 0D 55X18X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4980240,SUP,HCPCS C1713,,4980240  -  CAGE SPNL 0D 40X12X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4980245,SUP,HCPCS C1713,,4980245  -  CAGE SPNL 0D 45X12X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4980250,SUP,HCPCS C1713,,4980250  -  CAGE SPNL 0D 50X12X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4980255,SUP,HCPCS C1713,,4980255  -  CAGE SPNL 0D 55X12X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4980440,SUP,HCPCS C1713,,4980440  -  CAGE SPNL 0D 40X18X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4980445,SUP,HCPCS C1713,,4980445  -  CAGE SPNL 0D 45X18X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4980450,SUP,HCPCS C1713,,4980450  -  CAGE SPNL 0D 50X18X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4980455,SUP,HCPCS C1713,,4980455  -  CAGE SPNL 0D 55X18X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4980640,SUP,HCPCS C1713,,4980640  -  CAGE SPNL 0D 40X18X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4980645,SUP,HCPCS C1713,,4980645  -  CAGE SPNL 0D 45X18X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4980650,SUP,HCPCS C1713,,4980650  -  CAGE SPNL 0D 50X18X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4980655,SUP,HCPCS C1713,,4980655  -  CAGE SPNL 0D 55X18X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4980840,SUP,HCPCS C1713,,4980840  -  CAGE SPNL 0D 40X18X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4980845,SUP,HCPCS C1713,,4980845  -  CAGE SPNL 0D 45X18X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4980850,SUP,HCPCS C1713,,4980850  -  CAGE SPNL 0D 50X18X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4980855,SUP,HCPCS C1713,,4980855  -  CAGE SPNL 0D 55X18X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4986040,SUP,HCPCS C1713,,4986040  -  CAGE SPNL 6D 40X18X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4986045,SUP,HCPCS C1713,,4986045  -  CAGE SPNL 6D 45X18X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4986050,SUP,HCPCS C1713,,4986050  -  CAGE SPNL 6D 50X18X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4986055,SUP,HCPCS C1713,,4986055  -  CAGE SPNL 6D 55X18X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4986060,SUP,HCPCS C1713,,4986060  -  CAGE SPNL 6D 60X18X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4986240,SUP,HCPCS C1713,,4986240  -  CAGE SPNL 6D 40X18X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4986245,SUP,HCPCS C1713,,4986245  -  CAGE SPNL 6D 45X18X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4986250,SUP,HCPCS C1713,,4986250  -  CAGE SPNL 6D 50X18X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4986255,SUP,HCPCS C1713,,4986255  -  CAGE SPNL 6D 55X18X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4986260,SUP,HCPCS C1713,,4986260  -  CAGE SPNL 6D 60X18X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4986440,SUP,HCPCS C1713,,4986440  -  CAGE SPNL 6D 40X18X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4986445,SUP,HCPCS C1713,,4986445  -  CAGE SPNL 6D 45X18X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4986450,SUP,HCPCS C1713,,4986450  -  CAGE SPNL 6D 50X18X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4986455,SUP,HCPCS C1713,,4986455  -  CAGE SPNL 6D 55X18X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4986460,SUP,HCPCS C1713,,4986460  -  CAGE SPNL 6D 60X18X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4986640,SUP,HCPCS C1713,,4986640  -  CAGE SPNL 6D 40X18X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4986645,SUP,HCPCS C1713,,4986645  -  CAGE SPNL 6D 45X18X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4986650,SUP,HCPCS C1713,,4986650  -  CAGE SPNL 6D 50X18X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4986655,SUP,HCPCS C1713,,4986655  -  CAGE SPNL 6D 55X18X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4986660,SUP,HCPCS C1713,,4986660  -  CAGE SPNL 6D 60X18X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4986840,SUP,HCPCS C1713,,4986840  -  CAGE SPNL 6D 40X18X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4986845,SUP,HCPCS C1713,,4986845  -  CAGE SPNL 6D 45X18X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4986850,SUP,HCPCS C1713,,4986850  -  CAGE SPNL 6D 50X18X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4986855,SUP,HCPCS C1713,,4986855  -  CAGE SPNL 6D 55X18X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
4986860,SUP,HCPCS C1713,,4986860  -  CAGE SPNL 6D 60X18X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
5010001,SUP,HCPCS C1788,,5010001  -  DEVICE BX 6 PORT ASP BN MRW,$347.50,$0.00,$347.50,$156.38,$248.01,$0.00,$59.87,$0.00,$0.00,$60.84,$347.50,$0.00,$173.75,$275.22,$278.00,$0.00,$54.38,$0.00,$55.32,$0.00
5010005,SUP,Custom 27804086,,5010005  -  SUBSTITUTE BNGF 5ML STRL FORMAGRAFT GRNL BVN CLGN MTRX TCP,"$1,990.00",$0.00,"$1,990.00",$0.00,"$1,420.26",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,990.00",$0.00,$995.00,"$1,576.08","$1,592.00",$0.00,$0.00,$0.00,$0.00,$0.00
5010008,SUP,Custom 27203010,,5010008  -  NEEDLE SPNL 8IN ASP PORT,$347.50,$0.00,$347.50,$0.00,$248.01,$0.00,$0.00,$0.00,$0.00,$0.00,$347.50,$0.00,$173.75,$275.22,$278.00,$0.00,$0.00,$0.00,$0.00,$0.00
5010010,SUP,Custom 27804086,,5010010  -  SUBSTITUTE BNGF 10ML STRL FORMAGRAFT GRNL BVN CLGN MTRX,"$3,505.00",$0.00,"$3,505.00",$0.00,"$2,501.52",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,505.00",$0.00,"$1,752.50","$2,775.96","$2,804.00",$0.00,$0.00,$0.00,$0.00,$0.00
5010020,SUP,Custom 27804086,,5010020  -  SUBSTITUTE BNGF 20ML STRL FORMAGRAFT GRNL BVN CLGN MTRX TCP,"$3,505.00",$0.00,"$3,505.00",$0.00,"$2,501.52",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,505.00",$0.00,"$1,752.50","$2,775.96","$2,804.00",$0.00,$0.00,$0.00,$0.00,$0.00
5010024,SUP,HCPCS C1884,,5010024  -  FILTER CV .035IN LOPRFL CONE 9FR 70CM VNTC LP PROVEN DSGN,"$2,925.60",$0.00,"$2,925.60","$1,316.52","$2,088.00",$0.00,$504.07,$0.00,$0.00,$512.25,"$2,925.60",$0.00,"$1,462.80","$2,317.08","$2,340.48",$0.00,$457.86,$0.00,$465.76,$0.00
5010085,SUP,Custom 27804086,,5010085  -  SUBSTITUTE BNGF SM STRL FORMAGRAFT BLCK BVN CLGN MTRX TCP,"$4,130.00",$0.00,"$4,130.00",$0.00,"$2,947.58",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,130.00",$0.00,"$2,065.00","$3,270.96","$3,304.00",$0.00,$0.00,$0.00,$0.00,$0.00
5010125,SUP,HCPCS C1713,,5010125  -  SUBSTITUTE BNGF LG STRL FORMAGRAFT BLCK BVN CLGN MTRX TCP,"$4,462.50",$0.00,"$4,462.50","$2,008.13","$3,184.89",$0.00,$768.87,$0.00,$0.00,$781.35,"$4,462.50",$0.00,"$2,231.25","$3,534.30","$3,570.00",$0.00,$698.38,$0.00,$710.43,$0.00
5010205,SUP,Custom 27804086,,5010205  -  SUBSTITUTE BNGF 5ML STRL FORMAGRAFT STRP BVN CLGN MTRX TCP,"$1,990.00",$0.00,"$1,990.00",$0.00,"$1,420.26",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,990.00",$0.00,$995.00,"$1,576.08","$1,592.00",$0.00,$0.00,$0.00,$0.00,$0.00
5013001,SUP,HCPCS C1762,,5013001  -  GRAFT BONE OSTEOCEL PLUS CLLR BONE MTRX 1ML,"$1,222.50",$0.00,"$1,222.50",$0.00,$872.50,$0.00,$210.63,$0.00,$0.00,$0.00,"$1,222.50",$0.00,$611.25,$968.22,$978.00,$0.00,$191.32,$0.00,$0.00,$0.00
5013005,SUP,HCPCS C1762,,5013005  -  GRAFT BONE OSTEOCEL PLUS CLLR BONE MTRX 5ML,"$5,632.50",$0.00,"$5,632.50",$0.00,"$4,019.92",$0.00,$970.45,$0.00,$0.00,$0.00,"$5,632.50",$0.00,"$2,816.25","$4,460.94","$4,506.00",$0.00,$881.49,$0.00,$0.00,$0.00
5013010,SUP,Custom 27804086,,5013010  -  GRAFT BN 10ML OSTEOCEL + CLLR BN MTRX,"$9,625.00",$0.00,"$9,625.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$9,625.00",$0.00,"$4,812.50","$7,623.00","$7,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
5013015,SUP,HCPCS C1762,,5013015  -  GRAFT BONE OSTEOCEL PLUS CLLR BONE MTRX 15ML,"$11,475.00",$0.00,"$11,475.00",$0.00,"$5,158.80",$0.00,"$1,977.09",$0.00,$0.00,$0.00,"$11,475.00",$0.00,"$5,737.50","$9,088.20","$9,180.00",$0.00,"$1,795.84",$0.00,$0.00,$0.00
5016001,SUP,HCPCS C1762,,5016001  -  GRAFT BONE OSTEOCEL CLLR BONE MTRX 1ML,"$1,345.00",$0.00,"$1,345.00",$0.00,$959.93,$0.00,$231.74,$0.00,$0.00,$0.00,"$1,345.00",$0.00,$672.50,"$1,065.24","$1,076.00",$0.00,$210.49,$0.00,$0.00,$0.00
5016005,SUP,HCPCS C1762,,5016005  -  GRAFT BONE OSTEOCEL CLLR BONE MTRX 5ML,"$6,195.00",$0.00,"$6,195.00",$0.00,"$4,421.37",$0.00,"$1,067.37",$0.00,$0.00,$0.00,"$6,195.00",$0.00,"$3,097.50","$4,906.44","$4,956.00",$0.00,$969.52,$0.00,$0.00,$0.00
5016010,SUP,HCPCS C1762,,5016010  -  GRAFT BONE OSTEOCEL CLLR BONE MTRX 10ML,"$10,652.50",$0.00,"$10,652.50",$0.00,"$5,158.80",$0.00,"$1,835.37",$0.00,$0.00,$0.00,"$10,652.50",$0.00,"$5,326.25","$8,436.78","$8,522.00",$0.00,"$1,667.12",$0.00,$0.00,$0.00
5017905,SUP,HCPCS C1713,,5017905  -  SCREW BN 1.7MM 5MM NS LEIBINGER UNV 2 SLF DRL XPN TI MDFC,$147.90,$0.00,$147.90,$66.56,$105.56,$0.00,$25.48,$0.00,$0.00,$25.90,$147.90,$0.00,$73.95,$117.14,$118.32,$0.00,$23.15,$0.00,$23.55,$0.00
5020001,SUP,HCPCS C1713,,5020001  -  GRAFT BN SM STRL LF PROPEL ALGRF PTTY,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
5020005,SUP,HCPCS C1713,,5020005  -  GRAFT BN MED STRL LF PROPEL ALGRF PTTY,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
5020010,SUP,HCPCS C1713,,5020010  -  GRAFT BN LG STRL LF PROPEL ALGRF PTTY,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
5020404,SUP,HCPCS C1713,,5020404  -  SCREW BN 2MM 4MM AU NS LEIBINGER UNV 2 ST XPN TI MXLFCL,$125.93,$0.00,$125.93,$56.67,$89.87,$0.00,$21.70,$0.00,$0.00,$22.05,$125.93,$0.00,$62.96,$99.74,$100.74,$0.00,$19.71,$0.00,$20.05,$0.00
5022105,SUP,HCPCS C1713,,5022105  -  GRAFT BN MED PROPEL ALGRF DBM FBR,"$1,450.00",$0.00,"$1,450.00",$652.50,"$1,034.87",$0.00,$249.83,$0.00,$0.00,$253.88,"$1,450.00",$0.00,$725.00,"$1,148.40","$1,160.00",$0.00,$226.93,$0.00,$230.84,$0.00
5022112,SUP,HCPCS C1713,,5022112  -  GRAFT BN SM BOAT PROPEL ALGRF DBM FBR,"$1,625.00",$0.00,"$1,625.00",$731.25,"$1,159.76",$0.00,$279.98,$0.00,$0.00,$284.52,"$1,625.00",$0.00,$812.50,"$1,287.00","$1,300.00",$0.00,$254.31,$0.00,$258.70,$0.00
5022113,SUP,HCPCS C1713,,5022113  -  GRAFT BN LG BOAT PROPEL ALGRF DBM FBR,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
5030641,SUP,HCPCS C1713,,5030641  -  CAGE SPNL 11MM 14MMX6MM STRL ANTM RADOPQ PTC CRV INTRBD FS,"$5,940.00",$0.00,"$5,940.00","$2,673.00","$4,239.38",$0.00,"$1,023.43",$0.00,$0.00,"$1,040.05","$5,940.00",$0.00,"$2,970.00","$4,704.48","$4,752.00",$0.00,$929.61,$0.00,$945.65,$0.00
5101302,SUP,HCPCS C1713,,5101302  -  CAGE SPNL 12D 30X11X10MM NS CRNT PEEK ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5101308,SUP,HCPCS C1713,,5101308  -  CAGE SPNL 8D 30X11X10MM NS LF CRNT PEEK ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5104308,SUP,HCPCS C1713,,5104308  -  CAGE SPNL 8D 30MMX14MMX10 NS LF CRNT PEEK ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5109308,SUP,HCPCS C1713,,5109308  -  CAGE SPNL 8D 30X10X9MM NS LF CRNT PEEK ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5111308,SUP,HCPCS C1713,,5111308  -  CAGE SPNL 8D 30X11X11MM NS LF CRNT PEEK ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5119308,SUP,HCPCS C1713,,5119308  -  CAGE SPNL 8D 30X11X9MM NS LF CRNT PEEK ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5121308,SUP,HCPCS C1713,,5121308  -  CAGE SPNL 8D 30X12X11MM NS LF CRNT PEEK ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5129308,SUP,HCPCS C1713,,5129308  -  CAGE SPNL 8D 30X12X9MM NS LF CRNT PEEK ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5149308,SUP,HCPCS C1713,,5149308  -  CAGE SPNL 8D 30X14X9MM NS LF CRNT PEEK ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5161600,SUP,Custom 27803010,,5161600  -  ENDCAP 16MM RND 0 DEG OD16 TI XCORE 2,"$2,295.00",$0.00,"$2,295.00",$0.00,"$1,637.94",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,295.00",$0.00,"$1,147.50","$1,817.64","$1,836.00",$0.00,$0.00,$0.00,$0.00,$0.00
5161604,SUP,Custom 27803010,,5161604  -  ENDCAP 16MM RND 4 DEG OD16 TI XCORE 2,"$2,295.00",$0.00,"$2,295.00",$0.00,"$1,637.94",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,295.00",$0.00,"$1,147.50","$1,817.64","$1,836.00",$0.00,$0.00,$0.00,$0.00,$0.00
5161608,SUP,Custom 27803010,,5161608  -  ENDCAP 16MM RND 8 DEG OD16 2,"$2,295.00",$0.00,"$2,295.00",$0.00,"$1,637.94",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,295.00",$0.00,"$1,147.50","$1,817.64","$1,836.00",$0.00,$0.00,$0.00,$0.00,$0.00
5161612,SUP,Custom 27803010,,5161612  -  ENDCAP 16MM RND 12 DEG XCORE 2,"$2,295.00",$0.00,"$2,295.00",$0.00,"$1,637.94",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,295.00",$0.00,"$1,147.50","$1,817.64","$1,836.00",$0.00,$0.00,$0.00,$0.00,$0.00
5163000,SUP,Custom 27803010,,5163000  -  ENDCAP OD16X16X30MM 0 DEG TI XCORE 2,"$3,157.50",$0.00,"$3,157.50",$0.00,"$2,253.51",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,157.50",$0.00,"$1,578.75","$2,500.74","$2,526.00",$0.00,$0.00,$0.00,$0.00,$0.00
5163004,SUP,Custom 27803010,,5163004  -  ENDCAPÿ OD16X16X30MM 4 DEG TI XCORE 2,"$3,157.50",$0.00,"$3,157.50",$0.00,"$2,253.51",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,157.50",$0.00,"$1,578.75","$2,500.74","$2,526.00",$0.00,$0.00,$0.00,$0.00,$0.00
5163014,SUP,Custom 27803010,,5163014  -  ENDCAP OD16X16X30MM -4 DEG TI XCORE 2,"$3,157.50",$0.00,"$3,157.50",$0.00,"$2,253.51",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,157.50",$0.00,"$1,578.75","$2,500.74","$2,526.00",$0.00,$0.00,$0.00,$0.00,$0.00
5164000,SUP,Custom 27803010,,5164000  -  ENDCAP OD16X16X40MM 0 DEG TI XCORE 2,"$3,157.50",$0.00,"$3,157.50",$0.00,"$2,253.51",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,157.50",$0.00,"$1,578.75","$2,500.74","$2,526.00",$0.00,$0.00,$0.00,$0.00,$0.00
5164004,SUP,Custom 27803010,,5164004  -  ENDCAP OD16X16X40MM 4 DEG TI XCORE TI XCORE 2,"$3,157.50",$0.00,"$3,157.50",$0.00,"$2,253.51",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,157.50",$0.00,"$1,578.75","$2,500.74","$2,526.00",$0.00,$0.00,$0.00,$0.00,$0.00
5164014,SUP,Custom 27803010,,5164014  -  ENDCAP OD16X16X40MM -4 DEG TI OD16 TI XCORE 2,"$3,157.50",$0.00,"$3,157.50",$0.00,"$2,253.51",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,157.50",$0.00,"$1,578.75","$2,500.74","$2,526.00",$0.00,$0.00,$0.00,$0.00,$0.00
5181308,SUP,HCPCS C1713,,5181308  -  CAGE SPNL 8D 30X11X8MM NS CRNT PEEK ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5181800,SUP,Custom 27803010,,5181800  -  ENDCAP 18MM RND 0 DEG OD16 TI XCORE 2,"$2,295.00",$0.00,"$2,295.00",$0.00,"$1,637.94",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,295.00",$0.00,"$1,147.50","$1,817.64","$1,836.00",$0.00,$0.00,$0.00,$0.00,$0.00
5181804,SUP,Custom 27803010,,5181804  -  ENDCAP 18MM RND 4 DEG OD16 TI XCORE 2,"$2,295.00",$0.00,"$2,295.00",$0.00,"$1,637.94",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,295.00",$0.00,"$1,147.50","$1,817.64","$1,836.00",$0.00,$0.00,$0.00,$0.00,$0.00
5181808,SUP,Custom 27803010,,5181808  -  ENDCAP 18MM RND 8 DEG OD16 TI XCORE 2,"$2,295.00",$0.00,"$2,295.00",$0.00,"$1,637.94",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,295.00",$0.00,"$1,147.50","$1,817.64","$1,836.00",$0.00,$0.00,$0.00,$0.00,$0.00
5181812,SUP,Custom 27803010,,5181812  -  ENDCAP 18MM RND 12 DEG OD18 TI XCORE 2,"$2,295.00",$0.00,"$2,295.00",$0.00,"$1,637.94",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,295.00",$0.00,"$1,147.50","$1,817.64","$1,836.00",$0.00,$0.00,$0.00,$0.00,$0.00
5189300,SUP,HCPCS C1713,,5189300  -  CAGE SPNL 0D 30X9X8MM NS LF CRNT PEEK ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5189302,SUP,HCPCS C1713,,5189302  -  CAGE SPNL 12D 30X9X8MM NS CRNT PEEK ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5191302,SUP,HCPCS C1713,,5191302  -  CAGE SPNL 12D 30X11X9MM NS CRNT PEEK ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5191308,SUP,HCPCS C1713,,5191308  -  CAGE SPNL 8D 30X11X9MM NS LF CRNT PEEK ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5199300,SUP,HCPCS C1713,,5199300  -  CAGE SPNL 0D 30X9X9MM NS LF CRNT PEEK ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5199302,SUP,HCPCS C1713,,5199302  -  CAGE SPNL 12D 30X9X9MM NS LF CRNT PEEK ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5289308,SUP,HCPCS C1713,,5289308  -  CAGE SPNL 8D 30X9X8MM NS LF TI ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5300252,SUP,HCPCS C1713,,5300252  -  CAGE SPNL 12D OBLQ 25X10X10MM TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5300254,SUP,HCPCS C1713,,5300254  -  CAGE SPNL 4D OBLQ 25X10X10MM TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5300302,SUP,HCPCS C1713,,5300302  -  CAGE SPNL 12D OBLQ 30X10X10MM TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5300304,SUP,HCPCS C1713,,5300304  -  CAGE SPNL 4D OBLQ 30X10X10MM TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5300354,SUP,HCPCS C1713,,5300354  -  CAGE SPNL 4D OBLQ 35X10X10MM TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5304252,SUP,HCPCS C1713,,5304252  -  CAGE SPNL 12D OBLQ 25X10X14MM TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5304254,SUP,HCPCS C1713,,5304254  -  CAGE SPNL 4D OBLQ 25X10X14MM TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5304302,SUP,HCPCS C1713,,5304302  -  CAGE SPNL 12D OBLQ 30X10X14MM TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5304304,SUP,HCPCS C1713,,5304304  -  CAGE SPNL 4D OBLQ 30X10X14MM TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5320252,SUP,HCPCS C1713,,5320252  -  CAGE SPNL 12D OBLQ 25X12X10MM TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5320254,SUP,HCPCS C1713,,5320254  -  CAGE SPNL 4D OBLQ 25X12X10MM TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5320302,SUP,HCPCS C1713,,5320302  -  CAGE SPNL 12D OBLQ 30X12X10MM TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5320304,SUP,HCPCS C1713,,5320304  -  CAGE SPNL 4D OBLQ 30X12X10MM TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5320354,SUP,HCPCS C1713,,5320354  -  CAGE SPNL 4D OBLQ 35X12X10MM TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5324252,SUP,HCPCS C1713,,5324252  -  CAGE SPNL 12D OBLQ 25X12X14MM TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5324254,SUP,HCPCS C1713,,5324254  -  CAGE SPNL 4D OBLQ 25X12X14MM TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5324302,SUP,HCPCS C1713,,5324302  -  CAGE SPNL 12D OBLQ 30X12X14MM TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5324304,SUP,HCPCS C1713,,5324304  -  CAGE SPNL 4D OBLQ 30X12X14MM TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5340252,SUP,HCPCS C1713,,5340252  -  CAGE SPNL 12D OBLQ 25X14X10MM TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5340254,SUP,HCPCS C1713,,5340254  -  CAGE SPNL 4D OBLQ 25X14X10MM TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5340302,SUP,HCPCS C1713,,5340302  -  CAGE SPNL 12D OBLQ 30X14X10MM TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5340304,SUP,HCPCS C1713,,5340304  -  CAGE SPNL 4D OBLQ 30X14X10MM TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5340354,SUP,HCPCS C1713,,5340354  -  CAGE SPNL 4D OBLQ 35X14X10MM TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5380252,SUP,HCPCS C1713,,5380252  -  CAGE SPNL 12D OBLQ 25X8X10MM TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5380254,SUP,HCPCS C1713,,5380254  -  CAGE SPNL 4D OBLQ 25X8X10MM TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5380302,SUP,HCPCS C1713,,5380302  -  CAGE SPNL 12D OBLQ 30X8X10MM TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5380304,SUP,HCPCS C1713,,5380304  -  CAGE SPNL 4D OBLQ 30X8X10MM TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5380354,SUP,HCPCS C1713,,5380354  -  CAGE SPNL 4D OBLQ 35X8X10MM TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5384252,SUP,HCPCS C1713,,5384252  -  CAGE SPNL 12D OBLQ 25X8X14MM TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5384254,SUP,HCPCS C1713,,5384254  -  CAGE SPNL 4D OBLQ 25X8X14MM TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5384302,SUP,HCPCS C1713,,5384302  -  CAGE SPNL 12D OBLQ 30X8X14MM TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5384304,SUP,HCPCS C1713,,5384304  -  CAGE SPNL 4D OBLQ 30X8X14MM TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5400250,SUP,HCPCS C1713,,5400250  -  CAGE SPNL 0D OBLQ 25X10X10MM NS LF CRNT TI TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5400252,SUP,HCPCS C1713,,5400252  -  CAGE SPNL 12D OBLQ 25X10X10MM NS LF CRNT TI TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5400254,SUP,HCPCS C1713,,5400254  -  CAGE SPNL 4D OBLQ 25X10X10MM NS LF CRNT TI TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5400255,SUP,HCPCS C1713,,5400255  -  CAGE SPNL 15D OBLQ 25X10X10MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5400258,SUP,HCPCS C1713,,5400258  -  CAGE SPNL 8D OBLQ 25X10X10MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5400300,SUP,HCPCS C1713,,5400300  -  CAGE SPNL 0D OBLQ 30X10X10MM NS LF CRNT TI TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5400302,SUP,HCPCS C1713,,5400302  -  CAGE SPNL 12D OBLQ 30X10X10MM NS LF CRNT TI TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5400304,SUP,HCPCS C1713,,5400304  -  CAGE SPNL 4D OBLQ 30X10X10MM NS LF CRNT TI TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5400305,SUP,HCPCS C1713,,5400305  -  CAGE SPNL 15D OBLQ 30X10X10MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5400308,SUP,HCPCS C1713,,5400308  -  CAGE SPNL 8D OBLQ 30X10X10MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5400350,SUP,HCPCS C1713,,5400350  -  CAGE SPNL 0D OBLQ 35X10X10MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5400352,SUP,HCPCS C1713,,5400352  -  CAGE SPNL 12D OBLQ 35X10X10MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5400354,SUP,HCPCS C1713,,5400354  -  CAGE SPNL 4D OBLQ 35X10X10MM NS LF CRNT TI TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5400355,SUP,HCPCS C1713,,5400355  -  CAGE SPNL 15D OBLQ 35X10X10MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5400358,SUP,HCPCS C1713,,5400358  -  CAGE SPNL 8D OBLQ 35X10X10MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5400400,SUP,HCPCS C1713,,5400400  -  CAGE SPNL 0D OBLQ 40X10X10MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5400402,SUP,HCPCS C1713,,5400402  -  CAGE SPNL 12D OBLQ 40X10X10MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5400404,SUP,HCPCS C1713,,5400404  -  CAGE SPNL 4D OBLQ 40X10X10MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5400405,SUP,HCPCS C1713,,5400405  -  CAGE SPNL 15D OBLQ 40X10X10MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5400408,SUP,HCPCS C1713,,5400408  -  CAGE SPNL 8D OBLQ 40X10X10MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5404250,SUP,HCPCS C1713,,5404250  -  CAGE SPNL 0D OBLQ 25X14X10MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5404252,SUP,HCPCS C1713,,5404252  -  CAGE SPNL 12D OBLQ 25X14X10MM NS LF CRNT TI TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5404254,SUP,HCPCS C1713,,5404254  -  CAGE SPNL 4D OBLQ 25X14X10MM NS LF CRNT TI TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5404255,SUP,HCPCS C1713,,5404255  -  CAGE SPNL 15D OBLQ 25X14X10MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5404258,SUP,HCPCS C1713,,5404258  -  CAGE SPNL 8D OBLQ 25X14X10MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5404300,SUP,HCPCS C1713,,5404300  -  CAGE SPNL 0D OBLQ 30X14X10MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5404302,SUP,HCPCS C1713,,5404302  -  CAGE SPNL 12D OBLQ 30X14X10MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5404304,SUP,HCPCS C1713,,5404304  -  CAGE SPNL 4D OBLQ 30X14X10MM NS LF CRNT TI TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5404305,SUP,HCPCS C1713,,5404305  -  CAGE SPNL 15D OBLQ 30X14X10MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5404308,SUP,HCPCS C1713,,5404308  -  CAGE SPNL 8D OBLQ 30X14X10MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5404350,SUP,HCPCS C1713,,5404350  -  CAGE SPNL 0D OBLQ 35X14X10MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5404352,SUP,HCPCS C1713,,5404352  -  CAGE SPNL 12D OBLQ 35X14X10MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5404354,SUP,HCPCS C1713,,5404354  -  CAGE SPNL 4D OBLQ 35X14X10MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5404355,SUP,HCPCS C1713,,5404355  -  CAGE SPNL 15D OBLQ 35X14X10MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5404358,SUP,HCPCS C1713,,5404358  -  CAGE SPNL 8D OBLQ 35X14X10MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5404400,SUP,HCPCS C1713,,5404400  -  CAGE SPNL 0D OBLQ 40X14X10MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5404402,SUP,HCPCS C1713,,5404402  -  CAGE SPNL 12D OBLQ 40X14X10MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5404404,SUP,HCPCS C1713,,5404404  -  CAGE SPNL 4D OBLQ 40X14X10MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5404405,SUP,HCPCS C1713,,5404405  -  CAGE SPNL 15D OBLQ 40X14X10MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5404408,SUP,HCPCS C1713,,5404408  -  CAGE SPNL 8D OBLQ 40X14X10MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5410250,SUP,HCPCS C1713,,5410250  -  CAGE SPNL 0D OBLQ 25X10X11MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5410252,SUP,HCPCS C1713,,5410252  -  CAGE SPNL 12D OBLQ 25X10X11MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5410254,SUP,HCPCS C1713,,5410254  -  CAGE SPNL 4D OBLQ 25X10X11MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5410255,SUP,HCPCS C1713,,5410255  -  CAGE SPNL 15D OBLQ 25X10X11MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5410258,SUP,HCPCS C1713,,5410258  -  CAGE SPNL 8D OBLQ 25X10X11MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5410300,SUP,HCPCS C1713,,5410300  -  CAGE SPNL 0D OBLQ 30X10X11MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5410302,SUP,HCPCS C1713,,5410302  -  CAGE SPNL 12D OBLQ 30X10X11MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5410304,SUP,HCPCS C1713,,5410304  -  CAGE SPNL 4D OBLQ 30X10X11MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5410305,SUP,HCPCS C1713,,5410305  -  CAGE SPNL 15D OBLQ 30X10X11MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5410308,SUP,HCPCS C1713,,5410308  -  CAGE SPNL 8D OBLQ 30X10X11MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5410350,SUP,HCPCS C1713,,5410350  -  CAGE SPNL 0D OBLQ 35X10X11MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5410352,SUP,HCPCS C1713,,5410352  -  CAGE SPNL 12D OBLQ 35X10X11MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5410354,SUP,HCPCS C1713,,5410354  -  CAGE SPNL 4D OBLQ 35X10X11MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5410355,SUP,HCPCS C1713,,5410355  -  CAGE SPNL 15D OBLQ 35X10X11MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5410358,SUP,HCPCS C1713,,5410358  -  CAGE SPNL 8D OBLQ 35X10X11MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5410400,SUP,HCPCS C1713,,5410400  -  CAGE SPNL 0D OBLQ 40X10X11MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5410402,SUP,HCPCS C1713,,5410402  -  CAGE SPNL 12D OBLQ 40X10X11MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5410404,SUP,HCPCS C1713,,5410404  -  CAGE SPNL 4D OBLQ 40X10X11MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5410405,SUP,HCPCS C1713,,5410405  -  CAGE SPNL 15D OBLQ 40X10X11MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5410408,SUP,HCPCS C1713,,5410408  -  CAGE SPNL 8D OBLQ 40X10X11MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5414250,SUP,HCPCS C1713,,5414250  -  CAGE SPNL 0D OBLQ 25X14X11MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5414252,SUP,HCPCS C1713,,5414252  -  CAGE SPNL 12D OBLQ 25X14X11MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5414254,SUP,HCPCS C1713,,5414254  -  CAGE SPNL 4D OBLQ 25X14X11MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5414255,SUP,HCPCS C1713,,5414255  -  CAGE SPNL 15D OBLQ 25X14X11MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5414258,SUP,HCPCS C1713,,5414258  -  CAGE SPNL 8D OBLQ 25X14X11MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5414300,SUP,HCPCS C1713,,5414300  -  CAGE SPNL 0D OBLQ 30X14X11MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5414302,SUP,HCPCS C1713,,5414302  -  CAGE SPNL 12D OBLQ 30X14X11MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5414304,SUP,HCPCS C1713,,5414304  -  CAGE SPNL 4D OBLQ 30X14X11MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5414305,SUP,HCPCS C1713,,5414305  -  CAGE SPNL 15D OBLQ 30X14X11MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5414308,SUP,HCPCS C1713,,5414308  -  CAGE SPNL 8D OBLQ 30X14X11MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5414350,SUP,HCPCS C1713,,5414350  -  CAGE SPNL 0D OBLQ 35X14X11MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5414352,SUP,HCPCS C1713,,5414352  -  CAGE SPNL 12D OBLQ 35X14X11MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5414355,SUP,HCPCS C1713,,5414355  -  CAGE SPNL 15D OBLQ 35X14X11MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5414358,SUP,HCPCS C1713,,5414358  -  CAGE SPNL 8D OBLQ 35X14X11MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5414400,SUP,HCPCS C1713,,5414400  -  CAGE SPNL 0D OBLQ 40X14X11MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5414402,SUP,HCPCS C1713,,5414402  -  CAGE SPNL 12D OBLQ 40X14X11MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5414404,SUP,HCPCS C1713,,5414404  -  CAGE SPNL 4D OBLQ 40X14X11MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5414405,SUP,HCPCS C1713,,5414405  -  CAGE SPNL 15D OBLQ 40X14X11MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5414408,SUP,HCPCS C1713,,5414408  -  CAGE SPNL 8D OBLQ 40X14X11MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5420250,SUP,HCPCS C1713,,5420250  -  CAGE SPNL 0D OBLQ 25X10X12MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5420252,SUP,HCPCS C1713,,5420252  -  CAGE SPNL 12D OBLQ 25X10X12MM NS LF CRNT TI TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5420254,SUP,HCPCS C1713,,5420254  -  CAGE SPNL 4D OBLQ 25X10X12MM NS LF CRNT TI TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5420255,SUP,HCPCS C1713,,5420255  -  CAGE SPNL 15D OBLQ 25X10X12MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5420258,SUP,HCPCS C1713,,5420258  -  CAGE SPNL 8D OBLQ 25X10X12MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5420300,SUP,HCPCS C1713,,5420300  -  CAGE SPNL 0D OBLQ 30X10X12MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5420302,SUP,HCPCS C1713,,5420302  -  CAGE SPNL 12D OBLQ 30X10X12MM NS LF CRNT TI TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5420304,SUP,HCPCS C1713,,5420304  -  CAGE SPNL 4D OBLQ 30X10X12MM NS LF CRNT TI TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5420305,SUP,HCPCS C1713,,5420305  -  CAGE SPNL 15D OBLQ 30X10X12MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5420308,SUP,HCPCS C1713,,5420308  -  CAGE SPNL 8D OBLQ 30X10X12MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5420350,SUP,HCPCS C1713,,5420350  -  CAGE SPNL 0D OBLQ 35X10X12MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5420352,SUP,HCPCS C1713,,5420352  -  CAGE SPNL 12D OBLQ 35X10X12MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5420354,SUP,HCPCS C1713,,5420354  -  CAGE SPNL 4D OBLQ 35X10X12MM NS LF CRNT TI TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5420355,SUP,HCPCS C1713,,5420355  -  CAGE SPNL 15D OBLQ 35X10X12MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5420358,SUP,HCPCS C1713,,5420358  -  CAGE SPNL 8D OBLQ 35X10X12MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5420400,SUP,HCPCS C1713,,5420400  -  CAGE SPNL 0D OBLQ 40X10X12MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5420402,SUP,HCPCS C1713,,5420402  -  CAGE SPNL 12D OBLQ 40X10X12MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5420404,SUP,HCPCS C1713,,5420404  -  CAGE SPNL 4D OBLQ 40X10X12MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5420405,SUP,HCPCS C1713,,5420405  -  CAGE SPNL 15D OBLQ 40X10X12MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5420408,SUP,HCPCS C1713,,5420408  -  CAGE SPNL 8D OBLQ 40X10X12MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5424250,SUP,HCPCS C1713,,5424250  -  CAGE SPNL 0D OBLQ 25X14X12MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5424252,SUP,HCPCS C1713,,5424252  -  CAGE SPNL 12D OBLQ 25X14X12MM NS LF CRNT TI TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5424254,SUP,HCPCS C1713,,5424254  -  CAGE SPNL 4D OBLQ 25X14X12MM NS LF CRNT TI TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5424255,SUP,HCPCS C1713,,5424255  -  CAGE SPNL 15D OBLQ 25X14X12MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5424258,SUP,HCPCS C1713,,5424258  -  CAGE SPNL 8D OBLQ 25X14X12MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5424300,SUP,HCPCS C1713,,5424300  -  CAGE SPNL 0D OBLQ 30X14X12MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5424302,SUP,HCPCS C1713,,5424302  -  CAGE SPNL 12D OBLQ 30X14X12MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5424304,SUP,HCPCS C1713,,5424304  -  CAGE SPNL 4D OBLQ 30X14X12MM NS LF CRNT TI TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5424305,SUP,HCPCS C1713,,5424305  -  CAGE SPNL 15D OBLQ 30X14X12MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5424308,SUP,HCPCS C1713,,5424308  -  CAGE SPNL 8D OBLQ 30X14X12MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5424350,SUP,HCPCS C1713,,5424350  -  CAGE SPNL 0D OBLQ 35X14X12MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5424352,SUP,HCPCS C1713,,5424352  -  CAGE SPNL 12D OBLQ 35X14X12MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5424354,SUP,HCPCS C1713,,5424354  -  CAGE SPNL 4D OBLQ 35X14X12MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5424355,SUP,HCPCS C1713,,5424355  -  CAGE SPNL 15D OBLQ 35X14X12MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5424358,SUP,HCPCS C1713,,5424358  -  CAGE SPNL 8D OBLQ 35X14X12MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5424400,SUP,HCPCS C1713,,5424400  -  CAGE SPNL 0D OBLQ 40X14X12MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5424402,SUP,HCPCS C1713,,5424402  -  CAGE SPNL 12D OBLQ 40X14X12MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5424404,SUP,HCPCS C1713,,5424404  -  CAGE SPNL 4D OBLQ 40X14X12MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5424405,SUP,HCPCS C1713,,5424405  -  CAGE SPNL 15D OBLQ 40X14X12MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5424408,SUP,HCPCS C1713,,5424408  -  CAGE SPNL 8D OBLQ 40X14X12MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5430250,SUP,HCPCS C1713,,5430250  -  CAGE SPNL 0D OBLQ 25X10X13MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5430252,SUP,HCPCS C1713,,5430252  -  CAGE SPNL 12D OBLQ 25X10X13MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5430254,SUP,HCPCS C1713,,5430254  -  CAGE SPNL 4D OBLQ 25X10X13MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5430255,SUP,HCPCS C1713,,5430255  -  CAGE SPNL 15D OBLQ 25X10X13MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5430258,SUP,HCPCS C1713,,5430258  -  CAGE SPNL 8D OBLQ 25X10X13MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5430300,SUP,HCPCS C1713,,5430300  -  CAGE SPNL 0D OBLQ 30X10X13MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5430302,SUP,HCPCS C1713,,5430302  -  CAGE SPNL 12D OBLQ 30X10X13MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5430304,SUP,HCPCS C1713,,5430304  -  CAGE SPNL 4D OBLQ 30X10X13MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5430305,SUP,HCPCS C1713,,5430305  -  CAGE SPNL 15D OBLQ 30X10X13MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5430308,SUP,HCPCS C1713,,5430308  -  CAGE SPNL 8D OBLQ 30X10X13MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5430350,SUP,HCPCS C1713,,5430350  -  CAGE SPNL 0D OBLQ 35X10X13MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5430352,SUP,HCPCS C1713,,5430352  -  CAGE SPNL 12D OBLQ 35X10X13MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5430354,SUP,HCPCS C1713,,5430354  -  CAGE SPNL 4D OBLQ 35X10X13MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5430355,SUP,HCPCS C1713,,5430355  -  CAGE SPNL 15D OBLQ 35X10X13MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5430358,SUP,HCPCS C1713,,5430358  -  CAGE SPNL 8D OBLQ 35X10X13MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5430400,SUP,HCPCS C1713,,5430400  -  CAGE SPNL 0D OBLQ 40X10X13MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5430402,SUP,HCPCS C1713,,5430402  -  CAGE SPNL 12D OBLQ 40X10X13MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5430404,SUP,HCPCS C1713,,5430404  -  CAGE SPNL 4D OBLQ 40X10X13MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5430405,SUP,HCPCS C1713,,5430405  -  CAGE SPNL 15D OBLQ 40X10X13MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5430408,SUP,HCPCS C1713,,5430408  -  CAGE SPNL 8D OBLQ 40X10X13MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5434250,SUP,HCPCS C1713,,5434250  -  CAGE SPNL 0D OBLQ 25X14X13MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5434252,SUP,HCPCS C1713,,5434252  -  CAGE SPNL 12D OBLQ 25X14X13MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5434254,SUP,HCPCS C1713,,5434254  -  CAGE SPNL 4D OBLQ 25X14X13MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5434255,SUP,HCPCS C1713,,5434255  -  CAGE SPNL 15D OBLQ 25X14X13MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5434258,SUP,HCPCS C1713,,5434258  -  CAGE SPNL 8D OBLQ 25X14X13MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5434300,SUP,HCPCS C1713,,5434300  -  CAGE SPNL 0D OBLQ 30X14X13MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5434302,SUP,HCPCS C1713,,5434302  -  CAGE SPNL 12D OBLQ 30X14X13MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5434304,SUP,HCPCS C1713,,5434304  -  CAGE SPNL 4D OBLQ 30X14X13MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5434305,SUP,HCPCS C1713,,5434305  -  CAGE SPNL 15D OBLQ 30X14X13MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5434308,SUP,HCPCS C1713,,5434308  -  CAGE SPNL 8D OBLQ 30X14X13MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5434350,SUP,HCPCS C1713,,5434350  -  CAGE SPNL 0D OBLQ 35X14X13MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5434352,SUP,HCPCS C1713,,5434352  -  CAGE SPNL 12D OBLQ 35X14X13MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5434354,SUP,HCPCS C1713,,5434354  -  CAGE SPNL 4D OBLQ 35X14X13MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5434355,SUP,HCPCS C1713,,5434355  -  CAGE SPNL 15D OBLQ 35X14X13MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5434358,SUP,HCPCS C1713,,5434358  -  CAGE SPNL 8D OBLQ 35X14X13MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5434400,SUP,HCPCS C1713,,5434400  -  CAGE SPNL 0D OBLQ 40X14X13MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5434402,SUP,HCPCS C1713,,5434402  -  CAGE SPNL 12D OBLQ 40X14X13MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5434404,SUP,HCPCS C1713,,5434404  -  CAGE SPNL 4D OBLQ 40X14X13MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5434405,SUP,HCPCS C1713,,5434405  -  CAGE SPNL 15D OBLQ 40X14X13MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5434408,SUP,HCPCS C1713,,5434408  -  CAGE SPNL 8D OBLQ 40X14X13MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5440030,SUP,HCPCS C1713,,5440030  -  SET SCREW 5440030 4.75 TI NS BRK OFF,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
5440130,SUP,HCPCS C1713,,5440130  -  SET SCREW 5440130 4.75 TI NS NON BRK OFF,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
5440230,SUP,HCPCS C1713,,5440230  -  SET SCREW 5440230 4.75 TI NS RED BRK OFF,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
5440250,SUP,HCPCS C1713,,5440250  -  CAGE SPNL 0D OBLQ 25X10X14MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5440252,SUP,HCPCS C1713,,5440252  -  CAGE SPNL 12D OBLQ 25X10X14MM NS LF CRNT TI TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5440254,SUP,HCPCS C1713,,5440254  -  CAGE SPNL 4D OBLQ 25X10X14MM NS LF CRNT TI TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5440255,SUP,HCPCS C1713,,5440255  -  CAGE SPNL 15D OBLQ 25X10X14MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5440258,SUP,HCPCS C1713,,5440258  -  CAGE SPNL 8D OBLQ 25X10X14MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5440300,SUP,HCPCS C1713,,5440300  -  CAGE SPNL 0D OBLQ 30X10X14MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5440302,SUP,HCPCS C1713,,5440302  -  CAGE SPNL 12D OBLQ 30X10X14MM NS LF CRNT TI TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5440304,SUP,HCPCS C1713,,5440304  -  CAGE SPNL 4D OBLQ 30X10X14MM NS LF CRNT TI TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5440305,SUP,HCPCS C1713,,5440305  -  CAGE SPNL 15D OBLQ 30X10X14MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5440308,SUP,HCPCS C1713,,5440308  -  CAGE SPNL 8D OBLQ 30X10X14MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5440350,SUP,HCPCS C1713,,5440350  -  CAGE SPNL 0D OBLQ 35X10X14MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5440352,SUP,HCPCS C1713,,5440352  -  CAGE SPNL 12D OBLQ 35X10X14MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5440355,SUP,HCPCS C1713,,5440355  -  CAGE SPNL 15D OBLQ 35X10X14MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5440358,SUP,HCPCS C1713,,5440358  -  CAGE SPNL 8D OBLQ 35X10X14MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5440400,SUP,HCPCS C1713,,5440400  -  CAGE SPNL 0D OBLQ 40X10X14MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5440402,SUP,HCPCS C1713,,5440402  -  CAGE SPNL 12D OBLQ 40X10X14MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5440404,SUP,HCPCS C1713,,5440404  -  CAGE SPNL 4D OBLQ 40X10X14MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5440405,SUP,HCPCS C1713,,5440405  -  CAGE SPNL 15D OBLQ 40X10X14MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5440408,SUP,HCPCS C1713,,5440408  -  CAGE SPNL 8D OBLQ 40X10X14MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5440430,SUP,HCPCS C1713,,5440430  -  SCREW SET BREAKOFF SOLERA SEXTANT CD HORIZON TITANIUM SPN,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
5441101,SUP,HCPCS C1713,,5441101  -  HOOK 5441101 4.75 TI NS PEDICLE  XSML,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
5441102,SUP,HCPCS C1713,,5441102  -  HOOK 5441102 PEDICLE 4.75 SM TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
5441103,SUP,HCPCS C1713,,5441103  -  HOOK 5441103 PEDICLE 4.75 MD TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
5441104,SUP,HCPCS C1713,,5441104  -  HOOK 5441104 PEDICLE 4.75 LG TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
5441112,SUP,HCPCS C1713,,5441112  -  HOOK 5441112 WIDE BLADE 4.75 SM TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
5441113,SUP,HCPCS C1713,,5441113  -  HOOK 5441113 WIDE BLADE 4.75 MD TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
5441114,SUP,HCPCS C1713,,5441114  -  HOOK 5441114 WIDE BLADE 4.75 LG TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
5441122,SUP,HCPCS C1713,,5441122  -  HOOK 5441122 NARROW BLADE 4.75 SM TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
5441123,SUP,HCPCS C1713,,5441123  -  HOOK 5441123 NARROW BLADE 4.75 MD TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
5441124,SUP,HCPCS C1713,,5441124  -  HOOK 5441124 NARROW BLADE 4.75 LG TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
5441133,SUP,HCPCS C1713,,5441133  -  HOOK 5441133 RAMP WIDE BLADE 4.75 MD TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
5441142,SUP,HCPCS C1713,,5441142  -  HOOK 5441142 RMP NRW BLADE 4.75 SM TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
5441143,SUP,HCPCS C1713,,5441143  -  HOOK 5441143 RMP NRW BLADE 4.75 MD TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
5441172,SUP,HCPCS C1713,,5441172  -  HOOK 5441172 EXTENDED BODY 4.75 SM TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
5441173,SUP,HCPCS C1713,,5441173  -  HOOK 5441173 EXTENDED BODY 4.75 MD TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
5441174,SUP,HCPCS C1713,,5441174  -  HOOK 5441174 EXTENDED BODY 4.75 LG TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
5441196,SUP,HCPCS C1713,,5441196  -  HOOK 5441196 4.75 TI NS OFFSET SML RT,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
5441197,SUP,HCPCS C1713,,5441197  -  HOOK 5441197 4.75 TI NS OFFSET SML LEFT,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
5441198,SUP,HCPCS C1713,,5441198  -  HOOK 5441198 OFFSET 4.75 RIGHT TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
5441199,SUP,HCPCS C1713,,5441199  -  HOOK 5441199 OFFSET 4.75 LEFT TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
5441302,SUP,HCPCS C1713,,5441302  -  HOOK 5441302 4.75 TI NS TAH PEDICLE SML,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
5441303,SUP,HCPCS C1713,,5441303  -  HOOK 5441303 4.75 TI NS TAH PEDICLE MED,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
5441342,SUP,HCPCS C1713,,5441342  -  HOOK 5441342 4.75 TI NS TAH TRAN PRO SML,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
5441343,SUP,HCPCS C1713,,5441343  -  HOOK 5441343 4.75 TI NS TAH TRAN PRO MED,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
5442016,SUP,HCPCS C1713,,5442016  -  CROSSLINK 5442016 4.75 TI NS FIXED 16MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
5442019,SUP,HCPCS C1713,,5442019  -  CROSSLINK 5442019 4.75 TI NS FIXED 19MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
5442022,SUP,HCPCS C1713,,5442022  -  CROSSLINK 5442022 4.75 TI NS FIXED 22MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
5442025,SUP,HCPCS C1713,,5442025  -  CROSSLINK 5442025 4.75 TI NS FIXED 25MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
5442028,SUP,HCPCS C1713,,5442028  -  CROSSLINK 5442028 4.75 TI NS FIXED 28MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
5442031,SUP,HCPCS C1713,,5442031  -  CROSSLINK 5442031 4.75 TI NS FIXED 31MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
5442034,SUP,HCPCS C1713,,5442034  -  CROSSLINK 5442034 4.75 TI NS FIXED 34MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
5442037,SUP,HCPCS C1713,,5442037  -  CROSSLINK 5442037 4.75 TI NS FIXED 37MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
5442130,SUP,HCPCS C1713,,5442130  -  PLATE BN 30-32MM NS SOLERA X10 XLNK CD HZN MLSPN TI SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
5442132,SUP,HCPCS C1713,,5442132  -  PLATE BN 32-37MM NS SOLERA X10 XLNK CD HZN MLSPN TI SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
5442136,SUP,HCPCS C1713,,5442136  -  PLATE BN 36-38MM NS SOLERA X10 XLNK CD HZN MLSPN TI SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
5442138,SUP,HCPCS C1713,,5442138  -  PLATE BN 38-42MM NS SOLERA X10 XLNK CD HZN MLSPN TI SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
5442141,SUP,HCPCS C1713,,5442141  -  PLATE BN 41-48MM NS SOLERA X10 XLNK CD HZN MLSPN TI SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
5442144,SUP,HCPCS C1713,,5442144  -  CROSSLINK 5442144 4.75X10 MLTSPN 44-54MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
5442147,SUP,HCPCS C1713,,5442147  -  PLATE BN 47-60MM NS SOLERA X10 XLNK CD HZN MLSPN TI SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
5442152,SUP,HCPCS C1713,,5442152  -  CROSSLINK 5442152 4.75X10 MLTSPN 52-70MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
5442160,SUP,HCPCS C1713,,5442160  -  CROSSLINK 5442160 4.75X10 MLTSPN 60-86MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
5443110,SUP,Custom 27803010,,5443110  -  CONNECTOR 5443110 475/635 TI CL ILC 10MM,"$1,929.00",$0.00,"$1,929.00",$0.00,"$1,376.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,929.00",$0.00,$964.50,"$1,527.77","$1,543.20",$0.00,$0.00,$0.00,$0.00,$0.00
5443120,SUP,Custom 27803010,,5443120  -  CONNECTOR 5443120 475/635 TI CL ILC 20MM,"$1,929.00",$0.00,"$1,929.00",$0.00,"$1,376.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,929.00",$0.00,$964.50,"$1,527.77","$1,543.20",$0.00,$0.00,$0.00,$0.00,$0.00
5443130,SUP,Custom 27803010,,5443130  -  CONNECTOR 5443130 475/635 TI CL ILC 30MM,"$1,929.00",$0.00,"$1,929.00",$0.00,"$1,376.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,929.00",$0.00,$964.50,"$1,527.77","$1,543.20",$0.00,$0.00,$0.00,$0.00,$0.00
5443160,SUP,Custom 27803010,,5443160  -  CONNECTOR 5443160 475/635 TI CL ILC 60MM,"$1,929.00",$0.00,"$1,929.00",$0.00,"$1,376.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,929.00",$0.00,$964.50,"$1,527.77","$1,543.20",$0.00,$0.00,$0.00,$0.00,$0.00
5444250,SUP,HCPCS C1713,,5444250  -  CAGE SPNL 0D OBLQ 25X14X14MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5444252,SUP,HCPCS C1713,,5444252  -  CAGE SPNL 12D OBLQ 25X14X14MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5444254,SUP,HCPCS C1713,,5444254  -  CAGE SPNL 4D OBLQ 25X14X14MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5444255,SUP,HCPCS C1713,,5444255  -  CAGE SPNL 15D OBLQ 25X14X14MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5444258,SUP,HCPCS C1713,,5444258  -  CAGE SPNL 8D OBLQ 25X14X14MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5444300,SUP,HCPCS C1713,,5444300  -  CAGE SPNL 0D OBLQ 30X14X14MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5444302,SUP,HCPCS C1713,,5444302  -  CAGE SPNL 12D OBLQ 30X14X14MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5444304,SUP,HCPCS C1713,,5444304  -  CAGE SPNL 4D OBLQ 30X14X14MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5444305,SUP,HCPCS C1713,,5444305  -  CAGE SPNL 15D OBLQ 30X14X14MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5444308,SUP,HCPCS C1713,,5444308  -  CAGE SPNL 8D OBLQ 30X14X14MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5444350,SUP,HCPCS C1713,,5444350  -  CAGE SPNL 0D OBLQ 35X14X14MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5444352,SUP,HCPCS C1713,,5444352  -  CAGE SPNL 12D OBLQ 35X14X14MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5444354,SUP,HCPCS C1713,,5444354  -  CAGE SPNL 4D OBLQ 35X14X14MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5444355,SUP,HCPCS C1713,,5444355  -  CAGE SPNL 15D OBLQ 35X14X14MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5444358,SUP,HCPCS C1713,,5444358  -  CAGE SPNL 8D OBLQ 35X14X14MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5444400,SUP,HCPCS C1713,,5444400  -  CAGE SPNL 0D OBLQ 40X14X14MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5444402,SUP,HCPCS C1713,,5444402  -  CAGE SPNL 12D OBLQ 40X14X14MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5444404,SUP,HCPCS C1713,,5444404  -  CAGE SPNL 4D OBLQ 40X14X14MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5444405,SUP,HCPCS C1713,,5444405  -  CAGE SPNL 15D OBLQ 40X14X14MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5444408,SUP,HCPCS C1713,,5444408  -  CAGE SPNL 8D OBLQ 40X14X14MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5460250,SUP,HCPCS C1713,,5460250  -  CAGE SPNL 0D OBLQ 25X10X6MM NS LF CRNT TI TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5460252,SUP,HCPCS C1713,,5460252  -  CAGE SPNL 12D OBLQ 25X10X6MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5460254,SUP,HCPCS C1713,,5460254  -  CAGE SPNL 4D OBLQ 25X10X6MM NS LF CRNT TI TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5460255,SUP,HCPCS C1713,,5460255  -  CAGE SPNL 15D OBLQ 25X10X6MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5460258,SUP,HCPCS C1713,,5460258  -  CAGE SPNL 8D OBLQ 25X10X6MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5460300,SUP,HCPCS C1713,,5460300  -  CAGE SPNL 0D OBLQ 30X10X6MM NS LF CRNT TI TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5460302,SUP,HCPCS C1713,,5460302  -  CAGE SPNL 12D OBLQ 30X10X6MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5460304,SUP,HCPCS C1713,,5460304  -  CAGE SPNL 4D OBLQ 30X10X6MM NS LF CRNT TI TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5460305,SUP,HCPCS C1713,,5460305  -  CAGE SPNL 15D OBLQ 30X10X6MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5460308,SUP,HCPCS C1713,,5460308  -  CAGE SPNL 8D OBLQ 30X10X6MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5460350,SUP,HCPCS C1713,,5460350  -  CAGE SPNL 0D OBLQ 35X10X6MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5460352,SUP,HCPCS C1713,,5460352  -  CAGE SPNL 12D OBLQ 35X10X6MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5460354,SUP,HCPCS C1713,,5460354  -  CAGE SPNL 4D OBLQ 35X10X6MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5460355,SUP,HCPCS C1713,,5460355  -  CAGE SPNL 15D OBLQ 35X10X6MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5460358,SUP,HCPCS C1713,,5460358  -  CAGE SPNL 8D OBLQ 35X10X6MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5460400,SUP,HCPCS C1713,,5460400  -  CAGE SPNL 0D OBLQ 40X10X6MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5460402,SUP,HCPCS C1713,,5460402  -  CAGE SPNL 12D OBLQ 40X10X6MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5460404,SUP,HCPCS C1713,,5460404  -  CAGE SPNL 4D OBLQ 40X10X6MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5460405,SUP,HCPCS C1713,,5460405  -  CAGE SPNL 15D OBLQ 40X10X6MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5460408,SUP,HCPCS C1713,,5460408  -  CAGE SPNL 8D OBLQ 40X10X6MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5464250,SUP,HCPCS C1713,,5464250  -  CAGE SPNL 0D OBLQ 25X14X6MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5464252,SUP,HCPCS C1713,,5464252  -  CAGE SPNL 12D OBLQ 25X14X6MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5464254,SUP,HCPCS C1713,,5464254  -  CAGE SPNL 4D OBLQ 25X14X6MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5464255,SUP,HCPCS C1713,,5464255  -  CAGE SPNL 15D OBLQ 25X14X6MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5464258,SUP,HCPCS C1713,,5464258  -  CAGE SPNL 8D OBLQ 25X14X6MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5464300,SUP,HCPCS C1713,,5464300  -  CAGE SPNL 0D OBLQ 30X14X6MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5464302,SUP,HCPCS C1713,,5464302  -  CAGE SPNL 12D OBLQ 30X14X6MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5464304,SUP,HCPCS C1713,,5464304  -  CAGE SPNL 4D OBLQ 30X14X6MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5464305,SUP,HCPCS C1713,,5464305  -  CAGE SPNL 15D OBLQ 30X14X6MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5464308,SUP,HCPCS C1713,,5464308  -  CAGE SPNL 8D OBLQ 30X14X6MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5464350,SUP,HCPCS C1713,,5464350  -  CAGE SPNL 0D OBLQ 35X14X6MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5464352,SUP,HCPCS C1713,,5464352  -  CAGE SPNL 12D OBLQ 35X14X6MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5464354,SUP,HCPCS C1713,,5464354  -  CAGE SPNL 4D OBLQ 35X14X6MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5464355,SUP,HCPCS C1713,,5464355  -  CAGE SPNL 15D OBLQ 35X14X6MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5464358,SUP,HCPCS C1713,,5464358  -  CAGE SPNL 8D OBLQ 35X14X6MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5464400,SUP,HCPCS C1713,,5464400  -  CAGE SPNL 0D OBLQ 40X14X6MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5464402,SUP,HCPCS C1713,,5464402  -  CAGE SPNL 12D OBLQ 40X14X6MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5464404,SUP,HCPCS C1713,,5464404  -  CAGE SPNL 4D OBLQ 40X14X6MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5464405,SUP,HCPCS C1713,,5464405  -  CAGE SPNL 15D OBLQ 40X14X6MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5464408,SUP,HCPCS C1713,,5464408  -  CAGE SPNL 8D OBLQ 40X14X6MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5470250,SUP,HCPCS C1713,,5470250  -  CAGE SPNL 0D OBLQ 25X10X7MM NS LF CRNT TI TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5470252,SUP,HCPCS C1713,,5470252  -  CAGE SPNL 12D OBLQ 25X10X7MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5470254,SUP,HCPCS C1713,,5470254  -  CAGE SPNL 4D OBLQ 25X10X7MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5470255,SUP,HCPCS C1713,,5470255  -  CAGE SPNL 15D OBLQ 25X10X7MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5470258,SUP,HCPCS C1713,,5470258  -  CAGE SPNL 8D OBLQ 25X10X7MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5470300,SUP,HCPCS C1713,,5470300  -  CAGE SPNL 0D OBLQ 30X10X7MM NS LF CRNT TI TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5470302,SUP,HCPCS C1713,,5470302  -  CAGE SPNL 12D OBLQ 30X10X7MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5470304,SUP,HCPCS C1713,,5470304  -  CAGE SPNL 4D OBLQ 30X10X7MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5470305,SUP,HCPCS C1713,,5470305  -  CAGE SPNL 15D OBLQ 30X10X7MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5470308,SUP,HCPCS C1713,,5470308  -  CAGE SPNL 8D OBLQ 30X10X7MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5470350,SUP,HCPCS C1713,,5470350  -  CAGE SPNL 0D OBLQ 35X10X7MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5470352,SUP,HCPCS C1713,,5470352  -  CAGE SPNL 12D OBLQ 35X10X7MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5470354,SUP,HCPCS C1713,,5470354  -  CAGE SPNL 4D OBLQ 35X10X7MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5470355,SUP,HCPCS C1713,,5470355  -  CAGE SPNL 15D OBLQ 35X10X7MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5470358,SUP,HCPCS C1713,,5470358  -  CAGE SPNL 8D OBLQ 35X10X7MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5470400,SUP,HCPCS C1713,,5470400  -  CAGE SPNL 0D OBLQ 40X10X7MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5470402,SUP,HCPCS C1713,,5470402  -  CAGE SPNL 12D OBLQ 40X10X7MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5470404,SUP,HCPCS C1713,,5470404  -  CAGE SPNL 4D OBLQ 40X10X7MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5470405,SUP,HCPCS C1713,,5470405  -  CAGE SPNL 15D OBLQ 40X10X7MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5470408,SUP,HCPCS C1713,,5470408  -  CAGE SPNL 8D OBLQ 40X10X7MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5474250,SUP,HCPCS C1713,,5474250  -  CAGE SPNL 0D OBLQ 25X14X7MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5474252,SUP,HCPCS C1713,,5474252  -  CAGE SPNL 12D OBLQ 25X14X7MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5474254,SUP,HCPCS C1713,,5474254  -  CAGE SPNL 4D OBLQ 25X14X7MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5474255,SUP,HCPCS C1713,,5474255  -  CAGE SPNL 15D OBLQ 25X14X7MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5474258,SUP,HCPCS C1713,,5474258  -  CAGE SPNL 8D OBLQ 25X14X7MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5474300,SUP,HCPCS C1713,,5474300  -  CAGE SPNL 0D OBLQ 30X14X7MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5474302,SUP,HCPCS C1713,,5474302  -  CAGE SPNL 12D OBLQ 30X14X7MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5474304,SUP,HCPCS C1713,,5474304  -  CAGE SPNL 4D OBLQ 30X14X7MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5474305,SUP,HCPCS C1713,,5474305  -  CAGE SPNL 15D OBLQ 30X14X7MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5474308,SUP,HCPCS C1713,,5474308  -  CAGE SPNL 8D OBLQ 30X14X7MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5474350,SUP,HCPCS C1713,,5474350  -  CAGE SPNL 0D OBLQ 35X14X7MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5474352,SUP,HCPCS C1713,,5474352  -  CAGE SPNL 12D OBLQ 35X14X7MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5474355,SUP,HCPCS C1713,,5474355  -  CAGE SPNL 15D OBLQ 35X14X7MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5474358,SUP,HCPCS C1713,,5474358  -  CAGE SPNL 8D OBLQ 35X14X7MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5474400,SUP,HCPCS C1713,,5474400  -  CAGE SPNL 0D OBLQ 40X14X7MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5474402,SUP,HCPCS C1713,,5474402  -  CAGE SPNL 12D OBLQ 40X14X7MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5474404,SUP,HCPCS C1713,,5474404  -  CAGE SPNL 4D OBLQ 40X14X7MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5474405,SUP,HCPCS C1713,,5474405  -  CAGE SPNL 15D OBLQ 40X14X7MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5474408,SUP,HCPCS C1713,,5474408  -  CAGE SPNL 8D OBLQ 40X14X7MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5475525,SUP,HCPCS C1713,,5475525  -  SCREW BN 5.5MM 25MM NS CRNT FX ANG SPNE XLF SYS,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
5475540,SUP,HCPCS C1713,,5475540  -  SCREW BN 5.5MM 40MM NS CRNT FX ANG SPNE XLF SYS,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
5475545,SUP,HCPCS C1713,,5475545  -  SCREW BN 5.5MM 45MM NS CRNT FX ANG SPNE XLF SYS,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
5475550,SUP,HCPCS C1713,,5475550  -  SCREW BN 5.5MM 50MM NS CRNT FX ANG SPNE XLF SYS,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
5475555,SUP,HCPCS C1713,,5475555  -  SCREW BN 5.5MM 55MM NS CRNT FX ANG SPNE XLF SYS,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
5475560,SUP,HCPCS C1713,,5475560  -  SCREW BN 5.5MM 60MM NS CRNT FX ANG SPNE XLF SYS,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
5475565,SUP,HCPCS C1713,,5475565  -  SCREW BN 5.5MM 65MM CRNT XLIF FX SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
5475570,SUP,HCPCS C1713,,5475570  -  SCREW BN 5.5MM 70MM CRNT XLIF FX SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
5476525,SUP,HCPCS C1713,,5476525  -  SCREW BN 6.5MM 25MM CRNT XLIF FX SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
5476540,SUP,HCPCS C1713,,5476540  -  SCREW BN 6.5MM 40MM CRNT XLIF FX SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
5476545,SUP,HCPCS C1713,,5476545  -  SCREW BN 6.5MM 45MM CRNT XLIF FX SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
5476550,SUP,HCPCS C1713,,5476550  -  SCREW BN 6.5MM 50MM CRNT XLIF FX SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
5476555,SUP,HCPCS C1713,,5476555  -  SCREW BN 6.5MM 55MM FX SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
5476560,SUP,HCPCS C1713,,5476560  -  SCREW BN 6.5MM 60MM CRNT XLIF FX SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
5476565,SUP,HCPCS C1713,,5476565  -  SCREW BN 6.5MM 65MM CRNT XLIF FX SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
5476570,SUP,HCPCS C1713,,5476570  -  SCREW BN 6.5MM 70MM CRNT XLIF FX SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
5480250,SUP,HCPCS C1713,,5480250  -  CAGE SPNL 0D OBLQ 25X10X8MM NS LF CRNT TI TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5480252,SUP,HCPCS C1713,,5480252  -  CAGE SPNL 12D OBLQ 25X10X8MM NS LF CRNT TI TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5480254,SUP,HCPCS C1713,,5480254  -  CAGE SPNL 4D OBLQ 25X10X8MM NS LF CRNT TI TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5480255,SUP,HCPCS C1713,,5480255  -  CAGE SPNL 15D OBLQ 25X10X8MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5480258,SUP,HCPCS C1713,,5480258  -  CAGE SPNL 8D OBLQ 25X10X8MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5480300,SUP,HCPCS C1713,,5480300  -  CAGE SPNL 0D OBLQ 30X10X8MM NS LF CRNT TI TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5480302,SUP,HCPCS C1713,,5480302  -  CAGE SPNL 12D OBLQ 30X10X8MM NS LF CRNT TI TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5480304,SUP,HCPCS C1713,,5480304  -  CAGE SPNL 4D OBLQ 30X10X8MM NS LF CRNT TI TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5480305,SUP,HCPCS C1713,,5480305  -  CAGE SPNL 15D OBLQ 30X10X8MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5480308,SUP,HCPCS C1713,,5480308  -  CAGE SPNL 8D OBLQ 30X10X8MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5480350,SUP,HCPCS C1713,,5480350  -  CAGE SPNL 0D OBLQ 35X10X8MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5480352,SUP,HCPCS C1713,,5480352  -  CAGE SPNL 12D OBLQ 35X10X8MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5480354,SUP,HCPCS C1713,,5480354  -  CAGE SPNL 4D OBLQ 35X10X8MM NS LF CRNT TI TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5480355,SUP,HCPCS C1713,,5480355  -  CAGE SPNL 15D OBLQ 35X10X8MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5480358,SUP,HCPCS C1713,,5480358  -  CAGE SPNL 8D OBLQ 35X10X8MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5480400,SUP,HCPCS C1713,,5480400  -  CAGE SPNL 0D OBLQ 40X10X8MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5480402,SUP,HCPCS C1713,,5480402  -  CAGE SPNL 12D OBLQ 40X10X8MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5480404,SUP,HCPCS C1713,,5480404  -  CAGE SPNL 4D OBLQ 40X10X8MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5480405,SUP,HCPCS C1713,,5480405  -  CAGE SPNL 15D OBLQ 40X10X8MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5480408,SUP,HCPCS C1713,,5480408  -  CAGE SPNL 8D OBLQ 40X10X8MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5484250,SUP,HCPCS C1713,,5484250  -  CAGE SPNL 0D OBLQ 25X14X8MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5484252,SUP,HCPCS C1713,,5484252  -  CAGE SPNL 12D OBLQ 25X14X8MM NS LF CRNT TI TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5484254,SUP,HCPCS C1713,,5484254  -  CAGE SPNL 4D OBLQ 25X14X8MM NS LF CRNT TI TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5484258,SUP,HCPCS C1713,,5484258  -  CAGE SPNL 8D OBLQ 25X14X8MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5484300,SUP,HCPCS C1713,,5484300  -  CAGE SPNL 0D OBLQ 30X14X8MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5484350,SUP,HCPCS C1713,,5484350  -  CAGE SPNL 0D OBLQ 35X14X8MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5484352,SUP,HCPCS C1713,,5484352  -  CAGE SPNL 12D OBLQ 35X14X8MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5484354,SUP,HCPCS C1713,,5484354  -  CAGE SPNL 4D OBLQ 35X14X8MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5484355,SUP,HCPCS C1713,,5484355  -  CAGE SPNL 15D OBLQ 35X14X8MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5484358,SUP,HCPCS C1713,,5484358  -  CAGE SPNL 8D OBLQ 35X14X8MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5484400,SUP,HCPCS C1713,,5484400  -  CAGE SPNL 0D OBLQ 40X14X8MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5484402,SUP,HCPCS C1713,,5484402  -  CAGE SPNL 12D OBLQ 40X14X8MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5484404,SUP,HCPCS C1713,,5484404  -  CAGE SPNL 4D OBLQ 40X14X8MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5484405,SUP,HCPCS C1713,,5484405  -  CAGE SPNL 15D OBLQ 40X14X8MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5484408,SUP,HCPCS C1713,,5484408  -  CAGE SPNL 8D OBLQ 40X14X8MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5485525,SUP,HCPCS C1713,,5485525  -  SCREW BONE 5.5MM 25MM VARIABLE COROENT XLF SPN,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
5485540,SUP,HCPCS C1713,,5485540  -  SCREW BN 5.5MM 40MM NS CRNT VA SPNE XLF SYS,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
5485545,SUP,HCPCS C1713,,5485545  -  SCREW BN 5.5MM 45MM NS CRNT VA SPNE XLF SYS,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
5485550,SUP,HCPCS C1713,,5485550  -  SCREW BN 5.5MM 50MM CRNT XLF VA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
5485555,SUP,HCPCS C1713,,5485555  -  SCREW BN 5.5MM 55MM NS CRNT VA SPNE XLF SYS,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
5485560,SUP,HCPCS C1713,,5485560  -  SCREW BN 5.5MM 60MM NS CRNT VA SPNE XLF SYS,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
5485565,SUP,HCPCS C1713,,5485565  -  SCREW BN 5.5MM 65MM NS CRNT VA SPNE XLF SYS,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
5485570,SUP,HCPCS C1713,,5485570  -  SCREW BN 5.5MM 70MM CRNT XLF VAR SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
5486525,SUP,HCPCS C1713,,5486525  -  SCREW BN 6.5MM 25MM NS CRNT VA SPNE XLF SYS,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
5486540,SUP,HCPCS C1713,,5486540  -  SCREW BN 6.5MM 40MM NS CRNT VA SPNE XLF SYS,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
5486545,SUP,HCPCS C1713,,5486545  -  SCREW BN 6.5MM 45MM NS CRNT VA SPNE XLF SYS,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
5486550,SUP,HCPCS C1713,,5486550  -  SCREW BN 6.5MM 50MM NS CRNT VA SPNE XLF SYS,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
5486555,SUP,HCPCS C1713,,5486555  -  SCREW BN 6.5MM 55MM NS CRNT VA SPNE XLF SYS,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
5486560,SUP,HCPCS C1713,,5486560  -  SCREW BN 6.5MM 60MM NS CRNT VA SPNE XLF SYS,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
5486565,SUP,HCPCS C1713,,5486565  -  SCREW BN 6.5MM 65MM CRNT XLF VAR SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
5486570,SUP,HCPCS C1713,,5486570  -  SCREW BN 6.5MM 70MM CRNT XLF VAR SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
5490250,SUP,HCPCS C1713,,5490250  -  CAGE SPNL 0D OBLQ 25X10X9MM NS LF CRNT TI TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5490252,SUP,HCPCS C1713,,5490252  -  CAGE SPNL 12D OBLQ 25X10X9MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5490254,SUP,HCPCS C1713,,5490254  -  CAGE SPNL 4D OBLQ 25X10X9MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5490255,SUP,HCPCS C1713,,5490255  -  CAGE SPNL 15D OBLQ 25X10X9MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5490258,SUP,HCPCS C1713,,5490258  -  CAGE SPNL 8D OBLQ 25X10X9MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5490300,SUP,HCPCS C1713,,5490300  -  CAGE SPNL 0D OBLQ 30X10X9MM NS LF CRNT TI TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5490302,SUP,HCPCS C1713,,5490302  -  CAGE SPNL 12D OBLQ 30X10X9MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5490304,SUP,HCPCS C1713,,5490304  -  CAGE SPNL 4D OBLQ 30X10X9MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5490305,SUP,HCPCS C1713,,5490305  -  CAGE SPNL 15D OBLQ 30X10X9MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5490308,SUP,HCPCS C1713,,5490308  -  CAGE SPNL 8D OBLQ 30X10X9MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5490350,SUP,HCPCS C1713,,5490350  -  CAGE SPNL 0D OBLQ 35X10X9MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5490352,SUP,HCPCS C1713,,5490352  -  CAGE SPNL 12D OBLQ 35X10X9MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5490354,SUP,HCPCS C1713,,5490354  -  CAGE SPNL 4D OBLQ 35X10X9MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5490355,SUP,HCPCS C1713,,5490355  -  CAGE SPNL 15D OBLQ 35X10X9MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5490358,SUP,HCPCS C1713,,5490358  -  CAGE SPNL 8D OBLQ 35X10X9MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5490400,SUP,HCPCS C1713,,5490400  -  CAGE SPNL 0D OBLQ 40X10X9MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5490402,SUP,HCPCS C1713,,5490402  -  CAGE SPNL 12D OBLQ 40X10X9MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5490404,SUP,HCPCS C1713,,5490404  -  CAGE SPNL 4D OBLQ 40X10X9MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5490405,SUP,HCPCS C1713,,5490405  -  CAGE SPNL 15D OBLQ 40X10X9MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5490408,SUP,HCPCS C1713,,5490408  -  CAGE SPNL 8D OBLQ 40X10X9MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5494250,SUP,HCPCS C1713,,5494250  -  CAGE SPNL 0D OBLQ 25X14X9MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5494252,SUP,HCPCS C1713,,5494252  -  CAGE SPNL 12D OBLQ 25X14X9MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5494254,SUP,HCPCS C1713,,5494254  -  CAGE SPNL 4D OBLQ 25X14X9MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5494255,SUP,HCPCS C1713,,5494255  -  CAGE SPNL 15D OBLQ 25X14X9MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5494258,SUP,HCPCS C1713,,5494258  -  CAGE SPNL 8D OBLQ 25X14X9MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5494300,SUP,HCPCS C1713,,5494300  -  CAGE SPNL 0D OBLQ 30X14X9MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5494302,SUP,HCPCS C1713,,5494302  -  CAGE SPNL 12D OBLQ 30X14X9MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5494304,SUP,HCPCS C1713,,5494304  -  CAGE SPNL 4D OBLQ 30X14X9MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5494305,SUP,HCPCS C1713,,5494305  -  CAGE SPNL 15D OBLQ 30X14X9MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5494308,SUP,HCPCS C1713,,5494308  -  CAGE SPNL 8D OBLQ 30X14X9MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5494350,SUP,HCPCS C1713,,5494350  -  CAGE SPNL 0D OBLQ 35X14X9MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5494352,SUP,HCPCS C1713,,5494352  -  CAGE SPNL 12D OBLQ 35X14X9MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5494354,SUP,HCPCS C1713,,5494354  -  CAGE SPNL 4D OBLQ 35X14X9MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5494355,SUP,HCPCS C1713,,5494355  -  CAGE SPNL 15D OBLQ 35X14X9MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5494358,SUP,HCPCS C1713,,5494358  -  CAGE SPNL 8D OBLQ 35X14X9MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5494400,SUP,HCPCS C1713,,5494400  -  CAGE SPNL 0D OBLQ 40X14X9MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5494402,SUP,HCPCS C1713,,5494402  -  CAGE SPNL 12D OBLQ 40X14X9MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5494404,SUP,HCPCS C1713,,5494404  -  CAGE SPNL 4D OBLQ 40X14X9MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5494405,SUP,HCPCS C1713,,5494405  -  CAGE SPNL 15D OBLQ 40X14X9MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5494408,SUP,HCPCS C1713,,5494408  -  CAGE SPNL 8D OBLQ 40X14X9MM NS LF CRNT TI TLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
5500302,SUP,HCPCS C1769,,GUIDEWIRE VASC .035IN 150CM 3MM JTP FIX CORE PTFE,$32.50,$0.00,$32.50,$17.65,$23.20,$0.00,$5.60,$0.00,$0.00,$5.69,$32.50,$0.00,$16.25,$25.74,$26.00,$0.00,$5.09,$0.00,$5.17,$0.00
5500801,SUP,HCPCS C1769,,GUIDEWIRE VASC .035IN 150CM BNTSN STRG FIX CORE PTFE,$22.50,$0.00,$22.50,$12.22,$16.06,$0.00,$3.88,$0.00,$0.00,$3.94,$22.50,$0.00,$11.25,$17.82,$18.00,$0.00,$3.52,$0.00,$3.58,$0.00
5500803,SUP,Custom 27203010,,GUIDEWIRE BENTSON .038 150CM,$225.00,$0.00,$225.00,$0.00,$160.58,$0.00,$0.00,$0.00,$0.00,$0.00,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$0.00,$0.00,$0.00,$0.00
5501701,SUP,HCPCS C1769,,GUIDEWIRE VASC .035IN 150CM 1.5MM RSN CURVE JTP FIX CORE,$22.50,$0.00,$22.50,$12.22,$16.06,$0.00,$3.88,$0.00,$0.00,$3.94,$22.50,$0.00,$11.25,$17.82,$18.00,$0.00,$3.52,$0.00,$3.58,$0.00
5513150,SUP,HCPCS C1894,,5513150  -  INTRODUCER CATH 15FR 13CM ARGD VLV HMDIAL,$245.00,$0.00,$245.00,$133.04,$174.86,$0.00,$42.21,$0.00,$0.00,$42.90,$245.00,$0.00,$122.50,$194.04,$196.00,$0.00,$38.34,$0.00,$39.00,$0.00
5534010,SUP,HCPCS C1713,,5534010  -  SPACER ALGRF 30X10X2MM EXTENSURE SPNE,"$5,577.50",$0.00,"$5,577.50","$2,509.88","$3,980.66",$0.00,$960.98,$0.00,$0.00,$976.58,"$5,577.50",$0.00,"$2,788.75","$4,417.38","$4,462.00",$0.00,$872.88,$0.00,$887.94,$0.00
5534012,SUP,HCPCS C1713,,5534012  -  SPACER ALGRF 30X12X2MM EXTENSURE SPNE,"$5,577.50",$0.00,"$5,577.50","$2,509.88","$3,980.66",$0.00,$960.98,$0.00,$0.00,$976.58,"$5,577.50",$0.00,"$2,788.75","$4,417.38","$4,462.00",$0.00,$872.88,$0.00,$887.94,$0.00
5534014,SUP,HCPCS C1713,,5534014  -  SPACER ALGRF 30X14X2MM EXTENSURE SPNE,"$5,577.50",$0.00,"$5,577.50","$2,509.88","$3,980.66",$0.00,$960.98,$0.00,$0.00,$976.58,"$5,577.50",$0.00,"$2,788.75","$4,417.38","$4,462.00",$0.00,$872.88,$0.00,$887.94,$0.00
5534018,SUP,HCPCS C1713,,5534018  -  SPACER SPNL 30X18X2MM EXTENSURE ALGRF,"$5,577.50",$0.00,"$5,577.50","$2,509.88","$3,980.66",$0.00,$960.98,$0.00,$0.00,$976.58,"$5,577.50",$0.00,"$2,788.75","$4,417.38","$4,462.00",$0.00,$872.88,$0.00,$887.94,$0.00
5540030,SUP,HCPCS C1713,,5540030  -  SCREW SET BREAK OFF CD HORIZON TITANIUM SPINAL NONSTRL 5.5,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
5540130,SUP,HCPCS C1713,,5540130  -  SET SCREW 5540130  5.5/6.0 TI NS NON BO,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
5540230,SUP,HCPCS C1713,,5540230  -  SET SCREW 5540230 5.5/6.0 TI NS RED BO,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
5540430,SUP,HCPCS C1713,,5540430  -  SCREW SET SOLERA SEXTANT CD HORIZON TITANIUM 5.5-6MM NONSTRL,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
5560001,SUP,Custom 27804086,,5560001  -  GRAFT BN 13MMX5MM FACET DWL SPNE,"$3,177.50",$0.00,"$3,177.50",$0.00,"$2,267.78",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,177.50",$0.00,"$1,588.75","$2,516.58","$2,542.00",$0.00,$0.00,$0.00,$0.00,$0.00
5587000,SUP,HCPCS C1750,,5587000  -  KIT CATH REPR REPL CNCT PU HMDIAL,$325.28,$0.00,$325.28,$146.37,$232.15,$0.00,$56.04,$0.00,$0.00,$56.95,$325.28,$0.00,$162.64,$257.62,$260.22,$0.00,$50.91,$0.00,$51.78,$0.00
5688000,SUP,Custom 27203010,,5688000  -  TUNNELER SRG 30MM 8IN HMSPLT HMSPLT XK MLBL TPR,$61.25,$0.00,$61.25,$0.00,$43.71,$0.00,$0.00,$0.00,$0.00,$0.00,$61.25,$0.00,$30.63,$48.51,$49.00,$0.00,$0.00,$0.00,$0.00,$0.00
5740105,SUP,Custom 27804086,,5740105  -  GRAFT BN LRDTC 14X11X5MM SPNE,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
5740106,SUP,Custom 27804086,,5740106  -  GRAFT BONE 14X11X6MM ALLOGRAFT TRIAD CANCELLOUS CORTICAL SPN,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
5740107,SUP,Custom 27804086,,5740107  -  GRAFT BONE LORDOSIS 14X7X11MM ALLOGRAFT TRAID CANCELLOUS,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
5740109,SUP,Custom 27804086,,5740109  -  GRAFT BN LRDTC 14X11X9MM TRD ALGRF CORT CNC,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
5740110,SUP,Custom 27804086,,5740110  -  GRAFT BN LRDTC 14X11X10MM ALGRF,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
5750005,SUP,Custom 27804086,,5750005  -  GRAFT BN 14X11X5MM TRD ALGRF SPNE CRV,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
5750007,SUP,HCPCS C1713,,"5750007  -  TRIAD CR ALLOGRAFT, 7X 11X 14MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
5750010,SUP,Custom 27804086,,5750010  -  GRAFT BN 14X11X10MM TRD ALGRF SPNE CRV,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
5950007,SUP,HCPCS C1781,,5950007  -  PATCH SURG SMALL CIR 1.7IN STRAP VENTRALEX ST SEPRA,"$1,769.50",$0.00,"$1,769.50",$796.28,"$1,262.89",$0.00,$304.88,$0.00,$0.00,$309.83,"$1,769.50",$0.00,$884.75,"$1,401.44","$1,415.60",$0.00,$276.93,$0.00,$281.70,$0.00
5950008,SUP,HCPCS C1781,,5950008  -  PATCH SURG MEDIUM CIR 2.5IN STRAP VENTRALEX ST SEPRA,"$2,117.00",$0.00,"$2,117.00",$952.65,"$1,510.90",$0.00,$364.75,$0.00,$0.00,$370.67,"$2,117.00",$0.00,"$1,058.50","$1,676.66","$1,693.60",$0.00,$331.31,$0.00,$337.03,$0.00
5950009,SUP,HCPCS C1781,,5950009  -  PATCH SRG LG CRC 3.2IN STRL VNTRLX ST SEPRA SORBAFLEX SPRG,"$2,405.50",$0.00,"$2,405.50","$1,082.48","$1,716.81",$0.00,$414.46,$0.00,$0.00,$421.18,"$2,405.50",$0.00,"$1,202.75","$1,905.16","$1,924.40",$0.00,$376.46,$0.00,$382.96,$0.00
5950020,SUP,HCPCS C1781,,5950020  -  PATCH SURG LARGE CIR 4.5IN SELF EXPAND VENTRIO ST SORBAFLEX,"$2,760.75",$0.00,"$2,760.75","$1,242.34","$1,970.35",$0.00,$475.66,$0.00,$0.00,$483.39,"$2,760.75",$0.00,"$1,380.38","$2,186.51","$2,208.60",$0.00,$432.06,$0.00,$439.51,$0.00
5950030,SUP,HCPCS C1781,,5950030  -  PATCH SURG SMALL OVAL 4.7X3.1IN SELF EXPAND VENTRIO ST,"$1,213.38",$0.00,"$1,213.38",$546.02,$865.99,$0.00,$209.06,$0.00,$0.00,$212.45,"$1,213.38",$0.00,$606.69,$961.00,$970.70,$0.00,$189.89,$0.00,$193.17,$0.00
5950040,SUP,HCPCS C1781,,5950040  -  PATCH SURG MEDIUM OVAL 5.5X4.3IN SELF EXPAND VENTRIO ST,"$3,610.00",$0.00,"$3,610.00","$1,624.50","$2,576.46",$0.00,$621.98,$0.00,$0.00,$632.08,"$3,610.00",$0.00,"$1,805.00","$2,859.12","$2,888.00",$0.00,$564.97,$0.00,$574.71,$0.00
5950050,SUP,HCPCS C1781,,5950050  -  PATCH SURG LARGE OVAL 7X5.4IN SELF EXPAND VENTRIO ST,"$4,550.25",$0.00,"$4,550.25","$2,047.61","$3,247.51",$0.00,$783.99,$0.00,$0.00,$796.71,"$4,550.25",$0.00,"$2,275.13","$3,603.80","$3,640.20",$0.00,$712.11,$0.00,$724.40,$0.00
5950070,SUP,HCPCS C1781,,5950070  -  PATCH SURG XL CIR 9.7X7.7IN SELF EXPAND VENTRIO ST SORBAFLEX,"$6,143.00",$0.00,"$6,143.00","$2,764.35","$4,384.26",$0.00,"$1,058.41",$0.00,$0.00,"$1,075.59","$6,143.00",$0.00,"$3,071.50","$4,865.26","$4,914.40",$0.00,$961.38,$0.00,$977.97,$0.00
5950080,SUP,HCPCS C1781,,5950080  -  PATCH SURG XL CIR 10.7X8.7IN SELF EXPAND VENTRIO ST,"$7,356.25",$0.00,"$7,356.25","$3,310.31","$5,158.80",$0.00,"$1,267.45",$0.00,$0.00,"$1,288.02","$7,356.25",$0.00,"$3,678.13","$5,826.15","$5,885.00",$0.00,"$1,151.25",$0.00,"$1,171.12",$0.00
5960011,SUP,HCPCS C1713,,5960011  -  SCREW SET UNIVERSAL END CAP SPN,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
5960033,SUP,HCPCS C1713,,5960033  -  SCREW BN 12MM X-COR MN VBR LCK TI SPNE,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
5960034,SUP,HCPCS C1713,,5960034  -  SCREW BONE 14MM X-CORE MINI VBR TI SPN LOCK,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
5960200,SUP,HCPCS C1713,,5960200  -  END CAP SPNL PRLL 12MM 14MM NS X-COR MN,"$3,740.00",$0.00,"$3,740.00","$1,683.00","$2,669.24",$0.00,$644.38,$0.00,$0.00,$654.84,"$3,740.00",$0.00,"$1,870.00","$2,962.08","$2,992.00",$0.00,$585.31,$0.00,$595.41,$0.00
5960400,SUP,HCPCS C1713,,5960400  -  END CAP SPNL 16MM PRLL 14MM CORE,"$3,740.00",$0.00,"$3,740.00","$1,683.00","$2,669.24",$0.00,$644.38,$0.00,$0.00,$654.84,"$3,740.00",$0.00,"$1,870.00","$2,962.08","$2,992.00",$0.00,$585.31,$0.00,$595.41,$0.00
5962152,SUP,HCPCS C1713,,5962152  -  CAGE SPNL 12MM 15-20MM NS LF X-COR MN XPD VERT BD REPL,"$11,245.00",$0.00,"$11,245.00","$5,060.25","$5,158.80",$0.00,"$1,937.46",$0.00,$0.00,"$1,968.91","$11,245.00",$0.00,"$5,622.50","$8,906.04","$8,996.00",$0.00,"$1,759.84",$0.00,"$1,790.20",$0.00
5962172,SUP,Custom 27803010,,5962172  -  CAGE SPNL 12MM 17-24MM NS LF X-COR MN XPD VERT BD REPL,"$11,245.00",$0.00,"$11,245.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,245.00",$0.00,"$5,622.50","$8,906.04","$8,996.00",$0.00,$0.00,$0.00,$0.00,$0.00
5962223,SUP,HCPCS C1713,,5962223  -  CAGE SPNL 12MM 22-34MM NS LF X-COR MN,"$11,245.00",$0.00,"$11,245.00","$5,060.25","$5,158.80",$0.00,"$1,937.46",$0.00,$0.00,"$1,968.91","$11,245.00",$0.00,"$5,622.50","$8,906.04","$8,996.00",$0.00,"$1,759.84",$0.00,"$1,790.20",$0.00
5962253,SUP,HCPCS C1713,,5962253  -  CAGE SPNL 12MM 25-40MM NS LF X-COR MN,"$11,245.00",$0.00,"$11,245.00","$5,060.25","$5,158.80",$0.00,"$1,937.46",$0.00,$0.00,"$1,968.91","$11,245.00",$0.00,"$5,622.50","$8,906.04","$8,996.00",$0.00,"$1,759.84",$0.00,"$1,790.20",$0.00
5962294,SUP,HCPCS C1713,,5962294  -  CAGE SPNL 12MM 29-48MM NS LF X-COR MN,"$11,245.00",$0.00,"$11,245.00","$5,060.25","$5,158.80",$0.00,"$1,937.46",$0.00,$0.00,"$1,968.91","$11,245.00",$0.00,"$5,622.50","$8,906.04","$8,996.00",$0.00,"$1,759.84",$0.00,"$1,790.20",$0.00
5962366,SUP,HCPCS C1713,,5962366  -  CAGE SPNL 12MM 36-62MM NS LF X-COR MN,"$11,245.00",$0.00,"$11,245.00","$5,060.25","$5,158.80",$0.00,"$1,937.46",$0.00,$0.00,"$1,968.91","$11,245.00",$0.00,"$5,622.50","$8,906.04","$8,996.00",$0.00,"$1,759.84",$0.00,"$1,790.20",$0.00
5962427,SUP,HCPCS C1713,,5962427  -  CAGE SPNL 12MM 42-74MM NS LF X-COR MN,"$11,245.00",$0.00,"$11,245.00","$5,060.25","$5,158.80",$0.00,"$1,937.46",$0.00,$0.00,"$1,968.91","$11,245.00",$0.00,"$5,622.50","$8,906.04","$8,996.00",$0.00,"$1,759.84",$0.00,"$1,790.20",$0.00
5962520,SUP,Custom 27803010,,5962520  -  ENDCAP SPINAL 12MM 15MM PARALLEL TITANIUM 12MM CORE,"$3,740.00",$0.00,"$3,740.00",$0.00,"$2,669.24",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,740.00",$0.00,"$1,870.00","$2,962.08","$2,992.00",$0.00,$0.00,$0.00,$0.00,$0.00
5962521,SUP,Custom 27803010,,5962521  -  ENDCAP SPINAL CONVEX 12MM 15X12MM TOP X-CORE,"$3,740.00",$0.00,"$3,740.00",$0.00,"$2,669.24",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,740.00",$0.00,"$1,870.00","$2,962.08","$2,992.00",$0.00,$0.00,$0.00,$0.00,$0.00
5962526,SUP,Custom 27803010,,5962526  -  ENDCAP SPINAL 7D 12MM 15MM BOTTOM TITANIUM 12MM CORE,"$3,740.00",$0.00,"$3,740.00",$0.00,"$2,669.24",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,740.00",$0.00,"$1,870.00","$2,962.08","$2,992.00",$0.00,$0.00,$0.00,$0.00,$0.00
5962527,SUP,Custom 27803010,,5962527  -  ENDCAP SPINAL 7D 12MM 15MM TOP TITANIUM 12MM CORE,"$3,740.00",$0.00,"$3,740.00",$0.00,"$2,669.24",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,740.00",$0.00,"$1,870.00","$2,962.08","$2,992.00",$0.00,$0.00,$0.00,$0.00,$0.00
5962740,SUP,HCPCS C1713,,5962740  -  END CAP SPNL PRLL 12MM 17MM NS 14MM X-COR MN TI,"$3,740.00",$0.00,"$3,740.00","$1,683.00","$2,669.24",$0.00,$644.38,$0.00,$0.00,$654.84,"$3,740.00",$0.00,"$1,870.00","$2,962.08","$2,992.00",$0.00,$585.31,$0.00,$595.41,$0.00
5962741,SUP,HCPCS C1713,,5962741  -  END CAP SPNL 12MM 17MM NS 14MM X-COR MN CNTR TOP TI,"$3,740.00",$0.00,"$3,740.00","$1,683.00","$2,669.24",$0.00,$644.38,$0.00,$0.00,$654.84,"$3,740.00",$0.00,"$1,870.00","$2,962.08","$2,992.00",$0.00,$585.31,$0.00,$595.41,$0.00
5962746,SUP,HCPCS C1713,,5962746  -  END CAP SPNL 7D 12MM 17MM NS 14MM X-COR MN LRDTC BTM TI,"$3,740.00",$0.00,"$3,740.00","$1,683.00","$2,669.24",$0.00,$644.38,$0.00,$0.00,$654.84,"$3,740.00",$0.00,"$1,870.00","$2,962.08","$2,992.00",$0.00,$585.31,$0.00,$595.41,$0.00
5962747,SUP,HCPCS C1713,,5962747  -  END CAP SPNL 7D 12MM 17MM NS 14MM X-COR MN LRDTC TOP TI,"$3,740.00",$0.00,"$3,740.00","$1,683.00","$2,669.24",$0.00,$644.38,$0.00,$0.00,$654.84,"$3,740.00",$0.00,"$1,870.00","$2,962.08","$2,992.00",$0.00,$585.31,$0.00,$595.41,$0.00
5963740,SUP,HCPCS C1713,,5963740  -  END CAP SPNL ANG 14MM 17MM PRLL TOP TI 14MM COR,"$3,740.00",$0.00,"$3,740.00","$1,683.00","$2,669.24",$0.00,$644.38,$0.00,$0.00,$654.84,"$3,740.00",$0.00,"$1,870.00","$2,962.08","$2,992.00",$0.00,$585.31,$0.00,$595.41,$0.00
5963745,SUP,HCPCS C1713,,5963745  -  END CAP SPNL ANG 14MM 17MM PRLL BTM TI 14MM COR,"$3,740.00",$0.00,"$3,740.00","$1,683.00","$2,669.24",$0.00,$644.38,$0.00,$0.00,$654.84,"$3,740.00",$0.00,"$1,870.00","$2,962.08","$2,992.00",$0.00,$585.31,$0.00,$595.41,$0.00
5963746,SUP,HCPCS C1713,,5963746  -  END CAP SPNL 4D KYPHOTIC 14MM 17X14MM X-COR BTM,"$3,740.00",$0.00,"$3,740.00","$1,683.00","$2,669.24",$0.00,$644.38,$0.00,$0.00,$654.84,"$3,740.00",$0.00,"$1,870.00","$2,962.08","$2,992.00",$0.00,$585.31,$0.00,$595.41,$0.00
5963747,SUP,HCPCS C1713,,5963747  -  END CAP SPNL 4D KYPHOTIC 14MM 17X14MM X-COR TOP,"$3,740.00",$0.00,"$3,740.00","$1,683.00","$2,669.24",$0.00,$644.38,$0.00,$0.00,$654.84,"$3,740.00",$0.00,"$1,870.00","$2,962.08","$2,992.00",$0.00,$585.31,$0.00,$595.41,$0.00
5963960,SUP,HCPCS C1713,,5963960  -  END CAP SPNL ANG 16MM 19MM PRLL TOP TI 14MM COR,"$3,740.00",$0.00,"$3,740.00","$1,683.00","$2,669.24",$0.00,$644.38,$0.00,$0.00,$654.84,"$3,740.00",$0.00,"$1,870.00","$2,962.08","$2,992.00",$0.00,$585.31,$0.00,$595.41,$0.00
5963965,SUP,HCPCS C1713,,5963965  -  END CAP SPNL ANG 16MM 19MM PRLL BTM TI 14MM COR,"$3,740.00",$0.00,"$3,740.00","$1,683.00","$2,669.24",$0.00,$644.38,$0.00,$0.00,$654.84,"$3,740.00",$0.00,"$1,870.00","$2,962.08","$2,992.00",$0.00,$585.31,$0.00,$595.41,$0.00
5963966,SUP,HCPCS C1713,,5963966  -  END CAP SPNL 4D KYPHOTIC 14MM 19X16MM X-COR BTM,"$3,740.00",$0.00,"$3,740.00","$1,683.00","$2,669.24",$0.00,$644.38,$0.00,$0.00,$654.84,"$3,740.00",$0.00,"$1,870.00","$2,962.08","$2,992.00",$0.00,$585.31,$0.00,$595.41,$0.00
5963967,SUP,HCPCS C1713,,5963967  -  END CAP SPNL 4D KYPHOTIC 14MM 19X16MM X-COR TOP,"$3,740.00",$0.00,"$3,740.00","$1,683.00","$2,669.24",$0.00,$644.38,$0.00,$0.00,$654.84,"$3,740.00",$0.00,"$1,870.00","$2,962.08","$2,992.00",$0.00,$585.31,$0.00,$595.41,$0.00
5964152,SUP,HCPCS C1713,,5964152  -  CAGE SPNL 14MM 15-20MM NS LF X-COR MN,"$11,245.00",$0.00,"$11,245.00","$5,060.25","$5,158.80",$0.00,"$1,937.46",$0.00,$0.00,"$1,968.91","$11,245.00",$0.00,"$5,622.50","$8,906.04","$8,996.00",$0.00,"$1,759.84",$0.00,"$1,790.20",$0.00
5964172,SUP,Custom 27803010,,5964172  -  CAGE SPNL 14MM 17-24MM NS LF X-COR MN XPD VERT BD REPL,"$11,245.00",$0.00,"$11,245.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,245.00",$0.00,"$5,622.50","$8,906.04","$8,996.00",$0.00,$0.00,$0.00,$0.00,$0.00
5964223,SUP,HCPCS C1713,,5964223  -  CAGE SPNL 14MM 22-34MM NS LF X-COR MN XPD VERT BD REPL,"$11,245.00",$0.00,"$11,245.00","$5,060.25","$5,158.80",$0.00,"$1,937.46",$0.00,$0.00,"$1,968.91","$11,245.00",$0.00,"$5,622.50","$8,906.04","$8,996.00",$0.00,"$1,759.84",$0.00,"$1,790.20",$0.00
5964253,SUP,HCPCS C1713,,5964253  -  CAGE SPNL 14MM 25-40MM NS LF X-COR MN,"$11,245.00",$0.00,"$11,245.00","$5,060.25","$5,158.80",$0.00,"$1,937.46",$0.00,$0.00,"$1,968.91","$11,245.00",$0.00,"$5,622.50","$8,906.04","$8,996.00",$0.00,"$1,759.84",$0.00,"$1,790.20",$0.00
5964294,SUP,HCPCS C1713,,5964294  -  CAGE SPNL 14MM 29-48MM NS LF X-COR MN,"$11,245.00",$0.00,"$11,245.00","$5,060.25","$5,158.80",$0.00,"$1,937.46",$0.00,$0.00,"$1,968.91","$11,245.00",$0.00,"$5,622.50","$8,906.04","$8,996.00",$0.00,"$1,759.84",$0.00,"$1,790.20",$0.00
5964366,SUP,HCPCS C1713,,5964366  -  CAGE SPNL 14MM 36-62MM NS LF X-COR MN,"$11,245.00",$0.00,"$11,245.00","$5,060.25","$5,158.80",$0.00,"$1,937.46",$0.00,$0.00,"$1,968.91","$11,245.00",$0.00,"$5,622.50","$8,906.04","$8,996.00",$0.00,"$1,759.84",$0.00,"$1,790.20",$0.00
5964427,SUP,HCPCS C1713,,5964427  -  CAGE SPNL 14MM 42-74MM NS LF X-COR MN,"$11,245.00",$0.00,"$11,245.00","$5,060.25","$5,158.80",$0.00,"$1,937.46",$0.00,$0.00,"$1,968.91","$11,245.00",$0.00,"$5,622.50","$8,906.04","$8,996.00",$0.00,"$1,759.84",$0.00,"$1,790.20",$0.00
5964740,SUP,HCPCS C1713,,5964740  -  END CAP SPNL PRLL 14MM 17MM NS 14MM X-COR MN TI,"$3,740.00",$0.00,"$3,740.00","$1,683.00","$2,669.24",$0.00,$644.38,$0.00,$0.00,$654.84,"$3,740.00",$0.00,"$1,870.00","$2,962.08","$2,992.00",$0.00,$585.31,$0.00,$595.41,$0.00
5964741,SUP,HCPCS C1713,,5964741  -  END CAP SPNL 14MM 17MM NS 14MM X-COR MN CNTR TOP TI,"$3,740.00",$0.00,"$3,740.00","$1,683.00","$2,669.24",$0.00,$644.38,$0.00,$0.00,$654.84,"$3,740.00",$0.00,"$1,870.00","$2,962.08","$2,992.00",$0.00,$585.31,$0.00,$595.41,$0.00
5964746,SUP,HCPCS C1713,,5964746  -  END CAP SPNL 7D LRDTC 14MM 17MM NS 14MM X-COR MN TI,"$3,740.00",$0.00,"$3,740.00","$1,683.00","$2,669.24",$0.00,$644.38,$0.00,$0.00,$654.84,"$3,740.00",$0.00,"$1,870.00","$2,962.08","$2,992.00",$0.00,$585.31,$0.00,$595.41,$0.00
5964747,SUP,HCPCS C1713,,5964747  -  END CAP SPNL 7D LRDTC 14MM 17MM NS 14MM X-COR MN TI,"$3,740.00",$0.00,"$3,740.00","$1,683.00","$2,669.24",$0.00,$644.38,$0.00,$0.00,$654.84,"$3,740.00",$0.00,"$1,870.00","$2,962.08","$2,992.00",$0.00,$585.31,$0.00,$595.41,$0.00
5964960,SUP,HCPCS C1713,,5964960  -  END CAP SPNL PRLL 14MM 19MM NS 14MM X-COR MN TI,"$3,740.00",$0.00,"$3,740.00","$1,683.00","$2,669.24",$0.00,$644.38,$0.00,$0.00,$654.84,"$3,740.00",$0.00,"$1,870.00","$2,962.08","$2,992.00",$0.00,$585.31,$0.00,$595.41,$0.00
5964966,SUP,HCPCS C1713,,5964966  -  END CAP SPNL 7D LRDTC 14MM 19MM NS 16MM X-COR MN TI,"$3,740.00",$0.00,"$3,740.00","$1,683.00","$2,669.24",$0.00,$644.38,$0.00,$0.00,$654.84,"$3,740.00",$0.00,"$1,870.00","$2,962.08","$2,992.00",$0.00,$585.31,$0.00,$595.41,$0.00
5964967,SUP,HCPCS C1713,,5964967  -  END CAP SPNL 7D LRDTC 14MM 19MM NS 16MM X-COR MN TI,"$3,740.00",$0.00,"$3,740.00","$1,683.00","$2,669.24",$0.00,$644.38,$0.00,$0.00,$654.84,"$3,740.00",$0.00,"$1,870.00","$2,962.08","$2,992.00",$0.00,$585.31,$0.00,$595.41,$0.00
5975730,SUP,HCPCS C1713,,5975730  -  VUE POINT 435 X 30,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6014908,SUP,Custom 27203010,,6014908  -  DRILL TWST 1.4MM 18MM 8MM WL,$760.00,$0.00,$760.00,$0.00,$542.41,$0.00,$0.00,$0.00,$0.00,$0.00,$760.00,$0.00,$380.00,$601.92,$608.00,$0.00,$0.00,$0.00,$0.00,$0.00
6019135,SUP,Custom 27203010,,6019135  -  DRILL TWST 1.9MM 115MM LF,$800.00,$0.00,$800.00,$0.00,$570.96,$0.00,$0.00,$0.00,$0.00,$0.00,$800.00,$0.00,$400.00,$633.60,$640.00,$0.00,$0.00,$0.00,$0.00,$0.00
6046385,SUP,HCPCS C1713,,"6046385  -  4.0 CANNULATED, 38MM",$273.63,$0.00,$273.63,$123.13,$195.29,$0.00,$47.14,$0.00,$0.00,$47.91,$273.63,$0.00,$136.81,$216.71,$218.90,$0.00,$42.82,$0.00,$43.56,$0.00
6101045,SUP,HCPCS C1713,,6101045  -  SPACER SPNL XL STD 45X18X10CM C-THRU PEEK,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6101050,SUP,HCPCS C1713,,6101050  -  CAGE SPNL XL 50X18X10MM CRNT PEEK,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6101055,SUP,HCPCS C1713,,6101055  -  CAGE SPNL XL STD 55X18X10MM CRNT CT4,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6101060,SUP,HCPCS C1713,,6101060  -  CAGE SPNL XL STD 60X18X10MM CRNT CT4,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6101245,SUP,HCPCS C1713,,6101245  -  SPACER SPNL 45X18X12MM CRNT,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6101250,SUP,HCPCS C1713,,6101250  -  CAGE SPNL XL CRNL TPR 50X18X12MM CRNT PEEK-OPTM,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6101255,SUP,HCPCS C1713,,6101255  -  CAGE SPNL XL CRNL TPR 55X18X12MM CRNT PEEK-OPTM,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6101260,SUP,HCPCS C1713,,6101260  -  CAGE SPNL XL CRNL TPR 60X18X12MM CRNT PEEK-OPTM,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6101445,SUP,HCPCS C1713,,6101445  -  CAGE SPNL XL CRNL TPR 45X18X14MM CRNT PEEK-OPTM,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6101450,SUP,HCPCS C1713,,6101450  -  CAGE SPNL XL CRNL TPR 50X18X14MM CRNT PEEK-OPTM,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6101455,SUP,HCPCS C1713,,6101455  -  CAGE SPNL XL CRNL TPR 55X18X14MM CRNT PEEK-OPTM,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6101460,SUP,HCPCS C1713,,6101460  -  CAGE SPNL XL CRNL TPR 60X18X14MM CRNT PEEK-OPTM,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6101645,SUP,HCPCS C1713,,6101645  -  CAGE SPNL XL CRNL TPR 45X18X16MM CRNT PEEK-OPTM,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6101650,SUP,HCPCS C1713,,6101650  -  CAGE SPNL XL CRNL TPR 50X18X16MM CRNT PEEK-OPTM,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6101655,SUP,HCPCS C1713,,6101655  -  CAGE SPNL XL CRNL TPR 55X18X16MM CRNT PEEK-OPTM,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6101660,SUP,HCPCS C1713,,6101660  -  CAGE SPNL XL CRNL TPR 60X18X16MM CRNT PEEK-OPTM,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6111045,SUP,HCPCS C1713,,6111045  -  CAGE SPNL 10D LRDTC 45X18X10MM CRNT XLIF PEEK-OPTM,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6111050,SUP,HCPCS C1713,,6111050  -  CAGE SPNL 10D LRDTC 50X18X10MM CRNT XLIF PEEK-OPTM,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6111055,SUP,HCPCS C1713,,6111055  -  CAGE SPNL 10D LRDTC 55X18X10MM,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6111060,SUP,HCPCS C1713,,6111060  -  CAGE SPNL 10D LRDTC 60X18X10MM CRNT XLIF PEEK-OPTM,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6111245,SUP,HCPCS C1713,,6111245  -  CAGE SPNL 10D LRDTC 45X18X12MM CRNT XLIF PEEK-OPTM,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6111250,SUP,HCPCS C1713,,6111250  -  CAGE SPNL XL 10D 50X18X12MM CRNT COALITION PEEK,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6111255,SUP,HCPCS C1713,,6111255  -  CAGE SPNL 10D XL CRNL TPR 55X18X12MM CRNT PEEK-OPTM IM,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6111260,SUP,HCPCS C1713,,6111260  -  SPACER SPNL 10D XL 60X18X12MM PEEK BCK,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6111445,SUP,HCPCS C1713,,6111445  -  CAGE SPNL 10D XL CRNL TPR 45X18X14MM CRNT PEEK-OPTM IM,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6111450,SUP,HCPCS C1713,,6111450  -  CAGE SPNL 10D XL CRNL TPR 50X18X14MM CRNT PEEK-OPTM IM,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6111455,SUP,HCPCS C1713,,6111455  -  CAGE SPNL XL CRNL TPR 55X18X14MM CRNT PEEK-OPTM,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6111460,SUP,HCPCS C1713,,6111460  -  CAGE SPNL 10D XL CRNL TPR 60X18X14MM CRNT PEEK-OPTM IM,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6111645,SUP,HCPCS C1713,,6111645  -  CAGE SPNL 10D XL CRNL TPR 45X18X16MM CRNT PEEK-OPTM IM,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6111650,SUP,HCPCS C1713,,6111650  -  CAGE SPNL 10D XL CRNL TPR 50X18X16MM CRNT PEEK-OPTM IM,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6111655,SUP,HCPCS C1713,,6111655  -  CAGE SPNL 10D XL CRNL TPR 55X18X16MM CRNT PEEK-OPTM IM,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6111660,SUP,HCPCS C1713,,6111660  -  CAGE SPNL 10D XL CRNL TPR 60X18X16MM CRNT PEEK-OPTM IM,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6160850,SUP,HCPCS C1713,,6160850  -  CAGE SPNL XL W 50X22X8MM CRNT FX,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6160855,SUP,HCPCS C1713,,6160855  -  CAGE SPNL XL W 55X22X8MM CRNT FX,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6160860,SUP,HCPCS C1713,,6160860  -  CAGE SPNL XL W 60X22X8MM CRNT FX,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6161045,SUP,HCPCS C1713,,6161045  -  CAGE SPNL XL 45X22X10MM NS LF CRNT W FTPRNT,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6161050,SUP,HCPCS C1713,,6161050  -  CAGE SPNL XL W 50X22X10MM CRNT FX,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6161055,SUP,HCPCS C1713,,6161055  -  CAGE SPNL XL W 55X22X10MM CRNT FX,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6161060,SUP,HCPCS C1713,,6161060  -  CAGE SPNL XL W 60X22X10MM CRNT FX,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6161255,SUP,HCPCS C1713,,6161255  -  CAGE SPNL XL W 55X22X12MM CRNT FSN,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6161260,SUP,HCPCS C1713,,6161260  -  CAGE SPNL XL W 60X22X12MM CRNT FSN,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6161450,SUP,HCPCS C1713,,6161450  -  CAGE SPNL XL W 50X22X14MM CRNT FSN,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6161455,SUP,HCPCS C1713,,6161455  -  CAGE SPNL XL W 55X22X14MM CRNT FSN,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6161460,SUP,HCPCS C1713,,6161460  -  CAGE SPNL XL W 60X22X14MM CRNT FSN,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6170850,SUP,HCPCS C1713,,6170850  -  CAGE SPNL XL W LRDTC 50X22X8MM CRNT FSN,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6170855,SUP,HCPCS C1713,,6170855  -  CAGE SPNL XL LRDTC 55X22X8MM NS LF CRNT W FTPRNT,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6170860,SUP,HCPCS C1713,,6170860  -  CAGE SPNL XL LRDTC 60X22X8MM NS LF CRNT W FTPRNT,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6171050,SUP,HCPCS C1713,,6171050  -  SPACER SPNL XL W LRDTC 50X22X10MM CRNT FSN,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6171055,SUP,HCPCS C1713,,6171055  -  CAGE SPNL XL LRDTC 55X22X10MM NS LF CRNT W FTPRNT,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6171060,SUP,HCPCS C1713,,6171060  -  CAGE SPNL XL LRDTC 60X22X10MM NS LF CRNT W FTPRNT,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6171250,SUP,HCPCS C1713,,6171250  -  CAGE SPNL XL W LRDTC 50X22X12MM CRNT FSN,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6171255,SUP,HCPCS C1713,,6171255  -  CAGE SPNL XL LRDTC 55X22X12MM NS LF CRNT W FTPRNT,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6171260,SUP,HCPCS C1713,,6171260  -  CAGE SPNL XL LRDTC 60X22X12MM NS LF CRNT W FTPRNT,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6171450,SUP,HCPCS C1713,,6171450  -  CAGE SPNL XL W LRDTC 50X22X14MM CRNT,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6171455,SUP,HCPCS C1713,,6171455  -  CAGE SPNL XL W LRDTC 55X22X14MM CRNT,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6171460,SUP,HCPCS C1713,,6171460  -  CAGE SPNL XL W LRDTC 60X22X14MM CRNT,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6181800,SUP,Custom 27803010,,6181800  -  ENDCAP 18MM RND 0 DEG OD18 TI XCORE 2,"$2,295.00",$0.00,"$2,295.00",$0.00,"$1,637.94",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,295.00",$0.00,"$1,147.50","$1,817.64","$1,836.00",$0.00,$0.00,$0.00,$0.00,$0.00
6181804,SUP,Custom 27803010,,6181804  -  ENDCAP 18MM RND 4 DEG OD18 2,"$2,295.00",$0.00,"$2,295.00",$0.00,"$1,637.94",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,295.00",$0.00,"$1,147.50","$1,817.64","$1,836.00",$0.00,$0.00,$0.00,$0.00,$0.00
6181808,SUP,Custom 27803010,,6181808  -  ENDCAP 18MM RND 8 DEG XCORE 2,"$2,295.00",$0.00,"$2,295.00",$0.00,"$1,637.94",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,295.00",$0.00,"$1,147.50","$1,817.64","$1,836.00",$0.00,$0.00,$0.00,$0.00,$0.00
6183000,SUP,Custom 27803010,,6183000  -  ENDCAP OD18X18X30MM 0 DEG TI XCORE 2,"$3,157.50",$0.00,"$3,157.50",$0.00,"$2,253.51",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,157.50",$0.00,"$1,578.75","$2,500.74","$2,526.00",$0.00,$0.00,$0.00,$0.00,$0.00
6183004,SUP,Custom 27803010,,6183004  -  ENDCAP OD18X18X30MM 4 DEG TI XCORE 2,"$3,157.50",$0.00,"$3,157.50",$0.00,"$2,253.51",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,157.50",$0.00,"$1,578.75","$2,500.74","$2,526.00",$0.00,$0.00,$0.00,$0.00,$0.00
6183008,SUP,Custom 27803010,,6183008  -  ENDCAP OD18X18X30MM 8 DEG TI XCORE 2,"$3,157.50",$0.00,"$3,157.50",$0.00,"$2,253.51",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,157.50",$0.00,"$1,578.75","$2,500.74","$2,526.00",$0.00,$0.00,$0.00,$0.00,$0.00
6183014,SUP,Custom 27803010,,6183014  -  ENDCAP OD18X18X30MM 4 DEG TI XCORE 2,"$3,157.50",$0.00,"$3,157.50",$0.00,"$2,253.51",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,157.50",$0.00,"$1,578.75","$2,500.74","$2,526.00",$0.00,$0.00,$0.00,$0.00,$0.00
6184000,SUP,Custom 27803010,,6184000  -  ENDCAP OD18X18X40MM 0 DEG TI XCORE 2,"$3,157.50",$0.00,"$3,157.50",$0.00,"$2,253.51",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,157.50",$0.00,"$1,578.75","$2,500.74","$2,526.00",$0.00,$0.00,$0.00,$0.00,$0.00
6184004,SUP,Custom 27803010,,6184004  -  ENDCAP OD18X18X40MM 4 DEG TI XCORE 2,"$3,157.50",$0.00,"$3,157.50",$0.00,"$2,253.51",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,157.50",$0.00,"$1,578.75","$2,500.74","$2,526.00",$0.00,$0.00,$0.00,$0.00,$0.00
6184008,SUP,Custom 27803010,,6184008  -  ENDCAP OD18X18X40MM 8 DEG TI XCORE 2,"$3,157.50",$0.00,"$3,157.50",$0.00,"$2,253.51",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,157.50",$0.00,"$1,578.75","$2,500.74","$2,526.00",$0.00,$0.00,$0.00,$0.00,$0.00
6184014,SUP,Custom 27803010,,6184014  -  ENDCAP OD18X18X40MM 4 DEG TI XCORE 2,"$3,157.50",$0.00,"$3,157.50",$0.00,"$2,253.51",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,157.50",$0.00,"$1,578.75","$2,500.74","$2,526.00",$0.00,$0.00,$0.00,$0.00,$0.00
6185000,SUP,Custom 27803010,,6185000  -  ENDCAP OD18X18X50MM 0 DEG TI XCORE 2,"$3,157.50",$0.00,"$3,157.50",$0.00,"$2,253.51",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,157.50",$0.00,"$1,578.75","$2,500.74","$2,526.00",$0.00,$0.00,$0.00,$0.00,$0.00
6185004,SUP,Custom 27803010,,6185004  -  ENDCAP OD18X18X50MM 4 DEG TI XCORE 2,"$3,157.50",$0.00,"$3,157.50",$0.00,"$2,253.51",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,157.50",$0.00,"$1,578.75","$2,500.74","$2,526.00",$0.00,$0.00,$0.00,$0.00,$0.00
6185008,SUP,Custom 27803010,,6185008  -  ENDCAP OD18X18X50MM 8 DEG TI XCORE TI XCORE 2,"$3,157.50",$0.00,"$3,157.50",$0.00,"$2,253.51",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,157.50",$0.00,"$1,578.75","$2,500.74","$2,526.00",$0.00,$0.00,$0.00,$0.00,$0.00
6185014,SUP,Custom 27803010,,6185014  -  ENDCAP OD18X18X50MM 4 DEG TI OD18 TI XCORE 2,"$3,157.50",$0.00,"$3,157.50",$0.00,"$2,253.51",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,157.50",$0.00,"$1,578.75","$2,500.74","$2,526.00",$0.00,$0.00,$0.00,$0.00,$0.00
6200240,SUP,HCPCS C1713,,6200240  -  CAGE SPNL 20D XL HYPERLORDOTIC 40X22X2MM CRNT,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6200245,SUP,HCPCS C1713,,6200245  -  CAGE SPNL 20D XL 45X22X2MM CRNT PEEK,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6200250,SUP,HCPCS C1713,,6200250  -  CAGE SPNL 20D XL 50X22X2MM CRNT PEEK,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6200255,SUP,HCPCS C1713,,6200255  -  CAGE SPNL 20D XL 55X22X2MM CRNT PEEK,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6200260,SUP,HCPCS C1713,,6200260  -  CAGE SPNL 20D XL 60X22X2MM CRNT PEEK,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6200265,SUP,HCPCS C1713,,6200265  -  CAGE SPNL 20D XL HYPERLORDOTIC 65X22X2MM CRNT,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6200440,SUP,HCPCS C1713,,6200440  -  CAGE SPNL 20D XL HYPERLORDOTIC 40X22X4MM CRNT,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6200445,SUP,HCPCS C1713,,6200445  -  CAGE SPNL 20D XL 45X22X4MM CRNT PEEK,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6200450,SUP,HCPCS C1713,,6200450  -  CAGE SPNL 20D XL 50X22X4MM PEEK,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6200455,SUP,HCPCS C1713,,6200455  -  CAGE SPNL 20D XL 55X22X4MM PEEK,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6200460,SUP,HCPCS C1713,,6200460  -  CAGE SPNL 20D XL 60X22X4MM CRNT PEEK,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6200465,SUP,HCPCS C1713,,6200465  -  CAGE SPNL 20D XL HYPERLORDOTIC 65X22X4MM CRNT,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6200640,SUP,HCPCS C1713,,6200640  -  CAGE SPNL 20D XL HYPERLORDOTIC 40X22X6MM CRNT,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6200645,SUP,HCPCS C1713,,6200645  -  CAGE SPNL 20D XL 45X22X6MM CRNT PEEK,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6200650,SUP,HCPCS C1713,,6200650  -  CAGE SPNL 20D XL 50X22X6MM CRNT PEEK,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6200655,SUP,HCPCS C1713,,6200655  -  CAGE SPNL 20D XL HYPERLORDOTIC 55X22X6MM CRNT,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6200660,SUP,HCPCS C1713,,6200660  -  CAGE SPNL 20D XL HYPERLORDOTIC 60X22X6MM CRNT,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6200665,SUP,HCPCS C1713,,6200665  -  CAGE SPNL 20D XL HYPERLORDOTIC 65X22X6MM CRNT,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6200840,SUP,HCPCS C1713,,6200840  -  CAGE SPNL 20D XL HYPERLORDOTIC 40X22X8MM CRNT,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6200845,SUP,HCPCS C1713,,6200845  -  CAGE SPNL 20D XL HYPERLORDOTIC 45X22X8MM CRNT,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6200850,SUP,HCPCS C1713,,6200850  -  CAGE SPNL 20D XL HYPERLORDOTIC 50X22X8MM CRNT,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6200855,SUP,HCPCS C1713,,6200855  -  CAGE SPNL 20D XL HYPERLORDOTIC 55X22X8MM CRNT,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6200860,SUP,HCPCS C1713,,6200860  -  CAGE SPNL 20D XL HYPERLORDOTIC 60X22X8MM NS LF CRNT,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6200865,SUP,HCPCS C1713,,6200865  -  CAGE SPNL 20D XL HYPERLORDOTIC 65X22X8MM CRNT,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6201040,SUP,HCPCS C1713,,6201040  -  CAGE SPNL 20D XL HYPERLORDOTIC 40X22X10MM CRNT,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6201045,SUP,HCPCS C1713,,6201045  -  CAGE SPNL 20D XL HYPERLORDOTIC 45X22X10MM CRNT,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6201050,SUP,HCPCS C1713,,6201050  -  CAGE SPNL 20D XL HYPERLORDOTIC 50X22X10MM CRNT,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6201055,SUP,HCPCS C1713,,6201055  -  CAGE SPNL 20D XL HYPERLORDOTIC 55X22X10MM CRNT,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6201060,SUP,HCPCS C1713,,6201060  -  CAGE SPNL 20D XL HYPERLORDOTIC 60X22X10MM CRNT,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6201065,SUP,HCPCS C1713,,6201065  -  CAGE SPNL 20D XL HYPERLORDOTIC 65X22X10MM CRNT,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6208045,SUP,HCPCS C1713,,6208045  -  CAGE SPNL XL XW 45X26X8MM CRNT PEEK,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6208050,SUP,HCPCS C1713,,6208050  -  CAGE SPNL XL XW 50X26X8MM CRNT PEEK,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6208055,SUP,HCPCS C1713,,6208055  -  CAGE SPNL XL XW 55X26X8MM CRNT PEEK,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6208060,SUP,HCPCS C1713,,6208060  -  CAGE SPNL XL XW 60X26X8MM CRNT PEEK,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6208145,SUP,HCPCS C1713,,6208145  -  CAGE SPNL 10D XL XW 45X26X8MM CRNT PEEK,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6208150,SUP,HCPCS C1713,,6208150  -  CAGE SPNL 10D XL XW 50X26X8MM CRNT PEEK,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6208155,SUP,HCPCS C1713,,6208155  -  CAGE SPNL 10D XL XW 55X26X8MM CRNT PEEK,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6208160,SUP,HCPCS C1713,,6208160  -  CAGE SPNL 10D XL XW 60X26X8MM CRNT PEEK,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6210045,SUP,HCPCS C1713,,6210045  -  CAGE SPNL XL XW 45X26X10MM CRNT PEEK,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6210050,SUP,HCPCS C1713,,6210050  -  CAGE SPNL XL XW 50X26X10MM PEEK,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6210055,SUP,HCPCS C1713,,6210055  -  CAGE SPNL XL XW 55X26X10MM PEEK,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6210060,SUP,HCPCS C1713,,6210060  -  CAGE SPNL XL XW 60X26X10MM CRNT PEEK,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6210145,SUP,HCPCS C1713,,6210145  -  CAGE SPNL 10D XL XW 45X26X10MM CRNT PEEK,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6210150,SUP,HCPCS C1713,,6210150  -  CAGE SPNL 10D XL XW 50X26X10MM PEEK,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6210155,SUP,HCPCS C1713,,6210155  -  CAGE SPNL 10D XL XW 55X26X10MM PEEK,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6212045,SUP,HCPCS C1713,,6212045  -  CAGE SPNL XL XW 45X26X12MM CRNT PEEK,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6212050,SUP,HCPCS C1713,,6212050  -  CAGE SPNL XL XW 50X26X12MM CRNT PEEK,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6212055,SUP,HCPCS C1713,,6212055  -  CAGE SPNL XL XW 55X26X12MM CRNT PEEK,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6212060,SUP,HCPCS C1713,,6212060  -  CAGE SPNL XL XW 60X26X12MM CRNT PEEK,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6212145,SUP,HCPCS C1713,,6212145  -  CAGE SPNL 10D XL XW 45X26X12MM CRNT PEEK,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6212150,SUP,HCPCS C1713,,6212150  -  CAGE SPNL 10D XL XW LRDTC 50X26X12MM PEEK,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6212155,SUP,HCPCS C1713,,6212155  -  CAGE SPNL 10D XL XW LRDTC 55X26X12MM PEEK,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6212160,SUP,HCPCS C1713,,6212160  -  CAGE SPNL 10D XL XW 60X26X12MM CRNT PEEK,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6214045,SUP,HCPCS C1713,,6214045  -  CAGE SPNL XL XW 45X26X14MM CRNT PEEK,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6214050,SUP,HCPCS C1713,,6214050  -  CAGE SPNL XL XW 50X26X14MM CRNT PEEK,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6214055,SUP,HCPCS C1713,,6214055  -  CAGE SPNL XL XW 55X26X14MM CRNT PEEK,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6214060,SUP,HCPCS C1713,,6214060  -  CAGE SPNL XL XW 60X26X14MM CRNT PEEK,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6214145,SUP,HCPCS C1713,,6214145  -  CAGE SPNL 10D XL XW 45X26X14MM CRNT PEEK,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6214150,SUP,HCPCS C1713,,6214150  -  CAGE SPNL 10D XL XW 50X26X14MM CRNT PEEK,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6214155,SUP,HCPCS C1713,,6214155  -  CAGE SPNL 10D XL XW 55X26X14MM CRNT PEEK,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6214160,SUP,HCPCS C1713,,6214160  -  CAGE SPNL 10D XL XW 60X26X14MM CRNT PEEK,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6216045,SUP,HCPCS C1713,,6216045  -  CAGE SPNL XL XW 45X26X16MM CRNT PEEK,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6216050,SUP,HCPCS C1713,,6216050  -  CAGE SPNL XL XW 50X26X16MM CRNT PEEK,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6216055,SUP,HCPCS C1713,,6216055  -  CAGE SPNL XL XW 55X26X16MM CRNT PEEK,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6216060,SUP,HCPCS C1713,,6216060  -  CAGE SPNL XL XW 60X26X16MM CRNT PEEK,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6216145,SUP,HCPCS C1713,,6216145  -  CAGE SPNL 10D XL XW 45X26X16MM CRNT PEEK,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6216150,SUP,HCPCS C1713,,6216150  -  CAGE SPNL 10D XL XW 50X26X16MM CRNT PEEK,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6216155,SUP,HCPCS C1713,,6216155  -  CAGE SPNL 10D XL XW 55X26X16MM CRNT PEEK,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6216160,SUP,HCPCS C1713,,6216160  -  CAGE SPNL 10D XL XW 60X26X16MM CRNT PEEK,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6222200,SUP,Custom 27803010,,6222200  -  ENDCAP 22MM RND 0 DEG OD18 TI XCORE 2,"$2,295.00",$0.00,"$2,295.00",$0.00,"$1,637.94",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,295.00",$0.00,"$1,147.50","$1,817.64","$1,836.00",$0.00,$0.00,$0.00,$0.00,$0.00
6222204,SUP,Custom 27803010,,6222204  -  ENDCAP 22MM RND 4 DEG OD18 2,"$2,295.00",$0.00,"$2,295.00",$0.00,"$1,637.94",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,295.00",$0.00,"$1,147.50","$1,817.64","$1,836.00",$0.00,$0.00,$0.00,$0.00,$0.00
6222208,SUP,Custom 27803010,,6222208  -  ENDCAP 22MM RND 8 DEG XCORE 2,"$2,295.00",$0.00,"$2,295.00",$0.00,"$1,637.94",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,295.00",$0.00,"$1,147.50","$1,817.64","$1,836.00",$0.00,$0.00,$0.00,$0.00,$0.00
6223000,SUP,Custom 27803010,,6223000  -  ENDCAP OD18X22X30MM 0 DEG TI XCORE 2,"$3,157.50",$0.00,"$3,157.50",$0.00,"$2,253.51",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,157.50",$0.00,"$1,578.75","$2,500.74","$2,526.00",$0.00,$0.00,$0.00,$0.00,$0.00
6223004,SUP,HCPCS C1713,,6223004  -  END CAP SPNL 4D 18MM 30MM NS 22MM X-COR 2 TI,"$3,157.50",$0.00,"$3,157.50","$1,420.88","$2,253.51",$0.00,$544.02,$0.00,$0.00,$552.85,"$3,157.50",$0.00,"$1,578.75","$2,500.74","$2,526.00",$0.00,$494.15,$0.00,$502.67,$0.00
6223008,SUP,Custom 27803010,,6223008  -  ENDCAP OD18X22X30MM 8 DEG TI XCORE 2,"$3,157.50",$0.00,"$3,157.50",$0.00,"$2,253.51",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,157.50",$0.00,"$1,578.75","$2,500.74","$2,526.00",$0.00,$0.00,$0.00,$0.00,$0.00
6223012,SUP,Custom 27803010,,6223012  -  ENDCAP OD18X22X30MM 12 DEG TI XCORE 2,"$3,157.50",$0.00,"$3,157.50",$0.00,"$2,253.51",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,157.50",$0.00,"$1,578.75","$2,500.74","$2,526.00",$0.00,$0.00,$0.00,$0.00,$0.00
6224000,SUP,Custom 27803010,,6224000  -  ENDCAP OD18X22X40MM 0 DEG TI XCORE 2,"$3,157.50",$0.00,"$3,157.50",$0.00,"$2,253.51",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,157.50",$0.00,"$1,578.75","$2,500.74","$2,526.00",$0.00,$0.00,$0.00,$0.00,$0.00
6224004,SUP,Custom 27803010,,6224004  -  ENDCAP OD18X22X40MM 4 DEG TI XCORE 2,"$3,157.50",$0.00,"$3,157.50",$0.00,"$2,253.51",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,157.50",$0.00,"$1,578.75","$2,500.74","$2,526.00",$0.00,$0.00,$0.00,$0.00,$0.00
6224008,SUP,Custom 27803010,,6224008  -  ENDCAP OD18X22X40MM 8 DEG TI XCORE 2,"$3,157.50",$0.00,"$3,157.50",$0.00,"$2,253.51",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,157.50",$0.00,"$1,578.75","$2,500.74","$2,526.00",$0.00,$0.00,$0.00,$0.00,$0.00
6224012,SUP,Custom 27803010,,6224012  -  ENDCAP OD18X22X40MM 12 DEG TI XCORE 2,"$3,157.50",$0.00,"$3,157.50",$0.00,"$2,253.51",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,157.50",$0.00,"$1,578.75","$2,500.74","$2,526.00",$0.00,$0.00,$0.00,$0.00,$0.00
6225000,SUP,Custom 27803010,,6225000  -  ENDCAP OD18X22X50MM 0 DEG TI XCORE 2,"$3,157.50",$0.00,"$3,157.50",$0.00,"$2,253.51",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,157.50",$0.00,"$1,578.75","$2,500.74","$2,526.00",$0.00,$0.00,$0.00,$0.00,$0.00
6225004,SUP,Custom 27803010,,6225004  -  ENDCAP OD18X22X50MM 4 DEG TI XCORE 2,"$3,157.50",$0.00,"$3,157.50",$0.00,"$2,253.51",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,157.50",$0.00,"$1,578.75","$2,500.74","$2,526.00",$0.00,$0.00,$0.00,$0.00,$0.00
6225008,SUP,Custom 27803010,,6225008  -  ENDCAP OD18X22X50MM 8 DEG TI XCORE 2,"$3,157.50",$0.00,"$3,157.50",$0.00,"$2,253.51",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,157.50",$0.00,"$1,578.75","$2,500.74","$2,526.00",$0.00,$0.00,$0.00,$0.00,$0.00
6225012,SUP,Custom 27803010,,6225012  -  ENDCAP OD18X22X50MM 12 DEG TI XCORE 2,"$3,157.50",$0.00,"$3,157.50",$0.00,"$2,253.51",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,157.50",$0.00,"$1,578.75","$2,500.74","$2,526.00",$0.00,$0.00,$0.00,$0.00,$0.00
6226000,SUP,Custom 27803010,,6226000  -  ENDCAP OD18X22X60MM 0 DEG TI XCORE 2,"$3,157.50",$0.00,"$3,157.50",$0.00,"$2,253.51",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,157.50",$0.00,"$1,578.75","$2,500.74","$2,526.00",$0.00,$0.00,$0.00,$0.00,$0.00
6226004,SUP,Custom 27803010,,6226004  -  ENDCAP OD18X22X60MM 4 DEG TI XCORE 2,"$3,157.50",$0.00,"$3,157.50",$0.00,"$2,253.51",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,157.50",$0.00,"$1,578.75","$2,500.74","$2,526.00",$0.00,$0.00,$0.00,$0.00,$0.00
6226008,SUP,Custom 27803010,,6226008  -  ENDCAP OD18X22X60MM 8 DEG TI XCORE TI XCORE 2,"$3,157.50",$0.00,"$3,157.50",$0.00,"$2,253.51",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,157.50",$0.00,"$1,578.75","$2,500.74","$2,526.00",$0.00,$0.00,$0.00,$0.00,$0.00
6226012,SUP,Custom 27803010,,6226012  -  ENDCAP OD18X22X60MM 12 DEG TI OD18 TI XCORE 2,"$3,157.50",$0.00,"$3,157.50",$0.00,"$2,253.51",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,157.50",$0.00,"$1,578.75","$2,500.74","$2,526.00",$0.00,$0.00,$0.00,$0.00,$0.00
6240041,SUP,Custom 27803010,,6240041  -  SPACER SPNL 11MM 14X10MM VRTSTCK CRSTN PSR PEEK-OPTM CRV,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
6240064,SUP,Custom 27803010,,6240064  -  SPACER SPNL 6MM 14X16MM VRTSTCK CRSTN PSR PEEK-OPTM CRV,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
6240086,SUP,Custom 27803010,,6240086  -  SPACER SPNL 16MM 18X10MM VRTSTCK CRSTN PSR PEEK-OPTM CRV,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
6240141,SUP,Custom 27803010,,6240141  -  SPACER SPNL 11MM 14X11MM VRTSTCK CRSTN PSR PEEK-OPTM CRV,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
6240164,SUP,Custom 27803010,,6240164  -  SPACER SPNL 14MM 16X11MM VRTSTCK CRSTN PSR PEEK-OPTM CRV,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
6240186,SUP,Custom 27803010,,6240186  -  SPACER SPNL 16MM 18X11MM VRTSTCK CRSTN PSR PEEK-OPTM CRV,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
6240241,SUP,Custom 27803010,,6240241  -  SPACER SPNL 12MM 11X14MM VRTSTCK CRSTN PSR PEEK-OPTM CRV,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
6240264,SUP,Custom 27803010,,6240264  -  SPACER SPNL 14MM 16X12MM VRTSTCK CRSTN PSR PEEK-OPTM CRV,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
6240286,SUP,Custom 27803010,,6240286  -  SPACER SPNL 16MM 18X12MM VRTSTCK CRSTN PSR PEEK-OPTM CRV,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
6240341,SUP,Custom 27803010,,6240341  -  SPACER SPNL 13MM 11X14MM VRTSTCK CRSTN PSR PEEK-OPTM CRV,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
6240364,SUP,Custom 27803010,,6240364  -  SPACER SPNL 14MM 16X13MM VRTSTCK CRSTN PSR PEEK-OPTM CRV,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
6240386,SUP,Custom 27803010,,6240386  -  SPACER SPNL 16MM 18X13MM VRTSTCK CRSTN PSR PEEK-OPTM CRV,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
6240441,SUP,Custom 27803010,,6240441  -  SPACER SPNL 14MM 11X14MM VRTSTCK CRSTN PSR PEEK-OPTM CRV,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
6240464,SUP,Custom 27803010,,6240464  -  SPACER SPNL 14MM 16X14MM VRTSTCK CRSTN PSR PEEK-OPTM CRV,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
6240486,SUP,Custom 27803010,,6240486  -  SPACER SPNL 16MM 18X14MM VRTSTCK CRSTN PSR PEEK-OPTM CRV,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
6240541,SUP,Custom 27803010,,6240541  -  SPACER SPNL 11MM 14X5MM VRTSTCK CRSTN PSR PEEK-OPTM CRV,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
6240564,SUP,Custom 27803010,,6240564  -  SPACER SPNL 5MM 14X16MM VRTSTCK CRSTN PSR PEEK-OPTM CRV,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
6240586,SUP,Custom 27803010,,6240586  -  SPACER SPNL 16MM 18X5MM VRTSTCK CRSTN PSR PEEK-OPTM CRV,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
6240641,SUP,Custom 27803010,,6240641  -  SPACER SPNL 11MM 14X6MM VRTSTCK CRSTN PSR PEEK-OPTM CRV,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
6240664,SUP,Custom 27803010,,6240664  -  SPACER SPNL 6MM 14X16MM VRTSTCK CRSTN PSR PEEK-OPTM CRV,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
6240686,SUP,Custom 27803010,,6240686  -  SPACER SPNL 16MM 18X6MM VRTSTCK CRSTN PSR PEEK-OPTM CRV,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
6240741,SUP,Custom 27803010,,6240741  -  SPACER SPNL 11MM 14X7MM VRTSTCK CRSTN PSR PEEK-OPTM CRV,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
6240764,SUP,Custom 27803010,,6240764  -  SPACER SPNL 7MM 14X16MM VRTSTCK CRSTN PSR PEEK-OPTM CRV,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
6240786,SUP,Custom 27803010,,6240786  -  SPACER SPNL 16MM 18X7MM VRTSTCK CRSTN PSR PEEK-OPTM CRV,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
6240841,SUP,HCPCS C1713,,6240841  -  SPACER SPNL 11MM 14X8MM VRTSTCK CRSTN PSR PEEK-OPTM CRV,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6240864,SUP,Custom 27803010,,6240864  -  SPACER SPNL 8MM 14X16MM VRTSTCK CRSTN PSR PEEK-OPTM CRV,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
6240886,SUP,Custom 27803010,,6240886  -  SPACER SPNL 16MM 18X8MM VRTSTCK CRSTN PSR PEEK-OPTM CRV,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
6240941,SUP,Custom 27803010,,6240941  -  SPACER SPNL 11MM 14X9MM VRTSTCK CRSTN PSR PEEK-OPTM CRV,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
6240964,SUP,Custom 27803010,,6240964  -  SPACER SPNL 9MM 14X16MM VRTSTCK CRSTN PSR PEEK-OPTM CRV,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
6240986,SUP,Custom 27803010,,6240986  -  SPACER SPNL 16MM 18X9MM VRTSTCK CRSTN PSR PEEK-OPTM CRV,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
6241041,SUP,HCPCS C1713,,6241041  -  STRUT SPNL 11MM 14X5MM VRTSTCK HDRSRB PEEK-OPTM CRV,"$5,445.00",$0.00,"$5,445.00","$2,450.25","$3,886.10",$0.00,$938.15,$0.00,$0.00,$953.38,"$5,445.00",$0.00,"$2,722.50","$4,312.44","$4,356.00",$0.00,$852.14,$0.00,$866.84,$0.00
6241064,SUP,HCPCS C1713,,6241064  -  STRUT SPNL 14MM 16X5MM VRTSTCK HDRSRB PEEK-OPTM CRV,"$5,445.00",$0.00,"$5,445.00","$2,450.25","$3,886.10",$0.00,$938.15,$0.00,$0.00,$953.38,"$5,445.00",$0.00,"$2,722.50","$4,312.44","$4,356.00",$0.00,$852.14,$0.00,$866.84,$0.00
6241086,SUP,HCPCS C1713,,6241086  -  STRUT SPNL 16MM 18X5MM VRTSTCK HDRSRB PEEK-OPTM CRV,"$5,445.00",$0.00,"$5,445.00","$2,450.25","$3,886.10",$0.00,$938.15,$0.00,$0.00,$953.38,"$5,445.00",$0.00,"$2,722.50","$4,312.44","$4,356.00",$0.00,$852.14,$0.00,$866.84,$0.00
6242041,SUP,HCPCS C1713,,6242041  -  STRUT SPNL 11MM 14X24MM VRTSTCK HDRSRB PEEK-OPTM CRV,"$5,445.00",$0.00,"$5,445.00","$2,450.25","$3,886.10",$0.00,$938.15,$0.00,$0.00,$953.38,"$5,445.00",$0.00,"$2,722.50","$4,312.44","$4,356.00",$0.00,$852.14,$0.00,$866.84,$0.00
6242064,SUP,HCPCS C1713,,6242064  -  STRUT SPNL 14MM 16X24MM VRTSTCK HDRSRB PEEK-OPTM CRV,"$5,445.00",$0.00,"$5,445.00","$2,450.25","$3,886.10",$0.00,$938.15,$0.00,$0.00,$953.38,"$5,445.00",$0.00,"$2,722.50","$4,312.44","$4,356.00",$0.00,$852.14,$0.00,$866.84,$0.00
6242086,SUP,HCPCS C1713,,6242086  -  STRUT SPNL 16MM 18X24MM VRTSTCK HDRSRB PEEK-OPTM CRV,"$5,445.00",$0.00,"$5,445.00","$2,450.25","$3,886.10",$0.00,$938.15,$0.00,$0.00,$953.38,"$5,445.00",$0.00,"$2,722.50","$4,312.44","$4,356.00",$0.00,$852.14,$0.00,$866.84,$0.00
6260535,SUP,HCPCS C1713,,6260535  -  SCREW BONE 5MM 35MM RPS SPNL FIX,"$2,122.93",$0.00,"$2,122.93",$955.32,"$1,515.13",$0.00,$365.77,$0.00,$0.00,$371.71,"$2,122.93",$0.00,"$1,061.46","$1,681.36","$1,698.34",$0.00,$332.24,$0.00,$337.97,$0.00
6260540,SUP,HCPCS C1713,,6260540  -  SCREW BONE 5MM 40MM RPS SPNL FIX,"$2,122.93",$0.00,"$2,122.93",$955.32,"$1,515.13",$0.00,$365.77,$0.00,$0.00,$371.71,"$2,122.93",$0.00,"$1,061.46","$1,681.36","$1,698.34",$0.00,$332.24,$0.00,$337.97,$0.00
6260555,SUP,HCPCS C1713,,6260555  -  SCREW BONE 5MM 55MM RPS SPNL FIX,"$2,122.93",$0.00,"$2,122.93",$955.32,"$1,515.13",$0.00,$365.77,$0.00,$0.00,$371.71,"$2,122.93",$0.00,"$1,061.46","$1,681.36","$1,698.34",$0.00,$332.24,$0.00,$337.97,$0.00
6260560,SUP,HCPCS C1713,,6260560  -  SCREW BONE 5MM 60MM RPS SPNL FIX,"$2,122.93",$0.00,"$2,122.93",$955.32,"$1,515.13",$0.00,$365.77,$0.00,$0.00,$371.71,"$2,122.93",$0.00,"$1,061.46","$1,681.36","$1,698.34",$0.00,$332.24,$0.00,$337.97,$0.00
6260625,SUP,HCPCS C1713,,6260625  -  SCREW BONE 6MM 25MM TECHTONIX TI SPNL,"$3,232.75",$0.00,"$3,232.75","$1,454.74","$2,307.21",$0.00,$556.99,$0.00,$0.00,$566.03,"$3,232.75",$0.00,"$1,616.38","$2,560.34","$2,586.20",$0.00,$505.93,$0.00,$514.65,$0.00
6260630,SUP,HCPCS C1713,,6260630  -  SCREW BONE 6MM 30MM TECHTONIX SPNL,"$3,232.75",$0.00,"$3,232.75","$1,454.74","$2,307.21",$0.00,$556.99,$0.00,$0.00,$566.03,"$3,232.75",$0.00,"$1,616.38","$2,560.34","$2,586.20",$0.00,$505.93,$0.00,$514.65,$0.00
6260635,SUP,HCPCS C1713,,6260635  -  SCREW BONE 6MM 35MM TECHTONIX TI SPNL LP,"$3,232.75",$0.00,"$3,232.75","$1,454.74","$2,307.21",$0.00,$556.99,$0.00,$0.00,$566.03,"$3,232.75",$0.00,"$1,616.38","$2,560.34","$2,586.20",$0.00,$505.93,$0.00,$514.65,$0.00
6260640,SUP,HCPCS C1713,,6260640  -  SCREW BONE 6MM 40MM TECHTONIX TI SPNL LP,"$3,232.75",$0.00,"$3,232.75","$1,454.74","$2,307.21",$0.00,$556.99,$0.00,$0.00,$566.03,"$3,232.75",$0.00,"$1,616.38","$2,560.34","$2,586.20",$0.00,$505.93,$0.00,$514.65,$0.00
6260645,SUP,HCPCS C1713,,6260645  -  SCREW BONE 6MM 44MM TECHTONIX TI SPNL LP,"$3,232.75",$0.00,"$3,232.75","$1,454.74","$2,307.21",$0.00,$556.99,$0.00,$0.00,$566.03,"$3,232.75",$0.00,"$1,616.38","$2,560.34","$2,586.20",$0.00,$505.93,$0.00,$514.65,$0.00
6260650,SUP,HCPCS C1713,,6260650  -  SCREW BONE 6MM 50MM TECHTONIX TI SPNL LP,"$3,232.75",$0.00,"$3,232.75","$1,454.74","$2,307.21",$0.00,$556.99,$0.00,$0.00,$566.03,"$3,232.75",$0.00,"$1,616.38","$2,560.34","$2,586.20",$0.00,$505.93,$0.00,$514.65,$0.00
6260655,SUP,HCPCS C1713,,6260655  -  SCREW BONE 6MM 55MM TECHTONIX,"$3,232.75",$0.00,"$3,232.75","$1,454.74","$2,307.21",$0.00,$556.99,$0.00,$0.00,$566.03,"$3,232.75",$0.00,"$1,616.38","$2,560.34","$2,586.20",$0.00,$505.93,$0.00,$514.65,$0.00
6260660,SUP,HCPCS C1713,,6260660  -  SCREW BONE 6MM 60MM TECHTONIX,"$3,232.75",$0.00,"$3,232.75","$1,454.74","$2,307.21",$0.00,$556.99,$0.00,$0.00,$566.03,"$3,232.75",$0.00,"$1,616.38","$2,560.34","$2,586.20",$0.00,$505.93,$0.00,$514.65,$0.00
6262525,SUP,HCPCS C1713,,6262525  -  SCREW BONE 5MM 25MM TECHTONIX TI SPNL,"$3,232.75",$0.00,"$3,232.75","$1,454.74","$2,307.21",$0.00,$556.99,$0.00,$0.00,$566.03,"$3,232.75",$0.00,"$1,616.38","$2,560.34","$2,586.20",$0.00,$505.93,$0.00,$514.65,$0.00
6262530,SUP,HCPCS C1713,,6262530  -  SCREW BONE 5MM 30MM TECHTONIX,"$3,232.75",$0.00,"$3,232.75","$1,454.74","$2,307.21",$0.00,$556.99,$0.00,$0.00,$566.03,"$3,232.75",$0.00,"$1,616.38","$2,560.34","$2,586.20",$0.00,$505.93,$0.00,$514.65,$0.00
6262535,SUP,HCPCS C1713,,6262535  -  SCREW BONE 5MM 35MM TECHTONIX TI SPNL,"$3,232.75",$0.00,"$3,232.75","$1,454.74","$2,307.21",$0.00,$556.99,$0.00,$0.00,$566.03,"$3,232.75",$0.00,"$1,616.38","$2,560.34","$2,586.20",$0.00,$505.93,$0.00,$514.65,$0.00
6262540,SUP,HCPCS C1713,,6262540  -  SCREW BONE 5MM 40MM TECHTONIX SPNL,"$3,232.75",$0.00,"$3,232.75","$1,454.74","$2,307.21",$0.00,$556.99,$0.00,$0.00,$566.03,"$3,232.75",$0.00,"$1,616.38","$2,560.34","$2,586.20",$0.00,$505.93,$0.00,$514.65,$0.00
6262545,SUP,HCPCS C1713,,6262545  -  SCREW BONE 5MM 45MM TECHTONIX SPNL,"$3,232.75",$0.00,"$3,232.75","$1,454.74","$2,307.21",$0.00,$556.99,$0.00,$0.00,$566.03,"$3,232.75",$0.00,"$1,616.38","$2,560.34","$2,586.20",$0.00,$505.93,$0.00,$514.65,$0.00
6262550,SUP,HCPCS C1713,,6262550  -  SCREW BONE 5MM 50MM TECHTONIX SPNL,"$3,232.75",$0.00,"$3,232.75","$1,454.74","$2,307.21",$0.00,$556.99,$0.00,$0.00,$566.03,"$3,232.75",$0.00,"$1,616.38","$2,560.34","$2,586.20",$0.00,$505.93,$0.00,$514.65,$0.00
6262555,SUP,HCPCS C1713,,6262555  -  SCREW BONE 5MM 55MM TECHTONIX,"$3,232.75",$0.00,"$3,232.75","$1,454.74","$2,307.21",$0.00,$556.99,$0.00,$0.00,$566.03,"$3,232.75",$0.00,"$1,616.38","$2,560.34","$2,586.20",$0.00,$505.93,$0.00,$514.65,$0.00
6262560,SUP,HCPCS C1713,,6262560  -  SCREW BONE 5MM 60MM TECHTONIX,"$3,232.75",$0.00,"$3,232.75","$1,454.74","$2,307.21",$0.00,$556.99,$0.00,$0.00,$566.03,"$3,232.75",$0.00,"$1,616.38","$2,560.34","$2,586.20",$0.00,$505.93,$0.00,$514.65,$0.00
6262600,SUP,Custom 27803010,,6262600  -  ENDCAP 26MM RND 0 DEG OD18 TI XCORE 2,"$2,295.00",$0.00,"$2,295.00",$0.00,"$1,637.94",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,295.00",$0.00,"$1,147.50","$1,817.64","$1,836.00",$0.00,$0.00,$0.00,$0.00,$0.00
6262604,SUP,Custom 27803010,,6262604  -  ENDCAP 26MM RND 4 DEG OD18,"$2,295.00",$0.00,"$2,295.00",$0.00,"$1,637.94",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,295.00",$0.00,"$1,147.50","$1,817.64","$1,836.00",$0.00,$0.00,$0.00,$0.00,$0.00
6262608,SUP,Custom 27803010,,6262608  -  ENDCAP 26MM RND 8 DEG,"$2,295.00",$0.00,"$2,295.00",$0.00,"$1,637.94",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,295.00",$0.00,"$1,147.50","$1,817.64","$1,836.00",$0.00,$0.00,$0.00,$0.00,$0.00
6271044,SUP,HCPCS C1713,,6271044  -  SPACER SPNL 11MM 11X44MM STRL LF VRTSTCK CRSTN PSR STRUT,"$4,992.00",$0.00,"$4,992.00","$2,246.40","$3,562.79",$0.00,$860.10,$0.00,$0.00,$874.06,"$4,992.00",$0.00,"$2,496.00","$3,953.66","$3,993.60",$0.00,$781.25,$0.00,$794.73,$0.00
6272044,SUP,Custom 27803010,,6272044  -  SPACER SPNL 11MM 14X44MM STRL LF VRTSTCK CRSTN PSR STRUT,"$4,992.00",$0.00,"$4,992.00",$0.00,"$3,562.79",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,992.00",$0.00,"$2,496.00","$3,953.66","$3,993.60",$0.00,$0.00,$0.00,$0.00,$0.00
6273044,SUP,Custom 27803010,,6273044  -  SPACER SPNL 14MM 14X44MM STRL LF VRTSTCK CRSTN PSR STRUT,"$4,992.00",$0.00,"$4,992.00",$0.00,"$3,562.79",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,992.00",$0.00,"$2,496.00","$3,953.66","$3,993.60",$0.00,$0.00,$0.00,$0.00,$0.00
6276011,SUP,HCPCS C1713,,6276011  -  SPACER SPNL 11MM 11X10MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6276025,SUP,HCPCS C1713,,6276025  -  SPACER SPNL 11MM 11X25MM STRL LF VRTSTCK CRSTN PSR STRUT,"$4,992.00",$0.00,"$4,992.00","$2,246.40","$3,562.79",$0.00,$860.10,$0.00,$0.00,$874.06,"$4,992.00",$0.00,"$2,496.00","$3,953.66","$3,993.60",$0.00,$781.25,$0.00,$794.73,$0.00
6276111,SUP,HCPCS C1713,,6276111  -  SPACER SPNL 11MM 11X11MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6276211,SUP,HCPCS C1713,,6276211  -  SPACER SPNL 12MM 11X12MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6276311,SUP,HCPCS C1713,,6276311  -  SPACER SPNL 11MM 11X13MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6276411,SUP,HCPCS C1713,,6276411  -  SPACER SPNL 11MM 11X4MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6276511,SUP,HCPCS C1713,,6276511  -  SPACER SPNL 11MM 11X5MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6276611,SUP,HCPCS C1713,,6276611  -  SPACER SPNL 11MM 11X6MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6276711,SUP,HCPCS C1713,,6276711  -  SPACER SPNL 11MM 11X7MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6276811,SUP,HCPCS C1713,,6276811  -  SPACER SPNL 11MM 11X8MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6276911,SUP,HCPCS C1713,,6276911  -  SPACER SPNL 11MM 11X9MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6277006,SUP,HCPCS C1713,,6277006  -  SPACER SPNL 11MM 14X6MM STRL LF VRTSTCK CRSTN PSR STRUT,"$4,992.00",$0.00,"$4,992.00","$2,246.40","$3,562.79",$0.00,$860.10,$0.00,$0.00,$874.06,"$4,992.00",$0.00,"$2,496.00","$3,953.66","$3,993.60",$0.00,$781.25,$0.00,$794.73,$0.00
6277025,SUP,Custom 27803010,,6277025  -  SPACER SPNL 11MM 14X25MM STRL LF VRTSTCK CRSTN PSR STRUT,"$4,992.00",$0.00,"$4,992.00",$0.00,"$3,562.79",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,992.00",$0.00,"$2,496.00","$3,953.66","$3,993.60",$0.00,$0.00,$0.00,$0.00,$0.00
6277041,SUP,HCPCS C1713,,6277041  -  SPACER SPNL 11MM 14X10MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6277141,SUP,HCPCS C1713,,6277141  -  SPACER SPNL 11MM 14X10MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6277241,SUP,Custom 27803010,,6277241  -  SPACER SPNL 11MM 14X12MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
6277341,SUP,Custom 27803010,,6277341  -  SPACER SPNL 11MM 14X13MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
6277441,SUP,Custom 27803010,,6277441  -  SPACER SPNL 11MM 14X4MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
6277541,SUP,HCPCS C1713,,6277541  -  SPACER SPNL 11MM 14X5MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6277641,SUP,HCPCS C1713,,6277641  -  SPACER SPNL 11MM 14X6MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6277741,SUP,HCPCS C1713,,6277741  -  SPACER SPNL 11MM 14X7MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6277841,SUP,HCPCS C1713,,6277841  -  SPACER SPNL 11MM 14X8MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6277941,SUP,HCPCS C1713,,6277941  -  SPACER SPNL 11MM 14X9MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6278006,SUP,Custom 27803010,,6278006  -  SPACER SPNL 14MM 14X6MM STRL LF VRTSTCK CRSTN PSR STRUT,"$4,992.00",$0.00,"$4,992.00",$0.00,"$3,562.79",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,992.00",$0.00,"$2,496.00","$3,953.66","$3,993.60",$0.00,$0.00,$0.00,$0.00,$0.00
6278025,SUP,Custom 27803010,,6278025  -  SPACER SPNL 14MM 14X25MM STRL LF VRTSTCK CRSTN PSR STRUT,"$4,992.00",$0.00,"$4,992.00",$0.00,"$3,562.79",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,992.00",$0.00,"$2,496.00","$3,953.66","$3,993.60",$0.00,$0.00,$0.00,$0.00,$0.00
6278044,SUP,Custom 27803010,,6278044  -  SPACER SPNL 14MM 14X10MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
6278144,SUP,Custom 27803010,,6278144  -  SPACER SPNL 14MM 14X11MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
6278244,SUP,Custom 27803010,,6278244  -  SPACER SPNL 14MM 14X12MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
6278344,SUP,Custom 27803010,,6278344  -  SPACER SPNL 14MM 14X13MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
6278444,SUP,Custom 27803010,,6278444  -  SPACER SPNL 14MM 14X4MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
6278544,SUP,Custom 27803010,,6278544  -  SPACER SPNL 14MM 14X5MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
6278644,SUP,Custom 27803010,,6278644  -  SPACER SPNL 14MM 14X6MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
6278744,SUP,Custom 27803010,,6278744  -  SPACER SPNL 14MM 14X7MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
6278844,SUP,Custom 27803010,,6278844  -  SPACER SPNL 14MM 14X8MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
6278944,SUP,Custom 27803010,,6278944  -  SPACER SPNL 14MM 14X9MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
6284011,SUP,HCPCS C1713,,6284011  -  SPACER SPNL 11MM 11X10MM CRSTN PSR PEEK-OPTM CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6284041,SUP,HCPCS C1713,,6284041  -  SPACER SPNL 11MM 14X10MM CRSTN PSR PEEK-OPTM CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6284044,SUP,HCPCS C1713,,6284044  -  SPACER SPNL 14MM 14X10MM CRSTN PSR PEEK-OPTM CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6284111,SUP,HCPCS C1713,,6284111  -  SPACER SPNL 11MM 11X11MM CRSTN PSR PEEK-OPTM CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6284141,SUP,HCPCS C1713,,6284141  -  SPACER SPNL 11MM 14X11MM CRSTN PSR PEEK-OPTM CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6284144,SUP,HCPCS C1713,,6284144  -  SPACER SPNL 14MM 14X11MM CRSTN PSR PEEK-OPTM CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6284211,SUP,HCPCS C1713,,6284211  -  SPACER SPNL 11MM 11X12MM CRSTN PSR PEEK-OPTM CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6284241,SUP,HCPCS C1713,,6284241  -  SPACER SPNL 11MM 14X12MM CRSTN PSR PEEK-OPTM CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6284244,SUP,HCPCS C1713,,6284244  -  SPACER SPNL 14MM 14X12MM CRSTN PSR PEEK-OPTM CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6284311,SUP,HCPCS C1713,,6284311  -  SPACER SPNL 11MM 11X13MM CRSTN PSR PEEK-OPTM CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6284511,SUP,HCPCS C1713,,6284511  -  SPACER SPNL 11MM 11X5MM CRSTN PSR PEEK-OPTM CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6284541,SUP,HCPCS C1713,,6284541  -  SPACER SPNL 11MM 14X5MM CRSTN PSR PEEK-OPTM CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6284544,SUP,HCPCS C1713,,6284544  -  SPACER SPNL 14MM 14X5MM CRSTN PSR PEEK-OPTM CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6284611,SUP,HCPCS C1713,,6284611  -  SPACER SPNL 11MM 11X6MM CRSTN PSR PEEK-OPTM CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6284641,SUP,HCPCS C1713,,6284641  -  SPACER SPNL 11MM 14X6MM CRSTN PSR PEEK-OPTM CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6284644,SUP,HCPCS C1713,,6284644  -  SPACER SPNL 14MM 14X6MM CRSTN PSR PEEK-OPTM CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6284711,SUP,HCPCS C1713,,6284711  -  SPACER SPNL 11MM 11X7MM CRSTN PSR PEEK-OPTM CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6284741,SUP,HCPCS C1713,,6284741  -  SPACER SPNL 11MM 14X7MM CRSTN PSR PEEK-OPTM CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6284744,SUP,HCPCS C1713,,6284744  -  SPACER SPNL 14MM 14X7MM CRSTN PSR PEEK-OPTM CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6284811,SUP,HCPCS C1713,,6284811  -  SPACER SPNL 11MM 11X8MM CRSTN PSR PEEK-OPTM CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6284841,SUP,HCPCS C1713,,6284841  -  SPACER SPNL 11MM 14X8MM CRSTN PSR PEEK-OPTM CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6284844,SUP,HCPCS C1713,,6284844  -  SPACER SPNL 14MM 14X8MM CRSTN PSR PEEK-OPTM CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6284911,SUP,HCPCS C1713,,6284911  -  SPACER SPNL 11MM 11X9MM CRSTN PSR PEEK-OPTM CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6284941,SUP,HCPCS C1713,,6284941  -  SPACER SPNL 11MM 14X9MM CRSTN PSR PEEK-OPTM CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6284944,SUP,HCPCS C1713,,6284944  -  SPACER SPNL 14MM 14X9MM CRSTN PSR PEEK-OPTM CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6286011,SUP,HCPCS C1713,,6286011  -  SPACER SPNL 11MM 11X10MM VRTSTCK CRSTN PSR LAT PORT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6286111,SUP,HCPCS C1713,,6286111  -  SPACER SPNL 11MM 11X11MM VRTSTCK CRSTN PSR LAT PORT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6286211,SUP,HCPCS C1713,,6286211  -  SPACER SPNL 11MM 11X12MM VRTSTCK CRSTN PSR LAT PORT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6286311,SUP,HCPCS C1713,,6286311  -  SPACER SPNL 11MM 11X13MM VRTSTCK CRSTN PSR LAT PORT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6286511,SUP,HCPCS C1713,,6286511  -  SPACER SPNL 11MM 11X5MM VRTSTCK CRSTN PSR LAT PORT PEEK-OPTM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6286611,SUP,HCPCS C1713,,6286611  -  SPACER SPNL 11MM 11X6MM VRTSTCK CRSTN PSR LAT PORT PEEK-OPTM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6286711,SUP,HCPCS C1713,,6286711  -  SPACER SPNL 11MM 11X7MM VRTSTCK CRSTN PSR LAT PORT PEEK-OPTM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6286811,SUP,HCPCS C1713,,6286811  -  SPACER SPNL 11MM 11X8MM VRTSTCK CRSTN PSR LAT PORT PEEK-OPTM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6286911,SUP,HCPCS C1713,,6286911  -  SPACER SPNL 11MM 11X9MM VRTSTCK CRSTN PSR LAT PORT PEEK-OPTM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6287041,SUP,HCPCS C1713,,6287041  -  SPACER SPNL 11MM 14X10MM VRTSTCK CRSTN PSR LAT PORT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6287141,SUP,HCPCS C1713,,6287141  -  SPACER SPNL 11MM 14X11MM VRTSTCK CRSTN PSR LAT PORT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6287241,SUP,HCPCS C1713,,6287241  -  SPACER SPNL 11MM 14X12MM VRTSTCK CRSTN PSR LAT PORT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6287341,SUP,HCPCS C1713,,6287341  -  SPACER SPNL 11MM 14X13MM VRTSTCK CRSTN PSR LAT PORT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6287541,SUP,HCPCS C1713,,6287541  -  SPACER SPNL 11MM 14X5MM VRTSTCK CRSTN PSR LAT PORT PEEK-OPTM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6287641,SUP,HCPCS C1713,,6287641  -  SPACER SPNL 11MM 14X6MM VRTSTCK CRSTN PSR LAT PORT PEEK-OPTM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6287741,SUP,HCPCS C1713,,6287741  -  SPACER SPNL 11MM 14X7MM VRTSTCK CRSTN PSR LAT PORT PEEK-OPTM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6287841,SUP,HCPCS C1713,,6287841  -  SPACER SPNL 11MM 14X8MM VRTSTCK CRSTN PSR LAT PORT PEEK-OPTM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6287941,SUP,HCPCS C1713,,6287941  -  SPACER SPNL 11MM 14X9MM VRTSTCK CRSTN PSR LAT PORT PEEK-OPTM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6288044,SUP,HCPCS C1713,,6288044  -  SPACER SPNL 14MM 14X10MM VRTSTCK CRSTN PSR LAT PORT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6288144,SUP,HCPCS C1713,,6288144  -  SPACER SPNL 14MM 14X11MM VRTSTCK CRSTN PSR LAT PORT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6288244,SUP,HCPCS C1713,,6288244  -  SPACER SPNL 14MM 14X12MM VRTSTCK CRSTN PSR LAT PORT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6288344,SUP,HCPCS C1713,,6288344  -  SPACER SPNL 14MM 14X13MM VRTSTCK CRSTN PSR LAT PORT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6288544,SUP,HCPCS C1713,,6288544  -  SPACER SPNL 14MM 14X5MM VRTSTCK CRSTN PSR LAT PORT PEEK-OPTM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6288644,SUP,HCPCS C1713,,6288644  -  SPACER SPNL 14MM 14X6MM VRTSTCK CRSTN PSR LAT PORT PEEK-OPTM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6288744,SUP,HCPCS C1713,,6288744  -  SPACER SPNL 14MM 14X7MM VRTSTCK CRSTN PSR LAT PORT PEEK-OPTM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6288844,SUP,HCPCS C1713,,6288844  -  SPACER SPNL 14MM 14X8MM VRTSTCK CRSTN PSR LAT PORT PEEK-OPTM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6288944,SUP,HCPCS C1713,,6288944  -  SPACER SPNL 14MM 14X9MM VRTSTCK CRSTN PSR LAT PORT PEEK-OPTM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6300240,SUP,HCPCS C1713,,6300240  -  CAGE SPNL 30D XL HYPERLORDOTIC 40X22X2MM CRNT,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6300245,SUP,HCPCS C1713,,6300245  -  CAGE SPNL 30D XL HYPERLORDOTIC 45X22X2MM CRNT,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6300250,SUP,HCPCS C1713,,6300250  -  CAGE SPNL 30D XL HYPERLORDOTIC 50X22X2MM CRNT,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6300255,SUP,HCPCS C1713,,6300255  -  CAGE SPNL 30D XL HYPERLORDOTIC 55X22X2MM CRNT,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6300260,SUP,HCPCS C1713,,6300260  -  CAGE SPNL 30D XL HYPERLORDOTIC 60X22X2MM CRNT,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6300265,SUP,HCPCS C1713,,6300265  -  CAGE SPNL 30D XL HYPERLORDOTIC 65X22X2MM CRNT,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6300440,SUP,HCPCS C1713,,6300440  -  CAGE SPNL 30D XL HYPERLORDOTIC 40X22X4MM CRNT,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6300445,SUP,HCPCS C1713,,6300445  -  CAGE SPNL 30D XL HYPERLORDOTIC 45X22X4MM CRNT,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6300450,SUP,HCPCS C1713,,6300450  -  CAGE SPNL 30D XL HYPERLORDOTIC 50X22X4MM CRNT,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6300455,SUP,HCPCS C1713,,6300455  -  CAGE SPNL 30D XL HYPERLORDOTIC 55X22X4MM CRNT,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6300460,SUP,HCPCS C1713,,6300460  -  CAGE SPNL 30D XL HYPERLORDOTIC 60X22X4MM CRNT,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6300465,SUP,HCPCS C1713,,6300465  -  CAGE SPNL 30D XL HYPERLORDOTIC 65X22X4MM CRNT,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6300640,SUP,HCPCS C1713,,6300640  -  CAGE SPNL 30D XL HYPERLORDOTIC 40X22X6MM CRNT,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6300645,SUP,HCPCS C1713,,6300645  -  CAGE SPNL 30D XL HYPERLORDOTIC 45X22X6MM CRNT,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6300650,SUP,HCPCS C1713,,6300650  -  CAGE SPNL 30D XL HYPERLORDOTIC 50X22X6MM CRNT,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6300655,SUP,HCPCS C1713,,6300655  -  CAGE SPNL 30D LRDTC HI,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6300660,SUP,HCPCS C1713,,6300660  -  CAGE SPNL 30D XL HYPERLORDOTIC 60X22X6MM CRNT,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6300665,SUP,HCPCS C1713,,6300665  -  CAGE SPNL 30D XL HYPERLORDOTIC 65X22X6MM CRNT,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6300840,SUP,HCPCS C1713,,6300840  -  CAGE SPNL 30D XL HYPERLORDOTIC 40X22X8MM CRNT,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6300845,SUP,HCPCS C1713,,6300845  -  CAGE SPNL 30D XL HYPERLORDOTIC 45X22X8MM CRNT,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6300850,SUP,HCPCS C1713,,6300850  -  CAGE SPNL 30D XL HYPERLORDOTIC 50X22X8MM CRNT,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6300855,SUP,HCPCS C1713,,6300855  -  CAGE SPNL 30D XL HYPERLORDOTIC 55X22X8MM CRNT,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6300860,SUP,HCPCS C1713,,6300860  -  CAGE SPNL 30D XL HYPERLORDOTIC 60X22X8MM NS LF CRNT,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6300865,SUP,HCPCS C1713,,6300865  -  CAGE SPNL 30D XL HYPERLORDOTIC 65X22X8MM CRNT,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6301040,SUP,HCPCS C1713,,6301040  -  CAGE SPNL 30D XL HYPERLORDOTIC 40X22X10MM CRNT,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6301045,SUP,HCPCS C1713,,6301045  -  CAGE SPNL 30D XL HYPERLORDOTIC 45X22X10MM CRNT,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6301050,SUP,HCPCS C1713,,6301050  -  CAGE SPNL 30D XL HYPERLORDOTIC 50X22X10MM CRNT,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6301055,SUP,HCPCS C1713,,6301055  -  CAGE SPNL 30D XL HYPERLORDOTIC 55X22X10MM CRNT,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6301060,SUP,HCPCS C1713,,6301060  -  CAGE SPNL 30D XL HYPERLORDOTIC 60X22X10MM CRNT,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6301065,SUP,HCPCS C1713,,6301065  -  CAGE SPNL 30D XL HYPERLORDOTIC 65X22X10MM CRNT,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
6360032,SUP,HCPCS C1713,,6360032  -  SPACER SPNL XS 13X12X10MM PRIMTR C PEEK-OPTM CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6360053,SUP,HCPCS C1713,,6360053  -  SPACER SPNL XS 15X13X10MM PRIMTR C PEEK-OPTM CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6360132,SUP,HCPCS C1713,,6360132  -  SPACER SPNL XS 13X12X11MM PRIMTR C PEEK-OPTM CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6360153,SUP,HCPCS C1713,,6360153  -  SPACER SPNL XS 15X13X11MM PRIMTR C PEEK-OPTM CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6360232,SUP,HCPCS C1713,,6360232  -  SPACER SPNL XS 13X12X12MM PRIMTR C PEEK-OPTM CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6360253,SUP,HCPCS C1713,,6360253  -  SPACER SPNL XS 15X13X12MM PRIMTR C PEEK-OPTM CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6360532,SUP,HCPCS C1713,,6360532  -  SPACER SPNL XS 13X12X5MM PRIMTR C PEEK-OPTM CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6360553,SUP,HCPCS C1713,,6360553  -  SPACER SPNL XS 15X13X5MM PRIMTR C PEEK-OPTM CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6360632,SUP,HCPCS C1713,,6360632  -  SPACER SPNL XS 13X12X6MM PRIMTR C PEEK-OPTM CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6360653,SUP,HCPCS C1713,,6360653  -  SPACER SPNL XS 15X6X3MM PRIMTR C PEEK-OPTM CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6360732,SUP,HCPCS C1713,,6360732  -  SPACER SPNL XS 13X12X7MM PRIMTR C PEEK-OPTM CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6360753,SUP,HCPCS C1713,,6360753  -  SPACER SPNL XS 15X13X7MM PRIMTR C PEEK-OPTM CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6360832,SUP,HCPCS C1713,,6360832  -  SPACER SPNL XS 13X12X8MM PRIMTR C PEEK-OPTM CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6360853,SUP,HCPCS C1713,,6360853  -  SPACER SPNL XS 15X13X8MM PRIMTR C PEEK-OPTM CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6360932,SUP,HCPCS C1713,,6360932  -  SPACER SPNL XS 13X12X9MM PRIMTR C PEEK-OPTM CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6360953,SUP,HCPCS C1713,,6360953  -  SPACER SPNL XS 15X13X9MM PRIMTR C PEEK-OPTM CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6390206,SUP,Custom 27803010,,6390206  -  CAGE SPNL CYL LRDTC TPR 6MM 12MM AFF CLS CHMFR EDG MLT THR,"$6,988.50",$0.00,"$6,988.50",$0.00,"$4,987.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,988.50",$0.00,"$3,494.25","$5,534.89","$5,590.80",$0.00,$0.00,$0.00,$0.00,$0.00
6390207,SUP,Custom 27803010,,6390207  -  CAGE SPNL CYL LRDTC TPR 7MM 12MM AFF CLS CHMFR EDG MLT THR,"$6,988.50",$0.00,"$6,988.50",$0.00,"$4,987.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,988.50",$0.00,"$3,494.25","$5,534.89","$5,590.80",$0.00,$0.00,$0.00,$0.00,$0.00
6390208,SUP,Custom 27803010,,6390208  -  CAGE SPNL CYL LRDTC TPR 8MM 12MM AFF CLS CHMFR EDG MLT THR,"$6,988.50",$0.00,"$6,988.50",$0.00,"$4,987.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,988.50",$0.00,"$3,494.25","$5,534.89","$5,590.80",$0.00,$0.00,$0.00,$0.00,$0.00
6390209,SUP,Custom 27803010,,6390209  -  CAGE SPNL CYL LRDTC TPR 9MM 12MM AFF CLS CHMFR EDG MLT THR,"$6,988.50",$0.00,"$6,988.50",$0.00,"$4,987.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,988.50",$0.00,"$3,494.25","$5,534.89","$5,590.80",$0.00,$0.00,$0.00,$0.00,$0.00
6390210,SUP,Custom 27803010,,6390210  -  CAGE SPNL CYL LRDTC TPR 10MM 12MM AFF CLS CHMFR EDG MLT THR,"$6,988.50",$0.00,"$6,988.50",$0.00,"$4,987.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,988.50",$0.00,"$3,494.25","$5,534.89","$5,590.80",$0.00,$0.00,$0.00,$0.00,$0.00
6390211,SUP,Custom 27803010,,6390211  -  CAGE SPNL CYL LRDTC TPR 11MM 12MM AFF CLS CHMFR EDG MLT THR,"$6,988.50",$0.00,"$6,988.50",$0.00,"$4,987.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,988.50",$0.00,"$3,494.25","$5,534.89","$5,590.80",$0.00,$0.00,$0.00,$0.00,$0.00
6390212,SUP,Custom 27803010,,6390212  -  CAGE SPNL CYL LRDTC TPR 12MM 12MM AFF CLS CHMFR EDG MLT THR,"$6,988.50",$0.00,"$6,988.50",$0.00,"$4,987.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,988.50",$0.00,"$3,494.25","$5,534.89","$5,590.80",$0.00,$0.00,$0.00,$0.00,$0.00
6390406,SUP,Custom 27803010,,6390406  -  CAGE SPNL CYL LRDTC TPR 6MM 14MM AFF CLS CHMFR EDG MLT THR,"$6,988.50",$0.00,"$6,988.50",$0.00,"$4,987.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,988.50",$0.00,"$3,494.25","$5,534.89","$5,590.80",$0.00,$0.00,$0.00,$0.00,$0.00
6390407,SUP,Custom 27803010,,6390407  -  CAGE SPNL CYL LRDTC TPR 7MM 14MM AFF CLS CHMFR EDG MLT THR,"$6,988.50",$0.00,"$6,988.50",$0.00,"$4,987.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,988.50",$0.00,"$3,494.25","$5,534.89","$5,590.80",$0.00,$0.00,$0.00,$0.00,$0.00
6390408,SUP,Custom 27803010,,6390408  -  CAGE SPNL CYL LRDTC TPR 8MM 14MM AFF CLS CHMFR EDG MLT THR,"$6,988.50",$0.00,"$6,988.50",$0.00,"$4,987.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,988.50",$0.00,"$3,494.25","$5,534.89","$5,590.80",$0.00,$0.00,$0.00,$0.00,$0.00
6390409,SUP,Custom 27803010,,6390409  -  CAGE SPNL CYL LRDTC TPR 9MM 14MM AFF CLS CHMFR EDG MLT THR,"$6,988.50",$0.00,"$6,988.50",$0.00,"$4,987.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,988.50",$0.00,"$3,494.25","$5,534.89","$5,590.80",$0.00,$0.00,$0.00,$0.00,$0.00
6390410,SUP,Custom 27803010,,6390410  -  CAGE SPNL CYL LRDTC TPR 10MM 14MM AFF CLS CHMFR EDG MLT THR,"$6,988.50",$0.00,"$6,988.50",$0.00,"$4,987.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,988.50",$0.00,"$3,494.25","$5,534.89","$5,590.80",$0.00,$0.00,$0.00,$0.00,$0.00
6390411,SUP,Custom 27803010,,6390411  -  CAGE SPNL CYL LRDTC TPR 11MM 14MM AFF CLS CHMFR EDG MLT THR,"$6,988.50",$0.00,"$6,988.50",$0.00,"$4,987.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,988.50",$0.00,"$3,494.25","$5,534.89","$5,590.80",$0.00,$0.00,$0.00,$0.00,$0.00
6390412,SUP,Custom 27803010,,6390412  -  CAGE SPNL CYL LRDTC TPR 12MM 14MM AFF CLS CHMFR EDG MLT THR,"$6,988.50",$0.00,"$6,988.50",$0.00,"$4,987.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,988.50",$0.00,"$3,494.25","$5,534.89","$5,590.80",$0.00,$0.00,$0.00,$0.00,$0.00
6430530,SUP,HCPCS C1713,,6430530  -  SCREW SET TI 4.75MM SPN PERC SOLERA CD HZN STRL,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
6440530,SUP,HCPCS C1713,,6440530  -  SET SCREW 6440530 4.75 SOLERA PERC TI,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
6470314,SUP,Custom 27203010,,"6470314  -  BRYAN CERVICAL DISC, 14MM","$8,850.00",$0.00,"$8,850.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,850.00",$0.00,"$4,425.00","$7,009.20","$7,080.00",$0.00,$0.00,$0.00,$0.00,$0.00
6470315,SUP,Custom 27803010,,6470315  -  DISK SPINAL MOTION BRYAN 15MM CERV,"$8,850.00",$0.00,"$8,850.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,850.00",$0.00,"$4,425.00","$7,009.20","$7,080.00",$0.00,$0.00,$0.00,$0.00,$0.00
6474024,SUP,HCPCS C1713,,6474024  -  PIN DISTRACTION 14MM 3.5MM REUSABLE,$330.00,$0.00,$330.00,$148.50,$235.52,$0.00,$56.86,$0.00,$0.00,$57.78,$330.00,$0.00,$165.00,$261.36,$264.00,$0.00,$51.65,$0.00,$52.54,$0.00
6474176,SUP,Custom 27203010,,6474176  -  BIT DRILL SPN,$525.00,$0.00,$525.00,$0.00,$374.69,$0.00,$0.00,$0.00,$0.00,$0.00,$525.00,$0.00,$262.50,$415.80,$420.00,$0.00,$0.00,$0.00,$0.00,$0.00
6474524,SUP,Custom 27203010,,6474524  -  BRYAN DISC CUTTER 14MM,"$1,350.00",$0.00,"$1,350.00",$0.00,$963.50,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,350.00",$0.00,$675.00,"$1,069.20","$1,080.00",$0.00,$0.00,$0.00,$0.00,$0.00
6533131,SUP,HCPCS C1713,,6533131  -  END CAP SPNL 0D 30X18MM VBR EXPANDABLE,"$3,740.00",$0.00,"$3,740.00","$1,683.00","$2,669.24",$0.00,$644.38,$0.00,$0.00,$654.84,"$3,740.00",$0.00,"$1,870.00","$2,962.08","$2,992.00",$0.00,$585.31,$0.00,$595.41,$0.00
6533141,SUP,HCPCS C1713,,6533141  -  END CAP SPNL 0D 40X18MM VBR EXPANDABLE,"$3,740.00",$0.00,"$3,740.00","$1,683.00","$2,669.24",$0.00,$644.38,$0.00,$0.00,$654.84,"$3,740.00",$0.00,"$1,870.00","$2,962.08","$2,992.00",$0.00,$585.31,$0.00,$595.41,$0.00
6533151,SUP,HCPCS C1713,,6533151  -  CAGE SPNL 0D 50X18MM VBR ENDCP EXPANDABLE,"$3,740.00",$0.00,"$3,740.00","$1,683.00","$2,669.24",$0.00,$644.38,$0.00,$0.00,$654.84,"$3,740.00",$0.00,"$1,870.00","$2,962.08","$2,992.00",$0.00,$585.31,$0.00,$595.41,$0.00
6533231,SUP,HCPCS C1713,,6533231  -  END CAP SPNL 4D 30X18MM VBR EXPANDABLE,"$3,740.00",$0.00,"$3,740.00","$1,683.00","$2,669.24",$0.00,$644.38,$0.00,$0.00,$654.84,"$3,740.00",$0.00,"$1,870.00","$2,962.08","$2,992.00",$0.00,$585.31,$0.00,$595.41,$0.00
6533241,SUP,HCPCS C1713,,6533241  -  CAGE SPNL 4D 40X18MM VBR ENDCP EXPANDABLE,"$3,740.00",$0.00,"$3,740.00","$1,683.00","$2,669.24",$0.00,$644.38,$0.00,$0.00,$654.84,"$3,740.00",$0.00,"$1,870.00","$2,962.08","$2,992.00",$0.00,$585.31,$0.00,$595.41,$0.00
6533251,SUP,HCPCS C1713,,6533251  -  END CAP SPNL 4D 50X18MM VBR EXPANDABLE,"$3,740.00",$0.00,"$3,740.00","$1,683.00","$2,669.24",$0.00,$644.38,$0.00,$0.00,$654.84,"$3,740.00",$0.00,"$1,870.00","$2,962.08","$2,992.00",$0.00,$585.31,$0.00,$595.41,$0.00
6533331,SUP,HCPCS C1713,,6533331  -  CAGE SPNL 8D 30X18MM VBR ENDCP EXPANDABLE,"$3,740.00",$0.00,"$3,740.00","$1,683.00","$2,669.24",$0.00,$644.38,$0.00,$0.00,$654.84,"$3,740.00",$0.00,"$1,870.00","$2,962.08","$2,992.00",$0.00,$585.31,$0.00,$595.41,$0.00
6533341,SUP,HCPCS C1713,,6533341  -  CAGE SPNL 8D 40X18MM VBR ENDCP EXPANDABLE,"$3,740.00",$0.00,"$3,740.00","$1,683.00","$2,669.24",$0.00,$644.38,$0.00,$0.00,$654.84,"$3,740.00",$0.00,"$1,870.00","$2,962.08","$2,992.00",$0.00,$585.31,$0.00,$595.41,$0.00
6533351,SUP,HCPCS C1713,,6533351  -  CAGE SPNL 8D 50X18MM VBR ENDCP EXPANDABLE,"$3,740.00",$0.00,"$3,740.00","$1,683.00","$2,669.24",$0.00,$644.38,$0.00,$0.00,$654.84,"$3,740.00",$0.00,"$1,870.00","$2,962.08","$2,992.00",$0.00,$585.31,$0.00,$595.41,$0.00
6533431,SUP,HCPCS C1713,,6533431  -  END CAP SPNL -4D 30X18MM VBR EXPANDABLE,"$3,740.00",$0.00,"$3,740.00","$1,683.00","$2,669.24",$0.00,$644.38,$0.00,$0.00,$654.84,"$3,740.00",$0.00,"$1,870.00","$2,962.08","$2,992.00",$0.00,$585.31,$0.00,$595.41,$0.00
6533441,SUP,HCPCS C1713,,6533441  -  CAGE SPNL -4D 40X18MM VBR ENDCP EXPANDABLE,"$3,740.00",$0.00,"$3,740.00","$1,683.00","$2,669.24",$0.00,$644.38,$0.00,$0.00,$654.84,"$3,740.00",$0.00,"$1,870.00","$2,962.08","$2,992.00",$0.00,$585.31,$0.00,$595.41,$0.00
6533451,SUP,HCPCS C1713,,6533451  -  CAGE SPNL -4D 50X18MM VBR ENDCP EXPANDABLE,"$3,740.00",$0.00,"$3,740.00","$1,683.00","$2,669.24",$0.00,$644.38,$0.00,$0.00,$654.84,"$3,740.00",$0.00,"$1,870.00","$2,962.08","$2,992.00",$0.00,$585.31,$0.00,$595.41,$0.00
6535241,SUP,HCPCS C1713,,6535241  -  CAGE SPNL 0D 40X22MM VBR ENDCP EXPANDABLE,"$3,740.00",$0.00,"$3,740.00","$1,683.00","$2,669.24",$0.00,$644.38,$0.00,$0.00,$654.84,"$3,740.00",$0.00,"$1,870.00","$2,962.08","$2,992.00",$0.00,$585.31,$0.00,$595.41,$0.00
6535251,SUP,HCPCS C1713,,6535251  -  CAGE SPNL 0D 50X22MM VBR ENDCP EXPANDABLE,"$3,740.00",$0.00,"$3,740.00","$1,683.00","$2,669.24",$0.00,$644.38,$0.00,$0.00,$654.84,"$3,740.00",$0.00,"$1,870.00","$2,962.08","$2,992.00",$0.00,$585.31,$0.00,$595.41,$0.00
6535261,SUP,HCPCS C1713,,6535261  -  CAGE SPNL 0D 60X22MM VBR ENDCP EXPANDABLE,"$3,740.00",$0.00,"$3,740.00","$1,683.00","$2,669.24",$0.00,$644.38,$0.00,$0.00,$654.84,"$3,740.00",$0.00,"$1,870.00","$2,962.08","$2,992.00",$0.00,$585.31,$0.00,$595.41,$0.00
6535341,SUP,HCPCS C1713,,6535341  -  CAGE SPNL 4D 40X22MM VBR ENDCP EXPANDABLE,"$3,740.00",$0.00,"$3,740.00","$1,683.00","$2,669.24",$0.00,$644.38,$0.00,$0.00,$654.84,"$3,740.00",$0.00,"$1,870.00","$2,962.08","$2,992.00",$0.00,$585.31,$0.00,$595.41,$0.00
6535351,SUP,HCPCS C1713,,6535351  -  CAGE SPNL 4D 50X22MM VBR ENDCP EXPANDABLE,"$3,740.00",$0.00,"$3,740.00","$1,683.00","$2,669.24",$0.00,$644.38,$0.00,$0.00,$654.84,"$3,740.00",$0.00,"$1,870.00","$2,962.08","$2,992.00",$0.00,$585.31,$0.00,$595.41,$0.00
6535361,SUP,HCPCS C1713,,6535361  -  CAGE SPNL 4D 60X22MM VBR ENDCP EXPANDABLE,"$3,740.00",$0.00,"$3,740.00","$1,683.00","$2,669.24",$0.00,$644.38,$0.00,$0.00,$654.84,"$3,740.00",$0.00,"$1,870.00","$2,962.08","$2,992.00",$0.00,$585.31,$0.00,$595.41,$0.00
6535441,SUP,HCPCS C1713,,6535441  -  CAGE SPNL 8D 40X22MM VBR ENDCP EXPANDABLE,"$3,740.00",$0.00,"$3,740.00","$1,683.00","$2,669.24",$0.00,$644.38,$0.00,$0.00,$654.84,"$3,740.00",$0.00,"$1,870.00","$2,962.08","$2,992.00",$0.00,$585.31,$0.00,$595.41,$0.00
6535451,SUP,HCPCS C1713,,6535451  -  CAGE SPNL 8D 50X22MM VBR ENDCP EXPANDABLE,"$3,740.00",$0.00,"$3,740.00","$1,683.00","$2,669.24",$0.00,$644.38,$0.00,$0.00,$654.84,"$3,740.00",$0.00,"$1,870.00","$2,962.08","$2,992.00",$0.00,$585.31,$0.00,$595.41,$0.00
6535461,SUP,HCPCS C1713,,6535461  -  CAGE SPNL 8D 60X22MM VBR ENDCP EXPANDABLE,"$3,740.00",$0.00,"$3,740.00","$1,683.00","$2,669.24",$0.00,$644.38,$0.00,$0.00,$654.84,"$3,740.00",$0.00,"$1,870.00","$2,962.08","$2,992.00",$0.00,$585.31,$0.00,$595.41,$0.00
6535541,SUP,HCPCS C1713,,6535541  -  CAGE SPNL 12D 40X22MM VBR ENDCP EXPANDABLE,"$3,740.00",$0.00,"$3,740.00","$1,683.00","$2,669.24",$0.00,$644.38,$0.00,$0.00,$654.84,"$3,740.00",$0.00,"$1,870.00","$2,962.08","$2,992.00",$0.00,$585.31,$0.00,$595.41,$0.00
6535551,SUP,HCPCS C1713,,6535551  -  CAGE SPNL 12D 50X22MM VBR ENDCP EXPANDABLE,"$3,740.00",$0.00,"$3,740.00","$1,683.00","$2,669.24",$0.00,$644.38,$0.00,$0.00,$654.84,"$3,740.00",$0.00,"$1,870.00","$2,962.08","$2,992.00",$0.00,$585.31,$0.00,$595.41,$0.00
6535561,SUP,HCPCS C1713,,6535561  -  CAGE SPNL 12D 60X22MM VBR ENDCP EXPANDABLE,"$3,740.00",$0.00,"$3,740.00","$1,683.00","$2,669.24",$0.00,$644.38,$0.00,$0.00,$654.84,"$3,740.00",$0.00,"$1,870.00","$2,962.08","$2,992.00",$0.00,$585.31,$0.00,$595.41,$0.00
6537124,SUP,HCPCS C1713,,6537124  -  END CAP SPNL 0D RND 18MM 22MM VBR EXPANDABLE,"$2,352.50",$0.00,"$2,352.50","$1,058.63","$1,678.98",$0.00,$405.32,$0.00,$0.00,$411.90,"$2,352.50",$0.00,"$1,176.25","$1,863.18","$1,882.00",$0.00,$368.17,$0.00,$374.52,$0.00
6537125,SUP,HCPCS C1713,,6537125  -  CAGE SPNL 0D RND 18MM 26MM VBR ENDCP EXPANDABLE,"$2,352.50",$0.00,"$2,352.50","$1,058.63","$1,678.98",$0.00,$405.32,$0.00,$0.00,$411.90,"$2,352.50",$0.00,"$1,176.25","$1,863.18","$1,882.00",$0.00,$368.17,$0.00,$374.52,$0.00
6537134,SUP,HCPCS C1713,,6537134  -  END CAP SPNL 8D RND 18MM 22MM VBR EXPANDABLE,"$2,352.50",$0.00,"$2,352.50","$1,058.63","$1,678.98",$0.00,$405.32,$0.00,$0.00,$411.90,"$2,352.50",$0.00,"$1,176.25","$1,863.18","$1,882.00",$0.00,$368.17,$0.00,$374.52,$0.00
6537135,SUP,HCPCS C1713,,6537135  -  CAGE SPNL 8D RND 18MM 26MM VBR ENDCP EXPANDABLE,"$2,352.50",$0.00,"$2,352.50","$1,058.63","$1,678.98",$0.00,$405.32,$0.00,$0.00,$411.90,"$2,352.50",$0.00,"$1,176.25","$1,863.18","$1,882.00",$0.00,$368.17,$0.00,$374.52,$0.00
6537225,SUP,HCPCS C1713,,6537225  -  CAGE SPNL 0D RND 22MM 26MM VBR ENDCP EXPANDABLE,"$2,352.50",$0.00,"$2,352.50","$1,058.63","$1,678.98",$0.00,$405.32,$0.00,$0.00,$411.90,"$2,352.50",$0.00,"$1,176.25","$1,863.18","$1,882.00",$0.00,$368.17,$0.00,$374.52,$0.00
6537226,SUP,HCPCS C1713,,6537226  -  CAGE SPNL 0D RND 22MM 30MM VBR ENDCP EXPANDABLE,"$2,352.50",$0.00,"$2,352.50","$1,058.63","$1,678.98",$0.00,$405.32,$0.00,$0.00,$411.90,"$2,352.50",$0.00,"$1,176.25","$1,863.18","$1,882.00",$0.00,$368.17,$0.00,$374.52,$0.00
6537235,SUP,HCPCS C1713,,6537235  -  CAGE SPNL 8D RND 18MM 26MM VBR ENDCP EXPANDABLE,"$2,352.50",$0.00,"$2,352.50","$1,058.63","$1,678.98",$0.00,$405.32,$0.00,$0.00,$411.90,"$2,352.50",$0.00,"$1,176.25","$1,863.18","$1,882.00",$0.00,$368.17,$0.00,$374.52,$0.00
6537236,SUP,HCPCS C1713,,6537236  -  CAGE SPNL 8D RND 22MM 30MM VBR ENDCP EXPANDABLE,"$2,352.50",$0.00,"$2,352.50","$1,058.63","$1,678.98",$0.00,$405.32,$0.00,$0.00,$411.90,"$2,352.50",$0.00,"$1,176.25","$1,863.18","$1,882.00",$0.00,$368.17,$0.00,$374.52,$0.00
6539001,SUP,HCPCS C1713,,6539001  -  SCREW BN SM VBR EXPANDABLE LCK SPNE,$620.00,$0.00,$620.00,$279.00,$442.49,$0.00,$106.82,$0.00,$0.00,$108.56,$620.00,$0.00,$310.00,$491.04,$496.00,$0.00,$97.03,$0.00,$98.70,$0.00
6539002,SUP,HCPCS C1713,,6539002  -  SCREW BN LG VBR LCK EXPANDABLE SPNE,$620.00,$0.00,$620.00,$279.00,$442.49,$0.00,$106.82,$0.00,$0.00,$108.56,$620.00,$0.00,$310.00,$491.04,$496.00,$0.00,$97.03,$0.00,$98.70,$0.00
6540530,SUP,HCPCS C1713,,6540530  -  SCREW SET 5.5/6MM NS LF CD HZN SOLERAL VYGR,$912.50,$0.00,$912.50,$410.63,$651.25,$0.00,$157.22,$0.00,$0.00,$159.77,$912.50,$0.00,$456.25,$722.70,$730.00,$0.00,$142.81,$0.00,$145.27,$0.00
6541019,SUP,HCPCS C1713,,6541019  -  STAPLE 6541019 19MM ROSTRAL,"$2,932.13",$0.00,"$2,932.13","$1,319.46","$2,092.66",$0.00,$505.19,$0.00,$0.00,$513.39,"$2,932.13",$0.00,"$1,466.06","$2,322.25","$2,345.70",$0.00,$458.88,$0.00,$466.79,$0.00
6541021,SUP,HCPCS C1713,,6541021  -  STAPLE 6541021 21MM ROSTRAL,"$2,932.13",$0.00,"$2,932.13","$1,319.46","$2,092.66",$0.00,$505.19,$0.00,$0.00,$513.39,"$2,932.13",$0.00,"$1,466.06","$2,322.25","$2,345.70",$0.00,$458.88,$0.00,$466.79,$0.00
6541023,SUP,HCPCS C1713,,6541023  -  STAPLE 6541023 23MM ROSTRAL,"$2,932.13",$0.00,"$2,932.13","$1,319.46","$2,092.66",$0.00,$505.19,$0.00,$0.00,$513.39,"$2,932.13",$0.00,"$1,466.06","$2,322.25","$2,345.70",$0.00,$458.88,$0.00,$466.79,$0.00
6541025,SUP,HCPCS C1713,,6541025  -  STAPLE 6541025 25MM ROSTRAL,"$2,932.13",$0.00,"$2,932.13","$1,319.46","$2,092.66",$0.00,$505.19,$0.00,$0.00,$513.39,"$2,932.13",$0.00,"$1,466.06","$2,322.25","$2,345.70",$0.00,$458.88,$0.00,$466.79,$0.00
6541119,SUP,HCPCS C1713,,6541119  -  STAPLE 6541119 19MM CAUDAL,"$2,932.13",$0.00,"$2,932.13","$1,319.46","$2,092.66",$0.00,$505.19,$0.00,$0.00,$513.39,"$2,932.13",$0.00,"$1,466.06","$2,322.25","$2,345.70",$0.00,$458.88,$0.00,$466.79,$0.00
6541121,SUP,HCPCS C1713,,6541121  -  STAPLE 6541121 21MM CAUDAL,"$2,932.13",$0.00,"$2,932.13","$1,319.46","$2,092.66",$0.00,$505.19,$0.00,$0.00,$513.39,"$2,932.13",$0.00,"$1,466.06","$2,322.25","$2,345.70",$0.00,$458.88,$0.00,$466.79,$0.00
6541123,SUP,HCPCS C1713,,6541123  -  STAPLE 6541123 23MM CAUDAL,"$2,932.13",$0.00,"$2,932.13","$1,319.46","$2,092.66",$0.00,$505.19,$0.00,$0.00,$513.39,"$2,932.13",$0.00,"$1,466.06","$2,322.25","$2,345.70",$0.00,$458.88,$0.00,$466.79,$0.00
6541125,SUP,HCPCS C1713,,6541125  -  STAPLE 6541125 25MM CAUDAL,"$2,932.13",$0.00,"$2,932.13","$1,319.46","$2,092.66",$0.00,$505.19,$0.00,$0.00,$513.39,"$2,932.13",$0.00,"$1,466.06","$2,322.25","$2,345.70",$0.00,$458.88,$0.00,$466.79,$0.00
6541213,SUP,HCPCS C1713,,6541213  -  STAPLE 6541213 SINGLE 13MM,"$1,465.50",$0.00,"$1,465.50",$659.48,"$1,045.93",$0.00,$252.50,$0.00,$0.00,$256.60,"$1,465.50",$0.00,$732.75,"$1,160.68","$1,172.40",$0.00,$229.35,$0.00,$233.31,$0.00
6541215,SUP,HCPCS C1713,,6541215  -  STAPLE 6541215 SINGLE 15MM,"$1,465.50",$0.00,"$1,465.50",$659.48,"$1,045.93",$0.00,$252.50,$0.00,$0.00,$256.60,"$1,465.50",$0.00,$732.75,"$1,160.68","$1,172.40",$0.00,$229.35,$0.00,$233.31,$0.00
6541217,SUP,HCPCS C1713,,6541217  -  STAPLE 6541217 SINGLE 17MM,"$1,465.50",$0.00,"$1,465.50",$659.48,"$1,045.93",$0.00,$252.50,$0.00,$0.00,$256.60,"$1,465.50",$0.00,$732.75,"$1,160.68","$1,172.40",$0.00,$229.35,$0.00,$233.31,$0.00
6543420,SUP,HCPCS C1713,,6543420  -  SCREW 6543420 4.5MM FAS FOR 5.5 20MM LG,"$1,980.00",$0.00,"$1,980.00",$891.00,"$1,413.13",$0.00,$341.14,$0.00,$0.00,$346.68,"$1,980.00",$0.00,$990.00,"$1,568.16","$1,584.00",$0.00,$309.87,$0.00,$315.22,$0.00
6543425,SUP,HCPCS C1713,,6543425  -  SCREW 6543425 4.5MM FAS FOR 5.5 25MM LG,"$1,980.00",$0.00,"$1,980.00",$891.00,"$1,413.13",$0.00,$341.14,$0.00,$0.00,$346.68,"$1,980.00",$0.00,$990.00,"$1,568.16","$1,584.00",$0.00,$309.87,$0.00,$315.22,$0.00
6543430,SUP,HCPCS C1713,,6543430  -  SCREW 6543430 4.5MM FAS FOR 5.5 30MM LG,"$1,980.00",$0.00,"$1,980.00",$891.00,"$1,413.13",$0.00,$341.14,$0.00,$0.00,$346.68,"$1,980.00",$0.00,$990.00,"$1,568.16","$1,584.00",$0.00,$309.87,$0.00,$315.22,$0.00
6543435,SUP,HCPCS C1713,,6543435  -  SCREW 6543435 4.5MM FAS FOR 5.5 35MM LG,"$1,980.00",$0.00,"$1,980.00",$891.00,"$1,413.13",$0.00,$341.14,$0.00,$0.00,$346.68,"$1,980.00",$0.00,$990.00,"$1,568.16","$1,584.00",$0.00,$309.87,$0.00,$315.22,$0.00
6543440,SUP,HCPCS C1713,,6543440  -  SCREW 6543440 4.5MM FAS FOR 5.5 40MM LG,"$1,980.00",$0.00,"$1,980.00",$891.00,"$1,413.13",$0.00,$341.14,$0.00,$0.00,$346.68,"$1,980.00",$0.00,$990.00,"$1,568.16","$1,584.00",$0.00,$309.87,$0.00,$315.22,$0.00
6543445,SUP,HCPCS C1713,,6543445  -  SCREW 6543445 4.5MM FAS FOR 5.5 45MM LG,"$1,980.00",$0.00,"$1,980.00",$891.00,"$1,413.13",$0.00,$341.14,$0.00,$0.00,$346.68,"$1,980.00",$0.00,$990.00,"$1,568.16","$1,584.00",$0.00,$309.87,$0.00,$315.22,$0.00
6543450,SUP,HCPCS C1713,,6543450  -  SCREW 6543450 4.5MM FAS FOR 5.5 50MM LG,"$1,980.00",$0.00,"$1,980.00",$891.00,"$1,413.13",$0.00,$341.14,$0.00,$0.00,$346.68,"$1,980.00",$0.00,$990.00,"$1,568.16","$1,584.00",$0.00,$309.87,$0.00,$315.22,$0.00
6543520,SUP,HCPCS C1713,,6543520  -  SCREW 6543520 5.5MM FAS FOR 5.5 20MM LG,"$1,980.00",$0.00,"$1,980.00",$891.00,"$1,413.13",$0.00,$341.14,$0.00,$0.00,$346.68,"$1,980.00",$0.00,$990.00,"$1,568.16","$1,584.00",$0.00,$309.87,$0.00,$315.22,$0.00
6543525,SUP,HCPCS C1713,,6543525  -  SCREW 6543525 5.5MM FAS FOR 5.5 25MM LG,"$1,980.00",$0.00,"$1,980.00",$891.00,"$1,413.13",$0.00,$341.14,$0.00,$0.00,$346.68,"$1,980.00",$0.00,$990.00,"$1,568.16","$1,584.00",$0.00,$309.87,$0.00,$315.22,$0.00
6543530,SUP,HCPCS C1713,,6543530  -  SCREW 6543530 5.5MM FAS FOR 5.5 30MM LG,"$1,980.00",$0.00,"$1,980.00",$891.00,"$1,413.13",$0.00,$341.14,$0.00,$0.00,$346.68,"$1,980.00",$0.00,$990.00,"$1,568.16","$1,584.00",$0.00,$309.87,$0.00,$315.22,$0.00
6543535,SUP,HCPCS C1713,,6543535  -  SCREW 6543535 5.5MM FAS FOR 5.5 35MM LG,"$1,980.00",$0.00,"$1,980.00",$891.00,"$1,413.13",$0.00,$341.14,$0.00,$0.00,$346.68,"$1,980.00",$0.00,$990.00,"$1,568.16","$1,584.00",$0.00,$309.87,$0.00,$315.22,$0.00
6543540,SUP,HCPCS C1713,,6543540  -  SCREW 6543540 5.5MM FAS FOR 5.5 40MM LG,"$1,980.00",$0.00,"$1,980.00",$891.00,"$1,413.13",$0.00,$341.14,$0.00,$0.00,$346.68,"$1,980.00",$0.00,$990.00,"$1,568.16","$1,584.00",$0.00,$309.87,$0.00,$315.22,$0.00
6543545,SUP,HCPCS C1713,,6543545  -  SCREW 6543545 5.5MM FAS FOR 5.5 45MM LG,"$1,980.00",$0.00,"$1,980.00",$891.00,"$1,413.13",$0.00,$341.14,$0.00,$0.00,$346.68,"$1,980.00",$0.00,$990.00,"$1,568.16","$1,584.00",$0.00,$309.87,$0.00,$315.22,$0.00
6543550,SUP,HCPCS C1713,,6543550  -  SCREW 6543550 5.5MM FAS FOR 5.5 50MM LG,"$1,980.00",$0.00,"$1,980.00",$891.00,"$1,413.13",$0.00,$341.14,$0.00,$0.00,$346.68,"$1,980.00",$0.00,$990.00,"$1,568.16","$1,584.00",$0.00,$309.87,$0.00,$315.22,$0.00
6543620,SUP,HCPCS C1713,,6543620  -  SCREW 6543620 6.5MM FAS FOR 5.5 20MM LG,"$1,980.00",$0.00,"$1,980.00",$891.00,"$1,413.13",$0.00,$341.14,$0.00,$0.00,$346.68,"$1,980.00",$0.00,$990.00,"$1,568.16","$1,584.00",$0.00,$309.87,$0.00,$315.22,$0.00
6543625,SUP,HCPCS C1713,,6543625  -  SCREW 6543625 6.5MM FAS FOR 5.5 25MM LG,"$1,980.00",$0.00,"$1,980.00",$891.00,"$1,413.13",$0.00,$341.14,$0.00,$0.00,$346.68,"$1,980.00",$0.00,$990.00,"$1,568.16","$1,584.00",$0.00,$309.87,$0.00,$315.22,$0.00
6543630,SUP,HCPCS C1713,,6543630  -  SCREW 6543630 6.5MM FAS FOR 5.5 30MM LG,"$1,980.00",$0.00,"$1,980.00",$891.00,"$1,413.13",$0.00,$341.14,$0.00,$0.00,$346.68,"$1,980.00",$0.00,$990.00,"$1,568.16","$1,584.00",$0.00,$309.87,$0.00,$315.22,$0.00
6543635,SUP,HCPCS C1713,,6543635  -  SCREW 6543635 6.5MM FAS FOR 5.5 35MM LG,"$1,980.00",$0.00,"$1,980.00",$891.00,"$1,413.13",$0.00,$341.14,$0.00,$0.00,$346.68,"$1,980.00",$0.00,$990.00,"$1,568.16","$1,584.00",$0.00,$309.87,$0.00,$315.22,$0.00
6543640,SUP,HCPCS C1713,,6543640  -  SCREW 6543640 6.5MM FAS FOR 5.5 40MM LG,"$1,980.00",$0.00,"$1,980.00",$891.00,"$1,413.13",$0.00,$341.14,$0.00,$0.00,$346.68,"$1,980.00",$0.00,$990.00,"$1,568.16","$1,584.00",$0.00,$309.87,$0.00,$315.22,$0.00
6543645,SUP,HCPCS C1713,,6543645  -  SCREW 6543645 6.5MM FAS FOR 5.5 45MM LG,"$1,980.00",$0.00,"$1,980.00",$891.00,"$1,413.13",$0.00,$341.14,$0.00,$0.00,$346.68,"$1,980.00",$0.00,$990.00,"$1,568.16","$1,584.00",$0.00,$309.87,$0.00,$315.22,$0.00
6543650,SUP,HCPCS C1713,,6543650  -  SCREW 6543650 6.5MM FAS FOR 5.5 50MM LG,"$1,980.00",$0.00,"$1,980.00",$891.00,"$1,413.13",$0.00,$341.14,$0.00,$0.00,$346.68,"$1,980.00",$0.00,$990.00,"$1,568.16","$1,584.00",$0.00,$309.87,$0.00,$315.22,$0.00
6543655,SUP,HCPCS C1713,,6543655  -  SCREW 6543655 6.5MM FAS FOR 5.5 55MM LG,"$1,980.00",$0.00,"$1,980.00",$891.00,"$1,413.13",$0.00,$341.14,$0.00,$0.00,$346.68,"$1,980.00",$0.00,$990.00,"$1,568.16","$1,584.00",$0.00,$309.87,$0.00,$315.22,$0.00
6543660,SUP,HCPCS C1713,,6543660  -  SCREW 6543660 6.5MM FAS FOR 5.5 60MM LG,"$1,980.00",$0.00,"$1,980.00",$891.00,"$1,413.13",$0.00,$341.14,$0.00,$0.00,$346.68,"$1,980.00",$0.00,$990.00,"$1,568.16","$1,584.00",$0.00,$309.87,$0.00,$315.22,$0.00
6543720,SUP,HCPCS C1713,,6543720  -  SCREW 6543720 7.5MM FAS FOR 5.5 20MM LG,"$1,980.00",$0.00,"$1,980.00",$891.00,"$1,413.13",$0.00,$341.14,$0.00,$0.00,$346.68,"$1,980.00",$0.00,$990.00,"$1,568.16","$1,584.00",$0.00,$309.87,$0.00,$315.22,$0.00
6543725,SUP,HCPCS C1713,,6543725  -  SCREW 6543725 7.5MM FAS FOR 5.5 25MM LG,"$1,980.00",$0.00,"$1,980.00",$891.00,"$1,413.13",$0.00,$341.14,$0.00,$0.00,$346.68,"$1,980.00",$0.00,$990.00,"$1,568.16","$1,584.00",$0.00,$309.87,$0.00,$315.22,$0.00
6543730,SUP,HCPCS C1713,,6543730  -  SCREW 6543730 7.5MM FAS FOR 5.5 30MM LG,"$1,980.00",$0.00,"$1,980.00",$891.00,"$1,413.13",$0.00,$341.14,$0.00,$0.00,$346.68,"$1,980.00",$0.00,$990.00,"$1,568.16","$1,584.00",$0.00,$309.87,$0.00,$315.22,$0.00
6543735,SUP,HCPCS C1713,,6543735  -  SCREW 6543735 7.5MM FAS FOR 5.5 35MM LG,"$1,980.00",$0.00,"$1,980.00",$891.00,"$1,413.13",$0.00,$341.14,$0.00,$0.00,$346.68,"$1,980.00",$0.00,$990.00,"$1,568.16","$1,584.00",$0.00,$309.87,$0.00,$315.22,$0.00
6543740,SUP,HCPCS C1713,,6543740  -  SCREW 6543740 7.5MM FAS FOR 5.5 40MM LG,"$1,980.00",$0.00,"$1,980.00",$891.00,"$1,413.13",$0.00,$341.14,$0.00,$0.00,$346.68,"$1,980.00",$0.00,$990.00,"$1,568.16","$1,584.00",$0.00,$309.87,$0.00,$315.22,$0.00
6543745,SUP,HCPCS C1713,,6543745  -  SCREW 6543745 7.5MM FAS FOR 5.5 45MM LG,"$1,980.00",$0.00,"$1,980.00",$891.00,"$1,413.13",$0.00,$341.14,$0.00,$0.00,$346.68,"$1,980.00",$0.00,$990.00,"$1,568.16","$1,584.00",$0.00,$309.87,$0.00,$315.22,$0.00
6543750,SUP,HCPCS C1713,,6543750  -  SCREW 6543750 7.5MM FAS FOR 5.5 50MM LG,"$1,980.00",$0.00,"$1,980.00",$891.00,"$1,413.13",$0.00,$341.14,$0.00,$0.00,$346.68,"$1,980.00",$0.00,$990.00,"$1,568.16","$1,584.00",$0.00,$309.87,$0.00,$315.22,$0.00
6543755,SUP,HCPCS C1713,,6543755  -  SCREW 6543755 7.5MM FAS FOR 5.5 55MM LG,"$1,980.00",$0.00,"$1,980.00",$891.00,"$1,413.13",$0.00,$341.14,$0.00,$0.00,$346.68,"$1,980.00",$0.00,$990.00,"$1,568.16","$1,584.00",$0.00,$309.87,$0.00,$315.22,$0.00
6543760,SUP,HCPCS C1713,,6543760  -  SCREW 6543760 7.5MM FAS FOR 5.5 60MM LG,"$1,980.00",$0.00,"$1,980.00",$891.00,"$1,413.13",$0.00,$341.14,$0.00,$0.00,$346.68,"$1,980.00",$0.00,$990.00,"$1,568.16","$1,584.00",$0.00,$309.87,$0.00,$315.22,$0.00
6543820,SUP,HCPCS C1713,,6543820  -  SCREW 6543820 8.5MM FAS FOR 5.5 20MM LG,"$1,980.00",$0.00,"$1,980.00",$891.00,"$1,413.13",$0.00,$341.14,$0.00,$0.00,$346.68,"$1,980.00",$0.00,$990.00,"$1,568.16","$1,584.00",$0.00,$309.87,$0.00,$315.22,$0.00
6543825,SUP,HCPCS C1713,,6543825  -  SCREW 6543825 8.5MM FAS FOR 5.5 25MM LG,"$1,980.00",$0.00,"$1,980.00",$891.00,"$1,413.13",$0.00,$341.14,$0.00,$0.00,$346.68,"$1,980.00",$0.00,$990.00,"$1,568.16","$1,584.00",$0.00,$309.87,$0.00,$315.22,$0.00
6543830,SUP,HCPCS C1713,,6543830  -  SCREW 6543830 8.5MM FAS FOR 5.5 30MM LG,"$1,980.00",$0.00,"$1,980.00",$891.00,"$1,413.13",$0.00,$341.14,$0.00,$0.00,$346.68,"$1,980.00",$0.00,$990.00,"$1,568.16","$1,584.00",$0.00,$309.87,$0.00,$315.22,$0.00
6543835,SUP,HCPCS C1713,,6543835  -  SCREW 6543835 8.5MM FAS FOR 5.5 35MM LG,"$1,980.00",$0.00,"$1,980.00",$891.00,"$1,413.13",$0.00,$341.14,$0.00,$0.00,$346.68,"$1,980.00",$0.00,$990.00,"$1,568.16","$1,584.00",$0.00,$309.87,$0.00,$315.22,$0.00
6543840,SUP,HCPCS C1713,,6543840  -  SCREW 6543840 8.5MM FAS FOR 5.5 40MM LG,"$1,980.00",$0.00,"$1,980.00",$891.00,"$1,413.13",$0.00,$341.14,$0.00,$0.00,$346.68,"$1,980.00",$0.00,$990.00,"$1,568.16","$1,584.00",$0.00,$309.87,$0.00,$315.22,$0.00
6543845,SUP,HCPCS C1713,,6543845  -  SCREW 6543845 8.5MM FAS FOR 5.5 45MM LG,"$1,980.00",$0.00,"$1,980.00",$891.00,"$1,413.13",$0.00,$341.14,$0.00,$0.00,$346.68,"$1,980.00",$0.00,$990.00,"$1,568.16","$1,584.00",$0.00,$309.87,$0.00,$315.22,$0.00
6543850,SUP,HCPCS C1713,,6543850  -  SCREW 6543850 8.5MM FAS FOR 5.5 50MM LG,"$1,980.00",$0.00,"$1,980.00",$891.00,"$1,413.13",$0.00,$341.14,$0.00,$0.00,$346.68,"$1,980.00",$0.00,$990.00,"$1,568.16","$1,584.00",$0.00,$309.87,$0.00,$315.22,$0.00
6543855,SUP,HCPCS C1713,,6543855  -  SCREW 6543855 8.5MM FAS FOR 5.5 55MM LG,"$1,980.00",$0.00,"$1,980.00",$891.00,"$1,413.13",$0.00,$341.14,$0.00,$0.00,$346.68,"$1,980.00",$0.00,$990.00,"$1,568.16","$1,584.00",$0.00,$309.87,$0.00,$315.22,$0.00
6543860,SUP,HCPCS C1713,,6543860  -  SCREW 6543860 8.5MM FAS FOR 5.5 60MM LG,"$1,980.00",$0.00,"$1,980.00",$891.00,"$1,413.13",$0.00,$341.14,$0.00,$0.00,$346.68,"$1,980.00",$0.00,$990.00,"$1,568.16","$1,584.00",$0.00,$309.87,$0.00,$315.22,$0.00
6591011,SUP,HCPCS C1713,,6591011  -  CAGE SPNL 18MM 20-22MM VBR EXPANDABLE,"$11,245.00",$0.00,"$11,245.00","$5,060.25","$5,158.80",$0.00,"$1,937.46",$0.00,$0.00,"$1,968.91","$11,245.00",$0.00,"$5,622.50","$8,906.04","$8,996.00",$0.00,"$1,759.84",$0.00,"$1,790.20",$0.00
6591012,SUP,HCPCS C1713,,6591012  -  CAGE SPNL 18MM 21-25MM VBR EXPANDABLE,"$11,245.00",$0.00,"$11,245.00","$5,060.25","$5,158.80",$0.00,"$1,937.46",$0.00,$0.00,"$1,968.91","$11,245.00",$0.00,"$5,622.50","$8,906.04","$8,996.00",$0.00,"$1,759.84",$0.00,"$1,790.20",$0.00
6591013,SUP,HCPCS C1713,,6591013  -  CAGE SPNL 18MM 24-31MM VBR COR XPD,"$11,245.00",$0.00,"$11,245.00","$5,060.25","$5,158.80",$0.00,"$1,937.46",$0.00,$0.00,"$1,968.91","$11,245.00",$0.00,"$5,622.50","$8,906.04","$8,996.00",$0.00,"$1,759.84",$0.00,"$1,790.20",$0.00
6591014,SUP,HCPCS C1713,,6591014  -  CAGE SPNL 18MM 28-40MM VBR EXPANDABLE,"$11,245.00",$0.00,"$11,245.00","$5,060.25","$5,158.80",$0.00,"$1,937.46",$0.00,$0.00,"$1,968.91","$11,245.00",$0.00,"$5,622.50","$8,906.04","$8,996.00",$0.00,"$1,759.84",$0.00,"$1,790.20",$0.00
6591015,SUP,HCPCS C1713,,6591015  -  CAGE SPNL 18MM 35-52MM VBR EXPANDABLE,"$11,245.00",$0.00,"$11,245.00","$5,060.25","$5,158.80",$0.00,"$1,937.46",$0.00,$0.00,"$1,968.91","$11,245.00",$0.00,"$5,622.50","$8,906.04","$8,996.00",$0.00,"$1,759.84",$0.00,"$1,790.20",$0.00
6591016,SUP,HCPCS C1713,,6591016  -  CAGE SPNL 18MM 41-65MM VBR EXPANDABLE,"$11,245.00",$0.00,"$11,245.00","$5,060.25","$5,158.80",$0.00,"$1,937.46",$0.00,$0.00,"$1,968.91","$11,245.00",$0.00,"$5,622.50","$8,906.04","$8,996.00",$0.00,"$1,759.84",$0.00,"$1,790.20",$0.00
6591017,SUP,HCPCS C1713,,6591017  -  CAGE SPNL 18MM 47-75MM VBR EXPANDABLE,"$11,245.00",$0.00,"$11,245.00","$5,060.25","$5,158.80",$0.00,"$1,937.46",$0.00,$0.00,"$1,968.91","$11,245.00",$0.00,"$5,622.50","$8,906.04","$8,996.00",$0.00,"$1,759.84",$0.00,"$1,790.20",$0.00
6591021,SUP,HCPCS C1713,,6591021  -  CAGE SPNL 22MM 20-22MM VBR EXPANDABLE,"$11,245.00",$0.00,"$11,245.00","$5,060.25","$5,158.80",$0.00,"$1,937.46",$0.00,$0.00,"$1,968.91","$11,245.00",$0.00,"$5,622.50","$8,906.04","$8,996.00",$0.00,"$1,759.84",$0.00,"$1,790.20",$0.00
6591022,SUP,HCPCS C1713,,6591022  -  CAGE SPNL 22MM 21-25MM VBR EXPANDABLE,"$11,245.00",$0.00,"$11,245.00","$5,060.25","$5,158.80",$0.00,"$1,937.46",$0.00,$0.00,"$1,968.91","$11,245.00",$0.00,"$5,622.50","$8,906.04","$8,996.00",$0.00,"$1,759.84",$0.00,"$1,790.20",$0.00
6591023,SUP,HCPCS C1713,,6591023  -  CAGE SPNL 22MM 24-31MM VBR EXPANDABLE,"$11,245.00",$0.00,"$11,245.00","$5,060.25","$5,158.80",$0.00,"$1,937.46",$0.00,$0.00,"$1,968.91","$11,245.00",$0.00,"$5,622.50","$8,906.04","$8,996.00",$0.00,"$1,759.84",$0.00,"$1,790.20",$0.00
6591024,SUP,HCPCS C1713,,6591024  -  CAGE SPNL 22MM 28-40MM VBR EXPANDABLE,"$11,245.00",$0.00,"$11,245.00","$5,060.25","$5,158.80",$0.00,"$1,937.46",$0.00,$0.00,"$1,968.91","$11,245.00",$0.00,"$5,622.50","$8,906.04","$8,996.00",$0.00,"$1,759.84",$0.00,"$1,790.20",$0.00
6591025,SUP,HCPCS C1713,,6591025  -  CAGE SPNL 22MM 35-52MM VBR EXPANDABLE,"$11,245.00",$0.00,"$11,245.00","$5,060.25","$5,158.80",$0.00,"$1,937.46",$0.00,$0.00,"$1,968.91","$11,245.00",$0.00,"$5,622.50","$8,906.04","$8,996.00",$0.00,"$1,759.84",$0.00,"$1,790.20",$0.00
6591026,SUP,HCPCS C1713,,6591026  -  CAGE SPNL 22MM 41-65MM VBR EXPANDABLE,"$11,245.00",$0.00,"$11,245.00","$5,060.25","$5,158.80",$0.00,"$1,937.46",$0.00,$0.00,"$1,968.91","$11,245.00",$0.00,"$5,622.50","$8,906.04","$8,996.00",$0.00,"$1,759.84",$0.00,"$1,790.20",$0.00
6591027,SUP,HCPCS C1713,,6591027  -  CAGE SPNL 22MM 47-75MM VBR EXPANDABLE,"$11,245.00",$0.00,"$11,245.00","$5,060.25","$5,158.80",$0.00,"$1,937.46",$0.00,$0.00,"$1,968.91","$11,245.00",$0.00,"$5,622.50","$8,906.04","$8,996.00",$0.00,"$1,759.84",$0.00,"$1,790.20",$0.00
6605359,SUP,Custom 27203010,,CALIBRATOR FLW CYMTR FLW-CHK FLUOROSPHERES 10ML,$458.68,$0.00,$458.68,$0.00,$327.36,$0.00,$0.00,$0.00,$0.00,$0.00,$458.68,$0.00,$229.34,$363.27,$366.94,$0.00,$0.00,$0.00,$0.00,$0.00
6607007,SUP,Custom 27203010,,CALIBRATOR FLW CYMTR FLW-SET FLUOROSPHERES 10ML,$458.68,$0.00,$458.68,$0.00,$327.36,$0.00,$0.00,$0.00,$0.00,$0.00,$458.68,$0.00,$229.34,$363.27,$366.94,$0.00,$0.00,$0.00,$0.00,$0.00
6607013,SUP,Custom 27203010,,ANTIBODY CD45 CD4 CD8 CD3 CLONE B3821F4A SFCI12T4D11 SFCI21,$722.10,$0.00,$722.10,$0.00,$515.36,$0.00,$0.00,$0.00,$0.00,$0.00,$722.10,$0.00,$361.05,$571.90,$577.68,$0.00,$0.00,$0.00,$0.00,$0.00
6607023,SUP,Custom 27203010,,CALIBRATOR FLW CYMTR CYTO-COMP HMN LYMPH LYPH 250 TST,$285.35,$0.00,$285.35,$0.00,$203.65,$0.00,$0.00,$0.00,$0.00,$0.00,$285.35,$0.00,$142.68,$226.00,$228.28,$0.00,$0.00,$0.00,$0.00,$0.00
6607077,SUP,Custom 27203010,,CONTROL FLW CYMTR IMTRL POS 3ML 60 TST,$403.73,$0.00,$403.73,$0.00,$288.14,$0.00,$0.00,$0.00,$0.00,$0.00,$403.73,$0.00,$201.86,$319.75,$322.98,$0.00,$0.00,$0.00,$0.00,$0.00
6607098,SUP,Custom 27203010,,CONTROL FLW CYMTR IMTRL LOW 3ML 60 TST,$403.73,$0.00,$403.73,$0.00,$288.14,$0.00,$0.00,$0.00,$0.00,$0.00,$403.73,$0.00,$201.86,$319.75,$322.98,$0.00,$0.00,$0.00,$0.00,$0.00
6608125,SUP,HCPCS C1713,,6608125  -  CAGE SPNL 8D LG CNTR 25X11X8MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6608925,SUP,HCPCS C1713,,6608925  -  CAGE SPNL 8D LG CNTR 25X9X8MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6609125,SUP,HCPCS C1713,,6609125  -  CAGE SPNL LG 25X11X9MM CNTR PEEK-OPTM,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6609925,SUP,HCPCS C1713,,6609925  -  CAGE SPNL 8 25X9X9MM PEEK-OPTM,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6610125,SUP,HCPCS C1713,,6610125  -  CAGE SPNL 8D LG CNTR 25X11X10MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6610925,SUP,HCPCS C1713,,6610925  -  CAGE SPNL 8D LG CNTR 25X10X9MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6611125,SUP,HCPCS C1713,,6611125  -  SPACER SPNL LG 25X11X11MM CNTR PEEK-OPTM,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6611925,SUP,Custom 27803010,,6611925  -  CAGE SPNL 8D LG CNTR 25X9X11MM NS LF CRNT PEEK LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
6612125,SUP,HCPCS C1713,,6612125  -  CAGE SPNL 8D LG CNTR 25X12X11MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6612925,SUP,HCPCS C1713,,6612925  -  CAGE SPNL 8D LG CNTR 25X12X9MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6613125,SUP,HCPCS C1713,,6613125  -  SPACER SPNL 25X11X13MM PEEK-OPTM,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6613925,SUP,HCPCS C1713,,6613925  -  CAGE SPNL 8D LG CNTR 25X9X13MM NS LF CRNT PEEK LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6614125,SUP,HCPCS C1713,,6614125  -  CAGE SPNL 8D LG CNTR 25X14X11MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6614925,SUP,HCPCS C1713,,6614925  -  CAGE SPNL 8D LG CNTR 25X14X9MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6615125,SUP,HCPCS C1713,,6615125  -  SPACER SPNL LG 25X11X15MM CRNT PEEK-OPTM,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6615925,SUP,HCPCS C1713,,6615925  -  CAGE SPNL 8D LG 25X9X15MM PEEK-OPTM,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6616125,SUP,HCPCS C1713,,6616125  -  CAGE SPNL LG 25X11X16MM PEEK-OPTM,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6616925,SUP,HCPCS C1713,,6616925  -  CAGE SPNL 8D LG 25X9X16MM PEEK-OPTM,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6660725,SUP,HCPCS C1713,,6660725  -  SPACER SPNL 6D 25X10X7MM STRL CRSNT TI,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
6660730,SUP,HCPCS C1713,,6660730  -  SPACER SPNL 6D 30X10X7MM STRL CRSNT TI,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
6660736,SUP,HCPCS C1713,,6660736  -  SPACER SPNL 6D 36X10X7MM STRL CRSNT TI,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
6660825,SUP,HCPCS C1713,,6660825  -  SPACER SPNL 6D 25X10X8MM STRL CRSNT TI,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
6660830,SUP,HCPCS C1713,,6660830  -  SPACER SPNL 6D 30X10X8MM STRL CRSNT TI,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
6660836,SUP,HCPCS C1713,,6660836  -  SPACER SPNL 6D 36X10X8MM STRL CRSNT TI,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
6660925,SUP,HCPCS C1713,,6660925  -  SPACER SPNL 6D 25X10X9MM STRL CRSNT TI,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
6660930,SUP,HCPCS C1713,,6660930  -  SPACER SPNL 6D 30X10X9MM STRL CRSNT TI,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
6660936,SUP,HCPCS C1713,,6660936  -  SPACER SPNL 6D 36X10X9MM STRL CRSNT TI,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
6661025,SUP,HCPCS C1713,,6661025  -  SPACER SPNL 6D 25X10X10MM STRL CRSNT TI,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
6661030,SUP,HCPCS C1713,,6661030  -  SPACER SPNL 6D 30X10X10MM STRL CRSNT TI,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
6661036,SUP,HCPCS C1713,,6661036  -  SPACER SPNL 6D 36X10X10MM STRL CRSNT TI,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
6661125,SUP,HCPCS C1713,,6661125  -  SPACER SPNL 6D 25X10X11MM STRL CRSNT TI,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
6661130,SUP,HCPCS C1713,,6661130  -  SPACER SPNL 6D 30X10X11MM STRL CRSNT TI,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
6661136,SUP,HCPCS C1713,,6661136  -  SPACER SPNL 6D 36X10X11MM STRL CRSNT TI,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
6661225,SUP,HCPCS C1713,,6661225  -  SPACER SPNL 6D 25X10X12MM STRL CRSNT TI,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
6661230,SUP,HCPCS C1713,,6661230  -  SPACER SPNL 6D 30X10X12MM STRL CRSNT TI,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
6661236,SUP,HCPCS C1713,,6661236  -  SPACER SPNL 6D 36X10X12MM STRL CRSNT TI,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
6661325,SUP,HCPCS C1713,,6661325  -  SPACER SPNL 6D 25X10X13MM STRL CRSNT TI,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
6661330,SUP,HCPCS C1713,,6661330  -  SPACER SPNL 6D 30X10X13MM STRL CRSNT TI,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
6661336,SUP,HCPCS C1713,,6661336  -  SPACER SPNL 6D 36X10X13MM STRL CRSNT TI,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
6661425,SUP,HCPCS C1713,,6661425  -  SPACER SPNL 6D 25X10X14MM STRL CRSNT TI,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
6661430,SUP,HCPCS C1713,,6661430  -  SPACER SPNL 6D 30X10X14MM STRL CRSNT TI,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
6661436,SUP,HCPCS C1713,,6661436  -  SPACER SPNL 6D 36X10X14MM STRL CRSNT TI,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
6661525,SUP,HCPCS C1713,,6661525  -  SPACER SPNL 6D 25X10X15MM STRL CRSNT TI,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
6661530,SUP,HCPCS C1713,,6661530  -  SPACER SPNL 6D 30X10X15MM STRL CRSNT TI,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
6661536,SUP,HCPCS C1713,,6661536  -  SPACER SPNL 6D 36X10X15MM STRL CRSNT TI,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
6661625,SUP,HCPCS C1713,,6661625  -  SPACER SPNL 6D 25X10X16MM STRL CRSNT TI,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
6661630,SUP,HCPCS C1713,,6661630  -  SPACER SPNL 6D 30X10X16MM STRL CRSNT TI,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
6661636,SUP,HCPCS C1713,,6661636  -  SPACER SPNL 6D 36X10X16MM STRL CRSNT TI,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
6670725,SUP,HCPCS C1713,,6670725  -  SPACER SPNL W 25X10X7MM STRL CRSNT TI,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
6670730,SUP,HCPCS C1713,,6670730  -  SPACER SPNL W 30X10X7MM STRL CRSNT TI,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
6670736,SUP,HCPCS C1713,,6670736  -  SPACER SPNL W 36X10X7MM STRL CRSNT TI,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
6670825,SUP,HCPCS C1713,,6670825  -  SPACER SPNL W 25X10X8MM STRL CRSNT TI,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
6670830,SUP,HCPCS C1713,,6670830  -  SPACER SPNL W 30X10X8MM STRL CRSNT TI,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
6670836,SUP,HCPCS C1713,,6670836  -  SPACER SPNL W 36X10X8MM STRL CRSNT TI,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
6670925,SUP,HCPCS C1713,,6670925  -  SPACER SPNL W 25X10X9MM STRL CRSNT TI,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
6670930,SUP,HCPCS C1713,,6670930  -  SPACER SPNL W 30X10X9MM STRL CRSNT TI,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
6670936,SUP,HCPCS C1713,,6670936  -  SPACER SPNL W 36X10X9MM STRL CRSNT TI,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
6671025,SUP,HCPCS C1713,,6671025  -  SPACER SPNL W 25X10X10MM STRL CRSNT TI,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
6671030,SUP,HCPCS C1713,,6671030  -  SPACER SPNL W 30X10X10MM STRL CRSNT TI,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
6671036,SUP,HCPCS C1713,,6671036  -  SPACER SPNL W 36X10X10MM STRL CRSNT TI,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
6671125,SUP,HCPCS C1713,,6671125  -  SPACER SPNL W 25X10X11MM STRL CRSNT TI,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
6671130,SUP,HCPCS C1713,,6671130  -  SPACER SPNL W 30X10X11MM STRL CRSNT TI,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
6671136,SUP,HCPCS C1713,,6671136  -  SPACER SPNL W 36X10X11MM STRL CRSNT TI,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
6671225,SUP,HCPCS C1713,,6671225  -  SPACER SPNL W 25X10X12MM STRL CRSNT TI,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
6671230,SUP,HCPCS C1713,,6671230  -  SPACER SPNL W 30X10X12MM STRL CRSNT TI,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
6671236,SUP,HCPCS C1713,,6671236  -  SPACER SPNL W 36X10X12MM STRL CRSNT TI,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
6671325,SUP,HCPCS C1713,,6671325  -  SPACER SPNL W 25X10X13MM STRL CRSNT TI,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
6671330,SUP,HCPCS C1713,,6671330  -  SPACER SPNL W 30X10X13MM STRL CRSNT TI,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
6671336,SUP,HCPCS C1713,,6671336  -  SPACER SPNL W 36X10X13MM STRL CRSNT TI,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
6671425,SUP,HCPCS C1713,,6671425  -  SPACER SPNL W 25X10X14MM STRL CRSNT TI,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
6671430,SUP,HCPCS C1713,,6671430  -  SPACER SPNL W 30X10X14MM STRL CRSNT TI,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
6671436,SUP,HCPCS C1713,,6671436  -  SPACER SPNL W 36X10X14MM STRL CRSNT TI,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
6671525,SUP,HCPCS C1713,,6671525  -  SPACER SPNL W 25X10X15MM STRL CRSNT TI,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
6671530,SUP,HCPCS C1713,,6671530  -  SPACER SPNL W 30X10X15MM STRL CRSNT TI,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
6671536,SUP,HCPCS C1713,,6671536  -  SPACER SPNL W 36X10X15MM STRL CRSNT TI,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
6671625,SUP,HCPCS C1713,,6671625  -  SPACER SPNL W 25X10X16MM STRL CRSNT TI,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
6671630,SUP,HCPCS C1713,,6671630  -  SPACER SPNL W 30X10X16MM STRL CRSNT TI,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
6671636,SUP,HCPCS C1713,,6671636  -  SPACER SPNL W 36X10X16MM STRL CRSNT TI,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
6708120,SUP,HCPCS C1713,,6708120  -  CAGE SPNL 4D LG IMPCT 20X11X8MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6708126,SUP,Custom 27803010,,6708126  -  CAGE SPNL 4D LG IMPCT 26X11X8MM NS LF CRNT PEEK-OPTM,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
6708132,SUP,HCPCS C1713,,6708132  -  CAGE SPNL 4D LG IMPCT 32X11X8MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6708520,SUP,HCPCS C1713,,6708520  -  SPACER SPNL 20X9X8MM CRNT PEEK,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6708820,SUP,HCPCS C1713,,6708820  -  SPACER SPNL 8D LG 20X9X8MM CRNT THORLMBR INTRBD FS TPR PEEK,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6708926,SUP,Custom 27803010,,6708926  -  CAGE SPNL 4D LG IMPCT 26X9X8MM NS LF CRNT PEEK-OPTM,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
6708932,SUP,HCPCS C1713,,6708932  -  CAGE SPNL 4D LG IMPCT 32X9X8MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6709120,SUP,HCPCS C1713,,6709120  -  CAGE SPNL 4D LG IMPCT 20X11X9MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6709126,SUP,HCPCS C1713,,6709126  -  CAGE SPNL 4D LG IMPCT 26X11X9MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6709132,SUP,HCPCS C1713,,6709132  -  CAGE SPNL 4D LG IMPCT 32X11X9MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6709920,SUP,HCPCS C1713,,6709920  -  CAGE SPNL 4D LG IMPCT 20X9X9MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6709926,SUP,Custom 27803010,,6709926  -  CAGE SPNL 4D LG IMPCT 26X9X9MM NS LF CRNT PEEK-OPTM,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
6709932,SUP,Custom 27803010,,6709932  -  CAGE SPNL 4D LG IMPCT 32X9X9MM NS LF CRNT PEEK-OPTM,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
6710120,SUP,HCPCS C1713,,6710120  -  CAGE SPNL 4D LG IMPCT 20X11X10MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6710126,SUP,HCPCS C1713,,6710126  -  CAGE SPNL 4D LG IMPCT 26X11X10MM NS LF CRNT PEEK-OPTM,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6710132,SUP,HCPCS C1713,,6710132  -  CAGE SPNL 4D LG IMPCT 32X11X10MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6710520,SUP,HCPCS C1713,,6710520  -  SPACER SPNL 20X10X9MM PEEK,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6710820,SUP,HCPCS C1713,,6710820  -  SPACER SPNL 20X10X8MM CRNT THORLMBR INTRBD FS PEEK,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6710920,SUP,HCPCS C1713,,6710920  -  CAGE SPNL 20X10X9MM CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6710926,SUP,Custom 27803010,,6710926  -  CAGE SPNL 4D LG IMPCT 26X9X10MM NS LF CRNT PEEK-OPTM,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
6710932,SUP,HCPCS C1713,,6710932  -  CAGE SPNL 4D LG IMPCT 32X9X10MM NS LF CRNT PEEK-OPTM,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6711120,SUP,HCPCS C1713,,6711120  -  CAGE SPNL 4D LG IMPCT 20X11X11MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6711126,SUP,HCPCS C1713,,6711126  -  CAGE SPNL 4D LG IMPCT 26X11X11MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6711132,SUP,HCPCS C1713,,6711132  -  CAGE SPNL 4D LG IMPCT 32X11X11MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6711920,SUP,HCPCS C1713,,6711920  -  CAGE SPNL 4D LG IMPCT 20X11X9MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6711926,SUP,HCPCS C1713,,6711926  -  CAGE SPNL 4D LG IMPCT 26X11X9MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6711932,SUP,HCPCS C1713,,6711932  -  CAGE SPNL 4D LG IMPCT 32X11X9MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6712120,SUP,HCPCS C1713,,6712120  -  CAGE SPNL 4D LG IMPCT 20X12X11MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6712126,SUP,HCPCS C1713,,6712126  -  CAGE SPNL 4D LG IMPCT 26X12X11MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6712132,SUP,HCPCS C1713,,6712132  -  CAGE SPNL 4D LG IMPCT 32X12X11MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6712520,SUP,HCPCS C1713,,6712520  -  SPACER SPNL 12MM 15MM INTRBD FS PEEK,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6712820,SUP,HCPCS C1713,,6712820  -  CAGE SPNL 8D LG 20X9X12MM CRNT TPR PEEK-OPTM,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6712920,SUP,HCPCS C1713,,6712920  -  CAGE SPNL 4D LG IMPCT 20X12X9MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6712926,SUP,HCPCS C1713,,6712926  -  CAGE SPNL 4D LG IMPCT 26X12X9MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6712932,SUP,HCPCS C1713,,6712932  -  CAGE SPNL 4D LG IMPCT 32X12X9MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6713120,SUP,HCPCS C1713,,6713120  -  CAGE SPNL 4D LG IMPCT 20X13X11MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6713126,SUP,HCPCS C1713,,6713126  -  CAGE SPNL 4D LG IMPCT 26X13X11MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6713132,SUP,HCPCS C1713,,6713132  -  CAGE SPNL 4D LG IMPCT 32X13X11MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6713920,SUP,HCPCS C1713,,6713920  -  CAGE SPNL 4D LG IMPCT 20X13X9MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6713926,SUP,HCPCS C1713,,6713926  -  CAGE SPNL 4D LG IMPCT 26X13X9MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6713932,SUP,HCPCS C1713,,6713932  -  CAGE SPNL 4D LG IMPCT 32X13X9MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6714120,SUP,HCPCS C1713,,6714120  -  CAGE SPNL 4D LG IMPCT 20X14X11MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6714126,SUP,HCPCS C1713,,6714126  -  CAGE SPNL 4D LG IMPCT 26X14X11MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6714132,SUP,HCPCS C1713,,6714132  -  CAGE SPNL 4D LG IMPCT 32X14X11MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6714820,SUP,HCPCS C1713,,6714820  -  SPACER SPNL 20X14X9MM INTRBD FS TPR PEEK,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6714920,SUP,HCPCS C1713,,6714920  -  CAGE SPNL 4D LG IMPCT 20X14X9MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6714926,SUP,HCPCS C1713,,6714926  -  CAGE SPNL 4D LG IMPCT 26X14X9MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6714932,SUP,HCPCS C1713,,6714932  -  CAGE SPNL 4D LG IMPCT 32X14X9MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6733206,SUP,HCPCS C1713,,6733206  -  CAGE SPNL 10D SM 16X19X6MM NS LF CRNT ACR RADOPQ,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,$0.00,$0.00,$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
6733209,SUP,HCPCS C1713,,6733209  -  CAGE SPNL 10D SM 16X19X9MM NS LF CRNT ACR RADOPQ,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,$0.00,$0.00,$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
6736207,SUP,HCPCS C1713,,6736207  -  CAGE SPNL 10D 7X17X14MM NS CRNT ACR TA SM INTLK RADOPQ,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,$0.00,$0.00,$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
6790151,SUP,Custom 27203010,,6790151  -  BIT DRL SM 12-16MM INTLK DISP B,$575.00,$0.00,$575.00,$0.00,$410.38,$0.00,$0.00,$0.00,$0.00,$0.00,$575.00,$0.00,$287.50,$455.40,$460.00,$0.00,$0.00,$0.00,$0.00,$0.00
6790152,SUP,Custom 27203010,,6790152  -  TAP SRG 12MM TEMP SPNE DISP,$575.00,$0.00,$575.00,$0.00,$410.38,$0.00,$0.00,$0.00,$0.00,$0.00,$575.00,$0.00,$287.50,$455.40,$460.00,$0.00,$0.00,$0.00,$0.00,$0.00
6790225,SUP,HCPCS C1713,,6790225  -  CAGE SPNL 5MM CRNT INTLK CRV,"$4,832.50",$0.00,"$4,832.50","$2,174.63","$3,448.96",$0.00,$832.62,$0.00,$0.00,$846.13,"$4,832.50",$0.00,"$2,416.25","$3,827.34","$3,866.00",$0.00,$756.29,$0.00,$769.33,$0.00
6790228,SUP,HCPCS C1713,,6790228  -  CAGE SPNL 7D SM 17X14X8MM NS LF CRNT INTLK CRV,"$4,832.50",$0.00,"$4,832.50","$2,174.63","$3,448.96",$0.00,$832.62,$0.00,$0.00,$846.13,"$4,832.50",$0.00,"$2,416.25","$3,827.34","$3,866.00",$0.00,$756.29,$0.00,$769.33,$0.00
6790229,SUP,HCPCS C1713,,6790229  -  CAGE SPNL 9MM CRNT INTLK CRV,"$4,832.50",$0.00,"$4,832.50","$2,174.63","$3,448.96",$0.00,$832.62,$0.00,$0.00,$846.13,"$4,832.50",$0.00,"$2,416.25","$3,827.34","$3,866.00",$0.00,$756.29,$0.00,$769.33,$0.00
6790230,SUP,HCPCS C1713,,6790230  -  CAGE SPNL 10MM CRNT INTLK CRV,"$4,832.50",$0.00,"$4,832.50","$2,174.63","$3,448.96",$0.00,$832.62,$0.00,$0.00,$846.13,"$4,832.50",$0.00,"$2,416.25","$3,827.34","$3,866.00",$0.00,$756.29,$0.00,$769.33,$0.00
6790231,SUP,HCPCS C1713,,6790231  -  CAGE SPNL 11MM CRNT INTLK CRV,"$4,832.50",$0.00,"$4,832.50","$2,174.63","$3,448.96",$0.00,$832.62,$0.00,$0.00,$846.13,"$4,832.50",$0.00,"$2,416.25","$3,827.34","$3,866.00",$0.00,$756.29,$0.00,$769.33,$0.00
6790232,SUP,HCPCS C1713,,6790232  -  CAGE SPNL 12MM CRNT INTLK CRV,"$4,832.50",$0.00,"$4,832.50","$2,174.63","$3,448.96",$0.00,$832.62,$0.00,$0.00,$846.13,"$4,832.50",$0.00,"$2,416.25","$3,827.34","$3,866.00",$0.00,$756.29,$0.00,$769.33,$0.00
6791512,SUP,HCPCS C1713,,6791512  -  SCREW BN 4MM 12MM CRNT SLF DRL SPNE,$712.50,$0.00,$712.50,$320.63,$508.51,$0.00,$122.76,$0.00,$0.00,$124.75,$712.50,$0.00,$356.25,$564.30,$570.00,$0.00,$111.51,$0.00,$113.43,$0.00
6791513,SUP,HCPCS C1713,,6791513  -  SCREW BN 4MM 13MM CRNT SLF DRL SPNE,$712.50,$0.00,$712.50,$320.63,$508.51,$0.00,$122.76,$0.00,$0.00,$124.75,$712.50,$0.00,$356.25,$564.30,$570.00,$0.00,$111.51,$0.00,$113.43,$0.00
6791514,SUP,HCPCS C1713,,6791514  -  SCREW BN 4MM 14MM CRNT SLF DRL SPNE,$712.50,$0.00,$712.50,$320.63,$508.51,$0.00,$122.76,$0.00,$0.00,$124.75,$712.50,$0.00,$356.25,$564.30,$570.00,$0.00,$111.51,$0.00,$113.43,$0.00
6791515,SUP,HCPCS C1713,,6791515  -  SCREW BN 4MM 15MM CRNT SLF DRL SPNE,$712.50,$0.00,$712.50,$320.63,$508.51,$0.00,$122.76,$0.00,$0.00,$124.75,$712.50,$0.00,$356.25,$564.30,$570.00,$0.00,$111.51,$0.00,$113.43,$0.00
6791516,SUP,HCPCS C1713,,6791516  -  SCREW BN 4MM 16MM CRNT SLF DRL SPNE,$712.50,$0.00,$712.50,$320.63,$508.51,$0.00,$122.76,$0.00,$0.00,$124.75,$712.50,$0.00,$356.25,$564.30,$570.00,$0.00,$111.51,$0.00,$113.43,$0.00
6791612,SUP,HCPCS C1713,,6791612  -  SCREW BN 4.5MM 12MM CRNT SM INTLK SLF DRL SPNE,$712.50,$0.00,$712.50,$320.63,$508.51,$0.00,$122.76,$0.00,$0.00,$124.75,$712.50,$0.00,$356.25,$564.30,$570.00,$0.00,$111.51,$0.00,$113.43,$0.00
6791613,SUP,HCPCS C1713,,6791613  -  SCREW BN 4.5MM 13MM CRNT SM INTLK SLF DRL SPNE,$712.50,$0.00,$712.50,$320.63,$508.51,$0.00,$122.76,$0.00,$0.00,$124.75,$712.50,$0.00,$356.25,$564.30,$570.00,$0.00,$111.51,$0.00,$113.43,$0.00
6791614,SUP,HCPCS C1713,,6791614  -  SCREW BN 4.5MM 14MM CRNT SM INTLK SLF DRL SPNE,$712.50,$0.00,$712.50,$320.63,$508.51,$0.00,$122.76,$0.00,$0.00,$124.75,$712.50,$0.00,$356.25,$564.30,$570.00,$0.00,$111.51,$0.00,$113.43,$0.00
6791615,SUP,HCPCS C1713,,6791615  -  SCREW BN 4.5MM 15MM CRNT SM INTLK SLF DRL SPNE,$712.50,$0.00,$712.50,$320.63,$508.51,$0.00,$122.76,$0.00,$0.00,$124.75,$712.50,$0.00,$356.25,$564.30,$570.00,$0.00,$111.51,$0.00,$113.43,$0.00
6791616,SUP,HCPCS C1713,,6791616  -  SCREW BN 4.5MM 16MM CRNT SM INTLK SLF DRL SPNE,$712.50,$0.00,$712.50,$320.63,$508.51,$0.00,$122.76,$0.00,$0.00,$124.75,$712.50,$0.00,$356.25,$564.30,$570.00,$0.00,$111.51,$0.00,$113.43,$0.00
6791712,SUP,HCPCS C1713,,6791712  -  SCREW BN 4MM 12MM SPNE,$712.50,$0.00,$712.50,$320.63,$508.51,$0.00,$122.76,$0.00,$0.00,$124.75,$712.50,$0.00,$356.25,$564.30,$570.00,$0.00,$111.51,$0.00,$113.43,$0.00
6791713,SUP,HCPCS C1713,,6791713  -  SCREW BN 4MM 13MM RSC SPNE,$712.50,$0.00,$712.50,$320.63,$508.51,$0.00,$122.76,$0.00,$0.00,$124.75,$712.50,$0.00,$356.25,$564.30,$570.00,$0.00,$111.51,$0.00,$113.43,$0.00
6791714,SUP,HCPCS C1713,,6791714  -  SCREW BN 4MM 14MM RSC SPNE,$712.50,$0.00,$712.50,$320.63,$508.51,$0.00,$122.76,$0.00,$0.00,$124.75,$712.50,$0.00,$356.25,$564.30,$570.00,$0.00,$111.51,$0.00,$113.43,$0.00
6791715,SUP,HCPCS C1713,,6791715  -  SCREW BN 4MM 15MM SPNE,$712.50,$0.00,$712.50,$320.63,$508.51,$0.00,$122.76,$0.00,$0.00,$124.75,$712.50,$0.00,$356.25,$564.30,$570.00,$0.00,$111.51,$0.00,$113.43,$0.00
6791716,SUP,HCPCS C1713,,6791716  -  SCREW BN 4MM 16MM SPNE,$712.50,$0.00,$712.50,$320.63,$508.51,$0.00,$122.76,$0.00,$0.00,$124.75,$712.50,$0.00,$356.25,$564.30,$570.00,$0.00,$111.51,$0.00,$113.43,$0.00
6791812,SUP,HCPCS C1713,,6791812  -  SCREW BN 4.5MM 12MM RSC SPNE,$712.50,$0.00,$712.50,$320.63,$508.51,$0.00,$122.76,$0.00,$0.00,$124.75,$712.50,$0.00,$356.25,$564.30,$570.00,$0.00,$111.51,$0.00,$113.43,$0.00
6791813,SUP,HCPCS C1713,,6791813  -  SCREW BN 4.5MM 13MM RSC SPNE,$712.50,$0.00,$712.50,$320.63,$508.51,$0.00,$122.76,$0.00,$0.00,$124.75,$712.50,$0.00,$356.25,$564.30,$570.00,$0.00,$111.51,$0.00,$113.43,$0.00
6791814,SUP,HCPCS C1713,,6791814  -  SCREW BN 4.5MM 14MM RSC SPNE,$712.50,$0.00,$712.50,$320.63,$508.51,$0.00,$122.76,$0.00,$0.00,$124.75,$712.50,$0.00,$356.25,$564.30,$570.00,$0.00,$111.51,$0.00,$113.43,$0.00
6791816,SUP,HCPCS C1713,,6791816  -  SCREW BN 4.5MM 16MM RSC SPNE,$712.50,$0.00,$712.50,$320.63,$508.51,$0.00,$122.76,$0.00,$0.00,$124.75,$712.50,$0.00,$356.25,$564.30,$570.00,$0.00,$111.51,$0.00,$113.43,$0.00
6805115,SUP,HCPCS C1713,,6805115  -  CAGE SPNL SM 14X11X5MM NS LF CRNT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6805714,SUP,HCPCS C1713,,6805714  -  CAGE SPNL 5D SM LRDTC 14X11X5MM NS LF CRNT RDLCNT PEEK-OPTM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6805815,SUP,HCPCS C1713,,6805815  -  CAGE SPNL SM LRDTC + 15X13X5MM NS LF CRNT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6806115,SUP,HCPCS C1713,,6806115  -  CAGE SPNL SM 14X11X6MM NS LF CRNT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6806714,SUP,HCPCS C1713,,6806714  -  CAGE SPNL 5D SM LRDTC 14X11X6MM NS LF CRNT RDLCNT PEEK-OPTM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6806815,SUP,Custom 27803010,,6806815  -  CAGE SPNL SM LRDTC + 15X13X6MM NS LF CRNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
6807115,SUP,HCPCS C1713,,6807115  -  CAGE SPNL SM 14X11X7MM NS LF CRNT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6807714,SUP,HCPCS C1713,,6807714  -  CAGE SPNL 5D SM LRDTC 14X11X7MM NS LF CRNT RDLCNT PEEK-OPTM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6807815,SUP,HCPCS C1713,,6807815  -  CAGE SPNL 5D SM LRDTC + 15X13X7MM NS LF CRNT RDLCNT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6808115,SUP,HCPCS C1713,,6808115  -  CAGE SPNL SM 14X11X8MM NS LF CRNT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6808125,SUP,HCPCS C1713,,6808125  -  SPACER SPNL 25X11X8MM CRNT THORLMBR INTRBD FS PEEK,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6808130,SUP,HCPCS C1713,,6808130  -  RESTRICTOR CMNT PEEK,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6808240,SUP,HCPCS C1713,,6808240  -  SPACER SPNL XL W 40X22X8MM PEEK-OPTM,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6808340,SUP,HCPCS C1713,,6808340  -  SPACER SPNL XL 10 40X22X8MM PEEK-OPTM,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6808815,SUP,Custom 27803010,,6808815  -  CAGE SPNL SM LRDTC + 15X13X8MM NS LF CRNT PEEK,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
6808925,SUP,HCPCS C1713,,6808925  -  SPACER SPNL 25X9X8MM INTRBD FS PEEK,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6808930,SUP,HCPCS C1713,,6808930  -  SPACER SPNL 30X9X8MM INTRBD FS PEEK,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6809115,SUP,HCPCS C1713,,6809115  -  CAGE SPNL SM 14X11X9MM NS LF CRNT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6809714,SUP,HCPCS C1713,,6809714  -  CAGE SPNL 5D SM LRDTC 14X11X9MM NS LF CRNT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6809925,SUP,HCPCS C1713,,6809925  -  SPACER SPNL 25X9X9MM STRL CRNT LMBR INTRBD FS PEEK,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6810115,SUP,HCPCS C1713,,6810115  -  CAGE SPNL SM 14X11X10MM NS LF CRNT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6810125,SUP,HCPCS C1713,,6810125  -  SPACER SPNL 25X11X10MM STRL CRNT LMBR INTRBD FS PEEK,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6810130,SUP,HCPCS C1713,,6810130  -  SPACER SPNL 30INX11INX10MM STRL CRNT LMBR INTRBD FS PEEK,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6810240,SUP,HCPCS C1713,,6810240  -  SPACER SPNL XL W 40X22X10MM PEEK-OPTM,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6810340,SUP,HCPCS C1713,,6810340  -  SPACER SPNL 10D XL W LRDTC 40X22X10MM PEEK-OPTM,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6810714,SUP,HCPCS C1713,,6810714  -  CAGE SPNL 5D SM LRDTC 14X11X10MM NS LF CRNT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6810815,SUP,HCPCS C1713,,6810815  -  CAGE SPNL SM LRDTC + 15X13X10MM NS LF CRNT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6810925,SUP,HCPCS C1713,,6810925  -  SPACER SPNL NAR 25X10X9MM INTRBD FS PEEK-OPTM,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6810930,SUP,HCPCS C1713,,6810930  -  SPACER SPNL NAR 30X10X9MM INTRBD FS PEEK-OPTM,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6811115,SUP,HCPCS C1713,,6811115  -  CAGE SPNL SM 14X11X11MM NS LF CRNT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6811714,SUP,HCPCS C1713,,6811714  -  CAGE SPNL 5D SM LRDTC 14X11X11MM NS LF CRNT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6811815,SUP,HCPCS C1713,,6811815  -  CAGE SPNL SM LRDTC + 15X13X11MM NS LF CRNT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6811925,SUP,HCPCS C1713,,6811925  -  SPACER SPNL 25X11X9MM STRL CRNT LMBR INTRBD FS PEEK,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6812115,SUP,HCPCS C1713,,6812115  -  CAGE SPNL SM 14X11X11MM NS LF CRNT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6812125,SUP,HCPCS C1713,,6812125  -  SPACER SPNL LG 25X12X11MM CRNT THORLMBR INTRBD FS PEEK,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6812130,SUP,HCPCS C1713,,6812130  -  CAGE SPNL LG 30X12X10MM CRNT THORLMBR INTRBD FS RDLCNT PEEK,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6812240,SUP,HCPCS C1713,,6812240  -  SPACER SPNL XL W 40X22X12MM PEEK-OPTM,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6812340,SUP,HCPCS C1713,,6812340  -  SPACER SPNL 10 XL W LRDTC 40X22X12MM PEEK-OPTM,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6812714,SUP,HCPCS C1713,,6812714  -  CAGE SPNL 5D SM LRDTC 14X11X11MM NS LF CRNT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6812815,SUP,HCPCS C1713,,6812815  -  CAGE SPNL SM LRDTC + 15X13X10MM NS LF CRNT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6812925,SUP,HCPCS C1713,,6812925  -  SPACER SPNL 25X12X9MM CRNT PEEK,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6812930,SUP,HCPCS C1713,,6812930  -  SPACER SPNL 30X12X9MM STRL CRNT LMBR INTRBD FS PEEK,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6813815,SUP,HCPCS C1713,,6813815  -  SPACER SPNL SM 15X13X13MM LOPRFL PEEK-OPTM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6813925,SUP,HCPCS C1713,,6813925  -  SPACER SPNL LG NAR 25X13X9MM CRNT LMBR INTRBD FS PEEK,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6814125,SUP,HCPCS C1713,,6814125  -  SPACER SPNL LG 25X14X11MM CRNT THORLMBR INTRBD FS PEEK,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6814130,SUP,HCPCS C1713,,6814130  -  SPACER SPNL LG W 14X11X30MM CRNT LMBR INTRBD FS RDLCNT PEEK,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6814240,SUP,HCPCS C1713,,6814240  -  SPACER SPNL XL W 40X22X14MM PEEK-OPTM,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6814340,SUP,HCPCS C1713,,6814340  -  SPACER SPNL 10D XL W LRDTC 40X22X14MM PEEK-OPTM,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6814815,SUP,HCPCS C1713,,6814815  -  SPACER SPNL SM 15X14X13MM LOPRFL PEEK-OPTM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6814925,SUP,HCPCS C1713,,6814925  -  SPACER SPNL 25X14X9MM CRNT LMBR INTRBD FS PEEK,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6814930,SUP,HCPCS C1713,,6814930  -  CAGE SPNL LG NAR 30X9X14MM CRNT PEEK-OPTM,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6816240,SUP,HCPCS C1713,,6816240  -  SPACER SPNL XL W 40X22X16MM PEEK-OPTM,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6816340,SUP,HCPCS C1713,,6816340  -  SPACER SPNL 10D XL W LRDTC 40X22X16MM PEEK-OPTM,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6850810,SUP,HCPCS C1713,,6850810  -  SPACER SPNL GRN CRNT LMBR OBLQ,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6850811,SUP,HCPCS C1713,,6850811  -  CAGE SPNL 5D LG 30X10X8MM CRNT OBLQ PEEK-OPTM,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6850813,SUP,HCPCS C1713,,6850813  -  CAGE SPNL LG 40X10X8MM GRN OBLQ PEEK,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6851012,SUP,HCPCS C1713,,6851012  -  CAGE SPNL 5D LG 35X10X10MM CRNT OBLQ PEEK-OPTM,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6851013,SUP,HCPCS C1713,,6851013  -  CAGE SPNL 5D LG 40X10X10MM CRNT OBLQ PEEK-OPTM,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6851211,SUP,HCPCS C1713,,6851211  -  CAGE SPNL 30X12X10MM CRNT PEEK LRDTC 5,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6851212,SUP,HCPCS C1713,,6851212  -  SPACER SPNL 5D LG 35X12X10MM CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6851213,SUP,HCPCS C1713,,6851213  -  CAGE SPNL 5D LG 40X10X12MM CRNT OBLQ PEEK-OPTM,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6851411,SUP,HCPCS C1713,,6851411  -  SPACER SPNL 5D LG 30X14X10MM CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6851412,SUP,HCPCS C1713,,6851412  -  CAGE SPNL 5D LG OBLQ 35X14X10MM CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6851413,SUP,Custom 27804086,,6851413  -  GRAFT BN LG CRNT PEEK SPNE 5DE,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
6860010,SUP,HCPCS C1713,,6860010  -  SCREW BN 4MM 10MM PRMR ST TI CANC ANT CSPN,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
6860011,SUP,HCPCS C1713,,6860011  -  SCREW BN 4MM 11MM NS PRMR VA ST TI SPNE CRV CANC ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
6860012,SUP,HCPCS C1713,,6860012  -  SCREW BN 4MM 12MM NS PRMR VA ST TI SPNE CRV CANC ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
6860013,SUP,HCPCS C1713,,6860013  -  SCREW BN 4MM 13MM NS PRMR VA ST TI SPNE CRV CANC ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
6860014,SUP,HCPCS C1713,,6860014  -  SCREW BN 4MM 14MM NS PRMR VA ST TI SPNE CRV CANC ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
6860015,SUP,HCPCS C1713,,6860015  -  SCREW BN 4MM 15MM NS PRMR VA ST TI SPNE CRV CANC ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
6860016,SUP,HCPCS C1713,,6860016  -  SCREW BN 4MM 16MM NS PRMR VA ST TI SPNE CRV CANC ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
6860017,SUP,HCPCS C1713,,6860017  -  SCREW BN 4MM 17MM NS PRMR VA ST TI SPNE CRV CANC ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
6860018,SUP,HCPCS C1713,,6860018  -  SCREW BN 4MM 18MM NS PRMR VA ST TI SPNE CRV CANC ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
6860019,SUP,HCPCS C1713,,6860019  -  SCREW BN 4MM 19MM STRL PRMR ST TI CANC ANT CSPN,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
6860020,SUP,HCPCS C1713,,6860020  -  SCREW BN 4MM 20MM NS PRMR VA ST TI SPNE CRV CANC ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
6860053,SUP,HCPCS C1713,,6860053  -  SCREW BN 4.5MM 13MM NS PRMR VA ST TI SPNE CRV CANC ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
6860055,SUP,HCPCS C1713,,6860055  -  SCREW BN 4.5MM 15MM NS PRMR VA ST TI SPNE CRV CANC ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
6860057,SUP,HCPCS C1713,,6860057  -  SCREW BN 4.5MM 17MM NS PRMR VA ST TI SPNE CRV CANC ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
6860123,SUP,HCPCS C1713,,6860123  -  PLATE 6860123 23  MM ANTERIOR CERVICAL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6860125,SUP,HCPCS C1713,,6860125  -  PLATE 6860125 25  MM ANTERIOR CERVICAL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6860127,SUP,HCPCS C1713,,6860127  -  PLATE 6860127 27.5MM ANTERIOR CERVICAL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6860130,SUP,HCPCS C1713,,6860130  -  PLATE 6860130 30 MM ANTERIOR CERVICAL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6860132,SUP,HCPCS C1713,,6860132  -  PLATE 6860132 32.5MM ANTERIOR CERVICAL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6860135,SUP,HCPCS C1713,,6860135  -  PLATE 6860135 35  MM ANTERIOR CERVICAL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6860137,SUP,HCPCS C1713,,6860137  -  PLATE 6860137 37.5MM ANTERIOR CERVICAL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6860140,SUP,HCPCS C1713,,6860140  -  PLATE 6860140 40  MM ANTERIOR CERVICAL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6860142,SUP,HCPCS C1713,,6860142  -  PLATE 6860142 42.5MM ANTERIOR CERVICAL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6860145,SUP,HCPCS C1713,,6860145  -  PLATE 6860145 45  MM ANTERIOR CERVICAL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6860147,SUP,HCPCS C1713,,6860147  -  PLATE 6860147 47.5MM ANTERIOR CERVICAL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6860150,SUP,HCPCS C1713,,6860150  -  PLATE 6860150 50  MM ANTERIOR CERVICAL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6860152,SUP,HCPCS C1713,,6860152  -  PLATE 6860152 52.5MM ANTERIOR CERVICAL,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
6860155,SUP,HCPCS C1713,,6860155  -  PLATE 6860155 55  MM ANTERIOR CERVICAL,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
6860157,SUP,HCPCS C1713,,6860157  -  PLATE 6860157 57.5MM ANTERIOR CERVICAL,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
6860160,SUP,HCPCS C1713,,6860160  -  PLATE 6860160 60  MM ANTERIOR CERVICAL,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
6860162,SUP,HCPCS C1713,,6860162  -  PLATE 6860162 62.5MM ANTERIOR CERVICAL,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
6860165,SUP,HCPCS C1713,,6860165  -  PLATE 6860165 65  MM ANTERIOR CERVICAL,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
6860167,SUP,HCPCS C1713,,6860167  -  PLATE 6860167 67.5MM ANTERIOR CERVICAL,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
6860170,SUP,HCPCS C1713,,6860170  -  PLATE 6860170 70  MM ANTERIOR CERVICAL,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
6860172,SUP,HCPCS C1713,,6860172  -  PLATE 6860172 72.5MM ANTERIOR CERVICAL,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
6860175,SUP,HCPCS C1713,,6860175  -  PLATE 6860175 75 MM ANT CERV,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
6860177,SUP,HCPCS C1713,,6860177  -  PLATE 6860177 77 5MM ANT CERV,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
6860180,SUP,HCPCS C1713,,6860180  -  PLATE 6860180 80 MM ANT CERV,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
6860182,SUP,HCPCS C1713,,6860182  -  PLATE 6860182 82 5MM ANT CERV,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
6860185,SUP,HCPCS C1713,,6860185  -  PLATE 6860185 85 MM ANT CERV,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
6860187,SUP,HCPCS C1713,,6860187  -  PLATE 6860187 87 5MM ANT CERV,"$4,266.00",$0.00,"$4,266.00","$1,919.70","$3,044.64",$0.00,$735.01,$0.00,$0.00,$746.94,"$4,266.00",$0.00,"$2,133.00","$3,378.67","$3,412.80",$0.00,$667.63,$0.00,$679.15,$0.00
6860190,SUP,HCPCS C1713,,6860190  -  PLATE 6860190 90 MM ANT CERV,"$4,266.00",$0.00,"$4,266.00","$1,919.70","$3,044.64",$0.00,$735.01,$0.00,$0.00,$746.94,"$4,266.00",$0.00,"$2,133.00","$3,378.67","$3,412.80",$0.00,$667.63,$0.00,$679.15,$0.00
6860195,SUP,HCPCS C1713,,6860195  -  PLATE 6860195 95 MM ANT CERV,"$4,266.00",$0.00,"$4,266.00","$1,919.70","$3,044.64",$0.00,$735.01,$0.00,$0.00,$746.94,"$4,266.00",$0.00,"$2,133.00","$3,378.67","$3,412.80",$0.00,$667.63,$0.00,$679.15,$0.00
6860200,SUP,HCPCS C1713,,6860200  -  PLATE 6860200 100 MM ANT CERV,"$4,266.00",$0.00,"$4,266.00","$1,919.70","$3,044.64",$0.00,$735.01,$0.00,$0.00,$746.94,"$4,266.00",$0.00,"$2,133.00","$3,378.67","$3,412.80",$0.00,$667.63,$0.00,$679.15,$0.00
6860205,SUP,HCPCS C1713,,6860205  -  PLATE 6860205 105 MM ANT CERV,"$4,266.00",$0.00,"$4,266.00","$1,919.70","$3,044.64",$0.00,$735.01,$0.00,$0.00,$746.94,"$4,266.00",$0.00,"$2,133.00","$3,378.67","$3,412.80",$0.00,$667.63,$0.00,$679.15,$0.00
6860210,SUP,HCPCS C1713,,6860210  -  PLATE 6860210 110 MM ANT CERV,"$4,266.00",$0.00,"$4,266.00","$1,919.70","$3,044.64",$0.00,$735.01,$0.00,$0.00,$746.94,"$4,266.00",$0.00,"$2,133.00","$3,378.67","$3,412.80",$0.00,$667.63,$0.00,$679.15,$0.00
6860405,SUP,Custom 27803010,,6860405  -  PIN 6860405 PREMIER MIDLINE FIXATION,$177.00,$0.00,$177.00,$0.00,$126.32,$0.00,$0.00,$0.00,$0.00,$0.00,$177.00,$0.00,$88.50,$140.18,$141.60,$0.00,$0.00,$0.00,$0.00,$0.00
6861130,SUP,HCPCS C1713,,6861130  -  PLATE 6861130 30MM ANTERIOR CERVICAL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6861137,SUP,HCPCS C1713,,6861137  -  PLATE 6861137 37.5MM ANTERIOR CERVICAL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6861150,SUP,HCPCS C1713,,6861150  -  PLATE 6861150 50 MM ANT CERV PLATE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6861157,SUP,HCPCS C1713,,6861157  -  PLATE 6861157 57.5 MM ANT CERV,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
6861165,SUP,HCPCS C1713,,6861165  -  PLATE 6861165 65 MM ANT CERV,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
6861167,SUP,HCPCS C1713,,6861167  -  PLATE 6861167 67.5 MM ANT CERV,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
6861175,SUP,HCPCS C1713,,6861175  -  PLATE 6861175 75 MM ANT CERV,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
6861177,SUP,HCPCS C1713,,6861177  -  PLATE 6861177 77.5 MM ANT CERV,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
6861182,SUP,HCPCS C1713,,6861182  -  PLATE 6861182 82.5MM ANTERIOR CERVICAL,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
6861185,SUP,HCPCS C1713,,6861185  -  PLATE 6861185 85MM ANTERIOR CERVICAL,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
6861200,SUP,HCPCS C1713,,6861200  -  PLATE 6861200 100MM ANTERIOR CERVICAL,"$4,266.00",$0.00,"$4,266.00","$1,919.70","$3,044.64",$0.00,$735.01,$0.00,$0.00,$746.94,"$4,266.00",$0.00,"$2,133.00","$3,378.67","$3,412.80",$0.00,$667.63,$0.00,$679.15,$0.00
6861223,SUP,HCPCS C1713,,6861223  -  PLATE 6861223 23MM FSP ANTERIOR CRV,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6861225,SUP,HCPCS C1713,,6861225  -  PLATE 6861225 25MM FSP ANTERIOR CRV,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6861227,SUP,HCPCS C1713,,6861227  -  PLATE 6861227 27.5MM FSP ANTERIOR CRV,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6861230,SUP,HCPCS C1713,,6861230  -  PLATE 6861230 30MM FSP ANTERIOR CRV,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6861232,SUP,HCPCS C1713,,6861232  -  PLATE 6861232 32.5MM FSP ANTERIOR CRV,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6861235,SUP,HCPCS C1713,,6861235  -  PLATE 6861235 35MM FSP ANTERIOR CRV,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6861237,SUP,HCPCS C1713,,6861237  -  PLATE 6861237 37.5MM FSP ANTERIOR CRV,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6861240,SUP,HCPCS C1713,,6861240  -  PLATE 6861240 40 MM FSP ANTERIOR CRV,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6861242,SUP,HCPCS C1713,,6861242  -  PLATE 6861242 42.5MM FSP ANTERIOR CRV,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6861245,SUP,HCPCS C1713,,6861245  -  PLATE 6861245 45MM FSP ANTERIOR CRV,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6861247,SUP,HCPCS C1713,,6861247  -  PLATE 6861247 47.5MM FSP ANTERIOR CRV,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6861250,SUP,HCPCS C1713,,6861250  -  PLATE 6861250 50MM FSP ANTERIOR CRV,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
6861252,SUP,HCPCS C1713,,6861252  -  PLATE 6861252 52.5MM FSP ANTERIOR CRV,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
6861255,SUP,HCPCS C1713,,6861255  -  PLATE 6861255 55MM FSP ANTERIOR CRV,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
6861257,SUP,HCPCS C1713,,6861257  -  PLATE 6861257 57.5MM FSP ANTERIOR CRV,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
6861260,SUP,HCPCS C1713,,6861260  -  PLATE 6861260 60MM FSP ANTERIOR CRV,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
6861262,SUP,HCPCS C1713,,6861262  -  PLATE 6861262 62.5MM FSP ANTERIOR CRV,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
6861265,SUP,HCPCS C1713,,6861265  -  PLATE 6861265 65MM FSP ANTERIOR CRV,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
6861267,SUP,HCPCS C1713,,6861267  -  PLATE 6861267 67.5MM FSP ANTERIOR CRV,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
6861270,SUP,HCPCS C1713,,6861270  -  PLATE 6861270 70MM FSP ANTERIOR CRV,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
6861272,SUP,HCPCS C1713,,6861272  -  PLATE 6861272 72.5MM FSP ANTERIOR CRV,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
6861275,SUP,HCPCS C1713,,6861275  -  PLATE 6861275 75MM FSP ANTERIOR CRV,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
6861277,SUP,HCPCS C1713,,6861277  -  PLATE 6861277 77.5MM FSP ANTERIOR CRV,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
6861280,SUP,HCPCS C1713,,6861280  -  PLATE 6861280 80MM FSP ANTERIOR CRV,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
6861282,SUP,HCPCS C1713,,6861282  -  PLATE 6861282 82.5MM FSP ANTERIOR CRV,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
6861285,SUP,HCPCS C1713,,6861285  -  PLATE 6861285 85MM FSP ANTERIOR CRV,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
6861287,SUP,HCPCS C1713,,6861287  -  PLATE 6861287 87.5MM FSP ANTERIOR CRV,"$4,266.00",$0.00,"$4,266.00","$1,919.70","$3,044.64",$0.00,$735.01,$0.00,$0.00,$746.94,"$4,266.00",$0.00,"$2,133.00","$3,378.67","$3,412.80",$0.00,$667.63,$0.00,$679.15,$0.00
6861290,SUP,HCPCS C1713,,6861290  -  PLATE 6861290 90MM FSP ANTERIOR CRV,"$4,266.00",$0.00,"$4,266.00","$1,919.70","$3,044.64",$0.00,$735.01,$0.00,$0.00,$746.94,"$4,266.00",$0.00,"$2,133.00","$3,378.67","$3,412.80",$0.00,$667.63,$0.00,$679.15,$0.00
6861295,SUP,HCPCS C1713,,6861295  -  PLATE 6861295 95MM FSP ANTERIOR CRV,"$4,266.00",$0.00,"$4,266.00","$1,919.70","$3,044.64",$0.00,$735.01,$0.00,$0.00,$746.94,"$4,266.00",$0.00,"$2,133.00","$3,378.67","$3,412.80",$0.00,$667.63,$0.00,$679.15,$0.00
6861300,SUP,HCPCS C1713,,6861300  -  PLATE 6861300 100MM FSP ANTERIOR CRV,"$4,266.00",$0.00,"$4,266.00","$1,919.70","$3,044.64",$0.00,$735.01,$0.00,$0.00,$746.94,"$4,266.00",$0.00,"$2,133.00","$3,378.67","$3,412.80",$0.00,$667.63,$0.00,$679.15,$0.00
6861305,SUP,HCPCS C1713,,6861305  -  PLATE 6861305 105MM FSP ANTERIOR CRV,"$4,266.00",$0.00,"$4,266.00","$1,919.70","$3,044.64",$0.00,$735.01,$0.00,$0.00,$746.94,"$4,266.00",$0.00,"$2,133.00","$3,378.67","$3,412.80",$0.00,$667.63,$0.00,$679.15,$0.00
6861310,SUP,HCPCS C1713,,6861310  -  PLATE 6861310 110MM FSP ANTERIOR CRV,"$4,266.00",$0.00,"$4,266.00","$1,919.70","$3,044.64",$0.00,$735.01,$0.00,$0.00,$746.94,"$4,266.00",$0.00,"$2,133.00","$3,378.67","$3,412.80",$0.00,$667.63,$0.00,$679.15,$0.00
6900120,SUP,HCPCS C1713,,6900120  -  ROD SPNL SHRT 3.2MM 120MM VRTX MX CNCT PNT TI RECON SYS,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
6900240,SUP,HCPCS C1713,,6900240  -  ROD SPNL 240MM 3.2MM VRTX STD TI PCVD,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
6900241,SUP,Custom 27203010,,6900241  -  INSTRUMENT 6900241 3.2MMX240MM ROD TMPLT,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
6900270,SUP,HCPCS C1713,,6900270  -  ROD SPNL 100MM 3.2MM VRTX STD OCCPTL TI PCVD OCCPTL PLT,"$4,216.50",$0.00,"$4,216.50","$1,897.43","$3,009.32",$0.00,$726.48,$0.00,$0.00,$738.28,"$4,216.50",$0.00,"$2,108.25","$3,339.47","$3,373.20",$0.00,$659.88,$0.00,$671.27,$0.00
6900280,SUP,HCPCS C1713,,6900280  -  ROD SPNL 200MM 3.2MM VRTX STD OCCPTL TI PCVD OCCPTL PLT,"$4,216.50",$0.00,"$4,216.50","$1,897.43","$3,009.32",$0.00,$726.48,$0.00,$0.00,$738.28,"$4,216.50",$0.00,"$2,108.25","$3,339.47","$3,373.20",$0.00,$659.88,$0.00,$671.27,$0.00
6900506,SUP,HCPCS C1713,,6900506  -  SCREW BN 3.5MM 6MM NTR STRL VRTX MA VA TI SPNE THOR CANC,$696.00,$0.00,$696.00,$313.20,$496.74,$0.00,$119.92,$0.00,$0.00,$121.86,$696.00,$0.00,$348.00,$551.23,$556.80,$0.00,$108.92,$0.00,$110.80,$0.00
6900508,SUP,HCPCS C1713,,6900508  -  SCREW BN 3.5MM 8MM NTR STRL VRTX MA VA TI SPNE THOR CANC,$696.00,$0.00,$696.00,$313.20,$496.74,$0.00,$119.92,$0.00,$0.00,$121.86,$696.00,$0.00,$348.00,$551.23,$556.80,$0.00,$108.92,$0.00,$110.80,$0.00
6900510,SUP,HCPCS C1713,,6900510  -  SCREW BN 3.5MM 10MM NTR STRL VRTX MA VA TI SPNE THOR CANC,$696.00,$0.00,$696.00,$313.20,$496.74,$0.00,$119.92,$0.00,$0.00,$121.86,$696.00,$0.00,$348.00,$551.23,$556.80,$0.00,$108.92,$0.00,$110.80,$0.00
6900512,SUP,HCPCS C1713,,6900512  -  SCREW 6900512 VAS CANCELLOUS 3.5X12MM TI,$696.00,$0.00,$696.00,$313.20,$496.74,$0.00,$119.92,$0.00,$0.00,$121.86,$696.00,$0.00,$348.00,$551.23,$556.80,$0.00,$108.92,$0.00,$110.80,$0.00
6900514,SUP,HCPCS C1713,,6900514  -  SCREW 6900514 VAS CANCELLOUS 3.5X14MM TI,$696.00,$0.00,$696.00,$313.20,$496.74,$0.00,$119.92,$0.00,$0.00,$121.86,$696.00,$0.00,$348.00,$551.23,$556.80,$0.00,$108.92,$0.00,$110.80,$0.00
6900516,SUP,HCPCS C1713,,6900516  -  SCREW 6900516 VAS CANCELLOUS 3.5X16MM TI,$696.00,$0.00,$696.00,$313.20,$496.74,$0.00,$119.92,$0.00,$0.00,$121.86,$696.00,$0.00,$348.00,$551.23,$556.80,$0.00,$108.92,$0.00,$110.80,$0.00
6900518,SUP,HCPCS C1713,,6900518  -  SCREW 6900518 VAS CANCELLOUS 3.5X18MM TI,$696.00,$0.00,$696.00,$313.20,$496.74,$0.00,$119.92,$0.00,$0.00,$121.86,$696.00,$0.00,$348.00,$551.23,$556.80,$0.00,$108.92,$0.00,$110.80,$0.00
6900520,SUP,HCPCS C1713,,6900520  -  SCREW 6900520 VAS CANCELLOUS 3.5X20MM TI,$696.00,$0.00,$696.00,$313.20,$496.74,$0.00,$119.92,$0.00,$0.00,$121.86,$696.00,$0.00,$348.00,$551.23,$556.80,$0.00,$108.92,$0.00,$110.80,$0.00
6900522,SUP,HCPCS C1713,,6900522  -  SCREW BONE 3.5MM 22MM VRTX TI CANC THOR SPN MULTIAX STRL,$696.00,$0.00,$696.00,$313.20,$496.74,$0.00,$119.92,$0.00,$0.00,$121.86,$696.00,$0.00,$348.00,$551.23,$556.80,$0.00,$108.92,$0.00,$110.80,$0.00
6900524,SUP,HCPCS C1713,,6900524  -  SCREW 6900524 CANCELLOUS 3.5MMX24MM TI,$696.00,$0.00,$696.00,$313.20,$496.74,$0.00,$119.92,$0.00,$0.00,$121.86,$696.00,$0.00,$348.00,$551.23,$556.80,$0.00,$108.92,$0.00,$110.80,$0.00
6900606,SUP,HCPCS C1713,,6900606  -  SCREW BN 4MM 6MM NTR STRL VRTX MA VA TI SPNE THOR CANC,$696.00,$0.00,$696.00,$313.20,$496.74,$0.00,$119.92,$0.00,$0.00,$121.86,$696.00,$0.00,$348.00,$551.23,$556.80,$0.00,$108.92,$0.00,$110.80,$0.00
6900608,SUP,HCPCS C1713,,6900608  -  SCREW BN 4MM 8MM NTR STRL VRTX MA VA TI SPNE THOR CANC,$696.00,$0.00,$696.00,$313.20,$496.74,$0.00,$119.92,$0.00,$0.00,$121.86,$696.00,$0.00,$348.00,$551.23,$556.80,$0.00,$108.92,$0.00,$110.80,$0.00
6900610,SUP,HCPCS C1713,,6900610  -  SCREW BN 4MM 10MM NTR STRL VRTX MA VA TI SPNE THOR CANC,$696.00,$0.00,$696.00,$313.20,$496.74,$0.00,$119.92,$0.00,$0.00,$121.86,$696.00,$0.00,$348.00,$551.23,$556.80,$0.00,$108.92,$0.00,$110.80,$0.00
6900612,SUP,HCPCS C1713,,6900612  -  SCREW 6900612 VAS CANCELLOUS 4.0X12MM TI,$696.00,$0.00,$696.00,$313.20,$496.74,$0.00,$119.92,$0.00,$0.00,$121.86,$696.00,$0.00,$348.00,$551.23,$556.80,$0.00,$108.92,$0.00,$110.80,$0.00
6900614,SUP,HCPCS C1713,,6900614  -  SCREW 6900614 VAS CANCELLOUS 4.0X14MM TI,$696.00,$0.00,$696.00,$313.20,$496.74,$0.00,$119.92,$0.00,$0.00,$121.86,$696.00,$0.00,$348.00,$551.23,$556.80,$0.00,$108.92,$0.00,$110.80,$0.00
6900616,SUP,HCPCS C1713,,6900616  -  SCREW 6900616 VAS CANCELLOUS 4.0X16MM TI,$696.00,$0.00,$696.00,$313.20,$496.74,$0.00,$119.92,$0.00,$0.00,$121.86,$696.00,$0.00,$348.00,$551.23,$556.80,$0.00,$108.92,$0.00,$110.80,$0.00
6900618,SUP,HCPCS C1713,,6900618  -  SCREW 6900618 VAS CANCELLOUS 4.0X18MM TI,$696.00,$0.00,$696.00,$313.20,$496.74,$0.00,$119.92,$0.00,$0.00,$121.86,$696.00,$0.00,$348.00,$551.23,$556.80,$0.00,$108.92,$0.00,$110.80,$0.00
6900620,SUP,HCPCS C1713,,6900620  -  SCREW 6900620 VAS CANCELLOUS 4.0X20MM TI,$696.00,$0.00,$696.00,$313.20,$496.74,$0.00,$119.92,$0.00,$0.00,$121.86,$696.00,$0.00,$348.00,$551.23,$556.80,$0.00,$108.92,$0.00,$110.80,$0.00
6900622,SUP,HCPCS C1713,,6900622  -  BONE SCREW 6900622 4.0MMX22MM CANC TI,$696.00,$0.00,$696.00,$313.20,$496.74,$0.00,$119.92,$0.00,$0.00,$121.86,$696.00,$0.00,$348.00,$551.23,$556.80,$0.00,$108.92,$0.00,$110.80,$0.00
6900624,SUP,HCPCS C1713,,6900624  -  BONE SCREW 6900624 4.0MMX24MM CANC TI,$696.00,$0.00,$696.00,$313.20,$496.74,$0.00,$119.92,$0.00,$0.00,$121.86,$696.00,$0.00,$348.00,$551.23,$556.80,$0.00,$108.92,$0.00,$110.80,$0.00
6900626,SUP,HCPCS C1713,,6900626  -  BONE SCREW 6900626 4.0MMX26MM CORT TI,$696.00,$0.00,$696.00,$313.20,$496.74,$0.00,$119.92,$0.00,$0.00,$121.86,$696.00,$0.00,$348.00,$551.23,$556.80,$0.00,$108.92,$0.00,$110.80,$0.00
6900628,SUP,HCPCS C1713,,6900628  -  BONE SCREW 6900628 4.0MMX28MM CORT TI,$696.00,$0.00,$696.00,$313.20,$496.74,$0.00,$119.92,$0.00,$0.00,$121.86,$696.00,$0.00,$348.00,$551.23,$556.80,$0.00,$108.92,$0.00,$110.80,$0.00
6901000,SUP,Custom 27803010,,6901000  -  CONNECTOR 6901000 SCREW,$963.38,$0.00,$963.38,$0.00,$687.56,$0.00,$0.00,$0.00,$0.00,$0.00,$963.38,$0.00,$481.69,$763.00,$770.70,$0.00,$0.00,$0.00,$0.00,$0.00
6902130,SUP,Custom 27803010,,6902130  -  CONNECTOR 6902130 LATERAL CLOSED 10MM,$963.38,$0.00,$963.38,$0.00,$687.56,$0.00,$0.00,$0.00,$0.00,$0.00,$963.38,$0.00,$481.69,$763.00,$770.70,$0.00,$0.00,$0.00,$0.00,$0.00
6902131,SUP,Custom 27803010,,6902131  -  CONNECTOR 6902131 13MM LATRL CONCTR CLSE,$963.38,$0.00,$963.38,$0.00,$687.56,$0.00,$0.00,$0.00,$0.00,$0.00,$963.38,$0.00,$481.69,$763.00,$770.70,$0.00,$0.00,$0.00,$0.00,$0.00
6902135,SUP,Custom 27803010,,6902135  -  CONNECTOR 6902135 LATERAL OPEN 10MM,$963.38,$0.00,$963.38,$0.00,$687.56,$0.00,$0.00,$0.00,$0.00,$0.00,$963.38,$0.00,$481.69,$763.00,$770.70,$0.00,$0.00,$0.00,$0.00,$0.00
6902200,SUP,Custom 27803010,,6902200  -  CONNECTOR 6902200 ROD 3.2-5.5 TI,"$1,389.00",$0.00,"$1,389.00",$0.00,$991.33,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,389.00",$0.00,$694.50,"$1,100.09","$1,111.20",$0.00,$0.00,$0.00,$0.00,$0.00
6902220,SUP,Custom 27803010,,6902220  -  CONNECTOR 6902220 ROD 3.2-4.5 TI,"$1,389.00",$0.00,"$1,389.00",$0.00,$991.33,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,389.00",$0.00,$694.50,"$1,100.09","$1,111.20",$0.00,$0.00,$0.00,$0.00,$0.00
6902525,SUP,HCPCS C1713,,6902525  -  CROSSLINK 6902525 CRSSLNK CONNECTOR CLIP,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6902530,SUP,HCPCS C1713,,6902530  -  CROSSLINK 6902530 CRSSLNK CONNECTOR BAR,$276.00,$0.00,$276.00,$124.20,$196.98,$0.00,$47.55,$0.00,$0.00,$48.33,$276.00,$0.00,$138.00,$218.59,$220.80,$0.00,$43.19,$0.00,$43.94,$0.00
6904045,SUP,HCPCS C1713,,6904045  -  HOOK 6904045 LAMINAR 4.5MM,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
6904060,SUP,HCPCS C1713,,6904060  -  HOOK 6904060 LAMINAR 6.0MM,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
6904075,SUP,HCPCS C1713,,6904075  -  HOOK 6904075 LAMINAR 7.5MM,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
6904090,SUP,HCPCS C1713,,6904090  -  HOOK 6904090 LAMINAR 9.0MM,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
6908245,SUP,HCPCS C1713,,6908245  -  CAGE SPNL XL W 45X22X8MM NS LF CRNT,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6908250,SUP,HCPCS C1713,,6908250  -  CAGE SPNL XL W 50X22X8MM NS LF CRNT,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6908255,SUP,HCPCS C1713,,6908255  -  CAGE SPNL XL W 55X22X8MM NS LF CRNT,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6908260,SUP,HCPCS C1713,,6908260  -  CAGE SPNL XL W 60X22X8MM NS LF CRNT,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6908840,SUP,HCPCS C1713,,6908840  -  SPACER SPNL XL 40X18X8MM CRNT LMBR INTRBD FS PEEK,"$11,250.00",$0.00,"$11,250.00","$5,062.50","$5,158.80",$0.00,"$1,938.32",$0.00,$0.00,"$1,969.79","$11,250.00",$0.00,"$5,625.00","$8,910.00","$9,000.00",$0.00,"$1,760.63",$0.00,"$1,791.00",$0.00
6908845,SUP,HCPCS C1713,,6908845  -  CAGE SPNL XL 45X18X8MM NS LF CRNT PEEK LMBR INTRBD FS,"$11,250.00",$0.00,"$11,250.00","$5,062.50","$5,158.80",$0.00,"$1,938.32",$0.00,$0.00,"$1,969.79","$11,250.00",$0.00,"$5,625.00","$8,910.00","$9,000.00",$0.00,"$1,760.63",$0.00,"$1,791.00",$0.00
6908850,SUP,HCPCS C1713,,6908850  -  CAGE SPNL XL 50X18X8MM NS LF CRNT,"$11,250.00",$0.00,"$11,250.00","$5,062.50","$5,158.80",$0.00,"$1,938.32",$0.00,$0.00,"$1,969.79","$11,250.00",$0.00,"$5,625.00","$8,910.00","$9,000.00",$0.00,"$1,760.63",$0.00,"$1,791.00",$0.00
6908855,SUP,HCPCS C1713,,6908855  -  CAGE SPNL XL 55X18X8MM NS LF CRNT PEEK LMBR INTRBD FS,"$11,250.00",$0.00,"$11,250.00","$5,062.50","$5,158.80",$0.00,"$1,938.32",$0.00,$0.00,"$1,969.79","$11,250.00",$0.00,"$5,625.00","$8,910.00","$9,000.00",$0.00,"$1,760.63",$0.00,"$1,791.00",$0.00
6908860,SUP,HCPCS C1713,,6908860  -  CAGE SPNL XL 60X18X8MM NS LF CRNT,"$11,250.00",$0.00,"$11,250.00","$5,062.50","$5,158.80",$0.00,"$1,938.32",$0.00,$0.00,"$1,969.79","$11,250.00",$0.00,"$5,625.00","$8,910.00","$9,000.00",$0.00,"$1,760.63",$0.00,"$1,791.00",$0.00
6910245,SUP,HCPCS C1713,,6910245  -  CAGE SPNL XL W 45X22X10MM NS LF CRNT,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6910250,SUP,HCPCS C1713,,6910250  -  CAGE SPNL XL W 50X22X10MM NS LF CRNT,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6910255,SUP,Custom 27803010,,6910255  -  CAGE SPNL XL W 55X22X10MM NS LF CRNT PEEK,"$13,000.00",$0.00,"$13,000.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
6910260,SUP,HCPCS C1713,,6910260  -  CAGE SPNL XL W 60X22X10MM NS LF CRNT,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6910840,SUP,HCPCS C1713,,6910840  -  SPACER SPNL XL 40X18X10MM CRNT THORLMBR INTRBD FS RDLCNT,"$11,250.00",$0.00,"$11,250.00","$5,062.50","$5,158.80",$0.00,"$1,938.32",$0.00,$0.00,"$1,969.79","$11,250.00",$0.00,"$5,625.00","$8,910.00","$9,000.00",$0.00,"$1,760.63",$0.00,"$1,791.00",$0.00
6910845,SUP,HCPCS C1713,,6910845  -  CAGE SPNL XL 45X18X10MM NS LF CRNT RADOPQ PEEK TLIF,"$11,250.00",$0.00,"$11,250.00","$5,062.50","$5,158.80",$0.00,"$1,938.32",$0.00,$0.00,"$1,969.79","$11,250.00",$0.00,"$5,625.00","$8,910.00","$9,000.00",$0.00,"$1,760.63",$0.00,"$1,791.00",$0.00
6910850,SUP,HCPCS C1713,,6910850  -  CAGE SPNL XL 50X18X10MM NS LF CRNT,"$11,250.00",$0.00,"$11,250.00","$5,062.50","$5,158.80",$0.00,"$1,938.32",$0.00,$0.00,"$1,969.79","$11,250.00",$0.00,"$5,625.00","$8,910.00","$9,000.00",$0.00,"$1,760.63",$0.00,"$1,791.00",$0.00
6910855,SUP,HCPCS C1713,,6910855  -  CAGE SPNL XL 55X18X10MM NS LF CRNT RADOPQ PEEK TLIF,"$11,250.00",$0.00,"$11,250.00","$5,062.50","$5,158.80",$0.00,"$1,938.32",$0.00,$0.00,"$1,969.79","$11,250.00",$0.00,"$5,625.00","$8,910.00","$9,000.00",$0.00,"$1,760.63",$0.00,"$1,791.00",$0.00
6910860,SUP,HCPCS C1713,,6910860  -  CAGE SPNL XL 60X18X10MM NS LF CRNT,"$11,250.00",$0.00,"$11,250.00","$5,062.50","$5,158.80",$0.00,"$1,938.32",$0.00,$0.00,"$1,969.79","$11,250.00",$0.00,"$5,625.00","$8,910.00","$9,000.00",$0.00,"$1,760.63",$0.00,"$1,791.00",$0.00
6912245,SUP,HCPCS C1713,,6912245  -  CAGE SPNL XL W 45X22X12MM NS LF CRNT,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6912250,SUP,HCPCS C1713,,6912250  -  CAGE SPNL XL W 50X22X12MM NS LF CRNT,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6912255,SUP,HCPCS C1713,,6912255  -  CAGE SPNL XL W 55X22X12MM NS LF CRNT,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6912260,SUP,HCPCS C1713,,6912260  -  CAGE SPNL XL W 60X22X12MM NS LF CRNT,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6912840,SUP,HCPCS C1713,,6912840  -  SPACER SPNL XL 40X18X12MM CRNT LMBR INTRBD FS PEEK,"$11,250.00",$0.00,"$11,250.00","$5,062.50","$5,158.80",$0.00,"$1,938.32",$0.00,$0.00,"$1,969.79","$11,250.00",$0.00,"$5,625.00","$8,910.00","$9,000.00",$0.00,"$1,760.63",$0.00,"$1,791.00",$0.00
6912845,SUP,HCPCS C1713,,6912845  -  CAGE SPNL XL 45X18X12MM NS LF CRNT RADOPQ PEEK LMBR INTRBD,"$11,250.00",$0.00,"$11,250.00","$5,062.50","$5,158.80",$0.00,"$1,938.32",$0.00,$0.00,"$1,969.79","$11,250.00",$0.00,"$5,625.00","$8,910.00","$9,000.00",$0.00,"$1,760.63",$0.00,"$1,791.00",$0.00
6912850,SUP,HCPCS C1713,,6912850  -  CAGE SPNL XL 50X18X12MM NS LF CRNT RADOPQ PEEK LMBR INTRBD,"$11,250.00",$0.00,"$11,250.00","$5,062.50","$5,158.80",$0.00,"$1,938.32",$0.00,$0.00,"$1,969.79","$11,250.00",$0.00,"$5,625.00","$8,910.00","$9,000.00",$0.00,"$1,760.63",$0.00,"$1,791.00",$0.00
6912855,SUP,Custom 27803010,,6912855  -  CAGE SPNL XL 55X18X12MM NS LF CRNT RADOPQ PEEK LMBR INTRBD,"$11,250.00",$0.00,"$11,250.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,250.00",$0.00,"$5,625.00","$8,910.00","$9,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
6912860,SUP,HCPCS C1713,,6912860  -  CAGE SPNL XL 60X18X12MM NS LF CRNT,"$11,250.00",$0.00,"$11,250.00","$5,062.50","$5,158.80",$0.00,"$1,938.32",$0.00,$0.00,"$1,969.79","$11,250.00",$0.00,"$5,625.00","$8,910.00","$9,000.00",$0.00,"$1,760.63",$0.00,"$1,791.00",$0.00
6914245,SUP,HCPCS C1713,,6914245  -  SPACER SPNL XL W 45X22X14MM PEEK,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6914250,SUP,HCPCS C1713,,6914250  -  CAGE SPNL XL W 50X22X14MM NS LF CRNT,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6914255,SUP,HCPCS C1713,,6914255  -  SPACER SPNL XL W 55X22X14MM CRNT LMBR INTRBD FS RDLCNT PEEK,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6914260,SUP,HCPCS C1713,,6914260  -  CAGE SPNL XL 60X22X14MM PEEK,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6914840,SUP,HCPCS C1713,,6914840  -  SPACER SPNL 40X18X14MM INTRBD FS GFT RSTRC,"$11,250.00",$0.00,"$11,250.00","$5,062.50","$5,158.80",$0.00,"$1,938.32",$0.00,$0.00,"$1,969.79","$11,250.00",$0.00,"$5,625.00","$8,910.00","$9,000.00",$0.00,"$1,760.63",$0.00,"$1,791.00",$0.00
6914845,SUP,HCPCS C1713,,6914845  -  SPACER SPNL XL 45X18X14MM STRL CRNT LMBR INTRBD FS PEEK,"$11,250.00",$0.00,"$11,250.00","$5,062.50","$5,158.80",$0.00,"$1,938.32",$0.00,$0.00,"$1,969.79","$11,250.00",$0.00,"$5,625.00","$8,910.00","$9,000.00",$0.00,"$1,760.63",$0.00,"$1,791.00",$0.00
6914850,SUP,HCPCS C1713,,6914850  -  CAGE SPNL XL 50X18X14MM NS LF CRNT,"$11,250.00",$0.00,"$11,250.00","$5,062.50","$5,158.80",$0.00,"$1,938.32",$0.00,$0.00,"$1,969.79","$11,250.00",$0.00,"$5,625.00","$8,910.00","$9,000.00",$0.00,"$1,760.63",$0.00,"$1,791.00",$0.00
6914855,SUP,HCPCS C1713,,6914855  -  CAGE SPNL XL 55X18X14MM NS LF CRNT PEEK LMBR INTRBD FS,"$11,250.00",$0.00,"$11,250.00","$5,062.50","$5,158.80",$0.00,"$1,938.32",$0.00,$0.00,"$1,969.79","$11,250.00",$0.00,"$5,625.00","$8,910.00","$9,000.00",$0.00,"$1,760.63",$0.00,"$1,791.00",$0.00
6914860,SUP,HCPCS C1713,,6914860  -  CAGE SPNL 10D XL 60X18X14MM XLIF CRNT PEEK,"$11,250.00",$0.00,"$11,250.00","$5,062.50","$5,158.80",$0.00,"$1,938.32",$0.00,$0.00,"$1,969.79","$11,250.00",$0.00,"$5,625.00","$8,910.00","$9,000.00",$0.00,"$1,760.63",$0.00,"$1,791.00",$0.00
6916245,SUP,HCPCS C1713,,6916245  -  SPACER SPNL XL W 45X22X16MM PEEK,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6916250,SUP,HCPCS C1713,,6916250  -  CAGE SPNL XL W 50X22X16MM NS LF CRNT,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6916255,SUP,HCPCS C1713,,6916255  -  SPACER SPNL XL W 55X22X16MM PEEK,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6916260,SUP,HCPCS C1713,,6916260  -  SPACER SPNL XL W 60X22X16MM PEEK,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6916840,SUP,HCPCS C1713,,6916840  -  SPACER SPNL XL 40X18X16MM CRNT,"$11,250.00",$0.00,"$11,250.00","$5,062.50","$5,158.80",$0.00,"$1,938.32",$0.00,$0.00,"$1,969.79","$11,250.00",$0.00,"$5,625.00","$8,910.00","$9,000.00",$0.00,"$1,760.63",$0.00,"$1,791.00",$0.00
6916845,SUP,HCPCS C1713,,6916845  -  SPACER SPNL XL 45X18X16MM CRNT THORLMBR INTRBD FS PEEK,"$11,250.00",$0.00,"$11,250.00","$5,062.50","$5,158.80",$0.00,"$1,938.32",$0.00,$0.00,"$1,969.79","$11,250.00",$0.00,"$5,625.00","$8,910.00","$9,000.00",$0.00,"$1,760.63",$0.00,"$1,791.00",$0.00
6916850,SUP,HCPCS C1713,,6916850  -  CAGE SPNL XL 50X18X16MM NS LF CRNT,"$11,250.00",$0.00,"$11,250.00","$5,062.50","$5,158.80",$0.00,"$1,938.32",$0.00,$0.00,"$1,969.79","$11,250.00",$0.00,"$5,625.00","$8,910.00","$9,000.00",$0.00,"$1,760.63",$0.00,"$1,791.00",$0.00
6916855,SUP,HCPCS C1713,,6916855  -  SPACER SPNL XL 55X18X16MM CRNT THORLMBR INTRBD FS PEEK,"$11,250.00",$0.00,"$11,250.00","$5,062.50","$5,158.80",$0.00,"$1,938.32",$0.00,$0.00,"$1,969.79","$11,250.00",$0.00,"$5,625.00","$8,910.00","$9,000.00",$0.00,"$1,760.63",$0.00,"$1,791.00",$0.00
6916860,SUP,HCPCS C1713,,6916860  -  SPACER SPNL 10D XL 60X18X16MM XLIF CRNT PEEK,"$11,250.00",$0.00,"$11,250.00","$5,062.50","$5,158.80",$0.00,"$1,938.32",$0.00,$0.00,"$1,969.79","$11,250.00",$0.00,"$5,625.00","$8,910.00","$9,000.00",$0.00,"$1,760.63",$0.00,"$1,791.00",$0.00
6920845,SUP,HCPCS C1713,,6920845  -  CAGE SPNL XL W LRDTC 45X22X8MM NS LF CRNT,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6920855,SUP,HCPCS C1713,,6920855  -  CAGE SPNL XL W LRDTC 55X22X8MM NS LF CRNT,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6920860,SUP,HCPCS C1713,,6920860  -  CAGE SPNL XL W LRDTC 60X22X8MM NS LF CRNT PEEK-OPTM,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6921044,SUP,HCPCS C1713,,6921044  -  CAGE SPNL 8D XL 24X34X10MM CRNT RND PEEK-OPTM,"$15,000.00",$0.00,"$15,000.00","$6,750.00","$5,158.80",$0.00,"$2,584.43",$0.00,$0.00,"$2,626.38","$15,000.00",$0.00,"$7,500.00","$11,880.00","$12,000.00",$0.00,"$2,347.50",$0.00,"$2,388.00",$0.00
6921045,SUP,HCPCS C1713,,6921045  -  CAGE SPNL XL W LRDTC 45X22X10MM NS LF CRNT,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6921050,SUP,HCPCS C1713,,6921050  -  CAGE SPNL XL W LRDTC 50X22X10MM NS LF CRNT,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6921055,SUP,HCPCS C1713,,6921055  -  CAGE SPNL XL W LRDTC 55X22X10MM NS LF CRNT,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6921088,SUP,HCPCS C1713,,6921088  -  SPACER SPNL 8D XL 38X28X10MM CRNT PEEK-OPTM,"$15,000.00",$0.00,"$15,000.00","$6,750.00","$5,158.80",$0.00,"$2,584.43",$0.00,$0.00,"$2,626.38","$15,000.00",$0.00,"$7,500.00","$11,880.00","$12,000.00",$0.00,"$2,347.50",$0.00,"$2,388.00",$0.00
6921244,SUP,HCPCS C1713,,6921244  -  SPACER SPNL XL 12X34X24MM CRNT LMBR INTRBD FS PEEK,"$15,000.00",$0.00,"$15,000.00","$6,750.00","$5,158.80",$0.00,"$2,584.43",$0.00,$0.00,"$2,626.38","$15,000.00",$0.00,"$7,500.00","$11,880.00","$12,000.00",$0.00,"$2,347.50",$0.00,"$2,388.00",$0.00
6921245,SUP,HCPCS C1713,,6921245  -  CAGE SPNL XL W LRDTC 45X22X12MM NS LF CRNT,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6921255,SUP,HCPCS C1713,,6921255  -  CAGE SPNL XL W LRDTC 55X22X12MM NS LF CRNT PEEK LMBR INTRBD,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6921260,SUP,HCPCS C1713,,6921260  -  CAGE SPNL XL W LRDTC 60X22X12MM NS LF CRNT,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6921288,SUP,HCPCS C1713,,6921288  -  CAGE SPNL 8D XL 28X38X12MM CRNT RND PEEK-OPTM,"$15,000.00",$0.00,"$15,000.00","$6,750.00","$5,158.80",$0.00,"$2,584.43",$0.00,$0.00,"$2,626.38","$15,000.00",$0.00,"$7,500.00","$11,880.00","$12,000.00",$0.00,"$2,347.50",$0.00,"$2,388.00",$0.00
6921444,SUP,HCPCS C1713,,6921444  -  CAGE SPNL 8D XL 24X34X14MM CRNT RND PEEK-OPTM,"$15,000.00",$0.00,"$15,000.00","$6,750.00","$5,158.80",$0.00,"$2,584.43",$0.00,$0.00,"$2,626.38","$15,000.00",$0.00,"$7,500.00","$11,880.00","$12,000.00",$0.00,"$2,347.50",$0.00,"$2,388.00",$0.00
6921445,SUP,HCPCS C1713,,6921445  -  SPACER SPNL 10D LRDTC XL W 45X22X14MM PEEK,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6921450,SUP,HCPCS C1713,,6921450  -  SPACER SPNL 10D LRDTC XL W 50X22X14MM PEEK,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6921455,SUP,HCPCS C1713,,6921455  -  SPACER SPNL 10D LRDTC XL W 55X22X14MM PEEK,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6921460,SUP,HCPCS C1713,,6921460  -  SPACER SPNL 10D LRDTC XL W 60X22X14MM PEEK,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6921488,SUP,HCPCS C1713,,6921488  -  SPACER SPNL 8D XL 38X28X114MM LMBR INTRBD FS RDLCNT PEEK,"$15,000.00",$0.00,"$15,000.00","$6,750.00","$5,158.80",$0.00,"$2,584.43",$0.00,$0.00,"$2,626.38","$15,000.00",$0.00,"$7,500.00","$11,880.00","$12,000.00",$0.00,"$2,347.50",$0.00,"$2,388.00",$0.00
6921644,SUP,HCPCS C1713,,6921644  -  SPACER SPNL 8D XL 34X24X16MM CRNT PEEK,"$15,000.00",$0.00,"$15,000.00","$6,750.00","$5,158.80",$0.00,"$2,584.43",$0.00,$0.00,"$2,626.38","$15,000.00",$0.00,"$7,500.00","$11,880.00","$12,000.00",$0.00,"$2,347.50",$0.00,"$2,388.00",$0.00
6921645,SUP,HCPCS C1713,,6921645  -  SPACER SPNL 10D LRDTC XL W 45X22X16MM PEEK,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6921650,SUP,HCPCS C1713,,6921650  -  SPACER SPNL 10D LRDTC XL W 50X22X16MM PEEK,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6921655,SUP,HCPCS C1713,,6921655  -  SPACER SPNL 10D LRDTC XL W 55X22X16MM PEEK,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6921660,SUP,HCPCS C1713,,6921660  -  SPACER SPNL 10D LRDTC XL W 60X22X16MM PEEK,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6921688,SUP,HCPCS C1713,,6921688  -  SPACER SPNL 8D XL 38X28X16MM CRNT LMBR INTRBD FS PEEK,"$15,000.00",$0.00,"$15,000.00","$6,750.00","$5,158.80",$0.00,"$2,584.43",$0.00,$0.00,"$2,626.38","$15,000.00",$0.00,"$7,500.00","$11,880.00","$12,000.00",$0.00,"$2,347.50",$0.00,"$2,388.00",$0.00
6921844,SUP,HCPCS C1713,,6921844  -  SPACER SPNL 8D XL 34X24X18MM LMBR INTRBD FS RDLCNT PEEK-OPTM,"$15,000.00",$0.00,"$15,000.00","$6,750.00","$5,158.80",$0.00,"$2,584.43",$0.00,$0.00,"$2,626.38","$15,000.00",$0.00,"$7,500.00","$11,880.00","$12,000.00",$0.00,"$2,347.50",$0.00,"$2,388.00",$0.00
6921888,SUP,HCPCS C1713,,6921888  -  SPACER SPNL 8D XL 38X28X18MM LMBR INTRBD FS RDLCNT PEEK,"$15,000.00",$0.00,"$15,000.00","$6,750.00","$5,158.80",$0.00,"$2,584.43",$0.00,$0.00,"$2,626.38","$15,000.00",$0.00,"$7,500.00","$11,880.00","$12,000.00",$0.00,"$2,347.50",$0.00,"$2,388.00",$0.00
6922044,SUP,HCPCS C1713,,6922044  -  SPACER SPNL 8D XL 34X24X20MM LMBR INTRBD FS RDLCNT PEEK,"$15,000.00",$0.00,"$15,000.00","$6,750.00","$5,158.80",$0.00,"$2,584.43",$0.00,$0.00,"$2,626.38","$15,000.00",$0.00,"$7,500.00","$11,880.00","$12,000.00",$0.00,"$2,347.50",$0.00,"$2,388.00",$0.00
6922088,SUP,HCPCS C1713,,6922088  -  SPACER SPNL 8D XL 38X28X20MM LMBR INTRBD FS RDLCNT PEEK,"$15,000.00",$0.00,"$15,000.00","$6,750.00","$5,158.80",$0.00,"$2,584.43",$0.00,$0.00,"$2,626.38","$15,000.00",$0.00,"$7,500.00","$11,880.00","$12,000.00",$0.00,"$2,347.50",$0.00,"$2,388.00",$0.00
6931288,SUP,HCPCS C1713,,6931288  -  CAGE SPNL 15D XL 28X38X12MM CRNT RND PEEK-OPTM,"$15,000.00",$0.00,"$15,000.00","$6,750.00","$5,158.80",$0.00,"$2,584.43",$0.00,$0.00,"$2,626.38","$15,000.00",$0.00,"$7,500.00","$11,880.00","$12,000.00",$0.00,"$2,347.50",$0.00,"$2,388.00",$0.00
6931488,SUP,HCPCS C1713,,6931488  -  CAGE SPNL 15D XL 28X38X14MM CRNT RND PEEK-OPTM,"$15,000.00",$0.00,"$15,000.00","$6,750.00","$5,158.80",$0.00,"$2,584.43",$0.00,$0.00,"$2,626.38","$15,000.00",$0.00,"$7,500.00","$11,880.00","$12,000.00",$0.00,"$2,347.50",$0.00,"$2,388.00",$0.00
6931688,SUP,HCPCS C1713,,6931688  -  SPACER SPNL XL 38X28X16MM CRNT INTRBD FS PEEK,"$15,000.00",$0.00,"$15,000.00","$6,750.00","$5,158.80",$0.00,"$2,584.43",$0.00,$0.00,"$2,626.38","$15,000.00",$0.00,"$7,500.00","$11,880.00","$12,000.00",$0.00,"$2,347.50",$0.00,"$2,388.00",$0.00
6931888,SUP,HCPCS C1713,,6931888  -  SPACER SPNL 15D XL 38X28X18MM CRNT LMBR INTRBD FS PEEK,"$15,000.00",$0.00,"$15,000.00","$6,750.00","$5,158.80",$0.00,"$2,584.43",$0.00,$0.00,"$2,626.38","$15,000.00",$0.00,"$7,500.00","$11,880.00","$12,000.00",$0.00,"$2,347.50",$0.00,"$2,388.00",$0.00
6932088,SUP,HCPCS C1713,,6932088  -  SPACER SPNL 15D XL 38X28X20MM TLIF RDLCNT PEEK-OPTM,"$15,000.00",$0.00,"$15,000.00","$6,750.00","$5,158.80",$0.00,"$2,584.43",$0.00,$0.00,"$2,626.38","$15,000.00",$0.00,"$7,500.00","$11,880.00","$12,000.00",$0.00,"$2,347.50",$0.00,"$2,388.00",$0.00
6940664,SUP,HCPCS C1713,,6940664  -  GRAFT BN 16X14X6MM SPCR ANTM SPNE CRV,"$2,875.00",$0.00,"$2,875.00","$1,293.75","$2,051.89",$0.00,$495.35,$0.00,$0.00,$503.39,"$2,875.00",$0.00,"$1,437.50","$2,277.00","$2,300.00",$0.00,$449.94,$0.00,$457.70,$0.00
6940764,SUP,HCPCS C1713,,6940764  -  SPACER ALGRF 16X14X7MM SPNE CRV,"$2,875.00",$0.00,"$2,875.00","$1,293.75","$2,051.89",$0.00,$495.35,$0.00,$0.00,$503.39,"$2,875.00",$0.00,"$1,437.50","$2,277.00","$2,300.00",$0.00,$449.94,$0.00,$457.70,$0.00
6940864,SUP,HCPCS C1713,,6940864  -  SPACER ALGRF 16X14X8MM SPNE CRV,"$2,875.00",$0.00,"$2,875.00","$1,293.75","$2,051.89",$0.00,$495.35,$0.00,$0.00,$503.39,"$2,875.00",$0.00,"$1,437.50","$2,277.00","$2,300.00",$0.00,$449.94,$0.00,$457.70,$0.00
6940964,SUP,HCPCS C1713,,6940964  -  SPACER ALGRF 16X14X9MM SPNE CRV,"$2,875.00",$0.00,"$2,875.00","$1,293.75","$2,051.89",$0.00,$495.35,$0.00,$0.00,$503.39,"$2,875.00",$0.00,"$1,437.50","$2,277.00","$2,300.00",$0.00,$449.94,$0.00,$457.70,$0.00
6941034,SUP,HCPCS C1713,,6941034  -  CAGE SPNL 8D 34X24X10MM NS LF BRIGADE,"$13,782.50",$0.00,"$13,782.50","$6,202.13","$5,158.80",$0.00,"$2,374.66",$0.00,$0.00,"$2,413.21","$13,782.50",$0.00,"$6,891.25","$10,915.74","$11,026.00",$0.00,"$2,156.96",$0.00,"$2,194.17",$0.00
6941038,SUP,HCPCS C1713,,6941038  -  CAGE SPNL 8D 38X28X10MM NS LF BRIGADE,"$13,782.50",$0.00,"$13,782.50","$6,202.13","$5,158.80",$0.00,"$2,374.66",$0.00,$0.00,"$2,413.21","$13,782.50",$0.00,"$6,891.25","$10,915.74","$11,026.00",$0.00,"$2,156.96",$0.00,"$2,194.17",$0.00
6941042,SUP,HCPCS C1713,,6941042  -  CAGE SPNL 8D 42X30X10MM NS LF BRIGADE,"$13,782.50",$0.00,"$13,782.50","$6,202.13","$5,158.80",$0.00,"$2,374.66",$0.00,$0.00,"$2,413.21","$13,782.50",$0.00,"$6,891.25","$10,915.74","$11,026.00",$0.00,"$2,156.96",$0.00,"$2,194.17",$0.00
6941234,SUP,HCPCS C1713,,6941234  -  CAGE SPNL 8D 34X24X12MM NS LF BRIGADE TI,"$13,782.50",$0.00,"$13,782.50","$6,202.13","$5,158.80",$0.00,"$2,374.66",$0.00,$0.00,"$2,413.21","$13,782.50",$0.00,"$6,891.25","$10,915.74","$11,026.00",$0.00,"$2,156.96",$0.00,"$2,194.17",$0.00
6941238,SUP,HCPCS C1713,,6941238  -  CAGE SPNL 8D 38X28X12MM NS LF BRIGADE,"$13,782.50",$0.00,"$13,782.50","$6,202.13","$5,158.80",$0.00,"$2,374.66",$0.00,$0.00,"$2,413.21","$13,782.50",$0.00,"$6,891.25","$10,915.74","$11,026.00",$0.00,"$2,156.96",$0.00,"$2,194.17",$0.00
6941242,SUP,HCPCS C1713,,6941242  -  CAGE SPNL 8D 42X30X12MM NS LF BRIGADE,"$13,782.50",$0.00,"$13,782.50","$6,202.13","$5,158.80",$0.00,"$2,374.66",$0.00,$0.00,"$2,413.21","$13,782.50",$0.00,"$6,891.25","$10,915.74","$11,026.00",$0.00,"$2,156.96",$0.00,"$2,194.17",$0.00
6941434,SUP,HCPCS C1713,,6941434  -  CAGE SPNL 8D 34X24X14MM NS LF BRIGADE,"$13,782.50",$0.00,"$13,782.50","$6,202.13","$5,158.80",$0.00,"$2,374.66",$0.00,$0.00,"$2,413.21","$13,782.50",$0.00,"$6,891.25","$10,915.74","$11,026.00",$0.00,"$2,156.96",$0.00,"$2,194.17",$0.00
6941438,SUP,HCPCS C1713,,6941438  -  CAGE SPNL 8D 38X28X14MM NS LF BRIGADE,"$13,782.50",$0.00,"$13,782.50","$6,202.13","$5,158.80",$0.00,"$2,374.66",$0.00,$0.00,"$2,413.21","$13,782.50",$0.00,"$6,891.25","$10,915.74","$11,026.00",$0.00,"$2,156.96",$0.00,"$2,194.17",$0.00
6941442,SUP,HCPCS C1713,,6941442  -  CAGE SPNL 8D 42X30X14MM NS LF BRIGADE,"$13,782.50",$0.00,"$13,782.50","$6,202.13","$5,158.80",$0.00,"$2,374.66",$0.00,$0.00,"$2,413.21","$13,782.50",$0.00,"$6,891.25","$10,915.74","$11,026.00",$0.00,"$2,156.96",$0.00,"$2,194.17",$0.00
6941634,SUP,HCPCS C1713,,6941634  -  CAGE SPNL 8D 34X24X16MM NS LF BRIGADE,"$13,782.50",$0.00,"$13,782.50","$6,202.13","$5,158.80",$0.00,"$2,374.66",$0.00,$0.00,"$2,413.21","$13,782.50",$0.00,"$6,891.25","$10,915.74","$11,026.00",$0.00,"$2,156.96",$0.00,"$2,194.17",$0.00
6941638,SUP,HCPCS C1713,,6941638  -  CAGE SPNL 8D 38X28X16MM NS LF BRIGADE,"$13,782.50",$0.00,"$13,782.50","$6,202.13","$5,158.80",$0.00,"$2,374.66",$0.00,$0.00,"$2,413.21","$13,782.50",$0.00,"$6,891.25","$10,915.74","$11,026.00",$0.00,"$2,156.96",$0.00,"$2,194.17",$0.00
6941642,SUP,HCPCS C1713,,6941642  -  CAGE SPNL 8D 42X30X16MM NS LF BRIGADE,"$13,782.50",$0.00,"$13,782.50","$6,202.13","$5,158.80",$0.00,"$2,374.66",$0.00,$0.00,"$2,413.21","$13,782.50",$0.00,"$6,891.25","$10,915.74","$11,026.00",$0.00,"$2,156.96",$0.00,"$2,194.17",$0.00
6941834,SUP,HCPCS C1713,,6941834  -  CAGE SPNL 8D 34X24X18MM NS LF BRIGADE,"$13,782.50",$0.00,"$13,782.50","$6,202.13","$5,158.80",$0.00,"$2,374.66",$0.00,$0.00,"$2,413.21","$13,782.50",$0.00,"$6,891.25","$10,915.74","$11,026.00",$0.00,"$2,156.96",$0.00,"$2,194.17",$0.00
6941838,SUP,HCPCS C1713,,6941838  -  CAGE SPNL 8D 38X28X18MM NS LF BRIGADE,"$13,782.50",$0.00,"$13,782.50","$6,202.13","$5,158.80",$0.00,"$2,374.66",$0.00,$0.00,"$2,413.21","$13,782.50",$0.00,"$6,891.25","$10,915.74","$11,026.00",$0.00,"$2,156.96",$0.00,"$2,194.17",$0.00
6941842,SUP,HCPCS C1713,,6941842  -  CAGE SPNL 8D 42X30X18MM NS LF BRIGADE,"$13,782.50",$0.00,"$13,782.50","$6,202.13","$5,158.80",$0.00,"$2,374.66",$0.00,$0.00,"$2,413.21","$13,782.50",$0.00,"$6,891.25","$10,915.74","$11,026.00",$0.00,"$2,156.96",$0.00,"$2,194.17",$0.00
6942034,SUP,HCPCS C1713,,6942034  -  CAGE SPNL 8D 34X24X20MM NS LF BRIGADE,"$13,782.50",$0.00,"$13,782.50","$6,202.13","$5,158.80",$0.00,"$2,374.66",$0.00,$0.00,"$2,413.21","$13,782.50",$0.00,"$6,891.25","$10,915.74","$11,026.00",$0.00,"$2,156.96",$0.00,"$2,194.17",$0.00
6942038,SUP,HCPCS C1713,,6942038  -  CAGE SPNL 8D 38X28X20MM NS LF BRIGADE,"$13,782.50",$0.00,"$13,782.50","$6,202.13","$5,158.80",$0.00,"$2,374.66",$0.00,$0.00,"$2,413.21","$13,782.50",$0.00,"$6,891.25","$10,915.74","$11,026.00",$0.00,"$2,156.96",$0.00,"$2,194.17",$0.00
6942042,SUP,HCPCS C1713,,6942042  -  CAGE SPNL 8D 42X30X20MM NS LF BRIGADE,"$13,782.50",$0.00,"$13,782.50","$6,202.13","$5,158.80",$0.00,"$2,374.66",$0.00,$0.00,"$2,413.21","$13,782.50",$0.00,"$6,891.25","$10,915.74","$11,026.00",$0.00,"$2,156.96",$0.00,"$2,194.17",$0.00
6950305,SUP,HCPCS C1713,,6950305  -  SCREW BN 3.5MM 5MM LGHT BLU NS VRTX MX 3 RLF NTCH ST TOP LD,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
6950315,SUP,HCPCS C1713,,6950315  -  SCREW SET TI 15MM 3.5MM POST SPN M6 VRTX,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
6951034,SUP,HCPCS C1713,,6951034  -  CAGE SPNL 12D 34X24X10MM NS LF BRIGADE,"$13,782.50",$0.00,"$13,782.50","$6,202.13","$5,158.80",$0.00,"$2,374.66",$0.00,$0.00,"$2,413.21","$13,782.50",$0.00,"$6,891.25","$10,915.74","$11,026.00",$0.00,"$2,156.96",$0.00,"$2,194.17",$0.00
6951234,SUP,HCPCS C1713,,6951234  -  CAGE SPNL 12D 34X24X12MM NS LF BRIGADE,"$13,782.50",$0.00,"$13,782.50","$6,202.13","$5,158.80",$0.00,"$2,374.66",$0.00,$0.00,"$2,413.21","$13,782.50",$0.00,"$6,891.25","$10,915.74","$11,026.00",$0.00,"$2,156.96",$0.00,"$2,194.17",$0.00
6951238,SUP,HCPCS C1713,,6951238  -  CAGE SPNL 12D 38X28X12MM NS LF BRIGADE,"$13,782.50",$0.00,"$13,782.50","$6,202.13","$5,158.80",$0.00,"$2,374.66",$0.00,$0.00,"$2,413.21","$13,782.50",$0.00,"$6,891.25","$10,915.74","$11,026.00",$0.00,"$2,156.96",$0.00,"$2,194.17",$0.00
6951242,SUP,HCPCS C1713,,6951242  -  CAGE SPNL 12D 42X30X12MM NS LF BRIGADE,"$13,782.50",$0.00,"$13,782.50","$6,202.13","$5,158.80",$0.00,"$2,374.66",$0.00,$0.00,"$2,413.21","$13,782.50",$0.00,"$6,891.25","$10,915.74","$11,026.00",$0.00,"$2,156.96",$0.00,"$2,194.17",$0.00
6951434,SUP,HCPCS C1713,,6951434  -  CAGE SPNL 12D 34X24X14MM NS LF BRIGADE,"$13,782.50",$0.00,"$13,782.50","$6,202.13","$5,158.80",$0.00,"$2,374.66",$0.00,$0.00,"$2,413.21","$13,782.50",$0.00,"$6,891.25","$10,915.74","$11,026.00",$0.00,"$2,156.96",$0.00,"$2,194.17",$0.00
6951438,SUP,HCPCS C1713,,6951438  -  CAGE SPNL 12D 38X28X14MM NS LF BRIGADE,"$13,782.50",$0.00,"$13,782.50","$6,202.13","$5,158.80",$0.00,"$2,374.66",$0.00,$0.00,"$2,413.21","$13,782.50",$0.00,"$6,891.25","$10,915.74","$11,026.00",$0.00,"$2,156.96",$0.00,"$2,194.17",$0.00
6951442,SUP,HCPCS C1713,,6951442  -  CAGE SPNL 12D 42X30X14MM NS LF BRIGADE,"$13,782.50",$0.00,"$13,782.50","$6,202.13","$5,158.80",$0.00,"$2,374.66",$0.00,$0.00,"$2,413.21","$13,782.50",$0.00,"$6,891.25","$10,915.74","$11,026.00",$0.00,"$2,156.96",$0.00,"$2,194.17",$0.00
6951634,SUP,HCPCS C1713,,6951634  -  CAGE SPNL 12D 34X24X16MM NS LF BRIGADE,"$13,782.50",$0.00,"$13,782.50","$6,202.13","$5,158.80",$0.00,"$2,374.66",$0.00,$0.00,"$2,413.21","$13,782.50",$0.00,"$6,891.25","$10,915.74","$11,026.00",$0.00,"$2,156.96",$0.00,"$2,194.17",$0.00
6951638,SUP,HCPCS C1713,,6951638  -  CAGE SPNL 12D 38X28X16MM NS LF BRIGADE TI,"$13,782.50",$0.00,"$13,782.50","$6,202.13","$5,158.80",$0.00,"$2,374.66",$0.00,$0.00,"$2,413.21","$13,782.50",$0.00,"$6,891.25","$10,915.74","$11,026.00",$0.00,"$2,156.96",$0.00,"$2,194.17",$0.00
6951642,SUP,HCPCS C1713,,6951642  -  CAGE SPNL 12D 42X30X16MM NS LF BRIGADE,"$13,782.50",$0.00,"$13,782.50","$6,202.13","$5,158.80",$0.00,"$2,374.66",$0.00,$0.00,"$2,413.21","$13,782.50",$0.00,"$6,891.25","$10,915.74","$11,026.00",$0.00,"$2,156.96",$0.00,"$2,194.17",$0.00
6951834,SUP,HCPCS C1713,,6951834  -  CAGE SPNL 12D 34X24X18MM NS LF BRIGADE,"$13,782.50",$0.00,"$13,782.50","$6,202.13","$5,158.80",$0.00,"$2,374.66",$0.00,$0.00,"$2,413.21","$13,782.50",$0.00,"$6,891.25","$10,915.74","$11,026.00",$0.00,"$2,156.96",$0.00,"$2,194.17",$0.00
6951838,SUP,HCPCS C1713,,6951838  -  CAGE SPNL 12D 38X28X18MM NS LF BRIGADE,"$13,782.50",$0.00,"$13,782.50","$6,202.13","$5,158.80",$0.00,"$2,374.66",$0.00,$0.00,"$2,413.21","$13,782.50",$0.00,"$6,891.25","$10,915.74","$11,026.00",$0.00,"$2,156.96",$0.00,"$2,194.17",$0.00
6951842,SUP,HCPCS C1713,,6951842  -  CAGE SPNL 12D 42X30X18MM NS LF BRIGADE,"$13,782.50",$0.00,"$13,782.50","$6,202.13","$5,158.80",$0.00,"$2,374.66",$0.00,$0.00,"$2,413.21","$13,782.50",$0.00,"$6,891.25","$10,915.74","$11,026.00",$0.00,"$2,156.96",$0.00,"$2,194.17",$0.00
6952034,SUP,HCPCS C1713,,6952034  -  CAGE SPNL 12D 34X24X20MM NS LF BRIGADE,"$13,782.50",$0.00,"$13,782.50","$6,202.13","$5,158.80",$0.00,"$2,374.66",$0.00,$0.00,"$2,413.21","$13,782.50",$0.00,"$6,891.25","$10,915.74","$11,026.00",$0.00,"$2,156.96",$0.00,"$2,194.17",$0.00
6952038,SUP,HCPCS C1713,,6952038  -  CAGE SPNL 12D 38X28X20MM NS LF BRIGADE,"$13,782.50",$0.00,"$13,782.50","$6,202.13","$5,158.80",$0.00,"$2,374.66",$0.00,$0.00,"$2,413.21","$13,782.50",$0.00,"$6,891.25","$10,915.74","$11,026.00",$0.00,"$2,156.96",$0.00,"$2,194.17",$0.00
6952042,SUP,HCPCS C1713,,6952042  -  CAGE SPNL 12D 42X30X20MM NS LF BRIGADE,"$13,782.50",$0.00,"$13,782.50","$6,202.13","$5,158.80",$0.00,"$2,374.66",$0.00,$0.00,"$2,413.21","$13,782.50",$0.00,"$6,891.25","$10,915.74","$11,026.00",$0.00,"$2,156.96",$0.00,"$2,194.17",$0.00
6955240,SUP,Custom 27803010,,6955240  -  CONCTR ROD 240MM 3.2MM VRTX MX THRD TI SPNL RECON SYS,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
6955245,SUP,HCPCS C1713,,6955245  -  ROD SPNL 4.5MM 360MM VRTX MX THRD TI RECON SYS,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
6955255,SUP,HCPCS C1713,,6955255  -  ROD SPNL 5.5MM 360MM VRTX MX THRD TI OCPTL RECON SYS,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
6955260,SUP,HCPCS C1713,,6955260  -  ROD 6955260 3.2 X 100 PRECURVED OC TI,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
6955270,SUP,HCPCS C1713,,6955270  -  ROD 6955270 3.2 X 200 PRECURVED OC TI,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
6955273,SUP,HCPCS C1713,,6955273  -  PLATE 6955273 OCCIPITAL KEEL SMALL,"$6,735.00",$0.00,"$6,735.00","$3,030.75","$4,806.77",$0.00,"$1,160.41",$0.00,$0.00,"$1,179.24","$6,735.00",$0.00,"$3,367.50","$5,334.12","$5,388.00",$0.00,"$1,054.03",$0.00,"$1,072.21",$0.00
6955274,SUP,HCPCS C1713,,6955274  -  PLATE 6955274 OCCIPITAL KEEL MEDIUM,"$6,735.00",$0.00,"$6,735.00","$3,030.75","$4,806.77",$0.00,"$1,160.41",$0.00,$0.00,"$1,179.24","$6,735.00",$0.00,"$3,367.50","$5,334.12","$5,388.00",$0.00,"$1,054.03",$0.00,"$1,072.21",$0.00
6955275,SUP,HCPCS C1713,,6955275  -  PLATE 6955275 OCCIPITAL KEEL LARGE,"$6,735.00",$0.00,"$6,735.00","$3,030.75","$4,806.77",$0.00,"$1,160.41",$0.00,$0.00,"$1,179.24","$6,735.00",$0.00,"$3,367.50","$5,334.12","$5,388.00",$0.00,"$1,054.03",$0.00,"$1,072.21",$0.00
6955406,SUP,HCPCS C1713,,6955406  -  BONE SCREW 6955406 4.0 X 6MM CORTICAL,$694.88,$0.00,$694.88,$312.69,$495.93,$0.00,$119.72,$0.00,$0.00,$121.67,$694.88,$0.00,$347.44,$550.34,$555.90,$0.00,$108.75,$0.00,$110.62,$0.00
6955408,SUP,HCPCS C1713,,6955408  -  BONE SCREW 6955408 4.0 X 8MM CORTICAL,$694.88,$0.00,$694.88,$312.69,$495.93,$0.00,$119.72,$0.00,$0.00,$121.67,$694.88,$0.00,$347.44,$550.34,$555.90,$0.00,$108.75,$0.00,$110.62,$0.00
6955410,SUP,HCPCS C1713,,6955410  -  BONE SCREW 6955410 4.0 X 10MM CORTICAL,$694.88,$0.00,$694.88,$312.69,$495.93,$0.00,$119.72,$0.00,$0.00,$121.67,$694.88,$0.00,$347.44,$550.34,$555.90,$0.00,$108.75,$0.00,$110.62,$0.00
6955412,SUP,HCPCS C1713,,6955412  -  BONE SCREW 6955412 4.0 X 12MM CORTICAL,$694.88,$0.00,$694.88,$312.69,$495.93,$0.00,$119.72,$0.00,$0.00,$121.67,$694.88,$0.00,$347.44,$550.34,$555.90,$0.00,$108.75,$0.00,$110.62,$0.00
6955414,SUP,HCPCS C1713,,6955414  -  BONE SCREW 6955414 4.0 X 14MM CORTICAL,$694.88,$0.00,$694.88,$312.69,$495.93,$0.00,$119.72,$0.00,$0.00,$121.67,$694.88,$0.00,$347.44,$550.34,$555.90,$0.00,$108.75,$0.00,$110.62,$0.00
6955416,SUP,HCPCS C1713,,6955416  -  BONE SCREW 6955416 4.0 X 16MM CORTICAL,$694.88,$0.00,$694.88,$312.69,$495.93,$0.00,$119.72,$0.00,$0.00,$121.67,$694.88,$0.00,$347.44,$550.34,$555.90,$0.00,$108.75,$0.00,$110.62,$0.00
6955418,SUP,HCPCS C1713,,6955418  -  BONE SCREW 6955418 4.0 X 18MM CORTICAL,$694.88,$0.00,$694.88,$312.69,$495.93,$0.00,$119.72,$0.00,$0.00,$121.67,$694.88,$0.00,$347.44,$550.34,$555.90,$0.00,$108.75,$0.00,$110.62,$0.00
6955506,SUP,HCPCS C1713,,6955506  -  BONE SCREW 6955506 4.5 X 6MM CORTICAL,$694.88,$0.00,$694.88,$312.69,$495.93,$0.00,$119.72,$0.00,$0.00,$121.67,$694.88,$0.00,$347.44,$550.34,$555.90,$0.00,$108.75,$0.00,$110.62,$0.00
6955508,SUP,HCPCS C1713,,6955508  -  BONE SCREW 6955508 4.5 X 8MM CORTICAL,$694.88,$0.00,$694.88,$312.69,$495.93,$0.00,$119.72,$0.00,$0.00,$121.67,$694.88,$0.00,$347.44,$550.34,$555.90,$0.00,$108.75,$0.00,$110.62,$0.00
6955510,SUP,HCPCS C1713,,6955510  -  BONE SCREW 6955510 4.5 X 10MM CORTICAL,$694.88,$0.00,$694.88,$312.69,$495.93,$0.00,$119.72,$0.00,$0.00,$121.67,$694.88,$0.00,$347.44,$550.34,$555.90,$0.00,$108.75,$0.00,$110.62,$0.00
6955512,SUP,HCPCS C1713,,6955512  -  BONE SCREW 6955512 4.5 X 12MM CORTICAL,$694.88,$0.00,$694.88,$312.69,$495.93,$0.00,$119.72,$0.00,$0.00,$121.67,$694.88,$0.00,$347.44,$550.34,$555.90,$0.00,$108.75,$0.00,$110.62,$0.00
6955514,SUP,HCPCS C1713,,6955514  -  BONE SCREW 6955514 4.5 X 14MM CORTICAL,$694.88,$0.00,$694.88,$312.69,$495.93,$0.00,$119.72,$0.00,$0.00,$121.67,$694.88,$0.00,$347.44,$550.34,$555.90,$0.00,$108.75,$0.00,$110.62,$0.00
6955516,SUP,HCPCS C1713,,6955516  -  BONE SCREW 6955516 4.5 X 16MM CORTICAL,$694.88,$0.00,$694.88,$312.69,$495.93,$0.00,$119.72,$0.00,$0.00,$121.67,$694.88,$0.00,$347.44,$550.34,$555.90,$0.00,$108.75,$0.00,$110.62,$0.00
6955518,SUP,HCPCS C1713,,6955518  -  BONE SCREW 6955518 4.5 X 18MM CORTICAL,$694.88,$0.00,$694.88,$312.69,$495.93,$0.00,$119.72,$0.00,$0.00,$121.67,$694.88,$0.00,$347.44,$550.34,$555.90,$0.00,$108.75,$0.00,$110.62,$0.00
6955520,SUP,HCPCS C1713,,6955520  -  SCREW BONE 4.5MM 20MM TI CORT SPNL,$694.88,$0.00,$694.88,$312.69,$495.93,$0.00,$119.72,$0.00,$0.00,$121.67,$694.88,$0.00,$347.44,$550.34,$555.90,$0.00,$108.75,$0.00,$110.62,$0.00
6955524,SUP,HCPCS C1713,,6955524  -  SCREW BONE 4.5MM 24MM CORT SPNL,$694.88,$0.00,$694.88,$312.69,$495.93,$0.00,$119.72,$0.00,$0.00,$121.67,$694.88,$0.00,$347.44,$550.34,$555.90,$0.00,$108.75,$0.00,$110.62,$0.00
6955710,SUP,HCPCS C1713,,6955710  -  SCREW BN 3.5MM 10MM GRN VRTX MX MA ST ROT SDL TI THOR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
6955712,SUP,HCPCS C1713,,6955712  -  SCREW BN 3.5MM 12MM STRL VRTX MA TI THOR SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
6955714,SUP,HCPCS C1713,,6955714  -  SCREW BN 3.5MM 14MM GRN VRTX MX MA ST ROT SDL TI THOR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
6955718,SUP,HCPCS C1713,,6955718  -  SCREW BN 3.5MM 18MM GRN VRTX MX MA ST ROT SDL TI THOR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
6955826,SUP,HCPCS C1713,,6955826  -  SCREW BN 4MM 26MM BLU VRTX MX MA ST ROT SDL TI THOR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
6955830,SUP,HCPCS C1713,,6955830  -  SCREW BN 4MM 30MM AU VRTX MX MA ST ROT SDL TI THOR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
6955926,SUP,HCPCS C1713,,6955926  -  SCREW BN 4.5MM 26MM MAG VRTX MX MA ST ROT SDL TI THOR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
6955960,SUP,Custom 27803010,,6955960  -  CONNECTOR 6955960 10MM LAT OFFSET OPEN,$970.50,$0.00,$970.50,$0.00,$692.65,$0.00,$0.00,$0.00,$0.00,$0.00,$970.50,$0.00,$485.25,$768.64,$776.40,$0.00,$0.00,$0.00,$0.00,$0.00
6955965,SUP,Custom 27803010,,6955965  -  CONNECTOR 6955965 13MM LAT OFFSET OPEN,$970.50,$0.00,$970.50,$0.00,$692.65,$0.00,$0.00,$0.00,$0.00,$0.00,$970.50,$0.00,$485.25,$768.64,$776.40,$0.00,$0.00,$0.00,$0.00,$0.00
6955973,SUP,HCPCS C1713,,6955973  -  HOOK SPNL 4.5MM NS VRTX MX TI LMN RECON SYS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
6955974,SUP,HCPCS C1713,,6955974  -  HOOK SPNL 6MM VRTX MX LMNR,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
6956010,SUP,Custom 27203010,,6956010  -  BIT DRL 2.4MM STRL VRTX DISP,$649.50,$0.00,$649.50,$0.00,$463.55,$0.00,$0.00,$0.00,$0.00,$0.00,$649.50,$0.00,$324.75,$514.40,$519.60,$0.00,$0.00,$0.00,$0.00,$0.00
6956011,SUP,Custom 27203010,,6956011  -  BIT DRILL 26-52MM 2.9MM VRTX MX STRL DISP,$649.50,$0.00,$649.50,$0.00,$463.55,$0.00,$0.00,$0.00,$0.00,$0.00,$649.50,$0.00,$324.75,$514.40,$519.60,$0.00,$0.00,$0.00,$0.00,$0.00
6956035,SUP,HCPCS C1713,,6956035  -  TAP 3.5MM 10-24MM SURG VRTX MX,$385.50,$0.00,$385.50,$173.48,$275.13,$0.00,$66.42,$0.00,$0.00,$67.50,$385.50,$0.00,$192.75,$305.32,$308.40,$0.00,$60.33,$0.00,$61.37,$0.00
6957314,SUP,HCPCS C1769,,6957314  -  GWIRE ORTH 720MM SPN THRD,$261.00,$0.00,$261.00,$141.72,$186.28,$0.00,$44.97,$0.00,$0.00,$45.70,$261.00,$0.00,$130.50,$206.71,$208.80,$0.00,$40.85,$0.00,$41.55,$0.00
6957315,SUP,HCPCS C1769,,6957315  -  GWIRE ORTH 3MM CANN,$261.00,$0.00,$261.00,$141.72,$186.28,$0.00,$44.97,$0.00,$0.00,$45.70,$261.00,$0.00,$130.50,$206.71,$208.80,$0.00,$40.85,$0.00,$41.55,$0.00
6958710,SUP,HCPCS C1713,,6958710  -  SCREW BN 3.5MM 10MM GRN NS VRTX MX MA TI SPNE RECON SYS,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958712,SUP,HCPCS C1713,,6958712  -  SCREW BN 3.5MM 12MM GRN NS VRTX MX MA TI SPNE RECON SYS,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958714,SUP,HCPCS C1713,,6958714  -  SCREW BN 3.5MM 14MM GRN NS VRTX MX MA TI SPNE RECON SYS,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958716,SUP,HCPCS C1713,,6958716  -  SCREW BN 3.5MM 16MM GRN NS VRTX MX MA TI SPNE RECON SYS,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958718,SUP,HCPCS C1713,,6958718  -  SCREW BN 3.5MM 18MM GRN NS VRTX MX MA TI SPNE RECON SYS,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958720,SUP,HCPCS C1713,,6958720  -  SCREW BN 3.5MM 20MM GRN NS VRTX MX MA TI SPNE RECON SYS,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958722,SUP,HCPCS C1713,,6958722  -  SCREW BN 3.5MM 22MM GRN NS VRTX MX MA TI SPNE RECON SYS,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958724,SUP,HCPCS C1713,,6958724  -  SCREW BN 3.5MM 24MM GRN NS VRTX MX MA TI SPNE RECON SYS,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958726,SUP,HCPCS C1713,,6958726  -  SCREW BN 3.5MM 26MM GRN NS VRTX MX MA TI SPNE RECON SYS,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958728,SUP,HCPCS C1713,,6958728  -  SCREW BN 3.5MM 28MM GRN NS VRTX MX MA TI SPNE RECON SYS,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958730,SUP,HCPCS C1713,,6958730  -  SCREW BN 3.5MM 30MM GRN NS VRTX MX MA TI SPNE RECON SYS,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958732,SUP,HCPCS C1713,,6958732  -  SCREW BN 3.5MM 32MM GRN NS VRTX MX MA TI SPNE RECON SYS,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958734,SUP,HCPCS C1713,,6958734  -  SCREW BN 3.5MM 34MM GRN NS VRTX MX MA TI SPNE RECON SYS,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958736,SUP,HCPCS C1713,,6958736  -  SCREW BN 3.5MM 36MM GRN NS VRTX MX MA TI SPNE THOR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958738,SUP,HCPCS C1713,,6958738  -  SCREW BN 3.5MM 38MM GRN NS VRTX MX MA TI SPNE THOR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958740,SUP,HCPCS C1713,,6958740  -  SCREW BN 3.5MM 40MM GRN NS VRTX MX MA TI SPNE RECON SYS,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958742,SUP,HCPCS C1713,,6958742  -  SCREW BN 3.5MM 42MM GRN NS VRTX MX MA TI SPNE RECON SYS,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958744,SUP,HCPCS C1713,,6958744  -  SCREW BN 3.5MM 44MM GRN VRTX MX MA TI SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958746,SUP,HCPCS C1713,,6958746  -  SCREW BN 3.5MM 46MM GRN VRTX MX MA TI SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958748,SUP,HCPCS C1713,,6958748  -  SCREW BN 3.5MM 48MM GRN VRTX MX MA TI SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958750,SUP,HCPCS C1713,,6958750  -  SCREW BN 3.5MM 50MM GRN VRTX MX MA TI SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958752,SUP,HCPCS C1713,,6958752  -  SCREW BN 3.5MM 52MM GRN VRTX MX MA TI SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958810,SUP,HCPCS C1713,,6958810  -  SCREW BN 4MM 10MM BLU NS VRTX MX MA TI SPNE RECON SYS,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958812,SUP,HCPCS C1713,,6958812  -  SCREW 6958812 4.0 X 12MM MAS,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958814,SUP,HCPCS C1713,,6958814  -  SCREW BN 4MM 14MM BLU NS VRTX MX MA TI SPNE RECON SYS,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958816,SUP,HCPCS C1713,,6958816  -  SCREW BN 4MM 16MM BLU NS VRTX MX MA TI SPNE RECON SYS,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958818,SUP,HCPCS C1713,,6958818  -  SCREW BN 4MM 18MM BLU NS VRTX MX MA TI SPNE RECON SYS,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958820,SUP,HCPCS C1713,,6958820  -  SCREW BN 4MM 20MM BLU NS VRTX MX MA TI SPNE RECON SYS,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958822,SUP,HCPCS C1713,,6958822  -  SCREW BN 4MM 22MM BLU NS VRTX MX MA TI SPNE RECON SYS,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958824,SUP,HCPCS C1713,,6958824  -  SCREW BN 4MM 24MM BLU NS VRTX MX MA TI SPNE RECON SYS,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958826,SUP,HCPCS C1713,,6958826  -  SCREW BN 4MM 26MM AU NS VRTX MX MA TI SPNE RECON SYS,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958828,SUP,HCPCS C1713,,6958828  -  SCREW BN 4MM 28MM AU NS VRTX MX MA TI SPNE RECON SYS,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958830,SUP,HCPCS C1713,,6958830  -  SCREW BN 4MM 30MM AU NS VRTX MX MA TI SPNE RECON SYS,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958832,SUP,HCPCS C1713,,6958832  -  SCREW BN 4MM 32MM AU NS VRTX MX MA TI SPNE RECON SYS,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958834,SUP,HCPCS C1713,,6958834  -  SCREW BN 4MM 34MM AU NS VRTX MX MA TI SPNE RECON SYS,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958836,SUP,HCPCS C1713,,6958836  -  SCREW BN 4MM 36MM AU VRTX MX MA ST ROT SDL TI THOR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958838,SUP,HCPCS C1713,,6958838  -  SCREW BN 4MM 38MM AU NS VRTX MX MA TI SPNE THOR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958840,SUP,HCPCS C1713,,6958840  -  SCREW BN 4MM 40MM AU NS VRTX MX MA TI SPNE THOR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958842,SUP,HCPCS C1713,,6958842  -  SCREW BN 4MM 42MM AU NS VRTX MX MA TI SPNE THOR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958844,SUP,HCPCS C1713,,6958844  -  SCREW BN 4MM 44MM AU NS VRTX MX MA TI SPNE THOR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958846,SUP,HCPCS C1713,,6958846  -  SCREW BN 4MM 46MM AU NS VRTX MX MA TI SPNE THOR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958848,SUP,HCPCS C1713,,6958848  -  SCREW BN 4MM 48MM AU NS VRTX MX MA TI SPNE THOR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958850,SUP,HCPCS C1713,,6958850  -  SCREW BN 4MM 50MM AU NS VRTX MX MA TI SPNE THOR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958852,SUP,HCPCS C1713,,6958852  -  SCREW BN 4MM 52MM AU NS VRTX MX MA TI SPNE THOR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958910,SUP,HCPCS C1713,,6958910  -  SCREW BN 4.5MM 10MM MAG NS VRTX MX MA TI SPNE THOR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958912,SUP,HCPCS C1713,,6958912  -  SCREW BN 4.5MM 12MM MAG NS VRTX MX MA TI SPNE THOR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958914,SUP,HCPCS C1713,,6958914  -  SCREW BN 4.5MM 14MM MAG NS VRTX MX MA TI SPNE THOR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958916,SUP,HCPCS C1713,,6958916  -  SCREW BN 4.5MM 16MM MAG NS VRTX MX MA TI SPNE THOR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958918,SUP,HCPCS C1713,,6958918  -  SCREW BN 4.5MM 18MM MAG NS VRTX MX MA TI SPNE THOR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958920,SUP,HCPCS C1713,,6958920  -  SCREW BN 4.5MM 20MM MAG NS VRTX MX MA TI SPNE THOR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958922,SUP,HCPCS C1713,,6958922  -  SCREW BN 4.5MM 22MM MAG NS VRTX MX MA TI SPNE THOR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958924,SUP,HCPCS C1713,,6958924  -  SCREW BN 4.5MM 24MM MAG NS VRTX MX MA TI SPNE RECON SYS,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958926,SUP,HCPCS C1713,,6958926  -  SCREW BN 4.5MM 26MM MAG NS VRTX MX MA TI SPNE RECON SYS,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958928,SUP,HCPCS C1713,,6958928  -  SCREW BN 4.5MM 28MM MAG NS VRTX MX MA TI SPNE RECON SYS,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958930,SUP,HCPCS C1713,,6958930  -  SCREW BN 4.5MM 30MM MAG NS VRTX MX MA TI SPNE RECON SYS,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958932,SUP,HCPCS C1713,,6958932  -  SCREW BN 4.5MM 32MM MAG NS VRTX MX MA TI SPNE RECON SYS,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958934,SUP,HCPCS C1713,,6958934  -  SCREW BN 4.5MM 34MM MAG NS VRTX MX MA TI SPNE RECON SYS,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958936,SUP,HCPCS C1713,,6958936  -  SCREW BN 4.5MM 36MM MAG NS VRTX MX MA TI SPNE THOR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958938,SUP,HCPCS C1713,,6958938  -  SCREW BN 4.5MM 38MM MAG NS VRTX MX MA TI SPNE THOR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958940,SUP,HCPCS C1713,,6958940  -  SCREW BN 4.5MM 40MM MAG NS VRTX MX MA TI SPNE THOR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958942,SUP,HCPCS C1713,,6958942  -  SCREW BN 4.5MM 42MM MAG NS VRTX MX MA TI SPNE THOR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958944,SUP,HCPCS C1713,,6958944  -  SCREW 6958944 4.5 X 44MM MAS,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958946,SUP,HCPCS C1713,,6958946  -  SCREW 6958946 4.5 X 46MM MAS,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958948,SUP,HCPCS C1713,,6958948  -  SCREW 6958948 4.5 X 48MM MAS,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958950,SUP,HCPCS C1713,,6958950  -  SCREW 6958950 4.5 X 50MM MAS,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958952,SUP,HCPCS C1713,,6958952  -  SCREW 6958952 4.5 X 52MM MAS,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6959418,SUP,HCPCS C1713,,6959418  -  SCREW BN 4MM 18MM MA CNN TI SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6959420,SUP,HCPCS C1713,,6959420  -  SCREW BN 4MM 20MM MA CNN TI SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6959422,SUP,HCPCS C1713,,6959422  -  SCREW BN 4MM 22MM MA CNN TI SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6959424,SUP,HCPCS C1713,,6959424  -  SCREW BN 4MM 24MM MA CNN TI SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6959426,SUP,HCPCS C1713,,6959426  -  SCREW BN 4MM 26MM MA CNN TI SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6959430,SUP,HCPCS C1713,,6959430  -  SCREW BN 4MM 30MM MA CNN TI SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6959432,SUP,HCPCS C1713,,6959432  -  SCREW BN 4MM 32MM MA CNN TI SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6959434,SUP,HCPCS C1713,,6959434  -  SCREW BN 4MM 34MM MA CNN TI SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6959436,SUP,HCPCS C1713,,6959436  -  SCREW BN 4MM 36MM MA CNN TI SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6959438,SUP,HCPCS C1713,,6959438  -  SCREW BN 4MM 38MM MA CNN TI SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6959440,SUP,HCPCS C1713,,6959440  -  SCREW BN 4MM 40MM MA CNN TI SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6959442,SUP,HCPCS C1713,,6959442  -  SCREW BN 4MM 42MM MA CNN TI SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6959444,SUP,HCPCS C1713,,6959444  -  SCREW BN 4MM 44MM MA CNN TI SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6959446,SUP,HCPCS C1713,,6959446  -  SCREW BN 4MM 46MM MA CNN TI SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6959448,SUP,HCPCS C1713,,6959448  -  SCREW BN 4MM 48MM MA CNN TI SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6959450,SUP,HCPCS C1713,,6959450  -  SCREW BN 4MM 50MM MA CNN TI SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6959452,SUP,HCPCS C1713,,6959452  -  SCREW BN 4MM 52MM MA CNN TI SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6959510,SUP,HCPCS C1713,,6959510  -  SCREW BN 4.5MM 10MM MA CNN TI SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6959512,SUP,HCPCS C1713,,6959512  -  SCREW BN 4.5MM 12MM MA CNN TI SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6959514,SUP,HCPCS C1713,,6959514  -  SCREW BN 4.5MM 14MM MA CNN TI SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6959516,SUP,HCPCS C1713,,6959516  -  SCREW BN 4.5MM 16MM MA CNN TI SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6959518,SUP,HCPCS C1713,,6959518  -  SCREW BN 4.5MM 18MM MA CNN TI SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6959520,SUP,HCPCS C1713,,6959520  -  SCREW BN 4.5MM 20MM MA CNN TI SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6959522,SUP,HCPCS C1713,,6959522  -  SCREW BN 4.5MM 22MM MA CNN TI SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6959524,SUP,HCPCS C1713,,6959524  -  SCREW BN 4.5MM 24MM MA CNN TI SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6959526,SUP,HCPCS C1713,,6959526  -  SCREW BN 4.5MM 26MM MA CNN TI SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6959528,SUP,HCPCS C1713,,6959528  -  SCREW BN 4.5MM 28MM MA CNN TI SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6959530,SUP,HCPCS C1713,,6959530  -  SCREW BN 4.5MM 30MM MA CNN TI SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6959532,SUP,HCPCS C1713,,6959532  -  SCREW BN 4.5MM 32MM MA CNN TI SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6959534,SUP,HCPCS C1713,,6959534  -  SCREW BN 4.5MM 34MM MA CNN TI SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6959536,SUP,HCPCS C1713,,6959536  -  SCREW BN 4.5MM 36MM MA CNN TI SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6959538,SUP,HCPCS C1713,,6959538  -  SCREW BN 4.5MM 38MM MA CNN TI SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6959540,SUP,HCPCS C1713,,6959540  -  SCREW BN 4.5MM 40MM MA CNN TI SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6959542,SUP,HCPCS C1713,,6959542  -  SCREW BN 4.5MM 42MM MA CNN TI SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6959544,SUP,HCPCS C1713,,6959544  -  SCREW BN 4.5MM 44MM MA CNN TI SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6959546,SUP,HCPCS C1713,,6959546  -  SCREW BN 4.5MM 46MM MA CNN TI SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6959548,SUP,HCPCS C1713,,6959548  -  SCREW BN 4.5MM 48MM MA CNN TI SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6959550,SUP,HCPCS C1713,,6959550  -  SCREW BN 4.5MM 50MM MA CNN TI SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6959552,SUP,HCPCS C1713,,6959552  -  SCREW BN 4.5MM 52MM MA CNN TI SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6959970,SUP,HCPCS C1713,,6959970  -  PLATE 6959970 LP OC KEEL SMALL,"$7,095.00",$0.00,"$7,095.00","$3,192.75","$5,063.70",$0.00,"$1,222.43",$0.00,$0.00,"$1,242.28","$7,095.00",$0.00,"$3,547.50","$5,619.24","$5,676.00",$0.00,"$1,110.37",$0.00,"$1,129.52",$0.00
6959971,SUP,HCPCS C1713,,6959971  -  PLATE 6959971 LP OC KEEL MEDIUM,"$7,095.00",$0.00,"$7,095.00","$3,192.75","$5,063.70",$0.00,"$1,222.43",$0.00,$0.00,"$1,242.28","$7,095.00",$0.00,"$3,547.50","$5,619.24","$5,676.00",$0.00,"$1,110.37",$0.00,"$1,129.52",$0.00
6959972,SUP,HCPCS C1713,,6959972  -  PLATE 6959972 LP OC KEEL LARGE,"$7,095.00",$0.00,"$7,095.00","$3,192.75","$5,063.70",$0.00,"$1,222.43",$0.00,$0.00,"$1,242.28","$7,095.00",$0.00,"$3,547.50","$5,619.24","$5,676.00",$0.00,"$1,110.37",$0.00,"$1,129.52",$0.00
6960013,SUP,HCPCS C1713,,6960013  -  SCREW 6960013 PRSTG BON FAST 4.0X13MM,$633.00,$0.00,$633.00,$284.85,$451.77,$0.00,$109.06,$0.00,$0.00,$110.83,$633.00,$0.00,$316.50,$501.34,$506.40,$0.00,$99.06,$0.00,$100.77,$0.00
6960015,SUP,HCPCS C1713,,6960015  -  SCREW 6960015 PRSTG BONE FAST 4.0X15MM,$633.00,$0.00,$633.00,$284.85,$451.77,$0.00,$109.06,$0.00,$0.00,$110.83,$633.00,$0.00,$316.50,$501.34,$506.40,$0.00,$99.06,$0.00,$100.77,$0.00
6960113,SUP,HCPCS C1713,,6960113  -  SCREW 6960113 PRSTG BONE FAST 4.5X13MM,$810.00,$0.00,$810.00,$364.50,$578.10,$0.00,$139.56,$0.00,$0.00,$141.82,$810.00,$0.00,$405.00,$641.52,$648.00,$0.00,$126.77,$0.00,$128.95,$0.00
6960120,SUP,HCPCS C1713,,6960120  -  SCREW 6960120  LOCK,$268.50,$0.00,$268.50,$120.83,$191.63,$0.00,$46.26,$0.00,$0.00,$47.01,$268.50,$0.00,$134.25,$212.65,$214.80,$0.00,$42.02,$0.00,$42.75,$0.00
6961038,SUP,HCPCS C1713,,6961038  -  CAGE SPNL 8D 38X32X10MM NS LF BRIGADE,"$13,782.50",$0.00,"$13,782.50","$6,202.13","$5,158.80",$0.00,"$2,374.66",$0.00,$0.00,"$2,413.21","$13,782.50",$0.00,"$6,891.25","$10,915.74","$11,026.00",$0.00,"$2,156.96",$0.00,"$2,194.17",$0.00
6961238,SUP,HCPCS C1713,,6961238  -  CAGE SPNL 8D 38X32X12MM NS LF BRIGADE,"$13,782.50",$0.00,"$13,782.50","$6,202.13","$5,158.80",$0.00,"$2,374.66",$0.00,$0.00,"$2,413.21","$13,782.50",$0.00,"$6,891.25","$10,915.74","$11,026.00",$0.00,"$2,156.96",$0.00,"$2,194.17",$0.00
6961260,SUP,Custom 27803010,,6961260  -  PRESTIGE ARTIFICIAL DISC 6X12MM,"$7,342.50",$0.00,"$7,342.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,342.50",$0.00,"$3,671.25","$5,815.26","$5,874.00",$0.00,$0.00,$0.00,$0.00,$0.00
6961438,SUP,HCPCS C1713,,6961438  -  CAGE SPNL 8D 38X32X14MM NS LF BRIGADE,"$13,782.50",$0.00,"$13,782.50","$6,202.13","$5,158.80",$0.00,"$2,374.66",$0.00,$0.00,"$2,413.21","$13,782.50",$0.00,"$6,891.25","$10,915.74","$11,026.00",$0.00,"$2,156.96",$0.00,"$2,194.17",$0.00
6961460,SUP,Custom 27203010,,6961460  -  DISC 6961460 CERVICAL DISC 6MM X 14MM,"$7,342.50",$0.00,"$7,342.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,342.50",$0.00,"$3,671.25","$5,815.26","$5,874.00",$0.00,$0.00,$0.00,$0.00,$0.00
6961470,SUP,Custom 27203010,,6961470  -  DISC 6961470 PRESTIGE ARTIFICIAL 7X14MM,"$7,342.50",$0.00,"$7,342.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,342.50",$0.00,"$3,671.25","$5,815.26","$5,874.00",$0.00,$0.00,$0.00,$0.00,$0.00
6961638,SUP,HCPCS C1713,,6961638  -  CAGE SPNL 8D 38X32X16MM NS LF BRIGADE,"$13,782.50",$0.00,"$13,782.50","$6,202.13","$5,158.80",$0.00,"$2,374.66",$0.00,$0.00,"$2,413.21","$13,782.50",$0.00,"$6,891.25","$10,915.74","$11,026.00",$0.00,"$2,156.96",$0.00,"$2,194.17",$0.00
6961660,SUP,Custom 27203010,,6961660  -  DISC 6961660 CERVICAL DISC 6MM X 16MM,"$7,342.50",$0.00,"$7,342.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,342.50",$0.00,"$3,671.25","$5,815.26","$5,874.00",$0.00,$0.00,$0.00,$0.00,$0.00
6961670,SUP,Custom 27203010,,6961670  -  DISC 6961670 CERVICAL DISC 7MM X 16MM,"$7,342.50",$0.00,"$7,342.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,342.50",$0.00,"$3,671.25","$5,815.26","$5,874.00",$0.00,$0.00,$0.00,$0.00,$0.00
6961838,SUP,HCPCS C1713,,6961838  -  CAGE SPNL 8D 38X32X18MM NS LF BRIGADE,"$13,782.50",$0.00,"$13,782.50","$6,202.13","$5,158.80",$0.00,"$2,374.66",$0.00,$0.00,"$2,413.21","$13,782.50",$0.00,"$6,891.25","$10,915.74","$11,026.00",$0.00,"$2,156.96",$0.00,"$2,194.17",$0.00
6961870,SUP,Custom 27203010,,6961870  -  DISC 6961870 CERVICAL DISC 7MM X 18MM,"$7,342.50",$0.00,"$7,342.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,342.50",$0.00,"$3,671.25","$5,815.26","$5,874.00",$0.00,$0.00,$0.00,$0.00,$0.00
6962038,SUP,HCPCS C1713,,6962038  -  CAGE SPNL 8D 38X32X20MM NS LF BRIGADE,"$13,782.50",$0.00,"$13,782.50","$6,202.13","$5,158.80",$0.00,"$2,374.66",$0.00,$0.00,"$2,413.21","$13,782.50",$0.00,"$6,891.25","$10,915.74","$11,026.00",$0.00,"$2,156.96",$0.00,"$2,194.17",$0.00
6971238,SUP,HCPCS C1713,,6971238  -  CAGE SPNL 12D 38X32X12MM NS LF BRIGADE,"$13,782.50",$0.00,"$13,782.50","$6,202.13","$5,158.80",$0.00,"$2,374.66",$0.00,$0.00,"$2,413.21","$13,782.50",$0.00,"$6,891.25","$10,915.74","$11,026.00",$0.00,"$2,156.96",$0.00,"$2,194.17",$0.00
6971250,SUP,HCPCS C1713,,6971250  -  DISC ARTF 12MM 5MM CERV,"$10,200.00",$0.00,"$10,200.00","$4,590.00","$5,158.80",$0.00,"$1,757.41",$0.00,$0.00,"$1,785.94","$10,200.00",$0.00,"$5,100.00","$8,078.40","$8,160.00",$0.00,"$1,596.30",$0.00,"$1,623.84",$0.00
6971260,SUP,HCPCS C1713,,6971260  -  DISC ARTF 12MM 6MM CERV MTN,"$10,200.00",$0.00,"$10,200.00","$4,590.00","$5,158.80",$0.00,"$1,757.41",$0.00,$0.00,"$1,785.94","$10,200.00",$0.00,"$5,100.00","$8,078.40","$8,160.00",$0.00,"$1,596.30",$0.00,"$1,623.84",$0.00
6971270,SUP,HCPCS C1713,,6971270  -  DISC ARTF 12MM 7MM CERV MTN,"$10,200.00",$0.00,"$10,200.00","$4,590.00","$5,158.80",$0.00,"$1,757.41",$0.00,$0.00,"$1,785.94","$10,200.00",$0.00,"$5,100.00","$8,078.40","$8,160.00",$0.00,"$1,596.30",$0.00,"$1,623.84",$0.00
6971438,SUP,HCPCS C1713,,6971438  -  CAGE SPNL 12D 38X32X14MM NS LF BRIGADE,"$13,782.50",$0.00,"$13,782.50","$6,202.13","$5,158.80",$0.00,"$2,374.66",$0.00,$0.00,"$2,413.21","$13,782.50",$0.00,"$6,891.25","$10,915.74","$11,026.00",$0.00,"$2,156.96",$0.00,"$2,194.17",$0.00
6971450,SUP,HCPCS C1713,,6971450  -  DISC ARTF 14MM 5MM CERV,"$10,200.00",$0.00,"$10,200.00","$4,590.00","$5,158.80",$0.00,"$1,757.41",$0.00,$0.00,"$1,785.94","$10,200.00",$0.00,"$5,100.00","$8,078.40","$8,160.00",$0.00,"$1,596.30",$0.00,"$1,623.84",$0.00
6971460,SUP,HCPCS C1713,,6971460  -  DISC ARTF 14MM 6MM CERV MTN,"$10,200.00",$0.00,"$10,200.00","$4,590.00","$5,158.80",$0.00,"$1,757.41",$0.00,$0.00,"$1,785.94","$10,200.00",$0.00,"$5,100.00","$8,078.40","$8,160.00",$0.00,"$1,596.30",$0.00,"$1,623.84",$0.00
6971470,SUP,HCPCS C1713,,6971470  -  DISC ARTF 14MM 7MM CERV MTN,"$10,200.00",$0.00,"$10,200.00","$4,590.00","$5,158.80",$0.00,"$1,757.41",$0.00,$0.00,"$1,785.94","$10,200.00",$0.00,"$5,100.00","$8,078.40","$8,160.00",$0.00,"$1,596.30",$0.00,"$1,623.84",$0.00
6971480,SUP,HCPCS C1713,,6971480  -  DISC ARTF 14MM 8MM CERV MTN,"$10,200.00",$0.00,"$10,200.00","$4,590.00","$5,158.80",$0.00,"$1,757.41",$0.00,$0.00,"$1,785.94","$10,200.00",$0.00,"$5,100.00","$8,078.40","$8,160.00",$0.00,"$1,596.30",$0.00,"$1,623.84",$0.00
6971638,SUP,HCPCS C1713,,6971638  -  CAGE SPNL 12D 38X32X16MM NS LF BRIGADE,"$13,782.50",$0.00,"$13,782.50","$6,202.13","$5,158.80",$0.00,"$2,374.66",$0.00,$0.00,"$2,413.21","$13,782.50",$0.00,"$6,891.25","$10,915.74","$11,026.00",$0.00,"$2,156.96",$0.00,"$2,194.17",$0.00
6971650,SUP,HCPCS C1713,,6971650  -  DISC 6971650 CERVICAL 5MM X 16MM,"$10,200.00",$0.00,"$10,200.00","$4,590.00","$5,158.80",$0.00,"$1,757.41",$0.00,$0.00,"$1,785.94","$10,200.00",$0.00,"$5,100.00","$8,078.40","$8,160.00",$0.00,"$1,596.30",$0.00,"$1,623.84",$0.00
6971660,SUP,HCPCS C1713,,6971660  -  DISC ARTF 16MM 6MM CERV MTN,"$10,200.00",$0.00,"$10,200.00","$4,590.00","$5,158.80",$0.00,"$1,757.41",$0.00,$0.00,"$1,785.94","$10,200.00",$0.00,"$5,100.00","$8,078.40","$8,160.00",$0.00,"$1,596.30",$0.00,"$1,623.84",$0.00
6971670,SUP,HCPCS C1713,,6971670  -  DISC ARTF 16MM 7MM CERV MTN,"$10,200.00",$0.00,"$10,200.00","$4,590.00","$5,158.80",$0.00,"$1,757.41",$0.00,$0.00,"$1,785.94","$10,200.00",$0.00,"$5,100.00","$8,078.40","$8,160.00",$0.00,"$1,596.30",$0.00,"$1,623.84",$0.00
6971680,SUP,HCPCS C1713,,6971680  -  DISC ARTF 16MM 8MM CERV MTN,"$10,200.00",$0.00,"$10,200.00","$4,590.00","$5,158.80",$0.00,"$1,757.41",$0.00,$0.00,"$1,785.94","$10,200.00",$0.00,"$5,100.00","$8,078.40","$8,160.00",$0.00,"$1,596.30",$0.00,"$1,623.84",$0.00
6971838,SUP,HCPCS C1713,,6971838  -  CAGE SPNL 12D 38X32X18MM NS LF BRIGADE,"$13,782.50",$0.00,"$13,782.50","$6,202.13","$5,158.80",$0.00,"$2,374.66",$0.00,$0.00,"$2,413.21","$13,782.50",$0.00,"$6,891.25","$10,915.74","$11,026.00",$0.00,"$2,156.96",$0.00,"$2,194.17",$0.00
6971870,SUP,HCPCS C1713,,6971870  -  DISC ARTF 18MM 7MM CERV MTN,"$10,200.00",$0.00,"$10,200.00","$4,590.00","$5,158.80",$0.00,"$1,757.41",$0.00,$0.00,"$1,785.94","$10,200.00",$0.00,"$5,100.00","$8,078.40","$8,160.00",$0.00,"$1,596.30",$0.00,"$1,623.84",$0.00
6971880,SUP,HCPCS C1713,,6971880  -  DISC ARTF 18MM 8MM CERV MTN,"$10,200.00",$0.00,"$10,200.00","$4,590.00","$5,158.80",$0.00,"$1,757.41",$0.00,$0.00,"$1,785.94","$10,200.00",$0.00,"$5,100.00","$8,078.40","$8,160.00",$0.00,"$1,596.30",$0.00,"$1,623.84",$0.00
6972038,SUP,HCPCS C1713,,6972038  -  CAGE SPNL 12D 38X32X20MM NS LF BRIGADE,"$13,782.50",$0.00,"$13,782.50","$6,202.13","$5,158.80",$0.00,"$2,374.66",$0.00,$0.00,"$2,413.21","$13,782.50",$0.00,"$6,891.25","$10,915.74","$11,026.00",$0.00,"$2,156.96",$0.00,"$2,194.17",$0.00
6972118,SUP,Custom 27203010,,6972118  -  BIT DRL DMD 1.5MM STRL RAIL CTR DISP,$525.00,$0.00,$525.00,$0.00,$374.69,$0.00,$0.00,$0.00,$0.00,$0.00,$525.00,$0.00,$262.50,$415.80,$420.00,$0.00,$0.00,$0.00,$0.00,$0.00
6972250,SUP,HCPCS C1713,,6972250  -  DISC 6972250 PRESTIGE,"$10,200.00",$0.00,"$10,200.00","$4,590.00","$5,158.80",$0.00,"$1,757.41",$0.00,$0.00,"$1,785.94","$10,200.00",$0.00,"$5,100.00","$8,078.40","$8,160.00",$0.00,"$1,596.30",$0.00,"$1,623.84",$0.00
6972260,SUP,HCPCS C1713,,6972260  -  DISC INTVRTB 12MM 6MM PSTG LP CERV SPN TI,"$10,200.00",$0.00,"$10,200.00","$4,590.00","$5,158.80",$0.00,"$1,757.41",$0.00,$0.00,"$1,785.94","$10,200.00",$0.00,"$5,100.00","$8,078.40","$8,160.00",$0.00,"$1,596.30",$0.00,"$1,623.84",$0.00
6972270,SUP,HCPCS C1713,,6972270  -  DISC INTVRTB 12MM 7MM PSTG LP CERV SPN TI,"$10,200.00",$0.00,"$10,200.00","$4,590.00","$5,158.80",$0.00,"$1,757.41",$0.00,$0.00,"$1,785.94","$10,200.00",$0.00,"$5,100.00","$8,078.40","$8,160.00",$0.00,"$1,596.30",$0.00,"$1,623.84",$0.00
6972450,SUP,HCPCS C1713,,6972450  -  DISC INTVRTB 14MM 4MM PSTG LP CERV SPN TI,"$10,200.00",$0.00,"$10,200.00","$4,590.00","$5,158.80",$0.00,"$1,757.41",$0.00,$0.00,"$1,785.94","$10,200.00",$0.00,"$5,100.00","$8,078.40","$8,160.00",$0.00,"$1,596.30",$0.00,"$1,623.84",$0.00
6972460,SUP,HCPCS C1713,,6972460  -  DISC INTVRTB 14MM 6MM PSTG LP CERV SPN TI,"$10,200.00",$0.00,"$10,200.00","$4,590.00","$5,158.80",$0.00,"$1,757.41",$0.00,$0.00,"$1,785.94","$10,200.00",$0.00,"$5,100.00","$8,078.40","$8,160.00",$0.00,"$1,596.30",$0.00,"$1,623.84",$0.00
6972470,SUP,HCPCS C1713,,6972470  -  DISC INTVRTB 14MM 7MM PSTG LP CERV SPN TI,"$10,200.00",$0.00,"$10,200.00","$4,590.00","$5,158.80",$0.00,"$1,757.41",$0.00,$0.00,"$1,785.94","$10,200.00",$0.00,"$5,100.00","$8,078.40","$8,160.00",$0.00,"$1,596.30",$0.00,"$1,623.84",$0.00
6972480,SUP,HCPCS C1713,,6972480  -  DISC INTVRTB 14MM 8MM PSTG LP CERV SPN TI,"$10,200.00",$0.00,"$10,200.00","$4,590.00","$5,158.80",$0.00,"$1,757.41",$0.00,$0.00,"$1,785.94","$10,200.00",$0.00,"$5,100.00","$8,078.40","$8,160.00",$0.00,"$1,596.30",$0.00,"$1,623.84",$0.00
6972650,SUP,HCPCS C1713,,6972650  -  DISC INTVRTB 16MM 5MM PSTG LP CERV SPN TI,"$10,200.00",$0.00,"$10,200.00","$4,590.00","$5,158.80",$0.00,"$1,757.41",$0.00,$0.00,"$1,785.94","$10,200.00",$0.00,"$5,100.00","$8,078.40","$8,160.00",$0.00,"$1,596.30",$0.00,"$1,623.84",$0.00
6972660,SUP,HCPCS C1713,,6972660  -  DISC INTVRTB 16MM 6MM PSTG LP CERV SPN TI,"$10,200.00",$0.00,"$10,200.00","$4,590.00","$5,158.80",$0.00,"$1,757.41",$0.00,$0.00,"$1,785.94","$10,200.00",$0.00,"$5,100.00","$8,078.40","$8,160.00",$0.00,"$1,596.30",$0.00,"$1,623.84",$0.00
6972670,SUP,HCPCS C1713,,6972670  -  DISC INTVRTB 16MM 7MM PSTG LP CERV SPN TI,"$10,200.00",$0.00,"$10,200.00","$4,590.00","$5,158.80",$0.00,"$1,757.41",$0.00,$0.00,"$1,785.94","$10,200.00",$0.00,"$5,100.00","$8,078.40","$8,160.00",$0.00,"$1,596.30",$0.00,"$1,623.84",$0.00
6972680,SUP,HCPCS C1713,,6972680  -  DISC INTVRTB 16MM 8MM PSTG LP CERV SPN TI,"$10,200.00",$0.00,"$10,200.00","$4,590.00","$5,158.80",$0.00,"$1,757.41",$0.00,$0.00,"$1,785.94","$10,200.00",$0.00,"$5,100.00","$8,078.40","$8,160.00",$0.00,"$1,596.30",$0.00,"$1,623.84",$0.00
6972860,SUP,HCPCS C1713,,6972860  -  DISC INTVRTB 18MM 6MM PSTG LP CERV SPN TI,"$10,200.00",$0.00,"$10,200.00","$4,590.00","$5,158.80",$0.00,"$1,757.41",$0.00,$0.00,"$1,785.94","$10,200.00",$0.00,"$5,100.00","$8,078.40","$8,160.00",$0.00,"$1,596.30",$0.00,"$1,623.84",$0.00
6972870,SUP,HCPCS C1713,,6972870  -  DISC INTVRTB 18MM 7MM PSTG LP CERV SPN TI,"$10,200.00",$0.00,"$10,200.00","$4,590.00","$5,158.80",$0.00,"$1,757.41",$0.00,$0.00,"$1,785.94","$10,200.00",$0.00,"$5,100.00","$8,078.40","$8,160.00",$0.00,"$1,596.30",$0.00,"$1,623.84",$0.00
6972880,SUP,HCPCS C1713,,6972880  -  DISC INTVRTB 18MM 8MM PSTG LP CERV SPN TI,"$10,200.00",$0.00,"$10,200.00","$4,590.00","$5,158.80",$0.00,"$1,757.41",$0.00,$0.00,"$1,785.94","$10,200.00",$0.00,"$5,100.00","$8,078.40","$8,160.00",$0.00,"$1,596.30",$0.00,"$1,623.84",$0.00
6980840,SUP,HCPCS C1713,,6980840  -  SPACER SPNL 40X18X8MM LMBR INTRBD FS PEEK,"$11,250.00",$0.00,"$11,250.00","$5,062.50","$5,158.80",$0.00,"$1,938.32",$0.00,$0.00,"$1,969.79","$11,250.00",$0.00,"$5,625.00","$8,910.00","$9,000.00",$0.00,"$1,760.63",$0.00,"$1,791.00",$0.00
6980850,SUP,HCPCS C1713,,6980850  -  CAGE SPNL 10D XL 50X18X8MM NS LF CRNT,"$11,250.00",$0.00,"$11,250.00","$5,062.50","$5,158.80",$0.00,"$1,938.32",$0.00,$0.00,"$1,969.79","$11,250.00",$0.00,"$5,625.00","$8,910.00","$9,000.00",$0.00,"$1,760.63",$0.00,"$1,791.00",$0.00
6980855,SUP,HCPCS C1713,,6980855  -  CAGE SPNL 10D XL 55X18X8MM NS LF CRNT,"$11,250.00",$0.00,"$11,250.00","$5,062.50","$5,158.80",$0.00,"$1,938.32",$0.00,$0.00,"$1,969.79","$11,250.00",$0.00,"$5,625.00","$8,910.00","$9,000.00",$0.00,"$1,760.63",$0.00,"$1,791.00",$0.00
6980860,SUP,HCPCS C1713,,6980860  -  CAGE SPNL 10D XL 60X18X8MM NS LF CRNT,"$11,250.00",$0.00,"$11,250.00","$5,062.50","$5,158.80",$0.00,"$1,938.32",$0.00,$0.00,"$1,969.79","$11,250.00",$0.00,"$5,625.00","$8,910.00","$9,000.00",$0.00,"$1,760.63",$0.00,"$1,791.00",$0.00
6981040,SUP,HCPCS C1713,,6981040  -  CAGE SPNL 40X18X10MM PEEK,"$11,250.00",$0.00,"$11,250.00","$5,062.50","$5,158.80",$0.00,"$1,938.32",$0.00,$0.00,"$1,969.79","$11,250.00",$0.00,"$5,625.00","$8,910.00","$9,000.00",$0.00,"$1,760.63",$0.00,"$1,791.00",$0.00
6981045,SUP,Custom 27803010,,6981045  -  CAGE SPNL 10D XL 45X18X10MM NS LF CRNT PEEK,"$11,250.00",$0.00,"$11,250.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,250.00",$0.00,"$5,625.00","$8,910.00","$9,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
6981050,SUP,HCPCS C1713,,6981050  -  CAGE SPNL 10D XL 50X18X10MM NS LF CRNT,"$11,250.00",$0.00,"$11,250.00","$5,062.50","$5,158.80",$0.00,"$1,938.32",$0.00,$0.00,"$1,969.79","$11,250.00",$0.00,"$5,625.00","$8,910.00","$9,000.00",$0.00,"$1,760.63",$0.00,"$1,791.00",$0.00
6981055,SUP,HCPCS C1713,,6981055  -  CAGE SPNL 10D XL 55X18X10MM NS LF CRNT,"$11,250.00",$0.00,"$11,250.00","$5,062.50","$5,158.80",$0.00,"$1,938.32",$0.00,$0.00,"$1,969.79","$11,250.00",$0.00,"$5,625.00","$8,910.00","$9,000.00",$0.00,"$1,760.63",$0.00,"$1,791.00",$0.00
6981060,SUP,HCPCS C1713,,6981060  -  CAGE SPNL 10D XL 60X18X10MM NS LF CRNT,"$11,250.00",$0.00,"$11,250.00","$5,062.50","$5,158.80",$0.00,"$1,938.32",$0.00,$0.00,"$1,969.79","$11,250.00",$0.00,"$5,625.00","$8,910.00","$9,000.00",$0.00,"$1,760.63",$0.00,"$1,791.00",$0.00
6981240,SUP,HCPCS C1713,,6981240  -  SPACER SPNL LRDTC XL 40X18X12MM CRNT PEEK LMBR INTRBD FS,"$11,250.00",$0.00,"$11,250.00","$5,062.50","$5,158.80",$0.00,"$1,938.32",$0.00,$0.00,"$1,969.79","$11,250.00",$0.00,"$5,625.00","$8,910.00","$9,000.00",$0.00,"$1,760.63",$0.00,"$1,791.00",$0.00
6981245,SUP,Custom 27803010,,6981245  -  CAGE SPNL 10D XL 45X18X12MM NS LF CRNT PEEK LMBR INTRBD FS,"$11,250.00",$0.00,"$11,250.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,250.00",$0.00,"$5,625.00","$8,910.00","$9,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
6981250,SUP,HCPCS C1713,,6981250  -  CAGE SPNL 10D XL 50X18X12MM NS LF CRNT,"$11,250.00",$0.00,"$11,250.00","$5,062.50","$5,158.80",$0.00,"$1,938.32",$0.00,$0.00,"$1,969.79","$11,250.00",$0.00,"$5,625.00","$8,910.00","$9,000.00",$0.00,"$1,760.63",$0.00,"$1,791.00",$0.00
6981255,SUP,Custom 27803010,,6981255  -  CAGE SPNL 10D XL 55X18X12MM NS LF CRNT PEEK LMBR INTRBD FS,"$11,250.00",$0.00,"$11,250.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,250.00",$0.00,"$5,625.00","$8,910.00","$9,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
6981260,SUP,HCPCS C1713,,6981260  -  CAGE SPNL 10D XL 60X18X12MM NS LF CRNT,"$11,250.00",$0.00,"$11,250.00","$5,062.50","$5,158.80",$0.00,"$1,938.32",$0.00,$0.00,"$1,969.79","$11,250.00",$0.00,"$5,625.00","$8,910.00","$9,000.00",$0.00,"$1,760.63",$0.00,"$1,791.00",$0.00
6981440,SUP,HCPCS C1713,,6981440  -  SPACER SPNL XL 40X18X14MM CRNT LMBR INTRBD FS PEEK,"$11,250.00",$0.00,"$11,250.00","$5,062.50","$5,158.80",$0.00,"$1,938.32",$0.00,$0.00,"$1,969.79","$11,250.00",$0.00,"$5,625.00","$8,910.00","$9,000.00",$0.00,"$1,760.63",$0.00,"$1,791.00",$0.00
6981445,SUP,HCPCS C1713,,6981445  -  CAGE SPNL 10D XL 45X18X14MM CRNT PEEK,"$11,250.00",$0.00,"$11,250.00","$5,062.50","$5,158.80",$0.00,"$1,938.32",$0.00,$0.00,"$1,969.79","$11,250.00",$0.00,"$5,625.00","$8,910.00","$9,000.00",$0.00,"$1,760.63",$0.00,"$1,791.00",$0.00
6981455,SUP,HCPCS C1713,,6981455  -  CAGE SPNL 55X18X14MM CRNT THORLMBR INTRBD FS RDLCNT PEEK,"$11,250.00",$0.00,"$11,250.00","$5,062.50","$5,158.80",$0.00,"$1,938.32",$0.00,$0.00,"$1,969.79","$11,250.00",$0.00,"$5,625.00","$8,910.00","$9,000.00",$0.00,"$1,760.63",$0.00,"$1,791.00",$0.00
6981460,SUP,HCPCS C1713,,6981460  -  CAGE SPNL 10D XL 60X18X14MM CRNT PEEK,"$11,250.00",$0.00,"$11,250.00","$5,062.50","$5,158.80",$0.00,"$1,938.32",$0.00,$0.00,"$1,969.79","$11,250.00",$0.00,"$5,625.00","$8,910.00","$9,000.00",$0.00,"$1,760.63",$0.00,"$1,791.00",$0.00
6981640,SUP,HCPCS C1713,,6981640  -  SPACER SPNL XL 40X18X16MM INTRBD FS PEEK,"$11,250.00",$0.00,"$11,250.00","$5,062.50","$5,158.80",$0.00,"$1,938.32",$0.00,$0.00,"$1,969.79","$11,250.00",$0.00,"$5,625.00","$8,910.00","$9,000.00",$0.00,"$1,760.63",$0.00,"$1,791.00",$0.00
6981645,SUP,HCPCS C1713,,6981645  -  CAGE SPNL 10D XL 45X18X16MM CRNT,"$11,250.00",$0.00,"$11,250.00","$5,062.50","$5,158.80",$0.00,"$1,938.32",$0.00,$0.00,"$1,969.79","$11,250.00",$0.00,"$5,625.00","$8,910.00","$9,000.00",$0.00,"$1,760.63",$0.00,"$1,791.00",$0.00
6981650,SUP,HCPCS C1713,,6981650  -  CAGE SPNL 10D XL 50X18X16MM CRNT PEEK,"$11,250.00",$0.00,"$11,250.00","$5,062.50","$5,158.80",$0.00,"$1,938.32",$0.00,$0.00,"$1,969.79","$11,250.00",$0.00,"$5,625.00","$8,910.00","$9,000.00",$0.00,"$1,760.63",$0.00,"$1,791.00",$0.00
6981655,SUP,HCPCS C1713,,6981655  -  CAGE SPNL 55X18X16MM CRNT THORLMBR INTRBD FS PEEK,"$11,250.00",$0.00,"$11,250.00","$5,062.50","$5,158.80",$0.00,"$1,938.32",$0.00,$0.00,"$1,969.79","$11,250.00",$0.00,"$5,625.00","$8,910.00","$9,000.00",$0.00,"$1,760.63",$0.00,"$1,791.00",$0.00
6981660,SUP,HCPCS C1713,,6981660  -  CAGE SPNL XL LRDTC 60X18X14MM CRNT PEEK,"$11,250.00",$0.00,"$11,250.00","$5,062.50","$5,158.80",$0.00,"$1,938.32",$0.00,$0.00,"$1,969.79","$11,250.00",$0.00,"$5,625.00","$8,910.00","$9,000.00",$0.00,"$1,760.63",$0.00,"$1,791.00",$0.00
6990625,SUP,HCPCS C1713,,6990625  -  CAGE SPNL XL 25X16X6MM NS LF CRNT THOR,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6990630,SUP,HCPCS C1713,,6990630  -  CAGE SPNL XL 30X16X6MM NS LF CRNT THOR,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6990635,SUP,HCPCS C1713,,6990635  -  CAGE SPNL XL 35X16X6MM NS LF CRNT THOR,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6990640,SUP,HCPCS C1713,,6990640  -  CAGE SPNL XL 40X16X6MM NS LF CRNT THOR,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6990825,SUP,HCPCS C1713,,6990825  -  CAGE SPNL XL 25X16X8MM NS LF CRNT THOR,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6990830,SUP,HCPCS C1713,,6990830  -  CAGE SPNL XL 30X16X8MM NS LF CRNT THOR,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6990835,SUP,HCPCS C1713,,6990835  -  CAGE SPNL XL 35X16X8MM NS LF CRNT THOR,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6990840,SUP,HCPCS C1713,,6990840  -  CAGE SPNL XL 40X16X8MM NS LF CRNT THOR,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6991025,SUP,HCPCS C1713,,6991025  -  CAGE SPNL XL 25X16X10MM NS LF CRNT THOR,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6991030,SUP,HCPCS C1713,,6991030  -  CAGE SPNL XL 30X16X10MM NS LF CRNT THOR,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6991035,SUP,HCPCS C1713,,6991035  -  CAGE SPNL XL 35X16X10MM NS LF CRNT THOR,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6991040,SUP,HCPCS C1713,,6991040  -  CAGE SPNL XL 40X16X10MM NS LF CRNT THOR,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6991225,SUP,HCPCS C1713,,6991225  -  CAGE SPNL XL 25X16X12MM NS LF CRNT THOR,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6991230,SUP,HCPCS C1713,,6991230  -  CAGE SPNL XL 30X16X12MM NS LF CRNT THOR,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6991235,SUP,HCPCS C1713,,6991235  -  CAGE SPNL XL 35X16X12MM NS LF CRNT THOR,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
6991240,SUP,HCPCS C1713,,6991240  -  CAGE SPNL XL 40X16X12MM NS LF CRNT THOR,"$13,000.00",$0.00,"$13,000.00","$5,850.00","$5,158.80",$0.00,"$2,239.84",$0.00,$0.00,"$2,276.20","$13,000.00",$0.00,"$6,500.00","$10,296.00","$10,400.00",$0.00,"$2,034.50",$0.00,"$2,069.60",$0.00
7002500,SUP,HCPCS C1713,,7002500  -  CROSSLINK SET SCREW,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
7002525,SUP,HCPCS C1713,,7002525  -  LINK SPNL XLNK VRTX SM TI PLT RECON SYS,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7002526,SUP,HCPCS C1713,,7002526  -  PLATE BONE XLNK MED SPNL TI PLT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7002527,SUP,Custom 27803010,,7002527  -  CONCTR ROD LG VRTX MX XLNK PLT TI SPNL,"$2,000.00",$0.00,"$2,000.00",$0.00,"$1,427.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
7020500,SUP,HCPCS C1713,,7020500  -  BONE SCREW 7020500 ILIAC 5.5X100 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7020535,SUP,HCPCS C1713,,7020535  -  BONE SCREW 7020535 ILIAC 5.5X35 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7020540,SUP,HCPCS C1713,,7020540  -  BONE SCREW 7020540 ILIAC 5.5X40 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7020545,SUP,HCPCS C1713,,7020545  -  BONE SCREW 7020545 ILIAC 5.5X45 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7020550,SUP,HCPCS C1713,,7020550  -  BONE SCREW 7020550 ILIAC 5.5X50 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7020555,SUP,HCPCS C1713,,7020555  -  BONE SCREW 7020555 ILIAC 5.5X55 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7020560,SUP,HCPCS C1713,,7020560  -  BONE SCREW 7020560 ILIAC 5.5X60 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7020570,SUP,HCPCS C1713,,7020570  -  BONE SCREW 7020570 ILIAC 5.5X70 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7020580,SUP,HCPCS C1713,,7020580  -  BONE SCREW 7020580 ILIAC 5.5X80 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7020590,SUP,HCPCS C1713,,7020590  -  BONE SCREW 7020590 ILIAC 5.5X90 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7020600,SUP,HCPCS C1713,,7020600  -  BONE SCREW 7020600 ILIAC 6.5X100 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7020635,SUP,HCPCS C1713,,7020635  -  BONE SCREW 7020635 ILIAC 6.5X35 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7020640,SUP,HCPCS C1713,,7020640  -  BONE SCREW 7020640 ILIAC 6.5X40 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7020645,SUP,HCPCS C1713,,7020645  -  BONE SCREW 7020645 ILIAC 6.5X45 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7020650,SUP,HCPCS C1713,,7020650  -  BONE SCREW 7020650 ILIAC 6.5X50 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7020655,SUP,HCPCS C1713,,7020655  -  BONE SCREW 7020655 ILIAC 6.5X55 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7020660,SUP,HCPCS C1713,,7020660  -  BONE SCREW 7020660 ILIAC 6.5X60 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7020670,SUP,HCPCS C1713,,7020670  -  BONE SCREW 7020670 ILIAC 6.5X70 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7020680,SUP,HCPCS C1713,,7020680  -  BONE SCREW 7020680 ILIAC 6.5X80 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7020690,SUP,HCPCS C1713,,7020690  -  BONE SCREW 7020690 ILIAC 6.5X90 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7020700,SUP,HCPCS C1713,,7020700  -  BONE SCREW 7020700 ILIAC 7.5X100 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7020735,SUP,HCPCS C1713,,7020735  -  BONE SCREW 7020735 ILIAC 7.5X35 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7020740,SUP,HCPCS C1713,,7020740  -  BONE SCREW 7020740 ILIAC 7.5X40 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7020745,SUP,HCPCS C1713,,7020745  -  BONE SCREW 7020745 ILIAC 7.5X45 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7020750,SUP,HCPCS C1713,,7020750  -  BONE SCREW 7020750 ILIAC 7.5X50 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7020755,SUP,HCPCS C1713,,7020755  -  BONE SCREW 7020755 ILIAC 7.5X55 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7020760,SUP,HCPCS C1713,,7020760  -  BONE SCREW 7020760 ILIAC 7.5X60 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7020770,SUP,HCPCS C1713,,7020770  -  BONE SCREW 7020770 ILIAC 7.5X70 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7020780,SUP,HCPCS C1713,,7020780  -  BONE SCREW 7020780 ILIAC 7.5X80 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7020790,SUP,HCPCS C1713,,7020790  -  BONE SCREW 7020790 ILIAC 7.5X90 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7020800,SUP,HCPCS C1713,,7020800  -  BONE SCREW 7020800 ILIAC 8.5X100 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7020835,SUP,HCPCS C1713,,7020835  -  BONE SCREW 7020835 ILIAC 8.5X35 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7020840,SUP,HCPCS C1713,,7020840  -  BONE SCREW 7020840 ILIAC 8.5X40 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7020845,SUP,HCPCS C1713,,7020845  -  BONE SCREW 7020845 ILIAC 8.5X45 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7020850,SUP,HCPCS C1713,,7020850  -  BONE SCREW 7020850 ILIAC 8.5X50 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7020860,SUP,HCPCS C1713,,7020860  -  BONE SCREW 7020860 ILIAC 8.5X60 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7020870,SUP,HCPCS C1713,,7020870  -  BONE SCREW 7020870 ILIAC 8.5X70 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7020880,SUP,HCPCS C1713,,7020880  -  BONE SCREW 7020880 ILIAC 8.5X80 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7020890,SUP,HCPCS C1713,,7020890  -  BONE SCREW 7020890 ILIAC 8.5X90 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7021210,SUP,Custom 27803010,,7021210  -  CONCTR ROD 10MM 4.5/6.35MM CD HZN LGC CLOSE OFFST SS SPNL,"$1,730.18",$0.00,"$1,730.18",$0.00,"$1,234.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,730.18",$0.00,$865.09,"$1,370.30","$1,384.14",$0.00,$0.00,$0.00,$0.00,$0.00
7021220,SUP,Custom 27803010,,7021220  -  CONCTR ROD 20MM 4.5/6.35MM CD HZN LGC CLOSE OFFST SS SPNL,"$1,730.18",$0.00,"$1,730.18",$0.00,"$1,234.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,730.18",$0.00,$865.09,"$1,370.30","$1,384.14",$0.00,$0.00,$0.00,$0.00,$0.00
7021230,SUP,Custom 27803010,,7021230  -  CONCTR ROD 30MM 4.5/6.35MM CD HZN LGC CLOSE OFFST SS SPNL,"$1,730.18",$0.00,"$1,730.18",$0.00,"$1,234.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,730.18",$0.00,$865.09,"$1,370.30","$1,384.14",$0.00,$0.00,$0.00,$0.00,$0.00
7021310,SUP,Custom 27803010,,7021310  -  CONNECTOR 7021310 5.5 6.35 CLS LAT 10 SS,"$1,730.18",$0.00,"$1,730.18",$0.00,"$1,234.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,730.18",$0.00,$865.09,"$1,370.30","$1,384.14",$0.00,$0.00,$0.00,$0.00,$0.00
7021320,SUP,Custom 27803010,,7021320  -  CONNECTOR 7021320 5.5 6.35 CLS LAT 20 SS,"$1,730.18",$0.00,"$1,730.18",$0.00,"$1,234.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,730.18",$0.00,$865.09,"$1,370.30","$1,384.14",$0.00,$0.00,$0.00,$0.00,$0.00
7021330,SUP,Custom 27803010,,7021330  -  CONNECTOR 7021330 5.5 6.35 CLS LAT 30 SS,"$1,730.18",$0.00,"$1,730.18",$0.00,"$1,234.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,730.18",$0.00,$865.09,"$1,370.30","$1,384.14",$0.00,$0.00,$0.00,$0.00,$0.00
7021360,SUP,Custom 27803010,,7021360  -  CONCTR ROD 60MM 5.5/6.35MM CD HZN LGC CLOSE OFFST SS SPNL,"$1,730.18",$0.00,"$1,730.18",$0.00,"$1,234.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,730.18",$0.00,$865.09,"$1,370.30","$1,384.14",$0.00,$0.00,$0.00,$0.00,$0.00
7021410,SUP,Custom 27803010,,7021410  -  CONNECTOR 7021410 6.35 6.35 CLS LT 10 SS,"$1,730.18",$0.00,"$1,730.18",$0.00,"$1,234.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,730.18",$0.00,$865.09,"$1,370.30","$1,384.14",$0.00,$0.00,$0.00,$0.00,$0.00
7021420,SUP,Custom 27803010,,7021420  -  CONNECTOR 7021420 6.35 6.35 CLS LT 20 SS,"$1,730.18",$0.00,"$1,730.18",$0.00,"$1,234.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,730.18",$0.00,$865.09,"$1,370.30","$1,384.14",$0.00,$0.00,$0.00,$0.00,$0.00
7021430,SUP,Custom 27803010,,7021430  -  CONNECTOR 7021430 6.35 6.35 CLS LT 30 SS,"$1,730.18",$0.00,"$1,730.18",$0.00,"$1,234.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,730.18",$0.00,$865.09,"$1,370.30","$1,384.14",$0.00,$0.00,$0.00,$0.00,$0.00
7021460,SUP,Custom 27803010,,7021460  -  CONCTR ROD 60MM 6.35MM CD HZN LGC CLOSE OFFST SS SPNL LAT,"$1,730.18",$0.00,"$1,730.18",$0.00,"$1,234.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,730.18",$0.00,$865.09,"$1,370.30","$1,384.14",$0.00,$0.00,$0.00,$0.00,$0.00
7021600,SUP,HCPCS C1713,,7021600  -  BONE SCREW 7021600 10 DEG ILC 6.5X100 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7021635,SUP,HCPCS C1713,,7021635  -  BONE SCREW 7021635 10 DEG ILC 6.5X35 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7021640,SUP,HCPCS C1713,,7021640  -  BONE SCREW 7021640 10 DEG ILC 6.5X40 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7021645,SUP,HCPCS C1713,,7021645  -  BONE SCREW 7021645 10 DEG ILC 6.5X45 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7021650,SUP,HCPCS C1713,,7021650  -  BONE SCREW 7021650 10 DEG ILC 6.5X50 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7021655,SUP,HCPCS C1713,,7021655  -  BONE SCREW 7021655 10 DEG ILC 6.5X55 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7021660,SUP,HCPCS C1713,,7021660  -  BONE SCREW 7021660 10 DEG ILC 6.5X60 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7021670,SUP,HCPCS C1713,,7021670  -  BONE SCREW 7021670 10 DEG ILC 6.5X70 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7021680,SUP,HCPCS C1713,,7021680  -  BONE SCREW 7021680 10 DEG ILC 6.5X80 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7021690,SUP,HCPCS C1713,,7021690  -  BONE SCREW 7021690 10 DEG ILC 6.5X90 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7021700,SUP,HCPCS C1713,,7021700  -  BONE SCREW 7021700 10 DEG ILC 7.5X100 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7021735,SUP,HCPCS C1713,,7021735  -  BONE SCREW 7021735 10 DEG ILC 7.5X35 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7021740,SUP,HCPCS C1713,,7021740  -  BONE SCREW 7021740 10 DEG ILC 7.5X40 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7021745,SUP,HCPCS C1713,,7021745  -  BONE SCREW 7021745 10 DEG ILC 7.5X45 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7021750,SUP,HCPCS C1713,,7021750  -  BONE SCREW 7021750 10 DEG ILC 7.5X50 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7021755,SUP,HCPCS C1713,,7021755  -  BONE SCREW 7021755 10 DEG ILC 7.5X55 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7021760,SUP,HCPCS C1713,,7021760  -  BONE SCREW 7021760 10 DEG ILC 7.5X60 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7021770,SUP,HCPCS C1713,,7021770  -  BONE SCREW 7021770 10 DEG ILC 7.5X70 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7021780,SUP,HCPCS C1713,,7021780  -  BONE SCREW 7021780 10 DEG ILC 7.5X80 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7021790,SUP,HCPCS C1713,,7021790  -  BONE SCREW 7021790 10 DEG ILC 7.5X90 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7021800,SUP,HCPCS C1713,,7021800  -  BONE SCREW 7021800 10 DEG ILC 8.5X100 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7021835,SUP,HCPCS C1713,,7021835  -  BONE SCREW 7021835 10 DEG ILC 8.5X35 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7021840,SUP,HCPCS C1713,,7021840  -  BONE SCREW 7021840 10 DEG ILC 8.5X40 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7021845,SUP,HCPCS C1713,,7021845  -  BONE SCREW 7021845 10 DEG ILC 8.5X45 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7021850,SUP,HCPCS C1713,,7021850  -  BONE SCREW 7021850 10 DEG ILC 8.5X50 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7021855,SUP,HCPCS C1713,,7021855  -  BONE SCREW 7021855 10 DEG ILC 8.5X55 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7021860,SUP,HCPCS C1713,,7021860  -  BONE SCREW 7021860 10 DEG ILC 8.5X60 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7021870,SUP,HCPCS C1713,,7021870  -  BONE SCREW 7021870 10 DEG ILC 8.5X70 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7021880,SUP,HCPCS C1713,,7021880  -  BONE SCREW 7021880 10 DEG ILC 8.5X80 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7021890,SUP,HCPCS C1713,,7021890  -  BONE SCREW 7021890 10 DEG ILC 8.5X90 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7022210,SUP,Custom 27803010,,7022210  -  CONNECTOR 7022210 LAT CONN SS 4.5 12MM,"$1,981.85",$0.00,"$1,981.85",$0.00,"$1,414.45",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,981.85",$0.00,$990.93,"$1,569.63","$1,585.48",$0.00,$0.00,$0.00,$0.00,$0.00
7022230,SUP,Custom 27803010,,7022230  -  CONNECTOR 7022230 LAT CONN SS 4.5 32MM,"$1,981.85",$0.00,"$1,981.85",$0.00,"$1,414.45",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,981.85",$0.00,$990.93,"$1,569.63","$1,585.48",$0.00,$0.00,$0.00,$0.00,$0.00
7022310,SUP,Custom 27803010,,7022310  -  CONNECTOR 7022310 LAT CONN SS 5.5 12MM,"$1,981.85",$0.00,"$1,981.85",$0.00,"$1,414.45",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,981.85",$0.00,$990.93,"$1,569.63","$1,585.48",$0.00,$0.00,$0.00,$0.00,$0.00
7022330,SUP,Custom 27803010,,7022330  -  CONNECTOR 7022330 LAT CONN SS 5.5 32MM,"$1,981.85",$0.00,"$1,981.85",$0.00,"$1,414.45",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,981.85",$0.00,$990.93,"$1,569.63","$1,585.48",$0.00,$0.00,$0.00,$0.00,$0.00
7022410,SUP,Custom 27803010,,7022410  -  CONNECTOR 7022410 LAT CONN SS 6.35 12MM,"$1,981.85",$0.00,"$1,981.85",$0.00,"$1,414.45",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,981.85",$0.00,$990.93,"$1,569.63","$1,585.48",$0.00,$0.00,$0.00,$0.00,$0.00
7022430,SUP,Custom 27803010,,7022430  -  CONNECTOR 7022430 LAT CONN SS 6.35 32MM,"$1,981.85",$0.00,"$1,981.85",$0.00,"$1,414.45",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,981.85",$0.00,$990.93,"$1,569.63","$1,585.48",$0.00,$0.00,$0.00,$0.00,$0.00
7022600,SUP,HCPCS C1713,,7022600  -  BONE SCREW 7022600 20 DEG ILC 6.5X100 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7022635,SUP,HCPCS C1713,,7022635  -  BONE SCREW 7022635 20 DEG ILC 6.5X35 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7022640,SUP,HCPCS C1713,,7022640  -  BONE SCREW 7022640 20 DEG ILC 6.5X40 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7022645,SUP,HCPCS C1713,,7022645  -  BONE SCREW 7022645 20 DEG ILC 6.5X45 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7022650,SUP,HCPCS C1713,,7022650  -  BONE SCREW 7022650 20 DEG ILC 6.5X50 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7022655,SUP,HCPCS C1713,,7022655  -  BONE SCREW 7022655 20 DEG ILC 6.5X55 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7022660,SUP,HCPCS C1713,,7022660  -  BONE SCREW 7022660 20 DEG ILC 6.5X60 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7022670,SUP,HCPCS C1713,,7022670  -  BONE SCREW 7022670 20 DEG ILC 6.5X70 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7022680,SUP,HCPCS C1713,,7022680  -  BONE SCREW 7022680 20 DEG ILC 6.5X80 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7022690,SUP,HCPCS C1713,,7022690  -  BONE SCREW 7022690 20 DEG ILC 6.5X90 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7022700,SUP,HCPCS C1713,,7022700  -  BONE SCREW 7022700 20 DEG ILC 7.5X100 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7022735,SUP,HCPCS C1713,,7022735  -  BONE SCREW 7022735 20 DEG ILC 7.5X35 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7022740,SUP,HCPCS C1713,,7022740  -  BONE SCREW 7022740 20 DEG ILC 7.5X40 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7022750,SUP,HCPCS C1713,,7022750  -  BONE SCREW 7022750 20 DEG ILC 7.5X50 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7022755,SUP,HCPCS C1713,,7022755  -  BONE SCREW 7022755 20 DEG ILC 7.5X55 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7022760,SUP,HCPCS C1713,,7022760  -  BONE SCREW 7022760 20 DEG ILC 7.5X60 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7022770,SUP,HCPCS C1713,,7022770  -  BONE SCREW 7022770 20 DEG ILC 7.5X70 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7022780,SUP,HCPCS C1713,,7022780  -  BONE SCREW 7022780 20 DEG ILC 7.5X80 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7022790,SUP,HCPCS C1713,,7022790  -  BONE SCREW 7022790 20 DEG ILC 7.5X90 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7022800,SUP,HCPCS C1713,,7022800  -  BONE SCREW 7022800 20 DEG ILC 8.5X100 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7022835,SUP,HCPCS C1713,,7022835  -  BONE SCREW 7022835 20 DEG ILC 8.5X35 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7022840,SUP,HCPCS C1713,,7022840  -  BONE SCREW 7022840 20 DEG ILC 8.5X40 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7022845,SUP,HCPCS C1713,,7022845  -  BONE SCREW 7022845 20 DEG ILC 8.5X45 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7022850,SUP,HCPCS C1713,,7022850  -  BONE SCREW 7022850 20 DEG ILC 8.5X50 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7022855,SUP,HCPCS C1713,,7022855  -  BONE SCREW 7022855 20 DEG ILC 8.5X55 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7022860,SUP,HCPCS C1713,,7022860  -  BONE SCREW 7022860 20 DEG ILC 8.5X60 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7022870,SUP,HCPCS C1713,,7022870  -  BONE SCREW 7022870 20 DEG ILC 8.5X70 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7022880,SUP,HCPCS C1713,,7022880  -  BONE SCREW 7022880 20 DEG ILC 8.5X80 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7022890,SUP,HCPCS C1713,,7022890  -  BONE SCREW 7022890 20 DEG ILC 8.5X90 SS,"$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7023130,SUP,Custom 27203010,,7023130  -  CASE STERILIZATION ILIAC SCREW SET,$409.50,$0.00,$409.50,$0.00,$292.26,$0.00,$0.00,$0.00,$0.00,$0.00,$409.50,$0.00,$204.75,$324.32,$327.60,$0.00,$0.00,$0.00,$0.00,$0.00
7024855,SUP,HCPCS C1713,,7024855  -  SCREW SET SS .25IN 32 THRD SPN PDCL BRKOF CD HZN LGC 6.35MM,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
7025855,SUP,HCPCS C1713,,7025855  -  SET SCREW 7025855 1 4 32 BREAK OFF SS,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
7030500,SUP,HCPCS C1713,,"7030500  -  PROXIMAL SCREW 5.5 X 100, SS","$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7030550,SUP,HCPCS C1713,,"7030550  -  PROXIMAL SCREW 5.5 X 50, SS","$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7030555,SUP,HCPCS C1713,,"7030555  -  PROXIMAL SCREW 5.5 X 55, SS","$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7030560,SUP,HCPCS C1713,,"7030560  -  PROXIMAL SCREW 5.5 X 60, SS","$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7030570,SUP,HCPCS C1713,,"7030570  -  PROXIMAL SCREW 5.5 X 70, SS","$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7030580,SUP,HCPCS C1713,,"7030580  -  PROXIMAL SCREW 5.5 X 80, SS","$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7030590,SUP,HCPCS C1713,,"7030590  -  PROXIMAL SCREW 5.5 X 90, SS","$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7030600,SUP,HCPCS C1713,,"7030600  -  PROXIMAL SCREW 6.5 X 100, SS","$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7030655,SUP,HCPCS C1713,,"7030655  -  PROXIMAL SCREW 6.5 X 55, SS","$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7030680,SUP,HCPCS C1713,,"7030680  -  PROXIMAL SCREW 6.5 X 80, SS","$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7030690,SUP,HCPCS C1713,,"7030690  -  PROXIMAL SCREW 6.5 X 90, SS","$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7030750,SUP,HCPCS C1713,,"7030750  -  PROXIMAL SCREW 7.5 X 50, SS","$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7030755,SUP,HCPCS C1713,,"7030755  -  PROXIMAL SCREW 7.5 X 55, SS","$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7030850,SUP,HCPCS C1713,,"7030850  -  PROXIMAL SCREW 8.5 X 50, SS","$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7030855,SUP,HCPCS C1713,,"7030855  -  PROXIMAL SCREW 8.5 X 55, SS","$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7030860,SUP,HCPCS C1713,,"7030860  -  PROXIMAL SCREW 8.5 X 60, SS","$2,134.10",$0.00,"$2,134.10",$960.35,"$1,523.11",$0.00,$367.69,$0.00,$0.00,$373.66,"$2,134.10",$0.00,"$1,067.05","$1,690.21","$1,707.28",$0.00,$333.99,$0.00,$339.75,$0.00
7040500,SUP,HCPCS C1713,,7040500  -  BONE SCREW 7040500 ILIAC 5.5X100 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7040535,SUP,HCPCS C1713,,7040535  -  BONE SCREW 7040535 ILIAC 5.5X35 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7040540,SUP,HCPCS C1713,,7040540  -  BONE SCREW 7040540 ILIAC 5.5X40 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7040545,SUP,HCPCS C1713,,7040545  -  BONE SCREW 7040545 ILIAC 5.5X45 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7040550,SUP,HCPCS C1713,,7040550  -  BONE SCREW 7040550 ILIAC 5.5X50 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7040555,SUP,HCPCS C1713,,7040555  -  BONE SCREW 7040555 ILIAC 5.5X55 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7040570,SUP,HCPCS C1713,,7040570  -  BONE SCREW 7040570 ILIAC 5.5X70 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7040580,SUP,HCPCS C1713,,7040580  -  BONE SCREW 7040580 ILIAC 5.5X80 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7040590,SUP,HCPCS C1713,,7040590  -  BONE SCREW 7040590 ILIAC 5.5X90 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7040600,SUP,HCPCS C1713,,7040600  -  BONE SCREW 7040600 ILIAC 6.5X100 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7040635,SUP,HCPCS C1713,,7040635  -  BONE SCREW 7040635 ILIAC 6.5X35 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7040640,SUP,HCPCS C1713,,7040640  -  BONE SCREW 7040640 ILIAC 6.5X40 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7040645,SUP,HCPCS C1713,,7040645  -  BONE SCREW 7040645 ILIAC 6.5X45 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7040650,SUP,HCPCS C1713,,7040650  -  BONE SCREW 7040650 ILIAC 6.5X50 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7040655,SUP,HCPCS C1713,,7040655  -  BONE SCREW 7040655 ILIAC 6.5X55 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7040660,SUP,HCPCS C1713,,7040660  -  BONE SCREW 7040660 ILIAC 6.5X60 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7040670,SUP,HCPCS C1713,,7040670  -  BONE SCREW 7040670 ILIAC 6.5X70 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7040680,SUP,HCPCS C1713,,7040680  -  BONE SCREW 7040680 ILIAC 6.5X80 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7040690,SUP,HCPCS C1713,,7040690  -  BONE SCREW 7040690 ILIAC 6.5X90 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7040700,SUP,HCPCS C1713,,7040700  -  BONE SCREW 7040700 ILIAC 7.5X100 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7040740,SUP,HCPCS C1713,,7040740  -  BONE SCREW 7040740 ILIAC 7.5X40 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7040745,SUP,HCPCS C1713,,7040745  -  BONE SCREW 7040745 ILIAC 7.5X45 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7040750,SUP,HCPCS C1713,,7040750  -  BONE SCREW 7040750 ILIAC 7.5X50 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7040755,SUP,HCPCS C1713,,7040755  -  BONE SCREW 7040755 ILIAC 7.5X55 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7040760,SUP,HCPCS C1713,,7040760  -  BONE SCREW 7040760 ILIAC 7.5X60 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7040770,SUP,HCPCS C1713,,7040770  -  BONE SCREW 7040770 ILIAC 7.5X70 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7040780,SUP,HCPCS C1713,,7040780  -  BONE SCREW 7040780 ILIAC 7.5X80 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7040790,SUP,HCPCS C1713,,7040790  -  BONE SCREW 7040790 ILIAC 7.5X90 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7040800,SUP,HCPCS C1713,,7040800  -  BONE SCREW 7040800 ILIAC 8.5X100 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7040835,SUP,HCPCS C1713,,7040835  -  BONE SCREW 7040835 ILIAC 8.5X35 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7040840,SUP,HCPCS C1713,,7040840  -  BONE SCREW 7040840 ILIAC 8.5X40 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7040845,SUP,HCPCS C1713,,7040845  -  BONE SCREW 7040845 ILIAC 8.5X45 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7040850,SUP,HCPCS C1713,,7040850  -  BONE SCREW 7040850 ILIAC 8.5X50 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7040860,SUP,HCPCS C1713,,7040860  -  BONE SCREW 7040860 ILIAC 8.5X60 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7040870,SUP,HCPCS C1713,,7040870  -  BONE SCREW 7040870 ILIAC 8.5X70 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7040880,SUP,HCPCS C1713,,7040880  -  BONE SCREW 7040880 ILIAC 8.5X80 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7040890,SUP,HCPCS C1713,,7040890  -  BONE SCREW 7040890 ILIAC 8.5X90 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7041210,SUP,Custom 27803010,,7041210  -  CONCTR ROD 10MM CD HZN LGC CLOSE OFFST TI LAT SPNL 4.5/6.35,"$1,843.63",$0.00,"$1,843.63",$0.00,"$1,315.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,843.63",$0.00,$921.81,"$1,460.15","$1,474.90",$0.00,$0.00,$0.00,$0.00,$0.00
7041220,SUP,Custom 27803010,,7041220  -  CONECTOR 7041220 CLSLAT 20MM TI 4.5/6.35,"$1,843.63",$0.00,"$1,843.63",$0.00,"$1,315.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,843.63",$0.00,$921.81,"$1,460.15","$1,474.90",$0.00,$0.00,$0.00,$0.00,$0.00
7041230,SUP,Custom 27803010,,7041230  -  CONECTOR 7041230 CLSLAT 30MM TI 4.5/6.35,"$1,843.63",$0.00,"$1,843.63",$0.00,"$1,315.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,843.63",$0.00,$921.81,"$1,460.15","$1,474.90",$0.00,$0.00,$0.00,$0.00,$0.00
7041310,SUP,Custom 27803010,,7041310  -  CONNECTOR 7041310 5.5 6.35 CLS LAT 10 TI,"$1,843.63",$0.00,"$1,843.63",$0.00,"$1,315.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,843.63",$0.00,$921.81,"$1,460.15","$1,474.90",$0.00,$0.00,$0.00,$0.00,$0.00
7041320,SUP,Custom 27803010,,7041320  -  CONCTR ROD 20MM CD HZN LGC CLOSE OFFST TI LAT SPNL 5.5/6.35,"$1,843.63",$0.00,"$1,843.63",$0.00,"$1,315.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,843.63",$0.00,$921.81,"$1,460.15","$1,474.90",$0.00,$0.00,$0.00,$0.00,$0.00
7041330,SUP,Custom 27803010,,7041330  -  CONNECTOR 7041330 5.5 6.35 CLS LAT 30 TI,"$1,843.63",$0.00,"$1,843.63",$0.00,"$1,315.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,843.63",$0.00,$921.81,"$1,460.15","$1,474.90",$0.00,$0.00,$0.00,$0.00,$0.00
7041360,SUP,Custom 27803010,,7041360  -  CONECTR 7041360 5.5/6.35 CLS LAT 60MM TI,"$1,843.63",$0.00,"$1,843.63",$0.00,"$1,315.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,843.63",$0.00,$921.81,"$1,460.15","$1,474.90",$0.00,$0.00,$0.00,$0.00,$0.00
7041410,SUP,Custom 27803010,,7041410  -  CONNECTOR 7041410 6.35 6.35 CLS LT 10 TI,"$1,843.63",$0.00,"$1,843.63",$0.00,"$1,315.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,843.63",$0.00,$921.81,"$1,460.15","$1,474.90",$0.00,$0.00,$0.00,$0.00,$0.00
7041420,SUP,Custom 27803010,,7041420  -  CONNECTOR 7041420 6.35 6.35 CLS LT 20 TI,"$1,843.63",$0.00,"$1,843.63",$0.00,"$1,315.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,843.63",$0.00,$921.81,"$1,460.15","$1,474.90",$0.00,$0.00,$0.00,$0.00,$0.00
7041430,SUP,Custom 27803010,,7041430  -  CONNECTOR 7041430 6.35 6.35 CLS LT 30 TI,"$1,843.63",$0.00,"$1,843.63",$0.00,"$1,315.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,843.63",$0.00,$921.81,"$1,460.15","$1,474.90",$0.00,$0.00,$0.00,$0.00,$0.00
7041460,SUP,Custom 27803010,,7041460  -  CONECTR 7041460 6.35/6.35 CLS LAT 60MMTI,"$1,843.63",$0.00,"$1,843.63",$0.00,"$1,315.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,843.63",$0.00,$921.81,"$1,460.15","$1,474.90",$0.00,$0.00,$0.00,$0.00,$0.00
7041600,SUP,HCPCS C1713,,7041600  -  BONE SCREW 7041600 10 DEG ILC 6.5X100 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7041635,SUP,HCPCS C1713,,7041635  -  BONE SCREW 7041635 10 DEG ILC 6.5X35 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7041640,SUP,HCPCS C1713,,7041640  -  BONE SCREW 7041640 10 DEG ILC 6.5X40 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7041645,SUP,HCPCS C1713,,7041645  -  BONE SCREW 7041645 10 DEG ILC 6.5X45 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7041650,SUP,HCPCS C1713,,7041650  -  BONE SCREW 7041650 10 DEG ILC 6.5X50 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7041655,SUP,HCPCS C1713,,7041655  -  BONE SCREW 7041655 10 DEG ILC 6.5X55 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7041660,SUP,HCPCS C1713,,7041660  -  BONE SCREW 7041660 10 DEG ILC 6.5X60 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7041670,SUP,HCPCS C1713,,7041670  -  BONE SCREW 7041670 10 DEG ILC 6.5X70 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7041680,SUP,HCPCS C1713,,7041680  -  BONE SCREW 7041680 10 DEG ILC 6.5X80 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7041690,SUP,HCPCS C1713,,7041690  -  BONE SCREW 7041690 10 DEG ILC 6.5X90 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7041700,SUP,HCPCS C1713,,7041700  -  BONE SCREW 7041700 10 DEG ILC 7.5X100 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7041735,SUP,HCPCS C1713,,7041735  -  BONE SCREW 7041735 10 DEG ILC 7.5X35 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7041740,SUP,HCPCS C1713,,7041740  -  BONE SCREW 7041740 10 DEG ILC 7.5X40 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7041745,SUP,HCPCS C1713,,7041745  -  BONE SCREW 7041745 10 DEG ILC 7.5X45 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7041750,SUP,HCPCS C1713,,7041750  -  BONE SCREW 7041750 10 DEG ILC 7.5X50 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7041755,SUP,HCPCS C1713,,7041755  -  BONE SCREW 7041755 10 DEG ILC 7.5X55 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7041760,SUP,HCPCS C1713,,7041760  -  BONE SCREW 7041760 10 DEG ILC 7.5X60 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7041770,SUP,HCPCS C1713,,7041770  -  BONE SCREW 7041770 10 DEG ILC 7.5X70 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7041780,SUP,HCPCS C1713,,7041780  -  BONE SCREW 7041780 10 DEG ILC 7.5X80 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7041790,SUP,HCPCS C1713,,7041790  -  BONE SCREW 7041790 10 DEG ILC 7.5X90 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7041800,SUP,HCPCS C1713,,7041800  -  BONE SCREW 7041800 10 DEG ILC 8.5X100 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7041835,SUP,HCPCS C1713,,7041835  -  BONE SCREW 7041835 10 DEG ILC 8.5X35 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7041840,SUP,HCPCS C1713,,7041840  -  BONE SCREW 7041840 10 DEG ILC 8.5X40 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7041845,SUP,HCPCS C1713,,7041845  -  BONE SCREW 7041845 10 DEG ILC 8.5X45 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7041850,SUP,HCPCS C1713,,7041850  -  BONE SCREW 7041850 10 DEG ILC 8.5X50 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7041855,SUP,HCPCS C1713,,7041855  -  BONE SCREW 7041855 10 DEG ILC 8.5X55 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7041860,SUP,HCPCS C1713,,7041860  -  BONE SCREW 7041860 10 DEG ILC 8.5X60 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7041870,SUP,HCPCS C1713,,7041870  -  BONE SCREW 7041870 10 DEG ILC 8.5X70 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7041880,SUP,HCPCS C1713,,7041880  -  BONE SCREW 7041880 10 DEG ILC 8.5X80 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7041890,SUP,HCPCS C1713,,7041890  -  BONE SCREW 7041890 10 DEG ILC 8.5X90 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7042210,SUP,Custom 27803010,,7042210  -  CONNECTOR 7042210 LAT CONN TI 4.5 12MM,"$2,175.95",$0.00,"$2,175.95",$0.00,"$1,552.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,175.95",$0.00,"$1,087.98","$1,723.35","$1,740.76",$0.00,$0.00,$0.00,$0.00,$0.00
7042230,SUP,Custom 27803010,,7042230  -  CONNECTOR 7042230 LAT CONN TI 4.5 32MM,"$2,175.95",$0.00,"$2,175.95",$0.00,"$1,552.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,175.95",$0.00,"$1,087.98","$1,723.35","$1,740.76",$0.00,$0.00,$0.00,$0.00,$0.00
7042310,SUP,Custom 27803010,,7042310  -  CONNECTOR 7042310 LAT CONN TI 5.5 12MM,"$2,175.95",$0.00,"$2,175.95",$0.00,"$1,552.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,175.95",$0.00,"$1,087.98","$1,723.35","$1,740.76",$0.00,$0.00,$0.00,$0.00,$0.00
7042320,SUP,Custom 27803010,,7042320  -  CONNECTOR 7042320 LAT CONN TI 5.5 22MM,"$2,175.95",$0.00,"$2,175.95",$0.00,"$1,552.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,175.95",$0.00,"$1,087.98","$1,723.35","$1,740.76",$0.00,$0.00,$0.00,$0.00,$0.00
7042330,SUP,Custom 27803010,,7042330  -  CONNECTOR 7042330 LAT CONN TI 5.5 32MM,"$2,175.95",$0.00,"$2,175.95",$0.00,"$1,552.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,175.95",$0.00,"$1,087.98","$1,723.35","$1,740.76",$0.00,$0.00,$0.00,$0.00,$0.00
7042410,SUP,Custom 27803010,,7042410  -  CONNECTOR 7042410 LAT CONN TI 6.35 12MM,"$2,175.95",$0.00,"$2,175.95",$0.00,"$1,552.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,175.95",$0.00,"$1,087.98","$1,723.35","$1,740.76",$0.00,$0.00,$0.00,$0.00,$0.00
7042430,SUP,Custom 27803010,,7042430  -  CONNECTOR 7042430 LAT CONN TI 6.35 32MM,"$2,175.95",$0.00,"$2,175.95",$0.00,"$1,552.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,175.95",$0.00,"$1,087.98","$1,723.35","$1,740.76",$0.00,$0.00,$0.00,$0.00,$0.00
7042600,SUP,HCPCS C1713,,7042600  -  BONE SCREW 7042600 20 DEG ILC 6.5X100 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7042635,SUP,HCPCS C1713,,7042635  -  BONE SCREW 7042635 20 DEG ILC 6.5X35 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7042640,SUP,HCPCS C1713,,7042640  -  BONE SCREW 7042640 20 DEG ILC 6.5X40 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7042645,SUP,HCPCS C1713,,7042645  -  BONE SCREW 7042645 20 DEG ILC 6.5X45 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7042650,SUP,HCPCS C1713,,7042650  -  BONE SCREW 7042650 20 DEG ILC 6.5X50 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7042655,SUP,HCPCS C1713,,7042655  -  BONE SCREW 7042655 20 DEG ILC 6.5X55 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7042660,SUP,HCPCS C1713,,7042660  -  BONE SCREW 7042660 20 DEG ILC 6.5X60 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7042670,SUP,HCPCS C1713,,7042670  -  BONE SCREW 7042670 20 DEG ILC 6.5X70 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7042680,SUP,HCPCS C1713,,7042680  -  BONE SCREW 7042680 20 DEG ILC 6.5X80 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7042690,SUP,HCPCS C1713,,7042690  -  BONE SCREW 7042690 20 DEG ILC 6.5X90 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7042700,SUP,HCPCS C1713,,7042700  -  BONE SCREW 7042700 20 DEG ILC 7.5X100 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7042735,SUP,HCPCS C1713,,7042735  -  BONE SCREW 7042735 20 DEG ILC 7.5X35 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7042740,SUP,HCPCS C1713,,7042740  -  BONE SCREW 7042740 20 DEG ILC 7.5X40 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7042745,SUP,HCPCS C1713,,7042745  -  BONE SCREW 7042745 20 DEG ILC 7.5X45 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7042750,SUP,HCPCS C1713,,7042750  -  BONE SCREW 7042750 20 DEG ILC 7.5X50 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7042755,SUP,HCPCS C1713,,7042755  -  BONE SCREW 7042755 20 DEG ILC 7.5X55 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7042760,SUP,HCPCS C1713,,7042760  -  BONE SCREW 7042760 20 DEG ILC 7.5X60 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7042770,SUP,HCPCS C1713,,7042770  -  BONE SCREW 7042770 20 DEG ILC 7.5X70 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7042780,SUP,HCPCS C1713,,7042780  -  BONE SCREW 7042780 20 DEG ILC 7.5X80 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7042790,SUP,HCPCS C1713,,7042790  -  BONE SCREW 7042790 20 DEG ILC 7.5X90 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7042800,SUP,HCPCS C1713,,7042800  -  BONE SCREW 7042800 20 DEG ILC 8.5X100 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7042835,SUP,HCPCS C1713,,7042835  -  BONE SCREW 7042835 20 DEG ILC 8.5X35 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7042840,SUP,HCPCS C1713,,7042840  -  BONE SCREW 7042840 20 DEG ILC 8.5X40 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7042845,SUP,HCPCS C1713,,7042845  -  BONE SCREW 7042845 20 DEG ILC 8.5X45 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7042850,SUP,HCPCS C1713,,7042850  -  BONE SCREW 7042850 20 DEG ILC 8.5X50 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7042855,SUP,HCPCS C1713,,7042855  -  BONE SCREW 7042855 20 DEG ILC 8.5X55 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7042860,SUP,HCPCS C1713,,7042860  -  BONE SCREW 7042860 20 DEG ILC 8.5X60 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7042870,SUP,HCPCS C1713,,7042870  -  BONE SCREW 7042870 20 DEG ILC 8.5X70 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7042880,SUP,HCPCS C1713,,7042880  -  BONE SCREW 7042880 20 DEG ILC 8.5X80 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7042890,SUP,HCPCS C1713,,7042890  -  BONE SCREW 7042890 20 DEG ILC 8.5X90 TI,"$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7045855,SUP,HCPCS C1713,,7045855  -  SET SCREW 7045855 1 4 32 BREAK OFF TI,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
7049855,SUP,HCPCS C1713,,7049855  -  SCREW 7049855 HEX BREAK OFF TI .25 32,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
7050500,SUP,HCPCS C1713,,"7050500  -  PROXIMAL SCREW 5.5 X 100, TI","$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7050550,SUP,HCPCS C1713,,"7050550  -  PROXIMAL SCREW 5.5 X 50, TI","$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7050555,SUP,HCPCS C1713,,"7050555  -  PROXIMAL SCREW 5.5 X 55, TI","$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7050560,SUP,HCPCS C1713,,"7050560  -  PROXIMAL SCREW 5.5 X 60, TI","$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7050570,SUP,HCPCS C1713,,"7050570  -  PROXIMAL SCREW 5.5 X 70, TI","$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7050580,SUP,HCPCS C1713,,"7050580  -  PROXIMAL SCREW 5.5 X 80, TI","$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7050590,SUP,HCPCS C1713,,"7050590  -  PROXIMAL SCREW 5.5 X 90, TI","$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7050600,SUP,HCPCS C1713,,"7050600  -  PROXIMAL SCREW 6.5 X 100, TI","$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7050655,SUP,HCPCS C1713,,"7050655  -  PROXIMAL SCREW 6.5 X 55, TI","$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7050680,SUP,HCPCS C1713,,"7050680  -  PROXIMAL SCREW 6.5 X 80, TI","$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7050690,SUP,HCPCS C1713,,"7050690  -  PROXIMAL SCREW 6.5 X 90, TI","$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7050750,SUP,HCPCS C1713,,"7050750  -  PROXIMAL SCREW 7.5 X 50, TI","$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7050755,SUP,HCPCS C1713,,"7050755  -  PROXIMAL SCREW 7.5 X 55, TI","$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7050850,SUP,HCPCS C1713,,"7050850  -  PROXIMAL SCREW 8.5 X 50, TI","$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7050855,SUP,HCPCS C1713,,"7050855  -  PROXIMAL SCREW 8.5 X 55, TI","$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7050860,SUP,HCPCS C1713,,"7050860  -  PROXIMAL SCREW 8.5 X 60, TI","$2,273.50",$0.00,"$2,273.50","$1,023.08","$1,622.60",$0.00,$391.71,$0.00,$0.00,$398.07,"$2,273.50",$0.00,"$1,136.75","$1,800.61","$1,818.80",$0.00,$355.80,$0.00,$361.94,$0.00
7060300,SUP,Custom 27803010,,7060300  -  TUBE ET 9MM 6MM STRL LSRSHLD II CUF WRP REFLC SIL AL FLRPLAS,$445.00,$0.00,$445.00,$0.00,$317.60,$0.00,$0.00,$0.00,$0.00,$0.00,$445.00,$0.00,$222.50,$352.44,$356.00,$0.00,$0.00,$0.00,$0.00,$0.00
7060400,SUP,Custom 27803010,,7060400  -  TUBE ET 10.5MM 7MM STRL LSRSHLD II CUF WRP REFLC SIL AL,$445.00,$0.00,$445.00,$0.00,$317.60,$0.00,$0.00,$0.00,$0.00,$0.00,$445.00,$0.00,$222.50,$352.44,$356.00,$0.00,$0.00,$0.00,$0.00,$0.00
7060500,SUP,Custom 27803010,,7060500  -  TUBE ET 11.5MM 8MM STRL LF LSRSHLD II DISP,$420.00,$0.00,$420.00,$0.00,$299.75,$0.00,$0.00,$0.00,$0.00,$0.00,$420.00,$0.00,$210.00,$332.64,$336.00,$0.00,$0.00,$0.00,$0.00,$0.00
7070501,SUP,Custom 27203010,,7070501  -  DRILL SRG 4.5MM NS LF DISP MAS PLIF,"$1,125.00",$0.00,"$1,125.00",$0.00,$802.91,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$0.00,$0.00,$0.00,$0.00
7070502,SUP,Custom 27203010,,7070502  -  DRILL SRG 5MM DISP MAS PLIF,"$1,125.00",$0.00,"$1,125.00",$0.00,$802.91,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$0.00,$0.00,$0.00,$0.00
7070503,SUP,Custom 27203010,,7070503  -  DRILL SRG 5.5MM DISP MAS PLIF,"$1,125.00",$0.00,"$1,125.00",$0.00,$802.91,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$0.00,$0.00,$0.00,$0.00
7080510,SUP,Custom 27203010,,7080510  -  BIT DRL 11MM STRL DISP,$501.00,$0.00,$501.00,$0.00,$357.56,$0.00,$0.00,$0.00,$0.00,$0.00,$501.00,$0.00,$250.50,$396.79,$400.80,$0.00,$0.00,$0.00,$0.00,$0.00
7080513,SUP,Custom 27203010,,7080513  -  BIT DRL 13MM STRL DISP,$501.00,$0.00,$501.00,$0.00,$357.56,$0.00,$0.00,$0.00,$0.00,$0.00,$501.00,$0.00,$250.50,$396.79,$400.80,$0.00,$0.00,$0.00,$0.00,$0.00
7096530,SUP,HCPCS C1713,,7096530  -  SCREW BN 6.5MM 30MM MAS PLIF,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
7110001,SUP,HCPCS C1713,,7110001  -  SCREW LOCK DIA 16 CORE VBR 2,$125.00,$0.00,$125.00,$56.25,$89.21,$0.00,$21.54,$0.00,$0.00,$21.89,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$19.56,$0.00,$19.90,$0.00
7110003,SUP,HCPCS C1713,,7110003  -  SCREW LOCK  CORE DIA 18 DIA 22 XCORE 2 TI,$125.00,$0.00,$125.00,$56.25,$89.21,$0.00,$21.54,$0.00,$0.00,$21.89,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$19.56,$0.00,$19.90,$0.00
7124540,SUP,HCPCS C1713,,7124540  -  SCREW BN 4.5MM 40MM SPNE MAS PLIF,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7125025,SUP,HCPCS C1713,,7125025  -  SCREW BN 5MM 25MM NS MAS PA SPNE 3Z PLIF,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7125035,SUP,HCPCS C1713,,7125035  -  SCREW BN 5MM 35MM SPNE MAS PLIF,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7125525,SUP,HCPCS C1713,,7125525  -  SCREW BN 5.5MM 25MM SPNE MAS PLIF,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7125535,SUP,HCPCS C1713,,7125535  -  SCREW BN 5.5MM 35MM SPNE MAS PLIF,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7135100,SUP,Custom 27203010,,7135100  -  KIT AUTOTRANSFUSION BOWL SMALL ASMBLY LOW VOLUME CENTRIFUGE,"$1,378.93",$0.00,"$1,378.93",$0.00,$984.14,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,378.93",$0.00,$689.46,"$1,092.11","$1,103.14",$0.00,$0.00,$0.00,$0.00,$0.00
7140208,SUP,HCPCS C1713,,7140208  -  PLATE BN 8 NS DECADE 2 HL SPNE XLIF,"$9,005.00",$0.00,"$9,005.00","$4,052.25","$5,158.80",$0.00,"$1,551.52",$0.00,$0.00,"$1,576.70","$9,005.00",$0.00,"$4,502.50","$7,131.96","$7,204.00",$0.00,"$1,409.28",$0.00,"$1,433.60",$0.00
7140210,SUP,HCPCS C1713,,7140210  -  PLATE BN 10 NS DECADE 2 HL SPNE XLIF,"$9,005.00",$0.00,"$9,005.00","$4,052.25","$5,158.80",$0.00,"$1,551.52",$0.00,$0.00,"$1,576.70","$9,005.00",$0.00,"$4,502.50","$7,131.96","$7,204.00",$0.00,"$1,409.28",$0.00,"$1,433.60",$0.00
7140212,SUP,HCPCS C1713,,7140212  -  PLATE BN 12 NS DECADE 2 HL SPNE XLIF,"$9,005.00",$0.00,"$9,005.00","$4,052.25","$5,158.80",$0.00,"$1,551.52",$0.00,$0.00,"$1,576.70","$9,005.00",$0.00,"$4,502.50","$7,131.96","$7,204.00",$0.00,"$1,409.28",$0.00,"$1,433.60",$0.00
7140214,SUP,HCPCS C1713,,7140214  -  PLATE BN 14 NS DECADE 2 HL SPNE XLIF,"$9,005.00",$0.00,"$9,005.00","$4,052.25","$5,158.80",$0.00,"$1,551.52",$0.00,$0.00,"$1,576.70","$9,005.00",$0.00,"$4,502.50","$7,131.96","$7,204.00",$0.00,"$1,409.28",$0.00,"$1,433.60",$0.00
7140216,SUP,HCPCS C1713,,7140216  -  PLATE BN 16 NS DECADE 2 HL SPNE XLIF,"$9,005.00",$0.00,"$9,005.00","$4,052.25","$5,158.80",$0.00,"$1,551.52",$0.00,$0.00,"$1,576.70","$9,005.00",$0.00,"$4,502.50","$7,131.96","$7,204.00",$0.00,"$1,409.28",$0.00,"$1,433.60",$0.00
7140218,SUP,HCPCS C1713,,7140218  -  PLATE BN 18 NS DECADE 2 HL SPNE XLIF,"$9,005.00",$0.00,"$9,005.00","$4,052.25","$5,158.80",$0.00,"$1,551.52",$0.00,$0.00,"$1,576.70","$9,005.00",$0.00,"$4,502.50","$7,131.96","$7,204.00",$0.00,"$1,409.28",$0.00,"$1,433.60",$0.00
7140408,SUP,HCPCS C1713,,7140408  -  PLATE BN 8 NS DECADE 4 HL SPNE XLIF,"$9,642.50",$0.00,"$9,642.50","$4,339.13","$5,158.80",$0.00,"$1,661.35",$0.00,$0.00,"$1,688.32","$9,642.50",$0.00,"$4,821.25","$7,636.86","$7,714.00",$0.00,"$1,509.05",$0.00,"$1,535.09",$0.00
7140410,SUP,HCPCS C1713,,7140410  -  PLATE BN 10 NS DECADE 4 HL SPNE XLIF,"$9,642.50",$0.00,"$9,642.50","$4,339.13","$5,158.80",$0.00,"$1,661.35",$0.00,$0.00,"$1,688.32","$9,642.50",$0.00,"$4,821.25","$7,636.86","$7,714.00",$0.00,"$1,509.05",$0.00,"$1,535.09",$0.00
7140412,SUP,HCPCS C1713,,7140412  -  PLATE BN 12 NS DECADE 4 HL SPNE XLIF,"$9,642.50",$0.00,"$9,642.50","$4,339.13","$5,158.80",$0.00,"$1,661.35",$0.00,$0.00,"$1,688.32","$9,642.50",$0.00,"$4,821.25","$7,636.86","$7,714.00",$0.00,"$1,509.05",$0.00,"$1,535.09",$0.00
7140414,SUP,HCPCS C1713,,7140414  -  PLATE BN 14 NS DECADE 4 HL SPNE XLIF,"$9,642.50",$0.00,"$9,642.50","$4,339.13","$5,158.80",$0.00,"$1,661.35",$0.00,$0.00,"$1,688.32","$9,642.50",$0.00,"$4,821.25","$7,636.86","$7,714.00",$0.00,"$1,509.05",$0.00,"$1,535.09",$0.00
7140416,SUP,HCPCS C1713,,7140416  -  PLATE BN 16 NS DECADE 4 HL SPNE XLIF,"$9,642.50",$0.00,"$9,642.50","$4,339.13","$5,158.80",$0.00,"$1,661.35",$0.00,$0.00,"$1,688.32","$9,642.50",$0.00,"$4,821.25","$7,636.86","$7,714.00",$0.00,"$1,509.05",$0.00,"$1,535.09",$0.00
7140418,SUP,HCPCS C1713,,7140418  -  PLATE BN 18 NS DECADE 4 HL SPNE XLIF,"$9,642.50",$0.00,"$9,642.50","$4,339.13","$5,158.80",$0.00,"$1,661.35",$0.00,$0.00,"$1,688.32","$9,642.50",$0.00,"$4,821.25","$7,636.86","$7,714.00",$0.00,"$1,509.05",$0.00,"$1,535.09",$0.00
7141112,SUP,Custom 27203010,,7141112  -  GUIDE PIN ORTH 100MM DECADE SPNE XLIF,$262.50,$0.00,$262.50,$0.00,$187.35,$0.00,$0.00,$0.00,$0.00,$0.00,$262.50,$0.00,$131.25,$207.90,$210.00,$0.00,$0.00,$0.00,$0.00,$0.00
7141113,SUP,HCPCS C1713,,7141113  -  PIN FX DECADE SCR XLIF,$262.50,$0.00,$262.50,$118.13,$187.35,$0.00,$45.23,$0.00,$0.00,$45.96,$262.50,$0.00,$131.25,$207.90,$210.00,$0.00,$41.08,$0.00,$41.79,$0.00
7141230,SUP,HCPCS C1713,,7141230  -  BOLT SPNL SM 5MM 30MM DECADE IMPACTABLE XLIF,"$2,407.50",$0.00,"$2,407.50","$1,083.38","$1,718.23",$0.00,$414.80,$0.00,$0.00,$421.53,"$2,407.50",$0.00,"$1,203.75","$1,906.74","$1,926.00",$0.00,$376.77,$0.00,$383.27,$0.00
7141240,SUP,HCPCS C1713,,7141240  -  BOLT SPNL SM 5MM 40MM DECADE IMPACTABLE XLIF,"$2,407.50",$0.00,"$2,407.50","$1,083.38","$1,718.23",$0.00,$414.80,$0.00,$0.00,$421.53,"$2,407.50",$0.00,"$1,203.75","$1,906.74","$1,926.00",$0.00,$376.77,$0.00,$383.27,$0.00
7141250,SUP,HCPCS C1713,,7141250  -  BOLT SPNL SM 5MM 50MM DECADE IMPACTABLE XLIF,"$2,407.50",$0.00,"$2,407.50","$1,083.38","$1,718.23",$0.00,$414.80,$0.00,$0.00,$421.53,"$2,407.50",$0.00,"$1,203.75","$1,906.74","$1,926.00",$0.00,$376.77,$0.00,$383.27,$0.00
7145030,SUP,HCPCS C1713,,7145030  -  BOLT SPNL SM 5MM 30MM NS DECADE THRD PLT XLIF,"$2,407.50",$0.00,"$2,407.50","$1,083.38","$1,718.23",$0.00,$414.80,$0.00,$0.00,$421.53,"$2,407.50",$0.00,"$1,203.75","$1,906.74","$1,926.00",$0.00,$376.77,$0.00,$383.27,$0.00
7145035,SUP,HCPCS C1713,,7145035  -  BOLT SPNL SM 5MM 35MM NS DECADE THRD PLT XLIF,"$2,407.50",$0.00,"$2,407.50","$1,083.38","$1,718.23",$0.00,$414.80,$0.00,$0.00,$421.53,"$2,407.50",$0.00,"$1,203.75","$1,906.74","$1,926.00",$0.00,$376.77,$0.00,$383.27,$0.00
7145040,SUP,HCPCS C1713,,7145040  -  BOLT SPNL SM 5MM 40MM NS DECADE THRD PLT XLIF,"$2,407.50",$0.00,"$2,407.50","$1,083.38","$1,718.23",$0.00,$414.80,$0.00,$0.00,$421.53,"$2,407.50",$0.00,"$1,203.75","$1,906.74","$1,926.00",$0.00,$376.77,$0.00,$383.27,$0.00
7145045,SUP,HCPCS C1713,,7145045  -  BOLT SPNL SM 5MM 45MM NS DECADE THRD PLT XLIF,"$2,407.50",$0.00,"$2,407.50","$1,083.38","$1,718.23",$0.00,$414.80,$0.00,$0.00,$421.53,"$2,407.50",$0.00,"$1,203.75","$1,906.74","$1,926.00",$0.00,$376.77,$0.00,$383.27,$0.00
7145050,SUP,HCPCS C1713,,7145050  -  BOLT SPNL SM 5MM 50MM NS DECADE THRD PLT XLIF,"$2,407.50",$0.00,"$2,407.50","$1,083.38","$1,718.23",$0.00,$414.80,$0.00,$0.00,$421.53,"$2,407.50",$0.00,"$1,203.75","$1,906.74","$1,926.00",$0.00,$376.77,$0.00,$383.27,$0.00
7145055,SUP,HCPCS C1713,,7145055  -  BOLT SPNL SM 5MM 55MM NS DECADE THRD PLT XLIF,"$2,407.50",$0.00,"$2,407.50","$1,083.38","$1,718.23",$0.00,$414.80,$0.00,$0.00,$421.53,"$2,407.50",$0.00,"$1,203.75","$1,906.74","$1,926.00",$0.00,$376.77,$0.00,$383.27,$0.00
7145060,SUP,HCPCS C1713,,7145060  -  BOLT SPNL SM 5MM 60MM NS DECADE THRD PLT XLIF,"$2,407.50",$0.00,"$2,407.50","$1,083.38","$1,718.23",$0.00,$414.80,$0.00,$0.00,$421.53,"$2,407.50",$0.00,"$1,203.75","$1,906.74","$1,926.00",$0.00,$376.77,$0.00,$383.27,$0.00
7145130,SUP,HCPCS C1713,,7145130  -  BOLT SPNL SM 5.5MM 30MM NS DECADE THRD PLT XLIF,"$2,407.50",$0.00,"$2,407.50","$1,083.38","$1,718.23",$0.00,$414.80,$0.00,$0.00,$421.53,"$2,407.50",$0.00,"$1,203.75","$1,906.74","$1,926.00",$0.00,$376.77,$0.00,$383.27,$0.00
7145140,SUP,HCPCS C1713,,7145140  -  BOLT SPNL SM 5.5MM 40MM NS DECADE THRD PLT XLIF,"$2,407.50",$0.00,"$2,407.50","$1,083.38","$1,718.23",$0.00,$414.80,$0.00,$0.00,$421.53,"$2,407.50",$0.00,"$1,203.75","$1,906.74","$1,926.00",$0.00,$376.77,$0.00,$383.27,$0.00
7145150,SUP,HCPCS C1713,,7145150  -  BOLT SPNL SM 5.5MM 50MM NS DECADE THRD PLT XLIF,"$2,407.50",$0.00,"$2,407.50","$1,083.38","$1,718.23",$0.00,$414.80,$0.00,$0.00,$421.53,"$2,407.50",$0.00,"$1,203.75","$1,906.74","$1,926.00",$0.00,$376.77,$0.00,$383.27,$0.00
7145525,SUP,HCPCS C1713,,7145525  -  BOLT SPNL LG 5.5MM 25MM NS DECADE PLT XLIF,"$2,407.50",$0.00,"$2,407.50","$1,083.38","$1,718.23",$0.00,$414.80,$0.00,$0.00,$421.53,"$2,407.50",$0.00,"$1,203.75","$1,906.74","$1,926.00",$0.00,$376.77,$0.00,$383.27,$0.00
7145530,SUP,HCPCS C1713,,7145530  -  BOLT SPNL LG 5.5MM 30MM NS DECADE PLT XLIF,"$2,407.50",$0.00,"$2,407.50","$1,083.38","$1,718.23",$0.00,$414.80,$0.00,$0.00,$421.53,"$2,407.50",$0.00,"$1,203.75","$1,906.74","$1,926.00",$0.00,$376.77,$0.00,$383.27,$0.00
7145535,SUP,HCPCS C1713,,7145535  -  BOLT SPNL LG 5.5MM 35MM NS DECADE PLT XLIF,"$2,407.50",$0.00,"$2,407.50","$1,083.38","$1,718.23",$0.00,$414.80,$0.00,$0.00,$421.53,"$2,407.50",$0.00,"$1,203.75","$1,906.74","$1,926.00",$0.00,$376.77,$0.00,$383.27,$0.00
7145540,SUP,HCPCS C1713,,7145540  -  BOLT SPNL LG 5.5MM 40MM NS DECADE PLT XLIF,"$2,407.50",$0.00,"$2,407.50","$1,083.38","$1,718.23",$0.00,$414.80,$0.00,$0.00,$421.53,"$2,407.50",$0.00,"$1,203.75","$1,906.74","$1,926.00",$0.00,$376.77,$0.00,$383.27,$0.00
7145545,SUP,HCPCS C1713,,7145545  -  BOLT SPNL LG 5.5MM 45MM NS DECADE PLT XLIF,"$2,407.50",$0.00,"$2,407.50","$1,083.38","$1,718.23",$0.00,$414.80,$0.00,$0.00,$421.53,"$2,407.50",$0.00,"$1,203.75","$1,906.74","$1,926.00",$0.00,$376.77,$0.00,$383.27,$0.00
7145550,SUP,HCPCS C1713,,7145550  -  BOLT SPNL LG 5.5MM 50MM NS DECADE PLT XLIF,"$2,407.50",$0.00,"$2,407.50","$1,083.38","$1,718.23",$0.00,$414.80,$0.00,$0.00,$421.53,"$2,407.50",$0.00,"$1,203.75","$1,906.74","$1,926.00",$0.00,$376.77,$0.00,$383.27,$0.00
7145555,SUP,HCPCS C1713,,7145555  -  BOLT SPNL LG 5.5MM 55MM NS DECADE PLT XLIF,"$2,407.50",$0.00,"$2,407.50","$1,083.38","$1,718.23",$0.00,$414.80,$0.00,$0.00,$421.53,"$2,407.50",$0.00,"$1,203.75","$1,906.74","$1,926.00",$0.00,$376.77,$0.00,$383.27,$0.00
7145560,SUP,HCPCS C1713,,7145560  -  BOLT SPNL LG 5.5MM 60MM NS DECADE PLT XLIF,"$2,407.50",$0.00,"$2,407.50","$1,083.38","$1,718.23",$0.00,$414.80,$0.00,$0.00,$421.53,"$2,407.50",$0.00,"$1,203.75","$1,906.74","$1,926.00",$0.00,$376.77,$0.00,$383.27,$0.00
7146525,SUP,HCPCS C1713,,7146525  -  BOLT SPNL LG 6.5MM 25MM NS DECADE PLT XLIF,"$2,407.50",$0.00,"$2,407.50","$1,083.38","$1,718.23",$0.00,$414.80,$0.00,$0.00,$421.53,"$2,407.50",$0.00,"$1,203.75","$1,906.74","$1,926.00",$0.00,$376.77,$0.00,$383.27,$0.00
7146530,SUP,HCPCS C1713,,7146530  -  BOLT SPNL LG 6.5MM 30MM NS DECADE PLT XLIF,"$2,407.50",$0.00,"$2,407.50","$1,083.38","$1,718.23",$0.00,$414.80,$0.00,$0.00,$421.53,"$2,407.50",$0.00,"$1,203.75","$1,906.74","$1,926.00",$0.00,$376.77,$0.00,$383.27,$0.00
7146535,SUP,HCPCS C1713,,7146535  -  BOLT SPNL LG 6.5MM 35MM NS DECADE PLT XLIF,"$2,407.50",$0.00,"$2,407.50","$1,083.38","$1,718.23",$0.00,$414.80,$0.00,$0.00,$421.53,"$2,407.50",$0.00,"$1,203.75","$1,906.74","$1,926.00",$0.00,$376.77,$0.00,$383.27,$0.00
7146540,SUP,HCPCS C1713,,7146540  -  BOLT SPNL LG 6.5MM 40MM NS DECADE PLT XLIF,"$2,407.50",$0.00,"$2,407.50","$1,083.38","$1,718.23",$0.00,$414.80,$0.00,$0.00,$421.53,"$2,407.50",$0.00,"$1,203.75","$1,906.74","$1,926.00",$0.00,$376.77,$0.00,$383.27,$0.00
7146545,SUP,HCPCS C1713,,7146545  -  BOLT SPNL LG 6.5MM 45MM NS DECADE PLT XLIF,"$2,407.50",$0.00,"$2,407.50","$1,083.38","$1,718.23",$0.00,$414.80,$0.00,$0.00,$421.53,"$2,407.50",$0.00,"$1,203.75","$1,906.74","$1,926.00",$0.00,$376.77,$0.00,$383.27,$0.00
7146550,SUP,HCPCS C1713,,7146550  -  BOLT SPNL LG 6.5MM 50MM NS DECADE PLT XLIF,"$2,407.50",$0.00,"$2,407.50","$1,083.38","$1,718.23",$0.00,$414.80,$0.00,$0.00,$421.53,"$2,407.50",$0.00,"$1,203.75","$1,906.74","$1,926.00",$0.00,$376.77,$0.00,$383.27,$0.00
7146555,SUP,HCPCS C1713,,7146555  -  BOLT SPNL LG 6.5MM 55MM NS DECADE PLT XLIF,"$2,407.50",$0.00,"$2,407.50","$1,083.38","$1,718.23",$0.00,$414.80,$0.00,$0.00,$421.53,"$2,407.50",$0.00,"$1,203.75","$1,906.74","$1,926.00",$0.00,$376.77,$0.00,$383.27,$0.00
7146560,SUP,HCPCS C1713,,7146560  -  BOLT SPNL LG 6.5MM 60MM NS DECADE PLT XLIF,"$2,407.50",$0.00,"$2,407.50","$1,083.38","$1,718.23",$0.00,$414.80,$0.00,$0.00,$421.53,"$2,407.50",$0.00,"$1,203.75","$1,906.74","$1,926.00",$0.00,$376.77,$0.00,$383.27,$0.00
7160012,SUP,Custom 27803010,,7160012  -  CAGE SPNL 16MM 12MM NS LF X-COR 2 STC FTPRNT TI VERT BD REPL,"$13,962.50",$0.00,"$13,962.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,962.50",$0.00,"$6,981.25","$11,058.30","$11,170.00",$0.00,$0.00,$0.00,$0.00,$0.00
7160014,SUP,Custom 27803010,,7160014  -  CAGE SPNL 16MM 14MM NS LF X-COR 2 STC FTPRNT TI VERT BD REPL,"$13,962.50",$0.00,"$13,962.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,962.50",$0.00,"$6,981.25","$11,058.30","$11,170.00",$0.00,$0.00,$0.00,$0.00,$0.00
7160022,SUP,Custom 27803010,,7160022  -  CAGE SPNL 16MM 16-22MM NS LF X-COR 2 XPD TI VERT BD REPL,"$13,962.50",$0.00,"$13,962.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,962.50",$0.00,"$6,981.25","$11,058.30","$11,170.00",$0.00,$0.00,$0.00,$0.00,$0.00
7160025,SUP,Custom 27803010,,7160025  -  CAGE SPNL 16MM 18-25MM NS LF X-COR 2 XPD TI VERT BD REPL,"$13,962.50",$0.00,"$13,962.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,962.50",$0.00,"$6,981.25","$11,058.30","$11,170.00",$0.00,$0.00,$0.00,$0.00,$0.00
7160035,SUP,Custom 27803010,,7160035  -  CAGE SPNL 16MM 23-35MM NS LF X-COR 2 XPD TI VERT BD REPL,"$13,962.50",$0.00,"$13,962.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,962.50",$0.00,"$6,981.25","$11,058.30","$11,170.00",$0.00,$0.00,$0.00,$0.00,$0.00
7160041,SUP,Custom 27803010,,7160041  -  CAGE SPNL 16MM 26-41MM NS LF X-COR 2 XPD TI VERT BD REPL,"$13,962.50",$0.00,"$13,962.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,962.50",$0.00,"$6,981.25","$11,058.30","$11,170.00",$0.00,$0.00,$0.00,$0.00,$0.00
7160049,SUP,Custom 27803010,,7160049  -  CAGE SPNL 16MM 30-49MM NS LF X-COR 2 XPD TI VERT BD REPL,"$13,962.50",$0.00,"$13,962.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,962.50",$0.00,"$6,981.25","$11,058.30","$11,170.00",$0.00,$0.00,$0.00,$0.00,$0.00
7160063,SUP,Custom 27803010,,7160063  -  CAGE SPNL 16MM 37-63MM NS LF X-COR 2 XPD TI VERT BD REPL,"$13,962.50",$0.00,"$13,962.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,962.50",$0.00,"$6,981.25","$11,058.30","$11,170.00",$0.00,$0.00,$0.00,$0.00,$0.00
7160075,SUP,Custom 27803010,,7160075  -  CAGE SPNL 16MM 43-75MM NS LF X-COR 2 XPD TI VERT BD REPL,"$13,962.50",$0.00,"$13,962.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,962.50",$0.00,"$6,981.25","$11,058.30","$11,170.00",$0.00,$0.00,$0.00,$0.00,$0.00
7162000,SUP,HCPCS C1713,,7162000  -  SCREW LOCK ENDCAP XCORE 2 TI,$620.00,$0.00,$620.00,$279.00,$442.49,$0.00,$106.82,$0.00,$0.00,$108.56,$620.00,$0.00,$310.00,$491.04,$496.00,$0.00,$97.03,$0.00,$98.70,$0.00
7164565,SUP,HCPCS C1713,,7164565  -  5.0X 65MM SCREW,$648.00,$0.00,$648.00,$291.60,$462.48,$0.00,$111.65,$0.00,$0.00,$113.46,$648.00,$0.00,$324.00,$513.22,$518.40,$0.00,$101.41,$0.00,$103.16,$0.00
7180016,SUP,Custom 27803010,,7180016  -  CAGE SPNL 18MM 16MM NS LF X-COR 2 STC FTPRNT TI VERT BD REPL,"$13,962.50",$0.00,"$13,962.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,962.50",$0.00,"$6,981.25","$11,058.30","$11,170.00",$0.00,$0.00,$0.00,$0.00,$0.00
7180018,SUP,Custom 27803010,,7180018  -  CAGE SPNL 18MM 18MM NS LF X-COR 2 STC FTPRNT TI VERT BD REPL,"$13,962.50",$0.00,"$13,962.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,962.50",$0.00,"$6,981.25","$11,058.30","$11,170.00",$0.00,$0.00,$0.00,$0.00,$0.00
7180025,SUP,Custom 27803010,,7180025  -  CAGE SPNL 18MM 20-25MM NS LF X-COR 2 XPD TI VERT BD REPL,"$13,962.50",$0.00,"$13,962.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,962.50",$0.00,"$6,981.25","$11,058.30","$11,170.00",$0.00,$0.00,$0.00,$0.00,$0.00
7180027,SUP,Custom 27803010,,7180027  -  CAGE SPNL 18MM 21-27MM NS LF X-COR 2 XPD TI VERT BD REPL,"$13,962.50",$0.00,"$13,962.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,962.50",$0.00,"$6,981.25","$11,058.30","$11,170.00",$0.00,$0.00,$0.00,$0.00,$0.00
7180033,SUP,Custom 27803010,,7180033  -  CAGE SPNL 18MM 24-33MM NS LF X-COR 2 XPD TI VERT BD REPL,"$13,962.50",$0.00,"$13,962.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,962.50",$0.00,"$6,981.25","$11,058.30","$11,170.00",$0.00,$0.00,$0.00,$0.00,$0.00
7180041,SUP,Custom 27803010,,7180041  -  CAGE SPNL 18MM 28-41MM NS LF X-COR 2 XPD TI VERT BD REPL,"$13,962.50",$0.00,"$13,962.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,962.50",$0.00,"$6,981.25","$11,058.30","$11,170.00",$0.00,$0.00,$0.00,$0.00,$0.00
7180055,SUP,Custom 27803010,,7180055  -  CAGE SPINAL 18X35-55MM X-CORE 2 TI,"$13,962.50",$0.00,"$13,962.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,962.50",$0.00,"$6,981.25","$11,058.30","$11,170.00",$0.00,$0.00,$0.00,$0.00,$0.00
7180067,SUP,Custom 27803010,,7180067  -  CAGE SPNL 18MM 41-67MM NS LF X-COR 2 XPD TI VERT BD REPL,"$13,962.50",$0.00,"$13,962.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,962.50",$0.00,"$6,981.25","$11,058.30","$11,170.00",$0.00,$0.00,$0.00,$0.00,$0.00
7180079,SUP,Custom 27803010,,7180079  -  CAGE SPNL 18MM 47-79MM NS LF X-COR 2 XPD TI VERT BD REPL,"$13,962.50",$0.00,"$13,962.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,962.50",$0.00,"$6,981.25","$11,058.30","$11,170.00",$0.00,$0.00,$0.00,$0.00,$0.00
7180121,SUP,Custom 27803010,,7180121  -  CAGE SPNL 18MM 68-121MM NS LF X-COR 2 XPD TI VERT BD REPL,"$13,962.50",$0.00,"$13,962.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,962.50",$0.00,"$6,981.25","$11,058.30","$11,170.00",$0.00,$0.00,$0.00,$0.00,$0.00
7191525,SUP,HCPCS C1713,,7191525  -  CDH 7191525 HA COATED  5.5X25,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7191530,SUP,HCPCS C1713,,7191530  -  CDH 7191530 HA COATED  5.5X30,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7191535,SUP,HCPCS C1713,,7191535  -  SCREW BN 5.5MM 35MM STRL CD HZN LGC MA HA SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7191540,SUP,HCPCS C1713,,7191540  -  SCREW BN 5.5MM 40MM STRL CD HZN LGC MA HA SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7191545,SUP,HCPCS C1713,,7191545  -  CDH 7191545 HA COATED  5.5X45,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7191550,SUP,HCPCS C1713,,7191550  -  CDH HA COATED MAS 5.5X50,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7191555,SUP,HCPCS C1713,,7191555  -  CDH HA COATED MAS 5.5X55,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7191560,SUP,HCPCS C1713,,7191560  -  CDH HA COATED MAS 5.5X60,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7191625,SUP,HCPCS C1713,,7191625  -  CDH HA COATED MAS 6.5X25,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7191630,SUP,HCPCS C1713,,7191630  -  CDH HA COATED MAS 6.5X30,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7191635,SUP,HCPCS C1713,,7191635  -  SCREW BN 6.5MM 35MM STRL CD HZN LGC MA HA SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7191640,SUP,HCPCS C1713,,7191640  -  SCREW BN 6.5MM 40MM STRL CD HZN LGC MA HA SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7191645,SUP,HCPCS C1713,,7191645  -  SCREW BN 6.5MM 45MM STRL CD HZN LGC MA HA SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7191650,SUP,HCPCS C1713,,7191650  -  CDH HA COATED MAS 6.5X50,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7191655,SUP,HCPCS C1713,,7191655  -  CDH HA COATED MAS 6.5X55,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7191660,SUP,HCPCS C1713,,7191660  -  CDH HA COATED MAS 6.5X60,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7191665,SUP,HCPCS C1713,,7191665  -  CDH HA COATED MAS 6.5X65,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7191725,SUP,HCPCS C1713,,7191725  -  CDH HA COATED MAS 7.5X25,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7191730,SUP,HCPCS C1713,,7191730  -  CDH HA COATED MAS 7.5X30,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7191735,SUP,HCPCS C1713,,7191735  -  CDH 7191735 HA COATED  7.5X35,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7191740,SUP,HCPCS C1713,,7191740  -  SCREW BN 7.5MM 40MM STRL CD HZN LGC MA HA SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7191745,SUP,HCPCS C1713,,7191745  -  SCREW 7191745 MULTI-AXIAL HA COATED,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7191750,SUP,HCPCS C1713,,7191750  -  CDH HA COATED MAS 7.5X50,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7191755,SUP,HCPCS C1713,,7191755  -  CDH HA COATED MAS 7.5X55,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7191760,SUP,HCPCS C1713,,7191760  -  CDH HA COATED MAS 7.5X60,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7191765,SUP,HCPCS C1713,,7191765  -  SCREW 7191765 CDH HA COATED MA 7.5X65,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7191770,SUP,HCPCS C1713,,7191770  -  CDH HA COATED MAS 7.5X70,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7191825,SUP,HCPCS C1713,,7191825  -  CDH HA COATED MAS 8.5X25,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7191830,SUP,HCPCS C1713,,7191830  -  CDH HA COATED MAS 8.5X30,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7191835,SUP,HCPCS C1713,,7191835  -  CDH 7191835 HA COATED  8.5X35,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7191840,SUP,HCPCS C1713,,7191840  -  SCREW 7191840 MULTI-AXIAL HA COATED,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7191845,SUP,HCPCS C1713,,7191845  -  SCREW 7191845 MULTI-AXIAL HA COATED,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7191850,SUP,HCPCS C1713,,7191850  -  CDH HA COATED MAS 8.5X50,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7191855,SUP,HCPCS C1713,,7191855  -  CDH 7191855 HA COATED  8.5X55,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7191860,SUP,HCPCS C1713,,7191860  -  CDH HA COATED MAS 8.5X60,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7191865,SUP,HCPCS C1713,,7191865  -  CDH HA COATED MAS 8.5X65,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7195535,SUP,HCPCS C1713,,7195535  -  SCREW BN 5.5MM 35MM SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7195540,SUP,HCPCS C1713,,7195540  -  SCREW BN 5.5MM 40MM 2 LD CNN SPNE PDCL,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7195545,SUP,HCPCS C1713,,7195545  -  SCREW BN 5.5MM 45MM SPHERX II 2 LCK SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7195550,SUP,HCPCS C1713,,7195550  -  SCREW BN 5.5MM 50MM 2 LD CNN SPNE PDCL,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7195555,SUP,HCPCS C1713,,7195555  -  SCREW BN 5.5MM 55MM 2 LD CNN SPNE PDCL,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7196535,SUP,HCPCS C1713,,7196535  -  SCREW BN 6.5MM 35MM SPHERX II SPNE DLS,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7196540,SUP,HCPCS C1713,,7196540  -  SCREW BN 6.5MM 40MM SPHERX II 2 LCK SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7196545,SUP,HCPCS C1713,,7196545  -  SCREW BN 6.5MM 45MM SPHERX II 2 SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7196550,SUP,HCPCS C1713,,7196550  -  SCREW BN 6.5MM 50MM SPHERX II 2 LCK SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7196555,SUP,HCPCS C1713,,7196555  -  SCREW BN 6.5MM 55MM SPHERX II 2 LCK SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7197535,SUP,HCPCS C1713,,7197535  -  SCREW BN 7.5MM 40MM SPHERX II 2 LCK SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7197540,SUP,HCPCS C1713,,7197540  -  SCREW BN 7.5MM 40MM SPHERX II 2 LCK SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7197545,SUP,HCPCS C1713,,7197545  -  SCREW BN 7.5MM 45MM 2 LD SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7197550,SUP,HCPCS C1713,,7197550  -  SCREW BN 7.5MM 50MM 2 LD SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7197555,SUP,HCPCS C1713,,7197555  -  SCREW BN 7.5MM 55MM SPHERX II PA SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7200019,SUP,HCPCS C1713,,7200019  -  PLATE BN 19MM NS ATL VS ELT 1 LVL TI SPNE CRV ANT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7200021,SUP,HCPCS C1713,,7200021  -  PLATE BN 21MM NS ATL VS ELT 1 LVL TI SPNE CRV ANT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7200023,SUP,HCPCS C1713,,7200023  -  PLATE BN 23MM NS ATL VS ELT 1 LVL TI SPNE CRV ANT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7200025,SUP,HCPCS C1713,,7200025  -  PLATE BN 25MM NS ATL VS ELT 1 LVL TI SPNE CRV ANT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7200027,SUP,HCPCS C1713,,7200027  -  PLATE BN 27.5MM NS ATL VS ELT 1 LVL TI SPNE CRV ANT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7200030,SUP,HCPCS C1713,,7200030  -  PLATE BN 30MM NS ATL VS ELT 1 LVL TI SPNE CRV ANT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7200032,SUP,HCPCS C1713,,7200032  -  PLATE 7200032 ATL VISION ELITE 32.5MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7200035,SUP,HCPCS C1713,,7200035  -  PLATE BN 35MM NS ATL VS ELT 2 LVL TI SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7200037,SUP,HCPCS C1713,,7200037  -  PLATE BN 37.5MM NS ATL VS ELT 2 LVL TI SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7200040,SUP,HCPCS C1713,,7200040  -  PLATE BN 40MM NS ATL VS ELT 2 LVL TI SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7200042,SUP,HCPCS C1713,,7200042  -  PLATE BN 42.5MM NS ATL VS ELT 2 LVL TI SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7200045,SUP,HCPCS C1713,,7200045  -  PLATE BN 45MM NS ATL VS ELT 2 LVL TI SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7200047,SUP,HCPCS C1713,,7200047  -  PLATE BN 47.5MM NS ATL VS ELT 2 LVL TI SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7200050,SUP,HCPCS C1713,,7200050  -  PLATE 7200050 ATL VISION ELITE 50MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7200052,SUP,HCPCS C1713,,7200052  -  PLATE BN 52.5MM NS ATL VS ELT 3 LVL TI SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7200055,SUP,HCPCS C1713,,7200055  -  PLATE BN 55MM NS ATL VS ELT 3 LVL TI SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7200057,SUP,HCPCS C1713,,7200057  -  PLATE BN 57.5MM NS ATL VS ELT 3 LVL TI SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7200060,SUP,HCPCS C1713,,7200060  -  PLATE BN 60MM NS ATL VS ELT 3 LVL TI SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7200062,SUP,HCPCS C1713,,7200062  -  PLATE BN 62.5MM NS ATL VS ELT 3 LVL TI SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7200065,SUP,HCPCS C1713,,7200065  -  PLATE BN 65MM NS ATL VS ELT 3 LVL TI SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7200067,SUP,HCPCS C1713,,7200067  -  PLATE BN 67.5MM NS ATL VS ELT 3 LVL TI SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7200070,SUP,HCPCS C1713,,7200070  -  PLATE 7200070 ATL VISION ELITE 70MM,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7200072,SUP,HCPCS C1713,,7200072  -  PLATE 7200072 ATL VISION ELITE 72.5MM,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7200075,SUP,HCPCS C1713,,7200075  -  PLATE 7200075 ATL VISION ELITE 75MM,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
7200077,SUP,HCPCS C1713,,7200077  -  PLATE 7200077 ATL VISION ELITE 77.5MM,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
7200080,SUP,HCPCS C1713,,7200080  -  PLATE BN 80MM NS ATL VS ELT 4 LVL TI SPNE CRV ANT,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
7200082,SUP,HCPCS C1713,,7200082  -  PLATE BN 82.5MM NS ATL VS ELT 4 LVL TI SPNE CRV ANT,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
7200085,SUP,HCPCS C1713,,7200085  -  PLATE 7200085 ATL VISION ELITE 85MM,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
7200087,SUP,HCPCS C1713,,7200087  -  PLATE 7200087 ATL VISION ELITE 87.5MM,"$4,492.00",$0.00,"$4,492.00","$2,021.40","$3,205.94",$0.00,$773.95,$0.00,$0.00,$786.51,"$4,492.00",$0.00,"$2,246.00","$3,557.66","$3,593.60",$0.00,$703.00,$0.00,$715.13,$0.00
7200090,SUP,HCPCS C1713,,7200090  -  PLATE 7200090 ATL VISION ELITE 90MM,"$4,492.00",$0.00,"$4,492.00","$2,021.40","$3,205.94",$0.00,$773.95,$0.00,$0.00,$786.51,"$4,492.00",$0.00,"$2,246.00","$3,557.66","$3,593.60",$0.00,$703.00,$0.00,$715.13,$0.00
7200095,SUP,HCPCS C1713,,7200095  -  PLATE BN 95MM NS ATL VS ELT 5 LVL TI SPNE CRV ANT,"$4,492.00",$0.00,"$4,492.00","$2,021.40","$3,205.94",$0.00,$773.95,$0.00,$0.00,$786.51,"$4,492.00",$0.00,"$2,246.00","$3,557.66","$3,593.60",$0.00,$703.00,$0.00,$715.13,$0.00
7200100,SUP,HCPCS C1713,,7200100  -  PLATE 7200100 ATL VISION ELITE 100MM,"$4,492.00",$0.00,"$4,492.00","$2,021.40","$3,205.94",$0.00,$773.95,$0.00,$0.00,$786.51,"$4,492.00",$0.00,"$2,246.00","$3,557.66","$3,593.60",$0.00,$703.00,$0.00,$715.13,$0.00
7200105,SUP,HCPCS C1713,,7200105  -  PLATE 7200105 ATL VISION ELITE 105MM,"$4,492.00",$0.00,"$4,492.00","$2,021.40","$3,205.94",$0.00,$773.95,$0.00,$0.00,$786.51,"$4,492.00",$0.00,"$2,246.00","$3,557.66","$3,593.60",$0.00,$703.00,$0.00,$715.13,$0.00
7200110,SUP,HCPCS C1713,,7200110  -  PLATE 7200110 ATL VISION ELITE 110MM,"$4,492.00",$0.00,"$4,492.00","$2,021.40","$3,205.94",$0.00,$773.95,$0.00,$0.00,$786.51,"$4,492.00",$0.00,"$2,246.00","$3,557.66","$3,593.60",$0.00,$703.00,$0.00,$715.13,$0.00
7200127,SUP,Custom 27203010,,RESERVOIR REAGENT NTR CSTR PS MT CHNL PIPETTER 50ML STRL,$1.48,$0.00,$1.48,$0.00,$1.05,$0.00,$0.00,$0.00,$0.00,$0.00,$1.48,$0.00,$0.74,$1.17,$1.18,$0.00,$0.00,$0.00,$0.00,$0.00
7200130,SUP,HCPCS C1713,,7200130  -  PLATE 7200130 ATL VISION ELITE 30MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7200132,SUP,HCPCS C1713,,7200132  -  PLATE BN 32.5MM NS ATL VS ELT 1 LVL TI SPNE CRV ANT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7200145,SUP,HCPCS C1713,,7200145  -  PLATE BN 45MM NS ATL VS ELT 3 LVL TI SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7200147,SUP,HCPCS C1713,,7200147  -  PLATE 7200147 ATL VISION ELITE 47.5MM,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7200150,SUP,HCPCS C1713,,7200150  -  PLATE BN 50MM NS ATL VS ELT 3 LVL TI SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7200152,SUP,HCPCS C1713,,7200152  -  PLATE BN 52.5MM NS ATL VS ELT 2 LVL TI SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7200155,SUP,HCPCS C1713,,7200155  -  PLATE BN 55MM NS ATL VS ELT 2 LVL TI SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7200167,SUP,HCPCS C1713,,7200167  -  PLATE 7200167 ATL VISION ELITE 67.5MM,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
7200170,SUP,HCPCS C1713,,7200170  -  PLATE BN 70MM NS ATL VS ELT 4 LVL TI SPNE CRV ANT,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
7200172,SUP,HCPCS C1713,,7200172  -  PLATE BN 72.5MM NS ATL VS ELT 4 LVL TI SPNE CRV ANT,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
7200180,SUP,HCPCS C1713,,7200180  -  PLATE BN 80MM NS ATL VS ELT 5 LVL TI SPNE CRV ANT,"$4,492.00",$0.00,"$4,492.00","$2,021.40","$3,205.94",$0.00,$773.95,$0.00,$0.00,$786.51,"$4,492.00",$0.00,"$2,246.00","$3,557.66","$3,593.60",$0.00,$703.00,$0.00,$715.13,$0.00
7200182,SUP,HCPCS C1713,,7200182  -  PLATE 7200182 ATL VISION ELITE 82.5MM,"$4,492.00",$0.00,"$4,492.00","$2,021.40","$3,205.94",$0.00,$773.95,$0.00,$0.00,$786.51,"$4,492.00",$0.00,"$2,246.00","$3,557.66","$3,593.60",$0.00,$703.00,$0.00,$715.13,$0.00
7200185,SUP,HCPCS C1713,,7200185  -  PLATE BN 85MM NS ATL VS ELT 5 LVL TI SPNE CRV ANT,"$4,492.00",$0.00,"$4,492.00","$2,021.40","$3,205.94",$0.00,$773.95,$0.00,$0.00,$786.51,"$4,492.00",$0.00,"$2,246.00","$3,557.66","$3,593.60",$0.00,$703.00,$0.00,$715.13,$0.00
7200300,SUP,Custom 27203010,,TIP PIP 1-200UL POLYPRO GRAD BVL RK NTR NSTRL,$0.13,$0.00,$0.13,$0.00,$0.09,$0.00,$0.00,$0.00,$0.00,$0.00,$0.13,$0.00,$0.06,$0.10,$0.10,$0.00,$0.00,$0.00,$0.00,$0.00
7200502,SUP,HCPCS C1713,,7200502  -  WIRE FX LNG KRSH SS ORTH,$197.50,$0.00,$197.50,$88.88,$140.96,$0.00,$34.03,$0.00,$0.00,$34.58,$197.50,$0.00,$98.75,$156.42,$158.00,$0.00,$30.91,$0.00,$31.44,$0.00
7205345,SUP,Custom 27203010,,7205345  -  DYONICS 4.5MM INCISOR PLUS BLSDE BX/6,$56.10,$0.00,$56.10,$0.00,$40.04,$0.00,$0.00,$0.00,$0.00,$0.00,$56.10,$0.00,$28.05,$44.43,$44.88,$0.00,$0.00,$0.00,$0.00,$0.00
7209984,SUP,Custom 27203010,,7209984  -  CANNU ARTHRO 72MM OBT THRD CL-TRC STRL DISP 8.5MM LATEX FREE,$61.26,$0.00,$61.26,$0.00,$43.72,$0.00,$0.00,$0.00,$0.00,$0.00,$61.26,$0.00,$30.63,$48.52,$49.01,$0.00,$0.00,$0.00,$0.00,$0.00
7209985,SUP,Custom 27203010,,7209985  -  CANNU ENDSCP GRY 72MM OBT THRD CL-TRC CMPLT STRL DISP 7MM,$61.26,$0.00,$61.26,$0.00,$43.72,$0.00,$0.00,$0.00,$0.00,$0.00,$61.26,$0.00,$30.63,$48.52,$49.01,$0.00,$0.00,$0.00,$0.00,$0.00
7217020,SUP,HCPCS C1713,,7217020  -  ROD SPNL PREBNT 20MM,"$1,247.50",$0.00,"$1,247.50",$561.38,$890.34,$0.00,$214.94,$0.00,$0.00,$218.43,"$1,247.50",$0.00,$623.75,$988.02,$998.00,$0.00,$195.23,$0.00,$198.60,$0.00
7217025,SUP,HCPCS C1713,,7217025  -  ROD SPNL PREBNT 6MM 25MM SPHERX TI,"$1,247.50",$0.00,"$1,247.50",$561.38,$890.34,$0.00,$214.94,$0.00,$0.00,$218.43,"$1,247.50",$0.00,$623.75,$988.02,$998.00,$0.00,$195.23,$0.00,$198.60,$0.00
7217030,SUP,HCPCS C1713,,7217030  -  ROD SPNL PREBNT 6MM 30MM SPHERX DBR II TI,"$1,247.50",$0.00,"$1,247.50",$561.38,$890.34,$0.00,$214.94,$0.00,$0.00,$218.43,"$1,247.50",$0.00,$623.75,$988.02,$998.00,$0.00,$195.23,$0.00,$198.60,$0.00
7217035,SUP,HCPCS C1713,,7217035  -  ROD SPNL PREBNT 6MM 35MM TI,"$1,247.50",$0.00,"$1,247.50",$561.38,$890.34,$0.00,$214.94,$0.00,$0.00,$218.43,"$1,247.50",$0.00,$623.75,$988.02,$998.00,$0.00,$195.23,$0.00,$198.60,$0.00
7217040,SUP,HCPCS C1713,,7217040  -  ROD SPNL PREBNT 40MM SPHERX DBR II TI,"$1,247.50",$0.00,"$1,247.50",$561.38,$890.34,$0.00,$214.94,$0.00,$0.00,$218.43,"$1,247.50",$0.00,$623.75,$988.02,$998.00,$0.00,$195.23,$0.00,$198.60,$0.00
7217045,SUP,HCPCS C1713,,7217045  -  ROD SPNL PREBNT 45MM,"$1,247.50",$0.00,"$1,247.50",$561.38,$890.34,$0.00,$214.94,$0.00,$0.00,$218.43,"$1,247.50",$0.00,$623.75,$988.02,$998.00,$0.00,$195.23,$0.00,$198.60,$0.00
7217050,SUP,HCPCS C1713,,7217050  -  ROD SPNL PREBNT 6MM 50MM TI,"$1,247.50",$0.00,"$1,247.50",$561.38,$890.34,$0.00,$214.94,$0.00,$0.00,$218.43,"$1,247.50",$0.00,$623.75,$988.02,$998.00,$0.00,$195.23,$0.00,$198.60,$0.00
7217055,SUP,HCPCS C1713,,7217055  -  ROD SPNL PREBNT 55MM NS SPHERX DBR II TI,"$1,247.50",$0.00,"$1,247.50",$561.38,$890.34,$0.00,$214.94,$0.00,$0.00,$218.43,"$1,247.50",$0.00,$623.75,$988.02,$998.00,$0.00,$195.23,$0.00,$198.60,$0.00
7217060,SUP,HCPCS C1713,,7217060  -  ROD SPNL PREBNT 60MM SPHERX DBR II TI,"$1,247.50",$0.00,"$1,247.50",$561.38,$890.34,$0.00,$214.94,$0.00,$0.00,$218.43,"$1,247.50",$0.00,$623.75,$988.02,$998.00,$0.00,$195.23,$0.00,$198.60,$0.00
7217065,SUP,HCPCS C1713,,7217065  -  ROD SPNL PREBNT 65MM SPHERX DBR II TI,"$1,247.50",$0.00,"$1,247.50",$561.38,$890.34,$0.00,$214.94,$0.00,$0.00,$218.43,"$1,247.50",$0.00,$623.75,$988.02,$998.00,$0.00,$195.23,$0.00,$198.60,$0.00
7217070,SUP,HCPCS C1713,,7217070  -  ROD SPNL PREBNT 70MM SPHERX DBR II TI,"$1,247.50",$0.00,"$1,247.50",$561.38,$890.34,$0.00,$214.94,$0.00,$0.00,$218.43,"$1,247.50",$0.00,$623.75,$988.02,$998.00,$0.00,$195.23,$0.00,$198.60,$0.00
7217075,SUP,HCPCS C1713,,7217075  -  ROD SPNL PREBNT 75MM SPHERX DBR II TI,"$1,247.50",$0.00,"$1,247.50",$561.38,$890.34,$0.00,$214.94,$0.00,$0.00,$218.43,"$1,247.50",$0.00,$623.75,$988.02,$998.00,$0.00,$195.23,$0.00,$198.60,$0.00
7217080,SUP,HCPCS C1713,,7217080  -  ROD SPNL PREBNT 80MM SPHERX DBR II TI,"$1,247.50",$0.00,"$1,247.50",$561.38,$890.34,$0.00,$214.94,$0.00,$0.00,$218.43,"$1,247.50",$0.00,$623.75,$988.02,$998.00,$0.00,$195.23,$0.00,$198.60,$0.00
7217085,SUP,HCPCS C1713,,7217085  -  ROD SPNL PREBNT 85MM SPHERX DBR II,"$1,425.00",$0.00,"$1,425.00",$641.25,"$1,017.02",$0.00,$245.52,$0.00,$0.00,$249.51,"$1,425.00",$0.00,$712.50,"$1,128.60","$1,140.00",$0.00,$223.01,$0.00,$226.86,$0.00
7217090,SUP,HCPCS C1713,,7217090  -  ROD SPNL PREBNT 90MM SPHERX DBR II,"$1,425.00",$0.00,"$1,425.00",$641.25,"$1,017.02",$0.00,$245.52,$0.00,$0.00,$249.51,"$1,425.00",$0.00,$712.50,"$1,128.60","$1,140.00",$0.00,$223.01,$0.00,$226.86,$0.00
7217095,SUP,HCPCS C1713,,7217095  -  ROD SPNL PREBNT 95MM SPHERX DBR II,"$1,425.00",$0.00,"$1,425.00",$641.25,"$1,017.02",$0.00,$245.52,$0.00,$0.00,$249.51,"$1,425.00",$0.00,$712.50,"$1,128.60","$1,140.00",$0.00,$223.01,$0.00,$226.86,$0.00
7217100,SUP,HCPCS C1713,,7217100  -  ROD SPNL PREBNT 100MM SPHERX DBR II,"$1,425.00",$0.00,"$1,425.00",$641.25,"$1,017.02",$0.00,$245.52,$0.00,$0.00,$249.51,"$1,425.00",$0.00,$712.50,"$1,128.60","$1,140.00",$0.00,$223.01,$0.00,$226.86,$0.00
7217105,SUP,HCPCS C1713,,7217105  -  ROD SPNL PREBNT 105MM SPHERX DBR II,"$1,425.00",$0.00,"$1,425.00",$641.25,"$1,017.02",$0.00,$245.52,$0.00,$0.00,$249.51,"$1,425.00",$0.00,$712.50,"$1,128.60","$1,140.00",$0.00,$223.01,$0.00,$226.86,$0.00
7217110,SUP,HCPCS C1713,,7217110  -  ROD SPNL PREBNT 110MM SPHERX DBR II TI,"$1,425.00",$0.00,"$1,425.00",$641.25,"$1,017.02",$0.00,$245.52,$0.00,$0.00,$249.51,"$1,425.00",$0.00,$712.50,"$1,128.60","$1,140.00",$0.00,$223.01,$0.00,$226.86,$0.00
7217120,SUP,HCPCS C1713,,7217120  -  ROD SPNL PREBNT 120MM SPHERX DBR II TI,"$1,425.00",$0.00,"$1,425.00",$641.25,"$1,017.02",$0.00,$245.52,$0.00,$0.00,$249.51,"$1,425.00",$0.00,$712.50,"$1,128.60","$1,140.00",$0.00,$223.01,$0.00,$226.86,$0.00
7217130,SUP,HCPCS C1713,,7217130  -  ROD SPNL PREBNT 130MM SPHERX DBR II,"$1,425.00",$0.00,"$1,425.00",$641.25,"$1,017.02",$0.00,$245.52,$0.00,$0.00,$249.51,"$1,425.00",$0.00,$712.50,"$1,128.60","$1,140.00",$0.00,$223.01,$0.00,$226.86,$0.00
7217140,SUP,HCPCS C1713,,7217140  -  ROD SPNL PREBNT 140MM SPHERX II DBR,"$1,425.00",$0.00,"$1,425.00",$641.25,"$1,017.02",$0.00,$245.52,$0.00,$0.00,$249.51,"$1,425.00",$0.00,$712.50,"$1,128.60","$1,140.00",$0.00,$223.01,$0.00,$226.86,$0.00
7217150,SUP,HCPCS C1713,,7217150  -  ROD SPNL PREBNT 150MM SPHERX DBR II,"$1,425.00",$0.00,"$1,425.00",$641.25,"$1,017.02",$0.00,$245.52,$0.00,$0.00,$249.51,"$1,425.00",$0.00,$712.50,"$1,128.60","$1,140.00",$0.00,$223.01,$0.00,$226.86,$0.00
7220016,SUP,Custom 27803010,,7220016  -  CAGE SPNL 22MM 16MM NS LF X-COR 2 STC FTPRNT TI VERT BD REPL,"$13,962.50",$0.00,"$13,962.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,962.50",$0.00,"$6,981.25","$11,058.30","$11,170.00",$0.00,$0.00,$0.00,$0.00,$0.00
7220018,SUP,Custom 27803010,,7220018  -  CAGE SPNL 22MM 18MM NS LF X-COR 2 STC FTPRNT TI VERT BD REPL,"$13,962.50",$0.00,"$13,962.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,962.50",$0.00,"$6,981.25","$11,058.30","$11,170.00",$0.00,$0.00,$0.00,$0.00,$0.00
7220025,SUP,Custom 27803010,,7220025  -  CAGE SPNL 22MM 20-25MM NS LF X-COR 2 XPD TI VERT BD REPL,"$13,962.50",$0.00,"$13,962.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,962.50",$0.00,"$6,981.25","$11,058.30","$11,170.00",$0.00,$0.00,$0.00,$0.00,$0.00
7220027,SUP,Custom 27803010,,7220027  -  CAGE SPINAL 22X21-27MM X-CORE 2 TI,"$13,962.50",$0.00,"$13,962.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,962.50",$0.00,"$6,981.25","$11,058.30","$11,170.00",$0.00,$0.00,$0.00,$0.00,$0.00
7220033,SUP,Custom 27803010,,7220033  -  CAGE SPNL 22MM 24-33MM NS LF X-COR 2 XPD TI VERT BD REPL,"$13,962.50",$0.00,"$13,962.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,962.50",$0.00,"$6,981.25","$11,058.30","$11,170.00",$0.00,$0.00,$0.00,$0.00,$0.00
7220041,SUP,Custom 27803010,,7220041  -  CAGE SPNL 22MM 28-41MM NS LF X-COR 2 XPD TI VERT BD REPL,"$13,962.50",$0.00,"$13,962.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,962.50",$0.00,"$6,981.25","$11,058.30","$11,170.00",$0.00,$0.00,$0.00,$0.00,$0.00
7220055,SUP,Custom 27803010,,7220055  -  CAGE SPNL 22MM 35-55MM NS LF X-COR 2 XPD TI VERT BD REPL,"$13,962.50",$0.00,"$13,962.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,962.50",$0.00,"$6,981.25","$11,058.30","$11,170.00",$0.00,$0.00,$0.00,$0.00,$0.00
7220067,SUP,Custom 27803010,,7220067  -  CAGE SPNL 22MM 41-67MM NS LF X-COR 2 XPD TI VERT BD REPL,"$13,962.50",$0.00,"$13,962.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,962.50",$0.00,"$6,981.25","$11,058.30","$11,170.00",$0.00,$0.00,$0.00,$0.00,$0.00
7220079,SUP,Custom 27803010,,7220079  -  CAGE SPNL 22MM 47-79MM NS LF X-COR 2 XPD TI VERT BD REPL,"$13,962.50",$0.00,"$13,962.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,962.50",$0.00,"$6,981.25","$11,058.30","$11,170.00",$0.00,$0.00,$0.00,$0.00,$0.00
7220121,SUP,Custom 27803010,,7220121  -  CAGE SPNL 22MM 68-121MM NS LF X-COR 2 XPD TI VERT BD REPL,"$13,962.50",$0.00,"$13,962.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,962.50",$0.00,"$6,981.25","$11,058.30","$11,170.00",$0.00,$0.00,$0.00,$0.00,$0.00
7220850,SUP,HCPCS C1713,,7220850  -  SCREW SET 50MM 8.5MM SPNL,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
7222200,SUP,Custom 27803010,,7222200  -  ENDCAP SPNL 22MM RND 0 DEG OD 22 XCORE 2 TI,"$2,295.00",$0.00,"$2,295.00",$0.00,"$1,637.94",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,295.00",$0.00,"$1,147.50","$1,817.64","$1,836.00",$0.00,$0.00,$0.00,$0.00,$0.00
7222204,SUP,Custom 27803010,,7222204  -  ENDCAP SPNL 22MM RND 4 DEG OD 22 XCORE 2 TI,"$2,295.00",$0.00,"$2,295.00",$0.00,"$1,637.94",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,295.00",$0.00,"$1,147.50","$1,817.64","$1,836.00",$0.00,$0.00,$0.00,$0.00,$0.00
7222208,SUP,Custom 27803010,,7222208  -  ENDCAP SPNL 22MM RND 8 DEG OD 22 XCORE 2 TI,"$2,295.00",$0.00,"$2,295.00",$0.00,"$1,637.94",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,295.00",$0.00,"$1,147.50","$1,817.64","$1,836.00",$0.00,$0.00,$0.00,$0.00,$0.00
7222212,SUP,Custom 27803010,,7222212  -  ENDCAP SPNL 22MM RND 12 DEG OD 22 XCORE 2 TI,"$2,295.00",$0.00,"$2,295.00",$0.00,"$1,637.94",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,295.00",$0.00,"$1,147.50","$1,817.64","$1,836.00",$0.00,$0.00,$0.00,$0.00,$0.00
7224000,SUP,Custom 27803010,,7224000  -  ENDCAP SPNL OD 22X22X40MM 0 DEG XCORE 2 TI,"$3,157.50",$0.00,"$3,157.50",$0.00,"$2,253.51",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,157.50",$0.00,"$1,578.75","$2,500.74","$2,526.00",$0.00,$0.00,$0.00,$0.00,$0.00
7224004,SUP,Custom 27803010,,7224004  -  ENDCAP SPNL OD 22X22X40MM 4 DEG XCORE 2 TI,"$3,157.50",$0.00,"$3,157.50",$0.00,"$2,253.51",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,157.50",$0.00,"$1,578.75","$2,500.74","$2,526.00",$0.00,$0.00,$0.00,$0.00,$0.00
7224008,SUP,Custom 27803010,,7224008  -  ENDCAP SPNL OD 22X22X40MM 8 DEG XCORE 2 TI,"$3,157.50",$0.00,"$3,157.50",$0.00,"$2,253.51",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,157.50",$0.00,"$1,578.75","$2,500.74","$2,526.00",$0.00,$0.00,$0.00,$0.00,$0.00
7224012,SUP,Custom 27803010,,7224012  -  ENDCAP SPNL OD 22X22X40MM 12 DEG XCORE 2 TI,"$3,157.50",$0.00,"$3,157.50",$0.00,"$2,253.51",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,157.50",$0.00,"$1,578.75","$2,500.74","$2,526.00",$0.00,$0.00,$0.00,$0.00,$0.00
7225000,SUP,Custom 27803010,,7225000  -  ENDCAP SPNL OD 22X22X50MM 0 DEG XCORE 2 TI,"$3,157.50",$0.00,"$3,157.50",$0.00,"$2,253.51",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,157.50",$0.00,"$1,578.75","$2,500.74","$2,526.00",$0.00,$0.00,$0.00,$0.00,$0.00
7225004,SUP,Custom 27803010,,7225004  -  ENDCAP SPNL OD 22X22X50MM 4 DEG XCORE 2 TI,"$3,157.50",$0.00,"$3,157.50",$0.00,"$2,253.51",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,157.50",$0.00,"$1,578.75","$2,500.74","$2,526.00",$0.00,$0.00,$0.00,$0.00,$0.00
7225008,SUP,Custom 27803010,,7225008  -  ENDCAP SPNL OD 22X22X50MM 8 DEG XCORE 2 TI,"$3,157.50",$0.00,"$3,157.50",$0.00,"$2,253.51",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,157.50",$0.00,"$1,578.75","$2,500.74","$2,526.00",$0.00,$0.00,$0.00,$0.00,$0.00
7225012,SUP,Custom 27803010,,7225012  -  ENDCAP SPNL OD 22X22X50MM 12 DEG XCORE 2 TI,"$3,157.50",$0.00,"$3,157.50",$0.00,"$2,253.51",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,157.50",$0.00,"$1,578.75","$2,500.74","$2,526.00",$0.00,$0.00,$0.00,$0.00,$0.00
7226000,SUP,Custom 27803010,,7226000  -  ENDCAP SPNL OD 22X22X60MM 0 DEG XCORE 2 TI,"$3,157.50",$0.00,"$3,157.50",$0.00,"$2,253.51",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,157.50",$0.00,"$1,578.75","$2,500.74","$2,526.00",$0.00,$0.00,$0.00,$0.00,$0.00
7226004,SUP,Custom 27803010,,7226004  -  ENDCAP SPNL OD 22X22X60MM 4 DEG XCORE 2 TI,"$3,157.50",$0.00,"$3,157.50",$0.00,"$2,253.51",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,157.50",$0.00,"$1,578.75","$2,500.74","$2,526.00",$0.00,$0.00,$0.00,$0.00,$0.00
7226008,SUP,Custom 27803010,,7226008  -  ENDCAP SPNL OD 22X22X60MM 8 DEG XCORE 2 TI,"$3,157.50",$0.00,"$3,157.50",$0.00,"$2,253.51",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,157.50",$0.00,"$1,578.75","$2,500.74","$2,526.00",$0.00,$0.00,$0.00,$0.00,$0.00
7240033,SUP,HCPCS C1713,,7240033  -  TMPLT ROD 250MM,"$1,012.50",$0.00,"$1,012.50",$455.63,$722.62,$0.00,$174.45,$0.00,$0.00,$177.28,"$1,012.50",$0.00,$506.25,$801.90,$810.00,$0.00,$158.46,$0.00,$161.19,$0.00
7240034,SUP,HCPCS C1713,,7240034  -  TMPLT ROD 500MM SPHERX 2 TI,"$1,187.50",$0.00,"$1,187.50",$534.38,$847.52,$0.00,$204.60,$0.00,$0.00,$207.92,"$1,187.50",$0.00,$593.75,$940.50,$950.00,$0.00,$185.84,$0.00,$189.05,$0.00
7241045,SUP,HCPCS C1713,,7241045  -  CONNECTOR ROD 45-60MM SPHERX II TRNSV TI SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7241055,SUP,HCPCS C1713,,7241055  -  CONNECTOR ROD 55-81MM SPHERX II TRNSV TI SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7241075,SUP,HCPCS C1713,,7241075  -  CONNECTOR ROD 74-85MM SPHERX II TRNSV TI SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7241100,SUP,HCPCS C1713,,7241100  -  SCREW BN SM 1.5MM 10MM SPHERX DBR II LCK TI SPNE,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
7241102,SUP,HCPCS C1713,,7241102  -  HOOK SPNL SM SPHERX II TI PDCL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
7241103,SUP,HCPCS C1713,,7241103  -  HOOK SPNL MED SPHERX II TI PDCL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
7241104,SUP,HCPCS C1713,,7241104  -  HOOK SPNL 6MM SPHERX II NAR BLDE TI LMR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
7241105,SUP,HCPCS C1713,,7241105  -  HOOK SPNL 8MM SPHERX II NAR BLDE TI LMR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
7241106,SUP,HCPCS C1713,,7241106  -  HOOK SPNL 10MM SPHERX II NAR BLDE TI LMR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
7241107,SUP,HCPCS C1713,,7241107  -  HOOK SPNL 6MM SPHERX II W BLDE ANG LMR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
7241108,SUP,HCPCS C1713,,7241108  -  HOOK SPNL 8MM SPHERX II W BLDE ANG LMR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
7241109,SUP,HCPCS C1713,,7241109  -  HOOK SPNL 10MM SPHERX II W BLDE ANG LMR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
7241110,SUP,HCPCS C1713,,7241110  -  HOOK SPNL 6MM SPHERX II NAR BLDE ANG RDC TIP LMR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
7241111,SUP,HCPCS C1713,,7241111  -  HOOK SPNL 8MM SPHERX II NAR BLDE ANG RDC TIP LMR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
7241112,SUP,HCPCS C1713,,7241112  -  HOOK SPNL 10MM SPHERX II NAR BLDE ANG RDC TIP LMR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
7241113,SUP,HCPCS C1713,,7241113  -  HOOK SPNL 6MM SPHERX II WA RDC TIP LMR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
7241114,SUP,HCPCS C1713,,7241114  -  HOOK SPNL 8MM SPHERX II W BLDE ANG RDC TIP LMR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
7241115,SUP,HCPCS C1713,,7241115  -  HOOK SPNL 10MM SPHERX II W BLDE ANG RDC TIP LMR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
7241116,SUP,HCPCS C1713,,7241116  -  HOOK SPNL 6MM SPHERX II NAR BLDE DN ANG LMR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
7241117,SUP,HCPCS C1713,,7241117  -  HOOK SPNL 8MM SPHERX II NAR BLDE DN ANG LMR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
7241118,SUP,HCPCS C1713,,7241118  -  HOOK SPNL 10MM SPHERX II NAR BLDE DN ANG LMR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
7241119,SUP,HCPCS C1713,,7241119  -  HOOK SPNL 6MM SPHERX II NAR BLDE ANG XTD LMR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
7241120,SUP,HCPCS C1713,,7241120  -  HOOK SPNL 8MM SPHERX II NAR BLDE ANG XTD LMR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
7241121,SUP,HCPCS C1713,,7241121  -  HOOK SPNL 45D SPHERX II NAR BLDE ANG,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
7241122,SUP,HCPCS C1713,,7241122  -  HOOK SPNL SPHERX II NAR BLDE ANG RT OFST,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
7241123,SUP,HCPCS C1713,,7241123  -  HOOK SPNL SPHERX II NAR BLDE ANG LT OFST,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
7241124,SUP,HCPCS C1713,,7241124  -  HOOK SPNL SPHERX II NAR BLDE ANG RT OFST,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
7241125,SUP,HCPCS C1713,,7241125  -  HOOK SPNL SPHERX II NAR BLDE ANG LT OFST,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
7241131,SUP,HCPCS C1713,,7241131  -  HOOK SPNL 6MM SPHERX II ANG UP LMR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
7241132,SUP,HCPCS C1713,,7241132  -  HOOK SPNL 8MM SPHERX II ANG UP LMR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
7241133,SUP,HCPCS C1713,,7241133  -  HOOK SPNL 10MM SPHERX II ANG UP LMR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
7241200,SUP,HCPCS C1713,,7241200  -  CONNECTOR ROD 20MM SPHERX II TRNSV FA SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7241225,SUP,HCPCS C1713,,7241225  -  CONNECTOR ROD 22MM SPHERX II TRNSV FA SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7241250,SUP,HCPCS C1713,,7241250  -  CONNECTOR ROD 25MM SPHERX II TRNSV FA SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7241275,SUP,HCPCS C1713,,7241275  -  CONNECTOR ROD 27MM SPHERX II TRNSV FA SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7241300,SUP,HCPCS C1713,,7241300  -  CONNECTOR ROD 30MM TI SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7241325,SUP,HCPCS C1713,,7241325  -  CONNECTOR ROD 32.5MM TRNSV FX SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7241350,SUP,HCPCS C1713,,7241350  -  CONNECTOR ROD 35MM SPHERX II TRNSV FA TI SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7241375,SUP,HCPCS C1713,,7241375  -  CONNECTOR ROD 37.5MM SPHERX II TRNSV FA TI SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7241400,SUP,HCPCS C1713,,7241400  -  CONNECTOR ROD 40MM SPHERX II TRNSV FA TI SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7241450,SUP,HCPCS C1713,,7241450  -  CONNECTOR ROD 45MM SPHERX II TRNSV FA TI SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7241500,SUP,HCPCS C1713,,7241500  -  CONNECTOR ROD 50MM SPHERX II TRNSV FA TI SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7241550,SUP,HCPCS C1713,,7241550  -  CONNECTOR ROD 55MM SPHERX II TRNSV FA TI SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7241600,SUP,HCPCS C1713,,7241600  -  CONNECTOR ROD 60MM SPHERX II TRNSV FA TI SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7242020,SUP,HCPCS C1713,,7242020  -  ROD SPNL PREBNT 20MM SPHERX II,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
7242030,SUP,HCPCS C1713,,7242030  -  ROD SPNL PREBNT 30MM SPHERX II,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
7242035,SUP,HCPCS C1713,,7242035  -  ROD SPNL PREBNT 35MM SPHERX II,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
7242040,SUP,HCPCS C1713,,7242040  -  ROD SPINAL 40MM PREBENT CONVENTIONAL SPHERX II,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
7242050,SUP,HCPCS C1713,,7242050  -  ROD SPNL PREBNT 50MM SPHERX II,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
7242055,SUP,HCPCS C1713,,7242055  -  ROD SPNL PREBNT 55MM NS SPHERX II MAS PLIF,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
7242060,SUP,HCPCS C1713,,7242060  -  ROD SPNL PREBNT 60MM SPHERX II,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
7242065,SUP,HCPCS C1713,,7242065  -  ROD SPNL PREBNT 65MM SPHERX II,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
7242070,SUP,HCPCS C1713,,7242070  -  ROD SPNL PREBNT 70MM SPHERX II,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
7242075,SUP,HCPCS C1713,,7242075  -  ROD SPINAL 75MM PREBENT CONVENTIONAL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
7242080,SUP,HCPCS C1713,,7242080  -  ROD SPNL PREBNT 80MM NS SPHERX II MAS PLIF,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
7242085,SUP,HCPCS C1713,,7242085  -  ROD SPNL PREBNT 85MM SPHERX II,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
7242095,SUP,HCPCS C1713,,7242095  -  ROD SPNL PREBNT 95MM SPHERX II,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
7242110,SUP,HCPCS C1713,,7242110  -  ROD SPNL PREBNT 110MM SPHERX II,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
7243045,SUP,HCPCS C1713,,7243045  -  TRANSCONNECTOR ROD PREBNT 45-50MM ADJ ARCH SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7243050,SUP,HCPCS C1713,,7243050  -  CONNECTOR ROD 50-60MM TRNSV SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7243060,SUP,HCPCS C1713,,7243060  -  TRANSCONNECTOR ROD 60-70MM ADJ ARCH VAR SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7243070,SUP,HCPCS C1713,,7243070  -  CONNECTOR ROD 70-85MM VAR ADJ TRANSVRS,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7245525,SUP,HCPCS C1713,,7245525  -  SCREW BN 5.5MM 25MM SPHERX DBR II PA SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7245530,SUP,HCPCS C1713,,7245530  -  SCREW BN 5.5MM 30MM SPHERX DBR II PA TI SPNE 5.5MM ROD,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7245535,SUP,HCPCS C1713,,7245535  -  SCREW BN 5.5MM 35MM SPHERX DBR II PA TI SPNE 5.5MM ROD,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7245540,SUP,HCPCS C1713,,7245540  -  SCREW BN 5.5MM 40MM PA SPNE 5.5MM ROD,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7245545,SUP,HCPCS C1713,,7245545  -  SCREW BN 5.5MM 45MM SPHERX DBR II PA TI SPNE 5.5MM ROD,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7245550,SUP,HCPCS C1713,,7245550  -  SCREW BN 5.5MM 50MM SPHERX DBR II PA TI SPNE 5.5MM ROD,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7245555,SUP,HCPCS C1713,,7245555  -  SCREW BN 5.5MM 55MM SPHERX II PA TI SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7245560,SUP,HCPCS C1713,,7245560  -  SCREW BN 5.5MM 60MM SPHERX II PA SPNE 5.5MM ROD,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7246510,SUP,HCPCS C1713,,7246510  -  SCREW BN 6.5MM 100MM PA ILIUM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7246525,SUP,HCPCS C1713,,7246525  -  SCREW BN 6.5MM 25MM SPHERX II PA SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7246530,SUP,HCPCS C1713,,7246530  -  SCREW BN 6.5MM 30MM SPHERX DBR II PA TI SPNE 5.5MM ROD,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7246535,SUP,HCPCS C1713,,7246535  -  SCREW BN 6.5MM 35MM SPHERX DBR II PA TI SPNE 5.5MM ROD,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7246540,SUP,HCPCS C1713,,7246540  -  SCREW BN 6.5MM 40MM SPHERX DBR II PA TI SPNE 5.5MM ROD,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7246545,SUP,HCPCS C1713,,7246545  -  SCREW BN 6.5MM 45MM SPHERX DBR II PA TI SPNE 5.5MM ROD,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7246550,SUP,HCPCS C1713,,7246550  -  SCREW BN 6.5MM 50MM SPHERX DBR II PA TI SPNE 5.5MM ROD,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7246555,SUP,HCPCS C1713,,7246555  -  SCREW BN 6.5MM 55MM SPHERX II PA TI SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7246560,SUP,HCPCS C1713,,7246560  -  SCREW BN 6.5MM 60MM SPHERX II PA TI SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7246565,SUP,HCPCS C1713,,7246565  -  SCREW BN 6.5MM 65MM PA ILIUM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7246570,SUP,HCPCS C1713,,7246570  -  SCREW BN 6.5MM 70MM PA ILIUM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7246575,SUP,HCPCS C1713,,7246575  -  SCREW BN 6.5MM 75MM PA ILIUM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7246580,SUP,HCPCS C1713,,7246580  -  SCREW BN 6.5MM 80MM PA ILIUM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7246585,SUP,HCPCS C1713,,7246585  -  SCREW BN 6.5MM 85MM PA ILIUM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7246590,SUP,HCPCS C1713,,7246590  -  SCREW BN 6.5MM 90MM PA ILIUM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7246595,SUP,HCPCS C1713,,7246595  -  SCREW BN 6.5MM 95MM PA ILIUM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7247510,SUP,HCPCS C1713,,7247510  -  SCREW BN 7.5MM 100MM PA ILIUM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7247525,SUP,HCPCS C1713,,7247525  -  SCREW BN 7.5MM 25MM SPHERX II PA SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7247530,SUP,HCPCS C1713,,7247530  -  SCREW BN 7.5MM 30MM SPHERX II PA TI SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7247535,SUP,HCPCS C1713,,7247535  -  SCREW BN 7.5MM 35MM SPHERX DBR II PA TI SPNE 5.5MM ROD,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7247540,SUP,HCPCS C1713,,7247540  -  SCREW BN 7.5MM 40MM SPHERX II PA TI SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7247545,SUP,HCPCS C1713,,7247545  -  SCREW BN 7.5MM 45MM SPHERX DBR II PA TI SPNE 5.5MM ROD,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7247550,SUP,HCPCS C1713,,7247550  -  SCREW BN 7.5MM 50MM SPHERX II PA TI SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7247555,SUP,HCPCS C1713,,7247555  -  SCREW BN 7.5MM 55MM SPHERX II PA TI SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7247560,SUP,HCPCS C1713,,7247560  -  SCREW BN 7.5MM 60MM SPHERX II PA TI SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7247565,SUP,HCPCS C1713,,7247565  -  SCREW BN 7.5MM 65MM PA ILIUM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7247570,SUP,HCPCS C1713,,7247570  -  SCREW BN 7.5MM 70MM PA ILIUM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7247575,SUP,HCPCS C1713,,7247575  -  SCREW BN 7.5MM 75MM PA ILIUM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7247580,SUP,HCPCS C1713,,7247580  -  SCREW BN 7.5MM 80MM PA ILIUM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7247585,SUP,HCPCS C1713,,7247585  -  SCREW BN 7.5MM 85MM PA ILIUM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7247590,SUP,HCPCS C1713,,7247590  -  SCREW BN 7.5MM 90MM PA ILIUM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7247595,SUP,HCPCS C1713,,7247595  -  SCREW BN 7.5MM 95MM PA ILIUM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7248025,SUP,HCPCS C1713,,7248025  -  ROD SPNL 25MM SPHERX II CNV,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7248030,SUP,HCPCS C1713,,7248030  -  ROD SPNL 30MM SPHERX II CNV,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7248035,SUP,HCPCS C1713,,7248035  -  ROD SPNL 35MM SPHERX II CNV,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7248040,SUP,HCPCS C1713,,7248040  -  ROD SPNL 40MM SPHERX II CNV,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7248045,SUP,HCPCS C1713,,7248045  -  ROD SPNL 45MM SPHERX II CNV,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7248050,SUP,HCPCS C1713,,7248050  -  ROD SPNL 50MM SPHERX II CNV,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7248055,SUP,HCPCS C1713,,7248055  -  ROD SPNL 55MM SPHERX II CNV,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7248060,SUP,HCPCS C1713,,7248060  -  ROD SPNL 60MM SPHERX II CNV,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7248065,SUP,HCPCS C1713,,7248065  -  ROD SPNL 65MM SPHERX II CNV,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7248070,SUP,HCPCS C1713,,7248070  -  ROD SPNL 70MM SPHERX II CNV,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7248075,SUP,HCPCS C1713,,7248075  -  ROD SPNL 75MM SPHERX II CNV,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7248080,SUP,HCPCS C1713,,7248080  -  ROD SPNL 80MM SPHERX DBR II THOR,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7248085,SUP,HCPCS C1713,,7248085  -  ROD SPNL 85MM SPHERX II CNV,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7248090,SUP,HCPCS C1713,,7248090  -  ROD SPNL 90MM SPHERX II CNV,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7248095,SUP,HCPCS C1713,,7248095  -  ROD SPNL 95MM SPHERX II CNV,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7248100,SUP,HCPCS C1713,,7248100  -  ROD SPNL 100MM SPHERX II CNV,$600.00,$0.00,$600.00,$270.00,$428.22,$0.00,$103.38,$0.00,$0.00,$105.06,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$93.90,$0.00,$95.52,$0.00
7248105,SUP,HCPCS C1713,,7248105  -  ROD SPNL 105MM SPHERX II CNV,$600.00,$0.00,$600.00,$270.00,$428.22,$0.00,$103.38,$0.00,$0.00,$105.06,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$93.90,$0.00,$95.52,$0.00
7248110,SUP,HCPCS C1713,,7248110  -  ROD SPNL 110MM SPHERX II CNV,$600.00,$0.00,$600.00,$270.00,$428.22,$0.00,$103.38,$0.00,$0.00,$105.06,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$93.90,$0.00,$95.52,$0.00
7248115,SUP,HCPCS C1713,,7248115  -  ROD SPNL 115MM SPHERX II CNV,$600.00,$0.00,$600.00,$270.00,$428.22,$0.00,$103.38,$0.00,$0.00,$105.06,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$93.90,$0.00,$95.52,$0.00
7248120,SUP,HCPCS C1713,,7248120  -  ROD SPNL 120MM SPHERX II CNV,$600.00,$0.00,$600.00,$270.00,$428.22,$0.00,$103.38,$0.00,$0.00,$105.06,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$93.90,$0.00,$95.52,$0.00
7248125,SUP,HCPCS C1713,,7248125  -  ROD SPNL 125MM SPHERX II CNV,$600.00,$0.00,$600.00,$270.00,$428.22,$0.00,$103.38,$0.00,$0.00,$105.06,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$93.90,$0.00,$95.52,$0.00
7248130,SUP,HCPCS C1713,,7248130  -  ROD SPNL 130MM SPHERX II CNV,$600.00,$0.00,$600.00,$270.00,$428.22,$0.00,$103.38,$0.00,$0.00,$105.06,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$93.90,$0.00,$95.52,$0.00
7248135,SUP,HCPCS C1713,,7248135  -  ROD SPNL 135MM SPHERX II CNV,$600.00,$0.00,$600.00,$270.00,$428.22,$0.00,$103.38,$0.00,$0.00,$105.06,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$93.90,$0.00,$95.52,$0.00
7248140,SUP,HCPCS C1713,,7248140  -  ROD SPNL 140MM SPHERX II CNV,$600.00,$0.00,$600.00,$270.00,$428.22,$0.00,$103.38,$0.00,$0.00,$105.06,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$93.90,$0.00,$95.52,$0.00
7248145,SUP,HCPCS C1713,,7248145  -  ROD SPNL 145MM SPHERX II CNV,$600.00,$0.00,$600.00,$270.00,$428.22,$0.00,$103.38,$0.00,$0.00,$105.06,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$93.90,$0.00,$95.52,$0.00
7248150,SUP,HCPCS C1713,,7248150  -  ROD SPNL 150MM SPHERX II CNV,$600.00,$0.00,$600.00,$270.00,$428.22,$0.00,$103.38,$0.00,$0.00,$105.06,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$93.90,$0.00,$95.52,$0.00
7248300,SUP,HCPCS C1713,,7248300  -  ROD SPNL 300MM SPHERX II CNV,$600.00,$0.00,$600.00,$270.00,$428.22,$0.00,$103.38,$0.00,$0.00,$105.06,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$93.90,$0.00,$95.52,$0.00
7248500,SUP,HCPCS C1713,,7248500  -  ROD SPNL 500MM SPHERX II CNV,$600.00,$0.00,$600.00,$270.00,$428.22,$0.00,$103.38,$0.00,$0.00,$105.06,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$93.90,$0.00,$95.52,$0.00
7248510,SUP,HCPCS C1713,,7248510  -  SCREW BN 8.5MM 100MM PA ILIUM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7248525,SUP,HCPCS C1713,,7248525  -  SCREW BN 8.5MM 25MM SPHERX II PA TI SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7248530,SUP,HCPCS C1713,,7248530  -  SCREW BN 8.5MM 30MM SPHERX II PA TI SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7248535,SUP,HCPCS C1713,,7248535  -  SCREW BN 8.5MM 35MM SPHERX II PA TI SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7248540,SUP,HCPCS C1713,,7248540  -  SCREW BN 8.5MM 40MM SPHERX DBR II PA TI SPNE 5.5MM ROD,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7248545,SUP,HCPCS C1713,,7248545  -  SCREW BN 8.5MM 45MM SPHERX DBR II PA TI SPNE 5.5MM ROD,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7248550,SUP,HCPCS C1713,,7248550  -  SCREW BN 8.5MM 50MM SPHERX DBR II PA TI SPNE 5.5MM ROD,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7248555,SUP,HCPCS C1713,,7248555  -  SCREW BN 8.5MM 55MM PA SPNE PDCL,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7248560,SUP,HCPCS C1713,,7248560  -  SCREW BN 8.5MM 60MM SPHERX II PA TI SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7248565,SUP,HCPCS C1713,,7248565  -  SCREW BN 8.5MM 65MM PA ILIUM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7248570,SUP,HCPCS C1713,,7248570  -  SCREW BN 8.5MM 70MM PA ILIUM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7248575,SUP,HCPCS C1713,,7248575  -  SCREW BN 8.5MM 75MM PA ILIUM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7248580,SUP,HCPCS C1713,,7248580  -  SCREW BN 8.5MM 80MM PA ILIUM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7248585,SUP,HCPCS C1713,,7248585  -  SCREW BN 8.5MM 85MM PA ILIUM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7248590,SUP,HCPCS C1713,,7248590  -  SCREW BN 8.5MM 90MM PA ILIUM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7248595,SUP,HCPCS C1713,,7248595  -  SCREW BN 8.5MM 95MM PA ILIUM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7249310,SUP,HCPCS C1713,,7249310  -  CONNECTOR ROD OFST 100MM SPNE,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
7249335,SUP,HCPCS C1713,,7249335  -  CONNECTOR ROD OFST 35MM SPHERX II SPNE,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
7249350,SUP,HCPCS C1713,,7249350  -  CONNECTOR ROD OFST 50MM SPNE,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
7251526,SUP,HCPCS C1713,,7251526  -  STAPLE BN SM INFR ANT THOR SPNL,"$2,162.50",$0.00,"$2,162.50",$973.13,"$1,543.38",$0.00,$372.59,$0.00,$0.00,$378.64,"$2,162.50",$0.00,"$1,081.25","$1,712.70","$1,730.00",$0.00,$338.43,$0.00,$344.27,$0.00
7251528,SUP,HCPCS C1713,,7251528  -  STAPLE BN MED INFR ANT THOR SPNL,"$2,162.50",$0.00,"$2,162.50",$973.13,"$1,543.38",$0.00,$372.59,$0.00,$0.00,$378.64,"$2,162.50",$0.00,"$1,081.25","$1,712.70","$1,730.00",$0.00,$338.43,$0.00,$344.27,$0.00
7251530,SUP,HCPCS C1713,,7251530  -  STAPLE BN LG INFR ANT THOR SPNL,"$2,162.50",$0.00,"$2,162.50",$973.13,"$1,543.38",$0.00,$372.59,$0.00,$0.00,$378.64,"$2,162.50",$0.00,"$1,081.25","$1,712.70","$1,730.00",$0.00,$338.43,$0.00,$344.27,$0.00
7251626,SUP,HCPCS C1713,,7251626  -  STAPLE BN SM SUP ANT THOR SPNL,"$2,162.50",$0.00,"$2,162.50",$973.13,"$1,543.38",$0.00,$372.59,$0.00,$0.00,$378.64,"$2,162.50",$0.00,"$1,081.25","$1,712.70","$1,730.00",$0.00,$338.43,$0.00,$344.27,$0.00
7251628,SUP,HCPCS C1713,,7251628  -  STAPLE BN MED SUP ANT THOR SPNL,"$2,162.50",$0.00,"$2,162.50",$973.13,"$1,543.38",$0.00,$372.59,$0.00,$0.00,$378.64,"$2,162.50",$0.00,"$1,081.25","$1,712.70","$1,730.00",$0.00,$338.43,$0.00,$344.27,$0.00
7251630,SUP,HCPCS C1713,,7251630  -  STAPLE BN LG SUP ANT THOR SPNL,"$2,162.50",$0.00,"$2,162.50",$973.13,"$1,543.38",$0.00,$372.59,$0.00,$0.00,$378.64,"$2,162.50",$0.00,"$1,081.25","$1,712.70","$1,730.00",$0.00,$338.43,$0.00,$344.27,$0.00
7253012,SUP,HCPCS C1713,,7253012  -  STAPLE BN SM 1 HL,$947.50,$0.00,$947.50,$426.38,$676.23,$0.00,$163.25,$0.00,$0.00,$165.90,$947.50,$0.00,$473.75,$750.42,$758.00,$0.00,$148.28,$0.00,$150.84,$0.00
7253014,SUP,HCPCS C1713,,7253014  -  STAPLE BN MED 1 HL,$947.50,$0.00,$947.50,$426.38,$676.23,$0.00,$163.25,$0.00,$0.00,$165.90,$947.50,$0.00,$473.75,$750.42,$758.00,$0.00,$148.28,$0.00,$150.84,$0.00
7253016,SUP,HCPCS C1713,,7253016  -  STAPLE BN LG 1 HL,$947.50,$0.00,$947.50,$426.38,$676.23,$0.00,$163.25,$0.00,$0.00,$165.90,$947.50,$0.00,$473.75,$750.42,$758.00,$0.00,$148.28,$0.00,$150.84,$0.00
7253112,SUP,HCPCS C1713,,7253112  -  WASHER SPNL SM,$387.50,$0.00,$387.50,$174.38,$276.56,$0.00,$66.76,$0.00,$0.00,$67.85,$387.50,$0.00,$193.75,$306.90,$310.00,$0.00,$60.64,$0.00,$61.69,$0.00
7253114,SUP,HCPCS C1713,,7253114  -  WASHER SPNL MED,$387.50,$0.00,$387.50,$174.38,$276.56,$0.00,$66.76,$0.00,$0.00,$67.85,$387.50,$0.00,$193.75,$306.90,$310.00,$0.00,$60.64,$0.00,$61.69,$0.00
7253116,SUP,HCPCS C1713,,7253116  -  WASHER SPNL LG,$387.50,$0.00,$387.50,$174.38,$276.56,$0.00,$66.76,$0.00,$0.00,$67.85,$387.50,$0.00,$193.75,$306.90,$310.00,$0.00,$60.64,$0.00,$61.69,$0.00
7254022,SUP,HCPCS C1713,,7254022  -  CONNECTOR ROD 22MM SPHERX II FX SPNE ANT,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7254525,SUP,HCPCS C1713,,7254525  -  SCREW BN 4.5MM 25MM SPHERX II FA SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7254530,SUP,HCPCS C1713,,7254530  -  SCREW BN 4.5MM 30MM SPHERX II FA SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7254535,SUP,HCPCS C1713,,7254535  -  SCREW BN 4.5MM 35MM SPHERX II FA SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7254540,SUP,HCPCS C1713,,7254540  -  SCREW BN 4.5MM 40MM SPHERX II FA SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7254545,SUP,HCPCS C1713,,7254545  -  SCREW BN 4.5MM 45MM SPHERX II FA SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7254550,SUP,HCPCS C1713,,7254550  -  SCREW BN 4.5MM 50MM SPHERX II FA SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7255525,SUP,HCPCS C1713,,7255525  -  SCREW BN 5.5MM 25MM SPHERX II FA SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7255530,SUP,HCPCS C1713,,7255530  -  SCREW BN 5.5MM 30MM SPHERX II FA SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7255535,SUP,HCPCS C1713,,7255535  -  SCREW BN 5.5MM 35MM SPHERX II FA SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7255540,SUP,HCPCS C1713,,7255540  -  SCREW BN 5.5MM 40MM SPHERX DBR II FX ANG TI SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7255545,SUP,HCPCS C1713,,7255545  -  SCREW BN 5.5MM 45MM SPHERX DBR II FX ANG TI SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7255550,SUP,HCPCS C1713,,7255550  -  SCREW BN 5.5MM 50MM SPHERX II FA SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7255555,SUP,HCPCS C1713,,7255555  -  SCREW BN 5.5MM 55MM SPHERX II FA SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7255560,SUP,HCPCS C1713,,7255560  -  SCREW BN 5.5MM 60MM SPHERX II FA SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7256012,SUP,HCPCS C1713,,7256012  -  CONNECTOR ROD 12MM SPHERX II FX SPNE ANT,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7256013,SUP,HCPCS C1713,,7256013  -  CONNECTOR ROD 13MM SPHERX II FX SPNE ANT,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7256014,SUP,HCPCS C1713,,7256014  -  CONNECTOR ROD 14MM SPHERX II FX SPNE ANT,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7256015,SUP,HCPCS C1713,,7256015  -  CONNECTOR ROD 15MM SPHERX II FX SPNE ANT,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7256016,SUP,HCPCS C1713,,7256016  -  CONNECTOR ROD 16MM SPHERX II FX SPNE ANT,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7256017,SUP,HCPCS C1713,,7256017  -  CONNECTOR ROD 17MM SPHERX II FX SPNE ANT,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7256018,SUP,HCPCS C1713,,7256018  -  CONNECTOR ROD 18MM SPHERX II FX SPNE ANT,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7256019,SUP,HCPCS C1713,,7256019  -  CONNECTOR ROD 19MM TI THORLMBR SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7256020,SUP,HCPCS C1713,,7256020  -  CONNECTOR ROD 20MM TI THORLMBR SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7256021,SUP,HCPCS C1713,,7256021  -  CONNECTOR ROD 21MM SPHERX II FX SPNE ANT,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7256530,SUP,HCPCS C1713,,7256530  -  SCREW BN 6.5MM 30MM SPHERX II FA SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7256535,SUP,HCPCS C1713,,7256535  -  SCREW BN 6.5MM 35MM SPHERX II FA SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7256540,SUP,HCPCS C1713,,7256540  -  SCREW BN 6.5MM 40MM SPHERX DBR II FX ANG TI SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7256545,SUP,HCPCS C1713,,7256545  -  SCREW BN 6.5MM 45MM SPHERX II FX,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7256550,SUP,HCPCS C1713,,7256550  -  SCREW BN 6.5MM 50MM SPHERX DBR II FX ANG TI SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7256555,SUP,HCPCS C1713,,7256555  -  SCREW BN 6.5MM 55MM SPHERX II FA SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7256560,SUP,HCPCS C1713,,7256560  -  SCREW BN 6.5MM 60MM SPHERX II FA SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7257530,SUP,HCPCS C1713,,7257530  -  SCREW BN 7.5MM 30MM SPHERX II FA SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7257535,SUP,HCPCS C1713,,7257535  -  SCREW BN 7.5MM 35MM SPHERX II FA SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7257540,SUP,HCPCS C1713,,7257540  -  SCREW BN 7.5IN 40MM SPHERX II FA SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7257545,SUP,HCPCS C1713,,7257545  -  SCREW BN 7.5MM 45MM SPHERX II FA SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7257550,SUP,HCPCS C1713,,7257550  -  SCREW BN 7.5MM 50MM SPHERX II FA SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7257555,SUP,HCPCS C1713,,7257555  -  SCREW BN 7.5MM 55MM SPHERX II FA SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7257560,SUP,HCPCS C1713,,7257560  -  SCREW BN 7.5MM 60MM SPHERX II FA SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7258530,SUP,HCPCS C1713,,7258530  -  SCREW BN 8.5MM 30MM SPHERX II FA SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7258535,SUP,HCPCS C1713,,7258535  -  SCREW BN 8.5MM 35MM SPHERX II FA SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7258540,SUP,HCPCS C1713,,7258540  -  SCREW BN 8.5MM 40MM SPHERX II FA SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7258545,SUP,HCPCS C1713,,7258545  -  SCREW BN 8.5MM 45MM SPHERX II FA SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7258550,SUP,HCPCS C1713,,7258550  -  SCREW BN 8.5MM 50MM SPHERX II FA SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7258555,SUP,HCPCS C1713,,7258555  -  SCREW BN 8.5MM 55MM SPHERX II FA SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7258560,SUP,HCPCS C1713,,7258560  -  SCREW BN 8.5MM 60MM SPHERX II FA SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7262600,SUP,Custom 27803010,,7262600  -  ENDCAP SPNL 26MM RND 0 DEG OD 22 XCORE 2 TI,"$2,295.00",$0.00,"$2,295.00",$0.00,"$1,637.94",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,295.00",$0.00,"$1,147.50","$1,817.64","$1,836.00",$0.00,$0.00,$0.00,$0.00,$0.00
7262604,SUP,Custom 27803010,,7262604  -  ENDCAP SPNL 26MM RND 4 DEG OD 22 XCORE 2 TI,"$2,295.00",$0.00,"$2,295.00",$0.00,"$1,637.94",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,295.00",$0.00,"$1,147.50","$1,817.64","$1,836.00",$0.00,$0.00,$0.00,$0.00,$0.00
7262608,SUP,Custom 27803010,,7262608  -  ENDCAP SPNL 26MM RND 8 DEG OD 22 XCORE 2 TI,"$2,295.00",$0.00,"$2,295.00",$0.00,"$1,637.94",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,295.00",$0.00,"$1,147.50","$1,817.64","$1,836.00",$0.00,$0.00,$0.00,$0.00,$0.00
7262612,SUP,Custom 27803010,,7262612  -  ENDCAP SPNL 26MM RND 12 DEG OD 22 XCORE 2 TI,"$2,295.00",$0.00,"$2,295.00",$0.00,"$1,637.94",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,295.00",$0.00,"$1,147.50","$1,817.64","$1,836.00",$0.00,$0.00,$0.00,$0.00,$0.00
7265535,SUP,HCPCS C1713,,7265535  -  SCREW BN 5.5MM 35MM RDC PA SPNE 5.5MM ROD,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7265540,SUP,HCPCS C1713,,7265540  -  SCREW BN 5.5MM 40MM PA RDC SPNE 5.5MM ROD,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7265545,SUP,HCPCS C1713,,7265545  -  SCREW BN 5.5MM 45MM PA RDC SPNE 5.5MM ROD,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7265550,SUP,HCPCS C1713,,7265550  -  SCREW BN 5.5MM 50MM SPHERX PA SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7265555,SUP,HCPCS C1713,,7265555  -  SCREW BN 5.5MM 55MM SPHERX PA SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7266535,SUP,HCPCS C1713,,7266535  -  SCREW BN 6.5MM 35MM SPHERX PA SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7266540,SUP,HCPCS C1713,,7266540  -  SCREW BN 6.5MM 40MM SPHERX RDC SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7266545,SUP,HCPCS C1713,,7266545  -  SCREW BN 6.5MM 45MM SPHERX II RDC PA SPNE 5.5MM ROD,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7266550,SUP,HCPCS C1713,,7266550  -  SCREW BN 6.5MM 50MM SPHERX PA SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7266555,SUP,HCPCS C1713,,7266555  -  SCREW BN 6.5MM 55MM SPHERX PA SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7267535,SUP,HCPCS C1713,,7267535  -  SCREW BN 7.5MM 35MM SPHERX PA SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7267540,SUP,HCPCS C1713,,7267540  -  SCREW BN 7.5MM 40MM RDC PA SPNE 5.5MM ROD,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7267545,SUP,HCPCS C1713,,7267545  -  SCREW BN 7.5MM 45MM SPHERX PA SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7267550,SUP,HCPCS C1713,,7267550  -  SCREW BN 7.5MM 50MM SPHERX PA SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7267555,SUP,HCPCS C1713,,7267555  -  SCREW BN 7.5MM 55MM SPHERX PA SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7270100,SUP,HCPCS C1713,,7270100  -  WIRE FX KRSH BVL TIP,$200.00,$0.00,$200.00,$90.00,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
7270200,SUP,HCPCS C1713,,7270200  -  WIRE FX KRSH THRD,$200.00,$0.00,$200.00,$90.00,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
7270300,SUP,HCPCS C1713,,7270300  -  WIRE FX XLNG KRSH THRD TIP,$200.00,$0.00,$200.00,$90.00,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
7270411,SUP,HCPCS C1713,,7270411  -  SPACER SPNL 11MM 11X4MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7270441,SUP,HCPCS C1713,,7270441  -  SPACER SPNL 11MM 14X4MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7270444,SUP,HCPCS C1713,,7270444  -  SPACER SPNL 14MM 14X4MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7270511,SUP,HCPCS C1713,,7270511  -  SPACER SPNL 11MM 11X5MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7270541,SUP,HCPCS C1713,,7270541  -  SPACER SPNL 11MM 14X5MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7270544,SUP,HCPCS C1713,,7270544  -  SPACER SPNL 14MM 14X5MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7270611,SUP,HCPCS C1713,,7270611  -  SPACER SPNL 11MM 11X6MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7270641,SUP,HCPCS C1713,,7270641  -  SPACER SPNL 11MM 14X6MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7270644,SUP,HCPCS C1713,,7270644  -  SPACER SPNL 14MM 14X6MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7270711,SUP,HCPCS C1713,,7270711  -  SPACER SPNL 11MM 11X7MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7270741,SUP,HCPCS C1713,,7270741  -  SPACER SPNL 11MM 14X7MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7270744,SUP,HCPCS C1713,,7270744  -  SPACER SPNL 14MM 14X7MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7270811,SUP,HCPCS C1713,,7270811  -  SPACER SPNL 11MM 11X8MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7270841,SUP,HCPCS C1713,,7270841  -  SPACER SPNL 11MM 14X8MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7270844,SUP,HCPCS C1713,,7270844  -  SPACER SPNL 14MM 14X8MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7270911,SUP,HCPCS C1713,,7270911  -  SPACER SPNL 11MM 11X9MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7270941,SUP,HCPCS C1713,,7270941  -  SPACER SPNL 11MM 14X9MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7270944,SUP,HCPCS C1713,,7270944  -  SPACER SPNL 14MM 14X9MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7271011,SUP,HCPCS C1713,,7271011  -  SPACER SPNL 11MM 11X10MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7271041,SUP,HCPCS C1713,,7271041  -  SPACER SPNL 11MM 14X10MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7271044,SUP,HCPCS C1713,,7271044  -  SPACER SPNL 14MM 14X10MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7271111,SUP,HCPCS C1713,,7271111  -  SPACER SPNL 11MM 11X11MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7271141,SUP,HCPCS C1713,,7271141  -  SPACER SPNL 11MM 14X11MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7271144,SUP,HCPCS C1713,,7271144  -  SPACER SPNL 14MM 14X11MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7271211,SUP,HCPCS C1713,,7271211  -  SPACER SPNL 11MM 11X12MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7271241,SUP,HCPCS C1713,,7271241  -  SPACER SPNL 11MM 14X12MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7271244,SUP,HCPCS C1713,,7271244  -  SPACER SPNL 14MM 14X12MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7271311,SUP,HCPCS C1713,,7271311  -  SPACER SPNL 11MM 11X13MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7271341,SUP,HCPCS C1713,,7271341  -  SPACER SPNL 11MM 14X13MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7271344,SUP,HCPCS C1713,,7271344  -  SPACER SPNL 14MM 14X13MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7284525,SUP,HCPCS C1713,,7284525  -  SCREW BN 4.5MM 25MM SPHERX II PA TI SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7284530,SUP,HCPCS C1713,,7284530  -  SCREW BN 4.5MM 30MM SPHERX II PA TI SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7284535,SUP,HCPCS C1713,,7284535  -  SCREW BN 4.5MM 35MM PA SPNE 5.5MM ROD,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7284540,SUP,HCPCS C1713,,7284540  -  SCREW BN 4.5MM 40MM SPHERX II PA TI SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7284545,SUP,HCPCS C1713,,7284545  -  SCREW BN 4.5MM 45MM SPHERX II PA TI SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7284550,SUP,HCPCS C1713,,7284550  -  SCREW BN 4.5MM 50MM SPHERX II PA TI SPNE,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7291025,SUP,HCPCS C1713,,7291025  -  ROD SPNL 5.5MM 25MM SPHERX II TI,$782.50,$0.00,$782.50,$352.13,$558.47,$0.00,$134.82,$0.00,$0.00,$137.01,$782.50,$0.00,$391.25,$619.74,$626.00,$0.00,$122.46,$0.00,$124.57,$0.00
7291030,SUP,HCPCS C1713,,7291030  -  ROD SPNL 5.5MM 30MM SPHERX II TI,$782.50,$0.00,$782.50,$352.13,$558.47,$0.00,$134.82,$0.00,$0.00,$137.01,$782.50,$0.00,$391.25,$619.74,$626.00,$0.00,$122.46,$0.00,$124.57,$0.00
7291035,SUP,HCPCS C1713,,7291035  -  ROD SPNL 5.5MM 35MM 1 BALL,$782.50,$0.00,$782.50,$352.13,$558.47,$0.00,$134.82,$0.00,$0.00,$137.01,$782.50,$0.00,$391.25,$619.74,$626.00,$0.00,$122.46,$0.00,$124.57,$0.00
7291040,SUP,HCPCS C1713,,7291040  -  ROD SPNL PREBNT 5.5MM 40MM SPHERX II 1 BALL,$782.50,$0.00,$782.50,$352.13,$558.47,$0.00,$134.82,$0.00,$0.00,$137.01,$782.50,$0.00,$391.25,$619.74,$626.00,$0.00,$122.46,$0.00,$124.57,$0.00
7291045,SUP,HCPCS C1713,,7291045  -  ROD SPNL 5.5MM 45MM SPHERX II TI,$860.00,$0.00,$860.00,$387.00,$613.78,$0.00,$148.17,$0.00,$0.00,$150.58,$860.00,$0.00,$430.00,$681.12,$688.00,$0.00,$134.59,$0.00,$136.91,$0.00
7291050,SUP,HCPCS C1713,,7291050  -  ROD SPNL 5.5MM 50MM SPHERX II TI,$860.00,$0.00,$860.00,$387.00,$613.78,$0.00,$148.17,$0.00,$0.00,$150.58,$860.00,$0.00,$430.00,$681.12,$688.00,$0.00,$134.59,$0.00,$136.91,$0.00
7291055,SUP,HCPCS C1713,,7291055  -  ROD SPNL 5.5MM 55MM SPHERX II TI,$860.00,$0.00,$860.00,$387.00,$613.78,$0.00,$148.17,$0.00,$0.00,$150.58,$860.00,$0.00,$430.00,$681.12,$688.00,$0.00,$134.59,$0.00,$136.91,$0.00
7291060,SUP,HCPCS C1713,,7291060  -  ROD SPNL 5.5MM 60MM SPHERX II TI,$860.00,$0.00,$860.00,$387.00,$613.78,$0.00,$148.17,$0.00,$0.00,$150.58,$860.00,$0.00,$430.00,$681.12,$688.00,$0.00,$134.59,$0.00,$136.91,$0.00
7291065,SUP,HCPCS C1713,,7291065  -  ROD SPNL 5.5MM 65MM SPHERX II TI,$860.00,$0.00,$860.00,$387.00,$613.78,$0.00,$148.17,$0.00,$0.00,$150.58,$860.00,$0.00,$430.00,$681.12,$688.00,$0.00,$134.59,$0.00,$136.91,$0.00
7291070,SUP,HCPCS C1713,,7291070  -  ROD SPNL 5.5MM 70MM SPHERX II TI,$860.00,$0.00,$860.00,$387.00,$613.78,$0.00,$148.17,$0.00,$0.00,$150.58,$860.00,$0.00,$430.00,$681.12,$688.00,$0.00,$134.59,$0.00,$136.91,$0.00
7291075,SUP,HCPCS C1713,,7291075  -  ROD SPNL 5.5MM 75MM SPHERX II TI,$860.00,$0.00,$860.00,$387.00,$613.78,$0.00,$148.17,$0.00,$0.00,$150.58,$860.00,$0.00,$430.00,$681.12,$688.00,$0.00,$134.59,$0.00,$136.91,$0.00
7291080,SUP,HCPCS C1713,,7291080  -  ROD SPNL 5.5MM 80MM SPHERX II TI,$860.00,$0.00,$860.00,$387.00,$613.78,$0.00,$148.17,$0.00,$0.00,$150.58,$860.00,$0.00,$430.00,$681.12,$688.00,$0.00,$134.59,$0.00,$136.91,$0.00
7291085,SUP,HCPCS C1713,,7291085  -  ROD SPNL 5.5MM 85MM SPHERX II TI,$860.00,$0.00,$860.00,$387.00,$613.78,$0.00,$148.17,$0.00,$0.00,$150.58,$860.00,$0.00,$430.00,$681.12,$688.00,$0.00,$134.59,$0.00,$136.91,$0.00
7291090,SUP,HCPCS C1713,,7291090  -  ROD SPNL 5.5MM 90MM SPHERX II TI,$860.00,$0.00,$860.00,$387.00,$613.78,$0.00,$148.17,$0.00,$0.00,$150.58,$860.00,$0.00,$430.00,$681.12,$688.00,$0.00,$134.59,$0.00,$136.91,$0.00
7291095,SUP,HCPCS C1713,,7291095  -  ROD SPNL 5.5MM 95MM SPHERX II TI,$917.50,$0.00,$917.50,$412.88,$654.82,$0.00,$158.08,$0.00,$0.00,$160.65,$917.50,$0.00,$458.75,$726.66,$734.00,$0.00,$143.59,$0.00,$146.07,$0.00
7291100,SUP,HCPCS C1713,,7291100  -  ROD SPNL 5.5MM 100MM SPHERX II TI,$917.50,$0.00,$917.50,$412.88,$654.82,$0.00,$158.08,$0.00,$0.00,$160.65,$917.50,$0.00,$458.75,$726.66,$734.00,$0.00,$143.59,$0.00,$146.07,$0.00
7291110,SUP,HCPCS C1713,,7291110  -  ROD SPNL 5.5MM 110MM SPHERX II TI,$917.50,$0.00,$917.50,$412.88,$654.82,$0.00,$158.08,$0.00,$0.00,$160.65,$917.50,$0.00,$458.75,$726.66,$734.00,$0.00,$143.59,$0.00,$146.07,$0.00
7291120,SUP,HCPCS C1713,,7291120  -  ROD SPNL PREBNT 5.5MM 120MM SPHERX II TI,$917.50,$0.00,$917.50,$412.88,$654.82,$0.00,$158.08,$0.00,$0.00,$160.65,$917.50,$0.00,$458.75,$726.66,$734.00,$0.00,$143.59,$0.00,$146.07,$0.00
7291130,SUP,HCPCS C1713,,7291130  -  ROD SPNL 5.5MM 400MM SPHERX II TI,$917.50,$0.00,$917.50,$412.88,$654.82,$0.00,$158.08,$0.00,$0.00,$160.65,$917.50,$0.00,$458.75,$726.66,$734.00,$0.00,$143.59,$0.00,$146.07,$0.00
7291140,SUP,HCPCS C1713,,7291140  -  ROD SPNL PREBNT 5.5MM 140MM SPHERX II TI,$917.50,$0.00,$917.50,$412.88,$654.82,$0.00,$158.08,$0.00,$0.00,$160.65,$917.50,$0.00,$458.75,$726.66,$734.00,$0.00,$143.59,$0.00,$146.07,$0.00
7291150,SUP,HCPCS C1713,,7291150  -  ROD SPNL 150MM MAS PLIF,$917.50,$0.00,$917.50,$412.88,$654.82,$0.00,$158.08,$0.00,$0.00,$160.65,$917.50,$0.00,$458.75,$726.66,$734.00,$0.00,$143.59,$0.00,$146.07,$0.00
7291160,SUP,HCPCS C1713,,7291160  -  ROD SPNL PREBNT 5.5MM 160MM SPHERX II TI,$917.50,$0.00,$917.50,$412.88,$654.82,$0.00,$158.08,$0.00,$0.00,$160.65,$917.50,$0.00,$458.75,$726.66,$734.00,$0.00,$143.59,$0.00,$146.07,$0.00
7291180,SUP,HCPCS C1713,,7291180  -  ROD SPNL PREBNT 5.5MM 180MM SPHERX II TI,$917.50,$0.00,$917.50,$412.88,$654.82,$0.00,$158.08,$0.00,$0.00,$160.65,$917.50,$0.00,$458.75,$726.66,$734.00,$0.00,$143.59,$0.00,$146.07,$0.00
7291200,SUP,HCPCS C1713,,7291200  -  ROD SPNL PREBNT 5.5MM 200MM SPHERX II TI,$917.50,$0.00,$917.50,$412.88,$654.82,$0.00,$158.08,$0.00,$0.00,$160.65,$917.50,$0.00,$458.75,$726.66,$734.00,$0.00,$143.59,$0.00,$146.07,$0.00
7291300,SUP,HCPCS C1713,,7291300  -  ROD SPNL PREBNT 5.5MM 300MM SPHERX DBR II TI,$917.50,$0.00,$917.50,$412.88,$654.82,$0.00,$158.08,$0.00,$0.00,$160.65,$917.50,$0.00,$458.75,$726.66,$734.00,$0.00,$143.59,$0.00,$146.07,$0.00
7291500,SUP,HCPCS C1713,,7291500  -  ROD SPNL PREBNT 5.5MM 500MM SPHERX II TI,"$1,052.50",$0.00,"$1,052.50",$473.63,$751.17,$0.00,$181.34,$0.00,$0.00,$184.28,"$1,052.50",$0.00,$526.25,$833.58,$842.00,$0.00,$164.72,$0.00,$167.56,$0.00
7292025,SUP,HCPCS C1713,,7292025  -  ROD SPNL PREBNT 5.5MM 25MM SPHERX II TI,"$1,342.50",$0.00,"$1,342.50",$604.13,$958.14,$0.00,$231.31,$0.00,$0.00,$235.06,"$1,342.50",$0.00,$671.25,"$1,063.26","$1,074.00",$0.00,$210.10,$0.00,$213.73,$0.00
7292030,SUP,HCPCS C1713,,7292030  -  ROD SPNL PREBNT 5.5MM 30MM SPHERX II,"$1,342.50",$0.00,"$1,342.50",$604.13,$958.14,$0.00,$231.31,$0.00,$0.00,$235.06,"$1,342.50",$0.00,$671.25,"$1,063.26","$1,074.00",$0.00,$210.10,$0.00,$213.73,$0.00
7292040,SUP,HCPCS C1713,,7292040  -  ROD SPNL PREBNT 5.5MM 40MM SPHERX II TI,"$1,342.50",$0.00,"$1,342.50",$604.13,$958.14,$0.00,$231.31,$0.00,$0.00,$235.06,"$1,342.50",$0.00,$671.25,"$1,063.26","$1,074.00",$0.00,$210.10,$0.00,$213.73,$0.00
7292050,SUP,HCPCS C1713,,7292050  -  ROD SPNL PREBNT 5.5MM 50MM SPHERX II TI,"$1,342.50",$0.00,"$1,342.50",$604.13,$958.14,$0.00,$231.31,$0.00,$0.00,$235.06,"$1,342.50",$0.00,$671.25,"$1,063.26","$1,074.00",$0.00,$210.10,$0.00,$213.73,$0.00
7292060,SUP,HCPCS C1713,,7292060  -  ROD SPNL PREBNT 5.5MM 60MM SPHERX II TI,"$1,342.50",$0.00,"$1,342.50",$604.13,$958.14,$0.00,$231.31,$0.00,$0.00,$235.06,"$1,342.50",$0.00,$671.25,"$1,063.26","$1,074.00",$0.00,$210.10,$0.00,$213.73,$0.00
7292065,SUP,HCPCS C1713,,7292065  -  ROD SPNL PREBNT 5.5MM 65MM SPHERX II TI,"$1,342.50",$0.00,"$1,342.50",$604.13,$958.14,$0.00,$231.31,$0.00,$0.00,$235.06,"$1,342.50",$0.00,$671.25,"$1,063.26","$1,074.00",$0.00,$210.10,$0.00,$213.73,$0.00
7292070,SUP,HCPCS C1713,,7292070  -  ROD SPNL PREBNT 5.5MM 70MM SPHERX II,"$1,342.50",$0.00,"$1,342.50",$604.13,$958.14,$0.00,$231.31,$0.00,$0.00,$235.06,"$1,342.50",$0.00,$671.25,"$1,063.26","$1,074.00",$0.00,$210.10,$0.00,$213.73,$0.00
7292080,SUP,HCPCS C1713,,7292080  -  ROD SPNL PREBNT 5.5MM 80MM,"$1,342.50",$0.00,"$1,342.50",$604.13,$958.14,$0.00,$231.31,$0.00,$0.00,$235.06,"$1,342.50",$0.00,$671.25,"$1,063.26","$1,074.00",$0.00,$210.10,$0.00,$213.73,$0.00
7292085,SUP,HCPCS C1713,,7292085  -  ROD SPNL PREBNT 5.5MM 85MM,"$1,342.50",$0.00,"$1,342.50",$604.13,$958.14,$0.00,$231.31,$0.00,$0.00,$235.06,"$1,342.50",$0.00,$671.25,"$1,063.26","$1,074.00",$0.00,$210.10,$0.00,$213.73,$0.00
7292090,SUP,HCPCS C1713,,7292090  -  ROD SPNL PREBNT 5.5MM 90MM,"$1,342.50",$0.00,"$1,342.50",$604.13,$958.14,$0.00,$231.31,$0.00,$0.00,$235.06,"$1,342.50",$0.00,$671.25,"$1,063.26","$1,074.00",$0.00,$210.10,$0.00,$213.73,$0.00
7292095,SUP,HCPCS C1713,,7292095  -  ROD SPNL PREBNT 5.5MM 95MM,"$1,342.50",$0.00,"$1,342.50",$604.13,$958.14,$0.00,$231.31,$0.00,$0.00,$235.06,"$1,342.50",$0.00,$671.25,"$1,063.26","$1,074.00",$0.00,$210.10,$0.00,$213.73,$0.00
7292100,SUP,HCPCS C1713,,7292100  -  ROD SPNL PREBNT 5.5MM 100MM SPHERX II TI,"$1,342.50",$0.00,"$1,342.50",$604.13,$958.14,$0.00,$231.31,$0.00,$0.00,$235.06,"$1,342.50",$0.00,$671.25,"$1,063.26","$1,074.00",$0.00,$210.10,$0.00,$213.73,$0.00
7292120,SUP,HCPCS C1713,,7292120  -  ROD SPNL PREBNT 120MM SPHERX,"$1,342.50",$0.00,"$1,342.50",$604.13,$958.14,$0.00,$231.31,$0.00,$0.00,$235.06,"$1,342.50",$0.00,$671.25,"$1,063.26","$1,074.00",$0.00,$210.10,$0.00,$213.73,$0.00
7303000,SUP,Custom 27803010,,7303000  -  ENDCAP SPNL 30MM RND 0 DEG OD 22 XCORE 2 TI,"$2,295.00",$0.00,"$2,295.00",$0.00,"$1,637.94",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,295.00",$0.00,"$1,147.50","$1,817.64","$1,836.00",$0.00,$0.00,$0.00,$0.00,$0.00
7303004,SUP,Custom 27803010,,7303004  -  ENDCAP SPNL 30MM RND 4 DEG OD 22 XCORE 2 TI,"$2,295.00",$0.00,"$2,295.00",$0.00,"$1,637.94",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,295.00",$0.00,"$1,147.50","$1,817.64","$1,836.00",$0.00,$0.00,$0.00,$0.00,$0.00
7303008,SUP,Custom 27803010,,7303008  -  ENDCAP SPNL 30MM RND 8 DEG OD 22 XCORE 2 TI,"$2,295.00",$0.00,"$2,295.00",$0.00,"$1,637.94",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,295.00",$0.00,"$1,147.50","$1,817.64","$1,836.00",$0.00,$0.00,$0.00,$0.00,$0.00
7303012,SUP,Custom 27803010,,7303012  -  ENDCAP SPNL 30MM RND 12 DEG OD 22 XCORE 2 TI,"$2,295.00",$0.00,"$2,295.00",$0.00,"$1,637.94",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,295.00",$0.00,"$1,147.50","$1,817.64","$1,836.00",$0.00,$0.00,$0.00,$0.00,$0.00
7340000,SUP,HCPCS C1713,,7340000  -  SET SCREW 7340000 BREAKOFF M6XI BUTTRESS,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
7340300,SUP,HCPCS C1713,,7340300  -  ROD 7340300 3.5MM TI  300MM LENGTH,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7340500,SUP,HCPCS C1713,,7340500  -  ROD 7340500 3.5MM TI  500MM LENGTH,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7341101,SUP,HCPCS C1713,,7341101  -  HOOK 7341101 PEDICLE,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7341111,SUP,HCPCS C1713,,7341111  -  HOOK 7341111 SMALL LAMINIAR,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7341112,SUP,HCPCS C1713,,7341112  -  HOOK 7341112 MEDIUM LAMINIAR,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7341113,SUP,HCPCS C1713,,7341113  -  HOOK 7341113 LARGE LAMINIAR,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7341142,SUP,HCPCS C1713,,7341142  -  HOOK 7341142 RAMPED NARROW BLADE,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7341171,SUP,HCPCS C1713,,7341171  -  HOOK 7341171 EXTENDED BODY,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7342410,SUP,HCPCS C1713,,7342410  -  SCREW 7342410 FAS 4.0 X 10MM FOR 3.5 ROD,"$1,959.00",$0.00,"$1,959.00",$881.55,"$1,398.14",$0.00,$337.53,$0.00,$0.00,$343.01,"$1,959.00",$0.00,$979.50,"$1,551.53","$1,567.20",$0.00,$306.58,$0.00,$311.87,$0.00
7342415,SUP,HCPCS C1713,,7342415  -  SCREW 7342415 FAS 4.0 X 15MM FOR 3.5 ROD,"$1,959.00",$0.00,"$1,959.00",$881.55,"$1,398.14",$0.00,$337.53,$0.00,$0.00,$343.01,"$1,959.00",$0.00,$979.50,"$1,551.53","$1,567.20",$0.00,$306.58,$0.00,$311.87,$0.00
7342420,SUP,HCPCS C1713,,7342420  -  SCREW 7342420 FAS 4.0 X 20MM FOR 3.5 ROD,"$1,959.00",$0.00,"$1,959.00",$881.55,"$1,398.14",$0.00,$337.53,$0.00,$0.00,$343.01,"$1,959.00",$0.00,$979.50,"$1,551.53","$1,567.20",$0.00,$306.58,$0.00,$311.87,$0.00
7342425,SUP,HCPCS C1713,,7342425  -  SCREW 7342425 FAS 4.0 X 25MM FOR 3.5 ROD,"$1,959.00",$0.00,"$1,959.00",$881.55,"$1,398.14",$0.00,$337.53,$0.00,$0.00,$343.01,"$1,959.00",$0.00,$979.50,"$1,551.53","$1,567.20",$0.00,$306.58,$0.00,$311.87,$0.00
7342430,SUP,HCPCS C1713,,7342430  -  SCREW 7342430 FAS 4.0 X 30MM FOR 3.5 ROD,"$1,959.00",$0.00,"$1,959.00",$881.55,"$1,398.14",$0.00,$337.53,$0.00,$0.00,$343.01,"$1,959.00",$0.00,$979.50,"$1,551.53","$1,567.20",$0.00,$306.58,$0.00,$311.87,$0.00
7342435,SUP,HCPCS C1713,,7342435  -  FAS 4.0 X 35MM FOR 3.5 ROD,"$1,959.00",$0.00,"$1,959.00",$881.55,"$1,398.14",$0.00,$337.53,$0.00,$0.00,$343.01,"$1,959.00",$0.00,$979.50,"$1,551.53","$1,567.20",$0.00,$306.58,$0.00,$311.87,$0.00
7342440,SUP,HCPCS C1713,,7342440  -  FAS 4.0 X 40MM FOR 3.5 ROD,"$1,959.00",$0.00,"$1,959.00",$881.55,"$1,398.14",$0.00,$337.53,$0.00,$0.00,$343.01,"$1,959.00",$0.00,$979.50,"$1,551.53","$1,567.20",$0.00,$306.58,$0.00,$311.87,$0.00
7343310,SUP,HCPCS C1713,,7343310  -  SCREW 7343310 3.5 X 10,"$1,959.00",$0.00,"$1,959.00",$881.55,"$1,398.14",$0.00,$337.53,$0.00,$0.00,$343.01,"$1,959.00",$0.00,$979.50,"$1,551.53","$1,567.20",$0.00,$306.58,$0.00,$311.87,$0.00
7343315,SUP,HCPCS C1713,,7343315  -  SCREW 7343315 3.5 X 15,"$1,959.00",$0.00,"$1,959.00",$881.55,"$1,398.14",$0.00,$337.53,$0.00,$0.00,$343.01,"$1,959.00",$0.00,$979.50,"$1,551.53","$1,567.20",$0.00,$306.58,$0.00,$311.87,$0.00
7343320,SUP,HCPCS C1713,,7343320  -  SCREW 7343320 3.5 X 20,"$1,959.00",$0.00,"$1,959.00",$881.55,"$1,398.14",$0.00,$337.53,$0.00,$0.00,$343.01,"$1,959.00",$0.00,$979.50,"$1,551.53","$1,567.20",$0.00,$306.58,$0.00,$311.87,$0.00
7343325,SUP,HCPCS C1713,,7343325  -  SCREW 7343325 3.5 X 25,"$1,959.00",$0.00,"$1,959.00",$881.55,"$1,398.14",$0.00,$337.53,$0.00,$0.00,$343.01,"$1,959.00",$0.00,$979.50,"$1,551.53","$1,567.20",$0.00,$306.58,$0.00,$311.87,$0.00
7343330,SUP,HCPCS C1713,,7343330  -  SCREW 7343330 3.5 X 30,"$1,959.00",$0.00,"$1,959.00",$881.55,"$1,398.14",$0.00,$337.53,$0.00,$0.00,$343.01,"$1,959.00",$0.00,$979.50,"$1,551.53","$1,567.20",$0.00,$306.58,$0.00,$311.87,$0.00
7343415,SUP,HCPCS C1713,,7343415  -  SCREW 7343415 4.5 X 15,"$1,959.00",$0.00,"$1,959.00",$881.55,"$1,398.14",$0.00,$337.53,$0.00,$0.00,$343.01,"$1,959.00",$0.00,$979.50,"$1,551.53","$1,567.20",$0.00,$306.58,$0.00,$311.87,$0.00
7343420,SUP,HCPCS C1713,,7343420  -  SCREW 7343420 4.5 X 20,"$1,959.00",$0.00,"$1,959.00",$881.55,"$1,398.14",$0.00,$337.53,$0.00,$0.00,$343.01,"$1,959.00",$0.00,$979.50,"$1,551.53","$1,567.20",$0.00,$306.58,$0.00,$311.87,$0.00
7343425,SUP,HCPCS C1713,,7343425  -  SCREW 7343425 4.5 X 25,"$1,959.00",$0.00,"$1,959.00",$881.55,"$1,398.14",$0.00,$337.53,$0.00,$0.00,$343.01,"$1,959.00",$0.00,$979.50,"$1,551.53","$1,567.20",$0.00,$306.58,$0.00,$311.87,$0.00
7343430,SUP,HCPCS C1713,,7343430  -  SCREW 7343430 4.5 X 30,"$1,959.00",$0.00,"$1,959.00",$881.55,"$1,398.14",$0.00,$337.53,$0.00,$0.00,$343.01,"$1,959.00",$0.00,$979.50,"$1,551.53","$1,567.20",$0.00,$306.58,$0.00,$311.87,$0.00
7343435,SUP,HCPCS C1713,,7343435  -  SCREW 7343435 4.5 X 35,"$1,959.00",$0.00,"$1,959.00",$881.55,"$1,398.14",$0.00,$337.53,$0.00,$0.00,$343.01,"$1,959.00",$0.00,$979.50,"$1,551.53","$1,567.20",$0.00,$306.58,$0.00,$311.87,$0.00
7343440,SUP,HCPCS C1713,,7343440  -  SCREW 7343440 4.5 X 40,"$1,959.00",$0.00,"$1,959.00",$881.55,"$1,398.14",$0.00,$337.53,$0.00,$0.00,$343.01,"$1,959.00",$0.00,$979.50,"$1,551.53","$1,567.20",$0.00,$306.58,$0.00,$311.87,$0.00
7343520,SUP,HCPCS C1713,,7343520  -  SCREW 7343520 5.5 X 20,"$1,959.00",$0.00,"$1,959.00",$881.55,"$1,398.14",$0.00,$337.53,$0.00,$0.00,$343.01,"$1,959.00",$0.00,$979.50,"$1,551.53","$1,567.20",$0.00,$306.58,$0.00,$311.87,$0.00
7343525,SUP,HCPCS C1713,,7343525  -  SCREW 7343525 5.5 X 25,"$1,959.00",$0.00,"$1,959.00",$881.55,"$1,398.14",$0.00,$337.53,$0.00,$0.00,$343.01,"$1,959.00",$0.00,$979.50,"$1,551.53","$1,567.20",$0.00,$306.58,$0.00,$311.87,$0.00
7343530,SUP,HCPCS C1713,,7343530  -  SCREW 7343530 5.5 X 30,"$1,959.00",$0.00,"$1,959.00",$881.55,"$1,398.14",$0.00,$337.53,$0.00,$0.00,$343.01,"$1,959.00",$0.00,$979.50,"$1,551.53","$1,567.20",$0.00,$306.58,$0.00,$311.87,$0.00
7343535,SUP,HCPCS C1713,,7343535  -  SCREW 7343535 5.5 X 35,"$1,959.00",$0.00,"$1,959.00",$881.55,"$1,398.14",$0.00,$337.53,$0.00,$0.00,$343.01,"$1,959.00",$0.00,$979.50,"$1,551.53","$1,567.20",$0.00,$306.58,$0.00,$311.87,$0.00
7343540,SUP,HCPCS C1713,,7343540  -  SCREW 7343540 5.5 X 40,"$1,959.00",$0.00,"$1,959.00",$881.55,"$1,398.14",$0.00,$337.53,$0.00,$0.00,$343.01,"$1,959.00",$0.00,$979.50,"$1,551.53","$1,567.20",$0.00,$306.58,$0.00,$311.87,$0.00
7343545,SUP,HCPCS C1713,,7343545  -  SCREW 7343545 5.5 X 45,"$1,959.00",$0.00,"$1,959.00",$881.55,"$1,398.14",$0.00,$337.53,$0.00,$0.00,$343.01,"$1,959.00",$0.00,$979.50,"$1,551.53","$1,567.20",$0.00,$306.58,$0.00,$311.87,$0.00
7360000,SUP,HCPCS C1713,,7360000  -  SET SCREW 7360000 BRK OFF M6 BUTR PLG SS,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
7360300,SUP,HCPCS C1713,,7360300  -  ROD 7360300 ROD 3.5MM DIA SS L 300,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7360500,SUP,HCPCS C1713,,7360500  -  ROD 7360500 ROD 3.5MM DIA SS L 500,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7361101,SUP,HCPCS C1713,,7361101  -  HOOK 7361101 PEDICLE HOOK 3.5MM DIA SS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7361111,SUP,HCPCS C1713,,7361111  -  HOOK 7361111 S LAMINAR HOOK 3.5MM DIA SS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7361112,SUP,HCPCS C1713,,7361112  -  HOOK 7361112 M LAMINAR HOOK 3.5MM DIA SS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7361113,SUP,HCPCS C1713,,7361113  -  HOOK 7361113 L LAMINAR HOOK 3.5MM DIA SS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7361142,SUP,HCPCS C1713,,7361142  -  HOOK 7361142 RMP NAR BLD HK 3.5MM DIA SS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7361171,SUP,HCPCS C1713,,7361171  -  HOOK 7361171 EXTD BODY HOOK 3.5MM DIA SS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7362410,SUP,HCPCS C1713,,"7362410  -  FAS 4.0 X 10MM FOR 3.5 ROD, SS","$1,825.50",$0.00,"$1,825.50",$821.48,"$1,302.86",$0.00,$314.52,$0.00,$0.00,$319.63,"$1,825.50",$0.00,$912.75,"$1,445.80","$1,460.40",$0.00,$285.69,$0.00,$290.62,$0.00
7362415,SUP,HCPCS C1713,,"7362415  -  FAS 4.0 X 15MM FOR 3.5 ROD, SS","$1,825.50",$0.00,"$1,825.50",$821.48,"$1,302.86",$0.00,$314.52,$0.00,$0.00,$319.63,"$1,825.50",$0.00,$912.75,"$1,445.80","$1,460.40",$0.00,$285.69,$0.00,$290.62,$0.00
7362420,SUP,HCPCS C1713,,"7362420  -  FAS 4.0 X 20MM FOR 3.5 ROD, SS","$1,825.50",$0.00,"$1,825.50",$821.48,"$1,302.86",$0.00,$314.52,$0.00,$0.00,$319.63,"$1,825.50",$0.00,$912.75,"$1,445.80","$1,460.40",$0.00,$285.69,$0.00,$290.62,$0.00
7362425,SUP,HCPCS C1713,,"7362425  -  FAS 4.0 X 25MM FOR 3.5 ROD, SS","$1,825.50",$0.00,"$1,825.50",$821.48,"$1,302.86",$0.00,$314.52,$0.00,$0.00,$319.63,"$1,825.50",$0.00,$912.75,"$1,445.80","$1,460.40",$0.00,$285.69,$0.00,$290.62,$0.00
7362430,SUP,HCPCS C1713,,"7362430  -  FAS 4.0 X 30MM FOR 3.5 ROD, SS","$1,825.50",$0.00,"$1,825.50",$821.48,"$1,302.86",$0.00,$314.52,$0.00,$0.00,$319.63,"$1,825.50",$0.00,$912.75,"$1,445.80","$1,460.40",$0.00,$285.69,$0.00,$290.62,$0.00
7362435,SUP,HCPCS C1713,,"7362435  -  FAS 4.0 X 35MM FOR 3.5 ROD, SS","$1,825.50",$0.00,"$1,825.50",$821.48,"$1,302.86",$0.00,$314.52,$0.00,$0.00,$319.63,"$1,825.50",$0.00,$912.75,"$1,445.80","$1,460.40",$0.00,$285.69,$0.00,$290.62,$0.00
7362440,SUP,HCPCS C1713,,"7362440  -  FAS 4.0 X 40MM FOR 3.5 ROD, SS","$1,825.50",$0.00,"$1,825.50",$821.48,"$1,302.86",$0.00,$314.52,$0.00,$0.00,$319.63,"$1,825.50",$0.00,$912.75,"$1,445.80","$1,460.40",$0.00,$285.69,$0.00,$290.62,$0.00
7363310,SUP,HCPCS C1713,,7363310  -  BONE SCREW 7363310 FAS 3.5 X 10 SS,"$1,825.50",$0.00,"$1,825.50",$821.48,"$1,302.86",$0.00,$314.52,$0.00,$0.00,$319.63,"$1,825.50",$0.00,$912.75,"$1,445.80","$1,460.40",$0.00,$285.69,$0.00,$290.62,$0.00
7363315,SUP,HCPCS C1713,,7363315  -  BONE SCREW 7363315 FAS 3.5 X 15 SS,"$1,825.50",$0.00,"$1,825.50",$821.48,"$1,302.86",$0.00,$314.52,$0.00,$0.00,$319.63,"$1,825.50",$0.00,$912.75,"$1,445.80","$1,460.40",$0.00,$285.69,$0.00,$290.62,$0.00
7363320,SUP,HCPCS C1713,,7363320  -  BONE SCREW 7363320 FAS 3.5 X 20 SS,"$1,825.50",$0.00,"$1,825.50",$821.48,"$1,302.86",$0.00,$314.52,$0.00,$0.00,$319.63,"$1,825.50",$0.00,$912.75,"$1,445.80","$1,460.40",$0.00,$285.69,$0.00,$290.62,$0.00
7363325,SUP,HCPCS C1713,,7363325  -  BONE SCREW 7363325 FAS 3.5 X 25 SS,"$1,825.50",$0.00,"$1,825.50",$821.48,"$1,302.86",$0.00,$314.52,$0.00,$0.00,$319.63,"$1,825.50",$0.00,$912.75,"$1,445.80","$1,460.40",$0.00,$285.69,$0.00,$290.62,$0.00
7363330,SUP,HCPCS C1713,,7363330  -  BONE SCREW 7363330 FAS 3.5 X 30 SS,"$1,825.50",$0.00,"$1,825.50",$821.48,"$1,302.86",$0.00,$314.52,$0.00,$0.00,$319.63,"$1,825.50",$0.00,$912.75,"$1,445.80","$1,460.40",$0.00,$285.69,$0.00,$290.62,$0.00
7363415,SUP,HCPCS C1713,,7363415  -  BONE SCREW 7363415 FAS 4.5 X 15 SS,"$1,825.50",$0.00,"$1,825.50",$821.48,"$1,302.86",$0.00,$314.52,$0.00,$0.00,$319.63,"$1,825.50",$0.00,$912.75,"$1,445.80","$1,460.40",$0.00,$285.69,$0.00,$290.62,$0.00
7363420,SUP,HCPCS C1713,,7363420  -  BONE SCREW 7363420 FAS 4.5 X 20 SS,"$1,825.50",$0.00,"$1,825.50",$821.48,"$1,302.86",$0.00,$314.52,$0.00,$0.00,$319.63,"$1,825.50",$0.00,$912.75,"$1,445.80","$1,460.40",$0.00,$285.69,$0.00,$290.62,$0.00
7363425,SUP,HCPCS C1713,,7363425  -  BONE SCREW 7363425 FAS 4.5 X 25 SS,"$1,825.50",$0.00,"$1,825.50",$821.48,"$1,302.86",$0.00,$314.52,$0.00,$0.00,$319.63,"$1,825.50",$0.00,$912.75,"$1,445.80","$1,460.40",$0.00,$285.69,$0.00,$290.62,$0.00
7363430,SUP,HCPCS C1713,,7363430  -  BONE SCREW 7363430 FAS 4.5 X 30 SS,"$1,825.50",$0.00,"$1,825.50",$821.48,"$1,302.86",$0.00,$314.52,$0.00,$0.00,$319.63,"$1,825.50",$0.00,$912.75,"$1,445.80","$1,460.40",$0.00,$285.69,$0.00,$290.62,$0.00
7363435,SUP,HCPCS C1713,,7363435  -  BONE SCREW 7363435 FAS 4.5 X 35 SS,"$1,825.50",$0.00,"$1,825.50",$821.48,"$1,302.86",$0.00,$314.52,$0.00,$0.00,$319.63,"$1,825.50",$0.00,$912.75,"$1,445.80","$1,460.40",$0.00,$285.69,$0.00,$290.62,$0.00
7363440,SUP,HCPCS C1713,,7363440  -  BONE SCREW 7363440 FAS 4.5 X 40 SS,"$1,825.50",$0.00,"$1,825.50",$821.48,"$1,302.86",$0.00,$314.52,$0.00,$0.00,$319.63,"$1,825.50",$0.00,$912.75,"$1,445.80","$1,460.40",$0.00,$285.69,$0.00,$290.62,$0.00
7363520,SUP,HCPCS C1713,,7363520  -  BONE SCREW 7363520 FAS 5.5 X 20 SS,"$1,825.50",$0.00,"$1,825.50",$821.48,"$1,302.86",$0.00,$314.52,$0.00,$0.00,$319.63,"$1,825.50",$0.00,$912.75,"$1,445.80","$1,460.40",$0.00,$285.69,$0.00,$290.62,$0.00
7363525,SUP,HCPCS C1713,,7363525  -  BONE SCREW 7363525 FAS 5.5 X 25 SS,"$1,825.50",$0.00,"$1,825.50",$821.48,"$1,302.86",$0.00,$314.52,$0.00,$0.00,$319.63,"$1,825.50",$0.00,$912.75,"$1,445.80","$1,460.40",$0.00,$285.69,$0.00,$290.62,$0.00
7363530,SUP,HCPCS C1713,,7363530  -  BONE SCREW 7363530 FAS 5.5 X 30 SS,"$1,825.50",$0.00,"$1,825.50",$821.48,"$1,302.86",$0.00,$314.52,$0.00,$0.00,$319.63,"$1,825.50",$0.00,$912.75,"$1,445.80","$1,460.40",$0.00,$285.69,$0.00,$290.62,$0.00
7363535,SUP,HCPCS C1713,,7363535  -  BONE SCREW 7363535 FAS 5.5 X 35 SS,"$1,825.50",$0.00,"$1,825.50",$821.48,"$1,302.86",$0.00,$314.52,$0.00,$0.00,$319.63,"$1,825.50",$0.00,$912.75,"$1,445.80","$1,460.40",$0.00,$285.69,$0.00,$290.62,$0.00
7363540,SUP,HCPCS C1713,,7363540  -  BONE SCREW 7363540 FAS 5.5 X 40 SS,"$1,825.50",$0.00,"$1,825.50",$821.48,"$1,302.86",$0.00,$314.52,$0.00,$0.00,$319.63,"$1,825.50",$0.00,$912.75,"$1,445.80","$1,460.40",$0.00,$285.69,$0.00,$290.62,$0.00
7363545,SUP,HCPCS C1713,,7363545  -  BONE SCREW 7363545 FAS 5.5 X 45 SS,"$1,825.50",$0.00,"$1,825.50",$821.48,"$1,302.86",$0.00,$314.52,$0.00,$0.00,$319.63,"$1,825.50",$0.00,$912.75,"$1,445.80","$1,460.40",$0.00,$285.69,$0.00,$290.62,$0.00
7370100,SUP,HCPCS C1713,,7370100  -  SCREW BONE .5MM 10MM SPHERX DBR 2 TI SPNL LCK,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
7375530,SUP,HCPCS C1713,,7375530  -  SCREW BN 5.5MM 30MM SPHERX II PA CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
7375535,SUP,HCPCS C1713,,7375535  -  SCREW BN 5.5MM 35MM SPHERX DBR II PA CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
7375540,SUP,HCPCS C1713,,7375540  -  SCREW BN 5.5MM 40MM PA CNN CANC SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
7375545,SUP,HCPCS C1713,,7375545  -  SCREW BN 5.5MM 45MM PA CNN CANC SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
7375550,SUP,HCPCS C1713,,7375550  -  SCREW BN 5.5MM 50MM SPHERX DBR II PA CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
7375555,SUP,HCPCS C1713,,7375555  -  SCREW BN 5.5MM 55MM SPHERX DBR II PA CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
7376530,SUP,HCPCS C1713,,7376530  -  SCREW BN 6.5MM 30MM SPHERX DBR II PA CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
7376535,SUP,HCPCS C1713,,7376535  -  SCREW BN 6.5MM 35MM PA CANC SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
7376540,SUP,HCPCS C1713,,7376540  -  SCREW BN 6.5MM 40MM SPHERX DBR II PA CNN TI SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
7376550,SUP,HCPCS C1713,,7376550  -  SCREW BN 6.5MM 50MM SPHERX DBR II PA CNN TI SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
7376555,SUP,HCPCS C1713,,7376555  -  SCREW BN 6.5MM 55MM SPHERX DBR II PA CNN TI SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
7377530,SUP,HCPCS C1713,,7377530  -  SCREW BN 7.5MM 30MM SPHERX DBR II PA CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
7377535,SUP,HCPCS C1713,,7377535  -  SCREW BN 7.5MM 35MM SPHERX DBR II PA CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
7377540,SUP,HCPCS C1713,,7377540  -  SCREW BN 7.5MM 40MM SPHERX DBR II PA CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
7377545,SUP,HCPCS C1713,,7377545  -  SCREW BN 7.5MM 45MM SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
7377550,SUP,HCPCS C1713,,7377550  -  SCREW BN 7.5MM 50MM SPHERX DBR II PA CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
7377555,SUP,HCPCS C1713,,7377555  -  SCREW BN 7.5MM 55MM SPHERX DBR II PA CNN SPNE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
7401151,SUP,Custom 27203010,,KIT CYTOBLOCK REPL REAGENT TISS FRAG CELL PREP CYTO,$65.18,$0.00,$65.18,$0.00,$46.52,$0.00,$0.00,$0.00,$0.00,$0.00,$65.18,$0.00,$32.59,$51.62,$52.14,$0.00,$0.00,$0.00,$0.00,$0.00
7440020,SUP,HCPCS C1713,,7440020  -  SET SCREW 7440020 BREAKOFF TI,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
7440030,SUP,HCPCS C1713,,7440030  -  SET SCREW 7440030 L 4.5 G4 TI BRK OFF,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
7440100,SUP,HCPCS C1713,,"7440100  -  SET SCREW, NON BREAK-OFF, TI",$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
7440120,SUP,HCPCS C1713,,"7440120  -  SET SCREW, NON BREAK-OFF, TI",$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
7440122,SUP,HCPCS C1713,,7440122  -  PLATE BN 22MM NS GRDNT + 1 LVL SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7440124,SUP,HCPCS C1713,,7440124  -  PLATE BN 24MM NS GRDNT + 1 LVL SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7440126,SUP,HCPCS C1713,,7440126  -  PLATE BN 26MM NS GRDNT + 1 LVL SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7440128,SUP,HCPCS C1713,,7440128  -  PLATE BN 28MM NS GRDNT + 1 LVL SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7440130,SUP,HCPCS C1713,,7440130  -  PLATE BN 30MM NS GRDNT + 1 LVL SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7440132,SUP,HCPCS C1713,,7440132  -  PLATE BN 32MM NS GRDNT + 1 LVL SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7440134,SUP,HCPCS C1713,,7440134  -  PLATE BN 34MM NS GRDNT + 1 LVL SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7440136,SUP,HCPCS C1713,,7440136  -  PLATE BN 36MM NS GRDNT + 1 LVL SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7440236,SUP,HCPCS C1713,,7440236  -  PLATE BN 36MM NS GRDNT + 2 LVL SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7440238,SUP,HCPCS C1713,,7440238  -  PLATE BN 38MM NS GRDNT + 2 LVL SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7440240,SUP,HCPCS C1713,,7440240  -  PLATE BN 40MM NS GRDNT + 2 LVL SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7440242,SUP,HCPCS C1713,,7440242  -  PLATE BN 42MM NS GRDNT + 2 LVL SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7440244,SUP,HCPCS C1713,,7440244  -  PLATE BN 44MM NS GRDNT + 2 LVL SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7440246,SUP,HCPCS C1713,,7440246  -  PLATE BN 46MM NS GRDNT + 2 LVL SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7440248,SUP,HCPCS C1713,,7440248  -  PLATE BN 48MM NS GRDNT + 2 LVL SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7440250,SUP,HCPCS C1713,,7440250  -  PLATE BN 50MM NS GRDNT + 2 LVL SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7440252,SUP,HCPCS C1713,,7440252  -  PLATE BN 52MM NS GRDNT + 2 LVL SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7440254,SUP,HCPCS C1713,,7440254  -  PLATE BN 54MM NS GRDNT + 2 LVL SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7440354,SUP,HCPCS C1713,,7440354  -  PLATE BN 54MM NS GRDNT + 3 LVL SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7440356,SUP,HCPCS C1713,,7440356  -  PLATE BN 56MM NS GRDNT + 3 LVL SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7440358,SUP,HCPCS C1713,,7440358  -  PLATE BN 58MM NS GRDNT + 3 LVL SPNE,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7440360,SUP,HCPCS C1713,,7440360  -  PLATE BN 60MM NS GRDNT + 3 LVL SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7440362,SUP,HCPCS C1713,,7440362  -  PLATE BN 62MM NS GRDNT + 3 LVL SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7440364,SUP,HCPCS C1713,,7440364  -  PLATE BN 64MM NS GRDNT + 3 LVL SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7440366,SUP,HCPCS C1713,,7440366  -  PLATE BN 66MM NS GRDNT + 3 LVL SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7440368,SUP,HCPCS C1713,,7440368  -  PLATE BN 68MM NS GRDNT + 3 LVL SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7440468,SUP,HCPCS C1713,,7440468  -  PLATE BN 68MM NS GRDNT + 4 LVL SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7440470,SUP,HCPCS C1713,,7440470  -  PLATE BN 70MM NS GRDNT + 4 LVL SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7440474,SUP,HCPCS C1713,,7440474  -  PLATE BN 74MM NS GRDNT + 4 LVL SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7440478,SUP,HCPCS C1713,,7440478  -  PLATE BN 78MM NS GRDNT + 4 LVL SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7440482,SUP,HCPCS C1713,,7440482  -  PLATE BN 82MM NS GRDNT + 4 LVL SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7440486,SUP,HCPCS C1713,,7440486  -  PLATE BN 86MM NS GRDNT + 4 LVL SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7440490,SUP,HCPCS C1713,,7440490  -  PLATE BN 90MM NS GRDNT + 4 LVL SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7440500,SUP,HCPCS C1713,,7440500  -  PLATE BN RND HL CVR TI SPNE CRV ANT,$377.50,$0.00,$377.50,$169.88,$269.42,$0.00,$65.04,$0.00,$0.00,$66.10,$377.50,$0.00,$188.75,$298.98,$302.00,$0.00,$59.08,$0.00,$60.10,$0.00
7440918,SUP,Custom 27203010,,7440918  -  BIT DRL MN 10MM HLX ACP SPNE,$570.00,$0.00,$570.00,$0.00,$406.81,$0.00,$0.00,$0.00,$0.00,$0.00,$570.00,$0.00,$285.00,$451.44,$456.00,$0.00,$0.00,$0.00,$0.00,$0.00
7441102,SUP,HCPCS C1713,,7441102  -  HOOK 7441102 PEDICLE TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7441112,SUP,HCPCS C1713,,7441112  -  HOOK 7441112 WIDE BLADE SM TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7441113,SUP,HCPCS C1713,,7441113  -  HOOK 7441113 WIDE BLADE MED TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7441114,SUP,HCPCS C1713,,7441114  -  HOOK 7441114 WIDE BLADE LG TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7441122,SUP,HCPCS C1713,,7441122  -  HOOK 7441122 NARROW BLADE TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7441142,SUP,HCPCS C1713,,7441142  -  HOOK 7441142 RAMPED THORACIC TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7441162,SUP,HCPCS C1713,,7441162  -  HOOK 7441162 LUMBAR ANGLED BLADE TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7441172,SUP,HCPCS C1713,,7441172  -  HOOK 7441172 EXTENDED BODY TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7441198,SUP,HCPCS C1713,,7441198  -  HOOK 7441198 OFFSET RT TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7441199,SUP,HCPCS C1713,,7441199  -  HOOK 7441199 OFFSET LT TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7442420,SUP,HCPCS C1713,,7442420  -  BONE SCREW 7442420 FXD ANGLE 4.0X20 TI,"$1,864.50",$0.00,"$1,864.50",$839.03,"$1,330.69",$0.00,$321.24,$0.00,$0.00,$326.46,"$1,864.50",$0.00,$932.25,"$1,476.68","$1,491.60",$0.00,$291.79,$0.00,$296.83,$0.00
7442425,SUP,HCPCS C1713,,7442425  -  BONE SCREW 7442425 FXD ANGLE 4.0X25 TI,"$1,864.50",$0.00,"$1,864.50",$839.03,"$1,330.69",$0.00,$321.24,$0.00,$0.00,$326.46,"$1,864.50",$0.00,$932.25,"$1,476.68","$1,491.60",$0.00,$291.79,$0.00,$296.83,$0.00
7442430,SUP,HCPCS C1713,,7442430  -  BONE SCREW 7442430 FXD ANGLE 4.0X30 TI,"$1,864.50",$0.00,"$1,864.50",$839.03,"$1,330.69",$0.00,$321.24,$0.00,$0.00,$326.46,"$1,864.50",$0.00,$932.25,"$1,476.68","$1,491.60",$0.00,$291.79,$0.00,$296.83,$0.00
7442435,SUP,HCPCS C1713,,7442435  -  BONE SCREW 7442435 FXD ANGLE 4.0X35 TI,"$1,864.50",$0.00,"$1,864.50",$839.03,"$1,330.69",$0.00,$321.24,$0.00,$0.00,$326.46,"$1,864.50",$0.00,$932.25,"$1,476.68","$1,491.60",$0.00,$291.79,$0.00,$296.83,$0.00
7442440,SUP,HCPCS C1713,,7442440  -  BONE SCREW 7442440 FXD ANGLE 4.0X40 TI,"$1,864.50",$0.00,"$1,864.50",$839.03,"$1,330.69",$0.00,$321.24,$0.00,$0.00,$326.46,"$1,864.50",$0.00,$932.25,"$1,476.68","$1,491.60",$0.00,$291.79,$0.00,$296.83,$0.00
7442525,SUP,HCPCS C1713,,7442525  -  BONE SCREW 7442525 FXD ANGLE 5.0X25 TI,"$1,864.50",$0.00,"$1,864.50",$839.03,"$1,330.69",$0.00,$321.24,$0.00,$0.00,$326.46,"$1,864.50",$0.00,$932.25,"$1,476.68","$1,491.60",$0.00,$291.79,$0.00,$296.83,$0.00
7442528,SUP,HCPCS C1713,,"7442528  -  SCREW, FIXED ANGLE,5.0X27.5,TI","$1,864.50",$0.00,"$1,864.50",$839.03,"$1,330.69",$0.00,$321.24,$0.00,$0.00,$326.46,"$1,864.50",$0.00,$932.25,"$1,476.68","$1,491.60",$0.00,$291.79,$0.00,$296.83,$0.00
7442530,SUP,HCPCS C1713,,7442530  -  BONE SCREW 7442530 FXD ANGLE 5.0X30 TI,"$1,864.50",$0.00,"$1,864.50",$839.03,"$1,330.69",$0.00,$321.24,$0.00,$0.00,$326.46,"$1,864.50",$0.00,$932.25,"$1,476.68","$1,491.60",$0.00,$291.79,$0.00,$296.83,$0.00
7442533,SUP,HCPCS C1713,,"7442533  -  SCREW, FIXED ANGLE,5.0X32.5,TI","$1,864.50",$0.00,"$1,864.50",$839.03,"$1,330.69",$0.00,$321.24,$0.00,$0.00,$326.46,"$1,864.50",$0.00,$932.25,"$1,476.68","$1,491.60",$0.00,$291.79,$0.00,$296.83,$0.00
7442535,SUP,HCPCS C1713,,7442535  -  BONE SCREW 7442535 FXD ANGLE 5.0X35 TI,"$1,864.50",$0.00,"$1,864.50",$839.03,"$1,330.69",$0.00,$321.24,$0.00,$0.00,$326.46,"$1,864.50",$0.00,$932.25,"$1,476.68","$1,491.60",$0.00,$291.79,$0.00,$296.83,$0.00
7442538,SUP,HCPCS C1713,,"7442538  -  SCREW, FIXED ANGLE,5.0X37.5,TI","$1,864.50",$0.00,"$1,864.50",$839.03,"$1,330.69",$0.00,$321.24,$0.00,$0.00,$326.46,"$1,864.50",$0.00,$932.25,"$1,476.68","$1,491.60",$0.00,$291.79,$0.00,$296.83,$0.00
7442540,SUP,HCPCS C1713,,7442540  -  BONE SCREW 7442540 FXD ANGLE 5.0X40 TI,"$1,864.50",$0.00,"$1,864.50",$839.03,"$1,330.69",$0.00,$321.24,$0.00,$0.00,$326.46,"$1,864.50",$0.00,$932.25,"$1,476.68","$1,491.60",$0.00,$291.79,$0.00,$296.83,$0.00
7442545,SUP,HCPCS C1713,,7442545  -  BONE SCREW 7442545 FXD ANGLE 5.0X45 TI,"$1,864.50",$0.00,"$1,864.50",$839.03,"$1,330.69",$0.00,$321.24,$0.00,$0.00,$326.46,"$1,864.50",$0.00,$932.25,"$1,476.68","$1,491.60",$0.00,$291.79,$0.00,$296.83,$0.00
7442550,SUP,HCPCS C1713,,7442550  -  BONE SCREW 7442550 FXD ANGLE 5.0X50 TI,"$1,864.50",$0.00,"$1,864.50",$839.03,"$1,330.69",$0.00,$321.24,$0.00,$0.00,$326.46,"$1,864.50",$0.00,$932.25,"$1,476.68","$1,491.60",$0.00,$291.79,$0.00,$296.83,$0.00
7442625,SUP,HCPCS C1713,,7442625  -  BONE SCREW 7442625 FXD ANGLE6.0X25TI,"$1,864.50",$0.00,"$1,864.50",$839.03,"$1,330.69",$0.00,$321.24,$0.00,$0.00,$326.46,"$1,864.50",$0.00,$932.25,"$1,476.68","$1,491.60",$0.00,$291.79,$0.00,$296.83,$0.00
7442628,SUP,HCPCS C1713,,"7442628  -  SCREW, FIXED ANGLE,6.0X27.5,TI","$1,864.50",$0.00,"$1,864.50",$839.03,"$1,330.69",$0.00,$321.24,$0.00,$0.00,$326.46,"$1,864.50",$0.00,$932.25,"$1,476.68","$1,491.60",$0.00,$291.79,$0.00,$296.83,$0.00
7442630,SUP,HCPCS C1713,,7442630  -  BONE SCREW 7442630 FXD ANGLE6.0X30TI,"$1,864.50",$0.00,"$1,864.50",$839.03,"$1,330.69",$0.00,$321.24,$0.00,$0.00,$326.46,"$1,864.50",$0.00,$932.25,"$1,476.68","$1,491.60",$0.00,$291.79,$0.00,$296.83,$0.00
7442633,SUP,HCPCS C1713,,"7442633  -  SCREW, FIXED ANGLE,6.0X32.5,TI","$1,864.50",$0.00,"$1,864.50",$839.03,"$1,330.69",$0.00,$321.24,$0.00,$0.00,$326.46,"$1,864.50",$0.00,$932.25,"$1,476.68","$1,491.60",$0.00,$291.79,$0.00,$296.83,$0.00
7442635,SUP,HCPCS C1713,,7442635  -  BONE SCREW 7442635 FXD ANGLE6.0X35TI,"$1,864.50",$0.00,"$1,864.50",$839.03,"$1,330.69",$0.00,$321.24,$0.00,$0.00,$326.46,"$1,864.50",$0.00,$932.25,"$1,476.68","$1,491.60",$0.00,$291.79,$0.00,$296.83,$0.00
7442638,SUP,HCPCS C1713,,"7442638  -  SCREW, FIXED ANGLE,6.0X37.5,TI","$1,864.50",$0.00,"$1,864.50",$839.03,"$1,330.69",$0.00,$321.24,$0.00,$0.00,$326.46,"$1,864.50",$0.00,$932.25,"$1,476.68","$1,491.60",$0.00,$291.79,$0.00,$296.83,$0.00
7442640,SUP,HCPCS C1713,,7442640  -  BONE SCREW 7442640 FXD ANGLE6.0X40TI,"$1,864.50",$0.00,"$1,864.50",$839.03,"$1,330.69",$0.00,$321.24,$0.00,$0.00,$326.46,"$1,864.50",$0.00,$932.25,"$1,476.68","$1,491.60",$0.00,$291.79,$0.00,$296.83,$0.00
7442645,SUP,HCPCS C1713,,7442645  -  BONE SCREW 7442645 FXD ANGLE6.0X45TI,"$1,864.50",$0.00,"$1,864.50",$839.03,"$1,330.69",$0.00,$321.24,$0.00,$0.00,$326.46,"$1,864.50",$0.00,$932.25,"$1,476.68","$1,491.60",$0.00,$291.79,$0.00,$296.83,$0.00
7442650,SUP,HCPCS C1713,,7442650  -  BONE SCREW 7442650 FXD ANGLE6.0X50TI,"$1,864.50",$0.00,"$1,864.50",$839.03,"$1,330.69",$0.00,$321.24,$0.00,$0.00,$326.46,"$1,864.50",$0.00,$932.25,"$1,476.68","$1,491.60",$0.00,$291.79,$0.00,$296.83,$0.00
7443425,SUP,HCPCS C1713,,7443425  -  BONE SCREW 7443425 FXD ANGLE 4.5X25 TI,"$1,864.50",$0.00,"$1,864.50",$839.03,"$1,330.69",$0.00,$321.24,$0.00,$0.00,$326.46,"$1,864.50",$0.00,$932.25,"$1,476.68","$1,491.60",$0.00,$291.79,$0.00,$296.83,$0.00
7443428,SUP,HCPCS C1713,,"7443428  -  SCREW, FIXED ANGLE,4.5X27.5,TI","$1,864.50",$0.00,"$1,864.50",$839.03,"$1,330.69",$0.00,$321.24,$0.00,$0.00,$326.46,"$1,864.50",$0.00,$932.25,"$1,476.68","$1,491.60",$0.00,$291.79,$0.00,$296.83,$0.00
7443430,SUP,HCPCS C1713,,7443430  -  BONE SCREW 7443430 FXD ANGLE 4.5X30 TI,"$1,864.50",$0.00,"$1,864.50",$839.03,"$1,330.69",$0.00,$321.24,$0.00,$0.00,$326.46,"$1,864.50",$0.00,$932.25,"$1,476.68","$1,491.60",$0.00,$291.79,$0.00,$296.83,$0.00
7443433,SUP,HCPCS C1713,,"7443433  -  SCREW, FIXED ANGLE,4.5X32.5,TI","$1,864.50",$0.00,"$1,864.50",$839.03,"$1,330.69",$0.00,$321.24,$0.00,$0.00,$326.46,"$1,864.50",$0.00,$932.25,"$1,476.68","$1,491.60",$0.00,$291.79,$0.00,$296.83,$0.00
7443435,SUP,HCPCS C1713,,7443435  -  BONE SCREW 7443435 FXD ANGLE 4.5X35 TI,"$1,864.50",$0.00,"$1,864.50",$839.03,"$1,330.69",$0.00,$321.24,$0.00,$0.00,$326.46,"$1,864.50",$0.00,$932.25,"$1,476.68","$1,491.60",$0.00,$291.79,$0.00,$296.83,$0.00
7443438,SUP,HCPCS C1713,,"7443438  -  SCREW, FIXED ANGLE,4.5X37.5,TI","$1,864.50",$0.00,"$1,864.50",$839.03,"$1,330.69",$0.00,$321.24,$0.00,$0.00,$326.46,"$1,864.50",$0.00,$932.25,"$1,476.68","$1,491.60",$0.00,$291.79,$0.00,$296.83,$0.00
7443440,SUP,HCPCS C1713,,7443440  -  BONE SCREW 7443440 FXD ANGLE 4.5X40 TI,"$1,864.50",$0.00,"$1,864.50",$839.03,"$1,330.69",$0.00,$321.24,$0.00,$0.00,$326.46,"$1,864.50",$0.00,$932.25,"$1,476.68","$1,491.60",$0.00,$291.79,$0.00,$296.83,$0.00
7443445,SUP,HCPCS C1713,,"7443445  -  SCREW, FIXED ANGLE, 4.5X45, TI","$1,864.50",$0.00,"$1,864.50",$839.03,"$1,330.69",$0.00,$321.24,$0.00,$0.00,$326.46,"$1,864.50",$0.00,$932.25,"$1,476.68","$1,491.60",$0.00,$291.79,$0.00,$296.83,$0.00
7443450,SUP,HCPCS C1713,,"7443450  -  SCREW, FIXED ANGLE, 4.5X50, TI","$1,864.50",$0.00,"$1,864.50",$839.03,"$1,330.69",$0.00,$321.24,$0.00,$0.00,$326.46,"$1,864.50",$0.00,$932.25,"$1,476.68","$1,491.60",$0.00,$291.79,$0.00,$296.83,$0.00
7443525,SUP,HCPCS C1713,,7443525  -  BONE SCREW 7443525 FXD ANGLE 5.5X25 TI,"$1,864.50",$0.00,"$1,864.50",$839.03,"$1,330.69",$0.00,$321.24,$0.00,$0.00,$326.46,"$1,864.50",$0.00,$932.25,"$1,476.68","$1,491.60",$0.00,$291.79,$0.00,$296.83,$0.00
7443528,SUP,HCPCS C1713,,"7443528  -  SCREW, FIXED ANGLE,5.5X27.5,TI","$1,864.50",$0.00,"$1,864.50",$839.03,"$1,330.69",$0.00,$321.24,$0.00,$0.00,$326.46,"$1,864.50",$0.00,$932.25,"$1,476.68","$1,491.60",$0.00,$291.79,$0.00,$296.83,$0.00
7443530,SUP,HCPCS C1713,,7443530  -  BONE SCREW 7443530 FXD ANGLE5.5X30TI,"$1,864.50",$0.00,"$1,864.50",$839.03,"$1,330.69",$0.00,$321.24,$0.00,$0.00,$326.46,"$1,864.50",$0.00,$932.25,"$1,476.68","$1,491.60",$0.00,$291.79,$0.00,$296.83,$0.00
7443533,SUP,HCPCS C1713,,"7443533  -  SCREW, FIXED ANGLE,5.5X32.5,TI","$1,864.50",$0.00,"$1,864.50",$839.03,"$1,330.69",$0.00,$321.24,$0.00,$0.00,$326.46,"$1,864.50",$0.00,$932.25,"$1,476.68","$1,491.60",$0.00,$291.79,$0.00,$296.83,$0.00
7443535,SUP,HCPCS C1713,,7443535  -  BONE SCREW 7443535 FXD ANGLE5.5X35TI,"$1,864.50",$0.00,"$1,864.50",$839.03,"$1,330.69",$0.00,$321.24,$0.00,$0.00,$326.46,"$1,864.50",$0.00,$932.25,"$1,476.68","$1,491.60",$0.00,$291.79,$0.00,$296.83,$0.00
7443538,SUP,HCPCS C1713,,"7443538  -  SCREW, FIXED ANGLE,5.5X37.5,TI","$1,864.50",$0.00,"$1,864.50",$839.03,"$1,330.69",$0.00,$321.24,$0.00,$0.00,$326.46,"$1,864.50",$0.00,$932.25,"$1,476.68","$1,491.60",$0.00,$291.79,$0.00,$296.83,$0.00
7443540,SUP,HCPCS C1713,,7443540  -  BONE SCREW 7443540 FXD ANGLE5.5X40TI,"$1,864.50",$0.00,"$1,864.50",$839.03,"$1,330.69",$0.00,$321.24,$0.00,$0.00,$326.46,"$1,864.50",$0.00,$932.25,"$1,476.68","$1,491.60",$0.00,$291.79,$0.00,$296.83,$0.00
7443545,SUP,HCPCS C1713,,7443545  -  BONE SCREW 7443545 FXD ANGLE5.5X45TI,"$1,864.50",$0.00,"$1,864.50",$839.03,"$1,330.69",$0.00,$321.24,$0.00,$0.00,$326.46,"$1,864.50",$0.00,$932.25,"$1,476.68","$1,491.60",$0.00,$291.79,$0.00,$296.83,$0.00
7443550,SUP,HCPCS C1713,,7443550  -  BONE SCREW 7443550 FXD ANGLE5.5X50TI,"$1,864.50",$0.00,"$1,864.50",$839.03,"$1,330.69",$0.00,$321.24,$0.00,$0.00,$326.46,"$1,864.50",$0.00,$932.25,"$1,476.68","$1,491.60",$0.00,$291.79,$0.00,$296.83,$0.00
7443625,SUP,HCPCS C1713,,7443625  -  BONE SCREW 7443625 FXD ANGLE6.5X25TI,"$1,864.50",$0.00,"$1,864.50",$839.03,"$1,330.69",$0.00,$321.24,$0.00,$0.00,$326.46,"$1,864.50",$0.00,$932.25,"$1,476.68","$1,491.60",$0.00,$291.79,$0.00,$296.83,$0.00
7443628,SUP,HCPCS C1713,,"7443628  -  SCREW, FIXED ANGLE,6.5X27.5,TI","$1,864.50",$0.00,"$1,864.50",$839.03,"$1,330.69",$0.00,$321.24,$0.00,$0.00,$326.46,"$1,864.50",$0.00,$932.25,"$1,476.68","$1,491.60",$0.00,$291.79,$0.00,$296.83,$0.00
7443630,SUP,HCPCS C1713,,7443630  -  BONE SCREW 7443630 FXD ANGLE6.5X30TI,"$1,864.50",$0.00,"$1,864.50",$839.03,"$1,330.69",$0.00,$321.24,$0.00,$0.00,$326.46,"$1,864.50",$0.00,$932.25,"$1,476.68","$1,491.60",$0.00,$291.79,$0.00,$296.83,$0.00
7443633,SUP,HCPCS C1713,,"7443633  -  SCREW, FIXED ANGLE,6.5X32.5,TI","$1,864.50",$0.00,"$1,864.50",$839.03,"$1,330.69",$0.00,$321.24,$0.00,$0.00,$326.46,"$1,864.50",$0.00,$932.25,"$1,476.68","$1,491.60",$0.00,$291.79,$0.00,$296.83,$0.00
7443635,SUP,HCPCS C1713,,7443635  -  BONE SCREW 7443635 FXD ANGLE6.5X35TI,"$1,864.50",$0.00,"$1,864.50",$839.03,"$1,330.69",$0.00,$321.24,$0.00,$0.00,$326.46,"$1,864.50",$0.00,$932.25,"$1,476.68","$1,491.60",$0.00,$291.79,$0.00,$296.83,$0.00
7443638,SUP,HCPCS C1713,,"7443638  -  SCREW, FIXED ANGLE,6.5X37.5,TI","$1,864.50",$0.00,"$1,864.50",$839.03,"$1,330.69",$0.00,$321.24,$0.00,$0.00,$326.46,"$1,864.50",$0.00,$932.25,"$1,476.68","$1,491.60",$0.00,$291.79,$0.00,$296.83,$0.00
7443640,SUP,HCPCS C1713,,7443640  -  BONE SCREW 7443640 FXD ANGLE6.5X40TI,"$1,864.50",$0.00,"$1,864.50",$839.03,"$1,330.69",$0.00,$321.24,$0.00,$0.00,$326.46,"$1,864.50",$0.00,$932.25,"$1,476.68","$1,491.60",$0.00,$291.79,$0.00,$296.83,$0.00
7443645,SUP,HCPCS C1713,,7443645  -  BONE SCREW 7443645 FXD ANGLE6.5X45TI,"$1,864.50",$0.00,"$1,864.50",$839.03,"$1,330.69",$0.00,$321.24,$0.00,$0.00,$326.46,"$1,864.50",$0.00,$932.25,"$1,476.68","$1,491.60",$0.00,$291.79,$0.00,$296.83,$0.00
7443650,SUP,HCPCS C1713,,7443650  -  BONE SCREW 7443650 FXD ANGLE6.5X50TI,"$1,864.50",$0.00,"$1,864.50",$839.03,"$1,330.69",$0.00,$321.24,$0.00,$0.00,$326.46,"$1,864.50",$0.00,$932.25,"$1,476.68","$1,491.60",$0.00,$291.79,$0.00,$296.83,$0.00
7443655,SUP,HCPCS C1713,,7443655  -  BONE SCREW 7443655 FXD ANGLE6.5X55TI,"$1,864.50",$0.00,"$1,864.50",$839.03,"$1,330.69",$0.00,$321.24,$0.00,$0.00,$326.46,"$1,864.50",$0.00,$932.25,"$1,476.68","$1,491.60",$0.00,$291.79,$0.00,$296.83,$0.00
7443725,SUP,HCPCS C1713,,"7443725  -  SCREW, FIXED ANGLE,7.5X25,TI","$1,864.50",$0.00,"$1,864.50",$839.03,"$1,330.69",$0.00,$321.24,$0.00,$0.00,$326.46,"$1,864.50",$0.00,$932.25,"$1,476.68","$1,491.60",$0.00,$291.79,$0.00,$296.83,$0.00
7443728,SUP,HCPCS C1713,,"7443728  -  SCREW, FIXED ANGLE,7.5X27.5,TI","$1,864.50",$0.00,"$1,864.50",$839.03,"$1,330.69",$0.00,$321.24,$0.00,$0.00,$326.46,"$1,864.50",$0.00,$932.25,"$1,476.68","$1,491.60",$0.00,$291.79,$0.00,$296.83,$0.00
7443730,SUP,HCPCS C1713,,"7443730  -  SCREW, FIXED ANGLE,7.5X30,TI","$1,864.50",$0.00,"$1,864.50",$839.03,"$1,330.69",$0.00,$321.24,$0.00,$0.00,$326.46,"$1,864.50",$0.00,$932.25,"$1,476.68","$1,491.60",$0.00,$291.79,$0.00,$296.83,$0.00
7443733,SUP,HCPCS C1713,,"7443733  -  SCREW, FIXED ANGLE,7.5X32.5,TI","$1,864.50",$0.00,"$1,864.50",$839.03,"$1,330.69",$0.00,$321.24,$0.00,$0.00,$326.46,"$1,864.50",$0.00,$932.25,"$1,476.68","$1,491.60",$0.00,$291.79,$0.00,$296.83,$0.00
7443735,SUP,HCPCS C1713,,"7443735  -  SCREW, FIXED ANGLE,7.5X35,TI","$1,864.50",$0.00,"$1,864.50",$839.03,"$1,330.69",$0.00,$321.24,$0.00,$0.00,$326.46,"$1,864.50",$0.00,$932.25,"$1,476.68","$1,491.60",$0.00,$291.79,$0.00,$296.83,$0.00
7443738,SUP,HCPCS C1713,,"7443738  -  SCREW, FIXED ANGLE,7.5X37.5,TI","$1,864.50",$0.00,"$1,864.50",$839.03,"$1,330.69",$0.00,$321.24,$0.00,$0.00,$326.46,"$1,864.50",$0.00,$932.25,"$1,476.68","$1,491.60",$0.00,$291.79,$0.00,$296.83,$0.00
7443740,SUP,HCPCS C1713,,"7443740  -  SCREW, FIXED ANGLE,7.5X40,TI","$1,864.50",$0.00,"$1,864.50",$839.03,"$1,330.69",$0.00,$321.24,$0.00,$0.00,$326.46,"$1,864.50",$0.00,$932.25,"$1,476.68","$1,491.60",$0.00,$291.79,$0.00,$296.83,$0.00
7443745,SUP,HCPCS C1713,,"7443745  -  SCREW, FIXED ANGLE,7.5X45,TI","$1,864.50",$0.00,"$1,864.50",$839.03,"$1,330.69",$0.00,$321.24,$0.00,$0.00,$326.46,"$1,864.50",$0.00,$932.25,"$1,476.68","$1,491.60",$0.00,$291.79,$0.00,$296.83,$0.00
7443750,SUP,HCPCS C1713,,"7443750  -  SCREW, FIXED ANGLE,7.5X50,TI","$1,864.50",$0.00,"$1,864.50",$839.03,"$1,330.69",$0.00,$321.24,$0.00,$0.00,$326.46,"$1,864.50",$0.00,$932.25,"$1,476.68","$1,491.60",$0.00,$291.79,$0.00,$296.83,$0.00
7443755,SUP,HCPCS C1713,,"7443755  -  SCREW, FIXED ANGLE,7.5X55,TI","$1,864.50",$0.00,"$1,864.50",$839.03,"$1,330.69",$0.00,$321.24,$0.00,$0.00,$326.46,"$1,864.50",$0.00,$932.25,"$1,476.68","$1,491.60",$0.00,$291.79,$0.00,$296.83,$0.00
7450122,SUP,HCPCS C1713,,7450122  -  PLATE BN 22MM GRDNT + 1 LVL FX SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7450124,SUP,HCPCS C1713,,7450124  -  PLATE BN 24MM GRDNT + 1 LVL FX SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7450126,SUP,HCPCS C1713,,7450126  -  PLATE BN 26MM GRDNT + 1 LVL FX SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7450128,SUP,HCPCS C1713,,7450128  -  PLATE BN 28MM GRDNT + 1 LVL FX SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7450130,SUP,HCPCS C1713,,7450130  -  PLATE BN 30MM GRDNT + 1 LVL FX SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7450132,SUP,HCPCS C1713,,7450132  -  PLATE BN 32MM GRDNT + 1 LVL FX SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7450134,SUP,HCPCS C1713,,7450134  -  PLATE BN 34MM GRDNT + 1 LVL FX SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7450136,SUP,HCPCS C1713,,7450136  -  PLATE BN 36MM GRDNT + 1 LVL FX SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7450236,SUP,HCPCS C1713,,7450236  -  PLATE BN 36MM GRDNT + 2 LVL FX SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7450238,SUP,HCPCS C1713,,7450238  -  PLATE BN 38MM GRDNT + 2 LVL FX SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7450240,SUP,HCPCS C1713,,7450240  -  PLATE BN 40MM GRDNT + 2 LVL FX SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7450242,SUP,HCPCS C1713,,7450242  -  PLATE BN 42MM GRDNT + 2 LVL FX SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7450244,SUP,HCPCS C1713,,7450244  -  PLATE BN 44MM GRDNT + 2 LVL FX SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7450246,SUP,HCPCS C1713,,7450246  -  PLATE BN 46MM GRDNT + 2 LVL FX SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7450248,SUP,HCPCS C1713,,7450248  -  PLATE BN 48MM GRDNT + 2 LVL FX SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7450250,SUP,HCPCS C1713,,7450250  -  PLATE BN 50MM GRDNT + LVL 2 FX ANG TI SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7450252,SUP,HCPCS C1713,,7450252  -  PLATE BN 52MM GRDNT + LVL 2 FX ANG TI SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7450254,SUP,HCPCS C1713,,7450254  -  PLATE BN 54MM GRDNT + 2 LVL FX SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7450354,SUP,HCPCS C1713,,7450354  -  PLATE BN 54MM GRDNT + 3 LVL FX SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7450356,SUP,HCPCS C1713,,7450356  -  PLATE BN 56MM GRDNT + LVL 3 FX ANG TI SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7450358,SUP,HCPCS C1713,,7450358  -  PLATE BN 58MM GRDNT + 3 LVL FX SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7450360,SUP,HCPCS C1713,,7450360  -  PLATE BN 60MM GRDNT + 3 LVL FX SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7450362,SUP,HCPCS C1713,,7450362  -  PLATE BN 62MM GRDNT + 3 LVL FX SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7450364,SUP,HCPCS C1713,,7450364  -  PLATE BN 64MM GRDNT + 3 LVL FX SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7450366,SUP,HCPCS C1713,,7450366  -  PLATE BN 66MM GRDNT + 3 LVL FX SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7450368,SUP,HCPCS C1713,,7450368  -  PLATE BN 68MM GRDNT + 3 LVL FX SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7450468,SUP,HCPCS C1713,,7450468  -  PLATE BN 68MM GRDNT + 4 LVL FX SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7450470,SUP,HCPCS C1713,,7450470  -  PLATE BN 70MM GRDNT + 4 LVL FX SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7450474,SUP,HCPCS C1713,,7450474  -  PLATE BN 74MM GRDNT + 4 LVL FX SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7450478,SUP,HCPCS C1713,,7450478  -  PLATE BN 78MM GRDNT + 4 LVL FX SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7450482,SUP,HCPCS C1713,,7450482  -  PLATE BN 82MM GRDNT + 4 LVL FX SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7450486,SUP,HCPCS C1713,,7450486  -  PLATE BN 86MM GRDNT + 4 LVL FX SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7450490,SUP,HCPCS C1713,,7450490  -  PLATE BN 90MM GRDNT + LVL 4 FX ANG TI SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7450500,SUP,HCPCS C1713,,7450500  -  PLATE BN 100MM GRDNT + LVL 5 FX ANG TI SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7450505,SUP,HCPCS C1713,,7450505  -  PLATE BN 105MM GRDNT + LVL 5 FX ANG TI SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7450510,SUP,HCPCS C1713,,7450510  -  PLATE BN 110MM GRDNT + LVL 5 FX ANG TI SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7450595,SUP,HCPCS C1713,,7450595  -  PLATE BN 95MM GRDNT + LVL 5 FX ANG TI SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7450610,SUP,HCPCS C1713,,7450610  -  SCREW BN 4MM 10MM NS GRDNT + FX ANG SPNE CRV ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7450612,SUP,HCPCS C1713,,7450612  -  SCREW BN 4MM 12MM NS GRDNT + FX ANG SPNE CRV ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7450614,SUP,HCPCS C1713,,7450614  -  SCREW BN 4MM 14MM NS GRDNT + FX ANG SPNE CRV ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7450616,SUP,HCPCS C1713,,7450616  -  SCREW BN 4MM FA ANT CSPN,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7450710,SUP,HCPCS C1713,,7450710  -  SCREW BN 4.5MM 10MM NS GRDNT + FX ANG SPNE CRV ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7450712,SUP,HCPCS C1713,,7450712  -  SCREW BN 4.5MM 12MM NS GRDNT + FX ANG SPNE CRV ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7450714,SUP,HCPCS C1713,,7450714  -  SCREW BN 4.5MM 14MM NS GRDNT + FX ANG SPNE CRV ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7450716,SUP,HCPCS C1713,,7450716  -  SCREW BN 4.5MM 16MM GRDNT + FA ANT CSPN,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7450800,SUP,Custom 27803010,,7450800  -  HOLDER IMPL VLCK TEMP FX TACK,$377.50,$0.00,$377.50,$0.00,$269.42,$0.00,$0.00,$0.00,$0.00,$0.00,$377.50,$0.00,$188.75,$298.98,$302.00,$0.00,$0.00,$0.00,$0.00,$0.00
7451500,SUP,HCPCS C1713,,7451500  -  PLATE BN NS GRDNT + SLOT HL CVR TI SPNE,$377.50,$0.00,$377.50,$169.88,$269.42,$0.00,$65.04,$0.00,$0.00,$66.10,$377.50,$0.00,$188.75,$298.98,$302.00,$0.00,$59.08,$0.00,$60.10,$0.00
7451501,SUP,HCPCS C1713,,7451501  -  PLATE BN NS GRDNT + RND HL CVR TI SPNE,$377.50,$0.00,$377.50,$169.88,$269.42,$0.00,$65.04,$0.00,$0.00,$66.10,$377.50,$0.00,$188.75,$298.98,$302.00,$0.00,$59.08,$0.00,$60.10,$0.00
7460020,SUP,HCPCS C1713,,7460020  -  SET SCREW 7460020 BREAK OFF SS,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
7460120,SUP,HCPCS C1713,,"7460120  -  SET SCREW, NON BREAK-OFF, SS",$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
7460500,SUP,HCPCS C1713,,7460500  -  PLATE BN 100MM GRDNT + LVL 5 FX ANG TI SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7460505,SUP,HCPCS C1713,,7460505  -  PLATE BN 105MM GRDNT + LVL 5 FX ANG TI SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7460510,SUP,HCPCS C1713,,7460510  -  PLATE BN 110MM GRDNT + LVL 5 FX ANG TI SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7460595,SUP,HCPCS C1713,,7460595  -  PLATE BN 95MM GRDNT + LVL 5 FX ANG TI SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7460610,SUP,HCPCS C1713,,7460610  -  SCREW BN 4MM 10MM NS GRDNT + SPNE CRV ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7460612,SUP,HCPCS C1713,,7460612  -  SCREW BN 4MM 12MM NS GRDNT + SPNE CRV ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7460614,SUP,HCPCS C1713,,7460614  -  SCREW BN 4MM 14MM NS GRDNT + SPNE CRV ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7460616,SUP,HCPCS C1713,,7460616  -  SCREW BN 4MM 16MM GRDNT + VA TI SPNE CRV ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7460710,SUP,HCPCS C1713,,7460710  -  SCREW BN 4.5MM 10MM NS GRDNT + SPNE CRV ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7460712,SUP,HCPCS C1713,,7460712  -  SCREW BN 4.5MM 12MM NS GRDNT + SPNE CRV ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7460714,SUP,HCPCS C1713,,7460714  -  SCREW BN 4.5MM 14MM NS GRDNT + SPNE CRV ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7460716,SUP,HCPCS C1713,,7460716  -  SCREW BN 4.5MM 16MM GRDNT + VA ANT CSPN,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7461102,SUP,HCPCS C1713,,7461102  -  HOOK 7461102 PEDICLE SS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7461112,SUP,HCPCS C1713,,7461112  -  HOOK 7461112 WIDE BLADE SM SS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7461113,SUP,HCPCS C1713,,7461113  -  HOOK 7461113 WIDE BLADE MED SS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7461114,SUP,HCPCS C1713,,7461114  -  HOOK 7461114 WIDE BLADE LGE SS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7461122,SUP,HCPCS C1713,,7461122  -  HOOK 7461122 NARROW BLADE SS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7461142,SUP,HCPCS C1713,,7461142  -  HOOK 7461142 RAMPED THORACIC SS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7461162,SUP,HCPCS C1713,,7461162  -  HOOK 7461162 LUMBAR ANGLED BLADE SS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7461172,SUP,HCPCS C1713,,7461172  -  HOOK 7461172 EXTENDED BODY SS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7461198,SUP,HCPCS C1713,,7461198  -  HOOK 7461198 OFFSET RIGHT SS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7461199,SUP,HCPCS C1713,,7461199  -  HOOK 7461199 OFFSET LEFT SS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7461500,SUP,HCPCS C1713,,7461500  -  PLATE BN NS GRDNT + SLOT HL CVR TI SPNE,$377.50,$0.00,$377.50,$169.88,$269.42,$0.00,$65.04,$0.00,$0.00,$66.10,$377.50,$0.00,$188.75,$298.98,$302.00,$0.00,$59.08,$0.00,$60.10,$0.00
7461501,SUP,HCPCS C1713,,7461501  -  PLATE BN NS GRDNT + RND HL CVR TI SPNE,$377.50,$0.00,$377.50,$169.88,$269.42,$0.00,$65.04,$0.00,$0.00,$66.10,$377.50,$0.00,$188.75,$298.98,$302.00,$0.00,$59.08,$0.00,$60.10,$0.00
7462420,SUP,HCPCS C1713,,7462420  -  SCREW 7462420 FIXED ANGLE 4.0X20 SS,"$1,666.50",$0.00,"$1,666.50",$749.93,"$1,189.38",$0.00,$287.13,$0.00,$0.00,$291.79,"$1,666.50",$0.00,$833.25,"$1,319.87","$1,333.20",$0.00,$260.81,$0.00,$265.31,$0.00
7462425,SUP,HCPCS C1713,,7462425  -  SCREW 7462425 FIXED ANGLE 4.0X25 SS,"$1,666.50",$0.00,"$1,666.50",$749.93,"$1,189.38",$0.00,$287.13,$0.00,$0.00,$291.79,"$1,666.50",$0.00,$833.25,"$1,319.87","$1,333.20",$0.00,$260.81,$0.00,$265.31,$0.00
7462430,SUP,HCPCS C1713,,7462430  -  SCREW 7462430 FIXED ANGLE 4.0X30 SS,"$1,666.50",$0.00,"$1,666.50",$749.93,"$1,189.38",$0.00,$287.13,$0.00,$0.00,$291.79,"$1,666.50",$0.00,$833.25,"$1,319.87","$1,333.20",$0.00,$260.81,$0.00,$265.31,$0.00
7462435,SUP,HCPCS C1713,,7462435  -  SCREW 7462435 FIXED ANGLE 4.0X35 SS,"$1,666.50",$0.00,"$1,666.50",$749.93,"$1,189.38",$0.00,$287.13,$0.00,$0.00,$291.79,"$1,666.50",$0.00,$833.25,"$1,319.87","$1,333.20",$0.00,$260.81,$0.00,$265.31,$0.00
7462440,SUP,HCPCS C1713,,7462440  -  SCREW 7462440 FIXED ANGLE 4.0X40 SS,"$1,666.50",$0.00,"$1,666.50",$749.93,"$1,189.38",$0.00,$287.13,$0.00,$0.00,$291.79,"$1,666.50",$0.00,$833.25,"$1,319.87","$1,333.20",$0.00,$260.81,$0.00,$265.31,$0.00
7462525,SUP,HCPCS C1713,,7462525  -  SCREW 7462525 FIXED ANGLE 5.0X25 SS,"$1,666.50",$0.00,"$1,666.50",$749.93,"$1,189.38",$0.00,$287.13,$0.00,$0.00,$291.79,"$1,666.50",$0.00,$833.25,"$1,319.87","$1,333.20",$0.00,$260.81,$0.00,$265.31,$0.00
7462528,SUP,HCPCS C1713,,"7462528  -  SCREW, FIXED ANGLE,5.0X27.5,SS","$1,666.50",$0.00,"$1,666.50",$749.93,"$1,189.38",$0.00,$287.13,$0.00,$0.00,$291.79,"$1,666.50",$0.00,$833.25,"$1,319.87","$1,333.20",$0.00,$260.81,$0.00,$265.31,$0.00
7462530,SUP,HCPCS C1713,,7462530  -  SCREW 7462530 FIXED ANGLE 5.0X30 SS,"$1,666.50",$0.00,"$1,666.50",$749.93,"$1,189.38",$0.00,$287.13,$0.00,$0.00,$291.79,"$1,666.50",$0.00,$833.25,"$1,319.87","$1,333.20",$0.00,$260.81,$0.00,$265.31,$0.00
7462533,SUP,HCPCS C1713,,"7462533  -  SCREW, FIXED ANGLE,5.0X32.5,SS","$1,666.50",$0.00,"$1,666.50",$749.93,"$1,189.38",$0.00,$287.13,$0.00,$0.00,$291.79,"$1,666.50",$0.00,$833.25,"$1,319.87","$1,333.20",$0.00,$260.81,$0.00,$265.31,$0.00
7462535,SUP,HCPCS C1713,,7462535  -  SCREW 7462535 FIXED ANGLE 5.0X35 SS,"$1,666.50",$0.00,"$1,666.50",$749.93,"$1,189.38",$0.00,$287.13,$0.00,$0.00,$291.79,"$1,666.50",$0.00,$833.25,"$1,319.87","$1,333.20",$0.00,$260.81,$0.00,$265.31,$0.00
7462538,SUP,HCPCS C1713,,"7462538  -  SCREW, FIXED ANGLE,5.0X37.5,SS","$1,666.50",$0.00,"$1,666.50",$749.93,"$1,189.38",$0.00,$287.13,$0.00,$0.00,$291.79,"$1,666.50",$0.00,$833.25,"$1,319.87","$1,333.20",$0.00,$260.81,$0.00,$265.31,$0.00
7462540,SUP,HCPCS C1713,,7462540  -  SCREW 7462540 FIXED ANGLE 5.0X40 SS,"$1,666.50",$0.00,"$1,666.50",$749.93,"$1,189.38",$0.00,$287.13,$0.00,$0.00,$291.79,"$1,666.50",$0.00,$833.25,"$1,319.87","$1,333.20",$0.00,$260.81,$0.00,$265.31,$0.00
7462545,SUP,HCPCS C1713,,7462545  -  SCREW 7462545 FIXED ANGLE 5.0X45 SS,"$1,666.50",$0.00,"$1,666.50",$749.93,"$1,189.38",$0.00,$287.13,$0.00,$0.00,$291.79,"$1,666.50",$0.00,$833.25,"$1,319.87","$1,333.20",$0.00,$260.81,$0.00,$265.31,$0.00
7462550,SUP,HCPCS C1713,,7462550  -  SCREW 7462550 FIXED ANGLE 5.0X50 SS,"$1,666.50",$0.00,"$1,666.50",$749.93,"$1,189.38",$0.00,$287.13,$0.00,$0.00,$291.79,"$1,666.50",$0.00,$833.25,"$1,319.87","$1,333.20",$0.00,$260.81,$0.00,$265.31,$0.00
7462625,SUP,HCPCS C1713,,7462625  -  SCREW 7462625 FIXED ANGLE 6.0X25 SS,"$1,666.50",$0.00,"$1,666.50",$749.93,"$1,189.38",$0.00,$287.13,$0.00,$0.00,$291.79,"$1,666.50",$0.00,$833.25,"$1,319.87","$1,333.20",$0.00,$260.81,$0.00,$265.31,$0.00
7462628,SUP,HCPCS C1713,,"7462628  -  SCREW, FIXED ANGLE,6.0X27.5,SS","$1,666.50",$0.00,"$1,666.50",$749.93,"$1,189.38",$0.00,$287.13,$0.00,$0.00,$291.79,"$1,666.50",$0.00,$833.25,"$1,319.87","$1,333.20",$0.00,$260.81,$0.00,$265.31,$0.00
7462630,SUP,HCPCS C1713,,7462630  -  SCREW 7462630 FIXED ANGLE 6.0X30 SS,"$1,666.50",$0.00,"$1,666.50",$749.93,"$1,189.38",$0.00,$287.13,$0.00,$0.00,$291.79,"$1,666.50",$0.00,$833.25,"$1,319.87","$1,333.20",$0.00,$260.81,$0.00,$265.31,$0.00
7462633,SUP,HCPCS C1713,,"7462633  -  SCREW, FIXED ANGLE,6.0X32.5,SS","$1,666.50",$0.00,"$1,666.50",$749.93,"$1,189.38",$0.00,$287.13,$0.00,$0.00,$291.79,"$1,666.50",$0.00,$833.25,"$1,319.87","$1,333.20",$0.00,$260.81,$0.00,$265.31,$0.00
7462635,SUP,HCPCS C1713,,7462635  -  SCREW 7462635 FIXED ANGLE 6.0X35 SS,"$1,666.50",$0.00,"$1,666.50",$749.93,"$1,189.38",$0.00,$287.13,$0.00,$0.00,$291.79,"$1,666.50",$0.00,$833.25,"$1,319.87","$1,333.20",$0.00,$260.81,$0.00,$265.31,$0.00
7462638,SUP,HCPCS C1713,,"7462638  -  SCREW, FIXED ANGLE,6.0X37.5,SS","$1,666.50",$0.00,"$1,666.50",$749.93,"$1,189.38",$0.00,$287.13,$0.00,$0.00,$291.79,"$1,666.50",$0.00,$833.25,"$1,319.87","$1,333.20",$0.00,$260.81,$0.00,$265.31,$0.00
7462640,SUP,HCPCS C1713,,7462640  -  SCREW 7462640 FIXED ANGLE 6.0X40 SS,"$1,666.50",$0.00,"$1,666.50",$749.93,"$1,189.38",$0.00,$287.13,$0.00,$0.00,$291.79,"$1,666.50",$0.00,$833.25,"$1,319.87","$1,333.20",$0.00,$260.81,$0.00,$265.31,$0.00
7462645,SUP,HCPCS C1713,,7462645  -  SCREW 7462645 FIXED ANGLE 6.0X45 SS,"$1,666.50",$0.00,"$1,666.50",$749.93,"$1,189.38",$0.00,$287.13,$0.00,$0.00,$291.79,"$1,666.50",$0.00,$833.25,"$1,319.87","$1,333.20",$0.00,$260.81,$0.00,$265.31,$0.00
7462650,SUP,HCPCS C1713,,7462650  -  SCREW 7462650 FIXED ANGLE 6.0X50 SS,"$1,666.50",$0.00,"$1,666.50",$749.93,"$1,189.38",$0.00,$287.13,$0.00,$0.00,$291.79,"$1,666.50",$0.00,$833.25,"$1,319.87","$1,333.20",$0.00,$260.81,$0.00,$265.31,$0.00
7463425,SUP,HCPCS C1713,,7463425  -  SCREW 7463425 FIXED ANGLE 4.5X25 SS,"$1,666.50",$0.00,"$1,666.50",$749.93,"$1,189.38",$0.00,$287.13,$0.00,$0.00,$291.79,"$1,666.50",$0.00,$833.25,"$1,319.87","$1,333.20",$0.00,$260.81,$0.00,$265.31,$0.00
7463428,SUP,HCPCS C1713,,"7463428  -  SCREW, FIXED ANGLE,4.5X27.5,SS","$1,666.50",$0.00,"$1,666.50",$749.93,"$1,189.38",$0.00,$287.13,$0.00,$0.00,$291.79,"$1,666.50",$0.00,$833.25,"$1,319.87","$1,333.20",$0.00,$260.81,$0.00,$265.31,$0.00
7463430,SUP,HCPCS C1713,,7463430  -  SCREW 7463430 FIXED ANGLE 4.5X30 SS,"$1,666.50",$0.00,"$1,666.50",$749.93,"$1,189.38",$0.00,$287.13,$0.00,$0.00,$291.79,"$1,666.50",$0.00,$833.25,"$1,319.87","$1,333.20",$0.00,$260.81,$0.00,$265.31,$0.00
7463433,SUP,HCPCS C1713,,"7463433  -  SCREW, FIXED ANGLE,4.5X32.5,SS","$1,666.50",$0.00,"$1,666.50",$749.93,"$1,189.38",$0.00,$287.13,$0.00,$0.00,$291.79,"$1,666.50",$0.00,$833.25,"$1,319.87","$1,333.20",$0.00,$260.81,$0.00,$265.31,$0.00
7463435,SUP,HCPCS C1713,,7463435  -  SCREW 7463435 FIXED ANGLE 4.5X35 SS,"$1,666.50",$0.00,"$1,666.50",$749.93,"$1,189.38",$0.00,$287.13,$0.00,$0.00,$291.79,"$1,666.50",$0.00,$833.25,"$1,319.87","$1,333.20",$0.00,$260.81,$0.00,$265.31,$0.00
7463438,SUP,HCPCS C1713,,"7463438  -  SCREW, FIXED ANGLE,4.5X37.5,SS","$1,666.50",$0.00,"$1,666.50",$749.93,"$1,189.38",$0.00,$287.13,$0.00,$0.00,$291.79,"$1,666.50",$0.00,$833.25,"$1,319.87","$1,333.20",$0.00,$260.81,$0.00,$265.31,$0.00
7463440,SUP,HCPCS C1713,,7463440  -  SCREW 7463440 FIXED ANGLE 4.5X40 SS,"$1,666.50",$0.00,"$1,666.50",$749.93,"$1,189.38",$0.00,$287.13,$0.00,$0.00,$291.79,"$1,666.50",$0.00,$833.25,"$1,319.87","$1,333.20",$0.00,$260.81,$0.00,$265.31,$0.00
7463445,SUP,HCPCS C1713,,"7463445  -  SCREW, FIXED ANGLE, 4.5X45, SS","$1,666.50",$0.00,"$1,666.50",$749.93,"$1,189.38",$0.00,$287.13,$0.00,$0.00,$291.79,"$1,666.50",$0.00,$833.25,"$1,319.87","$1,333.20",$0.00,$260.81,$0.00,$265.31,$0.00
7463450,SUP,HCPCS C1713,,"7463450  -  SCREW, FIXED ANGLE, 4.5X50, SS","$1,666.50",$0.00,"$1,666.50",$749.93,"$1,189.38",$0.00,$287.13,$0.00,$0.00,$291.79,"$1,666.50",$0.00,$833.25,"$1,319.87","$1,333.20",$0.00,$260.81,$0.00,$265.31,$0.00
7463525,SUP,HCPCS C1713,,7463525  -  SCREW 7463525 FIXED ANGLE 5.5X25 SS,"$1,666.50",$0.00,"$1,666.50",$749.93,"$1,189.38",$0.00,$287.13,$0.00,$0.00,$291.79,"$1,666.50",$0.00,$833.25,"$1,319.87","$1,333.20",$0.00,$260.81,$0.00,$265.31,$0.00
7463528,SUP,HCPCS C1713,,"7463528  -  SCREW, FIXED ANGLE,5.5X27.5,SS","$1,666.50",$0.00,"$1,666.50",$749.93,"$1,189.38",$0.00,$287.13,$0.00,$0.00,$291.79,"$1,666.50",$0.00,$833.25,"$1,319.87","$1,333.20",$0.00,$260.81,$0.00,$265.31,$0.00
7463530,SUP,HCPCS C1713,,7463530  -  SCREW 7463530 FIXED ANGLE 5.5X30 SS,"$1,666.50",$0.00,"$1,666.50",$749.93,"$1,189.38",$0.00,$287.13,$0.00,$0.00,$291.79,"$1,666.50",$0.00,$833.25,"$1,319.87","$1,333.20",$0.00,$260.81,$0.00,$265.31,$0.00
7463533,SUP,HCPCS C1713,,"7463533  -  SCREW, FIXED ANGLE,5.5X32.5,SS","$1,666.50",$0.00,"$1,666.50",$749.93,"$1,189.38",$0.00,$287.13,$0.00,$0.00,$291.79,"$1,666.50",$0.00,$833.25,"$1,319.87","$1,333.20",$0.00,$260.81,$0.00,$265.31,$0.00
7463535,SUP,HCPCS C1713,,7463535  -  SCREW 7463535 FIXED ANGLE 5.5X35 SS,"$1,666.50",$0.00,"$1,666.50",$749.93,"$1,189.38",$0.00,$287.13,$0.00,$0.00,$291.79,"$1,666.50",$0.00,$833.25,"$1,319.87","$1,333.20",$0.00,$260.81,$0.00,$265.31,$0.00
7463538,SUP,HCPCS C1713,,"7463538  -  SCREW, FIXED ANGLE,5.5X37.5,SS","$1,666.50",$0.00,"$1,666.50",$749.93,"$1,189.38",$0.00,$287.13,$0.00,$0.00,$291.79,"$1,666.50",$0.00,$833.25,"$1,319.87","$1,333.20",$0.00,$260.81,$0.00,$265.31,$0.00
7463540,SUP,HCPCS C1713,,7463540  -  SCREW 7463540 FIXED ANGLE 5.5X40 SS,"$1,666.50",$0.00,"$1,666.50",$749.93,"$1,189.38",$0.00,$287.13,$0.00,$0.00,$291.79,"$1,666.50",$0.00,$833.25,"$1,319.87","$1,333.20",$0.00,$260.81,$0.00,$265.31,$0.00
7463545,SUP,HCPCS C1713,,7463545  -  SCREW 7463545 FIXED ANGLE 5.5X45 SS,"$1,666.50",$0.00,"$1,666.50",$749.93,"$1,189.38",$0.00,$287.13,$0.00,$0.00,$291.79,"$1,666.50",$0.00,$833.25,"$1,319.87","$1,333.20",$0.00,$260.81,$0.00,$265.31,$0.00
7463550,SUP,HCPCS C1713,,7463550  -  SCREW 7463550 FIXED ANGLE 5.5X50 SS,"$1,666.50",$0.00,"$1,666.50",$749.93,"$1,189.38",$0.00,$287.13,$0.00,$0.00,$291.79,"$1,666.50",$0.00,$833.25,"$1,319.87","$1,333.20",$0.00,$260.81,$0.00,$265.31,$0.00
7463625,SUP,HCPCS C1713,,7463625  -  SCREW 7463625 FIXED ANGLE 6.5X25 SS,"$1,666.50",$0.00,"$1,666.50",$749.93,"$1,189.38",$0.00,$287.13,$0.00,$0.00,$291.79,"$1,666.50",$0.00,$833.25,"$1,319.87","$1,333.20",$0.00,$260.81,$0.00,$265.31,$0.00
7463628,SUP,HCPCS C1713,,"7463628  -  SCREW, FIXED ANGLE,6.5X27.5,SS","$1,666.50",$0.00,"$1,666.50",$749.93,"$1,189.38",$0.00,$287.13,$0.00,$0.00,$291.79,"$1,666.50",$0.00,$833.25,"$1,319.87","$1,333.20",$0.00,$260.81,$0.00,$265.31,$0.00
7463630,SUP,HCPCS C1713,,7463630  -  SCREW 7463630 FIXED ANGLE 6.5X30 SS,"$1,666.50",$0.00,"$1,666.50",$749.93,"$1,189.38",$0.00,$287.13,$0.00,$0.00,$291.79,"$1,666.50",$0.00,$833.25,"$1,319.87","$1,333.20",$0.00,$260.81,$0.00,$265.31,$0.00
7463633,SUP,HCPCS C1713,,"7463633  -  SCREW, FIXED ANGLE,6.5X32.5,SS","$1,666.50",$0.00,"$1,666.50",$749.93,"$1,189.38",$0.00,$287.13,$0.00,$0.00,$291.79,"$1,666.50",$0.00,$833.25,"$1,319.87","$1,333.20",$0.00,$260.81,$0.00,$265.31,$0.00
7463635,SUP,HCPCS C1713,,7463635  -  SCREW 7463635 FIXED ANGLE 6.5X35 SS,"$1,666.50",$0.00,"$1,666.50",$749.93,"$1,189.38",$0.00,$287.13,$0.00,$0.00,$291.79,"$1,666.50",$0.00,$833.25,"$1,319.87","$1,333.20",$0.00,$260.81,$0.00,$265.31,$0.00
7463638,SUP,HCPCS C1713,,"7463638  -  SCREW, FIXED ANGLE,6.5X37.5,SS","$1,666.50",$0.00,"$1,666.50",$749.93,"$1,189.38",$0.00,$287.13,$0.00,$0.00,$291.79,"$1,666.50",$0.00,$833.25,"$1,319.87","$1,333.20",$0.00,$260.81,$0.00,$265.31,$0.00
7463640,SUP,HCPCS C1713,,7463640  -  SCREW 7463640 FIXED ANGLE 6.5X40 SS,"$1,666.50",$0.00,"$1,666.50",$749.93,"$1,189.38",$0.00,$287.13,$0.00,$0.00,$291.79,"$1,666.50",$0.00,$833.25,"$1,319.87","$1,333.20",$0.00,$260.81,$0.00,$265.31,$0.00
7463645,SUP,HCPCS C1713,,7463645  -  SCREW 7463645 FIXED ANGLE 6.5X45 SS,"$1,666.50",$0.00,"$1,666.50",$749.93,"$1,189.38",$0.00,$287.13,$0.00,$0.00,$291.79,"$1,666.50",$0.00,$833.25,"$1,319.87","$1,333.20",$0.00,$260.81,$0.00,$265.31,$0.00
7463650,SUP,HCPCS C1713,,7463650  -  SCREW 7463650 FIXED ANGLE 6.5X50 SS,"$1,666.50",$0.00,"$1,666.50",$749.93,"$1,189.38",$0.00,$287.13,$0.00,$0.00,$291.79,"$1,666.50",$0.00,$833.25,"$1,319.87","$1,333.20",$0.00,$260.81,$0.00,$265.31,$0.00
7463655,SUP,HCPCS C1713,,7463655  -  SCREW 7463655 FIXED ANGLE 6.5X55 SS,"$1,666.50",$0.00,"$1,666.50",$749.93,"$1,189.38",$0.00,$287.13,$0.00,$0.00,$291.79,"$1,666.50",$0.00,$833.25,"$1,319.87","$1,333.20",$0.00,$260.81,$0.00,$265.31,$0.00
7463725,SUP,HCPCS C1713,,"7463725  -  SCREW, FIXED ANGLE,7.5X25,SS","$1,666.50",$0.00,"$1,666.50",$749.93,"$1,189.38",$0.00,$287.13,$0.00,$0.00,$291.79,"$1,666.50",$0.00,$833.25,"$1,319.87","$1,333.20",$0.00,$260.81,$0.00,$265.31,$0.00
7463728,SUP,HCPCS C1713,,"7463728  -  SCREW, FIXED ANGLE,7.5X27.5,SS","$1,666.50",$0.00,"$1,666.50",$749.93,"$1,189.38",$0.00,$287.13,$0.00,$0.00,$291.79,"$1,666.50",$0.00,$833.25,"$1,319.87","$1,333.20",$0.00,$260.81,$0.00,$265.31,$0.00
7463730,SUP,HCPCS C1713,,"7463730  -  SCREW, FIXED ANGLE,7.5X30,SS","$1,666.50",$0.00,"$1,666.50",$749.93,"$1,189.38",$0.00,$287.13,$0.00,$0.00,$291.79,"$1,666.50",$0.00,$833.25,"$1,319.87","$1,333.20",$0.00,$260.81,$0.00,$265.31,$0.00
7463733,SUP,HCPCS C1713,,"7463733  -  SCREW, FIXED ANGLE,7.5X32.5,SS","$1,666.50",$0.00,"$1,666.50",$749.93,"$1,189.38",$0.00,$287.13,$0.00,$0.00,$291.79,"$1,666.50",$0.00,$833.25,"$1,319.87","$1,333.20",$0.00,$260.81,$0.00,$265.31,$0.00
7463735,SUP,HCPCS C1713,,"7463735  -  SCREW, FIXED ANGLE,7.5X35,SS","$1,666.50",$0.00,"$1,666.50",$749.93,"$1,189.38",$0.00,$287.13,$0.00,$0.00,$291.79,"$1,666.50",$0.00,$833.25,"$1,319.87","$1,333.20",$0.00,$260.81,$0.00,$265.31,$0.00
7463738,SUP,HCPCS C1713,,"7463738  -  SCREW, FIXED ANGLE,7.5X37.5,SS","$1,666.50",$0.00,"$1,666.50",$749.93,"$1,189.38",$0.00,$287.13,$0.00,$0.00,$291.79,"$1,666.50",$0.00,$833.25,"$1,319.87","$1,333.20",$0.00,$260.81,$0.00,$265.31,$0.00
7463740,SUP,HCPCS C1713,,"7463740  -  SCREW, FIXED ANGLE,7.5X40,SS","$1,666.50",$0.00,"$1,666.50",$749.93,"$1,189.38",$0.00,$287.13,$0.00,$0.00,$291.79,"$1,666.50",$0.00,$833.25,"$1,319.87","$1,333.20",$0.00,$260.81,$0.00,$265.31,$0.00
7463745,SUP,HCPCS C1713,,"7463745  -  SCREW, FIXED ANGLE,7.5X45,SS","$1,666.50",$0.00,"$1,666.50",$749.93,"$1,189.38",$0.00,$287.13,$0.00,$0.00,$291.79,"$1,666.50",$0.00,$833.25,"$1,319.87","$1,333.20",$0.00,$260.81,$0.00,$265.31,$0.00
7463750,SUP,HCPCS C1713,,"7463750  -  SCREW, FIXED ANGLE,7.5X50,SS","$1,666.50",$0.00,"$1,666.50",$749.93,"$1,189.38",$0.00,$287.13,$0.00,$0.00,$291.79,"$1,666.50",$0.00,$833.25,"$1,319.87","$1,333.20",$0.00,$260.81,$0.00,$265.31,$0.00
7463755,SUP,HCPCS C1713,,"7463755  -  SCREW, FIXED ANGLE,7.5X55,SS","$1,666.50",$0.00,"$1,666.50",$749.93,"$1,189.38",$0.00,$287.13,$0.00,$0.00,$291.79,"$1,666.50",$0.00,$833.25,"$1,319.87","$1,333.20",$0.00,$260.81,$0.00,$265.31,$0.00
7490122,SUP,HCPCS C1713,,7490122  -  PLATE BN 22MM GRDNT + 1 LVL FX SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7490124,SUP,HCPCS C1713,,7490124  -  PLATE BN 24MM GRDNT + 1 LVL FX SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7490126,SUP,HCPCS C1713,,7490126  -  PLATE BN 26MM GRDNT + 1 LVL FX SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7490128,SUP,HCPCS C1713,,7490128  -  PLATE BN 28MM GRDNT + 1 LVL FX SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7490236,SUP,HCPCS C1713,,7490236  -  PLATE BN 36MM NS GRDNT + 2 LVL SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7490238,SUP,HCPCS C1713,,7490238  -  PLATE BN 38MM NS GRDNT + 2 LVL SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7490240,SUP,HCPCS C1713,,7490240  -  PLATE BN 40MM GRDNT + 2 LVL FX SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7490242,SUP,HCPCS C1713,,7490242  -  PLATE BN 42MM GRDNT + 2 LVL FX SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7490244,SUP,HCPCS C1713,,7490244  -  PLATE BN 44MM GRDNT + 2 LVL FX SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7490246,SUP,HCPCS C1713,,7490246  -  PLATE BN 46MM GRDNT + 2 LVL FX SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7490248,SUP,HCPCS C1713,,7490248  -  PLATE BN 48MM GRDNT + 2 LVL FX SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7490354,SUP,HCPCS C1713,,7490354  -  PLATE BN 54MM GRDNT + 3 LVL FX SPNE,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7490356,SUP,HCPCS C1713,,7490356  -  PLATE BN 56MM GRDNT + 3 LVL FX SPNE,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7490358,SUP,HCPCS C1713,,7490358  -  PLATE BN 58MM GRDNT + 3 LVL FX SPNE,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7490360,SUP,HCPCS C1713,,7490360  -  PLATE BN 60MM GRDNT + 3 LVL FX SPNE,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7490362,SUP,HCPCS C1713,,7490362  -  PLATE BN 62MM GRDNT + 3 LVL FX SPNE,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7490364,SUP,HCPCS C1713,,7490364  -  PLATE BN 64MM GRDNT + 3 LVL FX SPNE,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7490366,SUP,HCPCS C1713,,7490366  -  PLATE BN 66MM GRDNT + 3 LVL FX SPNE,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7490468,SUP,HCPCS C1713,,7490468  -  PLATE BN 68MM GRDNT + 4 LVL FX SPNE,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7490470,SUP,HCPCS C1713,,7490470  -  PLATE BN 70MM GRDNT + 4 LVL FX SPNE,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7490474,SUP,HCPCS C1713,,7490474  -  PLATE BN 74MM GRDNT + 4 LVL FX SPNE,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7490478,SUP,HCPCS C1713,,7490478  -  PLATE BN 78MM GRDNT + 4 LVL FX SPNE,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7490482,SUP,HCPCS C1713,,7490482  -  PLATE BN 82MM GRDNT + 4 LVL FX SPNE,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7490486,SUP,HCPCS C1713,,7490486  -  PLATE BN 86MM GRDNT + 4 LVL FX SPNE,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7502073,SUP,HCPCS C1713,,7502073  -  CAGE SPNL 20D HYPERLORDOTIC 34X6X24MM CRNT BRIGADE,"$18,375.00",$0.00,"$18,375.00","$8,268.75","$5,158.80",$0.00,"$3,165.92",$0.00,$0.00,"$3,217.32","$18,375.00",$0.00,"$9,187.50","$14,553.00","$14,700.00",$0.00,"$2,875.69",$0.00,"$2,925.30",$0.00
7502077,SUP,HCPCS C1713,,7502077  -  CAGE SPNL 20D HYPERLORDOTIC 34X10X24MM NS BRIGADE,"$18,375.00",$0.00,"$18,375.00","$8,268.75","$5,158.80",$0.00,"$3,165.92",$0.00,$0.00,"$3,217.32","$18,375.00",$0.00,"$9,187.50","$14,553.00","$14,700.00",$0.00,"$2,875.69",$0.00,"$2,925.30",$0.00
7502100,SUP,HCPCS C1713,,7502100  -  CAGE SPNL 20D HYPERLORDOTIC 38X28X6MM NS LF BRIGADE,"$18,375.00",$0.00,"$18,375.00","$8,268.75","$5,158.80",$0.00,"$3,165.92",$0.00,$0.00,"$3,217.32","$18,375.00",$0.00,"$9,187.50","$14,553.00","$14,700.00",$0.00,"$2,875.69",$0.00,"$2,925.30",$0.00
7502102,SUP,HCPCS C1713,,7502102  -  CAGE SPNL 20D HYPERLORDOTIC 38X28X8MM NS LF BRIGADE,"$18,375.00",$0.00,"$18,375.00","$8,268.75","$5,158.80",$0.00,"$3,165.92",$0.00,$0.00,"$3,217.32","$18,375.00",$0.00,"$9,187.50","$14,553.00","$14,700.00",$0.00,"$2,875.69",$0.00,"$2,925.30",$0.00
7502104,SUP,HCPCS C1713,,7502104  -  CAGE SPNL 20D HYPERLORDOTIC 38X28X10MM NS LF BRIGADE,"$18,375.00",$0.00,"$18,375.00","$8,268.75","$5,158.80",$0.00,"$3,165.92",$0.00,$0.00,"$3,217.32","$18,375.00",$0.00,"$9,187.50","$14,553.00","$14,700.00",$0.00,"$2,875.69",$0.00,"$2,925.30",$0.00
7502219,SUP,HCPCS C1713,,7502219  -  CAGE SPNL 20D HYPERLORDOTIC 34X8X24MM CRNT BRIGADE,"$18,375.00",$0.00,"$18,375.00","$8,268.75","$5,158.80",$0.00,"$3,165.92",$0.00,$0.00,"$3,217.32","$18,375.00",$0.00,"$9,187.50","$14,553.00","$14,700.00",$0.00,"$2,875.69",$0.00,"$2,925.30",$0.00
7502221,SUP,HCPCS C1713,,7502221  -  CAGE SPNL 30D HYPERLORDOTIC 34X10X24MM CRNT BRIGADE,"$18,375.00",$0.00,"$18,375.00","$8,268.75","$5,158.80",$0.00,"$3,165.92",$0.00,$0.00,"$3,217.32","$18,375.00",$0.00,"$9,187.50","$14,553.00","$14,700.00",$0.00,"$2,875.69",$0.00,"$2,925.30",$0.00
7502244,SUP,HCPCS C1713,,7502244  -  CAGE SPNL 30D HYPERLORDOTIC 38X6X28MM CRNT BRIGADE,"$18,375.00",$0.00,"$18,375.00","$8,268.75","$5,158.80",$0.00,"$3,165.92",$0.00,$0.00,"$3,217.32","$18,375.00",$0.00,"$9,187.50","$14,553.00","$14,700.00",$0.00,"$2,875.69",$0.00,"$2,925.30",$0.00
7502246,SUP,HCPCS C1713,,7502246  -  CAGE SPNL 30D HYPERLORDOTIC 38X28X8MM NS LF BRIGADE,"$18,375.00",$0.00,"$18,375.00","$8,268.75","$5,158.80",$0.00,"$3,165.92",$0.00,$0.00,"$3,217.32","$18,375.00",$0.00,"$9,187.50","$14,553.00","$14,700.00",$0.00,"$2,875.69",$0.00,"$2,925.30",$0.00
7502248,SUP,HCPCS C1713,,7502248  -  CAGE SPNL 30D HYPERLORDOTIC 38X28X10MM NS LF BRIGADE,"$18,375.00",$0.00,"$18,375.00","$8,268.75","$5,158.80",$0.00,"$3,165.92",$0.00,$0.00,"$3,217.32","$18,375.00",$0.00,"$9,187.50","$14,553.00","$14,700.00",$0.00,"$2,875.69",$0.00,"$2,925.30",$0.00
7509145,SUP,Custom 27804086,,7509145  -  GRAFT BN 5X1.75CM MAGNIFUSE DBM,"$6,875.00",$0.00,"$6,875.00",$0.00,"$4,906.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,875.00",$0.00,"$3,437.50","$5,445.00","$5,500.00",$0.00,$0.00,$0.00,$0.00,$0.00
7509211,SUP,Custom 27804086,,7509211  -  GRAFT BN 10X1CM MAGNIFUSE DBM,"$6,500.00",$0.00,"$6,500.00",$0.00,"$4,639.05",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,500.00",$0.00,"$3,250.00","$5,148.00","$5,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
7509215,SUP,Custom 27804086,,7509215  -  GRAFT BN 5X1CM MAGNIFUSE DBM SPNE CRV POST,"$3,937.50",$0.00,"$3,937.50",$0.00,"$2,810.19",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,937.50",$0.00,"$1,968.75","$3,118.50","$3,150.00",$0.00,$0.00,$0.00,$0.00,$0.00
7510001,SUP,HCPCS C1713,,7510001  -  NUT LCK 5.5MM LAT PLT SPNE,$317.50,$0.00,$317.50,$142.88,$226.60,$0.00,$54.70,$0.00,$0.00,$55.59,$317.50,$0.00,$158.75,$251.46,$254.00,$0.00,$49.69,$0.00,$50.55,$0.00
7510050,SUP,HCPCS C1713,,7510050  -  GRAFT BONE 2XS 12MM 20MM ABSORBABLE SPONGE STERILE WATER,"$2,387.50",$0.00,"$2,387.50","$1,074.38","$1,703.96",$0.00,$411.35,$0.00,$0.00,$418.03,"$2,387.50",$0.00,"$1,193.75","$1,890.90","$1,910.00",$0.00,$373.64,$0.00,$380.09,$0.00
7510100,SUP,HCPCS C1713,,7510100  -  GRAFT BONE XS KIT INFUSE BOVINE COLLAGEN RHBMP-2 LUMBAR,"$4,762.50",$0.00,"$4,762.50","$2,143.13","$3,399.00",$0.00,$820.55,$0.00,$0.00,$833.88,"$4,762.50",$0.00,"$2,381.25","$3,771.90","$3,810.00",$0.00,$745.33,$0.00,$758.19,$0.00
7510200,SUP,HCPCS C1713,,7510200  -  GRAFT BONE SMALL 14MM 23MM ABSORBABLE SPONGE STERILE WATER,"$9,512.50",$0.00,"$9,512.50","$4,280.63","$5,158.80",$0.00,"$1,638.96",$0.00,$0.00,"$1,665.56","$9,512.50",$0.00,"$4,756.25","$7,533.90","$7,610.00",$0.00,"$1,488.71",$0.00,"$1,514.39",$0.00
7510400,SUP,HCPCS C1713,,7510400  -  GRAFT BONE MEDIUM 20GA 2X1IN VIAL ABSORBABLE COLLAGEN SPONGE,"$13,250.00",$0.00,"$13,250.00","$5,962.50","$5,158.80",$0.00,"$2,282.91",$0.00,$0.00,"$2,319.97","$13,250.00",$0.00,"$6,625.00","$10,494.00","$10,600.00",$0.00,"$2,073.63",$0.00,"$2,109.40",$0.00
7510800,SUP,HCPCS C1713,,7510800  -  GRAFT BONE LARGE II 18MM 26MM ABSORBABLE SPONGE STERILE,"$14,775.00",$0.00,"$14,775.00","$6,648.75","$5,158.80",$0.00,"$2,545.66",$0.00,$0.00,"$2,586.98","$14,775.00",$0.00,"$7,387.50","$11,701.80","$11,820.00",$0.00,"$2,312.29",$0.00,"$2,352.18",$0.00
7521006,SUP,HCPCS C1713,,7521006  -  PLATE BN 6MM XLP 2 HL TI SPNE LAT,"$7,022.50",$0.00,"$7,022.50","$3,160.13","$5,011.96",$0.00,"$1,209.94",$0.00,$0.00,"$1,229.58","$7,022.50",$0.00,"$3,511.25","$5,561.82","$5,618.00",$0.00,"$1,099.02",$0.00,"$1,117.98",$0.00
7521008,SUP,HCPCS C1713,,7521008  -  PLATE BN 8MM XLP 2 HL TI SPNE LAT,"$7,022.50",$0.00,"$7,022.50","$3,160.13","$5,011.96",$0.00,"$1,209.94",$0.00,$0.00,"$1,229.58","$7,022.50",$0.00,"$3,511.25","$5,561.82","$5,618.00",$0.00,"$1,099.02",$0.00,"$1,117.98",$0.00
7521012,SUP,HCPCS C1713,,7521012  -  PLATE BN 12MM XLP 2 HL TI SPNE LAT,"$7,022.50",$0.00,"$7,022.50","$3,160.13","$5,011.96",$0.00,"$1,209.94",$0.00,$0.00,"$1,229.58","$7,022.50",$0.00,"$3,511.25","$5,561.82","$5,618.00",$0.00,"$1,099.02",$0.00,"$1,117.98",$0.00
7521014,SUP,HCPCS C1713,,7521014  -  PLATE BN 14MM XLP 2 HL TI SPNE LAT,"$7,022.50",$0.00,"$7,022.50","$3,160.13","$5,011.96",$0.00,"$1,209.94",$0.00,$0.00,"$1,229.58","$7,022.50",$0.00,"$3,511.25","$5,561.82","$5,618.00",$0.00,"$1,099.02",$0.00,"$1,117.98",$0.00
7521016,SUP,HCPCS C1713,,7521016  -  PLATE BN 16MM XLP 2 HL TI SPNE LAT,"$7,022.50",$0.00,"$7,022.50","$3,160.13","$5,011.96",$0.00,"$1,209.94",$0.00,$0.00,"$1,229.58","$7,022.50",$0.00,"$3,511.25","$5,561.82","$5,618.00",$0.00,"$1,099.02",$0.00,"$1,117.98",$0.00
7533006,SUP,HCPCS C1713,,7533006  -  PLATE BN 6MM XLP + 4 HL SPNE,"$7,887.50",$0.00,"$7,887.50","$3,549.38","$5,158.80",$0.00,"$1,358.98",$0.00,$0.00,"$1,381.04","$7,887.50",$0.00,"$3,943.75","$6,246.90","$6,310.00",$0.00,"$1,234.39",$0.00,"$1,255.69",$0.00
7533008,SUP,HCPCS C1713,,7533008  -  PLATE BN 8MM XLP + 4 HL SPNE,"$7,887.50",$0.00,"$7,887.50","$3,549.38","$5,158.80",$0.00,"$1,358.98",$0.00,$0.00,"$1,381.04","$7,887.50",$0.00,"$3,943.75","$6,246.90","$6,310.00",$0.00,"$1,234.39",$0.00,"$1,255.69",$0.00
7533010,SUP,HCPCS C1713,,7533010  -  PLATE BN 10MM XLP + 4 HL SPNE,"$7,887.50",$0.00,"$7,887.50","$3,549.38","$5,158.80",$0.00,"$1,358.98",$0.00,$0.00,"$1,381.04","$7,887.50",$0.00,"$3,943.75","$6,246.90","$6,310.00",$0.00,"$1,234.39",$0.00,"$1,255.69",$0.00
7533012,SUP,HCPCS C1713,,7533012  -  PLATE BN 12MM XLP + 4 HL SPNE,"$7,887.50",$0.00,"$7,887.50","$3,549.38","$5,158.80",$0.00,"$1,358.98",$0.00,$0.00,"$1,381.04","$7,887.50",$0.00,"$3,943.75","$6,246.90","$6,310.00",$0.00,"$1,234.39",$0.00,"$1,255.69",$0.00
7533014,SUP,HCPCS C1713,,7533014  -  PLATE BN 14MM XLP + 4 HL SPNE,"$7,887.50",$0.00,"$7,887.50","$3,549.38","$5,158.80",$0.00,"$1,358.98",$0.00,$0.00,"$1,381.04","$7,887.50",$0.00,"$3,943.75","$6,246.90","$6,310.00",$0.00,"$1,234.39",$0.00,"$1,255.69",$0.00
7533016,SUP,HCPCS C1713,,7533016  -  PLATE BN 16MM XLP + 4 HL SPNE,"$7,887.50",$0.00,"$7,887.50","$3,549.38","$5,158.80",$0.00,"$1,358.98",$0.00,$0.00,"$1,381.04","$7,887.50",$0.00,"$3,943.75","$6,246.90","$6,310.00",$0.00,"$1,234.39",$0.00,"$1,255.69",$0.00
7534006,SUP,HCPCS C1713,,7534006  -  PLATE BN 6MM XLP + 2X2 HL SPNE,"$7,887.50",$0.00,"$7,887.50","$3,549.38","$5,158.80",$0.00,"$1,358.98",$0.00,$0.00,"$1,381.04","$7,887.50",$0.00,"$3,943.75","$6,246.90","$6,310.00",$0.00,"$1,234.39",$0.00,"$1,255.69",$0.00
7534008,SUP,HCPCS C1713,,7534008  -  PLATE BN 8MM XLP + 2X2 HL SPNE,"$7,887.50",$0.00,"$7,887.50","$3,549.38","$5,158.80",$0.00,"$1,358.98",$0.00,$0.00,"$1,381.04","$7,887.50",$0.00,"$3,943.75","$6,246.90","$6,310.00",$0.00,"$1,234.39",$0.00,"$1,255.69",$0.00
7534010,SUP,HCPCS C1713,,7534010  -  PLATE BN 10MM XLP + 2X2 HL SPNE,"$7,887.50",$0.00,"$7,887.50","$3,549.38","$5,158.80",$0.00,"$1,358.98",$0.00,$0.00,"$1,381.04","$7,887.50",$0.00,"$3,943.75","$6,246.90","$6,310.00",$0.00,"$1,234.39",$0.00,"$1,255.69",$0.00
7534012,SUP,HCPCS C1713,,7534012  -  PLATE BN 12MM XLP + 2X2 HL SPNE,"$7,887.50",$0.00,"$7,887.50","$3,549.38","$5,158.80",$0.00,"$1,358.98",$0.00,$0.00,"$1,381.04","$7,887.50",$0.00,"$3,943.75","$6,246.90","$6,310.00",$0.00,"$1,234.39",$0.00,"$1,255.69",$0.00
7534014,SUP,HCPCS C1713,,7534014  -  PLATE BN 14MM XLP + 2X2 HL SPNE,"$7,887.50",$0.00,"$7,887.50","$3,549.38","$5,158.80",$0.00,"$1,358.98",$0.00,$0.00,"$1,381.04","$7,887.50",$0.00,"$3,943.75","$6,246.90","$6,310.00",$0.00,"$1,234.39",$0.00,"$1,255.69",$0.00
7534016,SUP,HCPCS C1713,,7534016  -  PLATE BN 16MM XLP + 2X2 HL SPNE,"$7,887.50",$0.00,"$7,887.50","$3,549.38","$5,158.80",$0.00,"$1,358.98",$0.00,$0.00,"$1,381.04","$7,887.50",$0.00,"$3,943.75","$6,246.90","$6,310.00",$0.00,"$1,234.39",$0.00,"$1,255.69",$0.00
7539006,SUP,HCPCS C1713,,7539006  -  PLATE BN ANG FAVORED 6MM XLP + SPNE,"$7,887.50",$0.00,"$7,887.50","$3,549.38","$5,158.80",$0.00,"$1,358.98",$0.00,$0.00,"$1,381.04","$7,887.50",$0.00,"$3,943.75","$6,246.90","$6,310.00",$0.00,"$1,234.39",$0.00,"$1,255.69",$0.00
7539008,SUP,HCPCS C1713,,7539008  -  PLATE BN ANG FAVORED 8MM XLP + SPNE,"$7,887.50",$0.00,"$7,887.50","$3,549.38","$5,158.80",$0.00,"$1,358.98",$0.00,$0.00,"$1,381.04","$7,887.50",$0.00,"$3,943.75","$6,246.90","$6,310.00",$0.00,"$1,234.39",$0.00,"$1,255.69",$0.00
7539010,SUP,HCPCS C1713,,7539010  -  PLATE BN ANG FAVORED 10MM XLP + SPNE,"$7,887.50",$0.00,"$7,887.50","$3,549.38","$5,158.80",$0.00,"$1,358.98",$0.00,$0.00,"$1,381.04","$7,887.50",$0.00,"$3,943.75","$6,246.90","$6,310.00",$0.00,"$1,234.39",$0.00,"$1,255.69",$0.00
7539012,SUP,HCPCS C1713,,7539012  -  PLATE BN ANG FAVORED 12MM XLP + SPNE,"$7,887.50",$0.00,"$7,887.50","$3,549.38","$5,158.80",$0.00,"$1,358.98",$0.00,$0.00,"$1,381.04","$7,887.50",$0.00,"$3,943.75","$6,246.90","$6,310.00",$0.00,"$1,234.39",$0.00,"$1,255.69",$0.00
7539014,SUP,HCPCS C1713,,7539014  -  PLATE BN ANG FAVORED 14MM XLP + SPNE,"$7,887.50",$0.00,"$7,887.50","$3,549.38","$5,158.80",$0.00,"$1,358.98",$0.00,$0.00,"$1,381.04","$7,887.50",$0.00,"$3,943.75","$6,246.90","$6,310.00",$0.00,"$1,234.39",$0.00,"$1,255.69",$0.00
7539016,SUP,HCPCS C1713,,7539016  -  PLATE BN ANG FAVORED 16MM XLP + SPNE,"$7,887.50",$0.00,"$7,887.50","$3,549.38","$5,158.80",$0.00,"$1,358.98",$0.00,$0.00,"$1,381.04","$7,887.50",$0.00,"$3,943.75","$6,246.90","$6,310.00",$0.00,"$1,234.39",$0.00,"$1,255.69",$0.00
7540020,SUP,HCPCS C1713,,7540020  -  SCREW BONE 20MM SPNL TI BRKOF,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
7540120,SUP,HCPCS C1713,,7540120  -  SET SCREW 7540120 NON BREAK OFF TI,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
7540220,SUP,HCPCS C1713,,7540220  -  SET SCREW 7540220 LEGACY 5.5 RED PLUG TI,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
7541102,SUP,HCPCS C1713,,7541102  -  HOOK 7541102 PEDICLE SM TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7541103,SUP,HCPCS C1713,,7541103  -  HOOK 7541103 PEDICLE MD TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7541104,SUP,HCPCS C1713,,7541104  -  HOOK 7541104 PEDICLE LG TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7541112,SUP,HCPCS C1713,,7541112  -  HOOK 7541112 WIDE BLADE SM TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7541113,SUP,HCPCS C1713,,7541113  -  HOOK 7541113 WIDE BLADE MD TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7541114,SUP,HCPCS C1713,,7541114  -  HOOK 7541114 WIDE BLADE LG TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7541122,SUP,HCPCS C1713,,7541122  -  HOOK 7541122 NARROW BLADE SM TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7541123,SUP,HCPCS C1713,,7541123  -  HOOK 7541123 NARROW BLADE MD TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7541124,SUP,HCPCS C1713,,7541124  -  HOOK 7541124 NARROW BLADE LG TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7541133,SUP,HCPCS C1713,,7541133  -  HOOK 7541133 RAMP WIDE BLADE MD TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7541142,SUP,HCPCS C1713,,7541142  -  HOOK 7541142 RAMP NARROW BLADE SM TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7541143,SUP,HCPCS C1713,,7541143  -  HOOK 7541143 RAMP NARROW BLADE MD TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7541153,SUP,HCPCS C1713,,7541153  -  HOOK 7541153 SUPRA LAM LUMBAR MD TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7541162,SUP,HCPCS C1713,,7541162  -  HOOK 7541162 LUMBAR ANG BLADE SM TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7541163,SUP,HCPCS C1713,,7541163  -  HOOK 7541163 LUMBAR ANG BLADE MD TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7541172,SUP,HCPCS C1713,,7541172  -  HOOK 7541172 EXTENDED BODY SM TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7541173,SUP,HCPCS C1713,,7541173  -  HOOK 7541173 EXTENDED BODY MD TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7541174,SUP,HCPCS C1713,,7541174  -  HOOK 7541174 EXTENDED BODY LG TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7541188,SUP,HCPCS C1713,,7541188  -  HOOK 7541188 THORACIC ANG BLADE RT TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7541189,SUP,HCPCS C1713,,7541189  -  HOOK 7541189 THORACIC ANG BLADE LT TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7541198,SUP,HCPCS C1713,,7541198  -  HOOK 7541198 OFFSET RT TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7541199,SUP,HCPCS C1713,,7541199  -  HOOK 7541199 OFFSET LT TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7541203,SUP,HCPCS C1713,,7541203  -  HOOK 7541203 PEDICLE WITH LIP MD TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7541213,SUP,HCPCS C1713,,7541213  -  HOOK 7541213 WIDE BLADEW LIP MD TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7541223,SUP,HCPCS C1713,,7541223  -  HOOK 7541223 NARROW BLADEW LIP MD TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7541302,SUP,HCPCS C1713,,"7541302  -  TAH PEDICLE HOOK - SMALL, TI","$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7541303,SUP,HCPCS C1713,,"7541303  -  TAH PEDICLE HOOK - MEDIUM, TI","$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7541304,SUP,HCPCS C1713,,"7541304  -  TAH PEDICLE HOOK - LARGE,TI","$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7541312,SUP,HCPCS C1713,,"7541312  -  TAH SUPRA-LAMINAR HOOK -SM, TI","$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7541313,SUP,HCPCS C1713,,"7541313  -  TAH SUPRA-LAMINAR HOOK -MD, TI","$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7541314,SUP,HCPCS C1713,,"7541314  -  TAH SUPRA-LAMINAR HOOK-LG, TI","$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7541322,SUP,HCPCS C1713,,"7541322  -  TAH INFRA-LAMINAR HOOK-SM, TI","$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7541323,SUP,HCPCS C1713,,"7541323  -  TAH INFRA-LAMINAR HOOK-MD, TI","$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7541324,SUP,HCPCS C1713,,"7541324  -  TAH INFRA-LAMINAR HOOK-LG, TI","$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7541342,SUP,HCPCS C1713,,7541342  -  TAH TRANSVERSE PROCESS HOOK-SM,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7541343,SUP,HCPCS C1713,,7541343  -  TAH TRANSVERSE PROCESS HOOK-MD,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7541344,SUP,HCPCS C1713,,7541344  -  TAH TRANSVERSE PROCESS HOOK-TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7542420,SUP,HCPCS C1713,,"7542420  -  SCREW, FIXED ANGLE, 4.0X20, TI","$1,896.00",$0.00,"$1,896.00",$853.20,"$1,353.18",$0.00,$326.67,$0.00,$0.00,$331.97,"$1,896.00",$0.00,$948.00,"$1,501.63","$1,516.80",$0.00,$296.72,$0.00,$301.84,$0.00
7542425,SUP,HCPCS C1713,,7542425  -  SCREW 7542425 FIXED ANGLE 4.0X25 TI,"$1,896.00",$0.00,"$1,896.00",$853.20,"$1,353.18",$0.00,$326.67,$0.00,$0.00,$331.97,"$1,896.00",$0.00,$948.00,"$1,501.63","$1,516.80",$0.00,$296.72,$0.00,$301.84,$0.00
7542430,SUP,HCPCS C1713,,"7542430  -  SCREW, FIXED ANGLE, 4.0X30, TI","$1,896.00",$0.00,"$1,896.00",$853.20,"$1,353.18",$0.00,$326.67,$0.00,$0.00,$331.97,"$1,896.00",$0.00,$948.00,"$1,501.63","$1,516.80",$0.00,$296.72,$0.00,$301.84,$0.00
7542435,SUP,HCPCS C1713,,"7542435  -  SCREW, FIXED ANGLE, 4.0X35, TI","$1,896.00",$0.00,"$1,896.00",$853.20,"$1,353.18",$0.00,$326.67,$0.00,$0.00,$331.97,"$1,896.00",$0.00,$948.00,"$1,501.63","$1,516.80",$0.00,$296.72,$0.00,$301.84,$0.00
7542440,SUP,HCPCS C1713,,"7542440  -  SCREW, FIXED ANGLE, 4.0X40, TI","$1,896.00",$0.00,"$1,896.00",$853.20,"$1,353.18",$0.00,$326.67,$0.00,$0.00,$331.97,"$1,896.00",$0.00,$948.00,"$1,501.63","$1,516.80",$0.00,$296.72,$0.00,$301.84,$0.00
7542445,SUP,HCPCS C1713,,"7542445  -  SCREW, FIXED ANGLE, 4.0X45, TI","$1,896.00",$0.00,"$1,896.00",$853.20,"$1,353.18",$0.00,$326.67,$0.00,$0.00,$331.97,"$1,896.00",$0.00,$948.00,"$1,501.63","$1,516.80",$0.00,$296.72,$0.00,$301.84,$0.00
7542450,SUP,HCPCS C1713,,"7542450  -  SCREW, FIXED ANGLE, 4.0X50, TI","$1,896.00",$0.00,"$1,896.00",$853.20,"$1,353.18",$0.00,$326.67,$0.00,$0.00,$331.97,"$1,896.00",$0.00,$948.00,"$1,501.63","$1,516.80",$0.00,$296.72,$0.00,$301.84,$0.00
7542455,SUP,HCPCS C1713,,"7542455  -  SCREW, FIXED ANGLE, 4.0X55, TI","$1,896.00",$0.00,"$1,896.00",$853.20,"$1,353.18",$0.00,$326.67,$0.00,$0.00,$331.97,"$1,896.00",$0.00,$948.00,"$1,501.63","$1,516.80",$0.00,$296.72,$0.00,$301.84,$0.00
7542520,SUP,HCPCS C1713,,7542520  -  SCREW 7542520 FIXED ANGLE 5.0X20 TI,"$1,896.00",$0.00,"$1,896.00",$853.20,"$1,353.18",$0.00,$326.67,$0.00,$0.00,$331.97,"$1,896.00",$0.00,$948.00,"$1,501.63","$1,516.80",$0.00,$296.72,$0.00,$301.84,$0.00
7542525,SUP,HCPCS C1713,,7542525  -  SCREW BN 5MM 25MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM ROD,"$1,896.00",$0.00,"$1,896.00",$853.20,"$1,353.18",$0.00,$326.67,$0.00,$0.00,$331.97,"$1,896.00",$0.00,$948.00,"$1,501.63","$1,516.80",$0.00,$296.72,$0.00,$301.84,$0.00
7542530,SUP,HCPCS C1713,,7542530  -  SCREW BN 5MM 30MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM ROD,"$1,896.00",$0.00,"$1,896.00",$853.20,"$1,353.18",$0.00,$326.67,$0.00,$0.00,$331.97,"$1,896.00",$0.00,$948.00,"$1,501.63","$1,516.80",$0.00,$296.72,$0.00,$301.84,$0.00
7542535,SUP,HCPCS C1713,,7542535  -  SCREW BN 5MM 35MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM ROD,"$1,896.00",$0.00,"$1,896.00",$853.20,"$1,353.18",$0.00,$326.67,$0.00,$0.00,$331.97,"$1,896.00",$0.00,$948.00,"$1,501.63","$1,516.80",$0.00,$296.72,$0.00,$301.84,$0.00
7542540,SUP,HCPCS C1713,,7542540  -  SCREW BN 5MM 40MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM ROD,"$1,896.00",$0.00,"$1,896.00",$853.20,"$1,353.18",$0.00,$326.67,$0.00,$0.00,$331.97,"$1,896.00",$0.00,$948.00,"$1,501.63","$1,516.80",$0.00,$296.72,$0.00,$301.84,$0.00
7542545,SUP,HCPCS C1713,,7542545  -  SCREW BN 5MM 45MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM ROD,"$1,896.00",$0.00,"$1,896.00",$853.20,"$1,353.18",$0.00,$326.67,$0.00,$0.00,$331.97,"$1,896.00",$0.00,$948.00,"$1,501.63","$1,516.80",$0.00,$296.72,$0.00,$301.84,$0.00
7542550,SUP,HCPCS C1713,,7542550  -  SCREW 7542550 FIXED ANGLE 5.0X50 TI,"$1,896.00",$0.00,"$1,896.00",$853.20,"$1,353.18",$0.00,$326.67,$0.00,$0.00,$331.97,"$1,896.00",$0.00,$948.00,"$1,501.63","$1,516.80",$0.00,$296.72,$0.00,$301.84,$0.00
7542555,SUP,HCPCS C1713,,7542555  -  SCREW 7542555 FIXED ANGLE 5.0X55 TI,"$1,896.00",$0.00,"$1,896.00",$853.20,"$1,353.18",$0.00,$326.67,$0.00,$0.00,$331.97,"$1,896.00",$0.00,$948.00,"$1,501.63","$1,516.80",$0.00,$296.72,$0.00,$301.84,$0.00
7542625,SUP,HCPCS C1713,,7542625  -  SCREW 7542625 FIXED ANGLE 6.0X25 TI,"$1,896.00",$0.00,"$1,896.00",$853.20,"$1,353.18",$0.00,$326.67,$0.00,$0.00,$331.97,"$1,896.00",$0.00,$948.00,"$1,501.63","$1,516.80",$0.00,$296.72,$0.00,$301.84,$0.00
7542630,SUP,HCPCS C1713,,7542630  -  SCREW 7542630 FIXED ANGLE 6.0X30 TI,"$1,896.00",$0.00,"$1,896.00",$853.20,"$1,353.18",$0.00,$326.67,$0.00,$0.00,$331.97,"$1,896.00",$0.00,$948.00,"$1,501.63","$1,516.80",$0.00,$296.72,$0.00,$301.84,$0.00
7542635,SUP,HCPCS C1713,,7542635  -  SCREW 7542635 FIXED ANGLE 6.0X35 TI,"$1,896.00",$0.00,"$1,896.00",$853.20,"$1,353.18",$0.00,$326.67,$0.00,$0.00,$331.97,"$1,896.00",$0.00,$948.00,"$1,501.63","$1,516.80",$0.00,$296.72,$0.00,$301.84,$0.00
7542640,SUP,HCPCS C1713,,7542640  -  SCREW 7542640 FIXED ANGLE 6.0X40 TI,"$1,896.00",$0.00,"$1,896.00",$853.20,"$1,353.18",$0.00,$326.67,$0.00,$0.00,$331.97,"$1,896.00",$0.00,$948.00,"$1,501.63","$1,516.80",$0.00,$296.72,$0.00,$301.84,$0.00
7542645,SUP,HCPCS C1713,,7542645  -  BONE SCREW 7542645 FIXED ANGLE 6.0X45 TI,"$1,896.00",$0.00,"$1,896.00",$853.20,"$1,353.18",$0.00,$326.67,$0.00,$0.00,$331.97,"$1,896.00",$0.00,$948.00,"$1,501.63","$1,516.80",$0.00,$296.72,$0.00,$301.84,$0.00
7542650,SUP,HCPCS C1713,,7542650  -  SCREW 7542650 FIXED ANGLE 6.0X50 TI,"$1,896.00",$0.00,"$1,896.00",$853.20,"$1,353.18",$0.00,$326.67,$0.00,$0.00,$331.97,"$1,896.00",$0.00,$948.00,"$1,501.63","$1,516.80",$0.00,$296.72,$0.00,$301.84,$0.00
7542655,SUP,HCPCS C1713,,7542655  -  SCREW 7542655 FIXED ANGLE 6.0X55 TI,"$1,896.00",$0.00,"$1,896.00",$853.20,"$1,353.18",$0.00,$326.67,$0.00,$0.00,$331.97,"$1,896.00",$0.00,$948.00,"$1,501.63","$1,516.80",$0.00,$296.72,$0.00,$301.84,$0.00
7542660,SUP,HCPCS C1713,,7542660  -  SCREW 7542660 FIXED ANGLE 6.0X60 TI,"$1,896.00",$0.00,"$1,896.00",$853.20,"$1,353.18",$0.00,$326.67,$0.00,$0.00,$331.97,"$1,896.00",$0.00,$948.00,"$1,501.63","$1,516.80",$0.00,$296.72,$0.00,$301.84,$0.00
7543420,SUP,HCPCS C1713,,7543420  -  SCREW 7543420 FIXED ANGLE 4.5X20 TI,"$1,896.00",$0.00,"$1,896.00",$853.20,"$1,353.18",$0.00,$326.67,$0.00,$0.00,$331.97,"$1,896.00",$0.00,$948.00,"$1,501.63","$1,516.80",$0.00,$296.72,$0.00,$301.84,$0.00
7543425,SUP,HCPCS C1713,,7543425  -  SCREW BN 4.5MM 25MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM,"$1,896.00",$0.00,"$1,896.00",$853.20,"$1,353.18",$0.00,$326.67,$0.00,$0.00,$331.97,"$1,896.00",$0.00,$948.00,"$1,501.63","$1,516.80",$0.00,$296.72,$0.00,$301.84,$0.00
7543430,SUP,HCPCS C1713,,7543430  -  SCREW BN 4.5MM 30MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM,"$1,896.00",$0.00,"$1,896.00",$853.20,"$1,353.18",$0.00,$326.67,$0.00,$0.00,$331.97,"$1,896.00",$0.00,$948.00,"$1,501.63","$1,516.80",$0.00,$296.72,$0.00,$301.84,$0.00
7543435,SUP,HCPCS C1713,,7543435  -  SCREW BN 4.5MM 35MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM,"$1,896.00",$0.00,"$1,896.00",$853.20,"$1,353.18",$0.00,$326.67,$0.00,$0.00,$331.97,"$1,896.00",$0.00,$948.00,"$1,501.63","$1,516.80",$0.00,$296.72,$0.00,$301.84,$0.00
7543440,SUP,HCPCS C1713,,7543440  -  SCREW BN 4.5MM 40MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM,"$1,896.00",$0.00,"$1,896.00",$853.20,"$1,353.18",$0.00,$326.67,$0.00,$0.00,$331.97,"$1,896.00",$0.00,$948.00,"$1,501.63","$1,516.80",$0.00,$296.72,$0.00,$301.84,$0.00
7543445,SUP,HCPCS C1713,,7543445  -  SCREW BN 4.5MM 45MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM,"$1,896.00",$0.00,"$1,896.00",$853.20,"$1,353.18",$0.00,$326.67,$0.00,$0.00,$331.97,"$1,896.00",$0.00,$948.00,"$1,501.63","$1,516.80",$0.00,$296.72,$0.00,$301.84,$0.00
7543450,SUP,HCPCS C1713,,7543450  -  SCREW 7543450 FIXED ANGLE 4.5X50 TI,"$1,896.00",$0.00,"$1,896.00",$853.20,"$1,353.18",$0.00,$326.67,$0.00,$0.00,$331.97,"$1,896.00",$0.00,$948.00,"$1,501.63","$1,516.80",$0.00,$296.72,$0.00,$301.84,$0.00
7543455,SUP,HCPCS C1713,,7543455  -  SCREW 7543455 FIXED ANGLE 4.5X55 TI,"$1,896.00",$0.00,"$1,896.00",$853.20,"$1,353.18",$0.00,$326.67,$0.00,$0.00,$331.97,"$1,896.00",$0.00,$948.00,"$1,501.63","$1,516.80",$0.00,$296.72,$0.00,$301.84,$0.00
7543525,SUP,HCPCS C1713,,7543525  -  SCREW BN 5.5MM 25MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM,"$1,896.00",$0.00,"$1,896.00",$853.20,"$1,353.18",$0.00,$326.67,$0.00,$0.00,$331.97,"$1,896.00",$0.00,$948.00,"$1,501.63","$1,516.80",$0.00,$296.72,$0.00,$301.84,$0.00
7543530,SUP,HCPCS C1713,,7543530  -  SCREW BN 5.5MM 30MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM,"$1,896.00",$0.00,"$1,896.00",$853.20,"$1,353.18",$0.00,$326.67,$0.00,$0.00,$331.97,"$1,896.00",$0.00,$948.00,"$1,501.63","$1,516.80",$0.00,$296.72,$0.00,$301.84,$0.00
7543535,SUP,HCPCS C1713,,7543535  -  SCREW BN 5.5MM 35MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM,"$1,896.00",$0.00,"$1,896.00",$853.20,"$1,353.18",$0.00,$326.67,$0.00,$0.00,$331.97,"$1,896.00",$0.00,$948.00,"$1,501.63","$1,516.80",$0.00,$296.72,$0.00,$301.84,$0.00
7543540,SUP,HCPCS C1713,,7543540  -  SCREW BN 5.5MM 40MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM,"$1,896.00",$0.00,"$1,896.00",$853.20,"$1,353.18",$0.00,$326.67,$0.00,$0.00,$331.97,"$1,896.00",$0.00,$948.00,"$1,501.63","$1,516.80",$0.00,$296.72,$0.00,$301.84,$0.00
7543545,SUP,HCPCS C1713,,7543545  -  SCREW BN 5.5MM 45MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM,"$1,896.00",$0.00,"$1,896.00",$853.20,"$1,353.18",$0.00,$326.67,$0.00,$0.00,$331.97,"$1,896.00",$0.00,$948.00,"$1,501.63","$1,516.80",$0.00,$296.72,$0.00,$301.84,$0.00
7543550,SUP,HCPCS C1713,,7543550  -  SCREW BN 5.5MM 50MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM,"$1,896.00",$0.00,"$1,896.00",$853.20,"$1,353.18",$0.00,$326.67,$0.00,$0.00,$331.97,"$1,896.00",$0.00,$948.00,"$1,501.63","$1,516.80",$0.00,$296.72,$0.00,$301.84,$0.00
7543555,SUP,HCPCS C1713,,7543555  -  SCREW 7543555 FIXED ANGLE 5.5X55 TI,"$1,896.00",$0.00,"$1,896.00",$853.20,"$1,353.18",$0.00,$326.67,$0.00,$0.00,$331.97,"$1,896.00",$0.00,$948.00,"$1,501.63","$1,516.80",$0.00,$296.72,$0.00,$301.84,$0.00
7543560,SUP,HCPCS C1713,,7543560  -  SCREW 7543560 FIXED ANGLE 5.5X60 TI,"$1,896.00",$0.00,"$1,896.00",$853.20,"$1,353.18",$0.00,$326.67,$0.00,$0.00,$331.97,"$1,896.00",$0.00,$948.00,"$1,501.63","$1,516.80",$0.00,$296.72,$0.00,$301.84,$0.00
7543625,SUP,HCPCS C1713,,7543625  -  SCREW 7543625 FIXED ANGLE 6.5X25 TI,"$1,896.00",$0.00,"$1,896.00",$853.20,"$1,353.18",$0.00,$326.67,$0.00,$0.00,$331.97,"$1,896.00",$0.00,$948.00,"$1,501.63","$1,516.80",$0.00,$296.72,$0.00,$301.84,$0.00
7543630,SUP,HCPCS C1713,,7543630  -  SCREW BN 6.5MM 30MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM,"$1,896.00",$0.00,"$1,896.00",$853.20,"$1,353.18",$0.00,$326.67,$0.00,$0.00,$331.97,"$1,896.00",$0.00,$948.00,"$1,501.63","$1,516.80",$0.00,$296.72,$0.00,$301.84,$0.00
7543635,SUP,HCPCS C1713,,7543635  -  SCREW BN 6.5MM 35MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM,"$1,896.00",$0.00,"$1,896.00",$853.20,"$1,353.18",$0.00,$326.67,$0.00,$0.00,$331.97,"$1,896.00",$0.00,$948.00,"$1,501.63","$1,516.80",$0.00,$296.72,$0.00,$301.84,$0.00
7543640,SUP,HCPCS C1713,,7543640  -  SCREW BN 6.5MM 40MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM,"$1,896.00",$0.00,"$1,896.00",$853.20,"$1,353.18",$0.00,$326.67,$0.00,$0.00,$331.97,"$1,896.00",$0.00,$948.00,"$1,501.63","$1,516.80",$0.00,$296.72,$0.00,$301.84,$0.00
7543645,SUP,HCPCS C1713,,7543645  -  SCREW BN 6.5MM 45MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM,"$1,896.00",$0.00,"$1,896.00",$853.20,"$1,353.18",$0.00,$326.67,$0.00,$0.00,$331.97,"$1,896.00",$0.00,$948.00,"$1,501.63","$1,516.80",$0.00,$296.72,$0.00,$301.84,$0.00
7543650,SUP,HCPCS C1713,,7543650  -  SCREW BN 6.5MM 50MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM,"$1,896.00",$0.00,"$1,896.00",$853.20,"$1,353.18",$0.00,$326.67,$0.00,$0.00,$331.97,"$1,896.00",$0.00,$948.00,"$1,501.63","$1,516.80",$0.00,$296.72,$0.00,$301.84,$0.00
7543655,SUP,HCPCS C1713,,7543655  -  SCREW BN 6.5MM 55MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM,"$1,896.00",$0.00,"$1,896.00",$853.20,"$1,353.18",$0.00,$326.67,$0.00,$0.00,$331.97,"$1,896.00",$0.00,$948.00,"$1,501.63","$1,516.80",$0.00,$296.72,$0.00,$301.84,$0.00
7543660,SUP,HCPCS C1713,,7543660  -  SCREW 7543660 FIXED ANGLE 6.5X60 TI,"$1,896.00",$0.00,"$1,896.00",$853.20,"$1,353.18",$0.00,$326.67,$0.00,$0.00,$331.97,"$1,896.00",$0.00,$948.00,"$1,501.63","$1,516.80",$0.00,$296.72,$0.00,$301.84,$0.00
7543725,SUP,HCPCS C1713,,7543725  -  SCREW 7543725 FIXED ANGLE 7.5X25 TI,"$1,896.00",$0.00,"$1,896.00",$853.20,"$1,353.18",$0.00,$326.67,$0.00,$0.00,$331.97,"$1,896.00",$0.00,$948.00,"$1,501.63","$1,516.80",$0.00,$296.72,$0.00,$301.84,$0.00
7543730,SUP,HCPCS C1713,,7543730  -  SCREW BN 7.5MM 30MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM,"$1,896.00",$0.00,"$1,896.00",$853.20,"$1,353.18",$0.00,$326.67,$0.00,$0.00,$331.97,"$1,896.00",$0.00,$948.00,"$1,501.63","$1,516.80",$0.00,$296.72,$0.00,$301.84,$0.00
7543735,SUP,HCPCS C1713,,7543735  -  SCREW BN 7.5MM 35MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM,"$1,896.00",$0.00,"$1,896.00",$853.20,"$1,353.18",$0.00,$326.67,$0.00,$0.00,$331.97,"$1,896.00",$0.00,$948.00,"$1,501.63","$1,516.80",$0.00,$296.72,$0.00,$301.84,$0.00
7543740,SUP,HCPCS C1713,,7543740  -  SCREW BN 7.5MM 40MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM,"$1,896.00",$0.00,"$1,896.00",$853.20,"$1,353.18",$0.00,$326.67,$0.00,$0.00,$331.97,"$1,896.00",$0.00,$948.00,"$1,501.63","$1,516.80",$0.00,$296.72,$0.00,$301.84,$0.00
7543745,SUP,HCPCS C1713,,7543745  -  SCREW BN 7.5MM 45MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM,"$1,896.00",$0.00,"$1,896.00",$853.20,"$1,353.18",$0.00,$326.67,$0.00,$0.00,$331.97,"$1,896.00",$0.00,$948.00,"$1,501.63","$1,516.80",$0.00,$296.72,$0.00,$301.84,$0.00
7543750,SUP,HCPCS C1713,,7543750  -  SCREW BN 7.5MM 50MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM,"$1,896.00",$0.00,"$1,896.00",$853.20,"$1,353.18",$0.00,$326.67,$0.00,$0.00,$331.97,"$1,896.00",$0.00,$948.00,"$1,501.63","$1,516.80",$0.00,$296.72,$0.00,$301.84,$0.00
7543755,SUP,HCPCS C1713,,7543755  -  SCREW BN 7.5MM 55MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM,"$1,896.00",$0.00,"$1,896.00",$853.20,"$1,353.18",$0.00,$326.67,$0.00,$0.00,$331.97,"$1,896.00",$0.00,$948.00,"$1,501.63","$1,516.80",$0.00,$296.72,$0.00,$301.84,$0.00
7543760,SUP,HCPCS C1713,,7543760  -  SCREW 7543760 FIXED ANGLE 7.5X60 TI,"$1,896.00",$0.00,"$1,896.00",$853.20,"$1,353.18",$0.00,$326.67,$0.00,$0.00,$331.97,"$1,896.00",$0.00,$948.00,"$1,501.63","$1,516.80",$0.00,$296.72,$0.00,$301.84,$0.00
7543765,SUP,HCPCS C1713,,7543765  -  SCREW 7543765 FIXED ANGLE 7.5X65 TI,"$1,896.00",$0.00,"$1,896.00",$853.20,"$1,353.18",$0.00,$326.67,$0.00,$0.00,$331.97,"$1,896.00",$0.00,$948.00,"$1,501.63","$1,516.80",$0.00,$296.72,$0.00,$301.84,$0.00
7544035,SUP,HCPCS C1713,,7544035  -  SCREW BN 4MM 35MM CD HZN LGC MA TI SPNE 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7546999,SUP,Custom 27203010,,REAGENT SOL A B C IMPRP KT 300 TST ANALY,$559.15,$0.00,$559.15,$0.00,$399.07,$0.00,$0.00,$0.00,$0.00,$0.00,$559.15,$0.00,$279.58,$442.85,$447.32,$0.00,$0.00,$0.00,$0.00,$0.00
7547053,SUP,Custom 27203010,,CONTROL FLW CYMTR FLWCNT FLUOROSPHERES 20ML,$686.15,$0.00,$686.15,$0.00,$489.71,$0.00,$0.00,$0.00,$0.00,$0.00,$686.15,$0.00,$343.08,$543.43,$548.92,$0.00,$0.00,$0.00,$0.00,$0.00
7547116,SUP,Custom 27203010,,CONTROL CLTR 5C 3PK DISK 3.3ML HMTL,$40.83,$0.00,$40.83,$0.00,$29.14,$0.00,$0.00,$0.00,$0.00,$0.00,$40.83,$0.00,$20.41,$32.34,$32.66,$0.00,$0.00,$0.00,$0.00,$0.00
7547125,SUP,Custom 27203010,,CONTROL RETCYT CLTR RTC C GNS 3PK 3.3ML LH SER HMTL,$38.73,$0.00,$38.73,$0.00,$27.64,$0.00,$0.00,$0.00,$0.00,$0.00,$38.73,$0.00,$19.36,$30.67,$30.98,$0.00,$0.00,$0.00,$0.00,$0.00
7547178,SUP,Custom 27203010,,STAIN WRTS GMS TRUCOLOR 2L SLD LH SER HMTL,$517.38,$0.00,$517.38,$0.00,$369.25,$0.00,$0.00,$0.00,$0.00,$0.00,$517.38,$0.00,$258.69,$409.76,$413.90,$0.00,$0.00,$0.00,$0.00,$0.00
7547181,SUP,Custom 27203010,,STAIN WRTS GMS TRUCOLOR 2L SLD BUFF LH SER HMTL,$316.25,$0.00,$316.25,$0.00,$225.71,$0.00,$0.00,$0.00,$0.00,$0.00,$316.25,$0.00,$158.13,$250.47,$253.00,$0.00,$0.00,$0.00,$0.00,$0.00
7555025,SUP,HCPCS C1713,,7555025  -  BOLT SPNL 5.5MM 25MM PLT,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7555030,SUP,HCPCS C1713,,7555030  -  BOLT SPNL 5.5MM 30MM TI,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7555035,SUP,HCPCS C1713,,7555035  -  BOLT SPNL 5MM 35MM TI,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7555040,SUP,HCPCS C1713,,7555040  -  BOLT SPNL 5.5MM 40MM TI,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7555050,SUP,HCPCS C1713,,7555050  -  BOLT SPNL 5.5MM 50MM TI,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7555055,SUP,HCPCS C1713,,7555055  -  BOLT SPNL 5.5MM 55MM XLP,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7555060,SUP,HCPCS C1713,,7555060  -  BOLT SPNL 5.5MM 60MM,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7555065,SUP,HCPCS C1713,,7555065  -  BOLT SPNL 5.5MM 65MM TI,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7560020,SUP,HCPCS C1713,,7560020  -  SET SCREW 7560020 BREAK OFF SS,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
7560120,SUP,HCPCS C1713,,7560120  -  SET SCREW 7560120 NON BREAK OFF SS,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
7560220,SUP,HCPCS C1713,,7560220  -  SET SCREW 7560220 LEGACY 5.5 RED PLUG SS,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
7561102,SUP,HCPCS C1713,,7561102  -  HOOK 7561102 PEDICLE SM SS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7561103,SUP,HCPCS C1713,,7561103  -  HOOK 7561103 PEDICLE MD SS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7561104,SUP,HCPCS C1713,,7561104  -  HOOK 7561104 PEDICLE LG SS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7561112,SUP,HCPCS C1713,,7561112  -  HOOK 7561112 WIDE BLADE SM SS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7561113,SUP,HCPCS C1713,,7561113  -  HOOK 7561113 WIDE BLADE MD SS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7561114,SUP,HCPCS C1713,,7561114  -  HOOK 7561114 WIDE BLADE LG SS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7561122,SUP,HCPCS C1713,,7561122  -  HOOK 7561122 NARROW BLADE SM SS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7561123,SUP,HCPCS C1713,,7561123  -  HOOK 7561123 NARROW BLADE MD SS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7561124,SUP,HCPCS C1713,,7561124  -  HOOK 7561124 NARROW BLADE LG SS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7561133,SUP,HCPCS C1713,,7561133  -  HOOK SPNL MED CD HZN LGC RAMP W BLDE SS THOR 5.5MM ROD,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7561142,SUP,HCPCS C1713,,7561142  -  HOOK 7561142 RAMP NARROW BLADE SM SS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7561143,SUP,HCPCS C1713,,7561143  -  HOOK 7561143 RAMP NARROW BLADE MD SS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7561153,SUP,HCPCS C1713,,7561153  -  HOOK 7561153 SUPRA LAM LUMBAR MD SS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7561162,SUP,HCPCS C1713,,7561162  -  HOOK 7561162 LUMBAR ANG BLADE SM SS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7561163,SUP,HCPCS C1713,,7561163  -  HOOK 7561163 LUMBAR ANG BLADE MD SS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7561172,SUP,HCPCS C1713,,7561172  -  HOOK 7561172 EXTENDED BODY SM SS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7561173,SUP,HCPCS C1713,,7561173  -  HOOK 7561173 EXTENDED BODY MD SS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7561174,SUP,HCPCS C1713,,7561174  -  HOOK 7561174 EXTENDED BODY LG SS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7561188,SUP,HCPCS C1713,,7561188  -  HOOK 7561188 THORACIC ANG BLADE RT SS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7561189,SUP,HCPCS C1713,,7561189  -  HOOK 7561189 THORACIC ANG BLADE LT SS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7561198,SUP,HCPCS C1713,,7561198  -  HOOK 7561198 OFFSET RT SS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7561199,SUP,HCPCS C1713,,7561199  -  HOOK 7561199 OFFSET LT SS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7561203,SUP,HCPCS C1713,,7561203  -  HOOK 7561203 PEDICLE WITH LIP MD SS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7561213,SUP,HCPCS C1713,,7561213  -  HOOK 7561213 WIDE BLADE W LIP MD SS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7561223,SUP,HCPCS C1713,,7561223  -  HOOK 7561223 NARROW BLADE W LIP MD SS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7562420,SUP,HCPCS C1713,,"7562420  -  SCREW, FIXED ANGLE, 4.0X20, SS","$2,036.15",$0.00,"$2,036.15",$916.27,"$1,453.20",$0.00,$350.82,$0.00,$0.00,$356.51,"$2,036.15",$0.00,"$1,018.08","$1,612.63","$1,628.92",$0.00,$318.66,$0.00,$324.16,$0.00
7562425,SUP,HCPCS C1713,,"7562425  -  SCREW, FIXED ANGLE, 4.0X25, SS","$2,036.15",$0.00,"$2,036.15",$916.27,"$1,453.20",$0.00,$350.82,$0.00,$0.00,$356.51,"$2,036.15",$0.00,"$1,018.08","$1,612.63","$1,628.92",$0.00,$318.66,$0.00,$324.16,$0.00
7562430,SUP,HCPCS C1713,,"7562430  -  SCREW, FIXED ANGLE, 4.0X30, SS","$2,036.15",$0.00,"$2,036.15",$916.27,"$1,453.20",$0.00,$350.82,$0.00,$0.00,$356.51,"$2,036.15",$0.00,"$1,018.08","$1,612.63","$1,628.92",$0.00,$318.66,$0.00,$324.16,$0.00
7562435,SUP,HCPCS C1713,,"7562435  -  SCREW, FIXED ANGLE, 4.0X35, SS","$2,036.15",$0.00,"$2,036.15",$916.27,"$1,453.20",$0.00,$350.82,$0.00,$0.00,$356.51,"$2,036.15",$0.00,"$1,018.08","$1,612.63","$1,628.92",$0.00,$318.66,$0.00,$324.16,$0.00
7562440,SUP,HCPCS C1713,,"7562440  -  SCREW, FIXED ANGLE, 4.0X40, SS","$2,036.15",$0.00,"$2,036.15",$916.27,"$1,453.20",$0.00,$350.82,$0.00,$0.00,$356.51,"$2,036.15",$0.00,"$1,018.08","$1,612.63","$1,628.92",$0.00,$318.66,$0.00,$324.16,$0.00
7562445,SUP,HCPCS C1713,,"7562445  -  SCREW, FIXED ANGLE, 4.0X45, SS","$2,036.15",$0.00,"$2,036.15",$916.27,"$1,453.20",$0.00,$350.82,$0.00,$0.00,$356.51,"$2,036.15",$0.00,"$1,018.08","$1,612.63","$1,628.92",$0.00,$318.66,$0.00,$324.16,$0.00
7562450,SUP,HCPCS C1713,,"7562450  -  SCREW, FIXED ANGLE, 4.0X50, SS","$2,036.15",$0.00,"$2,036.15",$916.27,"$1,453.20",$0.00,$350.82,$0.00,$0.00,$356.51,"$2,036.15",$0.00,"$1,018.08","$1,612.63","$1,628.92",$0.00,$318.66,$0.00,$324.16,$0.00
7562455,SUP,HCPCS C1713,,"7562455  -  SCREW, FIXED ANGLE, 4.0X55, SS","$2,036.15",$0.00,"$2,036.15",$916.27,"$1,453.20",$0.00,$350.82,$0.00,$0.00,$356.51,"$2,036.15",$0.00,"$1,018.08","$1,612.63","$1,628.92",$0.00,$318.66,$0.00,$324.16,$0.00
7562520,SUP,HCPCS C1713,,7562520  -  SCREW 7562520 FIXED ANGLE 5.0X20 SS,"$2,036.15",$0.00,"$2,036.15",$916.27,"$1,453.20",$0.00,$350.82,$0.00,$0.00,$356.51,"$2,036.15",$0.00,"$1,018.08","$1,612.63","$1,628.92",$0.00,$318.66,$0.00,$324.16,$0.00
7562525,SUP,HCPCS C1713,,7562525  -  SCREW 7562525 FIXED ANGLE 5.0X25 SS,"$2,036.15",$0.00,"$2,036.15",$916.27,"$1,453.20",$0.00,$350.82,$0.00,$0.00,$356.51,"$2,036.15",$0.00,"$1,018.08","$1,612.63","$1,628.92",$0.00,$318.66,$0.00,$324.16,$0.00
7562530,SUP,HCPCS C1713,,7562530  -  BONE SCREW 7562530 FIXED ANGLE 5X30 SS,"$2,036.15",$0.00,"$2,036.15",$916.27,"$1,453.20",$0.00,$350.82,$0.00,$0.00,$356.51,"$2,036.15",$0.00,"$1,018.08","$1,612.63","$1,628.92",$0.00,$318.66,$0.00,$324.16,$0.00
7562535,SUP,HCPCS C1713,,7562535  -  SCREW 7562535 FIXED ANGLE 5.0X35 SS,"$2,036.15",$0.00,"$2,036.15",$916.27,"$1,453.20",$0.00,$350.82,$0.00,$0.00,$356.51,"$2,036.15",$0.00,"$1,018.08","$1,612.63","$1,628.92",$0.00,$318.66,$0.00,$324.16,$0.00
7562540,SUP,HCPCS C1713,,7562540  -  SCREW 7562540 FIXED ANGLE 5.0X40 SS,"$2,036.15",$0.00,"$2,036.15",$916.27,"$1,453.20",$0.00,$350.82,$0.00,$0.00,$356.51,"$2,036.15",$0.00,"$1,018.08","$1,612.63","$1,628.92",$0.00,$318.66,$0.00,$324.16,$0.00
7562545,SUP,HCPCS C1713,,7562545  -  SCREW 7562545 FIXED ANGLE 5.0X45 SS,"$2,036.15",$0.00,"$2,036.15",$916.27,"$1,453.20",$0.00,$350.82,$0.00,$0.00,$356.51,"$2,036.15",$0.00,"$1,018.08","$1,612.63","$1,628.92",$0.00,$318.66,$0.00,$324.16,$0.00
7562550,SUP,HCPCS C1713,,7562550  -  SCREW 7562550 FIXED ANGLE 5.0X50 SS,"$2,036.15",$0.00,"$2,036.15",$916.27,"$1,453.20",$0.00,$350.82,$0.00,$0.00,$356.51,"$2,036.15",$0.00,"$1,018.08","$1,612.63","$1,628.92",$0.00,$318.66,$0.00,$324.16,$0.00
7562555,SUP,HCPCS C1713,,7562555  -  SCREW 7562555 FIXED ANGLE 5.0X55 SS,"$2,036.15",$0.00,"$2,036.15",$916.27,"$1,453.20",$0.00,$350.82,$0.00,$0.00,$356.51,"$2,036.15",$0.00,"$1,018.08","$1,612.63","$1,628.92",$0.00,$318.66,$0.00,$324.16,$0.00
7562625,SUP,HCPCS C1713,,7562625  -  SCREW 7562625 FIXED ANGLE 6.0X25 SS,"$2,036.15",$0.00,"$2,036.15",$916.27,"$1,453.20",$0.00,$350.82,$0.00,$0.00,$356.51,"$2,036.15",$0.00,"$1,018.08","$1,612.63","$1,628.92",$0.00,$318.66,$0.00,$324.16,$0.00
7562630,SUP,HCPCS C1713,,7562630  -  SCREW 7562630 FIXED ANGLE 6.0X30 SS,"$2,036.15",$0.00,"$2,036.15",$916.27,"$1,453.20",$0.00,$350.82,$0.00,$0.00,$356.51,"$2,036.15",$0.00,"$1,018.08","$1,612.63","$1,628.92",$0.00,$318.66,$0.00,$324.16,$0.00
7562635,SUP,HCPCS C1713,,7562635  -  SCREW 7562635 FIXED ANGLE 6.0X35 SS,"$2,036.15",$0.00,"$2,036.15",$916.27,"$1,453.20",$0.00,$350.82,$0.00,$0.00,$356.51,"$2,036.15",$0.00,"$1,018.08","$1,612.63","$1,628.92",$0.00,$318.66,$0.00,$324.16,$0.00
7562640,SUP,HCPCS C1713,,7562640  -  SCREW 7562640 FIXED ANGLE 6.0X40 SS,"$2,036.15",$0.00,"$2,036.15",$916.27,"$1,453.20",$0.00,$350.82,$0.00,$0.00,$356.51,"$2,036.15",$0.00,"$1,018.08","$1,612.63","$1,628.92",$0.00,$318.66,$0.00,$324.16,$0.00
7562645,SUP,HCPCS C1713,,7562645  -  SCREW 7562645 FIXED ANGLE 6.0X45 SS,"$2,036.15",$0.00,"$2,036.15",$916.27,"$1,453.20",$0.00,$350.82,$0.00,$0.00,$356.51,"$2,036.15",$0.00,"$1,018.08","$1,612.63","$1,628.92",$0.00,$318.66,$0.00,$324.16,$0.00
7562650,SUP,HCPCS C1713,,7562650  -  SCREW 7562650 FIXED ANGLE 6.0X50 SS,"$2,036.15",$0.00,"$2,036.15",$916.27,"$1,453.20",$0.00,$350.82,$0.00,$0.00,$356.51,"$2,036.15",$0.00,"$1,018.08","$1,612.63","$1,628.92",$0.00,$318.66,$0.00,$324.16,$0.00
7562655,SUP,HCPCS C1713,,7562655  -  SCREW 7562655 FIXED ANGLE 6.0X55 SS,"$2,036.15",$0.00,"$2,036.15",$916.27,"$1,453.20",$0.00,$350.82,$0.00,$0.00,$356.51,"$2,036.15",$0.00,"$1,018.08","$1,612.63","$1,628.92",$0.00,$318.66,$0.00,$324.16,$0.00
7562660,SUP,HCPCS C1713,,7562660  -  SCREW 7562660 FIXED ANGLE 6.0X60 SS,"$2,036.15",$0.00,"$2,036.15",$916.27,"$1,453.20",$0.00,$350.82,$0.00,$0.00,$356.51,"$2,036.15",$0.00,"$1,018.08","$1,612.63","$1,628.92",$0.00,$318.66,$0.00,$324.16,$0.00
7563420,SUP,HCPCS C1713,,7563420  -  SCREW 7563420 FIXED ANGLE 4.5X20 SS,"$2,036.15",$0.00,"$2,036.15",$916.27,"$1,453.20",$0.00,$350.82,$0.00,$0.00,$356.51,"$2,036.15",$0.00,"$1,018.08","$1,612.63","$1,628.92",$0.00,$318.66,$0.00,$324.16,$0.00
7563425,SUP,HCPCS C1713,,7563425  -  SCREW 7563425 FIXED ANGLE 4.5X25 SS,"$2,036.15",$0.00,"$2,036.15",$916.27,"$1,453.20",$0.00,$350.82,$0.00,$0.00,$356.51,"$2,036.15",$0.00,"$1,018.08","$1,612.63","$1,628.92",$0.00,$318.66,$0.00,$324.16,$0.00
7563430,SUP,HCPCS C1713,,7563430  -  SCREW 7563430 FIXED ANGLE 4.5X30 SS,"$2,036.15",$0.00,"$2,036.15",$916.27,"$1,453.20",$0.00,$350.82,$0.00,$0.00,$356.51,"$2,036.15",$0.00,"$1,018.08","$1,612.63","$1,628.92",$0.00,$318.66,$0.00,$324.16,$0.00
7563435,SUP,HCPCS C1713,,7563435  -  SCREW 7563435 FIXED ANGLE 4.5X35 SS,"$2,036.15",$0.00,"$2,036.15",$916.27,"$1,453.20",$0.00,$350.82,$0.00,$0.00,$356.51,"$2,036.15",$0.00,"$1,018.08","$1,612.63","$1,628.92",$0.00,$318.66,$0.00,$324.16,$0.00
7563440,SUP,HCPCS C1713,,7563440  -  SCREW 7563440 FIXED ANGLE 4.5X40 SS,"$2,036.15",$0.00,"$2,036.15",$916.27,"$1,453.20",$0.00,$350.82,$0.00,$0.00,$356.51,"$2,036.15",$0.00,"$1,018.08","$1,612.63","$1,628.92",$0.00,$318.66,$0.00,$324.16,$0.00
7563445,SUP,HCPCS C1713,,7563445  -  SCREW 7563445 FIXED ANGLE 4.5X45 SS,"$2,036.15",$0.00,"$2,036.15",$916.27,"$1,453.20",$0.00,$350.82,$0.00,$0.00,$356.51,"$2,036.15",$0.00,"$1,018.08","$1,612.63","$1,628.92",$0.00,$318.66,$0.00,$324.16,$0.00
7563450,SUP,HCPCS C1713,,7563450  -  SCREW 7563450 FIXED ANGLE 4.5X50 SS,"$2,036.15",$0.00,"$2,036.15",$916.27,"$1,453.20",$0.00,$350.82,$0.00,$0.00,$356.51,"$2,036.15",$0.00,"$1,018.08","$1,612.63","$1,628.92",$0.00,$318.66,$0.00,$324.16,$0.00
7563455,SUP,HCPCS C1713,,7563455  -  SCREW 7563455 FIXED ANGLE 4.5X55 SS,"$2,036.15",$0.00,"$2,036.15",$916.27,"$1,453.20",$0.00,$350.82,$0.00,$0.00,$356.51,"$2,036.15",$0.00,"$1,018.08","$1,612.63","$1,628.92",$0.00,$318.66,$0.00,$324.16,$0.00
7563525,SUP,HCPCS C1713,,7563525  -  SCREW 7563525 FIXED ANGLE 5.5X25 SS,"$2,036.15",$0.00,"$2,036.15",$916.27,"$1,453.20",$0.00,$350.82,$0.00,$0.00,$356.51,"$2,036.15",$0.00,"$1,018.08","$1,612.63","$1,628.92",$0.00,$318.66,$0.00,$324.16,$0.00
7563530,SUP,HCPCS C1713,,7563530  -  SCREW 7563530 FIXED ANGLE 5.5X30 SS,"$2,036.15",$0.00,"$2,036.15",$916.27,"$1,453.20",$0.00,$350.82,$0.00,$0.00,$356.51,"$2,036.15",$0.00,"$1,018.08","$1,612.63","$1,628.92",$0.00,$318.66,$0.00,$324.16,$0.00
7563535,SUP,HCPCS C1713,,7563535  -  SCREW 7563535 FIXED ANGLE 5.5X35 SS,"$2,036.15",$0.00,"$2,036.15",$916.27,"$1,453.20",$0.00,$350.82,$0.00,$0.00,$356.51,"$2,036.15",$0.00,"$1,018.08","$1,612.63","$1,628.92",$0.00,$318.66,$0.00,$324.16,$0.00
7563540,SUP,HCPCS C1713,,7563540  -  SCREW 7563540 FIXED ANGLE 5.5X40 SS,"$2,036.15",$0.00,"$2,036.15",$916.27,"$1,453.20",$0.00,$350.82,$0.00,$0.00,$356.51,"$2,036.15",$0.00,"$1,018.08","$1,612.63","$1,628.92",$0.00,$318.66,$0.00,$324.16,$0.00
7563545,SUP,HCPCS C1713,,7563545  -  SCREW 7563545 FIXED ANGLE 5.5X45 SS,"$2,036.15",$0.00,"$2,036.15",$916.27,"$1,453.20",$0.00,$350.82,$0.00,$0.00,$356.51,"$2,036.15",$0.00,"$1,018.08","$1,612.63","$1,628.92",$0.00,$318.66,$0.00,$324.16,$0.00
7563550,SUP,HCPCS C1713,,7563550  -  SCREW 7563550 FIXED ANGLE 5.5X50 SS,"$2,036.15",$0.00,"$2,036.15",$916.27,"$1,453.20",$0.00,$350.82,$0.00,$0.00,$356.51,"$2,036.15",$0.00,"$1,018.08","$1,612.63","$1,628.92",$0.00,$318.66,$0.00,$324.16,$0.00
7563555,SUP,HCPCS C1713,,7563555  -  SCREW 7563555 FIXED ANGLE 5.5X55 SS,"$2,036.15",$0.00,"$2,036.15",$916.27,"$1,453.20",$0.00,$350.82,$0.00,$0.00,$356.51,"$2,036.15",$0.00,"$1,018.08","$1,612.63","$1,628.92",$0.00,$318.66,$0.00,$324.16,$0.00
7563560,SUP,HCPCS C1713,,7563560  -  SCREW 7563560 FIXED ANGLE 5.5X60 SS,"$2,036.15",$0.00,"$2,036.15",$916.27,"$1,453.20",$0.00,$350.82,$0.00,$0.00,$356.51,"$2,036.15",$0.00,"$1,018.08","$1,612.63","$1,628.92",$0.00,$318.66,$0.00,$324.16,$0.00
7563625,SUP,HCPCS C1713,,7563625  -  SCREW 7563625 FIXED ANGLE 6.5X25 SS,"$2,036.15",$0.00,"$2,036.15",$916.27,"$1,453.20",$0.00,$350.82,$0.00,$0.00,$356.51,"$2,036.15",$0.00,"$1,018.08","$1,612.63","$1,628.92",$0.00,$318.66,$0.00,$324.16,$0.00
7563630,SUP,HCPCS C1713,,7563630  -  SCREW 7563630 FIXED ANGLE 6.5X30 SS,"$2,036.15",$0.00,"$2,036.15",$916.27,"$1,453.20",$0.00,$350.82,$0.00,$0.00,$356.51,"$2,036.15",$0.00,"$1,018.08","$1,612.63","$1,628.92",$0.00,$318.66,$0.00,$324.16,$0.00
7563635,SUP,HCPCS C1713,,7563635  -  SCREW 7563635 FIXED ANGLE 6.5X35 SS,"$2,036.15",$0.00,"$2,036.15",$916.27,"$1,453.20",$0.00,$350.82,$0.00,$0.00,$356.51,"$2,036.15",$0.00,"$1,018.08","$1,612.63","$1,628.92",$0.00,$318.66,$0.00,$324.16,$0.00
7563640,SUP,HCPCS C1713,,7563640  -  SCREW 7563640 FIXED ANGLE 6.5X40 SS,"$2,036.15",$0.00,"$2,036.15",$916.27,"$1,453.20",$0.00,$350.82,$0.00,$0.00,$356.51,"$2,036.15",$0.00,"$1,018.08","$1,612.63","$1,628.92",$0.00,$318.66,$0.00,$324.16,$0.00
7563645,SUP,HCPCS C1713,,7563645  -  SCREW 7563645 FIXED ANGLE 6.5X45 SS,"$2,036.15",$0.00,"$2,036.15",$916.27,"$1,453.20",$0.00,$350.82,$0.00,$0.00,$356.51,"$2,036.15",$0.00,"$1,018.08","$1,612.63","$1,628.92",$0.00,$318.66,$0.00,$324.16,$0.00
7563650,SUP,HCPCS C1713,,7563650  -  SCREW 7563650 FIXED ANGLE 6.5X50 SS,"$2,036.15",$0.00,"$2,036.15",$916.27,"$1,453.20",$0.00,$350.82,$0.00,$0.00,$356.51,"$2,036.15",$0.00,"$1,018.08","$1,612.63","$1,628.92",$0.00,$318.66,$0.00,$324.16,$0.00
7563655,SUP,HCPCS C1713,,7563655  -  SCREW 7563655 FIXED ANGLE 6.5X55 SS,"$2,036.15",$0.00,"$2,036.15",$916.27,"$1,453.20",$0.00,$350.82,$0.00,$0.00,$356.51,"$2,036.15",$0.00,"$1,018.08","$1,612.63","$1,628.92",$0.00,$318.66,$0.00,$324.16,$0.00
7563660,SUP,HCPCS C1713,,7563660  -  SCREW 7563660 FIXED ANGLE 6.5X60 SS,"$2,036.15",$0.00,"$2,036.15",$916.27,"$1,453.20",$0.00,$350.82,$0.00,$0.00,$356.51,"$2,036.15",$0.00,"$1,018.08","$1,612.63","$1,628.92",$0.00,$318.66,$0.00,$324.16,$0.00
7563725,SUP,HCPCS C1713,,7563725  -  SCREW 7563725 FIXED ANGLE 7.5X25 SS,"$2,036.15",$0.00,"$2,036.15",$916.27,"$1,453.20",$0.00,$350.82,$0.00,$0.00,$356.51,"$2,036.15",$0.00,"$1,018.08","$1,612.63","$1,628.92",$0.00,$318.66,$0.00,$324.16,$0.00
7563730,SUP,HCPCS C1713,,7563730  -  SCREW 7563730 FIXED ANGLE 7.5X30 SS,"$2,036.15",$0.00,"$2,036.15",$916.27,"$1,453.20",$0.00,$350.82,$0.00,$0.00,$356.51,"$2,036.15",$0.00,"$1,018.08","$1,612.63","$1,628.92",$0.00,$318.66,$0.00,$324.16,$0.00
7563735,SUP,HCPCS C1713,,7563735  -  SCREW 7563735 FIXED ANGLE 7.5X35 SS,"$2,036.15",$0.00,"$2,036.15",$916.27,"$1,453.20",$0.00,$350.82,$0.00,$0.00,$356.51,"$2,036.15",$0.00,"$1,018.08","$1,612.63","$1,628.92",$0.00,$318.66,$0.00,$324.16,$0.00
7563740,SUP,HCPCS C1713,,7563740  -  SCREW 7563740 FIXED ANGLE 7.5X40 SS,"$2,036.15",$0.00,"$2,036.15",$916.27,"$1,453.20",$0.00,$350.82,$0.00,$0.00,$356.51,"$2,036.15",$0.00,"$1,018.08","$1,612.63","$1,628.92",$0.00,$318.66,$0.00,$324.16,$0.00
7563745,SUP,HCPCS C1713,,7563745  -  SCREW 7563745 FIXED ANGLE 7.5X45 SS,"$2,036.15",$0.00,"$2,036.15",$916.27,"$1,453.20",$0.00,$350.82,$0.00,$0.00,$356.51,"$2,036.15",$0.00,"$1,018.08","$1,612.63","$1,628.92",$0.00,$318.66,$0.00,$324.16,$0.00
7563750,SUP,HCPCS C1713,,7563750  -  SCREW 7563750 FIXED ANGLE 7.5X50 SS,"$2,036.15",$0.00,"$2,036.15",$916.27,"$1,453.20",$0.00,$350.82,$0.00,$0.00,$356.51,"$2,036.15",$0.00,"$1,018.08","$1,612.63","$1,628.92",$0.00,$318.66,$0.00,$324.16,$0.00
7563755,SUP,HCPCS C1713,,7563755  -  SCREW 7563755 FIXED ANGLE 7.5X55 SS,"$2,036.15",$0.00,"$2,036.15",$916.27,"$1,453.20",$0.00,$350.82,$0.00,$0.00,$356.51,"$2,036.15",$0.00,"$1,018.08","$1,612.63","$1,628.92",$0.00,$318.66,$0.00,$324.16,$0.00
7563760,SUP,HCPCS C1713,,7563760  -  SCREW 7563760 FIXED ANGLE 7.5X60 SS,"$2,036.15",$0.00,"$2,036.15",$916.27,"$1,453.20",$0.00,$350.82,$0.00,$0.00,$356.51,"$2,036.15",$0.00,"$1,018.08","$1,612.63","$1,628.92",$0.00,$318.66,$0.00,$324.16,$0.00
7563765,SUP,HCPCS C1713,,7563765  -  SCREW 7563765 FIXED ANGLE 7.5X65 SS,"$2,036.15",$0.00,"$2,036.15",$916.27,"$1,453.20",$0.00,$350.82,$0.00,$0.00,$356.51,"$2,036.15",$0.00,"$1,018.08","$1,612.63","$1,628.92",$0.00,$318.66,$0.00,$324.16,$0.00
7565025,SUP,HCPCS C1713,,7565025  -  BOLT SPNL 6.5MM 25MM PLT,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7565030,SUP,HCPCS C1713,,7565030  -  BOLT SPNL 6.5MM 30MM,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7565035,SUP,HCPCS C1713,,7565035  -  BOLT SPNL 6.5MM 35MM,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7565040,SUP,HCPCS C1713,,7565040  -  BOLT SPNL 6.5MM 40MM XLP,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7565045,SUP,HCPCS C1713,,7565045  -  BOLT SPNL 6.5MM 45MM TI,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7565050,SUP,HCPCS C1713,,7565050  -  BOLT SPNL 6.5MM 50MM TI,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7565055,SUP,HCPCS C1713,,7565055  -  BOLT SPNL 6.5MM 55MM TI,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7565060,SUP,HCPCS C1713,,7565060  -  BOLT SPNL 6.5MM 60MM,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7565065,SUP,HCPCS C1713,,7565065  -  BOLT SPNL 6.5MM 65MM,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7570955,SUP,HCPCS C1713,,7570955  -  SCREW SET CD HZN SXTNT II BRKOF SS SPNE PDCL ROD INS,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
7571030,SUP,HCPCS C1713,,7571030  -  ROD 7571030 5.5MM STRAIGHT 30MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7571035,SUP,HCPCS C1713,,7571035  -  PLATE BN 35MM AFFIX II SPNE SPINOUS PRC,"$8,730.00",$0.00,"$8,730.00","$3,928.50","$5,158.80",$0.00,"$1,504.14",$0.00,$0.00,"$1,528.55","$8,730.00",$0.00,"$4,365.00","$6,914.16","$6,984.00",$0.00,"$1,366.25",$0.00,"$1,389.82",$0.00
7571040,SUP,HCPCS C1713,,7571040  -  ROD 7571040 5.5MM STRAIGHT 40MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7571045,SUP,HCPCS C1713,,7571045  -  PLATE BN 45MM XLIF AFFIX XTRM SPNE,"$8,730.00",$0.00,"$8,730.00","$3,928.50","$5,158.80",$0.00,"$1,504.14",$0.00,$0.00,"$1,528.55","$8,730.00",$0.00,"$4,365.00","$6,914.16","$6,984.00",$0.00,"$1,366.25",$0.00,"$1,389.82",$0.00
7571050,SUP,HCPCS C1713,,7571050  -  ROD 7571050 5.5MM STRAIGHT 50MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7571055,SUP,HCPCS C1713,,7571055  -  PLATE BN 55MM AFFIX II SPNE SPINOUS PRC,"$8,730.00",$0.00,"$8,730.00","$3,928.50","$5,158.80",$0.00,"$1,504.14",$0.00,$0.00,"$1,528.55","$8,730.00",$0.00,"$4,365.00","$6,914.16","$6,984.00",$0.00,"$1,366.25",$0.00,"$1,389.82",$0.00
7571060,SUP,HCPCS C1713,,7571060  -  ROD 7571060 5.5MM STRAIGHT 60MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7571070,SUP,HCPCS C1713,,7571070  -  ROD 7571070 5.5MM STRAIGHT 70MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7571080,SUP,HCPCS C1713,,7571080  -  ROD 7571080 5.5MM STRAIGHT 80MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7571090,SUP,HCPCS C1713,,7571090  -  ROD 7571090 5.5MM STRAIGHT 90MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7571100,SUP,HCPCS C1713,,7571100  -  ROD 7571100 5.5MM STRAIGHT 100MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7571110,SUP,HCPCS C1713,,7571110  -  ROD 7571110 5.5MM STRAIGHT 110MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7571120,SUP,HCPCS C1713,,7571120  -  ROD 7571120 5.5MM STRAIGHT 120MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7571130,SUP,HCPCS C1713,,7571130  -  ROD 7571130 5.5MM STRAIGHT 130MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7571140,SUP,HCPCS C1713,,7571140  -  ROD 7571140 5.5MM STRAIGHT 140MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7571150,SUP,HCPCS C1713,,7571150  -  ROD 7571150 5.5MM STRAIGHT 150MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7571160,SUP,HCPCS C1713,,7571160  -  ROD 7571160 5.5MM STRAIGHT 160MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7571170,SUP,HCPCS C1713,,7571170  -  ROD 7571170 5.5MM STRAIGHT 170MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7571180,SUP,HCPCS C1713,,7571180  -  ROD 7571180 5.5MM STRAIGHT 180MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7571190,SUP,HCPCS C1713,,7571190  -  ROD 7571190 5.5MM STRAIGHT 190MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7571200,SUP,HCPCS C1713,,7571200  -  ROD 7571200 5.5MM STRAIGHT 200MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7571210,SUP,HCPCS C1713,,7571210  -  ROD 7571210 5.5MM STRAIGHT 210MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7571220,SUP,HCPCS C1713,,7571220  -  ROD 7571220 5.5MM STRAIGHT 220MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7571230,SUP,HCPCS C1713,,7571230  -  ROD 7571230 5.5MM STRAIGHT 230MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7571240,SUP,HCPCS C1713,,7571240  -  ROD 7571240 5.5MM STRAIGHT 240MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7571250,SUP,HCPCS C1713,,7571250  -  ROD 7571250 5.5MM STRAIGHT 250MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7571260,SUP,HCPCS C1713,,7571260  -  ROD 7571260 5.5MM STRAIGHT 260MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7571270,SUP,HCPCS C1713,,7571270  -  ROD 7571270 5.5MM STRAIGHT 270MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7571280,SUP,HCPCS C1713,,7571280  -  ROD 7571280 5.5MM STRAIGHT 280MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7571290,SUP,HCPCS C1713,,7571290  -  ROD 7571290 5.5MM STRAIGHT 290MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7571300,SUP,HCPCS C1713,,7571300  -  ROD 7571300 5.5MM STRAIGHT 300MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7571310,SUP,HCPCS C1713,,7571310  -  ROD 7571310 5.5MM STRAIGHT 310MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7571320,SUP,HCPCS C1713,,7571320  -  ROD 7571320 5.5MM STRAIGHT 320MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7571330,SUP,HCPCS C1713,,7571330  -  ROD 7571330 5.5MM STRAIGHT 330MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7571340,SUP,HCPCS C1713,,7571340  -  ROD 7571340 5.5MM STRAIGHT 340MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7571350,SUP,HCPCS C1713,,7571350  -  ROD 7571350 5.5MM STRAIGHT 350MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7571360,SUP,HCPCS C1713,,7571360  -  ROD 7571360 5.5MM STRAIGHT 360MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7571370,SUP,HCPCS C1713,,7571370  -  ROD 7571370 5.5MM STRAIGHT 370MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7571380,SUP,HCPCS C1713,,7571380  -  ROD 7571380 5.5MM STRAIGHT 380MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7571390,SUP,HCPCS C1713,,7571390  -  ROD 7571390 5.5MM STRAIGHT 390MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7571400,SUP,HCPCS C1713,,7571400  -  ROD 7571400 5.5MM STRAIGHT 400MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7571410,SUP,HCPCS C1713,,7571410  -  ROD 7571410 5.5MM STRAIGHT 410MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7571420,SUP,HCPCS C1713,,7571420  -  ROD 7571420 5.5MM STRAIGHT 420MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7571430,SUP,HCPCS C1713,,7571430  -  ROD 7571430 5.5MM STRAIGHT 430MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7571440,SUP,HCPCS C1713,,7571440  -  ROD 7571440 5.5MM STRAIGHT 440MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7571450,SUP,HCPCS C1713,,7571450  -  ROD 7571450 5.5MM STRAIGHT 450MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7571460,SUP,HCPCS C1713,,7571460  -  ROD 7571460 5.5MM STRAIGHT 460MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7571470,SUP,HCPCS C1713,,7571470  -  ROD 7571470 5.5MM STRAIGHT 470MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7571480,SUP,HCPCS C1713,,7571480  -  ROD 7571480 5.5MM STRAIGHT 480MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7571490,SUP,HCPCS C1713,,7571490  -  ROD 7571490 5.5MM STRAIGHT 490MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7571500,SUP,HCPCS C1713,,7571500  -  ROD 7571500 5.5MM STRAIGHT 500MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7575535,SUP,HCPCS C1713,,7575535  -  SCREW BN 5.5MM 35MM LGC CD HZN MA CNN TI SPNE PDCL 5.5MM ROD,"$6,185.00",$0.00,"$6,185.00","$2,783.25","$4,414.23",$0.00,"$1,065.64",$0.00,$0.00,"$1,082.94","$6,185.00",$0.00,"$3,092.50","$4,898.52","$4,948.00",$0.00,$967.95,$0.00,$984.65,$0.00
7575540,SUP,HCPCS C1713,,7575540  -  SCREW BN 5.5MM 40MM CD HZN LGC MA CNN TI SPNE PDCL 5.5MM ROD,"$6,185.00",$0.00,"$6,185.00","$2,783.25","$4,414.23",$0.00,"$1,065.64",$0.00,$0.00,"$1,082.94","$6,185.00",$0.00,"$3,092.50","$4,898.52","$4,948.00",$0.00,$967.95,$0.00,$984.65,$0.00
7575545,SUP,HCPCS C1713,,7575545  -  SCREW BN 5.5MM 45MM LGC CD HZN MA CNN TI SPNE PDCL 5.5MM ROD,"$6,185.00",$0.00,"$6,185.00","$2,783.25","$4,414.23",$0.00,"$1,065.64",$0.00,$0.00,"$1,082.94","$6,185.00",$0.00,"$3,092.50","$4,898.52","$4,948.00",$0.00,$967.95,$0.00,$984.65,$0.00
7575550,SUP,HCPCS C1713,,7575550  -  SCREW BN 5.5MM 50MM LGC CD HZN MA CNN TI SPNE PDCL 5.5MM ROD,"$6,185.00",$0.00,"$6,185.00","$2,783.25","$4,414.23",$0.00,"$1,065.64",$0.00,$0.00,"$1,082.94","$6,185.00",$0.00,"$3,092.50","$4,898.52","$4,948.00",$0.00,$967.95,$0.00,$984.65,$0.00
7576309,SUP,Custom 27203010,,7576309  -  INSTRUMENT 7576309 TALL REDUX NUT DR,$726.00,$0.00,$726.00,$0.00,$518.15,$0.00,$0.00,$0.00,$0.00,$0.00,$726.00,$0.00,$363.00,$574.99,$580.80,$0.00,$0.00,$0.00,$0.00,$0.00
7576535,SUP,HCPCS C1713,,7576535  -  SCREW BN 6.5MM 35MM LGC CD HZN MA CNN TI SPNE PDCL 5.5MM ROD,"$6,185.00",$0.00,"$6,185.00","$2,783.25","$4,414.23",$0.00,"$1,065.64",$0.00,$0.00,"$1,082.94","$6,185.00",$0.00,"$3,092.50","$4,898.52","$4,948.00",$0.00,$967.95,$0.00,$984.65,$0.00
7576540,SUP,HCPCS C1713,,7576540  -  SCREW BN 6.5MM 40MM LGC CD HZN MA CNN TI SPNE PDCL 5.5MM ROD,"$6,185.00",$0.00,"$6,185.00","$2,783.25","$4,414.23",$0.00,"$1,065.64",$0.00,$0.00,"$1,082.94","$6,185.00",$0.00,"$3,092.50","$4,898.52","$4,948.00",$0.00,$967.95,$0.00,$984.65,$0.00
7576545,SUP,HCPCS C1713,,7576545  -  SCREW BN 6.5MM 45MM LGC CD HZN MA CNN TI SPNE PDCL 5.5MM ROD,"$6,185.00",$0.00,"$6,185.00","$2,783.25","$4,414.23",$0.00,"$1,065.64",$0.00,$0.00,"$1,082.94","$6,185.00",$0.00,"$3,092.50","$4,898.52","$4,948.00",$0.00,$967.95,$0.00,$984.65,$0.00
7576550,SUP,HCPCS C1713,,7576550  -  SCREW BN 6.5MM 50MM LGC CD HZN MA CNN TI SPNE PDCL 5.5MM ROD,"$6,185.00",$0.00,"$6,185.00","$2,783.25","$4,414.23",$0.00,"$1,065.64",$0.00,$0.00,"$1,082.94","$6,185.00",$0.00,"$3,092.50","$4,898.52","$4,948.00",$0.00,$967.95,$0.00,$984.65,$0.00
7576555,SUP,HCPCS C1713,,7576555  -  SCREW BN 6.5MM 55MM LGC CD HZN MA CNN TI SPNE PDCL 5.5MM ROD,"$6,185.00",$0.00,"$6,185.00","$2,783.25","$4,414.23",$0.00,"$1,065.64",$0.00,$0.00,"$1,082.94","$6,185.00",$0.00,"$3,092.50","$4,898.52","$4,948.00",$0.00,$967.95,$0.00,$984.65,$0.00
7577025,SUP,HCPCS C1713,,7577025  -  PLATE BN MN 25MM NS AFFIX II SPNE LMBR,"$9,162.50",$0.00,"$9,162.50","$4,123.13","$5,158.80",$0.00,"$1,578.65",$0.00,$0.00,"$1,604.28","$9,162.50",$0.00,"$4,581.25","$7,256.70","$7,330.00",$0.00,"$1,433.93",$0.00,"$1,458.67",$0.00
7577035,SUP,HCPCS C1713,,7577035  -  PLATE BN 35MM NS AFFIX II SPNE LMBR,"$9,162.50",$0.00,"$9,162.50","$4,123.13","$5,158.80",$0.00,"$1,578.65",$0.00,$0.00,"$1,604.28","$9,162.50",$0.00,"$4,581.25","$7,256.70","$7,330.00",$0.00,"$1,433.93",$0.00,"$1,458.67",$0.00
7577045,SUP,HCPCS C1713,,7577045  -  PLATE BN 45MM NS AFFIX II SPNE LMBR,"$9,162.50",$0.00,"$9,162.50","$4,123.13","$5,158.80",$0.00,"$1,578.65",$0.00,$0.00,"$1,604.28","$9,162.50",$0.00,"$4,581.25","$7,256.70","$7,330.00",$0.00,"$1,433.93",$0.00,"$1,458.67",$0.00
7577055,SUP,HCPCS C1713,,7577055  -  PLATE BN 55MM NS AFFIX II SPNE LMBR,"$9,162.50",$0.00,"$9,162.50","$4,123.13","$5,158.80",$0.00,"$1,578.65",$0.00,$0.00,"$1,604.28","$9,162.50",$0.00,"$4,581.25","$7,256.70","$7,330.00",$0.00,"$1,433.93",$0.00,"$1,458.67",$0.00
7577530,SUP,HCPCS C1713,,7577530  -  SCREW BN 7.5MM 30MM LGC CD HZN MA CNN TI SPNE PDCL 5.5MM ROD,"$6,185.00",$0.00,"$6,185.00","$2,783.25","$4,414.23",$0.00,"$1,065.64",$0.00,$0.00,"$1,082.94","$6,185.00",$0.00,"$3,092.50","$4,898.52","$4,948.00",$0.00,$967.95,$0.00,$984.65,$0.00
7577535,SUP,HCPCS C1713,,7577535  -  SCREW BN 7.5MM 35MM LGC CD HZN MA CNN TI SPNE PDCL 5.5MM ROD,"$6,185.00",$0.00,"$6,185.00","$2,783.25","$4,414.23",$0.00,"$1,065.64",$0.00,$0.00,"$1,082.94","$6,185.00",$0.00,"$3,092.50","$4,898.52","$4,948.00",$0.00,$967.95,$0.00,$984.65,$0.00
7577540,SUP,HCPCS C1713,,7577540  -  SCREW BN 7.5MM 40MM LGC CD HZN MA CNN TI SPNE PDCL 5.5MM ROD,"$6,185.00",$0.00,"$6,185.00","$2,783.25","$4,414.23",$0.00,"$1,065.64",$0.00,$0.00,"$1,082.94","$6,185.00",$0.00,"$3,092.50","$4,898.52","$4,948.00",$0.00,$967.95,$0.00,$984.65,$0.00
7577545,SUP,HCPCS C1713,,7577545  -  SCREW BN 7.5MM 45MM LGC CD HZN MA CNN TI SPNE PDCL 5.5MM ROD,"$6,185.00",$0.00,"$6,185.00","$2,783.25","$4,414.23",$0.00,"$1,065.64",$0.00,$0.00,"$1,082.94","$6,185.00",$0.00,"$3,092.50","$4,898.52","$4,948.00",$0.00,$967.95,$0.00,$984.65,$0.00
7600320,SUP,HCPCS C1713,,7600320  -  SUB BNGFT CALCIUM PHOS CLGN 20ML MS GRFT VOID FILR MTRX,"$3,575.00",$0.00,"$3,575.00","$1,608.75","$2,551.48",$0.00,$615.95,$0.00,$0.00,$625.95,"$3,575.00",$0.00,"$1,787.50","$2,831.40","$2,860.00",$0.00,$559.49,$0.00,$569.14,$0.00
7640120,SUP,HCPCS C1713,,7640120  -  SET SCREW 7640120 NON BREAK OFF  TI,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
7640220,SUP,HCPCS C1713,,7640220  -  SET SCREW 7640220 REDUCTION PLUG  TI,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
7641102,SUP,HCPCS C1713,,7641102  -  HOOK 7641102 L6.35 PEDICLE SM TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7641103,SUP,HCPCS C1713,,7641103  -  HOOK 7641103 L6.35 PEDICLE MD TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7641104,SUP,HCPCS C1713,,7641104  -  HOOK 7641104 L6.35 PEDICLE LG TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7641112,SUP,HCPCS C1713,,7641112  -  HOOK 7641112 L6.35 WIDE BLADE SM TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7641113,SUP,HCPCS C1713,,7641113  -  HOOK 7641113 L6.35 WIDE BLADE MD TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7641114,SUP,HCPCS C1713,,7641114  -  HOOK 7641114 L6.35 WIDE BLADE LG TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7641122,SUP,HCPCS C1713,,7641122  -  HOOK 7641122 L6.35 NARRW BLDE SM TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7641123,SUP,HCPCS C1713,,7641123  -  HOOK 7641123 L6.35 NARRW BLDE MD TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7641124,SUP,HCPCS C1713,,7641124  -  HOOK 7641124 L6.35 NARRW BLDE LG TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7641133,SUP,HCPCS C1713,,7641133  -  HOOK 7641133 RAMP WIDE BLADE TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7641142,SUP,HCPCS C1713,,7641142  -  HOOK 7641142 RAMP NARROW BLADE SM TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7641143,SUP,HCPCS C1713,,7641143  -  HOOK 7641143 RAMP NARROW BLADE MED TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7641162,SUP,HCPCS C1713,,7641162  -  HOOK 7641162 LUMBAR ANG BLADE SM TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7641163,SUP,HCPCS C1713,,7641163  -  HOOK 7641163 LUMBAR ANG BLADE MED TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7641173,SUP,HCPCS C1713,,7641173  -  HOOK 7641173 EXTENDED BODY MED TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7641174,SUP,HCPCS C1713,,7641174  -  HOOK 7641174 EXTENDED BODY LARGE TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7641188,SUP,HCPCS C1713,,7641188  -  HOOK 7641188 THORACIC ANG BLADE RT TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7641189,SUP,HCPCS C1713,,7641189  -  HOOK 7641189 THORACIC ANG BLADE LT TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7641198,SUP,HCPCS C1713,,7641198  -  HOOK 7641198 OFFSET RIGHT TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7641199,SUP,HCPCS C1713,,7641199  -  HOOK 7641199 OFFSET LEFT TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7641202,SUP,HCPCS C1713,,7641202  -  HOOK 7641202 PEDICLE WITH LIP SM TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7641203,SUP,HCPCS C1713,,7641203  -  HOOK 7641203 PEDICLE WITH LIP MED TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7641204,SUP,HCPCS C1713,,7641204  -  HOOK 7641204 PEDICLE WITH LIP LG TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7641212,SUP,HCPCS C1713,,7641212  -  HOOK 7641212 WIDE BLADE W SHELF SM T,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7641213,SUP,HCPCS C1713,,7641213  -  HOOK 7641213 WIDE BLADE W SHELF MD TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7641214,SUP,HCPCS C1713,,7641214  -  HOOK 7641214 WIDE BLADE W SHELF LG TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7641222,SUP,HCPCS C1713,,7641222  -  HOOK 7641222 NARROW BLADE W SHELF SM TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7641223,SUP,HCPCS C1713,,7641223  -  HOOK 7641223 NARROW BLADE W SHELF MD TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7641224,SUP,HCPCS C1713,,7641224  -  HOOK 7641224 NARROW BLADE W SHELF LG T,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7642420,SUP,HCPCS C1713,,"7642420  -  SCREW, FIXED ANGLE, 4.0X20, TI","$1,933.50",$0.00,"$1,933.50",$870.08,"$1,379.94",$0.00,$333.13,$0.00,$0.00,$338.54,"$1,933.50",$0.00,$966.75,"$1,531.33","$1,546.80",$0.00,$302.59,$0.00,$307.81,$0.00
7642425,SUP,HCPCS C1713,,"7642425  -  SCREW, FIXED ANGLE, 4.0X25, TI","$1,933.50",$0.00,"$1,933.50",$870.08,"$1,379.94",$0.00,$333.13,$0.00,$0.00,$338.54,"$1,933.50",$0.00,$966.75,"$1,531.33","$1,546.80",$0.00,$302.59,$0.00,$307.81,$0.00
7642430,SUP,HCPCS C1713,,"7642430  -  SCREW, FIXED ANGLE, 4.0X30, TI","$1,933.50",$0.00,"$1,933.50",$870.08,"$1,379.94",$0.00,$333.13,$0.00,$0.00,$338.54,"$1,933.50",$0.00,$966.75,"$1,531.33","$1,546.80",$0.00,$302.59,$0.00,$307.81,$0.00
7642435,SUP,HCPCS C1713,,"7642435  -  SCREW, FIXED ANGLE, 4.0X35, TI","$1,933.50",$0.00,"$1,933.50",$870.08,"$1,379.94",$0.00,$333.13,$0.00,$0.00,$338.54,"$1,933.50",$0.00,$966.75,"$1,531.33","$1,546.80",$0.00,$302.59,$0.00,$307.81,$0.00
7642440,SUP,HCPCS C1713,,"7642440  -  SCREW, FIXED ANGLE, 4.0X40, TI","$1,933.50",$0.00,"$1,933.50",$870.08,"$1,379.94",$0.00,$333.13,$0.00,$0.00,$338.54,"$1,933.50",$0.00,$966.75,"$1,531.33","$1,546.80",$0.00,$302.59,$0.00,$307.81,$0.00
7642445,SUP,HCPCS C1713,,"7642445  -  SCREW, FIXED ANGLE, 4.0X45, TI","$1,933.50",$0.00,"$1,933.50",$870.08,"$1,379.94",$0.00,$333.13,$0.00,$0.00,$338.54,"$1,933.50",$0.00,$966.75,"$1,531.33","$1,546.80",$0.00,$302.59,$0.00,$307.81,$0.00
7642450,SUP,HCPCS C1713,,"7642450  -  SCREW, FIXED ANGLE, 4.0X50, TI","$1,933.50",$0.00,"$1,933.50",$870.08,"$1,379.94",$0.00,$333.13,$0.00,$0.00,$338.54,"$1,933.50",$0.00,$966.75,"$1,531.33","$1,546.80",$0.00,$302.59,$0.00,$307.81,$0.00
7642455,SUP,HCPCS C1713,,"7642455  -  SCREW, FIXED ANGLE, 4.0X55, TI","$1,933.50",$0.00,"$1,933.50",$870.08,"$1,379.94",$0.00,$333.13,$0.00,$0.00,$338.54,"$1,933.50",$0.00,$966.75,"$1,531.33","$1,546.80",$0.00,$302.59,$0.00,$307.81,$0.00
7642520,SUP,HCPCS C1713,,"7642520  -  SCREW, FIXED ANGLE, 5.0X20, TI","$1,933.50",$0.00,"$1,933.50",$870.08,"$1,379.94",$0.00,$333.13,$0.00,$0.00,$338.54,"$1,933.50",$0.00,$966.75,"$1,531.33","$1,546.80",$0.00,$302.59,$0.00,$307.81,$0.00
7642525,SUP,HCPCS C1713,,"7642525  -  SCREW, FIXED ANGLE, 5.0X25, TI","$1,933.50",$0.00,"$1,933.50",$870.08,"$1,379.94",$0.00,$333.13,$0.00,$0.00,$338.54,"$1,933.50",$0.00,$966.75,"$1,531.33","$1,546.80",$0.00,$302.59,$0.00,$307.81,$0.00
7642530,SUP,HCPCS C1713,,"7642530  -  SCREW, FIXED ANGLE, 5.0X30, TI","$1,933.50",$0.00,"$1,933.50",$870.08,"$1,379.94",$0.00,$333.13,$0.00,$0.00,$338.54,"$1,933.50",$0.00,$966.75,"$1,531.33","$1,546.80",$0.00,$302.59,$0.00,$307.81,$0.00
7642535,SUP,HCPCS C1713,,"7642535  -  SCREW, FIXED ANGLE, 5.0X35, TI","$1,933.50",$0.00,"$1,933.50",$870.08,"$1,379.94",$0.00,$333.13,$0.00,$0.00,$338.54,"$1,933.50",$0.00,$966.75,"$1,531.33","$1,546.80",$0.00,$302.59,$0.00,$307.81,$0.00
7642540,SUP,HCPCS C1713,,"7642540  -  SCREW, FIXED ANGLE, 5.0X40, TI","$1,933.50",$0.00,"$1,933.50",$870.08,"$1,379.94",$0.00,$333.13,$0.00,$0.00,$338.54,"$1,933.50",$0.00,$966.75,"$1,531.33","$1,546.80",$0.00,$302.59,$0.00,$307.81,$0.00
7642545,SUP,HCPCS C1713,,"7642545  -  SCREW, FIXED ANGLE, 5.0X45, TI","$1,933.50",$0.00,"$1,933.50",$870.08,"$1,379.94",$0.00,$333.13,$0.00,$0.00,$338.54,"$1,933.50",$0.00,$966.75,"$1,531.33","$1,546.80",$0.00,$302.59,$0.00,$307.81,$0.00
7642550,SUP,HCPCS C1713,,"7642550  -  SCREW, FIXED ANGLE, 5.0X50, TI","$1,933.50",$0.00,"$1,933.50",$870.08,"$1,379.94",$0.00,$333.13,$0.00,$0.00,$338.54,"$1,933.50",$0.00,$966.75,"$1,531.33","$1,546.80",$0.00,$302.59,$0.00,$307.81,$0.00
7642555,SUP,HCPCS C1713,,7642555  -  FIXED ANGLE 5.0X55 TI,"$1,933.50",$0.00,"$1,933.50",$870.08,"$1,379.94",$0.00,$333.13,$0.00,$0.00,$338.54,"$1,933.50",$0.00,$966.75,"$1,531.33","$1,546.80",$0.00,$302.59,$0.00,$307.81,$0.00
7642625,SUP,HCPCS C1713,,"7642625  -  SCREW, FIXED ANGLE, 6.0X25, TI","$1,933.50",$0.00,"$1,933.50",$870.08,"$1,379.94",$0.00,$333.13,$0.00,$0.00,$338.54,"$1,933.50",$0.00,$966.75,"$1,531.33","$1,546.80",$0.00,$302.59,$0.00,$307.81,$0.00
7642630,SUP,HCPCS C1713,,"7642630  -  SCREW, FIXED ANGLE, 6.0X30, TI","$1,933.50",$0.00,"$1,933.50",$870.08,"$1,379.94",$0.00,$333.13,$0.00,$0.00,$338.54,"$1,933.50",$0.00,$966.75,"$1,531.33","$1,546.80",$0.00,$302.59,$0.00,$307.81,$0.00
7642635,SUP,HCPCS C1713,,"7642635  -  SCREW, FIXED ANGLE, 6.0X35, TI","$1,933.50",$0.00,"$1,933.50",$870.08,"$1,379.94",$0.00,$333.13,$0.00,$0.00,$338.54,"$1,933.50",$0.00,$966.75,"$1,531.33","$1,546.80",$0.00,$302.59,$0.00,$307.81,$0.00
7642640,SUP,HCPCS C1713,,"7642640  -  SCREW, FIXED ANGLE, 6.0X40, TI","$1,933.50",$0.00,"$1,933.50",$870.08,"$1,379.94",$0.00,$333.13,$0.00,$0.00,$338.54,"$1,933.50",$0.00,$966.75,"$1,531.33","$1,546.80",$0.00,$302.59,$0.00,$307.81,$0.00
7642645,SUP,HCPCS C1713,,"7642645  -  SCREW, FIXED ANGLE, 6.0X45, TI","$1,933.50",$0.00,"$1,933.50",$870.08,"$1,379.94",$0.00,$333.13,$0.00,$0.00,$338.54,"$1,933.50",$0.00,$966.75,"$1,531.33","$1,546.80",$0.00,$302.59,$0.00,$307.81,$0.00
7642650,SUP,HCPCS C1713,,"7642650  -  SCREW, FIXED ANGLE, 6.0X50, TI","$1,933.50",$0.00,"$1,933.50",$870.08,"$1,379.94",$0.00,$333.13,$0.00,$0.00,$338.54,"$1,933.50",$0.00,$966.75,"$1,531.33","$1,546.80",$0.00,$302.59,$0.00,$307.81,$0.00
7642655,SUP,HCPCS C1713,,"7642655  -  SCREW, FIXED ANGLE, 6.0X55, TI","$1,933.50",$0.00,"$1,933.50",$870.08,"$1,379.94",$0.00,$333.13,$0.00,$0.00,$338.54,"$1,933.50",$0.00,$966.75,"$1,531.33","$1,546.80",$0.00,$302.59,$0.00,$307.81,$0.00
7642660,SUP,HCPCS C1713,,"7642660  -  SCREW, FIXED ANGLE, 6.0X60, TI","$1,933.50",$0.00,"$1,933.50",$870.08,"$1,379.94",$0.00,$333.13,$0.00,$0.00,$338.54,"$1,933.50",$0.00,$966.75,"$1,531.33","$1,546.80",$0.00,$302.59,$0.00,$307.81,$0.00
7643420,SUP,HCPCS C1713,,7643420  -  BONE SCREW 7643420 FXD ANGLE 4.5X20 TI,"$1,933.50",$0.00,"$1,933.50",$870.08,"$1,379.94",$0.00,$333.13,$0.00,$0.00,$338.54,"$1,933.50",$0.00,$966.75,"$1,531.33","$1,546.80",$0.00,$302.59,$0.00,$307.81,$0.00
7643425,SUP,HCPCS C1713,,7643425  -  BONE SCREW 7643425 FXD ANGLE 4.5X25 TI,"$1,933.50",$0.00,"$1,933.50",$870.08,"$1,379.94",$0.00,$333.13,$0.00,$0.00,$338.54,"$1,933.50",$0.00,$966.75,"$1,531.33","$1,546.80",$0.00,$302.59,$0.00,$307.81,$0.00
7643430,SUP,HCPCS C1713,,7643430  -  BONE SCREW 7643430 FXD ANGLE 4.5X30 TI,"$1,933.50",$0.00,"$1,933.50",$870.08,"$1,379.94",$0.00,$333.13,$0.00,$0.00,$338.54,"$1,933.50",$0.00,$966.75,"$1,531.33","$1,546.80",$0.00,$302.59,$0.00,$307.81,$0.00
7643435,SUP,HCPCS C1713,,7643435  -  BONE SCREW 7643435 FXD ANGLE 4.5X35 TI,"$1,933.50",$0.00,"$1,933.50",$870.08,"$1,379.94",$0.00,$333.13,$0.00,$0.00,$338.54,"$1,933.50",$0.00,$966.75,"$1,531.33","$1,546.80",$0.00,$302.59,$0.00,$307.81,$0.00
7643440,SUP,HCPCS C1713,,7643440  -  BONE SCREW 7643440 FXD ANGLE 4.5X40 TI,"$1,933.50",$0.00,"$1,933.50",$870.08,"$1,379.94",$0.00,$333.13,$0.00,$0.00,$338.54,"$1,933.50",$0.00,$966.75,"$1,531.33","$1,546.80",$0.00,$302.59,$0.00,$307.81,$0.00
7643445,SUP,HCPCS C1713,,7643445  -  BONE SCREW 7643445 FXD ANGLE 4.5X45 TI,"$1,933.50",$0.00,"$1,933.50",$870.08,"$1,379.94",$0.00,$333.13,$0.00,$0.00,$338.54,"$1,933.50",$0.00,$966.75,"$1,531.33","$1,546.80",$0.00,$302.59,$0.00,$307.81,$0.00
7643450,SUP,HCPCS C1713,,7643450  -  BONE SCREW 7643450 FXD ANGLE 4.5X50 TI,"$1,933.50",$0.00,"$1,933.50",$870.08,"$1,379.94",$0.00,$333.13,$0.00,$0.00,$338.54,"$1,933.50",$0.00,$966.75,"$1,531.33","$1,546.80",$0.00,$302.59,$0.00,$307.81,$0.00
7643455,SUP,HCPCS C1713,,7643455  -  BONE SCREW 7643455 FXD ANGLE 4.5X55 TI,"$1,933.50",$0.00,"$1,933.50",$870.08,"$1,379.94",$0.00,$333.13,$0.00,$0.00,$338.54,"$1,933.50",$0.00,$966.75,"$1,531.33","$1,546.80",$0.00,$302.59,$0.00,$307.81,$0.00
7643525,SUP,HCPCS C1713,,7643525  -  BONE SCREW 7643525 FXD ANGLE 5.5X25 TI,"$1,933.50",$0.00,"$1,933.50",$870.08,"$1,379.94",$0.00,$333.13,$0.00,$0.00,$338.54,"$1,933.50",$0.00,$966.75,"$1,531.33","$1,546.80",$0.00,$302.59,$0.00,$307.81,$0.00
7643530,SUP,HCPCS C1713,,7643530  -  BONE SCREW 7643530 FXD ANGLE 5.5X30 TI,"$1,933.50",$0.00,"$1,933.50",$870.08,"$1,379.94",$0.00,$333.13,$0.00,$0.00,$338.54,"$1,933.50",$0.00,$966.75,"$1,531.33","$1,546.80",$0.00,$302.59,$0.00,$307.81,$0.00
7643535,SUP,HCPCS C1713,,7643535  -  BONE SCREW 7643535 FXD ANGLE 5.5X35 TI,"$1,933.50",$0.00,"$1,933.50",$870.08,"$1,379.94",$0.00,$333.13,$0.00,$0.00,$338.54,"$1,933.50",$0.00,$966.75,"$1,531.33","$1,546.80",$0.00,$302.59,$0.00,$307.81,$0.00
7643540,SUP,HCPCS C1713,,7643540  -  BONE SCREW 7643540 FXD ANGLE 5.5X40 TI,"$1,933.50",$0.00,"$1,933.50",$870.08,"$1,379.94",$0.00,$333.13,$0.00,$0.00,$338.54,"$1,933.50",$0.00,$966.75,"$1,531.33","$1,546.80",$0.00,$302.59,$0.00,$307.81,$0.00
7643545,SUP,HCPCS C1713,,7643545  -  BONE SCREW 7643545 FXD ANGLE 5.5X45 TI,"$1,933.50",$0.00,"$1,933.50",$870.08,"$1,379.94",$0.00,$333.13,$0.00,$0.00,$338.54,"$1,933.50",$0.00,$966.75,"$1,531.33","$1,546.80",$0.00,$302.59,$0.00,$307.81,$0.00
7643550,SUP,HCPCS C1713,,7643550  -  BONE SCREW 7643550 FXD ANGLE 5.5X50 TI,"$1,933.50",$0.00,"$1,933.50",$870.08,"$1,379.94",$0.00,$333.13,$0.00,$0.00,$338.54,"$1,933.50",$0.00,$966.75,"$1,531.33","$1,546.80",$0.00,$302.59,$0.00,$307.81,$0.00
7643555,SUP,HCPCS C1713,,7643555  -  BONE SCREW 7643555 FXD ANGLE 5.5X55 TI,"$1,933.50",$0.00,"$1,933.50",$870.08,"$1,379.94",$0.00,$333.13,$0.00,$0.00,$338.54,"$1,933.50",$0.00,$966.75,"$1,531.33","$1,546.80",$0.00,$302.59,$0.00,$307.81,$0.00
7643560,SUP,HCPCS C1713,,7643560  -  BONE SCREW 7643560 FXD ANGLE 5.5X60 TI,"$1,933.50",$0.00,"$1,933.50",$870.08,"$1,379.94",$0.00,$333.13,$0.00,$0.00,$338.54,"$1,933.50",$0.00,$966.75,"$1,531.33","$1,546.80",$0.00,$302.59,$0.00,$307.81,$0.00
7643625,SUP,HCPCS C1713,,7643625  -  SCREW 7643625 FIXED ANGLE 6.5X25 TI,"$1,933.50",$0.00,"$1,933.50",$870.08,"$1,379.94",$0.00,$333.13,$0.00,$0.00,$338.54,"$1,933.50",$0.00,$966.75,"$1,531.33","$1,546.80",$0.00,$302.59,$0.00,$307.81,$0.00
7643630,SUP,HCPCS C1713,,7643630  -  SCREW 7643630 FIXED ANGLE 6.5X30 TI,"$1,933.50",$0.00,"$1,933.50",$870.08,"$1,379.94",$0.00,$333.13,$0.00,$0.00,$338.54,"$1,933.50",$0.00,$966.75,"$1,531.33","$1,546.80",$0.00,$302.59,$0.00,$307.81,$0.00
7643635,SUP,HCPCS C1713,,7643635  -  BONE SCREW 7643635 FXD ANGLE 6.5X35 TI,"$1,933.50",$0.00,"$1,933.50",$870.08,"$1,379.94",$0.00,$333.13,$0.00,$0.00,$338.54,"$1,933.50",$0.00,$966.75,"$1,531.33","$1,546.80",$0.00,$302.59,$0.00,$307.81,$0.00
7643640,SUP,HCPCS C1713,,7643640  -  BONE SCREW 7643640 FXD ANGLE 6.5X40 TI,"$1,933.50",$0.00,"$1,933.50",$870.08,"$1,379.94",$0.00,$333.13,$0.00,$0.00,$338.54,"$1,933.50",$0.00,$966.75,"$1,531.33","$1,546.80",$0.00,$302.59,$0.00,$307.81,$0.00
7643645,SUP,HCPCS C1713,,7643645  -  BONE SCREW 7643645 FXD ANGLE 6.5X45 TI,"$1,933.50",$0.00,"$1,933.50",$870.08,"$1,379.94",$0.00,$333.13,$0.00,$0.00,$338.54,"$1,933.50",$0.00,$966.75,"$1,531.33","$1,546.80",$0.00,$302.59,$0.00,$307.81,$0.00
7643650,SUP,HCPCS C1713,,7643650  -  BONE SCREW 7643650 FXD ANGLE 6.5X50 TI,"$1,933.50",$0.00,"$1,933.50",$870.08,"$1,379.94",$0.00,$333.13,$0.00,$0.00,$338.54,"$1,933.50",$0.00,$966.75,"$1,531.33","$1,546.80",$0.00,$302.59,$0.00,$307.81,$0.00
7643655,SUP,HCPCS C1713,,7643655  -  BONE SCREW 7643655 FXD ANGLE 6.5X55 TI,"$1,933.50",$0.00,"$1,933.50",$870.08,"$1,379.94",$0.00,$333.13,$0.00,$0.00,$338.54,"$1,933.50",$0.00,$966.75,"$1,531.33","$1,546.80",$0.00,$302.59,$0.00,$307.81,$0.00
7643660,SUP,HCPCS C1713,,7643660  -  BONE SCREW 7643660 FXD ANGLE 6.5X60 TI,"$1,933.50",$0.00,"$1,933.50",$870.08,"$1,379.94",$0.00,$333.13,$0.00,$0.00,$338.54,"$1,933.50",$0.00,$966.75,"$1,531.33","$1,546.80",$0.00,$302.59,$0.00,$307.81,$0.00
7643665,SUP,HCPCS C1713,,7643665  -  BONE SCREW 7643665 FXD ANGLE 6.5X65 TI,"$1,933.50",$0.00,"$1,933.50",$870.08,"$1,379.94",$0.00,$333.13,$0.00,$0.00,$338.54,"$1,933.50",$0.00,$966.75,"$1,531.33","$1,546.80",$0.00,$302.59,$0.00,$307.81,$0.00
7643670,SUP,HCPCS C1713,,7643670  -  BONE SCREW 7643670 FXD ANGLE 6.5X70 TI,"$1,933.50",$0.00,"$1,933.50",$870.08,"$1,379.94",$0.00,$333.13,$0.00,$0.00,$338.54,"$1,933.50",$0.00,$966.75,"$1,531.33","$1,546.80",$0.00,$302.59,$0.00,$307.81,$0.00
7643725,SUP,HCPCS C1713,,7643725  -  BONE SCREW 7643725 FXD ANGLE 7.5X25 TI,"$1,933.50",$0.00,"$1,933.50",$870.08,"$1,379.94",$0.00,$333.13,$0.00,$0.00,$338.54,"$1,933.50",$0.00,$966.75,"$1,531.33","$1,546.80",$0.00,$302.59,$0.00,$307.81,$0.00
7643730,SUP,HCPCS C1713,,7643730  -  BONE SCREW 7643730 FXD ANGLE 7.5X30 TI,"$1,933.50",$0.00,"$1,933.50",$870.08,"$1,379.94",$0.00,$333.13,$0.00,$0.00,$338.54,"$1,933.50",$0.00,$966.75,"$1,531.33","$1,546.80",$0.00,$302.59,$0.00,$307.81,$0.00
7643735,SUP,HCPCS C1713,,7643735  -  BONE SCREW 7643735 FXD ANGLE 7.5X35 TI,"$1,933.50",$0.00,"$1,933.50",$870.08,"$1,379.94",$0.00,$333.13,$0.00,$0.00,$338.54,"$1,933.50",$0.00,$966.75,"$1,531.33","$1,546.80",$0.00,$302.59,$0.00,$307.81,$0.00
7643740,SUP,HCPCS C1713,,7643740  -  BONE SCREW 7643740 FXD ANGLE 7.5X40 TI,"$1,933.50",$0.00,"$1,933.50",$870.08,"$1,379.94",$0.00,$333.13,$0.00,$0.00,$338.54,"$1,933.50",$0.00,$966.75,"$1,531.33","$1,546.80",$0.00,$302.59,$0.00,$307.81,$0.00
7643745,SUP,HCPCS C1713,,7643745  -  BONE SCREW 7643745 FXD ANGLE 7.5X45 TI,"$1,933.50",$0.00,"$1,933.50",$870.08,"$1,379.94",$0.00,$333.13,$0.00,$0.00,$338.54,"$1,933.50",$0.00,$966.75,"$1,531.33","$1,546.80",$0.00,$302.59,$0.00,$307.81,$0.00
7643750,SUP,HCPCS C1713,,7643750  -  BONE SCREW 7643750 FXD ANGLE 7.5X50 TI,"$1,933.50",$0.00,"$1,933.50",$870.08,"$1,379.94",$0.00,$333.13,$0.00,$0.00,$338.54,"$1,933.50",$0.00,$966.75,"$1,531.33","$1,546.80",$0.00,$302.59,$0.00,$307.81,$0.00
7643755,SUP,HCPCS C1713,,7643755  -  BONE SCREW 7643755 FXD ANGLE 7.5X55 TI,"$1,933.50",$0.00,"$1,933.50",$870.08,"$1,379.94",$0.00,$333.13,$0.00,$0.00,$338.54,"$1,933.50",$0.00,$966.75,"$1,531.33","$1,546.80",$0.00,$302.59,$0.00,$307.81,$0.00
7643760,SUP,HCPCS C1713,,7643760  -  BONE SCREW 7643760 FXD ANGLE 7.5X60 TI,"$1,933.50",$0.00,"$1,933.50",$870.08,"$1,379.94",$0.00,$333.13,$0.00,$0.00,$338.54,"$1,933.50",$0.00,$966.75,"$1,531.33","$1,546.80",$0.00,$302.59,$0.00,$307.81,$0.00
7643765,SUP,HCPCS C1713,,7643765  -  BONE SCREW 7643765 FXD ANGLE 7.5X65 TI,"$1,933.50",$0.00,"$1,933.50",$870.08,"$1,379.94",$0.00,$333.13,$0.00,$0.00,$338.54,"$1,933.50",$0.00,$966.75,"$1,531.33","$1,546.80",$0.00,$302.59,$0.00,$307.81,$0.00
7650008,SUP,HCPCS C1713,,7650008  -  PLATE BONE SMALL 8MM TRADITIONAL SPN CERV,"$2,212.50",$0.00,"$2,212.50",$995.63,"$1,579.06",$0.00,$381.20,$0.00,$0.00,$387.39,"$2,212.50",$0.00,"$1,106.25","$1,752.30","$1,770.00",$0.00,$346.26,$0.00,$352.23,$0.00
7650009,SUP,HCPCS C1713,,7650009  -  PLATE BONE MEDIUM 9.5MM TRADITIONAL SPN CERV,"$2,212.50",$0.00,"$2,212.50",$995.63,"$1,579.06",$0.00,$381.20,$0.00,$0.00,$387.39,"$2,212.50",$0.00,"$1,106.25","$1,752.30","$1,770.00",$0.00,$346.26,$0.00,$352.23,$0.00
7650011,SUP,HCPCS C1713,,7650011  -  PLATE BONE LARGE 11MM TRADITIONAL SPN CERV,"$2,212.50",$0.00,"$2,212.50",$995.63,"$1,579.06",$0.00,$381.20,$0.00,$0.00,$387.39,"$2,212.50",$0.00,"$1,106.25","$1,752.30","$1,770.00",$0.00,$346.26,$0.00,$352.23,$0.00
7650012,SUP,HCPCS C1713,,7650012  -  PLATE BN XL 12.5MM NS LVRG TRD SPNE CRV,"$2,212.50",$0.00,"$2,212.50",$995.63,"$1,579.06",$0.00,$381.20,$0.00,$0.00,$387.39,"$2,212.50",$0.00,"$1,106.25","$1,752.30","$1,770.00",$0.00,$346.26,$0.00,$352.23,$0.00
7650108,SUP,HCPCS C1713,,7650108  -  PLATE BN SM 8MM NS LVRG TRD SPNE CRV,"$2,212.50",$0.00,"$2,212.50",$995.63,"$1,579.06",$0.00,$381.20,$0.00,$0.00,$387.39,"$2,212.50",$0.00,"$1,106.25","$1,752.30","$1,770.00",$0.00,$346.26,$0.00,$352.23,$0.00
7650109,SUP,HCPCS C1713,,7650109  -  PLATE MED 9.5MM TRD BONE SPN CERV,"$2,212.50",$0.00,"$2,212.50",$995.63,"$1,579.06",$0.00,$381.20,$0.00,$0.00,$387.39,"$2,212.50",$0.00,"$1,106.25","$1,752.30","$1,770.00",$0.00,$346.26,$0.00,$352.23,$0.00
7650111,SUP,HCPCS C1713,,7650111  -  PLATE BN LG 11MM NS LVRG TRD SPNE CRV,"$2,212.50",$0.00,"$2,212.50",$995.63,"$1,579.06",$0.00,$381.20,$0.00,$0.00,$387.39,"$2,212.50",$0.00,"$1,106.25","$1,752.30","$1,770.00",$0.00,$346.26,$0.00,$352.23,$0.00
7650112,SUP,HCPCS C1713,,7650112  -  PLATE BN XL 12.5MM NS LVRG TRD SPNE CRV,"$2,212.50",$0.00,"$2,212.50",$995.63,"$1,579.06",$0.00,$381.20,$0.00,$0.00,$387.39,"$2,212.50",$0.00,"$1,106.25","$1,752.30","$1,770.00",$0.00,$346.26,$0.00,$352.23,$0.00
7650208,SUP,HCPCS C1713,,7650208  -  PLATE BONE SMALL 8MM GRAFT SPN CERV,"$2,212.50",$0.00,"$2,212.50",$995.63,"$1,579.06",$0.00,$381.20,$0.00,$0.00,$387.39,"$2,212.50",$0.00,"$1,106.25","$1,752.30","$1,770.00",$0.00,$346.26,$0.00,$352.23,$0.00
7650209,SUP,HCPCS C1713,,7650209  -  PLATE BONE MEDIUM 9.5MM GRAFT SPN CERV,"$2,212.50",$0.00,"$2,212.50",$995.63,"$1,579.06",$0.00,$381.20,$0.00,$0.00,$387.39,"$2,212.50",$0.00,"$1,106.25","$1,752.30","$1,770.00",$0.00,$346.26,$0.00,$352.23,$0.00
7650211,SUP,HCPCS C1713,,7650211  -  PLATE BN LG 11MM NS LVRG GFT SPNE CRV,"$2,212.50",$0.00,"$2,212.50",$995.63,"$1,579.06",$0.00,$381.20,$0.00,$0.00,$387.39,"$2,212.50",$0.00,"$1,106.25","$1,752.30","$1,770.00",$0.00,$346.26,$0.00,$352.23,$0.00
7650212,SUP,HCPCS C1713,,7650212  -  PLATE BN XL 12.5MM GFT SPNE CRV,"$2,212.50",$0.00,"$2,212.50",$995.63,"$1,579.06",$0.00,$381.20,$0.00,$0.00,$387.39,"$2,212.50",$0.00,"$1,106.25","$1,752.30","$1,770.00",$0.00,$346.26,$0.00,$352.23,$0.00
7650308,SUP,HCPCS C1713,,7650308  -  PLATE BN SM 8MM NS LVRG GFT SPNE CRV,"$2,212.50",$0.00,"$2,212.50",$995.63,"$1,579.06",$0.00,$381.20,$0.00,$0.00,$387.39,"$2,212.50",$0.00,"$1,106.25","$1,752.30","$1,770.00",$0.00,$346.26,$0.00,$352.23,$0.00
7650309,SUP,HCPCS C1713,,7650309  -  PLATE BN MED 9.5MM NS LVRG GFT SPNE CRV,"$2,212.50",$0.00,"$2,212.50",$995.63,"$1,579.06",$0.00,$381.20,$0.00,$0.00,$387.39,"$2,212.50",$0.00,"$1,106.25","$1,752.30","$1,770.00",$0.00,$346.26,$0.00,$352.23,$0.00
7650311,SUP,HCPCS C1713,,7650311  -  PLATE BN LG 11MM NS LVRG GFT SPNE CRV,"$2,212.50",$0.00,"$2,212.50",$995.63,"$1,579.06",$0.00,$381.20,$0.00,$0.00,$387.39,"$2,212.50",$0.00,"$1,106.25","$1,752.30","$1,770.00",$0.00,$346.26,$0.00,$352.23,$0.00
7650312,SUP,HCPCS C1713,,7650312  -  PLATE BN XL 12.5MM NS LVRG GFT SPNE CRV,"$2,212.50",$0.00,"$2,212.50",$995.63,"$1,579.06",$0.00,$381.20,$0.00,$0.00,$387.39,"$2,212.50",$0.00,"$1,106.25","$1,752.30","$1,770.00",$0.00,$346.26,$0.00,$352.23,$0.00
7650408,SUP,HCPCS C1713,,7650408  -  PLATE BN SM 8MM NS LVRG SPNE CRV LMN,"$2,212.50",$0.00,"$2,212.50",$995.63,"$1,579.06",$0.00,$381.20,$0.00,$0.00,$387.39,"$2,212.50",$0.00,"$1,106.25","$1,752.30","$1,770.00",$0.00,$346.26,$0.00,$352.23,$0.00
7650409,SUP,HCPCS C1713,,7650409  -  PLATE BN MED 9.5MM NS LVRG SPNE CRV LMN,"$2,212.50",$0.00,"$2,212.50",$995.63,"$1,579.06",$0.00,$381.20,$0.00,$0.00,$387.39,"$2,212.50",$0.00,"$1,106.25","$1,752.30","$1,770.00",$0.00,$346.26,$0.00,$352.23,$0.00
7650411,SUP,HCPCS C1713,,7650411  -  PLATE BN LG 11MM NS LVRG SPNE CRV LMN,"$2,212.50",$0.00,"$2,212.50",$995.63,"$1,579.06",$0.00,$381.20,$0.00,$0.00,$387.39,"$2,212.50",$0.00,"$1,106.25","$1,752.30","$1,770.00",$0.00,$346.26,$0.00,$352.23,$0.00
7650412,SUP,HCPCS C1713,,7650412  -  PLATE BN XL 12.5MM NS LVRG SPNE CRV LMN,"$2,212.50",$0.00,"$2,212.50",$995.63,"$1,579.06",$0.00,$381.20,$0.00,$0.00,$387.39,"$2,212.50",$0.00,"$1,106.25","$1,752.30","$1,770.00",$0.00,$346.26,$0.00,$352.23,$0.00
7650505,SUP,HCPCS C1713,,7650505  -  SCREW BONE 2.6MM 5MM LATERAL MASS CERV,$410.00,$0.00,$410.00,$184.50,$292.62,$0.00,$70.64,$0.00,$0.00,$71.79,$410.00,$0.00,$205.00,$324.72,$328.00,$0.00,$64.17,$0.00,$65.27,$0.00
7650506,SUP,HCPCS C1713,,7650506  -  SCREW BONE 2.6MM 6MM LATERAL MASS SPN CERV,$410.00,$0.00,$410.00,$184.50,$292.62,$0.00,$70.64,$0.00,$0.00,$71.79,$410.00,$0.00,$205.00,$324.72,$328.00,$0.00,$64.17,$0.00,$65.27,$0.00
7650507,SUP,HCPCS C1713,,7650507  -  SCREW BONE 2.6MM 7MM LATERAL MASS SPN CERV,$410.00,$0.00,$410.00,$184.50,$292.62,$0.00,$70.64,$0.00,$0.00,$71.79,$410.00,$0.00,$205.00,$324.72,$328.00,$0.00,$64.17,$0.00,$65.27,$0.00
7650508,SUP,HCPCS C1713,,"7650508  -  LATERAL MASS SCREW, 2.6X8MM",$410.00,$0.00,$410.00,$184.50,$292.62,$0.00,$70.64,$0.00,$0.00,$71.79,$410.00,$0.00,$205.00,$324.72,$328.00,$0.00,$64.17,$0.00,$65.27,$0.00
7650605,SUP,HCPCS C1713,,7650605  -  SCREW BONE 3MM 5MM LATERAL MASS CERV,$410.00,$0.00,$410.00,$184.50,$292.62,$0.00,$70.64,$0.00,$0.00,$71.79,$410.00,$0.00,$205.00,$324.72,$328.00,$0.00,$64.17,$0.00,$65.27,$0.00
7650607,SUP,HCPCS C1713,,7650607  -  SCREW BONE 3MM 7MM LATERAL MASS SPN CERV,$410.00,$0.00,$410.00,$184.50,$292.62,$0.00,$70.64,$0.00,$0.00,$71.79,$410.00,$0.00,$205.00,$324.72,$328.00,$0.00,$64.17,$0.00,$65.27,$0.00
7650608,SUP,HCPCS C1713,,7650608  -  SCREW BN 3MM 8MM NS LVRG LAT MASS SPNE CRV,$410.00,$0.00,$410.00,$184.50,$292.62,$0.00,$70.64,$0.00,$0.00,$71.79,$410.00,$0.00,$205.00,$324.72,$328.00,$0.00,$64.17,$0.00,$65.27,$0.00
7650705,SUP,HCPCS C1713,,7650705  -  SCREW BONE 2.6MM 5MM SPN CERV LAMINA,$575.00,$0.00,$575.00,$258.75,$410.38,$0.00,$99.07,$0.00,$0.00,$100.68,$575.00,$0.00,$287.50,$455.40,$460.00,$0.00,$89.99,$0.00,$91.54,$0.00
7650753,SUP,Custom 27203010,,7650753  -  BIT DRILL 3MM SHAFT SPN DISPOSABLE,$615.00,$0.00,$615.00,$0.00,$438.93,$0.00,$0.00,$0.00,$0.00,$0.00,$615.00,$0.00,$307.50,$487.08,$492.00,$0.00,$0.00,$0.00,$0.00,$0.00
7650755,SUP,Custom 27203010,,7650755  -  BIT DRILL 5MM SHAFT SPN DISPOSABLE,$615.00,$0.00,$615.00,$0.00,$438.93,$0.00,$0.00,$0.00,$0.00,$0.00,$615.00,$0.00,$307.50,$487.08,$492.00,$0.00,$0.00,$0.00,$0.00,$0.00
7650756,SUP,Custom 27203010,,7650756  -  BIT DRILL 6MM SHAFT SPN DISPOSABLE,$615.00,$0.00,$615.00,$0.00,$438.93,$0.00,$0.00,$0.00,$0.00,$0.00,$615.00,$0.00,$307.50,$487.08,$492.00,$0.00,$0.00,$0.00,$0.00,$0.00
7650757,SUP,Custom 27203010,,7650757  -  BIT DRILL 7MM SHAFT DISPOSABLE LVG LFS,$615.00,$0.00,$615.00,$0.00,$438.93,$0.00,$0.00,$0.00,$0.00,$0.00,$615.00,$0.00,$307.50,$487.08,$492.00,$0.00,$0.00,$0.00,$0.00,$0.00
7650758,SUP,Custom 27203010,,"7650758  -  LAMINOPLASTY DRILL BIT, 8MM",$615.00,$0.00,$615.00,$0.00,$438.93,$0.00,$0.00,$0.00,$0.00,$0.00,$615.00,$0.00,$307.50,$487.08,$492.00,$0.00,$0.00,$0.00,$0.00,$0.00
7650805,SUP,HCPCS C1713,,7650805  -  SCREW BONE 3MM 5MM LAMINA CERV SPN,$575.00,$0.00,$575.00,$258.75,$410.38,$0.00,$99.07,$0.00,$0.00,$100.68,$575.00,$0.00,$287.50,$455.40,$460.00,$0.00,$89.99,$0.00,$91.54,$0.00
7650811,SUP,HCPCS C1713,,7650811  -  CAGE SPNL 11MM ALGRF XLIF,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7650812,SUP,HCPCS C1713,,7650812  -  CAGE SPNL 12.5MM ALGRF XLIF,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7660020,SUP,HCPCS C1713,,7660020  -  SET SCREW 7660020 BREAK OFF  SS,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
7660120,SUP,HCPCS C1713,,7660120  -  SET SCREW 7660120 NON BREAK OFF  SS,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
7660220,SUP,HCPCS C1713,,7660220  -  SET SCREW 7660220 REDUCTION PLUG  SS,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
7661102,SUP,HCPCS C1713,,7661102  -  HOOK 7661102 PEDICLE SM SS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7661103,SUP,HCPCS C1713,,7661103  -  HOOK 7661103 PEDICLE MD SS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7661104,SUP,HCPCS C1713,,7661104  -  HOOK 7661104 PEDICLE LG SS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7661112,SUP,HCPCS C1713,,7661112  -  HOOK 7661112 WIDE BLADE SM SS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7661113,SUP,HCPCS C1713,,7661113  -  HOOK 7661113 WIDE BLADE MD SS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7661114,SUP,HCPCS C1713,,7661114  -  HOOK 7661114 WIDE BLADE LG SS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7661122,SUP,HCPCS C1713,,7661122  -  HOOK 7661122 NARROW BLADE SM SS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7661123,SUP,HCPCS C1713,,7661123  -  HOOK 7661123 NARROW BLADE MD SS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7661124,SUP,HCPCS C1713,,7661124  -  HOOK 7661124 NARROW BLADE LG SS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7661133,SUP,HCPCS C1713,,7661133  -  HOOK 7661133 RAMP WIDE BLADE MD SS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7661142,SUP,HCPCS C1713,,7661142  -  HOOK 7661142 RAMP NARROW BLADE SM SS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7661143,SUP,HCPCS C1713,,7661143  -  HOOK 7661143 RAMP NARROW BLADE MD SS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7661162,SUP,HCPCS C1713,,7661162  -  HOOK 7661162 LUMBAR ANG BLADE SM SS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7661163,SUP,HCPCS C1713,,7661163  -  HOOK 7661163 LUMBAR ANG BLADE MD SS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7661173,SUP,HCPCS C1713,,7661173  -  HOOK 7661173 EXTENDED BODY MD SS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7661174,SUP,HCPCS C1713,,7661174  -  HOOK 7661174 EXTENDED BODY LG SS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7661188,SUP,HCPCS C1713,,7661188  -  HOOK 7661188 THORACIC ANG BLADE RT SS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7661189,SUP,HCPCS C1713,,7661189  -  HOOK 7661189 THORACIC ANG BLADE LT SS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7661198,SUP,HCPCS C1713,,7661198  -  HOOK 7661198 OFFSET RT SS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7661199,SUP,HCPCS C1713,,7661199  -  HOOK 7661199 OFFSET LT SS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7661202,SUP,HCPCS C1713,,7661202  -  HOOK 7661202 PEDICLE WITH LIP SM SS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7661203,SUP,HCPCS C1713,,"7661203  -  HOOK, PEDICLE WITH LIP, MD,SS","$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7661204,SUP,HCPCS C1713,,"7661204  -  HOOK, PEDICLE WITH LIP, LG,SS","$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7661212,SUP,HCPCS C1713,,"7661212  -  HOOK, WIDE BLADE W/LIP,SM,SS","$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7661213,SUP,HCPCS C1713,,"7661213  -  HOOK, WIDE BLADE W/LIP,MD,SS","$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7661214,SUP,HCPCS C1713,,"7661214  -  HOOK, WIDE BLADE W/LIP,LG,SS","$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7661222,SUP,HCPCS C1713,,"7661222  -  HOOK, NARROW BLADE W/LIP,SM,SS","$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7661223,SUP,HCPCS C1713,,"7661223  -  HOOK, NARROW BLADE W/LIP,MD,SS","$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7661224,SUP,HCPCS C1713,,"7661224  -  HOOK, NARROW BLADE W/LIP,LG,SS","$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7662420,SUP,HCPCS C1713,,"7662420  -  SCREW, FIXED ANGLE, 4.0X20, SS","$1,762.50",$0.00,"$1,762.50",$793.13,"$1,257.90",$0.00,$303.67,$0.00,$0.00,$308.60,"$1,762.50",$0.00,$881.25,"$1,395.90","$1,410.00",$0.00,$275.83,$0.00,$280.59,$0.00
7662425,SUP,HCPCS C1713,,"7662425  -  SCREW, FIXED ANGLE, 4.0X25, SS","$1,762.50",$0.00,"$1,762.50",$793.13,"$1,257.90",$0.00,$303.67,$0.00,$0.00,$308.60,"$1,762.50",$0.00,$881.25,"$1,395.90","$1,410.00",$0.00,$275.83,$0.00,$280.59,$0.00
7662430,SUP,HCPCS C1713,,"7662430  -  SCREW, FIXED ANGLE, 4.0X30, SS","$1,762.50",$0.00,"$1,762.50",$793.13,"$1,257.90",$0.00,$303.67,$0.00,$0.00,$308.60,"$1,762.50",$0.00,$881.25,"$1,395.90","$1,410.00",$0.00,$275.83,$0.00,$280.59,$0.00
7662435,SUP,HCPCS C1713,,"7662435  -  SCREW, FIXED ANGLE, 4.0X35, SS","$1,762.50",$0.00,"$1,762.50",$793.13,"$1,257.90",$0.00,$303.67,$0.00,$0.00,$308.60,"$1,762.50",$0.00,$881.25,"$1,395.90","$1,410.00",$0.00,$275.83,$0.00,$280.59,$0.00
7662440,SUP,HCPCS C1713,,"7662440  -  SCREW, FIXED ANGLE, 4.0X40, SS","$1,762.50",$0.00,"$1,762.50",$793.13,"$1,257.90",$0.00,$303.67,$0.00,$0.00,$308.60,"$1,762.50",$0.00,$881.25,"$1,395.90","$1,410.00",$0.00,$275.83,$0.00,$280.59,$0.00
7662445,SUP,HCPCS C1713,,"7662445  -  SCREW, FIXED ANGLE, 4.0X45, SS","$1,762.50",$0.00,"$1,762.50",$793.13,"$1,257.90",$0.00,$303.67,$0.00,$0.00,$308.60,"$1,762.50",$0.00,$881.25,"$1,395.90","$1,410.00",$0.00,$275.83,$0.00,$280.59,$0.00
7662450,SUP,HCPCS C1713,,"7662450  -  SCREW, FIXED ANGLE, 4.0X50, SS","$1,762.50",$0.00,"$1,762.50",$793.13,"$1,257.90",$0.00,$303.67,$0.00,$0.00,$308.60,"$1,762.50",$0.00,$881.25,"$1,395.90","$1,410.00",$0.00,$275.83,$0.00,$280.59,$0.00
7662455,SUP,HCPCS C1713,,"7662455  -  SCREW, FIXED ANGLE, 4.0X55, SS","$1,762.50",$0.00,"$1,762.50",$793.13,"$1,257.90",$0.00,$303.67,$0.00,$0.00,$308.60,"$1,762.50",$0.00,$881.25,"$1,395.90","$1,410.00",$0.00,$275.83,$0.00,$280.59,$0.00
7662520,SUP,HCPCS C1713,,"7662520  -  SCREW, FIXED ANGLE, 5.0X20, SS","$1,762.50",$0.00,"$1,762.50",$793.13,"$1,257.90",$0.00,$303.67,$0.00,$0.00,$308.60,"$1,762.50",$0.00,$881.25,"$1,395.90","$1,410.00",$0.00,$275.83,$0.00,$280.59,$0.00
7662525,SUP,HCPCS C1713,,"7662525  -  SCREW, FIXED ANGLE, 5.0X25, SS","$1,762.50",$0.00,"$1,762.50",$793.13,"$1,257.90",$0.00,$303.67,$0.00,$0.00,$308.60,"$1,762.50",$0.00,$881.25,"$1,395.90","$1,410.00",$0.00,$275.83,$0.00,$280.59,$0.00
7662530,SUP,HCPCS C1713,,"7662530  -  SCREW, FIXED ANGLE, 5.0X30, SS","$1,762.50",$0.00,"$1,762.50",$793.13,"$1,257.90",$0.00,$303.67,$0.00,$0.00,$308.60,"$1,762.50",$0.00,$881.25,"$1,395.90","$1,410.00",$0.00,$275.83,$0.00,$280.59,$0.00
7662535,SUP,HCPCS C1713,,"7662535  -  SCREW, FIXED ANGLE, 5.0X35, SS","$1,762.50",$0.00,"$1,762.50",$793.13,"$1,257.90",$0.00,$303.67,$0.00,$0.00,$308.60,"$1,762.50",$0.00,$881.25,"$1,395.90","$1,410.00",$0.00,$275.83,$0.00,$280.59,$0.00
7662540,SUP,HCPCS C1713,,"7662540  -  SCREW, FIXED ANGLE, 5.0X40, SS","$1,762.50",$0.00,"$1,762.50",$793.13,"$1,257.90",$0.00,$303.67,$0.00,$0.00,$308.60,"$1,762.50",$0.00,$881.25,"$1,395.90","$1,410.00",$0.00,$275.83,$0.00,$280.59,$0.00
7662545,SUP,HCPCS C1713,,"7662545  -  SCREW, FIXED ANGLE, 5.0X45, SS","$1,762.50",$0.00,"$1,762.50",$793.13,"$1,257.90",$0.00,$303.67,$0.00,$0.00,$308.60,"$1,762.50",$0.00,$881.25,"$1,395.90","$1,410.00",$0.00,$275.83,$0.00,$280.59,$0.00
7662550,SUP,HCPCS C1713,,"7662550  -  SCREW, FIXED ANGLE, 5.0X50, SS","$1,762.50",$0.00,"$1,762.50",$793.13,"$1,257.90",$0.00,$303.67,$0.00,$0.00,$308.60,"$1,762.50",$0.00,$881.25,"$1,395.90","$1,410.00",$0.00,$275.83,$0.00,$280.59,$0.00
7662555,SUP,HCPCS C1713,,"7662555  -  SCREW, FIXED ANGLE, 5.0X55, SS","$1,762.50",$0.00,"$1,762.50",$793.13,"$1,257.90",$0.00,$303.67,$0.00,$0.00,$308.60,"$1,762.50",$0.00,$881.25,"$1,395.90","$1,410.00",$0.00,$275.83,$0.00,$280.59,$0.00
7662625,SUP,HCPCS C1713,,"7662625  -  SCREW, FIXED ANGLE, 6.0X25, SS","$1,762.50",$0.00,"$1,762.50",$793.13,"$1,257.90",$0.00,$303.67,$0.00,$0.00,$308.60,"$1,762.50",$0.00,$881.25,"$1,395.90","$1,410.00",$0.00,$275.83,$0.00,$280.59,$0.00
7662630,SUP,HCPCS C1713,,"7662630  -  SCREW, FIXED ANGLE, 6.0X30, SS","$1,762.50",$0.00,"$1,762.50",$793.13,"$1,257.90",$0.00,$303.67,$0.00,$0.00,$308.60,"$1,762.50",$0.00,$881.25,"$1,395.90","$1,410.00",$0.00,$275.83,$0.00,$280.59,$0.00
7662635,SUP,HCPCS C1713,,"7662635  -  SCREW, FIXED ANGLE, 6.0X35, SS","$1,762.50",$0.00,"$1,762.50",$793.13,"$1,257.90",$0.00,$303.67,$0.00,$0.00,$308.60,"$1,762.50",$0.00,$881.25,"$1,395.90","$1,410.00",$0.00,$275.83,$0.00,$280.59,$0.00
7662640,SUP,HCPCS C1713,,"7662640  -  SCREW, FIXED ANGLE, 6.0X40, SS","$1,762.50",$0.00,"$1,762.50",$793.13,"$1,257.90",$0.00,$303.67,$0.00,$0.00,$308.60,"$1,762.50",$0.00,$881.25,"$1,395.90","$1,410.00",$0.00,$275.83,$0.00,$280.59,$0.00
7662645,SUP,HCPCS C1713,,"7662645  -  SCREW, FIXED ANGLE, 6.0X45, SS","$1,762.50",$0.00,"$1,762.50",$793.13,"$1,257.90",$0.00,$303.67,$0.00,$0.00,$308.60,"$1,762.50",$0.00,$881.25,"$1,395.90","$1,410.00",$0.00,$275.83,$0.00,$280.59,$0.00
7662650,SUP,HCPCS C1713,,"7662650  -  SCREW, FIXED ANGLE, 6.0X50, SS","$1,762.50",$0.00,"$1,762.50",$793.13,"$1,257.90",$0.00,$303.67,$0.00,$0.00,$308.60,"$1,762.50",$0.00,$881.25,"$1,395.90","$1,410.00",$0.00,$275.83,$0.00,$280.59,$0.00
7662655,SUP,HCPCS C1713,,"7662655  -  SCREW, FIXED ANGLE, 6.0X55, SS","$1,762.50",$0.00,"$1,762.50",$793.13,"$1,257.90",$0.00,$303.67,$0.00,$0.00,$308.60,"$1,762.50",$0.00,$881.25,"$1,395.90","$1,410.00",$0.00,$275.83,$0.00,$280.59,$0.00
7662660,SUP,HCPCS C1713,,"7662660  -  SCREW, FIXED ANGLE, 6.0X60, SS","$1,762.50",$0.00,"$1,762.50",$793.13,"$1,257.90",$0.00,$303.67,$0.00,$0.00,$308.60,"$1,762.50",$0.00,$881.25,"$1,395.90","$1,410.00",$0.00,$275.83,$0.00,$280.59,$0.00
7663420,SUP,HCPCS C1713,,7663420  -  SCREW 7663420 FIXED ANGLE 4.5X20 SS,"$1,762.50",$0.00,"$1,762.50",$793.13,"$1,257.90",$0.00,$303.67,$0.00,$0.00,$308.60,"$1,762.50",$0.00,$881.25,"$1,395.90","$1,410.00",$0.00,$275.83,$0.00,$280.59,$0.00
7663425,SUP,HCPCS C1713,,7663425  -  SCREW 7663425 FIXED ANGLE 4.5X25 SS,"$1,762.50",$0.00,"$1,762.50",$793.13,"$1,257.90",$0.00,$303.67,$0.00,$0.00,$308.60,"$1,762.50",$0.00,$881.25,"$1,395.90","$1,410.00",$0.00,$275.83,$0.00,$280.59,$0.00
7663430,SUP,HCPCS C1713,,7663430  -  SCREW 7663430 FIXED ANGLE 4.5X30 SS,"$1,762.50",$0.00,"$1,762.50",$793.13,"$1,257.90",$0.00,$303.67,$0.00,$0.00,$308.60,"$1,762.50",$0.00,$881.25,"$1,395.90","$1,410.00",$0.00,$275.83,$0.00,$280.59,$0.00
7663435,SUP,HCPCS C1713,,7663435  -  SCREW 7663435 FIXED ANGLE 4.5X35 SS,"$1,762.50",$0.00,"$1,762.50",$793.13,"$1,257.90",$0.00,$303.67,$0.00,$0.00,$308.60,"$1,762.50",$0.00,$881.25,"$1,395.90","$1,410.00",$0.00,$275.83,$0.00,$280.59,$0.00
7663440,SUP,HCPCS C1713,,7663440  -  SCREW 7663440 FIXED ANGLE 4.5X40 SS,"$1,762.50",$0.00,"$1,762.50",$793.13,"$1,257.90",$0.00,$303.67,$0.00,$0.00,$308.60,"$1,762.50",$0.00,$881.25,"$1,395.90","$1,410.00",$0.00,$275.83,$0.00,$280.59,$0.00
7663445,SUP,HCPCS C1713,,7663445  -  SCREW 7663445 FIXED ANGLE 4.5X45 SS,"$1,762.50",$0.00,"$1,762.50",$793.13,"$1,257.90",$0.00,$303.67,$0.00,$0.00,$308.60,"$1,762.50",$0.00,$881.25,"$1,395.90","$1,410.00",$0.00,$275.83,$0.00,$280.59,$0.00
7663450,SUP,HCPCS C1713,,7663450  -  SCREW 7663450 FIXED ANGLE 4.5X50 SS,"$1,762.50",$0.00,"$1,762.50",$793.13,"$1,257.90",$0.00,$303.67,$0.00,$0.00,$308.60,"$1,762.50",$0.00,$881.25,"$1,395.90","$1,410.00",$0.00,$275.83,$0.00,$280.59,$0.00
7663455,SUP,HCPCS C1713,,7663455  -  SCREW 7663455 FIXED ANGLE 4.5X55 SS,"$1,762.50",$0.00,"$1,762.50",$793.13,"$1,257.90",$0.00,$303.67,$0.00,$0.00,$308.60,"$1,762.50",$0.00,$881.25,"$1,395.90","$1,410.00",$0.00,$275.83,$0.00,$280.59,$0.00
7663525,SUP,HCPCS C1713,,7663525  -  SCREW 7663525 FIXED ANGLE 5.5X25 SS,"$1,762.50",$0.00,"$1,762.50",$793.13,"$1,257.90",$0.00,$303.67,$0.00,$0.00,$308.60,"$1,762.50",$0.00,$881.25,"$1,395.90","$1,410.00",$0.00,$275.83,$0.00,$280.59,$0.00
7663530,SUP,HCPCS C1713,,7663530  -  SCREW 7663530 FIXED ANGLE 5.5X30 SS,"$1,762.50",$0.00,"$1,762.50",$793.13,"$1,257.90",$0.00,$303.67,$0.00,$0.00,$308.60,"$1,762.50",$0.00,$881.25,"$1,395.90","$1,410.00",$0.00,$275.83,$0.00,$280.59,$0.00
7663535,SUP,HCPCS C1713,,7663535  -  SCREW 7663535 FIXED ANGLE 5.5X35 SS,"$1,762.50",$0.00,"$1,762.50",$793.13,"$1,257.90",$0.00,$303.67,$0.00,$0.00,$308.60,"$1,762.50",$0.00,$881.25,"$1,395.90","$1,410.00",$0.00,$275.83,$0.00,$280.59,$0.00
7663540,SUP,HCPCS C1713,,7663540  -  SCREW 7663540 FIXED ANGLE 5.5X40 SS,"$1,762.50",$0.00,"$1,762.50",$793.13,"$1,257.90",$0.00,$303.67,$0.00,$0.00,$308.60,"$1,762.50",$0.00,$881.25,"$1,395.90","$1,410.00",$0.00,$275.83,$0.00,$280.59,$0.00
7663545,SUP,HCPCS C1713,,7663545  -  SCREW 7663545 FIXED ANGLE 5.5X45 SS,"$1,762.50",$0.00,"$1,762.50",$793.13,"$1,257.90",$0.00,$303.67,$0.00,$0.00,$308.60,"$1,762.50",$0.00,$881.25,"$1,395.90","$1,410.00",$0.00,$275.83,$0.00,$280.59,$0.00
7663550,SUP,HCPCS C1713,,7663550  -  SCREW 7663550 FIXED ANGLE 5.5X50 SS,"$1,762.50",$0.00,"$1,762.50",$793.13,"$1,257.90",$0.00,$303.67,$0.00,$0.00,$308.60,"$1,762.50",$0.00,$881.25,"$1,395.90","$1,410.00",$0.00,$275.83,$0.00,$280.59,$0.00
7663555,SUP,HCPCS C1713,,7663555  -  SCREW 7663555 FIXED ANGLE 5.5X55 SS,"$1,762.50",$0.00,"$1,762.50",$793.13,"$1,257.90",$0.00,$303.67,$0.00,$0.00,$308.60,"$1,762.50",$0.00,$881.25,"$1,395.90","$1,410.00",$0.00,$275.83,$0.00,$280.59,$0.00
7663560,SUP,HCPCS C1713,,7663560  -  SCREW 7663560 FIXED ANGLE 5.5X60 SS,"$1,762.50",$0.00,"$1,762.50",$793.13,"$1,257.90",$0.00,$303.67,$0.00,$0.00,$308.60,"$1,762.50",$0.00,$881.25,"$1,395.90","$1,410.00",$0.00,$275.83,$0.00,$280.59,$0.00
7663625,SUP,HCPCS C1713,,7663625  -  SCREW 7663625 FIXED ANGLE 6.5X25 SS,"$1,762.50",$0.00,"$1,762.50",$793.13,"$1,257.90",$0.00,$303.67,$0.00,$0.00,$308.60,"$1,762.50",$0.00,$881.25,"$1,395.90","$1,410.00",$0.00,$275.83,$0.00,$280.59,$0.00
7663630,SUP,HCPCS C1713,,7663630  -  SCREW 7663630 FIXED ANGLE 6.5X30 SS,"$1,762.50",$0.00,"$1,762.50",$793.13,"$1,257.90",$0.00,$303.67,$0.00,$0.00,$308.60,"$1,762.50",$0.00,$881.25,"$1,395.90","$1,410.00",$0.00,$275.83,$0.00,$280.59,$0.00
7663635,SUP,HCPCS C1713,,7663635  -  SCREW 7663635 FIXED ANGLE 6.5X35 SS,"$1,762.50",$0.00,"$1,762.50",$793.13,"$1,257.90",$0.00,$303.67,$0.00,$0.00,$308.60,"$1,762.50",$0.00,$881.25,"$1,395.90","$1,410.00",$0.00,$275.83,$0.00,$280.59,$0.00
7663640,SUP,HCPCS C1713,,7663640  -  SCREW 7663640 FIXED ANGLE 6.5X40 SS,"$1,762.50",$0.00,"$1,762.50",$793.13,"$1,257.90",$0.00,$303.67,$0.00,$0.00,$308.60,"$1,762.50",$0.00,$881.25,"$1,395.90","$1,410.00",$0.00,$275.83,$0.00,$280.59,$0.00
7663645,SUP,HCPCS C1713,,7663645  -  SCREW 7663645 FIXED ANGLE 6.5X45 SS,"$1,762.50",$0.00,"$1,762.50",$793.13,"$1,257.90",$0.00,$303.67,$0.00,$0.00,$308.60,"$1,762.50",$0.00,$881.25,"$1,395.90","$1,410.00",$0.00,$275.83,$0.00,$280.59,$0.00
7663650,SUP,HCPCS C1713,,7663650  -  SCREW 7663650 FIXED ANGLE 6.5X50 SS,"$1,762.50",$0.00,"$1,762.50",$793.13,"$1,257.90",$0.00,$303.67,$0.00,$0.00,$308.60,"$1,762.50",$0.00,$881.25,"$1,395.90","$1,410.00",$0.00,$275.83,$0.00,$280.59,$0.00
7663655,SUP,HCPCS C1713,,7663655  -  BONE SCREW 7663655 FIXED ANGLE 6.5X55 SS,"$1,762.50",$0.00,"$1,762.50",$793.13,"$1,257.90",$0.00,$303.67,$0.00,$0.00,$308.60,"$1,762.50",$0.00,$881.25,"$1,395.90","$1,410.00",$0.00,$275.83,$0.00,$280.59,$0.00
7663660,SUP,HCPCS C1713,,7663660  -  SCREW 7663660 FIXED ANGLE 6.5X60 SS,"$1,762.50",$0.00,"$1,762.50",$793.13,"$1,257.90",$0.00,$303.67,$0.00,$0.00,$308.60,"$1,762.50",$0.00,$881.25,"$1,395.90","$1,410.00",$0.00,$275.83,$0.00,$280.59,$0.00
7663665,SUP,HCPCS C1713,,7663665  -  SCREW 7663665 FIXED ANGLE 6.5X65 SS,"$1,762.50",$0.00,"$1,762.50",$793.13,"$1,257.90",$0.00,$303.67,$0.00,$0.00,$308.60,"$1,762.50",$0.00,$881.25,"$1,395.90","$1,410.00",$0.00,$275.83,$0.00,$280.59,$0.00
7663670,SUP,HCPCS C1713,,7663670  -  SCREW 7663670 FIXED ANGLE 6.5X70 SS,"$1,762.50",$0.00,"$1,762.50",$793.13,"$1,257.90",$0.00,$303.67,$0.00,$0.00,$308.60,"$1,762.50",$0.00,$881.25,"$1,395.90","$1,410.00",$0.00,$275.83,$0.00,$280.59,$0.00
7663725,SUP,HCPCS C1713,,7663725  -  SCREW 7663725 FIXED ANGLE 7.5X25 SS,"$1,762.50",$0.00,"$1,762.50",$793.13,"$1,257.90",$0.00,$303.67,$0.00,$0.00,$308.60,"$1,762.50",$0.00,$881.25,"$1,395.90","$1,410.00",$0.00,$275.83,$0.00,$280.59,$0.00
7663730,SUP,HCPCS C1713,,7663730  -  SCREW 7663730 FIXED ANGLE 7.5X30 SS,"$1,762.50",$0.00,"$1,762.50",$793.13,"$1,257.90",$0.00,$303.67,$0.00,$0.00,$308.60,"$1,762.50",$0.00,$881.25,"$1,395.90","$1,410.00",$0.00,$275.83,$0.00,$280.59,$0.00
7663735,SUP,HCPCS C1713,,7663735  -  SCREW 7663735 FIXED ANGLE 7.5X35 SS,"$1,762.50",$0.00,"$1,762.50",$793.13,"$1,257.90",$0.00,$303.67,$0.00,$0.00,$308.60,"$1,762.50",$0.00,$881.25,"$1,395.90","$1,410.00",$0.00,$275.83,$0.00,$280.59,$0.00
7663740,SUP,HCPCS C1713,,7663740  -  SCREW 7663740 FIXED ANGLE 7.5X40 SS,"$1,762.50",$0.00,"$1,762.50",$793.13,"$1,257.90",$0.00,$303.67,$0.00,$0.00,$308.60,"$1,762.50",$0.00,$881.25,"$1,395.90","$1,410.00",$0.00,$275.83,$0.00,$280.59,$0.00
7663745,SUP,HCPCS C1713,,7663745  -  SCREW 7663745 FIXED ANGLE 7.5X45 SS,"$1,762.50",$0.00,"$1,762.50",$793.13,"$1,257.90",$0.00,$303.67,$0.00,$0.00,$308.60,"$1,762.50",$0.00,$881.25,"$1,395.90","$1,410.00",$0.00,$275.83,$0.00,$280.59,$0.00
7663750,SUP,HCPCS C1713,,7663750  -  SCREW 7663750 FIXED ANGLE 7.5X50 SS,"$1,762.50",$0.00,"$1,762.50",$793.13,"$1,257.90",$0.00,$303.67,$0.00,$0.00,$308.60,"$1,762.50",$0.00,$881.25,"$1,395.90","$1,410.00",$0.00,$275.83,$0.00,$280.59,$0.00
7663755,SUP,HCPCS C1713,,7663755  -  SCREW 7663755 FIXED ANGLE 7.5X55 SS,"$1,762.50",$0.00,"$1,762.50",$793.13,"$1,257.90",$0.00,$303.67,$0.00,$0.00,$308.60,"$1,762.50",$0.00,$881.25,"$1,395.90","$1,410.00",$0.00,$275.83,$0.00,$280.59,$0.00
7663760,SUP,HCPCS C1713,,7663760  -  SCREW 7663760 FIXED ANGLE 7.5X60 SS,"$1,762.50",$0.00,"$1,762.50",$793.13,"$1,257.90",$0.00,$303.67,$0.00,$0.00,$308.60,"$1,762.50",$0.00,$881.25,"$1,395.90","$1,410.00",$0.00,$275.83,$0.00,$280.59,$0.00
7663765,SUP,HCPCS C1713,,7663765  -  SCREW 7663765 FIXED ANGLE 7.5X65 SS,"$1,762.50",$0.00,"$1,762.50",$793.13,"$1,257.90",$0.00,$303.67,$0.00,$0.00,$308.60,"$1,762.50",$0.00,$881.25,"$1,395.90","$1,410.00",$0.00,$275.83,$0.00,$280.59,$0.00
7670212,SUP,HCPCS C1713,,7670212  -  12MM CASPAR PINS,$362.50,$0.00,$362.50,$163.13,$258.72,$0.00,$62.46,$0.00,$0.00,$63.47,$362.50,$0.00,$181.25,$287.10,$290.00,$0.00,$56.73,$0.00,$57.71,$0.00
7670214,SUP,HCPCS C1713,,7670214  -  SCREW DSTRCT 14MM PCM SPNE,$362.50,$0.00,$362.50,$163.13,$258.72,$0.00,$62.46,$0.00,$0.00,$63.47,$362.50,$0.00,$181.25,$287.10,$290.00,$0.00,$56.73,$0.00,$57.71,$0.00
7680265,SUP,Custom 27803010,,7680265  -  DISK SPNL SM 6.5MM PCM CRV,"$13,077.50",$0.00,"$13,077.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,077.50",$0.00,"$6,538.75","$10,357.38","$10,462.00",$0.00,$0.00,$0.00,$0.00,$0.00
7680272,SUP,Custom 27803010,,7680272  -  DISC INTVRTB 14MM SM 17X7.2MM STRL LF PCM ARTF SPNE CRV,"$13,077.50",$0.00,"$13,077.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,077.50",$0.00,"$6,538.75","$10,357.38","$10,462.00",$0.00,$0.00,$0.00,$0.00,$0.00
7680280,SUP,Custom 27803010,,7680280  -  DISK SPNL SM 8MM PCM CRV,"$13,077.50",$0.00,"$13,077.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,077.50",$0.00,"$6,538.75","$10,357.38","$10,462.00",$0.00,$0.00,$0.00,$0.00,$0.00
7680372,SUP,Custom 27803010,,7680372  -  DISK SPNL MED 7.2MM PCM CRV,"$13,077.50",$0.00,"$13,077.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,077.50",$0.00,"$6,538.75","$10,357.38","$10,462.00",$0.00,$0.00,$0.00,$0.00,$0.00
7680380,SUP,Custom 27803010,,7680380  -  DISK SPNL MED 8MM PCM CRV,"$13,077.50",$0.00,"$13,077.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,077.50",$0.00,"$6,538.75","$10,357.38","$10,462.00",$0.00,$0.00,$0.00,$0.00,$0.00
7680465,SUP,Custom 27803010,,7680465  -  DISK SPNL LG 6.5MM PCM CRV,"$13,077.50",$0.00,"$13,077.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,077.50",$0.00,"$6,538.75","$10,357.38","$10,462.00",$0.00,$0.00,$0.00,$0.00,$0.00
7680472,SUP,Custom 27803010,,7680472  -  DISK SPNL LG 7.2MM PCM CRV,"$13,077.50",$0.00,"$13,077.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,077.50",$0.00,"$6,538.75","$10,357.38","$10,462.00",$0.00,$0.00,$0.00,$0.00,$0.00
7680480,SUP,Custom 27803010,,7680480  -  DISK SPNL LG 8MM PCM CRV,"$13,077.50",$0.00,"$13,077.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,077.50",$0.00,"$6,538.75","$10,357.38","$10,462.00",$0.00,$0.00,$0.00,$0.00,$0.00
7710635,SUP,HCPCS C1713,,7710635  -  CAGE SPNL 6MM CRNT LO CX PRFL PEEK,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
7710835,SUP,HCPCS C1713,,7710835  -  CAGE SPNL 8MM CRNT LO CX PRFL PEEK,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
7711055,SUP,HCPCS C1713,,7711055  -  CAGE SPNL 10MM CRNT LO CX PRFL PEEK,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
7711275,SUP,HCPCS C1713,,7711275  -  CAGE SPNL 12MM CRNT LX,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
7711495,SUP,HCPCS C1713,,7711495  -  SPACER SPNL 14MM CRNT LX EXTENSURE,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
7711615,SUP,HCPCS C1713,,7711615  -  SPACER SPNL 16MM CRNT LX EXTENSURE,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
7711835,SUP,HCPCS C1713,,7711835  -  SPACER SPNL 18MM CRNT LX EXTENSURE,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
7712055,SUP,HCPCS C1713,,7712055  -  SPACER SPNL 20MM CRNT LX EXTENSURE LMBR INTRBD FS PEEK,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
7713510,SUP,HCPCS C1713,,7713510  -  SCREW BONE 3.5MM 10MM ZEVO TI SPN CERV ANT VAR SLF,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7713511,SUP,HCPCS C1713,,7713511  -  SCREW BONE 3.5MM 11MM ZEVO TI SPN CERV ANT VAR SLF,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7713512,SUP,HCPCS C1713,,7713512  -  SCREW BONE 3.5MM 12MM ZEVO TI SPN CERV ANT VAR SLF,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7713514,SUP,HCPCS C1713,,7713514  -  SCREW BONE 3.5MM 14MM ZEVO TI SPN CERV ANT VAR SLF,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7713515,SUP,HCPCS C1713,,7713515  -  SCREW BONE 3.5MM 15MM ZEVO TI SPN CERV ANT VAR SLF,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7713516,SUP,HCPCS C1713,,7713516  -  SCREW BONE 3.5MM 16MM ZEVO TI SPN CERV ANT VAR SLF,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7713517,SUP,HCPCS C1713,,7713517  -  SCREW BONE 3.5MM 17MM ZEVO TI SPN CERV ANT VAR SLF,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7713518,SUP,HCPCS C1713,,7713518  -  SCREW BONE 3.5MM 18MM ZEVO TI SPN CERV ANT VAR SLF,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7713519,SUP,HCPCS C1713,,7713519  -  SCREW BONE 3.5MM 19MM ZEVO TI SPN CERV ANT VAR SLF,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7713520,SUP,HCPCS C1713,,7713520  -  SCREW BONE 3.5MM 20MM ZEVO TI SPN CERV ANT VAR SLF,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7713521,SUP,HCPCS C1713,,7713521  -  SCREW BONE 3.5MM 21MM ZEVO TI SPN CERV ANT VAR SLF,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7713522,SUP,HCPCS C1713,,7713522  -  SCREW BONE 3.5MM 22MM ZEVO TI SPN CERV ANT VAR SLF,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7713523,SUP,HCPCS C1713,,7713523  -  SCREW BONE 3.5MM 23MM ZEVO TI SPN CERV ANT VAR SLF,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7713524,SUP,HCPCS C1713,,7713524  -  SCREW BONE 3.5MM 24MM ZEVO TI SPN CERV ANT VAR SLF,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7714010,SUP,HCPCS C1713,,7714010  -  SCREW BONE 4MM 10MM ZEVO TI SPN CERV ANT VAR SLF,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7714011,SUP,HCPCS C1713,,7714011  -  SCREW BONE 4MM 11MM ZEVO TI SPN CERV ANT VAR SLF,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7714012,SUP,HCPCS C1713,,7714012  -  SCREW BONE 4MM 12MM ZEVO TI SPN CERV ANT VAR SLF,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7714014,SUP,HCPCS C1713,,7714014  -  SCREW BONE 4MM 14MM ZEVO TI SPN CERV ANT VAR SLF,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7714016,SUP,HCPCS C1713,,7714016  -  SCREW BONE 4MM 16MM ZEVO TI SPN CERV ANT VAR SLF,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7714018,SUP,HCPCS C1713,,7714018  -  SCREW BONE 4MM 18MM ZEVO TI SPN CERV ANT VAR SLF,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7714019,SUP,HCPCS C1713,,7714019  -  SCREW BONE 4MM 19MM ZEVO TI SPN CERV ANT VAR SLF,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7714020,SUP,HCPCS C1713,,7714020  -  SCREW BONE 4MM 20MM ZEVO TI SPN CERV ANT VAR SLF,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7714021,SUP,HCPCS C1713,,7714021  -  SCREW BONE 4MM 21MM ZEVO TI SPN CERV ANT VAR SLF,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7714022,SUP,HCPCS C1713,,7714022  -  SCREW BONE 4MM 22MM ZEVO TI SPN CERV ANT VAR SLF,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7714023,SUP,HCPCS C1713,,7714023  -  SCREW BONE 4MM 23MM ZEVO TI SPN CERV ANT VAR SLF,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7714024,SUP,HCPCS C1713,,7714024  -  SCREW BONE 4MM 24MM ZEVO TI SPN CERV ANT VAR SLF,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7723510,SUP,HCPCS C1713,,7723510  -  SCREW BONE 3.5MM 10MM ZEVO TI SPN CERV ANT VAR ST,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7723511,SUP,HCPCS C1713,,7723511  -  SCREW BONE 3.5MM 11MM ZEVO TI SPN CERV ANT VAR ST,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7723512,SUP,HCPCS C1713,,7723512  -  SCREW BONE 3.5MM 12MM ZEVO TI SPN CERV ANT VAR ST,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7723514,SUP,HCPCS C1713,,7723514  -  SCREW BN 3.5MM 14MM ZEVO VAR ST TI SPNE CRV ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7723515,SUP,HCPCS C1713,,7723515  -  SCREW BN 3.5MM 15MM ZEVO VAR ST TI SPNE CRV ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7723516,SUP,HCPCS C1713,,7723516  -  SCREW BONE 3.5MM 16MM ZEVO TI SPN CERV ANT VAR ST,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7723517,SUP,HCPCS C1713,,7723517  -  SCREW BONE 3.5MM 17MM VARIABLE SELF TAP ZEVO TITANIUM SPN,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7723518,SUP,HCPCS C1713,,7723518  -  SCREW BONE 3.5MM 18MM ZEVO TI SPN CERV ANT VAR ST,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7723519,SUP,HCPCS C1713,,7723519  -  SCREW BONE 3.5MM 19MM ZEVO TI SPN CERV ANT VAR ST,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7723520,SUP,HCPCS C1713,,7723520  -  SCREW BONE 3.5MM 20MM ZEVO TI SPN CERV ANT VAR ST,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7723521,SUP,HCPCS C1713,,7723521  -  SCREW BONE 3.5MM 21MM ZEVO TI SPN CERV ANT VAR ST,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7723522,SUP,HCPCS C1713,,7723522  -  SCREW BONE 3.5MM 22MM ZEVO TI SPN CERV ANT VAR ST,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7723523,SUP,HCPCS C1713,,7723523  -  SCREW BONE 3.5MM 23MM ZEVO TI SPN CERV ANT VAR ST,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7723524,SUP,HCPCS C1713,,7723524  -  SCREW BONE 3.5MM 24MM ZEVO TI SPN CERV ANT VAR ST,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7724010,SUP,HCPCS C1713,,7724010  -  SCREW BONE 4MM 10MM ZEVO TI SPN CERV ANT VAR ST,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7724011,SUP,HCPCS C1713,,7724011  -  SCREW BONE 4MM 11MM ZEVO TI SPN CERV ANT VAR ST,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7724012,SUP,HCPCS C1713,,7724012  -  SCREW BONE 4MM 12MM ZEVO TI SPN CERV ANT VAR ST,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7724014,SUP,HCPCS C1713,,7724014  -  SCREW BONE 4MM 14MM ZEVO TI SPN CERV ANT VAR ST,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7724016,SUP,HCPCS C1713,,7724016  -  SCREW BONE 4MM 16MM ZEVO TI SPN CERV ANT VAR ST,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7724017,SUP,HCPCS C1713,,7724017  -  SCREW BN 4MM 17MM ZEVO VAR ST TI SPNE CRV ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7724018,SUP,HCPCS C1713,,7724018  -  SCREW BONE 4MM 18MM ZEVO TI SPN CERV ANT VAR ST,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7724019,SUP,HCPCS C1713,,7724019  -  SCREW BONE 4MM 19MM ZEVO TI SPN CERV ANT VAR ST,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7724020,SUP,HCPCS C1713,,7724020  -  SCREW BONE 4MM 20MM ZEVO TI SPN CERV ANT VAR ST,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7724021,SUP,HCPCS C1713,,7724021  -  SCREW BONE 4MM 21MM ZEVO TI SPN CERV ANT VAR ST,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7724022,SUP,HCPCS C1713,,7724022  -  SCREW BONE 4MM 22MM ZEVO TI SPN CERV ANT VAR ST,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7724023,SUP,HCPCS C1713,,7724023  -  SCREW BONE 4MM 23MM ZEVO TI SPN CERV ANT VAR ST,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7724024,SUP,HCPCS C1713,,7724024  -  SCREW BONE 4MM 24MM ZEVO TI SPN CERV ANT VAR ST,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7730016,SUP,Custom 27203010,,7730016  -  BIT DRL 13MM STRL HLX ACP SPNE,$535.00,$0.00,$535.00,$0.00,$381.83,$0.00,$0.00,$0.00,$0.00,$0.00,$535.00,$0.00,$267.50,$423.72,$428.00,$0.00,$0.00,$0.00,$0.00,$0.00
7732111,SUP,HCPCS C1713,,7732111  -  SCREW BN 4MM 11MM NS HLX ACP SLF DRL FX ANG SPNE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7732113,SUP,HCPCS C1713,,7732113  -  SCREW BN 4MM 13MM NS HLX-T SLF DRL FX ANG SPNE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7732115,SUP,HCPCS C1713,,7732115  -  SCREW BN 4MM 15MM NS HLX-T SLF DRL FX ANG SPNE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7733111,SUP,HCPCS C1713,,7733111  -  SCREW BN 4MM 11MM NS HLX ACP ST VA SPNE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7733119,SUP,HCPCS C1713,,7733119  -  SCREW BN 4MM 19MM NS HLX ACP ST VA SPNE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7734111,SUP,HCPCS C1713,,7734111  -  SCREW BN 4MM 11MM NS HLX-T ACP ST FX ANG SPNE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7734113,SUP,HCPCS C1713,,7734113  -  SCREW BN 4MM 13MM NS HLX-T ST FX ANG SPNE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7734115,SUP,HCPCS C1713,,7734115  -  SCREW BN 4MM 15MM NS HLX-T ST FX ANG SPNE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7734117,SUP,HCPCS C1713,,7734117  -  SCREW BN 4MM 17MM NS HLX-T ACP ST FX ANG SPNE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7734119,SUP,HCPCS C1713,,7734119  -  SCREW BN 4MM 19MM NS HLX-T ACP ST FX ANG SPNE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7735111,SUP,HCPCS C1713,,7735111  -  SCREW BN 4.5MM 11MM HLX ACP VA ST SPNE CRV ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7735113,SUP,HCPCS C1713,,7735113  -  SCREW BN 4.5MM 13MM NS HLX-T ST VA SPNE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7735115,SUP,HCPCS C1713,,7735115  -  SCREW BN 4.5MM 15MM NS HLX-T ST VA SPNE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7735117,SUP,HCPCS C1713,,7735117  -  SCREW BN 4.5MM 17MM NS HLX ACP ST VA SPNE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7735119,SUP,HCPCS C1713,,7735119  -  SCREW BN 4.5MM 19MM NS HLX ACP ST VA SPNE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7736113,SUP,HCPCS C1713,,7736113  -  SCREW BN 4.5MM 13MM NS HLX-T ST FX ANG SPNE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7736115,SUP,HCPCS C1713,,7736115  -  SCREW BN 4.5MM 15MM NS HLX-T ST FX ANG SPNE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7736117,SUP,HCPCS C1713,,7736117  -  SCREW BN 4.5MM 17MM NS HLX ACP ST FX ANG SPNE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7737110,SUP,Custom 27203010,,7737110  -  HOLDER IMPL NS HLX ACP TEMP TACK SPNE,$535.00,$0.00,$535.00,$0.00,$381.83,$0.00,$0.00,$0.00,$0.00,$0.00,$535.00,$0.00,$267.50,$423.72,$428.00,$0.00,$0.00,$0.00,$0.00,$0.00
7738120,SUP,HCPCS C1713,,7738120  -  PLATE BN 20MM HLX LVL 1 TI SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7738122,SUP,HCPCS C1713,,7738122  -  PLATE BN 22MM HLX LVL 1 TI SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7738124,SUP,HCPCS C1713,,7738124  -  PLATE BN 24MM HLX ACP 1 LVL TI ANT CSPN,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7738126,SUP,HCPCS C1713,,7738126  -  PLATE BN 26MM HLX LVL 1 TI SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7738128,SUP,HCPCS C1713,,7738128  -  PLATE BN 28MM HLX LVL 1 TI SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7738130,SUP,HCPCS C1713,,7738130  -  PLATE BN 30MM HLX LVL 1 TI SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7738132,SUP,HCPCS C1713,,7738132  -  PLATE BN 32MM HLX LVL 1 TI SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7738134,SUP,HCPCS C1713,,7738134  -  PLATE BN 34MM HLX LVL 1 TI SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7738236,SUP,HCPCS C1713,,7738236  -  PLATE BN 36MM HLX LVL 2 TI SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7738238,SUP,HCPCS C1713,,7738238  -  PLATE BN 38MM HLX LVL 2 TI SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7738240,SUP,HCPCS C1713,,7738240  -  PLATE BN 40MM HLX LVL 2 TI SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7738242,SUP,HCPCS C1713,,7738242  -  PLATE BN 42MM HLX LVL 2 TI SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7738244,SUP,HCPCS C1713,,7738244  -  PLATE BN 44MM HLX LVL 2 TI SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7738246,SUP,HCPCS C1713,,7738246  -  PLATE BN 46MM HLX LVL 2 TI SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7738248,SUP,HCPCS C1713,,7738248  -  PLATE BN 48MM HLX LVL 2 TI SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7738250,SUP,HCPCS C1713,,7738250  -  PLATE BN 50MM HLX LVL 2 TI SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7738252,SUP,HCPCS C1713,,7738252  -  PLATE BN 52MM HLX LVL 2 TI SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7738254,SUP,HCPCS C1713,,7738254  -  PLATE BN 54MM HLX LVL 2 TI SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7738356,SUP,HCPCS C1713,,7738356  -  PLATE BN 56MM HLX LVL 3 TI SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7738358,SUP,HCPCS C1713,,7738358  -  PLATE BN 58MM HLX LVL 3 TI SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7738360,SUP,HCPCS C1713,,7738360  -  PLATE BN 60MM HLX LVL 3 TI SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7738362,SUP,HCPCS C1713,,7738362  -  PLATE BN 62MM HLX LVL 3 TI SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7738364,SUP,HCPCS C1713,,7738364  -  PLATE BN 64MM HLX LVL 3 TI SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7738366,SUP,HCPCS C1713,,7738366  -  PLATE BN 66MM HLX LVL 3 TI SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7738368,SUP,HCPCS C1713,,7738368  -  PLATE BN 68MM HLX LVL 3 TI SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7738470,SUP,HCPCS C1713,,7738470  -  PLATE BN 70MM HLX LVL 4 TI SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7738474,SUP,HCPCS C1713,,7738474  -  PLATE BN 74MM HLX LVL 4 TI SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7738478,SUP,HCPCS C1713,,7738478  -  PLATE BN 78MM HLX LVL 4 TI SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7738482,SUP,HCPCS C1713,,7738482  -  PLATE BN 82MM HLX LVL 4 TI SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7738486,SUP,HCPCS C1713,,7738486  -  PLATE BN 86MM HLX LVL 4 TI SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7738490,SUP,HCPCS C1713,,7738490  -  PLATE BN 90MM HLX LVL 4 TI SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7738500,SUP,HCPCS C1713,,7738500  -  PLATE BN 100MM HLX LVL 5 TI SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7738505,SUP,HCPCS C1713,,7738505  -  PLATE BN 105MM HLX LVL 5 TI SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7738510,SUP,HCPCS C1713,,7738510  -  PLATE BN 110MM HLX LVL 5 TI SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7738595,SUP,HCPCS C1713,,7738595  -  PLATE BN 95MM HLX LVL 5 TI SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7739111,SUP,HCPCS C1713,,7739111  -  SCREW BN 4MM 11MM NS HLX ACP SLF DRL VA SPNE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7739113,SUP,HCPCS C1713,,7739113  -  SCREW BN 4MM 13MM NS HLX-T SLF DRL VA SPNE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7739115,SUP,HCPCS C1713,,7739115  -  SCREW BN 4MM 15MM NS HLX-T SLF DRL VA SPNE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7739213,SUP,HCPCS C1713,,7739213  -  SCREW BN 4MM 13MM NS HLX-T ST VA SPNE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7739215,SUP,HCPCS C1713,,7739215  -  SCREW BN 4MM 15MM NS HLX-T ST VA SPNE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7739217,SUP,HCPCS C1713,,7739217  -  SCREW BN 4MM 17MM NS HLX ACP ST VA SPNE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7740120,SUP,HCPCS C1713,,7740120  -  PLATE BN MN 20MM HLX LVL 1 TI SPNE CRV ANT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7740122,SUP,HCPCS C1713,,7740122  -  PLATE BN MN 22MM HLX LVL 1 TI SPNE CRV ANT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7740124,SUP,HCPCS C1713,,7740124  -  PLATE BN MN 24MM HLX LVL 1 TI SPNE CRV ANT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7740126,SUP,HCPCS C1713,,7740126  -  PLATE BN MN 26MM HLX LVL 1 TI SPNE CRV ANT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7740128,SUP,HCPCS C1713,,7740128  -  PLATE BN MN 28MM HLX LVL 1 TI SPNE CRV ANT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7740130,SUP,HCPCS C1713,,7740130  -  PLATE BN MN 30MM HLX LVL 1 TI SPNE CRV ANT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7740132,SUP,HCPCS C1713,,7740132  -  PLATE BN MN 32MM HLX LVL 1 TI SPNE CRV ANT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7740134,SUP,HCPCS C1713,,7740134  -  PLATE BN MN 34MM HLX LVL 1 TI SPNE CRV ANT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7740236,SUP,HCPCS C1713,,7740236  -  PLATE BN MN 36MM HLX LVL 2 TI SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7740238,SUP,HCPCS C1713,,7740238  -  PLATE BN MN 38MM HLX LVL 2 TI SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7740240,SUP,HCPCS C1713,,7740240  -  PLATE BONE 40MM LEVEL 2 HELIX MINI TITANIUM SPN CERV,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7740242,SUP,HCPCS C1713,,7740242  -  PLATE BN MN 42MM HLX LVL 2 TI SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7740244,SUP,HCPCS C1713,,7740244  -  PLATE BN MN 44MM HLX LVL 2 TI SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7740246,SUP,HCPCS C1713,,7740246  -  PLATE BN MN 46MM HLX LVL 2 TI SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7740248,SUP,HCPCS C1713,,7740248  -  PLATE BN MN 48MM HLX LVL 2 TI SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7740250,SUP,HCPCS C1713,,7740250  -  PLATE BN MN 50MM HLX LVL 2 TI SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7741111,SUP,HCPCS C1713,,7741111  -  SCREW BN HEX 4MM 11MM VA SLF DRL SPNE CRV ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7741113,SUP,HCPCS C1713,,7741113  -  SCREW BN HEX 4MM 13MM VA SLF DRL SPNE CRV ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7741115,SUP,HCPCS C1713,,7741115  -  SCREW BN HEX 4MM 15MM VA SLF DRL SPNE CRV ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7742111,SUP,HCPCS C1713,,7742111  -  SCREW BN 4MM 11MM FX ANG SLF DRL SPNE CRV ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7742113,SUP,HCPCS C1713,,7742113  -  SCREW BN 4MM 13MM FX ANG SLF DRL SPNE CRV ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7742115,SUP,HCPCS C1713,,7742115  -  SCREW BN 4MM 15MM FX ANG SLF DRL SPNE CRV ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7746111,SUP,HCPCS C1713,,7746111  -  SCREW BN 4.5MM 11MM FX ANG ST SPNE CRV ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7746113,SUP,HCPCS C1713,,7746113  -  SCREW BN 4.5MM 13MM FX ANG ST SPNE CRV ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7746115,SUP,HCPCS C1713,,7746115  -  SCREW BN 4.5MM 15MM FX ANG ST SPNE CRV ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7747111,SUP,HCPCS C1713,,7747111  -  SCREW BN 4MM 11MM FX ANG ST SPNE CRV ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7747113,SUP,HCPCS C1713,,7747113  -  SCREW BONE 13MM FIX ANGLE SELF TAP 4MM SPN CERV ANTERIOR,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7747115,SUP,HCPCS C1713,,7747115  -  SCREW BN 4MM 15MM FX ANG ST SPNE CRV ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7748111,SUP,HCPCS C1713,,7748111  -  SCREW BN 4MM 11MM VA ST SPNE CRV ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7748113,SUP,HCPCS C1713,,7748113  -  SCREW BONE 13MM VAR ANG SELF TAP 4MM SPN CERV ANTERIOR,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7748115,SUP,HCPCS C1713,,7748115  -  SCREW BN 4MM 15MM VA ST SPNE CRV ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7750010,SUP,HCPCS C1713,,7750010  -  ROD 7750010 3.5MM ROD 120MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7750015,SUP,HCPCS C1713,,7750015  -  ROD 7750015 3.5MM ROD 240MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7750020,SUP,HCPCS C1713,,7750020  -  ROD 7750020 3.5MM ROD 300MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7750086,SUP,HCPCS C1713,,7750086  -  ROD 7750086 3.5MM CHROMALOY PLUS 120MM,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
7750087,SUP,HCPCS C1713,,7750087  -  ROD 7750087 3.5MM CHROMALOY PLUS 240MM,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
7750088,SUP,HCPCS C1713,,7750088  -  ROD 7750088 3.5MM CHROMALOY PLUS 300MM,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
7750346,SUP,Custom 27803010,,7750346  -  CONNECTOR 7750346 DMNO3.5 4.0 TO 3.5 4.0,"$1,458.00",$0.00,"$1,458.00",$0.00,"$1,040.57",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,458.00",$0.00,$729.00,"$1,154.74","$1,166.40",$0.00,$0.00,$0.00,$0.00,$0.00
7750347,SUP,Custom 27803010,,7750347  -  CONNECTOR 7750347 AX DOMNO3.5 4.0 TO 4.5,"$1,458.00",$0.00,"$1,458.00",$0.00,"$1,040.57",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,458.00",$0.00,$729.00,"$1,154.74","$1,166.40",$0.00,$0.00,$0.00,$0.00,$0.00
7750348,SUP,Custom 27803010,,7750348  -  CONNECTOR 7750348 AX DOMNO3.5 4.0 TO 5.5,"$1,458.00",$0.00,"$1,458.00",$0.00,"$1,040.57",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,458.00",$0.00,$729.00,"$1,154.74","$1,166.40",$0.00,$0.00,$0.00,$0.00,$0.00
7750443,SUP,HCPCS C1713,,"7750443  -  DOMINO 7750443 OFFSET 3.2,3.5 TO 3.2,3.5","$1,458.00",$0.00,"$1,458.00",$656.10,"$1,040.57",$0.00,$251.21,$0.00,$0.00,$255.28,"$1,458.00",$0.00,$729.00,"$1,154.74","$1,166.40",$0.00,$228.18,$0.00,$232.11,$0.00
7750444,SUP,HCPCS C1713,,7750444  -  DOMINO 7750444 OFSET 3.2-3.5 TO 4.5-4.75,"$1,458.00",$0.00,"$1,458.00",$656.10,"$1,040.57",$0.00,$251.21,$0.00,$0.00,$255.28,"$1,458.00",$0.00,$729.00,"$1,154.74","$1,166.40",$0.00,$228.18,$0.00,$232.11,$0.00
7750445,SUP,HCPCS C1713,,"7750445  -  DOMINO 7750445 OFFSET 3.2, 3.5 TO 5.5","$1,458.00",$0.00,"$1,458.00",$656.10,"$1,040.57",$0.00,$251.21,$0.00,$0.00,$255.28,"$1,458.00",$0.00,$729.00,"$1,154.74","$1,166.40",$0.00,$228.18,$0.00,$232.11,$0.00
7750506,SUP,HCPCS C1713,,7750506  -  SCREW BN 4.5MM 6MM VRTX SLCT TI SPNE OCPTL,$719.00,$0.00,$719.00,$323.55,$513.15,$0.00,$123.88,$0.00,$0.00,$125.89,$719.00,$0.00,$359.50,$569.45,$575.20,$0.00,$112.52,$0.00,$114.46,$0.00
7750508,SUP,HCPCS C1713,,7750508  -  SCREW BN 4.5MM 8MM VRTX SLCT TI SPNE OCPTL,$719.00,$0.00,$719.00,$323.55,$513.15,$0.00,$123.88,$0.00,$0.00,$125.89,$719.00,$0.00,$359.50,$569.45,$575.20,$0.00,$112.52,$0.00,$114.46,$0.00
7750510,SUP,HCPCS C1713,,7750510  -  SCREW BN 4.5MM 10MM VRTX TI SPNE CRV OCPTL CORT ANT,$719.00,$0.00,$719.00,$323.55,$513.15,$0.00,$123.88,$0.00,$0.00,$125.89,$719.00,$0.00,$359.50,$569.45,$575.20,$0.00,$112.52,$0.00,$114.46,$0.00
7750512,SUP,HCPCS C1713,,7750512  -  SCREW BN 4.5MM 12MM VRTX SLCT TI SPNE OCPTL,$719.00,$0.00,$719.00,$323.55,$513.15,$0.00,$123.88,$0.00,$0.00,$125.89,$719.00,$0.00,$359.50,$569.45,$575.20,$0.00,$112.52,$0.00,$114.46,$0.00
7750514,SUP,HCPCS C1713,,7750514  -  SCREW BN 4.5MM 14MM VRTX TI SPNE CRV OCPTL CORT ANT,$719.00,$0.00,$719.00,$323.55,$513.15,$0.00,$123.88,$0.00,$0.00,$125.89,$719.00,$0.00,$359.50,$569.45,$575.20,$0.00,$112.52,$0.00,$114.46,$0.00
7750516,SUP,HCPCS C1713,,7750516  -  SCREW BN 4.5MM 16MM VRTX TI SPNE CRV OCPTL CORT ANT,$719.00,$0.00,$719.00,$323.55,$513.15,$0.00,$123.88,$0.00,$0.00,$125.89,$719.00,$0.00,$359.50,$569.45,$575.20,$0.00,$112.52,$0.00,$114.46,$0.00
7750518,SUP,HCPCS C1713,,7750518  -  SCREW BN 4.5MM 18MM VRTX TI SPNE CRV OCPTL CORT ANT,$719.00,$0.00,$719.00,$323.55,$513.15,$0.00,$123.88,$0.00,$0.00,$125.89,$719.00,$0.00,$359.50,$569.45,$575.20,$0.00,$112.52,$0.00,$114.46,$0.00
7750606,SUP,HCPCS C1713,,7750606  -  SCREW BN 5MM 6MM VRTX TI SPNE CRV OCPTL CORT ANT,$719.00,$0.00,$719.00,$323.55,$513.15,$0.00,$123.88,$0.00,$0.00,$125.89,$719.00,$0.00,$359.50,$569.45,$575.20,$0.00,$112.52,$0.00,$114.46,$0.00
7750608,SUP,HCPCS C1713,,7750608  -  SCREW BONE 4MM 8MM CORT,$719.00,$0.00,$719.00,$323.55,$513.15,$0.00,$123.88,$0.00,$0.00,$125.89,$719.00,$0.00,$359.50,$569.45,$575.20,$0.00,$112.52,$0.00,$114.46,$0.00
7750610,SUP,HCPCS C1713,,7750610  -  SCREW BN 5MM 10MM VRTX TI SPNE CRV OCPTL CORT ANT,$719.00,$0.00,$719.00,$323.55,$513.15,$0.00,$123.88,$0.00,$0.00,$125.89,$719.00,$0.00,$359.50,$569.45,$575.20,$0.00,$112.52,$0.00,$114.46,$0.00
7750612,SUP,HCPCS C1713,,7750612  -  SCREW BN 5MM 12MM VRTX TI SPNE CRV OCPTL CORT ANT,$719.00,$0.00,$719.00,$323.55,$513.15,$0.00,$123.88,$0.00,$0.00,$125.89,$719.00,$0.00,$359.50,$569.45,$575.20,$0.00,$112.52,$0.00,$114.46,$0.00
7750614,SUP,HCPCS C1713,,7750614  -  SCREW BN 5MM 14MM VRTX TI SPNE CRV OCPTL CORT ANT,$719.00,$0.00,$719.00,$323.55,$513.15,$0.00,$123.88,$0.00,$0.00,$125.89,$719.00,$0.00,$359.50,$569.45,$575.20,$0.00,$112.52,$0.00,$114.46,$0.00
7750616,SUP,HCPCS C1713,,7750616  -  SCREW BN 5MM 16MM VRTX TI SPNE CRV OCPTL CORT ANT,$719.00,$0.00,$719.00,$323.55,$513.15,$0.00,$123.88,$0.00,$0.00,$125.89,$719.00,$0.00,$359.50,$569.45,$575.20,$0.00,$112.52,$0.00,$114.46,$0.00
7750618,SUP,HCPCS C1713,,7750618  -  SCREW BN 5MM 18MM VRTX TI SPNE CRV OCPTL CORT ANT,$719.00,$0.00,$719.00,$323.55,$513.15,$0.00,$123.88,$0.00,$0.00,$125.89,$719.00,$0.00,$359.50,$569.45,$575.20,$0.00,$112.52,$0.00,$114.46,$0.00
7751101,SUP,HCPCS C1713,,7751101  -  POSTED SCREW CONNECTOR 7751101 SMALL,"$1,794.00",$0.00,"$1,794.00",$807.30,"$1,280.38",$0.00,$309.10,$0.00,$0.00,$314.12,"$1,794.00",$0.00,$897.00,"$1,420.85","$1,435.20",$0.00,$280.76,$0.00,$285.60,$0.00
7751103,SUP,HCPCS C1713,,7751103  -  POSTED SCREW CONNECTOR 7751103 MEDIUM,"$1,794.00",$0.00,"$1,794.00",$807.30,"$1,280.38",$0.00,$309.10,$0.00,$0.00,$314.12,"$1,794.00",$0.00,$897.00,"$1,420.85","$1,435.20",$0.00,$280.76,$0.00,$285.60,$0.00
7751105,SUP,HCPCS C1713,,7751105  -  POSTED SCREW CONNECTOR 7751105 LARGE,"$1,794.00",$0.00,"$1,794.00",$807.30,"$1,280.38",$0.00,$309.10,$0.00,$0.00,$314.12,"$1,794.00",$0.00,$897.00,"$1,420.85","$1,435.20",$0.00,$280.76,$0.00,$285.60,$0.00
7751110,SUP,Custom 27803010,,7751110  -  CONNECTOR 7751110 OPEN CABLE CONN,"$1,155.00",$0.00,"$1,155.00",$0.00,$824.32,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,155.00",$0.00,$577.50,$914.76,$924.00,$0.00,$0.00,$0.00,$0.00,$0.00
7751710,SUP,HCPCS C1713,,7751710  -  SCREW 7751710 3.5 X 10MM POSTED,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751712,SUP,HCPCS C1713,,7751712  -  SCREW 7751712 3.5 X 12MM POSTED,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751714,SUP,HCPCS C1713,,7751714  -  SCREW 7751714 3.5 X 14MM POSTED,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751716,SUP,HCPCS C1713,,7751716  -  SCREW 7751716 3.5 X 16MM POSTED,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751718,SUP,HCPCS C1713,,7751718  -  SCREW 7751718 3.5 X 18MM POSTED,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751720,SUP,HCPCS C1713,,7751720  -  SCREW 7751720 3.5 X 20MM POSTED,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751722,SUP,HCPCS C1713,,7751722  -  SCREW 7751722 3.5 X 22MM POSTED,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751724,SUP,HCPCS C1713,,7751724  -  SCREW 7751724 3.5 X 24MM POSTED,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751726,SUP,HCPCS C1713,,7751726  -  SCREW 7751726 3.5 X 26MM POSTED,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751728,SUP,HCPCS C1713,,7751728  -  SCREW 7751728 3.5 X 28MM POSTED,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751730,SUP,HCPCS C1713,,7751730  -  SCREW 7751730 3.5 X 30MM POSTED,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751732,SUP,HCPCS C1713,,7751732  -  SCREW 7751732 3.5 X 32MM POSTED,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751734,SUP,HCPCS C1713,,7751734  -  SCREW 7751734 3.5 X 34MM POSTED,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751810,SUP,HCPCS C1713,,7751810  -  SCREW 7751810 4.0 X 10MM POSTED,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751812,SUP,HCPCS C1713,,7751812  -  SCREW 7751812 4.0 X 12MM POSTED,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751814,SUP,HCPCS C1713,,7751814  -  SCREW 7751814 4.0 X 14MM POSTED,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751816,SUP,HCPCS C1713,,7751816  -  SCREW 7751816 4.0 X 16MM POSTED,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751818,SUP,HCPCS C1713,,7751818  -  SCREW 7751818 4.0 X 18MM POSTED,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751820,SUP,HCPCS C1713,,7751820  -  SCREW 7751820 4.0 X 20MM POSTED,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751822,SUP,HCPCS C1713,,7751822  -  SCREW 7751822 4.0 X 22MM POSTED,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751824,SUP,HCPCS C1713,,7751824  -  SCREW 7751824 4.0 X 24MM POSTED,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751826,SUP,HCPCS C1713,,7751826  -  SCREW 7751826 4.0 X 26MM POSTED,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751828,SUP,HCPCS C1713,,7751828  -  SCREW 7751828 4.0 X 28MM POSTED,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751830,SUP,HCPCS C1713,,7751830  -  SCREW 7751830 4.0 X 30MM POSTED,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751832,SUP,HCPCS C1713,,7751832  -  SCREW 7751832 4.0 X 32MM POSTED,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751834,SUP,HCPCS C1713,,7751834  -  SCREW 7751834 4.0 X 34MM POSTED,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751924,SUP,HCPCS C1713,,7751924  -  SCREW 7751924 4.5 X 24MM POSTED,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751926,SUP,HCPCS C1713,,7751926  -  SCREW 7751926 4.5 X 26MM POSTED,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751928,SUP,HCPCS C1713,,7751928  -  SCREW 7751928 4.5 X 28MM POSTED,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751930,SUP,HCPCS C1713,,7751930  -  SCREW 7751930 4.5 X 30MM POSTED,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751932,SUP,HCPCS C1713,,7751932  -  SCREW 7751932 4.5 X 32MM POSTED,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751934,SUP,HCPCS C1713,,7751934  -  SCREW 7751934 4.5 X 34MM POSTED,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7752510,SUP,HCPCS C1713,,7752510  -  SET SCREW 7752510 CROSSLINK,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
7752515,SUP,HCPCS C1713,,7752515  -  SCREW 7752515 FLAT CONNECTOR SETSCREW,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
7752525,SUP,HCPCS C1713,,7752525  -  CROSSLINK 7752525 SMALL MAS,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7752526,SUP,HCPCS C1713,,7752526  -  CROSSLINK 7752526 MEDIUM MAS,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7752527,SUP,HCPCS C1713,,7752527  -  CROSSLINK 7752527 LARGE MAS,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7752528,SUP,Custom 27803010,,7752528  -  CONNECTOR 7752528 MAS CROSSLINK ROD,$719.00,$0.00,$719.00,$0.00,$513.15,$0.00,$0.00,$0.00,$0.00,$0.00,$719.00,$0.00,$359.50,$569.45,$575.20,$0.00,$0.00,$0.00,$0.00,$0.00
7752529,SUP,HCPCS C1713,,7752529  -  SCREW 7752529 MAS CROSSLINK LOCKING,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
7752535,SUP,HCPCS C1713,,7752535  -  CROSSLINK 7752535 SMALL ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7752536,SUP,HCPCS C1713,,7752536  -  CROSSLINK 7752536 MEDIUM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7752537,SUP,HCPCS C1713,,7752537  -  CROSSLINK 7752537 LARGE ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7753500,SUP,HCPCS C1713,,7753500  -  SET SCREW 7753500 MAS CONNECTOR,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
7753520,SUP,HCPCS C1713,,"7753520  -  SET SCREW 7753520 MAS EXT.,  LAT. CONN",$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
7753730,SUP,HCPCS C1713,,7753730  -  ROD SPINAL 30MM PRECUT VERTEX 3.5MM NONSTRL,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7753740,SUP,HCPCS C1713,,7753740  -  ROD SPNL 40MM 3.5MM VRTX PCUT,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7753750,SUP,HCPCS C1713,,7753750  -  ROD SPINAL 3.5MM 50MM PRECUT VERTEX NONSTRL,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7753760,SUP,HCPCS C1713,,7753760  -  ROD SPINAL 3.5MM 60MM PRECUT VERTEX SELECT,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7753770,SUP,HCPCS C1713,,7753770  -  ROD SPINAL 70MM PRECUT CCM PLUS 3.5MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7753780,SUP,HCPCS C1713,,7753780  -  ROD SPINAL 80MM PRECUT TITANIUM 3.5MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7753806,SUP,HCPCS C1713,,7753806  -  ROD SPINAL 420MM CCM PLUS STAINLESS STEEL 4.75MM 3.5MM,"$2,362.50",$0.00,"$2,362.50","$1,063.13","$1,686.12",$0.00,$407.05,$0.00,$0.00,$413.65,"$2,362.50",$0.00,"$1,181.25","$1,871.10","$1,890.00",$0.00,$369.73,$0.00,$376.11,$0.00
7753880,SUP,HCPCS C1713,,7753880  -  ROD SPINAL 80MM PRECUT CCM PLUS 3.5MM,"$1,252.50",$0.00,"$1,252.50",$563.63,$893.91,$0.00,$215.80,$0.00,$0.00,$219.30,"$1,252.50",$0.00,$626.25,$991.98,"$1,002.00",$0.00,$196.02,$0.00,$199.40,$0.00
7753890,SUP,HCPCS C1713,,7753890  -  ROD SPINAL 90MM PRECUT CCM PLUS 3.5MM,"$1,252.50",$0.00,"$1,252.50",$563.63,$893.91,$0.00,$215.80,$0.00,$0.00,$219.30,"$1,252.50",$0.00,$626.25,$991.98,"$1,002.00",$0.00,$196.02,$0.00,$199.40,$0.00
7753900,SUP,HCPCS C1713,,7753900  -  ROD SPINAL 100MM PRECUT CCM PLUS 3.5MM,"$1,252.50",$0.00,"$1,252.50",$563.63,$893.91,$0.00,$215.80,$0.00,$0.00,$219.30,"$1,252.50",$0.00,$626.25,$991.98,"$1,002.00",$0.00,$196.02,$0.00,$199.40,$0.00
7754525,SUP,HCPCS C1713,,7754525  -  SCREW BN 4.5MM 25MM CNN SHNK SPNE,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7754530,SUP,HCPCS C1713,,7754530  -  SCREW BN 4.5MM 35MM SHNK PPS SPNE,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7754535,SUP,HCPCS C1713,,7754535  -  SCREW BN 4.5MM 35MM CNN SHNK SPNE,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7754540,SUP,HCPCS C1713,,7754540  -  SCREW BN 4.5MM 40MM HLX-REV ACP SHNK PLYP-PHENYLENE SLF SPNE,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7754545,SUP,HCPCS C1713,,7754545  -  SCREW BN 4.5MM 45MM CNN SHNK SPNE,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7754550,SUP,HCPCS C1713,,7754550  -  SCREW BN 4.5MM 50MM CNN SHNK SPNE,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7755120,SUP,HCPCS C1713,,7755120  -  ROD SPNL 3.5MM HNG,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7755122,SUP,HCPCS C1713,,7755122  -  ROD SPNL 3.2/3.5MM 120MM HNG ADJ OCPTL,"$1,980.00",$0.00,"$1,980.00",$891.00,"$1,413.13",$0.00,$341.14,$0.00,$0.00,$346.68,"$1,980.00",$0.00,$990.00,"$1,568.16","$1,584.00",$0.00,$309.87,$0.00,$315.22,$0.00
7755123,SUP,HCPCS C1713,,7755123  -  ROD SPNL 3.5MM 3.2MM 220MM ADJ OCPTL,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7755124,SUP,HCPCS C1713,,7755124  -  ROD SPNL 3.5MM 220MM STRL VRTX ADJ TI OCPTL,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7755217,SUP,HCPCS C1713,,7755217  -  VERTEX SELECT PRE-CURVED OC ROD,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7755231,SUP,HCPCS C1713,,7755231  -  ROD SPNL 3.5MM 100MM OCPTL PLT,"$4,426.50",$0.00,"$4,426.50","$1,991.93","$3,159.19",$0.00,$762.66,$0.00,$0.00,$775.04,"$4,426.50",$0.00,"$2,213.25","$3,505.79","$3,541.20",$0.00,$692.75,$0.00,$704.70,$0.00
7755232,SUP,HCPCS C1713,,7755232  -  ROD SPNL 3.5MM 200MM PCRV PLT OCPTL,"$4,426.50",$0.00,"$4,426.50","$1,991.93","$3,159.19",$0.00,$762.66,$0.00,$0.00,$775.04,"$4,426.50",$0.00,"$2,213.25","$3,505.79","$3,541.20",$0.00,$692.75,$0.00,$704.70,$0.00
7755240,SUP,HCPCS C1713,,7755240  -  ROD SPNL 3.5MM 240MM VRTX THRD,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7755245,SUP,HCPCS C1713,,7755245  -  ROD THRD 4.5MM 360MM SPNE,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7755247,SUP,HCPCS C1713,,7755247  -  ROD SPNL 5.5MM 360MM VRTX THRD,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7755266,SUP,HCPCS C1713,,7755266  -  ROD SPNL P/T 4.75MM 360MM CIRC,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7755270,SUP,HCPCS C1713,,7755270  -  ROD SPNL 3.5MM 100MM PCRV,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7755271,SUP,HCPCS C1713,,7755271  -  ROD SPNL 3.5MM 200MM VRTX PCRV,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7755274,SUP,HCPCS C1713,,7755274  -  ROD 7755274 3.5 PRECURV CHROMALOY PL 100,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7755275,SUP,HCPCS C1713,,7755275  -  ROD SPNL CRV 3.5MM 200MM NS CHROMALOY +,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7755278,SUP,HCPCS C1713,,7755278  -  PLATE BN 50MM NS VRTX SLCT ADJ SPNE OCPTL RECON SYS,"$8,085.00",$0.00,"$8,085.00","$3,638.25","$5,158.80",$0.00,"$1,393.01",$0.00,$0.00,"$1,415.62","$8,085.00",$0.00,"$4,042.50","$6,403.32","$6,468.00",$0.00,"$1,265.30",$0.00,"$1,287.13",$0.00
7755325,SUP,HCPCS C1713,,7755325  -  CONNECTOR ROD SM LOPRFL SCR OCPTL SPNE,"$1,794.00",$0.00,"$1,794.00",$807.30,"$1,280.38",$0.00,$309.10,$0.00,$0.00,$314.12,"$1,794.00",$0.00,$897.00,"$1,420.85","$1,435.20",$0.00,$280.76,$0.00,$285.60,$0.00
7755327,SUP,HCPCS C1713,,7755327  -  SCREW BN OFST 27MM CNCT SPNE OCPTL,"$1,794.00",$0.00,"$1,794.00",$807.30,"$1,280.38",$0.00,$309.10,$0.00,$0.00,$314.12,"$1,794.00",$0.00,$897.00,"$1,420.85","$1,435.20",$0.00,$280.76,$0.00,$285.60,$0.00
7755530,SUP,HCPCS C1713,,7755530  -  SCREW BN 5.5MM 30MM CNN SHNK SPNE,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7755535,SUP,HCPCS C1713,,7755535  -  SCREW BN 5.5MM 35MM CNN SHNK SPNE,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7755540,SUP,HCPCS C1713,,7755540  -  SCREW BN 5.5MM 40MM CNN TI SPNE,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7755545,SUP,HCPCS C1713,,7755545  -  SCREW BN 5.5MM 45MM CNN TI SPNE,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7755550,SUP,HCPCS C1713,,7755550  -  SCREW BN 5.5MM 50MM CNN SHNK SPNE,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7755555,SUP,HCPCS C1713,,7755555  -  SCREW BN 5.5MM 55MM HLX-REV ACP SHNK SPNE,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7756007,SUP,Custom 27203010,,7756007  -  BIT DRILL 2.4MM,$660.00,$0.00,$660.00,$0.00,$471.04,$0.00,$0.00,$0.00,$0.00,$0.00,$660.00,$0.00,$330.00,$522.72,$528.00,$0.00,$0.00,$0.00,$0.00,$0.00
7756010,SUP,Custom 27203010,,7756010  -  BIT DRL 2.4MM STRL VRTX SLCT DISP,$660.00,$0.00,$660.00,$0.00,$471.04,$0.00,$0.00,$0.00,$0.00,$0.00,$660.00,$0.00,$330.00,$522.72,$528.00,$0.00,$0.00,$0.00,$0.00,$0.00
7756035,SUP,Custom 27203010,,7756035  -  TAP SURG INSTR 3.5MM,"$1,038.00",$0.00,"$1,038.00",$0.00,$740.82,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,038.00",$0.00,$519.00,$822.10,$830.40,$0.00,$0.00,$0.00,$0.00,$0.00
7756064,SUP,Custom 27803010,,"7756064  -  LATERAL CONNECTOR 7756064 OPEN, 10MM","$1,077.00",$0.00,"$1,077.00",$0.00,$768.65,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,077.00",$0.00,$538.50,$852.98,$861.60,$0.00,$0.00,$0.00,$0.00,$0.00
7756066,SUP,Custom 27803010,,"7756066  -  LATERAL CONNECTOR 7756066 OPEN, 13MM","$1,077.00",$0.00,"$1,077.00",$0.00,$768.65,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,077.00",$0.00,$538.50,$852.98,$861.60,$0.00,$0.00,$0.00,$0.00,$0.00
7756067,SUP,Custom 27803010,,"7756067  -  LATERAL CONNECTOR 7756067 CLOSED, 10MM","$1,018.50",$0.00,"$1,018.50",$0.00,$726.90,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,018.50",$0.00,$509.25,$806.65,$814.80,$0.00,$0.00,$0.00,$0.00,$0.00
7756068,SUP,Custom 27803010,,"7756068  -  LATERAL CONNECTOR 7756068 CLOSED, 13MM","$1,018.50",$0.00,"$1,018.50",$0.00,$726.90,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,018.50",$0.00,$509.25,$806.65,$814.80,$0.00,$0.00,$0.00,$0.00,$0.00
7756069,SUP,Custom 27803010,,"7756069  -  MAS EXTENSION CONN. 7756069 3.2, 3.5MM","$1,077.00",$0.00,"$1,077.00",$0.00,$768.65,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,077.00",$0.00,$538.50,$852.98,$861.60,$0.00,$0.00,$0.00,$0.00,$0.00
7756071,SUP,Custom 27803010,,7756071  -  CONNECTOR MAS EXT 7756071 4.5-4.75MM,"$1,077.00",$0.00,"$1,077.00",$0.00,$768.65,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,077.00",$0.00,$538.50,$852.98,$861.60,$0.00,$0.00,$0.00,$0.00,$0.00
7756072,SUP,Custom 27803010,,7756072  -  MAS EXTENSION CONN. 7756072 5.5MM,"$1,077.00",$0.00,"$1,077.00",$0.00,$768.65,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,077.00",$0.00,$538.50,$852.98,$861.60,$0.00,$0.00,$0.00,$0.00,$0.00
7756073,SUP,HCPCS C1713,,"7756073  -  HOOK 7756073 LAMINAR, 4.5MM","$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7756074,SUP,HCPCS C1713,,"7756074  -  HOOK 7756074 LAMINAR, 6.0MM","$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7756131,SUP,Custom 27203010,,7756131  -  DRILL BIT 7756131 3.2MM DRILL BIT,$676.50,$0.00,$676.50,$0.00,$482.82,$0.00,$0.00,$0.00,$0.00,$0.00,$676.50,$0.00,$338.25,$535.79,$541.20,$0.00,$0.00,$0.00,$0.00,$0.00
7756133,SUP,Custom 27203010,,7756133  -  DRILL BIT 7756133 3.2MM DRILL BIT,$676.50,$0.00,$676.50,$0.00,$482.82,$0.00,$0.00,$0.00,$0.00,$0.00,$676.50,$0.00,$338.25,$535.79,$541.20,$0.00,$0.00,$0.00,$0.00,$0.00
7756300,SUP,Custom 27203010,,7756300  -  TAP SPINAL VERTEX SELECT 3MM,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
7756530,SUP,HCPCS C1713,,7756530  -  SCREW BN 6.5MM 30MM CNN SHNK SPNE,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7756535,SUP,HCPCS C1713,,7756535  -  SCREW BN 6.5MM 35MM CNN TI SPNE,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7756540,SUP,HCPCS C1713,,7756540  -  SCREW BN 6.5MM 40MM CNN TI SPNE,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7756545,SUP,HCPCS C1713,,7756545  -  SCREW BN 6.5MM 45MM CNN SHNK SPNE,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7756550,SUP,HCPCS C1713,,7756550  -  SCREW BN 6.5MM 50MM CNN TI SPNE,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7756555,SUP,HCPCS C1713,,7756555  -  SCREW BN 6.5MM 55MM NEURO SHNK SPNE,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7757530,SUP,HCPCS C1713,,7757530  -  SCREW BN 7.5MM 30MM CNN SHNK SPNE,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7757535,SUP,HCPCS C1713,,7757535  -  SCREW BN 7.5MM 35MM SHNK CNN SPNE,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7757540,SUP,HCPCS C1713,,7757540  -  SCREW BN 7.5MM 40MM CNN TI SPNE,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7757545,SUP,HCPCS C1713,,7757545  -  SCREW BN 7.5MM 45MM CNN SHNK SPNE,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7757550,SUP,HCPCS C1713,,7757550  -  SCREW BN 7.5MM 50MM SPHERX PPS CNN SHNK SPNE,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7757555,SUP,HCPCS C1713,,7757555  -  SCREW BN 7.5MM 55MM CNN SHNK SPNE,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7758535,SUP,HCPCS C1713,,7758535  -  SCREW BN 8.5MM 35MM CNN SHNK SPNE,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7758540,SUP,HCPCS C1713,,7758540  -  SCREW BN 8.5MM 40MM CNN SHNK SPNE,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7758545,SUP,HCPCS C1713,,7758545  -  SCREW BN 8.5MM 45MM CNN SHNK SPNE,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7758550,SUP,HCPCS C1713,,7758550  -  SCREW BN 8.5MM 50MM CNN SHNK SPNE,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7759970,SUP,HCPCS C1713,,7759970  -  PLATE BN SM LOPRFL VRTX SLCT LCK SLCT SPNE OC,"$7,095.00",$0.00,"$7,095.00","$3,192.75","$5,063.70",$0.00,"$1,222.43",$0.00,$0.00,"$1,242.28","$7,095.00",$0.00,"$3,547.50","$5,619.24","$5,676.00",$0.00,"$1,110.37",$0.00,"$1,129.52",$0.00
7759971,SUP,HCPCS C1713,,7759971  -  PLATE BN MED LOPRFL VRTX SLCT LCK SLCT SPNE OC,"$7,095.00",$0.00,"$7,095.00","$3,192.75","$5,063.70",$0.00,"$1,222.43",$0.00,$0.00,"$1,242.28","$7,095.00",$0.00,"$3,547.50","$5,619.24","$5,676.00",$0.00,"$1,110.37",$0.00,"$1,129.52",$0.00
7759972,SUP,HCPCS C1713,,7759972  -  PLATE BN LG LOPRFL VRTX SLCT LCK SLCT SPNE OC,"$7,095.00",$0.00,"$7,095.00","$3,192.75","$5,063.70",$0.00,"$1,222.43",$0.00,$0.00,"$1,242.28","$7,095.00",$0.00,"$3,547.50","$5,619.24","$5,676.00",$0.00,"$1,110.37",$0.00,"$1,129.52",$0.00
7764525,SUP,HCPCS C1713,,7764525  -  SCREW BN 4.5MM 25MM NCLNLT SHNK SPNE,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7764530,SUP,HCPCS C1713,,7764530  -  SCREW BN 4.5MM 30MM NCLNLT SHNK SPNE,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7764535,SUP,HCPCS C1713,,7764535  -  SCREW BN 4.5MM 35MM NCLNLT SHNK SPNE,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7764540,SUP,HCPCS C1713,,7764540  -  SCREW BN 4.5MM 40MM NCLNLT SHNK SPNE,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7764545,SUP,HCPCS C1713,,7764545  -  SCREW BN 4.5MM 45MM NCLNLT SHNK SPNE,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7765530,SUP,HCPCS C1713,,7765530  -  SCREW BN 5.5MM 30MM NCLNLT SHNK SPNE,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7765535,SUP,HCPCS C1713,,7765535  -  SCREW BN 5.5MM 35MM NCLNLT SHNK SPNE,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7765540,SUP,HCPCS C1713,,7765540  -  SCREW BN 5.5MM 40MM NCLNLT SHNK SPNE,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7765545,SUP,HCPCS C1713,,7765545  -  SCREW BN 5.5MM 45MM NCLNLT SHNK SPNE,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7765550,SUP,HCPCS C1713,,7765550  -  SCREW BN 5.5MM 50MM NCLNLT SHNK SPNE,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7765555,SUP,HCPCS C1713,,7765555  -  SCREW BN 5.5MM 55MM NCLNLT SHNK SPNE,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7765560,SUP,HCPCS C1713,,7765560  -  SCREW BN 5.5MM 60MM NCLNLT SHNK SPNE,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7766530,SUP,HCPCS C1713,,7766530  -  SCREW BN 6.5MM 30MM NCLNLT SHNK SPNE,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7766535,SUP,HCPCS C1713,,7766535  -  SCREW BN 6.5MM 35MM NCLNLT SHNK SPNE,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7766540,SUP,HCPCS C1713,,7766540  -  SCREW BN 6.5MM 40MM NCLNLT SHNK SPNE,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7766545,SUP,HCPCS C1713,,7766545  -  SCREW BN 6.5MM 45MM TI SPNE,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7766550,SUP,HCPCS C1713,,7766550  -  SCREW BN 6.5MM 50MM NCLNLT SHNK SPNE,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7766555,SUP,HCPCS C1713,,7766555  -  SCREW BN 6.5MM 55MM NCLNLT SHNK SPNE,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7766560,SUP,HCPCS C1713,,7766560  -  SCREW BN 6.5MM 60MM NCLNLT SHNK SPNE,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7767530,SUP,HCPCS C1713,,7767530  -  SCREW BN 7.5MM 30MM NCLNLT SHNK SPNE,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7767535,SUP,HCPCS C1713,,7767535  -  SCREW BN 7.5MM 35MM NCLNLT SHNK SPNE,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7767540,SUP,HCPCS C1713,,7767540  -  SCREW BN 7.5MM 40MM NCLNLT SHNK SPNE,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7767545,SUP,HCPCS C1713,,7767545  -  SCREW BN 7.5MM 45MM NCLNLT SHNK SPNE,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7767550,SUP,HCPCS C1713,,7767550  -  SCREW BN 7.5MM 50MM NCLNLT SHNK SPNE,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7767555,SUP,HCPCS C1713,,7767555  -  SCREW BN 7.5MM 55MM NCLNLT SHNK SPNE,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7767560,SUP,HCPCS C1713,,7767560  -  SCREW BN 7.5MM 60MM NCLNLT SHNK SPNE,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7768535,SUP,HCPCS C1713,,7768535  -  SCREW BN 8.5MM 35MM NCLNLT SHNK SPNE,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7768540,SUP,HCPCS C1713,,7768540  -  SCREW BN 8.5MM 40MM NCLNLT SHNK SPNE,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7768545,SUP,HCPCS C1713,,7768545  -  SCREW BN 8.5MM 45MM NCLNLT SHNK SPNE,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7768550,SUP,HCPCS C1713,,7768550  -  SCREW BN 8.5MM 50MM NCLNLT SHNK SPNE,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
7770723,SUP,HCPCS C1713,,7770723  -  SPACER SPNL XLORDOTIC 23MMX7MM STRL ELEV PEEK TI,"$11,698.50",$0.00,"$11,698.50","$5,264.33","$5,158.80",$0.00,"$2,015.59",$0.00,$0.00,"$2,048.31","$11,698.50",$0.00,"$5,849.25","$9,265.21","$9,358.80",$0.00,"$1,830.82",$0.00,"$1,862.40",$0.00
7770728,SUP,HCPCS C1713,,7770728  -  SPACER SPNL XLORDOTIC 28MMX7MM STRL ELEV PEEK TI,"$11,698.50",$0.00,"$11,698.50","$5,264.33","$5,158.80",$0.00,"$2,015.59",$0.00,$0.00,"$2,048.31","$11,698.50",$0.00,"$5,849.25","$9,265.21","$9,358.80",$0.00,"$1,830.82",$0.00,"$1,862.40",$0.00
7770732,SUP,HCPCS C1713,,7770732  -  SPACER SPNL XLORDOTIC 32MMX7MM STRL ELEV PEEK TI,"$11,698.50",$0.00,"$11,698.50","$5,264.33","$5,158.80",$0.00,"$2,015.59",$0.00,$0.00,"$2,048.31","$11,698.50",$0.00,"$5,849.25","$9,265.21","$9,358.80",$0.00,"$1,830.82",$0.00,"$1,862.40",$0.00
7770823,SUP,HCPCS C1713,,7770823  -  SPACER SPNL STD 23MMX8MM STRL ELEV PEEK TI,"$11,698.50",$0.00,"$11,698.50","$5,264.33","$5,158.80",$0.00,"$2,015.59",$0.00,$0.00,"$2,048.31","$11,698.50",$0.00,"$5,849.25","$9,265.21","$9,358.80",$0.00,"$1,830.82",$0.00,"$1,862.40",$0.00
7770828,SUP,HCPCS C1713,,7770828  -  SPACER SPNL STD 28MMX8MM STRL ELEV PEEK TI,"$11,698.50",$0.00,"$11,698.50","$5,264.33","$5,158.80",$0.00,"$2,015.59",$0.00,$0.00,"$2,048.31","$11,698.50",$0.00,"$5,849.25","$9,265.21","$9,358.80",$0.00,"$1,830.82",$0.00,"$1,862.40",$0.00
7770832,SUP,HCPCS C1713,,7770832  -  SPACER SPNL STD 32MMX8MM STRL ELEV PEEK TI,"$11,698.50",$0.00,"$11,698.50","$5,264.33","$5,158.80",$0.00,"$2,015.59",$0.00,$0.00,"$2,048.31","$11,698.50",$0.00,"$5,849.25","$9,265.21","$9,358.80",$0.00,"$1,830.82",$0.00,"$1,862.40",$0.00
7770923,SUP,HCPCS C1713,,7770923  -  SPACER SPNL STD 23MMX9MM STRL ELEV PEEK TI,"$11,698.50",$0.00,"$11,698.50","$5,264.33","$5,158.80",$0.00,"$2,015.59",$0.00,$0.00,"$2,048.31","$11,698.50",$0.00,"$5,849.25","$9,265.21","$9,358.80",$0.00,"$1,830.82",$0.00,"$1,862.40",$0.00
7770928,SUP,HCPCS C1713,,7770928  -  SPACER SPNL STD 28MMX9MM STRL ELEV PEEK TI,"$11,698.50",$0.00,"$11,698.50","$5,264.33","$5,158.80",$0.00,"$2,015.59",$0.00,$0.00,"$2,048.31","$11,698.50",$0.00,"$5,849.25","$9,265.21","$9,358.80",$0.00,"$1,830.82",$0.00,"$1,862.40",$0.00
7770932,SUP,HCPCS C1713,,7770932  -  SPACER SPNL STD 32MMX9MM STRL ELEV PEEK TI,"$11,698.50",$0.00,"$11,698.50","$5,264.33","$5,158.80",$0.00,"$2,015.59",$0.00,$0.00,"$2,048.31","$11,698.50",$0.00,"$5,849.25","$9,265.21","$9,358.80",$0.00,"$1,830.82",$0.00,"$1,862.40",$0.00
7771023,SUP,HCPCS C1713,,7771023  -  SPACER SPNL STD 23MMX10MM STRL ELEV PEEK TI,"$11,698.50",$0.00,"$11,698.50","$5,264.33","$5,158.80",$0.00,"$2,015.59",$0.00,$0.00,"$2,048.31","$11,698.50",$0.00,"$5,849.25","$9,265.21","$9,358.80",$0.00,"$1,830.82",$0.00,"$1,862.40",$0.00
7771028,SUP,HCPCS C1713,,7771028  -  SPACER SPNL STD 28MMX10MM STRL ELEV PEEK TI,"$11,698.50",$0.00,"$11,698.50","$5,264.33","$5,158.80",$0.00,"$2,015.59",$0.00,$0.00,"$2,048.31","$11,698.50",$0.00,"$5,849.25","$9,265.21","$9,358.80",$0.00,"$1,830.82",$0.00,"$1,862.40",$0.00
7771032,SUP,HCPCS C1713,,7771032  -  SPACER SPNL STD 32MMX10MM STRL ELEV PEEK TI,"$11,698.50",$0.00,"$11,698.50","$5,264.33","$5,158.80",$0.00,"$2,015.59",$0.00,$0.00,"$2,048.31","$11,698.50",$0.00,"$5,849.25","$9,265.21","$9,358.80",$0.00,"$1,830.82",$0.00,"$1,862.40",$0.00
7771123,SUP,HCPCS C1713,,7771123  -  SPACER SPNL STD 23MMX11MM STRL ELEV PEEK TI,"$11,698.50",$0.00,"$11,698.50","$5,264.33","$5,158.80",$0.00,"$2,015.59",$0.00,$0.00,"$2,048.31","$11,698.50",$0.00,"$5,849.25","$9,265.21","$9,358.80",$0.00,"$1,830.82",$0.00,"$1,862.40",$0.00
7771128,SUP,HCPCS C1713,,7771128  -  SPACER SPNL STD 28MMX11MM STRL ELEV PEEK TI,"$11,698.50",$0.00,"$11,698.50","$5,264.33","$5,158.80",$0.00,"$2,015.59",$0.00,$0.00,"$2,048.31","$11,698.50",$0.00,"$5,849.25","$9,265.21","$9,358.80",$0.00,"$1,830.82",$0.00,"$1,862.40",$0.00
7771132,SUP,HCPCS C1713,,7771132  -  SPACER SPNL STD 32MMX11MM STRL ELEV PEEK TI,"$11,698.50",$0.00,"$11,698.50","$5,264.33","$5,158.80",$0.00,"$2,015.59",$0.00,$0.00,"$2,048.31","$11,698.50",$0.00,"$5,849.25","$9,265.21","$9,358.80",$0.00,"$1,830.82",$0.00,"$1,862.40",$0.00
7771174,SUP,Custom 27203010,,7771174  -  SLEEVE SPNL SPHERX PRODUCTIVE PPS,$137.50,$0.00,$137.50,$0.00,$98.13,$0.00,$0.00,$0.00,$0.00,$0.00,$137.50,$0.00,$68.75,$108.90,$110.00,$0.00,$0.00,$0.00,$0.00,$0.00
7772001,SUP,HCPCS C1713,,7772001  -  SCREW BN TULIP LCK SPNE 6.25 MM ROD,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
7781120,SUP,HCPCS C1713,,7781120  -  PLATE BN 20MM NS HLX-T 1 LVL SPNE,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7781122,SUP,HCPCS C1713,,7781122  -  PLATE BN 22MM NS HLX-T 1 LVL SPNE,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7781124,SUP,HCPCS C1713,,7781124  -  PLATE BN 24MM NS HLX-T 1 LVL SPNE,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7781126,SUP,HCPCS C1713,,7781126  -  PLATE BN 26MM NS HLX-T 1 LVL SPNE,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7781128,SUP,HCPCS C1713,,7781128  -  PLATE BN 28MM NS HLX-T 1 LVL SPNE,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7781130,SUP,HCPCS C1713,,7781130  -  PLATE BN 30MM NS HLX-T 1 LVL SPNE,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7781132,SUP,HCPCS C1713,,7781132  -  PLATE BN 32MM NS HLX-T 1 LVL SPNE,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7781134,SUP,HCPCS C1713,,7781134  -  PLATE BN 34MM NS HLX-T 1 LVL SPNE,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7781234,SUP,HCPCS C1713,,7781234  -  PLATE BN 34MM NS HLX-T 2 LVL SPNE,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7781236,SUP,HCPCS C1713,,7781236  -  PLATE BN 36MM NS HLX-T 2 LVL SPNE,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7781238,SUP,HCPCS C1713,,7781238  -  PLATE BN 38MM NS HLX-T 2 LVL SPNE,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7781240,SUP,HCPCS C1713,,7781240  -  PLATE BN 40MM NS HLX-T 2 LVL SPNE,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7781242,SUP,HCPCS C1713,,7781242  -  PLATE BN 42MM NS HLX-T 2 LVL SPNE,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7781244,SUP,HCPCS C1713,,7781244  -  PLATE BN 44MM NS HLX-T 2 LVL SPNE,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7781246,SUP,HCPCS C1713,,7781246  -  PLATE BN 46MM NS HLX-T 2 LVL SPNE,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7781248,SUP,HCPCS C1713,,7781248  -  PLATE BN 48MM NS HLX-T 2 LVL SPNE,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7781250,SUP,HCPCS C1713,,7781250  -  PLATE BN 50MM NS HLX-T 2 LVL SPNE,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7781252,SUP,HCPCS C1713,,7781252  -  PLATE BN 52MM NS HLX-T 2 LVL SPNE,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7781254,SUP,HCPCS C1713,,7781254  -  PLATE BN 54MM NS HLX-T 2 LVL SPNE,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7781354,SUP,HCPCS C1713,,7781354  -  PLATE BN 54MM NS HLX-T 3 LVL SPNE,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7781356,SUP,HCPCS C1713,,7781356  -  PLATE BN 56MM NS HLX-T 3 LVL SPNE,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7781358,SUP,HCPCS C1713,,7781358  -  PLATE BN 58MM NS HLX-T 3 LVL SPNE,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7781360,SUP,HCPCS C1713,,7781360  -  PLATE BN 60MM NS HLX-T 3 LVL SPNE,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7781362,SUP,HCPCS C1713,,7781362  -  PLATE BN 62MM NS HLX-T 3 LVL SPNE,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7781364,SUP,HCPCS C1713,,7781364  -  PLATE BN 64MM NS HLX-T 3 LVL SPNE,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7781366,SUP,HCPCS C1713,,7781366  -  PLATE BN 66MM NS HLX-T 3 LVL SPNE,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7781368,SUP,HCPCS C1713,,7781368  -  PLATE BN 68MM NS HLX-T 3 LVL SPNE,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7781470,SUP,HCPCS C1713,,7781470  -  PLATE BN 70MM NS HLX-T 4 LVL SPNE,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7781474,SUP,HCPCS C1713,,7781474  -  PLATE BN 74MM NS HLX-T 4 LVL SPNE,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7781478,SUP,HCPCS C1713,,7781478  -  PLATE BN 78MM NS HLX-T 4 LVL SPNE,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7781482,SUP,HCPCS C1713,,7781482  -  PLATE BN 82MM NS HLX-T 4 LVL SPNE,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7781486,SUP,HCPCS C1713,,7781486  -  PLATE BN 86MM NS HLX-T 4 LVL SPNE,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7781490,SUP,HCPCS C1713,,7781490  -  PLATE BN 90MM NS HLX-T 4 LVL SPNE,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7781501,SUP,HCPCS C1713,,7781501  -  PLATE BN T 100MM HLX LVL 5 TRANSLATIONAL SS SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7781505,SUP,HCPCS C1713,,7781505  -  PLATE BN T 105MM HLX LVL 5 TRANSLATIONAL SS SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7781510,SUP,HCPCS C1713,,7781510  -  PLATE BN T 110MM HLX LVL 5 TRANSLATIONAL SS SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7781595,SUP,HCPCS C1713,,7781595  -  PLATE BN T 95MM HLX LVL 5 TRANSLATIONAL SS SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7782001,SUP,HCPCS C1713,,7782001  -  SCREW LCK 5.5MM SPHERX PPS SPNE,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
7782300,SUP,HCPCS C1713,,7782300  -  ROD SPNL 5.5MM 300MM STRL SPHERX XTN,"$1,540.00",$0.00,"$1,540.00",$693.00,"$1,099.10",$0.00,$265.33,$0.00,$0.00,$269.64,"$1,540.00",$0.00,$770.00,"$1,219.68","$1,232.00",$0.00,$241.01,$0.00,$245.17,$0.00
7782500,SUP,HCPCS C1713,,7782500  -  ROD SPNL 5.5MM 500MM SPHERX XTN,"$1,540.00",$0.00,"$1,540.00",$693.00,"$1,099.10",$0.00,$265.33,$0.00,$0.00,$269.64,"$1,540.00",$0.00,$770.00,"$1,219.68","$1,232.00",$0.00,$241.01,$0.00,$245.17,$0.00
7783025,SUP,HCPCS C1713,,7783025  -  ROD SPNL PREBNT 5.5MM 25MM SPHERX XTN,"$1,790.00",$0.00,"$1,790.00",$805.50,"$1,277.52",$0.00,$308.41,$0.00,$0.00,$313.41,"$1,790.00",$0.00,$895.00,"$1,417.68","$1,432.00",$0.00,$280.14,$0.00,$284.97,$0.00
7783030,SUP,HCPCS C1713,,7783030  -  ROD SPNL PREBNT 5.5MM 30MM SPHERX XTN,"$1,790.00",$0.00,"$1,790.00",$805.50,"$1,277.52",$0.00,$308.41,$0.00,$0.00,$313.41,"$1,790.00",$0.00,$895.00,"$1,417.68","$1,432.00",$0.00,$280.14,$0.00,$284.97,$0.00
7783035,SUP,HCPCS C1713,,7783035  -  ROD SPNL PREBNT 5.5MM 35MM SPHERX XTN,"$1,790.00",$0.00,"$1,790.00",$805.50,"$1,277.52",$0.00,$308.41,$0.00,$0.00,$313.41,"$1,790.00",$0.00,$895.00,"$1,417.68","$1,432.00",$0.00,$280.14,$0.00,$284.97,$0.00
7783040,SUP,HCPCS C1713,,7783040  -  ROD SPNL PREBNT 5.5MM 40MM SPHERX XTN,"$1,790.00",$0.00,"$1,790.00",$805.50,"$1,277.52",$0.00,$308.41,$0.00,$0.00,$313.41,"$1,790.00",$0.00,$895.00,"$1,417.68","$1,432.00",$0.00,$280.14,$0.00,$284.97,$0.00
7783045,SUP,HCPCS C1713,,7783045  -  ROD SPNL PREBNT 5.5MM 45MM SPHERX XTN,"$1,790.00",$0.00,"$1,790.00",$805.50,"$1,277.52",$0.00,$308.41,$0.00,$0.00,$313.41,"$1,790.00",$0.00,$895.00,"$1,417.68","$1,432.00",$0.00,$280.14,$0.00,$284.97,$0.00
7783050,SUP,HCPCS C1713,,7783050  -  ROD SPNL PREBNT 5.5MM 50MM SPHERX XTN,"$1,790.00",$0.00,"$1,790.00",$805.50,"$1,277.52",$0.00,$308.41,$0.00,$0.00,$313.41,"$1,790.00",$0.00,$895.00,"$1,417.68","$1,432.00",$0.00,$280.14,$0.00,$284.97,$0.00
7783055,SUP,HCPCS C1713,,7783055  -  ROD SPNL PREBNT 5.5MM 55MM SPHERX XTN,"$1,790.00",$0.00,"$1,790.00",$805.50,"$1,277.52",$0.00,$308.41,$0.00,$0.00,$313.41,"$1,790.00",$0.00,$895.00,"$1,417.68","$1,432.00",$0.00,$280.14,$0.00,$284.97,$0.00
7783060,SUP,HCPCS C1713,,7783060  -  ROD SPNL PREBNT 5.5MM 60MM SPHERX XTN,"$1,972.50",$0.00,"$1,972.50",$887.63,"$1,407.77",$0.00,$339.85,$0.00,$0.00,$345.37,"$1,972.50",$0.00,$986.25,"$1,562.22","$1,578.00",$0.00,$308.70,$0.00,$314.02,$0.00
7783065,SUP,HCPCS C1713,,7783065  -  ROD SPNL PREBNT 5.5MM 65MM SPHERX XTN,"$1,972.50",$0.00,"$1,972.50",$887.63,"$1,407.77",$0.00,$339.85,$0.00,$0.00,$345.37,"$1,972.50",$0.00,$986.25,"$1,562.22","$1,578.00",$0.00,$308.70,$0.00,$314.02,$0.00
7783070,SUP,HCPCS C1713,,7783070  -  ROD SPNL PREBNT 5.5MM 70MM SPHERX PPS XTN,"$1,972.50",$0.00,"$1,972.50",$887.63,"$1,407.77",$0.00,$339.85,$0.00,$0.00,$345.37,"$1,972.50",$0.00,$986.25,"$1,562.22","$1,578.00",$0.00,$308.70,$0.00,$314.02,$0.00
7783075,SUP,HCPCS C1713,,7783075  -  ROD SPNL PREBNT 5.5MM 75MM SPHERX XTN,"$1,972.50",$0.00,"$1,972.50",$887.63,"$1,407.77",$0.00,$339.85,$0.00,$0.00,$345.37,"$1,972.50",$0.00,$986.25,"$1,562.22","$1,578.00",$0.00,$308.70,$0.00,$314.02,$0.00
7783080,SUP,HCPCS C1713,,7783080  -  ROD SPNL PREBNT 5.5MM 90MM SPHERX XTN,"$1,972.50",$0.00,"$1,972.50",$887.63,"$1,407.77",$0.00,$339.85,$0.00,$0.00,$345.37,"$1,972.50",$0.00,$986.25,"$1,562.22","$1,578.00",$0.00,$308.70,$0.00,$314.02,$0.00
7783085,SUP,HCPCS C1713,,7783085  -  ROD SPNL PREBNT 5.5MM 85MM SPHERX XTN,"$1,972.50",$0.00,"$1,972.50",$887.63,"$1,407.77",$0.00,$339.85,$0.00,$0.00,$345.37,"$1,972.50",$0.00,$986.25,"$1,562.22","$1,578.00",$0.00,$308.70,$0.00,$314.02,$0.00
7783090,SUP,HCPCS C1713,,7783090  -  ROD SPNL PREBNT 5.5MM 90MM SPHERX XTN,"$1,972.50",$0.00,"$1,972.50",$887.63,"$1,407.77",$0.00,$339.85,$0.00,$0.00,$345.37,"$1,972.50",$0.00,$986.25,"$1,562.22","$1,578.00",$0.00,$308.70,$0.00,$314.02,$0.00
7783095,SUP,HCPCS C1713,,7783095  -  ROD SPNL PREBNT 5.5MM 95MM SPHERX XTN,"$1,972.50",$0.00,"$1,972.50",$887.63,"$1,407.77",$0.00,$339.85,$0.00,$0.00,$345.37,"$1,972.50",$0.00,$986.25,"$1,562.22","$1,578.00",$0.00,$308.70,$0.00,$314.02,$0.00
7783100,SUP,HCPCS C1713,,7783100  -  ROD SPNL PREBNT 5.5MM 100MM SPHERX XTN,"$1,972.50",$0.00,"$1,972.50",$887.63,"$1,407.77",$0.00,$339.85,$0.00,$0.00,$345.37,"$1,972.50",$0.00,$986.25,"$1,562.22","$1,578.00",$0.00,$308.70,$0.00,$314.02,$0.00
7783110,SUP,HCPCS C1713,,7783110  -  ROD SPNL PREBNT 5.5MM 110MM SPHERX XTN,"$1,972.50",$0.00,"$1,972.50",$887.63,"$1,407.77",$0.00,$339.85,$0.00,$0.00,$345.37,"$1,972.50",$0.00,$986.25,"$1,562.22","$1,578.00",$0.00,$308.70,$0.00,$314.02,$0.00
7783120,SUP,HCPCS C1713,,7783120  -  ROD SPNL PREBNT 5.5MM 120MM SPHERX XTN,"$1,972.50",$0.00,"$1,972.50",$887.63,"$1,407.77",$0.00,$339.85,$0.00,$0.00,$345.37,"$1,972.50",$0.00,$986.25,"$1,562.22","$1,578.00",$0.00,$308.70,$0.00,$314.02,$0.00
7783150,SUP,HCPCS C1713,,7783150  -  ROD SPNL PREBNT 5.5MM 150MM SPHERX XTN,"$1,972.50",$0.00,"$1,972.50",$887.63,"$1,407.77",$0.00,$339.85,$0.00,$0.00,$345.37,"$1,972.50",$0.00,$986.25,"$1,562.22","$1,578.00",$0.00,$308.70,$0.00,$314.02,$0.00
7783300,SUP,HCPCS C1713,,7783300  -  ROD SPNL PREBNT 5.5MM 300MM SPHERX XTN,"$1,972.50",$0.00,"$1,972.50",$887.63,"$1,407.77",$0.00,$339.85,$0.00,$0.00,$345.37,"$1,972.50",$0.00,$986.25,"$1,562.22","$1,578.00",$0.00,$308.70,$0.00,$314.02,$0.00
7783500,SUP,HCPCS C1713,,7783500  -  ROD SPNL PREBNT 5.5MM 500MM SPHERX XTN,"$1,972.50",$0.00,"$1,972.50",$887.63,"$1,407.77",$0.00,$339.85,$0.00,$0.00,$345.37,"$1,972.50",$0.00,$986.25,"$1,562.22","$1,578.00",$0.00,$308.70,$0.00,$314.02,$0.00
7800015,SUP,HCPCS C1713,,7800015  -  PIN FX HLX TEMP SLFCNTR TACK SPNE,$535.00,$0.00,$535.00,$240.75,$381.83,$0.00,$92.18,$0.00,$0.00,$93.67,$535.00,$0.00,$267.50,$423.72,$428.00,$0.00,$83.73,$0.00,$85.17,$0.00
7800120,SUP,HCPCS C1713,,7800120  -  PLATE BONE 20MM LEVEL 1 HELIX T STAINLESS STEEL SPN CERV,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7800122,SUP,HCPCS C1713,,7800122  -  PLATE BONE 22MM LEVEL 1 HELIX T STAINLESS STEEL SPN CERV,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7800124,SUP,HCPCS C1713,,7800124  -  PLATE BN 24MM NS HLX R 1 LVL SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7800126,SUP,HCPCS C1713,,7800126  -  PLATE BN 26MM NS HLX R 1 LVL SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7800128,SUP,HCPCS C1713,,7800128  -  PLATE BN 28MM NS HLX R 1 LVL SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7800130,SUP,HCPCS C1713,,7800130  -  PLATE BN 30MM NS HLX R 1 LVL SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7800132,SUP,HCPCS C1713,,7800132  -  PLATE BN 32MM NS HLX R 1 LVL SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7800134,SUP,HCPCS C1713,,7800134  -  PLATE BN 34MM NS HLX R 1 LVL SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7800232,SUP,HCPCS C1713,,7800232  -  PLATE BN 32MM NS HLX R 2 LVL SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7800234,SUP,HCPCS C1713,,7800234  -  PLATE BN 34MM NS HLX R 2 LVL SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7800236,SUP,HCPCS C1713,,7800236  -  PLATE BN 36MM NS HLX R 2 LVL SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7800238,SUP,HCPCS C1713,,7800238  -  PLATE BONE 38MM LEVEL 2 HELIX-REVOLUTION SPN CERV ANTERIOR,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7800240,SUP,HCPCS C1713,,7800240  -  PLATE BONE 40MM LEVEL 1 HELIX-REVOLUTION SPN CERV ANTERIOR,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7800242,SUP,HCPCS C1713,,7800242  -  PLATE BN 42MM NS HLX R 2 LVL SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7800244,SUP,HCPCS C1713,,7800244  -  PLATE BN 44MM NS HLX R 2 LVL SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7800246,SUP,HCPCS C1713,,7800246  -  PLATE BN 46MM NS HLX R 2 LVL SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7800248,SUP,HCPCS C1713,,7800248  -  PLATE BN 48MM NS HLX R 2 LVL SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7800250,SUP,HCPCS C1713,,7800250  -  PLATE BN 50MM NS HLX R 2 LVL SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7800252,SUP,HCPCS C1713,,7800252  -  PLATE BN 52MM NS HLX R 2 LVL SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7800254,SUP,HCPCS C1713,,7800254  -  PLATE BN 54MM NS HLX R 2 LVL SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
7800350,SUP,HCPCS C1713,,7800350  -  PLATE BN 50MM NS HLX R 3 LVL SPNE,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7800352,SUP,HCPCS C1713,,7800352  -  PLATE BN 52MM NS HLX R 3 LVL SPNE,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7800354,SUP,HCPCS C1713,,7800354  -  PLATE BN 54MM NS HLX R 3 LVL SPNE,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7800356,SUP,HCPCS C1713,,7800356  -  PLATE BN 56MM NS HLX R 3 LVL SPNE,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7800358,SUP,HCPCS C1713,,7800358  -  PLATE BN 58MM NS HLX R 3 LVL SPNE,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7800360,SUP,HCPCS C1713,,7800360  -  PLATE BN 60MM NS HLX R 3 LVL SPNE,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7800362,SUP,HCPCS C1713,,7800362  -  PLATE BN 62MM NS HLX R 3 LVL SPNE,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7800364,SUP,HCPCS C1713,,7800364  -  PLATE BN 64MM NS HLX R 3 LVL SPNE,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7800366,SUP,HCPCS C1713,,7800366  -  PLATE BN 66MM NS HLX R 3 LVL SPNE,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7800368,SUP,HCPCS C1713,,7800368  -  PLATE BN 68MM NS HLX R 3 LVL SPNE,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
7800466,SUP,HCPCS C1713,,7800466  -  PLATE BN 66MM NS HLX R 4 LVL SPNE,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
7800468,SUP,HCPCS C1713,,7800468  -  PLATE BN 68MM NS HLX R 4 LVL SPNE,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
7800470,SUP,HCPCS C1713,,7800470  -  PLATE BN 70MM NS HLX R 4 LVL SPNE,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
7800474,SUP,HCPCS C1713,,7800474  -  PLATE BN 74MM NS HLX R 4 LVL SPNE,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
7800478,SUP,HCPCS C1713,,7800478  -  PLATE BN 78MM NS HLX R 4 LVL SPNE,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
7800482,SUP,HCPCS C1713,,7800482  -  PLATE BN 82MM NS HLX R 4 LVL SPNE,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
7800486,SUP,HCPCS C1713,,7800486  -  PLATE BN 86MM NS HLX R 4 LVL SPNE,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
7800490,SUP,HCPCS C1713,,7800490  -  PLATE BN 90MM NS HLX R 4 LVL SPNE,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
7800500,SUP,HCPCS C1713,,7800500  -  PLATE BN 100MM HLX-REV LVL 5 SPNE CRV ANT,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
7800505,SUP,HCPCS C1713,,7800505  -  PLATE BN 105MM HLX-REV LVL 5 SPNE CRV ANT,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
7800510,SUP,HCPCS C1713,,7800510  -  PLATE BN 110MM HLX-REV LVL 5 SPNE CRV ANT,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
7800590,SUP,HCPCS C1713,,7800590  -  PLATE BN 90MM HLX-REV LVL 5 SPNE CRV ANT,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
7800595,SUP,HCPCS C1713,,7800595  -  PLATE BN 95MM HLX-REV LVL 5 SPNE CRV ANT,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
7801111,SUP,HCPCS C1713,,7801111  -  SCREW BN 4MM 11MM NS HLX R SLF DRL VA SPNE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7801113,SUP,HCPCS C1713,,7801113  -  SCREW BONE 13MM VAR ANG SELF DRILL HELIX-REVOLUTION ACP 4MM,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7801115,SUP,HCPCS C1713,,7801115  -  SCREW BONE 15MM VAR ANG SELF DRILL HELIX-REVOLUTION ACP 4MM,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7801117,SUP,HCPCS C1713,,7801117  -  SCREW BN 4MM 17MM HLX REV ACP SLF DRL VA SPNE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7802211,SUP,HCPCS C1713,,7802211  -  SCREW BN 4MM 11MM NS HLX R SLF DRL FX ANG SPNE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7802213,SUP,HCPCS C1713,,7802213  -  SCREW BONE 13MM FIX ANGLE SELF DRILL HELIX-REVOLUTION ACP 4,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7802215,SUP,HCPCS C1713,,7802215  -  SCREW BONE 15MM FIX ANGLE SELF DRILL HELIX-REVOLUTION ACP 4,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7803111,SUP,HCPCS C1713,,7803111  -  SCREW BN 4MM 11MM NS HLX R ST VA SPNE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7803113,SUP,HCPCS C1713,,7803113  -  SCREW BONE 13MM VAR ANG SELF TAP HELIX-REVOLUTION ACP 4MM,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7803115,SUP,HCPCS C1713,,7803115  -  SCREW BONE 15MM VAR ANG SELF TAP HELIX-REVOLUTION ACP 4MM,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7803117,SUP,HCPCS C1713,,7803117  -  SCREW BN 4MM 17MM NS HLX R ST VA SPNE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7803119,SUP,HCPCS C1713,,7803119  -  SCREW BN 4MM 19MM NS HLX R ST VA SPNE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7804211,SUP,HCPCS C1713,,7804211  -  SCREW BN 4MM 11MM NS HLX R ST FX ANG SPNE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7804213,SUP,HCPCS C1713,,7804213  -  SCREW BONE 13MM FIX ANGLE SELF TAP HELIX-REVOLUTION ACP 4MM,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7804215,SUP,HCPCS C1713,,7804215  -  SCREW BN 4MM 15MM NS HLX R ST FX ANG SPNE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7804217,SUP,HCPCS C1713,,7804217  -  SCREW BN 4MM 17MM NS HLX R ST FX ANG SPNE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7804219,SUP,HCPCS C1713,,7804219  -  SCREW BN 4MM 19MM NS HLX R ST FX ANG SPNE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7805111,SUP,HCPCS C1713,,7805111  -  SCREW BN 4.5MM 11MM NS HLX R ST VA SPNE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7805113,SUP,HCPCS C1713,,7805113  -  SCREW BN 4.5MM 13MM NS HLX R ST VA SPNE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7805114,SUP,HCPCS C1713,,7805114  -  SCREW BN 4.5MM 14MM VAR ST SPNE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7805115,SUP,HCPCS C1713,,7805115  -  SCREW BN 4.5MM 15MM NS HLX R ST VA SPNE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7805117,SUP,HCPCS C1713,,7805117  -  SCREW BN 4.5MM 17MM NS HLX R ST VA SPNE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7805119,SUP,HCPCS C1713,,7805119  -  SCREW BN 4.5MM 19MM NS HLX R ST VA SPNE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7806211,SUP,HCPCS C1713,,7806211  -  SCREW BN 4.5MM 11MM NS HLX R ST FX ANG SPNE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7806213,SUP,HCPCS C1713,,7806213  -  SCREW BN 4.5MM 13MM NS HLX R ST FX ANG SPNE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7806215,SUP,HCPCS C1713,,7806215  -  SCREW BONE 15MM FIX ANGLE SELF TAP HELIX-REVOLUTION ACP 4.5,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7806217,SUP,HCPCS C1713,,7806217  -  SCREW BN 4.5MM 17MM NS HLX R ST FX ANG SPNE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7806219,SUP,HCPCS C1713,,7806219  -  SCREW BN 4.5MM 19MM NS HLX R ST FX ANG SPNE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
7807110,SUP,Custom 27203010,,7807110  -  PIN FIX TEMPORARY HELIX,$535.00,$0.00,$535.00,$0.00,$381.83,$0.00,$0.00,$0.00,$0.00,$0.00,$535.00,$0.00,$267.50,$423.72,$428.00,$0.00,$0.00,$0.00,$0.00,$0.00
7812025,SUP,Custom 27203010,,7812025  -  BIT DRILL 10MM,$535.00,$0.00,$535.00,$0.00,$381.83,$0.00,$0.00,$0.00,$0.00,$0.00,$535.00,$0.00,$267.50,$423.72,$428.00,$0.00,$0.00,$0.00,$0.00,$0.00
7820015,SUP,HCPCS C1713,,7820015  -  PLATE BONE 15MM FIX TRAVERSE SPN,"$10,232.50",$0.00,"$10,232.50","$4,604.63","$5,158.80",$0.00,"$1,763.01",$0.00,$0.00,"$1,791.63","$10,232.50",$0.00,"$5,116.25","$8,104.14","$8,186.00",$0.00,"$1,601.39",$0.00,"$1,629.01",$0.00
7820020,SUP,HCPCS C1713,,7820020  -  PLATE BN 20MM FX TRAVERSE SPNE,"$10,232.50",$0.00,"$10,232.50","$4,604.63","$5,158.80",$0.00,"$1,763.01",$0.00,$0.00,"$1,791.63","$10,232.50",$0.00,"$5,116.25","$8,104.14","$8,186.00",$0.00,"$1,601.39",$0.00,"$1,629.01",$0.00
7820025,SUP,HCPCS C1713,,7820025  -  PLATE BN 25MM FX TRAVERSE SPNE,"$10,232.50",$0.00,"$10,232.50","$4,604.63","$5,158.80",$0.00,"$1,763.01",$0.00,$0.00,"$1,791.63","$10,232.50",$0.00,"$5,116.25","$8,104.14","$8,186.00",$0.00,"$1,601.39",$0.00,"$1,629.01",$0.00
7820030,SUP,HCPCS C1713,,7820030  -  PLATE BONE 30MM FIX TRAVERSE SPN,"$10,232.50",$0.00,"$10,232.50","$4,604.63","$5,158.80",$0.00,"$1,763.01",$0.00,$0.00,"$1,791.63","$10,232.50",$0.00,"$5,116.25","$8,104.14","$8,186.00",$0.00,"$1,601.39",$0.00,"$1,629.01",$0.00
7820040,SUP,HCPCS C1713,,7820040  -  PLATE BONE 40MM FIX TRAVERSE SPN,"$10,232.50",$0.00,"$10,232.50","$4,604.63","$5,158.80",$0.00,"$1,763.01",$0.00,$0.00,"$1,791.63","$10,232.50",$0.00,"$5,116.25","$8,104.14","$8,186.00",$0.00,"$1,601.39",$0.00,"$1,629.01",$0.00
7820045,SUP,HCPCS C1713,,7820045  -  PLATE BN 45MM NS TRAVERSE FX SPNE,"$10,232.50",$0.00,"$10,232.50","$4,604.63","$5,158.80",$0.00,"$1,763.01",$0.00,$0.00,"$1,791.63","$10,232.50",$0.00,"$5,116.25","$8,104.14","$8,186.00",$0.00,"$1,601.39",$0.00,"$1,629.01",$0.00
7820050,SUP,HCPCS C1713,,7820050  -  PLATE BN 50MM NS TRAVERSE FX SPNE,"$10,232.50",$0.00,"$10,232.50","$4,604.63","$5,158.80",$0.00,"$1,763.01",$0.00,$0.00,"$1,791.63","$10,232.50",$0.00,"$5,116.25","$8,104.14","$8,186.00",$0.00,"$1,601.39",$0.00,"$1,629.01",$0.00
7820055,SUP,HCPCS C1713,,7820055  -  PLATE BN 55MM NS TRAVERSE FX SPNE,"$10,232.50",$0.00,"$10,232.50","$4,604.63","$5,158.80",$0.00,"$1,763.01",$0.00,$0.00,"$1,791.63","$10,232.50",$0.00,"$5,116.25","$8,104.14","$8,186.00",$0.00,"$1,601.39",$0.00,"$1,629.01",$0.00
7820060,SUP,HCPCS C1713,,7820060  -  PLATE BN 60MM NS TRAVERSE FX SPNE,"$10,232.50",$0.00,"$10,232.50","$4,604.63","$5,158.80",$0.00,"$1,763.01",$0.00,$0.00,"$1,791.63","$10,232.50",$0.00,"$5,116.25","$8,104.14","$8,186.00",$0.00,"$1,601.39",$0.00,"$1,629.01",$0.00
7820065,SUP,HCPCS C1713,,7820065  -  PLATE BN 65MM NS TRAVERSE FX SPNE,"$10,232.50",$0.00,"$10,232.50","$4,604.63","$5,158.80",$0.00,"$1,763.01",$0.00,$0.00,"$1,791.63","$10,232.50",$0.00,"$5,116.25","$8,104.14","$8,186.00",$0.00,"$1,601.39",$0.00,"$1,629.01",$0.00
7820070,SUP,HCPCS C1713,,7820070  -  PLATE BN 70MM NS TRAVERSE FX SPNE,"$10,232.50",$0.00,"$10,232.50","$4,604.63","$5,158.80",$0.00,"$1,763.01",$0.00,$0.00,"$1,791.63","$10,232.50",$0.00,"$5,116.25","$8,104.14","$8,186.00",$0.00,"$1,601.39",$0.00,"$1,629.01",$0.00
7820080,SUP,HCPCS C1713,,7820080  -  PLATE BN 80MM NS TRAVERSE FX SPNE,"$10,232.50",$0.00,"$10,232.50","$4,604.63","$5,158.80",$0.00,"$1,763.01",$0.00,$0.00,"$1,791.63","$10,232.50",$0.00,"$5,116.25","$8,104.14","$8,186.00",$0.00,"$1,601.39",$0.00,"$1,629.01",$0.00
7820090,SUP,HCPCS C1713,,7820090  -  PLATE BN 90MM NS TRAVERSE FX SPNE,"$10,232.50",$0.00,"$10,232.50","$4,604.63","$5,158.80",$0.00,"$1,763.01",$0.00,$0.00,"$1,791.63","$10,232.50",$0.00,"$5,116.25","$8,104.14","$8,186.00",$0.00,"$1,601.39",$0.00,"$1,629.01",$0.00
7821045,SUP,HCPCS C1713,,7821045  -  PLATE BN 45MM NS TRAVERSE CMPR SPNE,"$11,560.00",$0.00,"$11,560.00","$5,202.00","$5,158.80",$0.00,"$1,991.73",$0.00,$0.00,"$2,024.06","$11,560.00",$0.00,"$5,780.00","$9,155.52","$9,248.00",$0.00,"$1,809.14",$0.00,"$1,840.35",$0.00
7821050,SUP,HCPCS C1713,,7821050  -  PLATE BN 50MM NS TRAVERSE CMPR SPNE,"$11,560.00",$0.00,"$11,560.00","$5,202.00","$5,158.80",$0.00,"$1,991.73",$0.00,$0.00,"$2,024.06","$11,560.00",$0.00,"$5,780.00","$9,155.52","$9,248.00",$0.00,"$1,809.14",$0.00,"$1,840.35",$0.00
7821055,SUP,HCPCS C1713,,7821055  -  PLATE BN 55MM NS TRAVERSE CMPR SPNE,"$11,560.00",$0.00,"$11,560.00","$5,202.00","$5,158.80",$0.00,"$1,991.73",$0.00,$0.00,"$2,024.06","$11,560.00",$0.00,"$5,780.00","$9,155.52","$9,248.00",$0.00,"$1,809.14",$0.00,"$1,840.35",$0.00
7821060,SUP,HCPCS C1713,,7821060  -  PLATE BN 60MM NS TRAVERSE CMPR SPNE,"$11,560.00",$0.00,"$11,560.00","$5,202.00","$5,158.80",$0.00,"$1,991.73",$0.00,$0.00,"$2,024.06","$11,560.00",$0.00,"$5,780.00","$9,155.52","$9,248.00",$0.00,"$1,809.14",$0.00,"$1,840.35",$0.00
7821065,SUP,HCPCS C1713,,7821065  -  PLATE BN 65MM NS TRAVERSE CMPR SPNE,"$11,560.00",$0.00,"$11,560.00","$5,202.00","$5,158.80",$0.00,"$1,991.73",$0.00,$0.00,"$2,024.06","$11,560.00",$0.00,"$5,780.00","$9,155.52","$9,248.00",$0.00,"$1,809.14",$0.00,"$1,840.35",$0.00
7821070,SUP,HCPCS C1713,,7821070  -  PLATE BN 70MM NS TRAVERSE CMPR SPNE,"$11,560.00",$0.00,"$11,560.00","$5,202.00","$5,158.80",$0.00,"$1,991.73",$0.00,$0.00,"$2,024.06","$11,560.00",$0.00,"$5,780.00","$9,155.52","$9,248.00",$0.00,"$1,809.14",$0.00,"$1,840.35",$0.00
7821075,SUP,HCPCS C1713,,7821075  -  PLATE BN 75MM NS TRAVERSE CMPR SPNE,"$11,560.00",$0.00,"$11,560.00","$5,202.00","$5,158.80",$0.00,"$1,991.73",$0.00,$0.00,"$2,024.06","$11,560.00",$0.00,"$5,780.00","$9,155.52","$9,248.00",$0.00,"$1,809.14",$0.00,"$1,840.35",$0.00
7821080,SUP,HCPCS C1713,,7821080  -  PLATE BN 80MM NS TRAVERSE CMPR SPNE,"$11,560.00",$0.00,"$11,560.00","$5,202.00","$5,158.80",$0.00,"$1,991.73",$0.00,$0.00,"$2,024.06","$11,560.00",$0.00,"$5,780.00","$9,155.52","$9,248.00",$0.00,"$1,809.14",$0.00,"$1,840.35",$0.00
7821085,SUP,HCPCS C1713,,7821085  -  PLATE BN 85MM NS TRAVERSE CMPR SPNE,"$11,560.00",$0.00,"$11,560.00","$5,202.00","$5,158.80",$0.00,"$1,991.73",$0.00,$0.00,"$2,024.06","$11,560.00",$0.00,"$5,780.00","$9,155.52","$9,248.00",$0.00,"$1,809.14",$0.00,"$1,840.35",$0.00
7821095,SUP,HCPCS C1713,,7821095  -  PLATE BN 95MM NS TRAVERSE CMPR SPNE,"$11,560.00",$0.00,"$11,560.00","$5,202.00","$5,158.80",$0.00,"$1,991.73",$0.00,$0.00,"$2,024.06","$11,560.00",$0.00,"$5,780.00","$9,155.52","$9,248.00",$0.00,"$1,809.14",$0.00,"$1,840.35",$0.00
7821105,SUP,HCPCS C1713,,7821105  -  PLATE BN 105MM NS TRAVERSE CMPR SPNE,"$11,560.00",$0.00,"$11,560.00","$5,202.00","$5,158.80",$0.00,"$1,991.73",$0.00,$0.00,"$2,024.06","$11,560.00",$0.00,"$5,780.00","$9,155.52","$9,248.00",$0.00,"$1,809.14",$0.00,"$1,840.35",$0.00
7822035,SUP,HCPCS C1713,,7822035  -  PLATE BN 35MM NS TRAVERSE 2 BOLT SPNE,"$9,747.50",$0.00,"$9,747.50","$4,386.38","$5,158.80",$0.00,"$1,679.45",$0.00,$0.00,"$1,706.71","$9,747.50",$0.00,"$4,873.75","$7,720.02","$7,798.00",$0.00,"$1,525.48",$0.00,"$1,551.80",$0.00
7822040,SUP,HCPCS C1713,,7822040  -  PLATE BN 40MM NS TRAVERSE 2 BOLT SPNE,"$9,747.50",$0.00,"$9,747.50","$4,386.38","$5,158.80",$0.00,"$1,679.45",$0.00,$0.00,"$1,706.71","$9,747.50",$0.00,"$4,873.75","$7,720.02","$7,798.00",$0.00,"$1,525.48",$0.00,"$1,551.80",$0.00
7822045,SUP,HCPCS C1713,,7822045  -  PLATE BN 45MM NS TRAVERSE 2 BOLT SPNE,"$9,747.50",$0.00,"$9,747.50","$4,386.38","$5,158.80",$0.00,"$1,679.45",$0.00,$0.00,"$1,706.71","$9,747.50",$0.00,"$4,873.75","$7,720.02","$7,798.00",$0.00,"$1,525.48",$0.00,"$1,551.80",$0.00
7822050,SUP,HCPCS C1713,,7822050  -  PLATE BN 50MM NS TRAVERSE 2 BOLT SPNE,"$9,747.50",$0.00,"$9,747.50","$4,386.38","$5,158.80",$0.00,"$1,679.45",$0.00,$0.00,"$1,706.71","$9,747.50",$0.00,"$4,873.75","$7,720.02","$7,798.00",$0.00,"$1,525.48",$0.00,"$1,551.80",$0.00
7822055,SUP,HCPCS C1713,,7822055  -  PLATE BN 55MM NS TRAVERSE 2 BOLT SPNE,"$9,747.50",$0.00,"$9,747.50","$4,386.38","$5,158.80",$0.00,"$1,679.45",$0.00,$0.00,"$1,706.71","$9,747.50",$0.00,"$4,873.75","$7,720.02","$7,798.00",$0.00,"$1,525.48",$0.00,"$1,551.80",$0.00
7822060,SUP,HCPCS C1713,,7822060  -  PLATE BONE 60MM 2 BOLT TRAVERSE SPN,"$9,747.50",$0.00,"$9,747.50","$4,386.38","$5,158.80",$0.00,"$1,679.45",$0.00,$0.00,"$1,706.71","$9,747.50",$0.00,"$4,873.75","$7,720.02","$7,798.00",$0.00,"$1,525.48",$0.00,"$1,551.80",$0.00
7822065,SUP,HCPCS C1713,,7822065  -  PLATE BONE 65MM 2 BOLT TRAVERSE SPN,"$9,747.50",$0.00,"$9,747.50","$4,386.38","$5,158.80",$0.00,"$1,679.45",$0.00,$0.00,"$1,706.71","$9,747.50",$0.00,"$4,873.75","$7,720.02","$7,798.00",$0.00,"$1,525.48",$0.00,"$1,551.80",$0.00
7822070,SUP,HCPCS C1713,,7822070  -  PLATE BN 70MM 2 BOLT TRAVERSE SPNE,"$9,747.50",$0.00,"$9,747.50","$4,386.38","$5,158.80",$0.00,"$1,679.45",$0.00,$0.00,"$1,706.71","$9,747.50",$0.00,"$4,873.75","$7,720.02","$7,798.00",$0.00,"$1,525.48",$0.00,"$1,551.80",$0.00
7822075,SUP,HCPCS C1713,,7822075  -  PLATE BN 75MM 2 BOLT TRAVERSE SPNE,"$9,747.50",$0.00,"$9,747.50","$4,386.38","$5,158.80",$0.00,"$1,679.45",$0.00,$0.00,"$1,706.71","$9,747.50",$0.00,"$4,873.75","$7,720.02","$7,798.00",$0.00,"$1,525.48",$0.00,"$1,551.80",$0.00
7822080,SUP,HCPCS C1713,,7822080  -  PLATE BN 80MM 2 BOLT TRAVERSE SPNE,"$9,747.50",$0.00,"$9,747.50","$4,386.38","$5,158.80",$0.00,"$1,679.45",$0.00,$0.00,"$1,706.71","$9,747.50",$0.00,"$4,873.75","$7,720.02","$7,798.00",$0.00,"$1,525.48",$0.00,"$1,551.80",$0.00
7822085,SUP,HCPCS C1713,,7822085  -  PLATE BN 85MM 2 BOLT TRAVERSE SPNE,"$9,747.50",$0.00,"$9,747.50","$4,386.38","$5,158.80",$0.00,"$1,679.45",$0.00,$0.00,"$1,706.71","$9,747.50",$0.00,"$4,873.75","$7,720.02","$7,798.00",$0.00,"$1,525.48",$0.00,"$1,551.80",$0.00
7822095,SUP,HCPCS C1713,,7822095  -  PLATE BN 95MM 2 BOLT TRAVERSE SPNE,"$9,747.50",$0.00,"$9,747.50","$4,386.38","$5,158.80",$0.00,"$1,679.45",$0.00,$0.00,"$1,706.71","$9,747.50",$0.00,"$4,873.75","$7,720.02","$7,798.00",$0.00,"$1,525.48",$0.00,"$1,551.80",$0.00
7822105,SUP,HCPCS C1713,,7822105  -  PLATE BN 105MM 2 BOLT TRAVERSE SPNE,"$9,747.50",$0.00,"$9,747.50","$4,386.38","$5,158.80",$0.00,"$1,679.45",$0.00,$0.00,"$1,706.71","$9,747.50",$0.00,"$4,873.75","$7,720.02","$7,798.00",$0.00,"$1,525.48",$0.00,"$1,551.80",$0.00
7830002,SUP,HCPCS C1713,,7830002  -  SCREW BONE NUT LOCKING TITANIUM SPN,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
7835525,SUP,HCPCS C1713,,7835525  -  SCREW BONE 5.5MM 25MM ASMBLY TRAVERSE SPN,"$1,007.50",$0.00,"$1,007.50",$453.38,$719.05,$0.00,$173.59,$0.00,$0.00,$176.41,"$1,007.50",$0.00,$503.75,$797.94,$806.00,$0.00,$157.67,$0.00,$160.39,$0.00
7835530,SUP,HCPCS C1713,,7835530  -  SCREW BONE 5.5MM 30MM TRAVERSE SPN,"$1,007.50",$0.00,"$1,007.50",$453.38,$719.05,$0.00,$173.59,$0.00,$0.00,$176.41,"$1,007.50",$0.00,$503.75,$797.94,$806.00,$0.00,$157.67,$0.00,$160.39,$0.00
7835535,SUP,HCPCS C1713,,7835535  -  SCREW BONE 35MM TRAVERSE 5.5MM SPN,"$1,007.50",$0.00,"$1,007.50",$453.38,$719.05,$0.00,$173.59,$0.00,$0.00,$176.41,"$1,007.50",$0.00,$503.75,$797.94,$806.00,$0.00,$157.67,$0.00,$160.39,$0.00
7835540,SUP,HCPCS C1713,,7835540  -  SCREW BN 5.5MM 40MM NS TRAVERSE SPNE,"$1,007.50",$0.00,"$1,007.50",$453.38,$719.05,$0.00,$173.59,$0.00,$0.00,$176.41,"$1,007.50",$0.00,$503.75,$797.94,$806.00,$0.00,$157.67,$0.00,$160.39,$0.00
7835545,SUP,HCPCS C1713,,7835545  -  SCREW BN 5.5MM 45MM NS TRAVERSE SPNE,"$1,007.50",$0.00,"$1,007.50",$453.38,$719.05,$0.00,$173.59,$0.00,$0.00,$176.41,"$1,007.50",$0.00,$503.75,$797.94,$806.00,$0.00,$157.67,$0.00,$160.39,$0.00
7835550,SUP,HCPCS C1713,,7835550  -  SCREW BONE 5.5MM 50MM TRAVERSE SPN,"$1,007.50",$0.00,"$1,007.50",$453.38,$719.05,$0.00,$173.59,$0.00,$0.00,$176.41,"$1,007.50",$0.00,$503.75,$797.94,$806.00,$0.00,$157.67,$0.00,$160.39,$0.00
7835555,SUP,HCPCS C1713,,7835555  -  SCREW BN 5.5MM 55MM NS TRAVERSE SPNE,"$1,007.50",$0.00,"$1,007.50",$453.38,$719.05,$0.00,$173.59,$0.00,$0.00,$176.41,"$1,007.50",$0.00,$503.75,$797.94,$806.00,$0.00,$157.67,$0.00,$160.39,$0.00
7835560,SUP,HCPCS C1713,,7835560  -  SCREW BN 5.5MM 60MM NS TRAVERSE SPNE,"$1,007.50",$0.00,"$1,007.50",$453.38,$719.05,$0.00,$173.59,$0.00,$0.00,$176.41,"$1,007.50",$0.00,$503.75,$797.94,$806.00,$0.00,$157.67,$0.00,$160.39,$0.00
7835565,SUP,HCPCS C1713,,7835565  -  SCREW BN 5.5MM 65MM NS TRAVERSE SPNE,"$1,007.50",$0.00,"$1,007.50",$453.38,$719.05,$0.00,$173.59,$0.00,$0.00,$176.41,"$1,007.50",$0.00,$503.75,$797.94,$806.00,$0.00,$157.67,$0.00,$160.39,$0.00
7846525,SUP,HCPCS C1713,,7846525  -  SCREW BN 6.5MM 25MM NS TRAVERSE SPNE,"$1,007.50",$0.00,"$1,007.50",$453.38,$719.05,$0.00,$173.59,$0.00,$0.00,$176.41,"$1,007.50",$0.00,$503.75,$797.94,$806.00,$0.00,$157.67,$0.00,$160.39,$0.00
7846530,SUP,HCPCS C1713,,7846530  -  SCREW BONE 6.5MM 30MM TRAVERSE SPN,"$1,007.50",$0.00,"$1,007.50",$453.38,$719.05,$0.00,$173.59,$0.00,$0.00,$176.41,"$1,007.50",$0.00,$503.75,$797.94,$806.00,$0.00,$157.67,$0.00,$160.39,$0.00
7846535,SUP,HCPCS C1713,,7846535  -  SCREW BN 6.5MM 35MM NS TRAVERSE SPNE,"$1,007.50",$0.00,"$1,007.50",$453.38,$719.05,$0.00,$173.59,$0.00,$0.00,$176.41,"$1,007.50",$0.00,$503.75,$797.94,$806.00,$0.00,$157.67,$0.00,$160.39,$0.00
7846540,SUP,HCPCS C1713,,7846540  -  SCREW BN 6.5MM 40MM NS TRAVERSE SPNE,"$1,007.50",$0.00,"$1,007.50",$453.38,$719.05,$0.00,$173.59,$0.00,$0.00,$176.41,"$1,007.50",$0.00,$503.75,$797.94,$806.00,$0.00,$157.67,$0.00,$160.39,$0.00
7846545,SUP,HCPCS C1713,,7846545  -  TRAVERSE 6.5X 45MM VARIABLE SCREW,"$1,007.50",$0.00,"$1,007.50",$453.38,$719.05,$0.00,$173.59,$0.00,$0.00,$176.41,"$1,007.50",$0.00,$503.75,$797.94,$806.00,$0.00,$157.67,$0.00,$160.39,$0.00
7846550,SUP,HCPCS C1713,,7846550  -  TRAVERSE 6.5X 50MM VARIABLE SCREW,"$1,007.50",$0.00,"$1,007.50",$453.38,$719.05,$0.00,$173.59,$0.00,$0.00,$176.41,"$1,007.50",$0.00,$503.75,$797.94,$806.00,$0.00,$157.67,$0.00,$160.39,$0.00
7846555,SUP,HCPCS C1713,,7846555  -  SCREW BN 6.5MM 55MM NS TRAVERSE SPNE,"$1,007.50",$0.00,"$1,007.50",$453.38,$719.05,$0.00,$173.59,$0.00,$0.00,$176.41,"$1,007.50",$0.00,$503.75,$797.94,$806.00,$0.00,$157.67,$0.00,$160.39,$0.00
7846560,SUP,HCPCS C1713,,7846560  -  SCREW BN 6.5MM 60MM NS TRAVERSE SPNE,"$1,007.50",$0.00,"$1,007.50",$453.38,$719.05,$0.00,$173.59,$0.00,$0.00,$176.41,"$1,007.50",$0.00,$503.75,$797.94,$806.00,$0.00,$157.67,$0.00,$160.39,$0.00
7846565,SUP,HCPCS C1713,,7846565  -  SCREW BN 6.5MM 65MM NS TRAVERSE SPNE,"$1,007.50",$0.00,"$1,007.50",$453.38,$719.05,$0.00,$173.59,$0.00,$0.00,$176.41,"$1,007.50",$0.00,$503.75,$797.94,$806.00,$0.00,$157.67,$0.00,$160.39,$0.00
7856525,SUP,HCPCS C1713,,7856525  -  BOLT SPNL 6.5MM 25MM NS TRAVERSE PLT,"$1,487.50",$0.00,"$1,487.50",$669.38,"$1,061.63",$0.00,$256.29,$0.00,$0.00,$260.45,"$1,487.50",$0.00,$743.75,"$1,178.10","$1,190.00",$0.00,$232.79,$0.00,$236.81,$0.00
7856530,SUP,HCPCS C1713,,7856530  -  BOLT SPINAL 6.5MM 30MM,"$1,487.50",$0.00,"$1,487.50",$669.38,"$1,061.63",$0.00,$256.29,$0.00,$0.00,$260.45,"$1,487.50",$0.00,$743.75,"$1,178.10","$1,190.00",$0.00,$232.79,$0.00,$236.81,$0.00
7856535,SUP,HCPCS C1713,,7856535  -  BOLT SPINAL 6.5MM 35MM,"$1,487.50",$0.00,"$1,487.50",$669.38,"$1,061.63",$0.00,$256.29,$0.00,$0.00,$260.45,"$1,487.50",$0.00,$743.75,"$1,178.10","$1,190.00",$0.00,$232.79,$0.00,$236.81,$0.00
7856540,SUP,HCPCS C1713,,7856540  -  BOLT SPNL 6.5MM 40MM NS TRAVERSE PLT,"$1,487.50",$0.00,"$1,487.50",$669.38,"$1,061.63",$0.00,$256.29,$0.00,$0.00,$260.45,"$1,487.50",$0.00,$743.75,"$1,178.10","$1,190.00",$0.00,$232.79,$0.00,$236.81,$0.00
7856545,SUP,HCPCS C1713,,7856545  -  BOLT SPINAL 6.5MM 45MM TITANIUM,"$1,487.50",$0.00,"$1,487.50",$669.38,"$1,061.63",$0.00,$256.29,$0.00,$0.00,$260.45,"$1,487.50",$0.00,$743.75,"$1,178.10","$1,190.00",$0.00,$232.79,$0.00,$236.81,$0.00
7856550,SUP,HCPCS C1713,,7856550  -  BOLT SPINAL 6.5MM 50MM,"$1,487.50",$0.00,"$1,487.50",$669.38,"$1,061.63",$0.00,$256.29,$0.00,$0.00,$260.45,"$1,487.50",$0.00,$743.75,"$1,178.10","$1,190.00",$0.00,$232.79,$0.00,$236.81,$0.00
7856555,SUP,HCPCS C1713,,7856555  -  BOLT SPNL 6.5MM 55MM NS TRAVERSE PLT,"$1,487.50",$0.00,"$1,487.50",$669.38,"$1,061.63",$0.00,$256.29,$0.00,$0.00,$260.45,"$1,487.50",$0.00,$743.75,"$1,178.10","$1,190.00",$0.00,$232.79,$0.00,$236.81,$0.00
7856560,SUP,HCPCS C1713,,7856560  -  BOLT SPNL 6.5MM 60MM NS TRAVERSE PLT,"$1,487.50",$0.00,"$1,487.50",$669.38,"$1,061.63",$0.00,$256.29,$0.00,$0.00,$260.45,"$1,487.50",$0.00,$743.75,"$1,178.10","$1,190.00",$0.00,$232.79,$0.00,$236.81,$0.00
7856565,SUP,HCPCS C1713,,7856565  -  BOLT SPNL 6.5MM 65MM NS TRAVERSE PLT,"$1,487.50",$0.00,"$1,487.50",$669.38,"$1,061.63",$0.00,$256.29,$0.00,$0.00,$260.45,"$1,487.50",$0.00,$743.75,"$1,178.10","$1,190.00",$0.00,$232.79,$0.00,$236.81,$0.00
7860845,SUP,HCPCS C1713,,7860845  -  CAGE SPNL 45X18X8MM CRNT XLIF,"$13,750.00",$0.00,"$13,750.00","$6,187.50","$5,158.80",$0.00,"$2,369.06",$0.00,$0.00,"$2,407.52","$13,750.00",$0.00,"$6,875.00","$10,890.00","$11,000.00",$0.00,"$2,151.88",$0.00,"$2,189.00",$0.00
7860850,SUP,HCPCS C1713,,7860850  -  CAGE SPNL XL 50X18X8MM NS LF CRNT,"$13,750.00",$0.00,"$13,750.00","$6,187.50","$5,158.80",$0.00,"$2,369.06",$0.00,$0.00,"$2,407.52","$13,750.00",$0.00,"$6,875.00","$10,890.00","$11,000.00",$0.00,"$2,151.88",$0.00,"$2,189.00",$0.00
7860855,SUP,HCPCS C1713,,7860855  -  CAGE SPNL XL 55X18X8MM NS LF CRNT,"$13,750.00",$0.00,"$13,750.00","$6,187.50","$5,158.80",$0.00,"$2,369.06",$0.00,$0.00,"$2,407.52","$13,750.00",$0.00,"$6,875.00","$10,890.00","$11,000.00",$0.00,"$2,151.88",$0.00,"$2,189.00",$0.00
7860860,SUP,HCPCS C1713,,7860860  -  CAGE SPNL 10D LRDTC 60X18X8MM CRNT XLIF PEEK-OPTM,"$13,750.00",$0.00,"$13,750.00","$6,187.50","$5,158.80",$0.00,"$2,369.06",$0.00,$0.00,"$2,407.52","$13,750.00",$0.00,"$6,875.00","$10,890.00","$11,000.00",$0.00,"$2,151.88",$0.00,"$2,189.00",$0.00
7861045,SUP,HCPCS C1713,,7861045  -  SPACER SPNL 45X18X10MM CRNT,"$13,750.00",$0.00,"$13,750.00","$6,187.50","$5,158.80",$0.00,"$2,369.06",$0.00,$0.00,"$2,407.52","$13,750.00",$0.00,"$6,875.00","$10,890.00","$11,000.00",$0.00,"$2,151.88",$0.00,"$2,189.00",$0.00
7861050,SUP,HCPCS C1713,,7861050  -  CAGE SPNL XL 50X18X10MM NS LF CRNT,"$13,750.00",$0.00,"$13,750.00","$6,187.50","$5,158.80",$0.00,"$2,369.06",$0.00,$0.00,"$2,407.52","$13,750.00",$0.00,"$6,875.00","$10,890.00","$11,000.00",$0.00,"$2,151.88",$0.00,"$2,189.00",$0.00
7861055,SUP,HCPCS C1713,,7861055  -  CAGE SPNL XL 55X18X10MM NS LF CRNT,"$13,750.00",$0.00,"$13,750.00","$6,187.50","$5,158.80",$0.00,"$2,369.06",$0.00,$0.00,"$2,407.52","$13,750.00",$0.00,"$6,875.00","$10,890.00","$11,000.00",$0.00,"$2,151.88",$0.00,"$2,189.00",$0.00
7861060,SUP,HCPCS C1713,,7861060  -  CAGE SPNL STD XL 60X10MM PLT FSN PEEK,"$13,750.00",$0.00,"$13,750.00","$6,187.50","$5,158.80",$0.00,"$2,369.06",$0.00,$0.00,"$2,407.52","$13,750.00",$0.00,"$6,875.00","$10,890.00","$11,000.00",$0.00,"$2,151.88",$0.00,"$2,189.00",$0.00
7861245,SUP,HCPCS C1713,,7861245  -  SPACER SPNL XL 45X18X12MM CRNT 1ST LAT APRCH,"$13,750.00",$0.00,"$13,750.00","$6,187.50","$5,158.80",$0.00,"$2,369.06",$0.00,$0.00,"$2,407.52","$13,750.00",$0.00,"$6,875.00","$10,890.00","$11,000.00",$0.00,"$2,151.88",$0.00,"$2,189.00",$0.00
7861250,SUP,HCPCS C1713,,7861250  -  CAGE SPNL XL 50X12X12MM NS LF CRNT,"$13,750.00",$0.00,"$13,750.00","$6,187.50","$5,158.80",$0.00,"$2,369.06",$0.00,$0.00,"$2,407.52","$13,750.00",$0.00,"$6,875.00","$10,890.00","$11,000.00",$0.00,"$2,151.88",$0.00,"$2,189.00",$0.00
7861255,SUP,HCPCS C1713,,7861255  -  CAGE SPNL XL 55X12X12MM NS LF CRNT,"$13,750.00",$0.00,"$13,750.00","$6,187.50","$5,158.80",$0.00,"$2,369.06",$0.00,$0.00,"$2,407.52","$13,750.00",$0.00,"$6,875.00","$10,890.00","$11,000.00",$0.00,"$2,151.88",$0.00,"$2,189.00",$0.00
7861260,SUP,HCPCS C1713,,7861260  -  SPACER SPNL XL 60X18X12MM CRNT 1ST LAT APRCH,"$13,750.00",$0.00,"$13,750.00","$6,187.50","$5,158.80",$0.00,"$2,369.06",$0.00,$0.00,"$2,407.52","$13,750.00",$0.00,"$6,875.00","$10,890.00","$11,000.00",$0.00,"$2,151.88",$0.00,"$2,189.00",$0.00
7861445,SUP,HCPCS C1713,,7861445  -  SPACER SPNL XL 45X18X14MM CRNT 1ST LAT APRCH,"$13,750.00",$0.00,"$13,750.00","$6,187.50","$5,158.80",$0.00,"$2,369.06",$0.00,$0.00,"$2,407.52","$13,750.00",$0.00,"$6,875.00","$10,890.00","$11,000.00",$0.00,"$2,151.88",$0.00,"$2,189.00",$0.00
7861450,SUP,HCPCS C1713,,7861450  -  SPACER SPNL XL 50X18X14MM CRNT 1ST LAT APRCH,"$13,750.00",$0.00,"$13,750.00","$6,187.50","$5,158.80",$0.00,"$2,369.06",$0.00,$0.00,"$2,407.52","$13,750.00",$0.00,"$6,875.00","$10,890.00","$11,000.00",$0.00,"$2,151.88",$0.00,"$2,189.00",$0.00
7861455,SUP,HCPCS C1713,,7861455  -  IMPLANT SPNL 55X18X14MM XLIF CRNT,"$13,750.00",$0.00,"$13,750.00","$6,187.50","$5,158.80",$0.00,"$2,369.06",$0.00,$0.00,"$2,407.52","$13,750.00",$0.00,"$6,875.00","$10,890.00","$11,000.00",$0.00,"$2,151.88",$0.00,"$2,189.00",$0.00
7861460,SUP,HCPCS C1713,,7861460  -  SPACER SPNL XL 60X18X14MM CRNT 1ST LAT APRCH,"$13,750.00",$0.00,"$13,750.00","$6,187.50","$5,158.80",$0.00,"$2,369.06",$0.00,$0.00,"$2,407.52","$13,750.00",$0.00,"$6,875.00","$10,890.00","$11,000.00",$0.00,"$2,151.88",$0.00,"$2,189.00",$0.00
7861645,SUP,HCPCS C1713,,7861645  -  SPACER SPNL XL 45X18X16MM CRNT 1ST LAT APRCH,"$13,750.00",$0.00,"$13,750.00","$6,187.50","$5,158.80",$0.00,"$2,369.06",$0.00,$0.00,"$2,407.52","$13,750.00",$0.00,"$6,875.00","$10,890.00","$11,000.00",$0.00,"$2,151.88",$0.00,"$2,189.00",$0.00
7861650,SUP,HCPCS C1713,,7861650  -  SPACER SPNL XL 50X18X16MM CRNT 1ST LAT APRCH,"$13,750.00",$0.00,"$13,750.00","$6,187.50","$5,158.80",$0.00,"$2,369.06",$0.00,$0.00,"$2,407.52","$13,750.00",$0.00,"$6,875.00","$10,890.00","$11,000.00",$0.00,"$2,151.88",$0.00,"$2,189.00",$0.00
7861655,SUP,HCPCS C1713,,7861655  -  SPACER SPNL XL 55X18X16MM CRNT 1ST LAT APRCH,"$13,750.00",$0.00,"$13,750.00","$6,187.50","$5,158.80",$0.00,"$2,369.06",$0.00,$0.00,"$2,407.52","$13,750.00",$0.00,"$6,875.00","$10,890.00","$11,000.00",$0.00,"$2,151.88",$0.00,"$2,189.00",$0.00
7861660,SUP,HCPCS C1713,,7861660  -  SPACER SPNL XL 60X18X16MM CRNT 1ST LAT APRCH,"$13,750.00",$0.00,"$13,750.00","$6,187.50","$5,158.80",$0.00,"$2,369.06",$0.00,$0.00,"$2,407.52","$13,750.00",$0.00,"$6,875.00","$10,890.00","$11,000.00",$0.00,"$2,151.88",$0.00,"$2,189.00",$0.00
7861845,SUP,HCPCS C1713,,7861845  -  CAGE SPNL XL 45X18X18MM NS LF CRNT PEEK-OPTM 1ST LAT APRCH,"$13,750.00",$0.00,"$13,750.00","$6,187.50","$5,158.80",$0.00,"$2,369.06",$0.00,$0.00,"$2,407.52","$13,750.00",$0.00,"$6,875.00","$10,890.00","$11,000.00",$0.00,"$2,151.88",$0.00,"$2,189.00",$0.00
7861850,SUP,HCPCS C1713,,7861850  -  CAGE SPNL 10D LRDTC 50X18X10MM CRNT XLIF PEEK-OPTM,"$13,750.00",$0.00,"$13,750.00","$6,187.50","$5,158.80",$0.00,"$2,369.06",$0.00,$0.00,"$2,407.52","$13,750.00",$0.00,"$6,875.00","$10,890.00","$11,000.00",$0.00,"$2,151.88",$0.00,"$2,189.00",$0.00
7861855,SUP,HCPCS C1713,,7861855  -  SPACER SPNL XL 55X18X18MM CRNT 1ST LAT APRCH,"$13,750.00",$0.00,"$13,750.00","$6,187.50","$5,158.80",$0.00,"$2,369.06",$0.00,$0.00,"$2,407.52","$13,750.00",$0.00,"$6,875.00","$10,890.00","$11,000.00",$0.00,"$2,151.88",$0.00,"$2,189.00",$0.00
7861860,SUP,HCPCS C1713,,7861860  -  CAGE SPNL 10D LRDTC 60X18X8MM CRNT XLIF PEEK-OPTM,"$13,750.00",$0.00,"$13,750.00","$6,187.50","$5,158.80",$0.00,"$2,369.06",$0.00,$0.00,"$2,407.52","$13,750.00",$0.00,"$6,875.00","$10,890.00","$11,000.00",$0.00,"$2,151.88",$0.00,"$2,189.00",$0.00
7867525,SUP,HCPCS C1713,,7867525  -  BOLT SPNL 7.5MM 25MM NS TRAVERSE PLT,"$1,487.50",$0.00,"$1,487.50",$669.38,"$1,061.63",$0.00,$256.29,$0.00,$0.00,$260.45,"$1,487.50",$0.00,$743.75,"$1,178.10","$1,190.00",$0.00,$232.79,$0.00,$236.81,$0.00
7867530,SUP,HCPCS C1713,,7867530  -  BOLT SPNL 7.5MM 30MM NS TRAVERSE PLT,"$1,487.50",$0.00,"$1,487.50",$669.38,"$1,061.63",$0.00,$256.29,$0.00,$0.00,$260.45,"$1,487.50",$0.00,$743.75,"$1,178.10","$1,190.00",$0.00,$232.79,$0.00,$236.81,$0.00
7867535,SUP,HCPCS C1713,,7867535  -  BOLT SPNL 7.5MM 35MM NS TRAVERSE PLT,"$1,487.50",$0.00,"$1,487.50",$669.38,"$1,061.63",$0.00,$256.29,$0.00,$0.00,$260.45,"$1,487.50",$0.00,$743.75,"$1,178.10","$1,190.00",$0.00,$232.79,$0.00,$236.81,$0.00
7867540,SUP,HCPCS C1713,,7867540  -  BOLT SPNL 7.5MM 40MM NS TRAVERSE PLT,"$1,487.50",$0.00,"$1,487.50",$669.38,"$1,061.63",$0.00,$256.29,$0.00,$0.00,$260.45,"$1,487.50",$0.00,$743.75,"$1,178.10","$1,190.00",$0.00,$232.79,$0.00,$236.81,$0.00
7867545,SUP,HCPCS C1713,,7867545  -  BOLT SPNL 7.5MM 45MM NS TRAVERSE PLT,"$1,487.50",$0.00,"$1,487.50",$669.38,"$1,061.63",$0.00,$256.29,$0.00,$0.00,$260.45,"$1,487.50",$0.00,$743.75,"$1,178.10","$1,190.00",$0.00,$232.79,$0.00,$236.81,$0.00
7867550,SUP,HCPCS C1713,,7867550  -  BOLT SPNL 7.5MM 50MM NS TRAVERSE PLT,"$1,487.50",$0.00,"$1,487.50",$669.38,"$1,061.63",$0.00,$256.29,$0.00,$0.00,$260.45,"$1,487.50",$0.00,$743.75,"$1,178.10","$1,190.00",$0.00,$232.79,$0.00,$236.81,$0.00
7867555,SUP,HCPCS C1713,,7867555  -  BOLT SPNL 7.5MM 55MM NS TRAVERSE PLT,"$1,487.50",$0.00,"$1,487.50",$669.38,"$1,061.63",$0.00,$256.29,$0.00,$0.00,$260.45,"$1,487.50",$0.00,$743.75,"$1,178.10","$1,190.00",$0.00,$232.79,$0.00,$236.81,$0.00
7867560,SUP,HCPCS C1713,,7867560  -  BOLT SPNL 7.5MM 60MM NS TRAVERSE PLT,"$1,487.50",$0.00,"$1,487.50",$669.38,"$1,061.63",$0.00,$256.29,$0.00,$0.00,$260.45,"$1,487.50",$0.00,$743.75,"$1,178.10","$1,190.00",$0.00,$232.79,$0.00,$236.81,$0.00
7867565,SUP,HCPCS C1713,,7867565  -  BOLT SPNL 7.5MM 65MM NS TRAVERSE PLT,"$1,487.50",$0.00,"$1,487.50",$669.38,"$1,061.63",$0.00,$256.29,$0.00,$0.00,$260.45,"$1,487.50",$0.00,$743.75,"$1,178.10","$1,190.00",$0.00,$232.79,$0.00,$236.81,$0.00
7870845,SUP,HCPCS C1713,,7870845  -  SPACER SPNL 10D XL 45X18X8MM CRNT 1ST LAT APRCH,"$13,750.00",$0.00,"$13,750.00","$6,187.50","$5,158.80",$0.00,"$2,369.06",$0.00,$0.00,"$2,407.52","$13,750.00",$0.00,"$6,875.00","$10,890.00","$11,000.00",$0.00,"$2,151.88",$0.00,"$2,189.00",$0.00
7870850,SUP,HCPCS C1713,,7870850  -  CAGE SPNL 10D XL 50X18X8MM NS LF CRNT,"$13,750.00",$0.00,"$13,750.00","$6,187.50","$5,158.80",$0.00,"$2,369.06",$0.00,$0.00,"$2,407.52","$13,750.00",$0.00,"$6,875.00","$10,890.00","$11,000.00",$0.00,"$2,151.88",$0.00,"$2,189.00",$0.00
7870855,SUP,HCPCS C1713,,7870855  -  CAGE SPNL 10D XL 55X18X8MM NS LF CRNT,"$13,750.00",$0.00,"$13,750.00","$6,187.50","$5,158.80",$0.00,"$2,369.06",$0.00,$0.00,"$2,407.52","$13,750.00",$0.00,"$6,875.00","$10,890.00","$11,000.00",$0.00,"$2,151.88",$0.00,"$2,189.00",$0.00
7870860,SUP,HCPCS C1713,,7870860  -  CAGE SPNL 10D LRDTC 60X18X8MM CRNT XLIF PEEK-OPTM,"$13,750.00",$0.00,"$13,750.00","$6,187.50","$5,158.80",$0.00,"$2,369.06",$0.00,$0.00,"$2,407.52","$13,750.00",$0.00,"$6,875.00","$10,890.00","$11,000.00",$0.00,"$2,151.88",$0.00,"$2,189.00",$0.00
7871055,SUP,HCPCS C1713,,7871055  -  CAGE SPNL 10D XL 55X18X10MM NS LF CRNT,"$13,750.00",$0.00,"$13,750.00","$6,187.50","$5,158.80",$0.00,"$2,369.06",$0.00,$0.00,"$2,407.52","$13,750.00",$0.00,"$6,875.00","$10,890.00","$11,000.00",$0.00,"$2,151.88",$0.00,"$2,189.00",$0.00
7871060,SUP,HCPCS C1713,,7871060  -  CAGE SPNL 10D LRDTC 60X18X10MM CRNT XLIF PEEK-OPTM,"$13,750.00",$0.00,"$13,750.00","$6,187.50","$5,158.80",$0.00,"$2,369.06",$0.00,$0.00,"$2,407.52","$13,750.00",$0.00,"$6,875.00","$10,890.00","$11,000.00",$0.00,"$2,151.88",$0.00,"$2,189.00",$0.00
7871245,SUP,HCPCS C1713,,7871245  -  SPACER SPNL XL 45X18X12MM CRNT FSN,"$13,750.00",$0.00,"$13,750.00","$6,187.50","$5,158.80",$0.00,"$2,369.06",$0.00,$0.00,"$2,407.52","$13,750.00",$0.00,"$6,875.00","$10,890.00","$11,000.00",$0.00,"$2,151.88",$0.00,"$2,189.00",$0.00
7871250,SUP,HCPCS C1713,,7871250  -  CAGE SPNL 10D XL 50X18X10MM NS LF CRNT,"$13,750.00",$0.00,"$13,750.00","$6,187.50","$5,158.80",$0.00,"$2,369.06",$0.00,$0.00,"$2,407.52","$13,750.00",$0.00,"$6,875.00","$10,890.00","$11,000.00",$0.00,"$2,151.88",$0.00,"$2,189.00",$0.00
7871255,SUP,HCPCS C1713,,7871255  -  CAGE SPNL 10D XL 55X18X12MM NS LF CRNT,"$13,750.00",$0.00,"$13,750.00","$6,187.50","$5,158.80",$0.00,"$2,369.06",$0.00,$0.00,"$2,407.52","$13,750.00",$0.00,"$6,875.00","$10,890.00","$11,000.00",$0.00,"$2,151.88",$0.00,"$2,189.00",$0.00
7871260,SUP,HCPCS C1713,,7871260  -  CAGE SPNL 10D LRDTC 60X18X12MM CRNT XLIF PEEK-OPTM,"$13,750.00",$0.00,"$13,750.00","$6,187.50","$5,158.80",$0.00,"$2,369.06",$0.00,$0.00,"$2,407.52","$13,750.00",$0.00,"$6,875.00","$10,890.00","$11,000.00",$0.00,"$2,151.88",$0.00,"$2,189.00",$0.00
7871445,SUP,HCPCS C1713,,7871445  -  SPACER SPNL 10D XL 45X18X14MM CRNT 1ST LAT APRCH,"$13,750.00",$0.00,"$13,750.00","$6,187.50","$5,158.80",$0.00,"$2,369.06",$0.00,$0.00,"$2,407.52","$13,750.00",$0.00,"$6,875.00","$10,890.00","$11,000.00",$0.00,"$2,151.88",$0.00,"$2,189.00",$0.00
7871450,SUP,HCPCS C1713,,7871450  -  SPACER SPNL 10D XL 50X18X14MM CRNT 1ST LAT APRCH,"$13,750.00",$0.00,"$13,750.00","$6,187.50","$5,158.80",$0.00,"$2,369.06",$0.00,$0.00,"$2,407.52","$13,750.00",$0.00,"$6,875.00","$10,890.00","$11,000.00",$0.00,"$2,151.88",$0.00,"$2,189.00",$0.00
7871455,SUP,HCPCS C1713,,7871455  -  CAGE SPNL 10D LRDTC 55X18X14MM CRNT XLIF PEEK-OPTM,"$13,750.00",$0.00,"$13,750.00","$6,187.50","$5,158.80",$0.00,"$2,369.06",$0.00,$0.00,"$2,407.52","$13,750.00",$0.00,"$6,875.00","$10,890.00","$11,000.00",$0.00,"$2,151.88",$0.00,"$2,189.00",$0.00
7871460,SUP,HCPCS C1713,,7871460  -  CAGE SPNL 10D LRDTC 60X18X14MM CRNT XLIF PEEK-OPTM,"$13,750.00",$0.00,"$13,750.00","$6,187.50","$5,158.80",$0.00,"$2,369.06",$0.00,$0.00,"$2,407.52","$13,750.00",$0.00,"$6,875.00","$10,890.00","$11,000.00",$0.00,"$2,151.88",$0.00,"$2,189.00",$0.00
7871645,SUP,HCPCS C1713,,7871645  -  SPACER SPNL 10D XL 45X18X16MM CRNT 1ST LAT APRCH,"$13,750.00",$0.00,"$13,750.00","$6,187.50","$5,158.80",$0.00,"$2,369.06",$0.00,$0.00,"$2,407.52","$13,750.00",$0.00,"$6,875.00","$10,890.00","$11,000.00",$0.00,"$2,151.88",$0.00,"$2,189.00",$0.00
7871650,SUP,HCPCS C1713,,7871650  -  SPACER SPNL 10D XL 50X18X16MM CRNT 1ST LAT APRCH,"$13,750.00",$0.00,"$13,750.00","$6,187.50","$5,158.80",$0.00,"$2,369.06",$0.00,$0.00,"$2,407.52","$13,750.00",$0.00,"$6,875.00","$10,890.00","$11,000.00",$0.00,"$2,151.88",$0.00,"$2,189.00",$0.00
7871655,SUP,HCPCS C1713,,7871655  -  SPACER SPNL 10D XL 55X18X16MM CRNT 1ST LAT APRCH,"$13,750.00",$0.00,"$13,750.00","$6,187.50","$5,158.80",$0.00,"$2,369.06",$0.00,$0.00,"$2,407.52","$13,750.00",$0.00,"$6,875.00","$10,890.00","$11,000.00",$0.00,"$2,151.88",$0.00,"$2,189.00",$0.00
7871660,SUP,HCPCS C1713,,7871660  -  SPACER SPNL 10D XL 60X18X16MM CRNT 1ST LAT APRCH,"$13,750.00",$0.00,"$13,750.00","$6,187.50","$5,158.80",$0.00,"$2,369.06",$0.00,$0.00,"$2,407.52","$13,750.00",$0.00,"$6,875.00","$10,890.00","$11,000.00",$0.00,"$2,151.88",$0.00,"$2,189.00",$0.00
7871845,SUP,HCPCS C1713,,7871845  -  SPACER SPNL 10D XL 45X18X18MM CRNT 1ST LAT APRCH,"$13,750.00",$0.00,"$13,750.00","$6,187.50","$5,158.80",$0.00,"$2,369.06",$0.00,$0.00,"$2,407.52","$13,750.00",$0.00,"$6,875.00","$10,890.00","$11,000.00",$0.00,"$2,151.88",$0.00,"$2,189.00",$0.00
7871850,SUP,HCPCS C1713,,7871850  -  SPACER SPNL 10D XL 50X18X18MM CRNT 1ST LAT APRCH,"$13,750.00",$0.00,"$13,750.00","$6,187.50","$5,158.80",$0.00,"$2,369.06",$0.00,$0.00,"$2,407.52","$13,750.00",$0.00,"$6,875.00","$10,890.00","$11,000.00",$0.00,"$2,151.88",$0.00,"$2,189.00",$0.00
7871855,SUP,HCPCS C1713,,7871855  -  SPACER SPNL 10D XL 55X18X18MM CRNT 1ST LAT APRCH,"$13,750.00",$0.00,"$13,750.00","$6,187.50","$5,158.80",$0.00,"$2,369.06",$0.00,$0.00,"$2,407.52","$13,750.00",$0.00,"$6,875.00","$10,890.00","$11,000.00",$0.00,"$2,151.88",$0.00,"$2,189.00",$0.00
7871860,SUP,HCPCS C1713,,7871860  -  SPACER SPNL 10D XL 60X18X18MM CRNT 1ST LAT APRCH,"$13,750.00",$0.00,"$13,750.00","$6,187.50","$5,158.80",$0.00,"$2,369.06",$0.00,$0.00,"$2,407.52","$13,750.00",$0.00,"$6,875.00","$10,890.00","$11,000.00",$0.00,"$2,151.88",$0.00,"$2,189.00",$0.00
7875520,SUP,HCPCS C1713,,7875520  -  SCREW BN 5.5MM 20MM HALO SPNE,"$1,057.50",$0.00,"$1,057.50",$475.88,$754.74,$0.00,$182.20,$0.00,$0.00,$185.16,"$1,057.50",$0.00,$528.75,$837.54,$846.00,$0.00,$165.50,$0.00,$168.35,$0.00
7875522,SUP,HCPCS C1713,,7875522  -  SCREW BN 5.5MM 22MM HALO SPNE,"$1,057.50",$0.00,"$1,057.50",$475.88,$754.74,$0.00,$182.20,$0.00,$0.00,$185.16,"$1,057.50",$0.00,$528.75,$837.54,$846.00,$0.00,$165.50,$0.00,$168.35,$0.00
7875524,SUP,HCPCS C1713,,7875524  -  SCREW BN 5.5MM 24MM HALO SPNE,"$1,057.50",$0.00,"$1,057.50",$475.88,$754.74,$0.00,$182.20,$0.00,$0.00,$185.16,"$1,057.50",$0.00,$528.75,$837.54,$846.00,$0.00,$165.50,$0.00,$168.35,$0.00
7875526,SUP,HCPCS C1713,,7875526  -  SCREW BN 5.5MM 26MM HALO SPNE,"$1,057.50",$0.00,"$1,057.50",$475.88,$754.74,$0.00,$182.20,$0.00,$0.00,$185.16,"$1,057.50",$0.00,$528.75,$837.54,$846.00,$0.00,$165.50,$0.00,$168.35,$0.00
7875528,SUP,HCPCS C1713,,7875528  -  SCREW BN 5.5MM 28MM HALO SPNE,"$1,057.50",$0.00,"$1,057.50",$475.88,$754.74,$0.00,$182.20,$0.00,$0.00,$185.16,"$1,057.50",$0.00,$528.75,$837.54,$846.00,$0.00,$165.50,$0.00,$168.35,$0.00
7875530,SUP,HCPCS C1713,,7875530  -  SCREW BN 5.5MM 30MM HALO SPNE LMBR ANT,"$1,057.50",$0.00,"$1,057.50",$475.88,$754.74,$0.00,$182.20,$0.00,$0.00,$185.16,"$1,057.50",$0.00,$528.75,$837.54,$846.00,$0.00,$165.50,$0.00,$168.35,$0.00
7875532,SUP,HCPCS C1713,,7875532  -  SCREW BN 5.5MM 32MM HALO SPNE LMBR ANT,"$1,057.50",$0.00,"$1,057.50",$475.88,$754.74,$0.00,$182.20,$0.00,$0.00,$185.16,"$1,057.50",$0.00,$528.75,$837.54,$846.00,$0.00,$165.50,$0.00,$168.35,$0.00
7875534,SUP,HCPCS C1713,,7875534  -  SCREW BN 5.5MM 34MM HALO SPNE LMBR ANT,"$1,057.50",$0.00,"$1,057.50",$475.88,$754.74,$0.00,$182.20,$0.00,$0.00,$185.16,"$1,057.50",$0.00,$528.75,$837.54,$846.00,$0.00,$165.50,$0.00,$168.35,$0.00
7876520,SUP,HCPCS C1713,,7876520  -  SCREW BN 6.5MM 20MM HALO SPNE LMBR ANT,"$1,057.50",$0.00,"$1,057.50",$475.88,$754.74,$0.00,$182.20,$0.00,$0.00,$185.16,"$1,057.50",$0.00,$528.75,$837.54,$846.00,$0.00,$165.50,$0.00,$168.35,$0.00
7876522,SUP,HCPCS C1713,,7876522  -  SCREW BN 6.5MM 22MM HALO SPNE,"$1,057.50",$0.00,"$1,057.50",$475.88,$754.74,$0.00,$182.20,$0.00,$0.00,$185.16,"$1,057.50",$0.00,$528.75,$837.54,$846.00,$0.00,$165.50,$0.00,$168.35,$0.00
7876526,SUP,HCPCS C1713,,7876526  -  SCREW BN 6.5MM 26MM HALO ANT LMBR SPNE PLT,"$1,057.50",$0.00,"$1,057.50",$475.88,$754.74,$0.00,$182.20,$0.00,$0.00,$185.16,"$1,057.50",$0.00,$528.75,$837.54,$846.00,$0.00,$165.50,$0.00,$168.35,$0.00
7876528,SUP,HCPCS C1713,,7876528  -  SCREW BN 6.5MM 28MM HALO PLT ANT LMBR SPNE,"$1,057.50",$0.00,"$1,057.50",$475.88,$754.74,$0.00,$182.20,$0.00,$0.00,$185.16,"$1,057.50",$0.00,$528.75,$837.54,$846.00,$0.00,$165.50,$0.00,$168.35,$0.00
7876530,SUP,HCPCS C1713,,7876530  -  SCREW BN 6.5MM 30MM HALO SPNE LMBR ANT,"$1,057.50",$0.00,"$1,057.50",$475.88,$754.74,$0.00,$182.20,$0.00,$0.00,$185.16,"$1,057.50",$0.00,$528.75,$837.54,$846.00,$0.00,$165.50,$0.00,$168.35,$0.00
7876532,SUP,HCPCS C1713,,7876532  -  SCREW BN 6.5MM 32MM HALO SPNE LMBR ANT,"$1,057.50",$0.00,"$1,057.50",$475.88,$754.74,$0.00,$182.20,$0.00,$0.00,$185.16,"$1,057.50",$0.00,$528.75,$837.54,$846.00,$0.00,$165.50,$0.00,$168.35,$0.00
7876534,SUP,HCPCS C1713,,7876534  -  SCREW BN 6.5MM 34MM HALO SPNE LMBR ANT,"$1,057.50",$0.00,"$1,057.50",$475.88,$754.74,$0.00,$182.20,$0.00,$0.00,$185.16,"$1,057.50",$0.00,$528.75,$837.54,$846.00,$0.00,$165.50,$0.00,$168.35,$0.00
7890030,SUP,HCPCS C1713,,7890030  -  PIN SKL HALO SLV ANT LMBR SPNE,$220.00,$0.00,$220.00,$99.00,$157.01,$0.00,$37.90,$0.00,$0.00,$38.52,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$34.43,$0.00,$35.02,$0.00
7891032,SUP,HCPCS C1713,,7891032  -  PLATE BN 32MM HALO TI SPNE LMBR ANT,"$8,407.50",$0.00,"$8,407.50","$3,783.38","$5,158.80",$0.00,"$1,448.57",$0.00,$0.00,"$1,472.09","$8,407.50",$0.00,"$4,203.75","$6,658.74","$6,726.00",$0.00,"$1,315.77",$0.00,"$1,338.47",$0.00
7891034,SUP,HCPCS C1713,,7891034  -  PLATE BN 34MM HALO TI SPNE LMBR ANT,"$8,407.50",$0.00,"$8,407.50","$3,783.38","$5,158.80",$0.00,"$1,448.57",$0.00,$0.00,"$1,472.09","$8,407.50",$0.00,"$4,203.75","$6,658.74","$6,726.00",$0.00,"$1,315.77",$0.00,"$1,338.47",$0.00
7891036,SUP,HCPCS C1713,,7891036  -  PLATE BN 36MM HALO TI SPNE LMBR ANT,"$8,407.50",$0.00,"$8,407.50","$3,783.38","$5,158.80",$0.00,"$1,448.57",$0.00,$0.00,"$1,472.09","$8,407.50",$0.00,"$4,203.75","$6,658.74","$6,726.00",$0.00,"$1,315.77",$0.00,"$1,338.47",$0.00
7891038,SUP,HCPCS C1713,,7891038  -  PLATE BN 38MM HALO TI SPNE LMBR ANT,"$8,407.50",$0.00,"$8,407.50","$3,783.38","$5,158.80",$0.00,"$1,448.57",$0.00,$0.00,"$1,472.09","$8,407.50",$0.00,"$4,203.75","$6,658.74","$6,726.00",$0.00,"$1,315.77",$0.00,"$1,338.47",$0.00
7891040,SUP,HCPCS C1713,,7891040  -  PLATE BN 40MM HALO TI SPNE LMBR ANT,"$8,407.50",$0.00,"$8,407.50","$3,783.38","$5,158.80",$0.00,"$1,448.57",$0.00,$0.00,"$1,472.09","$8,407.50",$0.00,"$4,203.75","$6,658.74","$6,726.00",$0.00,"$1,315.77",$0.00,"$1,338.47",$0.00
7891042,SUP,HCPCS C1713,,7891042  -  PLATE BN 42MM HALO TI SPNE LMBR ANT,"$8,407.50",$0.00,"$8,407.50","$3,783.38","$5,158.80",$0.00,"$1,448.57",$0.00,$0.00,"$1,472.09","$8,407.50",$0.00,"$4,203.75","$6,658.74","$6,726.00",$0.00,"$1,315.77",$0.00,"$1,338.47",$0.00
7891044,SUP,HCPCS C1713,,7891044  -  PLATE BN 44MM HALO TI SPNE LMBR ANT,"$8,407.50",$0.00,"$8,407.50","$3,783.38","$5,158.80",$0.00,"$1,448.57",$0.00,$0.00,"$1,472.09","$8,407.50",$0.00,"$4,203.75","$6,658.74","$6,726.00",$0.00,"$1,315.77",$0.00,"$1,338.47",$0.00
7891046,SUP,HCPCS C1713,,7891046  -  PLATE BN 46MM HALO TI SPNE LMBR ANT,"$8,407.50",$0.00,"$8,407.50","$3,783.38","$5,158.80",$0.00,"$1,448.57",$0.00,$0.00,"$1,472.09","$8,407.50",$0.00,"$4,203.75","$6,658.74","$6,726.00",$0.00,"$1,315.77",$0.00,"$1,338.47",$0.00
7892032,SUP,HCPCS C1713,,7892032  -  PLATE BN 32MM HALO TI SPNE SCRM ANT,"$8,407.50",$0.00,"$8,407.50","$3,783.38","$5,158.80",$0.00,"$1,448.57",$0.00,$0.00,"$1,472.09","$8,407.50",$0.00,"$4,203.75","$6,658.74","$6,726.00",$0.00,"$1,315.77",$0.00,"$1,338.47",$0.00
7892034,SUP,HCPCS C1713,,7892034  -  PLATE BN 34MM HALO TI SPNE SCRM ANT,"$8,407.50",$0.00,"$8,407.50","$3,783.38","$5,158.80",$0.00,"$1,448.57",$0.00,$0.00,"$1,472.09","$8,407.50",$0.00,"$4,203.75","$6,658.74","$6,726.00",$0.00,"$1,315.77",$0.00,"$1,338.47",$0.00
7892038,SUP,HCPCS C1713,,7892038  -  PLATE BN 38MM HALO TI SPNE SCRM ANT,"$8,407.50",$0.00,"$8,407.50","$3,783.38","$5,158.80",$0.00,"$1,448.57",$0.00,$0.00,"$1,472.09","$8,407.50",$0.00,"$4,203.75","$6,658.74","$6,726.00",$0.00,"$1,315.77",$0.00,"$1,338.47",$0.00
7892042,SUP,HCPCS C1713,,7892042  -  PLATE BN 42MM HALO TI SPNE SCRM ANT,"$8,407.50",$0.00,"$8,407.50","$3,783.38","$5,158.80",$0.00,"$1,448.57",$0.00,$0.00,"$1,472.09","$8,407.50",$0.00,"$4,203.75","$6,658.74","$6,726.00",$0.00,"$1,315.77",$0.00,"$1,338.47",$0.00
7892044,SUP,HCPCS C1713,,7892044  -  PLATE BN 44MM HALO TI SPNE SCRM ANT,"$8,407.50",$0.00,"$8,407.50","$3,783.38","$5,158.80",$0.00,"$1,448.57",$0.00,$0.00,"$1,472.09","$8,407.50",$0.00,"$4,203.75","$6,658.74","$6,726.00",$0.00,"$1,315.77",$0.00,"$1,338.47",$0.00
7892046,SUP,HCPCS C1713,,7892046  -  PLATE BN 46MM HALO TI SPNE SCRM ANT,"$8,407.50",$0.00,"$8,407.50","$3,783.38","$5,158.80",$0.00,"$1,448.57",$0.00,$0.00,"$1,472.09","$8,407.50",$0.00,"$4,203.75","$6,658.74","$6,726.00",$0.00,"$1,315.77",$0.00,"$1,338.47",$0.00
7892525,SUP,HCPCS C1713,,7892525  -  SCREW 7892525 HA COATED NONCAN 5.5 X 25,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7892530,SUP,HCPCS C1713,,7892530  -  SCREW 7892530 HA COATED NONCAN 5.5 X 30,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7892535,SUP,HCPCS C1713,,7892535  -  SCREW 7892535 HA COATED NONCAN 5.5 X 35,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7892540,SUP,HCPCS C1713,,7892540  -  SCREW 7892540 HA COATED NONCAN 5.5 X 40,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7892545,SUP,HCPCS C1713,,7892545  -  SCREW 7892545 HA COATED NONCAN 5.5 X 45,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7892550,SUP,HCPCS C1713,,7892550  -  SCREW 7892550 HA COATED NONCAN 5.5 X 50,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7892555,SUP,HCPCS C1713,,7892555  -  SCREW 7892555 HA COATED NONCAN 5.5 X 55,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7892560,SUP,HCPCS C1713,,7892560  -  SCREW 7892560 HA COATED NONCANN 5.5X60,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7892625,SUP,HCPCS C1713,,7892625  -  SCREW 7892625 HA COATED NONCAN 6.5 X 25,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7892630,SUP,HCPCS C1713,,7892630  -  SCREW 7892630 HA COATED NONCAN 6.5 X 30,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7892635,SUP,HCPCS C1713,,7892635  -  SCREW 7892635 HA COATED NONCAN 6.5 X 35,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7892640,SUP,HCPCS C1713,,7892640  -  SCREW 7892640 HA COATED NONCAN 6.5 X 40,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7892645,SUP,HCPCS C1713,,7892645  -  SCREW 7892645 HA COATED NONCAN 6.5 X 45,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7892650,SUP,HCPCS C1713,,7892650  -  SCREW 7892650 HA COATED NONCAN 6.5 X 50,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7892655,SUP,HCPCS C1713,,7892655  -  SCREW 7892655 HA COATED NONCAN 6.5 X 55,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7892660,SUP,HCPCS C1713,,7892660  -  SCREW 7892660 HA COATED NONCAN 6.5 X 60,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7892665,SUP,HCPCS C1713,,7892665  -  SCREW 7892665 HA COATED NONCAN 6.5 X 65,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7892725,SUP,HCPCS C1713,,7892725  -  SCREW 7892725 HA COATED NONCAN 7.5 X 25,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7892730,SUP,HCPCS C1713,,7892730  -  SCREW 7892730 HA COATED NONCAN 7.5 X 30,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7892735,SUP,HCPCS C1713,,7892735  -  SCREW 7892735 HA COATED NONCAN 7.5 X 35,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7892740,SUP,HCPCS C1713,,7892740  -  SCREW BN 7.5MM 40MM STRL CD HZN LGC MA PEEK HA SPNE PDCL 5.5,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7892745,SUP,HCPCS C1713,,7892745  -  SCREW BN 7.5MM 45MM STRL CD HZN LGC MA PEEK HA SPNE PDCL 5.5,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7892750,SUP,HCPCS C1713,,7892750  -  SCREW 7892750 HA COATED NONCAN 7.5 X 50,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7892755,SUP,HCPCS C1713,,7892755  -  SCREW 7892755 HA COATED NONCAN 7.5 X 55,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7892760,SUP,HCPCS C1713,,7892760  -  SCREW 7892760 HA COATED NONCAN 7.5 X 60,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7892765,SUP,HCPCS C1713,,7892765  -  SCREW 7892765 HA COATED NONCAN 7.5 X 65,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7892770,SUP,HCPCS C1713,,7892770  -  SCREW 7892770 HA COATED NONCAN 7.5 X 70,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7892825,SUP,HCPCS C1713,,7892825  -  SCREW 7892825 HA COATED NONCAN 8.5 X 25,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7892830,SUP,HCPCS C1713,,7892830  -  SCREW 7892830 HA COATED NONCAN 8.5 X 30,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7892835,SUP,HCPCS C1713,,7892835  -  SCREW 7892835 HA COATED NONCAN 8.5 X 35,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7892840,SUP,HCPCS C1713,,7892840  -  SCREW 7892840 HA COATED NONCAN 8.5 X 40,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7892845,SUP,HCPCS C1713,,7892845  -  SCREW 7892845 HA COATED NONCAN 8.5 X 45,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7892850,SUP,HCPCS C1713,,7892850  -  SCREW 7892850 HA COATED NONCAN 8.5 X 50,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7892855,SUP,HCPCS C1713,,7892855  -  SCREW 7892855 HA COATED NONCAN 8.5 X 55,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7892860,SUP,HCPCS C1713,,7892860  -  SCREW 7892860 HA COATED NONCAN 8.5 X 60,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7892865,SUP,HCPCS C1713,,7892865  -  SCREW 7892865 HA COATED NONCAN 8.5 X 65,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7893025,SUP,HCPCS C1713,,7893025  -  ROD 7893025 6.35MM X 25MM PEEK ROD,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
7893030,SUP,HCPCS C1713,,7893030  -  ROD 7893030 6.35MM X 30MM PEEK ROD,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
7893035,SUP,HCPCS C1713,,7893035  -  ROD 7893035 6.35MM X 35MM PEEK ROD,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
7893040,SUP,HCPCS C1713,,7893040  -  ROD 7893040 6.35MM X 40MM PEEK ROD,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
7893045,SUP,HCPCS C1713,,7893045  -  ROD 7893045 6.35MM X 45MM PEEK ROD,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
7893050,SUP,HCPCS C1713,,7893050  -  ROD 7893050 6.35MM X 50MM PEEK ROD,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
7893055,SUP,HCPCS C1713,,7893055  -  ROD 7893055 6.35MM X 55MM PEEK ROD,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
7893060,SUP,HCPCS C1713,,7893060  -  ROD SPNL 60MM 6.35MM PEEK,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
7893065,SUP,HCPCS C1713,,7893065  -  ROD 7893065 6.35MM X 65MM PEEK ROD,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
7893070,SUP,HCPCS C1713,,7893070  -  ROD 7893070 6.35MM X 70MM PEEK ROD,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
7893075,SUP,HCPCS C1713,,7893075  -  ROD 7893075 6.35MM X 75MM PEEK ROD,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
7893076,SUP,HCPCS C1713,,7893076  -  PLATE BN 76MM HALO LVL 2 TI SPNE LMBR ANT,"$11,927.50",$0.00,"$11,927.50","$5,367.38","$5,158.80",$0.00,"$2,055.05",$0.00,$0.00,"$2,088.41","$11,927.50",$0.00,"$5,963.75","$9,446.58","$9,542.00",$0.00,"$1,866.65",$0.00,"$1,898.86",$0.00
7893080,SUP,HCPCS C1713,,7893080  -  PLATE BN 80MM HALO LVL 2 TI SPNE LMBR ANT,"$11,927.50",$0.00,"$11,927.50","$5,367.38","$5,158.80",$0.00,"$2,055.05",$0.00,$0.00,"$2,088.41","$11,927.50",$0.00,"$5,963.75","$9,446.58","$9,542.00",$0.00,"$1,866.65",$0.00,"$1,898.86",$0.00
7893084,SUP,HCPCS C1713,,7893084  -  PLATE BN 84MM HALO LVL 2 TI SPNE LMBR ANT,"$11,927.50",$0.00,"$11,927.50","$5,367.38","$5,158.80",$0.00,"$2,055.05",$0.00,$0.00,"$2,088.41","$11,927.50",$0.00,"$5,963.75","$9,446.58","$9,542.00",$0.00,"$1,866.65",$0.00,"$1,898.86",$0.00
7893085,SUP,HCPCS C1713,,7893085  -  ROD 7893085 6.35MM X 85MM PEEK ROD,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
7893088,SUP,HCPCS C1713,,7893088  -  PLATE BN 88MM HALO LVL 2 TI SPNE LMBR ANT,"$11,927.50",$0.00,"$11,927.50","$5,367.38","$5,158.80",$0.00,"$2,055.05",$0.00,$0.00,"$2,088.41","$11,927.50",$0.00,"$5,963.75","$9,446.58","$9,542.00",$0.00,"$1,866.65",$0.00,"$1,898.86",$0.00
7893090,SUP,HCPCS C1713,,7893090  -  ROD 7893090 6.35MM X 90MM PEEK ROD,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
7893092,SUP,HCPCS C1713,,7893092  -  PLATE BN 92MM HALO LVL 2 TI SPNE LMBR ANT,"$11,927.50",$0.00,"$11,927.50","$5,367.38","$5,158.80",$0.00,"$2,055.05",$0.00,$0.00,"$2,088.41","$11,927.50",$0.00,"$5,963.75","$9,446.58","$9,542.00",$0.00,"$1,866.65",$0.00,"$1,898.86",$0.00
7893095,SUP,HCPCS C1713,,7893095  -  ROD 7893095 6.35MM X 95MM PEEK ROD,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
7893096,SUP,HCPCS C1713,,7893096  -  PLATE BN 96MM HALO LVL 2 TI SPNE LMBR ANT,"$11,927.50",$0.00,"$11,927.50","$5,367.38","$5,158.80",$0.00,"$2,055.05",$0.00,$0.00,"$2,088.41","$11,927.50",$0.00,"$5,963.75","$9,446.58","$9,542.00",$0.00,"$1,866.65",$0.00,"$1,898.86",$0.00
7893100,SUP,HCPCS C1713,,7893100  -  PLATE BN 100MM HALO LVL 2 TI SPNE LMBR ANT,"$11,927.50",$0.00,"$11,927.50","$5,367.38","$5,158.80",$0.00,"$2,055.05",$0.00,$0.00,"$2,088.41","$11,927.50",$0.00,"$5,963.75","$9,446.58","$9,542.00",$0.00,"$1,866.65",$0.00,"$1,898.86",$0.00
7893105,SUP,HCPCS C1713,,7893105  -  ROD 7893105 6.35MM X 105MM PEEK ROD,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
7893110,SUP,HCPCS C1713,,7893110  -  ROD 7893110 6.35MM X 110MM PEEK ROD,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
7893115,SUP,HCPCS C1713,,7893115  -  ROD 7893115 6.35MM X 115MM PEEK ROD,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
7893120,SUP,HCPCS C1713,,7893120  -  ROD 7893120 6.35MM X 120MM PEEK ROD,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
7893125,SUP,HCPCS C1713,,7893125  -  ROD 7893125 6.35MM X 125MM PEEK ROD,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
7893130,SUP,HCPCS C1713,,7893130  -  ROD 7893130 6.35MM X 130MM PEEK ROD,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
7894525,SUP,HCPCS C1713,,7894525  -  SCREW 7894525 CDH PEEK 4.5X25 NON CANN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7894530,SUP,HCPCS C1713,,7894530  -  SCREW 7894530 CDH PEEK 4.5X30 NON CANN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7894535,SUP,HCPCS C1713,,7894535  -  SCREW 7894535 CDH PEEK 4.5X35 NON CANN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7894540,SUP,HCPCS C1713,,7894540  -  SCREW 7894540 CDH PEEK 4.5X40 NON CANN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7894545,SUP,HCPCS C1713,,7894545  -  SCREW 7894545 CDH PEEK 4.5X45 NON CANN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7894550,SUP,HCPCS C1713,,7894550  -  SCREW 7894550 CDH PEEK 4.5X50 NON CANN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7895525,SUP,HCPCS C1713,,7895525  -  SCREW 7895525 CDH PEEK 5.5X25 NON CANN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7895530,SUP,HCPCS C1713,,7895530  -  SCREW 7895530 CDH PEEK 5.5X30 NON CANN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7895535,SUP,HCPCS C1713,,7895535  -  SCREW 7895535 CDH PEEK 5.5X35 NON CANN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7895540,SUP,HCPCS C1713,,7895540  -  SCREW 7895540 CDH PEEK 5.5X40 NON CANN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7895545,SUP,HCPCS C1713,,7895545  -  SCREW BN 5.5MM 45MM STRL CD HZN LGC MA PEEK SPNE PDCL 5.5MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7895550,SUP,HCPCS C1713,,7895550  -  SCREW 7895550 CDH PEEK 5.5X50 NON CANN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7895555,SUP,HCPCS C1713,,7895555  -  SCREW 7895555 CDH PEEK 5.5X55 NON CANN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7895560,SUP,HCPCS C1713,,7895560  -  SCREW 7895560 CDH PEEK 5.5X60 NON CANN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7896525,SUP,HCPCS C1713,,7896525  -  SCREW 7896525 CDH PEEK 6.5X25 NON CANN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7896530,SUP,HCPCS C1713,,7896530  -  SCREW 7896530 CDH PEEK 6.5X30 NON CANN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7896535,SUP,HCPCS C1713,,7896535  -  SCREW BN 6.5MM 35MM STRL CD HZN LGC MA PEEK SPNE PDCL 5.5MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7896540,SUP,HCPCS C1713,,7896540  -  SCREW BN 6.5MM 40MM STRL CD HZN LGC MA PEEK SPNE PDCL 5.5MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7896545,SUP,HCPCS C1713,,7896545  -  SCREW BN 6.5MM 45MM STRL CD HZN LGC MA PEEK SPNE PDCL 5.5MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7896550,SUP,HCPCS C1713,,7896550  -  SCREW BN 6.5MM 50MM STRL CD HZN LGC MA PEEK SPNE PDCL 5.5MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7896555,SUP,HCPCS C1713,,7896555  -  SCREW 7896555 CDH PEEK 6.5X55 NON CANN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7896560,SUP,HCPCS C1713,,7896560  -  SCREW 7896560 CDH PEEK 6.5X60 NON CANN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7896565,SUP,HCPCS C1713,,7896565  -  SCREW 7896565 CDH PEEK 6.5X65 NON CANN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7897530,SUP,HCPCS C1713,,7897530  -  SCREW 7897530 CDH PEEK 7.5X30 NON CANN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7897535,SUP,HCPCS C1713,,7897535  -  SCREW 7897535 CDH PEEK 7.5X35 NON CANN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7897540,SUP,HCPCS C1713,,7897540  -  SCREW BONE 7.5MM 40MM CD HZN LGC PEEK SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7897545,SUP,HCPCS C1713,,7897545  -  SCREW 7897545 CDH PEEK 7.5X45 NON CANN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7897550,SUP,HCPCS C1713,,7897550  -  SCREW 7897550 CDH PEEK 7.5X50 NON CANN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7897555,SUP,HCPCS C1713,,7897555  -  SCREW 7897555 CDH PEEK 7.5X55 NON CANN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7897560,SUP,HCPCS C1713,,7897560  -  SCREW 7897560 CDH PEEK 7.5X60 NON CANN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7897565,SUP,HCPCS C1713,,7897565  -  SCREW 7897565 CDH PEEK 7.5X65 NON CANN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7897570,SUP,HCPCS C1713,,7897570  -  SCREW 7897570 CDH PEEK 7.5X70 NON CANN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7898530,SUP,HCPCS C1713,,7898530  -  SCREW 7898530 CDH PEEK 8.5X30 NON CANN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7898535,SUP,HCPCS C1713,,7898535  -  SCREW 7898535 CDH PEEK 8.5X35 NON CANN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7898540,SUP,HCPCS C1713,,7898540  -  SCREW 7898540 CDH PEEK 8.5X40 NON CANN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7898545,SUP,HCPCS C1713,,7898545  -  SCREW 7898545 CDH PEEK 8.5X45 NON CANN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7898550,SUP,HCPCS C1713,,7898550  -  SCREW 7898550 CDH PEEK 8.5X50 NON CANN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7898555,SUP,HCPCS C1713,,7898555  -  SCREW 7898555 CDH PEEK 8.5X55 NON CANN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7898560,SUP,HCPCS C1713,,7898560  -  SCREW 7898560 CDH PEEK 8.5X60 NON CANN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7898565,SUP,HCPCS C1713,,7898565  -  SCREW 7898565 CDH PEEK 8.5X65 NON CANN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905310,SUP,HCPCS C1713,,7905310  -  SCREW BONE 3.5MM 10MM TI SPNL MULTIAX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905312,SUP,HCPCS C1713,,7905312  -  SCREW BONE 3.5MM 12MM VUEPOINT POST CERV SPN MULTIAX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905314,SUP,HCPCS C1713,,7905314  -  SCREW BONE 3.5MM 14MM SPNL MULTIAX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905316,SUP,HCPCS C1713,,7905316  -  SCREW BONE 3.5MM 16MM VUEPOINT POST CERV SPN MULTIAX SYS,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905318,SUP,HCPCS C1713,,7905318  -  SCREW BONE 3.5MM 18MM SPNL MULTIAX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905320,SUP,HCPCS C1713,,7905320  -  SCREW BONE 3.5MM 20MM VUEPOINT POST CERV SPN MULTIAX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905322,SUP,HCPCS C1713,,7905322  -  SCREW BONE 3.5MM 22MM SPNL MULTIAX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905324,SUP,HCPCS C1713,,7905324  -  SCREW BONE 3.5MM 24MM SPNL MULTIAX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905326,SUP,HCPCS C1713,,7905326  -  SCREW BONE 3.5MM 26MM SPNL MULTIAX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905328,SUP,HCPCS C1713,,7905328  -  SCREW BONE 3.5MM 28MM SPNL MULTIAX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905330,SUP,HCPCS C1713,,7905330  -  SCREW BONE 3.5MM 30MM VUEPOINT POST CERV SPN MULTIAX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905332,SUP,HCPCS C1713,,7905332  -  SCREW BONE 3.5MM 32MM VUEPOINT POST CERV SPN MULTIAX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905334,SUP,HCPCS C1713,,7905334  -  SCREW BONE 34MM 3.5MM VUEPOINT POST CERV SPN MULTIAX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905410,SUP,HCPCS C1713,,7905410  -  SCREW BONE 4MM 10MM SPNL MULTIAX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905412,SUP,HCPCS C1713,,7905412  -  SCREW BONE 4MM 12MM SPNL MULTIAX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905414,SUP,HCPCS C1713,,7905414  -  SCREW BONE 4MM 14MM SPNL MULTIAX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905416,SUP,HCPCS C1713,,7905416  -  SCREW BONE 16MM 40MM SPNL MULTIAX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905418,SUP,HCPCS C1713,,7905418  -  SCREW BONE 4MM 18MM VUEPOINT TI POST CERV SPN MULTIAX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905420,SUP,HCPCS C1713,,7905420  -  SCREW BONE 24MM 40MM SPNL MULTIAX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905422,SUP,HCPCS C1713,,7905422  -  SCREW BONE 4MM 22MM POST CERV SPN MULTIAX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905424,SUP,HCPCS C1713,,7905424  -  SCREW BONE 4MM 24MM VUEPOINT POST CERV SPN MULTIAX SYS,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905426,SUP,HCPCS C1713,,7905426  -  SCREW BONE 4MM 26MM SPNL MULTIAX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905428,SUP,HCPCS C1713,,7905428  -  SCREW BONE 4MM 28MM VUEPOINT POST CERV SPN MULTIAX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905430,SUP,HCPCS C1713,,7905430  -  SCREW BONE 4MM 30MM VUEPOINT POST CERV SPN MULTIAX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905432,SUP,HCPCS C1713,,7905432  -  SCREW BONE 4MM 32MM SPNL MULTIAX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905434,SUP,HCPCS C1713,,7905434  -  SCREW BONE 4MM 34MM SPNL MULTIAX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905436,SUP,HCPCS C1713,,7905436  -  SCREW BONE 4MM 36MM SPNL MULTIAX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905438,SUP,HCPCS C1713,,7905438  -  SCREW BONE 4MM 38MM SPNL MULTIAX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905440,SUP,HCPCS C1713,,7905440  -  SCREW BONE 4MM 40MM VUEPOINT POST CERV SPN MULTIAX SYS,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905510,SUP,HCPCS C1713,,7905510  -  SCREW BONE 3.5MM 10MM VUEPOINT POST CERV SPN MULTIAX FAVORED,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905512,SUP,HCPCS C1713,,7905512  -  SCREW BONE 3.5MM 12MM TI SPNL FAVORED ANG,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905514,SUP,HCPCS C1713,,7905514  -  SCREW BONE 3.5MM 14MM VUEPOINT POST CERV SPN MULTIAX FAVORED,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905516,SUP,HCPCS C1713,,7905516  -  SCREW BONE 3.5MM 16MM VUEPOINT POST CERV SPN MULTIAX FAVORED,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905518,SUP,HCPCS C1713,,7905518  -  SCREW BONE 3.5MM 18MM VUEPOINT POST CERV SPN MULTIAX FAVORED,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905520,SUP,HCPCS C1713,,7905520  -  SCREW BONE 3.5MM 20MM VUEPOINT POST CERV SPN MULTIAX FAVORED,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905522,SUP,HCPCS C1713,,7905522  -  SCREW BONE 22MM 35MM SPNL FAVORED ANG FULTHRD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905524,SUP,HCPCS C1713,,7905524  -  SCREW BONE 3.5MM 24MM VUEPOINT POST CERV SPN MULTIAX FAVORED,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905526,SUP,HCPCS C1713,,7905526  -  SCREW BONE 3.5MM 26MM VUEPOINT POST CERV SPN MULTIAX FAVORED,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905528,SUP,HCPCS C1713,,7905528  -  SCREW BONE 3.5MM 28MM SPNL MULTIAX FAVORED ANG,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905530,SUP,HCPCS C1713,,7905530  -  SCREW BONE 3.5MM 30MM SPNL MULTIAX FAVORED ANG,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905532,SUP,HCPCS C1713,,7905532  -  SCREW BONE 3.5MM 32MM SPNL MULTIAX FAVORED ANG,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905534,SUP,HCPCS C1713,,7905534  -  SCREW BONE 3.5MM 34MM VUEPOINT POST CERV SPN MULTIAX FAVORED,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905610,SUP,HCPCS C1713,,7905610  -  SCREW BONE 4MM 10MM TULIP SPNL ANG,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905612,SUP,HCPCS C1713,,7905612  -  SCREW BONE 4MM 12MM TI SPNL FAVORED ANG,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905614,SUP,HCPCS C1713,,7905614  -  SCREW BONE 4MM 14MM TULIP SPNL ANG,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905616,SUP,HCPCS C1713,,7905616  -  SCREW BONE 4MM 20MM TULIP SPNL ANG,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905618,SUP,HCPCS C1713,,7905618  -  SCREW BONE 4MM 18MM TULIP SPNL ANG,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905620,SUP,HCPCS C1713,,7905620  -  SCREW BONE 4MM 20MM TULIP SPNL ANG,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905622,SUP,HCPCS C1713,,7905622  -  SCREW BONE 4MM 22MM TULIP SPNL ANG,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905624,SUP,HCPCS C1713,,7905624  -  SCREW BONE 4MM 24MM TULIP SPNL FAVORED ANG,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905626,SUP,HCPCS C1713,,7905626  -  SCREW BONE 4MM 26MM TULIP SPNL FAVORED ANG,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905628,SUP,HCPCS C1713,,7905628  -  SCREW BONE 4MM 28MM TULIP SPNL FAVORED ANG,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905630,SUP,HCPCS C1713,,7905630  -  SCREW BONE 4MM 30MM VUEPOINT TULIP POST CERV SPN FAVORED ANG,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905632,SUP,HCPCS C1713,,7905632  -  SCREW BONE 4MM 32MM TULIP SPNL FAVORED ANG,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905634,SUP,HCPCS C1713,,7905634  -  SCREW BONE 4MM 34MM TULIP SPNL FAVORED ANG,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905636,SUP,HCPCS C1713,,7905636  -  SCREW BONE 4MM 36MM TULIP SPNL FAVORED ANG,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905638,SUP,HCPCS C1713,,7905638  -  SCREW BONE 4MM 38MM TULIP SPNL FAVORED ANG,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905640,SUP,HCPCS C1713,,7905640  -  SCREW BONE 4MM 40MM TULIP SPNL FAVORED ANG,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905710,SUP,HCPCS C1713,,7905710  -  SCREW BONE 4.5MM 10MM SPNL MULTIAX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905712,SUP,HCPCS C1713,,7905712  -  SCREW BONE 4.5MM 12MM VUEPOINT SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905714,SUP,HCPCS C1713,,7905714  -  SCREW BONE 4.5MM 14MM SPNL MULTIAX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905716,SUP,HCPCS C1713,,7905716  -  SCREW BONE 4.5MM 16MM SPNL MULTIAX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905718,SUP,HCPCS C1713,,7905718  -  SCREW BONE 4.5MM 18MM SPNL MULTIAX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905720,SUP,HCPCS C1713,,7905720  -  SCREW BONE 4.5MM 20MM SPNL MULTIAX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905722,SUP,HCPCS C1713,,7905722  -  SCREW BONE 4.5MM 22MM SPNL MULTIAX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905724,SUP,HCPCS C1713,,7905724  -  SCREW BONE 4.5MM 24MM SPNL MULTIAX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905726,SUP,HCPCS C1713,,7905726  -  SCREW BONE 4.5MM 26MM SPNL MULTIAX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905728,SUP,HCPCS C1713,,7905728  -  SCREW BONE 4.5MM 28MM VUEPOINT POST CERV SPN SYS MULTIAX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905730,SUP,HCPCS C1713,,7905730  -  SCREW BONE 4.5MM 30MM VUEPOINT POST CERV SPN SYS MULTIAX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905732,SUP,HCPCS C1713,,7905732  -  SCREW BONE 4.5MM 32MM VUEPOINT POST CERV SPN SYS MULTIAX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905734,SUP,HCPCS C1713,,7905734  -  SCREW BONE 4.5MM 34MM VUEPOINT POST CERV SPN SYS MULTIAX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905736,SUP,HCPCS C1713,,7905736  -  SCREW BONE 4.5MM 36MM VUEPOINT POST CERV SPN SYS MULTIAX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905738,SUP,HCPCS C1713,,7905738  -  SCREW BONE 4.5MM 38MM VUEPOINT POST CERV SPN SYS MULTIAX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905740,SUP,HCPCS C1713,,7905740  -  SCREW BONE 4.5MM 40MM SPNL MULTIAX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905824,SUP,HCPCS C1713,,7905824  -  SCREW BONE 3.5MM 24MM SPNL FAVORED ANG PTTHRD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905826,SUP,HCPCS C1713,,7905826  -  SCREW BONE 3.5MM 26MM SPNL PTTHRD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905828,SUP,HCPCS C1713,,7905828  -  SCREW BONE 3.5MM 28MM VUEPOINT POST CERV SPN SYS FAVORED ANG,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905830,SUP,HCPCS C1713,,7905830  -  SCREW BONE 3.5MM 30MM VUEPOINT TI POST CERV SPN FAVORED ANG,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905832,SUP,HCPCS C1713,,7905832  -  SCREW BONE 3.5MM 32MM SPNL FAVORED ANG PTTHRD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905834,SUP,HCPCS C1713,,7905834  -  SCREW BONE 3.5MM 14MM VUEPOINT POST CERV SPN FAVORED ANG SYS,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7905836,SUP,HCPCS C1713,,7905836  -  SCREW BONE 3.5MM 36MM VUEPOINT PTHRD POST CERV SPN FAVORED,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7906000,SUP,HCPCS C1713,,7906000  -  SCREW SET 3.5MM POST CERV SPN LMNR HOOK TULIP SYS VUEPOINT,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
7906005,SUP,Custom 27803010,,7906005  -  HOOK SPNL 5MM LMNR,"$1,375.00",$0.00,"$1,375.00",$0.00,$981.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
7906007,SUP,Custom 27803010,,7906007  -  HOOK SPNL 7MM LMNR,"$1,375.00",$0.00,"$1,375.00",$0.00,$981.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
7906008,SUP,HCPCS C1713,,7906008  -  SCREW BONE 11MM VUEPOINT POST CERV SPN SYS OFFST CONCTR OPN,"$1,022.50",$0.00,"$1,022.50",$460.13,$729.76,$0.00,$176.17,$0.00,$0.00,$179.03,"$1,022.50",$0.00,$511.25,$809.82,$818.00,$0.00,$160.02,$0.00,$162.78,$0.00
7906022,SUP,HCPCS C1713,,7906022  -  SCREW BONE 25MM VUEPOINT LG POST CERV SPN SYS OFFST CONCTR,"$1,240.00",$0.00,"$1,240.00",$558.00,$884.99,$0.00,$213.65,$0.00,$0.00,$217.11,"$1,240.00",$0.00,$620.00,$982.08,$992.00,$0.00,$194.06,$0.00,$197.41,$0.00
7906025,SUP,HCPCS C1713,,7906025  -  CONCTR ROD ACUTE ANG OFFST,"$1,240.00",$0.00,"$1,240.00",$558.00,$884.99,$0.00,$213.65,$0.00,$0.00,$217.11,"$1,240.00",$0.00,$620.00,$982.08,$992.00,$0.00,$194.06,$0.00,$197.41,$0.00
7906035,SUP,HCPCS C1713,,7906035  -  CONCTR ROD 3.5MM INLN,"$1,830.00",$0.00,"$1,830.00",$823.50,"$1,306.07",$0.00,$315.30,$0.00,$0.00,$320.42,"$1,830.00",$0.00,$915.00,"$1,449.36","$1,464.00",$0.00,$286.40,$0.00,$291.34,$0.00
7906045,SUP,HCPCS C1713,,7906045  -  CONCTR ROD 3.5-4.5MM INLN,"$1,830.00",$0.00,"$1,830.00",$823.50,"$1,306.07",$0.00,$315.30,$0.00,$0.00,$320.42,"$1,830.00",$0.00,$915.00,"$1,449.36","$1,464.00",$0.00,$286.40,$0.00,$291.34,$0.00
7906055,SUP,HCPCS C1713,,7906055  -  CONCTR ROD 5.5MM 3.5MM INLN,"$1,830.00",$0.00,"$1,830.00",$823.50,"$1,306.07",$0.00,$315.30,$0.00,$0.00,$320.42,"$1,830.00",$0.00,$915.00,"$1,449.36","$1,464.00",$0.00,$286.40,$0.00,$291.34,$0.00
7906065,SUP,HCPCS C1713,,7906065  -  CONCTR ROD 6.5MM 3.5MM INLN,"$1,830.00",$0.00,"$1,830.00",$823.50,"$1,306.07",$0.00,$315.30,$0.00,$0.00,$320.42,"$1,830.00",$0.00,$915.00,"$1,449.36","$1,464.00",$0.00,$286.40,$0.00,$291.34,$0.00
7906120,SUP,HCPCS C1713,,7906120  -  CONCTR ROD 120MM 3.5MM VUEPOINT SYS POST CERV SPN,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7906126,SUP,HCPCS C1713,,7906126  -  CONCTR ROD 26MM FIX CX SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7906128,SUP,HCPCS C1713,,7906128  -  CONCTR ROD 28MM CX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7906130,SUP,HCPCS C1713,,7906130  -  CONCTR ROD 30MM FIX CX SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7906132,SUP,HCPCS C1713,,7906132  -  CONCTR ROD 32MM FIX CX TI SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7906134,SUP,HCPCS C1713,,7906134  -  CONCTR ROD 34MM CX FIX SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7906136,SUP,HCPCS C1713,,7906136  -  CONCTR ROD 36MM CX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7906138,SUP,HCPCS C1713,,7906138  -  CONCTR ROD 38MM VUEPOINT FIX CX SYS POST CERV SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7906140,SUP,HCPCS C1713,,7906140  -  CONCTR ROD 40MM CX FIX SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7906142,SUP,HCPCS C1713,,7906142  -  CONCTR ROD 42MM XLNK SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7906144,SUP,HCPCS C1713,,7906144  -  CONCTR ROD 44MM VUEPOINT FIX CX SYS POST CERV SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7906146,SUP,HCPCS C1713,,7906146  -  CONCTR ROD 46MM VUEPOINT FIX CX SYS POST CERV SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7906148,SUP,HCPCS C1713,,7906148  -  CONCTR ROD 48MM VUEPOINT FIX CX SYS POST CERV SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7906150,SUP,HCPCS C1713,,7906150  -  CONCTR ROD 50MM VUEPOINT FIX CX SYS POST CERV SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
7906160,SUP,HCPCS C1713,,7906160  -  CONCTR ROD 60MM 3.5MM VUEPOINT SYS POST CERV SPN,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7906240,SUP,HCPCS C1713,,7906240  -  ROD SPNL 240MM 3.5MM,$600.00,$0.00,$600.00,$270.00,$428.22,$0.00,$103.38,$0.00,$0.00,$105.06,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$93.90,$0.00,$95.52,$0.00
7906300,SUP,HCPCS C1713,,7906300  -  ROD SPNL 45D PCVD,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
7906302,SUP,Custom 27203010,,7906302  -  CONCTR CORD EYLT OCCPTL,"$1,277.50",$0.00,"$1,277.50",$0.00,$911.75,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,277.50",$0.00,$638.75,"$1,011.78","$1,022.00",$0.00,$0.00,$0.00,$0.00,$0.00
7906306,SUP,HCPCS C1713,,7906306  -  SCREW BONE 4.5MM 6MM VUEPOINT POST CERV SPN OCCPTL CORT SYS,$680.00,$0.00,$680.00,$306.00,$485.32,$0.00,$117.16,$0.00,$0.00,$119.06,$680.00,$0.00,$340.00,$538.56,$544.00,$0.00,$106.42,$0.00,$108.26,$0.00
7906308,SUP,HCPCS C1713,,7906308  -  SCREW BONE 4.5MM 8MM VUEPOINT POST CERV SPN OCCPTL CORT SYS,$680.00,$0.00,$680.00,$306.00,$485.32,$0.00,$117.16,$0.00,$0.00,$119.06,$680.00,$0.00,$340.00,$538.56,$544.00,$0.00,$106.42,$0.00,$108.26,$0.00
7906310,SUP,HCPCS C1713,,7906310  -  SCREW BONE 4.5MM 10MM VUEPOINT POST CERV SPN CORT OCCPTL SYS,$680.00,$0.00,$680.00,$306.00,$485.32,$0.00,$117.16,$0.00,$0.00,$119.06,$680.00,$0.00,$340.00,$538.56,$544.00,$0.00,$106.42,$0.00,$108.26,$0.00
7906312,SUP,HCPCS C1713,,7906312  -  SCREW BONE 4.5MM 12MM VUEPOINT POST CERV SPN CORT OCCPTL SYS,$680.00,$0.00,$680.00,$306.00,$485.32,$0.00,$117.16,$0.00,$0.00,$119.06,$680.00,$0.00,$340.00,$538.56,$544.00,$0.00,$106.42,$0.00,$108.26,$0.00
7906314,SUP,HCPCS C1713,,7906314  -  SCREW BONE 4.5MM 14MM VUEPOINT POST CERV SPN CORT OCCPTL SYS,$680.00,$0.00,$680.00,$306.00,$485.32,$0.00,$117.16,$0.00,$0.00,$119.06,$680.00,$0.00,$340.00,$538.56,$544.00,$0.00,$106.42,$0.00,$108.26,$0.00
7906335,SUP,HCPCS C1713,,7906335  -  PLATE 35MM KLD POST CERV SYS VUEPOINT BONE,"$6,355.00",$0.00,"$6,355.00","$2,859.75","$4,535.56",$0.00,"$1,094.93",$0.00,$0.00,"$1,112.71","$6,355.00",$0.00,"$3,177.50","$5,033.16","$5,084.00",$0.00,$994.56,$0.00,"$1,011.72",$0.00
7906340,SUP,HCPCS C1713,,7906340  -  PLATE 40MM KLD SYS VUEPOINT BONE POST CERV SPN,"$6,355.00",$0.00,"$6,355.00","$2,859.75","$4,535.56",$0.00,"$1,094.93",$0.00,$0.00,"$1,112.71","$6,355.00",$0.00,"$3,177.50","$5,033.16","$5,084.00",$0.00,$994.56,$0.00,"$1,011.72",$0.00
7906345,SUP,HCPCS C1713,,7906345  -  PLATE 45MM KLD BONE,"$6,355.00",$0.00,"$6,355.00","$2,859.75","$4,535.56",$0.00,"$1,094.93",$0.00,$0.00,"$1,112.71","$6,355.00",$0.00,"$3,177.50","$5,033.16","$5,084.00",$0.00,$994.56,$0.00,"$1,011.72",$0.00
7906355,SUP,HCPCS C1713,,7906355  -  ROD SPNL 3.5-5.5MM VUEPOINT TRNS,"$1,830.00",$0.00,"$1,830.00",$823.50,"$1,306.07",$0.00,$315.30,$0.00,$0.00,$320.42,"$1,830.00",$0.00,$915.00,"$1,449.36","$1,464.00",$0.00,$286.40,$0.00,$291.34,$0.00
7906356,SUP,HCPCS C1713,,7906356  -  SCREW BONE 5MM 6MM VUEPOINT POST CERV SPN OCCPTL CORT SYS,$680.00,$0.00,$680.00,$306.00,$485.32,$0.00,$117.16,$0.00,$0.00,$119.06,$680.00,$0.00,$340.00,$538.56,$544.00,$0.00,$106.42,$0.00,$108.26,$0.00
7906358,SUP,HCPCS C1713,,7906358  -  SCREW BONE 5MM 8MM VUEPOINT POST CERV SPN OCCPTL CORT SYS,$680.00,$0.00,$680.00,$306.00,$485.32,$0.00,$117.16,$0.00,$0.00,$119.06,$680.00,$0.00,$340.00,$538.56,$544.00,$0.00,$106.42,$0.00,$108.26,$0.00
7906360,SUP,HCPCS C1713,,7906360  -  SCREW BONE 5MM 10MM LEFT OCCPTL CORT,$680.00,$0.00,$680.00,$306.00,$485.32,$0.00,$117.16,$0.00,$0.00,$119.06,$680.00,$0.00,$340.00,$538.56,$544.00,$0.00,$106.42,$0.00,$108.26,$0.00
7906362,SUP,HCPCS C1713,,7906362  -  SCREW BONE 5MM 12MM VUEPOINT POST CERV SPN CORT OCCPTL SYS,$680.00,$0.00,$680.00,$306.00,$485.32,$0.00,$117.16,$0.00,$0.00,$119.06,$680.00,$0.00,$340.00,$538.56,$544.00,$0.00,$106.42,$0.00,$108.26,$0.00
7906364,SUP,HCPCS C1713,,7906364  -  SCREW BONE 5MM 14MM CORT OCCPTL,$680.00,$0.00,$680.00,$306.00,$485.32,$0.00,$117.16,$0.00,$0.00,$119.06,$680.00,$0.00,$340.00,$538.56,$544.00,$0.00,$106.42,$0.00,$108.26,$0.00
7906435,SUP,HCPCS C1713,,7906435  -  CONCTR ROD 35MM OFFST,"$1,830.00",$0.00,"$1,830.00",$823.50,"$1,306.07",$0.00,$315.30,$0.00,$0.00,$320.42,"$1,830.00",$0.00,$915.00,"$1,449.36","$1,464.00",$0.00,$286.40,$0.00,$291.34,$0.00
7906445,SUP,HCPCS C1713,,7906445  -  CONCTR ROD 4.5MM 3.5MM OFFST,"$1,830.00",$0.00,"$1,830.00",$823.50,"$1,306.07",$0.00,$315.30,$0.00,$0.00,$320.42,"$1,830.00",$0.00,$915.00,"$1,449.36","$1,464.00",$0.00,$286.40,$0.00,$291.34,$0.00
7906455,SUP,HCPCS C1713,,7906455  -  CONCTR ROD 5.5MM 3.5MM OFFST,"$1,830.00",$0.00,"$1,830.00",$823.50,"$1,306.07",$0.00,$315.30,$0.00,$0.00,$320.42,"$1,830.00",$0.00,$915.00,"$1,449.36","$1,464.00",$0.00,$286.40,$0.00,$291.34,$0.00
7906465,SUP,HCPCS C1713,,7906465  -  CONCTR ROD 6.25MM 3.5MM OFFST,"$1,830.00",$0.00,"$1,830.00",$823.50,"$1,306.07",$0.00,$315.30,$0.00,$0.00,$320.42,"$1,830.00",$0.00,$915.00,"$1,449.36","$1,464.00",$0.00,$286.40,$0.00,$291.34,$0.00
7907010,SUP,Custom 27203010,,7907010  -  BIT DRILL 2.05MM SYSTEM VUEPOINT POSTERIOR CERV SPN,$647.50,$0.00,$647.50,$0.00,$462.12,$0.00,$0.00,$0.00,$0.00,$0.00,$647.50,$0.00,$323.75,$512.82,$518.00,$0.00,$0.00,$0.00,$0.00,$0.00
7907012,SUP,Custom 27203010,,7907012  -  BIT DRILL 2.5MM,$647.50,$0.00,$647.50,$0.00,$462.12,$0.00,$0.00,$0.00,$0.00,$0.00,$647.50,$0.00,$323.75,$512.82,$518.00,$0.00,$0.00,$0.00,$0.00,$0.00
7907220,SUP,HCPCS C1713,,7907220  -  TEMPLATE SZ 120MM ROD,$137.50,$0.00,$137.50,$61.88,$98.13,$0.00,$23.69,$0.00,$0.00,$24.08,$137.50,$0.00,$68.75,$108.90,$110.00,$0.00,$21.52,$0.00,$21.89,$0.00
7907240,SUP,HCPCS C1713,,7907240  -  TMPLT ROD 240MM VUEPOINT POST CERV SPN,$157.50,$0.00,$157.50,$70.88,$112.41,$0.00,$27.14,$0.00,$0.00,$27.58,$157.50,$0.00,$78.75,$124.74,$126.00,$0.00,$24.65,$0.00,$25.07,$0.00
7908300,SUP,HCPCS C1713,,7908300  -  ROD SPNL VUEPOINT 45D COCR BNT,"$1,680.00",$0.00,"$1,680.00",$756.00,"$1,199.02",$0.00,$289.46,$0.00,$0.00,$294.15,"$1,680.00",$0.00,$840.00,"$1,330.56","$1,344.00",$0.00,$262.92,$0.00,$267.46,$0.00
7908355,SUP,HCPCS C1713,,7908355  -  ROD TRANSITION COCR 5.5 MM,"$3,150.00",$0.00,"$3,150.00","$1,417.50","$2,248.16",$0.00,$542.73,$0.00,$0.00,$551.54,"$3,150.00",$0.00,"$1,575.00","$2,494.80","$2,520.00",$0.00,$492.98,$0.00,$501.48,$0.00
7965520,SUP,HCPCS C1713,,7965520  -  SCREW 7965520 5.5MM X 20MM SELF TAP,$990.00,$0.00,$990.00,$445.50,$706.56,$0.00,$170.57,$0.00,$0.00,$173.34,$990.00,$0.00,$495.00,$784.08,$792.00,$0.00,$154.94,$0.00,$157.61,$0.00
7965525,SUP,HCPCS C1713,,7965525  -  SCREW 7965525 5.5MM X 25MM SELF TAP,$990.00,$0.00,$990.00,$445.50,$706.56,$0.00,$170.57,$0.00,$0.00,$173.34,$990.00,$0.00,$495.00,$784.08,$792.00,$0.00,$154.94,$0.00,$157.61,$0.00
7965530,SUP,HCPCS C1713,,7965530  -  SCREW 7965530 5.5MM X 30MM SELF TAP,$990.00,$0.00,$990.00,$445.50,$706.56,$0.00,$170.57,$0.00,$0.00,$173.34,$990.00,$0.00,$495.00,$784.08,$792.00,$0.00,$154.94,$0.00,$157.61,$0.00
7965535,SUP,HCPCS C1713,,7965535  -  SCREW 7965535 5.5MM X 35MM SELF TAP,$990.00,$0.00,$990.00,$445.50,$706.56,$0.00,$170.57,$0.00,$0.00,$173.34,$990.00,$0.00,$495.00,$784.08,$792.00,$0.00,$154.94,$0.00,$157.61,$0.00
7966020,SUP,HCPCS C1713,,7966020  -  SCREW 7966020 6.0MM X 20MM SELF TAP,$990.00,$0.00,$990.00,$445.50,$706.56,$0.00,$170.57,$0.00,$0.00,$173.34,$990.00,$0.00,$495.00,$784.08,$792.00,$0.00,$154.94,$0.00,$157.61,$0.00
7966025,SUP,HCPCS C1713,,7966025  -  SCREW 7966025 6.0MM X 25MM SELF TAP,$990.00,$0.00,$990.00,$445.50,$706.56,$0.00,$170.57,$0.00,$0.00,$173.34,$990.00,$0.00,$495.00,$784.08,$792.00,$0.00,$154.94,$0.00,$157.61,$0.00
7966030,SUP,HCPCS C1713,,7966030  -  SCREW 7966030 6.0MM X 30MM SELF TAP,$990.00,$0.00,$990.00,$445.50,$706.56,$0.00,$170.57,$0.00,$0.00,$173.34,$990.00,$0.00,$495.00,$784.08,$792.00,$0.00,$154.94,$0.00,$157.61,$0.00
7966035,SUP,HCPCS C1713,,7966035  -  SCREW 7966035 6.0MM X 35MM SELF TAP,$990.00,$0.00,$990.00,$445.50,$706.56,$0.00,$170.57,$0.00,$0.00,$173.34,$990.00,$0.00,$495.00,$784.08,$792.00,$0.00,$154.94,$0.00,$157.61,$0.00
7967210,SUP,HCPCS C1713,,7967210  -  SPACER SPNL 12D SM 32X23X10MM STRL CRSNT SVRGN CVR PLT PEEK,"$14,190.00",$0.00,"$14,190.00","$6,385.50","$5,158.80",$0.00,"$2,444.87",$0.00,$0.00,"$2,484.56","$14,190.00",$0.00,"$7,095.00","$11,238.48","$11,352.00",$0.00,"$2,220.74",$0.00,"$2,259.05",$0.00
7967212,SUP,HCPCS C1713,,7967212  -  SPACER SPNL 12D SM 32X23X12MM STRL CRSNT SVRGN CVR PLT PEEK,"$14,190.00",$0.00,"$14,190.00","$6,385.50","$5,158.80",$0.00,"$2,444.87",$0.00,$0.00,"$2,484.56","$14,190.00",$0.00,"$7,095.00","$11,238.48","$11,352.00",$0.00,"$2,220.74",$0.00,"$2,259.05",$0.00
7967214,SUP,HCPCS C1713,,7967214  -  SPACER SPNL 12D SM 32X23X14MM STRL CRSNT SVRGN CVR PLT PEEK,"$14,190.00",$0.00,"$14,190.00","$6,385.50","$5,158.80",$0.00,"$2,444.87",$0.00,$0.00,"$2,484.56","$14,190.00",$0.00,"$7,095.00","$11,238.48","$11,352.00",$0.00,"$2,220.74",$0.00,"$2,259.05",$0.00
7967216,SUP,HCPCS C1713,,7967216  -  SPACER SPNL 12D SM 32X23X16MM STRL CRSNT SVRGN CVR PLT PEEK,"$14,190.00",$0.00,"$14,190.00","$6,385.50","$5,158.80",$0.00,"$2,444.87",$0.00,$0.00,"$2,484.56","$14,190.00",$0.00,"$7,095.00","$11,238.48","$11,352.00",$0.00,"$2,220.74",$0.00,"$2,259.05",$0.00
7967218,SUP,HCPCS C1713,,7967218  -  SPACER SPNL 12D SM 32X23X18MM STRL CRSNT SVRGN CVR PLT PEEK,"$14,190.00",$0.00,"$14,190.00","$6,385.50","$5,158.80",$0.00,"$2,444.87",$0.00,$0.00,"$2,484.56","$14,190.00",$0.00,"$7,095.00","$11,238.48","$11,352.00",$0.00,"$2,220.74",$0.00,"$2,259.05",$0.00
7967220,SUP,HCPCS C1713,,7967220  -  SPACER SPNL 12D SM 32X23X20MM STRL CRSNT SVRGN CVR PLT PEEK,"$14,190.00",$0.00,"$14,190.00","$6,385.50","$5,158.80",$0.00,"$2,444.87",$0.00,$0.00,"$2,484.56","$14,190.00",$0.00,"$7,095.00","$11,238.48","$11,352.00",$0.00,"$2,220.74",$0.00,"$2,259.05",$0.00
7967810,SUP,HCPCS C1713,,7967810  -  SPACER SPNL 8D SM 32X23X10MM STRL CRSNT SVRGN CVR PLT PEEK,"$14,190.00",$0.00,"$14,190.00","$6,385.50","$5,158.80",$0.00,"$2,444.87",$0.00,$0.00,"$2,484.56","$14,190.00",$0.00,"$7,095.00","$11,238.48","$11,352.00",$0.00,"$2,220.74",$0.00,"$2,259.05",$0.00
7967812,SUP,HCPCS C1713,,7967812  -  SPACER SPNL 8D SM 32X23X12MM STRL CRSNT SVRGN CVR PLT PEEK,"$14,190.00",$0.00,"$14,190.00","$6,385.50","$5,158.80",$0.00,"$2,444.87",$0.00,$0.00,"$2,484.56","$14,190.00",$0.00,"$7,095.00","$11,238.48","$11,352.00",$0.00,"$2,220.74",$0.00,"$2,259.05",$0.00
7967814,SUP,HCPCS C1713,,7967814  -  SPACER SPNL 8D SM 32X23X14MM STRL CRSNT SVRGN CVR PLT PEEK,"$14,190.00",$0.00,"$14,190.00","$6,385.50","$5,158.80",$0.00,"$2,444.87",$0.00,$0.00,"$2,484.56","$14,190.00",$0.00,"$7,095.00","$11,238.48","$11,352.00",$0.00,"$2,220.74",$0.00,"$2,259.05",$0.00
7967816,SUP,HCPCS C1713,,7967816  -  SPACER SPNL 8D SM 32X23X16MM STRL CRSNT SVRGN CVR PLT PEEK,"$14,190.00",$0.00,"$14,190.00","$6,385.50","$5,158.80",$0.00,"$2,444.87",$0.00,$0.00,"$2,484.56","$14,190.00",$0.00,"$7,095.00","$11,238.48","$11,352.00",$0.00,"$2,220.74",$0.00,"$2,259.05",$0.00
7967818,SUP,HCPCS C1713,,7967818  -  SPACER SPNL 8D SM 32X23X18MM STRL CRSNT SVRGN CVR PLT PEEK,"$14,190.00",$0.00,"$14,190.00","$6,385.50","$5,158.80",$0.00,"$2,444.87",$0.00,$0.00,"$2,484.56","$14,190.00",$0.00,"$7,095.00","$11,238.48","$11,352.00",$0.00,"$2,220.74",$0.00,"$2,259.05",$0.00
7967820,SUP,HCPCS C1713,,7967820  -  SPACER SPNL 8D SM 32X23X20MM STRL CRSNT SVRGN CVR PLT PEEK,"$14,190.00",$0.00,"$14,190.00","$6,385.50","$5,158.80",$0.00,"$2,444.87",$0.00,$0.00,"$2,484.56","$14,190.00",$0.00,"$7,095.00","$11,238.48","$11,352.00",$0.00,"$2,220.74",$0.00,"$2,259.05",$0.00
7968210,SUP,HCPCS C1713,,7968210  -  SPACER SPNL 12D MED 37X27X10MM STRL CRSNT SVRGN CVR PLT PEEK,"$14,190.00",$0.00,"$14,190.00","$6,385.50","$5,158.80",$0.00,"$2,444.87",$0.00,$0.00,"$2,484.56","$14,190.00",$0.00,"$7,095.00","$11,238.48","$11,352.00",$0.00,"$2,220.74",$0.00,"$2,259.05",$0.00
7968212,SUP,HCPCS C1713,,7968212  -  SPACER SPNL 12D MED 37X27X12MM STRL CRSNT SVRGN CVR PLT PEEK,"$14,190.00",$0.00,"$14,190.00","$6,385.50","$5,158.80",$0.00,"$2,444.87",$0.00,$0.00,"$2,484.56","$14,190.00",$0.00,"$7,095.00","$11,238.48","$11,352.00",$0.00,"$2,220.74",$0.00,"$2,259.05",$0.00
7968214,SUP,HCPCS C1713,,7968214  -  SPACER SPNL 12D MED 37X27X14MM STRL CRSNT SVRGN CVR PLT PEEK,"$14,190.00",$0.00,"$14,190.00","$6,385.50","$5,158.80",$0.00,"$2,444.87",$0.00,$0.00,"$2,484.56","$14,190.00",$0.00,"$7,095.00","$11,238.48","$11,352.00",$0.00,"$2,220.74",$0.00,"$2,259.05",$0.00
7968216,SUP,HCPCS C1713,,7968216  -  SPACER SPNL 12D MED 37X27X16MM STRL CRSNT SVRGN CVR PLT PEEK,"$14,190.00",$0.00,"$14,190.00","$6,385.50","$5,158.80",$0.00,"$2,444.87",$0.00,$0.00,"$2,484.56","$14,190.00",$0.00,"$7,095.00","$11,238.48","$11,352.00",$0.00,"$2,220.74",$0.00,"$2,259.05",$0.00
7968218,SUP,HCPCS C1713,,7968218  -  SPACER SPNL 12D MED 37X27X18MM STRL CRSNT SVRGN CVR PLT PEEK,"$14,190.00",$0.00,"$14,190.00","$6,385.50","$5,158.80",$0.00,"$2,444.87",$0.00,$0.00,"$2,484.56","$14,190.00",$0.00,"$7,095.00","$11,238.48","$11,352.00",$0.00,"$2,220.74",$0.00,"$2,259.05",$0.00
7968220,SUP,HCPCS C1713,,7968220  -  SPACER SPNL 12D MED 37X27X20MM STRL CRSNT SVRGN CVR PLT PEEK,"$14,190.00",$0.00,"$14,190.00","$6,385.50","$5,158.80",$0.00,"$2,444.87",$0.00,$0.00,"$2,484.56","$14,190.00",$0.00,"$7,095.00","$11,238.48","$11,352.00",$0.00,"$2,220.74",$0.00,"$2,259.05",$0.00
7968810,SUP,HCPCS C1713,,7968810  -  SPACER SPNL 8D MED 37X27X10MM STRL CRSNT SVRGN CVR PLT PEEK,"$14,190.00",$0.00,"$14,190.00","$6,385.50","$5,158.80",$0.00,"$2,444.87",$0.00,$0.00,"$2,484.56","$14,190.00",$0.00,"$7,095.00","$11,238.48","$11,352.00",$0.00,"$2,220.74",$0.00,"$2,259.05",$0.00
7968812,SUP,HCPCS C1713,,7968812  -  SPACER SPNL 8D MED 37X27X12MM STRL CRSNT SVRGN CVR PLT PEEK,"$14,190.00",$0.00,"$14,190.00","$6,385.50","$5,158.80",$0.00,"$2,444.87",$0.00,$0.00,"$2,484.56","$14,190.00",$0.00,"$7,095.00","$11,238.48","$11,352.00",$0.00,"$2,220.74",$0.00,"$2,259.05",$0.00
7968814,SUP,HCPCS C1713,,7968814  -  SPACER SPNL 8D MED 37X27X14MM STRL CRSNT SVRGN CVR PLT PEEK,"$14,190.00",$0.00,"$14,190.00","$6,385.50","$5,158.80",$0.00,"$2,444.87",$0.00,$0.00,"$2,484.56","$14,190.00",$0.00,"$7,095.00","$11,238.48","$11,352.00",$0.00,"$2,220.74",$0.00,"$2,259.05",$0.00
7968816,SUP,HCPCS C1713,,7968816  -  SPACER SPNL 8D MED 37X27X16MM STRL CRSNT SVRGN CVR PLT PEEK,"$14,190.00",$0.00,"$14,190.00","$6,385.50","$5,158.80",$0.00,"$2,444.87",$0.00,$0.00,"$2,484.56","$14,190.00",$0.00,"$7,095.00","$11,238.48","$11,352.00",$0.00,"$2,220.74",$0.00,"$2,259.05",$0.00
7968818,SUP,HCPCS C1713,,7968818  -  SPACER SPNL 8D MED 37X27X18MM STRL CRSNT SVRGN CVR PLT PEEK,"$14,190.00",$0.00,"$14,190.00","$6,385.50","$5,158.80",$0.00,"$2,444.87",$0.00,$0.00,"$2,484.56","$14,190.00",$0.00,"$7,095.00","$11,238.48","$11,352.00",$0.00,"$2,220.74",$0.00,"$2,259.05",$0.00
7968820,SUP,HCPCS C1713,,7968820  -  SPACER SPNL 8D MED 37X27X20MM STRL CRSNT SVRGN CVR PLT PEEK,"$14,190.00",$0.00,"$14,190.00","$6,385.50","$5,158.80",$0.00,"$2,444.87",$0.00,$0.00,"$2,484.56","$14,190.00",$0.00,"$7,095.00","$11,238.48","$11,352.00",$0.00,"$2,220.74",$0.00,"$2,259.05",$0.00
7969210,SUP,HCPCS C1713,,7969210  -  SPACER SPNL 12D LG 42X30X10MM STRL CRSNT SVRGN CVR PLT PEEK,"$14,190.00",$0.00,"$14,190.00","$6,385.50","$5,158.80",$0.00,"$2,444.87",$0.00,$0.00,"$2,484.56","$14,190.00",$0.00,"$7,095.00","$11,238.48","$11,352.00",$0.00,"$2,220.74",$0.00,"$2,259.05",$0.00
7969212,SUP,HCPCS C1713,,7969212  -  SPACER SPNL 12D LG 42X30X12MM STRL CRSNT SVRGN CVR PLT PEEK,"$14,190.00",$0.00,"$14,190.00","$6,385.50","$5,158.80",$0.00,"$2,444.87",$0.00,$0.00,"$2,484.56","$14,190.00",$0.00,"$7,095.00","$11,238.48","$11,352.00",$0.00,"$2,220.74",$0.00,"$2,259.05",$0.00
7969214,SUP,HCPCS C1713,,7969214  -  SPACER SPNL 12D LG 42X30X14MM STRL CRSNT SVRGN CVR PLT PEEK,"$14,190.00",$0.00,"$14,190.00","$6,385.50","$5,158.80",$0.00,"$2,444.87",$0.00,$0.00,"$2,484.56","$14,190.00",$0.00,"$7,095.00","$11,238.48","$11,352.00",$0.00,"$2,220.74",$0.00,"$2,259.05",$0.00
7969216,SUP,HCPCS C1713,,7969216  -  SPACER SPNL 12D LG 42X30X16MM STRL CRSNT SVRGN CVR PLT PEEK,"$14,190.00",$0.00,"$14,190.00","$6,385.50","$5,158.80",$0.00,"$2,444.87",$0.00,$0.00,"$2,484.56","$14,190.00",$0.00,"$7,095.00","$11,238.48","$11,352.00",$0.00,"$2,220.74",$0.00,"$2,259.05",$0.00
7969218,SUP,HCPCS C1713,,7969218  -  SPACER SPNL 12D LG 42X30X18MM STRL CRSNT SVRGN CVR PLT PEEK,"$14,190.00",$0.00,"$14,190.00","$6,385.50","$5,158.80",$0.00,"$2,444.87",$0.00,$0.00,"$2,484.56","$14,190.00",$0.00,"$7,095.00","$11,238.48","$11,352.00",$0.00,"$2,220.74",$0.00,"$2,259.05",$0.00
7969220,SUP,HCPCS C1713,,7969220  -  SPACER SPNL 12D LG 42X30X20MM STRL CRSNT SVRGN CVR PLT PEEK,"$14,190.00",$0.00,"$14,190.00","$6,385.50","$5,158.80",$0.00,"$2,444.87",$0.00,$0.00,"$2,484.56","$14,190.00",$0.00,"$7,095.00","$11,238.48","$11,352.00",$0.00,"$2,220.74",$0.00,"$2,259.05",$0.00
7969810,SUP,HCPCS C1713,,7969810  -  SPACER SPNL 8D LG 42X30X10MM STRL CRSNT SVRGN CVR PLT PEEK,"$14,190.00",$0.00,"$14,190.00","$6,385.50","$5,158.80",$0.00,"$2,444.87",$0.00,$0.00,"$2,484.56","$14,190.00",$0.00,"$7,095.00","$11,238.48","$11,352.00",$0.00,"$2,220.74",$0.00,"$2,259.05",$0.00
7969812,SUP,HCPCS C1713,,7969812  -  SPACER SPNL 8D LG 42X30X12MM STRL CRSNT SVRGN CVR PLT PEEK,"$14,190.00",$0.00,"$14,190.00","$6,385.50","$5,158.80",$0.00,"$2,444.87",$0.00,$0.00,"$2,484.56","$14,190.00",$0.00,"$7,095.00","$11,238.48","$11,352.00",$0.00,"$2,220.74",$0.00,"$2,259.05",$0.00
7969814,SUP,HCPCS C1713,,7969814  -  SPACER SPNL 8D LG 42X30X14MM STRL CRSNT SVRGN CVR PLT PEEK,"$14,190.00",$0.00,"$14,190.00","$6,385.50","$5,158.80",$0.00,"$2,444.87",$0.00,$0.00,"$2,484.56","$14,190.00",$0.00,"$7,095.00","$11,238.48","$11,352.00",$0.00,"$2,220.74",$0.00,"$2,259.05",$0.00
7969816,SUP,HCPCS C1713,,7969816  -  SPACER SPNL 8D LG 42X30X16MM STRL CRSNT SVRGN CVR PLT PEEK,"$14,190.00",$0.00,"$14,190.00","$6,385.50","$5,158.80",$0.00,"$2,444.87",$0.00,$0.00,"$2,484.56","$14,190.00",$0.00,"$7,095.00","$11,238.48","$11,352.00",$0.00,"$2,220.74",$0.00,"$2,259.05",$0.00
7969818,SUP,HCPCS C1713,,7969818  -  SPACER SPNL 8D LG 42X30X18MM STRL CRSNT SVRGN CVR PLT PEEK,"$14,190.00",$0.00,"$14,190.00","$6,385.50","$5,158.80",$0.00,"$2,444.87",$0.00,$0.00,"$2,484.56","$14,190.00",$0.00,"$7,095.00","$11,238.48","$11,352.00",$0.00,"$2,220.74",$0.00,"$2,259.05",$0.00
7969820,SUP,HCPCS C1713,,7969820  -  SPACER SPNL 8D LG 42X30X20MM STRL CRSNT SVRGN CVR PLT PEEK,"$14,190.00",$0.00,"$14,190.00","$6,385.50","$5,158.80",$0.00,"$2,444.87",$0.00,$0.00,"$2,484.56","$14,190.00",$0.00,"$7,095.00","$11,238.48","$11,352.00",$0.00,"$2,220.74",$0.00,"$2,259.05",$0.00
7975520,SUP,HCPCS C1713,,7975520  -  SCREW 7975520 SOVEREIGN FA  5.5 X 20MM,$990.00,$0.00,$990.00,$445.50,$706.56,$0.00,$170.57,$0.00,$0.00,$173.34,$990.00,$0.00,$495.00,$784.08,$792.00,$0.00,$154.94,$0.00,$157.61,$0.00
7975525,SUP,HCPCS C1713,,7975525  -  SCREW 7975525 SOVEREIGN FA 5.5 X 25MM,$990.00,$0.00,$990.00,$445.50,$706.56,$0.00,$170.57,$0.00,$0.00,$173.34,$990.00,$0.00,$495.00,$784.08,$792.00,$0.00,$154.94,$0.00,$157.61,$0.00
7975530,SUP,HCPCS C1713,,7975530  -  SCREW 7975530 SOVEREIGN FA 5.5 X 30MM,$990.00,$0.00,$990.00,$445.50,$706.56,$0.00,$170.57,$0.00,$0.00,$173.34,$990.00,$0.00,$495.00,$784.08,$792.00,$0.00,$154.94,$0.00,$157.61,$0.00
7975535,SUP,HCPCS C1713,,7975535  -  SCREW 7975535 SOVEREIGN FA 5.5 X 35MM,$990.00,$0.00,$990.00,$445.50,$706.56,$0.00,$170.57,$0.00,$0.00,$173.34,$990.00,$0.00,$495.00,$784.08,$792.00,$0.00,$154.94,$0.00,$157.61,$0.00
7976020,SUP,HCPCS C1713,,7976020  -  SCREW 7976020 SOVEREIGN FA 6.0 X 20MM,$990.00,$0.00,$990.00,$445.50,$706.56,$0.00,$170.57,$0.00,$0.00,$173.34,$990.00,$0.00,$495.00,$784.08,$792.00,$0.00,$154.94,$0.00,$157.61,$0.00
7976025,SUP,HCPCS C1713,,7976025  -  SCREW 7976025 SOVEREIGN FA 6.0 X 25MM,$990.00,$0.00,$990.00,$445.50,$706.56,$0.00,$170.57,$0.00,$0.00,$173.34,$990.00,$0.00,$495.00,$784.08,$792.00,$0.00,$154.94,$0.00,$157.61,$0.00
7976030,SUP,HCPCS C1713,,7976030  -  SCREW 7976030 SOVEREIGN FA 6.0 X 30MM,$990.00,$0.00,$990.00,$445.50,$706.56,$0.00,$170.57,$0.00,$0.00,$173.34,$990.00,$0.00,$495.00,$784.08,$792.00,$0.00,$154.94,$0.00,$157.61,$0.00
7976035,SUP,HCPCS C1713,,7976035  -  SCREW 7976035 SOVEREIGN FA 6.0 X 35MM,$990.00,$0.00,$990.00,$445.50,$706.56,$0.00,$170.57,$0.00,$0.00,$173.34,$990.00,$0.00,$495.00,$784.08,$792.00,$0.00,$154.94,$0.00,$157.61,$0.00
8001501,SUP,Custom 27203010,,8001501  -  TRAY 8001501 CRANI FIX 1.5 MM ST,"$4,636.75",$0.00,"$4,636.75",$0.00,"$3,309.25",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,636.75",$0.00,"$2,318.38","$3,672.31","$3,709.40",$0.00,$0.00,$0.00,$0.00,$0.00
8001505,SUP,HCPCS C1713,,8001505  -  CADDY 8001505 SCREW CRANI FIX 1.5MM ST,"$1,177.25",$0.00,"$1,177.25",$529.76,$840.20,$0.00,$202.83,$0.00,$0.00,$206.13,"$1,177.25",$0.00,$588.63,$932.38,$941.80,$0.00,$184.24,$0.00,$187.42,$0.00
8001601,SUP,HCPCS C1713,,8001601  -  CADDY 8001601 SCREW 1.6 SDS,$930.75,$0.00,$930.75,$418.84,$664.28,$0.00,$160.36,$0.00,$0.00,$162.97,$930.75,$0.00,$465.38,$737.15,$744.60,$0.00,$145.66,$0.00,$148.18,$0.00
8001602,SUP,Custom 27203010,,8001602  -  TRAY 8001602 CRANI FIX 1.6MM SD,"$4,636.75",$0.00,"$4,636.75",$0.00,"$3,309.25",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,636.75",$0.00,"$2,318.38","$3,672.31","$3,709.40",$0.00,$0.00,$0.00,$0.00,$0.00
8001605,SUP,HCPCS C1713,,8001605  -  CADDY 8001605 CRANI FIX SCRW 1.6MM SD,"$1,247.38",$0.00,"$1,247.38",$561.32,$890.25,$0.00,$214.92,$0.00,$0.00,$218.41,"$1,247.38",$0.00,$623.69,$987.92,$997.90,$0.00,$195.21,$0.00,$198.58,$0.00
8001830,SUP,HCPCS C1713,,8001830  -  SCREW BONE 1.8MM 3MM RSC TI SPNL,$119.35,$0.00,$119.35,$53.71,$85.18,$0.00,$20.56,$0.00,$0.00,$20.90,$119.35,$0.00,$59.68,$94.53,$95.48,$0.00,$18.68,$0.00,$19.00,$0.00
8002635,SUP,HCPCS C1713,,8002635  -  SCREW BONE 1.6MM 3.5MM TIMESH TI CRANIAL SLFDRILL STRL,$126.08,$0.00,$126.08,$56.74,$89.99,$0.00,$21.72,$0.00,$0.00,$22.08,$126.08,$0.00,$63.04,$99.86,$100.87,$0.00,$19.73,$0.00,$20.07,$0.00
8004200,SUP,Custom 27203010,,8004200  -  BPD TRAY,$896.75,$0.00,$896.75,$0.00,$640.01,$0.00,$0.00,$0.00,$0.00,$0.00,$896.75,$0.00,$448.38,$710.23,$717.40,$0.00,$0.00,$0.00,$0.00,$0.00
8009000,SUP,Custom 27803010,,8009000  -  BASE 8009000 TRAY CRANI FIX 1.5/1.6MM,"$1,544.88",$0.00,"$1,544.88",$0.00,"$1,102.58",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,544.88",$0.00,$772.44,"$1,223.54","$1,235.90",$0.00,$0.00,$0.00,$0.00,$0.00
8009002,SUP,HCPCS C1713,,8009002  -  CADDY 8009002 PLATE CRANI FIX 1.5/1.6MM,$773.50,$0.00,$773.50,$348.08,$552.05,$0.00,$133.27,$0.00,$0.00,$135.43,$773.50,$0.00,$386.75,$612.61,$618.80,$0.00,$121.05,$0.00,$123.14,$0.00
8009220,SUP,Custom 27803010,,8009220  -  BASE 8009220 TRAY COMBO CRANI FIX SYS,$809.63,$0.00,$809.63,$0.00,$577.83,$0.00,$0.00,$0.00,$0.00,$0.00,$809.63,$0.00,$404.81,$641.23,$647.70,$0.00,$0.00,$0.00,$0.00,$0.00
8010050,SUP,Custom 27203010,,8010050  -  ELECTRODE EEG 2 NDL MNTR PK SPNE,$387.50,$0.00,$387.50,$0.00,$276.56,$0.00,$0.00,$0.00,$0.00,$0.00,$387.50,$0.00,$193.75,$306.90,$310.00,$0.00,$0.00,$0.00,$0.00,$0.00
8011830,SUP,HCPCS C1713,,8011830  -  SCREW 8011830 RESCUE SDS 1.8X3MM 1,$140.25,$0.00,$140.25,$63.11,$100.10,$0.00,$24.16,$0.00,$0.00,$24.56,$140.25,$0.00,$70.13,$111.08,$112.20,$0.00,$21.95,$0.00,$22.33,$0.00
8011850,SUP,HCPCS C1713,,8011850  -  SCREW 8011850 RESCUE SDS 1.8X5MM 1,$140.25,$0.00,$140.25,$63.11,$100.10,$0.00,$24.16,$0.00,$0.00,$24.56,$140.25,$0.00,$70.13,$111.08,$112.20,$0.00,$21.95,$0.00,$22.33,$0.00
8012635,SUP,HCPCS C1713,,8012635  -  SCREW 8012635 CRUCIATE SDS 1.6X3.5MM 1,$142.38,$0.00,$142.38,$64.07,$101.61,$0.00,$24.53,$0.00,$0.00,$24.93,$142.38,$0.00,$71.19,$112.76,$113.90,$0.00,$22.28,$0.00,$22.67,$0.00
8012640,SUP,HCPCS C1713,,8012640  -  SCREW 8012640 CRUCIATE SDS 1.6X4MM 1,$142.38,$0.00,$142.38,$64.07,$101.61,$0.00,$24.53,$0.00,$0.00,$24.93,$142.38,$0.00,$71.19,$112.76,$113.90,$0.00,$22.28,$0.00,$22.67,$0.00
8020016,SUP,Custom 27011340,,8020016  -  PROBE EMG M5 MOD,"$3,377.50",$0.00,"$3,377.50",$0.00,"$2,410.52",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,377.50",$0.00,"$1,688.75","$2,674.98","$2,702.00",$0.00,$0.00,$0.00,$0.00,$0.00
8020018,SUP,Custom 27203010,,8020018  -  ELECTRODE EMG SRFC MOD CLIP NVM5,"$3,377.50",$0.00,"$3,377.50",$0.00,"$2,410.52",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,377.50",$0.00,"$1,688.75","$2,674.98","$2,702.00",$0.00,$0.00,$0.00,$0.00,$0.00
8020020,SUP,Custom 27203010,,8020020  -  ELECTRODE EMG NRVSN MOD CLIP PRB,"$4,140.00",$0.00,"$4,140.00",$0.00,"$2,954.72",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,140.00",$0.00,"$2,070.00","$3,278.88","$3,312.00",$0.00,$0.00,$0.00,$0.00,$0.00
8020021,SUP,Custom 27203010,,8020021  -  ELECTRODE EMG MOD CLIP SHTH NVM5,"$3,367.50",$0.00,"$3,367.50",$0.00,"$2,403.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,367.50",$0.00,"$1,683.75","$2,667.06","$2,694.00",$0.00,$0.00,$0.00,$0.00,$0.00
8020029,SUP,Custom 27203010,,8020029  -  KIT EMG XLIF NVM5,"$4,442.50",$0.00,"$4,442.50",$0.00,"$3,170.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,442.50",$0.00,"$2,221.25","$3,518.46","$3,554.00",$0.00,$0.00,$0.00,$0.00,$0.00
8020215,SUP,Custom 27203010,,8020215  -  ELTRD EMG NRVSN MOD M5,"$3,572.50",$0.00,"$3,572.50",$0.00,"$2,549.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,572.50",$0.00,"$1,786.25","$2,829.42","$2,858.00",$0.00,$0.00,$0.00,$0.00,$0.00
8050015,SUP,Custom 27203010,,8050015  -  ELECTRODE EMG 15MM NEEDLE MODULE PROBE NEUROVISION M5,"$2,687.50",$0.00,"$2,687.50",$0.00,"$1,918.07",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,687.50",$0.00,"$1,343.75","$2,128.50","$2,150.00",$0.00,$0.00,$0.00,$0.00,$0.00
8050016,SUP,Custom 27203010,,8050016  -  MODULE EMG NDL PRB M5,"$3,377.50",$0.00,"$3,377.50",$0.00,"$2,410.52",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,377.50",$0.00,"$1,688.75","$2,674.98","$2,702.00",$0.00,$0.00,$0.00,$0.00,$0.00
8050018,SUP,Custom 27203010,,8050018  -  MODULE SPNL M5 NDL EMG CLIP,"$3,377.50",$0.00,"$3,377.50",$0.00,"$2,410.52",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,377.50",$0.00,"$1,688.75","$2,674.98","$2,702.00",$0.00,$0.00,$0.00,$0.00,$0.00
8050020,SUP,Custom 27203010,,8050020  -  ELECTRODE EMG 20MM NRVSN M5 NDL MOD PRB,"$4,140.00",$0.00,"$4,140.00",$0.00,"$2,954.72",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,140.00",$0.00,"$2,070.00","$3,278.88","$3,312.00",$0.00,$0.00,$0.00,$0.00,$0.00
8050021,SUP,Custom 27203010,,8050021  -  MODULE SPNL M5 NDL EMG CLIP SHTH,"$3,367.50",$0.00,"$3,367.50",$0.00,"$2,403.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,367.50",$0.00,"$1,683.75","$2,667.06","$2,694.00",$0.00,$0.00,$0.00,$0.00,$0.00
8050029,SUP,Custom 27203010,,8050029  -  MODULE SPNL M5 NDL EMG XLIF KT,"$4,442.50",$0.00,"$4,442.50",$0.00,"$3,170.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,442.50",$0.00,"$2,221.25","$3,518.46","$3,554.00",$0.00,$0.00,$0.00,$0.00,$0.00
8050215,SUP,Custom 27011340,,8050215  -  ELECTRODE EMG 15MM NEEDLE MODULE PROBE NEUROVISION M5,"$3,572.50",$0.00,"$3,572.50",$0.00,"$2,549.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,572.50",$0.00,"$1,786.25","$2,829.42","$2,858.00",$0.00,$0.00,$0.00,$0.00,$0.00
8051100,SUP,HCPCS C1713,,8051100  -  SCREW BONE 100MM TULIP TI LOCK CLOSE,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
8052025,SUP,HCPCS C1713,,8052025  -  ROD SPNL 25MM 5.5MM TI PREBNT ARM15,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8052030,SUP,HCPCS C1713,,8052030  -  ROD SPNL 30MM 5.5MM TI PREBNT ARM15,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8052035,SUP,HCPCS C1713,,8052035  -  ROD SPNL 35MM 5.5MM TI PREBNT ARM15,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8052040,SUP,HCPCS C1713,,8052040  -  ROD SPNL 40MM 5.5MM ARMADA TI PREBNT ARM15,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8052045,SUP,HCPCS C1713,,8052045  -  ROD SPNL 45MM 5.5MM ARMADA TI PREBNT ARM15,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8052050,SUP,HCPCS C1713,,8052050  -  ROD SPNL 50MM 5.5MM TI PREBNT ARM15,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8052055,SUP,HCPCS C1713,,8052055  -  ROD SPNL 55MM 5.5MM TI PREBNT ARM15,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8052060,SUP,HCPCS C1713,,8052060  -  ROD SPNL 60MM 5.5MM TI PREBNT ARM15,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8052065,SUP,HCPCS C1713,,8052065  -  ROD SPNL 65MM 5.5MM TI PREBNT ARM15,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8052070,SUP,HCPCS C1713,,8052070  -  ROD SPNL 70MM 5.5MM PREBNT ARM15 CNV,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8052075,SUP,HCPCS C1713,,8052075  -  ROD SPNL 75MM 5.5MM TI PREBNT ARM15,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8052080,SUP,HCPCS C1713,,8052080  -  ROD SPNL 80MM 5.5MM TI PREBNT ARM15,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8052085,SUP,HCPCS C1713,,8052085  -  ROD SPNL 85MM 5.5MM TI PREBNT ARM15,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8052090,SUP,HCPCS C1713,,8052090  -  ROD SPNL 90MM 5.5MM PREBNT ARM15 CNV,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8052095,SUP,HCPCS C1713,,8052095  -  ROD SPNL 95MM 5.5MM TI PREBNT ARM15,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8052100,SUP,HCPCS C1713,,8052100  -  ROD SPNL 100MM 5.5MM TI PREBNT ARM15,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8052110,SUP,HCPCS C1713,,8052110  -  ROD SPNL 110MM 5.5MM TI PREBNT ARM15,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8052120,SUP,HCPCS C1713,,8052120  -  ROD SPNL 120MM 5.5MM TI PREBNT ARM15,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8052200,SUP,HCPCS C1713,,8052200  -  ROD SPNL PREBNT 5.5MM 200MM ARMADA TI,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8060040,SUP,Custom 27011340,,8060040  -  PLANER SRG NUVAMAP,"$2,990.00",$0.00,"$2,990.00",$0.00,"$2,133.96",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,990.00",$0.00,"$1,495.00","$2,368.08","$2,392.00",$0.00,$0.00,$0.00,$0.00,$0.00
8100845,SUP,HCPCS C1713,,8100845  -  SCREW 8100845 BREAKOFF SET SCRW 10-32,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
8100855,SUP,HCPCS C1713,,8100855  -  SCREW 8100855  BREAKOFF SET 12 32,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
8103500,SUP,HCPCS C1713,,"8103500  -  SETSCREW, SS, FOR 3.5MM X10",$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
8103513,SUP,HCPCS C1713,,8103513  -  CROSSLINK 8103513 X10 FOR 3.5ROD L 13,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8103517,SUP,HCPCS C1713,,8103517  -  CROSSLINK 8103517 X10 FOR 3.5ROD L 17,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8103521,SUP,HCPCS C1713,,8103521  -  CROSSLINK 8103521 X10 FOR 3.5ROD L 21,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8103525,SUP,HCPCS C1713,,8103525  -  CROSSLINK 8103525 X10 FOR 3.5ROD L 25,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8103529,SUP,HCPCS C1713,,8103529  -  CROSSLINK 8103529 X10 FOR 3.5ROD L 29,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8103533,SUP,HCPCS C1713,,8103533  -  CROSSLINK 8103533 X10 FOR 3.5ROD L 33,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8103537,SUP,HCPCS C1713,,8103537  -  CROSSLINK 8103537 X10 FOR 3.5ROD L 37,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8104516,SUP,HCPCS C1713,,8104516  -  CROSSLINK 8104516 16MM X10 PLATE 4.5,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8104519,SUP,HCPCS C1713,,8104519  -  CROSSLINK 8104519 19MM X10 PLATE 4.5,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8104522,SUP,HCPCS C1713,,8104522  -  CROSSLINK 8104522 22MM X10 PLATE 4.5,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8104525,SUP,HCPCS C1713,,8104525  -  CROSSLINK 8104525 25MM X10 PLATE 4.5,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8104528,SUP,HCPCS C1713,,8104528  -  CROSSLINK 8104528 28MM X10 PLATE 4.5,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8104531,SUP,HCPCS C1713,,8104531  -  CROSSLINK 8104531 31MM X10 PLATE 4.5,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8104534,SUP,HCPCS C1713,,8104534  -  CROSSLINK 8104534 34MM X10 PLATE 4.5,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8104537,SUP,HCPCS C1713,,8104537  -  CROSSLINK 8104537 37MM X10 PLATE 4.5,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8104540,SUP,HCPCS C1713,,8104540  -  CROSSLINK 8104540 40MM X10 PLATE 4.5,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8105516,SUP,HCPCS C1713,,8105516  -  CROSSLINK 8105516 16MM X10 FIXED,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8105519,SUP,HCPCS C1713,,8105519  -  CROSSLINK 8105519 19MM X10 FIXED,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8105522,SUP,HCPCS C1713,,8105522  -  CROSSLINK 8105522 22MM X10 FIXED,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8105525,SUP,HCPCS C1713,,8105525  -  CROSSLINK 8105525 25MM X10 FIXED,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8105527,SUP,HCPCS C1713,,8105527  -  CROSSLINK 8105527 28MM FXD LP 5.5,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8105528,SUP,HCPCS C1713,,8105528  -  CROSSLINK 8105528 28TO30MM X10 MULTI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8105530,SUP,HCPCS C1713,,8105530  -  CROSSLINK 8105530 30TO34MM X10 MULTI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8105531,SUP,HCPCS C1713,,8105531  -  CROSSLINK 8105531 31MM FXD LP 5.5,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8105534,SUP,HCPCS C1713,,8105534  -  CROSSLINK 8105534 34TO36MM X10 MULTI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8105536,SUP,HCPCS C1713,,8105536  -  CROSSLINK 8105536 36TO39MM X10 MULTI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8105539,SUP,HCPCS C1713,,8105539  -  CROSSLINK 8105539 39TO45MM X10 MULTI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8105545,SUP,HCPCS C1713,,8105545  -  CROSSLINK 8105545 45TO58MM X10 MULTI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8105558,SUP,HCPCS C1713,,8105558  -  CROSSLINK 8105558 58TO80MM X10 MULTI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8106416,SUP,HCPCS C1713,,8106416  -  CROSSLINK 8106416 16MM X10 FIXED,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8106419,SUP,HCPCS C1713,,8106419  -  CROSSLINK 8106419 19MM X10 FIXED,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8106422,SUP,HCPCS C1713,,8106422  -  CROSSLINK 8106422 22MM X10 FIXED,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8106425,SUP,HCPCS C1713,,8106425  -  CROSSLINK 8106425 25MM X10 FIXED,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8106427,SUP,HCPCS C1713,,8106427  -  CROSSLINK 8106427 28MM FXD LP 6.35 SS,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8106428,SUP,HCPCS C1713,,8106428  -  CROSSLINK 8106428 28TO30MM X10 MULTI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8106430,SUP,HCPCS C1713,,8106430  -  CROSSLINK 8106430 30TO34MM X10 MULTI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8106431,SUP,HCPCS C1713,,8106431  -  CROSSLINK 8106431 31MM FXD LP 6.35 SS,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8106434,SUP,HCPCS C1713,,8106434  -  CROSSLINK 8106434 34TO36MM X10 MULTI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8106436,SUP,HCPCS C1713,,8106436  -  CROSSLINK 8106436 36TO39MM X10 MULTI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8106439,SUP,HCPCS C1713,,8106439  -  CROSSLINK 8106439 39TO45MM X10 MULTI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8106445,SUP,HCPCS C1713,,8106445  -  CROSSLINK 8106445 45TO58MM X10 MULTI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8106458,SUP,HCPCS C1713,,8106458  -  CROSSLINK 8106458 58TO80MM X10 MULTI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8110450,SUP,HCPCS C1713,,8110450  -  SCREW 8110450 NA LP CROSSLINK SET  TI,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
8110614,SUP,HCPCS C1713,,8110614  -  PLATE 14MM TI FIX CD HZN ANTARES XLNK BONE SPNL,"$4,155.00",$0.00,"$4,155.00","$1,869.75","$2,965.42",$0.00,$715.89,$0.00,$0.00,$727.51,"$4,155.00",$0.00,"$2,077.50","$3,290.76","$3,324.00",$0.00,$650.26,$0.00,$661.48,$0.00
8110713,SUP,HCPCS C1713,,8110713  -  CROSSLINK 8110713 ANTERIOR 13MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8110714,SUP,HCPCS C1713,,8110714  -  CROSSLINK 8110714 ANTERIOR 14MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8110715,SUP,HCPCS C1713,,8110715  -  CROSSLINK 8110715 ANTERIOR 15MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8110716,SUP,HCPCS C1713,,8110716  -  CROSSLINK 8110716 ANTERIOR 16MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8110717,SUP,HCPCS C1713,,8110717  -  CROSSLINK 8110717 ANTERIOR 17MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8110718,SUP,HCPCS C1713,,8110718  -  CROSSLINK 8110718 ANTERIOR 18MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8110719,SUP,HCPCS C1713,,8110719  -  CROSSLINK 8110719 ANTERIOR 19MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8110845,SUP,HCPCS C1713,,8110845  -  SCREW 8110845 BREAKOFF SET SCREW 10-32TI,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
8110855,SUP,HCPCS C1713,,8110855  -  SCREW SET TI 12-32MM 5.5MM SPNL BRKOF X10 XLNK,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
8113500,SUP,HCPCS C1713,,"8113500  -  SETSCREW, TI, FOR 3.5MM X10",$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
8113513,SUP,HCPCS C1713,,8113513  -  CROSSLINK 8113513 X10 FOR 3.5ROD L 13,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8113517,SUP,HCPCS C1713,,8113517  -  CROSSLINK 8113517 X10 FOR 3.5ROD L 17,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8113521,SUP,HCPCS C1713,,8113521  -  CROSSLINK 8113521 X10 FOR 3.5ROD L 21,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8113525,SUP,HCPCS C1713,,8113525  -  CROSSLINK 8113525 X10 FOR 3.5ROD L 25,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8113529,SUP,HCPCS C1713,,8113529  -  CROSSLINK 8113529 X10 FOR 3.5ROD L 29,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8113533,SUP,HCPCS C1713,,8113533  -  CROSSLINK 8113533 X10 FOR 3.5ROD L 33,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8113537,SUP,HCPCS C1713,,8113537  -  CROSSLINK 8113537 X10 FOR 3.5ROD L 37,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8114516,SUP,HCPCS C1713,,8114516  -  CROSSLINK 8114516 16MM X10 PLATE 4.5 TI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8114519,SUP,HCPCS C1713,,8114519  -  CROSSLINK 8114519 19MM X10 PLATE 4.5 TI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8114522,SUP,HCPCS C1713,,8114522  -  CROSSLINK 8114522 22MM X10 PLATE 4.5 TI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8114525,SUP,HCPCS C1713,,8114525  -  CROSSLINK 8114525 25MM X10 PLT 4.5,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8114528,SUP,HCPCS C1713,,8114528  -  CROSSLINK 8114528 28MM X10 PLATE 4.5 TI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8114531,SUP,HCPCS C1713,,8114531  -  CROSSLINK 8114531 31MM X10 PLATE 4.5 TI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8114534,SUP,HCPCS C1713,,8114534  -  CROSSLINK 8114534 34MM X10 PLATE 4.5 TI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8114537,SUP,HCPCS C1713,,8114537  -  CROSSLINK 8114537 37MM X10 PLATE 4.5 TI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8114540,SUP,HCPCS C1713,,8114540  -  CROSSLINK 8114540 40MM X10 PLATE 4.5 TI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8115516,SUP,HCPCS C1713,,8115516  -  PLATE BN 16MM STRL LG X10 XLNK CD HZN LOPRFL FX TI SPNE 5.5,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8115519,SUP,HCPCS C1713,,8115519  -  PLATE BN 19MM STRL LG X10 XLNK CD HZN LOPRFL FX TI SPNE 5.5,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8115522,SUP,HCPCS C1713,,8115522  -  CROSSLINK 8115522 22MM X10 FIXED,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8115525,SUP,HCPCS C1713,,8115525  -  PLATE BN 25MM STRL LG X10 XLNK CD HZN LOPRFL FX TI SPNE 5.5,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8115527,SUP,HCPCS C1713,,8115527  -  CROSSLINK 8115527 28MM FXD LP TI 5.5,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8115528,SUP,HCPCS C1713,,8115528  -  PLATE BN 28-30MM STRL LGC MLSPN X10 XLNK CD HZN LOPRFL TI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8115530,SUP,HCPCS C1713,,8115530  -  PLATE BN 30-34MM STRL LGC MLSPN X10 XLNK CD HZN LOPRFL TI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8115531,SUP,HCPCS C1713,,8115531  -  CROSSLINK 8115531 31MM FXD LP TI 5.5,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8115534,SUP,HCPCS C1713,,8115534  -  PLATE BN 34-36MM STRL LGC MLSPN X10 XLNK CD HZN LOPRFL TI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8115536,SUP,HCPCS C1713,,8115536  -  PLATE BN 36-39MM STRL LGC MLSPN X10 XLNK CD HZN LOPRFL TI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8115539,SUP,HCPCS C1713,,8115539  -  PLATE BN 39-45MM STRL LGC MLSPN X10 XLNK CD HZN LOPRFL TI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8115545,SUP,HCPCS C1713,,8115545  -  PLATE BN 45-58MM STRL LGC MLSPN X10 XLNK CD HZN LOPRFL TI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8115558,SUP,HCPCS C1713,,8115558  -  PLATE BN 58-81MM STRL LGC MLSPN X10 XLNK CD HZN LOPRFL TI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8116416,SUP,HCPCS C1713,,8116416  -  CROSSLINK 8116416 16MM X10 FIXED,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8116419,SUP,HCPCS C1713,,8116419  -  CROSSLINK 8116419 19MM X10 FIXED,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8116422,SUP,HCPCS C1713,,8116422  -  CROSSLINK 8116422 22MM X10 FIXED,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8116425,SUP,HCPCS C1713,,8116425  -  CROSSLINK 8116425 25MM X10 FIXED,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8116427,SUP,HCPCS C1713,,8116427  -  CROSSLINK 8116427 28MM FXD L P 6 35TI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8116428,SUP,HCPCS C1713,,8116428  -  CROSSLINK 8116428 28 30MM X10  MULTI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8116430,SUP,HCPCS C1713,,8116430  -  CROSSLINK 8116430 30 34MM X10 MULTI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8116431,SUP,HCPCS C1713,,8116431  -  CROSSLINK 8116431 31MM FXD LP TI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8116434,SUP,HCPCS C1713,,8116434  -  PLATE 34-36MM TI 6.35MM ROD MLSPN X10 XLNK BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8116436,SUP,HCPCS C1713,,8116436  -  CROSSLINK 8116436 36 39MM X10 MULTI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8116439,SUP,HCPCS C1713,,8116439  -  CROSSLINK 8116439 39 45MM X10 MULTI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8116445,SUP,HCPCS C1713,,8116445  -  PLATE 45-57MM TI 6.35MM ROD MLSPN X10 XLNK BONE SPNL STRL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8116458,SUP,HCPCS C1713,,8116458  -  PLATE 58-80MM TI 6.35MM SCR MULTIAX X10 XLNK BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8151100,SUP,HCPCS C1713,,8151100  -  SCREW BONE SS SPNL LCK CLOSE HEAD,$757.50,$0.00,$757.50,$340.88,$540.63,$0.00,$130.51,$0.00,$0.00,$132.63,$757.50,$0.00,$378.75,$599.94,$606.00,$0.00,$118.55,$0.00,$120.59,$0.00
8162102,SUP,HCPCS C1713,,8162102  -  STAPLE 8162102  2MM X 9MM TWO PRONG SMA,"$1,972.50",$0.00,"$1,972.50",$887.63,"$1,407.77",$0.00,$339.85,$0.00,$0.00,$345.37,"$1,972.50",$0.00,$986.25,"$1,562.22","$1,578.00",$0.00,$308.70,$0.00,$314.02,$0.00
8162103,SUP,HCPCS C1713,,8162103  -  STAPLE 8162103  3MM X 9MM TWO PRONG SMA,"$1,972.50",$0.00,"$1,972.50",$887.63,"$1,407.77",$0.00,$339.85,$0.00,$0.00,$345.37,"$1,972.50",$0.00,$986.25,"$1,562.22","$1,578.00",$0.00,$308.70,$0.00,$314.02,$0.00
8162104,SUP,HCPCS C1713,,8162104  -  STAPLE 8162104  4MM X 10MM 2PRONG SMA,"$1,972.50",$0.00,"$1,972.50",$887.63,"$1,407.77",$0.00,$339.85,$0.00,$0.00,$345.37,"$1,972.50",$0.00,$986.25,"$1,562.22","$1,578.00",$0.00,$308.70,$0.00,$314.02,$0.00
8162106,SUP,HCPCS C1713,,8162106  -  STAPLE 8162106  6MM X 11MM 2PRONG SMA,"$1,972.50",$0.00,"$1,972.50",$887.63,"$1,407.77",$0.00,$339.85,$0.00,$0.00,$345.37,"$1,972.50",$0.00,$986.25,"$1,562.22","$1,578.00",$0.00,$308.70,$0.00,$314.02,$0.00
8162108,SUP,HCPCS C1713,,8162108  -  STAPLE 8162108  8MM X 12MM 2PRONG SMA,"$1,972.50",$0.00,"$1,972.50",$887.63,"$1,407.77",$0.00,$339.85,$0.00,$0.00,$345.37,"$1,972.50",$0.00,$986.25,"$1,562.22","$1,578.00",$0.00,$308.70,$0.00,$314.02,$0.00
8162110,SUP,HCPCS C1713,,8162110  -  STAPLE 8162110  10MM X 13MM 2PRONG SMA,"$1,972.50",$0.00,"$1,972.50",$887.63,"$1,407.77",$0.00,$339.85,$0.00,$0.00,$345.37,"$1,972.50",$0.00,$986.25,"$1,562.22","$1,578.00",$0.00,$308.70,$0.00,$314.02,$0.00
8164604,SUP,HCPCS C1713,,8164604  -  STAPLE 8164604  4MM X 10MM 4 PRONG SMA,"$6,300.65",$0.00,"$6,300.65","$2,835.29","$4,496.77",$0.00,"$1,085.57",$0.00,$0.00,"$1,103.19","$6,300.65",$0.00,"$3,150.33","$4,990.11","$5,040.52",$0.00,$986.05,$0.00,"$1,003.06",$0.00
8164605,SUP,HCPCS C1713,,8164605  -  STAPLE BONE 4 PR 10X5MM SPNL SMA,"$6,300.65",$0.00,"$6,300.65","$2,835.29","$4,496.77",$0.00,"$1,085.57",$0.00,$0.00,"$1,103.19","$6,300.65",$0.00,"$3,150.33","$4,990.11","$5,040.52",$0.00,$986.05,$0.00,"$1,003.06",$0.00
8164606,SUP,HCPCS C1713,,8164606  -  STAPLE 8164606  6MM X 11MM 4 PRONG SMA,"$6,300.65",$0.00,"$6,300.65","$2,835.29","$4,496.77",$0.00,"$1,085.57",$0.00,$0.00,"$1,103.19","$6,300.65",$0.00,"$3,150.33","$4,990.11","$5,040.52",$0.00,$986.05,$0.00,"$1,003.06",$0.00
8164608,SUP,HCPCS C1713,,8164608  -  STAPLE 8164608  8MM X 12MM 4 PRONG SMA,"$6,300.65",$0.00,"$6,300.65","$2,835.29","$4,496.77",$0.00,"$1,085.57",$0.00,$0.00,"$1,103.19","$6,300.65",$0.00,"$3,150.33","$4,990.11","$5,040.52",$0.00,$986.05,$0.00,"$1,003.06",$0.00
8164610,SUP,HCPCS C1713,,8164610  -  STAPLE 8164610  10MM X 13MM 4 PRONG SMA,"$6,300.65",$0.00,"$6,300.65","$2,835.29","$4,496.77",$0.00,"$1,085.57",$0.00,$0.00,"$1,103.19","$6,300.65",$0.00,"$3,150.33","$4,990.11","$5,040.52",$0.00,$986.05,$0.00,"$1,003.06",$0.00
8164612,SUP,HCPCS C1713,,8164612  -  STAPLE 8164612 12MMX14MM 4PRNG SMA,"$6,300.65",$0.00,"$6,300.65","$2,835.29","$4,496.77",$0.00,"$1,085.57",$0.00,$0.00,"$1,103.19","$6,300.65",$0.00,"$3,150.33","$4,990.11","$5,040.52",$0.00,$986.05,$0.00,"$1,003.06",$0.00
8164614,SUP,HCPCS C1713,,8164614  -  STAPLE 8164614 14MMX15MM 4PRNG SMA,"$6,300.65",$0.00,"$6,300.65","$2,835.29","$4,496.77",$0.00,"$1,085.57",$0.00,$0.00,"$1,103.19","$6,300.65",$0.00,"$3,150.33","$4,990.11","$5,040.52",$0.00,$986.05,$0.00,"$1,003.06",$0.00
8200001,SUP,HCPCS C1713,,8200001  -  CLIP SPNL LG NUVASIVE INC,"$2,282.50",$0.00,"$2,282.50","$1,027.13","$1,629.02",$0.00,$393.26,$0.00,$0.00,$399.65,"$2,282.50",$0.00,"$1,141.25","$1,807.74","$1,826.00",$0.00,$357.21,$0.00,$363.37,$0.00
8200003,SUP,HCPCS C1769,,8200003  -  WIRE FX KRSH MAXCESS MOD,"$1,857.50",$0.00,"$1,857.50","$1,008.62","$1,325.70",$0.00,$320.04,$0.00,$0.00,$325.23,"$1,857.50",$0.00,$928.75,"$1,471.14","$1,486.00",$0.00,$290.70,$0.00,$295.71,$0.00
8200010,SUP,Custom 27203010,,8200010  -  KIT SPNL STRL MAXCESS SHIM DISP,"$3,572.50",$0.00,"$3,572.50",$0.00,"$2,549.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,572.50",$0.00,"$1,786.25","$2,829.42","$2,858.00",$0.00,$0.00,$0.00,$0.00,$0.00
8200011,SUP,Custom 27203010,,8200011  -  KIT SPNL STRL MAXCESS MOD DISP,"$5,115.00",$0.00,"$5,115.00",$0.00,"$3,650.58",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,115.00",$0.00,"$2,557.50","$4,051.08","$4,092.00",$0.00,$0.00,$0.00,$0.00,$0.00
8200200,SUP,HCPCS C1713,,8200200  -  SCREW BN MA MOD TLIF SPNE DISP,"$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
8200201,SUP,HCPCS C1713,,8200201  -  SCREW BN MA HP SHIM LGHT CBL SPNE TLIF,"$4,662.50",$0.00,"$4,662.50","$2,098.13","$3,327.63",$0.00,$803.33,$0.00,$0.00,$816.37,"$4,662.50",$0.00,"$2,331.25","$3,692.70","$3,730.00",$0.00,$729.68,$0.00,$742.27,$0.00
8200202,SUP,HCPCS C1713,,8200202  -  SCREW BN MA MOD TLIF HP SHIM SPNE,"$3,575.00",$0.00,"$3,575.00","$1,608.75","$2,551.48",$0.00,$615.95,$0.00,$0.00,$625.95,"$3,575.00",$0.00,"$1,787.50","$2,831.40","$2,860.00",$0.00,$559.49,$0.00,$569.14,$0.00
8203030,SUP,Custom 27203010,,8203030  -  AIRWAY PHARYNGEAL 3 SMALL 15MM CONCTR NONINFLATABLE CUFF,$35.08,$0.00,$35.08,$0.00,$25.04,$0.00,$0.00,$0.00,$0.00,$0.00,$35.08,$0.00,$17.54,$27.78,$28.06,$0.00,$0.00,$0.00,$0.00,$0.00
8227103,SUP,HCPCS C1898,,8227103  -  ELECTRODE EMG 4MM 12MM 2MM 2 CHANNEL NEEDLE LANCET TIP,$227.50,$0.00,$227.50,$102.38,$162.37,$0.00,$39.20,$0.00,$0.00,$39.83,$227.50,$0.00,$113.75,$180.18,$182.00,$0.00,$35.60,$0.00,$36.22,$0.00
8229507,SUP,Custom 27203010,,8229507  -  TUBE ENDOTRACHEAL NIM STAINLESS STEEL PVC OD10.5 MM ID7.0 MM,$960.00,$0.00,$960.00,$0.00,$685.15,$0.00,$0.00,$0.00,$0.00,$0.00,$960.00,$0.00,$480.00,$760.32,$768.00,$0.00,$0.00,$0.00,$0.00,$0.00
8229706,SUP,Custom 27803010,,8229706  -  TUBE ENDOTRAC STANDARD LP 8.2MM 6MM DEPH FREE NONREINFORCED,$923.88,$0.00,$923.88,$0.00,$659.37,$0.00,$0.00,$0.00,$0.00,$0.00,$923.88,$0.00,$461.94,$731.71,$739.10,$0.00,$0.00,$0.00,$0.00,$0.00
8229707,SUP,Custom 27803010,,8229707  -  TUBE ENDOTRAC STANDARD LP 8.2MM 6MM DEPH FREE NONREINFORCED,$923.88,$0.00,$923.88,$0.00,$659.37,$0.00,$0.00,$0.00,$0.00,$0.00,$923.88,$0.00,$461.94,$731.71,$739.10,$0.00,$0.00,$0.00,$0.00,$0.00
8229708,SUP,Custom 27803010,,8229708  -  TUBE ENDOTRAC STANDARD LP 10.7MM 8MM DEPH FREE NONREINFORCED,$852.63,$0.00,$852.63,$0.00,$608.52,$0.00,$0.00,$0.00,$0.00,$0.00,$852.63,$0.00,$426.31,$675.28,$682.10,$0.00,$0.00,$0.00,$0.00,$0.00
8240001,SUP,Custom 27203010,,8240001  -  KIT SPINAL 4 MAXCESS,"$2,385.00",$0.00,"$2,385.00",$0.00,"$1,702.17",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,385.00",$0.00,"$1,192.50","$1,888.92","$1,908.00",$0.00,$0.00,$0.00,$0.00,$0.00
8240060,SUP,Custom 27203010,,8240060  -  MODULE SPNL 4 MAXCESS,"$5,850.25",$0.00,"$5,850.25",$0.00,"$4,175.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,850.25",$0.00,"$2,925.13","$4,633.40","$4,680.20",$0.00,$0.00,$0.00,$0.00,$0.00
8240061,SUP,Custom 27203010,,8240061  -  MODULE SPNL 4 MAXCESS SHIM,"$4,695.25",$0.00,"$4,695.25",$0.00,"$3,351.00",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,695.25",$0.00,"$2,347.63","$3,718.64","$3,756.20",$0.00,$0.00,$0.00,$0.00,$0.00
8275525,SUP,HCPCS C1713,,8275525  -  SCREW BN 5.5MM 25MM RDC TI SPNE 5.5MM ROD,"$3,257.50",$0.00,"$3,257.50","$1,465.88","$2,324.88",$0.00,$561.25,$0.00,$0.00,$570.36,"$3,257.50",$0.00,"$1,628.75","$2,579.94","$2,606.00",$0.00,$509.80,$0.00,$518.59,$0.00
8275530,SUP,HCPCS C1713,,8275530  -  SCREW BN 5.5MM 30MM RDC TI SPNE 5.5MM ROD,"$3,257.50",$0.00,"$3,257.50","$1,465.88","$2,324.88",$0.00,$561.25,$0.00,$0.00,$570.36,"$3,257.50",$0.00,"$1,628.75","$2,579.94","$2,606.00",$0.00,$509.80,$0.00,$518.59,$0.00
8275535,SUP,HCPCS C1713,,8275535  -  SCREW BN 5.5MM 35MM RDC TI SPNE 5.5MM ROD,"$3,257.50",$0.00,"$3,257.50","$1,465.88","$2,324.88",$0.00,$561.25,$0.00,$0.00,$570.36,"$3,257.50",$0.00,"$1,628.75","$2,579.94","$2,606.00",$0.00,$509.80,$0.00,$518.59,$0.00
8275540,SUP,HCPCS C1713,,8275540  -  SCREW BONE 5.5MM 40MM REDX TITANIUM SPN 5.5MM ROD,"$3,257.50",$0.00,"$3,257.50","$1,465.88","$2,324.88",$0.00,$561.25,$0.00,$0.00,$570.36,"$3,257.50",$0.00,"$1,628.75","$2,579.94","$2,606.00",$0.00,$509.80,$0.00,$518.59,$0.00
8275545,SUP,HCPCS C1713,,8275545  -  SCREW BN 5.5MM 45MM RDC TI SPNE 5.5MM ROD,"$3,257.50",$0.00,"$3,257.50","$1,465.88","$2,324.88",$0.00,$561.25,$0.00,$0.00,$570.36,"$3,257.50",$0.00,"$1,628.75","$2,579.94","$2,606.00",$0.00,$509.80,$0.00,$518.59,$0.00
8275550,SUP,HCPCS C1713,,8275550  -  SCREW BN 5.5MM 50MM RDC TI SPNE 5.5MM ROD,"$3,257.50",$0.00,"$3,257.50","$1,465.88","$2,324.88",$0.00,$561.25,$0.00,$0.00,$570.36,"$3,257.50",$0.00,"$1,628.75","$2,579.94","$2,606.00",$0.00,$509.80,$0.00,$518.59,$0.00
8275555,SUP,HCPCS C1713,,8275555  -  SCREW BN 5.5MM 55MM RDC TI SPNE 5.5MM ROD,"$3,257.50",$0.00,"$3,257.50","$1,465.88","$2,324.88",$0.00,$561.25,$0.00,$0.00,$570.36,"$3,257.50",$0.00,"$1,628.75","$2,579.94","$2,606.00",$0.00,$509.80,$0.00,$518.59,$0.00
8276530,SUP,HCPCS C1713,,8276530  -  SCREW BN 6.5MM 30MM RDC TI SPNE 5.5MM ROD,"$3,257.50",$0.00,"$3,257.50","$1,465.88","$2,324.88",$0.00,$561.25,$0.00,$0.00,$570.36,"$3,257.50",$0.00,"$1,628.75","$2,579.94","$2,606.00",$0.00,$509.80,$0.00,$518.59,$0.00
8276535,SUP,HCPCS C1713,,8276535  -  SCREW BN 6.5MM 35MM RDC TI SPNE 5.5MM ROD,"$3,257.50",$0.00,"$3,257.50","$1,465.88","$2,324.88",$0.00,$561.25,$0.00,$0.00,$570.36,"$3,257.50",$0.00,"$1,628.75","$2,579.94","$2,606.00",$0.00,$509.80,$0.00,$518.59,$0.00
8276545,SUP,HCPCS C1713,,8276545  -  SCREW BN 6.5MM 45MM RDC TI SPNE 5.5MM ROD,"$3,257.50",$0.00,"$3,257.50","$1,465.88","$2,324.88",$0.00,$561.25,$0.00,$0.00,$570.36,"$3,257.50",$0.00,"$1,628.75","$2,579.94","$2,606.00",$0.00,$509.80,$0.00,$518.59,$0.00
8276555,SUP,HCPCS C1713,,8276555  -  SCREW BN 6.5MM 55MM RDC TI SPNE 5.5MM ROD,"$3,257.50",$0.00,"$3,257.50","$1,465.88","$2,324.88",$0.00,$561.25,$0.00,$0.00,$570.36,"$3,257.50",$0.00,"$1,628.75","$2,579.94","$2,606.00",$0.00,$509.80,$0.00,$518.59,$0.00
8277530,SUP,HCPCS C1713,,8277530  -  SCREW BN 7.5MM 30MM RDC TI SPNE 5.5MM ROD,"$3,257.50",$0.00,"$3,257.50","$1,465.88","$2,324.88",$0.00,$561.25,$0.00,$0.00,$570.36,"$3,257.50",$0.00,"$1,628.75","$2,579.94","$2,606.00",$0.00,$509.80,$0.00,$518.59,$0.00
8277535,SUP,HCPCS C1713,,8277535  -  SCREW BN 7.5MM 35MM RDC TI SPNE 5.5MM ROD,"$3,257.50",$0.00,"$3,257.50","$1,465.88","$2,324.88",$0.00,$561.25,$0.00,$0.00,$570.36,"$3,257.50",$0.00,"$1,628.75","$2,579.94","$2,606.00",$0.00,$509.80,$0.00,$518.59,$0.00
8277540,SUP,HCPCS C1713,,8277540  -  SCREW BN 7.5MM 40MM RDC TI SPNE 5.5MM ROD,"$3,257.50",$0.00,"$3,257.50","$1,465.88","$2,324.88",$0.00,$561.25,$0.00,$0.00,$570.36,"$3,257.50",$0.00,"$1,628.75","$2,579.94","$2,606.00",$0.00,$509.80,$0.00,$518.59,$0.00
8277550,SUP,HCPCS C1713,,8277550  -  SCREW BN 7.5MM 50MM RDC TI SPNE 5.5MM ROD,"$3,257.50",$0.00,"$3,257.50","$1,465.88","$2,324.88",$0.00,$561.25,$0.00,$0.00,$570.36,"$3,257.50",$0.00,"$1,628.75","$2,579.94","$2,606.00",$0.00,$509.80,$0.00,$518.59,$0.00
8281190,SUP,HCPCS C1713,,8281190  -  SCREW 8281190 TSRH .25 32 LOCK NON BREAK,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
8281246,SUP,HCPCS C1713,,8281246  -  SCREW 8281246 SET 3BDL HEX TI,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
8281248,SUP,HCPCS C1713,,8281248  -  SET SCREW 8281248 0.25 32 FLSH BRK LK TI,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
8350424,SUP,Custom 27203010,,8350424  -  TAP SURG OSTEOGRIP 5.5MM,$790.50,$0.00,$790.50,$0.00,$564.18,$0.00,$0.00,$0.00,$0.00,$0.00,$790.50,$0.00,$395.25,$626.08,$632.40,$0.00,$0.00,$0.00,$0.00,$0.00
8350426,SUP,Custom 27203010,,8350426  -  TAP SURG OSTEOGRIP 6.5MM,$790.50,$0.00,$790.50,$0.00,$564.18,$0.00,$0.00,$0.00,$0.00,$0.00,$790.50,$0.00,$395.25,$626.08,$632.40,$0.00,$0.00,$0.00,$0.00,$0.00
8351500,SUP,HCPCS C1713,,8351500  -  SET SCREW 8351500 TSRH 3DX FLUSH BREAK,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
8351502,SUP,HCPCS C1713,,8351502  -  SET SCREW 8351502 TSRH 3DX NON-BREAK,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
8351520,SUP,Custom 27803010,,8351520  -  CONNECTOR 8351520 TSRH 3DX SMALL,"$2,316.75",$0.00,"$2,316.75",$0.00,"$1,653.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,316.75",$0.00,"$1,158.38","$1,834.87","$1,853.40",$0.00,$0.00,$0.00,$0.00,$0.00
8351521,SUP,Custom 27803010,,8351521  -  CONNECTOR 8351521 TSRH 3DX MEDIUM,"$2,316.75",$0.00,"$2,316.75",$0.00,"$1,653.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,316.75",$0.00,"$1,158.38","$1,834.87","$1,853.40",$0.00,$0.00,$0.00,$0.00,$0.00
8351522,SUP,Custom 27803010,,8351522  -  CONNECTOR 8351522 TSRH 3DX LARGE,"$2,316.75",$0.00,"$2,316.75",$0.00,"$1,653.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,316.75",$0.00,"$1,158.38","$1,834.87","$1,853.40",$0.00,$0.00,$0.00,$0.00,$0.00
8351523,SUP,Custom 27803010,,8351523  -  CONNECTOR 8351523 TSRH 3DX 90 DEG OFFSET,"$2,316.75",$0.00,"$2,316.75",$0.00,"$1,653.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,316.75",$0.00,"$1,158.38","$1,834.87","$1,853.40",$0.00,$0.00,$0.00,$0.00,$0.00
8352200,SUP,HCPCS C1713,,8352200  -  ROD 5.5MM USS 200MM,"$2,017.50",$0.00,"$2,017.50",$907.88,"$1,439.89",$0.00,$347.61,$0.00,$0.00,$353.25,"$2,017.50",$0.00,"$1,008.75","$1,597.86","$1,614.00",$0.00,$315.74,$0.00,$321.19,$0.00
8352300,SUP,HCPCS C1713,,8352300  -  ROD 5.5MM USS 300MM,"$2,275.00",$0.00,"$2,275.00","$1,023.75","$1,623.67",$0.00,$391.97,$0.00,$0.00,$398.33,"$2,275.00",$0.00,"$1,137.50","$1,801.80","$1,820.00",$0.00,$356.04,$0.00,$362.18,$0.00
8352500,SUP,HCPCS C1713,,8352500  -  ROD 5.5MM USS 500MM,"$2,502.50",$0.00,"$2,502.50","$1,126.13","$1,786.03",$0.00,$431.17,$0.00,$0.00,$438.17,"$2,502.50",$0.00,"$1,251.25","$1,981.98","$2,002.00",$0.00,$391.64,$0.00,$398.40,$0.00
8352510,SUP,Custom 27803010,,8352510  -  CONNECTOR 8352510 5.5 SLOTTED TI,"$2,031.00",$0.00,"$2,031.00",$0.00,"$1,449.52",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,031.00",$0.00,"$1,015.50","$1,608.55","$1,624.80",$0.00,$0.00,$0.00,$0.00,$0.00
8354525,SUP,HCPCS C1713,,8354525  -  SCREW BONE 4.5MM 25MM SS SPNL LCK 5.5MM ROD,"$5,507.50",$0.00,"$5,507.50","$2,478.38","$3,930.70",$0.00,$948.91,$0.00,$0.00,$964.32,"$5,507.50",$0.00,"$2,753.75","$4,361.94","$4,406.00",$0.00,$861.92,$0.00,$876.79,$0.00
8354530,SUP,HCPCS C1713,,8354530  -  SCREW BONE 4.5MM 30MM SS SPNL LCK 5.5MM ROD,"$5,507.50",$0.00,"$5,507.50","$2,478.38","$3,930.70",$0.00,$948.91,$0.00,$0.00,$964.32,"$5,507.50",$0.00,"$2,753.75","$4,361.94","$4,406.00",$0.00,$861.92,$0.00,$876.79,$0.00
8354535,SUP,HCPCS C1713,,8354535  -  SCREW BONE 4.5MM 35MM SS SPNL LCK 5.5MM ROD,"$5,507.50",$0.00,"$5,507.50","$2,478.38","$3,930.70",$0.00,$948.91,$0.00,$0.00,$964.32,"$5,507.50",$0.00,"$2,753.75","$4,361.94","$4,406.00",$0.00,$861.92,$0.00,$876.79,$0.00
8354540,SUP,HCPCS C1713,,8354540  -  SCREW BONE 4.5MM 40MM SS SPNL LCK 5.5MM ROD,"$5,507.50",$0.00,"$5,507.50","$2,478.38","$3,930.70",$0.00,$948.91,$0.00,$0.00,$964.32,"$5,507.50",$0.00,"$2,753.75","$4,361.94","$4,406.00",$0.00,$861.92,$0.00,$876.79,$0.00
8355530,SUP,HCPCS C1713,,8355530  -  SCREW BONE 5.5MM 30MM SS SPNL LCK 5.5MM ROD,"$5,507.50",$0.00,"$5,507.50","$2,478.38","$3,930.70",$0.00,$948.91,$0.00,$0.00,$964.32,"$5,507.50",$0.00,"$2,753.75","$4,361.94","$4,406.00",$0.00,$861.92,$0.00,$876.79,$0.00
8355535,SUP,HCPCS C1713,,8355535  -  SCREW BONE 5.5MM 35MM SS SPNL LCK 5.5MM ROD,"$5,507.50",$0.00,"$5,507.50","$2,478.38","$3,930.70",$0.00,$948.91,$0.00,$0.00,$964.32,"$5,507.50",$0.00,"$2,753.75","$4,361.94","$4,406.00",$0.00,$861.92,$0.00,$876.79,$0.00
8355540,SUP,HCPCS C1713,,8355540  -  SCREW BONE 5.5MM 40MM SS SPNL LCK 5.5MM ROD,"$5,507.50",$0.00,"$5,507.50","$2,478.38","$3,930.70",$0.00,$948.91,$0.00,$0.00,$964.32,"$5,507.50",$0.00,"$2,753.75","$4,361.94","$4,406.00",$0.00,$861.92,$0.00,$876.79,$0.00
8355545,SUP,HCPCS C1713,,8355545  -  SCREW BONE 5.5MM 45MM SS SPNL LCK 5.5MM ROD,"$5,507.50",$0.00,"$5,507.50","$2,478.38","$3,930.70",$0.00,$948.91,$0.00,$0.00,$964.32,"$5,507.50",$0.00,"$2,753.75","$4,361.94","$4,406.00",$0.00,$861.92,$0.00,$876.79,$0.00
8356535,SUP,HCPCS C1713,,8356535  -  SCREW BONE 6.5MM 35MM SS SPNL LCK 5.5MM ROD,"$5,507.50",$0.00,"$5,507.50","$2,478.38","$3,930.70",$0.00,$948.91,$0.00,$0.00,$964.32,"$5,507.50",$0.00,"$2,753.75","$4,361.94","$4,406.00",$0.00,$861.92,$0.00,$876.79,$0.00
8356540,SUP,HCPCS C1713,,8356540  -  SCREW BONE 6.5MM 40MM SS SPNL LCK 5.5MM ROD,"$5,507.50",$0.00,"$5,507.50","$2,478.38","$3,930.70",$0.00,$948.91,$0.00,$0.00,$964.32,"$5,507.50",$0.00,"$2,753.75","$4,361.94","$4,406.00",$0.00,$861.92,$0.00,$876.79,$0.00
8356545,SUP,HCPCS C1713,,8356545  -  SCREW BONE 6.5MM 45MM SS SPNL LCK 5.5MM ROD,"$5,507.50",$0.00,"$5,507.50","$2,478.38","$3,930.70",$0.00,$948.91,$0.00,$0.00,$964.32,"$5,507.50",$0.00,"$2,753.75","$4,361.94","$4,406.00",$0.00,$861.92,$0.00,$876.79,$0.00
8364525,SUP,HCPCS C1713,,8364525  -  SCREW BONE 4.5MM 25MM SPNL LCK 6.35MM ROD,"$5,507.50",$0.00,"$5,507.50","$2,478.38","$3,930.70",$0.00,$948.91,$0.00,$0.00,$964.32,"$5,507.50",$0.00,"$2,753.75","$4,361.94","$4,406.00",$0.00,$861.92,$0.00,$876.79,$0.00
8364530,SUP,HCPCS C1713,,8364530  -  SCREW BONE 4.5MM 30MM SPNL LCK 6.35MM ROD,"$5,507.50",$0.00,"$5,507.50","$2,478.38","$3,930.70",$0.00,$948.91,$0.00,$0.00,$964.32,"$5,507.50",$0.00,"$2,753.75","$4,361.94","$4,406.00",$0.00,$861.92,$0.00,$876.79,$0.00
8364535,SUP,HCPCS C1713,,8364535  -  SCREW BONE 4.5MM 35MM SPNL LCK 6.35MM ROD,"$5,507.50",$0.00,"$5,507.50","$2,478.38","$3,930.70",$0.00,$948.91,$0.00,$0.00,$964.32,"$5,507.50",$0.00,"$2,753.75","$4,361.94","$4,406.00",$0.00,$861.92,$0.00,$876.79,$0.00
8364540,SUP,HCPCS C1713,,8364540  -  SCREW BONE 4.5MM 40MM SPNL LCK 6.35MM ROD,"$5,507.50",$0.00,"$5,507.50","$2,478.38","$3,930.70",$0.00,$948.91,$0.00,$0.00,$964.32,"$5,507.50",$0.00,"$2,753.75","$4,361.94","$4,406.00",$0.00,$861.92,$0.00,$876.79,$0.00
8364545,SUP,HCPCS C1713,,8364545  -  SCREW BONE 4.5MM 45MM SPNL LCK 6.35MM ROD,"$5,507.50",$0.00,"$5,507.50","$2,478.38","$3,930.70",$0.00,$948.91,$0.00,$0.00,$964.32,"$5,507.50",$0.00,"$2,753.75","$4,361.94","$4,406.00",$0.00,$861.92,$0.00,$876.79,$0.00
8365530,SUP,HCPCS C1713,,8365530  -  SCREW BONE 5.5MM 30MM SPNL LCK 6.35MM ROD,"$5,507.50",$0.00,"$5,507.50","$2,478.38","$3,930.70",$0.00,$948.91,$0.00,$0.00,$964.32,"$5,507.50",$0.00,"$2,753.75","$4,361.94","$4,406.00",$0.00,$861.92,$0.00,$876.79,$0.00
8365535,SUP,HCPCS C1713,,8365535  -  SCREW BONE 5.5MM 35MM SPNL LCK 6.35MM ROD,"$5,507.50",$0.00,"$5,507.50","$2,478.38","$3,930.70",$0.00,$948.91,$0.00,$0.00,$964.32,"$5,507.50",$0.00,"$2,753.75","$4,361.94","$4,406.00",$0.00,$861.92,$0.00,$876.79,$0.00
8365540,SUP,HCPCS C1713,,8365540  -  SCREW BONE 5.5MM 40MM SPNL LCK 6.35MM ROD,"$5,507.50",$0.00,"$5,507.50","$2,478.38","$3,930.70",$0.00,$948.91,$0.00,$0.00,$964.32,"$5,507.50",$0.00,"$2,753.75","$4,361.94","$4,406.00",$0.00,$861.92,$0.00,$876.79,$0.00
8365545,SUP,HCPCS C1713,,8365545  -  SCREW BONE 5.5MM 45MM SPNL LCK 6.35MM ROD,"$5,507.50",$0.00,"$5,507.50","$2,478.38","$3,930.70",$0.00,$948.91,$0.00,$0.00,$964.32,"$5,507.50",$0.00,"$2,753.75","$4,361.94","$4,406.00",$0.00,$861.92,$0.00,$876.79,$0.00
8366535,SUP,HCPCS C1713,,8366535  -  SCREW BONE 6.5MM 35MM SPNL LCK 6.35MM ROD,"$5,507.50",$0.00,"$5,507.50","$2,478.38","$3,930.70",$0.00,$948.91,$0.00,$0.00,$964.32,"$5,507.50",$0.00,"$2,753.75","$4,361.94","$4,406.00",$0.00,$861.92,$0.00,$876.79,$0.00
8366540,SUP,HCPCS C1713,,8366540  -  SCREW BONE 6.5MM 40MM SPNL LCK 6.35MM ROD,"$5,507.50",$0.00,"$5,507.50","$2,478.38","$3,930.70",$0.00,$948.91,$0.00,$0.00,$964.32,"$5,507.50",$0.00,"$2,753.75","$4,361.94","$4,406.00",$0.00,$861.92,$0.00,$876.79,$0.00
8366545,SUP,HCPCS C1713,,8366545  -  SCREW BONE 6.5MM 45MM SPNL LCK 6.35MM ROD,"$5,507.50",$0.00,"$5,507.50","$2,478.38","$3,930.70",$0.00,$948.91,$0.00,$0.00,$964.32,"$5,507.50",$0.00,"$2,753.75","$4,361.94","$4,406.00",$0.00,$861.92,$0.00,$876.79,$0.00
8367645,SUP,HCPCS C1713,,8367645  -  BONE SCREW 8367645 EXTRACTOR 4.5MM,"$1,138.50",$0.00,"$1,138.50",$512.33,$812.55,$0.00,$196.16,$0.00,$0.00,$199.34,"$1,138.50",$0.00,$569.25,$901.69,$910.80,$0.00,$178.18,$0.00,$181.25,$0.00
8367650,SUP,HCPCS C1713,,8367650  -  BONE SCREW 8367650 EXTRACTPR 5.0MM,"$1,138.50",$0.00,"$1,138.50",$512.33,$812.55,$0.00,$196.16,$0.00,$0.00,$199.34,"$1,138.50",$0.00,$569.25,$901.69,$910.80,$0.00,$178.18,$0.00,$181.25,$0.00
8367655,SUP,HCPCS C1713,,8367655  -  BONE SCREW 8367655 EXTRACTOR 5.5MM,"$1,138.50",$0.00,"$1,138.50",$512.33,$812.55,$0.00,$196.16,$0.00,$0.00,$199.34,"$1,138.50",$0.00,$569.25,$901.69,$910.80,$0.00,$178.18,$0.00,$181.25,$0.00
8367660,SUP,HCPCS C1713,,8367660  -  BONE SCREW 8367660 EXTRACTOR 6.0MM,"$1,138.50",$0.00,"$1,138.50",$512.33,$812.55,$0.00,$196.16,$0.00,$0.00,$199.34,"$1,138.50",$0.00,$569.25,$901.69,$910.80,$0.00,$178.18,$0.00,$181.25,$0.00
8367665,SUP,HCPCS C1713,,8367665  -  BONE SCREW 8367665 EXTRACTOR 6.5MM,"$1,138.50",$0.00,"$1,138.50",$512.33,$812.55,$0.00,$196.16,$0.00,$0.00,$199.34,"$1,138.50",$0.00,$569.25,$901.69,$910.80,$0.00,$178.18,$0.00,$181.25,$0.00
8367670,SUP,HCPCS C1713,,8367670  -  BONE SCREW 8367670 EXTRACTOR 7.0MM,"$1,138.50",$0.00,"$1,138.50",$512.33,$812.55,$0.00,$196.16,$0.00,$0.00,$199.34,"$1,138.50",$0.00,$569.25,$901.69,$910.80,$0.00,$178.18,$0.00,$181.25,$0.00
8367675,SUP,HCPCS C1713,,8367675  -  BONE SCREW 8367675 EXTRACTOR 7.5MM,"$1,138.50",$0.00,"$1,138.50",$512.33,$812.55,$0.00,$196.16,$0.00,$0.00,$199.34,"$1,138.50",$0.00,$569.25,$901.69,$910.80,$0.00,$178.18,$0.00,$181.25,$0.00
8367680,SUP,HCPCS C1713,,8367680  -  BONE SCREW 8367680 EXTRACTOR 8.0MM,"$1,138.50",$0.00,"$1,138.50",$512.33,$812.55,$0.00,$196.16,$0.00,$0.00,$199.34,"$1,138.50",$0.00,$569.25,$901.69,$910.80,$0.00,$178.18,$0.00,$181.25,$0.00
8367745,SUP,HCPCS C1713,,8367745  -  BONE SCREW 8367745 TREPHINE 4.5MM,"$1,138.50",$0.00,"$1,138.50",$512.33,$812.55,$0.00,$196.16,$0.00,$0.00,$199.34,"$1,138.50",$0.00,$569.25,$901.69,$910.80,$0.00,$178.18,$0.00,$181.25,$0.00
8367750,SUP,HCPCS C1713,,8367750  -  BONE SCREW 8367750 TREPHINE 5.0MM,"$1,138.50",$0.00,"$1,138.50",$512.33,$812.55,$0.00,$196.16,$0.00,$0.00,$199.34,"$1,138.50",$0.00,$569.25,$901.69,$910.80,$0.00,$178.18,$0.00,$181.25,$0.00
8367755,SUP,HCPCS C1713,,8367755  -  BONE SCREW 8367755 TREPHINE 5.5MM,"$1,138.50",$0.00,"$1,138.50",$512.33,$812.55,$0.00,$196.16,$0.00,$0.00,$199.34,"$1,138.50",$0.00,$569.25,$901.69,$910.80,$0.00,$178.18,$0.00,$181.25,$0.00
8367760,SUP,HCPCS C1713,,8367760  -  BONE SCREW 8367760 TREPHINE 6.0MM,"$1,138.50",$0.00,"$1,138.50",$512.33,$812.55,$0.00,$196.16,$0.00,$0.00,$199.34,"$1,138.50",$0.00,$569.25,$901.69,$910.80,$0.00,$178.18,$0.00,$181.25,$0.00
8367765,SUP,HCPCS C1713,,8367765  -  BONE SCREW 8367765 TREPHINE 6.5MM,"$1,138.50",$0.00,"$1,138.50",$512.33,$812.55,$0.00,$196.16,$0.00,$0.00,$199.34,"$1,138.50",$0.00,$569.25,$901.69,$910.80,$0.00,$178.18,$0.00,$181.25,$0.00
8367770,SUP,HCPCS C1713,,8367770  -  BONE SCREW 8367770 TREPHINE 7.0MM,"$1,138.50",$0.00,"$1,138.50",$512.33,$812.55,$0.00,$196.16,$0.00,$0.00,$199.34,"$1,138.50",$0.00,$569.25,$901.69,$910.80,$0.00,$178.18,$0.00,$181.25,$0.00
8367775,SUP,HCPCS C1713,,8367775  -  BONE SCREW 8367775 TREPHINE 7.5MM,"$1,138.50",$0.00,"$1,138.50",$512.33,$812.55,$0.00,$196.16,$0.00,$0.00,$199.34,"$1,138.50",$0.00,$569.25,$901.69,$910.80,$0.00,$178.18,$0.00,$181.25,$0.00
8367780,SUP,HCPCS C1713,,8367780  -  BONE SCREW 8367780 TREPHINE 8.0MM,"$1,138.50",$0.00,"$1,138.50",$512.33,$812.55,$0.00,$196.16,$0.00,$0.00,$199.34,"$1,138.50",$0.00,$569.25,$901.69,$910.80,$0.00,$178.18,$0.00,$181.25,$0.00
8370030,SUP,HCPCS C1713,,8370030  -  ROD 8370030 TSR2D PCUT BENT 3.0CMX5.5MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8370035,SUP,HCPCS C1713,,8370035  -  ROD 8370035 TSR2D PCUT BENT 3.5CMX5.5MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8370040,SUP,HCPCS C1713,,8370040  -  ROD 8370040 TSR2D PCUT BENT 4.0CMX5.5MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8370045,SUP,HCPCS C1713,,8370045  -  ROD SPNL 450MM 5.5MM TSRH3D TI PREBNT PCUT,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8370050,SUP,HCPCS C1713,,8370050  -  ROD 8370050 TSR2D PCUT BENT 5.0CMX5.5MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8370055,SUP,HCPCS C1713,,8370055  -  ROD SPNL 550MM 5.5MM TSRH3D TI PREBNT PCUT,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8370060,SUP,HCPCS C1713,,8370060  -  ROD 8370060 TSR2D PCUT BENT 6.0CMX5.5MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8370065,SUP,HCPCS C1713,,8370065  -  ROD 8370065 6.5CM X 5.5MM PRE-CUT/BENT,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8370070,SUP,HCPCS C1713,,8370070  -  ROD 8370070 TSR2D PCUT BENT 7.0CMX5.5MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8370080,SUP,HCPCS C1713,,8370080  -  ROD 8370080 TSR2D PCUT BENT8.0CMX5.5MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8370090,SUP,HCPCS C1713,,8370090  -  ROD 8370090 TSR2D PCUT BENT 9.0CMX5.5MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8370095,SUP,HCPCS C1713,,8370095  -  ROD SPNL 950MM 5.5MM TSRH3D TI PREBNT PCUT,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8370100,SUP,HCPCS C1713,,8370100  -  ROD 8370100 TSR2D PCUT BENT 10CMX5.5MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8370420,SUP,HCPCS C1713,,8370420  -  SCREW 8370420 TSRH SHORT POST4.5X20 TI,$984.00,$0.00,$984.00,$442.80,$702.28,$0.00,$169.54,$0.00,$0.00,$172.29,$984.00,$0.00,$492.00,$779.33,$787.20,$0.00,$154.00,$0.00,$156.65,$0.00
8370425,SUP,HCPCS C1713,,8370425  -  SCREW 8370425 TSRH SHORT POST4.5X25 TI,$984.00,$0.00,$984.00,$442.80,$702.28,$0.00,$169.54,$0.00,$0.00,$172.29,$984.00,$0.00,$492.00,$779.33,$787.20,$0.00,$154.00,$0.00,$156.65,$0.00
8370430,SUP,HCPCS C1713,,8370430  -  SCREW 8370430 TSRH SHORT POST4.5X30 TI,$984.00,$0.00,$984.00,$442.80,$702.28,$0.00,$169.54,$0.00,$0.00,$172.29,$984.00,$0.00,$492.00,$779.33,$787.20,$0.00,$154.00,$0.00,$156.65,$0.00
8370435,SUP,HCPCS C1713,,8370435  -  SCREW 8370435 TSRH SHORT POST4.5X35 TI,$984.00,$0.00,$984.00,$442.80,$702.28,$0.00,$169.54,$0.00,$0.00,$172.29,$984.00,$0.00,$492.00,$779.33,$787.20,$0.00,$154.00,$0.00,$156.65,$0.00
8370440,SUP,HCPCS C1713,,8370440  -  SCREW 8370440 TSRH SHORT POST4.5X40 TI,$984.00,$0.00,$984.00,$442.80,$702.28,$0.00,$169.54,$0.00,$0.00,$172.29,$984.00,$0.00,$492.00,$779.33,$787.20,$0.00,$154.00,$0.00,$156.65,$0.00
8370445,SUP,HCPCS C1713,,8370445  -  SCREW 8370445 TSRH SHORT POST4.5X45 TI,$984.00,$0.00,$984.00,$442.80,$702.28,$0.00,$169.54,$0.00,$0.00,$172.29,$984.00,$0.00,$492.00,$779.33,$787.20,$0.00,$154.00,$0.00,$156.65,$0.00
8370450,SUP,HCPCS C1713,,8370450  -  SCREW 8370450 TSRH SHORT POST4.5X50 TI,$984.00,$0.00,$984.00,$442.80,$702.28,$0.00,$169.54,$0.00,$0.00,$172.29,$984.00,$0.00,$492.00,$779.33,$787.20,$0.00,$154.00,$0.00,$156.65,$0.00
8370455,SUP,HCPCS C1713,,8370455  -  SCREW 8370455 TSRH SHORT POST4.5X55 TI,$984.00,$0.00,$984.00,$442.80,$702.28,$0.00,$169.54,$0.00,$0.00,$172.29,$984.00,$0.00,$492.00,$779.33,$787.20,$0.00,$154.00,$0.00,$156.65,$0.00
8371030,SUP,HCPCS C1713,,8371030  -  ROD 8371030 TSR2D PCUT BENT 3.0CMX6.35,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8371035,SUP,HCPCS C1713,,8371035  -  ROD 8371035 3.5CMX6.35 PRE CUT BENT,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8371040,SUP,HCPCS C1713,,8371040  -  ROD 8371040 TSR2D PCUT BENT 4.0CMX6.35,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8371050,SUP,HCPCS C1713,,8371050  -  ROD 8371050 TSR2D PCUT BENT 5.0CMX6.35,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8371060,SUP,HCPCS C1713,,8371060  -  ROD 8371060 TSR2D PCUT BENT 6.0CMX6.35,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8371070,SUP,HCPCS C1713,,8371070  -  ROD 8371070 TSR2D PCUT BENT 7.0CMX6.35,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8371080,SUP,HCPCS C1713,,8371080  -  ROD 8371080 TSR2D PCUT BENT 8.0CMX6.35,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8371090,SUP,HCPCS C1713,,8371090  -  ROD 8371090 TSR2D PCUT BENT 9.0CMX6.35,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8371100,SUP,HCPCS C1713,,8371100  -  ROD 8371100 TSR2D PCUT BENT 10.0CMX6.35,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8371530,SUP,HCPCS C1713,,8371530  -  SCREW 8371530 TSR3D THRD 5.5X30MM TI,"$1,191.00",$0.00,"$1,191.00",$535.95,$850.02,$0.00,$205.20,$0.00,$0.00,$208.53,"$1,191.00",$0.00,$595.50,$943.27,$952.80,$0.00,$186.39,$0.00,$189.61,$0.00
8371535,SUP,HCPCS C1713,,8371535  -  SCREW 8371535 TSR3D THRD 5.5X35MM TI,"$1,191.00",$0.00,"$1,191.00",$535.95,$850.02,$0.00,$205.20,$0.00,$0.00,$208.53,"$1,191.00",$0.00,$595.50,$943.27,$952.80,$0.00,$186.39,$0.00,$189.61,$0.00
8371540,SUP,HCPCS C1713,,8371540  -  SCREW 8371540 TSR3D THRD 5.5X40MM TI,"$1,191.00",$0.00,"$1,191.00",$535.95,$850.02,$0.00,$205.20,$0.00,$0.00,$208.53,"$1,191.00",$0.00,$595.50,$943.27,$952.80,$0.00,$186.39,$0.00,$189.61,$0.00
8371545,SUP,HCPCS C1713,,8371545  -  SCREW 8371545 TSR3D THRD 5.5X45MM TI,"$1,191.00",$0.00,"$1,191.00",$535.95,$850.02,$0.00,$205.20,$0.00,$0.00,$208.53,"$1,191.00",$0.00,$595.50,$943.27,$952.80,$0.00,$186.39,$0.00,$189.61,$0.00
8371550,SUP,HCPCS C1713,,8371550  -  SCREW 8371550 TSR3D THRD 5.5X50MM TI,"$1,191.00",$0.00,"$1,191.00",$535.95,$850.02,$0.00,$205.20,$0.00,$0.00,$208.53,"$1,191.00",$0.00,$595.50,$943.27,$952.80,$0.00,$186.39,$0.00,$189.61,$0.00
8371630,SUP,HCPCS C1713,,8371630  -  SCREW 8371630 TSR3D THRD 6.5X30MM TI,"$1,191.00",$0.00,"$1,191.00",$535.95,$850.02,$0.00,$205.20,$0.00,$0.00,$208.53,"$1,191.00",$0.00,$595.50,$943.27,$952.80,$0.00,$186.39,$0.00,$189.61,$0.00
8371635,SUP,HCPCS C1713,,8371635  -  SCREW 8371635 TSR3D THRD 6.5X35MM TI,"$1,191.00",$0.00,"$1,191.00",$535.95,$850.02,$0.00,$205.20,$0.00,$0.00,$208.53,"$1,191.00",$0.00,$595.50,$943.27,$952.80,$0.00,$186.39,$0.00,$189.61,$0.00
8371640,SUP,HCPCS C1713,,8371640  -  SCREW 8371640 TSR3D THRD 6.5X40MM TI,"$1,191.00",$0.00,"$1,191.00",$535.95,$850.02,$0.00,$205.20,$0.00,$0.00,$208.53,"$1,191.00",$0.00,$595.50,$943.27,$952.80,$0.00,$186.39,$0.00,$189.61,$0.00
8371645,SUP,HCPCS C1713,,8371645  -  SCREW 8371645 TSR3D THRD 6.5X45MM TI,"$1,191.00",$0.00,"$1,191.00",$535.95,$850.02,$0.00,$205.20,$0.00,$0.00,$208.53,"$1,191.00",$0.00,$595.50,$943.27,$952.80,$0.00,$186.39,$0.00,$189.61,$0.00
8371650,SUP,HCPCS C1713,,8371650  -  SCREW 8371650 TSR3D THRD 6.5X50MM TI,"$1,191.00",$0.00,"$1,191.00",$535.95,$850.02,$0.00,$205.20,$0.00,$0.00,$208.53,"$1,191.00",$0.00,$595.50,$943.27,$952.80,$0.00,$186.39,$0.00,$189.61,$0.00
8371655,SUP,HCPCS C1713,,8371655  -  SCREW 8371655 TSR3D THRD 6.5X55MM TI,"$1,191.00",$0.00,"$1,191.00",$535.95,$850.02,$0.00,$205.20,$0.00,$0.00,$208.53,"$1,191.00",$0.00,$595.50,$943.27,$952.80,$0.00,$186.39,$0.00,$189.61,$0.00
8371660,SUP,HCPCS C1713,,8371660  -  SCREW 8371660 TSR3D THRD 6.5X60MM TI,"$1,191.00",$0.00,"$1,191.00",$535.95,$850.02,$0.00,$205.20,$0.00,$0.00,$208.53,"$1,191.00",$0.00,$595.50,$943.27,$952.80,$0.00,$186.39,$0.00,$189.61,$0.00
8371730,SUP,HCPCS C1713,,8371730  -  SCREW 8371730 TSR3D THRD 7.5X30MM TI,"$1,191.00",$0.00,"$1,191.00",$535.95,$850.02,$0.00,$205.20,$0.00,$0.00,$208.53,"$1,191.00",$0.00,$595.50,$943.27,$952.80,$0.00,$186.39,$0.00,$189.61,$0.00
8371735,SUP,HCPCS C1713,,8371735  -  SCREW 8371735 TSR3D THRD 7.5X35MM TI,"$1,191.00",$0.00,"$1,191.00",$535.95,$850.02,$0.00,$205.20,$0.00,$0.00,$208.53,"$1,191.00",$0.00,$595.50,$943.27,$952.80,$0.00,$186.39,$0.00,$189.61,$0.00
8371740,SUP,HCPCS C1713,,8371740  -  SCREW 8371740 TSR3D THRD 7.5X40MM TI,"$1,191.00",$0.00,"$1,191.00",$535.95,$850.02,$0.00,$205.20,$0.00,$0.00,$208.53,"$1,191.00",$0.00,$595.50,$943.27,$952.80,$0.00,$186.39,$0.00,$189.61,$0.00
8371745,SUP,HCPCS C1713,,8371745  -  SCREW 8371745 TSR3D THRD 7.5X45MM TI,"$1,191.00",$0.00,"$1,191.00",$535.95,$850.02,$0.00,$205.20,$0.00,$0.00,$208.53,"$1,191.00",$0.00,$595.50,$943.27,$952.80,$0.00,$186.39,$0.00,$189.61,$0.00
8371750,SUP,HCPCS C1713,,8371750  -  SCREW 8371750 TSR3D THRD 7.5X50MM TI,"$1,191.00",$0.00,"$1,191.00",$535.95,$850.02,$0.00,$205.20,$0.00,$0.00,$208.53,"$1,191.00",$0.00,$595.50,$943.27,$952.80,$0.00,$186.39,$0.00,$189.61,$0.00
8371755,SUP,HCPCS C1713,,8371755  -  SCREW 8371755 TSR3D THRD 7.5X55MM TI,"$1,191.00",$0.00,"$1,191.00",$535.95,$850.02,$0.00,$205.20,$0.00,$0.00,$208.53,"$1,191.00",$0.00,$595.50,$943.27,$952.80,$0.00,$186.39,$0.00,$189.61,$0.00
8371760,SUP,HCPCS C1713,,8371760  -  SCREW 8371760 TSR3D THRD 7.5X60MM TI,"$1,191.00",$0.00,"$1,191.00",$535.95,$850.02,$0.00,$205.20,$0.00,$0.00,$208.53,"$1,191.00",$0.00,$595.50,$943.27,$952.80,$0.00,$186.39,$0.00,$189.61,$0.00
8371830,SUP,HCPCS C1713,,8371830  -  SCREW 8371830 TSRH 3D 8 5MMX30MM THR PST,"$1,191.00",$0.00,"$1,191.00",$535.95,$850.02,$0.00,$205.20,$0.00,$0.00,$208.53,"$1,191.00",$0.00,$595.50,$943.27,$952.80,$0.00,$186.39,$0.00,$189.61,$0.00
8371835,SUP,HCPCS C1713,,8371835  -  SCREW 8371835 TSRH 3D 8 5MMX35MM THR PST,"$1,191.00",$0.00,"$1,191.00",$535.95,$850.02,$0.00,$205.20,$0.00,$0.00,$208.53,"$1,191.00",$0.00,$595.50,$943.27,$952.80,$0.00,$186.39,$0.00,$189.61,$0.00
8371840,SUP,HCPCS C1713,,8371840  -  SCREW 8371840 TSRH 3D 8 5MMX40MM THR PST,"$1,191.00",$0.00,"$1,191.00",$535.95,$850.02,$0.00,$205.20,$0.00,$0.00,$208.53,"$1,191.00",$0.00,$595.50,$943.27,$952.80,$0.00,$186.39,$0.00,$189.61,$0.00
8371845,SUP,HCPCS C1713,,8371845  -  SCREW 8371845 TSRH 3D 8 5MMX45MM THR PST,"$1,191.00",$0.00,"$1,191.00",$535.95,$850.02,$0.00,$205.20,$0.00,$0.00,$208.53,"$1,191.00",$0.00,$595.50,$943.27,$952.80,$0.00,$186.39,$0.00,$189.61,$0.00
8371850,SUP,HCPCS C1713,,8371850  -  SCREW 8371850 TSRH 3D 8 5MMX50MM THR PST,"$1,191.00",$0.00,"$1,191.00",$535.95,$850.02,$0.00,$205.20,$0.00,$0.00,$208.53,"$1,191.00",$0.00,$595.50,$943.27,$952.80,$0.00,$186.39,$0.00,$189.61,$0.00
8371855,SUP,HCPCS C1713,,8371855  -  SCREW 8371855 TSRH 3D 8 5MMX55MM THR PST,"$1,191.00",$0.00,"$1,191.00",$535.95,$850.02,$0.00,$205.20,$0.00,$0.00,$208.53,"$1,191.00",$0.00,$595.50,$943.27,$952.80,$0.00,$186.39,$0.00,$189.61,$0.00
8371860,SUP,HCPCS C1713,,8371860  -  SCREW 8371860 TSRH 3D 8 5MMX60MM THR PST,"$1,191.00",$0.00,"$1,191.00",$535.95,$850.02,$0.00,$205.20,$0.00,$0.00,$208.53,"$1,191.00",$0.00,$595.50,$943.27,$952.80,$0.00,$186.39,$0.00,$189.61,$0.00
8372520,SUP,HCPCS C1713,,8372520  -  SCREW 8372520 TSR3D SHORT POST 5.5X20 TI,$984.00,$0.00,$984.00,$442.80,$702.28,$0.00,$169.54,$0.00,$0.00,$172.29,$984.00,$0.00,$492.00,$779.33,$787.20,$0.00,$154.00,$0.00,$156.65,$0.00
8372525,SUP,HCPCS C1713,,8372525  -  SCREW 8372525 TSR3D SHORT POST 5.5X25 TI,$984.00,$0.00,$984.00,$442.80,$702.28,$0.00,$169.54,$0.00,$0.00,$172.29,$984.00,$0.00,$492.00,$779.33,$787.20,$0.00,$154.00,$0.00,$156.65,$0.00
8372530,SUP,HCPCS C1713,,8372530  -  SCREW 8372530 TSR3D SHORT POST 5.5X30 TI,$984.00,$0.00,$984.00,$442.80,$702.28,$0.00,$169.54,$0.00,$0.00,$172.29,$984.00,$0.00,$492.00,$779.33,$787.20,$0.00,$154.00,$0.00,$156.65,$0.00
8372535,SUP,HCPCS C1713,,8372535  -  SCREW 8372535 TSR3D SHORT POST 5.5X35 TI,$984.00,$0.00,$984.00,$442.80,$702.28,$0.00,$169.54,$0.00,$0.00,$172.29,$984.00,$0.00,$492.00,$779.33,$787.20,$0.00,$154.00,$0.00,$156.65,$0.00
8372540,SUP,HCPCS C1713,,8372540  -  SCREW 8372540 TSR3D SHORT POST 5.5X40 TI,$984.00,$0.00,$984.00,$442.80,$702.28,$0.00,$169.54,$0.00,$0.00,$172.29,$984.00,$0.00,$492.00,$779.33,$787.20,$0.00,$154.00,$0.00,$156.65,$0.00
8372545,SUP,HCPCS C1713,,8372545  -  SCREW 8372545 TSR3D SHORT POST 5.5X45 TI,$984.00,$0.00,$984.00,$442.80,$702.28,$0.00,$169.54,$0.00,$0.00,$172.29,$984.00,$0.00,$492.00,$779.33,$787.20,$0.00,$154.00,$0.00,$156.65,$0.00
8372550,SUP,HCPCS C1713,,8372550  -  SCREW 8372550 TSR3D SHORT POST 5.5X50 TI,$984.00,$0.00,$984.00,$442.80,$702.28,$0.00,$169.54,$0.00,$0.00,$172.29,$984.00,$0.00,$492.00,$779.33,$787.20,$0.00,$154.00,$0.00,$156.65,$0.00
8372555,SUP,HCPCS C1713,,8372555  -  SCREW 8372555 TSR3D SHORT POST 5.5X55 TI,$984.00,$0.00,$984.00,$442.80,$702.28,$0.00,$169.54,$0.00,$0.00,$172.29,$984.00,$0.00,$492.00,$779.33,$787.20,$0.00,$154.00,$0.00,$156.65,$0.00
8372620,SUP,HCPCS C1713,,8372620  -  SCREW 8372620 TSR3D SHORT POST 6.5X20 TI,$984.00,$0.00,$984.00,$442.80,$702.28,$0.00,$169.54,$0.00,$0.00,$172.29,$984.00,$0.00,$492.00,$779.33,$787.20,$0.00,$154.00,$0.00,$156.65,$0.00
8372625,SUP,HCPCS C1713,,8372625  -  SCREW 8372625 TSR3D SHORT POST 6.5X25 TI,$984.00,$0.00,$984.00,$442.80,$702.28,$0.00,$169.54,$0.00,$0.00,$172.29,$984.00,$0.00,$492.00,$779.33,$787.20,$0.00,$154.00,$0.00,$156.65,$0.00
8372630,SUP,HCPCS C1713,,8372630  -  SCREW 8372630 TSR3D SHORT POST 6.5X30 TI,$984.00,$0.00,$984.00,$442.80,$702.28,$0.00,$169.54,$0.00,$0.00,$172.29,$984.00,$0.00,$492.00,$779.33,$787.20,$0.00,$154.00,$0.00,$156.65,$0.00
8372635,SUP,HCPCS C1713,,8372635  -  SCREW 8372635 TSR3D SHORT POST 6.5X35 TI,$984.00,$0.00,$984.00,$442.80,$702.28,$0.00,$169.54,$0.00,$0.00,$172.29,$984.00,$0.00,$492.00,$779.33,$787.20,$0.00,$154.00,$0.00,$156.65,$0.00
8372640,SUP,HCPCS C1713,,8372640  -  SCREW 8372640 TSR3D SHORT POST 6.5X40 TI,$984.00,$0.00,$984.00,$442.80,$702.28,$0.00,$169.54,$0.00,$0.00,$172.29,$984.00,$0.00,$492.00,$779.33,$787.20,$0.00,$154.00,$0.00,$156.65,$0.00
8372645,SUP,HCPCS C1713,,8372645  -  SCREW 8372645 TSR3D SHORT POST 6.5X45 TI,$984.00,$0.00,$984.00,$442.80,$702.28,$0.00,$169.54,$0.00,$0.00,$172.29,$984.00,$0.00,$492.00,$779.33,$787.20,$0.00,$154.00,$0.00,$156.65,$0.00
8372650,SUP,HCPCS C1713,,8372650  -  SCREW 8372650 TSR3D SHORT POST 6.5X50 TI,$984.00,$0.00,$984.00,$442.80,$702.28,$0.00,$169.54,$0.00,$0.00,$172.29,$984.00,$0.00,$492.00,$779.33,$787.20,$0.00,$154.00,$0.00,$156.65,$0.00
8372655,SUP,HCPCS C1713,,8372655  -  SCREW 8372655 TSR3D SHORT POST 6.5X55 TI,$984.00,$0.00,$984.00,$442.80,$702.28,$0.00,$169.54,$0.00,$0.00,$172.29,$984.00,$0.00,$492.00,$779.33,$787.20,$0.00,$154.00,$0.00,$156.65,$0.00
8372660,SUP,HCPCS C1713,,8372660  -  SCREW 8372660 TSR3D SHORT POST 6.5X60 TI,$984.00,$0.00,$984.00,$442.80,$702.28,$0.00,$169.54,$0.00,$0.00,$172.29,$984.00,$0.00,$492.00,$779.33,$787.20,$0.00,$154.00,$0.00,$156.65,$0.00
8372720,SUP,HCPCS C1713,,8372720  -  SCREW 8372720 TSR3D SHORT POST 7.5X20 TI,$984.00,$0.00,$984.00,$442.80,$702.28,$0.00,$169.54,$0.00,$0.00,$172.29,$984.00,$0.00,$492.00,$779.33,$787.20,$0.00,$154.00,$0.00,$156.65,$0.00
8372725,SUP,HCPCS C1713,,8372725  -  SCREW 8372725 TSR3D SHORT POST 7.5X25 TI,$984.00,$0.00,$984.00,$442.80,$702.28,$0.00,$169.54,$0.00,$0.00,$172.29,$984.00,$0.00,$492.00,$779.33,$787.20,$0.00,$154.00,$0.00,$156.65,$0.00
8372730,SUP,HCPCS C1713,,8372730  -  SCREW 8372730 TSR3D SHORT POST 7.5X30 TI,$984.00,$0.00,$984.00,$442.80,$702.28,$0.00,$169.54,$0.00,$0.00,$172.29,$984.00,$0.00,$492.00,$779.33,$787.20,$0.00,$154.00,$0.00,$156.65,$0.00
8372735,SUP,HCPCS C1713,,8372735  -  SCREW 8372735 TSR3D SHORT POST 7.5X35 TI,$984.00,$0.00,$984.00,$442.80,$702.28,$0.00,$169.54,$0.00,$0.00,$172.29,$984.00,$0.00,$492.00,$779.33,$787.20,$0.00,$154.00,$0.00,$156.65,$0.00
8372740,SUP,HCPCS C1713,,8372740  -  SCREW 8372740 TSR3D SHORT POST 7.5X40 TI,$984.00,$0.00,$984.00,$442.80,$702.28,$0.00,$169.54,$0.00,$0.00,$172.29,$984.00,$0.00,$492.00,$779.33,$787.20,$0.00,$154.00,$0.00,$156.65,$0.00
8372745,SUP,HCPCS C1713,,8372745  -  SCREW 8372745 TSR3D SHORT POST 7.5X45 TI,$984.00,$0.00,$984.00,$442.80,$702.28,$0.00,$169.54,$0.00,$0.00,$172.29,$984.00,$0.00,$492.00,$779.33,$787.20,$0.00,$154.00,$0.00,$156.65,$0.00
8372750,SUP,HCPCS C1713,,8372750  -  SCREW 8372750 TSR3D SHORT POST 7.5X50 TI,$984.00,$0.00,$984.00,$442.80,$702.28,$0.00,$169.54,$0.00,$0.00,$172.29,$984.00,$0.00,$492.00,$779.33,$787.20,$0.00,$154.00,$0.00,$156.65,$0.00
8372755,SUP,HCPCS C1713,,8372755  -  SCREW 8372755 TSR3D SHORT POST 7.5X55 TI,$984.00,$0.00,$984.00,$442.80,$702.28,$0.00,$169.54,$0.00,$0.00,$172.29,$984.00,$0.00,$492.00,$779.33,$787.20,$0.00,$154.00,$0.00,$156.65,$0.00
8372760,SUP,HCPCS C1713,,8372760  -  SCREW 8372760 TSR3D SHORT POST 7.5X60 TI,$984.00,$0.00,$984.00,$442.80,$702.28,$0.00,$169.54,$0.00,$0.00,$172.29,$984.00,$0.00,$492.00,$779.33,$787.20,$0.00,$154.00,$0.00,$156.65,$0.00
8372820,SUP,HCPCS C1713,,8372820  -  SCREW 8372820 TSR3D SHORT POST 8.5X20 TI,$984.00,$0.00,$984.00,$442.80,$702.28,$0.00,$169.54,$0.00,$0.00,$172.29,$984.00,$0.00,$492.00,$779.33,$787.20,$0.00,$154.00,$0.00,$156.65,$0.00
8372825,SUP,HCPCS C1713,,8372825  -  SCREW 8372825 TSR3D SHORT POST 8.5X25 TI,$984.00,$0.00,$984.00,$442.80,$702.28,$0.00,$169.54,$0.00,$0.00,$172.29,$984.00,$0.00,$492.00,$779.33,$787.20,$0.00,$154.00,$0.00,$156.65,$0.00
8372830,SUP,HCPCS C1713,,8372830  -  SCREW 8372830 TSR3D SHORT POST 8.5X30 TI,$984.00,$0.00,$984.00,$442.80,$702.28,$0.00,$169.54,$0.00,$0.00,$172.29,$984.00,$0.00,$492.00,$779.33,$787.20,$0.00,$154.00,$0.00,$156.65,$0.00
8372835,SUP,HCPCS C1713,,8372835  -  SCREW 8372835 TSR3D SHORT POST 8.5X35 TI,$984.00,$0.00,$984.00,$442.80,$702.28,$0.00,$169.54,$0.00,$0.00,$172.29,$984.00,$0.00,$492.00,$779.33,$787.20,$0.00,$154.00,$0.00,$156.65,$0.00
8372840,SUP,HCPCS C1713,,8372840  -  SCREW 8372840 TSR3D SHORT POST 8.5X40 TI,$984.00,$0.00,$984.00,$442.80,$702.28,$0.00,$169.54,$0.00,$0.00,$172.29,$984.00,$0.00,$492.00,$779.33,$787.20,$0.00,$154.00,$0.00,$156.65,$0.00
8372845,SUP,HCPCS C1713,,8372845  -  SCREW 8372845 TSR3D SHORT POST 8.5X45 TI,$984.00,$0.00,$984.00,$442.80,$702.28,$0.00,$169.54,$0.00,$0.00,$172.29,$984.00,$0.00,$492.00,$779.33,$787.20,$0.00,$154.00,$0.00,$156.65,$0.00
8372850,SUP,HCPCS C1713,,8372850  -  SCREW 8372850 TSR3D SHORT POST 8.5X50 TI,$984.00,$0.00,$984.00,$442.80,$702.28,$0.00,$169.54,$0.00,$0.00,$172.29,$984.00,$0.00,$492.00,$779.33,$787.20,$0.00,$154.00,$0.00,$156.65,$0.00
8372855,SUP,HCPCS C1713,,8372855  -  SCREW 8372855 TSR3D SHORT POST 8.5X55 TI,$984.00,$0.00,$984.00,$442.80,$702.28,$0.00,$169.54,$0.00,$0.00,$172.29,$984.00,$0.00,$492.00,$779.33,$787.20,$0.00,$154.00,$0.00,$156.65,$0.00
8372860,SUP,HCPCS C1713,,8372860  -  SCREW 8372860 TSR3D SHORT POST 8.5X60 TI,$984.00,$0.00,$984.00,$442.80,$702.28,$0.00,$169.54,$0.00,$0.00,$172.29,$984.00,$0.00,$492.00,$779.33,$787.20,$0.00,$154.00,$0.00,$156.65,$0.00
8373745,SUP,HCPCS C1713,,8373745  -  SCREW BONE 7.5MM 45MM SCRL,"$1,122.00",$0.00,"$1,122.00",$504.90,$800.77,$0.00,$193.31,$0.00,$0.00,$196.45,"$1,122.00",$0.00,$561.00,$888.62,$897.60,$0.00,$175.59,$0.00,$178.62,$0.00
8374535,SUP,HCPCS C1713,,8374535  -  SCREW BONE 4.5MM 35MM SPNL REDX 5.5MM ROD,"$5,220.00",$0.00,"$5,220.00","$2,349.00","$3,725.51",$0.00,$899.38,$0.00,$0.00,$913.98,"$5,220.00",$0.00,"$2,610.00","$4,134.24","$4,176.00",$0.00,$816.93,$0.00,$831.02,$0.00
8374540,SUP,HCPCS C1713,,8374540  -  SCREW BONE 4.5MM 40MM SPNL REDX 5.5MM ROD,"$5,220.00",$0.00,"$5,220.00","$2,349.00","$3,725.51",$0.00,$899.38,$0.00,$0.00,$913.98,"$5,220.00",$0.00,"$2,610.00","$4,134.24","$4,176.00",$0.00,$816.93,$0.00,$831.02,$0.00
8374545,SUP,HCPCS C1713,,8374545  -  SCREW BONE 4.5MM 45MM SPNL REDX 5.5MM ROD,"$5,220.00",$0.00,"$5,220.00","$2,349.00","$3,725.51",$0.00,$899.38,$0.00,$0.00,$913.98,"$5,220.00",$0.00,"$2,610.00","$4,134.24","$4,176.00",$0.00,$816.93,$0.00,$831.02,$0.00
8375530,SUP,HCPCS C1713,,8375530  -  SCREW BONE 5.5MM 30MM SPNL REDX 5.5MM ROD,"$5,220.00",$0.00,"$5,220.00","$2,349.00","$3,725.51",$0.00,$899.38,$0.00,$0.00,$913.98,"$5,220.00",$0.00,"$2,610.00","$4,134.24","$4,176.00",$0.00,$816.93,$0.00,$831.02,$0.00
8375535,SUP,HCPCS C1713,,8375535  -  SCREW BONE 5.5MM 35MM SPNL REDX 5.5MM ROD,"$5,220.00",$0.00,"$5,220.00","$2,349.00","$3,725.51",$0.00,$899.38,$0.00,$0.00,$913.98,"$5,220.00",$0.00,"$2,610.00","$4,134.24","$4,176.00",$0.00,$816.93,$0.00,$831.02,$0.00
8375540,SUP,HCPCS C1713,,8375540  -  SCREW BONE 5.5MM 40MM SPNL REDX 5.5MM ROD,"$5,220.00",$0.00,"$5,220.00","$2,349.00","$3,725.51",$0.00,$899.38,$0.00,$0.00,$913.98,"$5,220.00",$0.00,"$2,610.00","$4,134.24","$4,176.00",$0.00,$816.93,$0.00,$831.02,$0.00
8375545,SUP,HCPCS C1713,,8375545  -  SCREW BONE 5.5MM 45MM SPNL REDX 5.5MM ROD,"$5,220.00",$0.00,"$5,220.00","$2,349.00","$3,725.51",$0.00,$899.38,$0.00,$0.00,$913.98,"$5,220.00",$0.00,"$2,610.00","$4,134.24","$4,176.00",$0.00,$816.93,$0.00,$831.02,$0.00
8375550,SUP,HCPCS C1713,,8375550  -  SCREW BONE 5.5MM 50MM SPNL REDX 5.5MM ROD,"$5,220.00",$0.00,"$5,220.00","$2,349.00","$3,725.51",$0.00,$899.38,$0.00,$0.00,$913.98,"$5,220.00",$0.00,"$2,610.00","$4,134.24","$4,176.00",$0.00,$816.93,$0.00,$831.02,$0.00
8376520,SUP,HCPCS C1713,,"8376520  -  MPA SHRT SCREW, 5.5MMX20MM, TI","$1,279.50",$0.00,"$1,279.50",$575.78,$913.18,$0.00,$220.45,$0.00,$0.00,$224.03,"$1,279.50",$0.00,$639.75,"$1,013.36","$1,023.60",$0.00,$200.24,$0.00,$203.70,$0.00
8376525,SUP,HCPCS C1713,,"8376525  -  MPA SHRT SCREW, 5.5MMX25MM, TI","$1,279.50",$0.00,"$1,279.50",$575.78,$913.18,$0.00,$220.45,$0.00,$0.00,$224.03,"$1,279.50",$0.00,$639.75,"$1,013.36","$1,023.60",$0.00,$200.24,$0.00,$203.70,$0.00
8376530,SUP,HCPCS C1713,,"8376530  -  MPA SHRT SCREW, 5.5MMX30MM, TI","$1,279.50",$0.00,"$1,279.50",$575.78,$913.18,$0.00,$220.45,$0.00,$0.00,$224.03,"$1,279.50",$0.00,$639.75,"$1,013.36","$1,023.60",$0.00,$200.24,$0.00,$203.70,$0.00
8376535,SUP,HCPCS C1713,,8376535  -  SCREW 8376535 MPA SHRT 5 5MMX35MM TI,"$1,279.50",$0.00,"$1,279.50",$575.78,$913.18,$0.00,$220.45,$0.00,$0.00,$224.03,"$1,279.50",$0.00,$639.75,"$1,013.36","$1,023.60",$0.00,$200.24,$0.00,$203.70,$0.00
8376540,SUP,HCPCS C1713,,8376540  -  SCREW BONE 6.5MM 40MM SPNL REDX 5.5MM ROD,"$5,220.00",$0.00,"$5,220.00","$2,349.00","$3,725.51",$0.00,$899.38,$0.00,$0.00,$913.98,"$5,220.00",$0.00,"$2,610.00","$4,134.24","$4,176.00",$0.00,$816.93,$0.00,$831.02,$0.00
8376545,SUP,HCPCS C1713,,8376545  -  SCREW BONE 6.5MM 45MM SPNL REDX 5.5MM ROD,"$5,220.00",$0.00,"$5,220.00","$2,349.00","$3,725.51",$0.00,$899.38,$0.00,$0.00,$913.98,"$5,220.00",$0.00,"$2,610.00","$4,134.24","$4,176.00",$0.00,$816.93,$0.00,$831.02,$0.00
8376550,SUP,HCPCS C1713,,8376550  -  SCREW BONE 6.5MM 50MM SPNL REDX 5.5MM ROD,"$5,220.00",$0.00,"$5,220.00","$2,349.00","$3,725.51",$0.00,$899.38,$0.00,$0.00,$913.98,"$5,220.00",$0.00,"$2,610.00","$4,134.24","$4,176.00",$0.00,$816.93,$0.00,$831.02,$0.00
8376555,SUP,HCPCS C1713,,8376555  -  SCREW BONE 6.5MM 55MM SPNL REDX 5.5MM ROD,"$5,220.00",$0.00,"$5,220.00","$2,349.00","$3,725.51",$0.00,$899.38,$0.00,$0.00,$913.98,"$5,220.00",$0.00,"$2,610.00","$4,134.24","$4,176.00",$0.00,$816.93,$0.00,$831.02,$0.00
8376620,SUP,HCPCS C1713,,"8376620  -  MPA SHRT SCREW, 6.5MMX20MM, TI","$1,279.50",$0.00,"$1,279.50",$575.78,$913.18,$0.00,$220.45,$0.00,$0.00,$224.03,"$1,279.50",$0.00,$639.75,"$1,013.36","$1,023.60",$0.00,$200.24,$0.00,$203.70,$0.00
8376625,SUP,HCPCS C1713,,"8376625  -  MPA SHRT SCREW, 6.5MMX25MM, TI","$1,279.50",$0.00,"$1,279.50",$575.78,$913.18,$0.00,$220.45,$0.00,$0.00,$224.03,"$1,279.50",$0.00,$639.75,"$1,013.36","$1,023.60",$0.00,$200.24,$0.00,$203.70,$0.00
8376630,SUP,HCPCS C1713,,"8376630  -  MPA SHRT SCREW, 6.5MMX30MM, TI","$1,279.50",$0.00,"$1,279.50",$575.78,$913.18,$0.00,$220.45,$0.00,$0.00,$224.03,"$1,279.50",$0.00,$639.75,"$1,013.36","$1,023.60",$0.00,$200.24,$0.00,$203.70,$0.00
8376635,SUP,HCPCS C1713,,8376635  -  BONE SCREW 8376635 MPA SHRT 6.5MMX35MM,"$1,279.50",$0.00,"$1,279.50",$575.78,$913.18,$0.00,$220.45,$0.00,$0.00,$224.03,"$1,279.50",$0.00,$639.75,"$1,013.36","$1,023.60",$0.00,$200.24,$0.00,$203.70,$0.00
8376640,SUP,HCPCS C1713,,8376640  -  SCREW 8376640 MPA SHRT 6 5MMX40MM TI,"$1,279.50",$0.00,"$1,279.50",$575.78,$913.18,$0.00,$220.45,$0.00,$0.00,$224.03,"$1,279.50",$0.00,$639.75,"$1,013.36","$1,023.60",$0.00,$200.24,$0.00,$203.70,$0.00
8376645,SUP,HCPCS C1713,,8376645  -  SCREW 8376645 MPA SHRT 6 5MMX45MM TI,"$1,279.50",$0.00,"$1,279.50",$575.78,$913.18,$0.00,$220.45,$0.00,$0.00,$224.03,"$1,279.50",$0.00,$639.75,"$1,013.36","$1,023.60",$0.00,$200.24,$0.00,$203.70,$0.00
8376650,SUP,HCPCS C1713,,8376650  -  SCREW 8376650 MPA SHRT 6 5MMX50MM TI,"$1,279.50",$0.00,"$1,279.50",$575.78,$913.18,$0.00,$220.45,$0.00,$0.00,$224.03,"$1,279.50",$0.00,$639.75,"$1,013.36","$1,023.60",$0.00,$200.24,$0.00,$203.70,$0.00
8376655,SUP,HCPCS C1713,,"8376655  -  MPA SHRT SCREW, 6.5MMX55MM, TI","$1,279.50",$0.00,"$1,279.50",$575.78,$913.18,$0.00,$220.45,$0.00,$0.00,$224.03,"$1,279.50",$0.00,$639.75,"$1,013.36","$1,023.60",$0.00,$200.24,$0.00,$203.70,$0.00
8376660,SUP,HCPCS C1713,,"8376660  -  MPA SHRT SCREW, 6.5MMX60MM, TI","$1,279.50",$0.00,"$1,279.50",$575.78,$913.18,$0.00,$220.45,$0.00,$0.00,$224.03,"$1,279.50",$0.00,$639.75,"$1,013.36","$1,023.60",$0.00,$200.24,$0.00,$203.70,$0.00
8376720,SUP,HCPCS C1713,,"8376720  -  MPA SHRT SCREW, 7.5MMX20MM, TI","$1,279.50",$0.00,"$1,279.50",$575.78,$913.18,$0.00,$220.45,$0.00,$0.00,$224.03,"$1,279.50",$0.00,$639.75,"$1,013.36","$1,023.60",$0.00,$200.24,$0.00,$203.70,$0.00
8376725,SUP,HCPCS C1713,,"8376725  -  MPA SHRT SCREW, 7.5MMX25MM, TI","$1,279.50",$0.00,"$1,279.50",$575.78,$913.18,$0.00,$220.45,$0.00,$0.00,$224.03,"$1,279.50",$0.00,$639.75,"$1,013.36","$1,023.60",$0.00,$200.24,$0.00,$203.70,$0.00
8376730,SUP,HCPCS C1713,,"8376730  -  MPA SHRT SCREW, 7.5MMX30MM, TI","$1,279.50",$0.00,"$1,279.50",$575.78,$913.18,$0.00,$220.45,$0.00,$0.00,$224.03,"$1,279.50",$0.00,$639.75,"$1,013.36","$1,023.60",$0.00,$200.24,$0.00,$203.70,$0.00
8376735,SUP,HCPCS C1713,,8376735  -  SCREW 8376735 MPA SHRT 7 5MMX35MM TI,"$1,279.50",$0.00,"$1,279.50",$575.78,$913.18,$0.00,$220.45,$0.00,$0.00,$224.03,"$1,279.50",$0.00,$639.75,"$1,013.36","$1,023.60",$0.00,$200.24,$0.00,$203.70,$0.00
8376740,SUP,HCPCS C1713,,8376740  -  SCREW 8376740 MPA SHRT 7 5MMX40MM TI,"$1,279.50",$0.00,"$1,279.50",$575.78,$913.18,$0.00,$220.45,$0.00,$0.00,$224.03,"$1,279.50",$0.00,$639.75,"$1,013.36","$1,023.60",$0.00,$200.24,$0.00,$203.70,$0.00
8376745,SUP,HCPCS C1713,,8376745  -  SCREW 8376745 MPA SHRT 7 5MMX45MM TI,"$1,279.50",$0.00,"$1,279.50",$575.78,$913.18,$0.00,$220.45,$0.00,$0.00,$224.03,"$1,279.50",$0.00,$639.75,"$1,013.36","$1,023.60",$0.00,$200.24,$0.00,$203.70,$0.00
8376750,SUP,HCPCS C1713,,8376750  -  SCREW 8376750 MPA SHRT 7 5MMX50MM TI,"$1,279.50",$0.00,"$1,279.50",$575.78,$913.18,$0.00,$220.45,$0.00,$0.00,$224.03,"$1,279.50",$0.00,$639.75,"$1,013.36","$1,023.60",$0.00,$200.24,$0.00,$203.70,$0.00
8376755,SUP,HCPCS C1713,,8376755  -  SCREW 8376755 MPA SHRT 7 5MMX55MM TI,"$1,279.50",$0.00,"$1,279.50",$575.78,$913.18,$0.00,$220.45,$0.00,$0.00,$224.03,"$1,279.50",$0.00,$639.75,"$1,013.36","$1,023.60",$0.00,$200.24,$0.00,$203.70,$0.00
8376760,SUP,HCPCS C1713,,8376760  -  SCREW 8376760 MPA SHRT 7 5MMX60MM TI,"$1,279.50",$0.00,"$1,279.50",$575.78,$913.18,$0.00,$220.45,$0.00,$0.00,$224.03,"$1,279.50",$0.00,$639.75,"$1,013.36","$1,023.60",$0.00,$200.24,$0.00,$203.70,$0.00
8377530,SUP,HCPCS C1713,,8377530  -  BONE SCREW 8377530 MPA THRD 5.5X30 TI,"$1,549.50",$0.00,"$1,549.50",$697.28,"$1,105.88",$0.00,$266.97,$0.00,$0.00,$271.31,"$1,549.50",$0.00,$774.75,"$1,227.20","$1,239.60",$0.00,$242.50,$0.00,$246.68,$0.00
8377535,SUP,HCPCS C1713,,8377535  -  BONE SCREW 8377535 MPA THRD 5.5X35 TI,"$1,549.50",$0.00,"$1,549.50",$697.28,"$1,105.88",$0.00,$266.97,$0.00,$0.00,$271.31,"$1,549.50",$0.00,$774.75,"$1,227.20","$1,239.60",$0.00,$242.50,$0.00,$246.68,$0.00
8377540,SUP,HCPCS C1713,,8377540  -  SCREW BONE 7.5MM 40MM SPNL REDX 5.5MM ROD,"$5,220.00",$0.00,"$5,220.00","$2,349.00","$3,725.51",$0.00,$899.38,$0.00,$0.00,$913.98,"$5,220.00",$0.00,"$2,610.00","$4,134.24","$4,176.00",$0.00,$816.93,$0.00,$831.02,$0.00
8377545,SUP,HCPCS C1713,,8377545  -  SCREW BONE 7.5MM 45MM SPNL REDX 5.5MM ROD,"$5,220.00",$0.00,"$5,220.00","$2,349.00","$3,725.51",$0.00,$899.38,$0.00,$0.00,$913.98,"$5,220.00",$0.00,"$2,610.00","$4,134.24","$4,176.00",$0.00,$816.93,$0.00,$831.02,$0.00
8377550,SUP,HCPCS C1713,,8377550  -  SCREW BONE 7.5MM 50MM SPNL REDX 5.5MM ROD,"$5,220.00",$0.00,"$5,220.00","$2,349.00","$3,725.51",$0.00,$899.38,$0.00,$0.00,$913.98,"$5,220.00",$0.00,"$2,610.00","$4,134.24","$4,176.00",$0.00,$816.93,$0.00,$831.02,$0.00
8377555,SUP,HCPCS C1713,,8377555  -  SCREW BONE 7.5MM 55MM SPNL REDX 5.5MM ROD,"$5,220.00",$0.00,"$5,220.00","$2,349.00","$3,725.51",$0.00,$899.38,$0.00,$0.00,$913.98,"$5,220.00",$0.00,"$2,610.00","$4,134.24","$4,176.00",$0.00,$816.93,$0.00,$831.02,$0.00
8377630,SUP,HCPCS C1713,,8377630  -  BONE SCREW 8377630 MPA THRD 6.5X30 TI,"$1,549.50",$0.00,"$1,549.50",$697.28,"$1,105.88",$0.00,$266.97,$0.00,$0.00,$271.31,"$1,549.50",$0.00,$774.75,"$1,227.20","$1,239.60",$0.00,$242.50,$0.00,$246.68,$0.00
8377635,SUP,HCPCS C1713,,8377635  -  BONE SCREW 8377635 MPA THRD 6.5X35 TI,"$1,549.50",$0.00,"$1,549.50",$697.28,"$1,105.88",$0.00,$266.97,$0.00,$0.00,$271.31,"$1,549.50",$0.00,$774.75,"$1,227.20","$1,239.60",$0.00,$242.50,$0.00,$246.68,$0.00
8377640,SUP,HCPCS C1713,,8377640  -  BONE SCREW 8377640 MPA THRD 6.5X40 TI,"$1,549.50",$0.00,"$1,549.50",$697.28,"$1,105.88",$0.00,$266.97,$0.00,$0.00,$271.31,"$1,549.50",$0.00,$774.75,"$1,227.20","$1,239.60",$0.00,$242.50,$0.00,$246.68,$0.00
8377645,SUP,HCPCS C1713,,8377645  -  BONE SCREW 8377645 MPA THRD 6.5X45 TI,"$1,549.50",$0.00,"$1,549.50",$697.28,"$1,105.88",$0.00,$266.97,$0.00,$0.00,$271.31,"$1,549.50",$0.00,$774.75,"$1,227.20","$1,239.60",$0.00,$242.50,$0.00,$246.68,$0.00
8377650,SUP,HCPCS C1713,,8377650  -  BONE SCREW 8377650 MPA THRD 6.5X50 TI,"$1,549.50",$0.00,"$1,549.50",$697.28,"$1,105.88",$0.00,$266.97,$0.00,$0.00,$271.31,"$1,549.50",$0.00,$774.75,"$1,227.20","$1,239.60",$0.00,$242.50,$0.00,$246.68,$0.00
8377655,SUP,HCPCS C1713,,8377655  -  BONE SCREW 8377655 MPA THRD 6.5X55 TI,"$1,549.50",$0.00,"$1,549.50",$697.28,"$1,105.88",$0.00,$266.97,$0.00,$0.00,$271.31,"$1,549.50",$0.00,$774.75,"$1,227.20","$1,239.60",$0.00,$242.50,$0.00,$246.68,$0.00
8377660,SUP,HCPCS C1713,,8377660  -  BONE SCREW 8377660 MPA THRD 6.5X60 TI,"$1,549.50",$0.00,"$1,549.50",$697.28,"$1,105.88",$0.00,$266.97,$0.00,$0.00,$271.31,"$1,549.50",$0.00,$774.75,"$1,227.20","$1,239.60",$0.00,$242.50,$0.00,$246.68,$0.00
8377730,SUP,HCPCS C1713,,8377730  -  BONE SCREW 8377730 MPA THRD 7.5X30 TI,"$1,549.50",$0.00,"$1,549.50",$697.28,"$1,105.88",$0.00,$266.97,$0.00,$0.00,$271.31,"$1,549.50",$0.00,$774.75,"$1,227.20","$1,239.60",$0.00,$242.50,$0.00,$246.68,$0.00
8377735,SUP,HCPCS C1713,,8377735  -  BONE SCREW 8377735 MPA THRD 7.5X35 TI,"$1,549.50",$0.00,"$1,549.50",$697.28,"$1,105.88",$0.00,$266.97,$0.00,$0.00,$271.31,"$1,549.50",$0.00,$774.75,"$1,227.20","$1,239.60",$0.00,$242.50,$0.00,$246.68,$0.00
8377740,SUP,HCPCS C1713,,8377740  -  BONE SCREW 8377740 MPA THRD 7.5X40 TI,"$1,549.50",$0.00,"$1,549.50",$697.28,"$1,105.88",$0.00,$266.97,$0.00,$0.00,$271.31,"$1,549.50",$0.00,$774.75,"$1,227.20","$1,239.60",$0.00,$242.50,$0.00,$246.68,$0.00
8377745,SUP,HCPCS C1713,,8377745  -  BONE SCREW 8377745 MPA THRD 7.5X45 TI,"$1,549.50",$0.00,"$1,549.50",$697.28,"$1,105.88",$0.00,$266.97,$0.00,$0.00,$271.31,"$1,549.50",$0.00,$774.75,"$1,227.20","$1,239.60",$0.00,$242.50,$0.00,$246.68,$0.00
8377750,SUP,HCPCS C1713,,8377750  -  BONE SCREW 8377750 MPA THRD 7.5X50 TI,"$1,549.50",$0.00,"$1,549.50",$697.28,"$1,105.88",$0.00,$266.97,$0.00,$0.00,$271.31,"$1,549.50",$0.00,$774.75,"$1,227.20","$1,239.60",$0.00,$242.50,$0.00,$246.68,$0.00
8377755,SUP,HCPCS C1713,,8377755  -  BONE SCREW 8377755 MPA THRD 7.5X55 TI,"$1,549.50",$0.00,"$1,549.50",$697.28,"$1,105.88",$0.00,$266.97,$0.00,$0.00,$271.31,"$1,549.50",$0.00,$774.75,"$1,227.20","$1,239.60",$0.00,$242.50,$0.00,$246.68,$0.00
8377760,SUP,HCPCS C1713,,8377760  -  BONE SCREW 8377760 MPA THRD 7.5X60 TI,"$1,549.50",$0.00,"$1,549.50",$697.28,"$1,105.88",$0.00,$266.97,$0.00,$0.00,$271.31,"$1,549.50",$0.00,$774.75,"$1,227.20","$1,239.60",$0.00,$242.50,$0.00,$246.68,$0.00
8379120,SUP,Custom 27803010,,8379120  -  CONNECTOR 8379120 5.5 TSRH 3D SML TI,"$2,165.65",$0.00,"$2,165.65",$0.00,"$1,545.62",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,165.65",$0.00,"$1,082.83","$1,715.19","$1,732.52",$0.00,$0.00,$0.00,$0.00,$0.00
8379121,SUP,Custom 27803010,,8379121  -  CONNECTOR 8379121 5.5 TSRH 3D MED TI,"$2,165.65",$0.00,"$2,165.65",$0.00,"$1,545.62",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,165.65",$0.00,"$1,082.83","$1,715.19","$1,732.52",$0.00,$0.00,$0.00,$0.00,$0.00
8379122,SUP,Custom 27803010,,8379122  -  CONNECTOR 8379122 5.5 TSRH 3D LRG TI,"$2,165.65",$0.00,"$2,165.65",$0.00,"$1,545.62",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,165.65",$0.00,"$1,082.83","$1,715.19","$1,732.52",$0.00,$0.00,$0.00,$0.00,$0.00
8379124,SUP,Custom 27803010,,8379124  -  CONNECTOR 8379124 90 DEG OFFSET 5.5 TI,"$2,165.65",$0.00,"$2,165.65",$0.00,"$1,545.62",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,165.65",$0.00,"$1,082.83","$1,715.19","$1,732.52",$0.00,$0.00,$0.00,$0.00,$0.00
8379130,SUP,Custom 27803010,,8379130  -  CONNECTOR ROD 8379130 6.35 TSRH 3D SM,"$2,165.65",$0.00,"$2,165.65",$0.00,"$1,545.62",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,165.65",$0.00,"$1,082.83","$1,715.19","$1,732.52",$0.00,$0.00,$0.00,$0.00,$0.00
8379131,SUP,Custom 27803010,,8379131  -  CONNECTOR 8379131 6.35 TSRH 3D MED TI,"$2,165.65",$0.00,"$2,165.65",$0.00,"$1,545.62",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,165.65",$0.00,"$1,082.83","$1,715.19","$1,732.52",$0.00,$0.00,$0.00,$0.00,$0.00
8379132,SUP,Custom 27803010,,8379132  -  CONNECTOR 8379132 6.35 TSRH 3D LRG TI,"$2,165.65",$0.00,"$2,165.65",$0.00,"$1,545.62",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,165.65",$0.00,"$1,082.83","$1,715.19","$1,732.52",$0.00,$0.00,$0.00,$0.00,$0.00
8379134,SUP,Custom 27803010,,8379134  -  CONNECTOR 8379134 90 DEG OSET 6.35 TI,"$2,165.65",$0.00,"$2,165.65",$0.00,"$1,545.62",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,165.65",$0.00,"$1,082.83","$1,715.19","$1,732.52",$0.00,$0.00,$0.00,$0.00,$0.00
8379140,SUP,Custom 27803010,,8379140  -  CONNECTOR 8379140 SM TRSH-3D 6.35MM TI,"$2,165.65",$0.00,"$2,165.65",$0.00,"$1,545.62",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,165.65",$0.00,"$1,082.83","$1,715.19","$1,732.52",$0.00,$0.00,$0.00,$0.00,$0.00
8379141,SUP,Custom 27803010,,8379141  -  CONNECTOR 8379141 6.35 TSRH-3D MED,"$2,165.65",$0.00,"$2,165.65",$0.00,"$1,545.62",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,165.65",$0.00,"$1,082.83","$1,715.19","$1,732.52",$0.00,$0.00,$0.00,$0.00,$0.00
8379142,SUP,Custom 27803010,,8379142  -  CONCTR ROD LG 6.35MM TSRH3D CLOSE OFFST TI POST PDCL,"$2,165.65",$0.00,"$2,165.65",$0.00,"$1,545.62",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,165.65",$0.00,"$1,082.83","$1,715.19","$1,732.52",$0.00,$0.00,$0.00,$0.00,$0.00
8384535,SUP,HCPCS C1713,,8384535  -  SCREW BONE 4.5MM 35MM SPNL REDX 6.35MM ROD,"$5,220.00",$0.00,"$5,220.00","$2,349.00","$3,725.51",$0.00,$899.38,$0.00,$0.00,$913.98,"$5,220.00",$0.00,"$2,610.00","$4,134.24","$4,176.00",$0.00,$816.93,$0.00,$831.02,$0.00
8384540,SUP,HCPCS C1713,,8384540  -  SCREW BONE 4.5MM 40MM SPNL REDX 6.35MM ROD,"$5,220.00",$0.00,"$5,220.00","$2,349.00","$3,725.51",$0.00,$899.38,$0.00,$0.00,$913.98,"$5,220.00",$0.00,"$2,610.00","$4,134.24","$4,176.00",$0.00,$816.93,$0.00,$831.02,$0.00
8384545,SUP,HCPCS C1713,,8384545  -  SCREW BONE 4.5MM 45MM SPNL REDX 6.35MM ROD,"$5,220.00",$0.00,"$5,220.00","$2,349.00","$3,725.51",$0.00,$899.38,$0.00,$0.00,$913.98,"$5,220.00",$0.00,"$2,610.00","$4,134.24","$4,176.00",$0.00,$816.93,$0.00,$831.02,$0.00
8385040,SUP,HCPCS C1713,,8385040  -  SCREW BONE 5MM 40MM SPNL REDX 6.35MM ROD,"$5,220.00",$0.00,"$5,220.00","$2,349.00","$3,725.51",$0.00,$899.38,$0.00,$0.00,$913.98,"$5,220.00",$0.00,"$2,610.00","$4,134.24","$4,176.00",$0.00,$816.93,$0.00,$831.02,$0.00
8385045,SUP,HCPCS C1713,,8385045  -  SCREW BONE 5MM 45MM SPNL REDX 6.35MM ROD,"$5,220.00",$0.00,"$5,220.00","$2,349.00","$3,725.51",$0.00,$899.38,$0.00,$0.00,$913.98,"$5,220.00",$0.00,"$2,610.00","$4,134.24","$4,176.00",$0.00,$816.93,$0.00,$831.02,$0.00
8385050,SUP,HCPCS C1713,,8385050  -  SCREW BONE 5MM 50MM SPNL REDX 6.35MM ROD,"$5,220.00",$0.00,"$5,220.00","$2,349.00","$3,725.51",$0.00,$899.38,$0.00,$0.00,$913.98,"$5,220.00",$0.00,"$2,610.00","$4,134.24","$4,176.00",$0.00,$816.93,$0.00,$831.02,$0.00
8386535,SUP,HCPCS C1713,,8386535  -  SCREW BONE 6.5MM 35MM SPNL REDX 6.35MM ROD,"$5,220.00",$0.00,"$5,220.00","$2,349.00","$3,725.51",$0.00,$899.38,$0.00,$0.00,$913.98,"$5,220.00",$0.00,"$2,610.00","$4,134.24","$4,176.00",$0.00,$816.93,$0.00,$831.02,$0.00
8386540,SUP,HCPCS C1713,,8386540  -  SCREW BONE 6.5MM 40MM SPNL REDX 6.35MM ROD,"$5,220.00",$0.00,"$5,220.00","$2,349.00","$3,725.51",$0.00,$899.38,$0.00,$0.00,$913.98,"$5,220.00",$0.00,"$2,610.00","$4,134.24","$4,176.00",$0.00,$816.93,$0.00,$831.02,$0.00
8386545,SUP,HCPCS C1713,,8386545  -  SCREW BONE 6.5MM 45MM SPNL REDX 6.35MM ROD,"$5,220.00",$0.00,"$5,220.00","$2,349.00","$3,725.51",$0.00,$899.38,$0.00,$0.00,$913.98,"$5,220.00",$0.00,"$2,610.00","$4,134.24","$4,176.00",$0.00,$816.93,$0.00,$831.02,$0.00
8386550,SUP,HCPCS C1713,,8386550  -  SCREW BONE 6.5MM 50MM SPNL REDX 6.35MM ROD,"$5,220.00",$0.00,"$5,220.00","$2,349.00","$3,725.51",$0.00,$899.38,$0.00,$0.00,$913.98,"$5,220.00",$0.00,"$2,610.00","$4,134.24","$4,176.00",$0.00,$816.93,$0.00,$831.02,$0.00
8387540,SUP,HCPCS C1713,,8387540  -  SCREW BONE 7.5MM 40MM SPNL REDX 6.35MM ROD,"$5,220.00",$0.00,"$5,220.00","$2,349.00","$3,725.51",$0.00,$899.38,$0.00,$0.00,$913.98,"$5,220.00",$0.00,"$2,610.00","$4,134.24","$4,176.00",$0.00,$816.93,$0.00,$831.02,$0.00
8387545,SUP,HCPCS C1713,,8387545  -  SCREW BONE 7.5MM 45MM SPNL REDX 6.35MM ROD,"$5,220.00",$0.00,"$5,220.00","$2,349.00","$3,725.51",$0.00,$899.38,$0.00,$0.00,$913.98,"$5,220.00",$0.00,"$2,610.00","$4,134.24","$4,176.00",$0.00,$816.93,$0.00,$831.02,$0.00
8387550,SUP,HCPCS C1713,,8387550  -  SCREW BONE 7.5MM 50MM SPNL REDX 6.35MM ROD,"$5,220.00",$0.00,"$5,220.00","$2,349.00","$3,725.51",$0.00,$899.38,$0.00,$0.00,$913.98,"$5,220.00",$0.00,"$2,610.00","$4,134.24","$4,176.00",$0.00,$816.93,$0.00,$831.02,$0.00
8436510,SUP,HCPCS C1713,,8436510  -  SCREW BN 6.5MM 100MM SACROILIAC 5.5MM ROD,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8436560,SUP,HCPCS C1713,,8436560  -  SCREW BN 6.5MM 60MM SACROILIAC 5.5MM ROD,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8436570,SUP,HCPCS C1713,,8436570  -  SCREW BN 6.5MM 70MM SACROILIAC 5.5MM ROD,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8436580,SUP,HCPCS C1713,,8436580  -  SCREW BN 6.5MM 80MM SACROILIAC 5.5MM ROD,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8436590,SUP,HCPCS C1713,,8436590  -  SCREW BN 6.5MM 90MM SACROILIAC 5.5MM ROD,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8437510,SUP,HCPCS C1713,,8437510  -  SCREW BONE 7.5MM 100MM ILC 5.5MM ROD SLC,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8437560,SUP,HCPCS C1713,,8437560  -  SCREW BONE 7.5MM 60MM ILC 5.5MM ROD SLC,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8437570,SUP,HCPCS C1713,,8437570  -  SCREW BONE 7.5MM 70MM ILC 5.5MM ROD SLC,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8437580,SUP,HCPCS C1713,,8437580  -  SCREW BONE 7.5MM 80MM ILC 5.5MM ROD SLC,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8437590,SUP,HCPCS C1713,,8437590  -  SCREW BONE 7.5MM 90MM ILC 5.5MM ROD SLC,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8438510,SUP,HCPCS C1713,,8438510  -  SCREW BONE 8.5MM 100MM ILC 5.5MM ROD SLC,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8438560,SUP,HCPCS C1713,,8438560  -  SCREW BONE 8.5MM 60MM ILC 5.5MM ROD SLC,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8438570,SUP,HCPCS C1713,,8438570  -  SCREW BONE 8.5MM 70MM ILC 5.5MM ROD SLC,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8438580,SUP,HCPCS C1713,,8438580  -  SCREW BONE 8.5MM 80MM ILC 5.5MM ROD SLC,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8438590,SUP,HCPCS C1713,,8438590  -  SCREW BONE 8.5MM 90MM ILC 5.5MM ROD SLC,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8439510,SUP,HCPCS C1713,,8439510  -  SCREW BONE 9.5MM 100MM ILC 5.5MM ROD SLC,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8439560,SUP,HCPCS C1713,,8439560  -  SCREW BONE 9.5MM 60MM ILC 5.5MM ROD SLC,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8439570,SUP,HCPCS C1713,,8439570  -  SCREW BONE 9.5MM 70MM ILC 5.5MM ROD SLC,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8439580,SUP,HCPCS C1713,,8439580  -  SCREW BONE 9.5MM 80MM ILC 5.5MM ROD SLC,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8439590,SUP,HCPCS C1713,,8439590  -  SCREW BONE 9.5MM 90MM ILC 5.5MM ROD SLC,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8446510,SUP,HCPCS C1713,,8446510  -  SCREW BONE 6.5MM 100MM ILC SLT 5.5MM ROD,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8446560,SUP,HCPCS C1713,,8446560  -  SCREW BONE 6.5MM 60MM ILC SLT 5.5MM ROD,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8446570,SUP,HCPCS C1713,,8446570  -  SCREW BONE 6.5MM 70MM ILC SLT 5.5MM ROD,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8446580,SUP,HCPCS C1713,,8446580  -  SCREW BONE 6.5MM 80MM ILC SLT 5.5MM ROD,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8446590,SUP,HCPCS C1713,,8446590  -  SCREW BONE 6.5MM 90MM ILC SLT 5.5MM ROD,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8447510,SUP,HCPCS C1713,,8447510  -  SCREW BONE 7.5MM 100MM ILC SLT 5.5MM ROD,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8447560,SUP,HCPCS C1713,,8447560  -  SCREW BONE 7.5MM 60MM ILC SLT 5.5MM ROD,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8447570,SUP,HCPCS C1713,,8447570  -  SCREW BONE 7.5MM 70MM ILC SLT 5.5MM ROD,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8447580,SUP,HCPCS C1713,,8447580  -  SCREW BONE 7.5MM 80MM ILC SLT 5.5MM ROD,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8447590,SUP,HCPCS C1713,,8447590  -  SCREW BONE 7.5MM 90MM ILC SLT 5.5MM ROD,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8448510,SUP,HCPCS C1713,,8448510  -  SCREW BONE 8.5MM 100MM ILC SLT 5.5MM ROD,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8448560,SUP,HCPCS C1713,,8448560  -  SCREW BONE 8.5MM 60MM ILC SLT 5.5MM ROD,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8448570,SUP,HCPCS C1713,,8448570  -  SCREW BONE 8.5MM 70MM ILC SLT 5.5MM ROD,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8448580,SUP,HCPCS C1713,,8448580  -  SCREW BONE 8.5MM 80MM SPNL ILC,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8448590,SUP,HCPCS C1713,,8448590  -  SCREW BONE 8.5MM 90MM ILC SLT 5.5MM ROD,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8449510,SUP,HCPCS C1713,,8449510  -  SCREW BONE 9.5MM 100MM ILC SLT 5.5MM ROD,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8449560,SUP,HCPCS C1713,,8449560  -  SCREW BONE 9.5MM 60MM ILC SLT 5.5MM ROD,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8449570,SUP,HCPCS C1713,,8449570  -  SCREW BONE 9.5MM 70MM ILC SLT 5.5MM ROD,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8449580,SUP,HCPCS C1713,,8449580  -  SCREW BONE 9.5MM 80MM ILC SLT 5.5MM ROD,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8449590,SUP,HCPCS C1713,,8449590  -  SCREW BONE 9.5MM 90MM ILC SLT 5.5MM ROD,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8450120,SUP,HCPCS C1713,,8450120  -  CONCTR ROD 20MM 5.5MM FIX CX TI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8450122,SUP,HCPCS C1713,,8450122  -  CONCTR ROD 22MM 5.5MM FIX CX TI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8450125,SUP,HCPCS C1713,,8450125  -  CONCTR ROD 25MM 5.5MM FIX CX TI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8450127,SUP,HCPCS C1713,,8450127  -  CONCTR ROD 27.5MM BCN CX BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8450130,SUP,HCPCS C1713,,8450130  -  CONCTR ROD 30MM 5.5MM FIX CX TI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8450132,SUP,HCPCS C1713,,8450132  -  CONCTR ROD 32.5MM 5.5MM ARMADA CX SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8450135,SUP,HCPCS C1713,,8450135  -  CONCTR ROD 35MM 5.5MM FIX CX TI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8450137,SUP,HCPCS C1713,,8450137  -  CONCTR ROD 37MM 5.5MM FIX CX TI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8450140,SUP,HCPCS C1713,,8450140  -  CONCTR ROD 40MM 5.5MM FIX CX TI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8450145,SUP,HCPCS C1713,,8450145  -  CONCTR ROD 45MM 5.5MM FIX CX TI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8450150,SUP,HCPCS C1713,,8450150  -  CONCTR ROD 50MM 5.5MM FIX CX TI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8450155,SUP,HCPCS C1713,,8450155  -  CONCTR ROD 55MM 5.5MM FIX CX TI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8450160,SUP,HCPCS C1713,,8450160  -  CONCTR ROD 60MM 5.5MM FIX CX TI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8450245,SUP,HCPCS C1713,,8450245  -  TRNCON ROD 45-50MM ADJ ARCH,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8450250,SUP,HCPCS C1713,,8450250  -  CONCTR ROD 50-60MM ADJ TRNSVRS SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8450260,SUP,HCPCS C1713,,8450260  -  TRNCON ROD 60-70MM ADJ ARCH,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8451188,SUP,HCPCS C1713,,8451188  -  POSITIONING CLIP 8451188 5.5MM ROD,$37.50,$0.00,$37.50,$16.88,$26.76,$0.00,$6.46,$0.00,$0.00,$6.57,$37.50,$0.00,$18.75,$29.70,$30.00,$0.00,$5.87,$0.00,$5.97,$0.00
8451302,SUP,HCPCS C1713,,8451302  -  CONNECTOR ROD 5.5MM INLN TI,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8451402,SUP,HCPCS C1713,,8451402  -  CONCTR ROD 5.5MM T PRLL,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8451530,SUP,HCPCS C1713,,8451530  -  SCREW BONE 10.5MM 30MM POLYAXÿ 5.5MM TI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8451535,SUP,HCPCS C1713,,8451535  -  SCREW BONE 10.5MM 35MM POLYAXÿ 5.5MM TI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8451540,SUP,HCPCS C1713,,8451540  -  SCREW BONE 10.5MM 40MM POLYAXÿ 5.5MM TI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8451545,SUP,HCPCS C1713,,8451545  -  SCREW BONE 10.5MM 45MM POLYAXÿ 5.5MM TI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8451550,SUP,HCPCS C1713,,8451550  -  SCREW BONE 10.5MM 50MM POLYAXÿ 5.5MM TI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8451555,SUP,HCPCS C1713,,8451555  -  SCREW BONE 10.5MM 55MM POLYAXÿ 5.5MM TI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8451602,SUP,HCPCS C1713,,8451602  -  CONCTR ROD 5.5MM 4 HOLE TI ARM15,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8452004,SUP,HCPCS C1713,,8452004  -  ROD LATERAL OFFSET,"$2,350.00",$0.00,"$2,350.00","$1,057.50","$1,677.20",$0.00,$404.89,$0.00,$0.00,$411.47,"$2,350.00",$0.00,"$1,175.00","$1,861.20","$1,880.00",$0.00,$367.78,$0.00,$374.12,$0.00
8452025,SUP,HCPCS C1713,,8452025  -  ROD SPNL 25MM 5.5MM TI ARM15,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8452030,SUP,HCPCS C1713,,8452030  -  ROD SPNL 30MM 5.5MM TI ARM15,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8452035,SUP,HCPCS C1713,,8452035  -  ROD SPNL 35MM 5.5MM TI ARM15,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8452040,SUP,HCPCS C1713,,8452040  -  ROD SPNL 40MM 5.5MM TI ARM15,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8452045,SUP,HCPCS C1713,,8452045  -  ROD SPNL 45MM 5.5MM TI ARM15,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8452050,SUP,HCPCS C1713,,8452050  -  ROD SPNL 50MM 5.5MM TI ARM15,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8452055,SUP,HCPCS C1713,,8452055  -  ROD SPNL 55MM 5.5MM TI ARM15,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8452060,SUP,HCPCS C1713,,8452060  -  ROD SPNL 60MM 5.5MM TI ARM15,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8452065,SUP,HCPCS C1713,,8452065  -  ROD SPNL 65MM 5.5MM TI ARM15,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8452070,SUP,HCPCS C1713,,8452070  -  ROD SPNL 70MM 5.5MM TI ARM15,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8452075,SUP,HCPCS C1713,,8452075  -  ROD SPNL 5.5MM 75MM TI,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8452080,SUP,HCPCS C1713,,8452080  -  ROD SPNL 80MM 5.5MM TI ARM15,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8452090,SUP,HCPCS C1713,,8452090  -  ROD SPNL 90MM 5.5MM TI ARM15,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8452100,SUP,HCPCS C1713,,8452100  -  ROD SPNL 100MM 5.5MM TI ARM15,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8452120,SUP,HCPCS C1713,,8452120  -  ROD SPNL 120MM 5.5MM TI ARM15,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8452140,SUP,HCPCS C1713,,8452140  -  ROD SPNL 140MM 5.5MM TI ARM15,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8452152,SUP,HCPCS C1713,,8452152  -  ROD-ROD 5.5MM O -5.5MM O,"$3,530.00",$0.00,"$3,530.00","$1,588.50","$2,519.36",$0.00,$608.20,$0.00,$0.00,$618.07,"$3,530.00",$0.00,"$1,765.00","$2,795.76","$2,824.00",$0.00,$552.45,$0.00,$561.98,$0.00
8452156,SUP,HCPCS C1713,,8452156  -  ROD-ROD 5.5MM O-6.35MM O,"$3,530.00",$0.00,"$3,530.00","$1,588.50","$2,519.36",$0.00,$608.20,$0.00,$0.00,$618.07,"$3,530.00",$0.00,"$1,765.00","$2,795.76","$2,824.00",$0.00,$552.45,$0.00,$561.98,$0.00
8452160,SUP,HCPCS C1713,,8452160  -  ROD SPNL 160MM 5.5MM TI ARM15T,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8452166,SUP,HCPCS C1713,,8452166  -  ROD-ROD 6.35MM O-6.35MM O,"$3,530.00",$0.00,"$3,530.00","$1,588.50","$2,519.36",$0.00,$608.20,$0.00,$0.00,$618.07,"$3,530.00",$0.00,"$1,765.00","$2,795.76","$2,824.00",$0.00,$552.45,$0.00,$561.98,$0.00
8452200,SUP,HCPCS C1713,,8452200  -  ROD SPNL 200MM 5.5MM ARMADA TI ARM15T,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8452255,SUP,HCPCS C1713,,8452255  -  ROD-ROD 5.5MM O-5.5MM OW,"$3,530.00",$0.00,"$3,530.00","$1,588.50","$2,519.36",$0.00,$608.20,$0.00,$0.00,$618.07,"$3,530.00",$0.00,"$1,765.00","$2,795.76","$2,824.00",$0.00,$552.45,$0.00,$561.98,$0.00
8452256,SUP,HCPCS C1713,,8452256  -  ROD-ROD 5.5MM O-6.35MM OW,"$3,530.00",$0.00,"$3,530.00","$1,588.50","$2,519.36",$0.00,$608.20,$0.00,$0.00,$618.07,"$3,530.00",$0.00,"$1,765.00","$2,795.76","$2,824.00",$0.00,$552.45,$0.00,$561.98,$0.00
8452266,SUP,HCPCS C1713,,8452266  -  ROD-ROD 6.35MM O-6.35MM OW,"$3,530.00",$0.00,"$3,530.00","$1,588.50","$2,519.36",$0.00,$608.20,$0.00,$0.00,$618.07,"$3,530.00",$0.00,"$1,765.00","$2,795.76","$2,824.00",$0.00,$552.45,$0.00,$561.98,$0.00
8452300,SUP,HCPCS C1713,,8452300  -  ROD SPNL 300MM NS ARMADA ARM15T,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8452355,SUP,HCPCS C1713,,8452355  -  ROD-ROD 90 DEG 5.5MM O-5.5MM C,"$3,845.00",$0.00,"$3,845.00","$1,730.25","$2,744.18",$0.00,$662.47,$0.00,$0.00,$673.23,"$3,845.00",$0.00,"$1,922.50","$3,045.24","$3,076.00",$0.00,$601.74,$0.00,$612.12,$0.00
8452356,SUP,HCPCS C1713,,8452356  -  ROD-ROD 90 DEG 5.5MM O 6.35MM C,"$3,845.00",$0.00,"$3,845.00","$1,730.25","$2,744.18",$0.00,$662.47,$0.00,$0.00,$673.23,"$3,845.00",$0.00,"$1,922.50","$3,045.24","$3,076.00",$0.00,$601.74,$0.00,$612.12,$0.00
8452365,SUP,HCPCS C1713,,8452365  -  ROD-ROD 90 DEG 6.35MM O 5.5MM C,"$3,845.00",$0.00,"$3,845.00","$1,730.25","$2,744.18",$0.00,$662.47,$0.00,$0.00,$673.23,"$3,845.00",$0.00,"$1,922.50","$3,045.24","$3,076.00",$0.00,$601.74,$0.00,$612.12,$0.00
8452366,SUP,HCPCS C1713,,8452366  -  ROD-ROD 90 DEG 6.35MM O 6.35MM C,"$3,845.00",$0.00,"$3,845.00","$1,730.25","$2,744.18",$0.00,$662.47,$0.00,$0.00,$673.23,"$3,845.00",$0.00,"$1,922.50","$3,045.24","$3,076.00",$0.00,$601.74,$0.00,$612.12,$0.00
8452412,SUP,HCPCS C1713,,8452412  -  ROD CONNECTOR LH 5.5MM 15 X 200MM,"$5,105.00",$0.00,"$5,105.00","$2,297.25","$3,643.44",$0.00,$879.57,$0.00,$0.00,$893.84,"$5,105.00",$0.00,"$2,552.50","$4,043.16","$4,084.00",$0.00,$798.93,$0.00,$812.72,$0.00
8452422,SUP,HCPCS C1713,,8452422  -  ROD CONNECTOR LH 5.5MM 25 X 200MM,"$5,105.00",$0.00,"$5,105.00","$2,297.25","$3,643.44",$0.00,$879.57,$0.00,$0.00,$893.84,"$5,105.00",$0.00,"$2,552.50","$4,043.16","$4,084.00",$0.00,$798.93,$0.00,$812.72,$0.00
8452432,SUP,HCPCS C1713,,8452432  -  ROD CONNECTOR LH 5.5MM 35 X 200MM,"$5,105.00",$0.00,"$5,105.00","$2,297.25","$3,643.44",$0.00,$879.57,$0.00,$0.00,$893.84,"$5,105.00",$0.00,"$2,552.50","$4,043.16","$4,084.00",$0.00,$798.93,$0.00,$812.72,$0.00
8452442,SUP,HCPCS C1713,,8452442  -  ROD CONNECTOR LH 5.5MM 40 X 200MM,"$5,105.00",$0.00,"$5,105.00","$2,297.25","$3,643.44",$0.00,$879.57,$0.00,$0.00,$893.84,"$5,105.00",$0.00,"$2,552.50","$4,043.16","$4,084.00",$0.00,$798.93,$0.00,$812.72,$0.00
8452500,SUP,HCPCS C1713,,8452500  -  ROD SPNL 500MM 5.5MM TI,$600.00,$0.00,$600.00,$270.00,$428.22,$0.00,$103.38,$0.00,$0.00,$105.06,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$93.90,$0.00,$95.52,$0.00
8452512,SUP,HCPCS C1713,,8452512  -  ROD CONNECTOR RH 5.5MM 15 X 200MM,"$5,105.00",$0.00,"$5,105.00","$2,297.25","$3,643.44",$0.00,$879.57,$0.00,$0.00,$893.84,"$5,105.00",$0.00,"$2,552.50","$4,043.16","$4,084.00",$0.00,$798.93,$0.00,$812.72,$0.00
8452522,SUP,HCPCS C1713,,8452522  -  ROD CONNECTOR RH 5.5MM 25 X 200MM,"$5,105.00",$0.00,"$5,105.00","$2,297.25","$3,643.44",$0.00,$879.57,$0.00,$0.00,$893.84,"$5,105.00",$0.00,"$2,552.50","$4,043.16","$4,084.00",$0.00,$798.93,$0.00,$812.72,$0.00
8452532,SUP,HCPCS C1713,,8452532  -  ROD CONNECTOR RH 5.5MM 35 X 200MM,"$5,105.00",$0.00,"$5,105.00","$2,297.25","$3,643.44",$0.00,$879.57,$0.00,$0.00,$893.84,"$5,105.00",$0.00,"$2,552.50","$4,043.16","$4,084.00",$0.00,$798.93,$0.00,$812.72,$0.00
8452542,SUP,HCPCS C1713,,8452542  -  ROD CONNECTOR RH 5.5MM 40 X 200MM,"$5,105.00",$0.00,"$5,105.00","$2,297.25","$3,643.44",$0.00,$879.57,$0.00,$0.00,$893.84,"$5,105.00",$0.00,"$2,552.50","$4,043.16","$4,084.00",$0.00,$798.93,$0.00,$812.72,$0.00
8453101,SUP,Custom 27803010,,8453101  -  HOOK SPNL 5.5MM SM PDCL TI,"$1,375.00",$0.00,"$1,375.00",$0.00,$981.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
8453102,SUP,Custom 27803010,,8453102  -  HOOK SPNL 5.5MM MED PDCL TI,"$1,375.00",$0.00,"$1,375.00",$0.00,$981.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
8453112,SUP,Custom 27803010,,8453112  -  HOOK SPNL 6MM 5.5MM LMNR TI RED,"$1,375.00",$0.00,"$1,375.00",$0.00,$981.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
8453113,SUP,Custom 27803010,,8453113  -  HOOK SPNL 8MM 5.5MM LMNR TI RED,"$1,375.00",$0.00,"$1,375.00",$0.00,$981.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
8453114,SUP,Custom 27803010,,8453114  -  HOOK SPNL 10MM 5.5MM LMNR RED,"$1,375.00",$0.00,"$1,375.00",$0.00,$981.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
8453121,SUP,Custom 27803010,,8453121  -  HOOK SPNL 5.5MM RIGHT TI ANG,"$1,375.00",$0.00,"$1,375.00",$0.00,$981.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
8453122,SUP,Custom 27803010,,8453122  -  HOOK SPNL 5.5MM LEFT TI ANG,"$1,375.00",$0.00,"$1,375.00",$0.00,$981.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
8453123,SUP,Custom 27803010,,8453123  -  HOOK SPNL 5.5MM TI RIGHT OFFST,"$1,375.00",$0.00,"$1,375.00",$0.00,$981.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
8453124,SUP,Custom 27803010,,8453124  -  HOOK SPNL 5.5MM TI LEFT OFFST,"$1,375.00",$0.00,"$1,375.00",$0.00,$981.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
8454025,SUP,HCPCS C1713,,8454025  -  SCREW BONE 4MM 25MM POLYAX 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8454030,SUP,HCPCS C1713,,8454030  -  SCREW BONE 4MM 30MM POLYAX 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8454035,SUP,HCPCS C1713,,8454035  -  SCREW BONE 4MM 35MM POLYAX 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8454040,SUP,HCPCS C1713,,8454040  -  SCREW BONE 4MM 40MM POLYAX 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8454045,SUP,HCPCS C1713,,8454045  -  SCREW BONE 4MM 45MM POLYAX 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8454402,SUP,HCPCS C1713,,8454402  -  CONNECTOR ROD PARALLEL 5.5MM CLOSE TITANIUM SPN,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8454404,SUP,HCPCS C1713,,8454404  -  CONNECTOR ROD 5.5MM NS ARMADA PRLL SPNE ASF25T,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8454525,SUP,HCPCS C1713,,8454525  -  SCREW BONE 4.5MM 25MM POLYAX 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8454530,SUP,HCPCS C1713,,8454530  -  SCREW BONE 4.5MM 30MM POLYAX 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8454535,SUP,HCPCS C1713,,8454535  -  SCREW BONE 4.5MM 35MM POLYAX 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8454540,SUP,HCPCS C1713,,8454540  -  SCREW BONE 40MM 4.5MM POLYAX 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8454545,SUP,HCPCS C1713,,8454545  -  SCREW BONE 45MM 4.5MM POLYAX 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8454602,SUP,HCPCS C1713,,8454602  -  CONNECTOR ROD 5.5MM 4 HOLE TITANIUM SPN,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8454604,SUP,HCPCS C1713,,8454604  -  CONNECTOR ROD 5.5MM NS ARMADA 4 HL PRLL SPNE ASF25T,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8455025,SUP,HCPCS C1713,,8455025  -  SCREW BONE 5MM 25MM POLYAX 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8455030,SUP,HCPCS C1713,,8455030  -  SCREW BONE 5MM 30MM POLYAX 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8455035,SUP,HCPCS C1713,,8455035  -  SCREW BONE 5MM 35MM SPNL POLYAX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8455040,SUP,HCPCS C1713,,8455040  -  SCREW BONE 5MM 40MM POLYAX 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8455045,SUP,HCPCS C1713,,8455045  -  SCREW BONE 5MM 45MM POLYAX 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8455050,SUP,HCPCS C1713,,8455050  -  SCREW BONE 5MM 50MM POLYAX 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8455525,SUP,HCPCS C1713,,8455525  -  SCREW BONE 5.5MM 25MM POLYAX 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8455530,SUP,HCPCS C1713,,8455530  -  SCREW BONE 5.5MM 30MM SPNL POLYAX 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8455535,SUP,HCPCS C1713,,8455535  -  SCREW BONE 5.5MM 35MM SPNL POLYAX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8455540,SUP,HCPCS C1713,,8455540  -  SCREW BONE 5.5MM 40MM SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8455545,SUP,HCPCS C1713,,8455545  -  SCREW BONE 5.5MM 45MM SPNL POLYAX 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8455550,SUP,HCPCS C1713,,8455550  -  SCREW BONE 5.5MM 50MM POLYAX 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8455555,SUP,HCPCS C1713,,8455555  -  SCREW BONE 5.5MM 55MM POLYAX 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8456530,SUP,HCPCS C1713,,8456530  -  SCREW BONE 6.5MM 30MM POLYAX 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8456535,SUP,HCPCS C1713,,8456535  -  SCREW BONE 6.5MM 35MM SPNL POLYAX 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8456540,SUP,HCPCS C1713,,8456540  -  SCREW BN 6.5MM 40MM NS ARMADA PA TI SPNE ARM15T,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8456545,SUP,HCPCS C1713,,8456545  -  SCREW BN 6.5MM 45MM NS ARMADA PA TI SPNE ARM15T,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8456550,SUP,HCPCS C1713,,8456550  -  SCREW BN 6.5MM 50MM NS ARMADA PA TI SPNE ARM15T,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8456555,SUP,HCPCS C1713,,8456555  -  SCREW BN 6.5MM 55MM NS ARMADA PA TI SPNE ARM15T,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8456560,SUP,HCPCS C1713,,8456560  -  SCREW BONE 6.5MM 60MM POLYAX 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8457530,SUP,HCPCS C1713,,8457530  -  SCREW BONE 7.5MM 30MM POLYAX 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8457535,SUP,HCPCS C1713,,8457535  -  SCREW BONE 7.5MM 35MM SPNL POLYAX 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8457540,SUP,HCPCS C1713,,8457540  -  SCREW BN 7.5MM 40MM NS ARMADA PA TI SPNE ARM15T,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8457545,SUP,HCPCS C1713,,8457545  -  SCREW BN 7.5MM 45MM NS ARMADA PA TI SPNE ARM15T,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8457550,SUP,HCPCS C1713,,8457550  -  SCREW BN 7.5MM 50MM NS ARMADA PA TI SPNE ARM15T,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8457555,SUP,HCPCS C1713,,8457555  -  SCREW BN 7.5MM 55MM NS ARMADA PA TI SPNE ARM15T,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8457560,SUP,HCPCS C1713,,8457560  -  SCREW BN 7.5MM 60MM NS ARMADA PA TI SPNE ARM15T,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8458530,SUP,HCPCS C1713,,8458530  -  SCREW BONE 8.5MM 30MM POLYAX 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8458535,SUP,HCPCS C1713,,8458535  -  SCREW BONE 8.5MM 35MM POLYAX 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8458540,SUP,HCPCS C1713,,8458540  -  SCREW BONE 8.5MM 40MM POLYAX 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8458545,SUP,HCPCS C1713,,8458545  -  SCREW BONE 8.5MM 45MM SPNL POLYAX 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8458550,SUP,HCPCS C1713,,8458550  -  SCREW BN 8.5MM 50MM NS ARMADA PA TI SPNE ARM15T,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8459530,SUP,HCPCS C1713,,8459530  -  SCREW BONE 9.5MM 30MM POLYAX 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8459535,SUP,HCPCS C1713,,8459535  -  SCREW BONE 9.5MM 35MM POLYAX 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8459540,SUP,HCPCS C1713,,8459540  -  SCREW BONE 9.5MM 40MM POLYAX 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8459545,SUP,HCPCS C1713,,8459545  -  SCREW BONE 9.5MM 45MM POLYAX 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8459550,SUP,HCPCS C1713,,8459550  -  SCREW BONE 9.5MM 50MM POLYAX 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8459555,SUP,HCPCS C1713,,8459555  -  SCREW BONE 9.5MM 55MM POLYAX 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8461100,SUP,HCPCS C1713,,8461100  -  SCREW BN 5.5MM 100MM NS ARMADA LCK OPN TULIP TI SPNE,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
8461302,SUP,HCPCS C1713,,8461302  -  CONNECTOR ROD 5.5MM 6.25MM INLN TI,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8461402,SUP,HCPCS C1713,,8461402  -  CONCTR ROD 6.5/5.5MM PRLL,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8461602,SUP,HCPCS C1713,,8461602  -  CONCTR ROD 6.25/5.5MM 4 HOLE TI,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8464402,SUP,HCPCS C1713,,8464402  -  CONNECTOR ROD PARALLEL 5.5MM 6.35MM CLOSE TITANIUM SPN,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8464404,SUP,HCPCS C1713,,8464404  -  CONNECTOR ROD 5.5-6.35MM NS ARMADA PRLL SPNE ASF26T,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8464602,SUP,HCPCS C1713,,8464602  -  CONNECTOR ROD PARALLEL 5.5MM 6.35MM 4 HOLE TITANIUM SPN,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8464604,SUP,HCPCS C1713,,8464604  -  CONNECTOR ROD 5.5-6.35MM NS ARMADA 4 HL PRLL SPNE ASF26T,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8480511,SUP,HCPCS C1713,,8480511  -  STAPLE 8480511   3 PRONG 12MM TI,$579.00,$0.00,$579.00,$260.55,$413.23,$0.00,$99.76,$0.00,$0.00,$101.38,$579.00,$0.00,$289.50,$458.57,$463.20,$0.00,$90.61,$0.00,$92.18,$0.00
8480512,SUP,HCPCS C1713,,8480512  -  STAPLE 8480512 12MM TI,$579.00,$0.00,$579.00,$260.55,$413.23,$0.00,$99.76,$0.00,$0.00,$101.38,$579.00,$0.00,$289.50,$458.57,$463.20,$0.00,$90.61,$0.00,$92.18,$0.00
8481623,SUP,HCPCS C1713,,8481623  -  SCREW 8481623 CANNULATED BONE 6.5MM TI,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
8481625,SUP,HCPCS C1713,,8481625  -  SCREW 8481625 CANNULATED BONE 6.5MM TI,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
8481628,SUP,HCPCS C1713,,8481628  -  SCREW 8481628 CANNULATED BONE 6.5MM TI,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
8481630,SUP,HCPCS C1713,,8481630  -  SCREW 8481630 CANNULATED BONE 6.5MM TI,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
8481633,SUP,HCPCS C1713,,8481633  -  SCREW 8481633 CANNULATED BONE 6.5MM TI,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
8481635,SUP,HCPCS C1713,,8481635  -  SCREW 8481635 CANNULATED BONE 6.5MM TI,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
8481638,SUP,HCPCS C1713,,8481638  -  SCREW 8481638 CANNULATED BONE 6.5MM TI,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
8481640,SUP,HCPCS C1713,,8481640  -  SCREW 8481640 CANNULATED BONE 6.5MM TI,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
8481643,SUP,HCPCS C1713,,8481643  -  SCREW 8481643 CANNULATED BONE 6.5MM TI,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
8481645,SUP,HCPCS C1713,,8481645  -  SCREW 8481645 CANNULATED BONE 6.5MM TI,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
8481648,SUP,HCPCS C1713,,8481648  -  BONE SCREW 8481648 6.5MM TI CANNULATED,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
8481650,SUP,HCPCS C1713,,8481650  -  SCREW BONE 6.5MM 50MM TI SPNL CANN,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
8481653,SUP,HCPCS C1713,,8481653  -  SCREW BONE 6.5MM 53MM TI SPNL CANN,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
8481655,SUP,HCPCS C1713,,8481655  -  SCREW BONE 6.5MM 55MM TI SPNL CANN,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
8481723,SUP,HCPCS C1713,,8481723  -  SCREW BONE 7.5MM 48MM TI SPNL CANN,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
8481725,SUP,HCPCS C1713,,8481725  -  SCREW BONE 7.5MM 50MM TI SPNL CANN,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
8481728,SUP,HCPCS C1713,,8481728  -  SCREW BONE 7.5MM 53MM TI SPNL CANN,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
8481730,SUP,HCPCS C1713,,8481730  -  SCREW BONE 7.5MM 55MM TI SPNL CANN,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
8481733,SUP,HCPCS C1713,,8481733  -  SCREW 8481733 CANNULATED BONE 7.5MM TI,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
8481735,SUP,HCPCS C1713,,8481735  -  SCREW 8481735 CANNULATED BONE 7.5MM TI,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
8481738,SUP,HCPCS C1713,,8481738  -  SCREW 8481738 CANNULATED BONE 7.5MM TI,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
8481743,SUP,HCPCS C1713,,8481743  -  SCREW 8481743 CANNULATED BONE 7.5MM TI,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
8481745,SUP,HCPCS C1713,,8481745  -  SCREW 8481745 CANNULATED BONE 7.5MM TI,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
8481748,SUP,HCPCS C1713,,8481748  -  SCREW BONE 7.5MM 48MM TI SPNL CANN,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
8481750,SUP,HCPCS C1713,,8481750  -  SCREW BONE 7.5MM 50MM TI SPNL CANN,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
8481753,SUP,HCPCS C1713,,8481753  -  SCREW BONE 7.5MM 53MM TI SPNL CANN,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
8481755,SUP,HCPCS C1713,,8481755  -  SCREW BONE 7.5MM 55MM TI SPNL CANN,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
8481823,SUP,HCPCS C1713,,8481823  -  SCREW BONE 8.5MM 23MM TI SPNL CANN,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
8481825,SUP,HCPCS C1713,,8481825  -  SCREW 8481825 CANNULATED BONE 8.5MM TI,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
8481828,SUP,HCPCS C1713,,8481828  -  SCREW BONE 8.5MM 28MM TI SPNL CANN,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
8481830,SUP,HCPCS C1713,,8481830  -  SCREW 8481830 CANNULATED BONE 8.5MM TI,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
8481833,SUP,HCPCS C1713,,8481833  -  SCREW BONE 8.5MM 33MM TI SPNL CANN,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
8481835,SUP,HCPCS C1713,,8481835  -  SCREW 8481835 CANNULATED BONE 8.5MM TI,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
8481838,SUP,HCPCS C1713,,8481838  -  SCREW BONE 8.5MM 38MM TI SPNL CANN,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
8481840,SUP,HCPCS C1713,,8481840  -  SCREW 8481840 CANNULATED BONE 8.5MM TI,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
8481843,SUP,HCPCS C1713,,8481843  -  SCREW BONE 8.5MM 43MM TI SPNL CANN,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
8481845,SUP,HCPCS C1713,,8481845  -  SCREW 8481845 CANNULATED BONE 8.5MM TI,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
8481848,SUP,HCPCS C1713,,8481848  -  SCREW BONE 8.5MM 48MM TI SPNL CANN,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
8481850,SUP,HCPCS C1713,,8481850  -  SCREW BONE 8.5MM 50MM TI SPNL CANN,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
8481853,SUP,HCPCS C1713,,8481853  -  SCREW BONE 8.5MM 53MM TI SPNL CANN,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
8481855,SUP,HCPCS C1713,,8481855  -  SCREW BONE 8.5MM 55MM TI SPNL CANN,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
8481910,SUP,Custom 27203010,,8481910  -  INSTRUMENT 8481910 6.5MM RM CAN TAP,$945.00,$0.00,$945.00,$0.00,$674.45,$0.00,$0.00,$0.00,$0.00,$0.00,$945.00,$0.00,$472.50,$748.44,$756.00,$0.00,$0.00,$0.00,$0.00,$0.00
8481912,SUP,Custom 27203010,,8481912  -  INSTRUMENT 8481912 7.5MM RM TP HNDL GRN,$945.00,$0.00,$945.00,$0.00,$674.45,$0.00,$0.00,$0.00,$0.00,$0.00,$945.00,$0.00,$472.50,$748.44,$756.00,$0.00,$0.00,$0.00,$0.00,$0.00
8482623,SUP,HCPCS C1713,,8482623  -  SCREW 8482623 CDH ECLIPSE 6.5X22.5MM,"$2,890.50",$0.00,"$2,890.50","$1,300.73","$2,062.95",$0.00,$498.02,$0.00,$0.00,$506.10,"$2,890.50",$0.00,"$1,445.25","$2,289.28","$2,312.40",$0.00,$452.36,$0.00,$460.17,$0.00
8482625,SUP,HCPCS C1713,,8482625  -  SCREW 8482625 CDH ECLIPSE 6.5X25MM,"$2,890.50",$0.00,"$2,890.50","$1,300.73","$2,062.95",$0.00,$498.02,$0.00,$0.00,$506.10,"$2,890.50",$0.00,"$1,445.25","$2,289.28","$2,312.40",$0.00,$452.36,$0.00,$460.17,$0.00
8482628,SUP,HCPCS C1713,,8482628  -  SCREW 8482628 CDH ECLIPSE 6.5X27.5MM,"$2,890.50",$0.00,"$2,890.50","$1,300.73","$2,062.95",$0.00,$498.02,$0.00,$0.00,$506.10,"$2,890.50",$0.00,"$1,445.25","$2,289.28","$2,312.40",$0.00,$452.36,$0.00,$460.17,$0.00
8482630,SUP,HCPCS C1713,,8482630  -  SCREW 8482630 CDH ECLIPSE 6.5X30MM,"$2,890.50",$0.00,"$2,890.50","$1,300.73","$2,062.95",$0.00,$498.02,$0.00,$0.00,$506.10,"$2,890.50",$0.00,"$1,445.25","$2,289.28","$2,312.40",$0.00,$452.36,$0.00,$460.17,$0.00
8482633,SUP,HCPCS C1713,,8482633  -  SCREW 8482633 CDH ECLIPSE 6.5X32.5MM,"$2,890.50",$0.00,"$2,890.50","$1,300.73","$2,062.95",$0.00,$498.02,$0.00,$0.00,$506.10,"$2,890.50",$0.00,"$1,445.25","$2,289.28","$2,312.40",$0.00,$452.36,$0.00,$460.17,$0.00
8482635,SUP,HCPCS C1713,,8482635  -  SCREW 8482635 CDH ECLIPSE 6.5X35MM,"$2,890.50",$0.00,"$2,890.50","$1,300.73","$2,062.95",$0.00,$498.02,$0.00,$0.00,$506.10,"$2,890.50",$0.00,"$1,445.25","$2,289.28","$2,312.40",$0.00,$452.36,$0.00,$460.17,$0.00
8482638,SUP,HCPCS C1713,,8482638  -  SCREW 8482638 CDH ECLIPSE 6.5X37.5MM,"$2,890.50",$0.00,"$2,890.50","$1,300.73","$2,062.95",$0.00,$498.02,$0.00,$0.00,$506.10,"$2,890.50",$0.00,"$1,445.25","$2,289.28","$2,312.40",$0.00,$452.36,$0.00,$460.17,$0.00
8482640,SUP,HCPCS C1713,,8482640  -  SCREW 8482640 CDH ECLIPSE 6.5X40MM,"$2,890.50",$0.00,"$2,890.50","$1,300.73","$2,062.95",$0.00,$498.02,$0.00,$0.00,$506.10,"$2,890.50",$0.00,"$1,445.25","$2,289.28","$2,312.40",$0.00,$452.36,$0.00,$460.17,$0.00
8482643,SUP,HCPCS C1713,,8482643  -  SCREW 8482643 CDH ECLIPSE 6.5X42.5MM,"$2,890.50",$0.00,"$2,890.50","$1,300.73","$2,062.95",$0.00,$498.02,$0.00,$0.00,$506.10,"$2,890.50",$0.00,"$1,445.25","$2,289.28","$2,312.40",$0.00,$452.36,$0.00,$460.17,$0.00
8482645,SUP,HCPCS C1713,,8482645  -  SCREW 8482645 CDH ECLIPSE 6.5X45MM,"$2,890.50",$0.00,"$2,890.50","$1,300.73","$2,062.95",$0.00,$498.02,$0.00,$0.00,$506.10,"$2,890.50",$0.00,"$1,445.25","$2,289.28","$2,312.40",$0.00,$452.36,$0.00,$460.17,$0.00
8482648,SUP,HCPCS C1713,,8482648  -  SCREW BONE 6.5MM 47.5MM ECLPS SPNL,"$2,890.50",$0.00,"$2,890.50","$1,300.73","$2,062.95",$0.00,$498.02,$0.00,$0.00,$506.10,"$2,890.50",$0.00,"$1,445.25","$2,289.28","$2,312.40",$0.00,$452.36,$0.00,$460.17,$0.00
8482650,SUP,HCPCS C1713,,8482650  -  SCREW BONE 6.5MM 50MM ECLPS DBL HEX,"$2,890.50",$0.00,"$2,890.50","$1,300.73","$2,062.95",$0.00,$498.02,$0.00,$0.00,$506.10,"$2,890.50",$0.00,"$1,445.25","$2,289.28","$2,312.40",$0.00,$452.36,$0.00,$460.17,$0.00
8482653,SUP,HCPCS C1713,,8482653  -  SCREW BONE 6.5MM 52.5MM ECLPS SPNL,"$2,890.50",$0.00,"$2,890.50","$1,300.73","$2,062.95",$0.00,$498.02,$0.00,$0.00,$506.10,"$2,890.50",$0.00,"$1,445.25","$2,289.28","$2,312.40",$0.00,$452.36,$0.00,$460.17,$0.00
8482655,SUP,HCPCS C1713,,8482655  -  SCREW BONE 6.5MM 55MM ECLPS SPNL,"$2,890.50",$0.00,"$2,890.50","$1,300.73","$2,062.95",$0.00,$498.02,$0.00,$0.00,$506.10,"$2,890.50",$0.00,"$1,445.25","$2,289.28","$2,312.40",$0.00,$452.36,$0.00,$460.17,$0.00
8482723,SUP,HCPCS C1713,,8482723  -  SCREW 8482723 CDH ECLIPSE 7.5X22.5MM,"$2,890.50",$0.00,"$2,890.50","$1,300.73","$2,062.95",$0.00,$498.02,$0.00,$0.00,$506.10,"$2,890.50",$0.00,"$1,445.25","$2,289.28","$2,312.40",$0.00,$452.36,$0.00,$460.17,$0.00
8482725,SUP,HCPCS C1713,,8482725  -  SCREW 8482725 CDH ECLIPSE 7.5X25MM,"$2,890.50",$0.00,"$2,890.50","$1,300.73","$2,062.95",$0.00,$498.02,$0.00,$0.00,$506.10,"$2,890.50",$0.00,"$1,445.25","$2,289.28","$2,312.40",$0.00,$452.36,$0.00,$460.17,$0.00
8482728,SUP,HCPCS C1713,,8482728  -  SCREW 8482728 CDH ECLIPSE 7.5X27.5MM,"$2,890.50",$0.00,"$2,890.50","$1,300.73","$2,062.95",$0.00,$498.02,$0.00,$0.00,$506.10,"$2,890.50",$0.00,"$1,445.25","$2,289.28","$2,312.40",$0.00,$452.36,$0.00,$460.17,$0.00
8482730,SUP,HCPCS C1713,,8482730  -  SCREW 8482730 CDH ECLIPSE 7.5X30MM,"$2,890.50",$0.00,"$2,890.50","$1,300.73","$2,062.95",$0.00,$498.02,$0.00,$0.00,$506.10,"$2,890.50",$0.00,"$1,445.25","$2,289.28","$2,312.40",$0.00,$452.36,$0.00,$460.17,$0.00
8482733,SUP,HCPCS C1713,,8482733  -  SCREW 8482733 CDH ECLIPSE 7.5X32.5MM,"$2,890.50",$0.00,"$2,890.50","$1,300.73","$2,062.95",$0.00,$498.02,$0.00,$0.00,$506.10,"$2,890.50",$0.00,"$1,445.25","$2,289.28","$2,312.40",$0.00,$452.36,$0.00,$460.17,$0.00
8482735,SUP,HCPCS C1713,,8482735  -  SCREW 8482735 CDH ECLIPSE 7.5X35MM,"$2,890.50",$0.00,"$2,890.50","$1,300.73","$2,062.95",$0.00,$498.02,$0.00,$0.00,$506.10,"$2,890.50",$0.00,"$1,445.25","$2,289.28","$2,312.40",$0.00,$452.36,$0.00,$460.17,$0.00
8482738,SUP,HCPCS C1713,,8482738  -  SCREW 8482738 CDH ECLIPSE 7.5X37.5MM,"$2,890.50",$0.00,"$2,890.50","$1,300.73","$2,062.95",$0.00,$498.02,$0.00,$0.00,$506.10,"$2,890.50",$0.00,"$1,445.25","$2,289.28","$2,312.40",$0.00,$452.36,$0.00,$460.17,$0.00
8482740,SUP,HCPCS C1713,,8482740  -  SCREW 8482740 CDH ECLIPSE 7.5X40MM,"$2,890.50",$0.00,"$2,890.50","$1,300.73","$2,062.95",$0.00,$498.02,$0.00,$0.00,$506.10,"$2,890.50",$0.00,"$1,445.25","$2,289.28","$2,312.40",$0.00,$452.36,$0.00,$460.17,$0.00
8482743,SUP,HCPCS C1713,,8482743  -  SCREW 8482743 CDH ECLIPSE 7.5X42.5MM,"$2,890.50",$0.00,"$2,890.50","$1,300.73","$2,062.95",$0.00,$498.02,$0.00,$0.00,$506.10,"$2,890.50",$0.00,"$1,445.25","$2,289.28","$2,312.40",$0.00,$452.36,$0.00,$460.17,$0.00
8482745,SUP,HCPCS C1713,,8482745  -  SCREW 8482745 CDH ECLIPSE 7.5X45MM,"$2,890.50",$0.00,"$2,890.50","$1,300.73","$2,062.95",$0.00,$498.02,$0.00,$0.00,$506.10,"$2,890.50",$0.00,"$1,445.25","$2,289.28","$2,312.40",$0.00,$452.36,$0.00,$460.17,$0.00
8482748,SUP,HCPCS C1713,,8482748  -  SCREW BONE 7.5MM 47.5MM ECLPS DBL HEX,"$2,890.50",$0.00,"$2,890.50","$1,300.73","$2,062.95",$0.00,$498.02,$0.00,$0.00,$506.10,"$2,890.50",$0.00,"$1,445.25","$2,289.28","$2,312.40",$0.00,$452.36,$0.00,$460.17,$0.00
8482750,SUP,HCPCS C1713,,8482750  -  SCREW BONE 7.5MM 50MM ECLPS SPNL,"$2,890.50",$0.00,"$2,890.50","$1,300.73","$2,062.95",$0.00,$498.02,$0.00,$0.00,$506.10,"$2,890.50",$0.00,"$1,445.25","$2,289.28","$2,312.40",$0.00,$452.36,$0.00,$460.17,$0.00
8482753,SUP,HCPCS C1713,,8482753  -  SCREW BONE 7.5MM 52.5MM ECLPS DBL HEX,"$2,890.50",$0.00,"$2,890.50","$1,300.73","$2,062.95",$0.00,$498.02,$0.00,$0.00,$506.10,"$2,890.50",$0.00,"$1,445.25","$2,289.28","$2,312.40",$0.00,$452.36,$0.00,$460.17,$0.00
8482755,SUP,HCPCS C1713,,8482755  -  SCREW BONE 7.5MM 55MM ECLPS DBL HEX,"$2,890.50",$0.00,"$2,890.50","$1,300.73","$2,062.95",$0.00,$498.02,$0.00,$0.00,$506.10,"$2,890.50",$0.00,"$1,445.25","$2,289.28","$2,312.40",$0.00,$452.36,$0.00,$460.17,$0.00
8482823,SUP,HCPCS C1713,,8482823  -  SCREW BONE 8.5MM 22.5MM ECLPS SPNL,"$2,890.50",$0.00,"$2,890.50","$1,300.73","$2,062.95",$0.00,$498.02,$0.00,$0.00,$506.10,"$2,890.50",$0.00,"$1,445.25","$2,289.28","$2,312.40",$0.00,$452.36,$0.00,$460.17,$0.00
8482825,SUP,HCPCS C1713,,8482825  -  SCREW 8482825 CDH ECLIPSE 8.5X25MM,"$2,890.50",$0.00,"$2,890.50","$1,300.73","$2,062.95",$0.00,$498.02,$0.00,$0.00,$506.10,"$2,890.50",$0.00,"$1,445.25","$2,289.28","$2,312.40",$0.00,$452.36,$0.00,$460.17,$0.00
8482828,SUP,HCPCS C1713,,8482828  -  SCREW BONE 8.5MM 27.5MM ECLPS DBL HEX,"$2,890.50",$0.00,"$2,890.50","$1,300.73","$2,062.95",$0.00,$498.02,$0.00,$0.00,$506.10,"$2,890.50",$0.00,"$1,445.25","$2,289.28","$2,312.40",$0.00,$452.36,$0.00,$460.17,$0.00
8482830,SUP,HCPCS C1713,,8482830  -  SCREW 8482830 CDH ECLIPSE 8.5X30MM,"$2,890.50",$0.00,"$2,890.50","$1,300.73","$2,062.95",$0.00,$498.02,$0.00,$0.00,$506.10,"$2,890.50",$0.00,"$1,445.25","$2,289.28","$2,312.40",$0.00,$452.36,$0.00,$460.17,$0.00
8482833,SUP,HCPCS C1713,,8482833  -  SCREW BONE 8.5MM 32.5MM ECLPS DBL HEX,"$2,890.50",$0.00,"$2,890.50","$1,300.73","$2,062.95",$0.00,$498.02,$0.00,$0.00,$506.10,"$2,890.50",$0.00,"$1,445.25","$2,289.28","$2,312.40",$0.00,$452.36,$0.00,$460.17,$0.00
8482835,SUP,HCPCS C1713,,8482835  -  SCREW 8482835 CDH ECLIPSE 8.5X35MM,"$2,890.50",$0.00,"$2,890.50","$1,300.73","$2,062.95",$0.00,$498.02,$0.00,$0.00,$506.10,"$2,890.50",$0.00,"$1,445.25","$2,289.28","$2,312.40",$0.00,$452.36,$0.00,$460.17,$0.00
8482838,SUP,HCPCS C1713,,8482838  -  SCREW BONE 8.5MM 37.5MM ECLPS SPNL,"$2,890.50",$0.00,"$2,890.50","$1,300.73","$2,062.95",$0.00,$498.02,$0.00,$0.00,$506.10,"$2,890.50",$0.00,"$1,445.25","$2,289.28","$2,312.40",$0.00,$452.36,$0.00,$460.17,$0.00
8482840,SUP,HCPCS C1713,,8482840  -  SCREW 8482840 CDH ECLIPSE 8.5X40MM,"$2,890.50",$0.00,"$2,890.50","$1,300.73","$2,062.95",$0.00,$498.02,$0.00,$0.00,$506.10,"$2,890.50",$0.00,"$1,445.25","$2,289.28","$2,312.40",$0.00,$452.36,$0.00,$460.17,$0.00
8482843,SUP,HCPCS C1713,,8482843  -  SCREW BONE 8.5MM 42.5MM ECLPS SPNL,"$2,890.50",$0.00,"$2,890.50","$1,300.73","$2,062.95",$0.00,$498.02,$0.00,$0.00,$506.10,"$2,890.50",$0.00,"$1,445.25","$2,289.28","$2,312.40",$0.00,$452.36,$0.00,$460.17,$0.00
8482845,SUP,HCPCS C1713,,8482845  -  SCREW 8482845 CDH ECLIPSE 8.5X45MM,"$2,890.50",$0.00,"$2,890.50","$1,300.73","$2,062.95",$0.00,$498.02,$0.00,$0.00,$506.10,"$2,890.50",$0.00,"$1,445.25","$2,289.28","$2,312.40",$0.00,$452.36,$0.00,$460.17,$0.00
8482848,SUP,HCPCS C1713,,8482848  -  SCREW BONE 8.5MM 47.5MM ECLPS DBL HEX,"$2,890.50",$0.00,"$2,890.50","$1,300.73","$2,062.95",$0.00,$498.02,$0.00,$0.00,$506.10,"$2,890.50",$0.00,"$1,445.25","$2,289.28","$2,312.40",$0.00,$452.36,$0.00,$460.17,$0.00
8482850,SUP,HCPCS C1713,,8482850  -  SCREW BONE 8.5MM 50MM ECLPS SPNL,"$2,890.50",$0.00,"$2,890.50","$1,300.73","$2,062.95",$0.00,$498.02,$0.00,$0.00,$506.10,"$2,890.50",$0.00,"$1,445.25","$2,289.28","$2,312.40",$0.00,$452.36,$0.00,$460.17,$0.00
8482853,SUP,HCPCS C1713,,8482853  -  SCREW BONE 8.5MM 52.5MM ECLPS SPNL,"$2,890.50",$0.00,"$2,890.50","$1,300.73","$2,062.95",$0.00,$498.02,$0.00,$0.00,$506.10,"$2,890.50",$0.00,"$1,445.25","$2,289.28","$2,312.40",$0.00,$452.36,$0.00,$460.17,$0.00
8482855,SUP,HCPCS C1713,,8482855  -  SCREW BONE 8.5MM 55MM ECLPS DBL HEX,"$2,890.50",$0.00,"$2,890.50","$1,300.73","$2,062.95",$0.00,$498.02,$0.00,$0.00,$506.10,"$2,890.50",$0.00,"$1,445.25","$2,289.28","$2,312.40",$0.00,$452.36,$0.00,$460.17,$0.00
8530000,SUP,HCPCS C1713,,8530000  -  PLATE 8530000 TROUGH PLATE,"$1,093.50",$0.00,"$1,093.50",$492.08,$780.43,$0.00,$188.40,$0.00,$0.00,$191.46,"$1,093.50",$0.00,$546.75,$866.05,$874.80,$0.00,$171.13,$0.00,$174.09,$0.00
8530008,SUP,HCPCS C1713,,8530008  -  PLATE 8MM BONE SPN,"$1,093.50",$0.00,"$1,093.50",$492.08,$780.43,$0.00,$188.40,$0.00,$0.00,$191.46,"$1,093.50",$0.00,$546.75,$866.05,$874.80,$0.00,$171.13,$0.00,$174.09,$0.00
8530408,SUP,HCPCS C1713,,8530408  -  PLATE BN 8MM NS CENTERPIECE GFT SPNE,"$1,093.50",$0.00,"$1,093.50",$492.08,$780.43,$0.00,$188.40,$0.00,$0.00,$191.46,"$1,093.50",$0.00,$546.75,$866.05,$874.80,$0.00,$171.13,$0.00,$174.09,$0.00
8530605,SUP,Custom 27203010,,8530605  -  BIT DRL 1.9MM STRL 3 FLT DISP,$349.50,$0.00,$349.50,$0.00,$249.44,$0.00,$0.00,$0.00,$0.00,$0.00,$349.50,$0.00,$174.75,$276.80,$279.60,$0.00,$0.00,$0.00,$0.00,$0.00
8536510,SUP,HCPCS C1713,,8536510  -  SCREW ILIAC 6.5MM 100MM SC 5.5MM SS,"$5,602.50",$0.00,"$5,602.50","$2,521.13","$3,998.50",$0.00,$965.28,$0.00,$0.00,$980.95,"$5,602.50",$0.00,"$2,801.25","$4,437.18","$4,482.00",$0.00,$876.79,$0.00,$891.92,$0.00
8536560,SUP,HCPCS C1713,,8536560  -  SCREW ILIAC 6.5MM 60MM SC 5.5MM SS,"$5,602.50",$0.00,"$5,602.50","$2,521.13","$3,998.50",$0.00,$965.28,$0.00,$0.00,$980.95,"$5,602.50",$0.00,"$2,801.25","$4,437.18","$4,482.00",$0.00,$876.79,$0.00,$891.92,$0.00
8536570,SUP,HCPCS C1713,,8536570  -  SCREW ILIAC 6.5MM 70MM SC 5.5MM SS,"$5,602.50",$0.00,"$5,602.50","$2,521.13","$3,998.50",$0.00,$965.28,$0.00,$0.00,$980.95,"$5,602.50",$0.00,"$2,801.25","$4,437.18","$4,482.00",$0.00,$876.79,$0.00,$891.92,$0.00
8536580,SUP,HCPCS C1713,,8536580  -  SCREW ILIAC 6.5MM 80MM SC 5.5MM SS,"$5,602.50",$0.00,"$5,602.50","$2,521.13","$3,998.50",$0.00,$965.28,$0.00,$0.00,$980.95,"$5,602.50",$0.00,"$2,801.25","$4,437.18","$4,482.00",$0.00,$876.79,$0.00,$891.92,$0.00
8536590,SUP,HCPCS C1713,,8536590  -  SCREW ILIAC 6.5MM 90MM SC 5.5MM SS,"$5,602.50",$0.00,"$5,602.50","$2,521.13","$3,998.50",$0.00,$965.28,$0.00,$0.00,$980.95,"$5,602.50",$0.00,"$2,801.25","$4,437.18","$4,482.00",$0.00,$876.79,$0.00,$891.92,$0.00
8537510,SUP,HCPCS C1713,,8537510  -  SCREW ILIAC 7.5MM 100MM SC 5.5MM SS,"$5,602.50",$0.00,"$5,602.50","$2,521.13","$3,998.50",$0.00,$965.28,$0.00,$0.00,$980.95,"$5,602.50",$0.00,"$2,801.25","$4,437.18","$4,482.00",$0.00,$876.79,$0.00,$891.92,$0.00
8537570,SUP,HCPCS C1713,,8537570  -  SCREW ILIAC 7.5MM 70MM SC 5.5MM SS,"$5,602.50",$0.00,"$5,602.50","$2,521.13","$3,998.50",$0.00,$965.28,$0.00,$0.00,$980.95,"$5,602.50",$0.00,"$2,801.25","$4,437.18","$4,482.00",$0.00,$876.79,$0.00,$891.92,$0.00
8537580,SUP,HCPCS C1713,,8537580  -  SCREW ILIAC 7.5MM 80MM SC 5.5MM SS,"$5,602.50",$0.00,"$5,602.50","$2,521.13","$3,998.50",$0.00,$965.28,$0.00,$0.00,$980.95,"$5,602.50",$0.00,"$2,801.25","$4,437.18","$4,482.00",$0.00,$876.79,$0.00,$891.92,$0.00
8537590,SUP,HCPCS C1713,,8537590  -  SCREW ILIAC 7.5MM 90MM SC 5.5MM SS,"$5,602.50",$0.00,"$5,602.50","$2,521.13","$3,998.50",$0.00,$965.28,$0.00,$0.00,$980.95,"$5,602.50",$0.00,"$2,801.25","$4,437.18","$4,482.00",$0.00,$876.79,$0.00,$891.92,$0.00
8538510,SUP,HCPCS C1713,,8538510  -  SCREW ILIAC 8.5MM 100MM SC 5.5MM SS,"$5,602.50",$0.00,"$5,602.50","$2,521.13","$3,998.50",$0.00,$965.28,$0.00,$0.00,$980.95,"$5,602.50",$0.00,"$2,801.25","$4,437.18","$4,482.00",$0.00,$876.79,$0.00,$891.92,$0.00
8538570,SUP,HCPCS C1713,,8538570  -  SCREW ILIAC 8.5MM 70MM SC 5.5MM SS,"$5,602.50",$0.00,"$5,602.50","$2,521.13","$3,998.50",$0.00,$965.28,$0.00,$0.00,$980.95,"$5,602.50",$0.00,"$2,801.25","$4,437.18","$4,482.00",$0.00,$876.79,$0.00,$891.92,$0.00
8538580,SUP,HCPCS C1713,,8538580  -  SCREW ILIAC 8.5MM 80MM SC 5.5MM SS,"$5,602.50",$0.00,"$5,602.50","$2,521.13","$3,998.50",$0.00,$965.28,$0.00,$0.00,$980.95,"$5,602.50",$0.00,"$2,801.25","$4,437.18","$4,482.00",$0.00,$876.79,$0.00,$891.92,$0.00
8538590,SUP,HCPCS C1713,,8538590  -  SCREW ILIAC 8.5MM 90MM SC 5.5MM SS,"$5,602.50",$0.00,"$5,602.50","$2,521.13","$3,998.50",$0.00,$965.28,$0.00,$0.00,$980.95,"$5,602.50",$0.00,"$2,801.25","$4,437.18","$4,482.00",$0.00,$876.79,$0.00,$891.92,$0.00
8540611,SUP,HCPCS C1713,,8540611  -  CROSSLINK 8540611 11 MM ANTERIOR LPC TI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8540612,SUP,HCPCS C1713,,8540612  -  CROSSLINK 8540612 12 MM ANTERIOR LPC TI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8540613,SUP,HCPCS C1713,,8540613  -  CROSSLINK 8540613 13 MM ANTERIOR LPC TI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8540614,SUP,HCPCS C1713,,8540614  -  CROSSLINK 8540614 14 MM ANTERIOR LPC TI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8540615,SUP,HCPCS C1713,,8540615  -  CROSSLINK 8540615 15 MM ANTERIOR LPC TI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8540616,SUP,HCPCS C1713,,8540616  -  CROSSLINK 8540616 16 MM ANTERIOR LPC TI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8540617,SUP,HCPCS C1713,,8540617  -  CROSSLINK 8540617 17 MM ANTERIOR LPC TI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8546796,SUP,Custom 27203010,,REAGENT LYS SOL CLTR LYS S 5L MAXM/HMX/LH SER ANALY,$815.20,$0.00,$815.20,$0.00,$581.81,$0.00,$0.00,$0.00,$0.00,$0.00,$815.20,$0.00,$407.60,$645.64,$652.16,$0.00,$0.00,$0.00,$0.00,$0.00
8547008,SUP,Custom 27203010,,REAGENT SHTH FLUID ISFLW 1.8L ANALY,$38.05,$0.00,$38.05,$0.00,$27.16,$0.00,$0.00,$0.00,$0.00,$0.00,$38.05,$0.00,$19.03,$30.14,$30.44,$0.00,$0.00,$0.00,$0.00,$0.00
8547194,SUP,Custom 27203010,,REAGENT DILU CLTR ISOT CARBOY 20L LH700 SER ANALY,$64.33,$0.00,$64.33,$0.00,$45.91,$0.00,$0.00,$0.00,$0.00,$0.00,$64.33,$0.00,$32.16,$50.95,$51.46,$0.00,$0.00,$0.00,$0.00,$0.00
8547195,SUP,Custom 27203010,,REAGENT DILU CLTR SCTR PK 20L LH700 SER ANALY,$354.18,$0.00,$354.18,$0.00,$252.77,$0.00,$0.00,$0.00,$0.00,$0.00,$354.18,$0.00,$177.09,$280.51,$283.34,$0.00,$0.00,$0.00,$0.00,$0.00
8547196,SUP,Custom 27203010,,REAGENT RETCYT CLTR 20L LH700 SER ANALY,$419.10,$0.00,$419.10,$0.00,$299.11,$0.00,$0.00,$0.00,$0.00,$0.00,$419.10,$0.00,$209.55,$331.93,$335.28,$0.00,$0.00,$0.00,$0.00,$0.00
8548498,SUP,HCPCS C1713,,8548498  -  STAPLE 8548498  19MM CAUDAL TI,"$2,518.50",$0.00,"$2,518.50","$1,133.33","$1,797.45",$0.00,$433.92,$0.00,$0.00,$440.97,"$2,518.50",$0.00,"$1,259.25","$1,994.65","$2,014.80",$0.00,$394.15,$0.00,$400.95,$0.00
8548499,SUP,HCPCS C1713,,8548499  -  STAPLE 8548499  19MM ROSTRAL TI,"$2,518.50",$0.00,"$2,518.50","$1,133.33","$1,797.45",$0.00,$433.92,$0.00,$0.00,$440.97,"$2,518.50",$0.00,"$1,259.25","$1,994.65","$2,014.80",$0.00,$394.15,$0.00,$400.95,$0.00
8548500,SUP,HCPCS C1713,,8548500  -  STAPLE 8548500  21 MM CAUDAL TI,"$2,518.50",$0.00,"$2,518.50","$1,133.33","$1,797.45",$0.00,$433.92,$0.00,$0.00,$440.97,"$2,518.50",$0.00,"$1,259.25","$1,994.65","$2,014.80",$0.00,$394.15,$0.00,$400.95,$0.00
8548501,SUP,HCPCS C1713,,8548501  -  STAPLE 8548501  21 MM ROSTRAL TI,"$2,518.50",$0.00,"$2,518.50","$1,133.33","$1,797.45",$0.00,$433.92,$0.00,$0.00,$440.97,"$2,518.50",$0.00,"$1,259.25","$1,994.65","$2,014.80",$0.00,$394.15,$0.00,$400.95,$0.00
8549008,SUP,HCPCS C1713,,8549008  -  CROSSLINK 8549008 16TI LPC FOR 4.5ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8549009,SUP,HCPCS C1713,,8549009  -  CROSSLINK 8549009 19TI LPC FOR 4.5ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8549010,SUP,HCPCS C1713,,8549010  -  CROSSLINK 8549010 22TI LPC FOR 4.5ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8549011,SUP,HCPCS C1713,,8549011  -  CROSSLINK 8549011 25TI LPC FOR 4.5ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8549012,SUP,HCPCS C1713,,8549012  -  CROSSLINK 8549012 29TI LPC FOR 4.5ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8549013,SUP,HCPCS C1713,,8549013  -  CROSSLINK 8549013 32TI LPC FOR 4.5ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8549014,SUP,HCPCS C1713,,8549014  -  CROSSLINK 8549014 35TI LPC FOR 4.5ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8549015,SUP,HCPCS C1713,,8549015  -  CROSSLINK 8549015 38TI LPC FOR 4.5ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8549016,SUP,HCPCS C1713,,8549016  -  CROSSLINK 8549016 4.5MM MLTSPAN LPC SM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8549017,SUP,HCPCS C1713,,8549017  -  CROSSLINK 8549017 4.5MM MLTSPAN LPC MD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8549018,SUP,HCPCS C1713,,8549018  -  CROSSLINK 8549018 4.5MM MLTSPAN LPC LG,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8549300,SUP,Custom 27803010,,8549300  -  CONNECTOR 8549300 4.5 4.5 OPEN DOMINO TI,"$1,831.18",$0.00,"$1,831.18",$0.00,"$1,306.91",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,831.18",$0.00,$915.59,"$1,450.29","$1,464.94",$0.00,$0.00,$0.00,$0.00,$0.00
8549301,SUP,Custom 27803010,,8549301  -  CONNECTOR 8549301 4.5 5.5 OPEN DOMINO TI,"$1,831.18",$0.00,"$1,831.18",$0.00,"$1,306.91",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,831.18",$0.00,$915.59,"$1,450.29","$1,464.94",$0.00,$0.00,$0.00,$0.00,$0.00
8549305,SUP,Custom 27803010,,8549305  -  CONNECTOR 8549305 4.5 MM DOMINO,"$1,831.18",$0.00,"$1,831.18",$0.00,"$1,306.91",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,831.18",$0.00,$915.59,"$1,450.29","$1,464.94",$0.00,$0.00,$0.00,$0.00,$0.00
8549306,SUP,Custom 27803010,,8549306  -  CONNECTOR 8549306 4.5 MM 5.5MM DOMINO,"$1,831.18",$0.00,"$1,831.18",$0.00,"$1,306.91",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,831.18",$0.00,$915.59,"$1,450.29","$1,464.94",$0.00,$0.00,$0.00,$0.00,$0.00
8550120,SUP,HCPCS C1713,,8550120  -  CONCTR ROD 20MM 5.5MM CX FIX SS,"$3,630.00",$0.00,"$3,630.00","$1,633.50","$2,590.73",$0.00,$625.43,$0.00,$0.00,$635.58,"$3,630.00",$0.00,"$1,815.00","$2,874.96","$2,904.00",$0.00,$568.10,$0.00,$577.90,$0.00
8550122,SUP,HCPCS C1713,,8550122  -  CONCTR ROD 22.5MM 5.5MM CX FIX SS,"$3,630.00",$0.00,"$3,630.00","$1,633.50","$2,590.73",$0.00,$625.43,$0.00,$0.00,$635.58,"$3,630.00",$0.00,"$1,815.00","$2,874.96","$2,904.00",$0.00,$568.10,$0.00,$577.90,$0.00
8550125,SUP,HCPCS C1713,,8550125  -  CONCTR ROD 25MM 5.5MM SS CX FIX,"$3,630.00",$0.00,"$3,630.00","$1,633.50","$2,590.73",$0.00,$625.43,$0.00,$0.00,$635.58,"$3,630.00",$0.00,"$1,815.00","$2,874.96","$2,904.00",$0.00,$568.10,$0.00,$577.90,$0.00
8550127,SUP,HCPCS C1713,,8550127  -  CONCTR ROD 27.5MM 5.5MM SS CX FIX,"$3,630.00",$0.00,"$3,630.00","$1,633.50","$2,590.73",$0.00,$625.43,$0.00,$0.00,$635.58,"$3,630.00",$0.00,"$1,815.00","$2,874.96","$2,904.00",$0.00,$568.10,$0.00,$577.90,$0.00
8550130,SUP,HCPCS C1713,,8550130  -  CONCTR ROD 30MM 5.5MM SS CX FIX,"$3,630.00",$0.00,"$3,630.00","$1,633.50","$2,590.73",$0.00,$625.43,$0.00,$0.00,$635.58,"$3,630.00",$0.00,"$1,815.00","$2,874.96","$2,904.00",$0.00,$568.10,$0.00,$577.90,$0.00
8550132,SUP,HCPCS C1713,,8550132  -  CONCTR ROD 32.5MM 5.5MM SS CX FIX,"$3,630.00",$0.00,"$3,630.00","$1,633.50","$2,590.73",$0.00,$625.43,$0.00,$0.00,$635.58,"$3,630.00",$0.00,"$1,815.00","$2,874.96","$2,904.00",$0.00,$568.10,$0.00,$577.90,$0.00
8550135,SUP,HCPCS C1713,,8550135  -  CONCTR ROD 35MM 5.5MM SS CX FIX,"$3,630.00",$0.00,"$3,630.00","$1,633.50","$2,590.73",$0.00,$625.43,$0.00,$0.00,$635.58,"$3,630.00",$0.00,"$1,815.00","$2,874.96","$2,904.00",$0.00,$568.10,$0.00,$577.90,$0.00
8550137,SUP,HCPCS C1713,,8550137  -  CONCTR ROD 37.5MM 5.5MM SS CX FIX,"$3,630.00",$0.00,"$3,630.00","$1,633.50","$2,590.73",$0.00,$625.43,$0.00,$0.00,$635.58,"$3,630.00",$0.00,"$1,815.00","$2,874.96","$2,904.00",$0.00,$568.10,$0.00,$577.90,$0.00
8550140,SUP,HCPCS C1713,,8550140  -  CONCTR ROD 40MM 5.5MM SS CX FIX,"$3,630.00",$0.00,"$3,630.00","$1,633.50","$2,590.73",$0.00,$625.43,$0.00,$0.00,$635.58,"$3,630.00",$0.00,"$1,815.00","$2,874.96","$2,904.00",$0.00,$568.10,$0.00,$577.90,$0.00
8550145,SUP,HCPCS C1713,,8550145  -  CONCTR ROD 45MM 5.5MM SS CX FIX,"$3,630.00",$0.00,"$3,630.00","$1,633.50","$2,590.73",$0.00,$625.43,$0.00,$0.00,$635.58,"$3,630.00",$0.00,"$1,815.00","$2,874.96","$2,904.00",$0.00,$568.10,$0.00,$577.90,$0.00
8550150,SUP,HCPCS C1713,,8550150  -  CONCTR ROD 50MM 5.5MM SS CX FIX,"$3,630.00",$0.00,"$3,630.00","$1,633.50","$2,590.73",$0.00,$625.43,$0.00,$0.00,$635.58,"$3,630.00",$0.00,"$1,815.00","$2,874.96","$2,904.00",$0.00,$568.10,$0.00,$577.90,$0.00
8550245,SUP,HCPCS C1713,,8550245  -  CONCTR ROD 45-50MM 5.5MM SS CX,"$4,905.00",$0.00,"$4,905.00","$2,207.25","$3,500.70",$0.00,$845.11,$0.00,$0.00,$858.83,"$4,905.00",$0.00,"$2,452.50","$3,884.76","$3,924.00",$0.00,$767.63,$0.00,$780.88,$0.00
8550250,SUP,HCPCS C1713,,8550250  -  CONCTR ROD 50-60MM 5.5MM SS CX,"$4,905.00",$0.00,"$4,905.00","$2,207.25","$3,500.70",$0.00,$845.11,$0.00,$0.00,$858.83,"$4,905.00",$0.00,"$2,452.50","$3,884.76","$3,924.00",$0.00,$767.63,$0.00,$780.88,$0.00
8550260,SUP,HCPCS C1713,,8550260  -  CONCTR ROD 60-70MM 5.5MM SS CX,"$4,905.00",$0.00,"$4,905.00","$2,207.25","$3,500.70",$0.00,$845.11,$0.00,$0.00,$858.83,"$4,905.00",$0.00,"$2,452.50","$3,884.76","$3,924.00",$0.00,$767.63,$0.00,$780.88,$0.00
8550270,SUP,HCPCS C1713,,8550270  -  CONCTR ROD 70-85MM 5.5MM SS CX,"$4,905.00",$0.00,"$4,905.00","$2,207.25","$3,500.70",$0.00,$845.11,$0.00,$0.00,$858.83,"$4,905.00",$0.00,"$2,452.50","$3,884.76","$3,924.00",$0.00,$767.63,$0.00,$780.88,$0.00
8550302,SUP,HCPCS C1713,,8550302  -  CONCTR ROD 5.5MM SS INLN,"$2,880.00",$0.00,"$2,880.00","$1,296.00","$2,055.46",$0.00,$496.21,$0.00,$0.00,$504.26,"$2,880.00",$0.00,"$1,440.00","$2,280.96","$2,304.00",$0.00,$450.72,$0.00,$458.50,$0.00
8550402,SUP,HCPCS C1713,,8550402  -  CONCTR ROD 5.5MM SS PRLL,"$2,880.00",$0.00,"$2,880.00","$1,296.00","$2,055.46",$0.00,$496.21,$0.00,$0.00,$504.26,"$2,880.00",$0.00,"$1,440.00","$2,280.96","$2,304.00",$0.00,$450.72,$0.00,$458.50,$0.00
8550602,SUP,HCPCS C1713,,8550602  -  CONCTR ROD 5.5MM SS 4 HOLE,"$3,617.50",$0.00,"$3,617.50","$1,627.88","$2,581.81",$0.00,$623.28,$0.00,$0.00,$633.40,"$3,617.50",$0.00,"$1,808.75","$2,865.06","$2,894.00",$0.00,$566.14,$0.00,$575.91,$0.00
8552200,SUP,HCPCS C1713,,8552200  -  ROD 5.5MM 200MM SS,"$1,295.00",$0.00,"$1,295.00",$582.75,$924.24,$0.00,$223.12,$0.00,$0.00,$226.74,"$1,295.00",$0.00,$647.50,"$1,025.64","$1,036.00",$0.00,$202.67,$0.00,$206.16,$0.00
8552300,SUP,HCPCS C1713,,8552300  -  ROD 5.5MM 300MM SS,"$1,860.00",$0.00,"$1,860.00",$837.00,"$1,327.48",$0.00,$320.47,$0.00,$0.00,$325.67,"$1,860.00",$0.00,$930.00,"$1,473.12","$1,488.00",$0.00,$291.09,$0.00,$296.11,$0.00
8552500,SUP,HCPCS C1713,,8552500  -  ROD SPNL 500MM 5.5MM SS,"$1,922.50",$0.00,"$1,922.50",$865.13,"$1,372.09",$0.00,$331.24,$0.00,$0.00,$336.61,"$1,922.50",$0.00,$961.25,"$1,522.62","$1,538.00",$0.00,$300.87,$0.00,$306.06,$0.00
8553101,SUP,Custom 27803010,,8553101  -  HOOK SPNL 5.5MM SM PDCL SS,"$3,115.00",$0.00,"$3,115.00",$0.00,"$2,223.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,115.00",$0.00,"$1,557.50","$2,467.08","$2,492.00",$0.00,$0.00,$0.00,$0.00,$0.00
8553102,SUP,Custom 27803010,,8553102  -  HOOK SPNL 5.5MM MED PDCL SS,"$3,115.00",$0.00,"$3,115.00",$0.00,"$2,223.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,115.00",$0.00,"$1,557.50","$2,467.08","$2,492.00",$0.00,$0.00,$0.00,$0.00,$0.00
8553112,SUP,Custom 27803010,,8553112  -  HOOK SPNL 6MM LMNR SS RED 5.5MM ROD,"$3,115.00",$0.00,"$3,115.00",$0.00,"$2,223.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,115.00",$0.00,"$1,557.50","$2,467.08","$2,492.00",$0.00,$0.00,$0.00,$0.00,$0.00
8553113,SUP,Custom 27803010,,8553113  -  HOOK SPNL 8MM LMNR SS RED 5.5MM ROD,"$3,115.00",$0.00,"$3,115.00",$0.00,"$2,223.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,115.00",$0.00,"$1,557.50","$2,467.08","$2,492.00",$0.00,$0.00,$0.00,$0.00,$0.00
8553114,SUP,Custom 27803010,,8553114  -  HOOK SPNL 10MM LMNR SS RED 5.5MM ROD,"$3,115.00",$0.00,"$3,115.00",$0.00,"$2,223.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,115.00",$0.00,"$1,557.50","$2,467.08","$2,492.00",$0.00,$0.00,$0.00,$0.00,$0.00
8553121,SUP,Custom 27803010,,8553121  -  HOOK SPNL SS RIGHT ANG 5.5 MM ROD,"$3,950.00",$0.00,"$3,950.00",$0.00,"$2,819.12",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,950.00",$0.00,"$1,975.00","$3,128.40","$3,160.00",$0.00,$0.00,$0.00,$0.00,$0.00
8553122,SUP,Custom 27803010,,8553122  -  HOOK SPNL SS LEFT ANG 5.5 MM ROD,"$3,950.00",$0.00,"$3,950.00",$0.00,"$2,819.12",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,950.00",$0.00,"$1,975.00","$3,128.40","$3,160.00",$0.00,$0.00,$0.00,$0.00,$0.00
8553123,SUP,Custom 27803010,,8553123  -  HOOK SPNL SS RIGHT OFFST 5.5 MM ROD,"$3,950.00",$0.00,"$3,950.00",$0.00,"$2,819.12",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,950.00",$0.00,"$1,975.00","$3,128.40","$3,160.00",$0.00,$0.00,$0.00,$0.00,$0.00
8553124,SUP,Custom 27803010,,8553124  -  HOOK SPNL SS LEFT OFFST 5.5 MM ROD,"$3,950.00",$0.00,"$3,950.00",$0.00,"$2,819.12",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,950.00",$0.00,"$1,975.00","$3,128.40","$3,160.00",$0.00,$0.00,$0.00,$0.00,$0.00
8554025,SUP,HCPCS C1713,,8554025  -  SCREW BONE 4MM 25MM SPNL POLYAX 5.5MM ROD,"$4,607.50",$0.00,"$4,607.50","$2,073.38","$3,288.37",$0.00,$793.85,$0.00,$0.00,$806.74,"$4,607.50",$0.00,"$2,303.75","$3,649.14","$3,686.00",$0.00,$721.07,$0.00,$733.51,$0.00
8554030,SUP,HCPCS C1713,,8554030  -  SCREW BONE 4MM 30MM SPNL POLYAX 5.5MM ROD,"$4,607.50",$0.00,"$4,607.50","$2,073.38","$3,288.37",$0.00,$793.85,$0.00,$0.00,$806.74,"$4,607.50",$0.00,"$2,303.75","$3,649.14","$3,686.00",$0.00,$721.07,$0.00,$733.51,$0.00
8554035,SUP,HCPCS C1713,,8554035  -  SCREW BONE 4MM 35MM SPNL POLYAX 5.5MM ROD,"$4,607.50",$0.00,"$4,607.50","$2,073.38","$3,288.37",$0.00,$793.85,$0.00,$0.00,$806.74,"$4,607.50",$0.00,"$2,303.75","$3,649.14","$3,686.00",$0.00,$721.07,$0.00,$733.51,$0.00
8554040,SUP,HCPCS C1713,,8554040  -  SCREW BONE 4MM 40MM SPNL POLYAX 5.5MM ROD,"$4,607.50",$0.00,"$4,607.50","$2,073.38","$3,288.37",$0.00,$793.85,$0.00,$0.00,$806.74,"$4,607.50",$0.00,"$2,303.75","$3,649.14","$3,686.00",$0.00,$721.07,$0.00,$733.51,$0.00
8554525,SUP,HCPCS C1713,,8554525  -  SCREW BONE 4.5MM 25MM SPNL POLYAX 5.5MM ROD,"$4,607.50",$0.00,"$4,607.50","$2,073.38","$3,288.37",$0.00,$793.85,$0.00,$0.00,$806.74,"$4,607.50",$0.00,"$2,303.75","$3,649.14","$3,686.00",$0.00,$721.07,$0.00,$733.51,$0.00
8554530,SUP,HCPCS C1713,,8554530  -  SCREW BONE 4.5MM 30MM SPNL POLYAX 5.5MM ROD,"$4,607.50",$0.00,"$4,607.50","$2,073.38","$3,288.37",$0.00,$793.85,$0.00,$0.00,$806.74,"$4,607.50",$0.00,"$2,303.75","$3,649.14","$3,686.00",$0.00,$721.07,$0.00,$733.51,$0.00
8554535,SUP,HCPCS C1713,,8554535  -  SCREW BONE 4.5MM 35MM SPNL POLYAX 5.5MM ROD,"$4,607.50",$0.00,"$4,607.50","$2,073.38","$3,288.37",$0.00,$793.85,$0.00,$0.00,$806.74,"$4,607.50",$0.00,"$2,303.75","$3,649.14","$3,686.00",$0.00,$721.07,$0.00,$733.51,$0.00
8554540,SUP,HCPCS C1713,,8554540  -  SCREW BONE 4.5MM 40MM SPNL POLYAX 5.5MM ROD,"$4,607.50",$0.00,"$4,607.50","$2,073.38","$3,288.37",$0.00,$793.85,$0.00,$0.00,$806.74,"$4,607.50",$0.00,"$2,303.75","$3,649.14","$3,686.00",$0.00,$721.07,$0.00,$733.51,$0.00
8554545,SUP,HCPCS C1713,,8554545  -  SCREW BONE 4.5MM 45MM SS SPNL POLYAX 5.5MM ROD,"$4,607.50",$0.00,"$4,607.50","$2,073.38","$3,288.37",$0.00,$793.85,$0.00,$0.00,$806.74,"$4,607.50",$0.00,"$2,303.75","$3,649.14","$3,686.00",$0.00,$721.07,$0.00,$733.51,$0.00
8555025,SUP,HCPCS C1713,,8555025  -  SCREW BONE 5MM 25MM SS SPNL POLYAX 5.5MM ROD,"$4,607.50",$0.00,"$4,607.50","$2,073.38","$3,288.37",$0.00,$793.85,$0.00,$0.00,$806.74,"$4,607.50",$0.00,"$2,303.75","$3,649.14","$3,686.00",$0.00,$721.07,$0.00,$733.51,$0.00
8555030,SUP,HCPCS C1713,,8555030  -  SCREW BONE 5MM 30MM SS SPNL POLYAX 5.5MM ROD,"$4,607.50",$0.00,"$4,607.50","$2,073.38","$3,288.37",$0.00,$793.85,$0.00,$0.00,$806.74,"$4,607.50",$0.00,"$2,303.75","$3,649.14","$3,686.00",$0.00,$721.07,$0.00,$733.51,$0.00
8555035,SUP,HCPCS C1713,,8555035  -  SCREW BONE 5MM 35MM SS SPNL POLYAX 5.5MM ROD,"$4,607.50",$0.00,"$4,607.50","$2,073.38","$3,288.37",$0.00,$793.85,$0.00,$0.00,$806.74,"$4,607.50",$0.00,"$2,303.75","$3,649.14","$3,686.00",$0.00,$721.07,$0.00,$733.51,$0.00
8555040,SUP,HCPCS C1713,,8555040  -  SCREW BONE 5MM 40MM SS SPNL POLYAX 5.5MM ROD,"$4,607.50",$0.00,"$4,607.50","$2,073.38","$3,288.37",$0.00,$793.85,$0.00,$0.00,$806.74,"$4,607.50",$0.00,"$2,303.75","$3,649.14","$3,686.00",$0.00,$721.07,$0.00,$733.51,$0.00
8555045,SUP,HCPCS C1713,,8555045  -  SCREW BONE 5MM 45MM SS SPNL POLYAX 5.5MM ROD,"$4,607.50",$0.00,"$4,607.50","$2,073.38","$3,288.37",$0.00,$793.85,$0.00,$0.00,$806.74,"$4,607.50",$0.00,"$2,303.75","$3,649.14","$3,686.00",$0.00,$721.07,$0.00,$733.51,$0.00
8555530,SUP,HCPCS C1713,,8555530  -  SCREW BONE 5.5MM 30MM SS SPNL POLYAX 5.5MM ROD,"$4,607.50",$0.00,"$4,607.50","$2,073.38","$3,288.37",$0.00,$793.85,$0.00,$0.00,$806.74,"$4,607.50",$0.00,"$2,303.75","$3,649.14","$3,686.00",$0.00,$721.07,$0.00,$733.51,$0.00
8555535,SUP,HCPCS C1713,,8555535  -  SCREW BONE 5.5MM 35MM SS SPNL POLYAX 5.5MM ROD,"$4,607.50",$0.00,"$4,607.50","$2,073.38","$3,288.37",$0.00,$793.85,$0.00,$0.00,$806.74,"$4,607.50",$0.00,"$2,303.75","$3,649.14","$3,686.00",$0.00,$721.07,$0.00,$733.51,$0.00
8555540,SUP,HCPCS C1713,,8555540  -  SCREW BONE 5.5MM 40MM SS SPNL POLYAX 5.5MM ROD,"$4,607.50",$0.00,"$4,607.50","$2,073.38","$3,288.37",$0.00,$793.85,$0.00,$0.00,$806.74,"$4,607.50",$0.00,"$2,303.75","$3,649.14","$3,686.00",$0.00,$721.07,$0.00,$733.51,$0.00
8555545,SUP,HCPCS C1713,,8555545  -  SCREW BONE 5.5MM 45MM SS SPNL POLYAX 5.5MM ROD,"$4,607.50",$0.00,"$4,607.50","$2,073.38","$3,288.37",$0.00,$793.85,$0.00,$0.00,$806.74,"$4,607.50",$0.00,"$2,303.75","$3,649.14","$3,686.00",$0.00,$721.07,$0.00,$733.51,$0.00
8555550,SUP,HCPCS C1713,,8555550  -  SCREW BONE 5.5MM 50MM SS SPNL POLYAX 5.5MM ROD,"$4,607.50",$0.00,"$4,607.50","$2,073.38","$3,288.37",$0.00,$793.85,$0.00,$0.00,$806.74,"$4,607.50",$0.00,"$2,303.75","$3,649.14","$3,686.00",$0.00,$721.07,$0.00,$733.51,$0.00
8555555,SUP,HCPCS C1713,,8555555  -  SCREW BONE 5.5MM 55MM SS SPNL POLYAX 5.5MM ROD,"$4,607.50",$0.00,"$4,607.50","$2,073.38","$3,288.37",$0.00,$793.85,$0.00,$0.00,$806.74,"$4,607.50",$0.00,"$2,303.75","$3,649.14","$3,686.00",$0.00,$721.07,$0.00,$733.51,$0.00
8556535,SUP,HCPCS C1713,,8556535  -  SCREW BONE 6.5MM 35MM SPNL POLYAX 5.5MM ROD,"$4,607.50",$0.00,"$4,607.50","$2,073.38","$3,288.37",$0.00,$793.85,$0.00,$0.00,$806.74,"$4,607.50",$0.00,"$2,303.75","$3,649.14","$3,686.00",$0.00,$721.07,$0.00,$733.51,$0.00
8556540,SUP,HCPCS C1713,,8556540  -  SCREW BONE 6.5MM 40MM SPNL POLYAX 5.5MM ROD,"$4,607.50",$0.00,"$4,607.50","$2,073.38","$3,288.37",$0.00,$793.85,$0.00,$0.00,$806.74,"$4,607.50",$0.00,"$2,303.75","$3,649.14","$3,686.00",$0.00,$721.07,$0.00,$733.51,$0.00
8556545,SUP,HCPCS C1713,,8556545  -  SCREW BONE 6.5MM 45MM SS SPNL,"$4,607.50",$0.00,"$4,607.50","$2,073.38","$3,288.37",$0.00,$793.85,$0.00,$0.00,$806.74,"$4,607.50",$0.00,"$2,303.75","$3,649.14","$3,686.00",$0.00,$721.07,$0.00,$733.51,$0.00
8556550,SUP,HCPCS C1713,,8556550  -  SCREW BONE 6.5MM 50MM SPNL POLYAX 5.5MM ROD,"$4,607.50",$0.00,"$4,607.50","$2,073.38","$3,288.37",$0.00,$793.85,$0.00,$0.00,$806.74,"$4,607.50",$0.00,"$2,303.75","$3,649.14","$3,686.00",$0.00,$721.07,$0.00,$733.51,$0.00
8556555,SUP,HCPCS C1713,,8556555  -  SCREW BONE 6.5MM 55MM SPNL POLYAX 5.5MM ROD,"$4,607.50",$0.00,"$4,607.50","$2,073.38","$3,288.37",$0.00,$793.85,$0.00,$0.00,$806.74,"$4,607.50",$0.00,"$2,303.75","$3,649.14","$3,686.00",$0.00,$721.07,$0.00,$733.51,$0.00
8557535,SUP,HCPCS C1713,,8557535  -  SCREW BONE 7.5MM 35MM SPNL POLYAX 5.5MM ROD,"$4,607.50",$0.00,"$4,607.50","$2,073.38","$3,288.37",$0.00,$793.85,$0.00,$0.00,$806.74,"$4,607.50",$0.00,"$2,303.75","$3,649.14","$3,686.00",$0.00,$721.07,$0.00,$733.51,$0.00
8557540,SUP,HCPCS C1713,,8557540  -  SCREW BONE 7.5MM 40MM SPNL POLYAX 5.5MM ROD,"$4,607.50",$0.00,"$4,607.50","$2,073.38","$3,288.37",$0.00,$793.85,$0.00,$0.00,$806.74,"$4,607.50",$0.00,"$2,303.75","$3,649.14","$3,686.00",$0.00,$721.07,$0.00,$733.51,$0.00
8557545,SUP,HCPCS C1713,,8557545  -  SCREW BONE 7.5MM 45MM SS SPNL,"$4,607.50",$0.00,"$4,607.50","$2,073.38","$3,288.37",$0.00,$793.85,$0.00,$0.00,$806.74,"$4,607.50",$0.00,"$2,303.75","$3,649.14","$3,686.00",$0.00,$721.07,$0.00,$733.51,$0.00
8557550,SUP,HCPCS C1713,,8557550  -  SCREW BONE 7.5MM 50MM SPNL POLYAX 5.5MM ROD,"$4,607.50",$0.00,"$4,607.50","$2,073.38","$3,288.37",$0.00,$793.85,$0.00,$0.00,$806.74,"$4,607.50",$0.00,"$2,303.75","$3,649.14","$3,686.00",$0.00,$721.07,$0.00,$733.51,$0.00
8557555,SUP,HCPCS C1713,,8557555  -  SCREW BONE 7.5MM 55MM SPNL POLYAX 5.5MM ROD,"$4,607.50",$0.00,"$4,607.50","$2,073.38","$3,288.37",$0.00,$793.85,$0.00,$0.00,$806.74,"$4,607.50",$0.00,"$2,303.75","$3,649.14","$3,686.00",$0.00,$721.07,$0.00,$733.51,$0.00
8558540,SUP,HCPCS C1713,,8558540  -  SCREW BONE 8.5MM 40MM SPNL POLYAX 5.5MM ROD,"$4,607.50",$0.00,"$4,607.50","$2,073.38","$3,288.37",$0.00,$793.85,$0.00,$0.00,$806.74,"$4,607.50",$0.00,"$2,303.75","$3,649.14","$3,686.00",$0.00,$721.07,$0.00,$733.51,$0.00
8558545,SUP,HCPCS C1713,,8558545  -  SCREW BONE 8.5MM 45MM SPNL POLYAX 5.5MM ROD,"$4,607.50",$0.00,"$4,607.50","$2,073.38","$3,288.37",$0.00,$793.85,$0.00,$0.00,$806.74,"$4,607.50",$0.00,"$2,303.75","$3,649.14","$3,686.00",$0.00,$721.07,$0.00,$733.51,$0.00
8558550,SUP,HCPCS C1713,,8558550  -  SCREW BONE 8.5MM 50MM SPNL POLYAX 5.5MM ROD,"$4,607.50",$0.00,"$4,607.50","$2,073.38","$3,288.37",$0.00,$793.85,$0.00,$0.00,$806.74,"$4,607.50",$0.00,"$2,303.75","$3,649.14","$3,686.00",$0.00,$721.07,$0.00,$733.51,$0.00
8560302,SUP,HCPCS C1713,,8560302  -  CONCTR ROD 6.35/5.5MM SS INLN,"$2,880.00",$0.00,"$2,880.00","$1,296.00","$2,055.46",$0.00,$496.21,$0.00,$0.00,$504.26,"$2,880.00",$0.00,"$1,440.00","$2,280.96","$2,304.00",$0.00,$450.72,$0.00,$458.50,$0.00
8560402,SUP,HCPCS C1713,,8560402  -  CONCTR ROD 6.35/5.5MM SS PRLL,"$2,880.00",$0.00,"$2,880.00","$1,296.00","$2,055.46",$0.00,$496.21,$0.00,$0.00,$504.26,"$2,880.00",$0.00,"$1,440.00","$2,280.96","$2,304.00",$0.00,$450.72,$0.00,$458.50,$0.00
8560602,SUP,HCPCS C1713,,8560602  -  CONCTR ROD 6.35/5.5MM SS 4 HOLE,"$3,617.50",$0.00,"$3,617.50","$1,627.88","$2,581.81",$0.00,$623.28,$0.00,$0.00,$633.40,"$3,617.50",$0.00,"$1,808.75","$2,865.06","$2,894.00",$0.00,$566.14,$0.00,$575.91,$0.00
8561100,SUP,HCPCS C1713,,8561100  -  SCREW BONE ARMADA SPNL LCK,$910.00,$0.00,$910.00,$409.50,$649.47,$0.00,$156.79,$0.00,$0.00,$159.33,$910.00,$0.00,$455.00,$720.72,$728.00,$0.00,$142.42,$0.00,$144.87,$0.00
8561300,SUP,HCPCS C1713,,8561300  -  CONCTR ROD ROD TO ROD LCK SCR SIDE SPNL,$757.50,$0.00,$757.50,$340.88,$540.63,$0.00,$130.51,$0.00,$0.00,$132.63,$757.50,$0.00,$378.75,$599.94,$606.00,$0.00,$118.55,$0.00,$120.59,$0.00
8562010,SUP,Custom 27203010,,8562010  -  STIMULATOR NRV STD VRSTIM3 HNDHLD LCTR SUBDERMIS,$184.00,$0.00,$184.00,$0.00,$131.32,$0.00,$0.00,$0.00,$0.00,$0.00,$184.00,$0.00,$92.00,$145.73,$147.20,$0.00,$0.00,$0.00,$0.00,$0.00
8562250,SUP,HCPCS C1713,,8562250  -  ROD SPNL 250MM 6.35MM SS,"$1,860.00",$0.00,"$1,860.00",$837.00,"$1,327.48",$0.00,$320.47,$0.00,$0.00,$325.67,"$1,860.00",$0.00,$930.00,"$1,473.12","$1,488.00",$0.00,$291.09,$0.00,$296.11,$0.00
8562500,SUP,HCPCS C1713,,8562500  -  ROD SPNL 500MM 6.35MM SS,"$2,017.50",$0.00,"$2,017.50",$907.88,"$1,439.89",$0.00,$347.61,$0.00,$0.00,$353.25,"$2,017.50",$0.00,"$1,008.75","$1,597.86","$1,614.00",$0.00,$315.74,$0.00,$321.19,$0.00
8564525,SUP,HCPCS C1713,,8564525  -  SCREW BONE 4.5MM 25MM SPNL POLYAX 6.35MM ROD,"$4,607.50",$0.00,"$4,607.50","$2,073.38","$3,288.37",$0.00,$793.85,$0.00,$0.00,$806.74,"$4,607.50",$0.00,"$2,303.75","$3,649.14","$3,686.00",$0.00,$721.07,$0.00,$733.51,$0.00
8564530,SUP,HCPCS C1713,,8564530  -  SCREW BONE 4.5MM 30MM SPNL POLYAX 6.35MM ROD,"$4,607.50",$0.00,"$4,607.50","$2,073.38","$3,288.37",$0.00,$793.85,$0.00,$0.00,$806.74,"$4,607.50",$0.00,"$2,303.75","$3,649.14","$3,686.00",$0.00,$721.07,$0.00,$733.51,$0.00
8564535,SUP,HCPCS C1713,,8564535  -  SCREW BONE 4.5MM 35MM SPNL POLYAX 6.35MM ROD,"$4,607.50",$0.00,"$4,607.50","$2,073.38","$3,288.37",$0.00,$793.85,$0.00,$0.00,$806.74,"$4,607.50",$0.00,"$2,303.75","$3,649.14","$3,686.00",$0.00,$721.07,$0.00,$733.51,$0.00
8564540,SUP,HCPCS C1713,,8564540  -  SCREW BONE 4.5MM 40MM SPNL POLYAX 6.35MM ROD,"$4,607.50",$0.00,"$4,607.50","$2,073.38","$3,288.37",$0.00,$793.85,$0.00,$0.00,$806.74,"$4,607.50",$0.00,"$2,303.75","$3,649.14","$3,686.00",$0.00,$721.07,$0.00,$733.51,$0.00
8564545,SUP,HCPCS C1713,,8564545  -  SCREW BONE 4.5MM 45MM SPNL POLYAX 6.35MM ROD,"$4,607.50",$0.00,"$4,607.50","$2,073.38","$3,288.37",$0.00,$793.85,$0.00,$0.00,$806.74,"$4,607.50",$0.00,"$2,303.75","$3,649.14","$3,686.00",$0.00,$721.07,$0.00,$733.51,$0.00
8565530,SUP,HCPCS C1713,,8565530  -  SCREW BONE 5.5MM 30MM SPNL POLYAX 6.35MM ROD,"$4,607.50",$0.00,"$4,607.50","$2,073.38","$3,288.37",$0.00,$793.85,$0.00,$0.00,$806.74,"$4,607.50",$0.00,"$2,303.75","$3,649.14","$3,686.00",$0.00,$721.07,$0.00,$733.51,$0.00
8565535,SUP,HCPCS C1713,,8565535  -  SCREW BONE 5.5MM 35MM SPNL POLYAX 6.35MM ROD,"$4,607.50",$0.00,"$4,607.50","$2,073.38","$3,288.37",$0.00,$793.85,$0.00,$0.00,$806.74,"$4,607.50",$0.00,"$2,303.75","$3,649.14","$3,686.00",$0.00,$721.07,$0.00,$733.51,$0.00
8565540,SUP,HCPCS C1713,,8565540  -  SCREW BONE 5.5MM 40MM SPNL POLYAX 6.35MM ROD,"$4,607.50",$0.00,"$4,607.50","$2,073.38","$3,288.37",$0.00,$793.85,$0.00,$0.00,$806.74,"$4,607.50",$0.00,"$2,303.75","$3,649.14","$3,686.00",$0.00,$721.07,$0.00,$733.51,$0.00
8565545,SUP,HCPCS C1713,,8565545  -  SCREW BONE 5.5MM 45MM SPNL POLYAX 6.35MM ROD,"$4,607.50",$0.00,"$4,607.50","$2,073.38","$3,288.37",$0.00,$793.85,$0.00,$0.00,$806.74,"$4,607.50",$0.00,"$2,303.75","$3,649.14","$3,686.00",$0.00,$721.07,$0.00,$733.51,$0.00
8565550,SUP,HCPCS C1713,,8565550  -  SCREW BONE 5.5MM 50MM SPNL POLYAX 6.35MM ROD,"$4,607.50",$0.00,"$4,607.50","$2,073.38","$3,288.37",$0.00,$793.85,$0.00,$0.00,$806.74,"$4,607.50",$0.00,"$2,303.75","$3,649.14","$3,686.00",$0.00,$721.07,$0.00,$733.51,$0.00
8565555,SUP,HCPCS C1713,,8565555  -  SCREW BONE 5.5MM 55MM SPNL POLYAX 6.35MM ROD,"$4,607.50",$0.00,"$4,607.50","$2,073.38","$3,288.37",$0.00,$793.85,$0.00,$0.00,$806.74,"$4,607.50",$0.00,"$2,303.75","$3,649.14","$3,686.00",$0.00,$721.07,$0.00,$733.51,$0.00
8566530,SUP,HCPCS C1713,,8566530  -  SCREW BONE 6.5MM 30MM SPNL POLYAX 6.35MM ROD,"$4,607.50",$0.00,"$4,607.50","$2,073.38","$3,288.37",$0.00,$793.85,$0.00,$0.00,$806.74,"$4,607.50",$0.00,"$2,303.75","$3,649.14","$3,686.00",$0.00,$721.07,$0.00,$733.51,$0.00
8566535,SUP,HCPCS C1713,,8566535  -  SCREW BONE 6.5MM 35MM SPNL POLYAX 6.35MM ROD,"$4,607.50",$0.00,"$4,607.50","$2,073.38","$3,288.37",$0.00,$793.85,$0.00,$0.00,$806.74,"$4,607.50",$0.00,"$2,303.75","$3,649.14","$3,686.00",$0.00,$721.07,$0.00,$733.51,$0.00
8566540,SUP,HCPCS C1713,,8566540  -  SCREW BONE 6.5MM 40MM SPNL POLYAX 6.35MM ROD,"$4,607.50",$0.00,"$4,607.50","$2,073.38","$3,288.37",$0.00,$793.85,$0.00,$0.00,$806.74,"$4,607.50",$0.00,"$2,303.75","$3,649.14","$3,686.00",$0.00,$721.07,$0.00,$733.51,$0.00
8566545,SUP,HCPCS C1713,,8566545  -  SCREW BONE 6.5MM 45MM SPNL POLYAX 6.35MM ROD,"$4,607.50",$0.00,"$4,607.50","$2,073.38","$3,288.37",$0.00,$793.85,$0.00,$0.00,$806.74,"$4,607.50",$0.00,"$2,303.75","$3,649.14","$3,686.00",$0.00,$721.07,$0.00,$733.51,$0.00
8566550,SUP,HCPCS C1713,,8566550  -  SCREW BONE 6.5MM 50MM SPNL POLYAX 6.35MM ROD,"$4,607.50",$0.00,"$4,607.50","$2,073.38","$3,288.37",$0.00,$793.85,$0.00,$0.00,$806.74,"$4,607.50",$0.00,"$2,303.75","$3,649.14","$3,686.00",$0.00,$721.07,$0.00,$733.51,$0.00
8566555,SUP,HCPCS C1713,,8566555  -  SCREW BONE 6.5MM 55MM SPNL POLYAX 6.35MM ROD,"$4,607.50",$0.00,"$4,607.50","$2,073.38","$3,288.37",$0.00,$793.85,$0.00,$0.00,$806.74,"$4,607.50",$0.00,"$2,303.75","$3,649.14","$3,686.00",$0.00,$721.07,$0.00,$733.51,$0.00
8567535,SUP,HCPCS C1713,,8567535  -  SCREW BONE 7.5MM 35MM SPNL POLYAX 6.35MM ROD,"$4,607.50",$0.00,"$4,607.50","$2,073.38","$3,288.37",$0.00,$793.85,$0.00,$0.00,$806.74,"$4,607.50",$0.00,"$2,303.75","$3,649.14","$3,686.00",$0.00,$721.07,$0.00,$733.51,$0.00
8567540,SUP,HCPCS C1713,,8567540  -  SCREW BONE 7.5MM 40MM SPNL POLYAX 6.35MM ROD,"$4,607.50",$0.00,"$4,607.50","$2,073.38","$3,288.37",$0.00,$793.85,$0.00,$0.00,$806.74,"$4,607.50",$0.00,"$2,303.75","$3,649.14","$3,686.00",$0.00,$721.07,$0.00,$733.51,$0.00
8567545,SUP,HCPCS C1713,,8567545  -  SCREW BONE 7.5MM 45MM SPNL POLYAX 6.35MM ROD,"$4,607.50",$0.00,"$4,607.50","$2,073.38","$3,288.37",$0.00,$793.85,$0.00,$0.00,$806.74,"$4,607.50",$0.00,"$2,303.75","$3,649.14","$3,686.00",$0.00,$721.07,$0.00,$733.51,$0.00
8567550,SUP,HCPCS C1713,,8567550  -  SCREW BONE 7.5MM 50MM SPNL POLYAX 6.35MM ROD,"$4,607.50",$0.00,"$4,607.50","$2,073.38","$3,288.37",$0.00,$793.85,$0.00,$0.00,$806.74,"$4,607.50",$0.00,"$2,303.75","$3,649.14","$3,686.00",$0.00,$721.07,$0.00,$733.51,$0.00
8567555,SUP,HCPCS C1713,,8567555  -  SCREW BONE 7.5MM 55MM SPNL POLYAX 6.35MM ROD,"$4,607.50",$0.00,"$4,607.50","$2,073.38","$3,288.37",$0.00,$793.85,$0.00,$0.00,$806.74,"$4,607.50",$0.00,"$2,303.75","$3,649.14","$3,686.00",$0.00,$721.07,$0.00,$733.51,$0.00
8568535,SUP,HCPCS C1713,,8568535  -  SCREW BONE 8.5MM 35MM SPNL POLYAX 6.35MM ROD,"$4,607.50",$0.00,"$4,607.50","$2,073.38","$3,288.37",$0.00,$793.85,$0.00,$0.00,$806.74,"$4,607.50",$0.00,"$2,303.75","$3,649.14","$3,686.00",$0.00,$721.07,$0.00,$733.51,$0.00
8568540,SUP,HCPCS C1713,,8568540  -  SCREW BONE 8.5MM 40MM SPNL POLYAX 6.35MM ROD,"$4,607.50",$0.00,"$4,607.50","$2,073.38","$3,288.37",$0.00,$793.85,$0.00,$0.00,$806.74,"$4,607.50",$0.00,"$2,303.75","$3,649.14","$3,686.00",$0.00,$721.07,$0.00,$733.51,$0.00
8568545,SUP,HCPCS C1713,,8568545  -  SCREW BONE 8.5MM 45MM SPNL POLYAX 6.35MM ROD,"$4,607.50",$0.00,"$4,607.50","$2,073.38","$3,288.37",$0.00,$793.85,$0.00,$0.00,$806.74,"$4,607.50",$0.00,"$2,303.75","$3,649.14","$3,686.00",$0.00,$721.07,$0.00,$733.51,$0.00
8568550,SUP,HCPCS C1713,,8568550  -  SCREW BONE 8.5MM 50MM SPNL POLYAX 6.35MM ROD,"$4,607.50",$0.00,"$4,607.50","$2,073.38","$3,288.37",$0.00,$793.85,$0.00,$0.00,$806.74,"$4,607.50",$0.00,"$2,303.75","$3,649.14","$3,686.00",$0.00,$721.07,$0.00,$733.51,$0.00
8570611,SUP,HCPCS C1713,,8570611  -  CROSSLINK 8570611 4.5MM DUAL ROD 11MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8570612,SUP,HCPCS C1713,,8570612  -  CROSSLINK 8570612 4.5MM DUAL ROD 12MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8570613,SUP,HCPCS C1713,,8570613  -  CROSSLINK 8570613 4.5MM DUAL ROD 13MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8570614,SUP,HCPCS C1713,,8570614  -  CROSSLINK 8570614 4.5MM DUAL ROD 14MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8570615,SUP,HCPCS C1713,,8570615  -  CROSSLINK 8570615 4.5MM DUAL ROD 15MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8570616,SUP,HCPCS C1713,,8570616  -  CROSSLINK 8570616 4.5MM DUAL ROD 16MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8570617,SUP,HCPCS C1713,,8570617  -  CROSSLINK 8570617 4.5MM DUAL ROD 17MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8576510,SUP,HCPCS C1713,,8576510  -  SCREW BONE 6.5MM 80MM ILC SPNL 6.35MM ROD,"$5,602.50",$0.00,"$5,602.50","$2,521.13","$3,998.50",$0.00,$965.28,$0.00,$0.00,$980.95,"$5,602.50",$0.00,"$2,801.25","$4,437.18","$4,482.00",$0.00,$876.79,$0.00,$891.92,$0.00
8576570,SUP,HCPCS C1713,,8576570  -  SCREW BONE 6.5MM 70MM ILC SPNL 6.35MM ROD,"$5,602.50",$0.00,"$5,602.50","$2,521.13","$3,998.50",$0.00,$965.28,$0.00,$0.00,$980.95,"$5,602.50",$0.00,"$2,801.25","$4,437.18","$4,482.00",$0.00,$876.79,$0.00,$891.92,$0.00
8576580,SUP,HCPCS C1713,,8576580  -  SCREW BONE 6.5MM 80MM ILC SPNL 6.35MM ROD,"$5,602.50",$0.00,"$5,602.50","$2,521.13","$3,998.50",$0.00,$965.28,$0.00,$0.00,$980.95,"$5,602.50",$0.00,"$2,801.25","$4,437.18","$4,482.00",$0.00,$876.79,$0.00,$891.92,$0.00
8576590,SUP,HCPCS C1713,,8576590  -  SCREW BONE 6.5MM 90MM ILC SPNL 6.35MM ROD,"$5,602.50",$0.00,"$5,602.50","$2,521.13","$3,998.50",$0.00,$965.28,$0.00,$0.00,$980.95,"$5,602.50",$0.00,"$2,801.25","$4,437.18","$4,482.00",$0.00,$876.79,$0.00,$891.92,$0.00
8577510,SUP,HCPCS C1713,,8577510  -  SCREW BONE 7.5MM 100MM ILC SPNL 6.3MM,"$5,602.50",$0.00,"$5,602.50","$2,521.13","$3,998.50",$0.00,$965.28,$0.00,$0.00,$980.95,"$5,602.50",$0.00,"$2,801.25","$4,437.18","$4,482.00",$0.00,$876.79,$0.00,$891.92,$0.00
8577570,SUP,HCPCS C1713,,8577570  -  SCREW BONE 7.5MM 70MM ILC SPNL 6.35MM ROD,"$5,602.50",$0.00,"$5,602.50","$2,521.13","$3,998.50",$0.00,$965.28,$0.00,$0.00,$980.95,"$5,602.50",$0.00,"$2,801.25","$4,437.18","$4,482.00",$0.00,$876.79,$0.00,$891.92,$0.00
8577580,SUP,HCPCS C1713,,8577580  -  SCREW BONE 7.5MM 80MM ILC SPNL 6.35MM ROD,"$5,602.50",$0.00,"$5,602.50","$2,521.13","$3,998.50",$0.00,$965.28,$0.00,$0.00,$980.95,"$5,602.50",$0.00,"$2,801.25","$4,437.18","$4,482.00",$0.00,$876.79,$0.00,$891.92,$0.00
8577590,SUP,HCPCS C1713,,8577590  -  SCREW BONE 7.5MM 90MM ILC SPNL 6.35MM ROD,"$5,602.50",$0.00,"$5,602.50","$2,521.13","$3,998.50",$0.00,$965.28,$0.00,$0.00,$980.95,"$5,602.50",$0.00,"$2,801.25","$4,437.18","$4,482.00",$0.00,$876.79,$0.00,$891.92,$0.00
8578510,SUP,HCPCS C1713,,8578510  -  SCREW BONE 8.5MM 100MM ILC SPNL 6.3MM,"$5,602.50",$0.00,"$5,602.50","$2,521.13","$3,998.50",$0.00,$965.28,$0.00,$0.00,$980.95,"$5,602.50",$0.00,"$2,801.25","$4,437.18","$4,482.00",$0.00,$876.79,$0.00,$891.92,$0.00
8578570,SUP,HCPCS C1713,,8578570  -  SCREW BONE 8.5MM 70MM ILC SPNL 6.35MM ROD,"$5,602.50",$0.00,"$5,602.50","$2,521.13","$3,998.50",$0.00,$965.28,$0.00,$0.00,$980.95,"$5,602.50",$0.00,"$2,801.25","$4,437.18","$4,482.00",$0.00,$876.79,$0.00,$891.92,$0.00
8578580,SUP,HCPCS C1713,,8578580  -  SCREW BONE 8.5MM 80MM ILC SPNL 6.35MM ROD,"$5,602.50",$0.00,"$5,602.50","$2,521.13","$3,998.50",$0.00,$965.28,$0.00,$0.00,$980.95,"$5,602.50",$0.00,"$2,801.25","$4,437.18","$4,482.00",$0.00,$876.79,$0.00,$891.92,$0.00
8578590,SUP,HCPCS C1713,,8578590  -  SCREW BONE 8.5MM 90MM ILC SPNL 6.35MM ROD,"$5,602.50",$0.00,"$5,602.50","$2,521.13","$3,998.50",$0.00,$965.28,$0.00,$0.00,$980.95,"$5,602.50",$0.00,"$2,801.25","$4,437.18","$4,482.00",$0.00,$876.79,$0.00,$891.92,$0.00
8579008,SUP,HCPCS C1713,,8579008  -  CROSSLINK 8579008 4.5 LP .625 16MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8579009,SUP,HCPCS C1713,,8579009  -  CROSSLINK 8579009 4.5 LP .750 19MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8579010,SUP,HCPCS C1713,,8579010  -  CROSSLINK 8579010 4.5 LP .875 22MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8579011,SUP,HCPCS C1713,,8579011  -  CROSSLINK 8579011 4.5 LP 1.00 25MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8579012,SUP,HCPCS C1713,,8579012  -  CROSSLINK 8579012 4.5 LP 1.12529MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8579013,SUP,HCPCS C1713,,8579013  -  CROSSLINK 8579013 4.5 LP 1.25032MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8579014,SUP,HCPCS C1713,,8579014  -  CROSSLINK 8579014 4.5 LP 1.37535MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8579015,SUP,HCPCS C1713,,8579015  -  CROSSLINK 8579015 4.5 LP 1.50038MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8579016,SUP,HCPCS C1713,,8579016  -  CROSSLINK 8579016 4.5 LP 1.55 1.75,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8579017,SUP,HCPCS C1713,,8579017  -  CROSSLINK 8579017 4.5 LP 1.75 2.15,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8579018,SUP,HCPCS C1713,,8579018  -  CROSSLINK 8579018 4.5 LP 2.15 2.95,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8579300,SUP,Custom 27803010,,8579300  -  CONNECTOR 8579300 4.5 TO 4.5MM DOMINO,"$1,796.58",$0.00,"$1,796.58",$0.00,"$1,282.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,796.58",$0.00,$898.29,"$1,422.89","$1,437.26",$0.00,$0.00,$0.00,$0.00,$0.00
8579301,SUP,Custom 27803010,,8579301  -  CONNECTOR 8579301 4.5 TO 5.5MM DOMINO,"$1,796.58",$0.00,"$1,796.58",$0.00,"$1,282.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,796.58",$0.00,$898.29,"$1,422.89","$1,437.26",$0.00,$0.00,$0.00,$0.00,$0.00
8580858,SUP,HCPCS C1713,,"8580858  -  SET SCREW, BREAK-OFF, M8, SS",$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
8590855,SUP,HCPCS C1713,,8590855  -  SCREW SET TI 55MM SPNL BRKOF CLOSE HZNM8 5.5MM ROD,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
8590858,SUP,HCPCS C1713,,"8590858  -  SET SCREW, BREAK-OFF, M8, TI",$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
8594520,SUP,HCPCS C1713,,8594520  -  SCREW BN 4.5MM 20MM NS BRIGADE CRNT SPNE XLRF SYS,"$1,957.50",$0.00,"$1,957.50",$880.88,"$1,397.07",$0.00,$337.27,$0.00,$0.00,$342.74,"$1,957.50",$0.00,$978.75,"$1,550.34","$1,566.00",$0.00,$306.35,$0.00,$311.63,$0.00
8594522,SUP,HCPCS C1713,,8594522  -  SCREW BN 4.5MM 22.5MM NS BRIGADE CRNT SPNE XLRF SYS,"$1,957.50",$0.00,"$1,957.50",$880.88,"$1,397.07",$0.00,$337.27,$0.00,$0.00,$342.74,"$1,957.50",$0.00,$978.75,"$1,550.34","$1,566.00",$0.00,$306.35,$0.00,$311.63,$0.00
8594525,SUP,HCPCS C1713,,8594525  -  SCREW BONE 4.5MM 25MM POLYAX BRIGADE SPN,"$1,957.50",$0.00,"$1,957.50",$880.88,"$1,397.07",$0.00,$337.27,$0.00,$0.00,$342.74,"$1,957.50",$0.00,$978.75,"$1,550.34","$1,566.00",$0.00,$306.35,$0.00,$311.63,$0.00
8594527,SUP,HCPCS C1713,,8594527  -  SCREW BN 4.5MM 27.5MM NS BRIGADE CRNT SPNE XLRF SYS,"$1,957.50",$0.00,"$1,957.50",$880.88,"$1,397.07",$0.00,$337.27,$0.00,$0.00,$342.74,"$1,957.50",$0.00,$978.75,"$1,550.34","$1,566.00",$0.00,$306.35,$0.00,$311.63,$0.00
8594530,SUP,HCPCS C1713,,8594530  -  SCREW BN 4.5MM 30MM NS BRIGADE CRNT SPNE XLRF SYS,"$1,957.50",$0.00,"$1,957.50",$880.88,"$1,397.07",$0.00,$337.27,$0.00,$0.00,$342.74,"$1,957.50",$0.00,$978.75,"$1,550.34","$1,566.00",$0.00,$306.35,$0.00,$311.63,$0.00
8594535,SUP,HCPCS C1713,,8594535  -  SCREW BN 4.5MM 35MM NS BRIGADE CRNT SPNE XLRF SYS,"$1,957.50",$0.00,"$1,957.50",$880.88,"$1,397.07",$0.00,$337.27,$0.00,$0.00,$342.74,"$1,957.50",$0.00,$978.75,"$1,550.34","$1,566.00",$0.00,$306.35,$0.00,$311.63,$0.00
8595520,SUP,HCPCS C1713,,8595520  -  SCREW BN 5.5MM 20MM NS BRIGADE CRNT SPNE XLRF SYS,"$1,957.50",$0.00,"$1,957.50",$880.88,"$1,397.07",$0.00,$337.27,$0.00,$0.00,$342.74,"$1,957.50",$0.00,$978.75,"$1,550.34","$1,566.00",$0.00,$306.35,$0.00,$311.63,$0.00
8595522,SUP,HCPCS C1713,,8595522  -  SCREW BN 5.5MM 22.5MM NS BRIGADE CRNT SPNE XLRF SYS,"$1,957.50",$0.00,"$1,957.50",$880.88,"$1,397.07",$0.00,$337.27,$0.00,$0.00,$342.74,"$1,957.50",$0.00,$978.75,"$1,550.34","$1,566.00",$0.00,$306.35,$0.00,$311.63,$0.00
8595525,SUP,HCPCS C1713,,8595525  -  SCREW BN 5.5MM 25MM NS BRIGADE CRNT SPNE XLRF SYS,"$1,957.50",$0.00,"$1,957.50",$880.88,"$1,397.07",$0.00,$337.27,$0.00,$0.00,$342.74,"$1,957.50",$0.00,$978.75,"$1,550.34","$1,566.00",$0.00,$306.35,$0.00,$311.63,$0.00
8595527,SUP,HCPCS C1713,,8595527  -  SCREW BN 5.5MM 27.5MM NS BRIGADE CRNT SPNE XLRF SYS,"$1,957.50",$0.00,"$1,957.50",$880.88,"$1,397.07",$0.00,$337.27,$0.00,$0.00,$342.74,"$1,957.50",$0.00,$978.75,"$1,550.34","$1,566.00",$0.00,$306.35,$0.00,$311.63,$0.00
8595530,SUP,HCPCS C1713,,8595530  -  SCREW BN 5.5MM 30MM NS BRIGADE CRNT SPNE XLRF SYS,"$1,957.50",$0.00,"$1,957.50",$880.88,"$1,397.07",$0.00,$337.27,$0.00,$0.00,$342.74,"$1,957.50",$0.00,$978.75,"$1,550.34","$1,566.00",$0.00,$306.35,$0.00,$311.63,$0.00
8595535,SUP,HCPCS C1713,,8595535  -  SCREW BN 5.5MM 35MM NS BRIGADE CRNT SPNE XLRF SYS,"$1,957.50",$0.00,"$1,957.50",$880.88,"$1,397.07",$0.00,$337.27,$0.00,$0.00,$342.74,"$1,957.50",$0.00,$978.75,"$1,550.34","$1,566.00",$0.00,$306.35,$0.00,$311.63,$0.00
8610425,SUP,HCPCS C1713,,8610425  -  SCREW 8610425 CLRD 4.5MMX25MM,"$2,517.00",$0.00,"$2,517.00","$1,132.65","$1,796.38",$0.00,$433.67,$0.00,$0.00,$440.71,"$2,517.00",$0.00,"$1,258.50","$1,993.46","$2,013.60",$0.00,$393.91,$0.00,$400.71,$0.00
8610430,SUP,HCPCS C1713,,8610430  -  SCREW 8610430 CLRD 4.5MMX30MM,"$2,517.00",$0.00,"$2,517.00","$1,132.65","$1,796.38",$0.00,$433.67,$0.00,$0.00,$440.71,"$2,517.00",$0.00,"$1,258.50","$1,993.46","$2,013.60",$0.00,$393.91,$0.00,$400.71,$0.00
8610435,SUP,HCPCS C1713,,8610435  -  SCREW 8610435 CLRD 4.5MMX35MM,"$2,517.00",$0.00,"$2,517.00","$1,132.65","$1,796.38",$0.00,$433.67,$0.00,$0.00,$440.71,"$2,517.00",$0.00,"$1,258.50","$1,993.46","$2,013.60",$0.00,$393.91,$0.00,$400.71,$0.00
8610440,SUP,HCPCS C1713,,8610440  -  SCREW 8610440 CLRD 4.5MMX40MM,"$2,517.00",$0.00,"$2,517.00","$1,132.65","$1,796.38",$0.00,$433.67,$0.00,$0.00,$440.71,"$2,517.00",$0.00,"$1,258.50","$1,993.46","$2,013.60",$0.00,$393.91,$0.00,$400.71,$0.00
8610445,SUP,HCPCS C1713,,8610445  -  SCREW 8610445 CLRD  4.5MMX45MM,"$2,517.00",$0.00,"$2,517.00","$1,132.65","$1,796.38",$0.00,$433.67,$0.00,$0.00,$440.71,"$2,517.00",$0.00,"$1,258.50","$1,993.46","$2,013.60",$0.00,$393.91,$0.00,$400.71,$0.00
8610525,SUP,HCPCS C1713,,8610525  -  SCREW 8610525 CLRD 5.5MMX25MM,"$2,517.00",$0.00,"$2,517.00","$1,132.65","$1,796.38",$0.00,$433.67,$0.00,$0.00,$440.71,"$2,517.00",$0.00,"$1,258.50","$1,993.46","$2,013.60",$0.00,$393.91,$0.00,$400.71,$0.00
8610530,SUP,HCPCS C1713,,8610530  -  SCREW 8610530 CLRD 5.5MMX30MM,"$2,517.00",$0.00,"$2,517.00","$1,132.65","$1,796.38",$0.00,$433.67,$0.00,$0.00,$440.71,"$2,517.00",$0.00,"$1,258.50","$1,993.46","$2,013.60",$0.00,$393.91,$0.00,$400.71,$0.00
8610535,SUP,HCPCS C1713,,8610535  -  SCREW 8610535 CLRD 5.5MMX35MM,"$2,517.00",$0.00,"$2,517.00","$1,132.65","$1,796.38",$0.00,$433.67,$0.00,$0.00,$440.71,"$2,517.00",$0.00,"$1,258.50","$1,993.46","$2,013.60",$0.00,$393.91,$0.00,$400.71,$0.00
8610540,SUP,HCPCS C1713,,8610540  -  SCREW 8610540 CLRD 5.5MMX40MM,"$2,517.00",$0.00,"$2,517.00","$1,132.65","$1,796.38",$0.00,$433.67,$0.00,$0.00,$440.71,"$2,517.00",$0.00,"$1,258.50","$1,993.46","$2,013.60",$0.00,$393.91,$0.00,$400.71,$0.00
8610545,SUP,HCPCS C1713,,8610545  -  SCREW 8610545 CLRD 5.5MMX45MM,"$2,517.00",$0.00,"$2,517.00","$1,132.65","$1,796.38",$0.00,$433.67,$0.00,$0.00,$440.71,"$2,517.00",$0.00,"$1,258.50","$1,993.46","$2,013.60",$0.00,$393.91,$0.00,$400.71,$0.00
8610550,SUP,HCPCS C1713,,8610550  -  SCREW 8610550 CLRD 5.5MMX50MM,"$2,517.00",$0.00,"$2,517.00","$1,132.65","$1,796.38",$0.00,$433.67,$0.00,$0.00,$440.71,"$2,517.00",$0.00,"$1,258.50","$1,993.46","$2,013.60",$0.00,$393.91,$0.00,$400.71,$0.00
8610555,SUP,HCPCS C1713,,8610555  -  SCREW 8610555 CLRD 5.5MMX55MM,"$2,517.00",$0.00,"$2,517.00","$1,132.65","$1,796.38",$0.00,$433.67,$0.00,$0.00,$440.71,"$2,517.00",$0.00,"$1,258.50","$1,993.46","$2,013.60",$0.00,$393.91,$0.00,$400.71,$0.00
8610630,SUP,HCPCS C1713,,8610630  -  SCREW 8610630 CLRD 6.5MMX30MM,"$2,517.00",$0.00,"$2,517.00","$1,132.65","$1,796.38",$0.00,$433.67,$0.00,$0.00,$440.71,"$2,517.00",$0.00,"$1,258.50","$1,993.46","$2,013.60",$0.00,$393.91,$0.00,$400.71,$0.00
8610635,SUP,HCPCS C1713,,8610635  -  SCREW 8610635 CLRD 6.5MMX35MM,"$2,517.00",$0.00,"$2,517.00","$1,132.65","$1,796.38",$0.00,$433.67,$0.00,$0.00,$440.71,"$2,517.00",$0.00,"$1,258.50","$1,993.46","$2,013.60",$0.00,$393.91,$0.00,$400.71,$0.00
8610640,SUP,HCPCS C1713,,8610640  -  SCREW 8610640 CLRD 6.5MMX40MM,"$2,517.00",$0.00,"$2,517.00","$1,132.65","$1,796.38",$0.00,$433.67,$0.00,$0.00,$440.71,"$2,517.00",$0.00,"$1,258.50","$1,993.46","$2,013.60",$0.00,$393.91,$0.00,$400.71,$0.00
8610645,SUP,HCPCS C1713,,8610645  -  SCREW 8610645 CLRD 6.5MMX45MM,"$2,517.00",$0.00,"$2,517.00","$1,132.65","$1,796.38",$0.00,$433.67,$0.00,$0.00,$440.71,"$2,517.00",$0.00,"$1,258.50","$1,993.46","$2,013.60",$0.00,$393.91,$0.00,$400.71,$0.00
8610650,SUP,HCPCS C1713,,8610650  -  SCREW 8610650 CLRD 6.5MMX50MM,"$2,517.00",$0.00,"$2,517.00","$1,132.65","$1,796.38",$0.00,$433.67,$0.00,$0.00,$440.71,"$2,517.00",$0.00,"$1,258.50","$1,993.46","$2,013.60",$0.00,$393.91,$0.00,$400.71,$0.00
8610655,SUP,HCPCS C1713,,8610655  -  SCREW 8610655 CLRD 6.5MMX55MM,"$2,517.00",$0.00,"$2,517.00","$1,132.65","$1,796.38",$0.00,$433.67,$0.00,$0.00,$440.71,"$2,517.00",$0.00,"$1,258.50","$1,993.46","$2,013.60",$0.00,$393.91,$0.00,$400.71,$0.00
8610735,SUP,HCPCS C1713,,8610735  -  SCREW 8610735 CLRD 7.5MMX35MM,"$2,517.00",$0.00,"$2,517.00","$1,132.65","$1,796.38",$0.00,$433.67,$0.00,$0.00,$440.71,"$2,517.00",$0.00,"$1,258.50","$1,993.46","$2,013.60",$0.00,$393.91,$0.00,$400.71,$0.00
8610740,SUP,HCPCS C1713,,8610740  -  SCREW 8610740 CLRD 7.5MMX40MM,"$2,517.00",$0.00,"$2,517.00","$1,132.65","$1,796.38",$0.00,$433.67,$0.00,$0.00,$440.71,"$2,517.00",$0.00,"$1,258.50","$1,993.46","$2,013.60",$0.00,$393.91,$0.00,$400.71,$0.00
8610745,SUP,HCPCS C1713,,8610745  -  SCREW 8610745 CLRD 7.5MMX45MM,"$2,517.00",$0.00,"$2,517.00","$1,132.65","$1,796.38",$0.00,$433.67,$0.00,$0.00,$440.71,"$2,517.00",$0.00,"$1,258.50","$1,993.46","$2,013.60",$0.00,$393.91,$0.00,$400.71,$0.00
8610750,SUP,HCPCS C1713,,8610750  -  SCREW 8610750 CLRD 7.5MMX50MM,"$2,517.00",$0.00,"$2,517.00","$1,132.65","$1,796.38",$0.00,$433.67,$0.00,$0.00,$440.71,"$2,517.00",$0.00,"$1,258.50","$1,993.46","$2,013.60",$0.00,$393.91,$0.00,$400.71,$0.00
8611102,SUP,HCPCS C1713,,8611102  -  HOOK 8611102 PEDICULAR SM GROOVE,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
8611104,SUP,HCPCS C1713,,8611104  -  HOOK 8611104 PEDICULAR LG GROOVE,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
8611202,SUP,HCPCS C1713,,8611202  -  HOOK 8611202 LAMINAR SM GROOVE,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
8611203,SUP,HCPCS C1713,,8611203  -  HOOK 8611203 LAM MEDIUM GROOVE,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
8611204,SUP,HCPCS C1713,,8611204  -  HOOK 8611204 LAMINAR LG GROOVE,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
8611300,SUP,HCPCS C1713,,8611300  -  STAPLE 8611300 PEDICULAR HK,$873.00,$0.00,$873.00,$392.85,$623.06,$0.00,$150.41,$0.00,$0.00,$152.86,$873.00,$0.00,$436.50,$691.42,$698.40,$0.00,$136.62,$0.00,$138.98,$0.00
8611402,SUP,HCPCS C1713,,8611402  -  HOOK 8611402 CLOSED LAM THOR,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
8612055,SUP,HCPCS C1713,,8612055  -  SCREW 8612055 CLRD ILIO SCARAL 7.0X55MM,"$1,594.50",$0.00,"$1,594.50",$717.53,"$1,137.99",$0.00,$274.72,$0.00,$0.00,$279.18,"$1,594.50",$0.00,$797.25,"$1,262.84","$1,275.60",$0.00,$249.54,$0.00,$253.84,$0.00
8612060,SUP,HCPCS C1713,,8612060  -  SCREW 8612060 CLRD ILIO SCARAL 7.0X60MM,"$1,594.50",$0.00,"$1,594.50",$717.53,"$1,137.99",$0.00,$274.72,$0.00,$0.00,$279.18,"$1,594.50",$0.00,$797.25,"$1,262.84","$1,275.60",$0.00,$249.54,$0.00,$253.84,$0.00
8612065,SUP,HCPCS C1713,,8612065  -  SCREW 8612065 CLRD ILIO SCARAL 7.0X65MM,"$1,594.50",$0.00,"$1,594.50",$717.53,"$1,137.99",$0.00,$274.72,$0.00,$0.00,$279.18,"$1,594.50",$0.00,$797.25,"$1,262.84","$1,275.60",$0.00,$249.54,$0.00,$253.84,$0.00
8612070,SUP,HCPCS C1713,,8612070  -  SCREW 8612070 CLRD ILIO SCARAL 7.0X70MM,"$1,594.50",$0.00,"$1,594.50",$717.53,"$1,137.99",$0.00,$274.72,$0.00,$0.00,$279.18,"$1,594.50",$0.00,$797.25,"$1,262.84","$1,275.60",$0.00,$249.54,$0.00,$253.84,$0.00
8612075,SUP,HCPCS C1713,,8612075  -  SCREW 8612075 CLRD ILIO SCARAL 7.0X75MM,"$1,594.50",$0.00,"$1,594.50",$717.53,"$1,137.99",$0.00,$274.72,$0.00,$0.00,$279.18,"$1,594.50",$0.00,$797.25,"$1,262.84","$1,275.60",$0.00,$249.54,$0.00,$253.84,$0.00
8612080,SUP,HCPCS C1713,,8612080  -  SCREW 8612080 CLRD ILIO SCARAL 7.0X80MM,"$1,594.50",$0.00,"$1,594.50",$717.53,"$1,137.99",$0.00,$274.72,$0.00,$0.00,$279.18,"$1,594.50",$0.00,$797.25,"$1,262.84","$1,275.60",$0.00,$249.54,$0.00,$253.84,$0.00
8612230,SUP,HCPCS C1713,,8612230  -  SCREW 8612230 CLRD SACRAL 6.5X30MM,"$1,594.50",$0.00,"$1,594.50",$717.53,"$1,137.99",$0.00,$274.72,$0.00,$0.00,$279.18,"$1,594.50",$0.00,$797.25,"$1,262.84","$1,275.60",$0.00,$249.54,$0.00,$253.84,$0.00
8612235,SUP,HCPCS C1713,,8612235  -  SCREW 8612235 CLRD SACRAL 6.5X35MM,"$1,594.50",$0.00,"$1,594.50",$717.53,"$1,137.99",$0.00,$274.72,$0.00,$0.00,$279.18,"$1,594.50",$0.00,$797.25,"$1,262.84","$1,275.60",$0.00,$249.54,$0.00,$253.84,$0.00
8612240,SUP,HCPCS C1713,,8612240  -  SCREW 8612240 CLRD SACRAL 6.5X40MM,"$1,594.50",$0.00,"$1,594.50",$717.53,"$1,137.99",$0.00,$274.72,$0.00,$0.00,$279.18,"$1,594.50",$0.00,$797.25,"$1,262.84","$1,275.60",$0.00,$249.54,$0.00,$253.84,$0.00
8612245,SUP,HCPCS C1713,,8612245  -  SCREW 8612245 CLRD SACRAL 6.5X45MM,"$1,594.50",$0.00,"$1,594.50",$717.53,"$1,137.99",$0.00,$274.72,$0.00,$0.00,$279.18,"$1,594.50",$0.00,$797.25,"$1,262.84","$1,275.60",$0.00,$249.54,$0.00,$253.84,$0.00
8612250,SUP,HCPCS C1713,,8612250  -  SCREW 8612250 CLRD SACRAL 6.5X50MM,"$1,594.50",$0.00,"$1,594.50",$717.53,"$1,137.99",$0.00,$274.72,$0.00,$0.00,$279.18,"$1,594.50",$0.00,$797.25,"$1,262.84","$1,275.60",$0.00,$249.54,$0.00,$253.84,$0.00
8612255,SUP,HCPCS C1713,,8612255  -  SCREW 8612255 CLRD SACRAL 6.5X55MM,"$1,594.50",$0.00,"$1,594.50",$717.53,"$1,137.99",$0.00,$274.72,$0.00,$0.00,$279.18,"$1,594.50",$0.00,$797.25,"$1,262.84","$1,275.60",$0.00,$249.54,$0.00,$253.84,$0.00
8612260,SUP,HCPCS C1713,,8612260  -  SCREW 8612260 CLRD SACRAL 6.5X60MM,"$1,594.50",$0.00,"$1,594.50",$717.53,"$1,137.99",$0.00,$274.72,$0.00,$0.00,$279.18,"$1,594.50",$0.00,$797.25,"$1,262.84","$1,275.60",$0.00,$249.54,$0.00,$253.84,$0.00
8612265,SUP,HCPCS C1713,,8612265  -  SCREW 8612265 CLRD SACRAL 6.5X65MM,"$1,594.50",$0.00,"$1,594.50",$717.53,"$1,137.99",$0.00,$274.72,$0.00,$0.00,$279.18,"$1,594.50",$0.00,$797.25,"$1,262.84","$1,275.60",$0.00,$249.54,$0.00,$253.84,$0.00
8612270,SUP,HCPCS C1713,,8612270  -  SCREW 8612270 CLRD SACRAL 6.5X70MM,"$1,594.50",$0.00,"$1,594.50",$717.53,"$1,137.99",$0.00,$274.72,$0.00,$0.00,$279.18,"$1,594.50",$0.00,$797.25,"$1,262.84","$1,275.60",$0.00,$249.54,$0.00,$253.84,$0.00
8613505,SUP,HCPCS C1713,,8613505  -  ROD 8613505 CLRD 5.0X50MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8613506,SUP,HCPCS C1713,,8613506  -  ROD 8613506 CLRD 5.0X60MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8613507,SUP,HCPCS C1713,,8613507  -  ROD 8613507 CLRD 5.0X70MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8613508,SUP,HCPCS C1713,,8613508  -  ROD 8613508 CLRD 5.0X80MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8613509,SUP,HCPCS C1713,,8613509  -  ROD 8613509 CLRD 5.0X90MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8613510,SUP,HCPCS C1713,,8613510  -  ROD 8613510 CLRD 5.0X100MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8613511,SUP,HCPCS C1713,,8613511  -  ROD 8613511 CLRD 5.0X110MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8613512,SUP,HCPCS C1713,,8613512  -  ROD 8613512 CLRD 5.0X120MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8613514,SUP,HCPCS C1713,,8613514  -  ROD 8613514 CLRD 5.0X140MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8613516,SUP,HCPCS C1713,,8613516  -  ROD 8613516 CLRD 5.0X160MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8613518,SUP,HCPCS C1713,,8613518  -  ROD 8613518 CLRD 5.0X180MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8613520,SUP,HCPCS C1713,,8613520  -  ROD 8613520 CLRD 5.0X200MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8613522,SUP,HCPCS C1713,,8613522  -  ROD 8613522 CLRD 5.0X220MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8613524,SUP,HCPCS C1713,,8613524  -  ROD 8613524 CLRD 5.0X240MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8613526,SUP,HCPCS C1713,,8613526  -  ROD 8613526 CLRD 5.0X260MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8613528,SUP,HCPCS C1713,,8613528  -  ROD 8613528 CLRD 5.0X280MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8613530,SUP,HCPCS C1713,,8613530  -  ROD 8613530 CLRD 5.0X300MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8613532,SUP,HCPCS C1713,,8613532  -  ROD 8613532 CLRD 5.0X320MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8613534,SUP,HCPCS C1713,,8613534  -  ROD 8613534 CLRD 5.0X340MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8613536,SUP,HCPCS C1713,,8613536  -  ROD 8613536 CLRD 5.0X360MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8613538,SUP,HCPCS C1713,,8613538  -  ROD 8613538 CLRD 5.0X380MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8613544,SUP,HCPCS C1713,,8613544  -  ROD 8613544 CLRD 5.0X440MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8613560,SUP,HCPCS C1713,,8613560  -  ROD 8613560 CLRD 5MM X 600MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8614100,SUP,Custom 27803010,,8614100  -  CONNECTOR 8614100 CLAMP FOR 5MM ROD,"$1,255.50",$0.00,"$1,255.50",$0.00,$896.05,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,255.50",$0.00,$627.75,$994.36,"$1,004.40",$0.00,$0.00,$0.00,$0.00,$0.00
8614110,SUP,Custom 27803010,,8614110  -  CONNECTOR 8614110 SACRAL ILIO PLATE,"$1,710.00",$0.00,"$1,710.00",$0.00,"$1,220.43",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,710.00",$0.00,$855.00,"$1,354.32","$1,368.00",$0.00,$0.00,$0.00,$0.00,$0.00
8614111,SUP,HCPCS C1713,,8614111  -  SCREW 8614111  BREAK OFF NUT,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
8614120,SUP,HCPCS C1713,,8614120  -  SCREW 8614120  BREAK OFF SET  XLINK,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
8614200,SUP,Custom 27803010,,8614200  -  CONNECTOR 8614200 OFFSET,"$1,870.50",$0.00,"$1,870.50",$0.00,"$1,334.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,870.50",$0.00,$935.25,"$1,481.44","$1,496.40",$0.00,$0.00,$0.00,$0.00,$0.00
8615400,SUP,Custom 27803010,,8615400  -  CONNECTOR 8615400 5MM X 5MM AXIAL,"$2,631.50",$0.00,"$2,631.50",$0.00,"$1,878.10",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,631.50",$0.00,"$1,315.75","$2,084.15","$2,105.20",$0.00,$0.00,$0.00,$0.00,$0.00
8615405,SUP,HCPCS C1713,,8615405  -  SCREW 8615405  BK OFF  AXIALLAT CLSD HK,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
8615410,SUP,Custom 27803010,,8615410  -  CONNECTOR 8615410 5MM X 5MM LATERAL,"$2,631.50",$0.00,"$2,631.50",$0.00,"$1,878.10",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,631.50",$0.00,"$1,315.75","$2,084.15","$2,105.20",$0.00,$0.00,$0.00,$0.00,$0.00
8615420,SUP,Custom 27803010,,8615420  -  CONNECTOR 8615420 5MM X 5.5MM AXIAL,"$2,833.50",$0.00,"$2,833.50",$0.00,"$2,022.27",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,833.50",$0.00,"$1,416.75","$2,244.13","$2,266.80",$0.00,$0.00,$0.00,$0.00,$0.00
8615440,SUP,Custom 27803010,,8615440  -  CONNECTOR 8615440 5MM X 7MM AXIAL,"$2,631.50",$0.00,"$2,631.50",$0.00,"$1,878.10",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,631.50",$0.00,"$1,315.75","$2,084.15","$2,105.20",$0.00,$0.00,$0.00,$0.00,$0.00
8616100,SUP,Custom 27203010,,BLADE LRNSCP 1 MLLR IMRSB REUSE,$60.80,$0.00,$60.80,$0.00,$43.39,$0.00,$0.00,$0.00,$0.00,$0.00,$60.80,$0.00,$30.40,$48.15,$48.64,$0.00,$0.00,$0.00,$0.00,$0.00
8619110,SUP,HCPCS C1713,,8619110  -  PLATE 8619110 RIGHT SACRAL,"$3,873.00",$0.00,"$3,873.00","$1,742.85","$2,764.16",$0.00,$667.30,$0.00,$0.00,$678.13,"$3,873.00",$0.00,"$1,936.50","$3,067.42","$3,098.40",$0.00,$606.12,$0.00,$616.58,$0.00
8619120,SUP,HCPCS C1713,,8619120  -  PLATE 8619120 LEFT SACRAL,"$3,873.00",$0.00,"$3,873.00","$1,742.85","$2,764.16",$0.00,$667.30,$0.00,$0.00,$678.13,"$3,873.00",$0.00,"$1,936.50","$3,067.42","$3,098.40",$0.00,$606.12,$0.00,$616.58,$0.00
8619210,SUP,HCPCS C1713,,8619210  -  PLATE 8619210 RIGHT ILLIO SACRAL,"$4,800.00",$0.00,"$4,800.00","$2,160.00","$3,425.76",$0.00,$827.02,$0.00,$0.00,$840.44,"$4,800.00",$0.00,"$2,400.00","$3,801.60","$3,840.00",$0.00,$751.20,$0.00,$764.16,$0.00
8619220,SUP,HCPCS C1713,,8619220  -  PLATE 8619220 LEFT ILLIO SACRAL,"$4,800.00",$0.00,"$4,800.00","$2,160.00","$3,425.76",$0.00,$827.02,$0.00,$0.00,$840.44,"$4,800.00",$0.00,"$2,400.00","$3,801.60","$3,840.00",$0.00,$751.20,$0.00,$764.16,$0.00
8619300,SUP,HCPCS C1713,,8619300  -  SCREW 8619300  SET  SAC LLIO SAC PLATE,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
8619400,SUP,HCPCS C1713,,8619400  -  STAPLE 8619400 ANTERIOR,$873.00,$0.00,$873.00,$392.85,$623.06,$0.00,$150.41,$0.00,$0.00,$152.86,$873.00,$0.00,$436.50,$691.42,$698.40,$0.00,$136.62,$0.00,$138.98,$0.00
8619654,SUP,HCPCS C1713,,8619654  -  PLATE 8619654 INTERPEDICULAR 54MM,"$2,187.00",$0.00,"$2,187.00",$984.15,"$1,560.86",$0.00,$376.81,$0.00,$0.00,$382.93,"$2,187.00",$0.00,"$1,093.50","$1,732.10","$1,749.60",$0.00,$342.27,$0.00,$348.17,$0.00
8624110,SUP,Custom 27803010,,8624110  -  CONNECTOR 8624110 5.5MM ILIO SAC PLT,"$1,710.00",$0.00,"$1,710.00",$0.00,"$1,220.43",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,710.00",$0.00,$855.00,"$1,354.32","$1,368.00",$0.00,$0.00,$0.00,$0.00,$0.00
8630540,SUP,HCPCS C1713,,8630540  -  SCREW 8630540 CLRD 5.5MMX40MM,"$2,818.50",$0.00,"$2,818.50","$1,268.33","$2,011.56",$0.00,$485.61,$0.00,$0.00,$493.50,"$2,818.50",$0.00,"$1,409.25","$2,232.25","$2,254.80",$0.00,$441.10,$0.00,$448.71,$0.00
8630550,SUP,HCPCS C1713,,8630550  -  SCREW 8630550 CLRD 5.5MMX50MM,"$2,818.50",$0.00,"$2,818.50","$1,268.33","$2,011.56",$0.00,$485.61,$0.00,$0.00,$493.50,"$2,818.50",$0.00,"$1,409.25","$2,232.25","$2,254.80",$0.00,$441.10,$0.00,$448.71,$0.00
8630645,SUP,HCPCS C1713,,8630645  -  SCREW 8630645 CLRD 6.5MMX45MM,"$2,818.50",$0.00,"$2,818.50","$1,268.33","$2,011.56",$0.00,$485.61,$0.00,$0.00,$493.50,"$2,818.50",$0.00,"$1,409.25","$2,232.25","$2,254.80",$0.00,$441.10,$0.00,$448.71,$0.00
8630650,SUP,HCPCS C1713,,8630650  -  SCREW 8630650 CLRD 6.5MMX50MM,"$2,818.50",$0.00,"$2,818.50","$1,268.33","$2,011.56",$0.00,$485.61,$0.00,$0.00,$493.50,"$2,818.50",$0.00,"$1,409.25","$2,232.25","$2,254.80",$0.00,$441.10,$0.00,$448.71,$0.00
8631203,SUP,HCPCS C1713,,8631203  -  HOOK 8631203 MEDIUM LAMINAR,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
8631300,SUP,HCPCS C1713,,8631300  -  STAPLE 8631300,$988.50,$0.00,$988.50,$444.83,$705.49,$0.00,$170.31,$0.00,$0.00,$173.08,$988.50,$0.00,$494.25,$782.89,$790.80,$0.00,$154.70,$0.00,$157.37,$0.00
8631402,SUP,HCPCS C1713,,8631402  -  HOOK 8631402 CLOSED LAMINAR THORACIC,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
8632050,SUP,HCPCS C1713,,8632050  -  SCREW 8632050 CLRD ILIO SACRAL 7.0X50MM,"$1,811.63",$0.00,"$1,811.63",$815.23,"$1,292.96",$0.00,$312.13,$0.00,$0.00,$317.20,"$1,811.63",$0.00,$905.81,"$1,434.81","$1,449.30",$0.00,$283.52,$0.00,$288.41,$0.00
8632055,SUP,HCPCS C1713,,8632055  -  SCREW 8632055 CLRD ILIO SACRAL 7.0X55MM,"$1,821.23",$0.00,"$1,821.23",$819.55,"$1,299.81",$0.00,$313.79,$0.00,$0.00,$318.88,"$1,821.23",$0.00,$910.61,"$1,442.41","$1,456.98",$0.00,$285.02,$0.00,$289.94,$0.00
8632060,SUP,HCPCS C1713,,8632060  -  SCREW 8632060 CLRD ILIO SACRAL 7.0X60MM,"$1,821.23",$0.00,"$1,821.23",$819.55,"$1,299.81",$0.00,$313.79,$0.00,$0.00,$318.88,"$1,821.23",$0.00,$910.61,"$1,442.41","$1,456.98",$0.00,$285.02,$0.00,$289.94,$0.00
8632065,SUP,HCPCS C1713,,8632065  -  SCREW 8632065 CLRD ILIO SACRAL 7.0X65MM,"$1,821.23",$0.00,"$1,821.23",$819.55,"$1,299.81",$0.00,$313.79,$0.00,$0.00,$318.88,"$1,821.23",$0.00,$910.61,"$1,442.41","$1,456.98",$0.00,$285.02,$0.00,$289.94,$0.00
8632070,SUP,HCPCS C1713,,8632070  -  SCREW 8632070 CLRD ILIO SACRAL 7.0X70MM,"$1,821.23",$0.00,"$1,821.23",$819.55,"$1,299.81",$0.00,$313.79,$0.00,$0.00,$318.88,"$1,821.23",$0.00,$910.61,"$1,442.41","$1,456.98",$0.00,$285.02,$0.00,$289.94,$0.00
8632075,SUP,HCPCS C1713,,8632075  -  SCREW 8632075 CLRD ILIO SACRAL 7.0X75MM,"$1,811.63",$0.00,"$1,811.63",$815.23,"$1,292.96",$0.00,$312.13,$0.00,$0.00,$317.20,"$1,811.63",$0.00,$905.81,"$1,434.81","$1,449.30",$0.00,$283.52,$0.00,$288.41,$0.00
8632080,SUP,HCPCS C1713,,8632080  -  SCREW 8632080 CLRD ILIO SACRAL 7.0X80MM,"$1,811.63",$0.00,"$1,811.63",$815.23,"$1,292.96",$0.00,$312.13,$0.00,$0.00,$317.20,"$1,811.63",$0.00,$905.81,"$1,434.81","$1,449.30",$0.00,$283.52,$0.00,$288.41,$0.00
8632230,SUP,HCPCS C1713,,8632230  -  SCREW 8632230 CLRD SACRAL 6.5X30MM,"$1,821.23",$0.00,"$1,821.23",$819.55,"$1,299.81",$0.00,$313.79,$0.00,$0.00,$318.88,"$1,821.23",$0.00,$910.61,"$1,442.41","$1,456.98",$0.00,$285.02,$0.00,$289.94,$0.00
8632235,SUP,HCPCS C1713,,8632235  -  SCREW 8632235 CLRD SACRAL 6.5X35MM,"$1,821.23",$0.00,"$1,821.23",$819.55,"$1,299.81",$0.00,$313.79,$0.00,$0.00,$318.88,"$1,821.23",$0.00,$910.61,"$1,442.41","$1,456.98",$0.00,$285.02,$0.00,$289.94,$0.00
8632240,SUP,HCPCS C1713,,8632240  -  SCREW 8632240 CLRD SACRAL 6.5X40MM,"$1,821.23",$0.00,"$1,821.23",$819.55,"$1,299.81",$0.00,$313.79,$0.00,$0.00,$318.88,"$1,821.23",$0.00,$910.61,"$1,442.41","$1,456.98",$0.00,$285.02,$0.00,$289.94,$0.00
8632245,SUP,HCPCS C1713,,8632245  -  SCREW 8632245 CLRD SACRAL 6.5X45MM,"$1,821.23",$0.00,"$1,821.23",$819.55,"$1,299.81",$0.00,$313.79,$0.00,$0.00,$318.88,"$1,821.23",$0.00,$910.61,"$1,442.41","$1,456.98",$0.00,$285.02,$0.00,$289.94,$0.00
8632250,SUP,HCPCS C1713,,8632250  -  SCREW 8632250 CLRD SACRAL 6.5X50MM,"$1,821.23",$0.00,"$1,821.23",$819.55,"$1,299.81",$0.00,$313.79,$0.00,$0.00,$318.88,"$1,821.23",$0.00,$910.61,"$1,442.41","$1,456.98",$0.00,$285.02,$0.00,$289.94,$0.00
8632255,SUP,HCPCS C1713,,8632255  -  SCREW 8632255 CLRD SACRAL 6.5X55MM,"$1,821.23",$0.00,"$1,821.23",$819.55,"$1,299.81",$0.00,$313.79,$0.00,$0.00,$318.88,"$1,821.23",$0.00,$910.61,"$1,442.41","$1,456.98",$0.00,$285.02,$0.00,$289.94,$0.00
8632260,SUP,HCPCS C1713,,8632260  -  SCREW 8632260 CLRD SACRAL 6.5X60MM,"$1,821.23",$0.00,"$1,821.23",$819.55,"$1,299.81",$0.00,$313.79,$0.00,$0.00,$318.88,"$1,821.23",$0.00,$910.61,"$1,442.41","$1,456.98",$0.00,$285.02,$0.00,$289.94,$0.00
8632265,SUP,HCPCS C1713,,8632265  -  SCREW 8632265 CLRD SACRAL 6.5X65MM,"$1,821.23",$0.00,"$1,821.23",$819.55,"$1,299.81",$0.00,$313.79,$0.00,$0.00,$318.88,"$1,821.23",$0.00,$910.61,"$1,442.41","$1,456.98",$0.00,$285.02,$0.00,$289.94,$0.00
8632270,SUP,HCPCS C1713,,8632270  -  SCREW 8632270 CLRD SACRAL 6.5X70MM,"$1,821.23",$0.00,"$1,821.23",$819.55,"$1,299.81",$0.00,$313.79,$0.00,$0.00,$318.88,"$1,821.23",$0.00,$910.61,"$1,442.41","$1,456.98",$0.00,$285.02,$0.00,$289.94,$0.00
8632330,SUP,HCPCS C1713,,8632330  -  SCREW 8632330 CLRD SACRAL 7.0X30MM,"$1,811.63",$0.00,"$1,811.63",$815.23,"$1,292.96",$0.00,$312.13,$0.00,$0.00,$317.20,"$1,811.63",$0.00,$905.81,"$1,434.81","$1,449.30",$0.00,$283.52,$0.00,$288.41,$0.00
8632335,SUP,HCPCS C1713,,8632335  -  SCREW 8632335 CLRD SACRAL 7.0X35MM,"$1,811.63",$0.00,"$1,811.63",$815.23,"$1,292.96",$0.00,$312.13,$0.00,$0.00,$317.20,"$1,811.63",$0.00,$905.81,"$1,434.81","$1,449.30",$0.00,$283.52,$0.00,$288.41,$0.00
8632340,SUP,HCPCS C1713,,8632340  -  SCREW 8632340 CLRD SACRAL 7.0X40MM,"$1,811.63",$0.00,"$1,811.63",$815.23,"$1,292.96",$0.00,$312.13,$0.00,$0.00,$317.20,"$1,811.63",$0.00,$905.81,"$1,434.81","$1,449.30",$0.00,$283.52,$0.00,$288.41,$0.00
8632345,SUP,HCPCS C1713,,8632345  -  SCREW 8632345 CLRD SACRAL 7.0X45MM,"$1,811.63",$0.00,"$1,811.63",$815.23,"$1,292.96",$0.00,$312.13,$0.00,$0.00,$317.20,"$1,811.63",$0.00,$905.81,"$1,434.81","$1,449.30",$0.00,$283.52,$0.00,$288.41,$0.00
8632350,SUP,HCPCS C1713,,8632350  -  SCREW 8632350 CLRD SACRAL 7.0X50MM,"$1,811.63",$0.00,"$1,811.63",$815.23,"$1,292.96",$0.00,$312.13,$0.00,$0.00,$317.20,"$1,811.63",$0.00,$905.81,"$1,434.81","$1,449.30",$0.00,$283.52,$0.00,$288.41,$0.00
8632355,SUP,HCPCS C1713,,8632355  -  SCREW 8632355 CLRD SACRAL 7.0X55MM,"$1,811.63",$0.00,"$1,811.63",$815.23,"$1,292.96",$0.00,$312.13,$0.00,$0.00,$317.20,"$1,811.63",$0.00,$905.81,"$1,434.81","$1,449.30",$0.00,$283.52,$0.00,$288.41,$0.00
8632360,SUP,HCPCS C1713,,8632360  -  SCREW 8632360 CLRD SACRAL 7.0X60MM,"$1,811.63",$0.00,"$1,811.63",$815.23,"$1,292.96",$0.00,$312.13,$0.00,$0.00,$317.20,"$1,811.63",$0.00,$905.81,"$1,434.81","$1,449.30",$0.00,$283.52,$0.00,$288.41,$0.00
8632365,SUP,HCPCS C1713,,8632365  -  SCREW 8632365 CLRD SACRAL 7.0X65MM,"$1,811.63",$0.00,"$1,811.63",$815.23,"$1,292.96",$0.00,$312.13,$0.00,$0.00,$317.20,"$1,811.63",$0.00,$905.81,"$1,434.81","$1,449.30",$0.00,$283.52,$0.00,$288.41,$0.00
8632370,SUP,HCPCS C1713,,8632370  -  SCREW 8632370 CLRD SACRAL 7.0X70MM,"$1,811.63",$0.00,"$1,811.63",$815.23,"$1,292.96",$0.00,$312.13,$0.00,$0.00,$317.20,"$1,811.63",$0.00,$905.81,"$1,434.81","$1,449.30",$0.00,$283.52,$0.00,$288.41,$0.00
8634100,SUP,Custom 27803010,,8634100  -  CONNECTOR 8634100 CLAMP FOR 5MM ROD,"$1,453.50",$0.00,"$1,453.50",$0.00,"$1,037.36",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,453.50",$0.00,$726.75,"$1,151.17","$1,162.80",$0.00,$0.00,$0.00,$0.00,$0.00
8634110,SUP,Custom 27803010,,8634110  -  CONNECTOR 8634110 SACRAL ILIO PLATE,"$1,935.50",$0.00,"$1,935.50",$0.00,"$1,381.37",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,935.50",$0.00,$967.75,"$1,532.92","$1,548.40",$0.00,$0.00,$0.00,$0.00,$0.00
8634111,SUP,HCPCS C1713,,8634111  -  SCREW 8634111  BREAK OFF NUT,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
8634200,SUP,Custom 27803010,,8634200  -  CONNECTOR 8634200 OFFSET CLAMP,"$1,935.50",$0.00,"$1,935.50",$0.00,"$1,381.37",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,935.50",$0.00,$967.75,"$1,532.92","$1,548.40",$0.00,$0.00,$0.00,$0.00,$0.00
8635400,SUP,Custom 27803010,,8635400  -  CONNECTOR 8635400 5.5X5.5 LAT CLOSE CLMP,"$2,818.50",$0.00,"$2,818.50",$0.00,"$2,011.56",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,818.50",$0.00,"$1,409.25","$2,232.25","$2,254.80",$0.00,$0.00,$0.00,$0.00,$0.00
8635405,SUP,HCPCS C1713,,8635405  -  SCREW 8635405  BREAK OFF LOCKING,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
8635430,SUP,Custom 27803010,,8635430  -  CONNECTOR 8635430 LATERAL CLOSED,"$2,818.50",$0.00,"$2,818.50",$0.00,"$2,011.56",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,818.50",$0.00,"$1,409.25","$2,232.25","$2,254.80",$0.00,$0.00,$0.00,$0.00,$0.00
8638102,SUP,HCPCS C1713,,8638102  -  HOOK 8638102 PED SMALL GROOVE,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
8638104,SUP,HCPCS C1713,,8638104  -  HOOK 8638104 PED LARGE GROOVE,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
8638110,SUP,HCPCS C1713,,8638110  -  PLATE 8638110 RIGHT SACRAL,"$3,873.00",$0.00,"$3,873.00","$1,742.85","$2,764.16",$0.00,$667.30,$0.00,$0.00,$678.13,"$3,873.00",$0.00,"$1,936.50","$3,067.42","$3,098.40",$0.00,$606.12,$0.00,$616.58,$0.00
8638120,SUP,HCPCS C1713,,8638120  -  PLATE 8638120 LEFT SACRAL,"$3,873.00",$0.00,"$3,873.00","$1,742.85","$2,764.16",$0.00,$667.30,$0.00,$0.00,$678.13,"$3,873.00",$0.00,"$1,936.50","$3,067.42","$3,098.40",$0.00,$606.12,$0.00,$616.58,$0.00
8638203,SUP,HCPCS C1713,,8638203  -  HOOK 8638203 LAM MEDIUM GROOVE,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
8638210,SUP,HCPCS C1713,,8638210  -  PLATE 8638210 RIGHT LLIO SACRAL,"$4,938.00",$0.00,"$4,938.00","$2,222.10","$3,524.25",$0.00,$850.79,$0.00,$0.00,$864.60,"$4,938.00",$0.00,"$2,469.00","$3,910.90","$3,950.40",$0.00,$772.80,$0.00,$786.13,$0.00
8638220,SUP,HCPCS C1713,,8638220  -  PLATE 8638220 LEFT ILIO SACRAL,"$4,938.00",$0.00,"$4,938.00","$2,222.10","$3,524.25",$0.00,$850.79,$0.00,$0.00,$864.60,"$4,938.00",$0.00,"$2,469.00","$3,910.90","$3,950.40",$0.00,$772.80,$0.00,$786.13,$0.00
8638425,SUP,HCPCS C1713,,8638425  -  SCREW 8638425 PED D4.5MM L25MM,"$2,818.50",$0.00,"$2,818.50","$1,268.33","$2,011.56",$0.00,$485.61,$0.00,$0.00,$493.50,"$2,818.50",$0.00,"$1,409.25","$2,232.25","$2,254.80",$0.00,$441.10,$0.00,$448.71,$0.00
8638430,SUP,HCPCS C1713,,8638430  -  SCREW 8638430 CLRD PED 4.5X30MM,"$2,818.50",$0.00,"$2,818.50","$1,268.33","$2,011.56",$0.00,$485.61,$0.00,$0.00,$493.50,"$2,818.50",$0.00,"$1,409.25","$2,232.25","$2,254.80",$0.00,$441.10,$0.00,$448.71,$0.00
8638435,SUP,HCPCS C1713,,8638435  -  SCREW 8638435 CLRD PED 4.5X35MM,"$2,818.50",$0.00,"$2,818.50","$1,268.33","$2,011.56",$0.00,$485.61,$0.00,$0.00,$493.50,"$2,818.50",$0.00,"$1,409.25","$2,232.25","$2,254.80",$0.00,$441.10,$0.00,$448.71,$0.00
8638440,SUP,HCPCS C1713,,8638440  -  BONE SCREW 8638440 PED D4.5MM L40MM,"$2,818.50",$0.00,"$2,818.50","$1,268.33","$2,011.56",$0.00,$485.61,$0.00,$0.00,$493.50,"$2,818.50",$0.00,"$1,409.25","$2,232.25","$2,254.80",$0.00,$441.10,$0.00,$448.71,$0.00
8638445,SUP,HCPCS C1713,,8638445  -  SCREW 8638445 CLRD PED 4.5X45MM,"$2,818.50",$0.00,"$2,818.50","$1,268.33","$2,011.56",$0.00,$485.61,$0.00,$0.00,$493.50,"$2,818.50",$0.00,"$1,409.25","$2,232.25","$2,254.80",$0.00,$441.10,$0.00,$448.71,$0.00
8638525,SUP,HCPCS C1713,,8638525  -  SCREW 8638525 CLRD PED 5.5X25MM,"$2,818.50",$0.00,"$2,818.50","$1,268.33","$2,011.56",$0.00,$485.61,$0.00,$0.00,$493.50,"$2,818.50",$0.00,"$1,409.25","$2,232.25","$2,254.80",$0.00,$441.10,$0.00,$448.71,$0.00
8638530,SUP,HCPCS C1713,,8638530  -  SCREW 8638530 CLRD PED 5.5X30MM,"$2,818.50",$0.00,"$2,818.50","$1,268.33","$2,011.56",$0.00,$485.61,$0.00,$0.00,$493.50,"$2,818.50",$0.00,"$1,409.25","$2,232.25","$2,254.80",$0.00,$441.10,$0.00,$448.71,$0.00
8638535,SUP,HCPCS C1713,,8638535  -  SCREW 8638535 CLRD PED 5.5X35MM,"$2,818.50",$0.00,"$2,818.50","$1,268.33","$2,011.56",$0.00,$485.61,$0.00,$0.00,$493.50,"$2,818.50",$0.00,"$1,409.25","$2,232.25","$2,254.80",$0.00,$441.10,$0.00,$448.71,$0.00
8638540,SUP,HCPCS C1713,,8638540  -  SCREW 8638540 CLRD PED 5.5X40MM,"$2,818.50",$0.00,"$2,818.50","$1,268.33","$2,011.56",$0.00,$485.61,$0.00,$0.00,$493.50,"$2,818.50",$0.00,"$1,409.25","$2,232.25","$2,254.80",$0.00,$441.10,$0.00,$448.71,$0.00
8638545,SUP,HCPCS C1713,,8638545  -  SCREW 8638545 CLRD PED 5.5X45MM,"$2,818.50",$0.00,"$2,818.50","$1,268.33","$2,011.56",$0.00,$485.61,$0.00,$0.00,$493.50,"$2,818.50",$0.00,"$1,409.25","$2,232.25","$2,254.80",$0.00,$441.10,$0.00,$448.71,$0.00
8638550,SUP,HCPCS C1713,,8638550  -  SCREW 8638550 CLRD PED 5.5X50MM,"$2,818.50",$0.00,"$2,818.50","$1,268.33","$2,011.56",$0.00,$485.61,$0.00,$0.00,$493.50,"$2,818.50",$0.00,"$1,409.25","$2,232.25","$2,254.80",$0.00,$441.10,$0.00,$448.71,$0.00
8638555,SUP,HCPCS C1713,,8638555  -  SCREW 8638555 CLRD PED 5.5X55MM,"$2,818.50",$0.00,"$2,818.50","$1,268.33","$2,011.56",$0.00,$485.61,$0.00,$0.00,$493.50,"$2,818.50",$0.00,"$1,409.25","$2,232.25","$2,254.80",$0.00,$441.10,$0.00,$448.71,$0.00
8638625,SUP,HCPCS C1713,,8638625  -  SCREW 8638625 PED D6.5MM L25MM,"$2,818.50",$0.00,"$2,818.50","$1,268.33","$2,011.56",$0.00,$485.61,$0.00,$0.00,$493.50,"$2,818.50",$0.00,"$1,409.25","$2,232.25","$2,254.80",$0.00,$441.10,$0.00,$448.71,$0.00
8638630,SUP,HCPCS C1713,,8638630  -  SCREW 8638630 CLRD PED 6.5X30MM,"$2,818.50",$0.00,"$2,818.50","$1,268.33","$2,011.56",$0.00,$485.61,$0.00,$0.00,$493.50,"$2,818.50",$0.00,"$1,409.25","$2,232.25","$2,254.80",$0.00,$441.10,$0.00,$448.71,$0.00
8638635,SUP,HCPCS C1713,,8638635  -  SCREW BN 6.5MM 35MM CO2 SPNE PDCL,"$2,818.50",$0.00,"$2,818.50","$1,268.33","$2,011.56",$0.00,$485.61,$0.00,$0.00,$493.50,"$2,818.50",$0.00,"$1,409.25","$2,232.25","$2,254.80",$0.00,$441.10,$0.00,$448.71,$0.00
8638640,SUP,HCPCS C1713,,8638640  -  SCREW BN 6.5MM 35MM CO2 SPNE PDCL,"$2,818.50",$0.00,"$2,818.50","$1,268.33","$2,011.56",$0.00,$485.61,$0.00,$0.00,$493.50,"$2,818.50",$0.00,"$1,409.25","$2,232.25","$2,254.80",$0.00,$441.10,$0.00,$448.71,$0.00
8638645,SUP,HCPCS C1713,,8638645  -  SCREW 8638645 CLRD PED 6.5X45MM,"$2,818.50",$0.00,"$2,818.50","$1,268.33","$2,011.56",$0.00,$485.61,$0.00,$0.00,$493.50,"$2,818.50",$0.00,"$1,409.25","$2,232.25","$2,254.80",$0.00,$441.10,$0.00,$448.71,$0.00
8638650,SUP,HCPCS C1713,,8638650  -  SCREW 8638650 CLRD PED 6.5X50MM,"$2,818.50",$0.00,"$2,818.50","$1,268.33","$2,011.56",$0.00,$485.61,$0.00,$0.00,$493.50,"$2,818.50",$0.00,"$1,409.25","$2,232.25","$2,254.80",$0.00,$441.10,$0.00,$448.71,$0.00
8638655,SUP,HCPCS C1713,,8638655  -  SCREW 8638655 CLRD PED 6.5X55MM,"$2,818.50",$0.00,"$2,818.50","$1,268.33","$2,011.56",$0.00,$485.61,$0.00,$0.00,$493.50,"$2,818.50",$0.00,"$1,409.25","$2,232.25","$2,254.80",$0.00,$441.10,$0.00,$448.71,$0.00
8638660,SUP,HCPCS C1713,,8638660  -  SCREW 8638660 PED D6.5MM L60MM,"$2,818.50",$0.00,"$2,818.50","$1,268.33","$2,011.56",$0.00,$485.61,$0.00,$0.00,$493.50,"$2,818.50",$0.00,"$1,409.25","$2,232.25","$2,254.80",$0.00,$441.10,$0.00,$448.71,$0.00
8638665,SUP,HCPCS C1713,,8638665  -  SCREW 8638665 PED D6.5MM L65MM,"$2,818.50",$0.00,"$2,818.50","$1,268.33","$2,011.56",$0.00,$485.61,$0.00,$0.00,$493.50,"$2,818.50",$0.00,"$1,409.25","$2,232.25","$2,254.80",$0.00,$441.10,$0.00,$448.71,$0.00
8638725,SUP,HCPCS C1713,,8638725  -  SCREW 8638725 PED D7.5MM L25MM,"$2,818.50",$0.00,"$2,818.50","$1,268.33","$2,011.56",$0.00,$485.61,$0.00,$0.00,$493.50,"$2,818.50",$0.00,"$1,409.25","$2,232.25","$2,254.80",$0.00,$441.10,$0.00,$448.71,$0.00
8638730,SUP,HCPCS C1713,,8638730  -  BONE SCREW 8638730 PED D7.5MM L30MM,"$2,818.50",$0.00,"$2,818.50","$1,268.33","$2,011.56",$0.00,$485.61,$0.00,$0.00,$493.50,"$2,818.50",$0.00,"$1,409.25","$2,232.25","$2,254.80",$0.00,$441.10,$0.00,$448.71,$0.00
8638735,SUP,HCPCS C1713,,8638735  -  SCREW 8638735 CLRD PED 7.5X35MM,"$2,818.50",$0.00,"$2,818.50","$1,268.33","$2,011.56",$0.00,$485.61,$0.00,$0.00,$493.50,"$2,818.50",$0.00,"$1,409.25","$2,232.25","$2,254.80",$0.00,$441.10,$0.00,$448.71,$0.00
8638740,SUP,HCPCS C1713,,8638740  -  SCREW 8638740 CLRD PED 7.5X40MM,"$2,818.50",$0.00,"$2,818.50","$1,268.33","$2,011.56",$0.00,$485.61,$0.00,$0.00,$493.50,"$2,818.50",$0.00,"$1,409.25","$2,232.25","$2,254.80",$0.00,$441.10,$0.00,$448.71,$0.00
8638745,SUP,HCPCS C1713,,8638745  -  SCREW 8638745 CLRD PED 7.5X45MM,"$2,818.50",$0.00,"$2,818.50","$1,268.33","$2,011.56",$0.00,$485.61,$0.00,$0.00,$493.50,"$2,818.50",$0.00,"$1,409.25","$2,232.25","$2,254.80",$0.00,$441.10,$0.00,$448.71,$0.00
8638750,SUP,HCPCS C1713,,8638750  -  SCREW 8638750 CLRD PED 7.5X50MM,"$2,818.50",$0.00,"$2,818.50","$1,268.33","$2,011.56",$0.00,$485.61,$0.00,$0.00,$493.50,"$2,818.50",$0.00,"$1,409.25","$2,232.25","$2,254.80",$0.00,$441.10,$0.00,$448.71,$0.00
8638755,SUP,HCPCS C1713,,8638755  -  BONE SCREW 8638755 PED SCRW D7.5MM L55MM,"$2,818.50",$0.00,"$2,818.50","$1,268.33","$2,011.56",$0.00,$485.61,$0.00,$0.00,$493.50,"$2,818.50",$0.00,"$1,409.25","$2,232.25","$2,254.80",$0.00,$441.10,$0.00,$448.71,$0.00
8638760,SUP,HCPCS C1713,,8638760  -  SCREW 8638760 PED D7.5MM L60MM,"$2,818.50",$0.00,"$2,818.50","$1,268.33","$2,011.56",$0.00,$485.61,$0.00,$0.00,$493.50,"$2,818.50",$0.00,"$1,409.25","$2,232.25","$2,254.80",$0.00,$441.10,$0.00,$448.71,$0.00
8638765,SUP,HCPCS C1713,,8638765  -  SCREW 8638765 PED D7.5MM L65MM,"$2,818.50",$0.00,"$2,818.50","$1,268.33","$2,011.56",$0.00,$485.61,$0.00,$0.00,$493.50,"$2,818.50",$0.00,"$1,409.25","$2,232.25","$2,254.80",$0.00,$441.10,$0.00,$448.71,$0.00
8639300,SUP,HCPCS C1713,,8639300  -  SCREW 8639300  L AND ILIO L  SET,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
8639400,SUP,HCPCS C1713,,8639400  -  STAPLE 8639400  ANTERIOR,$988.50,$0.00,$988.50,$444.83,$705.49,$0.00,$170.31,$0.00,$0.00,$173.08,$988.50,$0.00,$494.25,$782.89,$790.80,$0.00,$154.70,$0.00,$157.37,$0.00
8644525,SUP,HCPCS C1713,,8644525  -  SCREW BN 4.5MM 25MM UNIPLANAR TI SPNE 5.5MM ROD,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8644530,SUP,HCPCS C1713,,8644530  -  SCREW BN 4.5MM 30MM UNIPLANAR TI SPNE 5.5MM ROD,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8644535,SUP,HCPCS C1713,,8644535  -  SCREW BN 4.5MM 35MM UNIPLANAR TI SPNE 5.5MM ROD,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8644540,SUP,HCPCS C1713,,8644540  -  SCREW BN 4.5MM 40MM UNIPLANAR TI SPNE 5.5MM ROD,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8644545,SUP,HCPCS C1713,,8644545  -  SCREW BN 4.5MM 45MM UNIPLANAR TI SPNE 5.5MM ROD,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8645025,SUP,HCPCS C1713,,8645025  -  SCREW BN 5MM 25MM UNIPLANAR TI SPNE 5.5MM ROD,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8645030,SUP,HCPCS C1713,,8645030  -  SCREW BN 5MM 30MM UNIPLANAR TI SPNE 5.5MM ROD,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8645035,SUP,HCPCS C1713,,8645035  -  SCREW BN 5MM 35MM UNIPLANAR TI SPNE 5.5MM ROD,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8645040,SUP,HCPCS C1713,,8645040  -  SCREW BN 5MM 40MM UNIPLANAR TI SPNE 5.5MM ROD,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8645045,SUP,HCPCS C1713,,8645045  -  SCREW BN 5MM 45MM UNIPLANAR TI SPNE 5.5MM ROD,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8645050,SUP,HCPCS C1713,,8645050  -  SCREW BN 6MM 55MM UNIPLANAR TI SPNE 5.5MM ROD,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8646030,SUP,HCPCS C1713,,8646030  -  SCREW BN 5MM 50MM UNIPLANAR TI SPNE 5.5MM ROD,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8646035,SUP,HCPCS C1713,,8646035  -  SCREW BN 6MM 30MM UNIPLANAR TI SPNE 5.5MM ROD,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8646040,SUP,HCPCS C1713,,8646040  -  SCREW BN 6MM 35MM UNIPLANAR TI SPNE 5.5MM ROD,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8646045,SUP,HCPCS C1713,,8646045  -  SCREW BN 6MM 40MM UNIPLANAR TI SPNE 5.5MM ROD,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8646050,SUP,HCPCS C1713,,8646050  -  SCREW BN 6MM 45MM UNIPLANAR TI SPNE 5.5MM ROD,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8646055,SUP,HCPCS C1713,,8646055  -  SCREW BN 6MM 50MM UNIPLANAR TI SPNE 5.5MM ROD,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
8650520,SUP,HCPCS C1713,,8650520  -  CONCTR ROD 20MM 5.5MM OFFST TI SPNL,"$1,655.00",$0.00,"$1,655.00",$744.75,"$1,181.17",$0.00,$285.15,$0.00,$0.00,$289.78,"$1,655.00",$0.00,$827.50,"$1,310.76","$1,324.00",$0.00,$259.01,$0.00,$263.48,$0.00
8650530,SUP,HCPCS C1713,,8650530  -  CONCTR ROD 30MM 4.5MM OFFST TI,"$1,655.00",$0.00,"$1,655.00",$744.75,"$1,181.17",$0.00,$285.15,$0.00,$0.00,$289.78,"$1,655.00",$0.00,$827.50,"$1,310.76","$1,324.00",$0.00,$259.01,$0.00,$263.48,$0.00
8650560,SUP,HCPCS C1713,,8650560  -  CONCTR ROD 60MM 4.5MM OFFST TI,"$1,655.00",$0.00,"$1,655.00",$744.75,"$1,181.17",$0.00,$285.15,$0.00,$0.00,$289.78,"$1,655.00",$0.00,$827.50,"$1,310.76","$1,324.00",$0.00,$259.01,$0.00,$263.48,$0.00
8651520,SUP,HCPCS C1713,,8651520  -  CONCTR ROD 5.5MM OFFST CLOSE TI,"$1,655.00",$0.00,"$1,655.00",$744.75,"$1,181.17",$0.00,$285.15,$0.00,$0.00,$289.78,"$1,655.00",$0.00,$827.50,"$1,310.76","$1,324.00",$0.00,$259.01,$0.00,$263.48,$0.00
8651530,SUP,HCPCS C1713,,8651530  -  CONCTR ROD 5.5MM OFFST CLOSE TI,"$1,655.00",$0.00,"$1,655.00",$744.75,"$1,181.17",$0.00,$285.15,$0.00,$0.00,$289.78,"$1,655.00",$0.00,$827.50,"$1,310.76","$1,324.00",$0.00,$259.01,$0.00,$263.48,$0.00
8651560,SUP,HCPCS C1713,,8651560  -  CONCTR ROD 5.5MM OFFST CLOSE TI,"$1,655.00",$0.00,"$1,655.00",$744.75,"$1,181.17",$0.00,$285.15,$0.00,$0.00,$289.78,"$1,655.00",$0.00,$827.50,"$1,310.76","$1,324.00",$0.00,$259.01,$0.00,$263.48,$0.00
8664110,SUP,Custom 27803010,,8664110  -  CONNECTOR 8664110 6.35MM SACRAL SS,"$1,710.00",$0.00,"$1,710.00",$0.00,"$1,220.43",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,710.00",$0.00,$855.00,"$1,354.32","$1,368.00",$0.00,$0.00,$0.00,$0.00,$0.00
8664111,SUP,HCPCS C1713,,8664111  -  SET SCREW 8664111 FOR 6.35MM CONN SS,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
8670001,SUP,HCPCS C1769,,8670001  -  GUIDEWIRE ORTHOPEDIC BLUNT INSTR SEXTANT TITANIUM SPN,$151.50,$0.00,$151.50,$82.26,$108.13,$0.00,$26.10,$0.00,$0.00,$26.53,$151.50,$0.00,$75.75,$119.99,$121.20,$0.00,$23.71,$0.00,$24.12,$0.00
8670002,SUP,HCPCS C1769,,8670002  -  GUIDEWIRE ORTHOPEDIC SHARP CD HORIZON TITANIUM SPN,$151.50,$0.00,$151.50,$82.26,$108.13,$0.00,$26.10,$0.00,$0.00,$26.53,$151.50,$0.00,$75.75,$119.99,$121.20,$0.00,$23.71,$0.00,$24.12,$0.00
8672030,SUP,HCPCS C1713,,8672030  -  ROD SPNL STD PREBNT CNTR 5.5MM 30MM SXTNT CD HZN TI,"$2,072.50",$0.00,"$2,072.50",$932.63,"$1,479.14",$0.00,$357.08,$0.00,$0.00,$362.88,"$2,072.50",$0.00,"$1,036.25","$1,641.42","$1,658.00",$0.00,$324.35,$0.00,$329.94,$0.00
8672035,SUP,HCPCS C1713,,8672035  -  ROD SPNL PREBNT 5.5MM 35MM SXTNT CD HZN TI,"$2,072.50",$0.00,"$2,072.50",$932.63,"$1,479.14",$0.00,$357.08,$0.00,$0.00,$362.88,"$2,072.50",$0.00,"$1,036.25","$1,641.42","$1,658.00",$0.00,$324.35,$0.00,$329.94,$0.00
8672040,SUP,HCPCS C1713,,8672040  -  ROD SPNL STD CNTR PREBNT 5.5MM 40MM CD HZN SXTNT PCUT TI,"$2,072.50",$0.00,"$2,072.50",$932.63,"$1,479.14",$0.00,$357.08,$0.00,$0.00,$362.88,"$2,072.50",$0.00,"$1,036.25","$1,641.42","$1,658.00",$0.00,$324.35,$0.00,$329.94,$0.00
8672045,SUP,HCPCS C1713,,8672045  -  ROD SPNL STD CNTR PREBNT 5.5MM 45MM CD HZN SXTNT PCUT TI,"$2,072.50",$0.00,"$2,072.50",$932.63,"$1,479.14",$0.00,$357.08,$0.00,$0.00,$362.88,"$2,072.50",$0.00,"$1,036.25","$1,641.42","$1,658.00",$0.00,$324.35,$0.00,$329.94,$0.00
8672050,SUP,HCPCS C1713,,8672050  -  ROD SPNL STD CNTR PREBNT 5.5MM 50MM CD HZN SXTNT PCUT TI,"$2,072.50",$0.00,"$2,072.50",$932.63,"$1,479.14",$0.00,$357.08,$0.00,$0.00,$362.88,"$2,072.50",$0.00,"$1,036.25","$1,641.42","$1,658.00",$0.00,$324.35,$0.00,$329.94,$0.00
8672055,SUP,HCPCS C1713,,8672055  -  ROD SPNL STD PREBNT PCUT CNTR 5.5MM 55MM SXTNT CD HZN TI,"$2,072.50",$0.00,"$2,072.50",$932.63,"$1,479.14",$0.00,$357.08,$0.00,$0.00,$362.88,"$2,072.50",$0.00,"$1,036.25","$1,641.42","$1,658.00",$0.00,$324.35,$0.00,$329.94,$0.00
8672060,SUP,HCPCS C1713,,8672060  -  ROD SPNL STD CNTR PREBNT 5.5MM 60MM CD HZN SXTNT PCUT TI,"$2,072.50",$0.00,"$2,072.50",$932.63,"$1,479.14",$0.00,$357.08,$0.00,$0.00,$362.88,"$2,072.50",$0.00,"$1,036.25","$1,641.42","$1,658.00",$0.00,$324.35,$0.00,$329.94,$0.00
8672065,SUP,HCPCS C1713,,8672065  -  ROD SPNL STD CNTR PREBNT 5.5MM 65MM CD HZN SXTNT PCUT TI,"$2,072.50",$0.00,"$2,072.50",$932.63,"$1,479.14",$0.00,$357.08,$0.00,$0.00,$362.88,"$2,072.50",$0.00,"$1,036.25","$1,641.42","$1,658.00",$0.00,$324.35,$0.00,$329.94,$0.00
8672070,SUP,HCPCS C1713,,8672070  -  ROD SPNL STD CNTR PREBNT 5.5MM 70MM CD HZN SXTNT PCUT TI,"$2,072.50",$0.00,"$2,072.50",$932.63,"$1,479.14",$0.00,$357.08,$0.00,$0.00,$362.88,"$2,072.50",$0.00,"$1,036.25","$1,641.42","$1,658.00",$0.00,$324.35,$0.00,$329.94,$0.00
8672075,SUP,HCPCS C1713,,8672075  -  ROD SPNL STD CNTR PREBNT 5.5MM 75MM CD HZN SXTNT PCUT TI,"$2,072.50",$0.00,"$2,072.50",$932.63,"$1,479.14",$0.00,$357.08,$0.00,$0.00,$362.88,"$2,072.50",$0.00,"$1,036.25","$1,641.42","$1,658.00",$0.00,$324.35,$0.00,$329.94,$0.00
8672080,SUP,HCPCS C1713,,8672080  -  ROD SPNL STD CNTR PREBNT 5.5MM 80MM CD HZN SXTNT PCUT TI,"$2,072.50",$0.00,"$2,072.50",$932.63,"$1,479.14",$0.00,$357.08,$0.00,$0.00,$362.88,"$2,072.50",$0.00,"$1,036.25","$1,641.42","$1,658.00",$0.00,$324.35,$0.00,$329.94,$0.00
8672085,SUP,HCPCS C1713,,8672085  -  ROD SPNL STD PREBNT PCUT CNTR 5.5MM 85MM SXTNT CD HZN TI,"$2,072.50",$0.00,"$2,072.50",$932.63,"$1,479.14",$0.00,$357.08,$0.00,$0.00,$362.88,"$2,072.50",$0.00,"$1,036.25","$1,641.42","$1,658.00",$0.00,$324.35,$0.00,$329.94,$0.00
8672090,SUP,HCPCS C1713,,8672090  -  ROD SPNL STD PREBNT CNTR 5.5MM 90MM SXTNT CD HZN TI,"$2,072.50",$0.00,"$2,072.50",$932.63,"$1,479.14",$0.00,$357.08,$0.00,$0.00,$362.88,"$2,072.50",$0.00,"$1,036.25","$1,641.42","$1,658.00",$0.00,$324.35,$0.00,$329.94,$0.00
8672095,SUP,HCPCS C1713,,8672095  -  ROD SPNL STD CNTR PREBNT 5.5MM 95MM CD HZN SXTNT PCUT TI,"$2,072.50",$0.00,"$2,072.50",$932.63,"$1,479.14",$0.00,$357.08,$0.00,$0.00,$362.88,"$2,072.50",$0.00,"$1,036.25","$1,641.42","$1,658.00",$0.00,$324.35,$0.00,$329.94,$0.00
8672100,SUP,HCPCS C1713,,8672100  -  ROD SPNL STD CNTR PREBNT 5.5MM 100MM CD HZN SXTNT PCUT TI,"$2,072.50",$0.00,"$2,072.50",$932.63,"$1,479.14",$0.00,$357.08,$0.00,$0.00,$362.88,"$2,072.50",$0.00,"$1,036.25","$1,641.42","$1,658.00",$0.00,$324.35,$0.00,$329.94,$0.00
8674110,SUP,Custom 27803010,,8674110  -  CONNECTOR 8674110 6.35MM SACRAL TI,"$1,935.50",$0.00,"$1,935.50",$0.00,"$1,381.37",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,935.50",$0.00,$967.75,"$1,532.92","$1,548.40",$0.00,$0.00,$0.00,$0.00,$0.00
8674111,SUP,HCPCS C1713,,8674111  -  SCREW 8674111  SET  FOR 6.35MM CONN TI,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
8680853,SUP,HCPCS C1713,,"8680853  -  M8 REDUCTION SCREW PLUG, SS",$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
8688498,SUP,HCPCS C1713,,8688498  -  STAPLE 8688498 19MM CAUDAL SS,"$2,173.50",$0.00,"$2,173.50",$978.08,"$1,551.23",$0.00,$374.48,$0.00,$0.00,$380.56,"$2,173.50",$0.00,"$1,086.75","$1,721.41","$1,738.80",$0.00,$340.15,$0.00,$346.02,$0.00
8688499,SUP,HCPCS C1713,,8688499  -  STAPLE 8688499 19MM ROSTRAL SS,"$2,173.50",$0.00,"$2,173.50",$978.08,"$1,551.23",$0.00,$374.48,$0.00,$0.00,$380.56,"$2,173.50",$0.00,"$1,086.75","$1,721.41","$1,738.80",$0.00,$340.15,$0.00,$346.02,$0.00
8688500,SUP,HCPCS C1713,,8688500  -  STAPLE 8688500 21MM CAUDAL SS,"$2,173.50",$0.00,"$2,173.50",$978.08,"$1,551.23",$0.00,$374.48,$0.00,$0.00,$380.56,"$2,173.50",$0.00,"$1,086.75","$1,721.41","$1,738.80",$0.00,$340.15,$0.00,$346.02,$0.00
8688501,SUP,HCPCS C1713,,8688501  -  STAPLE 8688501 21MM ROSTRAL SS,"$2,173.50",$0.00,"$2,173.50",$978.08,"$1,551.23",$0.00,$374.48,$0.00,$0.00,$380.56,"$2,173.50",$0.00,"$1,086.75","$1,721.41","$1,738.80",$0.00,$340.15,$0.00,$346.02,$0.00
8690024,SUP,HCPCS C1713,,8690024  -  ROD 8690024 5.5MM CCM ROD L 500MM,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
8690030,SUP,HCPCS C1713,,8690030  -  ROD SPNL PREBNT 5.5MM 30MM CD HZN TI CP,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8690035,SUP,HCPCS C1713,,"8690035  -  PRE-BENT ROD, 5.5X35, TI",$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8690040,SUP,HCPCS C1713,,8690040  -  ROD SPNL PREBNT 5.5MM 40MM LGC CD HZN TI CP,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8690045,SUP,HCPCS C1713,,"8690045  -  PRE-BENT ROD, 5.5X45, TI",$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8690050,SUP,HCPCS C1713,,8690050  -  ROD SPNL PCUT PREBNT 5.5MM 50MM LGC CD HZN TI CP,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8690055,SUP,HCPCS C1713,,8690055  -  ROD 8690055 PRE-BENT 5.5X55 TI,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8690060,SUP,HCPCS C1713,,8690060  -  ROD SPNL PREBNT 5.5MM 60MM CD HZN LGC CNTR POST TI THRX,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8690065,SUP,HCPCS C1713,,"8690065  -  PRE-BENT ROD, 5.5X65, TI",$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8690070,SUP,HCPCS C1713,,8690070  -  ROD SPNL PREBNT 5.5MM 70MM CD HZN LGC CNTR POST TI,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8690075,SUP,HCPCS C1713,,"8690075  -  PRE-BENT ROD, 5.5X75, TI",$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8690080,SUP,HCPCS C1713,,8690080  -  ROD SPNL 80MM 5.5MM CD HZN LGC TI PREBNT CP,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8690085,SUP,HCPCS C1713,,"8690085  -  PRE-BENT ROD, 5.5X85, TI",$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8690090,SUP,HCPCS C1713,,8690090  -  ROD SPNL PREBNT 5.5MM 90MM CD HZN LGC CNTR POST TI,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8690095,SUP,HCPCS C1713,,"8690095  -  ROD 8690095, PRE-BENT 5.5X95, TI",$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8690100,SUP,HCPCS C1713,,8690100  -  ROD SPNL PREBNT 5.5MM 100MM LGC CD HZN TI CP,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8690105,SUP,HCPCS C1713,,"8690105  -  PRE-BENT ROD, 5.5X105, TI",$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8690110,SUP,HCPCS C1713,,8690110  -  ROD 8690110 CDH PBNT 5.5X110 TI,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8690115,SUP,HCPCS C1713,,"8690115  -  PRE-BENT ROD, 5.5X115, TI",$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8690120,SUP,HCPCS C1713,,8690120  -  ROD 8690120 CDH PBNT 5.5X120 TI,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8690853,SUP,HCPCS C1713,,8690853  -  SCREW 8690853  M8 REDUCTION PLUG TI,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
8690878,SUP,HCPCS C1713,,"8690878  -  SET SCREW, REDUCTION, M8, TI",$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
8691530,SUP,HCPCS C1713,,8691530  -  CDH M8 5.5 X 30 RED FAS 5.5 TI,"$2,362.40",$0.00,"$2,362.40","$1,063.08","$1,686.04",$0.00,$407.03,$0.00,$0.00,$413.64,"$2,362.40",$0.00,"$1,181.20","$1,871.02","$1,889.92",$0.00,$369.72,$0.00,$376.09,$0.00
8691535,SUP,HCPCS C1713,,8691535  -  CDH M8 5.5 X 35 RED FAS 5.5 TI,"$2,362.40",$0.00,"$2,362.40","$1,063.08","$1,686.04",$0.00,$407.03,$0.00,$0.00,$413.64,"$2,362.40",$0.00,"$1,181.20","$1,871.02","$1,889.92",$0.00,$369.72,$0.00,$376.09,$0.00
8691540,SUP,HCPCS C1713,,8691540  -  CDH M8 5.5 X 40 RED FAS 5.5 TI,"$2,362.40",$0.00,"$2,362.40","$1,063.08","$1,686.04",$0.00,$407.03,$0.00,$0.00,$413.64,"$2,362.40",$0.00,"$1,181.20","$1,871.02","$1,889.92",$0.00,$369.72,$0.00,$376.09,$0.00
8691545,SUP,HCPCS C1713,,8691545  -  CDH M8 5.5 X 45 RED FAS 5.5 TI,"$2,362.40",$0.00,"$2,362.40","$1,063.08","$1,686.04",$0.00,$407.03,$0.00,$0.00,$413.64,"$2,362.40",$0.00,"$1,181.20","$1,871.02","$1,889.92",$0.00,$369.72,$0.00,$376.09,$0.00
8691550,SUP,HCPCS C1713,,8691550  -  CDH M8 5.5 X 50 RED FAS 5.5 TI,"$2,362.40",$0.00,"$2,362.40","$1,063.08","$1,686.04",$0.00,$407.03,$0.00,$0.00,$413.64,"$2,362.40",$0.00,"$1,181.20","$1,871.02","$1,889.92",$0.00,$369.72,$0.00,$376.09,$0.00
8691630,SUP,HCPCS C1713,,8691630  -  CDH M8 6.5 X 30 RED FAS 5.5 TI,"$2,362.40",$0.00,"$2,362.40","$1,063.08","$1,686.04",$0.00,$407.03,$0.00,$0.00,$413.64,"$2,362.40",$0.00,"$1,181.20","$1,871.02","$1,889.92",$0.00,$369.72,$0.00,$376.09,$0.00
8691635,SUP,HCPCS C1713,,8691635  -  CDH M8 6.5 X 35 RED FAS 5.5 TI,"$2,362.40",$0.00,"$2,362.40","$1,063.08","$1,686.04",$0.00,$407.03,$0.00,$0.00,$413.64,"$2,362.40",$0.00,"$1,181.20","$1,871.02","$1,889.92",$0.00,$369.72,$0.00,$376.09,$0.00
8691640,SUP,HCPCS C1713,,8691640  -  CDH M8 6.5 X 40 RED FAS 5.5 TI,"$2,362.40",$0.00,"$2,362.40","$1,063.08","$1,686.04",$0.00,$407.03,$0.00,$0.00,$413.64,"$2,362.40",$0.00,"$1,181.20","$1,871.02","$1,889.92",$0.00,$369.72,$0.00,$376.09,$0.00
8691645,SUP,HCPCS C1713,,8691645  -  CDH M8 6.5 X 45 RED FAS 5.5 TI,"$2,362.40",$0.00,"$2,362.40","$1,063.08","$1,686.04",$0.00,$407.03,$0.00,$0.00,$413.64,"$2,362.40",$0.00,"$1,181.20","$1,871.02","$1,889.92",$0.00,$369.72,$0.00,$376.09,$0.00
8691650,SUP,HCPCS C1713,,8691650  -  CDH M8 6.5 X 50 RED FAS 5.5 TI,"$2,362.40",$0.00,"$2,362.40","$1,063.08","$1,686.04",$0.00,$407.03,$0.00,$0.00,$413.64,"$2,362.40",$0.00,"$1,181.20","$1,871.02","$1,889.92",$0.00,$369.72,$0.00,$376.09,$0.00
8691655,SUP,HCPCS C1713,,8691655  -  CDH M8 6.5 X 55 RED FAS 5.5 TI,"$2,362.40",$0.00,"$2,362.40","$1,063.08","$1,686.04",$0.00,$407.03,$0.00,$0.00,$413.64,"$2,362.40",$0.00,"$1,181.20","$1,871.02","$1,889.92",$0.00,$369.72,$0.00,$376.09,$0.00
8691730,SUP,HCPCS C1713,,8691730  -  CDH M8 7.5 X 30 RED FAS 5.5 TI,"$2,362.40",$0.00,"$2,362.40","$1,063.08","$1,686.04",$0.00,$407.03,$0.00,$0.00,$413.64,"$2,362.40",$0.00,"$1,181.20","$1,871.02","$1,889.92",$0.00,$369.72,$0.00,$376.09,$0.00
8691735,SUP,HCPCS C1713,,8691735  -  CDH M8 7.5 X 35 RED FAS 5.5 TI,"$2,362.40",$0.00,"$2,362.40","$1,063.08","$1,686.04",$0.00,$407.03,$0.00,$0.00,$413.64,"$2,362.40",$0.00,"$1,181.20","$1,871.02","$1,889.92",$0.00,$369.72,$0.00,$376.09,$0.00
8691745,SUP,HCPCS C1713,,8691745  -  CDH M8 7.5 X 45 RED FAS 5.5 TI,"$2,362.40",$0.00,"$2,362.40","$1,063.08","$1,686.04",$0.00,$407.03,$0.00,$0.00,$413.64,"$2,362.40",$0.00,"$1,181.20","$1,871.02","$1,889.92",$0.00,$369.72,$0.00,$376.09,$0.00
8691750,SUP,HCPCS C1713,,8691750  -  CDH M8 7.5 X 50 RED FAS 5.5 TI,"$2,362.40",$0.00,"$2,362.40","$1,063.08","$1,686.04",$0.00,$407.03,$0.00,$0.00,$413.64,"$2,362.40",$0.00,"$1,181.20","$1,871.02","$1,889.92",$0.00,$369.72,$0.00,$376.09,$0.00
8692150,SUP,HCPCS C1713,,"8692150  -  M8 RED. STD. RAMPED HOOK, TI","$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
8692152,SUP,HCPCS C1713,,"8692152  -  M8 RED. NARROW RAMP HOOK, TI","$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
8698501,SUP,HCPCS C1713,,8698501  -  STAPLE BONE SM 2 ROD 21MM TI RSTRL SPN CD HZN ANTARES STRL,"$4,240.00",$0.00,"$4,240.00","$1,908.00","$3,026.09",$0.00,$730.53,$0.00,$0.00,$742.39,"$4,240.00",$0.00,"$2,120.00","$3,358.08","$3,392.00",$0.00,$663.56,$0.00,$675.01,$0.00
8698502,SUP,HCPCS C1713,,8698502  -  STAPLE BONE MED 2 ROD TI CDL SPN CD HZN ANTARES,"$4,240.00",$0.00,"$4,240.00","$1,908.00","$3,026.09",$0.00,$730.53,$0.00,$0.00,$742.39,"$4,240.00",$0.00,"$2,120.00","$3,358.08","$3,392.00",$0.00,$663.56,$0.00,$675.01,$0.00
8699050,SUP,HCPCS C1713,,"8699050  -  CDH 5.5X50 STRAIGHT ROD, TI CP",$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8699055,SUP,HCPCS C1713,,"8699055  -  CDH 5.5X55 STRAIGHT ROD, TI CP",$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8699060,SUP,HCPCS C1713,,"8699060  -  CDH 5.5X60 STRAIGHT ROD, TI CP",$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8699065,SUP,HCPCS C1713,,"8699065  -  CDH 5.5X65 STRAIGHT ROD, TI CP",$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8699070,SUP,HCPCS C1713,,"8699070  -  CDH 5.5X70 STRAIGHT ROD, TI CP",$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8699075,SUP,HCPCS C1713,,"8699075  -  CDH 5.5X75 STRAIGHT ROD, TI CP",$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8699080,SUP,HCPCS C1713,,"8699080  -  CDH 5.5X80 STRAIGHT ROD, TI CP",$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8699085,SUP,HCPCS C1713,,"8699085  -  CDH 5.5X85 STRAIGHT ROD, TI CP",$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8699090,SUP,HCPCS C1713,,"8699090  -  CDH 5.5X90 STRAIGHT ROD, TI CP",$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8699095,SUP,HCPCS C1713,,"8699095  -  CDH 5.5X95 STRAIGHT ROD, TI CP",$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8699100,SUP,HCPCS C1713,,"8699100  -  CDH 5.5X100 STRAIGHT ROD,TI CP",$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8730006,SUP,Custom 27203010,,"8730006  -  UCSS CANNULATED DRILL BIT, STERILE","$1,099.50",$0.00,"$1,099.50",$0.00,$784.71,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,099.50",$0.00,$549.75,$870.80,$879.60,$0.00,$0.00,$0.00,$0.00,$0.00
8750520,SUP,HCPCS C1713,,8750520  -  CONCTR ROD 20MM 5.5MM SS OFFST,"$2,482.50",$0.00,"$2,482.50","$1,117.13","$1,771.76",$0.00,$427.72,$0.00,$0.00,$434.67,"$2,482.50",$0.00,"$1,241.25","$1,966.14","$1,986.00",$0.00,$388.51,$0.00,$395.21,$0.00
8750530,SUP,HCPCS C1713,,8750530  -  CONCTR ROD 30MM 5.5MM SS OFFST,"$2,482.50",$0.00,"$2,482.50","$1,117.13","$1,771.76",$0.00,$427.72,$0.00,$0.00,$434.67,"$2,482.50",$0.00,"$1,241.25","$1,966.14","$1,986.00",$0.00,$388.51,$0.00,$395.21,$0.00
8750560,SUP,HCPCS C1713,,8750560  -  CONCTR ROD 60MM 5.5MM SS OFFST,"$2,482.50",$0.00,"$2,482.50","$1,117.13","$1,771.76",$0.00,$427.72,$0.00,$0.00,$434.67,"$2,482.50",$0.00,"$1,241.25","$1,966.14","$1,986.00",$0.00,$388.51,$0.00,$395.21,$0.00
8754025,SUP,HCPCS C1713,,8754025  -  SCREW UNIPLANER 4.0MM 25MM 5.5MM SS,"$5,192.50",$0.00,"$5,192.50","$2,336.63","$3,705.89",$0.00,$894.64,$0.00,$0.00,$909.17,"$5,192.50",$0.00,"$2,596.25","$4,112.46","$4,154.00",$0.00,$812.63,$0.00,$826.65,$0.00
8754030,SUP,HCPCS C1713,,8754030  -  SCREW UNIPLANER 4.0MM 30MM 5.5MM SS,"$5,192.50",$0.00,"$5,192.50","$2,336.63","$3,705.89",$0.00,$894.64,$0.00,$0.00,$909.17,"$5,192.50",$0.00,"$2,596.25","$4,112.46","$4,154.00",$0.00,$812.63,$0.00,$826.65,$0.00
8754035,SUP,HCPCS C1713,,8754035  -  SCREW UNIPLANER 4.0MM 35MM 5.5MM SS,"$5,192.50",$0.00,"$5,192.50","$2,336.63","$3,705.89",$0.00,$894.64,$0.00,$0.00,$909.17,"$5,192.50",$0.00,"$2,596.25","$4,112.46","$4,154.00",$0.00,$812.63,$0.00,$826.65,$0.00
8754040,SUP,HCPCS C1713,,8754040  -  SCREW UNIPLANER 4.0MM 40MM 5.5MM SS,"$5,192.50",$0.00,"$5,192.50","$2,336.63","$3,705.89",$0.00,$894.64,$0.00,$0.00,$909.17,"$5,192.50",$0.00,"$2,596.25","$4,112.46","$4,154.00",$0.00,$812.63,$0.00,$826.65,$0.00
8754045,SUP,HCPCS C1713,,8754045  -  SCREW UNIPLANER 4.0MM 45MM 5.5MM SS,"$5,192.50",$0.00,"$5,192.50","$2,336.63","$3,705.89",$0.00,$894.64,$0.00,$0.00,$909.17,"$5,192.50",$0.00,"$2,596.25","$4,112.46","$4,154.00",$0.00,$812.63,$0.00,$826.65,$0.00
8754525,SUP,HCPCS C1713,,8754525  -  SCREW UNIPLANER 4.5MM 25MM 5.5MM SS,"$5,192.50",$0.00,"$5,192.50","$2,336.63","$3,705.89",$0.00,$894.64,$0.00,$0.00,$909.17,"$5,192.50",$0.00,"$2,596.25","$4,112.46","$4,154.00",$0.00,$812.63,$0.00,$826.65,$0.00
8754530,SUP,HCPCS C1713,,8754530  -  SCREW UNIPLANER 4.5MM 30MM 5.5MM SS,"$5,192.50",$0.00,"$5,192.50","$2,336.63","$3,705.89",$0.00,$894.64,$0.00,$0.00,$909.17,"$5,192.50",$0.00,"$2,596.25","$4,112.46","$4,154.00",$0.00,$812.63,$0.00,$826.65,$0.00
8754535,SUP,HCPCS C1713,,8754535  -  SCREW UNIPLANER 4.5MM 35MM 5.5MM SS,"$5,192.50",$0.00,"$5,192.50","$2,336.63","$3,705.89",$0.00,$894.64,$0.00,$0.00,$909.17,"$5,192.50",$0.00,"$2,596.25","$4,112.46","$4,154.00",$0.00,$812.63,$0.00,$826.65,$0.00
8754540,SUP,HCPCS C1713,,8754540  -  SCREW UNIPLANER 4.5MM 40MM 5.5MM SS,"$5,192.50",$0.00,"$5,192.50","$2,336.63","$3,705.89",$0.00,$894.64,$0.00,$0.00,$909.17,"$5,192.50",$0.00,"$2,596.25","$4,112.46","$4,154.00",$0.00,$812.63,$0.00,$826.65,$0.00
8754545,SUP,HCPCS C1713,,8754545  -  SCREW UNIPLANER 4.5MM 45MM 5.5MM SS,"$5,192.50",$0.00,"$5,192.50","$2,336.63","$3,705.89",$0.00,$894.64,$0.00,$0.00,$909.17,"$5,192.50",$0.00,"$2,596.25","$4,112.46","$4,154.00",$0.00,$812.63,$0.00,$826.65,$0.00
8754550,SUP,HCPCS C1713,,8754550  -  SCREW UNIPLANER 4.5MM 50MM 5.5MM SS,"$5,192.50",$0.00,"$5,192.50","$2,336.63","$3,705.89",$0.00,$894.64,$0.00,$0.00,$909.17,"$5,192.50",$0.00,"$2,596.25","$4,112.46","$4,154.00",$0.00,$812.63,$0.00,$826.65,$0.00
8755025,SUP,HCPCS C1713,,8755025  -  SCREW UNIPLANER 5.0MM 25MM 5.5MM SS,"$5,192.50",$0.00,"$5,192.50","$2,336.63","$3,705.89",$0.00,$894.64,$0.00,$0.00,$909.17,"$5,192.50",$0.00,"$2,596.25","$4,112.46","$4,154.00",$0.00,$812.63,$0.00,$826.65,$0.00
8755030,SUP,HCPCS C1713,,8755030  -  SCREW UNIPLANER 5.0MM 30MM 5.5MM SS,"$5,192.50",$0.00,"$5,192.50","$2,336.63","$3,705.89",$0.00,$894.64,$0.00,$0.00,$909.17,"$5,192.50",$0.00,"$2,596.25","$4,112.46","$4,154.00",$0.00,$812.63,$0.00,$826.65,$0.00
8755035,SUP,HCPCS C1713,,8755035  -  SCREW UNIPLANER 5.0MM 35MM 5.5MM SS,"$5,192.50",$0.00,"$5,192.50","$2,336.63","$3,705.89",$0.00,$894.64,$0.00,$0.00,$909.17,"$5,192.50",$0.00,"$2,596.25","$4,112.46","$4,154.00",$0.00,$812.63,$0.00,$826.65,$0.00
8755040,SUP,HCPCS C1713,,8755040  -  SCREW UNIPLANER 5.0MM 40MM 5.5MM SS,"$5,192.50",$0.00,"$5,192.50","$2,336.63","$3,705.89",$0.00,$894.64,$0.00,$0.00,$909.17,"$5,192.50",$0.00,"$2,596.25","$4,112.46","$4,154.00",$0.00,$812.63,$0.00,$826.65,$0.00
8755045,SUP,HCPCS C1713,,8755045  -  SCREW UNIPLANER 5.0MM 45MM 5.5MM SS,"$5,192.50",$0.00,"$5,192.50","$2,336.63","$3,705.89",$0.00,$894.64,$0.00,$0.00,$909.17,"$5,192.50",$0.00,"$2,596.25","$4,112.46","$4,154.00",$0.00,$812.63,$0.00,$826.65,$0.00
8755050,SUP,HCPCS C1713,,8755050  -  SCREW UNIPLANER 5.0MM 50MM 5.5MM SS,"$5,192.50",$0.00,"$5,192.50","$2,336.63","$3,705.89",$0.00,$894.64,$0.00,$0.00,$909.17,"$5,192.50",$0.00,"$2,596.25","$4,112.46","$4,154.00",$0.00,$812.63,$0.00,$826.65,$0.00
8755525,SUP,HCPCS C1713,,8755525  -  SCREW UNIPLANER 5.5MM 25MM 5.5MM SS,"$5,192.50",$0.00,"$5,192.50","$2,336.63","$3,705.89",$0.00,$894.64,$0.00,$0.00,$909.17,"$5,192.50",$0.00,"$2,596.25","$4,112.46","$4,154.00",$0.00,$812.63,$0.00,$826.65,$0.00
8755530,SUP,HCPCS C1713,,8755530  -  SCREW UNIPLANER 5.5MM 30MM 5.5MM SS,"$5,192.50",$0.00,"$5,192.50","$2,336.63","$3,705.89",$0.00,$894.64,$0.00,$0.00,$909.17,"$5,192.50",$0.00,"$2,596.25","$4,112.46","$4,154.00",$0.00,$812.63,$0.00,$826.65,$0.00
8755535,SUP,HCPCS C1713,,8755535  -  SCREW UNIPLANER 5.5MM 35MM 5.5MM SS,"$5,192.50",$0.00,"$5,192.50","$2,336.63","$3,705.89",$0.00,$894.64,$0.00,$0.00,$909.17,"$5,192.50",$0.00,"$2,596.25","$4,112.46","$4,154.00",$0.00,$812.63,$0.00,$826.65,$0.00
8755540,SUP,HCPCS C1713,,8755540  -  SCREW UNIPLANER 5.5MM 40MM 5.5MM SS,"$5,192.50",$0.00,"$5,192.50","$2,336.63","$3,705.89",$0.00,$894.64,$0.00,$0.00,$909.17,"$5,192.50",$0.00,"$2,596.25","$4,112.46","$4,154.00",$0.00,$812.63,$0.00,$826.65,$0.00
8755545,SUP,HCPCS C1713,,8755545  -  SCREW UNIPLANER 5.5MM 45MM 5.5MM SS,"$5,192.50",$0.00,"$5,192.50","$2,336.63","$3,705.89",$0.00,$894.64,$0.00,$0.00,$909.17,"$5,192.50",$0.00,"$2,596.25","$4,112.46","$4,154.00",$0.00,$812.63,$0.00,$826.65,$0.00
8755550,SUP,HCPCS C1713,,8755550  -  SCREW UNIPLANER 5.5MM 50MM 5.5MM SS,"$5,192.50",$0.00,"$5,192.50","$2,336.63","$3,705.89",$0.00,$894.64,$0.00,$0.00,$909.17,"$5,192.50",$0.00,"$2,596.25","$4,112.46","$4,154.00",$0.00,$812.63,$0.00,$826.65,$0.00
8755555,SUP,HCPCS C1713,,8755555  -  SCREW UNIPLANER 5.5MM 55MM 5.5MM SS,"$5,192.50",$0.00,"$5,192.50","$2,336.63","$3,705.89",$0.00,$894.64,$0.00,$0.00,$909.17,"$5,192.50",$0.00,"$2,596.25","$4,112.46","$4,154.00",$0.00,$812.63,$0.00,$826.65,$0.00
8755560,SUP,HCPCS C1713,,8755560  -  SCREW UNIPLANER 5.5MM 60MM 5.5MM SS,"$5,192.50",$0.00,"$5,192.50","$2,336.63","$3,705.89",$0.00,$894.64,$0.00,$0.00,$909.17,"$5,192.50",$0.00,"$2,596.25","$4,112.46","$4,154.00",$0.00,$812.63,$0.00,$826.65,$0.00
8755565,SUP,HCPCS C1713,,8755565  -  SCREW UNIPLANER 5.5MM 65MM 5.5MM SS,"$5,192.50",$0.00,"$5,192.50","$2,336.63","$3,705.89",$0.00,$894.64,$0.00,$0.00,$909.17,"$5,192.50",$0.00,"$2,596.25","$4,112.46","$4,154.00",$0.00,$812.63,$0.00,$826.65,$0.00
8756025,SUP,HCPCS C1713,,8756025  -  SCREW UNIPLANER 6.0MM 25MM 5.5MM SS,"$5,192.50",$0.00,"$5,192.50","$2,336.63","$3,705.89",$0.00,$894.64,$0.00,$0.00,$909.17,"$5,192.50",$0.00,"$2,596.25","$4,112.46","$4,154.00",$0.00,$812.63,$0.00,$826.65,$0.00
8756030,SUP,HCPCS C1713,,8756030  -  SCREW UNIPLANER 6.0MM 30MM 5.5MM SS,"$5,192.50",$0.00,"$5,192.50","$2,336.63","$3,705.89",$0.00,$894.64,$0.00,$0.00,$909.17,"$5,192.50",$0.00,"$2,596.25","$4,112.46","$4,154.00",$0.00,$812.63,$0.00,$826.65,$0.00
8756035,SUP,HCPCS C1713,,8756035  -  SCREW UNIPLANER 6.0MM 35MM 5.5MM SS,"$5,192.50",$0.00,"$5,192.50","$2,336.63","$3,705.89",$0.00,$894.64,$0.00,$0.00,$909.17,"$5,192.50",$0.00,"$2,596.25","$4,112.46","$4,154.00",$0.00,$812.63,$0.00,$826.65,$0.00
8756040,SUP,HCPCS C1713,,8756040  -  SCREW UNIPLANER 6.0MM 40MM 5.5MM SS,"$5,192.50",$0.00,"$5,192.50","$2,336.63","$3,705.89",$0.00,$894.64,$0.00,$0.00,$909.17,"$5,192.50",$0.00,"$2,596.25","$4,112.46","$4,154.00",$0.00,$812.63,$0.00,$826.65,$0.00
8756045,SUP,HCPCS C1713,,8756045  -  SCREW UNIPLANER 6.0MM 45MM 5.5MM SS,"$5,192.50",$0.00,"$5,192.50","$2,336.63","$3,705.89",$0.00,$894.64,$0.00,$0.00,$909.17,"$5,192.50",$0.00,"$2,596.25","$4,112.46","$4,154.00",$0.00,$812.63,$0.00,$826.65,$0.00
8756050,SUP,HCPCS C1713,,8756050  -  SCREW UNIPLANER 6.0MM 50MM 5.5MM SS,"$5,192.50",$0.00,"$5,192.50","$2,336.63","$3,705.89",$0.00,$894.64,$0.00,$0.00,$909.17,"$5,192.50",$0.00,"$2,596.25","$4,112.46","$4,154.00",$0.00,$812.63,$0.00,$826.65,$0.00
8756055,SUP,HCPCS C1713,,8756055  -  SCREW UNIPLANER 6.0MM 55MM 5.5MM SS,"$5,192.50",$0.00,"$5,192.50","$2,336.63","$3,705.89",$0.00,$894.64,$0.00,$0.00,$909.17,"$5,192.50",$0.00,"$2,596.25","$4,112.46","$4,154.00",$0.00,$812.63,$0.00,$826.65,$0.00
8756060,SUP,HCPCS C1713,,8756060  -  SCREW UNIPLANER 6.0MM 60MM 5.5MM SS,"$5,192.50",$0.00,"$5,192.50","$2,336.63","$3,705.89",$0.00,$894.64,$0.00,$0.00,$909.17,"$5,192.50",$0.00,"$2,596.25","$4,112.46","$4,154.00",$0.00,$812.63,$0.00,$826.65,$0.00
8756065,SUP,HCPCS C1713,,8756065  -  SCREW UNIPLANER 6.0MM 65MM 5.5MM SS,"$5,192.50",$0.00,"$5,192.50","$2,336.63","$3,705.89",$0.00,$894.64,$0.00,$0.00,$909.17,"$5,192.50",$0.00,"$2,596.25","$4,112.46","$4,154.00",$0.00,$812.63,$0.00,$826.65,$0.00
8780111,SUP,HCPCS C1713,,8780111  -  SCREW BN 4MM 11MM ARCHON SLF DRL FX ANG SPNE DEGENERATIVE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
8780113,SUP,HCPCS C1713,,8780113  -  SCREW BN 4MM 13MM ARCHON SLF DRL FX ANG SPNE DEGENERATIVE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
8780115,SUP,HCPCS C1713,,8780115  -  SCREW BN 4MM 15MM ARCHON SLF DRL FX ANG SPNE DEGENERATIVE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
8780211,SUP,HCPCS C1713,,8780211  -  SCREW BN 4MM 11MM NS ARCHON SLF DRL VA SPNE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
8780213,SUP,HCPCS C1713,,8780213  -  SCREW BN 4MM 13MM ARCHON SLF DRL VA SPNE DEGENERATIVE DISC,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
8780215,SUP,HCPCS C1713,,8780215  -  SCREW BN 4MM 15MM NS ARCHON SLF DRL VA SPNE DEGENERATIVE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
8780216,SUP,HCPCS C1713,,8780216  -  SCREW BN 4MM 16MM SLF DRL VAR,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
8780311,SUP,HCPCS C1713,,8780311  -  SCREW BN 4MM 11MM ARCHON ST FX ANG SPNE DEGENERATIVE DISC,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
8780313,SUP,HCPCS C1713,,8780313  -  SCREW BN 4MM 13MM ARCHON ST FX ANG SPNE DEGENERATIVE DISC,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
8780319,SUP,HCPCS C1713,,8780319  -  SCREW BN 4MM 19MM ARCHON ST FX ANG SPNE DEGENERATIVE DISC,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
8780411,SUP,HCPCS C1713,,8780411  -  SCREW BN 4MM 11MM NS ARCHON SLF DRL VA SPNE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
8780511,SUP,HCPCS C1713,,8780511  -  SCREW BN 4.5MM 11MM ARCHON ST FX ANG SPNE DEGENERATIVE DISC,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
8780515,SUP,HCPCS C1713,,8780515  -  SCREW BN 4.5MM 15MM NS ARCHON ST FX ANG SPNE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
8780517,SUP,HCPCS C1713,,8780517  -  SCREW BN 4.5MM 17MM ARCHON ST FX ANG SPNE DEGENERATIVE DISC,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
8780519,SUP,HCPCS C1713,,8780519  -  SCREW BN 4.5MM 19MM ARCHON ST FX ANG SPNE DEGENERATIVE DISC,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
8780613,SUP,HCPCS C1713,,8780613  -  SCREW BN 4.5MM 13MM NS ARCHON ST VA SPNE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
8780617,SUP,HCPCS C1713,,8780617  -  SCREW BN 4.5MM 17MM NS ARCHON SLF DRL VA SPNE DEGENERATIVE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
8780619,SUP,HCPCS C1713,,8780619  -  SCREW BN 4.5MM 19MM NS ARCHON ST VA SPNE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
8780711,SUP,HCPCS C1713,,8780711  -  SCREW BN 4MM 11MM NS ARCHON SLF DRL FX ANG SPNE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
8780715,SUP,HCPCS C1713,,8780715  -  SCREW BN 4MM 15MM NS ARCHON SLF DRL FX ANG SPNE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
8780811,SUP,HCPCS C1713,,8780811  -  SCREW BN 4MM 11MM NS ARCHON ST FX ANG SPNE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
8780813,SUP,HCPCS C1713,,8780813  -  SCREW BN 4MM 13MM NS ARCHON ST FX ANG SPNE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
8780815,SUP,HCPCS C1713,,8780815  -  SCREW BN 4MM 15MM NS ARCHON ST FX ANG SPNE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
8780817,SUP,HCPCS C1713,,8780817  -  SCREW BN 4MM 17MM NS ARCHON ST FX ANG SPNE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
8780819,SUP,HCPCS C1713,,8780819  -  SCREW BN 4MM 19MM NS ARCHON ST FX ANG SPNE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
8780911,SUP,HCPCS C1713,,8780911  -  SCREW BN 4.5MM 11MM NS ARCHON ST FX ANG SPNE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
8780913,SUP,HCPCS C1713,,8780913  -  SCREW BN 4.5MM 13MM NS ARCHON ST FX ANG SPNE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
8780915,SUP,HCPCS C1713,,8780915  -  SCREW BN 4.5MM 15MM NS ARCHON ST FX ANG SPNE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
8780917,SUP,HCPCS C1713,,8780917  -  SCREW BN 4.5MM 17MM NS ARCHON SLF DRL FX ANG SPNE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
8780919,SUP,HCPCS C1713,,8780919  -  SCREW BN 4.5MM 19MM NS ARCHON ST FX ANG SPNE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
8787118,SUP,HCPCS C1713,,8787118  -  ARCHON 18MM PLATE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8787120,SUP,HCPCS C1713,,8787120  -  PLATE BN 20MM ARCHON 1 LVL SPNE DEGENERATIVE DISC,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8787128,SUP,HCPCS C1713,,8787128  -  PLATE BN 28MM NS ARCHON 1 LVL SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8787130,SUP,HCPCS C1713,,8787130  -  PLATE BN 30MM NS ARCHON 1 LVL SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8787132,SUP,HCPCS C1713,,8787132  -  PLATE BN 32MM NS ARCHON 1 LVL SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8787234,SUP,HCPCS C1713,,8787234  -  PLATE BN 34MM NS ARCHON 2 LVL SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8787236,SUP,HCPCS C1713,,8787236  -  PLATE BN 36MM NS ARCHON 2 LVL SPNE DEGENERATIVE DISC,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8787238,SUP,HCPCS C1713,,8787238  -  ARCHON 2 LEVEL PLATE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8787240,SUP,HCPCS C1713,,"8787240  -  ARCHON LEVEL2, CERVICAL PLATE","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8787242,SUP,HCPCS C1713,,8787242  -  PLATE BN 42MM ARCHON 2 LVL SPNE DEGENERATIVE DISC,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8787244,SUP,HCPCS C1713,,"8787244  -  ARCHON PLATE, 2 LEVEL, 44MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8787246,SUP,HCPCS C1713,,8787246  -  PLATE BN 46MM NS ARCHON 2 LVL SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8787248,SUP,HCPCS C1713,,8787248  -  PLATE BN 48MM NS ARCHON 2 LVL SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8787250,SUP,HCPCS C1713,,8787250  -  PLATE BN 50MM NS ARCHON 2 LVL SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8787252,SUP,HCPCS C1713,,8787252  -  PLATE BN 52MM NS ARCHON 2 LVL SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8787254,SUP,HCPCS C1713,,8787254  -  PLATE BN 54MM NS ARCHON 2 LVL SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8787350,SUP,HCPCS C1713,,8787350  -  PLATE BN 50MM NS ARCHON 3 LVL SPNE,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
8787352,SUP,HCPCS C1713,,8787352  -  PLATE BN 52MM NS ARCHON 3 LVL SPNE,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
8787356,SUP,HCPCS C1713,,8787356  -  PLATE BN 56MM NS ARCHON 3 LVL SPNE,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
8787364,SUP,HCPCS C1713,,8787364  -  PLATE BN 64MM NS ARCHON 3 LVL SPNE,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
8787366,SUP,HCPCS C1713,,8787366  -  PLATE BN 66MM NS ARCHON 3 LVL SPNE,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
8787368,SUP,HCPCS C1713,,8787368  -  PLATE BN 68MM NS ARCHON 3 LVL SPNE,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
8787468,SUP,HCPCS C1713,,8787468  -  PLATE BN 68MM ARCHON 4 LVL SPNE DEGENERATIVE DISC,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
8787474,SUP,HCPCS C1713,,8787474  -  PLATE BN 74MM ARCHON 4 LVL SPNE DEGENERATIVE DISC,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
8787486,SUP,HCPCS C1713,,8787486  -  PLATE BN 86MM ARCHON 4 LVL SPNE DEGENERATIVE DISC,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
8787500,SUP,HCPCS C1713,,8787500  -  PLATE BN 100MM ARCHON 5 LVL SPNE DEGENERATIVE DISC,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,$0.00,$0.00,$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
8787510,SUP,HCPCS C1713,,8787510  -  PLATE BN 110MM ARCHON 5 LVL SPNE DEGENERATIVE DISC,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,$0.00,$0.00,$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
8792111,SUP,HCPCS C1713,,8792111  -  SCREW 8792111 VAST CNCLLS 3.5X11MM,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
8792113,SUP,HCPCS C1713,,8792113  -  SCREW 8792113 ZEPHIR VAST 3.5X13,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
8792115,SUP,HCPCS C1713,,8792115  -  SCREW 8792115 ZEPHIR VAST 3.5X15,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
8792117,SUP,HCPCS C1713,,8792117  -  SCREW 8792117 ZEPHIR VAST 3.5X17,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
8792711,SUP,HCPCS C1713,,8792711  -  SCREW 8792711 VAST CNCLLS 4.0X11MM,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
8792713,SUP,HCPCS C1713,,8792713  -  SCREW 8792713 VAST CNCLLS 4.0X13MM,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
8792715,SUP,HCPCS C1713,,8792715  -  SCREW 8792715 VAST CNCLLS 4.0X15MM,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
8792717,SUP,HCPCS C1713,,8792717  -  SCREW 8792717 VASD CNCLLS 4.0X17MM,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
8792811,SUP,HCPCS C1713,,8792811  -  SCREW 8792811 VA SELF DRILLING 3.5X11MM,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
8792813,SUP,HCPCS C1713,,8792813  -  SCREW 8792813 VA SELF DRILLING 3.5X13MM,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
8792815,SUP,HCPCS C1713,,8792815  -  SCREW BN 3.5MM 15MM NS ZPHR VA SLF DRL TI SPNE CRV ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
8792817,SUP,HCPCS C1713,,8792817  -  SCREW 8792817 VA SELF DRILLING 3.5X17MM,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
8792911,SUP,HCPCS C1713,,8792911  -  SCREW 8792911 VA SELF DRILLING 4.0X11MM,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
8792913,SUP,HCPCS C1713,,8792913  -  SCREW 8792913 VA SELF DRILLING 4.0X13MM,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
8792915,SUP,HCPCS C1713,,8792915  -  SCREW BN 4MM 15MM NS ZPHR VA SLF DRL TI SPNE CRV ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
8792917,SUP,HCPCS C1713,,8792917  -  SCREW 8792917 VA SELF DRILLING 4.0X17MM,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
8799022,SUP,HCPCS C1713,,8799022  -  PLATE 8799022 ANT CERV  22.5MM TI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8799025,SUP,HCPCS C1713,,8799025  -  PLATE 8799025 ANT CERV 25MM TI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8799027,SUP,HCPCS C1713,,8799027  -  PLATE 8799027 ANT CERV 27.5MM TI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8799130,SUP,HCPCS C1713,,8799130  -  PLATE 8799130 ZEPHIR 30MM TI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8799132,SUP,HCPCS C1713,,8799132  -  PLATE 8799132 ZEPHIR 32.5MM TI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8799135,SUP,HCPCS C1713,,8799135  -  PLATE 8799135 ZEPHIR 35MM TI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8799137,SUP,HCPCS C1713,,8799137  -  PLATE 8799137 ZEPHIR 37.5MM TI,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8799140,SUP,HCPCS C1713,,8799140  -  PLATE 8799140 ZEPHIR  40MM TI,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8799142,SUP,HCPCS C1713,,8799142  -  PLATE 8799142 ZEPHIR 42.5MM TI,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8799145,SUP,HCPCS C1713,,8799145  -  PLATE 8799145 ZEPHIR 45MM TI,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8799147,SUP,HCPCS C1713,,8799147  -  PLATE 8799147ZEPHIR 47.5MM TI,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8799150,SUP,HCPCS C1713,,8799150  -  PLATE 8799150 ZEPHIR 50MM TI,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8799152,SUP,HCPCS C1713,,8799152  -  PLATE 8799152 ZEPHIR 52.5MM TI,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
8799155,SUP,HCPCS C1713,,8799155  -  PLATE 8799155 ZEPHIR 55MM TI,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
8799157,SUP,HCPCS C1713,,8799157  -  PLATE 8799157 ZEPHIR 57.5MM TI,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
8799160,SUP,HCPCS C1713,,8799160  -  PLATE 8799160 ZEPHIR 60MM TI,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
8799162,SUP,HCPCS C1713,,8799162  -  PLATE 8799162 ZEPHIR 62.5MM TI,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
8799165,SUP,HCPCS C1713,,8799165  -  PLATE 8799165 ZEPHIR 65MM TI,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
8799167,SUP,HCPCS C1713,,8799167  -  PLATE 8799167 ZEPHIR 67.5MM TI,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
8799170,SUP,HCPCS C1713,,8799170  -  PLATE 8799170 ZEPHIR 70MM TI,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
8799180,SUP,HCPCS C1713,,8799180  -  PLATE 8799180 ZEPHIR KIT 22MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8799190,SUP,HCPCS C1713,,8799190  -  PLATE 8799190 ZEPHIR KIT 25MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8799200,SUP,HCPCS C1713,,8799200  -  PLATE 8799200 ZEPHIR KIT 27MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8799230,SUP,HCPCS C1713,,"8799230  -  ZEPHIR DUAL SLOT PLATE, 30MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8799232,SUP,HCPCS C1713,,"8799232  -  ZEPHIR DUAL SLOT PLATE, 32.5MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8799235,SUP,HCPCS C1713,,"8799235  -  ZEPHIR DUAL SLOT PLATE, 35MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8799237,SUP,HCPCS C1713,,"8799237  -  ZEPHIR DUAL SLOT PLATE, 37.5MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8799245,SUP,HCPCS C1713,,"8799245  -  ZEPHIR DUAL SLOT PLATE, 45MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8799247,SUP,HCPCS C1713,,"8799247  -  ZEPHIR DUAL SLOT PLATE, 47.5MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8799250,SUP,HCPCS C1713,,"8799250  -  ZEPHIR DUAL SLOT PLATE, 50MM","$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8799252,SUP,HCPCS C1713,,"8799252  -  ZEPHIR DUAL SLOT PLATE, 52.5MM","$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
8799255,SUP,HCPCS C1713,,"8799255  -  ZEPHIR DUAL SLOT PLATE, 55MM","$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
8799257,SUP,HCPCS C1713,,"8799257  -  ZEPHIR DUAL SLOT PLATE, 57.5MM","$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
8799260,SUP,HCPCS C1713,,"8799260  -  ZEPHIR DUAL SLOT PLATE, 60MM","$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
8799262,SUP,HCPCS C1713,,"8799262  -  ZEPHIR DUAL SLOT PLATE, 62.5MM","$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
8799265,SUP,HCPCS C1713,,"8799265  -  ZEPHIR DUAL SLOT PLATE, 65MM","$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
8799267,SUP,HCPCS C1713,,"8799267  -  ZEPHIR DUAL SLOT PLATE, 67.5MM","$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
8799270,SUP,HCPCS C1713,,"8799270  -  ZEPHIR DUAL SLOT PLATE, 70MM","$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
8800000,SUP,HCPCS C1713,,8800000  -  SCREW BONE SPNL MULTIAX LCK,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
8801054,SUP,Custom 27203010,,8801054  -  MARKER SRG STRL NDI 4 SPHR IN TRY STD MNT POST DISP,$65.00,$0.00,$65.00,$0.00,$46.39,$0.00,$0.00,$0.00,$0.00,$0.00,$65.00,$0.00,$32.50,$51.48,$52.00,$0.00,$0.00,$0.00,$0.00,$0.00
8801068,SUP,HCPCS C1769,,8801068  -  WIRE KWIRE SPNL THRD,$225.00,$0.00,$225.00,$122.18,$160.58,$0.00,$38.77,$0.00,$0.00,$39.40,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$35.21,$0.00,$35.82,$0.00
8801269,SUP,HCPCS C1713,,8801269  -  WIRE FX LNG PRCPT GSB MAS KRSH BVL TIP NTNL,$225.00,$0.00,$225.00,$101.25,$160.58,$0.00,$38.77,$0.00,$0.00,$39.40,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$35.21,$0.00,$35.82,$0.00
8804525,SUP,HCPCS C1713,,8804525  -  SCREW BONE 4.5MM 25MM POLYAX PRECEPT SPN,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8804530,SUP,HCPCS C1713,,8804530  -  SCREW BONE 4.5MM 30MM SPNL POLYAX,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
8804535,SUP,HCPCS C1713,,8804535  -  SCREW BONE 4.5MM 35MM POLYAX PRECEPT SPN,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8804540,SUP,HCPCS C1713,,8804540  -  SCREW BONE 4.5MM 40MM POLYAX PRECEPT SPN,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8804545,SUP,HCPCS C1713,,8804545  -  SCREW BONE 4.5MM 45MM POLYAX PRECEPT SPN,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8805530,SUP,HCPCS C1713,,8805530  -  SCREW BONE 5.5MM 30MM POLYAX PRECEPT SPN,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8805535,SUP,HCPCS C1713,,8805535  -  SCREW BONE 5.5MM 35MM POLYAX PRECEPT SPN,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8805540,SUP,HCPCS C1713,,8805540  -  SCREW BONE 5.5MM 40MM POLYAX PRECEPT SPN,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8805545,SUP,HCPCS C1713,,8805545  -  SCREW BONE 5.5MM 45MM POLYAX PRECEPT SPN,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8805550,SUP,HCPCS C1713,,8805550  -  SCREW BONE 5.5MM 50MM POLYAX PRECEPT SPN,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8805555,SUP,HCPCS C1713,,8805555  -  SCREW BONE 5.5MM 55MM POLYAX PRECEPT SPN,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8806530,SUP,HCPCS C1713,,8806530  -  SCREW BONE 6.5MM 30MM POLYAX PRECEPT SPN,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8806535,SUP,HCPCS C1713,,8806535  -  SCREW BONE 6.5MM 35MM POLYAX PRECEPT SPN,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8806540,SUP,HCPCS C1713,,8806540  -  SCREW BONE 6.5MM 40MM POLYAX PRECEPT SPN,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8806545,SUP,HCPCS C1713,,8806545  -  SCREW BONE 6.5MM 45MM SPNL MULTIAX,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8806550,SUP,HCPCS C1713,,8806550  -  SCREW BONE 6.5MM 50MM MULTIAX PRECEPT SPN,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8806555,SUP,HCPCS C1713,,8806555  -  SCREW BONE 6.5MM 55MM POLYAX PRECEPT SPN,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8807500,SUP,HCPCS C1713,,8807500  -  SCREW BONE 7.5MM 50MM SPNL MULTIAX,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8807530,SUP,HCPCS C1713,,8807530  -  SCREW BONE 7.5MM 30MM SPNL POLYAX,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8807535,SUP,HCPCS C1713,,8807535  -  SCREW BONE 7.5MM 35MM SPNL POLYAX,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8807540,SUP,HCPCS C1713,,8807540  -  SCREW BONE 7.5MM 40MM SPNL POLYAX,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8807545,SUP,HCPCS C1713,,8807545  -  SCREW BONE 7.5MM 45MM SPNL POLYAX,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8807550,SUP,HCPCS C1713,,8807550  -  SCREW BONE 7.5MM 50MM SPNL MULTIAX,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8807555,SUP,HCPCS C1713,,8807555  -  SCREW BONE 7.5MM 55MM SPNL MULTIAX,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8807560,SUP,HCPCS C1713,,8807560  -  SCREW BONE 7.5MM 60MM SPNL MULTIAX,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8807570,SUP,HCPCS C1713,,8807570  -  SCREW BONE 7.5MM 70MM SPNL MULTIAX,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8807580,SUP,HCPCS C1713,,8807580  -  SCREW BONE 7.5MM 80MM SPNL MULTIAX,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8807590,SUP,HCPCS C1713,,8807590  -  SCREW BONE 7.5MM 90MM SPNL MULTIAX,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8808500,SUP,HCPCS C1713,,8808500  -  SCREW BONE 8.5MM 100MM SPNL MULTIAX,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8808535,SUP,HCPCS C1713,,8808535  -  SCREW BONE 8.5MM 35MM SPNL MULTIAX,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8808540,SUP,HCPCS C1713,,8808540  -  SCREW BONE 8.5MM 40MM SPNL MULTIAX,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8808545,SUP,HCPCS C1713,,8808545  -  SCREW BONE 8.5MM 45MM SPNL MULTIAX,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8808550,SUP,HCPCS C1713,,8808550  -  SCREW BONE 8.5MM 50MM SPNL MULTIAX,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8808555,SUP,HCPCS C1713,,8808555  -  SCREW BONE 8.5MM 55MM SPNL MULTIAX,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8808560,SUP,HCPCS C1713,,8808560  -  SCREW BONE 8.5MM 60MM SPNL MULTIAX,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8808570,SUP,HCPCS C1713,,8808570  -  SCREW BONE 8.5MM 70MM SPNL MULTIAX,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8808580,SUP,HCPCS C1713,,8808580  -  SCREW BONE 8.5MM 80MM SPNL MULTIAX,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8808590,SUP,HCPCS C1713,,8808590  -  SCREW BONE 8.5MM 90MM SPNL MULTIAX,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8824525,SUP,HCPCS C1713,,8824525  -  SCREW BN 4.5MM 25MM PRCPT RDC SPNE,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
8824530,SUP,HCPCS C1713,,8824530  -  SCREW BN 4.5MM 30MM PRCPT RDC SPNE,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
8824535,SUP,HCPCS C1713,,8824535  -  SCREW BN 4.5MM 35MM PRCPT RDC SPNE,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
8824540,SUP,HCPCS C1713,,8824540  -  SCREW BN 4.5MM 40MM PRCPT RDC SPNE,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
8824545,SUP,HCPCS C1713,,8824545  -  SCREW BN 4.5MM 45MM PRCPT RDC SPNE,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
8825530,SUP,HCPCS C1713,,8825530  -  SCREW BN 7.5MM 35MM PRCPT RDC SPNE,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
8825545,SUP,HCPCS C1713,,8825545  -  SCREW BN 7.5MM 50MM PRCPT RDC SPNE,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
8825550,SUP,HCPCS C1713,,8825550  -  SCREW BN 7.5MM 55MM PRCPT RDC SPNE,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
8825555,SUP,HCPCS C1713,,8825555  -  SCREW BN 6.5MM 40MM PRCPT RDC SPNE,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
8826530,SUP,HCPCS C1713,,8826530  -  SCREW BN 6.5MM 45MM PRCPT RDC SPNE,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
8826540,SUP,HCPCS C1713,,8826540  -  SCREW BN 6.5MM 40MM NS PRCPT RDC SPNE,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
8826550,SUP,HCPCS C1713,,8826550  -  SCREW BN 5.5MM 30MM PRCPT RDC SPNE,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
8826555,SUP,HCPCS C1713,,8826555  -  SCREW BN 5.5MM 35MM PRCPT RDC SPNE,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
8827500,SUP,HCPCS C1713,,8827500  -  SCREW BN 7.5MM 100MM PRCPT RDC SPNE,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
8827530,SUP,HCPCS C1713,,8827530  -  SCREW BN 5.5MM 40MM PRCPT RDC SPNE,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
8827535,SUP,HCPCS C1713,,8827535  -  SCREW BN 5.5MM 45MM PRCPT RDC SPNE,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
8827550,SUP,HCPCS C1713,,8827550  -  SCREW BN 6.5MM 30MM PRCPT RDC SPNE,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
8827555,SUP,HCPCS C1713,,8827555  -  SCREW BN 6.5MM 35MM PRCPT RDC SPNE,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
8827560,SUP,HCPCS C1713,,8827560  -  SCREW BN 7.5MM 60MM PRCPT RDC SPNE,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
8827570,SUP,HCPCS C1713,,8827570  -  SCREW BN 7.5MM 70MM PRCPT RDC SPNE,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
8827580,SUP,HCPCS C1713,,8827580  -  SCREW BN 7.5MM 80MM PRCPT RDC SPNE,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
8827590,SUP,HCPCS C1713,,8827590  -  SCREW BN 7.5MM 90MM PRCPT RDC SPNE,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
8828500,SUP,HCPCS C1713,,8828500  -  SCREW BN 8.5MM 100MM PRCPT RDC SPNE,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
8828535,SUP,HCPCS C1713,,8828535  -  SCREW BN 8.5MM 35MM PRCPT RDC SPNE,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
8828540,SUP,HCPCS C1713,,8828540  -  SCREW BN 8.5MM 40MM PRCPT RDC SPNE,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
8828545,SUP,HCPCS C1713,,8828545  -  SCREW BN 8.5MM 45MM PRCPT RDC SPNE,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
8828550,SUP,HCPCS C1713,,8828550  -  SCREW BN 8.5MM 50MM PRCPT RDC SPNE,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
8828555,SUP,HCPCS C1713,,8828555  -  SCREW BN 8.5MM 55MM PRCPT RDC SPNE,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
8828560,SUP,HCPCS C1713,,8828560  -  SCREW BN 8.5MM 60MM PRCPT RDC SPNE,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
8828570,SUP,HCPCS C1713,,8828570  -  SCREW BN 8.5MM 70MM PRCPT RDC SPNE,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
8828580,SUP,HCPCS C1713,,8828580  -  SCREW BN 8.5MM 80MM PRCPT RDC SPNE,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
8828590,SUP,HCPCS C1713,,8828590  -  SCREW BN 8.5MM 90MM PRCPT RDC SPNE,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
8847020,SUP,HCPCS C1713,,8847020  -  ROD SPNL 20MM PRCPT PREBNT TI,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
8847025,SUP,HCPCS C1713,,8847025  -  ROD SPNL 25MM PRCPT PREBNT TI,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
8847030,SUP,HCPCS C1713,,8847030  -  ROD SPNL 30MM PRCPT PREBNT TI,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
8847035,SUP,HCPCS C1713,,8847035  -  ROD SPNL 35MM PRCPT PREBNT TI,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
8847040,SUP,HCPCS C1713,,8847040  -  ROD SPNL 540MM PRCPT PREBNT TI,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
8847045,SUP,HCPCS C1713,,8847045  -  ROD SPNL 45MM PRCPT PREBNT TI,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
8847050,SUP,HCPCS C1713,,8847050  -  ROD SPNL 50MM PRCPT PREBNT TI,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
8847055,SUP,HCPCS C1713,,8847055  -  ROD SPNL 55MM PRCPT PREBNT TI,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
8847060,SUP,HCPCS C1713,,8847060  -  ROD SPNL 60MM PRCPT PREBNT TI,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
8847065,SUP,HCPCS C1713,,8847065  -  ROD SPNL 65MM PRCPT PREBNT TI,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
8847070,SUP,HCPCS C1713,,8847070  -  ROD SPNL 70MM PRCPT PREBNT TI,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
8847075,SUP,HCPCS C1713,,8847075  -  ROD SPNL 75MM PRCPT PREBNT TI,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
8847080,SUP,HCPCS C1713,,8847080  -  ROD SPNL 80MM PRCPT PREBNT TI,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
8847085,SUP,HCPCS C1713,,8847085  -  ROD SPNL 85MM PRCPT PREBNT TI,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
8847090,SUP,HCPCS C1713,,8847090  -  ROD SPNL 90MM PRCPT PREBNT TI,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
8847095,SUP,HCPCS C1713,,8847095  -  ROD SPNL 95MM PRCPT PREBNT TI,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
8847100,SUP,HCPCS C1713,,8847100  -  ROD SPNL 100MM PRCPT PREBNT TI,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
8847110,SUP,HCPCS C1713,,8847110  -  ROD SPNL 110MM PRCPT PREBNT TI,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
8847120,SUP,HCPCS C1713,,8847120  -  ROD SPNL 120MM PRCPT PREBNT TI,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
8847130,SUP,HCPCS C1713,,8847130  -  ROD SPNL 130MM PRCPT PREBNT TI,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
8847140,SUP,HCPCS C1713,,8847140  -  ROD SPNL 140MM PRCPT PREBNT TI,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
8847150,SUP,HCPCS C1713,,8847150  -  ROD SPNL 150MM PRCPT PREBNT TI,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
8847160,SUP,HCPCS C1713,,8847160  -  ROD SPNL 160MM PRCPT PREBNT TI,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
8848160,SUP,HCPCS C1713,,8848160  -  ROD SPNL 160MM PRCPT STRAIGHT TI,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
8848170,SUP,HCPCS C1713,,8848170  -  ROD SPNL 170MM PRCPT STRAIGHT TI,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
8848180,SUP,HCPCS C1713,,8848180  -  ROD SPNL 180MM PRCPT STRAIGHT TI,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
8848190,SUP,HCPCS C1713,,8848190  -  ROD SPNL 190MM PRCPT STRAIGHT TI,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
8848200,SUP,HCPCS C1713,,8848200  -  ROD SPNL 200MM PRCPT STRAIGHT TI,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
8848210,SUP,HCPCS C1713,,8848210  -  ROD SPNL 210MM PRCPT STRAIGHT TI,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
8848220,SUP,HCPCS C1713,,8848220  -  ROD SPNL 220MM PRCPT STRAIGHT TI,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
8848230,SUP,HCPCS C1713,,8848230  -  ROD SPNL 230MM PRCPT STRAIGHT TI,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
8848240,SUP,HCPCS C1713,,8848240  -  ROD SPNL 240MM PRCPT STRAIGHT TI,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
8848250,SUP,HCPCS C1713,,8848250  -  ROD SPNL 250MM PRCPT STRAIGHT TI,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
8848300,SUP,HCPCS C1713,,8848300  -  ROD SPNL 300MM PRCPT STRAIGHT TI,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
8848500,SUP,HCPCS C1713,,8848500  -  ROD SPNL 500MM PRCPT STRAIGHT TI,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
8848600,SUP,HCPCS C1713,,8848600  -  ROD SPNL 600MM PRCPT STRAIGHT TI,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
8880823,SUP,HCPCS C1713,,8880823  -  SPACER SPNL XLORDOTIC 23MMX8MM STRL ELEV PEEK TI,"$11,698.50",$0.00,"$11,698.50","$5,264.33","$5,158.80",$0.00,"$2,015.59",$0.00,$0.00,"$2,048.31","$11,698.50",$0.00,"$5,849.25","$9,265.21","$9,358.80",$0.00,"$1,830.82",$0.00,"$1,862.40",$0.00
8880828,SUP,HCPCS C1713,,8880828  -  SPACER SPNL XLORDOTIC 28MMX8MM STRL ELEV PEEK TI,"$11,698.50",$0.00,"$11,698.50","$5,264.33","$5,158.80",$0.00,"$2,015.59",$0.00,$0.00,"$2,048.31","$11,698.50",$0.00,"$5,849.25","$9,265.21","$9,358.80",$0.00,"$1,830.82",$0.00,"$1,862.40",$0.00
8880832,SUP,HCPCS C1713,,8880832  -  SPACER SPNL XLORDOTIC 32MMX8MM STRL ELEV PEEK TI,"$11,698.50",$0.00,"$11,698.50","$5,264.33","$5,158.80",$0.00,"$2,015.59",$0.00,$0.00,"$2,048.31","$11,698.50",$0.00,"$5,849.25","$9,265.21","$9,358.80",$0.00,"$1,830.82",$0.00,"$1,862.40",$0.00
8880923,SUP,HCPCS C1713,,8880923  -  SPACER SPNL XLORDOTIC 23MMX9MM STRL ELEV PEEK TI,"$11,698.50",$0.00,"$11,698.50","$5,264.33","$5,158.80",$0.00,"$2,015.59",$0.00,$0.00,"$2,048.31","$11,698.50",$0.00,"$5,849.25","$9,265.21","$9,358.80",$0.00,"$1,830.82",$0.00,"$1,862.40",$0.00
8880928,SUP,HCPCS C1713,,8880928  -  SPACER SPNL 28MMX9MM ELEV XLORDOTIC PEEK TI STRL,"$11,698.50",$0.00,"$11,698.50","$5,264.33","$5,158.80",$0.00,"$2,015.59",$0.00,$0.00,"$2,048.31","$11,698.50",$0.00,"$5,849.25","$9,265.21","$9,358.80",$0.00,"$1,830.82",$0.00,"$1,862.40",$0.00
8880932,SUP,HCPCS C1713,,8880932  -  SPACER SPNL XLORDOTIC 32MMX9MM STRL ELEV PEEK TI,"$11,698.50",$0.00,"$11,698.50","$5,264.33","$5,158.80",$0.00,"$2,015.59",$0.00,$0.00,"$2,048.31","$11,698.50",$0.00,"$5,849.25","$9,265.21","$9,358.80",$0.00,"$1,830.82",$0.00,"$1,862.40",$0.00
8881023,SUP,HCPCS C1713,,8881023  -  SPACER SPNL XLORDOTIC 23MMX10MM STRL ELEV PEEK TI,"$11,698.50",$0.00,"$11,698.50","$5,264.33","$5,158.80",$0.00,"$2,015.59",$0.00,$0.00,"$2,048.31","$11,698.50",$0.00,"$5,849.25","$9,265.21","$9,358.80",$0.00,"$1,830.82",$0.00,"$1,862.40",$0.00
8881028,SUP,HCPCS C1713,,8881028  -  SPACER SPNL XLORDOTIC 28MMX10MM STRL ELEV PEEK TI,"$11,698.50",$0.00,"$11,698.50","$5,264.33","$5,158.80",$0.00,"$2,015.59",$0.00,$0.00,"$2,048.31","$11,698.50",$0.00,"$5,849.25","$9,265.21","$9,358.80",$0.00,"$1,830.82",$0.00,"$1,862.40",$0.00
8881032,SUP,HCPCS C1713,,8881032  -  SPACER SPNL XLORDOTIC 32MMX10MM STRL ELEV PEEK TI,"$11,698.50",$0.00,"$11,698.50","$5,264.33","$5,158.80",$0.00,"$2,015.59",$0.00,$0.00,"$2,048.31","$11,698.50",$0.00,"$5,849.25","$9,265.21","$9,358.80",$0.00,"$1,830.82",$0.00,"$1,862.40",$0.00
8881123,SUP,HCPCS C1713,,8881123  -  SPACER SPNL XLORDOTIC 23MMX11MM STRL ELEV PEEK TI,"$11,698.50",$0.00,"$11,698.50","$5,264.33","$5,158.80",$0.00,"$2,015.59",$0.00,$0.00,"$2,048.31","$11,698.50",$0.00,"$5,849.25","$9,265.21","$9,358.80",$0.00,"$1,830.82",$0.00,"$1,862.40",$0.00
8881128,SUP,HCPCS C1713,,8881128  -  SPACER SPNL XLORDOTIC 28MMX11MM STRL ELEV PEEK TI,"$11,698.50",$0.00,"$11,698.50","$5,264.33","$5,158.80",$0.00,"$2,015.59",$0.00,$0.00,"$2,048.31","$11,698.50",$0.00,"$5,849.25","$9,265.21","$9,358.80",$0.00,"$1,830.82",$0.00,"$1,862.40",$0.00
8881132,SUP,HCPCS C1713,,8881132  -  SPACER SPNL XLORDOTIC 32MMX11MM STRL ELEV PEEK TI,"$11,698.50",$0.00,"$11,698.50","$5,264.33","$5,158.80",$0.00,"$2,015.59",$0.00,$0.00,"$2,048.31","$11,698.50",$0.00,"$5,849.25","$9,265.21","$9,358.80",$0.00,"$1,830.82",$0.00,"$1,862.40",$0.00
8896555,SUP,HCPCS C1713,,8896555  -  SCREW BONE 6.5MM 55MM GSB PRCPT SPN MDLR CANN SHNK,"$1,000.00",$0.00,"$1,000.00",$450.00,$713.70,$0.00,$172.30,$0.00,$0.00,$175.09,"$1,000.00",$0.00,$500.00,$792.00,$800.00,$0.00,$156.50,$0.00,$159.20,$0.00
8914000,SUP,HCPCS C1713,,8914000  -  M4 BREAK-OFF SCREW,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
8915008,SUP,HCPCS C1713,,8915008  -  SPACER SPNL SM FLT 8MM STRL VRTSTCK ADON PEEK LMBR INTRBD FS,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
8915010,SUP,HCPCS C1713,,8915010  -  SPACER SPNL SM FLT 10MM STRL VRTSTCK ADON PEEK LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
8915012,SUP,HCPCS C1713,,8915012  -  SPACER SPNL SM FLT 12MM STRL VRTSTCK ADON PEEK LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
8915014,SUP,HCPCS C1713,,8915014  -  SPACER SPNL SM FLT 14MM STRL VRTSTCK ADON PEEK LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
8915016,SUP,HCPCS C1713,,8915016  -  SPACER SPNL SM FLT 16MM STRL VRTSTCK ADON PEEK LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
8915018,SUP,HCPCS C1713,,8915018  -  SPACER SPNL SM FLT 18MM STRL VRTSTCK ADON PEEK LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
8915020,SUP,HCPCS C1713,,8915020  -  SPACER SPNL SM FLT 20MM STRL VRTSTCK ADON PEEK LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
8915408,SUP,HCPCS C1713,,8915408  -  SPACER SPNL SM LRDTC 8MM STRL VRTSTCK ADON PEEK LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
8915410,SUP,HCPCS C1713,,8915410  -  SPACER SPNL SM LRDTC 10MM STRL VRTSTCK ADON PEEK LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
8915412,SUP,HCPCS C1713,,8915412  -  SPACER SPNL SM LRDTC 12MM STRL VRTSTCK ADON PEEK LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
8915414,SUP,HCPCS C1713,,8915414  -  SPACER SPNL SM LRDTC 14MM STRL VRTSTCK ADON PEEK LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
8915416,SUP,HCPCS C1713,,8915416  -  SPACER SPNL SM LRDTC 16MM STRL VRTSTCK ADON PEEK LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
8915418,SUP,HCPCS C1713,,8915418  -  SPACER SPNL SM LRDTC 18MM STRL VRTSTCK ADON PEEK LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
8915420,SUP,HCPCS C1713,,8915420  -  SPACER SPNL SM LRDTC 20MM STRL VRTSTCK ADON PEEK LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
8915805,SUP,HCPCS C1713,,8915805  -  SPACER SPNL SM 5MM STRL VRTSTCK CENTERPIECE PEEK LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
8915810,SUP,HCPCS C1713,,8915810  -  SPACER SPNL SM 10MM STRL VRTSTCK CENTERPIECE PEEK LMBR,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
8915820,SUP,HCPCS C1713,,8915820  -  SPACER SPNL SM 20MM STRL VRTSTCK CENTERPIECE PEEK LMBR,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
8915830,SUP,HCPCS C1713,,8915830  -  SPACER SPNL SM 30MM STRL VRTSTCK CENTERPIECE PEEK LMBR,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
8915840,SUP,HCPCS C1713,,8915840  -  SPACER SPNL SM 40MM STRL VRTSTCK CENTERPIECE PEEK LMBR,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
8916008,SUP,HCPCS C1713,,8916008  -  SPACER SPNL LG FLT 8MM STRL VRTSTCK ADON PEEK LMBR INTRBD FS,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
8916010,SUP,HCPCS C1713,,8916010  -  SPACER SPNL LG FLT 10MM STRL VRTSTCK ADON PEEK LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
8916012,SUP,HCPCS C1713,,8916012  -  SPACER SPNL LG FLT 12MM STRL VRTSTCK ADON PEEK LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
8916014,SUP,HCPCS C1713,,8916014  -  SPACER SPNL LG FLT 14MM STRL VRTSTCK ADON PEEK LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
8916016,SUP,HCPCS C1713,,8916016  -  SPACER SPNL LG FLT 16MM STRL VRTSTCK ADON PEEK LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
8916018,SUP,HCPCS C1713,,8916018  -  SPACER SPNL LG FLT 18MM STRL VRTSTCK ADON PEEK LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
8916020,SUP,HCPCS C1713,,8916020  -  SPACER SPNL LG FLT 20MM STRL VRTSTCK ADON PEEK LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
8916408,SUP,HCPCS C1713,,8916408  -  SPACER SPNL LG LRDTC 8MM STRL VRTSTCK ADON PEEK LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
8916410,SUP,HCPCS C1713,,8916410  -  SPACER SPNL LG LRDTC 10MM STRL VRTSTCK ADON PEEK LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
8916412,SUP,HCPCS C1713,,8916412  -  SPACER SPNL LG LRDTC 12MM STRL VRTSTCK ADON PEEK LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
8916414,SUP,HCPCS C1713,,8916414  -  SPACER SPNL LG LRDTC 14MM STRL VRTSTCK ADON PEEK LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
8916416,SUP,HCPCS C1713,,8916416  -  SPACER SPNL LG LRDTC 16MM STRL VRTSTCK ADON PEEK LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
8916418,SUP,HCPCS C1713,,8916418  -  SPACER SPNL LG LRDTC 18MM STRL VRTSTCK ADON PEEK LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
8916420,SUP,HCPCS C1713,,8916420  -  SPACER SPNL LG LRDTC 20MM STRL VRTSTCK ADON PEEK LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
8916805,SUP,HCPCS C1713,,8916805  -  SPACER SPNL LG 5MM STRL VRTSTCK CENTERPIECE PEEK LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
8916810,SUP,HCPCS C1713,,8916810  -  SPACER SPNL LG 10MM STRL VRTSTCK CENTERPIECE PEEK LMBR,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
8916820,SUP,HCPCS C1713,,8916820  -  SPACER SPNL LG 20MM STRL VRTSTCK CENTERPIECE PEEK LMBR,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
8916830,SUP,HCPCS C1713,,8916830  -  SPACER SPNL LG 30MM STRL VRTSTCK CENTERPIECE PEEK LMBR,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
8916840,SUP,HCPCS C1713,,8916840  -  SPACER SPNL LG 40MM STRL VRTSTCK CENTERPIECE PEEK LMBR,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
8941420,SUP,Custom 27803010,,8941420  -  CAGE SPNL 14MM 20X17MM LTCG TI LMBR TPR FSN DEV,"$7,226.25",$0.00,"$7,226.25",$0.00,"$5,157.37",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,226.25",$0.00,"$3,613.13","$5,723.19","$5,781.00",$0.00,$0.00,$0.00,$0.00,$0.00
8941423,SUP,Custom 27803010,,8941423  -  CAGE SPNL 14MM 23X17.5MM LTCG TI LMBR TPR FSN DEV,"$7,226.25",$0.00,"$7,226.25",$0.00,"$5,157.37",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,226.25",$0.00,"$3,613.13","$5,723.19","$5,781.00",$0.00,$0.00,$0.00,$0.00,$0.00
8941620,SUP,Custom 27803010,,8941620  -  CAGE SPNL 16MM 20X19MM LTCG TI LMBR TPR FSN DEV,"$7,226.25",$0.00,"$7,226.25",$0.00,"$5,157.37",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,226.25",$0.00,"$3,613.13","$5,723.19","$5,781.00",$0.00,$0.00,$0.00,$0.00,$0.00
8941623,SUP,Custom 27803010,,8941623  -  CAGE SPNL 16MM 23X19MM LTCG TI LMBR TPR FSN DEV,"$7,226.25",$0.00,"$7,226.25",$0.00,"$5,157.37",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,226.25",$0.00,"$3,613.13","$5,723.19","$5,781.00",$0.00,$0.00,$0.00,$0.00,$0.00
8941626,SUP,Custom 27803010,,8941626  -  CAGE SPNL 16MM 26X20MM LTCG TI LMBR TPR FSN DEV,"$7,226.25",$0.00,"$7,226.25",$0.00,"$5,157.37",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,226.25",$0.00,"$3,613.13","$5,723.19","$5,781.00",$0.00,$0.00,$0.00,$0.00,$0.00
8941823,SUP,Custom 27803010,,8941823  -  CAGE SPNL 18MM 23X21.5MM LTCG TI LMBR TPR FSN DEV,"$7,226.25",$0.00,"$7,226.25",$0.00,"$5,157.37",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,226.25",$0.00,"$3,613.13","$5,723.19","$5,781.00",$0.00,$0.00,$0.00,$0.00,$0.00
8941826,SUP,Custom 27803010,,8941826  -  CAGE SPNL 18MM 26X22MM LTCG TI LMBR TPR FSN DEV,"$7,226.25",$0.00,"$7,226.25",$0.00,"$5,157.37",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,226.25",$0.00,"$3,613.13","$5,723.19","$5,781.00",$0.00,$0.00,$0.00,$0.00,$0.00
8954025,SUP,HCPCS C1713,,8954025  -  SCREW BONE 25MM 4MM SS FIX 5.5MM ROD,"$2,802.50",$0.00,"$2,802.50","$1,261.13","$2,000.14",$0.00,$482.86,$0.00,$0.00,$490.70,"$2,802.50",$0.00,"$1,401.25","$2,219.58","$2,242.00",$0.00,$438.59,$0.00,$446.16,$0.00
8954030,SUP,HCPCS C1713,,8954030  -  SCREW BONE 30MM 4MM SS FIX 5.5MM ROD,"$2,802.50",$0.00,"$2,802.50","$1,261.13","$2,000.14",$0.00,$482.86,$0.00,$0.00,$490.70,"$2,802.50",$0.00,"$1,401.25","$2,219.58","$2,242.00",$0.00,$438.59,$0.00,$446.16,$0.00
8954035,SUP,HCPCS C1713,,8954035  -  SCREW BONE 35MM 4MM SS FIX 5.5MM ROD,"$2,802.50",$0.00,"$2,802.50","$1,261.13","$2,000.14",$0.00,$482.86,$0.00,$0.00,$490.70,"$2,802.50",$0.00,"$1,401.25","$2,219.58","$2,242.00",$0.00,$438.59,$0.00,$446.16,$0.00
8954525,SUP,HCPCS C1713,,8954525  -  SCREW BONE 25MM 4.5MM SS FIX 5.5MM ROD,"$2,802.50",$0.00,"$2,802.50","$1,261.13","$2,000.14",$0.00,$482.86,$0.00,$0.00,$490.70,"$2,802.50",$0.00,"$1,401.25","$2,219.58","$2,242.00",$0.00,$438.59,$0.00,$446.16,$0.00
8954530,SUP,HCPCS C1713,,8954530  -  SCREW BONE 30MM 4.5MM SS FIX 5.5MM ROD,"$2,802.50",$0.00,"$2,802.50","$1,261.13","$2,000.14",$0.00,$482.86,$0.00,$0.00,$490.70,"$2,802.50",$0.00,"$1,401.25","$2,219.58","$2,242.00",$0.00,$438.59,$0.00,$446.16,$0.00
8954535,SUP,HCPCS C1713,,8954535  -  SCREW BONE 35MM 4.5MM SS FIX 5.5MM ROD,"$2,802.50",$0.00,"$2,802.50","$1,261.13","$2,000.14",$0.00,$482.86,$0.00,$0.00,$490.70,"$2,802.50",$0.00,"$1,401.25","$2,219.58","$2,242.00",$0.00,$438.59,$0.00,$446.16,$0.00
8954540,SUP,HCPCS C1713,,8954540  -  SCREW BONE 40MM 4.5MM SS FIX 5.5MM ROD,"$2,802.50",$0.00,"$2,802.50","$1,261.13","$2,000.14",$0.00,$482.86,$0.00,$0.00,$490.70,"$2,802.50",$0.00,"$1,401.25","$2,219.58","$2,242.00",$0.00,$438.59,$0.00,$446.16,$0.00
8954545,SUP,HCPCS C1713,,8954545  -  SCREW BONE 45MM 4.5MM SS FIX 5.5MM ROD,"$2,802.50",$0.00,"$2,802.50","$1,261.13","$2,000.14",$0.00,$482.86,$0.00,$0.00,$490.70,"$2,802.50",$0.00,"$1,401.25","$2,219.58","$2,242.00",$0.00,$438.59,$0.00,$446.16,$0.00
8955530,SUP,HCPCS C1713,,8955530  -  SCREW BONE 30MM 5.5MM SS FIX 5.5MM ROD,"$2,802.50",$0.00,"$2,802.50","$1,261.13","$2,000.14",$0.00,$482.86,$0.00,$0.00,$490.70,"$2,802.50",$0.00,"$1,401.25","$2,219.58","$2,242.00",$0.00,$438.59,$0.00,$446.16,$0.00
8955535,SUP,HCPCS C1713,,8955535  -  SCREW BONE 35MM 5.5MM SS FIX 5.5MM ROD,"$2,802.50",$0.00,"$2,802.50","$1,261.13","$2,000.14",$0.00,$482.86,$0.00,$0.00,$490.70,"$2,802.50",$0.00,"$1,401.25","$2,219.58","$2,242.00",$0.00,$438.59,$0.00,$446.16,$0.00
8955540,SUP,HCPCS C1713,,8955540  -  SCREW BONE 40MM 5.5MM SS FIX 5.5MM ROD,"$2,802.50",$0.00,"$2,802.50","$1,261.13","$2,000.14",$0.00,$482.86,$0.00,$0.00,$490.70,"$2,802.50",$0.00,"$1,401.25","$2,219.58","$2,242.00",$0.00,$438.59,$0.00,$446.16,$0.00
8955545,SUP,HCPCS C1713,,8955545  -  SCREW BONE 45MM 5.5MM SS FIX 5.5MM ROD,"$2,802.50",$0.00,"$2,802.50","$1,261.13","$2,000.14",$0.00,$482.86,$0.00,$0.00,$490.70,"$2,802.50",$0.00,"$1,401.25","$2,219.58","$2,242.00",$0.00,$438.59,$0.00,$446.16,$0.00
8956535,SUP,HCPCS C1713,,8956535  -  SCREW BONE 35MM 6.5MM SS FIX 5.5MM ROD,"$2,802.50",$0.00,"$2,802.50","$1,261.13","$2,000.14",$0.00,$482.86,$0.00,$0.00,$490.70,"$2,802.50",$0.00,"$1,401.25","$2,219.58","$2,242.00",$0.00,$438.59,$0.00,$446.16,$0.00
8956540,SUP,HCPCS C1713,,8956540  -  SCREW BONE 40MM 6.5MM SS FIX 5.5MM ROD,"$2,802.50",$0.00,"$2,802.50","$1,261.13","$2,000.14",$0.00,$482.86,$0.00,$0.00,$490.70,"$2,802.50",$0.00,"$1,401.25","$2,219.58","$2,242.00",$0.00,$438.59,$0.00,$446.16,$0.00
8956545,SUP,HCPCS C1713,,8956545  -  SCREW BONE 45MM 6.5MM SS FIX 5.5MM ROD,"$2,802.50",$0.00,"$2,802.50","$1,261.13","$2,000.14",$0.00,$482.86,$0.00,$0.00,$490.70,"$2,802.50",$0.00,"$1,401.25","$2,219.58","$2,242.00",$0.00,$438.59,$0.00,$446.16,$0.00
8956550,SUP,HCPCS C1713,,8956550  -  SCREW BONE 50MM 6.5MM SS FIX 5.5MM ROD,"$2,802.50",$0.00,"$2,802.50","$1,261.13","$2,000.14",$0.00,$482.86,$0.00,$0.00,$490.70,"$2,802.50",$0.00,"$1,401.25","$2,219.58","$2,242.00",$0.00,$438.59,$0.00,$446.16,$0.00
8957535,SUP,HCPCS C1713,,8957535  -  SCREW BONE 35MM 7.5MM SS FIX 5.5MM ROD,"$2,802.50",$0.00,"$2,802.50","$1,261.13","$2,000.14",$0.00,$482.86,$0.00,$0.00,$490.70,"$2,802.50",$0.00,"$1,401.25","$2,219.58","$2,242.00",$0.00,$438.59,$0.00,$446.16,$0.00
8957540,SUP,HCPCS C1713,,8957540  -  SCREW BONE 40MM 7.5MM SS FIX 5.5MM ROD,"$2,802.50",$0.00,"$2,802.50","$1,261.13","$2,000.14",$0.00,$482.86,$0.00,$0.00,$490.70,"$2,802.50",$0.00,"$1,401.25","$2,219.58","$2,242.00",$0.00,$438.59,$0.00,$446.16,$0.00
8957545,SUP,HCPCS C1713,,8957545  -  SCREW BONE 45MM 7.5MM SS FIX 5.5MM ROD,"$2,802.50",$0.00,"$2,802.50","$1,261.13","$2,000.14",$0.00,$482.86,$0.00,$0.00,$490.70,"$2,802.50",$0.00,"$1,401.25","$2,219.58","$2,242.00",$0.00,$438.59,$0.00,$446.16,$0.00
8957550,SUP,HCPCS C1713,,8957550  -  SCREW BONE 50MM 7.5MM SS FIX 5.5MM ROD,"$2,802.50",$0.00,"$2,802.50","$1,261.13","$2,000.14",$0.00,$482.86,$0.00,$0.00,$490.70,"$2,802.50",$0.00,"$1,401.25","$2,219.58","$2,242.00",$0.00,$438.59,$0.00,$446.16,$0.00
8964525,SUP,HCPCS C1713,,8964525  -  SCREW BONE 4.5MM 25MM SS SPNL FIX 6.35MM ROD,"$2,802.50",$0.00,"$2,802.50","$1,261.13","$2,000.14",$0.00,$482.86,$0.00,$0.00,$490.70,"$2,802.50",$0.00,"$1,401.25","$2,219.58","$2,242.00",$0.00,$438.59,$0.00,$446.16,$0.00
8964530,SUP,HCPCS C1713,,8964530  -  SCREW BONE 4.5MM 30MM SS SPNL FIX 6.35MM ROD,"$2,802.50",$0.00,"$2,802.50","$1,261.13","$2,000.14",$0.00,$482.86,$0.00,$0.00,$490.70,"$2,802.50",$0.00,"$1,401.25","$2,219.58","$2,242.00",$0.00,$438.59,$0.00,$446.16,$0.00
8964535,SUP,HCPCS C1713,,8964535  -  SCREW BONE 4.5MM 35MM SS SPNL FIX 6.35MM ROD,"$2,802.50",$0.00,"$2,802.50","$1,261.13","$2,000.14",$0.00,$482.86,$0.00,$0.00,$490.70,"$2,802.50",$0.00,"$1,401.25","$2,219.58","$2,242.00",$0.00,$438.59,$0.00,$446.16,$0.00
8964540,SUP,HCPCS C1713,,8964540  -  SCREW BONE 4.5MM 40MM SS SPNL FIX 6.35MM ROD,"$2,802.50",$0.00,"$2,802.50","$1,261.13","$2,000.14",$0.00,$482.86,$0.00,$0.00,$490.70,"$2,802.50",$0.00,"$1,401.25","$2,219.58","$2,242.00",$0.00,$438.59,$0.00,$446.16,$0.00
8964545,SUP,HCPCS C1713,,8964545  -  SCREW BONE 4.5MM 45MM SS SPNL FIX 6.35MM ROD,"$2,802.50",$0.00,"$2,802.50","$1,261.13","$2,000.14",$0.00,$482.86,$0.00,$0.00,$490.70,"$2,802.50",$0.00,"$1,401.25","$2,219.58","$2,242.00",$0.00,$438.59,$0.00,$446.16,$0.00
8965530,SUP,HCPCS C1713,,8965530  -  SCREW BONE 5.5MM 30MM SS SPNL FIX 6.35MM ROD,"$2,802.50",$0.00,"$2,802.50","$1,261.13","$2,000.14",$0.00,$482.86,$0.00,$0.00,$490.70,"$2,802.50",$0.00,"$1,401.25","$2,219.58","$2,242.00",$0.00,$438.59,$0.00,$446.16,$0.00
8965535,SUP,HCPCS C1713,,8965535  -  SCREW BONE 5.5MM 35MM SS SPNL FIX 6.35MM ROD,"$2,802.50",$0.00,"$2,802.50","$1,261.13","$2,000.14",$0.00,$482.86,$0.00,$0.00,$490.70,"$2,802.50",$0.00,"$1,401.25","$2,219.58","$2,242.00",$0.00,$438.59,$0.00,$446.16,$0.00
8965540,SUP,HCPCS C1713,,8965540  -  SCREW BONE 5.5MM 40MM SS SPNL FIX 6.35MM ROD,"$2,802.50",$0.00,"$2,802.50","$1,261.13","$2,000.14",$0.00,$482.86,$0.00,$0.00,$490.70,"$2,802.50",$0.00,"$1,401.25","$2,219.58","$2,242.00",$0.00,$438.59,$0.00,$446.16,$0.00
8965545,SUP,HCPCS C1713,,8965545  -  SCREW BONE 5.5MM 45MM SS SPNL FIX 6.35MM ROD,"$2,802.50",$0.00,"$2,802.50","$1,261.13","$2,000.14",$0.00,$482.86,$0.00,$0.00,$490.70,"$2,802.50",$0.00,"$1,401.25","$2,219.58","$2,242.00",$0.00,$438.59,$0.00,$446.16,$0.00
8966535,SUP,HCPCS C1713,,8966535  -  SCREW BONE 6.5MM 35MM SS SPNL FIX 6.35MM ROD,"$2,802.50",$0.00,"$2,802.50","$1,261.13","$2,000.14",$0.00,$482.86,$0.00,$0.00,$490.70,"$2,802.50",$0.00,"$1,401.25","$2,219.58","$2,242.00",$0.00,$438.59,$0.00,$446.16,$0.00
8966540,SUP,HCPCS C1713,,8966540  -  SCREW BONE 6.5MM 40MM SS SPNL FIX 6.35MM ROD,"$2,802.50",$0.00,"$2,802.50","$1,261.13","$2,000.14",$0.00,$482.86,$0.00,$0.00,$490.70,"$2,802.50",$0.00,"$1,401.25","$2,219.58","$2,242.00",$0.00,$438.59,$0.00,$446.16,$0.00
8966545,SUP,HCPCS C1713,,8966545  -  SCREW BONE 6.5MM 6.35MM 45MM SS SPNL FIX,"$2,802.50",$0.00,"$2,802.50","$1,261.13","$2,000.14",$0.00,$482.86,$0.00,$0.00,$490.70,"$2,802.50",$0.00,"$1,401.25","$2,219.58","$2,242.00",$0.00,$438.59,$0.00,$446.16,$0.00
8966550,SUP,HCPCS C1713,,8966550  -  SCREW BONE 6.5MM 6.35MM 50MM SS SPNL FIX,"$2,802.50",$0.00,"$2,802.50","$1,261.13","$2,000.14",$0.00,$482.86,$0.00,$0.00,$490.70,"$2,802.50",$0.00,"$1,401.25","$2,219.58","$2,242.00",$0.00,$438.59,$0.00,$446.16,$0.00
8967535,SUP,HCPCS C1713,,8967535  -  SCREW BONE 7.5MM 6.35MM 35MM SS SPNL FIX,"$2,802.50",$0.00,"$2,802.50","$1,261.13","$2,000.14",$0.00,$482.86,$0.00,$0.00,$490.70,"$2,802.50",$0.00,"$1,401.25","$2,219.58","$2,242.00",$0.00,$438.59,$0.00,$446.16,$0.00
8967540,SUP,HCPCS C1713,,8967540  -  SCREW BONE 7.5MM 6.35MM 40MM SS SPNL FIX,"$2,802.50",$0.00,"$2,802.50","$1,261.13","$2,000.14",$0.00,$482.86,$0.00,$0.00,$490.70,"$2,802.50",$0.00,"$1,401.25","$2,219.58","$2,242.00",$0.00,$438.59,$0.00,$446.16,$0.00
8967545,SUP,HCPCS C1713,,8967545  -  SCREW BONE 7.5MM 6.35MM 45MM SS SPNL FIX,"$2,802.50",$0.00,"$2,802.50","$1,261.13","$2,000.14",$0.00,$482.86,$0.00,$0.00,$490.70,"$2,802.50",$0.00,"$1,401.25","$2,219.58","$2,242.00",$0.00,$438.59,$0.00,$446.16,$0.00
8967550,SUP,HCPCS C1713,,8967550  -  SCREW BONE 7.5MM 6.35MM 50MM SS SPNL FIX,"$2,802.50",$0.00,"$2,802.50","$1,261.13","$2,000.14",$0.00,$482.86,$0.00,$0.00,$490.70,"$2,802.50",$0.00,"$1,401.25","$2,219.58","$2,242.00",$0.00,$438.59,$0.00,$446.16,$0.00
8968625,SUP,HCPCS C1713,,8968625  -  SCREW 8968625 PYRMD BONE FAS 6.5X25MM,$880.50,$0.00,$880.50,$396.23,$628.41,$0.00,$151.71,$0.00,$0.00,$154.17,$880.50,$0.00,$440.25,$697.36,$704.40,$0.00,$137.80,$0.00,$140.18,$0.00
8968630,SUP,HCPCS C1713,,8968630  -  SCREW 8968630 PYRMD BONE FAS 6.5X30MM,$880.50,$0.00,$880.50,$396.23,$628.41,$0.00,$151.71,$0.00,$0.00,$154.17,$880.50,$0.00,$440.25,$697.36,$704.40,$0.00,$137.80,$0.00,$140.18,$0.00
8968635,SUP,HCPCS C1713,,8968635  -  SCREW 8968635 PYRMD BONE FAS 6.5X35MM,$880.50,$0.00,$880.50,$396.23,$628.41,$0.00,$151.71,$0.00,$0.00,$154.17,$880.50,$0.00,$440.25,$697.36,$704.40,$0.00,$137.80,$0.00,$140.18,$0.00
8969117,SUP,HCPCS C1713,,8969117  -  PLATE 8969117 PLATE 17MM,"$8,377.50",$0.00,"$8,377.50","$3,769.88","$5,158.80",$0.00,"$1,443.40",$0.00,$0.00,"$1,466.83","$8,377.50",$0.00,"$4,188.75","$6,634.98","$6,702.00",$0.00,"$1,311.08",$0.00,"$1,333.70",$0.00
8969119,SUP,HCPCS C1713,,8969119  -  PLATE 8969119 PLATE 19MM,"$8,377.50",$0.00,"$8,377.50","$3,769.88","$5,158.80",$0.00,"$1,443.40",$0.00,$0.00,"$1,466.83","$8,377.50",$0.00,"$4,188.75","$6,634.98","$6,702.00",$0.00,"$1,311.08",$0.00,"$1,333.70",$0.00
8969121,SUP,HCPCS C1713,,8969121  -  PLATE 8969121 PLATE 21MM,"$8,377.50",$0.00,"$8,377.50","$3,769.88","$5,158.80",$0.00,"$1,443.40",$0.00,$0.00,"$1,466.83","$8,377.50",$0.00,"$4,188.75","$6,634.98","$6,702.00",$0.00,"$1,311.08",$0.00,"$1,333.70",$0.00
8969123,SUP,HCPCS C1713,,8969123  -  PLATE 8969123 PLATE 23MM,"$8,377.50",$0.00,"$8,377.50","$3,769.88","$5,158.80",$0.00,"$1,443.40",$0.00,$0.00,"$1,466.83","$8,377.50",$0.00,"$4,188.75","$6,634.98","$6,702.00",$0.00,"$1,311.08",$0.00,"$1,333.70",$0.00
8969125,SUP,HCPCS C1713,,8969125  -  PLATE 8969125 PLATE 25MM,"$8,377.50",$0.00,"$8,377.50","$3,769.88","$5,158.80",$0.00,"$1,443.40",$0.00,$0.00,"$1,466.83","$8,377.50",$0.00,"$4,188.75","$6,634.98","$6,702.00",$0.00,"$1,311.08",$0.00,"$1,333.70",$0.00
8969127,SUP,HCPCS C1713,,8969127  -  PLATE 8969127 PLATE 27MM,"$8,377.50",$0.00,"$8,377.50","$3,769.88","$5,158.80",$0.00,"$1,443.40",$0.00,$0.00,"$1,466.83","$8,377.50",$0.00,"$4,188.75","$6,634.98","$6,702.00",$0.00,"$1,311.08",$0.00,"$1,333.70",$0.00
8969201,SUP,HCPCS C1713,,8969201  -  SET SCREW 8969201 LOCKING PLATE,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
8969217,SUP,HCPCS C1713,,8969217  -  PLATE 8969217 COVER PLATE 17MM,"$1,105.50",$0.00,"$1,105.50",$497.48,$789.00,$0.00,$190.47,$0.00,$0.00,$193.56,"$1,105.50",$0.00,$552.75,$875.56,$884.40,$0.00,$173.01,$0.00,$176.00,$0.00
8969219,SUP,HCPCS C1713,,8969219  -  PLATE 8969219 COVER PLATE 19MM,"$1,105.50",$0.00,"$1,105.50",$497.48,$789.00,$0.00,$190.47,$0.00,$0.00,$193.56,"$1,105.50",$0.00,$552.75,$875.56,$884.40,$0.00,$173.01,$0.00,$176.00,$0.00
8969221,SUP,HCPCS C1713,,8969221  -  PLATE 8969221 COVER PLATE 21MM,"$1,105.50",$0.00,"$1,105.50",$497.48,$789.00,$0.00,$190.47,$0.00,$0.00,$193.56,"$1,105.50",$0.00,$552.75,$875.56,$884.40,$0.00,$173.01,$0.00,$176.00,$0.00
8969223,SUP,HCPCS C1713,,8969223  -  PLATE 8969223 COVER PLATE 23MM,"$1,105.50",$0.00,"$1,105.50",$497.48,$789.00,$0.00,$190.47,$0.00,$0.00,$193.56,"$1,105.50",$0.00,$552.75,$875.56,$884.40,$0.00,$173.01,$0.00,$176.00,$0.00
8969225,SUP,HCPCS C1713,,8969225  -  PLATE 8969225 COVER PLATE 25MM,"$1,105.50",$0.00,"$1,105.50",$497.48,$789.00,$0.00,$190.47,$0.00,$0.00,$193.56,"$1,105.50",$0.00,$552.75,$875.56,$884.40,$0.00,$173.01,$0.00,$176.00,$0.00
8969227,SUP,HCPCS C1713,,8969227  -  PLATE 8969227 COVER PLATE 27MM,"$1,105.50",$0.00,"$1,105.50",$497.48,$789.00,$0.00,$190.47,$0.00,$0.00,$193.56,"$1,105.50",$0.00,$552.75,$875.56,$884.40,$0.00,$173.01,$0.00,$176.00,$0.00
8970000,SUP,HCPCS C1713,,8970000  -  SCREW LOCK 2 VUE POINT,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
8970240,SUP,HCPCS C1713,,"8970240  -  VUE POINT II, ROD TEMPLATE",$372.50,$0.00,$372.50,$167.63,$265.85,$0.00,$64.18,$0.00,$0.00,$65.22,$372.50,$0.00,$186.25,$295.02,$298.00,$0.00,$58.30,$0.00,$59.30,$0.00
8975310,SUP,HCPCS C1713,,8975310  -  SCREW BN 3.5MM 10MM NS VUEPOINT II MA SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8975312,SUP,HCPCS C1713,,8975312  -  SCREW BN 3.5MM 12MM NS VUEPOINT II MA SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8975314,SUP,HCPCS C1713,,8975314  -  SCREW BN 3.5MM 14MM NS VUEPOINT II MA SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8975318,SUP,HCPCS C1713,,8975318  -  SCREW BN 3.5MM 18MM NS VUEPOINT II MA SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8975320,SUP,HCPCS C1713,,8975320  -  SCREW BN 3.5MM 20MM NS VUEPOINT II MA SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8975322,SUP,HCPCS C1713,,8975322  -  SCREW BN 3.5MM 22MM NS VUEPOINT II MA SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8975324,SUP,HCPCS C1713,,8975324  -  SCREW BN 3.5MM 24MM NS VUEPOINT II MA SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8975326,SUP,HCPCS C1713,,8975326  -  SCREW BN 3.5MM 26MM NS VUEPOINT II MA SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8975328,SUP,HCPCS C1713,,8975328  -  SCREW BN 3.5MM 28MM NS VUEPOINT II MA SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8975330,SUP,HCPCS C1713,,8975330  -  SCREW BN 3.5MM 30MM NS VUEPOINT II MA SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8975332,SUP,HCPCS C1713,,8975332  -  SCREW BN 3.5MM 32MM NS VUEPOINT II MA SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8975334,SUP,HCPCS C1713,,8975334  -  SCREW BN 3.5MM 34MM NS VUEPOINT II MA SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8975410,SUP,HCPCS C1713,,8975410  -  SCREW BN 4MM 10MM NS VUEPOINT II MA SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8975412,SUP,HCPCS C1713,,8975412  -  SCREW BN 4MM 12MM NS VUEPOINT II MA SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8975414,SUP,HCPCS C1713,,8975414  -  SCREW BN 4MM 14MM NS VUEPOINT II MA SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8975416,SUP,HCPCS C1713,,8975416  -  SCREW BN 4MM 16MM NS VUEPOINT II MA SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8975418,SUP,HCPCS C1713,,8975418  -  SCREW BN 4MM 18MM NS VUEPOINT II MA SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8975420,SUP,HCPCS C1713,,8975420  -  SCREW BN 4MM 20MM NS VUEPOINT II MA SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8975422,SUP,HCPCS C1713,,8975422  -  SCREW BN 4MM 22MM NS VUEPOINT II MA SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8975424,SUP,HCPCS C1713,,8975424  -  SCREW BN 4MM 24MM NS VUEPOINT II MA SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8975426,SUP,HCPCS C1713,,8975426  -  SCREW BN 4MM 26MM NS VUEPOINT II MA SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8975428,SUP,HCPCS C1713,,8975428  -  SCREW BN 4MM 28MM NS VUEPOINT II MA SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8975430,SUP,HCPCS C1713,,8975430  -  SCREW BN 4MM 30MM NS VUEPOINT II MA SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8975432,SUP,HCPCS C1713,,8975432  -  SCREW BN 4MM 32MM NS VUEPOINT II MA SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8975434,SUP,HCPCS C1713,,8975434  -  SCREW BN 4MM 34MM NS VUEPOINT II MA SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8975436,SUP,HCPCS C1713,,8975436  -  SCREW BN 4MM 36MM NS VUEPOINT II MA SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8975438,SUP,HCPCS C1713,,8975438  -  SCREW BN 4MM 38MM NS VUEPOINT II MA SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8975440,SUP,HCPCS C1713,,8975440  -  SCREW BN 4MM 40MM NS VUEPOINT II MA SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8975510,SUP,HCPCS C1713,,8975510  -  SCREW BONE 3.5MM 10MM FAVORED ANGLE SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8975512,SUP,HCPCS C1713,,8975512  -  SCREW BONE 2MM 12MM VUEPOINT POSTERIOR CERV SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8975514,SUP,HCPCS C1713,,8975514  -  SCREW BONE 3.5MM 14MM VUEPOINT SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8975516,SUP,HCPCS C1713,,8975516  -  SCREW BN 3.5MM 16MM VUEPOINT II FAVOR ANG SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8975518,SUP,HCPCS C1713,,8975518  -  SCREW BN 3.5MM 18MM NS VUEPOINT II FAVORED ANG SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8975526,SUP,HCPCS C1713,,8975526  -  SCREW BN 3.5MM 26MM NS VUEPOINT II FAVORED ANG SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8975528,SUP,HCPCS C1713,,8975528  -  SCREW BN 3.5MM 28MM NS VUEPOINT II FAVORED ANG SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8975530,SUP,HCPCS C1713,,8975530  -  SCREW BN 3.5MM 30MM NS VUEPOINT II FAVORED ANG SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8975532,SUP,HCPCS C1713,,8975532  -  SCREW BN 3.5MM 32MM NS VUEPOINT II FAVORED ANG SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8975534,SUP,HCPCS C1713,,8975534  -  SCREW BN 3.5MM 34MM NS VUEPOINT II FAVORED ANG SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8975618,SUP,HCPCS C1713,,8975618  -  SCREW BN 4MM 18MM VUEPOINT II FAVOR ANG SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8975622,SUP,HCPCS C1713,,"8975622  -  VUE POINT 2, 4.0X 22MM, FAVORED ANGLE","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8975624,SUP,HCPCS C1713,,8975624  -  VUE POINT 2 4.0X 24MM SCREW,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8975636,SUP,HCPCS C1713,,8975636  -  SCREW BN 4MM 36MM NS VUEPOINT II FAVORED ANG SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8975638,SUP,HCPCS C1713,,8975638  -  SCREW BN 4MM 38MM NS VUEPOINT II FAVORED ANG SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8975640,SUP,HCPCS C1713,,8975640  -  SCREW BN 4MM 40MM NS VUEPOINT II FAVORED ANG SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8975710,SUP,HCPCS C1713,,8975710  -  SCREW BN 4.5MM 10MM NS VUEPOINT II MA SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8975712,SUP,HCPCS C1713,,8975712  -  SCREW BN 4.5MM 12MM NS VUEPOINT II MA SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8975716,SUP,HCPCS C1713,,8975716  -  SCREW BN 4.5MM 16MM NS VUEPOINT II MA SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8975718,SUP,HCPCS C1713,,8975718  -  SCREW BN 4.5MM 18MM NS VUEPOINT II MA SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8975720,SUP,HCPCS C1713,,8975720  -  VUE POINT 435 X 20,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8975722,SUP,HCPCS C1713,,8975722  -  SCREW BN 4.5MM 22MM NS VUEPOINT II MA SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8975724,SUP,HCPCS C1713,,8975724  -  SCREW BONE MULTIAX TITANIUM SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8975726,SUP,HCPCS C1713,,8975726  -  SCREW BN 4.5MM 26MM NS VUEPOINT II MA SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8975728,SUP,HCPCS C1713,,8975728  -  VUEPOINT 2 MULTI-AXIAL SCREW 4.5 X28,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8975732,SUP,HCPCS C1713,,"8975732  -  VUE POINT II, SCREW 4.5X32MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8975734,SUP,HCPCS C1713,,"8975734  -  VUE POINT II, SCREW 4.5X34MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8975736,SUP,HCPCS C1713,,"8975736  -  VUE POINT II, SCREW 4.5X36MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8975738,SUP,HCPCS C1713,,"8975738  -  VUE POINT II, SCREW 4.5X38MM","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8975740,SUP,HCPCS C1713,,8975740  -  SCREW BN 4.5MM 40MM NS VUEPOINT II MA SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8975824,SUP,HCPCS C1713,,8975824  -  SCREW BN P/T 3.5MM 24MM NS VUEPOINT II FAVORED ANG SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8975834,SUP,HCPCS C1713,,8975834  -  SCREW BN P/T 3.5MM 34MM VUEPOINT II FAVOR ANG SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8975838,SUP,HCPCS C1713,,"8975838  -  VUE POINT II, FA/PT SCREW 3.5X38","$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8976006,SUP,HCPCS C1713,,8976006  -  HOOK SPNL 6MM NS VUEPOINT II LMN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8976008,SUP,HCPCS C1713,,8976008  -  HOOK SPNL 8MM NS VUEPOINT II LMN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8976011,SUP,HCPCS C1713,,8976011  -  CONNECTOR ROD 11MM OFST VUEPOINT II OPN SPNE,"$1,095.00",$0.00,"$1,095.00",$492.75,$781.50,$0.00,$188.66,$0.00,$0.00,$191.73,"$1,095.00",$0.00,$547.50,$867.24,$876.00,$0.00,$171.37,$0.00,$174.32,$0.00
8976025,SUP,HCPCS C1713,,8976025  -  CONNECTOR ROD 25MM LNG OFST NS VUEPOINT II OPN SPNE,"$1,222.50",$0.00,"$1,222.50",$550.13,$872.50,$0.00,$210.63,$0.00,$0.00,$214.05,"$1,222.50",$0.00,$611.25,$968.22,$978.00,$0.00,$191.32,$0.00,$194.62,$0.00
8976030,SUP,HCPCS C1713,,8976030  -  CONNECTOR ROD 45D OFST NS VUEPOINT II SPNE,"$1,222.50",$0.00,"$1,222.50",$550.13,$872.50,$0.00,$210.63,$0.00,$0.00,$214.05,"$1,222.50",$0.00,$611.25,$968.22,$978.00,$0.00,$191.32,$0.00,$194.62,$0.00
8976035,SUP,HCPCS C1713,,8976035  -  CONNECTOR ROD 3.5MM NS VUEPOINT II INLN SPNE,"$1,867.50",$0.00,"$1,867.50",$840.38,"$1,332.83",$0.00,$321.76,$0.00,$0.00,$326.98,"$1,867.50",$0.00,$933.75,"$1,479.06","$1,494.00",$0.00,$292.26,$0.00,$297.31,$0.00
8976055,SUP,HCPCS C1713,,8976055  -  CONNECTOR ROD 3.5-5.5MM NS VUEPOINT II INLN SPNE,"$1,867.50",$0.00,"$1,867.50",$840.38,"$1,332.83",$0.00,$321.76,$0.00,$0.00,$326.98,"$1,867.50",$0.00,$933.75,"$1,479.06","$1,494.00",$0.00,$292.26,$0.00,$297.31,$0.00
8976112,SUP,HCPCS C1713,,8976112  -  ROD SPNL 3.5MM 120MM VUEPOINT II,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8976124,SUP,HCPCS C1713,,8976124  -  ROD 240MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8976128,SUP,HCPCS C1713,,8976128  -  CONNECTOR ROD 28MM NS VUEPOINT II FX CX SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8976130,SUP,HCPCS C1713,,8976130  -  CONNECTOR ROD 30MM NS VUEPOINT II FX CX SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8976132,SUP,HCPCS C1713,,8976132  -  VUE POINT 2 32MM FIXED CROSS CONN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8976136,SUP,HCPCS C1713,,8976136  -  CONNECTOR ROD 36MM NS VUEPOINT II FX CX SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8976138,SUP,HCPCS C1713,,8976138  -  CONNECTOR ROD 38MM VUEPOINT II CX STC SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8976160,SUP,HCPCS C1713,,8976160  -  VUE POINT II ROD 60MM,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
8976165,SUP,HCPCS C1713,,8976165  -  CONNECTOR ROD NS VUEPOINT II X SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8976180,SUP,HCPCS C1713,,8976180  -  ROD SPNL 80MM NS VUEPOINT II PRECONTOUR,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
8976240,SUP,HCPCS C1713,,8976240  -  ROD SPNL 45D 240MM NS VUEPOINT II PRECURVE,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
8976355,SUP,HCPCS C1713,,"8976355  -  TRANSITION ROD, 3.5X 5.5MM","$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
8976406,SUP,HCPCS C1713,,8976406  -  SCREW BN 4.5MM 6MM VUEPOINT II SPNE OCPTL CORT,"$1,087.50",$0.00,"$1,087.50",$489.38,$776.15,$0.00,$187.37,$0.00,$0.00,$190.41,"$1,087.50",$0.00,$543.75,$861.30,$870.00,$0.00,$170.19,$0.00,$173.13,$0.00
8976412,SUP,HCPCS C1713,,8976412  -  SCREW BN 4.5MM 12MM NS VUEPOINT II SPNE OCPTL,"$1,087.50",$0.00,"$1,087.50",$489.38,$776.15,$0.00,$187.37,$0.00,$0.00,$190.41,"$1,087.50",$0.00,$543.75,$861.30,$870.00,$0.00,$170.19,$0.00,$173.13,$0.00
8976414,SUP,HCPCS C1713,,8976414  -  SCREW BN 4.5MM 14MM VUEPOINT II SPNE OCPTL CORT,"$1,087.50",$0.00,"$1,087.50",$489.38,$776.15,$0.00,$187.37,$0.00,$0.00,$190.41,"$1,087.50",$0.00,$543.75,$861.30,$870.00,$0.00,$170.19,$0.00,$173.13,$0.00
8976435,SUP,HCPCS C1713,,8976435  -  CONNECTOR ROD OFST 3.5MM NS VUEPOINT II SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8976455,SUP,HCPCS C1713,,8976455  -  CONNECTOR ROD OFST 3.5-5.5MM NS VUEPOINT II SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8976506,SUP,HCPCS C1713,,8976506  -  SCREW BN 5MM 6MM VUEPOINT II SPNE OCPTL CORT,"$1,087.50",$0.00,"$1,087.50",$489.38,$776.15,$0.00,$187.37,$0.00,$0.00,$190.41,"$1,087.50",$0.00,$543.75,$861.30,$870.00,$0.00,$170.19,$0.00,$173.13,$0.00
8976508,SUP,HCPCS C1713,,8976508  -  SCREW BN 5MM 8MM VUEPOINT II SPNE OCPTL CORT,"$1,087.50",$0.00,"$1,087.50",$489.38,$776.15,$0.00,$187.37,$0.00,$0.00,$190.41,"$1,087.50",$0.00,$543.75,$861.30,$870.00,$0.00,$170.19,$0.00,$173.13,$0.00
8976510,SUP,HCPCS C1713,,8976510  -  SCREW BN 5MM 10MM VUEPOINT II SPNE OCPTL CORT,"$1,087.50",$0.00,"$1,087.50",$489.38,$776.15,$0.00,$187.37,$0.00,$0.00,$190.41,"$1,087.50",$0.00,$543.75,$861.30,$870.00,$0.00,$170.19,$0.00,$173.13,$0.00
8976512,SUP,HCPCS C1713,,8976512  -  SCREW BN 5MM 12MM VUEPOINT II SPNE OCPTL CORT,"$1,087.50",$0.00,"$1,087.50",$489.38,$776.15,$0.00,$187.37,$0.00,$0.00,$190.41,"$1,087.50",$0.00,$543.75,$861.30,$870.00,$0.00,$170.19,$0.00,$173.13,$0.00
8976514,SUP,HCPCS C1713,,8976514  -  SCREW BN 5MM 14MM VUEPOINT II SPNE OCPTL CORT,"$1,087.50",$0.00,"$1,087.50",$489.38,$776.15,$0.00,$187.37,$0.00,$0.00,$190.41,"$1,087.50",$0.00,$543.75,$861.30,$870.00,$0.00,$170.19,$0.00,$173.13,$0.00
8977010,SUP,Custom 27203010,,8977010  -  DRILL BIT VUE POINT 2 2.4MM,$712.50,$0.00,$712.50,$0.00,$508.51,$0.00,$0.00,$0.00,$0.00,$0.00,$712.50,$0.00,$356.25,$564.30,$570.00,$0.00,$0.00,$0.00,$0.00,$0.00
8977035,SUP,HCPCS C1713,,8977035  -  SCREW TAP VUE POINT 3.5MM,$712.50,$0.00,$712.50,$320.63,$508.51,$0.00,$122.76,$0.00,$0.00,$124.75,$712.50,$0.00,$356.25,$564.30,$570.00,$0.00,$111.51,$0.00,$113.43,$0.00
8977040,SUP,HCPCS C1713,,8977040  -  SCREW TAP VUE POINT 4.0MM,$712.50,$0.00,$712.50,$320.63,$508.51,$0.00,$122.76,$0.00,$0.00,$124.75,$712.50,$0.00,$356.25,$564.30,$570.00,$0.00,$111.51,$0.00,$113.43,$0.00
9000027,SUP,Custom 27203010,,9000027  -  SPIDER FLEX SERRATED GRASPER,$237.50,$0.00,$237.50,$0.00,$169.50,$0.00,$0.00,$0.00,$0.00,$0.00,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$0.00,$0.00,$0.00,$0.00
9000028,SUP,Custom 27203010,,9000028  -  SPIDER FLEX MARYLAND DISSECTOR,$237.50,$0.00,$237.50,$0.00,$169.50,$0.00,$0.00,$0.00,$0.00,$0.00,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$0.00,$0.00,$0.00,$0.00
9000031,SUP,Custom 27203010,,9000031  -  SPIDER FLEX MONOPOLAR HOOK,$225.00,$0.00,$225.00,$0.00,$160.58,$0.00,$0.00,$0.00,$0.00,$0.00,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$0.00,$0.00,$0.00,$0.00
9000240,SUP,HCPCS C1713,,9000240  -  SCREW BONE 40MM CANN TITANIUM 12MM SACROILIAC,"$11,000.00",$0.00,"$11,000.00","$4,950.00","$5,158.80",$0.00,"$1,895.25",$0.00,$0.00,"$1,926.01","$11,000.00",$0.00,"$5,500.00","$8,712.00","$8,800.00",$0.00,"$1,721.50",$0.00,"$1,751.20",$0.00
9000250,SUP,HCPCS C1713,,9000250  -  SCREW BONE 12MM 50MM TI SACROILIAC CANN,"$11,000.00",$0.00,"$11,000.00","$4,950.00","$5,158.80",$0.00,"$1,895.25",$0.00,$0.00,"$1,926.01","$11,000.00",$0.00,"$5,500.00","$8,712.00","$8,800.00",$0.00,"$1,721.50",$0.00,"$1,751.20",$0.00
9001635,SUP,HCPCS C1713,,9001635  -  SCREW BONE 1.6MM 35MM TIMESH TI SPNL,$146.20,$0.00,$146.20,$65.79,$104.34,$0.00,$25.19,$0.00,$0.00,$25.60,$146.20,$0.00,$73.10,$115.79,$116.96,$0.00,$22.88,$0.00,$23.28,$0.00
9001640,SUP,HCPCS C1713,,9001640  -  SCREW BONE 1.6MM 4MM TI SPNL SLFDRILL STRL,$731.00,$0.00,$731.00,$328.95,$521.71,$0.00,$125.95,$0.00,$0.00,$127.99,$731.00,$0.00,$365.50,$578.95,$584.80,$0.00,$114.40,$0.00,$116.38,$0.00
9002196,SUP,Custom 27203010,,9002196  -  KIT NDL GD 21GA 96IN STRT US,$53.50,$0.00,$53.50,$0.00,$38.18,$0.00,$0.00,$0.00,$0.00,$0.00,$53.50,$0.00,$26.75,$42.37,$42.80,$0.00,$0.00,$0.00,$0.00,$0.00
9011221,SUP,Custom 27803010,,9011221  -  CAGE SPNL 12MM 20MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
9011225,SUP,Custom 27803010,,9011225  -  CAGE SPNL 12MM 25MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
9011420,SUP,Custom 27803010,,9011420  -  CAGE SPNL 14MM 20MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
9011423,SUP,Custom 27803010,,9011423  -  CAGE SPNL 14MM 23MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
9011426,SUP,Custom 27803010,,9011426  -  CAGE SPNL 14MM 26MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
9011429,SUP,Custom 27803010,,9011429  -  CAGE SPNL 14MM 29MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
9011620,SUP,Custom 27803010,,9011620  -  CAGE SPNL 16MM 20MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
9011623,SUP,Custom 27803010,,9011623  -  CAGE SPNL 16MM 23MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
9011626,SUP,Custom 27803010,,9011626  -  CAGE SPNL 16MM 26MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
9011629,SUP,Custom 27803010,,9011629  -  CAGE SPNL 16MM 29MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
9011635,SUP,HCPCS C1713,,9011635  -  SCREW 9011635 TIMESH 1.6X3.5MM SDS OPT 1,$127.50,$0.00,$127.50,$57.38,$91.00,$0.00,$21.97,$0.00,$0.00,$22.32,$127.50,$0.00,$63.75,$100.98,$102.00,$0.00,$19.95,$0.00,$20.30,$0.00
9011640,SUP,HCPCS C1713,,9011640  -  SCREW 9011640 TIMESH 1.6X4.0MM SDS OPT 1,$129.63,$0.00,$129.63,$58.33,$92.51,$0.00,$22.33,$0.00,$0.00,$22.70,$129.63,$0.00,$64.81,$102.67,$103.70,$0.00,$20.29,$0.00,$20.64,$0.00
9011820,SUP,Custom 27803010,,9011820  -  CAGE SPNL 18MM 20MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
9011823,SUP,Custom 27803010,,9011823  -  CAGE SPNL 18MM 23MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
9011826,SUP,Custom 27803010,,9011826  -  CAGE SPNL 18MM 26MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
9011829,SUP,Custom 27803010,,9011829  -  CAGE SPNL 18MM 29MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
9012020,SUP,Custom 27803010,,9012020  -  CAGE SPNL 20MM 20MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
9012023,SUP,Custom 27803010,,9012023  -  CAGE SPNL 20MM 23MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
9012026,SUP,Custom 27803010,,9012026  -  CAGE SPNL 20MM 26MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
9012029,SUP,Custom 27803010,,9012029  -  CAGE SPNL 20MM 29MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
9012220,SUP,Custom 27803010,,9012220  -  CAGE SPNL 22MM 20MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
9012223,SUP,Custom 27803010,,9012223  -  CAGE SPNL 22MM 23MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
9012226,SUP,Custom 27803010,,9012226  -  CAGE SPNL 22MM 26MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
9012229,SUP,Custom 27803010,,9012229  -  CAGE SPNL 22MM 29MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
9012420,SUP,Custom 27803010,,9012420  -  CAGE SPNL 24MM 20MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
9012423,SUP,Custom 27803010,,9012423  -  CAGE SPNL 24MM 23MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
9012426,SUP,Custom 27803010,,9012426  -  CAGE SPNL 24MM 26MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
9012429,SUP,Custom 27803010,,9012429  -  CAGE SPNL 24MM 29MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
9050012,SUP,HCPCS C1781,,9050012  -  CAGE SPNL 12MM PRMSH MESH TI LMBR INTRBD FS,"$7,138.60",$0.00,"$7,138.60","$3,212.37","$5,094.82",$0.00,"$1,229.95",$0.00,$0.00,"$1,249.91","$7,138.60",$0.00,"$3,569.30","$5,653.77","$5,710.88",$0.00,"$1,117.19",$0.00,"$1,136.47",$0.00
9050014,SUP,HCPCS C1781,,9050014  -  CAGE SPNL 14MM PRMSH MESH TI LMBR INTRBD FS,"$7,138.60",$0.00,"$7,138.60","$3,212.37","$5,094.82",$0.00,"$1,229.95",$0.00,$0.00,"$1,249.91","$7,138.60",$0.00,"$3,569.30","$5,653.77","$5,710.88",$0.00,"$1,117.19",$0.00,"$1,136.47",$0.00
9050016,SUP,HCPCS C1781,,9050016  -  CAGE SPNL 16MM PRMSH MESH TI LMBR INTRBD FS,"$7,138.60",$0.00,"$7,138.60","$3,212.37","$5,094.82",$0.00,"$1,229.95",$0.00,$0.00,"$1,249.91","$7,138.60",$0.00,"$3,569.30","$5,653.77","$5,710.88",$0.00,"$1,117.19",$0.00,"$1,136.47",$0.00
9050018,SUP,HCPCS C1781,,9050018  -  CAGE SPNL 18MM PRMSH MESH TI LMBR INTRBD FS,"$7,138.60",$0.00,"$7,138.60","$3,212.37","$5,094.82",$0.00,"$1,229.95",$0.00,$0.00,"$1,249.91","$7,138.60",$0.00,"$3,569.30","$5,653.77","$5,710.88",$0.00,"$1,117.19",$0.00,"$1,136.47",$0.00
9050020,SUP,HCPCS C1781,,9050020  -  CAGE SPNL 20MM PRMSH MESH TI LMBR INTRBD FS,"$7,138.60",$0.00,"$7,138.60","$3,212.37","$5,094.82",$0.00,"$1,229.95",$0.00,$0.00,"$1,249.91","$7,138.60",$0.00,"$3,569.30","$5,653.77","$5,710.88",$0.00,"$1,117.19",$0.00,"$1,136.47",$0.00
9050413,SUP,HCPCS C1781,,9050413  -  CAGE SPNL OVOID 14X13X10MM PRMSH MESH TI LMBR INTRBD FS,"$7,138.60",$0.00,"$7,138.60","$3,212.37","$5,094.82",$0.00,"$1,229.95",$0.00,$0.00,"$1,249.91","$7,138.60",$0.00,"$3,569.30","$5,653.77","$5,710.88",$0.00,"$1,117.19",$0.00,"$1,136.47",$0.00
9050414,SUP,HCPCS C1781,,9050414  -  CAGE SPNL OVOID 14X14X10MM PRMSH MESH TI LMBR INTRBD FS,"$7,138.60",$0.00,"$7,138.60","$3,212.37","$5,094.82",$0.00,"$1,229.95",$0.00,$0.00,"$1,249.91","$7,138.60",$0.00,"$3,569.30","$5,653.77","$5,710.88",$0.00,"$1,117.19",$0.00,"$1,136.47",$0.00
9050450,SUP,HCPCS C1781,,9050450  -  MESH 9050450 PYRAMESH IMP 10MMX14MMX50MM,"$12,604.58",$0.00,"$12,604.58","$5,672.06","$5,158.80",$0.00,"$2,171.71",$0.00,$0.00,"$2,206.96","$12,604.58",$0.00,"$6,302.29","$9,982.83","$10,083.66",$0.00,"$1,972.62",$0.00,"$2,006.65",$0.00
9050513,SUP,HCPCS C1781,,9050513  -  CAGE SPNL OVOID 17X13X13MM PRMSH MESH TI LMBR INTRBD FS,"$7,138.60",$0.00,"$7,138.60","$3,212.37","$5,094.82",$0.00,"$1,229.95",$0.00,$0.00,"$1,249.91","$7,138.60",$0.00,"$3,569.30","$5,653.77","$5,710.88",$0.00,"$1,117.19",$0.00,"$1,136.47",$0.00
9050514,SUP,HCPCS C1781,,9050514  -  CAGE SPNL OVOID 17X13X14MM PRMSH MESH TI LMBR INTRBD FS,"$7,138.60",$0.00,"$7,138.60","$3,212.37","$5,094.82",$0.00,"$1,229.95",$0.00,$0.00,"$1,249.91","$7,138.60",$0.00,"$3,569.30","$5,653.77","$5,710.88",$0.00,"$1,117.19",$0.00,"$1,136.47",$0.00
9050700,SUP,Custom 27203010,,9050700  -  INSTRUMENT 9050700 PYMSH END CAP INSERT,"$3,630.00",$0.00,"$3,630.00",$0.00,"$2,590.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,630.00",$0.00,"$1,815.00","$2,874.96","$2,904.00",$0.00,$0.00,$0.00,$0.00,$0.00
9050713,SUP,HCPCS C1781,,9050713  -  MESH 9050713  PYMSH IMPL 13MM END CAP,$858.00,$0.00,$858.00,$386.10,$612.35,$0.00,$147.83,$0.00,$0.00,$150.23,$858.00,$0.00,$429.00,$679.54,$686.40,$0.00,$134.28,$0.00,$136.59,$0.00
9050716,SUP,HCPCS C1781,,9050716  -  MESH 9050716  PYMSH IMPL 16MM END CAP,$858.00,$0.00,$858.00,$386.10,$612.35,$0.00,$147.83,$0.00,$0.00,$150.23,$858.00,$0.00,$429.00,$679.54,$686.40,$0.00,$134.28,$0.00,$136.59,$0.00
9050719,SUP,HCPCS C1781,,9050719  -  MESH 9050719  PYMSH IMPL 19MM END CAP,$858.00,$0.00,$858.00,$386.10,$612.35,$0.00,$147.83,$0.00,$0.00,$150.23,$858.00,$0.00,$429.00,$679.54,$686.40,$0.00,$134.28,$0.00,$136.59,$0.00
9050722,SUP,HCPCS C1781,,9050722  -  MESH 9050722 PYMSH IMPL 22MM END CAP,$858.00,$0.00,$858.00,$386.10,$612.35,$0.00,$147.83,$0.00,$0.00,$150.23,$858.00,$0.00,$429.00,$679.54,$686.40,$0.00,$134.28,$0.00,$136.59,$0.00
9050725,SUP,HCPCS C1781,,9050725  -  MESH 9050725 PYMSH IMPL 25MM END CAP,$858.00,$0.00,$858.00,$386.10,$612.35,$0.00,$147.83,$0.00,$0.00,$150.23,$858.00,$0.00,$429.00,$679.54,$686.40,$0.00,$134.28,$0.00,$136.59,$0.00
9050823,SUP,HCPCS C1781,,9050823  -  CAGE SPNL OVOID 24X10X8MM PRMSH MESH TI LMBR INTRBD FS,"$7,138.60",$0.00,"$7,138.60","$3,212.37","$5,094.82",$0.00,"$1,229.95",$0.00,$0.00,"$1,249.91","$7,138.60",$0.00,"$3,569.30","$5,653.77","$5,710.88",$0.00,"$1,117.19",$0.00,"$1,136.47",$0.00
9051009,SUP,HCPCS C1781,,9051009  -  CAGE SPNL RND 10MM 9MM PRMSH MESH TI LMBR INTRBD FS,"$3,513.85",$0.00,"$3,513.85","$1,581.23","$2,507.83",$0.00,$605.42,$0.00,$0.00,$615.25,"$3,513.85",$0.00,"$1,756.93","$2,782.97","$2,811.08",$0.00,$549.92,$0.00,$559.40,$0.00
9051011,SUP,HCPCS C1781,,9051011  -  CAGE SPNL RND 10MM 10MM PRMSH MESH TI LMBR INTRBD FS,"$3,513.85",$0.00,"$3,513.85","$1,581.23","$2,507.83",$0.00,$605.42,$0.00,$0.00,$615.25,"$3,513.85",$0.00,"$1,756.93","$2,782.97","$2,811.08",$0.00,$549.92,$0.00,$559.40,$0.00
9051013,SUP,HCPCS C1781,,9051013  -  CAGE SPNL 13MMX10MM PRMSH LMBR INTRBD FS RND TI,"$3,513.85",$0.00,"$3,513.85","$1,581.23","$2,507.83",$0.00,$605.42,$0.00,$0.00,$615.25,"$3,513.85",$0.00,"$1,756.93","$2,782.97","$2,811.08",$0.00,$549.92,$0.00,$559.40,$0.00
9051014,SUP,HCPCS C1781,,9051014  -  CAGE SPNL RND 10MM 14MM PRMSH MESH TI LMBR INTRBD FS,"$3,513.85",$0.00,"$3,513.85","$1,581.23","$2,507.83",$0.00,$605.42,$0.00,$0.00,$615.25,"$3,513.85",$0.00,"$1,756.93","$2,782.97","$2,811.08",$0.00,$549.92,$0.00,$559.40,$0.00
9051023,SUP,HCPCS C1781,,9051023  -  CAGE SPNL RND 10MM 23MM PRMSH MESH TI LMBR INTRBD FS,"$7,138.60",$0.00,"$7,138.60","$3,212.37","$5,094.82",$0.00,"$1,229.95",$0.00,$0.00,"$1,249.91","$7,138.60",$0.00,"$3,569.30","$5,653.77","$5,710.88",$0.00,"$1,117.19",$0.00,"$1,136.47",$0.00
9051050,SUP,HCPCS C1781,,9051050  -  CAGE SPNL RND 10MM 50MM PRMSH MESH TI LMBR INTRBD FS,"$12,604.58",$0.00,"$12,604.58","$5,672.06","$5,158.80",$0.00,"$2,171.71",$0.00,$0.00,"$2,206.96","$12,604.58",$0.00,"$6,302.29","$9,982.83","$10,083.66",$0.00,"$1,972.62",$0.00,"$2,006.65",$0.00
9051223,SUP,HCPCS C1781,,9051223  -  CAGE SPNL RND 12MM 23MM PRMSH MESH TI LMBR INTRBD FS,"$7,138.60",$0.00,"$7,138.60","$3,212.37","$5,094.82",$0.00,"$1,229.95",$0.00,$0.00,"$1,249.91","$7,138.60",$0.00,"$3,569.30","$5,653.77","$5,710.88",$0.00,"$1,117.19",$0.00,"$1,136.47",$0.00
9051314,SUP,HCPCS C1781,,9051314  -  CAGE SPNL RND 13MM 14MM PRMSH MESH TI LMBR INTRBD FS,"$3,513.85",$0.00,"$3,513.85","$1,581.23","$2,507.83",$0.00,$605.42,$0.00,$0.00,$615.25,"$3,513.85",$0.00,"$1,756.93","$2,782.97","$2,811.08",$0.00,$549.92,$0.00,$559.40,$0.00
9051315,SUP,HCPCS C1781,,9051315  -  CAGE SPNL RND 13MM 15MM PRMSH MESH TI LMBR INTRBD FS,"$3,513.85",$0.00,"$3,513.85","$1,581.23","$2,507.83",$0.00,$605.42,$0.00,$0.00,$615.25,"$3,513.85",$0.00,"$1,756.93","$2,782.97","$2,811.08",$0.00,$549.92,$0.00,$559.40,$0.00
9051350,SUP,HCPCS C1781,,9051350  -  MESH 9051350 PYRAMESH IMP 13MMX50MM RND,"$12,604.58",$0.00,"$12,604.58","$5,672.06","$5,158.80",$0.00,"$2,171.71",$0.00,$0.00,"$2,206.96","$12,604.58",$0.00,"$6,302.29","$9,982.83","$10,083.66",$0.00,"$1,972.62",$0.00,"$2,006.65",$0.00
9051423,SUP,HCPCS C1781,,9051423  -  CAGE SPNL RND 14MM 23MM PRMSH MESH TI LMBR INTRBD FS,"$7,138.60",$0.00,"$7,138.60","$3,212.37","$5,094.82",$0.00,"$1,229.95",$0.00,$0.00,"$1,249.91","$7,138.60",$0.00,"$3,569.30","$5,653.77","$5,710.88",$0.00,"$1,117.19",$0.00,"$1,136.47",$0.00
9051690,SUP,HCPCS C1781,,9051690  -  CAGE SPNL RND 16MM 90MM PRMSH MESH TI LMBR INTRBD FS,"$12,604.58",$0.00,"$12,604.58","$5,672.06","$5,158.80",$0.00,"$2,171.71",$0.00,$0.00,"$2,206.96","$12,604.58",$0.00,"$6,302.29","$9,982.83","$10,083.66",$0.00,"$1,972.62",$0.00,"$2,006.65",$0.00
9051710,SUP,HCPCS C1781,,9051710  -  CAGE SPNL OVOID 22X17X10MM PRMSH MESH TI LMBR INTRBD FS,"$7,138.60",$0.00,"$7,138.60","$3,212.37","$5,094.82",$0.00,"$1,229.95",$0.00,$0.00,"$1,249.91","$7,138.60",$0.00,"$3,569.30","$5,653.77","$5,710.88",$0.00,"$1,117.19",$0.00,"$1,136.47",$0.00
9051715,SUP,HCPCS C1781,,9051715  -  CAGE SPNL OVOID 22X17X15MM PRMSH MESH TI LMBR INTRBD FS,"$7,138.60",$0.00,"$7,138.60","$3,212.37","$5,094.82",$0.00,"$1,229.95",$0.00,$0.00,"$1,249.91","$7,138.60",$0.00,"$3,569.30","$5,653.77","$5,710.88",$0.00,"$1,117.19",$0.00,"$1,136.47",$0.00
9051730,SUP,HCPCS C1781,,9051730  -  CAGE SPNL RND 22MM 30MM PRMSH MESH TI LMBR INTRBD FS,"$7,138.60",$0.00,"$7,138.60","$3,212.37","$5,094.82",$0.00,"$1,229.95",$0.00,$0.00,"$1,249.91","$7,138.60",$0.00,"$3,569.30","$5,653.77","$5,710.88",$0.00,"$1,117.19",$0.00,"$1,136.47",$0.00
9051750,SUP,HCPCS C1781,,9051750  -  CAGE SPNL OVOID 22X17X50MM PRMSH MESH TI LMBR INTRBD FS,"$12,604.58",$0.00,"$12,604.58","$5,672.06","$5,158.80",$0.00,"$2,171.71",$0.00,$0.00,"$2,206.96","$12,604.58",$0.00,"$6,302.29","$9,982.83","$10,083.66",$0.00,"$1,972.62",$0.00,"$2,006.65",$0.00
9051770,SUP,HCPCS C1781,,9051770  -  CAGE SPNL OVOID 22X17X70MM PRMSH MESH TI LMBR INTRBD FS,"$12,604.58",$0.00,"$12,604.58","$5,672.06","$5,158.80",$0.00,"$2,171.71",$0.00,$0.00,"$2,206.96","$12,604.58",$0.00,"$6,302.29","$9,982.83","$10,083.66",$0.00,"$1,972.62",$0.00,"$2,006.65",$0.00
9051790,SUP,HCPCS C1781,,9051790  -  CAGE SPNL OVOID 22X17X90MM PRMSH MESH TI LMBR INTRBD FS,"$12,604.58",$0.00,"$12,604.58","$5,672.06","$5,158.80",$0.00,"$2,171.71",$0.00,$0.00,"$2,206.96","$12,604.58",$0.00,"$6,302.29","$9,982.83","$10,083.66",$0.00,"$1,972.62",$0.00,"$2,006.65",$0.00
9051915,SUP,HCPCS C1781,,9051915  -  CAGE SPNL RND 15MM PRMSH MESH TI LMBR INTRBD FS,"$7,138.60",$0.00,"$7,138.60","$3,212.37","$5,094.82",$0.00,"$1,229.95",$0.00,$0.00,"$1,249.91","$7,138.60",$0.00,"$3,569.30","$5,653.77","$5,710.88",$0.00,"$1,117.19",$0.00,"$1,136.47",$0.00
9051918,SUP,HCPCS C1781,,9051918  -  CAGE SPNL RND 18MM PRMSH MESH TI LMBR INTRBD FS,"$7,138.60",$0.00,"$7,138.60","$3,212.37","$5,094.82",$0.00,"$1,229.95",$0.00,$0.00,"$1,249.91","$7,138.60",$0.00,"$3,569.30","$5,653.77","$5,710.88",$0.00,"$1,117.19",$0.00,"$1,136.47",$0.00
9052205,SUP,HCPCS C1781,,9052205  -  CAGE SPNL RND 22MM 15MM PRMSH MESH TI LMBR INTRBD FS,"$7,138.60",$0.00,"$7,138.60","$3,212.37","$5,094.82",$0.00,"$1,229.95",$0.00,$0.00,"$1,249.91","$7,138.60",$0.00,"$3,569.30","$5,653.77","$5,710.88",$0.00,"$1,117.19",$0.00,"$1,136.47",$0.00
9052208,SUP,HCPCS C1781,,9052208  -  MESH 9052208 PYRMSH IMPL 22MM AGL 13X18,"$7,138.60",$0.00,"$7,138.60","$3,212.37","$5,094.82",$0.00,"$1,229.95",$0.00,$0.00,"$1,249.91","$7,138.60",$0.00,"$3,569.30","$5,653.77","$5,710.88",$0.00,"$1,117.19",$0.00,"$1,136.47",$0.00
9052215,SUP,HCPCS C1781,,9052215  -  MESH 9052215 PYRAMESH IMPLT 22MMX15MM RD,"$7,138.60",$0.00,"$7,138.60","$3,212.37","$5,094.82",$0.00,"$1,229.95",$0.00,$0.00,"$1,249.91","$7,138.60",$0.00,"$3,569.30","$5,653.77","$5,710.88",$0.00,"$1,117.19",$0.00,"$1,136.47",$0.00
9052230,SUP,HCPCS C1781,,9052230  -  MESH 9052230 PYRAMESH IMPLT 22MMX30MM RD,"$7,138.60",$0.00,"$7,138.60","$3,212.37","$5,094.82",$0.00,"$1,229.95",$0.00,$0.00,"$1,249.91","$7,138.60",$0.00,"$3,569.30","$5,653.77","$5,710.88",$0.00,"$1,117.19",$0.00,"$1,136.47",$0.00
9052250,SUP,HCPCS C1781,,9052250  -  CAGE SPNL RND 22MM 50MM PRMSH MESH TI LMBR INTRBD FS,"$12,604.58",$0.00,"$12,604.58","$5,672.06","$5,158.80",$0.00,"$2,171.71",$0.00,$0.00,"$2,206.96","$12,604.58",$0.00,"$6,302.29","$9,982.83","$10,083.66",$0.00,"$1,972.62",$0.00,"$2,006.65",$0.00
9052270,SUP,HCPCS C1781,,9052270  -  MESH 9052270  PYRM IMPLANT 22MMX70MM RND,"$12,604.58",$0.00,"$12,604.58","$5,672.06","$5,158.80",$0.00,"$2,171.71",$0.00,$0.00,"$2,206.96","$12,604.58",$0.00,"$6,302.29","$9,982.83","$10,083.66",$0.00,"$1,972.62",$0.00,"$2,006.65",$0.00
9052290,SUP,HCPCS C1781,,9052290  -  MESH 9052290 PYRAMESH IMP 22MMX90MM RND,"$12,604.58",$0.00,"$12,604.58","$5,672.06","$5,158.80",$0.00,"$2,171.71",$0.00,$0.00,"$2,206.96","$12,604.58",$0.00,"$6,302.29","$9,982.83","$10,083.66",$0.00,"$1,972.62",$0.00,"$2,006.65",$0.00
9052315,SUP,HCPCS C1781,,9052315  -  MESH 9052315 PYMSH IMPL 23X27 AGL 10X15,"$7,138.60",$0.00,"$7,138.60","$3,212.37","$5,094.82",$0.00,"$1,229.95",$0.00,$0.00,"$1,249.91","$7,138.60",$0.00,"$3,569.30","$5,653.77","$5,710.88",$0.00,"$1,117.19",$0.00,"$1,136.47",$0.00
9052318,SUP,HCPCS C1781,,9052318  -  MESH 9052318 PYMSH IMPL 25X27 AGL 13X18,"$7,138.60",$0.00,"$7,138.60","$3,212.37","$5,094.82",$0.00,"$1,229.95",$0.00,$0.00,"$1,249.91","$7,138.60",$0.00,"$3,569.30","$5,653.77","$5,710.88",$0.00,"$1,117.19",$0.00,"$1,136.47",$0.00
9052518,SUP,HCPCS C1781,,9052518  -  MESH 9052518 PYRMSH IMPL 25MM AGL 13X18,"$7,138.60",$0.00,"$7,138.60","$3,212.37","$5,094.82",$0.00,"$1,229.95",$0.00,$0.00,"$1,249.91","$7,138.60",$0.00,"$3,569.30","$5,653.77","$5,710.88",$0.00,"$1,117.19",$0.00,"$1,136.47",$0.00
9052815,SUP,HCPCS C1781,,9052815  -  MESH 9052815 PYRAMESH IMP 22MMX28MMX15MM,"$7,138.60",$0.00,"$7,138.60","$3,212.37","$5,094.82",$0.00,"$1,229.95",$0.00,$0.00,"$1,249.91","$7,138.60",$0.00,"$3,569.30","$5,653.77","$5,710.88",$0.00,"$1,117.19",$0.00,"$1,136.47",$0.00
9052830,SUP,HCPCS C1781,,9052830  -  MESH 9052830 PYRAMESH IMP 22MMX28MMX30MM,"$12,604.58",$0.00,"$12,604.58","$5,672.06","$5,158.80",$0.00,"$2,171.71",$0.00,$0.00,"$2,206.96","$12,604.58",$0.00,"$6,302.29","$9,982.83","$10,083.66",$0.00,"$1,972.62",$0.00,"$2,006.65",$0.00
9052850,SUP,HCPCS C1781,,9052850  -  MESH SRG OVOID 50X28X22MM NS PRMSH CG TI,"$12,604.58",$0.00,"$12,604.58","$5,672.06","$5,158.80",$0.00,"$2,171.71",$0.00,$0.00,"$2,206.96","$12,604.58",$0.00,"$6,302.29","$9,982.83","$10,083.66",$0.00,"$1,972.62",$0.00,"$2,006.65",$0.00
9052870,SUP,HCPCS C1781,,9052870  -  PYRAMESH IMPL 22MMX28MMX70MM,"$12,604.58",$0.00,"$12,604.58","$5,672.06","$5,158.80",$0.00,"$2,171.71",$0.00,$0.00,"$2,206.96","$12,604.58",$0.00,"$6,302.29","$9,982.83","$10,083.66",$0.00,"$1,972.62",$0.00,"$2,006.65",$0.00
9052890,SUP,HCPCS C1781,,9052890  -  CAGE SPNL OVOID 28X22X90MM PRMSH HLW CNTR OP-EN TI LMBR,"$16,827.60",$0.00,"$16,827.60","$7,572.42","$5,158.80",$0.00,"$2,899.31",$0.00,$0.00,"$2,946.38","$16,827.60",$0.00,"$8,413.80","$13,327.46","$13,462.08",$0.00,"$2,633.52",$0.00,"$2,678.95",$0.00
9059104,SUP,Custom 27203010,,9059104  -  DISPOSABLE 9059104 MESH CUTTER BLADE,$412.50,$0.00,$412.50,$0.00,$294.40,$0.00,$0.00,$0.00,$0.00,$0.00,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$0.00,$0.00,$0.00,$0.00
9098526,SUP,HCPCS C1713,,9098526  -  SCREW BONE 4MM 26MM CORT SPNL,"$1,384.50",$0.00,"$1,384.50",$623.03,$988.12,$0.00,$238.54,$0.00,$0.00,$242.41,"$1,384.50",$0.00,$692.25,"$1,096.52","$1,107.60",$0.00,$216.67,$0.00,$220.41,$0.00
9098530,SUP,HCPCS C1713,,9098530  -  SCREW BONE 4MM 30MM CORT SPNL,"$1,384.50",$0.00,"$1,384.50",$623.03,$988.12,$0.00,$238.54,$0.00,$0.00,$242.41,"$1,384.50",$0.00,$692.25,"$1,096.52","$1,107.60",$0.00,$216.67,$0.00,$220.41,$0.00
9098534,SUP,HCPCS C1713,,9098534  -  SCREW BONE 4MM 34MM CORT SPNL,"$1,384.50",$0.00,"$1,384.50",$623.03,$988.12,$0.00,$238.54,$0.00,$0.00,$242.41,"$1,384.50",$0.00,$692.25,"$1,096.52","$1,107.60",$0.00,$216.67,$0.00,$220.41,$0.00
9098538,SUP,HCPCS C1713,,9098538  -  SCREW BONE 4MM 38MM CORTEX SPN,"$1,384.50",$0.00,"$1,384.50",$623.03,$988.12,$0.00,$238.54,$0.00,$0.00,$242.41,"$1,384.50",$0.00,$692.25,"$1,096.52","$1,107.60",$0.00,$216.67,$0.00,$220.41,$0.00
9098540,SUP,HCPCS C1713,,9098540  -  SCREW BONE 4MM 40MM CORTEX SPN,"$1,384.50",$0.00,"$1,384.50",$623.03,$988.12,$0.00,$238.54,$0.00,$0.00,$242.41,"$1,384.50",$0.00,$692.25,"$1,096.52","$1,107.60",$0.00,$216.67,$0.00,$220.41,$0.00
9098542,SUP,HCPCS C1713,,9098542  -  SCREW BONE 4MM 42MM CORT SPNL,"$1,384.50",$0.00,"$1,384.50",$623.03,$988.12,$0.00,$238.54,$0.00,$0.00,$242.41,"$1,384.50",$0.00,$692.25,"$1,096.52","$1,107.60",$0.00,$216.67,$0.00,$220.41,$0.00
9098544,SUP,HCPCS C1713,,9098544  -  SCREW BONE 4MM 44MM CORT SPNL,"$1,384.50",$0.00,"$1,384.50",$623.03,$988.12,$0.00,$238.54,$0.00,$0.00,$242.41,"$1,384.50",$0.00,$692.25,"$1,096.52","$1,107.60",$0.00,$216.67,$0.00,$220.41,$0.00
9098546,SUP,HCPCS C1713,,9098546  -  SCREW BONE 4MM 46MM CORT SPNL,"$1,384.50",$0.00,"$1,384.50",$623.03,$988.12,$0.00,$238.54,$0.00,$0.00,$242.41,"$1,384.50",$0.00,$692.25,"$1,096.52","$1,107.60",$0.00,$216.67,$0.00,$220.41,$0.00
9098548,SUP,HCPCS C1713,,9098548  -  SCREW BONE 4MM 48MM CORT SPNL,"$1,384.50",$0.00,"$1,384.50",$623.03,$988.12,$0.00,$238.54,$0.00,$0.00,$242.41,"$1,384.50",$0.00,$692.25,"$1,096.52","$1,107.60",$0.00,$216.67,$0.00,$220.41,$0.00
9098550,SUP,HCPCS C1713,,9098550  -  SCREW BONE 4MM 50MM CORTEX SPN,"$1,384.50",$0.00,"$1,384.50",$623.03,$988.12,$0.00,$238.54,$0.00,$0.00,$242.41,"$1,384.50",$0.00,$692.25,"$1,096.52","$1,107.60",$0.00,$216.67,$0.00,$220.41,$0.00
9098552,SUP,HCPCS C1713,,9098552  -  SCREW BONE 4MM 52MM CORT SPNL,"$1,384.50",$0.00,"$1,384.50",$623.03,$988.12,$0.00,$238.54,$0.00,$0.00,$242.41,"$1,384.50",$0.00,$692.25,"$1,096.52","$1,107.60",$0.00,$216.67,$0.00,$220.41,$0.00
9098554,SUP,HCPCS C1713,,9098554  -  SCREW BONE 4MM 54MM CORT SPNL,"$1,384.50",$0.00,"$1,384.50",$623.03,$988.12,$0.00,$238.54,$0.00,$0.00,$242.41,"$1,384.50",$0.00,$692.25,"$1,096.52","$1,107.60",$0.00,$216.67,$0.00,$220.41,$0.00
9098556,SUP,HCPCS C1713,,9098556  -  SCREW BONE 4MM 56MM CORT SPNL,"$1,384.50",$0.00,"$1,384.50",$623.03,$988.12,$0.00,$238.54,$0.00,$0.00,$242.41,"$1,384.50",$0.00,$692.25,"$1,096.52","$1,107.60",$0.00,$216.67,$0.00,$220.41,$0.00
9098558,SUP,HCPCS C1713,,9098558  -  SCREW BONE 4MM 58MM CORT SPNL,"$1,384.50",$0.00,"$1,384.50",$623.03,$988.12,$0.00,$238.54,$0.00,$0.00,$242.41,"$1,384.50",$0.00,$692.25,"$1,096.52","$1,107.60",$0.00,$216.67,$0.00,$220.41,$0.00
9098560,SUP,HCPCS C1713,,9098560  -  SCREW BONE 4MM 60MM CORT SPNL,"$1,384.50",$0.00,"$1,384.50",$623.03,$988.12,$0.00,$238.54,$0.00,$0.00,$242.41,"$1,384.50",$0.00,$692.25,"$1,096.52","$1,107.60",$0.00,$216.67,$0.00,$220.41,$0.00
9164400,SUP,Custom 27803010,,9164400  -  CONNECTOR 9164400 CDH 4.5 DOMINO,"$1,506.00",$0.00,"$1,506.00",$0.00,"$1,074.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,506.00",$0.00,$753.00,"$1,192.75","$1,204.80",$0.00,$0.00,$0.00,$0.00,$0.00
9192507,SUP,HCPCS C1713,,9192507  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 25X10X7MM VRTSTCK CRSNT,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
9192508,SUP,HCPCS C1713,,9192508  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 25X10X8MM VRTSTCK CRSNT,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
9192509,SUP,HCPCS C1713,,9192509  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 25X10X9MM VRTSTCK CRSNT,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
9192510,SUP,HCPCS C1713,,9192510  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 25X10X10MM VRTSTCK CRSNT,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
9192511,SUP,HCPCS C1713,,9192511  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 25X10X11MM VRTSTCK CRSNT,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
9192512,SUP,HCPCS C1713,,9192512  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 25X10X12MM VRTSTCK CRSNT,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
9192513,SUP,HCPCS C1713,,9192513  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 25X10X13MM VRTSTCK CRSNT,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
9192514,SUP,HCPCS C1713,,9192514  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 25X10X14MM VRTSTCK CRSNT,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
9192515,SUP,HCPCS C1713,,9192515  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 25X10X15MM VRTSTCK CRSNT,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
9193007,SUP,HCPCS C1713,,9193007  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 30X10X7MM VRTSTCK CRSNT,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
9193008,SUP,HCPCS C1713,,9193008  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 30X10X8MM VRTSTCK CRSNT,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
9193009,SUP,HCPCS C1713,,9193009  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 30X10X9MM VRTSTCK CRSNT,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
9193010,SUP,HCPCS C1713,,9193010  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 30X10X10MM VRTSTCK CRSNT,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
9193011,SUP,HCPCS C1713,,9193011  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 30X10X11MM VRTSTCK CRSNT,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
9193012,SUP,HCPCS C1713,,9193012  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 30X10X12MM VRTSTCK CRSNT,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
9193013,SUP,HCPCS C1713,,9193013  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 30X10X13MM VRTSTCK CRSNT,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
9193014,SUP,HCPCS C1713,,9193014  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 30X10X14MM VRTSTCK CRSNT,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
9193015,SUP,HCPCS C1713,,9193015  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 30X10X15MM VRTSTCK CRSNT,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
9193607,SUP,HCPCS C1713,,9193607  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 36X10X7MM VRTSTCK CRSNT,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
9193608,SUP,HCPCS C1713,,9193608  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 36X10X8MM VRTSTCK CRSNT,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
9193609,SUP,HCPCS C1713,,9193609  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 36X10X9MM VRTSTCK CRSNT,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
9193610,SUP,HCPCS C1713,,9193610  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 36X10X10MM VRTSTCK CRSNT,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
9193611,SUP,HCPCS C1713,,9193611  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 36X10X11MM VRTSTCK CRSNT,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
9193612,SUP,HCPCS C1713,,9193612  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 36X10X12MM VRTSTCK CRSNT,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
9193613,SUP,HCPCS C1713,,9193613  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 36X10X13MM VRTSTCK CRSNT,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
9193614,SUP,HCPCS C1713,,9193614  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 36X10X14MM VRTSTCK CRSNT,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
9193615,SUP,HCPCS C1713,,9193615  -  SPACER SPNL 6D LRDTC STRG BLT NOSE 36X10X15MM VRTSTCK CRSNT,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
9206768,SUP,HCPCS C1713,,9206768  -  PLATE BN 90D STD L 4MM 9 HL BAR CRNMXF LT,"$1,315.00",$0.00,"$1,315.00",$591.75,$938.52,$0.00,$226.57,$0.00,$0.00,$230.25,"$1,315.00",$0.00,$657.50,"$1,041.48","$1,052.00",$0.00,$205.80,$0.00,$209.35,$0.00
9240100,SUP,HCPCS C1713,,9240100  -  PLATE 9240100 SPINOUS PROCESS,"$8,608.50",$0.00,"$8,608.50","$3,873.83","$5,158.80",$0.00,"$1,483.20",$0.00,$0.00,"$1,507.28","$8,608.50",$0.00,"$4,304.25","$6,817.93","$6,886.80",$0.00,"$1,347.23",$0.00,"$1,370.47",$0.00
9240150,SUP,HCPCS C1713,,9240150  -  SCREW 9240150 M4 BREAKOFFS,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
9240200,SUP,HCPCS C1713,,9240200  -  PLATE  9240200 35MM SPIRE,"$8,608.50",$0.00,"$8,608.50","$3,873.83","$5,158.80",$0.00,"$1,483.20",$0.00,$0.00,"$1,507.28","$8,608.50",$0.00,"$4,304.25","$6,817.93","$6,886.80",$0.00,"$1,347.23",$0.00,"$1,370.47",$0.00
9255562,SUP,HCPCS C1713,,9255562  -  PLATE BN 3D CRV 1.5MM 6X2 HL CRNMXF,"$1,965.00",$0.00,"$1,965.00",$884.25,"$1,402.42",$0.00,$338.56,$0.00,$0.00,$344.06,"$1,965.00",$0.00,$982.50,"$1,556.28","$1,572.00",$0.00,$307.52,$0.00,$312.83,$0.00
9330000,SUP,HCPCS C1713,,9330000  -  NUT LOCK VNTG SPNL TI LCK SCR SET STRL,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
9330001,SUP,HCPCS C1713,,9330001  -  STAPLE BONE 2 HOLE TI RSTRL VNTG STRL,"$2,805.00",$0.00,"$2,805.00","$1,262.25","$2,001.93",$0.00,$483.29,$0.00,$0.00,$491.13,"$2,805.00",$0.00,"$1,402.50","$2,221.56","$2,244.00",$0.00,$438.98,$0.00,$446.56,$0.00
9330002,SUP,HCPCS C1713,,9330002  -  STAPLE BONE 2 HOLE TI CDL VNTG STRL,"$2,805.00",$0.00,"$2,805.00","$1,262.25","$2,001.93",$0.00,$483.29,$0.00,$0.00,$491.13,"$2,805.00",$0.00,"$1,402.50","$2,221.56","$2,244.00",$0.00,$438.98,$0.00,$446.56,$0.00
9330003,SUP,HCPCS C1713,,9330003  -  STAPLE BONE 2 HOLE TI RSTRL VNTG STRL,"$2,805.00",$0.00,"$2,805.00","$1,262.25","$2,001.93",$0.00,$483.29,$0.00,$0.00,$491.13,"$2,805.00",$0.00,"$1,402.50","$2,221.56","$2,244.00",$0.00,$438.98,$0.00,$446.56,$0.00
9330004,SUP,HCPCS C1713,,9330004  -  STAPLE BONE 2 HOLE TI CDL VNTG STRL,"$2,805.00",$0.00,"$2,805.00","$1,262.25","$2,001.93",$0.00,$483.29,$0.00,$0.00,$491.13,"$2,805.00",$0.00,"$1,402.50","$2,221.56","$2,244.00",$0.00,$438.98,$0.00,$446.56,$0.00
9330040,SUP,HCPCS C1713,,9330040  -  PLATE 9330040 4CM ATL TI,"$6,778.50",$0.00,"$6,778.50","$3,050.33","$4,837.82",$0.00,"$1,167.90",$0.00,$0.00,"$1,186.86","$6,778.50",$0.00,"$3,389.25","$5,368.57","$5,422.80",$0.00,"$1,060.84",$0.00,"$1,079.14",$0.00
9330045,SUP,HCPCS C1713,,9330045  -  PLATE 9330045 4 5CM ATL TI,"$6,778.50",$0.00,"$6,778.50","$3,050.33","$4,837.82",$0.00,"$1,167.90",$0.00,$0.00,"$1,186.86","$6,778.50",$0.00,"$3,389.25","$5,368.57","$5,422.80",$0.00,"$1,060.84",$0.00,"$1,079.14",$0.00
9330050,SUP,HCPCS C1713,,9330050  -  PLATE 9330050 5CM ATL TI,"$6,778.50",$0.00,"$6,778.50","$3,050.33","$4,837.82",$0.00,"$1,167.90",$0.00,$0.00,"$1,186.86","$6,778.50",$0.00,"$3,389.25","$5,368.57","$5,422.80",$0.00,"$1,060.84",$0.00,"$1,079.14",$0.00
9330055,SUP,HCPCS C1713,,9330055  -  PLATE 9330055 5 5CM ATL TI,"$6,778.50",$0.00,"$6,778.50","$3,050.33","$4,837.82",$0.00,"$1,167.90",$0.00,$0.00,"$1,186.86","$6,778.50",$0.00,"$3,389.25","$5,368.57","$5,422.80",$0.00,"$1,060.84",$0.00,"$1,079.14",$0.00
9330060,SUP,HCPCS C1713,,9330060  -  PLATE BN 6CM VNTG SMTH TI SPNE THORLMBR ANT,"$6,778.50",$0.00,"$6,778.50","$3,050.33","$4,837.82",$0.00,"$1,167.90",$0.00,$0.00,"$1,186.86","$6,778.50",$0.00,"$3,389.25","$5,368.57","$5,422.80",$0.00,"$1,060.84",$0.00,"$1,079.14",$0.00
9330065,SUP,HCPCS C1713,,9330065  -  PLATE 65MM TI LCK ATLNTS BONE ANT CERV SPN,"$6,778.50",$0.00,"$6,778.50","$3,050.33","$4,837.82",$0.00,"$1,167.90",$0.00,$0.00,"$1,186.86","$6,778.50",$0.00,"$3,389.25","$5,368.57","$5,422.80",$0.00,"$1,060.84",$0.00,"$1,079.14",$0.00
9330070,SUP,HCPCS C1713,,9330070  -  PLATE 7CM TI LCK VNTG BONE LAT LMBR,"$6,778.50",$0.00,"$6,778.50","$3,050.33","$4,837.82",$0.00,"$1,167.90",$0.00,$0.00,"$1,186.86","$6,778.50",$0.00,"$3,389.25","$5,368.57","$5,422.80",$0.00,"$1,060.84",$0.00,"$1,079.14",$0.00
9330075,SUP,HCPCS C1713,,9330075  -  PLATE 9330075 7 5CM ATL TI,"$6,778.50",$0.00,"$6,778.50","$3,050.33","$4,837.82",$0.00,"$1,167.90",$0.00,$0.00,"$1,186.86","$6,778.50",$0.00,"$3,389.25","$5,368.57","$5,422.80",$0.00,"$1,060.84",$0.00,"$1,079.14",$0.00
9330080,SUP,HCPCS C1713,,9330080  -  PLATE 9330080 8CM ATL TI,"$6,778.50",$0.00,"$6,778.50","$3,050.33","$4,837.82",$0.00,"$1,167.90",$0.00,$0.00,"$1,186.86","$6,778.50",$0.00,"$3,389.25","$5,368.57","$5,422.80",$0.00,"$1,060.84",$0.00,"$1,079.14",$0.00
9330085,SUP,HCPCS C1713,,9330085  -  PLATE 9330085 8 5CM ATL TI,"$6,778.50",$0.00,"$6,778.50","$3,050.33","$4,837.82",$0.00,"$1,167.90",$0.00,$0.00,"$1,186.86","$6,778.50",$0.00,"$3,389.25","$5,368.57","$5,422.80",$0.00,"$1,060.84",$0.00,"$1,079.14",$0.00
9330090,SUP,HCPCS C1713,,9330090  -  PLATE 9330090 9CM ATL TI,"$6,778.50",$0.00,"$6,778.50","$3,050.33","$4,837.82",$0.00,"$1,167.90",$0.00,$0.00,"$1,186.86","$6,778.50",$0.00,"$3,389.25","$5,368.57","$5,422.80",$0.00,"$1,060.84",$0.00,"$1,079.14",$0.00
9330095,SUP,HCPCS C1713,,9330095  -  PLATE 9330095 9 5CM ATL TI,"$6,778.50",$0.00,"$6,778.50","$3,050.33","$4,837.82",$0.00,"$1,167.90",$0.00,$0.00,"$1,186.86","$6,778.50",$0.00,"$3,389.25","$5,368.57","$5,422.80",$0.00,"$1,060.84",$0.00,"$1,079.14",$0.00
9330100,SUP,HCPCS C1713,,9330100  -  PLATE 9330100 10CM ATL TI,"$6,778.50",$0.00,"$6,778.50","$3,050.33","$4,837.82",$0.00,"$1,167.90",$0.00,$0.00,"$1,186.86","$6,778.50",$0.00,"$3,389.25","$5,368.57","$5,422.80",$0.00,"$1,060.84",$0.00,"$1,079.14",$0.00
9331025,SUP,Custom 27803010,,9331025  -  PLATE 25MM TI VNTG BONE ANT THORLMBR SPN STRL,"$6,778.50",$0.00,"$6,778.50",$0.00,"$4,837.82",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,778.50",$0.00,"$3,389.25","$5,368.57","$5,422.80",$0.00,$0.00,$0.00,$0.00,$0.00
9331030,SUP,HCPCS C1713,,9331030  -  PLATE 9331030 3CM THORACIC TI,"$6,778.50",$0.00,"$6,778.50","$3,050.33","$4,837.82",$0.00,"$1,167.90",$0.00,$0.00,"$1,186.86","$6,778.50",$0.00,"$3,389.25","$5,368.57","$5,422.80",$0.00,"$1,060.84",$0.00,"$1,079.14",$0.00
9331035,SUP,HCPCS C1713,,9331035  -  PLATE 9331035 3 5CM THORACIC TI,"$6,778.50",$0.00,"$6,778.50","$3,050.33","$4,837.82",$0.00,"$1,167.90",$0.00,$0.00,"$1,186.86","$6,778.50",$0.00,"$3,389.25","$5,368.57","$5,422.80",$0.00,"$1,060.84",$0.00,"$1,079.14",$0.00
9331040,SUP,HCPCS C1713,,9331040  -  PLATE 9331040 4CM THORACIC TI,"$6,778.50",$0.00,"$6,778.50","$3,050.33","$4,837.82",$0.00,"$1,167.90",$0.00,$0.00,"$1,186.86","$6,778.50",$0.00,"$3,389.25","$5,368.57","$5,422.80",$0.00,"$1,060.84",$0.00,"$1,079.14",$0.00
9331045,SUP,HCPCS C1713,,9331045  -  PLATE 9331045 4 5CM THORACIC TI,"$6,778.50",$0.00,"$6,778.50","$3,050.33","$4,837.82",$0.00,"$1,167.90",$0.00,$0.00,"$1,186.86","$6,778.50",$0.00,"$3,389.25","$5,368.57","$5,422.80",$0.00,"$1,060.84",$0.00,"$1,079.14",$0.00
9331050,SUP,HCPCS C1713,,9331050  -  PLATE 9331050 5CM THORACIC TI,"$6,778.50",$0.00,"$6,778.50","$3,050.33","$4,837.82",$0.00,"$1,167.90",$0.00,$0.00,"$1,186.86","$6,778.50",$0.00,"$3,389.25","$5,368.57","$5,422.80",$0.00,"$1,060.84",$0.00,"$1,079.14",$0.00
9331055,SUP,HCPCS C1713,,9331055  -  PLATE BN 5.5CM VNTG SMTH TI SPNE THOR ANT,"$6,778.50",$0.00,"$6,778.50","$3,050.33","$4,837.82",$0.00,"$1,167.90",$0.00,$0.00,"$1,186.86","$6,778.50",$0.00,"$3,389.25","$5,368.57","$5,422.80",$0.00,"$1,060.84",$0.00,"$1,079.14",$0.00
9331060,SUP,HCPCS C1713,,9331060  -  PLATE BN 6CM VNTG SMTH TI SPNE THOR ANT,"$6,778.50",$0.00,"$6,778.50","$3,050.33","$4,837.82",$0.00,"$1,167.90",$0.00,$0.00,"$1,186.86","$6,778.50",$0.00,"$3,389.25","$5,368.57","$5,422.80",$0.00,"$1,060.84",$0.00,"$1,079.14",$0.00
9331065,SUP,HCPCS C1713,,9331065  -  PLATE 9331065 6 5CM THORACIC TI,"$6,778.50",$0.00,"$6,778.50","$3,050.33","$4,837.82",$0.00,"$1,167.90",$0.00,$0.00,"$1,186.86","$6,778.50",$0.00,"$3,389.25","$5,368.57","$5,422.80",$0.00,"$1,060.84",$0.00,"$1,079.14",$0.00
9331070,SUP,HCPCS C1713,,9331070  -  PLATE 9331070 7CM THORACIC TI,"$6,778.50",$0.00,"$6,778.50","$3,050.33","$4,837.82",$0.00,"$1,167.90",$0.00,$0.00,"$1,186.86","$6,778.50",$0.00,"$3,389.25","$5,368.57","$5,422.80",$0.00,"$1,060.84",$0.00,"$1,079.14",$0.00
9331075,SUP,HCPCS C1713,,9331075  -  PLATE 9331075 7CM THORACIC TI 5,"$6,778.50",$0.00,"$6,778.50","$3,050.33","$4,837.82",$0.00,"$1,167.90",$0.00,$0.00,"$1,186.86","$6,778.50",$0.00,"$3,389.25","$5,368.57","$5,422.80",$0.00,"$1,060.84",$0.00,"$1,079.14",$0.00
9331080,SUP,HCPCS C1713,,9331080  -  PLATE 9331080 8CM THORACIC TI,"$6,778.50",$0.00,"$6,778.50","$3,050.33","$4,837.82",$0.00,"$1,167.90",$0.00,$0.00,"$1,186.86","$6,778.50",$0.00,"$3,389.25","$5,368.57","$5,422.80",$0.00,"$1,060.84",$0.00,"$1,079.14",$0.00
9335515,SUP,HCPCS C1713,,9335515  -  SCREW 9335515 THORACIC 5.5X15MM TI,"$1,305.00",$0.00,"$1,305.00",$587.25,$931.38,$0.00,$224.84,$0.00,$0.00,$228.50,"$1,305.00",$0.00,$652.50,"$1,033.56","$1,044.00",$0.00,$204.23,$0.00,$207.76,$0.00
9335520,SUP,HCPCS C1713,,9335520  -  SCREW 9335520 THORACIC 5.5X20MM TI,"$1,305.00",$0.00,"$1,305.00",$587.25,$931.38,$0.00,$224.84,$0.00,$0.00,$228.50,"$1,305.00",$0.00,$652.50,"$1,033.56","$1,044.00",$0.00,$204.23,$0.00,$207.76,$0.00
9335525,SUP,HCPCS C1713,,9335525  -  SCREW 9335525 THORACIC 5.5X25MM TI,"$1,305.00",$0.00,"$1,305.00",$587.25,$931.38,$0.00,$224.84,$0.00,$0.00,$228.50,"$1,305.00",$0.00,$652.50,"$1,033.56","$1,044.00",$0.00,$204.23,$0.00,$207.76,$0.00
9335530,SUP,HCPCS C1713,,9335530  -  SCREW 9335530 THORACIC 5.5X30MM TI,"$1,305.00",$0.00,"$1,305.00",$587.25,$931.38,$0.00,$224.84,$0.00,$0.00,$228.50,"$1,305.00",$0.00,$652.50,"$1,033.56","$1,044.00",$0.00,$204.23,$0.00,$207.76,$0.00
9335535,SUP,HCPCS C1713,,9335535  -  SCREW BN 5.5MM 35MM NS VNTG ST INTNL HEX CLR CD CUT TI SPNE,"$1,305.00",$0.00,"$1,305.00",$587.25,$931.38,$0.00,$224.84,$0.00,$0.00,$228.50,"$1,305.00",$0.00,$652.50,"$1,033.56","$1,044.00",$0.00,$204.23,$0.00,$207.76,$0.00
9335540,SUP,HCPCS C1713,,9335540  -  SCREW BN 5.5MM 40MM NS VNTG ST INTNL HEX CLR CD CUT TI SPNE,"$1,305.00",$0.00,"$1,305.00",$587.25,$931.38,$0.00,$224.84,$0.00,$0.00,$228.50,"$1,305.00",$0.00,$652.50,"$1,033.56","$1,044.00",$0.00,$204.23,$0.00,$207.76,$0.00
9335545,SUP,HCPCS C1713,,9335545  -  SCREW 9335545 THORACIC 5.5X45MM TI,"$1,305.00",$0.00,"$1,305.00",$587.25,$931.38,$0.00,$224.84,$0.00,$0.00,$228.50,"$1,305.00",$0.00,$652.50,"$1,033.56","$1,044.00",$0.00,$204.23,$0.00,$207.76,$0.00
9335550,SUP,HCPCS C1713,,9335550  -  SCREW 9335550 THORACIC 5.5X50MM TI,"$1,305.00",$0.00,"$1,305.00",$587.25,$931.38,$0.00,$224.84,$0.00,$0.00,$228.50,"$1,305.00",$0.00,$652.50,"$1,033.56","$1,044.00",$0.00,$204.23,$0.00,$207.76,$0.00
9336525,SUP,HCPCS C1713,,9336525  -  SCREW BONE 6.5MM 25MM ATLNTS TI ANT CERV SPN,"$1,305.00",$0.00,"$1,305.00",$587.25,$931.38,$0.00,$224.84,$0.00,$0.00,$228.50,"$1,305.00",$0.00,$652.50,"$1,033.56","$1,044.00",$0.00,$204.23,$0.00,$207.76,$0.00
9336530,SUP,HCPCS C1713,,9336530  -  SCREW 9336530 FAST ATL 6.5X30MM TI,"$1,305.00",$0.00,"$1,305.00",$587.25,$931.38,$0.00,$224.84,$0.00,$0.00,$228.50,"$1,305.00",$0.00,$652.50,"$1,033.56","$1,044.00",$0.00,$204.23,$0.00,$207.76,$0.00
9336535,SUP,HCPCS C1713,,9336535  -  SCREW BONE 6.5MM 35MM ATLNTS TI ANT CERV SPN,"$1,305.00",$0.00,"$1,305.00",$587.25,$931.38,$0.00,$224.84,$0.00,$0.00,$228.50,"$1,305.00",$0.00,$652.50,"$1,033.56","$1,044.00",$0.00,$204.23,$0.00,$207.76,$0.00
9336540,SUP,HCPCS C1713,,9336540  -  SCREW BN 6.5MM 40MM NS ATLNTS VNTG FST CLSR TI SPNE CRV ANT,"$1,305.00",$0.00,"$1,305.00",$587.25,$931.38,$0.00,$224.84,$0.00,$0.00,$228.50,"$1,305.00",$0.00,$652.50,"$1,033.56","$1,044.00",$0.00,$204.23,$0.00,$207.76,$0.00
9336545,SUP,HCPCS C1713,,9336545  -  SCREW 9336545 FAST ATL 6.5X45MM TI,"$1,305.00",$0.00,"$1,305.00",$587.25,$931.38,$0.00,$224.84,$0.00,$0.00,$228.50,"$1,305.00",$0.00,$652.50,"$1,033.56","$1,044.00",$0.00,$204.23,$0.00,$207.76,$0.00
9336550,SUP,HCPCS C1713,,9336550  -  SCREW 9336550 FAST ATL 6.5X50MM TI,"$1,305.00",$0.00,"$1,305.00",$587.25,$931.38,$0.00,$224.84,$0.00,$0.00,$228.50,"$1,305.00",$0.00,$652.50,"$1,033.56","$1,044.00",$0.00,$204.23,$0.00,$207.76,$0.00
9336555,SUP,HCPCS C1713,,9336555  -  SCREW 9336555 FAST ATL 6.5X55MM TI,"$1,305.00",$0.00,"$1,305.00",$587.25,$931.38,$0.00,$224.84,$0.00,$0.00,$228.50,"$1,305.00",$0.00,$652.50,"$1,033.56","$1,044.00",$0.00,$204.23,$0.00,$207.76,$0.00
9336560,SUP,HCPCS C1713,,9336560  -  SCREW BONE 6.5MM 60MM ATLNTS TI ANT CERV SPN,"$1,305.00",$0.00,"$1,305.00",$587.25,$931.38,$0.00,$224.84,$0.00,$0.00,$228.50,"$1,305.00",$0.00,$652.50,"$1,033.56","$1,044.00",$0.00,$204.23,$0.00,$207.76,$0.00
9338020,SUP,HCPCS C1713,,9338020  -  BOLT SPNL 20MM 8MM ANT,"$4,525.50",$0.00,"$4,525.50","$2,036.48","$3,229.85",$0.00,$779.72,$0.00,$0.00,$792.38,"$4,525.50",$0.00,"$2,262.75","$3,584.20","$3,620.40",$0.00,$708.24,$0.00,$720.46,$0.00
9338025,SUP,HCPCS C1713,,9338025  -  BOLT SPNL 25MM 8MM VNTG TI,"$4,525.50",$0.00,"$4,525.50","$2,036.48","$3,229.85",$0.00,$779.72,$0.00,$0.00,$792.38,"$4,525.50",$0.00,"$2,262.75","$3,584.20","$3,620.40",$0.00,$708.24,$0.00,$720.46,$0.00
9338030,SUP,HCPCS C1713,,9338030  -  BOLT SPNL 30MM 8MM ANT TI SGL,"$4,525.50",$0.00,"$4,525.50","$2,036.48","$3,229.85",$0.00,$779.72,$0.00,$0.00,$792.38,"$4,525.50",$0.00,"$2,262.75","$3,584.20","$3,620.40",$0.00,$708.24,$0.00,$720.46,$0.00
9338035,SUP,HCPCS C1713,,9338035  -  SCREW BONE 8MM 35MM TI ANT SPN,"$4,525.50",$0.00,"$4,525.50","$2,036.48","$3,229.85",$0.00,$779.72,$0.00,$0.00,$792.38,"$4,525.50",$0.00,"$2,262.75","$3,584.20","$3,620.40",$0.00,$708.24,$0.00,$720.46,$0.00
9338040,SUP,HCPCS C1713,,9338040  -  BOLT SPNL 40MM 8MM VNTG TI,"$4,525.50",$0.00,"$4,525.50","$2,036.48","$3,229.85",$0.00,$779.72,$0.00,$0.00,$792.38,"$4,525.50",$0.00,"$2,262.75","$3,584.20","$3,620.40",$0.00,$708.24,$0.00,$720.46,$0.00
9338045,SUP,HCPCS C1713,,9338045  -  SCREW BONE 8MM 45MM TI ANT SPN,"$4,525.50",$0.00,"$4,525.50","$2,036.48","$3,229.85",$0.00,$779.72,$0.00,$0.00,$792.38,"$4,525.50",$0.00,"$2,262.75","$3,584.20","$3,620.40",$0.00,$708.24,$0.00,$720.46,$0.00
9338050,SUP,HCPCS C1713,,9338050  -  BOLT SPNL 50MM 8MM TI,"$4,525.50",$0.00,"$4,525.50","$2,036.48","$3,229.85",$0.00,$779.72,$0.00,$0.00,$792.38,"$4,525.50",$0.00,"$2,262.75","$3,584.20","$3,620.40",$0.00,$708.24,$0.00,$720.46,$0.00
9338055,SUP,HCPCS C1713,,9338055  -  BOLT SPNL 55MM 8MM TI,"$4,525.50",$0.00,"$4,525.50","$2,036.48","$3,229.85",$0.00,$779.72,$0.00,$0.00,$792.38,"$4,525.50",$0.00,"$2,262.75","$3,584.20","$3,620.40",$0.00,$708.24,$0.00,$720.46,$0.00
9338920,SUP,HCPCS C1713,,9338920  -  BOLT SPNL 20MM 9MM TI,"$4,525.50",$0.00,"$4,525.50","$2,036.48","$3,229.85",$0.00,$779.72,$0.00,$0.00,$792.38,"$4,525.50",$0.00,"$2,262.75","$3,584.20","$3,620.40",$0.00,$708.24,$0.00,$720.46,$0.00
9338925,SUP,HCPCS C1713,,9338925  -  BOLT SPNL 25MM 9MM TI,"$4,525.50",$0.00,"$4,525.50","$2,036.48","$3,229.85",$0.00,$779.72,$0.00,$0.00,$792.38,"$4,525.50",$0.00,"$2,262.75","$3,584.20","$3,620.40",$0.00,$708.24,$0.00,$720.46,$0.00
9338930,SUP,HCPCS C1713,,9338930  -  BOLT SPNL 30MM 9MM TI,"$4,525.50",$0.00,"$4,525.50","$2,036.48","$3,229.85",$0.00,$779.72,$0.00,$0.00,$792.38,"$4,525.50",$0.00,"$2,262.75","$3,584.20","$3,620.40",$0.00,$708.24,$0.00,$720.46,$0.00
9338935,SUP,HCPCS C1713,,9338935  -  BOLT SPNL 35MM 6MM TI,"$4,525.50",$0.00,"$4,525.50","$2,036.48","$3,229.85",$0.00,$779.72,$0.00,$0.00,$792.38,"$4,525.50",$0.00,"$2,262.75","$3,584.20","$3,620.40",$0.00,$708.24,$0.00,$720.46,$0.00
9338940,SUP,HCPCS C1713,,9338940  -  BOLT SPNL 40MM 9MM SGL,"$4,525.50",$0.00,"$4,525.50","$2,036.48","$3,229.85",$0.00,$779.72,$0.00,$0.00,$792.38,"$4,525.50",$0.00,"$2,262.75","$3,584.20","$3,620.40",$0.00,$708.24,$0.00,$720.46,$0.00
9338945,SUP,HCPCS C1713,,9338945  -  BOLT SPNL 45MM 9MM TI,"$4,525.50",$0.00,"$4,525.50","$2,036.48","$3,229.85",$0.00,$779.72,$0.00,$0.00,$792.38,"$4,525.50",$0.00,"$2,262.75","$3,584.20","$3,620.40",$0.00,$708.24,$0.00,$720.46,$0.00
9338950,SUP,HCPCS C1713,,9338950  -  BOLT SPNL 50MM 9MM TI,"$4,525.50",$0.00,"$4,525.50","$2,036.48","$3,229.85",$0.00,$779.72,$0.00,$0.00,$792.38,"$4,525.50",$0.00,"$2,262.75","$3,584.20","$3,620.40",$0.00,$708.24,$0.00,$720.46,$0.00
9338955,SUP,HCPCS C1713,,9338955  -  BOLT SPNL 55MM 9MM TI,"$4,525.50",$0.00,"$4,525.50","$2,036.48","$3,229.85",$0.00,$779.72,$0.00,$0.00,$792.38,"$4,525.50",$0.00,"$2,262.75","$3,584.20","$3,620.40",$0.00,$708.24,$0.00,$720.46,$0.00
9391316,SUP,HCPCS C1713,,9391316  -  CAGE SPNL 13MM 16MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR,"$9,968.75",$0.00,"$9,968.75","$4,485.94","$5,158.80",$0.00,"$1,717.57",$0.00,$0.00,"$1,745.45","$9,968.75",$0.00,"$4,984.38","$7,895.25","$7,975.00",$0.00,"$1,560.11",$0.00,"$1,587.03",$0.00
9391319,SUP,HCPCS C1713,,9391319  -  CAGE SPNL 13MM 19MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR,"$9,968.75",$0.00,"$9,968.75","$4,485.94","$5,158.80",$0.00,"$1,717.57",$0.00,$0.00,"$1,745.45","$9,968.75",$0.00,"$4,984.38","$7,895.25","$7,975.00",$0.00,"$1,560.11",$0.00,"$1,587.03",$0.00
9391322,SUP,HCPCS C1713,,9391322  -  CAGE SPNL 13MM 22MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR,"$9,968.75",$0.00,"$9,968.75","$4,485.94","$5,158.80",$0.00,"$1,717.57",$0.00,$0.00,"$1,745.45","$9,968.75",$0.00,"$4,984.38","$7,895.25","$7,975.00",$0.00,"$1,560.11",$0.00,"$1,587.03",$0.00
9391326,SUP,HCPCS C1713,,9391326  -  CAGE SPNL 13MM 26MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR,"$9,968.75",$0.00,"$9,968.75","$4,485.94","$5,158.80",$0.00,"$1,717.57",$0.00,$0.00,"$1,745.45","$9,968.75",$0.00,"$4,984.38","$7,895.25","$7,975.00",$0.00,"$1,560.11",$0.00,"$1,587.03",$0.00
9391332,SUP,HCPCS C1713,,9391332  -  CAGE SPNL 13MM 32MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR,"$11,687.50",$0.00,"$11,687.50","$5,259.38","$5,158.80",$0.00,"$2,013.70",$0.00,$0.00,"$2,046.39","$11,687.50",$0.00,"$5,843.75","$9,256.50","$9,350.00",$0.00,"$1,829.09",$0.00,"$1,860.65",$0.00
9391341,SUP,HCPCS C1713,,9391341  -  CAGE SPNL 13MM 41MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR,"$11,687.50",$0.00,"$11,687.50","$5,259.38","$5,158.80",$0.00,"$2,013.70",$0.00,$0.00,"$2,046.39","$11,687.50",$0.00,"$5,843.75","$9,256.50","$9,350.00",$0.00,"$1,829.09",$0.00,"$1,860.65",$0.00
9391617,SUP,HCPCS C1713,,9391617  -  CAGE SPNL 16MM 17MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR,"$9,968.75",$0.00,"$9,968.75","$4,485.94","$5,158.80",$0.00,"$1,717.57",$0.00,$0.00,"$1,745.45","$9,968.75",$0.00,"$4,984.38","$7,895.25","$7,975.00",$0.00,"$1,560.11",$0.00,"$1,587.03",$0.00
9391620,SUP,HCPCS C1713,,9391620  -  CENTERPIECE 9391620 16 X 20MM 16B,"$9,968.75",$0.00,"$9,968.75","$4,485.94","$5,158.80",$0.00,"$1,717.57",$0.00,$0.00,"$1,745.45","$9,968.75",$0.00,"$4,984.38","$7,895.25","$7,975.00",$0.00,"$1,560.11",$0.00,"$1,587.03",$0.00
9391623,SUP,HCPCS C1713,,9391623  -  CAGE SPNL 16MM 23MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR,"$9,968.75",$0.00,"$9,968.75","$4,485.94","$5,158.80",$0.00,"$1,717.57",$0.00,$0.00,"$1,745.45","$9,968.75",$0.00,"$4,984.38","$7,895.25","$7,975.00",$0.00,"$1,560.11",$0.00,"$1,587.03",$0.00
9391628,SUP,HCPCS C1713,,9391628  -  CAGE SPNL 16MM 28MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR,"$9,968.75",$0.00,"$9,968.75","$4,485.94","$5,158.80",$0.00,"$1,717.57",$0.00,$0.00,"$1,745.45","$9,968.75",$0.00,"$4,984.38","$7,895.25","$7,975.00",$0.00,"$1,560.11",$0.00,"$1,587.03",$0.00
9391633,SUP,HCPCS C1713,,9391633  -  CAGE SPNL 16MM 33MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR,"$11,687.50",$0.00,"$11,687.50","$5,259.38","$5,158.80",$0.00,"$2,013.70",$0.00,$0.00,"$2,046.39","$11,687.50",$0.00,"$5,843.75","$9,256.50","$9,350.00",$0.00,"$1,829.09",$0.00,"$1,860.65",$0.00
9391641,SUP,HCPCS C1713,,9391641  -  CAGE SPNL 16MM 41MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR,"$11,687.50",$0.00,"$11,687.50","$5,259.38","$5,158.80",$0.00,"$2,013.70",$0.00,$0.00,"$2,046.39","$11,687.50",$0.00,"$5,843.75","$9,256.50","$9,350.00",$0.00,"$1,829.09",$0.00,"$1,860.65",$0.00
9391919,SUP,HCPCS C1713,,9391919  -  CAGE SPNL 19MM 19MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR,"$11,687.50",$0.00,"$11,687.50","$5,259.38","$5,158.80",$0.00,"$2,013.70",$0.00,$0.00,"$2,046.39","$11,687.50",$0.00,"$5,843.75","$9,256.50","$9,350.00",$0.00,"$1,829.09",$0.00,"$1,860.65",$0.00
9391923,SUP,HCPCS C1713,,9391923  -  CAGE SPNL 19MM 23MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR,"$11,687.50",$0.00,"$11,687.50","$5,259.38","$5,158.80",$0.00,"$2,013.70",$0.00,$0.00,"$2,046.39","$11,687.50",$0.00,"$5,843.75","$9,256.50","$9,350.00",$0.00,"$1,829.09",$0.00,"$1,860.65",$0.00
9391928,SUP,HCPCS C1713,,9391928  -  CAGE SPNL 19MM 28MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR,"$11,687.50",$0.00,"$11,687.50","$5,259.38","$5,158.80",$0.00,"$2,013.70",$0.00,$0.00,"$2,046.39","$11,687.50",$0.00,"$5,843.75","$9,256.50","$9,350.00",$0.00,"$1,829.09",$0.00,"$1,860.65",$0.00
9391936,SUP,HCPCS C1713,,9391936  -  CAGE SPNL 19MM 36MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR,"$11,687.50",$0.00,"$11,687.50","$5,259.38","$5,158.80",$0.00,"$2,013.70",$0.00,$0.00,"$2,046.39","$11,687.50",$0.00,"$5,843.75","$9,256.50","$9,350.00",$0.00,"$1,829.09",$0.00,"$1,860.65",$0.00
9391947,SUP,HCPCS C1713,,9391947  -  CAGE SPNL 19MM 47MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR,"$13,406.25",$0.00,"$13,406.25","$6,032.81","$5,158.80",$0.00,"$2,309.83",$0.00,$0.00,"$2,347.33","$13,406.25",$0.00,"$6,703.13","$10,617.75","$10,725.00",$0.00,"$2,098.08",$0.00,"$2,134.28",$0.00
9391969,SUP,HCPCS C1713,,9391969  -  CAGE SPNL 19MM 69MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR,"$13,406.25",$0.00,"$13,406.25","$6,032.81","$5,158.80",$0.00,"$2,309.83",$0.00,$0.00,"$2,347.33","$13,406.25",$0.00,"$6,703.13","$10,617.75","$10,725.00",$0.00,"$2,098.08",$0.00,"$2,134.28",$0.00
9392221,SUP,HCPCS C1713,,9392221  -  CAGE SPNL 22MM 21MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR,"$11,687.50",$0.00,"$11,687.50","$5,259.38","$5,158.80",$0.00,"$2,013.70",$0.00,$0.00,"$2,046.39","$11,687.50",$0.00,"$5,843.75","$9,256.50","$9,350.00",$0.00,"$1,829.09",$0.00,"$1,860.65",$0.00
9392225,SUP,HCPCS C1713,,9392225  -  CAGE SPNL 22MM 25MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR,"$11,687.50",$0.00,"$11,687.50","$5,259.38","$5,158.80",$0.00,"$2,013.70",$0.00,$0.00,"$2,046.39","$11,687.50",$0.00,"$5,843.75","$9,256.50","$9,350.00",$0.00,"$1,829.09",$0.00,"$1,860.65",$0.00
9392231,SUP,HCPCS C1713,,9392231  -  CAGE SPNL 22MM 31MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR,"$11,687.50",$0.00,"$11,687.50","$5,259.38","$5,158.80",$0.00,"$2,013.70",$0.00,$0.00,"$2,046.39","$11,687.50",$0.00,"$5,843.75","$9,256.50","$9,350.00",$0.00,"$1,829.09",$0.00,"$1,860.65",$0.00
9392237,SUP,HCPCS C1713,,9392237  -  CAGE SPNL 22MM 37MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR,"$11,687.50",$0.00,"$11,687.50","$5,259.38","$5,158.80",$0.00,"$2,013.70",$0.00,$0.00,"$2,046.39","$11,687.50",$0.00,"$5,843.75","$9,256.50","$9,350.00",$0.00,"$1,829.09",$0.00,"$1,860.65",$0.00
9392248,SUP,HCPCS C1713,,9392248  -  CAGE SPNL 22MM 48MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR,"$13,406.25",$0.00,"$13,406.25","$6,032.81","$5,158.80",$0.00,"$2,309.83",$0.00,$0.00,"$2,347.33","$13,406.25",$0.00,"$6,703.13","$10,617.75","$10,725.00",$0.00,"$2,098.08",$0.00,"$2,134.28",$0.00
9392268,SUP,HCPCS C1713,,9392268  -  CAGE SPNL 22MM 68MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR,"$13,406.25",$0.00,"$13,406.25","$6,032.81","$5,158.80",$0.00,"$2,309.83",$0.00,$0.00,"$2,347.33","$13,406.25",$0.00,"$6,703.13","$10,617.75","$10,725.00",$0.00,"$2,098.08",$0.00,"$2,134.28",$0.00
9392507,SUP,HCPCS C1713,,9392507  -  SPACER SPNL 25MMX7MM LF CRSNT PEEK-OPTM VERT BD REPL,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
9392508,SUP,HCPCS C1713,,9392508  -  SPACER SPNL 25MMX8MM LF CRSNT PEEK-OPTM VERT BD REPL,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
9392509,SUP,HCPCS C1713,,9392509  -  SPACER SPNL 25MMX9MM LF CRSNT PEEK-OPTM VERT BD REPL,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
9392510,SUP,HCPCS C1713,,9392510  -  SPACER SPNL 25MMX10MM LF CRSNT PEEK-OPTM VERT BD REPL,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
9392511,SUP,HCPCS C1713,,9392511  -  SPACER SPNL 25MMX11MM LF CRSNT PEEK-OPTM VERT BD REPL,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
9392512,SUP,HCPCS C1713,,9392512  -  SPACER SPNL 25MMX12MM LF CRSNT PEEK-OPTM VERT BD REPL,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
9392513,SUP,HCPCS C1713,,9392513  -  SPACER SPNL 25MMX13MM LF CRSNT PEEK-OPTM VERT BD REPL,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
9392514,SUP,HCPCS C1713,,9392514  -  SPACER SPNL 25MMX14MM LF CRSNT PEEK-OPTM VERT BD REPL,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
9392515,SUP,HCPCS C1713,,9392515  -  SPACER SPNL 25MMX15MM LF CRSNT PEEK-OPTM VERT BD REPL,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
9392521,SUP,HCPCS C1713,,9392521  -  CAGE SPNL 25MM 21MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR,"$11,687.50",$0.00,"$11,687.50","$5,259.38","$5,158.80",$0.00,"$2,013.70",$0.00,$0.00,"$2,046.39","$11,687.50",$0.00,"$5,843.75","$9,256.50","$9,350.00",$0.00,"$1,829.09",$0.00,"$1,860.65",$0.00
9392525,SUP,HCPCS C1713,,9392525  -  CAGE SPNL 25MM 25MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR,"$11,687.50",$0.00,"$11,687.50","$5,259.38","$5,158.80",$0.00,"$2,013.70",$0.00,$0.00,"$2,046.39","$11,687.50",$0.00,"$5,843.75","$9,256.50","$9,350.00",$0.00,"$1,829.09",$0.00,"$1,860.65",$0.00
9392531,SUP,HCPCS C1713,,9392531  -  CAGE SPNL 25MM 31MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR,"$11,687.50",$0.00,"$11,687.50","$5,259.38","$5,158.80",$0.00,"$2,013.70",$0.00,$0.00,"$2,046.39","$11,687.50",$0.00,"$5,843.75","$9,256.50","$9,350.00",$0.00,"$1,829.09",$0.00,"$1,860.65",$0.00
9392537,SUP,HCPCS C1713,,9392537  -  CAGE SPNL 25MM 37MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR,"$11,687.50",$0.00,"$11,687.50","$5,259.38","$5,158.80",$0.00,"$2,013.70",$0.00,$0.00,"$2,046.39","$11,687.50",$0.00,"$5,843.75","$9,256.50","$9,350.00",$0.00,"$1,829.09",$0.00,"$1,860.65",$0.00
9392548,SUP,HCPCS C1713,,9392548  -  CAGE SPNL 25MM 48MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR,"$13,406.25",$0.00,"$13,406.25","$6,032.81","$5,158.80",$0.00,"$2,309.83",$0.00,$0.00,"$2,347.33","$13,406.25",$0.00,"$6,703.13","$10,617.75","$10,725.00",$0.00,"$2,098.08",$0.00,"$2,134.28",$0.00
9392568,SUP,HCPCS C1713,,9392568  -  CAGE SPNL 25MM 68MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR,"$13,406.25",$0.00,"$13,406.25","$6,032.81","$5,158.80",$0.00,"$2,309.83",$0.00,$0.00,"$2,347.33","$13,406.25",$0.00,"$6,703.13","$10,617.75","$10,725.00",$0.00,"$2,098.08",$0.00,"$2,134.28",$0.00
9393007,SUP,HCPCS C1713,,9393007  -  SPACER SPNL 30MMX7MM LF CRSNT PEEK-OPTM VERT BD REPL,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
9393008,SUP,HCPCS C1713,,9393008  -  SPACER SPNL 30MMX8MM LF CRSNT PEEK-OPTM VERT BD REPL,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
9393009,SUP,HCPCS C1713,,9393009  -  SPACER SPNL 30MMX9MM LF CRSNT PEEK-OPTM VERT BD REPL,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
9393010,SUP,HCPCS C1713,,9393010  -  SPACER SPNL 30MMX10MM LF CRSNT PEEK-OPTM VERT BD REPL,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
9393011,SUP,HCPCS C1713,,9393011  -  SPACER SPNL 30MMX11MM LF CRSNT PEEK-OPTM VERT BD REPL,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
9393012,SUP,HCPCS C1713,,9393012  -  SPACER SPNL 30MMX12MM LF CRSNT PEEK-OPTM VERT BD REPL,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
9393013,SUP,HCPCS C1713,,9393013  -  SPACER SPNL 30MMX13MM LF CRSNT PEEK-OPTM VERT BD REPL,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
9393014,SUP,HCPCS C1713,,9393014  -  SPACER SPNL 30MMX14MM LF CRSNT PEEK-OPTM VERT BD REPL,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
9393015,SUP,HCPCS C1713,,9393015  -  SPACER SPNL 30MMX15MM LF CRSNT PEEK-OPTM VERT BD REPL,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
9393607,SUP,HCPCS C1713,,9393607  -  SPACER SPNL 36MMX7MM LF CRSNT PEEK-OPTM VERT BD REPL,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
9393608,SUP,HCPCS C1713,,9393608  -  SPACER SPNL 36MMX8MM LF CRSNT PEEK-OPTM VERT BD REPL,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
9393609,SUP,HCPCS C1713,,9393609  -  SPACER SPNL 36MMX9MM LF CRSNT PEEK-OPTM VERT BD REPL,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
9393610,SUP,HCPCS C1713,,9393610  -  SPACER SPNL 36MMX10MM LF CRSNT PEEK-OPTM VERT BD REPL,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
9393611,SUP,HCPCS C1713,,9393611  -  SPACER SPNL 36MMX11MM LF CRSNT PEEK-OPTM VERT BD REPL,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
9393612,SUP,HCPCS C1713,,9393612  -  SPACER SPNL 36MMX12MM LF CRSNT PEEK-OPTM VERT BD REPL,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
9393613,SUP,HCPCS C1713,,9393613  -  SPACER SPNL 36MMX13MM LF CRSNT PEEK-OPTM VERT BD REPL,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
9393614,SUP,HCPCS C1713,,9393614  -  SPACER SPNL 36MMX14MM LF CRSNT PEEK-OPTM VERT BD REPL,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
9393615,SUP,HCPCS C1713,,9393615  -  SPACER SPNL 36MMX15MM LF CRSNT PEEK-OPTM VERT BD REPL,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
9401300,SUP,HCPCS C1713,,9401300  -  END CAP 9401300 13MM 0 DEGREE,$907.50,$0.00,$907.50,$408.38,$647.68,$0.00,$156.36,$0.00,$0.00,$158.90,$907.50,$0.00,$453.75,$718.74,$726.00,$0.00,$142.02,$0.00,$144.47,$0.00
9401304,SUP,HCPCS C1713,,9401304  -  END CAP 9401304 13MM 4 DEGREE,$907.50,$0.00,$907.50,$408.38,$647.68,$0.00,$156.36,$0.00,$0.00,$158.90,$907.50,$0.00,$453.75,$718.74,$726.00,$0.00,$142.02,$0.00,$144.47,$0.00
9401308,SUP,HCPCS C1713,,9401308  -  END CAP 9401308 13MM 8 DEGREE,$907.50,$0.00,$907.50,$408.38,$647.68,$0.00,$156.36,$0.00,$0.00,$158.90,$907.50,$0.00,$453.75,$718.74,$726.00,$0.00,$142.02,$0.00,$144.47,$0.00
9401315,SUP,HCPCS C1713,,9401315  -  END CAP 9401315 13MM 15 DEGREE,$907.50,$0.00,$907.50,$408.38,$647.68,$0.00,$156.36,$0.00,$0.00,$158.90,$907.50,$0.00,$453.75,$718.74,$726.00,$0.00,$142.02,$0.00,$144.47,$0.00
9401600,SUP,HCPCS C1713,,9401600  -  END CAP 9401600 16MM 0 DEGREE,$907.50,$0.00,$907.50,$408.38,$647.68,$0.00,$156.36,$0.00,$0.00,$158.90,$907.50,$0.00,$453.75,$718.74,$726.00,$0.00,$142.02,$0.00,$144.47,$0.00
9401604,SUP,HCPCS C1713,,9401604  -  END CAP 9401604 16MM 4 DEGREE,$907.50,$0.00,$907.50,$408.38,$647.68,$0.00,$156.36,$0.00,$0.00,$158.90,$907.50,$0.00,$453.75,$718.74,$726.00,$0.00,$142.02,$0.00,$144.47,$0.00
9401608,SUP,HCPCS C1713,,9401608  -  END CAP 9401608 16MM 8 DEGREE,$907.50,$0.00,$907.50,$408.38,$647.68,$0.00,$156.36,$0.00,$0.00,$158.90,$907.50,$0.00,$453.75,$718.74,$726.00,$0.00,$142.02,$0.00,$144.47,$0.00
9401615,SUP,HCPCS C1713,,9401615  -  END CAP 9401615 16MM 15 DEGREE,$907.50,$0.00,$907.50,$408.38,$647.68,$0.00,$156.36,$0.00,$0.00,$158.90,$907.50,$0.00,$453.75,$718.74,$726.00,$0.00,$142.02,$0.00,$144.47,$0.00
9401900,SUP,HCPCS C1713,,9401900  -  END CAP 9401900 19MM 0 DEGREE,$907.50,$0.00,$907.50,$408.38,$647.68,$0.00,$156.36,$0.00,$0.00,$158.90,$907.50,$0.00,$453.75,$718.74,$726.00,$0.00,$142.02,$0.00,$144.47,$0.00
9401904,SUP,HCPCS C1713,,9401904  -  END CAP 9401904 19MM 4 DEGREE,$907.50,$0.00,$907.50,$408.38,$647.68,$0.00,$156.36,$0.00,$0.00,$158.90,$907.50,$0.00,$453.75,$718.74,$726.00,$0.00,$142.02,$0.00,$144.47,$0.00
9401908,SUP,HCPCS C1713,,9401908  -  END CAP 9401908 19MM 8 DEGREE,$907.50,$0.00,$907.50,$408.38,$647.68,$0.00,$156.36,$0.00,$0.00,$158.90,$907.50,$0.00,$453.75,$718.74,$726.00,$0.00,$142.02,$0.00,$144.47,$0.00
9401915,SUP,HCPCS C1713,,9401915  -  END CAP 9401915 19MM 15 DEGREE,$907.50,$0.00,$907.50,$408.38,$647.68,$0.00,$156.36,$0.00,$0.00,$158.90,$907.50,$0.00,$453.75,$718.74,$726.00,$0.00,$142.02,$0.00,$144.47,$0.00
9402200,SUP,HCPCS C1713,,9402200  -  END CAP 9402200 22MM 0 DEGREE,$907.50,$0.00,$907.50,$408.38,$647.68,$0.00,$156.36,$0.00,$0.00,$158.90,$907.50,$0.00,$453.75,$718.74,$726.00,$0.00,$142.02,$0.00,$144.47,$0.00
9402204,SUP,HCPCS C1713,,9402204  -  CAGE SPNL 4D 22MM T2 XVBR CENTERPIECE END CAP TI COCR NTNL,$907.50,$0.00,$907.50,$408.38,$647.68,$0.00,$156.36,$0.00,$0.00,$158.90,$907.50,$0.00,$453.75,$718.74,$726.00,$0.00,$142.02,$0.00,$144.47,$0.00
9402208,SUP,HCPCS C1713,,9402208  -  END CAP 9402208 22MM 8 DEGREE,$907.50,$0.00,$907.50,$408.38,$647.68,$0.00,$156.36,$0.00,$0.00,$158.90,$907.50,$0.00,$453.75,$718.74,$726.00,$0.00,$142.02,$0.00,$144.47,$0.00
9402215,SUP,HCPCS C1713,,9402215  -  END CAP 9402215 22MM 15 DEGREE,$907.50,$0.00,$907.50,$408.38,$647.68,$0.00,$156.36,$0.00,$0.00,$158.90,$907.50,$0.00,$453.75,$718.74,$726.00,$0.00,$142.02,$0.00,$144.47,$0.00
9402500,SUP,HCPCS C1713,,9402500  -  END CAP 9402500 25MM 0 DEGREE,$907.50,$0.00,$907.50,$408.38,$647.68,$0.00,$156.36,$0.00,$0.00,$158.90,$907.50,$0.00,$453.75,$718.74,$726.00,$0.00,$142.02,$0.00,$144.47,$0.00
9402504,SUP,HCPCS C1713,,9402504  -  CAGE SPNL 4D 25MM T2 XVBR CENTERPIECE END CAP TI COCR NTNL,$907.50,$0.00,$907.50,$408.38,$647.68,$0.00,$156.36,$0.00,$0.00,$158.90,$907.50,$0.00,$453.75,$718.74,$726.00,$0.00,$142.02,$0.00,$144.47,$0.00
9402508,SUP,HCPCS C1713,,9402508  -  END CAP 9402508 25MM 8 DEGREE,$907.50,$0.00,$907.50,$408.38,$647.68,$0.00,$156.36,$0.00,$0.00,$158.90,$907.50,$0.00,$453.75,$718.74,$726.00,$0.00,$142.02,$0.00,$144.47,$0.00
9402515,SUP,HCPCS C1713,,9402515  -  END CAP 9402515 25MM 15 DEGREE,$907.50,$0.00,$907.50,$408.38,$647.68,$0.00,$156.36,$0.00,$0.00,$158.90,$907.50,$0.00,$453.75,$718.74,$726.00,$0.00,$142.02,$0.00,$144.47,$0.00
9450002,SUP,Custom 27203010,,9450002  -  DISPOSABLE 9450002 ELECTRO LOW IMPED22MM,$669.00,$0.00,$669.00,$0.00,$477.47,$0.00,$0.00,$0.00,$0.00,$0.00,$669.00,$0.00,$334.50,$529.85,$535.20,$0.00,$0.00,$0.00,$0.00,$0.00
9450003,SUP,Custom 27203010,,9450003  -  DISPOSABLE 9450003 ELECTRO TWST PAIR 8CH,$936.00,$0.00,$936.00,$0.00,$668.02,$0.00,$0.00,$0.00,$0.00,$0.00,$936.00,$0.00,$468.00,$741.31,$748.80,$0.00,$0.00,$0.00,$0.00,$0.00
9450019,SUP,Custom 27203010,,9450019  -  DISPOSABLE 9450019 NIM PED PROBE THORAC,"$1,237.50",$0.00,"$1,237.50",$0.00,$883.20,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,237.50",$0.00,$618.75,$980.10,$990.00,$0.00,$0.00,$0.00,$0.00,$0.00
9450020,SUP,Custom 27203010,,9450020  -  NEEDLE SPNL STRL LF NIM-SPNE ACC PDCL DISP,"$1,237.50",$0.00,"$1,237.50",$0.00,$883.20,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,237.50",$0.00,$618.75,$980.10,$990.00,$0.00,$0.00,$0.00,$0.00,$0.00
9450047,SUP,Custom 27203010,,9450047  -  DISPOSABLE 9450047 NEW PED PROBE LMBR,"$1,237.50",$0.00,"$1,237.50",$0.00,$883.20,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,237.50",$0.00,$618.75,$980.10,$990.00,$0.00,$0.00,$0.00,$0.00,$0.00
9450051,SUP,Custom 27203010,,9450051  -  DISPOSABLE 9450051 NIM 2.3MM BLL TIP PRB,$270.00,$0.00,$270.00,$0.00,$192.70,$0.00,$0.00,$0.00,$0.00,$0.00,$270.00,$0.00,$135.00,$213.84,$216.00,$0.00,$0.00,$0.00,$0.00,$0.00
9560551,SUP,Custom 27203010,,9560551  -  INSTRUMENT 9560551 METRX SHTHD KNF BLDE,$645.00,$0.00,$645.00,$0.00,$460.34,$0.00,$0.00,$0.00,$0.00,$0.00,$645.00,$0.00,$322.50,$510.84,$516.00,$0.00,$0.00,$0.00,$0.00,$0.00
9560658,SUP,Custom 27203010,,9560658  -  INSTRUMENT 9560658 QUADRANT ILLUMIN SYS,"$1,207.50",$0.00,"$1,207.50",$0.00,$861.79,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,207.50",$0.00,$603.75,$956.34,$966.00,$0.00,$0.00,$0.00,$0.00,$0.00
9560659,SUP,Custom 27203010,,9560659  -  KNIFE SRG BYNT STRL MTRX SPNE CRV ANT DISP DSCTMY,$781.50,$0.00,$781.50,$0.00,$557.76,$0.00,$0.00,$0.00,$0.00,$0.00,$781.50,$0.00,$390.75,$618.95,$625.20,$0.00,$0.00,$0.00,$0.00,$0.00
9560702,SUP,Custom 27203010,,9560702  -  INSTRUMENT 9560702 RADIANCE ILLUMIN SYS,"$1,062.00",$0.00,"$1,062.00",$0.00,$757.95,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,062.00",$0.00,$531.00,$841.10,$849.60,$0.00,$0.00,$0.00,$0.00,$0.00
9560703,SUP,Custom 27203010,,9560703  -  INSTRUMENT 9560703 DISP 22MMX3CM RTRCT,$631.50,$0.00,$631.50,$0.00,$450.70,$0.00,$0.00,$0.00,$0.00,$0.00,$631.50,$0.00,$315.75,$500.15,$505.20,$0.00,$0.00,$0.00,$0.00,$0.00
9560704,SUP,Custom 27203010,,9560704  -  INSTRUMENT 9560704 DISP 22MMX4CM RTRCT,$631.50,$0.00,$631.50,$0.00,$450.70,$0.00,$0.00,$0.00,$0.00,$0.00,$631.50,$0.00,$315.75,$500.15,$505.20,$0.00,$0.00,$0.00,$0.00,$0.00
9560705,SUP,Custom 27203010,,9560705  -  INSTRUMENT 9560705 DISP 22MMX5CM RTRCT,$631.50,$0.00,$631.50,$0.00,$450.70,$0.00,$0.00,$0.00,$0.00,$0.00,$631.50,$0.00,$315.75,$500.15,$505.20,$0.00,$0.00,$0.00,$0.00,$0.00
9560706,SUP,Custom 27203010,,9560706  -  INSTRUMENT 9560706 DISP 22MMX6CM RTRCT,$631.50,$0.00,$631.50,$0.00,$450.70,$0.00,$0.00,$0.00,$0.00,$0.00,$631.50,$0.00,$315.75,$500.15,$505.20,$0.00,$0.00,$0.00,$0.00,$0.00
9560707,SUP,Custom 27203010,,9560707  -  INSTRUMENT 9560707 DISP 22MMX7CM RTRCT,$631.50,$0.00,$631.50,$0.00,$450.70,$0.00,$0.00,$0.00,$0.00,$0.00,$631.50,$0.00,$315.75,$500.15,$505.20,$0.00,$0.00,$0.00,$0.00,$0.00
9560708,SUP,Custom 27203010,,9560708  -  INSTRUMENT 9560708 DISP 22MMX8CM RTRCT,$631.50,$0.00,$631.50,$0.00,$450.70,$0.00,$0.00,$0.00,$0.00,$0.00,$631.50,$0.00,$315.75,$500.15,$505.20,$0.00,$0.00,$0.00,$0.00,$0.00
9560709,SUP,Custom 27203010,,9560709  -  INSTRUMENT 9560709 DISP 22MMX9CM RTRCT,$631.50,$0.00,$631.50,$0.00,$450.70,$0.00,$0.00,$0.00,$0.00,$0.00,$631.50,$0.00,$315.75,$500.15,$505.20,$0.00,$0.00,$0.00,$0.00,$0.00
9560757,SUP,Custom 27203010,,9560757  -  INSTRUMENT 9560757 RDINCEXILLUMIN SYS,"$1,290.00",$0.00,"$1,290.00",$0.00,$920.67,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,290.00",$0.00,$645.00,"$1,021.68","$1,032.00",$0.00,$0.00,$0.00,$0.00,$0.00
9560802,SUP,Custom 27803010,,9560802  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$958.50,$0.00,$958.50,$0.00,$684.08,$0.00,$0.00,$0.00,$0.00,$0.00,$958.50,$0.00,$479.25,$759.13,$766.80,$0.00,$0.00,$0.00,$0.00,$0.00
9561424,SUP,Custom 27203010,,9561424  -  PLATE 18MM TI BONE SPNL,$921.00,$0.00,$921.00,$0.00,$657.32,$0.00,$0.00,$0.00,$0.00,$0.00,$921.00,$0.00,$460.50,$729.43,$736.80,$0.00,$0.00,$0.00,$0.00,$0.00
9561426,SUP,Custom 27203010,,9561426  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$966.00,$0.00,$966.00,$0.00,$689.43,$0.00,$0.00,$0.00,$0.00,$0.00,$966.00,$0.00,$483.00,$765.07,$772.80,$0.00,$0.00,$0.00,$0.00,$0.00
9561427,SUP,Custom 27203010,,9561427  -  PLATE 18MM TI BONE SPNL,$966.00,$0.00,$966.00,$0.00,$689.43,$0.00,$0.00,$0.00,$0.00,$0.00,$966.00,$0.00,$483.00,$765.07,$772.80,$0.00,$0.00,$0.00,$0.00,$0.00
9561428,SUP,Custom 27203010,,9561428  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$966.00,$0.00,$966.00,$0.00,$689.43,$0.00,$0.00,$0.00,$0.00,$0.00,$966.00,$0.00,$483.00,$765.07,$772.80,$0.00,$0.00,$0.00,$0.00,$0.00
9561523,SUP,Custom 27203010,,9561523  -  PLATE 18MM TI BONE SPNL,"$5,940.00",$0.00,"$5,940.00",$0.00,"$4,239.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,940.00",$0.00,"$2,970.00","$4,704.48","$4,752.00",$0.00,$0.00,$0.00,$0.00,$0.00
9561524,SUP,Custom 27203010,,9561524  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$8,920.50",$0.00,"$8,920.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,920.50",$0.00,"$4,460.25","$7,065.04","$7,136.40",$0.00,$0.00,$0.00,$0.00,$0.00
9561525,SUP,Custom 27203010,,9561525  -  PLATE 18MM TI BONE SPNL,"$2,314.50",$0.00,"$2,314.50",$0.00,"$1,651.86",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,314.50",$0.00,"$1,157.25","$1,833.08","$1,851.60",$0.00,$0.00,$0.00,$0.00,$0.00
9561526,SUP,Custom 27203010,,9561526  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$252.00,$0.00,$252.00,$0.00,$179.85,$0.00,$0.00,$0.00,$0.00,$0.00,$252.00,$0.00,$126.00,$199.58,$201.60,$0.00,$0.00,$0.00,$0.00,$0.00
9561813,SUP,Custom 27203010,,9561813  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$631.50,$0.00,$631.50,$0.00,$450.70,$0.00,$0.00,$0.00,$0.00,$0.00,$631.50,$0.00,$315.75,$500.15,$505.20,$0.00,$0.00,$0.00,$0.00,$0.00
9561814,SUP,Custom 27203010,,9561814  -  PLATE 18MM TI BONE SPNL,$631.50,$0.00,$631.50,$0.00,$450.70,$0.00,$0.00,$0.00,$0.00,$0.00,$631.50,$0.00,$315.75,$500.15,$505.20,$0.00,$0.00,$0.00,$0.00,$0.00
9561815,SUP,Custom 27203010,,9561815  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$631.50,$0.00,$631.50,$0.00,$450.70,$0.00,$0.00,$0.00,$0.00,$0.00,$631.50,$0.00,$315.75,$500.15,$505.20,$0.00,$0.00,$0.00,$0.00,$0.00
9561816,SUP,Custom 27203010,,9561816  -  PLATE 18MM TI BONE SPNL,$631.50,$0.00,$631.50,$0.00,$450.70,$0.00,$0.00,$0.00,$0.00,$0.00,$631.50,$0.00,$315.75,$500.15,$505.20,$0.00,$0.00,$0.00,$0.00,$0.00
9561817,SUP,Custom 27203010,,9561817  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$631.50,$0.00,$631.50,$0.00,$450.70,$0.00,$0.00,$0.00,$0.00,$0.00,$631.50,$0.00,$315.75,$500.15,$505.20,$0.00,$0.00,$0.00,$0.00,$0.00
9561818,SUP,Custom 27203010,,9561818  -  PLATE 18MM TI BONE SPNL,$631.50,$0.00,$631.50,$0.00,$450.70,$0.00,$0.00,$0.00,$0.00,$0.00,$631.50,$0.00,$315.75,$500.15,$505.20,$0.00,$0.00,$0.00,$0.00,$0.00
9561819,SUP,Custom 27203010,,9561819  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$631.50,$0.00,$631.50,$0.00,$450.70,$0.00,$0.00,$0.00,$0.00,$0.00,$631.50,$0.00,$315.75,$500.15,$505.20,$0.00,$0.00,$0.00,$0.00,$0.00
9562613,SUP,Custom 27203010,,9562613  -  PLATE 18MM TI BONE SPNL,$631.50,$0.00,$631.50,$0.00,$450.70,$0.00,$0.00,$0.00,$0.00,$0.00,$631.50,$0.00,$315.75,$500.15,$505.20,$0.00,$0.00,$0.00,$0.00,$0.00
9562614,SUP,Custom 27203010,,9562614  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$631.50,$0.00,$631.50,$0.00,$450.70,$0.00,$0.00,$0.00,$0.00,$0.00,$631.50,$0.00,$315.75,$500.15,$505.20,$0.00,$0.00,$0.00,$0.00,$0.00
9562615,SUP,Custom 27203010,,9562615  -  PLATE 18MM TI BONE SPNL,$600.00,$0.00,$600.00,$0.00,$428.22,$0.00,$0.00,$0.00,$0.00,$0.00,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$0.00,$0.00,$0.00,$0.00
9562616,SUP,Custom 27203010,,9562616  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$600.00,$0.00,$600.00,$0.00,$428.22,$0.00,$0.00,$0.00,$0.00,$0.00,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$0.00,$0.00,$0.00,$0.00
9562617,SUP,Custom 27203010,,9562617  -  PLATE 18MM TI BONE SPNL,$600.00,$0.00,$600.00,$0.00,$428.22,$0.00,$0.00,$0.00,$0.00,$0.00,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$0.00,$0.00,$0.00,$0.00
9562618,SUP,Custom 27203010,,9562618  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$600.00,$0.00,$600.00,$0.00,$428.22,$0.00,$0.00,$0.00,$0.00,$0.00,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$0.00,$0.00,$0.00,$0.00
9562619,SUP,Custom 27203010,,9562619  -  PLATE 18MM TI BONE SPNL,$600.00,$0.00,$600.00,$0.00,$428.22,$0.00,$0.00,$0.00,$0.00,$0.00,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$0.00,$0.00,$0.00,$0.00
9569575,SUP,Custom 27203010,,9569575  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$207.00,$0.00,$207.00,$0.00,$147.74,$0.00,$0.00,$0.00,$0.00,$0.00,$207.00,$0.00,$103.50,$163.94,$165.60,$0.00,$0.00,$0.00,$0.00,$0.00
9569813,SUP,Custom 27203010,,9569813  -  PLATE 18MM TI BONE SPNL,$681.00,$0.00,$681.00,$0.00,$486.03,$0.00,$0.00,$0.00,$0.00,$0.00,$681.00,$0.00,$340.50,$539.35,$544.80,$0.00,$0.00,$0.00,$0.00,$0.00
9569814,SUP,Custom 27203010,,9569814  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$681.00,$0.00,$681.00,$0.00,$486.03,$0.00,$0.00,$0.00,$0.00,$0.00,$681.00,$0.00,$340.50,$539.35,$544.80,$0.00,$0.00,$0.00,$0.00,$0.00
9569815,SUP,Custom 27203010,,9569815  -  PLATE 18MM TI BONE SPNL,$681.00,$0.00,$681.00,$0.00,$486.03,$0.00,$0.00,$0.00,$0.00,$0.00,$681.00,$0.00,$340.50,$539.35,$544.80,$0.00,$0.00,$0.00,$0.00,$0.00
9569816,SUP,Custom 27203010,,9569816  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$681.00,$0.00,$681.00,$0.00,$486.03,$0.00,$0.00,$0.00,$0.00,$0.00,$681.00,$0.00,$340.50,$539.35,$544.80,$0.00,$0.00,$0.00,$0.00,$0.00
9569817,SUP,Custom 27203010,,9569817  -  PLATE 18MM TI BONE SPNL,$681.00,$0.00,$681.00,$0.00,$486.03,$0.00,$0.00,$0.00,$0.00,$0.00,$681.00,$0.00,$340.50,$539.35,$544.80,$0.00,$0.00,$0.00,$0.00,$0.00
9569818,SUP,Custom 27203010,,9569818  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$681.00,$0.00,$681.00,$0.00,$486.03,$0.00,$0.00,$0.00,$0.00,$0.00,$681.00,$0.00,$340.50,$539.35,$544.80,$0.00,$0.00,$0.00,$0.00,$0.00
9569819,SUP,Custom 27203010,,9569819  -  PLATE 18MM TI BONE SPNL,$681.00,$0.00,$681.00,$0.00,$486.03,$0.00,$0.00,$0.00,$0.00,$0.00,$681.00,$0.00,$340.50,$539.35,$544.80,$0.00,$0.00,$0.00,$0.00,$0.00
9680050,SUP,Custom 27203010,,9680050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,451.00",$0.00,"$2,451.00",$0.00,"$1,749.28",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,451.00",$0.00,"$1,225.50","$1,941.19","$1,960.80",$0.00,$0.00,$0.00,$0.00,$0.00
9680853,SUP,HCPCS C1713,,9680853  -  PLATE 18MM TI BONE SPNL,$342.00,$0.00,$342.00,$153.90,$244.09,$0.00,$58.92,$0.00,$0.00,$59.88,$342.00,$0.00,$171.00,$270.86,$273.60,$0.00,$53.52,$0.00,$54.45,$0.00
9680854,SUP,HCPCS C1713,,9680854  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
9680855,SUP,HCPCS C1713,,9680855  -  PLATE 18MM TI BONE SPNL,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
9690030,SUP,HCPCS C1713,,9690030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
9690040,SUP,HCPCS C1713,,9690040  -  PLATE 18MM TI BONE SPNL,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
9690050,SUP,HCPCS C1713,,9690050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
9690060,SUP,HCPCS C1713,,9690060  -  PLATE 18MM TI BONE SPNL,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
9690070,SUP,HCPCS C1713,,9690070  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
9690080,SUP,HCPCS C1713,,9690080  -  PLATE 18MM TI BONE SPNL,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
9690090,SUP,HCPCS C1713,,9690090  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
9690100,SUP,HCPCS C1713,,9690100  -  PLATE 18MM TI BONE SPNL,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
9690110,SUP,HCPCS C1713,,9690110  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
9690853,SUP,HCPCS C1713,,9690853  -  PLATE 18MM TI BONE SPNL,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
9690854,SUP,HCPCS C1713,,9690854  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
9690855,SUP,HCPCS C1713,,9690855  -  PLATE 18MM TI BONE SPNL,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
9733065,SUP,Custom 27203010,,9733065  -  SYSTEM GUIDANCE EXTERNAL TRAJECTORY KIT NAVIGUS,"$2,937.50",$0.00,"$2,937.50",$0.00,"$2,096.49",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,937.50",$0.00,"$1,468.75","$2,326.50","$2,350.00",$0.00,$0.00,$0.00,$0.00,$0.00
9733068,SUP,Custom 27203010,,9733068  -  KIT BIOP NEEDLE PASSIVE NAVIGUS,"$1,562.50",$0.00,"$1,562.50",$0.00,"$1,115.16",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,562.50",$0.00,$781.25,"$1,237.50","$1,250.00",$0.00,$0.00,$0.00,$0.00,$0.00
9733497,SUP,Custom 27203010,,9733497  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,642.50",$0.00,"$1,642.50",$0.00,"$1,172.25",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,642.50",$0.00,$821.25,"$1,300.86","$1,314.00",$0.00,$0.00,$0.00,$0.00,$0.00
9733498,SUP,Custom 27203010,,9733498  -  KIT STRTC STRL LF NAVIGATE ACC SPNE PDCL DISP,$907.50,$0.00,$907.50,$0.00,$647.68,$0.00,$0.00,$0.00,$0.00,$0.00,$907.50,$0.00,$453.75,$718.74,$726.00,$0.00,$0.00,$0.00,$0.00,$0.00
9734887,SUP,Custom 27203010,,9734887  -  TRACKER NVG STRL LF NINVS DISP,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
9735428,SUP,Custom 27203010,,9735428  -  STYLET NVG STRL LF 2 COIL DISP,"$1,365.00",$0.00,"$1,365.00",$0.00,$974.20,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,365.00",$0.00,$682.50,"$1,081.08","$1,092.00",$0.00,$0.00,$0.00,$0.00,$0.00
9790019,SUP,HCPCS C1713,,9790019  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
9790021,SUP,HCPCS C1713,,9790021  -  PLATE 21MM TI LCK VNTR BONE ANT CERV SPN STRL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
9790023,SUP,HCPCS C1713,,9790023  -  PLATE BN 23MM STRL VNTR INTGR LCK MDLN ALGN NTCH LOPRFL TI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
9790025,SUP,HCPCS C1713,,9790025  -  PLATE BN 25MM STRL VNTR INTGR LCK MDLN ALGN NTCH LOPRFL TI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
9790027,SUP,HCPCS C1713,,9790027  -  PLATE BN 27.5MM STRL VNTR INTGR LCK MDLN ALGN NTCH LOPRFL TI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
9790030,SUP,HCPCS C1713,,9790030  -  PLATE BN 30MM STRL VNTR INTGR LCK MDLN ALGN NTCH LOPRFL TI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
9790032,SUP,HCPCS C1713,,9790032  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
9790035,SUP,HCPCS C1713,,9790035  -  PLATE 35MM TI LCK VNTR BONE ANT CERV SPN STRL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
9790037,SUP,HCPCS C1713,,9790037  -  PLATE 37.5MM TI LCK VNTR BONE ANT CERV SPN STRL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
9790040,SUP,HCPCS C1713,,9790040  -  PLATE BN 40MM STRL VNTR INTGR LCK MDLN ALGN NTCH LOPRFL TI,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
9790042,SUP,HCPCS C1713,,9790042  -  PLATE 42.5MM TI LCK VNTR BONE ANT CERV SPN STRL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
9790045,SUP,HCPCS C1713,,9790045  -  PLATE BN 45MM STRL VNTR INTGR LCK MDLN ALGN NTCH LOPRFL TI,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
9790047,SUP,HCPCS C1713,,9790047  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
9790050,SUP,HCPCS C1713,,9790050  -  PLATE BN 50MM STRL VNTR INTGR LCK MDLN ALGN NTCH LOPRFL TI,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
9790052,SUP,HCPCS C1713,,9790052  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
9790055,SUP,HCPCS C1713,,9790055  -  PLATE 18MM TI BONE SPNL,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
9790057,SUP,HCPCS C1713,,9790057  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
9790060,SUP,HCPCS C1713,,9790060  -  PLATE 18MM TI BONE SPNL,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
9790062,SUP,HCPCS C1713,,9790062  -  PLATE BN 62.5MM STRL VNTR INTGR LCK MDLN ALGN NTCH LOPRFL TI,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
9790065,SUP,HCPCS C1713,,9790065  -  PLATE BN 65MM STRL VNTR INTGR LCK MDLN ALGN NTCH LOPRFL TI,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
9790067,SUP,HCPCS C1713,,9790067  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
9790070,SUP,HCPCS C1713,,9790070  -  PLATE 18MM TI BONE SPNL,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
9790072,SUP,HCPCS C1713,,9790072  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
9790075,SUP,HCPCS C1713,,9790075  -  PLATE 18MM TI BONE SPNL,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
9790077,SUP,HCPCS C1713,,9790077  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
9790080,SUP,HCPCS C1713,,9790080  -  PLATE 18MM TI BONE SPNL,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
9790082,SUP,HCPCS C1713,,9790082  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
9790085,SUP,HCPCS C1713,,9790085  -  PLATE 18MM TI BONE SPNL,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
9790087,SUP,HCPCS C1713,,9790087  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$4,525.50",$0.00,"$4,525.50","$2,036.48","$3,229.85",$0.00,$779.72,$0.00,$0.00,$792.38,"$4,525.50",$0.00,"$2,262.75","$3,584.20","$3,620.40",$0.00,$708.24,$0.00,$720.46,$0.00
9790090,SUP,HCPCS C1713,,9790090  -  PLATE 18MM TI BONE SPNL,"$4,525.50",$0.00,"$4,525.50","$2,036.48","$3,229.85",$0.00,$779.72,$0.00,$0.00,$792.38,"$4,525.50",$0.00,"$2,262.75","$3,584.20","$3,620.40",$0.00,$708.24,$0.00,$720.46,$0.00
9790095,SUP,HCPCS C1713,,9790095  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$4,525.50",$0.00,"$4,525.50","$2,036.48","$3,229.85",$0.00,$779.72,$0.00,$0.00,$792.38,"$4,525.50",$0.00,"$2,262.75","$3,584.20","$3,620.40",$0.00,$708.24,$0.00,$720.46,$0.00
9790100,SUP,HCPCS C1713,,9790100  -  PLATE 18MM TI BONE SPNL,"$4,525.50",$0.00,"$4,525.50","$2,036.48","$3,229.85",$0.00,$779.72,$0.00,$0.00,$792.38,"$4,525.50",$0.00,"$2,262.75","$3,584.20","$3,620.40",$0.00,$708.24,$0.00,$720.46,$0.00
9790105,SUP,HCPCS C1713,,9790105  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$4,525.50",$0.00,"$4,525.50","$2,036.48","$3,229.85",$0.00,$779.72,$0.00,$0.00,$792.38,"$4,525.50",$0.00,"$2,262.75","$3,584.20","$3,620.40",$0.00,$708.24,$0.00,$720.46,$0.00
9790110,SUP,HCPCS C1713,,9790110  -  PLATE 18MM TI BONE SPNL,"$4,525.50",$0.00,"$4,525.50","$2,036.48","$3,229.85",$0.00,$779.72,$0.00,$0.00,$792.38,"$4,525.50",$0.00,"$2,262.75","$3,584.20","$3,620.40",$0.00,$708.24,$0.00,$720.46,$0.00
9790211,SUP,HCPCS C1713,,9790211  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
9790213,SUP,HCPCS C1713,,9790213  -  SCREW BONE 4MM 13MM VNTR TI ANT CERV SPN SLFTAP FIXANG STRL,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
9790215,SUP,HCPCS C1713,,9790215  -  SCREW BN 4MM 15MM NS VNTR ST FX ANG TI SPNE CRV ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
9790217,SUP,HCPCS C1713,,9790217  -  SCREW BONE 4MM 17MM VNTR TI ANT CERV SPN SLFTAP FIXANG STRL,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
9790219,SUP,HCPCS C1713,,9790219  -  PLATE 18MM TI BONE SPNL,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
9790221,SUP,HCPCS C1713,,9790221  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
9790223,SUP,HCPCS C1713,,9790223  -  PLATE 18MM TI BONE SPNL,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
9790311,SUP,HCPCS C1713,,9790311  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
9790312,SUP,HCPCS C1713,,9790312  -  PLATE 18MM TI BONE SPNL,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
9790313,SUP,HCPCS C1713,,9790313  -  SCREW BONE 4MM 13MM VNTR TI ANT CERV SPN SLFTAP VAR ANG STRL,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
9790315,SUP,HCPCS C1713,,9790315  -  SCREW BONE 4MM 15MM VNTR TI ANT CERV SPN SLFTAP VAR ANG STRL,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
9790317,SUP,HCPCS C1713,,9790317  -  SCREW BONE 4MM 15MM TI SLFTAP,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
9790319,SUP,HCPCS C1713,,9790319  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
9790325,SUP,HCPCS C1713,,9790325  -  PLATE 18MM TI BONE SPNL,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
9790904,SUP,HCPCS C1713,,9790904  -  PIN FIX PREFIXATION SPNL,$291.00,$0.00,$291.00,$130.95,$207.69,$0.00,$50.14,$0.00,$0.00,$50.95,$291.00,$0.00,$145.50,$230.47,$232.80,$0.00,$45.54,$0.00,$46.33,$0.00
9790915,SUP,Custom 27203010,,9790915  -  BIT DRL 11MM STRL DISP,$718.50,$0.00,$718.50,$0.00,$512.79,$0.00,$0.00,$0.00,$0.00,$0.00,$718.50,$0.00,$359.25,$569.05,$574.80,$0.00,$0.00,$0.00,$0.00,$0.00
9791030,SUP,HCPCS C1713,,9791030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
9791150,SUP,HCPCS C1713,,9791150  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
9791221,SUP,HCPCS C1713,,9791221  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
9791222,SUP,HCPCS C1713,,9791222  -  PLATE 18MM TI BONE SPNL,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
9791223,SUP,HCPCS C1713,,9791223  -  SCREW BN 4MM 13MM NS VNTR SLF DRL FX ANG INTGR LCK TI SPNE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
9791224,SUP,HCPCS C1713,,9791224  -  PLATE 18MM TI BONE SPNL,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
9791225,SUP,HCPCS C1713,,9791225  -  SCREW BN 4MM 15MM NS VNTR SLF DRL FX ANG INTGR LCK TI SPNE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
9791226,SUP,HCPCS C1713,,9791226  -  PLATE 18MM TI BONE SPNL,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
9791227,SUP,HCPCS C1713,,9791227  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
9791321,SUP,HCPCS C1713,,9791321  -  PLATE 18MM TI BONE SPNL,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
9791322,SUP,HCPCS C1713,,9791322  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
9791323,SUP,HCPCS C1713,,9791323  -  SCREW BN 4MM 13MM NS VNTR SLF DRL VA INTGR LCK TI SPNE CRV,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
9791324,SUP,HCPCS C1713,,9791324  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
9791325,SUP,HCPCS C1713,,9791325  -  SCREW BN 4MM 15MM NS VNTR SLF DRL VA INTGR LCK TI SPNE CRV,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
9791326,SUP,HCPCS C1713,,9791326  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
9791327,SUP,HCPCS C1713,,9791327  -  PLATE 18MM TI BONE SPNL,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
9795211,SUP,HCPCS C1713,,9795211  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
9795213,SUP,HCPCS C1713,,9795213  -  PLATE 18MM TI BONE SPNL,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
9795215,SUP,HCPCS C1713,,9795215  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
9795217,SUP,HCPCS C1713,,9795217  -  PLATE 18MM TI BONE SPNL,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
9795219,SUP,HCPCS C1713,,9795219  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
9795221,SUP,HCPCS C1713,,9795221  -  PLATE 18MM TI BONE SPNL,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
9795223,SUP,HCPCS C1713,,9795223  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
9795225,SUP,HCPCS C1713,,9795225  -  PLATE 18MM TI BONE SPNL,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
9795227,SUP,HCPCS C1713,,9795227  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
9795229,SUP,HCPCS C1713,,9795229  -  PLATE 18MM TI BONE SPNL,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
9795311,SUP,HCPCS C1713,,9795311  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
9795313,SUP,HCPCS C1713,,9795313  -  PLATE 18MM TI BONE SPNL,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
9795315,SUP,HCPCS C1713,,9795315  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
9795317,SUP,HCPCS C1713,,9795317  -  PLATE 18MM TI BONE SPNL,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
9795319,SUP,HCPCS C1713,,9795319  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
9795321,SUP,HCPCS C1713,,9795321  -  PLATE 18MM TI BONE SPNL,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
9795323,SUP,HCPCS C1713,,9795323  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
9795325,SUP,HCPCS C1713,,9795325  -  PLATE 18MM TI BONE SPNL,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
9795327,SUP,HCPCS C1713,,9795327  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
9795329,SUP,HCPCS C1713,,9795329  -  PLATE 18MM TI BONE SPNL,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
9873033,SUP,HCPCS C1713,,9873033  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$9,487.50",$0.00,"$9,487.50","$4,269.38","$5,158.80",$0.00,"$1,634.65",$0.00,$0.00,"$1,661.19","$9,487.50",$0.00,"$4,743.75","$7,514.10","$7,590.00",$0.00,"$1,484.79",$0.00,"$1,510.41",$0.00
9873035,SUP,HCPCS C1713,,9873035  -  PLATE 18MM TI BONE SPNL,"$9,487.50",$0.00,"$9,487.50","$4,269.38","$5,158.80",$0.00,"$1,634.65",$0.00,$0.00,"$1,661.19","$9,487.50",$0.00,"$4,743.75","$7,514.10","$7,590.00",$0.00,"$1,484.79",$0.00,"$1,510.41",$0.00
9873037,SUP,HCPCS C1713,,9873037  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$9,487.50",$0.00,"$9,487.50","$4,269.38","$5,158.80",$0.00,"$1,634.65",$0.00,$0.00,"$1,661.19","$9,487.50",$0.00,"$4,743.75","$7,514.10","$7,590.00",$0.00,"$1,484.79",$0.00,"$1,510.41",$0.00
9873039,SUP,HCPCS C1713,,9873039  -  PLATE 18MM TI BONE SPNL,"$9,487.50",$0.00,"$9,487.50","$4,269.38","$5,158.80",$0.00,"$1,634.65",$0.00,$0.00,"$1,661.19","$9,487.50",$0.00,"$4,743.75","$7,514.10","$7,590.00",$0.00,"$1,484.79",$0.00,"$1,510.41",$0.00
9873041,SUP,HCPCS C1713,,9873041  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$9,487.50",$0.00,"$9,487.50","$4,269.38","$5,158.80",$0.00,"$1,634.65",$0.00,$0.00,"$1,661.19","$9,487.50",$0.00,"$4,743.75","$7,514.10","$7,590.00",$0.00,"$1,484.79",$0.00,"$1,510.41",$0.00
9873133,SUP,HCPCS C1713,,9873133  -  PLATE 18MM TI BONE SPNL,"$9,487.50",$0.00,"$9,487.50","$4,269.38","$5,158.80",$0.00,"$1,634.65",$0.00,$0.00,"$1,661.19","$9,487.50",$0.00,"$4,743.75","$7,514.10","$7,590.00",$0.00,"$1,484.79",$0.00,"$1,510.41",$0.00
9873135,SUP,HCPCS C1713,,9873135  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$9,487.50",$0.00,"$9,487.50","$4,269.38","$5,158.80",$0.00,"$1,634.65",$0.00,$0.00,"$1,661.19","$9,487.50",$0.00,"$4,743.75","$7,514.10","$7,590.00",$0.00,"$1,484.79",$0.00,"$1,510.41",$0.00
9873137,SUP,HCPCS C1713,,9873137  -  PLATE 18MM TI BONE SPNL,"$9,487.50",$0.00,"$9,487.50","$4,269.38","$5,158.80",$0.00,"$1,634.65",$0.00,$0.00,"$1,661.19","$9,487.50",$0.00,"$4,743.75","$7,514.10","$7,590.00",$0.00,"$1,484.79",$0.00,"$1,510.41",$0.00
9873139,SUP,HCPCS C1713,,9873139  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$9,487.50",$0.00,"$9,487.50","$4,269.38","$5,158.80",$0.00,"$1,634.65",$0.00,$0.00,"$1,661.19","$9,487.50",$0.00,"$4,743.75","$7,514.10","$7,590.00",$0.00,"$1,484.79",$0.00,"$1,510.41",$0.00
9873141,SUP,HCPCS C1713,,9873141  -  PLATE 18MM TI BONE SPNL,"$9,487.50",$0.00,"$9,487.50","$4,269.38","$5,158.80",$0.00,"$1,634.65",$0.00,$0.00,"$1,661.19","$9,487.50",$0.00,"$4,743.75","$7,514.10","$7,590.00",$0.00,"$1,484.79",$0.00,"$1,510.41",$0.00
9874035,SUP,HCPCS C1713,,9874035  -  PLATE BN 35MM PRMD 4 HL SPNE LMBR ANT,"$9,487.50",$0.00,"$9,487.50","$4,269.38","$5,158.80",$0.00,"$1,634.65",$0.00,$0.00,"$1,661.19","$9,487.50",$0.00,"$4,743.75","$7,514.10","$7,590.00",$0.00,"$1,484.79",$0.00,"$1,510.41",$0.00
9874037,SUP,HCPCS C1713,,9874037  -  PLATE BN 37MM PRMD 4 HL SPNE LMBR ANT,"$9,487.50",$0.00,"$9,487.50","$4,269.38","$5,158.80",$0.00,"$1,634.65",$0.00,$0.00,"$1,661.19","$9,487.50",$0.00,"$4,743.75","$7,514.10","$7,590.00",$0.00,"$1,484.79",$0.00,"$1,510.41",$0.00
9874039,SUP,HCPCS C1713,,9874039  -  PLATE BN 39MM PRMD 4 HL SPNE LMBR ANT,"$9,487.50",$0.00,"$9,487.50","$4,269.38","$5,158.80",$0.00,"$1,634.65",$0.00,$0.00,"$1,661.19","$9,487.50",$0.00,"$4,743.75","$7,514.10","$7,590.00",$0.00,"$1,484.79",$0.00,"$1,510.41",$0.00
9874041,SUP,HCPCS C1713,,9874041  -  PLATE 18MM TI BONE SPNL,"$9,487.50",$0.00,"$9,487.50","$4,269.38","$5,158.80",$0.00,"$1,634.65",$0.00,$0.00,"$1,661.19","$9,487.50",$0.00,"$4,743.75","$7,514.10","$7,590.00",$0.00,"$1,484.79",$0.00,"$1,510.41",$0.00
9874043,SUP,HCPCS C1713,,9874043  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$9,487.50",$0.00,"$9,487.50","$4,269.38","$5,158.80",$0.00,"$1,634.65",$0.00,$0.00,"$1,661.19","$9,487.50",$0.00,"$4,743.75","$7,514.10","$7,590.00",$0.00,"$1,484.79",$0.00,"$1,510.41",$0.00
9874045,SUP,HCPCS C1713,,9874045  -  PLATE 18MM TI BONE SPNL,"$9,487.50",$0.00,"$9,487.50","$4,269.38","$5,158.80",$0.00,"$1,634.65",$0.00,$0.00,"$1,661.19","$9,487.50",$0.00,"$4,743.75","$7,514.10","$7,590.00",$0.00,"$1,484.79",$0.00,"$1,510.41",$0.00
9990700,SUP,Custom 27203010,,KWIQ DIP,$223.78,$0.00,$223.78,$0.00,$159.71,$0.00,$0.00,$0.00,$0.00,$0.00,$223.78,$0.00,$111.89,$177.23,$179.02,$0.00,$0.00,$0.00,$0.00,$0.00
10000607,SUP,HCPCS C1713,,10000607  -  WIRE FX RELINE MAS BLNT THRD NTNL,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
10004354,SUP,Custom 27203010,,MAX-FAST FOREHEAD SENSOR WITH HEADBAND,$117.73,$0.00,$117.73,$0.00,$84.02,$0.00,$0.00,$0.00,$0.00,$0.00,$117.73,$0.00,$58.87,$93.24,$94.19,$0.00,$0.00,$0.00,$0.00,$0.00
10055332,SUP,HCPCS C1713,,10055332  -  RELINE FIXED CROSS CONN. 37.5MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
10055425,SUP,HCPCS C1713,,10055425  -  CONNECTOR ROD 5.5MM 25-30MM RELINE CX ADJ LOPRFL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
10056425,SUP,HCPCS C1713,,10056425  -  CONNECTOR ROD 5.5-6MM 25-30MM RELINE CX ADJ LOPRFL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
10612513,SUP,Custom 27203010,,TIP PIP 1000UL DISP BLK,"$1,844.75",$0.00,"$1,844.75",$0.00,"$1,316.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,844.75",$0.00,$922.38,"$1,461.04","$1,475.80",$0.00,$0.00,$0.00,$0.00,$0.00
10719701,SUP,HCPCS C1725,,CATHETER ANGIO .035IN 5FR 65CM C1 CURVE NBRD SFT RADIOPQ TIP,$9.00,$0.00,$9.00,$4.89,$6.42,$0.00,$1.55,$0.00,$0.00,$1.58,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$1.41,$0.00,$1.43,$0.00
10719702,SUP,HCPCS C1725,,CATHETER ANGIO .035IN C2 CURVE 5FR 65CM 2 SH NBRD SFT,$9.00,$0.00,$9.00,$4.89,$6.42,$0.00,$1.55,$0.00,$0.00,$1.58,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$1.41,$0.00,$1.43,$0.00
10720401,SUP,HCPCS C1725,,CATHETER ANGIO .038IN SOS OMNI1 CURVE 5FR 80CM NBRD SFT,$23.50,$0.00,$23.50,$12.76,$16.77,$0.00,$4.05,$0.00,$0.00,$4.11,$23.50,$0.00,$11.75,$18.61,$18.80,$0.00,$3.68,$0.00,$3.74,$0.00
10720405,SUP,HCPCS C1725,,CATHETER ANGIO .038IN SOS OMNI2 CURVE 5FR 80CM NBRD SFT,$23.75,$0.00,$23.75,$12.90,$16.95,$0.00,$4.09,$0.00,$0.00,$4.16,$23.75,$0.00,$11.88,$18.81,$19.00,$0.00,$3.72,$0.00,$3.78,$0.00
10722102,SUP,HCPCS C1725,,CATHETER ANGIO .038IN BERN CURVE 5FR 100CM NBRD SFT RADIOPQ,$30.00,$0.00,$30.00,$16.29,$21.41,$0.00,$5.17,$0.00,$0.00,$5.25,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$4.70,$0.00,$4.78,$0.00
10732101,SUP,HCPCS C1725,,CATHETER ANGIO .038IN MIK CURVE 5FR 80CM NBRD SFT RADIOPQ,$23.75,$0.00,$23.75,$12.90,$16.95,$0.00,$4.09,$0.00,$0.00,$4.16,$23.75,$0.00,$11.88,$18.81,$19.00,$0.00,$3.72,$0.00,$3.78,$0.00
10800702,SUP,HCPCS C1769,,SET CATH 20CM .035IN SCHN XL GUIDEWIRE INTROD NDL HMDIAL,$245.00,$0.00,$245.00,$133.04,$174.86,$0.00,$42.21,$0.00,$0.00,$42.90,$245.00,$0.00,$122.50,$194.04,$196.00,$0.00,$38.34,$0.00,$39.00,$0.00
10802701,SUP,HCPCS C1769,,SET CATH 15CM .035IN SIL SCHN XL GUIDEWIRE INTROD NDL FULL,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$0.00,$0.00,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
10802702,SUP,HCPCS C1769,,SET CATH 20CM .035IN SIL SCHN XL GUIDEWIRE INTROD NDL FULL,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$0.00,$0.00,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
10802703,SUP,HCPCS C1752,,10802703  -  SET CATH 24CM SCHN XL FULL HMDIAL,$818.34,$0.00,$818.34,$0.00,$584.05,$0.00,$0.00,$0.00,$0.00,$0.00,$818.34,$0.00,$409.17,$648.13,$654.67,$0.00,$0.00,$0.00,$0.00,$0.00
11221000,SUP,Custom 27203010,,11221000  -  COLLAR XTRIC MN PRFT AC SM CERV PLST ADJ PED,$74.37,$0.00,$74.37,$0.00,$53.07,$0.00,$0.00,$0.00,$0.00,$0.00,$74.37,$0.00,$37.18,$58.90,$59.49,$0.00,$0.00,$0.00,$0.00,$0.00
11355025,SUP,HCPCS C1713,,11355025  -  ROD SPNL LRDTC 5.5MM 25MM NS RELINE TI MAS,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
11355030,SUP,HCPCS C1713,,11355030  -  ROD SPNL LRDTC 5.5MM 30MM NS RELINE TI MAS,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
11355035,SUP,HCPCS C1713,,11355035  -  ROD SPNL LRDTC 5.5MM 35MM NS RELINE TI MAS,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
11355045,SUP,HCPCS C1713,,11355045  -  ROD SPNL LRDTC 5.5MM 45MM NS RELINE TI MAS,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
11355050,SUP,HCPCS C1713,,11355050  -  ROD SPNL LRDTC 5.5MM 50MM NS RELINE TI MAS,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
11355055,SUP,HCPCS C1713,,11355055  -  ROD SPNL LRDTC 5.5MM 55MM NS RELINE TI MAS,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
11355060,SUP,HCPCS C1713,,11355060  -  ROD SPNL LRDTC 5.5MM 60MM NS RELINE TI MAS,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
11355070,SUP,HCPCS C1713,,11355070  -  ROD SPNL LRDTC 5.5MM 70MM NS RELINE TI MAS,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
11355085,SUP,HCPCS C1713,,11355085  -  RELINE ROD 85MM,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
11355090,SUP,HCPCS C1713,,"11355090  -  RELINE ROD, 90MM",$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
11355095,SUP,HCPCS C1713,,11355095  -  ROD SPNL LRDTC 5.5MM 95MM NS RELINE TI MAS,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
11355110,SUP,HCPCS C1713,,11355110  -  ROD SPNL LRDTC 5.5MM 110MM NS RELINE TI MAS,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
11355150,SUP,HCPCS C1713,,11355150  -  ROD SPNL LRDTC 5.5MM 150MM NS RELINE TI MAS,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
11355160,SUP,HCPCS C1713,,11355160  -  ROD SPNL LRDTC 5.5MM 160MM NS RELINE TI MAS,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
11403002,SUP,Custom 27203010,,11403002  -  KIT PROCEDURE .035IN 21GA 65CM LONG ACCES GWIRE NEEDLE GOLD,"$1,000.00",$0.00,"$1,000.00",$0.00,$713.70,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,000.00",$0.00,$500.00,$792.00,$800.00,$0.00,$0.00,$0.00,$0.00,$0.00
12401812,SUP,HCPCS C1757,,12401812  -  CATHETER THROMBECTOMY 5FR 135CM 10CM OCCLUDING BALL WIRE,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
12401813,SUP,HCPCS C1729,,CATHETER INFUS 5FR 25MM 20CM SLT DSGN FLW THRU HUB OCL WIRE,$412.50,$0.00,$412.50,$223.99,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
12401816,SUP,HCPCS C1729,,CATHETER INFUS 5FR 25MM 50CM CORON SLT DSGN FLW THRU HUB OCL,$412.50,$0.00,$412.50,$223.99,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
13010545,SUP,HCPCS C1713,,13010545  -  SCREW BN 2S 10.5MM 45MM NS RELINE-O PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
13014030,SUP,HCPCS C1713,,13014030  -  SCREW BN 2S 4MM 30MM NS RELINE-O PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
13014040,SUP,HCPCS C1713,,13014040  -  SCREW BN 2S 4MM 40MM NS RELINE-O PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
13014530,SUP,HCPCS C1713,,13014530  -  SCREW BN 2S 4.5MM 30MM NS RELINE-O PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
13014540,SUP,HCPCS C1713,,13014540  -  SCREW BN 2S 4.5MM 40MM NS RELINE-O PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
13015035,SUP,HCPCS C1713,,13015035  -  SCREW BN 2S 5MM 35MM NS RELINE-O PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
13015045,SUP,HCPCS C1713,,13015045  -  SCREW BN 2S 5MM 45MM NS RELINE-O PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
13015050,SUP,HCPCS C1713,,13015050  -  SCREW BN 2S 5MM 50MM NS RELINE-O PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
13015055,SUP,HCPCS C1713,,13015055  -  SCREW BN 2S 5MM 55MM NS RELINE-O PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
13015525,SUP,HCPCS C1713,,13015525  -  SCREW BN 2S 5.5MM 25MM NS RELINE-O PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
13015530,SUP,HCPCS C1713,,13015530  -  SCREW BN 2S 5.5MM 30MM NS RELINE-O PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
13015535,SUP,HCPCS C1713,,13015535  -  SCREW BN 2S 5.5MM 35MM NS RELINE-O PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
13015540,SUP,HCPCS C1713,,13015540  -  SCREW BN 2S 5.5MM 40MM NS RELINE-O PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
13015545,SUP,HCPCS C1713,,13015545  -  SCREW BN 2S 5.5MM 45MM NS RELINE-O PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
13015550,SUP,HCPCS C1713,,13015550  -  SCREW BN 2S 5.5MM 50MM NS RELINE-O PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
13015555,SUP,HCPCS C1713,,13015555  -  SCREW BN 2S 5.5MM 55MM NS RELINE-O PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
13016535,SUP,HCPCS C1713,,13016535  -  SCREW BN 2S 6.5MM 35MM NS RELINE-O PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
13016540,SUP,HCPCS C1713,,13016540  -  SCREW BN 2S 6.5MM 40MM NS RELINE-O PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
13016545,SUP,HCPCS C1713,,13016545  -  SCREW BN 2S 6.5MM 45MM NS RELINE-O PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
13016550,SUP,HCPCS C1713,,13016550  -  SCREW BN 2S 6.5MM 50MM NS RELINE-O PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
13016555,SUP,HCPCS C1713,,13016555  -  SCREW BN 2S 6.5MM 55MM NS RELINE-O PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
13017535,SUP,HCPCS C1713,,13017535  -  SCREW BN 2S 7.5MM 35MM NS RELINE-O PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
13017540,SUP,HCPCS C1713,,13017540  -  SCREW BN 2S 7.5MM 40MM NS RELINE-O PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
13017545,SUP,HCPCS C1713,,13017545  -  SCREW BN 2S 7.5MM 45MM NS RELINE-O PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
13017550,SUP,HCPCS C1713,,13017550  -  SCREW BN 2S 7.5MM 50MM NS LF RELINE-O PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
13017555,SUP,HCPCS C1713,,13017555  -  SCREW BN 2S 7.5MM 55MM NS RELINE-O PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
13018535,SUP,HCPCS C1713,,13018535  -  SCREW BN 2S 8.5MM 35MM NS RELINE-O PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
13018540,SUP,HCPCS C1713,,13018540  -  SCREW BN 2S 8.5MM 40MM NS RELINE-O PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
13018545,SUP,HCPCS C1713,,13018545  -  SCREW BN 2S 8.5MM 45MM NS RELINE-O PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
13018550,SUP,HCPCS C1713,,13018550  -  SCREW BN 2S 8.5MM 50MM NS RELINE-O PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
13018555,SUP,HCPCS C1713,,13018555  -  SCREW BN 2S 8.5MM 55MM NS RELINE-O PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
13018560,SUP,HCPCS C1713,,13018560  -  SCREW BN 2S 8.5MM 60MM NS LF RELINE-O PA SPNE LLIAC,"$3,450.00",$0.00,"$3,450.00","$1,552.50","$2,462.27",$0.00,$594.42,$0.00,$0.00,$604.07,"$3,450.00",$0.00,"$1,725.00","$2,732.40","$2,760.00",$0.00,$539.93,$0.00,$549.24,$0.00
13018580,SUP,HCPCS C1713,,13018580  -  SCREW BN 2S 8.5MM 80MM NS RELINE-O PA SPNE LLIAC,"$3,450.00",$0.00,"$3,450.00","$1,552.50","$2,462.27",$0.00,$594.42,$0.00,$0.00,$604.07,"$3,450.00",$0.00,"$1,725.00","$2,732.40","$2,760.00",$0.00,$539.93,$0.00,$549.24,$0.00
13019545,SUP,HCPCS C1713,,13019545  -  SCREW BN 2S 9.5MM 45MM NS RELINE-O PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
13025545,SUP,HCPCS C1713,,13025545  -  SCREW BN 2S 5.5MM 45MM NS RELINE RELINEO RDC SPNE,"$3,580.00",$0.00,"$3,580.00","$1,611.00","$2,555.05",$0.00,$616.82,$0.00,$0.00,$626.83,"$3,580.00",$0.00,"$1,790.00","$2,835.36","$2,864.00",$0.00,$560.27,$0.00,$569.94,$0.00
13025555,SUP,HCPCS C1713,,13025555  -  SCREW BN 2S 5.5MM 55MM NS RELINE RELINEO RDC SPNE,"$3,580.00",$0.00,"$3,580.00","$1,611.00","$2,555.05",$0.00,$616.82,$0.00,$0.00,$626.83,"$3,580.00",$0.00,"$1,790.00","$2,835.36","$2,864.00",$0.00,$560.27,$0.00,$569.94,$0.00
13026545,SUP,HCPCS C1713,,13026545  -  SCREW BN 2S 6.5MM 45MM NS RELINE-O RDC SPNE,"$3,580.00",$0.00,"$3,580.00","$1,611.00","$2,555.05",$0.00,$616.82,$0.00,$0.00,$626.83,"$3,580.00",$0.00,"$1,790.00","$2,835.36","$2,864.00",$0.00,$560.27,$0.00,$569.94,$0.00
13037590,SUP,HCPCS C1713,,13037590  -  SCREW BN 2S 7.5MM 90MM NS RELINE-O CLS PA SPNE ILC,"$3,450.00",$0.00,"$3,450.00","$1,552.50","$2,462.27",$0.00,$594.42,$0.00,$0.00,$604.07,"$3,450.00",$0.00,"$1,725.00","$2,732.40","$2,760.00",$0.00,$539.93,$0.00,$549.24,$0.00
13038560,SUP,HCPCS C1713,,13038560  -  SCREW BN 2S 8.5MM 60MM NS RELINE-O CLS SPNE ILC,"$3,450.00",$0.00,"$3,450.00","$1,552.50","$2,462.27",$0.00,$594.42,$0.00,$0.00,$604.07,"$3,450.00",$0.00,"$1,725.00","$2,732.40","$2,760.00",$0.00,$539.93,$0.00,$549.24,$0.00
13038580,SUP,HCPCS C1713,,13038580  -  SCREW BN 2S 8.5MM 80MM NS RELINE-O CLS SPNE ILC,"$3,450.00",$0.00,"$3,450.00","$1,552.50","$2,462.27",$0.00,$594.42,$0.00,$0.00,$604.07,"$3,450.00",$0.00,"$1,725.00","$2,732.40","$2,760.00",$0.00,$539.93,$0.00,$549.24,$0.00
13039510,SUP,HCPCS C1713,,13039510  -  SCREW BN 2S 9.5MM 100MM NS RELINE-O CLS SPNE ILC,"$3,450.00",$0.00,"$3,450.00","$1,552.50","$2,462.27",$0.00,$594.42,$0.00,$0.00,$604.07,"$3,450.00",$0.00,"$1,725.00","$2,732.40","$2,760.00",$0.00,$539.93,$0.00,$549.24,$0.00
13114540,SUP,HCPCS C1713,,13114540  -  SCREW BN 4.5MM 40MM NS RELINE-O PA TRC SPNE,"$3,125.00",$0.00,"$3,125.00","$1,406.25","$2,230.31",$0.00,$538.42,$0.00,$0.00,$547.16,"$3,125.00",$0.00,"$1,562.50","$2,475.00","$2,500.00",$0.00,$489.06,$0.00,$497.50,$0.00
13115540,SUP,HCPCS C1713,,13115540  -  SCREW BN 5.5MM 40MM NS RELINE-O PA TRC SPNE,"$3,125.00",$0.00,"$3,125.00","$1,406.25","$2,230.31",$0.00,$538.42,$0.00,$0.00,$547.16,"$3,125.00",$0.00,"$1,562.50","$2,475.00","$2,500.00",$0.00,$489.06,$0.00,$497.50,$0.00
13115545,SUP,HCPCS C1713,,13115545  -  SCREW BN 5.5MM 45MM NS RELINE-O PA TRC SPNE,"$3,125.00",$0.00,"$3,125.00","$1,406.25","$2,230.31",$0.00,$538.42,$0.00,$0.00,$547.16,"$3,125.00",$0.00,"$1,562.50","$2,475.00","$2,500.00",$0.00,$489.06,$0.00,$497.50,$0.00
13115550,SUP,HCPCS C1713,,13115550  -  SCREW BN 5.5MM 50MM NS RELINE-O PA TRC SPNE,"$3,125.00",$0.00,"$3,125.00","$1,406.25","$2,230.31",$0.00,$538.42,$0.00,$0.00,$547.16,"$3,125.00",$0.00,"$1,562.50","$2,475.00","$2,500.00",$0.00,$489.06,$0.00,$497.50,$0.00
13115555,SUP,HCPCS C1713,,13115555  -  SCREW BN 5.5MM 55MM NS RELINE-O PA TRC SPNE,"$3,125.00",$0.00,"$3,125.00","$1,406.25","$2,230.31",$0.00,$538.42,$0.00,$0.00,$547.16,"$3,125.00",$0.00,"$1,562.50","$2,475.00","$2,500.00",$0.00,$489.06,$0.00,$497.50,$0.00
13116545,SUP,HCPCS C1713,,13116545  -  SCREW BN 6.5MM 45MM NS RELINE-O PA TRC SPNE,"$3,125.00",$0.00,"$3,125.00","$1,406.25","$2,230.31",$0.00,$538.42,$0.00,$0.00,$547.16,"$3,125.00",$0.00,"$1,562.50","$2,475.00","$2,500.00",$0.00,$489.06,$0.00,$497.50,$0.00
13116550,SUP,HCPCS C1713,,13116550  -  SCREW BN 6.5MM 50MM NS RELINE-O PA TRC SPNE,"$3,125.00",$0.00,"$3,125.00","$1,406.25","$2,230.31",$0.00,$538.42,$0.00,$0.00,$547.16,"$3,125.00",$0.00,"$1,562.50","$2,475.00","$2,500.00",$0.00,$489.06,$0.00,$497.50,$0.00
13117550,SUP,HCPCS C1713,,13117550  -  SCREW BN 7.5MM 50MM NS RELINE-O PA TRC SPNE,"$3,125.00",$0.00,"$3,125.00","$1,406.25","$2,230.31",$0.00,$538.42,$0.00,$0.00,$547.16,"$3,125.00",$0.00,"$1,562.50","$2,475.00","$2,500.00",$0.00,$489.06,$0.00,$497.50,$0.00
13117555,SUP,HCPCS C1713,,13117555  -  SCREW BN 7.5MM 55MM NS RELINE-O PA TRC SPNE,"$3,125.00",$0.00,"$3,125.00","$1,406.25","$2,230.31",$0.00,$538.42,$0.00,$0.00,$547.16,"$3,125.00",$0.00,"$1,562.50","$2,475.00","$2,500.00",$0.00,$489.06,$0.00,$497.50,$0.00
13118555,SUP,HCPCS C1713,,13118555  -  SCREW BN 8.5MM 55MM NS RELINE-O PA TRC SPNE,"$3,125.00",$0.00,"$3,125.00","$1,406.25","$2,230.31",$0.00,$538.42,$0.00,$0.00,$547.16,"$3,125.00",$0.00,"$1,562.50","$2,475.00","$2,500.00",$0.00,$489.06,$0.00,$497.50,$0.00
13210510,SUP,HCPCS C1713,,13210510  -  SCREW BN 10.5MM 100MM NS RELINE PA 2 FENESTRATE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
13210511,SUP,HCPCS C1713,,13210511  -  SCREW BN 10.5MM 110MM NS RELINE PA 2 FENESTRATE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
13210512,SUP,HCPCS C1713,,13210512  -  SCREW BN 10.5MM 120MM NS RELINE PA 2 FENESTRATE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
13210525,SUP,HCPCS C1713,,13210525  -  SCREW BN 10.5MM 25MM NS RELINE PA 2 FENESTRATE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
13210530,SUP,HCPCS C1713,,13210530  -  SCREW BN 10.5MM 30MM NS RELINE PA 2 FENESTRATE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
13210535,SUP,HCPCS C1713,,13210535  -  SCREW BN 10.5MM 35MM NS RELINE PA 2 FENESTRATE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
13210540,SUP,HCPCS C1713,,13210540  -  SCREW BN 10.5MM 40MM NS RELINE PA 2 FENESTRATE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
13210545,SUP,HCPCS C1713,,13210545  -  SCREW BN 10.5MM 45MM NS RELINE PA 2 FENESTRATE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
13210550,SUP,HCPCS C1713,,13210550  -  SCREW BN 10.5MM 50MM NS RELINE PA 2 FENESTRATE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
13210555,SUP,HCPCS C1713,,13210555  -  SCREW BN 10.5MM 55MM NS RELINE PA 2 FENESTRATE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
13210560,SUP,HCPCS C1713,,13210560  -  SCREW BN 10.5MM 60MM NS RELINE PA 2 FENESTRATE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
13210565,SUP,HCPCS C1713,,13210565  -  SCREW BN 10.5MM 65MM NS RELINE PA 2 FENESTRATE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
13210570,SUP,HCPCS C1713,,13210570  -  SCREW BN 10.5MM 70MM NS RELINE PA 2 FENESTRATE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
13210575,SUP,HCPCS C1713,,13210575  -  SCREW BN 10.5MM 75MM NS RELINE PA 2 FENESTRATE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
13210580,SUP,HCPCS C1713,,13210580  -  SCREW BN 10.5MM 80MM NS RELINE PA 2 FENESTRATE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
13210585,SUP,HCPCS C1713,,13210585  -  SCREW BN 10.5MM 85MM NS RELINE PA 2 FENESTRATE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
13210590,SUP,HCPCS C1713,,13210590  -  SCREW BN 10.5MM 90MM NS RELINE PA 2 FENESTRATE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
13210595,SUP,HCPCS C1713,,13210595  -  SCREW BN 10.5MM 95MM NS RELINE PA 2 FENESTRATE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
13211010,SUP,HCPCS C1713,,13211010  -  SCREW BN 10MM 100MM NS RELINE PA 2 FENESTRATE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
13219545,SUP,HCPCS C1713,,13219545  -  SCREW BN 9.5MM 45MM NS RELINE PA 2 FENESTRATE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
13550000,SUP,HCPCS C1713,,13550000  -  RELINE LOCK SCREW,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
13600000,SUP,HCPCS C1713,,13600000  -  SCREW BN 6MM NS RELINE LCK OPN TULIP SPNE,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
14355030,SUP,HCPCS C1713,,14355030  -  ROD SPNL LRDTC 5.5MM 30MM NS RELINE-O TI,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
14355035,SUP,HCPCS C1713,,14355035  -  ROD SPNL LRDTC 5.5MM 35MM NS RELINE-O TI,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
14355045,SUP,HCPCS C1713,,"14355045  -  RELINE ROD, 45MM",$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
14355050,SUP,HCPCS C1713,,14355050  -  ROD SPNL LRDTC 5.5MM 50MM NS RELINE-O TI,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
14355055,SUP,HCPCS C1713,,14355055  -  ROD SPNL LRDTC 5.5MM 55MM NS RELINE-O TI,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
14355060,SUP,HCPCS C1713,,14355060  -  ROD SPNL LRDTC 5.5MM 60MM NS RELINE-O TI,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
14910164,SUP,Custom 27203010,,KIT IMMUN TST PRMR POS NEG CNTRL H PYLR IGG 96 TST,"$1,619.25",$0.00,"$1,619.25",$0.00,"$1,155.66",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,619.25",$0.00,$809.63,"$1,282.45","$1,295.40",$0.00,$0.00,$0.00,$0.00,$0.00
15355300,SUP,HCPCS C1713,,"15355300  -  RELINE ROD, 300MM",$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
16014520,SUP,HCPCS C1713,,16014520  -  SCREW BN 4.5MM 20MM NS RELINE MAS PA SPNL 2C,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
16015520,SUP,HCPCS C1713,,16015520  -  SCREW BN 5.5MM 20MM NS RELINE MAS PA SPNL 2C,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
16015540,SUP,HCPCS C1713,,16015540  -  SCREW BN 2C 5.5MM 40MM NS RELINE PA SPNE MAS,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
16016520,SUP,HCPCS C1713,,16016520  -  SCREW BN 6.5MM 20MM NS RELINE MAS PA SPNL 2C,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
16016535,SUP,HCPCS C1713,,16016535  -  SCREW BN 2C 6.5MM 35MM NS LF RELINE PA SPNE MAS,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
16016550,SUP,HCPCS C1713,,16016550  -  SCREW BN 6.5MM 50MM RELINE POLYAX MA SPNE 2C,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
16017540,SUP,HCPCS C1713,,16017540  -  SCREW BN 2C 7.5MM 40MM NS RELINE PA SPNE MAS,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
16017545,SUP,HCPCS C1713,,16017545  -  SCREW BN 2C 7.5MM 45MM NS RELINE PA SPNE MAS,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
16018510,SUP,HCPCS C1713,,16018510  -  SCREW BN 2C 8.5MM 100MM NS RELINE PA SPNE ILC MAS,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
16018580,SUP,HCPCS C1713,,16018580  -  SCREW BN 2C 8.5MM 80MM NS LF RELINE PA SPNE LLIAC MAS,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
16018590,SUP,HCPCS C1713,,16018590  -  RELINE MAS SCREW 8.5X 90,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
16024530,SUP,HCPCS C1713,,16024530  -  SCREW BN 2C 4.5MM 30MM RD NS RELINE PA SPNE MAS,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
16024535,SUP,HCPCS C1713,,16024535  -  SCREW BN 2C 4.5MM 35MM RD NS RELINE PA SPNE MAS,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
16024540,SUP,HCPCS C1713,,16024540  -  SCREW BN 2C 4.5MM 40MM RD NS RELINE PA SPNE MAS,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
16024545,SUP,HCPCS C1713,,16024545  -  SCREW BN 2C 4.5MM 45MM RD NS RELINE PA SPNE MAS,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
16025535,SUP,HCPCS C1713,,16025535  -  SCREW BN 2C 5.5MM 35MM RD NS RELINE PA SPNE MAS,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
16026540,SUP,HCPCS C1713,,16026540  -  SCREW BN 2C 6.5MM 40MM RD NS RELINE PA SPNE MAS,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
16026545,SUP,HCPCS C1713,,"16026545  -  RELINE REDUCTIONSCREW, 6.5 X 45","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
16026550,SUP,HCPCS C1713,,"16026550  -  RELINE MAS REDUCTION SCREW, 6.5X 50","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
16026555,SUP,HCPCS C1713,,"16026555  -  RELINE MAS REDUCTION SCREW, 6.5X 55","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
16027535,SUP,HCPCS C1713,,16027535  -  SCREW BN 2C 7.5MM 35MM RD NS RELINE PA SPNE MAS,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
16027555,SUP,HCPCS C1713,,"16027555  -  RELINE REDUCTION SCREW, 7.5X 55","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
16028535,SUP,HCPCS C1713,,16028535  -  SCREW BN 2C 8.5MM 35MM RD NS RELINE PA SPNE MAS,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
16028540,SUP,HCPCS C1713,,16028540  -  SCREW BN 2C 8.5MM 40MM RD NS RELINE PA SPNE MAS,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
16028545,SUP,HCPCS C1713,,16028545  -  SCREW BN 2C 8.5MM 45MM RD NS RELINE PA SPNE MAS,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
16028550,SUP,HCPCS C1713,,16028550  -  SCREW BN 2C 8.5MM 50MM RD NS RELINE PA SPNE MAS,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
16028555,SUP,HCPCS C1713,,16028555  -  SCREW BN 2C 8.5MM 55MM RD NS RELINE PA SPNE MAS,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
16084520,SUP,HCPCS C1713,,16084520  -  SCREW BN T 4.5MM 20MM NS RELINE MAS MA SPNL 2C,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
16085520,SUP,HCPCS C1713,,16085520  -  SCREW BN T 5.5MM 20MM NS RELINE MAS MA SPNL 2C,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
16086520,SUP,HCPCS C1713,,16086520  -  SCREW BN T 5.5MM 20MM RELINE MAS MA SPNL,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
16500311,SUP,HCPCS C1876,,BALLOON WORKHOUSE  7-2/5/75,$2.50,$0.00,$2.50,$1.13,$1.78,$0.00,$0.43,$0.00,$0.00,$0.44,$2.50,$0.00,$1.25,$1.98,$2.00,$0.00,$0.39,$0.00,$0.40,$0.00
16500317,SUP,HCPCS C1725,,CATHETER BALDILAT 5MM 100CM 2CM NC LOW PROFILE HI-PRS,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$0.00,$0.00,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
16500412,SUP,HCPCS C1725,,CATHETER BALDILAT 6FR 8MM 75CM 2CM NC LOW PROFILE HI-PRS,$320.00,$0.00,$320.00,$173.76,$228.38,$0.00,$55.13,$0.00,$0.00,$56.03,$320.00,$0.00,$160.00,$253.44,$256.00,$0.00,$50.08,$0.00,$50.94,$0.00
16500414,SUP,HCPCS C1725,,CATHETER BALDILAT 6FR 6MM 75CM 4CM NC LOW PROFILE HI-PRS,$312.50,$0.00,$312.50,$169.69,$223.03,$0.00,$53.84,$0.00,$0.00,$54.72,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$48.91,$0.00,$49.75,$0.00
16500416,SUP,HCPCS C1725,,CATHETER BALDILAT 6FR 8MM 75CM 4CM NC LOW PROFILE HI-PRS,$312.50,$0.00,$312.50,$169.69,$223.03,$0.00,$53.84,$0.00,$0.00,$54.72,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$48.91,$0.00,$49.75,$0.00
16500446,SUP,HCPCS C1725,,CATHETER BALDILAT 7FR 10MM 75CM 4CM NC LOW PROFILE HI-PRS,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$0.00,$0.00,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
16500448,SUP,HCPCS C1725,,CATHETER BALDILAT 7FR 10MM 100CM 4CM NC LOW PROFILE HI-PRS,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$0.00,$0.00,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
16701001,SUP,HCPCS C1876,,STENT BILIARY OMNIFLEX 6FR X 75CM X 5MM X 15MM BALLOON EXPAN,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
18600545,SUP,HCPCS C1713,,18600545  -  SCREW ACTB,$70.00,$0.00,$70.00,$31.50,$49.96,$0.00,$12.06,$0.00,$0.00,$12.26,$70.00,$0.00,$35.00,$55.44,$56.00,$0.00,$10.96,$0.00,$11.14,$0.00
18600550,SUP,HCPCS C1713,,18600550  -  SCREW ACTB,$70.00,$0.00,$70.00,$31.50,$49.96,$0.00,$12.06,$0.00,$0.00,$12.26,$70.00,$0.00,$35.00,$55.44,$56.00,$0.00,$10.96,$0.00,$11.14,$0.00
18600555,SUP,HCPCS C1713,,18600555  -  SCREW ACTB,$70.00,$0.00,$70.00,$31.50,$49.96,$0.00,$12.06,$0.00,$0.00,$12.26,$70.00,$0.00,$35.00,$55.44,$56.00,$0.00,$10.96,$0.00,$11.14,$0.00
18600560,SUP,HCPCS C1713,,18600560  -  SCREW ACTB,$70.00,$0.00,$70.00,$31.50,$49.96,$0.00,$12.06,$0.00,$0.00,$12.26,$70.00,$0.00,$35.00,$55.44,$56.00,$0.00,$10.96,$0.00,$11.14,$0.00
20585507,SUP,Custom 27203010,,HEMOCONCENTRATOR PK RINSELESS TBG CONNCTR WST BAG PRFSN 1400,$655.10,$0.00,$655.10,$0.00,$467.54,$0.00,$0.00,$0.00,$0.00,$0.00,$655.10,$0.00,$327.55,$518.84,$524.08,$0.00,$0.00,$0.00,$0.00,$0.00
21074025,SUP,Custom 27203010,,21074025  -  BIT DRILL 4MM 25MM STERILE,$367.50,$0.00,$367.50,$0.00,$262.28,$0.00,$0.00,$0.00,$0.00,$0.00,$367.50,$0.00,$183.75,$291.06,$294.00,$0.00,$0.00,$0.00,$0.00,$0.00
21381338,SUP,Custom 27203010,,TIP PIP 2.5ML EPNDF CMBTP PLUS 25UL INCR GRAD PLNG CYL STRL,$3.15,$0.00,$3.15,$0.00,$2.25,$0.00,$0.00,$0.00,$0.00,$0.00,$3.15,$0.00,$1.58,$2.49,$2.52,$0.00,$0.00,$0.00,$0.00,$0.00
22046341,SUP,Custom 27203010,,REAGENT CLRT 3 1GL CLR AGNT HISTOLGY,$68.75,$0.00,$68.75,$0.00,$49.07,$0.00,$0.00,$0.00,$0.00,$0.00,$68.75,$0.00,$34.38,$54.45,$55.00,$0.00,$0.00,$0.00,$0.00,$0.00
22046344,SUP,Custom 27203010,,REAGENT METHNL ISOPRPNL FLX 100 1GL ABST DEHYDRANT BTL,$40.60,$0.00,$40.60,$0.00,$28.98,$0.00,$0.00,$0.00,$0.00,$0.00,$40.60,$0.00,$20.30,$32.16,$32.48,$0.00,$0.00,$0.00,$0.00,$0.00
22046346,SUP,Custom 27203010,,REAGENT METHNL ISOPRPNL FLX 95 1GL DEHYDRANT BTL HISTOLGY,$158.90,$0.00,$158.90,$0.00,$113.41,$0.00,$0.00,$0.00,$0.00,$0.00,$158.90,$0.00,$79.45,$125.85,$127.12,$0.00,$0.00,$0.00,$0.00,$0.00
22046348,SUP,Custom 27203010,,REAGENT METHNL ISOPRPNL FLX 80 1GL DEHYDRANT BTL HISTOLGY,$169.55,$0.00,$169.55,$0.00,$121.01,$0.00,$0.00,$0.00,$0.00,$0.00,$169.55,$0.00,$84.78,$134.28,$135.64,$0.00,$0.00,$0.00,$0.00,$0.00
22046619,SUP,Custom 27203010,,CONTROL OSMTR ACCUREF 2ML 290 SER,$116.03,$0.00,$116.03,$0.00,$82.81,$0.00,$0.00,$0.00,$0.00,$0.00,$116.03,$0.00,$58.01,$91.90,$92.82,$0.00,$0.00,$0.00,$0.00,$0.00
22266306,SUP,Custom 27203010,,TIP PIP 5ML CMBTP PLUS EPPPENDORF INCRM NSTRL,$273.28,$0.00,$273.28,$0.00,$195.04,$0.00,$0.00,$0.00,$0.00,$0.00,$273.28,$0.00,$136.64,$216.44,$218.62,$0.00,$0.00,$0.00,$0.00,$0.00
22610135,SUP,Custom 27203010,,CAP TUBE 12MM FLNG,$0.08,$0.00,$0.08,$0.00,$0.05,$0.00,$0.00,$0.00,$0.00,$0.00,$0.08,$0.00,$0.04,$0.06,$0.06,$0.00,$0.00,$0.00,$0.00,$0.00
23022523,SUP,Custom 27203010,,AIR CMPR AERS DSTR EXTN TUBE O3 SAFE TRPL FLTR 11OZ 5IN SUP,$43.33,$0.00,$43.33,$0.00,$30.92,$0.00,$0.00,$0.00,$0.00,$0.00,$43.33,$0.00,$21.66,$34.32,$34.66,$0.00,$0.00,$0.00,$0.00,$0.00
23022524,SUP,Custom 27203010,,FREEZER CRYGN SUP FRND FRZ-IT AERS TISS SPRY PE SNORKEL 11OZ,$35.83,$0.00,$35.83,$0.00,$25.57,$0.00,$0.00,$0.00,$0.00,$0.00,$35.83,$0.00,$17.91,$28.38,$28.66,$0.00,$0.00,$0.00,$0.00,$0.00
23030817,SUP,HCPCS C1783,,23030817  -  DRAIN GLAUCOMA IMNPLANT BAERVELDT SILICONE ANTER CHAM,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
23038384,SUP,Custom 27203010,,CONTROL MLANLT MAS NRM VL 60ML UA,$236.25,$0.00,$236.25,$0.00,$168.61,$0.00,$0.00,$0.00,$0.00,$0.00,$236.25,$0.00,$118.13,$187.11,$189.00,$0.00,$0.00,$0.00,$0.00,$0.00
23046581,SUP,Custom 27203010,,CONTROL ESR ESRCHX LVL 1 2 9ML HMTL,$780.00,$0.00,$780.00,$0.00,$556.69,$0.00,$0.00,$0.00,$0.00,$0.00,$780.00,$0.00,$390.00,$617.76,$624.00,$0.00,$0.00,$0.00,$0.00,$0.00
23046595,SUP,Custom 27203010,,KIT IMMUN TST CLRVW COMBO 2 CLIA COMPLEXITY WVD SER URN HCG,$108.25,$0.00,$108.25,$0.00,$77.26,$0.00,$0.00,$0.00,$0.00,$0.00,$108.25,$0.00,$54.13,$85.73,$86.60,$0.00,$0.00,$0.00,$0.00,$0.00
23255961,SUP,Custom 27203010,,STAIN MCBL GM IOD PRTCL 500ML,$66.35,$0.00,$66.35,$0.00,$47.35,$0.00,$0.00,$0.00,$0.00,$0.00,$66.35,$0.00,$33.18,$52.55,$53.08,$0.00,$0.00,$0.00,$0.00,$0.00
23270181,SUP,Custom 27203010,,STAIN MCBL GM IOD UNSTBL PRTCL 1GL,$324.78,$0.00,$324.78,$0.00,$231.79,$0.00,$0.00,$0.00,$0.00,$0.00,$324.78,$0.00,$162.39,$257.23,$259.82,$0.00,$0.00,$0.00,$0.00,$0.00
23285625,SUP,Custom 27203010,,REAGENT SCKL SCRN SCKCHX BUFF PWDR HMTL,$8.53,$0.00,$8.53,$0.00,$6.08,$0.00,$0.00,$0.00,$0.00,$0.00,$8.53,$0.00,$4.26,$6.76,$6.82,$0.00,$0.00,$0.00,$0.00,$0.00
30100101,SUP,Custom 27203010,,30100101  -  BIT DRILL 16-24MM BIOTRAK STD CANN BIOTRACK,$542.50,$9.12,$657.00,$29.07,$23.81,$22.19,$9.12,$23.81,$23.81,$24.09,$657.00,$17.12,$45.56,$429.66,$525.60,$23.64,$25.67,$16.30,$17.97,$16.30
30100102,SUP,Custom 27203010,,30100102  -  BIT DRILL BIOTRAK STD TAP,$542.50,$6.62,$782.00,$32.19,$8.77,$24.58,$12.13,$8.77,$8.77,$8.87,$782.00,$25.29,$16.78,$429.66,$625.60,$34.93,$9.45,$24.09,$6.62,$24.09
30100151,SUP,Custom 27203010,,30100151  -  BIT DRL MN BIOTRAK,$542.50,$13.12,$464.00,$34.50,$28.25,$26.33,$13.12,$28.25,$28.25,$28.59,$464.00,$27.37,$54.08,$429.66,$371.20,$37.80,$30.46,$26.07,$21.33,$26.07
30100152,SUP,Custom 27203010,,30100152  -  BIT DRL BIOTRAK TAP,$542.50,$13.12,$464.00,$34.50,$28.25,$26.33,$13.12,$28.25,$28.25,$28.59,$464.00,$27.37,$54.08,$429.66,$371.20,$37.80,$30.46,$26.07,$21.33,$26.07
30100153,SUP,Custom 27203010,,30100153  -  DRIVER MINI BIOTRAK SURG,$542.50,$10.62,$429.66,$27.63,$22.62,$19.23,$10.62,$22.62,$22.62,$22.90,$176.00,$22.14,$43.30,$429.66,$140.80,$30.58,$24.40,$21.09,$17.08,$21.09
30100154,SUP,Custom 27203010,,30100154  -  EJTR MINI BLADE BIOTRAK INDIV SET NONSTRL,$470.00,$0.00,$470.00,$0.00,$335.44,$0.00,$0.00,$0.00,$0.00,$0.00,$470.00,$0.00,$235.00,$372.24,$376.00,$0.00,$0.00,$0.00,$0.00,$0.00
30100351,SUP,Custom 27203010,,30100351  -  DRILL SRG BIOTRAK,$542.50,$11.88,$429.66,$37.85,$31.01,$28.89,$11.88,$31.01,$31.01,$31.36,$276.00,$22.29,$59.34,$429.66,$220.80,$30.78,$33.42,$21.23,$23.39,$21.23
31002701,SUP,Custom 27803010,,31002701  -  VALVE MTRL 27MM 35MM 24MM 19MM 14MM MSC CNCH FLXB STNT,"$19,500.00",$0.00,"$19,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$19,500.00",$0.00,"$9,750.00","$15,444.00","$15,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
37129000,SUP,Custom 27203010,,FORMULA 237ML PTMN SUPPL CHOC,$7.28,$0.00,$7.28,$0.00,$5.19,$0.00,$0.00,$0.00,$0.00,$0.00,$7.28,$0.00,$3.64,$5.77,$5.82,$0.00,$0.00,$0.00,$0.00,$0.00
38204020,SUP,HCPCS C1713,,038204020  -  SCREW BONE 4MM 20MM MULTIAX XIA II TITANIUM SPN,"$5,000.00",$0.00,"$5,000.00","$2,250.00","$3,568.50",$0.00,$861.48,$0.00,$0.00,$875.46,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$782.50,$0.00,$796.00,$0.00
38204025,SUP,HCPCS C1713,,038204025  -  SCREW BONE 4MM 25MM MULTIAX XIA II TITANIUM SPN,"$5,000.00",$0.00,"$5,000.00","$2,250.00","$3,568.50",$0.00,$861.48,$0.00,$0.00,$875.46,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$782.50,$0.00,$796.00,$0.00
38204030,SUP,HCPCS C1713,,038204030  -  SCREW BONE 4MM 30MM MULTIAX XIA II TITANIUM SPN,"$5,000.00",$0.00,"$5,000.00","$2,250.00","$3,568.50",$0.00,$861.48,$0.00,$0.00,$875.46,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$782.50,$0.00,$796.00,$0.00
38204035,SUP,HCPCS C1713,,038204035  -  SCREW BONE 4MM 35MM MNOAX XIA II TITANIUM SPN THORACOLUMBAR,"$5,000.00",$0.00,"$5,000.00","$2,250.00","$3,568.50",$0.00,$861.48,$0.00,$0.00,$875.46,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$782.50,$0.00,$796.00,$0.00
38204040,SUP,HCPCS C1713,,038204040  -  SCREW BONE 4MM 40MM MULTIAX XIA II TITANIUM SPN,"$5,000.00",$0.00,"$5,000.00","$2,250.00","$3,568.50",$0.00,$861.48,$0.00,$0.00,$875.46,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$782.50,$0.00,$796.00,$0.00
38205025,SUP,HCPCS C1713,,038205025  -  SCREW BONE 5MM 25MM MNOAX XIA II TITANIUM SPN THORACOLUMBAR,"$5,000.00",$0.00,"$5,000.00","$2,250.00","$3,568.50",$0.00,$861.48,$0.00,$0.00,$875.46,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$782.50,$0.00,$796.00,$0.00
38205030,SUP,HCPCS C1713,,038205030  -  SCREW BONE 5MM 30MM MNOAX XIA II TITANIUM SPN THORACOLUMBAR,"$5,000.00",$0.00,"$5,000.00","$2,250.00","$3,568.50",$0.00,$861.48,$0.00,$0.00,$875.46,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$782.50,$0.00,$796.00,$0.00
38205035,SUP,HCPCS C1713,,038205035  -  SCREW BONE 5MM 35MM MNOAX XIA II TITANIUM SPN THORACOLUMBAR,"$5,000.00",$0.00,"$5,000.00","$2,250.00","$3,568.50",$0.00,$861.48,$0.00,$0.00,$875.46,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$782.50,$0.00,$796.00,$0.00
38205040,SUP,HCPCS C1713,,038205040  -  SCREW BONE 5MM 40MM MNOAX XIA II TITANIUM SPN THORACOLUMBAR,"$5,000.00",$0.00,"$5,000.00","$2,250.00","$3,568.50",$0.00,$861.48,$0.00,$0.00,$875.46,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$782.50,$0.00,$796.00,$0.00
38205045,SUP,HCPCS C1713,,038205045  -  SCREW BONE 5MM 45MM MNOAX XIA II TITANIUM SPN THORACOLUMBAR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
38214020,SUP,HCPCS C1713,,038214020  -  SCREW BONE 4MM 20MM POLYAX XIA II TITANIUM SPN THORACOLUMBAR,"$6,212.50",$0.00,"$6,212.50","$2,795.63","$4,433.86",$0.00,"$1,070.38",$0.00,$0.00,"$1,087.76","$6,212.50",$0.00,"$3,106.25","$4,920.30","$4,970.00",$0.00,$972.26,$0.00,$989.03,$0.00
38214025,SUP,HCPCS C1713,,038214025  -  SCREW BONE 4MM 25MM POLYAX XIA II TITANIUM SPN THORACOLUMBAR,"$6,212.50",$0.00,"$6,212.50","$2,795.63","$4,433.86",$0.00,"$1,070.38",$0.00,$0.00,"$1,087.76","$6,212.50",$0.00,"$3,106.25","$4,920.30","$4,970.00",$0.00,$972.26,$0.00,$989.03,$0.00
38214030,SUP,HCPCS C1713,,038214030  -  SCREW BONE 4MM 30MM POLYAX XIA II TITANIUM SPN THORACOLUMBAR,"$6,212.50",$0.00,"$6,212.50","$2,795.63","$4,433.86",$0.00,"$1,070.38",$0.00,$0.00,"$1,087.76","$6,212.50",$0.00,"$3,106.25","$4,920.30","$4,970.00",$0.00,$972.26,$0.00,$989.03,$0.00
38214035,SUP,HCPCS C1713,,038214035  -  SCREW BONE 4MM 35MM POLYAX XIA II TITANIUM SPN THORACOLUMBAR,"$6,212.50",$0.00,"$6,212.50","$2,795.63","$4,433.86",$0.00,"$1,070.38",$0.00,$0.00,"$1,087.76","$6,212.50",$0.00,"$3,106.25","$4,920.30","$4,970.00",$0.00,$972.26,$0.00,$989.03,$0.00
38214040,SUP,HCPCS C1713,,038214040  -  SCREW BONE 4MM 40MM POLYAX XIA II TITANIUM SPN THORACOLUMBAR,"$6,212.50",$0.00,"$6,212.50","$2,795.63","$4,433.86",$0.00,"$1,070.38",$0.00,$0.00,"$1,087.76","$6,212.50",$0.00,"$3,106.25","$4,920.30","$4,970.00",$0.00,$972.26,$0.00,$989.03,$0.00
38215025,SUP,HCPCS C1713,,038215025  -  SCREW BONE 5MM 25MM POLYAX XIA II TITANIUM SPN THORACOLUMBAR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
38215030,SUP,HCPCS C1713,,038215030  -  SCREW BONE 5MM 30MM POLYAX XIA II TITANIUM SPN THORACOLUMBAR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
38215035,SUP,HCPCS C1713,,038215035  -  SCREW BONE 5MM 35MM POLYAX XIA II TITANIUM SPN THORACOLUMBAR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
38215040,SUP,HCPCS C1713,,038215040  -  SCREW BONE 5MM 40MM POLYAX XIA II TITANIUM SPN THORACOLUMBAR,"$5,737.50",$0.00,"$5,737.50","$2,581.88","$4,094.85",$0.00,$988.54,$0.00,$0.00,"$1,004.59","$5,737.50",$0.00,"$2,868.75","$4,544.10","$4,590.00",$0.00,$897.92,$0.00,$913.41,$0.00
38215045,SUP,HCPCS C1713,,038215045  -  SCREW BONE 5MM 45MM POLYAX XIA II TITANIUM SPN THORACOLUMBAR,"$5,737.50",$0.00,"$5,737.50","$2,581.88","$4,094.85",$0.00,$988.54,$0.00,$0.00,"$1,004.59","$5,737.50",$0.00,"$2,868.75","$4,544.10","$4,590.00",$0.00,$897.92,$0.00,$913.41,$0.00
40036170,SUP,Custom 27803010,,61421  -  SPACER SPNL 21MMX14MM RYTFC UNT,"$8,031.25",$0.00,"$8,031.25",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,031.25",$0.00,"$4,015.63","$6,360.75","$6,425.00",$0.00,$0.00,$0.00,$0.00,$0.00
48030022,SUP,HCPCS C1713,,48030022  -  PLATE BONE 22MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR,"$8,793.48",$0.00,"$8,793.48","$3,957.06","$5,158.80",$0.00,"$1,515.07",$0.00,$0.00,"$1,539.67","$8,793.48",$0.00,"$4,396.74","$6,964.44","$7,034.78",$0.00,"$1,376.18",$0.00,"$1,399.92",$0.00
48030025,SUP,HCPCS C1713,,48030025  -  PLATE BONE 25MM NONCOMPRESSION 1 LEVEL THORACIC,"$8,793.48",$0.00,"$8,793.48","$3,957.06","$5,158.80",$0.00,"$1,515.07",$0.00,$0.00,"$1,539.67","$8,793.48",$0.00,"$4,396.74","$6,964.44","$7,034.78",$0.00,"$1,376.18",$0.00,"$1,399.92",$0.00
48030028,SUP,HCPCS C1713,,48030028  -  PLATE BONE 28MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR,"$8,793.48",$0.00,"$8,793.48","$3,957.06","$5,158.80",$0.00,"$1,515.07",$0.00,$0.00,"$1,539.67","$8,793.48",$0.00,"$4,396.74","$6,964.44","$7,034.78",$0.00,"$1,376.18",$0.00,"$1,399.92",$0.00
48030031,SUP,HCPCS C1713,,48030031  -  PLATE BONE 31MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR,"$8,793.48",$0.00,"$8,793.48","$3,957.06","$5,158.80",$0.00,"$1,515.07",$0.00,$0.00,"$1,539.67","$8,793.48",$0.00,"$4,396.74","$6,964.44","$7,034.78",$0.00,"$1,376.18",$0.00,"$1,399.92",$0.00
48030034,SUP,HCPCS C1713,,48030034  -  PLATE BONE 34MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR,"$8,793.48",$0.00,"$8,793.48","$3,957.06","$5,158.80",$0.00,"$1,515.07",$0.00,$0.00,"$1,539.67","$8,793.48",$0.00,"$4,396.74","$6,964.44","$7,034.78",$0.00,"$1,376.18",$0.00,"$1,399.92",$0.00
48030037,SUP,HCPCS C1713,,48030037  -  PLATE BONE 37MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR,"$8,793.48",$0.00,"$8,793.48","$3,957.06","$5,158.80",$0.00,"$1,515.07",$0.00,$0.00,"$1,539.67","$8,793.48",$0.00,"$4,396.74","$6,964.44","$7,034.78",$0.00,"$1,376.18",$0.00,"$1,399.92",$0.00
48030040,SUP,HCPCS C1713,,48030040  -  PLATE BONE 40MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR,"$8,793.48",$0.00,"$8,793.48","$3,957.06","$5,158.80",$0.00,"$1,515.07",$0.00,$0.00,"$1,539.67","$8,793.48",$0.00,"$4,396.74","$6,964.44","$7,034.78",$0.00,"$1,376.18",$0.00,"$1,399.92",$0.00
48030225,SUP,HCPCS C1713,,48030225  -  SCREW BONE 6.5MM 22MM COMPRESSION SPN THORACIC,"$1,008.65",$0.00,"$1,008.65",$453.89,$719.87,$0.00,$173.79,$0.00,$0.00,$176.61,"$1,008.65",$0.00,$504.33,$798.85,$806.92,$0.00,$157.85,$0.00,$160.58,$0.00
48030265,SUP,HCPCS C1713,,48030265  -  PLATE BONE 65MM LEVEL 2 COMPRESSION SPN THORACIC SACRUM,"$12,217.15",$0.00,"$12,217.15","$5,497.72","$5,158.80",$0.00,"$2,104.95",$0.00,$0.00,"$2,139.13","$12,217.15",$0.00,"$6,108.58","$9,675.98","$9,773.72",$0.00,"$1,911.98",$0.00,"$1,944.97",$0.00
48030271,SUP,HCPCS C1713,,48030271  -  PLATE BONE 71MM LEVEL 2 COMPRESSION SPN THORACIC SACRUM,"$12,217.15",$0.00,"$12,217.15","$5,497.72","$5,158.80",$0.00,"$2,104.95",$0.00,$0.00,"$2,139.13","$12,217.15",$0.00,"$6,108.58","$9,675.98","$9,773.72",$0.00,"$1,911.98",$0.00,"$1,944.97",$0.00
48030277,SUP,HCPCS C1713,,48030277  -  PLATE BONE 77MM LEVEL 2 COMPRESSION SPN THORACIC SACRUM,"$12,217.15",$0.00,"$12,217.15","$5,497.72","$5,158.80",$0.00,"$2,104.95",$0.00,$0.00,"$2,139.13","$12,217.15",$0.00,"$6,108.58","$9,675.98","$9,773.72",$0.00,"$1,911.98",$0.00,"$1,944.97",$0.00
48030283,SUP,HCPCS C1713,,48030283  -  PLATE BONE 83MM LEVEL 2 COMPRESSION SPN THORACIC SACRUM,"$12,217.15",$0.00,"$12,217.15","$5,497.72","$5,158.80",$0.00,"$2,104.95",$0.00,$0.00,"$2,139.13","$12,217.15",$0.00,"$6,108.58","$9,675.98","$9,773.72",$0.00,"$1,911.98",$0.00,"$1,944.97",$0.00
48030289,SUP,HCPCS C1713,,48030289  -  PLATE BONE 89MM LEVEL 2 COMPRESSION SPN THORACIC SACRUM,"$12,217.15",$0.00,"$12,217.15","$5,497.72","$5,158.80",$0.00,"$2,104.95",$0.00,$0.00,"$2,139.13","$12,217.15",$0.00,"$6,108.58","$9,675.98","$9,773.72",$0.00,"$1,911.98",$0.00,"$1,944.97",$0.00
48030350,SUP,HCPCS C1713,,48030350  -  SCREW BONE 6MM 35MM COMPRESSION SPN THORACIC,"$1,008.65",$0.00,"$1,008.65",$453.89,$719.87,$0.00,$173.79,$0.00,$0.00,$176.61,"$1,008.65",$0.00,$504.33,$798.85,$806.92,$0.00,$157.85,$0.00,$160.58,$0.00
48032040,SUP,HCPCS C1713,,48032040  -  PLATE BONE 40MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR,"$12,217.15",$0.00,"$12,217.15","$5,497.72","$5,158.80",$0.00,"$2,104.95",$0.00,$0.00,"$2,139.13","$12,217.15",$0.00,"$6,108.58","$9,675.98","$9,773.72",$0.00,"$1,911.98",$0.00,"$1,944.97",$0.00
48032044,SUP,HCPCS C1713,,48032044  -  PLATE BONE 44MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR,"$12,217.15",$0.00,"$12,217.15","$5,497.72","$5,158.80",$0.00,"$2,104.95",$0.00,$0.00,"$2,139.13","$12,217.15",$0.00,"$6,108.58","$9,675.98","$9,773.72",$0.00,"$1,911.98",$0.00,"$1,944.97",$0.00
48032048,SUP,HCPCS C1713,,48032048  -  PLATE BONE 48MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR,"$12,217.15",$0.00,"$12,217.15","$5,497.72","$5,158.80",$0.00,"$2,104.95",$0.00,$0.00,"$2,139.13","$12,217.15",$0.00,"$6,108.58","$9,675.98","$9,773.72",$0.00,"$1,911.98",$0.00,"$1,944.97",$0.00
48032052,SUP,HCPCS C1713,,48032052  -  PLATE BONE 52MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR,"$12,217.15",$0.00,"$12,217.15","$5,497.72","$5,158.80",$0.00,"$2,104.95",$0.00,$0.00,"$2,139.13","$12,217.15",$0.00,"$6,108.58","$9,675.98","$9,773.72",$0.00,"$1,911.98",$0.00,"$1,944.97",$0.00
48032056,SUP,HCPCS C1713,,48032056  -  PLATE BONE 56MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR,"$12,217.15",$0.00,"$12,217.15","$5,497.72","$5,158.80",$0.00,"$2,104.95",$0.00,$0.00,"$2,139.13","$12,217.15",$0.00,"$6,108.58","$9,675.98","$9,773.72",$0.00,"$1,911.98",$0.00,"$1,944.97",$0.00
48032060,SUP,HCPCS C1713,,48032060  -  PLATE BONE 60MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR,"$12,217.15",$0.00,"$12,217.15","$5,497.72","$5,158.80",$0.00,"$2,104.95",$0.00,$0.00,"$2,139.13","$12,217.15",$0.00,"$6,108.58","$9,675.98","$9,773.72",$0.00,"$1,911.98",$0.00,"$1,944.97",$0.00
48032064,SUP,HCPCS C1713,,48032064  -  PLATE BONE 64MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR,"$12,217.15",$0.00,"$12,217.15","$5,497.72","$5,158.80",$0.00,"$2,104.95",$0.00,$0.00,"$2,139.13","$12,217.15",$0.00,"$6,108.58","$9,675.98","$9,773.72",$0.00,"$1,911.98",$0.00,"$1,944.97",$0.00
48032068,SUP,HCPCS C1713,,48032068  -  PLATE BONE 68MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR,"$12,217.15",$0.00,"$12,217.15","$5,497.72","$5,158.80",$0.00,"$2,104.95",$0.00,$0.00,"$2,139.13","$12,217.15",$0.00,"$6,108.58","$9,675.98","$9,773.72",$0.00,"$1,911.98",$0.00,"$1,944.97",$0.00
48032072,SUP,HCPCS C1713,,48032072  -  PLATE BONE 72MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR,"$12,217.15",$0.00,"$12,217.15","$5,497.72","$5,158.80",$0.00,"$2,104.95",$0.00,$0.00,"$2,139.13","$12,217.15",$0.00,"$6,108.58","$9,675.98","$9,773.72",$0.00,"$1,911.98",$0.00,"$1,944.97",$0.00
48032076,SUP,HCPCS C1713,,48032076  -  PLATE BONE 76MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR,"$12,217.15",$0.00,"$12,217.15","$5,497.72","$5,158.80",$0.00,"$2,104.95",$0.00,$0.00,"$2,139.13","$12,217.15",$0.00,"$6,108.58","$9,675.98","$9,773.72",$0.00,"$1,911.98",$0.00,"$1,944.97",$0.00
48032080,SUP,HCPCS C1713,,48032080  -  PLATE BONE 80MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR,"$13,963.70",$0.00,"$13,963.70","$6,283.67","$5,158.80",$0.00,"$2,405.88",$0.00,$0.00,"$2,444.93","$13,963.70",$0.00,"$6,981.85","$11,059.25","$11,170.96",$0.00,"$2,185.32",$0.00,"$2,223.02",$0.00
48032084,SUP,HCPCS C1713,,48032084  -  PLATE BONE 84MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR,"$13,963.70",$0.00,"$13,963.70","$6,283.67","$5,158.80",$0.00,"$2,405.88",$0.00,$0.00,"$2,444.93","$13,963.70",$0.00,"$6,981.85","$11,059.25","$11,170.96",$0.00,"$2,185.32",$0.00,"$2,223.02",$0.00
48032088,SUP,HCPCS C1713,,48032088  -  PLATE BONE 88MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR,"$13,963.70",$0.00,"$13,963.70","$6,283.67","$5,158.80",$0.00,"$2,405.88",$0.00,$0.00,"$2,444.93","$13,963.70",$0.00,"$6,981.85","$11,059.25","$11,170.96",$0.00,"$2,185.32",$0.00,"$2,223.02",$0.00
48032092,SUP,HCPCS C1713,,48032092  -  PLATE BONE 92MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR,"$13,963.70",$0.00,"$13,963.70","$6,283.67","$5,158.80",$0.00,"$2,405.88",$0.00,$0.00,"$2,444.93","$13,963.70",$0.00,"$6,981.85","$11,059.25","$11,170.96",$0.00,"$2,185.32",$0.00,"$2,223.02",$0.00
48032096,SUP,HCPCS C1713,,48032096  -  PLATE BONE 96MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR,"$13,963.70",$0.00,"$13,963.70","$6,283.67","$5,158.80",$0.00,"$2,405.88",$0.00,$0.00,"$2,444.93","$13,963.70",$0.00,"$6,981.85","$11,059.25","$11,170.96",$0.00,"$2,185.32",$0.00,"$2,223.02",$0.00
48032100,SUP,HCPCS C1713,,48032100  -  PLATE BONE 100MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR,"$13,963.70",$0.00,"$13,963.70","$6,283.67","$5,158.80",$0.00,"$2,405.88",$0.00,$0.00,"$2,444.93","$13,963.70",$0.00,"$6,981.85","$11,059.25","$11,170.96",$0.00,"$2,185.32",$0.00,"$2,223.02",$0.00
48034525,SUP,HCPCS C1713,,48034525  -  PLATE BONE 25MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR,"$9,160.23",$0.00,"$9,160.23","$4,122.10","$5,158.80",$0.00,"$1,578.26",$0.00,$0.00,"$1,603.88","$9,160.23",$0.00,"$4,580.11","$7,254.90","$7,328.18",$0.00,"$1,433.58",$0.00,"$1,458.31",$0.00
48034528,SUP,HCPCS C1713,,48034528  -  PLATE BONE 28MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR,"$9,160.23",$0.00,"$9,160.23","$4,122.10","$5,158.80",$0.00,"$1,578.26",$0.00,$0.00,"$1,603.88","$9,160.23",$0.00,"$4,580.11","$7,254.90","$7,328.18",$0.00,"$1,433.58",$0.00,"$1,458.31",$0.00
48034531,SUP,HCPCS C1713,,48034531  -  PLATE BONE 31MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR,"$9,160.23",$0.00,"$9,160.23","$4,122.10","$5,158.80",$0.00,"$1,578.26",$0.00,$0.00,"$1,603.88","$9,160.23",$0.00,"$4,580.11","$7,254.90","$7,328.18",$0.00,"$1,433.58",$0.00,"$1,458.31",$0.00
48034534,SUP,HCPCS C1713,,48034534  -  PLATE BONE 34MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR,"$9,160.23",$0.00,"$9,160.23","$4,122.10","$5,158.80",$0.00,"$1,578.26",$0.00,$0.00,"$1,603.88","$9,160.23",$0.00,"$4,580.11","$7,254.90","$7,328.18",$0.00,"$1,433.58",$0.00,"$1,458.31",$0.00
48034537,SUP,HCPCS C1713,,48034537  -  PLATE BONE 37MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR,"$9,160.23",$0.00,"$9,160.23","$4,122.10","$5,158.80",$0.00,"$1,578.26",$0.00,$0.00,"$1,603.88","$9,160.23",$0.00,"$4,580.11","$7,254.90","$7,328.18",$0.00,"$1,433.58",$0.00,"$1,458.31",$0.00
48035125,SUP,HCPCS C1713,,48035125  -  PLATE BONE 25MM LEVEL 1 COMPRESSION SPN THORACIC SACRUM,"$9,160.23",$0.00,"$9,160.23","$4,122.10","$5,158.80",$0.00,"$1,578.26",$0.00,$0.00,"$1,603.88","$9,160.23",$0.00,"$4,580.11","$7,254.90","$7,328.18",$0.00,"$1,433.58",$0.00,"$1,458.31",$0.00
48035128,SUP,HCPCS C1713,,48035128  -  PLATE BONE 28MM LEVEL 1 COMPRESSION SPN THORACIC SACRUM,"$9,160.23",$0.00,"$9,160.23","$4,122.10","$5,158.80",$0.00,"$1,578.26",$0.00,$0.00,"$1,603.88","$9,160.23",$0.00,"$4,580.11","$7,254.90","$7,328.18",$0.00,"$1,433.58",$0.00,"$1,458.31",$0.00
48035131,SUP,HCPCS C1713,,48035131  -  PLATE BONE 31MM LEVEL 1 COMPRESSION SPN THORACIC SACRUM,"$9,160.23",$0.00,"$9,160.23","$4,122.10","$5,158.80",$0.00,"$1,578.26",$0.00,$0.00,"$1,603.88","$9,160.23",$0.00,"$4,580.11","$7,254.90","$7,328.18",$0.00,"$1,433.58",$0.00,"$1,458.31",$0.00
48035134,SUP,HCPCS C1713,,48035134  -  PLATE BONE 34MM LEVEL 1 COMPRESSION SPN THORACIC SACRUM,"$9,160.23",$0.00,"$9,160.23","$4,122.10","$5,158.80",$0.00,"$1,578.26",$0.00,$0.00,"$1,603.88","$9,160.23",$0.00,"$4,580.11","$7,254.90","$7,328.18",$0.00,"$1,433.58",$0.00,"$1,458.31",$0.00
48035137,SUP,HCPCS C1713,,48035137  -  PLATE BONE 37MM LEVEL 1 COMPRESSION SPN THORACIC SACRUM,"$9,160.23",$0.00,"$9,160.23","$4,122.10","$5,158.80",$0.00,"$1,578.26",$0.00,$0.00,"$1,603.88","$9,160.23",$0.00,"$4,580.11","$7,254.90","$7,328.18",$0.00,"$1,433.58",$0.00,"$1,458.31",$0.00
48035225,SUP,HCPCS C1713,,48035225  -  SCREW BONE 6.5MM 22MM COMPRESSION THORACIC SPN,"$1,008.65",$0.00,"$1,008.65",$453.89,$719.87,$0.00,$173.79,$0.00,$0.00,$176.61,"$1,008.65",$0.00,$504.33,$798.85,$806.92,$0.00,$157.85,$0.00,$160.58,$0.00
48035350,SUP,HCPCS C1713,,48035350  -  SCREW BONE 6.5MM 35MM COMPRESSION THORACIC SPN,"$1,008.65",$0.00,"$1,008.65",$453.89,$719.87,$0.00,$173.79,$0.00,$0.00,$176.61,"$1,008.65",$0.00,$504.33,$798.85,$806.92,$0.00,$157.85,$0.00,$160.58,$0.00
48130000,SUP,Custom 27803010,,48130000  -  SCREW SET BLOCKER XIA TITANIUM SPN 4.5 MM ROD,$125.00,$0.00,$125.00,$0.00,$89.21,$0.00,$0.00,$0.00,$0.00,$0.00,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$0.00,$0.00,$0.00,$0.00
48130110,SUP,HCPCS C1713,,48130110  -  STAPLE BONE SMALL 4.5MM 2 XIA TITANIUM SPN CAUDAL,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48130111,SUP,HCPCS C1713,,48130111  -  STAPLE BONE SMALL 4.5MM 2 XIA TITANIUM SPN ROSTRAL,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48130112,SUP,HCPCS C1713,,48130112  -  STAPLE BONE LARGE 4.5MM 2 XIA TITANIUM SPN CAUDAL,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48130113,SUP,HCPCS C1713,,48130113  -  STAPLE BONE LARGE 4.5MM 2 XIA TITANIUM SPN ROSTRAL,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48130201,SUP,Custom 27803010,,48130201  -  HOOK SPINAL SMALL XIA TITANIUM LMNR 4.5MM ROD,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48130202,SUP,Custom 27803010,,48130202  -  HOOK SPINAL MEDIUM XIA TITANIUM LMNR 4.5MM ROD,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48130203,SUP,Custom 27803010,,48130203  -  HOOK SPINAL LARGE XIA TITANIUM LMNR 4.5MM ROD,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48130204,SUP,Custom 27803010,,48130204  -  HOOK SPINAL EXTEND XIA TITANIUM LMNR 4.5 MM ROD,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48130208,SUP,Custom 27803010,,48130208  -  HOOK SPINAL ANGLED BLADE XIA TITANIUM LMNR 4.5 MM ROD,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48130210,SUP,Custom 27803010,,48130210  -  HOOK SPINAL XIA TITANIUM LMNR THORACIC 4.5 MM ROD,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48130212,SUP,Custom 27803010,,48130212  -  HOOK SPINAL RIGHT OFFST XIA TITANIUM LMNR THORACIC 4.5 MM,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48130213,SUP,Custom 27803010,,48130213  -  HOOK SPINAL LEFT OFFST XIA TITANIUM LMNR THORACIC 4.5 MM ROD,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48130214,SUP,Custom 27803010,,48130214  -  HOOK SPINAL RIGHT OFFST XIA TITANIUM SUPRA LMNR 4.5 MM ROD,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48130215,SUP,Custom 27803010,,48130215  -  HOOK SPINAL LEFT OFFST XIA TITANIUM SUPRA LMNR 4.5 MM ROD,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48130220,SUP,Custom 27803010,,48130220  -  HOOK SPINAL SMALL XIA TITANIUM PEDICLE 4.5MM ROD,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48130221,SUP,Custom 27803010,,48130221  -  HOOK SPINAL LARGE XIA TITANIUM PEDICLE 4.5MM ROD,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48130230,SUP,Custom 27803010,,48130230  -  HOOK SPINAL RIGHT OFFST TRNSVRS PROCESS XIA TITANIUM 4.5 MM,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48130231,SUP,Custom 27803010,,48130231  -  HOOK SPINAL LEFT OFFST TRNSVRS PROCESS XIA TITANIUM 4.5 MM,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48132040,SUP,HCPCS C1713,,48132040  -  ROD SPNL STRG 4.5MM 40MM XIA HEX VIT,$437.50,$0.00,$437.50,$196.88,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
48132090,SUP,HCPCS C1713,,48132090  -  ROD SPNL STRG 4.5MM 90MM XIA HEX VIT,$437.50,$0.00,$437.50,$196.88,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
48132100,SUP,HCPCS C1713,,48132100  -  ROD SPNL STRG 4.5MM 100MM XIA HEX VIT,$437.50,$0.00,$437.50,$196.88,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
48132601,SUP,HCPCS C1713,,48132601  -  ROD SPINAL 4.5MM 600MM XIA VITALLIUM,$437.50,$0.00,$437.50,$196.88,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
48133012,SUP,HCPCS C1713,,48133012  -  SCREW BONE 4.5MM 12MM CONCTR MONOBLOCK XIA TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48133013,SUP,HCPCS C1713,,48133013  -  SCREW BONE 4.5MM 13MM CONCTR MONOBLOCK XIA TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48133014,SUP,HCPCS C1713,,48133014  -  SCREW BONE 4.5MM 14MM CONCTR MONOBLOCK XIA TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48133015,SUP,Custom 27803010,,48133015  -  CROSSLINK SPINAL 15MM,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48133016,SUP,HCPCS C1713,,48133016  -  SCREW BONE 4.5MM 16MM CONCTR MONOBLOCK XIA TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48133017,SUP,HCPCS C1713,,48133017  -  SCREW BONE 4.5MM 17MM CONCTR MONOBLOCK XIA TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48133018,SUP,HCPCS C1713,,48133018  -  SCREW BONE 4.5MM 18MM CONCTR MONOBLOCK XIA TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48133019,SUP,HCPCS C1713,,48133019  -  CONNECTOR ROD 4.5MM 19MM MONOBLOCK CROSSLINK XIA SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48133021,SUP,HCPCS C1713,,48133021  -  SCREW BONE 4.5MM 21MM CONCTR MONOBLOCK XIA TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48133023,SUP,HCPCS C1713,,48133023  -  SCREW BONE 4.5MM 23MM CONCTR MONOBLOCK XIA TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48133024,SUP,HCPCS C1713,,48133024  -  SCREW BONE 4.5MM 24MM CONCTR MONOBLOCK XIA TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48133200,SUP,Custom 27803010,,48133200  -  ROD SPINAL 5.5MM 40MM XIA TITANIUM,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
48133224,SUP,Custom 27803010,,48133224  -  CONNECTOR ROD SMALL 24-30MM POLYAX CROSS XIA 3 TITANIUM,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48133230,SUP,Custom 27803010,,48133230  -  CONNECTOR ROD MEDIUM 30-36MM POLYAX CROSS XIA 3 TITANIUM,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48133236,SUP,Custom 27803010,,48133236  -  CONNECTOR ROD LARGE 36-45MM CROSSLINK XIA TITANIUM,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48133245,SUP,Custom 27803010,,48133245  -  CONNECTOR ROD LARGE 45-60MM POLYAX CROSS XIA 3 TITANIUM,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48133480,SUP,Custom 27803010,,48133480  -  ROD SPINAL 4.5MM 480MM XIA TITANIUM,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
48134020,SUP,HCPCS C1713,,48134020  -  SCREW BONE 4MM 20MM MNOAX XIA TITANIUM SPN THORACOLUMBAR 4.5,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48134025,SUP,HCPCS C1713,,48134025  -  SCREW BONE 4MM 25MM MNOAX XIA TITANIUM SPN THORACOLUMBAR 4.5,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48134030,SUP,HCPCS C1713,,48134030  -  SCREW BONE 4MM 30MM MNOAX XIA TITANIUM SPN THORACOLUMBAR 4.5,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48134035,SUP,HCPCS C1713,,48134035  -  SCREW BONE 4MM 35MM MNOAX XIA TITANIUM SPN THORACOLUMBAR 4.5,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48134040,SUP,HCPCS C1713,,48134040  -  SCREW BONE 4MM 40MM MNOAX XIA TITANIUM SPN THORACOLUMBAR 4.5,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48134520,SUP,HCPCS C1713,,48134520  -  SCREW BONE 4.5MM 20MM MNOAX XIA SPN 4.5MM ROD,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48134525,SUP,HCPCS C1713,,48134525  -  SCREW BONE 4.5MM 25MM MNOAX XIA TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48134530,SUP,HCPCS C1713,,48134530  -  SCREW BONE 4.5MM 30MM MNOAX XIA TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48134535,SUP,HCPCS C1713,,48134535  -  SCREW BONE 4.5MM 35MM MNOAX XIA TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48134540,SUP,HCPCS C1713,,48134540  -  SCREW BONE 4.5MM 40MM MNOAX XIA TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48134545,SUP,HCPCS C1713,,48134545  -  SCREW BONE 4.5MM 45MM MNOAX XIA TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48135000,SUP,Custom 27803010,,48135000  -  CONNECTOR ROD 4.5MM 30MM ROD TO ROD XIA TITANIUM SPN,"$1,819.65",$0.00,"$1,819.65",$0.00,"$1,298.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,819.65",$0.00,$909.83,"$1,441.16","$1,455.72",$0.00,$0.00,$0.00,$0.00,$0.00
48135000,SUP,Custom 27803010,,0048135000  -  CONNECTOR ROD 4.5MM 30MM ROD TO ROD XIA TITANIUM SPN,"$1,819.65",$0.00,"$1,819.65",$0.00,"$1,298.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,819.65",$0.00,$909.83,"$1,441.16","$1,455.72",$0.00,$0.00,$0.00,$0.00,$0.00
48135001,SUP,Custom 27803010,,48135001  -  CONNECTOR ROD 4.5MM 60MM XIA SPN,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48135003,SUP,Custom 27803010,,48135003  -  CONNECTOR ROD 4.5-5.5/6MM ROD TO ROD PARALLEL XIA SPN,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48135004,SUP,Custom 27803010,,48135004  -  CONNECTOR ROD 4.5-6MM ROD TO ROD XIA SPN,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48135005,SUP,Custom 27803010,,48135005  -  CONNECTOR ROD SMALL 4.5MM ROD TO ROD PARALLEL XIA SPN,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48135006,SUP,Custom 27803010,,48135006  -  CONNECTOR ROD LARGE 4.5MM ROD TO ROD PARALLEL XIA SPN,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48135008,SUP,Custom 27803010,,48135008  -  CONNECTOR ROD 4.5-5.5/6MM ROD TO ROD PARALLEL XIA SPN,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48135020,SUP,HCPCS C1713,,48135020  -  SCREW BONE 5MM 20MM MNOAX XIA SPN 4.5MM ROD,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48135025,SUP,HCPCS C1713,,48135025  -  SCREW BONE 5MM 25MM MNOAX XIA TITANIUM SPN THORACOLUMBAR 4.5,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48135030,SUP,HCPCS C1713,,48135030  -  SCREW BONE 5MM 30MM MNOAX XIA TITANIUM SPN THORACOLUMBAR 4.5,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48135035,SUP,HCPCS C1713,,48135035  -  SCREW BONE 5MM 35MM MNOAX XIA TITANIUM SPN THORACOLUMBAR 4.5,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48135040,SUP,HCPCS C1713,,48135040  -  SCREW BONE 5MM 40MM MNOAX XIA TITANIUM SPN THORACOLUMBAR 4.5,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48135045,SUP,HCPCS C1713,,48135045  -  SCREW BONE 5MM 45MM MNOAX XIA TITANIUM SPN THORACOLUMBAR 4.5,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48135050,SUP,HCPCS C1713,,48135050  -  SCREW BONE 5MM 50MM MNOAX XIA TITANIUM SPN THORACOLUMBAR 4.5,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48135055,SUP,HCPCS C1713,,48135055  -  SCREW BONE 5MM 55MM MNOAX XIA SPN 4.5MM ROD,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48135060,SUP,HCPCS C1713,,48135060  -  SCREW BONE 5MM 60MM MNOAX XIA SPN 4.5MM ROD,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48135070,SUP,HCPCS C1713,,48135070  -  SCREW BONE 5MM 70MM MNOAX XIA SPN 4.5MM ROD,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48135080,SUP,HCPCS C1713,,48135080  -  SCREW BONE 5MM 80MM MNOAX XIA SPN 4.5MM ROD,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48135101,SUP,Custom 27803010,,48135101  -  CONNECTOR ROD 4.5MM 30MM OFFST XIA TITANIUM SPN,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
48135102,SUP,Custom 27803010,,48135102  -  CONNECTOR ROD 4.5MM 70MM OFFST XIA SPN,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
48135103,SUP,Custom 27803010,,48135103  -  CONNECTOR ROD SMALL EXTEND XIA TITANIUM THORACOLUMBAR SPN,"$3,032.78",$0.00,"$3,032.78",$0.00,"$2,164.49",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,032.78",$0.00,"$1,516.39","$2,401.96","$2,426.22",$0.00,$0.00,$0.00,$0.00,$0.00
48135104,SUP,Custom 27803010,,48135104  -  CONNECTOR ROD LONG 4.5MM EXTEND XIA SPN,"$3,032.78",$0.00,"$3,032.78",$0.00,"$2,164.49",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,032.78",$0.00,"$1,516.39","$2,401.96","$2,426.22",$0.00,$0.00,$0.00,$0.00,$0.00
48135105,SUP,Custom 27803010,,48135105  -  CONNECTOR ROD STR XIA TITANIUM ILIAC SPN,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48135106,SUP,Custom 27803010,,48135106  -  CONNECTOR ROD 15D 4.5MM STR XIA SPN ILIAC,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48135107,SUP,Custom 27803010,,48135107  -  CONNECTOR ROD 25D 4.5MM STR XIA SPN ILIAC,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48135108,SUP,Custom 27803010,,48135108  -  CONNECTOR ROD 35D 4.5MM STR XIA SPN ILIAC,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48135109,SUP,Custom 27803010,,48135109  -  CONNECTOR ROD 45D 4.5MM STR XIA SPN ILIAC,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48135520,SUP,HCPCS C1713,,48135520  -  SCREW BONE 5.5MM 20MM MNOAX XIA SPN 4.5MM ROD,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48135525,SUP,HCPCS C1713,,48135525  -  SCREW BONE 5.5MM 25MM MNOAX XIA TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48135530,SUP,HCPCS C1713,,48135530  -  SCREW BONE 5.5MM 30MM MNOAX XIA TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48135535,SUP,HCPCS C1713,,48135535  -  SCREW BONE 5.5MM 35MM MNOAX XIA TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48135540,SUP,HCPCS C1713,,48135540  -  SCREW BONE 5.5MM 40MM MNOAX XIA TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48135545,SUP,HCPCS C1713,,48135545  -  SCREW BONE 5.5MM 45MM MNOAX XIA TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48135550,SUP,HCPCS C1713,,48135550  -  SCREW BONE 5.5MM 50MM MNOAX XIA TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48135555,SUP,HCPCS C1713,,48135555  -  SCREW BONE 5.5MM 55MM MNOAX XIA TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48135560,SUP,HCPCS C1713,,48135560  -  SCREW BONE 5.5MM 60MM MNOAX XIA SPN 4.5MM ROD,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48135570,SUP,HCPCS C1713,,48135570  -  SCREW BONE 5.5MM 70MM MNOAX XIA SPN 4.5MM ROD,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48135580,SUP,HCPCS C1713,,48135580  -  SCREW BONE 5.5MM 80MM MNOAX XIA SPN 4.5MM ROD,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48136025,SUP,HCPCS C1713,,48136025  -  SCREW BONE 6MM 25MM MNOAX XIA SPN 4.5MM ROD,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48136030,SUP,HCPCS C1713,,48136030  -  SCREW BONE 6MM 30MM MNOAX XIA SPN 4.5MM ROD,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48136035,SUP,HCPCS C1713,,48136035  -  SCREW BONE 6MM 35MM MNOAX XIA SPN 4.5MM ROD,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48136040,SUP,HCPCS C1713,,48136040  -  SCREW BONE 6MM 40MM MNOAX XIA SPN 4.5MM ROD,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48136045,SUP,HCPCS C1713,,48136045  -  SCREW BONE 6MM 45MM MNOAX XIA SPN 4.5MM ROD,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48136050,SUP,HCPCS C1713,,48136050  -  SCREW BONE 6MM 50MM MNOAX XIA SPN 4.5MM ROD,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48136055,SUP,HCPCS C1713,,48136055  -  SCREW BONE 6MM 55MM MNOAX XIA SPN 4.5MM ROD,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48136060,SUP,HCPCS C1713,,48136060  -  SCREW BONE 6MM 60MM MNOAX XIA SPN 4.5MM ROD,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48136070,SUP,HCPCS C1713,,48136070  -  SCREW BONE 6MM 70MM MNOAX XIA SPN 4.5MM ROD,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48136080,SUP,HCPCS C1713,,48136080  -  SCREW BONE 6MM 80MM MNOAX XIA SPN 4.5MM ROD,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48136530,SUP,HCPCS C1713,,48136530  -  SCREW BONE 6.5MM 30MM MNOAX XIA TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48136535,SUP,HCPCS C1713,,48136535  -  SCREW BONE 6.5MM 35MM MNOAX XIA TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48136540,SUP,HCPCS C1713,,48136540  -  SCREW BONE 6.5MM 40MM MNOAX XIA TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48136545,SUP,HCPCS C1713,,48136545  -  SCREW BONE 6.5MM 45MM MNOAX XIA TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48136550,SUP,HCPCS C1713,,48136550  -  SCREW BONE 6.5MM 50MM MNOAX XIA TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48136555,SUP,HCPCS C1713,,48136555  -  SCREW BONE 6.5MM 55MM MNOAX XIA TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48136560,SUP,HCPCS C1713,,48136560  -  SCREW BONE 6.5MM 60MM MNOAX XIA TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48136570,SUP,HCPCS C1713,,48136570  -  SCREW BONE 6.5MM 70MM MNOAX XIA SPN 4.5MM ROD,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48136580,SUP,HCPCS C1713,,48136580  -  SCREW BONE 6.5MM 80MM MNOAX XIA SPN 4.5MM ROD,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48137030,SUP,HCPCS C1713,,48137030  -  SCREW BONE 7MM 30MM MNOAX XIA SPN 4.5MM ROD,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48137035,SUP,HCPCS C1713,,48137035  -  SCREW BONE 7MM 35MM MNOAX XIA SPN 4.5MM ROD,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48137040,SUP,HCPCS C1713,,48137040  -  SCREW BONE 7MM 40MM MNOAX XIA SPN 4.5MM ROD,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48137045,SUP,HCPCS C1713,,48137045  -  SCREW BONE 7MM 45MM MNOAX XIA SPN 4.5MM ROD,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48137050,SUP,HCPCS C1713,,48137050  -  SCREW BONE 7MM 50MM MNOAX XIA SPN 4.5MM ROD,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48137060,SUP,HCPCS C1713,,48137060  -  SCREW BONE 7MM 60MM MNOAX XIA SPN 4.5MM ROD,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48137070,SUP,HCPCS C1713,,48137070  -  SCREW BONE 7MM 70MM MNOAX XIA SPN 4.5MM ROD,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48137080,SUP,HCPCS C1713,,48137080  -  SCREW BONE 7MM 80MM MNOAX XIA SPN 4.5MM ROD,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48137530,SUP,HCPCS C1713,,48137530  -  SCREW BONE 7.5MM 30MM MNOAX XIA SPN 4.5MM ROD,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48137535,SUP,HCPCS C1713,,48137535  -  SCREW BONE 7.5MM 35MM MNOAX XIA SPN 4.5MM ROD,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48137540,SUP,HCPCS C1713,,48137540  -  SCREW BONE 7.5MM 40MM MNOAX XIA SPN 4.5MM ROD,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48137545,SUP,HCPCS C1713,,48137545  -  SCREW BONE 7.5MM 45MM MNOAX XIA SPN 4.5MM ROD,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48137550,SUP,HCPCS C1713,,48137550  -  SCREW BONE 7.5MM 50MM MNOAX XIA SPN 4.5MM ROD,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48137555,SUP,HCPCS C1713,,48137555  -  SCREW BONE 7.5MM 55MM MNOAX XIA SPN 4.5MM ROD,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48137560,SUP,HCPCS C1713,,48137560  -  SCREW BONE 7.5MM 60MM MNOAX XIA SPN 4.5MM ROD,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48137570,SUP,HCPCS C1713,,48137570  -  SCREW BONE 7.5MM 70MM MNOAX XIA SPN 4.5MM ROD,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48137580,SUP,HCPCS C1713,,48137580  -  SCREW BONE 7.5MM 80MM MNOAX XIA SPN 4.5MM ROD,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
48144020,SUP,HCPCS C1713,,48144020  -  SCREW BONE 4MM 20MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48144025,SUP,HCPCS C1713,,48144025  -  SCREW BONE 4MM 25MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48144030,SUP,HCPCS C1713,,48144030  -  SCREW BONE 4MM 30MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48144035,SUP,HCPCS C1713,,48144035  -  SCREW BONE 4MM 35MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48144040,SUP,HCPCS C1713,,48144040  -  SCREW BONE 4MM 40MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48144520,SUP,HCPCS C1713,,48144520  -  SCREW BONE 4.5MM 20MM POLYAX XIA SPN 4.5MM ROD,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48144525,SUP,HCPCS C1713,,48144525  -  SCREW BONE 4.5MM 25MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48144530,SUP,HCPCS C1713,,48144530  -  SCREW BONE 4.5MM 30MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48144535,SUP,HCPCS C1713,,48144535  -  SCREW BONE 4.5MM 35MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48144540,SUP,HCPCS C1713,,48144540  -  SCREW BONE 4.5MM 40MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48144545,SUP,HCPCS C1713,,48144545  -  SCREW BONE 4.5MM 45MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48144560,SUP,HCPCS C1713,,48144560  -  SCREW BONE 4.5MM 60MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48144570,SUP,HCPCS C1713,,48144570  -  SCREW BONE 4.5MM 70MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48145020,SUP,HCPCS C1713,,48145020  -  SCREW BONE 5MM 20MM POLYAX XIA SPN 4.5MM ROD,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48145025,SUP,HCPCS C1713,,48145025  -  SCREW BONE 5MM 25MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48145030,SUP,HCPCS C1713,,48145030  -  SCREW BONE 5MM 30MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48145035,SUP,HCPCS C1713,,48145035  -  SCREW BONE 5MM 35MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48145040,SUP,HCPCS C1713,,48145040  -  SCREW BONE 5MM 40MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48145045,SUP,HCPCS C1713,,48145045  -  SCREW BONE 5MM 45MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48145050,SUP,HCPCS C1713,,48145050  -  SCREW BONE 5MM 50MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48145055,SUP,HCPCS C1713,,48145055  -  SCREW BONE 5MM 55MM POLYAX XIA SPN 4.5MM ROD,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48145060,SUP,HCPCS C1713,,48145060  -  SCREW BONE 5MM 60MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48145070,SUP,HCPCS C1713,,48145070  -  SCREW BONE 5MM 70MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48145080,SUP,HCPCS C1713,,48145080  -  SCREW BONE 5MM 80MM POLYAX XIA SPN 4.5MM ROD,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48145520,SUP,HCPCS C1713,,48145520  -  SCREW BONE 5.5MM 20MM POLYAX XIA SPN 4.5MM ROD,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48145525,SUP,HCPCS C1713,,48145525  -  SCREW BONE 5.5MM 25MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48145530,SUP,HCPCS C1713,,48145530  -  SCREW BONE 5.5MM 30MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48145535,SUP,HCPCS C1713,,48145535  -  SCREW BONE 5.5MM 35MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48145540,SUP,HCPCS C1713,,48145540  -  SCREW BONE 5.5MM 40MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48145545,SUP,HCPCS C1713,,48145545  -  SCREW BONE 5.5MM 45MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48145550,SUP,HCPCS C1713,,48145550  -  SCREW BONE 5.5MM 50MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48145555,SUP,HCPCS C1713,,48145555  -  SCREW BONE 5.5MM 55MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48145560,SUP,HCPCS C1713,,48145560  -  SCREW BONE 5.5MM 60MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48145570,SUP,HCPCS C1713,,48145570  -  SCREW BONE 5.5MM 70MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48145580,SUP,HCPCS C1713,,48145580  -  SCREW BONE 5.5MM 80MM POLYAX XIA SPN 4.5MM ROD,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48146025,SUP,HCPCS C1713,,48146025  -  SCREW BONE 6MM 25MM POLYAX XIA TITANIUM THORACOLUMBAR SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48146030,SUP,HCPCS C1713,,48146030  -  SCREW BONE 6MM 30MM POLYAX XIA TITANIUM THORACOLUMBAR SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48146035,SUP,HCPCS C1713,,48146035  -  SCREW BONE 6MM 35MM POLYAX XIA TITANIUM THORACOLUMBAR SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48146040,SUP,HCPCS C1713,,48146040  -  SCREW BONE 6MM 40MM POLYAX XIA TITANIUM THORACOLUMBAR SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48146045,SUP,HCPCS C1713,,48146045  -  SCREW BONE 6MM 45MM POLYAX XIA TITANIUM THORACOLUMBAR SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48146050,SUP,HCPCS C1713,,48146050  -  SCREW BONE 6MM 50MM POLYAX XIA TITANIUM THORACOLUMBAR SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48146055,SUP,HCPCS C1713,,48146055  -  SCREW BONE 6MM 55MM POLYAX XIA TITANIUM THORACOLUMBAR SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48146060,SUP,HCPCS C1713,,48146060  -  SCREW BONE 6MM 60MM POLYAX XIA TITANIUM THORACOLUMBAR SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48146070,SUP,HCPCS C1713,,48146070  -  SCREW BONE 6MM 70MM POLYAX XIA SPN 4.5MM ROD,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48146080,SUP,HCPCS C1713,,48146080  -  SCREW BONE 6MM 80MM POLYAX XIA TITANIUM THORACOLUMBAR SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48146530,SUP,HCPCS C1713,,48146530  -  SCREW BONE 6.5MM 30MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48146535,SUP,HCPCS C1713,,48146535  -  SCREW BONE 6.5MM 35MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48146540,SUP,HCPCS C1713,,48146540  -  SCREW BONE 6.5MM 40MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48146545,SUP,HCPCS C1713,,48146545  -  SCREW BONE 6.5MM 45MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48146550,SUP,HCPCS C1713,,48146550  -  SCREW BONE 6.5MM 50MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48146555,SUP,HCPCS C1713,,48146555  -  SCREW BONE 6.5MM 55MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48146560,SUP,HCPCS C1713,,48146560  -  SCREW BONE 6.5MM 60MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48146570,SUP,HCPCS C1713,,48146570  -  SCREW BONE 6.5MM 70MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48146580,SUP,HCPCS C1713,,48146580  -  SCREW BONE 6.5MM 80MM POLYAX XIA SPN 4.5MM ROD,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48147030,SUP,HCPCS C1713,,48147030  -  SCREW BONE 7MM 30MM POLYAX XIA TITANIUM THORACOLUMBAR SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48147035,SUP,HCPCS C1713,,48147035  -  SCREW BONE 7MM 35MM POLYAX XIA TITANIUM THORACOLUMBAR SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48147040,SUP,HCPCS C1713,,48147040  -  SCREW BONE 7MM 40MM POLYAX XIA TITANIUM THORACOLUMBAR SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48147045,SUP,HCPCS C1713,,48147045  -  SCREW BONE 7MM 45MM POLYAX XIA TITANIUM THORACOLUMBAR SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48147050,SUP,HCPCS C1713,,48147050  -  SCREW BONE 7MM 50MM POLYAX XIA TITANIUM THORACOLUMBAR SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48147055,SUP,HCPCS C1713,,48147055  -  SCREW BONE 7MM 55MM POLYAX XIA TITANIUM THORACOLUMBAR SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48147060,SUP,HCPCS C1713,,48147060  -  SCREW BONE 7MM 60MM POLYAX XIA TITANIUM THORACOLUMBAR SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48147070,SUP,HCPCS C1713,,48147070  -  SCREW BONE 7MM 70MM POLYAX XIA SPN 4.5MM ROD,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48147080,SUP,HCPCS C1713,,48147080  -  SCREW BONE 7MM 80MM POLYAX XIA SPN 4.5MM ROD,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48147530,SUP,HCPCS C1713,,48147530  -  SCREW BONE 7.5MM 30MM POLYAX XIA TITANIUM THORACOLUMBAR SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48147535,SUP,HCPCS C1713,,48147535  -  SCREW BONE 7.5MM 35MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48147540,SUP,HCPCS C1713,,48147540  -  SCREW BONE 7.5MM 40MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48147545,SUP,HCPCS C1713,,48147545  -  SCREW BONE 7.5MM 45MM POLYAX XIA TITANIUM THORACOLUMBAR SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48147550,SUP,HCPCS C1713,,48147550  -  SCREW BONE 7.5MM 50MM POLYAX XIA TITANIUM THORACOLUMBAR SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48147555,SUP,HCPCS C1713,,48147555  -  SCREW BONE 7.5MM 55MM POLYAX XIA TITANIUM THORACOLUMBAR SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48147560,SUP,HCPCS C1713,,48147560  -  SCREW BONE 7.5MM 60MM POLYAX XIA TITANIUM THORACOLUMBAR SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48147570,SUP,HCPCS C1713,,48147570  -  SCREW BONE 7.5MM 70MM POLYAX XIA SPN 4.5MM ROD,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48147580,SUP,HCPCS C1713,,48147580  -  SCREW BONE 7.5MM 80MM POLYAX XIA SPN 4.5MM ROD,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48200000,SUP,HCPCS C1713,,48200000  -  BLOCKER SPINAL BLOCKER TECHTONIX LUMBAR SACRAL,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
48200005,SUP,Custom 27803010,,48200005  -  BLOCKER SPINAL 4.5MM BLOCKER TECHTONIX LUMBAR SACRAL,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
48200022,SUP,HCPCS C1713,,48200022  -  PLATE BONE 22MM LEVEL 2 TECHTONIX TITANIUM SPN,"$3,306.20",$0.00,"$3,306.20","$1,487.79","$2,359.63",$0.00,$569.64,$0.00,$0.00,$578.89,"$3,306.20",$0.00,"$1,653.10","$2,618.51","$2,644.96",$0.00,$517.42,$0.00,$526.35,$0.00
48202234,SUP,HCPCS C1713,,48202234  -  PLATE BONE 22-34MM LEVEL 2 TECHTONIX TITANIUM SPN,"$3,306.20",$0.00,"$3,306.20","$1,487.79","$2,359.63",$0.00,$569.64,$0.00,$0.00,$578.89,"$3,306.20",$0.00,"$1,653.10","$2,618.51","$2,644.96",$0.00,$517.42,$0.00,$526.35,$0.00
48202840,SUP,HCPCS C1713,,48202840  -  PLATE BONE 28-40MM LEVEL 2 TECHTONIX TITANIUM SPN,"$3,306.20",$0.00,"$3,306.20","$1,487.79","$2,359.63",$0.00,$569.64,$0.00,$0.00,$578.89,"$3,306.20",$0.00,"$1,653.10","$2,618.51","$2,644.96",$0.00,$517.42,$0.00,$526.35,$0.00
48204658,SUP,HCPCS C1713,,48204658  -  PLATE BONE 46-58MM LEVEL 2 TECHTONIX TITANIUM SPN,"$3,729.85",$0.00,"$3,729.85","$1,678.43","$2,661.99",$0.00,$642.63,$0.00,$0.00,$653.07,"$3,729.85",$0.00,"$1,864.93","$2,954.04","$2,983.88",$0.00,$583.72,$0.00,$593.79,$0.00
48213017,SUP,Custom 27803010,,48213017  -  CONNECTOR ROD 17MM MONOBLOCK MAC TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48213020,SUP,Custom 27803010,,48213020  -  CONNECTOR ROD 20MM MONOBLOCK MAC TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48213023,SUP,Custom 27803010,,48213023  -  CONNECTOR ROD 23MM MULTIAX CROSS XIA MAC TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48213026,SUP,Custom 27803010,,48213026  -  CONNECTOR ROD 26MM MULTIAX CROSS XIA MAC TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48213029,SUP,Custom 27803010,,48213029  -  CONNECTOR ROD 29-31MM CROSS MAC TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48213031,SUP,Custom 27803010,,48213031  -  CONNECTOR ROD SMALL 31-35MM MAC TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48213035,SUP,Custom 27803010,,48213035  -  CONNECTOR ROD SMALL 35-40MM MAC TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48213038,SUP,Custom 27803010,,48213038  -  CONNECTOR ROD STANDARD 39-43MM MAC TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48213042,SUP,Custom 27803010,,48213042  -  CONNECTOR ROD 42MM MULTIAX CROSSLINK MAC TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48213050,SUP,Custom 27803010,,48213050  -  CONNECTOR ROD 50MM MULTIAX CROSSLINK MAC TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48213066,SUP,Custom 27803010,,48213066  -  CONNECTOR ROD 67-99MM MULTIAX CROSS XIA MAC TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48218030,SUP,Custom 27803010,,48218030  -  ROD SPINAL 3.5IN RAD PREBENT 30MM XIA TITANIUM,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
48218035,SUP,Custom 27803010,,48218035  -  ROD SPINAL 6MM 35MM RAD XIA TITANIUM,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
48218040,SUP,Custom 27803010,,48218040  -  ROD SPINAL 3.5IN 40MM XIA RAD,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
48218045,SUP,Custom 27803010,,48218045  -  ROD SPINAL 4.25IN RAD 6MM 45MM RAD XIA TITANIUM,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
48218050,SUP,Custom 27803010,,48218050  -  ROD SPINAL 4.25IN RAD 6MM 50MM CVD XIA TITANIUM,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
48218060,SUP,Custom 27803010,,48218060  -  ROD SPINAL 4.25IN RAD 6MM 60MM CVD XIA TITANIUM,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
48218070,SUP,Custom 27803010,,48218070  -  ROD SPINAL 6MM 70MM RAD XIA RAD,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
48218080,SUP,Custom 27803010,,48218080  -  ROD SPINAL 5IN RAD 5IN 80MM XIA,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
48218090,SUP,Custom 27803010,,48218090  -  ROD SPINAL 5IN RAD PREBENT 90MM XIA TITANIUM,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
48219050,SUP,Custom 27803010,,48219050  -  ROD SPNL 50MM 6MM XIA TI RAD,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
48219060,SUP,Custom 27803010,,48219060  -  ROD SPNL 60MM XIA TI 2 RAD,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
48219070,SUP,Custom 27803010,,48219070  -  ROD SPNL 70MM XIA MXTI 2 RAD,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
48219080,SUP,Custom 27803010,,48219080  -  ROD SPNL 80MM XIA TI 2 RAD,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
48220000,SUP,Custom 27803010,,48220000  -  SCREW SET BUTTRESS THREAD BLOCKER XIA STAINLESS STEEL,"$2,400.00",$0.00,"$2,400.00",$0.00,"$1,712.88",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,400.00",$0.00,"$1,200.00","$1,900.80","$1,920.00",$0.00,$0.00,$0.00,$0.00,$0.00
48220100,SUP,HCPCS C1713,,48220100  -  WASHER SPINAL XIA STAINLESS STEEL THORACOLUMBAR SPN SCOLIOS,$202.18,$0.00,$202.18,$90.98,$144.29,$0.00,$34.83,$0.00,$0.00,$35.40,$202.18,$0.00,$101.09,$160.13,$161.74,$0.00,$31.64,$0.00,$32.19,$0.00
48220101,SUP,Custom 27803010,,48220101  -  CONNECTOR ROD OFFST XIA STAINLESS STEEL SCOLIOS,$556.50,$0.00,$556.50,$0.00,$397.17,$0.00,$0.00,$0.00,$0.00,$0.00,$556.50,$0.00,$278.25,$440.75,$445.20,$0.00,$0.00,$0.00,$0.00,$0.00
48220102,SUP,Custom 27803010,,48220102  -  CONNECTOR ROD AXIAL OFFST XIA STAINLESS STEEL THORACOLUMBAR,"$1,001.30",$0.00,"$1,001.30",$0.00,$714.63,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,001.30",$0.00,$500.65,$793.03,$801.04,$0.00,$0.00,$0.00,$0.00,$0.00
48220103,SUP,Custom 27803010,,48220103  -  CONNECTOR ROD AXIAL OFFST XIA STAINLESS STEEL THORACOLUMBAR,"$1,001.30",$0.00,"$1,001.30",$0.00,$714.63,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,001.30",$0.00,$500.65,$793.03,$801.04,$0.00,$0.00,$0.00,$0.00,$0.00
48220104,SUP,HCPCS C1713,,48220104  -  STAPLE BONE XIA STAINLESS STEEL THORACOLUMBAR SPN SCOLIOS,$223.38,$0.00,$223.38,$100.52,$159.42,$0.00,$38.49,$0.00,$0.00,$39.11,$223.38,$0.00,$111.69,$176.92,$178.70,$0.00,$34.96,$0.00,$35.56,$0.00
48220110,SUP,HCPCS C1713,,48220110  -  STAPLE BONE SMALL 2 HOLE XIA STAINLESS STEEL ANTERIOR CAUDAL,"$2,133.55",$0.00,"$2,133.55",$960.10,"$1,522.71",$0.00,$367.60,$0.00,$0.00,$373.57,"$2,133.55",$0.00,"$1,066.78","$1,689.77","$1,706.84",$0.00,$333.90,$0.00,$339.66,$0.00
48220111,SUP,HCPCS C1713,,48220111  -  STAPLE BONE SMALL 2 HOLE XIA STAINLESS STEEL ANTERIOR,"$2,133.55",$0.00,"$2,133.55",$960.10,"$1,522.71",$0.00,$367.60,$0.00,$0.00,$373.57,"$2,133.55",$0.00,"$1,066.78","$1,689.77","$1,706.84",$0.00,$333.90,$0.00,$339.66,$0.00
48220112,SUP,HCPCS C1713,,48220112  -  STAPLE BONE MEDIUM 2 HOLE XIA STAINLESS STEEL ANTERIOR,"$2,133.55",$0.00,"$2,133.55",$960.10,"$1,522.71",$0.00,$367.60,$0.00,$0.00,$373.57,"$2,133.55",$0.00,"$1,066.78","$1,689.77","$1,706.84",$0.00,$333.90,$0.00,$339.66,$0.00
48220113,SUP,HCPCS C1713,,48220113  -  STAPLE BONE MEDIUM 2 HOLE XIA STAINLESS STEEL ANTERIOR,"$2,133.55",$0.00,"$2,133.55",$960.10,"$1,522.71",$0.00,$367.60,$0.00,$0.00,$373.57,"$2,133.55",$0.00,"$1,066.78","$1,689.77","$1,706.84",$0.00,$333.90,$0.00,$339.66,$0.00
48220114,SUP,HCPCS C1713,,48220114  -  STAPLE BONE LARGE 2 HOLE XIA STAINLESS STEEL ANTERIOR CAUDAL,"$2,133.55",$0.00,"$2,133.55",$960.10,"$1,522.71",$0.00,$367.60,$0.00,$0.00,$373.57,"$2,133.55",$0.00,"$1,066.78","$1,689.77","$1,706.84",$0.00,$333.90,$0.00,$339.66,$0.00
48220115,SUP,HCPCS C1713,,48220115  -  STAPLE BONE LARGE 2 HOLE XIA STAINLESS STEEL ANTERIOR,"$2,133.55",$0.00,"$2,133.55",$960.10,"$1,522.71",$0.00,$367.60,$0.00,$0.00,$373.57,"$2,133.55",$0.00,"$1,066.78","$1,689.77","$1,706.84",$0.00,$333.90,$0.00,$339.66,$0.00
48220130,SUP,Custom 27803010,,48220130  -  CONNECTOR ROD 75D OFFST XIA STAINLESS STEEL SPN,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
48220131,SUP,Custom 27803010,,48220131  -  CONNECTOR ROD OFFST STAINLESS STEEL SPN,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
48220132,SUP,Custom 27803010,,48220132  -  CONNECTOR ROD 105D OFFST XIA STAINLESS STEEL SPN,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
48220133,SUP,Custom 27803010,,48220133  -  CONNECTOR ROD NEUTRAL LONG OFFST XIA STAINLESS STEEL SPN,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
48220134,SUP,Custom 27803010,,48220134  -  CONNECTOR ROD 0D SMALL PARALLEL XIA STAINLESS STEEL SPN,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48220135,SUP,Custom 27803010,,48220135  -  CONNECTOR ROD 30D SMALL ROD TO ROD XIA STAINLESS STEEL SPN,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48220136,SUP,Custom 27803010,,48220136  -  CONNECTOR ROD 0D LARGE ROD TO ROD XIA STAINLESS STEEL SPN,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48220137,SUP,Custom 27803010,,48220137  -  CONNECTOR ROD 30D LARGE ROD TO ROD XIA STAINLESS STEEL SPN,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48220200,SUP,Custom 27803010,,48220200  -  HOOK SPINAL SMALL STANDARD LAMINATE XIA STAINLESS STEEL LMNR,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48220201,SUP,Custom 27803010,,48220201  -  HOOK SPINAL SMALL NARROW XIA STAINLESS STEEL LMNR SCOLIOS,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48220202,SUP,Custom 27803010,,48220202  -  HOOK SPINAL LARGE STANDARD BLADE XIA STAINLESS STEEL LAMINA,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48220203,SUP,Custom 27203010,,48220203  -  HOOK SURG LARGE NARROW BLADE XIA STAINLESS STEEL SPINAL LMNR,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48220204,SUP,Custom 27803010,,48220204  -  HOOK SPINAL EXTENDED BODY XIA STAINLESS STEEL LMNR SCOLIOS,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48220205,SUP,Custom 27803010,,48220205  -  HOOK SPINAL ANGLED BLADE XIA STAINLESS STEEL LMNR THORACIC,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48220206,SUP,Custom 27803010,,48220206  -  HOOK SPINAL OFFST XIA STAINLESS STEEL RIGHT LMNR SCOLIOS,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48220207,SUP,Custom 27803010,,48220207  -  HOOK SPINAL OFFST XIA LEFT LMNR SCOLIOS,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48220208,SUP,Custom 27803010,,48220208  -  HOOK SPINAL ANGLED BLADE XIA STAINLESS STEEL LMNR THORACIC,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48220210,SUP,Custom 27803010,,48220210  -  HOOK SPINAL STANDARD BLADE XIA STAINLESS STEEL LMNR SCOLIOS,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48220211,SUP,Custom 27803010,,48220211  -  HOOK SPINAL NARROW BLADE XIA STAINLESS STEEL LMNR THORACIC,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48220212,SUP,Custom 27803010,,48220212  -  HOOK SPINAL SMALL RIGHT OFFST XIA STAINLESS STEEL LMNR,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48220213,SUP,Custom 27803010,,48220213  -  HOOK SPINAL SMALL LEFT OFFST XIA STAINLESS STEEL LMNR,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48220214,SUP,Custom 27803010,,48220214  -  HOOK SPINAL LARGE STANDARD RIGHT OFFST XIA STAINLESS STEEL,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48220215,SUP,Custom 27803010,,48220215  -  HOOK SPINAL LARGE LEFT OFFST XIA STAINLESS STEEL LMNR,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48220220,SUP,Custom 27803010,,48220220  -  HOOK SPINAL SMALL XIA PEDICLE SCOLIOS,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48220221,SUP,Custom 27803010,,48220221  -  HOOK SPINAL LARGE XIA PEDICLE SCOLIOS,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48220230,SUP,Custom 27803010,,48220230  -  HOOK SPINAL STANDARD TRNSVRS PROCESS XIA STAINLESS STEEL,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48220231,SUP,Custom 27803010,,48220231  -  HOOK SPINAL LEFT OFFST TRNSVRS PROCESS XIA STAINLESS STEEL,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48220240,SUP,Custom 27203010,,48220240  -  HOOK RETRACTION WIDE LAMINA RBH,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48220241,SUP,Custom 27803010,,48220241  -  HOOK SPINAL WIDE BLADE RED XIA STAINLESS STEEL LMNR THORACIC,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48220242,SUP,Custom 27203010,,48220242  -  HOOK RETRACTION ANGLED LP,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48220243,SUP,Custom 27803010,,48220243  -  HOOK SPINAL RED NARROW BLADE XIA TITANIUM LMNR THORACIC,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48220244,SUP,Custom 27803010,,48220244  -  HOOK SPINAL RED BLADE XIA STAINLESS STEEL PEDICLE SCOLIOS,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48220317,SUP,Custom 27803010,,48220317  -  CONNECTOR ROD 17MM CROSS XIA MAC STAINLESS STEEL,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48220319,SUP,Custom 27803010,,48220319  -  CONNECTOR ROD 19MM MULTIAX CROSS XIA MAC STAINLESS STEEL,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48220321,SUP,Custom 27803010,,48220321  -  CONNECTOR ROD 21MM MOMO TYPE XIA MAC STAINLESS STEEL,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48220323,SUP,Custom 27803010,,48220323  -  CONNECTOR ROD 23MM MULTIAX CROSS XIA STAINLESS STEEL,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48220326,SUP,Custom 27803010,,48220326  -  CONNECTOR ROD 26MM MOMO TYPE XIA MAC STAINLESS STEEL,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48220329,SUP,Custom 27803010,,48220329  -  CONNECTOR ROD 29MM MULTIAX MONO XIA STAINLESS STEEL,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48220331,SUP,Custom 27803010,,48220331  -  CROSSLINK SPINAL 31-34MM MULTIAX XIA STAINLESS STEEL,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48220335,SUP,Custom 27803010,,48220335  -  CONNECTOR ROD SMALL 35-37MM MULTIAX CROSS XIA STAINLESS,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48220338,SUP,Custom 27803010,,48220338  -  CROSSLINK SPINAL 38-43MM MULTIAX XIA STAINLESS STEEL,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48220342,SUP,Custom 27803010,,48220342  -  CONNECTOR ROD 42-51MM MULTIAX CROSS XIA MAC STAINLESS STEEL,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48220350,SUP,Custom 27803010,,48220350  -  CONNECTOR ROD 50-67MM CROSSLINK XIA SPN SCOLIOS,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48220425,SUP,HCPCS C1713,,48220425  -  SCREW BONE 4.5MM 25MM MNOAX XIA STAINLESS STEEL SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
48220430,SUP,HCPCS C1713,,48220430  -  SCREW BONE 4.5MM 30MM MNOAX XIA STAINLESS STEEL SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
48220435,SUP,HCPCS C1713,,48220435  -  SCREW BONE 4.5MM 35MM MNOAX XIA STAINLESS STEEL SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
48220440,SUP,HCPCS C1713,,48220440  -  SCREW BONE 4.5MM 40MM MNOAX XIA STAINLESS STEEL SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
48220445,SUP,HCPCS C1713,,48220445  -  SCREW BONE 4.5MM 45MM MNOAX XIA STAINLESS STEEL SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
48220525,SUP,HCPCS C1713,,48220525  -  SCREW BONE 5.5MM 25MM MNOAX XIA STAINLESS STEEL SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
48220530,SUP,HCPCS C1713,,48220530  -  SCREW BONE 5.5MM 30MM MNOAX XIA STAINLESS STEEL SPN,"$6,300.00",$0.00,"$6,300.00","$2,835.00","$4,496.31",$0.00,"$1,085.46",$0.00,$0.00,"$1,103.08","$6,300.00",$0.00,"$3,150.00","$4,989.60","$5,040.00",$0.00,$985.95,$0.00,"$1,002.96",$0.00
48220535,SUP,HCPCS C1713,,48220535  -  SCREW BONE 5.5MM 35MM MNOAX XIA STAINLESS STEEL SPN,"$6,300.00",$0.00,"$6,300.00","$2,835.00","$4,496.31",$0.00,"$1,085.46",$0.00,$0.00,"$1,103.08","$6,300.00",$0.00,"$3,150.00","$4,989.60","$5,040.00",$0.00,$985.95,$0.00,"$1,002.96",$0.00
48220540,SUP,HCPCS C1713,,48220540  -  SCREW BONE 5.5MM 40MM MNOAX XIA STAINLESS STEEL SPN,"$6,300.00",$0.00,"$6,300.00","$2,835.00","$4,496.31",$0.00,"$1,085.46",$0.00,$0.00,"$1,103.08","$6,300.00",$0.00,"$3,150.00","$4,989.60","$5,040.00",$0.00,$985.95,$0.00,"$1,002.96",$0.00
48220545,SUP,HCPCS C1713,,48220545  -  SCREW BONE 5.5MM 45MM MNOAX XIA STAINLESS STEEL SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
48220550,SUP,HCPCS C1713,,48220550  -  SCREW BONE 5.5MM 50MM MNOAX XIA STAINLESS STEEL SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
48220555,SUP,HCPCS C1713,,48220555  -  SCREW BONE 5.5MM 55MM MNOAX XIA STAINLESS STEEL SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
48220600,SUP,HCPCS C1713,,48220600  -  SCREW BONE 6.5MM 100MM MNOAX XIA STAINLESS STEEL SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
48220630,SUP,HCPCS C1713,,48220630  -  SCREW BONE 6.5MM 30MM MNOAX XIA STAINLESS STEEL SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
48220635,SUP,HCPCS C1713,,48220635  -  SCREW BONE 6.5MM 35MM MNOAX XIA STAINLESS STEEL SPN,"$6,300.00",$0.00,"$6,300.00","$2,835.00","$4,496.31",$0.00,"$1,085.46",$0.00,$0.00,"$1,103.08","$6,300.00",$0.00,"$3,150.00","$4,989.60","$5,040.00",$0.00,$985.95,$0.00,"$1,002.96",$0.00
48220640,SUP,HCPCS C1713,,48220640  -  SCREW BONE 6.5MM 40MM MNOAX XIA STAINLESS STEEL SPN,"$6,300.00",$0.00,"$6,300.00","$2,835.00","$4,496.31",$0.00,"$1,085.46",$0.00,$0.00,"$1,103.08","$6,300.00",$0.00,"$3,150.00","$4,989.60","$5,040.00",$0.00,$985.95,$0.00,"$1,002.96",$0.00
48220645,SUP,HCPCS C1713,,48220645  -  SCREW BONE 6.5MM 45MM MNOAX XIA STAINLESS STEEL SPN,"$6,300.00",$0.00,"$6,300.00","$2,835.00","$4,496.31",$0.00,"$1,085.46",$0.00,$0.00,"$1,103.08","$6,300.00",$0.00,"$3,150.00","$4,989.60","$5,040.00",$0.00,$985.95,$0.00,"$1,002.96",$0.00
48220650,SUP,HCPCS C1713,,48220650  -  SCREW BONE 6.5MM 50MM MNOAX XIA STAINLESS STEEL SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
48220655,SUP,HCPCS C1713,,48220655  -  SCREW BONE 6.5MM 55MM MNOAX XIA STAINLESS STEEL SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
48220660,SUP,HCPCS C1713,,48220660  -  SCREW BONE 6.5MM 60MM MNOAX XIA STAINLESS STEEL SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
48220670,SUP,HCPCS C1713,,48220670  -  SCREW BONE 6.5MM 70MM MNOAX XIA STAINLESS STEEL SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
48220680,SUP,HCPCS C1713,,48220680  -  SCREW BONE 6.5MM 80MM MNOAX XIA STAINLESS STEEL SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
48220690,SUP,HCPCS C1713,,48220690  -  SCREW BONE 6.5MM 90MM MNOAX XIA STAINLESS STEEL SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
48220700,SUP,HCPCS C1713,,48220700  -  SCREW BONE 7.5MM 100MM MNOAX XIA STAINLESS STEEL SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
48220730,SUP,HCPCS C1713,,48220730  -  SCREW BONE 7.5MM 30MM MNOAX XIA STAINLESS STEEL SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
48220735,SUP,HCPCS C1713,,48220735  -  SCREW BONE 7.5MM 35MM MNOAX XIA STAINLESS STEEL SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
48220740,SUP,HCPCS C1713,,48220740  -  SCREW BONE 7.5MM 40MM MNOAX XIA STAINLESS STEEL SPN,"$6,300.00",$0.00,"$6,300.00","$2,835.00","$4,496.31",$0.00,"$1,085.46",$0.00,$0.00,"$1,103.08","$6,300.00",$0.00,"$3,150.00","$4,989.60","$5,040.00",$0.00,$985.95,$0.00,"$1,002.96",$0.00
48220745,SUP,HCPCS C1713,,48220745  -  SCREW BONE 7.5MM 45MM MNOAX XIA STAINLESS STEEL SPN,"$6,300.00",$0.00,"$6,300.00","$2,835.00","$4,496.31",$0.00,"$1,085.46",$0.00,$0.00,"$1,103.08","$6,300.00",$0.00,"$3,150.00","$4,989.60","$5,040.00",$0.00,$985.95,$0.00,"$1,002.96",$0.00
48220750,SUP,HCPCS C1713,,48220750  -  SCREW BONE 7.5MM 50MM MNOAX XIA STAINLESS STEEL SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
48220755,SUP,HCPCS C1713,,48220755  -  SCREW BONE 7.5MM 55MM MNOAX XIA STAINLESS STEEL SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
48220760,SUP,HCPCS C1713,,48220760  -  SCREW BONE 7.5MM 60MM MNOAX XIA STAINLESS STEEL SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
48220770,SUP,HCPCS C1713,,48220770  -  SCREW BONE 7.5MM 70MM MNOAX XIA STAINLESS STEEL SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
48220780,SUP,HCPCS C1713,,48220780  -  SCREW BONE 7.5MM 80MM MNOAX XIA STAINLESS STEEL SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
48220790,SUP,HCPCS C1713,,48220790  -  SCREW BONE 7.5MM 90MM MNOAX XIA STAINLESS STEEL SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
48220800,SUP,HCPCS C1713,,48220800  -  SCREW BONE 8.5MM 100MM MNOAX XIA STAINLESS STEEL SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
48220830,SUP,HCPCS C1713,,48220830  -  SCREW BONE 8.5MM 30MM MNOAX XIA STAINLESS STEEL SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
48220835,SUP,HCPCS C1713,,48220835  -  SCREW BONE 8.5MM 35MM MNOAX XIA STAINLESS STEEL SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
48220840,SUP,HCPCS C1713,,48220840  -  SCREW BONE 8.5MM 40MM MNOAX XIA STAINLESS STEEL SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
48220845,SUP,HCPCS C1713,,48220845  -  SCREW BONE 8.5MM 45MM MNOAX XIA STAINLESS STEEL SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
48220850,SUP,HCPCS C1713,,48220850  -  SCREW BONE 8.5MM 50MM MNOAX XIA STAINLESS STEEL SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
48220855,SUP,HCPCS C1713,,48220855  -  SCREW BONE 8.5MM 55MM MNOAX XIA STAINLESS STEEL SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
48220860,SUP,HCPCS C1713,,48220860  -  SCREW BONE 8.5MM 60MM MNOAX XIA STAINLESS STEEL SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
48220870,SUP,HCPCS C1713,,48220870  -  SCREW BONE 8.5MM 70MM MNOAX XIA STAINLESS STEEL SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
48220880,SUP,HCPCS C1713,,48220880  -  SCREW BONE 8.5MM 80MM MNOAX XIA STAINLESS STEEL SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
48220890,SUP,HCPCS C1713,,48220890  -  SCREW BONE 8.5MM 90MM MNOAX XIA STAINLESS STEEL SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
48220900,SUP,HCPCS C1713,,48220900  -  SCREW BONE 9.5MM 100MM MNOAX XIA STAINLESS STEEL SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
48220960,SUP,HCPCS C1713,,48220960  -  SCREW BONE 9.5MM 60MM MNOAX XIA STAINLESS STEEL SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
48220970,SUP,HCPCS C1713,,48220970  -  SCREW BONE 9.5MM 70MM MNOAX XIA STAINLESS STEEL SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
48220980,SUP,HCPCS C1713,,48220980  -  SCREW BONE 9.5MM 80MM MNOAX XIA STAINLESS STEEL SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
48220990,SUP,HCPCS C1713,,48220990  -  SCREW BONE 9.5MM 90MM MNOAX XIA STAINLESS STEEL SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
48221015,SUP,Custom 27803010,,48221015  -  CONNECTOR ROD 15MM MULTIAX CROSS XIA MAC STAINLESS STEEL,"$2,000.00",$0.00,"$2,000.00",$0.00,"$1,427.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
48221016,SUP,Custom 27803010,,48221016  -  CONNECTOR ROD 16MM MULTIAX CROSS XIA MAC STAINLESS STEEL,"$2,000.00",$0.00,"$2,000.00",$0.00,"$1,427.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
48221017,SUP,Custom 27803010,,48221017  -  CONNECTOR ROD 17MM MULTIAX CROSS XIA MAC STAINLESS STEEL,"$2,000.00",$0.00,"$2,000.00",$0.00,"$1,427.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
48221018,SUP,Custom 27803010,,48221018  -  CONNECTOR ROD 18MM MULTIAX CROSS XIA MAC STAINLESS STEEL,"$2,000.00",$0.00,"$2,000.00",$0.00,"$1,427.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
48221019,SUP,Custom 27803010,,48221019  -  CONNECTOR ROD 19MM MULTIAX CROSS XIA MAC STAINLESS STEEL,"$2,000.00",$0.00,"$2,000.00",$0.00,"$1,427.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
48221020,SUP,Custom 27803010,,48221020  -  CONNECTOR ROD 20MM MULTIAX CROSS XIA MAC STAINLESS STEEL,"$2,000.00",$0.00,"$2,000.00",$0.00,"$1,427.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
48221425,SUP,HCPCS C1713,,48221425  -  SCREW BONE 4.5MM 25MM POLYAX XIA STAINLESS STEEL SPN,"$5,875.00",$0.00,"$5,875.00","$2,643.75","$4,192.99",$0.00,"$1,012.23",$0.00,$0.00,"$1,028.67","$5,875.00",$0.00,"$2,937.50","$4,653.00","$4,700.00",$0.00,$919.44,$0.00,$935.30,$0.00
48221430,SUP,HCPCS C1713,,48221430  -  SCREW BONE 4.5MM 30MM POLYAX XIA STAINLESS STEEL SPN,"$5,875.00",$0.00,"$5,875.00","$2,643.75","$4,192.99",$0.00,"$1,012.23",$0.00,$0.00,"$1,028.67","$5,875.00",$0.00,"$2,937.50","$4,653.00","$4,700.00",$0.00,$919.44,$0.00,$935.30,$0.00
48221435,SUP,HCPCS C1713,,48221435  -  SCREW BONE 4.5MM 35MM POLYAX XIA STAINLESS STEEL SPN,"$5,875.00",$0.00,"$5,875.00","$2,643.75","$4,192.99",$0.00,"$1,012.23",$0.00,$0.00,"$1,028.67","$5,875.00",$0.00,"$2,937.50","$4,653.00","$4,700.00",$0.00,$919.44,$0.00,$935.30,$0.00
48221440,SUP,HCPCS C1713,,48221440  -  SCREW BONE 4.5MM 40MM POLYAX XIA STAINLESS STEEL SPN,"$5,875.00",$0.00,"$5,875.00","$2,643.75","$4,192.99",$0.00,"$1,012.23",$0.00,$0.00,"$1,028.67","$5,875.00",$0.00,"$2,937.50","$4,653.00","$4,700.00",$0.00,$919.44,$0.00,$935.30,$0.00
48221445,SUP,HCPCS C1713,,48221445  -  SCREW BONE 4.5MM 45MM POLYAX XIA STAINLESS STEEL SPN,"$5,737.50",$0.00,"$5,737.50","$2,581.88","$4,094.85",$0.00,$988.54,$0.00,$0.00,"$1,004.59","$5,737.50",$0.00,"$2,868.75","$4,544.10","$4,590.00",$0.00,$897.92,$0.00,$913.41,$0.00
48221525,SUP,HCPCS C1713,,48221525  -  SCREW BONE 5.5MM 25MM POLYAX XIA STAINLESS STEEL SPN,"$5,737.50",$0.00,"$5,737.50","$2,581.88","$4,094.85",$0.00,$988.54,$0.00,$0.00,"$1,004.59","$5,737.50",$0.00,"$2,868.75","$4,544.10","$4,590.00",$0.00,$897.92,$0.00,$913.41,$0.00
48221530,SUP,HCPCS C1713,,48221530  -  SCREW BONE 5.5MM 30MM POLYAX XIA STAINLESS STEEL SPN,"$5,737.50",$0.00,"$5,737.50","$2,581.88","$4,094.85",$0.00,$988.54,$0.00,$0.00,"$1,004.59","$5,737.50",$0.00,"$2,868.75","$4,544.10","$4,590.00",$0.00,$897.92,$0.00,$913.41,$0.00
48221535,SUP,HCPCS C1713,,48221535  -  SCREW BONE 5.5MM 35MM POLYAX XIA STAINLESS STEEL SPN,"$5,737.50",$0.00,"$5,737.50","$2,581.88","$4,094.85",$0.00,$988.54,$0.00,$0.00,"$1,004.59","$5,737.50",$0.00,"$2,868.75","$4,544.10","$4,590.00",$0.00,$897.92,$0.00,$913.41,$0.00
48221540,SUP,HCPCS C1713,,48221540  -  SCREW BONE 5.5MM 40MM POLYAX XIA STAINLESS STEEL SPN,"$5,737.50",$0.00,"$5,737.50","$2,581.88","$4,094.85",$0.00,$988.54,$0.00,$0.00,"$1,004.59","$5,737.50",$0.00,"$2,868.75","$4,544.10","$4,590.00",$0.00,$897.92,$0.00,$913.41,$0.00
48221545,SUP,HCPCS C1713,,48221545  -  SCREW BONE 5.5MM 45MM POLYAX XIA STAINLESS STEEL SPN,"$5,287.50",$0.00,"$5,287.50","$2,379.38","$3,773.69",$0.00,$911.01,$0.00,$0.00,$925.80,"$5,287.50",$0.00,"$2,643.75","$4,187.70","$4,230.00",$0.00,$827.49,$0.00,$841.77,$0.00
48221550,SUP,HCPCS C1713,,48221550  -  SCREW BONE 5.5MM 50MM POLYAX XIA STAINLESS STEEL SPN,"$5,287.50",$0.00,"$5,287.50","$2,379.38","$3,773.69",$0.00,$911.01,$0.00,$0.00,$925.80,"$5,287.50",$0.00,"$2,643.75","$4,187.70","$4,230.00",$0.00,$827.49,$0.00,$841.77,$0.00
48221555,SUP,HCPCS C1713,,48221555  -  SCREW BONE 5.5MM 55MM POLYAX XIA STAINLESS STEEL SPN,"$5,287.50",$0.00,"$5,287.50","$2,379.38","$3,773.69",$0.00,$911.01,$0.00,$0.00,$925.80,"$5,287.50",$0.00,"$2,643.75","$4,187.70","$4,230.00",$0.00,$827.49,$0.00,$841.77,$0.00
48221600,SUP,HCPCS C1713,,48221600  -  SCREW BONE 6.5MM 100MM POLYAX XIA STAINLESS STEEL SPN,"$5,287.50",$0.00,"$5,287.50","$2,379.38","$3,773.69",$0.00,$911.01,$0.00,$0.00,$925.80,"$5,287.50",$0.00,"$2,643.75","$4,187.70","$4,230.00",$0.00,$827.49,$0.00,$841.77,$0.00
48221630,SUP,HCPCS C1713,,48221630  -  SCREW BONE 6.5MM 30MM POLYAX XIA STAINLESS STEEL SPN,"$5,287.50",$0.00,"$5,287.50","$2,379.38","$3,773.69",$0.00,$911.01,$0.00,$0.00,$925.80,"$5,287.50",$0.00,"$2,643.75","$4,187.70","$4,230.00",$0.00,$827.49,$0.00,$841.77,$0.00
48221635,SUP,HCPCS C1713,,48221635  -  SCREW BONE 6.5MM 35MM POLYAX XIA STAINLESS STEEL SPN,"$5,287.50",$0.00,"$5,287.50","$2,379.38","$3,773.69",$0.00,$911.01,$0.00,$0.00,$925.80,"$5,287.50",$0.00,"$2,643.75","$4,187.70","$4,230.00",$0.00,$827.49,$0.00,$841.77,$0.00
48221640,SUP,HCPCS C1713,,48221640  -  SCREW BONE 6.5MM 40MM POLYAX XIA STAINLESS STEEL SPN,"$5,287.50",$0.00,"$5,287.50","$2,379.38","$3,773.69",$0.00,$911.01,$0.00,$0.00,$925.80,"$5,287.50",$0.00,"$2,643.75","$4,187.70","$4,230.00",$0.00,$827.49,$0.00,$841.77,$0.00
48221645,SUP,HCPCS C1713,,48221645  -  SCREW BONE 6.5MM 45MM POLYAX XIA STAINLESS STEEL SPN,"$5,287.50",$0.00,"$5,287.50","$2,379.38","$3,773.69",$0.00,$911.01,$0.00,$0.00,$925.80,"$5,287.50",$0.00,"$2,643.75","$4,187.70","$4,230.00",$0.00,$827.49,$0.00,$841.77,$0.00
48221650,SUP,HCPCS C1713,,48221650  -  SCREW BONE 6.5MM 50MM POLYAX XIA STAINLESS STEEL SPN,"$5,287.50",$0.00,"$5,287.50","$2,379.38","$3,773.69",$0.00,$911.01,$0.00,$0.00,$925.80,"$5,287.50",$0.00,"$2,643.75","$4,187.70","$4,230.00",$0.00,$827.49,$0.00,$841.77,$0.00
48221655,SUP,HCPCS C1713,,48221655  -  SCREW BONE 6.5MM 55MM POLYAX XIA STAINLESS STEEL SPN,"$5,287.50",$0.00,"$5,287.50","$2,379.38","$3,773.69",$0.00,$911.01,$0.00,$0.00,$925.80,"$5,287.50",$0.00,"$2,643.75","$4,187.70","$4,230.00",$0.00,$827.49,$0.00,$841.77,$0.00
48221660,SUP,HCPCS C1713,,48221660  -  SCREW BONE 6.5MM 60MM POLYAX XIA STAINLESS STEEL SPN,"$5,287.50",$0.00,"$5,287.50","$2,379.38","$3,773.69",$0.00,$911.01,$0.00,$0.00,$925.80,"$5,287.50",$0.00,"$2,643.75","$4,187.70","$4,230.00",$0.00,$827.49,$0.00,$841.77,$0.00
48221670,SUP,HCPCS C1713,,48221670  -  SCREW BONE 6.5MM 70MM POLYAX XIA STAINLESS STEEL SPN,"$5,287.50",$0.00,"$5,287.50","$2,379.38","$3,773.69",$0.00,$911.01,$0.00,$0.00,$925.80,"$5,287.50",$0.00,"$2,643.75","$4,187.70","$4,230.00",$0.00,$827.49,$0.00,$841.77,$0.00
48221680,SUP,HCPCS C1713,,48221680  -  SCREW BONE 6.5MM 80MM POLYAX XIA STAINLESS STEEL SPN,"$5,287.50",$0.00,"$5,287.50","$2,379.38","$3,773.69",$0.00,$911.01,$0.00,$0.00,$925.80,"$5,287.50",$0.00,"$2,643.75","$4,187.70","$4,230.00",$0.00,$827.49,$0.00,$841.77,$0.00
48221690,SUP,HCPCS C1713,,48221690  -  SCREW BONE 6.5MM 90MM POLYAX XIA STAINLESS STEEL SPN,"$5,287.50",$0.00,"$5,287.50","$2,379.38","$3,773.69",$0.00,$911.01,$0.00,$0.00,$925.80,"$5,287.50",$0.00,"$2,643.75","$4,187.70","$4,230.00",$0.00,$827.49,$0.00,$841.77,$0.00
48221700,SUP,HCPCS C1713,,48221700  -  SCREW BONE 7.5MM 100MM POLYAX XIA STAINLESS STEEL SPN,"$5,287.50",$0.00,"$5,287.50","$2,379.38","$3,773.69",$0.00,$911.01,$0.00,$0.00,$925.80,"$5,287.50",$0.00,"$2,643.75","$4,187.70","$4,230.00",$0.00,$827.49,$0.00,$841.77,$0.00
48221730,SUP,HCPCS C1713,,48221730  -  SCREW BONE 7.5MM 30MM POLYAX XIA STAINLESS STEEL SPN,"$5,287.50",$0.00,"$5,287.50","$2,379.38","$3,773.69",$0.00,$911.01,$0.00,$0.00,$925.80,"$5,287.50",$0.00,"$2,643.75","$4,187.70","$4,230.00",$0.00,$827.49,$0.00,$841.77,$0.00
48221735,SUP,HCPCS C1713,,48221735  -  SCREW BONE 7.5MM 35MM POLYAX XIA STAINLESS STEEL SPN,"$5,287.50",$0.00,"$5,287.50","$2,379.38","$3,773.69",$0.00,$911.01,$0.00,$0.00,$925.80,"$5,287.50",$0.00,"$2,643.75","$4,187.70","$4,230.00",$0.00,$827.49,$0.00,$841.77,$0.00
48221740,SUP,HCPCS C1713,,48221740  -  SCREW BONE 7.5MM 40MM POLYAX XIA STAINLESS STEEL SPN,"$5,287.50",$0.00,"$5,287.50","$2,379.38","$3,773.69",$0.00,$911.01,$0.00,$0.00,$925.80,"$5,287.50",$0.00,"$2,643.75","$4,187.70","$4,230.00",$0.00,$827.49,$0.00,$841.77,$0.00
48221745,SUP,HCPCS C1713,,48221745  -  SCREW BONE 7.5MM 45MM POLYAX XIA STAINLESS STEEL SPN,"$5,287.50",$0.00,"$5,287.50","$2,379.38","$3,773.69",$0.00,$911.01,$0.00,$0.00,$925.80,"$5,287.50",$0.00,"$2,643.75","$4,187.70","$4,230.00",$0.00,$827.49,$0.00,$841.77,$0.00
48221750,SUP,HCPCS C1713,,48221750  -  SCREW BONE 7.5MM 50MM POLYAX XIA STAINLESS STEEL SPN,"$5,287.50",$0.00,"$5,287.50","$2,379.38","$3,773.69",$0.00,$911.01,$0.00,$0.00,$925.80,"$5,287.50",$0.00,"$2,643.75","$4,187.70","$4,230.00",$0.00,$827.49,$0.00,$841.77,$0.00
48221755,SUP,HCPCS C1713,,48221755  -  SCREW BONE 7.5MM 55MM POLYAX XIA STAINLESS STEEL SPN,"$5,287.50",$0.00,"$5,287.50","$2,379.38","$3,773.69",$0.00,$911.01,$0.00,$0.00,$925.80,"$5,287.50",$0.00,"$2,643.75","$4,187.70","$4,230.00",$0.00,$827.49,$0.00,$841.77,$0.00
48221760,SUP,HCPCS C1713,,48221760  -  SCREW BONE 7.5MM 60MM POLYAX XIA STAINLESS STEEL SPN,"$5,287.50",$0.00,"$5,287.50","$2,379.38","$3,773.69",$0.00,$911.01,$0.00,$0.00,$925.80,"$5,287.50",$0.00,"$2,643.75","$4,187.70","$4,230.00",$0.00,$827.49,$0.00,$841.77,$0.00
48221770,SUP,HCPCS C1713,,48221770  -  SCREW BONE 7.5MM 70MM POLYAX XIA STAINLESS STEEL SPN,"$5,287.50",$0.00,"$5,287.50","$2,379.38","$3,773.69",$0.00,$911.01,$0.00,$0.00,$925.80,"$5,287.50",$0.00,"$2,643.75","$4,187.70","$4,230.00",$0.00,$827.49,$0.00,$841.77,$0.00
48221780,SUP,HCPCS C1713,,48221780  -  SCREW BONE 7.5MM 80MM POLYAX XIA STAINLESS STEEL SPN,"$5,287.50",$0.00,"$5,287.50","$2,379.38","$3,773.69",$0.00,$911.01,$0.00,$0.00,$925.80,"$5,287.50",$0.00,"$2,643.75","$4,187.70","$4,230.00",$0.00,$827.49,$0.00,$841.77,$0.00
48221790,SUP,HCPCS C1713,,48221790  -  SCREW BONE 7.5MM 90MM POLYAX XIA STAINLESS STEEL SPN,"$5,287.50",$0.00,"$5,287.50","$2,379.38","$3,773.69",$0.00,$911.01,$0.00,$0.00,$925.80,"$5,287.50",$0.00,"$2,643.75","$4,187.70","$4,230.00",$0.00,$827.49,$0.00,$841.77,$0.00
48222000,SUP,Custom 27803010,,48222000  -  ROD SPINAL STANDARD 5.5MM 480MM XIA STAINLESS STEEL SCOLIOS,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
48222001,SUP,Custom 27803010,,48222001  -  ROD SPINAL STANDARD 5.5MM 480MM STIFF XIA STAINLESS STEEL,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
48222003,SUP,Custom 27803010,,48222003  -  ROD SPNL 5.5MM 480MM NS XIA STF HEX SS,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
48222600,SUP,Custom 27803010,,48222600  -  ROD SPINAL STANDARD 600MM XIA STAINLESS STEEL SCOLIOS,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
48222601,SUP,Custom 27803010,,48222601  -  ROD SPINAL 600MM STIFF XIA STAINLESS STEEL SCOLIOS,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
48222603,SUP,Custom 27803010,,48222603  -  ROD SPNL 5.5MM 600MM NS XIA STF HEX SS,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
48223425,SUP,HCPCS C1713,,48223425  -  SCREW BONE 4.5MM 25MM UNIPLNR XIA STAINLESS STEEL SPN,"$6,800.00",$0.00,"$6,800.00","$3,060.00","$4,853.16",$0.00,"$1,171.61",$0.00,$0.00,"$1,190.63","$6,800.00",$0.00,"$3,400.00","$5,385.60","$5,440.00",$0.00,"$1,064.20",$0.00,"$1,082.56",$0.00
48223430,SUP,HCPCS C1713,,48223430  -  SCREW BONE 4.5MM 30MM UNIPLNR XIA STAINLESS STEEL SPN,"$10,975.00",$0.00,"$10,975.00","$4,938.75","$5,158.80",$0.00,"$1,890.94",$0.00,$0.00,"$1,921.63","$10,975.00",$0.00,"$5,487.50","$8,692.20","$8,780.00",$0.00,"$1,717.59",$0.00,"$1,747.22",$0.00
48223435,SUP,HCPCS C1713,,48223435  -  SCREW BONE 4.5MM 35MM UNIPLNR XIA STAINLESS STEEL SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48223440,SUP,HCPCS C1713,,48223440  -  SCREW BONE 4.5MM 40MM UNIPLNR XIA STAINLESS STEEL SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48223445,SUP,HCPCS C1713,,48223445  -  SCREW BONE 4.5MM 45MM UNIPLNR XIA STAINLESS STEEL SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48223530,SUP,HCPCS C1713,,48223530  -  SCREW BONE 5.5MM 30MM UNIPLNR XIA STAINLESS STEEL SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48223535,SUP,HCPCS C1713,,48223535  -  SCREW BONE 5.5MM 35MM UNIPLNR XIA STAINLESS STEEL SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48223540,SUP,HCPCS C1713,,48223540  -  SCREW BONE 5.5MM 40MM UNIPLNR XIA STAINLESS STEEL SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48223545,SUP,HCPCS C1713,,48223545  -  SCREW BONE 5.5MM 45MM UNIPLNR XIA STAINLESS STEEL SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48223550,SUP,HCPCS C1713,,48223550  -  SCREW BONE 5.5MM 50MM UNIPLNR XIA STAINLESS STEEL SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48223630,SUP,HCPCS C1713,,48223630  -  SCREW BONE 6.5MM 30MM UNIPLNR XIA STAINLESS STEEL SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48223635,SUP,HCPCS C1713,,48223635  -  SCREW BONE 6.5MM 35MM UNIPLNR XIA STAINLESS STEEL SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48223640,SUP,HCPCS C1713,,48223640  -  SCREW BONE 6.5MM 40MM UNIPLNR XIA STAINLESS STEEL SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48223645,SUP,HCPCS C1713,,48223645  -  SCREW BONE 6.5MM 45MM UNIPLNR XIA STAINLESS STEEL SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48223650,SUP,HCPCS C1713,,48223650  -  SCREW BONE 6.5MM 50MM UNIPLNR XIA STAINLESS STEEL SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48227201,SUP,Custom 27803010,,48227201  -  HOOK SPINAL LONG ARM REDX STAINLESS STEEL LMNR,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48227202,SUP,Custom 27803010,,48227202  -  HOOK SPINAL LONG ARM REDX STAINLESS STEEL LMNR,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48227203,SUP,Custom 27803010,,48227203  -  HOOK SPINAL LONG ARM REDX STAINLESS STEEL LMNR,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48227211,SUP,Custom 27803010,,48227211  -  HOOK SPINAL LONG ARM REDX STAINLESS STEEL LMNR,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48227220,SUP,Custom 27803010,,48227220  -  HOOK SPINAL REDX LONG ARM STAINLESS STEEL PEDICLE,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48228425,SUP,HCPCS C1713,,48228425  -  SCREW BONE 4.5MM 25MM REDX LONG ARM MNOAX STAINLESS STEEL,"$6,300.00",$0.00,"$6,300.00","$2,835.00","$4,496.31",$0.00,"$1,085.46",$0.00,$0.00,"$1,103.08","$6,300.00",$0.00,"$3,150.00","$4,989.60","$5,040.00",$0.00,$985.95,$0.00,"$1,002.96",$0.00
48228430,SUP,HCPCS C1713,,48228430  -  SCREW BONE 4.5MM 30MM REDX LONG ARM MNOAX STAINLESS STEEL,"$6,300.00",$0.00,"$6,300.00","$2,835.00","$4,496.31",$0.00,"$1,085.46",$0.00,$0.00,"$1,103.08","$6,300.00",$0.00,"$3,150.00","$4,989.60","$5,040.00",$0.00,$985.95,$0.00,"$1,002.96",$0.00
48228435,SUP,HCPCS C1713,,48228435  -  SCREW BONE 4.5MM 35MM REDX LONG ARM MNOAX STAINLESS STEEL,"$6,300.00",$0.00,"$6,300.00","$2,835.00","$4,496.31",$0.00,"$1,085.46",$0.00,$0.00,"$1,103.08","$6,300.00",$0.00,"$3,150.00","$4,989.60","$5,040.00",$0.00,$985.95,$0.00,"$1,002.96",$0.00
48228440,SUP,HCPCS C1713,,48228440  -  SCREW BONE 4.5MM 40MM REDX LONG ARM MNOAX STAINLESS STEEL,"$6,300.00",$0.00,"$6,300.00","$2,835.00","$4,496.31",$0.00,"$1,085.46",$0.00,$0.00,"$1,103.08","$6,300.00",$0.00,"$3,150.00","$4,989.60","$5,040.00",$0.00,$985.95,$0.00,"$1,002.96",$0.00
48228445,SUP,HCPCS C1713,,48228445  -  SCREW BONE 4.5MM 45MM REDX LONG ARM MNOAX STAINLESS STEEL,"$6,300.00",$0.00,"$6,300.00","$2,835.00","$4,496.31",$0.00,"$1,085.46",$0.00,$0.00,"$1,103.08","$6,300.00",$0.00,"$3,150.00","$4,989.60","$5,040.00",$0.00,$985.95,$0.00,"$1,002.96",$0.00
48228530,SUP,HCPCS C1713,,48228530  -  SCREW BONE 5.5MM 30MM REDX MNOAX LONG ARM STAINLESS STEEL,"$6,300.00",$0.00,"$6,300.00","$2,835.00","$4,496.31",$0.00,"$1,085.46",$0.00,$0.00,"$1,103.08","$6,300.00",$0.00,"$3,150.00","$4,989.60","$5,040.00",$0.00,$985.95,$0.00,"$1,002.96",$0.00
48228535,SUP,HCPCS C1713,,48228535  -  SCREW BONE 5.5MM 35MM REDX LONG ARM MNOAX STAINLESS STEEL,"$6,300.00",$0.00,"$6,300.00","$2,835.00","$4,496.31",$0.00,"$1,085.46",$0.00,$0.00,"$1,103.08","$6,300.00",$0.00,"$3,150.00","$4,989.60","$5,040.00",$0.00,$985.95,$0.00,"$1,002.96",$0.00
48228540,SUP,HCPCS C1713,,48228540  -  SCREW BONE 5.5MM 40MM REDX LONG ARM MNOAX STAINLESS STEEL,"$6,300.00",$0.00,"$6,300.00","$2,835.00","$4,496.31",$0.00,"$1,085.46",$0.00,$0.00,"$1,103.08","$6,300.00",$0.00,"$3,150.00","$4,989.60","$5,040.00",$0.00,$985.95,$0.00,"$1,002.96",$0.00
48228545,SUP,HCPCS C1713,,48228545  -  SCREW BONE 5.5MM 45MM REDX LONG ARM MNOAX STAINLESS STEEL,"$6,300.00",$0.00,"$6,300.00","$2,835.00","$4,496.31",$0.00,"$1,085.46",$0.00,$0.00,"$1,103.08","$6,300.00",$0.00,"$3,150.00","$4,989.60","$5,040.00",$0.00,$985.95,$0.00,"$1,002.96",$0.00
48228550,SUP,HCPCS C1713,,48228550  -  SCREW BONE 5.5MM 50MM REDX LONG ARM MNOAX STAINLESS STEEL,"$6,300.00",$0.00,"$6,300.00","$2,835.00","$4,496.31",$0.00,"$1,085.46",$0.00,$0.00,"$1,103.08","$6,300.00",$0.00,"$3,150.00","$4,989.60","$5,040.00",$0.00,$985.95,$0.00,"$1,002.96",$0.00
48228555,SUP,HCPCS C1713,,48228555  -  SCREW BONE 5.5MM 55MM REDX LONG ARM MNOAX STAINLESS STEEL,"$6,300.00",$0.00,"$6,300.00","$2,835.00","$4,496.31",$0.00,"$1,085.46",$0.00,$0.00,"$1,103.08","$6,300.00",$0.00,"$3,150.00","$4,989.60","$5,040.00",$0.00,$985.95,$0.00,"$1,002.96",$0.00
48228630,SUP,HCPCS C1713,,48228630  -  SCREW BONE 6.5MM 30MM REDX LONG ARM MNOAX STAINLESS STEEL,"$6,300.00",$0.00,"$6,300.00","$2,835.00","$4,496.31",$0.00,"$1,085.46",$0.00,$0.00,"$1,103.08","$6,300.00",$0.00,"$3,150.00","$4,989.60","$5,040.00",$0.00,$985.95,$0.00,"$1,002.96",$0.00
48228635,SUP,HCPCS C1713,,48228635  -  SCREW BONE 6.5MM 35MM REDX LONG ARM MNOAX STAINLESS STEEL,"$6,300.00",$0.00,"$6,300.00","$2,835.00","$4,496.31",$0.00,"$1,085.46",$0.00,$0.00,"$1,103.08","$6,300.00",$0.00,"$3,150.00","$4,989.60","$5,040.00",$0.00,$985.95,$0.00,"$1,002.96",$0.00
48228640,SUP,HCPCS C1713,,48228640  -  SCREW BONE 6.5MM 40MM REDX LONG ARM MNOAX STAINLESS STEEL,"$6,300.00",$0.00,"$6,300.00","$2,835.00","$4,496.31",$0.00,"$1,085.46",$0.00,$0.00,"$1,103.08","$6,300.00",$0.00,"$3,150.00","$4,989.60","$5,040.00",$0.00,$985.95,$0.00,"$1,002.96",$0.00
48228645,SUP,HCPCS C1713,,48228645  -  SCREW BONE 6.5MM 45MM REDX LONG ARM MNOAX STAINLESS STEEL,"$6,300.00",$0.00,"$6,300.00","$2,835.00","$4,496.31",$0.00,"$1,085.46",$0.00,$0.00,"$1,103.08","$6,300.00",$0.00,"$3,150.00","$4,989.60","$5,040.00",$0.00,$985.95,$0.00,"$1,002.96",$0.00
48228650,SUP,HCPCS C1713,,48228650  -  SCREW BONE 6.5MM 50MM REDX LONG ARM MNOAX STAINLESS STEEL,"$6,300.00",$0.00,"$6,300.00","$2,835.00","$4,496.31",$0.00,"$1,085.46",$0.00,$0.00,"$1,103.08","$6,300.00",$0.00,"$3,150.00","$4,989.60","$5,040.00",$0.00,$985.95,$0.00,"$1,002.96",$0.00
48228655,SUP,HCPCS C1713,,48228655  -  SCREW BONE 6.5MM 55MM REDX LONG ARM MNOAX STAINLESS STEEL,"$6,212.50",$0.00,"$6,212.50","$2,795.63","$4,433.86",$0.00,"$1,070.38",$0.00,$0.00,"$1,087.76","$6,212.50",$0.00,"$3,106.25","$4,920.30","$4,970.00",$0.00,$972.26,$0.00,$989.03,$0.00
48228660,SUP,HCPCS C1713,,48228660  -  SCREW BONE 6.5MM 60MM REDX LONG ARM MNOAX STAINLESS STEEL,"$6,212.50",$0.00,"$6,212.50","$2,795.63","$4,433.86",$0.00,"$1,070.38",$0.00,$0.00,"$1,087.76","$6,212.50",$0.00,"$3,106.25","$4,920.30","$4,970.00",$0.00,$972.26,$0.00,$989.03,$0.00
48228730,SUP,HCPCS C1713,,48228730  -  SCREW BONE 7.5MM 30MM REDX LONG ARM MNOAX STAINLESS STEEL,"$6,212.50",$0.00,"$6,212.50","$2,795.63","$4,433.86",$0.00,"$1,070.38",$0.00,$0.00,"$1,087.76","$6,212.50",$0.00,"$3,106.25","$4,920.30","$4,970.00",$0.00,$972.26,$0.00,$989.03,$0.00
48228735,SUP,HCPCS C1713,,48228735  -  SCREW BONE 7.5MM 35MM REDX LONG ARM MNOAX STAINLESS STEEL,"$6,212.50",$0.00,"$6,212.50","$2,795.63","$4,433.86",$0.00,"$1,070.38",$0.00,$0.00,"$1,087.76","$6,212.50",$0.00,"$3,106.25","$4,920.30","$4,970.00",$0.00,$972.26,$0.00,$989.03,$0.00
48228740,SUP,HCPCS C1713,,48228740  -  SCREW BONE 7.5MM 40MM REDX LONG ARM MNOAX STAINLESS STEEL,"$6,212.50",$0.00,"$6,212.50","$2,795.63","$4,433.86",$0.00,"$1,070.38",$0.00,$0.00,"$1,087.76","$6,212.50",$0.00,"$3,106.25","$4,920.30","$4,970.00",$0.00,$972.26,$0.00,$989.03,$0.00
48228745,SUP,HCPCS C1713,,48228745  -  SCREW BONE 7.5MM 45MM REDX LONG ARM MNOAX STAINLESS STEEL,"$6,212.50",$0.00,"$6,212.50","$2,795.63","$4,433.86",$0.00,"$1,070.38",$0.00,$0.00,"$1,087.76","$6,212.50",$0.00,"$3,106.25","$4,920.30","$4,970.00",$0.00,$972.26,$0.00,$989.03,$0.00
48228750,SUP,HCPCS C1713,,48228750  -  SCREW BONE 7.5MM 50MM REDX LONG ARM MNOAX STAINLESS STEEL,"$6,212.50",$0.00,"$6,212.50","$2,795.63","$4,433.86",$0.00,"$1,070.38",$0.00,$0.00,"$1,087.76","$6,212.50",$0.00,"$3,106.25","$4,920.30","$4,970.00",$0.00,$972.26,$0.00,$989.03,$0.00
48228755,SUP,HCPCS C1713,,48228755  -  SCREW BONE 7.5MM 55MM REDX LONG ARM MNOAX STAINLESS STEEL,"$6,212.50",$0.00,"$6,212.50","$2,795.63","$4,433.86",$0.00,"$1,070.38",$0.00,$0.00,"$1,087.76","$6,212.50",$0.00,"$3,106.25","$4,920.30","$4,970.00",$0.00,$972.26,$0.00,$989.03,$0.00
48228760,SUP,HCPCS C1713,,48228760  -  SCREW BONE 7.5MM 60MM REDX LONG ARM MNOAX STAINLESS STEEL,"$6,212.50",$0.00,"$6,212.50","$2,795.63","$4,433.86",$0.00,"$1,070.38",$0.00,$0.00,"$1,087.76","$6,212.50",$0.00,"$3,106.25","$4,920.30","$4,970.00",$0.00,$972.26,$0.00,$989.03,$0.00
48229425,SUP,HCPCS C1713,,48229425  -  SCREW BONE LONG ARM 4.5MM 25MM POLYAX REDX XIA STAINLESS,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
48229430,SUP,HCPCS C1713,,48229430  -  SCREW BONE 4.5MM 30MM REDX LONG ARM POLYAX XIA STAINLESS,"$6,675.00",$0.00,"$6,675.00","$3,003.75","$4,763.95",$0.00,"$1,150.07",$0.00,$0.00,"$1,168.74","$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,"$1,044.64",$0.00,"$1,062.66",$0.00
48229435,SUP,HCPCS C1713,,48229435  -  SCREW BONE 4.5MM 35MM REDX LONG ARM POLYAX XIA STAINLESS,"$6,675.00",$0.00,"$6,675.00","$3,003.75","$4,763.95",$0.00,"$1,150.07",$0.00,$0.00,"$1,168.74","$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,"$1,044.64",$0.00,"$1,062.66",$0.00
48229440,SUP,HCPCS C1713,,48229440  -  SCREW BONE 4.5MM 40MM REDX LONG ARM POLYAX XIA STAINLESS,"$6,675.00",$0.00,"$6,675.00","$3,003.75","$4,763.95",$0.00,"$1,150.07",$0.00,$0.00,"$1,168.74","$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,"$1,044.64",$0.00,"$1,062.66",$0.00
48229445,SUP,HCPCS C1713,,48229445  -  SCREW BONE LONG ARM 4.5MM 45MM POLYAX REDX XIA STAINLESS,"$6,675.00",$0.00,"$6,675.00","$3,003.75","$4,763.95",$0.00,"$1,150.07",$0.00,$0.00,"$1,168.74","$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,"$1,044.64",$0.00,"$1,062.66",$0.00
48229530,SUP,HCPCS C1713,,48229530  -  SCREW BONE 5.5MM 30MM REDX LONG ARM POLYAX XIA STAINLESS,"$6,675.00",$0.00,"$6,675.00","$3,003.75","$4,763.95",$0.00,"$1,150.07",$0.00,$0.00,"$1,168.74","$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,"$1,044.64",$0.00,"$1,062.66",$0.00
48229535,SUP,HCPCS C1713,,48229535  -  SCREW BONE 5.5MM 35MM REDX LONG ARM POLYAX XIA STAINLESS,"$6,675.00",$0.00,"$6,675.00","$3,003.75","$4,763.95",$0.00,"$1,150.07",$0.00,$0.00,"$1,168.74","$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,"$1,044.64",$0.00,"$1,062.66",$0.00
48229540,SUP,HCPCS C1713,,48229540  -  SCREW BONE 5.5MM 40MM REDX LONG ARM POLYAX XIA STAINLESS,"$6,675.00",$0.00,"$6,675.00","$3,003.75","$4,763.95",$0.00,"$1,150.07",$0.00,$0.00,"$1,168.74","$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,"$1,044.64",$0.00,"$1,062.66",$0.00
48229545,SUP,HCPCS C1713,,48229545  -  SCREW BONE LONG ARM 5.5MM 45MM POLYAX REDX XIA STAINLESS,"$6,675.00",$0.00,"$6,675.00","$3,003.75","$4,763.95",$0.00,"$1,150.07",$0.00,$0.00,"$1,168.74","$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,"$1,044.64",$0.00,"$1,062.66",$0.00
48229550,SUP,HCPCS C1713,,48229550  -  SCREW BONE LONG ARM 5.5MM 50MM POLYAX REDX XIA STAINLESS,"$6,675.00",$0.00,"$6,675.00","$3,003.75","$4,763.95",$0.00,"$1,150.07",$0.00,$0.00,"$1,168.74","$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,"$1,044.64",$0.00,"$1,062.66",$0.00
48229555,SUP,HCPCS C1713,,48229555  -  SCREW BONE LONG ARM 5.5MM 55MM POLYAX REDX XIA STAINLESS,"$6,675.00",$0.00,"$6,675.00","$3,003.75","$4,763.95",$0.00,"$1,150.07",$0.00,$0.00,"$1,168.74","$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,"$1,044.64",$0.00,"$1,062.66",$0.00
48229630,SUP,HCPCS C1713,,48229630  -  SCREW BONE 6.5MM 30MM REDX LONG ARM POLYAX XIA STAINLESS,"$6,675.00",$0.00,"$6,675.00","$3,003.75","$4,763.95",$0.00,"$1,150.07",$0.00,$0.00,"$1,168.74","$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,"$1,044.64",$0.00,"$1,062.66",$0.00
48229635,SUP,HCPCS C1713,,48229635  -  SCREW BONE 6.5MM 35MM REDX LONG ARM POLYAX XIA STAINLESS,"$6,675.00",$0.00,"$6,675.00","$3,003.75","$4,763.95",$0.00,"$1,150.07",$0.00,$0.00,"$1,168.74","$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,"$1,044.64",$0.00,"$1,062.66",$0.00
48229640,SUP,HCPCS C1713,,48229640  -  SCREW BONE 6.5MM 40MM REDX LONG ARM POLYAX XIA STAINLESS,"$6,675.00",$0.00,"$6,675.00","$3,003.75","$4,763.95",$0.00,"$1,150.07",$0.00,$0.00,"$1,168.74","$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,"$1,044.64",$0.00,"$1,062.66",$0.00
48229645,SUP,HCPCS C1713,,48229645  -  SCREW BONE 6.5MM 45MM REDX LONG ARM POLYAX XIA STAINLESS,"$6,675.00",$0.00,"$6,675.00","$3,003.75","$4,763.95",$0.00,"$1,150.07",$0.00,$0.00,"$1,168.74","$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,"$1,044.64",$0.00,"$1,062.66",$0.00
48229650,SUP,HCPCS C1713,,48229650  -  SCREW BONE 6.5MM 50MM REDX LONG ARM POLYAX XIA STAINLESS,"$6,675.00",$0.00,"$6,675.00","$3,003.75","$4,763.95",$0.00,"$1,150.07",$0.00,$0.00,"$1,168.74","$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,"$1,044.64",$0.00,"$1,062.66",$0.00
48229655,SUP,HCPCS C1713,,48229655  -  SCREW BONE 6.5MM 55MM REDX LONG ARM POLYAX XIA STAINLESS,"$6,675.00",$0.00,"$6,675.00","$3,003.75","$4,763.95",$0.00,"$1,150.07",$0.00,$0.00,"$1,168.74","$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,"$1,044.64",$0.00,"$1,062.66",$0.00
48229660,SUP,HCPCS C1713,,48229660  -  SCREW BONE LONG ARM 6.5MM 60MM POLYAX REDX XIA STAINLESS,"$6,675.00",$0.00,"$6,675.00","$3,003.75","$4,763.95",$0.00,"$1,150.07",$0.00,$0.00,"$1,168.74","$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,"$1,044.64",$0.00,"$1,062.66",$0.00
48229730,SUP,HCPCS C1713,,48229730  -  SCREW BONE LONG ARM 7.5MM 30MM POLYAX REDX XIA STAINLESS,"$6,675.00",$0.00,"$6,675.00","$3,003.75","$4,763.95",$0.00,"$1,150.07",$0.00,$0.00,"$1,168.74","$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,"$1,044.64",$0.00,"$1,062.66",$0.00
48229735,SUP,HCPCS C1713,,48229735  -  SCREW BONE LONG ARM 7.5MM 35MM POLYAX REDX XIA STAINLESS,"$6,675.00",$0.00,"$6,675.00","$3,003.75","$4,763.95",$0.00,"$1,150.07",$0.00,$0.00,"$1,168.74","$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,"$1,044.64",$0.00,"$1,062.66",$0.00
48229740,SUP,HCPCS C1713,,48229740  -  SCREW BONE LONG ARM 7.5MM 40MM POLYAX REDX XIA STAINLESS,"$6,675.00",$0.00,"$6,675.00","$3,003.75","$4,763.95",$0.00,"$1,150.07",$0.00,$0.00,"$1,168.74","$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,"$1,044.64",$0.00,"$1,062.66",$0.00
48229745,SUP,HCPCS C1713,,48229745  -  SCREW BONE LONG ARM 7.5MM 45MM POLYAX REDX XIA STAINLESS,"$6,675.00",$0.00,"$6,675.00","$3,003.75","$4,763.95",$0.00,"$1,150.07",$0.00,$0.00,"$1,168.74","$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,"$1,044.64",$0.00,"$1,062.66",$0.00
48229750,SUP,HCPCS C1713,,48229750  -  SCREW BONE LONG ARM 7.5MM 50MM POLYAX REDX XIA STAINLESS,"$6,675.00",$0.00,"$6,675.00","$3,003.75","$4,763.95",$0.00,"$1,150.07",$0.00,$0.00,"$1,168.74","$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,"$1,044.64",$0.00,"$1,062.66",$0.00
48229755,SUP,HCPCS C1713,,48229755  -  SCREW BONE LONG ARM 7.5MM 55MM POLYAX REDX XIA STAINLESS,"$6,675.00",$0.00,"$6,675.00","$3,003.75","$4,763.95",$0.00,"$1,150.07",$0.00,$0.00,"$1,168.74","$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,"$1,044.64",$0.00,"$1,062.66",$0.00
48229760,SUP,HCPCS C1713,,48229760  -  BLOCKER SPNL XIA 3 TI SPNE,"$6,675.00",$0.00,"$6,675.00","$3,003.75","$4,763.95",$0.00,"$1,150.07",$0.00,$0.00,"$1,168.74","$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,"$1,044.64",$0.00,"$1,062.66",$0.00
48230000,SUP,Custom 27803010,,48230000  -  SCREW SET BLOCKER XIA 3 TITANIUM SPN,$125.00,$0.00,$125.00,$0.00,$89.21,$0.00,$0.00,$0.00,$0.00,$0.00,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$0.00,$0.00,$0.00,$0.00
48230133,SUP,Custom 27803010,,48230133  -  CONNECTOR ROD LARGE OFFST ILIAC PELVIC,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
48230138,SUP,Custom 27803010,,48230138  -  CONNECTOR ROD SMALL REVISION OFFST ILIOSACRAL SPN,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
48230139,SUP,Custom 27803010,,48230139  -  CONNECTOR ROD LONG REVISION OFFST XIA 3 ILIOSACRAL,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
48230141,SUP,Custom 27803010,,48230141  -  CONNECTOR ROD SMALL 7MM REVISION ROD TO ROD PARALLEL XIA 3,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
48230143,SUP,Custom 27803010,,48230143  -  CONNECTOR ROD REVISION J HOOK OFFST ILIOSACRAL,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
48230144,SUP,Custom 27803010,,48230144  -  CONNECTOR ROD REVISION OFFST ILIOSACRAL,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
48230201,SUP,Custom 27803010,,48230201  -  HOOK SPINAL NARROW BLADE XIA TITANIUM LMNR,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48230202,SUP,Custom 27803010,,48230202  -  HOOK SPINAL LARGE XIA TITANIUM LMNR,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48230203,SUP,Custom 27803010,,48230203  -  HOOK SPINAL NARROW BLADE XIA TITANIUM LMNR,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48230204,SUP,Custom 27803010,,48230204  -  HOOK SPINAL EXTENDED BODY XIA TITANIUM LMNR,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48230205,SUP,Custom 27803010,,48230205  -  HOOK SPINAL EXTENDED BODY XIA 3 TITANIUM LMNR,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48230206,SUP,Custom 27803010,,48230206  -  HOOK SPINAL RIGHT OFFST XIA LMNR,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48230207,SUP,Custom 27803010,,48230207  -  HOOK SPINAL LEFT OFFST XIA LMNR,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48230208,SUP,Custom 27803010,,48230208  -  HOOK SPINAL ANGLED BLADE XIA TITANIUM LMNR,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48230209,SUP,Custom 27803010,,48230209  -  HOOK SPINAL ANGLED BLADE XIA TITANIUM LMNR,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48230210,SUP,Custom 27803010,,48230210  -  HOOK SPINAL OPEN XIA THORACIC,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48230211,SUP,Custom 27803010,,48230211  -  HOOK SPINAL NARROW BLADE XIA TITANIUM LMNR THORACIC,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48230212,SUP,Custom 27803010,,48230212  -  HOOK SPINAL XIA RIGHT LMNR THORACIC,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48230213,SUP,Custom 27803010,,48230213  -  HOOK SPINAL XIA LEFT LMNR THORACIC,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48230214,SUP,Custom 27803010,,48230214  -  HOOK SPINAL LARGE OFFST XIA 3 TITANIUM RIGHT LMNR THORACIC,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48230215,SUP,Custom 27803010,,48230215  -  HOOK SPINAL LARGE OFFST XIA 3 TITANIUM LEFT LMNR THORACIC,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48230216,SUP,Custom 27803010,,48230216  -  HOOK SPINAL SMALL XIA TITANIUM LMNR THORACIC,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48230217,SUP,Custom 27803010,,48230217  -  HOOK SPNL XIA LG TI RIGHT OFFST,"$2,687.35",$0.00,"$2,687.35",$0.00,"$1,917.96",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,687.35",$0.00,"$1,343.68","$2,128.38","$2,149.88",$0.00,$0.00,$0.00,$0.00,$0.00
48230218,SUP,Custom 27803010,,48230218  -  HOOK SPNL XIA LG TI LEFT OFFST,"$2,687.35",$0.00,"$2,687.35",$0.00,"$1,917.96",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,687.35",$0.00,"$1,343.68","$2,128.38","$2,149.88",$0.00,$0.00,$0.00,$0.00,$0.00
48230220,SUP,Custom 27803010,,48230220  -  HOOK SPINAL SMALL XIA TITANIUM PEDICLE,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48230221,SUP,Custom 27803010,,48230221  -  HOOK SPINAL MEDIUM XIA TITANIUM PEDICLE,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48230222,SUP,Custom 27803010,,48230222  -  HOOK SPINAL LARGE XIA TITANIUM PEDICLE,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48230230,SUP,HCPCS C1713,,48230230  -  WIRE FIX SHARP CANN KWIRE SPN,$125.00,$0.00,$125.00,$56.25,$89.21,$0.00,$21.54,$0.00,$0.00,$21.89,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$19.56,$0.00,$19.90,$0.00
48230231,SUP,HCPCS C1713,,48230231  -  WIRE FIX BLUNT KWIRE,$125.00,$0.00,$125.00,$56.25,$89.21,$0.00,$21.54,$0.00,$0.00,$21.89,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$19.56,$0.00,$19.90,$0.00
48230232,SUP,Custom 27803010,,48230232  -  HOOK SPINAL TRNSVRS PROCESS XIA TITANIUM RIGHT,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48230233,SUP,Custom 27803010,,48230233  -  HOOK SPINAL TRNSVRS PROCESS XIA TITANIUM LEFT,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48230240,SUP,Custom 27803010,,48230240  -  HOOK SPINAL NARROW BLADE XIA TITANIUM LMNR,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48230241,SUP,Custom 27803010,,48230241  -  HOOK SPINAL XIA TITANIUM LMNR,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48230250,SUP,Custom 27803010,,48230250  -  HOOK SPINAL MEDIUM LMNR,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48230260,SUP,Custom 27803010,,48230260  -  HOOK SPINAL REVISION ILIOSACRAL,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48231535,SUP,HCPCS C1713,,48231535  -  SCREW BONE 5.5MM 35MM CANN XIA TITANIUM SPN THORACOLUMBAR,"$2,612.50",$0.00,"$2,612.50","$1,175.63","$1,864.54",$0.00,$450.12,$0.00,$0.00,$457.43,"$2,612.50",$0.00,"$1,306.25","$2,069.10","$2,090.00",$0.00,$408.86,$0.00,$415.91,$0.00
48231540,SUP,HCPCS C1713,,48231540  -  SCREW BONE 5.5MM 40MM CANN XIA TITANIUM SPN THORACOLUMBAR,"$2,612.50",$0.00,"$2,612.50","$1,175.63","$1,864.54",$0.00,$450.12,$0.00,$0.00,$457.43,"$2,612.50",$0.00,"$1,306.25","$2,069.10","$2,090.00",$0.00,$408.86,$0.00,$415.91,$0.00
48231545,SUP,HCPCS C1713,,48231545  -  SCREW BONE 5.5MM 45MM CANN XIA TITANIUM SPN THORACOLUMBAR,"$2,612.50",$0.00,"$2,612.50","$1,175.63","$1,864.54",$0.00,$450.12,$0.00,$0.00,$457.43,"$2,612.50",$0.00,"$1,306.25","$2,069.10","$2,090.00",$0.00,$408.86,$0.00,$415.91,$0.00
48231550,SUP,HCPCS C1713,,48231550  -  SCREW BONE 5.5MM 50MM CANN XIA TITANIUM SPN THORACOLUMBAR,"$2,612.50",$0.00,"$2,612.50","$1,175.63","$1,864.54",$0.00,$450.12,$0.00,$0.00,$457.43,"$2,612.50",$0.00,"$1,306.25","$2,069.10","$2,090.00",$0.00,$408.86,$0.00,$415.91,$0.00
48231630,SUP,HCPCS C1713,,48231630  -  SCREW BONE 6.5MM 30MM CANN XIA TITANIUM SPN THORACOLUMBAR,"$2,612.50",$0.00,"$2,612.50","$1,175.63","$1,864.54",$0.00,$450.12,$0.00,$0.00,$457.43,"$2,612.50",$0.00,"$1,306.25","$2,069.10","$2,090.00",$0.00,$408.86,$0.00,$415.91,$0.00
48231635,SUP,HCPCS C1713,,48231635  -  SCREW BONE 6.5MM 35MM CANN XIA TITANIUM SPN THORACOLUMBAR,"$2,612.50",$0.00,"$2,612.50","$1,175.63","$1,864.54",$0.00,$450.12,$0.00,$0.00,$457.43,"$2,612.50",$0.00,"$1,306.25","$2,069.10","$2,090.00",$0.00,$408.86,$0.00,$415.91,$0.00
48231640,SUP,HCPCS C1713,,48231640  -  SCREW BONE 6.5MM 40MM CANN XIA TITANIUM SPN THORACOLUMBAR,"$2,612.50",$0.00,"$2,612.50","$1,175.63","$1,864.54",$0.00,$450.12,$0.00,$0.00,$457.43,"$2,612.50",$0.00,"$1,306.25","$2,069.10","$2,090.00",$0.00,$408.86,$0.00,$415.91,$0.00
48231645,SUP,HCPCS C1713,,48231645  -  SCREW BONE 6.5MM 45MM CANN XIA TITANIUM SPN THORACOLUMBAR,"$2,612.50",$0.00,"$2,612.50","$1,175.63","$1,864.54",$0.00,$450.12,$0.00,$0.00,$457.43,"$2,612.50",$0.00,"$1,306.25","$2,069.10","$2,090.00",$0.00,$408.86,$0.00,$415.91,$0.00
48231650,SUP,HCPCS C1713,,48231650  -  SCREW BONE 6.5MM 50MM CANN XIA TITANIUM SPN THORACOLUMBAR,"$2,612.50",$0.00,"$2,612.50","$1,175.63","$1,864.54",$0.00,$450.12,$0.00,$0.00,$457.43,"$2,612.50",$0.00,"$1,306.25","$2,069.10","$2,090.00",$0.00,$408.86,$0.00,$415.91,$0.00
48231655,SUP,HCPCS C1713,,48231655  -  SCREW BN 6.5MM 50MM XIA 3 PA TI SPNE THORLMBR,"$2,612.50",$0.00,"$2,612.50","$1,175.63","$1,864.54",$0.00,$450.12,$0.00,$0.00,$457.43,"$2,612.50",$0.00,"$1,306.25","$2,069.10","$2,090.00",$0.00,$408.86,$0.00,$415.91,$0.00
48231730,SUP,HCPCS C1713,,48231730  -  SCREW BONE 7.5MM 30MM CANN XIA TITANIUM SPN THORACOLUMBAR,"$2,612.50",$0.00,"$2,612.50","$1,175.63","$1,864.54",$0.00,$450.12,$0.00,$0.00,$457.43,"$2,612.50",$0.00,"$1,306.25","$2,069.10","$2,090.00",$0.00,$408.86,$0.00,$415.91,$0.00
48231735,SUP,HCPCS C1713,,48231735  -  SCREW BONE 7.5MM 35MM CANN XIA TITANIUM SPN THORACOLUMBAR,"$2,612.50",$0.00,"$2,612.50","$1,175.63","$1,864.54",$0.00,$450.12,$0.00,$0.00,$457.43,"$2,612.50",$0.00,"$1,306.25","$2,069.10","$2,090.00",$0.00,$408.86,$0.00,$415.91,$0.00
48231740,SUP,HCPCS C1713,,48231740  -  SCREW BONE 7.5MM 40MM CANN XIA TITANIUM SPN THORACOLUMBAR,"$2,612.50",$0.00,"$2,612.50","$1,175.63","$1,864.54",$0.00,$450.12,$0.00,$0.00,$457.43,"$2,612.50",$0.00,"$1,306.25","$2,069.10","$2,090.00",$0.00,$408.86,$0.00,$415.91,$0.00
48231745,SUP,HCPCS C1713,,48231745  -  SCREW BN 7.5MM 45MM XIA 3 PA TI SPNE THORLMBR,"$2,612.50",$0.00,"$2,612.50","$1,175.63","$1,864.54",$0.00,$450.12,$0.00,$0.00,$457.43,"$2,612.50",$0.00,"$1,306.25","$2,069.10","$2,090.00",$0.00,$408.86,$0.00,$415.91,$0.00
48231750,SUP,HCPCS C1713,,48231750  -  SCREW BONE 7.5MM 50MM CANN XIA TITANIUM SPN THORACOLUMBAR,"$2,612.50",$0.00,"$2,612.50","$1,175.63","$1,864.54",$0.00,$450.12,$0.00,$0.00,$457.43,"$2,612.50",$0.00,"$1,306.25","$2,069.10","$2,090.00",$0.00,$408.86,$0.00,$415.91,$0.00
48231755,SUP,HCPCS C1713,,48231755  -  SCREW BN 7.5MM 50MM XIA CNN TI SPNE THORLMBR,"$2,612.50",$0.00,"$2,612.50","$1,175.63","$1,864.54",$0.00,$450.12,$0.00,$0.00,$457.43,"$2,612.50",$0.00,"$1,306.25","$2,069.10","$2,090.00",$0.00,$408.86,$0.00,$415.91,$0.00
48232030,SUP,Custom 27803010,,48232030  -  ROD SPINAL 6MM 30MM COMPRESSION XIA TITANIUM,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
48232040,SUP,Custom 27803010,,48232040  -  ROD SPINAL 40MM XIA,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
48232050,SUP,Custom 27803010,,48232050  -  ROD SPINAL 6MM 50MM COMPRESSION XIA TITANIUM,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
48232060,SUP,Custom 27803010,,48232060  -  ROD SPINAL 6MM 60MM COMPRESSION XIA TITANIUM,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
48232070,SUP,Custom 27803010,,48232070  -  ROD SPINAL 6MM 70MM COMPRESSION XIA TITANIUM,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
48232080,SUP,Custom 27803010,,48232080  -  ROD SPINAL 6MM 80MM COMPRESSION XIA TITANIUM,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
48232090,SUP,Custom 27803010,,48232090  -  ROD SPINAL 6MM 90MM COMPRESSION XIA TITANIUM,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
48232100,SUP,Custom 27803010,,48232100  -  ROD SPINAL 6MM 100MM COMPRESSION XIA TITANIUM,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
48232110,SUP,Custom 27803010,,48232110  -  ROD SPINAL 6MM 110MM COMPRESSION XIA TITANIUM,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
48232120,SUP,Custom 27803010,,48232120  -  ROD SPINAL 6MM 120MM COMPRESSION XIA TITANIUM,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
48232130,SUP,Custom 27803010,,48232130  -  ROD SPINAL 6MM 130MM COMPRESSION XIA TITANIUM,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
48232140,SUP,Custom 27803010,,48232140  -  ROD SPINAL 6MM 140MM COMPRESSION XIA TITANIUM,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
48232150,SUP,Custom 27803010,,48232150  -  ROD SPINAL 6MM 30MM XIA 3 TITANIUM RAD,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
48232480,SUP,Custom 27803010,,48232480  -  ROD SPINAL 6MM 480MM COMPRESSION XIA TITANIUM,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
48232600,SUP,Custom 27803010,,48232600  -  ROD SPINAL 6MM 600MM COMPRESSION XIA TITANIUM,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
48233030,SUP,Custom 27803010,,48233030  -  ROD SPINAL 6MM 30MM XIA 3 TITANIUM,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
48233040,SUP,Custom 27803010,,48233040  -  ROD SPINAL 6MM 40MM XIA 3 TITANIUM,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
48233050,SUP,Custom 27803010,,48233050  -  ROD SPINAL 6MM 50MM XIA 3 TITANIUM,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
48233060,SUP,Custom 27803010,,48233060  -  ROD SPINAL 6MM 60MM XIA 3 TITANIUM,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
48233070,SUP,Custom 27803010,,48233070  -  ROD SPINAL 6MM 70MM XIA TITANIUM,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
48233080,SUP,Custom 27803010,,48233080  -  ROD SPINAL 6MM 80MM XIA TITANIUM ALLOY,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
48233090,SUP,Custom 27803010,,48233090  -  ROD SPINAL 6MM 90MM XIA TITANIUM,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
48233100,SUP,Custom 27803010,,48233100  -  ROD SPINAL 100MM STR DIAPASON XIA,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
48233110,SUP,Custom 27803010,,48233110  -  ROD SPINAL 110MM STR DIAPASON XIA,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
48233120,SUP,Custom 27803010,,48233120  -  ROD SPINAL 6MM 120MM XIA TITANIUM ALLOY,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
48233130,SUP,Custom 27803010,,48233130  -  ROD SPINAL 6MM 13MM XIA TITANIUM ALLOY,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
48233140,SUP,Custom 27803010,,48233140  -  ROD SPINAL 6MM 14MM XIA TITANIUM ALLOY,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
48233150,SUP,Custom 27803010,,48233150  -  ROD SPINAL 6MM 15MM XIA TITANIUM ALLOY,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
48233420,SUP,HCPCS C1713,,48233420  -  SCREW BONE 4.5MM 20MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48233425,SUP,HCPCS C1713,,48233425  -  SCREW BONE 4.5MM 25MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48233430,SUP,HCPCS C1713,,48233430  -  SCREW BONE 4.5MM 30MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48233435,SUP,HCPCS C1713,,48233435  -  SCREW BONE 4.5MM 35MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48233440,SUP,HCPCS C1713,,48233440  -  SCREW BONE 4.5MM 40MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48233445,SUP,HCPCS C1713,,48233445  -  SCREW BONE 4.5MM 45MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48233480,SUP,HCPCS C1713,,48233480  -  ROD SPINAL 6MM 480MM XIA 3,$437.50,$0.00,$437.50,$196.88,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
48233500,SUP,HCPCS C1713,,48233500  -  SCREW SET M6 NS XIA 3 SPNE,$125.00,$0.00,$125.00,$56.25,$89.21,$0.00,$21.54,$0.00,$0.00,$21.89,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$19.56,$0.00,$19.90,$0.00
48233520,SUP,HCPCS C1713,,48233520  -  SCREW BONE 5.5MM 20MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48233525,SUP,HCPCS C1713,,48233525  -  SCREW BONE 5.5MM 25MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48233530,SUP,HCPCS C1713,,48233530  -  SCREW BONE 5.5MM 30MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48233535,SUP,HCPCS C1713,,48233535  -  SCREW BONE 5.5MM 35MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48233540,SUP,HCPCS C1713,,48233540  -  SCREW BONE 5.5MM 40MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48233545,SUP,HCPCS C1713,,48233545  -  SCREW BONE 5.5MM 45MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48233550,SUP,HCPCS C1713,,48233550  -  SCREW BONE 5.5MM 50MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48233555,SUP,HCPCS C1713,,48233555  -  SCREW BONE 5.5MM 55MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48233600,SUP,Custom 27803010,,48233600  -  ROD SPINAL 6MM 60MM XIA TITANIUM ALLOY,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
48233625,SUP,HCPCS C1713,,48233625  -  SCREW BONE 6.5MM 25MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48233630,SUP,HCPCS C1713,,48233630  -  SCREW BONE 6.5MM 30MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48233635,SUP,HCPCS C1713,,48233635  -  SCREW BONE 6.5MM 35MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48233640,SUP,HCPCS C1713,,48233640  -  SCREW BONE 6.5MM 40MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48233645,SUP,HCPCS C1713,,48233645  -  SCREW BONE 6.5MM 45MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48233650,SUP,HCPCS C1713,,48233650  -  SCREW BONE 6.5MM 50MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48233655,SUP,HCPCS C1713,,48233655  -  SCREW BONE 6.5MM 55MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48233660,SUP,HCPCS C1713,,48233660  -  SCREW BONE 6.5MM 60MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48233730,SUP,HCPCS C1713,,48233730  -  SCREW BONE 7.5MM 30MM UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48233735,SUP,HCPCS C1713,,48233735  -  SCREW BONE 7.5MM 35MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48233740,SUP,HCPCS C1713,,48233740  -  SCREW BONE 7.5MM 40MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48233745,SUP,HCPCS C1713,,48233745  -  SCREW BONE 7.5MM 45MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48233750,SUP,HCPCS C1713,,48233750  -  SCREW BONE 7.5MM 50MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48233755,SUP,HCPCS C1713,,48233755  -  SCREW BONE 7.5MM 55MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48233760,SUP,HCPCS C1713,,48233760  -  SCREW BONE 7.5MM 60MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48235007,SUP,HCPCS C1713,,48235007  -  SCREW BONE REVISION SPN ILIOSACRAL,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
48235008,SUP,Custom 27803010,,48235008  -  CONNECTOR ROD REVISION ILIOSACRAL,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
48235009,SUP,Custom 27803010,,48235009  -  CONNECTOR ROD LARGE PARALLEL 11MM XIA 3 TITANIUM SPN,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
48235010,SUP,HCPCS C1713,,48235010  -  SCREW BONE REVISION PARALLEL ILIOSACRAL,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
48235011,SUP,Custom 27803010,,48235011  -  CONNECTOR ROD REVISION ROD TO ROD PARALLEL ILIOSACRAL,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
48235012,SUP,Custom 27803010,,48235012  -  CONNECTOR ROD REVISION ROD TO ROD ILIOSACRAL,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
48236014,SUP,Custom 27803010,,48236014  -  CROSSLINK SPINAL 14MM MONOBLOCK XIA TITANIUM,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48236015,SUP,Custom 27803010,,48236015  -  CROSSLINK SPINAL 15MM MONOBLOCK XIA 3 TITANIUM,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48236016,SUP,Custom 27803010,,48236016  -  CROSSLINK SPINAL 16MM MONOBLOCK XIA 3 TITANIUM,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48236017,SUP,Custom 27803010,,48236017  -  CROSSLINK SPINAL 17MM MONOBLOCK XIA 3 TITANIUM,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48236018,SUP,Custom 27803010,,48236018  -  CROSSLINK SPINAL 18MM MONOBLOCK XIA 3 TITANIUM,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48236019,SUP,Custom 27803010,,48236019  -  CROSSLINK SPINAL 19MM MONOBLOCK XIA 3 TITANIUM,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48236020,SUP,Custom 27803010,,48236020  -  CROSSLINK SPINAL 20MM MONOBLOCK XIA 3 TITANIUM,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48236022,SUP,Custom 27803010,,48236022  -  CROSSLINK SPINAL 22MM MONOBLOCK XIA 3 TITANIUM,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48236024,SUP,Custom 27803010,,48236024  -  CROSSLINK SPINAL 24MM MONOBLOCK XIA TITANIUM,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48236026,SUP,HCPCS C1713,,48236026  -  SCREW BONE 26MM MONOBLOCK SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48236028,SUP,Custom 27803010,,48236028  -  CONNECTOR ROD 28-31MM MULTIAX CROSS XIA 3 TITANIUM,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48236030,SUP,Custom 27803010,,48236030  -  CONNECTOR ROD 35-44MM XIA 3 MA CX TI THORLMBR SPNE,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48236035,SUP,Custom 27803010,,48236035  -  CONNECTOR ROD 35-44MM MULTIAX CROSS XIA 3 TITANIUM,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48236043,SUP,Custom 27803010,,48236043  -  CONNECTOR ROD 70-99MM XIA 3 MA CX TI THORLMBR SPNE,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48236053,SUP,Custom 27803010,,48236053  -  CONNECTOR ROD 53-73MM MULTIAX CROSS XIA 3 TITANIUM,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48236070,SUP,HCPCS C1713,,48236070  -  CONNECTOR ROD 70-99MM MULTIAX CROSS XIA 3 TITANIUM,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48236540,SUP,HCPCS C1713,,48236540  -  SCREW BONE 6.5MM 40MM REVISION ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48236550,SUP,HCPCS C1713,,48236550  -  SCREW BONE 6.5MM 50MM REVISION ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48236560,SUP,HCPCS C1713,,48236560  -  SCREW BONE 6.5MM 60MM REVISION ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48237105,SUP,Custom 27203010,,48237105  -  NEEDLE BIOP 10GA 5IN JAMSHIDI,$73.55,$0.00,$73.55,$0.00,$52.49,$0.00,$0.00,$0.00,$0.00,$0.00,$73.55,$0.00,$36.78,$58.25,$58.84,$0.00,$0.00,$0.00,$0.00,$0.00
48237110,SUP,Custom 27203010,,48237110  -  BLADE SURG 10GA 9IN JAMSHIDI,$73.55,$0.00,$73.55,$0.00,$52.49,$0.00,$0.00,$0.00,$0.00,$0.00,$73.55,$0.00,$36.78,$58.25,$58.84,$0.00,$0.00,$0.00,$0.00,$0.00
48237115,SUP,HCPCS C1713,,48237115  -  WIRE FIX JAMSHIDI SPN,$73.55,$0.00,$73.55,$33.10,$52.49,$0.00,$12.67,$0.00,$0.00,$12.88,$73.55,$0.00,$36.78,$58.25,$58.84,$0.00,$11.51,$0.00,$11.71,$0.00
48237135,SUP,Custom 27203010,,48237135  -  NEEDLE BIOP 13GA 5IN,$73.55,$0.00,$73.55,$0.00,$52.49,$0.00,$0.00,$0.00,$0.00,$0.00,$73.55,$0.00,$36.78,$58.25,$58.84,$0.00,$0.00,$0.00,$0.00,$0.00
48237540,SUP,HCPCS C1713,,48237540  -  SCREW BONE 7.5MM 40MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48237550,SUP,HCPCS C1713,,48237550  -  SCREW BONE 7.5MM 50MM REVISION ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48237560,SUP,HCPCS C1713,,48237560  -  SCREW BONE 7.5MM 60MM REVISION ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48238030,SUP,Custom 27803010,,48238030  -  ROD SPINAL 6MM 30MM RADIOLUCENT XIA 3 TITANIUM,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
48238035,SUP,Custom 27803010,,48238035  -  ROD SPINAL 6MM 35MM RADIOLUCENT XIA 3 TITANIUM,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
48238040,SUP,Custom 27803010,,48238040  -  ROD SPINAL 6MM 40MM RADIOLUCENT XIA 3 TITANIUM,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
48238045,SUP,Custom 27803010,,48238045  -  ROD SPINAL 6MM 45MM RADIOLUCENT XIA 3 TITANIUM,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
48238050,SUP,Custom 27803010,,48238050  -  ROD SPINAL 6MM 50MM RADIOLUCENT XIA 3 TITANIUM,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
48238060,SUP,Custom 27803010,,48238060  -  ROD SPINAL 6MM 60MM RADIOLUCENT XIA 3 TITANIUM,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
48238070,SUP,Custom 27803010,,48238070  -  ROD SPINAL 6MM 70MM RADIOLUCENT XIA 3 TITANIUM,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
48238080,SUP,Custom 27803010,,48238080  -  ROD SPINAL 6MM 80MM RADIOLUCENT XIA 3 TITANIUM,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
48238090,SUP,Custom 27803010,,48238090  -  ROD SPINAL 6MM 90MM RADIOLUCENT XIA 3 TITANIUM,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
48238100,SUP,Custom 27803010,,48238100  -  ROD SPINAL 6MM 100MM XIA 3 TITANIUM,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
48238110,SUP,Custom 27803010,,48238110  -  ROD SPINAL 6MM 110MM XIA TITANIUM,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
48238120,SUP,Custom 27803010,,48238120  -  ROD SPINAL 6MM 120MM XIA TITANIUM,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
48238540,SUP,HCPCS C1713,,48238540  -  SCREW BONE 8.5MM 40MM REVISION ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48238550,SUP,HCPCS C1713,,48238550  -  SCREW BONE 8.5MM 50MM REVISION ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48238560,SUP,HCPCS C1713,,48238560  -  SCREW BONE 8.5MM 60MM REVISION ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48239050,SUP,Custom 27803010,,48239050  -  ROD SPNL 50MM XIA 2 BND,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
48239060,SUP,Custom 27803010,,48239060  -  ROD SPINAL 60MM MAX XIA,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
48239070,SUP,Custom 27803010,,48239070  -  ROD SPINAL 70MM XIA MAX,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
48239080,SUP,Custom 27803010,,48239080  -  ROD SPINAL 80MM XIA MAXL,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
48239090,SUP,Custom 27803010,,48239090  -  ROD SPINAL 90MM RAD MAX,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
48239100,SUP,Custom 27803010,,48239100  -  ROD SPINAL 100MM RAD XIA,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
48239110,SUP,Custom 27803010,,48239110  -  ROD SPINAL 110MM RAD XIA,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
48239120,SUP,Custom 27803010,,48239120  -  ROD SPINAL 120MM RAD XIA,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
48239540,SUP,HCPCS C1713,,48239540  -  SCREW BONE 9.5MM 40MM REVISION ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48239550,SUP,HCPCS C1713,,48239550  -  SCREW BONE 9.5MM 50MM REVISION ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48239560,SUP,HCPCS C1713,,48239560  -  SCREW BONE 9.5MM 60MM REVISION ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48250210,SUP,Custom 27203010,,48250210  -  RETRACTOR FIBER OPTIC LUXOR,$597.13,$0.00,$597.13,$0.00,$426.17,$0.00,$0.00,$0.00,$0.00,$0.00,$597.13,$0.00,$298.56,$472.93,$477.70,$0.00,$0.00,$0.00,$0.00,$0.00
48251040,SUP,Custom 27803010,,48251040  -  SLEEVE RB 40MM LUXOR SIL,$906.95,$0.00,$906.95,$0.00,$647.29,$0.00,$0.00,$0.00,$0.00,$0.00,$906.95,$0.00,$453.48,$718.30,$725.56,$0.00,$0.00,$0.00,$0.00,$0.00
48251050,SUP,Custom 27803010,,48251050  -  SLEEVE RB 50MM LUXOR SIL,$906.95,$0.00,$906.95,$0.00,$647.29,$0.00,$0.00,$0.00,$0.00,$0.00,$906.95,$0.00,$453.48,$718.30,$725.56,$0.00,$0.00,$0.00,$0.00,$0.00
48251060,SUP,Custom 27803010,,48251060  -  SPREADER SURG OVAL 60MM SLEEVE LUXOR SILICONE THORACOLUMBAR,$906.95,$0.00,$906.95,$0.00,$647.29,$0.00,$0.00,$0.00,$0.00,$0.00,$906.95,$0.00,$453.48,$718.30,$725.56,$0.00,$0.00,$0.00,$0.00,$0.00
48251070,SUP,Custom 27803010,,48251070  -  SPREADER SURG OVAL 70MM SLEEVE LUXOR SILICONE SPN,$906.95,$0.00,$906.95,$0.00,$647.29,$0.00,$0.00,$0.00,$0.00,$0.00,$906.95,$0.00,$453.48,$718.30,$725.56,$0.00,$0.00,$0.00,$0.00,$0.00
48251080,SUP,Custom 27803010,,48251080  -  SPREADER SURG OVAL 80MM SLEEVE LUXOR SILICONE SPN,$906.95,$0.00,$906.95,$0.00,$647.29,$0.00,$0.00,$0.00,$0.00,$0.00,$906.95,$0.00,$453.48,$718.30,$725.56,$0.00,$0.00,$0.00,$0.00,$0.00
48251090,SUP,Custom 27803010,,48251090  -  SLEEVE RB 90MM LUXOR SIL,$906.95,$0.00,$906.95,$0.00,$647.29,$0.00,$0.00,$0.00,$0.00,$0.00,$906.95,$0.00,$453.48,$718.30,$725.56,$0.00,$0.00,$0.00,$0.00,$0.00
48251105,SUP,Custom 27803010,,48251105  -  SLEEVE RB 105MM LUXOR SIL,$906.95,$0.00,$906.95,$0.00,$647.29,$0.00,$0.00,$0.00,$0.00,$0.00,$906.95,$0.00,$453.48,$718.30,$725.56,$0.00,$0.00,$0.00,$0.00,$0.00
48251120,SUP,Custom 27803010,,48251120  -  SLEEVE RB 120MM LUXOR SIL,$906.95,$0.00,$906.95,$0.00,$647.29,$0.00,$0.00,$0.00,$0.00,$0.00,$906.95,$0.00,$453.48,$718.30,$725.56,$0.00,$0.00,$0.00,$0.00,$0.00
48285425,SUP,HCPCS C1713,,48285425  -  SCREW BONE 4.5MM 25MM CANN MANTIS SPN,"$1,875.00",$0.00,"$1,875.00",$843.75,"$1,338.19",$0.00,$323.05,$0.00,$0.00,$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
48285430,SUP,HCPCS C1713,,48285430  -  SCREW BONE 4.5MM 30MM CANN MANTIS SPN,"$1,875.00",$0.00,"$1,875.00",$843.75,"$1,338.19",$0.00,$323.05,$0.00,$0.00,$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
48285435,SUP,HCPCS C1713,,48285435  -  SCREW BONE 4.5MM 35MM POLYAX CANN XIA MANTIS SPN PEDICLE,"$1,875.00",$0.00,"$1,875.00",$843.75,"$1,338.19",$0.00,$323.05,$0.00,$0.00,$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
48285440,SUP,HCPCS C1713,,48285440  -  SCREW BONE 4.5MM 40MM POLYAX CANN XIA MANTIS SPN PEDICLE,"$1,875.00",$0.00,"$1,875.00",$843.75,"$1,338.19",$0.00,$323.05,$0.00,$0.00,$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
48285445,SUP,HCPCS C1713,,48285445  -  SCREW BONE 4.5MM 45MM POLYAX CANN XIA MANTIS SPN PEDICLE,"$1,875.00",$0.00,"$1,875.00",$843.75,"$1,338.19",$0.00,$323.05,$0.00,$0.00,$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
48285530,SUP,HCPCS C1713,,48285530  -  SCREW BONE 5.5MM 30MM POLYAX CANN XIA MANTIS SPN PEDICLE,"$1,875.00",$0.00,"$1,875.00",$843.75,"$1,338.19",$0.00,$323.05,$0.00,$0.00,$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
48285535,SUP,HCPCS C1713,,48285535  -  SCREW BONE 5.5MM 35MM POLYAX CANN XIA MANTIS SPN PEDICLE,"$1,875.00",$0.00,"$1,875.00",$843.75,"$1,338.19",$0.00,$323.05,$0.00,$0.00,$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
48285540,SUP,HCPCS C1713,,48285540  -  SCREW BONE 5.5MM 40MM POLYAX CANN XIA MANTIS SPN PEDICLE,"$1,875.00",$0.00,"$1,875.00",$843.75,"$1,338.19",$0.00,$323.05,$0.00,$0.00,$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
48285545,SUP,HCPCS C1713,,48285545  -  SCREW BONE 5.5MM 45MM POLYAX CANN XIA MANTIS SPN PEDICLE,"$1,875.00",$0.00,"$1,875.00",$843.75,"$1,338.19",$0.00,$323.05,$0.00,$0.00,$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
48285550,SUP,HCPCS C1713,,48285550  -  SCREW BONE 5.5MM 50MM POLYAX CANN XIA MANTIS SPN PEDICLE,"$1,875.00",$0.00,"$1,875.00",$843.75,"$1,338.19",$0.00,$323.05,$0.00,$0.00,$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
48285555,SUP,HCPCS C1713,,48285555  -  SCREW BONE 5.5MM 55MM POLYAX CANN XIA MANTIS SPN PEDICLE,"$1,875.00",$0.00,"$1,875.00",$843.75,"$1,338.19",$0.00,$323.05,$0.00,$0.00,$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
48285630,SUP,HCPCS C1713,,48285630  -  SCREW BONE 6.5MM 30MM POLYAX CANN XIA MANTIS SPN PEDICLE,"$1,875.00",$0.00,"$1,875.00",$843.75,"$1,338.19",$0.00,$323.05,$0.00,$0.00,$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
48285635,SUP,HCPCS C1713,,48285635  -  SCREW BONE 6.5MM 35MM POLYAX CANN XIA MANTIS SPN PEDICLE,"$1,875.00",$0.00,"$1,875.00",$843.75,"$1,338.19",$0.00,$323.05,$0.00,$0.00,$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
48285640,SUP,HCPCS C1713,,48285640  -  SCREW BONE 6.5MM 40MM POLYAX CANN XIA MANTIS SPN PEDICLE,"$1,875.00",$0.00,"$1,875.00",$843.75,"$1,338.19",$0.00,$323.05,$0.00,$0.00,$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
48285645,SUP,HCPCS C1713,,48285645  -  SCREW BONE 6.5MM 45MM POLYAX CANN XIA MANTIS SPN PEDICLE,"$1,875.00",$0.00,"$1,875.00",$843.75,"$1,338.19",$0.00,$323.05,$0.00,$0.00,$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
48285650,SUP,HCPCS C1713,,48285650  -  SCREW BONE 6.5MM 50MM POLYAX CANN XIA MANTIS SPN PEDICLE,"$1,875.00",$0.00,"$1,875.00",$843.75,"$1,338.19",$0.00,$323.05,$0.00,$0.00,$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
48285655,SUP,HCPCS C1713,,48285655  -  SCREW BONE 6.5MM 55MM POLYAX CANN XIA MANTIS SPN PEDICLE,"$1,875.00",$0.00,"$1,875.00",$843.75,"$1,338.19",$0.00,$323.05,$0.00,$0.00,$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
48285660,SUP,HCPCS C1713,,48285660  -  SCREW BONE 6.5MM 60MM POLYAX CANN XIA MANTIS SPN PEDICLE,"$1,875.00",$0.00,"$1,875.00",$843.75,"$1,338.19",$0.00,$323.05,$0.00,$0.00,$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
48285730,SUP,HCPCS C1713,,48285730  -  SCREW BONE 7.5MM 30MM POLYAX CANN XIA MANTIS SPN PEDICLE,"$1,875.00",$0.00,"$1,875.00",$843.75,"$1,338.19",$0.00,$323.05,$0.00,$0.00,$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
48285735,SUP,HCPCS C1713,,48285735  -  SCREW BONE 7.5MM 35MM POLYAX CANN XIA MANTIS SPN PEDICLE,"$1,875.00",$0.00,"$1,875.00",$843.75,"$1,338.19",$0.00,$323.05,$0.00,$0.00,$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
48285740,SUP,HCPCS C1713,,48285740  -  SCREW BONE 7.5MM 40MM POLYAX CANN XIA MANTIS SPN PEDICLE,"$1,875.00",$0.00,"$1,875.00",$843.75,"$1,338.19",$0.00,$323.05,$0.00,$0.00,$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
48285745,SUP,HCPCS C1713,,48285745  -  SCREW BONE 7.5MM 45MM POLYAX CANN XIA MANTIS SPN PEDICLE,"$1,875.00",$0.00,"$1,875.00",$843.75,"$1,338.19",$0.00,$323.05,$0.00,$0.00,$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
48285750,SUP,HCPCS C1713,,48285750  -  SCREW BONE 7.5MM 50MM POLYAX CANN XIA MANTIS SPN PEDICLE,"$1,875.00",$0.00,"$1,875.00",$843.75,"$1,338.19",$0.00,$323.05,$0.00,$0.00,$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
48285755,SUP,HCPCS C1713,,48285755  -  SCREW BONE 7.5MM 55MM POLYAX CANN XIA MANTIS SPN PEDICLE,"$1,875.00",$0.00,"$1,875.00",$843.75,"$1,338.19",$0.00,$323.05,$0.00,$0.00,$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
48285760,SUP,HCPCS C1713,,48285760  -  SCREW BONE 7.5MM 60MM POLYAX CANN XIA MANTIS SPN PEDICLE,"$1,875.00",$0.00,"$1,875.00",$843.75,"$1,338.19",$0.00,$323.05,$0.00,$0.00,$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
48286030,SUP,Custom 27803010,,48286030  -  ROD SPINAL 6MM 30MM RADIOPQ MANTIS PEDICLE,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48286035,SUP,Custom 27803010,,48286035  -  ROD SPINAL 6MM 35MM RAD MANTIS TITANIUM PEDICLE,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48286040,SUP,Custom 27803010,,48286040  -  ROD SPINAL 6MM 40MM RAD MANTIS TITANIUM PEDICLE,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48286045,SUP,Custom 27803010,,48286045  -  ROD SPINAL 6MM 45MM RAD MANTIS TITANIUM PEDICLE,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48286050,SUP,Custom 27803010,,48286050  -  ROD SPINAL 6MM 50MM RAD MANTIS TITANIUM PEDICLE,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48286060,SUP,Custom 27803010,,48286060  -  ROD SPINAL 6MM 60MM RAD MANTIS TITANIUM PEDICLE,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48286070,SUP,Custom 27803010,,48286070  -  ROD SPINAL 6MM 70MM RAD MANTIS TITANIUM PEDICLE,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48286080,SUP,Custom 27803010,,48286080  -  ROD SPINAL 6MM 80MM RAD MANTIS TITANIUM PEDICLE,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48286090,SUP,Custom 27803010,,48286090  -  ROD SPINAL 6MM 90MM RAD MANTIS TITANIUM PEDICLE,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48286100,SUP,Custom 27803010,,48286100  -  ROD SPINAL 6MM 100MM RAD MANTIS TITANIUM PEDICLE,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48286110,SUP,Custom 27803010,,48286110  -  ROD SPINAL 6MM 110MM RADIOPQ MANTIS PEDICLE,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48286120,SUP,Custom 27803010,,48286120  -  ROD SPINAL 120MM CVD,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48286130,SUP,Custom 27803010,,48286130  -  ROD SPINAL 6MM 130MM RADIOPQ MANTIS PEDICLE,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48287050,SUP,Custom 27803010,,48287050  -  ROD SPINAL 6MM 50MM RADIOPQ MANTIS PEDICLE,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48287060,SUP,Custom 27803010,,48287060  -  ROD SPINAL 6MM 60MM RADIOPQ MANTIS PEDICLE,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48287070,SUP,Custom 27803010,,48287070  -  ROD SPINAL 6MM 70MM RADIOPQ MANTIS PEDICLE,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48287080,SUP,Custom 27803010,,48287080  -  ROD SPINAL 6MM 80MM RADIOPQ MANTIS PEDICLE,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48287090,SUP,Custom 27803010,,48287090  -  ROD SPINAL 6MM 90MM RADIOPQ MANTIS PEDICLE,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48287100,SUP,Custom 27803010,,48287100  -  ROD SPINAL 6MM 100MM RADIOPQ MANTIS PEDICLE,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48287110,SUP,Custom 27803010,,48287110  -  ROD SPINAL 6MM 110MM RADIOPQ MANTIS PEDICLE,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48287120,SUP,Custom 27803010,,48287120  -  ROD SPINAL 6MM 120MM RADIOPQ MANTIS PEDICLE,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48287130,SUP,Custom 27803010,,48287130  -  ROD SPINAL 6MM 130MM RADIOPQ MANTIS PEDICLE,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48287200,SUP,Custom 27803010,,48287200  -  ROD SPINAL 6MM 200MM STR MANTIS PEDICLE,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
48288030,SUP,Custom 27803010,,48288030  -  ROD SPINAL STR 6MM 30MM MANTIS,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
48288040,SUP,Custom 27803010,,48288040  -  ROD SPINAL STR 6MM 40MM MANTIS,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
48288050,SUP,Custom 27803010,,48288050  -  ROD SPINAL 6MM 50MM STR MANTIS,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
48288060,SUP,Custom 27803010,,48288060  -  ROD SPINAL 6MM 60MM STR MANTIS,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
48288070,SUP,Custom 27803010,,48288070  -  ROD SPINAL STR 6MM 70MM MANTIS,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
48288080,SUP,Custom 27803010,,48288080  -  ROD SPINAL STR 6MM 80MM MANTIS,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
48288090,SUP,Custom 27803010,,48288090  -  ROD SPINAL 6MM 90MM STR MANTIS,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
48288100,SUP,Custom 27803010,,48288100  -  ROD SPINAL 6MM 100MM STR MANTIS,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
48288110,SUP,Custom 27803010,,48288110  -  ROD SPINAL STR 6MM 110MM MANTIS,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
48288120,SUP,Custom 27803010,,48288120  -  ROD SPINAL 6MM 120MM STR MANTIS,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
48288130,SUP,Custom 27803010,,48288130  -  ROD SPINAL 6MM 130MM STR MANTIS,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
48288480,SUP,Custom 27803010,,48288480  -  ROD SPINAL 6MM 480MM STR MANTIS,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
48290220,SUP,Custom 27803010,,48290220  -  END CAP SPNL 20D 22MM 18MM NS VLIFT TI LMBR INTRBD FS,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
48290225,SUP,Custom 27803010,,48290225  -  ENDCAP SPINAL 25D 22MM CLOSE,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
48290230,SUP,Custom 27803010,,48290230  -  ENDCAP SPINAL 30D 22MM CLOSE,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
48291180,SUP,Custom 27803010,,48291180  -  ENDCAP SPINAL 0D 18MM MODULAR OPEN SNAP EXTERIOR METAL,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
48291183,SUP,Custom 27803010,,48291183  -  ENDCAP SPINAL 3D 18MM MODULAR OPEN SNAP EXTERIOR METAL,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
48291188,SUP,Custom 27803010,,48291188  -  ENDCAP SPINAL 8D 18MM 118MM VLIFT,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
48291220,SUP,Custom 27803010,,48291220  -  ENDCAP SPINAL 0D 22MM MODULAR OPEN SNAP EXTERIOR METAL,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
48291223,SUP,Custom 27803010,,48291223  -  ENDCAP SPINAL 3D 22MM MODULAR OPEN SNAP EXTERIOR METAL,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
48291228,SUP,Custom 27803010,,48291228  -  ENDCAP SPINAL 8D 22MM MODULAR OPEN SNAP EXTERIOR METAL,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
48291800,SUP,HCPCS C1781,,48291800  -  EXTENSION STEM 18MM VLIFT,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
48291820,SUP,Custom 27803010,,48291820  -  CAGE SPNL 18MM 20MM NS LF VLIFT TI LMBR INTRBD FS,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48291825,SUP,Custom 27803010,,48291825  -  CAGE SPNL 18MM 25MM NS LF VLIFT TI LMBR INTRBD FS,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48291832,SUP,Custom 27803010,,48291832  -  CAGE SPNL 18MM 32MM NS LF VLIFT TI LMBR INTRBD FS,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48292200,SUP,Custom 27803010,,48292200  -  EXTENSION SPNL 22MM NS LF VLIFT TI LMBR INTRBD FS,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
48292215,SUP,Custom 27803010,,48292215  -  ENDCAP SPINAL 15D 22MM MODULAR OPEN SNAP EXTERIOR METAL,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
48292225,SUP,Custom 27803010,,48292225  -  CAGE SPNL 22MM 25MM NS LF VLIFT TI LMBR INTRBD FS,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48292232,SUP,Custom 27803010,,48292232  -  CAGE SPNL 22MM 32MM NS LF VLIFT TI LMBR INTRBD FS,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48292237,SUP,Custom 27803010,,48292237  -  CAGE SPNL 22MM 37MM NS LF VLIFT TI LMBR INTRBD FS,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48321060,SUP,Custom 27803010,,48321060  -  CAGE SPNL 0D 12MM RECT 14X6MM NS LF AVS ANCH-C RADOPQ HLW,"$3,875.00",$0.00,"$3,875.00",$0.00,"$2,765.59",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,875.00",$0.00,"$1,937.50","$3,069.00","$3,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48321064,SUP,Custom 27803010,,48321064  -  CAGE SPNL 4D 12MM RECT 14X6MM NS LF AVS ANCH-C RADOPQ HLW,"$3,875.00",$0.00,"$3,875.00",$0.00,"$2,765.59",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,875.00",$0.00,"$1,937.50","$3,069.00","$3,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48321068,SUP,Custom 27803010,,48321068  -  CAGE SPNL 8D 12MM RECT 14X6MM NS LF AVS ANCH-C RADOPQ HLW,"$3,875.00",$0.00,"$3,875.00",$0.00,"$2,765.59",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,875.00",$0.00,"$1,937.50","$3,069.00","$3,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48321070,SUP,Custom 27803010,,48321070  -  CAGE SPNL 0D 12MM RECT 14X7MM NS LF AVS ANCH-C RADOPQ HLW,"$3,875.00",$0.00,"$3,875.00",$0.00,"$2,765.59",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,875.00",$0.00,"$1,937.50","$3,069.00","$3,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48321074,SUP,Custom 27803010,,48321074  -  CAGE SPNL 4D 12MM RECT 14X7MM NS LF AVS ANCH-C RADOPQ HLW,"$3,875.00",$0.00,"$3,875.00",$0.00,"$2,765.59",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,875.00",$0.00,"$1,937.50","$3,069.00","$3,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48321078,SUP,Custom 27803010,,48321078  -  CAGE SPNL 8D 12MM RECT 14X7MM NS LF AVS ANCH-C RADOPQ HLW,"$3,875.00",$0.00,"$3,875.00",$0.00,"$2,765.59",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,875.00",$0.00,"$1,937.50","$3,069.00","$3,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48321080,SUP,Custom 27803010,,48321080  -  CAGE SPNL 0D 12MM RECT 14X8MM NS LF AVS ANCH-C RADOPQ HLW,"$3,875.00",$0.00,"$3,875.00",$0.00,"$2,765.59",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,875.00",$0.00,"$1,937.50","$3,069.00","$3,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48321084,SUP,Custom 27803010,,48321084  -  CAGE SPNL 4D 12MM RECT 14X8MM NS LF AVS ANCH-C RADOPQ HLW,"$3,875.00",$0.00,"$3,875.00",$0.00,"$2,765.59",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,875.00",$0.00,"$1,937.50","$3,069.00","$3,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48321088,SUP,Custom 27803010,,48321088  -  CAGE SPNL 8D 12MM RECT 14X8MM NS LF AVS ANCH-C RADOPQ HLW,"$3,875.00",$0.00,"$3,875.00",$0.00,"$2,765.59",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,875.00",$0.00,"$1,937.50","$3,069.00","$3,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48321090,SUP,Custom 27803010,,48321090  -  CAGE SPNL 0D 12MM RECT 14X9MM NS LF AVS ANCH-C RADOPQ HLW,"$3,875.00",$0.00,"$3,875.00",$0.00,"$2,765.59",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,875.00",$0.00,"$1,937.50","$3,069.00","$3,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48321094,SUP,Custom 27803010,,48321094  -  CAGE SPNL 4D 12MM RECT 14X9MM NS LF AVS ANCH-C RADOPQ HLW,"$3,875.00",$0.00,"$3,875.00",$0.00,"$2,765.59",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,875.00",$0.00,"$1,937.50","$3,069.00","$3,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48321098,SUP,Custom 27803010,,48321098  -  CAGE SPNL 8D 12MM RECT 14X9MM NS LF AVS ANCH-C RADOPQ HLW,"$3,875.00",$0.00,"$3,875.00",$0.00,"$2,765.59",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,875.00",$0.00,"$1,937.50","$3,069.00","$3,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48321100,SUP,Custom 27803010,,48321100  -  CAGE SPNL 0D 12MM RECT 14X10MM NS LF AVS ANCH-C RADOPQ HLW,"$3,875.00",$0.00,"$3,875.00",$0.00,"$2,765.59",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,875.00",$0.00,"$1,937.50","$3,069.00","$3,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48321104,SUP,Custom 27803010,,48321104  -  CAGE SPNL 4D 12MM RECT 14X10MM NS LF AVS ANCH-C RADOPQ HLW,"$3,875.00",$0.00,"$3,875.00",$0.00,"$2,765.59",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,875.00",$0.00,"$1,937.50","$3,069.00","$3,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48321108,SUP,Custom 27803010,,48321108  -  CAGE SPNL 8D 12MM RECT 14X10MM NS LF AVS ANCH-C RADOPQ HLW,"$3,875.00",$0.00,"$3,875.00",$0.00,"$2,765.59",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,875.00",$0.00,"$1,937.50","$3,069.00","$3,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48321110,SUP,Custom 27803010,,48321110  -  CAGE SPNL 0D 12MM RECT 14X11MM NS LF AVS ANCH-C RADOPQ HLW,"$3,875.00",$0.00,"$3,875.00",$0.00,"$2,765.59",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,875.00",$0.00,"$1,937.50","$3,069.00","$3,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48321114,SUP,Custom 27803010,,48321114  -  CAGE SPNL 4D 12MM RECT 14X11MM NS LF AVS ANCH-C RADOPQ HLW,"$3,875.00",$0.00,"$3,875.00",$0.00,"$2,765.59",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,875.00",$0.00,"$1,937.50","$3,069.00","$3,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48321118,SUP,Custom 27803010,,48321118  -  CAGE SPNL 8D 12MM RECT 14X11MM NS LF AVS ANCH-C RADOPQ HLW,"$3,875.00",$0.00,"$3,875.00",$0.00,"$2,765.59",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,875.00",$0.00,"$1,937.50","$3,069.00","$3,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48321120,SUP,Custom 27803010,,48321120  -  CAGE SPNL 0D 12MM RECT 14X12MM NS LF AVS ANCH-C RADOPQ HLW,"$3,875.00",$0.00,"$3,875.00",$0.00,"$2,765.59",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,875.00",$0.00,"$1,937.50","$3,069.00","$3,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48321124,SUP,Custom 27803010,,48321124  -  CAGE SPNL 4D 12MM RECT 14X12MM NS LF AVS ANCH-C RADOPQ HLW,"$3,875.00",$0.00,"$3,875.00",$0.00,"$2,765.59",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,875.00",$0.00,"$1,937.50","$3,069.00","$3,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48321128,SUP,Custom 27803010,,48321128  -  CAGE SPNL 8D 12MM RECT 14X12MM NS LF AVS ANCH-C RADOPQ HLW,"$3,875.00",$0.00,"$3,875.00",$0.00,"$2,765.59",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,875.00",$0.00,"$1,937.50","$3,069.00","$3,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48322040,SUP,Custom 27803010,,48322040  -  SPACER SPNL 0D 12MM 14X4MM AVS AS PEEK CRV INTRBD FS,"$1,375.00",$0.00,"$1,375.00",$0.00,$981.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48322044,SUP,Custom 27803010,,48322044  -  SPACER SPNL 4D 12MM 14X4MM AVS AS PEEK CRV INTRBD FS,"$1,375.00",$0.00,"$1,375.00",$0.00,$981.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48322050,SUP,Custom 27803010,,48322050  -  SPACER SPNL 0D 12MM 14X5MM AVS AS PEEK CRV INTRBD FS,"$1,375.00",$0.00,"$1,375.00",$0.00,$981.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48322054,SUP,Custom 27803010,,48322054  -  SPACER SPNL 4D 12MM 14X5MM AVS AS PEEK CRV INTRBD FS,"$1,375.00",$0.00,"$1,375.00",$0.00,$981.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48322060,SUP,Custom 27803010,,48322060  -  SPACER SPNL 0D 12MM 14X6MM AVS AS PEEK CRV INTRBD FS,"$1,375.00",$0.00,"$1,375.00",$0.00,$981.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48322064,SUP,Custom 27803010,,48322064  -  SPACER SPNL 4D 12MM 14X6MM AVS AS PEEK CRV INTRBD FS,"$1,375.00",$0.00,"$1,375.00",$0.00,$981.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48322070,SUP,Custom 27803010,,48322070  -  SPACER SPNL 0D 12MM 14X7MM AVS AS PEEK CRV INTRBD FS,"$1,375.00",$0.00,"$1,375.00",$0.00,$981.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48322074,SUP,Custom 27803010,,48322074  -  SPACER SPNL 4D 12MM 14X7MM AVS AS PEEK CRV INTRBD FS,"$1,375.00",$0.00,"$1,375.00",$0.00,$981.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48322080,SUP,Custom 27803010,,48322080  -  SPACER SPNL 0D 12MM 14X8MM AVS AS PEEK CRV INTRBD FS,"$1,375.00",$0.00,"$1,375.00",$0.00,$981.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48322084,SUP,Custom 27803010,,48322084  -  SPACER SPNL 4D 12MM 14X8MM AVS AS PEEK CRV INTRBD FS,"$1,375.00",$0.00,"$1,375.00",$0.00,$981.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48322090,SUP,Custom 27803010,,48322090  -  SPACER SPNL 0D 12MM 14X9MM AVS AS PEEK CRV INTRBD FS,"$1,375.00",$0.00,"$1,375.00",$0.00,$981.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48322094,SUP,Custom 27803010,,48322094  -  SPACER SPNL 4D 12MM 14X9MM AVS AS PEEK CRV INTRBD FS,"$1,375.00",$0.00,"$1,375.00",$0.00,$981.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48322100,SUP,Custom 27803010,,48322100  -  SPACER SPNL 0D 12MM 14X10MM AVS AS PEEK CRV INTRBD FS,"$1,375.00",$0.00,"$1,375.00",$0.00,$981.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48322104,SUP,Custom 27803010,,48322104  -  SPACER SPNL 4D 12MM 14X10MM AVS AS PEEK CRV INTRBD FS,"$1,375.00",$0.00,"$1,375.00",$0.00,$981.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48322110,SUP,Custom 27803010,,48322110  -  SPACER SPNL 0D 12MM 14X11MM AVS AS PEEK CRV INTRBD FS,"$1,375.00",$0.00,"$1,375.00",$0.00,$981.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48322114,SUP,Custom 27803010,,48322114  -  SPACER SPNL 4D 12MM 14X11MM AVS AS PEEK CRV INTRBD FS,"$1,375.00",$0.00,"$1,375.00",$0.00,$981.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48322120,SUP,Custom 27803010,,48322120  -  SPACER SPNL 0D 12MM 14X12MM AVS AS PEEK CRV INTRBD FS,"$1,375.00",$0.00,"$1,375.00",$0.00,$981.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48322124,SUP,Custom 27803010,,48322124  -  SPACER SPNL 4D 12MM 14X12MM AVS AS PEEK CRV INTRBD FS,"$1,375.00",$0.00,"$1,375.00",$0.00,$981.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48322204,SUP,Custom 27803010,,48322204  -  SPACER SPNL 4D 12MM 14X20MM AVS AS PEEK CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
48323060,SUP,Custom 27803010,,48323060  -  CAGE SPNL 0D 14MM RECT 16X6MM NS LF AVS ANCH-C RADOPQ HLW,"$3,875.00",$0.00,"$3,875.00",$0.00,"$2,765.59",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,875.00",$0.00,"$1,937.50","$3,069.00","$3,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48323064,SUP,Custom 27803010,,48323064  -  CAGE SPNL 4D 14MM RECT 16X6MM NS LF AVS ANCH-C RADOPQ HLW,"$3,875.00",$0.00,"$3,875.00",$0.00,"$2,765.59",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,875.00",$0.00,"$1,937.50","$3,069.00","$3,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48323068,SUP,Custom 27803010,,48323068  -  CAGE SPNL 8D 14MM RECT 16X6MM NS LF AVS ANCH-C RADOPQ HLW,"$3,875.00",$0.00,"$3,875.00",$0.00,"$2,765.59",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,875.00",$0.00,"$1,937.50","$3,069.00","$3,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48323070,SUP,Custom 27803010,,48323070  -  CAGE SPNL 0D 14MM RECT 16X7MM NS LF AVS ANCH-C RADOPQ HLW,"$3,875.00",$0.00,"$3,875.00",$0.00,"$2,765.59",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,875.00",$0.00,"$1,937.50","$3,069.00","$3,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48323074,SUP,Custom 27803010,,48323074  -  CAGE SPNL 4D 14MM RECT 16X7MM NS LF AVS ANCH-C RADOPQ HLW,"$3,875.00",$0.00,"$3,875.00",$0.00,"$2,765.59",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,875.00",$0.00,"$1,937.50","$3,069.00","$3,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48323078,SUP,Custom 27803010,,48323078  -  CAGE SPNL 8D 14MM RECT 16X7MM NS LF AVS ANCH-C RADOPQ HLW,"$3,875.00",$0.00,"$3,875.00",$0.00,"$2,765.59",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,875.00",$0.00,"$1,937.50","$3,069.00","$3,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48323080,SUP,Custom 27803010,,48323080  -  CAGE SPNL 0D 14MM RECT 16X8MM NS LF AVS ANCH-C RADOPQ HLW,"$3,875.00",$0.00,"$3,875.00",$0.00,"$2,765.59",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,875.00",$0.00,"$1,937.50","$3,069.00","$3,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48323084,SUP,Custom 27803010,,48323084  -  CAGE SPNL 4D 14MM RECT 16X8MM NS LF AVS ANCH-C RADOPQ HLW,"$3,875.00",$0.00,"$3,875.00",$0.00,"$2,765.59",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,875.00",$0.00,"$1,937.50","$3,069.00","$3,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48323088,SUP,Custom 27803010,,48323088  -  CAGE SPNL 8D 14MM RECT 16X8MM NS LF AVS ANCH-C RADOPQ HLW,"$3,875.00",$0.00,"$3,875.00",$0.00,"$2,765.59",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,875.00",$0.00,"$1,937.50","$3,069.00","$3,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48323090,SUP,Custom 27803010,,48323090  -  CAGE SPNL 0D 14MM RECT 16X9MM NS LF AVS ANCH-C RADOPQ HLW,"$3,875.00",$0.00,"$3,875.00",$0.00,"$2,765.59",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,875.00",$0.00,"$1,937.50","$3,069.00","$3,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48323094,SUP,Custom 27803010,,48323094  -  CAGE SPNL 4D 14MM RECT 16X9MM NS LF AVS ANCH-C RADOPQ HLW,"$3,875.00",$0.00,"$3,875.00",$0.00,"$2,765.59",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,875.00",$0.00,"$1,937.50","$3,069.00","$3,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48323098,SUP,Custom 27803010,,48323098  -  CAGE SPNL 8D 14MM RECT 16X9MM NS LF AVS ANCH-C RADOPQ HLW,"$3,875.00",$0.00,"$3,875.00",$0.00,"$2,765.59",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,875.00",$0.00,"$1,937.50","$3,069.00","$3,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48323100,SUP,Custom 27803010,,48323100  -  CAGE SPNL 0D 14MM RECT 16X10MM NS LF AVS ANCH-C RADOPQ HLW,"$3,875.00",$0.00,"$3,875.00",$0.00,"$2,765.59",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,875.00",$0.00,"$1,937.50","$3,069.00","$3,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48323104,SUP,Custom 27803010,,48323104  -  CAGE SPNL 4D 14MM RECT 16X10MM NS LF AVS ANCH-C RADOPQ HLW,"$3,875.00",$0.00,"$3,875.00",$0.00,"$2,765.59",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,875.00",$0.00,"$1,937.50","$3,069.00","$3,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48323108,SUP,Custom 27803010,,48323108  -  CAGE SPNL 8D 14MM RECT 16X10MM NS LF AVS ANCH-C RADOPQ HLW,"$3,875.00",$0.00,"$3,875.00",$0.00,"$2,765.59",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,875.00",$0.00,"$1,937.50","$3,069.00","$3,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48323110,SUP,Custom 27803010,,48323110  -  CAGE SPNL 0D 14MM RECT 16X11MM NS LF AVS ANCH-C RADOPQ HLW,"$3,875.00",$0.00,"$3,875.00",$0.00,"$2,765.59",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,875.00",$0.00,"$1,937.50","$3,069.00","$3,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48323114,SUP,Custom 27803010,,48323114  -  CAGE SPNL 4D 14MM RECT 16X11MM NS LF AVS ANCH-C RADOPQ HLW,"$3,875.00",$0.00,"$3,875.00",$0.00,"$2,765.59",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,875.00",$0.00,"$1,937.50","$3,069.00","$3,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48323118,SUP,Custom 27803010,,48323118  -  CAGE SPNL 8D 14MM RECT 16X11MM NS LF AVS ANCH-C RADOPQ HLW,"$3,875.00",$0.00,"$3,875.00",$0.00,"$2,765.59",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,875.00",$0.00,"$1,937.50","$3,069.00","$3,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48323120,SUP,Custom 27803010,,48323120  -  CAGE SPNL 0D 14MM RECT 16X12MM NS LF AVS ANCH-C RADOPQ HLW,"$3,875.00",$0.00,"$3,875.00",$0.00,"$2,765.59",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,875.00",$0.00,"$1,937.50","$3,069.00","$3,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48323124,SUP,Custom 27803010,,48323124  -  CAGE SPNL 4D 14MM RECT 16X12MM NS LF AVS ANCH-C RADOPQ HLW,"$3,875.00",$0.00,"$3,875.00",$0.00,"$2,765.59",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,875.00",$0.00,"$1,937.50","$3,069.00","$3,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48323128,SUP,Custom 27803010,,48323128  -  CAGE SPNL 8D 14MM RECT 16X12MM NS LF AVS ANCH-C RADOPQ HLW,"$3,875.00",$0.00,"$3,875.00",$0.00,"$2,765.59",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,875.00",$0.00,"$1,937.50","$3,069.00","$3,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48324040,SUP,Custom 27803010,,48324040  -  SPACER SPNL 0D 14MM 16X4MM AVS AS PEEK CRV INTRBD FS,"$1,375.00",$0.00,"$1,375.00",$0.00,$981.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48324044,SUP,Custom 27803010,,48324044  -  SPACER SPNL 4D 14MM 16X4MM AVS AS PEEK CRV INTRBD FS,"$1,375.00",$0.00,"$1,375.00",$0.00,$981.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48324050,SUP,Custom 27803010,,48324050  -  SPACER SPNL 0D 14MM 16X5MM AVS AS PEEK CRV INTRBD FS,"$1,375.00",$0.00,"$1,375.00",$0.00,$981.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48324054,SUP,Custom 27803010,,48324054  -  SPACER SPNL 4D 14MM 16X5MM AVS AS PEEK CRV INTRBD FS,"$1,375.00",$0.00,"$1,375.00",$0.00,$981.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48324060,SUP,Custom 27803010,,48324060  -  SPACER SPNL 0D 14MM 16X6MM AVS AS PEEK CRV INTRBD FS,"$1,375.00",$0.00,"$1,375.00",$0.00,$981.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48324064,SUP,Custom 27803010,,48324064  -  SPACER SPNL 4D 14MM 16X6MM AVS AS PEEK CRV INTRBD FS,"$1,375.00",$0.00,"$1,375.00",$0.00,$981.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48324070,SUP,Custom 27803010,,48324070  -  SPACER SPNL 0D 14MM 16X7MM AVS AS PEEK CRV INTRBD FS,"$1,375.00",$0.00,"$1,375.00",$0.00,$981.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48324074,SUP,Custom 27803010,,48324074  -  SPACER SPNL 4D 14MM 16X7MM AVS AS PEEK CRV INTRBD FS,"$1,375.00",$0.00,"$1,375.00",$0.00,$981.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48324080,SUP,Custom 27803010,,48324080  -  SPACER SPNL 0D 14MM 16X8MM AVS AS PEEK CRV INTRBD FS,"$1,375.00",$0.00,"$1,375.00",$0.00,$981.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48324084,SUP,Custom 27803010,,48324084  -  SPACER SPNL 4D 14MM 16X8MM AVS AS PEEK CRV INTRBD FS,"$1,375.00",$0.00,"$1,375.00",$0.00,$981.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48324090,SUP,Custom 27803010,,48324090  -  SPACER SPNL 0D 14MM 16X9MM AVS AS PEEK CRV INTRBD FS,"$1,375.00",$0.00,"$1,375.00",$0.00,$981.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48324094,SUP,Custom 27803010,,48324094  -  SPACER SPNL 4D 14MM 16X9MM AVS AS PEEK CRV INTRBD FS,"$1,375.00",$0.00,"$1,375.00",$0.00,$981.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48324100,SUP,Custom 27803010,,48324100  -  SPACER SPNL 0D 14MM 16X10MM AVS AS PEEK CRV INTRBD FS,"$1,375.00",$0.00,"$1,375.00",$0.00,$981.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48324104,SUP,Custom 27803010,,48324104  -  SPACER SPNL 4D 14MM 16X10MM AVS AS PEEK CRV INTRBD FS,"$1,375.00",$0.00,"$1,375.00",$0.00,$981.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48324110,SUP,Custom 27803010,,48324110  -  SPACER SPNL 0D 14MM 16X11MM AVS AS PEEK CRV INTRBD FS,"$1,375.00",$0.00,"$1,375.00",$0.00,$981.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48324114,SUP,Custom 27803010,,48324114  -  SPACER SPNL 4D 14MM 16X11MM AVS AS PEEK CRV INTRBD FS,"$1,375.00",$0.00,"$1,375.00",$0.00,$981.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48324120,SUP,Custom 27803010,,48324120  -  SPACER SPNL 0D 14MM 16X12MM AVS AS PEEK CRV INTRBD FS,"$1,375.00",$0.00,"$1,375.00",$0.00,$981.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48324124,SUP,Custom 27803010,,48324124  -  SPACER SPNL 4D 14MM 16X12MM AVS AS PEEK CRV INTRBD FS,"$1,375.00",$0.00,"$1,375.00",$0.00,$981.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
48325308,SUP,HCPCS C1713,,48325308  -  SCREW BONE 3.5MM 8MM SPNL SLFTAP,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48325310,SUP,HCPCS C1713,,48325310  -  SCREW BONE 3.5MM 10MM SELF TAP AVS ANCHOR-C TITANIUM SPN,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48325312,SUP,HCPCS C1713,,48325312  -  SCREW BONE 3.5MM 12MM SELF TAP AVS ANCHOR-C TITANIUM SPN,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48325314,SUP,HCPCS C1713,,48325314  -  SCREW BONE 3.5MM 14MM SPNL SLFTAP,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48325408,SUP,HCPCS C1713,,48325408  -  SCREW BONE 4MM 8MM SPNL SLFTAP,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48325410,SUP,HCPCS C1713,,48325410  -  SCREW BONE 4MM 10MM SELF TAP AVS ANCHOR-C TITANIUM SPN CERV,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48325412,SUP,HCPCS C1713,,48325412  -  SCREW BONE 4MM 12MM SELF TAP AVS ANCHOR-C TITANIUM SPN CERV,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48325414,SUP,HCPCS C1713,,48325414  -  ANCHOR-C  4.0 X 14MM SELF TAPPING SCREW,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48326084,SUP,Custom 27803010,,48326084  -  SPACER SPNL 4D 28X22X8MM AVS AL PEEK ALIF,"$5,000.00",$0.00,"$5,000.00",$0.00,"$3,568.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48326088,SUP,Custom 27803010,,48326088  -  SPACER SPNL 8D 28X22X8MM AVS AL PEEK ALIF,"$5,000.00",$0.00,"$5,000.00",$0.00,"$3,568.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48326104,SUP,Custom 27803010,,48326104  -  SPACER SPNL 4D 28X22X10MM AVS AL PEEK ALIF,"$5,000.00",$0.00,"$5,000.00",$0.00,"$3,568.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48326108,SUP,Custom 27803010,,48326108  -  SPACER SPNL 8D 28X22X10MM AVS AL PEEK ALIF,"$5,000.00",$0.00,"$5,000.00",$0.00,"$3,568.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48326122,SUP,Custom 27803010,,48326122  -  SPACER SPNL 12D 28X22X12MM AVS AL PEEK ALIF,"$5,000.00",$0.00,"$5,000.00",$0.00,"$3,568.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48326124,SUP,Custom 27803010,,48326124  -  SPACER SPNL 4D 28X22X12MM AVS AL PEEK ALIF,"$5,000.00",$0.00,"$5,000.00",$0.00,"$3,568.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48326126,SUP,Custom 27803010,,48326126  -  SPACER SPNL 16D 28X22X12MM AVS AL PEEK ALIF,"$5,000.00",$0.00,"$5,000.00",$0.00,"$3,568.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48326128,SUP,Custom 27803010,,48326128  -  SPACER SPNL 8D 28X22X12MM AVS AL PEEK ALIF,"$5,000.00",$0.00,"$5,000.00",$0.00,"$3,568.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48326142,SUP,Custom 27803010,,48326142  -  SPACER SPNL 12D 28X22X14MM AVS AL PEEK ALIF,"$5,000.00",$0.00,"$5,000.00",$0.00,"$3,568.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48326144,SUP,Custom 27803010,,48326144  -  SPACER SPNL 4D 28X22X14MM AVS AL PEEK ALIF,"$5,000.00",$0.00,"$5,000.00",$0.00,"$3,568.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48326146,SUP,Custom 27803010,,48326146  -  SPACER SPNL 16D 28X22X14MM AVS AL PEEK ALIF,"$5,000.00",$0.00,"$5,000.00",$0.00,"$3,568.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48326148,SUP,Custom 27803010,,48326148  -  SPACER SPNL 8D 28X22X14MM AVS AL PEEK ALIF,"$5,000.00",$0.00,"$5,000.00",$0.00,"$3,568.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48326162,SUP,Custom 27803010,,48326162  -  SPACER SPNL 12D 28X22X16MM AVS AL PEEK ALIF,"$5,000.00",$0.00,"$5,000.00",$0.00,"$3,568.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48326164,SUP,Custom 27803010,,48326164  -  SPACER SPNL 4D 28X22X16MM AVS AL PEEK ALIF,"$5,000.00",$0.00,"$5,000.00",$0.00,"$3,568.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48326166,SUP,Custom 27803010,,48326166  -  SPACER SPNL 16D 28X22X16MM AVS AL PEEK ALIF,"$5,000.00",$0.00,"$5,000.00",$0.00,"$3,568.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48326168,SUP,Custom 27803010,,48326168  -  SPACER SPNL 8D 28X22X16MM AVS AL PEEK ALIF,"$5,000.00",$0.00,"$5,000.00",$0.00,"$3,568.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48326182,SUP,Custom 27803010,,48326182  -  SPACER SPNL 12D 28X22X18MM AVS AL PEEK ALIF,"$5,000.00",$0.00,"$5,000.00",$0.00,"$3,568.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48326184,SUP,Custom 27803010,,48326184  -  SPACER SPNL 4D 28X22X18MM AVS AL PEEK ALIF,"$5,000.00",$0.00,"$5,000.00",$0.00,"$3,568.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48326186,SUP,Custom 27803010,,48326186  -  SPACER SPNL 16D 28X22X18MM AVS AL PEEK ALIF,"$5,000.00",$0.00,"$5,000.00",$0.00,"$3,568.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48326188,SUP,Custom 27803010,,48326188  -  SPACER SPNL 8D 28X22X18MM AVS AL PEEK ALIF,"$5,000.00",$0.00,"$5,000.00",$0.00,"$3,568.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48326202,SUP,Custom 27803010,,48326202  -  SPACER SPNL 12D 28X22X20MM AVS AL PEEK ALIF,"$5,000.00",$0.00,"$5,000.00",$0.00,"$3,568.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48326204,SUP,Custom 27803010,,48326204  -  SPACER SPNL 4D 28X22X20MM AVS AL PEEK ALIF,"$5,000.00",$0.00,"$5,000.00",$0.00,"$3,568.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48326206,SUP,Custom 27803010,,48326206  -  SPACER SPNL 16D 22X28X20MM AVS AL PEEK ALIF,"$5,000.00",$0.00,"$5,000.00",$0.00,"$3,568.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48326208,SUP,Custom 27803010,,48326208  -  SPACER SPNL 8D 28X22X20MM AVS AL PEEK ALIF,"$5,000.00",$0.00,"$5,000.00",$0.00,"$3,568.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48328084,SUP,Custom 27803010,,48328084  -  SPACER SPNL 4D 28X33X8MM AVS AL PEEK ALIF,"$5,000.00",$0.00,"$5,000.00",$0.00,"$3,568.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48328088,SUP,Custom 27803010,,48328088  -  SPACER SPNL 8D 28X33X8MM AVS AL PEEK ALIF,"$5,000.00",$0.00,"$5,000.00",$0.00,"$3,568.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48328104,SUP,Custom 27803010,,48328104  -  SPACER SPNL 4D 28X33X10MM AVS AL PEEK ALIF,"$5,000.00",$0.00,"$5,000.00",$0.00,"$3,568.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48328108,SUP,Custom 27803010,,48328108  -  SPACER SPNL 8D 28X33X10MM AVS AL PEEK ALIF,"$5,000.00",$0.00,"$5,000.00",$0.00,"$3,568.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48328122,SUP,Custom 27803010,,48328122  -  SPACER SPNL 12D 28X33X12MM AVS AL PEEK ALIF,"$5,000.00",$0.00,"$5,000.00",$0.00,"$3,568.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48328124,SUP,Custom 27803010,,48328124  -  SPACER SPNL 4D 28X33X12MM AVS AL PEEK ALIF,"$5,000.00",$0.00,"$5,000.00",$0.00,"$3,568.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48328126,SUP,Custom 27803010,,48328126  -  SPACER SPNL 16D 28X33X12MM AVS AL PEEK ALIF,"$5,000.00",$0.00,"$5,000.00",$0.00,"$3,568.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48328128,SUP,Custom 27803010,,48328128  -  SPACER SPNL 8D 28X33X12MM AVS AL PEEK ALIF,"$5,000.00",$0.00,"$5,000.00",$0.00,"$3,568.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48328142,SUP,Custom 27803010,,48328142  -  SPACER SPNL 12D 28X33X14MM AVS AL PEEK ALIF,"$5,000.00",$0.00,"$5,000.00",$0.00,"$3,568.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48328144,SUP,Custom 27803010,,48328144  -  SPACER SPNL 4D 28X33X14MM AVS AL PEEK ALIF,"$5,000.00",$0.00,"$5,000.00",$0.00,"$3,568.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48328146,SUP,Custom 27803010,,48328146  -  SPACER SPNL 16D 28X33X14MM AVS AL PEEK ALIF,"$5,000.00",$0.00,"$5,000.00",$0.00,"$3,568.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48328148,SUP,Custom 27803010,,48328148  -  SPACER SPNL 8D 28X33X14MM AVS AL PEEK ALIF,"$5,000.00",$0.00,"$5,000.00",$0.00,"$3,568.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48328162,SUP,Custom 27803010,,48328162  -  SPACER SPNL 12D 28X33X16MM AVS AL PEEK ALIF,"$5,000.00",$0.00,"$5,000.00",$0.00,"$3,568.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48328164,SUP,Custom 27803010,,48328164  -  SPACER SPNL 4D 28X33X16MM AVS AL PEEK ALIF,"$5,000.00",$0.00,"$5,000.00",$0.00,"$3,568.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48328166,SUP,Custom 27803010,,48328166  -  SPACER SPNL 16D 28X33X16MM AVS AL PEEK ALIF,"$5,000.00",$0.00,"$5,000.00",$0.00,"$3,568.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48328168,SUP,Custom 27803010,,48328168  -  SPACER SPNL 8D 28X33X16MM AVS AL PEEK ALIF,"$5,000.00",$0.00,"$5,000.00",$0.00,"$3,568.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48328182,SUP,Custom 27803010,,48328182  -  SPACER SPNL 12D 28X33X18MM AVS AL PEEK ALIF,"$5,000.00",$0.00,"$5,000.00",$0.00,"$3,568.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48328184,SUP,Custom 27803010,,48328184  -  SPACER SPNL 4D 28X33X18MM AVS AL PEEK ALIF,"$5,000.00",$0.00,"$5,000.00",$0.00,"$3,568.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48328186,SUP,Custom 27803010,,48328186  -  SPACER SPNL 16D 28X33X18MM AVS AL PEEK ALIF,"$5,000.00",$0.00,"$5,000.00",$0.00,"$3,568.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48328188,SUP,Custom 27803010,,48328188  -  SPACER SPNL 8D 28X33X18MM AVS AL PEEK ALIF,"$5,000.00",$0.00,"$5,000.00",$0.00,"$3,568.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48328202,SUP,Custom 27803010,,48328202  -  SPACER SPNL 12D 28X33X20MM AVS AL PEEK ALIF,"$5,000.00",$0.00,"$5,000.00",$0.00,"$3,568.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48328204,SUP,Custom 27803010,,48328204  -  SPACER SPNL 4D 28X33X20MM AVS AL PEEK ALIF,"$5,000.00",$0.00,"$5,000.00",$0.00,"$3,568.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48328206,SUP,Custom 27803010,,48328206  -  SPACER SPNL 16D 33X28X20MM AVS AL PEEK ALIF,"$5,000.00",$0.00,"$5,000.00",$0.00,"$3,568.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48328208,SUP,Custom 27803010,,48328208  -  SPACER SPNL 8D 28X33X20MM AVS AL PEEK ALIF,"$5,000.00",$0.00,"$5,000.00",$0.00,"$3,568.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48328908,SUP,Custom 27203010,,48328908  -  BIT DRILL 2.3MM 8MM AVS ANCHOR-C,$125.00,$0.00,$125.00,$0.00,$89.21,$0.00,$0.00,$0.00,$0.00,$0.00,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$0.00,$0.00,$0.00,$0.00
48328910,SUP,Custom 27203010,,48328910  -  BIT DRILL 2.3MM 10MM AVS ANCHOR-C,$125.00,$0.00,$125.00,$0.00,$89.21,$0.00,$0.00,$0.00,$0.00,$0.00,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$0.00,$0.00,$0.00,$0.00
48328912,SUP,Custom 27203010,,48328912  -  BIT DRILL 2.3MM 12MM AVS ANCHOR-C,$125.00,$0.00,$125.00,$0.00,$89.21,$0.00,$0.00,$0.00,$0.00,$0.00,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$0.00,$0.00,$0.00,$0.00
48335308,SUP,HCPCS C1713,,48335308  -  ANCHOR-C  3.5 X 8MM SELF DRILLING SCREW,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48335310,SUP,HCPCS C1713,,48335310  -  ANCHOR-C  3.5 X 10MM SELF DRILLING SCREW,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48335312,SUP,HCPCS C1713,,48335312  -  SCREW BONE 3.5MM 12MM SPNL SLFDRILL,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48335314,SUP,HCPCS C1713,,48335314  -  SCREW BONE 3.5MM 14MM SPNL SLFDRILL,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48335408,SUP,HCPCS C1713,,48335408  -  SCREW BONE 4MM 8MM,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48335410,SUP,HCPCS C1713,,48335410  -  ANCHOR-C  4.0 X 10MM SELF DRILLING SCREW,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48335412,SUP,HCPCS C1713,,48335412  -  SCREW BONE 4MM 12MM SPNL SLFDRILL,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48335414,SUP,HCPCS C1713,,48335414  -  SCREW BONE 4MM 14MM SPNL SLFDRILL,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48340074,SUP,Custom 27803010,,48340074  -  SPACER SPNL 4D WDG 20X9X7MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48340084,SUP,Custom 27803010,,48340084  -  SPACER SPNL 4D WDG 20X9X8MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48340090,SUP,Custom 27803010,,48340090  -  SPACER SPNL 0D RECT 20X9X9MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48340094,SUP,Custom 27803010,,48340094  -  SPACER SPNL 4D WDG 20X9X9MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48340098,SUP,Custom 27803010,,48340098  -  SPACER SPNL 8D WDG 20X9X9MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48340100,SUP,Custom 27803010,,48340100  -  SPACER SPNL 0D RECT 20X9X10MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48340104,SUP,Custom 27803010,,48340104  -  SPACER SPNL 4D WDG 20X9X10MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48340108,SUP,Custom 27803010,,48340108  -  SPACER SPNL 8D WDG 20X9X10MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48340110,SUP,Custom 27803010,,48340110  -  SPACER SPNL 0D RECT 20X9X11MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48340114,SUP,Custom 27803010,,48340114  -  SPACER SPNL 4D WDG 20X9X11MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48340118,SUP,Custom 27803010,,48340118  -  SPACER SPNL 8D WDG 20X9X11MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48340120,SUP,Custom 27803010,,48340120  -  SPACER SPNL 0D RECT 20X9X12MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48340124,SUP,Custom 27803010,,48340124  -  SPACER SPNL 4D WDG 20X9X12MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48340128,SUP,Custom 27803010,,48340128  -  SPACER SPNL 8D WDG 20X9X12MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48340130,SUP,Custom 27803010,,48340130  -  SPACER SPNL 0D RECT 20X9X13MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48340134,SUP,Custom 27803010,,48340134  -  SPACER SPNL 4D WDG 20X9X13MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48340138,SUP,Custom 27803010,,48340138  -  SPACER SPNL 8D WDG 20X9X13MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48340140,SUP,Custom 27803010,,48340140  -  SPACER SPNL 0D RECT 20X9X14MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48340144,SUP,Custom 27803010,,48340144  -  SPACER SPNL 4D WDG 20X9X14MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48340148,SUP,Custom 27803010,,48340148  -  SPACER SPNL 8D WDG 20X9X14MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48340150,SUP,Custom 27803010,,48340150  -  SPACER SPNL 0D RECT 20X9X15MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48340154,SUP,Custom 27803010,,48340154  -  SPACER SPNL 4D WDG 20X9X15MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48340158,SUP,Custom 27803010,,48340158  -  SPACER SPNL 8D WDG 20X9X15MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48340160,SUP,Custom 27803010,,48340160  -  SPACER SPNL 0D RECT 20X9X16MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48340164,SUP,Custom 27803010,,48340164  -  SPACER SPNL 4D WDG 20X9X16MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48340168,SUP,Custom 27803010,,48340168  -  SPACER SPNL 8D WDG 20X9X16MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48345074,SUP,Custom 27803010,,48345074  -  SPACER SPNL 4D WDG 25X8X7MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48345084,SUP,Custom 27803010,,48345084  -  SPACER SPNL 4D WDG 25X8X8MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48345090,SUP,Custom 27803010,,48345090  -  SPACER SPNL 0D RECT 25X8X9MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48345094,SUP,Custom 27803010,,48345094  -  SPACER SPNL 4D WDG 25X8X9MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48345098,SUP,Custom 27803010,,48345098  -  SPACER SPNL 8D WDG 25X8X9MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48345100,SUP,Custom 27803010,,48345100  -  SPACER SPNL 0D RECT 25X8X10MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48345104,SUP,Custom 27803010,,48345104  -  SPACER SPNL 4D WDG 25X8X10MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48345108,SUP,Custom 27803010,,48345108  -  SPACER SPNL 8D WDG 25X8X10MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48345110,SUP,Custom 27803010,,48345110  -  SPACER SPNL 0D RECT 25X8X11MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48345114,SUP,Custom 27803010,,48345114  -  SPACER SPNL 4D WDG 25X8X11MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48345118,SUP,Custom 27803010,,48345118  -  SPACER SPNL 8D WDG 25X8X11MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48345120,SUP,Custom 27803010,,48345120  -  SPACER SPNL 0D RECT 25X8X12MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48345124,SUP,Custom 27803010,,48345124  -  SPACER SPNL 4D WDG 25X8X12MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48345128,SUP,Custom 27803010,,48345128  -  SPACER SPNL 8D WDG 25X8X12MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48345130,SUP,Custom 27803010,,48345130  -  SPACER SPNL 0D RECT 25X8X13MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48345134,SUP,Custom 27803010,,48345134  -  SPACER SPNL 4D WDG 25X8X13MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48345138,SUP,Custom 27803010,,48345138  -  SPACER SPNL 8D WDG 25X8X13MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48345140,SUP,Custom 27803010,,48345140  -  SPACER SPNL 0D RECT 25X8X14MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48345144,SUP,Custom 27803010,,48345144  -  SPACER SPNL 4D WDG 25X8X14MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48345148,SUP,Custom 27803010,,48345148  -  SPACER SPNL 8D WDG 25X8X14MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48345150,SUP,Custom 27803010,,48345150  -  SPACER SPNL 0D RECT 25X8X15MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48345154,SUP,Custom 27803010,,48345154  -  SPACER SPNL 4D WDG 25X8X15MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48345158,SUP,Custom 27803010,,48345158  -  SPACER SPNL 8D WDG 25X8X15MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48345160,SUP,Custom 27803010,,48345160  -  SPACER SPNL 0D RECT 25X8X16MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48345164,SUP,Custom 27803010,,48345164  -  SPACER SPNL 4D WDG 25X8X16MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48345168,SUP,Custom 27803010,,48345168  -  SPACER SPNL 8D WDG 25X8X16MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48350060,SUP,Custom 27803010,,48350060  -  SPACER SPNL 0D WDG NOSE 20X11X6MM AVS UNILIF HLW PEEK-OPTM,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48350064,SUP,Custom 27803010,,48350064  -  SPACER SPNL 4D LRDTC WDG NOSE 20X11X6MM AVS UNILIF HLW,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48350070,SUP,Custom 27803010,,48350070  -  SPACER SPNL 0D WDG NOSE 20X11X7MM AVS UNILIF HLW PEEK-OPTM,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48350074,SUP,Custom 27803010,,48350074  -  SPACER SPNL 4D LRDTC WDG NOSE 20X11X7MM AVS UNILIF HLW,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48350080,SUP,Custom 27803010,,48350080  -  SPACER SPNL 0D WDG NOSE 20X11X8MM AVS UNILIF HLW PEEK-OPTM,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48350084,SUP,Custom 27803010,,48350084  -  SPACER SPNL 4D LRDTC WDG NOSE 20X11X8MM AVS UNILIF HLW,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48350090,SUP,Custom 27803010,,48350090  -  SPACER SPNL 0D RECT 20X11X9MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48350094,SUP,Custom 27803010,,48350094  -  SPACER SPNL 4D WDG 20X11X9MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48350100,SUP,Custom 27803010,,48350100  -  SPACER SPNL 0D RECT 20X11X10MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48350104,SUP,Custom 27803010,,48350104  -  SPACER SPNL 4D WDG 20X11X10MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48350110,SUP,Custom 27803010,,48350110  -  SPACER SPNL 0D RECT 20X11X11MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48350114,SUP,Custom 27803010,,48350114  -  SPACER SPNL 4D WDG 20X11X11MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48350120,SUP,Custom 27803010,,48350120  -  SPACER SPNL 0D RECT 20X11X12MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48350124,SUP,Custom 27803010,,48350124  -  SPACER SPNL 4D WDG 20X11X12MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48350130,SUP,Custom 27803010,,48350130  -  SPACER SPNL 0D RECT 20X11X13MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48350134,SUP,Custom 27803010,,48350134  -  SPACER SPNL 4D WDG 20X11X13MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48350160,SUP,Custom 27803010,,48350160  -  SPACER SPNL 0D RECT 20X11X16MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48350164,SUP,Custom 27803010,,48350164  -  SPACER SPNL 4D WDG 20X11X16MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48350180,SUP,Custom 27803010,,48350180  -  SPACER SPNL 0D RECT 20X11X18MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48350184,SUP,Custom 27803010,,48350184  -  SPACER SPNL 4D WDG 20X11X18MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48351060,SUP,Custom 27803010,,48351060  -  SPACER SPNL 0D WDG NOSE 30X11X6MM AVS UNILIF HLW PEEK-OPTM,"$5,500.00",$0.00,"$5,500.00",$0.00,"$3,925.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,500.00",$0.00,"$2,750.00","$4,356.00","$4,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
48351064,SUP,Custom 27803010,,48351064  -  SPACER SPNL 4D LRDTC WDG NOSE 30X11X6MM AVS UNILIF HLW,"$5,500.00",$0.00,"$5,500.00",$0.00,"$3,925.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,500.00",$0.00,"$2,750.00","$4,356.00","$4,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
48351070,SUP,Custom 27803010,,48351070  -  SPACER SPNL 0D WDG NOSE 30X11X7MM AVS UNILIF HLW PEEK-OPTM,"$5,500.00",$0.00,"$5,500.00",$0.00,"$3,925.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,500.00",$0.00,"$2,750.00","$4,356.00","$4,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
48351074,SUP,Custom 27803010,,48351074  -  SPACER SPNL 4D LRDTC WDG NOSE 30X11X7MM AVS UNILIF HLW,"$5,500.00",$0.00,"$5,500.00",$0.00,"$3,925.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,500.00",$0.00,"$2,750.00","$4,356.00","$4,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
48351080,SUP,Custom 27803010,,48351080  -  SPACER SPNL 0D WDG NOSE 30X11X8MM AVS UNILIF HLW PEEK-OPTM,"$5,500.00",$0.00,"$5,500.00",$0.00,"$3,925.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,500.00",$0.00,"$2,750.00","$4,356.00","$4,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
48351084,SUP,Custom 27803010,,48351084  -  SPACER SPNL 4D LRDTC WDG NOSE 30X11X8MM AVS UNILIF HLW,"$5,500.00",$0.00,"$5,500.00",$0.00,"$3,925.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,500.00",$0.00,"$2,750.00","$4,356.00","$4,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
48351090,SUP,Custom 27803010,,48351090  -  SPACER SPNL 0D WDG NOSE 30X11X9MM AVS UNILIF HLW PEEK-OPTM,"$5,500.00",$0.00,"$5,500.00",$0.00,"$3,925.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,500.00",$0.00,"$2,750.00","$4,356.00","$4,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
48351094,SUP,Custom 27803010,,48351094  -  SPACER SPNL 4D LRDTC WDG NOSE 30X11X9MM AVS UNILIF HLW,"$5,500.00",$0.00,"$5,500.00",$0.00,"$3,925.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,500.00",$0.00,"$2,750.00","$4,356.00","$4,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
48351100,SUP,Custom 27803010,,48351100  -  SPACER SPNL 0D WDG NOSE 30X11X10MM AVS UNILIF HLW PEEK-OPTM,"$5,500.00",$0.00,"$5,500.00",$0.00,"$3,925.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,500.00",$0.00,"$2,750.00","$4,356.00","$4,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
48351104,SUP,Custom 27803010,,48351104  -  SPACER SPNL 4D LRDTC WDG NOSE 30X11X10MM AVS UNILIF HLW,"$5,500.00",$0.00,"$5,500.00",$0.00,"$3,925.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,500.00",$0.00,"$2,750.00","$4,356.00","$4,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
48351110,SUP,Custom 27803010,,48351110  -  SPACER SPNL 0D WDG NOSE 30X11X11MM AVS UNILIF HLW PEEK-OPTM,"$5,500.00",$0.00,"$5,500.00",$0.00,"$3,925.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,500.00",$0.00,"$2,750.00","$4,356.00","$4,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
48351114,SUP,Custom 27803010,,48351114  -  SPACER SPNL 4D LRDTC WDG NOSE 30X11X11MM AVS UNILIF HLW,"$5,500.00",$0.00,"$5,500.00",$0.00,"$3,925.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,500.00",$0.00,"$2,750.00","$4,356.00","$4,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
48351120,SUP,Custom 27803010,,48351120  -  SPACER SPNL 0D WDG NOSE 30X11X12MM AVS UNILIF HLW PEEK-OPTM,"$5,500.00",$0.00,"$5,500.00",$0.00,"$3,925.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,500.00",$0.00,"$2,750.00","$4,356.00","$4,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
48351124,SUP,Custom 27803010,,48351124  -  SPACER SPNL 4D LRDTC WDG NOSE 30X11X12MM AVS UNILIF HLW,"$5,500.00",$0.00,"$5,500.00",$0.00,"$3,925.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,500.00",$0.00,"$2,750.00","$4,356.00","$4,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
48351130,SUP,Custom 27803010,,48351130  -  SPACER SPNL 0D WDG NOSE 30X11X13MM AVS UNILIF HLW PEEK-OPTM,"$5,500.00",$0.00,"$5,500.00",$0.00,"$3,925.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,500.00",$0.00,"$2,750.00","$4,356.00","$4,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
48351134,SUP,Custom 27803010,,48351134  -  SPACER SPNL 4D LRDTC WDG NOSE 30X11X13MM AVS UNILIF HLW,"$5,500.00",$0.00,"$5,500.00",$0.00,"$3,925.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,500.00",$0.00,"$2,750.00","$4,356.00","$4,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
48351140,SUP,Custom 27803010,,48351140  -  SPACER SPNL 0D WDG NOSE 30X11X14MM AVS UNILIF HLW PEEK-OPTM,"$5,500.00",$0.00,"$5,500.00",$0.00,"$3,925.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,500.00",$0.00,"$2,750.00","$4,356.00","$4,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
48351144,SUP,Custom 27803010,,48351144  -  SPACER SPNL 4D LRDTC WDG NOSE 30X11X14MM AVS UNILIF HLW,"$5,500.00",$0.00,"$5,500.00",$0.00,"$3,925.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,500.00",$0.00,"$2,750.00","$4,356.00","$4,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
48353060,SUP,HCPCS C1713,,48353060  -  SPACER SPNL 0D WDG NOSE 33X11X6MM AVS UNILIF HLW PEEK-OPTM,"$5,500.00",$0.00,"$5,500.00","$2,475.00","$3,925.35",$0.00,$947.62,$0.00,$0.00,$963.01,"$5,500.00",$0.00,"$2,750.00","$4,356.00","$4,400.00",$0.00,$860.75,$0.00,$875.60,$0.00
48353064,SUP,Custom 27803010,,48353064  -  SPACER SPNL 4D LRDTC WDG NOSE 33X11X6MM AVS UNILIF HLW,"$5,500.00",$0.00,"$5,500.00",$0.00,"$3,925.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,500.00",$0.00,"$2,750.00","$4,356.00","$4,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
48353070,SUP,Custom 27803010,,48353070  -  SPACER SPNL 0D WDG NOSE 33X11X7MM AVS UNILIF HLW PEEK-OPTM,"$5,500.00",$0.00,"$5,500.00",$0.00,"$3,925.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,500.00",$0.00,"$2,750.00","$4,356.00","$4,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
48353074,SUP,Custom 27803010,,48353074  -  SPACER SPNL 4D LRDTC WDG NOSE 33X11X7MM AVS UNILIF HLW,"$5,500.00",$0.00,"$5,500.00",$0.00,"$3,925.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,500.00",$0.00,"$2,750.00","$4,356.00","$4,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
48353080,SUP,Custom 27803010,,48353080  -  SPACER SPNL 0D WDG NOSE 33X11X8MM AVS UNILIF HLW PEEK-OPTM,"$5,500.00",$0.00,"$5,500.00",$0.00,"$3,925.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,500.00",$0.00,"$2,750.00","$4,356.00","$4,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
48353084,SUP,Custom 27803010,,48353084  -  SPACER SPNL 4D LRDTC WDG NOSE 33X11X8MM AVS UNILIF HLW,"$5,500.00",$0.00,"$5,500.00",$0.00,"$3,925.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,500.00",$0.00,"$2,750.00","$4,356.00","$4,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
48353090,SUP,Custom 27803010,,48353090  -  SPACER SPNL 0D WDG NOSE 33X11X9MM AVS UNILIF HLW PEEK-OPTM,"$5,500.00",$0.00,"$5,500.00",$0.00,"$3,925.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,500.00",$0.00,"$2,750.00","$4,356.00","$4,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
48353094,SUP,Custom 27803010,,48353094  -  SPACER SPNL 4D LRDTC WDG NOSE 33X11X9MM AVS UNILIF HLW,"$5,500.00",$0.00,"$5,500.00",$0.00,"$3,925.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,500.00",$0.00,"$2,750.00","$4,356.00","$4,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
48353100,SUP,Custom 27803010,,48353100  -  SPACER SPNL 0D WDG NOSE 33X11X10MM AVS UNILIF HLW PEEK-OPTM,"$5,500.00",$0.00,"$5,500.00",$0.00,"$3,925.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,500.00",$0.00,"$2,750.00","$4,356.00","$4,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
48353104,SUP,Custom 27803010,,48353104  -  SPACER SPNL 4D LRDTC WDG NOSE 33X11X10MM AVS UNILIF HLW,"$5,500.00",$0.00,"$5,500.00",$0.00,"$3,925.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,500.00",$0.00,"$2,750.00","$4,356.00","$4,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
48353110,SUP,Custom 27803010,,48353110  -  SPACER SPNL 0D WDG NOSE 33X11X11MM AVS UNILIF HLW PEEK-OPTM,"$5,500.00",$0.00,"$5,500.00",$0.00,"$3,925.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,500.00",$0.00,"$2,750.00","$4,356.00","$4,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
48353114,SUP,Custom 27803010,,48353114  -  SPACER SPNL 4D LRDTC WDG NOSE 33X11X11MM AVS UNILIF HLW,"$5,500.00",$0.00,"$5,500.00",$0.00,"$3,925.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,500.00",$0.00,"$2,750.00","$4,356.00","$4,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
48353120,SUP,Custom 27803010,,48353120  -  SPACER SPNL 0D WDG NOSE 33X11X12MM AVS UNILIF HLW PEEK-OPTM,"$5,500.00",$0.00,"$5,500.00",$0.00,"$3,925.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,500.00",$0.00,"$2,750.00","$4,356.00","$4,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
48353124,SUP,Custom 27803010,,48353124  -  SPACER SPNL 4D LRDTC WDG NOSE 33X11X12MM AVS UNILIF HLW,"$5,500.00",$0.00,"$5,500.00",$0.00,"$3,925.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,500.00",$0.00,"$2,750.00","$4,356.00","$4,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
48353130,SUP,Custom 27803010,,48353130  -  SPACER SPNL 0D WDG NOSE 33X11X13MM AVS UNILIF HLW PEEK-OPTM,"$5,500.00",$0.00,"$5,500.00",$0.00,"$3,925.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,500.00",$0.00,"$2,750.00","$4,356.00","$4,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
48353134,SUP,Custom 27803010,,48353134  -  SPACER SPNL 4D LRDTC WDG NOSE 33X11X13MM AVS UNILIF HLW,"$5,500.00",$0.00,"$5,500.00",$0.00,"$3,925.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,500.00",$0.00,"$2,750.00","$4,356.00","$4,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
48353140,SUP,Custom 27803010,,48353140  -  SPACER SPNL 0D WDG NOSE 33X11X14MM AVS UNILIF HLW PEEK-OPTM,"$5,500.00",$0.00,"$5,500.00",$0.00,"$3,925.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,500.00",$0.00,"$2,750.00","$4,356.00","$4,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
48353144,SUP,Custom 27803010,,48353144  -  SPACER SPNL 4D LRDTC WDG NOSE 33X11X14MM AVS UNILIF HLW,"$5,500.00",$0.00,"$5,500.00",$0.00,"$3,925.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,500.00",$0.00,"$2,750.00","$4,356.00","$4,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
48355060,SUP,Custom 27803010,,48355060  -  SPACER SPNL 0D WDG NOSE 25X11X6MM AVS UNILIF HLW PEEK-OPTM,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48355064,SUP,Custom 27803010,,48355064  -  SPACER SPNL 4D LRDTC WDG NOSE 25X11X6MM AVS UNILIF HLW,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48355070,SUP,Custom 27803010,,48355070  -  SPACER SPNL 0D WDG NOSE 25X11X7MM AVS UNILIF HLW PEEK-OPTM,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48355074,SUP,Custom 27803010,,48355074  -  SPACER SPNL 4D LRDTC WDG NOSE 25X11X7MM AVS UNILIF HLW,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48355080,SUP,Custom 27803010,,48355080  -  SPACER SPNL 0D WDG NOSE 25X11X8MM AVS UNILIF HLW PEEK-OPTM,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48355084,SUP,Custom 27803010,,48355084  -  SPACER SPNL 4D LRDTC WDG NOSE 25X11X8MM AVS UNILIF HLW,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48355090,SUP,Custom 27803010,,48355090  -  SPACER SPNL 0D RECT 25X11X9MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48355094,SUP,Custom 27803010,,48355094  -  SPACER SPNL 4D WDG 25X11X9MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48355100,SUP,Custom 27803010,,48355100  -  SPACER SPNL 0D RECT 25X11X10MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48355104,SUP,Custom 27803010,,48355104  -  SPACER SPNL 4D WDG 25X11X10MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48355110,SUP,Custom 27803010,,48355110  -  SPACER SPNL 0D RECT 25X11X11MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48355114,SUP,Custom 27803010,,48355114  -  SPACER SPNL 4D WDG 25X11X11MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48355120,SUP,Custom 27803010,,48355120  -  SPACER SPNL 0D RECT 25X11X12MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48355124,SUP,Custom 27803010,,48355124  -  SPACER SPNL 4D WDG 25X11X12MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48355130,SUP,Custom 27803010,,48355130  -  SPACER SPNL 0D RECT 25X11X13MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48355134,SUP,Custom 27803010,,48355134  -  SPACER SPNL 4D WDG 25X11X13MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48355164,SUP,Custom 27803010,,48355164  -  SPACER SPNL 4D WDG 25X11X16MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48355180,SUP,Custom 27803010,,48355180  -  SPACER SPNL 0D RECT 25X11X18MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48355184,SUP,Custom 27803010,,48355184  -  SPACER SPNL 4D WDG 25X11X18MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48370090,SUP,Custom 27803010,,48370090  -  SPACER SPNL 0D PRLL 30X9MM AVS TL HLW PEEK TLIF,"$5,500.00",$0.00,"$5,500.00",$0.00,"$3,925.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,500.00",$0.00,"$2,750.00","$4,356.00","$4,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
48370094,SUP,Custom 27803010,,48370094  -  SPACER SPNL 4D WDG 30X9MM AVS TL HLW PEEK TLIF,"$5,500.00",$0.00,"$5,500.00",$0.00,"$3,925.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,500.00",$0.00,"$2,750.00","$4,356.00","$4,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
48370100,SUP,Custom 27803010,,48370100  -  SPACER SPNL 0D PRLL 30X10MM AVS TL HLW PEEK TLIF,"$5,500.00",$0.00,"$5,500.00",$0.00,"$3,925.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,500.00",$0.00,"$2,750.00","$4,356.00","$4,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
48370104,SUP,Custom 27803010,,48370104  -  SPACER SPNL 4D WDG 30X10MM AVS TL HLW PEEK TLIF,"$5,500.00",$0.00,"$5,500.00",$0.00,"$3,925.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,500.00",$0.00,"$2,750.00","$4,356.00","$4,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
48370110,SUP,Custom 27803010,,48370110  -  SPACER SPNL 0D PRLL 30X11MM AVS TL HLW PEEK TLIF,"$5,500.00",$0.00,"$5,500.00",$0.00,"$3,925.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,500.00",$0.00,"$2,750.00","$4,356.00","$4,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
48370114,SUP,Custom 27803010,,48370114  -  SPACER SPNL 4D WDG 30X11MM AVS TL HLW PEEK TLIF,"$5,500.00",$0.00,"$5,500.00",$0.00,"$3,925.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,500.00",$0.00,"$2,750.00","$4,356.00","$4,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
48370120,SUP,Custom 27803010,,48370120  -  SPACER SPNL 0D PRLL 30X12MM AVS TL HLW PEEK TLIF,"$5,500.00",$0.00,"$5,500.00",$0.00,"$3,925.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,500.00",$0.00,"$2,750.00","$4,356.00","$4,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
48370124,SUP,Custom 27803010,,48370124  -  SPACER SPNL 4D WDG 30X12MM AVS TL HLW PEEK TLIF,"$5,500.00",$0.00,"$5,500.00",$0.00,"$3,925.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,500.00",$0.00,"$2,750.00","$4,356.00","$4,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
48370130,SUP,Custom 27803010,,48370130  -  SPACER SPNL 0D PRLL 30X13MM AVS TL HLW PEEK TLIF,"$5,500.00",$0.00,"$5,500.00",$0.00,"$3,925.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,500.00",$0.00,"$2,750.00","$4,356.00","$4,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
48370134,SUP,Custom 27803010,,48370134  -  SPACER SPNL 4D WDG 30X13MM AVS TL HLW PEEK TLIF,"$5,500.00",$0.00,"$5,500.00",$0.00,"$3,925.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,500.00",$0.00,"$2,750.00","$4,356.00","$4,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
48370140,SUP,Custom 27803010,,48370140  -  SPACER SPNL 0D PRLL 30X14MM AVS TL HLW PEEK TLIF,"$5,500.00",$0.00,"$5,500.00",$0.00,"$3,925.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,500.00",$0.00,"$2,750.00","$4,356.00","$4,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
48370144,SUP,Custom 27803010,,48370144  -  SPACER SPNL 4D WDG 30X14MM AVS TL HLW PEEK TLIF,"$5,500.00",$0.00,"$5,500.00",$0.00,"$3,925.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,500.00",$0.00,"$2,750.00","$4,356.00","$4,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
48370150,SUP,Custom 27803010,,48370150  -  SPACER SPNL 0D PRLL 30X15MM AVS TL HLW PEEK TLIF,"$5,500.00",$0.00,"$5,500.00",$0.00,"$3,925.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,500.00",$0.00,"$2,750.00","$4,356.00","$4,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
48370154,SUP,Custom 27803010,,48370154  -  SPACER SPNL 4D WDG 30X15MM AVS TL HLW PEEK TLIF,"$5,500.00",$0.00,"$5,500.00",$0.00,"$3,925.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,500.00",$0.00,"$2,750.00","$4,356.00","$4,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
48370160,SUP,Custom 27803010,,48370160  -  SPACER SPNL 0D PRLL 30X16MM AVS TL HLW PEEK TLIF,"$5,500.00",$0.00,"$5,500.00",$0.00,"$3,925.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,500.00",$0.00,"$2,750.00","$4,356.00","$4,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
48370164,SUP,Custom 27803010,,48370164  -  SPACER SPNL 4D WDG 30X16MM AVS TL HLW PEEK TLIF,"$5,500.00",$0.00,"$5,500.00",$0.00,"$3,925.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,500.00",$0.00,"$2,750.00","$4,356.00","$4,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
48370170,SUP,Custom 27803010,,48370170  -  SPACER SPNL 0D PRLL 30X17MM AVS TL HLW PEEK TLIF,"$5,500.00",$0.00,"$5,500.00",$0.00,"$3,925.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,500.00",$0.00,"$2,750.00","$4,356.00","$4,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
48370174,SUP,Custom 27803010,,48370174  -  SPACER SPNL 4D WDG 30X17MM AVS TL HLW PEEK TLIF,"$5,500.00",$0.00,"$5,500.00",$0.00,"$3,925.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,500.00",$0.00,"$2,750.00","$4,356.00","$4,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
48370180,SUP,Custom 27803010,,48370180  -  SPACER SPNL 0D PRLL 30X18MM AVS TL HLW PEEK TLIF,"$5,500.00",$0.00,"$5,500.00",$0.00,"$3,925.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,500.00",$0.00,"$2,750.00","$4,356.00","$4,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
48370184,SUP,Custom 27803010,,48370184  -  SPACER SPNL 4D WDG 30X18MM AVS TL HLW PEEK TLIF,"$5,500.00",$0.00,"$5,500.00",$0.00,"$3,925.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,500.00",$0.00,"$2,750.00","$4,356.00","$4,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
48375070,SUP,Custom 27803010,,48375070  -  SPACER SPNL 0D PRLL 25X7MM AVS TL HLW PEEK TLIF,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48375074,SUP,Custom 27803010,,48375074  -  SPACER SPNL 4D WDG 25X7MM AVS TL HLW PEEK TLIF,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48375080,SUP,Custom 27803010,,48375080  -  SPACER SPNL 0D PRLL 25X8MM AVS TL HLW PEEK TLIF,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48375084,SUP,Custom 27803010,,48375084  -  SPACER SPNL 4D WDG 25X8MM AVS TL HLW PEEK TLIF,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48375090,SUP,Custom 27803010,,48375090  -  SPACER SPNL 0D PRLL 25X9MM AVS TL HLW PEEK TLIF,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48375094,SUP,Custom 27803010,,48375094  -  SPACER SPNL 4D WDG 25X9MM AVS TL HLW PEEK TLIF,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48375100,SUP,Custom 27803010,,48375100  -  SPACER SPNL 0D PRLL 25X10MM AVS TL HLW PEEK TLIF,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48375104,SUP,Custom 27803010,,48375104  -  SPACER SPNL 4D WDG 25X10MM AVS TL HLW PEEK TLIF,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48375110,SUP,Custom 27803010,,48375110  -  SPACER SPNL 0D PRLL 25X11MM AVS TL HLW PEEK TLIF,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48375114,SUP,Custom 27803010,,48375114  -  SPACER SPNL 4D WDG 25X11MM AVS TL HLW PEEK TLIF,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48375120,SUP,Custom 27803010,,48375120  -  SPACER SPNL 0D PRLL 25X12MM AVS TL HLW PEEK TLIF,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48375124,SUP,Custom 27803010,,48375124  -  SPACER SPNL 4D WDG 25X12MM AVS TL HLW PEEK TLIF,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48375130,SUP,Custom 27803010,,48375130  -  SPACER SPNL 0D PRLL 25X13MM AVS TL HLW PEEK TLIF,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48375134,SUP,Custom 27803010,,48375134  -  SPACER SPNL 4D WDG 25X13MM AVS TL HLW PEEK TLIF,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48375140,SUP,Custom 27803010,,48375140  -  SPACER SPNL 0D PRLL 25X14MM AVS TL HLW PEEK TLIF,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48375144,SUP,Custom 27803010,,48375144  -  SPACER SPNL 4D WDG 25X14MM AVS TL HLW PEEK TLIF,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48390090,SUP,Custom 27803010,,48390090  -  SPACER SPNL 0D WDG NOSE 20X11X9MM AVS UNILIF HLW PEEK-OPTM,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48390094,SUP,Custom 27803010,,48390094  -  SPACER SPNL 4D LRDTC WDG NOSE 20X11X9MM AVS UNILIF HLW,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48390101,SUP,Custom 27803010,,48390101  -  SPACER SPNL 0D WDG NOSE 20X11X10MM AVS UNILIF HLW PEEK-OPTM,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48390104,SUP,Custom 27803010,,48390104  -  SPACER SPNL 4D LRDTC WDG NOSE 20X11X10MM AVS UNILIF HLW,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48390111,SUP,Custom 27803010,,48390111  -  SPACER SPNL 0D WDG NOSE 20X11X11MM AVS UNILIF HLW PEEK-OPTM,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48390114,SUP,Custom 27803010,,48390114  -  SPACER SPNL 4D LRDTC WDG NOSE 20X11X11MM AVS UNILIF HLW,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48390120,SUP,Custom 27803010,,48390120  -  SPACER SPNL 0D WDG NOSE 20X11X12MM AVS UNILIF HLW PEEK-OPTM,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48390124,SUP,Custom 27803010,,48390124  -  SPACER SPNL 4D LRDTC WDG NOSE 20X11X12MM AVS UNILIF HLW,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48390130,SUP,Custom 27803010,,48390130  -  SPACER SPNL 0D WDG NOSE 20X11X13MM AVS UNILIF HLW PEEK-OPTM,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48390134,SUP,Custom 27803010,,48390134  -  SPACER SPNL 4D LRDTC WDG NOSE 20X11X13MM AVS UNILIF HLW,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48390140,SUP,Custom 27803010,,48390140  -  SPACER SPNL 0D WDG NOSE 20X11X14MM AVS UNILIF HLW PEEK-OPTM,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48390144,SUP,Custom 27803010,,48390144  -  SPACER SPNL 4D LRDTC WDG NOSE 20X11X14MM AVS UNILIF HLW,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48390150,SUP,Custom 27803010,,48390150  -  SPACER SPNL 0D WDG NOSE 20X11X15MM AVS UNILIF HLW PEEK-OPTM,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48390154,SUP,Custom 27803010,,48390154  -  SPACER SPNL 4D LRDTC WDG NOSE 20X11X15MM AVS UNILIF HLW,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48390160,SUP,Custom 27803010,,48390160  -  SPACER SPNL 0D WDG NOSE 20X11X16MM AVS UNILIF HLW PEEK-OPTM,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48390164,SUP,Custom 27803010,,48390164  -  SPACER SPNL 4D LRDTC WDG NOSE 20X11X16MM AVS UNILIF HLW,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48390180,SUP,Custom 27803010,,48390180  -  SPACER SPNL 0D WDG NOSE 20X11X18MM AVS UNILIF HLW PEEK-OPTM,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48395090,SUP,Custom 27803010,,48395090  -  SPACER SPNL 0D WDG NOSE 25X11X9MM AVS UNILIF HLW PEEK-OPTM,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48395094,SUP,Custom 27803010,,48395094  -  SPACER SPNL 4D LRDTC WDG NOSE 25X11X9MM AVS UNILIF HLW,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48395100,SUP,Custom 27803010,,48395100  -  SPACER SPNL 0D WDG NOSE 25X11X10MM AVS UNILIF HLW PEEK-OPTM,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48395104,SUP,Custom 27803010,,48395104  -  SPACER SPNL 4D LRDTC WDG NOSE 25X11X10MM AVS UNILIF HLW,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48395110,SUP,Custom 27803010,,48395110  -  SPACER SPNL 0D WDG NOSE 25X11X11MM AVS UNILIF HLW PEEK-OPTM,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48395114,SUP,Custom 27803010,,48395114  -  SPACER SPNL 4D LRDTC WDG NOSE 25X11X11MM AVS UNILIF HLW,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48395120,SUP,Custom 27803010,,48395120  -  SPACER SPNL 0D WDG NOSE 25X11X12MM AVS UNILIF HLW PEEK-OPTM,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48395124,SUP,Custom 27803010,,48395124  -  SPACER SPNL 4D LRDTC WDG NOSE 25X11X12MM AVS UNILIF HLW,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48395130,SUP,Custom 27803010,,48395130  -  SPACER SPNL 0D WDG NOSE 25X11X13MM AVS UNILIF HLW PEEK-OPTM,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48395134,SUP,Custom 27803010,,48395134  -  SPACER SPNL 4D LRDTC WDG NOSE 25X11X13MM AVS UNILIF HLW,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48395140,SUP,Custom 27803010,,48395140  -  SPACER SPNL 0D WDG NOSE 25X11X14MM AVS UNILIF HLW PEEK-OPTM,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48395144,SUP,Custom 27803010,,48395144  -  SPACER SPNL 4D LRDTC WDG NOSE 25X11X14MM AVS UNILIF HLW,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48395150,SUP,Custom 27803010,,48395150  -  SPACER SPNL 0D WDG NOSE 25X11X15MM AVS UNILIF HLW PEEK-OPTM,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48395154,SUP,Custom 27803010,,48395154  -  SPACER SPNL 4D LRDTC WDG NOSE 25X11X15MM AVS UNILIF HLW,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48395160,SUP,Custom 27803010,,48395160  -  SPACER SPNL 0D WDG NOSE 25X11X16MM AVS UNILIF HLW PEEK-OPTM,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48395164,SUP,Custom 27803010,,48395164  -  SPACER SPNL 4D LRDTC WDG NOSE 25X11X16MM AVS UNILIF HLW,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48395180,SUP,Custom 27803010,,48395180  -  SPACER SPNL 0D WDG NOSE 25X11X18MM AVS UNILIF HLW PEEK-OPTM,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48395184,SUP,Custom 27803010,,48395184  -  SPACER SPNL 4D LRDTC WDG NOSE 25X11X18MM AVS UNILIF HLW,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48480074,SUP,Custom 27803010,,48480074  -  SPACER SPNL 4D LRDTC WDG NOSE 20X9X7MM AVS UNILIF HLW,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48480084,SUP,Custom 27803010,,48480084  -  SPACER SPNL 4D LRDTC WDG NOSE 20X9X8MM AVS UNILIF HLW,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48480090,SUP,Custom 27803010,,48480090  -  SPACER SPNL 0D WDG NOSE 20X9X9MM AVS UNILIF HLW PEEK-OPTM,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48480094,SUP,Custom 27803010,,48480094  -  SPACER SPNL 4D LRDTC WDG NOSE 20X9X9MM AVS UNILIF HLW,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48480100,SUP,Custom 27803010,,48480100  -  SPACER SPNL 0D WDG NOSE 20X9X10MM AVS UNILIF HLW PEEK-OPTM,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48480104,SUP,Custom 27803010,,48480104  -  SPACER SPNL 4D LRDTC WDG NOSE 20X9X10MM AVS UNILIF HLW,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48480110,SUP,Custom 27803010,,48480110  -  SPACER SPNL 0D WDG NOSE 20X9X11MM AVS UNILIF HLW PEEK-OPTM,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48480114,SUP,Custom 27803010,,48480114  -  SPACER SPNL 4D LRDTC WDG NOSE 20X9X11MM AVS UNILIF HLW,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48480120,SUP,Custom 27803010,,48480120  -  SPACER SPNL 0D WDG NOSE 20X9X12MM AVS UNILIF HLW PEEK-OPTM,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48480124,SUP,Custom 27803010,,48480124  -  SPACER SPNL 4D LRDTC WDG NOSE 20X9X12MM AVS UNILIF HLW,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48480130,SUP,Custom 27803010,,48480130  -  SPACER SPNL 0D WDG NOSE 20X9X13MM AVS UNILIF HLW PEEK-OPTM,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48480134,SUP,Custom 27803010,,48480134  -  SPACER SPNL 4D LRDTC WDG NOSE 20X9X13MM AVS UNILIF HLW,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48480140,SUP,Custom 27803010,,48480140  -  SPACER SPNL 0D WDG NOSE 20X9X14MM AVS UNILIF HLW PEEK-OPTM,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48480144,SUP,Custom 27803010,,48480144  -  SPACER SPNL 4D LRDTC WDG NOSE 20X9X14MM AVS UNILIF HLW,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48480150,SUP,Custom 27803010,,48480150  -  SPACER SPNL 0D WDG NOSE 20X9X15MM AVS UNILIF HLW PEEK-OPTM,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48480154,SUP,Custom 27803010,,48480154  -  SPACER SPNL 4D LRDTC WDG NOSE 20X9X15MM AVS UNILIF HLW,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48480160,SUP,Custom 27803010,,48480160  -  SPACER SPNL 0D WDG NOSE 20X9X16MM AVS UNILIF HLW PEEK-OPTM,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48480164,SUP,Custom 27803010,,48480164  -  SPACER SPNL 4D LRDTC WDG NOSE 20X9X16MM AVS UNILIF HLW,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48482001,SUP,HCPCS C1713,,48482001  -  SCREW BONE DIAPASON OSS LMBR SPN COMBO,$271.83,$0.00,$271.83,$122.32,$194.00,$0.00,$46.83,$0.00,$0.00,$47.59,$271.83,$0.00,$135.91,$215.29,$217.46,$0.00,$42.54,$0.00,$43.27,$0.00
48482010,SUP,HCPCS C1713,,48482010  -  CAP IMPL DIAPASON OSS BLOCKER SPNE,$271.83,$0.00,$271.83,$122.32,$194.00,$0.00,$46.83,$0.00,$0.00,$47.59,$271.83,$0.00,$135.91,$215.29,$217.46,$0.00,$42.54,$0.00,$43.27,$0.00
48482020,SUP,HCPCS C1713,,48482020  -  RING IMPL DIAPASON OSS BLOCKER SPNE,$271.83,$0.00,$271.83,$122.32,$194.00,$0.00,$46.83,$0.00,$0.00,$47.59,$271.83,$0.00,$135.91,$215.29,$217.46,$0.00,$42.54,$0.00,$43.27,$0.00
48485074,SUP,Custom 27803010,,48485074  -  SPACER SPNL 4D LRDTC WDG NOSE 25X8X7MM AVS UNILIF HLW,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48485084,SUP,Custom 27803010,,48485084  -  SPACER SPNL 4D LRDTC WDG NOSE 25X8X8MM AVS UNILIF HLW,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48485090,SUP,Custom 27803010,,48485090  -  SPACER SPNL 0D WDG NOSE 25X8X9MM AVS UNILIF HLW PEEK-OPTM,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48485094,SUP,Custom 27803010,,48485094  -  SPACER SPNL 4D LRDTC WDG NOSE 25X8X9MM AVS UNILIF HLW,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48485100,SUP,Custom 27803010,,48485100  -  SPACER SPNL 0D WDG NOSE 25X8X10MM AVS UNILIF HLW PEEK-OPTM,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48485104,SUP,Custom 27803010,,48485104  -  SPACER SPNL 4D LRDTC WDG NOSE 25X8X10MM AVS UNILIF HLW,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48485110,SUP,Custom 27803010,,48485110  -  SPACER SPNL 0D WDG NOSE 25X8X11MM AVS UNILIF HLW PEEK-OPTM,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48485114,SUP,Custom 27803010,,48485114  -  SPACER SPNL 4D LRDTC WDG NOSE 25X8X11MM AVS UNILIF HLW,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48485120,SUP,Custom 27803010,,48485120  -  SPACER SPNL 0D WDG NOSE 25X8X12MM AVS UNILIF HLW PEEK-OPTM,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48485124,SUP,Custom 27803010,,48485124  -  SPACER SPNL 4D LRDTC WDG NOSE 25X8X12MM AVS UNILIF HLW,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48485130,SUP,Custom 27803010,,48485130  -  SPACER SPNL 0D WDG NOSE 25X8X13MM AVS UNILIF HLW PEEK-OPTM,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48485134,SUP,Custom 27803010,,48485134  -  SPACER SPNL 4D LRDTC WDG NOSE 25X8X13MM AVS UNILIF HLW,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48485140,SUP,Custom 27803010,,48485140  -  SPACER SPNL 0D WDG NOSE 25X8X14MM AVS UNILIF HLW PEEK-OPTM,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48485144,SUP,Custom 27803010,,48485144  -  SPACER SPNL 4D LRDTC WDG NOSE 25X8X14MM AVS UNILIF HLW,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48485150,SUP,Custom 27803010,,48485150  -  SPACER SPNL 0D WDG NOSE 25X8X15MM AVS UNILIF HLW PEEK-OPTM,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48485154,SUP,Custom 27803010,,48485154  -  SPACER SPNL 4D LRDTC WDG NOSE 25X8X15MM AVS UNILIF HLW,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48485160,SUP,Custom 27803010,,48485160  -  SPACER SPNL 0D WDG NOSE 25X8X16MM AVS UNILIF HLW PEEK-OPTM,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48485164,SUP,Custom 27803010,,48485164  -  SPACER SPNL 4D LRDTC WDG NOSE 25X8X16MM AVS UNILIF HLW,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
48485530,SUP,HCPCS C1713,,48485530  -  SCREW BONE 5.5MM 30MM DIAPASON OSS THOR SPN,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
48485535,SUP,HCPCS C1713,,48485535  -  SCREW BONE 5.5MM 35MM DIAPASON OSS THOR SPN,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
48485540,SUP,HCPCS C1713,,48485540  -  SCREW BONE 5.5MM 40MM DIAPASON OSS THOR SPN,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
48485545,SUP,HCPCS C1713,,48485545  -  SCREW BONE 5.5MM 45MM DIAPASON OSS THOR SPN,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
48485550,SUP,HCPCS C1713,,48485550  -  SCREW BONE 5.5MM 50MM DIAPASON OSS THOR SPN,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
48485555,SUP,HCPCS C1713,,48485555  -  SCREW BONE 5.5MM 55MM DIAPASON OSS THOR SPN,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
48486730,SUP,HCPCS C1713,,48486730  -  SCREW BONE 6.7MM 30MM DIAPASON OSS LMBR SPN,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
48486735,SUP,HCPCS C1713,,48486735  -  SCREW BONE 6.7MM 35MM DIAPASON OSS THOR SPN,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
48486740,SUP,HCPCS C1713,,48486740  -  SCREW BONE 6.7MM 40MM DIAPASON OSS LMBR SPN,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
48486745,SUP,HCPCS C1713,,48486745  -  SCREW BONE 6.7MM 45MM DIAPASON OSS LMBR SPN,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
48486750,SUP,HCPCS C1713,,48486750  -  SCREW BONE 6.7MM 50MM DIAPASON OSS LMBR SPN,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
48486755,SUP,HCPCS C1713,,48486755  -  SCREW BONE 6.7MM 55MM DIAPASON OSS LMBR SPN,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
48486760,SUP,HCPCS C1713,,48486760  -  SCREW BONE 6.7MM 60MM DIAPASON OSS LMBR SPN,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
48487730,SUP,HCPCS C1713,,48487730  -  SCREW BONE 7.7MM 30MM DIAPASON OSS TI LMBR SPN,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
48487735,SUP,HCPCS C1713,,48487735  -  SCREW BONE 7.7MM 35MM DIAPASON OSS LMBR SPN,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
48487740,SUP,HCPCS C1713,,48487740  -  SCREW BONE 7.7MM 40MM DIAPASON OSS LMBR SPN,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
48487745,SUP,HCPCS C1713,,48487745  -  SCREW BONE 7.7MM 45MM DIAPASON OSS LMBR SPN,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
48487750,SUP,HCPCS C1713,,48487750  -  SCREW BONE 7.7MM 50MM DIAPASON OSS LMBR SPN,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
48487755,SUP,HCPCS C1713,,48487755  -  SCREW BONE 7.7MM 55MM DIAPASON OSS LMBR SPN,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
48487760,SUP,HCPCS C1713,,48487760  -  SCREW BONE 7.7MM 60MM DIAPASON OSS LMBR SPN,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
48488035,SUP,HCPCS C1713,,48488035  -  SCREW BONE 8MM 35MM DIAPASON OSS SCRL SPN,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
48488040,SUP,HCPCS C1713,,48488040  -  SCREW BONE 8MM 40MM DIAPASON OSS SCRL SPN,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
48488045,SUP,HCPCS C1713,,48488045  -  SCREW BONE 8MM 45MM DIAPASON OSS SCRL SPN,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
48488050,SUP,HCPCS C1713,,48488050  -  SCREW BONE 8MM 50MM DIAPASON OSS SCRL SPN,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
48488055,SUP,HCPCS C1713,,48488055  -  SCREW BONE 8MM 55MM DIAPASON OSS SCRL SPN,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
48489040,SUP,HCPCS C1713,,48489040  -  SCREW BONE 9MM 40MM DIAPASON OSS SCRL SPN,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
48489045,SUP,HCPCS C1713,,48489045  -  SCREW BONE 9MM 45MM DIAPASON OSS SCRL SPN,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
48489050,SUP,HCPCS C1713,,48489050  -  SCREW BONE 9MM 50MM DIAPASON OSS SCRL SPN,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
48489055,SUP,HCPCS C1713,,48489055  -  SCREW BONE 9MM 55MM DIAPASON OSS TI SCRL SPN,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
48510410,SUP,Custom 27203010,,48510410  -  PIN FIX STANDARD TEMPORARY NAIL REFLEX SPN,$125.00,$0.00,$125.00,$0.00,$89.21,$0.00,$0.00,$0.00,$0.00,$0.00,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$0.00,$0.00,$0.00,$0.00
48510420,SUP,Custom 27203010,,48510420  -  PIN FIX LONG REFLEX HYBRID,$125.00,$0.00,$125.00,$0.00,$89.21,$0.00,$0.00,$0.00,$0.00,$0.00,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$0.00,$0.00,$0.00,$0.00
48510610,SUP,HCPCS C1729,,48510610  -  BIT DRILL 10MM REFLEX HYBRID STERILE,$125.00,$0.00,$125.00,$67.88,$89.21,$0.00,$21.54,$0.00,$0.00,$21.89,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$19.56,$0.00,$19.90,$0.00
48510612,SUP,Custom 27203010,,48510612  -  BIT DRILL 12MM REFLEX HYBRID SPN CERV ANTERIOR STERILE,$125.00,$0.00,$125.00,$0.00,$89.21,$0.00,$0.00,$0.00,$0.00,$0.00,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$0.00,$0.00,$0.00,$0.00
48510614,SUP,Custom 27203010,,48510614  -  BIT DRILL 14MM REFLEX HYBRID SPN CERV ANTERIOR STERILE,$125.00,$0.00,$125.00,$0.00,$89.21,$0.00,$0.00,$0.00,$0.00,$0.00,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$0.00,$0.00,$0.00,$0.00
48510616,SUP,Custom 27203010,,48510616  -  BIT DRILL 16MM REFLEX HYBRID SPN CERV ANTERIOR STERILE,$125.00,$0.00,$125.00,$0.00,$89.21,$0.00,$0.00,$0.00,$0.00,$0.00,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$0.00,$0.00,$0.00,$0.00
48510618,SUP,HCPCS C1729,,48510618  -  BIT DRILL 18MM REFLEX HYBRID SPN CERV ANTERIOR STERILE,$125.00,$0.00,$125.00,$67.88,$89.21,$0.00,$21.54,$0.00,$0.00,$21.89,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$19.56,$0.00,$19.90,$0.00
48510620,SUP,HCPCS C1729,,48510620  -  BIT DRILL 20MM,$262.50,$0.00,$262.50,$142.54,$187.35,$0.00,$45.23,$0.00,$0.00,$45.96,$262.50,$0.00,$131.25,$207.90,$210.00,$0.00,$41.08,$0.00,$41.79,$0.00
48550260,SUP,HCPCS C1713,,48550260  -  ROD SPNL 60MM 3.5MM OASYS TI,$480.48,$0.00,$480.48,$216.21,$342.92,$0.00,$82.78,$0.00,$0.00,$84.13,$480.48,$0.00,$240.24,$380.54,$384.38,$0.00,$75.19,$0.00,$76.49,$0.00
48551000,SUP,Custom 27803010,,48551000  -  SCREW SET BUTTRESS THREAD BLOCKER OASYS TITANIUM,$125.00,$0.00,$125.00,$0.00,$89.21,$0.00,$0.00,$0.00,$0.00,$0.00,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$0.00,$0.00,$0.00,$0.00
48551006,SUP,HCPCS C1713,,48551006  -  SCREW SET OASYS SPN CONCTR,$125.00,$0.00,$125.00,$56.25,$89.21,$0.00,$21.54,$0.00,$0.00,$21.89,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$19.56,$0.00,$19.90,$0.00
48551040,SUP,HCPCS C1713,,48551040  -  PLATE BONE 130D STR OASYS TITANIUM SPN THORACIC,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
48551042,SUP,HCPCS C1713,,48551042  -  PLATE BONE 100D STR OASYS TITANIUM SPN THORACIC,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
48551044,SUP,HCPCS C1713,,48551044  -  PLATE BONE SMALL OASYS TITANIUM SPN THORACIC,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
48551045,SUP,HCPCS C1713,,48551045  -  PLATE BONE MEDIUM OASYS TITANIUM SPN THORACIC,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
48551046,SUP,HCPCS C1713,,48551046  -  PLATE BONE LARGE OASYS TITANIUM SPN THORACIC,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
48551047,SUP,HCPCS C1713,,48551047  -  PLATE BONE LARGE LONG OASYS TITANIUM SPN THORACIC,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
48551048,SUP,HCPCS C1713,,48551048  -  PLATE BONE MINI OASYS TITANIUM SPN THORACIC OCCIPITOCERVICAL,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
48551049,SUP,Custom 27803010,,48551049  -  HOOK SPINAL 3.5MM OASYS TITANIUM,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48551050,SUP,Custom 27803010,,48551050  -  HOOK SPINAL SHORT 5MM OASYS TITANIUM,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48551053,SUP,Custom 27803010,,48551053  -  HOOK SPINAL 6.5MM OASYS TITANIUM,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48551055,SUP,Custom 27803010,,48551055  -  HOOK SPINAL STANDARD 8MM TALL OASYS TITANIUM,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48551060,SUP,Custom 27803010,,48551060  -  HOOK SPINAL RIGHT OFFST OASYS TITANIUM,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48551065,SUP,Custom 27803010,,48551065  -  HOOK SPINAL LEFT OFFST OASYS TITANIUM,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
48551070,SUP,Custom 27803010,,48551070  -  CONNECTOR ROD TRNSVRS POLYAX OASYS CROSSLINK SPN,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
48551071,SUP,Custom 27803010,,48551071  -  CONNECTOR ROD 60MM TRNSVRS SPN,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
48551072,SUP,Custom 27803010,,48551072  -  CONNECTOR ROD 40MM TRNSVRS SPN,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
48551073,SUP,HCPCS C1713,,48551073  -  PLATE BONE SMALL CROSS CONCTR OASYS SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48551074,SUP,Custom 27203010,,48551074  -  CONNECTOR ROD MEDIUM 32MM CROSS PLATE OASYS SPN NONSTRL 91,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48551075,SUP,HCPCS C1713,,48551075  -  PLATE BONE CROSS CONCTR OASYS TITANIUM SPN THORACIC,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48551080,SUP,Custom 27803010,,48551080  -  CONNECTOR ROD OFFST OASYS SPN,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
48551081,SUP,Custom 27803010,,48551081  -  CONNECTOR ROD 12MM CROSS PLATE OASYS CERV SPN NONSTRL,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
48551084,SUP,Custom 27803010,,48551084  -  CONNECTOR ROD 3.5-4.5MM AXIAL,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
48551085,SUP,Custom 27803010,,48551085  -  CONNECTOR ROD 3.5/3.5MM AXIAL OASYS SPN,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
48551086,SUP,Custom 27803010,,48551086  -  CONNECTOR ROD 3.5/5.5MM AXIAL OASYS SPN,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
48551087,SUP,Custom 27803010,,48551087  -  CONNECTOR ROD 3.5/6MM AXIAL OASYS SPN,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
48551088,SUP,Custom 27803010,,48551088  -  CONNECTOR ROD 3.5/3.5MM ROD TO ROD OASYS SPN,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
48551089,SUP,Custom 27803010,,48551089  -  CONNECTOR ROD 3.5/5.5MM ROD TO ROD OASYS SPN,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
48551090,SUP,Custom 27803010,,48551090  -  CONNECTOR ROD 3.5MM 90MM POLYAX ROD TO ROD OASYS TITANIUM,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
48551091,SUP,Custom 27803010,,48551091  -  CONNECTOR ROD 3.5/4.5MM,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
48551094,SUP,Custom 27803010,,48551094  -  CONNECTOR ROD SADDLE SCREW OASYS SPN 3.5 MM ROD,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
48551240,SUP,Custom 27803010,,48551240  -  ROD SPINAL 3.5MM 240MM OASYS,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
48551350,SUP,Custom 27803010,,48551350  -  ROD SPINAL 3.5MM 350MM,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
48552025,SUP,Custom 27803010,,48552025  -  ROD SPINAL 3.5MM 25MM OASYS TITANIUM OCCIPITOCERVICOTHORACIC,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
48552030,SUP,Custom 27803010,,48552030  -  ROD SPINAL 3.5MM 30MM OASYS TITANIUM OCCIPITOCERVICOTHORACIC,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
48552040,SUP,Custom 27803010,,48552040  -  ROD SPINAL 3.5MM 40MM OASYS TITANIUM OCCIPITOCERVICOTHORACIC,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
48552050,SUP,Custom 27803010,,48552050  -  ROD SPINAL 3.5MM 50MM OASYS TITANIUM OCCIPITO CERVICO,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
48552060,SUP,Custom 27803010,,48552060  -  ROD SPINAL 3.5MM 60MM OASYS TITANIUM OCCIPITOCERVICOTHORACIC,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
48552070,SUP,Custom 27803010,,48552070  -  ROD SPINAL 3.5MM 70MM OASYS TITANIUM OCCIPITOCERVICOTHORACIC,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
48552080,SUP,Custom 27803010,,48552080  -  ROD SPINAL 3.5MM 80MM OASYS TITANIUM OCCIPITOCERVICOTHORACIC,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
48552120,SUP,Custom 27803010,,48552120  -  ROD SPINAL 3.5MM 120MM OASYS TITANIUM,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
48552240,SUP,Custom 27803010,,48552240  -  ROD SPINAL 3.5MM 240MM OASYS TITANIUM,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
48552310,SUP,HCPCS C1713,,48552310  -  SCREW BONE 3.5MM 10MM BIAS ANGLE POLYAX OASYS SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48552312,SUP,HCPCS C1713,,48552312  -  SCREW BONE LP 3.5MM 12MM BIAS ANGLE POLYAX OASYS TITANIUM,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48552314,SUP,HCPCS C1713,,48552314  -  SCREW BONE LP 3.5MM 14MM BIAS ANGLE POLYAX OASYS TITANIUM,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48552316,SUP,HCPCS C1713,,48552316  -  SCREW BONE LP 3.5MM 16MM BIAS ANGLE POLYAX OASYS TITANIUM,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48552318,SUP,HCPCS C1713,,48552318  -  SCREW BONE LP 3.5MM 18MM BIAS ANGLE POLYAX OASYS TITANIUM,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48552320,SUP,HCPCS C1713,,48552320  -  SCREW BONE LP 3.5MM 20MM BIAS ANGLE POLYAX OASYS TITANIUM,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48552322,SUP,HCPCS C1713,,48552322  -  SCREW BONE LP 3.5MM 22MM BIAS ANGLE POLYAX OASYS TITANIUM,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48552324,SUP,HCPCS C1713,,48552324  -  SCREW BONE LP 3.5MM 24MM BIAS ANGLE POLYAX OASYS TITANIUM,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48552326,SUP,HCPCS C1713,,48552326  -  SCREW BONE LP 3.5MM 26MM BIAS ANGLE POLYAX OASYS TITANIUM,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48552328,SUP,HCPCS C1713,,48552328  -  SCREW BONE LP 3.5MM 28MM BIAS ANGLE POLYAX OASYS TITANIUM,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48552330,SUP,HCPCS C1713,,48552330  -  SCREW BONE LP 3.5MM 30MM BIAS ANGLE POLYAX OASYS TITANIUM,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48552332,SUP,HCPCS C1713,,48552332  -  SCREW BONE LP 3.5MM 32MM BIAS ANGLE POLYAX OASYS TITANIUM,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48552334,SUP,HCPCS C1713,,48552334  -  SCREW BONE LP 3.5MM 34MM BIAS ANGLE POLYAX OASYS TITANIUM,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48552336,SUP,HCPCS C1713,,48552336  -  SCREW BONE 3.5MM 36MM POLYAX OASYS SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48552338,SUP,HCPCS C1713,,48552338  -  SCREW BONE 3.5MM 38MM POLYAX OASYS SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48552340,SUP,HCPCS C1713,,48552340  -  SCREW BONE 3.5MM 40MM POLYAX OASYS SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48552342,SUP,HCPCS C1713,,48552342  -  SCREW BONE 3.5MM 42MM POLYAX OASYS SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48552344,SUP,HCPCS C1713,,48552344  -  SCREW BONE 3.5MM 44MM POLYAX OASYS SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48552346,SUP,HCPCS C1713,,48552346  -  SCREW BONE 3.5MM 46MM POLYAX OASYS SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48552348,SUP,HCPCS C1713,,48552348  -  SCREW BONE 3.5MM 48MM POLYAX OASYS SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48552350,SUP,HCPCS C1713,,48552350  -  SCREW BONE 3.5MM 50MM POLYAX OASYS SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48552352,SUP,HCPCS C1713,,48552352  -  SCREW BONE 3.5MM 52MM POLYAX OASYS SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48552354,SUP,HCPCS C1713,,48552354  -  SCREW BONE 3.5MM 54MM POLYAX OASYS SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48552410,SUP,HCPCS C1713,,48552410  -  SCREW BONE LP 4MM 10MM BIAS ANGLE POLYAX OASYS TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48552412,SUP,HCPCS C1713,,48552412  -  SCREW BONE LP 4MM 12MM BIAS ANGLE POLYAX OASYS TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48552414,SUP,HCPCS C1713,,48552414  -  SCREW BONE LP 4MM 14MM BIAS ANGLE POLYAX OASYS TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48552416,SUP,HCPCS C1713,,48552416  -  SCREW BONE LP 4MM 16MM BIAS ANGLE POLYAX OASYS TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48552418,SUP,HCPCS C1713,,48552418  -  SCREW BONE LP 4MM 18MM BIAS ANGLE POLYAX OASYS TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48552420,SUP,HCPCS C1713,,48552420  -  SCREW BONE LP 4MM 20MM BIAS ANGLE POLYAX OASYS TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48552422,SUP,HCPCS C1713,,48552422  -  SCREW BONE LP 4MM 22MM BIAS ANGLE POLYAX OASYS TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48552424,SUP,HCPCS C1713,,48552424  -  SCREW BONE LP 4MM 24MM BIAS ANGLE POLYAX OASYS TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48552426,SUP,HCPCS C1713,,48552426  -  SCREW BONE LP 4MM 26MM BIAS ANGLE POLYAX OASYS TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48552428,SUP,HCPCS C1713,,48552428  -  SCREW BONE LP 4MM 28MM BIAS ANGLE POLYAX OASYS TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48552430,SUP,HCPCS C1713,,48552430  -  SCREW BONE LP 4MM 30MM BIAS ANGLE POLYAX OASYS TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48552432,SUP,HCPCS C1713,,48552432  -  SCREW BONE LP 4MM 32MM BIAS ANGLE POLYAX OASYS TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48552434,SUP,HCPCS C1713,,48552434  -  SCREW BONE LP 4MM 34MM BIAS ANGLE POLYAX OASYS TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48552436,SUP,HCPCS C1713,,48552436  -  SCREW BONE LP 4MM 36MM BIAS ANGLE POLYAX OASYS TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48552438,SUP,HCPCS C1713,,48552438  -  SCREW BONE LP 4MM 38MM BIAS ANGLE POLYAX OASYS TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48552440,SUP,HCPCS C1713,,48552440  -  SCREW BONE LP 4MM 40MM BIAS ANGLE POLYAX OASYS TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48552442,SUP,HCPCS C1713,,48552442  -  SCREW BONE LP 4MM 42MM BIAS ANGLE POLYAX OASYS TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48552446,SUP,HCPCS C1713,,48552446  -  SCREW BONE LP 4MM 46MM BIAS ANGLE POLYAX OASYS TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48552450,SUP,HCPCS C1713,,48552450  -  SCREW BONE LP 4MM 50MM BIAS ANGLE POLYAX OASYS TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48553600,SUP,Custom 27803010,,48553600  -  ROD SPINAL 3.5-4.5MM 600MM TRANSITION OASYS TITANIUM,$875.00,$0.00,$875.00,$0.00,$624.49,$0.00,$0.00,$0.00,$0.00,$0.00,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$0.00,$0.00,$0.00,$0.00
48553602,SUP,Custom 27803010,,48553602  -  ROD SPNL 3.5-4.5MM 600MM NS LF OASYS TRNS VIT,$875.00,$0.00,$875.00,$0.00,$624.49,$0.00,$0.00,$0.00,$0.00,$0.00,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$0.00,$0.00,$0.00,$0.00
48553604,SUP,Custom 27803010,,48553604  -  ROD SPNL 3.5-5.5MM 600MM NS OASYS TRNS TI,$875.00,$0.00,$875.00,$0.00,$624.49,$0.00,$0.00,$0.00,$0.00,$0.00,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$0.00,$0.00,$0.00,$0.00
48553606,SUP,Custom 27803010,,48553606  -  ROD SPINAL 3.5-5.5MM TRANSITION OASYS VITALLIUM,$875.00,$0.00,$875.00,$0.00,$624.49,$0.00,$0.00,$0.00,$0.00,$0.00,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$0.00,$0.00,$0.00,$0.00
48553608,SUP,Custom 27803010,,48553608  -  ROD SPNL 3.5-6MM 600MM NS OASYS TRNS TI,$875.00,$0.00,$875.00,$0.00,$624.49,$0.00,$0.00,$0.00,$0.00,$0.00,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$0.00,$0.00,$0.00,$0.00
48553610,SUP,Custom 27803010,,48553610  -  ROD SPINAL 3.5-6MM TRANSITION OASYS VITALLIUM,$875.00,$0.00,$875.00,$0.00,$624.49,$0.00,$0.00,$0.00,$0.00,$0.00,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$0.00,$0.00,$0.00,$0.00
48554306,SUP,HCPCS C1713,,48554306  -  SCREW BONE LP 3.5MM 6MM OASYS TITANIUM SPN,$312.50,$0.00,$312.50,$140.63,$223.03,$0.00,$53.84,$0.00,$0.00,$54.72,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$48.91,$0.00,$49.75,$0.00
48554308,SUP,HCPCS C1713,,48554308  -  SCREW BONE LP 3.5MM 8MM OASYS TITANIUM SPN,$312.50,$0.00,$312.50,$140.63,$223.03,$0.00,$53.84,$0.00,$0.00,$54.72,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$48.91,$0.00,$49.75,$0.00
48554310,SUP,HCPCS C1713,,48554310  -  SCREW BONE LP 3.5MM 10MM OASYS TITANIUM SPN,$312.50,$0.00,$312.50,$140.63,$223.03,$0.00,$53.84,$0.00,$0.00,$54.72,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$48.91,$0.00,$49.75,$0.00
48554312,SUP,HCPCS C1713,,48554312  -  SCREW BONE LP 3.5MM 12MM OASYS TITANIUM SPN,$312.50,$0.00,$312.50,$140.63,$223.03,$0.00,$53.84,$0.00,$0.00,$54.72,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$48.91,$0.00,$49.75,$0.00
48554314,SUP,HCPCS C1713,,48554314  -  SCREW BONE LP 3.5MM 14MM OASYS TITANIUM SPN,$312.50,$0.00,$312.50,$140.63,$223.03,$0.00,$53.84,$0.00,$0.00,$54.72,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$48.91,$0.00,$49.75,$0.00
48554316,SUP,HCPCS C1713,,48554316  -  SCREW BONE LP 3.5MM 16MM OASYS TITANIUM SPN,$312.50,$0.00,$312.50,$140.63,$223.03,$0.00,$53.84,$0.00,$0.00,$54.72,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$48.91,$0.00,$49.75,$0.00
48554406,SUP,HCPCS C1713,,48554406  -  SCREW BONE LP 4MM 6MM OASYS TITANIUM SPN,$312.50,$0.00,$312.50,$140.63,$223.03,$0.00,$53.84,$0.00,$0.00,$54.72,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$48.91,$0.00,$49.75,$0.00
48554408,SUP,HCPCS C1713,,48554408  -  SCREW BONE LP 4MM 8MM OASYS TITANIUM SPN,$312.50,$0.00,$312.50,$140.63,$223.03,$0.00,$53.84,$0.00,$0.00,$54.72,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$48.91,$0.00,$49.75,$0.00
48554410,SUP,HCPCS C1713,,48554410  -  SCREW BONE LP 4MM 10MM OASYS TITANIUM SPN,$312.50,$0.00,$312.50,$140.63,$223.03,$0.00,$53.84,$0.00,$0.00,$54.72,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$48.91,$0.00,$49.75,$0.00
48554412,SUP,HCPCS C1713,,48554412  -  SCREW BONE LP 4MM 12MM OASYS TITANIUM SPN,$312.50,$0.00,$312.50,$140.63,$223.03,$0.00,$53.84,$0.00,$0.00,$54.72,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$48.91,$0.00,$49.75,$0.00
48554414,SUP,HCPCS C1713,,48554414  -  SCREW BONE LP 4MM 14MM OASYS TITANIUM SPN,$312.50,$0.00,$312.50,$140.63,$223.03,$0.00,$53.84,$0.00,$0.00,$54.72,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$48.91,$0.00,$49.75,$0.00
48554416,SUP,HCPCS C1713,,48554416  -  SCREW BONE LP 4MM 16MM OASYS TITANIUM SPN,$312.50,$0.00,$312.50,$140.63,$223.03,$0.00,$53.84,$0.00,$0.00,$54.72,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$48.91,$0.00,$49.75,$0.00
48554506,SUP,HCPCS C1713,,48554506  -  SCREW BONE LP 4.5MM 6MM OASYS TITANIUM SPN,$312.50,$0.00,$312.50,$140.63,$223.03,$0.00,$53.84,$0.00,$0.00,$54.72,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$48.91,$0.00,$49.75,$0.00
48554508,SUP,HCPCS C1713,,48554508  -  SCREW BONE LP 4.5MM 8MM OASYS TITANIUM SPN,$312.50,$0.00,$312.50,$140.63,$223.03,$0.00,$53.84,$0.00,$0.00,$54.72,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$48.91,$0.00,$49.75,$0.00
48554510,SUP,HCPCS C1713,,48554510  -  SCREW BONE 4.5MM 10MM OASYS SPN,$312.50,$0.00,$312.50,$140.63,$223.03,$0.00,$53.84,$0.00,$0.00,$54.72,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$48.91,$0.00,$49.75,$0.00
48554512,SUP,HCPCS C1713,,48554512  -  SCREW BONE 4.5MM 12MM OASYS SPN,$312.50,$0.00,$312.50,$140.63,$223.03,$0.00,$53.84,$0.00,$0.00,$54.72,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$48.91,$0.00,$49.75,$0.00
48554514,SUP,HCPCS C1713,,48554514  -  SCREW BONE 4.5MM 14MM OASYS SPN,$312.50,$0.00,$312.50,$140.63,$223.03,$0.00,$53.84,$0.00,$0.00,$54.72,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$48.91,$0.00,$49.75,$0.00
48554516,SUP,HCPCS C1713,,48554516  -  SCREW BONE 4.5MM 16MM OASYS SPN,$312.50,$0.00,$312.50,$140.63,$223.03,$0.00,$53.84,$0.00,$0.00,$54.72,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$48.91,$0.00,$49.75,$0.00
48555320,SUP,HCPCS C1713,,48555320  -  SCREW BONE LP 3.5MM 20MM BIAS ANGLE POLYAX OASYS TITANIUM,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48555322,SUP,HCPCS C1713,,48555322  -  SCREW BONE LP 3.5MM 22MM BIAS ANGLE POLYAX OASYS TITANIUM,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48555324,SUP,HCPCS C1713,,48555324  -  SCREW BONE LP 3.5MM 24MM BIAS ANGLE POLYAX OASYS TITANIUM,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48555328,SUP,HCPCS C1713,,48555328  -  SCREW BONE LP 3.5MM 28MM BIAS ANGLE POLYAX OASYS TITANIUM,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48555332,SUP,HCPCS C1713,,48555332  -  SCREW BONE LP 3.5MM 32MM BIAS ANGLE POLYAX OASYS TITANIUM,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48555336,SUP,HCPCS C1713,,48555336  -  SCREW BONE LP 3.5MM 36MM BIAS ANGLE POLYAX OASYS TITANIUM,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48555340,SUP,HCPCS C1713,,48555340  -  SCREW BONE LP 3.5MM 40MM BIAS ANGLE POLYAX OASYS TITANIUM,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48555420,SUP,HCPCS C1713,,48555420  -  SCREW BONE LP 4MM 20MM BIAS ANGLE POLYAX OASYS TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48555422,SUP,HCPCS C1713,,48555422  -  SCREW BONE LP 4MM 22MM BIAS ANGLE POLYAX OASYS TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48555424,SUP,HCPCS C1713,,48555424  -  SCREW BONE LP 4MM 24MM BIAS ANGLE POLYAX OASYS TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48555428,SUP,HCPCS C1713,,48555428  -  SCREW BONE LP 4MM 28MM BIAS ANGLE POLYAX OASYS TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48555432,SUP,HCPCS C1713,,48555432  -  SCREW BONE LP 4MM 32MM BIAS ANGLE POLYAX OASYS TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48555436,SUP,HCPCS C1713,,48555436  -  SCREW BONE LP 4MM 36MM BIAS ANGLE POLYAX OASYS TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48555440,SUP,HCPCS C1713,,48555440  -  SCREW BONE LP 4MM 40MM BIAS ANGLE POLYAX OASYS TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48555444,SUP,HCPCS C1713,,48555444  -  SCREW BONE LP 4MM 44MM BIAS ANGLE POLYAX OASYS TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48555448,SUP,HCPCS C1713,,48555448  -  SCREW BONE LP 4MM 48MM BIAS ANGLE POLYAX OASYS TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48555452,SUP,HCPCS C1713,,48555452  -  SCREW BONE LP 4MM 52MM BIAS ANGLE POLYAX OASYS TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48556322,SUP,HCPCS C1713,,48556322  -  SCREW BONE LP 3.5MM 22MM BIAS ANGLE SMOOTH SHANK OASYS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48556324,SUP,HCPCS C1713,,48556324  -  SCREW BONE LP 3.5MM 24MM BIAS ANGLE SMOOTH SHANK OASYS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48556326,SUP,HCPCS C1713,,48556326  -  SCREW BONE LP 3.5MM 26MM BIAS ANGLE SMOOTH SHANK OASYS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48556328,SUP,HCPCS C1713,,48556328  -  SCREW BONE LP 3.5MM 28MM BIAS ANGLE SMOOTH SHANK OASYS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48556330,SUP,HCPCS C1713,,48556330  -  SCREW BONE LP 3.5MM 30MM BIAS ANGLE SMOOTH SHANK OASYS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48556332,SUP,HCPCS C1713,,48556332  -  SCREW BONE LP 3.5MM 32MM BIAS ANGLE SMOOTH SHANK OASYS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48556334,SUP,HCPCS C1713,,48556334  -  SCREW BONE LP 3.5MM 34MM BIAS ANGLE SMOOTH SHANK OASYS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48556336,SUP,HCPCS C1713,,48556336  -  SCREW BONE LP 3.5MM 36MM BIAS ANGLE SMOOTH SHANK OASYS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48556338,SUP,HCPCS C1713,,48556338  -  SCREW BONE LP 3.5MM 38MM BIAS ANGLE SMOOTH SHANK OASYS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48556340,SUP,HCPCS C1713,,48556340  -  SCREW BONE LP 3.5MM 40MM BIAS ANGLE SMOOTH SHANK OASYS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48557310,SUP,HCPCS C1713,,48557310  -  SCREW BONE LP 3.5MM 10MM BIAS ANGLE POLYAX OASYS TITANIUM,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48557312,SUP,HCPCS C1713,,48557312  -  SCREW BONE LP 3.5MM 12MM BIAS ANGLE POLYAX OASYS TITANIUM,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48557314,SUP,HCPCS C1713,,48557314  -  SCREW BONE LP 3.5MM 14MM BIAS ANGLE POLYAX OASYS TITANIUM,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48557316,SUP,HCPCS C1713,,48557316  -  SCREW BONE LP 3.5MM 16MM BIAS ANGLE POLYAX OASYS TITANIUM,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48557318,SUP,HCPCS C1713,,48557318  -  SCREW BONE LP 3.5MM 18MM BIAS ANGLE POLYAX OASYS TITANIUM,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48557320,SUP,HCPCS C1713,,48557320  -  SCREW BONE LP 3.5MM 20MM BIAS ANGLE POLYAX OASYS TITANIUM,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48557322,SUP,HCPCS C1713,,48557322  -  SCREW BONE LP 3.5MM 22MM BIAS ANGLE POLYAX OASYS TITANIUM,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48557324,SUP,HCPCS C1713,,48557324  -  SCREW BONE LP 3.5MM 24MM BIAS ANGLE POLYAX OASYS TITANIUM,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48557410,SUP,HCPCS C1713,,48557410  -  SCREW BONE LP 4MM 10MM BIAS ANGLE POLYAX OASYS TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48557412,SUP,HCPCS C1713,,48557412  -  SCREW BONE LP 4MM 12MM BIAS ANGLE POLYAX OASYS TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48557414,SUP,HCPCS C1713,,48557414  -  SCREW BONE LP 4MM 14MM BIAS ANGLE POLYAX OASYS TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48557416,SUP,HCPCS C1713,,48557416  -  SCREW BONE LP 4MM 16MM BIAS ANGLE POLYAX OASYS TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48557418,SUP,HCPCS C1713,,48557418  -  SCREW BONE LP 4MM 18MM BIAS ANGLE POLYAX OASYS TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48557420,SUP,HCPCS C1713,,48557420  -  SCREW BONE LP 4MM 20MM BIAS ANGLE POLYAX OASYS TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48557422,SUP,HCPCS C1713,,48557422  -  SCREW BONE LP 4MM 22MM BIAS ANGLE POLYAX OASYS TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48557424,SUP,HCPCS C1713,,48557424  -  SCREW BONE LP 4MM 24MM BIAS ANGLE POLYAX OASYS TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48558310,SUP,HCPCS C1713,,48558310  -  SCREW BONE LP 3.5MM 10MM POLYAX OASYS TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48558312,SUP,HCPCS C1713,,48558312  -  SCREW BN 3.5MM 12MM FCHSA NS OASYS PA NONBIAS ANG TULIP HD,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48558314,SUP,HCPCS C1713,,48558314  -  SCREW BN 3.5MM 14MM FCHSA NS OASYS PA NONBIAS ANG TULIP HD,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48558316,SUP,HCPCS C1713,,48558316  -  SCREW BONE LP 3.5MM 16MM POLYAX OASYS TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48558318,SUP,HCPCS C1713,,48558318  -  SCREW BONE LP 3.5MM 18MM POLYAX OASYS TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48558320,SUP,HCPCS C1713,,48558320  -  SCREW BONE LP 3.5MM 20MM POLYAX OASYS TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48558410,SUP,HCPCS C1713,,48558410  -  SCREW BONE LP 4MM 10MM POLYAX OASYS TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48558412,SUP,HCPCS C1713,,48558412  -  SCREW BONE LP 4MM 12MM POLYAX OASYS TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48558414,SUP,HCPCS C1713,,48558414  -  SCREW BONE LP 4MM 14MM POLYAX OASYS TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48558416,SUP,HCPCS C1713,,48558416  -  SCREW BONE LP 4MM 16MM POLYAX OASYS TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48558418,SUP,HCPCS C1713,,48558418  -  SCREW BONE LP 4MM 18MM POLYAX OASYS TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48558420,SUP,HCPCS C1713,,48558420  -  SCREW BONE LP 4MM 20MM POLYAX OASYS TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48558520,SUP,HCPCS C1713,,48558520  -  SCREW BONE LP 4.5MM 20MM POLYAX OASYS TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48558524,SUP,HCPCS C1713,,48558524  -  SCREW BN 4.5MM 24MM FCHSA NS OASYS PA NONBIAS ANG TULIP HD,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48558528,SUP,HCPCS C1713,,48558528  -  SCREW BONE LP 4.5MM 28MM POLYAX OASYS TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48558532,SUP,HCPCS C1713,,48558532  -  SCREW BONE LP 4.5MM 32MM POLYAX OASYS TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48558536,SUP,HCPCS C1713,,48558536  -  SCREW BONE LP 4.5MM 36MM POLYAX OASYS TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48558540,SUP,HCPCS C1713,,48558540  -  SCREW BONE LP 4.5MM 40MM POLYAX OASYS TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48558544,SUP,HCPCS C1713,,48558544  -  SCREW BONE LP 4.5MM 44MM POLYAX OASYS TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48558548,SUP,HCPCS C1713,,48558548  -  SCREW BONE LP 4.5MM 48MM POLYAX OASYS TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48558552,SUP,HCPCS C1713,,48558552  -  SCREW BONE LP 4.5MM 52MM POLYAX OASYS TITANIUM SPN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
48560314,SUP,Custom 27803010,,48560314  -  TAP SPINAL 3.5MM DRILL BIT OASYS,$490.83,$0.00,$490.83,$0.00,$350.30,$0.00,$0.00,$0.00,$0.00,$0.00,$490.83,$0.00,$245.41,$388.74,$392.66,$0.00,$0.00,$0.00,$0.00,$0.00
48560323,SUP,Custom 27203010,,48560323  -  BIT DRL 2.5MM 3.5MM PA SCR,$125.00,$0.00,$125.00,$0.00,$89.21,$0.00,$0.00,$0.00,$0.00,$0.00,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$0.00,$0.00,$0.00,$0.00
48560414,SUP,HCPCS C1713,,48560414  -  TAP SURG 4MM OASYS SPN 4MM SCREW,$490.83,$0.00,$490.83,$220.87,$350.30,$0.00,$84.57,$0.00,$0.00,$85.94,$490.83,$0.00,$245.41,$388.74,$392.66,$0.00,$76.81,$0.00,$78.14,$0.00
48560423,SUP,Custom 27203010,,48560423  -  DRILL SURG 3MM OASYS SPN STERILE 4MM SCREW,$125.00,$0.00,$125.00,$0.00,$89.21,$0.00,$0.00,$0.00,$0.00,$0.00,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$0.00,$0.00,$0.00,$0.00
48560514,SUP,HCPCS C1713,,48560514  -  TAP SPINAL 3.5MM OASYS SPN,$425.30,$0.00,$425.30,$191.39,$303.54,$0.00,$73.28,$0.00,$0.00,$74.47,$425.30,$0.00,$212.65,$336.84,$340.24,$0.00,$66.56,$0.00,$67.71,$0.00
48570114,SUP,Custom 27203010,,48570114  -  BIT DRL 4MM ESCALATE LAMINOPLASTY,$125.00,$0.00,$125.00,$0.00,$89.21,$0.00,$0.00,$0.00,$0.00,$0.00,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$0.00,$0.00,$0.00,$0.00
48570116,SUP,Custom 27203010,,48570116  -  DRILL SURG 6MM ESCALATE NONSTRL LAMINOPLASTY,$125.00,$0.00,$125.00,$0.00,$89.21,$0.00,$0.00,$0.00,$0.00,$0.00,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$0.00,$0.00,$0.00,$0.00
48570118,SUP,Custom 27203010,,48570118  -  DRILL SURG 8MM ESCALATE NONSTRL LAMINOPLASTY,$125.00,$0.00,$125.00,$0.00,$89.21,$0.00,$0.00,$0.00,$0.00,$0.00,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$0.00,$0.00,$0.00,$0.00
48570204,SUP,HCPCS C1713,,48570204  -  SCREW BONE 2MM 4MM SELF DRILL ESCALATE MAGENTA SPN CERV,$125.00,$0.00,$125.00,$56.25,$89.21,$0.00,$21.54,$0.00,$0.00,$21.89,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$19.56,$0.00,$19.90,$0.00
48570206,SUP,HCPCS C1713,,48570206  -  SCREW BONE 2MM 6MM SELF DRILL ESCALATE MAGENTA SPN CERV,$125.00,$0.00,$125.00,$56.25,$89.21,$0.00,$21.54,$0.00,$0.00,$21.89,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$19.56,$0.00,$19.90,$0.00
48570208,SUP,HCPCS C1713,,48570208  -  SCREW BONE 2MM 8MM SELF DRILL ESCALATE MAGENTA SPN CERV,$125.00,$0.00,$125.00,$56.25,$89.21,$0.00,$21.54,$0.00,$0.00,$21.89,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$19.56,$0.00,$19.90,$0.00
48570210,SUP,HCPCS C1713,,48570210  -  ESCALATE 2.0 X 10MM SELF DRILLING SCREW,$125.00,$0.00,$125.00,$56.25,$89.21,$0.00,$21.54,$0.00,$0.00,$21.89,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$19.56,$0.00,$19.90,$0.00
48570240,SUP,HCPCS C1713,,48570240  -  ESCALATE 2.4 X 10MM SELF TAPPING SCREW,$125.00,$0.00,$125.00,$56.25,$89.21,$0.00,$21.54,$0.00,$0.00,$21.89,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$19.56,$0.00,$19.90,$0.00
48570244,SUP,HCPCS C1713,,48570244  -  ESCALATE 2.4 X 4MM SELF TAPPING SCREW,$125.00,$0.00,$125.00,$56.25,$89.21,$0.00,$21.54,$0.00,$0.00,$21.89,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$19.56,$0.00,$19.90,$0.00
48570246,SUP,HCPCS C1713,,48570246  -  ESCALATE 2.4 X 6MM SELF TAPPING SCREW,$125.00,$0.00,$125.00,$56.25,$89.21,$0.00,$21.54,$0.00,$0.00,$21.89,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$19.56,$0.00,$19.90,$0.00
48570248,SUP,HCPCS C1713,,48570248  -  ESCALATE 2.4 X 8MM SELF TAPPING SCREW,$125.00,$0.00,$125.00,$56.25,$89.21,$0.00,$21.54,$0.00,$0.00,$21.89,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$19.56,$0.00,$19.90,$0.00
48570300,SUP,HCPCS C1713,,48570300  -  PLATE BONE 5MM EXPANDABLE ESCALATE TITANIUM SPN CERV NONSTRL,"$1,000.00",$0.00,"$1,000.00",$450.00,$713.70,$0.00,$172.30,$0.00,$0.00,$175.09,"$1,000.00",$0.00,$500.00,$792.00,$800.00,$0.00,$156.50,$0.00,$159.20,$0.00
48570301,SUP,HCPCS C1713,,48570301  -  PLATE BONE 5MM 2 HOLE BASE ESCALATE TITANIUM SPN CERV,"$1,000.00",$0.00,"$1,000.00",$450.00,$713.70,$0.00,$172.30,$0.00,$0.00,$175.09,"$1,000.00",$0.00,$500.00,$792.00,$800.00,$0.00,$156.50,$0.00,$159.20,$0.00
48610112,SUP,HCPCS C1713,,48610112  -  PLATE 12MM TI 1 LVL RFLX BONE ANT CERV SPN,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
48610114,SUP,HCPCS C1713,,48610114  -  PLATE 14MM TI 1 LVL RFLX BONE ANT CERV SPN,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
48610116,SUP,HCPCS C1713,,48610116  -  PLATE 16MM TI 1 LVL RFLX HB BONE ANT CERV SPN,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
48610118,SUP,HCPCS C1713,,48610118  -  PLATE 18MM TI 1 LVL RFLX BONE ANT CERV SPN,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
48610120,SUP,HCPCS C1713,,48610120  -  PLATE 20MM TI 1 LVL RFLX BONE ANT CERV SPN,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
48610122,SUP,HCPCS C1713,,48610122  -  PLATE 22MM TI 1 LVL RFLX BONE ANT CERV SPN,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
48610224,SUP,HCPCS C1713,,48610224  -  PLATE 24MM TI 2 LVL RFLX BONE ANT CERV SPN,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
48610226,SUP,HCPCS C1713,,48610226  -  PLATE 26MM TI 2 LVL RFLX HB BONE ANT CERV SPN,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
48610228,SUP,HCPCS C1713,,48610228  -  PLATE 28MM TI 2 LVL RFLX BONE ANT CERV SPN,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
48610230,SUP,HCPCS C1713,,48610230  -  PLATE 30MM TI 2 LVL RFLX BONE ANT CERV SPN,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
48610232,SUP,HCPCS C1713,,48610232  -  PLATE 32MM TI 2 LVL RFLX BONE ANT CERV,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
48610234,SUP,HCPCS C1713,,48610234  -  PLATE 34MM TI 2 LVL RFLX BONE ANT CERV SPN,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
48610237,SUP,HCPCS C1713,,48610237  -  PLATE 37MM TI 2 LVL RFLX BONE ANT CERV SPN,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
48610240,SUP,HCPCS C1713,,48610240  -  PLATE 40MM TI 2 LVL RFLX HB BONE ANT CERV SPN,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
48610243,SUP,HCPCS C1713,,48610243  -  PLATE 43MM TI 2 LVL RFLX BONE ANT CERV SPN,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
48610246,SUP,HCPCS C1713,,48610246  -  PLATE 46MM 2 LVL RFLX BONE ANT CERV SPN,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
48610339,SUP,HCPCS C1713,,48610339  -  PLATE 39MM TI 3 LVL RFLX BONE ANT CERV SPN,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
48610342,SUP,HCPCS C1713,,48610342  -  PLATE 42MM TI 3 LVL RFLX BONE ANT CERV,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
48610345,SUP,HCPCS C1713,,48610345  -  PLATE 45MM TI 3 LVL RFLX BONE ANT CERV SPN,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
48610348,SUP,HCPCS C1713,,48610348  -  PLATE 48MM 3 LVL RFLX BONE ANT CERV SPN,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
48610351,SUP,HCPCS C1713,,48610351  -  PLATE 51MM TI 3 LVL RFLX BONE ANT CERV SPN,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
48610354,SUP,HCPCS C1713,,48610354  -  PLATE 54MM TI 3 LVL RFLX HB BONE ANT CERV SPN,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
48610357,SUP,HCPCS C1713,,48610357  -  PLATE 57MM TI 3 LVL RFLX BONE ANT CERV SPN,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
48610360,SUP,HCPCS C1713,,48610360  -  PLATE 60MM TI 3 LVL RFLX BONE ANT CERV SPN,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
48610363,SUP,HCPCS C1713,,48610363  -  PLATE 63MM TI 3 LVL RFLX BONE ANT CERV SPN,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
48610366,SUP,HCPCS C1713,,48610366  -  PLATE 66MM TI 3 LVL RFLX BONE ANT CERV SPN,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
48610369,SUP,HCPCS C1713,,48610369  -  PLATE 69MM TI 3 LVL RFLX BONE ANT CERV SPN,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
48610460,SUP,HCPCS C1713,,48610460  -  PLATE 60MM TI 4 LVL RFLX BONE ANT CERV SPN,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
48610464,SUP,HCPCS C1713,,48610464  -  PLATE 64MM TI 4 LVL RFLX BONE ANT CERV SPN,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
48610468,SUP,HCPCS C1713,,48610468  -  PLATE 68MM TI 4 LVL RFLX BONE ANT CERV SPN,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
48610472,SUP,HCPCS C1713,,48610472  -  PLATE 72MM TI 4 LVL RFLX BONE ANT CERV SPN,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
48610476,SUP,HCPCS C1713,,48610476  -  PLATE 76MM TI 4 LVL RFLX BONE ANT CERV SPN,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
48610480,SUP,HCPCS C1713,,48610480  -  PLATE 80MM TI 4 LVL RFLX BONE ANT CERV SPN,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
48610484,SUP,HCPCS C1713,,48610484  -  PLATE 84MM TI 4 LVL RFLX BONE ANT CERV SPN,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
48624010,SUP,HCPCS C1713,,48624010  -  SCREW BONE 4MM 10MM RFLX HB TI ANT CERV SPN,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
48624012,SUP,HCPCS C1713,,48624012  -  SCREW BONE 4MM 12MM RFLX TI ANT CERV SPN SLFTAP,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
48624014,SUP,HCPCS C1713,,48624014  -  SCREW BONE 4MM 14MM RFLX,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
48624016,SUP,HCPCS C1713,,48624016  -  SCREW BONE 4MM 16MM RFLX,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
48624018,SUP,HCPCS C1713,,48624018  -  SCREW BONE 4MM 18MM RFLX TI ANT CERV SPN SLFTAP,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
48624020,SUP,HCPCS C1713,,48624020  -  SCREW BONE 4MM 20MM RFLX TI ANT CERV SPN SLFTAP,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
48624022,SUP,HCPCS C1713,,48624022  -  SCREW BONE 4MM 22MM RFLX TI ANT CERV SPN SLFTAP,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
48624512,SUP,HCPCS C1713,,48624512  -  SCREW BONE 4.5MM 12MM RFLX TI ANT CERV SPN SLFTAP,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
48624514,SUP,HCPCS C1713,,48624514  -  SCREW BONE 4.5MM 14MM RFLX TI ANT CERV SPN SLFTAP,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
48624516,SUP,HCPCS C1713,,48624516  -  SCREW BONE 4.5MM 16MM RFLX TI ANT CERV SPN SLFTAP,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
48624518,SUP,HCPCS C1713,,48624518  -  SCREW BONE 4.5MM 18MM RFLX TI ANT CERV SPN SLFTAP,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
48624520,SUP,HCPCS C1713,,48624520  -  SCREW BONE 4.5MM 20MM RFLX TI ANT CERV SPN SLFTAP,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
48624522,SUP,HCPCS C1713,,48624522  -  SCREW BONE 4.5MM 22MM RFLX TI ANT CERV SPN SLFTAP,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
48644010,SUP,HCPCS C1713,,48644010  -  SCREW BONE 4MM 10MM RFLX HB TI SPNL SLFDRILL VAR ANG,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
48644012,SUP,HCPCS C1713,,48644012  -  SCREW BONE 4MM 12MM VAR ANG SELF DRILL DYNATRAN REFLEX,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48644014,SUP,HCPCS C1713,,48644014  -  SCREW BONE 4MM 14MM VAR ANG SELF DRILL DYNATRAN REFLEX,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48644016,SUP,HCPCS C1713,,48644016  -  SCREW BONE 4MM 16MM VAR ANG SELF DRILL DYNATRAN REFLEX,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48644018,SUP,HCPCS C1713,,48644018  -  SCREW BONE 4MM 18MM VAR ANG SELF DRILL DYNATRAN REFLEX,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48650228,SUP,HCPCS C1713,,48650228  -  PLATE BN 28MM RFLX HB LVL 2 TI SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
48651112,SUP,HCPCS C1713,,48651112  -  PLATE BONE 12MM LEVEL 1 REFLEX HYBRID TITANIUM SPN CERV,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
48651114,SUP,HCPCS C1713,,48651114  -  PLATE BN 14MM NS RFLX HB LVL 1 TI SPNE CRV ANT,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
48651116,SUP,HCPCS C1713,,48651116  -  PLATE BONE 16MM LEVEL 1 REFLEX HYBRID TITANIUM SPN CERV,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
48651118,SUP,HCPCS C1713,,48651118  -  PLATE BONE 18MM LEVEL 1 REFLEX HYBRID TITANIUM SPN CERV,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
48651120,SUP,HCPCS C1713,,48651120  -  PLATE BONE 20MM LEVEL 1 REFLEX HYBRID TITANIUM SPN CERV,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
48651122,SUP,HCPCS C1713,,48651122  -  PLATE BONE 22MM LEVEL 1 REFLEX HYBRID TITANIUM SPN CERV,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
48651224,SUP,HCPCS C1713,,48651224  -  PLATE BONE 24MM LEVEL 2 REFLEX HYBRID TITANIUM SPN CERV,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
48651226,SUP,HCPCS C1713,,48651226  -  PLATE BONE 26MM LEVEL 2 REFLEX HYBRID TITANIUM SPN CERV,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
48651228,SUP,HCPCS C1713,,48651228  -  PLATE BN 28MM NS RFLX HB LVL 2 TI SPNE CRV ANT,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
48651230,SUP,HCPCS C1713,,48651230  -  PLATE BONE 30MM LEVEL 2 REFLEX HYBRID TITANIUM SPN CERV,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
48651232,SUP,HCPCS C1713,,48651232  -  PLATE BN 32MM NS RFLX HB LVL 2 TI SPNE CRV ANT,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
48651234,SUP,HCPCS C1713,,48651234  -  PLATE BONE 34MM LEVEL 2 REFLEX HYBRID TITANIUM SPN CERV,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
48651237,SUP,HCPCS C1713,,48651237  -  PLATE BONE 37MM 6 HOLE LEVEL 2 REFLEX HYBRID TITANIUM SPN,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
48651240,SUP,HCPCS C1713,,48651240  -  PLATE BONE 40MM LEVEL 2 REFLEX HYBRID TITANIUM SPN CERV,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
48651243,SUP,HCPCS C1713,,48651243  -  PLATE BONE 43MM LEVEL 2 REFLEX HYBRID TITANIUM SPN CERV,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
48651246,SUP,HCPCS C1713,,48651246  -  PLATE BONE 46MM LEVEL 2 REFLEX HYBRID TITANIUM SPN CERV,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
48651339,SUP,HCPCS C1713,,48651339  -  PLATE BONE 39MM LEVEL 3 REFLEX HYBRID TITANIUM SPN CERV,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
48651342,SUP,HCPCS C1713,,48651342  -  PLATE BONE 42MM LEVEL 3 REFLEX HYBRID TITANIUM SPN CERV,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
48651345,SUP,HCPCS C1713,,48651345  -  PLATE BONE 45MM LEVEL 3 REFLEX HYBRID TITANIUM SPN CERV,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
48651348,SUP,HCPCS C1713,,48651348  -  PLATE BN 48MM NS RFLX HB LVL 3 TI SPNE CRV ANT,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
48651351,SUP,HCPCS C1713,,48651351  -  PLATE BONE 51MM LEVEL 3 REFLEX HYBRID TITANIUM SPN CERV,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
48651354,SUP,HCPCS C1713,,48651354  -  PLATE BONE 54MM LEVEL 3 REFLEX HYBRID TITANIUM SPN CERV,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
48651357,SUP,HCPCS C1713,,48651357  -  PLATE BONE 57MM LEVEL 3 REFLEX HYBRID TITANIUM SPN CERV,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
48651360,SUP,HCPCS C1713,,48651360  -  PLATE BN 60MM NS RFLX HB LVL 3 TI SPNE CRV ANT,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
48651363,SUP,HCPCS C1713,,48651363  -  PLATE BN 63MM RFLX HB LVL 3 TI SPNE CRV ANT,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
48651366,SUP,HCPCS C1713,,48651366  -  PLATE BN 66MM RFLX HB LVL 3 TI SPNE CRV ANT,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
48651369,SUP,HCPCS C1713,,48651369  -  PLATE BN 69MM RFLX HB LVL 3 TI SPNE CRV ANT,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
48651460,SUP,HCPCS C1713,,48651460  -  PLATE BN 60MM NS RFLX HB LVL 4 TI SPNE CRV ANT,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
48651464,SUP,HCPCS C1713,,48651464  -  PLATE BONE 64MM LEVEL 4 REFLEX HYBRID TITANIUM SPN CERV,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
48651468,SUP,HCPCS C1713,,48651468  -  PLATE BONE 68MM LEVEL 4 REFLEX HYBRID TITANIUM SPN CERV,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
48651472,SUP,HCPCS C1713,,48651472  -  PLATE BONE 72MM LEVEL 4 REFLEX HYBRID TITANIUM SPN CERV,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
48651476,SUP,HCPCS C1713,,48651476  -  PLATE BN 76MM RFLX HB LVL 4 TI SPNE CRV ANT,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
48651480,SUP,HCPCS C1713,,48651480  -  PLATE BN 80MM RFLX HB LVL 4 TI SPNE CRV ANT,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
48651484,SUP,HCPCS C1713,,48651484  -  PLATE BONE 84MM LEVEL 4 REFLEX HYBRID TITANIUM SPN CERV,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
48651488,SUP,HCPCS C1713,,48651488  -  PLATE BONE 88MM LEVEL 4 REFLEX HYBRID TITANIUM SPN CERV,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
48651492,SUP,HCPCS C1713,,48651492  -  PLATE BN 92MM LVL 4 SPNE CRV ANT,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
48651496,SUP,HCPCS C1713,,48651496  -  PLATE BN 96MM LVL 4 SPNE CRV ANT,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
48654010,SUP,HCPCS C1713,,48654010  -  SCREW BONE 4MM 10MM FIX ANGLE SELF DRILL DYNATRAN REFLEX,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48654012,SUP,HCPCS C1713,,48654012  -  SCREW BONE 4MM 12MM FIX ANGLE SELF DRILL DYNATRAN REFLEX,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48654014,SUP,HCPCS C1713,,48654014  -  SCREW BONE 4MM 14MM FIX ANGLE SELF DRILL DYNATRAN REFLEX,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48654016,SUP,HCPCS C1713,,48654016  -  SCREW BONE 4MM 16MM FIX ANGLE SELF DRILL DYNATRAN REFLEX,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48654018,SUP,HCPCS C1713,,48654018  -  SCREW BONE 4MM 18MM FIX ANGLE SELF DRILL DYNATRAN REFLEX,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48660112,SUP,HCPCS C1713,,48660112  -  PLATE 12MM 1 LVL ZERO PRFL ACP BONE ANT CERV SPN,"$4,263.88",$0.00,"$4,263.88","$1,918.74","$3,043.13",$0.00,$734.64,$0.00,$0.00,$746.57,"$4,263.88",$0.00,"$2,131.94","$3,376.99","$3,411.10",$0.00,$667.30,$0.00,$678.81,$0.00
48660114,SUP,HCPCS C1713,,48660114  -  PLATE 14MM 1 LVL BONE,"$4,263.88",$0.00,"$4,263.88","$1,918.74","$3,043.13",$0.00,$734.64,$0.00,$0.00,$746.57,"$4,263.88",$0.00,"$2,131.94","$3,376.99","$3,411.10",$0.00,$667.30,$0.00,$678.81,$0.00
48660116,SUP,HCPCS C1713,,48660116  -  PLATE 16MM ZERO PRFL ACP BONE ANT CERV SPN,"$4,263.88",$0.00,"$4,263.88","$1,918.74","$3,043.13",$0.00,$734.64,$0.00,$0.00,$746.57,"$4,263.88",$0.00,"$2,131.94","$3,376.99","$3,411.10",$0.00,$667.30,$0.00,$678.81,$0.00
48660118,SUP,HCPCS C1713,,48660118  -  PLATE 18MM 1 LVL BONE ANT CERV SPN,"$4,263.88",$0.00,"$4,263.88","$1,918.74","$3,043.13",$0.00,$734.64,$0.00,$0.00,$746.57,"$4,263.88",$0.00,"$2,131.94","$3,376.99","$3,411.10",$0.00,$667.30,$0.00,$678.81,$0.00
48660120,SUP,HCPCS C1713,,48660120  -  PLATE 20MM 1 LVL ZERO PRFL ACP BONE,"$4,263.88",$0.00,"$4,263.88","$1,918.74","$3,043.13",$0.00,$734.64,$0.00,$0.00,$746.57,"$4,263.88",$0.00,"$2,131.94","$3,376.99","$3,411.10",$0.00,$667.30,$0.00,$678.81,$0.00
48660122,SUP,HCPCS C1713,,48660122  -  PLATE 22MM 1 LVL ACP BONE ANT CERV SPN,"$4,263.88",$0.00,"$4,263.88","$1,918.74","$3,043.13",$0.00,$734.64,$0.00,$0.00,$746.57,"$4,263.88",$0.00,"$2,131.94","$3,376.99","$3,411.10",$0.00,$667.30,$0.00,$678.81,$0.00
48660124,SUP,HCPCS C1713,,48660124  -  PLATE 24MM 1 LVL ACP BONE ANT CERV SPN,"$4,263.88",$0.00,"$4,263.88","$1,918.74","$3,043.13",$0.00,$734.64,$0.00,$0.00,$746.57,"$4,263.88",$0.00,"$2,131.94","$3,376.99","$3,411.10",$0.00,$667.30,$0.00,$678.81,$0.00
48660224,SUP,HCPCS C1713,,48660224  -  PLATE 24MM 2 LVL ACP BONE ANT CERV SPN,"$4,477.28",$0.00,"$4,477.28","$2,014.77","$3,195.43",$0.00,$771.41,$0.00,$0.00,$783.94,"$4,477.28",$0.00,"$2,238.64","$3,546.01","$3,581.82",$0.00,$700.69,$0.00,$712.78,$0.00
48660226,SUP,HCPCS C1713,,48660226  -  PLATE 26MM 2 LVL ACP BONE ANT CERV SPN,"$4,477.28",$0.00,"$4,477.28","$2,014.77","$3,195.43",$0.00,$771.41,$0.00,$0.00,$783.94,"$4,477.28",$0.00,"$2,238.64","$3,546.01","$3,581.82",$0.00,$700.69,$0.00,$712.78,$0.00
48660228,SUP,HCPCS C1713,,48660228  -  PLATE 28MM 2 LVL ACP BONE ANT CERV SPN,"$4,477.28",$0.00,"$4,477.28","$2,014.77","$3,195.43",$0.00,$771.41,$0.00,$0.00,$783.94,"$4,477.28",$0.00,"$2,238.64","$3,546.01","$3,581.82",$0.00,$700.69,$0.00,$712.78,$0.00
48660230,SUP,HCPCS C1713,,48660230  -  PLATE 30MM 2 LVL BONE SPNL,"$4,477.28",$0.00,"$4,477.28","$2,014.77","$3,195.43",$0.00,$771.41,$0.00,$0.00,$783.94,"$4,477.28",$0.00,"$2,238.64","$3,546.01","$3,581.82",$0.00,$700.69,$0.00,$712.78,$0.00
48660232,SUP,HCPCS C1713,,48660232  -  PLATE 32MM 2 LVL ACP BONE,"$4,477.28",$0.00,"$4,477.28","$2,014.77","$3,195.43",$0.00,$771.41,$0.00,$0.00,$783.94,"$4,477.28",$0.00,"$2,238.64","$3,546.01","$3,581.82",$0.00,$700.69,$0.00,$712.78,$0.00
48660234,SUP,HCPCS C1713,,48660234  -  PLATE 34MM 2 LVL BONE ANT CERV SPN,"$4,477.28",$0.00,"$4,477.28","$2,014.77","$3,195.43",$0.00,$771.41,$0.00,$0.00,$783.94,"$4,477.28",$0.00,"$2,238.64","$3,546.01","$3,581.82",$0.00,$700.69,$0.00,$712.78,$0.00
48660236,SUP,HCPCS C1713,,48660236  -  PLATE 36MM 2 LVL ACP BONE,"$4,477.28",$0.00,"$4,477.28","$2,014.77","$3,195.43",$0.00,$771.41,$0.00,$0.00,$783.94,"$4,477.28",$0.00,"$2,238.64","$3,546.01","$3,581.82",$0.00,$700.69,$0.00,$712.78,$0.00
48660238,SUP,HCPCS C1713,,48660238  -  PLATE 38MM 2 LVL ACP BONE ANT CERV SPN,"$4,477.28",$0.00,"$4,477.28","$2,014.77","$3,195.43",$0.00,$771.41,$0.00,$0.00,$783.94,"$4,477.28",$0.00,"$2,238.64","$3,546.01","$3,581.82",$0.00,$700.69,$0.00,$712.78,$0.00
48660240,SUP,HCPCS C1713,,48660240  -  PLATE 40MM 2 LVL ACP BONE ANT CERV SPN,"$4,477.28",$0.00,"$4,477.28","$2,014.77","$3,195.43",$0.00,$771.41,$0.00,$0.00,$783.94,"$4,477.28",$0.00,"$2,238.64","$3,546.01","$3,581.82",$0.00,$700.69,$0.00,$712.78,$0.00
48660242,SUP,HCPCS C1713,,48660242  -  PLATE 42MM 2 LVL ACP BONE ANT CERV SPN,"$4,477.28",$0.00,"$4,477.28","$2,014.77","$3,195.43",$0.00,$771.41,$0.00,$0.00,$783.94,"$4,477.28",$0.00,"$2,238.64","$3,546.01","$3,581.82",$0.00,$700.69,$0.00,$712.78,$0.00
48665030,SUP,HCPCS C1713,,48665030  -  SCREW BN 5MM 30MM AVS ANCH-L ST SLF DRL 2 THRD LD CUT FLUT,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
48667000,SUP,HCPCS C1713,,48667000  -  ANCHOR-L LOCKING PLATE,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
48668142,SUP,HCPCS C1713,,48668142  -  SPACER SPNL 12D RECT 28X40X14MM NS LF AVS ANCH-L RADOPQ HLW,"$9,375.00",$0.00,"$9,375.00","$4,218.75","$5,158.80",$0.00,"$1,615.27",$0.00,$0.00,"$1,641.49","$9,375.00",$0.00,"$4,687.50","$7,425.00","$7,500.00",$0.00,"$1,467.19",$0.00,"$1,492.50",$0.00
48674010,SUP,HCPCS C1713,,48674010  -  SCREW BONE FLUTE 4MM 10MM FIX ANGLE SELF TAP COLOR CODED,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48674012,SUP,HCPCS C1713,,48674012  -  SCREW BONE FLUTE 4MM 12MM FIX ANGLE SELF TAP COLOR CODED,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48674014,SUP,HCPCS C1713,,48674014  -  SCREW BONE FLUTE 4MM 14MM FIX ANGLE SELF TAP COLOR CODED,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48674016,SUP,HCPCS C1713,,48674016  -  SCREW BONE FLUTE 4MM 16MM FIX ANGLE SELF TAP COLOR CODED,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48674018,SUP,HCPCS C1713,,48674018  -  SCREW BONE FLUTE 4MM 18MM FIX ANGLE SELF TAP COLOR CODED,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48674020,SUP,HCPCS C1713,,48674020  -  SCREW BONE FLUTE 4MM 20MM FIX ANGLE SELF TAP COLOR CODED,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48674512,SUP,HCPCS C1713,,48674512  -  SCREW BONE FLUTE 4.5MM 12MM FIX ANGLE SELF TAP COLOR CODED,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48674514,SUP,HCPCS C1713,,48674514  -  SCREW BONE FLUTE 4.5MM 14MM FIX ANGLE SELF TAP COLOR CODED,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48674516,SUP,HCPCS C1713,,48674516  -  SCREW BONE FLUTE 4.5MM 16MM FIX ANGLE SELF TAP COLOR CODED,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48674518,SUP,HCPCS C1713,,48674518  -  SCREW BONE FLUTE 4.5MM 18MM FIX ANGLE SELF TAP COLOR CODED,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48674520,SUP,HCPCS C1713,,48674520  -  SCREW BONE FLUTE 4.5MM 20MM FIX ANGLE SELF TAP COLOR CODED,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48694010,SUP,HCPCS C1713,,48694010  -  SCREW BONE FLUTE 4MM 10MM VAR ANG SELF TAP COLOR CODED,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48694012,SUP,HCPCS C1713,,48694012  -  SCREW BONE FLUTE 4MM 12MM VAR ANG SELF TAP COLOR CODED,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48694014,SUP,HCPCS C1713,,48694014  -  SCREW BONE FLUTE 4MM 14MM VAR ANG SELF TAP COLOR CODED,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48694016,SUP,HCPCS C1713,,48694016  -  SCREW BONE FLUTE 4MM 16MM VAR ANG SELF TAP COLOR CODED,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48694018,SUP,HCPCS C1713,,48694018  -  SCREW BONE FLUTE 4MM 18MM VAR ANG SELF TAP COLOR CODED,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48694020,SUP,HCPCS C1713,,48694020  -  SCREW BONE FLUTE 4MM 20MM VAR ANG SELF TAP COLOR CODED,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48694512,SUP,HCPCS C1713,,48694512  -  SCREW BONE FLUTE 4.5MM 12MM VAR ANG SELF TAP COLOR CODED,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48694514,SUP,HCPCS C1713,,48694514  -  SCREW BONE FLUTE 4.5MM 14MM VAR ANG SELF TAP COLOR CODED,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48694516,SUP,HCPCS C1713,,48694516  -  SCREW BONE FLUTE 4.5MM 16MM VAR ANG SELF TAP COLOR CODED,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48694518,SUP,HCPCS C1713,,48694518  -  SCREW BONE FLUTE 4.5MM 18MM VAR ANG SELF TAP COLOR CODED,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48694520,SUP,HCPCS C1713,,48694520  -  SCREW BONE FLUTE 4.5MM 20MM VAR ANG SELF TAP COLOR CODED,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48770410,SUP,Custom 27203010,,48770410  -  PIN FIX TEMPORARY AVIATOR,$125.00,$0.00,$125.00,$0.00,$89.21,$0.00,$0.00,$0.00,$0.00,$0.00,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$0.00,$0.00,$0.00,$0.00
48770610,SUP,Custom 27203010,,48770610  -  BIT DRILL 10MM AVTR,$656.90,$0.00,$656.90,$0.00,$468.83,$0.00,$0.00,$0.00,$0.00,$0.00,$656.90,$0.00,$328.45,$520.26,$525.52,$0.00,$0.00,$0.00,$0.00,$0.00
48770612,SUP,Custom 27203010,,48770612  -  BIT DRILL 12MM AVTR,$656.90,$0.00,$656.90,$0.00,$468.83,$0.00,$0.00,$0.00,$0.00,$0.00,$656.90,$0.00,$328.45,$520.26,$525.52,$0.00,$0.00,$0.00,$0.00,$0.00
48770614,SUP,Custom 27203010,,48770614  -  BIT DRILL 14MM AVTR,$656.90,$0.00,$656.90,$0.00,$468.83,$0.00,$0.00,$0.00,$0.00,$0.00,$656.90,$0.00,$328.45,$520.26,$525.52,$0.00,$0.00,$0.00,$0.00,$0.00
48770616,SUP,Custom 27203010,,48770616  -  BIT DRILL 16MM AVTR,$656.90,$0.00,$656.90,$0.00,$468.83,$0.00,$0.00,$0.00,$0.00,$0.00,$656.90,$0.00,$328.45,$520.26,$525.52,$0.00,$0.00,$0.00,$0.00,$0.00
48771610,SUP,Custom 27203010,,48771610  -  BIT DRILL 2.5MM 10MM AVIATOR,$125.00,$0.00,$125.00,$0.00,$89.21,$0.00,$0.00,$0.00,$0.00,$0.00,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$0.00,$0.00,$0.00,$0.00
48771612,SUP,Custom 27203010,,48771612  -  BIT DRILL 2.5MM 12MM AVIATOR,$125.00,$0.00,$125.00,$0.00,$89.21,$0.00,$0.00,$0.00,$0.00,$0.00,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$0.00,$0.00,$0.00,$0.00
48771614,SUP,Custom 27203010,,48771614  -  BIT DRILL 2.5MM 14MM AVIATOR,$125.00,$0.00,$125.00,$0.00,$89.21,$0.00,$0.00,$0.00,$0.00,$0.00,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$0.00,$0.00,$0.00,$0.00
48771616,SUP,Custom 27203010,,48771616  -  BIT DRILL 2.5MM 16MM AVIATOR,$125.00,$0.00,$125.00,$0.00,$89.21,$0.00,$0.00,$0.00,$0.00,$0.00,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$0.00,$0.00,$0.00,$0.00
48811112,SUP,HCPCS C1713,,48811112  -  PLATE BONE 12X17.4X2.5MM LEVEL 1 AUTO LOCK SYSTEM SPRING,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
48811114,SUP,HCPCS C1713,,48811114  -  PLATE BONE 14X17.4X2.5MM LEVEL 1 AUTO LOCK SYSTEM SPRING,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
48811116,SUP,HCPCS C1713,,48811116  -  PLATE BONE 16X17.4X2.5MM LEVEL 1 AUTO LOCK SYSTEM SPRING,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
48811118,SUP,HCPCS C1713,,48811118  -  PLATE BONE 18X17.4X2.5MM LEVEL 1 AUTO LOCK SYSTEM SPRING,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
48811120,SUP,HCPCS C1713,,48811120  -  PLATE BONE 20X17.4X2.5MM LEVEL 1 AUTO LOCK SYSTEM SPRING,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
48811122,SUP,HCPCS C1713,,48811122  -  PLATE BONE 22X17.4X2.5MM LEVEL 1 AUTO LOCK SYSTEM SPRING,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
48811224,SUP,HCPCS C1713,,48811224  -  PLATE BONE 24X17.4X2.5MM LEVEL 2 AUTO LOCK SYSTEM SPRING,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
48811226,SUP,HCPCS C1713,,48811226  -  PLATE BONE 26X17.4X2.5MM LEVEL 2 AUTO LOCK SYSTEM SPRING,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
48811228,SUP,HCPCS C1713,,48811228  -  PLATE BONE 28X17.4X2.5MM LEVEL 2 AUTO LOCK SYSTEM SPRING,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
48811230,SUP,HCPCS C1713,,48811230  -  PLATE BONE 30X17.4X2.5MM LEVEL 2 AUTO LOCK SYSTEM SPRING,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
48811232,SUP,HCPCS C1713,,48811232  -  PLATE BONE 32X17.4X2.5MM LEVEL 2 AUTO LOCK SYSTEM SPRING,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
48811234,SUP,HCPCS C1713,,48811234  -  PLATE BONE 34X17.4X2.5MM LEVEL 2 AUTO LOCK SYSTEM SPRING,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
48811237,SUP,HCPCS C1713,,48811237  -  PLATE BONE 37X17.4X2.5MM LEVEL 2 AUTO LOCK SYSTEM SPRING,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
48811240,SUP,HCPCS C1713,,48811240  -  PLATE BONE 40X17.4X2.5MM LEVEL 2 AUTO LOCK SYSTEM SPRING,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
48811243,SUP,HCPCS C1713,,48811243  -  PLATE BONE 43X17.4X2.5MM LEVEL 2 AUTO LOCK SYSTEM SPRING,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
48811246,SUP,HCPCS C1713,,48811246  -  PLATE BONE 46X17.4X2.5MM LEVEL 2 AUTO LOCK SYSTEM SPRING,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
48811339,SUP,HCPCS C1713,,48811339  -  PLATE BONE 39X17.4X2.5MM LEVEL 3 AUTO LOCK SYSTEM SPRING,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
48811342,SUP,HCPCS C1713,,48811342  -  PLATE BONE 42X17.4X2.5MM LEVEL 3 AUTO LOCK SYSTEM SPRING,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
48811345,SUP,HCPCS C1713,,48811345  -  PLATE BONE 45X17.4X2.5MM LEVEL 3 AUTO LOCK SYSTEM SPRING,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
48811348,SUP,HCPCS C1713,,48811348  -  PLATE BONE 48X17.4X2.5MM LEVEL 3 AUTO LOCK SYSTEM SPRING,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
48811351,SUP,HCPCS C1713,,48811351  -  PLATE BONE 51X17.4X2.5MM LEVEL 3 AUTO LOCK SYSTEM SPRING,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
48811354,SUP,HCPCS C1713,,48811354  -  PLATE BONE 54X17.4X2.5MM LEVEL 3 AUTO LOCK SYSTEM SPRING,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
48811357,SUP,HCPCS C1713,,48811357  -  PLATE BONE 57X17.4X2.5MM LEVEL 3 AUTO LOCK SYSTEM SPRING,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
48811360,SUP,HCPCS C1713,,48811360  -  PLATE BONE 60X17.4X2.5MM LEVEL 3 AUTO LOCK SYSTEM SPRING,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
48811363,SUP,HCPCS C1713,,48811363  -  PLATE BONE 63X17.4X2.5MM LEVEL 3 AUTO LOCK SYSTEM SPRING,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
48811366,SUP,HCPCS C1713,,48811366  -  PLATE BONE 66MM LEVEL 3 AVIATOR SPN CERV ANTERIOR,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
48811369,SUP,HCPCS C1713,,48811369  -  PLATE BONE 69MM LEVEL 3 AVIATOR SPN CERV ANTERIOR,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
48811456,SUP,HCPCS C1713,,48811456  -  PLATE BONE 56MM LEVEL 4 AVIATOR SPN CERV ANTERIOR,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
48811460,SUP,HCPCS C1713,,48811460  -  PLATE BONE 60MM LEVEL 4 AVIATOR SPN CERV ANTERIOR,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
48811464,SUP,HCPCS C1713,,48811464  -  PLATE BONE 64MM LEVEL 4 AVIATOR SPN CERV ANTERIOR,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
48811468,SUP,HCPCS C1713,,48811468  -  PLATE BONE 68MM LEVEL 4 AVIATOR SPN CERV ANTERIOR,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
48811472,SUP,HCPCS C1713,,48811472  -  PLATE BONE 72MM LEVEL 4 AVIATOR SPN CERV ANTERIOR,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
48811476,SUP,HCPCS C1713,,48811476  -  PLATE BONE 76MM LEVEL 4 AVIATOR SPN CERV ANTERIOR,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
48811480,SUP,HCPCS C1713,,48811480  -  PLATE BONE 80MM LEVEL 4 AVIATOR SPN CERV ANTERIOR,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
48811484,SUP,HCPCS C1713,,48811484  -  PLATE BONE 84MM LEVEL 4 AVIATOR SPN CERV ANTERIOR,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
48811488,SUP,HCPCS C1713,,48811488  -  PLATE BONE 88MM LEVEL 4 AVIATOR SPN CERV ANTERIOR,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
48811492,SUP,HCPCS C1713,,48811492  -  PLATE BONE 92MM LEVEL 4 AVIATOR SPN CERV ANTERIOR,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
48811496,SUP,HCPCS C1713,,48811496  -  PLATE BONE 96MM LEVEL 4 AVIATOR SPN CERV ANTERIOR,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
48814010,SUP,HCPCS C1713,,48814010  -  SCREW BONE 4MM 10MM VAR ANG SELF TAP AVIATOR TITANIUM SPN,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48814012,SUP,HCPCS C1713,,48814012  -  SCREW BONE 4MM 12MM VAR ANG SELF TAP AVIATOR TITANIUM SPN,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48814014,SUP,HCPCS C1713,,48814014  -  SCREW BONE 4MM 14MM VAR ANG SELF TAP AVIATOR TITANIUM SPN,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48814016,SUP,HCPCS C1713,,48814016  -  SCREW BONE 4MM 16MM VAR ANG SELF TAP AVIATOR TITANIUM SPN,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48814018,SUP,HCPCS C1713,,48814018  -  SCREW BONE 4MM 18MM VAR ANG SELF TAP AVIATOR TITANIUM SPN,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48814512,SUP,HCPCS C1713,,48814512  -  SCREW BONE 4.35MM 12MM VAR ANG SELF TAP AVIATOR TITANIUM SPN,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48814514,SUP,HCPCS C1713,,48814514  -  SCREW BONE 4.35MM 14MM VAR ANG SELF TAP AVIATOR TITANIUM SPN,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48814516,SUP,HCPCS C1713,,48814516  -  SCREW BONE 4.35MM 16MM VAR ANG SELF TAP AVIATOR TITANIUM SPN,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48814518,SUP,HCPCS C1713,,48814518  -  SCREW BONE 4.35MM 18MM VAR ANG SELF TAP AVIATOR TITANIUM SPN,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48814520,SUP,HCPCS C1713,,48814520  -  SCREW BONE 4.35MM 20MM VAR ANG SELF TAP AVIATOR TITANIUM SPN,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48815540,SUP,HCPCS C1713,,48815540  -  SCREW POLYAXIAL 5.5X40MM XIA CT,"$2,375.00",$0.00,"$2,375.00","$1,068.75","$1,695.04",$0.00,$409.20,$0.00,$0.00,$415.84,"$2,375.00",$0.00,"$1,187.50","$1,881.00","$1,900.00",$0.00,$371.69,$0.00,$378.10,$0.00
48824010,SUP,HCPCS C1713,,48824010  -  SCREW BONE 4MM 10MM VAR ANG SELF DRILL AVIATOR TITANIUM SPN,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48824012,SUP,HCPCS C1713,,48824012  -  SCREW BONE 4MM 12MM VAR ANG SELF DRILL AVIATOR TITANIUM SPN,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48824014,SUP,HCPCS C1713,,48824014  -  SCREW BONE 4MM 14MM VAR ANG SELF DRILL AVIATOR TITANIUM SPN,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48824016,SUP,HCPCS C1713,,48824016  -  SCREW BONE 4MM 16MM VAR ANG SELF DRILL AVIATOR TITANIUM SPN,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48824018,SUP,HCPCS C1713,,48824018  -  SCREW BONE 4MM 18MM VAR ANG SELF DRILL AVIATOR TITANIUM SPN,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48834010,SUP,HCPCS C1713,,48834010  -  SCREW BONE 4MM 10MM FIX ANGLE SELF TAP AVIATOR TITANIUM SPN,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48834012,SUP,HCPCS C1713,,48834012  -  SCREW BONE 4MM 12MM FIX ANGLE SELF TAP AVIATOR TITANIUM SPN,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48834014,SUP,HCPCS C1713,,48834014  -  SCREW BONE 4MM 14MM FIX ANGLE SELF TAP AVIATOR SPN CERV,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48834016,SUP,HCPCS C1713,,48834016  -  SCREW BONE 4MM 16MM FIX ANGLE SELF TAP AVIATOR TITANIUM SPN,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48834018,SUP,HCPCS C1713,,48834018  -  SCREW BONE 4MM 18MM SPNL FIX SLFDRILL,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48834512,SUP,HCPCS C1713,,48834512  -  SCREW BONE 4.35MM 12MM FIX ANGLE SELF TAP AVIATOR TITANIUM,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48834514,SUP,HCPCS C1713,,48834514  -  SCREW BN 4.35MM 14MM AVTR ST FA SPNE,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48834516,SUP,HCPCS C1713,,48834516  -  SCREW BONE 4.35MM 16MM FIX ANGLE SELF TAP AVIATOR TITANIUM,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48834518,SUP,HCPCS C1713,,48834518  -  SCREW BONE 4.35MM 18MM SELF TAP FIX ANGLE AVIATOR SPN CERV,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48834520,SUP,HCPCS C1713,,48834520  -  SCREW BONE 4.35MM 20MM SELF TAP FIX ANGLE AVIATOR SPN CERV,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48844010,SUP,HCPCS C1713,,48844010  -  SCREW BONE 4MM 10MM FIX ANGLE SELF DRILL AVIATOR TITANIUM,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48844012,SUP,HCPCS C1713,,48844012  -  SCREW BONE 4MM 12MM FIX ANGLE SELF DRILL AVIATOR TITANIUM,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48844014,SUP,HCPCS C1713,,48844014  -  SCREW BONE 4MM 14MM FIX ANGLE SELF DRILL AVIATOR TITANIUM,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48844016,SUP,HCPCS C1713,,48844016  -  SCREW BONE 4MM 16MM FIX ANGLE SELF DRILL AVIATOR TITANIUM,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48844018,SUP,HCPCS C1713,,48844018  -  SCREW BONE 4MM 18MM SELF DRILL FIX ANGLE AVIATOR SPN CERV,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
48850000,SUP,HCPCS C1713,,48850000  -  BLOCKER SPNL CORT XIA,$125.00,$0.00,$125.00,$56.25,$89.21,$0.00,$21.54,$0.00,$0.00,$21.89,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$19.56,$0.00,$19.90,$0.00
48857535,SUP,Custom 27203010,,48857535  -  XIA CT 05.0mmX35mm TAP MARKER,$406.58,$0.00,$406.58,$0.00,$290.17,$0.00,$0.00,$0.00,$0.00,$0.00,$406.58,$0.00,$203.29,$322.01,$325.26,$0.00,$0.00,$0.00,$0.00,$0.00
48858435,SUP,Custom 27203010,,48858435  -  XIA CT 04.5mmX35mm TAP MARKER,$406.58,$0.00,$406.58,$0.00,$290.17,$0.00,$0.00,$0.00,$0.00,$0.00,$406.58,$0.00,$203.29,$322.01,$325.26,$0.00,$0.00,$0.00,$0.00,$0.00
48858535,SUP,Custom 27203010,,48858535  -  XIA CT 05.5mmX35mm TAP MARKER,$406.58,$0.00,$406.58,$0.00,$290.17,$0.00,$0.00,$0.00,$0.00,$0.00,$406.58,$0.00,$203.29,$322.01,$325.26,$0.00,$0.00,$0.00,$0.00,$0.00
48900425,SUP,HCPCS C1713,,48900425  -  SCREW BONE STANDARD POST 4.5MM 25MM TITANIUM SPN,$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
48900430,SUP,HCPCS C1713,,48900430  -  SCREW BONE STANDARD POST 4.5MM 30MM TITANIUM SPN,$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
48900435,SUP,HCPCS C1713,,48900435  -  SCREW BONE STANDARD POST 4.5MM 35MM TITANIUM SPN,$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
48900440,SUP,HCPCS C1713,,48900440  -  SCREW BONE STANDARD POST 4.5MM 40MM TITANIUM SPN,$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
48900445,SUP,HCPCS C1713,,48900445  -  SCREW BONE 4.5MM 45MM STANDARD POST TRIO SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48900450,SUP,HCPCS C1713,,48900450  -  SCREW BONE 4.5MM 50MM STANDARD POST TRIO SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48900455,SUP,HCPCS C1713,,48900455  -  SCREW BONE 4.5MM 55MM STANDARD POST TRIO SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48900525,SUP,HCPCS C1713,,48900525  -  SCREW BONE STANDARD POST 5.5MM 25MM TITANIUM SPN,$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
48900530,SUP,HCPCS C1713,,48900530  -  SCREW BONE STANDARD POST 5.5MM 30MM TITANIUM SPN,$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
48900535,SUP,HCPCS C1713,,48900535  -  SCREW BONE STANDARD POST 5.5MM 35MM TITANIUM SPN,$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
48900540,SUP,HCPCS C1713,,48900540  -  SCREW BONE STANDARD POST 5.5MM 40MM TITANIUM SPN,$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
48900545,SUP,HCPCS C1713,,48900545  -  SCREW BONE STANDARD POST 5.5MM 45MM TITANIUM SPN,$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
48900550,SUP,HCPCS C1713,,48900550  -  SCREW BONE STANDARD POST 5.5MM 50MM TITANIUM SPN,$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
48900555,SUP,HCPCS C1713,,48900555  -  SCREW BONE 5.5MM 55MM STANDARD POST TRIO SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48900560,SUP,HCPCS C1713,,48900560  -  SCREW BONE 5.5MM 60MM STANDARD POST TRIO SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
48900630,SUP,HCPCS C1713,,48900630  -  SCREW BONE STANDARD POST 6.5MM 30MM TITANIUM SPN,$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
48900635,SUP,HCPCS C1713,,48900635  -  SCREW BONE STANDARD POST 6.5MM 35MM TITANIUM SPN,$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
48900640,SUP,HCPCS C1713,,48900640  -  SCREW BONE STANDARD POST 6.5MM 40MM TITANIUM SPN,$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
48900645,SUP,HCPCS C1713,,48900645  -  SCREW BONE STANDARD POST 6.5MM 45MM TITANIUM SPN,$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
48900650,SUP,HCPCS C1713,,48900650  -  SCREW BONE STANDARD POST 6.5MM 50MM TITANIUM SPN,$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
48900655,SUP,HCPCS C1713,,48900655  -  SCREW BONE STANDARD POST 6.5MM 55MM TITANIUM SPN,$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
48900660,SUP,HCPCS C1713,,48900660  -  SCREW BONE STANDARD POST 6.5MM 60MM TITANIUM SPN,$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
48900730,SUP,HCPCS C1713,,48900730  -  SCREW BONE STANDARD POST 7.5MM 30MM TITANIUM SPN,$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
48900735,SUP,HCPCS C1713,,48900735  -  SCREW BONE STANDARD POST 7.5MM 35MM TITANIUM SPN,$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
48900740,SUP,HCPCS C1713,,48900740  -  SCREW BONE STANDARD POST 7.5MM 40MM TITANIUM SPN,$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
48900745,SUP,HCPCS C1713,,48900745  -  SCREW BONE STANDARD POST 7.5MM 45MM TITANIUM SPN,$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
48900750,SUP,HCPCS C1713,,48900750  -  SCREW BONE STANDARD POST 7.5MM 50MM TITANIUM SPN,$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
48900755,SUP,HCPCS C1713,,48900755  -  SCREW BONE STANDARD POST 7.5MM 55MM TITANIUM SPN,$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
48900760,SUP,HCPCS C1713,,48900760  -  SCREW BONE STANDARD POST 7.5MM 60MM TITANIUM SPN,$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
48900830,SUP,HCPCS C1713,,48900830  -  SCREW BONE STANDARD POST 8.5MM 30MM TITANIUM SPN,$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
48900835,SUP,HCPCS C1713,,48900835  -  SCREW BONE STANDARD POST 8.5MM 35MM TITANIUM SPN,$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
48900840,SUP,HCPCS C1713,,48900840  -  SCREW BONE STANDARD POST 8.5MM 40MM TITANIUM SPN,$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
48900845,SUP,HCPCS C1713,,48900845  -  SCREW BONE STANDARD POST 8.5MM 45MM TITANIUM SPN,$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
48900850,SUP,HCPCS C1713,,48900850  -  SCREW BONE STANDARD POST 8.5MM 50MM TITANIUM SPN,$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
48900855,SUP,HCPCS C1713,,48900855  -  SCREW BONE STANDARD POST 8.5MM 55MM TITANIUM SPN,$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
48900860,SUP,HCPCS C1713,,48900860  -  SCREW BONE STANDARD POST 8.5MM 60MM TITANIUM SPN,$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
48901640,SUP,HCPCS C1713,,48901640  -  SCREW BONE LONG POST 6.5MM 40MM TITANIUM SPN,$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
48901645,SUP,HCPCS C1713,,48901645  -  SCREW BONE LONG POST 6.5MM 45MM TITANIUM SPN,$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
48901650,SUP,HCPCS C1713,,48901650  -  SCREW BONE LONG POST 6.5MM 50MM TITANIUM SPN,$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
48901740,SUP,HCPCS C1713,,48901740  -  SCREW BONE LONG POST 7.5MM 40MM TITANIUM SPN,$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
48901745,SUP,HCPCS C1713,,48901745  -  SCREW BONE LONG POST 7.5MM 45MM TITANIUM SPN,$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
48901750,SUP,HCPCS C1713,,48901750  -  SCREW BONE LONG POST 7.5MM 50MM TITANIUM SPN,$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
48902015,SUP,Custom 27803010,,48902015  -  CONNECTOR ROD SMALL OFFST UPGRADE TRIO SPN,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
48902025,SUP,Custom 27803010,,48902025  -  CONNECTOR ROD MEDIUM LP SPN,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
48902035,SUP,Custom 27803010,,48902035  -  CONNECTOR ROD LARGE LP OFFST SPN,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
48902040,SUP,Custom 27803010,,48902040  -  CONNECTOR ROD 2 STEP LOCKING TITANIUM SPN,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
48902060,SUP,Custom 27803010,,48902060  -  CONNECTOR ROD RIGHT OFFST BIASED SPN,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
48902070,SUP,Custom 27803010,,48902070  -  CONNECTOR ROD LEFT BIASED OFFST TITANIUM SPN,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
48910530,SUP,HCPCS C1713,,48910530  -  SCREW BONE 5.5MM 30MM STD POST PS,"$1,285.00",$0.00,"$1,285.00",$578.25,$917.10,$0.00,$221.40,$0.00,$0.00,$224.99,"$1,285.00",$0.00,$642.50,"$1,017.72","$1,028.00",$0.00,$201.10,$0.00,$204.57,$0.00
48910535,SUP,HCPCS C1713,,48910535  -  SCREW BONE 5.5MM 35MM STD POST PS,"$1,285.00",$0.00,"$1,285.00",$578.25,$917.10,$0.00,$221.40,$0.00,$0.00,$224.99,"$1,285.00",$0.00,$642.50,"$1,017.72","$1,028.00",$0.00,$201.10,$0.00,$204.57,$0.00
48910540,SUP,HCPCS C1713,,48910540  -  SCREW BONE 5.5MM 40MM STD POST PS,"$1,285.00",$0.00,"$1,285.00",$578.25,$917.10,$0.00,$221.40,$0.00,$0.00,$224.99,"$1,285.00",$0.00,$642.50,"$1,017.72","$1,028.00",$0.00,$201.10,$0.00,$204.57,$0.00
48910545,SUP,HCPCS C1713,,48910545  -  SCREW BONE 5.5MM 45MM STD POST PS,"$1,285.00",$0.00,"$1,285.00",$578.25,$917.10,$0.00,$221.40,$0.00,$0.00,$224.99,"$1,285.00",$0.00,$642.50,"$1,017.72","$1,028.00",$0.00,$201.10,$0.00,$204.57,$0.00
48910550,SUP,HCPCS C1713,,48910550  -  SCREW BONE 5.5MM 50MM STD POST PS,"$1,285.00",$0.00,"$1,285.00",$578.25,$917.10,$0.00,$221.40,$0.00,$0.00,$224.99,"$1,285.00",$0.00,$642.50,"$1,017.72","$1,028.00",$0.00,$201.10,$0.00,$204.57,$0.00
48910635,SUP,HCPCS C1713,,48910635  -  SCREW BONE 6.5MM 35MM TI STD POST SPNL PS,"$1,285.00",$0.00,"$1,285.00",$578.25,$917.10,$0.00,$221.40,$0.00,$0.00,$224.99,"$1,285.00",$0.00,$642.50,"$1,017.72","$1,028.00",$0.00,$201.10,$0.00,$204.57,$0.00
48910640,SUP,HCPCS C1713,,48910640  -  SCREW BONE 6.5MM 40MM STD POST PS,"$1,285.00",$0.00,"$1,285.00",$578.25,$917.10,$0.00,$221.40,$0.00,$0.00,$224.99,"$1,285.00",$0.00,$642.50,"$1,017.72","$1,028.00",$0.00,$201.10,$0.00,$204.57,$0.00
48910645,SUP,HCPCS C1713,,48910645  -  SCREW BONE 6.5MM 45MM STD POST PS,"$1,285.00",$0.00,"$1,285.00",$578.25,$917.10,$0.00,$221.40,$0.00,$0.00,$224.99,"$1,285.00",$0.00,$642.50,"$1,017.72","$1,028.00",$0.00,$201.10,$0.00,$204.57,$0.00
48910655,SUP,HCPCS C1713,,48910655  -  SCREW BONE 6.5MM 55MM STD POST PS,"$1,285.00",$0.00,"$1,285.00",$578.25,$917.10,$0.00,$221.40,$0.00,$0.00,$224.99,"$1,285.00",$0.00,$642.50,"$1,017.72","$1,028.00",$0.00,$201.10,$0.00,$204.57,$0.00
48910660,SUP,HCPCS C1713,,48910660  -  SCREW BONE 6.5MM 60MM STD POST PS,"$1,285.00",$0.00,"$1,285.00",$578.25,$917.10,$0.00,$221.40,$0.00,$0.00,$224.99,"$1,285.00",$0.00,$642.50,"$1,017.72","$1,028.00",$0.00,$201.10,$0.00,$204.57,$0.00
48910730,SUP,HCPCS C1713,,48910730  -  SCREW BONE 7.5MM 30MM STD POST PS,"$1,285.00",$0.00,"$1,285.00",$578.25,$917.10,$0.00,$221.40,$0.00,$0.00,$224.99,"$1,285.00",$0.00,$642.50,"$1,017.72","$1,028.00",$0.00,$201.10,$0.00,$204.57,$0.00
48910735,SUP,HCPCS C1713,,48910735  -  SCREW BONE 7.5MM 35MM STD POST PS,"$1,285.00",$0.00,"$1,285.00",$578.25,$917.10,$0.00,$221.40,$0.00,$0.00,$224.99,"$1,285.00",$0.00,$642.50,"$1,017.72","$1,028.00",$0.00,$201.10,$0.00,$204.57,$0.00
48910740,SUP,HCPCS C1713,,48910740  -  SCREW BONE 7.5MM 40MM STD POST PS,"$1,285.00",$0.00,"$1,285.00",$578.25,$917.10,$0.00,$221.40,$0.00,$0.00,$224.99,"$1,285.00",$0.00,$642.50,"$1,017.72","$1,028.00",$0.00,$201.10,$0.00,$204.57,$0.00
48910745,SUP,HCPCS C1713,,48910745  -  SCREW BONE 7.5MM 45MM STD POST PS,"$1,285.00",$0.00,"$1,285.00",$578.25,$917.10,$0.00,$221.40,$0.00,$0.00,$224.99,"$1,285.00",$0.00,$642.50,"$1,017.72","$1,028.00",$0.00,$201.10,$0.00,$204.57,$0.00
48910755,SUP,HCPCS C1713,,48910755  -  SCREW BONE 7.5MM 55MM STD POST PS,"$1,285.00",$0.00,"$1,285.00",$578.25,$917.10,$0.00,$221.40,$0.00,$0.00,$224.99,"$1,285.00",$0.00,$642.50,"$1,017.72","$1,028.00",$0.00,$201.10,$0.00,$204.57,$0.00
48910760,SUP,HCPCS C1713,,48910760  -  SCREW BONE 7.5MM 60MM STD POST PS,"$1,285.00",$0.00,"$1,285.00",$578.25,$917.10,$0.00,$221.40,$0.00,$0.00,$224.99,"$1,285.00",$0.00,$642.50,"$1,017.72","$1,028.00",$0.00,$201.10,$0.00,$204.57,$0.00
48910830,SUP,HCPCS C1713,,48910830  -  SCREW BONE 8.5MM 30MM STD POST PS,"$1,285.00",$0.00,"$1,285.00",$578.25,$917.10,$0.00,$221.40,$0.00,$0.00,$224.99,"$1,285.00",$0.00,$642.50,"$1,017.72","$1,028.00",$0.00,$201.10,$0.00,$204.57,$0.00
48910835,SUP,HCPCS C1713,,48910835  -  SCREW BONE 8.5MM 35MM STD POST PS,"$1,285.00",$0.00,"$1,285.00",$578.25,$917.10,$0.00,$221.40,$0.00,$0.00,$224.99,"$1,285.00",$0.00,$642.50,"$1,017.72","$1,028.00",$0.00,$201.10,$0.00,$204.57,$0.00
48910840,SUP,HCPCS C1713,,48910840  -  SCREW BONE 8.5MM 40MM STD POST PS,"$1,285.00",$0.00,"$1,285.00",$578.25,$917.10,$0.00,$221.40,$0.00,$0.00,$224.99,"$1,285.00",$0.00,$642.50,"$1,017.72","$1,028.00",$0.00,$201.10,$0.00,$204.57,$0.00
48910855,SUP,HCPCS C1713,,48910855  -  SCREW BONE 8.5MM 55MM STD POST PS,"$1,285.00",$0.00,"$1,285.00",$578.25,$917.10,$0.00,$221.40,$0.00,$0.00,$224.99,"$1,285.00",$0.00,$642.50,"$1,017.72","$1,028.00",$0.00,$201.10,$0.00,$204.57,$0.00
48910860,SUP,HCPCS C1713,,48910860  -  SCREW BONE 8.5MM 60MM STD POST PS,"$1,285.00",$0.00,"$1,285.00",$578.25,$917.10,$0.00,$221.40,$0.00,$0.00,$224.99,"$1,285.00",$0.00,$642.50,"$1,017.72","$1,028.00",$0.00,$201.10,$0.00,$204.57,$0.00
48911640,SUP,HCPCS C1713,,48911640  -  SCREW BONE 6.5MM 40MM LNG POST PS,"$1,520.88",$0.00,"$1,520.88",$684.39,"$1,085.45",$0.00,$262.04,$0.00,$0.00,$266.29,"$1,520.88",$0.00,$760.44,"$1,204.54","$1,216.70",$0.00,$238.02,$0.00,$242.12,$0.00
48911645,SUP,HCPCS C1713,,48911645  -  SCREW BONE 6.5MM 45MM LNG POST PS,"$1,520.88",$0.00,"$1,520.88",$684.39,"$1,085.45",$0.00,$262.04,$0.00,$0.00,$266.29,"$1,520.88",$0.00,$760.44,"$1,204.54","$1,216.70",$0.00,$238.02,$0.00,$242.12,$0.00
48911650,SUP,HCPCS C1713,,48911650  -  SCREW BONE 6.5MM 50MM LNG POST PS,"$1,520.88",$0.00,"$1,520.88",$684.39,"$1,085.45",$0.00,$262.04,$0.00,$0.00,$266.29,"$1,520.88",$0.00,$760.44,"$1,204.54","$1,216.70",$0.00,$238.02,$0.00,$242.12,$0.00
48911740,SUP,HCPCS C1713,,48911740  -  SCREW BONE 7.5MM 40MM LNG POST PS,"$1,520.88",$0.00,"$1,520.88",$684.39,"$1,085.45",$0.00,$262.04,$0.00,$0.00,$266.29,"$1,520.88",$0.00,$760.44,"$1,204.54","$1,216.70",$0.00,$238.02,$0.00,$242.12,$0.00
48911745,SUP,HCPCS C1713,,48911745  -  SCREW BONE 7.5MM 45MM LNG POST PS,"$1,520.88",$0.00,"$1,520.88",$684.39,"$1,085.45",$0.00,$262.04,$0.00,$0.00,$266.29,"$1,520.88",$0.00,$760.44,"$1,204.54","$1,216.70",$0.00,$238.02,$0.00,$242.12,$0.00
48911750,SUP,HCPCS C1713,,48911750  -  SCREW BONE 7.5MM 50MM LNG POST PS,"$1,520.88",$0.00,"$1,520.88",$684.39,"$1,085.45",$0.00,$262.04,$0.00,$0.00,$266.29,"$1,520.88",$0.00,$760.44,"$1,204.54","$1,216.70",$0.00,$238.02,$0.00,$242.12,$0.00
48912035,SUP,HCPCS C1713,,48912035  -  PLATE 35MM LRDTC STAB BONE POST,"$2,866.53",$0.00,"$2,866.53","$1,289.94","$2,045.84",$0.00,$493.89,$0.00,$0.00,$501.91,"$2,866.53",$0.00,"$1,433.26","$2,270.29","$2,293.22",$0.00,$448.61,$0.00,$456.35,$0.00
48912040,SUP,HCPCS C1713,,48912040  -  PLATE 40MM LRDTC STAB BONE POST,"$2,866.53",$0.00,"$2,866.53","$1,289.94","$2,045.84",$0.00,$493.89,$0.00,$0.00,$501.91,"$2,866.53",$0.00,"$1,433.26","$2,270.29","$2,293.22",$0.00,$448.61,$0.00,$456.35,$0.00
48912060,SUP,HCPCS C1713,,48912060  -  PLATE 60MM LRDTC STAB BONE POST,"$3,102.43",$0.00,"$3,102.43","$1,396.09","$2,214.20",$0.00,$534.53,$0.00,$0.00,$543.21,"$3,102.43",$0.00,"$1,551.21","$2,457.12","$2,481.94",$0.00,$485.53,$0.00,$493.91,$0.00
48912070,SUP,HCPCS C1713,,48912070  -  PLATE 70MM POST STAB LRDTC BONE SPNL,"$3,102.43",$0.00,"$3,102.43","$1,396.09","$2,214.20",$0.00,$534.53,$0.00,$0.00,$543.21,"$3,102.43",$0.00,"$1,551.21","$2,457.12","$2,481.94",$0.00,$485.53,$0.00,$493.91,$0.00
48912080,SUP,HCPCS C1713,,48912080  -  PLATE 80MM POST STAB LRDTC BONE SPNL,"$3,102.43",$0.00,"$3,102.43","$1,396.09","$2,214.20",$0.00,$534.53,$0.00,$0.00,$543.21,"$3,102.43",$0.00,"$1,551.21","$2,457.12","$2,481.94",$0.00,$485.53,$0.00,$493.91,$0.00
48912090,SUP,HCPCS C1713,,48912090  -  PLATE 90MM POST STAB LRDTC BONE SPNL,"$3,102.43",$0.00,"$3,102.43","$1,396.09","$2,214.20",$0.00,$534.53,$0.00,$0.00,$543.21,"$3,102.43",$0.00,"$1,551.21","$2,457.12","$2,481.94",$0.00,$485.53,$0.00,$493.91,$0.00
48912105,SUP,HCPCS C1713,,48912105  -  PLATE 105MM POST STAB LRDTC BONE SPNL,"$3,338.33",$0.00,"$3,338.33","$1,502.25","$2,382.56",$0.00,$575.18,$0.00,$0.00,$584.51,"$3,338.33",$0.00,"$1,669.16","$2,643.96","$2,670.66",$0.00,$522.45,$0.00,$531.46,$0.00
48912120,SUP,HCPCS C1713,,48912120  -  PLATE 120MM POST STAB LRDTC BONE SPNL,"$3,338.33",$0.00,"$3,338.33","$1,502.25","$2,382.56",$0.00,$575.18,$0.00,$0.00,$584.51,"$3,338.33",$0.00,"$1,669.16","$2,643.96","$2,670.66",$0.00,$522.45,$0.00,$531.46,$0.00
48912510,SUP,Custom 27803010,,48912510  -  NUT LOCK 9MM POST TI HEX STAB POST STAB,$294.28,$0.00,$294.28,$0.00,$210.02,$0.00,$0.00,$0.00,$0.00,$0.00,$294.28,$0.00,$147.14,$233.07,$235.42,$0.00,$0.00,$0.00,$0.00,$0.00
48912520,SUP,HCPCS C1713,,48912520  -  PLATE 20MM POST STAB POLYAX DOME BONE SPNL,$224.65,$0.00,$224.65,$101.09,$160.33,$0.00,$38.71,$0.00,$0.00,$39.33,$224.65,$0.00,$112.33,$177.92,$179.72,$0.00,$35.16,$0.00,$35.76,$0.00
48953112,SUP,Custom 27803010,,48953112  -  CAGE SPNL 12D LRDTC 28X11X11MM STRL LF TRITANIUM PLIF,"$10,000.00",$0.00,"$10,000.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
48955106,SUP,Custom 27203010,,48955106  -  CAGE SPNL 6D LRDTC 28X11X10MM STRL LF TRITANIUM PLIF,"$5,500.00",$0.00,"$5,500.00",$0.00,"$3,925.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,500.00",$0.00,"$2,750.00","$4,356.00","$4,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
48955126,SUP,HCPCS C1713,,48955126  -  POSTERIOR LUMBAR CAGE 12MM X 28MM X 6 - 11MM,"$5,500.00",$0.00,"$5,500.00","$2,475.00","$3,925.35",$0.00,$947.62,$0.00,$0.00,$963.01,"$5,500.00",$0.00,"$2,750.00","$4,356.00","$4,400.00",$0.00,$860.75,$0.00,$875.60,$0.00
50506000,SUP,Custom 27011340,,050506000  -  CONCTR PRFSN STR EQL 3/8INX3/8IN 3/8INX3/8IN STRL,$248.78,$0.00,$248.78,$0.00,$177.55,$0.00,$0.00,$0.00,$0.00,$0.00,$248.78,$0.00,$124.39,$197.03,$199.02,$0.00,$0.00,$0.00,$0.00,$0.00
50516000,SUP,Custom 27011340,,050516000  -  CONNECTOR PRFSN .25IN 3/8IN STRL RDCR,$281.50,$0.00,$281.50,$0.00,$200.91,$0.00,$0.00,$0.00,$0.00,$0.00,$281.50,$0.00,$140.75,$222.95,$225.20,$0.00,$0.00,$0.00,$0.00,$0.00
50524000,SUP,Custom 27011340,,050524000  -  CONNECTOR PRFSN .25IN X .25IN X .25IN STRL Y EQL,$11.28,$0.00,$11.28,$0.00,$8.05,$0.00,$0.00,$0.00,$0.00,$0.00,$11.28,$0.00,$5.64,$8.93,$9.02,$0.00,$0.00,$0.00,$0.00,$0.00
50524000,SUP,Custom 27011340,,50524000  -  CONNECTOR PERFUSION EQUAL Y STER 1/4 X 1/4IN,$12.75,$0.00,$11.28,$0.00,$8.05,$0.00,$0.00,$0.00,$0.00,$0.00,$11.28,$0.00,$5.64,$10.10,$9.02,$0.00,$0.00,$0.00,$0.00,$0.00
50526000,SUP,Custom 27203010,,CONNECTOR PRFSN Y EQL 3/8INX3/8INX3/8IN,$10.95,$0.00,$10.95,$0.00,$7.82,$0.00,$0.00,$0.00,$0.00,$0.00,$10.95,$0.00,$5.48,$8.67,$8.76,$0.00,$0.00,$0.00,$0.00,$0.00
50529000,SUP,Custom 27011340,,050529000  -  CONCTR PRFSN RDC WYE .5X3/8IN STRL,$22.39,$0.00,$22.39,$0.00,$15.98,$0.00,$0.00,$0.00,$0.00,$0.00,$22.39,$0.00,$11.19,$17.73,$17.91,$0.00,$0.00,$0.00,$0.00,$0.00
60060083,SUP,Custom 27203010,,60060083  -  KIT PRSS MNTR CSTM TRNDCR RT HRT,$35.57,$0.00,$35.57,$0.00,$25.38,$0.00,$0.00,$0.00,$0.00,$0.00,$35.57,$0.00,$17.78,$28.17,$28.45,$0.00,$0.00,$0.00,$0.00,$0.00
65305001,SUP,HCPCS C1762,,65305001  -  GRAFT BONE DBM 10ML SPNL,"$1,000.00",$0.00,"$1,000.00",$0.00,$713.70,$0.00,$172.30,$0.00,$0.00,$0.00,"$1,000.00",$0.00,$500.00,$792.00,$800.00,$0.00,$156.50,$0.00,$0.00,$0.00
66020016,SUP,Custom 27203010,,66020016  -  BANDAGE COMPRESSION 7.25+ IN 4IN MULTILAYER HIGH WOUND,$21.97,$0.00,$21.97,$0.00,$15.68,$0.00,$0.00,$0.00,$0.00,$0.00,$21.97,$0.00,$10.99,$17.40,$17.58,$0.00,$0.00,$0.00,$0.00,$0.00
66800433,SUP,Custom 27203010,,66800433  -  DRESSING BRN 16X16IN STRL LF ACTCT FLX 3 ANMC BRR FLXB SFT,$152.85,$0.00,$152.85,$0.00,$109.09,$0.00,$0.00,$0.00,$0.00,$0.00,$152.85,$0.00,$76.42,$121.06,$122.28,$0.00,$0.00,$0.00,$0.00,$0.00
66800434,SUP,Custom 27203010,,66800434 -  DRESSING BURN 16X16IN ANTIBACTERIAL FAST ACT BARRIER CONTROL,$175.61,$0.00,$175.61,$0.00,$125.33,$0.00,$0.00,$0.00,$0.00,$0.00,$175.61,$0.00,$87.81,$139.08,$140.49,$0.00,$0.00,$0.00,$0.00,$0.00
67005200,SUP,HCPCS C1887,,CATHETER GUID XB3 CURVE 6FR .070IN 100CM PTFE VSBR BLUE YLW,$139.93,$0.00,$139.93,$75.98,$99.86,$0.00,$24.11,$0.00,$0.00,$24.50,$139.93,$0.00,$69.96,$110.82,$111.94,$0.00,$21.90,$0.00,$22.28,$0.00
67005300,SUP,HCPCS C1887,,CATHETER GUID XB3 CURVE 6FR .070IN 100CM SH PTFE VSBR BLUE,$139.93,$0.00,$139.93,$75.98,$99.86,$0.00,$24.11,$0.00,$0.00,$24.50,$139.93,$0.00,$69.96,$110.82,$111.94,$0.00,$21.90,$0.00,$22.28,$0.00
67005500,SUP,HCPCS C1887,,CATHETER GUID XB3.5 CURVE 6FR .070IN 100CM SH PTFE VSBR BLUE,$139.93,$0.00,$139.93,$75.98,$99.86,$0.00,$24.11,$0.00,$0.00,$24.50,$139.93,$0.00,$69.96,$110.82,$111.94,$0.00,$21.90,$0.00,$22.28,$0.00
67011200,SUP,HCPCS C1887,,CATHETER GUID AR2 CURVE 6FR .070IN 100CM PTFE VSBR BLUE YLW,$139.93,$0.00,$139.93,$75.98,$99.86,$0.00,$24.11,$0.00,$0.00,$24.50,$139.93,$0.00,$69.96,$110.82,$111.94,$0.00,$21.90,$0.00,$22.28,$0.00
68304060,SUP,Custom 27803010,,68304060  -  ROD SPNL 60MM 4MM CENTAUR,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
68304070,SUP,Custom 27803010,,68304070  -  ROD SPNL 70MM 4MM CENTAUR,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
68304080,SUP,Custom 27803010,,68304080  -  ROD SPNL 80MM 4MM CENTAUR,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
68304090,SUP,Custom 27803010,,68304090  -  ROD SPNL 90MM 4MM CENTAUR,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
68304100,SUP,Custom 27803010,,68304100  -  ROD SPNL 100MM 4MM CENTAUR,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
68304110,SUP,Custom 27803010,,68304110  -  ROD SPNL 110MM 4MM CENTAUR,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
68304120,SUP,Custom 27803010,,68304120  -  ROD SPNL 120MM 4MM CENTAUR,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
68304130,SUP,Custom 27803010,,68304130  -  ROD SPNL 130MM 4MM CENTAUR,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
68304140,SUP,Custom 27803010,,68304140  -  ROD SPNL 140MM 4MM CENTAUR,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
68304150,SUP,Custom 27803010,,68304150  -  ROD SPNL 150MM 4MM CENTAUR,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
68304160,SUP,Custom 27803010,,68304160  -  ROD SPNL 160MM 4MM CENTAUR,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
68306060,SUP,Custom 27803010,,68306060  -  ROD SPNL 60MM 6MM CENTAUR,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
68306070,SUP,Custom 27803010,,68306070  -  ROD SPNL 70MM 6MM CENTAUR,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
68306080,SUP,Custom 27803010,,68306080  -  ROD SPNL 80MM 6MM CENTAUR,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
68306090,SUP,Custom 27803010,,68306090  -  ROD SPNL 90MM 6MM CENTAUR,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
68306100,SUP,Custom 27803010,,68306100  -  ROD SPNL 100MM 6MM CENTAUR,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
68306110,SUP,Custom 27803010,,68306110  -  ROD SPNL 110MM 6MM CENTAUR,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
68306120,SUP,Custom 27803010,,68306120  -  ROD SPNL 120MM 6MM CENTAUR,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
68306130,SUP,Custom 27803010,,68306130  -  ROD SPNL 130MM 6MM CENTAUR,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
68306140,SUP,Custom 27803010,,68306140  -  ROD SPNL 140MM 6MM CENTAUR,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
68306150,SUP,Custom 27803010,,68306150  -  ROD SPNL 150MM 6MM CENTAUR,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
68306160,SUP,Custom 27803010,,68306160  -  ROD SPNL 160MM 6MM CENTAUR,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
68415525,SUP,HCPCS C1713,,68415525  -  SCREW BONE 5.5MM 25MM CENTAUR SPNL PLT,"$1,204.15",$0.00,"$1,204.15",$541.87,$859.40,$0.00,$207.47,$0.00,$0.00,$210.84,"$1,204.15",$0.00,$602.08,$953.69,$963.32,$0.00,$188.45,$0.00,$191.70,$0.00
68415530,SUP,HCPCS C1713,,68415530  -  SCREW BONE 5.5MM 30MM CENTAUR SPNL PLT,"$1,204.15",$0.00,"$1,204.15",$541.87,$859.40,$0.00,$207.47,$0.00,$0.00,$210.84,"$1,204.15",$0.00,$602.08,$953.69,$963.32,$0.00,$188.45,$0.00,$191.70,$0.00
68415535,SUP,HCPCS C1713,,68415535  -  SCREW BONE 5.5MM 35MM CENTAUR SPNL PLT,"$1,204.15",$0.00,"$1,204.15",$541.87,$859.40,$0.00,$207.47,$0.00,$0.00,$210.84,"$1,204.15",$0.00,$602.08,$953.69,$963.32,$0.00,$188.45,$0.00,$191.70,$0.00
68415540,SUP,HCPCS C1713,,68415540  -  SCREW BONE 5.5MM 40MM CENTAUR SPNL PLT,"$1,204.15",$0.00,"$1,204.15",$541.87,$859.40,$0.00,$207.47,$0.00,$0.00,$210.84,"$1,204.15",$0.00,$602.08,$953.69,$963.32,$0.00,$188.45,$0.00,$191.70,$0.00
68415545,SUP,HCPCS C1713,,68415545  -  SCREW BONE 5.5MM 45MM CENTAUR SPNL PLT,"$1,204.15",$0.00,"$1,204.15",$541.87,$859.40,$0.00,$207.47,$0.00,$0.00,$210.84,"$1,204.15",$0.00,$602.08,$953.69,$963.32,$0.00,$188.45,$0.00,$191.70,$0.00
68415550,SUP,HCPCS C1713,,68415550  -  SCREW BONE 5.5MM 50MM CENTAUR SPNL PLT,"$1,204.15",$0.00,"$1,204.15",$541.87,$859.40,$0.00,$207.47,$0.00,$0.00,$210.84,"$1,204.15",$0.00,$602.08,$953.69,$963.32,$0.00,$188.45,$0.00,$191.70,$0.00
68415555,SUP,HCPCS C1713,,68415555  -  SCREW BONE 5.5MM 55MM CENTAUR SPNL PLT,"$1,204.15",$0.00,"$1,204.15",$541.87,$859.40,$0.00,$207.47,$0.00,$0.00,$210.84,"$1,204.15",$0.00,$602.08,$953.69,$963.32,$0.00,$188.45,$0.00,$191.70,$0.00
68417025,SUP,HCPCS C1713,,68417025  -  SCREW BONE 7MM 25MM CENTAUR SPNL PLT,"$1,204.15",$0.00,"$1,204.15",$541.87,$859.40,$0.00,$207.47,$0.00,$0.00,$210.84,"$1,204.15",$0.00,$602.08,$953.69,$963.32,$0.00,$188.45,$0.00,$191.70,$0.00
68417030,SUP,HCPCS C1713,,68417030  -  SCREW BONE 30MM 7MM CENTAUR PLT,"$1,204.15",$0.00,"$1,204.15",$541.87,$859.40,$0.00,$207.47,$0.00,$0.00,$210.84,"$1,204.15",$0.00,$602.08,$953.69,$963.32,$0.00,$188.45,$0.00,$191.70,$0.00
68417035,SUP,HCPCS C1713,,68417035  -  SCREW BONE 7MM 35MM CENTAUR SPNL PLT,"$1,204.15",$0.00,"$1,204.15",$541.87,$859.40,$0.00,$207.47,$0.00,$0.00,$210.84,"$1,204.15",$0.00,$602.08,$953.69,$963.32,$0.00,$188.45,$0.00,$191.70,$0.00
68417040,SUP,HCPCS C1713,,68417040  -  SCREW BONE 7MM 40MM CENTAUR SPNL PLT,"$1,204.15",$0.00,"$1,204.15",$541.87,$859.40,$0.00,$207.47,$0.00,$0.00,$210.84,"$1,204.15",$0.00,$602.08,$953.69,$963.32,$0.00,$188.45,$0.00,$191.70,$0.00
68417045,SUP,HCPCS C1713,,68417045  -  SCREW BONE 7MM 45MM CENTAUR SPNL PLT,"$1,204.15",$0.00,"$1,204.15",$541.87,$859.40,$0.00,$207.47,$0.00,$0.00,$210.84,"$1,204.15",$0.00,$602.08,$953.69,$963.32,$0.00,$188.45,$0.00,$191.70,$0.00
68417050,SUP,HCPCS C1713,,68417050  -  SCREW BONE 7MM 50MM CENTAUR SPNL PLT,"$1,204.15",$0.00,"$1,204.15",$541.87,$859.40,$0.00,$207.47,$0.00,$0.00,$210.84,"$1,204.15",$0.00,$602.08,$953.69,$963.32,$0.00,$188.45,$0.00,$191.70,$0.00
68417055,SUP,HCPCS C1713,,68417055  -  SCREW BONE 7MM 55MM CENTAUR SPNL PLT,"$1,204.15",$0.00,"$1,204.15",$541.87,$859.40,$0.00,$207.47,$0.00,$0.00,$210.84,"$1,204.15",$0.00,$602.08,$953.69,$963.32,$0.00,$188.45,$0.00,$191.70,$0.00
68420000,SUP,HCPCS C1713,,68420000  -  PLATE SPRT CENTAUR BONE SPNL,$354.95,$0.00,$354.95,$159.73,$253.33,$0.00,$61.16,$0.00,$0.00,$62.15,$354.95,$0.00,$177.48,$281.12,$283.96,$0.00,$55.55,$0.00,$56.51,$0.00
68425525,SUP,HCPCS C1713,,68425525  -  BOLT SPNL 25MM 5.5MM CENTAUR,"$1,392.85",$0.00,"$1,392.85",$626.78,$994.08,$0.00,$239.98,$0.00,$0.00,$243.88,"$1,392.85",$0.00,$696.43,"$1,103.14","$1,114.28",$0.00,$217.98,$0.00,$221.74,$0.00
68425530,SUP,HCPCS C1713,,68425530  -  BOLT SPNL 30MM 5.5MM CENTAUR,"$1,392.85",$0.00,"$1,392.85",$626.78,$994.08,$0.00,$239.98,$0.00,$0.00,$243.88,"$1,392.85",$0.00,$696.43,"$1,103.14","$1,114.28",$0.00,$217.98,$0.00,$221.74,$0.00
68425535,SUP,HCPCS C1713,,68425535  -  BOLT SPNL 35MM 5.5MM CENTAUR,"$1,392.85",$0.00,"$1,392.85",$626.78,$994.08,$0.00,$239.98,$0.00,$0.00,$243.88,"$1,392.85",$0.00,$696.43,"$1,103.14","$1,114.28",$0.00,$217.98,$0.00,$221.74,$0.00
68425540,SUP,HCPCS C1713,,68425540  -  BOLT SPNL 40MM 5.5MM CENTAUR,"$1,392.85",$0.00,"$1,392.85",$626.78,$994.08,$0.00,$239.98,$0.00,$0.00,$243.88,"$1,392.85",$0.00,$696.43,"$1,103.14","$1,114.28",$0.00,$217.98,$0.00,$221.74,$0.00
68425545,SUP,HCPCS C1713,,68425545  -  BOLT SPNL 45MM 5.5MM CENTAUR,"$1,392.85",$0.00,"$1,392.85",$626.78,$994.08,$0.00,$239.98,$0.00,$0.00,$243.88,"$1,392.85",$0.00,$696.43,"$1,103.14","$1,114.28",$0.00,$217.98,$0.00,$221.74,$0.00
68425550,SUP,HCPCS C1713,,68425550  -  BOLT SPNL 50MM 5.5MM CENTAUR,"$1,392.85",$0.00,"$1,392.85",$626.78,$994.08,$0.00,$239.98,$0.00,$0.00,$243.88,"$1,392.85",$0.00,$696.43,"$1,103.14","$1,114.28",$0.00,$217.98,$0.00,$221.74,$0.00
68425555,SUP,HCPCS C1713,,68425555  -  BOLT SPNL 55MM 5.5MM CENTAUR,"$1,392.85",$0.00,"$1,392.85",$626.78,$994.08,$0.00,$239.98,$0.00,$0.00,$243.88,"$1,392.85",$0.00,$696.43,"$1,103.14","$1,114.28",$0.00,$217.98,$0.00,$221.74,$0.00
68427025,SUP,HCPCS C1713,,68427025  -  BOLT SPNL 25MM 7MM CENTAUR,"$1,392.85",$0.00,"$1,392.85",$626.78,$994.08,$0.00,$239.98,$0.00,$0.00,$243.88,"$1,392.85",$0.00,$696.43,"$1,103.14","$1,114.28",$0.00,$217.98,$0.00,$221.74,$0.00
68427030,SUP,HCPCS C1713,,68427030  -  BOLT SPNL 30MM 7MM CENTAUR,"$1,392.85",$0.00,"$1,392.85",$626.78,$994.08,$0.00,$239.98,$0.00,$0.00,$243.88,"$1,392.85",$0.00,$696.43,"$1,103.14","$1,114.28",$0.00,$217.98,$0.00,$221.74,$0.00
68427035,SUP,HCPCS C1713,,68427035  -  BOLT SPNL 35MM 7MM CENTAUR,"$1,392.85",$0.00,"$1,392.85",$626.78,$994.08,$0.00,$239.98,$0.00,$0.00,$243.88,"$1,392.85",$0.00,$696.43,"$1,103.14","$1,114.28",$0.00,$217.98,$0.00,$221.74,$0.00
68427040,SUP,HCPCS C1713,,68427040  -  BOLT SPNL 40MM 7MM CENTAUR,"$1,392.85",$0.00,"$1,392.85",$626.78,$994.08,$0.00,$239.98,$0.00,$0.00,$243.88,"$1,392.85",$0.00,$696.43,"$1,103.14","$1,114.28",$0.00,$217.98,$0.00,$221.74,$0.00
68427045,SUP,HCPCS C1713,,68427045  -  BOLT SPNL 45MM 7MM CENTAUR,"$1,392.85",$0.00,"$1,392.85",$626.78,$994.08,$0.00,$239.98,$0.00,$0.00,$243.88,"$1,392.85",$0.00,$696.43,"$1,103.14","$1,114.28",$0.00,$217.98,$0.00,$221.74,$0.00
68427050,SUP,HCPCS C1713,,68427050  -  BOLT SPNL 50MM 7MM CENTAUR,"$1,392.85",$0.00,"$1,392.85",$626.78,$994.08,$0.00,$239.98,$0.00,$0.00,$243.88,"$1,392.85",$0.00,$696.43,"$1,103.14","$1,114.28",$0.00,$217.98,$0.00,$221.74,$0.00
68427055,SUP,HCPCS C1713,,68427055  -  BOLT SPNL 55MM 7MM CENTAUR,"$1,392.85",$0.00,"$1,392.85",$626.78,$994.08,$0.00,$239.98,$0.00,$0.00,$243.88,"$1,392.85",$0.00,$696.43,"$1,103.14","$1,114.28",$0.00,$217.98,$0.00,$221.74,$0.00
68430000,SUP,Custom 27803010,,68430000  -  CONCTR ROD CENTAUR SET SPNL,"$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
68435525,SUP,Custom 27803010,,68435525  -  BOLT SPNL 25MM 5.5MM CENTAUR ROD,"$1,392.85",$0.00,"$1,392.85",$0.00,$994.08,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,392.85",$0.00,$696.43,"$1,103.14","$1,114.28",$0.00,$0.00,$0.00,$0.00,$0.00
68435530,SUP,Custom 27803010,,68435530  -  BOLT SPNL 30MM 5.5MM CENTAUR ROD,"$1,392.85",$0.00,"$1,392.85",$0.00,$994.08,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,392.85",$0.00,$696.43,"$1,103.14","$1,114.28",$0.00,$0.00,$0.00,$0.00,$0.00
68435535,SUP,Custom 27803010,,68435535  -  BOLT SPNL 35MM 5.5MM CENTAUR ROD,"$1,392.85",$0.00,"$1,392.85",$0.00,$994.08,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,392.85",$0.00,$696.43,"$1,103.14","$1,114.28",$0.00,$0.00,$0.00,$0.00,$0.00
68435540,SUP,Custom 27803010,,68435540  -  BOLT SPNL 40MM 5.5MM CENTAUR ROD,"$1,392.85",$0.00,"$1,392.85",$0.00,$994.08,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,392.85",$0.00,$696.43,"$1,103.14","$1,114.28",$0.00,$0.00,$0.00,$0.00,$0.00
68435545,SUP,Custom 27803010,,68435545  -  BOLT SPNL 45MM 5.5MM CENTAUR ROD,"$1,392.85",$0.00,"$1,392.85",$0.00,$994.08,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,392.85",$0.00,$696.43,"$1,103.14","$1,114.28",$0.00,$0.00,$0.00,$0.00,$0.00
68435550,SUP,Custom 27803010,,68435550  -  BOLT SPNL 50MM 5.5MM CENTAUR ROD,"$1,392.85",$0.00,"$1,392.85",$0.00,$994.08,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,392.85",$0.00,$696.43,"$1,103.14","$1,114.28",$0.00,$0.00,$0.00,$0.00,$0.00
68435555,SUP,Custom 27803010,,68435555  -  BOLT SPNL 55MM 5.5MM CENTAUR ROD,"$1,392.85",$0.00,"$1,392.85",$0.00,$994.08,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,392.85",$0.00,$696.43,"$1,103.14","$1,114.28",$0.00,$0.00,$0.00,$0.00,$0.00
68437025,SUP,Custom 27803010,,68437025  -  BOLT SPNL 25MM 7MM CENTAUR ROD,"$1,392.85",$0.00,"$1,392.85",$0.00,$994.08,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,392.85",$0.00,$696.43,"$1,103.14","$1,114.28",$0.00,$0.00,$0.00,$0.00,$0.00
68437030,SUP,Custom 27803010,,68437030  -  BOLT SPNL 30MM 7MM CENTAUR ROD,"$1,392.85",$0.00,"$1,392.85",$0.00,$994.08,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,392.85",$0.00,$696.43,"$1,103.14","$1,114.28",$0.00,$0.00,$0.00,$0.00,$0.00
68437035,SUP,Custom 27803010,,68437035  -  BOLT SPNL 35MM 7MM CENTAUR ROD,"$1,392.85",$0.00,"$1,392.85",$0.00,$994.08,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,392.85",$0.00,$696.43,"$1,103.14","$1,114.28",$0.00,$0.00,$0.00,$0.00,$0.00
68437040,SUP,Custom 27803010,,68437040  -  BOLT SPNL 40MM 7MM CENTAUR ROD,"$1,392.85",$0.00,"$1,392.85",$0.00,$994.08,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,392.85",$0.00,$696.43,"$1,103.14","$1,114.28",$0.00,$0.00,$0.00,$0.00,$0.00
68437045,SUP,Custom 27803010,,68437045  -  BOLT SPNL 45MM 7MM CENTAUR ROD,"$1,392.85",$0.00,"$1,392.85",$0.00,$994.08,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,392.85",$0.00,$696.43,"$1,103.14","$1,114.28",$0.00,$0.00,$0.00,$0.00,$0.00
68437050,SUP,Custom 27803010,,68437050  -  BOLT SPNL 50MM 7MM CENTAUR ROD,"$1,392.85",$0.00,"$1,392.85",$0.00,$994.08,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,392.85",$0.00,$696.43,"$1,103.14","$1,114.28",$0.00,$0.00,$0.00,$0.00,$0.00
68437055,SUP,Custom 27803010,,68437055  -  BOLT SPNL 55MM 7MM CENTAUR ROD,"$1,392.85",$0.00,"$1,392.85",$0.00,$994.08,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,392.85",$0.00,$696.43,"$1,103.14","$1,114.28",$0.00,$0.00,$0.00,$0.00,$0.00
68470030,SUP,HCPCS C1713,,68470030  -  PLATE 30MM STR CENTAUR BONE SPNL,"$6,274.48",$0.00,"$6,274.48","$2,823.51","$4,478.09",$0.00,"$1,081.06",$0.00,$0.00,"$1,098.61","$6,274.48",$0.00,"$3,137.24","$4,969.39","$5,019.58",$0.00,$981.96,$0.00,$998.90,$0.00
68470040,SUP,HCPCS C1713,,68470040  -  PLATE 40MM STR CENTAUR BONE SPNL,"$6,274.48",$0.00,"$6,274.48","$2,823.51","$4,478.09",$0.00,"$1,081.06",$0.00,$0.00,"$1,098.61","$6,274.48",$0.00,"$3,137.24","$4,969.39","$5,019.58",$0.00,$981.96,$0.00,$998.90,$0.00
68470050,SUP,HCPCS C1713,,68470050  -  PLATE 50MM STR CENTAUR BONE SPNL,"$6,723.78",$0.00,"$6,723.78","$3,025.70","$4,798.76",$0.00,"$1,158.47",$0.00,$0.00,"$1,177.28","$6,723.78",$0.00,"$3,361.89","$5,325.23","$5,379.02",$0.00,"$1,052.27",$0.00,"$1,070.42",$0.00
68470060,SUP,HCPCS C1713,,68470060  -  PLATE 60MM STR CENTAUR BONE SPNL,"$6,723.78",$0.00,"$6,723.78","$3,025.70","$4,798.76",$0.00,"$1,158.47",$0.00,$0.00,"$1,177.28","$6,723.78",$0.00,"$3,361.89","$5,325.23","$5,379.02",$0.00,"$1,052.27",$0.00,"$1,070.42",$0.00
68470070,SUP,HCPCS C1713,,68470070  -  PLATE 70MM STR CENTAUR BONE SPNL,"$7,006.85",$0.00,"$7,006.85","$3,153.08","$5,000.79",$0.00,"$1,207.25",$0.00,$0.00,"$1,226.84","$7,006.85",$0.00,"$3,503.43","$5,549.43","$5,605.48",$0.00,"$1,096.57",$0.00,"$1,115.49",$0.00
68470080,SUP,HCPCS C1713,,68470080  -  PLATE 80MM STR CENTAUR BONE SPNL,"$7,006.85",$0.00,"$7,006.85","$3,153.08","$5,000.79",$0.00,"$1,207.25",$0.00,$0.00,"$1,226.84","$7,006.85",$0.00,"$3,503.43","$5,549.43","$5,605.48",$0.00,"$1,096.57",$0.00,"$1,115.49",$0.00
68470090,SUP,HCPCS C1713,,68470090  -  PLATE 90MM STR CENTAUR BONE SPNL,"$7,465.13",$0.00,"$7,465.13","$3,359.31","$5,158.80",$0.00,"$1,286.20",$0.00,$0.00,"$1,307.08","$7,465.13",$0.00,"$3,732.56","$5,912.38","$5,972.10",$0.00,"$1,168.29",$0.00,"$1,188.45",$0.00
68480060,SUP,HCPCS C1713,,68480060  -  PLATE 60MM LRDTC CENTAUR BONE SPNL,"$4,953.53",$0.00,"$4,953.53","$2,229.09","$3,535.33",$0.00,$853.47,$0.00,$0.00,$867.32,"$4,953.53",$0.00,"$2,476.76","$3,923.20","$3,962.82",$0.00,$775.23,$0.00,$788.60,$0.00
68480070,SUP,HCPCS C1713,,68480070  -  PLATE 70MM LRDTC CENTAUR BONE SPNL,"$5,166.98",$0.00,"$5,166.98","$2,325.14","$3,687.67",$0.00,$890.24,$0.00,$0.00,$904.70,"$5,166.98",$0.00,"$2,583.49","$4,092.25","$4,133.58",$0.00,$808.63,$0.00,$822.58,$0.00
68480080,SUP,HCPCS C1713,,68480080  -  PLATE 80MM LRDTC CENTAUR BONE SPNL,"$5,366.88",$0.00,"$5,366.88","$2,415.09","$3,830.34",$0.00,$924.69,$0.00,$0.00,$939.70,"$5,366.88",$0.00,"$2,683.44","$4,250.57","$4,293.50",$0.00,$839.92,$0.00,$854.41,$0.00
68480090,SUP,HCPCS C1713,,68480090  -  PLATE 90MM LRDTC CENTAUR BONE SPNL,"$5,366.88",$0.00,"$5,366.88","$2,415.09","$3,830.34",$0.00,$924.69,$0.00,$0.00,$939.70,"$5,366.88",$0.00,"$2,683.44","$4,250.57","$4,293.50",$0.00,$839.92,$0.00,$854.41,$0.00
68490050,SUP,HCPCS C1713,,68490050  -  PLATE 50MM KYPHOTIC CENTAUR BONE SPNL,"$6,818.15",$0.00,"$6,818.15","$3,068.17","$4,866.11",$0.00,"$1,174.73",$0.00,$0.00,"$1,193.80","$6,818.15",$0.00,"$3,409.08","$5,399.97","$5,454.52",$0.00,"$1,067.04",$0.00,"$1,085.45",$0.00
68490060,SUP,HCPCS C1713,,68490060  -  PLATE 60MM KYPHOTIC CENTAUR BONE SPNL,"$7,112.45",$0.00,"$7,112.45","$3,200.60","$5,076.16",$0.00,"$1,225.44",$0.00,$0.00,"$1,245.33","$7,112.45",$0.00,"$3,556.23","$5,633.06","$5,689.96",$0.00,"$1,113.10",$0.00,"$1,132.30",$0.00
68490070,SUP,HCPCS C1713,,68490070  -  PLATE 70MM KYPHOTIC CENTAUR BONE SPNL,"$7,395.48",$0.00,"$7,395.48","$3,327.96","$5,158.80",$0.00,"$1,274.20",$0.00,$0.00,"$1,294.89","$7,395.48",$0.00,"$3,697.74","$5,857.22","$5,916.38",$0.00,"$1,157.39",$0.00,"$1,177.36",$0.00
68490080,SUP,HCPCS C1713,,68490080  -  PLATE 80MM KYPHOTIC CENTAUR BONE SPNL,"$7,831.35",$0.00,"$7,831.35","$3,524.11","$5,158.80",$0.00,"$1,349.30",$0.00,$0.00,"$1,371.21","$7,831.35",$0.00,"$3,915.68","$6,202.43","$6,265.08",$0.00,"$1,225.61",$0.00,"$1,246.75",$0.00
68490090,SUP,HCPCS C1713,,68490090  -  PLATE 90MM KYPHOTIC CENTAUR BONE SPNL,"$8,386.20",$0.00,"$8,386.20","$3,773.79","$5,158.80",$0.00,"$1,444.90",$0.00,$0.00,"$1,468.36","$8,386.20",$0.00,"$4,193.10","$6,641.87","$6,708.96",$0.00,"$1,312.44",$0.00,"$1,335.08",$0.00
70000267,SUP,HCPCS C1894,,612606 - INTRODUCER SHTH 9FR 16CM TRAW ADPR DILAT SET INDN SPNLK .035,$67.10,$0.00,$67.10,$36.44,$47.89,$0.00,$11.56,$0.00,$0.00,$11.75,$67.10,$0.00,$33.55,$53.14,$53.68,$0.00,$10.50,$0.00,$10.68,$0.00
70035009,SUP,Custom 27203010,,70035009  -  STOPCOCK ANGIO 400 PSI NAMIC 3W ROT ADPR RT PORT,$2.80,$0.00,$2.80,$0.00,$2.00,$0.00,$0.00,$0.00,$0.00,$0.00,$2.80,$0.00,$1.40,$2.22,$2.24,$0.00,$0.00,$0.00,$0.00,$0.00
70055017,SUP,Custom 27203010,,70055017  -  STOPCOCK ANGIO 1050 PSI NAMIC 1 WY FX M LL,$161.28,$0.00,$161.28,$0.00,$115.10,$0.00,$0.00,$0.00,$0.00,$0.00,$161.28,$0.00,$80.64,$127.73,$129.02,$0.00,$0.00,$0.00,$0.00,$0.00
70245550,SUP,HCPCS C1713,,70245550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
70245560,SUP,HCPCS C1713,,70245560  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
70260500,SUP,HCPCS C1713,,70260500  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
70260511,SUP,HCPCS C1713,,70260511  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
70260580,SUP,HCPCS C1713,,70260580  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
70260590,SUP,HCPCS C1713,,70260590  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
70265530,SUP,HCPCS C1713,,70265530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
70265535,SUP,HCPCS C1713,,70265535  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
70265540,SUP,HCPCS C1713,,70265540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
70265545,SUP,HCPCS C1713,,70265545  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
70265550,SUP,HCPCS C1713,,70265550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
70265555,SUP,HCPCS C1713,,70265555  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
70265560,SUP,HCPCS C1713,,70265560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
70266535,SUP,HCPCS C1713,,70266535  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
70266540,SUP,HCPCS C1713,,70266540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
70266545,SUP,HCPCS C1713,,70266545  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
70266550,SUP,HCPCS C1713,,70266550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
70266555,SUP,HCPCS C1713,,70266555  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
70266560,SUP,HCPCS C1713,,70266560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
70266570,SUP,HCPCS C1713,,70266570  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
70267500,SUP,HCPCS C1713,,70267500  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
70267540,SUP,HCPCS C1713,,70267540  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
70267545,SUP,HCPCS C1713,,70267545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
70267550,SUP,HCPCS C1713,,70267550  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
70267555,SUP,HCPCS C1713,,70267555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
70267560,SUP,HCPCS C1713,,70267560  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
70267570,SUP,HCPCS C1713,,70267570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
70267580,SUP,HCPCS C1713,,70267580  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
70267590,SUP,HCPCS C1713,,70267590  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
70268500,SUP,HCPCS C1713,,70268500  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
70268540,SUP,HCPCS C1713,,70268540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
70268545,SUP,HCPCS C1713,,70268545  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
70268550,SUP,HCPCS C1713,,70268550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
70268555,SUP,HCPCS C1713,,70268555  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
70268560,SUP,HCPCS C1713,,70268560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
70268570,SUP,HCPCS C1713,,70268570  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
70268580,SUP,HCPCS C1713,,70268580  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
70268590,SUP,HCPCS C1713,,70268590  -  SCREW BN 8.5MM 90MM SOLERA CD HZN LGC MA CLS SS SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
70269500,SUP,HCPCS C1713,,70269500  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
70269511,SUP,HCPCS C1713,,70269511  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
70269580,SUP,HCPCS C1713,,70269580  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
70269590,SUP,HCPCS C1713,,70269590  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
70460500,SUP,HCPCS C1713,,70460500  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$3,091.50",$0.00,"$3,091.50","$1,391.18","$2,206.40",$0.00,$532.65,$0.00,$0.00,$541.30,"$3,091.50",$0.00,"$1,545.75","$2,448.47","$2,473.20",$0.00,$483.82,$0.00,$492.17,$0.00
70460511,SUP,HCPCS C1713,,70460511  -  PLATE 18MM TI BONE SPNL,"$3,091.50",$0.00,"$3,091.50","$1,391.18","$2,206.40",$0.00,$532.65,$0.00,$0.00,$541.30,"$3,091.50",$0.00,"$1,545.75","$2,448.47","$2,473.20",$0.00,$483.82,$0.00,$492.17,$0.00
70460580,SUP,HCPCS C1713,,70460580  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$3,091.50",$0.00,"$3,091.50","$1,391.18","$2,206.40",$0.00,$532.65,$0.00,$0.00,$541.30,"$3,091.50",$0.00,"$1,545.75","$2,448.47","$2,473.20",$0.00,$483.82,$0.00,$492.17,$0.00
70460590,SUP,HCPCS C1713,,70460590  -  PLATE 18MM TI BONE SPNL,"$3,091.50",$0.00,"$3,091.50","$1,391.18","$2,206.40",$0.00,$532.65,$0.00,$0.00,$541.30,"$3,091.50",$0.00,"$1,545.75","$2,448.47","$2,473.20",$0.00,$483.82,$0.00,$492.17,$0.00
70465530,SUP,HCPCS C1713,,70465530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$3,091.50",$0.00,"$3,091.50","$1,391.18","$2,206.40",$0.00,$532.65,$0.00,$0.00,$541.30,"$3,091.50",$0.00,"$1,545.75","$2,448.47","$2,473.20",$0.00,$483.82,$0.00,$492.17,$0.00
70465535,SUP,HCPCS C1713,,70465535  -  PLATE 18MM TI BONE SPNL,"$3,091.50",$0.00,"$3,091.50","$1,391.18","$2,206.40",$0.00,$532.65,$0.00,$0.00,$541.30,"$3,091.50",$0.00,"$1,545.75","$2,448.47","$2,473.20",$0.00,$483.82,$0.00,$492.17,$0.00
70465540,SUP,HCPCS C1713,,70465540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$3,091.50",$0.00,"$3,091.50","$1,391.18","$2,206.40",$0.00,$532.65,$0.00,$0.00,$541.30,"$3,091.50",$0.00,"$1,545.75","$2,448.47","$2,473.20",$0.00,$483.82,$0.00,$492.17,$0.00
70465545,SUP,HCPCS C1713,,70465545  -  PLATE 18MM TI BONE SPNL,"$3,091.50",$0.00,"$3,091.50","$1,391.18","$2,206.40",$0.00,$532.65,$0.00,$0.00,$541.30,"$3,091.50",$0.00,"$1,545.75","$2,448.47","$2,473.20",$0.00,$483.82,$0.00,$492.17,$0.00
70465550,SUP,HCPCS C1713,,70465550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$3,091.50",$0.00,"$3,091.50","$1,391.18","$2,206.40",$0.00,$532.65,$0.00,$0.00,$541.30,"$3,091.50",$0.00,"$1,545.75","$2,448.47","$2,473.20",$0.00,$483.82,$0.00,$492.17,$0.00
70465555,SUP,HCPCS C1713,,70465555  -  PLATE 18MM TI BONE SPNL,"$3,091.50",$0.00,"$3,091.50","$1,391.18","$2,206.40",$0.00,$532.65,$0.00,$0.00,$541.30,"$3,091.50",$0.00,"$1,545.75","$2,448.47","$2,473.20",$0.00,$483.82,$0.00,$492.17,$0.00
70465560,SUP,HCPCS C1713,,70465560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$3,091.50",$0.00,"$3,091.50","$1,391.18","$2,206.40",$0.00,$532.65,$0.00,$0.00,$541.30,"$3,091.50",$0.00,"$1,545.75","$2,448.47","$2,473.20",$0.00,$483.82,$0.00,$492.17,$0.00
70466535,SUP,HCPCS C1713,,70466535  -  PLATE 18MM TI BONE SPNL,"$3,091.50",$0.00,"$3,091.50","$1,391.18","$2,206.40",$0.00,$532.65,$0.00,$0.00,$541.30,"$3,091.50",$0.00,"$1,545.75","$2,448.47","$2,473.20",$0.00,$483.82,$0.00,$492.17,$0.00
70466540,SUP,HCPCS C1713,,70466540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$3,091.50",$0.00,"$3,091.50","$1,391.18","$2,206.40",$0.00,$532.65,$0.00,$0.00,$541.30,"$3,091.50",$0.00,"$1,545.75","$2,448.47","$2,473.20",$0.00,$483.82,$0.00,$492.17,$0.00
70466545,SUP,HCPCS C1713,,70466545  -  PLATE 18MM TI BONE SPNL,"$3,091.50",$0.00,"$3,091.50","$1,391.18","$2,206.40",$0.00,$532.65,$0.00,$0.00,$541.30,"$3,091.50",$0.00,"$1,545.75","$2,448.47","$2,473.20",$0.00,$483.82,$0.00,$492.17,$0.00
70466550,SUP,HCPCS C1713,,70466550  -  SCREW BN 6.5MM 50MM SOLERA CD HZN LGC MA CLS TI SPNE,"$3,091.50",$0.00,"$3,091.50","$1,391.18","$2,206.40",$0.00,$532.65,$0.00,$0.00,$541.30,"$3,091.50",$0.00,"$1,545.75","$2,448.47","$2,473.20",$0.00,$483.82,$0.00,$492.17,$0.00
70466555,SUP,HCPCS C1713,,70466555  -  PLATE 18MM TI BONE SPNL,"$3,091.50",$0.00,"$3,091.50","$1,391.18","$2,206.40",$0.00,$532.65,$0.00,$0.00,$541.30,"$3,091.50",$0.00,"$1,545.75","$2,448.47","$2,473.20",$0.00,$483.82,$0.00,$492.17,$0.00
70466560,SUP,HCPCS C1713,,70466560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$3,091.50",$0.00,"$3,091.50","$1,391.18","$2,206.40",$0.00,$532.65,$0.00,$0.00,$541.30,"$3,091.50",$0.00,"$1,545.75","$2,448.47","$2,473.20",$0.00,$483.82,$0.00,$492.17,$0.00
70466570,SUP,HCPCS C1713,,70466570  -  SCREW BN 6.5MM 70MM SOLERA CD HZN LGC MA CLS TI SPNE,"$3,091.50",$0.00,"$3,091.50","$1,391.18","$2,206.40",$0.00,$532.65,$0.00,$0.00,$541.30,"$3,091.50",$0.00,"$1,545.75","$2,448.47","$2,473.20",$0.00,$483.82,$0.00,$492.17,$0.00
70467500,SUP,HCPCS C1713,,70467500  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$3,091.50",$0.00,"$3,091.50","$1,391.18","$2,206.40",$0.00,$532.65,$0.00,$0.00,$541.30,"$3,091.50",$0.00,"$1,545.75","$2,448.47","$2,473.20",$0.00,$483.82,$0.00,$492.17,$0.00
70467540,SUP,HCPCS C1713,,70467540  -  PLATE 18MM TI BONE SPNL,"$3,091.50",$0.00,"$3,091.50","$1,391.18","$2,206.40",$0.00,$532.65,$0.00,$0.00,$541.30,"$3,091.50",$0.00,"$1,545.75","$2,448.47","$2,473.20",$0.00,$483.82,$0.00,$492.17,$0.00
70467545,SUP,HCPCS C1713,,70467545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$3,091.50",$0.00,"$3,091.50","$1,391.18","$2,206.40",$0.00,$532.65,$0.00,$0.00,$541.30,"$3,091.50",$0.00,"$1,545.75","$2,448.47","$2,473.20",$0.00,$483.82,$0.00,$492.17,$0.00
70467550,SUP,HCPCS C1713,,70467550  -  PLATE 18MM TI BONE SPNL,"$3,091.50",$0.00,"$3,091.50","$1,391.18","$2,206.40",$0.00,$532.65,$0.00,$0.00,$541.30,"$3,091.50",$0.00,"$1,545.75","$2,448.47","$2,473.20",$0.00,$483.82,$0.00,$492.17,$0.00
70467555,SUP,HCPCS C1713,,70467555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$3,091.50",$0.00,"$3,091.50","$1,391.18","$2,206.40",$0.00,$532.65,$0.00,$0.00,$541.30,"$3,091.50",$0.00,"$1,545.75","$2,448.47","$2,473.20",$0.00,$483.82,$0.00,$492.17,$0.00
70467560,SUP,HCPCS C1713,,70467560  -  SCREW BN 7.5MM 60MM SOLERA CD HZN LGC MA CLS TI SPNE,"$3,091.50",$0.00,"$3,091.50","$1,391.18","$2,206.40",$0.00,$532.65,$0.00,$0.00,$541.30,"$3,091.50",$0.00,"$1,545.75","$2,448.47","$2,473.20",$0.00,$483.82,$0.00,$492.17,$0.00
70467570,SUP,HCPCS C1713,,70467570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$3,091.50",$0.00,"$3,091.50","$1,391.18","$2,206.40",$0.00,$532.65,$0.00,$0.00,$541.30,"$3,091.50",$0.00,"$1,545.75","$2,448.47","$2,473.20",$0.00,$483.82,$0.00,$492.17,$0.00
70467580,SUP,HCPCS C1713,,70467580  -  PLATE 18MM TI BONE SPNL,"$3,091.50",$0.00,"$3,091.50","$1,391.18","$2,206.40",$0.00,$532.65,$0.00,$0.00,$541.30,"$3,091.50",$0.00,"$1,545.75","$2,448.47","$2,473.20",$0.00,$483.82,$0.00,$492.17,$0.00
70467590,SUP,HCPCS C1713,,70467590  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$3,091.50",$0.00,"$3,091.50","$1,391.18","$2,206.40",$0.00,$532.65,$0.00,$0.00,$541.30,"$3,091.50",$0.00,"$1,545.75","$2,448.47","$2,473.20",$0.00,$483.82,$0.00,$492.17,$0.00
70468500,SUP,HCPCS C1713,,70468500  -  PLATE 18MM TI BONE SPNL,"$3,091.50",$0.00,"$3,091.50","$1,391.18","$2,206.40",$0.00,$532.65,$0.00,$0.00,$541.30,"$3,091.50",$0.00,"$1,545.75","$2,448.47","$2,473.20",$0.00,$483.82,$0.00,$492.17,$0.00
70468540,SUP,HCPCS C1713,,70468540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$3,091.50",$0.00,"$3,091.50","$1,391.18","$2,206.40",$0.00,$532.65,$0.00,$0.00,$541.30,"$3,091.50",$0.00,"$1,545.75","$2,448.47","$2,473.20",$0.00,$483.82,$0.00,$492.17,$0.00
70468545,SUP,HCPCS C1713,,70468545  -  PLATE 18MM TI BONE SPNL,"$3,091.50",$0.00,"$3,091.50","$1,391.18","$2,206.40",$0.00,$532.65,$0.00,$0.00,$541.30,"$3,091.50",$0.00,"$1,545.75","$2,448.47","$2,473.20",$0.00,$483.82,$0.00,$492.17,$0.00
70468550,SUP,HCPCS C1713,,70468550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$3,091.50",$0.00,"$3,091.50","$1,391.18","$2,206.40",$0.00,$532.65,$0.00,$0.00,$541.30,"$3,091.50",$0.00,"$1,545.75","$2,448.47","$2,473.20",$0.00,$483.82,$0.00,$492.17,$0.00
70468555,SUP,HCPCS C1713,,70468555  -  PLATE 18MM TI BONE SPNL,"$3,091.50",$0.00,"$3,091.50","$1,391.18","$2,206.40",$0.00,$532.65,$0.00,$0.00,$541.30,"$3,091.50",$0.00,"$1,545.75","$2,448.47","$2,473.20",$0.00,$483.82,$0.00,$492.17,$0.00
70468560,SUP,HCPCS C1713,,70468560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$3,091.50",$0.00,"$3,091.50","$1,391.18","$2,206.40",$0.00,$532.65,$0.00,$0.00,$541.30,"$3,091.50",$0.00,"$1,545.75","$2,448.47","$2,473.20",$0.00,$483.82,$0.00,$492.17,$0.00
70468570,SUP,HCPCS C1713,,70468570  -  SCREW BN 8.5MM 70MM SOLERA CD HZN LGC MA CLS TI SPNE,"$3,091.50",$0.00,"$3,091.50","$1,391.18","$2,206.40",$0.00,$532.65,$0.00,$0.00,$541.30,"$3,091.50",$0.00,"$1,545.75","$2,448.47","$2,473.20",$0.00,$483.82,$0.00,$492.17,$0.00
70468580,SUP,HCPCS C1713,,70468580  -  SCREW BN 8.5MM 80MM SOLERA CD HZN LGC MA CLS TI SPNE,"$3,091.50",$0.00,"$3,091.50","$1,391.18","$2,206.40",$0.00,$532.65,$0.00,$0.00,$541.30,"$3,091.50",$0.00,"$1,545.75","$2,448.47","$2,473.20",$0.00,$483.82,$0.00,$492.17,$0.00
70468590,SUP,HCPCS C1713,,70468590  -  SCREW BN 8.5MM 90MM SOLERA CD HZN LGC MA CLS TI SPNE,"$3,091.50",$0.00,"$3,091.50","$1,391.18","$2,206.40",$0.00,$532.65,$0.00,$0.00,$541.30,"$3,091.50",$0.00,"$1,545.75","$2,448.47","$2,473.20",$0.00,$483.82,$0.00,$492.17,$0.00
70469500,SUP,HCPCS C1713,,70469500  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$3,091.50",$0.00,"$3,091.50","$1,391.18","$2,206.40",$0.00,$532.65,$0.00,$0.00,$541.30,"$3,091.50",$0.00,"$1,545.75","$2,448.47","$2,473.20",$0.00,$483.82,$0.00,$492.17,$0.00
70469511,SUP,HCPCS C1713,,70469511  -  PLATE 18MM TI BONE SPNL,"$3,091.50",$0.00,"$3,091.50","$1,391.18","$2,206.40",$0.00,$532.65,$0.00,$0.00,$541.30,"$3,091.50",$0.00,"$1,545.75","$2,448.47","$2,473.20",$0.00,$483.82,$0.00,$492.17,$0.00
70469580,SUP,HCPCS C1713,,70469580  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$3,091.50",$0.00,"$3,091.50","$1,391.18","$2,206.40",$0.00,$532.65,$0.00,$0.00,$541.30,"$3,091.50",$0.00,"$1,545.75","$2,448.47","$2,473.20",$0.00,$483.82,$0.00,$492.17,$0.00
70469590,SUP,HCPCS C1713,,70469590  -  SCREW BN 9.5MM 90MM SOLERA CD HZN LGC MA CLS TI SPNE,"$3,091.50",$0.00,"$3,091.50","$1,391.18","$2,206.40",$0.00,$532.65,$0.00,$0.00,$541.30,"$3,091.50",$0.00,"$1,545.75","$2,448.47","$2,473.20",$0.00,$483.82,$0.00,$492.17,$0.00
71010705,SUP,HCPCS C1713,,71010705  -  BOLT EXFIX ILZ RSN WIRE,$147.60,$0.00,$147.60,$66.42,$105.34,$0.00,$25.43,$0.00,$0.00,$25.84,$147.60,$0.00,$73.80,$116.90,$118.08,$0.00,$23.10,$0.00,$23.50,$0.00
71011002,SUP,HCPCS C1713,,71011002  -  NUT XTRNFX ILZ QCK CNCT CIRC,$175.10,$0.00,$175.10,$78.80,$124.97,$0.00,$30.17,$0.00,$0.00,$30.66,$175.10,$0.00,$87.55,$138.68,$140.08,$0.00,$27.40,$0.00,$27.88,$0.00
71011550,SUP,HCPCS C1713,,71011550  -  WASHER ORTH 7MM TI,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
71012000,SUP,HCPCS C1713,,71012000  -  WASHER XTRNFX CNCL CPL SM BN FXTR,$192.00,$0.00,$192.00,$86.40,$137.03,$0.00,$33.08,$0.00,$0.00,$33.62,$192.00,$0.00,$96.00,$152.06,$153.60,$0.00,$30.05,$0.00,$30.57,$0.00
71012005,SUP,HCPCS C1713,,71012005  -  NUT XTRNFX CIRC NYL SM BN FXTR,$29.70,$0.00,$29.70,$13.37,$21.20,$0.00,$5.12,$0.00,$0.00,$5.20,$29.70,$0.00,$14.85,$23.52,$23.76,$0.00,$4.65,$0.00,$4.73,$0.00
71012502,SUP,HCPCS C1713,,71012502  -  PIN HLF 5MM 180MM ILZ SS ANKL/FT XTRNFXTR,$627.30,$0.00,$627.30,$282.29,$447.70,$0.00,$108.08,$0.00,$0.00,$109.84,$627.30,$0.00,$313.65,$496.82,$501.84,$0.00,$98.17,$0.00,$99.87,$0.00
71013000,SUP,Custom 27203010,,71013000  -  BOLT XTRNFX LNG ILZ SLOT WRE,$178.50,$0.00,$178.50,$0.00,$127.40,$0.00,$0.00,$0.00,$0.00,$0.00,$178.50,$0.00,$89.25,$141.37,$142.80,$0.00,$0.00,$0.00,$0.00,$0.00
71013204,SUP,HCPCS C1713,,71013204  -  BOLT EXFIX ILIZAROV,$148.33,$0.00,$148.33,$66.75,$105.86,$0.00,$25.56,$0.00,$0.00,$25.97,$148.33,$0.00,$74.16,$117.48,$118.66,$0.00,$23.21,$0.00,$23.61,$0.00
71021027,SUP,HCPCS C1713,,71021027  -  PIN HLF 6MM 45MM HXFX TI,$472.60,$0.00,$472.60,$212.67,$337.29,$0.00,$81.43,$0.00,$0.00,$82.75,$472.60,$0.00,$236.30,$374.30,$378.08,$0.00,$73.96,$0.00,$75.24,$0.00
71021029,SUP,HCPCS C1713,,71021029  -  PIN HLF 6MM 55MM HXFX TI,$472.60,$0.00,$472.60,$212.67,$337.29,$0.00,$81.43,$0.00,$0.00,$82.75,$472.60,$0.00,$236.30,$374.30,$378.08,$0.00,$73.96,$0.00,$75.24,$0.00
71021031,SUP,HCPCS C1713,,71021031  -  PIN HLF 6MM 65MM HXFX TI ORTH XTRNFX SYS,$719.10,$0.00,$719.10,$323.60,$513.22,$0.00,$123.90,$0.00,$0.00,$125.91,$719.10,$0.00,$359.55,$569.53,$575.28,$0.00,$112.54,$0.00,$114.48,$0.00
71021033,SUP,HCPCS C1713,,71021033  -  PIN HLF 6MM 75MM HXFX TI ORTH XTRNFX SYS,$719.10,$0.00,$719.10,$323.60,$513.22,$0.00,$123.90,$0.00,$0.00,$125.91,$719.10,$0.00,$359.55,$569.53,$575.28,$0.00,$112.54,$0.00,$114.48,$0.00
71021035,SUP,HCPCS C1713,,71021035  -  PIN HLF 6MM 85MM HXFX TI ORTH XTRNFX SYS,$719.10,$0.00,$719.10,$323.60,$513.22,$0.00,$123.90,$0.00,$0.00,$125.91,$719.10,$0.00,$359.55,$569.53,$575.28,$0.00,$112.54,$0.00,$114.48,$0.00
71021072,SUP,HCPCS C1713,,71021072  -  PIN HLF 6MM 20MM HXFX SS ORTH XTRNFX SYS,$719.10,$0.00,$719.10,$323.60,$513.22,$0.00,$123.90,$0.00,$0.00,$125.91,$719.10,$0.00,$359.55,$569.53,$575.28,$0.00,$112.54,$0.00,$114.48,$0.00
71021073,SUP,HCPCS C1713,,71021073  -  PIN HLF 6MM 25MM HXFX SS,$248.20,$0.00,$248.20,$111.69,$177.14,$0.00,$42.76,$0.00,$0.00,$43.46,$248.20,$0.00,$124.10,$196.57,$198.56,$0.00,$38.84,$0.00,$39.51,$0.00
71021074,SUP,HCPCS C1713,,71021074  -  PIN HLF 6MM 30MM HXFX SS,$496.40,$0.00,$496.40,$223.38,$354.28,$0.00,$85.53,$0.00,$0.00,$86.92,$496.40,$0.00,$248.20,$393.15,$397.12,$0.00,$77.69,$0.00,$79.03,$0.00
71021075,SUP,HCPCS C1713,,71021075  -  PIN HLF 6MM 35MM HXFX SS,$282.20,$0.00,$282.20,$126.99,$201.41,$0.00,$48.62,$0.00,$0.00,$49.41,$282.20,$0.00,$141.10,$223.50,$225.76,$0.00,$44.16,$0.00,$44.93,$0.00
71021077,SUP,HCPCS C1713,,71021077  -  PIN HLF 6MM 45MM HXFX SS ORTH XTRNFX SYS,$719.10,$0.00,$719.10,$323.60,$513.22,$0.00,$123.90,$0.00,$0.00,$125.91,$719.10,$0.00,$359.55,$569.53,$575.28,$0.00,$112.54,$0.00,$114.48,$0.00
71021079,SUP,HCPCS C1713,,71021079  -  PIN HLF 6MM 55MM HXFX SS,$282.20,$0.00,$282.20,$126.99,$201.41,$0.00,$48.62,$0.00,$0.00,$49.41,$282.20,$0.00,$141.10,$223.50,$225.76,$0.00,$44.16,$0.00,$44.93,$0.00
71021081,SUP,HCPCS C1713,,71021081  -  PIN HLF 6MM 65MM HXFX SS ORTH XTRNFX SYS,$409.70,$0.00,$409.70,$184.37,$292.40,$0.00,$70.59,$0.00,$0.00,$71.74,$409.70,$0.00,$204.85,$324.48,$327.76,$0.00,$64.12,$0.00,$65.22,$0.00
71021083,SUP,HCPCS C1713,,71021083  -  PIN HLF 6MM 75MM HXFX SS ORTH XTRNFX SYS,$409.70,$0.00,$409.70,$184.37,$292.40,$0.00,$70.59,$0.00,$0.00,$71.74,$409.70,$0.00,$204.85,$324.48,$327.76,$0.00,$64.12,$0.00,$65.22,$0.00
71021085,SUP,HCPCS C1713,,71021085  -  PIN HLF 6MM 85MM HXFX SS ORTH XTRNFX SYS,$409.70,$0.00,$409.70,$184.37,$292.40,$0.00,$70.59,$0.00,$0.00,$71.74,$409.70,$0.00,$204.85,$324.48,$327.76,$0.00,$64.12,$0.00,$65.22,$0.00
71022001,SUP,HCPCS C1713,,71022001  -  PIN FX 3MM 120MM 16MM COVE PNT ORTH,$533.80,$0.00,$533.80,$240.21,$380.97,$0.00,$91.97,$0.00,$0.00,$93.46,$533.80,$0.00,$266.90,$422.77,$427.04,$0.00,$83.54,$0.00,$84.98,$0.00
71022002,SUP,HCPCS C1713,,71022002  -  PIN FX 3MM 120MM 22MM COVE PNT ORTH,$533.80,$0.00,$533.80,$240.21,$380.97,$0.00,$91.97,$0.00,$0.00,$93.46,$533.80,$0.00,$266.90,$422.77,$427.04,$0.00,$83.54,$0.00,$84.98,$0.00
71022003,SUP,HCPCS C1713,,71022003  -  PIN HLF 3MM 28MM 28MM COVE PNT DIST RADL,$533.80,$0.00,$533.80,$240.21,$380.97,$0.00,$91.97,$0.00,$0.00,$93.46,$533.80,$0.00,$266.90,$422.77,$427.04,$0.00,$83.54,$0.00,$84.98,$0.00
71031033,SUP,HCPCS C1713,,71031033  -  POSITIONER SRG 5MM HXFX CENTERING SLV PIN,$691.90,$0.00,$691.90,$311.36,$493.81,$0.00,$119.21,$0.00,$0.00,$121.15,$691.90,$0.00,$345.95,$547.98,$553.52,$0.00,$108.28,$0.00,$110.15,$0.00
71031034,SUP,HCPCS C1713,,71031034  -  POSITIONER SRG 6MM HXFX CENTERING SLV PIN,$691.90,$0.00,$691.90,$311.36,$493.81,$0.00,$119.21,$0.00,$0.00,$121.15,$691.90,$0.00,$345.95,$547.98,$553.52,$0.00,$108.28,$0.00,$110.15,$0.00
71031040,SUP,Custom 27203010,,71031040  -  GUIDE HXFX TROCAR SURG,"$5,262.50",$0.00,"$5,262.50",$0.00,"$3,755.85",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,262.50",$0.00,"$2,631.25","$4,167.90","$4,210.00",$0.00,$0.00,$0.00,$0.00,$0.00
71033019,SUP,Custom 27203010,,71033019  -  BIT DRL 2MM DIST RDS SYS,$914.60,$0.00,$914.60,$0.00,$652.75,$0.00,$0.00,$0.00,$0.00,$0.00,$914.60,$0.00,$457.30,$724.36,$731.68,$0.00,$0.00,$0.00,$0.00,$0.00
71053002,SUP,Custom 27203010,,71053002  -  BIT DRL 2.8MM,"$1,106.70",$0.00,"$1,106.70",$0.00,$789.85,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,106.70",$0.00,$553.35,$876.51,$885.36,$0.00,$0.00,$0.00,$0.00,$0.00
71053004,SUP,Custom 27203010,,71053004  -  BIT DRL 4.8MM,"$1,106.70",$0.00,"$1,106.70",$0.00,$789.85,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,106.70",$0.00,$553.35,$876.51,$885.36,$0.00,$0.00,$0.00,$0.00,$0.00
71053033,SUP,HCPCS C1713,,71053033  -  WASHER XTRNFX 8MM CNTR BD LCK BOLT,$265.20,$0.00,$265.20,$119.34,$189.27,$0.00,$45.69,$0.00,$0.00,$46.43,$265.20,$0.00,$132.60,$210.04,$212.16,$0.00,$41.50,$0.00,$42.22,$0.00
71053101,SUP,HCPCS C1713,,71053101  -  PIN HLF 3MM 10MM JTX TI ORTH XTRNFX SYS,$218.75,$0.00,$218.75,$98.44,$156.12,$0.00,$37.69,$0.00,$0.00,$38.30,$218.75,$0.00,$109.38,$173.25,$175.00,$0.00,$34.23,$0.00,$34.83,$0.00
71053151,SUP,HCPCS C1713,,71053151  -  PIN HLF 3MM 15MM JTX TI ORTH XTRNFX SYS,$218.75,$0.00,$218.75,$98.44,$156.12,$0.00,$37.69,$0.00,$0.00,$38.30,$218.75,$0.00,$109.38,$173.25,$175.00,$0.00,$34.23,$0.00,$34.83,$0.00
71053201,SUP,HCPCS C1713,,71053201  -  PIN HLF 3MM 20MM JTX TI ORTH XTRNFX SYS,$218.75,$0.00,$218.75,$98.44,$156.12,$0.00,$37.69,$0.00,$0.00,$38.30,$218.75,$0.00,$109.38,$173.25,$175.00,$0.00,$34.23,$0.00,$34.83,$0.00
71053251,SUP,HCPCS C1713,,71053251  -  PIN HLF 3MM 25MM JTX TI ORTH XTRNFX SYS,$218.75,$0.00,$218.75,$98.44,$156.12,$0.00,$37.69,$0.00,$0.00,$38.30,$218.75,$0.00,$109.38,$173.25,$175.00,$0.00,$34.23,$0.00,$34.83,$0.00
71054151,SUP,HCPCS C1713,,71054151  -  PIN HLF 4MM 15MM JTX TI ORTH XTRNFX SYS,$231.88,$0.00,$231.88,$104.34,$165.49,$0.00,$39.95,$0.00,$0.00,$40.60,$231.88,$0.00,$115.94,$183.65,$185.50,$0.00,$36.29,$0.00,$36.91,$0.00
71054201,SUP,HCPCS C1713,,71054201  -  PIN HLF 4MM 20MM JTX TI ORTH XTRNFX SYS,$231.88,$0.00,$231.88,$104.34,$165.49,$0.00,$39.95,$0.00,$0.00,$40.60,$231.88,$0.00,$115.94,$183.65,$185.50,$0.00,$36.29,$0.00,$36.91,$0.00
71054251,SUP,HCPCS C1713,,71054251  -  PIN HLF 4MM 25MM JTX TI ORTH XTRNFX SYS,$231.88,$0.00,$231.88,$104.34,$165.49,$0.00,$39.95,$0.00,$0.00,$40.60,$231.88,$0.00,$115.94,$183.65,$185.50,$0.00,$36.29,$0.00,$36.91,$0.00
71054301,SUP,HCPCS C1713,,71054301  -  PIN HLF 4MM 30MM JTX TI ORTH XTRNFX SYS,$231.88,$0.00,$231.88,$104.34,$165.49,$0.00,$39.95,$0.00,$0.00,$40.60,$231.88,$0.00,$115.94,$183.65,$185.50,$0.00,$36.29,$0.00,$36.91,$0.00
71054351,SUP,HCPCS C1713,,71054351  -  PIN HLF 4MM 35MM JTX TI ORTH XTRNFX SYS,$231.88,$0.00,$231.88,$104.34,$165.49,$0.00,$39.95,$0.00,$0.00,$40.60,$231.88,$0.00,$115.94,$183.65,$185.50,$0.00,$36.29,$0.00,$36.91,$0.00
71055020,SUP,HCPCS C1713,,71055020  -  PIN HLF 5MM 20MM JTX SS ORTH XTRNFX SYS,$121.13,$0.00,$121.13,$54.51,$86.45,$0.00,$20.87,$0.00,$0.00,$21.21,$121.13,$0.00,$60.56,$95.93,$96.90,$0.00,$18.96,$0.00,$19.28,$0.00
71055201,SUP,HCPCS C1713,,71055201  -  PIN HLF SHRT 5MM 20MM JTX TI NTRD,$253.75,$0.00,$253.75,$114.19,$181.10,$0.00,$43.72,$0.00,$0.00,$44.43,$253.75,$0.00,$126.88,$200.97,$203.00,$0.00,$39.71,$0.00,$40.40,$0.00
71055251,SUP,HCPCS C1713,,71055251  -  PIN HLF SHRT 5MM 25MM JTX TI NTRD,$253.75,$0.00,$253.75,$114.19,$181.10,$0.00,$43.72,$0.00,$0.00,$44.43,$253.75,$0.00,$126.88,$200.97,$203.00,$0.00,$39.71,$0.00,$40.40,$0.00
71055301,SUP,HCPCS C1713,,71055301  -  PIN HLF SHRT 5MM 30MM TI,$253.75,$0.00,$253.75,$114.19,$181.10,$0.00,$43.72,$0.00,$0.00,$44.43,$253.75,$0.00,$126.88,$200.97,$203.00,$0.00,$39.71,$0.00,$40.40,$0.00
71055351,SUP,HCPCS C1713,,71055351  -  PIN HLF SHRT 5MM 35MM TI,$253.75,$0.00,$253.75,$114.19,$181.10,$0.00,$43.72,$0.00,$0.00,$44.43,$253.75,$0.00,$126.88,$200.97,$203.00,$0.00,$39.71,$0.00,$40.40,$0.00
71055401,SUP,HCPCS C1713,,71055401  -  PIN HLF SHRT 5MM 40MM TI,$253.75,$0.00,$253.75,$114.19,$181.10,$0.00,$43.72,$0.00,$0.00,$44.43,$253.75,$0.00,$126.88,$200.97,$203.00,$0.00,$39.71,$0.00,$40.40,$0.00
71055451,SUP,HCPCS C1713,,71055451  -  PIN HLF SHRT 5MM 45MM TI,$253.75,$0.00,$253.75,$114.19,$181.10,$0.00,$43.72,$0.00,$0.00,$44.43,$253.75,$0.00,$126.88,$200.97,$203.00,$0.00,$39.71,$0.00,$40.40,$0.00
71055501,SUP,HCPCS C1713,,71055501  -  PIN HLF SHRT 5MM 50MM TI,$253.75,$0.00,$253.75,$114.19,$181.10,$0.00,$43.72,$0.00,$0.00,$44.43,$253.75,$0.00,$126.88,$200.97,$203.00,$0.00,$39.71,$0.00,$40.40,$0.00
71055502,SUP,HCPCS C1713,,71055502  -  PIN HLF LNG 5MM 50MM TI,$234.50,$0.00,$234.50,$105.53,$167.36,$0.00,$40.40,$0.00,$0.00,$41.06,$234.50,$0.00,$117.25,$185.72,$187.60,$0.00,$36.70,$0.00,$37.33,$0.00
71055503,SUP,HCPCS C1713,,71055503  -  PIN HLF 5MM 50MM STRL TI,$718.38,$0.00,$718.38,$323.27,$512.70,$0.00,$123.77,$0.00,$0.00,$125.78,$718.38,$0.00,$359.19,$568.96,$574.70,$0.00,$112.43,$0.00,$114.37,$0.00
71055551,SUP,HCPCS C1713,,71055551  -  PIN HLF SHRT 5MM 55MM TI,$253.75,$0.00,$253.75,$114.19,$181.10,$0.00,$43.72,$0.00,$0.00,$44.43,$253.75,$0.00,$126.88,$200.97,$203.00,$0.00,$39.71,$0.00,$40.40,$0.00
71055552,SUP,HCPCS C1713,,71055552  -  PIN HLF LNG 5MM 55MM TI,$234.50,$0.00,$234.50,$105.53,$167.36,$0.00,$40.40,$0.00,$0.00,$41.06,$234.50,$0.00,$117.25,$185.72,$187.60,$0.00,$36.70,$0.00,$37.33,$0.00
71055601,SUP,HCPCS C1713,,71055601  -  PIN HLF SHRT 5MM 60MM TI,$253.75,$0.00,$253.75,$114.19,$181.10,$0.00,$43.72,$0.00,$0.00,$44.43,$253.75,$0.00,$126.88,$200.97,$203.00,$0.00,$39.71,$0.00,$40.40,$0.00
71055602,SUP,HCPCS C1713,,71055602  -  PIN HLF LNG 5MM 60MM TI,$234.50,$0.00,$234.50,$105.53,$167.36,$0.00,$40.40,$0.00,$0.00,$41.06,$234.50,$0.00,$117.25,$185.72,$187.60,$0.00,$36.70,$0.00,$37.33,$0.00
71055651,SUP,HCPCS C1713,,71055651  -  PIN HLF SHRT 5MM 65MM TI,$253.75,$0.00,$253.75,$114.19,$181.10,$0.00,$43.72,$0.00,$0.00,$44.43,$253.75,$0.00,$126.88,$200.97,$203.00,$0.00,$39.71,$0.00,$40.40,$0.00
71055701,SUP,HCPCS C1713,,71055701  -  PIN HLF SHRT 5MM 70MM TI,$253.75,$0.00,$253.75,$114.19,$181.10,$0.00,$43.72,$0.00,$0.00,$44.43,$253.75,$0.00,$126.88,$200.97,$203.00,$0.00,$39.71,$0.00,$40.40,$0.00
71055702,SUP,HCPCS C1713,,71055702  -  PIN HLF LNG 5MM 70MM TI,$234.50,$0.00,$234.50,$105.53,$167.36,$0.00,$40.40,$0.00,$0.00,$41.06,$234.50,$0.00,$117.25,$185.72,$187.60,$0.00,$36.70,$0.00,$37.33,$0.00
71056208,SUP,HCPCS C1713,,71056208  -  PIN HLF SHRT 6MM 20MM JTX TI NTRD,$259.00,$0.00,$259.00,$116.55,$184.85,$0.00,$44.62,$0.00,$0.00,$45.35,$259.00,$0.00,$129.50,$205.13,$207.20,$0.00,$40.53,$0.00,$41.23,$0.00
71056209,SUP,HCPCS C1713,,71056209  -  PIN HLF LNG 20MM JTX TI ORTH,$248.50,$0.00,$248.50,$111.83,$177.35,$0.00,$42.82,$0.00,$0.00,$43.51,$248.50,$0.00,$124.25,$196.81,$198.80,$0.00,$38.89,$0.00,$39.56,$0.00
71056258,SUP,HCPCS C1713,,71056258  -  PIN HLF SHRT 6MM 25MM JTX TI NTRD,$259.00,$0.00,$259.00,$116.55,$184.85,$0.00,$44.62,$0.00,$0.00,$45.35,$259.00,$0.00,$129.50,$205.13,$207.20,$0.00,$40.53,$0.00,$41.23,$0.00
71056308,SUP,HCPCS C1713,,71056308  -  PIN HLF SHRT 6MM 30MM JTX TI NTRD,$259.00,$0.00,$259.00,$116.55,$184.85,$0.00,$44.62,$0.00,$0.00,$45.35,$259.00,$0.00,$129.50,$205.13,$207.20,$0.00,$40.53,$0.00,$41.23,$0.00
71056309,SUP,HCPCS C1713,,71056309  -  PIN HLF LNG 30MM JTX TI ORTH,$248.50,$0.00,$248.50,$111.83,$177.35,$0.00,$42.82,$0.00,$0.00,$43.51,$248.50,$0.00,$124.25,$196.81,$198.80,$0.00,$38.89,$0.00,$39.56,$0.00
71056358,SUP,HCPCS C1713,,71056358  -  PIN HLF SHRT 6MM 35MM JTX TI NTRD,$259.00,$0.00,$259.00,$116.55,$184.85,$0.00,$44.62,$0.00,$0.00,$45.35,$259.00,$0.00,$129.50,$205.13,$207.20,$0.00,$40.53,$0.00,$41.23,$0.00
71056408,SUP,HCPCS C1713,,71056408  -  PIN HLF SHRT 6MM 40MM JTX TI NTRD,$259.00,$0.00,$259.00,$116.55,$184.85,$0.00,$44.62,$0.00,$0.00,$45.35,$259.00,$0.00,$129.50,$205.13,$207.20,$0.00,$40.53,$0.00,$41.23,$0.00
71056409,SUP,HCPCS C1713,,71056409  -  PIN HLF LNG 40MM JTX TI ORTH,$248.50,$0.00,$248.50,$111.83,$177.35,$0.00,$42.82,$0.00,$0.00,$43.51,$248.50,$0.00,$124.25,$196.81,$198.80,$0.00,$38.89,$0.00,$39.56,$0.00
71056458,SUP,HCPCS C1713,,71056458  -  PIN HLF SHRT 6MM 45MM JTX TI NTRD,$259.00,$0.00,$259.00,$116.55,$184.85,$0.00,$44.62,$0.00,$0.00,$45.35,$259.00,$0.00,$129.50,$205.13,$207.20,$0.00,$40.53,$0.00,$41.23,$0.00
71056459,SUP,HCPCS C1713,,71056459  -  PIN HLF LNG 45MM JTX TI ORTH,$248.50,$0.00,$248.50,$111.83,$177.35,$0.00,$42.82,$0.00,$0.00,$43.51,$248.50,$0.00,$124.25,$196.81,$198.80,$0.00,$38.89,$0.00,$39.56,$0.00
71056508,SUP,HCPCS C1713,,71056508  -  PIN HLF SHRT 6MM 50MM JTX TI NTRD,$259.00,$0.00,$259.00,$116.55,$184.85,$0.00,$44.62,$0.00,$0.00,$45.35,$259.00,$0.00,$129.50,$205.13,$207.20,$0.00,$40.53,$0.00,$41.23,$0.00
71056509,SUP,HCPCS C1713,,71056509  -  PIN HLF LNG 50MM JTX TI ORTH,$260.75,$0.00,$260.75,$117.34,$186.10,$0.00,$44.93,$0.00,$0.00,$45.66,$260.75,$0.00,$130.38,$206.51,$208.60,$0.00,$40.81,$0.00,$41.51,$0.00
71056558,SUP,HCPCS C1713,,71056558  -  PIN HLF SHRT 6MM 55MM JTX TI NTRD,$259.00,$0.00,$259.00,$116.55,$184.85,$0.00,$44.62,$0.00,$0.00,$45.35,$259.00,$0.00,$129.50,$205.13,$207.20,$0.00,$40.53,$0.00,$41.23,$0.00
71056608,SUP,HCPCS C1713,,71056608  -  PIN HLF SHRT 6MM 60MM JTX TI NTRD,$259.00,$0.00,$259.00,$116.55,$184.85,$0.00,$44.62,$0.00,$0.00,$45.35,$259.00,$0.00,$129.50,$205.13,$207.20,$0.00,$40.53,$0.00,$41.23,$0.00
71056609,SUP,HCPCS C1713,,71056609  -  PIN HLF 60MM JTX TI ORTH,$260.75,$0.00,$260.75,$117.34,$186.10,$0.00,$44.93,$0.00,$0.00,$45.66,$260.75,$0.00,$130.38,$206.51,$208.60,$0.00,$40.81,$0.00,$41.51,$0.00
71056658,SUP,HCPCS C1713,,71056658  -  PIN HLF SHRT 6MM 65MM JTX TI NTRD,$259.00,$0.00,$259.00,$116.55,$184.85,$0.00,$44.62,$0.00,$0.00,$45.35,$259.00,$0.00,$129.50,$205.13,$207.20,$0.00,$40.53,$0.00,$41.23,$0.00
71056708,SUP,HCPCS C1713,,71056708  -  PIN HLF SHRT 6MM 70MM JTX TI NTRD,$259.00,$0.00,$259.00,$116.55,$184.85,$0.00,$44.62,$0.00,$0.00,$45.35,$259.00,$0.00,$129.50,$205.13,$207.20,$0.00,$40.53,$0.00,$41.23,$0.00
71056709,SUP,HCPCS C1713,,71056709  -  PIN HLF LNG 60MM JTX TI ORTH,$260.75,$0.00,$260.75,$117.34,$186.10,$0.00,$44.93,$0.00,$0.00,$45.66,$260.75,$0.00,$130.38,$206.51,$208.60,$0.00,$40.81,$0.00,$41.51,$0.00
71061001,SUP,HCPCS C1713,,71061001  -  PIN FX 3.2MM 86MM TROC PNT 1 END ORTH,$494.00,$0.00,$494.00,$222.30,$352.57,$0.00,$85.11,$0.00,$0.00,$86.50,$494.00,$0.00,$247.00,$391.25,$395.20,$0.00,$77.31,$0.00,$78.64,$0.00
71062007,SUP,HCPCS C1713,,71062007  -  CAP PCTV 5MM,$60.30,$0.00,$60.30,$27.14,$43.04,$0.00,$10.39,$0.00,$0.00,$10.56,$60.30,$0.00,$30.15,$47.76,$48.24,$0.00,$9.44,$0.00,$9.60,$0.00
71062008,SUP,HCPCS C1713,,71062008  -  BAR XTRNFX JTX CAP,$69.10,$0.00,$69.10,$31.10,$49.32,$0.00,$11.91,$0.00,$0.00,$12.10,$69.10,$0.00,$34.55,$54.73,$55.28,$0.00,$10.81,$0.00,$11.00,$0.00
71062017,SUP,HCPCS C1713,,71062017  -  CAP END 4MM JTX PIN ORTH XTRNFX SYS,$115.50,$0.00,$115.50,$51.98,$82.43,$0.00,$19.90,$0.00,$0.00,$20.22,$115.50,$0.00,$57.75,$91.48,$92.40,$0.00,$18.08,$0.00,$18.39,$0.00
71062200,SUP,HCPCS C1713,,71062200  -  BAR XTRNFX 200MM NS JTX CFBR DISP,$400.75,$0.00,$400.75,$180.34,$286.02,$0.00,$69.05,$0.00,$0.00,$70.17,$400.75,$0.00,$200.38,$317.39,$320.60,$0.00,$62.72,$0.00,$63.80,$0.00
71062250,SUP,Custom 27203010,,71062250  -  BAR XTRNFX 250MM NS JTX CFBR DISP,$430.50,$0.00,$430.50,$0.00,$307.25,$0.00,$0.00,$0.00,$0.00,$0.00,$430.50,$0.00,$215.25,$340.96,$344.40,$0.00,$0.00,$0.00,$0.00,$0.00
71062300,SUP,HCPCS C1713,,71062300  -  BAR XTRNFX 300MM NS JTX CFBR DISP,$430.50,$0.00,$430.50,$193.73,$307.25,$0.00,$74.17,$0.00,$0.00,$75.38,$430.50,$0.00,$215.25,$340.96,$344.40,$0.00,$67.37,$0.00,$68.54,$0.00
71062350,SUP,HCPCS C1713,,71062350  -  BAR XTRNFX 350MM NS JTX CFBR DISP,$430.50,$0.00,$430.50,$193.73,$307.25,$0.00,$74.17,$0.00,$0.00,$75.38,$430.50,$0.00,$215.25,$340.96,$344.40,$0.00,$67.37,$0.00,$68.54,$0.00
71062400,SUP,HCPCS C1713,,71062400  -  BAR XTRNFX 400MM NS JTX CFBR DISP,$474.25,$0.00,$474.25,$213.41,$338.47,$0.00,$81.71,$0.00,$0.00,$83.04,$474.25,$0.00,$237.13,$375.61,$379.40,$0.00,$74.22,$0.00,$75.50,$0.00
71063006,SUP,Custom 27203010,,71063006  -  BIT DRL 3.5MM STRL JTX AO CNCT,$470.75,$0.00,$470.75,$0.00,$335.97,$0.00,$0.00,$0.00,$0.00,$0.00,$470.75,$0.00,$235.38,$372.83,$376.60,$0.00,$0.00,$0.00,$0.00,$0.00
71063011,SUP,HCPCS C1769,,71063011  -  GUIDEWIRE ESCP 1.6MM,"$1,876.88",$0.00,"$1,876.88","$1,019.14","$1,339.53",$0.00,$323.38,$0.00,$0.00,$328.63,"$1,876.88",$0.00,$938.44,"$1,486.49","$1,501.50",$0.00,$293.73,$0.00,$298.80,$0.00
71063028,SUP,Custom 27203010,,71063028  -  BIT DRL 3.5MM STRL JTX GRAD STP SHRT HLF PIN,$413.88,$0.00,$413.88,$0.00,$295.38,$0.00,$0.00,$0.00,$0.00,$0.00,$413.88,$0.00,$206.94,$327.79,$331.10,$0.00,$0.00,$0.00,$0.00,$0.00
71063152,SUP,HCPCS C1713,,71063152  -  PIN XTRNFX SHRT 3MM 15MM JTX TI NTRD DIST RDS XTRNFX SYS,$317.63,$0.00,$317.63,$142.93,$226.69,$0.00,$54.73,$0.00,$0.00,$55.61,$317.63,$0.00,$158.81,$251.56,$254.10,$0.00,$49.71,$0.00,$50.57,$0.00
71063202,SUP,HCPCS C1713,,71063202  -  PIN XTRNFX SHRT 3MM 20MM JTX TI NTRD DIST RDS XTRNFX SYS,$317.63,$0.00,$317.63,$142.93,$226.69,$0.00,$54.73,$0.00,$0.00,$55.61,$317.63,$0.00,$158.81,$251.56,$254.10,$0.00,$49.71,$0.00,$50.57,$0.00
71063203,SUP,Custom 27203010,,71063203  -  BIT DRL SHRT 3MM STRL GRAD HLF PIN,$388.50,$0.00,$388.50,$0.00,$277.27,$0.00,$0.00,$0.00,$0.00,$0.00,$388.50,$0.00,$194.25,$307.69,$310.80,$0.00,$0.00,$0.00,$0.00,$0.00
71064151,SUP,HCPCS C1713,,71064151  -  PIN HLF 4MM 95MM 15MM JTX SS DIST RDS FT XTRNFX SYS,$219.63,$0.00,$219.63,$98.83,$156.75,$0.00,$37.84,$0.00,$0.00,$38.45,$219.63,$0.00,$109.81,$173.95,$175.70,$0.00,$34.37,$0.00,$34.96,$0.00
71064158,SUP,HCPCS C1713,,71064158  -  PIN HLF SHRT 4MM 15MM JTX TI NTRD XTRNFX SYS,$219.63,$0.00,$219.63,$98.83,$156.75,$0.00,$37.84,$0.00,$0.00,$38.45,$219.63,$0.00,$109.81,$173.95,$175.70,$0.00,$34.37,$0.00,$34.96,$0.00
71064201,SUP,HCPCS C1713,,71064201  -  PIN HLF 4MM 20MM JTX SS ORTH XTRNFX SYS,$219.63,$0.00,$219.63,$98.83,$156.75,$0.00,$37.84,$0.00,$0.00,$38.45,$219.63,$0.00,$109.81,$173.95,$175.70,$0.00,$34.37,$0.00,$34.96,$0.00
71064208,SUP,HCPCS C1713,,71064208  -  PIN HLF SHRT 4MM 20MM JTX TI NTRD XTRNFX SYS,$219.63,$0.00,$219.63,$98.83,$156.75,$0.00,$37.84,$0.00,$0.00,$38.45,$219.63,$0.00,$109.81,$173.95,$175.70,$0.00,$34.37,$0.00,$34.96,$0.00
71064251,SUP,HCPCS C1713,,71064251  -  PIN HLF 4MM 25MM JTX SS ORTH XTRNFX SYS,$219.63,$0.00,$219.63,$98.83,$156.75,$0.00,$37.84,$0.00,$0.00,$38.45,$219.63,$0.00,$109.81,$173.95,$175.70,$0.00,$34.37,$0.00,$34.96,$0.00
71064258,SUP,HCPCS C1713,,71064258  -  PIN HLF SHRT 4MM 25MM JTX TI NTRD XTRNFX SYS,$219.63,$0.00,$219.63,$98.83,$156.75,$0.00,$37.84,$0.00,$0.00,$38.45,$219.63,$0.00,$109.81,$173.95,$175.70,$0.00,$34.37,$0.00,$34.96,$0.00
71064301,SUP,HCPCS C1713,,71064301  -  PIN HLF SHRT 4MM 30MM JTX SS ORTH XTRNFX SYS,$219.63,$0.00,$219.63,$98.83,$156.75,$0.00,$37.84,$0.00,$0.00,$38.45,$219.63,$0.00,$109.81,$173.95,$175.70,$0.00,$34.37,$0.00,$34.96,$0.00
71064308,SUP,HCPCS C1713,,71064308  -  PIN HALF SHORT 4MM 30MM JET-X TITANIUM NITRIDE ORTHOPEDIC,$219.63,$0.00,$219.63,$98.83,$156.75,$0.00,$37.84,$0.00,$0.00,$38.45,$219.63,$0.00,$109.81,$173.95,$175.70,$0.00,$34.37,$0.00,$34.96,$0.00
71064351,SUP,HCPCS C1713,,71064351  -  PIN HLF 4MM 35MM JTX SS ORTH XTRNFX SYS,$219.63,$0.00,$219.63,$98.83,$156.75,$0.00,$37.84,$0.00,$0.00,$38.45,$219.63,$0.00,$109.81,$173.95,$175.70,$0.00,$34.37,$0.00,$34.96,$0.00
71064358,SUP,HCPCS C1713,,71064358  -  PIN HLF SHRT 4MM 35MM JTX TI NTRD ORTH XTRNFX SYS,$219.63,$0.00,$219.63,$98.83,$156.75,$0.00,$37.84,$0.00,$0.00,$38.45,$219.63,$0.00,$109.81,$173.95,$175.70,$0.00,$34.37,$0.00,$34.96,$0.00
71065301,SUP,HCPCS C1713,,71065301  -  PIN HLF 5MM 17.5CM 30MM JTX SS XTRNFX SYS,$278.25,$0.00,$278.25,$125.21,$198.59,$0.00,$47.94,$0.00,$0.00,$48.72,$278.25,$0.00,$139.13,$220.37,$222.60,$0.00,$43.55,$0.00,$44.30,$0.00
71065302,SUP,HCPCS C1713,,71065302  -  PIN HLF LNG 5MM 255MM 30MM JTX SS XTRNFX SYS,$278.25,$0.00,$278.25,$125.21,$198.59,$0.00,$47.94,$0.00,$0.00,$48.72,$278.25,$0.00,$139.13,$220.37,$222.60,$0.00,$43.55,$0.00,$44.30,$0.00
71065304,SUP,HCPCS C1713,,71065304  -  PIN HLF XSH 5MM 30MM JTX TI NTRD ORTH XTRNFX SYS,$278.25,$0.00,$278.25,$125.21,$198.59,$0.00,$47.94,$0.00,$0.00,$48.72,$278.25,$0.00,$139.13,$220.37,$222.60,$0.00,$43.55,$0.00,$44.30,$0.00
71065309,SUP,HCPCS C1713,,71065309  -  PIN HLF LNG 5MM 30MM JTX TI NTRD ORTH XTRNFX SYS,$308.00,$0.00,$308.00,$138.60,$219.82,$0.00,$53.07,$0.00,$0.00,$53.93,$308.00,$0.00,$154.00,$243.94,$246.40,$0.00,$48.20,$0.00,$49.03,$0.00
71065351,SUP,HCPCS C1713,,71065351  -  PIN HLF 5MM 17.5CM 35MM JTX SS XTRNFX SYS,$278.25,$0.00,$278.25,$125.21,$198.59,$0.00,$47.94,$0.00,$0.00,$48.72,$278.25,$0.00,$139.13,$220.37,$222.60,$0.00,$43.55,$0.00,$44.30,$0.00
71065352,SUP,HCPCS C1713,,71065352  -  PIN HLF LNG 5MM 255MM 35MM JTX SS XTRNFX SYS,$278.25,$0.00,$278.25,$125.21,$198.59,$0.00,$47.94,$0.00,$0.00,$48.72,$278.25,$0.00,$139.13,$220.37,$222.60,$0.00,$43.55,$0.00,$44.30,$0.00
71065354,SUP,HCPCS C1713,,71065354  -  PIN HLF XSH 5MM 35MM JTX TI NTRD ORTH XTRNFX SYS,$278.25,$0.00,$278.25,$125.21,$198.59,$0.00,$47.94,$0.00,$0.00,$48.72,$278.25,$0.00,$139.13,$220.37,$222.60,$0.00,$43.55,$0.00,$44.30,$0.00
71065358,SUP,HCPCS C1713,,71065358  -  PIN HLF SHRT 5MM 35MM JTX TI NTRD XTRNFX SYS,$308.00,$0.00,$308.00,$138.60,$219.82,$0.00,$53.07,$0.00,$0.00,$53.93,$308.00,$0.00,$154.00,$243.94,$246.40,$0.00,$48.20,$0.00,$49.03,$0.00
71065359,SUP,HCPCS C1713,,71065359  -  PIN HLF LNG 5MM 35MM JTX TI NTRD XTRNFX SYS,$308.00,$0.00,$308.00,$138.60,$219.82,$0.00,$53.07,$0.00,$0.00,$53.93,$308.00,$0.00,$154.00,$243.94,$246.40,$0.00,$48.20,$0.00,$49.03,$0.00
71065400,SUP,HCPCS C1713,,71065400  -  PIN HLF 5MM 40MM JTX CNN TI NTRD ORTH XTRNFX SYS,$392.00,$0.00,$392.00,$176.40,$279.77,$0.00,$67.54,$0.00,$0.00,$68.64,$392.00,$0.00,$196.00,$310.46,$313.60,$0.00,$61.35,$0.00,$62.41,$0.00
71065401,SUP,HCPCS C1713,,71065401  -  PIN HLF 5MM 17.5CM 40MM JTX SS XTRNFX SYS,$278.25,$0.00,$278.25,$125.21,$198.59,$0.00,$47.94,$0.00,$0.00,$48.72,$278.25,$0.00,$139.13,$220.37,$222.60,$0.00,$43.55,$0.00,$44.30,$0.00
71065402,SUP,HCPCS C1713,,71065402  -  PIN HLF LNG 5MM 225MM 40MM JTX SS ORTH XTRNFX SYS,$278.25,$0.00,$278.25,$125.21,$198.59,$0.00,$47.94,$0.00,$0.00,$48.72,$278.25,$0.00,$139.13,$220.37,$222.60,$0.00,$43.55,$0.00,$44.30,$0.00
71065404,SUP,HCPCS C1713,,71065404  -  PIN HLF XSH 5MM 40MM JTX TI NTRD ORTH XTRNFX SYS,$278.25,$0.00,$278.25,$125.21,$198.59,$0.00,$47.94,$0.00,$0.00,$48.72,$278.25,$0.00,$139.13,$220.37,$222.60,$0.00,$43.55,$0.00,$44.30,$0.00
71065407,SUP,HCPCS C1713,,71065407  -  PIN HLF XSH 1.6MM 40MM 40MM JTX CNN TI NTRD ORTH XTRNFX SYS,$392.00,$0.00,$392.00,$176.40,$279.77,$0.00,$67.54,$0.00,$0.00,$68.64,$392.00,$0.00,$196.00,$310.46,$313.60,$0.00,$61.35,$0.00,$62.41,$0.00
71065408,SUP,HCPCS C1713,,71065408  -  PIN HLF SHRT 5MM 40MM JTX TI NTRD XTRNFX SYS,$308.00,$0.00,$308.00,$138.60,$219.82,$0.00,$53.07,$0.00,$0.00,$53.93,$308.00,$0.00,$154.00,$243.94,$246.40,$0.00,$48.20,$0.00,$49.03,$0.00
71065409,SUP,HCPCS C1713,,71065409  -  PIN HLF LNG 5MM 40MM JTX TI NTRD XTRNFX SYS,$308.00,$0.00,$308.00,$138.60,$219.82,$0.00,$53.07,$0.00,$0.00,$53.93,$308.00,$0.00,$154.00,$243.94,$246.40,$0.00,$48.20,$0.00,$49.03,$0.00
71065451,SUP,HCPCS C1713,,71065451  -  PIN HLF 5MM 17.5CM 45MM JTX SS XTRNFX SYS,$278.25,$0.00,$278.25,$125.21,$198.59,$0.00,$47.94,$0.00,$0.00,$48.72,$278.25,$0.00,$139.13,$220.37,$222.60,$0.00,$43.55,$0.00,$44.30,$0.00
71065452,SUP,HCPCS C1713,,71065452  -  PIN HLF LNG 5MM 255MM 45MM JTX SS ORTH XTRNFX SYS,$278.25,$0.00,$278.25,$125.21,$198.59,$0.00,$47.94,$0.00,$0.00,$48.72,$278.25,$0.00,$139.13,$220.37,$222.60,$0.00,$43.55,$0.00,$44.30,$0.00
71065454,SUP,HCPCS C1713,,71065454  -  PIN HLF XSH 5MM 45MM JTX TI NTRD ORTH XTRNFX SYS,$278.25,$0.00,$278.25,$125.21,$198.59,$0.00,$47.94,$0.00,$0.00,$48.72,$278.25,$0.00,$139.13,$220.37,$222.60,$0.00,$43.55,$0.00,$44.30,$0.00
71065458,SUP,HCPCS C1713,,71065458  -  PIN HLF SHRT 5MM 45MM JTX TI NTRD ORTH XTRNFX SYS,$308.00,$0.00,$308.00,$138.60,$219.82,$0.00,$53.07,$0.00,$0.00,$53.93,$308.00,$0.00,$154.00,$243.94,$246.40,$0.00,$48.20,$0.00,$49.03,$0.00
71065459,SUP,HCPCS C1713,,71065459  -  PIN HLF LNG 5MM 45MM JTX TI NTRD ORTH XTRNFX SYS,$308.00,$0.00,$308.00,$138.60,$219.82,$0.00,$53.07,$0.00,$0.00,$53.93,$308.00,$0.00,$154.00,$243.94,$246.40,$0.00,$48.20,$0.00,$49.03,$0.00
71065501,SUP,HCPCS C1713,,71065501  -  PIN HLF SHRT 5MM 175MM 50MM JTX SS ORTH XTRNFX SYS,$278.25,$0.00,$278.25,$125.21,$198.59,$0.00,$47.94,$0.00,$0.00,$48.72,$278.25,$0.00,$139.13,$220.37,$222.60,$0.00,$43.55,$0.00,$44.30,$0.00
71065502,SUP,HCPCS C1713,,71065502  -  PIN HLF LNG 5MM 255MM 50MM JTX SS ORTH XTRNFX SYS,$278.25,$0.00,$278.25,$125.21,$198.59,$0.00,$47.94,$0.00,$0.00,$48.72,$278.25,$0.00,$139.13,$220.37,$222.60,$0.00,$43.55,$0.00,$44.30,$0.00
71065508,SUP,HCPCS C1713,,71065508  -  PIN HLF SHRT 5MM 50MM JTX TI NTRD ORTH XTRNFX SYS,$233.63,$0.00,$233.63,$105.13,$166.74,$0.00,$40.25,$0.00,$0.00,$40.91,$233.63,$0.00,$116.81,$185.03,$186.90,$0.00,$36.56,$0.00,$37.19,$0.00
71065509,SUP,HCPCS C1713,,71065509  -  PIN HLF LNG 5MM 50MM JTX TI NTRD ORTH XTRNFX SYS,$233.63,$0.00,$233.63,$105.13,$166.74,$0.00,$40.25,$0.00,$0.00,$40.91,$233.63,$0.00,$116.81,$185.03,$186.90,$0.00,$36.56,$0.00,$37.19,$0.00
71065551,SUP,HCPCS C1713,,71065551  -  PIN HLF SHRT 5MM 175MM 55MM JTX SS ORTH XTRNFX SYS,$278.25,$0.00,$278.25,$125.21,$198.59,$0.00,$47.94,$0.00,$0.00,$48.72,$278.25,$0.00,$139.13,$220.37,$222.60,$0.00,$43.55,$0.00,$44.30,$0.00
71065552,SUP,HCPCS C1713,,71065552  -  PIN HLF LNG 5MM 255MM 55MM JTX SS ORTH XTRNFX SYS,$278.25,$0.00,$278.25,$125.21,$198.59,$0.00,$47.94,$0.00,$0.00,$48.72,$278.25,$0.00,$139.13,$220.37,$222.60,$0.00,$43.55,$0.00,$44.30,$0.00
71065558,SUP,HCPCS C1713,,71065558  -  PIN HLF SHRT 5MM 55MM JTX TI NTRD ORTH XTRNFX SYS,$233.63,$0.00,$233.63,$105.13,$166.74,$0.00,$40.25,$0.00,$0.00,$40.91,$233.63,$0.00,$116.81,$185.03,$186.90,$0.00,$36.56,$0.00,$37.19,$0.00
71065559,SUP,HCPCS C1713,,71065559  -  PIN HLF LNG 5MM 55MM JTX TI NTRD ORTH XTRNFX SYS,$233.63,$0.00,$233.63,$105.13,$166.74,$0.00,$40.25,$0.00,$0.00,$40.91,$233.63,$0.00,$116.81,$185.03,$186.90,$0.00,$36.56,$0.00,$37.19,$0.00
71065601,SUP,HCPCS C1713,,71065601  -  PIN HLF SHRT 5MM 60MM JTX SS ORTH XTRNFX SYS,$278.25,$0.00,$278.25,$125.21,$198.59,$0.00,$47.94,$0.00,$0.00,$48.72,$278.25,$0.00,$139.13,$220.37,$222.60,$0.00,$43.55,$0.00,$44.30,$0.00
71065602,SUP,HCPCS C1713,,71065602  -  PIN HLF LNG 5MM 60MM JTX SS ORTH XTRNFX SYS,$278.25,$0.00,$278.25,$125.21,$198.59,$0.00,$47.94,$0.00,$0.00,$48.72,$278.25,$0.00,$139.13,$220.37,$222.60,$0.00,$43.55,$0.00,$44.30,$0.00
71065608,SUP,HCPCS C1713,,71065608  -  PIN HLF SHRT 5MM 60MM JTX TI NTRD ORTH XTRNFX SYS,$233.63,$0.00,$233.63,$105.13,$166.74,$0.00,$40.25,$0.00,$0.00,$40.91,$233.63,$0.00,$116.81,$185.03,$186.90,$0.00,$36.56,$0.00,$37.19,$0.00
71065609,SUP,HCPCS C1713,,71065609  -  PIN HLF LNG 5MM 60MM JTX TI NTRD ORTH XTRNFX SYS,$233.63,$0.00,$233.63,$105.13,$166.74,$0.00,$40.25,$0.00,$0.00,$40.91,$233.63,$0.00,$116.81,$185.03,$186.90,$0.00,$36.56,$0.00,$37.19,$0.00
71065651,SUP,HCPCS C1713,,71065651  -  PIN HLF SHRT 5MM 65MM JTX SS ORTH XTRNFX SYS,$278.25,$0.00,$278.25,$125.21,$198.59,$0.00,$47.94,$0.00,$0.00,$48.72,$278.25,$0.00,$139.13,$220.37,$222.60,$0.00,$43.55,$0.00,$44.30,$0.00
71065652,SUP,HCPCS C1713,,71065652  -  PIN HLF LNG 5MM 65MM JTX SS ORTH XTRNFX SYS,$278.25,$0.00,$278.25,$125.21,$198.59,$0.00,$47.94,$0.00,$0.00,$48.72,$278.25,$0.00,$139.13,$220.37,$222.60,$0.00,$43.55,$0.00,$44.30,$0.00
71065658,SUP,HCPCS C1713,,71065658  -  PIN HLF SHRT 5MM 65MM JTX TI NTRD ORTH XTRNFX SYS,$233.63,$0.00,$233.63,$105.13,$166.74,$0.00,$40.25,$0.00,$0.00,$40.91,$233.63,$0.00,$116.81,$185.03,$186.90,$0.00,$36.56,$0.00,$37.19,$0.00
71065659,SUP,HCPCS C1713,,71065659  -  PIN HLF LNG 5MM 65MM JTX TI NTRD ORTH XTRNFX SYS,$230.13,$0.00,$230.13,$103.56,$164.24,$0.00,$39.65,$0.00,$0.00,$40.29,$230.13,$0.00,$115.06,$182.26,$184.10,$0.00,$36.01,$0.00,$36.64,$0.00
71065701,SUP,HCPCS C1713,,71065701  -  PIN HLF SHRT 5MM 70MM JTX SS ORTH XTRNFX SYS,$278.25,$0.00,$278.25,$125.21,$198.59,$0.00,$47.94,$0.00,$0.00,$48.72,$278.25,$0.00,$139.13,$220.37,$222.60,$0.00,$43.55,$0.00,$44.30,$0.00
71065702,SUP,HCPCS C1713,,71065702  -  PIN HLF LNG 5MM 70MM JTX SS ORTH XTRNFX SYS,$278.25,$0.00,$278.25,$125.21,$198.59,$0.00,$47.94,$0.00,$0.00,$48.72,$278.25,$0.00,$139.13,$220.37,$222.60,$0.00,$43.55,$0.00,$44.30,$0.00
71065708,SUP,HCPCS C1713,,71065708  -  PIN HLF SHRT 5MM 70MM JTX TI NTRD ORTH XTRNFX SYS,$233.63,$0.00,$233.63,$105.13,$166.74,$0.00,$40.25,$0.00,$0.00,$40.91,$233.63,$0.00,$116.81,$185.03,$186.90,$0.00,$36.56,$0.00,$37.19,$0.00
71065709,SUP,HCPCS C1713,,71065709  -  PIN HLF LNG 5MM 70MM JTX TI NTRD ORTH XTRNFX SYS,$233.63,$0.00,$233.63,$105.13,$166.74,$0.00,$40.25,$0.00,$0.00,$40.91,$233.63,$0.00,$116.81,$185.03,$186.90,$0.00,$36.56,$0.00,$37.19,$0.00
71066409,SUP,HCPCS C1713,,71066409  -  PIN FX LNG 6MM 40MM NS 160MM JTX SLF DRL ST TI NTRD,$308.00,$0.00,$308.00,$138.60,$219.82,$0.00,$53.07,$0.00,$0.00,$53.93,$308.00,$0.00,$154.00,$243.94,$246.40,$0.00,$48.20,$0.00,$49.03,$0.00
71066459,SUP,HCPCS C1713,,71066459  -  PIN HLF LNG 6MM 45MM JTX TI NTRD,$233.63,$0.00,$233.63,$105.13,$166.74,$0.00,$40.25,$0.00,$0.00,$40.91,$233.63,$0.00,$116.81,$185.03,$186.90,$0.00,$36.56,$0.00,$37.19,$0.00
71066509,SUP,HCPCS C1713,,71066509  -  PIN HALF 50MM 6MM JTX LNG TI NTRD,$308.00,$0.00,$308.00,$138.60,$219.82,$0.00,$53.07,$0.00,$0.00,$53.93,$308.00,$0.00,$154.00,$243.94,$246.40,$0.00,$48.20,$0.00,$49.03,$0.00
71066559,SUP,HCPCS C1713,,71066559  -  PIN HLF LNG 6MM 55MM JTX TI NTRD,$233.63,$0.00,$233.63,$105.13,$166.74,$0.00,$40.25,$0.00,$0.00,$40.91,$233.63,$0.00,$116.81,$185.03,$186.90,$0.00,$36.56,$0.00,$37.19,$0.00
71067315,SUP,Custom 27203010,,71067315  -  BIT DRL 2MM 3MM HLF PIN,$569.63,$0.00,$569.63,$0.00,$406.54,$0.00,$0.00,$0.00,$0.00,$0.00,$569.63,$0.00,$284.81,$451.15,$455.70,$0.00,$0.00,$0.00,$0.00,$0.00
71067319,SUP,Custom 27203010,,71067319  -  BIT DRILL LNG 5MM HALF PIN,$569.63,$0.00,$569.63,$0.00,$406.54,$0.00,$0.00,$0.00,$0.00,$0.00,$569.63,$0.00,$284.81,$451.15,$455.70,$0.00,$0.00,$0.00,$0.00,$0.00
71067321,SUP,Custom 27203010,,71067321  -  BIT DRILL 6 MM HALF PIN,$569.63,$0.00,$569.63,$0.00,$406.54,$0.00,$0.00,$0.00,$0.00,$0.00,$569.63,$0.00,$284.81,$451.15,$455.70,$0.00,$0.00,$0.00,$0.00,$0.00
71067374,SUP,HCPCS C1713,,71067374  -  CLAMP EXFIX 10.5MM 10.5MM QUICK CONNECT BAR TO BAR JET-X,"$1,015.00",$0.00,"$1,015.00",$456.75,$724.41,$0.00,$174.88,$0.00,$0.00,$177.72,"$1,015.00",$0.00,$507.50,$803.88,$812.00,$0.00,$158.85,$0.00,$161.59,$0.00
71070113,SUP,HCPCS C1713,,71070113  -  RING EXFIX CIR FULL 130MM TAYLOR SPATIAL FRAME,"$3,230.00",$0.00,"$3,230.00","$1,453.50","$2,305.25",$0.00,$556.51,$0.00,$0.00,$565.55,"$3,230.00",$0.00,"$1,615.00","$2,558.16","$2,584.00",$0.00,$505.50,$0.00,$514.22,$0.00
71070116,SUP,HCPCS C1713,,71070116  -  RING EXFIX FULL 205MM ALUMINUM TAYLOR SPATIAL FRAME,"$3,230.00",$0.00,"$3,230.00","$1,453.50","$2,305.25",$0.00,$556.51,$0.00,$0.00,$565.55,"$3,230.00",$0.00,"$1,615.00","$2,558.16","$2,584.00",$0.00,$505.50,$0.00,$514.22,$0.00
71070117,SUP,Custom 27203010,,71070117  -  RING EXFIX 230MM FULL RING CIRCULAR TAYLOR SPATIAL FRAME,"$3,230.00",$0.00,"$3,230.00",$0.00,"$2,305.25",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,230.00",$0.00,"$1,615.00","$2,558.16","$2,584.00",$0.00,$0.00,$0.00,$0.00,$0.00
71070124,SUP,Custom 27011340,,71070124  -  RING EXFIX 155MM CIR HALF TLT SP,"$3,459.50",$0.00,"$3,459.50",$0.00,"$2,469.05",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,459.50",$0.00,"$1,729.75","$2,739.92","$2,767.60",$0.00,$0.00,$0.00,$0.00,$0.00
71070144,SUP,Custom 27011340,,71070144  -  RING EXFIX 155MM LNG CIR FT TLT SP,"$4,080.00",$0.00,"$4,080.00",$0.00,"$2,911.90",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,080.00",$0.00,"$2,040.00","$3,231.36","$3,264.00",$0.00,$0.00,$0.00,$0.00,$0.00
71070272,SUP,HCPCS C1776,,71070272  -  SLEEVE CENTERING 6MM,$406.30,$0.00,$406.30,$182.84,$289.98,$0.00,$70.00,$0.00,$0.00,$71.14,$406.30,$0.00,$203.15,$321.79,$325.04,$0.00,$63.59,$0.00,$64.68,$0.00
71070273,SUP,Custom 27011340,,71070273  -  CUBE XTRNFX ILZ 1 HL POST RNCH SYS,$527.00,$0.00,$527.00,$0.00,$376.12,$0.00,$0.00,$0.00,$0.00,$0.00,$527.00,$0.00,$263.50,$417.38,$421.60,$0.00,$0.00,$0.00,$0.00,$0.00
71070282,SUP,Custom 27011340,,71070282  -  CONNECTOR EXFIX 30MM SHRT XTD,$406.30,$0.00,$406.30,$0.00,$289.98,$0.00,$0.00,$0.00,$0.00,$0.00,$406.30,$0.00,$203.15,$321.79,$325.04,$0.00,$0.00,$0.00,$0.00,$0.00
71070283,SUP,Custom 27011340,,71070283  -  CONNECTOR ROD 50MM LNG XTD,$406.30,$0.00,$406.30,$0.00,$289.98,$0.00,$0.00,$0.00,$0.00,$0.00,$406.30,$0.00,$203.15,$321.79,$325.04,$0.00,$0.00,$0.00,$0.00,$0.00
71070284,SUP,HCPCS C1713,,71070284  -  BOLT XTRNFX ILZ CMBN WRE,$191.20,$0.00,$191.20,$86.04,$136.46,$0.00,$32.94,$0.00,$0.00,$33.48,$191.20,$0.00,$95.60,$151.43,$152.96,$0.00,$29.92,$0.00,$30.44,$0.00
71070285,SUP,HCPCS C1713,,71070285  -  NUT ORTH LNG RSN,$32.80,$0.00,$32.80,$14.76,$23.41,$0.00,$5.65,$0.00,$0.00,$5.74,$32.80,$0.00,$16.40,$25.98,$26.24,$0.00,$5.13,$0.00,$5.22,$0.00
71070286,SUP,HCPCS C1713,,71070286  -  NUT ORTH 10MM,$109.00,$0.00,$109.00,$49.05,$77.79,$0.00,$18.78,$0.00,$0.00,$19.09,$109.00,$0.00,$54.50,$86.33,$87.20,$0.00,$17.06,$0.00,$17.35,$0.00
71070290,SUP,HCPCS C1713,,71070290  -  CAP PIN 6MM HALF HALF ORANGE,$80.33,$0.00,$80.33,$36.15,$57.33,$0.00,$13.84,$0.00,$0.00,$14.06,$80.33,$0.00,$40.16,$63.62,$64.26,$0.00,$12.57,$0.00,$12.79,$0.00
71070340,SUP,HCPCS C1713,,71070340  -  KIT XTRNFX FST FX ID BAND STD STRUT,"$1,057.40",$0.00,"$1,057.40",$475.83,$754.67,$0.00,$182.18,$0.00,$0.00,$185.14,"$1,057.40",$0.00,$528.70,$837.46,$845.92,$0.00,$165.48,$0.00,$168.34,$0.00
71070345,SUP,Custom 27203010,,71070345  -  DRILL SURG SHORT 3.8MM STEP,"$1,072.70",$0.00,"$1,072.70",$0.00,$765.59,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,072.70",$0.00,$536.35,$849.58,$858.16,$0.00,$0.00,$0.00,$0.00,$0.00
71070348,SUP,Custom 27203010,,71070348  -  DRILL SURG LONG 3.8MM STEP,"$1,072.70",$0.00,"$1,072.70",$0.00,$765.59,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,072.70",$0.00,$536.35,$849.58,$858.16,$0.00,$0.00,$0.00,$0.00,$0.00
71070365,SUP,Custom 27011340,,71070365  -  RING EXFIX 180MM 155MM RCKR,"$2,592.50",$0.00,"$2,592.50",$0.00,"$1,850.27",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,592.50",$0.00,"$1,296.25","$2,053.26","$2,074.00",$0.00,$0.00,$0.00,$0.00,$0.00
71070515,SUP,HCPCS C1713,,71070515  -  BOLT CNCT 12MM TLT SP,$25.00,$0.00,$25.00,$11.25,$17.84,$0.00,$4.31,$0.00,$0.00,$4.38,$25.00,$0.00,$12.50,$19.80,$20.00,$0.00,$3.91,$0.00,$3.98,$0.00
71070720,SUP,HCPCS C1713,,71070720  -  STRUT EXFIX MEDIUM CIR 143-205MM FAST-FIX TAYLOR SPATIAL,"$3,332.00",$0.00,"$3,332.00","$1,499.40","$2,378.05",$0.00,$574.09,$0.00,$0.00,$583.41,"$3,332.00",$0.00,"$1,666.00","$2,638.94","$2,665.60",$0.00,$521.46,$0.00,$530.45,$0.00
71070730,SUP,HCPCS C1713,,71070730  -  STRUT XTRNFX LNG 195-311MM FST FX TLT SP,"$3,332.00",$0.00,"$3,332.00","$1,499.40","$2,378.05",$0.00,$574.09,$0.00,$0.00,$583.41,"$3,332.00",$0.00,"$1,666.00","$2,638.94","$2,665.60",$0.00,$521.46,$0.00,$530.45,$0.00
71070800,SUP,HCPCS C1713,,71070800  -  PIN HLF 6MM 150MM 20MM HA XTRNFX SYS,$586.50,$0.00,$586.50,$263.93,$418.59,$0.00,$101.05,$0.00,$0.00,$102.69,$586.50,$0.00,$293.25,$464.51,$469.20,$0.00,$91.79,$0.00,$93.37,$0.00
71070801,SUP,HCPCS C1713,,71070801  -  PIN HLF 6MM 200MM 20MM HA XTRNFX SYS,$586.50,$0.00,$586.50,$263.93,$418.59,$0.00,$101.05,$0.00,$0.00,$102.69,$586.50,$0.00,$293.25,$464.51,$469.20,$0.00,$91.79,$0.00,$93.37,$0.00
71070802,SUP,HCPCS C1713,,71070802  -  PIN HALF 6MM 150MM 25MM HA EXFIX SYSTEM,$586.50,$0.00,$586.50,$263.93,$418.59,$0.00,$101.05,$0.00,$0.00,$102.69,$586.50,$0.00,$293.25,$464.51,$469.20,$0.00,$91.79,$0.00,$93.37,$0.00
71070803,SUP,HCPCS C1713,,71070803  -  PIN HALF 6MM 200MM 25MM HA ORTHOPEDIC EXFIX SYSTEM,$586.50,$0.00,$586.50,$263.93,$418.59,$0.00,$101.05,$0.00,$0.00,$102.69,$586.50,$0.00,$293.25,$464.51,$469.20,$0.00,$91.79,$0.00,$93.37,$0.00
71070804,SUP,HCPCS C1713,,71070804  -  PIN HALF 6MM 150MM 30MM HA EXFIX SYSTEM,$586.50,$0.00,$586.50,$263.93,$418.59,$0.00,$101.05,$0.00,$0.00,$102.69,$586.50,$0.00,$293.25,$464.51,$469.20,$0.00,$91.79,$0.00,$93.37,$0.00
71070805,SUP,HCPCS C1713,,71070805  -  PIN HLF 6MM 200MM 30MM HA ORTH XTRNFX SYS,$586.50,$0.00,$586.50,$263.93,$418.59,$0.00,$101.05,$0.00,$0.00,$102.69,$586.50,$0.00,$293.25,$464.51,$469.20,$0.00,$91.79,$0.00,$93.37,$0.00
71070806,SUP,HCPCS C1713,,71070806  -  PIN HALF 6MM 150MM 35MM HA EXFIX SYSTEM,$586.50,$0.00,$586.50,$263.93,$418.59,$0.00,$101.05,$0.00,$0.00,$102.69,$586.50,$0.00,$293.25,$464.51,$469.20,$0.00,$91.79,$0.00,$93.37,$0.00
71070808,SUP,HCPCS C1713,,71070808  -  PIN HALF 6MM 150MM 40MM HA EXFIX SYSTEM,$586.50,$0.00,$586.50,$263.93,$418.59,$0.00,$101.05,$0.00,$0.00,$102.69,$586.50,$0.00,$293.25,$464.51,$469.20,$0.00,$91.79,$0.00,$93.37,$0.00
71070809,SUP,HCPCS C1713,,71070809  -  PIN HALF 200MM 6MM HA 40MM EXFIX SYS,$586.50,$0.00,$586.50,$263.93,$418.59,$0.00,$101.05,$0.00,$0.00,$102.69,$586.50,$0.00,$293.25,$464.51,$469.20,$0.00,$91.79,$0.00,$93.37,$0.00
71070812,SUP,HCPCS C1713,,71070812  -  PIN HLF 6MM 150MM 55MM HA XTRNFX SYS,$586.50,$0.00,$586.50,$263.93,$418.59,$0.00,$101.05,$0.00,$0.00,$102.69,$586.50,$0.00,$293.25,$464.51,$469.20,$0.00,$91.79,$0.00,$93.37,$0.00
71070814,SUP,HCPCS C1713,,71070814  -  PIN HLF 6MM 150MM 60MM HA XTRNFX SYS,$586.50,$0.00,$586.50,$263.93,$418.59,$0.00,$101.05,$0.00,$0.00,$102.69,$586.50,$0.00,$293.25,$464.51,$469.20,$0.00,$91.79,$0.00,$93.37,$0.00
71070815,SUP,HCPCS C1713,,71070815  -  PIN HLF 6MM 200MM 60MM HAP XTRNFX SYS,$586.50,$0.00,$586.50,$263.93,$418.59,$0.00,$101.05,$0.00,$0.00,$102.69,$586.50,$0.00,$293.25,$464.51,$469.20,$0.00,$91.79,$0.00,$93.37,$0.00
71070816,SUP,HCPCS C1713,,71070816  -  PIN HLF 6MM 150MM 65MM HA XTRNFX SYS,$586.50,$0.00,$586.50,$263.93,$418.59,$0.00,$101.05,$0.00,$0.00,$102.69,$586.50,$0.00,$293.25,$464.51,$469.20,$0.00,$91.79,$0.00,$93.37,$0.00
71070817,SUP,HCPCS C1713,,71070817  -  PIN HLF 6MM 200MM 65MM HAP XTRNFX SYS,$586.50,$0.00,$586.50,$263.93,$418.59,$0.00,$101.05,$0.00,$0.00,$102.69,$586.50,$0.00,$293.25,$464.51,$469.20,$0.00,$91.79,$0.00,$93.37,$0.00
71070818,SUP,HCPCS C1713,,71070818  -  PIN HLF 6MM 150MM 70MM HA XTRNFX SYS,$586.50,$0.00,$586.50,$263.93,$418.59,$0.00,$101.05,$0.00,$0.00,$102.69,$586.50,$0.00,$293.25,$464.51,$469.20,$0.00,$91.79,$0.00,$93.37,$0.00
71070819,SUP,HCPCS C1713,,71070819  -  PIN HLF 6MM 200MM 70MM HAP ORTH XTRNFX SYS,$586.50,$0.00,$586.50,$263.93,$418.59,$0.00,$101.05,$0.00,$0.00,$102.69,$586.50,$0.00,$293.25,$464.51,$469.20,$0.00,$91.79,$0.00,$93.37,$0.00
71070820,SUP,HCPCS C1713,,71070820  -  PIN HLF 6MM 200MM 80MM HA XTRNFX SYS,$586.50,$0.00,$586.50,$263.93,$418.59,$0.00,$101.05,$0.00,$0.00,$102.69,$586.50,$0.00,$293.25,$464.51,$469.20,$0.00,$91.79,$0.00,$93.37,$0.00
71070821,SUP,HCPCS C1713,,71070821  -  PIN HLF 6MM 200MM 90MM HAP ORTH XTRNFX SYS,$586.50,$0.00,$586.50,$263.93,$418.59,$0.00,$101.05,$0.00,$0.00,$102.69,$586.50,$0.00,$293.25,$464.51,$469.20,$0.00,$91.79,$0.00,$93.37,$0.00
71070822,SUP,HCPCS C1713,,71070822  -  PIN HLF 6MM 150MM 20MM HAP ORTH XTRNFX SYS,$586.50,$0.00,$586.50,$263.93,$418.59,$0.00,$101.05,$0.00,$0.00,$102.69,$586.50,$0.00,$293.25,$464.51,$469.20,$0.00,$91.79,$0.00,$93.37,$0.00
71070823,SUP,HCPCS C1713,,71070823  -  PIN HLF 4.5MM 150MM 10MM HA XTRNFX SYS,$586.50,$0.00,$586.50,$263.93,$418.59,$0.00,$101.05,$0.00,$0.00,$102.69,$586.50,$0.00,$293.25,$464.51,$469.20,$0.00,$91.79,$0.00,$93.37,$0.00
71070824,SUP,HCPCS C1713,,71070824  -  PIN HLF 4.5MM 150MM 20MM HA XTRNFX SYS,$586.50,$0.00,$586.50,$263.93,$418.59,$0.00,$101.05,$0.00,$0.00,$102.69,$586.50,$0.00,$293.25,$464.51,$469.20,$0.00,$91.79,$0.00,$93.37,$0.00
71070825,SUP,HCPCS C1713,,71070825  -  PIN HALF 4.5MM 150MM 30MM THREAD HA ORTHOPEDIC EXFIX SYSTEM,$586.50,$0.00,$586.50,$263.93,$418.59,$0.00,$101.05,$0.00,$0.00,$102.69,$586.50,$0.00,$293.25,$464.51,$469.20,$0.00,$91.79,$0.00,$93.37,$0.00
71070826,SUP,HCPCS C1713,,71070826  -  PIN HALF 4.5MM 150MM 40MM THREAD HA ORTHOPEDIC EXFIX SYSTEM,$586.50,$0.00,$586.50,$263.93,$418.59,$0.00,$101.05,$0.00,$0.00,$102.69,$586.50,$0.00,$293.25,$464.51,$469.20,$0.00,$91.79,$0.00,$93.37,$0.00
71070827,SUP,HCPCS C1713,,71070827  -  PIN HLF 4.5MM 150MM 50MM THRD HA ORTH XTRNFX SYS,$586.50,$0.00,$586.50,$263.93,$418.59,$0.00,$101.05,$0.00,$0.00,$102.69,$586.50,$0.00,$293.25,$464.51,$469.20,$0.00,$91.79,$0.00,$93.37,$0.00
71070828,SUP,HCPCS C1713,,71070828  -  PIN HLF 6MM 150MM 15MM HA ORTH XTRNFX SYS,$586.50,$0.00,$586.50,$263.93,$418.59,$0.00,$101.05,$0.00,$0.00,$102.69,$586.50,$0.00,$293.25,$464.51,$469.20,$0.00,$91.79,$0.00,$93.37,$0.00
71070829,SUP,HCPCS C1713,,71070829  -  PIN HLF 6MM 200MM 15MM HAP ORTH XTRNFX SYS,$586.50,$0.00,$586.50,$263.93,$418.59,$0.00,$101.05,$0.00,$0.00,$102.69,$586.50,$0.00,$293.25,$464.51,$469.20,$0.00,$91.79,$0.00,$93.37,$0.00
71070835,SUP,HCPCS C1713,,71070835  -  PIN HLF 6MM 150MM 45MM HA XTRNFX SYS,$586.50,$0.00,$586.50,$263.93,$418.59,$0.00,$101.05,$0.00,$0.00,$102.69,$586.50,$0.00,$293.25,$464.51,$469.20,$0.00,$91.79,$0.00,$93.37,$0.00
71070836,SUP,HCPCS C1713,,71070836  -  PIN HLF 6MM 200MM 45MM HAP XTRNFX SYS,$586.50,$0.00,$586.50,$263.93,$418.59,$0.00,$101.05,$0.00,$0.00,$102.69,$586.50,$0.00,$293.25,$464.51,$469.20,$0.00,$91.79,$0.00,$93.37,$0.00
71070844,SUP,Custom 27203010,,71070844  -  BIT DRL LNG 4.8MM HA PIN,"$1,237.60",$0.00,"$1,237.60",$0.00,$883.28,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,237.60",$0.00,$618.80,$980.18,$990.08,$0.00,$0.00,$0.00,$0.00,$0.00
71070845,SUP,Custom 27203010,,71070845  -  BIT DRL 1.8MM 4.8MM CNN HA PIN,"$1,603.10",$0.00,"$1,603.10",$0.00,"$1,144.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,603.10",$0.00,$801.55,"$1,269.66","$1,282.48",$0.00,$0.00,$0.00,$0.00,$0.00
71070846,SUP,Custom 27203010,,71070846  -  BIT DRL 1.5MM 3.8MM CNN HA PIN,"$1,603.10",$0.00,"$1,603.10",$0.00,"$1,144.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,603.10",$0.00,$801.55,"$1,269.66","$1,282.48",$0.00,$0.00,$0.00,$0.00,$0.00
71100045,SUP,HCPCS C1713,,71100045  -  SCREW BN 6.5MM 45MM STRL 32MM CNN ORTH,$531.30,$0.00,$531.30,$239.09,$379.19,$0.00,$91.54,$0.00,$0.00,$93.03,$531.30,$0.00,$265.65,$420.79,$425.04,$0.00,$83.15,$0.00,$84.58,$0.00
71100050,SUP,HCPCS C1713,,71100050  -  SCREW BN 6.5MM 8MM 3.5MM 50MM STRL 32MM CNN SS HIP ACPT 2.4,$531.30,$0.00,$531.30,$239.09,$379.19,$0.00,$91.54,$0.00,$0.00,$93.03,$531.30,$0.00,$265.65,$420.79,$425.04,$0.00,$83.15,$0.00,$84.58,$0.00
71100055,SUP,HCPCS C1713,,71100055  -  SCREW BN 6.5MM 8MM 3.5MM 55MM STRL 32MM CNN SS HIP ACPT 2.4,$531.30,$0.00,$531.30,$239.09,$379.19,$0.00,$91.54,$0.00,$0.00,$93.03,$531.30,$0.00,$265.65,$420.79,$425.04,$0.00,$83.15,$0.00,$84.58,$0.00
71100060,SUP,HCPCS C1713,,71100060  -  SCREW BN 6.5MM 8MM 3.5MM 60MM STRL 32MM CNN SS HIP ACPT 2.4,$531.30,$0.00,$531.30,$239.09,$379.19,$0.00,$91.54,$0.00,$0.00,$93.03,$531.30,$0.00,$265.65,$420.79,$425.04,$0.00,$83.15,$0.00,$84.58,$0.00
71100065,SUP,HCPCS C1713,,71100065  -  SCREW BN 6.5MM 8MM 3.5MM 65MM STRL 32MM CNN SS HIP ACPT 2.4,$531.30,$0.00,$531.30,$239.09,$379.19,$0.00,$91.54,$0.00,$0.00,$93.03,$531.30,$0.00,$265.65,$420.79,$425.04,$0.00,$83.15,$0.00,$84.58,$0.00
71100070,SUP,HCPCS C1713,,71100070  -  SCREW BN 6.5MM 8MM 3.5MM 70MM STRL 32MM CNN SS HIP ACPT 2.4,$531.30,$0.00,$531.30,$239.09,$379.19,$0.00,$91.54,$0.00,$0.00,$93.03,$531.30,$0.00,$265.65,$420.79,$425.04,$0.00,$83.15,$0.00,$84.58,$0.00
71100075,SUP,HCPCS C1713,,71100075  -  SCREW BN 6.5MM 8MM 3.5MM 75MM STRL 32MM CNN SS HIP ACPT 2.4,$531.30,$0.00,$531.30,$239.09,$379.19,$0.00,$91.54,$0.00,$0.00,$93.03,$531.30,$0.00,$265.65,$420.79,$425.04,$0.00,$83.15,$0.00,$84.58,$0.00
71100080,SUP,HCPCS C1713,,71100080  -  SCREW BN 6.5MM 8MM 3.5MM 80MM STRL 32MM CNN SS HIP ACPT 2.4,$531.30,$0.00,$531.30,$239.09,$379.19,$0.00,$91.54,$0.00,$0.00,$93.03,$531.30,$0.00,$265.65,$420.79,$425.04,$0.00,$83.15,$0.00,$84.58,$0.00
71100085,SUP,HCPCS C1713,,71100085  -  SCREW BN 6.5MM 8MM 3.5MM 85MM STRL 32MM CNN SS HIP ACPT 2.4,$531.30,$0.00,$531.30,$239.09,$379.19,$0.00,$91.54,$0.00,$0.00,$93.03,$531.30,$0.00,$265.65,$420.79,$425.04,$0.00,$83.15,$0.00,$84.58,$0.00
71100090,SUP,HCPCS C1713,,71100090  -  SCREW BN 6.5MM 8MM 3.5MM 90MM STRL 32MM CNN SS HIP ACPT 2.4,$531.30,$0.00,$531.30,$239.09,$379.19,$0.00,$91.54,$0.00,$0.00,$93.03,$531.30,$0.00,$265.65,$420.79,$425.04,$0.00,$83.15,$0.00,$84.58,$0.00
71100095,SUP,HCPCS C1713,,71100095  -  SCREW BN 6.5MM 8MM 3.5MM 95MM STRL 32MM CNN SS HIP ACPT 2.4,$531.30,$0.00,$531.30,$239.09,$379.19,$0.00,$91.54,$0.00,$0.00,$93.03,$531.30,$0.00,$265.65,$420.79,$425.04,$0.00,$83.15,$0.00,$84.58,$0.00
71100100,SUP,HCPCS C1713,,71100100  -  SCREW BN 6.5MM 8MM 3.5MM 100MM STRL 32MM CNN SS HIP ACPT 2.4,$531.30,$0.00,$531.30,$239.09,$379.19,$0.00,$91.54,$0.00,$0.00,$93.03,$531.30,$0.00,$265.65,$420.79,$425.04,$0.00,$83.15,$0.00,$84.58,$0.00
71100105,SUP,HCPCS C1713,,71100105  -  SCREW BN 6.5MM 105MM STRL 32MM CNN ORTH,$531.30,$0.00,$531.30,$239.09,$379.19,$0.00,$91.54,$0.00,$0.00,$93.03,$531.30,$0.00,$265.65,$420.79,$425.04,$0.00,$83.15,$0.00,$84.58,$0.00
71100110,SUP,HCPCS C1713,,71100110  -  SCREW BN 6.5MM 8MM 3.5MM 110MM STRL 32MM CNN SS HIP ACPT 2.4,$531.30,$0.00,$531.30,$239.09,$379.19,$0.00,$91.54,$0.00,$0.00,$93.03,$531.30,$0.00,$265.65,$420.79,$425.04,$0.00,$83.15,$0.00,$84.58,$0.00
71100115,SUP,HCPCS C1713,,71100115  -  SCREW BN 6.5MM 115MM STRL 32MM CNN ORTH,$531.30,$0.00,$531.30,$239.09,$379.19,$0.00,$91.54,$0.00,$0.00,$93.03,$531.30,$0.00,$265.65,$420.79,$425.04,$0.00,$83.15,$0.00,$84.58,$0.00
71100120,SUP,HCPCS C1713,,71100120  -  SCREW BN 6.5MM 8MM 3.5MM 120MM STRL 32MM CNN SS HIP ACPT 2.4,$531.30,$0.00,$531.30,$239.09,$379.19,$0.00,$91.54,$0.00,$0.00,$93.03,$531.30,$0.00,$265.65,$420.79,$425.04,$0.00,$83.15,$0.00,$84.58,$0.00
71100125,SUP,HCPCS C1713,,71100125  -  SCREW BN 6.5MM 125MM STRL 32MM CNN ORTH,$531.30,$0.00,$531.30,$239.09,$379.19,$0.00,$91.54,$0.00,$0.00,$93.03,$531.30,$0.00,$265.65,$420.79,$425.04,$0.00,$83.15,$0.00,$84.58,$0.00
71100130,SUP,HCPCS C1713,,71100130  -  SCREW BN 6.5MM 8MM 3.5MM 130MM STRL 32MM CNN SS HIP ACPT 2.4,$531.30,$0.00,$531.30,$239.09,$379.19,$0.00,$91.54,$0.00,$0.00,$93.03,$531.30,$0.00,$265.65,$420.79,$425.04,$0.00,$83.15,$0.00,$84.58,$0.00
71101000,SUP,HCPCS C1713,,71101000  -  WASHER ORTH 8MM 4MM STRL TI,$187.70,$0.00,$187.70,$84.47,$133.96,$0.00,$32.34,$0.00,$0.00,$32.86,$187.70,$0.00,$93.85,$148.66,$150.16,$0.00,$29.38,$0.00,$29.88,$0.00
71101020,SUP,HCPCS C1713,,71101020  -  SCREW BN 4MM 20MM STRL 8MM CNN TI ORTH,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
71101022,SUP,HCPCS C1713,,71101022  -  SCREW BN 4MM 22MM STRL 10MM CNN TI ORTH,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
71101024,SUP,HCPCS C1713,,71101024  -  SCREW BN 4MM 24MM STRL 12MM CNN TI ORTH,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
71101026,SUP,HCPCS C1713,,71101026  -  SCREW BN 4MM 26MM STRL 14MM CNN TI ORTH,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
71101028,SUP,HCPCS C1713,,71101028  -  SCREW BN 4MM 28MM STRL 14MM CNN TI ORTH,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
71101030,SUP,HCPCS C1713,,71101030  -  SCREW BN 4MM 30MM STRL 14MM CNN TI ORTH,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
71101032,SUP,HCPCS C1713,,71101032  -  SCREW BN 4MM 32MM STRL 14MM CNN TI ORTH,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
71101034,SUP,HCPCS C1713,,71101034  -  SCREW BN 4MM 34MM STRL 14MM CNN TI ORTH,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
71101036,SUP,HCPCS C1713,,71101036  -  SCREW BN 4MM 36MM STRL 14MM CNN TI ORTH,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
71101038,SUP,HCPCS C1713,,71101038  -  SCREW BN 4MM 38MM STRL 14MM CNN TI ORTH,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
71101040,SUP,HCPCS C1713,,71101040  -  SCREW BN 4MM 40MM STRL 14MM CNN TI ORTH,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
71101042,SUP,HCPCS C1713,,71101042  -  SCREW BN 4MM 42MM STRL 14MM CNN TI ORTH,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
71101044,SUP,HCPCS C1713,,71101044  -  SCREW BN 4MM 44MM STRL 15MM CNN TI ORTH,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
71101046,SUP,HCPCS C1713,,71101046  -  SCREW BN 4MM 46MM STRL 15MM CNN TI ORTH,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
71101048,SUP,HCPCS C1713,,71101048  -  SCREW BN 4MM 48MM STRL 15MM CNN TI ORTH,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
71101050,SUP,HCPCS C1713,,71101050  -  SCREW BN 4MM 50MM STRL 15MM CNN TI ORTH,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
71101052,SUP,HCPCS C1713,,71101052  -  SCREW BN 4MM 52MM STRL 15MM CNN TI ORTH,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
71101054,SUP,HCPCS C1713,,71101054  -  SCREW BN 4MM 54MM STRL 15MM CNN TI ORTH,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
71101056,SUP,HCPCS C1713,,71101056  -  SCREW BN 4MM 56MM STRL 15MM CNN TI ORTH,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
71101058,SUP,HCPCS C1713,,71101058  -  SCREW BN 4MM 58MM STRL 15MM CNN TI ORTH,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
71101060,SUP,HCPCS C1713,,71101060  -  SCREW BN 4MM 60MM STRL 15MM CNN TI ORTH,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
71101065,SUP,HCPCS C1713,,71101065  -  SCREW BN 4MM 65MM STRL 15MM CNN TI ORTH,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
71101070,SUP,HCPCS C1713,,71101070  -  SCREW BN 4MM 70MM STRL 15MM CNN TI ORTH,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
71101401,SUP,HCPCS C1713,,71101401  -  CAP PCTV 1.1 MM WRE,$30.70,$0.00,$30.70,$13.82,$21.91,$0.00,$5.29,$0.00,$0.00,$5.38,$30.70,$0.00,$15.35,$24.31,$24.56,$0.00,$4.80,$0.00,$4.89,$0.00
71101402,SUP,HCPCS C1713,,71101402  -  CAP PCTV 1.25 MM WRE,$30.70,$0.00,$30.70,$13.82,$21.91,$0.00,$5.29,$0.00,$0.00,$5.38,$30.70,$0.00,$15.35,$24.31,$24.56,$0.00,$4.80,$0.00,$4.89,$0.00
71101403,SUP,HCPCS C1713,,71101403  -  CAP PCTV 1.6 MM WRE,$30.70,$0.00,$30.70,$13.82,$21.91,$0.00,$5.29,$0.00,$0.00,$5.38,$30.70,$0.00,$15.35,$24.31,$24.56,$0.00,$4.80,$0.00,$4.89,$0.00
71101404,SUP,HCPCS C1713,,71101404  -  CAP PCTV 2 MM WRE,$30.70,$0.00,$30.70,$13.82,$21.91,$0.00,$5.29,$0.00,$0.00,$5.38,$30.70,$0.00,$15.35,$24.31,$24.56,$0.00,$4.80,$0.00,$4.89,$0.00
71101501,SUP,Custom 27203010,,71101501  -  WIRE FX 2MM 150MM DRL TIP,$145.50,$0.00,$145.50,$0.00,$103.84,$0.00,$0.00,$0.00,$0.00,$0.00,$145.50,$0.00,$72.75,$115.24,$116.40,$0.00,$0.00,$0.00,$0.00,$0.00
71101502,SUP,Custom 27203010,,71101502  -  WIRE FX FLUT 1.6MM 150MM VLP DRL TIP COCR,$105.63,$0.00,$105.63,$0.00,$75.38,$0.00,$0.00,$0.00,$0.00,$0.00,$105.63,$0.00,$52.81,$83.66,$84.50,$0.00,$0.00,$0.00,$0.00,$0.00
71101691,SUP,HCPCS C1713,,71101691  -  WASHER ORTH 21.7MM 12.7MM OBLNG SS,$109.20,$0.00,$109.20,$49.14,$77.94,$0.00,$18.81,$0.00,$0.00,$19.12,$109.20,$0.00,$54.60,$86.49,$87.36,$0.00,$17.09,$0.00,$17.38,$0.00
71101693,SUP,HCPCS C1713,,71101693  -  WASHER ORTH 21.7MM BTRFLY SS,$103.33,$0.00,$103.33,$46.50,$73.74,$0.00,$17.80,$0.00,$0.00,$18.09,$103.33,$0.00,$51.66,$81.84,$82.66,$0.00,$16.17,$0.00,$16.45,$0.00
71102000,SUP,HCPCS C1713,,71102000  -  WASHER ORTH 12.7MM 6.5MM 1MM TI,$242.40,$0.00,$242.40,$109.08,$173.00,$0.00,$41.76,$0.00,$0.00,$42.44,$242.40,$0.00,$121.20,$191.98,$193.92,$0.00,$37.94,$0.00,$38.59,$0.00
71102030,SUP,HCPCS C1713,,71102030  -  PIN FX 30MM 16MM CNN TI HIP,$741.30,$0.00,$741.30,$333.59,$529.07,$0.00,$127.72,$0.00,$0.00,$129.80,$741.30,$0.00,$370.65,$587.11,$593.04,$0.00,$116.01,$0.00,$118.01,$0.00
71102035,SUP,HCPCS C1713,,71102035  -  PIN FX 35MM 16MM CNN TI HIP,$741.30,$0.00,$741.30,$333.59,$529.07,$0.00,$127.72,$0.00,$0.00,$129.80,$741.30,$0.00,$370.65,$587.11,$593.04,$0.00,$116.01,$0.00,$118.01,$0.00
71102040,SUP,HCPCS C1713,,71102040  -  PIN FX 40MM 16MM CNN TI HIP,$741.30,$0.00,$741.30,$333.59,$529.07,$0.00,$127.72,$0.00,$0.00,$129.80,$741.30,$0.00,$370.65,$587.11,$593.04,$0.00,$116.01,$0.00,$118.01,$0.00
71102045,SUP,HCPCS C1713,,71102045  -  PIN FX 45MM 16MM CNN TI HIP,$741.30,$0.00,$741.30,$333.59,$529.07,$0.00,$127.72,$0.00,$0.00,$129.80,$741.30,$0.00,$370.65,$587.11,$593.04,$0.00,$116.01,$0.00,$118.01,$0.00
71102050,SUP,HCPCS C1713,,71102050  -  PIN FX 50MM 16MM CNN TI HIP,$741.30,$0.00,$741.30,$333.59,$529.07,$0.00,$127.72,$0.00,$0.00,$129.80,$741.30,$0.00,$370.65,$587.11,$593.04,$0.00,$116.01,$0.00,$118.01,$0.00
71102055,SUP,HCPCS C1713,,71102055  -  PIN FX 55MM 16MM CNN TI HIP,$741.30,$0.00,$741.30,$333.59,$529.07,$0.00,$127.72,$0.00,$0.00,$129.80,$741.30,$0.00,$370.65,$587.11,$593.04,$0.00,$116.01,$0.00,$118.01,$0.00
71102060,SUP,HCPCS C1713,,71102060  -  PIN FX 60MM 16MM CNN TI HIP,$741.30,$0.00,$741.30,$333.59,$529.07,$0.00,$127.72,$0.00,$0.00,$129.80,$741.30,$0.00,$370.65,$587.11,$593.04,$0.00,$116.01,$0.00,$118.01,$0.00
71102065,SUP,HCPCS C1713,,71102065  -  PIN FX 65MM 16MM CNN TI HIP,$741.30,$0.00,$741.30,$333.59,$529.07,$0.00,$127.72,$0.00,$0.00,$129.80,$741.30,$0.00,$370.65,$587.11,$593.04,$0.00,$116.01,$0.00,$118.01,$0.00
71102070,SUP,HCPCS C1713,,71102070  -  PIN FX 70MM 16MM CNN TI HIP,$741.30,$0.00,$741.30,$333.59,$529.07,$0.00,$127.72,$0.00,$0.00,$129.80,$741.30,$0.00,$370.65,$587.11,$593.04,$0.00,$116.01,$0.00,$118.01,$0.00
71102075,SUP,HCPCS C1713,,71102075  -  PIN FX 75MM 16MM CNN TI HIP,$741.30,$0.00,$741.30,$333.59,$529.07,$0.00,$127.72,$0.00,$0.00,$129.80,$741.30,$0.00,$370.65,$587.11,$593.04,$0.00,$116.01,$0.00,$118.01,$0.00
71102080,SUP,HCPCS C1713,,71102080  -  PIN FX 80MM 16MM CNN TI HIP,$741.30,$0.00,$741.30,$333.59,$529.07,$0.00,$127.72,$0.00,$0.00,$129.80,$741.30,$0.00,$370.65,$587.11,$593.04,$0.00,$116.01,$0.00,$118.01,$0.00
71102085,SUP,HCPCS C1713,,71102085  -  PIN FX 85MM 16MM CNN TI HIP,$741.30,$0.00,$741.30,$333.59,$529.07,$0.00,$127.72,$0.00,$0.00,$129.80,$741.30,$0.00,$370.65,$587.11,$593.04,$0.00,$116.01,$0.00,$118.01,$0.00
71102090,SUP,HCPCS C1713,,71102090  -  PIN FX 90MM 16MM CNN TI HIP,$741.30,$0.00,$741.30,$333.59,$529.07,$0.00,$127.72,$0.00,$0.00,$129.80,$741.30,$0.00,$370.65,$587.11,$593.04,$0.00,$116.01,$0.00,$118.01,$0.00
71102095,SUP,HCPCS C1713,,71102095  -  PIN FX 95MM 16MM CNN TI HIP,$741.30,$0.00,$741.30,$333.59,$529.07,$0.00,$127.72,$0.00,$0.00,$129.80,$741.30,$0.00,$370.65,$587.11,$593.04,$0.00,$116.01,$0.00,$118.01,$0.00
71102100,SUP,HCPCS C1713,,71102100  -  PIN FX 100MM 16MM CNN TI HIP,$741.30,$0.00,$741.30,$333.59,$529.07,$0.00,$127.72,$0.00,$0.00,$129.80,$741.30,$0.00,$370.65,$587.11,$593.04,$0.00,$116.01,$0.00,$118.01,$0.00
71102105,SUP,HCPCS C1713,,71102105  -  PIN FX 105MM 16MM CNN TI HIP,$741.30,$0.00,$741.30,$333.59,$529.07,$0.00,$127.72,$0.00,$0.00,$129.80,$741.30,$0.00,$370.65,$587.11,$593.04,$0.00,$116.01,$0.00,$118.01,$0.00
71102110,SUP,HCPCS C1713,,71102110  -  PIN FX 110MM 16MM CNN TI HIP,$741.30,$0.00,$741.30,$333.59,$529.07,$0.00,$127.72,$0.00,$0.00,$129.80,$741.30,$0.00,$370.65,$587.11,$593.04,$0.00,$116.01,$0.00,$118.01,$0.00
71102115,SUP,HCPCS C1713,,71102115  -  PIN FX 115MM 16MM CNN TI HIP,$741.30,$0.00,$741.30,$333.59,$529.07,$0.00,$127.72,$0.00,$0.00,$129.80,$741.30,$0.00,$370.65,$587.11,$593.04,$0.00,$116.01,$0.00,$118.01,$0.00
71102120,SUP,HCPCS C1713,,71102120  -  PIN FX 120MM 16MM CNN TI HIP,$741.30,$0.00,$741.30,$333.59,$529.07,$0.00,$127.72,$0.00,$0.00,$129.80,$741.30,$0.00,$370.65,$587.11,$593.04,$0.00,$116.01,$0.00,$118.01,$0.00
71102125,SUP,HCPCS C1713,,71102125  -  PIN FX 125MM 16MM CNN TI HIP,$741.30,$0.00,$741.30,$333.59,$529.07,$0.00,$127.72,$0.00,$0.00,$129.80,$741.30,$0.00,$370.65,$587.11,$593.04,$0.00,$116.01,$0.00,$118.01,$0.00
71102130,SUP,HCPCS C1713,,71102130  -  PIN FX 130MM 16MM CNN TI HIP,$741.30,$0.00,$741.30,$333.59,$529.07,$0.00,$127.72,$0.00,$0.00,$129.80,$741.30,$0.00,$370.65,$587.11,$593.04,$0.00,$116.01,$0.00,$118.01,$0.00
71102135,SUP,HCPCS C1713,,71102135  -  PIN FX 135MM 16MM CNN TI HIP,$741.30,$0.00,$741.30,$333.59,$529.07,$0.00,$127.72,$0.00,$0.00,$129.80,$741.30,$0.00,$370.65,$587.11,$593.04,$0.00,$116.01,$0.00,$118.01,$0.00
71103045,SUP,HCPCS C1713,,71103045  -  PIN FX 45MM 32MM CNN TI HIP,$741.30,$0.00,$741.30,$333.59,$529.07,$0.00,$127.72,$0.00,$0.00,$129.80,$741.30,$0.00,$370.65,$587.11,$593.04,$0.00,$116.01,$0.00,$118.01,$0.00
71107030,SUP,HCPCS C1713,,71107030  -  SCREW BN 7MM 30MM STRL 16MM CNN TI ORTH,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71107035,SUP,HCPCS C1713,,71107035  -  SCREW BN 7MM 35MM STRL 16MM CNN TI ORTH,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71107040,SUP,HCPCS C1713,,71107040  -  SCREW BN 7MM 40MM STRL 16MM CNN TI ORTH,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71107045,SUP,HCPCS C1713,,71107045  -  SCREW BN 7MM 45MM 16MM CNN P/T TI ORTH,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71107050,SUP,HCPCS C1713,,71107050  -  SCREW BN 7MM 50MM 16MM CNN P/T TI ORTH,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71107055,SUP,HCPCS C1713,,71107055  -  SCREW BN 7MM 55MM STRL 16MM CNN TI ORTH,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71107060,SUP,HCPCS C1713,,71107060  -  SCREW BN 7MM 60MM STRL 16MM CNN TI ORTH,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71107065,SUP,HCPCS C1713,,71107065  -  SCREW BN P/T 7MM 65MM STRL 16MM CNN TI,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71107070,SUP,HCPCS C1713,,71107070  -  SCREW BN P/T 7MM 70MM STRL 16MM CNN TI,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71107075,SUP,HCPCS C1713,,71107075  -  SCREW BN P/T 7MM 75MM STRL 16MM CNN TI,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71107080,SUP,HCPCS C1713,,71107080  -  SCREW BN P/T 7MM 80MM STRL 16MM CNN TI,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71107085,SUP,HCPCS C1713,,71107085  -  SCREW BN P/T 7MM 85MM STRL 16MM CNN TI SM BN LNG BN,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71107090,SUP,HCPCS C1713,,71107090  -  SCREW BN P/T 7MM 90MM STRL 16MM CNN TI,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71107095,SUP,HCPCS C1713,,71107095  -  SCREW BN P/T 7MM 95MM STRL 16MM CNN TI,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71107100,SUP,HCPCS C1713,,71107100  -  SCREW BN P/T 7MM 100MM STRL 16MM CNN TI,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71107105,SUP,HCPCS C1713,,71107105  -  SCREW BN P/T 7MM 105MM STRL 16MM CNN TI SM BN LNG BN,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71107110,SUP,HCPCS C1713,,71107110  -  SCREW BN 7MM 110MM STRL 16MM CNN TI ORTH,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71107115,SUP,HCPCS C1713,,71107115  -  SCREW BN 7MM 115MM STRL 16MM CNN TI ORTH,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71107120,SUP,HCPCS C1713,,71107120  -  SCREW BN 7MM 120MM STRL 16MM CNN TI ORTH,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71107125,SUP,HCPCS C1713,,71107125  -  SCREW BN 7MM 125MM STRL 16MM CNN TI ORTH,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71107130,SUP,HCPCS C1713,,71107130  -  SCREW BN 7MM 130MM STRL 16MM CNN TI ORTH,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71107135,SUP,HCPCS C1713,,71107135  -  SCREW BN 7MM 135MM STRL 16MM CNN TI ORTH,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71107140,SUP,HCPCS C1713,,71107140  -  SCREW BN 7MM 140MM STRL 16MM CNN TI ORTH,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71107145,SUP,HCPCS C1713,,71107145  -  SCREW BN 7MM 145MM STRL 16MM CNN TI ORTH,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71107150,SUP,HCPCS C1713,,71107150  -  SCREW BN 7MM 150MM STRL 16MM CNN TI ORTH,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71108045,SUP,HCPCS C1713,,71108045  -  SCREW BN 7MM 45MM STRL 32MM CNN TI ORTH,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71108050,SUP,HCPCS C1713,,71108050  -  SCREW BN 7MM 50MM STRL 32MM CNN TI ORTH,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71108055,SUP,HCPCS C1713,,71108055  -  SCREW BN 7MM 55MM STRL 32MM CNN TI ORTH,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71108060,SUP,HCPCS C1713,,71108060  -  SCREW BN 7MM 60MM STRL 32MM CNN TI ORTH,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71108065,SUP,HCPCS C1713,,71108065  -  SCREW BN 7MM 65MM STRL 32MM CNN TI ORTH,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71108070,SUP,HCPCS C1713,,71108070  -  SCREW BN 7MM 70MM STRL 32MM CNN TI ORTH,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71108075,SUP,HCPCS C1713,,71108075  -  SCREW BN P/T 7MM 75MM STRL 32MM CNN TI,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71108080,SUP,HCPCS C1713,,71108080  -  SCREW BN P/T 7MM 80MM STRL 32MM CNN TI,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71108085,SUP,HCPCS C1713,,71108085  -  SCREW BN 7MM 85MM 32MM CNN P/T TI ORTH,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71108090,SUP,HCPCS C1713,,71108090  -  SCREW BN P/T 7MM 90MM STRL 32MM CNN TI,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71108095,SUP,HCPCS C1713,,71108095  -  SCREW BN P/T 7MM 95MM STRL 32MM CNN TI,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71108100,SUP,HCPCS C1713,,71108100  -  SCREW BN P/T 7MM 100MM STRL 32MM CNN TI,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71108105,SUP,HCPCS C1713,,71108105  -  SCREW BN 7MM 105MM STRL 32MM CNN TI ORTH,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71108110,SUP,HCPCS C1713,,71108110  -  SCREW BN 7MM 110MM STRL 32MM CNN TI ORTH,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71108115,SUP,HCPCS C1713,,71108115  -  SCREW BN 7MM 115MM STRL 32MM CNN TI ORTH,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71108120,SUP,HCPCS C1713,,71108120  -  SCREW BN 7MM 120MM STRL 32MM CNN TI ORTH,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71108125,SUP,HCPCS C1713,,71108125  -  SCREW BN 7MM 125MM STRL 32MM CNN TI ORTH,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71108130,SUP,HCPCS C1713,,71108130  -  SCREW BN 7MM 130MM STRL 32MM CNN TI ORTH,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71108135,SUP,HCPCS C1713,,71108135  -  SCREW BN 7MM 135MM STRL 32MM CNN TI ORTH,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71108140,SUP,HCPCS C1713,,71108140  -  SCREW BN 7MM 140MM STRL 32MM CNN TI ORTH,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71108145,SUP,HCPCS C1713,,71108145  -  SCREW BN 7MM 145MM STRL 32MM CNN TI ORTH,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71108150,SUP,HCPCS C1713,,71108150  -  SCREW BN 7MM 150MM STRL 32MM CNN TI ORTH,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71108670,SUP,HCPCS C1713,,71108670  -  SCREW BN P/T 8MM 170MM 24MM CNN SS CANC,$810.00,$0.00,$810.00,$364.50,$578.10,$0.00,$139.56,$0.00,$0.00,$141.82,$810.00,$0.00,$405.00,$641.52,$648.00,$0.00,$126.77,$0.00,$128.95,$0.00
71109030,SUP,HCPCS C1713,,71109030  -  SCREW BN FT 7MM 30MM STRL CNN TI ORTH,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71109035,SUP,HCPCS C1713,,71109035  -  SCREW BN FT 7MM 35MM STRL CNN TI ORTH,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71109040,SUP,HCPCS C1713,,71109040  -  SCREW BN FT 7MM 40MM STRL CNN TI ORTH,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71109045,SUP,HCPCS C1713,,71109045  -  SCREW BN FT 7MM 45MM STRL CNN TI ORTH,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71109050,SUP,HCPCS C1713,,71109050  -  SCREW BN FT 7MM 50MM STRL CNN TI ORTH,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71109055,SUP,HCPCS C1713,,71109055  -  SCREW BN FT 7MM 55MM STRL CNN TI ORTH,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71109060,SUP,HCPCS C1713,,71109060  -  SCREW BN FT 7MM 60MM STRL CNN TI ORTH,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71109065,SUP,HCPCS C1713,,71109065  -  SCREW BN FT 7MM 65MM STRL CNN TI ORTH,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71109070,SUP,HCPCS C1713,,71109070  -  SCREW BN FT 7MM 70MM STRL CNN TI ORTH,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71109075,SUP,HCPCS C1713,,71109075  -  SCREW BN FT 7MM 75MM STRL CNN TI ORTH,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71109080,SUP,HCPCS C1713,,71109080  -  SCREW BN FT 7MM 80MM STRL CNN TI ORTH,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71109085,SUP,HCPCS C1713,,71109085  -  SCREW BN FT 7MM 85MM STRL CNN TI ORTH,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71109090,SUP,HCPCS C1713,,71109090  -  SCREW BN FT 7MM 90MM STRL CNN TI ORTH,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71109095,SUP,HCPCS C1713,,71109095  -  SCREW BN FT 7MM 95MM STRL CNN TI ORTH,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71109100,SUP,HCPCS C1713,,71109100  -  SCREW BN FT 7MM 100MM STRL CNN TI ORTH,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71109105,SUP,HCPCS C1713,,71109105  -  SCREW BN FT 7MM 105MM STRL CNN TI ORTH,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71109110,SUP,HCPCS C1713,,71109110  -  SCREW BN FT 7MM 110MM STRL CNN TI ORTH,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71109115,SUP,HCPCS C1713,,71109115  -  SCREW BN 7MM 115MM STRL CNN FT TI ORTH,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71109120,SUP,HCPCS C1713,,71109120  -  SCREW BN 7MM 120MM STRL CNN FT TI ORTH,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71109125,SUP,HCPCS C1713,,71109125  -  SCREW BN FT 7MM 125MM STRL CNN TI ORTH,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71109130,SUP,HCPCS C1713,,71109130  -  SCREW BN FT 7MM 130MM STRL CNN TI ORTH,$519.75,$0.00,$519.75,$233.89,$370.95,$0.00,$89.55,$0.00,$0.00,$91.00,$519.75,$0.00,$259.88,$411.64,$415.80,$0.00,$81.34,$0.00,$82.74,$0.00
71110027,SUP,Custom 27203010,,71110027  -  BIT DRL 4.5MM TWST,$143.85,$0.00,$143.85,$0.00,$102.67,$0.00,$0.00,$0.00,$0.00,$0.00,$143.85,$0.00,$71.93,$113.93,$115.08,$0.00,$0.00,$0.00,$0.00,$0.00
71110045,SUP,Custom 27203010,,71110045  -  BIT DRL 3.5MM TWST,$114.45,$0.00,$114.45,$0.00,$81.68,$0.00,$0.00,$0.00,$0.00,$0.00,$114.45,$0.00,$57.23,$90.64,$91.56,$0.00,$0.00,$0.00,$0.00,$0.00
71116060,SUP,HCPCS C1713,,71116060  -  PIN FX 3IN ORTH,"$1,459.50",$0.00,"$1,459.50",$656.78,"$1,041.65",$0.00,$251.46,$0.00,$0.00,$255.55,"$1,459.50",$0.00,$729.75,"$1,155.92","$1,167.60",$0.00,$228.41,$0.00,$232.35,$0.00
71119005,SUP,HCPCS C1713,,71119005  -  WASHER XTRNFX 12.7MM SLV 7MM CNN SCR,$308.70,$0.00,$308.70,$138.92,$220.32,$0.00,$53.19,$0.00,$0.00,$54.05,$308.70,$0.00,$154.35,$244.49,$246.96,$0.00,$48.31,$0.00,$49.15,$0.00
71119007,SUP,Custom 27203010,,71119007  -  BIT DRL 4MM STRL CNN,$807.45,$0.00,$807.45,$0.00,$576.28,$0.00,$0.00,$0.00,$0.00,$0.00,$807.45,$0.00,$403.73,$639.50,$645.96,$0.00,$0.00,$0.00,$0.00,$0.00
71119106,SUP,Custom 27203010,,71119106  -  BIT DRL 5.2MM STRL CNN 7MM SCR,$940.80,$0.00,$940.80,$0.00,$671.45,$0.00,$0.00,$0.00,$0.00,$0.00,$940.80,$0.00,$470.40,$745.11,$752.64,$0.00,$0.00,$0.00,$0.00,$0.00
71120006,SUP,HCPCS C1713,,71120006  -  WASHER ORTH THK1MM 8MM 4MM STRL CNN SS 4MM CNN SCR,$121.90,$0.00,$121.90,$54.86,$87.00,$0.00,$21.00,$0.00,$0.00,$21.34,$121.90,$0.00,$60.95,$96.54,$97.52,$0.00,$19.08,$0.00,$19.41,$0.00
71123122,SUP,HCPCS C1713,,71123122  -  PLATE BN 90D 55MM CHS 3 HL INTMD SS PED HIP,"$1,832.25",$0.00,"$1,832.25",$824.51,"$1,307.68",$0.00,$315.69,$0.00,$0.00,$320.81,"$1,832.25",$0.00,$916.13,"$1,451.14","$1,465.80",$0.00,$286.75,$0.00,$291.69,$0.00
71123124,SUP,HCPCS C1713,,71123124  -  PLATE BN 100D 55MM CHS 3 HL INTMD SS PED HIP,"$1,832.25",$0.00,"$1,832.25",$824.51,"$1,307.68",$0.00,$315.69,$0.00,$0.00,$320.81,"$1,832.25",$0.00,$916.13,"$1,451.14","$1,465.80",$0.00,$286.75,$0.00,$291.69,$0.00
71123126,SUP,HCPCS C1713,,71123126  -  PLATE BN 110D 55MM CHS 3 HL INTMD SS PED HIP,"$1,832.25",$0.00,"$1,832.25",$824.51,"$1,307.68",$0.00,$315.69,$0.00,$0.00,$320.81,"$1,832.25",$0.00,$916.13,"$1,451.14","$1,465.80",$0.00,$286.75,$0.00,$291.69,$0.00
71123128,SUP,HCPCS C1713,,71123128  -  PLATE BN 120D 55MM CHS 3 HL INTMD SS PED HIP,"$1,832.25",$0.00,"$1,832.25",$824.51,"$1,307.68",$0.00,$315.69,$0.00,$0.00,$320.81,"$1,832.25",$0.00,$916.13,"$1,451.14","$1,465.80",$0.00,$286.75,$0.00,$291.69,$0.00
71123130,SUP,HCPCS C1713,,71123130  -  PLATE BN 130D 55MM CHS 3 HL INTMD SS PED HIP,"$1,832.25",$0.00,"$1,832.25",$824.51,"$1,307.68",$0.00,$315.69,$0.00,$0.00,$320.81,"$1,832.25",$0.00,$916.13,"$1,451.14","$1,465.80",$0.00,$286.75,$0.00,$291.69,$0.00
71123132,SUP,HCPCS C1713,,71123132  -  PLATE BN 135D 55MM CHS 3 HL INTMD SS PED HIP,"$1,832.25",$0.00,"$1,832.25",$824.51,"$1,307.68",$0.00,$315.69,$0.00,$0.00,$320.81,"$1,832.25",$0.00,$916.13,"$1,451.14","$1,465.80",$0.00,$286.75,$0.00,$291.69,$0.00
71123134,SUP,HCPCS C1713,,71123134  -  PLATE BN 140D 55MM CHS 3 HL INTMD SS PED HIP,"$1,832.25",$0.00,"$1,832.25",$824.51,"$1,307.68",$0.00,$315.69,$0.00,$0.00,$320.81,"$1,832.25",$0.00,$916.13,"$1,451.14","$1,465.80",$0.00,$286.75,$0.00,$291.69,$0.00
71123136,SUP,HCPCS C1713,,71123136  -  PLATE BN 145D 55MM CHS 3 HL INTMD SS PED HIP,"$1,832.25",$0.00,"$1,832.25",$824.51,"$1,307.68",$0.00,$315.69,$0.00,$0.00,$320.81,"$1,832.25",$0.00,$916.13,"$1,451.14","$1,465.80",$0.00,$286.75,$0.00,$291.69,$0.00
71123138,SUP,HCPCS C1713,,71123138  -  PLATE BN 150D 55MM CHS 3 HL INTMD SS PED HIP,"$1,832.25",$0.00,"$1,832.25",$824.51,"$1,307.68",$0.00,$315.69,$0.00,$0.00,$320.81,"$1,832.25",$0.00,$916.13,"$1,451.14","$1,465.80",$0.00,$286.75,$0.00,$291.69,$0.00
71123140,SUP,HCPCS C1713,,71123140  -  PLATE BN 90D 76MM CHS 4 HL INTMD SS PED HIP,"$1,832.25",$0.00,"$1,832.25",$824.51,"$1,307.68",$0.00,$315.69,$0.00,$0.00,$320.81,"$1,832.25",$0.00,$916.13,"$1,451.14","$1,465.80",$0.00,$286.75,$0.00,$291.69,$0.00
71123142,SUP,HCPCS C1713,,71123142  -  PLATE BN 100D 76MM CHS 4 HL INTMD SS PED HIP,"$1,832.25",$0.00,"$1,832.25",$824.51,"$1,307.68",$0.00,$315.69,$0.00,$0.00,$320.81,"$1,832.25",$0.00,$916.13,"$1,451.14","$1,465.80",$0.00,$286.75,$0.00,$291.69,$0.00
71123144,SUP,HCPCS C1713,,71123144  -  PLATE BN 110D 76MM CHS 4 HL INTMD SS PED HIP,"$1,832.25",$0.00,"$1,832.25",$824.51,"$1,307.68",$0.00,$315.69,$0.00,$0.00,$320.81,"$1,832.25",$0.00,$916.13,"$1,451.14","$1,465.80",$0.00,$286.75,$0.00,$291.69,$0.00
71123146,SUP,HCPCS C1713,,71123146  -  PLATE BN 120D 76MM CHS 4 HL INTMD SS PED HIP,"$1,832.25",$0.00,"$1,832.25",$824.51,"$1,307.68",$0.00,$315.69,$0.00,$0.00,$320.81,"$1,832.25",$0.00,$916.13,"$1,451.14","$1,465.80",$0.00,$286.75,$0.00,$291.69,$0.00
71123148,SUP,HCPCS C1713,,71123148  -  PLATE BN 130D 76MM CHS 4 HL INTMD SS PED HIP,"$1,832.25",$0.00,"$1,832.25",$824.51,"$1,307.68",$0.00,$315.69,$0.00,$0.00,$320.81,"$1,832.25",$0.00,$916.13,"$1,451.14","$1,465.80",$0.00,$286.75,$0.00,$291.69,$0.00
71123150,SUP,HCPCS C1713,,71123150  -  PLATE BN 135D 76MM CHS 4 HL INTMD SS PED HIP,"$1,832.25",$0.00,"$1,832.25",$824.51,"$1,307.68",$0.00,$315.69,$0.00,$0.00,$320.81,"$1,832.25",$0.00,$916.13,"$1,451.14","$1,465.80",$0.00,$286.75,$0.00,$291.69,$0.00
71123152,SUP,HCPCS C1713,,71123152  -  PLATE BN 140D 76MM CHS 4 HL INTMD SS PED HIP,"$1,832.25",$0.00,"$1,832.25",$824.51,"$1,307.68",$0.00,$315.69,$0.00,$0.00,$320.81,"$1,832.25",$0.00,$916.13,"$1,451.14","$1,465.80",$0.00,$286.75,$0.00,$291.69,$0.00
71123154,SUP,HCPCS C1713,,71123154  -  PLATE BN 145D 76MM CHS 4 HL INTMD SS PED HIP,"$1,832.25",$0.00,"$1,832.25",$824.51,"$1,307.68",$0.00,$315.69,$0.00,$0.00,$320.81,"$1,832.25",$0.00,$916.13,"$1,451.14","$1,465.80",$0.00,$286.75,$0.00,$291.69,$0.00
71123156,SUP,HCPCS C1713,,71123156  -  PLATE BN 150D 76MM CHS 4 HL INTMD SS PED HIP,"$1,832.25",$0.00,"$1,832.25",$824.51,"$1,307.68",$0.00,$315.69,$0.00,$0.00,$320.81,"$1,832.25",$0.00,$916.13,"$1,451.14","$1,465.80",$0.00,$286.75,$0.00,$291.69,$0.00
71123158,SUP,HCPCS C1713,,71123158  -  PLATE BN 90D 102MM CHS 6 HL INTMD SS PED HIP,"$1,832.25",$0.00,"$1,832.25",$824.51,"$1,307.68",$0.00,$315.69,$0.00,$0.00,$320.81,"$1,832.25",$0.00,$916.13,"$1,451.14","$1,465.80",$0.00,$286.75,$0.00,$291.69,$0.00
71123160,SUP,HCPCS C1713,,71123160  -  PLATE BN 100D 102MM CHS 6 HL INTMD SS PED HIP,"$1,832.25",$0.00,"$1,832.25",$824.51,"$1,307.68",$0.00,$315.69,$0.00,$0.00,$320.81,"$1,832.25",$0.00,$916.13,"$1,451.14","$1,465.80",$0.00,$286.75,$0.00,$291.69,$0.00
71123162,SUP,HCPCS C1713,,71123162  -  PLATE BN 110D 102MM CHS 6 HL INTMD SS PED HIP,"$1,832.25",$0.00,"$1,832.25",$824.51,"$1,307.68",$0.00,$315.69,$0.00,$0.00,$320.81,"$1,832.25",$0.00,$916.13,"$1,451.14","$1,465.80",$0.00,$286.75,$0.00,$291.69,$0.00
71123164,SUP,HCPCS C1713,,71123164  -  PLATE BN 120D 102MM CHS 6 HL INTMD SS PED HIP,"$1,832.25",$0.00,"$1,832.25",$824.51,"$1,307.68",$0.00,$315.69,$0.00,$0.00,$320.81,"$1,832.25",$0.00,$916.13,"$1,451.14","$1,465.80",$0.00,$286.75,$0.00,$291.69,$0.00
71123166,SUP,HCPCS C1713,,71123166  -  PLATE BN 130D 102MM CHS 6 HL INTMD SS PED HIP,"$1,832.25",$0.00,"$1,832.25",$824.51,"$1,307.68",$0.00,$315.69,$0.00,$0.00,$320.81,"$1,832.25",$0.00,$916.13,"$1,451.14","$1,465.80",$0.00,$286.75,$0.00,$291.69,$0.00
71123168,SUP,HCPCS C1713,,71123168  -  PLATE BN 135D 102MM CHS 6 HL INTMD SS PED HIP,"$1,832.25",$0.00,"$1,832.25",$824.51,"$1,307.68",$0.00,$315.69,$0.00,$0.00,$320.81,"$1,832.25",$0.00,$916.13,"$1,451.14","$1,465.80",$0.00,$286.75,$0.00,$291.69,$0.00
71123170,SUP,HCPCS C1713,,71123170  -  PLATE BN 140D 102MM CHS 6 HL INTMD SS PED HIP,"$1,832.25",$0.00,"$1,832.25",$824.51,"$1,307.68",$0.00,$315.69,$0.00,$0.00,$320.81,"$1,832.25",$0.00,$916.13,"$1,451.14","$1,465.80",$0.00,$286.75,$0.00,$291.69,$0.00
71123172,SUP,HCPCS C1713,,71123172  -  PLATE BN 145D 102MM CHS 6 HL INTMD SS PED HIP,"$1,832.25",$0.00,"$1,832.25",$824.51,"$1,307.68",$0.00,$315.69,$0.00,$0.00,$320.81,"$1,832.25",$0.00,$916.13,"$1,451.14","$1,465.80",$0.00,$286.75,$0.00,$291.69,$0.00
71123174,SUP,HCPCS C1713,,71123174  -  PLATE BN 150D 102MM CHS 6 HL INTMD SS PED HIP,"$1,832.25",$0.00,"$1,832.25",$824.51,"$1,307.68",$0.00,$315.69,$0.00,$0.00,$320.81,"$1,832.25",$0.00,$916.13,"$1,451.14","$1,465.80",$0.00,$286.75,$0.00,$291.69,$0.00
71123176,SUP,HCPCS C1713,,71123176  -  PLATE BN 130D 127MM CHS 8 HL INTMD SS PED HIP,"$1,832.25",$0.00,"$1,832.25",$824.51,"$1,307.68",$0.00,$315.69,$0.00,$0.00,$320.81,"$1,832.25",$0.00,$916.13,"$1,451.14","$1,465.80",$0.00,$286.75,$0.00,$291.69,$0.00
71123178,SUP,HCPCS C1713,,71123178  -  PLATE BN 135D 127MM CHS 8 HL INTMD SS PED HIP,"$1,832.25",$0.00,"$1,832.25",$824.51,"$1,307.68",$0.00,$315.69,$0.00,$0.00,$320.81,"$1,832.25",$0.00,$916.13,"$1,451.14","$1,465.80",$0.00,$286.75,$0.00,$291.69,$0.00
71123180,SUP,HCPCS C1713,,71123180  -  PLATE BN 140D 127MM CHS 8 HL INTMD SS PED HIP,"$1,832.25",$0.00,"$1,832.25",$824.51,"$1,307.68",$0.00,$315.69,$0.00,$0.00,$320.81,"$1,832.25",$0.00,$916.13,"$1,451.14","$1,465.80",$0.00,$286.75,$0.00,$291.69,$0.00
71123182,SUP,HCPCS C1713,,71123182  -  PLATE BN 145D 127MM CHS 8 HL INTMD SS PED HIP,"$1,832.25",$0.00,"$1,832.25",$824.51,"$1,307.68",$0.00,$315.69,$0.00,$0.00,$320.81,"$1,832.25",$0.00,$916.13,"$1,451.14","$1,465.80",$0.00,$286.75,$0.00,$291.69,$0.00
71123184,SUP,HCPCS C1713,,71123184  -  PLATE BN 150D 127MM CHS 8 HL INTMD SS PED HIP,"$1,832.25",$0.00,"$1,832.25",$824.51,"$1,307.68",$0.00,$315.69,$0.00,$0.00,$320.81,"$1,832.25",$0.00,$916.13,"$1,451.14","$1,465.80",$0.00,$286.75,$0.00,$291.69,$0.00
71123186,SUP,HCPCS C1713,,71123186  -  SCREW BN 35MM CHS INTMD LG SS PED HIP,"$1,307.25",$0.00,"$1,307.25",$588.26,$932.98,$0.00,$225.23,$0.00,$0.00,$228.89,"$1,307.25",$0.00,$653.63,"$1,035.34","$1,045.80",$0.00,$204.58,$0.00,$208.11,$0.00
71123187,SUP,HCPCS C1713,,71123187  -  SCREW BN 40MM CHS INTMD LG SS PED HIP,"$1,307.25",$0.00,"$1,307.25",$588.26,$932.98,$0.00,$225.23,$0.00,$0.00,$228.89,"$1,307.25",$0.00,$653.63,"$1,035.34","$1,045.80",$0.00,$204.58,$0.00,$208.11,$0.00
71123188,SUP,HCPCS C1713,,71123188  -  SCREW BN 45MM CHS INTMD LG SS PED HIP,"$1,307.25",$0.00,"$1,307.25",$588.26,$932.98,$0.00,$225.23,$0.00,$0.00,$228.89,"$1,307.25",$0.00,$653.63,"$1,035.34","$1,045.80",$0.00,$204.58,$0.00,$208.11,$0.00
71123189,SUP,HCPCS C1713,,71123189  -  SCREW BN 50MM CHS INTMD LG SS PED HIP,"$1,307.25",$0.00,"$1,307.25",$588.26,$932.98,$0.00,$225.23,$0.00,$0.00,$228.89,"$1,307.25",$0.00,$653.63,"$1,035.34","$1,045.80",$0.00,$204.58,$0.00,$208.11,$0.00
71123190,SUP,HCPCS C1713,,71123190  -  SCREW BN 55MM CHS INTMD LG SS HIP,"$1,307.25",$0.00,"$1,307.25",$588.26,$932.98,$0.00,$225.23,$0.00,$0.00,$228.89,"$1,307.25",$0.00,$653.63,"$1,035.34","$1,045.80",$0.00,$204.58,$0.00,$208.11,$0.00
71123191,SUP,HCPCS C1713,,71123191  -  SCREW BN 60MM CHS INTMD LG SS HIP,"$1,307.25",$0.00,"$1,307.25",$588.26,$932.98,$0.00,$225.23,$0.00,$0.00,$228.89,"$1,307.25",$0.00,$653.63,"$1,035.34","$1,045.80",$0.00,$204.58,$0.00,$208.11,$0.00
71123192,SUP,HCPCS C1713,,71123192  -  SCREW BN 65MM CHS INTMD LG SS HIP,"$1,307.25",$0.00,"$1,307.25",$588.26,$932.98,$0.00,$225.23,$0.00,$0.00,$228.89,"$1,307.25",$0.00,$653.63,"$1,035.34","$1,045.80",$0.00,$204.58,$0.00,$208.11,$0.00
71123193,SUP,HCPCS C1713,,71123193  -  SCREW BN 70MM CHS INTMD LG SS PED HIP,"$1,307.25",$0.00,"$1,307.25",$588.26,$932.98,$0.00,$225.23,$0.00,$0.00,$228.89,"$1,307.25",$0.00,$653.63,"$1,035.34","$1,045.80",$0.00,$204.58,$0.00,$208.11,$0.00
71123194,SUP,HCPCS C1713,,71123194  -  SCREW BN 75MM CHS INTMD LG SS HIP,"$1,307.25",$0.00,"$1,307.25",$588.26,$932.98,$0.00,$225.23,$0.00,$0.00,$228.89,"$1,307.25",$0.00,$653.63,"$1,035.34","$1,045.80",$0.00,$204.58,$0.00,$208.11,$0.00
71123195,SUP,HCPCS C1713,,71123195  -  SCREW BN 80MM CHS INTMD LG SS HIP,"$1,307.25",$0.00,"$1,307.25",$588.26,$932.98,$0.00,$225.23,$0.00,$0.00,$228.89,"$1,307.25",$0.00,$653.63,"$1,035.34","$1,045.80",$0.00,$204.58,$0.00,$208.11,$0.00
71123196,SUP,HCPCS C1713,,71123196  -  SCREW BN 85MM CHS INTMD LG SS HIP,"$1,307.25",$0.00,"$1,307.25",$588.26,$932.98,$0.00,$225.23,$0.00,$0.00,$228.89,"$1,307.25",$0.00,$653.63,"$1,035.34","$1,045.80",$0.00,$204.58,$0.00,$208.11,$0.00
71123197,SUP,HCPCS C1713,,71123197  -  SCREW BN 90MM CHS INTMD LG SS HIP,"$1,307.25",$0.00,"$1,307.25",$588.26,$932.98,$0.00,$225.23,$0.00,$0.00,$228.89,"$1,307.25",$0.00,$653.63,"$1,035.34","$1,045.80",$0.00,$204.58,$0.00,$208.11,$0.00
71123198,SUP,HCPCS C1713,,71123198  -  SCREW BN 95MM CHS INTMD LG SS HIP,"$1,307.25",$0.00,"$1,307.25",$588.26,$932.98,$0.00,$225.23,$0.00,$0.00,$228.89,"$1,307.25",$0.00,$653.63,"$1,035.34","$1,045.80",$0.00,$204.58,$0.00,$208.11,$0.00
71123199,SUP,HCPCS C1713,,71123199  -  SCREW BN 2.5MM CHS INTMD CMPR HEX HD SS PED HIP,$216.30,$0.00,$216.30,$97.34,$154.37,$0.00,$37.27,$0.00,$0.00,$37.87,$216.30,$0.00,$108.15,$171.31,$173.04,$0.00,$33.85,$0.00,$34.43,$0.00
71123228,SUP,HCPCS C1713,,71123228  -  SCREW BN FT 2.7MM 28MM ST PED HIP,$40.70,$0.00,$40.70,$18.32,$29.05,$0.00,$7.01,$0.00,$0.00,$7.13,$40.70,$0.00,$20.35,$32.23,$32.56,$0.00,$6.37,$0.00,$6.48,$0.00
71123232,SUP,HCPCS C1713,,71123232  -  SCREW BN 2.7MM 32MM ST HEX HD,$41.80,$0.00,$41.80,$18.81,$29.83,$0.00,$7.20,$0.00,$0.00,$7.32,$41.80,$0.00,$20.90,$33.11,$33.44,$0.00,$6.54,$0.00,$6.65,$0.00
71123234,SUP,HCPCS C1713,,71123234  -  SCREW BN 2.7MM 34MM ST HEX HD,$41.80,$0.00,$41.80,$18.81,$29.83,$0.00,$7.20,$0.00,$0.00,$7.32,$41.80,$0.00,$20.90,$33.11,$33.44,$0.00,$6.54,$0.00,$6.65,$0.00
71123236,SUP,HCPCS C1713,,71123236  -  SCREW BN 2.7MM 36MM ST HEX HD,$41.80,$0.00,$41.80,$18.81,$29.83,$0.00,$7.20,$0.00,$0.00,$7.32,$41.80,$0.00,$20.90,$33.11,$33.44,$0.00,$6.54,$0.00,$6.65,$0.00
71123238,SUP,HCPCS C1713,,71123238  -  SCREW BN 2.7MM 38MM ST HEX HD,$41.80,$0.00,$41.80,$18.81,$29.83,$0.00,$7.20,$0.00,$0.00,$7.32,$41.80,$0.00,$20.90,$33.11,$33.44,$0.00,$6.54,$0.00,$6.65,$0.00
71123242,SUP,HCPCS C1713,,71123242  -  PLATE BN 90D 50MM CHS 4 PROX HL SS PED HIP,"$2,394.00",$0.00,"$2,394.00","$1,077.30","$1,708.60",$0.00,$412.47,$0.00,$0.00,$419.17,"$2,394.00",$0.00,"$1,197.00","$1,896.05","$1,915.20",$0.00,$374.66,$0.00,$381.12,$0.00
71123244,SUP,HCPCS C1713,,71123244  -  PLATE BN 100D .385IN CHS 4 PROX HL SS PED HIP,"$2,394.00",$0.00,"$2,394.00","$1,077.30","$1,708.60",$0.00,$412.47,$0.00,$0.00,$419.17,"$2,394.00",$0.00,"$1,197.00","$1,896.05","$1,915.20",$0.00,$374.66,$0.00,$381.12,$0.00
71123246,SUP,HCPCS C1713,,71123246  -  PLATE BN 110D 50MM CHS 4 PROX HL SS PED HIP,"$2,394.00",$0.00,"$2,394.00","$1,077.30","$1,708.60",$0.00,$412.47,$0.00,$0.00,$419.17,"$2,394.00",$0.00,"$1,197.00","$1,896.05","$1,915.20",$0.00,$374.66,$0.00,$381.12,$0.00
71123248,SUP,HCPCS C1713,,71123248  -  PLATE BN 120D 50MM CHS 4 PROX HL SS PED HIP,"$2,394.00",$0.00,"$2,394.00","$1,077.30","$1,708.60",$0.00,$412.47,$0.00,$0.00,$419.17,"$2,394.00",$0.00,"$1,197.00","$1,896.05","$1,915.20",$0.00,$374.66,$0.00,$381.12,$0.00
71123250,SUP,HCPCS C1713,,71123250  -  PLATE BN 130D 50MM CHS 4 PROX HL SS PED HIP,"$2,394.00",$0.00,"$2,394.00","$1,077.30","$1,708.60",$0.00,$412.47,$0.00,$0.00,$419.17,"$2,394.00",$0.00,"$1,197.00","$1,896.05","$1,915.20",$0.00,$374.66,$0.00,$381.12,$0.00
71123252,SUP,HCPCS C1713,,71123252  -  PLATE BN 140D 50MM CHS 4 PROX HL SS PED HIP,"$2,394.00",$0.00,"$2,394.00","$1,077.30","$1,708.60",$0.00,$412.47,$0.00,$0.00,$419.17,"$2,394.00",$0.00,"$1,197.00","$1,896.05","$1,915.20",$0.00,$374.66,$0.00,$381.12,$0.00
71123254,SUP,HCPCS C1713,,71123254  -  SCREW BN 22MM CHS LG SS PED HIP,"$1,412.25",$0.00,"$1,412.25",$635.51,"$1,007.92",$0.00,$243.32,$0.00,$0.00,$247.27,"$1,412.25",$0.00,$706.13,"$1,118.50","$1,129.80",$0.00,$221.02,$0.00,$224.83,$0.00
71123256,SUP,HCPCS C1713,,71123256  -  SCREW BN 25MM CHS LG SS PED HIP,"$1,412.25",$0.00,"$1,412.25",$635.51,"$1,007.92",$0.00,$243.32,$0.00,$0.00,$247.27,"$1,412.25",$0.00,$706.13,"$1,118.50","$1,129.80",$0.00,$221.02,$0.00,$224.83,$0.00
71123258,SUP,HCPCS C1713,,71123258  -  SCREW BN 28MM CHS LG SS PED HIP,"$1,412.25",$0.00,"$1,412.25",$635.51,"$1,007.92",$0.00,$243.32,$0.00,$0.00,$247.27,"$1,412.25",$0.00,$706.13,"$1,118.50","$1,129.80",$0.00,$221.02,$0.00,$224.83,$0.00
71123260,SUP,HCPCS C1713,,71123260  -  SCREW BN 31MM CHS LG SS PED HIP,"$1,412.25",$0.00,"$1,412.25",$635.51,"$1,007.92",$0.00,$243.32,$0.00,$0.00,$247.27,"$1,412.25",$0.00,$706.13,"$1,118.50","$1,129.80",$0.00,$221.02,$0.00,$224.83,$0.00
71123262,SUP,HCPCS C1713,,71123262  -  SCREW BN 34MM CHS LG SS PED HIP,"$1,412.25",$0.00,"$1,412.25",$635.51,"$1,007.92",$0.00,$243.32,$0.00,$0.00,$247.27,"$1,412.25",$0.00,$706.13,"$1,118.50","$1,129.80",$0.00,$221.02,$0.00,$224.83,$0.00
71123264,SUP,HCPCS C1713,,71123264  -  SCREW BN 37MM CHS LG SS PED HIP,"$1,412.25",$0.00,"$1,412.25",$635.51,"$1,007.92",$0.00,$243.32,$0.00,$0.00,$247.27,"$1,412.25",$0.00,$706.13,"$1,118.50","$1,129.80",$0.00,$221.02,$0.00,$224.83,$0.00
71123266,SUP,HCPCS C1713,,71123266  -  SCREW BN 40MM CHS LG SS PED HIP,"$1,412.25",$0.00,"$1,412.25",$635.51,"$1,007.92",$0.00,$243.32,$0.00,$0.00,$247.27,"$1,412.25",$0.00,$706.13,"$1,118.50","$1,129.80",$0.00,$221.02,$0.00,$224.83,$0.00
71124002,SUP,HCPCS C1713,,71124002  -  NAIL IM 4MM 22CM FRSGHT SET FRARM,"$6,380.00",$0.00,"$6,380.00","$2,871.00","$4,553.41",$0.00,"$1,099.24",$0.00,$0.00,"$1,117.09","$6,380.00",$0.00,"$3,190.00","$5,052.96","$5,104.00",$0.00,$998.47,$0.00,"$1,015.70",$0.00
71124010,SUP,HCPCS C1713,,71124010  -  SCREW BN 2.7MM 10MM UNICORTICAL,$373.40,$0.00,$373.40,$168.03,$266.50,$0.00,$64.33,$0.00,$0.00,$65.38,$373.40,$0.00,$186.70,$295.73,$298.72,$0.00,$58.44,$0.00,$59.45,$0.00
71126130,SUP,HCPCS C1713,,71126130  -  PLATE BN 130D CLS 4 HL CMPR LOPRFL HIP,$715.05,$0.00,$715.05,$321.77,$510.33,$0.00,$123.20,$0.00,$0.00,$125.20,$715.05,$0.00,$357.53,$566.32,$572.04,$0.00,$111.91,$0.00,$113.84,$0.00
71126131,SUP,HCPCS C1713,,71126131  -  PLATE BN 135D CLS LP 4 HL,$532.35,$0.00,$532.35,$239.56,$379.94,$0.00,$91.72,$0.00,$0.00,$93.21,$532.35,$0.00,$266.18,$421.62,$425.88,$0.00,$83.31,$0.00,$84.75,$0.00
71127030,SUP,HCPCS C1713,,71127030  -  SCREW BN 7MM 30MM STRL 16MM CNN SS ORTH,$487.20,$0.00,$487.20,$219.24,$347.71,$0.00,$83.94,$0.00,$0.00,$85.30,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$76.25,$0.00,$77.56,$0.00
71127035,SUP,HCPCS C1713,,71127035  -  SCREW BN 7MM 35MM STRL 16MM CNN SS ORTH,$487.20,$0.00,$487.20,$219.24,$347.71,$0.00,$83.94,$0.00,$0.00,$85.30,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$76.25,$0.00,$77.56,$0.00
71127040,SUP,HCPCS C1713,,71127040  -  SCREW BN 7MM 40MM STRL 16MM CNN SS ORTH,$487.20,$0.00,$487.20,$219.24,$347.71,$0.00,$83.94,$0.00,$0.00,$85.30,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$76.25,$0.00,$77.56,$0.00
71127045,SUP,HCPCS C1713,,71127045  -  SCREW BN 7MM 45MM STRL 16MM CNN SS ORTH,$487.20,$0.00,$487.20,$219.24,$347.71,$0.00,$83.94,$0.00,$0.00,$85.30,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$76.25,$0.00,$77.56,$0.00
71127050,SUP,HCPCS C1713,,71127050  -  SCREW BN 7MM 50MM STRL 16MM CNN SS CORT,$487.20,$0.00,$487.20,$219.24,$347.71,$0.00,$83.94,$0.00,$0.00,$85.30,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$76.25,$0.00,$77.56,$0.00
71127055,SUP,HCPCS C1713,,71127055  -  SCREW BN 7MM 55MM STRL 16MM CNN SS CORT,$487.20,$0.00,$487.20,$219.24,$347.71,$0.00,$83.94,$0.00,$0.00,$85.30,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$76.25,$0.00,$77.56,$0.00
71127060,SUP,HCPCS C1713,,71127060  -  SCREW BN 7MM 60MM STRL 16MM CNN SS CORT,$487.20,$0.00,$487.20,$219.24,$347.71,$0.00,$83.94,$0.00,$0.00,$85.30,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$76.25,$0.00,$77.56,$0.00
71127065,SUP,HCPCS C1713,,71127065  -  SCREW BN 7MM 65MM STRL 16MM CNN SS CORT,$487.20,$0.00,$487.20,$219.24,$347.71,$0.00,$83.94,$0.00,$0.00,$85.30,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$76.25,$0.00,$77.56,$0.00
71127070,SUP,HCPCS C1713,,71127070  -  SCREW BN P/T TROC SPHR 7MM 5.2MM 70MM 16MM CNN SLFDRL ST HD,$487.20,$0.00,$487.20,$219.24,$347.71,$0.00,$83.94,$0.00,$0.00,$85.30,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$76.25,$0.00,$77.56,$0.00
71127075,SUP,HCPCS C1713,,71127075  -  SCREW BN 7MM 75MM STRL 16MM CNN SS CORT,$487.20,$0.00,$487.20,$219.24,$347.71,$0.00,$83.94,$0.00,$0.00,$85.30,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$76.25,$0.00,$77.56,$0.00
71127080,SUP,HCPCS C1713,,71127080  -  SCREW BN 7MM 80MM STRL 16MM CNN SS CORT,$487.20,$0.00,$487.20,$219.24,$347.71,$0.00,$83.94,$0.00,$0.00,$85.30,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$76.25,$0.00,$77.56,$0.00
71127085,SUP,HCPCS C1713,,71127085  -  SCREW BN 7MM 85MM STRL 16MM CNN SS CORT,$487.20,$0.00,$487.20,$219.24,$347.71,$0.00,$83.94,$0.00,$0.00,$85.30,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$76.25,$0.00,$77.56,$0.00
71127090,SUP,HCPCS C1713,,71127090  -  SCREW BN 7MM 90MM STRL 16MM CNN SS CORT,$487.20,$0.00,$487.20,$219.24,$347.71,$0.00,$83.94,$0.00,$0.00,$85.30,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$76.25,$0.00,$77.56,$0.00
71127095,SUP,HCPCS C1713,,71127095  -  SCREW BN 7MM 95MM STRL 16MM CNN SS CORT,$487.20,$0.00,$487.20,$219.24,$347.71,$0.00,$83.94,$0.00,$0.00,$85.30,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$76.25,$0.00,$77.56,$0.00
71127100,SUP,HCPCS C1713,,71127100  -  SCREW BN 7MM 100MM STRL 16MM CNN SS CORT,$487.20,$0.00,$487.20,$219.24,$347.71,$0.00,$83.94,$0.00,$0.00,$85.30,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$76.25,$0.00,$77.56,$0.00
71127105,SUP,HCPCS C1713,,71127105  -  SCREW BN 7MM 105MM STRL 16MM CNN SS CORT,$487.20,$0.00,$487.20,$219.24,$347.71,$0.00,$83.94,$0.00,$0.00,$85.30,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$76.25,$0.00,$77.56,$0.00
71127110,SUP,HCPCS C1713,,71127110  -  SCREW BN 7MM 110MM STRL 16MM CNN SS ORTH,$487.20,$0.00,$487.20,$219.24,$347.71,$0.00,$83.94,$0.00,$0.00,$85.30,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$76.25,$0.00,$77.56,$0.00
71127115,SUP,HCPCS C1713,,71127115  -  SCREW BN 7MM 115MM STRL 16MM CNN SS ORTH,$487.20,$0.00,$487.20,$219.24,$347.71,$0.00,$83.94,$0.00,$0.00,$85.30,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$76.25,$0.00,$77.56,$0.00
71127120,SUP,HCPCS C1713,,71127120  -  SCREW BN 7MM 120MM STRL 16MM CNN SS ORTH,$487.20,$0.00,$487.20,$219.24,$347.71,$0.00,$83.94,$0.00,$0.00,$85.30,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$76.25,$0.00,$77.56,$0.00
71127125,SUP,HCPCS C1713,,71127125  -  SCREW BN 7MM 125MM STRL 16MM CNN SS ORTH,$487.20,$0.00,$487.20,$219.24,$347.71,$0.00,$83.94,$0.00,$0.00,$85.30,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$76.25,$0.00,$77.56,$0.00
71127130,SUP,HCPCS C1713,,71127130  -  SCREW BN 7MM 130MM STRL 16MM CNN SS ORTH,$487.20,$0.00,$487.20,$219.24,$347.71,$0.00,$83.94,$0.00,$0.00,$85.30,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$76.25,$0.00,$77.56,$0.00
71127135,SUP,HCPCS C1713,,71127135  -  SCREW BN 7MM 135MM STRL 16MM CNN SS ORTH,$487.20,$0.00,$487.20,$219.24,$347.71,$0.00,$83.94,$0.00,$0.00,$85.30,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$76.25,$0.00,$77.56,$0.00
71127140,SUP,HCPCS C1713,,71127140  -  SCREW BN 7MM 140MM STRL 16MM CNN SS ORTH,$487.20,$0.00,$487.20,$219.24,$347.71,$0.00,$83.94,$0.00,$0.00,$85.30,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$76.25,$0.00,$77.56,$0.00
71127145,SUP,HCPCS C1713,,71127145  -  SCREW BN 7MM 145MM STRL 16MM CNN SS ORTH,$487.20,$0.00,$487.20,$219.24,$347.71,$0.00,$83.94,$0.00,$0.00,$85.30,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$76.25,$0.00,$77.56,$0.00
71127150,SUP,HCPCS C1713,,71127150  -  SCREW BN 7MM 150MM STRL 16MM CNN SS ORTH,$487.20,$0.00,$487.20,$219.24,$347.71,$0.00,$83.94,$0.00,$0.00,$85.30,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$76.25,$0.00,$77.56,$0.00
71128045,SUP,HCPCS C1713,,71128045  -  SCREW BN 7MM 45MM STRL 32MM CNN SS ORTH,$487.20,$0.00,$487.20,$219.24,$347.71,$0.00,$83.94,$0.00,$0.00,$85.30,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$76.25,$0.00,$77.56,$0.00
71128050,SUP,HCPCS C1713,,71128050  -  SCREW BN 7MM 50MM STRL 32MM CNN SS ORTH,$487.20,$0.00,$487.20,$219.24,$347.71,$0.00,$83.94,$0.00,$0.00,$85.30,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$76.25,$0.00,$77.56,$0.00
71128055,SUP,HCPCS C1713,,71128055  -  SCREW BN 7MM 55MM STRL 32MM CNN SS CORT,$487.20,$0.00,$487.20,$219.24,$347.71,$0.00,$83.94,$0.00,$0.00,$85.30,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$76.25,$0.00,$77.56,$0.00
71128060,SUP,HCPCS C1713,,71128060  -  SCREW BN 7MM 60MM STRL 32MM CNN SS ORTH,$487.20,$0.00,$487.20,$219.24,$347.71,$0.00,$83.94,$0.00,$0.00,$85.30,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$76.25,$0.00,$77.56,$0.00
71128065,SUP,HCPCS C1713,,71128065  -  SCREW BN 7MM 65MM STRL 32MM CNN SS CORT,$487.20,$0.00,$487.20,$219.24,$347.71,$0.00,$83.94,$0.00,$0.00,$85.30,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$76.25,$0.00,$77.56,$0.00
71128070,SUP,HCPCS C1713,,71128070  -  SCREW BN 7MM 70MM STRL 32MM CNN SS CORT,$487.20,$0.00,$487.20,$219.24,$347.71,$0.00,$83.94,$0.00,$0.00,$85.30,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$76.25,$0.00,$77.56,$0.00
71128075,SUP,HCPCS C1713,,71128075  -  SCREW BN 7MM 75MM STRL 32MM CNN SET SS ORTH IMPL,$487.20,$0.00,$487.20,$219.24,$347.71,$0.00,$83.94,$0.00,$0.00,$85.30,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$76.25,$0.00,$77.56,$0.00
71128080,SUP,HCPCS C1713,,71128080  -  SCREW BN 7MM 80MM STRL 32MM CNN SS CORT,$487.20,$0.00,$487.20,$219.24,$347.71,$0.00,$83.94,$0.00,$0.00,$85.30,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$76.25,$0.00,$77.56,$0.00
71128085,SUP,HCPCS C1713,,71128085  -  SCREW BN 7MM 85MM STRL 32MM CNN SS CORT,$487.20,$0.00,$487.20,$219.24,$347.71,$0.00,$83.94,$0.00,$0.00,$85.30,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$76.25,$0.00,$77.56,$0.00
71128090,SUP,HCPCS C1713,,71128090  -  SCREW BN 7MM 90MM STRL 32MM CNN SS ORTH,$487.20,$0.00,$487.20,$219.24,$347.71,$0.00,$83.94,$0.00,$0.00,$85.30,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$76.25,$0.00,$77.56,$0.00
71128095,SUP,HCPCS C1713,,71128095  -  SCREW BN 7MM 95MM STRL 32MM CNN SS CORT,$487.20,$0.00,$487.20,$219.24,$347.71,$0.00,$83.94,$0.00,$0.00,$85.30,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$76.25,$0.00,$77.56,$0.00
71128100,SUP,HCPCS C1713,,71128100  -  SCREW BN 7MM 100MM STRL 32MM CNN SS CORT,$487.20,$0.00,$487.20,$219.24,$347.71,$0.00,$83.94,$0.00,$0.00,$85.30,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$76.25,$0.00,$77.56,$0.00
71128105,SUP,HCPCS C1713,,71128105  -  SCREW BN 7MM 105MM STRL 32MM CNN SS CORT,$487.20,$0.00,$487.20,$219.24,$347.71,$0.00,$83.94,$0.00,$0.00,$85.30,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$76.25,$0.00,$77.56,$0.00
71128110,SUP,HCPCS C1713,,71128110  -  SCREW BN 7MM 110MM STRL 32MM CNN SS ORTH,$487.20,$0.00,$487.20,$219.24,$347.71,$0.00,$83.94,$0.00,$0.00,$85.30,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$76.25,$0.00,$77.56,$0.00
71128115,SUP,HCPCS C1713,,71128115  -  SCREW BN 7MM 115MM STRL 32MM CNN SS ORTH,$487.20,$0.00,$487.20,$219.24,$347.71,$0.00,$83.94,$0.00,$0.00,$85.30,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$76.25,$0.00,$77.56,$0.00
71128120,SUP,HCPCS C1713,,71128120  -  SCREW BN 7MM 120MM STRL 32MM CNN SS ORTH,$487.20,$0.00,$487.20,$219.24,$347.71,$0.00,$83.94,$0.00,$0.00,$85.30,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$76.25,$0.00,$77.56,$0.00
71128125,SUP,HCPCS C1713,,71128125  -  SCREW BN 7MM 125MM STRL 32MM CNN SS ORTH,$487.20,$0.00,$487.20,$219.24,$347.71,$0.00,$83.94,$0.00,$0.00,$85.30,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$76.25,$0.00,$77.56,$0.00
71128130,SUP,HCPCS C1713,,71128130  -  SCREW BN 7MM 130MM STRL 32MM CNN SS ORTH,$487.20,$0.00,$487.20,$219.24,$347.71,$0.00,$83.94,$0.00,$0.00,$85.30,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$76.25,$0.00,$77.56,$0.00
71128135,SUP,HCPCS C1713,,71128135  -  SCREW BN 7MM 135MM STRL 32MM CNN SS ORTH,$467.25,$0.00,$467.25,$210.26,$333.48,$0.00,$80.50,$0.00,$0.00,$81.81,$467.25,$0.00,$233.63,$370.06,$373.80,$0.00,$73.12,$0.00,$74.39,$0.00
71128140,SUP,HCPCS C1713,,71128140  -  SCREW BN 7MM 140MM STRL 32MM CNN SS ORTH,$487.20,$0.00,$487.20,$219.24,$347.71,$0.00,$83.94,$0.00,$0.00,$85.30,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$76.25,$0.00,$77.56,$0.00
71128145,SUP,HCPCS C1713,,71128145  -  SCREW BN 7MM 145MM STRL 32MM CNN SS ORTH,$467.25,$0.00,$467.25,$210.26,$333.48,$0.00,$80.50,$0.00,$0.00,$81.81,$467.25,$0.00,$233.63,$370.06,$373.80,$0.00,$73.12,$0.00,$74.39,$0.00
71128150,SUP,HCPCS C1713,,71128150  -  SCREW BN 7MM 150MM STRL 32MM CNN SS ORTH,$487.20,$0.00,$487.20,$219.24,$347.71,$0.00,$83.94,$0.00,$0.00,$85.30,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$76.25,$0.00,$77.56,$0.00
71128690,SUP,HCPCS C1713,,71128690  -  STAPLE BN SM 23X10.8MM SPK FX,$507.15,$0.00,$507.15,$228.22,$361.95,$0.00,$87.38,$0.00,$0.00,$88.80,$507.15,$0.00,$253.58,$401.66,$405.72,$0.00,$79.37,$0.00,$80.74,$0.00
71128691,SUP,HCPCS C1713,,71128691  -  STAPLE BN SM 23X10.8MM FX,$507.15,$0.00,$507.15,$228.22,$361.95,$0.00,$87.38,$0.00,$0.00,$88.80,$507.15,$0.00,$253.58,$401.66,$405.72,$0.00,$79.37,$0.00,$80.74,$0.00
71128692,SUP,HCPCS C1713,,71128692  -  STAPLE BN SM 23X12MM SPK FX,$507.15,$0.00,$507.15,$228.22,$361.95,$0.00,$87.38,$0.00,$0.00,$88.80,$507.15,$0.00,$253.58,$401.66,$405.72,$0.00,$79.37,$0.00,$80.74,$0.00
71128693,SUP,HCPCS C1713,,71128693  -  STAPLE BN SM 23X12MM FX,$507.15,$0.00,$507.15,$228.22,$361.95,$0.00,$87.38,$0.00,$0.00,$88.80,$507.15,$0.00,$253.58,$401.66,$405.72,$0.00,$79.37,$0.00,$80.74,$0.00
71128694,SUP,HCPCS C1713,,71128694  -  STAPLE BN MED 23X15MM SPK FX,$507.15,$0.00,$507.15,$228.22,$361.95,$0.00,$87.38,$0.00,$0.00,$88.80,$507.15,$0.00,$253.58,$401.66,$405.72,$0.00,$79.37,$0.00,$80.74,$0.00
71128695,SUP,HCPCS C1713,,71128695  -  STAPLE BN MED 23X15MM FX,$507.15,$0.00,$507.15,$228.22,$361.95,$0.00,$87.38,$0.00,$0.00,$88.80,$507.15,$0.00,$253.58,$401.66,$405.72,$0.00,$79.37,$0.00,$80.74,$0.00
71128696,SUP,HCPCS C1713,,71128696  -  STAPLE BN LG 23X18MM SPK FX,$507.15,$0.00,$507.15,$228.22,$361.95,$0.00,$87.38,$0.00,$0.00,$88.80,$507.15,$0.00,$253.58,$401.66,$405.72,$0.00,$79.37,$0.00,$80.74,$0.00
71128697,SUP,HCPCS C1713,,71128697  -  STAPLE BN LG 23X18MM FX,$507.15,$0.00,$507.15,$228.22,$361.95,$0.00,$87.38,$0.00,$0.00,$88.80,$507.15,$0.00,$253.58,$401.66,$405.72,$0.00,$79.37,$0.00,$80.74,$0.00
71128698,SUP,HCPCS C1713,,71128698  -  STAPLE BN SM 16X13MM TBL FX,$507.15,$0.00,$507.15,$228.22,$361.95,$0.00,$87.38,$0.00,$0.00,$88.80,$507.15,$0.00,$253.58,$401.66,$405.72,$0.00,$79.37,$0.00,$80.74,$0.00
71128699,SUP,HCPCS C1713,,71128699  -  STAPLE BN MED 22X16MM TBL FX,$507.15,$0.00,$507.15,$228.22,$361.95,$0.00,$87.38,$0.00,$0.00,$88.80,$507.15,$0.00,$253.58,$401.66,$405.72,$0.00,$79.37,$0.00,$80.74,$0.00
71128720,SUP,HCPCS C1713,,71128720  -  STAPLE BN SM 15X11MM SPK FX,$507.15,$0.00,$507.15,$228.22,$361.95,$0.00,$87.38,$0.00,$0.00,$88.80,$507.15,$0.00,$253.58,$401.66,$405.72,$0.00,$79.37,$0.00,$80.74,$0.00
71128721,SUP,HCPCS C1713,,71128721  -  STAPLE BN SM 15X11MM FX,$507.15,$0.00,$507.15,$228.22,$361.95,$0.00,$87.38,$0.00,$0.00,$88.80,$507.15,$0.00,$253.58,$401.66,$405.72,$0.00,$79.37,$0.00,$80.74,$0.00
71128722,SUP,HCPCS C1713,,71128722  -  STAPLE BN SM 15X12.5MM SPK FX,$507.15,$0.00,$507.15,$228.22,$361.95,$0.00,$87.38,$0.00,$0.00,$88.80,$507.15,$0.00,$253.58,$401.66,$405.72,$0.00,$79.37,$0.00,$80.74,$0.00
71128723,SUP,HCPCS C1713,,71128723  -  STAPLE BN SM 23X12.5MM FX,$507.15,$0.00,$507.15,$228.22,$361.95,$0.00,$87.38,$0.00,$0.00,$88.80,$507.15,$0.00,$253.58,$401.66,$405.72,$0.00,$79.37,$0.00,$80.74,$0.00
71128724,SUP,HCPCS C1713,,71128724  -  STAPLE BN SM 16X15MM SPK FX,$507.15,$0.00,$507.15,$228.22,$361.95,$0.00,$87.38,$0.00,$0.00,$88.80,$507.15,$0.00,$253.58,$401.66,$405.72,$0.00,$79.37,$0.00,$80.74,$0.00
71128725,SUP,HCPCS C1713,,71128725  -  STAPLE BN SM 16X15MM FX,$507.15,$0.00,$507.15,$228.22,$361.95,$0.00,$87.38,$0.00,$0.00,$88.80,$507.15,$0.00,$253.58,$401.66,$405.72,$0.00,$79.37,$0.00,$80.74,$0.00
71128726,SUP,HCPCS C1713,,71128726  -  STAPLE BN LG 19X15MM SPK FX,$507.15,$0.00,$507.15,$228.22,$361.95,$0.00,$87.38,$0.00,$0.00,$88.80,$507.15,$0.00,$253.58,$401.66,$405.72,$0.00,$79.37,$0.00,$80.74,$0.00
71128727,SUP,HCPCS C1713,,71128727  -  STAPLE BN LG 19X15MM FX,$507.15,$0.00,$507.15,$228.22,$361.95,$0.00,$87.38,$0.00,$0.00,$88.80,$507.15,$0.00,$253.58,$401.66,$405.72,$0.00,$79.37,$0.00,$80.74,$0.00
71129030,SUP,HCPCS C1713,,71129030  -  SCREW BN FT 7MM 30MM STRL CNN SS ORTH,$487.20,$0.00,$487.20,$219.24,$347.71,$0.00,$83.94,$0.00,$0.00,$85.30,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$76.25,$0.00,$77.56,$0.00
71129035,SUP,HCPCS C1713,,71129035  -  SCREW BN FT 7MM 35MM STRL CNN SS ORTH,$487.20,$0.00,$487.20,$219.24,$347.71,$0.00,$83.94,$0.00,$0.00,$85.30,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$76.25,$0.00,$77.56,$0.00
71129040,SUP,HCPCS C1713,,71129040  -  SCREW BN FT 7MM 40MM STRL CNN SS ORTH,$487.20,$0.00,$487.20,$219.24,$347.71,$0.00,$83.94,$0.00,$0.00,$85.30,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$76.25,$0.00,$77.56,$0.00
71129045,SUP,HCPCS C1713,,71129045  -  SCREW BN FT 7MM 45MM STRL CNN SS ORTH,$487.20,$0.00,$487.20,$219.24,$347.71,$0.00,$83.94,$0.00,$0.00,$85.30,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$76.25,$0.00,$77.56,$0.00
71129050,SUP,HCPCS C1713,,71129050  -  SCREW BN FT 7MM 50MM STRL CNN SS ORTH,$487.20,$0.00,$487.20,$219.24,$347.71,$0.00,$83.94,$0.00,$0.00,$85.30,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$76.25,$0.00,$77.56,$0.00
71129055,SUP,HCPCS C1713,,71129055  -  SCREW BN FT 7MM 55MM STRL CNN SS ORTH,$487.20,$0.00,$487.20,$219.24,$347.71,$0.00,$83.94,$0.00,$0.00,$85.30,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$76.25,$0.00,$77.56,$0.00
71129060,SUP,HCPCS C1713,,71129060  -  SCREW BN FT 7MM 60MM STRL CNN SS ORTH,$487.20,$0.00,$487.20,$219.24,$347.71,$0.00,$83.94,$0.00,$0.00,$85.30,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$76.25,$0.00,$77.56,$0.00
71129065,SUP,HCPCS C1713,,71129065  -  SCREW BN FT 7MM 65MM STRL CNN SS ORTH,$487.20,$0.00,$487.20,$219.24,$347.71,$0.00,$83.94,$0.00,$0.00,$85.30,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$76.25,$0.00,$77.56,$0.00
71129070,SUP,HCPCS C1713,,71129070  -  SCREW BN FT 7MM 70MM STRL CNN SS ORTH,$487.20,$0.00,$487.20,$219.24,$347.71,$0.00,$83.94,$0.00,$0.00,$85.30,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$76.25,$0.00,$77.56,$0.00
71129075,SUP,HCPCS C1713,,71129075  -  SCREW BN FT 7MM 75MM STRL CNN SS ORTH,$487.20,$0.00,$487.20,$219.24,$347.71,$0.00,$83.94,$0.00,$0.00,$85.30,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$76.25,$0.00,$77.56,$0.00
71129080,SUP,HCPCS C1713,,71129080  -  SCREW BN FT 7MM 80MM STRL CNN SS ORTH,$487.20,$0.00,$487.20,$219.24,$347.71,$0.00,$83.94,$0.00,$0.00,$85.30,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$76.25,$0.00,$77.56,$0.00
71129085,SUP,HCPCS C1713,,71129085  -  SCREW BN FT 7MM 85MM STRL CNN SS ORTH,$487.20,$0.00,$487.20,$219.24,$347.71,$0.00,$83.94,$0.00,$0.00,$85.30,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$76.25,$0.00,$77.56,$0.00
71129090,SUP,HCPCS C1713,,71129090  -  SCREW BN FT 7MM 90MM STRL CNN SS ORTH,$487.20,$0.00,$487.20,$219.24,$347.71,$0.00,$83.94,$0.00,$0.00,$85.30,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$76.25,$0.00,$77.56,$0.00
71129095,SUP,HCPCS C1713,,71129095  -  SCREW BN FT 7MM 95MM STRL CNN SS ORTH,$487.20,$0.00,$487.20,$219.24,$347.71,$0.00,$83.94,$0.00,$0.00,$85.30,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$76.25,$0.00,$77.56,$0.00
71129100,SUP,HCPCS C1713,,71129100  -  SCREW BN FT 7MM 100MM STRL CNN SS ORTH,$487.20,$0.00,$487.20,$219.24,$347.71,$0.00,$83.94,$0.00,$0.00,$85.30,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$76.25,$0.00,$77.56,$0.00
71129105,SUP,HCPCS C1713,,71129105  -  SCREW BN FT 7MM 105MM STRL CNN SS ORTH,$487.20,$0.00,$487.20,$219.24,$347.71,$0.00,$83.94,$0.00,$0.00,$85.30,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$76.25,$0.00,$77.56,$0.00
71129110,SUP,HCPCS C1713,,71129110  -  SCREW BN FT 7MM 110MM STRL CNN SS ORTH,$487.20,$0.00,$487.20,$219.24,$347.71,$0.00,$83.94,$0.00,$0.00,$85.30,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$76.25,$0.00,$77.56,$0.00
71129115,SUP,HCPCS C1713,,71129115  -  SCREW BN FT 7MM 115MM STRL CNN SS ORTH,$487.20,$0.00,$487.20,$219.24,$347.71,$0.00,$83.94,$0.00,$0.00,$85.30,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$76.25,$0.00,$77.56,$0.00
71129120,SUP,HCPCS C1713,,71129120  -  SCREW BN FT 7MM 120MM STRL CNN SS ORTH,$467.25,$0.00,$467.25,$210.26,$333.48,$0.00,$80.50,$0.00,$0.00,$81.81,$467.25,$0.00,$233.63,$370.06,$373.80,$0.00,$73.12,$0.00,$74.39,$0.00
71129125,SUP,HCPCS C1713,,71129125  -  SCREW BN FT 7MM 125MM STRL CNN SS ORTH,$467.25,$0.00,$467.25,$210.26,$333.48,$0.00,$80.50,$0.00,$0.00,$81.81,$467.25,$0.00,$233.63,$370.06,$373.80,$0.00,$73.12,$0.00,$74.39,$0.00
71129130,SUP,HCPCS C1713,,71129130  -  SCREW BN FT 7MM 130MM STRL CNN SS ORTH,$487.20,$0.00,$487.20,$219.24,$347.71,$0.00,$83.94,$0.00,$0.00,$85.30,$487.20,$0.00,$243.60,$385.86,$389.76,$0.00,$76.25,$0.00,$77.56,$0.00
71129212,SUP,HCPCS C1713,,71129212  -  SCREW BN 4.5MM 12MM AMBI CLS ST CORT,$54.13,$0.00,$54.13,$24.36,$38.63,$0.00,$9.33,$0.00,$0.00,$9.48,$54.13,$0.00,$27.06,$42.87,$43.30,$0.00,$8.47,$0.00,$8.62,$0.00
71129214,SUP,HCPCS C1713,,71129214  -  SCREW BN 4.5MM 3.2MM 14MM AMBI CLS ST SS CORT HIP PLT,$54.13,$0.00,$54.13,$24.36,$38.63,$0.00,$9.33,$0.00,$0.00,$9.48,$54.13,$0.00,$27.06,$42.87,$43.30,$0.00,$8.47,$0.00,$8.62,$0.00
71129216,SUP,HCPCS C1713,,71129216  -  SCREW BN 4.5MM 8MM 16MM AMBI CLS ST SS HIP CORT,$54.13,$0.00,$54.13,$24.36,$38.63,$0.00,$9.33,$0.00,$0.00,$9.48,$54.13,$0.00,$27.06,$42.87,$43.30,$0.00,$8.47,$0.00,$8.62,$0.00
71129218,SUP,HCPCS C1713,,71129218  -  SCREW BN 4.5MM 8MM 18MM AMBI CLS ST SS HIP CORT,$54.13,$0.00,$54.13,$24.36,$38.63,$0.00,$9.33,$0.00,$0.00,$9.48,$54.13,$0.00,$27.06,$42.87,$43.30,$0.00,$8.47,$0.00,$8.62,$0.00
71129220,SUP,HCPCS C1713,,71129220  -  SCREW BN 4.5MM 8MM 20MM AMBI CLS ST SS HIP CORT,$54.13,$0.00,$54.13,$24.36,$38.63,$0.00,$9.33,$0.00,$0.00,$9.48,$54.13,$0.00,$27.06,$42.87,$43.30,$0.00,$8.47,$0.00,$8.62,$0.00
71129222,SUP,HCPCS C1713,,71129222  -  SCREW BN 4.5MM 8MM 22MM AMBI CLS ST SS HIP CORT,$54.13,$0.00,$54.13,$24.36,$38.63,$0.00,$9.33,$0.00,$0.00,$9.48,$54.13,$0.00,$27.06,$42.87,$43.30,$0.00,$8.47,$0.00,$8.62,$0.00
71129224,SUP,HCPCS C1713,,71129224  -  SCREW BN 4.5MM 24MM CHS ST SS CORT HIP PLT,$54.13,$0.00,$54.13,$24.36,$38.63,$0.00,$9.33,$0.00,$0.00,$9.48,$54.13,$0.00,$27.06,$42.87,$43.30,$0.00,$8.47,$0.00,$8.62,$0.00
71129226,SUP,HCPCS C1713,,71129226  -  SCREW BN 4.5MM 26MM AMBI CLS ST SS CORT,$54.13,$0.00,$54.13,$24.36,$38.63,$0.00,$9.33,$0.00,$0.00,$9.48,$54.13,$0.00,$27.06,$42.87,$43.30,$0.00,$8.47,$0.00,$8.62,$0.00
71129228,SUP,HCPCS C1713,,71129228  -  SCREW BN 4.5MM 8MM 28MM AMBI CLS ST SS HIP CORT,$54.13,$0.00,$54.13,$24.36,$38.63,$0.00,$9.33,$0.00,$0.00,$9.48,$54.13,$0.00,$27.06,$42.87,$43.30,$0.00,$8.47,$0.00,$8.62,$0.00
71129230,SUP,HCPCS C1713,,71129230  -  SCREW BN 4.5MM 3.2MM 30MM ST SS CORT SP CNDL PLT,$54.13,$0.00,$54.13,$24.36,$38.63,$0.00,$9.33,$0.00,$0.00,$9.48,$54.13,$0.00,$27.06,$42.87,$43.30,$0.00,$8.47,$0.00,$8.62,$0.00
71129232,SUP,HCPCS C1713,,71129232  -  SCREW BN 4.5MM 8MM 32MM AMBI CLS ST SS HIP CORT,$54.13,$0.00,$54.13,$24.36,$38.63,$0.00,$9.33,$0.00,$0.00,$9.48,$54.13,$0.00,$27.06,$42.87,$43.30,$0.00,$8.47,$0.00,$8.62,$0.00
71129234,SUP,HCPCS C1713,,71129234  -  SCREW BN 4.5MM 34MM IMHS ST SS CORT IM NL,$54.13,$0.00,$54.13,$24.36,$38.63,$0.00,$9.33,$0.00,$0.00,$9.48,$54.13,$0.00,$27.06,$42.87,$43.30,$0.00,$8.47,$0.00,$8.62,$0.00
71129236,SUP,HCPCS C1713,,71129236  -  SCREW BN 4.5MM 8MM 36MM AMBI CLS ST SS HIP CORT,$54.13,$0.00,$54.13,$24.36,$38.63,$0.00,$9.33,$0.00,$0.00,$9.48,$54.13,$0.00,$27.06,$42.87,$43.30,$0.00,$8.47,$0.00,$8.62,$0.00
71129238,SUP,HCPCS C1713,,71129238  -  SCREW BN 4.5MM 8MM 38MM AMBI CLS ST SS HIP CORT,$54.13,$0.00,$54.13,$24.36,$38.63,$0.00,$9.33,$0.00,$0.00,$9.48,$54.13,$0.00,$27.06,$42.87,$43.30,$0.00,$8.47,$0.00,$8.62,$0.00
71129240,SUP,HCPCS C1713,,71129240  -  SCREW BN 4.5MM 8MM 40MM ST HIP CORT,$54.13,$0.00,$54.13,$24.36,$38.63,$0.00,$9.33,$0.00,$0.00,$9.48,$54.13,$0.00,$27.06,$42.87,$43.30,$0.00,$8.47,$0.00,$8.62,$0.00
71129242,SUP,HCPCS C1713,,71129242  -  SCREW BN 4.5MM 8MM 42MM AMBI CLS ST SS HIP CORT,$54.13,$0.00,$54.13,$24.36,$38.63,$0.00,$9.33,$0.00,$0.00,$9.48,$54.13,$0.00,$27.06,$42.87,$43.30,$0.00,$8.47,$0.00,$8.62,$0.00
71129244,SUP,HCPCS C1713,,71129244  -  SCREW BN 4.5MM 8MM 44MM AMBI CLS ST SS HIP CORT,$54.13,$0.00,$54.13,$24.36,$38.63,$0.00,$9.33,$0.00,$0.00,$9.48,$54.13,$0.00,$27.06,$42.87,$43.30,$0.00,$8.47,$0.00,$8.62,$0.00
71129246,SUP,HCPCS C1713,,71129246  -  SCREW BN 4.5MM 8MM 46MM AMBI CLS ST SS HIP CORT,$54.13,$0.00,$54.13,$24.36,$38.63,$0.00,$9.33,$0.00,$0.00,$9.48,$54.13,$0.00,$27.06,$42.87,$43.30,$0.00,$8.47,$0.00,$8.62,$0.00
71129248,SUP,HCPCS C1713,,71129248  -  SCREW BN 4.5MM 8MM 48MM AMBI CLS ST SS HIP CORT,$54.13,$0.00,$54.13,$24.36,$38.63,$0.00,$9.33,$0.00,$0.00,$9.48,$54.13,$0.00,$27.06,$42.87,$43.30,$0.00,$8.47,$0.00,$8.62,$0.00
71129250,SUP,HCPCS C1713,,71129250  -  SCREW BN 4.5MM 8MM 50MM AMBI CLS ST SS HIP CORT,$54.13,$0.00,$54.13,$24.36,$38.63,$0.00,$9.33,$0.00,$0.00,$9.48,$54.13,$0.00,$27.06,$42.87,$43.30,$0.00,$8.47,$0.00,$8.62,$0.00
71129252,SUP,HCPCS C1713,,71129252  -  SCREW BN 4.5MM 8MM 52MM AMBI CLS ST SS HIP CORT,$54.13,$0.00,$54.13,$24.36,$38.63,$0.00,$9.33,$0.00,$0.00,$9.48,$54.13,$0.00,$27.06,$42.87,$43.30,$0.00,$8.47,$0.00,$8.62,$0.00
71129254,SUP,HCPCS C1713,,71129254  -  SCREW BN 4.5MM 8MM 54MM AMBI CLS ST SS HIP CORT,$54.13,$0.00,$54.13,$24.36,$38.63,$0.00,$9.33,$0.00,$0.00,$9.48,$54.13,$0.00,$27.06,$42.87,$43.30,$0.00,$8.47,$0.00,$8.62,$0.00
71129256,SUP,HCPCS C1713,,71129256  -  SCREW BN 4.5MM 8MM 56MM AMBI CLS ST SS HIP CORT,$54.13,$0.00,$54.13,$24.36,$38.63,$0.00,$9.33,$0.00,$0.00,$9.48,$54.13,$0.00,$27.06,$42.87,$43.30,$0.00,$8.47,$0.00,$8.62,$0.00
71129258,SUP,HCPCS C1713,,71129258  -  SCREW BN 4.5MM 3.2MM 58MM AMBI CLS ST SS CORT HIP PLT,$54.13,$0.00,$54.13,$24.36,$38.63,$0.00,$9.33,$0.00,$0.00,$9.48,$54.13,$0.00,$27.06,$42.87,$43.30,$0.00,$8.47,$0.00,$8.62,$0.00
71129260,SUP,HCPCS C1713,,71129260  -  SCREW BN 4.5MM 8MM 60MM AMBI CLS ST SS HIP CORT,$54.13,$0.00,$54.13,$24.36,$38.63,$0.00,$9.33,$0.00,$0.00,$9.48,$54.13,$0.00,$27.06,$42.87,$43.30,$0.00,$8.47,$0.00,$8.62,$0.00
71129262,SUP,HCPCS C1713,,71129262  -  SCREW BN 4.5MM 3.2MM 62MM AMBI CLS ST SS CORT HIP PLT,$54.13,$0.00,$54.13,$24.36,$38.63,$0.00,$9.33,$0.00,$0.00,$9.48,$54.13,$0.00,$27.06,$42.87,$43.30,$0.00,$8.47,$0.00,$8.62,$0.00
71129264,SUP,HCPCS C1713,,71129264  -  SCREW BN 4.5MM 8MM 64MM AMBI CLS ST SS HIP CORT,$54.13,$0.00,$54.13,$24.36,$38.63,$0.00,$9.33,$0.00,$0.00,$9.48,$54.13,$0.00,$27.06,$42.87,$43.30,$0.00,$8.47,$0.00,$8.62,$0.00
71130205,SUP,HCPCS C1713,,71130205  -  PLATE BN 3.5MM 5 HL CMPR PRV FX 3.5MM SCR SM FRAG SET,$359.10,$0.00,$359.10,$161.60,$256.29,$0.00,$61.87,$0.00,$0.00,$62.88,$359.10,$0.00,$179.55,$284.41,$287.28,$0.00,$56.20,$0.00,$57.17,$0.00
71130206,SUP,HCPCS C1713,,71130206  -  PLATE BN 3.5MM 6 HL CMPR PRV FX 3.5MM SCR SM FRAG SET,$378.00,$0.00,$378.00,$170.10,$269.78,$0.00,$65.13,$0.00,$0.00,$66.18,$378.00,$0.00,$189.00,$299.38,$302.40,$0.00,$59.16,$0.00,$60.18,$0.00
71130207,SUP,HCPCS C1713,,71130207  -  PLATE BN 3.5MM 7 HL CMPR PRV FX 3.5MM SCR SM FRAG SET,$389.55,$0.00,$389.55,$175.30,$278.02,$0.00,$67.12,$0.00,$0.00,$68.21,$389.55,$0.00,$194.78,$308.52,$311.64,$0.00,$60.96,$0.00,$62.02,$0.00
71130208,SUP,HCPCS C1713,,71130208  -  PLATE BN 3.5MM 8 HL CMPR PRV FX 3.5MM SCR SM FRAG SET,$411.60,$0.00,$411.60,$185.22,$293.76,$0.00,$70.92,$0.00,$0.00,$72.07,$411.60,$0.00,$205.80,$325.99,$329.28,$0.00,$64.42,$0.00,$65.53,$0.00
71130209,SUP,HCPCS C1713,,71130209  -  PLATE BN 3.5MM 9 HL CMPR PRV FX 3.5MM SCR SM FRAG SET,$434.70,$0.00,$434.70,$195.62,$310.25,$0.00,$74.90,$0.00,$0.00,$76.11,$434.70,$0.00,$217.35,$344.28,$347.76,$0.00,$68.03,$0.00,$69.20,$0.00
71130210,SUP,HCPCS C1713,,71130210  -  PLATE BN 3.5MM 10 HL CMPR PRV FX 3.5MM SCR SM FRAG SET,$442.05,$0.00,$442.05,$198.92,$315.49,$0.00,$76.16,$0.00,$0.00,$77.40,$442.05,$0.00,$221.03,$350.10,$353.64,$0.00,$69.18,$0.00,$70.37,$0.00
71130303,SUP,HCPCS C1713,,71130303  -  PLATE BN 1/3 TBLR 3 HL COLR PRV FX SM FRAG SET,$190.05,$0.00,$190.05,$85.52,$135.64,$0.00,$32.74,$0.00,$0.00,$33.28,$190.05,$0.00,$95.03,$150.52,$152.04,$0.00,$29.74,$0.00,$30.26,$0.00
71130304,SUP,HCPCS C1713,,71130304  -  PLATE BN 1/3 TBLR 4 HL COLR PRV FX SM FRAG SET,$204.75,$0.00,$204.75,$92.14,$146.13,$0.00,$35.28,$0.00,$0.00,$35.85,$204.75,$0.00,$102.38,$162.16,$163.80,$0.00,$32.04,$0.00,$32.60,$0.00
71130305,SUP,HCPCS C1713,,71130305  -  PLATE BN 1/3 TBLR 5 HL COLR PRV FX SM FRAG SET,$218.40,$0.00,$218.40,$98.28,$155.87,$0.00,$37.63,$0.00,$0.00,$38.24,$218.40,$0.00,$109.20,$172.97,$174.72,$0.00,$34.18,$0.00,$34.77,$0.00
71130306,SUP,HCPCS C1713,,71130306  -  PLATE BN 1/3 TBLR 6 HL COLR PRV FX SM FRAG SET,$211.05,$0.00,$211.05,$94.97,$150.63,$0.00,$36.36,$0.00,$0.00,$36.95,$211.05,$0.00,$105.53,$167.15,$168.84,$0.00,$33.03,$0.00,$33.60,$0.00
71130307,SUP,HCPCS C1713,,71130307  -  PLATE BN 1/3 TBLR 7 HL COLR PRV FX SM FRAG SET,$227.85,$0.00,$227.85,$102.53,$162.62,$0.00,$39.26,$0.00,$0.00,$39.89,$227.85,$0.00,$113.93,$180.46,$182.28,$0.00,$35.66,$0.00,$36.27,$0.00
71130308,SUP,HCPCS C1713,,71130308  -  PLATE BN 1/3 TBLR 8 HL COLR PRV FX SM FRAG SET,$235.20,$0.00,$235.20,$105.84,$167.86,$0.00,$40.52,$0.00,$0.00,$41.18,$235.20,$0.00,$117.60,$186.28,$188.16,$0.00,$36.81,$0.00,$37.44,$0.00
71130310,SUP,HCPCS C1713,,71130310  -  PLATE BN 1/3 TBLR 10 HL COLR PRV FX SM FRAG SET,$246.75,$0.00,$246.75,$111.04,$176.11,$0.00,$42.51,$0.00,$0.00,$43.20,$246.75,$0.00,$123.38,$195.43,$197.40,$0.00,$38.62,$0.00,$39.28,$0.00
71130403,SUP,HCPCS C1713,,71130403  -  PLATE BN T SM 3 HL PRV FX SM FRAG SET,$352.80,$0.00,$352.80,$158.76,$251.79,$0.00,$60.79,$0.00,$0.00,$61.77,$352.80,$0.00,$176.40,$279.42,$282.24,$0.00,$55.21,$0.00,$56.17,$0.00
71130404,SUP,HCPCS C1713,,71130404  -  PLATE BN T SM 4 HL PRV FX SM FRAG SET,$360.15,$0.00,$360.15,$162.07,$257.04,$0.00,$62.05,$0.00,$0.00,$63.06,$360.15,$0.00,$180.08,$285.24,$288.12,$0.00,$56.36,$0.00,$57.34,$0.00
71130405,SUP,HCPCS C1713,,71130405  -  PLATE BN T SM 5 HL PRV FX SM FRAG SET,$456.75,$0.00,$456.75,$205.54,$325.98,$0.00,$78.70,$0.00,$0.00,$79.97,$456.75,$0.00,$228.38,$361.75,$365.40,$0.00,$71.48,$0.00,$72.71,$0.00
71130503,SUP,HCPCS C1713,,71130503  -  PLATE BN T OBLQ 3 HL PRV FX SM FRAG SET,$581.70,$0.00,$581.70,$261.77,$415.16,$0.00,$100.22,$0.00,$0.00,$101.85,$581.70,$0.00,$290.85,$460.71,$465.36,$0.00,$91.04,$0.00,$92.61,$0.00
71130504,SUP,HCPCS C1713,,71130504  -  PLATE BN T OBLQ 4 HL PRV FX SM FRAG SET,$630.00,$0.00,$630.00,$283.50,$449.63,$0.00,$108.55,$0.00,$0.00,$110.31,$630.00,$0.00,$315.00,$498.96,$504.00,$0.00,$98.60,$0.00,$100.30,$0.00
71130505,SUP,HCPCS C1713,,71130505  -  PLATE BN T OBLQ 5 HL PRV FX SM FRAG SET,$640.50,$0.00,$640.50,$288.23,$457.12,$0.00,$110.35,$0.00,$0.00,$112.15,$640.50,$0.00,$320.25,$507.28,$512.40,$0.00,$100.24,$0.00,$101.97,$0.00
71130603,SUP,HCPCS C1713,,71130603  -  PLATE BN CLVRLF 3 HL PRV FX SM FRAG SET,$819.00,$0.00,$819.00,$368.55,$584.52,$0.00,$141.11,$0.00,$0.00,$143.40,$819.00,$0.00,$409.50,$648.65,$655.20,$0.00,$128.17,$0.00,$130.38,$0.00
71130804,SUP,HCPCS C1713,,71130804  -  PLATE BN L BTRS 4 HL PRV FX LT LG FRAG SET,$922.95,$0.00,$922.95,$415.33,$658.71,$0.00,$159.02,$0.00,$0.00,$161.60,$922.95,$0.00,$461.48,$730.98,$738.36,$0.00,$144.44,$0.00,$146.93,$0.00
71130904,SUP,HCPCS C1713,,71130904  -  PLATE BN L BTRS 4 HL PRV FX RT LG FRAG SET,$922.95,$0.00,$922.95,$415.33,$658.71,$0.00,$159.02,$0.00,$0.00,$161.60,$922.95,$0.00,$461.48,$730.98,$738.36,$0.00,$144.44,$0.00,$146.93,$0.00
71131007,SUP,HCPCS C1713,,71131007  -  PLATE BN BTRS 7 HL PRV FX TIBHD RL LG FRAG SET,"$1,974.00",$0.00,"$1,974.00",$888.30,"$1,408.84",$0.00,$340.11,$0.00,$0.00,$345.63,"$1,974.00",$0.00,$987.00,"$1,563.41","$1,579.20",$0.00,$308.93,$0.00,$314.26,$0.00
71131009,SUP,HCPCS C1713,,71131009  -  PLATE BN BTRS 9 HL PRV FX TIBHD RL LG FRAG SET,"$2,110.50",$0.00,"$2,110.50",$949.73,"$1,506.26",$0.00,$363.63,$0.00,$0.00,$369.53,"$2,110.50",$0.00,"$1,055.25","$1,671.52","$1,688.40",$0.00,$330.29,$0.00,$335.99,$0.00
71131107,SUP,HCPCS C1713,,71131107  -  PLATE BN BTRS 7 HL PRV FX TIBHD L/L LG FRAG SET,"$1,974.00",$0.00,"$1,974.00",$888.30,"$1,408.84",$0.00,$340.11,$0.00,$0.00,$345.63,"$1,974.00",$0.00,$987.00,"$1,563.41","$1,579.20",$0.00,$308.93,$0.00,$314.26,$0.00
71131109,SUP,HCPCS C1713,,71131109  -  PLATE BN BTRS 9 HL PRV FX TIBHD L/L LG FRAG SET,"$2,110.50",$0.00,"$2,110.50",$949.73,"$1,506.26",$0.00,$363.63,$0.00,$0.00,$369.53,"$2,110.50",$0.00,"$1,055.25","$1,671.52","$1,688.40",$0.00,$330.29,$0.00,$335.99,$0.00
71131206,SUP,HCPCS C1713,,71131206  -  PLATE BN 4.5MM BRD 6 HL PRV FX PERIART MTPHSL 4.5MM SCR LG,$703.50,$0.00,$703.50,$316.58,$502.09,$0.00,$121.21,$0.00,$0.00,$123.18,$703.50,$0.00,$351.75,$557.17,$562.80,$0.00,$110.10,$0.00,$112.00,$0.00
71131207,SUP,HCPCS C1713,,71131207  -  PLATE BN 4.5MM BRD 7 HL PRV FX PERIART MTPHSL 4.5MM SCR LG,$703.50,$0.00,$703.50,$316.58,$502.09,$0.00,$121.21,$0.00,$0.00,$123.18,$703.50,$0.00,$351.75,$557.17,$562.80,$0.00,$110.10,$0.00,$112.00,$0.00
71131208,SUP,HCPCS C1713,,71131208  -  PLATE BN 4.5MM BRD 8 HL PRV FX PERIART MTPHSL 4.5MM SCR LG,$875.70,$0.00,$875.70,$394.07,$624.99,$0.00,$150.88,$0.00,$0.00,$153.33,$875.70,$0.00,$437.85,$693.55,$700.56,$0.00,$137.05,$0.00,$139.41,$0.00
71131209,SUP,HCPCS C1713,,71131209  -  PLATE BN 4.5MM BRD 9 HL PRV FX PERIART MTPHSL 4.5MM SCR LG,$875.70,$0.00,$875.70,$394.07,$624.99,$0.00,$150.88,$0.00,$0.00,$153.33,$875.70,$0.00,$437.85,$693.55,$700.56,$0.00,$137.05,$0.00,$139.41,$0.00
71131210,SUP,HCPCS C1713,,71131210  -  PLATE BN 4.5MM BRD 10 HL PRV FX PERIART MTPHSL 4.5MM SCR LG,$875.70,$0.00,$875.70,$394.07,$624.99,$0.00,$150.88,$0.00,$0.00,$153.33,$875.70,$0.00,$437.85,$693.55,$700.56,$0.00,$137.05,$0.00,$139.41,$0.00
71131212,SUP,HCPCS C1713,,71131212  -  PLATE BN 4.5MM BRD 12 HL PRV FX PERIART MTPHSL 4.5MM SCR LG,$939.75,$0.00,$939.75,$422.89,$670.70,$0.00,$161.91,$0.00,$0.00,$164.54,$939.75,$0.00,$469.88,$744.28,$751.80,$0.00,$147.07,$0.00,$149.61,$0.00
71131214,SUP,HCPCS C1713,,71131214  -  PLATE BN 4.5MM BRD 14 HL PRV FX PERIART MTPHSL 4.5MM SCR LG,$939.75,$0.00,$939.75,$422.89,$670.70,$0.00,$161.91,$0.00,$0.00,$164.54,$939.75,$0.00,$469.88,$744.28,$751.80,$0.00,$147.07,$0.00,$149.61,$0.00
71131304,SUP,HCPCS C1713,,71131304  -  PLATE BN SMTB 4 HL PRV FX LG FRAG SET,$190.05,$0.00,$190.05,$85.52,$135.64,$0.00,$32.74,$0.00,$0.00,$33.28,$190.05,$0.00,$95.03,$150.52,$152.04,$0.00,$29.74,$0.00,$30.26,$0.00
71131305,SUP,HCPCS C1713,,71131305  -  PLATE BN SMTB 5 HL PRV FX LG FRAG SET,$192.15,$0.00,$192.15,$86.47,$137.14,$0.00,$33.11,$0.00,$0.00,$33.64,$192.15,$0.00,$96.08,$152.18,$153.72,$0.00,$30.07,$0.00,$30.59,$0.00
71131306,SUP,HCPCS C1713,,71131306  -  PLATE BN SMTB 6 HL PRV FX LG FRAG SET,$211.05,$0.00,$211.05,$94.97,$150.63,$0.00,$36.36,$0.00,$0.00,$36.95,$211.05,$0.00,$105.53,$167.15,$168.84,$0.00,$33.03,$0.00,$33.60,$0.00
71131307,SUP,HCPCS C1713,,71131307  -  PLATE BN SMTB 7 HL PRV FX LG FRAG SET,$223.65,$0.00,$223.65,$100.64,$159.62,$0.00,$38.53,$0.00,$0.00,$39.16,$223.65,$0.00,$111.83,$177.13,$178.92,$0.00,$35.00,$0.00,$35.61,$0.00
71131403,SUP,HCPCS C1713,,71131403  -  PLATE BN NAR 3 HL PRV FX PERIART MTPHSL 4.5MM SCR LG FRAG,$473.55,$0.00,$473.55,$213.10,$337.97,$0.00,$81.59,$0.00,$0.00,$82.91,$473.55,$0.00,$236.78,$375.05,$378.84,$0.00,$74.11,$0.00,$75.39,$0.00
71131404,SUP,HCPCS C1713,,71131404  -  PLATE BN NAR 4 HL PRV FX PERIART MTPHSL 4.5MM SCR LG FRAG,$473.55,$0.00,$473.55,$213.10,$337.97,$0.00,$81.59,$0.00,$0.00,$82.91,$473.55,$0.00,$236.78,$375.05,$378.84,$0.00,$74.11,$0.00,$75.39,$0.00
71131405,SUP,HCPCS C1713,,71131405  -  PLATE BN NAR 5 HL PRV FX PERIART MTPHSL 4.5MM SCR LG FRAG,$473.55,$0.00,$473.55,$213.10,$337.97,$0.00,$81.59,$0.00,$0.00,$82.91,$473.55,$0.00,$236.78,$375.05,$378.84,$0.00,$74.11,$0.00,$75.39,$0.00
71131406,SUP,HCPCS C1713,,71131406  -  PLATE BN NAR 6 HL PRV FX PERIART MTPHSL 4.5MM SCR LG FRAG,$441.00,$0.00,$441.00,$198.45,$314.74,$0.00,$75.98,$0.00,$0.00,$77.22,$441.00,$0.00,$220.50,$349.27,$352.80,$0.00,$69.02,$0.00,$70.21,$0.00
71131407,SUP,HCPCS C1713,,71131407  -  PLATE BN NAR 7 HL PRV FX PERIART MTPHSL 4.5MM SCR LG FRAG,$526.05,$0.00,$526.05,$236.72,$375.44,$0.00,$90.64,$0.00,$0.00,$92.11,$526.05,$0.00,$263.03,$416.63,$420.84,$0.00,$82.33,$0.00,$83.75,$0.00
71131408,SUP,HCPCS C1713,,71131408  -  PLATE BN NAR 8 HL PRV FX PERIART MTPHSL 4.5MM SCR LG FRAG,$441.00,$0.00,$441.00,$198.45,$314.74,$0.00,$75.98,$0.00,$0.00,$77.22,$441.00,$0.00,$220.50,$349.27,$352.80,$0.00,$69.02,$0.00,$70.21,$0.00
71131409,SUP,HCPCS C1713,,71131409  -  PLATE BN NAR 9 HL PRV FX PERIART MTPHSL 4.5MM SCR LG FRAG,$441.00,$0.00,$441.00,$198.45,$314.74,$0.00,$75.98,$0.00,$0.00,$77.22,$441.00,$0.00,$220.50,$349.27,$352.80,$0.00,$69.02,$0.00,$70.21,$0.00
71131410,SUP,HCPCS C1713,,71131410  -  PLATE BN NAR 10 HL PRV FX PERIART MTPHSL 4.5MM SCR LG FRAG,$570.15,$0.00,$570.15,$256.57,$406.92,$0.00,$98.23,$0.00,$0.00,$99.83,$570.15,$0.00,$285.08,$451.56,$456.12,$0.00,$89.23,$0.00,$90.77,$0.00
71131411,SUP,HCPCS C1713,,71131411  -  PLATE BN NAR 11 HL PRV FX PERIART MTPHSL 4.5MM SCR LG FRAG,$696.15,$0.00,$696.15,$313.27,$496.84,$0.00,$119.94,$0.00,$0.00,$121.89,$696.15,$0.00,$348.08,$551.35,$556.92,$0.00,$108.95,$0.00,$110.83,$0.00
71131412,SUP,HCPCS C1713,,71131412  -  PLATE BN NAR 12 HL PRV FX PERIART MTPHSL 4.5MM SCR LG FRAG,$696.15,$0.00,$696.15,$313.27,$496.84,$0.00,$119.94,$0.00,$0.00,$121.89,$696.15,$0.00,$348.08,$551.35,$556.92,$0.00,$108.95,$0.00,$110.83,$0.00
71131510,SUP,HCPCS C1713,,71131510  -  PIN FX LG ST 2MM 61MM 10MM TRL SS,$221.55,$0.00,$221.55,$99.70,$158.12,$0.00,$38.17,$0.00,$0.00,$38.79,$221.55,$0.00,$110.78,$175.47,$177.24,$0.00,$34.67,$0.00,$35.27,$0.00
71131511,SUP,HCPCS C1713,,71131511  -  PIN FX LG MED THRD 2MM 38MM 13MM TRL SS,$221.55,$0.00,$221.55,$99.70,$158.12,$0.00,$38.17,$0.00,$0.00,$38.79,$221.55,$0.00,$110.78,$175.47,$177.24,$0.00,$34.67,$0.00,$35.27,$0.00
71131512,SUP,HCPCS C1713,,71131512  -  PIN FX LG L/T 2MM 61MM 23MM TRL SS,$235.20,$0.00,$235.20,$105.84,$167.86,$0.00,$40.52,$0.00,$0.00,$41.18,$235.20,$0.00,$117.60,$186.28,$188.16,$0.00,$36.81,$0.00,$37.44,$0.00
71131604,SUP,HCPCS C1713,,71131604  -  PLATE BN T 4 HL PRV FX LG FRAG SET,$340.20,$0.00,$340.20,$153.09,$242.80,$0.00,$58.61,$0.00,$0.00,$59.57,$340.20,$0.00,$170.10,$269.44,$272.16,$0.00,$53.24,$0.00,$54.16,$0.00
71131606,SUP,HCPCS C1713,,71131606  -  PLATE BN T 6 HL PRV FX LG FRAG SET,$376.95,$0.00,$376.95,$169.63,$269.03,$0.00,$64.95,$0.00,$0.00,$66.00,$376.95,$0.00,$188.48,$298.54,$301.56,$0.00,$58.99,$0.00,$60.01,$0.00
71131608,SUP,HCPCS C1713,,71131608  -  PLATE BN T 8 HL PRV FX LG FRAG SET,"$1,118.25",$0.00,"$1,118.25",$503.21,$798.10,$0.00,$192.67,$0.00,$0.00,$195.80,"$1,118.25",$0.00,$559.13,$885.65,$894.60,$0.00,$175.01,$0.00,$178.03,$0.00
71134016,SUP,Custom 27203010,,71134016  -  BIT DRL 2MM TWST PED,$91.40,$0.00,$91.40,$0.00,$65.23,$0.00,$0.00,$0.00,$0.00,$0.00,$91.40,$0.00,$45.70,$72.39,$73.12,$0.00,$0.00,$0.00,$0.00,$0.00
71134064,SUP,Custom 27203010,,71134064  -  BIT DRL 2.7MM TWST PED,$95.70,$0.00,$95.70,$0.00,$68.30,$0.00,$0.00,$0.00,$0.00,$0.00,$95.70,$0.00,$47.85,$75.79,$76.56,$0.00,$0.00,$0.00,$0.00,$0.00
71140003,SUP,HCPCS C1713,,71140003  -  PLATE BN 45MM TC100 3 HL RECON SS PLVC 4.5MM SCR,$798.00,$0.00,$798.00,$359.10,$569.53,$0.00,$137.49,$0.00,$0.00,$139.72,$798.00,$0.00,$399.00,$632.02,$638.40,$0.00,$124.89,$0.00,$127.04,$0.00
71140004,SUP,HCPCS C1713,,71140004  -  PLATE BN 61MM TC100 4 HL RECON SS PLVC 4.5MM SCR,$846.30,$0.00,$846.30,$380.84,$604.00,$0.00,$145.81,$0.00,$0.00,$148.18,$846.30,$0.00,$423.15,$670.27,$677.04,$0.00,$132.45,$0.00,$134.73,$0.00
71140005,SUP,HCPCS C1713,,71140005  -  PLATE BN 77MM TC100 5 HL RECON SS PLVC 4.5MM SCR,$910.35,$0.00,$910.35,$409.66,$649.72,$0.00,$156.85,$0.00,$0.00,$159.40,$910.35,$0.00,$455.18,$721.00,$728.28,$0.00,$142.47,$0.00,$144.93,$0.00
71140006,SUP,HCPCS C1713,,71140006  -  PLATE BN 93MM TC100 6 HL RECON SS PLVC 4.5MM SCR,$972.30,$0.00,$972.30,$437.54,$693.93,$0.00,$167.52,$0.00,$0.00,$170.24,$972.30,$0.00,$486.15,$770.06,$777.84,$0.00,$152.16,$0.00,$154.79,$0.00
71140007,SUP,HCPCS C1713,,71140007  -  PLATE BN 109MM TC100 7 HL RECON SS PLVC 4.5MM SCR,"$1,025.85",$0.00,"$1,025.85",$461.63,$732.15,$0.00,$176.75,$0.00,$0.00,$179.62,"$1,025.85",$0.00,$512.93,$812.47,$820.68,$0.00,$160.55,$0.00,$163.32,$0.00
71140008,SUP,HCPCS C1713,,71140008  -  PLATE BN 125MM TC100 8 HL RECON SS PLVC 4.5MM SCR,"$1,302.00",$0.00,"$1,302.00",$585.90,$929.24,$0.00,$224.33,$0.00,$0.00,$227.97,"$1,302.00",$0.00,$651.00,"$1,031.18","$1,041.60",$0.00,$203.76,$0.00,$207.28,$0.00
71140009,SUP,HCPCS C1713,,71140009  -  PLATE BN 141MM TC100 9 HL RECON SS PLVC 4.5MM SCR,"$1,391.25",$0.00,"$1,391.25",$626.06,$992.94,$0.00,$239.71,$0.00,$0.00,$243.60,"$1,391.25",$0.00,$695.63,"$1,101.87","$1,113.00",$0.00,$217.73,$0.00,$221.49,$0.00
71140010,SUP,HCPCS C1713,,71140010  -  PLATE BN 157MM TC100 10 HL RECON SS PLVC 4.5MM SCR,"$1,464.75",$0.00,"$1,464.75",$659.14,"$1,045.39",$0.00,$252.37,$0.00,$0.00,$256.47,"$1,464.75",$0.00,$732.38,"$1,160.08","$1,171.80",$0.00,$229.23,$0.00,$233.19,$0.00
71140011,SUP,HCPCS C1713,,71140011  -  PLATE BN 173MM TC100 11 HL RECON SS PLVC 4.5MM SCR,"$1,506.75",$0.00,"$1,506.75",$678.04,"$1,075.37",$0.00,$259.61,$0.00,$0.00,$263.82,"$1,506.75",$0.00,$753.38,"$1,193.35","$1,205.40",$0.00,$235.81,$0.00,$239.87,$0.00
71140012,SUP,HCPCS C1713,,71140012  -  PLATE BN 189MM TC100 12 HL RECON SS PLVC 4.5MM SCR,"$1,302.00",$0.00,"$1,302.00",$585.90,$929.24,$0.00,$224.33,$0.00,$0.00,$227.97,"$1,302.00",$0.00,$651.00,"$1,031.18","$1,041.60",$0.00,$203.76,$0.00,$207.28,$0.00
71140013,SUP,HCPCS C1713,,71140013  -  PLATE BN 205MM TC100 13 HL RECON SS PLVC 4.5MM SCR,"$1,701.00",$0.00,"$1,701.00",$765.45,"$1,214.00",$0.00,$293.07,$0.00,$0.00,$297.83,"$1,701.00",$0.00,$850.50,"$1,347.19","$1,360.80",$0.00,$266.21,$0.00,$270.80,$0.00
71140014,SUP,HCPCS C1713,,71140014  -  PLATE BN 221MM TC100 14 HL RECON SS PLVC 4.5MM SCR,"$1,422.75",$0.00,"$1,422.75",$640.24,"$1,015.42",$0.00,$245.13,$0.00,$0.00,$249.11,"$1,422.75",$0.00,$711.38,"$1,126.82","$1,138.20",$0.00,$222.66,$0.00,$226.50,$0.00
71140015,SUP,HCPCS C1713,,71140015  -  PLATE BN 237MM TC100 15 HL RECON SS PLVC 4.5MM SCR,"$1,806.00",$0.00,"$1,806.00",$812.70,"$1,288.94",$0.00,$311.16,$0.00,$0.00,$316.22,"$1,806.00",$0.00,$903.00,"$1,430.35","$1,444.80",$0.00,$282.64,$0.00,$287.52,$0.00
71140016,SUP,HCPCS C1713,,71140016  -  PLATE BN 253MM TC100 16 HL RECON SS PLVC 4.5MM SCR,"$1,869.00",$0.00,"$1,869.00",$841.05,"$1,333.91",$0.00,$322.02,$0.00,$0.00,$327.25,"$1,869.00",$0.00,$934.50,"$1,480.25","$1,495.20",$0.00,$292.50,$0.00,$297.54,$0.00
71140104,SUP,HCPCS C1713,,71140104  -  PLATE BN 46MM TC100 4 HL RECON SS PLVC 3.5MM SCR SM FRAG SET,$875.70,$0.00,$875.70,$394.07,$624.99,$0.00,$150.88,$0.00,$0.00,$153.33,$875.70,$0.00,$437.85,$693.55,$700.56,$0.00,$137.05,$0.00,$139.41,$0.00
71140105,SUP,HCPCS C1713,,71140105  -  PLATE BN 58MM TC100 5 HL RECON SS PLVC 3.5MM SCR SM FRAG SET,$812.70,$0.00,$812.70,$365.72,$580.02,$0.00,$140.02,$0.00,$0.00,$142.30,$812.70,$0.00,$406.35,$643.66,$650.16,$0.00,$127.19,$0.00,$129.38,$0.00
71140106,SUP,HCPCS C1713,,71140106  -  PLATE BN 70MM TC100 6 HL RECON SS PLVC 3.5MM SCR SM FRAG SET,"$1,022.70",$0.00,"$1,022.70",$460.22,$729.90,$0.00,$176.21,$0.00,$0.00,$179.07,"$1,022.70",$0.00,$511.35,$809.98,$818.16,$0.00,$160.05,$0.00,$162.81,$0.00
71140107,SUP,HCPCS C1713,,71140107  -  PLATE BN 82MM TC100 7 HL RECON SS PLVC 3.5MM SCR SM FRAG SET,$974.40,$0.00,$974.40,$438.48,$695.43,$0.00,$167.88,$0.00,$0.00,$170.61,$974.40,$0.00,$487.20,$771.72,$779.52,$0.00,$152.49,$0.00,$155.12,$0.00
71140108,SUP,HCPCS C1713,,71140108  -  PLATE BN 94MM TC100 8 HL RECON SS PLVC 3.5MM SCR SM FRAG SET,"$1,118.25",$0.00,"$1,118.25",$503.21,$798.10,$0.00,$192.67,$0.00,$0.00,$195.80,"$1,118.25",$0.00,$559.13,$885.65,$894.60,$0.00,$175.01,$0.00,$178.03,$0.00
71140109,SUP,HCPCS C1713,,71140109  -  PLATE BN 106MM TC100 9 HL RECON SS PLVC 3.5MM SCR SM FRAG,"$1,050.00",$0.00,"$1,050.00",$472.50,$749.39,$0.00,$180.91,$0.00,$0.00,$183.85,"$1,050.00",$0.00,$525.00,$831.60,$840.00,$0.00,$164.33,$0.00,$167.16,$0.00
71140110,SUP,HCPCS C1713,,71140110  -  PLATE BN 118MM TC100 10 HL RECON SS PLVC 3.5MM SCR,"$1,149.75",$0.00,"$1,149.75",$517.39,$820.58,$0.00,$198.10,$0.00,$0.00,$201.31,"$1,149.75",$0.00,$574.88,$910.60,$919.80,$0.00,$179.94,$0.00,$183.04,$0.00
71140111,SUP,HCPCS C1713,,71140111  -  PLATE BN 130MM TC100 11 HL RECON SS PLVC 3.5MM SCR SM FRAG,"$1,118.25",$0.00,"$1,118.25",$503.21,$798.10,$0.00,$192.67,$0.00,$0.00,$195.80,"$1,118.25",$0.00,$559.13,$885.65,$894.60,$0.00,$175.01,$0.00,$178.03,$0.00
71140112,SUP,HCPCS C1713,,71140112  -  PLATE BN 142MM TC100 12 HL RECON SS PLVC 3.5MM SCR,"$1,260.00",$0.00,"$1,260.00",$567.00,$899.26,$0.00,$217.09,$0.00,$0.00,$220.62,"$1,260.00",$0.00,$630.00,$997.92,"$1,008.00",$0.00,$197.19,$0.00,$200.59,$0.00
71140113,SUP,HCPCS C1713,,71140113  -  PLATE BN 154MM TC100 13 HL RECON SS PLVC 3.5MM SCR SM FRAG,"$1,496.25",$0.00,"$1,496.25",$673.31,"$1,067.87",$0.00,$257.80,$0.00,$0.00,$261.98,"$1,496.25",$0.00,$748.13,"$1,185.03","$1,197.00",$0.00,$234.16,$0.00,$238.20,$0.00
71140114,SUP,HCPCS C1713,,71140114  -  PLATE BN 166MM TC100 14 HL RECON SS PLVC 3.5MM SCR SM FRAG,"$1,380.75",$0.00,"$1,380.75",$621.34,$985.44,$0.00,$237.90,$0.00,$0.00,$241.76,"$1,380.75",$0.00,$690.38,"$1,093.55","$1,104.60",$0.00,$216.09,$0.00,$219.82,$0.00
71140115,SUP,HCPCS C1713,,71140115  -  PLATE BN 178MM TC100 15 HL RECON SS PLVC 3.5MM SCR SM FRAG,"$1,648.50",$0.00,"$1,648.50",$741.83,"$1,176.53",$0.00,$284.03,$0.00,$0.00,$288.64,"$1,648.50",$0.00,$824.25,"$1,305.61","$1,318.80",$0.00,$257.99,$0.00,$262.44,$0.00
71140116,SUP,HCPCS C1713,,71140116  -  PLATE BN 190MM TC100 16 HL RECON SS PLVC 3.5MM SCR SM FRAG,"$1,407.00",$0.00,"$1,407.00",$633.15,"$1,004.18",$0.00,$242.42,$0.00,$0.00,$246.35,"$1,407.00",$0.00,$703.50,"$1,114.34","$1,125.60",$0.00,$220.20,$0.00,$223.99,$0.00
71140118,SUP,HCPCS C1713,,71140118  -  PLATE BN 214MM TC100 18 HL RECON SS PLVC 3.5MM SCR SM FRAG,"$1,480.50",$0.00,"$1,480.50",$666.23,"$1,056.63",$0.00,$255.08,$0.00,$0.00,$259.22,"$1,480.50",$0.00,$740.25,"$1,172.56","$1,184.40",$0.00,$231.70,$0.00,$235.70,$0.00
71140120,SUP,HCPCS C1713,,71140120  -  PLATE BN 238MM TC100 20 HL RECON SS PLVC 3.5MM SCR SM FRAG,"$1,800.75",$0.00,"$1,800.75",$810.34,"$1,285.20",$0.00,$310.26,$0.00,$0.00,$315.30,"$1,800.75",$0.00,$900.38,"$1,426.19","$1,440.60",$0.00,$281.82,$0.00,$286.68,$0.00
71140122,SUP,HCPCS C1713,,71140122  -  PLATE BN 263MM TC100 22 HL RECON SS PLVC 3.5MM SCR SM FRAG,"$2,283.75",$0.00,"$2,283.75","$1,027.69","$1,629.91",$0.00,$393.48,$0.00,$0.00,$399.87,"$2,283.75",$0.00,"$1,141.88","$1,808.73","$1,827.00",$0.00,$357.41,$0.00,$363.57,$0.00
71140202,SUP,HCPCS C1713,,71140202  -  PLATE BN 25MM TC100 2 HL CMPR SS PLVC 3.5MM SCR SM FRAG SET,$296.10,$0.00,$296.10,$133.25,$211.33,$0.00,$51.02,$0.00,$0.00,$51.84,$296.10,$0.00,$148.05,$234.51,$236.88,$0.00,$46.34,$0.00,$47.14,$0.00
71140203,SUP,HCPCS C1713,,71140203  -  PLATE BN 37MM TC100 3 HL CMPR SS PLVC 3.5MM SCR SM FRAG SET,$309.75,$0.00,$309.75,$139.39,$221.07,$0.00,$53.37,$0.00,$0.00,$54.23,$309.75,$0.00,$154.88,$245.32,$247.80,$0.00,$48.48,$0.00,$49.31,$0.00
71140204,SUP,HCPCS C1713,,71140204  -  PLATE BN 49MM TC100 4 HL CMPR SS PLVC 3.5MM SCR SM FRAG SET,$316.05,$0.00,$316.05,$142.22,$225.56,$0.00,$54.45,$0.00,$0.00,$55.34,$316.05,$0.00,$158.03,$250.31,$252.84,$0.00,$49.46,$0.00,$50.32,$0.00
71140205,SUP,HCPCS C1713,,71140205  -  PLATE BN 61MM TC100 5 HL CMPR SS PLVC 3.5MM SCR SM FRAG SET,$345.45,$0.00,$345.45,$155.45,$246.55,$0.00,$59.52,$0.00,$0.00,$60.49,$345.45,$0.00,$172.73,$273.60,$276.36,$0.00,$54.06,$0.00,$55.00,$0.00
71140206,SUP,HCPCS C1713,,71140206  -  PLATE BN 73MM TC100 6 HL CMPR SS PLVC 3.5MM SCR SM FRAG SET,$361.20,$0.00,$361.20,$162.54,$257.79,$0.00,$62.23,$0.00,$0.00,$63.24,$361.20,$0.00,$180.60,$286.07,$288.96,$0.00,$56.53,$0.00,$57.50,$0.00
71140207,SUP,HCPCS C1713,,71140207  -  PLATE BN 85MM TC100 7 HL CMPR SS PLVC 3.5MM SCR,$378.00,$0.00,$378.00,$170.10,$269.78,$0.00,$65.13,$0.00,$0.00,$66.18,$378.00,$0.00,$189.00,$299.38,$302.40,$0.00,$59.16,$0.00,$60.18,$0.00
71140208,SUP,HCPCS C1713,,71140208  -  PLATE BN 97MM 8 HL HIP 3.5MM SCR SM FRAG SET,$405.30,$0.00,$405.30,$182.39,$289.26,$0.00,$69.83,$0.00,$0.00,$70.96,$405.30,$0.00,$202.65,$321.00,$324.24,$0.00,$63.43,$0.00,$64.52,$0.00
71140209,SUP,HCPCS C1713,,71140209  -  PLATE BN 109MM TC100 9 HL CMPR SS PLVC 3.5MM SCR SM FRAG SET,$414.75,$0.00,$414.75,$186.64,$296.01,$0.00,$71.46,$0.00,$0.00,$72.62,$414.75,$0.00,$207.38,$328.48,$331.80,$0.00,$64.91,$0.00,$66.03,$0.00
71140210,SUP,HCPCS C1713,,71140210  -  PLATE BN 121MM TC100 10 HL CMPR SS PLVC 3.5MM SCR SM FRAG,$426.30,$0.00,$426.30,$191.84,$304.25,$0.00,$73.45,$0.00,$0.00,$74.64,$426.30,$0.00,$213.15,$337.63,$341.04,$0.00,$66.72,$0.00,$67.87,$0.00
71140212,SUP,HCPCS C1713,,71140212  -  PLATE BN 145MM TC100 12 HL CMPR SS PLVC 3.5MM SCR SM FRAG,$473.55,$0.00,$473.55,$213.10,$337.97,$0.00,$81.59,$0.00,$0.00,$82.91,$473.55,$0.00,$236.78,$375.05,$378.84,$0.00,$74.11,$0.00,$75.39,$0.00
71140214,SUP,HCPCS C1713,,71140214  -  PLATE BN 169MM TC100 14 HL CMPR SS PLVC 3.5MM SCR SM FRAG,$889.35,$0.00,$889.35,$400.21,$634.73,$0.00,$153.23,$0.00,$0.00,$155.72,$889.35,$0.00,$444.68,$704.37,$711.48,$0.00,$139.18,$0.00,$141.58,$0.00
71140216,SUP,HCPCS C1713,,71140216  -  PLATE BN 194MM TC100 16 HL CMPR SS PLVC 3.5MM SCR SM FRAG,"$1,025.85",$0.00,"$1,025.85",$461.63,$732.15,$0.00,$176.75,$0.00,$0.00,$179.62,"$1,025.85",$0.00,$512.93,$812.47,$820.68,$0.00,$160.55,$0.00,$163.32,$0.00
71140218,SUP,HCPCS C1713,,71140218  -  PLATE BN 217MM TC100 18 HL CMPR SS PLVC 3.5MM SCR SM FRAG,"$1,380.75",$0.00,"$1,380.75",$621.34,$985.44,$0.00,$237.90,$0.00,$0.00,$241.76,"$1,380.75",$0.00,$690.38,"$1,093.55","$1,104.60",$0.00,$216.09,$0.00,$219.82,$0.00
71140220,SUP,HCPCS C1713,,71140220  -  PLATE BN 242MM TC100 20 HL CMPR SS PLVC 3.5MM SCR SM FRAG,"$1,270.50",$0.00,"$1,270.50",$571.73,$906.76,$0.00,$218.90,$0.00,$0.00,$222.45,"$1,270.50",$0.00,$635.25,"$1,006.24","$1,016.40",$0.00,$198.83,$0.00,$202.26,$0.00
71140222,SUP,HCPCS C1713,,71140222  -  PLATE BN 265MM TC100 22 HL CMPR SS PLVC 3.5MM SCR SM FRAG,"$1,701.00",$0.00,"$1,701.00",$765.45,"$1,214.00",$0.00,$293.07,$0.00,$0.00,$297.83,"$1,701.00",$0.00,$850.50,"$1,347.19","$1,360.80",$0.00,$266.21,$0.00,$270.80,$0.00
71140302,SUP,HCPCS C1713,,71140302  -  PLATE BN 25MM TC100 2 HL 1/3 TBLR COLR SS PLVC 3.5MM SCR SM,$169.05,$0.00,$169.05,$76.07,$120.65,$0.00,$29.13,$0.00,$0.00,$29.60,$169.05,$0.00,$84.53,$133.89,$135.24,$0.00,$26.46,$0.00,$26.91,$0.00
71140303,SUP,HCPCS C1713,,71140303  -  PLATE BN 37MM TC100 3 HL 1/3 TBLR COLR SS PLVC 3.5MM SCR SM,$143.85,$0.00,$143.85,$64.73,$102.67,$0.00,$24.78,$0.00,$0.00,$25.19,$143.85,$0.00,$71.93,$113.93,$115.08,$0.00,$22.51,$0.00,$22.90,$0.00
71140304,SUP,HCPCS C1713,,71140304  -  PLATE BN 49MM TC100 4 HL 1/3 TBLR COLR SS PLVC 3.5MM SCR SM,$169.05,$0.00,$169.05,$76.07,$120.65,$0.00,$29.13,$0.00,$0.00,$29.60,$169.05,$0.00,$84.53,$133.89,$135.24,$0.00,$26.46,$0.00,$26.91,$0.00
71140305,SUP,HCPCS C1713,,71140305  -  PLATE BN 61MM TC100 5 HL 1/3 TBLR COLR SS PLVC 3.5MM SCR SM,$211.05,$0.00,$211.05,$94.97,$150.63,$0.00,$36.36,$0.00,$0.00,$36.95,$211.05,$0.00,$105.53,$167.15,$168.84,$0.00,$33.03,$0.00,$33.60,$0.00
71140306,SUP,HCPCS C1713,,71140306  -  PLATE BN 73MM TC100 6 HL 1/3 TBLR COLR SS PLVC 3.5MM SCR SM,$175.35,$0.00,$175.35,$78.91,$125.15,$0.00,$30.21,$0.00,$0.00,$30.70,$175.35,$0.00,$87.68,$138.88,$140.28,$0.00,$27.44,$0.00,$27.92,$0.00
71140307,SUP,HCPCS C1713,,71140307  -  PLATE BN 1/3 TBLR 85MM NS TC100 7 HL COLR SS PLVC 3.5MM SCR,$175.35,$0.00,$175.35,$78.91,$125.15,$0.00,$30.21,$0.00,$0.00,$30.70,$175.35,$0.00,$87.68,$138.88,$140.28,$0.00,$27.44,$0.00,$27.92,$0.00
71140308,SUP,HCPCS C1713,,71140308  -  PLATE BN 97MM TC100 8 HL 1/3 TBLR COLR SS PLVC 3.5MM SCR SM,$177.45,$0.00,$177.45,$79.85,$126.65,$0.00,$30.57,$0.00,$0.00,$31.07,$177.45,$0.00,$88.73,$140.54,$141.96,$0.00,$27.77,$0.00,$28.25,$0.00
71140309,SUP,HCPCS C1713,,71140309  -  PLATE BN 109MM TC100 9 HL 1/3 TBLR COLR SS PLVC 3.5MM SCR SM,$177.45,$0.00,$177.45,$79.85,$126.65,$0.00,$30.57,$0.00,$0.00,$31.07,$177.45,$0.00,$88.73,$140.54,$141.96,$0.00,$27.77,$0.00,$28.25,$0.00
71140310,SUP,HCPCS C1713,,71140310  -  PLATE BN 121MM TC100 10 HL 1/3 TBLR COLR SS PLVC 3.5MM SCR,$177.45,$0.00,$177.45,$79.85,$126.65,$0.00,$30.57,$0.00,$0.00,$31.07,$177.45,$0.00,$88.73,$140.54,$141.96,$0.00,$27.77,$0.00,$28.25,$0.00
71140312,SUP,HCPCS C1713,,71140312  -  PLATE BN 145MM TC100 12 HL 1/3 TBLR COLR SS ORTH SM FRAG SET,$181.65,$0.00,$181.65,$81.74,$129.64,$0.00,$31.30,$0.00,$0.00,$31.81,$181.65,$0.00,$90.83,$143.87,$145.32,$0.00,$28.43,$0.00,$28.92,$0.00
71140403,SUP,HCPCS C1713,,71140403  -  PLATE BN SM T RT ANG 50MM TC100 3X3 HL SS PLVC SM FRAG SET,$313.95,$0.00,$313.95,$141.28,$224.07,$0.00,$54.09,$0.00,$0.00,$54.97,$313.95,$0.00,$156.98,$248.65,$251.16,$0.00,$49.13,$0.00,$49.98,$0.00
71140404,SUP,HCPCS C1713,,71140404  -  PLATE BN SM T RT ANG 50MM TC100 4X4 HL SS PLVC SM FRAG SET,$320.25,$0.00,$320.25,$144.11,$228.56,$0.00,$55.18,$0.00,$0.00,$56.07,$320.25,$0.00,$160.13,$253.64,$256.20,$0.00,$50.12,$0.00,$50.98,$0.00
71140405,SUP,HCPCS C1713,,71140405  -  PLATE BN SM T RT ANG 50MM TC100 3X5 HL SS PLVC SM FRAG SET,$360.15,$0.00,$360.15,$162.07,$257.04,$0.00,$62.05,$0.00,$0.00,$63.06,$360.15,$0.00,$180.08,$285.24,$288.12,$0.00,$56.36,$0.00,$57.34,$0.00
71140406,SUP,HCPCS C1713,,71140406  -  PLATE BN 78MM TC100 4 HLE/HD 6 HL SHFT T RT ANG SS ORTH SM,$414.75,$0.00,$414.75,$186.64,$296.01,$0.00,$71.46,$0.00,$0.00,$72.62,$414.75,$0.00,$207.38,$328.48,$331.80,$0.00,$64.91,$0.00,$66.03,$0.00
71140503,SUP,HCPCS C1713,,71140503  -  PLATE BN SM T OBLQ 53MM TC100 3X3 HL SS PLVC SM FRAG SET,$563.85,$0.00,$563.85,$253.73,$402.42,$0.00,$97.15,$0.00,$0.00,$98.73,$563.85,$0.00,$281.93,$446.57,$451.08,$0.00,$88.24,$0.00,$89.76,$0.00
71140504,SUP,HCPCS C1713,,71140504  -  PLATE BN SM T OBLQ 53MM TC100 3X4 HL SS PLVC SM FRAG SET,$588.00,$0.00,$588.00,$264.60,$419.66,$0.00,$101.31,$0.00,$0.00,$102.95,$588.00,$0.00,$294.00,$465.70,$470.40,$0.00,$92.02,$0.00,$93.61,$0.00
71140505,SUP,HCPCS C1713,,71140505  -  PLATE BN SM T OBLQ 53MM TC100 3X5 HL SS PLVC SM FRAG SET,$609.00,$0.00,$609.00,$274.05,$434.64,$0.00,$104.93,$0.00,$0.00,$106.63,$609.00,$0.00,$304.50,$482.33,$487.20,$0.00,$95.31,$0.00,$96.95,$0.00
71140603,SUP,HCPCS C1713,,71140603  -  PLATE BN 88MM TC100 3 HL CLVRLF SS ORTH SM FRAG SET,$744.45,$0.00,$744.45,$335.00,$531.31,$0.00,$128.27,$0.00,$0.00,$130.35,$744.45,$0.00,$372.23,$589.60,$595.56,$0.00,$116.51,$0.00,$118.52,$0.00
71140604,SUP,HCPCS C1713,,71140604  -  PLATE BN 104MM TC100 4 HL CLVRLF SS ORTH SM FRAG SET,$798.00,$0.00,$798.00,$359.10,$569.53,$0.00,$137.49,$0.00,$0.00,$139.72,$798.00,$0.00,$399.00,$632.02,$638.40,$0.00,$124.89,$0.00,$127.04,$0.00
71140606,SUP,HCPCS C1713,,71140606  -  PLATE BN 70MM TC100 6 HL CRV RECON SS PLVC 3.5MM SCR,"$1,039.50",$0.00,"$1,039.50",$467.78,$741.89,$0.00,$179.10,$0.00,$0.00,$182.01,"$1,039.50",$0.00,$519.75,$823.28,$831.60,$0.00,$162.68,$0.00,$165.49,$0.00
71140608,SUP,HCPCS C1713,,71140608  -  PLATE BN 94MM TC100 8 HL CRV RECON SS PLVC 3.5MM SCR,"$1,134.00",$0.00,"$1,134.00",$510.30,$809.34,$0.00,$195.38,$0.00,$0.00,$198.55,"$1,134.00",$0.00,$567.00,$898.13,$907.20,$0.00,$177.47,$0.00,$180.53,$0.00
71140610,SUP,HCPCS C1713,,71140610  -  PLATE BN 118MM TC100 10 HL CRV RECON SS PLVC 3.5MM SCR,"$1,186.50",$0.00,"$1,186.50",$533.93,$846.81,$0.00,$204.43,$0.00,$0.00,$207.75,"$1,186.50",$0.00,$593.25,$939.71,$949.20,$0.00,$185.69,$0.00,$188.89,$0.00
71140612,SUP,HCPCS C1713,,71140612  -  PLATE BN 142MM TC100 12 HL CRV RECON SS PLVC 3.5MM SCR,"$1,244.25",$0.00,"$1,244.25",$559.91,$888.02,$0.00,$214.38,$0.00,$0.00,$217.86,"$1,244.25",$0.00,$622.13,$985.45,$995.40,$0.00,$194.73,$0.00,$198.08,$0.00
71140614,SUP,HCPCS C1713,,71140614  -  PLATE BN 166MM TC100 14 HL CRV RECON SS PLVC 3.5MM SCR,"$1,401.75",$0.00,"$1,401.75",$630.79,"$1,000.43",$0.00,$241.51,$0.00,$0.00,$245.44,"$1,401.75",$0.00,$700.88,"$1,110.19","$1,121.40",$0.00,$219.37,$0.00,$223.16,$0.00
71140616,SUP,HCPCS C1713,,71140616  -  PLATE BN 190MM TC100 16 HL CRV RECON SS PLVC 3.5MM SCR,"$1,485.75",$0.00,"$1,485.75",$668.59,"$1,060.38",$0.00,$255.99,$0.00,$0.00,$260.14,"$1,485.75",$0.00,$742.88,"$1,176.71","$1,188.60",$0.00,$232.52,$0.00,$236.53,$0.00
71140618,SUP,HCPCS C1713,,71140618  -  PLATE BN 214MM TC100 18 HL CRV RECON SS PLVC 3.5MM SCR,"$1,601.25",$0.00,"$1,601.25",$720.56,"$1,142.81",$0.00,$275.89,$0.00,$0.00,$280.37,"$1,601.25",$0.00,$800.63,"$1,268.19","$1,281.00",$0.00,$250.60,$0.00,$254.92,$0.00
71140625,SUP,HCPCS C1713,,71140625  -  PLATE BN 120MM TC100 5 HL CLVRLF SS ORTH SM FRAG SET,"$1,013.25",$0.00,"$1,013.25",$455.96,$723.16,$0.00,$174.58,$0.00,$0.00,$177.41,"$1,013.25",$0.00,$506.63,$802.49,$810.60,$0.00,$158.57,$0.00,$161.31,$0.00
71140626,SUP,HCPCS C1713,,71140626  -  PLATE BN 136MM TC100 6 HL CLVRLF SS ORTH SM FRAG SET,"$1,113.00",$0.00,"$1,113.00",$500.85,$794.35,$0.00,$191.76,$0.00,$0.00,$194.88,"$1,113.00",$0.00,$556.50,$881.50,$890.40,$0.00,$174.18,$0.00,$177.19,$0.00
71140627,SUP,HCPCS C1713,,71140627  -  PLATE BN 152MM TC100 7 HL CLVRLF SS ORTH SM FRAG SET,"$1,186.50",$0.00,"$1,186.50",$533.93,$846.81,$0.00,$204.43,$0.00,$0.00,$207.75,"$1,186.50",$0.00,$593.25,$939.71,$949.20,$0.00,$185.69,$0.00,$188.89,$0.00
71140628,SUP,HCPCS C1713,,71140628  -  PLATE BN 168MM TC100 8 HL CLVRLF SS ORTH SM FRAG SET,"$1,260.00",$0.00,"$1,260.00",$567.00,$899.26,$0.00,$217.09,$0.00,$0.00,$220.62,"$1,260.00",$0.00,$630.00,$997.92,"$1,008.00",$0.00,$197.19,$0.00,$200.59,$0.00
71140629,SUP,HCPCS C1713,,71140629  -  PLATE BN 184MM TC100 9 HL CLVRLF SS ORTH SM FRAG SET,"$1,365.00",$0.00,"$1,365.00",$614.25,$974.20,$0.00,$235.18,$0.00,$0.00,$239.00,"$1,365.00",$0.00,$682.50,"$1,081.08","$1,092.00",$0.00,$213.62,$0.00,$217.31,$0.00
71140704,SUP,HCPCS C1713,,71140704  -  PLATE BN 80MM TC100 4 HL T BTRS SS ORTH LG FRAG SET,$926.10,$0.00,$926.10,$416.75,$660.96,$0.00,$159.56,$0.00,$0.00,$162.15,$926.10,$0.00,$463.05,$733.47,$740.88,$0.00,$144.93,$0.00,$147.44,$0.00
71140705,SUP,HCPCS C1713,,71140705  -  PLATE BN 96MM TC100 5 HL T BTRS SS ORTH LG FRAG SET,"$1,149.75",$0.00,"$1,149.75",$517.39,$820.58,$0.00,$198.10,$0.00,$0.00,$201.31,"$1,149.75",$0.00,$574.88,$910.60,$919.80,$0.00,$179.94,$0.00,$183.04,$0.00
71140706,SUP,HCPCS C1713,,71140706  -  PLATE BN 112MM TC100 6 HL T BTRS SS ORTH LG FRAG SET,"$1,249.50",$0.00,"$1,249.50",$562.28,$891.77,$0.00,$215.28,$0.00,$0.00,$218.78,"$1,249.50",$0.00,$624.75,$989.60,$999.60,$0.00,$195.55,$0.00,$198.92,$0.00
71140804,SUP,HCPCS C1713,,71140804  -  PLATE BN 86MM TC100 4 HL L BTRS RT ANG SS TIB LT LG FRAG SET,$828.45,$0.00,$828.45,$372.80,$591.26,$0.00,$142.74,$0.00,$0.00,$145.05,$828.45,$0.00,$414.23,$656.13,$662.76,$0.00,$129.65,$0.00,$131.89,$0.00
71140904,SUP,HCPCS C1713,,71140904  -  PLATE BN 86MM TC100 4 HL L BTRS LT ANG SS TIB RT LG FRAG SET,$828.45,$0.00,$828.45,$372.80,$591.26,$0.00,$142.74,$0.00,$0.00,$145.05,$828.45,$0.00,$414.23,$656.13,$662.76,$0.00,$129.65,$0.00,$131.89,$0.00
71141003,SUP,HCPCS C1713,,71141003  -  PLATE BN 86.5MM TC100 3 HL BTRS SS TIBHD RL LG FRAG SET,"$1,422.75",$0.00,"$1,422.75",$640.24,"$1,015.42",$0.00,$245.13,$0.00,$0.00,$249.11,"$1,422.75",$0.00,$711.38,"$1,126.82","$1,138.20",$0.00,$222.66,$0.00,$226.50,$0.00
71141005,SUP,HCPCS C1713,,71141005  -  PLATE BN 188MM TC100 5 HL BTRS SS TIBHD RL LG FRAG SET,"$1,669.50",$0.00,"$1,669.50",$751.28,"$1,191.52",$0.00,$287.65,$0.00,$0.00,$292.32,"$1,669.50",$0.00,$834.75,"$1,322.24","$1,335.60",$0.00,$261.28,$0.00,$265.78,$0.00
71141007,SUP,HCPCS C1713,,71141007  -  PLATE BN 149MM TC100 7 HL BTRS SS TIBHD RL LG FRAG SET,"$1,785.00",$0.00,"$1,785.00",$803.25,"$1,273.95",$0.00,$307.55,$0.00,$0.00,$312.54,"$1,785.00",$0.00,$892.50,"$1,413.72","$1,428.00",$0.00,$279.35,$0.00,$284.17,$0.00
71141009,SUP,HCPCS C1713,,71141009  -  PLATE BN 181MM TC100 9 HL BTRS SS TIBHD RL LG FRAG SET,"$1,905.75",$0.00,"$1,905.75",$857.59,"$1,360.13",$0.00,$328.35,$0.00,$0.00,$333.68,"$1,905.75",$0.00,$952.88,"$1,509.35","$1,524.60",$0.00,$298.25,$0.00,$303.40,$0.00
71141011,SUP,HCPCS C1713,,71141011  -  PLATE BN 214MM TC100 11 HL BTRS SS TIBHD RL LG FRAG SET,"$2,499.00",$0.00,"$2,499.00","$1,124.55","$1,783.54",$0.00,$430.57,$0.00,$0.00,$437.55,"$2,499.00",$0.00,"$1,249.50","$1,979.21","$1,999.20",$0.00,$391.09,$0.00,$397.84,$0.00
71141013,SUP,HCPCS C1713,,71141013  -  PLATE BN 246MM TC100 13 HL BTRS SS TIBHD RL LG FRAG SET,"$2,593.50",$0.00,"$2,593.50","$1,167.08","$1,850.98",$0.00,$446.85,$0.00,$0.00,$454.10,"$2,593.50",$0.00,"$1,296.75","$2,054.05","$2,074.80",$0.00,$405.88,$0.00,$412.89,$0.00
71141103,SUP,HCPCS C1713,,71141103  -  PLATE BN 86.5MM TC100 3 HL BTRS SS TIBHD L/L LG FRAG SET,"$1,422.75",$0.00,"$1,422.75",$640.24,"$1,015.42",$0.00,$245.13,$0.00,$0.00,$249.11,"$1,422.75",$0.00,$711.38,"$1,126.82","$1,138.20",$0.00,$222.66,$0.00,$226.50,$0.00
71141105,SUP,HCPCS C1713,,71141105  -  PLATE BN 188MM TC100 5 HL BTRS SS TIBHD L/L LG FRAG SET,"$1,669.50",$0.00,"$1,669.50",$751.28,"$1,191.52",$0.00,$287.65,$0.00,$0.00,$292.32,"$1,669.50",$0.00,$834.75,"$1,322.24","$1,335.60",$0.00,$261.28,$0.00,$265.78,$0.00
71141107,SUP,HCPCS C1713,,71141107  -  PLATE BN 149MM TC100 7 HL BTRS SS TIBHD L/L LG FRAG SET,"$1,785.00",$0.00,"$1,785.00",$803.25,"$1,273.95",$0.00,$307.55,$0.00,$0.00,$312.54,"$1,785.00",$0.00,$892.50,"$1,413.72","$1,428.00",$0.00,$279.35,$0.00,$284.17,$0.00
71141109,SUP,HCPCS C1713,,71141109  -  PLATE BN 181MM TC100 9 HL BTRS SS TIBHD L/L LG FRAG SET,"$1,905.75",$0.00,"$1,905.75",$857.59,"$1,360.13",$0.00,$328.35,$0.00,$0.00,$333.68,"$1,905.75",$0.00,$952.88,"$1,509.35","$1,524.60",$0.00,$298.25,$0.00,$303.40,$0.00
71141111,SUP,HCPCS C1713,,71141111  -  PLATE BN 214MM TC100 11 HL BTRS SS TIBHD L/L LG FRAG SET,"$2,499.00",$0.00,"$2,499.00","$1,124.55","$1,783.54",$0.00,$430.57,$0.00,$0.00,$437.55,"$2,499.00",$0.00,"$1,249.50","$1,979.21","$1,999.20",$0.00,$391.09,$0.00,$397.84,$0.00
71141113,SUP,HCPCS C1713,,71141113  -  PLATE BN 246MM TC100 13 HL BTRS SS TIBHD L/L LG FRAG SET,"$2,593.50",$0.00,"$2,593.50","$1,167.08","$1,850.98",$0.00,$446.85,$0.00,$0.00,$454.10,"$2,593.50",$0.00,"$1,296.75","$2,054.05","$2,074.80",$0.00,$405.88,$0.00,$412.89,$0.00
71141206,SUP,HCPCS C1713,,71141206  -  PLATE BN BRD 103MM TC100 6 HL CMPR SS ORTH 4.5MM SCR LG FRAG,$546.00,$0.00,$546.00,$245.70,$389.68,$0.00,$94.07,$0.00,$0.00,$95.60,$546.00,$0.00,$273.00,$432.43,$436.80,$0.00,$85.45,$0.00,$86.92,$0.00
71141207,SUP,HCPCS C1713,,71141207  -  PLATE BN BRD 119MM TC100 7 HL CMPR SS ORTH 4.5MM SCR LG FRAG,$546.00,$0.00,$546.00,$245.70,$389.68,$0.00,$94.07,$0.00,$0.00,$95.60,$546.00,$0.00,$273.00,$432.43,$436.80,$0.00,$85.45,$0.00,$86.92,$0.00
71141208,SUP,HCPCS C1713,,71141208  -  PLATE BN BRD 135MM TC100 8 HL CMPR SS ORTH 4.5MM SCR LG FRAG,$680.40,$0.00,$680.40,$306.18,$485.60,$0.00,$117.23,$0.00,$0.00,$119.13,$680.40,$0.00,$340.20,$538.88,$544.32,$0.00,$106.48,$0.00,$108.32,$0.00
71141209,SUP,HCPCS C1713,,71141209  -  PLATE BN BRD 151MM TC100 9 HL CMPR SS ORTH 4.5MM SCR LG FRAG,$680.40,$0.00,$680.40,$306.18,$485.60,$0.00,$117.23,$0.00,$0.00,$119.13,$680.40,$0.00,$340.20,$538.88,$544.32,$0.00,$106.48,$0.00,$108.32,$0.00
71141210,SUP,HCPCS C1713,,71141210  -  PLATE BN BRD 167MM TC100 10 HL CMPR SS 4.5MM SCR LG FRAG SET,$680.40,$0.00,$680.40,$306.18,$485.60,$0.00,$117.23,$0.00,$0.00,$119.13,$680.40,$0.00,$340.20,$538.88,$544.32,$0.00,$106.48,$0.00,$108.32,$0.00
71141212,SUP,HCPCS C1713,,71141212  -  PLATE BN BRD 199MM TC100 12 HL CMPR SS ORTH 4.5MM SCR LG,$731.85,$0.00,$731.85,$329.33,$522.32,$0.00,$126.09,$0.00,$0.00,$128.14,$731.85,$0.00,$365.93,$579.63,$585.48,$0.00,$114.53,$0.00,$116.51,$0.00
71141214,SUP,HCPCS C1713,,71141214  -  PLATE BN BRD 231MM TC100 14 HL CMPR SS 4.5MM SCR LG FRAG SET,$731.85,$0.00,$731.85,$329.33,$522.32,$0.00,$126.09,$0.00,$0.00,$128.14,$731.85,$0.00,$365.93,$579.63,$585.48,$0.00,$114.53,$0.00,$116.51,$0.00
71141216,SUP,HCPCS C1713,,71141216  -  PLATE BN BRD 263MM TC100 16 HL CMPR SS ORTH 4.5MM SCR LG,$926.10,$0.00,$926.10,$416.75,$660.96,$0.00,$159.56,$0.00,$0.00,$162.15,$926.10,$0.00,$463.05,$733.47,$740.88,$0.00,$144.93,$0.00,$147.44,$0.00
71141218,SUP,HCPCS C1713,,71141218  -  PLATE BN BRD 295MM TC100 18 HL CMPR SS ORTH 4.5MM SCR LG,"$1,022.70",$0.00,"$1,022.70",$460.22,$729.90,$0.00,$176.21,$0.00,$0.00,$179.07,"$1,022.70",$0.00,$511.35,$809.98,$818.16,$0.00,$160.05,$0.00,$162.81,$0.00
71141220,SUP,HCPCS C1713,,71141220  -  PLATE BN BRD 326MM TC100 20 HL CMPR SS ORTH 4.5MM SCR LG,"$1,459.50",$0.00,"$1,459.50",$656.78,"$1,041.65",$0.00,$251.46,$0.00,$0.00,$255.55,"$1,459.50",$0.00,$729.75,"$1,155.92","$1,167.60",$0.00,$228.41,$0.00,$232.35,$0.00
71141222,SUP,HCPCS C1713,,71141222  -  PLATE BN BRD 358MM TC100 22 HL CMPR SS ORTH 4.5MM SCR LG,"$1,543.50",$0.00,"$1,543.50",$694.58,"$1,101.60",$0.00,$265.94,$0.00,$0.00,$270.25,"$1,543.50",$0.00,$771.75,"$1,222.45","$1,234.80",$0.00,$241.56,$0.00,$245.73,$0.00
71141224,SUP,HCPCS C1713,,71141224  -  PLATE BN BRD 390MM TC100 24 HL CMPR SS ORTH 4.5MM SCR LG,"$1,711.50",$0.00,"$1,711.50",$770.18,"$1,221.50",$0.00,$294.88,$0.00,$0.00,$299.67,"$1,711.50",$0.00,$855.75,"$1,355.51","$1,369.20",$0.00,$267.85,$0.00,$272.47,$0.00
71141226,SUP,HCPCS C1713,,71141226  -  PLATE BN BRD 423MM TC100 26 HL CMPR SS ORTH 4.5MM SCR LG,"$1,811.25",$0.00,"$1,811.25",$815.06,"$1,292.69",$0.00,$312.07,$0.00,$0.00,$317.14,"$1,811.25",$0.00,$905.63,"$1,434.51","$1,449.00",$0.00,$283.46,$0.00,$288.35,$0.00
71141302,SUP,HCPCS C1713,,71141302  -  PLATE BN 39MM TC100 2 HL SMTB SS ORTH LG FRAG SET,$142.80,$0.00,$142.80,$64.26,$101.92,$0.00,$24.60,$0.00,$0.00,$25.00,$142.80,$0.00,$71.40,$113.10,$114.24,$0.00,$22.35,$0.00,$22.73,$0.00
71141303,SUP,HCPCS C1713,,71141303  -  PLATE BN 55MM TC100 3 HL SMTB SS ORTH LG FRAG SET,$147.00,$0.00,$147.00,$66.15,$104.91,$0.00,$25.33,$0.00,$0.00,$25.74,$147.00,$0.00,$73.50,$116.42,$117.60,$0.00,$23.01,$0.00,$23.40,$0.00
71141304,SUP,HCPCS C1713,,71141304  -  PLATE BN 71MM TC100 4 HL SMTB SS ORTH LG FRAG SET,$159.60,$0.00,$159.60,$71.82,$113.91,$0.00,$27.50,$0.00,$0.00,$27.94,$159.60,$0.00,$79.80,$126.40,$127.68,$0.00,$24.98,$0.00,$25.41,$0.00
71141305,SUP,HCPCS C1713,,71141305  -  PLATE BN 87MM TC100 5 HL SMTB SS ORTH LG FRAG SET,$166.95,$0.00,$166.95,$75.13,$119.15,$0.00,$28.76,$0.00,$0.00,$29.23,$166.95,$0.00,$83.48,$132.22,$133.56,$0.00,$26.13,$0.00,$26.58,$0.00
71141306,SUP,HCPCS C1713,,71141306  -  PLATE BN 103MM TC100 6 HL SMTB SS ORTH LG FRAG SET,$177.45,$0.00,$177.45,$79.85,$126.65,$0.00,$30.57,$0.00,$0.00,$31.07,$177.45,$0.00,$88.73,$140.54,$141.96,$0.00,$27.77,$0.00,$28.25,$0.00
71141307,SUP,HCPCS C1713,,71141307  -  PLATE BN 119MM TC100 7 HL SMTB SS ORTH LG FRAG SET,$192.15,$0.00,$192.15,$86.47,$137.14,$0.00,$33.11,$0.00,$0.00,$33.64,$192.15,$0.00,$96.08,$152.18,$153.72,$0.00,$30.07,$0.00,$30.59,$0.00
71141308,SUP,HCPCS C1713,,71141308  -  PLATE BN 135MM TC100 8 HL SMTB SS ORTH LG FRAG SET,$246.75,$0.00,$246.75,$111.04,$176.11,$0.00,$42.51,$0.00,$0.00,$43.20,$246.75,$0.00,$123.38,$195.43,$197.40,$0.00,$38.62,$0.00,$39.28,$0.00
71141309,SUP,HCPCS C1713,,71141309  -  PLATE BN 151MM TC100 9 HL SMTB SS ORTH LG FRAG SET,$218.40,$0.00,$218.40,$98.28,$155.87,$0.00,$37.63,$0.00,$0.00,$38.24,$218.40,$0.00,$109.20,$172.97,$174.72,$0.00,$34.18,$0.00,$34.77,$0.00
71141310,SUP,HCPCS C1713,,71141310  -  PLATE BN 167MM TC100 10 HL SMTB SS ORTH LG FRAG SET,$270.90,$0.00,$270.90,$121.91,$193.34,$0.00,$46.67,$0.00,$0.00,$47.43,$270.90,$0.00,$135.45,$214.55,$216.72,$0.00,$42.40,$0.00,$43.13,$0.00
71141311,SUP,HCPCS C1713,,71141311  -  PLATE BN 183MM TC100 11 HL SMTB SS ORTH LG FRAG SET,$282.45,$0.00,$282.45,$127.10,$201.58,$0.00,$48.66,$0.00,$0.00,$49.45,$282.45,$0.00,$141.23,$223.70,$225.96,$0.00,$44.20,$0.00,$44.97,$0.00
71141312,SUP,HCPCS C1713,,71141312  -  PLATE BN 199MM TC100 12 HL SMTB SS ORTH LG FRAG SET,$288.75,$0.00,$288.75,$129.94,$206.08,$0.00,$49.75,$0.00,$0.00,$50.56,$288.75,$0.00,$144.38,$228.69,$231.00,$0.00,$45.19,$0.00,$45.97,$0.00
71141402,SUP,HCPCS C1713,,71141402  -  PLATE BN NAR 39MM TC100 2 HL CMPR SS ORTH 4.5MM SCR,$352.80,$0.00,$352.80,$158.76,$251.79,$0.00,$60.79,$0.00,$0.00,$61.77,$352.80,$0.00,$176.40,$279.42,$282.24,$0.00,$55.21,$0.00,$56.17,$0.00
71141403,SUP,HCPCS C1713,,71141403  -  PLATE BN NAR 55MM TC100 3 HL CMPR SS 4.5MM SCR LG FRAG SET,$368.55,$0.00,$368.55,$165.85,$263.03,$0.00,$63.50,$0.00,$0.00,$64.53,$368.55,$0.00,$184.28,$291.89,$294.84,$0.00,$57.68,$0.00,$58.67,$0.00
71141404,SUP,HCPCS C1713,,71141404  -  PLATE BN NAR 71MM TC100 4 HL CMPR SS ORTH 4.5MM SCR LG FRAG,$368.55,$0.00,$368.55,$165.85,$263.03,$0.00,$63.50,$0.00,$0.00,$64.53,$368.55,$0.00,$184.28,$291.89,$294.84,$0.00,$57.68,$0.00,$58.67,$0.00
71141405,SUP,HCPCS C1713,,71141405  -  PLATE BN NAR 87MM TC100 5 HL CMPR SS ORTH 4.5MM SCR LG FRAG,$368.55,$0.00,$368.55,$165.85,$263.03,$0.00,$63.50,$0.00,$0.00,$64.53,$368.55,$0.00,$184.28,$291.89,$294.84,$0.00,$57.68,$0.00,$58.67,$0.00
71141406,SUP,HCPCS C1713,,71141406  -  PLATE BN NAR 103MM TC100 6 HL CMPR SS ORTH 4.5MM SCR LG FRAG,$410.55,$0.00,$410.55,$184.75,$293.01,$0.00,$70.74,$0.00,$0.00,$71.88,$410.55,$0.00,$205.28,$325.16,$328.44,$0.00,$64.25,$0.00,$65.36,$0.00
71141407,SUP,HCPCS C1713,,71141407  -  PLATE BN NAR 119MM TC100 7 HL CMPR SS ORTH 4.5MM SCR LG FRAG,$410.55,$0.00,$410.55,$184.75,$293.01,$0.00,$70.74,$0.00,$0.00,$71.88,$410.55,$0.00,$205.28,$325.16,$328.44,$0.00,$64.25,$0.00,$65.36,$0.00
71141408,SUP,HCPCS C1713,,71141408  -  PLATE BN NAR 135MM TC100 8 HL CMPR SS ORTH 4.5MM SCR,$410.55,$0.00,$410.55,$184.75,$293.01,$0.00,$70.74,$0.00,$0.00,$71.88,$410.55,$0.00,$205.28,$325.16,$328.44,$0.00,$64.25,$0.00,$65.36,$0.00
71141409,SUP,HCPCS C1713,,71141409  -  PLATE BN NAR 151MM TC100 9 HL CMPR SS ORTH 4.5MM SCR LG FRAG,$410.55,$0.00,$410.55,$184.75,$293.01,$0.00,$70.74,$0.00,$0.00,$71.88,$410.55,$0.00,$205.28,$325.16,$328.44,$0.00,$64.25,$0.00,$65.36,$0.00
71141410,SUP,HCPCS C1713,,71141410  -  PLATE BN NAR 167MM TC100 10 HL CMPR SS ORTH 4.5MM SCR LG,$535.50,$0.00,$535.50,$240.98,$382.19,$0.00,$92.26,$0.00,$0.00,$93.76,$535.50,$0.00,$267.75,$424.12,$428.40,$0.00,$83.81,$0.00,$85.25,$0.00
71141411,SUP,HCPCS C1713,,71141411  -  PLATE BN NAR 183MM TC100 11 HL CMPR SS ORTH 4.5MM SCR LG,$535.50,$0.00,$535.50,$240.98,$382.19,$0.00,$92.26,$0.00,$0.00,$93.76,$535.50,$0.00,$267.75,$424.12,$428.40,$0.00,$83.81,$0.00,$85.25,$0.00
71141412,SUP,HCPCS C1713,,71141412  -  PLATE BN NAR 199MM TC100 12 HL CMPR SS ORTH 4.5MM SCR LG,$535.50,$0.00,$535.50,$240.98,$382.19,$0.00,$92.26,$0.00,$0.00,$93.76,$535.50,$0.00,$267.75,$424.12,$428.40,$0.00,$83.81,$0.00,$85.25,$0.00
71141413,SUP,HCPCS C1713,,71141413  -  PLATE BN NAR 215MM TC100 13 HL CMPR SS ORTH 4.5MM SCR LG,$630.00,$0.00,$630.00,$283.50,$449.63,$0.00,$108.55,$0.00,$0.00,$110.31,$630.00,$0.00,$315.00,$498.96,$504.00,$0.00,$98.60,$0.00,$100.30,$0.00
71141414,SUP,HCPCS C1713,,71141414  -  PLATE BN NAR 231MM TC100 14 HL CMPR SS ORTH 4.5MM SCR LG,$763.35,$0.00,$763.35,$343.51,$544.80,$0.00,$131.52,$0.00,$0.00,$133.66,$763.35,$0.00,$381.68,$604.57,$610.68,$0.00,$119.46,$0.00,$121.53,$0.00
71141415,SUP,HCPCS C1713,,71141415  -  PLATE BN NAR 247MM TC100 15 HL CMPR SS ORTH 4.5MM SCR LG,$805.35,$0.00,$805.35,$362.41,$574.78,$0.00,$138.76,$0.00,$0.00,$141.01,$805.35,$0.00,$402.68,$637.84,$644.28,$0.00,$126.04,$0.00,$128.21,$0.00
71141416,SUP,HCPCS C1713,,71141416  -  PLATE BN NAR 263MM TC100 16 HL CMPR SS ORTH 4.5MM SCR LG,$805.35,$0.00,$805.35,$362.41,$574.78,$0.00,$138.76,$0.00,$0.00,$141.01,$805.35,$0.00,$402.68,$637.84,$644.28,$0.00,$126.04,$0.00,$128.21,$0.00
71141418,SUP,HCPCS C1713,,71141418  -  PLATE BN NAR 295MM TC100 18 HL CMPR SS ORTH 4.5MM SCR LG,"$1,149.75",$0.00,"$1,149.75",$517.39,$820.58,$0.00,$198.10,$0.00,$0.00,$201.31,"$1,149.75",$0.00,$574.88,$910.60,$919.80,$0.00,$179.94,$0.00,$183.04,$0.00
71141420,SUP,HCPCS C1713,,71141420  -  PLATE BN NAR 326MM TC100 20 HL CMPR SS ORTH 4.5MM SCR LG,"$1,038.45",$0.00,"$1,038.45",$467.30,$741.14,$0.00,$178.92,$0.00,$0.00,$181.82,"$1,038.45",$0.00,$519.23,$822.45,$830.76,$0.00,$162.52,$0.00,$165.32,$0.00
71141422,SUP,HCPCS C1713,,71141422  -  PLATE BN NAR 358MM TC100 22 HL CMPR SS ORTH 4.5MM SCR LG,"$1,401.75",$0.00,"$1,401.75",$630.79,"$1,000.43",$0.00,$241.51,$0.00,$0.00,$245.44,"$1,401.75",$0.00,$700.88,"$1,110.19","$1,121.40",$0.00,$219.37,$0.00,$223.16,$0.00
71141424,SUP,HCPCS C1713,,71141424  -  PLATE BN NAR 390MM TC100 24 HL CMPR SS ORTH 4.5MM SCR LG,"$1,517.25",$0.00,"$1,517.25",$682.76,"$1,082.86",$0.00,$261.41,$0.00,$0.00,$265.66,"$1,517.25",$0.00,$758.63,"$1,201.66","$1,213.80",$0.00,$237.45,$0.00,$241.55,$0.00
71141505,SUP,HCPCS C1713,,71141505  -  PLATE BN 100MM TC100 5 HL SPN SS ORTH 4.5MM SCR LG FRAG SET,$866.25,$0.00,$866.25,$389.81,$618.24,$0.00,$149.25,$0.00,$0.00,$151.67,$866.25,$0.00,$433.13,$686.07,$693.00,$0.00,$135.57,$0.00,$137.91,$0.00
71141506,SUP,HCPCS C1713,,71141506  -  PLATE BN 120MM TC100 6 HL SPN SS ORTH 4.5MM SCR LG FRAG SET,$753.90,$0.00,$753.90,$339.26,$538.06,$0.00,$129.89,$0.00,$0.00,$132.00,$753.90,$0.00,$376.95,$597.09,$603.12,$0.00,$117.99,$0.00,$120.02,$0.00
71141603,SUP,HCPCS C1713,,71141603  -  PLATE BN 68MM TC100 3 HL T SS ORTH 4.5MM SCR LG FRAG SET,$568.05,$0.00,$568.05,$255.62,$405.42,$0.00,$97.87,$0.00,$0.00,$99.46,$568.05,$0.00,$284.03,$449.90,$454.44,$0.00,$88.90,$0.00,$90.43,$0.00
71141604,SUP,HCPCS C1713,,71141604  -  PLATE BN 84MM TC100 4 HL T SS ORTH 4.5MM SCR LG FRAG SET,$631.05,$0.00,$631.05,$283.97,$450.38,$0.00,$108.73,$0.00,$0.00,$110.49,$631.05,$0.00,$315.53,$499.79,$504.84,$0.00,$98.76,$0.00,$100.46,$0.00
71141605,SUP,HCPCS C1713,,71141605  -  PLATE BN 100MM TC100 5 HL T SS ORTH 4.5MM SCR LG FRAG SET,$670.95,$0.00,$670.95,$301.93,$478.86,$0.00,$115.60,$0.00,$0.00,$117.48,$670.95,$0.00,$335.48,$531.39,$536.76,$0.00,$105.00,$0.00,$106.82,$0.00
71141606,SUP,HCPCS C1713,,71141606  -  PLATE BN 116MM TC100 6 HL T SS ORTH 4.5MM SCR LG FRAG SET,$742.35,$0.00,$742.35,$334.06,$529.82,$0.00,$127.90,$0.00,$0.00,$129.98,$742.35,$0.00,$371.18,$587.94,$593.88,$0.00,$116.18,$0.00,$118.18,$0.00
71141608,SUP,HCPCS C1713,,71141608  -  PLATE BN 148MM TC100 8 HL T SS ORTH 4.5MM SCR LG FRAG SET,"$1,025.85",$0.00,"$1,025.85",$461.63,$732.15,$0.00,$176.75,$0.00,$0.00,$179.62,"$1,025.85",$0.00,$512.93,$812.47,$820.68,$0.00,$160.55,$0.00,$163.32,$0.00
71141704,SUP,HCPCS C1713,,71141704  -  PLATE BN 123MM TC100 4 HL HK SS ORTH 4.5MM SCR LG FRAG SET,"$2,084.25",$0.00,"$2,084.25",$937.91,"$1,487.53",$0.00,$359.11,$0.00,$0.00,$364.94,"$2,084.25",$0.00,"$1,042.13","$1,650.73","$1,667.40",$0.00,$326.19,$0.00,$331.81,$0.00
71141809,SUP,HCPCS C1713,,71141809  -  PLATE BN 188MM TC100 9 HL CBR HD SS ORTH 4.5MM SCR LG FRAG,$945.00,$0.00,$945.00,$425.25,$674.45,$0.00,$162.82,$0.00,$0.00,$165.46,$945.00,$0.00,$472.50,$748.44,$756.00,$0.00,$147.89,$0.00,$150.44,$0.00
71141900,SUP,HCPCS C1713,,71141900  -  PLATE BN 20MM TC100 2 HL CMPR SS ORTH 2.7MM SCR SM FRAG SET,$345.45,$0.00,$345.45,$155.45,$246.55,$0.00,$59.52,$0.00,$0.00,$60.49,$345.45,$0.00,$172.73,$273.60,$276.36,$0.00,$54.06,$0.00,$55.00,$0.00
71141902,SUP,HCPCS C1713,,71141902  -  PLATE BN 26MM TC100 2 HL CMPR SS ORTH 2.7MM SCR SM FRAG SET,$410.55,$0.00,$410.55,$184.75,$293.01,$0.00,$70.74,$0.00,$0.00,$71.88,$410.55,$0.00,$205.28,$325.16,$328.44,$0.00,$64.25,$0.00,$65.36,$0.00
71141904,SUP,HCPCS C1713,,71141904  -  PLATE BN 36MM TC100 4 HL CMPR SS ORTH 2.7MM SCR SM FRAG SET,$316.05,$0.00,$316.05,$142.22,$225.56,$0.00,$54.45,$0.00,$0.00,$55.34,$316.05,$0.00,$158.03,$250.31,$252.84,$0.00,$49.46,$0.00,$50.32,$0.00
71141905,SUP,HCPCS C1713,,71141905  -  PLATE BN 44MM TC100 5 HL CMPR SS ORTH 2.7MM SCR SM FRAG SET,$375.90,$0.00,$375.90,$169.16,$268.28,$0.00,$64.77,$0.00,$0.00,$65.82,$375.90,$0.00,$187.95,$297.71,$300.72,$0.00,$58.83,$0.00,$59.84,$0.00
71141906,SUP,HCPCS C1713,,71141906  -  PLATE BN 52MM 6 HL 2.7MM SCR,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
71141907,SUP,HCPCS C1713,,71141907  -  PLATE BN 60MM TC100 7 HL CMPR SS ORTH 2.7MM SCR SM FRAG SET,$452.55,$0.00,$452.55,$203.65,$322.98,$0.00,$77.97,$0.00,$0.00,$79.24,$452.55,$0.00,$226.28,$358.42,$362.04,$0.00,$70.82,$0.00,$72.05,$0.00
71141908,SUP,HCPCS C1713,,71141908  -  PLATE BN 68MM TC100 8 HL CMPR SS ORTH 2.7MM SCR SM FRAG SET,$495.60,$0.00,$495.60,$223.02,$353.71,$0.00,$85.39,$0.00,$0.00,$86.78,$495.60,$0.00,$247.80,$392.52,$396.48,$0.00,$77.56,$0.00,$78.90,$0.00
71141909,SUP,HCPCS C1713,,71141909  -  PLATE BN 76MM TC100 9 HL CMPR SS ORTH 2.7MM SCR SM FRAG SET,$639.45,$0.00,$639.45,$287.75,$456.38,$0.00,$110.17,$0.00,$0.00,$111.96,$639.45,$0.00,$319.73,$506.44,$511.56,$0.00,$100.07,$0.00,$101.80,$0.00
71141910,SUP,HCPCS C1713,,71141910  -  PLATE BN 84MM TC100 10 HL CMPR SS ORTH 2.7MM SCR SM FRAG SET,$701.40,$0.00,$701.40,$315.63,$500.59,$0.00,$120.85,$0.00,$0.00,$122.81,$701.40,$0.00,$350.70,$555.51,$561.12,$0.00,$109.77,$0.00,$111.66,$0.00
71141912,SUP,HCPCS C1713,,71141912  -  PLATE BN 100MM TC100 12 HL CMPR SS ORTH 2.7MM SCR SM FRAG,$777.00,$0.00,$777.00,$349.65,$554.54,$0.00,$133.87,$0.00,$0.00,$136.05,$777.00,$0.00,$388.50,$615.38,$621.60,$0.00,$121.60,$0.00,$123.70,$0.00
71142007,SUP,HCPCS C1713,,71142007  -  PLATE BN 158MM TC100 7 HL BTRS SS CNDYL LT 4.5MM SCR LG FRAG,"$1,953.00",$0.00,"$1,953.00",$878.85,"$1,393.86",$0.00,$336.49,$0.00,$0.00,$341.95,"$1,953.00",$0.00,$976.50,"$1,546.78","$1,562.40",$0.00,$305.64,$0.00,$310.92,$0.00
71142009,SUP,HCPCS C1713,,71142009  -  PLATE BN 190MM TC100 9 HL BTRS SS CNDYL LT 4.5MM SCR LG FRAG,"$2,026.50",$0.00,"$2,026.50",$911.93,"$1,446.31",$0.00,$349.16,$0.00,$0.00,$354.82,"$2,026.50",$0.00,"$1,013.25","$1,604.99","$1,621.20",$0.00,$317.15,$0.00,$322.62,$0.00
71142011,SUP,HCPCS C1713,,71142011  -  PLATE BN 221MM TC100 11 HL BTRS SS CNDYL LT 4.5MM SCR LG,"$2,541.00",$0.00,"$2,541.00","$1,143.45","$1,813.51",$0.00,$437.80,$0.00,$0.00,$444.91,"$2,541.00",$0.00,"$1,270.50","$2,012.47","$2,032.80",$0.00,$397.67,$0.00,$404.53,$0.00
71142013,SUP,HCPCS C1713,,71142013  -  PLATE BN 253MM TC100 13 HL BTRS SS CNDYL LT 4.5MM SCR LG,"$2,136.75",$0.00,"$2,136.75",$961.54,"$1,525.00",$0.00,$368.15,$0.00,$0.00,$374.13,"$2,136.75",$0.00,"$1,068.38","$1,692.31","$1,709.40",$0.00,$334.40,$0.00,$340.17,$0.00
71142015,SUP,HCPCS C1713,,71142015  -  PLATE BN 285MM TC100 15 HL BTRS SS CNDYL LT 4.5MM SCR LG,"$2,682.75",$0.00,"$2,682.75","$1,207.24","$1,914.68",$0.00,$462.22,$0.00,$0.00,$469.73,"$2,682.75",$0.00,"$1,341.38","$2,124.74","$2,146.20",$0.00,$419.85,$0.00,$427.09,$0.00
71142107,SUP,HCPCS C1713,,71142107  -  PLATE BN 158MM TC100 7 HL BTRS SS CNDYL RT 4.5MM SCR LG FRAG,"$2,367.75",$0.00,"$2,367.75","$1,065.49","$1,689.86",$0.00,$407.95,$0.00,$0.00,$414.57,"$2,367.75",$0.00,"$1,183.88","$1,875.26","$1,894.20",$0.00,$370.55,$0.00,$376.95,$0.00
71142109,SUP,HCPCS C1713,,71142109  -  PLATE BN 190MM TC100 9 HL BTRS SS CNDYL RT 4.5MM SCR LG FRAG,"$2,026.50",$0.00,"$2,026.50",$911.93,"$1,446.31",$0.00,$349.16,$0.00,$0.00,$354.82,"$2,026.50",$0.00,"$1,013.25","$1,604.99","$1,621.20",$0.00,$317.15,$0.00,$322.62,$0.00
71142111,SUP,HCPCS C1713,,71142111  -  PLATE BN 221MM TC100 11 HL BTRS SS CNDYL RT 4.5MM SCR LG,"$2,541.00",$0.00,"$2,541.00","$1,143.45","$1,813.51",$0.00,$437.80,$0.00,$0.00,$444.91,"$2,541.00",$0.00,"$1,270.50","$2,012.47","$2,032.80",$0.00,$397.67,$0.00,$404.53,$0.00
71142113,SUP,HCPCS C1713,,71142113  -  PLATE BN 253MM TC100 13 HL BTRS SS CNDYL RT 4.5MM SCR LG,"$2,604.00",$0.00,"$2,604.00","$1,171.80","$1,858.47",$0.00,$448.66,$0.00,$0.00,$455.94,"$2,604.00",$0.00,"$1,302.00","$2,062.37","$2,083.20",$0.00,$407.53,$0.00,$414.56,$0.00
71142115,SUP,HCPCS C1713,,71142115  -  PLATE BN 285MM TC100 15 HL BTRS SS CNDYL RT 4.5MM SCR LG,"$2,682.75",$0.00,"$2,682.75","$1,207.24","$1,914.68",$0.00,$462.22,$0.00,$0.00,$469.73,"$2,682.75",$0.00,"$1,341.38","$2,124.74","$2,146.20",$0.00,$419.85,$0.00,$427.09,$0.00
71143004,SUP,HCPCS C1713,,71143004  -  WASHER ORTH 4.5MM 2.2MM STRL TC100 SS,$94.40,$0.00,$94.40,$42.48,$67.37,$0.00,$16.26,$0.00,$0.00,$16.53,$94.40,$0.00,$47.20,$74.76,$75.52,$0.00,$14.77,$0.00,$15.03,$0.00
71143007,SUP,HCPCS C1713,,71143007  -  WASHER ORTH 7MM 3.7MM STRL TC100 SS,$94.40,$0.00,$94.40,$42.48,$67.37,$0.00,$16.26,$0.00,$0.00,$16.53,$94.40,$0.00,$47.20,$74.76,$75.52,$0.00,$14.77,$0.00,$15.03,$0.00
71143010,SUP,HCPCS C1713,,71143010  -  WASHER ORTH THK2MM 10MM ILZ SPC CIRC,$109.00,$0.00,$109.00,$49.05,$77.79,$0.00,$18.78,$0.00,$0.00,$19.09,$109.00,$0.00,$54.50,$86.33,$87.20,$0.00,$17.06,$0.00,$17.35,$0.00
71143013,SUP,HCPCS C1713,,71143013  -  WASHER ORTH 13MM 6.6MM STRL TC100 SS,$120.00,$0.00,$120.00,$54.00,$85.64,$0.00,$20.68,$0.00,$0.00,$21.01,$120.00,$0.00,$60.00,$95.04,$96.00,$0.00,$18.78,$0.00,$19.10,$0.00
71143045,SUP,HCPCS C1713,,71143045  -  NUT ORTH STRL TC100 SS 4.5 MM CORT SCR,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
71143104,SUP,HCPCS C1713,,71143104  -  WASHER ORTH 4.5MM 2.2MM NS TC100 SS,$94.40,$0.00,$94.40,$42.48,$67.37,$0.00,$16.26,$0.00,$0.00,$16.53,$94.40,$0.00,$47.20,$74.76,$75.52,$0.00,$14.77,$0.00,$15.03,$0.00
71143107,SUP,HCPCS C1713,,71143107  -  WASHER ORTH HEX 7MM NS TC100,$94.40,$0.00,$94.40,$42.48,$67.37,$0.00,$16.26,$0.00,$0.00,$16.53,$94.40,$0.00,$47.20,$74.76,$75.52,$0.00,$14.77,$0.00,$15.03,$0.00
71143110,SUP,HCPCS C1713,,71143110  -  WASHER ORTH 10MM NS TC100,$109.00,$0.00,$109.00,$49.05,$77.79,$0.00,$18.78,$0.00,$0.00,$19.09,$109.00,$0.00,$54.50,$86.33,$87.20,$0.00,$17.06,$0.00,$17.35,$0.00
71143113,SUP,HCPCS C1713,,71143113  -  WASHER ORTH 13MM NS TC100 SS,$94.40,$0.00,$94.40,$42.48,$67.37,$0.00,$16.26,$0.00,$0.00,$16.53,$94.40,$0.00,$47.20,$74.76,$75.52,$0.00,$14.77,$0.00,$15.03,$0.00
71144010,SUP,HCPCS C1713,,71144010  -  PLATE BN 60MM STRL TC100 TMPLT SS CALCANEUS 3.5MM CORT SCR 4,"$1,338.75",$0.00,"$1,338.75",$602.44,$955.47,$0.00,$230.66,$0.00,$0.00,$234.40,"$1,338.75",$0.00,$669.38,"$1,060.29","$1,071.00",$0.00,$209.51,$0.00,$213.13,$0.00
71144011,SUP,HCPCS C1713,,71144011  -  PLATE BN 70MM STRL TC100 TMPLT SS CALCANEUS 3.5MM CORT SCR 4,"$1,354.50",$0.00,"$1,354.50",$609.53,$966.71,$0.00,$233.37,$0.00,$0.00,$237.16,"$1,354.50",$0.00,$677.25,"$1,072.76","$1,083.60",$0.00,$211.98,$0.00,$215.64,$0.00
71144012,SUP,HCPCS C1713,,71144012  -  PLATE BN STRL TC100 9 HL BNDRG TMPLT SS CALCANEUS 3.5 MM SCR,"$1,559.25",$0.00,"$1,559.25",$701.66,"$1,112.84",$0.00,$268.65,$0.00,$0.00,$273.01,"$1,559.25",$0.00,$779.63,"$1,234.93","$1,247.40",$0.00,$244.02,$0.00,$248.23,$0.00
71145020,SUP,HCPCS C1713,,71145020  -  PLATE BN 100MM TC100 20 HL STRG SS ORTH 1.5MM SCR MN FRAG,$570.15,$0.00,$570.15,$256.57,$406.92,$0.00,$98.23,$0.00,$0.00,$99.83,$570.15,$0.00,$285.08,$451.56,$456.12,$0.00,$89.23,$0.00,$90.77,$0.00
71145022,SUP,HCPCS C1713,,71145022  -  PLATE BN TC100 3 HLE/HD 9 HL SHFT T SS ORTH 1.5 MM SCR MN,$504.00,$0.00,$504.00,$226.80,$359.70,$0.00,$86.84,$0.00,$0.00,$88.25,$504.00,$0.00,$252.00,$399.17,$403.20,$0.00,$78.88,$0.00,$80.24,$0.00
71145024,SUP,HCPCS C1713,,71145024  -  PLATE BN TC100 4 HLE/HD 9 HL SHFT T SS ORTH 1.5 MM SCR MN,$534.45,$0.00,$534.45,$240.50,$381.44,$0.00,$92.08,$0.00,$0.00,$93.58,$534.45,$0.00,$267.23,$423.28,$427.56,$0.00,$83.64,$0.00,$85.08,$0.00
71145026,SUP,HCPCS C1713,,71145026  -  PLATE BN TC100 7 HL SS CNDYL LT 1.5 MM SCR MN FRAG SET,$708.75,$0.00,$708.75,$318.94,$505.83,$0.00,$122.11,$0.00,$0.00,$124.10,$708.75,$0.00,$354.38,$561.33,$567.00,$0.00,$110.92,$0.00,$112.83,$0.00
71145028,SUP,HCPCS C1713,,71145028  -  PLATE BN TC100 7 HL SS CNDYL RT 1.5 MM SCR MN FRAG SET,$708.75,$0.00,$708.75,$318.94,$505.83,$0.00,$122.11,$0.00,$0.00,$124.10,$708.75,$0.00,$354.38,$561.33,$567.00,$0.00,$110.92,$0.00,$112.83,$0.00
71145030,SUP,HCPCS C1713,,71145030  -  PLATE BN TC100 4 HL H SS ORTH 1.5 MM SCR MN FRAG SET,$406.35,$0.00,$406.35,$182.86,$290.01,$0.00,$70.01,$0.00,$0.00,$71.15,$406.35,$0.00,$203.18,$321.83,$325.08,$0.00,$63.59,$0.00,$64.69,$0.00
71146020,SUP,HCPCS C1713,,71146020  -  PLATE BN 20MM TC100 3 HL STRG SS CNDYL 2MM SCR MN FRAG SET,$134.40,$0.00,$134.40,$60.48,$95.92,$0.00,$23.16,$0.00,$0.00,$23.53,$134.40,$0.00,$67.20,$106.44,$107.52,$0.00,$21.03,$0.00,$21.40,$0.00
71146022,SUP,HCPCS C1713,,71146022  -  PLATE BN 22MM TC100 4 HL STRG SS CNDYL 2MM SCR MN FRAG SET,$148.05,$0.00,$148.05,$66.62,$105.66,$0.00,$25.51,$0.00,$0.00,$25.92,$148.05,$0.00,$74.03,$117.26,$118.44,$0.00,$23.17,$0.00,$23.57,$0.00
71146024,SUP,HCPCS C1713,,71146024  -  PLATE BN 24MM TC100 5 HL STRG SS CNDYL 2MM SCR MN FRAG SET,$159.60,$0.00,$159.60,$71.82,$113.91,$0.00,$27.50,$0.00,$0.00,$27.94,$159.60,$0.00,$79.80,$126.40,$127.68,$0.00,$24.98,$0.00,$25.41,$0.00
71146026,SUP,HCPCS C1713,,71146026  -  PLATE BN 35MM TC100 6 HL STRG SS ORTH 2MM SCR MN FRAG SET,$177.45,$0.00,$177.45,$79.85,$126.65,$0.00,$30.57,$0.00,$0.00,$31.07,$177.45,$0.00,$88.73,$140.54,$141.96,$0.00,$27.77,$0.00,$28.25,$0.00
71146028,SUP,HCPCS C1713,,71146028  -  PLATE BN 28MM TC100 20 HL STRG SS CNDYL 2MM SCR MN FRAG SET,$568.05,$0.00,$568.05,$255.62,$405.42,$0.00,$97.87,$0.00,$0.00,$99.46,$568.05,$0.00,$284.03,$449.90,$454.44,$0.00,$88.90,$0.00,$90.43,$0.00
71146030,SUP,HCPCS C1713,,71146030  -  PLATE BN 5X1.2MM TC100 3 HLE/HD 9 HL SHFT T SS CNDYL 2MM SCR,$504.00,$0.00,$504.00,$226.80,$359.70,$0.00,$86.84,$0.00,$0.00,$88.25,$504.00,$0.00,$252.00,$399.17,$403.20,$0.00,$78.88,$0.00,$80.24,$0.00
71146032,SUP,HCPCS C1713,,71146032  -  PLATE BN 5X1.2MM TC100 4 HLE/HD 9 HL SHFT T SS CNDYL 2MM SCR,$534.45,$0.00,$534.45,$240.50,$381.44,$0.00,$92.08,$0.00,$0.00,$93.58,$534.45,$0.00,$267.23,$423.28,$427.56,$0.00,$83.64,$0.00,$85.08,$0.00
71146034,SUP,HCPCS C1713,,71146034  -  PLATE BN 5X.9MM TC100 2 HLE/HD 2 HL SHFT T SS CNDYL 2MM SCR,$134.40,$0.00,$134.40,$60.48,$95.92,$0.00,$23.16,$0.00,$0.00,$23.53,$134.40,$0.00,$67.20,$106.44,$107.52,$0.00,$21.03,$0.00,$21.40,$0.00
71146036,SUP,HCPCS C1713,,71146036  -  PLATE BN 5X.9MM TC100 2 HL SHFT L RT OBLQ SS CNDYL 2MM SCR,$134.40,$0.00,$134.40,$60.48,$95.92,$0.00,$23.16,$0.00,$0.00,$23.53,$134.40,$0.00,$67.20,$106.44,$107.52,$0.00,$21.03,$0.00,$21.40,$0.00
71146038,SUP,HCPCS C1713,,71146038  -  PLATE BN 5X.9MM TC100 2 HL SHFT L LT OBLQ SS CNDYL 2MM SCR,$134.40,$0.00,$134.40,$60.48,$95.92,$0.00,$23.16,$0.00,$0.00,$23.53,$134.40,$0.00,$67.20,$106.44,$107.52,$0.00,$21.03,$0.00,$21.40,$0.00
71146040,SUP,HCPCS C1713,,71146040  -  PLATE BN TC100 7 HL SS CNDYL LT 2 MM SCR MN FRAG SET,$678.30,$0.00,$678.30,$305.24,$484.10,$0.00,$116.87,$0.00,$0.00,$118.76,$678.30,$0.00,$339.15,$537.21,$542.64,$0.00,$106.15,$0.00,$107.99,$0.00
71146042,SUP,HCPCS C1713,,71146042  -  PLATE BN 39X5X12MM TC100 7 HL SS CNDYL RT 2MM SCR MN FRAG,$678.30,$0.00,$678.30,$305.24,$484.10,$0.00,$116.87,$0.00,$0.00,$118.76,$678.30,$0.00,$339.15,$537.21,$542.64,$0.00,$106.15,$0.00,$107.99,$0.00
71146044,SUP,HCPCS C1713,,71146044  -  PLATE BN TC100 L SS RT ORTH 2 MM SCR MN FRAG SET,$134.40,$0.00,$134.40,$60.48,$95.92,$0.00,$23.16,$0.00,$0.00,$23.53,$134.40,$0.00,$67.20,$106.44,$107.52,$0.00,$21.03,$0.00,$21.40,$0.00
71146046,SUP,HCPCS C1713,,71146046  -  PLATE BN TC100 L SS LT ORTH 2 MM SCR MN FRAG SET,$134.40,$0.00,$134.40,$60.48,$95.92,$0.00,$23.16,$0.00,$0.00,$23.53,$134.40,$0.00,$67.20,$106.44,$107.52,$0.00,$21.03,$0.00,$21.40,$0.00
71146048,SUP,HCPCS C1713,,71146048  -  PLATE BN TC100 4 HL H SS ORTH 2 MM SCR MN FRAG SET,$406.35,$0.00,$406.35,$182.86,$290.01,$0.00,$70.01,$0.00,$0.00,$71.15,$406.35,$0.00,$203.18,$321.83,$325.08,$0.00,$63.59,$0.00,$64.69,$0.00
71147001,SUP,HCPCS C1713,,71147001  -  PLATE BN TC100 L SS RT ORTH 2.7 MM SCR MN FRAG SET,$142.80,$0.00,$142.80,$64.26,$101.92,$0.00,$24.60,$0.00,$0.00,$25.00,$142.80,$0.00,$71.40,$113.10,$114.24,$0.00,$22.35,$0.00,$22.73,$0.00
71147002,SUP,HCPCS C1713,,71147002  -  PLATE BN 35X7X1.2MM TC100 L LT OBLQ SS CNDYL 2.7MM SCR MN,$142.80,$0.00,$142.80,$64.26,$101.92,$0.00,$24.60,$0.00,$0.00,$25.00,$142.80,$0.00,$71.40,$113.10,$114.24,$0.00,$22.35,$0.00,$22.73,$0.00
71147003,SUP,HCPCS C1713,,71147003  -  PLATE BN TC100 L SS LT ORTH 2.7 MM SCR MN FRAG SET,$142.80,$0.00,$142.80,$64.26,$101.92,$0.00,$24.60,$0.00,$0.00,$25.00,$142.80,$0.00,$71.40,$113.10,$114.24,$0.00,$22.35,$0.00,$22.73,$0.00
71147004,SUP,HCPCS C1713,,71147004  -  PLATE BN 35X7X1.2MM TC100 L RT OBLQ SS CNDYL 2.7MM SCR MN,$142.80,$0.00,$142.80,$64.26,$101.92,$0.00,$24.60,$0.00,$0.00,$25.00,$142.80,$0.00,$71.40,$113.10,$114.24,$0.00,$22.35,$0.00,$22.73,$0.00
71147006,SUP,HCPCS C1713,,71147006  -  PLATE BN 32X7X1.2MM TC100 3 HL T SS CNDYL 2.7MM SCR MN FRAG,$142.80,$0.00,$142.80,$64.26,$101.92,$0.00,$24.60,$0.00,$0.00,$25.00,$142.80,$0.00,$71.40,$113.10,$114.24,$0.00,$22.35,$0.00,$22.73,$0.00
71147008,SUP,HCPCS C1713,,71147008  -  PLATE BN 57X7X1.4MM TC100 7 HL SS CNDYL LT 2.7MM SCR MN FRAG,$720.30,$0.00,$720.30,$324.14,$514.08,$0.00,$124.10,$0.00,$0.00,$126.12,$720.30,$0.00,$360.15,$570.48,$576.24,$0.00,$112.73,$0.00,$114.67,$0.00
71147010,SUP,HCPCS C1713,,71147010  -  PLATE BN 57X7X1.4MM TC100 7 HL SS CNDYL RT 2.7MM SCR MN FRAG,$720.30,$0.00,$720.30,$324.14,$514.08,$0.00,$124.10,$0.00,$0.00,$126.12,$720.30,$0.00,$360.15,$570.48,$576.24,$0.00,$112.73,$0.00,$114.67,$0.00
71147012,SUP,HCPCS C1713,,71147012  -  PLATE BN TC100 7 HL MULTIFRAGMENT SS ORTH 2.7 MM SCR MN FRAG,$169.05,$0.00,$169.05,$76.07,$120.65,$0.00,$29.13,$0.00,$0.00,$29.60,$169.05,$0.00,$84.53,$133.89,$135.24,$0.00,$26.46,$0.00,$26.91,$0.00
71148003,SUP,HCPCS C1713,,71148003  -  PLATE BN 23MM TC100 3 HL .25 TBLR SS ORTH 2.7MM SCR MN FRAG,$159.60,$0.00,$159.60,$71.82,$113.91,$0.00,$27.50,$0.00,$0.00,$27.94,$159.60,$0.00,$79.80,$126.40,$127.68,$0.00,$24.98,$0.00,$25.41,$0.00
71148004,SUP,HCPCS C1713,,71148004  -  PLATE BN 31MM TC100 4 HL .25 TBLR SS CNDYL 2.7MM SCR MN FRAG,$175.35,$0.00,$175.35,$78.91,$125.15,$0.00,$30.21,$0.00,$0.00,$30.70,$175.35,$0.00,$87.68,$138.88,$140.28,$0.00,$27.44,$0.00,$27.92,$0.00
71148005,SUP,HCPCS C1713,,71148005  -  PLATE BN 39MM TC100 5 HL .25 TBLR SS CNDYL 2.7MM SCR MN FRAG,$185.85,$0.00,$185.85,$83.63,$132.64,$0.00,$32.02,$0.00,$0.00,$32.54,$185.85,$0.00,$92.93,$147.19,$148.68,$0.00,$29.09,$0.00,$29.59,$0.00
71148006,SUP,HCPCS C1713,,71148006  -  PLATE BN 47MM TC100 6 HL .25 TBLR SS CNDYL 2.7MM SCR MN FRAG,$205.80,$0.00,$205.80,$92.61,$146.88,$0.00,$35.46,$0.00,$0.00,$36.03,$205.80,$0.00,$102.90,$162.99,$164.64,$0.00,$32.21,$0.00,$32.76,$0.00
71148007,SUP,HCPCS C1713,,71148007  -  PLATE BN 55MM TC100 7 HL .25 TBLR SS ORTH 2.7MM SCR MN FRAG,$214.20,$0.00,$214.20,$96.39,$152.87,$0.00,$36.91,$0.00,$0.00,$37.50,$214.20,$0.00,$107.10,$169.65,$171.36,$0.00,$33.52,$0.00,$34.10,$0.00
71148008,SUP,HCPCS C1713,,71148008  -  PLATE BN 63MM TC100 QT TBLR SS ORTH 2.7MM SCR MN FRAG SET,$227.85,$0.00,$227.85,$102.53,$162.62,$0.00,$39.26,$0.00,$0.00,$39.89,$227.85,$0.00,$113.93,$180.46,$182.28,$0.00,$35.66,$0.00,$36.27,$0.00
71149006,SUP,HCPCS C1713,,71149006  -  SCREW BN 1.5MM 6MM TC100 ST CRCTE HD SS CORT MN FRAG SET,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
71149007,SUP,HCPCS C1713,,71149007  -  SCREW BN 1.5MM 7MM TC100 ST CRCTE HD SS CORT MN FRAG SET,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
71149008,SUP,HCPCS C1713,,71149008  -  SCREW BN 1.5MM 8MM TC100 ST CRCTE HD SS CORT MN FRAG SET,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
71149009,SUP,HCPCS C1713,,71149009  -  SCREW BN 1.5MM 9MM TC100 ST CRCTE HD SS CORT MN FRAG SET,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
71149010,SUP,HCPCS C1713,,71149010  -  SCREW BN 1.5MM 10MM TC100 ST CRCTE HD SS CORT MN FRAG SET,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
71149011,SUP,HCPCS C1713,,71149011  -  SCREW BN 1.5MM 11MM TC100 ST CRCTE HD SS CORT MN FRAG SET,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
71149012,SUP,HCPCS C1713,,71149012  -  SCREW BN 1.5MM 12MM TC100 ST CRCTE HD SS CORT MN FRAG SET,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
71149014,SUP,HCPCS C1713,,71149014  -  SCREW BN 1.5MM 14MM TC100 ST CRCTE HD SS CORT MN FRAG SET,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
71149016,SUP,HCPCS C1713,,71149016  -  SCREW BN 1.5MM 16MM TC100 ST CRCTE HD SS CORT MN FRAG SET,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
71149018,SUP,HCPCS C1713,,71149018  -  SCREW BN 1.5MM 18MM TC100 ST CRCTE HD SS CORT MN FRAG SET,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
71149020,SUP,HCPCS C1713,,71149020  -  SCREW BN 1.5MM 20MM TC100 ST CRCTE HD SS CORT MN FRAG SET,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
71149022,SUP,HCPCS C1713,,71149022  -  SCREW BN 1.5MM 22MM TC100 ST CRCTE HD SS CORT MN FRAG SET,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
71149024,SUP,HCPCS C1713,,71149024  -  SCREW BN 1.5MM 24MM TC100 ST CRCTE HD SS CORT MN FRAG SET,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
71149106,SUP,HCPCS C1713,,71149106  -  SCREW BN 1.5MM 6MM TC100 ST HEX SS CORT,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
71149107,SUP,HCPCS C1713,,71149107  -  SCREW BN 1.5MM 7MM TC100 ST HEX SS CORT MN FRAG SET,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
71149108,SUP,HCPCS C1713,,71149108  -  SCREW BN 1.5MM 8MM TC100 ST HEX SS CORT MN FRAG SET,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
71149109,SUP,HCPCS C1713,,71149109  -  SCREW BN 1.5MM 9MM TC100 ST HEX SS CORT MN FRAG SET,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
71149110,SUP,HCPCS C1713,,71149110  -  SCREW BN 1.5MM 10MM TC100 ST HEX SS CORT MN FRAG SET,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
71149111,SUP,HCPCS C1713,,71149111  -  SCREW BN 1.5MM 11MM TC100 ST HEX SS CORT MN FRAG SET,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
71149112,SUP,HCPCS C1713,,71149112  -  SCREW BN 1.5MM 12MM TC100 ST HEX SS CORT MN FRAG SET,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
71149114,SUP,HCPCS C1713,,71149114  -  SCREW BN 1.5MM 14MM TC100 ST HEX SS CORT MN FRAG SET,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
71149116,SUP,HCPCS C1713,,71149116  -  SCREW BN 1.5MM 16MM TC100 ST HEX SS CORT MN FRAG SET,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
71149118,SUP,HCPCS C1713,,71149118  -  SCREW BN 1.5MM 3MM 18MM TC100 HEX HD ST SS CORT MN FRAG SET,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
71149120,SUP,HCPCS C1713,,71149120  -  SCREW BN 1.5MM 3MM 20MM TC100 HEX HD ST SS CORT MN FRAG SET,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
71149122,SUP,HCPCS C1713,,71149122  -  SCREW BN 1.5MM 3MM 22MM TC100 HEX HD ST SS CORT MN FRAG SET,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
71149124,SUP,HCPCS C1713,,71149124  -  SCREW BN 1.5MM 3MM 24MM TC100 HEX HD ST SS CORT MN FRAG SET,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
71149206,SUP,HCPCS C1713,,71149206  -  SCREW BN 2MM 6MM TC100 ST CRCTE HD SS CORT MN FRAG SET,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
71149208,SUP,HCPCS C1713,,71149208  -  SCREW BN 2MM 8MM TC100 ST CRCTE HD SS CORT MN FRAG SET,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
71149210,SUP,HCPCS C1713,,71149210  -  SCREW BN 2MM 10MM TC100 ST CRCTE HD SS CORT MN FRAG SET,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
71149212,SUP,HCPCS C1713,,71149212  -  SCREW BN 2MM 12MM TC100 ST CRCTE HD SS CORT MN FRAG SET,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
71149214,SUP,HCPCS C1713,,71149214  -  SCREW BN 2MM 14MM TC100 ST CRCTE HD SS CORT MN FRAG SET,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
71149216,SUP,HCPCS C1713,,71149216  -  SCREW BN 2MM 16MM TC100 ST CRCTE HD SS CORT MN FRAG SET,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
71149218,SUP,HCPCS C1713,,71149218  -  SCREW BN 2MM 18MM TC100 ST CRCTE HD SS CORT MN FRAG SET,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
71149220,SUP,HCPCS C1713,,71149220  -  SCREW BN 2MM 20MM TC100 ST CRCTE HD SS CORT MN FRAG SET,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
71149222,SUP,HCPCS C1713,,71149222  -  SCREW BN 2MM 22MM TC100 ST CRCTE HD SS CORT MN FRAG SET,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
71149224,SUP,HCPCS C1713,,71149224  -  SCREW BN 2MM 24MM TC100 ST LTWT MDLR CRCTE HD SS CORT MN,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
71149226,SUP,HCPCS C1713,,71149226  -  SCREW BN 2MM 26MM TC100 ST CRCTE HD SS CORT MN FRAG SET,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
71149228,SUP,HCPCS C1713,,71149228  -  SCREW BN 2MM 28MM TC100 ST CRCTE HD SS CORT MN FRAG SET,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
71149230,SUP,HCPCS C1713,,71149230  -  SCREW BN 2MM 30MM TC100 ST CRCTE HD SS CORT MN FRAG SET,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
71149232,SUP,HCPCS C1713,,71149232  -  SCREW BN 2MM 32MM TC100 ST CRCTE HD SS CORT MN FRAG SET,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
71149234,SUP,HCPCS C1713,,71149234  -  SCREW BN 2MM 34MM TC100 ST CRCTE HD SS CORT MN FRAG SET,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
71149236,SUP,HCPCS C1713,,71149236  -  SCREW BN 2MM 36MM TC100 ST CRCTE HD SS CORT MN FRAG SET,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
71149238,SUP,HCPCS C1713,,71149238  -  SCREW BN 2MM 38MM TC100 ST CRCTE HD SS CORT MN FRAG SET,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
71149306,SUP,HCPCS C1713,,71149306  -  SCREW BN MN 2MM 4MM 6MM TC100 ST HEX HD SS CORT MN FRAG SYS,$79.43,$0.00,$79.43,$35.74,$56.69,$0.00,$13.68,$0.00,$0.00,$13.91,$79.43,$0.00,$39.71,$62.91,$63.54,$0.00,$12.43,$0.00,$12.64,$0.00
71149308,SUP,HCPCS C1713,,71149308  -  SCREW BN 2MM 4MM 8MM TC100 ST HEX HD SS CORT MN FRAG SYS,$79.43,$0.00,$79.43,$35.74,$56.69,$0.00,$13.68,$0.00,$0.00,$13.91,$79.43,$0.00,$39.71,$62.91,$63.54,$0.00,$12.43,$0.00,$12.64,$0.00
71149310,SUP,HCPCS C1713,,71149310  -  SCREW BN 2MM 4MM 10MM TC100 ST HEX HD SS CORT MN FRAG SYS,$79.43,$0.00,$79.43,$35.74,$56.69,$0.00,$13.68,$0.00,$0.00,$13.91,$79.43,$0.00,$39.71,$62.91,$63.54,$0.00,$12.43,$0.00,$12.64,$0.00
71149312,SUP,HCPCS C1713,,71149312  -  SCREW BN 2MM 4MM 12MM TC100 ST HEX HD SS CORT MN FRAG SYS,$79.43,$0.00,$79.43,$35.74,$56.69,$0.00,$13.68,$0.00,$0.00,$13.91,$79.43,$0.00,$39.71,$62.91,$63.54,$0.00,$12.43,$0.00,$12.64,$0.00
71149314,SUP,HCPCS C1713,,71149314  -  SCREW BN 2MM 4MM 14MM TC100 ST HEX HD SS CORT MN FRAG SYS,$79.43,$0.00,$79.43,$35.74,$56.69,$0.00,$13.68,$0.00,$0.00,$13.91,$79.43,$0.00,$39.71,$62.91,$63.54,$0.00,$12.43,$0.00,$12.64,$0.00
71149316,SUP,HCPCS C1713,,71149316  -  SCREW BN 2MM 4MM 16MM TC100 ST HEX HD SS CORT MN FRAG SYS,$79.43,$0.00,$79.43,$35.74,$56.69,$0.00,$13.68,$0.00,$0.00,$13.91,$79.43,$0.00,$39.71,$62.91,$63.54,$0.00,$12.43,$0.00,$12.64,$0.00
71149318,SUP,HCPCS C1713,,71149318  -  SCREW BN 2MM 4MM 18MM TC100 ST HEX HD SS CORT MN FRAG SYS,$79.43,$0.00,$79.43,$35.74,$56.69,$0.00,$13.68,$0.00,$0.00,$13.91,$79.43,$0.00,$39.71,$62.91,$63.54,$0.00,$12.43,$0.00,$12.64,$0.00
71149320,SUP,HCPCS C1713,,71149320  -  SCREW BN 2MM 4MM 20MM TC100 ST HEX HD SS CORT MN FRAG SYS,$79.43,$0.00,$79.43,$35.74,$56.69,$0.00,$13.68,$0.00,$0.00,$13.91,$79.43,$0.00,$39.71,$62.91,$63.54,$0.00,$12.43,$0.00,$12.64,$0.00
71149322,SUP,HCPCS C1713,,71149322  -  SCREW BN 2MM 4MM 22MM TC100 ST HEX HD SS CORT MN FRAG SYS,$79.43,$0.00,$79.43,$35.74,$56.69,$0.00,$13.68,$0.00,$0.00,$13.91,$79.43,$0.00,$39.71,$62.91,$63.54,$0.00,$12.43,$0.00,$12.64,$0.00
71149324,SUP,HCPCS C1713,,71149324  -  SCREW BN 2MM 4MM 24MM TC100 ST HEX HD SS CORT MN FRAG SYS,$79.43,$0.00,$79.43,$35.74,$56.69,$0.00,$13.68,$0.00,$0.00,$13.91,$79.43,$0.00,$39.71,$62.91,$63.54,$0.00,$12.43,$0.00,$12.64,$0.00
71149326,SUP,HCPCS C1713,,71149326  -  SCREW BN 2MM 26MM TC100 ST CORT,$79.43,$0.00,$79.43,$35.74,$56.69,$0.00,$13.68,$0.00,$0.00,$13.91,$79.43,$0.00,$39.71,$62.91,$63.54,$0.00,$12.43,$0.00,$12.64,$0.00
71149328,SUP,HCPCS C1713,,71149328  -  SCREW BN 2MM 28MM TC100 ST CORT,$79.43,$0.00,$79.43,$35.74,$56.69,$0.00,$13.68,$0.00,$0.00,$13.91,$79.43,$0.00,$39.71,$62.91,$63.54,$0.00,$12.43,$0.00,$12.64,$0.00
71149330,SUP,HCPCS C1713,,71149330  -  SCREW BN 2MM 30MM TC100 ST CORT,$79.43,$0.00,$79.43,$35.74,$56.69,$0.00,$13.68,$0.00,$0.00,$13.91,$79.43,$0.00,$39.71,$62.91,$63.54,$0.00,$12.43,$0.00,$12.64,$0.00
71149332,SUP,HCPCS C1713,,71149332  -  SCREW BN 2MM 32MM TC100 ST CORT,$79.43,$0.00,$79.43,$35.74,$56.69,$0.00,$13.68,$0.00,$0.00,$13.91,$79.43,$0.00,$39.71,$62.91,$63.54,$0.00,$12.43,$0.00,$12.64,$0.00
71149334,SUP,HCPCS C1713,,71149334  -  SCREW BN 2MM 34MM TC100 ST CORT,$79.43,$0.00,$79.43,$35.74,$56.69,$0.00,$13.68,$0.00,$0.00,$13.91,$79.43,$0.00,$39.71,$62.91,$63.54,$0.00,$12.43,$0.00,$12.64,$0.00
71149336,SUP,HCPCS C1713,,71149336  -  SCREW BN 2MM 36MM TC100 ST CORT,$79.43,$0.00,$79.43,$35.74,$56.69,$0.00,$13.68,$0.00,$0.00,$13.91,$79.43,$0.00,$39.71,$62.91,$63.54,$0.00,$12.43,$0.00,$12.64,$0.00
71149338,SUP,HCPCS C1713,,71149338  -  SCREW BN 2MM 38MM TC100 ST CORT,$79.43,$0.00,$79.43,$35.74,$56.69,$0.00,$13.68,$0.00,$0.00,$13.91,$79.43,$0.00,$39.71,$62.91,$63.54,$0.00,$12.43,$0.00,$12.64,$0.00
71149406,SUP,HCPCS C1713,,71149406  -  SCREW BN 2.7MM 5MM 6MM TC100 ST HEX SCKT SS METACARPUS,$69.73,$0.00,$69.73,$31.38,$49.76,$0.00,$12.01,$0.00,$0.00,$12.21,$69.73,$0.00,$34.86,$55.23,$55.78,$0.00,$10.91,$0.00,$11.10,$0.00
71149408,SUP,HCPCS C1713,,71149408  -  SCREW BN 2.7MM 5MM 8MM TC100 ST HEX SCKT SS METACARPUS,$69.73,$0.00,$69.73,$31.38,$49.76,$0.00,$12.01,$0.00,$0.00,$12.21,$69.73,$0.00,$34.86,$55.23,$55.78,$0.00,$10.91,$0.00,$11.10,$0.00
71149410,SUP,HCPCS C1713,,71149410  -  SCREW BN 2.7MM 5MM 10MM TC100 ST HEX SCKT SS METACARPUS,$69.73,$0.00,$69.73,$31.38,$49.76,$0.00,$12.01,$0.00,$0.00,$12.21,$69.73,$0.00,$34.86,$55.23,$55.78,$0.00,$10.91,$0.00,$11.10,$0.00
71149412,SUP,HCPCS C1713,,71149412  -  SCREW BN 2.7MM 5MM 12MM TC100 ST HEX SCKT SS METACARPUS,$69.73,$0.00,$69.73,$31.38,$49.76,$0.00,$12.01,$0.00,$0.00,$12.21,$69.73,$0.00,$34.86,$55.23,$55.78,$0.00,$10.91,$0.00,$11.10,$0.00
71149414,SUP,HCPCS C1713,,71149414  -  SCREW BN 2.7MM 5MM 14MM TC100 ST HEX SCKT SS METACARPUS,$69.73,$0.00,$69.73,$31.38,$49.76,$0.00,$12.01,$0.00,$0.00,$12.21,$69.73,$0.00,$34.86,$55.23,$55.78,$0.00,$10.91,$0.00,$11.10,$0.00
71149416,SUP,HCPCS C1713,,71149416  -  SCREW BN 2.7MM 5MM 16MM TC100 ST HEX SCKT SS METACARPUS,$69.73,$0.00,$69.73,$31.38,$49.76,$0.00,$12.01,$0.00,$0.00,$12.21,$69.73,$0.00,$34.86,$55.23,$55.78,$0.00,$10.91,$0.00,$11.10,$0.00
71149418,SUP,HCPCS C1713,,71149418  -  SCREW BN 2.7MM 18MM TC100 ST CORT,$69.73,$0.00,$69.73,$31.38,$49.76,$0.00,$12.01,$0.00,$0.00,$12.21,$69.73,$0.00,$34.86,$55.23,$55.78,$0.00,$10.91,$0.00,$11.10,$0.00
71149420,SUP,HCPCS C1713,,71149420  -  SCREW BN 2.7MM 5MM 20MM TC100 ST HEX SCKT SS METACARPUS,$69.73,$0.00,$69.73,$31.38,$49.76,$0.00,$12.01,$0.00,$0.00,$12.21,$69.73,$0.00,$34.86,$55.23,$55.78,$0.00,$10.91,$0.00,$11.10,$0.00
71149422,SUP,HCPCS C1713,,71149422  -  SCREW BN 2.7MM 5MM 22MM TC100 ST HEX SCKT SS METACARPUS,$69.73,$0.00,$69.73,$31.38,$49.76,$0.00,$12.01,$0.00,$0.00,$12.21,$69.73,$0.00,$34.86,$55.23,$55.78,$0.00,$10.91,$0.00,$11.10,$0.00
71149424,SUP,HCPCS C1713,,71149424  -  SCREW BN 2.7MM 5MM 24MM TC100 ST HEX SCKT SS METACARPUS,$69.73,$0.00,$69.73,$31.38,$49.76,$0.00,$12.01,$0.00,$0.00,$12.21,$69.73,$0.00,$34.86,$55.23,$55.78,$0.00,$10.91,$0.00,$11.10,$0.00
71149426,SUP,HCPCS C1713,,71149426  -  SCREW BN 2.7MM 5MM 26MM TC100 ST HEX SCKT SS METACARPUS,$69.73,$0.00,$69.73,$31.38,$49.76,$0.00,$12.01,$0.00,$0.00,$12.21,$69.73,$0.00,$34.86,$55.23,$55.78,$0.00,$10.91,$0.00,$11.10,$0.00
71149428,SUP,HCPCS C1713,,71149428  -  SCREW BN 2.7MM 5MM 28MM TC100 ST HEX SCKT SS METACARPUS,$69.73,$0.00,$69.73,$31.38,$49.76,$0.00,$12.01,$0.00,$0.00,$12.21,$69.73,$0.00,$34.86,$55.23,$55.78,$0.00,$10.91,$0.00,$11.10,$0.00
71149430,SUP,HCPCS C1713,,71149430  -  SCREW BN 2.7MM 5MM 30MM TC100 ST HEX SCKT SS METACARPUS,$69.73,$0.00,$69.73,$31.38,$49.76,$0.00,$12.01,$0.00,$0.00,$12.21,$69.73,$0.00,$34.86,$55.23,$55.78,$0.00,$10.91,$0.00,$11.10,$0.00
71149432,SUP,HCPCS C1713,,71149432  -  SCREW BN 2.7MM 5MM 32MM TC100 ST HEX SCKT SS METACARPUS,$69.73,$0.00,$69.73,$31.38,$49.76,$0.00,$12.01,$0.00,$0.00,$12.21,$69.73,$0.00,$34.86,$55.23,$55.78,$0.00,$10.91,$0.00,$11.10,$0.00
71149434,SUP,HCPCS C1713,,71149434  -  SCREW BN 2.7MM 5MM 34MM TC100 ST HEX SCKT SS METACARPUS,$69.73,$0.00,$69.73,$31.38,$49.76,$0.00,$12.01,$0.00,$0.00,$12.21,$69.73,$0.00,$34.86,$55.23,$55.78,$0.00,$10.91,$0.00,$11.10,$0.00
71149436,SUP,HCPCS C1713,,71149436  -  SCREW BN 2.7MM 5MM 36MM TC100 ST HEX SCKT SS METACARPUS,$69.73,$0.00,$69.73,$31.38,$49.76,$0.00,$12.01,$0.00,$0.00,$12.21,$69.73,$0.00,$34.86,$55.23,$55.78,$0.00,$10.91,$0.00,$11.10,$0.00
71149438,SUP,HCPCS C1713,,71149438  -  SCREW BN 2.7MM 5MM 38MM TC100 ST HEX SCKT SS METACARPUS,$69.73,$0.00,$69.73,$31.38,$49.76,$0.00,$12.01,$0.00,$0.00,$12.21,$69.73,$0.00,$34.86,$55.23,$55.78,$0.00,$10.91,$0.00,$11.10,$0.00
71149440,SUP,HCPCS C1713,,71149440  -  SCREW BN 2.7MM 5MM 40MM TC100 ST HEX SCKT SS METACARPUS,$69.73,$0.00,$69.73,$31.38,$49.76,$0.00,$12.01,$0.00,$0.00,$12.21,$69.73,$0.00,$34.86,$55.23,$55.78,$0.00,$10.91,$0.00,$11.10,$0.00
71149445,SUP,HCPCS C1713,,71149445  -  SCREW BN 2.7MM 5MM 45MM TC100 ST HEX SCKT SS METACARPUS,$69.73,$0.00,$69.73,$31.38,$49.76,$0.00,$12.01,$0.00,$0.00,$12.21,$69.73,$0.00,$34.86,$55.23,$55.78,$0.00,$10.91,$0.00,$11.10,$0.00
71149450,SUP,HCPCS C1713,,71149450  -  SCREW BN 2.7MM 5MM 50MM TC100 ST HEX SCKT SS METACARPUS,$69.73,$0.00,$69.73,$31.38,$49.76,$0.00,$12.01,$0.00,$0.00,$12.21,$69.73,$0.00,$34.86,$55.23,$55.78,$0.00,$10.91,$0.00,$11.10,$0.00
71149455,SUP,HCPCS C1713,,71149455  -  SCREW BN 2.7MM 5MM 55MM TC100 ST HEX SCKT SS METACARPUS,$69.73,$0.00,$69.73,$31.38,$49.76,$0.00,$12.01,$0.00,$0.00,$12.21,$69.73,$0.00,$34.86,$55.23,$55.78,$0.00,$10.91,$0.00,$11.10,$0.00
71149460,SUP,HCPCS C1713,,71149460  -  SCREW BN 2.7MM 5MM 60MM TC100 ST HEX SCKT SS METACARPUS,$69.73,$0.00,$69.73,$31.38,$49.76,$0.00,$12.01,$0.00,$0.00,$12.21,$69.73,$0.00,$34.86,$55.23,$55.78,$0.00,$10.91,$0.00,$11.10,$0.00
71149465,SUP,HCPCS C1713,,71149465  -  SCREW BN 2.7MM 5MM 65MM TC100 ST HEX SCKT SS METACARPUS,$69.73,$0.00,$69.73,$31.38,$49.76,$0.00,$12.01,$0.00,$0.00,$12.21,$69.73,$0.00,$34.86,$55.23,$55.78,$0.00,$10.91,$0.00,$11.10,$0.00
71149470,SUP,HCPCS C1713,,71149470  -  SCREW BN 2.7MM 5MM 70MM TC100 ST HEX SCKT SS METACARPUS,$69.73,$0.00,$69.73,$31.38,$49.76,$0.00,$12.01,$0.00,$0.00,$12.21,$69.73,$0.00,$34.86,$55.23,$55.78,$0.00,$10.91,$0.00,$11.10,$0.00
71149510,SUP,HCPCS C1713,,71149510  -  SCREW BN 3.5MM 6MM 10MM TC100 ST HEX SCKT SS CORT SM FRAG,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
71149512,SUP,HCPCS C1713,,71149512  -  SCREW BN 3.5MM 6MM 12MM TC100 ST HEX SCKT SS CORT SM FRAG,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
71149514,SUP,HCPCS C1713,,71149514  -  SCREW BN 3.5MM 14MM ST DIST CORT VOLR RDS,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
71149516,SUP,HCPCS C1713,,71149516  -  SCREW BN HEX 3.5MM 16MM ST DIST CORT VOLR RDS,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
71149518,SUP,HCPCS C1713,,71149518  -  SCREW BN 3.5MM 6MM 18MM TC100 ST HEX SCKT SS CORT SM FRAG,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
71149520,SUP,HCPCS C1713,,71149520  -  SCREW BN 3.5MM 6MM 20MM TC100 ST HEX SCKT SS CORT SM FRAG,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
71149522,SUP,HCPCS C1713,,71149522  -  SCREW BN 3.5MM 6MM 22MM TC100 ST HEX SCKT SS CORT SM FRAG,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
71149524,SUP,HCPCS C1713,,71149524  -  SCREW BN 3.5MM 6MM 24MM TC100 ST HEX SCKT SS CORT SM FRAG,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
71149526,SUP,HCPCS C1713,,71149526  -  SCREW BN 3.5MM 6MM 26MM TC100 ST HEX SCKT SS CORT SM FRAG,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
71149528,SUP,HCPCS C1713,,71149528  -  SCREW BN 3.5MM 6MM 28MM TC100 ST HEX SCKT SS CORT SM FRAG,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
71149530,SUP,HCPCS C1713,,71149530  -  SCREW BN 3.5MM 6MM 30MM TC100 ST HEX SCKT SS CORT SM FRAG,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
71149532,SUP,HCPCS C1713,,71149532  -  SCREW BN 3.5MM 6MM 32MM TC100 ST HEX SCKT SS CORT SM FRAG,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
71149534,SUP,HCPCS C1713,,71149534  -  SCREW BN 3.5MM 6MM 34MM TC100 ST HEX SCKT SS CORT SM FRAG,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
71149536,SUP,HCPCS C1713,,71149536  -  SCREW BN 3.5MM 6MM 36MM TC100 ST HEX SCKT SS CORT SM FRAG,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
71149538,SUP,HCPCS C1713,,71149538  -  SCREW BN 3.5MM 6MM 38MM TC100 ST HEX SCKT SS CORT SM FRAG,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
71149540,SUP,HCPCS C1713,,71149540  -  SCREW BN 3.5MM 6MM 40MM TC100 ST HEX SCKT SS CORT SM FRAG,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
71149545,SUP,HCPCS C1713,,71149545  -  SCREW BN 3.5MM 6MM 45MM TC100 ST HEX SCKT SS CORT SM FRAG,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
71149550,SUP,HCPCS C1713,,71149550  -  SCREW BN 3.5MM 6MM 50MM TC100 ST HEX SCKT SS CORT SM FRAG,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
71149555,SUP,HCPCS C1713,,71149555  -  SCREW BN 3.5MM 6MM 55MM TC100 ST HEX SCKT SS CORT SM FRAG,$91.45,$0.00,$91.45,$41.15,$65.27,$0.00,$15.76,$0.00,$0.00,$16.01,$91.45,$0.00,$45.73,$72.43,$73.16,$0.00,$14.31,$0.00,$14.56,$0.00
71149560,SUP,HCPCS C1713,,71149560  -  SCREW BN 3.5MM 6MM 60MM TC100 ST HEX SCKT SS CORT SM FRAG,$91.45,$0.00,$91.45,$41.15,$65.27,$0.00,$15.76,$0.00,$0.00,$16.01,$91.45,$0.00,$45.73,$72.43,$73.16,$0.00,$14.31,$0.00,$14.56,$0.00
71149565,SUP,HCPCS C1713,,71149565  -  SCREW BN 3.5MM 6MM 65MM TC100 ST HEX SCKT SS CORT SM FRAG,$91.45,$0.00,$91.45,$41.15,$65.27,$0.00,$15.76,$0.00,$0.00,$16.01,$91.45,$0.00,$45.73,$72.43,$73.16,$0.00,$14.31,$0.00,$14.56,$0.00
71149570,SUP,HCPCS C1713,,71149570  -  SCREW BN 3.5MM 6MM 70MM TC100 ST HEX SCKT SS CORT SM FRAG,$91.45,$0.00,$91.45,$41.15,$65.27,$0.00,$15.76,$0.00,$0.00,$16.01,$91.45,$0.00,$45.73,$72.43,$73.16,$0.00,$14.31,$0.00,$14.56,$0.00
71149575,SUP,HCPCS C1713,,71149575  -  SCREW BN 3.5MM 6MM 75MM TC100 ST HEX SCKT SS CORT SM FRAG,$91.45,$0.00,$91.45,$41.15,$65.27,$0.00,$15.76,$0.00,$0.00,$16.01,$91.45,$0.00,$45.73,$72.43,$73.16,$0.00,$14.31,$0.00,$14.56,$0.00
71149580,SUP,HCPCS C1713,,71149580  -  SCREW BN 3.5MM 6MM 80MM TC100 ST HEX SCKT SS CORT SM FRAG,$91.45,$0.00,$91.45,$41.15,$65.27,$0.00,$15.76,$0.00,$0.00,$16.01,$91.45,$0.00,$45.73,$72.43,$73.16,$0.00,$14.31,$0.00,$14.56,$0.00
71149585,SUP,HCPCS C1713,,71149585  -  SCREW BN 3.5MM 6MM 85MM TC100 ST HEX SCKT SS CORT SM FRAG,$91.45,$0.00,$91.45,$41.15,$65.27,$0.00,$15.76,$0.00,$0.00,$16.01,$91.45,$0.00,$45.73,$72.43,$73.16,$0.00,$14.31,$0.00,$14.56,$0.00
71149590,SUP,HCPCS C1713,,71149590  -  SCREW BN 3.5MM 6MM 90MM TC100 ST HEX SCKT SS CORT SM FRAG,$91.45,$0.00,$91.45,$41.15,$65.27,$0.00,$15.76,$0.00,$0.00,$16.01,$91.45,$0.00,$45.73,$72.43,$73.16,$0.00,$14.31,$0.00,$14.56,$0.00
71149595,SUP,HCPCS C1713,,71149595  -  SCREW BN 3.5MM 6MM 95MM TC100 ST HEX SCKT SS CORT SM FRAG,$91.45,$0.00,$91.45,$41.15,$65.27,$0.00,$15.76,$0.00,$0.00,$16.01,$91.45,$0.00,$45.73,$72.43,$73.16,$0.00,$14.31,$0.00,$14.56,$0.00
71149600,SUP,HCPCS C1713,,71149600  -  SCREW BN 3.5MM 100MM TC100 ST DP HEX HD SS CORT SM FRAG SET,$91.45,$0.00,$91.45,$41.15,$65.27,$0.00,$15.76,$0.00,$0.00,$16.01,$91.45,$0.00,$45.73,$72.43,$73.16,$0.00,$14.31,$0.00,$14.56,$0.00
71149605,SUP,HCPCS C1713,,71149605  -  SCREW BN 3.5MM 105MM TC100 ST DP HEX HD SS CORT SM FRAG SET,$91.45,$0.00,$91.45,$41.15,$65.27,$0.00,$15.76,$0.00,$0.00,$16.01,$91.45,$0.00,$45.73,$72.43,$73.16,$0.00,$14.31,$0.00,$14.56,$0.00
71149610,SUP,HCPCS C1713,,71149610  -  SCREW BN 3.5MM 110MM TC100 ST DP HEX HD SS CORT SM FRAG SET,$91.45,$0.00,$91.45,$41.15,$65.27,$0.00,$15.76,$0.00,$0.00,$16.01,$91.45,$0.00,$45.73,$72.43,$73.16,$0.00,$14.31,$0.00,$14.56,$0.00
71149615,SUP,HCPCS C1713,,71149615  -  SCREW BN 3.5MM 115MM STRL TC100 ST DP HEX HD SS CORT SM FRAG,$93.35,$0.00,$93.35,$42.01,$66.62,$0.00,$16.08,$0.00,$0.00,$16.34,$93.35,$0.00,$46.68,$73.93,$74.68,$0.00,$14.61,$0.00,$14.86,$0.00
71149620,SUP,HCPCS C1713,,71149620  -  SCREW BN 3.5MM 120MM STRL TC100 ST DP HEX HD SS CORT SM FRAG,$93.35,$0.00,$93.35,$42.01,$66.62,$0.00,$16.08,$0.00,$0.00,$16.34,$93.35,$0.00,$46.68,$73.93,$74.68,$0.00,$14.61,$0.00,$14.86,$0.00
71149625,SUP,HCPCS C1713,,71149625  -  SCREW BN 3.5MM 125MM STRL TC100 ST DP HEX HD SS CORT SM FRAG,$93.35,$0.00,$93.35,$42.01,$66.62,$0.00,$16.08,$0.00,$0.00,$16.34,$93.35,$0.00,$46.68,$73.93,$74.68,$0.00,$14.61,$0.00,$14.86,$0.00
71149630,SUP,HCPCS C1713,,71149630  -  SCREW BN 3.5MM 130MM STRL TC100 ST DP HEX HD SS CORT SM FRAG,$93.35,$0.00,$93.35,$42.01,$66.62,$0.00,$16.08,$0.00,$0.00,$16.34,$93.35,$0.00,$46.68,$73.93,$74.68,$0.00,$14.61,$0.00,$14.86,$0.00
71149714,SUP,HCPCS C1713,,71149714  -  SCREW BN 4.5MM 14MM TC100 ST HEX SCKT SS CORT LG SCR SET,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
71149716,SUP,HCPCS C1713,,71149716  -  SCREW BN 4.5MM 16MM TC100 ST HEX SCKT SS CORT LG FRAG SET,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
71149718,SUP,HCPCS C1713,,71149718  -  SCREW BN 4.5MM 18MM TC100 ST HEX SCKT SS CORT LG SCR SET,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
71149720,SUP,HCPCS C1713,,71149720  -  SCREW BN 4.5MM 20MM TC100 ST HEX SCKT SS CORT LG SCR SET,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
71149722,SUP,HCPCS C1713,,71149722  -  SCREW BN 4.5MM 22MM TC100 ST HEX SCKT SS CORT LG FRAG SET,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
71149724,SUP,HCPCS C1713,,71149724  -  SCREW BN 4.5MM 24MM TC100 ST HEX SCKT SS CORT LG FRAG SYS,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
71149726,SUP,HCPCS C1713,,71149726  -  SCREW BN 4.5MM 26MM TC100 ST HEX SCKT SS CORT LG FRAG SYS,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
71149728,SUP,HCPCS C1713,,71149728  -  SCREW BN 4.5MM 28MM TC100 ST HEX SCKT SS CORT LG FRAG SYS,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
71149730,SUP,HCPCS C1713,,71149730  -  SCREW BN 4.5MM 30MM TC100 ST HEX SCKT SS CORT LG FRAG SET,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
71149732,SUP,HCPCS C1713,,71149732  -  SCREW BN 4.5MM 32MM TC100 ST HEX SCKT SS CORT LG FRAG SYS,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
71149734,SUP,HCPCS C1713,,71149734  -  SCREW BN 4.5MM 34MM TC100 ST HEX SCKT SS CORT LG FRAG SYS,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
71149736,SUP,HCPCS C1713,,71149736  -  SCREW BN 4.5MM 36MM TC100 ST HEX SCKT SS CORT LG FRAG SYS,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
71149738,SUP,HCPCS C1713,,71149738  -  SCREW BN 4.5MM 38MM TC100 ST HEX SCKT SS CORT LG FRAG SYS,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
71149740,SUP,HCPCS C1713,,71149740  -  SCREW BN 4.5MM 40MM TC100 ST HEX SCKT SS CORT LG FRAG SYS,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
71149742,SUP,HCPCS C1713,,71149742  -  SCREW BN HEX 4.5MM 42MM TC100 ST SCKT SS CORT LG FRAG SYS,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
71149744,SUP,HCPCS C1713,,71149744  -  SCREW BN HEX 4.5MM 44MM TC100 ST SCKT SS CORT LG FRAG SYS,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
71149746,SUP,HCPCS C1713,,71149746  -  SCREW BN 4.5MM 46MM TC100 ST HEX SCKT SS CORT LG FRAG SYS,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
71149748,SUP,HCPCS C1713,,71149748  -  SCREW BN 4.5MM 48MM TC100 ST HEX SCKT SS CORT LG FRAG SYS,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
71149750,SUP,HCPCS C1713,,71149750  -  SCREW BN 4.5MM 50MM TC100 ST HEX SCKT SS CORT LG FRAG SYS,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
71149752,SUP,HCPCS C1713,,71149752  -  SCREW BN 4.5MM 52MM TC100 ST HEX SCKT SS CORT LG FRAG SYS,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
71149754,SUP,HCPCS C1713,,71149754  -  SCREW BN 4.5MM 54MM TC100 ST HEX SCKT SS CORT LG FRAG SYS,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
71149756,SUP,HCPCS C1713,,71149756  -  SCREW BN 4.5MM 56MM TC100 ST HEX SCKT SS CORT LG FRAG SYS,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
71149758,SUP,HCPCS C1713,,71149758  -  SCREW BN 4.5MM 58MM TC100 ST HEX SCKT SS CORT LG FRAG SET,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
71149760,SUP,HCPCS C1713,,71149760  -  SCREW BN 4.5MM 60MM TC100 ST HEX SCKT SS CORT LG SCR SET,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
71149762,SUP,HCPCS C1713,,71149762  -  SCREW BN 4.5MM 62MM TC100 ST HEX SCKT SS CORT LG FRAG SYS,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
71149764,SUP,HCPCS C1713,,71149764  -  SCREW BN 4.5MM 64MM TC100 ST HEX SCKT SS CORT LG FRAG SET,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
71149766,SUP,HCPCS C1713,,71149766  -  SCREW BN 4.5MM 66MM TC100 ST HEX SCKT SS CORT LG FRAG SYS,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
71149768,SUP,HCPCS C1713,,71149768  -  SCREW BN 4.5MM 68MM TC100 ST HEX SCKT SS CORT LG FRAG SYS,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
71149770,SUP,HCPCS C1713,,71149770  -  SCREW BN 4.5MM 70MM TC100 ST HEX SCKT SS CORT LG FRAG SET,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
71149772,SUP,HCPCS C1713,,71149772  -  SCREW BN 4.5MM 72MM TC100 ST HEX SCKT SS CORT LG FRAG SYS,$126.00,$0.00,$126.00,$56.70,$89.93,$0.00,$21.71,$0.00,$0.00,$22.06,$126.00,$0.00,$63.00,$99.79,$100.80,$0.00,$19.72,$0.00,$20.06,$0.00
71149776,SUP,HCPCS C1713,,71149776  -  SCREW BN 4.5MM 76MM TC100 ST HEX SCKT SS CORT LG FRAG SYS,$126.00,$0.00,$126.00,$56.70,$89.93,$0.00,$21.71,$0.00,$0.00,$22.06,$126.00,$0.00,$63.00,$99.79,$100.80,$0.00,$19.72,$0.00,$20.06,$0.00
71149785,SUP,HCPCS C1713,,71149785  -  SCREW BN 4.5MM 85MM TC100 ST HEX SCKT SS CORT LG FRAG SYS,$126.00,$0.00,$126.00,$56.70,$89.93,$0.00,$21.71,$0.00,$0.00,$22.06,$126.00,$0.00,$63.00,$99.79,$100.80,$0.00,$19.72,$0.00,$20.06,$0.00
71149795,SUP,HCPCS C1713,,71149795  -  SCREW BN 4.5MM 95MM TC100 ST HEX SCKT SS CORT LG FRAG SYS,$126.00,$0.00,$126.00,$56.70,$89.93,$0.00,$21.71,$0.00,$0.00,$22.06,$126.00,$0.00,$63.00,$99.79,$100.80,$0.00,$19.72,$0.00,$20.06,$0.00
71149800,SUP,HCPCS C1713,,71149800  -  SCREW BN 4.5MM 100MM TC100 ST HEX HD SS CORT LG FRAG SET,$126.00,$0.00,$126.00,$56.70,$89.93,$0.00,$21.71,$0.00,$0.00,$22.06,$126.00,$0.00,$63.00,$99.79,$100.80,$0.00,$19.72,$0.00,$20.06,$0.00
71149805,SUP,HCPCS C1713,,71149805  -  SCREW BN 4.5MM 105MM TC100 ST HEX HD SS CORT LG FRAG SET,$126.00,$0.00,$126.00,$56.70,$89.93,$0.00,$21.71,$0.00,$0.00,$22.06,$126.00,$0.00,$63.00,$99.79,$100.80,$0.00,$19.72,$0.00,$20.06,$0.00
71149810,SUP,HCPCS C1713,,71149810  -  SCREW BN 4.5MM 110MM TC100 ST HEX HD SS CORT LG FRAG SET,$126.00,$0.00,$126.00,$56.70,$89.93,$0.00,$21.71,$0.00,$0.00,$22.06,$126.00,$0.00,$63.00,$99.79,$100.80,$0.00,$19.72,$0.00,$20.06,$0.00
71149815,SUP,HCPCS C1713,,71149815  -  SCREW BN 4.5MM 115MM TC100 ST HEX HD SS CORT LG FRAG SET,$126.00,$0.00,$126.00,$56.70,$89.93,$0.00,$21.71,$0.00,$0.00,$22.06,$126.00,$0.00,$63.00,$99.79,$100.80,$0.00,$19.72,$0.00,$20.06,$0.00
71149820,SUP,HCPCS C1713,,71149820  -  SCREW BN 4.5MM 120MM TC100 ST HEX HD SS CORT LG FRAG SET,$126.00,$0.00,$126.00,$56.70,$89.93,$0.00,$21.71,$0.00,$0.00,$22.06,$126.00,$0.00,$63.00,$99.79,$100.80,$0.00,$19.72,$0.00,$20.06,$0.00
71149825,SUP,HCPCS C1713,,71149825  -  SCREW BN 4.5MM 125MM TC100 ST HEX HD SS CORT LG FRAG SET,$126.00,$0.00,$126.00,$56.70,$89.93,$0.00,$21.71,$0.00,$0.00,$22.06,$126.00,$0.00,$63.00,$99.79,$100.80,$0.00,$19.72,$0.00,$20.06,$0.00
71149830,SUP,HCPCS C1713,,71149830  -  SCREW BN 4.5MM 130MM TC100 ST HEX HD SS CORT LG FRAG SET,$126.00,$0.00,$126.00,$56.70,$89.93,$0.00,$21.71,$0.00,$0.00,$22.06,$126.00,$0.00,$63.00,$99.79,$100.80,$0.00,$19.72,$0.00,$20.06,$0.00
71149835,SUP,HCPCS C1713,,71149835  -  SCREW BN 4.5MM 135MM TC100 ST HEX HD SS CORT LG FRAG SET,$126.00,$0.00,$126.00,$56.70,$89.93,$0.00,$21.71,$0.00,$0.00,$22.06,$126.00,$0.00,$63.00,$99.79,$100.80,$0.00,$19.72,$0.00,$20.06,$0.00
71149840,SUP,HCPCS C1713,,71149840  -  SCREW BN 4.5MM 140MM TC100 ST HEX HD SS CORT LG FRAG SET,$126.00,$0.00,$126.00,$56.70,$89.93,$0.00,$21.71,$0.00,$0.00,$22.06,$126.00,$0.00,$63.00,$99.79,$100.80,$0.00,$19.72,$0.00,$20.06,$0.00
71149845,SUP,HCPCS C1713,,71149845  -  SCREW BN 4.5MM 145MM TC100 ST HEX HD SS CORT LG FRAG SET,$126.00,$0.00,$126.00,$56.70,$89.93,$0.00,$21.71,$0.00,$0.00,$22.06,$126.00,$0.00,$63.00,$99.79,$100.80,$0.00,$19.72,$0.00,$20.06,$0.00
71160095,SUP,HCPCS C1713,,71160095  -  SCREW BN 95MM LG TI ORTH,$689.85,$0.00,$689.85,$310.43,$492.35,$0.00,$118.86,$0.00,$0.00,$120.79,$689.85,$0.00,$344.93,$546.36,$551.88,$0.00,$107.96,$0.00,$109.82,$0.00
71161008,SUP,HCPCS C1769,,71161008  -  WIRE FX .8MM 70MM STRL KRSH TROC PNT 1 END SS ORTH,$47.70,$0.00,$47.70,$25.90,$34.04,$0.00,$8.22,$0.00,$0.00,$8.35,$47.70,$0.00,$23.85,$37.78,$38.16,$0.00,$7.47,$0.00,$7.59,$0.00
71161010,SUP,HCPCS C1769,,71161010  -  WIRE FX 1MM 150MM STRL KRSH TROC PNT 1 END SS ORTH,$47.70,$0.00,$47.70,$25.90,$34.04,$0.00,$8.22,$0.00,$0.00,$8.35,$47.70,$0.00,$23.85,$37.78,$38.16,$0.00,$7.47,$0.00,$7.59,$0.00
71161020,SUP,Custom 27203010,,71161020  -  WIRE FX 2MM 150MM STRL KRSH TROC PNT SS ORTH DISP,$67.20,$0.00,$67.20,$0.00,$47.96,$0.00,$0.00,$0.00,$0.00,$0.00,$67.20,$0.00,$33.60,$53.22,$53.76,$0.00,$0.00,$0.00,$0.00,$0.00
71161040,SUP,HCPCS C1713,,71161040  -  SCREW BN P/T 6.5MM 40MM NS 20MM CNN TI,$535.50,$0.00,$535.50,$240.98,$382.19,$0.00,$92.26,$0.00,$0.00,$93.76,$535.50,$0.00,$267.75,$424.12,$428.40,$0.00,$83.81,$0.00,$85.25,$0.00
71161045,SUP,HCPCS C1713,,71161045  -  SCREW BN P/T 6.5MM 45MM NS 20MM CNN TI,$535.50,$0.00,$535.50,$240.98,$382.19,$0.00,$92.26,$0.00,$0.00,$93.76,$535.50,$0.00,$267.75,$424.12,$428.40,$0.00,$83.81,$0.00,$85.25,$0.00
71161050,SUP,HCPCS C1713,,71161050  -  SCREW BN P/T 6.5MM 50MM NS 20MM CNN TI,$535.50,$0.00,$535.50,$240.98,$382.19,$0.00,$92.26,$0.00,$0.00,$93.76,$535.50,$0.00,$267.75,$424.12,$428.40,$0.00,$83.81,$0.00,$85.25,$0.00
71161055,SUP,HCPCS C1713,,71161055  -  SCREW BN P/T 6.5MM 55MM NS 20MM CNN TI,$535.50,$0.00,$535.50,$240.98,$382.19,$0.00,$92.26,$0.00,$0.00,$93.76,$535.50,$0.00,$267.75,$424.12,$428.40,$0.00,$83.81,$0.00,$85.25,$0.00
71161060,SUP,HCPCS C1713,,71161060  -  SCREW BN P/T 6.5MM 60MM NS 20MM CNN TI,$535.50,$0.00,$535.50,$240.98,$382.19,$0.00,$92.26,$0.00,$0.00,$93.76,$535.50,$0.00,$267.75,$424.12,$428.40,$0.00,$83.81,$0.00,$85.25,$0.00
71161065,SUP,HCPCS C1713,,71161065  -  SCREW BN P/T 6.5MM 65MM NS 20MM CNN TI,$535.50,$0.00,$535.50,$240.98,$382.19,$0.00,$92.26,$0.00,$0.00,$93.76,$535.50,$0.00,$267.75,$424.12,$428.40,$0.00,$83.81,$0.00,$85.25,$0.00
71161066,SUP,HCPCS C1769,,71161066  -  WIRE FX .6MM STRL KRSH,$47.70,$0.00,$47.70,$25.90,$34.04,$0.00,$8.22,$0.00,$0.00,$8.35,$47.70,$0.00,$23.85,$37.78,$38.16,$0.00,$7.47,$0.00,$7.59,$0.00
71161070,SUP,HCPCS C1713,,71161070  -  SCREW BN 6.5MM 70MM NS 20MM CNN P/T TI ORTH,$535.50,$0.00,$535.50,$240.98,$382.19,$0.00,$92.26,$0.00,$0.00,$93.76,$535.50,$0.00,$267.75,$424.12,$428.40,$0.00,$83.81,$0.00,$85.25,$0.00
71161075,SUP,HCPCS C1713,,71161075  -  SCREW BN 6.5MM 75MM NS 20MM CNN P/T TI ORTH,$535.50,$0.00,$535.50,$240.98,$382.19,$0.00,$92.26,$0.00,$0.00,$93.76,$535.50,$0.00,$267.75,$424.12,$428.40,$0.00,$83.81,$0.00,$85.25,$0.00
71161080,SUP,HCPCS C1713,,71161080  -  SCREW BN LG 6.5MM 80MM STRL 20MM CNN THRD TI ORTH,$535.50,$0.00,$535.50,$240.98,$382.19,$0.00,$92.26,$0.00,$0.00,$93.76,$535.50,$0.00,$267.75,$424.12,$428.40,$0.00,$83.81,$0.00,$85.25,$0.00
71161085,SUP,HCPCS C1713,,71161085  -  SCREW BN 6.5MM 85MM NS 20MM CNN P/T TI ORTH,$535.50,$0.00,$535.50,$240.98,$382.19,$0.00,$92.26,$0.00,$0.00,$93.76,$535.50,$0.00,$267.75,$424.12,$428.40,$0.00,$83.81,$0.00,$85.25,$0.00
71161090,SUP,HCPCS C1713,,71161090  -  SCREW BN 6.5MM 90MM NS 20MM CNN P/T TI ORTH,$535.50,$0.00,$535.50,$240.98,$382.19,$0.00,$92.26,$0.00,$0.00,$93.76,$535.50,$0.00,$267.75,$424.12,$428.40,$0.00,$83.81,$0.00,$85.25,$0.00
71161095,SUP,HCPCS C1713,,71161095  -  SCREW BN 6.5MM 95MM NS 20MM CNN P/T TI ORTH,$535.50,$0.00,$535.50,$240.98,$382.19,$0.00,$92.26,$0.00,$0.00,$93.76,$535.50,$0.00,$267.75,$424.12,$428.40,$0.00,$83.81,$0.00,$85.25,$0.00
71161100,SUP,HCPCS C1713,,71161100  -  SCREW BN 6.5MM 100MM NS 20MM CNN P/T TI ORTH,$535.50,$0.00,$535.50,$240.98,$382.19,$0.00,$92.26,$0.00,$0.00,$93.76,$535.50,$0.00,$267.75,$424.12,$428.40,$0.00,$83.81,$0.00,$85.25,$0.00
71161105,SUP,HCPCS C1713,,71161105  -  SCREW BN 6.5MM 105MM NS 20MM CNN P/T TI ORTH,$535.50,$0.00,$535.50,$240.98,$382.19,$0.00,$92.26,$0.00,$0.00,$93.76,$535.50,$0.00,$267.75,$424.12,$428.40,$0.00,$83.81,$0.00,$85.25,$0.00
71161110,SUP,HCPCS C1713,,71161110  -  SCREW BN 6.5MM 110MM NS 20MM CNN P/T TI ORTH,$535.50,$0.00,$535.50,$240.98,$382.19,$0.00,$92.26,$0.00,$0.00,$93.76,$535.50,$0.00,$267.75,$424.12,$428.40,$0.00,$83.81,$0.00,$85.25,$0.00
71161303,SUP,HCPCS C1713,,71161303  -  PLATE BN 130D CLS 3 HL CMPR TI HIP,"$1,422.75",$0.00,"$1,422.75",$640.24,"$1,015.42",$0.00,$245.13,$0.00,$0.00,$249.11,"$1,422.75",$0.00,$711.38,"$1,126.82","$1,138.20",$0.00,$222.66,$0.00,$226.50,$0.00
71161352,SUP,HCPCS C1713,,71161352  -  PLATE BN 135D CLS 2 HL CMPR TI HIP,"$1,422.75",$0.00,"$1,422.75",$640.24,"$1,015.42",$0.00,$245.13,$0.00,$0.00,$249.11,"$1,422.75",$0.00,$711.38,"$1,126.82","$1,138.20",$0.00,$222.66,$0.00,$226.50,$0.00
71161354,SUP,HCPCS C1713,,71161354  -  PLATE BN 135D CLS 4 HL CMPR TI HIP,"$1,422.75",$0.00,"$1,422.75",$640.24,"$1,015.42",$0.00,$245.13,$0.00,$0.00,$249.11,"$1,422.75",$0.00,$711.38,"$1,126.82","$1,138.20",$0.00,$222.66,$0.00,$226.50,$0.00
71161355,SUP,HCPCS C1713,,71161355  -  PLATE BN 135D CLS 5 HL CMPR TI HIP,"$1,422.75",$0.00,"$1,422.75",$640.24,"$1,015.42",$0.00,$245.13,$0.00,$0.00,$249.11,"$1,422.75",$0.00,$711.38,"$1,126.82","$1,138.20",$0.00,$222.66,$0.00,$226.50,$0.00
71161404,SUP,HCPCS C1713,,71161404  -  PLATE BN 140D CLS 4 HL CMPR TI HIP,"$1,422.75",$0.00,"$1,422.75",$640.24,"$1,015.42",$0.00,$245.13,$0.00,$0.00,$249.11,"$1,422.75",$0.00,$711.38,"$1,126.82","$1,138.20",$0.00,$222.66,$0.00,$226.50,$0.00
71161405,SUP,HCPCS C1713,,71161405  -  PLATE BN 140D CLS 5 HL CMPR TI HIP,"$1,422.75",$0.00,"$1,422.75",$640.24,"$1,015.42",$0.00,$245.13,$0.00,$0.00,$249.11,"$1,422.75",$0.00,$711.38,"$1,126.82","$1,138.20",$0.00,$222.66,$0.00,$226.50,$0.00
71161506,SUP,HCPCS C1713,,71161506  -  SCREW BN 1.5MM 6MM TC100 HEX SCKT SS CORT,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71161507,SUP,HCPCS C1713,,71161507  -  SCREW BN 1.5MM 7MM TC100 HEX SCKT SS CORT,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71161508,SUP,HCPCS C1713,,71161508  -  SCREW BN 1.5MM 8MM TC100 HEX SCKT SS CORT,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71161509,SUP,HCPCS C1713,,71161509  -  SCREW BN 1.5MM 9MM TC100 HEX SCKT SS CORT,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71161510,SUP,HCPCS C1713,,71161510  -  SCREW BN 1.5MM 10MM TC100 HEX SCKT SS CORT,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71161511,SUP,HCPCS C1713,,71161511  -  SCREW BN 1.5MM 11MM TC100 HEX SCKT SS CORT,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71161512,SUP,HCPCS C1713,,71161512  -  SCREW BN 1.5MM 12MM TC100 HEX SCKT SS CORT,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71161514,SUP,HCPCS C1713,,71161514  -  SCREW BN 1.5MM 14MM TC100 HEX SCKT SS CORT,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71161516,SUP,HCPCS C1713,,71161516  -  SCREW BN 1.5MM 16MM TC100 HEX SCKT SS CORT,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71161518,SUP,HCPCS C1713,,71161518  -  SCREW BN 1.5MM 18MM TC100 HEX SCKT SS CORT,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71161520,SUP,HCPCS C1713,,71161520  -  SCREW BN 1.5MM 20MM TC100 HEX SCKT SS CORT,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71161606,SUP,HCPCS C1713,,71161606  -  SCREW BN MN 1.5MM 6MM TC100 CRCTE HD SS CORT,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71161607,SUP,HCPCS C1713,,71161607  -  SCREW BN MN 1.5MM 7MM TC100 CRCTE HD SS CORT,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71161608,SUP,HCPCS C1713,,71161608  -  SCREW BN MN 1.5MM 8MM TC100 CRCTE HD SS CORT,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71161609,SUP,HCPCS C1713,,71161609  -  SCREW BN MN 1.5MM 9MM TC100 CRCTE HD SS CORT,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71161610,SUP,HCPCS C1713,,71161610  -  SCREW BN 1.5MM 10MM TC100 CRCTE SCKT SS CORT,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71161611,SUP,HCPCS C1713,,71161611  -  SCREW BN MN 1.5MM 11MM TC100 CRCTE HD SS CORT,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71161612,SUP,HCPCS C1713,,71161612  -  SCREW BN 1.5MM 12MM TC100 CRCTE SCKT SS CORT,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71161614,SUP,HCPCS C1713,,71161614  -  SCREW BN 1.5MM 14MM TC100 CRCTE SCKT SS CORT,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71161616,SUP,HCPCS C1713,,71161616  -  SCREW BN 1.5MM 16MM TC100 CRCTE SCKT SS CORT,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71161618,SUP,HCPCS C1713,,71161618  -  SCREW BN 1.5MM 18MM TC100 CRCTE SCKT SS CORT,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71161620,SUP,HCPCS C1713,,71161620  -  SCREW BN 1.5MM 20MM TC100 CRCTE SCKT SS CORT,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71162008,SUP,HCPCS C1713,,71162008  -  SCREW BN 2MM 8MM TC100 HEX HD SS CORT,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71162010,SUP,HCPCS C1713,,71162010  -  SCREW BN 2MM 10MM TC100 HEX HD SS CORT,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71162012,SUP,HCPCS C1713,,71162012  -  SCREW BN 2MM 12MM TC100 HEX HD SS CORT,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71162014,SUP,HCPCS C1713,,71162014  -  SCREW BN 2MM 14MM TC100 HEX HD SS CORT,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71162016,SUP,HCPCS C1713,,71162016  -  SCREW BN 2MM 16MM TC100 HEX HD SS CORT,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71162018,SUP,HCPCS C1713,,71162018  -  SCREW BN 2MM 18MM TC100 HEX HD SS CORT,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71162020,SUP,HCPCS C1713,,71162020  -  SCREW BN 2MM 20MM TC100 HEX HD SS CORT,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71162022,SUP,HCPCS C1713,,71162022  -  SCREW BN 2MM 22MM TC100 HEX HD SS CORT,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71162024,SUP,HCPCS C1713,,71162024  -  SCREW BN 2MM 24MM TC100 HEX HD SS CORT,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71162026,SUP,HCPCS C1713,,71162026  -  SCREW BN 2MM 26MM TC100 HEX HD SS CORT,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71162028,SUP,HCPCS C1713,,71162028  -  SCREW BN 2MM 28MM TC100 HEX HD SS CORT,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71162030,SUP,HCPCS C1713,,71162030  -  SCREW BN 2MM 30MM TC100 HEX HD SS CORT,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71162032,SUP,HCPCS C1713,,71162032  -  SCREW BN 2MM 32MM TC100 HEX HD SS CORT,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71162036,SUP,HCPCS C1713,,71162036  -  SCREW BN 2MM 36MM TC100 HEX HD SS CORT,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71162038,SUP,HCPCS C1713,,71162038  -  SCREW BN 2MM 38MM TC100 HEX HD SS CORT,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71162106,SUP,HCPCS C1713,,71162106  -  SCREW BN 2MM 6MM TC100 CRCTE HD SS CORT,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71162108,SUP,HCPCS C1713,,71162108  -  SCREW BN 2MM 8MM TC100 CRCTE HD SS CORT,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71162110,SUP,HCPCS C1713,,71162110  -  SCREW BN 2MM 10MM TC100 CRCTE HD SS CORT,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71162112,SUP,HCPCS C1713,,71162112  -  SCREW BN 2MM 12MM TC100 CRCTE HD SS CORT,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71162114,SUP,HCPCS C1713,,71162114  -  SCREW BN 2MM 14MM TC100 CRCTE HD SS CORT,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71162116,SUP,HCPCS C1713,,71162116  -  SCREW BN 2MM 16MM TC100 CRCTE HD SS CORT,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71162118,SUP,HCPCS C1713,,71162118  -  SCREW BN 2MM 18MM TC100 CRCTE HD SS CORT,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71162120,SUP,HCPCS C1713,,71162120  -  SCREW BN 2MM 20MM TC100 CRCTE HD SS CORT,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71162122,SUP,HCPCS C1713,,71162122  -  SCREW BN 2MM 22MM TC100 CRCTE HD SS CORT,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71162124,SUP,HCPCS C1713,,71162124  -  SCREW BN 2MM 24MM TC100 CRCTE HD SS CORT,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71162126,SUP,HCPCS C1713,,71162126  -  SCREW BN 2MM 26MM TC100 CRCTE HD SS CORT,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71162128,SUP,HCPCS C1713,,71162128  -  SCREW BN 2MM 28MM TC100 CRCTE HD SS CORT,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71162130,SUP,HCPCS C1713,,71162130  -  SCREW BN 2MM 30MM TC100 CRCTE HD SS CORT,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71162132,SUP,HCPCS C1713,,71162132  -  SCREW BN 2MM 32MM TC100 CRCTE HD SS CORT,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71162134,SUP,HCPCS C1713,,71162134  -  SCREW BN 2MM 34MM STRL TC100 CRCTE HD SS CORT,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71162206,SUP,HCPCS C1713,,71162206  -  SCREW BN 2MM 6MM STRL TC100 HEX HD SS CORT,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71163006,SUP,HCPCS C1769,,71163006  -  WIRE FX .6MM 175MM STRL KRSH CRLGE SS ORTH,$50.40,$0.00,$50.40,$27.37,$35.97,$0.00,$8.68,$0.00,$0.00,$8.82,$50.40,$0.00,$25.20,$39.92,$40.32,$0.00,$7.89,$0.00,$8.02,$0.00
71163008,SUP,HCPCS C1769,,71163008  -  WIRE FX .8MM 200MM STRL KRSH CRLGE SS ORTH,$50.40,$0.00,$50.40,$27.37,$35.97,$0.00,$8.68,$0.00,$0.00,$8.82,$50.40,$0.00,$25.20,$39.92,$40.32,$0.00,$7.89,$0.00,$8.02,$0.00
71164026,SUP,HCPCS C1713,,71164026  -  SCREW BN 4.5MM 26MM ST CMPR TI CORT HIP,$60.38,$0.00,$60.38,$27.17,$43.09,$0.00,$10.40,$0.00,$0.00,$10.57,$60.38,$0.00,$30.19,$47.82,$48.30,$0.00,$9.45,$0.00,$9.61,$0.00
71164028,SUP,HCPCS C1713,,71164028  -  SCREW BN 4.5MM 28MM ST CMPR TI CORT,$60.38,$0.00,$60.38,$27.17,$43.09,$0.00,$10.40,$0.00,$0.00,$10.57,$60.38,$0.00,$30.19,$47.82,$48.30,$0.00,$9.45,$0.00,$9.61,$0.00
71164030,SUP,HCPCS C1713,,71164030  -  SCREW BN 4.5MM 30MM ST TI ORTH,$60.38,$0.00,$60.38,$27.17,$43.09,$0.00,$10.40,$0.00,$0.00,$10.57,$60.38,$0.00,$30.19,$47.82,$48.30,$0.00,$9.45,$0.00,$9.61,$0.00
71164032,SUP,HCPCS C1713,,71164032  -  SCREW BN 4.5MM 32MM ST CMPR TI CORT,$60.38,$0.00,$60.38,$27.17,$43.09,$0.00,$10.40,$0.00,$0.00,$10.57,$60.38,$0.00,$30.19,$47.82,$48.30,$0.00,$9.45,$0.00,$9.61,$0.00
71164034,SUP,HCPCS C1713,,71164034  -  SCREW BN 4.5MM 34MM ST CMPR TI CORT HIP,$60.38,$0.00,$60.38,$27.17,$43.09,$0.00,$10.40,$0.00,$0.00,$10.57,$60.38,$0.00,$30.19,$47.82,$48.30,$0.00,$9.45,$0.00,$9.61,$0.00
71164036,SUP,HCPCS C1713,,71164036  -  SCREW BN 4.5MM 36MM ST CMPR TI CORT HIP,$60.38,$0.00,$60.38,$27.17,$43.09,$0.00,$10.40,$0.00,$0.00,$10.57,$60.38,$0.00,$30.19,$47.82,$48.30,$0.00,$9.45,$0.00,$9.61,$0.00
71164038,SUP,HCPCS C1713,,71164038  -  SCREW BN 4.5MM 38MM ST CMPR TI CORT,$60.38,$0.00,$60.38,$27.17,$43.09,$0.00,$10.40,$0.00,$0.00,$10.57,$60.38,$0.00,$30.19,$47.82,$48.30,$0.00,$9.45,$0.00,$9.61,$0.00
71164040,SUP,HCPCS C1713,,71164040  -  SCREW BN 4.5MM 40MM ST CMPR TI CORT HIP,$60.38,$0.00,$60.38,$27.17,$43.09,$0.00,$10.40,$0.00,$0.00,$10.57,$60.38,$0.00,$30.19,$47.82,$48.30,$0.00,$9.45,$0.00,$9.61,$0.00
71164042,SUP,HCPCS C1713,,71164042  -  SCREW BN 4.5MM 42MM ST CMPR TI CORT HIP,$60.38,$0.00,$60.38,$27.17,$43.09,$0.00,$10.40,$0.00,$0.00,$10.57,$60.38,$0.00,$30.19,$47.82,$48.30,$0.00,$9.45,$0.00,$9.61,$0.00
71164044,SUP,HCPCS C1713,,71164044  -  SCREW BN 4.5MM 44MM ST CMPR TI CORT HIP,$60.38,$0.00,$60.38,$27.17,$43.09,$0.00,$10.40,$0.00,$0.00,$10.57,$60.38,$0.00,$30.19,$47.82,$48.30,$0.00,$9.45,$0.00,$9.61,$0.00
71164046,SUP,HCPCS C1713,,71164046  -  SCREW BN 4.5MM 46MM ST CMPR TI CORT HIP,$60.38,$0.00,$60.38,$27.17,$43.09,$0.00,$10.40,$0.00,$0.00,$10.57,$60.38,$0.00,$30.19,$47.82,$48.30,$0.00,$9.45,$0.00,$9.61,$0.00
71164048,SUP,HCPCS C1713,,71164048  -  SCREW BN 4.5MM 48MM ST CMPR TI CORT HIP,$60.38,$0.00,$60.38,$27.17,$43.09,$0.00,$10.40,$0.00,$0.00,$10.57,$60.38,$0.00,$30.19,$47.82,$48.30,$0.00,$9.45,$0.00,$9.61,$0.00
71164050,SUP,HCPCS C1713,,71164050  -  SCREW BN 4.5MM 50MM ST CMPR TI CORT HIP,$60.38,$0.00,$60.38,$27.17,$43.09,$0.00,$10.40,$0.00,$0.00,$10.57,$60.38,$0.00,$30.19,$47.82,$48.30,$0.00,$9.45,$0.00,$9.61,$0.00
71164052,SUP,HCPCS C1713,,71164052  -  SCREW BN 4.5MM 52MM ST CMPR TI CORT HIP,$60.38,$0.00,$60.38,$27.17,$43.09,$0.00,$10.40,$0.00,$0.00,$10.57,$60.38,$0.00,$30.19,$47.82,$48.30,$0.00,$9.45,$0.00,$9.61,$0.00
71170001,SUP,Custom 27203010,,71170001  -  BIT DRL 1.1MM QC,$163.80,$0.00,$163.80,$0.00,$116.90,$0.00,$0.00,$0.00,$0.00,$0.00,$163.80,$0.00,$81.90,$129.73,$131.04,$0.00,$0.00,$0.00,$0.00,$0.00
71170003,SUP,Custom 27203010,,71170003  -  BIT DRL 1.5MM 85MM STRL 60MM TC100 QC,$163.80,$0.00,$163.80,$0.00,$116.90,$0.00,$0.00,$0.00,$0.00,$0.00,$163.80,$0.00,$81.90,$129.73,$131.04,$0.00,$0.00,$0.00,$0.00,$0.00
71170005,SUP,Custom 27203010,,71170005  -  BIT DRL 2MM STRL GLD HL,$163.80,$0.00,$163.80,$0.00,$116.90,$0.00,$0.00,$0.00,$0.00,$0.00,$163.80,$0.00,$81.90,$129.73,$131.04,$0.00,$0.00,$0.00,$0.00,$0.00
71170007,SUP,Custom 27203010,,71170007  -  BIT DRL 2.7MM QC,$163.80,$0.00,$163.80,$0.00,$116.90,$0.00,$0.00,$0.00,$0.00,$0.00,$163.80,$0.00,$81.90,$129.73,$131.04,$0.00,$0.00,$0.00,$0.00,$0.00
71170071,SUP,Custom 27203010,,71170071  -  BIT DRL 2.5MM 110MM AU STRL QC,$270.90,$0.00,$270.90,$0.00,$193.34,$0.00,$0.00,$0.00,$0.00,$0.00,$270.90,$0.00,$135.45,$214.55,$216.72,$0.00,$0.00,$0.00,$0.00,$0.00
71170073,SUP,Custom 27203010,,71170073  -  BIT DRL 3.5MM 110MM STRL QC,$236.25,$0.00,$236.25,$0.00,$168.61,$0.00,$0.00,$0.00,$0.00,$0.00,$236.25,$0.00,$118.13,$187.11,$189.00,$0.00,$0.00,$0.00,$0.00,$0.00
71170111,SUP,Custom 27203010,,71170111  -  BIT DRL 3.2MM 145MM STRL QC,$163.80,$0.00,$163.80,$0.00,$116.90,$0.00,$0.00,$0.00,$0.00,$0.00,$163.80,$0.00,$81.90,$129.73,$131.04,$0.00,$0.00,$0.00,$0.00,$0.00
71170113,SUP,Custom 27203010,,71170113  -  BIT DRL 4.5MM 145MM STRL QC,$204.75,$0.00,$204.75,$0.00,$146.13,$0.00,$0.00,$0.00,$0.00,$0.00,$204.75,$0.00,$102.38,$162.16,$163.80,$0.00,$0.00,$0.00,$0.00,$0.00
71170147,SUP,Custom 27203010,,71170147  -  BIT DRL LNG 3.5MM 195MM STRL QC,$279.30,$0.00,$279.30,$0.00,$199.34,$0.00,$0.00,$0.00,$0.00,$0.00,$279.30,$0.00,$139.65,$221.21,$223.44,$0.00,$0.00,$0.00,$0.00,$0.00
71170149,SUP,Custom 27203010,,71170149  -  BIT DRL LNG 4.5MM 195MM STRL QC,$279.30,$0.00,$279.30,$0.00,$199.34,$0.00,$0.00,$0.00,$0.00,$0.00,$279.30,$0.00,$139.65,$221.21,$223.44,$0.00,$0.00,$0.00,$0.00,$0.00
71170151,SUP,Custom 27203010,,71170151  -  BIT DRL 4.5MM 196MM STRL QC 3 FLT,$433.65,$0.00,$433.65,$0.00,$309.50,$0.00,$0.00,$0.00,$0.00,$0.00,$433.65,$0.00,$216.83,$343.45,$346.92,$0.00,$0.00,$0.00,$0.00,$0.00
71170153,SUP,Custom 27203010,,71170153  -  BIT DRL 2.5MM 230MM STRL QC 3 FLT,$576.45,$0.00,$576.45,$0.00,$411.41,$0.00,$0.00,$0.00,$0.00,$0.00,$576.45,$0.00,$288.23,$456.55,$461.16,$0.00,$0.00,$0.00,$0.00,$0.00
71170155,SUP,Custom 27203010,,71170155  -  BIT DRL 3.2MM 230MM STRL QC 3 FLT,$576.45,$0.00,$576.45,$0.00,$411.41,$0.00,$0.00,$0.00,$0.00,$0.00,$576.45,$0.00,$288.23,$456.55,$461.16,$0.00,$0.00,$0.00,$0.00,$0.00
71170315,SUP,HCPCS C1713,,71170315  -  SCREW BN 6MM 190MM TC100 SCHNZ DMD PT SS ORTH,"$1,000.65",$0.00,"$1,000.65",$450.29,$714.16,$0.00,$172.41,$0.00,$0.00,$175.21,"$1,000.65",$0.00,$500.33,$792.51,$800.52,$0.00,$156.60,$0.00,$159.30,$0.00
71173501,SUP,Custom 27203010,,71173501  -  BIT DRILL 2MM 190MM QUICK CONNECT PERI-LOC DISPOSABLE,$180.60,$0.00,$180.60,$0.00,$128.89,$0.00,$0.00,$0.00,$0.00,$0.00,$180.60,$0.00,$90.30,$143.04,$144.48,$0.00,$0.00,$0.00,$0.00,$0.00
71173505,SUP,Custom 27203010,,71173505  -  BIT DRL 3.5MM 220MM STRL PRLC AO QCK CNCT CLBRT DISP,$280.35,$0.00,$280.35,$0.00,$200.09,$0.00,$0.00,$0.00,$0.00,$0.00,$280.35,$0.00,$140.18,$222.04,$224.28,$0.00,$0.00,$0.00,$0.00,$0.00
71173581,SUP,Custom 27203010,,71173581  -  BIT DRL 2.7MM 155MM CNN DISP,$743.40,$0.00,$743.40,$0.00,$530.56,$0.00,$0.00,$0.00,$0.00,$0.00,$743.40,$0.00,$371.70,$588.77,$594.72,$0.00,$0.00,$0.00,$0.00,$0.00
71173807,SUP,HCPCS C1713,,71173807  -  PIN FX 2MM 14MM VLP,$307.50,$0.00,$307.50,$138.38,$219.46,$0.00,$52.98,$0.00,$0.00,$53.84,$307.50,$0.00,$153.75,$243.54,$246.00,$0.00,$48.12,$0.00,$48.95,$0.00
71173808,SUP,HCPCS C1713,,71173808  -  PIN FIX 2MM 25MM TRIAL,$332.50,$0.00,$332.50,$149.63,$237.31,$0.00,$57.29,$0.00,$0.00,$58.22,$332.50,$0.00,$166.25,$263.34,$266.00,$0.00,$52.04,$0.00,$52.93,$0.00
71174904,SUP,HCPCS C1713,,71174904  -  PIN FX 1.5MM,$343.75,$0.00,$343.75,$154.69,$245.33,$0.00,$59.23,$0.00,$0.00,$60.19,$343.75,$0.00,$171.88,$272.25,$275.00,$0.00,$53.80,$0.00,$54.73,$0.00
71174909,SUP,HCPCS C1713,,71174909  -  PIN FX 1.8MM,$343.75,$0.00,$343.75,$154.69,$245.33,$0.00,$59.23,$0.00,$0.00,$60.19,$343.75,$0.00,$171.88,$272.25,$275.00,$0.00,$53.80,$0.00,$54.73,$0.00
71174914,SUP,HCPCS C1713,,71174914  -  PIN FX 2MM 30MM EVOS MN,$343.75,$0.00,$343.75,$154.69,$245.33,$0.00,$59.23,$0.00,$0.00,$60.19,$343.75,$0.00,$171.88,$272.25,$275.00,$0.00,$53.80,$0.00,$54.73,$0.00
71175022,SUP,Custom 27203010,,71175022  -  DRILL SRG SM LNG 2.5MM STRL LF EVOS AO QCK CNCT REUSE,$270.88,$0.00,$270.88,$0.00,$193.32,$0.00,$0.00,$0.00,$0.00,$0.00,$270.88,$0.00,$135.44,$214.54,$216.70,$0.00,$0.00,$0.00,$0.00,$0.00
71175023,SUP,Custom 27203010,,71175023  -  DRILL SRG SM SHRT 2.5MM STRL LF EVOS AO QCK CNCT REUSE,$225.50,$0.00,$225.50,$0.00,$160.94,$0.00,$0.00,$0.00,$0.00,$0.00,$225.50,$0.00,$112.75,$178.60,$180.40,$0.00,$0.00,$0.00,$0.00,$0.00
71175027,SUP,Custom 27203010,,71175027  -  SCREW BN 3.5MM 14MM STRL EVOS ST CORT,$312.13,$0.00,$312.13,$0.00,$222.76,$0.00,$0.00,$0.00,$0.00,$0.00,$312.13,$0.00,$156.06,$247.21,$249.70,$0.00,$0.00,$0.00,$0.00,$0.00
71175029,SUP,Custom 27203010,,71175029  -  TAP BN 4.7MM STRL LF EVOS AO QCK CNCT DISP,$309.38,$0.00,$309.38,$0.00,$220.80,$0.00,$0.00,$0.00,$0.00,$0.00,$309.38,$0.00,$154.69,$245.03,$247.50,$0.00,$0.00,$0.00,$0.00,$0.00
71175701,SUP,HCPCS C1713,,71175701  -  PIN DRL 3.2MM 358MM DRL TIP,$124.88,$0.00,$124.88,$56.19,$89.12,$0.00,$21.52,$0.00,$0.00,$21.86,$124.88,$0.00,$62.44,$98.90,$99.90,$0.00,$19.54,$0.00,$19.88,$0.00
71175702,SUP,HCPCS C1713,,71175702  -  PIN FX 4.5MM 80MM PRLC TRL TARGETER DRL TIP,$348.75,$0.00,$348.75,$156.94,$248.90,$0.00,$60.09,$0.00,$0.00,$61.06,$348.75,$0.00,$174.38,$276.21,$279.00,$0.00,$54.58,$0.00,$55.52,$0.00
71175703,SUP,HCPCS C1713,,71175703  -  PIN FX 3.5MM 18MM TARGETER,$348.75,$0.00,$348.75,$156.94,$248.90,$0.00,$60.09,$0.00,$0.00,$61.06,$348.75,$0.00,$174.38,$276.21,$279.00,$0.00,$54.58,$0.00,$55.52,$0.00
71175705,SUP,HCPCS C1713,,71175705  -  PIN FX SHRT 4.5MM 80MM PRLC TRL DRL TIP,$348.75,$0.00,$348.75,$156.94,$248.90,$0.00,$60.09,$0.00,$0.00,$61.06,$348.75,$0.00,$174.38,$276.21,$279.00,$0.00,$54.58,$0.00,$55.52,$0.00
71175706,SUP,HCPCS C1713,,71175706  -  PIN FX SHRT 3.5MM 18MM PRLC TRL DRL TIP,$348.75,$0.00,$348.75,$156.94,$248.90,$0.00,$60.09,$0.00,$0.00,$61.06,$348.75,$0.00,$174.38,$276.21,$279.00,$0.00,$54.58,$0.00,$55.52,$0.00
71176011,SUP,Custom 27203010,,71176011  -  BIT DRL 1.1MM 30MM QC,$244.65,$0.00,$244.65,$0.00,$174.61,$0.00,$0.00,$0.00,$0.00,$0.00,$244.65,$0.00,$122.33,$193.76,$195.72,$0.00,$0.00,$0.00,$0.00,$0.00
71176015,SUP,Custom 27203010,,71176015  -  BIT DRL 1.5MM 85MM QC,$244.65,$0.00,$244.65,$0.00,$174.61,$0.00,$0.00,$0.00,$0.00,$0.00,$244.65,$0.00,$122.33,$193.76,$195.72,$0.00,$0.00,$0.00,$0.00,$0.00
71176016,SUP,Custom 27203010,,71176016  -  BIT DRL 1.5MM 110MM STRL 85MM TC100 QC,$262.50,$0.00,$262.50,$0.00,$187.35,$0.00,$0.00,$0.00,$0.00,$0.00,$262.50,$0.00,$131.25,$207.90,$210.00,$0.00,$0.00,$0.00,$0.00,$0.00
71176020,SUP,Custom 27203010,,71176020  -  BIT DRL 2MM 100MM QC,$236.25,$0.00,$236.25,$0.00,$168.61,$0.00,$0.00,$0.00,$0.00,$0.00,$236.25,$0.00,$118.13,$187.11,$189.00,$0.00,$0.00,$0.00,$0.00,$0.00
71176021,SUP,Custom 27203010,,71176021  -  BIT DRL 2MM 125MM QC,$257.25,$0.00,$257.25,$0.00,$183.60,$0.00,$0.00,$0.00,$0.00,$0.00,$257.25,$0.00,$128.63,$203.74,$205.80,$0.00,$0.00,$0.00,$0.00,$0.00
71176025,SUP,Custom 27203010,,71176025  -  BIT DRL 2.5MM 110MM AU QC,$273.00,$0.00,$273.00,$0.00,$194.84,$0.00,$0.00,$0.00,$0.00,$0.00,$273.00,$0.00,$136.50,$216.22,$218.40,$0.00,$0.00,$0.00,$0.00,$0.00
71176026,SUP,Custom 27203010,,71176026  -  BIT DRL 2.5MM 180MM AU QC,$354.90,$0.00,$354.90,$0.00,$253.29,$0.00,$0.00,$0.00,$0.00,$0.00,$354.90,$0.00,$177.45,$281.08,$283.92,$0.00,$0.00,$0.00,$0.00,$0.00
71176027,SUP,Custom 27203010,,71176027  -  BIT DRL 2.7MM 100MM QC,$244.65,$0.00,$244.65,$0.00,$174.61,$0.00,$0.00,$0.00,$0.00,$0.00,$244.65,$0.00,$122.33,$193.76,$195.72,$0.00,$0.00,$0.00,$0.00,$0.00
71176028,SUP,Custom 27203010,,71176028  -  BIT DRL 2.7MM 125MM STRL QC,$267.75,$0.00,$267.75,$0.00,$191.09,$0.00,$0.00,$0.00,$0.00,$0.00,$267.75,$0.00,$133.88,$212.06,$214.20,$0.00,$0.00,$0.00,$0.00,$0.00
71176032,SUP,Custom 27203010,,71176032  -  BIT DRL 3.2MM 145MM STRL QC,$236.25,$0.00,$236.25,$0.00,$168.61,$0.00,$0.00,$0.00,$0.00,$0.00,$236.25,$0.00,$118.13,$187.11,$189.00,$0.00,$0.00,$0.00,$0.00,$0.00
71176033,SUP,Custom 27203010,,71176033  -  BIT DRL 3.2MM 195MM QC,$354.90,$0.00,$354.90,$0.00,$253.29,$0.00,$0.00,$0.00,$0.00,$0.00,$354.90,$0.00,$177.45,$281.08,$283.92,$0.00,$0.00,$0.00,$0.00,$0.00
71176035,SUP,Custom 27203010,,71176035  -  BIT DRL 3.5MM 110MM QC,$236.25,$0.00,$236.25,$0.00,$168.61,$0.00,$0.00,$0.00,$0.00,$0.00,$236.25,$0.00,$118.13,$187.11,$189.00,$0.00,$0.00,$0.00,$0.00,$0.00
71176037,SUP,Custom 27203010,,71176037  -  BIT DRL 3.5MM 195MM QC,$354.90,$0.00,$354.90,$0.00,$253.29,$0.00,$0.00,$0.00,$0.00,$0.00,$354.90,$0.00,$177.45,$281.08,$283.92,$0.00,$0.00,$0.00,$0.00,$0.00
71176045,SUP,Custom 27203010,,71176045  -  BIT DRL 4.5MM 145MM QC,$354.90,$0.00,$354.90,$0.00,$253.29,$0.00,$0.00,$0.00,$0.00,$0.00,$354.90,$0.00,$177.45,$281.08,$283.92,$0.00,$0.00,$0.00,$0.00,$0.00
71176047,SUP,Custom 27203010,,71176047  -  BIT DRL 4.5MM 195MM QC,$354.90,$0.00,$354.90,$0.00,$253.29,$0.00,$0.00,$0.00,$0.00,$0.00,$354.90,$0.00,$177.45,$281.08,$283.92,$0.00,$0.00,$0.00,$0.00,$0.00
71176125,SUP,Custom 27203010,,71176125  -  BIT DRL 2.5MM 230MM QC 3 FLT,$606.90,$0.00,$606.90,$0.00,$433.14,$0.00,$0.00,$0.00,$0.00,$0.00,$606.90,$0.00,$303.45,$480.66,$485.52,$0.00,$0.00,$0.00,$0.00,$0.00
71176132,SUP,Custom 27203010,,71176132  -  BIT DRL LNG 3.2MM 230MM QC 3 FLT,$606.90,$0.00,$606.90,$0.00,$433.14,$0.00,$0.00,$0.00,$0.00,$0.00,$606.90,$0.00,$303.45,$480.66,$485.52,$0.00,$0.00,$0.00,$0.00,$0.00
71176145,SUP,Custom 27203010,,71176145  -  BIT DRL 4.5MM 196MM STRL QC 3 FLT,$470.40,$0.00,$470.40,$0.00,$335.72,$0.00,$0.00,$0.00,$0.00,$0.00,$470.40,$0.00,$235.20,$372.56,$376.32,$0.00,$0.00,$0.00,$0.00,$0.00
71176511,SUP,Custom 27203010,,71176511  -  BIT DRL 1.1MM 45MM STRL NQCK CPLNG,$233.10,$0.00,$233.10,$0.00,$166.36,$0.00,$0.00,$0.00,$0.00,$0.00,$233.10,$0.00,$116.55,$184.62,$186.48,$0.00,$0.00,$0.00,$0.00,$0.00
71176516,SUP,Custom 27203010,,71176516  -  BIT DRL 1.5MM 95MM STRL NQCK CPLNG,$241.50,$0.00,$241.50,$0.00,$172.36,$0.00,$0.00,$0.00,$0.00,$0.00,$241.50,$0.00,$120.75,$191.27,$193.20,$0.00,$0.00,$0.00,$0.00,$0.00
71176521,SUP,Custom 27203010,,71176521  -  BIT DRL 2MM 110MM NQCK CPLNG,$281.40,$0.00,$281.40,$0.00,$200.84,$0.00,$0.00,$0.00,$0.00,$0.00,$281.40,$0.00,$140.70,$222.87,$225.12,$0.00,$0.00,$0.00,$0.00,$0.00
71176525,SUP,Custom 27203010,,71176525  -  BIT DRL 2.5MM 95MM AU NQCK CPLNG,$296.10,$0.00,$296.10,$0.00,$211.33,$0.00,$0.00,$0.00,$0.00,$0.00,$296.10,$0.00,$148.05,$234.51,$236.88,$0.00,$0.00,$0.00,$0.00,$0.00
71176528,SUP,Custom 27203010,,71176528  -  BIT DRL 2.7MM 110MM NQCK CPLNG,$255.15,$0.00,$255.15,$0.00,$182.10,$0.00,$0.00,$0.00,$0.00,$0.00,$255.15,$0.00,$127.58,$202.08,$204.12,$0.00,$0.00,$0.00,$0.00,$0.00
71176532,SUP,Custom 27203010,,71176532  -  BIT DRL 3.2MM 130MM NQCK CPLNG,$224.70,$0.00,$224.70,$0.00,$160.37,$0.00,$0.00,$0.00,$0.00,$0.00,$224.70,$0.00,$112.35,$177.96,$179.76,$0.00,$0.00,$0.00,$0.00,$0.00
71176533,SUP,Custom 27203010,,71176533  -  BIT DRL 3.2MM 180MM NQCK CPLNG,$352.80,$0.00,$352.80,$0.00,$251.79,$0.00,$0.00,$0.00,$0.00,$0.00,$352.80,$0.00,$176.40,$279.42,$282.24,$0.00,$0.00,$0.00,$0.00,$0.00
71176535,SUP,Custom 27203010,,71176535  -  BIT DRL 3.5MM 95MM NQCK CPLNG,$270.90,$0.00,$270.90,$0.00,$193.34,$0.00,$0.00,$0.00,$0.00,$0.00,$270.90,$0.00,$135.45,$214.55,$216.72,$0.00,$0.00,$0.00,$0.00,$0.00
71176537,SUP,Custom 27203010,,71176537  -  BIT DRL 3.5MM 180MM NQCK CPLNG,$281.40,$0.00,$281.40,$0.00,$200.84,$0.00,$0.00,$0.00,$0.00,$0.00,$281.40,$0.00,$140.70,$222.87,$225.12,$0.00,$0.00,$0.00,$0.00,$0.00
71176545,SUP,Custom 27203010,,71176545  -  BIT DRL 4.5MM 130MM STRL NQCK CPLNG,$270.90,$0.00,$270.90,$0.00,$193.34,$0.00,$0.00,$0.00,$0.00,$0.00,$270.90,$0.00,$135.45,$214.55,$216.72,$0.00,$0.00,$0.00,$0.00,$0.00
71176547,SUP,Custom 27203010,,71176547  -  BIT DRL 4.5MM 180MM NQCK CPLNG,$303.45,$0.00,$303.45,$0.00,$216.57,$0.00,$0.00,$0.00,$0.00,$0.00,$303.45,$0.00,$151.73,$240.33,$242.76,$0.00,$0.00,$0.00,$0.00,$0.00
71177134,SUP,Custom 27203010,,71177134  -  BIT DRL 5MM CNN,$918.75,$0.00,$918.75,$0.00,$655.71,$0.00,$0.00,$0.00,$0.00,$0.00,$918.75,$0.00,$459.38,$727.65,$735.00,$0.00,$0.00,$0.00,$0.00,$0.00
71177135,SUP,Custom 27203010,,71177135  -  BIT DRL 5.5MM CNN 8MM SCR,$918.75,$0.00,$918.75,$0.00,$655.71,$0.00,$0.00,$0.00,$0.00,$0.00,$918.75,$0.00,$459.38,$727.65,$735.00,$0.00,$0.00,$0.00,$0.00,$0.00
71177197,SUP,Custom 27203010,,71177197  -  BIT DRL SHRT 2MM VLP MN-MOD AO QC OVR,$242.00,$0.00,$242.00,$0.00,$172.72,$0.00,$0.00,$0.00,$0.00,$0.00,$242.00,$0.00,$121.00,$191.66,$193.60,$0.00,$0.00,$0.00,$0.00,$0.00
71177201,SUP,HCPCS C1713,,71177201  -  PIN GD 3.2MM 300MM THRD,$170.80,$0.00,$170.80,$76.86,$121.90,$0.00,$29.43,$0.00,$0.00,$29.91,$170.80,$0.00,$85.40,$135.27,$136.64,$0.00,$26.73,$0.00,$27.19,$0.00
71177202,SUP,Custom 27203010,,71177202  -  BIT DRL 3.2MM 300MM QC,$361.20,$0.00,$361.20,$0.00,$257.79,$0.00,$0.00,$0.00,$0.00,$0.00,$361.20,$0.00,$180.60,$286.07,$288.96,$0.00,$0.00,$0.00,$0.00,$0.00
71190808,SUP,HCPCS C1713,,71190808  -  PIN HLF 6MM HAP ORTH,$85.00,$0.00,$85.00,$38.25,$60.66,$0.00,$14.65,$0.00,$0.00,$14.88,$85.00,$0.00,$42.50,$67.32,$68.00,$0.00,$13.30,$0.00,$13.53,$0.00
71191010,SUP,HCPCS C1713,,71191010  -  TRIAL SRG 3.5MM SMPL LCK PLT HUM LT PROX,$393.75,$0.00,$393.75,$177.19,$281.02,$0.00,$67.84,$0.00,$0.00,$68.94,$393.75,$0.00,$196.88,$311.85,$315.00,$0.00,$61.62,$0.00,$62.69,$0.00
71191019,SUP,HCPCS C1713,,71191019  -  TRIAL SRG SMPL LCK PLT RT OLCRN,$500.85,$0.00,$500.85,$225.38,$357.46,$0.00,$86.29,$0.00,$0.00,$87.69,$500.85,$0.00,$250.43,$396.67,$400.68,$0.00,$78.38,$0.00,$79.74,$0.00
71191025,SUP,HCPCS C1713,,71191025  -  TRIAL SRG 10 HL SMPL LCK PLT INFR MDL CLVCL,$465.15,$0.00,$465.15,$209.32,$331.98,$0.00,$80.14,$0.00,$0.00,$81.44,$465.15,$0.00,$232.58,$368.40,$372.12,$0.00,$72.80,$0.00,$74.05,$0.00
71192010,SUP,HCPCS C1713,,71192010  -  TRIAL SRG 2.7MM 55MM SMPL LCK SCR CORT,$18.23,$0.00,$18.23,$8.20,$13.01,$0.00,$3.14,$0.00,$0.00,$3.19,$18.23,$0.00,$9.11,$14.44,$14.58,$0.00,$2.85,$0.00,$2.90,$0.00
71192011,SUP,HCPCS C1713,,71192011  -  TRIAL SRG 2.7MM 20MM SMPL SCR CORT,$17.65,$0.00,$17.65,$7.94,$12.60,$0.00,$3.04,$0.00,$0.00,$3.09,$17.65,$0.00,$8.83,$13.98,$14.12,$0.00,$2.76,$0.00,$2.81,$0.00
71192012,SUP,HCPCS C1713,,71192012  -  TRIAL SRG 2.7MM 55MM SMPL SCR CORT,$19.53,$0.00,$19.53,$8.79,$13.93,$0.00,$3.36,$0.00,$0.00,$3.42,$19.53,$0.00,$9.76,$15.47,$15.62,$0.00,$3.06,$0.00,$3.11,$0.00
71192016,SUP,HCPCS C1713,,71192016  -  TRIAL SRG 2.5MM 20MM SMPL SCR CORT,$17.65,$0.00,$17.65,$7.94,$12.60,$0.00,$3.04,$0.00,$0.00,$3.09,$17.65,$0.00,$8.83,$13.98,$14.12,$0.00,$2.76,$0.00,$2.81,$0.00
71192535,SUP,HCPCS C1713,,71192535  -  TRIAL SRG 5MM 35MM HEX SCR ORTH SMPL,$26.78,$0.00,$26.78,$12.05,$19.11,$0.00,$4.61,$0.00,$0.00,$4.69,$26.78,$0.00,$13.39,$21.21,$21.42,$0.00,$4.19,$0.00,$4.26,$0.00
71192570,SUP,HCPCS C1713,,71192570  -  TRIAL SRG 5MM 70MM HEX SCR ORTH SMPL,$39.33,$0.00,$39.33,$17.70,$28.07,$0.00,$6.78,$0.00,$0.00,$6.89,$39.33,$0.00,$19.66,$31.15,$31.46,$0.00,$6.15,$0.00,$6.26,$0.00
71193006,SUP,HCPCS C1713,,71193006  -  SCREW SET ASIAN SMPL HIP IM NL,$65.30,$0.00,$65.30,$29.39,$46.60,$0.00,$11.25,$0.00,$0.00,$11.43,$65.30,$0.00,$32.65,$51.72,$52.24,$0.00,$10.22,$0.00,$10.40,$0.00
71193039,SUP,HCPCS C1713,,71193039  -  NAIL IM 11.5MM 40CM TRGN RTRGD TI FEM,$178.88,$0.00,$178.88,$80.49,$127.66,$0.00,$30.82,$0.00,$0.00,$31.32,$178.88,$0.00,$89.44,$141.67,$143.10,$0.00,$27.99,$0.00,$28.48,$0.00
71193111,SUP,HCPCS C1713,,71193111  -  TRIAL SRG MT-NL SMPL CAP NL,$29.35,$0.00,$29.35,$13.21,$20.95,$0.00,$5.06,$0.00,$0.00,$5.14,$29.35,$0.00,$14.68,$23.25,$23.48,$0.00,$4.59,$0.00,$4.67,$0.00
71193125,SUP,HCPCS C1713,,71193125  -  NAIL IM 11.5MM 25CM TRGN TI FEM,$176.40,$0.00,$176.40,$79.38,$125.90,$0.00,$30.39,$0.00,$0.00,$30.89,$176.40,$0.00,$88.20,$139.71,$141.12,$0.00,$27.61,$0.00,$28.08,$0.00
71193632,SUP,HCPCS C1713,,71193632  -  NAIL IM 10MM 32CM TRGN TI TIB DIST,$239.63,$0.00,$239.63,$107.83,$171.02,$0.00,$41.29,$0.00,$0.00,$41.96,$239.63,$0.00,$119.81,$189.79,$191.70,$0.00,$37.50,$0.00,$38.15,$0.00
71194828,SUP,HCPCS C1713,,71194828  -  NAIL IM 10/8.5MM 28CM TRGN BNT TI HUM,$339.75,$0.00,$339.75,$152.89,$242.48,$0.00,$58.54,$0.00,$0.00,$59.49,$339.75,$0.00,$169.88,$269.08,$271.80,$0.00,$53.17,$0.00,$54.09,$0.00
71220006,SUP,HCPCS C1713,,71220006  -  SCREW BN 2.7MM 6MM TC100 SS CORT MN FRAG SET,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71220008,SUP,HCPCS C1713,,71220008  -  SCREW BN 2.7MM 8MM TC100 SS CORT MN FRAG SET,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71220010,SUP,HCPCS C1713,,71220010  -  SCREW BN MN 2.7MM 10MM TC100 SS CORT,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71220012,SUP,HCPCS C1713,,71220012  -  SCREW BN MN 2.7MM 12MM TC100 SS CORT,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71220014,SUP,HCPCS C1713,,71220014  -  SCREW BN MN 2.7MM 14MM TC100 SS CORT,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71220016,SUP,HCPCS C1713,,71220016  -  SCREW BN MN 2.7MM 16MM TC100 SS CORT,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71220018,SUP,HCPCS C1713,,71220018  -  SCREW BN 2.7MM 18MM TC100 SS CORT MN FRAG SET,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71220020,SUP,HCPCS C1713,,71220020  -  SCREW BN 2.7MM 20MM TC100 SS CORT MN FRAG SET,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71220022,SUP,HCPCS C1713,,71220022  -  SCREW BN 2.7MM 22MM TC100 SS CORT MN FRAG SET,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71220024,SUP,HCPCS C1713,,71220024  -  SCREW BN 2.7MM 24MM TC100 SS CORT MN FRAG SET,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71220026,SUP,HCPCS C1713,,71220026  -  SCREW BN 2.7MM 26MM TC100 SS CORT MN FRAG SET,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71220028,SUP,HCPCS C1713,,71220028  -  SCREW BN 2.7MM 28MM TC100 SS CORT MN FRAG SET,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71220030,SUP,HCPCS C1713,,71220030  -  SCREW BN 2.7MM 30MM TC100 SS CORT MN FRAG SET,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71220032,SUP,HCPCS C1713,,71220032  -  SCREW BN 2.7MM 32MM TC100 SS CORT MN FRAG SET,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71220034,SUP,HCPCS C1713,,71220034  -  SCREW BN MN 2.7MM 34MM TC100 SS CORT,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71220036,SUP,HCPCS C1713,,71220036  -  SCREW BN 2.7MM 36MM TC100 ST HEX HD SS CORT MN FRAG SET,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71220038,SUP,HCPCS C1713,,71220038  -  SCREW BN 2.7MM 38MM TC100 SS CORT MN FRAG SET,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71220040,SUP,HCPCS C1713,,71220040  -  SCREW BN 2.7MM 40MM TC100 SS CORT MN FRAG SET,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71220045,SUP,HCPCS C1713,,71220045  -  SCREW BN MN 2.7MM 45MM TC100 SS CORT,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71220050,SUP,HCPCS C1713,,71220050  -  SCREW BN 2.7MM 50MM STRL TC100 SS CORT MN FRAG SET,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71222010,SUP,HCPCS C1713,,71222010  -  SCREW BN 3.5MM 6MM 10MM TC100 SS CORT SM FRAG SYS,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71222012,SUP,HCPCS C1713,,71222012  -  SCREW BN 3.5MM 6MM 12MM TC100 SS CORT SM FRAG SYS,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71222014,SUP,HCPCS C1713,,71222014  -  SCREW BN 3.5MM 6MM 14MM TC100 SS CORT SM FRAG SYS,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71222016,SUP,HCPCS C1713,,71222016  -  SCREW BN 3.5MM 6MM 16MM TC100 SS CORT SM FRAG SYS,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71222018,SUP,HCPCS C1713,,71222018  -  SCREW BN 3.5MM 6MM 18MM TC100 SS CORT SM FRAG SYS,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71222020,SUP,HCPCS C1713,,71222020  -  SCREW BN 3.5MM 6MM 20MM TC100 SS CORT SM FRAG SYS,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71222022,SUP,HCPCS C1713,,71222022  -  SCREW BN 3.5MM 6MM 22MM TC100 SS CORT SM FRAG SYS,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71222024,SUP,HCPCS C1713,,71222024  -  SCREW BN 3.5MM 6MM 24MM TC100 SS CORT SM FRAG SYS,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71222026,SUP,HCPCS C1713,,71222026  -  SCREW BN 3.5MM 6MM 26MM TC100 SS CORT SM FRAG SYS,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71222028,SUP,HCPCS C1713,,71222028  -  SCREW BN 3.5MM 6MM 28MM TC100 SS CORT SM FRAG SYS,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71222030,SUP,HCPCS C1713,,71222030  -  SCREW BN 3.5MM 6MM 30MM TC100 SS CORT SM FRAG SYS,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71222032,SUP,HCPCS C1713,,71222032  -  SCREW BN 3.5MM 6MM 32MM TC100 SS CORT SM FRAG SYS,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71222034,SUP,HCPCS C1713,,71222034  -  SCREW BN 3.5MM 6MM 34MM TC100 SS CORT SM FRAG SYS,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71222036,SUP,HCPCS C1713,,71222036  -  SCREW BN 3.5MM 6MM 36MM TC100 SS CORT SM FRAG SYS,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71222038,SUP,HCPCS C1713,,71222038  -  SCREW BN 3.5MM 6MM 38MM TC100 SS CORT SM FRAG SYS,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71222040,SUP,HCPCS C1713,,71222040  -  SCREW BN 3.5MM 6MM 40MM TC100 SS CORT SM FRAG SYS,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71222045,SUP,HCPCS C1713,,71222045  -  SCREW BN 3.5MM 6MM 45MM TC100 SS CORT SM FRAG SYS,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71222050,SUP,HCPCS C1713,,71222050  -  SCREW BN 3.5MM 6MM 50MM TC100 SS CORT SM FRAG SYS,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71222055,SUP,HCPCS C1713,,71222055  -  SCREW BN 3.5MM 6MM 55MM TC100 SS CORT SM FRAG SYS,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71222060,SUP,HCPCS C1713,,71222060  -  SCREW BN 3.5MM 6MM 60MM TC100 SS CORT SM FRAG SYS,$89.40,$0.00,$89.40,$40.23,$63.80,$0.00,$15.40,$0.00,$0.00,$15.65,$89.40,$0.00,$44.70,$70.80,$71.52,$0.00,$13.99,$0.00,$14.23,$0.00
71222065,SUP,HCPCS C1713,,71222065  -  SCREW BN 3.5MM 6MM 65MM TC100 SS CORT SM FRAG SYS,$89.40,$0.00,$89.40,$40.23,$63.80,$0.00,$15.40,$0.00,$0.00,$15.65,$89.40,$0.00,$44.70,$70.80,$71.52,$0.00,$13.99,$0.00,$14.23,$0.00
71222070,SUP,HCPCS C1713,,71222070  -  SCREW BN 3.5MM 6MM 70MM TC100 SS CORT SM FRAG SYS,$89.40,$0.00,$89.40,$40.23,$63.80,$0.00,$15.40,$0.00,$0.00,$15.65,$89.40,$0.00,$44.70,$70.80,$71.52,$0.00,$13.99,$0.00,$14.23,$0.00
71222075,SUP,HCPCS C1713,,71222075  -  SCREW BN 3.5MM 6MM 75MM TC100 SS CORT SM FRAG SYS,$89.40,$0.00,$89.40,$40.23,$63.80,$0.00,$15.40,$0.00,$0.00,$15.65,$89.40,$0.00,$44.70,$70.80,$71.52,$0.00,$13.99,$0.00,$14.23,$0.00
71222080,SUP,HCPCS C1713,,71222080  -  SCREW BN 3.5MM 6MM 80MM TC100 SS CORT SM FRAG SYS,$89.40,$0.00,$89.40,$40.23,$63.80,$0.00,$15.40,$0.00,$0.00,$15.65,$89.40,$0.00,$44.70,$70.80,$71.52,$0.00,$13.99,$0.00,$14.23,$0.00
71222085,SUP,HCPCS C1713,,71222085  -  SCREW BN 3.5MM 6MM 85MM TC100 SS CORT SM FRAG SYS,$89.40,$0.00,$89.40,$40.23,$63.80,$0.00,$15.40,$0.00,$0.00,$15.65,$89.40,$0.00,$44.70,$70.80,$71.52,$0.00,$13.99,$0.00,$14.23,$0.00
71222090,SUP,HCPCS C1713,,71222090  -  SCREW BN 3.5MM 6MM 90MM TC100 SS CORT SM FRAG SYS,$89.40,$0.00,$89.40,$40.23,$63.80,$0.00,$15.40,$0.00,$0.00,$15.65,$89.40,$0.00,$44.70,$70.80,$71.52,$0.00,$13.99,$0.00,$14.23,$0.00
71222095,SUP,HCPCS C1713,,71222095  -  SCREW BN 3.5MM 6MM 95MM TC100 SS CORT SM FRAG SYS,$89.40,$0.00,$89.40,$40.23,$63.80,$0.00,$15.40,$0.00,$0.00,$15.65,$89.40,$0.00,$44.70,$70.80,$71.52,$0.00,$13.99,$0.00,$14.23,$0.00
71222100,SUP,HCPCS C1713,,71222100  -  SCREW BN 3.5MM 100MM TC100 SS CORT SM FRAG SET,$89.40,$0.00,$89.40,$40.23,$63.80,$0.00,$15.40,$0.00,$0.00,$15.65,$89.40,$0.00,$44.70,$70.80,$71.52,$0.00,$13.99,$0.00,$14.23,$0.00
71222105,SUP,HCPCS C1713,,71222105  -  SCREW BN 3.5MM 105MM TC100 SS CORT SM FRAG SET,$89.40,$0.00,$89.40,$40.23,$63.80,$0.00,$15.40,$0.00,$0.00,$15.65,$89.40,$0.00,$44.70,$70.80,$71.52,$0.00,$13.99,$0.00,$14.23,$0.00
71222110,SUP,HCPCS C1713,,71222110  -  SCREW BN SM 3.5MM 110MM TC100 SS CORT,$89.40,$0.00,$89.40,$40.23,$63.80,$0.00,$15.40,$0.00,$0.00,$15.65,$89.40,$0.00,$44.70,$70.80,$71.52,$0.00,$13.99,$0.00,$14.23,$0.00
71222115,SUP,HCPCS C1713,,71222115  -  SCREW BN 3.5MM 115MM TC100 SS CORT SM FRAG SET,$101.48,$0.00,$101.48,$45.66,$72.42,$0.00,$17.48,$0.00,$0.00,$17.77,$101.48,$0.00,$50.74,$80.37,$81.18,$0.00,$15.88,$0.00,$16.15,$0.00
71222120,SUP,HCPCS C1713,,71222120  -  SCREW BN 3.5MM 120MM TC100 SS CORT SM FRAG SET,$101.48,$0.00,$101.48,$45.66,$72.42,$0.00,$17.48,$0.00,$0.00,$17.77,$101.48,$0.00,$50.74,$80.37,$81.18,$0.00,$15.88,$0.00,$16.15,$0.00
71222130,SUP,HCPCS C1713,,71222130  -  SCREW BN 3.5MM 130MM TC100 SS CORT SM FRAG SET,$101.48,$0.00,$101.48,$45.66,$72.42,$0.00,$17.48,$0.00,$0.00,$17.77,$101.48,$0.00,$50.74,$80.37,$81.18,$0.00,$15.88,$0.00,$16.15,$0.00
71223010,SUP,HCPCS C1713,,71223010  -  SCREW BN FT 4MM 6MM 10MM TC100 SS CANC SM FRAG SYS,$61.70,$0.00,$61.70,$27.77,$44.04,$0.00,$10.63,$0.00,$0.00,$10.80,$61.70,$0.00,$30.85,$48.87,$49.36,$0.00,$9.66,$0.00,$9.82,$0.00
71223012,SUP,HCPCS C1713,,71223012  -  SCREW BN FT 4MM 6MM 12MM TC100 SS CANC SM FRAG SYS,$61.70,$0.00,$61.70,$27.77,$44.04,$0.00,$10.63,$0.00,$0.00,$10.80,$61.70,$0.00,$30.85,$48.87,$49.36,$0.00,$9.66,$0.00,$9.82,$0.00
71223014,SUP,HCPCS C1713,,71223014  -  SCREW BN FT 4MM 6MM 14MM TC100 SS CANC SM FRAG SYS,$61.70,$0.00,$61.70,$27.77,$44.04,$0.00,$10.63,$0.00,$0.00,$10.80,$61.70,$0.00,$30.85,$48.87,$49.36,$0.00,$9.66,$0.00,$9.82,$0.00
71223016,SUP,HCPCS C1713,,71223016  -  SCREW BN FT 4MM 6MM 16MM TC100 SS CANC SM FRAG SYS,$61.70,$0.00,$61.70,$27.77,$44.04,$0.00,$10.63,$0.00,$0.00,$10.80,$61.70,$0.00,$30.85,$48.87,$49.36,$0.00,$9.66,$0.00,$9.82,$0.00
71223018,SUP,HCPCS C1713,,71223018  -  SCREW BN FT 4MM 6MM 18MM TC100 SS CANC SM FRAG SYS,$61.70,$0.00,$61.70,$27.77,$44.04,$0.00,$10.63,$0.00,$0.00,$10.80,$61.70,$0.00,$30.85,$48.87,$49.36,$0.00,$9.66,$0.00,$9.82,$0.00
71223020,SUP,HCPCS C1713,,71223020  -  SCREW BN FT 4MM 6MM 20MM TC100 SS CANC SM FRAG SYS,$61.70,$0.00,$61.70,$27.77,$44.04,$0.00,$10.63,$0.00,$0.00,$10.80,$61.70,$0.00,$30.85,$48.87,$49.36,$0.00,$9.66,$0.00,$9.82,$0.00
71223022,SUP,HCPCS C1713,,71223022  -  SCREW BN FT 4MM 6MM 22MM TC100 SS CANC SM FRAG SYS,$61.70,$0.00,$61.70,$27.77,$44.04,$0.00,$10.63,$0.00,$0.00,$10.80,$61.70,$0.00,$30.85,$48.87,$49.36,$0.00,$9.66,$0.00,$9.82,$0.00
71223024,SUP,HCPCS C1713,,71223024  -  SCREW BN FT 4MM 6MM 24MM TC100 SS CANC SM FRAG SYS,$61.70,$0.00,$61.70,$27.77,$44.04,$0.00,$10.63,$0.00,$0.00,$10.80,$61.70,$0.00,$30.85,$48.87,$49.36,$0.00,$9.66,$0.00,$9.82,$0.00
71223026,SUP,HCPCS C1713,,71223026  -  SCREW BN FT 4MM 6MM 26MM TC100 SS CANC SM FRAG SYS,$61.70,$0.00,$61.70,$27.77,$44.04,$0.00,$10.63,$0.00,$0.00,$10.80,$61.70,$0.00,$30.85,$48.87,$49.36,$0.00,$9.66,$0.00,$9.82,$0.00
71223028,SUP,HCPCS C1713,,71223028  -  SCREW BN FT 4MM 6MM 28MM TC100 SS CANC SM FRAG SYS,$61.70,$0.00,$61.70,$27.77,$44.04,$0.00,$10.63,$0.00,$0.00,$10.80,$61.70,$0.00,$30.85,$48.87,$49.36,$0.00,$9.66,$0.00,$9.82,$0.00
71223030,SUP,HCPCS C1713,,71223030  -  SCREW BN FT 4MM 6MM 30MM TC100 SS CANC SM FRAG SYS,$61.70,$0.00,$61.70,$27.77,$44.04,$0.00,$10.63,$0.00,$0.00,$10.80,$61.70,$0.00,$30.85,$48.87,$49.36,$0.00,$9.66,$0.00,$9.82,$0.00
71223032,SUP,HCPCS C1713,,71223032  -  SCREW BN FT 4MM 6MM 32MM TC100 SS CANC SM FRAG SYS,$61.70,$0.00,$61.70,$27.77,$44.04,$0.00,$10.63,$0.00,$0.00,$10.80,$61.70,$0.00,$30.85,$48.87,$49.36,$0.00,$9.66,$0.00,$9.82,$0.00
71223035,SUP,HCPCS C1713,,71223035  -  SCREW BN FT 4MM 6MM 35MM TC100 SS CANC SM FRAG SYS,$61.70,$0.00,$61.70,$27.77,$44.04,$0.00,$10.63,$0.00,$0.00,$10.80,$61.70,$0.00,$30.85,$48.87,$49.36,$0.00,$9.66,$0.00,$9.82,$0.00
71223036,SUP,HCPCS C1713,,71223036  -  SCREW BN FT 4MM 6MM 36MM TC100 SS CANC SM FRAG SYS,$61.70,$0.00,$61.70,$27.77,$44.04,$0.00,$10.63,$0.00,$0.00,$10.80,$61.70,$0.00,$30.85,$48.87,$49.36,$0.00,$9.66,$0.00,$9.82,$0.00
71223040,SUP,HCPCS C1713,,71223040  -  SCREW BN FT 4MM 6MM 40MM TC100 SS CANC SM FRAG SYS,$61.70,$0.00,$61.70,$27.77,$44.04,$0.00,$10.63,$0.00,$0.00,$10.80,$61.70,$0.00,$30.85,$48.87,$49.36,$0.00,$9.66,$0.00,$9.82,$0.00
71223045,SUP,HCPCS C1713,,71223045  -  SCREW BN FT 4MM 6MM 45MM TC100 SS CANC SM FRAG SYS,$61.70,$0.00,$61.70,$27.77,$44.04,$0.00,$10.63,$0.00,$0.00,$10.80,$61.70,$0.00,$30.85,$48.87,$49.36,$0.00,$9.66,$0.00,$9.82,$0.00
71223050,SUP,HCPCS C1713,,71223050  -  SCREW BN FT 4MM 6MM 50MM TC100 SS CANC SM FRAG SYS,$61.70,$0.00,$61.70,$27.77,$44.04,$0.00,$10.63,$0.00,$0.00,$10.80,$61.70,$0.00,$30.85,$48.87,$49.36,$0.00,$9.66,$0.00,$9.82,$0.00
71223055,SUP,HCPCS C1713,,71223055  -  SCREW BN FT 4MM 6MM 55MM TC100 SS CANC SM FRAG SYS,$61.70,$0.00,$61.70,$27.77,$44.04,$0.00,$10.63,$0.00,$0.00,$10.80,$61.70,$0.00,$30.85,$48.87,$49.36,$0.00,$9.66,$0.00,$9.82,$0.00
71223060,SUP,HCPCS C1713,,71223060  -  SCREW BN FT 4MM 6MM 60MM TC100 SS CANC SM FRAG SYS,$61.70,$0.00,$61.70,$27.77,$44.04,$0.00,$10.63,$0.00,$0.00,$10.80,$61.70,$0.00,$30.85,$48.87,$49.36,$0.00,$9.66,$0.00,$9.82,$0.00
71223065,SUP,HCPCS C1713,,71223065  -  SCREW BN FT 4MM 6MM 65MM TC100 SS CANC SM FRAG SYS,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71223070,SUP,HCPCS C1713,,71223070  -  SCREW BN FT 4MM 6MM 70MM TC100 SS CANC SM FRAG SYS,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71223075,SUP,HCPCS C1713,,71223075  -  SCREW BN FT 4MM 6MM 75MM TC100 SS CANC SM FRAG SYS,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71223080,SUP,HCPCS C1713,,71223080  -  SCREW BN FT 4MM 6MM 80MM TC100 SS CANC SM FRAG SYS,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71223085,SUP,HCPCS C1713,,71223085  -  SCREW BN FT 4MM 6MM 85MM TC100 SS CANC SM FRAG SYS,$81.53,$0.00,$81.53,$36.69,$58.18,$0.00,$14.05,$0.00,$0.00,$14.27,$81.53,$0.00,$40.76,$64.57,$65.22,$0.00,$12.76,$0.00,$12.98,$0.00
71223090,SUP,HCPCS C1713,,71223090  -  SCREW BN FT 4MM 6MM 90MM TC100 SS CANC SM FRAG SYS,$81.53,$0.00,$81.53,$36.69,$58.18,$0.00,$14.05,$0.00,$0.00,$14.27,$81.53,$0.00,$40.76,$64.57,$65.22,$0.00,$12.76,$0.00,$12.98,$0.00
71223095,SUP,HCPCS C1713,,71223095  -  SCREW BN FT 4MM 6MM 95MM TC100 SS CANC SM FRAG SYS,$81.53,$0.00,$81.53,$36.69,$58.18,$0.00,$14.05,$0.00,$0.00,$14.27,$81.53,$0.00,$40.76,$64.57,$65.22,$0.00,$12.76,$0.00,$12.98,$0.00
71223100,SUP,HCPCS C1713,,71223100  -  SCREW BN FT 4MM 100MM TC100 SS CANC SM FRAG SET,$81.53,$0.00,$81.53,$36.69,$58.18,$0.00,$14.05,$0.00,$0.00,$14.27,$81.53,$0.00,$40.76,$64.57,$65.22,$0.00,$12.76,$0.00,$12.98,$0.00
71223210,SUP,HCPCS C1713,,71223210  -  SCREW BN P/T 4MM 6MM 10MM TC100 SS CANC SM FRAG SYS,$59.53,$0.00,$59.53,$26.79,$42.48,$0.00,$10.26,$0.00,$0.00,$10.42,$59.53,$0.00,$29.76,$47.15,$47.62,$0.00,$9.32,$0.00,$9.48,$0.00
71223212,SUP,HCPCS C1713,,71223212  -  SCREW BN P/T 4MM 6MM 12MM TC100 SS CANC SM FRAG SYS,$59.53,$0.00,$59.53,$26.79,$42.48,$0.00,$10.26,$0.00,$0.00,$10.42,$59.53,$0.00,$29.76,$47.15,$47.62,$0.00,$9.32,$0.00,$9.48,$0.00
71223214,SUP,HCPCS C1713,,71223214  -  SCREW BN P/T 4MM 6MM 14MM TC100 SS CANC SM FRAG SYS,$59.53,$0.00,$59.53,$26.79,$42.48,$0.00,$10.26,$0.00,$0.00,$10.42,$59.53,$0.00,$29.76,$47.15,$47.62,$0.00,$9.32,$0.00,$9.48,$0.00
71223216,SUP,HCPCS C1713,,71223216  -  SCREW BN P/T 4MM 6MM 16MM TC100 SS CANC SM FRAG SYS,$59.53,$0.00,$59.53,$26.79,$42.48,$0.00,$10.26,$0.00,$0.00,$10.42,$59.53,$0.00,$29.76,$47.15,$47.62,$0.00,$9.32,$0.00,$9.48,$0.00
71223218,SUP,HCPCS C1713,,71223218  -  SCREW BN P/T 4MM 6MM 18MM TC100 SS CANC SM FRAG SYS,$59.53,$0.00,$59.53,$26.79,$42.48,$0.00,$10.26,$0.00,$0.00,$10.42,$59.53,$0.00,$29.76,$47.15,$47.62,$0.00,$9.32,$0.00,$9.48,$0.00
71223220,SUP,HCPCS C1713,,71223220  -  SCREW BN P/T 4MM 6MM 20MM TC100 SS CANC SM FRAG SYS,$59.53,$0.00,$59.53,$26.79,$42.48,$0.00,$10.26,$0.00,$0.00,$10.42,$59.53,$0.00,$29.76,$47.15,$47.62,$0.00,$9.32,$0.00,$9.48,$0.00
71223222,SUP,HCPCS C1713,,71223222  -  SCREW BN P/T 4MM 6MM 22MM TC100 SS CANC SM FRAG SYS,$59.53,$0.00,$59.53,$26.79,$42.48,$0.00,$10.26,$0.00,$0.00,$10.42,$59.53,$0.00,$29.76,$47.15,$47.62,$0.00,$9.32,$0.00,$9.48,$0.00
71223224,SUP,HCPCS C1713,,71223224  -  SCREW BN P/T 4MM 6MM 24MM TC100 SS CANC SM FRAG SYS,$59.53,$0.00,$59.53,$26.79,$42.48,$0.00,$10.26,$0.00,$0.00,$10.42,$59.53,$0.00,$29.76,$47.15,$47.62,$0.00,$9.32,$0.00,$9.48,$0.00
71223226,SUP,HCPCS C1713,,71223226  -  SCREW BN P/T 4MM 6MM 26MM TC100 SS CANC SM FRAG SYS,$59.53,$0.00,$59.53,$26.79,$42.48,$0.00,$10.26,$0.00,$0.00,$10.42,$59.53,$0.00,$29.76,$47.15,$47.62,$0.00,$9.32,$0.00,$9.48,$0.00
71223228,SUP,HCPCS C1713,,71223228  -  SCREW BN P/T 4MM 6MM 28MM TC100 SS CANC SM FRAG SYS,$59.53,$0.00,$59.53,$26.79,$42.48,$0.00,$10.26,$0.00,$0.00,$10.42,$59.53,$0.00,$29.76,$47.15,$47.62,$0.00,$9.32,$0.00,$9.48,$0.00
71223230,SUP,HCPCS C1713,,71223230  -  SCREW BN P/T 4MM 6MM 30MM TC100 SS CANC SM FRAG SYS,$59.53,$0.00,$59.53,$26.79,$42.48,$0.00,$10.26,$0.00,$0.00,$10.42,$59.53,$0.00,$29.76,$47.15,$47.62,$0.00,$9.32,$0.00,$9.48,$0.00
71223235,SUP,HCPCS C1713,,71223235  -  SCREW BN P/T 4MM 6MM 35MM TC100 SS CANC SM FRAG SYS,$59.53,$0.00,$59.53,$26.79,$42.48,$0.00,$10.26,$0.00,$0.00,$10.42,$59.53,$0.00,$29.76,$47.15,$47.62,$0.00,$9.32,$0.00,$9.48,$0.00
71223240,SUP,HCPCS C1713,,71223240  -  SCREW BN P/T 4MM 6MM 40MM TC100 SS CANC SM FRAG SYS,$59.53,$0.00,$59.53,$26.79,$42.48,$0.00,$10.26,$0.00,$0.00,$10.42,$59.53,$0.00,$29.76,$47.15,$47.62,$0.00,$9.32,$0.00,$9.48,$0.00
71223245,SUP,HCPCS C1713,,71223245  -  SCREW BN P/T 4MM 6MM 45MM TC100 SS CANC SM FRAG SYS,$59.53,$0.00,$59.53,$26.79,$42.48,$0.00,$10.26,$0.00,$0.00,$10.42,$59.53,$0.00,$29.76,$47.15,$47.62,$0.00,$9.32,$0.00,$9.48,$0.00
71223250,SUP,HCPCS C1713,,71223250  -  SCREW BN P/T 4MM 6MM 50MM TC100 SS CANC SM FRAG SYS,$59.53,$0.00,$59.53,$26.79,$42.48,$0.00,$10.26,$0.00,$0.00,$10.42,$59.53,$0.00,$29.76,$47.15,$47.62,$0.00,$9.32,$0.00,$9.48,$0.00
71223255,SUP,HCPCS C1713,,71223255  -  SCREW BN P/T 4MM 6MM 55MM TC100 SS CANC SM FRAG SYS,$59.53,$0.00,$59.53,$26.79,$42.48,$0.00,$10.26,$0.00,$0.00,$10.42,$59.53,$0.00,$29.76,$47.15,$47.62,$0.00,$9.32,$0.00,$9.48,$0.00
71223260,SUP,HCPCS C1713,,71223260  -  SCREW BN P/T 4MM 6MM 60MM TC100 SS CANC SM FRAG SYS,$59.53,$0.00,$59.53,$26.79,$42.48,$0.00,$10.26,$0.00,$0.00,$10.42,$59.53,$0.00,$29.76,$47.15,$47.62,$0.00,$9.32,$0.00,$9.48,$0.00
71223265,SUP,HCPCS C1713,,71223265  -  SCREW BN P/T 4MM 6MM 65MM TC100 SS CANC SM FRAG SYS,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71223270,SUP,HCPCS C1713,,71223270  -  SCREW BN P/T 4MM 6MM 70MM TC100 SS CANC SM FRAG SYS,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71223275,SUP,HCPCS C1713,,71223275  -  SCREW BN P/T 4MM 6MM 75MM TC100 SS CANC SM FRAG SYS,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71223280,SUP,HCPCS C1713,,71223280  -  SCREW BN P/T 4MM 6MM 80MM TC100 SS CANC SM FRAG SYS,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71223285,SUP,HCPCS C1713,,71223285  -  SCREW BN P/T 4MM 6MM 85MM TC100 SS CANC SM FRAG SYS,$69.73,$0.00,$69.73,$31.38,$49.76,$0.00,$12.01,$0.00,$0.00,$12.21,$69.73,$0.00,$34.86,$55.23,$55.78,$0.00,$10.91,$0.00,$11.10,$0.00
71223290,SUP,HCPCS C1713,,71223290  -  SCREW BN P/T 4MM 6MM 90MM TC100 SS CANC SM FRAG SYS,$69.73,$0.00,$69.73,$31.38,$49.76,$0.00,$12.01,$0.00,$0.00,$12.21,$69.73,$0.00,$34.86,$55.23,$55.78,$0.00,$10.91,$0.00,$11.10,$0.00
71223295,SUP,HCPCS C1713,,71223295  -  SCREW BN P/T 4MM 6MM 95MM TC100 SS CANC SM FRAG SYS,$69.73,$0.00,$69.73,$31.38,$49.76,$0.00,$12.01,$0.00,$0.00,$12.21,$69.73,$0.00,$34.86,$55.23,$55.78,$0.00,$10.91,$0.00,$11.10,$0.00
71223300,SUP,HCPCS C1713,,71223300  -  SCREW BN 4MM 100MM TC100 P/T SS CANC,$69.73,$0.00,$69.73,$31.38,$49.76,$0.00,$12.01,$0.00,$0.00,$12.21,$69.73,$0.00,$34.86,$55.23,$55.78,$0.00,$10.91,$0.00,$11.10,$0.00
71225014,SUP,HCPCS C1713,,71225014  -  SCREW BN 4.5MM 14MM TC100 CORT,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71225016,SUP,HCPCS C1713,,71225016  -  SCREW BN 4.5MM 16MM TC100 CORT,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71225018,SUP,HCPCS C1713,,71225018  -  SCREW BN 4.5MM 18MM TC100 CORT,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71225020,SUP,HCPCS C1713,,71225020  -  SCREW BN 4.5MM 20MM TC100 CORT,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71225022,SUP,HCPCS C1713,,71225022  -  SCREW BN 4.5MM 22MM TC100 CORT,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71225024,SUP,HCPCS C1713,,71225024  -  SCREW BN 4.5MM 24MM TC100 CORT,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71225026,SUP,HCPCS C1713,,71225026  -  SCREW BN 4.5MM 26MM TC100 CORT,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71225028,SUP,HCPCS C1713,,71225028  -  SCREW BN 4.5MM 28MM TC100 CORT,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71225030,SUP,HCPCS C1713,,71225030  -  SCREW BN 4.5MM 30MM TC100 CORT,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71225032,SUP,HCPCS C1713,,71225032  -  SCREW BN 4.5MM 32MM TC100 CORT,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71225034,SUP,HCPCS C1713,,71225034  -  SCREW BN 4.5MM 34MM TC100 CORT,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71225036,SUP,HCPCS C1713,,71225036  -  SCREW BN 4.5MM 36MM TC100 CORT,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71225038,SUP,HCPCS C1713,,71225038  -  SCREW BN 4.5MM 38MM TC100 CORT,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71225040,SUP,HCPCS C1713,,71225040  -  SCREW BN 4.5MM 40MM TC100 CORT,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71225042,SUP,HCPCS C1713,,71225042  -  SCREW BN 4.5MM 42MM TC100 CORT,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71225044,SUP,HCPCS C1713,,71225044  -  SCREW BN 4.5MM 44MM TC100 CORT,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71225046,SUP,HCPCS C1713,,71225046  -  SCREW BN 4.5MM 46MM TC100 CORT,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71225048,SUP,HCPCS C1713,,71225048  -  SCREW BN 4.5MM 48MM TC100 CORT,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71225050,SUP,HCPCS C1713,,71225050  -  SCREW BN 4.5MM 50MM TC100 CORT,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71225052,SUP,HCPCS C1713,,71225052  -  SCREW BN 4.5MM 52MM TC100 CORT,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71225054,SUP,HCPCS C1713,,71225054  -  SCREW BN 4.5MM 54MM TC100 CORT,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71225056,SUP,HCPCS C1713,,71225056  -  SCREW BN 4.5MM 56MM TC100 CORT,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71225058,SUP,HCPCS C1713,,71225058  -  SCREW BN 4.5MM 58MM TC100 CORT,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71225060,SUP,HCPCS C1713,,71225060  -  SCREW BN 4.5MM 8MM 60MM TC100 SS CORT LG FRAG SYS,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71225062,SUP,HCPCS C1713,,71225062  -  SCREW BN 4.5MM 62MM TC100 CORT,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71225064,SUP,HCPCS C1713,,71225064  -  SCREW BN 4.5MM 64MM TC100 CORT,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71225066,SUP,HCPCS C1713,,71225066  -  SCREW BN 4.5MM 66MM TC100 CORT,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71225068,SUP,HCPCS C1713,,71225068  -  SCREW BN 4.5MM 68MM TC100 CORT,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71225070,SUP,HCPCS C1713,,71225070  -  SCREW BN 4.5MM 70MM TC100 CORT,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71225072,SUP,HCPCS C1713,,71225072  -  SCREW BN 4.5MM 72MM TC100 CORT,$57.60,$0.00,$57.60,$25.92,$41.11,$0.00,$9.92,$0.00,$0.00,$10.09,$57.60,$0.00,$28.80,$45.62,$46.08,$0.00,$9.01,$0.00,$9.17,$0.00
71225076,SUP,HCPCS C1713,,71225076  -  SCREW BN 4.5MM 8MM 76MM TC100 SS CORT LG FRAG SYS,$99.33,$0.00,$99.33,$44.70,$70.89,$0.00,$17.11,$0.00,$0.00,$17.39,$99.33,$0.00,$49.66,$78.67,$79.46,$0.00,$15.54,$0.00,$15.81,$0.00
71225080,SUP,HCPCS C1713,,71225080  -  SCREW BN 4.5MM 8MM 80MM TC100 SS CORT LG FRAG SYS,$99.33,$0.00,$99.33,$44.70,$70.89,$0.00,$17.11,$0.00,$0.00,$17.39,$99.33,$0.00,$49.66,$78.67,$79.46,$0.00,$15.54,$0.00,$15.81,$0.00
71225085,SUP,HCPCS C1713,,71225085  -  SCREW BN 4.5MM 8MM 85MM TC100 SS CORT LG FRAG SYS,$99.33,$0.00,$99.33,$44.70,$70.89,$0.00,$17.11,$0.00,$0.00,$17.39,$99.33,$0.00,$49.66,$78.67,$79.46,$0.00,$15.54,$0.00,$15.81,$0.00
71225090,SUP,HCPCS C1713,,71225090  -  SCREW BN 4.5MM 8MM 90MM TC100 SS CORT LG FRAG SYS,$99.33,$0.00,$99.33,$44.70,$70.89,$0.00,$17.11,$0.00,$0.00,$17.39,$99.33,$0.00,$49.66,$78.67,$79.46,$0.00,$15.54,$0.00,$15.81,$0.00
71225095,SUP,HCPCS C1713,,71225095  -  SCREW BN 4.5MM 8MM 95MM TC100 SS CORT LG FRAG SYS,$99.33,$0.00,$99.33,$44.70,$70.89,$0.00,$17.11,$0.00,$0.00,$17.39,$99.33,$0.00,$49.66,$78.67,$79.46,$0.00,$15.54,$0.00,$15.81,$0.00
71225100,SUP,HCPCS C1713,,71225100  -  SCREW BN 4.5MM 100MM TC100 SS CORT LG FRAG SET,$99.33,$0.00,$99.33,$44.70,$70.89,$0.00,$17.11,$0.00,$0.00,$17.39,$99.33,$0.00,$49.66,$78.67,$79.46,$0.00,$15.54,$0.00,$15.81,$0.00
71225105,SUP,HCPCS C1713,,71225105  -  SCREW BN 4.5MM 105MM TC100 SS CORT LG FRAG SET,$99.33,$0.00,$99.33,$44.70,$70.89,$0.00,$17.11,$0.00,$0.00,$17.39,$99.33,$0.00,$49.66,$78.67,$79.46,$0.00,$15.54,$0.00,$15.81,$0.00
71225110,SUP,HCPCS C1713,,71225110  -  SCREW BN LG 4.5MM 110MM TC100 SS CORT,$108.15,$0.00,$108.15,$48.67,$77.19,$0.00,$18.63,$0.00,$0.00,$18.94,$108.15,$0.00,$54.08,$85.65,$86.52,$0.00,$16.93,$0.00,$17.22,$0.00
71225115,SUP,HCPCS C1713,,71225115  -  SCREW BN 4.5MM 115MM TC100 SS CORT LG FRAG SET,$108.15,$0.00,$108.15,$48.67,$77.19,$0.00,$18.63,$0.00,$0.00,$18.94,$108.15,$0.00,$54.08,$85.65,$86.52,$0.00,$16.93,$0.00,$17.22,$0.00
71225120,SUP,HCPCS C1713,,71225120  -  SCREW BN 4.5MM 120MM TC100 SS CORT LG FRAG SET,$108.15,$0.00,$108.15,$48.67,$77.19,$0.00,$18.63,$0.00,$0.00,$18.94,$108.15,$0.00,$54.08,$85.65,$86.52,$0.00,$16.93,$0.00,$17.22,$0.00
71225125,SUP,HCPCS C1713,,71225125  -  SCREW BN 4.5MM 125MM TC100 SS CORT LG FRAG SET,$108.15,$0.00,$108.15,$48.67,$77.19,$0.00,$18.63,$0.00,$0.00,$18.94,$108.15,$0.00,$54.08,$85.65,$86.52,$0.00,$16.93,$0.00,$17.22,$0.00
71225130,SUP,HCPCS C1713,,71225130  -  SCREW BN 4.5MM 130MM TC100 SS CORT LG FRAG SET,$108.15,$0.00,$108.15,$48.67,$77.19,$0.00,$18.63,$0.00,$0.00,$18.94,$108.15,$0.00,$54.08,$85.65,$86.52,$0.00,$16.93,$0.00,$17.22,$0.00
71225135,SUP,HCPCS C1713,,71225135  -  SCREW BN 4.5MM 135MM TC100 SS CORT LG FRAG SET,$108.15,$0.00,$108.15,$48.67,$77.19,$0.00,$18.63,$0.00,$0.00,$18.94,$108.15,$0.00,$54.08,$85.65,$86.52,$0.00,$16.93,$0.00,$17.22,$0.00
71225140,SUP,HCPCS C1713,,71225140  -  SCREW BN 4.5MM 140MM TC100 SS CORT LG FRAG SET,$108.15,$0.00,$108.15,$48.67,$77.19,$0.00,$18.63,$0.00,$0.00,$18.94,$108.15,$0.00,$54.08,$85.65,$86.52,$0.00,$16.93,$0.00,$17.22,$0.00
71225145,SUP,HCPCS C1713,,71225145  -  SCREW BN 4.5MM 145MM TC100 SS CORT LG FRAG SET,$108.15,$0.00,$108.15,$48.67,$77.19,$0.00,$18.63,$0.00,$0.00,$18.94,$108.15,$0.00,$54.08,$85.65,$86.52,$0.00,$16.93,$0.00,$17.22,$0.00
71225225,SUP,HCPCS C1713,,71225225  -  SCREW BN 4.5MM 25MM STRL 12MM TC100 SS MLR LG FRAG SET,$126.00,$0.00,$126.00,$56.70,$89.93,$0.00,$21.71,$0.00,$0.00,$22.06,$126.00,$0.00,$63.00,$99.79,$100.80,$0.00,$19.72,$0.00,$20.06,$0.00
71225230,SUP,HCPCS C1713,,71225230  -  SCREW BN 4.5MM 30MM STRL 15MM TC100 SS MLR LG FRAG SET,$126.00,$0.00,$126.00,$56.70,$89.93,$0.00,$21.71,$0.00,$0.00,$22.06,$126.00,$0.00,$63.00,$99.79,$100.80,$0.00,$19.72,$0.00,$20.06,$0.00
71225235,SUP,HCPCS C1713,,71225235  -  SCREW BN 4.5MM 35MM STRL 18MM TC100 SS MLR LG FRAG SET,$126.00,$0.00,$126.00,$56.70,$89.93,$0.00,$21.71,$0.00,$0.00,$22.06,$126.00,$0.00,$63.00,$99.79,$100.80,$0.00,$19.72,$0.00,$20.06,$0.00
71225240,SUP,HCPCS C1713,,71225240  -  SCREW BN 4.5MM 40MM STRL 20MM TC100 SS MLR LG FRAG SET,$126.00,$0.00,$126.00,$56.70,$89.93,$0.00,$21.71,$0.00,$0.00,$22.06,$126.00,$0.00,$63.00,$99.79,$100.80,$0.00,$19.72,$0.00,$20.06,$0.00
71225245,SUP,HCPCS C1713,,71225245  -  SCREW BN 4.5MM 45MM STRL 22MM TC100 SS MLR LG FRAG SET,$126.00,$0.00,$126.00,$56.70,$89.93,$0.00,$21.71,$0.00,$0.00,$22.06,$126.00,$0.00,$63.00,$99.79,$100.80,$0.00,$19.72,$0.00,$20.06,$0.00
71225250,SUP,HCPCS C1713,,71225250  -  SCREW BN 4.5MM 50MM STRL 24MM TC100 SS MLR LG FRAG SET,$126.00,$0.00,$126.00,$56.70,$89.93,$0.00,$21.71,$0.00,$0.00,$22.06,$126.00,$0.00,$63.00,$99.79,$100.80,$0.00,$19.72,$0.00,$20.06,$0.00
71225255,SUP,HCPCS C1713,,71225255  -  SCREW BN 4.5MM 55MM STRL 26MM TC100 SS MLR LG FRAG SET,$126.00,$0.00,$126.00,$56.70,$89.93,$0.00,$21.71,$0.00,$0.00,$22.06,$126.00,$0.00,$63.00,$99.79,$100.80,$0.00,$19.72,$0.00,$20.06,$0.00
71225260,SUP,HCPCS C1713,,71225260  -  SCREW BN 4.5MM 60MM STRL 28MM TC100 SS MLR LG FRAG SET,$126.00,$0.00,$126.00,$56.70,$89.93,$0.00,$21.71,$0.00,$0.00,$22.06,$126.00,$0.00,$63.00,$99.79,$100.80,$0.00,$19.72,$0.00,$20.06,$0.00
71225265,SUP,HCPCS C1713,,71225265  -  SCREW BN 4.5MM 65MM STRL 30MM TC100 SS MLR LG FRAG SET,$126.00,$0.00,$126.00,$56.70,$89.93,$0.00,$21.71,$0.00,$0.00,$22.06,$126.00,$0.00,$63.00,$99.79,$100.80,$0.00,$19.72,$0.00,$20.06,$0.00
71225270,SUP,HCPCS C1713,,71225270  -  SCREW BN 4.5MM 70MM STRL 32MM TC100 SS MLR LG FRAG SET,$126.00,$0.00,$126.00,$56.70,$89.93,$0.00,$21.71,$0.00,$0.00,$22.06,$126.00,$0.00,$63.00,$99.79,$100.80,$0.00,$19.72,$0.00,$20.06,$0.00
71225320,SUP,HCPCS C1713,,71225320  -  PLATE BN 90D 10MM DSPL 40MM TC100 4 HL OSTM SS ADLT FEM PROX,"$1,669.50",$0.00,"$1,669.50",$751.28,"$1,191.52",$0.00,$287.65,$0.00,$0.00,$292.32,"$1,669.50",$0.00,$834.75,"$1,322.24","$1,335.60",$0.00,$261.28,$0.00,$265.78,$0.00
71225321,SUP,HCPCS C1713,,71225321  -  PLATE BN 90D 10MM DSPL 50MM TC100 4 HL OSTM SS ADLT PROX FEM,"$1,669.50",$0.00,"$1,669.50",$751.28,"$1,191.52",$0.00,$287.65,$0.00,$0.00,$292.32,"$1,669.50",$0.00,$834.75,"$1,322.24","$1,335.60",$0.00,$261.28,$0.00,$265.78,$0.00
71225322,SUP,HCPCS C1713,,71225322  -  PLATE BN 90D 10MM DSPL 55MM TC100 4 HL OSTM SS ADLT FEM PROX,"$1,669.50",$0.00,"$1,669.50",$751.28,"$1,191.52",$0.00,$287.65,$0.00,$0.00,$292.32,"$1,669.50",$0.00,$834.75,"$1,322.24","$1,335.60",$0.00,$261.28,$0.00,$265.78,$0.00
71225323,SUP,HCPCS C1713,,71225323  -  PLATE BN 90D 10MM DSPL 60MM TC100 4 HL OSTM SS ADLT PROX FEM,"$1,669.50",$0.00,"$1,669.50",$751.28,"$1,191.52",$0.00,$287.65,$0.00,$0.00,$292.32,"$1,669.50",$0.00,$834.75,"$1,322.24","$1,335.60",$0.00,$261.28,$0.00,$265.78,$0.00
71225324,SUP,HCPCS C1713,,71225324  -  PLATE BN 90D 10MM DSPL 65MM TC100 4 HL OSTM SS ADLT FEM PROX,"$1,669.50",$0.00,"$1,669.50",$751.28,"$1,191.52",$0.00,$287.65,$0.00,$0.00,$292.32,"$1,669.50",$0.00,$834.75,"$1,322.24","$1,335.60",$0.00,$261.28,$0.00,$265.78,$0.00
71225325,SUP,HCPCS C1713,,71225325  -  PLATE BN 90D 10MM DSPL 70MM TC100 4 HL OSTM SS ADLT FEM PROX,"$1,669.50",$0.00,"$1,669.50",$751.28,"$1,191.52",$0.00,$287.65,$0.00,$0.00,$292.32,"$1,669.50",$0.00,$834.75,"$1,322.24","$1,335.60",$0.00,$261.28,$0.00,$265.78,$0.00
71225326,SUP,HCPCS C1713,,71225326  -  PLATE BN 90D 10MM DSPL 80MM TC100 4 HL OSTM SS ADLT FEM PROX,"$1,669.50",$0.00,"$1,669.50",$751.28,"$1,191.52",$0.00,$287.65,$0.00,$0.00,$292.32,"$1,669.50",$0.00,$834.75,"$1,322.24","$1,335.60",$0.00,$261.28,$0.00,$265.78,$0.00
71225327,SUP,HCPCS C1713,,71225327  -  PLATE BN 90D 15MM DSPL 40MM TC100 4 HL OSTM SS ADLT FEM PROX,"$1,669.50",$0.00,"$1,669.50",$751.28,"$1,191.52",$0.00,$287.65,$0.00,$0.00,$292.32,"$1,669.50",$0.00,$834.75,"$1,322.24","$1,335.60",$0.00,$261.28,$0.00,$265.78,$0.00
71225328,SUP,HCPCS C1713,,71225328  -  PLATE BN 90D 15MM DSPL 50MM TC100 4 HL OSTM SS ADLT FEM PROX,"$1,669.50",$0.00,"$1,669.50",$751.28,"$1,191.52",$0.00,$287.65,$0.00,$0.00,$292.32,"$1,669.50",$0.00,$834.75,"$1,322.24","$1,335.60",$0.00,$261.28,$0.00,$265.78,$0.00
71225329,SUP,HCPCS C1713,,71225329  -  PLATE BN 90D 15MM DSPL 55MM TC100 4 HL OSTM SS ADLT FEM PROX,"$1,669.50",$0.00,"$1,669.50",$751.28,"$1,191.52",$0.00,$287.65,$0.00,$0.00,$292.32,"$1,669.50",$0.00,$834.75,"$1,322.24","$1,335.60",$0.00,$261.28,$0.00,$265.78,$0.00
71225330,SUP,HCPCS C1713,,71225330  -  PLATE BN 90D 15MM DSPL 60MM TC100 4 HL OSTM SS ADLT FEM PROX,"$1,669.50",$0.00,"$1,669.50",$751.28,"$1,191.52",$0.00,$287.65,$0.00,$0.00,$292.32,"$1,669.50",$0.00,$834.75,"$1,322.24","$1,335.60",$0.00,$261.28,$0.00,$265.78,$0.00
71225331,SUP,HCPCS C1713,,71225331  -  PLATE BN 90D 15MM DSPL 65MM TC100 4 HL OSTM SS ADLT FEM PROX,"$1,669.50",$0.00,"$1,669.50",$751.28,"$1,191.52",$0.00,$287.65,$0.00,$0.00,$292.32,"$1,669.50",$0.00,$834.75,"$1,322.24","$1,335.60",$0.00,$261.28,$0.00,$265.78,$0.00
71225332,SUP,HCPCS C1713,,71225332  -  PLATE BN 90D 15MM DSPL 70MM TC100 4 HL OSTM SS ADLT FEM PROX,"$1,669.50",$0.00,"$1,669.50",$751.28,"$1,191.52",$0.00,$287.65,$0.00,$0.00,$292.32,"$1,669.50",$0.00,$834.75,"$1,322.24","$1,335.60",$0.00,$261.28,$0.00,$265.78,$0.00
71225333,SUP,HCPCS C1713,,71225333  -  PLATE BN 90D 15MM DSPL 75MM TC100 4 HL OSTM SS ADLT FEM PROX,"$1,669.50",$0.00,"$1,669.50",$751.28,"$1,191.52",$0.00,$287.65,$0.00,$0.00,$292.32,"$1,669.50",$0.00,$834.75,"$1,322.24","$1,335.60",$0.00,$261.28,$0.00,$265.78,$0.00
71225334,SUP,HCPCS C1713,,71225334  -  PLATE BN 90D 15MM DSPL 80MM TC100 4 HL OSTM SS ADLT FEM PROX,"$1,669.50",$0.00,"$1,669.50",$751.28,"$1,191.52",$0.00,$287.65,$0.00,$0.00,$292.32,"$1,669.50",$0.00,$834.75,"$1,322.24","$1,335.60",$0.00,$261.28,$0.00,$265.78,$0.00
71225335,SUP,HCPCS C1713,,71225335  -  PLATE BN 90D 20MM DSPL 50MM TC100 4 HL OSTM SS ADLT FEM PROX,"$1,669.50",$0.00,"$1,669.50",$751.28,"$1,191.52",$0.00,$287.65,$0.00,$0.00,$292.32,"$1,669.50",$0.00,$834.75,"$1,322.24","$1,335.60",$0.00,$261.28,$0.00,$265.78,$0.00
71225336,SUP,HCPCS C1713,,71225336  -  PLATE BN 90D 20MM DSPL 60MM TC100 4 HL OSTM SS ADLT FEM PROX,"$1,669.50",$0.00,"$1,669.50",$751.28,"$1,191.52",$0.00,$287.65,$0.00,$0.00,$292.32,"$1,669.50",$0.00,$834.75,"$1,322.24","$1,335.60",$0.00,$261.28,$0.00,$265.78,$0.00
71225337,SUP,HCPCS C1713,,71225337  -  PLATE BN 90D 20MM DSPL 70MM TC100 4 HL OSTM SS ADLT FEM PROX,"$1,669.50",$0.00,"$1,669.50",$751.28,"$1,191.52",$0.00,$287.65,$0.00,$0.00,$292.32,"$1,669.50",$0.00,$834.75,"$1,322.24","$1,335.60",$0.00,$261.28,$0.00,$265.78,$0.00
71225338,SUP,HCPCS C1713,,71225338  -  PLATE BN 90D 20MM DSPL 75MM TC100 4 HL OSTM SS ADLT FEM PROX,"$1,669.50",$0.00,"$1,669.50",$751.28,"$1,191.52",$0.00,$287.65,$0.00,$0.00,$292.32,"$1,669.50",$0.00,$834.75,"$1,322.24","$1,335.60",$0.00,$261.28,$0.00,$265.78,$0.00
71225339,SUP,HCPCS C1713,,71225339  -  PLATE BN 100D 10MM DSPL 50MM TC100 4 HL OSTM SS ADLT FEM,"$1,669.50",$0.00,"$1,669.50",$751.28,"$1,191.52",$0.00,$287.65,$0.00,$0.00,$292.32,"$1,669.50",$0.00,$834.75,"$1,322.24","$1,335.60",$0.00,$261.28,$0.00,$265.78,$0.00
71225340,SUP,HCPCS C1713,,71225340  -  PLATE BN 100D 10MM DSPL 60MM TC100 4 HL OSTM SS ADLT FEM,"$1,669.50",$0.00,"$1,669.50",$751.28,"$1,191.52",$0.00,$287.65,$0.00,$0.00,$292.32,"$1,669.50",$0.00,$834.75,"$1,322.24","$1,335.60",$0.00,$261.28,$0.00,$265.78,$0.00
71225341,SUP,HCPCS C1713,,71225341  -  PLATE BN 110D 65MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5MM,"$1,669.50",$0.00,"$1,669.50",$751.28,"$1,191.52",$0.00,$287.65,$0.00,$0.00,$292.32,"$1,669.50",$0.00,$834.75,"$1,322.24","$1,335.60",$0.00,$261.28,$0.00,$265.78,$0.00
71225342,SUP,HCPCS C1713,,71225342  -  PLATE BN 110D 75MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5MM,"$1,669.50",$0.00,"$1,669.50",$751.28,"$1,191.52",$0.00,$287.65,$0.00,$0.00,$292.32,"$1,669.50",$0.00,$834.75,"$1,322.24","$1,335.60",$0.00,$261.28,$0.00,$265.78,$0.00
71225343,SUP,HCPCS C1713,,71225343  -  PLATE BN 110D 85MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5MM,"$1,669.50",$0.00,"$1,669.50",$751.28,"$1,191.52",$0.00,$287.65,$0.00,$0.00,$292.32,"$1,669.50",$0.00,$834.75,"$1,322.24","$1,335.60",$0.00,$261.28,$0.00,$265.78,$0.00
71225344,SUP,HCPCS C1713,,71225344  -  PLATE BN 120D 65MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5MM,"$1,669.50",$0.00,"$1,669.50",$751.28,"$1,191.52",$0.00,$287.65,$0.00,$0.00,$292.32,"$1,669.50",$0.00,$834.75,"$1,322.24","$1,335.60",$0.00,$261.28,$0.00,$265.78,$0.00
71225345,SUP,HCPCS C1713,,71225345  -  PLATE BN 120D 75MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5MM,"$1,669.50",$0.00,"$1,669.50",$751.28,"$1,191.52",$0.00,$287.65,$0.00,$0.00,$292.32,"$1,669.50",$0.00,$834.75,"$1,322.24","$1,335.60",$0.00,$261.28,$0.00,$265.78,$0.00
71225346,SUP,HCPCS C1713,,71225346  -  PLATE BN 120D 85MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5MM,"$1,669.50",$0.00,"$1,669.50",$751.28,"$1,191.52",$0.00,$287.65,$0.00,$0.00,$292.32,"$1,669.50",$0.00,$834.75,"$1,322.24","$1,335.60",$0.00,$261.28,$0.00,$265.78,$0.00
71225347,SUP,HCPCS C1713,,71225347  -  PLATE BN 130D 65MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5MM,"$1,669.50",$0.00,"$1,669.50",$751.28,"$1,191.52",$0.00,$287.65,$0.00,$0.00,$292.32,"$1,669.50",$0.00,$834.75,"$1,322.24","$1,335.60",$0.00,$261.28,$0.00,$265.78,$0.00
71225348,SUP,HCPCS C1713,,71225348  -  PLATE BN 130D 70MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5MM,"$1,669.50",$0.00,"$1,669.50",$751.28,"$1,191.52",$0.00,$287.65,$0.00,$0.00,$292.32,"$1,669.50",$0.00,$834.75,"$1,322.24","$1,335.60",$0.00,$261.28,$0.00,$265.78,$0.00
71225349,SUP,HCPCS C1713,,71225349  -  PLATE BN 130D 75MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5MM,"$1,669.50",$0.00,"$1,669.50",$751.28,"$1,191.52",$0.00,$287.65,$0.00,$0.00,$292.32,"$1,669.50",$0.00,$834.75,"$1,322.24","$1,335.60",$0.00,$261.28,$0.00,$265.78,$0.00
71225350,SUP,HCPCS C1713,,71225350  -  PLATE BN 130D 80MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5MM,"$1,669.50",$0.00,"$1,669.50",$751.28,"$1,191.52",$0.00,$287.65,$0.00,$0.00,$292.32,"$1,669.50",$0.00,$834.75,"$1,322.24","$1,335.60",$0.00,$261.28,$0.00,$265.78,$0.00
71225351,SUP,HCPCS C1713,,71225351  -  PLATE BN 130D 85MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5MM,"$1,669.50",$0.00,"$1,669.50",$751.28,"$1,191.52",$0.00,$287.65,$0.00,$0.00,$292.32,"$1,669.50",$0.00,$834.75,"$1,322.24","$1,335.60",$0.00,$261.28,$0.00,$265.78,$0.00
71225352,SUP,HCPCS C1713,,71225352  -  PLATE BN 130D 90MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5MM,"$1,669.50",$0.00,"$1,669.50",$751.28,"$1,191.52",$0.00,$287.65,$0.00,$0.00,$292.32,"$1,669.50",$0.00,$834.75,"$1,322.24","$1,335.60",$0.00,$261.28,$0.00,$265.78,$0.00
71225353,SUP,HCPCS C1713,,71225353  -  PLATE BN 130D 95MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5MM,"$1,669.50",$0.00,"$1,669.50",$751.28,"$1,191.52",$0.00,$287.65,$0.00,$0.00,$292.32,"$1,669.50",$0.00,$834.75,"$1,322.24","$1,335.60",$0.00,$261.28,$0.00,$265.78,$0.00
71225354,SUP,HCPCS C1713,,71225354  -  PLATE BN 130D 100MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5MM,"$1,669.50",$0.00,"$1,669.50",$751.28,"$1,191.52",$0.00,$287.65,$0.00,$0.00,$292.32,"$1,669.50",$0.00,$834.75,"$1,322.24","$1,335.60",$0.00,$261.28,$0.00,$265.78,$0.00
71225355,SUP,HCPCS C1713,,71225355  -  PLATE BN 130D 105MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5MM,"$1,669.50",$0.00,"$1,669.50",$751.28,"$1,191.52",$0.00,$287.65,$0.00,$0.00,$292.32,"$1,669.50",$0.00,$834.75,"$1,322.24","$1,335.60",$0.00,$261.28,$0.00,$265.78,$0.00
71225356,SUP,HCPCS C1713,,71225356  -  PLATE BN 130D 110MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5MM,"$1,669.50",$0.00,"$1,669.50",$751.28,"$1,191.52",$0.00,$287.65,$0.00,$0.00,$292.32,"$1,669.50",$0.00,$834.75,"$1,322.24","$1,335.60",$0.00,$261.28,$0.00,$265.78,$0.00
71225400,SUP,HCPCS C1713,,71225400  -  PLATE BN 95D 92MM 50MM TC100 5 HL OSTM SS ADLT CNDYL FEM,"$1,669.50",$0.00,"$1,669.50",$751.28,"$1,191.52",$0.00,$287.65,$0.00,$0.00,$292.32,"$1,669.50",$0.00,$834.75,"$1,322.24","$1,335.60",$0.00,$261.28,$0.00,$265.78,$0.00
71225401,SUP,HCPCS C1713,,71225401  -  PLATE BN 95D 92MM 60MM TC100 5 HL OSTM SS ADLT CNDYL FEM,"$1,669.50",$0.00,"$1,669.50",$751.28,"$1,191.52",$0.00,$287.65,$0.00,$0.00,$292.32,"$1,669.50",$0.00,$834.75,"$1,322.24","$1,335.60",$0.00,$261.28,$0.00,$265.78,$0.00
71225402,SUP,HCPCS C1713,,71225402  -  PLATE BN 95D 92MM 70MM TC100 5 HL OSTM SS ADLT CNDYL FEM,"$1,669.50",$0.00,"$1,669.50",$751.28,"$1,191.52",$0.00,$287.65,$0.00,$0.00,$292.32,"$1,669.50",$0.00,$834.75,"$1,322.24","$1,335.60",$0.00,$261.28,$0.00,$265.78,$0.00
71225403,SUP,HCPCS C1713,,71225403  -  PLATE BN 95D 92MM 80MM TC100 5 HL OSTM SS ADLT CNDYL FEM,"$1,669.50",$0.00,"$1,669.50",$751.28,"$1,191.52",$0.00,$287.65,$0.00,$0.00,$292.32,"$1,669.50",$0.00,$834.75,"$1,322.24","$1,335.60",$0.00,$261.28,$0.00,$265.78,$0.00
71225404,SUP,HCPCS C1713,,71225404  -  PLATE BN 95D 124MM 50MM TC100 7 HL OSTM SS ADLT CNDYL FEM,"$1,669.50",$0.00,"$1,669.50",$751.28,"$1,191.52",$0.00,$287.65,$0.00,$0.00,$292.32,"$1,669.50",$0.00,$834.75,"$1,322.24","$1,335.60",$0.00,$261.28,$0.00,$265.78,$0.00
71225405,SUP,HCPCS C1713,,71225405  -  PLATE BN 95D 124MM 60MM TC100 7 HL OSTM SS ADLT CNDYL FEM,"$1,669.50",$0.00,"$1,669.50",$751.28,"$1,191.52",$0.00,$287.65,$0.00,$0.00,$292.32,"$1,669.50",$0.00,$834.75,"$1,322.24","$1,335.60",$0.00,$261.28,$0.00,$265.78,$0.00
71225406,SUP,HCPCS C1713,,71225406  -  PLATE BN 95D 124MM 70MM TC100 7 HL OSTM SS ADLT CNDYL FEM,"$1,669.50",$0.00,"$1,669.50",$751.28,"$1,191.52",$0.00,$287.65,$0.00,$0.00,$292.32,"$1,669.50",$0.00,$834.75,"$1,322.24","$1,335.60",$0.00,$261.28,$0.00,$265.78,$0.00
71225407,SUP,HCPCS C1713,,71225407  -  PLATE BN 95D 124MM 80MM TC100 7 HL OSTM SS ADLT CNDYL FEM,"$1,669.50",$0.00,"$1,669.50",$751.28,"$1,191.52",$0.00,$287.65,$0.00,$0.00,$292.32,"$1,669.50",$0.00,$834.75,"$1,322.24","$1,335.60",$0.00,$261.28,$0.00,$265.78,$0.00
71225408,SUP,HCPCS C1713,,71225408  -  PLATE BN 95D 156MM 50MM TC100 9 HL OSTM SS ADLT CNDYL FEM,"$1,669.50",$0.00,"$1,669.50",$751.28,"$1,191.52",$0.00,$287.65,$0.00,$0.00,$292.32,"$1,669.50",$0.00,$834.75,"$1,322.24","$1,335.60",$0.00,$261.28,$0.00,$265.78,$0.00
71225409,SUP,HCPCS C1713,,71225409  -  PLATE BN 95D 156MM 60MM TC100 9 HL OSTM SS ADLT CNDYL FEM,"$1,669.50",$0.00,"$1,669.50",$751.28,"$1,191.52",$0.00,$287.65,$0.00,$0.00,$292.32,"$1,669.50",$0.00,$834.75,"$1,322.24","$1,335.60",$0.00,$261.28,$0.00,$265.78,$0.00
71225410,SUP,HCPCS C1713,,71225410  -  PLATE BN 95D 156MM 70MM TC100 9 HL OSTM SS ADLT CNDYL FEM,"$1,669.50",$0.00,"$1,669.50",$751.28,"$1,191.52",$0.00,$287.65,$0.00,$0.00,$292.32,"$1,669.50",$0.00,$834.75,"$1,322.24","$1,335.60",$0.00,$261.28,$0.00,$265.78,$0.00
71225411,SUP,HCPCS C1713,,71225411  -  PLATE BN 95D 156MM 80MM TC100 9 HL OSTM SS ADLT CNDYL FEM,"$1,669.50",$0.00,"$1,669.50",$751.28,"$1,191.52",$0.00,$287.65,$0.00,$0.00,$292.32,"$1,669.50",$0.00,$834.75,"$1,322.24","$1,335.60",$0.00,$261.28,$0.00,$265.78,$0.00
71225412,SUP,HCPCS C1713,,71225412  -  PLATE BN 95D 204MM 50MM TC100 12 HL OSTM SS ADLT CNDYL FEM,"$1,669.50",$0.00,"$1,669.50",$751.28,"$1,191.52",$0.00,$287.65,$0.00,$0.00,$292.32,"$1,669.50",$0.00,$834.75,"$1,322.24","$1,335.60",$0.00,$261.28,$0.00,$265.78,$0.00
71225413,SUP,HCPCS C1713,,71225413  -  PLATE BN 95D 204MM 60MM TC100 12 HL OSTM SS ADLT CNDYL FEM,"$1,669.50",$0.00,"$1,669.50",$751.28,"$1,191.52",$0.00,$287.65,$0.00,$0.00,$292.32,"$1,669.50",$0.00,$834.75,"$1,322.24","$1,335.60",$0.00,$261.28,$0.00,$265.78,$0.00
71225414,SUP,HCPCS C1713,,71225414  -  PLATE BN 95D 204MM 70MM TC100 12 HL OSTM SS ADLT CNDYL FEM,"$1,669.50",$0.00,"$1,669.50",$751.28,"$1,191.52",$0.00,$287.65,$0.00,$0.00,$292.32,"$1,669.50",$0.00,$834.75,"$1,322.24","$1,335.60",$0.00,$261.28,$0.00,$265.78,$0.00
71225415,SUP,HCPCS C1713,,71225415  -  PLATE BN 95D 204MM 80MM TC100 12 HL OSTM SS ADLT CNDYL FEM,"$1,669.50",$0.00,"$1,669.50",$751.28,"$1,191.52",$0.00,$287.65,$0.00,$0.00,$292.32,"$1,669.50",$0.00,$834.75,"$1,322.24","$1,335.60",$0.00,$261.28,$0.00,$265.78,$0.00
71225416,SUP,HCPCS C1713,,71225416  -  PLATE BN 95D 235MM 50MM TC100 14 HL OSTM SS ADLT CNDYL FEM,"$2,955.75",$0.00,"$2,955.75","$1,330.09","$2,109.52",$0.00,$509.26,$0.00,$0.00,$517.53,"$2,955.75",$0.00,"$1,477.88","$2,340.95","$2,364.60",$0.00,$462.57,$0.00,$470.56,$0.00
71225417,SUP,HCPCS C1713,,71225417  -  PLATE BN 95D 235MM 60MM TC100 14 HL OSTM SS ADLT CNDYL FEM,"$2,955.75",$0.00,"$2,955.75","$1,330.09","$2,109.52",$0.00,$509.26,$0.00,$0.00,$517.53,"$2,955.75",$0.00,"$1,477.88","$2,340.95","$2,364.60",$0.00,$462.57,$0.00,$470.56,$0.00
71225418,SUP,HCPCS C1713,,71225418  -  PLATE BN 95D 235MM 70MM TC100 14 HL OSTM SS ADLT CNDYL FEM,"$2,955.75",$0.00,"$2,955.75","$1,330.09","$2,109.52",$0.00,$509.26,$0.00,$0.00,$517.53,"$2,955.75",$0.00,"$1,477.88","$2,340.95","$2,364.60",$0.00,$462.57,$0.00,$470.56,$0.00
71225419,SUP,HCPCS C1713,,71225419  -  PLATE BN 95D 235MM 80MM TC100 14 HL OSTM SS ADLT CNDYL FEM,"$2,955.75",$0.00,"$2,955.75","$1,330.09","$2,109.52",$0.00,$509.26,$0.00,$0.00,$517.53,"$2,955.75",$0.00,"$1,477.88","$2,340.95","$2,364.60",$0.00,$462.57,$0.00,$470.56,$0.00
71225420,SUP,HCPCS C1713,,71225420  -  PLATE BN 95D 267MM 60MM TC100 16 HL OSTM SS ADLT CNDYL FEM,"$2,955.75",$0.00,"$2,955.75","$1,330.09","$2,109.52",$0.00,$509.26,$0.00,$0.00,$517.53,"$2,955.75",$0.00,"$1,477.88","$2,340.95","$2,364.60",$0.00,$462.57,$0.00,$470.56,$0.00
71225421,SUP,HCPCS C1713,,71225421  -  PLATE BN 95D 267MM 70MM TC100 16 HL OSTM SS ADLT CNDYL FEM,"$2,955.75",$0.00,"$2,955.75","$1,330.09","$2,109.52",$0.00,$509.26,$0.00,$0.00,$517.53,"$2,955.75",$0.00,"$1,477.88","$2,340.95","$2,364.60",$0.00,$462.57,$0.00,$470.56,$0.00
71225422,SUP,HCPCS C1713,,71225422  -  PLATE BN 95D 267MM 80MM TC100 16 HL OSTM SS ADLT CNDYL FEM,"$2,955.75",$0.00,"$2,955.75","$1,330.09","$2,109.52",$0.00,$509.26,$0.00,$0.00,$517.53,"$2,955.75",$0.00,"$1,477.88","$2,340.95","$2,364.60",$0.00,$462.57,$0.00,$470.56,$0.00
71225423,SUP,HCPCS C1713,,71225423  -  PLATE BN 95D 299MM 60MM TC100 18 HL OSTM SS ADLT CNDYL FEM,"$2,955.75",$0.00,"$2,955.75","$1,330.09","$2,109.52",$0.00,$509.26,$0.00,$0.00,$517.53,"$2,955.75",$0.00,"$1,477.88","$2,340.95","$2,364.60",$0.00,$462.57,$0.00,$470.56,$0.00
71225424,SUP,HCPCS C1713,,71225424  -  PLATE BN 95D 299MM 70MM TC100 18 HL OSTM SS ADLT CNDYL FEM,"$2,955.75",$0.00,"$2,955.75","$1,330.09","$2,109.52",$0.00,$509.26,$0.00,$0.00,$517.53,"$2,955.75",$0.00,"$1,477.88","$2,340.95","$2,364.60",$0.00,$462.57,$0.00,$470.56,$0.00
71225430,SUP,HCPCS C1713,,71225430  -  PLATE BN 95D SM STAT 92MM 40MM TC100 5 HL OSTM SS CNDYL,"$1,260.00",$0.00,"$1,260.00",$567.00,$899.26,$0.00,$217.09,$0.00,$0.00,$220.62,"$1,260.00",$0.00,$630.00,$997.92,"$1,008.00",$0.00,$197.19,$0.00,$200.59,$0.00
71225431,SUP,HCPCS C1713,,71225431  -  PLATE BN 95D SM STAT 92MM 50MM TC100 5 HL OSTM SS CNDYL,"$1,260.00",$0.00,"$1,260.00",$567.00,$899.26,$0.00,$217.09,$0.00,$0.00,$220.62,"$1,260.00",$0.00,$630.00,$997.92,"$1,008.00",$0.00,$197.19,$0.00,$200.59,$0.00
71225432,SUP,HCPCS C1713,,71225432  -  PLATE BN 95D SM STAT 92MM 60MM TC100 5 HL OSTM SS CNDYL,"$1,260.00",$0.00,"$1,260.00",$567.00,$899.26,$0.00,$217.09,$0.00,$0.00,$220.62,"$1,260.00",$0.00,$630.00,$997.92,"$1,008.00",$0.00,$197.19,$0.00,$200.59,$0.00
71225433,SUP,HCPCS C1713,,71225433  -  PLATE BN 95D SM STAT 92MM 70MM TC100 5 HL OSTM SS CNDYL,"$1,260.00",$0.00,"$1,260.00",$567.00,$899.26,$0.00,$217.09,$0.00,$0.00,$220.62,"$1,260.00",$0.00,$630.00,$997.92,"$1,008.00",$0.00,$197.19,$0.00,$200.59,$0.00
71225434,SUP,HCPCS C1713,,71225434  -  PLATE BN 95D SM STAT 124MM 40MM TC100 7 HL OSTM SS CNDYL,"$1,580.25",$0.00,"$1,580.25",$711.11,"$1,127.82",$0.00,$272.27,$0.00,$0.00,$276.69,"$1,580.25",$0.00,$790.13,"$1,251.56","$1,264.20",$0.00,$247.31,$0.00,$251.58,$0.00
71225435,SUP,HCPCS C1713,,71225435  -  PLATE BN 95D SM STAT 124MM 50MM TC100 7 HL OSTM SS CNDYL,"$1,580.25",$0.00,"$1,580.25",$711.11,"$1,127.82",$0.00,$272.27,$0.00,$0.00,$276.69,"$1,580.25",$0.00,$790.13,"$1,251.56","$1,264.20",$0.00,$247.31,$0.00,$251.58,$0.00
71225436,SUP,HCPCS C1713,,71225436  -  PLATE BN 95D SM STAT 124MM 60MM TC100 7 HL OSTM SS CNDYL,"$1,580.25",$0.00,"$1,580.25",$711.11,"$1,127.82",$0.00,$272.27,$0.00,$0.00,$276.69,"$1,580.25",$0.00,$790.13,"$1,251.56","$1,264.20",$0.00,$247.31,$0.00,$251.58,$0.00
71225437,SUP,HCPCS C1713,,71225437  -  PLATE BN 95D SM STAT 124MM 70MM TC100 7 HL OSTM SS CNDYL,"$1,580.25",$0.00,"$1,580.25",$711.11,"$1,127.82",$0.00,$272.27,$0.00,$0.00,$276.69,"$1,580.25",$0.00,$790.13,"$1,251.56","$1,264.20",$0.00,$247.31,$0.00,$251.58,$0.00
71225438,SUP,HCPCS C1713,,71225438  -  PLATE BN 95D SM STAT 156MM 40MM TC100 9 HL OSTM SS CNDYL,"$1,711.50",$0.00,"$1,711.50",$770.18,"$1,221.50",$0.00,$294.88,$0.00,$0.00,$299.67,"$1,711.50",$0.00,$855.75,"$1,355.51","$1,369.20",$0.00,$267.85,$0.00,$272.47,$0.00
71225439,SUP,HCPCS C1713,,71225439  -  PLATE BN 95D SM STAT 156MM 50MM TC100 9 HL OSTM SS CNDYL,"$1,711.50",$0.00,"$1,711.50",$770.18,"$1,221.50",$0.00,$294.88,$0.00,$0.00,$299.67,"$1,711.50",$0.00,$855.75,"$1,355.51","$1,369.20",$0.00,$267.85,$0.00,$272.47,$0.00
71225440,SUP,HCPCS C1713,,71225440  -  PLATE BN 95D SM STAT 156MM 60MM TC100 9 HL OSTM SS CNDYL,"$1,711.50",$0.00,"$1,711.50",$770.18,"$1,221.50",$0.00,$294.88,$0.00,$0.00,$299.67,"$1,711.50",$0.00,$855.75,"$1,355.51","$1,369.20",$0.00,$267.85,$0.00,$272.47,$0.00
71225441,SUP,HCPCS C1713,,71225441  -  PLATE BN 95D SM STAT 156MM 70MM TC100 9 HL OSTM SS CNDYL,"$1,711.50",$0.00,"$1,711.50",$770.18,"$1,221.50",$0.00,$294.88,$0.00,$0.00,$299.67,"$1,711.50",$0.00,$855.75,"$1,355.51","$1,369.20",$0.00,$267.85,$0.00,$272.47,$0.00
71225500,SUP,HCPCS C1713,,71225500  -  PLATE BN 130D 50MM 60MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5,"$1,412.25",$0.00,"$1,412.25",$635.51,"$1,007.92",$0.00,$243.32,$0.00,$0.00,$247.27,"$1,412.25",$0.00,$706.13,"$1,118.50","$1,129.80",$0.00,$221.02,$0.00,$224.83,$0.00
71225501,SUP,HCPCS C1713,,71225501  -  PLATE BN 130D 60MM 60MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5,"$1,412.25",$0.00,"$1,412.25",$635.51,"$1,007.92",$0.00,$243.32,$0.00,$0.00,$247.27,"$1,412.25",$0.00,$706.13,"$1,118.50","$1,129.80",$0.00,$221.02,$0.00,$224.83,$0.00
71225502,SUP,HCPCS C1713,,71225502  -  PLATE BN 130D 70MM 60MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5,"$1,412.25",$0.00,"$1,412.25",$635.51,"$1,007.92",$0.00,$243.32,$0.00,$0.00,$247.27,"$1,412.25",$0.00,$706.13,"$1,118.50","$1,129.80",$0.00,$221.02,$0.00,$224.83,$0.00
71225503,SUP,HCPCS C1713,,71225503  -  PLATE BN 130D 75MM 60MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5,"$1,412.25",$0.00,"$1,412.25",$635.51,"$1,007.92",$0.00,$243.32,$0.00,$0.00,$247.27,"$1,412.25",$0.00,$706.13,"$1,118.50","$1,129.80",$0.00,$221.02,$0.00,$224.83,$0.00
71225504,SUP,HCPCS C1713,,71225504  -  PLATE BN 130D 80MM 60MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5,"$1,412.25",$0.00,"$1,412.25",$635.51,"$1,007.92",$0.00,$243.32,$0.00,$0.00,$247.27,"$1,412.25",$0.00,$706.13,"$1,118.50","$1,129.80",$0.00,$221.02,$0.00,$224.83,$0.00
71225505,SUP,HCPCS C1713,,71225505  -  PLATE BN 130D 85MM 60MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5,"$1,412.25",$0.00,"$1,412.25",$635.51,"$1,007.92",$0.00,$243.32,$0.00,$0.00,$247.27,"$1,412.25",$0.00,$706.13,"$1,118.50","$1,129.80",$0.00,$221.02,$0.00,$224.83,$0.00
71225506,SUP,HCPCS C1713,,71225506  -  PLATE BN 130D 90MM 60MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5,"$1,412.25",$0.00,"$1,412.25",$635.51,"$1,007.92",$0.00,$243.32,$0.00,$0.00,$247.27,"$1,412.25",$0.00,$706.13,"$1,118.50","$1,129.80",$0.00,$221.02,$0.00,$224.83,$0.00
71225507,SUP,HCPCS C1713,,71225507  -  PLATE BN 130D 95MM 60MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5,"$1,412.25",$0.00,"$1,412.25",$635.51,"$1,007.92",$0.00,$243.32,$0.00,$0.00,$247.27,"$1,412.25",$0.00,$706.13,"$1,118.50","$1,129.80",$0.00,$221.02,$0.00,$224.83,$0.00
71225508,SUP,HCPCS C1713,,71225508  -  PLATE BN 130D 100MM 60MM TC100 4 HL OSTM SS ADLT FEM PROX,"$1,412.25",$0.00,"$1,412.25",$635.51,"$1,007.92",$0.00,$243.32,$0.00,$0.00,$247.27,"$1,412.25",$0.00,$706.13,"$1,118.50","$1,129.80",$0.00,$221.02,$0.00,$224.83,$0.00
71225509,SUP,HCPCS C1713,,71225509  -  PLATE BN 130D 105MM 60MM TC100 4 HL OSTM SS ADLT FEM PROX,"$1,412.25",$0.00,"$1,412.25",$635.51,"$1,007.92",$0.00,$243.32,$0.00,$0.00,$247.27,"$1,412.25",$0.00,$706.13,"$1,118.50","$1,129.80",$0.00,$221.02,$0.00,$224.83,$0.00
71225510,SUP,HCPCS C1713,,71225510  -  PLATE BN 130D 110MM 60MM TC100 4 HL OSTM SS ADLT FEM PROX,"$1,412.25",$0.00,"$1,412.25",$635.51,"$1,007.92",$0.00,$243.32,$0.00,$0.00,$247.27,"$1,412.25",$0.00,$706.13,"$1,118.50","$1,129.80",$0.00,$221.02,$0.00,$224.83,$0.00
71225511,SUP,HCPCS C1713,,71225511  -  PLATE BN 130D 50MM 104MM TC100 6 HL OSTM SS ADLT FEM PROX,"$1,496.25",$0.00,"$1,496.25",$673.31,"$1,067.87",$0.00,$257.80,$0.00,$0.00,$261.98,"$1,496.25",$0.00,$748.13,"$1,185.03","$1,197.00",$0.00,$234.16,$0.00,$238.20,$0.00
71225512,SUP,HCPCS C1713,,71225512  -  PLATE BN 130D 60MM 104MM TC100 6 HL OSTM SS ADLT FEM PROX,"$1,496.25",$0.00,"$1,496.25",$673.31,"$1,067.87",$0.00,$257.80,$0.00,$0.00,$261.98,"$1,496.25",$0.00,$748.13,"$1,185.03","$1,197.00",$0.00,$234.16,$0.00,$238.20,$0.00
71225513,SUP,HCPCS C1713,,71225513  -  PLATE BN 130D 70MM 104MM TC100 6 HL OSTM SS ADLT FEM PROX,"$1,496.25",$0.00,"$1,496.25",$673.31,"$1,067.87",$0.00,$257.80,$0.00,$0.00,$261.98,"$1,496.25",$0.00,$748.13,"$1,185.03","$1,197.00",$0.00,$234.16,$0.00,$238.20,$0.00
71225514,SUP,HCPCS C1713,,71225514  -  PLATE BN 130D 80MM 104MM TC100 6 HL OSTM SS ADLT FEM PROX,"$1,496.25",$0.00,"$1,496.25",$673.31,"$1,067.87",$0.00,$257.80,$0.00,$0.00,$261.98,"$1,496.25",$0.00,$748.13,"$1,185.03","$1,197.00",$0.00,$234.16,$0.00,$238.20,$0.00
71225515,SUP,HCPCS C1713,,71225515  -  PLATE BN 130D 90MM 104MM TC100 6 HL OSTM SS ADLT FEM PROX,"$1,496.25",$0.00,"$1,496.25",$673.31,"$1,067.87",$0.00,$257.80,$0.00,$0.00,$261.98,"$1,496.25",$0.00,$748.13,"$1,185.03","$1,197.00",$0.00,$234.16,$0.00,$238.20,$0.00
71225516,SUP,HCPCS C1713,,71225516  -  PLATE BN 130D 70MM 152MM TC100 9 HL OSTM SS ADLT FEM PROX,"$1,669.50",$0.00,"$1,669.50",$751.28,"$1,191.52",$0.00,$287.65,$0.00,$0.00,$292.32,"$1,669.50",$0.00,$834.75,"$1,322.24","$1,335.60",$0.00,$261.28,$0.00,$265.78,$0.00
71225517,SUP,HCPCS C1713,,71225517  -  PLATE BN 130D 80MM 152MM TC100 9 HL OSTM SS ADLT FEM PROX,"$1,669.50",$0.00,"$1,669.50",$751.28,"$1,191.52",$0.00,$287.65,$0.00,$0.00,$292.32,"$1,669.50",$0.00,$834.75,"$1,322.24","$1,335.60",$0.00,$261.28,$0.00,$265.78,$0.00
71225518,SUP,HCPCS C1713,,71225518  -  PLATE BN 130D 90MM 152MM TC100 9 HL OSTM SS ADLT FEM PROX,"$1,669.50",$0.00,"$1,669.50",$751.28,"$1,191.52",$0.00,$287.65,$0.00,$0.00,$292.32,"$1,669.50",$0.00,$834.75,"$1,322.24","$1,335.60",$0.00,$261.28,$0.00,$265.78,$0.00
71225519,SUP,HCPCS C1713,,71225519  -  PLATE BN 130D 70MM 200MM TC100 12 HL OSTM SS ADLT FEM PROX,"$1,911.00",$0.00,"$1,911.00",$859.95,"$1,363.88",$0.00,$329.26,$0.00,$0.00,$334.60,"$1,911.00",$0.00,$955.50,"$1,513.51","$1,528.80",$0.00,$299.07,$0.00,$304.23,$0.00
71225520,SUP,HCPCS C1713,,71225520  -  PLATE BN 130D 80MM 200MM TC100 12 HL OSTM SS ADLT FEM PROX,"$1,911.00",$0.00,"$1,911.00",$859.95,"$1,363.88",$0.00,$329.26,$0.00,$0.00,$334.60,"$1,911.00",$0.00,$955.50,"$1,513.51","$1,528.80",$0.00,$299.07,$0.00,$304.23,$0.00
71225521,SUP,HCPCS C1713,,71225521  -  PLATE BN 130D 90MM 200MM TC100 12 HL OSTM SS ADLT FEM PROX,"$1,911.00",$0.00,"$1,911.00",$859.95,"$1,363.88",$0.00,$329.26,$0.00,$0.00,$334.60,"$1,911.00",$0.00,$955.50,"$1,513.51","$1,528.80",$0.00,$299.07,$0.00,$304.23,$0.00
71225530,SUP,HCPCS C1713,,71225530  -  PLATE BN 130D SM STAT 50MM 60MM TC100 4 HL OSTM SS FEM PROX,"$1,580.25",$0.00,"$1,580.25",$711.11,"$1,127.82",$0.00,$272.27,$0.00,$0.00,$276.69,"$1,580.25",$0.00,$790.13,"$1,251.56","$1,264.20",$0.00,$247.31,$0.00,$251.58,$0.00
71225531,SUP,HCPCS C1713,,71225531  -  PLATE BN 130D SM STAT 60MM 60MM TC100 4 HL OSTM SS FEM PROX,"$1,580.25",$0.00,"$1,580.25",$711.11,"$1,127.82",$0.00,$272.27,$0.00,$0.00,$276.69,"$1,580.25",$0.00,$790.13,"$1,251.56","$1,264.20",$0.00,$247.31,$0.00,$251.58,$0.00
71225532,SUP,HCPCS C1713,,71225532  -  PLATE BN 130D SM STAT 70MM 60MM TC100 4 HL OSTM SS FEM PROX,"$1,580.25",$0.00,"$1,580.25",$711.11,"$1,127.82",$0.00,$272.27,$0.00,$0.00,$276.69,"$1,580.25",$0.00,$790.13,"$1,251.56","$1,264.20",$0.00,$247.31,$0.00,$251.58,$0.00
71225533,SUP,HCPCS C1713,,71225533  -  PLATE BN 130D SM STAT 80MM 60MM TC100 4 HL OSTM SS FEM PROX,"$1,580.25",$0.00,"$1,580.25",$711.11,"$1,127.82",$0.00,$272.27,$0.00,$0.00,$276.69,"$1,580.25",$0.00,$790.13,"$1,251.56","$1,264.20",$0.00,$247.31,$0.00,$251.58,$0.00
71225534,SUP,HCPCS C1713,,71225534  -  PLATE BN 130D SM STAT 50MM 104MM TC100 6 HL OSTM SS FEM PROX,"$1,680.00",$0.00,"$1,680.00",$756.00,"$1,199.02",$0.00,$289.46,$0.00,$0.00,$294.15,"$1,680.00",$0.00,$840.00,"$1,330.56","$1,344.00",$0.00,$262.92,$0.00,$267.46,$0.00
71225535,SUP,HCPCS C1713,,71225535  -  PLATE BN 130D SM STAT 104MM 70MM TC100 6 HL ANG SS FEM PROX,"$1,680.00",$0.00,"$1,680.00",$756.00,"$1,199.02",$0.00,$289.46,$0.00,$0.00,$294.15,"$1,680.00",$0.00,$840.00,"$1,330.56","$1,344.00",$0.00,$262.92,$0.00,$267.46,$0.00
71225536,SUP,HCPCS C1713,,71225536  -  PLATE BN 130D SM STAT 104MM 60MM TC100 6 HL ANG SS FEM PROX,"$1,680.00",$0.00,"$1,680.00",$756.00,"$1,199.02",$0.00,$289.46,$0.00,$0.00,$294.15,"$1,680.00",$0.00,$840.00,"$1,330.56","$1,344.00",$0.00,$262.92,$0.00,$267.46,$0.00
71225537,SUP,HCPCS C1713,,71225537  -  PLATE BN 130D SM STAT 104MM 80MM TC100 6 HL ANG SS FEM PROX,"$1,680.00",$0.00,"$1,680.00",$756.00,"$1,199.02",$0.00,$289.46,$0.00,$0.00,$294.15,"$1,680.00",$0.00,$840.00,"$1,330.56","$1,344.00",$0.00,$262.92,$0.00,$267.46,$0.00
71225539,SUP,HCPCS C1713,,71225539  -  PLATE BN 130D SM STAT 152MM 60MM TC100 9 HL ANG SS FEM PROX,"$1,853.25",$0.00,"$1,853.25",$833.96,"$1,322.66",$0.00,$319.31,$0.00,$0.00,$324.49,"$1,853.25",$0.00,$926.63,"$1,467.77","$1,482.60",$0.00,$290.03,$0.00,$295.04,$0.00
71225540,SUP,HCPCS C1713,,71225540  -  PLATE BN 130D SM STAT 152MM 72MM TC100 9 HL ANG SS FEM PROX,"$1,853.25",$0.00,"$1,853.25",$833.96,"$1,322.66",$0.00,$319.31,$0.00,$0.00,$324.49,"$1,853.25",$0.00,$926.63,"$1,467.77","$1,482.60",$0.00,$290.03,$0.00,$295.04,$0.00
71225541,SUP,HCPCS C1713,,71225541  -  PLATE BN 130D SM STAT 152MM 80MM TC100 9 HL ANG SS FEM PROX,"$1,853.25",$0.00,"$1,853.25",$833.96,"$1,322.66",$0.00,$319.31,$0.00,$0.00,$324.49,"$1,853.25",$0.00,$926.63,"$1,467.77","$1,482.60",$0.00,$290.03,$0.00,$295.04,$0.00
71225600,SUP,HCPCS C1713,,71225600  -  PLATE BN 90D 7MM 25MM TC100 3 HL ANG SS PED PROX FEM 3.5MM,"$1,149.75",$0.00,"$1,149.75",$517.39,$820.58,$0.00,$198.10,$0.00,$0.00,$201.31,"$1,149.75",$0.00,$574.88,$910.60,$919.80,$0.00,$179.94,$0.00,$183.04,$0.00
71225601,SUP,HCPCS C1713,,71225601  -  PLATE BN 90D 12MM 25MM TC100 3 HL ANG SS PED PROX FEM 3.5MM,"$1,149.75",$0.00,"$1,149.75",$517.39,$820.58,$0.00,$198.10,$0.00,$0.00,$201.31,"$1,149.75",$0.00,$574.88,$910.60,$919.80,$0.00,$179.94,$0.00,$183.04,$0.00
71225602,SUP,HCPCS C1713,,71225602  -  PLATE BN 90D 7MM 32MM TC100 3 HL ANG SS PED PROX FEM 3.5MM,"$1,149.75",$0.00,"$1,149.75",$517.39,$820.58,$0.00,$198.10,$0.00,$0.00,$201.31,"$1,149.75",$0.00,$574.88,$910.60,$919.80,$0.00,$179.94,$0.00,$183.04,$0.00
71225603,SUP,HCPCS C1713,,71225603  -  PLATE BN 90D 12MM 32MM TC100 3 HL ANG SS PED PROX FEM 3.5MM,"$1,149.75",$0.00,"$1,149.75",$517.39,$820.58,$0.00,$198.10,$0.00,$0.00,$201.31,"$1,149.75",$0.00,$574.88,$910.60,$919.80,$0.00,$179.94,$0.00,$183.04,$0.00
71225610,SUP,HCPCS C1713,,71225610  -  PLATE BN 115D 5MM 30MM TC100 BFUR ANG SS PED FEM PROX 3.5MM,$680.40,$0.00,$680.40,$306.18,$485.60,$0.00,$117.23,$0.00,$0.00,$119.13,$680.40,$0.00,$340.20,$538.88,$544.32,$0.00,$106.48,$0.00,$108.32,$0.00
71225611,SUP,HCPCS C1713,,71225611  -  PLATE BN 115D 5MM 35MM TC100 BFUR ANG SS PED FEM PROX 3.5MM,$680.40,$0.00,$680.40,$306.18,$485.60,$0.00,$117.23,$0.00,$0.00,$119.13,$680.40,$0.00,$340.20,$538.88,$544.32,$0.00,$106.48,$0.00,$108.32,$0.00
71225620,SUP,HCPCS C1713,,71225620  -  PLATE BN 80D 8MM 35MM TC100 3 HL ANG SS PED PROX FEM 4.5MM,"$1,149.75",$0.00,"$1,149.75",$517.39,$820.58,$0.00,$198.10,$0.00,$0.00,$201.31,"$1,149.75",$0.00,$574.88,$910.60,$919.80,$0.00,$179.94,$0.00,$183.04,$0.00
71225621,SUP,HCPCS C1713,,71225621  -  PLATE BN 80D 8MM 45MM TC100 3 HL ANG SS PED PROX FEM 4.5MM,"$1,149.75",$0.00,"$1,149.75",$517.39,$820.58,$0.00,$198.10,$0.00,$0.00,$201.31,"$1,149.75",$0.00,$574.88,$910.60,$919.80,$0.00,$179.94,$0.00,$183.04,$0.00
71225622,SUP,HCPCS C1713,,71225622  -  PLATE BN 90D 8MM 35MM TC100 3 HL ANG SS PED PROX FEM 4.5MM,$951.30,$0.00,$951.30,$428.09,$678.94,$0.00,$163.90,$0.00,$0.00,$166.57,$951.30,$0.00,$475.65,$753.43,$761.04,$0.00,$148.88,$0.00,$151.45,$0.00
71225623,SUP,HCPCS C1713,,71225623  -  PLATE BN 90D 8MM 45MM TC100 3 HL ANG SS PED PROX FEM 4.5MM,"$1,149.75",$0.00,"$1,149.75",$517.39,$820.58,$0.00,$198.10,$0.00,$0.00,$201.31,"$1,149.75",$0.00,$574.88,$910.60,$919.80,$0.00,$179.94,$0.00,$183.04,$0.00
71225624,SUP,HCPCS C1713,,71225624  -  PLATE BN 100D 8MM 35MM TC100 3 HL ANG SS PED PROX FEM 4.5MM,"$1,149.75",$0.00,"$1,149.75",$517.39,$820.58,$0.00,$198.10,$0.00,$0.00,$201.31,"$1,149.75",$0.00,$574.88,$910.60,$919.80,$0.00,$179.94,$0.00,$183.04,$0.00
71225625,SUP,HCPCS C1713,,71225625  -  PLATE BN 100D 8MM 45MM TC100 3 HL ANG SS PED PROX FEM 4.5MM,"$1,149.75",$0.00,"$1,149.75",$517.39,$820.58,$0.00,$198.10,$0.00,$0.00,$201.31,"$1,149.75",$0.00,$574.88,$910.60,$919.80,$0.00,$179.94,$0.00,$183.04,$0.00
71225640,SUP,HCPCS C1713,,71225640  -  PLATE BN 90D 10MM 40MM TC100 3 HL ANG SS PED PROX FEM 4.5MM,"$1,302.00",$0.00,"$1,302.00",$585.90,$929.24,$0.00,$224.33,$0.00,$0.00,$227.97,"$1,302.00",$0.00,$651.00,"$1,031.18","$1,041.60",$0.00,$203.76,$0.00,$207.28,$0.00
71225641,SUP,HCPCS C1713,,71225641  -  PLATE BN 90D 15MM 40MM TC100 3 HL ANG SS PED PROX FEM 4.5MM,"$1,302.00",$0.00,"$1,302.00",$585.90,$929.24,$0.00,$224.33,$0.00,$0.00,$227.97,"$1,302.00",$0.00,$651.00,"$1,031.18","$1,041.60",$0.00,$203.76,$0.00,$207.28,$0.00
71225642,SUP,HCPCS C1713,,71225642  -  PLATE BN 90D 10MM 50MM TC100 3 HL ANG SS PED FEM PROX 4.5MM,"$1,302.00",$0.00,"$1,302.00",$585.90,$929.24,$0.00,$224.33,$0.00,$0.00,$227.97,"$1,302.00",$0.00,$651.00,"$1,031.18","$1,041.60",$0.00,$203.76,$0.00,$207.28,$0.00
71225643,SUP,HCPCS C1713,,71225643  -  PLATE BN 90D 15MM 50MM TC100 3 HL ANG SS PED FEM PROX 4.5MM,"$1,302.00",$0.00,"$1,302.00",$585.90,$929.24,$0.00,$224.33,$0.00,$0.00,$227.97,"$1,302.00",$0.00,$651.00,"$1,031.18","$1,041.60",$0.00,$203.76,$0.00,$207.28,$0.00
71225644,SUP,HCPCS C1713,,71225644  -  PLATE BN 90D 15MM 60MM TC100 3 HL ANG SS PED FEM PROX 4.5MM,"$1,302.00",$0.00,"$1,302.00",$585.90,$929.24,$0.00,$224.33,$0.00,$0.00,$227.97,"$1,302.00",$0.00,$651.00,"$1,031.18","$1,041.60",$0.00,$203.76,$0.00,$207.28,$0.00
71225716,SUP,HCPCS C1713,,71225716  -  SCREW BN 3.5MM 16MM STRL 6MM TC100 ST SHFT SS ORTH SM FRAG,$65.53,$0.00,$65.53,$29.49,$46.77,$0.00,$11.29,$0.00,$0.00,$11.47,$65.53,$0.00,$32.76,$51.90,$52.42,$0.00,$10.25,$0.00,$10.43,$0.00
71225718,SUP,HCPCS C1713,,71225718  -  SCREW BN 3.5MM 18MM STRL 6MM TC100 ST SHFT SS ORTH SM FRAG,$65.53,$0.00,$65.53,$29.49,$46.77,$0.00,$11.29,$0.00,$0.00,$11.47,$65.53,$0.00,$32.76,$51.90,$52.42,$0.00,$10.25,$0.00,$10.43,$0.00
71225720,SUP,HCPCS C1713,,71225720  -  SCREW BN 3.5MM 20MM STRL 6MM TC100 ST SHFT SS ORTH SM FRAG,$65.53,$0.00,$65.53,$29.49,$46.77,$0.00,$11.29,$0.00,$0.00,$11.47,$65.53,$0.00,$32.76,$51.90,$52.42,$0.00,$10.25,$0.00,$10.43,$0.00
71225722,SUP,HCPCS C1713,,71225722  -  SCREW BN 3.5MM 22MM STRL 6MM TC100 ST SHFT SS ORTH SM FRAG,$65.53,$0.00,$65.53,$29.49,$46.77,$0.00,$11.29,$0.00,$0.00,$11.47,$65.53,$0.00,$32.76,$51.90,$52.42,$0.00,$10.25,$0.00,$10.43,$0.00
71225724,SUP,HCPCS C1713,,71225724  -  SCREW BN 3.5MM 24MM STRL 10MM TC100 ST SHFT SS ORTH SM FRAG,$65.53,$0.00,$65.53,$29.49,$46.77,$0.00,$11.29,$0.00,$0.00,$11.47,$65.53,$0.00,$32.76,$51.90,$52.42,$0.00,$10.25,$0.00,$10.43,$0.00
71225726,SUP,HCPCS C1713,,71225726  -  SCREW BN 3.5MM 26MM STRL 10MM TC100 ST SHFT SS ORTH SM FRAG,$65.53,$0.00,$65.53,$29.49,$46.77,$0.00,$11.29,$0.00,$0.00,$11.47,$65.53,$0.00,$32.76,$51.90,$52.42,$0.00,$10.25,$0.00,$10.43,$0.00
71225728,SUP,HCPCS C1713,,71225728  -  SCREW BN 3.5MM 28MM STRL 10MM TC100 ST SHFT SS ORTH SM FRAG,$65.53,$0.00,$65.53,$29.49,$46.77,$0.00,$11.29,$0.00,$0.00,$11.47,$65.53,$0.00,$32.76,$51.90,$52.42,$0.00,$10.25,$0.00,$10.43,$0.00
71225730,SUP,HCPCS C1713,,71225730  -  SCREW BN 3.5MM 30MM STRL 10MM TC100 ST SHFT SS ORTH SM FRAG,$65.53,$0.00,$65.53,$29.49,$46.77,$0.00,$11.29,$0.00,$0.00,$11.47,$65.53,$0.00,$32.76,$51.90,$52.42,$0.00,$10.25,$0.00,$10.43,$0.00
71225732,SUP,HCPCS C1713,,71225732  -  SCREW BN 3.5MM 32MM STRL 12MM TC100 ST SHFT SS ORTH SM FRAG,$65.53,$0.00,$65.53,$29.49,$46.77,$0.00,$11.29,$0.00,$0.00,$11.47,$65.53,$0.00,$32.76,$51.90,$52.42,$0.00,$10.25,$0.00,$10.43,$0.00
71225734,SUP,HCPCS C1713,,71225734  -  SCREW BN 3.5MM 34MM STRL 12MM TC100 ST SHFT SS ORTH SM FRAG,$65.53,$0.00,$65.53,$29.49,$46.77,$0.00,$11.29,$0.00,$0.00,$11.47,$65.53,$0.00,$32.76,$51.90,$52.42,$0.00,$10.25,$0.00,$10.43,$0.00
71225736,SUP,HCPCS C1713,,71225736  -  SCREW BN 3.5MM 36MM STRL 12MM TC100 ST SS ORTH,$65.53,$0.00,$65.53,$29.49,$46.77,$0.00,$11.29,$0.00,$0.00,$11.47,$65.53,$0.00,$32.76,$51.90,$52.42,$0.00,$10.25,$0.00,$10.43,$0.00
71225738,SUP,HCPCS C1713,,71225738  -  SCREW BN 3.5MM 38MM STRL 12MM TC100 ST SHFT SS ORTH SM FRAG,$65.53,$0.00,$65.53,$29.49,$46.77,$0.00,$11.29,$0.00,$0.00,$11.47,$65.53,$0.00,$32.76,$51.90,$52.42,$0.00,$10.25,$0.00,$10.43,$0.00
71225740,SUP,HCPCS C1713,,71225740  -  SCREW BN 3.5MM 40MM STRL 12MM TC100 ST SHFT SS ORTH SM FRAG,$65.53,$0.00,$65.53,$29.49,$46.77,$0.00,$11.29,$0.00,$0.00,$11.47,$65.53,$0.00,$32.76,$51.90,$52.42,$0.00,$10.25,$0.00,$10.43,$0.00
71225745,SUP,HCPCS C1713,,71225745  -  SCREW BN 3.5MM 45MM STRL 15MM TC100 ST SHFT SS ORTH SM FRAG,$65.53,$0.00,$65.53,$29.49,$46.77,$0.00,$11.29,$0.00,$0.00,$11.47,$65.53,$0.00,$32.76,$51.90,$52.42,$0.00,$10.25,$0.00,$10.43,$0.00
71225750,SUP,HCPCS C1713,,71225750  -  SCREW BN 3.5MM 50MM STRL 15MM TC100 ST SHFT SS ORTH SM FRAG,$65.53,$0.00,$65.53,$29.49,$46.77,$0.00,$11.29,$0.00,$0.00,$11.47,$65.53,$0.00,$32.76,$51.90,$52.42,$0.00,$10.25,$0.00,$10.43,$0.00
71225822,SUP,HCPCS C1713,,71225822  -  SCREW BN 4.5MM 22MM STRL 12MM TC100 ST SHFT SS ORTH LG FRAG,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71225824,SUP,HCPCS C1713,,71225824  -  SCREW BN 4.5MM 24MM STRL 12MM TC100 ST SHFT SS ORTH LG FRAG,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71225826,SUP,HCPCS C1713,,71225826  -  SCREW BN 4.5MM 26MM STRL 12MM TC100 ST SHFT SS ORTH LG FRAG,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71225828,SUP,HCPCS C1713,,71225828  -  SCREW BN 4.5MM 28MM STRL 12MM TC100 ST SHFT SS ORTH LG FRAG,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71225830,SUP,HCPCS C1713,,71225830  -  SCREW BN 4.5MM 30MM STRL 12MM TC100 ST SHFT SS ORTH LG FRAG,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71225832,SUP,HCPCS C1713,,71225832  -  SCREW BN 4.5MM 32MM STRL 12MM TC100 ST SHFT SS ORTH LG FRAG,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71225834,SUP,HCPCS C1713,,71225834  -  SCREW BN 4.5MM 34MM STRL 12MM TC100 ST SHFT SS ORTH LG FRAG,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71225836,SUP,HCPCS C1713,,71225836  -  SCREW BN 4.5MM 36MM STRL 12MM TC100 ST SHFT SS ORTH LG FRAG,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71225838,SUP,HCPCS C1713,,71225838  -  SCREW BN 4.5MM 38MM STRL 12MM TC100 ST SHFT SS ORTH LG FRAG,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71225840,SUP,HCPCS C1713,,71225840  -  SCREW BN 4.5MM 40MM STRL 12MM TC100 ST SHFT SS ORTH LG FRAG,$67.53,$0.00,$67.53,$30.39,$48.19,$0.00,$11.63,$0.00,$0.00,$11.82,$67.53,$0.00,$33.76,$53.48,$54.02,$0.00,$10.57,$0.00,$10.75,$0.00
71225842,SUP,HCPCS C1713,,71225842  -  SCREW BN 4.5MM 42MM STRL 12MM TC100 ST SHFT SS ORTH LG FRAG,$69.73,$0.00,$69.73,$31.38,$49.76,$0.00,$12.01,$0.00,$0.00,$12.21,$69.73,$0.00,$34.86,$55.23,$55.78,$0.00,$10.91,$0.00,$11.10,$0.00
71225844,SUP,HCPCS C1713,,71225844  -  SCREW BN 4.5MM 44MM STRL 12MM TC100 ST SHFT SS ORTH LG FRAG,$69.73,$0.00,$69.73,$31.38,$49.76,$0.00,$12.01,$0.00,$0.00,$12.21,$69.73,$0.00,$34.86,$55.23,$55.78,$0.00,$10.91,$0.00,$11.10,$0.00
71225846,SUP,HCPCS C1713,,71225846  -  SCREW BN 4.5MM 46MM STRL 12MM TC100 ST SHFT SS ORTH LG FRAG,$69.73,$0.00,$69.73,$31.38,$49.76,$0.00,$12.01,$0.00,$0.00,$12.21,$69.73,$0.00,$34.86,$55.23,$55.78,$0.00,$10.91,$0.00,$11.10,$0.00
71225848,SUP,HCPCS C1713,,71225848  -  SCREW BN 4.5MM 48MM STRL 12MM TC100 ST SS ORTH,$69.73,$0.00,$69.73,$31.38,$49.76,$0.00,$12.01,$0.00,$0.00,$12.21,$69.73,$0.00,$34.86,$55.23,$55.78,$0.00,$10.91,$0.00,$11.10,$0.00
71225850,SUP,HCPCS C1713,,71225850  -  SCREW BN 4.5MM 50MM STRL 12MM TC100 ST SHFT SS ORTH LG FRAG,$69.73,$0.00,$69.73,$31.38,$49.76,$0.00,$12.01,$0.00,$0.00,$12.21,$69.73,$0.00,$34.86,$55.23,$55.78,$0.00,$10.91,$0.00,$11.10,$0.00
71225852,SUP,HCPCS C1713,,71225852  -  SCREW BN 4.5MM 52MM STRL 15MM TC100 ST SS ORTH,$69.73,$0.00,$69.73,$31.38,$49.76,$0.00,$12.01,$0.00,$0.00,$12.21,$69.73,$0.00,$34.86,$55.23,$55.78,$0.00,$10.91,$0.00,$11.10,$0.00
71225854,SUP,HCPCS C1713,,71225854  -  SCREW BN 4.5MM 54MM STRL 15MM TC100 ST SHFT SS ORTH LG FRAG,$69.73,$0.00,$69.73,$31.38,$49.76,$0.00,$12.01,$0.00,$0.00,$12.21,$69.73,$0.00,$34.86,$55.23,$55.78,$0.00,$10.91,$0.00,$11.10,$0.00
71225856,SUP,HCPCS C1713,,71225856  -  SCREW BN 4.5MM 56MM STRL 15MM TC100 ST SS ORTH,$69.73,$0.00,$69.73,$31.38,$49.76,$0.00,$12.01,$0.00,$0.00,$12.21,$69.73,$0.00,$34.86,$55.23,$55.78,$0.00,$10.91,$0.00,$11.10,$0.00
71225858,SUP,HCPCS C1713,,71225858  -  SCREW BN 4.5MM 58MM STRL 15MM TC100 ST SS ORTH,$69.73,$0.00,$69.73,$31.38,$49.76,$0.00,$12.01,$0.00,$0.00,$12.21,$69.73,$0.00,$34.86,$55.23,$55.78,$0.00,$10.91,$0.00,$11.10,$0.00
71225860,SUP,HCPCS C1713,,71225860  -  SCREW BN 4.5MM 60MM STRL 15MM TC100 ST SHFT SS ORTH LG FRAG,$69.73,$0.00,$69.73,$31.38,$49.76,$0.00,$12.01,$0.00,$0.00,$12.21,$69.73,$0.00,$34.86,$55.23,$55.78,$0.00,$10.91,$0.00,$11.10,$0.00
71225864,SUP,HCPCS C1713,,71225864  -  SCREW BN 4.5MM 64MM STRL 18MM TC100 ST SS ORTH,$69.73,$0.00,$69.73,$31.38,$49.76,$0.00,$12.01,$0.00,$0.00,$12.21,$69.73,$0.00,$34.86,$55.23,$55.78,$0.00,$10.91,$0.00,$11.10,$0.00
71225868,SUP,HCPCS C1713,,71225868  -  SCREW BN 4.5MM 68MM STRL 18MM TC100 ST SHFT SS ORTH LG FRAG,$69.73,$0.00,$69.73,$31.38,$49.76,$0.00,$12.01,$0.00,$0.00,$12.21,$69.73,$0.00,$34.86,$55.23,$55.78,$0.00,$10.91,$0.00,$11.10,$0.00
71225872,SUP,HCPCS C1713,,71225872  -  SCREW BN 4.5MM 72MM STRL 18MM TC100 ST SHFT SS ORTH LG FRAG,$69.73,$0.00,$69.73,$31.38,$49.76,$0.00,$12.01,$0.00,$0.00,$12.21,$69.73,$0.00,$34.86,$55.23,$55.78,$0.00,$10.91,$0.00,$11.10,$0.00
71225876,SUP,HCPCS C1713,,71225876  -  SCREW BN 4.5MM 76MM STRL 18MM TC100 ST SHFT SS ORTH LG FRAG,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
71225880,SUP,HCPCS C1713,,71225880  -  SCREW BN 4.5MM 80MM STRL 18MM TC100 ST SHFT SS ORTH LG FRAG,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
71225885,SUP,HCPCS C1713,,71225885  -  SCREW BN 4.5MM 85MM STRL 22MM TC100 ST SHFT SS ORTH LG FRAG,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
71225890,SUP,HCPCS C1713,,71225890  -  SCREW BN 4.5MM 90MM STRL 22MM TC100 ST SHFT SS ORTH LG FRAG,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
71225895,SUP,HCPCS C1713,,71225895  -  SCREW BN 4.5MM 95MM STRL 26MM TC100 ST SHFT SS ORTH LG FRAG,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
71225900,SUP,HCPCS C1713,,71225900  -  SCREW BN 4.5MM 100MM STRL 26MM TC100 ST SHFT SS ORTH LG FRAG,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
71226030,SUP,HCPCS C1713,,71226030  -  SCREW BN P/T 6.5MM 8MM 30MM 16MM TC100 SS CANC LG FRAG SYS,$123.90,$0.00,$123.90,$55.76,$88.43,$0.00,$21.35,$0.00,$0.00,$21.69,$123.90,$0.00,$61.95,$98.13,$99.12,$0.00,$19.39,$0.00,$19.72,$0.00
71226035,SUP,HCPCS C1713,,71226035  -  SCREW BN P/T 6.5MM 8MM 35MM 16MM TC100 SS CANC LG FRAG SYS,$123.90,$0.00,$123.90,$55.76,$88.43,$0.00,$21.35,$0.00,$0.00,$21.69,$123.90,$0.00,$61.95,$98.13,$99.12,$0.00,$19.39,$0.00,$19.72,$0.00
71226040,SUP,HCPCS C1713,,71226040  -  SCREW BN P/T 6.5MM 8MM 40MM 16MM TC100 SS CANC LG FRAG SYS,$123.90,$0.00,$123.90,$55.76,$88.43,$0.00,$21.35,$0.00,$0.00,$21.69,$123.90,$0.00,$61.95,$98.13,$99.12,$0.00,$19.39,$0.00,$19.72,$0.00
71226045,SUP,HCPCS C1713,,71226045  -  SCREW BN P/T 6.5MM 8MM 45MM 16MM TC100 SS CANC LG FRAG SYS,$123.90,$0.00,$123.90,$55.76,$88.43,$0.00,$21.35,$0.00,$0.00,$21.69,$123.90,$0.00,$61.95,$98.13,$99.12,$0.00,$19.39,$0.00,$19.72,$0.00
71226050,SUP,HCPCS C1713,,71226050  -  SCREW BN P/T 6.5MM 8MM 50MM 16MM TC100 SS CANC LG FRAG SYS,$123.90,$0.00,$123.90,$55.76,$88.43,$0.00,$21.35,$0.00,$0.00,$21.69,$123.90,$0.00,$61.95,$98.13,$99.12,$0.00,$19.39,$0.00,$19.72,$0.00
71226055,SUP,HCPCS C1713,,71226055  -  SCREW BN P/T 6.5MM 8MM 55MM 16MM TC100 SS CANC LG FRAG SYS,$123.90,$0.00,$123.90,$55.76,$88.43,$0.00,$21.35,$0.00,$0.00,$21.69,$123.90,$0.00,$61.95,$98.13,$99.12,$0.00,$19.39,$0.00,$19.72,$0.00
71226060,SUP,HCPCS C1713,,71226060  -  SCREW BN P/T 6.5MM 8MM 60MM 16MM TC100 SS CANC LG FRAG SYS,$123.90,$0.00,$123.90,$55.76,$88.43,$0.00,$21.35,$0.00,$0.00,$21.69,$123.90,$0.00,$61.95,$98.13,$99.12,$0.00,$19.39,$0.00,$19.72,$0.00
71226065,SUP,HCPCS C1713,,71226065  -  SCREW BN P/T 6.5MM 8MM 65MM 16MM TC100 SS CANC LG FRAG SYS,$123.90,$0.00,$123.90,$55.76,$88.43,$0.00,$21.35,$0.00,$0.00,$21.69,$123.90,$0.00,$61.95,$98.13,$99.12,$0.00,$19.39,$0.00,$19.72,$0.00
71226070,SUP,HCPCS C1713,,71226070  -  SCREW BN P/T 6.5MM 8MM 70MM 16MM TC100 SS CANC LG FRAG SYS,$123.90,$0.00,$123.90,$55.76,$88.43,$0.00,$21.35,$0.00,$0.00,$21.69,$123.90,$0.00,$61.95,$98.13,$99.12,$0.00,$19.39,$0.00,$19.72,$0.00
71226075,SUP,HCPCS C1713,,71226075  -  SCREW BN P/T 6.5MM 8MM 75MM 16MM TC100 SS CANC LG FRAG SYS,$123.90,$0.00,$123.90,$55.76,$88.43,$0.00,$21.35,$0.00,$0.00,$21.69,$123.90,$0.00,$61.95,$98.13,$99.12,$0.00,$19.39,$0.00,$19.72,$0.00
71226080,SUP,HCPCS C1713,,71226080  -  SCREW BN P/T 6.5MM 8MM 80MM 16MM TC100 SS CANC LG FRAG SYS,$123.90,$0.00,$123.90,$55.76,$88.43,$0.00,$21.35,$0.00,$0.00,$21.69,$123.90,$0.00,$61.95,$98.13,$99.12,$0.00,$19.39,$0.00,$19.72,$0.00
71226085,SUP,HCPCS C1713,,71226085  -  SCREW BN P/T 6.5MM 8MM 85MM 16MM TC100 SS CANC LG FRAG SYS,$135.45,$0.00,$135.45,$60.95,$96.67,$0.00,$23.34,$0.00,$0.00,$23.72,$135.45,$0.00,$67.73,$107.28,$108.36,$0.00,$21.20,$0.00,$21.56,$0.00
71226090,SUP,HCPCS C1713,,71226090  -  SCREW BN P/T 6.5MM 8MM 90MM 16MM TC100 SS CANC LG FRAG SYS,$135.45,$0.00,$135.45,$60.95,$96.67,$0.00,$23.34,$0.00,$0.00,$23.72,$135.45,$0.00,$67.73,$107.28,$108.36,$0.00,$21.20,$0.00,$21.56,$0.00
71226095,SUP,HCPCS C1713,,71226095  -  SCREW BN P/T 6.5MM 8MM 95MM 16MM TC100 SS CANC LG FRAG SYS,$135.45,$0.00,$135.45,$60.95,$96.67,$0.00,$23.34,$0.00,$0.00,$23.72,$135.45,$0.00,$67.73,$107.28,$108.36,$0.00,$21.20,$0.00,$21.56,$0.00
71226100,SUP,HCPCS C1713,,71226100  -  SCREW BN 6.5MM 100MM 16MM TC100 THRD SS CANC LG FRAG SET,$135.45,$0.00,$135.45,$60.95,$96.67,$0.00,$23.34,$0.00,$0.00,$23.72,$135.45,$0.00,$67.73,$107.28,$108.36,$0.00,$21.20,$0.00,$21.56,$0.00
71226105,SUP,HCPCS C1713,,71226105  -  SCREW BN 6.5MM 105MM 16MM TC100 SS CANC LG FRAG SET,$135.45,$0.00,$135.45,$60.95,$96.67,$0.00,$23.34,$0.00,$0.00,$23.72,$135.45,$0.00,$67.73,$107.28,$108.36,$0.00,$21.20,$0.00,$21.56,$0.00
71226110,SUP,HCPCS C1713,,71226110  -  SCREW BN 6.5MM 110MM 16MM TC100 THRD SS CANC LG FRAG SET,$135.45,$0.00,$135.45,$60.95,$96.67,$0.00,$23.34,$0.00,$0.00,$23.72,$135.45,$0.00,$67.73,$107.28,$108.36,$0.00,$21.20,$0.00,$21.56,$0.00
71226115,SUP,HCPCS C1713,,71226115  -  SCREW BN 6.5MM 115MM 16MM TC100 SS CANC LG FRAG SET,$174.30,$0.00,$174.30,$78.44,$124.40,$0.00,$30.03,$0.00,$0.00,$30.52,$174.30,$0.00,$87.15,$138.05,$139.44,$0.00,$27.28,$0.00,$27.75,$0.00
71226120,SUP,HCPCS C1713,,71226120  -  SCREW BN 6.5MM 120MM 16MM TC100 SS CANC LG FRAG SET,$174.30,$0.00,$174.30,$78.44,$124.40,$0.00,$30.03,$0.00,$0.00,$30.52,$174.30,$0.00,$87.15,$138.05,$139.44,$0.00,$27.28,$0.00,$27.75,$0.00
71226125,SUP,HCPCS C1713,,71226125  -  SCREW BN 6.5MM 125MM 16MM TC100 SS CANC LG FRAG SET,$174.30,$0.00,$174.30,$78.44,$124.40,$0.00,$30.03,$0.00,$0.00,$30.52,$174.30,$0.00,$87.15,$138.05,$139.44,$0.00,$27.28,$0.00,$27.75,$0.00
71226130,SUP,HCPCS C1713,,71226130  -  SCREW BN 6.5MM 130MM 16MM TC100 SS CANC LG FRAG SET,$174.30,$0.00,$174.30,$78.44,$124.40,$0.00,$30.03,$0.00,$0.00,$30.52,$174.30,$0.00,$87.15,$138.05,$139.44,$0.00,$27.28,$0.00,$27.75,$0.00
71226135,SUP,HCPCS C1713,,71226135  -  SCREW BN 6.5MM 135MM 16MM TC100 SS CANC LG FRAG SET,$174.30,$0.00,$174.30,$78.44,$124.40,$0.00,$30.03,$0.00,$0.00,$30.52,$174.30,$0.00,$87.15,$138.05,$139.44,$0.00,$27.28,$0.00,$27.75,$0.00
71226140,SUP,HCPCS C1713,,71226140  -  SCREW BN 6.5MM 140MM 16MM TC100 SS CANC LG FRAG SET,$174.30,$0.00,$174.30,$78.44,$124.40,$0.00,$30.03,$0.00,$0.00,$30.52,$174.30,$0.00,$87.15,$138.05,$139.44,$0.00,$27.28,$0.00,$27.75,$0.00
71226145,SUP,HCPCS C1713,,71226145  -  SCREW BN 6.5MM 145MM 16MM TC100 SS CANC LG FRAG SET,$174.30,$0.00,$174.30,$78.44,$124.40,$0.00,$30.03,$0.00,$0.00,$30.52,$174.30,$0.00,$87.15,$138.05,$139.44,$0.00,$27.28,$0.00,$27.75,$0.00
71226150,SUP,HCPCS C1713,,71226150  -  SCREW BN 6.5MM 150MM 16MM TC100 SS CANC LG FRAG SET,$174.30,$0.00,$174.30,$78.44,$124.40,$0.00,$30.03,$0.00,$0.00,$30.52,$174.30,$0.00,$87.15,$138.05,$139.44,$0.00,$27.28,$0.00,$27.75,$0.00
71228045,SUP,HCPCS C1713,,71228045  -  SCREW BN 6.5MM 45MM 32MM TC100 THRD SS CANC LG FRAG SET,$123.90,$0.00,$123.90,$55.76,$88.43,$0.00,$21.35,$0.00,$0.00,$21.69,$123.90,$0.00,$61.95,$98.13,$99.12,$0.00,$19.39,$0.00,$19.72,$0.00
71228050,SUP,HCPCS C1713,,71228050  -  SCREW BN 6.5MM 50MM 32MM TC100 THRD SS CANC LG FRAG SET,$123.90,$0.00,$123.90,$55.76,$88.43,$0.00,$21.35,$0.00,$0.00,$21.69,$123.90,$0.00,$61.95,$98.13,$99.12,$0.00,$19.39,$0.00,$19.72,$0.00
71228055,SUP,HCPCS C1713,,71228055  -  SCREW BN 6.5MM 55MM 32MM TC100 THRD SS CANC LG FRAG SET,$123.90,$0.00,$123.90,$55.76,$88.43,$0.00,$21.35,$0.00,$0.00,$21.69,$123.90,$0.00,$61.95,$98.13,$99.12,$0.00,$19.39,$0.00,$19.72,$0.00
71228060,SUP,HCPCS C1713,,71228060  -  SCREW BN 6.5MM 60MM 32MM TC100 THRD SS CANC LG FRAG SET,$123.90,$0.00,$123.90,$55.76,$88.43,$0.00,$21.35,$0.00,$0.00,$21.69,$123.90,$0.00,$61.95,$98.13,$99.12,$0.00,$19.39,$0.00,$19.72,$0.00
71228065,SUP,HCPCS C1713,,71228065  -  SCREW BN 6.5MM 65MM 32MM TC100 THRD SS CANC LG FRAG SET,$123.90,$0.00,$123.90,$55.76,$88.43,$0.00,$21.35,$0.00,$0.00,$21.69,$123.90,$0.00,$61.95,$98.13,$99.12,$0.00,$19.39,$0.00,$19.72,$0.00
71228070,SUP,HCPCS C1713,,71228070  -  SCREW BN 6.5MM 70MM 32MM TC100 THRD SS CANC LG FRAG SET,$123.90,$0.00,$123.90,$55.76,$88.43,$0.00,$21.35,$0.00,$0.00,$21.69,$123.90,$0.00,$61.95,$98.13,$99.12,$0.00,$19.39,$0.00,$19.72,$0.00
71228075,SUP,HCPCS C1713,,71228075  -  SCREW BN 6.5MM 75MM 32MM TC100 THRD SS CANC LG FRAG SET,$123.90,$0.00,$123.90,$55.76,$88.43,$0.00,$21.35,$0.00,$0.00,$21.69,$123.90,$0.00,$61.95,$98.13,$99.12,$0.00,$19.39,$0.00,$19.72,$0.00
71228080,SUP,HCPCS C1713,,71228080  -  SCREW BN 6.5MM 80MM 32MM TC100 THRD SS CANC LG FRAG SET,$123.90,$0.00,$123.90,$55.76,$88.43,$0.00,$21.35,$0.00,$0.00,$21.69,$123.90,$0.00,$61.95,$98.13,$99.12,$0.00,$19.39,$0.00,$19.72,$0.00
71228085,SUP,HCPCS C1713,,71228085  -  SCREW BN 6.5MM 85MM 32MM TC100 THRD SS CANC LG FRAG SET,$143.85,$0.00,$143.85,$64.73,$102.67,$0.00,$24.78,$0.00,$0.00,$25.19,$143.85,$0.00,$71.93,$113.93,$115.08,$0.00,$22.51,$0.00,$22.90,$0.00
71228090,SUP,HCPCS C1713,,71228090  -  SCREW BN 6.5MM 90MM 32MM TC100 THRD SS CANC LG FRAG SET,$135.45,$0.00,$135.45,$60.95,$96.67,$0.00,$23.34,$0.00,$0.00,$23.72,$135.45,$0.00,$67.73,$107.28,$108.36,$0.00,$21.20,$0.00,$21.56,$0.00
71228095,SUP,HCPCS C1713,,71228095  -  SCREW BN 6.5MM 95MM 32MM TC100 THRD SS CANC LG FRAG SET,$135.45,$0.00,$135.45,$60.95,$96.67,$0.00,$23.34,$0.00,$0.00,$23.72,$135.45,$0.00,$67.73,$107.28,$108.36,$0.00,$21.20,$0.00,$21.56,$0.00
71228100,SUP,HCPCS C1713,,71228100  -  SCREW BN 6.5MM 100MM 32MM TC100 SS CANC LG FRAG SET,$135.45,$0.00,$135.45,$60.95,$96.67,$0.00,$23.34,$0.00,$0.00,$23.72,$135.45,$0.00,$67.73,$107.28,$108.36,$0.00,$21.20,$0.00,$21.56,$0.00
71228105,SUP,HCPCS C1713,,71228105  -  SCREW BN 6.5MM 105MM 32MM TC100 SS CANC LG FRAG SET,$135.45,$0.00,$135.45,$60.95,$96.67,$0.00,$23.34,$0.00,$0.00,$23.72,$135.45,$0.00,$67.73,$107.28,$108.36,$0.00,$21.20,$0.00,$21.56,$0.00
71228110,SUP,HCPCS C1713,,71228110  -  SCREW BN 6.5MM 110MM 32MM TC100 SS CANC LG FRAG SET,$135.45,$0.00,$135.45,$60.95,$96.67,$0.00,$23.34,$0.00,$0.00,$23.72,$135.45,$0.00,$67.73,$107.28,$108.36,$0.00,$21.20,$0.00,$21.56,$0.00
71228115,SUP,HCPCS C1713,,71228115  -  SCREW BN 6.5MM 115MM 32MM TC100 SS CANC LG FRAG SET,$174.30,$0.00,$174.30,$78.44,$124.40,$0.00,$30.03,$0.00,$0.00,$30.52,$174.30,$0.00,$87.15,$138.05,$139.44,$0.00,$27.28,$0.00,$27.75,$0.00
71228120,SUP,HCPCS C1713,,71228120  -  SCREW BN 6.5MM 120MM 32MM TC100 SS CANC LG FRAG SET,$174.30,$0.00,$174.30,$78.44,$124.40,$0.00,$30.03,$0.00,$0.00,$30.52,$174.30,$0.00,$87.15,$138.05,$139.44,$0.00,$27.28,$0.00,$27.75,$0.00
71228125,SUP,HCPCS C1713,,71228125  -  SCREW BN 6.5MM 125MM 32MM TC100 SS CANC LG FRAG SET,$174.30,$0.00,$174.30,$78.44,$124.40,$0.00,$30.03,$0.00,$0.00,$30.52,$174.30,$0.00,$87.15,$138.05,$139.44,$0.00,$27.28,$0.00,$27.75,$0.00
71228130,SUP,HCPCS C1713,,71228130  -  SCREW BN 6.5MM 130MM 32MM TC100 SS CANC LG FRAG SET,$174.30,$0.00,$174.30,$78.44,$124.40,$0.00,$30.03,$0.00,$0.00,$30.52,$174.30,$0.00,$87.15,$138.05,$139.44,$0.00,$27.28,$0.00,$27.75,$0.00
71228135,SUP,HCPCS C1713,,71228135  -  SCREW BN 6.5MM 135MM 32MM TC100 SS CANC LG FRAG SET,$174.30,$0.00,$174.30,$78.44,$124.40,$0.00,$30.03,$0.00,$0.00,$30.52,$174.30,$0.00,$87.15,$138.05,$139.44,$0.00,$27.28,$0.00,$27.75,$0.00
71228140,SUP,HCPCS C1713,,71228140  -  SCREW BN 6.5MM 140MM 32MM TC100 SS CANC LG FRAG SET,$174.30,$0.00,$174.30,$78.44,$124.40,$0.00,$30.03,$0.00,$0.00,$30.52,$174.30,$0.00,$87.15,$138.05,$139.44,$0.00,$27.28,$0.00,$27.75,$0.00
71228145,SUP,HCPCS C1713,,71228145  -  SCREW BN 6.5MM 145MM 32MM TC100 SS CANC LG FRAG SET,$174.30,$0.00,$174.30,$78.44,$124.40,$0.00,$30.03,$0.00,$0.00,$30.52,$174.30,$0.00,$87.15,$138.05,$139.44,$0.00,$27.28,$0.00,$27.75,$0.00
71228150,SUP,HCPCS C1713,,71228150  -  SCREW BN 6.5MM 150MM 32MM TC100 SS CANC LG FRAG SET,$174.30,$0.00,$174.30,$78.44,$124.40,$0.00,$30.03,$0.00,$0.00,$30.52,$174.30,$0.00,$87.15,$138.05,$139.44,$0.00,$27.28,$0.00,$27.75,$0.00
71229025,SUP,HCPCS C1713,,71229025  -  SCREW BN FT 6.5MM 8MM 25MM TC100 SS CANC LG FRAG SYS,$123.90,$0.00,$123.90,$55.76,$88.43,$0.00,$21.35,$0.00,$0.00,$21.69,$123.90,$0.00,$61.95,$98.13,$99.12,$0.00,$19.39,$0.00,$19.72,$0.00
71229030,SUP,HCPCS C1713,,71229030  -  SCREW BN FT 6.5MM 8MM 30MM TC100 SS CANC LG FRAG SYS,$123.90,$0.00,$123.90,$55.76,$88.43,$0.00,$21.35,$0.00,$0.00,$21.69,$123.90,$0.00,$61.95,$98.13,$99.12,$0.00,$19.39,$0.00,$19.72,$0.00
71229035,SUP,HCPCS C1713,,71229035  -  SCREW BN FT 6.5MM 8MM 35MM TC100 SS CANC LG FRAG SYS,$123.90,$0.00,$123.90,$55.76,$88.43,$0.00,$21.35,$0.00,$0.00,$21.69,$123.90,$0.00,$61.95,$98.13,$99.12,$0.00,$19.39,$0.00,$19.72,$0.00
71229040,SUP,HCPCS C1713,,71229040  -  SCREW BN FT 6.5MM 8MM 40MM TC100 SS CANC LG FRAG SYS,$123.90,$0.00,$123.90,$55.76,$88.43,$0.00,$21.35,$0.00,$0.00,$21.69,$123.90,$0.00,$61.95,$98.13,$99.12,$0.00,$19.39,$0.00,$19.72,$0.00
71229045,SUP,HCPCS C1713,,71229045  -  SCREW BN FT 6.5MM 8MM 45MM TC100 SS CANC LG FRAG SYS,$123.90,$0.00,$123.90,$55.76,$88.43,$0.00,$21.35,$0.00,$0.00,$21.69,$123.90,$0.00,$61.95,$98.13,$99.12,$0.00,$19.39,$0.00,$19.72,$0.00
71229050,SUP,HCPCS C1713,,71229050  -  SCREW BN FT 6.5MM 8MM 50MM TC100 SS CANC LG FRAG SYS,$123.90,$0.00,$123.90,$55.76,$88.43,$0.00,$21.35,$0.00,$0.00,$21.69,$123.90,$0.00,$61.95,$98.13,$99.12,$0.00,$19.39,$0.00,$19.72,$0.00
71229055,SUP,HCPCS C1713,,71229055  -  SCREW BN FT 6.5MM 8MM 55MM TC100 SS CANC LG FRAG SYS,$123.90,$0.00,$123.90,$55.76,$88.43,$0.00,$21.35,$0.00,$0.00,$21.69,$123.90,$0.00,$61.95,$98.13,$99.12,$0.00,$19.39,$0.00,$19.72,$0.00
71229060,SUP,HCPCS C1713,,71229060  -  SCREW BN FT 6.5MM 8MM 60MM TC100 SS CANC LG FRAG SYS,$123.90,$0.00,$123.90,$55.76,$88.43,$0.00,$21.35,$0.00,$0.00,$21.69,$123.90,$0.00,$61.95,$98.13,$99.12,$0.00,$19.39,$0.00,$19.72,$0.00
71229065,SUP,HCPCS C1713,,71229065  -  SCREW BN FT 6.5MM 8MM 65MM TC100 SS CANC LG FRAG SYS,$123.90,$0.00,$123.90,$55.76,$88.43,$0.00,$21.35,$0.00,$0.00,$21.69,$123.90,$0.00,$61.95,$98.13,$99.12,$0.00,$19.39,$0.00,$19.72,$0.00
71229070,SUP,HCPCS C1713,,71229070  -  SCREW BN FT 6.5MM 8MM 70MM TC100 SS CANC LG FRAG SYS,$123.90,$0.00,$123.90,$55.76,$88.43,$0.00,$21.35,$0.00,$0.00,$21.69,$123.90,$0.00,$61.95,$98.13,$99.12,$0.00,$19.39,$0.00,$19.72,$0.00
71229075,SUP,HCPCS C1713,,71229075  -  SCREW BN FT 6.5MM 75MM TC100 CANC,$123.90,$0.00,$123.90,$55.76,$88.43,$0.00,$21.35,$0.00,$0.00,$21.69,$123.90,$0.00,$61.95,$98.13,$99.12,$0.00,$19.39,$0.00,$19.72,$0.00
71229080,SUP,HCPCS C1713,,71229080  -  SCREW BN FT 6.5MM 80MM TC100 CANC,$135.45,$0.00,$135.45,$60.95,$96.67,$0.00,$23.34,$0.00,$0.00,$23.72,$135.45,$0.00,$67.73,$107.28,$108.36,$0.00,$21.20,$0.00,$21.56,$0.00
71229085,SUP,HCPCS C1713,,71229085  -  SCREW BN FT 6.5MM 85MM TC100 CANC,$135.45,$0.00,$135.45,$60.95,$96.67,$0.00,$23.34,$0.00,$0.00,$23.72,$135.45,$0.00,$67.73,$107.28,$108.36,$0.00,$21.20,$0.00,$21.56,$0.00
71229090,SUP,HCPCS C1713,,71229090  -  SCREW BN FT 6.5MM 90MM TC100 CANC,$135.45,$0.00,$135.45,$60.95,$96.67,$0.00,$23.34,$0.00,$0.00,$23.72,$135.45,$0.00,$67.73,$107.28,$108.36,$0.00,$21.20,$0.00,$21.56,$0.00
71229095,SUP,HCPCS C1713,,71229095  -  SCREW BN FT 6.5MM 8MM 95MM TC100 SS CANC LG FRAG SYS,$135.45,$0.00,$135.45,$60.95,$96.67,$0.00,$23.34,$0.00,$0.00,$23.72,$135.45,$0.00,$67.73,$107.28,$108.36,$0.00,$21.20,$0.00,$21.56,$0.00
71229100,SUP,HCPCS C1713,,71229100  -  SCREW BN FT 6.5MM 100MM TC100 SS CANC LG FRAG SET,$135.45,$0.00,$135.45,$60.95,$96.67,$0.00,$23.34,$0.00,$0.00,$23.72,$135.45,$0.00,$67.73,$107.28,$108.36,$0.00,$21.20,$0.00,$21.56,$0.00
71229105,SUP,HCPCS C1713,,71229105  -  SCREW BN FT 6.5MM 105MM TC100 SS CANC LG FRAG SET,$135.45,$0.00,$135.45,$60.95,$96.67,$0.00,$23.34,$0.00,$0.00,$23.72,$135.45,$0.00,$67.73,$107.28,$108.36,$0.00,$21.20,$0.00,$21.56,$0.00
71229110,SUP,HCPCS C1713,,71229110  -  SCREW BN FT 6.5MM 110MM TC100 SS CANC LG FRAG SET,$135.45,$0.00,$135.45,$60.95,$96.67,$0.00,$23.34,$0.00,$0.00,$23.72,$135.45,$0.00,$67.73,$107.28,$108.36,$0.00,$21.20,$0.00,$21.56,$0.00
71229115,SUP,HCPCS C1713,,71229115  -  SCREW BN FT 6.5MM 115MM TC100 SS CANC LG FRAG SET,$174.30,$0.00,$174.30,$78.44,$124.40,$0.00,$30.03,$0.00,$0.00,$30.52,$174.30,$0.00,$87.15,$138.05,$139.44,$0.00,$27.28,$0.00,$27.75,$0.00
71229120,SUP,HCPCS C1713,,71229120  -  SCREW BN FT 6.5MM 120MM TC100 SS CANC LG FRAG SET,$174.30,$0.00,$174.30,$78.44,$124.40,$0.00,$30.03,$0.00,$0.00,$30.52,$174.30,$0.00,$87.15,$138.05,$139.44,$0.00,$27.28,$0.00,$27.75,$0.00
71229125,SUP,HCPCS C1713,,71229125  -  SCREW BN FT 6.5MM 125MM TC100 SS CANC LG FRAG SET,$174.30,$0.00,$174.30,$78.44,$124.40,$0.00,$30.03,$0.00,$0.00,$30.52,$174.30,$0.00,$87.15,$138.05,$139.44,$0.00,$27.28,$0.00,$27.75,$0.00
71229130,SUP,HCPCS C1713,,71229130  -  SCREW BN FT 6.5MM 130MM TC100 SS CANC LG FRAG SET,$174.30,$0.00,$174.30,$78.44,$124.40,$0.00,$30.03,$0.00,$0.00,$30.52,$174.30,$0.00,$87.15,$138.05,$139.44,$0.00,$27.28,$0.00,$27.75,$0.00
71229135,SUP,HCPCS C1713,,71229135  -  SCREW BN FT 6.5MM 135MM TC100 SS CANC LG FRAG SET,$174.30,$0.00,$174.30,$78.44,$124.40,$0.00,$30.03,$0.00,$0.00,$30.52,$174.30,$0.00,$87.15,$138.05,$139.44,$0.00,$27.28,$0.00,$27.75,$0.00
71229140,SUP,HCPCS C1713,,71229140  -  SCREW BN FT 6.5MM 140MM TC100 SS CANC LG FRAG SET,$174.30,$0.00,$174.30,$78.44,$124.40,$0.00,$30.03,$0.00,$0.00,$30.52,$174.30,$0.00,$87.15,$138.05,$139.44,$0.00,$27.28,$0.00,$27.75,$0.00
71229145,SUP,HCPCS C1713,,71229145  -  SCREW BN FT 6.5MM 145MM TC100 SS CANC LG FRAG SET,$174.30,$0.00,$174.30,$78.44,$124.40,$0.00,$30.03,$0.00,$0.00,$30.52,$174.30,$0.00,$87.15,$138.05,$139.44,$0.00,$27.28,$0.00,$27.75,$0.00
71229150,SUP,HCPCS C1713,,71229150  -  SCREW BN FT 6.5MM 150MM TC100 SS CANC LG FRAG SET,$174.30,$0.00,$174.30,$78.44,$124.40,$0.00,$30.03,$0.00,$0.00,$30.52,$174.30,$0.00,$87.15,$138.05,$139.44,$0.00,$27.28,$0.00,$27.75,$0.00
71453122,SUP,HCPCS C1776,,71453122  -  INSERT TIB 5-6 11MM LEGION CR HI FLXN XLPE KN,"$10,175.00",$0.00,"$10,175.00","$4,578.75","$5,158.80",$0.00,"$1,753.10",$0.00,$0.00,"$1,781.56","$10,175.00",$0.00,"$5,087.50","$8,058.60","$8,140.00",$0.00,"$1,592.39",$0.00,"$1,619.86",$0.00
71525986,SUP,HCPCS C1713,,71525986  -  SCREW BN 5MM 55MM ORTH,$306.00,$0.00,$306.00,$137.70,$218.39,$0.00,$52.72,$0.00,$0.00,$53.58,$306.00,$0.00,$153.00,$242.35,$244.80,$0.00,$47.89,$0.00,$48.72,$0.00
71525989,SUP,HCPCS C1713,,71525989  -  SCREW BN 5MM 70MM ORTH,$306.00,$0.00,$306.00,$137.70,$218.39,$0.00,$52.72,$0.00,$0.00,$53.58,$306.00,$0.00,$153.00,$242.35,$244.80,$0.00,$47.89,$0.00,$48.72,$0.00
71525990,SUP,HCPCS C1713,,71525990  -  SCREW BN 5MM 75MM ORTH,$306.00,$0.00,$306.00,$137.70,$218.39,$0.00,$52.72,$0.00,$0.00,$53.58,$306.00,$0.00,$153.00,$242.35,$244.80,$0.00,$47.89,$0.00,$48.72,$0.00
71525991,SUP,HCPCS C1713,,71525991  -  SCREW BN 5MM 80MM ORTH,$306.00,$0.00,$306.00,$137.70,$218.39,$0.00,$52.72,$0.00,$0.00,$53.58,$306.00,$0.00,$153.00,$242.35,$244.80,$0.00,$47.89,$0.00,$48.72,$0.00
71525993,SUP,HCPCS C1713,,71525993  -  SCREW BN 5MM 90MM ORTH,$306.00,$0.00,$306.00,$137.70,$218.39,$0.00,$52.72,$0.00,$0.00,$53.58,$306.00,$0.00,$153.00,$242.35,$244.80,$0.00,$47.89,$0.00,$48.72,$0.00
71525994,SUP,HCPCS C1713,,71525994  -  SCREW BN 5MM 95MM ORTH,$306.00,$0.00,$306.00,$137.70,$218.39,$0.00,$52.72,$0.00,$0.00,$53.58,$306.00,$0.00,$153.00,$242.35,$244.80,$0.00,$47.89,$0.00,$48.72,$0.00
71525995,SUP,HCPCS C1713,,71525995  -  SCREW BN 5MM 100MM ORTH,$306.00,$0.00,$306.00,$137.70,$218.39,$0.00,$52.72,$0.00,$0.00,$53.58,$306.00,$0.00,$153.00,$242.35,$244.80,$0.00,$47.89,$0.00,$48.72,$0.00
71525996,SUP,HCPCS C1713,,71525996  -  SCREW BN 5MM 105MM ORTH,$306.00,$0.00,$306.00,$137.70,$218.39,$0.00,$52.72,$0.00,$0.00,$53.58,$306.00,$0.00,$153.00,$242.35,$244.80,$0.00,$47.89,$0.00,$48.72,$0.00
71525997,SUP,HCPCS C1713,,71525997  -  SCREW BN 5MM 110MM ORTH,$306.00,$0.00,$306.00,$137.70,$218.39,$0.00,$52.72,$0.00,$0.00,$53.58,$306.00,$0.00,$153.00,$242.35,$244.80,$0.00,$47.89,$0.00,$48.72,$0.00
71631035,SUP,Custom 27203010,,71631035  -  DRILL SURG 6.4MM STERILE,$587.25,$0.00,$587.25,$0.00,$419.12,$0.00,$0.00,$0.00,$0.00,$0.00,$587.25,$0.00,$293.63,$465.10,$469.80,$0.00,$0.00,$0.00,$0.00,$0.00
71631110,SUP,Custom 27203010,,71631110  -  BIT DRILL LONG 4MM PILOT TRIGEN GOLD STERILE DISPOSABLE,$504.00,$0.00,$504.00,$0.00,$359.70,$0.00,$0.00,$0.00,$0.00,$0.00,$504.00,$0.00,$252.00,$399.17,$403.20,$0.00,$0.00,$0.00,$0.00,$0.00
71631112,SUP,Custom 27203010,,71631112  -  BIT DRL SHRT 3.2MM STRL TRGN PILT,$148.50,$0.00,$148.50,$0.00,$105.98,$0.00,$0.00,$0.00,$0.00,$0.00,$148.50,$0.00,$74.25,$117.61,$118.80,$0.00,$0.00,$0.00,$0.00,$0.00
71631117,SUP,Custom 27203010,,71631117  -  BIT DRILL 4MM TRGN SHRT PILT STRL DISP,$157.50,$0.00,$157.50,$0.00,$112.41,$0.00,$0.00,$0.00,$0.00,$0.00,$157.50,$0.00,$78.75,$124.74,$126.00,$0.00,$0.00,$0.00,$0.00,$0.00
71631626,SUP,HCPCS C1769,,71631626  -  GUIDE ROD ORTH BALL 3MM 1000MM STRL TRGN BALL TIP SS DISP,$433.13,$0.00,$433.13,$235.19,$309.12,$0.00,$74.63,$0.00,$0.00,$75.84,$433.13,$0.00,$216.56,$343.04,$346.50,$0.00,$67.78,$0.00,$68.95,$0.00
71631690,SUP,Custom 27203010,,71631690  -  GUIDEWIRE ORTHOPEDIC THREAD 3.2MM TRIGEN DISTAL FEMUR,$209.25,$0.00,$209.25,$0.00,$149.34,$0.00,$0.00,$0.00,$0.00,$0.00,$209.25,$0.00,$104.63,$165.73,$167.40,$0.00,$0.00,$0.00,$0.00,$0.00
71632001,SUP,HCPCS C1713,,71632001  -  NUT ORTH 5MM STRL TRGN STBLK LCK STAB 5MM SCR,$585.00,$0.00,$585.00,$263.25,$417.51,$0.00,$100.79,$0.00,$0.00,$102.43,$585.00,$0.00,$292.50,$463.32,$468.00,$0.00,$91.55,$0.00,$93.13,$0.00
71632002,SUP,HCPCS C1713,,71632002  -  NUT ORTH 4.5MM STBLK WSHR,$303.75,$0.00,$303.75,$136.69,$216.79,$0.00,$52.33,$0.00,$0.00,$53.18,$303.75,$0.00,$151.88,$240.57,$243.00,$0.00,$47.54,$0.00,$48.36,$0.00
71632125,SUP,HCPCS C1713,,71632125  -  SCREW BN 4.5MM 25MM GRY TRGN ST SLFDRL FLUT TIP CPTR TI KN,$407.25,$0.00,$407.25,$183.26,$290.65,$0.00,$70.17,$0.00,$0.00,$71.31,$407.25,$0.00,$203.63,$322.54,$325.80,$0.00,$63.73,$0.00,$64.83,$0.00
71632130,SUP,HCPCS C1713,,71632130  -  SCREW BN 4.5MM 30MM GRY TRGN ST SLFDRL CPTR FLUT TIP TI KN,$407.25,$0.00,$407.25,$183.26,$290.65,$0.00,$70.17,$0.00,$0.00,$71.31,$407.25,$0.00,$203.63,$322.54,$325.80,$0.00,$63.73,$0.00,$64.83,$0.00
71632135,SUP,HCPCS C1713,,71632135  -  SCREW BN 4.5MM 35MM GRY TRGN ST SLFDRL CPTR FLUT TIP TI KN,$407.25,$0.00,$407.25,$183.26,$290.65,$0.00,$70.17,$0.00,$0.00,$71.31,$407.25,$0.00,$203.63,$322.54,$325.80,$0.00,$63.73,$0.00,$64.83,$0.00
71632140,SUP,HCPCS C1713,,71632140  -  SCREW BN 4.5MM 40MM GRY TRGN ST SLFDRL FLUT TIP CPTR TI KN,$407.25,$0.00,$407.25,$183.26,$290.65,$0.00,$70.17,$0.00,$0.00,$71.31,$407.25,$0.00,$203.63,$322.54,$325.80,$0.00,$63.73,$0.00,$64.83,$0.00
71632150,SUP,HCPCS C1713,,71632150  -  SCREW BN 4.5MM 50MM GRY TRGN ST SLFDRL FLUT TIP CPTR TI KN,$407.25,$0.00,$407.25,$183.26,$290.65,$0.00,$70.17,$0.00,$0.00,$71.31,$407.25,$0.00,$203.63,$322.54,$325.80,$0.00,$63.73,$0.00,$64.83,$0.00
71632200,SUP,HCPCS C1713,,71632200  -  SCREW BN 5MM 100MM AU TRGN ST SLFDRL FLUT TIP CPTR TI KN,$407.25,$0.00,$407.25,$183.26,$290.65,$0.00,$70.17,$0.00,$0.00,$71.31,$407.25,$0.00,$203.63,$322.54,$325.80,$0.00,$63.73,$0.00,$64.83,$0.00
71632205,SUP,HCPCS C1713,,71632205  -  SCREW BN 5MM 105MM AU TRGN ST SLFDRL FLUT TIP CPTR TI KN IM,$407.25,$0.00,$407.25,$183.26,$290.65,$0.00,$70.17,$0.00,$0.00,$71.31,$407.25,$0.00,$203.63,$322.54,$325.80,$0.00,$63.73,$0.00,$64.83,$0.00
71632210,SUP,HCPCS C1713,,71632210  -  SCREW BN 5MM 110MM AU TRGN ST SLFDRL FLUT TIP CPTR TI KN IM,$407.25,$0.00,$407.25,$183.26,$290.65,$0.00,$70.17,$0.00,$0.00,$71.31,$407.25,$0.00,$203.63,$322.54,$325.80,$0.00,$63.73,$0.00,$64.83,$0.00
71632220,SUP,HCPCS C1713,,71632220  -  SCREW BN 5MM 20MM AU TRGN ST SLFDRL CPTR FLUT TIP THRD TI KN,$407.25,$0.00,$407.25,$183.26,$290.65,$0.00,$70.17,$0.00,$0.00,$71.31,$407.25,$0.00,$203.63,$322.54,$325.80,$0.00,$63.73,$0.00,$64.83,$0.00
71632230,SUP,HCPCS C1713,,71632230  -  SCREW BN 5MM 30MM AU TRGN FLUT TIP ST DRL CPTR TI KN,$407.25,$0.00,$407.25,$183.26,$290.65,$0.00,$70.17,$0.00,$0.00,$71.31,$407.25,$0.00,$203.63,$322.54,$325.80,$0.00,$63.73,$0.00,$64.83,$0.00
71632260,SUP,HCPCS C1713,,71632260  -  SCREW BN 5MM 60MM AU TRGN CPTR SLF DRL ST TI KN,$407.25,$0.00,$407.25,$183.26,$290.65,$0.00,$70.17,$0.00,$0.00,$71.31,$407.25,$0.00,$203.63,$322.54,$325.80,$0.00,$63.73,$0.00,$64.83,$0.00
71632275,SUP,HCPCS C1713,,71632275  -  SCREW BN 5MM 75MM AU TRGN ST SLF DRL FLUT TIP CPTR TI KN,$407.25,$0.00,$407.25,$183.26,$290.65,$0.00,$70.17,$0.00,$0.00,$71.31,$407.25,$0.00,$203.63,$322.54,$325.80,$0.00,$63.73,$0.00,$64.83,$0.00
71632280,SUP,HCPCS C1713,,71632280  -  SCREW BN 5MM 80MM AU TRGN ST SLF DRL FLUT TIP CPTR TI KN,$407.25,$0.00,$407.25,$183.26,$290.65,$0.00,$70.17,$0.00,$0.00,$71.31,$407.25,$0.00,$203.63,$322.54,$325.80,$0.00,$63.73,$0.00,$64.83,$0.00
71632300,SUP,HCPCS C1713,,71632300  -  SCREW BN 6.4MM 100MM BLU TRGN SLF DRL ST CPTR RECON TI KN IM,$685.13,$0.00,$685.13,$308.31,$488.97,$0.00,$118.04,$0.00,$0.00,$119.96,$685.13,$0.00,$342.56,$542.62,$548.10,$0.00,$107.22,$0.00,$109.07,$0.00
71632305,SUP,HCPCS C1713,,71632305  -  SCREW BN 6.4MM 105MM BLU TRGN ST SLFDRL CPTR RECON TI KN IM,$685.13,$0.00,$685.13,$308.31,$488.97,$0.00,$118.04,$0.00,$0.00,$119.96,$685.13,$0.00,$342.56,$542.62,$548.10,$0.00,$107.22,$0.00,$109.07,$0.00
71632316,SUP,HCPCS C1713,,71632316  -  SCREW BN 6.4MM 115MM BLU TRGN SLF DRL ST CPTR RECON TI KN IM,$685.13,$0.00,$685.13,$308.31,$488.97,$0.00,$118.04,$0.00,$0.00,$119.96,$685.13,$0.00,$342.56,$542.62,$548.10,$0.00,$107.22,$0.00,$109.07,$0.00
71632325,SUP,HCPCS C1713,,71632325  -  SCREW BN 6.4MM 125MM BLU TRGN CPTR RECON TI KN IM NL,$685.13,$0.00,$685.13,$308.31,$488.97,$0.00,$118.04,$0.00,$0.00,$119.96,$685.13,$0.00,$342.56,$542.62,$548.10,$0.00,$107.22,$0.00,$109.07,$0.00
71632375,SUP,HCPCS C1713,,71632375  -  SCREW BN 6.4MM 75MM BLU TRGN SLF DRL ST CPTR RECON TI KN IM,$685.13,$0.00,$685.13,$308.31,$488.97,$0.00,$118.04,$0.00,$0.00,$119.96,$685.13,$0.00,$342.56,$542.62,$548.10,$0.00,$107.22,$0.00,$109.07,$0.00
71632380,SUP,HCPCS C1713,,71632380  -  SCREW BN 6.4MM 80MM BLU TRGN SLF DRL ST CPTR RECON TI KN IM,$685.13,$0.00,$685.13,$308.31,$488.97,$0.00,$118.04,$0.00,$0.00,$119.96,$685.13,$0.00,$342.56,$542.62,$548.10,$0.00,$107.22,$0.00,$109.07,$0.00
71632385,SUP,HCPCS C1713,,71632385  -  SCREW BN 6.4MM 85MM BLU TRGN CPTR RECON TI KN IM NL,$685.13,$0.00,$685.13,$308.31,$488.97,$0.00,$118.04,$0.00,$0.00,$119.96,$685.13,$0.00,$342.56,$542.62,$548.10,$0.00,$107.22,$0.00,$109.07,$0.00
71632390,SUP,HCPCS C1713,,71632390  -  SCREW BN 6.4MM 90MM BLU TRGN SLF DRL ST CPTR RECON TI KN IM,$685.13,$0.00,$685.13,$308.31,$488.97,$0.00,$118.04,$0.00,$0.00,$119.96,$685.13,$0.00,$342.56,$542.62,$548.10,$0.00,$107.22,$0.00,$109.07,$0.00
71632395,SUP,HCPCS C1713,,71632395  -  SCREW BN 6.4MM 95MM BLU TRGN ST SLFDRL CPTR RECON TI KN IM,$685.13,$0.00,$685.13,$308.31,$488.97,$0.00,$118.04,$0.00,$0.00,$119.96,$685.13,$0.00,$342.56,$542.62,$548.10,$0.00,$107.22,$0.00,$109.07,$0.00
71633005,SUP,HCPCS C1713,,71633005  -  CAP END 5MM 5MM TRGN XTD TI FEM IM NL,$418.50,$0.00,$418.50,$188.33,$298.68,$0.00,$72.11,$0.00,$0.00,$73.28,$418.50,$0.00,$209.25,$331.45,$334.80,$0.00,$65.50,$0.00,$66.63,$0.00
71633010,SUP,HCPCS C1713,,71633010  -  CAP END 10MM 10MM TRGN XTD TI FEM IM NL,$418.50,$0.00,$418.50,$188.33,$298.68,$0.00,$72.11,$0.00,$0.00,$73.28,$418.50,$0.00,$209.25,$331.45,$334.80,$0.00,$65.50,$0.00,$66.63,$0.00
71633015,SUP,HCPCS C1713,,71633015  -  CAP END 15MM TRGN TI ORTH IM NL,$418.50,$0.00,$418.50,$188.33,$298.68,$0.00,$72.11,$0.00,$0.00,$73.28,$418.50,$0.00,$209.25,$331.45,$334.80,$0.00,$65.50,$0.00,$66.63,$0.00
71633020,SUP,HCPCS C1713,,71633020  -  CAP END 20MM TRGN TI ORTH IM NL,$418.50,$0.00,$418.50,$188.33,$298.68,$0.00,$72.11,$0.00,$0.00,$73.28,$418.50,$0.00,$209.25,$331.45,$334.80,$0.00,$65.50,$0.00,$66.63,$0.00
71633315,SUP,HCPCS C1713,,71633315  -  NAIL IM 11.5MM 15CM AU TRGN SET TI KN SP CNDL,"$3,937.50",$0.00,"$3,937.50","$1,771.88","$2,810.19",$0.00,$678.41,$0.00,$0.00,$689.42,"$3,937.50",$0.00,"$1,968.75","$3,118.50","$3,150.00",$0.00,$616.22,$0.00,$626.85,$0.00
71633320,SUP,HCPCS C1713,,71633320  -  NAIL IM 11.5MM 20CM AU TRGN TI KN TIB,"$3,937.50",$0.00,"$3,937.50","$1,771.88","$2,810.19",$0.00,$678.41,$0.00,$0.00,$689.42,"$3,937.50",$0.00,"$1,968.75","$3,118.50","$3,150.00",$0.00,$616.22,$0.00,$626.85,$0.00
71633325,SUP,HCPCS C1713,,71633325  -  NAIL IM 11.5MM 25CM AU TRGN SET TI KN SP CNDL,"$3,937.50",$0.00,"$3,937.50","$1,771.88","$2,810.19",$0.00,$678.41,$0.00,$0.00,$689.42,"$3,937.50",$0.00,"$1,968.75","$3,118.50","$3,150.00",$0.00,$616.22,$0.00,$626.85,$0.00
71633415,SUP,HCPCS C1713,,71633415  -  NAIL IM 13MM 15CM AU TRGN SET TI KN SP CNDL,"$3,937.50",$0.00,"$3,937.50","$1,771.88","$2,810.19",$0.00,$678.41,$0.00,$0.00,$689.42,"$3,937.50",$0.00,"$1,968.75","$3,118.50","$3,150.00",$0.00,$616.22,$0.00,$626.85,$0.00
71633420,SUP,HCPCS C1713,,71633420  -  NAIL IM 13MM 20CM AU TRGN SET TI KN SP CNDL,"$3,937.50",$0.00,"$3,937.50","$1,771.88","$2,810.19",$0.00,$678.41,$0.00,$0.00,$689.42,"$3,937.50",$0.00,"$1,968.75","$3,118.50","$3,150.00",$0.00,$616.22,$0.00,$626.85,$0.00
71633425,SUP,HCPCS C1713,,71633425  -  NAIL IM 13MM 25CM AU TRGN SET TI KN SP CNDL,"$3,937.50",$0.00,"$3,937.50","$1,771.88","$2,810.19",$0.00,$678.41,$0.00,$0.00,$689.42,"$3,937.50",$0.00,"$1,968.75","$3,118.50","$3,150.00",$0.00,$616.22,$0.00,$626.85,$0.00
71633448,SUP,HCPCS C1713,,71633448  -  NAIL IM 13MM 48CM AU TRGN RTRGD ANTGRD TI FEM TIB,"$6,490.00",$0.00,"$6,490.00","$2,920.50","$4,631.91",$0.00,"$1,118.19",$0.00,$0.00,"$1,136.35","$6,490.00",$0.00,"$3,245.00","$5,140.08","$5,192.00",$0.00,"$1,015.69",$0.00,"$1,033.21",$0.00
71634000,SUP,HCPCS C1713,,71634000  -  CAP END 0MM TRGN SET TI DISP INTNL HEX IM NL,$420.75,$0.00,$420.75,$189.34,$300.29,$0.00,$72.49,$0.00,$0.00,$73.67,$420.75,$0.00,$210.38,$333.23,$336.60,$0.00,$65.85,$0.00,$66.98,$0.00
71634005,SUP,HCPCS C1713,,71634005  -  CAP END 5MM TRGN SET TI DISP INTNL HEX IM NL,$420.75,$0.00,$420.75,$189.34,$300.29,$0.00,$72.49,$0.00,$0.00,$73.67,$420.75,$0.00,$210.38,$333.23,$336.60,$0.00,$65.85,$0.00,$66.98,$0.00
71634010,SUP,HCPCS C1713,,71634010  -  CAP END 10MM 10MM TRGN TI ORTH IM NL,$420.75,$0.00,$420.75,$189.34,$300.29,$0.00,$72.49,$0.00,$0.00,$73.67,$420.75,$0.00,$210.38,$333.23,$336.60,$0.00,$65.85,$0.00,$66.98,$0.00
71634015,SUP,HCPCS C1713,,71634015  -  CAP END 15MM 15MM TRGN ORTH IM NL,$420.75,$0.00,$420.75,$189.34,$300.29,$0.00,$72.49,$0.00,$0.00,$73.67,$420.75,$0.00,$210.38,$333.23,$336.60,$0.00,$65.85,$0.00,$66.98,$0.00
71634020,SUP,HCPCS C1713,,71634020  -  CAP END 20MM TRGN TI INTNL HEX IM NL,$420.75,$0.00,$420.75,$189.34,$300.29,$0.00,$72.49,$0.00,$0.00,$73.67,$420.75,$0.00,$210.38,$333.23,$336.60,$0.00,$65.85,$0.00,$66.98,$0.00
71634230,SUP,HCPCS C1713,,71634230  -  NAIL IM STD 10MM 30CM LIME TRGN ANTGRD FAN TI FEM LT,"$4,044.38",$0.00,"$4,044.38","$1,819.97","$2,886.47",$0.00,$696.83,$0.00,$0.00,$708.14,"$4,044.38",$0.00,"$2,022.19","$3,203.15","$3,235.50",$0.00,$632.94,$0.00,$643.86,$0.00
71634232,SUP,HCPCS C1713,,71634232  -  NAIL IM STD 10MM 32CM LIME TRGN ANTGRD FAN TI FEM LT,"$4,044.38",$0.00,"$4,044.38","$1,819.97","$2,886.47",$0.00,$696.83,$0.00,$0.00,$708.14,"$4,044.38",$0.00,"$2,022.19","$3,203.15","$3,235.50",$0.00,$632.94,$0.00,$643.86,$0.00
71634234,SUP,HCPCS C1713,,71634234  -  NAIL IM STD 10MM 34CM LIME TRGN ANTGRD FAN TI FEM LT,"$4,044.38",$0.00,"$4,044.38","$1,819.97","$2,886.47",$0.00,$696.83,$0.00,$0.00,$708.14,"$4,044.38",$0.00,"$2,022.19","$3,203.15","$3,235.50",$0.00,$632.94,$0.00,$643.86,$0.00
71634236,SUP,HCPCS C1713,,71634236  -  NAIL IM STD 10MM 36CM LIME TRGN ANTGRD FAN TI FEM LT,"$3,870.00",$0.00,"$3,870.00","$1,741.50","$2,762.02",$0.00,$666.78,$0.00,$0.00,$677.61,"$3,870.00",$0.00,"$1,935.00","$3,065.04","$3,096.00",$0.00,$605.66,$0.00,$616.10,$0.00
71634238,SUP,HCPCS C1713,,71634238  -  NAIL IM STD 10MM 38CM LIME TRGN ANTGRD FAN TI FEM LT,"$3,870.00",$0.00,"$3,870.00","$1,741.50","$2,762.02",$0.00,$666.78,$0.00,$0.00,$677.61,"$3,870.00",$0.00,"$1,935.00","$3,065.04","$3,096.00",$0.00,$605.66,$0.00,$616.10,$0.00
71634240,SUP,HCPCS C1713,,71634240  -  NAIL IM STD 10MM 40CM LIME TRGN ANTGRD TI FEM LT,"$3,870.00",$0.00,"$3,870.00","$1,741.50","$2,762.02",$0.00,$666.78,$0.00,$0.00,$677.61,"$3,870.00",$0.00,"$1,935.00","$3,065.04","$3,096.00",$0.00,$605.66,$0.00,$616.10,$0.00
71634242,SUP,HCPCS C1713,,71634242  -  NAIL IM STD 10MM 42CM LIME TRGN ANTGRD TI FEM LT,"$3,870.00",$0.00,"$3,870.00","$1,741.50","$2,762.02",$0.00,$666.78,$0.00,$0.00,$677.61,"$3,870.00",$0.00,"$1,935.00","$3,065.04","$3,096.00",$0.00,$605.66,$0.00,$616.10,$0.00
71634244,SUP,HCPCS C1713,,71634244  -  NAIL IM STD 10MM 44CM LIME TRGN ANTGRD TI FEM LT,"$4,044.38",$0.00,"$4,044.38","$1,819.97","$2,886.47",$0.00,$696.83,$0.00,$0.00,$708.14,"$4,044.38",$0.00,"$2,022.19","$3,203.15","$3,235.50",$0.00,$632.94,$0.00,$643.86,$0.00
71634246,SUP,HCPCS C1713,,71634246  -  NAIL IM STD 10MM 46CM LIME TRGN ANTGRD TI FEM LT,"$4,044.38",$0.00,"$4,044.38","$1,819.97","$2,886.47",$0.00,$696.83,$0.00,$0.00,$708.14,"$4,044.38",$0.00,"$2,022.19","$3,203.15","$3,235.50",$0.00,$632.94,$0.00,$643.86,$0.00
71634248,SUP,HCPCS C1713,,71634248  -  NAIL IM STD 10MM 48CM LIME TRGN ANTGRD TI FEM LT,"$4,044.38",$0.00,"$4,044.38","$1,819.97","$2,886.47",$0.00,$696.83,$0.00,$0.00,$708.14,"$4,044.38",$0.00,"$2,022.19","$3,203.15","$3,235.50",$0.00,$632.94,$0.00,$643.86,$0.00
71634250,SUP,HCPCS C1713,,71634250  -  NAIL IM 10MM 50CM LIME TRGN ANTGRD TI FEM LT,"$4,044.38",$0.00,"$4,044.38","$1,819.97","$2,886.47",$0.00,$696.83,$0.00,$0.00,$708.14,"$4,044.38",$0.00,"$2,022.19","$3,203.15","$3,235.50",$0.00,$632.94,$0.00,$643.86,$0.00
71634330,SUP,HCPCS C1713,,71634330  -  NAIL IM 11.5MM 30CM LIME TRGN ANTGRD TI FEM LT,"$4,044.38",$0.00,"$4,044.38","$1,819.97","$2,886.47",$0.00,$696.83,$0.00,$0.00,$708.14,"$4,044.38",$0.00,"$2,022.19","$3,203.15","$3,235.50",$0.00,$632.94,$0.00,$643.86,$0.00
71634332,SUP,HCPCS C1713,,71634332  -  NAIL IM STD 11.5MM 32CM LIME TRGN ANTGRD TI FEM LT,"$4,044.38",$0.00,"$4,044.38","$1,819.97","$2,886.47",$0.00,$696.83,$0.00,$0.00,$708.14,"$4,044.38",$0.00,"$2,022.19","$3,203.15","$3,235.50",$0.00,$632.94,$0.00,$643.86,$0.00
71634334,SUP,HCPCS C1713,,71634334  -  NAIL IM STD 11.5MM 34CM LIME TRGN ANTGRD TI FEM LT,"$4,044.38",$0.00,"$4,044.38","$1,819.97","$2,886.47",$0.00,$696.83,$0.00,$0.00,$708.14,"$4,044.38",$0.00,"$2,022.19","$3,203.15","$3,235.50",$0.00,$632.94,$0.00,$643.86,$0.00
71634336,SUP,HCPCS C1713,,71634336  -  NAIL IM STD 11.5MM 36CM LIME TRGN ANTGRD TI FEM LT,"$3,870.00",$0.00,"$3,870.00","$1,741.50","$2,762.02",$0.00,$666.78,$0.00,$0.00,$677.61,"$3,870.00",$0.00,"$1,935.00","$3,065.04","$3,096.00",$0.00,$605.66,$0.00,$616.10,$0.00
71634338,SUP,HCPCS C1713,,71634338  -  NAIL IM STD 11.5MM 38CM FAN LIME TRGN ANTGRD RECON TI FEM LT,"$3,870.00",$0.00,"$3,870.00","$1,741.50","$2,762.02",$0.00,$666.78,$0.00,$0.00,$677.61,"$3,870.00",$0.00,"$1,935.00","$3,065.04","$3,096.00",$0.00,$605.66,$0.00,$616.10,$0.00
71634340,SUP,HCPCS C1713,,71634340  -  NAIL IM STD 11.5MM 40CM LIME TRGN ANTGRD TI FEM LT,"$3,870.00",$0.00,"$3,870.00","$1,741.50","$2,762.02",$0.00,$666.78,$0.00,$0.00,$677.61,"$3,870.00",$0.00,"$1,935.00","$3,065.04","$3,096.00",$0.00,$605.66,$0.00,$616.10,$0.00
71634342,SUP,HCPCS C1713,,71634342  -  NAIL IM STD 11.5MM 42CM FAN LIME TRGN ANTGRD TI LT,"$3,870.00",$0.00,"$3,870.00","$1,741.50","$2,762.02",$0.00,$666.78,$0.00,$0.00,$677.61,"$3,870.00",$0.00,"$1,935.00","$3,065.04","$3,096.00",$0.00,$605.66,$0.00,$616.10,$0.00
71634344,SUP,HCPCS C1713,,71634344  -  NAIL IM STD 11.5MM 44CM LIME TRGN ANTGRD TI FEM LT,"$4,044.38",$0.00,"$4,044.38","$1,819.97","$2,886.47",$0.00,$696.83,$0.00,$0.00,$708.14,"$4,044.38",$0.00,"$2,022.19","$3,203.15","$3,235.50",$0.00,$632.94,$0.00,$643.86,$0.00
71634346,SUP,HCPCS C1713,,71634346  -  NAIL IM STD 11.5MM 46CM LIME TRGN ANTGRD TI FEM LT,"$4,044.38",$0.00,"$4,044.38","$1,819.97","$2,886.47",$0.00,$696.83,$0.00,$0.00,$708.14,"$4,044.38",$0.00,"$2,022.19","$3,203.15","$3,235.50",$0.00,$632.94,$0.00,$643.86,$0.00
71634348,SUP,HCPCS C1713,,71634348  -  NAIL IM STD 11.5MM 48CM LIME TRGN ANTGRD TI FEM LT,"$4,044.38",$0.00,"$4,044.38","$1,819.97","$2,886.47",$0.00,$696.83,$0.00,$0.00,$708.14,"$4,044.38",$0.00,"$2,022.19","$3,203.15","$3,235.50",$0.00,$632.94,$0.00,$643.86,$0.00
71634350,SUP,HCPCS C1713,,71634350  -  NAIL IM 11.5MM 50CM LIME TRGN ANTGRD TI FEM LT,"$4,044.38",$0.00,"$4,044.38","$1,819.97","$2,886.47",$0.00,$696.83,$0.00,$0.00,$708.14,"$4,044.38",$0.00,"$2,022.19","$3,203.15","$3,235.50",$0.00,$632.94,$0.00,$643.86,$0.00
71634430,SUP,HCPCS C1713,,71634430  -  NAIL IM 13MM 30CM LIME TRGN ANTGRD TI FEM LT,"$4,044.38",$0.00,"$4,044.38","$1,819.97","$2,886.47",$0.00,$696.83,$0.00,$0.00,$708.14,"$4,044.38",$0.00,"$2,022.19","$3,203.15","$3,235.50",$0.00,$632.94,$0.00,$643.86,$0.00
71634432,SUP,HCPCS C1713,,71634432  -  NAIL IM STD 13MM 32CM LIME TRGN ANTGRD TI FEM LT,"$4,044.38",$0.00,"$4,044.38","$1,819.97","$2,886.47",$0.00,$696.83,$0.00,$0.00,$708.14,"$4,044.38",$0.00,"$2,022.19","$3,203.15","$3,235.50",$0.00,$632.94,$0.00,$643.86,$0.00
71634434,SUP,HCPCS C1713,,71634434  -  NAIL IM STD 13MM 34CM LIME TRGN ANTGRD TI FEM LT,"$4,044.38",$0.00,"$4,044.38","$1,819.97","$2,886.47",$0.00,$696.83,$0.00,$0.00,$708.14,"$4,044.38",$0.00,"$2,022.19","$3,203.15","$3,235.50",$0.00,$632.94,$0.00,$643.86,$0.00
71634436,SUP,HCPCS C1713,,71634436  -  NAIL IM STD 13MM 36CM LIME TRGN ANTGRD TI FEM LT,"$3,870.00",$0.00,"$3,870.00","$1,741.50","$2,762.02",$0.00,$666.78,$0.00,$0.00,$677.61,"$3,870.00",$0.00,"$1,935.00","$3,065.04","$3,096.00",$0.00,$605.66,$0.00,$616.10,$0.00
71634438,SUP,HCPCS C1713,,71634438  -  NAIL IM STD 13MM 38CM LIME TRGN ANTGRD TI FEM LT,"$3,870.00",$0.00,"$3,870.00","$1,741.50","$2,762.02",$0.00,$666.78,$0.00,$0.00,$677.61,"$3,870.00",$0.00,"$1,935.00","$3,065.04","$3,096.00",$0.00,$605.66,$0.00,$616.10,$0.00
71634440,SUP,HCPCS C1713,,71634440  -  NAIL IM STD 13MM 40CM LIME TRGN ANTGRD TI FEM LT,"$3,870.00",$0.00,"$3,870.00","$1,741.50","$2,762.02",$0.00,$666.78,$0.00,$0.00,$677.61,"$3,870.00",$0.00,"$1,935.00","$3,065.04","$3,096.00",$0.00,$605.66,$0.00,$616.10,$0.00
71634442,SUP,HCPCS C1713,,71634442  -  NAIL IM STD 13MM 42CM LIME TRGN ANTGRD TI FEM LT,"$3,870.00",$0.00,"$3,870.00","$1,741.50","$2,762.02",$0.00,$666.78,$0.00,$0.00,$677.61,"$3,870.00",$0.00,"$1,935.00","$3,065.04","$3,096.00",$0.00,$605.66,$0.00,$616.10,$0.00
71634444,SUP,HCPCS C1713,,71634444  -  NAIL IM STD 13MM 44CM LIME TRGN ANTGRD TI FEM LT,"$4,044.38",$0.00,"$4,044.38","$1,819.97","$2,886.47",$0.00,$696.83,$0.00,$0.00,$708.14,"$4,044.38",$0.00,"$2,022.19","$3,203.15","$3,235.50",$0.00,$632.94,$0.00,$643.86,$0.00
71634446,SUP,HCPCS C1713,,71634446  -  NAIL IM STD 13MM 46CM LIME TRGN ANTGRD TI FEM LT,"$4,044.38",$0.00,"$4,044.38","$1,819.97","$2,886.47",$0.00,$696.83,$0.00,$0.00,$708.14,"$4,044.38",$0.00,"$2,022.19","$3,203.15","$3,235.50",$0.00,$632.94,$0.00,$643.86,$0.00
71634448,SUP,HCPCS C1713,,71634448  -  NAIL IM STD 13MM 48CM LIME TRGN ANTGRD TI FEM LT,"$4,044.38",$0.00,"$4,044.38","$1,819.97","$2,886.47",$0.00,$696.83,$0.00,$0.00,$708.14,"$4,044.38",$0.00,"$2,022.19","$3,203.15","$3,235.50",$0.00,$632.94,$0.00,$643.86,$0.00
71634450,SUP,HCPCS C1713,,71634450  -  NAIL IM 13MM 50CM LIME TRGN ANTGRD TI FEM LT,"$4,044.38",$0.00,"$4,044.38","$1,819.97","$2,886.47",$0.00,$696.83,$0.00,$0.00,$708.14,"$4,044.38",$0.00,"$2,022.19","$3,203.15","$3,235.50",$0.00,$632.94,$0.00,$643.86,$0.00
71634830,SUP,HCPCS C1713,,71634830  -  NAIL IM 130D 8.5MM 30CM ROSE TN RT,"$3,971.25",$0.00,"$3,971.25","$1,787.06","$2,834.28",$0.00,$684.23,$0.00,$0.00,$695.33,"$3,971.25",$0.00,"$1,985.63","$3,145.23","$3,177.00",$0.00,$621.50,$0.00,$632.22,$0.00
71635230,SUP,HCPCS C1713,,71635230  -  NAIL IM 10MM 30CM ROSE TRGN ANTGRD TI FEM RT,"$4,044.38",$0.00,"$4,044.38","$1,819.97","$2,886.47",$0.00,$696.83,$0.00,$0.00,$708.14,"$4,044.38",$0.00,"$2,022.19","$3,203.15","$3,235.50",$0.00,$632.94,$0.00,$643.86,$0.00
71635232,SUP,HCPCS C1713,,71635232  -  NAIL IM STD 10MM 32CM ROSE TRGN ANTGRD TI FEM RT,"$4,044.38",$0.00,"$4,044.38","$1,819.97","$2,886.47",$0.00,$696.83,$0.00,$0.00,$708.14,"$4,044.38",$0.00,"$2,022.19","$3,203.15","$3,235.50",$0.00,$632.94,$0.00,$643.86,$0.00
71635234,SUP,HCPCS C1713,,71635234  -  NAIL IM STD 10MM 34CM ROSE TRGN ANTGRD TI FEM RT,"$4,044.38",$0.00,"$4,044.38","$1,819.97","$2,886.47",$0.00,$696.83,$0.00,$0.00,$708.14,"$4,044.38",$0.00,"$2,022.19","$3,203.15","$3,235.50",$0.00,$632.94,$0.00,$643.86,$0.00
71635236,SUP,HCPCS C1713,,71635236  -  NAIL IM 130D STD 10MM 36CM ROSE TRGN ANTGRD RND XSECT CNN TI,"$3,870.00",$0.00,"$3,870.00","$1,741.50","$2,762.02",$0.00,$666.78,$0.00,$0.00,$677.61,"$3,870.00",$0.00,"$1,935.00","$3,065.04","$3,096.00",$0.00,$605.66,$0.00,$616.10,$0.00
71635238,SUP,HCPCS C1713,,71635238  -  NAIL IM STD 10MM 38CM ROSE TRGN ANTGRD TI FEM RT,"$3,870.00",$0.00,"$3,870.00","$1,741.50","$2,762.02",$0.00,$666.78,$0.00,$0.00,$677.61,"$3,870.00",$0.00,"$1,935.00","$3,065.04","$3,096.00",$0.00,$605.66,$0.00,$616.10,$0.00
71635240,SUP,HCPCS C1713,,71635240  -  NAIL IM STD 10MM 40CM ROSE TRGN ANTGRD TI FEM RT,"$3,870.00",$0.00,"$3,870.00","$1,741.50","$2,762.02",$0.00,$666.78,$0.00,$0.00,$677.61,"$3,870.00",$0.00,"$1,935.00","$3,065.04","$3,096.00",$0.00,$605.66,$0.00,$616.10,$0.00
71635242,SUP,HCPCS C1713,,71635242  -  NAIL IM STD 10MM 42CM ROSE TRGN ANTGRD TI FEM RT,"$3,870.00",$0.00,"$3,870.00","$1,741.50","$2,762.02",$0.00,$666.78,$0.00,$0.00,$677.61,"$3,870.00",$0.00,"$1,935.00","$3,065.04","$3,096.00",$0.00,$605.66,$0.00,$616.10,$0.00
71635244,SUP,HCPCS C1713,,71635244  -  NAIL IM STD 10MM 44CM ROSE TRGN ANTGRD TI FEM RT,"$4,044.38",$0.00,"$4,044.38","$1,819.97","$2,886.47",$0.00,$696.83,$0.00,$0.00,$708.14,"$4,044.38",$0.00,"$2,022.19","$3,203.15","$3,235.50",$0.00,$632.94,$0.00,$643.86,$0.00
71635246,SUP,HCPCS C1713,,71635246  -  NAIL IM STD 10MM 46CM ROSE TRGN ANTGRD TI FEM RT,"$4,044.38",$0.00,"$4,044.38","$1,819.97","$2,886.47",$0.00,$696.83,$0.00,$0.00,$708.14,"$4,044.38",$0.00,"$2,022.19","$3,203.15","$3,235.50",$0.00,$632.94,$0.00,$643.86,$0.00
71635248,SUP,HCPCS C1713,,71635248  -  NAIL IM STD 10MM 48CM ROSE TRGN ANTGRD TI FEM RT,"$4,044.38",$0.00,"$4,044.38","$1,819.97","$2,886.47",$0.00,$696.83,$0.00,$0.00,$708.14,"$4,044.38",$0.00,"$2,022.19","$3,203.15","$3,235.50",$0.00,$632.94,$0.00,$643.86,$0.00
71635250,SUP,HCPCS C1713,,71635250  -  NAIL IM 10MM 50CM ROSE TRGN ANTGRD TI FEM RT,"$4,044.38",$0.00,"$4,044.38","$1,819.97","$2,886.47",$0.00,$696.83,$0.00,$0.00,$708.14,"$4,044.38",$0.00,"$2,022.19","$3,203.15","$3,235.50",$0.00,$632.94,$0.00,$643.86,$0.00
71635330,SUP,HCPCS C1713,,71635330  -  NAIL IM 11.5MM 30CM ROSE TRGN ANTGRD TI FEM RT,"$4,044.38",$0.00,"$4,044.38","$1,819.97","$2,886.47",$0.00,$696.83,$0.00,$0.00,$708.14,"$4,044.38",$0.00,"$2,022.19","$3,203.15","$3,235.50",$0.00,$632.94,$0.00,$643.86,$0.00
71635332,SUP,HCPCS C1713,,71635332  -  NAIL IM STD 11.5MM 32CM ROSE TRGN ANTGRD TI FEM RT,"$4,044.38",$0.00,"$4,044.38","$1,819.97","$2,886.47",$0.00,$696.83,$0.00,$0.00,$708.14,"$4,044.38",$0.00,"$2,022.19","$3,203.15","$3,235.50",$0.00,$632.94,$0.00,$643.86,$0.00
71635334,SUP,HCPCS C1713,,71635334  -  NAIL IM STD 11.5MM 34CM ROSE TRGN ANTGRD TI FEM RT,"$4,044.38",$0.00,"$4,044.38","$1,819.97","$2,886.47",$0.00,$696.83,$0.00,$0.00,$708.14,"$4,044.38",$0.00,"$2,022.19","$3,203.15","$3,235.50",$0.00,$632.94,$0.00,$643.86,$0.00
71635336,SUP,HCPCS C1713,,71635336  -  NAIL IM STD 11.5MM 36CM ROSE TRGN ANTGRD TI FEM RT,"$3,870.00",$0.00,"$3,870.00","$1,741.50","$2,762.02",$0.00,$666.78,$0.00,$0.00,$677.61,"$3,870.00",$0.00,"$1,935.00","$3,065.04","$3,096.00",$0.00,$605.66,$0.00,$616.10,$0.00
71635338,SUP,HCPCS C1713,,71635338  -  NAIL IM STD 11.5MM 38CM FAN ROSE TRGN ANTGRD TI FEM RT,"$3,870.00",$0.00,"$3,870.00","$1,741.50","$2,762.02",$0.00,$666.78,$0.00,$0.00,$677.61,"$3,870.00",$0.00,"$1,935.00","$3,065.04","$3,096.00",$0.00,$605.66,$0.00,$616.10,$0.00
71635340,SUP,HCPCS C1713,,71635340  -  NAIL IM STD 11.5MM 40CM ROSE TRGN ANTGRD TI FEM RT,"$3,870.00",$0.00,"$3,870.00","$1,741.50","$2,762.02",$0.00,$666.78,$0.00,$0.00,$677.61,"$3,870.00",$0.00,"$1,935.00","$3,065.04","$3,096.00",$0.00,$605.66,$0.00,$616.10,$0.00
71635342,SUP,HCPCS C1713,,71635342  -  NAIL IM STD 11.5MM 42CM ROSE TRGN ANTGRD TI FEM RT,"$3,870.00",$0.00,"$3,870.00","$1,741.50","$2,762.02",$0.00,$666.78,$0.00,$0.00,$677.61,"$3,870.00",$0.00,"$1,935.00","$3,065.04","$3,096.00",$0.00,$605.66,$0.00,$616.10,$0.00
71635344,SUP,HCPCS C1713,,71635344  -  NAIL IM STD 11.5MM 44CM ROSE TRGN ANTGRD TI FEM RT,"$4,044.38",$0.00,"$4,044.38","$1,819.97","$2,886.47",$0.00,$696.83,$0.00,$0.00,$708.14,"$4,044.38",$0.00,"$2,022.19","$3,203.15","$3,235.50",$0.00,$632.94,$0.00,$643.86,$0.00
71635346,SUP,HCPCS C1713,,71635346  -  NAIL IM STD 11.5MM 46CM ROSE TRGN ANTGRD TI FEM RT,"$4,044.38",$0.00,"$4,044.38","$1,819.97","$2,886.47",$0.00,$696.83,$0.00,$0.00,$708.14,"$4,044.38",$0.00,"$2,022.19","$3,203.15","$3,235.50",$0.00,$632.94,$0.00,$643.86,$0.00
71635348,SUP,HCPCS C1713,,71635348  -  NAIL IM STD 11.5MM 48CM ROSE TRGN ANTGRD TI FEM RT,"$4,044.38",$0.00,"$4,044.38","$1,819.97","$2,886.47",$0.00,$696.83,$0.00,$0.00,$708.14,"$4,044.38",$0.00,"$2,022.19","$3,203.15","$3,235.50",$0.00,$632.94,$0.00,$643.86,$0.00
71635350,SUP,HCPCS C1713,,71635350  -  NAIL IM 11.5MM 50CM ROSE TRGN ANTGRD TI FEM RT,"$4,044.38",$0.00,"$4,044.38","$1,819.97","$2,886.47",$0.00,$696.83,$0.00,$0.00,$708.14,"$4,044.38",$0.00,"$2,022.19","$3,203.15","$3,235.50",$0.00,$632.94,$0.00,$643.86,$0.00
71635430,SUP,HCPCS C1713,,71635430  -  NAIL IM 13MM 30CM ROSE TRGN ANTGRD TI FEM RT,"$4,044.38",$0.00,"$4,044.38","$1,819.97","$2,886.47",$0.00,$696.83,$0.00,$0.00,$708.14,"$4,044.38",$0.00,"$2,022.19","$3,203.15","$3,235.50",$0.00,$632.94,$0.00,$643.86,$0.00
71635432,SUP,HCPCS C1713,,71635432  -  NAIL IM STD 13MM 32CM ROSE TRGN ANTGRD TI FEM RT,"$4,044.38",$0.00,"$4,044.38","$1,819.97","$2,886.47",$0.00,$696.83,$0.00,$0.00,$708.14,"$4,044.38",$0.00,"$2,022.19","$3,203.15","$3,235.50",$0.00,$632.94,$0.00,$643.86,$0.00
71635434,SUP,HCPCS C1713,,71635434  -  NAIL IM STD 13MM 34CM ROSE TRGN ANTGRD TI FEM RT,"$4,044.38",$0.00,"$4,044.38","$1,819.97","$2,886.47",$0.00,$696.83,$0.00,$0.00,$708.14,"$4,044.38",$0.00,"$2,022.19","$3,203.15","$3,235.50",$0.00,$632.94,$0.00,$643.86,$0.00
71635436,SUP,HCPCS C1713,,71635436  -  NAIL IM STD 13MM 36CM ROSE TRGN ANTGRD TI FEM RT,"$3,870.00",$0.00,"$3,870.00","$1,741.50","$2,762.02",$0.00,$666.78,$0.00,$0.00,$677.61,"$3,870.00",$0.00,"$1,935.00","$3,065.04","$3,096.00",$0.00,$605.66,$0.00,$616.10,$0.00
71635438,SUP,HCPCS C1713,,71635438  -  NAIL IM STD 13MM 38CM ROSE TRGN ANTGRD TI FEM RT,"$3,870.00",$0.00,"$3,870.00","$1,741.50","$2,762.02",$0.00,$666.78,$0.00,$0.00,$677.61,"$3,870.00",$0.00,"$1,935.00","$3,065.04","$3,096.00",$0.00,$605.66,$0.00,$616.10,$0.00
71635440,SUP,HCPCS C1713,,71635440  -  NAIL IM STD 13MM 40CM ROSE TRGN ANTGRD TI FEM RT,"$3,870.00",$0.00,"$3,870.00","$1,741.50","$2,762.02",$0.00,$666.78,$0.00,$0.00,$677.61,"$3,870.00",$0.00,"$1,935.00","$3,065.04","$3,096.00",$0.00,$605.66,$0.00,$616.10,$0.00
71635442,SUP,HCPCS C1713,,71635442  -  NAIL IM STD 13MM 42CM ROSE TRGN ANTGRD TI FEM RT,"$3,870.00",$0.00,"$3,870.00","$1,741.50","$2,762.02",$0.00,$666.78,$0.00,$0.00,$677.61,"$3,870.00",$0.00,"$1,935.00","$3,065.04","$3,096.00",$0.00,$605.66,$0.00,$616.10,$0.00
71635444,SUP,HCPCS C1713,,71635444  -  NAIL IM STD 13MM 44CM ROSE TRGN ANTGRD TI FEM RT,"$4,044.38",$0.00,"$4,044.38","$1,819.97","$2,886.47",$0.00,$696.83,$0.00,$0.00,$708.14,"$4,044.38",$0.00,"$2,022.19","$3,203.15","$3,235.50",$0.00,$632.94,$0.00,$643.86,$0.00
71635446,SUP,HCPCS C1713,,71635446  -  NAIL IM STD 13MM 46CM ROSE TRGN ANTGRD TI FEM LT,"$4,044.38",$0.00,"$4,044.38","$1,819.97","$2,886.47",$0.00,$696.83,$0.00,$0.00,$708.14,"$4,044.38",$0.00,"$2,022.19","$3,203.15","$3,235.50",$0.00,$632.94,$0.00,$643.86,$0.00
71635448,SUP,HCPCS C1713,,71635448  -  NAIL IM STD 13MM 48CM ROSE TRGN ANTGRD TI FEM RT,"$4,044.38",$0.00,"$4,044.38","$1,819.97","$2,886.47",$0.00,$696.83,$0.00,$0.00,$708.14,"$4,044.38",$0.00,"$2,022.19","$3,203.15","$3,235.50",$0.00,$632.94,$0.00,$643.86,$0.00
71635450,SUP,HCPCS C1713,,71635450  -  NAIL IM 13MM 50CM ROSE TRGN ANTGRD TI FEM RT,"$4,044.38",$0.00,"$4,044.38","$1,819.97","$2,886.47",$0.00,$696.83,$0.00,$0.00,$708.14,"$4,044.38",$0.00,"$2,022.19","$3,203.15","$3,235.50",$0.00,$632.94,$0.00,$643.86,$0.00
71636126,SUP,HCPCS C1713,,71636126  -  NAIL IM 8.5IN 26IN GRY TRGN ANTGRD TI FEM,"$3,870.00",$0.00,"$3,870.00","$1,741.50","$2,762.02",$0.00,$666.78,$0.00,$0.00,$677.61,"$3,870.00",$0.00,"$1,935.00","$3,065.04","$3,096.00",$0.00,$605.66,$0.00,$616.10,$0.00
71636128,SUP,HCPCS C1713,,71636128  -  NAIL IM 8.5MM 28CM GRY TRGN ANTGRD TI FEM,"$3,870.00",$0.00,"$3,870.00","$1,741.50","$2,762.02",$0.00,$666.78,$0.00,$0.00,$677.61,"$3,870.00",$0.00,"$1,935.00","$3,065.04","$3,096.00",$0.00,$605.66,$0.00,$616.10,$0.00
71636130,SUP,HCPCS C1713,,71636130  -  NAIL IM 10MM 30CM GRY TRGN ANTGRD TI FEM,"$4,044.38",$0.00,"$4,044.38","$1,819.97","$2,886.47",$0.00,$696.83,$0.00,$0.00,$708.14,"$4,044.38",$0.00,"$2,022.19","$3,203.15","$3,235.50",$0.00,$632.94,$0.00,$643.86,$0.00
71636132,SUP,HCPCS C1713,,71636132  -  NAIL IM 8.5MM 32CM GRY TRGN ANTGRD TI KN FEM,"$4,044.38",$0.00,"$4,044.38","$1,819.97","$2,886.47",$0.00,$696.83,$0.00,$0.00,$708.14,"$4,044.38",$0.00,"$2,022.19","$3,203.15","$3,235.50",$0.00,$632.94,$0.00,$643.86,$0.00
71636134,SUP,HCPCS C1713,,71636134  -  NAIL IM 8.5MM 34CM GRY TRGN CNN ANTGRD TI FEM,"$4,044.38",$0.00,"$4,044.38","$1,819.97","$2,886.47",$0.00,$696.83,$0.00,$0.00,$708.14,"$4,044.38",$0.00,"$2,022.19","$3,203.15","$3,235.50",$0.00,$632.94,$0.00,$643.86,$0.00
71636136,SUP,HCPCS C1713,,71636136  -  NAIL IM 8.5MM 36CM GRY TRGN ANTGRD TI FEM,"$3,870.00",$0.00,"$3,870.00","$1,741.50","$2,762.02",$0.00,$666.78,$0.00,$0.00,$677.61,"$3,870.00",$0.00,"$1,935.00","$3,065.04","$3,096.00",$0.00,$605.66,$0.00,$616.10,$0.00
71636138,SUP,HCPCS C1713,,71636138  -  NAIL IM 8.5MM 38CM GRY TRGN ANTGRD TI FEM,"$3,870.00",$0.00,"$3,870.00","$1,741.50","$2,762.02",$0.00,$666.78,$0.00,$0.00,$677.61,"$3,870.00",$0.00,"$1,935.00","$3,065.04","$3,096.00",$0.00,$605.66,$0.00,$616.10,$0.00
71636140,SUP,HCPCS C1713,,71636140  -  NAIL IM 8.5MM 40CM GRY TRGN ANTGRD TI FEM,"$3,870.00",$0.00,"$3,870.00","$1,741.50","$2,762.02",$0.00,$666.78,$0.00,$0.00,$677.61,"$3,870.00",$0.00,"$1,935.00","$3,065.04","$3,096.00",$0.00,$605.66,$0.00,$616.10,$0.00
71637124,SUP,HCPCS C1713,,71637124  -  NAIL IM 135D 8.5MM 24CM LIME LT TROCH,"$2,840.63",$0.00,"$2,840.63","$1,278.28","$2,027.35",$0.00,$489.43,$0.00,$0.00,$497.37,"$2,840.63",$0.00,"$1,420.31","$2,249.78","$2,272.50",$0.00,$444.56,$0.00,$452.23,$0.00
71637130,SUP,HCPCS C1713,,71637130  -  NAIL IM 135D 8.5MM 30CM LIME LT TROCH,"$2,840.63",$0.00,"$2,840.63","$1,278.28","$2,027.35",$0.00,$489.43,$0.00,$0.00,$497.37,"$2,840.63",$0.00,"$1,420.31","$2,249.78","$2,272.50",$0.00,$444.56,$0.00,$452.23,$0.00
71637132,SUP,HCPCS C1713,,71637132  -  NAIL IM 135D 8.5MM 32CM LIME LT TROCH,"$2,840.63",$0.00,"$2,840.63","$1,278.28","$2,027.35",$0.00,$489.43,$0.00,$0.00,$497.37,"$2,840.63",$0.00,"$1,420.31","$2,249.78","$2,272.50",$0.00,$444.56,$0.00,$452.23,$0.00
71637134,SUP,HCPCS C1713,,71637134  -  NAIL IM 135D 8.5MM 34CM LIME LT TROCH,"$2,840.63",$0.00,"$2,840.63","$1,278.28","$2,027.35",$0.00,$489.43,$0.00,$0.00,$497.37,"$2,840.63",$0.00,"$1,420.31","$2,249.78","$2,272.50",$0.00,$444.56,$0.00,$452.23,$0.00
71637136,SUP,HCPCS C1713,,71637136  -  NAIL IM 135D 8.5MM 36CM LIME LT TROCH,"$2,840.63",$0.00,"$2,840.63","$1,278.28","$2,027.35",$0.00,$489.43,$0.00,$0.00,$497.37,"$2,840.63",$0.00,"$1,420.31","$2,249.78","$2,272.50",$0.00,$444.56,$0.00,$452.23,$0.00
71637138,SUP,HCPCS C1713,,71637138  -  NAIL IM 135D 8.5MM 38CM LIME LT TROCH,"$2,840.63",$0.00,"$2,840.63","$1,278.28","$2,027.35",$0.00,$489.43,$0.00,$0.00,$497.37,"$2,840.63",$0.00,"$1,420.31","$2,249.78","$2,272.50",$0.00,$444.56,$0.00,$452.23,$0.00
71637140,SUP,HCPCS C1713,,71637140  -  NAIL IM 135D 8.5MM 40CM LIME LT TROCH,"$2,840.63",$0.00,"$2,840.63","$1,278.28","$2,027.35",$0.00,$489.43,$0.00,$0.00,$497.37,"$2,840.63",$0.00,"$1,420.31","$2,249.78","$2,272.50",$0.00,$444.56,$0.00,$452.23,$0.00
71637230,SUP,HCPCS C1713,,71637230  -  NAIL IM 135D 10MM 30CM LIME TRGN ANTGRD TI LT TROCH,"$4,921.88",$0.00,"$4,921.88","$2,214.84","$3,512.74",$0.00,$848.01,$0.00,$0.00,$861.78,"$4,921.88",$0.00,"$2,460.94","$3,898.13","$3,937.50",$0.00,$770.27,$0.00,$783.56,$0.00
71637232,SUP,HCPCS C1713,,71637232  -  NAIL IM 135D 10MM 32CM LIME TRGN ANTGRD TI LT TROCH,"$4,921.88",$0.00,"$4,921.88","$2,214.84","$3,512.74",$0.00,$848.01,$0.00,$0.00,$861.78,"$4,921.88",$0.00,"$2,460.94","$3,898.13","$3,937.50",$0.00,$770.27,$0.00,$783.56,$0.00
71637234,SUP,HCPCS C1713,,71637234  -  NAIL IM 135D 10MM 34MM LGHT LIME TRGN ANTGRD TI LT,"$4,921.88",$0.00,"$4,921.88","$2,214.84","$3,512.74",$0.00,$848.01,$0.00,$0.00,$861.78,"$4,921.88",$0.00,"$2,460.94","$3,898.13","$3,937.50",$0.00,$770.27,$0.00,$783.56,$0.00
71637236,SUP,HCPCS C1713,,71637236  -  NAIL IM 135D 10MM 36MM LGHT LIME TRGN ANTGRD TI LT,"$4,921.88",$0.00,"$4,921.88","$2,214.84","$3,512.74",$0.00,$848.01,$0.00,$0.00,$861.78,"$4,921.88",$0.00,"$2,460.94","$3,898.13","$3,937.50",$0.00,$770.27,$0.00,$783.56,$0.00
71637238,SUP,HCPCS C1713,,71637238  -  NAIL IM 135D 10MM 38MM LGHT LIME TRGN ANTGRD TI LT,"$4,696.88",$0.00,"$4,696.88","$2,113.59","$3,352.16",$0.00,$809.25,$0.00,$0.00,$822.39,"$4,696.88",$0.00,"$2,348.44","$3,719.93","$3,757.50",$0.00,$735.06,$0.00,$747.74,$0.00
71637240,SUP,HCPCS C1713,,71637240  -  NAIL IM 135D 10MM 40CM LIME TRGN ANTGRD TI LT TROCH,"$4,696.88",$0.00,"$4,696.88","$2,113.59","$3,352.16",$0.00,$809.25,$0.00,$0.00,$822.39,"$4,696.88",$0.00,"$2,348.44","$3,719.93","$3,757.50",$0.00,$735.06,$0.00,$747.74,$0.00
71637242,SUP,HCPCS C1713,,71637242  -  NAIL IM 135D 10MM 42CM LIME TRGN ANTGRD TI LT TROCH,"$4,696.88",$0.00,"$4,696.88","$2,113.59","$3,352.16",$0.00,$809.25,$0.00,$0.00,$822.39,"$4,696.88",$0.00,"$2,348.44","$3,719.93","$3,757.50",$0.00,$735.06,$0.00,$747.74,$0.00
71637244,SUP,HCPCS C1713,,71637244  -  NAIL IM 135D 10MM 44CM LIME TRGN ANTGRD TI LT TROCH,"$4,921.88",$0.00,"$4,921.88","$2,214.84","$3,512.74",$0.00,$848.01,$0.00,$0.00,$861.78,"$4,921.88",$0.00,"$2,460.94","$3,898.13","$3,937.50",$0.00,$770.27,$0.00,$783.56,$0.00
71637246,SUP,HCPCS C1713,,71637246  -  NAIL IM 135D 10MM 46CM LIME TRGN ANTGRD TI LT TROCH,"$4,921.88",$0.00,"$4,921.88","$2,214.84","$3,512.74",$0.00,$848.01,$0.00,$0.00,$861.78,"$4,921.88",$0.00,"$2,460.94","$3,898.13","$3,937.50",$0.00,$770.27,$0.00,$783.56,$0.00
71637248,SUP,HCPCS C1713,,71637248  -  NAIL IM 135D 10MM 48CM LIME TRGN ANTGRD TI LT TROCH,"$4,921.88",$0.00,"$4,921.88","$2,214.84","$3,512.74",$0.00,$848.01,$0.00,$0.00,$861.78,"$4,921.88",$0.00,"$2,460.94","$3,898.13","$3,937.50",$0.00,$770.27,$0.00,$783.56,$0.00
71637250,SUP,HCPCS C1713,,71637250  -  NAIL IM 135D 10MM 50CM LIME TRGN ANTGRD TI LT TROCH,"$4,921.88",$0.00,"$4,921.88","$2,214.84","$3,512.74",$0.00,$848.01,$0.00,$0.00,$861.78,"$4,921.88",$0.00,"$2,460.94","$3,898.13","$3,937.50",$0.00,$770.27,$0.00,$783.56,$0.00
71637330,SUP,HCPCS C1713,,71637330  -  NAIL IM 135D 11.5MM 30CM LIME TRGN ANTGRD TI LT TROCH,"$4,921.88",$0.00,"$4,921.88","$2,214.84","$3,512.74",$0.00,$848.01,$0.00,$0.00,$861.78,"$4,921.88",$0.00,"$2,460.94","$3,898.13","$3,937.50",$0.00,$770.27,$0.00,$783.56,$0.00
71637332,SUP,HCPCS C1713,,71637332  -  NAIL IM 135D 11.5MM 32CM LIME TRGN ANTGRD TI LT TROCH,"$4,921.88",$0.00,"$4,921.88","$2,214.84","$3,512.74",$0.00,$848.01,$0.00,$0.00,$861.78,"$4,921.88",$0.00,"$2,460.94","$3,898.13","$3,937.50",$0.00,$770.27,$0.00,$783.56,$0.00
71637334,SUP,HCPCS C1713,,71637334  -  NAIL IM 135D 11.5MM 34CM LIME TRGN ANTGRD TI LT TROCH,"$4,921.88",$0.00,"$4,921.88","$2,214.84","$3,512.74",$0.00,$848.01,$0.00,$0.00,$861.78,"$4,921.88",$0.00,"$2,460.94","$3,898.13","$3,937.50",$0.00,$770.27,$0.00,$783.56,$0.00
71637336,SUP,HCPCS C1713,,71637336  -  NAIL IM 135D 11.5MM 36CM LIME TRGN ANTGRD TI LT TROCH,"$4,696.88",$0.00,"$4,696.88","$2,113.59","$3,352.16",$0.00,$809.25,$0.00,$0.00,$822.39,"$4,696.88",$0.00,"$2,348.44","$3,719.93","$3,757.50",$0.00,$735.06,$0.00,$747.74,$0.00
71637338,SUP,HCPCS C1713,,71637338  -  NAIL IM 135D 11.5MM 38CM LIME TRGN ANTGRD TI LT TROCH,"$4,696.88",$0.00,"$4,696.88","$2,113.59","$3,352.16",$0.00,$809.25,$0.00,$0.00,$822.39,"$4,696.88",$0.00,"$2,348.44","$3,719.93","$3,757.50",$0.00,$735.06,$0.00,$747.74,$0.00
71637340,SUP,HCPCS C1713,,71637340  -  NAIL IM 135D 11.5MM 40CM LIME TRGN ANTGRD TI LT TROCH,"$4,696.88",$0.00,"$4,696.88","$2,113.59","$3,352.16",$0.00,$809.25,$0.00,$0.00,$822.39,"$4,696.88",$0.00,"$2,348.44","$3,719.93","$3,757.50",$0.00,$735.06,$0.00,$747.74,$0.00
71637342,SUP,HCPCS C1713,,71637342  -  NAIL IM 135D 11.5MM 42CM LIME TRGN ANTGRD TI LT TROCH,"$4,696.88",$0.00,"$4,696.88","$2,113.59","$3,352.16",$0.00,$809.25,$0.00,$0.00,$822.39,"$4,696.88",$0.00,"$2,348.44","$3,719.93","$3,757.50",$0.00,$735.06,$0.00,$747.74,$0.00
71637344,SUP,HCPCS C1713,,71637344  -  NAIL IM 135D 11.5MM 44CM LIME TRGN ANTGRD TI LT TROCH,"$4,921.88",$0.00,"$4,921.88","$2,214.84","$3,512.74",$0.00,$848.01,$0.00,$0.00,$861.78,"$4,921.88",$0.00,"$2,460.94","$3,898.13","$3,937.50",$0.00,$770.27,$0.00,$783.56,$0.00
71637346,SUP,HCPCS C1713,,71637346  -  NAIL IM 135D 11.5MM 46CM LIME TRGN ANTGRD TI LT TROCH,"$4,921.88",$0.00,"$4,921.88","$2,214.84","$3,512.74",$0.00,$848.01,$0.00,$0.00,$861.78,"$4,921.88",$0.00,"$2,460.94","$3,898.13","$3,937.50",$0.00,$770.27,$0.00,$783.56,$0.00
71637348,SUP,HCPCS C1713,,71637348  -  NAIL IM 135D 11.5MM 48CM LIME TRGN ANTGRD TI LT TROCH,"$4,921.88",$0.00,"$4,921.88","$2,214.84","$3,512.74",$0.00,$848.01,$0.00,$0.00,$861.78,"$4,921.88",$0.00,"$2,460.94","$3,898.13","$3,937.50",$0.00,$770.27,$0.00,$783.56,$0.00
71637350,SUP,HCPCS C1713,,71637350  -  NAIL IM 135D 11.5MM 50CM LIME TRGN ANTGRD TI LT TROCH,"$4,921.88",$0.00,"$4,921.88","$2,214.84","$3,512.74",$0.00,$848.01,$0.00,$0.00,$861.78,"$4,921.88",$0.00,"$2,460.94","$3,898.13","$3,937.50",$0.00,$770.27,$0.00,$783.56,$0.00
71637430,SUP,HCPCS C1713,,71637430  -  NAIL IM 135D 13MM 30CM LIME TRGN ANTGRD TI LT TROCH,"$4,921.88",$0.00,"$4,921.88","$2,214.84","$3,512.74",$0.00,$848.01,$0.00,$0.00,$861.78,"$4,921.88",$0.00,"$2,460.94","$3,898.13","$3,937.50",$0.00,$770.27,$0.00,$783.56,$0.00
71637432,SUP,HCPCS C1713,,71637432  -  NAIL IM 135D 13MM 32CM LIME TRGN ANTGRD TI LT TROCH,"$4,921.88",$0.00,"$4,921.88","$2,214.84","$3,512.74",$0.00,$848.01,$0.00,$0.00,$861.78,"$4,921.88",$0.00,"$2,460.94","$3,898.13","$3,937.50",$0.00,$770.27,$0.00,$783.56,$0.00
71637434,SUP,HCPCS C1713,,71637434  -  NAIL IM 135D 13MM 34CM LIME TRGN ANTGRD TI LT TROCH,"$4,921.88",$0.00,"$4,921.88","$2,214.84","$3,512.74",$0.00,$848.01,$0.00,$0.00,$861.78,"$4,921.88",$0.00,"$2,460.94","$3,898.13","$3,937.50",$0.00,$770.27,$0.00,$783.56,$0.00
71637436,SUP,HCPCS C1713,,71637436  -  NAIL IM 135D 13MM 36CM LIME TRGN ANTGRD TI LT TROCH,"$4,696.88",$0.00,"$4,696.88","$2,113.59","$3,352.16",$0.00,$809.25,$0.00,$0.00,$822.39,"$4,696.88",$0.00,"$2,348.44","$3,719.93","$3,757.50",$0.00,$735.06,$0.00,$747.74,$0.00
71637438,SUP,HCPCS C1713,,71637438  -  NAIL IM 135D 13MM 38CM LIME TRGN ANTGRD TI LT TROCH,"$4,696.88",$0.00,"$4,696.88","$2,113.59","$3,352.16",$0.00,$809.25,$0.00,$0.00,$822.39,"$4,696.88",$0.00,"$2,348.44","$3,719.93","$3,757.50",$0.00,$735.06,$0.00,$747.74,$0.00
71637440,SUP,HCPCS C1713,,71637440  -  NAIL IM 135D 13MM 40CM LIME TRGN ANTGRD TI LT TROCH,"$4,696.88",$0.00,"$4,696.88","$2,113.59","$3,352.16",$0.00,$809.25,$0.00,$0.00,$822.39,"$4,696.88",$0.00,"$2,348.44","$3,719.93","$3,757.50",$0.00,$735.06,$0.00,$747.74,$0.00
71637442,SUP,HCPCS C1713,,71637442  -  NAIL IM 135D 13MM 42CM LIME TRGN ANTGRD TI LT TROCH,"$4,696.88",$0.00,"$4,696.88","$2,113.59","$3,352.16",$0.00,$809.25,$0.00,$0.00,$822.39,"$4,696.88",$0.00,"$2,348.44","$3,719.93","$3,757.50",$0.00,$735.06,$0.00,$747.74,$0.00
71637444,SUP,HCPCS C1713,,71637444  -  NAIL IM 135D 13MM 44CM LIME TRGN ANTGRD TI LT TROCH,"$4,921.88",$0.00,"$4,921.88","$2,214.84","$3,512.74",$0.00,$848.01,$0.00,$0.00,$861.78,"$4,921.88",$0.00,"$2,460.94","$3,898.13","$3,937.50",$0.00,$770.27,$0.00,$783.56,$0.00
71637446,SUP,HCPCS C1713,,71637446  -  NAIL IM 135D 13MM 46CM LIME TRGN ANTGRD TI LT TROCH,"$4,921.88",$0.00,"$4,921.88","$2,214.84","$3,512.74",$0.00,$848.01,$0.00,$0.00,$861.78,"$4,921.88",$0.00,"$2,460.94","$3,898.13","$3,937.50",$0.00,$770.27,$0.00,$783.56,$0.00
71637448,SUP,HCPCS C1713,,71637448  -  NAIL IM 135D 13MM 48CM LIME TRGN ANTGRD TI LT TROCH,"$4,921.88",$0.00,"$4,921.88","$2,214.84","$3,512.74",$0.00,$848.01,$0.00,$0.00,$861.78,"$4,921.88",$0.00,"$2,460.94","$3,898.13","$3,937.50",$0.00,$770.27,$0.00,$783.56,$0.00
71637450,SUP,HCPCS C1713,,71637450  -  NAIL IM 135D 13MM 50CM LIME TRGN ANTGRD TI LT TROCH,"$4,921.88",$0.00,"$4,921.88","$2,214.84","$3,512.74",$0.00,$848.01,$0.00,$0.00,$861.78,"$4,921.88",$0.00,"$2,460.94","$3,898.13","$3,937.50",$0.00,$770.27,$0.00,$783.56,$0.00
71638124,SUP,HCPCS C1713,,71638124  -  NAIL IM 135D 8.5MM 24CM ROSE RT TROCH,"$2,840.63",$0.00,"$2,840.63","$1,278.28","$2,027.35",$0.00,$489.43,$0.00,$0.00,$497.37,"$2,840.63",$0.00,"$1,420.31","$2,249.78","$2,272.50",$0.00,$444.56,$0.00,$452.23,$0.00
71638128,SUP,HCPCS C1713,,71638128  -  NAIL IM 135D 8.5MM 28CM ROSE RT TROCH,"$2,840.63",$0.00,"$2,840.63","$1,278.28","$2,027.35",$0.00,$489.43,$0.00,$0.00,$497.37,"$2,840.63",$0.00,"$1,420.31","$2,249.78","$2,272.50",$0.00,$444.56,$0.00,$452.23,$0.00
71638130,SUP,HCPCS C1713,,71638130  -  NAIL IM 135D 8.5MM 30CM ROSE RT TROCH,"$2,840.63",$0.00,"$2,840.63","$1,278.28","$2,027.35",$0.00,$489.43,$0.00,$0.00,$497.37,"$2,840.63",$0.00,"$1,420.31","$2,249.78","$2,272.50",$0.00,$444.56,$0.00,$452.23,$0.00
71638132,SUP,HCPCS C1713,,71638132  -  NAIL IM 135D 8.5MM 32CM ROSE RT TROCH,"$2,840.63",$0.00,"$2,840.63","$1,278.28","$2,027.35",$0.00,$489.43,$0.00,$0.00,$497.37,"$2,840.63",$0.00,"$1,420.31","$2,249.78","$2,272.50",$0.00,$444.56,$0.00,$452.23,$0.00
71638134,SUP,HCPCS C1713,,71638134  -  NAIL IM 135D 8.5MM 34CM ROSE RT TROCH,"$2,840.63",$0.00,"$2,840.63","$1,278.28","$2,027.35",$0.00,$489.43,$0.00,$0.00,$497.37,"$2,840.63",$0.00,"$1,420.31","$2,249.78","$2,272.50",$0.00,$444.56,$0.00,$452.23,$0.00
71638136,SUP,HCPCS C1713,,71638136  -  NAIL IM 135D 8.5MM 36CM ROSE RT TROCH,"$2,840.63",$0.00,"$2,840.63","$1,278.28","$2,027.35",$0.00,$489.43,$0.00,$0.00,$497.37,"$2,840.63",$0.00,"$1,420.31","$2,249.78","$2,272.50",$0.00,$444.56,$0.00,$452.23,$0.00
71638138,SUP,HCPCS C1713,,71638138  -  NAIL IM 135D 8.5MM 38CM ROSE RT TROCH,"$2,840.63",$0.00,"$2,840.63","$1,278.28","$2,027.35",$0.00,$489.43,$0.00,$0.00,$497.37,"$2,840.63",$0.00,"$1,420.31","$2,249.78","$2,272.50",$0.00,$444.56,$0.00,$452.23,$0.00
71638140,SUP,HCPCS C1713,,71638140  -  NAIL IM 135D 8.5MM 40CM ROSE RT TROCH,"$2,840.63",$0.00,"$2,840.63","$1,278.28","$2,027.35",$0.00,$489.43,$0.00,$0.00,$497.37,"$2,840.63",$0.00,"$1,420.31","$2,249.78","$2,272.50",$0.00,$444.56,$0.00,$452.23,$0.00
71638230,SUP,HCPCS C1713,,71638230  -  NAIL IM 135D 10MM 30CM ROSE TRGN ANTGRD TI RT TROCH,"$4,921.88",$0.00,"$4,921.88","$2,214.84","$3,512.74",$0.00,$848.01,$0.00,$0.00,$861.78,"$4,921.88",$0.00,"$2,460.94","$3,898.13","$3,937.50",$0.00,$770.27,$0.00,$783.56,$0.00
71638232,SUP,HCPCS C1713,,71638232  -  NAIL IM 135D 10MM 32CM ROSE TRGN ANTGRD TI RT TROCH,"$4,921.88",$0.00,"$4,921.88","$2,214.84","$3,512.74",$0.00,$848.01,$0.00,$0.00,$861.78,"$4,921.88",$0.00,"$2,460.94","$3,898.13","$3,937.50",$0.00,$770.27,$0.00,$783.56,$0.00
71638234,SUP,HCPCS C1713,,71638234  -  NAIL IM 135D 10MM 34CM ROSE TRGN ANTGRD TI RT TROCH,"$4,921.88",$0.00,"$4,921.88","$2,214.84","$3,512.74",$0.00,$848.01,$0.00,$0.00,$861.78,"$4,921.88",$0.00,"$2,460.94","$3,898.13","$3,937.50",$0.00,$770.27,$0.00,$783.56,$0.00
71638236,SUP,HCPCS C1713,,71638236  -  NAIL IM 135D 10MM 36CM ROSE TRGN ANTGRD TI RT TROCH,"$4,696.88",$0.00,"$4,696.88","$2,113.59","$3,352.16",$0.00,$809.25,$0.00,$0.00,$822.39,"$4,696.88",$0.00,"$2,348.44","$3,719.93","$3,757.50",$0.00,$735.06,$0.00,$747.74,$0.00
71638238,SUP,HCPCS C1713,,71638238  -  NAIL IM 135D 10MM 38CM ROSE TRGN ANTGRD TI RT TROCH,"$4,696.88",$0.00,"$4,696.88","$2,113.59","$3,352.16",$0.00,$809.25,$0.00,$0.00,$822.39,"$4,696.88",$0.00,"$2,348.44","$3,719.93","$3,757.50",$0.00,$735.06,$0.00,$747.74,$0.00
71638240,SUP,HCPCS C1713,,71638240  -  NAIL IM 135D 10MM 40CM ROSE TRGN ANTGRD TI RT TROCH,"$4,696.88",$0.00,"$4,696.88","$2,113.59","$3,352.16",$0.00,$809.25,$0.00,$0.00,$822.39,"$4,696.88",$0.00,"$2,348.44","$3,719.93","$3,757.50",$0.00,$735.06,$0.00,$747.74,$0.00
71638242,SUP,HCPCS C1713,,71638242  -  NAIL IM 135D 10MM 42CM ROSE TRGN ANTGRD TI RT TROCH,"$4,696.88",$0.00,"$4,696.88","$2,113.59","$3,352.16",$0.00,$809.25,$0.00,$0.00,$822.39,"$4,696.88",$0.00,"$2,348.44","$3,719.93","$3,757.50",$0.00,$735.06,$0.00,$747.74,$0.00
71638244,SUP,HCPCS C1713,,71638244  -  NAIL IM 135D 10MM 44CM ROSE TRGN ANTGRD TI RT TROCH,"$4,921.88",$0.00,"$4,921.88","$2,214.84","$3,512.74",$0.00,$848.01,$0.00,$0.00,$861.78,"$4,921.88",$0.00,"$2,460.94","$3,898.13","$3,937.50",$0.00,$770.27,$0.00,$783.56,$0.00
71638246,SUP,HCPCS C1713,,71638246  -  NAIL IM 135D 10MM 46CM ROSE TRGN ANTGRD TI RT TROCH,"$4,921.88",$0.00,"$4,921.88","$2,214.84","$3,512.74",$0.00,$848.01,$0.00,$0.00,$861.78,"$4,921.88",$0.00,"$2,460.94","$3,898.13","$3,937.50",$0.00,$770.27,$0.00,$783.56,$0.00
71638248,SUP,HCPCS C1713,,71638248  -  NAIL IM 135D 10MM 48CM ROSE TRGN ANTGRD TI RT TROCH,"$4,921.88",$0.00,"$4,921.88","$2,214.84","$3,512.74",$0.00,$848.01,$0.00,$0.00,$861.78,"$4,921.88",$0.00,"$2,460.94","$3,898.13","$3,937.50",$0.00,$770.27,$0.00,$783.56,$0.00
71638250,SUP,HCPCS C1713,,71638250  -  NAIL IM 135D 10MM 50CM ROSE TRGN ANTGRD TI RT TROCH,"$4,921.88",$0.00,"$4,921.88","$2,214.84","$3,512.74",$0.00,$848.01,$0.00,$0.00,$861.78,"$4,921.88",$0.00,"$2,460.94","$3,898.13","$3,937.50",$0.00,$770.27,$0.00,$783.56,$0.00
71638330,SUP,HCPCS C1713,,71638330  -  NAIL IM 135D 11.5MM 30CM ROSE TRGN ANTGRD TI RT TROCH,"$4,921.88",$0.00,"$4,921.88","$2,214.84","$3,512.74",$0.00,$848.01,$0.00,$0.00,$861.78,"$4,921.88",$0.00,"$2,460.94","$3,898.13","$3,937.50",$0.00,$770.27,$0.00,$783.56,$0.00
71638332,SUP,HCPCS C1713,,71638332  -  NAIL IM 135D 11.5MM 32CM ROSE TRGN ANTGRD TI RT TROCH,"$4,921.88",$0.00,"$4,921.88","$2,214.84","$3,512.74",$0.00,$848.01,$0.00,$0.00,$861.78,"$4,921.88",$0.00,"$2,460.94","$3,898.13","$3,937.50",$0.00,$770.27,$0.00,$783.56,$0.00
71638334,SUP,HCPCS C1713,,71638334  -  NAIL IM 135D 11.5MM 34CM ROSE TRGN ANTGRD TI RT TROCH,"$4,921.88",$0.00,"$4,921.88","$2,214.84","$3,512.74",$0.00,$848.01,$0.00,$0.00,$861.78,"$4,921.88",$0.00,"$2,460.94","$3,898.13","$3,937.50",$0.00,$770.27,$0.00,$783.56,$0.00
71638336,SUP,HCPCS C1713,,71638336  -  NAIL IM 135D 11.5MM 36CM ROSE TRGN ANTGRD TI RT TROCH,"$4,696.88",$0.00,"$4,696.88","$2,113.59","$3,352.16",$0.00,$809.25,$0.00,$0.00,$822.39,"$4,696.88",$0.00,"$2,348.44","$3,719.93","$3,757.50",$0.00,$735.06,$0.00,$747.74,$0.00
71638338,SUP,HCPCS C1713,,71638338  -  NAIL IM 135D 11.5MM 38CM ROSE TN TRGN ANTGRD TI RT TROCH,"$4,696.88",$0.00,"$4,696.88","$2,113.59","$3,352.16",$0.00,$809.25,$0.00,$0.00,$822.39,"$4,696.88",$0.00,"$2,348.44","$3,719.93","$3,757.50",$0.00,$735.06,$0.00,$747.74,$0.00
71638340,SUP,HCPCS C1713,,71638340  -  NAIL IM 135D 11.5MM 40CM ROSE TRGN ANTGRD TI RT TROCH,"$4,696.88",$0.00,"$4,696.88","$2,113.59","$3,352.16",$0.00,$809.25,$0.00,$0.00,$822.39,"$4,696.88",$0.00,"$2,348.44","$3,719.93","$3,757.50",$0.00,$735.06,$0.00,$747.74,$0.00
71638342,SUP,HCPCS C1713,,71638342  -  NAIL IM 135D 11.5MM 42CM ROSE TRGN ANTGRD TI RT TROCH,"$4,696.88",$0.00,"$4,696.88","$2,113.59","$3,352.16",$0.00,$809.25,$0.00,$0.00,$822.39,"$4,696.88",$0.00,"$2,348.44","$3,719.93","$3,757.50",$0.00,$735.06,$0.00,$747.74,$0.00
71638344,SUP,HCPCS C1713,,71638344  -  NAIL IM 135D 11.5MM 44CM ROSE TRGN ANTGRD TI RT TROCH,"$4,921.88",$0.00,"$4,921.88","$2,214.84","$3,512.74",$0.00,$848.01,$0.00,$0.00,$861.78,"$4,921.88",$0.00,"$2,460.94","$3,898.13","$3,937.50",$0.00,$770.27,$0.00,$783.56,$0.00
71638346,SUP,HCPCS C1713,,71638346  -  NAIL IM 135D 11.5MM 46CM ROSE TRGN ANTGRD TI RT TROCH,"$4,921.88",$0.00,"$4,921.88","$2,214.84","$3,512.74",$0.00,$848.01,$0.00,$0.00,$861.78,"$4,921.88",$0.00,"$2,460.94","$3,898.13","$3,937.50",$0.00,$770.27,$0.00,$783.56,$0.00
71638348,SUP,HCPCS C1713,,71638348  -  NAIL IM 135D 11.5MM 48CM ROSE TRGN ANTGRD TI RT TROCH,"$4,921.88",$0.00,"$4,921.88","$2,214.84","$3,512.74",$0.00,$848.01,$0.00,$0.00,$861.78,"$4,921.88",$0.00,"$2,460.94","$3,898.13","$3,937.50",$0.00,$770.27,$0.00,$783.56,$0.00
71638350,SUP,HCPCS C1713,,71638350  -  NAIL IM 135D 11.5MM 50CM ROSE TRGN ANTGRD TI RT TROCH,"$4,921.88",$0.00,"$4,921.88","$2,214.84","$3,512.74",$0.00,$848.01,$0.00,$0.00,$861.78,"$4,921.88",$0.00,"$2,460.94","$3,898.13","$3,937.50",$0.00,$770.27,$0.00,$783.56,$0.00
71638430,SUP,HCPCS C1713,,71638430  -  NAIL IM 135D 13MM 30CM ROSE TRGN ANTGRD TI RT TROCH,"$4,921.88",$0.00,"$4,921.88","$2,214.84","$3,512.74",$0.00,$848.01,$0.00,$0.00,$861.78,"$4,921.88",$0.00,"$2,460.94","$3,898.13","$3,937.50",$0.00,$770.27,$0.00,$783.56,$0.00
71638432,SUP,HCPCS C1713,,71638432  -  NAIL IM 135D 13MM 32CM ROSE TRGN ANTGRD TI RT TROCH,"$4,921.88",$0.00,"$4,921.88","$2,214.84","$3,512.74",$0.00,$848.01,$0.00,$0.00,$861.78,"$4,921.88",$0.00,"$2,460.94","$3,898.13","$3,937.50",$0.00,$770.27,$0.00,$783.56,$0.00
71638434,SUP,HCPCS C1713,,71638434  -  NAIL IM 135D 13MM 34CM ROSE TRGN ANTGRD TI RT TROCH,"$4,921.88",$0.00,"$4,921.88","$2,214.84","$3,512.74",$0.00,$848.01,$0.00,$0.00,$861.78,"$4,921.88",$0.00,"$2,460.94","$3,898.13","$3,937.50",$0.00,$770.27,$0.00,$783.56,$0.00
71638436,SUP,HCPCS C1713,,71638436  -  NAIL IM 135D 13MM 36CM ROSE TRGN ANTGRD TI RT TROCH,"$4,696.88",$0.00,"$4,696.88","$2,113.59","$3,352.16",$0.00,$809.25,$0.00,$0.00,$822.39,"$4,696.88",$0.00,"$2,348.44","$3,719.93","$3,757.50",$0.00,$735.06,$0.00,$747.74,$0.00
71638438,SUP,HCPCS C1713,,71638438  -  NAIL IM 135D 13MM 38CM ROSE TRGN ANTGRD TI RT TROCH,"$4,696.88",$0.00,"$4,696.88","$2,113.59","$3,352.16",$0.00,$809.25,$0.00,$0.00,$822.39,"$4,696.88",$0.00,"$2,348.44","$3,719.93","$3,757.50",$0.00,$735.06,$0.00,$747.74,$0.00
71638440,SUP,HCPCS C1713,,71638440  -  NAIL IM 135D 13MM 40CM ROSE TRGN ANTGRD TI RT TROCH,"$4,696.88",$0.00,"$4,696.88","$2,113.59","$3,352.16",$0.00,$809.25,$0.00,$0.00,$822.39,"$4,696.88",$0.00,"$2,348.44","$3,719.93","$3,757.50",$0.00,$735.06,$0.00,$747.74,$0.00
71638442,SUP,HCPCS C1713,,71638442  -  NAIL IM 135D 13MM 42CM ROSE TRGN ANTGRD TI RT TROCH,"$4,696.88",$0.00,"$4,696.88","$2,113.59","$3,352.16",$0.00,$809.25,$0.00,$0.00,$822.39,"$4,696.88",$0.00,"$2,348.44","$3,719.93","$3,757.50",$0.00,$735.06,$0.00,$747.74,$0.00
71638444,SUP,HCPCS C1713,,71638444  -  NAIL IM 135D 13MM 44CM ROSE TRGN ANTGRD TI RT TROCH,"$4,921.88",$0.00,"$4,921.88","$2,214.84","$3,512.74",$0.00,$848.01,$0.00,$0.00,$861.78,"$4,921.88",$0.00,"$2,460.94","$3,898.13","$3,937.50",$0.00,$770.27,$0.00,$783.56,$0.00
71638446,SUP,HCPCS C1713,,71638446  -  NAIL IM 135D 13MM 46CM ROSE TRGN ANTGRD TI RT TROCH,"$4,921.88",$0.00,"$4,921.88","$2,214.84","$3,512.74",$0.00,$848.01,$0.00,$0.00,$861.78,"$4,921.88",$0.00,"$2,460.94","$3,898.13","$3,937.50",$0.00,$770.27,$0.00,$783.56,$0.00
71638448,SUP,HCPCS C1713,,71638448  -  NAIL IM 135D 13MM 48CM ROSE TRGN ANTGRD TI RT TROCH,"$4,921.88",$0.00,"$4,921.88","$2,214.84","$3,512.74",$0.00,$848.01,$0.00,$0.00,$861.78,"$4,921.88",$0.00,"$2,460.94","$3,898.13","$3,937.50",$0.00,$770.27,$0.00,$783.56,$0.00
71638450,SUP,HCPCS C1713,,71638450  -  NAIL IM 135D 13MM 50CM ROSE TRGN ANTGRD TI RT TROCH,"$4,921.88",$0.00,"$4,921.88","$2,214.84","$3,512.74",$0.00,$848.01,$0.00,$0.00,$861.78,"$4,921.88",$0.00,"$2,460.94","$3,898.13","$3,937.50",$0.00,$770.27,$0.00,$783.56,$0.00
71639215,SUP,HCPCS C1713,,71639215  -  NAIL IM SHRT BND 10MM 15CM BLU TRGN ANTGRD TI FEM TROCH,"$2,857.50",$0.00,"$2,857.50","$1,285.88","$2,039.40",$0.00,$492.33,$0.00,$0.00,$500.33,"$2,857.50",$0.00,"$1,428.75","$2,263.14","$2,286.00",$0.00,$447.20,$0.00,$454.91,$0.00
71639315,SUP,HCPCS C1713,,71639315  -  NAIL IM SHRT 11.5MM 15CM BLU TRGN ANTGRD BND TI FEM TROCH,"$4,033.13",$0.00,"$4,033.13","$1,814.91","$2,878.44",$0.00,$694.89,$0.00,$0.00,$706.17,"$4,033.13",$0.00,"$2,016.56","$3,194.24","$3,226.50",$0.00,$631.18,$0.00,$642.07,$0.00
71640530,SUP,HCPCS C1713,,71640530  -  NAIL IM 9MM 30CM ROSE TRGN MT-TN ANTGRD FEM TROCH RT,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71640532,SUP,HCPCS C1713,,71640532  -  NAIL IM 9MM 32CM ROSE TRGN MT-TN ANTGRD FEM TROCH RT,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71640534,SUP,HCPCS C1713,,71640534  -  NAIL IM 9MM 34CM ROSE TRGN MT-TN ANTGRD FEM TROCH RT,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71640536,SUP,HCPCS C1713,,71640536  -  NAIL IM 9MM 36CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71640538,SUP,HCPCS C1713,,71640538  -  NAIL IM 9MM 38CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71640540,SUP,HCPCS C1713,,71640540  -  NAIL IM 9MM 40CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71640542,SUP,HCPCS C1713,,71640542  -  NAIL IM 9MM 42CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71640544,SUP,HCPCS C1713,,71640544  -  NAIL IM 9MM 44CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71640546,SUP,HCPCS C1713,,71640546  -  NAIL IM 9MM 46CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71640548,SUP,HCPCS C1713,,71640548  -  NAIL IM 9MM 48CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71640550,SUP,HCPCS C1713,,71640550  -  NAIL IM 9MM 50CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71640630,SUP,HCPCS C1713,,71640630  -  NAIL IM 10MM 30CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71640632,SUP,HCPCS C1713,,71640632  -  NAIL IM 10MM 32CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71640634,SUP,HCPCS C1713,,71640634  -  NAIL IM 10MM 34CM ROSE TRGN MT-TN RT,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71640636,SUP,HCPCS C1713,,71640636  -  NAIL IM 10MM 36CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71640638,SUP,HCPCS C1713,,71640638  -  NAIL IM 10MM 38CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71640640,SUP,HCPCS C1713,,71640640  -  NAIL IM 10MM 40CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71640642,SUP,HCPCS C1713,,71640642  -  NAIL IM 10MM 42CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71640644,SUP,HCPCS C1713,,71640644  -  NAIL IM 10MM 44CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71640646,SUP,HCPCS C1713,,71640646  -  NAIL IM 10MM 46CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71640648,SUP,HCPCS C1713,,71640648  -  NAIL IM 10MM 48CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71640650,SUP,HCPCS C1713,,71640650  -  NAIL IM 10MM 50CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71640730,SUP,HCPCS C1713,,71640730  -  NAIL IM 11.5MM 30CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71640732,SUP,HCPCS C1713,,71640732  -  NAIL IM 11.5MM 32CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71640734,SUP,HCPCS C1713,,71640734  -  NAIL IM 11.5MM 34CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71640736,SUP,HCPCS C1713,,71640736  -  NAIL IM 11.5MM 36CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71640738,SUP,HCPCS C1713,,71640738  -  NAIL IM 11.5MM 38CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71640740,SUP,HCPCS C1713,,71640740  -  NAIL IM 11.5MM 40CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71640742,SUP,HCPCS C1713,,71640742  -  NAIL IM 11.5MM 42CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71640744,SUP,HCPCS C1713,,71640744  -  NAIL IM 11.5MM 44CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71640746,SUP,HCPCS C1713,,71640746  -  NAIL IM 11.5MM 46CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71640748,SUP,HCPCS C1713,,71640748  -  NAIL IM 11.5MM 48CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71640750,SUP,HCPCS C1713,,71640750  -  NAIL IM 11.5MM 50CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71640830,SUP,HCPCS C1713,,71640830  -  NAIL IM 13MM 30CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71640832,SUP,HCPCS C1713,,71640832  -  NAIL IM 13MM 32CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71640834,SUP,HCPCS C1713,,71640834  -  NAIL IM 13MM 34CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71640836,SUP,HCPCS C1713,,71640836  -  NAIL IM 13MM 36CM MT-NL TN RT,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71640838,SUP,HCPCS C1713,,71640838  -  NAIL IM 13MM 38CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71640840,SUP,HCPCS C1713,,71640840  -  NAIL IM 13MM 40CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71640842,SUP,HCPCS C1713,,71640842  -  NAIL IM 13MM 42CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71640844,SUP,HCPCS C1713,,71640844  -  NAIL IM 13MM 44CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71640846,SUP,HCPCS C1713,,71640846  -  NAIL IM 13MM 46CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71640848,SUP,HCPCS C1713,,71640848  -  NAIL IM 13MM 48CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71640850,SUP,HCPCS C1713,,71640850  -  NAIL IM 13MM 50CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71641123,SUP,Custom 27203010,,71641123  -  BIT DRL SHRT 4MM STRL TRGN AO STP SET DPHSL DISP,$225.00,$0.00,$225.00,$0.00,$160.58,$0.00,$0.00,$0.00,$0.00,$0.00,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$0.00,$0.00,$0.00,$0.00
71642120,SUP,HCPCS C1713,,71642120  -  SCREW BN 4.5MM 20MM TRGN CPTR TI ORTH,$283.50,$0.00,$283.50,$127.58,$202.33,$0.00,$48.85,$0.00,$0.00,$49.64,$283.50,$0.00,$141.75,$224.53,$226.80,$0.00,$44.37,$0.00,$45.13,$0.00
71642125,SUP,HCPCS C1713,,71642125  -  SCREW BN 4.5MM 25MM GRY TRGN INTNL CPTR HEX TI FEM IM NL,$438.75,$0.00,$438.75,$197.44,$313.14,$0.00,$75.59,$0.00,$0.00,$76.82,$438.75,$0.00,$219.38,$347.49,$351.00,$0.00,$68.66,$0.00,$69.85,$0.00
71642130,SUP,HCPCS C1713,,71642130  -  SCREW BN 4.5MM 30MM GRY TRGN INTNL CPTR TI FEM IM NL,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71642135,SUP,HCPCS C1713,,71642135  -  SCREW BN HEX 4.5MM 35MM GRY TRGN INTNL CPTR TI FEM IM NL SYS,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71642140,SUP,HCPCS C1713,,71642140  -  SCREW BN HEX 4.5MM 40MM GRY TRGN INTNL CPTR TI KN TIB IM NL,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71642145,SUP,HCPCS C1713,,71642145  -  SCREW BN 4.5MM 45MM GRY TRGN INTNL CPTR TI ORTH IM NL,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71642150,SUP,HCPCS C1713,,71642150  -  SCREW BN HEX 4.5MM 50MM GRY TRGN INTNL CPTR TI FEM IM NL SYS,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71642155,SUP,HCPCS C1713,,71642155  -  SCREW BN FT 4.5MM 55MM GRY TRGN INTNL CPTR HEX HD TI FEM,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71642160,SUP,HCPCS C1713,,71642160  -  SCREW BN 4.5MM 60MM GRY TRGN INTNL CPTR HEX HD TI FEM IM NL,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71642165,SUP,HCPCS C1713,,71642165  -  SCREW BN 4.5MM 65MM GRY TRGN INTNL CPTR TI ORTH IM NL,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71642200,SUP,HCPCS C1713,,71642200  -  SCREW BN HEX 5MM 100MM AU TRGN INTNL CPTR TI FEM IM NL SYS,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71642205,SUP,HCPCS C1713,,71642205  -  SCREW BN FT 5MM 105MM AU TRGN NTERNAL CPTR HEX HD TI FEM,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71642210,SUP,HCPCS C1713,,71642210  -  SCREW BN FT 5MM 110MM AU TRGN INTNL CPTR HEX HD TI FEM,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71642220,SUP,HCPCS C1713,,71642220  -  SCREW BN 5MM 20MM TRGN INTNL CPTR HEX HD TI FEM IM NL,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71642225,SUP,HCPCS C1713,,71642225  -  SCREW BN 5MM 25MM AU INTNL CPTR HEX TI FEM TRGN IM NL SYS,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71642230,SUP,HCPCS C1713,,71642230  -  SCREW BN 5MM 30MM AU INTNL CPTR HEX TI FEM TRGN IM NL SYS,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71642235,SUP,HCPCS C1713,,71642235  -  SCREW BN HEX 5MM 35MM AU TRGN INTNL CPTR TI FEM IM NL SYS,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71642240,SUP,HCPCS C1713,,71642240  -  SCREW BONE HEXAGON 5MM 40MM INTERNAL CAPTURE TRIGEN GOLD,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71642245,SUP,HCPCS C1713,,71642245  -  SCREW BONE HEXAGON 5MM 45MM INTERNAL CAPTURE TRIGEN GOLD,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71642250,SUP,HCPCS C1713,,71642250  -  SCREW BONE HEXAGON 5MM 50MM INTERNAL CAPTURE TRIGEN GOLD,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71642255,SUP,HCPCS C1713,,71642255  -  SCREW BN HEX 5MM 55MM AU TRGN INTNL CPTR TI FEM IM NL SYS,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71642260,SUP,HCPCS C1713,,71642260  -  SCREW BONE HEXAGON 5MM 60MM INTERNAL CAPTURE TRIGEN GOLD,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71642265,SUP,HCPCS C1713,,71642265  -  SCREW BN HEX 5MM 65MM AU TRGN INTNL CPTR TI FEM IM NL,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71642270,SUP,HCPCS C1713,,71642270  -  SCREW BONE HEXAGON 5MM 70MM INTERNAL CAPTURE TRIGEN GOLD,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71642275,SUP,HCPCS C1713,,71642275  -  SCREW BN HEX 5MM 75MM AU TRGN INTNL CPTR TI FEM IM NL,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71642280,SUP,HCPCS C1713,,71642280  -  SCREW BN HEX 5MM 80MM AU TRGN INTNL CPTR TI FEM IM NL SYS,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71642285,SUP,HCPCS C1713,,71642285  -  SCREW BN HEX 5MM 85MM AU TRGN INTNL CPTR TI FEM IM NL,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71642290,SUP,HCPCS C1713,,71642290  -  SCREW BN HEX 5MM 90MM AU TRGN INTNL CPTR TI FEM IM NL SYS,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71642295,SUP,HCPCS C1713,,71642295  -  SCREW BN HEX 5MM 95MM AU TRGN INTNL CPTR TI FEM IM NL SYS,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71642300,SUP,HCPCS C1713,,71642300  -  SCREW BONE HEXAGON 6.4MM 100MM INTERNAL CAPTURE,$727.88,$0.00,$727.88,$327.54,$519.48,$0.00,$125.41,$0.00,$0.00,$127.45,$727.88,$0.00,$363.94,$576.48,$582.30,$0.00,$113.91,$0.00,$115.88,$0.00
71642305,SUP,HCPCS C1713,,71642305  -  SCREW BONE HEXAGON 6.4MM 105MM INTERNAL CAPTURE,$727.88,$0.00,$727.88,$327.54,$519.48,$0.00,$125.41,$0.00,$0.00,$127.45,$727.88,$0.00,$363.94,$576.48,$582.30,$0.00,$113.91,$0.00,$115.88,$0.00
71642320,SUP,HCPCS C1713,,71642320  -  SCREW BN HEX 6.4MM 120MM BLU TRGN INTNL CPTR RECON TI FEM IM,$727.88,$0.00,$727.88,$327.54,$519.48,$0.00,$125.41,$0.00,$0.00,$127.45,$727.88,$0.00,$363.94,$576.48,$582.30,$0.00,$113.91,$0.00,$115.88,$0.00
71642325,SUP,HCPCS C1713,,71642325  -  SCREW BN HEX 6.4MM 125MM BLU TRGN INTNL CPTR RECON TI FEM IM,$727.88,$0.00,$727.88,$327.54,$519.48,$0.00,$125.41,$0.00,$0.00,$127.45,$727.88,$0.00,$363.94,$576.48,$582.30,$0.00,$113.91,$0.00,$115.88,$0.00
71642365,SUP,HCPCS C1713,,71642365  -  SCREW BN HEX 6.4MM 65MM BLU TRGN INTNL CPTR RECON TI FEM IM,$727.88,$0.00,$727.88,$327.54,$519.48,$0.00,$125.41,$0.00,$0.00,$127.45,$727.88,$0.00,$363.94,$576.48,$582.30,$0.00,$113.91,$0.00,$115.88,$0.00
71642370,SUP,HCPCS C1713,,71642370  -  SCREW BONE HEXAGON 6.4MM 70MM INTERNAL CAPTURE,$727.88,$0.00,$727.88,$327.54,$519.48,$0.00,$125.41,$0.00,$0.00,$127.45,$727.88,$0.00,$363.94,$576.48,$582.30,$0.00,$113.91,$0.00,$115.88,$0.00
71642375,SUP,HCPCS C1713,,71642375  -  SCREW BONE HEXAGON 6.4MM 75MM INTERNAL CAPTURE,$727.88,$0.00,$727.88,$327.54,$519.48,$0.00,$125.41,$0.00,$0.00,$127.45,$727.88,$0.00,$363.94,$576.48,$582.30,$0.00,$113.91,$0.00,$115.88,$0.00
71642380,SUP,HCPCS C1713,,71642380  -  SCREW BONE HEXAGON 6.4MM 80MM INTERNAL CAPTURE,$727.88,$0.00,$727.88,$327.54,$519.48,$0.00,$125.41,$0.00,$0.00,$127.45,$727.88,$0.00,$363.94,$576.48,$582.30,$0.00,$113.91,$0.00,$115.88,$0.00
71642385,SUP,HCPCS C1713,,71642385  -  SCREW BONE HEXAGON 6.4MM 85MM INTERNAL CAPTURE,$727.88,$0.00,$727.88,$327.54,$519.48,$0.00,$125.41,$0.00,$0.00,$127.45,$727.88,$0.00,$363.94,$576.48,$582.30,$0.00,$113.91,$0.00,$115.88,$0.00
71642390,SUP,HCPCS C1713,,71642390  -  SCREW BN 6.4MM 90MM BLU INTNL CPTR RECON HEX TI TROCH TRGN,$727.88,$0.00,$727.88,$327.54,$519.48,$0.00,$125.41,$0.00,$0.00,$127.45,$727.88,$0.00,$363.94,$576.48,$582.30,$0.00,$113.91,$0.00,$115.88,$0.00
71642395,SUP,HCPCS C1713,,71642395  -  SCREW BN 6.4MM 95MM BLU INTNL CPTR RECON HEX TI TROCH TRGN,$727.88,$0.00,$727.88,$327.54,$519.48,$0.00,$125.41,$0.00,$0.00,$127.45,$727.88,$0.00,$363.94,$576.48,$582.30,$0.00,$113.91,$0.00,$115.88,$0.00
71642520,SUP,HCPCS C1713,,71642520  -  SCREW BN 5MM 20MM SURESHOT,$510.00,$0.00,$510.00,$229.50,$363.99,$0.00,$87.87,$0.00,$0.00,$89.30,$510.00,$0.00,$255.00,$403.92,$408.00,$0.00,$79.82,$0.00,$81.19,$0.00
71642527,SUP,HCPCS C1713,,71642527  -  SCREW BN 5MM 27.5MM SURESHOT,$510.00,$0.00,$510.00,$229.50,$363.99,$0.00,$87.87,$0.00,$0.00,$89.30,$510.00,$0.00,$255.00,$403.92,$408.00,$0.00,$79.82,$0.00,$81.19,$0.00
71642530,SUP,HCPCS C1713,,71642530  -  SCREW BN 5MM 30MM SURESHOT,$510.00,$0.00,$510.00,$229.50,$363.99,$0.00,$87.87,$0.00,$0.00,$89.30,$510.00,$0.00,$255.00,$403.92,$408.00,$0.00,$79.82,$0.00,$81.19,$0.00
71642532,SUP,HCPCS C1713,,71642532  -  SCREW BN 5MM 32.5MM SURESHOT,$510.00,$0.00,$510.00,$229.50,$363.99,$0.00,$87.87,$0.00,$0.00,$89.30,$510.00,$0.00,$255.00,$403.92,$408.00,$0.00,$79.82,$0.00,$81.19,$0.00
71642535,SUP,HCPCS C1713,,71642535  -  SCREW BN 5MM 35MM SURESHOT,$510.00,$0.00,$510.00,$229.50,$363.99,$0.00,$87.87,$0.00,$0.00,$89.30,$510.00,$0.00,$255.00,$403.92,$408.00,$0.00,$79.82,$0.00,$81.19,$0.00
71642537,SUP,HCPCS C1713,,71642537  -  SCREW BN 5MM 37.5MM SURESHOT,$510.00,$0.00,$510.00,$229.50,$363.99,$0.00,$87.87,$0.00,$0.00,$89.30,$510.00,$0.00,$255.00,$403.92,$408.00,$0.00,$79.82,$0.00,$81.19,$0.00
71642540,SUP,HCPCS C1713,,71642540  -  SCREW BN 5MM 40MM SURESHOT,$510.00,$0.00,$510.00,$229.50,$363.99,$0.00,$87.87,$0.00,$0.00,$89.30,$510.00,$0.00,$255.00,$403.92,$408.00,$0.00,$79.82,$0.00,$81.19,$0.00
71642542,SUP,HCPCS C1713,,71642542  -  SCREW BN 5MM 42.5MM SURESHOT,$510.00,$0.00,$510.00,$229.50,$363.99,$0.00,$87.87,$0.00,$0.00,$89.30,$510.00,$0.00,$255.00,$403.92,$408.00,$0.00,$79.82,$0.00,$81.19,$0.00
71642545,SUP,HCPCS C1713,,71642545  -  SCREW BN 5MM 45MM SURESHOT,$510.00,$0.00,$510.00,$229.50,$363.99,$0.00,$87.87,$0.00,$0.00,$89.30,$510.00,$0.00,$255.00,$403.92,$408.00,$0.00,$79.82,$0.00,$81.19,$0.00
71642550,SUP,HCPCS C1713,,71642550  -  SCREW BN 5MM 50MM SURESHOT,$510.00,$0.00,$510.00,$229.50,$363.99,$0.00,$87.87,$0.00,$0.00,$89.30,$510.00,$0.00,$255.00,$403.92,$408.00,$0.00,$79.82,$0.00,$81.19,$0.00
71642552,SUP,HCPCS C1713,,71642552  -  SCREW BN 5MM 52.5MM SURESHOT,$510.00,$0.00,$510.00,$229.50,$363.99,$0.00,$87.87,$0.00,$0.00,$89.30,$510.00,$0.00,$255.00,$403.92,$408.00,$0.00,$79.82,$0.00,$81.19,$0.00
71642555,SUP,HCPCS C1713,,71642555  -  SCREW BN 5MM 55MM SURESHOT,$510.00,$0.00,$510.00,$229.50,$363.99,$0.00,$87.87,$0.00,$0.00,$89.30,$510.00,$0.00,$255.00,$403.92,$408.00,$0.00,$79.82,$0.00,$81.19,$0.00
71642557,SUP,HCPCS C1713,,71642557  -  SCREW BN 5MM 57.5MM SURESHOT,$510.00,$0.00,$510.00,$229.50,$363.99,$0.00,$87.87,$0.00,$0.00,$89.30,$510.00,$0.00,$255.00,$403.92,$408.00,$0.00,$79.82,$0.00,$81.19,$0.00
71642565,SUP,HCPCS C1713,,71642565  -  SCREW BN 5MM 65MM SURESHOT,$356.63,$0.00,$356.63,$160.48,$254.52,$0.00,$61.44,$0.00,$0.00,$62.44,$356.63,$0.00,$178.31,$282.45,$285.30,$0.00,$55.81,$0.00,$56.77,$0.00
71642575,SUP,HCPCS C1713,,71642575  -  SCREW BN 5MM 75MM SURESHOT,$510.00,$0.00,$510.00,$229.50,$363.99,$0.00,$87.87,$0.00,$0.00,$89.30,$510.00,$0.00,$255.00,$403.92,$408.00,$0.00,$79.82,$0.00,$81.19,$0.00
71642630,SUP,HCPCS C1713,,71642630  -  SCREW BN 2.5MM 30MM TN SURESHOT LG CMPR TROCH,$706.00,$0.00,$706.00,$317.70,$503.87,$0.00,$121.64,$0.00,$0.00,$123.61,$706.00,$0.00,$353.00,$559.15,$564.80,$0.00,$110.49,$0.00,$112.40,$0.00
71642735,SUP,HCPCS C1713,,71642735  -  SCREW SET 0MM TN SURESHOT,$630.00,$0.00,$630.00,$283.50,$449.63,$0.00,$108.55,$0.00,$0.00,$110.31,$630.00,$0.00,$315.00,$498.96,$504.00,$0.00,$98.60,$0.00,$100.30,$0.00
71642736,SUP,HCPCS C1713,,71642736  -  SCREW SET 5MM TN SURESHOT,$630.00,$0.00,$630.00,$283.50,$449.63,$0.00,$108.55,$0.00,$0.00,$110.31,$630.00,$0.00,$315.00,$498.96,$504.00,$0.00,$98.60,$0.00,$100.30,$0.00
71642737,SUP,HCPCS C1713,,71642737  -  SCREW SET 10MM TN SURESHOT,$630.00,$0.00,$630.00,$283.50,$449.63,$0.00,$108.55,$0.00,$0.00,$110.31,$630.00,$0.00,$315.00,$498.96,$504.00,$0.00,$98.60,$0.00,$100.30,$0.00
71642840,SUP,HCPCS C1713,,71642840  -  SCREW BN 4.5MM 40MM SURESHOT LNG BN,$510.00,$0.00,$510.00,$229.50,$363.99,$0.00,$87.87,$0.00,$0.00,$89.30,$510.00,$0.00,$255.00,$403.92,$408.00,$0.00,$79.82,$0.00,$81.19,$0.00
71642845,SUP,HCPCS C1713,,71642845  -  SCREW BN 4.5MM 45MM SURESHOT,$510.00,$0.00,$510.00,$229.50,$363.99,$0.00,$87.87,$0.00,$0.00,$89.30,$510.00,$0.00,$255.00,$403.92,$408.00,$0.00,$79.82,$0.00,$81.19,$0.00
71642850,SUP,HCPCS C1713,,71642850  -  SCREW BN 4.5MM 50MM SURESHOT,$510.00,$0.00,$510.00,$229.50,$363.99,$0.00,$87.87,$0.00,$0.00,$89.30,$510.00,$0.00,$255.00,$403.92,$408.00,$0.00,$79.82,$0.00,$81.19,$0.00
71642935,SUP,HCPCS C1713,,71642935  -  SCREW BN 35MM MT-TN CMPR FEM,$559.13,$0.00,$559.13,$251.61,$399.05,$0.00,$96.33,$0.00,$0.00,$97.90,$559.13,$0.00,$279.56,$442.83,$447.30,$0.00,$87.50,$0.00,$89.01,$0.00
71642936,SUP,HCPCS C1713,,71642936  -  SET SCR MT-TN INTGR CNN,$427.50,$0.00,$427.50,$192.38,$305.11,$0.00,$73.66,$0.00,$0.00,$74.85,$427.50,$0.00,$213.75,$338.58,$342.00,$0.00,$66.90,$0.00,$68.06,$0.00
71642937,SUP,HCPCS C1713,,71642937  -  SET SCR 5MM TRGN MT-TN,$427.50,$0.00,$427.50,$192.38,$305.11,$0.00,$73.66,$0.00,$0.00,$74.85,$427.50,$0.00,$213.75,$338.58,$342.00,$0.00,$66.90,$0.00,$68.06,$0.00
71642938,SUP,HCPCS C1713,,71642938  -  SCREW SET 10MM MT-TN MT-TN,$427.50,$0.00,$427.50,$192.38,$305.11,$0.00,$73.66,$0.00,$0.00,$74.85,$427.50,$0.00,$213.75,$338.58,$342.00,$0.00,$66.90,$0.00,$68.06,$0.00
71644536,SUP,HCPCS C1713,,71644536  -  NAIL IM 14.5MM 36CM LIME ANTGRD FEM,"$7,008.75",$0.00,"$7,008.75","$3,153.94","$5,002.14",$0.00,"$1,207.57",$0.00,$0.00,"$1,227.18","$7,008.75",$0.00,"$3,504.38","$5,550.93","$5,607.00",$0.00,"$1,096.87",$0.00,"$1,115.79",$0.00
71644538,SUP,HCPCS C1713,,71644538  -  NAIL IM 14.5MM 38CM LIME ANTGRD FEM,"$7,008.75",$0.00,"$7,008.75","$3,153.94","$5,002.14",$0.00,"$1,207.57",$0.00,$0.00,"$1,227.18","$7,008.75",$0.00,"$3,504.38","$5,550.93","$5,607.00",$0.00,"$1,096.87",$0.00,"$1,115.79",$0.00
71644540,SUP,HCPCS C1713,,71644540  -  NAIL IM 14.5MM 40CM LIME ANTGRD FEM,"$7,008.75",$0.00,"$7,008.75","$3,153.94","$5,002.14",$0.00,"$1,207.57",$0.00,$0.00,"$1,227.18","$7,008.75",$0.00,"$3,504.38","$5,550.93","$5,607.00",$0.00,"$1,096.87",$0.00,"$1,115.79",$0.00
71644542,SUP,HCPCS C1713,,71644542  -  NAIL IM 14.5MM 42CM LIME ANTGRD FEM,"$7,008.75",$0.00,"$7,008.75","$3,153.94","$5,002.14",$0.00,"$1,207.57",$0.00,$0.00,"$1,227.18","$7,008.75",$0.00,"$3,504.38","$5,550.93","$5,607.00",$0.00,"$1,096.87",$0.00,"$1,115.79",$0.00
71644544,SUP,HCPCS C1713,,71644544  -  NAIL IM 14.5MM 44CM LIME ANTGRD FEM,"$7,008.75",$0.00,"$7,008.75","$3,153.94","$5,002.14",$0.00,"$1,207.57",$0.00,$0.00,"$1,227.18","$7,008.75",$0.00,"$3,504.38","$5,550.93","$5,607.00",$0.00,"$1,096.87",$0.00,"$1,115.79",$0.00
71644636,SUP,HCPCS C1713,,71644636  -  NAIL IM 16MM 36CM LIME ANTGRD FEM,"$7,008.75",$0.00,"$7,008.75","$3,153.94","$5,002.14",$0.00,"$1,207.57",$0.00,$0.00,"$1,227.18","$7,008.75",$0.00,"$3,504.38","$5,550.93","$5,607.00",$0.00,"$1,096.87",$0.00,"$1,115.79",$0.00
71644638,SUP,HCPCS C1713,,71644638  -  NAIL IM 16MM 38CM LIME ANTGRD FEM,"$7,008.75",$0.00,"$7,008.75","$3,153.94","$5,002.14",$0.00,"$1,207.57",$0.00,$0.00,"$1,227.18","$7,008.75",$0.00,"$3,504.38","$5,550.93","$5,607.00",$0.00,"$1,096.87",$0.00,"$1,115.79",$0.00
71644640,SUP,HCPCS C1713,,71644640  -  NAIL IM 16MM 40CM LIME ANTGRD FEM,"$7,008.75",$0.00,"$7,008.75","$3,153.94","$5,002.14",$0.00,"$1,207.57",$0.00,$0.00,"$1,227.18","$7,008.75",$0.00,"$3,504.38","$5,550.93","$5,607.00",$0.00,"$1,096.87",$0.00,"$1,115.79",$0.00
71644642,SUP,HCPCS C1713,,71644642  -  NAIL IM 16MM 42CM LIME ANTGRD FEM,"$7,008.75",$0.00,"$7,008.75","$3,153.94","$5,002.14",$0.00,"$1,207.57",$0.00,$0.00,"$1,227.18","$7,008.75",$0.00,"$3,504.38","$5,550.93","$5,607.00",$0.00,"$1,096.87",$0.00,"$1,115.79",$0.00
71644644,SUP,HCPCS C1713,,71644644  -  NAIL IM 16MM 44CM LIME TRGN ANTGRD TI FEM LT,"$7,008.75",$0.00,"$7,008.75","$3,153.94","$5,002.14",$0.00,"$1,207.57",$0.00,$0.00,"$1,227.18","$7,008.75",$0.00,"$3,504.38","$5,550.93","$5,607.00",$0.00,"$1,096.87",$0.00,"$1,115.79",$0.00
71645020,SUP,HCPCS C1713,,71645020  -  SCREW BN 5MM 20MM TRGN LOPRFL FEM,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71645022,SUP,HCPCS C1713,,71645022  -  SCREW BONE 5MM 22.5MM TRGN FEM LP HEXDRIVER,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71645025,SUP,HCPCS C1713,,71645025  -  SCREW BN 5MM 25MM LOPRFL INTNL HEX FEM TRGN IM NL SYS,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71645027,SUP,HCPCS C1713,,71645027  -  SCREW BN 5MM 27MM LOPRFL INTNL HEX FEM TRGN IM NL SYS,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71645030,SUP,HCPCS C1713,,71645030  -  SCREW BN 5MM 30MM LOPRFL INTNL HEX FEM TRGN IM NL SYS,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71645032,SUP,HCPCS C1713,,71645032  -  SCREW BN 5MM 32.5MM LOPRFL INTNL HEX FEM TRGN IM NL SYS,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71645035,SUP,HCPCS C1713,,71645035  -  SCREW BN 5MM 35MM LOPRFL INTNL HEX FEM TRGN IM NL SYS,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71645037,SUP,HCPCS C1713,,71645037  -  SCREW BN 5MM 37.5MM LOPRFL INTNL HEX FEM TRGN IM NL SYS,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71645040,SUP,HCPCS C1713,,71645040  -  SCREW BN 5MM 40MM LOPRFL INTNL HEX FEM TRGN IM NL SYS,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71645042,SUP,HCPCS C1713,,71645042  -  SCREW BN 5MM 42.5MM LOPRFL INTNL HEX FEM TRGN IM NL SYS,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71645045,SUP,HCPCS C1713,,71645045  -  SCREW BN 5MM 45MM LOPRFL INTNL HEX FEM TRGN IM NL SYS,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71645047,SUP,HCPCS C1713,,71645047  -  SCREW BN 5MM 47.5MM LOPRFL INTNL HEX FEM TRGN IM NL SYS,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71645050,SUP,HCPCS C1713,,71645050  -  SCREW BN 5MM 50MM LOPRFL INTNL HEX FEM TRGN IM NL SYS,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71645052,SUP,HCPCS C1713,,71645052  -  SCREW BN 5MM 52.5MM LOPRFL INTNL HEX FEM TRGN IM NL SYS,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71645055,SUP,HCPCS C1713,,71645055  -  SCREW BN 5MM 55MM LOPRFL INTNL HEX FEM TRGN IM NL SYS,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71645057,SUP,HCPCS C1713,,71645057  -  SCREW BN 5MM 57MM LOPRFL INTNL HEX FEM TRGN IM NL SYS,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71645060,SUP,HCPCS C1713,,71645060  -  SCREW BN 5MM 60MM LOPRFL INTNL HEX FEM TRGN IM NL SYS,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71645062,SUP,HCPCS C1713,,71645062  -  SCREW BONE 5MM 62.5MM LP TRIGEN FEMUR,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71645065,SUP,HCPCS C1713,,71645065  -  SCREW BN LOPRFL 5MM 65MM TRGN FEM IM NL SYS,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71645067,SUP,HCPCS C1713,,71645067  -  SCREW BN 5MM 67MM LOPRFL INTNL HEX FEM TRGN IM NL SYS,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71645070,SUP,HCPCS C1713,,71645070  -  SCREW BN 5MM 70MM LOPRFL INTNL HEX FEM TRGN IM NL SYS,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71645072,SUP,HCPCS C1713,,71645072  -  SCREW BN 5MM 72MM LOPRFL INTNL HEX FEM TRGN IM NL SYS,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71645075,SUP,HCPCS C1713,,71645075  -  SCREW BN 5MM 75MM LOPRFL INTNL HEX FEM TRGN IM NL SYS,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71645077,SUP,HCPCS C1713,,71645077  -  SCREW BONE 5MM 77.5MM LP TRIGEN FEMUR,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71645080,SUP,HCPCS C1713,,71645080  -  SCREW BN 5MM 80MM LOPRFL INTNL HEX FEM TRGN IM NL SYS,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71645085,SUP,HCPCS C1713,,71645085  -  SCREW BN LOPRFL 5MM 85MM TRGN FEM IM NL SYS,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71645090,SUP,HCPCS C1713,,71645090  -  SCREW BN LOPRFL 5MM 90MM TRGN FEM IM NL SYS,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71645095,SUP,HCPCS C1713,,71645095  -  SCREW BN 5MM 95MM TRGN LOPRFL HEXDRIVER FEM,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71645100,SUP,HCPCS C1713,,71645100  -  SCREW BONE 5MM 100MM TRGN FEM LP,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71645105,SUP,HCPCS C1713,,71645105  -  SCREW BN 5MM 105MM TRGN LOPRFL IM NL SYS,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71645110,SUP,HCPCS C1713,,71645110  -  SCREW BN 5MM 110MM TRGN LOPRFL IM NL SYS,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71645124,SUP,HCPCS C1713,,71645124  -  NAIL IM 130D 8.5MM 24CM LIME TRGN ANTGRD TI ADLT FEM LT,"$3,751.88",$0.00,"$3,751.88","$1,688.34","$2,677.71",$0.00,$646.43,$0.00,$0.00,$656.92,"$3,751.88",$0.00,"$1,875.94","$2,971.49","$3,001.50",$0.00,$587.17,$0.00,$597.30,$0.00
71645126,SUP,HCPCS C1713,,71645126  -  NAIL IM 130D 8.5MM 26CM LIME TRGN ANTGRD TI PED LT TROCH,"$3,751.88",$0.00,"$3,751.88","$1,688.34","$2,677.71",$0.00,$646.43,$0.00,$0.00,$656.92,"$3,751.88",$0.00,"$1,875.94","$2,971.49","$3,001.50",$0.00,$587.17,$0.00,$597.30,$0.00
71645128,SUP,HCPCS C1713,,71645128  -  NAIL IM 130D 8.5MM 28CM TRGN ANTGRD TI PED LT TROCH,"$3,751.88",$0.00,"$3,751.88","$1,688.34","$2,677.71",$0.00,$646.43,$0.00,$0.00,$656.92,"$3,751.88",$0.00,"$1,875.94","$2,971.49","$3,001.50",$0.00,$587.17,$0.00,$597.30,$0.00
71645130,SUP,HCPCS C1713,,71645130  -  NAIL IM 130D 8.5MM 30CM LIME TRGN ANTGRD TI PED LT TROCH,"$3,751.88",$0.00,"$3,751.88","$1,688.34","$2,677.71",$0.00,$646.43,$0.00,$0.00,$656.92,"$3,751.88",$0.00,"$1,875.94","$2,971.49","$3,001.50",$0.00,$587.17,$0.00,$597.30,$0.00
71645132,SUP,HCPCS C1713,,71645132  -  NAIL IM 130D 8.5MM 32CM LIME TRGN ANTGRD PED LT TROCH,"$3,751.88",$0.00,"$3,751.88","$1,688.34","$2,677.71",$0.00,$646.43,$0.00,$0.00,$656.92,"$3,751.88",$0.00,"$1,875.94","$2,971.49","$3,001.50",$0.00,$587.17,$0.00,$597.30,$0.00
71645134,SUP,HCPCS C1713,,71645134  -  NAIL IM 130D 8.5MM 34CM LIME TRGN ANTGRD TI ADLT FEM LT,"$3,751.88",$0.00,"$3,751.88","$1,688.34","$2,677.71",$0.00,$646.43,$0.00,$0.00,$656.92,"$3,751.88",$0.00,"$1,875.94","$2,971.49","$3,001.50",$0.00,$587.17,$0.00,$597.30,$0.00
71645136,SUP,HCPCS C1713,,71645136  -  NAIL IM 130D 8.5MM 36CM LIME TRGN ANTGRD SET TI PED LT TROCH,"$3,751.88",$0.00,"$3,751.88","$1,688.34","$2,677.71",$0.00,$646.43,$0.00,$0.00,$656.92,"$3,751.88",$0.00,"$1,875.94","$2,971.49","$3,001.50",$0.00,$587.17,$0.00,$597.30,$0.00
71645138,SUP,HCPCS C1713,,71645138  -  NAIL IM 130D 8.5MM 38CM LIME TRGN ANTGRD TI ADLT FEM LT,"$3,751.88",$0.00,"$3,751.88","$1,688.34","$2,677.71",$0.00,$646.43,$0.00,$0.00,$656.92,"$3,751.88",$0.00,"$1,875.94","$2,971.49","$3,001.50",$0.00,$587.17,$0.00,$597.30,$0.00
71645140,SUP,HCPCS C1713,,71645140  -  NAIL IM 130D 8.5MM 40CM LIME TRGN ANTGRD SET TI PED LT TROCH,"$3,751.88",$0.00,"$3,751.88","$1,688.34","$2,677.71",$0.00,$646.43,$0.00,$0.00,$656.92,"$3,751.88",$0.00,"$1,875.94","$2,971.49","$3,001.50",$0.00,$587.17,$0.00,$597.30,$0.00
71645420,SUP,HCPCS C1713,,71645420  -  SCREW BN 4.5MM 20MM TRGN LOPRFL IM NL SYS,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71645422,SUP,HCPCS C1713,,71645422  -  SCREW BN 4.5MM 22.5MM TRGN LOPRFL IM NL SYS,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71645425,SUP,HCPCS C1713,,71645425  -  SCREW BN LOPRFL 4.5MM 25MM TRGN FEM IM NL SYS,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71645427,SUP,HCPCS C1713,,71645427  -  SCREW BONE 4.5MM 27.5MM TRGN LP IM NL SYS,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71645430,SUP,HCPCS C1713,,71645430  -  SCREW BN LOPRFL 4.5MM 30MM TRGN FEM IM NL SYS,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71645432,SUP,HCPCS C1713,,71645432  -  SCREW BN 4.5MM 32.5MM LOPRFL INTNL CPTR FEM TRGN IM NL SYS,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71645435,SUP,HCPCS C1713,,71645435  -  SCREW BONE LP 4.5MM 35MM TRIGEN FEMUR INTRAMEDULLARY NAIL,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71645437,SUP,HCPCS C1713,,71645437  -  SCREW BN 4.5MM 37.5MM TRGN LOPRFL IM NL SYS,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71645440,SUP,HCPCS C1713,,71645440  -  SCREW BN 4.5MM 40MM LOPRFL INTNL CPTR FEM TRGN IM NL SYS,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71645442,SUP,HCPCS C1713,,71645442  -  SCREW BN 4.5MM 42.5MM TRGN LOPRFL FEM,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71645445,SUP,HCPCS C1713,,71645445  -  SCREW BN 4.5MM 45MM LOPRFL INTNL CPTR FEM TRGN IM NL SYS,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71645447,SUP,HCPCS C1713,,71645447  -  SCREW BN 4.5MM 47.5MM TRGN LOPRFL IM NL SYS,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71645450,SUP,HCPCS C1713,,71645450  -  SCREW BN 4.5MM 50MM LOPRFL INTNL CPTR FEM TRGN IM NL SYS,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71645452,SUP,HCPCS C1713,,71645452  -  SCREW BN 4.5MM 52.5MM TRGN LOPRFL IM NL SYS,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71645455,SUP,HCPCS C1713,,71645455  -  SCREW BN 4.5MM 55MM TRGN LOPRFL IM NL SYS,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71645457,SUP,HCPCS C1713,,71645457  -  SCREW BN 4.5MM 57.5MM TRGN LOPRFL IM NL SYS,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71645460,SUP,HCPCS C1713,,71645460  -  SCREW BN 4.5MM 60MM TRGN LOPRFL IM NL SYS,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71645462,SUP,HCPCS C1713,,71645462  -  SCREW BN 4.5MM 62.5MM TRGN LOPRFL IM NL SYS,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71645465,SUP,HCPCS C1713,,71645465  -  SCREW BN 4.5MM 6.5MM TRGN LOPRFL FEM,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
71645536,SUP,HCPCS C1713,,71645536  -  NAIL IM 14.5MM 36CM ROSE ANTGRD FEM RT,"$7,008.75",$0.00,"$7,008.75","$3,153.94","$5,002.14",$0.00,"$1,207.57",$0.00,$0.00,"$1,227.18","$7,008.75",$0.00,"$3,504.38","$5,550.93","$5,607.00",$0.00,"$1,096.87",$0.00,"$1,115.79",$0.00
71645538,SUP,HCPCS C1713,,71645538  -  NAIL IM 14.5MM 38CM ROSE ANTGRD FEM RT,"$7,008.75",$0.00,"$7,008.75","$3,153.94","$5,002.14",$0.00,"$1,207.57",$0.00,$0.00,"$1,227.18","$7,008.75",$0.00,"$3,504.38","$5,550.93","$5,607.00",$0.00,"$1,096.87",$0.00,"$1,115.79",$0.00
71645540,SUP,HCPCS C1713,,71645540  -  NAIL IM 14.5MM 40CM ROSE TRGN ANTGRD TI FEM RT,"$7,008.75",$0.00,"$7,008.75","$3,153.94","$5,002.14",$0.00,"$1,207.57",$0.00,$0.00,"$1,227.18","$7,008.75",$0.00,"$3,504.38","$5,550.93","$5,607.00",$0.00,"$1,096.87",$0.00,"$1,115.79",$0.00
71645542,SUP,HCPCS C1713,,71645542  -  NAIL IM 14.5MM 42CM ROSE ANTGRD FEM RT,"$7,008.75",$0.00,"$7,008.75","$3,153.94","$5,002.14",$0.00,"$1,207.57",$0.00,$0.00,"$1,227.18","$7,008.75",$0.00,"$3,504.38","$5,550.93","$5,607.00",$0.00,"$1,096.87",$0.00,"$1,115.79",$0.00
71645544,SUP,HCPCS C1713,,71645544  -  NAIL IM 14.5MM 44CM ROSE ANTGRD FEM RT,"$7,008.75",$0.00,"$7,008.75","$3,153.94","$5,002.14",$0.00,"$1,207.57",$0.00,$0.00,"$1,227.18","$7,008.75",$0.00,"$3,504.38","$5,550.93","$5,607.00",$0.00,"$1,096.87",$0.00,"$1,115.79",$0.00
71645636,SUP,HCPCS C1713,,71645636  -  NAIL IM 16MM 36CM ROSE TRGN ANTGRD TI FEM RT,"$7,008.75",$0.00,"$7,008.75","$3,153.94","$5,002.14",$0.00,"$1,207.57",$0.00,$0.00,"$1,227.18","$7,008.75",$0.00,"$3,504.38","$5,550.93","$5,607.00",$0.00,"$1,096.87",$0.00,"$1,115.79",$0.00
71645638,SUP,HCPCS C1713,,71645638  -  NAIL IM 16MM 38CM ROSE TRGN ANTGRD TI FEM RT,"$7,008.75",$0.00,"$7,008.75","$3,153.94","$5,002.14",$0.00,"$1,207.57",$0.00,$0.00,"$1,227.18","$7,008.75",$0.00,"$3,504.38","$5,550.93","$5,607.00",$0.00,"$1,096.87",$0.00,"$1,115.79",$0.00
71645640,SUP,HCPCS C1713,,71645640  -  NAIL IM 16MM 40CM ROSE TRGN ANTGRD TI FEM RT,"$7,008.75",$0.00,"$7,008.75","$3,153.94","$5,002.14",$0.00,"$1,207.57",$0.00,$0.00,"$1,227.18","$7,008.75",$0.00,"$3,504.38","$5,550.93","$5,607.00",$0.00,"$1,096.87",$0.00,"$1,115.79",$0.00
71645642,SUP,HCPCS C1713,,71645642  -  NAIL IM 16MM 42CM ROSE TRGN ANTGRD TI FEM RT,"$7,008.75",$0.00,"$7,008.75","$3,153.94","$5,002.14",$0.00,"$1,207.57",$0.00,$0.00,"$1,227.18","$7,008.75",$0.00,"$3,504.38","$5,550.93","$5,607.00",$0.00,"$1,096.87",$0.00,"$1,115.79",$0.00
71645644,SUP,HCPCS C1713,,71645644  -  NAIL IM 16MM 44CM ROSE TRGN ANTGRD TI FEM RT,"$7,008.75",$0.00,"$7,008.75","$3,153.94","$5,002.14",$0.00,"$1,207.57",$0.00,$0.00,"$1,227.18","$7,008.75",$0.00,"$3,504.38","$5,550.93","$5,607.00",$0.00,"$1,096.87",$0.00,"$1,115.79",$0.00
71646124,SUP,HCPCS C1713,,71646124  -  NAIL IM 130D 8.5MM 24CM ROSE TRGN ANTGRD TI ADLT FEM RT,"$3,751.88",$0.00,"$3,751.88","$1,688.34","$2,677.71",$0.00,$646.43,$0.00,$0.00,$656.92,"$3,751.88",$0.00,"$1,875.94","$2,971.49","$3,001.50",$0.00,$587.17,$0.00,$597.30,$0.00
71646126,SUP,HCPCS C1713,,71646126  -  NAIL IM 130D 8.5MM 26CM ROSE TRGN ANTGRD TI ADLT FEM RT,"$3,751.88",$0.00,"$3,751.88","$1,688.34","$2,677.71",$0.00,$646.43,$0.00,$0.00,$656.92,"$3,751.88",$0.00,"$1,875.94","$2,971.49","$3,001.50",$0.00,$587.17,$0.00,$597.30,$0.00
71646128,SUP,HCPCS C1713,,71646128  -  NAIL IM 130D 8.5MM 28CM ROSE TRGN ANTGRD TI ADLT FEM RT,"$3,751.88",$0.00,"$3,751.88","$1,688.34","$2,677.71",$0.00,$646.43,$0.00,$0.00,$656.92,"$3,751.88",$0.00,"$1,875.94","$2,971.49","$3,001.50",$0.00,$587.17,$0.00,$597.30,$0.00
71646130,SUP,HCPCS C1713,,71646130  -  NAIL IM 8.5MM 30CM TN RT,"$3,751.88",$0.00,"$3,751.88","$1,688.34","$2,677.71",$0.00,$646.43,$0.00,$0.00,$656.92,"$3,751.88",$0.00,"$1,875.94","$2,971.49","$3,001.50",$0.00,$587.17,$0.00,$597.30,$0.00
71646132,SUP,HCPCS C1713,,71646132  -  NAIL IM 130D 8.5MM 32CM ROSE TRGN ANTGRD TI ADLT FEM RT,"$3,751.88",$0.00,"$3,751.88","$1,688.34","$2,677.71",$0.00,$646.43,$0.00,$0.00,$656.92,"$3,751.88",$0.00,"$1,875.94","$2,971.49","$3,001.50",$0.00,$587.17,$0.00,$597.30,$0.00
71646134,SUP,HCPCS C1713,,71646134  -  NAIL IM 130D 8.5MM 34CM ROSE TRGN ANTGRD TI ADLT FEM RT,"$3,751.88",$0.00,"$3,751.88","$1,688.34","$2,677.71",$0.00,$646.43,$0.00,$0.00,$656.92,"$3,751.88",$0.00,"$1,875.94","$2,971.49","$3,001.50",$0.00,$587.17,$0.00,$597.30,$0.00
71646136,SUP,HCPCS C1713,,71646136  -  NAIL IM 130D 8.5MM 36CM ROSE TRGN ANTGRD TI ADLT FEM RT,"$3,751.88",$0.00,"$3,751.88","$1,688.34","$2,677.71",$0.00,$646.43,$0.00,$0.00,$656.92,"$3,751.88",$0.00,"$1,875.94","$2,971.49","$3,001.50",$0.00,$587.17,$0.00,$597.30,$0.00
71646138,SUP,HCPCS C1713,,71646138  -  NAIL INTRAMEDULLARY 130D 8.5MM 38CM ANTEGRADE TRIGEN ROSE,"$3,751.88",$0.00,"$3,751.88","$1,688.34","$2,677.71",$0.00,$646.43,$0.00,$0.00,$656.92,"$3,751.88",$0.00,"$1,875.94","$2,971.49","$3,001.50",$0.00,$587.17,$0.00,$597.30,$0.00
71646140,SUP,HCPCS C1713,,71646140  -  NAIL IM 130D 8.5MM 40CM ROSE TRGN ANTGRD TI PED RT TROCH,"$3,751.88",$0.00,"$3,751.88","$1,688.34","$2,677.71",$0.00,$646.43,$0.00,$0.00,$656.92,"$3,751.88",$0.00,"$1,875.94","$2,971.49","$3,001.50",$0.00,$587.17,$0.00,$597.30,$0.00
71647230,SUP,HCPCS C1713,,71647230  -  NAIL IM 130D 10MM 30CM LIME TRGN ANTGRD TI LT TROCH,"$4,050.00",$0.00,"$4,050.00","$1,822.50","$2,890.49",$0.00,$697.79,$0.00,$0.00,$709.12,"$4,050.00",$0.00,"$2,025.00","$3,207.60","$3,240.00",$0.00,$633.83,$0.00,$644.76,$0.00
71647232,SUP,HCPCS C1713,,71647232  -  NAIL IM 130D 10MM 32CM LIME TRGN ANTGRD TI LT TROCH,"$4,050.00",$0.00,"$4,050.00","$1,822.50","$2,890.49",$0.00,$697.79,$0.00,$0.00,$709.12,"$4,050.00",$0.00,"$2,025.00","$3,207.60","$3,240.00",$0.00,$633.83,$0.00,$644.76,$0.00
71647234,SUP,HCPCS C1713,,71647234  -  NAIL IM 130D 10MM 34CM LIME TRGN ANTGRD TI LT TROCH,"$4,050.00",$0.00,"$4,050.00","$1,822.50","$2,890.49",$0.00,$697.79,$0.00,$0.00,$709.12,"$4,050.00",$0.00,"$2,025.00","$3,207.60","$3,240.00",$0.00,$633.83,$0.00,$644.76,$0.00
71647236,SUP,HCPCS C1713,,71647236  -  NAIL INTRAMEDULLARY 130D 10MM 36CM ANTEGRADE TRIGEN LIME,"$4,050.00",$0.00,"$4,050.00","$1,822.50","$2,890.49",$0.00,$697.79,$0.00,$0.00,$709.12,"$4,050.00",$0.00,"$2,025.00","$3,207.60","$3,240.00",$0.00,$633.83,$0.00,$644.76,$0.00
71647238,SUP,HCPCS C1713,,71647238  -  NAIL IM 130D 10MM 38CM LIME TRGN ANTGRD TI LT TROCH,"$4,050.00",$0.00,"$4,050.00","$1,822.50","$2,890.49",$0.00,$697.79,$0.00,$0.00,$709.12,"$4,050.00",$0.00,"$2,025.00","$3,207.60","$3,240.00",$0.00,$633.83,$0.00,$644.76,$0.00
71647240,SUP,HCPCS C1713,,71647240  -  NAIL INTRAMEDULLARY 130D 10MM 40CM ANTEGRADE TRIGEN LIME,"$4,050.00",$0.00,"$4,050.00","$1,822.50","$2,890.49",$0.00,$697.79,$0.00,$0.00,$709.12,"$4,050.00",$0.00,"$2,025.00","$3,207.60","$3,240.00",$0.00,$633.83,$0.00,$644.76,$0.00
71647242,SUP,HCPCS C1713,,71647242  -  NAIL IM 130D 10MM 42CM LIME TRGN ANTGRD TI LT TROCH,"$4,050.00",$0.00,"$4,050.00","$1,822.50","$2,890.49",$0.00,$697.79,$0.00,$0.00,$709.12,"$4,050.00",$0.00,"$2,025.00","$3,207.60","$3,240.00",$0.00,$633.83,$0.00,$644.76,$0.00
71647244,SUP,HCPCS C1713,,71647244  -  NAIL IM 130D 10MM 44CM LIME TRGN ANTGRD TI LT TROCH,"$4,050.00",$0.00,"$4,050.00","$1,822.50","$2,890.49",$0.00,$697.79,$0.00,$0.00,$709.12,"$4,050.00",$0.00,"$2,025.00","$3,207.60","$3,240.00",$0.00,$633.83,$0.00,$644.76,$0.00
71647246,SUP,HCPCS C1713,,71647246  -  NAIL INTRAMEDULLARY 130D 10MM 46CM ANTEGRADE TRIGEN LIME,"$4,050.00",$0.00,"$4,050.00","$1,822.50","$2,890.49",$0.00,$697.79,$0.00,$0.00,$709.12,"$4,050.00",$0.00,"$2,025.00","$3,207.60","$3,240.00",$0.00,$633.83,$0.00,$644.76,$0.00
71647248,SUP,HCPCS C1713,,71647248  -  NAIL IM 130D 10MM 48CM LIME TRGN ANTGRD TI LT TROCH,"$4,050.00",$0.00,"$4,050.00","$1,822.50","$2,890.49",$0.00,$697.79,$0.00,$0.00,$709.12,"$4,050.00",$0.00,"$2,025.00","$3,207.60","$3,240.00",$0.00,$633.83,$0.00,$644.76,$0.00
71647250,SUP,HCPCS C1713,,71647250  -  NAIL IM 130D 10MM 50CM LIME TRGN ANTGRD TI LT TROCH,"$4,050.00",$0.00,"$4,050.00","$1,822.50","$2,890.49",$0.00,$697.79,$0.00,$0.00,$709.12,"$4,050.00",$0.00,"$2,025.00","$3,207.60","$3,240.00",$0.00,$633.83,$0.00,$644.76,$0.00
71647330,SUP,HCPCS C1713,,71647330  -  NAIL IM 130D 11.5MM 30CM LIME TRGN ANTGRD TI LT TROCH,"$4,050.00",$0.00,"$4,050.00","$1,822.50","$2,890.49",$0.00,$697.79,$0.00,$0.00,$709.12,"$4,050.00",$0.00,"$2,025.00","$3,207.60","$3,240.00",$0.00,$633.83,$0.00,$644.76,$0.00
71647332,SUP,HCPCS C1713,,71647332  -  NAIL IM 130D 11.5MM 32CM LIME TRGN ANTGRD TI LT TROCH,"$4,050.00",$0.00,"$4,050.00","$1,822.50","$2,890.49",$0.00,$697.79,$0.00,$0.00,$709.12,"$4,050.00",$0.00,"$2,025.00","$3,207.60","$3,240.00",$0.00,$633.83,$0.00,$644.76,$0.00
71647334,SUP,HCPCS C1713,,71647334  -  NAIL IM 130D 11.5MM 34CM LIME TRGN ANTGRD TI LT TROCH,"$4,050.00",$0.00,"$4,050.00","$1,822.50","$2,890.49",$0.00,$697.79,$0.00,$0.00,$709.12,"$4,050.00",$0.00,"$2,025.00","$3,207.60","$3,240.00",$0.00,$633.83,$0.00,$644.76,$0.00
71647336,SUP,HCPCS C1713,,71647336  -  NAIL IM 130D 11.5MM 36CM LIME TRGN ANTGRD TI LT TROCH,"$4,050.00",$0.00,"$4,050.00","$1,822.50","$2,890.49",$0.00,$697.79,$0.00,$0.00,$709.12,"$4,050.00",$0.00,"$2,025.00","$3,207.60","$3,240.00",$0.00,$633.83,$0.00,$644.76,$0.00
71647338,SUP,HCPCS C1713,,71647338  -  NAIL INTRAMEDULLARY 130D 11.5MM 38CM 5 HOLE STATIC DYNAMIC,"$4,050.00",$0.00,"$4,050.00","$1,822.50","$2,890.49",$0.00,$697.79,$0.00,$0.00,$709.12,"$4,050.00",$0.00,"$2,025.00","$3,207.60","$3,240.00",$0.00,$633.83,$0.00,$644.76,$0.00
71647340,SUP,HCPCS C1713,,71647340  -  NAIL INTRAMEDULLARY 130D 11.5MM 40CM 5 HOLE STATIC DYNAMIC,"$4,050.00",$0.00,"$4,050.00","$1,822.50","$2,890.49",$0.00,$697.79,$0.00,$0.00,$709.12,"$4,050.00",$0.00,"$2,025.00","$3,207.60","$3,240.00",$0.00,$633.83,$0.00,$644.76,$0.00
71647342,SUP,HCPCS C1713,,71647342  -  NAIL INTRAMEDULLARY 130D 11.5MM 42CM ANTEGRADE TRIGEN LIME,"$4,050.00",$0.00,"$4,050.00","$1,822.50","$2,890.49",$0.00,$697.79,$0.00,$0.00,$709.12,"$4,050.00",$0.00,"$2,025.00","$3,207.60","$3,240.00",$0.00,$633.83,$0.00,$644.76,$0.00
71647346,SUP,HCPCS C1713,,71647346  -  NAIL IM 130D 11.5MM 46CM LIME TRGN ANTGRD TI LT TROCH,"$4,050.00",$0.00,"$4,050.00","$1,822.50","$2,890.49",$0.00,$697.79,$0.00,$0.00,$709.12,"$4,050.00",$0.00,"$2,025.00","$3,207.60","$3,240.00",$0.00,$633.83,$0.00,$644.76,$0.00
71647348,SUP,HCPCS C1713,,71647348  -  NAIL IM 130D 11.5MM 48CM LIME TRGN ANTGRD TI LT TROCH,"$4,050.00",$0.00,"$4,050.00","$1,822.50","$2,890.49",$0.00,$697.79,$0.00,$0.00,$709.12,"$4,050.00",$0.00,"$2,025.00","$3,207.60","$3,240.00",$0.00,$633.83,$0.00,$644.76,$0.00
71647350,SUP,HCPCS C1713,,71647350  -  NAIL IM 130D 11.5MM 50CM LIME TRGN ANTGRD TI LT TROCH,"$4,050.00",$0.00,"$4,050.00","$1,822.50","$2,890.49",$0.00,$697.79,$0.00,$0.00,$709.12,"$4,050.00",$0.00,"$2,025.00","$3,207.60","$3,240.00",$0.00,$633.83,$0.00,$644.76,$0.00
71647430,SUP,HCPCS C1713,,71647430  -  NAIL IM 130D 13MM 30CM LIME TRGN ANTGRD TI LT TROCH,"$4,050.00",$0.00,"$4,050.00","$1,822.50","$2,890.49",$0.00,$697.79,$0.00,$0.00,$709.12,"$4,050.00",$0.00,"$2,025.00","$3,207.60","$3,240.00",$0.00,$633.83,$0.00,$644.76,$0.00
71647432,SUP,HCPCS C1713,,71647432  -  NAIL IM 130D 13MM 32CM LIME TRGN ANTGRD TI LT TROCH,"$4,050.00",$0.00,"$4,050.00","$1,822.50","$2,890.49",$0.00,$697.79,$0.00,$0.00,$709.12,"$4,050.00",$0.00,"$2,025.00","$3,207.60","$3,240.00",$0.00,$633.83,$0.00,$644.76,$0.00
71647434,SUP,HCPCS C1713,,71647434  -  NAIL IM 130D 13MM 34CM LIME TRGN ANTGRD TI LT TROCH,"$4,050.00",$0.00,"$4,050.00","$1,822.50","$2,890.49",$0.00,$697.79,$0.00,$0.00,$709.12,"$4,050.00",$0.00,"$2,025.00","$3,207.60","$3,240.00",$0.00,$633.83,$0.00,$644.76,$0.00
71647436,SUP,HCPCS C1713,,71647436  -  NAIL IM 130D 13MM 36CM LIME TRGN ANTGRD TI LT TROCH,"$4,050.00",$0.00,"$4,050.00","$1,822.50","$2,890.49",$0.00,$697.79,$0.00,$0.00,$709.12,"$4,050.00",$0.00,"$2,025.00","$3,207.60","$3,240.00",$0.00,$633.83,$0.00,$644.76,$0.00
71647438,SUP,HCPCS C1713,,71647438  -  NAIL IM 130D 13MM 38CM LIME TRGN ANTGRD TI LT TROCH IM NL,"$4,050.00",$0.00,"$4,050.00","$1,822.50","$2,890.49",$0.00,$697.79,$0.00,$0.00,$709.12,"$4,050.00",$0.00,"$2,025.00","$3,207.60","$3,240.00",$0.00,$633.83,$0.00,$644.76,$0.00
71647440,SUP,HCPCS C1713,,71647440  -  NAIL IM 130D 13MM 40CM LIME TRGN ANTGRD TI LT TROCH,"$4,050.00",$0.00,"$4,050.00","$1,822.50","$2,890.49",$0.00,$697.79,$0.00,$0.00,$709.12,"$4,050.00",$0.00,"$2,025.00","$3,207.60","$3,240.00",$0.00,$633.83,$0.00,$644.76,$0.00
71647442,SUP,HCPCS C1713,,71647442  -  NAIL IM 130D 13MM 42CM LIME TRGN ANTGRD TI LT TROCH,"$4,050.00",$0.00,"$4,050.00","$1,822.50","$2,890.49",$0.00,$697.79,$0.00,$0.00,$709.12,"$4,050.00",$0.00,"$2,025.00","$3,207.60","$3,240.00",$0.00,$633.83,$0.00,$644.76,$0.00
71647444,SUP,HCPCS C1713,,71647444  -  NAIL IM 130D 13MM 44CM LIME TRGN TN 5 HL STC DYNMC PROX DIST,"$4,050.00",$0.00,"$4,050.00","$1,822.50","$2,890.49",$0.00,$697.79,$0.00,$0.00,$709.12,"$4,050.00",$0.00,"$2,025.00","$3,207.60","$3,240.00",$0.00,$633.83,$0.00,$644.76,$0.00
71647446,SUP,HCPCS C1713,,71647446  -  NAIL IM 130D 13MM 46CM LIME TRGN ANTGRD TI LT TROCH,"$4,050.00",$0.00,"$4,050.00","$1,822.50","$2,890.49",$0.00,$697.79,$0.00,$0.00,$709.12,"$4,050.00",$0.00,"$2,025.00","$3,207.60","$3,240.00",$0.00,$633.83,$0.00,$644.76,$0.00
71647448,SUP,HCPCS C1713,,71647448  -  NAIL IM 130D 13MM 48CM LIME TRGN ANTGRD TI LT TROCH,"$4,050.00",$0.00,"$4,050.00","$1,822.50","$2,890.49",$0.00,$697.79,$0.00,$0.00,$709.12,"$4,050.00",$0.00,"$2,025.00","$3,207.60","$3,240.00",$0.00,$633.83,$0.00,$644.76,$0.00
71647450,SUP,HCPCS C1713,,71647450  -  NAIL IM 130D 13MM 50CM LIME TRGN ANTGRD TI LT TROCH,"$4,050.00",$0.00,"$4,050.00","$1,822.50","$2,890.49",$0.00,$697.79,$0.00,$0.00,$709.12,"$4,050.00",$0.00,"$2,025.00","$3,207.60","$3,240.00",$0.00,$633.83,$0.00,$644.76,$0.00
71648230,SUP,HCPCS C1713,,71648230  -  NAIL IM 130D 10MM 30CM ROSE TRGN ANTGRD TI RT TROCH,"$4,050.00",$0.00,"$4,050.00","$1,822.50","$2,890.49",$0.00,$697.79,$0.00,$0.00,$709.12,"$4,050.00",$0.00,"$2,025.00","$3,207.60","$3,240.00",$0.00,$633.83,$0.00,$644.76,$0.00
71648232,SUP,HCPCS C1713,,71648232  -  NAIL IM 130D 10MM 32CM ROSE TRGN ANTGRD TI RT TROCH,"$4,050.00",$0.00,"$4,050.00","$1,822.50","$2,890.49",$0.00,$697.79,$0.00,$0.00,$709.12,"$4,050.00",$0.00,"$2,025.00","$3,207.60","$3,240.00",$0.00,$633.83,$0.00,$644.76,$0.00
71648234,SUP,HCPCS C1713,,71648234  -  NAIL IM 130D 10MM 34CM ROSE TRGN TN 5 HL STC DYNMC RND XSECT,"$4,050.00",$0.00,"$4,050.00","$1,822.50","$2,890.49",$0.00,$697.79,$0.00,$0.00,$709.12,"$4,050.00",$0.00,"$2,025.00","$3,207.60","$3,240.00",$0.00,$633.83,$0.00,$644.76,$0.00
71648236,SUP,HCPCS C1713,,71648236  -  NAIL INTRAMEDULLARY 130D 10MM 36CM ANTEGRADE TRIGEN ROSE,"$4,050.00",$0.00,"$4,050.00","$1,822.50","$2,890.49",$0.00,$697.79,$0.00,$0.00,$709.12,"$4,050.00",$0.00,"$2,025.00","$3,207.60","$3,240.00",$0.00,$633.83,$0.00,$644.76,$0.00
71648238,SUP,HCPCS C1713,,71648238  -  NAIL INTRAMEDULLARY 130D 10MM 38CM SET ANTEGRADE TRIGEN ROSE,"$4,050.00",$0.00,"$4,050.00","$1,822.50","$2,890.49",$0.00,$697.79,$0.00,$0.00,$709.12,"$4,050.00",$0.00,"$2,025.00","$3,207.60","$3,240.00",$0.00,$633.83,$0.00,$644.76,$0.00
71648240,SUP,HCPCS C1713,,71648240  -  NAIL INTRAMEDULLARY 130D 10MM 40CM ANTEGRADE TRIGEN ROSE,"$4,050.00",$0.00,"$4,050.00","$1,822.50","$2,890.49",$0.00,$697.79,$0.00,$0.00,$709.12,"$4,050.00",$0.00,"$2,025.00","$3,207.60","$3,240.00",$0.00,$633.83,$0.00,$644.76,$0.00
71648242,SUP,HCPCS C1713,,71648242  -  NAIL INTRAMEDULLARY 130D 10MM 42CM ANTEGRADE TRIGEN ROSE,"$4,050.00",$0.00,"$4,050.00","$1,822.50","$2,890.49",$0.00,$697.79,$0.00,$0.00,$709.12,"$4,050.00",$0.00,"$2,025.00","$3,207.60","$3,240.00",$0.00,$633.83,$0.00,$644.76,$0.00
71648244,SUP,HCPCS C1713,,71648244  -  NAIL IM 130D 10MM 44CM ROSE TRGN ANTGRD TI RT TROCH,"$4,050.00",$0.00,"$4,050.00","$1,822.50","$2,890.49",$0.00,$697.79,$0.00,$0.00,$709.12,"$4,050.00",$0.00,"$2,025.00","$3,207.60","$3,240.00",$0.00,$633.83,$0.00,$644.76,$0.00
71648246,SUP,HCPCS C1713,,71648246  -  NAIL IM 130D 10MM 46CM ROSE TRGN ANTGRD TI RT TROCH,"$4,050.00",$0.00,"$4,050.00","$1,822.50","$2,890.49",$0.00,$697.79,$0.00,$0.00,$709.12,"$4,050.00",$0.00,"$2,025.00","$3,207.60","$3,240.00",$0.00,$633.83,$0.00,$644.76,$0.00
71648248,SUP,HCPCS C1713,,71648248  -  NAIL IM 130D 10MM 48CM ROSE TRGN ANTGRD TI RT TROCH,"$4,050.00",$0.00,"$4,050.00","$1,822.50","$2,890.49",$0.00,$697.79,$0.00,$0.00,$709.12,"$4,050.00",$0.00,"$2,025.00","$3,207.60","$3,240.00",$0.00,$633.83,$0.00,$644.76,$0.00
71648250,SUP,HCPCS C1713,,71648250  -  NAIL IM 130D 10MM 50CM ROSE TRGN ANTGRD TI RT TROCH,"$4,050.00",$0.00,"$4,050.00","$1,822.50","$2,890.49",$0.00,$697.79,$0.00,$0.00,$709.12,"$4,050.00",$0.00,"$2,025.00","$3,207.60","$3,240.00",$0.00,$633.83,$0.00,$644.76,$0.00
71648330,SUP,HCPCS C1713,,71648330  -  NAIL IM 130D 11.5MM 30CM ROSE TRGN ANTGRD TI RT TROCH,"$4,050.00",$0.00,"$4,050.00","$1,822.50","$2,890.49",$0.00,$697.79,$0.00,$0.00,$709.12,"$4,050.00",$0.00,"$2,025.00","$3,207.60","$3,240.00",$0.00,$633.83,$0.00,$644.76,$0.00
71648332,SUP,HCPCS C1713,,71648332  -  NAIL IM 130D 11.5MM 32CM ROSE TRGN ANTGRD TI RT TROCH,"$4,050.00",$0.00,"$4,050.00","$1,822.50","$2,890.49",$0.00,$697.79,$0.00,$0.00,$709.12,"$4,050.00",$0.00,"$2,025.00","$3,207.60","$3,240.00",$0.00,$633.83,$0.00,$644.76,$0.00
71648334,SUP,HCPCS C1713,,71648334  -  NAIL INTRAMEDULLARY 130D 11.5MM 34CM ANTEGRADE TRIGEN ROSE,"$4,050.00",$0.00,"$4,050.00","$1,822.50","$2,890.49",$0.00,$697.79,$0.00,$0.00,$709.12,"$4,050.00",$0.00,"$2,025.00","$3,207.60","$3,240.00",$0.00,$633.83,$0.00,$644.76,$0.00
71648336,SUP,HCPCS C1713,,71648336  -  NAIL IM 130D 11.5MM 36CM ROSE TRGN ANTGRD TI RT TROCH,"$4,050.00",$0.00,"$4,050.00","$1,822.50","$2,890.49",$0.00,$697.79,$0.00,$0.00,$709.12,"$4,050.00",$0.00,"$2,025.00","$3,207.60","$3,240.00",$0.00,$633.83,$0.00,$644.76,$0.00
71648338,SUP,HCPCS C1713,,71648338  -  NAIL INTRAMEDULLARY 130D 11.5MM 38CM SET ANTEGRADE TRIGEN,"$4,050.00",$0.00,"$4,050.00","$1,822.50","$2,890.49",$0.00,$697.79,$0.00,$0.00,$709.12,"$4,050.00",$0.00,"$2,025.00","$3,207.60","$3,240.00",$0.00,$633.83,$0.00,$644.76,$0.00
71648340,SUP,HCPCS C1713,,71648340  -  NAIL INTRAMEDULLARY 130D 11.5MM 40CM ANTEGRADE SET TRIGEN,"$4,050.00",$0.00,"$4,050.00","$1,822.50","$2,890.49",$0.00,$697.79,$0.00,$0.00,$709.12,"$4,050.00",$0.00,"$2,025.00","$3,207.60","$3,240.00",$0.00,$633.83,$0.00,$644.76,$0.00
71648342,SUP,HCPCS C1713,,71648342  -  NAIL IM 130D 11.5MM 42CM ROSE STRL TRGN TI RT TROCH,"$4,050.00",$0.00,"$4,050.00","$1,822.50","$2,890.49",$0.00,$697.79,$0.00,$0.00,$709.12,"$4,050.00",$0.00,"$2,025.00","$3,207.60","$3,240.00",$0.00,$633.83,$0.00,$644.76,$0.00
71648344,SUP,HCPCS C1713,,71648344  -  NAIL INTRAMEDULLARY TRIGEN TITANIUM  L44 CM OD11.5 MM TAN,"$4,050.00",$0.00,"$4,050.00","$1,822.50","$2,890.49",$0.00,$697.79,$0.00,$0.00,$709.12,"$4,050.00",$0.00,"$2,025.00","$3,207.60","$3,240.00",$0.00,$633.83,$0.00,$644.76,$0.00
71648348,SUP,HCPCS C1713,,71648348  -  NAIL IM 130D 11.5MM 48CM ROSE TRGN ANTGRD TI RT TROCH,"$4,050.00",$0.00,"$4,050.00","$1,822.50","$2,890.49",$0.00,$697.79,$0.00,$0.00,$709.12,"$4,050.00",$0.00,"$2,025.00","$3,207.60","$3,240.00",$0.00,$633.83,$0.00,$644.76,$0.00
71648350,SUP,HCPCS C1713,,71648350  -  NAIL IM 130D 11.5MM 50CM ROSE TRGN ANTGRD TI RT TROCH,"$4,050.00",$0.00,"$4,050.00","$1,822.50","$2,890.49",$0.00,$697.79,$0.00,$0.00,$709.12,"$4,050.00",$0.00,"$2,025.00","$3,207.60","$3,240.00",$0.00,$633.83,$0.00,$644.76,$0.00
71648430,SUP,HCPCS C1713,,71648430  -  NAIL IM 130D 13MM 30CM ROSE TRGN ANTGRD TI RT TROCH,"$4,050.00",$0.00,"$4,050.00","$1,822.50","$2,890.49",$0.00,$697.79,$0.00,$0.00,$709.12,"$4,050.00",$0.00,"$2,025.00","$3,207.60","$3,240.00",$0.00,$633.83,$0.00,$644.76,$0.00
71648432,SUP,HCPCS C1713,,71648432  -  NAIL IM 130D 13MM 32CM ROSE TRGN ANTGRD TI RT TROCH,"$4,050.00",$0.00,"$4,050.00","$1,822.50","$2,890.49",$0.00,$697.79,$0.00,$0.00,$709.12,"$4,050.00",$0.00,"$2,025.00","$3,207.60","$3,240.00",$0.00,$633.83,$0.00,$644.76,$0.00
71648434,SUP,HCPCS C1713,,71648434  -  NAIL IM 130D 13MM 34CM ROSE TRGN ANTGRD TI RT TROCH,"$4,050.00",$0.00,"$4,050.00","$1,822.50","$2,890.49",$0.00,$697.79,$0.00,$0.00,$709.12,"$4,050.00",$0.00,"$2,025.00","$3,207.60","$3,240.00",$0.00,$633.83,$0.00,$644.76,$0.00
71648436,SUP,HCPCS C1713,,71648436  -  NAIL IM 130D 13MM 36CM ROSE TRGN ANTGRD TN SET TI RT TROCH,"$4,050.00",$0.00,"$4,050.00","$1,822.50","$2,890.49",$0.00,$697.79,$0.00,$0.00,$709.12,"$4,050.00",$0.00,"$2,025.00","$3,207.60","$3,240.00",$0.00,$633.83,$0.00,$644.76,$0.00
71648438,SUP,HCPCS C1713,,71648438  -  NAIL IM 130D 13MM 38CM ROSE TRGN ANTGRD TI RT TROCH,"$4,050.00",$0.00,"$4,050.00","$1,822.50","$2,890.49",$0.00,$697.79,$0.00,$0.00,$709.12,"$4,050.00",$0.00,"$2,025.00","$3,207.60","$3,240.00",$0.00,$633.83,$0.00,$644.76,$0.00
71648440,SUP,HCPCS C1713,,71648440  -  NAIL IM 130D 13MM 40CM ROSE TRGN ANTGRD TI RT TROCH,"$4,050.00",$0.00,"$4,050.00","$1,822.50","$2,890.49",$0.00,$697.79,$0.00,$0.00,$709.12,"$4,050.00",$0.00,"$2,025.00","$3,207.60","$3,240.00",$0.00,$633.83,$0.00,$644.76,$0.00
71648442,SUP,HCPCS C1713,,71648442  -  NAIL IM 130D 13MM 42CM ROSE TRGN ANTGRD TI RT TROCH,"$4,050.00",$0.00,"$4,050.00","$1,822.50","$2,890.49",$0.00,$697.79,$0.00,$0.00,$709.12,"$4,050.00",$0.00,"$2,025.00","$3,207.60","$3,240.00",$0.00,$633.83,$0.00,$644.76,$0.00
71648446,SUP,HCPCS C1713,,71648446  -  NAIL IM 130D 13MM 46CM ROSE TRGN ANTGRD TI RT TROCH,"$4,050.00",$0.00,"$4,050.00","$1,822.50","$2,890.49",$0.00,$697.79,$0.00,$0.00,$709.12,"$4,050.00",$0.00,"$2,025.00","$3,207.60","$3,240.00",$0.00,$633.83,$0.00,$644.76,$0.00
71648448,SUP,HCPCS C1713,,71648448  -  NAIL IM 130D 13MM 48CM ROSE TRGN ANTGRD TI RT TROCH,"$4,050.00",$0.00,"$4,050.00","$1,822.50","$2,890.49",$0.00,$697.79,$0.00,$0.00,$709.12,"$4,050.00",$0.00,"$2,025.00","$3,207.60","$3,240.00",$0.00,$633.83,$0.00,$644.76,$0.00
71648450,SUP,HCPCS C1713,,71648450  -  NAIL IM 130D RT ANG 13MM 50CM ROSE TN SET TROCH,"$4,050.00",$0.00,"$4,050.00","$1,822.50","$2,890.49",$0.00,$697.79,$0.00,$0.00,$709.12,"$4,050.00",$0.00,"$2,025.00","$3,207.60","$3,240.00",$0.00,$633.83,$0.00,$644.76,$0.00
71649530,SUP,HCPCS C1713,,71649530  -  NAIL IM 9MM 30CM LIME TRGN MT-TN ANTGRD FEM LT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71649532,SUP,HCPCS C1713,,71649532  -  NAIL IM 9MM 32CM LIME TRGN MT-TN ANTGRD FEM LT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71649534,SUP,HCPCS C1713,,71649534  -  NAIL IM 9MM 34CM LIME TRGN MT-TN ANTGRD FEM LT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71649536,SUP,HCPCS C1713,,71649536  -  NAIL IM 9MM 36CM LIME TRGN MT-TN ANTGRD FEM LT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71649538,SUP,HCPCS C1713,,71649538  -  NAIL IM 9MM 38CM LIME TRGN MT-TN ANTGRD FEM LT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71649540,SUP,HCPCS C1713,,71649540  -  NAIL IM 9MM 40CM LIME TRGN MT-TN ANTGRD FEM LT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71649542,SUP,HCPCS C1713,,71649542  -  NAIL IM 9MM 42MM LIME TRGN MT-TN ANTGRD FEM LT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71649544,SUP,HCPCS C1713,,71649544  -  NAIL IM 9MM 44MM LIME TRGN MT-TN ANTGRD FEM LT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71649546,SUP,HCPCS C1713,,71649546  -  NAIL IM 9MM 46MM LIME TRGN MT-TN ANTGRD FEM LT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71649548,SUP,HCPCS C1713,,71649548  -  NAIL IM 9MM 48MM LIME TRGN MT-TN ANTGRD FEM LT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71649550,SUP,HCPCS C1713,,71649550  -  NAIL IM 9MM 50MM LIME TRGN MT-TN ANTGRD FEM LT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71649630,SUP,HCPCS C1713,,71649630  -  NAIL IM 10MM 30MM LIME TRGN MT-TN ANTGRD FEM LT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71649632,SUP,HCPCS C1713,,71649632  -  NAIL IM 10MM 32MM LIME TRGN MT-TN ANTGRD FEM LT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71649634,SUP,HCPCS C1713,,71649634  -  NAIL IM 10MM 34CM LIME TRGN MT-TN LT,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71649636,SUP,HCPCS C1713,,71649636  -  NAIL IM 10MM 36MM LIME TRGN MT-TN ANTGRD FEM LT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71649638,SUP,HCPCS C1713,,71649638  -  NAIL IM 10MM 38MM LIME TRGN MT-TN ANTGRD FEM LT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71649640,SUP,HCPCS C1713,,71649640  -  NAIL IM 10MM 40MM LIME TRGN MT-TN ANTGRD FEM LT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71649642,SUP,HCPCS C1713,,71649642  -  NAIL IM 10MM 42MM LIME TRGN MT-TN ANTGRD FEM LT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71649644,SUP,HCPCS C1713,,71649644  -  NAIL IM 10MM 44MM LIME TRGN MT-TN ANTGRD FEM LT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71649646,SUP,HCPCS C1713,,71649646  -  NAIL IM 10MM 46MM LIME TRGN MT-TN ANTGRD FEM LT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71649648,SUP,HCPCS C1713,,71649648  -  NAIL IM 10MM 48MM LIME TRGN MT-TN ANTGRD FEM LT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71649650,SUP,HCPCS C1713,,71649650  -  NAIL IM 10MM 50MM LIME TRGN MT-TN ANTGRD FEM LT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71649730,SUP,HCPCS C1713,,71649730  -  NAIL IM 11.5MM 30CM LIME TRGN MT-TN ANTGRD FEM LT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71649732,SUP,HCPCS C1713,,71649732  -  NAIL IM 11.5MM 32CM LIME TRGN MT-TN ANTGRD FEM LT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71649734,SUP,HCPCS C1713,,71649734  -  NAIL IM 11.5MM 34CM LIME TRGN MT-TN ANTGRD FEM LT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71649736,SUP,HCPCS C1713,,71649736  -  NAIL IM 11.5MM 36CM LIME TRGN MT-TN ANTGRD FEM LT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71649738,SUP,HCPCS C1713,,71649738  -  NAIL IM 11.5MM 38CM LIME TRGN MT-TN ANTGRD FEM LT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71649740,SUP,HCPCS C1713,,71649740  -  NAIL IM 11.5MM 40CM LIME TRGN MT-TN ANTGRD FEM LT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71649742,SUP,HCPCS C1713,,71649742  -  NAIL IM 11.5MM 42CM LIME TRGN MT-TN ANTGRD FEM LT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71649744,SUP,HCPCS C1713,,71649744  -  NAIL IM 11.5MM 44CM LIME TRGN MT-TN ANTGRD FEM LT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71649746,SUP,HCPCS C1713,,71649746  -  NAIL IM 11.5MM 46CM LIME TRGN MT-TN ANTGRD FEM LT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71649748,SUP,HCPCS C1713,,71649748  -  NAIL IM 11.5MM 48CM MT-TN LT,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71649750,SUP,HCPCS C1713,,71649750  -  NAIL IM 11.5MM 50CM MT-TN LT,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71649830,SUP,HCPCS C1713,,71649830  -  NAIL IM 13MM 30CM LIME TRGN MT-TN LT,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71649832,SUP,HCPCS C1713,,71649832  -  NAIL IM 13MM 32CM LIME TRGN MT-TN ANTGRD FEM LT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71649834,SUP,HCPCS C1713,,71649834  -  NAIL IM 13MM 34CM LIME TRGN MT-TN ANTGRD FEM LT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71649836,SUP,HCPCS C1713,,71649836  -  NAIL IM 13MM 36CM LIME TRGN MT-TN ANTGRD FEM LT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71649838,SUP,HCPCS C1713,,71649838  -  NAIL IM 13MM 38CM LIME TRGN MT-TN ANTGRD FEM LT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71649840,SUP,HCPCS C1713,,71649840  -  NAIL IM 13MM 40CM LIME TRGN MT-TN ANTGRD FEM LT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71649842,SUP,HCPCS C1713,,71649842  -  NAIL IM 13MM 42CM LIME TRGN MT-TN ANTGRD FEM LT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71649844,SUP,HCPCS C1713,,71649844  -  NAIL IM 13MM 44CM LIME TRGN MT-TN ANTGRD FEM LT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71649846,SUP,HCPCS C1713,,71649846  -  NAIL IM 13MM 46CM LIME TRGN MT-TN ANTGRD FEM LT TROCH,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71649848,SUP,HCPCS C1713,,71649848  -  NAIL IM 13MM 48CM MT-TN LT,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71649850,SUP,HCPCS C1713,,71649850  -  NAIL IM 13MM 50CM MT-TN LT,"$3,526.88",$0.00,"$3,526.88","$1,587.09","$2,517.13",$0.00,$607.66,$0.00,$0.00,$617.53,"$3,526.88",$0.00,"$1,763.44","$2,793.29","$2,821.50",$0.00,$551.96,$0.00,$561.48,$0.00
71653018,SUP,HCPCS C1713,,71653018  -  NAIL IM 10MM 18CM MT-NL RTRGD TI FEM,"$3,622.50",$0.00,"$3,622.50","$1,630.13","$2,585.38",$0.00,$624.14,$0.00,$0.00,$634.27,"$3,622.50",$0.00,"$1,811.25","$2,869.02","$2,898.00",$0.00,$566.92,$0.00,$576.70,$0.00
71653020,SUP,HCPCS C1713,,71653020  -  NAIL IM 10MM 20CM MT-NL RTRGD TI FEM,"$3,622.50",$0.00,"$3,622.50","$1,630.13","$2,585.38",$0.00,$624.14,$0.00,$0.00,$634.27,"$3,622.50",$0.00,"$1,811.25","$2,869.02","$2,898.00",$0.00,$566.92,$0.00,$576.70,$0.00
71653022,SUP,HCPCS C1713,,71653022  -  NAIL IM 10MM 22CM MT-NL RTRGD TI FEM,"$3,622.50",$0.00,"$3,622.50","$1,630.13","$2,585.38",$0.00,$624.14,$0.00,$0.00,$634.27,"$3,622.50",$0.00,"$1,811.25","$2,869.02","$2,898.00",$0.00,$566.92,$0.00,$576.70,$0.00
71653024,SUP,HCPCS C1713,,71653024  -  NAIL IM 10MM 24CM MT-NL RTRGD TI FEM,"$3,622.50",$0.00,"$3,622.50","$1,630.13","$2,585.38",$0.00,$624.14,$0.00,$0.00,$634.27,"$3,622.50",$0.00,"$1,811.25","$2,869.02","$2,898.00",$0.00,$566.92,$0.00,$576.70,$0.00
71653026,SUP,HCPCS C1713,,71653026  -  NAIL IM 10MM 26CM MT-NL RTRGD TI FEM,"$3,622.50",$0.00,"$3,622.50","$1,630.13","$2,585.38",$0.00,$624.14,$0.00,$0.00,$634.27,"$3,622.50",$0.00,"$1,811.25","$2,869.02","$2,898.00",$0.00,$566.92,$0.00,$576.70,$0.00
71653028,SUP,HCPCS C1713,,71653028  -  NAIL IM 10MM 28CM MT-NL RTRGD TI FEM,"$3,622.50",$0.00,"$3,622.50","$1,630.13","$2,585.38",$0.00,$624.14,$0.00,$0.00,$634.27,"$3,622.50",$0.00,"$1,811.25","$2,869.02","$2,898.00",$0.00,$566.92,$0.00,$576.70,$0.00
71653030,SUP,HCPCS C1713,,71653030  -  NAIL IM 10MM 30CM MT-NL RTRGD TI FEM,"$3,622.50",$0.00,"$3,622.50","$1,630.13","$2,585.38",$0.00,$624.14,$0.00,$0.00,$634.27,"$3,622.50",$0.00,"$1,811.25","$2,869.02","$2,898.00",$0.00,$566.92,$0.00,$576.70,$0.00
71653032,SUP,HCPCS C1713,,71653032  -  NAIL IM 10MM 32CM MT-NL RTRGD TI FEM,"$3,622.50",$0.00,"$3,622.50","$1,630.13","$2,585.38",$0.00,$624.14,$0.00,$0.00,$634.27,"$3,622.50",$0.00,"$1,811.25","$2,869.02","$2,898.00",$0.00,$566.92,$0.00,$576.70,$0.00
71653034,SUP,HCPCS C1713,,71653034  -  NAIL IM 10MM 34CM AU TRGN MT-NL RTRGD TI FEM,"$3,622.50",$0.00,"$3,622.50","$1,630.13","$2,585.38",$0.00,$624.14,$0.00,$0.00,$634.27,"$3,622.50",$0.00,"$1,811.25","$2,869.02","$2,898.00",$0.00,$566.92,$0.00,$576.70,$0.00
71653036,SUP,HCPCS C1713,,71653036  -  NAIL IM 10MM 36CM MT-NL RTRGD TI FEM,"$3,622.50",$0.00,"$3,622.50","$1,630.13","$2,585.38",$0.00,$624.14,$0.00,$0.00,$634.27,"$3,622.50",$0.00,"$1,811.25","$2,869.02","$2,898.00",$0.00,$566.92,$0.00,$576.70,$0.00
71653038,SUP,HCPCS C1713,,71653038  -  NAIL IM 10MM 38CM AU TRGN MT-NL RTRGD TI FEM,"$3,622.50",$0.00,"$3,622.50","$1,630.13","$2,585.38",$0.00,$624.14,$0.00,$0.00,$634.27,"$3,622.50",$0.00,"$1,811.25","$2,869.02","$2,898.00",$0.00,$566.92,$0.00,$576.70,$0.00
71653040,SUP,HCPCS C1713,,71653040  -  NAIL IM STD 10MM 40CM AU STRL TRGN MT-NL RTRGD HMR SLT TI,"$3,622.50",$0.00,"$3,622.50","$1,630.13","$2,585.38",$0.00,$624.14,$0.00,$0.00,$634.27,"$3,622.50",$0.00,"$1,811.25","$2,869.02","$2,898.00",$0.00,$566.92,$0.00,$576.70,$0.00
71653042,SUP,HCPCS C1713,,71653042  -  NAIL IM STD 10MM 42CM AU STRL TRGN MT-NL RTRGD HMR SLT TI,"$3,622.50",$0.00,"$3,622.50","$1,630.13","$2,585.38",$0.00,$624.14,$0.00,$0.00,$634.27,"$3,622.50",$0.00,"$1,811.25","$2,869.02","$2,898.00",$0.00,$566.92,$0.00,$576.70,$0.00
71653044,SUP,HCPCS C1713,,71653044  -  NAIL IM 10MM 44CM MT-NL RTRGD TI FEM,"$3,622.50",$0.00,"$3,622.50","$1,630.13","$2,585.38",$0.00,$624.14,$0.00,$0.00,$634.27,"$3,622.50",$0.00,"$1,811.25","$2,869.02","$2,898.00",$0.00,$566.92,$0.00,$576.70,$0.00
71653046,SUP,HCPCS C1713,,71653046  -  NAIL IM 10MM 46CM MT-NL RTRGD TI FEM,"$3,622.50",$0.00,"$3,622.50","$1,630.13","$2,585.38",$0.00,$624.14,$0.00,$0.00,$634.27,"$3,622.50",$0.00,"$1,811.25","$2,869.02","$2,898.00",$0.00,$566.92,$0.00,$576.70,$0.00
71653048,SUP,HCPCS C1713,,71653048  -  NAIL IM 10MM 48CM MT-NL RTRGD TI FEM,"$3,622.50",$0.00,"$3,622.50","$1,630.13","$2,585.38",$0.00,$624.14,$0.00,$0.00,$634.27,"$3,622.50",$0.00,"$1,811.25","$2,869.02","$2,898.00",$0.00,$566.92,$0.00,$576.70,$0.00
71653050,SUP,HCPCS C1713,,71653050  -  NAIL IM 10MM 50CM MT-NL RTRGD TI FEM,"$3,622.50",$0.00,"$3,622.50","$1,630.13","$2,585.38",$0.00,$624.14,$0.00,$0.00,$634.27,"$3,622.50",$0.00,"$1,811.25","$2,869.02","$2,898.00",$0.00,$566.92,$0.00,$576.70,$0.00
71653120,SUP,HCPCS C1713,,71653120  -  NAIL IM 11.5MM 20CM TRGN TI SP CNDL,"$3,510.00",$0.00,"$3,510.00","$1,579.50","$2,505.09",$0.00,$604.76,$0.00,$0.00,$614.57,"$3,510.00",$0.00,"$1,755.00","$2,779.92","$2,808.00",$0.00,$549.32,$0.00,$558.79,$0.00
71653125,SUP,HCPCS C1713,,71653125  -  NAIL IM 11.5MM 25CM TRGN TI SP CNDL,"$3,510.00",$0.00,"$3,510.00","$1,579.50","$2,505.09",$0.00,$604.76,$0.00,$0.00,$614.57,"$3,510.00",$0.00,"$1,755.00","$2,779.92","$2,808.00",$0.00,$549.32,$0.00,$558.79,$0.00
71653218,SUP,HCPCS C1713,,71653218  -  NAIL IM 11.5MM 18CM MT-NL RTRGD TI FEM,"$3,622.50",$0.00,"$3,622.50","$1,630.13","$2,585.38",$0.00,$624.14,$0.00,$0.00,$634.27,"$3,622.50",$0.00,"$1,811.25","$2,869.02","$2,898.00",$0.00,$566.92,$0.00,$576.70,$0.00
71653220,SUP,HCPCS C1713,,71653220  -  NAIL IM 11.5MM 20CM MT-NL RTRGD TI6AL4V FEM,"$3,622.50",$0.00,"$3,622.50","$1,630.13","$2,585.38",$0.00,$624.14,$0.00,$0.00,$634.27,"$3,622.50",$0.00,"$1,811.25","$2,869.02","$2,898.00",$0.00,$566.92,$0.00,$576.70,$0.00
71653222,SUP,HCPCS C1713,,71653222  -  NAIL IM 11.5MM 22CM MT-NL RTRGD TI FEM,"$3,622.50",$0.00,"$3,622.50","$1,630.13","$2,585.38",$0.00,$624.14,$0.00,$0.00,$634.27,"$3,622.50",$0.00,"$1,811.25","$2,869.02","$2,898.00",$0.00,$566.92,$0.00,$576.70,$0.00
71653224,SUP,HCPCS C1713,,71653224  -  NAIL IM 11.5MM 24CM MT-NL RTRGD TI FEM,"$3,622.50",$0.00,"$3,622.50","$1,630.13","$2,585.38",$0.00,$624.14,$0.00,$0.00,$634.27,"$3,622.50",$0.00,"$1,811.25","$2,869.02","$2,898.00",$0.00,$566.92,$0.00,$576.70,$0.00
71653226,SUP,HCPCS C1713,,71653226  -  NAIL IM 11.5MM 26CM MT-NL RTRGD TI FEM,"$3,622.50",$0.00,"$3,622.50","$1,630.13","$2,585.38",$0.00,$624.14,$0.00,$0.00,$634.27,"$3,622.50",$0.00,"$1,811.25","$2,869.02","$2,898.00",$0.00,$566.92,$0.00,$576.70,$0.00
71653228,SUP,HCPCS C1713,,71653228  -  NAIL IM 11.5MM 28CM MT-NL RTRGD TI FEM,"$3,622.50",$0.00,"$3,622.50","$1,630.13","$2,585.38",$0.00,$624.14,$0.00,$0.00,$634.27,"$3,622.50",$0.00,"$1,811.25","$2,869.02","$2,898.00",$0.00,$566.92,$0.00,$576.70,$0.00
71653230,SUP,HCPCS C1713,,71653230  -  NAIL IM 11.5MM 30CM TRGN MT-NL IMPL SET RTRGD TI FEM,"$3,622.50",$0.00,"$3,622.50","$1,630.13","$2,585.38",$0.00,$624.14,$0.00,$0.00,$634.27,"$3,622.50",$0.00,"$1,811.25","$2,869.02","$2,898.00",$0.00,$566.92,$0.00,$576.70,$0.00
71653232,SUP,HCPCS C1713,,71653232  -  NAIL IM 11.5MM 32CM AU TRGN MT-NL RTRGD TI FEM,"$3,622.50",$0.00,"$3,622.50","$1,630.13","$2,585.38",$0.00,$624.14,$0.00,$0.00,$634.27,"$3,622.50",$0.00,"$1,811.25","$2,869.02","$2,898.00",$0.00,$566.92,$0.00,$576.70,$0.00
71653234,SUP,HCPCS C1713,,71653234  -  NAIL IM 11.5MM 34CM MT-NL RTRGD TI FEM,"$3,622.50",$0.00,"$3,622.50","$1,630.13","$2,585.38",$0.00,$624.14,$0.00,$0.00,$634.27,"$3,622.50",$0.00,"$1,811.25","$2,869.02","$2,898.00",$0.00,$566.92,$0.00,$576.70,$0.00
71653236,SUP,HCPCS C1713,,71653236  -  NAIL IM 11.5MM 36CM TRGN MT-NL IMPL SET RTRGD TI FEM,"$3,622.50",$0.00,"$3,622.50","$1,630.13","$2,585.38",$0.00,$624.14,$0.00,$0.00,$634.27,"$3,622.50",$0.00,"$1,811.25","$2,869.02","$2,898.00",$0.00,$566.92,$0.00,$576.70,$0.00
71653238,SUP,HCPCS C1713,,71653238  -  NAIL IM 10MM 38CM MT-NL RTRGD TI FEM,"$3,622.50",$0.00,"$3,622.50","$1,630.13","$2,585.38",$0.00,$624.14,$0.00,$0.00,$634.27,"$3,622.50",$0.00,"$1,811.25","$2,869.02","$2,898.00",$0.00,$566.92,$0.00,$576.70,$0.00
71653240,SUP,HCPCS C1713,,"71653240  -  RETROGRADE FEMUR NAIL, 11.5MMX40CM","$3,622.50",$0.00,"$3,622.50","$1,630.13","$2,585.38",$0.00,$624.14,$0.00,$0.00,$634.27,"$3,622.50",$0.00,"$1,811.25","$2,869.02","$2,898.00",$0.00,$566.92,$0.00,$576.70,$0.00
71653242,SUP,HCPCS C1713,,71653242  -  NAIL IM 11.5MM 42CM TRGN MT-NL RTRGD FEM,"$3,622.50",$0.00,"$3,622.50","$1,630.13","$2,585.38",$0.00,$624.14,$0.00,$0.00,$634.27,"$3,622.50",$0.00,"$1,811.25","$2,869.02","$2,898.00",$0.00,$566.92,$0.00,$576.70,$0.00
71653244,SUP,HCPCS C1713,,71653244  -  NAIL IM 11.5MM 44CM MT-NL RTRGD TI FEM,"$3,622.50",$0.00,"$3,622.50","$1,630.13","$2,585.38",$0.00,$624.14,$0.00,$0.00,$634.27,"$3,622.50",$0.00,"$1,811.25","$2,869.02","$2,898.00",$0.00,$566.92,$0.00,$576.70,$0.00
71653246,SUP,HCPCS C1713,,71653246  -  NAIL IM 11.5MM 46CM MT-NL RTRGD TI FEM,"$3,622.50",$0.00,"$3,622.50","$1,630.13","$2,585.38",$0.00,$624.14,$0.00,$0.00,$634.27,"$3,622.50",$0.00,"$1,811.25","$2,869.02","$2,898.00",$0.00,$566.92,$0.00,$576.70,$0.00
71653248,SUP,HCPCS C1713,,71653248  -  NAIL IM 11.5MM 48CM MT-NL RTRGD TI FEM,"$3,622.50",$0.00,"$3,622.50","$1,630.13","$2,585.38",$0.00,$624.14,$0.00,$0.00,$634.27,"$3,622.50",$0.00,"$1,811.25","$2,869.02","$2,898.00",$0.00,$566.92,$0.00,$576.70,$0.00
71653250,SUP,HCPCS C1713,,71653250  -  NAIL IM 11.5MM 50CM MT-NL RTRGD TI FEM,"$3,622.50",$0.00,"$3,622.50","$1,630.13","$2,585.38",$0.00,$624.14,$0.00,$0.00,$634.27,"$3,622.50",$0.00,"$1,811.25","$2,869.02","$2,898.00",$0.00,$566.92,$0.00,$576.70,$0.00
71653320,SUP,HCPCS C1713,,71653320  -  NAIL IM 13MM 20CM TRGN TI TIB,"$3,510.00",$0.00,"$3,510.00","$1,579.50","$2,505.09",$0.00,$604.76,$0.00,$0.00,$614.57,"$3,510.00",$0.00,"$1,755.00","$2,779.92","$2,808.00",$0.00,$549.32,$0.00,$558.79,$0.00
71653325,SUP,HCPCS C1713,,71653325  -  NAIL IM 13MM 25CM TRGN TI TIB,"$3,510.00",$0.00,"$3,510.00","$1,579.50","$2,505.09",$0.00,$604.76,$0.00,$0.00,$614.57,"$3,510.00",$0.00,"$1,755.00","$2,779.92","$2,808.00",$0.00,$549.32,$0.00,$558.79,$0.00
71653418,SUP,HCPCS C1713,,71653418  -  NAIL IM 13MM 18CM MT-NL RTRGD TI FEM,"$3,622.50",$0.00,"$3,622.50","$1,630.13","$2,585.38",$0.00,$624.14,$0.00,$0.00,$634.27,"$3,622.50",$0.00,"$1,811.25","$2,869.02","$2,898.00",$0.00,$566.92,$0.00,$576.70,$0.00
71653420,SUP,HCPCS C1713,,71653420  -  NAIL IM 13MM 20CM MT-NL RTRGD TI FEM,"$3,622.50",$0.00,"$3,622.50","$1,630.13","$2,585.38",$0.00,$624.14,$0.00,$0.00,$634.27,"$3,622.50",$0.00,"$1,811.25","$2,869.02","$2,898.00",$0.00,$566.92,$0.00,$576.70,$0.00
71653422,SUP,HCPCS C1713,,71653422  -  NAIL IM 13MM 22CM MT-NL RTRGD TI FEM,"$3,622.50",$0.00,"$3,622.50","$1,630.13","$2,585.38",$0.00,$624.14,$0.00,$0.00,$634.27,"$3,622.50",$0.00,"$1,811.25","$2,869.02","$2,898.00",$0.00,$566.92,$0.00,$576.70,$0.00
71653424,SUP,HCPCS C1713,,71653424  -  NAIL IM 13MM 24CM MT-NL RTRGD TI FEM,"$3,622.50",$0.00,"$3,622.50","$1,630.13","$2,585.38",$0.00,$624.14,$0.00,$0.00,$634.27,"$3,622.50",$0.00,"$1,811.25","$2,869.02","$2,898.00",$0.00,$566.92,$0.00,$576.70,$0.00
71653426,SUP,HCPCS C1713,,71653426  -  NAIL IM 13MM 26CM MT-NL RTRGD TI FEM,"$3,622.50",$0.00,"$3,622.50","$1,630.13","$2,585.38",$0.00,$624.14,$0.00,$0.00,$634.27,"$3,622.50",$0.00,"$1,811.25","$2,869.02","$2,898.00",$0.00,$566.92,$0.00,$576.70,$0.00
71653428,SUP,HCPCS C1713,,71653428  -  NAIL IM 13MM 28CM MT-NL RTRGD TI FEM,"$3,622.50",$0.00,"$3,622.50","$1,630.13","$2,585.38",$0.00,$624.14,$0.00,$0.00,$634.27,"$3,622.50",$0.00,"$1,811.25","$2,869.02","$2,898.00",$0.00,$566.92,$0.00,$576.70,$0.00
71653430,SUP,HCPCS C1713,,71653430  -  NAIL IM 13MM 30CM MT-NL RTRGD TI FEM,"$3,622.50",$0.00,"$3,622.50","$1,630.13","$2,585.38",$0.00,$624.14,$0.00,$0.00,$634.27,"$3,622.50",$0.00,"$1,811.25","$2,869.02","$2,898.00",$0.00,$566.92,$0.00,$576.70,$0.00
71653432,SUP,HCPCS C1713,,71653432  -  NAIL IM 13MM 32CM MT-NL RTRGD TI FEM,"$3,622.50",$0.00,"$3,622.50","$1,630.13","$2,585.38",$0.00,$624.14,$0.00,$0.00,$634.27,"$3,622.50",$0.00,"$1,811.25","$2,869.02","$2,898.00",$0.00,$566.92,$0.00,$576.70,$0.00
71653434,SUP,HCPCS C1713,,71653434  -  NAIL IM 13MM 34CM TRGN MT-NL IMPL SET RTRGD TI FEM,"$3,622.50",$0.00,"$3,622.50","$1,630.13","$2,585.38",$0.00,$624.14,$0.00,$0.00,$634.27,"$3,622.50",$0.00,"$1,811.25","$2,869.02","$2,898.00",$0.00,$566.92,$0.00,$576.70,$0.00
71653436,SUP,HCPCS C1713,,71653436  -  NAIL IM 13MM 36CM MT-NL RTRGD TI FEM,"$3,622.50",$0.00,"$3,622.50","$1,630.13","$2,585.38",$0.00,$624.14,$0.00,$0.00,$634.27,"$3,622.50",$0.00,"$1,811.25","$2,869.02","$2,898.00",$0.00,$566.92,$0.00,$576.70,$0.00
71653438,SUP,HCPCS C1713,,71653438  -  NAIL IM 13MM 38CM MT-NL RTRGD TI FEM,"$3,622.50",$0.00,"$3,622.50","$1,630.13","$2,585.38",$0.00,$624.14,$0.00,$0.00,$634.27,"$3,622.50",$0.00,"$1,811.25","$2,869.02","$2,898.00",$0.00,$566.92,$0.00,$576.70,$0.00
71653440,SUP,HCPCS C1713,,71653440  -  NAIL IM STD 13MM 40CM AU STRL TRGN MT-NL RTRGD HMR SLT TI,"$3,622.50",$0.00,"$3,622.50","$1,630.13","$2,585.38",$0.00,$624.14,$0.00,$0.00,$634.27,"$3,622.50",$0.00,"$1,811.25","$2,869.02","$2,898.00",$0.00,$566.92,$0.00,$576.70,$0.00
71653442,SUP,HCPCS C1713,,71653442  -  NAIL IM 13MM 42CM MT-NL RTRGD TI FEM,"$3,622.50",$0.00,"$3,622.50","$1,630.13","$2,585.38",$0.00,$624.14,$0.00,$0.00,$634.27,"$3,622.50",$0.00,"$1,811.25","$2,869.02","$2,898.00",$0.00,$566.92,$0.00,$576.70,$0.00
71653444,SUP,HCPCS C1713,,71653444  -  NAIL IM 13MM 44CM MT-NL RTRGD TI FEM,"$3,622.50",$0.00,"$3,622.50","$1,630.13","$2,585.38",$0.00,$624.14,$0.00,$0.00,$634.27,"$3,622.50",$0.00,"$1,811.25","$2,869.02","$2,898.00",$0.00,$566.92,$0.00,$576.70,$0.00
71653446,SUP,HCPCS C1713,,71653446  -  NAIL IM 13MM 46CM MT-NL RTRGD TI FEM,"$3,622.50",$0.00,"$3,622.50","$1,630.13","$2,585.38",$0.00,$624.14,$0.00,$0.00,$634.27,"$3,622.50",$0.00,"$1,811.25","$2,869.02","$2,898.00",$0.00,$566.92,$0.00,$576.70,$0.00
71653448,SUP,HCPCS C1713,,71653448  -  NAIL IM 13MM 48CM MT-NL RTRGD TI FEM,"$3,622.50",$0.00,"$3,622.50","$1,630.13","$2,585.38",$0.00,$624.14,$0.00,$0.00,$634.27,"$3,622.50",$0.00,"$1,811.25","$2,869.02","$2,898.00",$0.00,$566.92,$0.00,$576.70,$0.00
71653450,SUP,HCPCS C1713,,71653450  -  NAIL IM 13MM 50CM MT-NL RTRGD TI FEM,"$3,622.50",$0.00,"$3,622.50","$1,630.13","$2,585.38",$0.00,$624.14,$0.00,$0.00,$634.27,"$3,622.50",$0.00,"$1,811.25","$2,869.02","$2,898.00",$0.00,$566.92,$0.00,$576.70,$0.00
71655016,SUP,HCPCS C1713,,71655016  -  NAIL IM 8.5MM 16CM MT-NL TI TIB,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655018,SUP,HCPCS C1713,,71655018  -  NAIL IM 8.5MM 18CM MT-NL TI TIB,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655020,SUP,HCPCS C1713,,71655020  -  NAIL IM 8.5MM 20CM MT-NL TI TIB,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655022,SUP,HCPCS C1713,,71655022  -  NAIL IM 8.5MM 22CM MT-NL TI TIB,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655024,SUP,HCPCS C1713,,71655024  -  NAIL IM 8.5MM 24CM MT-NL TI TIB,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655026,SUP,HCPCS C1713,,71655026  -  NAIL IM 8.5MM 26CM MT-NL TI TIB,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655028,SUP,HCPCS C1713,,71655028  -  NAIL IM 8.5MM 28CM MT-NL TI TIB,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655029,SUP,HCPCS C1713,,71655029  -  NAIL IM 8.5MM 29CM TRGN MT-NL TIB,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655030,SUP,HCPCS C1713,,71655030  -  NAIL 8.5MM 30CM TIB MT-NAIL IM TI,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655031,SUP,HCPCS C1713,,71655031  -  NAIL IM 8.5MM 31CM MT-NL TI TIB,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655032,SUP,HCPCS C1713,,71655032  -  NAIL IM 8.5MM 32CM MT-NL TI TIB,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655034,SUP,HCPCS C1713,,71655034  -  NAIL IM 8.5MM 34CM TRGN MT-NL TI TIB,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655035,SUP,HCPCS C1713,,71655035  -  NAIL IM 8.5MM 35CM MT-NL TI TIB METAPHYSIS,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655036,SUP,HCPCS C1713,,71655036  -  NAIL IM 8.5MM 36CM TRGN MT-NL TI TIB,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655037,SUP,HCPCS C1713,,71655037  -  NAIL IM 8.5MM 37CM MT-NL TI TIB,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655038,SUP,HCPCS C1713,,71655038  -  NAIL IM 8.5MM 38CM MT-NL TI TIB,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655039,SUP,HCPCS C1713,,71655039  -  NAIL IM 8.5MM 39CM MT-NL TI TIB,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655040,SUP,HCPCS C1713,,71655040  -  NAIL IM 8.5MM 40CM MT-NL TI TIB,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655041,SUP,HCPCS C1713,,71655041  -  NAIL IM 8.5MM 41CM MT-NL TI TIB,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655042,SUP,HCPCS C1713,,71655042  -  NAIL IM 8.5MM 42CM MT-NL TI TIB,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655043,SUP,HCPCS C1713,,71655043  -  NAIL IM 8.5MM 43CM MT-NL TI TIB,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655044,SUP,HCPCS C1713,,71655044  -  NAIL IM 8.5MM 44CM MT-NL TI TIB,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655046,SUP,HCPCS C1713,,71655046  -  NAIL IM 8.5MM 46CM MT-NL TI TIB,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655048,SUP,HCPCS C1713,,71655048  -  NAIL IM 8.5MM 48CM MT-NL TI TIB,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655050,SUP,HCPCS C1713,,71655050  -  NAIL IM 8.5MM 50CM MT-NL TI TIB,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655116,SUP,HCPCS C1713,,71655116  -  NAIL IM 10MM 16CM MT-NL TI TIB,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655118,SUP,HCPCS C1713,,71655118  -  NAIL IM 10MM 18CM MT-NL TI TIB,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655120,SUP,HCPCS C1713,,71655120  -  NAIL IM 10MM 20CM MT-NL TI TIB,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655122,SUP,HCPCS C1713,,71655122  -  NAIL IM 10MM 22CM MT-NL TI TIB,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655124,SUP,HCPCS C1713,,71655124  -  NAIL IM 10MM 24CM MT-NL TI TIB,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655126,SUP,HCPCS C1713,,71655126  -  NAIL IM 10MM 26CM MT-NL TI TIB,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655128,SUP,HCPCS C1713,,71655128  -  NAIL IM 10MM 28CM MT-NL TI TIB,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655129,SUP,HCPCS C1713,,71655129  -  NAIL IM 10MM 29CM MT-NL TI TIB,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655130,SUP,HCPCS C1713,,71655130  -  NAIL IM 10MM 30CM MT-NL TI TIB,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655131,SUP,HCPCS C1713,,71655131  -  NAIL IM 10MM 31CM MT-NL TI TIB,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655132,SUP,HCPCS C1713,,71655132  -  NAIL INTRAMEDULLARY 10MM 32CM META-NAIL TITANIUM TIBIA,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655133,SUP,HCPCS C1713,,71655133  -  NAIL IM 10MM 33CM MT-NL TI TIB,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655134,SUP,HCPCS C1713,,71655134  -  NAIL INTRAMEDULLARY 10MM 34CM META-NAIL TITANIUM TIBIA,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655135,SUP,HCPCS C1713,,71655135  -  NAIL INTRAMEDULLARY 10MM 35CM META-NAIL TITANIUM TIBIA,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655136,SUP,HCPCS C1713,,71655136  -  NAIL INTRAMEDULLARY 10MM 36CM META-NAIL TITANIUM TIBIA,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655137,SUP,HCPCS C1713,,71655137  -  NAIL INTRAMEDULLARY 10MM 37CM META-NAIL TITANIUM TIBIA,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655138,SUP,HCPCS C1713,,71655138  -  NAIL INTRAMEDULLARY 10MM 38CM META-NAIL TITANIUM TIBIA,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655139,SUP,HCPCS C1713,,71655139  -  NAIL INTRAMEDULLARY 10MM 39CM META-NAIL TITANIUM TIBIA,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655142,SUP,HCPCS C1713,,71655142  -  NAIL IM 10MM 42CM MT-NL TI TIB,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655143,SUP,HCPCS C1713,,71655143  -  NAIL IM 10MM 43CM MT-NL TI TIB,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655144,SUP,HCPCS C1713,,71655144  -  NAIL IM 10MM 44CM MT-NL TI TIB,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655146,SUP,HCPCS C1713,,71655146  -  NAIL IM 10MM 46CM MT-NL TI TIB,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655148,SUP,HCPCS C1713,,71655148  -  NAIL IM 10MM 48CM MT-NL TI TIB,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655150,SUP,HCPCS C1713,,71655150  -  NAIL IM 10MM 50CM MT-NL TI TIB,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655216,SUP,HCPCS C1713,,71655216  -  NAIL IM 11.5MM 16CM MT-NL TI TIB,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655218,SUP,HCPCS C1713,,71655218  -  NAIL IM 11.5MM 18CM MT-NL TI TIB,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655220,SUP,HCPCS C1713,,71655220  -  NAIL IM 11.5MM 20CM MT-NL TI TIB,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655222,SUP,HCPCS C1713,,71655222  -  NAIL IM 11.5MM 22CM MT-NL TI TIB,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655224,SUP,HCPCS C1713,,71655224  -  NAIL IM 11.5MM 24CM MT-NL TI TIB,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655226,SUP,HCPCS C1713,,71655226  -  NAIL IM 11.5MM 26CM MT-NL TI TIB,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655228,SUP,HCPCS C1713,,71655228  -  NAIL IM 11.5MM 28CM MT-NL TI TIB,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655229,SUP,HCPCS C1713,,71655229  -  NAIL IM 11.5MM 29CM MT-NL TI TIB,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655230,SUP,HCPCS C1713,,71655230  -  NAIL IM 11.5MM 30CM MT-NL TI TIB,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655231,SUP,HCPCS C1713,,71655231  -  NAIL IM 11.5MM 31CM MT-NL TI TIB,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655232,SUP,HCPCS C1713,,71655232  -  NAIL IM 11.5MM 32CM MT-NL TI TIB,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655233,SUP,HCPCS C1713,,71655233  -  NAIL IM 11.5MM 33CM MT-NL TI TIB,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655234,SUP,HCPCS C1713,,71655234  -  NAIL IM 11.5MM 34CM MT-NL TI TIB,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655235,SUP,HCPCS C1713,,71655235  -  NAIL IM 11.5MM 35CM MT-NL TI TIB,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655236,SUP,HCPCS C1713,,71655236  -  NAIL 11.5MM 36CM TIB TRGN MT-NAIL IM HMR SLT TI,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655237,SUP,HCPCS C1713,,71655237  -  NAIL IM 11.5MM 37CM MT-NL TI TIB,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655238,SUP,HCPCS C1713,,71655238  -  NAIL IM 11.5MM 38CM AU STRL TRGN MT-NL HMR SLT TI TIB,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655239,SUP,HCPCS C1713,,71655239  -  NAIL IM 11.5MM 39CM MT-NL TI TIB,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655240,SUP,HCPCS C1713,,71655240  -  NAIL INTRAMEDULLARY 11.5MM 40CM META-NAIL TITANIUM TIBIA,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655241,SUP,HCPCS C1713,,71655241  -  NAIL IM 11.5MM 41CM MT-NL TI TIB,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655242,SUP,HCPCS C1713,,71655242  -  NAIL IM 11.5MM 42CM MT-NL TI TIB,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655243,SUP,HCPCS C1713,,71655243  -  NAIL IM 11.5MM 43CM MT-NL TI TIB,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655244,SUP,HCPCS C1713,,71655244  -  NAIL IM 11.5MM 44CM MT-NL TI TIB,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655246,SUP,HCPCS C1713,,71655246  -  NAIL IM 11.5MM 46CM MT-NL TI TIB,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655248,SUP,HCPCS C1713,,71655248  -  NAIL IM 11.5MM 48CM MT-NL TI TIB,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655250,SUP,HCPCS C1713,,71655250  -  NAIL IM 11.5MM 50CM MT-NL TI TIB,"$3,538.13",$0.00,"$3,538.13","$1,592.16","$2,525.16",$0.00,$609.60,$0.00,$0.00,$619.50,"$3,538.13",$0.00,"$1,769.06","$2,802.20","$2,830.50",$0.00,$553.72,$0.00,$563.27,$0.00
71655316,SUP,HCPCS C1713,,71655316  -  NAIL IM 13MM 16CM MT-NL TI TIB,"$3,487.50",$0.00,"$3,487.50","$1,569.38","$2,489.03",$0.00,$600.88,$0.00,$0.00,$610.63,"$3,487.50",$0.00,"$1,743.75","$2,762.10","$2,790.00",$0.00,$545.79,$0.00,$555.21,$0.00
71655318,SUP,HCPCS C1713,,71655318  -  NAIL IM 13MM 18CM MT-NL TI TIB,"$3,487.50",$0.00,"$3,487.50","$1,569.38","$2,489.03",$0.00,$600.88,$0.00,$0.00,$610.63,"$3,487.50",$0.00,"$1,743.75","$2,762.10","$2,790.00",$0.00,$545.79,$0.00,$555.21,$0.00
71655320,SUP,HCPCS C1713,,71655320  -  NAIL IM 13MM 20CM MT-NL TI TIB,"$3,487.50",$0.00,"$3,487.50","$1,569.38","$2,489.03",$0.00,$600.88,$0.00,$0.00,$610.63,"$3,487.50",$0.00,"$1,743.75","$2,762.10","$2,790.00",$0.00,$545.79,$0.00,$555.21,$0.00
71655322,SUP,HCPCS C1713,,71655322  -  NAIL IM 13MM 22CM MT-NL TI TIB,"$3,487.50",$0.00,"$3,487.50","$1,569.38","$2,489.03",$0.00,$600.88,$0.00,$0.00,$610.63,"$3,487.50",$0.00,"$1,743.75","$2,762.10","$2,790.00",$0.00,$545.79,$0.00,$555.21,$0.00
71655324,SUP,HCPCS C1713,,71655324  -  NAIL IM 13MM 24CM MT-NL TI TIB,"$3,487.50",$0.00,"$3,487.50","$1,569.38","$2,489.03",$0.00,$600.88,$0.00,$0.00,$610.63,"$3,487.50",$0.00,"$1,743.75","$2,762.10","$2,790.00",$0.00,$545.79,$0.00,$555.21,$0.00
71655326,SUP,HCPCS C1713,,71655326  -  NAIL IM 13MM 26CM MT-NL TI TIB,"$3,487.50",$0.00,"$3,487.50","$1,569.38","$2,489.03",$0.00,$600.88,$0.00,$0.00,$610.63,"$3,487.50",$0.00,"$1,743.75","$2,762.10","$2,790.00",$0.00,$545.79,$0.00,$555.21,$0.00
71655328,SUP,HCPCS C1713,,71655328  -  NAIL IM 13MM 28CM MT-NL TI TIB,"$3,487.50",$0.00,"$3,487.50","$1,569.38","$2,489.03",$0.00,$600.88,$0.00,$0.00,$610.63,"$3,487.50",$0.00,"$1,743.75","$2,762.10","$2,790.00",$0.00,$545.79,$0.00,$555.21,$0.00
71655329,SUP,HCPCS C1713,,71655329  -  NAIL IM 13MM 29CM MT-NL TI TIB,"$3,487.50",$0.00,"$3,487.50","$1,569.38","$2,489.03",$0.00,$600.88,$0.00,$0.00,$610.63,"$3,487.50",$0.00,"$1,743.75","$2,762.10","$2,790.00",$0.00,$545.79,$0.00,$555.21,$0.00
71655330,SUP,HCPCS C1713,,71655330  -  NAIL IM 13MM 30CM MT-NL TI TIB,"$3,487.50",$0.00,"$3,487.50","$1,569.38","$2,489.03",$0.00,$600.88,$0.00,$0.00,$610.63,"$3,487.50",$0.00,"$1,743.75","$2,762.10","$2,790.00",$0.00,$545.79,$0.00,$555.21,$0.00
71655331,SUP,HCPCS C1713,,71655331  -  NAIL IM 13MM 31CM MT-NL TI TIB,"$3,487.50",$0.00,"$3,487.50","$1,569.38","$2,489.03",$0.00,$600.88,$0.00,$0.00,$610.63,"$3,487.50",$0.00,"$1,743.75","$2,762.10","$2,790.00",$0.00,$545.79,$0.00,$555.21,$0.00
71655332,SUP,HCPCS C1713,,71655332  -  NAIL IM 13MM 32CM MT-NL TI TIB,"$3,487.50",$0.00,"$3,487.50","$1,569.38","$2,489.03",$0.00,$600.88,$0.00,$0.00,$610.63,"$3,487.50",$0.00,"$1,743.75","$2,762.10","$2,790.00",$0.00,$545.79,$0.00,$555.21,$0.00
71655333,SUP,HCPCS C1713,,71655333  -  NAIL IM 13MM 33CM MT-NL TI TIB,"$3,487.50",$0.00,"$3,487.50","$1,569.38","$2,489.03",$0.00,$600.88,$0.00,$0.00,$610.63,"$3,487.50",$0.00,"$1,743.75","$2,762.10","$2,790.00",$0.00,$545.79,$0.00,$555.21,$0.00
71655334,SUP,HCPCS C1713,,71655334  -  NAIL IM RND 13MM 34CM AU MT-NL TI TIB,"$3,487.50",$0.00,"$3,487.50","$1,569.38","$2,489.03",$0.00,$600.88,$0.00,$0.00,$610.63,"$3,487.50",$0.00,"$1,743.75","$2,762.10","$2,790.00",$0.00,$545.79,$0.00,$555.21,$0.00
71655335,SUP,HCPCS C1713,,71655335  -  NAIL IM 13MM 35CM MT-NL TI TIB,"$3,487.50",$0.00,"$3,487.50","$1,569.38","$2,489.03",$0.00,$600.88,$0.00,$0.00,$610.63,"$3,487.50",$0.00,"$1,743.75","$2,762.10","$2,790.00",$0.00,$545.79,$0.00,$555.21,$0.00
71655336,SUP,HCPCS C1713,,71655336  -  NAIL IM 13MM 36CM MT-NL TI TIB,"$3,487.50",$0.00,"$3,487.50","$1,569.38","$2,489.03",$0.00,$600.88,$0.00,$0.00,$610.63,"$3,487.50",$0.00,"$1,743.75","$2,762.10","$2,790.00",$0.00,$545.79,$0.00,$555.21,$0.00
71655337,SUP,HCPCS C1713,,71655337  -  NAIL IM 13MM 37CM MT-NL TI TIB,"$3,487.50",$0.00,"$3,487.50","$1,569.38","$2,489.03",$0.00,$600.88,$0.00,$0.00,$610.63,"$3,487.50",$0.00,"$1,743.75","$2,762.10","$2,790.00",$0.00,$545.79,$0.00,$555.21,$0.00
71655338,SUP,HCPCS C1713,,71655338  -  NAIL IM 13MM 38CM MT-NL TI TIB,"$3,487.50",$0.00,"$3,487.50","$1,569.38","$2,489.03",$0.00,$600.88,$0.00,$0.00,$610.63,"$3,487.50",$0.00,"$1,743.75","$2,762.10","$2,790.00",$0.00,$545.79,$0.00,$555.21,$0.00
71655339,SUP,HCPCS C1713,,71655339  -  NAIL IM 13MM 39CM MT-NL TI TIB,"$3,487.50",$0.00,"$3,487.50","$1,569.38","$2,489.03",$0.00,$600.88,$0.00,$0.00,$610.63,"$3,487.50",$0.00,"$1,743.75","$2,762.10","$2,790.00",$0.00,$545.79,$0.00,$555.21,$0.00
71655340,SUP,HCPCS C1713,,71655340  -  NAIL IM RND 13MM 40CM AU MT-NL TI TIB,"$3,487.50",$0.00,"$3,487.50","$1,569.38","$2,489.03",$0.00,$600.88,$0.00,$0.00,$610.63,"$3,487.50",$0.00,"$1,743.75","$2,762.10","$2,790.00",$0.00,$545.79,$0.00,$555.21,$0.00
71655341,SUP,HCPCS C1713,,71655341  -  NAIL IM 13MM 41CM MT-NL TI TIB,"$3,487.50",$0.00,"$3,487.50","$1,569.38","$2,489.03",$0.00,$600.88,$0.00,$0.00,$610.63,"$3,487.50",$0.00,"$1,743.75","$2,762.10","$2,790.00",$0.00,$545.79,$0.00,$555.21,$0.00
71655342,SUP,HCPCS C1713,,71655342  -  NAIL IM 13MM 42CM MT-NL TI TIB,"$3,487.50",$0.00,"$3,487.50","$1,569.38","$2,489.03",$0.00,$600.88,$0.00,$0.00,$610.63,"$3,487.50",$0.00,"$1,743.75","$2,762.10","$2,790.00",$0.00,$545.79,$0.00,$555.21,$0.00
71655343,SUP,HCPCS C1713,,71655343  -  NAIL IM 13MM 43CM MT-NL TI TIB,"$3,487.50",$0.00,"$3,487.50","$1,569.38","$2,489.03",$0.00,$600.88,$0.00,$0.00,$610.63,"$3,487.50",$0.00,"$1,743.75","$2,762.10","$2,790.00",$0.00,$545.79,$0.00,$555.21,$0.00
71655344,SUP,HCPCS C1713,,71655344  -  NAIL IM 13MM 44CM MT-NL TI TIB,"$3,487.50",$0.00,"$3,487.50","$1,569.38","$2,489.03",$0.00,$600.88,$0.00,$0.00,$610.63,"$3,487.50",$0.00,"$1,743.75","$2,762.10","$2,790.00",$0.00,$545.79,$0.00,$555.21,$0.00
71655346,SUP,HCPCS C1713,,71655346  -  NAIL IM 13MM 46CM MT-NL TI TIB,"$3,487.50",$0.00,"$3,487.50","$1,569.38","$2,489.03",$0.00,$600.88,$0.00,$0.00,$610.63,"$3,487.50",$0.00,"$1,743.75","$2,762.10","$2,790.00",$0.00,$545.79,$0.00,$555.21,$0.00
71655348,SUP,HCPCS C1713,,71655348  -  NAIL IM 13MM 48CM MT-NL TI TIB,"$3,487.50",$0.00,"$3,487.50","$1,569.38","$2,489.03",$0.00,$600.88,$0.00,$0.00,$610.63,"$3,487.50",$0.00,"$1,743.75","$2,762.10","$2,790.00",$0.00,$545.79,$0.00,$555.21,$0.00
71655350,SUP,HCPCS C1713,,71655350  -  NAIL IM 13MM 50CM MT-NL TI TIB,"$3,487.50",$0.00,"$3,487.50","$1,569.38","$2,489.03",$0.00,$600.88,$0.00,$0.00,$610.63,"$3,487.50",$0.00,"$1,743.75","$2,762.10","$2,790.00",$0.00,$545.79,$0.00,$555.21,$0.00
71656000,SUP,HCPCS C1713,,71656000  -  CAP END 0MM MT-NL NL SCR SET TI TIB,$354.38,$0.00,$354.38,$159.47,$252.92,$0.00,$61.06,$0.00,$0.00,$62.05,$354.38,$0.00,$177.19,$280.67,$283.50,$0.00,$55.46,$0.00,$56.42,$0.00
71661222,SUP,HCPCS C1713,,71661222  -  SCREW BN 4.5MM 22MM IMHS CP LCK CPTR HIP IM NL SYS,$593.25,$0.00,$593.25,$266.96,$423.40,$0.00,$102.21,$0.00,$0.00,$103.87,$593.25,$0.00,$296.63,$469.85,$474.60,$0.00,$92.84,$0.00,$94.45,$0.00
71661224,SUP,HCPCS C1713,,71661224  -  SCREW BN 4.5MM 24MM IMHS CP LCK CPTR HIP IM NL SYS,$593.25,$0.00,$593.25,$266.96,$423.40,$0.00,$102.21,$0.00,$0.00,$103.87,$593.25,$0.00,$296.63,$469.85,$474.60,$0.00,$92.84,$0.00,$94.45,$0.00
71661226,SUP,HCPCS C1713,,71661226  -  SCREW BN 4.5MM 26MM IMHS CP CPTR LCK HIP IM NL SYS,$593.25,$0.00,$593.25,$266.96,$423.40,$0.00,$102.21,$0.00,$0.00,$103.87,$593.25,$0.00,$296.63,$469.85,$474.60,$0.00,$92.84,$0.00,$94.45,$0.00
71661228,SUP,HCPCS C1713,,71661228  -  SCREW BN 4.5MM 28MM IMHS CP LCK CPTR HIP IM NL SYS,$593.25,$0.00,$593.25,$266.96,$423.40,$0.00,$102.21,$0.00,$0.00,$103.87,$593.25,$0.00,$296.63,$469.85,$474.60,$0.00,$92.84,$0.00,$94.45,$0.00
71661230,SUP,HCPCS C1713,,71661230  -  SCREW BN 4.5MM 30MM IMHS CP LCK CPTR HIP IM NL SYS,$593.25,$0.00,$593.25,$266.96,$423.40,$0.00,$102.21,$0.00,$0.00,$103.87,$593.25,$0.00,$296.63,$469.85,$474.60,$0.00,$92.84,$0.00,$94.45,$0.00
71661232,SUP,HCPCS C1713,,71661232  -  SCREW BN 4.5MM 32MM IMHS CP LCK CPTR HIP IM NL SYS,$593.25,$0.00,$593.25,$266.96,$423.40,$0.00,$102.21,$0.00,$0.00,$103.87,$593.25,$0.00,$296.63,$469.85,$474.60,$0.00,$92.84,$0.00,$94.45,$0.00
71661234,SUP,HCPCS C1713,,71661234  -  SCREW BN 4.5MM 34MM IMHS CP LCK CPTR HIP IM NL SYS,$593.25,$0.00,$593.25,$266.96,$423.40,$0.00,$102.21,$0.00,$0.00,$103.87,$593.25,$0.00,$296.63,$469.85,$474.60,$0.00,$92.84,$0.00,$94.45,$0.00
71661236,SUP,HCPCS C1713,,71661236  -  SCREW BN 4.5MM 36MM IMHS CP LCK CPTR HIP IM NL SYS,$593.25,$0.00,$593.25,$266.96,$423.40,$0.00,$102.21,$0.00,$0.00,$103.87,$593.25,$0.00,$296.63,$469.85,$474.60,$0.00,$92.84,$0.00,$94.45,$0.00
71661238,SUP,HCPCS C1713,,71661238  -  SCREW BN 4.5MM 38MM IMHS CP LCK CPTR HIP IM NL SYS,$593.25,$0.00,$593.25,$266.96,$423.40,$0.00,$102.21,$0.00,$0.00,$103.87,$593.25,$0.00,$296.63,$469.85,$474.60,$0.00,$92.84,$0.00,$94.45,$0.00
71661240,SUP,HCPCS C1713,,71661240  -  SCREW BN 4.5MM 40MM IMHS CP LCK CPTR HIP IM NL SYS,$593.25,$0.00,$593.25,$266.96,$423.40,$0.00,$102.21,$0.00,$0.00,$103.87,$593.25,$0.00,$296.63,$469.85,$474.60,$0.00,$92.84,$0.00,$94.45,$0.00
71661242,SUP,HCPCS C1713,,71661242  -  SCREW BN 4.5MM 42MM IMHS CP LCK CPTR HIP IM NL SYS,$593.25,$0.00,$593.25,$266.96,$423.40,$0.00,$102.21,$0.00,$0.00,$103.87,$593.25,$0.00,$296.63,$469.85,$474.60,$0.00,$92.84,$0.00,$94.45,$0.00
71661244,SUP,HCPCS C1713,,71661244  -  SCREW BN 4.5MM 44MM IMHS CP LCK CPTR HIP IM NL,$593.25,$0.00,$593.25,$266.96,$423.40,$0.00,$102.21,$0.00,$0.00,$103.87,$593.25,$0.00,$296.63,$469.85,$474.60,$0.00,$92.84,$0.00,$94.45,$0.00
71661246,SUP,HCPCS C1713,,71661246  -  SCREW BN 4.5MM 46MM IMHS CP LCK CPTR HIP IM NL SYS,$593.25,$0.00,$593.25,$266.96,$423.40,$0.00,$102.21,$0.00,$0.00,$103.87,$593.25,$0.00,$296.63,$469.85,$474.60,$0.00,$92.84,$0.00,$94.45,$0.00
71661248,SUP,HCPCS C1713,,71661248  -  SCREW BN 4.5MM 48MM IMHS CP LCK CPTR HIP IM NL SYS,$593.25,$0.00,$593.25,$266.96,$423.40,$0.00,$102.21,$0.00,$0.00,$103.87,$593.25,$0.00,$296.63,$469.85,$474.60,$0.00,$92.84,$0.00,$94.45,$0.00
71661250,SUP,HCPCS C1713,,71661250  -  SCREW BN 4.5MM 50MM IMHS CP LCK CPTR HIP IM NL SYS,$593.25,$0.00,$593.25,$266.96,$423.40,$0.00,$102.21,$0.00,$0.00,$103.87,$593.25,$0.00,$296.63,$469.85,$474.60,$0.00,$92.84,$0.00,$94.45,$0.00
71661252,SUP,HCPCS C1713,,71661252  -  SCREW BN 4.5MM 52MM IMHS CP LCK CPTR HIP IM NL,$593.25,$0.00,$593.25,$266.96,$423.40,$0.00,$102.21,$0.00,$0.00,$103.87,$593.25,$0.00,$296.63,$469.85,$474.60,$0.00,$92.84,$0.00,$94.45,$0.00
71661254,SUP,HCPCS C1713,,71661254  -  SCREW BN 4.5MM 54MM IMHS CP LCK CPTR HIP IM NL,$593.25,$0.00,$593.25,$266.96,$423.40,$0.00,$102.21,$0.00,$0.00,$103.87,$593.25,$0.00,$296.63,$469.85,$474.60,$0.00,$92.84,$0.00,$94.45,$0.00
71661256,SUP,HCPCS C1713,,71661256  -  SCREW BN 4.5MM 56MM IMHS CP LCK CPTR HIP IM NL,$593.25,$0.00,$593.25,$266.96,$423.40,$0.00,$102.21,$0.00,$0.00,$103.87,$593.25,$0.00,$296.63,$469.85,$474.60,$0.00,$92.84,$0.00,$94.45,$0.00
71661258,SUP,HCPCS C1713,,71661258  -  SCREW BN 4.5MM 58MM IMHS CP LCK CPTR HIP IM NL SYS,$593.25,$0.00,$593.25,$266.96,$423.40,$0.00,$102.21,$0.00,$0.00,$103.87,$593.25,$0.00,$296.63,$469.85,$474.60,$0.00,$92.84,$0.00,$94.45,$0.00
71661260,SUP,HCPCS C1713,,71661260  -  SCREW BN 4.5MM 60MM IMHS CP LCK CPTR HIP IM NL,$593.25,$0.00,$593.25,$266.96,$423.40,$0.00,$102.21,$0.00,$0.00,$103.87,$593.25,$0.00,$296.63,$469.85,$474.60,$0.00,$92.84,$0.00,$94.45,$0.00
71661262,SUP,HCPCS C1713,,71661262  -  SCREW BN 4.5MM 62MM IMHS CP LCK CPTR HIP IM NL,$593.25,$0.00,$593.25,$266.96,$423.40,$0.00,$102.21,$0.00,$0.00,$103.87,$593.25,$0.00,$296.63,$469.85,$474.60,$0.00,$92.84,$0.00,$94.45,$0.00
71661264,SUP,HCPCS C1713,,71661264  -  SCREW BN 4.5MM 64MM IMHS CP LCK CPTR HIP IM NL,$593.25,$0.00,$593.25,$266.96,$423.40,$0.00,$102.21,$0.00,$0.00,$103.87,$593.25,$0.00,$296.63,$469.85,$474.60,$0.00,$92.84,$0.00,$94.45,$0.00
71665026,SUP,HCPCS C1769,,71665026  -  GUIDE ROD ORTHOPEDIC 3MM 600MM BALL TIP TRIGEN DISPOSABLE,$490.88,$0.00,$490.88,$266.55,$350.34,$0.00,$84.58,$0.00,$0.00,$85.95,$490.88,$0.00,$245.44,$388.78,$392.70,$0.00,$76.82,$0.00,$78.15,$0.00
71672030,SUP,HCPCS C1713,,71672030  -  SCREW BONE 11MM 30MM COMPRESSION INTERTAN TROCHANTER,$659.25,$0.00,$659.25,$296.66,$470.51,$0.00,$113.59,$0.00,$0.00,$115.43,$659.25,$0.00,$329.63,$522.13,$527.40,$0.00,$103.17,$0.00,$104.95,$0.00
71672035,SUP,HCPCS C1713,,71672035  -  SCREW BN 35MM CMPR ORTH,$676.00,$0.00,$676.00,$304.20,$482.46,$0.00,$116.47,$0.00,$0.00,$118.36,$676.00,$0.00,$338.00,$535.39,$540.80,$0.00,$105.79,$0.00,$107.62,$0.00
71672040,SUP,HCPCS C1713,,71672040  -  SCREW BN 40MM CMPR ORTH,$460.13,$0.00,$460.13,$207.06,$328.39,$0.00,$79.28,$0.00,$0.00,$80.56,$460.13,$0.00,$230.06,$364.42,$368.10,$0.00,$72.01,$0.00,$73.25,$0.00
71673040,SUP,HCPCS C1713,,71673040  -  NAIL IM 130D 10MM 40CM INTERTAN LT TROCH,"$3,155.63",$0.00,"$3,155.63","$1,420.03","$2,252.17",$0.00,$543.70,$0.00,$0.00,$552.52,"$3,155.63",$0.00,"$1,577.81","$2,499.26","$2,524.50",$0.00,$493.86,$0.00,$502.38,$0.00
71673125,SUP,HCPCS C1713,,71673125  -  SCREW BN 11MM 125MM LG,$892.00,$0.00,$892.00,$401.40,$636.62,$0.00,$153.69,$0.00,$0.00,$156.18,$892.00,$0.00,$446.00,$706.46,$713.60,$0.00,$139.60,$0.00,$142.01,$0.00
71674029,SUP,HCPCS C1713,,71674029  -  GUIDEPIN ORTH 343MM 3.2MM THRD,$335.65,$0.00,$335.65,$151.04,$239.55,$0.00,$57.83,$0.00,$0.00,$58.77,$335.65,$0.00,$167.83,$265.83,$268.52,$0.00,$52.53,$0.00,$53.44,$0.00
71674034,SUP,HCPCS C1713,,71674034  -  GUIDE SURG 7MM 7MM COMPRESSION SCREW TRIGEN INTERTAN,$381.38,$0.00,$381.38,$171.62,$272.19,$0.00,$65.71,$0.00,$0.00,$66.78,$381.38,$0.00,$190.69,$302.05,$305.10,$0.00,$59.69,$0.00,$60.71,$0.00
71674130,SUP,Custom 27203010,,71674130  -  GUIDE PIN ORTHOPEDIC 3.2MM 343MM BRAD POINT TIP THREADED,$308.25,$0.00,$308.25,$0.00,$220.00,$0.00,$0.00,$0.00,$0.00,$0.00,$308.25,$0.00,$154.13,$244.13,$246.60,$0.00,$0.00,$0.00,$0.00,$0.00
71674540,SUP,HCPCS C1713,,71674540  -  INTERTAN LAG SCREW DRILL,"$1,032.75",$0.00,"$1,032.75",$464.74,$737.07,$0.00,$177.94,$0.00,$0.00,$180.83,"$1,032.75",$0.00,$516.38,$817.94,$826.20,$0.00,$161.63,$0.00,$164.41,$0.00
71675030,SUP,HCPCS C1713,,71675030  -  SCREW BN INTERTAN SET,$493.88,$0.00,$493.88,$222.24,$352.48,$0.00,$85.09,$0.00,$0.00,$86.47,$493.88,$0.00,$246.94,$391.15,$395.10,$0.00,$77.29,$0.00,$78.62,$0.00
71675040,SUP,HCPCS C1713,,71675040  -  CAP END INTERTAN TROCH IM NL,$279.00,$0.00,$279.00,$125.55,$199.12,$0.00,$48.07,$0.00,$0.00,$48.85,$279.00,$0.00,$139.50,$220.97,$223.20,$0.00,$43.66,$0.00,$44.42,$0.00
71675201,SUP,HCPCS C1713,,71675201  -  NAIL IM 125D SHRT 10MM 180MM INTERTAN TI TROCH,"$3,330.00",$0.00,"$3,330.00","$1,498.50","$2,376.62",$0.00,$573.74,$0.00,$0.00,$583.06,"$3,330.00",$0.00,"$1,665.00","$2,637.36","$2,664.00",$0.00,$521.15,$0.00,$530.14,$0.00
71675202,SUP,HCPCS C1713,,71675202  -  NAIL IM 125D 11.5MM 18CM INTERTAN TI TROCH,"$3,330.00",$0.00,"$3,330.00","$1,498.50","$2,376.62",$0.00,$573.74,$0.00,$0.00,$583.06,"$3,330.00",$0.00,"$1,665.00","$2,637.36","$2,664.00",$0.00,$521.15,$0.00,$530.14,$0.00
71675203,SUP,HCPCS C1713,,71675203  -  NAIL IM 125D SHRT 13MM 18CM INTERTAN TI TROCH,"$3,330.00",$0.00,"$3,330.00","$1,498.50","$2,376.62",$0.00,$573.74,$0.00,$0.00,$583.06,"$3,330.00",$0.00,"$1,665.00","$2,637.36","$2,664.00",$0.00,$521.15,$0.00,$530.14,$0.00
71675204,SUP,HCPCS C1713,,71675204  -  NAIL IM 125D 10MM 20CM INTERTAN TI TROCH,"$3,330.00",$0.00,"$3,330.00","$1,498.50","$2,376.62",$0.00,$573.74,$0.00,$0.00,$583.06,"$3,330.00",$0.00,"$1,665.00","$2,637.36","$2,664.00",$0.00,$521.15,$0.00,$530.14,$0.00
71675205,SUP,HCPCS C1713,,71675205  -  NAIL IM 125D 11.5MM 20CM INTERTAN TI TROCH,"$3,330.00",$0.00,"$3,330.00","$1,498.50","$2,376.62",$0.00,$573.74,$0.00,$0.00,$583.06,"$3,330.00",$0.00,"$1,665.00","$2,637.36","$2,664.00",$0.00,$521.15,$0.00,$530.14,$0.00
71675206,SUP,HCPCS C1713,,71675206  -  NAIL IM 125D 13MM 20CM INTERTAN,"$3,330.00",$0.00,"$3,330.00","$1,498.50","$2,376.62",$0.00,$573.74,$0.00,$0.00,$583.06,"$3,330.00",$0.00,"$1,665.00","$2,637.36","$2,664.00",$0.00,$521.15,$0.00,$530.14,$0.00
71675207,SUP,HCPCS C1713,,71675207  -  NAIL IM 130D SHRT 10MM 18CM INTERTAN ANTGRD TI INTST,"$3,330.00",$0.00,"$3,330.00","$1,498.50","$2,376.62",$0.00,$573.74,$0.00,$0.00,$583.06,"$3,330.00",$0.00,"$1,665.00","$2,637.36","$2,664.00",$0.00,$521.15,$0.00,$530.14,$0.00
71675208,SUP,HCPCS C1713,,71675208  -  NAIL IM 130D SHRT 11.5MM 18CM INTERTAN ANTGRD TI INTST,"$3,330.00",$0.00,"$3,330.00","$1,498.50","$2,376.62",$0.00,$573.74,$0.00,$0.00,$583.06,"$3,330.00",$0.00,"$1,665.00","$2,637.36","$2,664.00",$0.00,$521.15,$0.00,$530.14,$0.00
71675209,SUP,HCPCS C1713,,71675209  -  NAIL IM 130D SHRT 13MM 18CM INTERTAN TI TROCH,"$3,330.00",$0.00,"$3,330.00","$1,498.50","$2,376.62",$0.00,$573.74,$0.00,$0.00,$583.06,"$3,330.00",$0.00,"$1,665.00","$2,637.36","$2,664.00",$0.00,$521.15,$0.00,$530.14,$0.00
71675210,SUP,HCPCS C1713,,71675210  -  NAIL IM 130D 10MM 20CM INTERTAN TI ORTH,"$3,330.00",$0.00,"$3,330.00","$1,498.50","$2,376.62",$0.00,$573.74,$0.00,$0.00,$583.06,"$3,330.00",$0.00,"$1,665.00","$2,637.36","$2,664.00",$0.00,$521.15,$0.00,$530.14,$0.00
71675211,SUP,HCPCS C1713,,71675211  -  NAIL IM 130D 11.5MM 20CM INTERTAN TI TROCH,"$3,330.00",$0.00,"$3,330.00","$1,498.50","$2,376.62",$0.00,$573.74,$0.00,$0.00,$583.06,"$3,330.00",$0.00,"$1,665.00","$2,637.36","$2,664.00",$0.00,$521.15,$0.00,$530.14,$0.00
71675212,SUP,HCPCS C1713,,71675212  -  NAIL IM 130D 13MM 20CM INTERTAN TI TROCH,"$3,330.00",$0.00,"$3,330.00","$1,498.50","$2,376.62",$0.00,$573.74,$0.00,$0.00,$583.06,"$3,330.00",$0.00,"$1,665.00","$2,637.36","$2,664.00",$0.00,$521.15,$0.00,$530.14,$0.00
71675213,SUP,HCPCS C1713,,71675213  -  NAIL IM 125D 10MM 26CM INTERTAN TI LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675214,SUP,HCPCS C1713,,71675214  -  NAIL IM 125D 10MM 26CM INTERTAN TI RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675215,SUP,HCPCS C1713,,71675215  -  NAIL IM 125D 10MM 28CM INTERTAN TI LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675216,SUP,HCPCS C1713,,71675216  -  NAIL IM 125D 10MM 28CM INTERTAN TI RT ORTH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675217,SUP,HCPCS C1713,,71675217  -  NAIL IM 125D 10MM 30CM INTERTAN TI LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675218,SUP,HCPCS C1713,,71675218  -  NAIL IM 125D 10MM 30CM INTERTAN TI RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675219,SUP,HCPCS C1713,,71675219  -  NAIL IM 125D 10MM 32CM INTERTAN TI LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675220,SUP,HCPCS C1713,,71675220  -  NAIL IM 125D 10MM 32CM INTERTAN TI RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675221,SUP,HCPCS C1713,,71675221  -  NAIL IM 125D LG 10MM 34CM INTERTAN LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675222,SUP,HCPCS C1713,,71675222  -  NAIL IM 125D 10MM 34CM ROSE INTERTAN TI RT,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675223,SUP,HCPCS C1713,,71675223  -  NAIL IM 125D 10MM 36CM LIME INTERTAN TI LT,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675224,SUP,HCPCS C1713,,71675224  -  NAIL IM 125D 10MM 36CM ROSE INTERTAN TI RT,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675225,SUP,HCPCS C1713,,71675225  -  NAIL IM 125D LG 10MM 38CM INTERTAN TI LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675226,SUP,HCPCS C1713,,71675226  -  NAIL IM 125D LG 10MM 38CM ROSE INTERTAN TI RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675227,SUP,HCPCS C1713,,71675227  -  NAIL IM 125D LG 10MM 40CM INTERTAN TI LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675228,SUP,HCPCS C1713,,71675228  -  NAIL IM 125D LG 10MM 400MM INTERTAN TI RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675229,SUP,HCPCS C1713,,71675229  -  NAIL IM 125D 10MM 42CM LIME INTERTAN TI LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675230,SUP,HCPCS C1713,,71675230  -  NAIL IM 125D 10MM 42CM ROSE INTERTAN TI RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675231,SUP,HCPCS C1713,,71675231  -  NAIL IM 125D 10MM 44CM INTERTAN LT,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675232,SUP,HCPCS C1713,,71675232  -  NAIL IM 125D 10MM 44CM ROSE INTERTAN TI RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675233,SUP,HCPCS C1713,,71675233  -  NAIL IM 125D 10MM 46CM LIME INTERTAN TI LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675234,SUP,HCPCS C1713,,71675234  -  NAIL IM 125D 10MM 46CM ROSE INTERTAN TI RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675235,SUP,HCPCS C1713,,71675235  -  NAIL IM 125D 11.5MM 26CM INTERTAN TI LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675236,SUP,HCPCS C1713,,71675236  -  NAIL IM 125D 11.5MM 26CM INTERTAN TI RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675237,SUP,HCPCS C1713,,71675237  -  NAIL IM 125D 11.5MM 28CM INTERTAN TI LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675238,SUP,HCPCS C1713,,71675238  -  NAIL IM 125D 11.5MM 28CM INTERTAN TI RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675239,SUP,HCPCS C1713,,71675239  -  NAIL IM 125D LG 11.5MM 30CM INTERTAN TI LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675240,SUP,HCPCS C1713,,71675240  -  NAIL IM 125D 11.5MM 30CM INTERTAN TI RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675241,SUP,HCPCS C1713,,71675241  -  NAIL IM 125D 11.5MM 32CM INTERTAN TI LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675242,SUP,HCPCS C1713,,71675242  -  NAIL IM 125D 11.5MM 32CM INTERTAN TI RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675243,SUP,HCPCS C1713,,71675243  -  NAIL IM 125D LG 11.5MM 34CM INTERTAN LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675244,SUP,HCPCS C1713,,71675244  -  NAIL IM 125D 11.5MM 34CM ROSE INTERTAN TI RT,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675245,SUP,HCPCS C1713,,71675245  -  NAIL IM 125D LG 11.5MM 360MM INTERTAN TI LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675246,SUP,HCPCS C1713,,71675246  -  NAIL IM 125D LG 11.5MM 36CM ROSE INTERTAN TI RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675247,SUP,HCPCS C1713,,71675247  -  NAIL IM 125D 11.5MM 38CM LIME INTERTAN TI LT,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675248,SUP,HCPCS C1713,,71675248  -  NAIL IM 125D LG 11.5MM 380MM ROSE INTERTAN TI RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675249,SUP,HCPCS C1713,,71675249  -  NAIL IM 125D LG 11.5MM 40CM LIME TRGN TI LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675250,SUP,HCPCS C1713,,71675250  -  NAIL IM 125D LG 11.5MM 400MM INTERTAN TI RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675251,SUP,HCPCS C1713,,71675251  -  NAIL IM 125D 11.5MM 42CM LIME INTERTAN TI LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675252,SUP,HCPCS C1713,,71675252  -  NAIL IM 125D 11.5MM 42CM ROSE INTERTAN TI RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675253,SUP,HCPCS C1713,,71675253  -  NAIL IM 125D 11.5MM 44CM LIME INTERTAN TI LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675254,SUP,HCPCS C1713,,71675254  -  NAIL IM 125D 11.5MM 44CM ROSE INTERTAN TI RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675255,SUP,HCPCS C1713,,71675255  -  NAIL IM 125D 11.5MM 46CM LIME INTERTAN TI LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675256,SUP,HCPCS C1713,,71675256  -  NAIL IM 125D 11.5MM 46CM ROSE INTERTAN TI RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675257,SUP,HCPCS C1713,,71675257  -  NAIL IM 130D 10MM 26CM INTERTAN TI LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675258,SUP,HCPCS C1713,,71675258  -  NAIL IM 130D 10MM 26CM INTERTAN TI RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675259,SUP,HCPCS C1713,,71675259  -  NAIL IM 130D 10MM 28CM INTERTAN TI LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675260,SUP,HCPCS C1713,,71675260  -  NAIL IM 130D 10MM 28CM INTERTAN TI RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675261,SUP,HCPCS C1713,,71675261  -  NAIL IM 130D 10MM 30CM INTERTAN TI LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675262,SUP,HCPCS C1713,,71675262  -  NAIL IM 130D 10MM 30CM INTERTAN TI RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675263,SUP,HCPCS C1713,,71675263  -  NAIL IM 130D 10MM 32CM INTERTAN TI LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675264,SUP,HCPCS C1713,,71675264  -  NAIL IM 130D 10MM 32CM INTERTAN TI RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675265,SUP,HCPCS C1713,,71675265  -  NAIL IM 130D LNG 10MM 34CM LIME ROSE INTERTAN TRGN NK ANG LT,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675266,SUP,HCPCS C1713,,71675266  -  NAIL IM 130D LNG 10MM 34CM ROSE INTERTAN TI RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675267,SUP,HCPCS C1713,,71675267  -  NAIL IM 130D LNG 10MM 36CM LIME INTERTAN TI LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675268,SUP,HCPCS C1713,,71675268  -  NAIL IM 130D LNG 10MM 36CM ROSE INTERTAN TI RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675269,SUP,HCPCS C1713,,71675269  -  NAIL IM 130D 10MM 38CM LIME INTERTAN TI LT,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675270,SUP,HCPCS C1713,,71675270  -  NAIL IM 130D LNG 10MM 380MM INTERTAN TI RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675271,SUP,HCPCS C1713,,71675271  -  NAIL IM 130D LNG 10MM 40CM LIME INTERTAN TI LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675272,SUP,HCPCS C1713,,71675272  -  NAIL IM 130D LNG 10MM 40CM ROSE INTERTAN TI RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675273,SUP,HCPCS C1713,,71675273  -  NAIL IM 130D 10MM 42CM INTERTAN LT,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675274,SUP,HCPCS C1713,,71675274  -  NAIL IM 130D LNG 10MM 42CM ROSE INTERTAN TI RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675275,SUP,HCPCS C1713,,71675275  -  NAIL IM 130D 10MM 44CM LIME INTERTAN TI LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675276,SUP,HCPCS C1713,,71675276  -  NAIL IM 130D 10MM 44CM ROSE INTERTAN TI RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675277,SUP,HCPCS C1713,,71675277  -  NAIL IM 130D 10MM 46CM LIME INTERTAN TI LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675278,SUP,HCPCS C1713,,71675278  -  NAIL IM 130D 10MM 46CM ROSE INTERTAN TI RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675279,SUP,HCPCS C1713,,71675279  -  NAIL IM 130D 11.5MM 26CM INTERTAN TI LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675280,SUP,HCPCS C1713,,71675280  -  NAIL IM 130D 11.5MM 26CM INTERTAN TI RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675281,SUP,HCPCS C1713,,71675281  -  NAIL IM 130D 11.5MM 28CM INTERTAN TI LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675282,SUP,HCPCS C1713,,71675282  -  NAIL IM 130D 11.5MM 28CM INTERTAN TI RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675283,SUP,HCPCS C1713,,71675283  -  NAIL IM 130D 11.5MM 30CM INTERTAN TI LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675284,SUP,HCPCS C1713,,71675284  -  NAIL IM 130D 11.5MM 30CM INTERTAN TI RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675285,SUP,HCPCS C1713,,71675285  -  NAIL IM 130D 11.5MM 32CM INTERTAN LT,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675286,SUP,HCPCS C1713,,71675286  -  NAIL IM 130D 11.5MM 32CM INTERTAN TI RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675287,SUP,HCPCS C1713,,71675287  -  NAIL IM 130D 11.5MM 34CM INTERTAN ANTGRD TI LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675288,SUP,HCPCS C1713,,71675288  -  NAIL IM 130D LNG 11.5MM 34CM ROSE INTERTAN TI RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675289,SUP,HCPCS C1713,,71675289  -  NAIL IM 130D LNG 11.5MM 360MM LIME INTERTAN TI LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675290,SUP,HCPCS C1713,,71675290  -  NAIL IM 130D LNG 11.5MM 36CM INTERTAN TI RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675291,SUP,HCPCS C1713,,71675291  -  NAIL IM 130D LNG 11.5MM 380MM LIME INTERTAN TI LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675292,SUP,HCPCS C1713,,71675292  -  NAIL IM 130D LNG 11.5MM 380MM INTERTAN TI RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675293,SUP,HCPCS C1713,,71675293  -  NAIL IM 130D LNG 11.5MM 40CM LIME INTERTAN TI LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675294,SUP,HCPCS C1713,,71675294  -  NAIL IM 130D LNG 11.5MM 40CM INTERTAN TI RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675295,SUP,HCPCS C1713,,71675295  -  NAIL IM 130D LNG 11.5MM 42CM LIME INTERTAN TI LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675361,SUP,HCPCS C1713,,71675361  -  NAIL IM 135D 13MM 26CM INTERTAN TI LT TROCH,"$5,550.00",$0.00,"$5,550.00","$2,497.50","$3,961.04",$0.00,$956.24,$0.00,$0.00,$971.76,"$5,550.00",$0.00,"$2,775.00","$4,395.60","$4,440.00",$0.00,$868.58,$0.00,$883.56,$0.00
71675362,SUP,HCPCS C1713,,71675362  -  NAIL IM 135D 13MM 26CM INTERTAN TI RT TROCH,"$5,550.00",$0.00,"$5,550.00","$2,497.50","$3,961.04",$0.00,$956.24,$0.00,$0.00,$971.76,"$5,550.00",$0.00,"$2,775.00","$4,395.60","$4,440.00",$0.00,$868.58,$0.00,$883.56,$0.00
71675363,SUP,HCPCS C1713,,71675363  -  NAIL IM 135D 13MM 28CM INTERTAN TI LT TROCH,"$5,550.00",$0.00,"$5,550.00","$2,497.50","$3,961.04",$0.00,$956.24,$0.00,$0.00,$971.76,"$5,550.00",$0.00,"$2,775.00","$4,395.60","$4,440.00",$0.00,$868.58,$0.00,$883.56,$0.00
71675364,SUP,HCPCS C1713,,71675364  -  NAIL IM 135D 13MM 28CM INTERTAN TI RT TROCH,"$5,550.00",$0.00,"$5,550.00","$2,497.50","$3,961.04",$0.00,$956.24,$0.00,$0.00,$971.76,"$5,550.00",$0.00,"$2,775.00","$4,395.60","$4,440.00",$0.00,$868.58,$0.00,$883.56,$0.00
71675365,SUP,HCPCS C1713,,71675365  -  NAIL IM 135D 13MM 30CM INTERTAN TI LT TROCH,"$5,550.00",$0.00,"$5,550.00","$2,497.50","$3,961.04",$0.00,$956.24,$0.00,$0.00,$971.76,"$5,550.00",$0.00,"$2,775.00","$4,395.60","$4,440.00",$0.00,$868.58,$0.00,$883.56,$0.00
71675366,SUP,HCPCS C1713,,71675366  -  NAIL IM 135D 13MM 30CM INTERTAN TI RT TROCH,"$5,550.00",$0.00,"$5,550.00","$2,497.50","$3,961.04",$0.00,$956.24,$0.00,$0.00,$971.76,"$5,550.00",$0.00,"$2,775.00","$4,395.60","$4,440.00",$0.00,$868.58,$0.00,$883.56,$0.00
71675367,SUP,HCPCS C1713,,71675367  -  NAIL IM 135D 13MM 32CM INTERTAN TI LT TROCH,"$5,550.00",$0.00,"$5,550.00","$2,497.50","$3,961.04",$0.00,$956.24,$0.00,$0.00,$971.76,"$5,550.00",$0.00,"$2,775.00","$4,395.60","$4,440.00",$0.00,$868.58,$0.00,$883.56,$0.00
71675368,SUP,HCPCS C1713,,71675368  -  NAIL IM 135D 13MM 32CM INTERTAN TI RT TROCH,"$5,550.00",$0.00,"$5,550.00","$2,497.50","$3,961.04",$0.00,$956.24,$0.00,$0.00,$971.76,"$5,550.00",$0.00,"$2,775.00","$4,395.60","$4,440.00",$0.00,$868.58,$0.00,$883.56,$0.00
71675369,SUP,HCPCS C1713,,71675369  -  NAIL IM 135D 13MM 34CM INTERTAN TI LT TROCH,"$5,550.00",$0.00,"$5,550.00","$2,497.50","$3,961.04",$0.00,$956.24,$0.00,$0.00,$971.76,"$5,550.00",$0.00,"$2,775.00","$4,395.60","$4,440.00",$0.00,$868.58,$0.00,$883.56,$0.00
71675370,SUP,HCPCS C1713,,71675370  -  NAIL IM 135D 13MM 34CM INTERTAN TI RT TROCH,"$5,550.00",$0.00,"$5,550.00","$2,497.50","$3,961.04",$0.00,$956.24,$0.00,$0.00,$971.76,"$5,550.00",$0.00,"$2,775.00","$4,395.60","$4,440.00",$0.00,$868.58,$0.00,$883.56,$0.00
71675371,SUP,HCPCS C1713,,71675371  -  NAIL IM 135D 13MM 36CM INTERTAN TI LT TROCH,"$5,550.00",$0.00,"$5,550.00","$2,497.50","$3,961.04",$0.00,$956.24,$0.00,$0.00,$971.76,"$5,550.00",$0.00,"$2,775.00","$4,395.60","$4,440.00",$0.00,$868.58,$0.00,$883.56,$0.00
71675372,SUP,HCPCS C1713,,71675372  -  NAIL IM 135D 13MM 36CM INTERTAN TI RT TROCH,"$5,550.00",$0.00,"$5,550.00","$2,497.50","$3,961.04",$0.00,$956.24,$0.00,$0.00,$971.76,"$5,550.00",$0.00,"$2,775.00","$4,395.60","$4,440.00",$0.00,$868.58,$0.00,$883.56,$0.00
71675373,SUP,HCPCS C1713,,71675373  -  NAIL IM 135D 13MM 38CM INTERTAN TI LT TROCH,"$5,550.00",$0.00,"$5,550.00","$2,497.50","$3,961.04",$0.00,$956.24,$0.00,$0.00,$971.76,"$5,550.00",$0.00,"$2,775.00","$4,395.60","$4,440.00",$0.00,$868.58,$0.00,$883.56,$0.00
71675374,SUP,HCPCS C1713,,71675374  -  NAIL IM 135D 13MM 38CM INTERTAN TI RT TROCH,"$6,220.00",$0.00,"$6,220.00","$2,799.00","$4,439.21",$0.00,"$1,071.67",$0.00,$0.00,"$1,089.07","$6,220.00",$0.00,"$3,110.00","$4,926.24","$4,976.00",$0.00,$973.43,$0.00,$990.22,$0.00
71675375,SUP,HCPCS C1713,,71675375  -  NAIL IM 135D 13MM 40CM INTERTAN TI LT TROCH,"$5,550.00",$0.00,"$5,550.00","$2,497.50","$3,961.04",$0.00,$956.24,$0.00,$0.00,$971.76,"$5,550.00",$0.00,"$2,775.00","$4,395.60","$4,440.00",$0.00,$868.58,$0.00,$883.56,$0.00
71675376,SUP,HCPCS C1713,,71675376  -  NAIL IM 135D 13MM 40CM INTERTAN TI RT TROCH,"$5,550.00",$0.00,"$5,550.00","$2,497.50","$3,961.04",$0.00,$956.24,$0.00,$0.00,$971.76,"$5,550.00",$0.00,"$2,775.00","$4,395.60","$4,440.00",$0.00,$868.58,$0.00,$883.56,$0.00
71675377,SUP,HCPCS C1713,,71675377  -  NAIL IM 135D 13MM 42CM INTERTAN TI LT TROCH,"$5,550.00",$0.00,"$5,550.00","$2,497.50","$3,961.04",$0.00,$956.24,$0.00,$0.00,$971.76,"$5,550.00",$0.00,"$2,775.00","$4,395.60","$4,440.00",$0.00,$868.58,$0.00,$883.56,$0.00
71675378,SUP,HCPCS C1713,,71675378  -  NAIL IM 135D 13MM 42CM INTERTAN TI RT TROCH,"$5,550.00",$0.00,"$5,550.00","$2,497.50","$3,961.04",$0.00,$956.24,$0.00,$0.00,$971.76,"$5,550.00",$0.00,"$2,775.00","$4,395.60","$4,440.00",$0.00,$868.58,$0.00,$883.56,$0.00
71675379,SUP,HCPCS C1713,,71675379  -  NAIL IM 135D 13MM 44CM INTERTAN TI LT TROCH,"$5,550.00",$0.00,"$5,550.00","$2,497.50","$3,961.04",$0.00,$956.24,$0.00,$0.00,$971.76,"$5,550.00",$0.00,"$2,775.00","$4,395.60","$4,440.00",$0.00,$868.58,$0.00,$883.56,$0.00
71675380,SUP,HCPCS C1713,,71675380  -  NAIL IM 135D 13MM 44CM INTERTAN TI RT TROCH,"$5,550.00",$0.00,"$5,550.00","$2,497.50","$3,961.04",$0.00,$956.24,$0.00,$0.00,$971.76,"$5,550.00",$0.00,"$2,775.00","$4,395.60","$4,440.00",$0.00,$868.58,$0.00,$883.56,$0.00
71675381,SUP,HCPCS C1713,,71675381  -  NAIL IM 135D 13MM 46CM INTERTAN TI LT TROCH,"$5,550.00",$0.00,"$5,550.00","$2,497.50","$3,961.04",$0.00,$956.24,$0.00,$0.00,$971.76,"$5,550.00",$0.00,"$2,775.00","$4,395.60","$4,440.00",$0.00,$868.58,$0.00,$883.56,$0.00
71675382,SUP,HCPCS C1713,,71675382  -  NAIL IM 135D 13MM 46CM INTERTAN TI RT TROCH,"$5,550.00",$0.00,"$5,550.00","$2,497.50","$3,961.04",$0.00,$956.24,$0.00,$0.00,$971.76,"$5,550.00",$0.00,"$2,775.00","$4,395.60","$4,440.00",$0.00,$868.58,$0.00,$883.56,$0.00
71675383,SUP,HCPCS C1713,,71675383  -  NAIL IM 125D 10MM 18CM INTERTAN,"$3,330.00",$0.00,"$3,330.00","$1,498.50","$2,376.62",$0.00,$573.74,$0.00,$0.00,$583.06,"$3,330.00",$0.00,"$1,665.00","$2,637.36","$2,664.00",$0.00,$521.15,$0.00,$530.14,$0.00
71675384,SUP,HCPCS C1713,,71675384  -  NAIL IM 130D 10MM 18CM INTERTAN,"$3,330.00",$0.00,"$3,330.00","$1,498.50","$2,376.62",$0.00,$573.74,$0.00,$0.00,$583.06,"$3,330.00",$0.00,"$1,665.00","$2,637.36","$2,664.00",$0.00,$521.15,$0.00,$530.14,$0.00
71675385,SUP,HCPCS C1713,,71675385  -  NAIL IM 125D SHRT 10MM 20CM INTERTAN TROCH,"$3,330.00",$0.00,"$3,330.00","$1,498.50","$2,376.62",$0.00,$573.74,$0.00,$0.00,$583.06,"$3,330.00",$0.00,"$1,665.00","$2,637.36","$2,664.00",$0.00,$521.15,$0.00,$530.14,$0.00
71675386,SUP,HCPCS C1713,,71675386  -  NAIL IM 130D SHRT 10MM 20CM INTERTAN TROCH,"$3,330.00",$0.00,"$3,330.00","$1,498.50","$2,376.62",$0.00,$573.74,$0.00,$0.00,$583.06,"$3,330.00",$0.00,"$1,665.00","$2,637.36","$2,664.00",$0.00,$521.15,$0.00,$530.14,$0.00
71675401,SUP,HCPCS C1713,,71675401  -  NAIL IM 125D 13MM 26CM INTERTAN TI LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675402,SUP,HCPCS C1713,,71675402  -  NAIL IM 125D 13MM 26CM INTERTAN TI RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675403,SUP,HCPCS C1713,,71675403  -  NAIL IM 125D 13MM 28CM INTERTAN TI LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675404,SUP,HCPCS C1713,,71675404  -  NAIL IM 125D 13MM 28CM INTERTAN TI RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675405,SUP,HCPCS C1713,,71675405  -  NAIL IM 125D 13MM 30CM INTERTAN TI LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675406,SUP,HCPCS C1713,,71675406  -  NAIL IM 125D 13MM 30CM INTERTAN TI RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675407,SUP,HCPCS C1713,,71675407  -  NAIL IM 125D LNG 13MM 32CM INTERTAN TI LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675408,SUP,HCPCS C1713,,71675408  -  NAIL IM 125D 13MM 32CM INTERTAN TI RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675409,SUP,HCPCS C1713,,71675409  -  NAIL IM 125D 13MM 34CM INTERTAN TI LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675410,SUP,HCPCS C1713,,71675410  -  NAIL IM 125D 13MM 34CM INTERTAN TI RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675411,SUP,HCPCS C1713,,71675411  -  NAIL IM 125D 13MM 36CM INTERTAN TI LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675412,SUP,HCPCS C1713,,71675412  -  NAIL IM 125D 13MM 36CM INTERTAN TI RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675413,SUP,HCPCS C1713,,71675413  -  NAIL IM 125D 13MM 38CM INTERTAN TI LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675414,SUP,HCPCS C1713,,71675414  -  NAIL IM 125D 13MM 38CM INTERTAN TI RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675415,SUP,HCPCS C1713,,71675415  -  NAIL IM 125D 13MM 40CM INTERTAN TI LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675416,SUP,HCPCS C1713,,71675416  -  NAIL IM 125D 13MM 40CM INTERTAN TI RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675417,SUP,HCPCS C1713,,71675417  -  NAIL IM 125D 13MM 42CM INTERTAN TI LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675418,SUP,HCPCS C1713,,71675418  -  NAIL IM 125D 13MM 42CM INTERTAN TI RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675419,SUP,HCPCS C1713,,71675419  -  NAIL IM 125D 13MM 44CM INTERTAN LT,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675420,SUP,HCPCS C1713,,71675420  -  NAIL IM 125D 13MM 44CM INTERTAN TI RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675421,SUP,HCPCS C1713,,71675421  -  NAIL IM 125D 13MM 46CM INTERTAN TI LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675422,SUP,HCPCS C1713,,71675422  -  NAIL IM 125D 13MM 46CM INTERTAN TI RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675423,SUP,HCPCS C1713,,71675423  -  NAIL IM 130D 13MM 26CM INTERTAN TI LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675424,SUP,HCPCS C1713,,71675424  -  NAIL IM 130D 13MM 26CM INTERTAN TI RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675425,SUP,HCPCS C1713,,71675425  -  NAIL IM 130D 13MM 28CM INTERTAN TI LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675426,SUP,HCPCS C1713,,71675426  -  NAIL IM 130D 13MM 28CM INTERTAN TI RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675427,SUP,HCPCS C1713,,71675427  -  NAIL IM 130D 13MM 30CM INTERTAN TI LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675428,SUP,HCPCS C1713,,71675428  -  NAIL IM 130D 13MM 30CM INTERTAN TI RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675429,SUP,HCPCS C1713,,71675429  -  NAIL IM 130D 13MM 32CM INTERTAN TI LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675430,SUP,HCPCS C1713,,71675430  -  NAIL IM 130D 13MM 32CM INTERTAN TI RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675431,SUP,HCPCS C1713,,71675431  -  NAIL IM 130D 13MM 34CM INTERTAN TI LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675432,SUP,HCPCS C1713,,71675432  -  NAIL IM 130D 13MM 34CM INTERTAN TI RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675433,SUP,HCPCS C1713,,71675433  -  NAIL IM 130D 13MM 36CM INTERTAN TI LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675434,SUP,HCPCS C1713,,71675434  -  NAIL IM 130D 13MM 36CM INTERTAN TI RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675435,SUP,HCPCS C1713,,71675435  -  NAIL IM 130D 13MM 38CM INTERTAN TI LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675436,SUP,HCPCS C1713,,71675436  -  NAIL IM 130D 13MM 38CM INTERTAN ANTGRD TI RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675437,SUP,HCPCS C1713,,71675437  -  NAIL IM 130D 13MM 40CM INTERTAN TI LT,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675438,SUP,HCPCS C1713,,71675438  -  NAIL IM 130D 13MM 40CM INTERTAN TI RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675439,SUP,HCPCS C1713,,71675439  -  NAIL IM 130D 13MM 42CM INTERTAN TI LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675440,SUP,HCPCS C1713,,71675440  -  NAIL IM 130D 13MM 42CM INTERTAN TI RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675441,SUP,HCPCS C1713,,71675441  -  NAIL IM 130D 13MM 44CM INTERTAN TI LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675442,SUP,HCPCS C1713,,71675442  -  NAIL IM 130D 13MM 44CM INTERTAN TI RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675443,SUP,HCPCS C1713,,71675443  -  NAIL IM 130D 13MM 46CM INTERTAN TI LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675444,SUP,HCPCS C1713,,71675444  -  NAIL IM 130D 13MM 46CM INTERTAN TI RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675501,SUP,HCPCS C1713,,71675501  -  NAIL IM 125D 10MM 26CM INTERTAN LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675502,SUP,HCPCS C1713,,71675502  -  NAIL IM 130D 10MM 26CM INTERTAN LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675503,SUP,HCPCS C1713,,71675503  -  NAIL IM 125D 10MM 28CM INTERTAN LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675504,SUP,HCPCS C1713,,71675504  -  NAIL IM 130D 10MM 28CM INTERTAN LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675505,SUP,HCPCS C1713,,71675505  -  NAIL IM 125D 10MM 30CM INTERTAN LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675506,SUP,HCPCS C1713,,71675506  -  NAIL IM 130D 10MM 30CM INTERTAN LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675507,SUP,HCPCS C1713,,71675507  -  NAIL IM 125D 10MM 32CM INTERTAN LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675508,SUP,HCPCS C1713,,71675508  -  NAIL IM 130D 10MM 30CM INTERTAN LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675509,SUP,HCPCS C1713,,71675509  -  NAIL IM 125D 10MM 34CM INTERTAN LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675510,SUP,HCPCS C1713,,71675510  -  NAIL IM 130D 10MM 34CM INTERTAN LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675511,SUP,HCPCS C1713,,71675511  -  NAIL IM 125D 10MM 36CM INTERTAN LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675512,SUP,HCPCS C1713,,71675512  -  NAIL IM 130D 10MM 36CM INTERTAN LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675513,SUP,HCPCS C1713,,71675513  -  NAIL IM 125D 10MM 38CM INTERTAN LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675514,SUP,HCPCS C1713,,71675514  -  NAIL IM 130D 10MM 38CM INTERTAN LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675515,SUP,HCPCS C1713,,71675515  -  NAIL IM 125D 10MM 40CM INTERTAN LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675516,SUP,HCPCS C1713,,71675516  -  NAIL IM 130D 10MM 40CM INTERTAN LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675517,SUP,HCPCS C1713,,71675517  -  NAIL IM 125D 10MM 42CM INTERTAN LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675518,SUP,HCPCS C1713,,71675518  -  NAIL IM 130D 10MM 42CM INTERTAN LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675519,SUP,HCPCS C1713,,71675519  -  NAIL IM 125D 10MM 44CM INTERTAN LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675520,SUP,HCPCS C1713,,71675520  -  NAIL IM 130D 10MM 44CM INTERTAN LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675521,SUP,HCPCS C1713,,71675521  -  NAIL IM 125D 10MM 46CM INTERTAN LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675522,SUP,HCPCS C1713,,71675522  -  NAIL IM 130D 10MM 46CM INTERTAN LT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675523,SUP,HCPCS C1713,,71675523  -  NAIL IM 125D 10MM 26CM INTERTAN RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675524,SUP,HCPCS C1713,,71675524  -  NAIL IM 130D 10MM 26CM INTERTAN RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675525,SUP,HCPCS C1713,,71675525  -  NAIL IM 125D 10MM 28CM INTERTAN RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675526,SUP,HCPCS C1713,,71675526  -  NAIL IM 130D 10MM 28CM INTERTAN RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675527,SUP,HCPCS C1713,,71675527  -  NAIL IM 125D 10MM 30CM INTERTAN RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675528,SUP,HCPCS C1713,,71675528  -  NAIL IM 130D 10MM 30CM INTERTAN RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675529,SUP,HCPCS C1713,,71675529  -  NAIL IM 125D 10MM 36CM INTERTAN RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675530,SUP,HCPCS C1713,,71675530  -  NAIL IM 130D 10MM 32CM INTERTAN RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675531,SUP,HCPCS C1713,,71675531  -  NAIL IM 125D 10MM 34CM INTERTAN RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675532,SUP,HCPCS C1713,,71675532  -  NAIL IM 130D 10MM 34CM INTERTAN RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675533,SUP,HCPCS C1713,,71675533  -  NAIL IM 125D 10MM 36CM INTERTAN RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675534,SUP,HCPCS C1713,,71675534  -  NAIL IM 130D 10MM 36CM INTERTAN RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675535,SUP,HCPCS C1713,,71675535  -  NAIL IM 125D 10MM 38CM INTERTAN RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675536,SUP,HCPCS C1713,,71675536  -  NAIL IM 130D 10MM 38CM INTERTAN RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675537,SUP,HCPCS C1713,,71675537  -  NAIL IM 125D 10MM 40CM INTERTAN RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675538,SUP,HCPCS C1713,,71675538  -  NAIL IM 130D 10MM 40CM INTERTAN RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675539,SUP,HCPCS C1713,,71675539  -  NAIL IM 125D 10MM 42CM INTERTAN RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675540,SUP,HCPCS C1713,,71675540  -  NAIL IM 130D 10MM 42CM INTERTAN RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675541,SUP,HCPCS C1713,,71675541  -  NAIL IM 125D 10MM 44CM INTERTAN RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675542,SUP,HCPCS C1713,,71675542  -  NAIL IM 130D 10MM 44CM INTERTAN RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675543,SUP,HCPCS C1713,,71675543  -  NAIL IM 125D 10MM 46CM INTERTAN RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71675544,SUP,HCPCS C1713,,71675544  -  NAIL IM 130D 10MM 46CM INTERTAN RT TROCH,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676501,SUP,HCPCS C1713,,71676501  -  NAIL IM 125D 1.5MM 26CM 10MM INTERTAN LT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676502,SUP,HCPCS C1713,,71676502  -  NAIL IM 125D 1.5MM 26CM 10MM INTERTAN RT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676503,SUP,HCPCS C1713,,71676503  -  NAIL IM 125D 1.5MM 28CM 10MM INTERTAN LT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676504,SUP,HCPCS C1713,,71676504  -  NAIL IM 125D 1.5MM 10MM 28CM INTERTAN INTERTROCHANTER RT,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676505,SUP,HCPCS C1713,,71676505  -  NAIL IM 125D 1.5MM 30CM 10MM INTERTAN LT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676506,SUP,HCPCS C1713,,71676506  -  NAIL IM 125D 1.5MM 30CM 10MM INTERTAN RT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676507,SUP,HCPCS C1713,,71676507  -  NAIL IM 125D 1.5MM 32CM 10MM INTERTAN LT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676508,SUP,HCPCS C1713,,71676508  -  NAIL IM 125D 1.5MM 32CM 10MM INTERTAN RT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676509,SUP,HCPCS C1713,,71676509  -  NAIL IM 125D 1.5MM 34CM 10MM INTERTAN LT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676510,SUP,HCPCS C1713,,71676510  -  NAIL IM 125D 1.5MM 34CM 10MM INTERTAN RT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676511,SUP,HCPCS C1713,,71676511  -  NAIL IM 125D 1.5MM 36CM 10MM INTERTAN LT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676512,SUP,HCPCS C1713,,71676512  -  NAIL IM 125D 1.5MM 36CM 10MM INTERTAN RT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676513,SUP,HCPCS C1713,,71676513  -  NAIL IM 125D 1.5MM 38CM 10MM INTERTAN LT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676514,SUP,HCPCS C1713,,71676514  -  NAIL IM 125D 1.5MM 38CM 10MM INTERTAN RT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676515,SUP,HCPCS C1713,,71676515  -  NAIL IM 125D 1.5MM 40CM 10MM INTERTAN LT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676516,SUP,HCPCS C1713,,71676516  -  NAIL IM 125D 1.5MM 40CM 10MM INTERTAN RT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676517,SUP,HCPCS C1713,,71676517  -  NAIL IM 125D 1.5MM 42CM 10MM INTERTAN LT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676518,SUP,HCPCS C1713,,71676518  -  NAIL IM 125D 1.5MM 42CM 10MM INTERTAN RT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676519,SUP,HCPCS C1713,,71676519  -  NAIL IM 125D 1.5MM 44CM 10MM INTERTAN LT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676520,SUP,HCPCS C1713,,71676520  -  NAIL IM 125D 1.5MM 44CM 10MM INTERTAN RT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676521,SUP,HCPCS C1713,,71676521  -  NAIL IM 125D 1.5MM 46CM 10MM INTERTAN LT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676522,SUP,HCPCS C1713,,71676522  -  NAIL IM 125D 1.5MM 46CM 10MM INTERTAN RT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676523,SUP,HCPCS C1713,,71676523  -  NAIL IM 130D 1.5MM 26CM 10MM INTERTAN LT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676524,SUP,HCPCS C1713,,71676524  -  NAIL IM 130D 1.5MM 26CM 10MM INTERTAN RT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676525,SUP,HCPCS C1713,,71676525  -  NAIL IM 130D 1.5MM 28CM 10MM INTERTAN LT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676526,SUP,HCPCS C1713,,71676526  -  NAIL IM 130D 1.5MM 28CM 10MM INTERTAN RT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676527,SUP,HCPCS C1713,,71676527  -  NAIL IM 130D 1.5MM 30CM 10MM INTERTAN LT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676528,SUP,HCPCS C1713,,71676528  -  NAIL IM 130D 1.5MM 30CM 10MM INTERTAN RT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676529,SUP,HCPCS C1713,,71676529  -  NAIL IM 130D 1.5MM 32CM 10MM INTERTAN LT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676530,SUP,HCPCS C1713,,71676530  -  NAIL IM 130D 1.5MM 32CM 10MM INTERTAN RT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676531,SUP,HCPCS C1713,,71676531  -  NAIL IM 130D 1.5MM 34CM 10MM INTERTAN LT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676532,SUP,HCPCS C1713,,71676532  -  NAIL IM 130D 1.5MM 34CM 10MM INTERTAN RT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676533,SUP,HCPCS C1713,,71676533  -  NAIL IM 130D 1.5MM 36CM 10MM INTERTAN LT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676534,SUP,HCPCS C1713,,71676534  -  NAIL IM 130D 1.5MM 36CM 10MM INTERTAN RT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676535,SUP,HCPCS C1713,,71676535  -  NAIL IM 130D 1.5MM 38CM 10MM INTERTAN LT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676536,SUP,HCPCS C1713,,71676536  -  NAIL IM 130D 1.5MM 38CM 10MM INTERTAN RT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676537,SUP,HCPCS C1713,,71676537  -  NAIL IM 130D 1.5MM 40CM 10MM INTERTAN LT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676538,SUP,HCPCS C1713,,71676538  -  NAIL IM 130D 1.5MM 40CM 10MM INTERTAN RT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676539,SUP,HCPCS C1713,,71676539  -  NAIL IM 130D 1.5MM 42CM 10MM INTERTAN LT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676540,SUP,HCPCS C1713,,71676540  -  NAIL IM 130D 1.5MM 42CM 10MM INTERTAN RT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676541,SUP,HCPCS C1713,,71676541  -  NAIL IM 130D 1.5MM 44CM 10MM INTERTAN LT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676542,SUP,HCPCS C1713,,71676542  -  NAIL IM 130D 1.5MM 44CM 10MM INTERTAN RT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676543,SUP,HCPCS C1713,,71676543  -  NAIL IM 130D 1.5MM 46CM 10MM INTERTAN LT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676544,SUP,HCPCS C1713,,71676544  -  NAIL IM 130D 1.5MM 46CM 10MM INTERTAN RT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676545,SUP,HCPCS C1713,,71676545  -  NAIL IM 125D 1.5MM 26CM 11.5MM INTERTAN LT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676546,SUP,HCPCS C1713,,71676546  -  NAIL IM 125D 1.5MM 26CM 11.5MM INTERTAN RT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676547,SUP,HCPCS C1713,,71676547  -  NAIL IM 125D 1.5MM 28CM 11.5MM INTERTAN LT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676548,SUP,HCPCS C1713,,71676548  -  NAIL IM 125D 1.5MM 28CM 11.5MM INTERTAN RT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676549,SUP,HCPCS C1713,,71676549  -  NAIL IM 125D 1.5MM 30CM 11.5MM INTERTAN LT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676550,SUP,HCPCS C1713,,71676550  -  NAIL IM 125D 1.5MM 30CM 11.5MM INTERTAN RT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676551,SUP,HCPCS C1713,,71676551  -  NAIL IM 125D 1.5MM 32CM 11.5MM INTERTAN LT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676552,SUP,HCPCS C1713,,71676552  -  NAIL IM 125D 1.5MM 32CM 11.5MM INTERTAN RT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676553,SUP,HCPCS C1713,,71676553  -  NAIL INTRAMEDULLARY 125D 1.5MM 34CM 11.5MM INTERTAN LEFT,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676554,SUP,HCPCS C1713,,71676554  -  NAIL IM 125D 1.5MM 34CM 11.5MM INTERTAN RT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676555,SUP,HCPCS C1713,,71676555  -  NAIL IM 125D 1.5MM 36CM 11.5MM INTERTAN LT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676556,SUP,HCPCS C1713,,71676556  -  NAIL IM 125D 1.5MM 36CM 11.5MM INTERTAN RT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676557,SUP,HCPCS C1713,,71676557  -  NAIL IM 125D 1.5MM 38CM 11.5MM INTERTAN LT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676558,SUP,HCPCS C1713,,71676558  -  NAIL INTRAMEDULLARY 125D 1.5MM 38CM 11.5MM INTERTAN RIGHT,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676559,SUP,HCPCS C1713,,71676559  -  NAIL IM 125D 1.5MM 40CM 11.5MM INTERTAN LT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676560,SUP,HCPCS C1713,,71676560  -  NAIL IM 125D 1.5MM 40CM 11.5MM INTERTAN RT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676561,SUP,HCPCS C1713,,71676561  -  NAIL IM 125D 1.5MM 42CM 11.5MM INTERTAN LT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676562,SUP,HCPCS C1713,,71676562  -  NAIL IM 125D 1.5MM 42CM 11.5MM INTERTAN RT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676563,SUP,HCPCS C1713,,71676563  -  NAIL IM 125D 1.5MM 44CM 11.5MM INTERTAN LT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676564,SUP,HCPCS C1713,,71676564  -  NAIL IM 125D 1.5MM 44CM 11.5MM INTERTAN RT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676565,SUP,HCPCS C1713,,71676565  -  NAIL IM 125D 1.5MM 46CM 11.5MM INTERTAN LT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676566,SUP,HCPCS C1713,,71676566  -  NAIL IM 125D 1.5MM 46CM 11.5MM INTERTAN RT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676567,SUP,HCPCS C1713,,71676567  -  NAIL IM 130D 1.5MM 26CM 11.5MM INTERTAN LT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676568,SUP,HCPCS C1713,,71676568  -  NAIL IM 130D 1.5MM 26CM 11.5MM INTERTAN RT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676569,SUP,HCPCS C1713,,71676569  -  NAIL IM 130D 1.5MM 28CM 11.5MM INTERTAN LT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676570,SUP,HCPCS C1713,,71676570  -  NAIL IM 130D 1.5MM 28CM 11.5MM INTERTAN RT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676571,SUP,HCPCS C1713,,71676571  -  NAIL IM 130D 1.5MM 30CM 11.5MM INTERTAN LT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676572,SUP,HCPCS C1713,,71676572  -  NAIL IM 130D 1.5MM 30CM 11.5MM INTERTAN RT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676573,SUP,HCPCS C1713,,71676573  -  NAIL IM 130D 1.5MM 32CM 11.5MM INTERTAN LT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676574,SUP,HCPCS C1713,,71676574  -  NAIL IM 130D 1.5MM 32CM 11.5MM INTERTAN RT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676575,SUP,HCPCS C1713,,71676575  -  NAIL IM 130D 1.5MM 34CM 11.5MM INTERTAN LT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676576,SUP,HCPCS C1713,,71676576  -  NAIL IM 130D 1.5MM 34CM 11.5MM INTERTAN RT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676577,SUP,HCPCS C1713,,71676577  -  NAIL IM 130D 1.5MM 36CM 11.5MM INTERTAN LT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676578,SUP,HCPCS C1713,,71676578  -  NAIL IM 130D 1.5MM 36CM 11.5MM INTERTAN RT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676579,SUP,HCPCS C1713,,71676579  -  NAIL IM 130D 1.5MM 38CM 11.5MM INTERTAN LT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676580,SUP,HCPCS C1713,,71676580  -  NAIL IM 130D 1.5MM 38CM 11.5MM INTERTAN RT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676581,SUP,HCPCS C1713,,71676581  -  NAIL IM 130D 1.5MM 40CM 11.5MM INTERTAN LT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676582,SUP,HCPCS C1713,,71676582  -  NAIL IM 130D 1.5MM 40CM 11.5MM INTERTAN RT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676583,SUP,HCPCS C1713,,71676583  -  NAIL IM 130D 1.5MM 42CM 11.5MM INTERTAN LT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676584,SUP,HCPCS C1713,,71676584  -  NAIL IM 130D 1.5MM 42CM 11.5MM INTERTAN RT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676585,SUP,HCPCS C1713,,71676585  -  NAIL IM 130D 1.5MM 44CM 11.5MM INTERTAN LT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676586,SUP,HCPCS C1713,,71676586  -  NAIL IM 130D 1.5MM 44CM 11.5MM INTERTAN RT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676587,SUP,HCPCS C1713,,71676587  -  NAIL IM 130D 1.5MM 46CM 11.5MM INTERTAN LT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676588,SUP,HCPCS C1713,,71676588  -  NAIL IM 130D 1.5MM 46CM 11.5MM INTERTAN RT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676589,SUP,HCPCS C1713,,71676589  -  NAIL IM 125D 1.5MM 26CM 13MM INTERTAN LT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676590,SUP,HCPCS C1713,,71676590  -  NAIL IM 125D 1.5MM 26CM 13MM INTERTAN RT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676591,SUP,HCPCS C1713,,71676591  -  NAIL IM 125D 1.5MM 28CM 13MM INTERTAN LT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676592,SUP,HCPCS C1713,,71676592  -  NAIL IM 125D 1.5MM 28CM 13MM INTERTAN RT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676593,SUP,HCPCS C1713,,71676593  -  NAIL IM 125D 1.5MM 30CM 13MM INTERTAN LT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676594,SUP,HCPCS C1713,,71676594  -  NAIL IM 125D 1.5MM 30CM 13MM INTERTAN RT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676595,SUP,HCPCS C1713,,71676595  -  NAIL IM 125D 1.5MM 32CM 13MM INTERTAN LT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676596,SUP,HCPCS C1713,,71676596  -  NAIL IM 125D 1.5MM 32CM 13MM INTERTAN RT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676597,SUP,HCPCS C1713,,71676597  -  NAIL IM 125D 1.5MM 34CM 13MM INTERTAN LT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676598,SUP,HCPCS C1713,,71676598  -  NAIL IM 125D 1.5MM 34CM 13MM INTERTAN RT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676599,SUP,HCPCS C1713,,71676599  -  NAIL IM 125D 1.5MM 36CM 13MM INTERTAN LT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676600,SUP,HCPCS C1713,,71676600  -  NAIL IM 125D 1.5MM 36CM 13MM INTERTAN RT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676601,SUP,HCPCS C1713,,71676601  -  NAIL IM 125D 1.5MM 38CM 13MM INTERTAN LT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676602,SUP,HCPCS C1713,,71676602  -  NAIL IM 125D 1.5MM 38CM 13MM INTERTAN RT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676603,SUP,HCPCS C1713,,71676603  -  NAIL IM 125D 1.5MM 40CM 13MM INTERTAN LT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676604,SUP,HCPCS C1713,,71676604  -  NAIL IM 125D 1.5MM 40CM 13MM INTERTAN RT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676605,SUP,HCPCS C1713,,71676605  -  NAIL IM 125D 1.5MM 42CM 13MM INTERTAN LT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676606,SUP,HCPCS C1713,,71676606  -  NAIL IM 125D 1.5MM 42CM 13MM INTERTAN RT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676607,SUP,HCPCS C1713,,71676607  -  NAIL IM 125D 1.5MM 44CM 13MM INTERTAN LT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676608,SUP,HCPCS C1713,,71676608  -  NAIL IM 125D 1.5MM 44CM 13MM INTERTAN RT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676609,SUP,HCPCS C1713,,71676609  -  NAIL IM 125D 1.5MM 46CM 13MM INTERTAN LT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676610,SUP,HCPCS C1713,,71676610  -  NAIL IM 125D 1.5MM 46CM 13MM INTERTAN RT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676611,SUP,HCPCS C1713,,71676611  -  NAIL IM 130D 1.5MM 26CM 13MM INTERTAN LT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676612,SUP,HCPCS C1713,,71676612  -  NAIL IM 130D 1.5MM 26CM 13MM INTERTAN RT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676613,SUP,HCPCS C1713,,71676613  -  NAIL IM 130D 1.5MM 28CM 13MM INTERTAN LT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676614,SUP,HCPCS C1713,,71676614  -  NAIL IM 130D 1.5MM 28CM 13MM INTERTAN RT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676615,SUP,HCPCS C1713,,71676615  -  NAIL IM 130D 1.5MM 30CM 13MM INTERTAN LT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676616,SUP,HCPCS C1713,,71676616  -  NAIL IM 130D 1.5MM 30CM 13MM INTERTAN RT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676617,SUP,HCPCS C1713,,71676617  -  NAIL IM 130D 1.5MM 32CM 13MM INTERTAN LT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676618,SUP,HCPCS C1713,,71676618  -  NAIL IM 130D 1.5MM 32CM 13MM INTERTAN RT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676619,SUP,HCPCS C1713,,71676619  -  NAIL IM 130D 1.5MM 34CM 13MM INTERTAN LT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676620,SUP,HCPCS C1713,,71676620  -  NAIL IM 130D 1.5MM 34CM 13MM INTERTAN RT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676621,SUP,HCPCS C1713,,71676621  -  NAIL IM 130D 1.5MM 36CM 13MM INTERTAN LT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676622,SUP,HCPCS C1713,,71676622  -  NAIL IM 130D 1.5MM 36CM 13MM INTERTAN RT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676623,SUP,HCPCS C1713,,71676623  -  NAIL IM 130D 1.5MM 38CM 13MM INTERTAN LT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676624,SUP,HCPCS C1713,,71676624  -  NAIL IM 130D 1.5MM 38CM 13MM INTERTAN RT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676625,SUP,HCPCS C1713,,71676625  -  NAIL IM 130D 1.5MM 40CM 13MM INTERTAN LT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676626,SUP,HCPCS C1713,,71676626  -  NAIL IM 130D 1.5MM 40CM 13MM INTERTAN RT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676627,SUP,HCPCS C1713,,71676627  -  NAIL IM 130D 1.5MM 42CM 13MM INTERTAN LT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676628,SUP,HCPCS C1713,,71676628  -  NAIL IM 130D 1.5MM 42CM 13MM INTERTAN RT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676629,SUP,HCPCS C1713,,71676629  -  NAIL IM 130D 1.5MM 44CM 13MM INTERTAN LT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676630,SUP,HCPCS C1713,,71676630  -  NAIL IM 130D 1.5MM 44CM 13MM INTERTAN RT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676631,SUP,HCPCS C1713,,71676631  -  NAIL IM 130D 1.5MM 46CM 13MM INTERTAN LT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71676632,SUP,HCPCS C1713,,71676632  -  NAIL IM 130D 1.5MM 46CM 13MM INTERTAN RT INTERTROCHANTER,"$4,443.75",$0.00,"$4,443.75","$1,999.69","$3,171.50",$0.00,$765.64,$0.00,$0.00,$778.07,"$4,443.75",$0.00,"$2,221.88","$3,519.45","$3,555.00",$0.00,$695.45,$0.00,$707.45,$0.00
71677070,SUP,HCPCS C1713,,71677070  -  SCREW BN 70/65MM INTERTAN LG CMPR TROCH CMBN PK,"$1,417.50",$0.00,"$1,417.50",$637.88,"$1,011.67",$0.00,$244.23,$0.00,$0.00,$248.19,"$1,417.50",$0.00,$708.75,"$1,122.66","$1,134.00",$0.00,$221.84,$0.00,$225.67,$0.00
71677075,SUP,HCPCS C1713,,71677075  -  SCREW BN 75/70MM INTERTAN LG CMPR TROCH CMBN PK,"$1,417.50",$0.00,"$1,417.50",$637.88,"$1,011.67",$0.00,$244.23,$0.00,$0.00,$248.19,"$1,417.50",$0.00,$708.75,"$1,122.66","$1,134.00",$0.00,$221.84,$0.00,$225.67,$0.00
71677080,SUP,HCPCS C1713,,71677080  -  KIT SCR 80MMX70MM INTERTAN LG CMPR TROCH TI CMBN PK,"$1,417.50",$0.00,"$1,417.50",$637.88,"$1,011.67",$0.00,$244.23,$0.00,$0.00,$248.19,"$1,417.50",$0.00,$708.75,"$1,122.66","$1,134.00",$0.00,$221.84,$0.00,$225.67,$0.00
71677085,SUP,HCPCS C1713,,71677085  -  SCREW BN 11MM 7MM 85MM 80MM INTERTAN KT CMPR LG INTGR INTLK,"$1,417.50",$0.00,"$1,417.50",$637.88,"$1,011.67",$0.00,$244.23,$0.00,$0.00,$248.19,"$1,417.50",$0.00,$708.75,"$1,122.66","$1,134.00",$0.00,$221.84,$0.00,$225.67,$0.00
71677090,SUP,HCPCS C1713,,71677090  -  KIT SCREW 4.5MM 90MM 85MM LAG COMPRESSION INTEGRATE,"$1,417.50",$0.00,"$1,417.50",$637.88,"$1,011.67",$0.00,$244.23,$0.00,$0.00,$248.19,"$1,417.50",$0.00,$708.75,"$1,122.66","$1,134.00",$0.00,$221.84,$0.00,$225.67,$0.00
71677095,SUP,HCPCS C1713,,71677095  -  KIT SCREW 4.5MM 95MM 90MM LAG COMPRESSION INTEGRATED INTLCK,"$1,417.50",$0.00,"$1,417.50",$637.88,"$1,011.67",$0.00,$244.23,$0.00,$0.00,$248.19,"$1,417.50",$0.00,$708.75,"$1,122.66","$1,134.00",$0.00,$221.84,$0.00,$225.67,$0.00
71677120,SUP,HCPCS C1713,,71677120  -  SCREW BN 11MM 7MM 120MM 115MM INTERTAN KT CMPR LG INTGR,"$1,417.50",$0.00,"$1,417.50",$637.88,"$1,011.67",$0.00,$244.23,$0.00,$0.00,$248.19,"$1,417.50",$0.00,$708.75,"$1,122.66","$1,134.00",$0.00,$221.84,$0.00,$225.67,$0.00
71677125,SUP,HCPCS C1713,,71677125  -  SCREW BN 125/120MM INTERTAN LG CMPR TROCH CMBN PK,"$1,417.50",$0.00,"$1,417.50",$637.88,"$1,011.67",$0.00,$244.23,$0.00,$0.00,$248.19,"$1,417.50",$0.00,$708.75,"$1,122.66","$1,134.00",$0.00,$221.84,$0.00,$225.67,$0.00
71678005,SUP,HCPCS C1713,,71678005  -  SCREW BN 11MM 105MM INTERTAN LG TI SUBTROCHANTER,"$1,141.88",$0.00,"$1,141.88",$513.84,$814.96,$0.00,$196.74,$0.00,$0.00,$199.93,"$1,141.88",$0.00,$570.94,$904.37,$913.50,$0.00,$178.70,$0.00,$181.79,$0.00
71678010,SUP,HCPCS C1713,,71678010  -  SCREW BN 11MM 100MM INTERTAN LG TI SUBTROCHANTER,"$1,141.88",$0.00,"$1,141.88",$513.84,$814.96,$0.00,$196.74,$0.00,$0.00,$199.93,"$1,141.88",$0.00,$570.94,$904.37,$913.50,$0.00,$178.70,$0.00,$181.79,$0.00
71678011,SUP,HCPCS C1713,,71678011  -  SCREW BN 11MM 110MM INTERTAN LG TI SUBTROCHANTER,"$1,141.88",$0.00,"$1,141.88",$513.84,$814.96,$0.00,$196.74,$0.00,$0.00,$199.93,"$1,141.88",$0.00,$570.94,$904.37,$913.50,$0.00,$178.70,$0.00,$181.79,$0.00
71678012,SUP,HCPCS C1713,,71678012  -  SCREW BN 11MM 120MM INTERTAN LG TI SUBTROCHANTER,"$1,141.88",$0.00,"$1,141.88",$513.84,$814.96,$0.00,$196.74,$0.00,$0.00,$199.93,"$1,141.88",$0.00,$570.94,$904.37,$913.50,$0.00,$178.70,$0.00,$181.79,$0.00
71678015,SUP,HCPCS C1713,,71678015  -  SCREW BN 11MM 115MM INTERTAN LG TI SUBTROCHANTER,"$1,141.88",$0.00,"$1,141.88",$513.84,$814.96,$0.00,$196.74,$0.00,$0.00,$199.93,"$1,141.88",$0.00,$570.94,$904.37,$913.50,$0.00,$178.70,$0.00,$181.79,$0.00
71678025,SUP,HCPCS C1713,,71678025  -  SCREW BN 11MM 125MM INTERTAN LG SBTCH,"$1,141.88",$0.00,"$1,141.88",$513.84,$814.96,$0.00,$196.74,$0.00,$0.00,$199.93,"$1,141.88",$0.00,$570.94,$904.37,$913.50,$0.00,$178.70,$0.00,$181.79,$0.00
71678070,SUP,HCPCS C1713,,71678070  -  SCREW BN 11MM 70MM INTERTAN LG SBTCH,"$1,141.88",$0.00,"$1,141.88",$513.84,$814.96,$0.00,$196.74,$0.00,$0.00,$199.93,"$1,141.88",$0.00,$570.94,$904.37,$913.50,$0.00,$178.70,$0.00,$181.79,$0.00
71678075,SUP,HCPCS C1713,,71678075  -  SCREW BN 11MM 75MM INTERTAN LG SBTCH,"$1,141.88",$0.00,"$1,141.88",$513.84,$814.96,$0.00,$196.74,$0.00,$0.00,$199.93,"$1,141.88",$0.00,$570.94,$904.37,$913.50,$0.00,$178.70,$0.00,$181.79,$0.00
71678080,SUP,HCPCS C1713,,71678080  -  SCREW BN 11MM 80MM INTERTAN LG TI SUBTROCHANTER,"$1,141.88",$0.00,"$1,141.88",$513.84,$814.96,$0.00,$196.74,$0.00,$0.00,$199.93,"$1,141.88",$0.00,$570.94,$904.37,$913.50,$0.00,$178.70,$0.00,$181.79,$0.00
71678085,SUP,HCPCS C1713,,71678085  -  SCREW BN 11MM 85MM INTERTAN LG TI SUBTROCHANTER,"$1,141.88",$0.00,"$1,141.88",$513.84,$814.96,$0.00,$196.74,$0.00,$0.00,$199.93,"$1,141.88",$0.00,$570.94,$904.37,$913.50,$0.00,$178.70,$0.00,$181.79,$0.00
71678090,SUP,HCPCS C1713,,71678090  -  SCREW BN 11MM 90MM INTERTAN LG TI SUBTROCHANTER,"$1,141.88",$0.00,"$1,141.88",$513.84,$814.96,$0.00,$196.74,$0.00,$0.00,$199.93,"$1,141.88",$0.00,$570.94,$904.37,$913.50,$0.00,$178.70,$0.00,$181.79,$0.00
71678095,SUP,HCPCS C1713,,71678095  -  SCREW BN 11MM 95MM INTERTAN LG TI SUBTROCHANTER,"$1,141.88",$0.00,"$1,141.88",$513.84,$814.96,$0.00,$196.74,$0.00,$0.00,$199.93,"$1,141.88",$0.00,$570.94,$904.37,$913.50,$0.00,$178.70,$0.00,$181.79,$0.00
71679002,SUP,HCPCS C1713,,71679002  -  PLATE BN 127D 80MM INTERTAN CHS 2 HL SS,"$2,080.00",$0.00,"$2,080.00",$936.00,"$1,484.50",$0.00,$358.37,$0.00,$0.00,$364.19,"$2,080.00",$0.00,"$1,040.00","$1,647.36","$1,664.00",$0.00,$325.52,$0.00,$331.14,$0.00
71679003,SUP,HCPCS C1713,,71679003  -  PLATE BN 127D 92MM INTERTAN CHS 3 HL SS,"$2,080.00",$0.00,"$2,080.00",$936.00,"$1,484.50",$0.00,$358.37,$0.00,$0.00,$364.19,"$2,080.00",$0.00,"$1,040.00","$1,647.36","$1,664.00",$0.00,$325.52,$0.00,$331.14,$0.00
71679004,SUP,HCPCS C1713,,71679004  -  PLATE BN 127D 104MM INTERTAN CHS 4 HL SS,"$2,080.00",$0.00,"$2,080.00",$936.00,"$1,484.50",$0.00,$358.37,$0.00,$0.00,$364.19,"$2,080.00",$0.00,"$1,040.00","$1,647.36","$1,664.00",$0.00,$325.52,$0.00,$331.14,$0.00
71679005,SUP,HCPCS C1713,,71679005  -  PLATE BN 127D 116MM INTERTAN CHS 5 HL SS HIP,"$2,080.00",$0.00,"$2,080.00",$936.00,"$1,484.50",$0.00,$358.37,$0.00,$0.00,$364.19,"$2,080.00",$0.00,"$1,040.00","$1,647.36","$1,664.00",$0.00,$325.52,$0.00,$331.14,$0.00
71679006,SUP,HCPCS C1713,,71679006  -  PLATE BN 127D 128MM INTERTAN CHS 6 HL SS HIP,"$2,080.00",$0.00,"$2,080.00",$936.00,"$1,484.50",$0.00,$358.37,$0.00,$0.00,$364.19,"$2,080.00",$0.00,"$1,040.00","$1,647.36","$1,664.00",$0.00,$325.52,$0.00,$331.14,$0.00
71679102,SUP,HCPCS C1713,,71679102  -  PLATE BN 135D 84MM INTERTAN CHS 2 HL SS,"$2,080.00",$0.00,"$2,080.00",$936.00,"$1,484.50",$0.00,$358.37,$0.00,$0.00,$364.19,"$2,080.00",$0.00,"$1,040.00","$1,647.36","$1,664.00",$0.00,$325.52,$0.00,$331.14,$0.00
71679103,SUP,HCPCS C1713,,71679103  -  PLATE BN 135D 96MM INTERTAN CHS 3 HL SS HIP,"$2,080.00",$0.00,"$2,080.00",$936.00,"$1,484.50",$0.00,$358.37,$0.00,$0.00,$364.19,"$2,080.00",$0.00,"$1,040.00","$1,647.36","$1,664.00",$0.00,$325.52,$0.00,$331.14,$0.00
71679104,SUP,HCPCS C1713,,71679104  -  PLATE BN 135D 4 HL CMPR ORTH,"$2,080.00",$0.00,"$2,080.00",$936.00,"$1,484.50",$0.00,$358.37,$0.00,$0.00,$364.19,"$2,080.00",$0.00,"$1,040.00","$1,647.36","$1,664.00",$0.00,$325.52,$0.00,$331.14,$0.00
71679105,SUP,HCPCS C1713,,71679105  -  PLATE BN 135D 120MM INTERTAN CHS 5 HL SS HIP,"$2,080.00",$0.00,"$2,080.00",$936.00,"$1,484.50",$0.00,$358.37,$0.00,$0.00,$364.19,"$2,080.00",$0.00,"$1,040.00","$1,647.36","$1,664.00",$0.00,$325.52,$0.00,$331.14,$0.00
71679106,SUP,HCPCS C1713,,71679106  -  SCREW BN 135D 132MM INTERTAN CHS 6 HL SS,"$2,080.00",$0.00,"$2,080.00",$936.00,"$1,484.50",$0.00,$358.37,$0.00,$0.00,$364.19,"$2,080.00",$0.00,"$1,040.00","$1,647.36","$1,664.00",$0.00,$325.52,$0.00,$331.14,$0.00
71679230,SUP,HCPCS C1713,,71679230  -  SCREW BN 30MM INTERTAN CHS CMPR SS,$904.00,$0.00,$904.00,$406.80,$645.18,$0.00,$155.75,$0.00,$0.00,$158.28,$904.00,$0.00,$452.00,$715.97,$723.20,$0.00,$141.48,$0.00,$143.92,$0.00
71679265,SUP,HCPCS C1713,,71679265  -  SCREW BN 65/60 INTERTAN CHS LG CMPR SS,"$1,642.00",$0.00,"$1,642.00",$738.90,"$1,171.90",$0.00,$282.91,$0.00,$0.00,$287.50,"$1,642.00",$0.00,$821.00,"$1,300.46","$1,313.60",$0.00,$256.97,$0.00,$261.41,$0.00
71679270,SUP,HCPCS C1713,,71679270  -  SCREW BN 70/65 INTERTAN CHS LG CMPR SS,"$1,642.00",$0.00,"$1,642.00",$738.90,"$1,171.90",$0.00,$282.91,$0.00,$0.00,$287.50,"$1,642.00",$0.00,$821.00,"$1,300.46","$1,313.60",$0.00,$256.97,$0.00,$261.41,$0.00
71679275,SUP,HCPCS C1713,,71679275  -  SCREW BN 75/70 INTERTAN CHS CMPR LG SS HIP,"$1,642.00",$0.00,"$1,642.00",$738.90,"$1,171.90",$0.00,$282.91,$0.00,$0.00,$287.50,"$1,642.00",$0.00,$821.00,"$1,300.46","$1,313.60",$0.00,$256.97,$0.00,$261.41,$0.00
71679280,SUP,HCPCS C1713,,71679280  -  SCREW BN 80/75 INTERTAN CHS LG CMPR SS,"$1,642.00",$0.00,"$1,642.00",$738.90,"$1,171.90",$0.00,$282.91,$0.00,$0.00,$287.50,"$1,642.00",$0.00,$821.00,"$1,300.46","$1,313.60",$0.00,$256.97,$0.00,$261.41,$0.00
71679285,SUP,HCPCS C1713,,71679285  -  SCREW BN 85/80 INTERTAN CHS LG CMPR SS,"$1,642.00",$0.00,"$1,642.00",$738.90,"$1,171.90",$0.00,$282.91,$0.00,$0.00,$287.50,"$1,642.00",$0.00,$821.00,"$1,300.46","$1,313.60",$0.00,$256.97,$0.00,$261.41,$0.00
71679290,SUP,HCPCS C1713,,71679290  -  SCREW BN 90/85 INTERTAN CHS LG CMPR SS,"$1,642.00",$0.00,"$1,642.00",$738.90,"$1,171.90",$0.00,$282.91,$0.00,$0.00,$287.50,"$1,642.00",$0.00,$821.00,"$1,300.46","$1,313.60",$0.00,$256.97,$0.00,$261.41,$0.00
71679295,SUP,HCPCS C1713,,71679295  -  SCREW BN 95/90 INTERTAN CHS LG CMPR SS,"$1,642.00",$0.00,"$1,642.00",$738.90,"$1,171.90",$0.00,$282.91,$0.00,$0.00,$287.50,"$1,642.00",$0.00,$821.00,"$1,300.46","$1,313.60",$0.00,$256.97,$0.00,$261.41,$0.00
71679300,SUP,HCPCS C1713,,71679300  -  SCREW BN 100/95 INTERTAN CHS LG CMPR SS,"$1,642.00",$0.00,"$1,642.00",$738.90,"$1,171.90",$0.00,$282.91,$0.00,$0.00,$287.50,"$1,642.00",$0.00,$821.00,"$1,300.46","$1,313.60",$0.00,$256.97,$0.00,$261.41,$0.00
71679305,SUP,HCPCS C1713,,71679305  -  SCREW BN 105/100 INTERTAN CHS LG CMPR SS,"$1,642.00",$0.00,"$1,642.00",$738.90,"$1,171.90",$0.00,$282.91,$0.00,$0.00,$287.50,"$1,642.00",$0.00,$821.00,"$1,300.46","$1,313.60",$0.00,$256.97,$0.00,$261.41,$0.00
71679310,SUP,HCPCS C1713,,71679310  -  SCREW BN 110/105 INTERTAN CHS LG CMPR SS,"$1,642.00",$0.00,"$1,642.00",$738.90,"$1,171.90",$0.00,$282.91,$0.00,$0.00,$287.50,"$1,642.00",$0.00,$821.00,"$1,300.46","$1,313.60",$0.00,$256.97,$0.00,$261.41,$0.00
71679315,SUP,HCPCS C1713,,71679315  -  SCREW BN 115/110 INTERTAN CHS LG CMPR SS,"$1,642.00",$0.00,"$1,642.00",$738.90,"$1,171.90",$0.00,$282.91,$0.00,$0.00,$287.50,"$1,642.00",$0.00,$821.00,"$1,300.46","$1,313.60",$0.00,$256.97,$0.00,$261.41,$0.00
71679320,SUP,HCPCS C1713,,71679320  -  SCREW BN 120/115 INTERTAN CHS LG CMPR SS,"$1,530.00",$0.00,"$1,530.00",$688.50,"$1,091.96",$0.00,$263.61,$0.00,$0.00,$267.89,"$1,530.00",$0.00,$765.00,"$1,211.76","$1,224.00",$0.00,$239.45,$0.00,$243.58,$0.00
71679325,SUP,HCPCS C1713,,71679325  -  SCREW BN 125/120 INTERTAN CHS LG CMPR SS,"$1,530.00",$0.00,"$1,530.00",$688.50,"$1,091.96",$0.00,$263.61,$0.00,$0.00,$267.89,"$1,530.00",$0.00,$765.00,"$1,211.76","$1,224.00",$0.00,$239.45,$0.00,$243.58,$0.00
71679330,SUP,HCPCS C1713,,71679330  -  SCREW BN 130/125 INTERTAN CHS LG CMPR SS,"$1,530.00",$0.00,"$1,530.00",$688.50,"$1,091.96",$0.00,$263.61,$0.00,$0.00,$267.89,"$1,530.00",$0.00,$765.00,"$1,211.76","$1,224.00",$0.00,$239.45,$0.00,$243.58,$0.00
71679335,SUP,HCPCS C1713,,71679335  -  SCREW BN 135/130MM INTERTAN CHS LG CMPR SS,"$1,530.00",$0.00,"$1,530.00",$688.50,"$1,091.96",$0.00,$263.61,$0.00,$0.00,$267.89,"$1,530.00",$0.00,$765.00,"$1,211.76","$1,224.00",$0.00,$239.45,$0.00,$243.58,$0.00
71679340,SUP,HCPCS C1713,,71679340  -  SCREW BN 140/135 INTERTAN CHS LG CMPR SS,"$1,530.00",$0.00,"$1,530.00",$688.50,"$1,091.96",$0.00,$263.61,$0.00,$0.00,$267.89,"$1,530.00",$0.00,$765.00,"$1,211.76","$1,224.00",$0.00,$239.45,$0.00,$243.58,$0.00
71683935,SUP,HCPCS C1713,,71683935  -  CAP END IMHS CP HIP IM NL,$700.88,$0.00,$700.88,$315.39,$500.21,$0.00,$120.76,$0.00,$0.00,$122.72,$700.88,$0.00,$350.44,$555.10,$560.70,$0.00,$109.69,$0.00,$111.58,$0.00
71683940,SUP,HCPCS C1713,,71683940  -  SET SCR IMHS CP CNN INTRAMEDULLARLY HIP SCR,$476.88,$0.00,$476.88,$214.59,$340.35,$0.00,$82.16,$0.00,$0.00,$83.50,$476.88,$0.00,$238.44,$377.69,$381.50,$0.00,$74.63,$0.00,$75.92,$0.00
71683945,SUP,HCPCS C1713,,71683945  -  SCREW BN 19MM IMHS CP CPTR CMPR HIP IM NL SYS,$600.25,$0.00,$600.25,$270.11,$428.40,$0.00,$103.42,$0.00,$0.00,$105.10,$600.25,$0.00,$300.13,$475.40,$480.20,$0.00,$93.94,$0.00,$95.56,$0.00
71684070,SUP,HCPCS C1713,,71684070  -  SCREW BN 12.7MM 70MM IMHS CP LG SBTCH IM NL,"$1,260.00",$0.00,"$1,260.00",$567.00,$899.26,$0.00,$217.09,$0.00,$0.00,$220.62,"$1,260.00",$0.00,$630.00,$997.92,"$1,008.00",$0.00,$197.19,$0.00,$200.59,$0.00
71684075,SUP,HCPCS C1713,,71684075  -  SCREW BN 12.7MM 75MM IMHS CP LG SBTCH IM NL,"$1,260.00",$0.00,"$1,260.00",$567.00,$899.26,$0.00,$217.09,$0.00,$0.00,$220.62,"$1,260.00",$0.00,$630.00,$997.92,"$1,008.00",$0.00,$197.19,$0.00,$200.59,$0.00
71684080,SUP,HCPCS C1713,,71684080  -  SCREW BN 12.7MM 80MM IMHS CP LG SBTCH IM NL,"$1,260.00",$0.00,"$1,260.00",$567.00,$899.26,$0.00,$217.09,$0.00,$0.00,$220.62,"$1,260.00",$0.00,$630.00,$997.92,"$1,008.00",$0.00,$197.19,$0.00,$200.59,$0.00
71684085,SUP,HCPCS C1713,,71684085  -  SCREW BN 12.7MM 85MM IMHS CP LG SUBTROCHANTER IM NL SYS,"$1,260.00",$0.00,"$1,260.00",$567.00,$899.26,$0.00,$217.09,$0.00,$0.00,$220.62,"$1,260.00",$0.00,$630.00,$997.92,"$1,008.00",$0.00,$197.19,$0.00,$200.59,$0.00
71684090,SUP,HCPCS C1713,,71684090  -  SCREW BN 12.7MM 90MM IMHS CP LG SUBTROCHANTER IM NL SYS,"$1,260.00",$0.00,"$1,260.00",$567.00,$899.26,$0.00,$217.09,$0.00,$0.00,$220.62,"$1,260.00",$0.00,$630.00,$997.92,"$1,008.00",$0.00,$197.19,$0.00,$200.59,$0.00
71684095,SUP,HCPCS C1713,,71684095  -  SCREW BN 12.7MM 95MM IMHS CP LG SBTCH IM NL,"$1,260.00",$0.00,"$1,260.00",$567.00,$899.26,$0.00,$217.09,$0.00,$0.00,$220.62,"$1,260.00",$0.00,$630.00,$997.92,"$1,008.00",$0.00,$197.19,$0.00,$200.59,$0.00
71684100,SUP,HCPCS C1713,,71684100  -  SCREW BN 12.7MM 100MM IMHS CP LG SUBTROCHANTER IM NL SYS,"$1,260.00",$0.00,"$1,260.00",$567.00,$899.26,$0.00,$217.09,$0.00,$0.00,$220.62,"$1,260.00",$0.00,$630.00,$997.92,"$1,008.00",$0.00,$197.19,$0.00,$200.59,$0.00
71684105,SUP,HCPCS C1713,,71684105  -  SCREW BN 12.7MM 105MM IMHS CP LG SUBTROCHANTER IM NL SYS,"$1,260.00",$0.00,"$1,260.00",$567.00,$899.26,$0.00,$217.09,$0.00,$0.00,$220.62,"$1,260.00",$0.00,$630.00,$997.92,"$1,008.00",$0.00,$197.19,$0.00,$200.59,$0.00
71684110,SUP,HCPCS C1713,,71684110  -  SCREW BN 12.7MM 110MM IMHS CP LG SUBTROCHANTER IM NL SYS,"$1,260.00",$0.00,"$1,260.00",$567.00,$899.26,$0.00,$217.09,$0.00,$0.00,$220.62,"$1,260.00",$0.00,$630.00,$997.92,"$1,008.00",$0.00,$197.19,$0.00,$200.59,$0.00
71684115,SUP,HCPCS C1713,,71684115  -  SCREW BN 12.7MM 115MM IMHS CP LG SUBTROCHANTER IM NL SYS,"$1,260.00",$0.00,"$1,260.00",$567.00,$899.26,$0.00,$217.09,$0.00,$0.00,$220.62,"$1,260.00",$0.00,$630.00,$997.92,"$1,008.00",$0.00,$197.19,$0.00,$200.59,$0.00
71684120,SUP,HCPCS C1713,,71684120  -  SCREW BN 12.7MM 120MM IMHS CP LG SBTCH IM NL,"$1,260.00",$0.00,"$1,260.00",$567.00,$899.26,$0.00,$217.09,$0.00,$0.00,$220.62,"$1,260.00",$0.00,$630.00,$997.92,"$1,008.00",$0.00,$197.19,$0.00,$200.59,$0.00
71684125,SUP,HCPCS C1713,,71684125  -  SCREW BN 12.7MM 125MM IMHS CP LG SBTCH IM NL,"$1,260.00",$0.00,"$1,260.00",$567.00,$899.26,$0.00,$217.09,$0.00,$0.00,$220.62,"$1,260.00",$0.00,$630.00,$997.92,"$1,008.00",$0.00,$197.19,$0.00,$200.59,$0.00
71684130,SUP,HCPCS C1713,,71684130  -  SCREW BN 12.7MM 130MM IMHS CP LG SBTCH IM NL,"$1,260.00",$0.00,"$1,260.00",$567.00,$899.26,$0.00,$217.09,$0.00,$0.00,$220.62,"$1,260.00",$0.00,$630.00,$997.92,"$1,008.00",$0.00,$197.19,$0.00,$200.59,$0.00
71684135,SUP,HCPCS C1713,,71684135  -  SCREW BN 12.7MM 135MM IMHS CP LG SBTCH IM NL,"$1,260.00",$0.00,"$1,260.00",$567.00,$899.26,$0.00,$217.09,$0.00,$0.00,$220.62,"$1,260.00",$0.00,$630.00,$997.92,"$1,008.00",$0.00,$197.19,$0.00,$200.59,$0.00
71684140,SUP,HCPCS C1713,,71684140  -  SCREW BN 12.7MM 140MM IMHS CP LG SBTCH IM NL,"$1,260.00",$0.00,"$1,260.00",$567.00,$899.26,$0.00,$217.09,$0.00,$0.00,$220.62,"$1,260.00",$0.00,$630.00,$997.92,"$1,008.00",$0.00,$197.19,$0.00,$200.59,$0.00
71687000,SUP,Custom 27203010,,71687000  -  GUIDE PIN ORTHOPEDIC 3.2MM THREAD TIP IMHS CP INTRAMEDULLARY,$189.00,$0.00,$189.00,$0.00,$134.89,$0.00,$0.00,$0.00,$0.00,$0.00,$189.00,$0.00,$94.50,$149.69,$151.20,$0.00,$0.00,$0.00,$0.00,$0.00
71751136,SUP,HCPCS C1713,,71751136  -  TROCAR SRG 3.2MM 3.2MM TRGN PIN HUM DISP,$353.25,$0.00,$353.25,$158.96,$252.11,$0.00,$60.86,$0.00,$0.00,$61.85,$353.25,$0.00,$176.63,$279.77,$282.60,$0.00,$55.28,$0.00,$56.24,$0.00
71751148,SUP,Custom 27203010,,71751148  -  BIT DRL SHRT 3.2MM STRL TRGN GRAD BRAD PNT DISP IM NL,$505.13,$0.00,$505.13,$0.00,$360.51,$0.00,$0.00,$0.00,$0.00,$0.00,$505.13,$0.00,$252.56,$400.06,$404.10,$0.00,$0.00,$0.00,$0.00,$0.00
71751149,SUP,Custom 27203010,,71751149  -  BIT DRL LNG 3.2MM STRL TRGN GRAD BRAD PNT DISP IM NL,$505.13,$0.00,$505.13,$0.00,$360.51,$0.00,$0.00,$0.00,$0.00,$0.00,$505.13,$0.00,$252.56,$400.06,$404.10,$0.00,$0.00,$0.00,$0.00,$0.00
71754020,SUP,HCPCS C1713,,71754020  -  SCREW BN 4MM 20MM TRGN ST TI HUM CORT IM NL SYS,$360.00,$0.00,$360.00,$162.00,$256.93,$0.00,$62.03,$0.00,$0.00,$63.03,$360.00,$0.00,$180.00,$285.12,$288.00,$0.00,$56.34,$0.00,$57.31,$0.00
71754022,SUP,HCPCS C1713,,71754022  -  SCREW BN 4MM 22MM TRGN ST TI HUM CORT IM NL SYS,$360.00,$0.00,$360.00,$162.00,$256.93,$0.00,$62.03,$0.00,$0.00,$63.03,$360.00,$0.00,$180.00,$285.12,$288.00,$0.00,$56.34,$0.00,$57.31,$0.00
71754024,SUP,HCPCS C1713,,71754024  -  SCREW BN 4MM 24MM TRGN ST TI HUM CORT IM NL SYS,$360.00,$0.00,$360.00,$162.00,$256.93,$0.00,$62.03,$0.00,$0.00,$63.03,$360.00,$0.00,$180.00,$285.12,$288.00,$0.00,$56.34,$0.00,$57.31,$0.00
71754026,SUP,HCPCS C1713,,71754026  -  SCREW BN 4MM 26MM TRGN ST TI HUM CORT IM NL SYS,$360.00,$0.00,$360.00,$162.00,$256.93,$0.00,$62.03,$0.00,$0.00,$63.03,$360.00,$0.00,$180.00,$285.12,$288.00,$0.00,$56.34,$0.00,$57.31,$0.00
71754028,SUP,HCPCS C1713,,71754028  -  SCREW BN 4MM 28MM TRGN ST TI HUM CORT IM NL SYS,$360.00,$0.00,$360.00,$162.00,$256.93,$0.00,$62.03,$0.00,$0.00,$63.03,$360.00,$0.00,$180.00,$285.12,$288.00,$0.00,$56.34,$0.00,$57.31,$0.00
71754030,SUP,HCPCS C1713,,71754030  -  SCREW BN 4MM 30MM TRGN ST TI HUM CORT IM NL SYS,$360.00,$0.00,$360.00,$162.00,$256.93,$0.00,$62.03,$0.00,$0.00,$63.03,$360.00,$0.00,$180.00,$285.12,$288.00,$0.00,$56.34,$0.00,$57.31,$0.00
71754032,SUP,HCPCS C1713,,71754032  -  SCREW BN 4MM 32MM TRGN ST TI HUM CORT IM NL SYS,$360.00,$0.00,$360.00,$162.00,$256.93,$0.00,$62.03,$0.00,$0.00,$63.03,$360.00,$0.00,$180.00,$285.12,$288.00,$0.00,$56.34,$0.00,$57.31,$0.00
71754034,SUP,HCPCS C1713,,71754034  -  SCREW BN 4MM 34MM TRGN ST TI HUM CORT IM NL SYS,$360.00,$0.00,$360.00,$162.00,$256.93,$0.00,$62.03,$0.00,$0.00,$63.03,$360.00,$0.00,$180.00,$285.12,$288.00,$0.00,$56.34,$0.00,$57.31,$0.00
71754036,SUP,HCPCS C1713,,71754036  -  SCREW BN 4MM 36MM TRGN ST TI HUM CORT IM NL SYS,$360.00,$0.00,$360.00,$162.00,$256.93,$0.00,$62.03,$0.00,$0.00,$63.03,$360.00,$0.00,$180.00,$285.12,$288.00,$0.00,$56.34,$0.00,$57.31,$0.00
71754038,SUP,HCPCS C1713,,71754038  -  SCREW BN 4MM 38MM TRGN ST TI HUM CORT IM NL SYS,$360.00,$0.00,$360.00,$162.00,$256.93,$0.00,$62.03,$0.00,$0.00,$63.03,$360.00,$0.00,$180.00,$285.12,$288.00,$0.00,$56.34,$0.00,$57.31,$0.00
71754040,SUP,HCPCS C1713,,71754040  -  SCREW BN 4MM 40MM TRGN ST TI HUM CORT IM NL SYS,$360.00,$0.00,$360.00,$162.00,$256.93,$0.00,$62.03,$0.00,$0.00,$63.03,$360.00,$0.00,$180.00,$285.12,$288.00,$0.00,$56.34,$0.00,$57.31,$0.00
71754042,SUP,HCPCS C1713,,71754042  -  SCREW BN 4MM 42MM TRGN ST TI HUM CORT IM NL,$342.00,$0.00,$342.00,$153.90,$244.09,$0.00,$58.92,$0.00,$0.00,$59.88,$342.00,$0.00,$171.00,$270.86,$273.60,$0.00,$53.52,$0.00,$54.45,$0.00
71754044,SUP,HCPCS C1713,,71754044  -  SCREW BN 4MM 44MM TRGN ST TI HUM CORT IM NL,$342.00,$0.00,$342.00,$153.90,$244.09,$0.00,$58.92,$0.00,$0.00,$59.88,$342.00,$0.00,$171.00,$270.86,$273.60,$0.00,$53.52,$0.00,$54.45,$0.00
71754046,SUP,HCPCS C1713,,71754046  -  SCREW BN 4MM 44MM TRGN ST TI HUM CORT IM NL,$342.00,$0.00,$342.00,$153.90,$244.09,$0.00,$58.92,$0.00,$0.00,$59.88,$342.00,$0.00,$171.00,$270.86,$273.60,$0.00,$53.52,$0.00,$54.45,$0.00
71754048,SUP,HCPCS C1713,,71754048  -  SCREW BN 4MM 48MM TRGN ST TI HUM CORT IM NL,$342.00,$0.00,$342.00,$153.90,$244.09,$0.00,$58.92,$0.00,$0.00,$59.88,$342.00,$0.00,$171.00,$270.86,$273.60,$0.00,$53.52,$0.00,$54.45,$0.00
71754050,SUP,HCPCS C1713,,71754050  -  SCREW BN 4MM 50MM TRGN ST TI HUM CORT IM NL,$342.00,$0.00,$342.00,$153.90,$244.09,$0.00,$58.92,$0.00,$0.00,$59.88,$342.00,$0.00,$171.00,$270.86,$273.60,$0.00,$53.52,$0.00,$54.45,$0.00
71754052,SUP,HCPCS C1713,,71754052  -  SCREW BN 4MM 52MM TRGN ST TI HUM CORT IM NL,$310.50,$0.00,$310.50,$139.73,$221.60,$0.00,$53.50,$0.00,$0.00,$54.37,$310.50,$0.00,$155.25,$245.92,$248.40,$0.00,$48.59,$0.00,$49.43,$0.00
71754054,SUP,HCPCS C1713,,71754054  -  SCREW BN 4MM 54MM TRGN ST TI HUM CORT IM NL,$342.00,$0.00,$342.00,$153.90,$244.09,$0.00,$58.92,$0.00,$0.00,$59.88,$342.00,$0.00,$171.00,$270.86,$273.60,$0.00,$53.52,$0.00,$54.45,$0.00
71754056,SUP,HCPCS C1713,,71754056  -  SCREW BN 4MM 56MM TRGN ST TI HUM CORT IM NL,$310.50,$0.00,$310.50,$139.73,$221.60,$0.00,$53.50,$0.00,$0.00,$54.37,$310.50,$0.00,$155.25,$245.92,$248.40,$0.00,$48.59,$0.00,$49.43,$0.00
71754058,SUP,HCPCS C1713,,71754058  -  SCREW BN 4MM 58MM TRGN ST TI HUM CORT IM NL,$310.50,$0.00,$310.50,$139.73,$221.60,$0.00,$53.50,$0.00,$0.00,$54.37,$310.50,$0.00,$155.25,$245.92,$248.40,$0.00,$48.59,$0.00,$49.43,$0.00
71754060,SUP,HCPCS C1713,,71754060  -  SCREW BN 4MM 60MM TRGN ST TI HUM CORT IM NL,$310.50,$0.00,$310.50,$139.73,$221.60,$0.00,$53.50,$0.00,$0.00,$54.37,$310.50,$0.00,$155.25,$245.92,$248.40,$0.00,$48.59,$0.00,$49.43,$0.00
71755024,SUP,HCPCS C1713,,71755024  -  SCREW BN 5MM 24MM TRGN ST TI HUM CANC IM NL SYS,$437.63,$0.00,$437.63,$196.93,$312.33,$0.00,$75.40,$0.00,$0.00,$76.62,$437.63,$0.00,$218.81,$346.60,$350.10,$0.00,$68.49,$0.00,$69.67,$0.00
71755026,SUP,HCPCS C1713,,71755026  -  SCREW BN 5MM 26MM TRGN ST TI HUM CANC IM NL SYS,$437.63,$0.00,$437.63,$196.93,$312.33,$0.00,$75.40,$0.00,$0.00,$76.62,$437.63,$0.00,$218.81,$346.60,$350.10,$0.00,$68.49,$0.00,$69.67,$0.00
71755028,SUP,HCPCS C1713,,71755028  -  SCREW BN 5MM 28MM TRGN CNN ST TI HUM CANC IM NL,$437.63,$0.00,$437.63,$196.93,$312.33,$0.00,$75.40,$0.00,$0.00,$76.62,$437.63,$0.00,$218.81,$346.60,$350.10,$0.00,$68.49,$0.00,$69.67,$0.00
71755030,SUP,HCPCS C1713,,71755030  -  SCREW BN 5MM 30MM TRGN ST TI HUM CANC IM NL SYS,$437.63,$0.00,$437.63,$196.93,$312.33,$0.00,$75.40,$0.00,$0.00,$76.62,$437.63,$0.00,$218.81,$346.60,$350.10,$0.00,$68.49,$0.00,$69.67,$0.00
71755032,SUP,HCPCS C1713,,71755032  -  SCREW BN 5MM 32MM TRGN ST TI HUM CANC IM NL SYS,$437.63,$0.00,$437.63,$196.93,$312.33,$0.00,$75.40,$0.00,$0.00,$76.62,$437.63,$0.00,$218.81,$346.60,$350.10,$0.00,$68.49,$0.00,$69.67,$0.00
71755034,SUP,HCPCS C1713,,71755034  -  SCREW BN 5MM 34MM TRGN ST TI HUM CANC IM NL SYS,$437.63,$0.00,$437.63,$196.93,$312.33,$0.00,$75.40,$0.00,$0.00,$76.62,$437.63,$0.00,$218.81,$346.60,$350.10,$0.00,$68.49,$0.00,$69.67,$0.00
71755036,SUP,HCPCS C1713,,71755036  -  SCREW BN 5MM 36MM TRGN ST TI HUM CANC IM NL SYS,$437.63,$0.00,$437.63,$196.93,$312.33,$0.00,$75.40,$0.00,$0.00,$76.62,$437.63,$0.00,$218.81,$346.60,$350.10,$0.00,$68.49,$0.00,$69.67,$0.00
71755038,SUP,HCPCS C1713,,71755038  -  SCREW BN 5MM 38MM TRGN ST TI HUM CANC IM NL SYS,$437.63,$0.00,$437.63,$196.93,$312.33,$0.00,$75.40,$0.00,$0.00,$76.62,$437.63,$0.00,$218.81,$346.60,$350.10,$0.00,$68.49,$0.00,$69.67,$0.00
71755040,SUP,HCPCS C1713,,71755040  -  SCREW BN 5MM 40MM TRGN ST TI HUM CANC IM NL SYS,$437.63,$0.00,$437.63,$196.93,$312.33,$0.00,$75.40,$0.00,$0.00,$76.62,$437.63,$0.00,$218.81,$346.60,$350.10,$0.00,$68.49,$0.00,$69.67,$0.00
71755042,SUP,HCPCS C1713,,71755042  -  SCREW BN 5MM 42MM TRGN ST TI HUM CANC IM NL SYS,$437.63,$0.00,$437.63,$196.93,$312.33,$0.00,$75.40,$0.00,$0.00,$76.62,$437.63,$0.00,$218.81,$346.60,$350.10,$0.00,$68.49,$0.00,$69.67,$0.00
71755044,SUP,HCPCS C1713,,71755044  -  SCREW BN 5MM 44MM TRGN ST TI HUM CANC IM NL SYS,$437.63,$0.00,$437.63,$196.93,$312.33,$0.00,$75.40,$0.00,$0.00,$76.62,$437.63,$0.00,$218.81,$346.60,$350.10,$0.00,$68.49,$0.00,$69.67,$0.00
71755046,SUP,HCPCS C1713,,71755046  -  SCREW BN 5MM 46MM TRGN ST TI HUM CANC IM NL SYS,$437.63,$0.00,$437.63,$196.93,$312.33,$0.00,$75.40,$0.00,$0.00,$76.62,$437.63,$0.00,$218.81,$346.60,$350.10,$0.00,$68.49,$0.00,$69.67,$0.00
71755048,SUP,HCPCS C1713,,71755048  -  SCREW BN 5MM 48MM TRGN ST TI HUM CANC IM NL SYS,$437.63,$0.00,$437.63,$196.93,$312.33,$0.00,$75.40,$0.00,$0.00,$76.62,$437.63,$0.00,$218.81,$346.60,$350.10,$0.00,$68.49,$0.00,$69.67,$0.00
71755050,SUP,HCPCS C1713,,71755050  -  SCREW BN 5MM 50MM TRGN ST TI HUM CANC IM NL SYS,$437.63,$0.00,$437.63,$196.93,$312.33,$0.00,$75.40,$0.00,$0.00,$76.62,$437.63,$0.00,$218.81,$346.60,$350.10,$0.00,$68.49,$0.00,$69.67,$0.00
71755052,SUP,HCPCS C1713,,71755052  -  SCREW BN 5MM 52MM TRGN ST TI HUM CANC IM NL SYS,$437.63,$0.00,$437.63,$196.93,$312.33,$0.00,$75.40,$0.00,$0.00,$76.62,$437.63,$0.00,$218.81,$346.60,$350.10,$0.00,$68.49,$0.00,$69.67,$0.00
71755054,SUP,HCPCS C1713,,71755054  -  SCREW BN 5MM 54MM TRGN ST TI HUM CANC IM NL SYS,$437.63,$0.00,$437.63,$196.93,$312.33,$0.00,$75.40,$0.00,$0.00,$76.62,$437.63,$0.00,$218.81,$346.60,$350.10,$0.00,$68.49,$0.00,$69.67,$0.00
71755056,SUP,HCPCS C1713,,71755056  -  SCREW BN 5MM 56MM TRGN ST TI HUM CANC IM NL SYS,$437.63,$0.00,$437.63,$196.93,$312.33,$0.00,$75.40,$0.00,$0.00,$76.62,$437.63,$0.00,$218.81,$346.60,$350.10,$0.00,$68.49,$0.00,$69.67,$0.00
71755058,SUP,HCPCS C1713,,71755058  -  SCREW BN 5MM 58MM TRGN ST TI HUM CANC IM NL SYS,$437.63,$0.00,$437.63,$196.93,$312.33,$0.00,$75.40,$0.00,$0.00,$76.62,$437.63,$0.00,$218.81,$346.60,$350.10,$0.00,$68.49,$0.00,$69.67,$0.00
71755060,SUP,HCPCS C1713,,71755060  -  SCREW BN 5MM 60MM TRGN ST TI HUM CANC IM NL SYS,$437.63,$0.00,$437.63,$196.93,$312.33,$0.00,$75.40,$0.00,$0.00,$76.62,$437.63,$0.00,$218.81,$346.60,$350.10,$0.00,$68.49,$0.00,$69.67,$0.00
71755062,SUP,HCPCS C1713,,71755062  -  SCREW BN 5MM 62MM TRGN ST TI HUM CANC IM NL SYS,$437.63,$0.00,$437.63,$196.93,$312.33,$0.00,$75.40,$0.00,$0.00,$76.62,$437.63,$0.00,$218.81,$346.60,$350.10,$0.00,$68.49,$0.00,$69.67,$0.00
71755064,SUP,HCPCS C1713,,71755064  -  SCREW BN 5MM 64MM TRGN ST TI HUM CANC IM NL SYS,$437.63,$0.00,$437.63,$196.93,$312.33,$0.00,$75.40,$0.00,$0.00,$76.62,$437.63,$0.00,$218.81,$346.60,$350.10,$0.00,$68.49,$0.00,$69.67,$0.00
71760000,SUP,HCPCS C1713,,71760000  -  CAP END 0MM TRGN HUM IM NL,$221.63,$0.00,$221.63,$99.73,$158.17,$0.00,$38.18,$0.00,$0.00,$38.80,$221.63,$0.00,$110.81,$175.53,$177.30,$0.00,$34.68,$0.00,$35.28,$0.00
71760816,SUP,HCPCS C1713,,71760816  -  NAIL IM 8/7MM 16CM TRGN STRG TI HUM,"$3,656.25",$0.00,"$3,656.25","$1,645.31","$2,609.47",$0.00,$629.95,$0.00,$0.00,$640.18,"$3,656.25",$0.00,"$1,828.13","$2,895.75","$2,925.00",$0.00,$572.20,$0.00,$582.08,$0.00
71760818,SUP,HCPCS C1713,,71760818  -  NAIL IM 8/7MM 18CM TRGN STRG TI HUM,"$3,048.75",$0.00,"$3,048.75","$1,371.94","$2,175.89",$0.00,$525.28,$0.00,$0.00,$533.81,"$3,048.75",$0.00,"$1,524.38","$2,414.61","$2,439.00",$0.00,$477.13,$0.00,$485.36,$0.00
71760820,SUP,HCPCS C1713,,71760820  -  NAIL IM 8/7MM 20CM TRGN STRG TI HUM,"$3,656.25",$0.00,"$3,656.25","$1,645.31","$2,609.47",$0.00,$629.95,$0.00,$0.00,$640.18,"$3,656.25",$0.00,"$1,828.13","$2,895.75","$2,925.00",$0.00,$572.20,$0.00,$582.08,$0.00
71760822,SUP,HCPCS C1713,,71760822  -  NAIL IM 8/7MM 22CM TRGN STRG TI HUM,"$3,656.25",$0.00,"$3,656.25","$1,645.31","$2,609.47",$0.00,$629.95,$0.00,$0.00,$640.18,"$3,656.25",$0.00,"$1,828.13","$2,895.75","$2,925.00",$0.00,$572.20,$0.00,$582.08,$0.00
71760826,SUP,HCPCS C1713,,71760826  -  NAIL IM 8/7MM 26CM TRGN STRG TI HUM,"$3,656.25",$0.00,"$3,656.25","$1,645.31","$2,609.47",$0.00,$629.95,$0.00,$0.00,$640.18,"$3,656.25",$0.00,"$1,828.13","$2,895.75","$2,925.00",$0.00,$572.20,$0.00,$582.08,$0.00
71760828,SUP,HCPCS C1713,,71760828  -  NAIL IM 8/7MM 28CM TRGN STRG TI HUM,"$3,656.25",$0.00,"$3,656.25","$1,645.31","$2,609.47",$0.00,$629.95,$0.00,$0.00,$640.18,"$3,656.25",$0.00,"$1,828.13","$2,895.75","$2,925.00",$0.00,$572.20,$0.00,$582.08,$0.00
71760830,SUP,HCPCS C1713,,71760830  -  NAIL IM 8/7MM 30CM HUM,"$4,370.00",$0.00,"$4,370.00","$1,966.50","$3,118.87",$0.00,$752.93,$0.00,$0.00,$765.15,"$4,370.00",$0.00,"$2,185.00","$3,461.04","$3,496.00",$0.00,$683.91,$0.00,$695.70,$0.00
71760918,SUP,HCPCS C1713,,71760918  -  NAIL IM 8/7MM 18CM TRGN STRG TI HUM,"$3,656.25",$0.00,"$3,656.25","$1,645.31","$2,609.47",$0.00,$629.95,$0.00,$0.00,$640.18,"$3,656.25",$0.00,"$1,828.13","$2,895.75","$2,925.00",$0.00,$572.20,$0.00,$582.08,$0.00
71760920,SUP,HCPCS C1713,,71760920  -  NAIL IM 9/7.5MM 20CM TRGN STRG TI HUM,"$3,656.25",$0.00,"$3,656.25","$1,645.31","$2,609.47",$0.00,$629.95,$0.00,$0.00,$640.18,"$3,656.25",$0.00,"$1,828.13","$2,895.75","$2,925.00",$0.00,$572.20,$0.00,$582.08,$0.00
71760922,SUP,HCPCS C1713,,71760922  -  NAIL IM 9/7.5MM 22CM TRGN STRG TI HUM,"$3,656.25",$0.00,"$3,656.25","$1,645.31","$2,609.47",$0.00,$629.95,$0.00,$0.00,$640.18,"$3,656.25",$0.00,"$1,828.13","$2,895.75","$2,925.00",$0.00,$572.20,$0.00,$582.08,$0.00
71760924,SUP,HCPCS C1713,,71760924  -  NAIL IM 9/7.5MM 24CM TRGN STRG TI HUM,"$3,656.25",$0.00,"$3,656.25","$1,645.31","$2,609.47",$0.00,$629.95,$0.00,$0.00,$640.18,"$3,656.25",$0.00,"$1,828.13","$2,895.75","$2,925.00",$0.00,$572.20,$0.00,$582.08,$0.00
71760926,SUP,HCPCS C1713,,71760926  -  NAIL IM 9/7.5MM 26CM TRGN STRG TI HUM,"$3,656.25",$0.00,"$3,656.25","$1,645.31","$2,609.47",$0.00,$629.95,$0.00,$0.00,$640.18,"$3,656.25",$0.00,"$1,828.13","$2,895.75","$2,925.00",$0.00,$572.20,$0.00,$582.08,$0.00
71760928,SUP,HCPCS C1713,,71760928  -  NAIL IM 9/7.5MM 28CM TRGN STRG TI HUM,"$3,656.25",$0.00,"$3,656.25","$1,645.31","$2,609.47",$0.00,$629.95,$0.00,$0.00,$640.18,"$3,656.25",$0.00,"$1,828.13","$2,895.75","$2,925.00",$0.00,$572.20,$0.00,$582.08,$0.00
71760930,SUP,HCPCS C1713,,71760930  -  NAIL IM 9/7MM 30CM HUM,"$4,370.00",$0.00,"$4,370.00","$1,966.50","$3,118.87",$0.00,$752.93,$0.00,$0.00,$765.15,"$4,370.00",$0.00,"$2,185.00","$3,461.04","$3,496.00",$0.00,$683.91,$0.00,$695.70,$0.00
71761018,SUP,HCPCS C1713,,71761018  -  NAIL IM 10/8.5MM 18CM TRGN STRG TI HUM,"$3,656.25",$0.00,"$3,656.25","$1,645.31","$2,609.47",$0.00,$629.95,$0.00,$0.00,$640.18,"$3,656.25",$0.00,"$1,828.13","$2,895.75","$2,925.00",$0.00,$572.20,$0.00,$582.08,$0.00
71761020,SUP,HCPCS C1713,,71761020  -  NAIL IM 10/8.5MM 20CM TRGN STRG TI HUM,"$3,048.75",$0.00,"$3,048.75","$1,371.94","$2,175.89",$0.00,$525.28,$0.00,$0.00,$533.81,"$3,048.75",$0.00,"$1,524.38","$2,414.61","$2,439.00",$0.00,$477.13,$0.00,$485.36,$0.00
71761022,SUP,HCPCS C1713,,71761022  -  NAIL IM 10/8.5MM 22CM TRGN STRG TI HUM,"$3,656.25",$0.00,"$3,656.25","$1,645.31","$2,609.47",$0.00,$629.95,$0.00,$0.00,$640.18,"$3,656.25",$0.00,"$1,828.13","$2,895.75","$2,925.00",$0.00,$572.20,$0.00,$582.08,$0.00
71761024,SUP,HCPCS C1713,,71761024  -  NAIL IM 10/8.5MM 24CM TRGN STRG TI HUM,"$3,656.25",$0.00,"$3,656.25","$1,645.31","$2,609.47",$0.00,$629.95,$0.00,$0.00,$640.18,"$3,656.25",$0.00,"$1,828.13","$2,895.75","$2,925.00",$0.00,$572.20,$0.00,$582.08,$0.00
71761026,SUP,HCPCS C1713,,71761026  -  NAIL IM 10/8.5MM 26CM TRGN STRG TI HUM,"$3,656.25",$0.00,"$3,656.25","$1,645.31","$2,609.47",$0.00,$629.95,$0.00,$0.00,$640.18,"$3,656.25",$0.00,"$1,828.13","$2,895.75","$2,925.00",$0.00,$572.20,$0.00,$582.08,$0.00
71761028,SUP,HCPCS C1713,,71761028  -  NAIL IM 10/8.5MM 28CM TRGN STRG TI HUM,"$3,656.25",$0.00,"$3,656.25","$1,645.31","$2,609.47",$0.00,$629.95,$0.00,$0.00,$640.18,"$3,656.25",$0.00,"$1,828.13","$2,895.75","$2,925.00",$0.00,$572.20,$0.00,$582.08,$0.00
71761030,SUP,HCPCS C1713,,71761030  -  NAIL IM 10/8.5MM 30CM HUM,"$4,370.00",$0.00,"$4,370.00","$1,966.50","$3,118.87",$0.00,$752.93,$0.00,$0.00,$765.15,"$4,370.00",$0.00,"$2,185.00","$3,461.04","$3,496.00",$0.00,$683.91,$0.00,$695.70,$0.00
71761118,SUP,HCPCS C1713,,71761118  -  NAIL IM 11/9.5MM 18CM HUM,"$4,370.00",$0.00,"$4,370.00","$1,966.50","$3,118.87",$0.00,$752.93,$0.00,$0.00,$765.15,"$4,370.00",$0.00,"$2,185.00","$3,461.04","$3,496.00",$0.00,$683.91,$0.00,$695.70,$0.00
71761120,SUP,HCPCS C1713,,71761120  -  NAIL IM 11/9.5MM 20CM HUM,"$4,370.00",$0.00,"$4,370.00","$1,966.50","$3,118.87",$0.00,$752.93,$0.00,$0.00,$765.15,"$4,370.00",$0.00,"$2,185.00","$3,461.04","$3,496.00",$0.00,$683.91,$0.00,$695.70,$0.00
71761122,SUP,HCPCS C1713,,71761122  -  NAIL IM 11/9.5MM 22CM HUM,"$4,370.00",$0.00,"$4,370.00","$1,966.50","$3,118.87",$0.00,$752.93,$0.00,$0.00,$765.15,"$4,370.00",$0.00,"$2,185.00","$3,461.04","$3,496.00",$0.00,$683.91,$0.00,$695.70,$0.00
71761124,SUP,HCPCS C1713,,71761124  -  NAIL IM 11/9.5MM 24CM HUM,"$4,370.00",$0.00,"$4,370.00","$1,966.50","$3,118.87",$0.00,$752.93,$0.00,$0.00,$765.15,"$4,370.00",$0.00,"$2,185.00","$3,461.04","$3,496.00",$0.00,$683.91,$0.00,$695.70,$0.00
71761126,SUP,HCPCS C1713,,71761126  -  NAIL IM 11/9.5MM 26CM HUM,"$3,048.75",$0.00,"$3,048.75","$1,371.94","$2,175.89",$0.00,$525.28,$0.00,$0.00,$533.81,"$3,048.75",$0.00,"$1,524.38","$2,414.61","$2,439.00",$0.00,$477.13,$0.00,$485.36,$0.00
71761128,SUP,HCPCS C1713,,71761128  -  NAIL IM 11/9.5MM 28CM HUM,"$4,370.00",$0.00,"$4,370.00","$1,966.50","$3,118.87",$0.00,$752.93,$0.00,$0.00,$765.15,"$4,370.00",$0.00,"$2,185.00","$3,461.04","$3,496.00",$0.00,$683.91,$0.00,$695.70,$0.00
71761130,SUP,HCPCS C1713,,71761130  -  NAIL IM 11/9.5MM 30CM HUM,"$4,370.00",$0.00,"$4,370.00","$1,966.50","$3,118.87",$0.00,$752.93,$0.00,$0.00,$765.15,"$4,370.00",$0.00,"$2,185.00","$3,461.04","$3,496.00",$0.00,$683.91,$0.00,$695.70,$0.00
71770816,SUP,HCPCS C1713,,71770816  -  NAIL IM LNG 8/7MM 16CM TRGN IMPL SET BNT TI HUM,"$3,656.25",$0.00,"$3,656.25","$1,645.31","$2,609.47",$0.00,$629.95,$0.00,$0.00,$640.18,"$3,656.25",$0.00,"$1,828.13","$2,895.75","$2,925.00",$0.00,$572.20,$0.00,$582.08,$0.00
71770818,SUP,HCPCS C1713,,71770818  -  NAIL IM 8/7MM 18CM TRGN BNT TI HUM,"$3,656.25",$0.00,"$3,656.25","$1,645.31","$2,609.47",$0.00,$629.95,$0.00,$0.00,$640.18,"$3,656.25",$0.00,"$1,828.13","$2,895.75","$2,925.00",$0.00,$572.20,$0.00,$582.08,$0.00
71770820,SUP,HCPCS C1713,,71770820  -  NAIL IM 8/7MM 20CM TRGN BNT TI HUM,"$3,656.25",$0.00,"$3,656.25","$1,645.31","$2,609.47",$0.00,$629.95,$0.00,$0.00,$640.18,"$3,656.25",$0.00,"$1,828.13","$2,895.75","$2,925.00",$0.00,$572.20,$0.00,$582.08,$0.00
71770822,SUP,HCPCS C1713,,71770822  -  NAIL IM 8/7MM 22CM TRGN BNT TI HUM,"$3,656.25",$0.00,"$3,656.25","$1,645.31","$2,609.47",$0.00,$629.95,$0.00,$0.00,$640.18,"$3,656.25",$0.00,"$1,828.13","$2,895.75","$2,925.00",$0.00,$572.20,$0.00,$582.08,$0.00
71770824,SUP,HCPCS C1713,,71770824  -  NAIL IM 8/7MM 24CM TRGN BNT TI HUM,"$3,656.25",$0.00,"$3,656.25","$1,645.31","$2,609.47",$0.00,$629.95,$0.00,$0.00,$640.18,"$3,656.25",$0.00,"$1,828.13","$2,895.75","$2,925.00",$0.00,$572.20,$0.00,$582.08,$0.00
71770826,SUP,HCPCS C1713,,71770826  -  NAIL IM LNG 8/7MM 26CM TRGN IMPL SET BNT TI HUM,"$3,656.25",$0.00,"$3,656.25","$1,645.31","$2,609.47",$0.00,$629.95,$0.00,$0.00,$640.18,"$3,656.25",$0.00,"$1,828.13","$2,895.75","$2,925.00",$0.00,$572.20,$0.00,$582.08,$0.00
71770828,SUP,HCPCS C1713,,71770828  -  NAIL IM 8/7MM 28CM TRGN BNT TI HUM,"$3,656.25",$0.00,"$3,656.25","$1,645.31","$2,609.47",$0.00,$629.95,$0.00,$0.00,$640.18,"$3,656.25",$0.00,"$1,828.13","$2,895.75","$2,925.00",$0.00,$572.20,$0.00,$582.08,$0.00
71770830,SUP,HCPCS C1713,,71770830  -  NAIL IM 8/7MM 30CM TRGN BNT TI HUM,"$3,656.25",$0.00,"$3,656.25","$1,645.31","$2,609.47",$0.00,$629.95,$0.00,$0.00,$640.18,"$3,656.25",$0.00,"$1,828.13","$2,895.75","$2,925.00",$0.00,$572.20,$0.00,$582.08,$0.00
71770918,SUP,HCPCS C1713,,71770918  -  NAIL IM 9/7.5MM 18CM TRGN BNT TI HUM,"$3,656.25",$0.00,"$3,656.25","$1,645.31","$2,609.47",$0.00,$629.95,$0.00,$0.00,$640.18,"$3,656.25",$0.00,"$1,828.13","$2,895.75","$2,925.00",$0.00,$572.20,$0.00,$582.08,$0.00
71770920,SUP,HCPCS C1713,,71770920  -  NAIL IM LNG 9/7.5MM 20CM TRGN IMPL SET BNT TI HUM,"$3,656.25",$0.00,"$3,656.25","$1,645.31","$2,609.47",$0.00,$629.95,$0.00,$0.00,$640.18,"$3,656.25",$0.00,"$1,828.13","$2,895.75","$2,925.00",$0.00,$572.20,$0.00,$582.08,$0.00
71770922,SUP,HCPCS C1713,,71770922  -  NAIL IM LNG 9/7.5MM 22CM TRGN IMPL SET BNT TI HUM,"$3,656.25",$0.00,"$3,656.25","$1,645.31","$2,609.47",$0.00,$629.95,$0.00,$0.00,$640.18,"$3,656.25",$0.00,"$1,828.13","$2,895.75","$2,925.00",$0.00,$572.20,$0.00,$582.08,$0.00
71770924,SUP,HCPCS C1713,,71770924  -  NAIL IM LNG 9/7.5MM 24CM TRGN BNT TI HUM,"$3,656.25",$0.00,"$3,656.25","$1,645.31","$2,609.47",$0.00,$629.95,$0.00,$0.00,$640.18,"$3,656.25",$0.00,"$1,828.13","$2,895.75","$2,925.00",$0.00,$572.20,$0.00,$582.08,$0.00
71770926,SUP,HCPCS C1713,,71770926  -  NAIL IM 9 7.5MM 26CM TRGN SET TI HUM,"$3,656.25",$0.00,"$3,656.25","$1,645.31","$2,609.47",$0.00,$629.95,$0.00,$0.00,$640.18,"$3,656.25",$0.00,"$1,828.13","$2,895.75","$2,925.00",$0.00,$572.20,$0.00,$582.08,$0.00
71770928,SUP,HCPCS C1713,,71770928  -  NAIL IM 9/7.5MM 28CM TRGN BNT TI HUM,"$3,656.25",$0.00,"$3,656.25","$1,645.31","$2,609.47",$0.00,$629.95,$0.00,$0.00,$640.18,"$3,656.25",$0.00,"$1,828.13","$2,895.75","$2,925.00",$0.00,$572.20,$0.00,$582.08,$0.00
71770930,SUP,HCPCS C1713,,71770930  -  NAIL IM 9/7.5MM 30CM TRGN BNT TI HUM,"$3,656.25",$0.00,"$3,656.25","$1,645.31","$2,609.47",$0.00,$629.95,$0.00,$0.00,$640.18,"$3,656.25",$0.00,"$1,828.13","$2,895.75","$2,925.00",$0.00,$572.20,$0.00,$582.08,$0.00
71771018,SUP,HCPCS C1713,,71771018  -  NAIL IM 10/8.5MM 18CM TRGN BNT TI HUM,"$3,656.25",$0.00,"$3,656.25","$1,645.31","$2,609.47",$0.00,$629.95,$0.00,$0.00,$640.18,"$3,656.25",$0.00,"$1,828.13","$2,895.75","$2,925.00",$0.00,$572.20,$0.00,$582.08,$0.00
71771020,SUP,HCPCS C1713,,71771020  -  NAIL IM 10/8.5MM 20CM TRGN BNT TI HUM,"$3,656.25",$0.00,"$3,656.25","$1,645.31","$2,609.47",$0.00,$629.95,$0.00,$0.00,$640.18,"$3,656.25",$0.00,"$1,828.13","$2,895.75","$2,925.00",$0.00,$572.20,$0.00,$582.08,$0.00
71771022,SUP,HCPCS C1713,,71771022  -  NAIL IM LNG 10MM 8.5MM 22CM TRGN BNT TI HUM,"$3,656.25",$0.00,"$3,656.25","$1,645.31","$2,609.47",$0.00,$629.95,$0.00,$0.00,$640.18,"$3,656.25",$0.00,"$1,828.13","$2,895.75","$2,925.00",$0.00,$572.20,$0.00,$582.08,$0.00
71771024,SUP,HCPCS C1713,,71771024  -  NAIL IM 10MM 8.5MM 24CM FRSGHT BNT TI HUM,"$3,656.25",$0.00,"$3,656.25","$1,645.31","$2,609.47",$0.00,$629.95,$0.00,$0.00,$640.18,"$3,656.25",$0.00,"$1,828.13","$2,895.75","$2,925.00",$0.00,$572.20,$0.00,$582.08,$0.00
71771026,SUP,HCPCS C1713,,71771026  -  NAIL IM 10MM 8.5MM 26CM TRGN IMPL SET TI HUM,"$3,656.25",$0.00,"$3,656.25","$1,645.31","$2,609.47",$0.00,$629.95,$0.00,$0.00,$640.18,"$3,656.25",$0.00,"$1,828.13","$2,895.75","$2,925.00",$0.00,$572.20,$0.00,$582.08,$0.00
71771028,SUP,HCPCS C1713,,71771028  -  NAIL IM 10 8.5MM 28CM TRGN BNT TI HUM,"$3,656.25",$0.00,"$3,656.25","$1,645.31","$2,609.47",$0.00,$629.95,$0.00,$0.00,$640.18,"$3,656.25",$0.00,"$1,828.13","$2,895.75","$2,925.00",$0.00,$572.20,$0.00,$582.08,$0.00
71771030,SUP,HCPCS C1713,,71771030  -  NAIL IM 10/8.5MM 30CM TRGN BNT TI HUM,"$3,656.25",$0.00,"$3,656.25","$1,645.31","$2,609.47",$0.00,$629.95,$0.00,$0.00,$640.18,"$3,656.25",$0.00,"$1,828.13","$2,895.75","$2,925.00",$0.00,$572.20,$0.00,$582.08,$0.00
71771118,SUP,HCPCS C1713,,71771118  -  NAIL IM 11/9.5MM 18CM HUM,"$2,576.25",$0.00,"$2,576.25","$1,159.31","$1,838.67",$0.00,$443.87,$0.00,$0.00,$451.08,"$2,576.25",$0.00,"$1,288.13","$2,040.39","$2,061.00",$0.00,$403.18,$0.00,$410.14,$0.00
71771120,SUP,HCPCS C1713,,71771120  -  NAIL IM 11/9.5MM 20CM HUM,"$2,576.25",$0.00,"$2,576.25","$1,159.31","$1,838.67",$0.00,$443.87,$0.00,$0.00,$451.08,"$2,576.25",$0.00,"$1,288.13","$2,040.39","$2,061.00",$0.00,$403.18,$0.00,$410.14,$0.00
71771122,SUP,HCPCS C1713,,71771122  -  NAIL IM 11/9.5MM 22CM HUM,"$2,576.25",$0.00,"$2,576.25","$1,159.31","$1,838.67",$0.00,$443.87,$0.00,$0.00,$451.08,"$2,576.25",$0.00,"$1,288.13","$2,040.39","$2,061.00",$0.00,$403.18,$0.00,$410.14,$0.00
71771124,SUP,HCPCS C1713,,71771124  -  NAIL IM 11/9.5MM 24CM HUM,"$2,576.25",$0.00,"$2,576.25","$1,159.31","$1,838.67",$0.00,$443.87,$0.00,$0.00,$451.08,"$2,576.25",$0.00,"$1,288.13","$2,040.39","$2,061.00",$0.00,$403.18,$0.00,$410.14,$0.00
71771126,SUP,HCPCS C1713,,71771126  -  NAIL IM 11/9.5MM 26CM HUM,"$2,576.25",$0.00,"$2,576.25","$1,159.31","$1,838.67",$0.00,$443.87,$0.00,$0.00,$451.08,"$2,576.25",$0.00,"$1,288.13","$2,040.39","$2,061.00",$0.00,$403.18,$0.00,$410.14,$0.00
71771128,SUP,HCPCS C1713,,71771128  -  NAIL IM 11/9.5MM 28CM HUM,"$2,576.25",$0.00,"$2,576.25","$1,159.31","$1,838.67",$0.00,$443.87,$0.00,$0.00,$451.08,"$2,576.25",$0.00,"$1,288.13","$2,040.39","$2,061.00",$0.00,$403.18,$0.00,$410.14,$0.00
71771130,SUP,HCPCS C1713,,71771130  -  NAIL IM 11/9.5MM 30CM HUM,"$3,048.75",$0.00,"$3,048.75","$1,371.94","$2,175.89",$0.00,$525.28,$0.00,$0.00,$533.81,"$3,048.75",$0.00,"$1,524.38","$2,414.61","$2,439.00",$0.00,$477.13,$0.00,$485.36,$0.00
71800308,SUP,HCPCS C1713,,71800308  -  PLATE BN 165MM PRLC 8 HL LCK SS TIB RT PROX LAT 4.5MM SCR,"$3,402.00",$0.00,"$3,402.00","$1,530.90","$2,428.01",$0.00,$586.15,$0.00,$0.00,$595.66,"$3,402.00",$0.00,"$1,701.00","$2,694.38","$2,721.60",$0.00,$532.41,$0.00,$541.60,$0.00
71800313,SUP,HCPCS C1713,,71800313  -  PLATE BN 255MM PRLC 13 HL LCK SS TIB RT PROX LAT 4.5MM SCR,"$3,491.25",$0.00,"$3,491.25","$1,571.06","$2,491.71",$0.00,$601.52,$0.00,$0.00,$611.29,"$3,491.25",$0.00,"$1,745.63","$2,765.07","$2,793.00",$0.00,$546.38,$0.00,$555.81,$0.00
71800413,SUP,HCPCS C1713,,71800413  -  PLATE BN 187MM PRLC 13 HL LCK SS TIB LT PROX LAT 3.5MM SCR,"$3,491.25",$0.00,"$3,491.25","$1,571.06","$2,491.71",$0.00,$601.52,$0.00,$0.00,$611.29,"$3,491.25",$0.00,"$1,745.63","$2,765.07","$2,793.00",$0.00,$546.38,$0.00,$555.81,$0.00
71800513,SUP,HCPCS C1713,,71800513  -  PLATE BN 187MM PRLC 13 HL LCK SS TIB RT PROX LAT 3.5MM SCR,"$3,491.25",$0.00,"$3,491.25","$1,571.06","$2,491.71",$0.00,$601.52,$0.00,$0.00,$611.29,"$3,491.25",$0.00,"$1,745.63","$2,765.07","$2,793.00",$0.00,$546.38,$0.00,$555.81,$0.00
71801222,SUP,HCPCS C1713,,71801222  -  SCREW BN 3.5MM 22MM STRL PRLC VLP ST LCK FT FIB CORT,$244.65,$0.00,$244.65,$110.09,$174.61,$0.00,$42.15,$0.00,$0.00,$42.84,$244.65,$0.00,$122.33,$193.76,$195.72,$0.00,$38.29,$0.00,$38.95,$0.00
71801320,SUP,HCPCS C1713,,71801320  -  SCREW BN HEX LOPRFL 3.5MM 20MM STRL PRLC VLP ST FT CORT,$43.58,$0.00,$43.58,$19.61,$31.10,$0.00,$7.51,$0.00,$0.00,$7.63,$43.58,$0.00,$21.79,$34.52,$34.86,$0.00,$6.82,$0.00,$6.94,$0.00
71801328,SUP,HCPCS C1713,,71801328  -  SCREW BN LOPRFL 3.5MM 28MM STRL VLP ST HEX DRV RCS CORT FT,$43.58,$0.00,$43.58,$19.61,$31.10,$0.00,$7.51,$0.00,$0.00,$7.63,$43.58,$0.00,$21.79,$34.52,$34.86,$0.00,$6.82,$0.00,$6.94,$0.00
71801332,SUP,HCPCS C1713,,71801332  -  SCREW BN HEX LOPRFL 3.5MM 32MM STRL PRLC VLP ST FT CORT,$43.58,$0.00,$43.58,$19.61,$31.10,$0.00,$7.51,$0.00,$0.00,$7.63,$43.58,$0.00,$21.79,$34.52,$34.86,$0.00,$6.82,$0.00,$6.94,$0.00
71801336,SUP,HCPCS C1713,,71801336  -  SCREW BN LOPRFL 3.5MM 36MM STRL VLP ST HEX DRV RCS CORT FT,$43.58,$0.00,$43.58,$19.61,$31.10,$0.00,$7.51,$0.00,$0.00,$7.63,$43.58,$0.00,$21.79,$34.52,$34.86,$0.00,$6.82,$0.00,$6.94,$0.00
71801340,SUP,HCPCS C1713,,71801340  -  SCREW BN LOPRFL 3.5MM 40MM STRL VLP ST HEX DRV RCS CORT FT,$43.58,$0.00,$43.58,$19.61,$31.10,$0.00,$7.51,$0.00,$0.00,$7.63,$43.58,$0.00,$21.79,$34.52,$34.86,$0.00,$6.82,$0.00,$6.94,$0.00
71801365,SUP,HCPCS C1713,,71801365  -  SCREW BN HEX LOPRFL 3.5MM 65MM STRL PRLC VLP ST FT CORT,$43.58,$0.00,$43.58,$19.61,$31.10,$0.00,$7.51,$0.00,$0.00,$7.63,$43.58,$0.00,$21.79,$34.52,$34.86,$0.00,$6.82,$0.00,$6.94,$0.00
71801375,SUP,HCPCS C1713,,71801375  -  SCREW BN HEX LOPRFL 3.5MM 75MM STRL PRLC VLP ST FT CORT,$43.58,$0.00,$43.58,$19.61,$31.10,$0.00,$7.51,$0.00,$0.00,$7.63,$43.58,$0.00,$21.79,$34.52,$34.86,$0.00,$6.82,$0.00,$6.94,$0.00
71802506,SUP,HCPCS C1713,,71802506  -  SCREW BN 2.5MM 6MM ST CORT,$75.58,$0.00,$75.58,$34.01,$53.94,$0.00,$13.02,$0.00,$0.00,$13.23,$75.58,$0.00,$37.79,$59.86,$60.46,$0.00,$11.83,$0.00,$12.03,$0.00
71802508,SUP,HCPCS C1713,,71802508  -  SCREW BN 2.5MM 8MM ST CORT,$75.58,$0.00,$75.58,$34.01,$53.94,$0.00,$13.02,$0.00,$0.00,$13.23,$75.58,$0.00,$37.79,$59.86,$60.46,$0.00,$11.83,$0.00,$12.03,$0.00
71802532,SUP,HCPCS C1713,,71802532  -  SCREW BN 2.5MM 32MM ST CORT,$75.58,$0.00,$75.58,$34.01,$53.94,$0.00,$13.02,$0.00,$0.00,$13.23,$75.58,$0.00,$37.79,$59.86,$60.46,$0.00,$11.83,$0.00,$12.03,$0.00
71802534,SUP,HCPCS C1713,,71802534  -  SCREW BN 2.5MM 34MM ST CORT,$75.58,$0.00,$75.58,$34.01,$53.94,$0.00,$13.02,$0.00,$0.00,$13.23,$75.58,$0.00,$37.79,$59.86,$60.46,$0.00,$11.83,$0.00,$12.03,$0.00
71802536,SUP,HCPCS C1713,,71802536  -  SCREW BN 2.5MM 36MM ST CORT,$75.58,$0.00,$75.58,$34.01,$53.94,$0.00,$13.02,$0.00,$0.00,$13.23,$75.58,$0.00,$37.79,$59.86,$60.46,$0.00,$11.83,$0.00,$12.03,$0.00
71802538,SUP,HCPCS C1713,,71802538  -  SCREW BN 2.5MM 38MM ST CORT,$75.58,$0.00,$75.58,$34.01,$53.94,$0.00,$13.02,$0.00,$0.00,$13.23,$75.58,$0.00,$37.79,$59.86,$60.46,$0.00,$11.83,$0.00,$12.03,$0.00
71802540,SUP,HCPCS C1713,,71802540  -  SCREW BN 2.5MM 40MM ST CORT,$75.58,$0.00,$75.58,$34.01,$53.94,$0.00,$13.02,$0.00,$0.00,$13.23,$75.58,$0.00,$37.79,$59.86,$60.46,$0.00,$11.83,$0.00,$12.03,$0.00
71802545,SUP,HCPCS C1713,,71802545  -  SCREW BN 2.5MM 45MM ST CORT,$75.58,$0.00,$75.58,$34.01,$53.94,$0.00,$13.02,$0.00,$0.00,$13.23,$75.58,$0.00,$37.79,$59.86,$60.46,$0.00,$11.83,$0.00,$12.03,$0.00
71802550,SUP,HCPCS C1713,,71802550  -  SCREW BN 2.5MM 50MM ST CORT,$75.58,$0.00,$75.58,$34.01,$53.94,$0.00,$13.02,$0.00,$0.00,$13.23,$75.58,$0.00,$37.79,$59.86,$60.46,$0.00,$11.83,$0.00,$12.03,$0.00
71802606,SUP,HCPCS C1713,,71802606  -  PLATE BN 70MM PRLC 6 HL LCK RECON SS 3.5MM SCR,"$1,060.50",$0.00,"$1,060.50",$477.23,$756.88,$0.00,$182.72,$0.00,$0.00,$185.69,"$1,060.50",$0.00,$530.25,$839.92,$848.40,$0.00,$165.97,$0.00,$168.83,$0.00
71803006,SUP,HCPCS C1713,,71803006  -  SCREW BN 2.7MM 6MM STRL ST CORT FOREFOOT MIDFOOT,$75.58,$0.00,$75.58,$34.01,$53.94,$0.00,$13.02,$0.00,$0.00,$13.23,$75.58,$0.00,$37.79,$59.86,$60.46,$0.00,$11.83,$0.00,$12.03,$0.00
71809006,SUP,HCPCS C1713,,71809006  -  PLATE BN TBLR RCHRD 6 HL LCK HIP 3.5MM SCR,$347.55,$0.00,$347.55,$156.40,$248.05,$0.00,$59.88,$0.00,$0.00,$60.85,$347.55,$0.00,$173.78,$275.26,$278.04,$0.00,$54.39,$0.00,$55.33,$0.00
71823032,SUP,HCPCS C1713,,71823032  -  SCREW BN 2.7MM 32MM ST SS CORT PRLC VLP SM FRAG SYS,$44.90,$0.00,$44.90,$20.21,$32.05,$0.00,$7.74,$0.00,$0.00,$7.86,$44.90,$0.00,$22.45,$35.56,$35.92,$0.00,$7.03,$0.00,$7.15,$0.00
71840112,SUP,HCPCS C1713,,71840112  -  TEMPLATE BNDRG TC100 12 HL CMPR LG FRAG PLT,$142.80,$0.00,$142.80,$64.26,$101.92,$0.00,$24.60,$0.00,$0.00,$25.00,$142.80,$0.00,$71.40,$113.10,$114.24,$0.00,$22.35,$0.00,$22.73,$0.00
71840202,SUP,HCPCS C1713,,71840202  -  PLATE BN 26MM 2 HL CMPR 3.5MM SCR SM FRAG SET,$332.85,$0.00,$332.85,$149.78,$237.56,$0.00,$57.35,$0.00,$0.00,$58.28,$332.85,$0.00,$166.43,$263.62,$266.28,$0.00,$52.09,$0.00,$52.99,$0.00
71840203,SUP,HCPCS C1713,,71840203  -  PLATE BN 39MM 3 HL CMPR ORTH 3.5MM SCR SM FRAG SET,$341.25,$0.00,$341.25,$153.56,$243.55,$0.00,$58.80,$0.00,$0.00,$59.75,$341.25,$0.00,$170.63,$270.27,$273.00,$0.00,$53.41,$0.00,$54.33,$0.00
71840204,SUP,HCPCS C1713,,71840204  -  PLATE BN 52MM TC100 4 HL CMPR PLVC 3.5MM SCR SM FRAG SET,$354.90,$0.00,$354.90,$159.71,$253.29,$0.00,$61.15,$0.00,$0.00,$62.14,$354.90,$0.00,$177.45,$281.08,$283.92,$0.00,$55.54,$0.00,$56.50,$0.00
71840205,SUP,HCPCS C1713,,71840205  -  PLATE BN 65MM TC100 5 HL CMPR PLVC 3.5MM SCR SM FRAG SET,$382.20,$0.00,$382.20,$171.99,$272.78,$0.00,$65.85,$0.00,$0.00,$66.92,$382.20,$0.00,$191.10,$302.70,$305.76,$0.00,$59.81,$0.00,$60.85,$0.00
71840206,SUP,HCPCS C1713,,71840206  -  PLATE BN 78MM TC100 6 HL CMPR PLVC 3.5MM SCR SM FRAG SET,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
71840207,SUP,HCPCS C1713,,71840207  -  PLATE BN 91MM TC100 7 HL CMPR PLVC 3.5MM SCR SM FRAG SET,$414.75,$0.00,$414.75,$186.64,$296.01,$0.00,$71.46,$0.00,$0.00,$72.62,$414.75,$0.00,$207.38,$328.48,$331.80,$0.00,$64.91,$0.00,$66.03,$0.00
71840208,SUP,HCPCS C1713,,71840208  -  PLATE BN 104MM TC100 8 HL CMPR PLVC 3.5MM SCR SM FRAG SET,$446.25,$0.00,$446.25,$200.81,$318.49,$0.00,$76.89,$0.00,$0.00,$78.13,$446.25,$0.00,$223.13,$353.43,$357.00,$0.00,$69.84,$0.00,$71.04,$0.00
71840209,SUP,HCPCS C1713,,71840209  -  PLATE BN 117MM 9 HL CMPR ORTH 3.5MM SCR SM FRAG SET,$454.65,$0.00,$454.65,$204.59,$324.48,$0.00,$78.33,$0.00,$0.00,$79.61,$454.65,$0.00,$227.33,$360.08,$363.72,$0.00,$71.15,$0.00,$72.38,$0.00
71840210,SUP,HCPCS C1713,,71840210  -  PLATE BN 130MM 10 HL CMPR ORTH 3.5MM SCR SM FRAG SET,$470.40,$0.00,$470.40,$211.68,$335.72,$0.00,$81.05,$0.00,$0.00,$82.36,$470.40,$0.00,$235.20,$372.56,$376.32,$0.00,$73.62,$0.00,$74.89,$0.00
71840211,SUP,HCPCS C1713,,71840211  -  PLATE BN 143MM 11 HL CMPR 3.5MM SCR SM FRAG SET,$470.40,$0.00,$470.40,$211.68,$335.72,$0.00,$81.05,$0.00,$0.00,$82.36,$470.40,$0.00,$235.20,$372.56,$376.32,$0.00,$73.62,$0.00,$74.89,$0.00
71840212,SUP,HCPCS C1713,,71840212  -  PLATE BN 156MM 12 HL CMPR 3.5MM SCR SM FRAG SET,$520.80,$0.00,$520.80,$234.36,$371.69,$0.00,$89.73,$0.00,$0.00,$91.19,$520.80,$0.00,$260.40,$412.47,$416.64,$0.00,$81.51,$0.00,$82.91,$0.00
71840214,SUP,HCPCS C1713,,71840214  -  PLATE BN 182MM 14 HL CMPR 3.5MM SCR SM FRAG SET,"$1,181.25",$0.00,"$1,181.25",$531.56,$843.06,$0.00,$203.52,$0.00,$0.00,$206.83,"$1,181.25",$0.00,$590.63,$935.55,$945.00,$0.00,$184.87,$0.00,$188.06,$0.00
71840215,SUP,HCPCS C1713,,71840215  -  PLATE BN 195MM 15 HL CMPR 3.5MM SCR SM FRAG SET,"$1,233.75",$0.00,"$1,233.75",$555.19,$880.53,$0.00,$212.57,$0.00,$0.00,$216.02,"$1,233.75",$0.00,$616.88,$977.13,$987.00,$0.00,$193.08,$0.00,$196.41,$0.00
71840216,SUP,HCPCS C1713,,71840216  -  PLATE BN 208MM 16 HL CMPR 3.5MM SCR SM FRAG SET,"$1,359.75",$0.00,"$1,359.75",$611.89,$970.45,$0.00,$234.28,$0.00,$0.00,$238.08,"$1,359.75",$0.00,$679.88,"$1,076.92","$1,087.80",$0.00,$212.80,$0.00,$216.47,$0.00
71840218,SUP,HCPCS C1713,,71840218  -  PLATE BN 234MM 18 HL CMPR 3.5MM SCR SM FRAG SET,"$1,517.25",$0.00,"$1,517.25",$682.76,"$1,082.86",$0.00,$261.41,$0.00,$0.00,$265.66,"$1,517.25",$0.00,$758.63,"$1,201.66","$1,213.80",$0.00,$237.45,$0.00,$241.55,$0.00
71840220,SUP,HCPCS C1713,,71840220  -  PLATE BN 260MM 20 HL CMPR 3.5MM SCR SM FRAG SET,"$1,711.50",$0.00,"$1,711.50",$770.18,"$1,221.50",$0.00,$294.88,$0.00,$0.00,$299.67,"$1,711.50",$0.00,$855.75,"$1,355.51","$1,369.20",$0.00,$267.85,$0.00,$272.47,$0.00
71841012,SUP,HCPCS C1713,,71841012  -  TEMPLATE BNDRG TC100 12 HL SM FRAG PLT,$88.68,$0.00,$88.68,$39.90,$63.29,$0.00,$15.28,$0.00,$0.00,$15.53,$88.68,$0.00,$44.34,$70.23,$70.94,$0.00,$13.88,$0.00,$14.12,$0.00
71841206,SUP,HCPCS C1713,,71841206  -  PLATE BN BRD 108MM 6 HL CMPR 4.5MM SCR,$577.50,$0.00,$577.50,$259.88,$412.16,$0.00,$99.50,$0.00,$0.00,$101.12,$577.50,$0.00,$288.75,$457.38,$462.00,$0.00,$90.38,$0.00,$91.94,$0.00
71841207,SUP,HCPCS C1713,,71841207  -  PLATE BN BRD 126MM 7 HL CMPR 4.5MM SCR,$577.50,$0.00,$577.50,$259.88,$412.16,$0.00,$99.50,$0.00,$0.00,$101.12,$577.50,$0.00,$288.75,$457.38,$462.00,$0.00,$90.38,$0.00,$91.94,$0.00
71841208,SUP,HCPCS C1713,,71841208  -  PLATE BN BRD 144MM 8 HL CMPR 4.5MM SCR,$718.20,$0.00,$718.20,$323.19,$512.58,$0.00,$123.74,$0.00,$0.00,$125.75,$718.20,$0.00,$359.10,$568.81,$574.56,$0.00,$112.40,$0.00,$114.34,$0.00
71841209,SUP,HCPCS C1713,,71841209  -  PLATE BN BRD 162MM 9 HL CMPR 4.5MM SCR,$718.20,$0.00,$718.20,$323.19,$512.58,$0.00,$123.74,$0.00,$0.00,$125.75,$718.20,$0.00,$359.10,$568.81,$574.56,$0.00,$112.40,$0.00,$114.34,$0.00
71841210,SUP,HCPCS C1713,,71841210  -  PLATE BN BRD 180MM 10 HL CMPR 4.5MM SCR,$718.20,$0.00,$718.20,$323.19,$512.58,$0.00,$123.74,$0.00,$0.00,$125.75,$718.20,$0.00,$359.10,$568.81,$574.56,$0.00,$112.40,$0.00,$114.34,$0.00
71841211,SUP,HCPCS C1713,,71841211  -  PLATE BN BRD 198MM 11 HL CMPR 4.5MM SCR,$904.05,$0.00,$904.05,$406.82,$645.22,$0.00,$155.76,$0.00,$0.00,$158.29,$904.05,$0.00,$452.03,$716.01,$723.24,$0.00,$141.48,$0.00,$143.92,$0.00
71841212,SUP,HCPCS C1713,,71841212  -  PLATE BN BRD 216MM 12 HL CMPR ORTH 4.5MM SCR,$770.70,$0.00,$770.70,$346.82,$550.05,$0.00,$132.79,$0.00,$0.00,$134.94,$770.70,$0.00,$385.35,$610.39,$616.56,$0.00,$120.61,$0.00,$122.70,$0.00
71841214,SUP,HCPCS C1713,,71841214  -  PLATE BN BRD 252MM 14 HL CMPR 4.5MM SCR,$770.70,$0.00,$770.70,$346.82,$550.05,$0.00,$132.79,$0.00,$0.00,$134.94,$770.70,$0.00,$385.35,$610.39,$616.56,$0.00,$120.61,$0.00,$122.70,$0.00
71841218,SUP,HCPCS C1713,,71841218  -  PLATE BN BRD 324MM 18 HL CMPR 4.5MM SCR,"$1,139.25",$0.00,"$1,139.25",$512.66,$813.08,$0.00,$196.29,$0.00,$0.00,$199.47,"$1,139.25",$0.00,$569.63,$902.29,$911.40,$0.00,$178.29,$0.00,$181.37,$0.00
71841222,SUP,HCPCS C1713,,71841222  -  PLATE BN BRD 396MM 22 HL CMPR 4.5MM SCR,"$1,722.00",$0.00,"$1,722.00",$774.90,"$1,228.99",$0.00,$296.69,$0.00,$0.00,$301.51,"$1,722.00",$0.00,$861.00,"$1,363.82","$1,377.60",$0.00,$269.49,$0.00,$274.14,$0.00
71841402,SUP,HCPCS C1713,,71841402  -  PLATE BN NAR 36MM 2 HL CMPR 4.5MM SCR,$473.55,$0.00,$473.55,$213.10,$337.97,$0.00,$81.59,$0.00,$0.00,$82.91,$473.55,$0.00,$236.78,$375.05,$378.84,$0.00,$74.11,$0.00,$75.39,$0.00
71841403,SUP,HCPCS C1713,,71841403  -  PLATE BN NAR 54MM 3 HL CMPR 4.5MM SCR,$387.45,$0.00,$387.45,$174.35,$276.52,$0.00,$66.76,$0.00,$0.00,$67.84,$387.45,$0.00,$193.73,$306.86,$309.96,$0.00,$60.64,$0.00,$61.68,$0.00
71841404,SUP,HCPCS C1713,,71841404  -  PLATE BN NAR 72MM 4 HL CMPR 4.5MM SCR,$387.45,$0.00,$387.45,$174.35,$276.52,$0.00,$66.76,$0.00,$0.00,$67.84,$387.45,$0.00,$193.73,$306.86,$309.96,$0.00,$60.64,$0.00,$61.68,$0.00
71841405,SUP,HCPCS C1713,,71841405  -  PLATE BN NAR 90MM 5 HL CMPR 4.5MM SCR,$387.45,$0.00,$387.45,$174.35,$276.52,$0.00,$66.76,$0.00,$0.00,$67.84,$387.45,$0.00,$193.73,$306.86,$309.96,$0.00,$60.64,$0.00,$61.68,$0.00
71841406,SUP,HCPCS C1713,,71841406  -  PLATE BN NAR 108MM 6 HL CMPR 4.5MM SCR,$441.00,$0.00,$441.00,$198.45,$314.74,$0.00,$75.98,$0.00,$0.00,$77.22,$441.00,$0.00,$220.50,$349.27,$352.80,$0.00,$69.02,$0.00,$70.21,$0.00
71841407,SUP,HCPCS C1713,,71841407  -  PLATE BN NAR 126MM 7 HL CMPR 4.5MM SCR,$441.00,$0.00,$441.00,$198.45,$314.74,$0.00,$75.98,$0.00,$0.00,$77.22,$441.00,$0.00,$220.50,$349.27,$352.80,$0.00,$69.02,$0.00,$70.21,$0.00
71841408,SUP,HCPCS C1713,,71841408  -  PLATE BN NAR 144MM 8 HL CMPR 4.5MM SCR,$441.00,$0.00,$441.00,$198.45,$314.74,$0.00,$75.98,$0.00,$0.00,$77.22,$441.00,$0.00,$220.50,$349.27,$352.80,$0.00,$69.02,$0.00,$70.21,$0.00
71841409,SUP,HCPCS C1713,,71841409  -  PLATE BN NAR 162MM 9 HL CMPR 4.5MM SCR,$441.00,$0.00,$441.00,$198.45,$314.74,$0.00,$75.98,$0.00,$0.00,$77.22,$441.00,$0.00,$220.50,$349.27,$352.80,$0.00,$69.02,$0.00,$70.21,$0.00
71841410,SUP,HCPCS C1713,,71841410  -  PLATE BN NAR 180MM 10 HL CMPR 4.5MM SCR,$568.05,$0.00,$568.05,$255.62,$405.42,$0.00,$97.87,$0.00,$0.00,$99.46,$568.05,$0.00,$284.03,$449.90,$454.44,$0.00,$88.90,$0.00,$90.43,$0.00
71841411,SUP,HCPCS C1713,,71841411  -  PLATE BN NAR 198MM 11 HL CMPR 4.5MM SCR,$568.05,$0.00,$568.05,$255.62,$405.42,$0.00,$97.87,$0.00,$0.00,$99.46,$568.05,$0.00,$284.03,$449.90,$454.44,$0.00,$88.90,$0.00,$90.43,$0.00
71841412,SUP,HCPCS C1713,,71841412  -  PLATE BN NAR 216MM 12 HL CMPR 4.5MM SCR,$568.05,$0.00,$568.05,$255.62,$405.42,$0.00,$97.87,$0.00,$0.00,$99.46,$568.05,$0.00,$284.03,$449.90,$454.44,$0.00,$88.90,$0.00,$90.43,$0.00
71841413,SUP,HCPCS C1713,,71841413  -  PLATE BN NAR 234MM 13 HL CMPR 4.5MM SCR,$820.05,$0.00,$820.05,$369.02,$585.27,$0.00,$141.29,$0.00,$0.00,$143.58,$820.05,$0.00,$410.03,$649.48,$656.04,$0.00,$128.34,$0.00,$130.55,$0.00
71841414,SUP,HCPCS C1713,,71841414  -  PLATE BN NAR 252MM 14 HL CMPR 4.5MM SCR,$820.05,$0.00,$820.05,$369.02,$585.27,$0.00,$141.29,$0.00,$0.00,$143.58,$820.05,$0.00,$410.03,$649.48,$656.04,$0.00,$128.34,$0.00,$130.55,$0.00
71841416,SUP,HCPCS C1713,,71841416  -  PLATE BN NAR 288MM 16 HL CMPR 4.5MM SCR,$866.25,$0.00,$866.25,$389.81,$618.24,$0.00,$149.25,$0.00,$0.00,$151.67,$866.25,$0.00,$433.13,$686.07,$693.00,$0.00,$135.57,$0.00,$137.91,$0.00
71841418,SUP,HCPCS C1713,,71841418  -  PLATE BN NAR 324MM 18 HL CMPR 4.5MM SCR,"$1,270.50",$0.00,"$1,270.50",$571.73,$906.76,$0.00,$218.90,$0.00,$0.00,$222.45,"$1,270.50",$0.00,$635.25,"$1,006.24","$1,016.40",$0.00,$198.83,$0.00,$202.26,$0.00
71841420,SUP,HCPCS C1713,,71841420  -  PLATE BN NAR 360MM 20 HL CMPR 4.5MM SCR,"$1,396.50",$0.00,"$1,396.50",$628.43,$996.68,$0.00,$240.61,$0.00,$0.00,$244.52,"$1,396.50",$0.00,$698.25,"$1,106.03","$1,117.20",$0.00,$218.55,$0.00,$222.32,$0.00
71925062,SUP,Custom 27203010,,71925062  -  GUIDE PIN ORTHOPEDIC 2.4MM 450MM THREAD,"$1,022.50",$0.00,"$1,022.50",$0.00,$729.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,022.50",$0.00,$511.25,$809.82,$818.00,$0.00,$0.00,$0.00,$0.00,$0.00
71931590,SUP,HCPCS C1713,,71931590  -  NAIL IM 11.5MM 60CM FEM,"$6,918.75",$0.00,"$6,918.75","$3,113.44","$4,937.91",$0.00,"$1,192.07",$0.00,$0.00,"$1,211.42","$6,918.75",$0.00,"$3,459.38","$5,479.65","$5,535.00",$0.00,"$1,082.78",$0.00,"$1,101.47",$0.00
71931594,SUP,HCPCS C1713,,71931594  -  NAIL IM 11.5MM 80CM KN RT FEM,"$6,918.75",$0.00,"$6,918.75","$3,113.44","$4,937.91",$0.00,"$1,192.07",$0.00,$0.00,"$1,211.42","$6,918.75",$0.00,"$3,459.38","$5,479.65","$5,535.00",$0.00,"$1,082.78",$0.00,"$1,101.47",$0.00
71931602,SUP,HCPCS C1713,,71931602  -  NAIL IM 11.5MM FAN FSN KN,"$6,918.75",$0.00,"$6,918.75","$3,113.44","$4,937.91",$0.00,"$1,192.07",$0.00,$0.00,"$1,211.42","$6,918.75",$0.00,"$3,459.38","$5,479.65","$5,535.00",$0.00,"$1,082.78",$0.00,"$1,101.47",$0.00
71931604,SUP,HCPCS C1713,,71931604  -  NAIL IM 11.5MM 85MM LCK FSN FEM,"$6,918.75",$0.00,"$6,918.75","$3,113.44","$4,937.91",$0.00,"$1,192.07",$0.00,$0.00,"$1,211.42","$6,918.75",$0.00,"$3,459.38","$5,479.65","$5,535.00",$0.00,"$1,082.78",$0.00,"$1,101.47",$0.00
71931663,SUP,HCPCS C1713,,71931663  -  NAIL IM 13MM 75CM FSN LT KN,"$6,918.75",$0.00,"$6,918.75","$3,113.44","$4,937.91",$0.00,"$1,192.07",$0.00,$0.00,"$1,211.42","$6,918.75",$0.00,"$3,459.38","$5,479.65","$5,535.00",$0.00,"$1,082.78",$0.00,"$1,101.47",$0.00
71931664,SUP,HCPCS C1713,,71931664  -  NAIL IM 13MM 80CM KN FEM,"$6,918.75",$0.00,"$6,918.75","$3,113.44","$4,937.91",$0.00,"$1,192.07",$0.00,$0.00,"$1,211.42","$6,918.75",$0.00,"$3,459.38","$5,479.65","$5,535.00",$0.00,"$1,082.78",$0.00,"$1,101.47",$0.00
71931665,SUP,HCPCS C1713,,71931665  -  NAIL IM 85CMX13MM ANTGRD FSN LT,"$6,918.75",$0.00,"$6,918.75","$3,113.44","$4,937.91",$0.00,"$1,192.07",$0.00,$0.00,"$1,211.42","$6,918.75",$0.00,"$3,459.38","$5,479.65","$5,535.00",$0.00,"$1,082.78",$0.00,"$1,101.47",$0.00
71931672,SUP,HCPCS C1713,,71931672  -  NAIL IM 13MM 75CM KN FEM,"$6,918.75",$0.00,"$6,918.75","$3,113.44","$4,937.91",$0.00,"$1,192.07",$0.00,$0.00,"$1,211.42","$6,918.75",$0.00,"$3,459.38","$5,479.65","$5,535.00",$0.00,"$1,082.78",$0.00,"$1,101.47",$0.00
71933134,SUP,HCPCS C1713,,71933134  -  SCREW BN 3MM 4MM 30MM 3MM SM HDLS SCR CNN SCR SYS TI ACPT,"$6,283.13",$0.00,"$6,283.13","$2,827.41","$4,484.27",$0.00,"$1,082.55",$0.00,$0.00,"$1,100.12","$6,283.13",$0.00,"$3,141.56","$4,976.24","$5,026.50",$0.00,$983.31,$0.00,"$1,000.27",$0.00
71933306,SUP,Custom 27203010,,71933306  -  RING EXFIX 255MM 2/3 RING,"$9,400.00",$0.00,"$9,400.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$9,400.00",$0.00,"$4,700.00","$7,444.80","$7,520.00",$0.00,$0.00,$0.00,$0.00,$0.00
71933335,SUP,Custom 27203010,,71933335  -  RAIL XTRNFX STD SEG DIST MDLR SYS,"$1,534.25",$0.00,"$1,534.25",$0.00,"$1,094.99",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,534.25",$0.00,$767.13,"$1,215.13","$1,227.40",$0.00,$0.00,$0.00,$0.00,$0.00
71933336,SUP,Custom 27203010,,71933336  -  ARCH XTRNFX RAIL ROT CNCT,"$2,443.75",$0.00,"$2,443.75",$0.00,"$1,744.10",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,443.75",$0.00,"$1,221.88","$1,935.45","$1,955.00",$0.00,$0.00,$0.00,$0.00,$0.00
71933338,SUP,Custom 27203010,,71933338  -  ARCH XTRNFX RAIL ROT CNCT,"$1,525.75",$0.00,"$1,525.75",$0.00,"$1,088.93",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,525.75",$0.00,$762.88,"$1,208.39","$1,220.60",$0.00,$0.00,$0.00,$0.00,$0.00
71933339,SUP,Custom 27203010,,71933339  -  ARCH XTRNFX RAIL ROT CNCT,"$1,323.88",$0.00,"$1,323.88",$0.00,$944.85,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,323.88",$0.00,$661.94,"$1,048.51","$1,059.10",$0.00,$0.00,$0.00,$0.00,$0.00
71933501,SUP,HCPCS C1713,,71933501  -  SCREW BN 4.5MM 48MM ST CORT,$38.50,$0.00,$38.50,$17.33,$27.48,$0.00,$6.63,$0.00,$0.00,$6.74,$38.50,$0.00,$19.25,$30.49,$30.80,$0.00,$6.03,$0.00,$6.13,$0.00
71933626,SUP,Custom 27203010,,71933626  -  CONNECTOR XTRNFX RAIL CLP,"$1,039.13",$0.00,"$1,039.13",$0.00,$741.62,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,039.13",$0.00,$519.56,$822.99,$831.30,$0.00,$0.00,$0.00,$0.00,$0.00
71933940,SUP,Custom 27203010,,71933940  -  RAIL XTRNFX SM MDLR RL ARC CNCT,"$1,564.00",$0.00,"$1,564.00",$0.00,"$1,116.23",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,564.00",$0.00,$782.00,"$1,238.69","$1,251.20",$0.00,$0.00,$0.00,$0.00,$0.00
71933941,SUP,Custom 27203010,,71933941  -  RAIL XTRNFX SM,"$2,613.75",$0.00,"$2,613.75",$0.00,"$1,865.43",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,613.75",$0.00,"$1,306.88","$2,070.09","$2,091.00",$0.00,$0.00,$0.00,$0.00,$0.00
71933943,SUP,Custom 27203010,,71933943  -  RAIL XTRNFX SM ARC ROT CNCT,"$1,323.88",$0.00,"$1,323.88",$0.00,$944.85,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,323.88",$0.00,$661.94,"$1,048.51","$1,059.10",$0.00,$0.00,$0.00,$0.00,$0.00
71934046,SUP,Custom 27203010,,71934046  -  ARCH XTRNFX SHRT MDLR RL SM RAIL,"$2,613.75",$0.00,"$2,613.75",$0.00,"$1,865.43",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,613.75",$0.00,"$1,306.88","$2,070.09","$2,091.00",$0.00,$0.00,$0.00,$0.00,$0.00
71934155,SUP,Custom 27203010,,71934155  -  RAIL XTRNFX SM ARC PREASSEMBLE,"$9,360.63",$0.00,"$9,360.63",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$9,360.63",$0.00,"$4,680.31","$7,413.62","$7,488.50",$0.00,$0.00,$0.00,$0.00,$0.00
71934479,SUP,HCPCS C1713,,71934479  -  NAIL IM 125D 10MM 24CM TRGN FEM,"$3,780.00",$0.00,"$3,780.00","$1,701.00","$2,697.79",$0.00,$651.28,$0.00,$0.00,$661.85,"$3,780.00",$0.00,"$1,890.00","$2,993.76","$3,024.00",$0.00,$591.57,$0.00,$601.78,$0.00
71934482,SUP,HCPCS C1713,,71934482  -  NAIL IM 130D 11.5MM 24CM TRGN FEM,"$3,780.00",$0.00,"$3,780.00","$1,701.00","$2,697.79",$0.00,$651.28,$0.00,$0.00,$661.85,"$3,780.00",$0.00,"$1,890.00","$2,993.76","$3,024.00",$0.00,$591.57,$0.00,$601.78,$0.00
71934624,SUP,Custom 27203010,,71934624  -  RAIL XTRNFX ARC CNCT THRD,"$1,525.75",$0.00,"$1,525.75",$0.00,"$1,088.93",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,525.75",$0.00,$762.88,"$1,208.39","$1,220.60",$0.00,$0.00,$0.00,$0.00,$0.00
71934625,SUP,Custom 27203010,,71934625  -  RAIL XTRNFX ARC,"$2,496.88",$0.00,"$2,496.88",$0.00,"$1,782.02",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,496.88",$0.00,"$1,248.44","$1,977.53","$1,997.50",$0.00,$0.00,$0.00,$0.00,$0.00
71934626,SUP,Custom 27203010,,71934626  -  RAIL XTRNFX SM ARC CNCT THRD,"$1,525.75",$0.00,"$1,525.75",$0.00,"$1,088.93",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,525.75",$0.00,$762.88,"$1,208.39","$1,220.60",$0.00,$0.00,$0.00,$0.00,$0.00
71934627,SUP,Custom 27203010,,71934627  -  RAIL XTRNFX SM ARC,"$2,496.88",$0.00,"$2,496.88",$0.00,"$1,782.02",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,496.88",$0.00,"$1,248.44","$1,977.53","$1,997.50",$0.00,$0.00,$0.00,$0.00,$0.00
71934628,SUP,Custom 27203010,,71934628  -  RAIL XTRNFX SM ARCH,"$2,496.88",$0.00,"$2,496.88",$0.00,"$1,782.02",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,496.88",$0.00,"$1,248.44","$1,977.53","$1,997.50",$0.00,$0.00,$0.00,$0.00,$0.00
71934629,SUP,Custom 27203010,,71934629  -  RAIL XTRNFX 180MM ARC,"$2,496.88",$0.00,"$2,496.88",$0.00,"$1,782.02",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,496.88",$0.00,"$1,248.44","$1,977.53","$1,997.50",$0.00,$0.00,$0.00,$0.00,$0.00
71934630,SUP,Custom 27203010,,71934630  -  RAIL XTRNFX SM 180MM ARC,"$2,496.88",$0.00,"$2,496.88",$0.00,"$1,782.02",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,496.88",$0.00,"$1,248.44","$1,977.53","$1,997.50",$0.00,$0.00,$0.00,$0.00,$0.00
71934647,SUP,Custom 27203010,,71934647  -  RAIL XTRNFX 50MM LCK,"$1,071.00",$0.00,"$1,071.00",$0.00,$764.37,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,071.00",$0.00,$535.50,$848.23,$856.80,$0.00,$0.00,$0.00,$0.00,$0.00
71934648,SUP,Custom 27203010,,71934648  -  RAIL XTRNFX 60MM LCK,"$1,060.38",$0.00,"$1,060.38",$0.00,$756.79,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,060.38",$0.00,$530.19,$839.82,$848.30,$0.00,$0.00,$0.00,$0.00,$0.00
71934649,SUP,Custom 27203010,,71934649  -  RAIL XTRNFX 70MM LCK,"$1,071.00",$0.00,"$1,071.00",$0.00,$764.37,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,071.00",$0.00,$535.50,$848.23,$856.80,$0.00,$0.00,$0.00,$0.00,$0.00
71934650,SUP,Custom 27203010,,71934650  -  RAIL XTRNFX 80MM LCK,"$1,060.38",$0.00,"$1,060.38",$0.00,$756.79,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,060.38",$0.00,$530.19,$839.82,$848.30,$0.00,$0.00,$0.00,$0.00,$0.00
71934651,SUP,Custom 27203010,,71934651  -  RAIL XTRNFX 90MM LCK,"$1,060.38",$0.00,"$1,060.38",$0.00,$756.79,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,060.38",$0.00,$530.19,$839.82,$848.30,$0.00,$0.00,$0.00,$0.00,$0.00
71934652,SUP,Custom 27203010,,71934652  -  RAIL XTRNFX 100MM LCK,"$1,060.38",$0.00,"$1,060.38",$0.00,$756.79,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,060.38",$0.00,$530.19,$839.82,$848.30,$0.00,$0.00,$0.00,$0.00,$0.00
71934776,SUP,HCPCS C1713,,71934776  -  NAIL 10MM 34CM FEM LEFT IM 25D ANTGRD LIME,"$4,522.50",$0.00,"$4,522.50","$2,035.13","$3,227.71",$0.00,$779.20,$0.00,$0.00,$791.85,"$4,522.50",$0.00,"$2,261.25","$3,581.82","$3,618.00",$0.00,$707.77,$0.00,$719.98,$0.00
71934777,SUP,HCPCS C1713,,71934777  -  NAIL 10MM 36CM FEM LEFT IM 25D ANTGRD LIME,"$4,522.50",$0.00,"$4,522.50","$2,035.13","$3,227.71",$0.00,$779.20,$0.00,$0.00,$791.85,"$4,522.50",$0.00,"$2,261.25","$3,581.82","$3,618.00",$0.00,$707.77,$0.00,$719.98,$0.00
71934778,SUP,HCPCS C1713,,71934778  -  NAIL 10MM 38CM FEM LEFT IM 25D ANTGRD LIME,"$4,522.50",$0.00,"$4,522.50","$2,035.13","$3,227.71",$0.00,$779.20,$0.00,$0.00,$791.85,"$4,522.50",$0.00,"$2,261.25","$3,581.82","$3,618.00",$0.00,$707.77,$0.00,$719.98,$0.00
71934779,SUP,HCPCS C1713,,71934779  -  NAIL 10MM 40CM FEM LEFT IM 25D ANTGRD LIME,"$4,522.50",$0.00,"$4,522.50","$2,035.13","$3,227.71",$0.00,$779.20,$0.00,$0.00,$791.85,"$4,522.50",$0.00,"$2,261.25","$3,581.82","$3,618.00",$0.00,$707.77,$0.00,$719.98,$0.00
71934780,SUP,HCPCS C1713,,71934780  -  NAIL 10MM 42CM FEM LEFT IM 25D ANTGRD LIME,"$4,522.50",$0.00,"$4,522.50","$2,035.13","$3,227.71",$0.00,$779.20,$0.00,$0.00,$791.85,"$4,522.50",$0.00,"$2,261.25","$3,581.82","$3,618.00",$0.00,$707.77,$0.00,$719.98,$0.00
71934781,SUP,HCPCS C1713,,71934781  -  NAIL 10MM 44CM FEM LEFT IM 25D ANTGRD LIME,"$4,522.50",$0.00,"$4,522.50","$2,035.13","$3,227.71",$0.00,$779.20,$0.00,$0.00,$791.85,"$4,522.50",$0.00,"$2,261.25","$3,581.82","$3,618.00",$0.00,$707.77,$0.00,$719.98,$0.00
71934782,SUP,HCPCS C1713,,71934782  -  NAIL 10MM 34CM FEM RIGHT IM 25D ANTGRD ROSE,"$4,522.50",$0.00,"$4,522.50","$2,035.13","$3,227.71",$0.00,$779.20,$0.00,$0.00,$791.85,"$4,522.50",$0.00,"$2,261.25","$3,581.82","$3,618.00",$0.00,$707.77,$0.00,$719.98,$0.00
71934783,SUP,HCPCS C1713,,71934783  -  NAIL 10MM 36CM FEM RIGHT IM 25D ANTGRD ROSE,"$4,522.50",$0.00,"$4,522.50","$2,035.13","$3,227.71",$0.00,$779.20,$0.00,$0.00,$791.85,"$4,522.50",$0.00,"$2,261.25","$3,581.82","$3,618.00",$0.00,$707.77,$0.00,$719.98,$0.00
71934784,SUP,HCPCS C1713,,71934784  -  NAIL 10MM 38CM FEM RIGHT IM 25D ANTGRD ROSE,"$4,522.50",$0.00,"$4,522.50","$2,035.13","$3,227.71",$0.00,$779.20,$0.00,$0.00,$791.85,"$4,522.50",$0.00,"$2,261.25","$3,581.82","$3,618.00",$0.00,$707.77,$0.00,$719.98,$0.00
71934785,SUP,HCPCS C1713,,71934785  -  NAIL 10MM 40CM FEM RIGHT IM 25D ANTGRD ROSE,"$4,522.50",$0.00,"$4,522.50","$2,035.13","$3,227.71",$0.00,$779.20,$0.00,$0.00,$791.85,"$4,522.50",$0.00,"$2,261.25","$3,581.82","$3,618.00",$0.00,$707.77,$0.00,$719.98,$0.00
71934787,SUP,HCPCS C1713,,71934787  -  NAIL 10MM 44CM FEM RIGHT IM 25D ANTGRD ROSE,"$4,522.50",$0.00,"$4,522.50","$2,035.13","$3,227.71",$0.00,$779.20,$0.00,$0.00,$791.85,"$4,522.50",$0.00,"$2,261.25","$3,581.82","$3,618.00",$0.00,$707.77,$0.00,$719.98,$0.00
71934788,SUP,HCPCS C1713,,71934788  -  NAIL 11.5MM 36CM FEM LEFT IM 25D ANTGRD LIME,"$4,522.50",$0.00,"$4,522.50","$2,035.13","$3,227.71",$0.00,$779.20,$0.00,$0.00,$791.85,"$4,522.50",$0.00,"$2,261.25","$3,581.82","$3,618.00",$0.00,$707.77,$0.00,$719.98,$0.00
71934789,SUP,HCPCS C1713,,71934789  -  NAIL 11.5MM 38CM FEM LEFT IM 25D ANTGRD LIME,"$4,522.50",$0.00,"$4,522.50","$2,035.13","$3,227.71",$0.00,$779.20,$0.00,$0.00,$791.85,"$4,522.50",$0.00,"$2,261.25","$3,581.82","$3,618.00",$0.00,$707.77,$0.00,$719.98,$0.00
71934790,SUP,HCPCS C1713,,71934790  -  NAIL 11.5MM 40CM FEM LEFT IM 25D ANTGRD LIME,"$4,522.50",$0.00,"$4,522.50","$2,035.13","$3,227.71",$0.00,$779.20,$0.00,$0.00,$791.85,"$4,522.50",$0.00,"$2,261.25","$3,581.82","$3,618.00",$0.00,$707.77,$0.00,$719.98,$0.00
71934791,SUP,HCPCS C1713,,71934791  -  NAIL 11.5MM 42CM FEM LEFT IM 25D ANTGRD LIME,"$4,522.50",$0.00,"$4,522.50","$2,035.13","$3,227.71",$0.00,$779.20,$0.00,$0.00,$791.85,"$4,522.50",$0.00,"$2,261.25","$3,581.82","$3,618.00",$0.00,$707.77,$0.00,$719.98,$0.00
71934792,SUP,HCPCS C1713,,71934792  -  NAIL 11.5MM 44CM FEM LEFT IM 25D ANTGRD LIME,"$4,522.50",$0.00,"$4,522.50","$2,035.13","$3,227.71",$0.00,$779.20,$0.00,$0.00,$791.85,"$4,522.50",$0.00,"$2,261.25","$3,581.82","$3,618.00",$0.00,$707.77,$0.00,$719.98,$0.00
71934793,SUP,HCPCS C1713,,71934793  -  NAIL 11.5MM 46CM FEM LEFT IM 25D ANTGRD LIME,"$4,522.50",$0.00,"$4,522.50","$2,035.13","$3,227.71",$0.00,$779.20,$0.00,$0.00,$791.85,"$4,522.50",$0.00,"$2,261.25","$3,581.82","$3,618.00",$0.00,$707.77,$0.00,$719.98,$0.00
71934794,SUP,HCPCS C1713,,71934794  -  NAIL 11.5MM 36CM FEM RIGHT IM 25D ANTGRD ROSE,"$4,522.50",$0.00,"$4,522.50","$2,035.13","$3,227.71",$0.00,$779.20,$0.00,$0.00,$791.85,"$4,522.50",$0.00,"$2,261.25","$3,581.82","$3,618.00",$0.00,$707.77,$0.00,$719.98,$0.00
71934795,SUP,HCPCS C1713,,71934795  -  NAIL 11.5MM 38CM FEM RIGHT IM 25D ANTGRD ROSE,"$4,522.50",$0.00,"$4,522.50","$2,035.13","$3,227.71",$0.00,$779.20,$0.00,$0.00,$791.85,"$4,522.50",$0.00,"$2,261.25","$3,581.82","$3,618.00",$0.00,$707.77,$0.00,$719.98,$0.00
71934796,SUP,HCPCS C1713,,71934796  -  NAIL 11.5MM 40CM FEM RIGHT IM 25D ANTGRD ROSE,"$4,522.50",$0.00,"$4,522.50","$2,035.13","$3,227.71",$0.00,$779.20,$0.00,$0.00,$791.85,"$4,522.50",$0.00,"$2,261.25","$3,581.82","$3,618.00",$0.00,$707.77,$0.00,$719.98,$0.00
71934797,SUP,HCPCS C1713,,71934797  -  NAIL 11.5MM 42CM FEM RIGHT IM 25D ANTGRD ROSE,"$4,522.50",$0.00,"$4,522.50","$2,035.13","$3,227.71",$0.00,$779.20,$0.00,$0.00,$791.85,"$4,522.50",$0.00,"$2,261.25","$3,581.82","$3,618.00",$0.00,$707.77,$0.00,$719.98,$0.00
71934798,SUP,HCPCS C1713,,71934798  -  NAIL 11.5MM 44CM FEM RIGHT IM 25D ANTGRD ROSE,"$4,522.50",$0.00,"$4,522.50","$2,035.13","$3,227.71",$0.00,$779.20,$0.00,$0.00,$791.85,"$4,522.50",$0.00,"$2,261.25","$3,581.82","$3,618.00",$0.00,$707.77,$0.00,$719.98,$0.00
71934799,SUP,HCPCS C1713,,71934799  -  NAIL 11.5MM 46CM FEM RIGHT IM 25D ANTGRD ROSE,"$4,522.50",$0.00,"$4,522.50","$2,035.13","$3,227.71",$0.00,$779.20,$0.00,$0.00,$791.85,"$4,522.50",$0.00,"$2,261.25","$3,581.82","$3,618.00",$0.00,$707.77,$0.00,$719.98,$0.00
71934800,SUP,HCPCS C1713,,71934800  -  NAIL 13MM 36CM FEM LEFT IM 25D ANTGRD LIME,"$4,522.50",$0.00,"$4,522.50","$2,035.13","$3,227.71",$0.00,$779.20,$0.00,$0.00,$791.85,"$4,522.50",$0.00,"$2,261.25","$3,581.82","$3,618.00",$0.00,$707.77,$0.00,$719.98,$0.00
71934801,SUP,HCPCS C1713,,71934801  -  NAIL 13MM 38CM FEM LEFT IM 25D ANTGRD LIME,"$4,522.50",$0.00,"$4,522.50","$2,035.13","$3,227.71",$0.00,$779.20,$0.00,$0.00,$791.85,"$4,522.50",$0.00,"$2,261.25","$3,581.82","$3,618.00",$0.00,$707.77,$0.00,$719.98,$0.00
71934802,SUP,HCPCS C1713,,71934802  -  NAIL 13MM 40CM FEM LEFT IM 25D ANTGRD LIME,"$4,522.50",$0.00,"$4,522.50","$2,035.13","$3,227.71",$0.00,$779.20,$0.00,$0.00,$791.85,"$4,522.50",$0.00,"$2,261.25","$3,581.82","$3,618.00",$0.00,$707.77,$0.00,$719.98,$0.00
71934803,SUP,HCPCS C1713,,71934803  -  NAIL 13MM 42CM FEM LEFT IM 25D ANTGRD LIME,"$4,522.50",$0.00,"$4,522.50","$2,035.13","$3,227.71",$0.00,$779.20,$0.00,$0.00,$791.85,"$4,522.50",$0.00,"$2,261.25","$3,581.82","$3,618.00",$0.00,$707.77,$0.00,$719.98,$0.00
71934804,SUP,HCPCS C1713,,71934804  -  NAIL 13MM 44CM FEM LEFT IM 25D ANTGRD LIME,"$4,522.50",$0.00,"$4,522.50","$2,035.13","$3,227.71",$0.00,$779.20,$0.00,$0.00,$791.85,"$4,522.50",$0.00,"$2,261.25","$3,581.82","$3,618.00",$0.00,$707.77,$0.00,$719.98,$0.00
71934805,SUP,HCPCS C1713,,71934805  -  NAIL 13MM 46CM FEM LEFT IM 25D ANTGRD LIME,"$4,522.50",$0.00,"$4,522.50","$2,035.13","$3,227.71",$0.00,$779.20,$0.00,$0.00,$791.85,"$4,522.50",$0.00,"$2,261.25","$3,581.82","$3,618.00",$0.00,$707.77,$0.00,$719.98,$0.00
71934806,SUP,HCPCS C1713,,71934806  -  NAIL 13MM 36CM FEM RIGHT IM 25D ANTGRD ROSE,"$4,522.50",$0.00,"$4,522.50","$2,035.13","$3,227.71",$0.00,$779.20,$0.00,$0.00,$791.85,"$4,522.50",$0.00,"$2,261.25","$3,581.82","$3,618.00",$0.00,$707.77,$0.00,$719.98,$0.00
71934807,SUP,HCPCS C1713,,71934807  -  NAIL 13MM 38CM FEM RIGHT IM 25D ANTGRD ROSE,"$4,522.50",$0.00,"$4,522.50","$2,035.13","$3,227.71",$0.00,$779.20,$0.00,$0.00,$791.85,"$4,522.50",$0.00,"$2,261.25","$3,581.82","$3,618.00",$0.00,$707.77,$0.00,$719.98,$0.00
71934808,SUP,HCPCS C1713,,71934808  -  NAIL 13MM 40CM FEM RIGHT IM 25D ANTGRD ROSE,"$4,522.50",$0.00,"$4,522.50","$2,035.13","$3,227.71",$0.00,$779.20,$0.00,$0.00,$791.85,"$4,522.50",$0.00,"$2,261.25","$3,581.82","$3,618.00",$0.00,$707.77,$0.00,$719.98,$0.00
71934809,SUP,HCPCS C1713,,71934809  -  NAIL 13MM 42CM FEM RIGHT IM 25D ANTGRD ROSE,"$4,522.50",$0.00,"$4,522.50","$2,035.13","$3,227.71",$0.00,$779.20,$0.00,$0.00,$791.85,"$4,522.50",$0.00,"$2,261.25","$3,581.82","$3,618.00",$0.00,$707.77,$0.00,$719.98,$0.00
71934810,SUP,HCPCS C1713,,71934810  -  NAIL 13MM 44CM FEM RIGHT IM 25D ANTGRD ROSE,"$4,522.50",$0.00,"$4,522.50","$2,035.13","$3,227.71",$0.00,$779.20,$0.00,$0.00,$791.85,"$4,522.50",$0.00,"$2,261.25","$3,581.82","$3,618.00",$0.00,$707.77,$0.00,$719.98,$0.00
71934811,SUP,HCPCS C1713,,71934811  -  NAIL 13MM 46CM FEM RIGHT IM 25D ANTGRD ROSE,"$4,522.50",$0.00,"$4,522.50","$2,035.13","$3,227.71",$0.00,$779.20,$0.00,$0.00,$791.85,"$4,522.50",$0.00,"$2,261.25","$3,581.82","$3,618.00",$0.00,$707.77,$0.00,$719.98,$0.00
71934845,SUP,Custom 27203010,,71934845  -  RAIL XTRNFX 339MM,"$2,666.88",$0.00,"$2,666.88",$0.00,"$1,903.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,666.88",$0.00,"$1,333.44","$2,112.17","$2,133.50",$0.00,$0.00,$0.00,$0.00,$0.00
71934846,SUP,Custom 27203010,,71934846  -  RAIL XTRNFX SM 226MM,"$2,666.88",$0.00,"$2,666.88",$0.00,"$1,903.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,666.88",$0.00,"$1,333.44","$2,112.17","$2,133.50",$0.00,$0.00,$0.00,$0.00,$0.00
71934996,SUP,HCPCS C1713,,71934996  -  NAIL 10MM 46CM LEFT FAN IM 25D LIME DH,"$4,522.50",$0.00,"$4,522.50","$2,035.13","$3,227.71",$0.00,$779.20,$0.00,$0.00,$791.85,"$4,522.50",$0.00,"$2,261.25","$3,581.82","$3,618.00",$0.00,$707.77,$0.00,$719.98,$0.00
71934997,SUP,HCPCS C1713,,71934997  -  NAIL 10MM 46CM RIGHT FAN IM 25D ROSE DH,"$4,522.50",$0.00,"$4,522.50","$2,035.13","$3,227.71",$0.00,$779.20,$0.00,$0.00,$791.85,"$4,522.50",$0.00,"$2,261.25","$3,581.82","$3,618.00",$0.00,$707.77,$0.00,$719.98,$0.00
71934998,SUP,HCPCS C1713,,71934998  -  NAIL 11.5MM 32CM LEFT FAN IM 25D LIME DH,"$4,522.50",$0.00,"$4,522.50","$2,035.13","$3,227.71",$0.00,$779.20,$0.00,$0.00,$791.85,"$4,522.50",$0.00,"$2,261.25","$3,581.82","$3,618.00",$0.00,$707.77,$0.00,$719.98,$0.00
71934999,SUP,HCPCS C1713,,71934999  -  NAIL 11.5MM 34CM LEFT FAN IM 25D LIME DH,"$4,522.50",$0.00,"$4,522.50","$2,035.13","$3,227.71",$0.00,$779.20,$0.00,$0.00,$791.85,"$4,522.50",$0.00,"$2,261.25","$3,581.82","$3,618.00",$0.00,$707.77,$0.00,$719.98,$0.00
71935001,SUP,HCPCS C1713,,71935001  -  NAIL 11.5MM 34CM RIGHT FAN IM 25D ROSE DH,"$4,522.50",$0.00,"$4,522.50","$2,035.13","$3,227.71",$0.00,$779.20,$0.00,$0.00,$791.85,"$4,522.50",$0.00,"$2,261.25","$3,581.82","$3,618.00",$0.00,$707.77,$0.00,$719.98,$0.00
71935002,SUP,HCPCS C1713,,71935002  -  NAIL 13MM 32CM LEFT FAN IM 25D LIME DH,"$4,522.50",$0.00,"$4,522.50","$2,035.13","$3,227.71",$0.00,$779.20,$0.00,$0.00,$791.85,"$4,522.50",$0.00,"$2,261.25","$3,581.82","$3,618.00",$0.00,$707.77,$0.00,$719.98,$0.00
71935003,SUP,HCPCS C1713,,71935003  -  NAIL 13MM 34CM LEFT FAN IM 25D LIME DH,"$4,522.50",$0.00,"$4,522.50","$2,035.13","$3,227.71",$0.00,$779.20,$0.00,$0.00,$791.85,"$4,522.50",$0.00,"$2,261.25","$3,581.82","$3,618.00",$0.00,$707.77,$0.00,$719.98,$0.00
71935004,SUP,HCPCS C1713,,71935004  -  NAIL 13MM 32CM RIGHT FAN IM 25D ROSE DH,"$4,522.50",$0.00,"$4,522.50","$2,035.13","$3,227.71",$0.00,$779.20,$0.00,$0.00,$791.85,"$4,522.50",$0.00,"$2,261.25","$3,581.82","$3,618.00",$0.00,$707.77,$0.00,$719.98,$0.00
71935005,SUP,HCPCS C1713,,71935005  -  NAIL 13MM 34CM RIGHT FAN IM 25D ROSE DH,"$4,522.50",$0.00,"$4,522.50","$2,035.13","$3,227.71",$0.00,$779.20,$0.00,$0.00,$791.85,"$4,522.50",$0.00,"$2,261.25","$3,581.82","$3,618.00",$0.00,$707.77,$0.00,$719.98,$0.00
72200634,SUP,Custom 27203010,,72200634  -  PAD PSTN 9IN 1.5IN 11IN SUPN POST HIP PERINEUM DISP,$208.70,$0.00,$208.70,$0.00,$148.95,$0.00,$0.00,$0.00,$0.00,$0.00,$208.70,$0.00,$104.35,$165.29,$166.96,$0.00,$0.00,$0.00,$0.00,$0.00
72202468,SUP,HCPCS C1713,,72202468  -  DEVICE FX 360D CRV FSTFX 2 ANCH PRETIE 2-0 5MM SUT MNSCL,"$1,163.90",$0.00,"$1,163.90",$523.76,$830.68,$0.00,$200.53,$0.00,$0.00,$203.79,"$1,163.90",$0.00,$581.95,$921.81,$931.12,$0.00,$182.15,$0.00,$185.29,$0.00
72400024,SUP,HCPCS C1815,,72400024  -  IMPL URO A800 CONTINENCE URN CNTRL SYS INHBZN 61-70 CMW URN,"$5,000.00",$0.00,"$5,000.00","$2,250.00","$3,568.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$0.00,$0.00,$796.00,$0.00
72400025,SUP,HCPCS C1815,,72400025  -  IMPLANT UROLOGICAL 71-80CU CM PRESSURE BALLOON AMS 800,"$5,867.50",$0.00,"$5,867.50","$2,640.38","$4,187.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,867.50",$0.00,"$2,933.75","$4,647.06","$4,694.00",$0.00,$0.00,$0.00,$934.11,$0.00
72402006,SUP,HCPCS C1713,,72402006  -  SCREW BN T6 2MM 3MM 6MM STRL SLFRET SCRDRVR ST FLT HD CORT,$73.50,$0.00,$73.50,$33.08,$52.46,$0.00,$12.66,$0.00,$0.00,$12.87,$73.50,$0.00,$36.75,$58.21,$58.80,$0.00,$11.50,$0.00,$11.70,$0.00
72402007,SUP,HCPCS C1713,,72402007  -  SCREW BN T6 2MM 3MM 7MM STRL SLFRET SCRDRVR ST FLT HD CORT,$73.50,$0.00,$73.50,$33.08,$52.46,$0.00,$12.66,$0.00,$0.00,$12.87,$73.50,$0.00,$36.75,$58.21,$58.80,$0.00,$11.50,$0.00,$11.70,$0.00
72402008,SUP,HCPCS C1713,,72402008  -  SCREW BN T6 2MM 8MM STRL EVOS ST SLFRET DRV SS SM BN LNG BN,$73.50,$0.00,$73.50,$33.08,$52.46,$0.00,$12.66,$0.00,$0.00,$12.87,$73.50,$0.00,$36.75,$58.21,$58.80,$0.00,$11.50,$0.00,$11.70,$0.00
72402009,SUP,HCPCS C1713,,72402009  -  SCREW BN T6 2MM 3MM 9MM STRL SLFRET SCRDRVR ST FLT HD CORT,$73.50,$0.00,$73.50,$33.08,$52.46,$0.00,$12.66,$0.00,$0.00,$12.87,$73.50,$0.00,$36.75,$58.21,$58.80,$0.00,$11.50,$0.00,$11.70,$0.00
72402010,SUP,HCPCS C1713,,72402010  -  SCREW BN T6 2MM 3MM 10MM STRL SLFRET SCRDRVR ST FLT HD CORT,$73.50,$0.00,$73.50,$33.08,$52.46,$0.00,$12.66,$0.00,$0.00,$12.87,$73.50,$0.00,$36.75,$58.21,$58.80,$0.00,$11.50,$0.00,$11.70,$0.00
72402011,SUP,HCPCS C1713,,72402011  -  SCREW BN T6 2MM 3MM 11MM EVOS ST CORT MN PLT SYS,$73.50,$0.00,$73.50,$33.08,$52.46,$0.00,$12.66,$0.00,$0.00,$12.87,$73.50,$0.00,$36.75,$58.21,$58.80,$0.00,$11.50,$0.00,$11.70,$0.00
72402012,SUP,HCPCS C1713,,72402012  -  SCREW BN T6 2MM 3MM 12MM STRL SLFRET SCRDRVR ST FLT HD CORT,$73.50,$0.00,$73.50,$33.08,$52.46,$0.00,$12.66,$0.00,$0.00,$12.87,$73.50,$0.00,$36.75,$58.21,$58.80,$0.00,$11.50,$0.00,$11.70,$0.00
72402013,SUP,HCPCS C1713,,72402013  -  SCREW BN T6 2MM 3MM 13MM EVOS ST CORT MN PLT SYS,$73.50,$0.00,$73.50,$33.08,$52.46,$0.00,$12.66,$0.00,$0.00,$12.87,$73.50,$0.00,$36.75,$58.21,$58.80,$0.00,$11.50,$0.00,$11.70,$0.00
72402014,SUP,HCPCS C1713,,72402014  -  SCREW BN T6 2MM 3MM 14MM STRL SLFRET SCRDRVR ST FLT HD CORT,$73.50,$0.00,$73.50,$33.08,$52.46,$0.00,$12.66,$0.00,$0.00,$12.87,$73.50,$0.00,$36.75,$58.21,$58.80,$0.00,$11.50,$0.00,$11.70,$0.00
72402015,SUP,HCPCS C1713,,72402015  -  SCREW BN T6 2MM 3MM 15MM STRL EVOS MN ST CORT,$73.50,$0.00,$73.50,$33.08,$52.46,$0.00,$12.66,$0.00,$0.00,$12.87,$73.50,$0.00,$36.75,$58.21,$58.80,$0.00,$11.50,$0.00,$11.70,$0.00
72402016,SUP,HCPCS C1713,,72402016  -  SCREW BN T6 2MM 3MM 16MM STRL SLFRET SCRDRVR ST FLT HD CORT,$73.50,$0.00,$73.50,$33.08,$52.46,$0.00,$12.66,$0.00,$0.00,$12.87,$73.50,$0.00,$36.75,$58.21,$58.80,$0.00,$11.50,$0.00,$11.70,$0.00
72402017,SUP,HCPCS C1713,,72402017  -  SCREW BN T6 2MM 3MM 17MM STRL SLFRET SCRDRVR ST FLT HD CORT,$73.50,$0.00,$73.50,$33.08,$52.46,$0.00,$12.66,$0.00,$0.00,$12.87,$73.50,$0.00,$36.75,$58.21,$58.80,$0.00,$11.50,$0.00,$11.70,$0.00
72402018,SUP,HCPCS C1713,,72402018  -  SCREW BN T6 2MM 3MM 18MM EVOS ST CORT MN PLT SYS,$73.50,$0.00,$73.50,$33.08,$52.46,$0.00,$12.66,$0.00,$0.00,$12.87,$73.50,$0.00,$36.75,$58.21,$58.80,$0.00,$11.50,$0.00,$11.70,$0.00
72402019,SUP,HCPCS C1713,,72402019  -  SCREW BN T6 2MM 3MM 19MM STRL SLFRET SCRDRVR ST FLT HD CORT,$73.50,$0.00,$73.50,$33.08,$52.46,$0.00,$12.66,$0.00,$0.00,$12.87,$73.50,$0.00,$36.75,$58.21,$58.80,$0.00,$11.50,$0.00,$11.70,$0.00
72402020,SUP,HCPCS C1713,,72402020  -  SCREW BN T6 2MM 3MM 20MM EVOS ST CORT MN PLT SYS,$73.50,$0.00,$73.50,$33.08,$52.46,$0.00,$12.66,$0.00,$0.00,$12.87,$73.50,$0.00,$36.75,$58.21,$58.80,$0.00,$11.50,$0.00,$11.70,$0.00
72402021,SUP,HCPCS C1713,,72402021  -  SCREW BN T6 2MM 3MM 21MM STRL SLFRET SCRDRVR ST FLT HD CORT,$73.50,$0.00,$73.50,$33.08,$52.46,$0.00,$12.66,$0.00,$0.00,$12.87,$73.50,$0.00,$36.75,$58.21,$58.80,$0.00,$11.50,$0.00,$11.70,$0.00
72402022,SUP,HCPCS C1713,,72402022  -  SCREW BN T6 2MM 3MM 22MM STRL SLFRET SCRDRVR ST FLT HD CORT,$73.50,$0.00,$73.50,$33.08,$52.46,$0.00,$12.66,$0.00,$0.00,$12.87,$73.50,$0.00,$36.75,$58.21,$58.80,$0.00,$11.50,$0.00,$11.70,$0.00
72402023,SUP,HCPCS C1713,,72402023  -  SCREW BN T6 2MM 3MM 23MM STRL SLFRET SCRDRVR ST FLT HD CORT,$73.50,$0.00,$73.50,$33.08,$52.46,$0.00,$12.66,$0.00,$0.00,$12.87,$73.50,$0.00,$36.75,$58.21,$58.80,$0.00,$11.50,$0.00,$11.70,$0.00
72402024,SUP,HCPCS C1713,,72402024  -  SCREW BN T6 2MM 3MM 24MM STRL SLFRET SCRDRVR ST FLT HD CORT,$73.50,$0.00,$73.50,$33.08,$52.46,$0.00,$12.66,$0.00,$0.00,$12.87,$73.50,$0.00,$36.75,$58.21,$58.80,$0.00,$11.50,$0.00,$11.70,$0.00
72402026,SUP,HCPCS C1713,,72402026  -  SCREW BN T6 2MM 3MM 26MM STRL EVOS MN ST DRVR LNG BN SM BN,$73.50,$0.00,$73.50,$33.08,$52.46,$0.00,$12.66,$0.00,$0.00,$12.87,$73.50,$0.00,$36.75,$58.21,$58.80,$0.00,$11.50,$0.00,$11.70,$0.00
72402028,SUP,HCPCS C1713,,72402028  -  SCREW BN T6 2MM 3MM 28MM STRL SLFRET SCRDRVR ST FLT HD CORT,$73.50,$0.00,$73.50,$33.08,$52.46,$0.00,$12.66,$0.00,$0.00,$12.87,$73.50,$0.00,$36.75,$58.21,$58.80,$0.00,$11.50,$0.00,$11.70,$0.00
72402030,SUP,HCPCS C1713,,72402030  -  SCREW BN T6 2MM 3MM 30MM STRL SLFRET SCRDRVR ST FLT HD CORT,$73.50,$0.00,$73.50,$33.08,$52.46,$0.00,$12.66,$0.00,$0.00,$12.87,$73.50,$0.00,$36.75,$58.21,$58.80,$0.00,$11.50,$0.00,$11.70,$0.00
72402032,SUP,HCPCS C1713,,72402032  -  SCREW BN T6 2MM 3MM 32MM STRL SLFRET SCRDRVR ST FLT HD CORT,$73.50,$0.00,$73.50,$33.08,$52.46,$0.00,$12.66,$0.00,$0.00,$12.87,$73.50,$0.00,$36.75,$58.21,$58.80,$0.00,$11.50,$0.00,$11.70,$0.00
72402034,SUP,HCPCS C1713,,72402034  -  SCREW BN T6 2MM 3MM 34MM STRL SLFRET SCRDRVR ST FLT HD CORT,$73.50,$0.00,$73.50,$33.08,$52.46,$0.00,$12.66,$0.00,$0.00,$12.87,$73.50,$0.00,$36.75,$58.21,$58.80,$0.00,$11.50,$0.00,$11.70,$0.00
72402036,SUP,HCPCS C1713,,72402036  -  SCREW BN T6 2MM 3MM 36MM STRL SLFRET SCRDRVR ST FLT HD CORT,$73.50,$0.00,$73.50,$33.08,$52.46,$0.00,$12.66,$0.00,$0.00,$12.87,$73.50,$0.00,$36.75,$58.21,$58.80,$0.00,$11.50,$0.00,$11.70,$0.00
72402038,SUP,HCPCS C1713,,72402038  -  SCREW BN T6 2MM 3MM 38MM STRL SLFRET SCRDRVR ST FLT HD CORT,$73.50,$0.00,$73.50,$33.08,$52.46,$0.00,$12.66,$0.00,$0.00,$12.87,$73.50,$0.00,$36.75,$58.21,$58.80,$0.00,$11.50,$0.00,$11.70,$0.00
72402040,SUP,HCPCS C1713,,72402040  -  SCREW BN T6 2MM 3MM 40MM STRL SLFRET SCRDRVR ST FLT HD CORT,$73.50,$0.00,$73.50,$33.08,$52.46,$0.00,$12.66,$0.00,$0.00,$12.87,$73.50,$0.00,$36.75,$58.21,$58.80,$0.00,$11.50,$0.00,$11.70,$0.00
72402406,SUP,HCPCS C1713,,72402406  -  SCREW BN 3.5MM T7 2.4MM 3.8MM 6MM STRL SLFRET SCRDRVR ST FLT,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
72402407,SUP,HCPCS C1713,,72402407  -  SCREW BN T7 2.4MM 7MM STRL EVOS MN SS CORT,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
72402408,SUP,HCPCS C1713,,72402408  -  SCREW BN 3.5MM T7 2.4MM 3.8MM 8MM STRL SLFRET SCRDRVR ST FLT,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
72402409,SUP,HCPCS C1713,,72402409  -  SCREW BN 3.5MM T7 2.4MM 3.8MM 9MM STRL SLFRET SCRDRVR ST FLT,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
72402410,SUP,HCPCS C1713,,72402410  -  SCREW BN 3.5MM T7 2.4MM 3.8MM 10MM STRL SLFRET SCRDRVR ST,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
72402411,SUP,HCPCS C1713,,72402411  -  SCREW BN T7 2.4MM 3.8MM 11MM STRL EVOS MN ST DRVR LNG BN SM,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
72402412,SUP,HCPCS C1713,,72402412  -  SCREW BN T7 2.4MM 3.8MM 12MM STRL EVOS MN ST DRVR LNG BN SM,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
72402413,SUP,HCPCS C1713,,72402413  -  SCREW BN T7 2.4MM 3.8MM 13MM STRL EVOS MN ST CORT,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
72402414,SUP,HCPCS C1713,,72402414  -  SCREW BN T7 2.4MM 14MM EVOS ST SLFRET DRV SS SM BN LNG BN,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
72402415,SUP,HCPCS C1713,,72402415  -  SCREW BN 3.5MM T7 2.4MM 3.8MM 15MM STRL SLFRET SCRDRVR ST,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
72402416,SUP,HCPCS C1713,,72402416  -  SCREW BN T7 2.4MM 16MM EVOS ST SLFRET DRV SS SM BN LNG BN,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
72402417,SUP,HCPCS C1713,,72402417  -  SCREW BN 3.5MM T7 2.4MM 3.8MM 17MM STRL SLFRET SCRDRVR ST,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
72402418,SUP,HCPCS C1713,,72402418  -  SCREW BN T7 2.4MM 3.8MM 18MM STRL EVOS MN ST DRVR LNG BN SM,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
72402419,SUP,HCPCS C1713,,72402419  -  SCREW BN 3.5MM T7 2.4MM 3.8MM 19MM STRL SLFRET SCRDRVR ST,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
72402420,SUP,HCPCS C1713,,72402420  -  SCREW BN 3.5MM T7 2.4MM 3.8MM 20MM STRL SLFRET SCRDRVR ST,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
72402421,SUP,HCPCS C1713,,72402421  -  SCREW BN T7 2.4MM 21MM STRL EVOS MN ST CORT,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
72402422,SUP,HCPCS C1713,,72402422  -  SCREW BN T7 2.4MM 22MM STRL EVOS MN ST CORT,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
72402423,SUP,HCPCS C1713,,72402423  -  SCREW BN T7 2.4MM 23MM STRL EVOS MN ST CORT,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
72402424,SUP,HCPCS C1713,,72402424  -  SCREW BN T7 2.4MM 24MM STRL EVOS MN ST CORT,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
72402426,SUP,HCPCS C1713,,72402426  -  SCREW BN T7 2.4MM 26MM STRL EVOS MN ST CORT,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
72402430,SUP,HCPCS C1713,,72402430  -  SCREW BN T7 2.4MM 30MM STRL EVOS MN ST CORT,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
72402432,SUP,HCPCS C1713,,72402432  -  SCREW BN T7 2.4MM 32MM STRL EVOS MN ST CORT,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
72402434,SUP,HCPCS C1713,,72402434  -  SCREW BN T7 2.4MM 34MM STRL EVOS MN ST CORT,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
72402436,SUP,HCPCS C1713,,72402436  -  SCREW BN T7 2.4MM 36MM STRL EVOS MN ST CORT,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
72402438,SUP,HCPCS C1713,,72402438  -  SCREW BN T7 2.4MM 38MM STRL EVOS MN ST CORT,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
72402442,SUP,HCPCS C1713,,72402442  -  SCREW BN T7 2.4MM 42MM STRL EVOS MN ST CORT,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
72402444,SUP,HCPCS C1713,,72402444  -  SCREW BN T7 2.4MM 44MM STRL EVOS MN ST CORT,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
72402446,SUP,HCPCS C1713,,72402446  -  SCREW BN T7 2.4MM 46MM STRL EVOS MN ST CORT,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
72402448,SUP,HCPCS C1713,,72402448  -  SCREW BN T7 2.4MM 48MM STRL EVOS MN ST CORT,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
72402455,SUP,HCPCS C1713,,72402455  -  SCREW BN 3.5MM T7 2.4MM 3.8MM 55MM STRL SLFRET SCRDRVR ST,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
72402460,SUP,HCPCS C1713,,72402460  -  SCREW BN 3.5MM T7 2.4MM 3.8MM 60MM STRL SLFRET SCRDRVR ST,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
72402465,SUP,HCPCS C1713,,72402465  -  SCREW BN 3.5MM T7 2.4MM 3.8MM 65MM STRL SLFRET SCRDRVR ST,$106.15,$0.00,$106.15,$47.77,$75.76,$0.00,$18.29,$0.00,$0.00,$18.59,$106.15,$0.00,$53.08,$84.07,$84.92,$0.00,$16.61,$0.00,$16.90,$0.00
72402470,SUP,HCPCS C1713,,72402470  -  SCREW BN 3.5MM T7 2.4MM 3.8MM 70MM STRL SLFRET SCRDRVR ST,$106.15,$0.00,$106.15,$47.77,$75.76,$0.00,$18.29,$0.00,$0.00,$18.59,$106.15,$0.00,$53.08,$84.07,$84.92,$0.00,$16.61,$0.00,$16.90,$0.00
72402475,SUP,HCPCS C1713,,72402475  -  SCREW BN 3.5MM T7 2.4MM 3.8MM 75MM STRL SLFRET SCRDRVR ST,$106.15,$0.00,$106.15,$47.77,$75.76,$0.00,$18.29,$0.00,$0.00,$18.59,$106.15,$0.00,$53.08,$84.07,$84.92,$0.00,$16.61,$0.00,$16.90,$0.00
72402480,SUP,HCPCS C1713,,72402480  -  SCREW BN 3.5MM T7 2.4MM 3.8MM 80MM STRL SLFRET SCRDRVR ST,$106.15,$0.00,$106.15,$47.77,$75.76,$0.00,$18.29,$0.00,$0.00,$18.59,$106.15,$0.00,$53.08,$84.07,$84.92,$0.00,$16.61,$0.00,$16.90,$0.00
72402706,SUP,HCPCS C1713,,72402706  -  SCREW BN T8 2MM 2.7MM 4.5MM 6MM ST CORT EVOS,$81.68,$0.00,$81.68,$36.75,$58.29,$0.00,$14.07,$0.00,$0.00,$14.30,$81.68,$0.00,$40.84,$64.69,$65.34,$0.00,$12.78,$0.00,$13.00,$0.00
72402707,SUP,HCPCS C1713,,72402707  -  SCREW BN T7 2.7MM 4.5MM 7MM STRL SLFRET SCRDRVR ST FLT HD,$81.68,$0.00,$81.68,$36.75,$58.29,$0.00,$14.07,$0.00,$0.00,$14.30,$81.68,$0.00,$40.84,$64.69,$65.34,$0.00,$12.78,$0.00,$13.00,$0.00
72402708,SUP,HCPCS C1713,,72402708  -  SCREW BN T8 2.7MM 4.5MM 8MM EVOS ST CORT MN PLT SYS,$81.68,$0.00,$81.68,$36.75,$58.29,$0.00,$14.07,$0.00,$0.00,$14.30,$81.68,$0.00,$40.84,$64.69,$65.34,$0.00,$12.78,$0.00,$13.00,$0.00
72402709,SUP,HCPCS C1713,,72402709  -  SCREW BN T8 2.7MM 9MM EVOS ST SLFRET DRV SS SM BN LNG BN,$81.68,$0.00,$81.68,$36.75,$58.29,$0.00,$14.07,$0.00,$0.00,$14.30,$81.68,$0.00,$40.84,$64.69,$65.34,$0.00,$12.78,$0.00,$13.00,$0.00
72402710,SUP,HCPCS C1713,,72402710  -  SCREW BN T8 2.7MM 4.5MM 10MM EVOS ST CORT MN PLT SYS,$81.68,$0.00,$81.68,$36.75,$58.29,$0.00,$14.07,$0.00,$0.00,$14.30,$81.68,$0.00,$40.84,$64.69,$65.34,$0.00,$12.78,$0.00,$13.00,$0.00
72402711,SUP,HCPCS C1713,,72402711  -  SCREW BN 2.7MM 4.5MM 11MM EVOS T8 DRVR 2 END DRL GD ST CORT,$81.68,$0.00,$81.68,$36.75,$58.29,$0.00,$14.07,$0.00,$0.00,$14.30,$81.68,$0.00,$40.84,$64.69,$65.34,$0.00,$12.78,$0.00,$13.00,$0.00
72402712,SUP,HCPCS C1713,,72402712  -  SCREW BN T8 2.7MM 12MM STRL EVOS MN SS CORT,$81.68,$0.00,$81.68,$36.75,$58.29,$0.00,$14.07,$0.00,$0.00,$14.30,$81.68,$0.00,$40.84,$64.69,$65.34,$0.00,$12.78,$0.00,$13.00,$0.00
72402713,SUP,HCPCS C1713,,72402713  -  SCREW BN 2.7MM 4.5MM 13MM EVOS T8 DRVR 2 END DRL GD ST CORT,$81.68,$0.00,$81.68,$36.75,$58.29,$0.00,$14.07,$0.00,$0.00,$14.30,$81.68,$0.00,$40.84,$64.69,$65.34,$0.00,$12.78,$0.00,$13.00,$0.00
72402714,SUP,HCPCS C1713,,72402714  -  SCREW BN T7 2.7MM 4.5MM 14MM STRL SLFRET SCRDRVR ST FLT HD,$81.68,$0.00,$81.68,$36.75,$58.29,$0.00,$14.07,$0.00,$0.00,$14.30,$81.68,$0.00,$40.84,$64.69,$65.34,$0.00,$12.78,$0.00,$13.00,$0.00
72402715,SUP,HCPCS C1713,,72402715  -  SCREW BN T7 2.7MM 4.5MM 15MM STRL SLFRET SCRDRVR ST FLT HD,$81.68,$0.00,$81.68,$36.75,$58.29,$0.00,$14.07,$0.00,$0.00,$14.30,$81.68,$0.00,$40.84,$64.69,$65.34,$0.00,$12.78,$0.00,$13.00,$0.00
72402716,SUP,HCPCS C1713,,72402716  -  SCREW BN T8 2.7MM 4.5MM 16MM EVOS ST CORT MN PLT SYS,$81.68,$0.00,$81.68,$36.75,$58.29,$0.00,$14.07,$0.00,$0.00,$14.30,$81.68,$0.00,$40.84,$64.69,$65.34,$0.00,$12.78,$0.00,$13.00,$0.00
72402717,SUP,HCPCS C1713,,72402717  -  SCREW BN T8 2.7MM 4.5MM 17MM NS EVOS ST CORT MN PLT SYS,$81.68,$0.00,$81.68,$36.75,$58.29,$0.00,$14.07,$0.00,$0.00,$14.30,$81.68,$0.00,$40.84,$64.69,$65.34,$0.00,$12.78,$0.00,$13.00,$0.00
72402718,SUP,HCPCS C1713,,72402718  -  SCREW BN T8 2.7MM 4.5MM 18MM NS EVOS ST CORT MN PLT SYS,$81.68,$0.00,$81.68,$36.75,$58.29,$0.00,$14.07,$0.00,$0.00,$14.30,$81.68,$0.00,$40.84,$64.69,$65.34,$0.00,$12.78,$0.00,$13.00,$0.00
72402719,SUP,HCPCS C1713,,72402719  -  SCREW BN T8 2MM 2.7MM 4.5MM 19MM ST CORT EVOS,$81.68,$0.00,$81.68,$36.75,$58.29,$0.00,$14.07,$0.00,$0.00,$14.30,$81.68,$0.00,$40.84,$64.69,$65.34,$0.00,$12.78,$0.00,$13.00,$0.00
72402720,SUP,HCPCS C1713,,72402720  -  SCREW BN T7 2.7MM 4.5MM 20MM STRL SLFRET SCRDRVR ST FLT HD,$81.68,$0.00,$81.68,$36.75,$58.29,$0.00,$14.07,$0.00,$0.00,$14.30,$81.68,$0.00,$40.84,$64.69,$65.34,$0.00,$12.78,$0.00,$13.00,$0.00
72402721,SUP,HCPCS C1713,,72402721  -  SCREW BN T7 2.7MM 4.5MM 21MM STRL SLFRET SCRDRVR ST FLT HD,$81.68,$0.00,$81.68,$36.75,$58.29,$0.00,$14.07,$0.00,$0.00,$14.30,$81.68,$0.00,$40.84,$64.69,$65.34,$0.00,$12.78,$0.00,$13.00,$0.00
72402722,SUP,HCPCS C1713,,72402722  -  SCREW BN T7 2.7MM 4.5MM 22MM STRL SLFRET SCRDRVR ST FLT HD,$81.68,$0.00,$81.68,$36.75,$58.29,$0.00,$14.07,$0.00,$0.00,$14.30,$81.68,$0.00,$40.84,$64.69,$65.34,$0.00,$12.78,$0.00,$13.00,$0.00
72402723,SUP,HCPCS C1713,,72402723  -  SCREW BN T7 2.7MM 4.5MM 23MM STRL SLFRET SCRDRVR ST FLT HD,$81.68,$0.00,$81.68,$36.75,$58.29,$0.00,$14.07,$0.00,$0.00,$14.30,$81.68,$0.00,$40.84,$64.69,$65.34,$0.00,$12.78,$0.00,$13.00,$0.00
72402724,SUP,HCPCS C1713,,72402724  -  SCREW BN T7 2.7MM 4.5MM 24MM STRL SLFRET SCRDRVR ST FLT HD,$81.68,$0.00,$81.68,$36.75,$58.29,$0.00,$14.07,$0.00,$0.00,$14.30,$81.68,$0.00,$40.84,$64.69,$65.34,$0.00,$12.78,$0.00,$13.00,$0.00
72402726,SUP,HCPCS C1713,,72402726  -  SCREW BN T7 2.7MM 4.5MM 26MM STRL SLFRET SCRDRVR ST FLT HD,$81.68,$0.00,$81.68,$36.75,$58.29,$0.00,$14.07,$0.00,$0.00,$14.30,$81.68,$0.00,$40.84,$64.69,$65.34,$0.00,$12.78,$0.00,$13.00,$0.00
72402728,SUP,HCPCS C1713,,72402728  -  SCREW BN T8 2MM 2.7MM 4.5MM 28MM ST CORT EVOS,$81.68,$0.00,$81.68,$36.75,$58.29,$0.00,$14.07,$0.00,$0.00,$14.30,$81.68,$0.00,$40.84,$64.69,$65.34,$0.00,$12.78,$0.00,$13.00,$0.00
72402730,SUP,HCPCS C1713,,72402730  -  SCREW BN T7 2.7MM 4.5MM 30MM STRL SLFRET SCRDRVR ST FLT HD,$81.68,$0.00,$81.68,$36.75,$58.29,$0.00,$14.07,$0.00,$0.00,$14.30,$81.68,$0.00,$40.84,$64.69,$65.34,$0.00,$12.78,$0.00,$13.00,$0.00
72402732,SUP,HCPCS C1713,,72402732  -  SCREW BN T8 2MM 2.7MM 4.5MM 32MM ST CORT EVOS,$81.68,$0.00,$81.68,$36.75,$58.29,$0.00,$14.07,$0.00,$0.00,$14.30,$81.68,$0.00,$40.84,$64.69,$65.34,$0.00,$12.78,$0.00,$13.00,$0.00
72402734,SUP,HCPCS C1713,,72402734  -  SCREW BN T7 2.7MM 4.5MM 34MM STRL SLFRET SCRDRVR ST FLT HD,$81.68,$0.00,$81.68,$36.75,$58.29,$0.00,$14.07,$0.00,$0.00,$14.30,$81.68,$0.00,$40.84,$64.69,$65.34,$0.00,$12.78,$0.00,$13.00,$0.00
72402736,SUP,HCPCS C1713,,72402736  -  SCREW BN T8 2MM 2.7MM 4.5MM 36MM ST CORT EVOS,$81.68,$0.00,$81.68,$36.75,$58.29,$0.00,$14.07,$0.00,$0.00,$14.30,$81.68,$0.00,$40.84,$64.69,$65.34,$0.00,$12.78,$0.00,$13.00,$0.00
72402738,SUP,HCPCS C1713,,72402738  -  SCREW BN T8 2.7MM 4.5MM 38MM STRL EVOS MN ST CORT,$81.68,$0.00,$81.68,$36.75,$58.29,$0.00,$14.07,$0.00,$0.00,$14.30,$81.68,$0.00,$40.84,$64.69,$65.34,$0.00,$12.78,$0.00,$13.00,$0.00
72402740,SUP,HCPCS C1713,,72402740  -  SCREW BN T8 2.7MM 4.5MM 40MM STRL EVOS MN ST DRVR LNG BN SM,$81.68,$0.00,$81.68,$36.75,$58.29,$0.00,$14.07,$0.00,$0.00,$14.30,$81.68,$0.00,$40.84,$64.69,$65.34,$0.00,$12.78,$0.00,$13.00,$0.00
72402742,SUP,HCPCS C1713,,72402742  -  SCREW BN T7 2.7MM 4.5MM 42MM STRL SLFRET SCRDRVR ST FLT HD,$81.68,$0.00,$81.68,$36.75,$58.29,$0.00,$14.07,$0.00,$0.00,$14.30,$81.68,$0.00,$40.84,$64.69,$65.34,$0.00,$12.78,$0.00,$13.00,$0.00
72402744,SUP,HCPCS C1713,,72402744  -  SCREW BN T8 2MM 2.7MM 4.5MM 44MM ST CORT EVOS,$81.68,$0.00,$81.68,$36.75,$58.29,$0.00,$14.07,$0.00,$0.00,$14.30,$81.68,$0.00,$40.84,$64.69,$65.34,$0.00,$12.78,$0.00,$13.00,$0.00
72402746,SUP,HCPCS C1713,,72402746  -  SCREW BN T7 2.7MM 4.5MM 46MM STRL SLFRET SCRDRVR ST FLT HD,$81.68,$0.00,$81.68,$36.75,$58.29,$0.00,$14.07,$0.00,$0.00,$14.30,$81.68,$0.00,$40.84,$64.69,$65.34,$0.00,$12.78,$0.00,$13.00,$0.00
72402748,SUP,HCPCS C1713,,72402748  -  SCREW BN T7 2.7MM 4.5MM 48MM STRL SLFRET SCRDRVR ST FLT HD,$81.68,$0.00,$81.68,$36.75,$58.29,$0.00,$14.07,$0.00,$0.00,$14.30,$81.68,$0.00,$40.84,$64.69,$65.34,$0.00,$12.78,$0.00,$13.00,$0.00
72402750,SUP,HCPCS C1713,,72402750  -  SCREW BN T7 2.7MM 4.5MM 50MM STRL SLFRET SCRDRVR ST FLT HD,$81.68,$0.00,$81.68,$36.75,$58.29,$0.00,$14.07,$0.00,$0.00,$14.30,$81.68,$0.00,$40.84,$64.69,$65.34,$0.00,$12.78,$0.00,$13.00,$0.00
72402755,SUP,HCPCS C1713,,72402755  -  SCREW BN T7 2.7MM 4.5MM 55MM STRL SLFRET SCRDRVR ST FLT HD,$81.68,$0.00,$81.68,$36.75,$58.29,$0.00,$14.07,$0.00,$0.00,$14.30,$81.68,$0.00,$40.84,$64.69,$65.34,$0.00,$12.78,$0.00,$13.00,$0.00
72402760,SUP,HCPCS C1713,,72402760  -  SCREW BN T7 2.7MM 4.5MM 60MM STRL SLFRET SCRDRVR ST FLT HD,$81.68,$0.00,$81.68,$36.75,$58.29,$0.00,$14.07,$0.00,$0.00,$14.30,$81.68,$0.00,$40.84,$64.69,$65.34,$0.00,$12.78,$0.00,$13.00,$0.00
72402765,SUP,HCPCS C1713,,72402765  -  SCREW BN T7 2.7MM 4.5MM 65MM STRL SLFRET SCRDRVR ST FLT HD,$110.28,$0.00,$110.28,$49.62,$78.70,$0.00,$19.00,$0.00,$0.00,$19.31,$110.28,$0.00,$55.14,$87.34,$88.22,$0.00,$17.26,$0.00,$17.56,$0.00
72402770,SUP,HCPCS C1713,,72402770  -  SCREW BN T7 2.7MM 4.5MM 70MM STRL SLFRET SCRDRVR ST FLT HD,$110.28,$0.00,$110.28,$49.62,$78.70,$0.00,$19.00,$0.00,$0.00,$19.31,$110.28,$0.00,$55.14,$87.34,$88.22,$0.00,$17.26,$0.00,$17.56,$0.00
72402775,SUP,HCPCS C1713,,72402775  -  SCREW BN T8 2.7MM 4.5MM 75MM STRL EVOS MN ST DRVR LNG BN SM,$110.28,$0.00,$110.28,$49.62,$78.70,$0.00,$19.00,$0.00,$0.00,$19.31,$110.28,$0.00,$55.14,$87.34,$88.22,$0.00,$17.26,$0.00,$17.56,$0.00
72402780,SUP,HCPCS C1713,,72402780  -  SCREW BN T7 2.7MM 4.5MM 80MM STRL SLFRET SCRDRVR ST FLT HD,$110.28,$0.00,$110.28,$49.62,$78.70,$0.00,$19.00,$0.00,$0.00,$19.31,$110.28,$0.00,$55.14,$87.34,$88.22,$0.00,$17.26,$0.00,$17.56,$0.00
72403513,SUP,HCPCS C1713,,72403513  -  SCREW BN 1.7MM 5MM ST AX STAB LWR PRFL,$58.73,$0.00,$58.73,$26.43,$41.91,$0.00,$10.12,$0.00,$0.00,$10.28,$58.73,$0.00,$29.36,$46.51,$46.98,$0.00,$9.19,$0.00,$9.35,$0.00
72403514,SUP,HCPCS C1713,,72403514  -  SCREW BN 1.7MM 4MM SLF DRL AX STAB LWR PRFL,$58.73,$0.00,$58.73,$26.43,$41.91,$0.00,$10.12,$0.00,$0.00,$10.28,$58.73,$0.00,$29.36,$46.51,$46.98,$0.00,$9.19,$0.00,$9.35,$0.00
72403528,SUP,HCPCS C1713,,72403528  -  SCREW BN 3.5MM 28MM STRL EVOS ST CORT,$58.73,$0.00,$58.73,$26.43,$41.91,$0.00,$10.12,$0.00,$0.00,$10.28,$58.73,$0.00,$29.36,$46.51,$46.98,$0.00,$9.19,$0.00,$9.35,$0.00
72403540,SUP,HCPCS C1713,,72403540  -  SCREW BN 3.5MM 40MM STRL EVOS ST CORT,$58.73,$0.00,$58.73,$26.43,$41.91,$0.00,$10.12,$0.00,$0.00,$10.28,$58.73,$0.00,$29.36,$46.51,$46.98,$0.00,$9.19,$0.00,$9.35,$0.00
72403550,SUP,HCPCS C1713,,72403550  -  SCREW BN 3.5MM 50MM STRL EVOS ST CORT,$58.73,$0.00,$58.73,$26.43,$41.91,$0.00,$10.12,$0.00,$0.00,$10.28,$58.73,$0.00,$29.36,$46.51,$46.98,$0.00,$9.19,$0.00,$9.35,$0.00
72403830,SUP,HCPCS C1771,,72403830  -  SLING PUBOVAGINAL MONARC FMALE,"$3,177.50",$0.00,"$3,177.50","$1,429.88","$2,267.78",$0.00,$547.47,$0.00,$0.00,$556.35,"$3,177.50",$0.00,"$1,588.75","$2,516.58","$2,542.00",$0.00,$497.28,$0.00,$505.86,$0.00
72403867,SUP,HCPCS C1813,,72403867  -  PROS PENL AMS 700 DP PENOSCROTAL,$725.00,$0.00,$725.00,$326.25,$517.43,$0.00,$0.00,$0.00,$0.00,$0.00,$725.00,$0.00,$362.50,$574.20,$580.00,$0.00,$0.00,$0.00,$115.42,$0.00
72404127,SUP,HCPCS C1813,,72404127  -  PROS PENL A800 PMP INHBZN,"$10,500.00",$0.00,"$10,500.00","$4,725.00","$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$10,500.00",$0.00,"$5,250.00","$8,316.00","$8,400.00",$0.00,$0.00,$0.00,"$1,671.60",$0.00
72404131,SUP,HCPCS C1815,,72404131  -  IMPLANT UROLOGICAL 4.5CM CUFF AMS 800 INHIBIZONE SPHINCTER,"$9,010.63",$0.00,"$9,010.63","$4,054.78","$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$9,010.63",$0.00,"$4,505.31","$7,136.42","$7,208.50",$0.00,$0.00,$0.00,"$1,434.49",$0.00
72404132,SUP,HCPCS C1815,,72404132  -  IMPLANT UROLOGICAL 5CM CONTINENCE PUMP AMS 800 INHIBIZONE,"$12,487.50",$0.00,"$12,487.50","$5,619.38","$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$12,487.50",$0.00,"$6,243.75","$9,890.10","$9,990.00",$0.00,$0.00,$0.00,"$1,988.01",$0.00
72404133,SUP,HCPCS C1815,,72404133  -  IMPLANT UROLOGICAL 5.5CM CONTINENCE PUMP AMS 800 INHIBIZONE,"$12,487.50",$0.00,"$12,487.50","$5,619.38","$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$12,487.50",$0.00,"$6,243.75","$9,890.10","$9,990.00",$0.00,$0.00,$0.00,"$1,988.01",$0.00
72404250,SUP,HCPCS C1813,,72404250  -  PROSTHESIS PENILE 12/12MM PRECONNECT PUMP PRECON MS,"$19,557.50",$0.00,"$19,557.50","$8,800.88","$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$19,557.50",$0.00,"$9,778.75","$15,489.54","$15,646.00",$0.00,$0.00,$0.00,"$3,113.55",$0.00
72404256,SUP,HCPCS C1813,,72404256  -  PROSTHESIS PENL AMS 700 LGX MS PMP 15CM 3 PC INFL,"$23,330.00",$0.00,"$23,330.00","$10,498.50","$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$23,330.00",$0.00,"$11,665.00","$18,477.36","$18,664.00",$0.00,$0.00,$0.00,"$3,714.14",$0.00
72404257,SUP,HCPCS C1813,,72404257  -  PROSTHESIS PENILE 18CM INFLATABLE AMS 700 MS PUMP INHIBIZONE,"$21,352.50",$0.00,"$21,352.50","$9,608.63","$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,352.50",$0.00,"$10,676.25","$16,911.18","$17,082.00",$0.00,$0.00,$0.00,"$3,399.32",$0.00
72412006,SUP,HCPCS C1713,,72412006  -  SCREW BN T6 2.7MM 4.5MM 6MM STRL LCK SLFRET SCRDRVR ST FLT,$246.13,$0.00,$246.13,$110.76,$175.66,$0.00,$42.41,$0.00,$0.00,$43.09,$246.13,$0.00,$123.06,$194.93,$196.90,$0.00,$38.52,$0.00,$39.18,$0.00
72412007,SUP,HCPCS C1713,,72412007  -  SCREW BN T6 2MM 3.3MM 7MM STRL LCK SLFRET SCRDRVR ST FLT HD,$246.13,$0.00,$246.13,$110.76,$175.66,$0.00,$42.41,$0.00,$0.00,$43.09,$246.13,$0.00,$123.06,$194.93,$196.90,$0.00,$38.52,$0.00,$39.18,$0.00
72412008,SUP,HCPCS C1713,,72412008  -  SCREW BN T6 2MM 8MM STRL EVOS ST SLFRET DRV SS SM BN LNG BN,$246.13,$0.00,$246.13,$110.76,$175.66,$0.00,$42.41,$0.00,$0.00,$43.09,$246.13,$0.00,$123.06,$194.93,$196.90,$0.00,$38.52,$0.00,$39.18,$0.00
72412009,SUP,HCPCS C1713,,72412009  -  SCREW BN T6 2MM 3.3MM 9MM STRL LCK SLFRET SCRDRVR ST FLT HD,$246.13,$0.00,$246.13,$110.76,$175.66,$0.00,$42.41,$0.00,$0.00,$43.09,$246.13,$0.00,$123.06,$194.93,$196.90,$0.00,$38.52,$0.00,$39.18,$0.00
72412010,SUP,HCPCS C1713,,72412010  -  SCREW BN T6 2MM 3.3MM 10MM STRL EVOS MN LCK DRVR LNG BN SM,$246.13,$0.00,$246.13,$110.76,$175.66,$0.00,$42.41,$0.00,$0.00,$43.09,$246.13,$0.00,$123.06,$194.93,$196.90,$0.00,$38.52,$0.00,$39.18,$0.00
72412011,SUP,HCPCS C1713,,72412011  -  SCREW BN T6 2MM 3.3MM 11MM STRL LCK SLFRET SCRDRVR ST FLT HD,$246.13,$0.00,$246.13,$110.76,$175.66,$0.00,$42.41,$0.00,$0.00,$43.09,$246.13,$0.00,$123.06,$194.93,$196.90,$0.00,$38.52,$0.00,$39.18,$0.00
72412012,SUP,HCPCS C1713,,72412012  -  SCREW BN T6 2MM 3.3MM 12MM STRL EVOS MN LCK SS LNG BN SM BN,$246.13,$0.00,$246.13,$110.76,$175.66,$0.00,$42.41,$0.00,$0.00,$43.09,$246.13,$0.00,$123.06,$194.93,$196.90,$0.00,$38.52,$0.00,$39.18,$0.00
72412013,SUP,HCPCS C1713,,72412013  -  SCREW BN T6 2MM 3.3MM 13MM STRL EVOS MN LCK LNG BN SM BN,$246.13,$0.00,$246.13,$110.76,$175.66,$0.00,$42.41,$0.00,$0.00,$43.09,$246.13,$0.00,$123.06,$194.93,$196.90,$0.00,$38.52,$0.00,$39.18,$0.00
72412014,SUP,HCPCS C1713,,72412014  -  SCREW BN T6 2MM 3.3MM 14MM STRL EVOS MN LCK LNG BN SM BN,$246.13,$0.00,$246.13,$110.76,$175.66,$0.00,$42.41,$0.00,$0.00,$43.09,$246.13,$0.00,$123.06,$194.93,$196.90,$0.00,$38.52,$0.00,$39.18,$0.00
72412015,SUP,HCPCS C1713,,72412015  -  SCREW BN T6 2MM 3.3MM 15MM STRL EVOS MN LCK SS LNG BN SM BN,$246.13,$0.00,$246.13,$110.76,$175.66,$0.00,$42.41,$0.00,$0.00,$43.09,$246.13,$0.00,$123.06,$194.93,$196.90,$0.00,$38.52,$0.00,$39.18,$0.00
72412016,SUP,HCPCS C1713,,72412016  -  SCREW BN T6 2MM 3.3MM 16MM STRL EVOS MN LCK DRVR LNG BN SM,$246.13,$0.00,$246.13,$110.76,$175.66,$0.00,$42.41,$0.00,$0.00,$43.09,$246.13,$0.00,$123.06,$194.93,$196.90,$0.00,$38.52,$0.00,$39.18,$0.00
72412017,SUP,HCPCS C1713,,72412017  -  SCREW BN T6 2MM 3.3MM 17MM STRL EVOS MN LCK SS LNG BN SM BN,$246.13,$0.00,$246.13,$110.76,$175.66,$0.00,$42.41,$0.00,$0.00,$43.09,$246.13,$0.00,$123.06,$194.93,$196.90,$0.00,$38.52,$0.00,$39.18,$0.00
72412018,SUP,HCPCS C1713,,72412018  -  SCREW BN T6 2MM 3.3MM 18MM STRL EVOS MN LCK DRVR LNG BN SM,$246.13,$0.00,$246.13,$110.76,$175.66,$0.00,$42.41,$0.00,$0.00,$43.09,$246.13,$0.00,$123.06,$194.93,$196.90,$0.00,$38.52,$0.00,$39.18,$0.00
72412019,SUP,HCPCS C1713,,72412019  -  SCREW BN T6 2MM 3.3MM 19MM STRL EVOS MN LCK SS LNG BN SM BN,$246.13,$0.00,$246.13,$110.76,$175.66,$0.00,$42.41,$0.00,$0.00,$43.09,$246.13,$0.00,$123.06,$194.93,$196.90,$0.00,$38.52,$0.00,$39.18,$0.00
72412020,SUP,HCPCS C1713,,72412020  -  SCREW BN T6 2MM 3.3MM 20MM STRL EVOS MN LCK SS LNG BN SM BN,$246.13,$0.00,$246.13,$110.76,$175.66,$0.00,$42.41,$0.00,$0.00,$43.09,$246.13,$0.00,$123.06,$194.93,$196.90,$0.00,$38.52,$0.00,$39.18,$0.00
72412021,SUP,HCPCS C1713,,72412021  -  SCREW BN T6 2MM 3.3MM 21MM STRL EVOS MN LCK SS LNG BN SM BN,$246.13,$0.00,$246.13,$110.76,$175.66,$0.00,$42.41,$0.00,$0.00,$43.09,$246.13,$0.00,$123.06,$194.93,$196.90,$0.00,$38.52,$0.00,$39.18,$0.00
72412022,SUP,HCPCS C1713,,72412022  -  SCREW BN T6 2MM 3.3MM 22MM STRL EVOS MN LCK SS LNG BN SM BN,$246.13,$0.00,$246.13,$110.76,$175.66,$0.00,$42.41,$0.00,$0.00,$43.09,$246.13,$0.00,$123.06,$194.93,$196.90,$0.00,$38.52,$0.00,$39.18,$0.00
72412023,SUP,HCPCS C1713,,72412023  -  SCREW BN T6 2MM 3.3MM 23MM STRL EVOS MN LCK SS LNG BN SM BN,$246.13,$0.00,$246.13,$110.76,$175.66,$0.00,$42.41,$0.00,$0.00,$43.09,$246.13,$0.00,$123.06,$194.93,$196.90,$0.00,$38.52,$0.00,$39.18,$0.00
72412024,SUP,HCPCS C1713,,72412024  -  SCREW BN T6 2MM 3.3MM 24MM STRL EVOS MN LCK SS LNG BN SM BN,$246.13,$0.00,$246.13,$110.76,$175.66,$0.00,$42.41,$0.00,$0.00,$43.09,$246.13,$0.00,$123.06,$194.93,$196.90,$0.00,$38.52,$0.00,$39.18,$0.00
72412026,SUP,HCPCS C1713,,72412026  -  SCREW BN T6 2MM 3.3MM 26MM STRL EVOS MN LCK SS LNG BN SM BN,$246.13,$0.00,$246.13,$110.76,$175.66,$0.00,$42.41,$0.00,$0.00,$43.09,$246.13,$0.00,$123.06,$194.93,$196.90,$0.00,$38.52,$0.00,$39.18,$0.00
72412028,SUP,HCPCS C1713,,72412028  -  SCREW BN T6 2MM 3.3MM 28MM STRL EVOS MN LCK SS LNG BN SM BN,$246.13,$0.00,$246.13,$110.76,$175.66,$0.00,$42.41,$0.00,$0.00,$43.09,$246.13,$0.00,$123.06,$194.93,$196.90,$0.00,$38.52,$0.00,$39.18,$0.00
72412030,SUP,HCPCS C1713,,72412030  -  SCREW BN T6 2MM 3.3MM 30MM STRL EVOS MN LCK SS LNG BN SM BN,$246.13,$0.00,$246.13,$110.76,$175.66,$0.00,$42.41,$0.00,$0.00,$43.09,$246.13,$0.00,$123.06,$194.93,$196.90,$0.00,$38.52,$0.00,$39.18,$0.00
72412032,SUP,HCPCS C1713,,72412032  -  SCREW BN T6 2MM 3.3MM 32MM STRL EVOS MN LCK SS LNG BN SM BN,$246.13,$0.00,$246.13,$110.76,$175.66,$0.00,$42.41,$0.00,$0.00,$43.09,$246.13,$0.00,$123.06,$194.93,$196.90,$0.00,$38.52,$0.00,$39.18,$0.00
72412034,SUP,HCPCS C1713,,72412034  -  SCREW BN T6 2MM 3.3MM 34MM STRL EVOS MN LCK SS LNG BN SM BN,$246.13,$0.00,$246.13,$110.76,$175.66,$0.00,$42.41,$0.00,$0.00,$43.09,$246.13,$0.00,$123.06,$194.93,$196.90,$0.00,$38.52,$0.00,$39.18,$0.00
72412036,SUP,HCPCS C1713,,72412036  -  SCREW BN T6 2MM 3.3MM 36MM STRL EVOS MN LCK SS LNG BN SM BN,$246.13,$0.00,$246.13,$110.76,$175.66,$0.00,$42.41,$0.00,$0.00,$43.09,$246.13,$0.00,$123.06,$194.93,$196.90,$0.00,$38.52,$0.00,$39.18,$0.00
72412038,SUP,HCPCS C1713,,72412038  -  SCREW BN T6 2MM 3.3MM 38MM STRL EVOS MN LCK SS LNG BN SM BN,$246.13,$0.00,$246.13,$110.76,$175.66,$0.00,$42.41,$0.00,$0.00,$43.09,$246.13,$0.00,$123.06,$194.93,$196.90,$0.00,$38.52,$0.00,$39.18,$0.00
72412040,SUP,HCPCS C1713,,72412040  -  SCREW BN T6 2MM 3.3MM 40MM STRL EVOS MN LCK SS LNG BN SM BN,$246.13,$0.00,$246.13,$110.76,$175.66,$0.00,$42.41,$0.00,$0.00,$43.09,$246.13,$0.00,$123.06,$194.93,$196.90,$0.00,$38.52,$0.00,$39.18,$0.00
72412406,SUP,HCPCS C1713,,72412406  -  SCREW BN T7 2.4MM 3.8MM 6MM STRL EVOS MN LCK SS LNG BN SM BN,$251.63,$0.00,$251.63,$113.23,$179.58,$0.00,$43.35,$0.00,$0.00,$44.06,$251.63,$0.00,$125.81,$199.29,$201.30,$0.00,$39.38,$0.00,$40.06,$0.00
72412407,SUP,HCPCS C1713,,72412407  -  SCREW BN T7 2.4MM 3.8MM 7MM STRL EVOS MN LCK SS LNG BN SM BN,$251.63,$0.00,$251.63,$113.23,$179.58,$0.00,$43.35,$0.00,$0.00,$44.06,$251.63,$0.00,$125.81,$199.29,$201.30,$0.00,$39.38,$0.00,$40.06,$0.00
72412408,SUP,HCPCS C1713,,72412408  -  SCREW BN T7 2.4MM 3.8MM 8MM STRL EVOS LCK SM BN LNG BN MN,$251.63,$0.00,$251.63,$113.23,$179.58,$0.00,$43.35,$0.00,$0.00,$44.06,$251.63,$0.00,$125.81,$199.29,$201.30,$0.00,$39.38,$0.00,$40.06,$0.00
72412409,SUP,HCPCS C1713,,72412409  -  SCREW BN T7 2.4MM 3.8MM 9MM STRL EVOS MN LCK SS LNG BN SM BN,$251.63,$0.00,$251.63,$113.23,$179.58,$0.00,$43.35,$0.00,$0.00,$44.06,$251.63,$0.00,$125.81,$199.29,$201.30,$0.00,$39.38,$0.00,$40.06,$0.00
72412410,SUP,HCPCS C1713,,72412410  -  SCREW BN T7 2.4MM 3.8MM 10MM STRL EVOS MN LCK SS LNG BN SM,$251.63,$0.00,$251.63,$113.23,$179.58,$0.00,$43.35,$0.00,$0.00,$44.06,$251.63,$0.00,$125.81,$199.29,$201.30,$0.00,$39.38,$0.00,$40.06,$0.00
72412411,SUP,HCPCS C1713,,72412411  -  SCREW BN T7 2.4MM 3.8MM 11MM STRL EVOS MN LCK SS LNG BN SM,$251.63,$0.00,$251.63,$113.23,$179.58,$0.00,$43.35,$0.00,$0.00,$44.06,$251.63,$0.00,$125.81,$199.29,$201.30,$0.00,$39.38,$0.00,$40.06,$0.00
72412412,SUP,HCPCS C1713,,72412412  -  SCREW BN T7 2.4MM 3.8MM 12MM STRL EVOS MN LCK LNG BN SM BN,$251.63,$0.00,$251.63,$113.23,$179.58,$0.00,$43.35,$0.00,$0.00,$44.06,$251.63,$0.00,$125.81,$199.29,$201.30,$0.00,$39.38,$0.00,$40.06,$0.00
72412413,SUP,HCPCS C1713,,72412413  -  SCREW BN T7 2.4MM 3.8MM 13MM STRL EVOS MN LCK DRVR LNG BN SM,$251.63,$0.00,$251.63,$113.23,$179.58,$0.00,$43.35,$0.00,$0.00,$44.06,$251.63,$0.00,$125.81,$199.29,$201.30,$0.00,$39.38,$0.00,$40.06,$0.00
72412414,SUP,HCPCS C1713,,72412414  -  SCREW BN T7 2.4MM 3.8MM 14MM STRL EVOS MN LCK SS LNG BN SM,$251.63,$0.00,$251.63,$113.23,$179.58,$0.00,$43.35,$0.00,$0.00,$44.06,$251.63,$0.00,$125.81,$199.29,$201.30,$0.00,$39.38,$0.00,$40.06,$0.00
72412415,SUP,HCPCS C1713,,72412415  -  SCREW BN T7 2.4MM 3.8MM 15MM STRL EVOS MN LCK SS LNG BN SM,$251.63,$0.00,$251.63,$113.23,$179.58,$0.00,$43.35,$0.00,$0.00,$44.06,$251.63,$0.00,$125.81,$199.29,$201.30,$0.00,$39.38,$0.00,$40.06,$0.00
72412416,SUP,HCPCS C1713,,72412416  -  SCREW BN T7 2.4MM 3.8MM 16MM STRL EVOS MN LCK LNG BN SM BN,$251.63,$0.00,$251.63,$113.23,$179.58,$0.00,$43.35,$0.00,$0.00,$44.06,$251.63,$0.00,$125.81,$199.29,$201.30,$0.00,$39.38,$0.00,$40.06,$0.00
72412417,SUP,HCPCS C1713,,72412417  -  SCREW BN T7 2.4MM 3.8MM 17MM STRL EVOS MN LCK SS LNG BN SM,$251.63,$0.00,$251.63,$113.23,$179.58,$0.00,$43.35,$0.00,$0.00,$44.06,$251.63,$0.00,$125.81,$199.29,$201.30,$0.00,$39.38,$0.00,$40.06,$0.00
72412418,SUP,HCPCS C1713,,72412418  -  SCREW BN T7 2.4MM 3.8MM 18MM STRL EVOS MN LCK DRVR LNG BN SM,$251.63,$0.00,$251.63,$113.23,$179.58,$0.00,$43.35,$0.00,$0.00,$44.06,$251.63,$0.00,$125.81,$199.29,$201.30,$0.00,$39.38,$0.00,$40.06,$0.00
72412419,SUP,HCPCS C1713,,72412419  -  SCREW BN T7 2.4MM 3.8MM 19MM STRL EVOS MN LCK SS LNG BN SM,$251.63,$0.00,$251.63,$113.23,$179.58,$0.00,$43.35,$0.00,$0.00,$44.06,$251.63,$0.00,$125.81,$199.29,$201.30,$0.00,$39.38,$0.00,$40.06,$0.00
72412420,SUP,HCPCS C1713,,72412420  -  SCREW BN T7 2.4MM 3.8MM 20MM STRL EVOS LCK SM BN LNG BN MN,$251.63,$0.00,$251.63,$113.23,$179.58,$0.00,$43.35,$0.00,$0.00,$44.06,$251.63,$0.00,$125.81,$199.29,$201.30,$0.00,$39.38,$0.00,$40.06,$0.00
72412421,SUP,HCPCS C1713,,72412421  -  SCREW BN T7 2.4MM 3.8MM 21MM STRL EVOS MN LCK SS LNG BN SM,$251.63,$0.00,$251.63,$113.23,$179.58,$0.00,$43.35,$0.00,$0.00,$44.06,$251.63,$0.00,$125.81,$199.29,$201.30,$0.00,$39.38,$0.00,$40.06,$0.00
72412422,SUP,HCPCS C1713,,72412422  -  SCREW BN T7 2.4MM 3.8MM 22MM STRL EVOS MN LCK SS LNG BN SM,$251.63,$0.00,$251.63,$113.23,$179.58,$0.00,$43.35,$0.00,$0.00,$44.06,$251.63,$0.00,$125.81,$199.29,$201.30,$0.00,$39.38,$0.00,$40.06,$0.00
72412423,SUP,HCPCS C1713,,72412423  -  SCREW BN T7 2.4MM 3.8MM 23MM STRL EVOS MN LCK SS LNG BN SM,$251.63,$0.00,$251.63,$113.23,$179.58,$0.00,$43.35,$0.00,$0.00,$44.06,$251.63,$0.00,$125.81,$199.29,$201.30,$0.00,$39.38,$0.00,$40.06,$0.00
72412424,SUP,HCPCS C1713,,72412424  -  SCREW BN T7 2.4MM 3.8MM 24MM STRL EVOS MN LCK SS LNG BN SM,$251.63,$0.00,$251.63,$113.23,$179.58,$0.00,$43.35,$0.00,$0.00,$44.06,$251.63,$0.00,$125.81,$199.29,$201.30,$0.00,$39.38,$0.00,$40.06,$0.00
72412426,SUP,HCPCS C1713,,72412426  -  SCREW BN T7 2.4MM 3.8MM 26MM STRL EVOS MN LCK SS LNG BN SM,$251.63,$0.00,$251.63,$113.23,$179.58,$0.00,$43.35,$0.00,$0.00,$44.06,$251.63,$0.00,$125.81,$199.29,$201.30,$0.00,$39.38,$0.00,$40.06,$0.00
72412428,SUP,HCPCS C1713,,72412428  -  SCREW BN T7 2.4MM 3.8MM 28MM STRL EVOS MN LCK SS LNG BN SM,$251.63,$0.00,$251.63,$113.23,$179.58,$0.00,$43.35,$0.00,$0.00,$44.06,$251.63,$0.00,$125.81,$199.29,$201.30,$0.00,$39.38,$0.00,$40.06,$0.00
72412430,SUP,HCPCS C1713,,72412430  -  SCREW BN T7 2.4MM 3.8MM 30MM STRL EVOS MN LCK SS LNG BN SM,$251.63,$0.00,$251.63,$113.23,$179.58,$0.00,$43.35,$0.00,$0.00,$44.06,$251.63,$0.00,$125.81,$199.29,$201.30,$0.00,$39.38,$0.00,$40.06,$0.00
72412432,SUP,HCPCS C1713,,72412432  -  SCREW BN T7 2.4MM 3.8MM 32MM STRL EVOS MN LCK SS LNG BN SM,$251.63,$0.00,$251.63,$113.23,$179.58,$0.00,$43.35,$0.00,$0.00,$44.06,$251.63,$0.00,$125.81,$199.29,$201.30,$0.00,$39.38,$0.00,$40.06,$0.00
72412434,SUP,HCPCS C1713,,72412434  -  SCREW BN T7 2.4MM 3.8MM 34MM STRL EVOS MN LCK SS LNG BN SM,$251.63,$0.00,$251.63,$113.23,$179.58,$0.00,$43.35,$0.00,$0.00,$44.06,$251.63,$0.00,$125.81,$199.29,$201.30,$0.00,$39.38,$0.00,$40.06,$0.00
72412436,SUP,HCPCS C1713,,72412436  -  SCREW BN T7 2.4MM 3.8MM 36MM STRL EVOS MN LCK LNG BN SM BN,$251.63,$0.00,$251.63,$113.23,$179.58,$0.00,$43.35,$0.00,$0.00,$44.06,$251.63,$0.00,$125.81,$199.29,$201.30,$0.00,$39.38,$0.00,$40.06,$0.00
72412438,SUP,HCPCS C1713,,72412438  -  SCREW BN T7 2.4MM 3.8MM 38MM STRL EVOS MN LCK LNG BN SM BN,$251.63,$0.00,$251.63,$113.23,$179.58,$0.00,$43.35,$0.00,$0.00,$44.06,$251.63,$0.00,$125.81,$199.29,$201.30,$0.00,$39.38,$0.00,$40.06,$0.00
72412440,SUP,HCPCS C1713,,72412440  -  SCREW BN T7 2.4MM 3.8MM 40MM STRL EVOS MN LCK LNG BN SM BN,$251.63,$0.00,$251.63,$113.23,$179.58,$0.00,$43.35,$0.00,$0.00,$44.06,$251.63,$0.00,$125.81,$199.29,$201.30,$0.00,$39.38,$0.00,$40.06,$0.00
72412442,SUP,HCPCS C1713,,72412442  -  SCREW BN T7 2.4MM 3.8MM 42MM STRL EVOS MN LCK LNG BN SM BN,$251.63,$0.00,$251.63,$113.23,$179.58,$0.00,$43.35,$0.00,$0.00,$44.06,$251.63,$0.00,$125.81,$199.29,$201.30,$0.00,$39.38,$0.00,$40.06,$0.00
72412444,SUP,HCPCS C1713,,72412444  -  SCREW BN T7 2.4MM 3.8MM 44MM STRL EVOS MN LCK LNG BN SM BN,$251.63,$0.00,$251.63,$113.23,$179.58,$0.00,$43.35,$0.00,$0.00,$44.06,$251.63,$0.00,$125.81,$199.29,$201.30,$0.00,$39.38,$0.00,$40.06,$0.00
72412446,SUP,HCPCS C1713,,72412446  -  SCREW BN T7 2.4MM 3.8MM 46MM STRL EVOS MN LCK LNG BN SM BN,$251.63,$0.00,$251.63,$113.23,$179.58,$0.00,$43.35,$0.00,$0.00,$44.06,$251.63,$0.00,$125.81,$199.29,$201.30,$0.00,$39.38,$0.00,$40.06,$0.00
72412448,SUP,HCPCS C1713,,72412448  -  SCREW BN T7 2.4MM 3.8MM 48MM STRL EVOS MN LCK LNG BN SM BN,$251.63,$0.00,$251.63,$113.23,$179.58,$0.00,$43.35,$0.00,$0.00,$44.06,$251.63,$0.00,$125.81,$199.29,$201.30,$0.00,$39.38,$0.00,$40.06,$0.00
72412450,SUP,HCPCS C1713,,72412450  -  SCREW BN T7 2.4MM 3.8MM 50MM STRL EVOS MN LCK LNG BN SM BN,$251.63,$0.00,$251.63,$113.23,$179.58,$0.00,$43.35,$0.00,$0.00,$44.06,$251.63,$0.00,$125.81,$199.29,$201.30,$0.00,$39.38,$0.00,$40.06,$0.00
72412455,SUP,HCPCS C1713,,72412455  -  SCREW BN T7 2.4MM 3.8MM 55MM STRL EVOS MN LCK LNG BN SM BN,$251.63,$0.00,$251.63,$113.23,$179.58,$0.00,$43.35,$0.00,$0.00,$44.06,$251.63,$0.00,$125.81,$199.29,$201.30,$0.00,$39.38,$0.00,$40.06,$0.00
72412460,SUP,HCPCS C1713,,72412460  -  SCREW BN T7 2.4MM 3.8MM 60MM STRL EVOS MN LCK LNG BN SM BN,$251.63,$0.00,$251.63,$113.23,$179.58,$0.00,$43.35,$0.00,$0.00,$44.06,$251.63,$0.00,$125.81,$199.29,$201.30,$0.00,$39.38,$0.00,$40.06,$0.00
72412465,SUP,HCPCS C1713,,72412465  -  SCREW BN T7 2.4MM 3.8MM 65MM STRL EVOS MN LCK LNG BN SM BN,$279.13,$0.00,$279.13,$125.61,$199.21,$0.00,$48.09,$0.00,$0.00,$48.87,$279.13,$0.00,$139.56,$221.07,$223.30,$0.00,$43.68,$0.00,$44.44,$0.00
72412470,SUP,HCPCS C1713,,72412470  -  SCREW BN T7 2.4MM 3.8MM 70MM STRL EVOS MN LCK LNG BN SM BN,$279.13,$0.00,$279.13,$125.61,$199.21,$0.00,$48.09,$0.00,$0.00,$48.87,$279.13,$0.00,$139.56,$221.07,$223.30,$0.00,$43.68,$0.00,$44.44,$0.00
72412475,SUP,HCPCS C1713,,72412475  -  SCREW BN T7 2.4MM 3.8MM 75MM STRL EVOS MN LCK LNG BN SM BN,$279.13,$0.00,$279.13,$125.61,$199.21,$0.00,$48.09,$0.00,$0.00,$48.87,$279.13,$0.00,$139.56,$221.07,$223.30,$0.00,$43.68,$0.00,$44.44,$0.00
72412480,SUP,HCPCS C1713,,72412480  -  SCREW BN T7 2.4MM 3.8MM 80MM STRL EVOS MN LCK LNG BN SM BN,$279.13,$0.00,$279.13,$125.61,$199.21,$0.00,$48.09,$0.00,$0.00,$48.87,$279.13,$0.00,$139.56,$221.07,$223.30,$0.00,$43.68,$0.00,$44.44,$0.00
72412706,SUP,HCPCS C1713,,72412706  -  SCREW BN T8 2.7MM 4.5MM 6MM STRL EVOS MN ST SS CORT,$254.38,$0.00,$254.38,$114.47,$181.55,$0.00,$43.83,$0.00,$0.00,$44.54,$254.38,$0.00,$127.19,$201.47,$203.50,$0.00,$39.81,$0.00,$40.50,$0.00
72412707,SUP,HCPCS C1713,,72412707  -  SCREW BN T8 2.7MM 4.5MM 7MM STRL EVOS MN ST SS CORT,$254.38,$0.00,$254.38,$114.47,$181.55,$0.00,$43.83,$0.00,$0.00,$44.54,$254.38,$0.00,$127.19,$201.47,$203.50,$0.00,$39.81,$0.00,$40.50,$0.00
72412708,SUP,HCPCS C1713,,72412708  -  SCREW BN T8 2.7MM 4.3MM 8MM STRL EVOS LCK SM BN LNG BN MN,$254.38,$0.00,$254.38,$114.47,$181.55,$0.00,$43.83,$0.00,$0.00,$44.54,$254.38,$0.00,$127.19,$201.47,$203.50,$0.00,$39.81,$0.00,$40.50,$0.00
72412709,SUP,HCPCS C1713,,72412709  -  SCREW BN T8 2.7MM 4.5MM 9MM STRL EVOS MN ST SS CORT,$254.38,$0.00,$254.38,$114.47,$181.55,$0.00,$43.83,$0.00,$0.00,$44.54,$254.38,$0.00,$127.19,$201.47,$203.50,$0.00,$39.81,$0.00,$40.50,$0.00
72412710,SUP,HCPCS C1713,,72412710  -  SCREW BN T8 2.7MM 4.5MM 10MM STRL EVOS MN ST SS CORT,$254.38,$0.00,$254.38,$114.47,$181.55,$0.00,$43.83,$0.00,$0.00,$44.54,$254.38,$0.00,$127.19,$201.47,$203.50,$0.00,$39.81,$0.00,$40.50,$0.00
72412711,SUP,HCPCS C1713,,72412711  -  SCREW BN T8 2.7MM 4.5MM 11MM STRL EVOS MN ST SS CORT,$254.38,$0.00,$254.38,$114.47,$181.55,$0.00,$43.83,$0.00,$0.00,$44.54,$254.38,$0.00,$127.19,$201.47,$203.50,$0.00,$39.81,$0.00,$40.50,$0.00
72412712,SUP,HCPCS C1713,,72412712  -  SCREW BN T8 2.7MM 4.5MM 12MM STRL EVOS MN ST SS CORT,$254.38,$0.00,$254.38,$114.47,$181.55,$0.00,$43.83,$0.00,$0.00,$44.54,$254.38,$0.00,$127.19,$201.47,$203.50,$0.00,$39.81,$0.00,$40.50,$0.00
72412713,SUP,HCPCS C1713,,72412713  -  SCREW BN T8 2.7MM 4.5MM 13MM STRL EVOS MN ST SS CORT,$254.38,$0.00,$254.38,$114.47,$181.55,$0.00,$43.83,$0.00,$0.00,$44.54,$254.38,$0.00,$127.19,$201.47,$203.50,$0.00,$39.81,$0.00,$40.50,$0.00
72412714,SUP,HCPCS C1713,,72412714  -  SCREW BN T8 2MM 2.7MM 4.3MM 14MM ST LCK SM BN LNG BN EVOS,$254.38,$0.00,$254.38,$114.47,$181.55,$0.00,$43.83,$0.00,$0.00,$44.54,$254.38,$0.00,$127.19,$201.47,$203.50,$0.00,$39.81,$0.00,$40.50,$0.00
72412715,SUP,HCPCS C1713,,72412715  -  SCREW BN T8 2.7MM 4.5MM 15MM STRL EVOS MN ST SS CORT,$254.38,$0.00,$254.38,$114.47,$181.55,$0.00,$43.83,$0.00,$0.00,$44.54,$254.38,$0.00,$127.19,$201.47,$203.50,$0.00,$39.81,$0.00,$40.50,$0.00
72412716,SUP,HCPCS C1713,,72412716  -  SCREW BN T8 2MM 2.7MM 4.3MM 16MM ST LCK EVOS,$254.38,$0.00,$254.38,$114.47,$181.55,$0.00,$43.83,$0.00,$0.00,$44.54,$254.38,$0.00,$127.19,$201.47,$203.50,$0.00,$39.81,$0.00,$40.50,$0.00
72412717,SUP,HCPCS C1713,,72412717  -  SCREW BN T8 2.7MM 4.5MM 17MM STRL EVOS MN ST SS CORT,$254.38,$0.00,$254.38,$114.47,$181.55,$0.00,$43.83,$0.00,$0.00,$44.54,$254.38,$0.00,$127.19,$201.47,$203.50,$0.00,$39.81,$0.00,$40.50,$0.00
72412718,SUP,HCPCS C1713,,72412718  -  SCREW BN T8 2MM 2.7MM 4.3MM 18MM ST LCK SM BN LNG BN EVOS,$254.38,$0.00,$254.38,$114.47,$181.55,$0.00,$43.83,$0.00,$0.00,$44.54,$254.38,$0.00,$127.19,$201.47,$203.50,$0.00,$39.81,$0.00,$40.50,$0.00
72412719,SUP,HCPCS C1713,,72412719  -  SCREW BN T8 2.7MM 4.5MM 19MM STRL EVOS MN ST SS CORT,$254.38,$0.00,$254.38,$114.47,$181.55,$0.00,$43.83,$0.00,$0.00,$44.54,$254.38,$0.00,$127.19,$201.47,$203.50,$0.00,$39.81,$0.00,$40.50,$0.00
72412720,SUP,HCPCS C1713,,72412720  -  SCREW BN T8 2.7MM 4.5MM 20MM STRL EVOS MN ST SS CORT,$254.38,$0.00,$254.38,$114.47,$181.55,$0.00,$43.83,$0.00,$0.00,$44.54,$254.38,$0.00,$127.19,$201.47,$203.50,$0.00,$39.81,$0.00,$40.50,$0.00
72412721,SUP,HCPCS C1713,,72412721  -  SCREW BN T8 2.7MM 4.5MM 21MM STRL EVOS MN ST SS CORT,$254.38,$0.00,$254.38,$114.47,$181.55,$0.00,$43.83,$0.00,$0.00,$44.54,$254.38,$0.00,$127.19,$201.47,$203.50,$0.00,$39.81,$0.00,$40.50,$0.00
72412722,SUP,HCPCS C1713,,72412722  -  SCREW BN T8 2.7MM 4.5MM 22MM STRL EVOS MN ST SS CORT,$254.38,$0.00,$254.38,$114.47,$181.55,$0.00,$43.83,$0.00,$0.00,$44.54,$254.38,$0.00,$127.19,$201.47,$203.50,$0.00,$39.81,$0.00,$40.50,$0.00
72412723,SUP,HCPCS C1713,,72412723  -  SCREW BN T8 2.7MM 4.5MM 23MM STRL EVOS MN ST SS CORT,$254.38,$0.00,$254.38,$114.47,$181.55,$0.00,$43.83,$0.00,$0.00,$44.54,$254.38,$0.00,$127.19,$201.47,$203.50,$0.00,$39.81,$0.00,$40.50,$0.00
72412724,SUP,HCPCS C1713,,72412724  -  SCREW BN T8 2MM 2.7MM 4.3MM 24MM ST LCK EVOS,$254.38,$0.00,$254.38,$114.47,$181.55,$0.00,$43.83,$0.00,$0.00,$44.54,$254.38,$0.00,$127.19,$201.47,$203.50,$0.00,$39.81,$0.00,$40.50,$0.00
72412726,SUP,HCPCS C1713,,72412726  -  SCREW BN T8 2.7MM 4.3MM 26MM LCK SLF RTN FLT HD SS LNG BN SM,$254.38,$0.00,$254.38,$114.47,$181.55,$0.00,$43.83,$0.00,$0.00,$44.54,$254.38,$0.00,$127.19,$201.47,$203.50,$0.00,$39.81,$0.00,$40.50,$0.00
72412728,SUP,HCPCS C1713,,72412728  -  SCREW BN T8 2.7MM 4.3MM 28MM LCK SLF RTN FLT HD SS LNG BN SM,$254.38,$0.00,$254.38,$114.47,$181.55,$0.00,$43.83,$0.00,$0.00,$44.54,$254.38,$0.00,$127.19,$201.47,$203.50,$0.00,$39.81,$0.00,$40.50,$0.00
72412730,SUP,HCPCS C1713,,72412730  -  SCREW BN T8 2.7MM 4.3MM 30MM LCK SLF RTN FLT HD SS LNG BN SM,$254.38,$0.00,$254.38,$114.47,$181.55,$0.00,$43.83,$0.00,$0.00,$44.54,$254.38,$0.00,$127.19,$201.47,$203.50,$0.00,$39.81,$0.00,$40.50,$0.00
72412732,SUP,HCPCS C1713,,72412732  -  SCREW BN T8 2.7MM 4.3MM 32MM LCK SLF RTN FLT HD SS LNG BN SM,$254.38,$0.00,$254.38,$114.47,$181.55,$0.00,$43.83,$0.00,$0.00,$44.54,$254.38,$0.00,$127.19,$201.47,$203.50,$0.00,$39.81,$0.00,$40.50,$0.00
72412734,SUP,HCPCS C1713,,72412734  -  SCREW BN T8 2.7MM 4.3MM 34MM LCK SLF RTN FLT HD SS LNG BN SM,$254.38,$0.00,$254.38,$114.47,$181.55,$0.00,$43.83,$0.00,$0.00,$44.54,$254.38,$0.00,$127.19,$201.47,$203.50,$0.00,$39.81,$0.00,$40.50,$0.00
72412736,SUP,HCPCS C1713,,72412736  -  SCREW BN T8 2.7MM 4.3MM 36MM LCK SLF RTN FLT HD SS LNG BN SM,$254.38,$0.00,$254.38,$114.47,$181.55,$0.00,$43.83,$0.00,$0.00,$44.54,$254.38,$0.00,$127.19,$201.47,$203.50,$0.00,$39.81,$0.00,$40.50,$0.00
72412738,SUP,HCPCS C1713,,72412738  -  SCREW BN T8 2.7MM 4.3MM 38MM LCK SLF RTN FLT HD SS LNG BN SM,$254.38,$0.00,$254.38,$114.47,$181.55,$0.00,$43.83,$0.00,$0.00,$44.54,$254.38,$0.00,$127.19,$201.47,$203.50,$0.00,$39.81,$0.00,$40.50,$0.00
72412740,SUP,HCPCS C1713,,72412740  -  SCREW BN T8 2.7MM 4.3MM 40MM LCK SLF RTN FLT HD SS LNG BN SM,$254.38,$0.00,$254.38,$114.47,$181.55,$0.00,$43.83,$0.00,$0.00,$44.54,$254.38,$0.00,$127.19,$201.47,$203.50,$0.00,$39.81,$0.00,$40.50,$0.00
72412742,SUP,HCPCS C1713,,72412742  -  SCREW BN T8 2.7MM 4.3MM 42MM LCK SLF RTN FLT HD SS LNG BN SM,$254.38,$0.00,$254.38,$114.47,$181.55,$0.00,$43.83,$0.00,$0.00,$44.54,$254.38,$0.00,$127.19,$201.47,$203.50,$0.00,$39.81,$0.00,$40.50,$0.00
72412744,SUP,HCPCS C1713,,72412744  -  SCREW BN T8 2.7MM 4.3MM 44MM LCK SLF RTN FLT HD SS LNG BN SM,$254.38,$0.00,$254.38,$114.47,$181.55,$0.00,$43.83,$0.00,$0.00,$44.54,$254.38,$0.00,$127.19,$201.47,$203.50,$0.00,$39.81,$0.00,$40.50,$0.00
72412746,SUP,HCPCS C1713,,72412746  -  SCREW BN T8 2.7MM 4.3MM 46MM LCK SLF RTN FLT HD SS LNG BN SM,$254.38,$0.00,$254.38,$114.47,$181.55,$0.00,$43.83,$0.00,$0.00,$44.54,$254.38,$0.00,$127.19,$201.47,$203.50,$0.00,$39.81,$0.00,$40.50,$0.00
72412748,SUP,HCPCS C1713,,72412748  -  SCREW BN T8 2.7MM 4.3MM 48MM LCK SLF RTN FLT HD SS LNG BN SM,$254.38,$0.00,$254.38,$114.47,$181.55,$0.00,$43.83,$0.00,$0.00,$44.54,$254.38,$0.00,$127.19,$201.47,$203.50,$0.00,$39.81,$0.00,$40.50,$0.00
72412750,SUP,HCPCS C1713,,72412750  -  SCREW BN T8 2.7MM 4.3MM 50MM LCK SLF RTN FLT HD SS LNG BN SM,$254.38,$0.00,$254.38,$114.47,$181.55,$0.00,$43.83,$0.00,$0.00,$44.54,$254.38,$0.00,$127.19,$201.47,$203.50,$0.00,$39.81,$0.00,$40.50,$0.00
72412755,SUP,HCPCS C1713,,72412755  -  SCREW BN T8 2.7MM 4.3MM 55MM LCK SLF RTN FLT HD SS LNG BN SM,$254.38,$0.00,$254.38,$114.47,$181.55,$0.00,$43.83,$0.00,$0.00,$44.54,$254.38,$0.00,$127.19,$201.47,$203.50,$0.00,$39.81,$0.00,$40.50,$0.00
72412760,SUP,HCPCS C1713,,72412760  -  SCREW BN T8 2.7MM 4.5MM 60MM STRL EVOS MN ST SS CORT,$254.38,$0.00,$254.38,$114.47,$181.55,$0.00,$43.83,$0.00,$0.00,$44.54,$254.38,$0.00,$127.19,$201.47,$203.50,$0.00,$39.81,$0.00,$40.50,$0.00
72412765,SUP,HCPCS C1713,,72412765  -  SCREW BN T8 2.7MM 4.5MM 65MM STRL EVOS MN ST SS CORT,$287.38,$0.00,$287.38,$129.32,$205.10,$0.00,$49.51,$0.00,$0.00,$50.32,$287.38,$0.00,$143.69,$227.60,$229.90,$0.00,$44.97,$0.00,$45.75,$0.00
72412770,SUP,HCPCS C1713,,72412770  -  SCREW BN T8 2.7MM 4.5MM 70MM STRL EVOS MN ST SS CORT,$287.38,$0.00,$287.38,$129.32,$205.10,$0.00,$49.51,$0.00,$0.00,$50.32,$287.38,$0.00,$143.69,$227.60,$229.90,$0.00,$44.97,$0.00,$45.75,$0.00
72412775,SUP,HCPCS C1713,,72412775  -  SCREW BN T8 2.7MM 4.5MM 75MM STRL EVOS MN ST SS CORT,$287.38,$0.00,$287.38,$129.32,$205.10,$0.00,$49.51,$0.00,$0.00,$50.32,$287.38,$0.00,$143.69,$227.60,$229.90,$0.00,$44.97,$0.00,$45.75,$0.00
72412780,SUP,HCPCS C1713,,72412780  -  SCREW BN T8 2.7MM 4.5MM 80MM STRL EVOS MN ST SS CORT,$287.38,$0.00,$287.38,$129.32,$205.10,$0.00,$49.51,$0.00,$0.00,$50.32,$287.38,$0.00,$143.69,$227.60,$229.90,$0.00,$44.97,$0.00,$45.75,$0.00
72413565,SUP,HCPCS C1713,,72413565  -  SCREW BN 3.5MM 65MM STRL EVOS ST LCK,$305.25,$0.00,$305.25,$137.36,$217.86,$0.00,$52.59,$0.00,$0.00,$53.45,$305.25,$0.00,$152.63,$241.76,$244.20,$0.00,$47.77,$0.00,$48.60,$0.00
72413570,SUP,HCPCS C1713,,72413570  -  SCREW BN 3.5MM 70MM STRL EVOS ST LCK,$305.25,$0.00,$305.25,$137.36,$217.86,$0.00,$52.59,$0.00,$0.00,$53.45,$305.25,$0.00,$152.63,$241.76,$244.20,$0.00,$47.77,$0.00,$48.60,$0.00
72423010,SUP,HCPCS C1713,,72423010  -  SCREW BN T7 3MM 3.8MM 10MM STRL EVOS MN SS LNG BN SM BN,$156.75,$0.00,$156.75,$70.54,$111.87,$0.00,$27.01,$0.00,$0.00,$27.45,$156.75,$0.00,$78.38,$124.15,$125.40,$0.00,$24.53,$0.00,$24.95,$0.00
72423012,SUP,HCPCS C1713,,72423012  -  SCREW BN T7 3MM 3.8MM 12MM STRL EVOS MN SS LNG BN SM BN,$156.75,$0.00,$156.75,$70.54,$111.87,$0.00,$27.01,$0.00,$0.00,$27.45,$156.75,$0.00,$78.38,$124.15,$125.40,$0.00,$24.53,$0.00,$24.95,$0.00
72423014,SUP,HCPCS C1713,,72423014  -  SCREW BN T7 3MM 3.8MM 14MM STRL EVOS MN SS LNG BN SM BN,$156.75,$0.00,$156.75,$70.54,$111.87,$0.00,$27.01,$0.00,$0.00,$27.45,$156.75,$0.00,$78.38,$124.15,$125.40,$0.00,$24.53,$0.00,$24.95,$0.00
72423016,SUP,HCPCS C1713,,72423016  -  SCREW BN T7 3MM 3.8MM 16MM STRL EVOS MN SS LNG BN SM BN,$156.75,$0.00,$156.75,$70.54,$111.87,$0.00,$27.01,$0.00,$0.00,$27.45,$156.75,$0.00,$78.38,$124.15,$125.40,$0.00,$24.53,$0.00,$24.95,$0.00
72423018,SUP,HCPCS C1713,,72423018  -  SCREW BN T7 3MM 3.8MM 18MM STRL EVOS MN SS LNG BN SM BN,$156.75,$0.00,$156.75,$70.54,$111.87,$0.00,$27.01,$0.00,$0.00,$27.45,$156.75,$0.00,$78.38,$124.15,$125.40,$0.00,$24.53,$0.00,$24.95,$0.00
72423020,SUP,HCPCS C1713,,72423020  -  SCREW BN T7 3MM 3.8MM 20MM STRL EVOS MN SS LNG BN SM BN,$156.75,$0.00,$156.75,$70.54,$111.87,$0.00,$27.01,$0.00,$0.00,$27.45,$156.75,$0.00,$78.38,$124.15,$125.40,$0.00,$24.53,$0.00,$24.95,$0.00
72423022,SUP,HCPCS C1713,,72423022  -  SCREW BN T7 3MM 3.8MM 22MM STRL EVOS MN SS LNG BN SM BN,$156.75,$0.00,$156.75,$70.54,$111.87,$0.00,$27.01,$0.00,$0.00,$27.45,$156.75,$0.00,$78.38,$124.15,$125.40,$0.00,$24.53,$0.00,$24.95,$0.00
72423024,SUP,HCPCS C1713,,72423024  -  SCREW BN T7 3MM 3.8MM 24MM STRL EVOS MN SS LNG BN SM BN,$156.75,$0.00,$156.75,$70.54,$111.87,$0.00,$27.01,$0.00,$0.00,$27.45,$156.75,$0.00,$78.38,$124.15,$125.40,$0.00,$24.53,$0.00,$24.95,$0.00
72423026,SUP,HCPCS C1713,,72423026  -  SCREW BN T7 3MM 3.8MM 26MM STRL EVOS MN SS LNG BN SM BN,$156.75,$0.00,$156.75,$70.54,$111.87,$0.00,$27.01,$0.00,$0.00,$27.45,$156.75,$0.00,$78.38,$124.15,$125.40,$0.00,$24.53,$0.00,$24.95,$0.00
72423028,SUP,HCPCS C1713,,72423028  -  SCREW BN T7 3MM 3.8MM 28MM STRL EVOS MN SS LNG BN SM BN,$156.75,$0.00,$156.75,$70.54,$111.87,$0.00,$27.01,$0.00,$0.00,$27.45,$156.75,$0.00,$78.38,$124.15,$125.40,$0.00,$24.53,$0.00,$24.95,$0.00
72423030,SUP,HCPCS C1713,,72423030  -  SCREW BN T7 3MM 3.8MM 30MM STRL EVOS MN SS LNG BN SM BN,$156.75,$0.00,$156.75,$70.54,$111.87,$0.00,$27.01,$0.00,$0.00,$27.45,$156.75,$0.00,$78.38,$124.15,$125.40,$0.00,$24.53,$0.00,$24.95,$0.00
72423032,SUP,HCPCS C1713,,72423032  -  SCREW BN T7 3MM 3.8MM 32MM STRL EVOS MN SS LNG BN SM BN,$156.75,$0.00,$156.75,$70.54,$111.87,$0.00,$27.01,$0.00,$0.00,$27.45,$156.75,$0.00,$78.38,$124.15,$125.40,$0.00,$24.53,$0.00,$24.95,$0.00
72423034,SUP,HCPCS C1713,,72423034  -  SCREW BN T7 3MM 3.8MM 34MM STRL EVOS MN SS LNG BN SM BN,$156.75,$0.00,$156.75,$70.54,$111.87,$0.00,$27.01,$0.00,$0.00,$27.45,$156.75,$0.00,$78.38,$124.15,$125.40,$0.00,$24.53,$0.00,$24.95,$0.00
72423036,SUP,HCPCS C1713,,72423036  -  SCREW BN T7 3MM 3.8MM 36MM STRL EVOS MN SS LNG BN SM BN,$156.75,$0.00,$156.75,$70.54,$111.87,$0.00,$27.01,$0.00,$0.00,$27.45,$156.75,$0.00,$78.38,$124.15,$125.40,$0.00,$24.53,$0.00,$24.95,$0.00
72423038,SUP,HCPCS C1713,,72423038  -  SCREW BN T7 3MM 3.8MM 38MM STRL EVOS MN SS LNG BN SM BN,$156.75,$0.00,$156.75,$70.54,$111.87,$0.00,$27.01,$0.00,$0.00,$27.45,$156.75,$0.00,$78.38,$124.15,$125.40,$0.00,$24.53,$0.00,$24.95,$0.00
72423040,SUP,HCPCS C1713,,72423040  -  SCREW BN T7 3MM 3.8MM 40MM STRL EVOS MN SS LNG BN SM BN,$156.75,$0.00,$156.75,$70.54,$111.87,$0.00,$27.01,$0.00,$0.00,$27.45,$156.75,$0.00,$78.38,$124.15,$125.40,$0.00,$24.53,$0.00,$24.95,$0.00
72423042,SUP,HCPCS C1713,,72423042  -  SCREW BN T7 3MM 3.8MM 42MM STRL EVOS MN SS LNG BN SM BN,$156.75,$0.00,$156.75,$70.54,$111.87,$0.00,$27.01,$0.00,$0.00,$27.45,$156.75,$0.00,$78.38,$124.15,$125.40,$0.00,$24.53,$0.00,$24.95,$0.00
72423044,SUP,HCPCS C1713,,72423044  -  SCREW BN T7 3MM 3.8MM 44MM STRL EVOS MN SS LNG BN SM BN,$156.75,$0.00,$156.75,$70.54,$111.87,$0.00,$27.01,$0.00,$0.00,$27.45,$156.75,$0.00,$78.38,$124.15,$125.40,$0.00,$24.53,$0.00,$24.95,$0.00
72423046,SUP,HCPCS C1713,,72423046  -  SCREW BN T7 3MM 3.8MM 46MM STRL EVOS MN SS LNG BN SM BN,$156.75,$0.00,$156.75,$70.54,$111.87,$0.00,$27.01,$0.00,$0.00,$27.45,$156.75,$0.00,$78.38,$124.15,$125.40,$0.00,$24.53,$0.00,$24.95,$0.00
72423048,SUP,HCPCS C1713,,72423048  -  SCREW BN T7 3MM 3.8MM 48MM STRL EVOS MN SS LNG BN SM BN,$156.75,$0.00,$156.75,$70.54,$111.87,$0.00,$27.01,$0.00,$0.00,$27.45,$156.75,$0.00,$78.38,$124.15,$125.40,$0.00,$24.53,$0.00,$24.95,$0.00
72423050,SUP,HCPCS C1713,,72423050  -  SCREW BN T7 3MM 3.8MM 50MM STRL EVOS MN SS LNG BN SM BN,$156.75,$0.00,$156.75,$70.54,$111.87,$0.00,$27.01,$0.00,$0.00,$27.45,$156.75,$0.00,$78.38,$124.15,$125.40,$0.00,$24.53,$0.00,$24.95,$0.00
72423055,SUP,HCPCS C1713,,72423055  -  SCREW BN T7 3MM 3.8MM 55MM STRL EVOS MN SS LNG BN SM BN,$156.75,$0.00,$156.75,$70.54,$111.87,$0.00,$27.01,$0.00,$0.00,$27.45,$156.75,$0.00,$78.38,$124.15,$125.40,$0.00,$24.53,$0.00,$24.95,$0.00
72423060,SUP,HCPCS C1713,,72423060  -  SCREW BN T7 3MM 3.8MM 60MM STRL EVOS MN SS LNG BN SM BN,$156.75,$0.00,$156.75,$70.54,$111.87,$0.00,$27.01,$0.00,$0.00,$27.45,$156.75,$0.00,$78.38,$124.15,$125.40,$0.00,$24.53,$0.00,$24.95,$0.00
72423065,SUP,HCPCS C1713,,72423065  -  SCREW BN T7 3MM 3.8MM 65MM STRL EVOS MN SS LNG BN SM BN,$188.38,$0.00,$188.38,$84.77,$134.44,$0.00,$32.46,$0.00,$0.00,$32.98,$188.38,$0.00,$94.19,$149.20,$150.70,$0.00,$29.48,$0.00,$29.99,$0.00
72423070,SUP,HCPCS C1713,,72423070  -  SCREW BN T7 3MM 3.8MM 70MM STRL EVOS MN SS LNG BN SM BN,$188.38,$0.00,$188.38,$84.77,$134.44,$0.00,$32.46,$0.00,$0.00,$32.98,$188.38,$0.00,$94.19,$149.20,$150.70,$0.00,$29.48,$0.00,$29.99,$0.00
72423075,SUP,HCPCS C1713,,72423075  -  SCREW BN T7 3MM 3.8MM 75MM STRL EVOS MN SS LNG BN SM BN,$188.38,$0.00,$188.38,$84.77,$134.44,$0.00,$32.46,$0.00,$0.00,$32.98,$188.38,$0.00,$94.19,$149.20,$150.70,$0.00,$29.48,$0.00,$29.99,$0.00
72423080,SUP,HCPCS C1713,,72423080  -  SCREW BN T7 3MM 3.8MM 80MM STRL EVOS MN SS LNG BN SM BN,$188.38,$0.00,$188.38,$84.77,$134.44,$0.00,$32.46,$0.00,$0.00,$32.98,$188.38,$0.00,$94.19,$149.20,$150.70,$0.00,$29.48,$0.00,$29.99,$0.00
72424010,SUP,HCPCS C1713,,72424010  -  SCREW BN T8 FT 4MM 4.5MM 10MM SLFRET SCRDRVR TAP EVOS MN,$188.38,$0.00,$188.38,$84.77,$134.44,$0.00,$32.46,$0.00,$0.00,$32.98,$188.38,$0.00,$94.19,$149.20,$150.70,$0.00,$29.48,$0.00,$29.99,$0.00
72424012,SUP,HCPCS C1713,,72424012  -  SCREW BN T8 FT 4MM 4.5MM 12MM SLFRET SCRDRVR TAP EVOS MN,$188.38,$0.00,$188.38,$84.77,$134.44,$0.00,$32.46,$0.00,$0.00,$32.98,$188.38,$0.00,$94.19,$149.20,$150.70,$0.00,$29.48,$0.00,$29.99,$0.00
72424014,SUP,HCPCS C1713,,72424014  -  SCREW BN T8 FT 4MM 4.5MM 14MM SLFRET SCRDRVR TAP EVOS MN,$188.38,$0.00,$188.38,$84.77,$134.44,$0.00,$32.46,$0.00,$0.00,$32.98,$188.38,$0.00,$94.19,$149.20,$150.70,$0.00,$29.48,$0.00,$29.99,$0.00
72424016,SUP,HCPCS C1713,,72424016  -  SCREW BN T8 FT 4MM 4.5MM 16MM SLFRET SCRDRVR EVOS MN,$188.38,$0.00,$188.38,$84.77,$134.44,$0.00,$32.46,$0.00,$0.00,$32.98,$188.38,$0.00,$94.19,$149.20,$150.70,$0.00,$29.48,$0.00,$29.99,$0.00
72424018,SUP,HCPCS C1713,,72424018  -  SCREW BN T8 FT 4MM 4.5MM 18MM SLFRET SCRDRVR EVOS MN,$188.38,$0.00,$188.38,$84.77,$134.44,$0.00,$32.46,$0.00,$0.00,$32.98,$188.38,$0.00,$94.19,$149.20,$150.70,$0.00,$29.48,$0.00,$29.99,$0.00
72424020,SUP,HCPCS C1713,,72424020  -  SCREW BN T8 FT 4MM 4.5MM 20MM SLFRET SCRDRVR EVOS MN,$188.38,$0.00,$188.38,$84.77,$134.44,$0.00,$32.46,$0.00,$0.00,$32.98,$188.38,$0.00,$94.19,$149.20,$150.70,$0.00,$29.48,$0.00,$29.99,$0.00
72424022,SUP,HCPCS C1713,,72424022  -  SCREW BN T8 FT 4MM 4.5MM 22MM SLFRET SCRDRVR TAP EVOS MN,$188.38,$0.00,$188.38,$84.77,$134.44,$0.00,$32.46,$0.00,$0.00,$32.98,$188.38,$0.00,$94.19,$149.20,$150.70,$0.00,$29.48,$0.00,$29.99,$0.00
72424024,SUP,HCPCS C1713,,72424024  -  SCREW BN T8 FT 4MM 4.5MM 24MM SLFRET SCRDRVR TAP EVOS MN,$188.38,$0.00,$188.38,$84.77,$134.44,$0.00,$32.46,$0.00,$0.00,$32.98,$188.38,$0.00,$94.19,$149.20,$150.70,$0.00,$29.48,$0.00,$29.99,$0.00
72424026,SUP,HCPCS C1713,,72424026  -  SCREW BN T8 FT 4MM 4.5MM 10MM SLFRET SCRDRVR TAP EVOS MN,$188.38,$0.00,$188.38,$84.77,$134.44,$0.00,$32.46,$0.00,$0.00,$32.98,$188.38,$0.00,$94.19,$149.20,$150.70,$0.00,$29.48,$0.00,$29.99,$0.00
72424028,SUP,HCPCS C1713,,72424028  -  SCREW BN T8 FT 4MM 4.5MM 10MM SLFRET SCRDRVR TAP EVOS MN,$188.38,$0.00,$188.38,$84.77,$134.44,$0.00,$32.46,$0.00,$0.00,$32.98,$188.38,$0.00,$94.19,$149.20,$150.70,$0.00,$29.48,$0.00,$29.99,$0.00
72424030,SUP,HCPCS C1713,,72424030  -  SCREW BN T8 FT 4MM 4.5MM 30MM STRL EVOS MN VA SLFRET SCRDRVR,$188.38,$0.00,$188.38,$84.77,$134.44,$0.00,$32.46,$0.00,$0.00,$32.98,$188.38,$0.00,$94.19,$149.20,$150.70,$0.00,$29.48,$0.00,$29.99,$0.00
72424032,SUP,HCPCS C1713,,72424032  -  SCREW BN FT T8 4MM 4.5MM 32MM STRL EVOS MN VA SLFRET SCRDRVR,$188.38,$0.00,$188.38,$84.77,$134.44,$0.00,$32.46,$0.00,$0.00,$32.98,$188.38,$0.00,$94.19,$149.20,$150.70,$0.00,$29.48,$0.00,$29.99,$0.00
72424034,SUP,HCPCS C1713,,72424034  -  SCREW BN FT T8 4MM 4.5MM 34MM STRL EVOS MN VA SLFRET SCRDRVR,$188.38,$0.00,$188.38,$84.77,$134.44,$0.00,$32.46,$0.00,$0.00,$32.98,$188.38,$0.00,$94.19,$149.20,$150.70,$0.00,$29.48,$0.00,$29.99,$0.00
72424036,SUP,HCPCS C1713,,72424036  -  SCREW BN FT T8 4MM 4.5MM 36MM STRL EVOS MN VA SLFRET SCRDRVR,$188.38,$0.00,$188.38,$84.77,$134.44,$0.00,$32.46,$0.00,$0.00,$32.98,$188.38,$0.00,$94.19,$149.20,$150.70,$0.00,$29.48,$0.00,$29.99,$0.00
72424038,SUP,HCPCS C1713,,72424038  -  SCREW BN FT T8 4MM 4.5MM 38MM STRL EVOS MN VA SLFRET SCRDRVR,$188.38,$0.00,$188.38,$84.77,$134.44,$0.00,$32.46,$0.00,$0.00,$32.98,$188.38,$0.00,$94.19,$149.20,$150.70,$0.00,$29.48,$0.00,$29.99,$0.00
72424040,SUP,HCPCS C1713,,72424040  -  SCREW BN FT T8 4MM 4.5MM 40MM STRL EVOS MN VA SLFRET SCRDRVR,$188.38,$0.00,$188.38,$84.77,$134.44,$0.00,$32.46,$0.00,$0.00,$32.98,$188.38,$0.00,$94.19,$149.20,$150.70,$0.00,$29.48,$0.00,$29.99,$0.00
72424042,SUP,HCPCS C1713,,72424042  -  SCREW BN FT T8 4MM 4.5MM 42MM STRL EVOS MN VA SLFRET SCRDRVR,$188.38,$0.00,$188.38,$84.77,$134.44,$0.00,$32.46,$0.00,$0.00,$32.98,$188.38,$0.00,$94.19,$149.20,$150.70,$0.00,$29.48,$0.00,$29.99,$0.00
72424044,SUP,HCPCS C1713,,72424044  -  SCREW BN FT T8 4MM 4.5MM 44MM STRL EVOS MN VA SLFRET SCRDRVR,$188.38,$0.00,$188.38,$84.77,$134.44,$0.00,$32.46,$0.00,$0.00,$32.98,$188.38,$0.00,$94.19,$149.20,$150.70,$0.00,$29.48,$0.00,$29.99,$0.00
72424046,SUP,HCPCS C1713,,72424046  -  SCREW BN FT T8 4MM 4.5MM 46MM STRL EVOS MN VA SLFRET SCRDRVR,$188.38,$0.00,$188.38,$84.77,$134.44,$0.00,$32.46,$0.00,$0.00,$32.98,$188.38,$0.00,$94.19,$149.20,$150.70,$0.00,$29.48,$0.00,$29.99,$0.00
72424048,SUP,HCPCS C1713,,72424048  -  SCREW BN FT T8 4MM 4.5MM 48MM STRL EVOS MN VA SLFRET SCRDRVR,$188.38,$0.00,$188.38,$84.77,$134.44,$0.00,$32.46,$0.00,$0.00,$32.98,$188.38,$0.00,$94.19,$149.20,$150.70,$0.00,$29.48,$0.00,$29.99,$0.00
72424050,SUP,HCPCS C1713,,72424050  -  SCREW BN FT T8 4MM 4.5MM 50MM STRL EVOS MN VA SLFRET SCRDRVR,$188.38,$0.00,$188.38,$84.77,$134.44,$0.00,$32.46,$0.00,$0.00,$32.98,$188.38,$0.00,$94.19,$149.20,$150.70,$0.00,$29.48,$0.00,$29.99,$0.00
72424055,SUP,HCPCS C1713,,72424055  -  SCREW BN FT T8 4MM 4.5MM 55MM STRL EVOS MN VA SLFRET SCRDRVR,$188.38,$0.00,$188.38,$84.77,$134.44,$0.00,$32.46,$0.00,$0.00,$32.98,$188.38,$0.00,$94.19,$149.20,$150.70,$0.00,$29.48,$0.00,$29.99,$0.00
72424060,SUP,HCPCS C1713,,72424060  -  SCREW BN FT T8 4MM 4.5MM 60MM STRL EVOS MN VA SLFRET SCRDRVR,$188.38,$0.00,$188.38,$84.77,$134.44,$0.00,$32.46,$0.00,$0.00,$32.98,$188.38,$0.00,$94.19,$149.20,$150.70,$0.00,$29.48,$0.00,$29.99,$0.00
72424065,SUP,HCPCS C1713,,72424065  -  SCREW BN FT T8 4MM 4.5MM 65MM STRL EVOS MN VA SLFRET SCRDRVR,$188.38,$0.00,$188.38,$84.77,$134.44,$0.00,$32.46,$0.00,$0.00,$32.98,$188.38,$0.00,$94.19,$149.20,$150.70,$0.00,$29.48,$0.00,$29.99,$0.00
72424070,SUP,HCPCS C1713,,72424070  -  SCREW BN FT T8 4MM 4.5MM 70MM STRL EVOS MN LNG BN SM BN,$188.38,$0.00,$188.38,$84.77,$134.44,$0.00,$32.46,$0.00,$0.00,$32.98,$188.38,$0.00,$94.19,$149.20,$150.70,$0.00,$29.48,$0.00,$29.99,$0.00
72424075,SUP,HCPCS C1713,,72424075  -  SCREW BN FT T8 4MM 4.5MM 75MM STRL EVOS MN LNG BN SM BN,$188.38,$0.00,$188.38,$84.77,$134.44,$0.00,$32.46,$0.00,$0.00,$32.98,$188.38,$0.00,$94.19,$149.20,$150.70,$0.00,$29.48,$0.00,$29.99,$0.00
72424080,SUP,HCPCS C1713,,72424080  -  SCREW BN FT T8 4MM 4.5MM 80MM STRL EVOS MN LNG BN SM BN,$188.38,$0.00,$188.38,$84.77,$134.44,$0.00,$32.46,$0.00,$0.00,$32.98,$188.38,$0.00,$94.19,$149.20,$150.70,$0.00,$29.48,$0.00,$29.99,$0.00
72434026,SUP,HCPCS C1713,,72434026  -  SCREW BN T8 P/T 4MM 4.5MM 26MM SLFRET SCRDRVR EVOS MN,$188.38,$0.00,$188.38,$84.77,$134.44,$0.00,$32.46,$0.00,$0.00,$32.98,$188.38,$0.00,$94.19,$149.20,$150.70,$0.00,$29.48,$0.00,$29.99,$0.00
72434028,SUP,HCPCS C1713,,72434028  -  SCREW BN T8 P/T 4MM 4.5MM 28MM SLFRET SCRDRVR TAP EVOS MN,$188.38,$0.00,$188.38,$84.77,$134.44,$0.00,$32.46,$0.00,$0.00,$32.98,$188.38,$0.00,$94.19,$149.20,$150.70,$0.00,$29.48,$0.00,$29.99,$0.00
72434030,SUP,HCPCS C1713,,72434030  -  SCREW BN T8 P/T 4MM 4.5MM 30MM SLFRET SCRDRVR TAP EVOS MN,$188.38,$0.00,$188.38,$84.77,$134.44,$0.00,$32.46,$0.00,$0.00,$32.98,$188.38,$0.00,$94.19,$149.20,$150.70,$0.00,$29.48,$0.00,$29.99,$0.00
72434032,SUP,HCPCS C1713,,72434032  -  SCREW BN T8 P/T 4MM 4.5MM 32MM SLFRET SCRDRVR TAP EVOS MN,$188.38,$0.00,$188.38,$84.77,$134.44,$0.00,$32.46,$0.00,$0.00,$32.98,$188.38,$0.00,$94.19,$149.20,$150.70,$0.00,$29.48,$0.00,$29.99,$0.00
72434034,SUP,HCPCS C1713,,72434034  -  SCREW BN T8 P/T 4MM 4.5MM 34MM SLFRET SCRDRVR TAP EVOS MN,$188.38,$0.00,$188.38,$84.77,$134.44,$0.00,$32.46,$0.00,$0.00,$32.98,$188.38,$0.00,$94.19,$149.20,$150.70,$0.00,$29.48,$0.00,$29.99,$0.00
72434036,SUP,HCPCS C1713,,72434036  -  SCREW BN T8 P/T 4MM 4.5MM 36MM SLFRET SCRDRVR TAP EVOS MN,$188.38,$0.00,$188.38,$84.77,$134.44,$0.00,$32.46,$0.00,$0.00,$32.98,$188.38,$0.00,$94.19,$149.20,$150.70,$0.00,$29.48,$0.00,$29.99,$0.00
72434038,SUP,HCPCS C1713,,72434038  -  SCREW BN T8 P/T 4MM 4.5MM 38MM SLFRET SCRDRVR TAP EVOS MN,$188.38,$0.00,$188.38,$84.77,$134.44,$0.00,$32.46,$0.00,$0.00,$32.98,$188.38,$0.00,$94.19,$149.20,$150.70,$0.00,$29.48,$0.00,$29.99,$0.00
72434040,SUP,HCPCS C1713,,72434040  -  SCREW BN T8 P/T 4MM 4.5MM 40MM SLFRET SCRDRVR TAP EVOS MN,$188.38,$0.00,$188.38,$84.77,$134.44,$0.00,$32.46,$0.00,$0.00,$32.98,$188.38,$0.00,$94.19,$149.20,$150.70,$0.00,$29.48,$0.00,$29.99,$0.00
72434042,SUP,HCPCS C1713,,72434042  -  SCREW BN T8 P/T 4MM 4.5MM 42MM SLFRET SCRDRVR TAP EVOS MN,$188.38,$0.00,$188.38,$84.77,$134.44,$0.00,$32.46,$0.00,$0.00,$32.98,$188.38,$0.00,$94.19,$149.20,$150.70,$0.00,$29.48,$0.00,$29.99,$0.00
72434044,SUP,HCPCS C1713,,72434044  -  SCREW BN T8 P/T 4MM 4.5MM 44MM SLFRET SCRDRVR EVOS MN,$188.38,$0.00,$188.38,$84.77,$134.44,$0.00,$32.46,$0.00,$0.00,$32.98,$188.38,$0.00,$94.19,$149.20,$150.70,$0.00,$29.48,$0.00,$29.99,$0.00
72434046,SUP,HCPCS C1713,,72434046  -  SCREW BN T8 P/T 4MM 4.5MM 46MM SLFRET SCRDRVR TAP EVOS MN,$188.38,$0.00,$188.38,$84.77,$134.44,$0.00,$32.46,$0.00,$0.00,$32.98,$188.38,$0.00,$94.19,$149.20,$150.70,$0.00,$29.48,$0.00,$29.99,$0.00
72434048,SUP,HCPCS C1713,,72434048  -  SCREW BN T8 P/T 4MM 4.5MM 48MM SLFRET SCRDRVR EVOS MN,$188.38,$0.00,$188.38,$84.77,$134.44,$0.00,$32.46,$0.00,$0.00,$32.98,$188.38,$0.00,$94.19,$149.20,$150.70,$0.00,$29.48,$0.00,$29.99,$0.00
72434050,SUP,HCPCS C1713,,72434050  -  SCREW BN T8 P/T 4MM 4.5MM 50MM SLFRET SCRDRVR TAP EVOS MN,$188.38,$0.00,$188.38,$84.77,$134.44,$0.00,$32.46,$0.00,$0.00,$32.98,$188.38,$0.00,$94.19,$149.20,$150.70,$0.00,$29.48,$0.00,$29.99,$0.00
72434055,SUP,HCPCS C1713,,72434055  -  SCREW BN T8 P/T 4MM 4.5MM 55MM SLFRET SCRDRVR EVOS MN,$188.38,$0.00,$188.38,$84.77,$134.44,$0.00,$32.46,$0.00,$0.00,$32.98,$188.38,$0.00,$94.19,$149.20,$150.70,$0.00,$29.48,$0.00,$29.99,$0.00
72434060,SUP,HCPCS C1713,,72434060  -  SCREW BN T8 P/T 4MM 4.5MM 60MM SLFRET SCRDRVR TAP EVOS MN,$188.38,$0.00,$188.38,$84.77,$134.44,$0.00,$32.46,$0.00,$0.00,$32.98,$188.38,$0.00,$94.19,$149.20,$150.70,$0.00,$29.48,$0.00,$29.99,$0.00
72434065,SUP,HCPCS C1713,,72434065  -  SCREW BN T8 P/T 4MM 4.5MM 65MM SLFRET SCRDRVR EVOS MN,$213.13,$0.00,$213.13,$95.91,$152.11,$0.00,$36.72,$0.00,$0.00,$37.32,$213.13,$0.00,$106.56,$168.80,$170.50,$0.00,$33.35,$0.00,$33.93,$0.00
72434070,SUP,HCPCS C1713,,72434070  -  SCREW BN T8 P/T 4MM 4.5MM 70MM SLFRET SCRDRVR TAP EVOS MN,$213.13,$0.00,$213.13,$95.91,$152.11,$0.00,$36.72,$0.00,$0.00,$37.32,$213.13,$0.00,$106.56,$168.80,$170.50,$0.00,$33.35,$0.00,$33.93,$0.00
72434075,SUP,HCPCS C1713,,72434075  -  SCREW BN T8 P/T 4MM 4.5MM 75MM SLFRET SCRDRVR TAP EVOS MN,$213.13,$0.00,$213.13,$95.91,$152.11,$0.00,$36.72,$0.00,$0.00,$37.32,$213.13,$0.00,$106.56,$168.80,$170.50,$0.00,$33.35,$0.00,$33.93,$0.00
72434080,SUP,HCPCS C1713,,72434080  -  SCREW BN T8 P/T 4MM 4.5MM 80MM SLFRET SCRDRVR EVOS MN,$213.13,$0.00,$213.13,$95.91,$152.11,$0.00,$36.72,$0.00,$0.00,$37.32,$213.13,$0.00,$106.56,$168.80,$170.50,$0.00,$33.35,$0.00,$33.93,$0.00
72441010,SUP,HCPCS C1713,,72441010  -  PLATE BN 127MM STRL EVOS 10 HL CMPR 3.5MM SCR,$456.50,$0.00,$456.50,$205.43,$325.80,$0.00,$78.65,$0.00,$0.00,$79.93,$456.50,$0.00,$228.25,$361.55,$365.20,$0.00,$71.44,$0.00,$72.67,$0.00
72442050,SUP,HCPCS C1713,,72442050  -  PLATE BN T 36MM EVOS MN 2 HLE/HD 6 HL SHFT LOPRFL VA SS SM,"$1,225.13",$0.00,"$1,225.13",$551.31,$874.37,$0.00,$211.08,$0.00,$0.00,$214.51,"$1,225.13",$0.00,$612.56,$970.30,$980.10,$0.00,$191.73,$0.00,$195.04,$0.00
72442052,SUP,HCPCS C1713,,72442052  -  PLATE BN T 46MM EVOS MN 2 HLE/HD 8 HL SHFT LOPRFL VA SS SM,"$1,225.13",$0.00,"$1,225.13",$551.31,$874.37,$0.00,$211.08,$0.00,$0.00,$214.51,"$1,225.13",$0.00,$612.56,$970.30,$980.10,$0.00,$191.73,$0.00,$195.04,$0.00
72442054,SUP,HCPCS C1713,,72442054  -  PLATE BN 5MM SPC T 31X5-15.3X1.2MM STRL 71MM EVOS MN 3,"$1,225.13",$0.00,"$1,225.13",$551.31,$874.37,$0.00,$211.08,$0.00,$0.00,$214.51,"$1,225.13",$0.00,$612.56,$970.30,$980.10,$0.00,$191.73,$0.00,$195.04,$0.00
72442056,SUP,HCPCS C1713,,72442056  -  PLATE BN T 51MM EVOS MN 2 HLE/HD 9 HL SHFT LOPRFL VA SS SM,"$1,225.13",$0.00,"$1,225.13",$551.31,$874.37,$0.00,$211.08,$0.00,$0.00,$214.51,"$1,225.13",$0.00,$612.56,$970.30,$980.10,$0.00,$191.73,$0.00,$195.04,$0.00
72442058,SUP,HCPCS C1713,,72442058  -  PLATE BN 21MM EVOS MN 4 HL FLX LOPRFL VA SS SM BN LNG BN 2MM,"$1,266.38",$0.00,"$1,266.38",$569.87,$903.81,$0.00,$218.19,$0.00,$0.00,$221.73,"$1,266.38",$0.00,$633.19,"$1,002.97","$1,013.10",$0.00,$198.19,$0.00,$201.61,$0.00
72442060,SUP,HCPCS C1713,,72442060  -  PLATE BN 5MM SPC 31X5X1.2MM STRL EVOS LOPRFL 6 HL VA FLX SS,"$1,266.38",$0.00,"$1,266.38",$569.87,$903.81,$0.00,$218.19,$0.00,$0.00,$221.73,"$1,266.38",$0.00,$633.19,"$1,002.97","$1,013.10",$0.00,$198.19,$0.00,$201.61,$0.00
72442062,SUP,HCPCS C1713,,72442062  -  PLATE BN 41MM EVOS MN 8 HL FLX LOPRFL VA SS SM BN LNG BN 2MM,"$1,266.38",$0.00,"$1,266.38",$569.87,$903.81,$0.00,$218.19,$0.00,$0.00,$221.73,"$1,266.38",$0.00,$633.19,"$1,002.97","$1,013.10",$0.00,$198.19,$0.00,$201.61,$0.00
72442064,SUP,HCPCS C1713,,72442064  -  PLATE BN 51MM EVOS MN 10 HL FLX LOPRFL VA SS SM BN LNG BN 2,"$1,266.38",$0.00,"$1,266.38",$569.87,$903.81,$0.00,$218.19,$0.00,$0.00,$221.73,"$1,266.38",$0.00,$633.19,"$1,002.97","$1,013.10",$0.00,$198.19,$0.00,$201.61,$0.00
72442066,SUP,HCPCS C1713,,72442066  -  PLATE BN 101MM EVOS MN 20 HL FLX LOPRFL VA SS SM BN LNG BN 2,"$1,266.38",$0.00,"$1,266.38",$569.87,$903.81,$0.00,$218.19,$0.00,$0.00,$221.73,"$1,266.38",$0.00,$633.19,"$1,002.97","$1,013.10",$0.00,$198.19,$0.00,$201.61,$0.00
72442068,SUP,HCPCS C1713,,72442068  -  PLATE BN 21MM EVOS MN 4 HL STRTH LOPRFL VA SS SM BN LNG BN 2,"$1,266.38",$0.00,"$1,266.38",$569.87,$903.81,$0.00,$218.19,$0.00,$0.00,$221.73,"$1,266.38",$0.00,$633.19,"$1,002.97","$1,013.10",$0.00,$198.19,$0.00,$201.61,$0.00
72442070,SUP,HCPCS C1713,,72442070  -  PLATE BN 31MM EVOS MN 6 HL STRTH LOPRFL VA SS SM BN LNG BN 2,"$1,266.38",$0.00,"$1,266.38",$569.87,$903.81,$0.00,$218.19,$0.00,$0.00,$221.73,"$1,266.38",$0.00,$633.19,"$1,002.97","$1,013.10",$0.00,$198.19,$0.00,$201.61,$0.00
72442072,SUP,HCPCS C1713,,72442072  -  PLATE BN 41MM EVOS MN 8 HL STRTH LOPRFL VA SS SM BN LNG BN 2,"$1,266.38",$0.00,"$1,266.38",$569.87,$903.81,$0.00,$218.19,$0.00,$0.00,$221.73,"$1,266.38",$0.00,$633.19,"$1,002.97","$1,013.10",$0.00,$198.19,$0.00,$201.61,$0.00
72442074,SUP,HCPCS C1713,,72442074  -  PLATE BN 51MM EVOS MN 10 HL STRTH LOPRFL VA SS SM BN LNG BN,"$1,266.38",$0.00,"$1,266.38",$569.87,$903.81,$0.00,$218.19,$0.00,$0.00,$221.73,"$1,266.38",$0.00,$633.19,"$1,002.97","$1,013.10",$0.00,$198.19,$0.00,$201.61,$0.00
72442076,SUP,HCPCS C1713,,72442076  -  PLATE BN 101MM EVOS MN 20 HL STRTH LOPRFL VA SS SM BN LNG BN,"$1,266.38",$0.00,"$1,266.38",$569.87,$903.81,$0.00,$218.19,$0.00,$0.00,$221.73,"$1,266.38",$0.00,$633.19,"$1,002.97","$1,013.10",$0.00,$198.19,$0.00,$201.61,$0.00
72442078,SUP,HCPCS C1713,,72442078  -  PLATE BN STRG 28MM EVOS MN 5 HL TINE LOPRFL VA SS SM BN LNG,"$1,512.50",$0.00,"$1,512.50",$680.63,"$1,079.47",$0.00,$260.60,$0.00,$0.00,$264.83,"$1,512.50",$0.00,$756.25,"$1,197.90","$1,210.00",$0.00,$236.71,$0.00,$240.79,$0.00
72442080,SUP,HCPCS C1713,,72442080  -  PLATE BN STRG 38MM EVOS MN 7 HL TINE LOPRFL VA SS SM BN LNG,"$1,512.50",$0.00,"$1,512.50",$680.63,"$1,079.47",$0.00,$260.60,$0.00,$0.00,$264.83,"$1,512.50",$0.00,$756.25,"$1,197.90","$1,210.00",$0.00,$236.71,$0.00,$240.79,$0.00
72442120,SUP,HCPCS C1713,,72442120  -  WASHER ORTH 5MM EVOS 2MM SCR MN PLT SYS,$73.50,$0.00,$73.50,$33.08,$52.46,$0.00,$12.66,$0.00,$0.00,$12.87,$73.50,$0.00,$36.75,$58.21,$58.80,$0.00,$11.50,$0.00,$11.70,$0.00
72442124,SUP,HCPCS C1713,,72442124  -  WASHER ORTH 6MM EVOS 2.4MM SCR MN PLT SYS,$73.50,$0.00,$73.50,$33.08,$52.46,$0.00,$12.66,$0.00,$0.00,$12.87,$73.50,$0.00,$36.75,$58.21,$58.80,$0.00,$11.50,$0.00,$11.70,$0.00
72442127,SUP,HCPCS C1713,,72442127  -  WASHER ORTH 7MM EVOS 2.7MM SCR MN PLT SYS,$73.50,$0.00,$73.50,$33.08,$52.46,$0.00,$12.66,$0.00,$0.00,$12.87,$73.50,$0.00,$36.75,$58.21,$58.80,$0.00,$11.50,$0.00,$11.70,$0.00
72442135,SUP,HCPCS C1713,,72442135  -  WASHER ORTH STRL EVOS 3.5 MM SCR,$83.60,$0.00,$83.60,$37.62,$59.67,$0.00,$14.40,$0.00,$0.00,$14.64,$83.60,$0.00,$41.80,$66.21,$66.88,$0.00,$13.08,$0.00,$13.31,$0.00
72442220,SUP,HCPCS C1713,,72442220  -  WASHER ORTH 10MM EVOS 2 2.4MM SCR MN PLT SYS,$147.13,$0.00,$147.13,$66.21,$105.00,$0.00,$25.35,$0.00,$0.00,$25.76,$147.13,$0.00,$73.56,$116.53,$117.70,$0.00,$23.03,$0.00,$23.42,$0.00
72442224,SUP,HCPCS C1713,,72442224  -  WASHER ORTH 11MM EVOS 2 2.4MM SCR MN PLT SYS,$147.13,$0.00,$147.13,$66.21,$105.00,$0.00,$25.35,$0.00,$0.00,$25.76,$147.13,$0.00,$73.56,$116.53,$117.70,$0.00,$23.03,$0.00,$23.42,$0.00
72442227,SUP,HCPCS C1713,,72442227  -  WASHER ORTH 13MM EVOS 2 2.7MM SCR MN PLT SYS,$147.13,$0.00,$147.13,$66.21,$105.00,$0.00,$25.35,$0.00,$0.00,$25.76,$147.13,$0.00,$73.56,$116.53,$117.70,$0.00,$23.03,$0.00,$23.42,$0.00
72442450,SUP,HCPCS C1713,,72442450  -  PLATE BN T 43MM EVOS MN 2 HLE/HD 6 HL SHFT LOPRFL VA SS SM,"$1,553.75",$0.00,"$1,553.75",$699.19,"$1,108.91",$0.00,$267.70,$0.00,$0.00,$272.05,"$1,553.75",$0.00,$776.88,"$1,230.57","$1,243.00",$0.00,$243.16,$0.00,$247.36,$0.00
72442452,SUP,HCPCS C1713,,72442452  -  PLATE BN T 55MM EVOS MN 2 HLE/HD 8 HL SHFT LOPRFL VA SS SM,"$1,553.75",$0.00,"$1,553.75",$699.19,"$1,108.91",$0.00,$267.70,$0.00,$0.00,$272.05,"$1,553.75",$0.00,$776.88,"$1,230.57","$1,243.00",$0.00,$243.16,$0.00,$247.36,$0.00
72442454,SUP,HCPCS C1713,,72442454  -  PLATE BN T 37MM EVOS MN 3 HLE/HD 5 HL SHFT LOPRFL VA SS SM,"$1,553.75",$0.00,"$1,553.75",$699.19,"$1,108.91",$0.00,$267.70,$0.00,$0.00,$272.05,"$1,553.75",$0.00,$776.88,"$1,230.57","$1,243.00",$0.00,$243.16,$0.00,$247.36,$0.00
72442456,SUP,HCPCS C1713,,72442456  -  PLATE BN T 61MM EVOS MN 3 HLE/HD 9 HL SHFT LOPRFL VA SS SM,"$1,553.75",$0.00,"$1,553.75",$699.19,"$1,108.91",$0.00,$267.70,$0.00,$0.00,$272.05,"$1,553.75",$0.00,$776.88,"$1,230.57","$1,243.00",$0.00,$243.16,$0.00,$247.36,$0.00
72442458,SUP,HCPCS C1713,,72442458  -  PLATE BN 25MM EVOS MN 4 HL FLX LOPRFL VA SS SM BN LNG BN 2.4,"$1,595.00",$0.00,"$1,595.00",$717.75,"$1,138.35",$0.00,$274.81,$0.00,$0.00,$279.27,"$1,595.00",$0.00,$797.50,"$1,263.24","$1,276.00",$0.00,$249.62,$0.00,$253.92,$0.00
72442460,SUP,HCPCS C1713,,72442460  -  PLATE BN 37X6X1.4MM EVOS MN 6 HL FLX LOPRFL VA SS LG BN SM,"$1,595.00",$0.00,"$1,595.00",$717.75,"$1,138.35",$0.00,$274.81,$0.00,$0.00,$279.27,"$1,595.00",$0.00,$797.50,"$1,263.24","$1,276.00",$0.00,$249.62,$0.00,$253.92,$0.00
72442462,SUP,HCPCS C1713,,72442462  -  PLATE BN 49MM EVOS MN 8 HL FLX LOPRFL VA SS SM BN LNG BN 2.4,"$1,595.00",$0.00,"$1,595.00",$717.75,"$1,138.35",$0.00,$274.81,$0.00,$0.00,$279.27,"$1,595.00",$0.00,$797.50,"$1,263.24","$1,276.00",$0.00,$249.62,$0.00,$253.92,$0.00
72442464,SUP,HCPCS C1713,,72442464  -  PLATE BN 61MM EVOS MN 10 HL FLX LOPRFL VA SS SM BN LNG BN,"$1,595.00",$0.00,"$1,595.00",$717.75,"$1,138.35",$0.00,$274.81,$0.00,$0.00,$279.27,"$1,595.00",$0.00,$797.50,"$1,263.24","$1,276.00",$0.00,$249.62,$0.00,$253.92,$0.00
72442466,SUP,HCPCS C1713,,72442466  -  PLATE BN 121MM EVOS MN 20 HL FLX LOPRFL VA SS SM BN LNG BN,"$1,595.00",$0.00,"$1,595.00",$717.75,"$1,138.35",$0.00,$274.81,$0.00,$0.00,$279.27,"$1,595.00",$0.00,$797.50,"$1,263.24","$1,276.00",$0.00,$249.62,$0.00,$253.92,$0.00
72442468,SUP,HCPCS C1713,,72442468  -  PLATE BN 25MM STRL EVOS MN 4 HL LOPRFL VA LCK SS 2.4MM SCR,"$1,595.00",$0.00,"$1,595.00",$717.75,"$1,138.35",$0.00,$274.81,$0.00,$0.00,$279.27,"$1,595.00",$0.00,$797.50,"$1,263.24","$1,276.00",$0.00,$249.62,$0.00,$253.92,$0.00
72442470,SUP,HCPCS C1713,,72442470  -  PLATE BN 37MM EVOS MN 6 HL STRTH LOPRFL SS,"$1,595.00",$0.00,"$1,595.00",$717.75,"$1,138.35",$0.00,$274.81,$0.00,$0.00,$279.27,"$1,595.00",$0.00,$797.50,"$1,263.24","$1,276.00",$0.00,$249.62,$0.00,$253.92,$0.00
72442472,SUP,HCPCS C1713,,72442472  -  PLATE BN 49MM EVOS MN 20 HL STRENGHT LOPRFL VA SS SM BN LNG,"$1,595.00",$0.00,"$1,595.00",$717.75,"$1,138.35",$0.00,$274.81,$0.00,$0.00,$279.27,"$1,595.00",$0.00,$797.50,"$1,263.24","$1,276.00",$0.00,$249.62,$0.00,$253.92,$0.00
72442474,SUP,HCPCS C1713,,72442474  -  PLATE BN 61MM EVOS MN 10 HL STRENGHT LOPRFL VA SS SM BN LNG,"$1,595.00",$0.00,"$1,595.00",$717.75,"$1,138.35",$0.00,$274.81,$0.00,$0.00,$279.27,"$1,595.00",$0.00,$797.50,"$1,263.24","$1,276.00",$0.00,$249.62,$0.00,$253.92,$0.00
72442476,SUP,HCPCS C1713,,72442476  -  PLATE BN 121MM EVOS MN 20 HL STRENGHT LOPRFL VA SS SM BN LNG,"$1,595.00",$0.00,"$1,595.00",$717.75,"$1,138.35",$0.00,$274.81,$0.00,$0.00,$279.27,"$1,595.00",$0.00,$797.50,"$1,263.24","$1,276.00",$0.00,$249.62,$0.00,$253.92,$0.00
72442478,SUP,HCPCS C1713,,72442478  -  PLATE BN STRG 34MM EVOS MN 5 HL TINE LOPRFL VA SS SM BN LNG,"$1,677.50",$0.00,"$1,677.50",$754.88,"$1,197.23",$0.00,$289.02,$0.00,$0.00,$293.72,"$1,677.50",$0.00,$838.75,"$1,328.58","$1,342.00",$0.00,$262.53,$0.00,$267.06,$0.00
72442482,SUP,HCPCS C1713,,72442482  -  PLATE BN 47MM EVOS MN 5 HL LOPRFL VA SS SM BN LNG BN 2.4MM,"$1,753.13",$0.00,"$1,753.13",$788.91,"$1,251.21",$0.00,$302.05,$0.00,$0.00,$306.96,"$1,753.13",$0.00,$876.56,"$1,388.48","$1,402.50",$0.00,$274.36,$0.00,$279.10,$0.00
72442484,SUP,HCPCS C1713,,72442484  -  PLATE BN 59MM EVOS MN 7 HL LOPRFL VA SS SM BN LNG BN 2.4MM,"$1,753.13",$0.00,"$1,753.13",$788.91,"$1,251.21",$0.00,$302.05,$0.00,$0.00,$306.96,"$1,753.13",$0.00,$876.56,"$1,388.48","$1,402.50",$0.00,$274.36,$0.00,$279.10,$0.00
72442486,SUP,HCPCS C1713,,72442486  -  PLATE BN Y 45MM EVOS MN 5 HL TINE LOPRFL VA SS SM BN LNG BN,"$1,966.25",$0.00,"$1,966.25",$884.81,"$1,403.31",$0.00,$338.78,$0.00,$0.00,$344.27,"$1,966.25",$0.00,$983.13,"$1,557.27","$1,573.00",$0.00,$307.72,$0.00,$313.03,$0.00
72442488,SUP,HCPCS C1713,,72442488  -  PLATE BN Y 57MM EVOS MN 7 HL TINE LOPRFL VA SS SM BN LNG BN,"$1,966.25",$0.00,"$1,966.25",$884.81,"$1,403.31",$0.00,$338.78,$0.00,$0.00,$344.27,"$1,966.25",$0.00,$983.13,"$1,557.27","$1,573.00",$0.00,$307.72,$0.00,$313.03,$0.00
72442490,SUP,HCPCS C1713,,72442490  -  PLATE BN 3ANG 55MM EVOS MN 6 HL LOPRFL VA SS SM BN LNG BN,"$1,753.13",$0.00,"$1,753.13",$788.91,"$1,251.21",$0.00,$302.05,$0.00,$0.00,$306.96,"$1,753.13",$0.00,$876.56,"$1,388.48","$1,402.50",$0.00,$274.36,$0.00,$279.10,$0.00
72442492,SUP,HCPCS C1713,,72442492  -  PLATE BN 3ANG 67MM EVOS MN 8 HL LOPRFL VA SS SM BN LNG BN,"$1,753.13",$0.00,"$1,753.13",$788.91,"$1,251.21",$0.00,$302.05,$0.00,$0.00,$306.96,"$1,753.13",$0.00,$876.56,"$1,388.48","$1,402.50",$0.00,$274.36,$0.00,$279.10,$0.00
72442494,SUP,HCPCS C1713,,72442494  -  PLATE BN TRPZD 24X18X1.4MM EVOS LOPRFL VA 5 HL SS 2.4MM SCR,"$2,000.63",$0.00,"$2,000.63",$900.28,"$1,427.85",$0.00,$344.70,$0.00,$0.00,$350.29,"$2,000.63",$0.00,"$1,000.31","$1,584.50","$1,600.50",$0.00,$313.10,$0.00,$318.50,$0.00
72442720,SUP,HCPCS C1713,,72442720  -  PLATE BN T 42X7.5-21.5X1.4MM STRL EVOS MN 3 HLE/HD 5 HL SHFT,"$1,718.75",$0.00,"$1,718.75",$773.44,"$1,226.67",$0.00,$296.13,$0.00,$0.00,$300.94,"$1,718.75",$0.00,$859.38,"$1,361.25","$1,375.00",$0.00,$268.98,$0.00,$273.63,$0.00
72442722,SUP,HCPCS C1713,,72442722  -  PLATE BN T 71MM EVOS MN 3 HLE/HD 9 HL SHFT LOPRFL VA SS SM,"$1,718.75",$0.00,"$1,718.75",$773.44,"$1,226.67",$0.00,$296.13,$0.00,$0.00,$300.94,"$1,718.75",$0.00,$859.38,"$1,361.25","$1,375.00",$0.00,$268.98,$0.00,$273.63,$0.00
72442724,SUP,HCPCS C1713,,72442724  -  PLATE BN 28MM EVOS MN 4 HL FLX LOPRFL VA SS SM BN LNG BN 2.7,"$1,753.13",$0.00,"$1,753.13",$788.91,"$1,251.21",$0.00,$302.05,$0.00,$0.00,$306.96,"$1,753.13",$0.00,$876.56,"$1,388.48","$1,402.50",$0.00,$274.36,$0.00,$279.10,$0.00
72442726,SUP,HCPCS C1713,,72442726  -  PLATE BN 42MM EVOS MN 4 HL FLX LOPRFL VA SS SM BN LNG BN 2.7,"$1,753.13",$0.00,"$1,753.13",$788.91,"$1,251.21",$0.00,$302.05,$0.00,$0.00,$306.96,"$1,753.13",$0.00,$876.56,"$1,388.48","$1,402.50",$0.00,$274.36,$0.00,$279.10,$0.00
72442728,SUP,HCPCS C1713,,72442728  -  PLATE BN 56MM EVOS MN 8 HL FLX LOPRFL VA SS SM BN LNG BN 2.7,"$1,753.13",$0.00,"$1,753.13",$788.91,"$1,251.21",$0.00,$302.05,$0.00,$0.00,$306.96,"$1,753.13",$0.00,$876.56,"$1,388.48","$1,402.50",$0.00,$274.36,$0.00,$279.10,$0.00
72442760,SUP,HCPCS C1713,,72442760  -  PLATE BN 70MM EVOS MN 10 HL FLX LOPRFL VA SS SM BN LNG BN,"$1,753.13",$0.00,"$1,753.13",$788.91,"$1,251.21",$0.00,$302.05,$0.00,$0.00,$306.96,"$1,753.13",$0.00,$876.56,"$1,388.48","$1,402.50",$0.00,$274.36,$0.00,$279.10,$0.00
72442762,SUP,HCPCS C1713,,72442762  -  PLATE BN 140MM EVOS MN 20 HL FLX LOPRFL VA SS SM BN LNG BN,"$1,753.13",$0.00,"$1,753.13",$788.91,"$1,251.21",$0.00,$302.05,$0.00,$0.00,$306.96,"$1,753.13",$0.00,$876.56,"$1,388.48","$1,402.50",$0.00,$274.36,$0.00,$279.10,$0.00
72442764,SUP,HCPCS C1713,,72442764  -  PLATE BN 28MM EVOS MN 4 HL STRENGHT LOPRFL VA SS SM BN LNG,"$1,753.13",$0.00,"$1,753.13",$788.91,"$1,251.21",$0.00,$302.05,$0.00,$0.00,$306.96,"$1,753.13",$0.00,$876.56,"$1,388.48","$1,402.50",$0.00,$274.36,$0.00,$279.10,$0.00
72442766,SUP,HCPCS C1713,,72442766  -  PLATE BN 7MM SPC 42X7.5X2.2MM 140MM EVOS MN 6 HL SHFT VA LCK,"$1,753.13",$0.00,"$1,753.13",$788.91,"$1,251.21",$0.00,$302.05,$0.00,$0.00,$306.96,"$1,753.13",$0.00,$876.56,"$1,388.48","$1,402.50",$0.00,$274.36,$0.00,$279.10,$0.00
72442768,SUP,HCPCS C1713,,72442768  -  PLATE BN 7MM SPC 56X7.5X2.2MM 140MM EVOS MN 6 HL SHFT VA LCK,"$1,753.13",$0.00,"$1,753.13",$788.91,"$1,251.21",$0.00,$302.05,$0.00,$0.00,$306.96,"$1,753.13",$0.00,$876.56,"$1,388.48","$1,402.50",$0.00,$274.36,$0.00,$279.10,$0.00
72442770,SUP,HCPCS C1713,,72442770  -  PLATE BN 7MM SPC 70X7.5X2.2MM 140MM EVOS MN 6 HL SHFT VA LCK,"$1,753.13",$0.00,"$1,753.13",$788.91,"$1,251.21",$0.00,$302.05,$0.00,$0.00,$306.96,"$1,753.13",$0.00,$876.56,"$1,388.48","$1,402.50",$0.00,$274.36,$0.00,$279.10,$0.00
72442772,SUP,HCPCS C1713,,72442772  -  PLATE BN 140MM EVOS MN 20 HL STRENGHT LOPRFL VA SS SM BN LNG,"$1,753.13",$0.00,"$1,753.13",$788.91,"$1,251.21",$0.00,$302.05,$0.00,$0.00,$306.96,"$1,753.13",$0.00,$876.56,"$1,388.48","$1,402.50",$0.00,$274.36,$0.00,$279.10,$0.00
72442774,SUP,HCPCS C1713,,72442774  -  PLATE BN STRG 38MM EVOS MN 5 HL TINE LOPRFL VA SS SM BN LNG,"$1,842.50",$0.00,"$1,842.50",$829.13,"$1,314.99",$0.00,$317.45,$0.00,$0.00,$322.61,"$1,842.50",$0.00,$921.25,"$1,459.26","$1,474.00",$0.00,$288.35,$0.00,$293.33,$0.00
72442776,SUP,HCPCS C1713,,72442776  -  PLATE BN STRG 52MM EVOS MN 7 HL TINE LOPRFL VA SS SM BN LNG,"$1,842.50",$0.00,"$1,842.50",$829.13,"$1,314.99",$0.00,$317.45,$0.00,$0.00,$322.61,"$1,842.50",$0.00,$921.25,"$1,459.26","$1,474.00",$0.00,$288.35,$0.00,$293.33,$0.00
72442778,SUP,HCPCS C1713,,72442778  -  PLATE BN Y 55MM EVOS MN 5 HL LOPRFL VA SS SM BN LNG BN 2.7MM,"$1,931.88",$0.00,"$1,931.88",$869.34,"$1,378.78",$0.00,$332.85,$0.00,$0.00,$338.26,"$1,931.88",$0.00,$965.94,"$1,530.05","$1,545.50",$0.00,$302.34,$0.00,$307.55,$0.00
72442780,SUP,HCPCS C1713,,72442780  -  PLATE BN Y 69MM EVOS MN 7 HL LOPRFL VA SS SM BN LNG BN 2.7MM,"$1,931.88",$0.00,"$1,931.88",$869.34,"$1,378.78",$0.00,$332.85,$0.00,$0.00,$338.26,"$1,931.88",$0.00,$965.94,"$1,530.05","$1,545.50",$0.00,$302.34,$0.00,$307.55,$0.00
72442782,SUP,HCPCS C1713,,72442782  -  PLATE BN Y 52MM EVOS MN 5 HL TINE LOPRFL VA SS SM BN LNG BN,"$2,206.88",$0.00,"$2,206.88",$993.09,"$1,575.05",$0.00,$380.23,$0.00,$0.00,$386.41,"$2,206.88",$0.00,"$1,103.44","$1,747.85","$1,765.50",$0.00,$345.38,$0.00,$351.33,$0.00
72442784,SUP,HCPCS C1713,,72442784  -  PLATE BN Y 66MM EVOS MN 7HOLE TINE LOPRFL VA SS SM BN LNG BN,"$2,206.88",$0.00,"$2,206.88",$993.09,"$1,575.05",$0.00,$380.23,$0.00,$0.00,$386.41,"$2,206.88",$0.00,"$1,103.44","$1,747.85","$1,765.50",$0.00,$345.38,$0.00,$351.33,$0.00
72442786,SUP,HCPCS C1713,,72442786  -  PLATE BN 3ANG 54MM EVOS MN 6 HL LOPRFL VA SS SM BN LNG BN,"$1,931.88",$0.00,"$1,931.88",$869.34,"$1,378.78",$0.00,$332.85,$0.00,$0.00,$338.26,"$1,931.88",$0.00,$965.94,"$1,530.05","$1,545.50",$0.00,$302.34,$0.00,$307.55,$0.00
72442788,SUP,HCPCS C1713,,72442788  -  PLATE BN 3ANG 68MM EVOS MN 8 HL LOPRFL VA SS SM BN LNG BN,"$1,931.88",$0.00,"$1,931.88",$869.34,"$1,378.78",$0.00,$332.85,$0.00,$0.00,$338.26,"$1,931.88",$0.00,$965.94,"$1,530.05","$1,545.50",$0.00,$302.34,$0.00,$307.55,$0.00
72800107,SUP,HCPCS C1713,,72800107  -  PLATE BN 98MM PRLC VLP 7 HL LCK TIB LT POSTEROMEDIAL PROX,"$2,157.75",$0.00,"$2,157.75",$970.99,"$1,539.99",$0.00,$371.77,$0.00,$0.00,$377.80,"$2,157.75",$0.00,"$1,078.88","$1,708.94","$1,726.20",$0.00,$337.69,$0.00,$343.51,$0.00
72823110,SUP,HCPCS C1713,,72823110  -  SCREW BN 2.7MM 10MM PRLC VLP LCK ST SS CORT,$286.25,$0.00,$286.25,$128.81,$204.30,$0.00,$49.32,$0.00,$0.00,$50.12,$286.25,$0.00,$143.13,$226.71,$229.00,$0.00,$44.80,$0.00,$45.57,$0.00
72823112,SUP,HCPCS C1713,,72823112  -  SCREW BN 2.7MM 12MM PRLC VLP ST LCK SS FOREFOOT MIDFOOT CORT,$286.25,$0.00,$286.25,$128.81,$204.30,$0.00,$49.32,$0.00,$0.00,$50.12,$286.25,$0.00,$143.13,$226.71,$229.00,$0.00,$44.80,$0.00,$45.57,$0.00
72823114,SUP,HCPCS C1713,,72823114  -  SCREW BN 2.7MM 14MM PRLC VLP ST LCK SS FOREFOOT MIDFOOT CORT,$286.25,$0.00,$286.25,$128.81,$204.30,$0.00,$49.32,$0.00,$0.00,$50.12,$286.25,$0.00,$143.13,$226.71,$229.00,$0.00,$44.80,$0.00,$45.57,$0.00
72823116,SUP,HCPCS C1713,,72823116  -  SCREW BN 2.7MM 16MM PRLC VLP ST LCK SS FOREFOOT MIDFOOT CORT,$286.25,$0.00,$286.25,$128.81,$204.30,$0.00,$49.32,$0.00,$0.00,$50.12,$286.25,$0.00,$143.13,$226.71,$229.00,$0.00,$44.80,$0.00,$45.57,$0.00
72823118,SUP,HCPCS C1713,,72823118  -  SCREW BN 2.7MM 18MM PRLC VLP ST LCK SS FOREFOOT MIDFOOT CORT,$286.25,$0.00,$286.25,$128.81,$204.30,$0.00,$49.32,$0.00,$0.00,$50.12,$286.25,$0.00,$143.13,$226.71,$229.00,$0.00,$44.80,$0.00,$45.57,$0.00
72823120,SUP,HCPCS C1713,,72823120  -  SCREW BN 2.7MM 20MM PRLC VLP ST LCK SS FOREFOOT MIDFOOT CORT,$286.25,$0.00,$286.25,$128.81,$204.30,$0.00,$49.32,$0.00,$0.00,$50.12,$286.25,$0.00,$143.13,$226.71,$229.00,$0.00,$44.80,$0.00,$45.57,$0.00
72823122,SUP,HCPCS C1713,,72823122  -  SCREW BN 2.7MM 22MM VLP LCK ST VA FT CORT,$286.25,$0.00,$286.25,$128.81,$204.30,$0.00,$49.32,$0.00,$0.00,$50.12,$286.25,$0.00,$143.13,$226.71,$229.00,$0.00,$44.80,$0.00,$45.57,$0.00
72823124,SUP,HCPCS C1713,,72823124  -  SCREW BN 2.7MM 24MM PRLC VLP LCK ST SS FOREFOOT MIDFOOT CORT,$286.25,$0.00,$286.25,$128.81,$204.30,$0.00,$49.32,$0.00,$0.00,$50.12,$286.25,$0.00,$143.13,$226.71,$229.00,$0.00,$44.80,$0.00,$45.57,$0.00
72823126,SUP,HCPCS C1713,,72823126  -  SCREW BN 2.7MM 26MM PRLC VLP LCK ST CORT,$286.25,$0.00,$286.25,$128.81,$204.30,$0.00,$49.32,$0.00,$0.00,$50.12,$286.25,$0.00,$143.13,$226.71,$229.00,$0.00,$44.80,$0.00,$45.57,$0.00
72823128,SUP,HCPCS C1713,,72823128  -  SCREW BN 2.7MM 28MM PRLC VLP LCK ST SS FOREFOOT MIDFOOT CORT,$286.25,$0.00,$286.25,$128.81,$204.30,$0.00,$49.32,$0.00,$0.00,$50.12,$286.25,$0.00,$143.13,$226.71,$229.00,$0.00,$44.80,$0.00,$45.57,$0.00
72823130,SUP,HCPCS C1713,,72823130  -  SCREW BN 2.7MM 30MM PRLC VLP LCK ST SS FOREFOOT MIDFOOT CORT,$286.25,$0.00,$286.25,$128.81,$204.30,$0.00,$49.32,$0.00,$0.00,$50.12,$286.25,$0.00,$143.13,$226.71,$229.00,$0.00,$44.80,$0.00,$45.57,$0.00
72823132,SUP,HCPCS C1713,,72823132  -  SCREW BN 2.7MM 32MM PRLC VLP LCK ST SS FOREFOOT MIDFOOT CORT,$286.25,$0.00,$286.25,$128.81,$204.30,$0.00,$49.32,$0.00,$0.00,$50.12,$286.25,$0.00,$143.13,$226.71,$229.00,$0.00,$44.80,$0.00,$45.57,$0.00
72823134,SUP,HCPCS C1713,,72823134  -  SCREW BN 2.7MM 34MM PRLC VLP LCK ST SS FOREFOOT MIDFOOT CORT,$286.25,$0.00,$286.25,$128.81,$204.30,$0.00,$49.32,$0.00,$0.00,$50.12,$286.25,$0.00,$143.13,$226.71,$229.00,$0.00,$44.80,$0.00,$45.57,$0.00
72823136,SUP,HCPCS C1713,,72823136  -  SCREW BN 2.7MM 36MM PRLC VLP LCK ST SS FOREFOOT MIDFOOT CORT,$286.25,$0.00,$286.25,$128.81,$204.30,$0.00,$49.32,$0.00,$0.00,$50.12,$286.25,$0.00,$143.13,$226.71,$229.00,$0.00,$44.80,$0.00,$45.57,$0.00
72823138,SUP,HCPCS C1713,,72823138  -  SCREW BN 2.7MM 38MM PRLC VLP LCK ST SS FOREFOOT MIDFOOT CORT,$286.25,$0.00,$286.25,$128.81,$204.30,$0.00,$49.32,$0.00,$0.00,$50.12,$286.25,$0.00,$143.13,$226.71,$229.00,$0.00,$44.80,$0.00,$45.57,$0.00
72823140,SUP,HCPCS C1713,,72823140  -  SCREW BN 2.7MM 40MM PRLC VLP LCK ST SS FOREFOOT MIDFOOT CORT,$286.25,$0.00,$286.25,$128.81,$204.30,$0.00,$49.32,$0.00,$0.00,$50.12,$286.25,$0.00,$143.13,$226.71,$229.00,$0.00,$44.80,$0.00,$45.57,$0.00
72823210,SUP,HCPCS C1713,,72823210  -  SCREW BN FT 4MM 10MM PRLC VLP OSTEOPENIA CORT,$145.00,$0.00,$145.00,$65.25,$103.49,$0.00,$24.98,$0.00,$0.00,$25.39,$145.00,$0.00,$72.50,$114.84,$116.00,$0.00,$22.69,$0.00,$23.08,$0.00
72823212,SUP,HCPCS C1713,,72823212  -  SCREW BN FT 4MM 12MM PRLC VLP SS FOREFOOT MIDFOOT CORT,$145.00,$0.00,$145.00,$65.25,$103.49,$0.00,$24.98,$0.00,$0.00,$25.39,$145.00,$0.00,$72.50,$114.84,$116.00,$0.00,$22.69,$0.00,$23.08,$0.00
72823214,SUP,HCPCS C1713,,72823214  -  SCREW BN FT 4MM 14MM PRLC VLP OSTEOPENIA CORT FT,$145.00,$0.00,$145.00,$65.25,$103.49,$0.00,$24.98,$0.00,$0.00,$25.39,$145.00,$0.00,$72.50,$114.84,$116.00,$0.00,$22.69,$0.00,$23.08,$0.00
72823216,SUP,HCPCS C1713,,72823216  -  SCREW BN FT 4MM 16MM PRLC VLP OSTEOPENIA CORT,$145.00,$0.00,$145.00,$65.25,$103.49,$0.00,$24.98,$0.00,$0.00,$25.39,$145.00,$0.00,$72.50,$114.84,$116.00,$0.00,$22.69,$0.00,$23.08,$0.00
72823218,SUP,HCPCS C1713,,72823218  -  SCREW BN FT 4MM 18MM PRLC VLP SS FOREFOOT MIDFOOT CORT,$145.00,$0.00,$145.00,$65.25,$103.49,$0.00,$24.98,$0.00,$0.00,$25.39,$145.00,$0.00,$72.50,$114.84,$116.00,$0.00,$22.69,$0.00,$23.08,$0.00
72823220,SUP,HCPCS C1713,,72823220  -  SCREW BN FT 4MM 20MM PRLC VLP OSTEOPENIA CORT,$145.00,$0.00,$145.00,$65.25,$103.49,$0.00,$24.98,$0.00,$0.00,$25.39,$145.00,$0.00,$72.50,$114.84,$116.00,$0.00,$22.69,$0.00,$23.08,$0.00
72823222,SUP,HCPCS C1713,,72823222  -  SCREW BN 4MM 22MM PRLC VLP FT OSTEOPENIA,$145.00,$0.00,$145.00,$65.25,$103.49,$0.00,$24.98,$0.00,$0.00,$25.39,$145.00,$0.00,$72.50,$114.84,$116.00,$0.00,$22.69,$0.00,$23.08,$0.00
72823224,SUP,HCPCS C1713,,72823224  -  SCREW BN FT 4MM 24MM PRLC VLP OSTEOPENIA CORT,$145.00,$0.00,$145.00,$65.25,$103.49,$0.00,$24.98,$0.00,$0.00,$25.39,$145.00,$0.00,$72.50,$114.84,$116.00,$0.00,$22.69,$0.00,$23.08,$0.00
72823226,SUP,HCPCS C1713,,72823226  -  SCREW BN FT 4MM 26MM PRLC VLP OSTEOPENIA CORT,$145.00,$0.00,$145.00,$65.25,$103.49,$0.00,$24.98,$0.00,$0.00,$25.39,$145.00,$0.00,$72.50,$114.84,$116.00,$0.00,$22.69,$0.00,$23.08,$0.00
72823228,SUP,HCPCS C1713,,72823228  -  SCREW BN FT 4MM 28MM PRLC VLP OSTEOPENIA CORT FT,$145.00,$0.00,$145.00,$65.25,$103.49,$0.00,$24.98,$0.00,$0.00,$25.39,$145.00,$0.00,$72.50,$114.84,$116.00,$0.00,$22.69,$0.00,$23.08,$0.00
72823230,SUP,HCPCS C1713,,72823230  -  SCREW BN FT 4MM 4.9MM 30MM NS LOPRFL HEX FT PRLC VLP,$145.00,$0.00,$145.00,$65.25,$103.49,$0.00,$24.98,$0.00,$0.00,$25.39,$145.00,$0.00,$72.50,$114.84,$116.00,$0.00,$22.69,$0.00,$23.08,$0.00
72823232,SUP,HCPCS C1713,,72823232  -  SCREW BONE FULTHD 4MM 32MM OSTEOPENIA VAR ANG PERI-LOC VLP,$145.00,$0.00,$145.00,$65.25,$103.49,$0.00,$24.98,$0.00,$0.00,$25.39,$145.00,$0.00,$72.50,$114.84,$116.00,$0.00,$22.69,$0.00,$23.08,$0.00
72823234,SUP,HCPCS C1713,,72823234  -  SCREW BONE 4MM 34MM FULTHRD OSTEOPENIA PERI-LOC VLP,$145.00,$0.00,$145.00,$65.25,$103.49,$0.00,$24.98,$0.00,$0.00,$25.39,$145.00,$0.00,$72.50,$114.84,$116.00,$0.00,$22.69,$0.00,$23.08,$0.00
72823236,SUP,HCPCS C1713,,72823236  -  SCREW BN FT 4MM 36MM PRLC VLP SS FOREFOOT MIDFOOT CORT,$145.00,$0.00,$145.00,$65.25,$103.49,$0.00,$24.98,$0.00,$0.00,$25.39,$145.00,$0.00,$72.50,$114.84,$116.00,$0.00,$22.69,$0.00,$23.08,$0.00
72823238,SUP,HCPCS C1713,,72823238  -  SCREW BN 4MM 38MM PRLC VLP FT OSTEOPENIA,$145.00,$0.00,$145.00,$65.25,$103.49,$0.00,$24.98,$0.00,$0.00,$25.39,$145.00,$0.00,$72.50,$114.84,$116.00,$0.00,$22.69,$0.00,$23.08,$0.00
72823240,SUP,HCPCS C1713,,72823240  -  SCREW BN FT 4MM 40MM PRLC VLP SS FOREFOOT MIDFOOT CORT,$145.00,$0.00,$145.00,$65.25,$103.49,$0.00,$24.98,$0.00,$0.00,$25.39,$145.00,$0.00,$72.50,$114.84,$116.00,$0.00,$22.69,$0.00,$23.08,$0.00
72823410,SUP,HCPCS C1713,,72823410  -  SCREW BN 4MM 10MM PRLC VLP LCK OSTEOPENIA CORT,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823412,SUP,HCPCS C1713,,72823412  -  SCREW BN 4MM 12MM PRLC VLP LCK OSTEOPENIA CORT,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823414,SUP,HCPCS C1713,,72823414  -  SCREW BN 4MM 14MM PRLC VLP LCK OSTEOPENIA CORT,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823416,SUP,HCPCS C1713,,72823416  -  SCREW BN 4MM 16MM PRLC VLP LCK OSTEOPENIA CORT,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823418,SUP,HCPCS C1713,,72823418  -  SCREW BN 4MM 18MM PRLC VLP LCK OSTEOPENIA CORT,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823420,SUP,HCPCS C1713,,72823420  -  SCREW BN 4MM 20MM PRLC VLP LCK FOREFOOT MIDFOOT OSTEOPENIA,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823422,SUP,HCPCS C1713,,72823422  -  SCREW BN 4MM 22MM PRLC VLP LCK OSTEOPENIA CORT,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823424,SUP,HCPCS C1713,,72823424  -  SCREW BN 4MM 24MM PRLC VLP LCK FOREFOOT MIDFOOT OSTEOPENIA,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823426,SUP,HCPCS C1713,,72823426  -  SCREW BONE 4MM 26MM LOCKING OSTEOPENIA PERI-LOC VLP CORTICAL,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823428,SUP,HCPCS C1713,,72823428  -  SCREW BN 4MM 4.9MM 28MM LCK LOPRFL HD FT PRLC VLP OSTEOPENIA,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823430,SUP,HCPCS C1713,,72823430  -  SCREW BONE 4MM 30MM LOCKING OSTEOPENIA PERI-LOC VLP CORTICAL,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823432,SUP,HCPCS C1713,,72823432  -  SCREW BONE 4MM 32MM LOCKING OSTEOPENIA PERI-LOC VLP CORTICAL,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823434,SUP,HCPCS C1713,,72823434  -  SCREW BN 4MM 34MM PRLC VLP LCK OSTEOPENIA,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823436,SUP,HCPCS C1713,,72823436  -  SCREW BN 4MM 36MM PRLC VLP LCK OSTEOPENIA,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823438,SUP,HCPCS C1713,,72823438  -  SCREW BN 4MM 38MM PRLC VLP LCK OSTEOPENIA,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823440,SUP,HCPCS C1713,,72823440  -  SCREW BN 4MM 40MM PRLC VLP LCK OSTEOPENIA CORT,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823510,SUP,HCPCS C1713,,72823510  -  SCREW BN 15D 2.5MM 5MM 5.4MM 10MMX3.3MM VLP LCK LOPRFL HD,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823512,SUP,HCPCS C1713,,72823512  -  SCREW BN 15D 2.5MM 5MM 5.4MM 12MMX3.3MM VLP LCK LOPRFL HD,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823514,SUP,HCPCS C1713,,72823514  -  SCREW BN 15D 2.5MM 5MM 5.4MM 14MMX3.3MM VLP LCK LOPRFL HD,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823516,SUP,HCPCS C1713,,72823516  -  SCREW BN 15D 2.5MM 5MM 5.4MM 16MMX3.3MM VLP LCK LOPRFL HD,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823518,SUP,HCPCS C1713,,72823518  -  SCREW BN 15D 2.5MM 5MM 5.4MM 18MMX3.3MM VLP LCK LOPRFL HD,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823520,SUP,HCPCS C1713,,72823520  -  SCREW BN 15D 2.5MM 5MM 5.4MM 20MMX3.3MM VLP LCK LOPRFL HD,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823522,SUP,HCPCS C1713,,72823522  -  SCREW BN 15D 2.5MM 5MM 5.4MM 22MMX3.3MM VLP LCK LOPRFL HD,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823524,SUP,HCPCS C1713,,72823524  -  SCREW BN 15D 2.5MM 5MM 5.4MM 24MMX3.3MM VLP LCK LOPRFL HD,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823526,SUP,HCPCS C1713,,72823526  -  SCREW BN 15D 2.5MM 5MM 5.4MM 26MMX3.3MM VLP LCK LOPRFL HD,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823528,SUP,HCPCS C1713,,72823528  -  SCREW BN 15D 2.5MM 5MM 5.4MM 28MMX3.3MM VLP LCK LOPRFL HD,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823530,SUP,HCPCS C1713,,72823530  -  SCREW BN 15D 2.5MM 5MM 5.4MM 30MMX3.3MM VLP LCK LOPRFL HD,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823532,SUP,HCPCS C1713,,72823532  -  SCREW BN 15D 2.5MM 5MM 5.4MM 32MM VLP LCK LOPRFL HD HEX RCS,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823534,SUP,HCPCS C1713,,72823534  -  SCREW BN 15D 2.5MM 5MM 5.4MM 34MM VLP LCK LOPRFL HD HEX RCS,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823536,SUP,HCPCS C1713,,72823536  -  SCREW BN 15D 2.5MM 5MM 5.4MM 36MMX3.3MM VLP LCK LOPRFL HD,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823538,SUP,HCPCS C1713,,72823538  -  SCREW BN 15D 2.5MM 5MM 5.4MM 38MMX3.3MM VLP LCK LOPRFL HD,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823540,SUP,HCPCS C1713,,72823540  -  SCREW BN 15D 2.5MM 5MM 5.4MM 40MMX3.3MM VLP LCK LOPRFL HD,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823542,SUP,HCPCS C1713,,72823542  -  SCREW BN 15D 2.5MM 5MM 5.4MM 42MMX3.3MM VLP LCK LOPRFL HD,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823544,SUP,HCPCS C1713,,72823544  -  SCREW BN 15D 2.5MM 5MM 5.4MM 44MMX3.3MM VLP LCK LOPRFL HD,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823546,SUP,HCPCS C1713,,72823546  -  SCREW BN 15D 2.5MM 5MM 5.4MM 46MMX3.3MM VLP LCK LOPRFL HD,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823548,SUP,HCPCS C1713,,72823548  -  SCREW BN 15D 2.5MM 5MM 5.4MM 48MM VLP LCK LOPRFL HD HEX RCS,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823550,SUP,HCPCS C1713,,72823550  -  SCREW BN 15D 2.5MM 5MM 5.4MM 50MMX3.3MM VLP LCK LOPRFL HD,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823555,SUP,HCPCS C1713,,72823555  -  SCREW BN 15D 2.5MM 5MM 5.4MM 55MMX3.3MM VLP LCK LOPRFL HD,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823560,SUP,HCPCS C1713,,72823560  -  SCREW BN 15D 2.5MM 5MM 5.4MM 60MMX3.3MM VLP LCK LOPRFL HD,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
73804026,SUP,HCPCS C1713,,73804026  -  SCREW BN T20 3.5MM 26MM PRLC ST STRDR CORT,$48.83,$0.00,$48.83,$21.97,$34.85,$0.00,$8.41,$0.00,$0.00,$8.55,$48.83,$0.00,$24.41,$38.67,$39.06,$0.00,$7.64,$0.00,$7.77,$0.00
73804028,SUP,HCPCS C1713,,73804028  -  SCREW BN 3.5MM 28MM PRLC ST T20 STRDR RCS CORT,$48.83,$0.00,$48.83,$21.97,$34.85,$0.00,$8.41,$0.00,$0.00,$8.55,$48.83,$0.00,$24.41,$38.67,$39.06,$0.00,$7.64,$0.00,$7.77,$0.00
73804030,SUP,HCPCS C1713,,73804030  -  SCREW BN 3.5MM 30MM PRLC ST T20 STRDR RCS CORT,$48.83,$0.00,$48.83,$21.97,$34.85,$0.00,$8.41,$0.00,$0.00,$8.55,$48.83,$0.00,$24.41,$38.67,$39.06,$0.00,$7.64,$0.00,$7.77,$0.00
73804032,SUP,HCPCS C1713,,73804032  -  SCREW BN 3.5MM 32MM PRLC ST T20 STRDR RCS CORT,$48.83,$0.00,$48.83,$21.97,$34.85,$0.00,$8.41,$0.00,$0.00,$8.55,$48.83,$0.00,$24.41,$38.67,$39.06,$0.00,$7.64,$0.00,$7.77,$0.00
73804034,SUP,HCPCS C1713,,73804034  -  SCREW BN T20 3.5MM 34MM PRLC ST STRDR CORT,$48.83,$0.00,$48.83,$21.97,$34.85,$0.00,$8.41,$0.00,$0.00,$8.55,$48.83,$0.00,$24.41,$38.67,$39.06,$0.00,$7.64,$0.00,$7.77,$0.00
73804038,SUP,HCPCS C1713,,73804038  -  SCREW BN 3.5MM 38MM PRLC ST T20 STRDR RCS CORT,$48.83,$0.00,$48.83,$21.97,$34.85,$0.00,$8.41,$0.00,$0.00,$8.55,$48.83,$0.00,$24.41,$38.67,$39.06,$0.00,$7.64,$0.00,$7.77,$0.00
73804040,SUP,HCPCS C1713,,73804040  -  SCREW BN 3.5MM 40MM PRLC ST T20 STRDR RCS CORT,$48.83,$0.00,$48.83,$21.97,$34.85,$0.00,$8.41,$0.00,$0.00,$8.55,$48.83,$0.00,$24.41,$38.67,$39.06,$0.00,$7.64,$0.00,$7.77,$0.00
73804044,SUP,HCPCS C1713,,73804044  -  SCREW BN 3.5MM 44MM PRLC ST T20 STRDR RCS CORT,$48.83,$0.00,$48.83,$21.97,$34.85,$0.00,$8.41,$0.00,$0.00,$8.55,$48.83,$0.00,$24.41,$38.67,$39.06,$0.00,$7.64,$0.00,$7.77,$0.00
73804050,SUP,HCPCS C1713,,73804050  -  SCREW BN 3.5MM 50MM PRLC ST T20 STRDR RCS CORT,$48.83,$0.00,$48.83,$21.97,$34.85,$0.00,$8.41,$0.00,$0.00,$8.55,$48.83,$0.00,$24.41,$38.67,$39.06,$0.00,$7.64,$0.00,$7.77,$0.00
73805026,SUP,HCPCS C1713,,73805026  -  SCREW BN T20 3.5MM 26MM PRLC ST LCK,$254.10,$0.00,$254.10,$114.35,$181.35,$0.00,$43.78,$0.00,$0.00,$44.49,$254.10,$0.00,$127.05,$201.25,$203.28,$0.00,$39.77,$0.00,$40.45,$0.00
73805030,SUP,HCPCS C1713,,73805030  -  SCREW BN 3.5MM 30MM PRLC ST LCK T20 STRDR RCS SM BN LNG BN,$254.10,$0.00,$254.10,$114.35,$181.35,$0.00,$43.78,$0.00,$0.00,$44.49,$254.10,$0.00,$127.05,$201.25,$203.28,$0.00,$39.77,$0.00,$40.45,$0.00
73805065,SUP,HCPCS C1713,,73805065  -  SCREW BN 3.5MM 65MM PRLC ST LCK T20 STRDR RCS SM BN LNG BN,$292.95,$0.00,$292.95,$131.83,$209.08,$0.00,$50.47,$0.00,$0.00,$51.29,$292.95,$0.00,$146.48,$232.02,$234.36,$0.00,$45.85,$0.00,$46.64,$0.00
73805070,SUP,HCPCS C1713,,73805070  -  SCREW BN 3.5MM 70MM PRLC ST LCK T20 STRDR RCS SM BN LNG BN,$292.95,$0.00,$292.95,$131.83,$209.08,$0.00,$50.47,$0.00,$0.00,$51.29,$292.95,$0.00,$146.48,$232.02,$234.36,$0.00,$45.85,$0.00,$46.64,$0.00
73805075,SUP,HCPCS C1713,,73805075  -  SCREW BN 3.5MM 75MM PRLC ST LCK T20 STRDR RCS SM BN LNG BN,$292.95,$0.00,$292.95,$131.83,$209.08,$0.00,$50.47,$0.00,$0.00,$51.29,$292.95,$0.00,$146.48,$232.02,$234.36,$0.00,$45.85,$0.00,$46.64,$0.00
73805080,SUP,HCPCS C1713,,73805080  -  SCREW BN 3.5MM 80MM PRLC ST LCK T20 STRDR RCS SM BN LNG BN,$292.95,$0.00,$292.95,$131.83,$209.08,$0.00,$50.47,$0.00,$0.00,$51.29,$292.95,$0.00,$146.48,$232.02,$234.36,$0.00,$45.85,$0.00,$46.64,$0.00
73805230,SUP,HCPCS C1713,,73805230  -  SCREW BN FT 4MM 30MM PRLC T20 STRDR RCS CANC,$64.43,$0.00,$64.43,$28.99,$45.98,$0.00,$11.10,$0.00,$0.00,$11.28,$64.43,$0.00,$32.21,$51.03,$51.54,$0.00,$10.08,$0.00,$10.26,$0.00
73806024,SUP,HCPCS C1713,,73806024  -  SCREW BN 4.5MM 24MM PRLC ST T25 STRDR RCS FT/ANKL CORT,$48.83,$0.00,$48.83,$21.97,$34.85,$0.00,$8.41,$0.00,$0.00,$8.55,$48.83,$0.00,$24.41,$38.67,$39.06,$0.00,$7.64,$0.00,$7.77,$0.00
73806026,SUP,HCPCS C1713,,73806026  -  SCREW BN 4.5MM 26MM PRLC ST T25 STRDR RCS FT/ANKL CORT,$48.83,$0.00,$48.83,$21.97,$34.85,$0.00,$8.41,$0.00,$0.00,$8.55,$48.83,$0.00,$24.41,$38.67,$39.06,$0.00,$7.64,$0.00,$7.77,$0.00
73806028,SUP,HCPCS C1713,,73806028  -  SCREW BN 4.5MM 28MM PRLC ST T25 STRDR RCS FT/ANKL CORT,$48.83,$0.00,$48.83,$21.97,$34.85,$0.00,$8.41,$0.00,$0.00,$8.55,$48.83,$0.00,$24.41,$38.67,$39.06,$0.00,$7.64,$0.00,$7.77,$0.00
73806030,SUP,HCPCS C1713,,73806030  -  SCREW BN 4.5MM 30MM PRLC ST T25 STRDR RCS FT/ANKL CORT,$48.83,$0.00,$48.83,$21.97,$34.85,$0.00,$8.41,$0.00,$0.00,$8.55,$48.83,$0.00,$24.41,$38.67,$39.06,$0.00,$7.64,$0.00,$7.77,$0.00
73806034,SUP,HCPCS C1713,,73806034  -  SCREW BN 4.5MM 34MM PRLC ST T25 STRDR RCS FT/ANKL CORT,$48.83,$0.00,$48.83,$21.97,$34.85,$0.00,$8.41,$0.00,$0.00,$8.55,$48.83,$0.00,$24.41,$38.67,$39.06,$0.00,$7.64,$0.00,$7.77,$0.00
73806040,SUP,HCPCS C1713,,73806040  -  SCREW BN 4.5MM 40MM PRLC ST T25 STRDR RCS FT/ANKL CORT,$48.83,$0.00,$48.83,$21.97,$34.85,$0.00,$8.41,$0.00,$0.00,$8.55,$48.83,$0.00,$24.41,$38.67,$39.06,$0.00,$7.64,$0.00,$7.77,$0.00
73807060,SUP,HCPCS C1713,,73807060  -  SCREW BN 4.5MM 60MM PRLC ST LCK T25 STRDR RCS ANKL/FT,$298.20,$0.00,$298.20,$134.19,$212.83,$0.00,$51.38,$0.00,$0.00,$52.21,$298.20,$0.00,$149.10,$236.17,$238.56,$0.00,$46.67,$0.00,$47.47,$0.00
73807066,SUP,HCPCS C1713,,73807066  -  SCREW BN 4.5MM 66MM PRLC ST LCK T25 STRDR RCS ANKL/FT,$298.20,$0.00,$298.20,$134.19,$212.83,$0.00,$51.38,$0.00,$0.00,$52.21,$298.20,$0.00,$149.10,$236.17,$238.56,$0.00,$46.67,$0.00,$47.47,$0.00
73807070,SUP,HCPCS C1713,,73807070  -  SCREW BN 4.5MM 70MM PRLC ST LCK T25 STRDR RCS ANKL/FT,$298.20,$0.00,$298.20,$134.19,$212.83,$0.00,$51.38,$0.00,$0.00,$52.21,$298.20,$0.00,$149.10,$236.17,$238.56,$0.00,$46.67,$0.00,$47.47,$0.00
73807074,SUP,HCPCS C1713,,73807074  -  SCREW BN 4.5MM 74MM PRLC ST LCK T25 STRDR RCS ANKL/FT,$298.20,$0.00,$298.20,$134.19,$212.83,$0.00,$51.38,$0.00,$0.00,$52.21,$298.20,$0.00,$149.10,$236.17,$238.56,$0.00,$46.67,$0.00,$47.47,$0.00
73807076,SUP,HCPCS C1713,,73807076  -  SCREW BN 4.5MM 76MM PRLC ST LCK T25 STRDR RCS ANKL/FT,$298.20,$0.00,$298.20,$134.19,$212.83,$0.00,$51.38,$0.00,$0.00,$52.21,$298.20,$0.00,$149.10,$236.17,$238.56,$0.00,$46.67,$0.00,$47.47,$0.00
73807085,SUP,HCPCS C1713,,73807085  -  SCREW BN 4.5MM 85MM PRLC ST LCK T25 STRDR RCS ANKL/FT,$298.20,$0.00,$298.20,$134.19,$212.83,$0.00,$51.38,$0.00,$0.00,$52.21,$298.20,$0.00,$149.10,$236.17,$238.56,$0.00,$46.67,$0.00,$47.47,$0.00
73807090,SUP,HCPCS C1713,,73807090  -  SCREW BN 4.5MM 90MM PRLC ST LCK T25 STRDR RCS ANKL/FT,$309.75,$0.00,$309.75,$139.39,$221.07,$0.00,$53.37,$0.00,$0.00,$54.23,$309.75,$0.00,$154.88,$245.32,$247.80,$0.00,$48.48,$0.00,$49.31,$0.00
74132105,SUP,HCPCS C1713,,74132105  -  SCREW BN 6.5MM 105MM 22MM CNN CNCL P/T SS,$481.50,$0.00,$481.50,$216.68,$343.65,$0.00,$82.96,$0.00,$0.00,$84.31,$481.50,$0.00,$240.75,$381.35,$385.20,$0.00,$75.35,$0.00,$76.65,$0.00
74133070,SUP,HCPCS C1713,,74133070  -  SCREW BN FT 6.5MM 70MM CNN LCK SS,$554.63,$0.00,$554.63,$249.58,$395.84,$0.00,$95.56,$0.00,$0.00,$97.11,$554.63,$0.00,$277.31,$439.27,$443.70,$0.00,$86.80,$0.00,$88.30,$0.00
74133075,SUP,HCPCS C1713,,74133075  -  SCREW BN FT 6.5MM 75MM CNN LCK SS,$684.00,$0.00,$684.00,$307.80,$488.17,$0.00,$117.85,$0.00,$0.00,$119.76,$684.00,$0.00,$342.00,$541.73,$547.20,$0.00,$107.05,$0.00,$108.89,$0.00
74133080,SUP,HCPCS C1713,,74133080  -  SCREW BN FT 6.5MM 80MM CNN LCK SS,$684.00,$0.00,$684.00,$307.80,$488.17,$0.00,$117.85,$0.00,$0.00,$119.76,$684.00,$0.00,$342.00,$541.73,$547.20,$0.00,$107.05,$0.00,$108.89,$0.00
74133085,SUP,HCPCS C1713,,74133085  -  SCREW BN FT 6.5MM 85MM CNN LCK SS,$684.00,$0.00,$684.00,$307.80,$488.17,$0.00,$117.85,$0.00,$0.00,$119.76,$684.00,$0.00,$342.00,$541.73,$547.20,$0.00,$107.05,$0.00,$108.89,$0.00
74133411,SUP,HCPCS C1713,,74133411  -  PIN FX SHRT 4.5MM 80MM PRLC TRL,$480.00,$0.00,$480.00,$216.00,$342.58,$0.00,$82.70,$0.00,$0.00,$84.04,$480.00,$0.00,$240.00,$380.16,$384.00,$0.00,$75.12,$0.00,$76.42,$0.00
74133412,SUP,HCPCS C1713,,74133412  -  PIN FX 3.5MM 18MM PRLC,$520.00,$0.00,$520.00,$234.00,$371.12,$0.00,$89.59,$0.00,$0.00,$91.05,$520.00,$0.00,$260.00,$411.84,$416.00,$0.00,$81.38,$0.00,$82.78,$0.00
74133413,SUP,HCPCS C1713,,74133413  -  PIN FX SHRT 3.5MM 18MM PRLC PRV FX,$520.00,$0.00,$520.00,$234.00,$371.12,$0.00,$89.59,$0.00,$0.00,$91.05,$520.00,$0.00,$260.00,$411.84,$416.00,$0.00,$81.38,$0.00,$82.78,$0.00
74133420,SUP,Custom 27203010,,74133420  -  BIT DRL 2.7MM 358MM TARGETER,"$1,102.00",$0.00,"$1,102.00",$0.00,$786.50,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,102.00",$0.00,$551.00,$872.78,$881.60,$0.00,$0.00,$0.00,$0.00,$0.00
74133421,SUP,HCPCS C1713,,74133421  -  PIN FX SHRT 4.5MM 80MM PRLC TARGETER DRL TIP PRV FX,$520.00,$0.00,$520.00,$234.00,$371.12,$0.00,$89.59,$0.00,$0.00,$91.05,$520.00,$0.00,$260.00,$411.84,$416.00,$0.00,$81.38,$0.00,$82.78,$0.00
74133424,SUP,HCPCS C1713,,74133424  -  PLATE BN TLL PRLC CBL SDL,$363.38,$0.00,$363.38,$163.52,$259.34,$0.00,$62.61,$0.00,$0.00,$63.62,$363.38,$0.00,$181.69,$287.80,$290.70,$0.00,$56.87,$0.00,$57.85,$0.00
74133425,SUP,HCPCS C1713,,74133425  -  SCREW BN PRLC HL FIL,$492.00,$0.00,$492.00,$221.40,$351.14,$0.00,$84.77,$0.00,$0.00,$86.15,$492.00,$0.00,$246.00,$389.66,$393.60,$0.00,$77.00,$0.00,$78.33,$0.00
74402001,SUP,HCPCS C1713,,74402001  -  WASHER ORTH VLP 2 MM SCR,$146.00,$0.00,$146.00,$65.70,$104.20,$0.00,$25.16,$0.00,$0.00,$25.56,$146.00,$0.00,$73.00,$115.63,$116.80,$0.00,$22.85,$0.00,$23.24,$0.00
74402006,SUP,HCPCS C1713,,74402006  -  SCREW BN T6 2MM 6MM VLP ST TI FT CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402007,SUP,HCPCS C1713,,74402007  -  SCREW BN T6 2MM 7MM VLP ST TI FT CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402008,SUP,HCPCS C1713,,74402008  -  SCREW BN T6 2MM 8MM VLP ST TI FT CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402009,SUP,HCPCS C1713,,74402009  -  SCREW BN T6 2MM 9MM VLP ST TI FT CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402011,SUP,HCPCS C1713,,74402011  -  SCREW BN T6 2MM 11MM VLP ST TI CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402012,SUP,HCPCS C1713,,74402012  -  SCREW BN T6 2MM 12MM VLP ST TI CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402013,SUP,HCPCS C1713,,74402013  -  SCREW BN T6 2MM 13MM VLP ST TI FT CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402014,SUP,HCPCS C1713,,74402014  -  SCREW BN T6 2MM 14MM VLP ST TI FT CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402015,SUP,HCPCS C1713,,74402015  -  SCREW BN T6 2MM 15MM VLP ST TI FT CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402016,SUP,HCPCS C1713,,74402016  -  SCREW BN T6 2MM 16MM VLP ST TI CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402017,SUP,HCPCS C1713,,74402017  -  SCREW BN T6 2MM 17MM VLP ST TI FT CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402018,SUP,HCPCS C1713,,74402018  -  SCREW BN T6 2MM 18MM VLP ST TI FT CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402019,SUP,HCPCS C1713,,74402019  -  SCREW BN T6 2MM 19MM VLP ST TI FT CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402020,SUP,HCPCS C1713,,74402020  -  SCREW BN T6 2MM 20MM VLP ST TI FT CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402021,SUP,HCPCS C1713,,74402021  -  SCREW BN T6 2MM 21MM VLP ST TI FT CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402022,SUP,HCPCS C1713,,74402022  -  SCREW BN T6 2MM 22MM VLP ST TI FT CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402023,SUP,HCPCS C1713,,74402023  -  SCREW BN T6 2MM 23MM VLP ST TI FT CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402024,SUP,HCPCS C1713,,74402024  -  SCREW BN T6 2MM 24MM VLP ST TI FT CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402026,SUP,HCPCS C1713,,74402026  -  SCREW BN T6 2MM 26MM VLP ST TI FT CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402028,SUP,HCPCS C1713,,74402028  -  SCREW BN T6 2MM 28MM VLP ST TI FT CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402030,SUP,HCPCS C1713,,74402030  -  SCREW BN T6 2MM 30MM VLP ST TI FT CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402032,SUP,HCPCS C1713,,74402032  -  SCREW BN T6 2MM 32MM VLP ST TI FT CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402034,SUP,HCPCS C1713,,74402034  -  SCREW BN T6 2MM 34MM VLP ST TI FT CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402036,SUP,HCPCS C1713,,74402036  -  SCREW BN T6 2MM 36MM VLP ST TI FT CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402038,SUP,HCPCS C1713,,74402038  -  SCREW BN T6 2MM 38MM VLP ST TI FT CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402040,SUP,HCPCS C1713,,74402040  -  SCREW BN T6 2MM 40MM VLP ST TI FT CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402401,SUP,HCPCS C1713,,74402401  -  WASHER ORTH VLP 2.4 MM T7 SCR,$146.00,$0.00,$146.00,$65.70,$104.20,$0.00,$25.16,$0.00,$0.00,$25.56,$146.00,$0.00,$73.00,$115.63,$116.80,$0.00,$22.85,$0.00,$23.24,$0.00
74402406,SUP,HCPCS C1713,,74402406  -  SCREW BN T7 2.4MM 6MM VLP ST TI FT CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402407,SUP,HCPCS C1713,,74402407  -  SCREW BN T7 2.4MM 7MM VLP ST TI FT CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402408,SUP,HCPCS C1713,,74402408  -  SCREW BN T7 2.4MM 8MM VLP ST TI FT CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402409,SUP,HCPCS C1713,,74402409  -  SCREW BN T7 2.4MM 9MM VLP ST TI FT CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402410,SUP,HCPCS C1713,,74402410  -  SCREW BN T7 2.4MM 10MM VLP ST TI FT CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402411,SUP,HCPCS C1713,,74402411  -  SCREW BN T7 2.4MM 11MM VLP ST TI FT CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402412,SUP,HCPCS C1713,,74402412  -  SCREW BN T7 2.4MM 12MM VLP ST TI FT CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402413,SUP,HCPCS C1713,,74402413  -  SCREW BN T7 2.4MM 13MM VLP ST TI FT CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402414,SUP,HCPCS C1713,,74402414  -  SCREW BN T7 2.4MM 14MM VLP ST TI FT CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402415,SUP,HCPCS C1713,,74402415  -  SCREW BN T7 2.4MM 15MM VLP ST TI FT CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402416,SUP,HCPCS C1713,,74402416  -  SCREW BN T7 2.4MM 16MM VLP ST TI FT CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402417,SUP,HCPCS C1713,,74402417  -  SCREW BN T7 2.4MM 17MM VLP ST TI FT CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402418,SUP,HCPCS C1713,,74402418  -  SCREW BN T7 2.4MM 18MM VLP ST TI FT CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402419,SUP,HCPCS C1713,,74402419  -  SCREW BN T7 2.4MM 19MM VLP ST TI FT CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402420,SUP,HCPCS C1713,,74402420  -  SCREW BN T7 2.4MM 20MM VLP ST TI FT CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402421,SUP,HCPCS C1713,,74402421  -  SCREW BN T7 2.4MM 21MM VLP ST TI FT CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402422,SUP,HCPCS C1713,,74402422  -  SCREW BN T7 2.4MM 22MM VLP ST TI FT CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402423,SUP,HCPCS C1713,,74402423  -  SCREW BN T7 2.4MM 23MM VLP ST TI FT CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402424,SUP,HCPCS C1713,,74402424  -  SCREW BN T7 2.4MM 24MM VLP ST TI FT CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402426,SUP,HCPCS C1713,,74402426  -  SCREW BN T7 2.4MM 26MM VLP ST TI FT CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402428,SUP,HCPCS C1713,,74402428  -  SCREW BN T7 2.4MM 28MM VLP ST TI FT CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402430,SUP,HCPCS C1713,,74402430  -  SCREW BN T7 2.4MM 30MM VLP ST TI FT CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402434,SUP,HCPCS C1713,,74402434  -  SCREW BN T7 2.4MM 34MM VLP ST TI FT CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402438,SUP,HCPCS C1713,,74402438  -  SCREW BN T7 2.4MM 38MM VLP ST TI FT CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402440,SUP,HCPCS C1713,,74402440  -  SCREW BN T7 2.4MM 40MM VLP ST TI FT CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402442,SUP,HCPCS C1713,,74402442  -  SCREW BN T7 2.4MM 42MM VLP ST TI FT CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402444,SUP,HCPCS C1713,,74402444  -  SCREW BN T7 2.4MM 44MM VLP ST TI FT CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402446,SUP,HCPCS C1713,,74402446  -  SCREW BN T7 2.4MM 46MM VLP ST TI FT CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402448,SUP,HCPCS C1713,,74402448  -  SCREW BN T7 2.4MM 48MM VLP ST TI FT CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402450,SUP,HCPCS C1713,,74402450  -  SCREW BN T7 2.4MM 50MM VLP ST TI FT CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402455,SUP,HCPCS C1713,,74402455  -  SCREW BN T7 2.4MM 55MM VLP ST TI FT CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402460,SUP,HCPCS C1713,,74402460  -  SCREW BN T7 2.4MM 60MM VLP ST TI FT CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402465,SUP,HCPCS C1713,,74402465  -  SCREW BN T7 2.4MM 65MM VLP ST TI FT CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402470,SUP,HCPCS C1713,,74402470  -  SCREW BN T7 2.4MM 70MM VLP ST TI FT CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402475,SUP,HCPCS C1713,,74402475  -  SCREW BN T7 2.4MM 75MM VLP ST TI FT CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402480,SUP,HCPCS C1713,,74402480  -  SCREW BN T7 2.4MM 80MM VLP ST TI FT CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74412007,SUP,HCPCS C1713,,74412007  -  SCREW BN T6 2MM 7MM VLP LCK ST TI FT,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412008,SUP,HCPCS C1713,,74412008  -  SCREW BN T6 2MM 8MM VLP LCK ST TI FT,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412011,SUP,HCPCS C1713,,74412011  -  SCREW BN T6 2MM 11MM VLP LCK ST TI,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412012,SUP,HCPCS C1713,,74412012  -  SCREW BN T6 2MM 12MM NS VLP LCK ST TI SM BN LNG BN,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412014,SUP,HCPCS C1713,,74412014  -  SCREW BN T6 2MM 14MM VLP LCK ST TI FT,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412015,SUP,HCPCS C1713,,74412015  -  SCREW BN T6 2MM 15MM VLP LCK ST TI FT,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412016,SUP,HCPCS C1713,,74412016  -  SCREW BN T6 2MM 16MM VLP LCK ST TI FT,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412017,SUP,HCPCS C1713,,74412017  -  SCREW BN T6 2MM 17MM VLP LCK ST TI FT,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412018,SUP,HCPCS C1713,,74412018  -  SCREW BN T6 2MM 18MM VLP LCK ST TI FT,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412019,SUP,HCPCS C1713,,74412019  -  SCREW BN T6 2MM 19MM VLP LCK ST TI FT,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412020,SUP,HCPCS C1713,,74412020  -  SCREW BN T6 2MM 20MM VLP LCK ST TI FT,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412021,SUP,HCPCS C1713,,74412021  -  SCREW BN T6 2MM 21MM VLP LCK ST TI FT,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412022,SUP,HCPCS C1713,,74412022  -  SCREW BN T6 2MM 22MM VLP LCK ST TI FT,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412023,SUP,HCPCS C1713,,74412023  -  SCREW BN T6 2MM 23MM VLP LCK ST TI FT,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412024,SUP,HCPCS C1713,,74412024  -  SCREW BN T6 2MM 24MM VLP LCK ST TI FT,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412026,SUP,HCPCS C1713,,74412026  -  SCREW BN T6 2MM 26MM VLP LCK ST TI FT,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412028,SUP,HCPCS C1713,,74412028  -  SCREW BN T6 2MM 28MM VLP LCK ST TI FT,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412030,SUP,HCPCS C1713,,74412030  -  SCREW BN T6 2MM 30MM VLP LCK ST TI FT,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412032,SUP,HCPCS C1713,,74412032  -  SCREW BN T6 2MM 32MM VLP LCK ST TI FT,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412034,SUP,HCPCS C1713,,74412034  -  SCREW BN T6 2MM 34MM VLP LCK ST TI FT,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412036,SUP,HCPCS C1713,,74412036  -  SCREW BN T6 2MM 36MM VLP LCK ST TI FT,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412038,SUP,HCPCS C1713,,74412038  -  SCREW BN T6 2MM 38MM VLP LCK ST TI FT,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412040,SUP,HCPCS C1713,,74412040  -  SCREW BN T6 2MM 40MM VLP LCK ST TI FT,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412406,SUP,HCPCS C1713,,74412406  -  SCREW BN T7 2.4MM 6MM VLP LCK ST TI FT,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412407,SUP,HCPCS C1713,,74412407  -  SCREW BN T7 2.4MM 7MM VLP LCK ST TI FT,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412408,SUP,HCPCS C1713,,74412408  -  SCREW BN T7 2.4MM 8MM VLP LCK ST TI FT,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412409,SUP,HCPCS C1713,,74412409  -  SCREW BN T7 2.4MM 9MM VLP LCK ST TI FT,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412410,SUP,HCPCS C1713,,74412410  -  SCREW BN T7 2.4MM 10MM VLP LCK ST TI FT,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412411,SUP,HCPCS C1713,,74412411  -  SCREW BN T7 2.4MM 11MM VLP LCK ST TI FT,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412412,SUP,HCPCS C1713,,74412412  -  SCREW BN T7 2.4MM 12MM VLP LCK ST TI FT,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412413,SUP,HCPCS C1713,,74412413  -  SCREW BN 2.4MM 13MM VLP LCK ST T7 DRVR TI FT,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412414,SUP,HCPCS C1713,,74412414  -  SCREW BN 2.4MM 14MM VLP LCK ST T7 DRVR TI FT,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412415,SUP,HCPCS C1713,,74412415  -  SCREW BN T7 2.4MM 15MM VLP LCK ST TI FT,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412416,SUP,HCPCS C1713,,74412416  -  SCREW BN T7 2.4MM 16MM VLP LCK ST TI FT,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412417,SUP,HCPCS C1713,,74412417  -  SCREW BN T7 2.4MM 17MM VLP LCK ST TI FT,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412418,SUP,HCPCS C1713,,74412418  -  SCREW BN 2.4MM 18MM VLP LCK ST T7 DRVR TI FT,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412419,SUP,HCPCS C1713,,74412419  -  SCREW BN T7 2.4MM 19MM VLP LCK ST TI FT,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412420,SUP,HCPCS C1713,,74412420  -  SCREW BN T7 2.4MM 20MM VLP LCK ST TI FT,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412421,SUP,HCPCS C1713,,74412421  -  SCREW BN T7 2.4MM 21MM VLP LCK ST TI FT,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412422,SUP,HCPCS C1713,,74412422  -  SCREW BN 2.4MM 22MM VLP LCK ST T7 DRVR TI FT,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412423,SUP,HCPCS C1713,,74412423  -  SCREW BN T7 2.4MM 23MM VLP LCK ST TI FT,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412424,SUP,HCPCS C1713,,74412424  -  SCREW BN T7 2.4MM 24MM VLP LCK ST TI FT,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412426,SUP,HCPCS C1713,,74412426  -  SCREW BN T7 2.4MM 26MM VLP LCK ST TI FT,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412428,SUP,HCPCS C1713,,74412428  -  SCREW BN T7 2.4MM 28MM VLP LCK ST TI FT,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412430,SUP,HCPCS C1713,,74412430  -  SCREW BN T7 2.4MM 30MM VLP LCK ST TI FT,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412432,SUP,HCPCS C1713,,74412432  -  SCREW BN T7 2.4MM 32MM VLP LCK ST TI FT,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412434,SUP,HCPCS C1713,,74412434  -  SCREW BN T7 2.4MM 34MM VLP LCK ST TI FT,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412436,SUP,HCPCS C1713,,74412436  -  SCREW BN T7 2.4MM 36MM VLP LCK ST TI FT,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412438,SUP,HCPCS C1713,,74412438  -  SCREW BN T7 2.4MM 38MM VLP LCK ST TI FT,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412440,SUP,HCPCS C1713,,74412440  -  SCREW BN T7 2.4MM 40MM VLP LCK ST TI FT,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412442,SUP,HCPCS C1713,,74412442  -  SCREW BN T7 2.4MM 42MM VLP LCK ST TI FT,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412444,SUP,HCPCS C1713,,74412444  -  SCREW BN T7 2.4MM 44MM VLP LCK ST TI FT,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412446,SUP,HCPCS C1713,,74412446  -  SCREW BN T7 2.4MM 46MM VLP LCK ST TI FT,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412448,SUP,HCPCS C1713,,74412448  -  SCREW BN T7 2.4MM 48MM VLP LCK ST TI FT,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412450,SUP,HCPCS C1713,,74412450  -  SCREW BN T7 2.4MM 50MM VLP LCK ST TI FT,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412455,SUP,HCPCS C1713,,74412455  -  SCREW BN T7 2.4MM 55MM VLP LCK ST TI FT,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412460,SUP,HCPCS C1713,,74412460  -  SCREW BN T7 2.4MM 60MM VLP LCK ST TI FT,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412465,SUP,HCPCS C1713,,74412465  -  SCREW BN T7 2.4MM 65MM VLP LCK ST TI FT,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412470,SUP,HCPCS C1713,,74412470  -  SCREW BN T7 2.4MM 70MM VLP LCK ST TI FT,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412475,SUP,HCPCS C1713,,74412475  -  SCREW BN T7 2.4MM 75MM VLP LCK ST TI FT,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412480,SUP,HCPCS C1713,,74412480  -  SCREW BN T7 2.4MM 80MM VLP LCK ST TI FT,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74423010,SUP,HCPCS C1713,,74423010  -  SCREW BN T7 3MM 10MM VLP TI FT OSTEOPENIA,$176.00,$0.00,$176.00,$79.20,$125.61,$0.00,$30.32,$0.00,$0.00,$30.82,$176.00,$0.00,$88.00,$139.39,$140.80,$0.00,$27.54,$0.00,$28.02,$0.00
74423012,SUP,HCPCS C1713,,74423012  -  SCREW BN T7 3MM 12MM VLP TI FT OSTEOPENIA,$176.00,$0.00,$176.00,$79.20,$125.61,$0.00,$30.32,$0.00,$0.00,$30.82,$176.00,$0.00,$88.00,$139.39,$140.80,$0.00,$27.54,$0.00,$28.02,$0.00
74423014,SUP,HCPCS C1713,,74423014  -  SCREW BN T7 3MM 14MM VLP TI FT OSTEOPENIA,$176.00,$0.00,$176.00,$79.20,$125.61,$0.00,$30.32,$0.00,$0.00,$30.82,$176.00,$0.00,$88.00,$139.39,$140.80,$0.00,$27.54,$0.00,$28.02,$0.00
74423016,SUP,HCPCS C1713,,74423016  -  SCREW BN T7 3MM 16MM VLP TI FT OSTEOPENIA,$176.00,$0.00,$176.00,$79.20,$125.61,$0.00,$30.32,$0.00,$0.00,$30.82,$176.00,$0.00,$88.00,$139.39,$140.80,$0.00,$27.54,$0.00,$28.02,$0.00
74423018,SUP,HCPCS C1713,,74423018  -  SCREW BN T7 3MM 18MM VLP TI FT OSTEOPENIA,$176.00,$0.00,$176.00,$79.20,$125.61,$0.00,$30.32,$0.00,$0.00,$30.82,$176.00,$0.00,$88.00,$139.39,$140.80,$0.00,$27.54,$0.00,$28.02,$0.00
74423020,SUP,HCPCS C1713,,74423020  -  SCREW BN T7 3MM 20MM VLP TI FT OSTEOPENIA,$176.00,$0.00,$176.00,$79.20,$125.61,$0.00,$30.32,$0.00,$0.00,$30.82,$176.00,$0.00,$88.00,$139.39,$140.80,$0.00,$27.54,$0.00,$28.02,$0.00
74423022,SUP,HCPCS C1713,,74423022  -  SCREW BN T7 3MM 22MM VLP TI FT OSTEOPENIA,$176.00,$0.00,$176.00,$79.20,$125.61,$0.00,$30.32,$0.00,$0.00,$30.82,$176.00,$0.00,$88.00,$139.39,$140.80,$0.00,$27.54,$0.00,$28.02,$0.00
74423024,SUP,HCPCS C1713,,74423024  -  SCREW BN T7 3MM 24MM VLP TI FT OSTEOPENIA,$176.00,$0.00,$176.00,$79.20,$125.61,$0.00,$30.32,$0.00,$0.00,$30.82,$176.00,$0.00,$88.00,$139.39,$140.80,$0.00,$27.54,$0.00,$28.02,$0.00
74423026,SUP,HCPCS C1713,,74423026  -  SCREW BN T7 3MM 26MM VLP TI FT OSTEOPENIA,$176.00,$0.00,$176.00,$79.20,$125.61,$0.00,$30.32,$0.00,$0.00,$30.82,$176.00,$0.00,$88.00,$139.39,$140.80,$0.00,$27.54,$0.00,$28.02,$0.00
74423028,SUP,HCPCS C1713,,74423028  -  SCREW BN T7 3MM 28MM VLP TI FT OSTEOPENIA,$176.00,$0.00,$176.00,$79.20,$125.61,$0.00,$30.32,$0.00,$0.00,$30.82,$176.00,$0.00,$88.00,$139.39,$140.80,$0.00,$27.54,$0.00,$28.02,$0.00
74423030,SUP,HCPCS C1713,,74423030  -  SCREW BN T7 3MM 30MM VLP TI FT OSTEOPENIA,$176.00,$0.00,$176.00,$79.20,$125.61,$0.00,$30.32,$0.00,$0.00,$30.82,$176.00,$0.00,$88.00,$139.39,$140.80,$0.00,$27.54,$0.00,$28.02,$0.00
74423032,SUP,HCPCS C1713,,74423032  -  SCREW BN T7 3MM 32MM VLP TI FT OSTEOPENIA,$176.00,$0.00,$176.00,$79.20,$125.61,$0.00,$30.32,$0.00,$0.00,$30.82,$176.00,$0.00,$88.00,$139.39,$140.80,$0.00,$27.54,$0.00,$28.02,$0.00
74423034,SUP,HCPCS C1713,,74423034  -  SCREW BN T7 3MM 34MM VLP TI FT OSTEOPENIA,$176.00,$0.00,$176.00,$79.20,$125.61,$0.00,$30.32,$0.00,$0.00,$30.82,$176.00,$0.00,$88.00,$139.39,$140.80,$0.00,$27.54,$0.00,$28.02,$0.00
74423036,SUP,HCPCS C1713,,74423036  -  SCREW BN T7 3MM 36MM VLP TI FT OSTEOPENIA,$176.00,$0.00,$176.00,$79.20,$125.61,$0.00,$30.32,$0.00,$0.00,$30.82,$176.00,$0.00,$88.00,$139.39,$140.80,$0.00,$27.54,$0.00,$28.02,$0.00
74423038,SUP,HCPCS C1713,,74423038  -  SCREW BN T7 3MM 38MM VLP TI FT OSTEOPENIA,$176.00,$0.00,$176.00,$79.20,$125.61,$0.00,$30.32,$0.00,$0.00,$30.82,$176.00,$0.00,$88.00,$139.39,$140.80,$0.00,$27.54,$0.00,$28.02,$0.00
74423040,SUP,HCPCS C1713,,74423040  -  SCREW BN T7 3MM 40MM VLP TI FT OSTEOPENIA,$176.00,$0.00,$176.00,$79.20,$125.61,$0.00,$30.32,$0.00,$0.00,$30.82,$176.00,$0.00,$88.00,$139.39,$140.80,$0.00,$27.54,$0.00,$28.02,$0.00
74423042,SUP,HCPCS C1713,,74423042  -  SCREW BN T7 3MM 42MM VLP TI FT OSTEOPENIA,$176.00,$0.00,$176.00,$79.20,$125.61,$0.00,$30.32,$0.00,$0.00,$30.82,$176.00,$0.00,$88.00,$139.39,$140.80,$0.00,$27.54,$0.00,$28.02,$0.00
74423044,SUP,HCPCS C1713,,74423044  -  SCREW BN T7 3MM 44MM VLP TI FT OSTEOPENIA,$176.00,$0.00,$176.00,$79.20,$125.61,$0.00,$30.32,$0.00,$0.00,$30.82,$176.00,$0.00,$88.00,$139.39,$140.80,$0.00,$27.54,$0.00,$28.02,$0.00
74423046,SUP,HCPCS C1713,,74423046  -  SCREW BN T7 3MM 46MM VLP TI FT OSTEOPENIA,$176.00,$0.00,$176.00,$79.20,$125.61,$0.00,$30.32,$0.00,$0.00,$30.82,$176.00,$0.00,$88.00,$139.39,$140.80,$0.00,$27.54,$0.00,$28.02,$0.00
74423048,SUP,HCPCS C1713,,74423048  -  SCREW BN T7 3MM 48MM VLP TI FT OSTEOPENIA,$176.00,$0.00,$176.00,$79.20,$125.61,$0.00,$30.32,$0.00,$0.00,$30.82,$176.00,$0.00,$88.00,$139.39,$140.80,$0.00,$27.54,$0.00,$28.02,$0.00
74423050,SUP,HCPCS C1713,,74423050  -  SCREW BN T7 3MM 50MM VLP TI FT OSTEOPENIA,$176.00,$0.00,$176.00,$79.20,$125.61,$0.00,$30.32,$0.00,$0.00,$30.82,$176.00,$0.00,$88.00,$139.39,$140.80,$0.00,$27.54,$0.00,$28.02,$0.00
74423055,SUP,HCPCS C1713,,74423055  -  SCREW BN T7 3MM 55MM VLP TI FT OSTEOPENIA,$176.00,$0.00,$176.00,$79.20,$125.61,$0.00,$30.32,$0.00,$0.00,$30.82,$176.00,$0.00,$88.00,$139.39,$140.80,$0.00,$27.54,$0.00,$28.02,$0.00
74423060,SUP,HCPCS C1713,,74423060  -  SCREW BN T7 3MM 60MM VLP TI FT OSTEOPENIA,$176.00,$0.00,$176.00,$79.20,$125.61,$0.00,$30.32,$0.00,$0.00,$30.82,$176.00,$0.00,$88.00,$139.39,$140.80,$0.00,$27.54,$0.00,$28.02,$0.00
74423065,SUP,HCPCS C1713,,74423065  -  SCREW BN T7 3MM 65MM VLP TI FT OSTEOPENIA,$176.00,$0.00,$176.00,$79.20,$125.61,$0.00,$30.32,$0.00,$0.00,$30.82,$176.00,$0.00,$88.00,$139.39,$140.80,$0.00,$27.54,$0.00,$28.02,$0.00
74423070,SUP,HCPCS C1713,,74423070  -  SCREW BN T7 3MM 70MM VLP TI FT OSTEOPENIA,$176.00,$0.00,$176.00,$79.20,$125.61,$0.00,$30.32,$0.00,$0.00,$30.82,$176.00,$0.00,$88.00,$139.39,$140.80,$0.00,$27.54,$0.00,$28.02,$0.00
74423075,SUP,HCPCS C1713,,74423075  -  SCREW BN T7 3MM 75MM VLP TI FT OSTEOPENIA,$176.00,$0.00,$176.00,$79.20,$125.61,$0.00,$30.32,$0.00,$0.00,$30.82,$176.00,$0.00,$88.00,$139.39,$140.80,$0.00,$27.54,$0.00,$28.02,$0.00
74423080,SUP,HCPCS C1713,,74423080  -  SCREW BN T7 3MM 80MM VLP TI FT OSTEOPENIA,$176.00,$0.00,$176.00,$79.20,$125.61,$0.00,$30.32,$0.00,$0.00,$30.82,$176.00,$0.00,$88.00,$139.39,$140.80,$0.00,$27.54,$0.00,$28.02,$0.00
74442010,SUP,HCPCS C1713,,74442010  -  PLATE BN Y VLP MN-MOD 6 HL 2MM SCR,"$1,608.75",$0.00,"$1,608.75",$723.94,"$1,148.16",$0.00,$277.18,$0.00,$0.00,$281.68,"$1,608.75",$0.00,$804.38,"$1,274.13","$1,287.00",$0.00,$251.77,$0.00,$256.11,$0.00
74442012,SUP,HCPCS C1713,,74442012  -  PLATE BN Y VLP MN-MOD 8 HL 2MM SCR,"$1,925.00",$0.00,"$1,925.00",$866.25,"$1,373.87",$0.00,$331.67,$0.00,$0.00,$337.05,"$1,925.00",$0.00,$962.50,"$1,524.60","$1,540.00",$0.00,$301.26,$0.00,$306.46,$0.00
74442014,SUP,HCPCS C1713,,74442014  -  PLATE BN T VLP MN-MOD 2X6 HL 2MM SCR,"$1,124.75",$0.00,"$1,124.75",$506.14,$802.73,$0.00,$193.79,$0.00,$0.00,$196.93,"$1,124.75",$0.00,$562.38,$890.80,$899.80,$0.00,$176.02,$0.00,$179.06,$0.00
74442016,SUP,HCPCS C1713,,74442016  -  PLATE BN T 1.2MM VLP MN-MOD 2 HLE/HD 8 HL SHFT TI SM BN 2MM,"$1,443.75",$0.00,"$1,443.75",$649.69,"$1,030.40",$0.00,$248.75,$0.00,$0.00,$252.79,"$1,443.75",$0.00,$721.88,"$1,143.45","$1,155.00",$0.00,$225.95,$0.00,$229.85,$0.00
74442018,SUP,HCPCS C1713,,74442018  -  PLATE BN T VLP MN-MOD 3X6 HL 2MM SCR,"$1,608.75",$0.00,"$1,608.75",$723.94,"$1,148.16",$0.00,$277.18,$0.00,$0.00,$281.68,"$1,608.75",$0.00,$804.38,"$1,274.13","$1,287.00",$0.00,$251.77,$0.00,$256.11,$0.00
74442020,SUP,HCPCS C1713,,74442020  -  PLATE BN T VLP MN-MOD 3X8 HL 2MM SCR,"$1,925.00",$0.00,"$1,925.00",$866.25,"$1,373.87",$0.00,$331.67,$0.00,$0.00,$337.05,"$1,925.00",$0.00,$962.50,"$1,524.60","$1,540.00",$0.00,$301.26,$0.00,$306.46,$0.00
74442022,SUP,HCPCS C1713,,74442022  -  PLATE BN STRG VLP MN-MOD 6 HL 2MM SCR,$965.25,$0.00,$965.25,$434.36,$688.90,$0.00,$166.31,$0.00,$0.00,$169.01,$965.25,$0.00,$482.63,$764.48,$772.20,$0.00,$151.06,$0.00,$153.67,$0.00
74442024,SUP,HCPCS C1713,,74442024  -  PLATE BN STRG VLP MN-MOD 8 HL 2MM SCR,"$1,285.63",$0.00,"$1,285.63",$578.53,$917.55,$0.00,$221.51,$0.00,$0.00,$225.10,"$1,285.63",$0.00,$642.81,"$1,018.22","$1,028.50",$0.00,$201.20,$0.00,$204.67,$0.00
74442028,SUP,HCPCS C1713,,74442028  -  PLATE BN STOUT VLP MN-MOD 6 HL 2MM SCR,"$1,124.75",$0.00,"$1,124.75",$506.14,$802.73,$0.00,$193.79,$0.00,$0.00,$196.93,"$1,124.75",$0.00,$562.38,$890.80,$899.80,$0.00,$176.02,$0.00,$179.06,$0.00
74442030,SUP,HCPCS C1713,,74442030  -  PLATE BN STOUT VLP MN-MOD 8 HL 2MM SCR,"$1,443.75",$0.00,"$1,443.75",$649.69,"$1,030.40",$0.00,$248.75,$0.00,$0.00,$252.79,"$1,443.75",$0.00,$721.88,"$1,143.45","$1,155.00",$0.00,$225.95,$0.00,$229.85,$0.00
74442410,SUP,HCPCS C1713,,74442410  -  PLATE BN Y VLP MN-MOD 6 HL 2.4MM SCR,"$1,608.75",$0.00,"$1,608.75",$723.94,"$1,148.16",$0.00,$277.18,$0.00,$0.00,$281.68,"$1,608.75",$0.00,$804.38,"$1,274.13","$1,287.00",$0.00,$251.77,$0.00,$256.11,$0.00
74442412,SUP,HCPCS C1713,,74442412  -  PLATE BN Y VLP MN-MOD 8 HL 2.4MM SCR,"$1,925.00",$0.00,"$1,925.00",$866.25,"$1,373.87",$0.00,$331.67,$0.00,$0.00,$337.05,"$1,925.00",$0.00,$962.50,"$1,524.60","$1,540.00",$0.00,$301.26,$0.00,$306.46,$0.00
74442414,SUP,HCPCS C1713,,74442414  -  PLATE BN T VLP MN-MOD 2X6 HL SM BN 2.4MM,"$1,124.75",$0.00,"$1,124.75",$506.14,$802.73,$0.00,$193.79,$0.00,$0.00,$196.93,"$1,124.75",$0.00,$562.38,$890.80,$899.80,$0.00,$176.02,$0.00,$179.06,$0.00
74442416,SUP,HCPCS C1713,,74442416  -  PLATE BN T VLP MN-MOD 2X8 HL 2.4MM SCR,"$1,443.75",$0.00,"$1,443.75",$649.69,"$1,030.40",$0.00,$248.75,$0.00,$0.00,$252.79,"$1,443.75",$0.00,$721.88,"$1,143.45","$1,155.00",$0.00,$225.95,$0.00,$229.85,$0.00
74442418,SUP,HCPCS C1713,,74442418  -  PLATE BN T VLP MN-MOD 3X6 HL 2.4MM SCR,"$1,608.75",$0.00,"$1,608.75",$723.94,"$1,148.16",$0.00,$277.18,$0.00,$0.00,$281.68,"$1,608.75",$0.00,$804.38,"$1,274.13","$1,287.00",$0.00,$251.77,$0.00,$256.11,$0.00
74442420,SUP,HCPCS C1713,,74442420  -  PLATE BN T VLP MN-MOD 3X8 HL 2.4MM SCR,"$1,925.00",$0.00,"$1,925.00",$866.25,"$1,373.87",$0.00,$331.67,$0.00,$0.00,$337.05,"$1,925.00",$0.00,$962.50,"$1,524.60","$1,540.00",$0.00,$301.26,$0.00,$306.46,$0.00
74442422,SUP,HCPCS C1713,,74442422  -  PLATE BN STRG VLP MN-MOD 6 HL 2.4MM SCR,$965.25,$0.00,$965.25,$434.36,$688.90,$0.00,$166.31,$0.00,$0.00,$169.01,$965.25,$0.00,$482.63,$764.48,$772.20,$0.00,$151.06,$0.00,$153.67,$0.00
74442424,SUP,HCPCS C1713,,74442424  -  PLATE BN STRG VLP MN-MOD 8 HL 2.4MM SCR,"$1,285.63",$0.00,"$1,285.63",$578.53,$917.55,$0.00,$221.51,$0.00,$0.00,$225.10,"$1,285.63",$0.00,$642.81,"$1,018.22","$1,028.50",$0.00,$201.20,$0.00,$204.67,$0.00
74442426,SUP,HCPCS C1713,,74442426  -  PLATE BN STRG VLP MN-MOD 12 HL 2.4MM SCR,"$1,925.00",$0.00,"$1,925.00",$866.25,"$1,373.87",$0.00,$331.67,$0.00,$0.00,$337.05,"$1,925.00",$0.00,$962.50,"$1,524.60","$1,540.00",$0.00,$301.26,$0.00,$306.46,$0.00
74442428,SUP,HCPCS C1713,,74442428  -  PLATE BN VLP MN-MOD 12X3 HL MESH 2.4 MM SCR,"$2,413.13",$0.00,"$2,413.13","$1,085.91","$1,722.25",$0.00,$415.77,$0.00,$0.00,$422.52,"$2,413.13",$0.00,"$1,206.56","$1,911.20","$1,930.50",$0.00,$377.65,$0.00,$384.17,$0.00
74442430,SUP,HCPCS C1713,,74442430  -  PLATE BN STOUT VLP MN-MOD 6 HL 2.4MM SCR,"$1,124.75",$0.00,"$1,124.75",$506.14,$802.73,$0.00,$193.79,$0.00,$0.00,$196.93,"$1,124.75",$0.00,$562.38,$890.80,$899.80,$0.00,$176.02,$0.00,$179.06,$0.00
74442432,SUP,HCPCS C1713,,74442432  -  PLATE BN STOUT VLP MN-MOD 8 HL 2.4MM SCR,"$1,443.75",$0.00,"$1,443.75",$649.69,"$1,030.40",$0.00,$248.75,$0.00,$0.00,$252.79,"$1,443.75",$0.00,$721.88,"$1,143.45","$1,155.00",$0.00,$225.95,$0.00,$229.85,$0.00
74442434,SUP,HCPCS C1713,,74442434  -  PLATE BN STOUT VLP MN-MOD 12 HL 2.4MM SCR,"$1,766.88",$0.00,"$1,766.88",$795.09,"$1,261.02",$0.00,$304.42,$0.00,$0.00,$309.37,"$1,766.88",$0.00,$883.44,"$1,399.37","$1,413.50",$0.00,$276.52,$0.00,$281.29,$0.00
74444020,SUP,HCPCS C1713,,74444020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74444025,SUP,HCPCS C1713,,74444025  -  SCREW BN 4MM 25MM LGC CD HZN MA TI SPNE 4.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74444030,SUP,HCPCS C1713,,74444030  -  SCREW BN 4MM 30MM LGC CD HZN MA TI SPNE 4.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74444035,SUP,HCPCS C1713,,74444035  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74444040,SUP,HCPCS C1713,,74444040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74444520,SUP,HCPCS C1713,,74444520  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74444525,SUP,HCPCS C1713,,74444525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74444530,SUP,HCPCS C1713,,74444530  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74444535,SUP,HCPCS C1713,,74444535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74444540,SUP,HCPCS C1713,,74444540  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74445025,SUP,HCPCS C1713,,74445025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74445030,SUP,HCPCS C1713,,74445030  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74445035,SUP,HCPCS C1713,,74445035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74445040,SUP,HCPCS C1713,,74445040  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74445045,SUP,HCPCS C1713,,74445045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74445050,SUP,HCPCS C1713,,74445050  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74445525,SUP,HCPCS C1713,,74445525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74445530,SUP,HCPCS C1713,,74445530  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74445535,SUP,HCPCS C1713,,74445535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74445540,SUP,HCPCS C1713,,74445540  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74445545,SUP,HCPCS C1713,,74445545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74445550,SUP,HCPCS C1713,,74445550  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74446025,SUP,HCPCS C1713,,74446025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74446030,SUP,HCPCS C1713,,74446030  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74446035,SUP,HCPCS C1713,,74446035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74446040,SUP,HCPCS C1713,,74446040  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74446045,SUP,HCPCS C1713,,74446045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74446050,SUP,HCPCS C1713,,74446050  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74446525,SUP,HCPCS C1713,,74446525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74446530,SUP,HCPCS C1713,,74446530  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74446535,SUP,HCPCS C1713,,74446535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74446540,SUP,HCPCS C1713,,74446540  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74446545,SUP,HCPCS C1713,,74446545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74446550,SUP,HCPCS C1713,,74446550  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74446555,SUP,HCPCS C1713,,74446555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74447525,SUP,HCPCS C1713,,74447525  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74447530,SUP,HCPCS C1713,,74447530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74447535,SUP,HCPCS C1713,,74447535  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74447540,SUP,HCPCS C1713,,74447540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74447545,SUP,HCPCS C1713,,74447545  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74447550,SUP,HCPCS C1713,,74447550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74447555,SUP,HCPCS C1713,,74447555  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74462002,SUP,Custom 27203010,,74462002  -  BIT DRL SHRT 1.5MM VLP MN-MOD QC,$242.00,$0.00,$242.00,$0.00,$172.72,$0.00,$0.00,$0.00,$0.00,$0.00,$242.00,$0.00,$121.00,$191.66,$193.60,$0.00,$0.00,$0.00,$0.00,$0.00
74462004,SUP,Custom 27203010,,74462004  -  BIT DRL LNG 1.5MM VLP MN-MOD QC,$281.88,$0.00,$281.88,$0.00,$201.17,$0.00,$0.00,$0.00,$0.00,$0.00,$281.88,$0.00,$140.94,$223.25,$225.50,$0.00,$0.00,$0.00,$0.00,$0.00
74462006,SUP,Custom 27203010,,74462006  -  BIT DRL 2MM VLP MN-MOD QC OVR,$242.00,$0.00,$242.00,$0.00,$172.72,$0.00,$0.00,$0.00,$0.00,$0.00,$242.00,$0.00,$121.00,$191.66,$193.60,$0.00,$0.00,$0.00,$0.00,$0.00
74462410,SUP,Custom 27203010,,74462410  -  BIT DRL 2.4MM VLP MN-MOD AO QC OVR,$242.00,$0.00,$242.00,$0.00,$172.72,$0.00,$0.00,$0.00,$0.00,$0.00,$242.00,$0.00,$121.00,$191.66,$193.60,$0.00,$0.00,$0.00,$0.00,$0.00
74640132,SUP,HCPCS C1713,,74640132  -  SCREW BN 9MM 32MM TN SURESHOT RT TROCH,"$5,270.00",$0.00,"$5,270.00","$2,371.50","$3,761.20",$0.00,$907.99,$0.00,$0.00,$922.73,"$5,270.00",$0.00,"$2,635.00","$4,173.84","$4,216.00",$0.00,$824.76,$0.00,$838.98,$0.00
74640134,SUP,HCPCS C1713,,74640134  -  SCREW BN 9MM 34MM TN SURESHOT RT TROCH,"$5,270.00",$0.00,"$5,270.00","$2,371.50","$3,761.20",$0.00,$907.99,$0.00,$0.00,$922.73,"$5,270.00",$0.00,"$2,635.00","$4,173.84","$4,216.00",$0.00,$824.76,$0.00,$838.98,$0.00
74640136,SUP,HCPCS C1713,,74640136  -  SCREW BN 9MM 36MM TN SURESHOT RT TROCH,"$5,270.00",$0.00,"$5,270.00","$2,371.50","$3,761.20",$0.00,$907.99,$0.00,$0.00,$922.73,"$5,270.00",$0.00,"$2,635.00","$4,173.84","$4,216.00",$0.00,$824.76,$0.00,$838.98,$0.00
74640138,SUP,HCPCS C1713,,74640138  -  SCREW BN 9MM 38MM TN SURESHOT RT TROCH,"$5,270.00",$0.00,"$5,270.00","$2,371.50","$3,761.20",$0.00,$907.99,$0.00,$0.00,$922.73,"$5,270.00",$0.00,"$2,635.00","$4,173.84","$4,216.00",$0.00,$824.76,$0.00,$838.98,$0.00
74640234,SUP,HCPCS C1713,,74640234  -  SCREW BN 10MM 34MM TN SURESHOT RT TROCH,"$5,270.00",$0.00,"$5,270.00","$2,371.50","$3,761.20",$0.00,$907.99,$0.00,$0.00,$922.73,"$5,270.00",$0.00,"$2,635.00","$4,173.84","$4,216.00",$0.00,$824.76,$0.00,$838.98,$0.00
74640236,SUP,HCPCS C1713,,74640236  -  SCREW BN 10MM 36MM TN SURESHOT RT TROCH,"$5,270.00",$0.00,"$5,270.00","$2,371.50","$3,761.20",$0.00,$907.99,$0.00,$0.00,$922.73,"$5,270.00",$0.00,"$2,635.00","$4,173.84","$4,216.00",$0.00,$824.76,$0.00,$838.98,$0.00
74640238,SUP,HCPCS C1713,,74640238  -  SCREW BN 10MM 38MM TN SURESHOT RT TROCH,"$5,270.00",$0.00,"$5,270.00","$2,371.50","$3,761.20",$0.00,$907.99,$0.00,$0.00,$922.73,"$5,270.00",$0.00,"$2,635.00","$4,173.84","$4,216.00",$0.00,$824.76,$0.00,$838.98,$0.00
74640240,SUP,HCPCS C1713,,74640240  -  SCREW BN 10MM 40MM TN SURESHOT RT TROCH,"$5,270.00",$0.00,"$5,270.00","$2,371.50","$3,761.20",$0.00,$907.99,$0.00,$0.00,$922.73,"$5,270.00",$0.00,"$2,635.00","$4,173.84","$4,216.00",$0.00,$824.76,$0.00,$838.98,$0.00
74640336,SUP,HCPCS C1713,,74640336  -  SCREW BN 11.5MM 36MM TN SURESHOT RT TROCH,"$5,270.00",$0.00,"$5,270.00","$2,371.50","$3,761.20",$0.00,$907.99,$0.00,$0.00,$922.73,"$5,270.00",$0.00,"$2,635.00","$4,173.84","$4,216.00",$0.00,$824.76,$0.00,$838.98,$0.00
74640338,SUP,HCPCS C1713,,74640338  -  SCREW BN 11.5MM 38MM TN SURESHOT RT TROCH,"$5,270.00",$0.00,"$5,270.00","$2,371.50","$3,761.20",$0.00,$907.99,$0.00,$0.00,$922.73,"$5,270.00",$0.00,"$2,635.00","$4,173.84","$4,216.00",$0.00,$824.76,$0.00,$838.98,$0.00
74640340,SUP,HCPCS C1713,,74640340  -  SCREW BN 11.5MM 40MM TN SURESHOT RT TROCH,"$5,270.00",$0.00,"$5,270.00","$2,371.50","$3,761.20",$0.00,$907.99,$0.00,$0.00,$922.73,"$5,270.00",$0.00,"$2,635.00","$4,173.84","$4,216.00",$0.00,$824.76,$0.00,$838.98,$0.00
74640342,SUP,HCPCS C1713,,74640342  -  SCREW BN 11.5MM 42MM TN SURESHOT RT TROCH,"$5,270.00",$0.00,"$5,270.00","$2,371.50","$3,761.20",$0.00,$907.99,$0.00,$0.00,$922.73,"$5,270.00",$0.00,"$2,635.00","$4,173.84","$4,216.00",$0.00,$824.76,$0.00,$838.98,$0.00
74640440,SUP,HCPCS C1713,,74640440  -  SCREW BN 13MM 40MM TN SURESHOT RT TROCH,"$5,270.00",$0.00,"$5,270.00","$2,371.50","$3,761.20",$0.00,$907.99,$0.00,$0.00,$922.73,"$5,270.00",$0.00,"$2,635.00","$4,173.84","$4,216.00",$0.00,$824.76,$0.00,$838.98,$0.00
74640442,SUP,HCPCS C1713,,74640442  -  SCREW BN 13MM 42MM TN SURESHOT RT TROCH,"$5,270.00",$0.00,"$5,270.00","$2,371.50","$3,761.20",$0.00,$907.99,$0.00,$0.00,$922.73,"$5,270.00",$0.00,"$2,635.00","$4,173.84","$4,216.00",$0.00,$824.76,$0.00,$838.98,$0.00
74644020,SUP,HCPCS C1713,,74644020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74644025,SUP,HCPCS C1713,,74644025  -  SCREW BN 4MM 25MM STRL LGC CD HZN MA SS SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74644030,SUP,HCPCS C1713,,74644030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74644035,SUP,HCPCS C1713,,74644035  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74644040,SUP,HCPCS C1713,,74644040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74644520,SUP,HCPCS C1713,,74644520  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74644525,SUP,HCPCS C1713,,74644525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74644530,SUP,HCPCS C1713,,74644530  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74644535,SUP,HCPCS C1713,,74644535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74644540,SUP,HCPCS C1713,,74644540  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74645025,SUP,HCPCS C1713,,74645025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74645030,SUP,HCPCS C1713,,74645030  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74645035,SUP,HCPCS C1713,,74645035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74645040,SUP,HCPCS C1713,,74645040  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74645045,SUP,HCPCS C1713,,74645045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74645050,SUP,HCPCS C1713,,74645050  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74645525,SUP,HCPCS C1713,,74645525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74645530,SUP,HCPCS C1713,,74645530  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74645535,SUP,HCPCS C1713,,74645535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74645540,SUP,HCPCS C1713,,74645540  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74645545,SUP,HCPCS C1713,,74645545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74645550,SUP,HCPCS C1713,,74645550  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74646025,SUP,HCPCS C1713,,74646025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74646030,SUP,HCPCS C1713,,74646030  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74646035,SUP,HCPCS C1713,,74646035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74646040,SUP,HCPCS C1713,,74646040  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74646045,SUP,HCPCS C1713,,74646045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74646050,SUP,HCPCS C1713,,74646050  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74646525,SUP,HCPCS C1713,,74646525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74646530,SUP,HCPCS C1713,,74646530  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74646535,SUP,HCPCS C1713,,74646535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74646540,SUP,HCPCS C1713,,74646540  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74646545,SUP,HCPCS C1713,,74646545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74646550,SUP,HCPCS C1713,,74646550  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74646555,SUP,HCPCS C1713,,74646555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74647525,SUP,HCPCS C1713,,74647525  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74647530,SUP,HCPCS C1713,,74647530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74647535,SUP,HCPCS C1713,,74647535  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74647540,SUP,HCPCS C1713,,74647540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74647545,SUP,HCPCS C1713,,74647545  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74647550,SUP,HCPCS C1713,,74647550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74647555,SUP,HCPCS C1713,,74647555  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
74649132,SUP,HCPCS C1713,,74649132  -  SCREW BN 9MM 32MM SURESHOT TN LT EVAL,"$5,270.00",$0.00,"$5,270.00","$2,371.50","$3,761.20",$0.00,$907.99,$0.00,$0.00,$922.73,"$5,270.00",$0.00,"$2,635.00","$4,173.84","$4,216.00",$0.00,$824.76,$0.00,$838.98,$0.00
74649134,SUP,HCPCS C1713,,74649134  -  SCREW BN 9MM 34MM TN SURESHOT LT TROCH,"$5,270.00",$0.00,"$5,270.00","$2,371.50","$3,761.20",$0.00,$907.99,$0.00,$0.00,$922.73,"$5,270.00",$0.00,"$2,635.00","$4,173.84","$4,216.00",$0.00,$824.76,$0.00,$838.98,$0.00
74649136,SUP,HCPCS C1713,,74649136  -  SCREW BN 9MM 36MM TN SURESHOT LT TROCH,"$5,270.00",$0.00,"$5,270.00","$2,371.50","$3,761.20",$0.00,$907.99,$0.00,$0.00,$922.73,"$5,270.00",$0.00,"$2,635.00","$4,173.84","$4,216.00",$0.00,$824.76,$0.00,$838.98,$0.00
74649138,SUP,HCPCS C1713,,74649138  -  SCREW BN 9MM 38MM TN SURESHOT LT TROCH,"$5,270.00",$0.00,"$5,270.00","$2,371.50","$3,761.20",$0.00,$907.99,$0.00,$0.00,$922.73,"$5,270.00",$0.00,"$2,635.00","$4,173.84","$4,216.00",$0.00,$824.76,$0.00,$838.98,$0.00
74649234,SUP,HCPCS C1713,,74649234  -  SCREW BN 10MM 34MM TN SURESHOT LT TROCH,"$5,270.00",$0.00,"$5,270.00","$2,371.50","$3,761.20",$0.00,$907.99,$0.00,$0.00,$922.73,"$5,270.00",$0.00,"$2,635.00","$4,173.84","$4,216.00",$0.00,$824.76,$0.00,$838.98,$0.00
74649236,SUP,HCPCS C1713,,74649236  -  SCREW BN 10MM 36MM TN SURESHOT LT TROCH,"$5,270.00",$0.00,"$5,270.00","$2,371.50","$3,761.20",$0.00,$907.99,$0.00,$0.00,$922.73,"$5,270.00",$0.00,"$2,635.00","$4,173.84","$4,216.00",$0.00,$824.76,$0.00,$838.98,$0.00
74649238,SUP,HCPCS C1713,,74649238  -  SCREW BN 10MM 38MM TN SURESHOT LT TROCH,"$5,270.00",$0.00,"$5,270.00","$2,371.50","$3,761.20",$0.00,$907.99,$0.00,$0.00,$922.73,"$5,270.00",$0.00,"$2,635.00","$4,173.84","$4,216.00",$0.00,$824.76,$0.00,$838.98,$0.00
74649240,SUP,HCPCS C1713,,74649240  -  SCREW BN 10MM 40MM TN SURESHOT LT TROCH,"$5,270.00",$0.00,"$5,270.00","$2,371.50","$3,761.20",$0.00,$907.99,$0.00,$0.00,$922.73,"$5,270.00",$0.00,"$2,635.00","$4,173.84","$4,216.00",$0.00,$824.76,$0.00,$838.98,$0.00
74649336,SUP,HCPCS C1713,,74649336  -  SCREW BN 11.5MM 36MM TN SURESHOT LT TROCH,"$5,270.00",$0.00,"$5,270.00","$2,371.50","$3,761.20",$0.00,$907.99,$0.00,$0.00,$922.73,"$5,270.00",$0.00,"$2,635.00","$4,173.84","$4,216.00",$0.00,$824.76,$0.00,$838.98,$0.00
74649338,SUP,HCPCS C1713,,74649338  -  SCREW BN 11.5MM 38MM TN SURESHOT LT TROCH,"$5,270.00",$0.00,"$5,270.00","$2,371.50","$3,761.20",$0.00,$907.99,$0.00,$0.00,$922.73,"$5,270.00",$0.00,"$2,635.00","$4,173.84","$4,216.00",$0.00,$824.76,$0.00,$838.98,$0.00
74649340,SUP,HCPCS C1713,,74649340  -  SCREW BN 11.5MM 40MM TN SURESHOT LT TROCH,"$5,270.00",$0.00,"$5,270.00","$2,371.50","$3,761.20",$0.00,$907.99,$0.00,$0.00,$922.73,"$5,270.00",$0.00,"$2,635.00","$4,173.84","$4,216.00",$0.00,$824.76,$0.00,$838.98,$0.00
74649342,SUP,HCPCS C1713,,74649342  -  SCREW BN 11.5MM 42MM TN SURESHOT LT TROCH,"$5,270.00",$0.00,"$5,270.00","$2,371.50","$3,761.20",$0.00,$907.99,$0.00,$0.00,$922.73,"$5,270.00",$0.00,"$2,635.00","$4,173.84","$4,216.00",$0.00,$824.76,$0.00,$838.98,$0.00
74649440,SUP,HCPCS C1713,,74649440  -  SCREW BN 13MM 40MM TN SURESHOT LT TROCH,"$5,270.00",$0.00,"$5,270.00","$2,371.50","$3,761.20",$0.00,$907.99,$0.00,$0.00,$922.73,"$5,270.00",$0.00,"$2,635.00","$4,173.84","$4,216.00",$0.00,$824.76,$0.00,$838.98,$0.00
74649442,SUP,HCPCS C1713,,74649442  -  SCREW BN 13MM 42MM TN SURESHOT LT TROCH,"$5,270.00",$0.00,"$5,270.00","$2,371.50","$3,761.20",$0.00,$907.99,$0.00,$0.00,$922.73,"$5,270.00",$0.00,"$2,635.00","$4,173.84","$4,216.00",$0.00,$824.76,$0.00,$838.98,$0.00
74692424,SUP,HCPCS C1713,,74692424  -  SCREW BN 2.4MM 24MM D-RAD SMRT PK LCK ST T7 DRVR TI DIST,$182.70,$0.00,$182.70,$82.22,$130.39,$0.00,$31.48,$0.00,$0.00,$31.99,$182.70,$0.00,$91.35,$144.70,$146.16,$0.00,$28.59,$0.00,$29.09,$0.00
74800060,SUP,HCPCS C1713,,74800060  -  SCREW BN CONE 6.5MM 60MM CNN SS PROX FEM,$555.75,$0.00,$555.75,$250.09,$396.64,$0.00,$95.75,$0.00,$0.00,$97.31,$555.75,$0.00,$277.88,$440.15,$444.60,$0.00,$86.97,$0.00,$88.48,$0.00
74800065,SUP,HCPCS C1713,,74800065  -  SCREW BN CONE 6.5MM 65MM CNN SS PROX FEM,$555.75,$0.00,$555.75,$250.09,$396.64,$0.00,$95.75,$0.00,$0.00,$97.31,$555.75,$0.00,$277.88,$440.15,$444.60,$0.00,$86.97,$0.00,$88.48,$0.00
74800070,SUP,HCPCS C1713,,74800070  -  SCREW BN CONE 6.5MM 70MM CNN SS PROX FEM,$555.75,$0.00,$555.75,$250.09,$396.64,$0.00,$95.75,$0.00,$0.00,$97.31,$555.75,$0.00,$277.88,$440.15,$444.60,$0.00,$86.97,$0.00,$88.48,$0.00
74800075,SUP,HCPCS C1713,,74800075  -  SCREW BN CONE 6.5MM 75MM CNN SS PROX FEM,$555.75,$0.00,$555.75,$250.09,$396.64,$0.00,$95.75,$0.00,$0.00,$97.31,$555.75,$0.00,$277.88,$440.15,$444.60,$0.00,$86.97,$0.00,$88.48,$0.00
74800080,SUP,HCPCS C1713,,74800080  -  SCREW BN CONE 6.5MM 80MM CNN SS PROX FEM,$555.75,$0.00,$555.75,$250.09,$396.64,$0.00,$95.75,$0.00,$0.00,$97.31,$555.75,$0.00,$277.88,$440.15,$444.60,$0.00,$86.97,$0.00,$88.48,$0.00
74800085,SUP,HCPCS C1713,,74800085  -  SCREW BN CONE 6.5MM 85MM CNN SS PROX FEM,$555.75,$0.00,$555.75,$250.09,$396.64,$0.00,$95.75,$0.00,$0.00,$97.31,$555.75,$0.00,$277.88,$440.15,$444.60,$0.00,$86.97,$0.00,$88.48,$0.00
74800095,SUP,HCPCS C1713,,74800095  -  SCREW BN CONE 6.5MM 95MM CNN SS PROX FEM,$555.75,$0.00,$555.75,$250.09,$396.64,$0.00,$95.75,$0.00,$0.00,$97.31,$555.75,$0.00,$277.88,$440.15,$444.60,$0.00,$86.97,$0.00,$88.48,$0.00
74800100,SUP,HCPCS C1713,,74800100  -  SCREW BN CONE 6.5MM 100MM CNN SS PROX FEM,$559.13,$0.00,$559.13,$251.61,$399.05,$0.00,$96.33,$0.00,$0.00,$97.90,$559.13,$0.00,$279.56,$442.83,$447.30,$0.00,$87.50,$0.00,$89.01,$0.00
74800105,SUP,HCPCS C1713,,74800105  -  SCREW BN CONE 6.5MM 105MM CNN SS PROX FEM,$559.13,$0.00,$559.13,$251.61,$399.05,$0.00,$96.33,$0.00,$0.00,$97.90,$559.13,$0.00,$279.56,$442.83,$447.30,$0.00,$87.50,$0.00,$89.01,$0.00
74800110,SUP,HCPCS C1713,,74800110  -  SCREW BN CONE 6.5MM 110MM CNN SS PROX FEM,$559.13,$0.00,$559.13,$251.61,$399.05,$0.00,$96.33,$0.00,$0.00,$97.90,$559.13,$0.00,$279.56,$442.83,$447.30,$0.00,$87.50,$0.00,$89.01,$0.00
74800115,SUP,HCPCS C1713,,74800115  -  SCREW BN CONE 6.5MM 115MM CNN SS PROX FEM,$559.13,$0.00,$559.13,$251.61,$399.05,$0.00,$96.33,$0.00,$0.00,$97.90,$559.13,$0.00,$279.56,$442.83,$447.30,$0.00,$87.50,$0.00,$89.01,$0.00
74800120,SUP,HCPCS C1713,,74800120  -  SCREW BN CONE 6.5MM 120MM CNN SS PROX FEM,$559.13,$0.00,$559.13,$251.61,$399.05,$0.00,$96.33,$0.00,$0.00,$97.90,$559.13,$0.00,$279.56,$442.83,$447.30,$0.00,$87.50,$0.00,$89.01,$0.00
74800125,SUP,HCPCS C1713,,74800125  -  SCREW BN CONE 6.5MM 125MM CNN SS PROX FEM,$559.13,$0.00,$559.13,$251.61,$399.05,$0.00,$96.33,$0.00,$0.00,$97.90,$559.13,$0.00,$279.56,$442.83,$447.30,$0.00,$87.50,$0.00,$89.01,$0.00
74800130,SUP,HCPCS C1713,,74800130  -  SCREW BN CONE 6.5MM 130MM CNN SS PROX FEM,$559.13,$0.00,$559.13,$251.61,$399.05,$0.00,$96.33,$0.00,$0.00,$97.90,$559.13,$0.00,$279.56,$442.83,$447.30,$0.00,$87.50,$0.00,$89.01,$0.00
74800260,SUP,HCPCS C1713,,74800260  -  SCREW BN 6.5MM 60MM CNN LCK SS PROX FEM,$645.75,$0.00,$645.75,$290.59,$460.87,$0.00,$111.26,$0.00,$0.00,$113.07,$645.75,$0.00,$322.88,$511.43,$516.60,$0.00,$101.06,$0.00,$102.80,$0.00
74800265,SUP,HCPCS C1713,,74800265  -  SCREW BN 6.5MM 65MM CNN LCK SS PROX FEM,$645.75,$0.00,$645.75,$290.59,$460.87,$0.00,$111.26,$0.00,$0.00,$113.07,$645.75,$0.00,$322.88,$511.43,$516.60,$0.00,$101.06,$0.00,$102.80,$0.00
74800270,SUP,HCPCS C1713,,74800270  -  SCREW BN 6.5MM 70MM CNN LCK SS PROX FEM,$645.75,$0.00,$645.75,$290.59,$460.87,$0.00,$111.26,$0.00,$0.00,$113.07,$645.75,$0.00,$322.88,$511.43,$516.60,$0.00,$101.06,$0.00,$102.80,$0.00
74800275,SUP,HCPCS C1713,,74800275  -  SCREW BN 6.5MM 75MM CNN LCK SS PROX FEM,$645.75,$0.00,$645.75,$290.59,$460.87,$0.00,$111.26,$0.00,$0.00,$113.07,$645.75,$0.00,$322.88,$511.43,$516.60,$0.00,$101.06,$0.00,$102.80,$0.00
74800280,SUP,HCPCS C1713,,74800280  -  SCREW BN 6.5MM 80MM CNN LCK SS PROX FEM,$645.75,$0.00,$645.75,$290.59,$460.87,$0.00,$111.26,$0.00,$0.00,$113.07,$645.75,$0.00,$322.88,$511.43,$516.60,$0.00,$101.06,$0.00,$102.80,$0.00
74800285,SUP,HCPCS C1713,,74800285  -  SCREW BN 6.5MM 85MM CNN LCK SS PROX FEM,$645.75,$0.00,$645.75,$290.59,$460.87,$0.00,$111.26,$0.00,$0.00,$113.07,$645.75,$0.00,$322.88,$511.43,$516.60,$0.00,$101.06,$0.00,$102.80,$0.00
74800290,SUP,HCPCS C1713,,74800290  -  SCREW BN 6.5MM 90MM CNN LCK SS PROX FEM,$645.75,$0.00,$645.75,$290.59,$460.87,$0.00,$111.26,$0.00,$0.00,$113.07,$645.75,$0.00,$322.88,$511.43,$516.60,$0.00,$101.06,$0.00,$102.80,$0.00
74800295,SUP,HCPCS C1713,,74800295  -  SCREW BN 6.5MM 95MM CNN LCK SS PROX FEM,$645.75,$0.00,$645.75,$290.59,$460.87,$0.00,$111.26,$0.00,$0.00,$113.07,$645.75,$0.00,$322.88,$511.43,$516.60,$0.00,$101.06,$0.00,$102.80,$0.00
74800300,SUP,HCPCS C1713,,74800300  -  SCREW BN 6.5MM 100MM CNN LCK SS PROX FEM,$645.75,$0.00,$645.75,$290.59,$460.87,$0.00,$111.26,$0.00,$0.00,$113.07,$645.75,$0.00,$322.88,$511.43,$516.60,$0.00,$101.06,$0.00,$102.80,$0.00
74800305,SUP,HCPCS C1713,,74800305  -  SCREW BN 6.5MM 105MM CNN LCK SS PROX FEM,$645.75,$0.00,$645.75,$290.59,$460.87,$0.00,$111.26,$0.00,$0.00,$113.07,$645.75,$0.00,$322.88,$511.43,$516.60,$0.00,$101.06,$0.00,$102.80,$0.00
74800310,SUP,HCPCS C1713,,74800310  -  SCREW BN 6.5MM 110MM CNN LCK SS PROX FEM,$645.75,$0.00,$645.75,$290.59,$460.87,$0.00,$111.26,$0.00,$0.00,$113.07,$645.75,$0.00,$322.88,$511.43,$516.60,$0.00,$101.06,$0.00,$102.80,$0.00
74800315,SUP,HCPCS C1713,,74800315  -  SCREW BN 6.5MM 115MM CNN LCK SS PROX FEM,$645.75,$0.00,$645.75,$290.59,$460.87,$0.00,$111.26,$0.00,$0.00,$113.07,$645.75,$0.00,$322.88,$511.43,$516.60,$0.00,$101.06,$0.00,$102.80,$0.00
74800320,SUP,HCPCS C1713,,74800320  -  SCREW BN 6.5MM 120MM CNN LCK SS PROX FEM,$645.75,$0.00,$645.75,$290.59,$460.87,$0.00,$111.26,$0.00,$0.00,$113.07,$645.75,$0.00,$322.88,$511.43,$516.60,$0.00,$101.06,$0.00,$102.80,$0.00
74800325,SUP,HCPCS C1713,,74800325  -  SCREW BN 6.5MM 125MM CNN LCK SS PROX FEM,$645.75,$0.00,$645.75,$290.59,$460.87,$0.00,$111.26,$0.00,$0.00,$113.07,$645.75,$0.00,$322.88,$511.43,$516.60,$0.00,$101.06,$0.00,$102.80,$0.00
74800330,SUP,HCPCS C1713,,74800330  -  SCREW BN 6.5MM 130MM CNN LCK SS PROX FEM,$645.75,$0.00,$645.75,$290.59,$460.87,$0.00,$111.26,$0.00,$0.00,$113.07,$645.75,$0.00,$322.88,$511.43,$516.60,$0.00,$101.06,$0.00,$102.80,$0.00
74800402,SUP,HCPCS C1713,,74800402  -  PLATE BN 44MM 2 HL LCK SS LT PROX FEM 4.5MM SCR,"$3,380.63",$0.00,"$3,380.63","$1,521.28","$2,412.75",$0.00,$582.46,$0.00,$0.00,$591.92,"$3,380.63",$0.00,"$1,690.31","$2,677.46","$2,704.50",$0.00,$529.07,$0.00,$538.20,$0.00
74800404,SUP,HCPCS C1713,,74800404  -  PLATE BN 144MM 4 HL LCK SS LT PROX FEM 4.5MM SCR,"$3,431.25",$0.00,"$3,431.25","$1,544.06","$2,448.88",$0.00,$591.19,$0.00,$0.00,$600.78,"$3,431.25",$0.00,"$1,715.63","$2,717.55","$2,745.00",$0.00,$536.99,$0.00,$546.26,$0.00
74800406,SUP,HCPCS C1713,,74800406  -  PLATE BN 180MM 6 HL LCK SS LT PROX FEM 4.5MM SCR,"$3,498.75",$0.00,"$3,498.75","$1,574.44","$2,497.06",$0.00,$602.82,$0.00,$0.00,$612.60,"$3,498.75",$0.00,"$1,749.38","$2,771.01","$2,799.00",$0.00,$547.55,$0.00,$557.00,$0.00
74800409,SUP,HCPCS C1713,,74800409  -  PLATE BN 234MM 9 HL LCK SS LT PROX FEM 4.5MM SCR,"$3,633.75",$0.00,"$3,633.75","$1,635.19","$2,593.41",$0.00,$626.08,$0.00,$0.00,$636.24,"$3,633.75",$0.00,"$1,816.88","$2,877.93","$2,907.00",$0.00,$568.68,$0.00,$578.49,$0.00
74800412,SUP,HCPCS C1713,,74800412  -  PLATE BN 288MM 12 HL LCK SS LT PROX FEM 4.5MM SCR,"$4,246.88",$0.00,"$4,246.88","$1,911.09","$3,030.99",$0.00,$731.72,$0.00,$0.00,$743.59,"$4,246.88",$0.00,"$2,123.44","$3,363.53","$3,397.50",$0.00,$664.64,$0.00,$676.10,$0.00
74800415,SUP,HCPCS C1713,,74800415  -  PLATE BN 15MM LCK SS LT PROX FEM,"$4,584.38",$0.00,"$4,584.38","$2,062.97","$3,271.87",$0.00,$789.86,$0.00,$0.00,$802.69,"$4,584.38",$0.00,"$2,292.19","$3,630.83","$3,667.50",$0.00,$717.45,$0.00,$729.83,$0.00
74800418,SUP,HCPCS C1713,,74800418  -  PLATE BN 396MM 18 HL LCK SS LT PROX FEM 4.5MM SCR,"$4,921.88",$0.00,"$4,921.88","$2,214.84","$3,512.74",$0.00,$848.01,$0.00,$0.00,$861.78,"$4,921.88",$0.00,"$2,460.94","$3,898.13","$3,937.50",$0.00,$770.27,$0.00,$783.56,$0.00
74800502,SUP,HCPCS C1713,,74800502  -  PLATE BN 99MM 2 HL LCK SS RT PROX FEM 4.5MM SCR,"$3,380.63",$0.00,"$3,380.63","$1,521.28","$2,412.75",$0.00,$582.46,$0.00,$0.00,$591.92,"$3,380.63",$0.00,"$1,690.31","$2,677.46","$2,704.50",$0.00,$529.07,$0.00,$538.20,$0.00
74800504,SUP,HCPCS C1713,,74800504  -  PLATE BN 144MM 4 HL LCK SS RT PROX FEM 4.5MM SCR,"$3,431.25",$0.00,"$3,431.25","$1,544.06","$2,448.88",$0.00,$591.19,$0.00,$0.00,$600.78,"$3,431.25",$0.00,"$1,715.63","$2,717.55","$2,745.00",$0.00,$536.99,$0.00,$546.26,$0.00
74800506,SUP,HCPCS C1713,,74800506  -  PLATE BN 180MM 6 HL LCK SS RT PROX FEM 4.5MM SCR,"$3,498.75",$0.00,"$3,498.75","$1,574.44","$2,497.06",$0.00,$602.82,$0.00,$0.00,$612.60,"$3,498.75",$0.00,"$1,749.38","$2,771.01","$2,799.00",$0.00,$547.55,$0.00,$557.00,$0.00
74800509,SUP,HCPCS C1713,,74800509  -  PLATE BN 234MM 9 HL LCK SS RT PROX FEM 4.5MM SCR,"$3,633.75",$0.00,"$3,633.75","$1,635.19","$2,593.41",$0.00,$626.08,$0.00,$0.00,$636.24,"$3,633.75",$0.00,"$1,816.88","$2,877.93","$2,907.00",$0.00,$568.68,$0.00,$578.49,$0.00
74800512,SUP,HCPCS C1713,,74800512  -  PLATE BN 288MM 12 HL LCK SS RT PROX FEM 4.5MM SCR,"$4,246.88",$0.00,"$4,246.88","$1,911.09","$3,030.99",$0.00,$731.72,$0.00,$0.00,$743.59,"$4,246.88",$0.00,"$2,123.44","$3,363.53","$3,397.50",$0.00,$664.64,$0.00,$676.10,$0.00
74800515,SUP,HCPCS C1713,,74800515  -  PLATE BN 342MM 15 HL LCK SS RT PROX FEM 4.5MM SCR,"$4,550.63",$0.00,"$4,550.63","$2,047.78","$3,247.78",$0.00,$784.05,$0.00,$0.00,$796.78,"$4,550.63",$0.00,"$2,275.31","$3,604.10","$3,640.50",$0.00,$712.17,$0.00,$724.46,$0.00
74800518,SUP,HCPCS C1713,,74800518  -  PLATE BN 396MM PRLC 18 HL LCK SS FEM RT PROX 4.5MM SCR,"$4,882.50",$0.00,"$4,882.50","$2,197.13","$3,484.64",$0.00,$841.23,$0.00,$0.00,$854.89,"$4,882.50",$0.00,"$2,441.25","$3,866.94","$3,906.00",$0.00,$764.11,$0.00,$777.29,$0.00
74800601,SUP,HCPCS C1713,,74800601  -  PLATE BN SHRT PRLC CBL SDL SS,$408.38,$0.00,$408.38,$183.77,$291.46,$0.00,$70.36,$0.00,$0.00,$71.50,$408.38,$0.00,$204.19,$323.44,$326.70,$0.00,$63.91,$0.00,$65.01,$0.00
74800602,SUP,HCPCS C1713,,74800602  -  PLATE BN TLL PRLC CBL SDL SS,$408.38,$0.00,$408.38,$183.77,$291.46,$0.00,$70.36,$0.00,$0.00,$71.50,$408.38,$0.00,$204.19,$323.44,$326.70,$0.00,$63.91,$0.00,$65.01,$0.00
74800603,SUP,HCPCS C1713,,74800603  -  SCREW BN 4.5MM PRLC HL FIL SS FEM PROX,$319.50,$0.00,$319.50,$143.78,$228.03,$0.00,$55.05,$0.00,$0.00,$55.94,$319.50,$0.00,$159.75,$253.04,$255.60,$0.00,$50.00,$0.00,$50.86,$0.00
74800607,SUP,HCPCS C1713,,74800607  -  PLATE BN PRLC LCK INS HEX SS HUM 4.5 MM SCR,$231.75,$0.00,$231.75,$104.29,$165.40,$0.00,$39.93,$0.00,$0.00,$40.58,$231.75,$0.00,$115.88,$183.55,$185.40,$0.00,$36.27,$0.00,$36.89,$0.00
74820060,SUP,HCPCS C1713,,74820060  -  SCREW BN CONE 6.5MM 60MM PRLC CNN SS FEM PROX,$555.75,$0.00,$555.75,$250.09,$396.64,$0.00,$95.75,$0.00,$0.00,$97.31,$555.75,$0.00,$277.88,$440.15,$444.60,$0.00,$86.97,$0.00,$88.48,$0.00
74820065,SUP,HCPCS C1713,,74820065  -  SCREW BN CONE 6.5MM 65MM PRLC CNN SS FEM PROX,$555.75,$0.00,$555.75,$250.09,$396.64,$0.00,$95.75,$0.00,$0.00,$97.31,$555.75,$0.00,$277.88,$440.15,$444.60,$0.00,$86.97,$0.00,$88.48,$0.00
74820070,SUP,HCPCS C1713,,74820070  -  SCREW BN CONE 6.5MM 70MM PRLC CNN SS FEM PROX,$555.75,$0.00,$555.75,$250.09,$396.64,$0.00,$95.75,$0.00,$0.00,$97.31,$555.75,$0.00,$277.88,$440.15,$444.60,$0.00,$86.97,$0.00,$88.48,$0.00
74820075,SUP,HCPCS C1713,,74820075  -  SCREW BN CONE 6.5MM 75MM PRLC CNN SS FEM PROX,$555.75,$0.00,$555.75,$250.09,$396.64,$0.00,$95.75,$0.00,$0.00,$97.31,$555.75,$0.00,$277.88,$440.15,$444.60,$0.00,$86.97,$0.00,$88.48,$0.00
74820080,SUP,HCPCS C1713,,74820080  -  SCREW BN CONE 6.5MM 80MM PRLC CNN SS FEM PROX,$555.75,$0.00,$555.75,$250.09,$396.64,$0.00,$95.75,$0.00,$0.00,$97.31,$555.75,$0.00,$277.88,$440.15,$444.60,$0.00,$86.97,$0.00,$88.48,$0.00
74820085,SUP,HCPCS C1713,,74820085  -  SCREW BN CONE 6.5MM 85MM PRLC CNN SS FEM PROX,$555.75,$0.00,$555.75,$250.09,$396.64,$0.00,$95.75,$0.00,$0.00,$97.31,$555.75,$0.00,$277.88,$440.15,$444.60,$0.00,$86.97,$0.00,$88.48,$0.00
74820090,SUP,HCPCS C1713,,74820090  -  SCREW BN CONE 6.5MM 90MM PRLC CNN SS FEM PROX,$555.75,$0.00,$555.75,$250.09,$396.64,$0.00,$95.75,$0.00,$0.00,$97.31,$555.75,$0.00,$277.88,$440.15,$444.60,$0.00,$86.97,$0.00,$88.48,$0.00
74820095,SUP,HCPCS C1713,,74820095  -  SCREW BN CONE 6.5MM 95MM PRLC CNN SS FEM PROX,$555.75,$0.00,$555.75,$250.09,$396.64,$0.00,$95.75,$0.00,$0.00,$97.31,$555.75,$0.00,$277.88,$440.15,$444.60,$0.00,$86.97,$0.00,$88.48,$0.00
74820100,SUP,HCPCS C1713,,74820100  -  SCREW BN CONE 6.5MM 100MM PRLC CNN SS FEM PROX,$555.75,$0.00,$555.75,$250.09,$396.64,$0.00,$95.75,$0.00,$0.00,$97.31,$555.75,$0.00,$277.88,$440.15,$444.60,$0.00,$86.97,$0.00,$88.48,$0.00
74820105,SUP,HCPCS C1713,,74820105  -  SCREW BN CONE 6.5MM 105MM PRLC CNN SS FEM PROX,$555.75,$0.00,$555.75,$250.09,$396.64,$0.00,$95.75,$0.00,$0.00,$97.31,$555.75,$0.00,$277.88,$440.15,$444.60,$0.00,$86.97,$0.00,$88.48,$0.00
74820110,SUP,HCPCS C1713,,74820110  -  SCREW BN CONE 6.5MM 110MM PRLC CNN SS FEM PROX,$555.75,$0.00,$555.75,$250.09,$396.64,$0.00,$95.75,$0.00,$0.00,$97.31,$555.75,$0.00,$277.88,$440.15,$444.60,$0.00,$86.97,$0.00,$88.48,$0.00
74820115,SUP,HCPCS C1713,,74820115  -  SCREW BN CONE 6.5MM 115MM PRLC CNN SS FEM PROX,$555.75,$0.00,$555.75,$250.09,$396.64,$0.00,$95.75,$0.00,$0.00,$97.31,$555.75,$0.00,$277.88,$440.15,$444.60,$0.00,$86.97,$0.00,$88.48,$0.00
74820120,SUP,HCPCS C1713,,74820120  -  SCREW BN CONE 6.5MM 120MM PRLC CNN SS FEM PROX,$555.75,$0.00,$555.75,$250.09,$396.64,$0.00,$95.75,$0.00,$0.00,$97.31,$555.75,$0.00,$277.88,$440.15,$444.60,$0.00,$86.97,$0.00,$88.48,$0.00
74820125,SUP,HCPCS C1713,,74820125  -  SCREW BN CONE 6.5MM 125MM PRLC CNN SS FEM PROX,$555.75,$0.00,$555.75,$250.09,$396.64,$0.00,$95.75,$0.00,$0.00,$97.31,$555.75,$0.00,$277.88,$440.15,$444.60,$0.00,$86.97,$0.00,$88.48,$0.00
74820130,SUP,HCPCS C1713,,74820130  -  SCREW BN CONE 6.5MM 130MM PRLC CNN SS FEM PROX,$555.75,$0.00,$555.75,$250.09,$396.64,$0.00,$95.75,$0.00,$0.00,$97.31,$555.75,$0.00,$277.88,$440.15,$444.60,$0.00,$86.97,$0.00,$88.48,$0.00
74820260,SUP,HCPCS C1713,,74820260  -  SCREW BN FT 6.5MM 60MM PRLC LCK CNN SS FEM PROX,$637.88,$0.00,$637.88,$287.04,$455.25,$0.00,$109.90,$0.00,$0.00,$111.69,$637.88,$0.00,$318.94,$505.20,$510.30,$0.00,$99.83,$0.00,$101.55,$0.00
74820265,SUP,HCPCS C1713,,74820265  -  SCREW BN FT 6.5MM 65MM PRLC LCK CNN SS FEM PROX,$637.88,$0.00,$637.88,$287.04,$455.25,$0.00,$109.90,$0.00,$0.00,$111.69,$637.88,$0.00,$318.94,$505.20,$510.30,$0.00,$99.83,$0.00,$101.55,$0.00
74820270,SUP,HCPCS C1713,,74820270  -  SCREW BN FT 6.5MM 70MM PRLC LCK CNN SS FEM PROX,$637.88,$0.00,$637.88,$287.04,$455.25,$0.00,$109.90,$0.00,$0.00,$111.69,$637.88,$0.00,$318.94,$505.20,$510.30,$0.00,$99.83,$0.00,$101.55,$0.00
74820275,SUP,HCPCS C1713,,74820275  -  SCREW BN FT 6.5MM 75MM PRLC LCK CNN SS FEM PROX,$637.88,$0.00,$637.88,$287.04,$455.25,$0.00,$109.90,$0.00,$0.00,$111.69,$637.88,$0.00,$318.94,$505.20,$510.30,$0.00,$99.83,$0.00,$101.55,$0.00
74820280,SUP,HCPCS C1713,,74820280  -  SCREW BN FT 6.5MM 80MM PRLC LCK CNN SS FEM PROX,$637.88,$0.00,$637.88,$287.04,$455.25,$0.00,$109.90,$0.00,$0.00,$111.69,$637.88,$0.00,$318.94,$505.20,$510.30,$0.00,$99.83,$0.00,$101.55,$0.00
74820285,SUP,HCPCS C1713,,74820285  -  SCREW BN FT 6.5MM 85MM PRLC LCK CNN SS FEM PROX,$637.88,$0.00,$637.88,$287.04,$455.25,$0.00,$109.90,$0.00,$0.00,$111.69,$637.88,$0.00,$318.94,$505.20,$510.30,$0.00,$99.83,$0.00,$101.55,$0.00
74820290,SUP,HCPCS C1713,,74820290  -  SCREW BN FT 6.5MM 90MM PRLC LCK CNN SS FEM PROX,$637.88,$0.00,$637.88,$287.04,$455.25,$0.00,$109.90,$0.00,$0.00,$111.69,$637.88,$0.00,$318.94,$505.20,$510.30,$0.00,$99.83,$0.00,$101.55,$0.00
74820295,SUP,HCPCS C1713,,74820295  -  SCREW BN FT 6.5MM 95MM PRLC LCK CNN SS FEM PROX,$637.88,$0.00,$637.88,$287.04,$455.25,$0.00,$109.90,$0.00,$0.00,$111.69,$637.88,$0.00,$318.94,$505.20,$510.30,$0.00,$99.83,$0.00,$101.55,$0.00
74820300,SUP,HCPCS C1713,,74820300  -  SCREW BN FT 6.5MM 100MM PRLC LCK CNN SS FEM PROX,$637.88,$0.00,$637.88,$287.04,$455.25,$0.00,$109.90,$0.00,$0.00,$111.69,$637.88,$0.00,$318.94,$505.20,$510.30,$0.00,$99.83,$0.00,$101.55,$0.00
74820305,SUP,HCPCS C1713,,74820305  -  SCREW BN FT 6.5MM 105MM PRLC LCK CNN SS FEM PROX,$637.88,$0.00,$637.88,$287.04,$455.25,$0.00,$109.90,$0.00,$0.00,$111.69,$637.88,$0.00,$318.94,$505.20,$510.30,$0.00,$99.83,$0.00,$101.55,$0.00
74820310,SUP,HCPCS C1713,,74820310  -  SCREW BN FT 6.5MM 110MM PRLC LCK CNN SS FEM PROX,$637.88,$0.00,$637.88,$287.04,$455.25,$0.00,$109.90,$0.00,$0.00,$111.69,$637.88,$0.00,$318.94,$505.20,$510.30,$0.00,$99.83,$0.00,$101.55,$0.00
74820315,SUP,HCPCS C1713,,74820315  -  SCREW BN FT 6.5MM 115MM PRLC LCK CNN SS FEM PROX,$637.88,$0.00,$637.88,$287.04,$455.25,$0.00,$109.90,$0.00,$0.00,$111.69,$637.88,$0.00,$318.94,$505.20,$510.30,$0.00,$99.83,$0.00,$101.55,$0.00
74820320,SUP,HCPCS C1713,,74820320  -  SCREW BN FT 6.5MM 120MM PRLC LCK CNN SS FEM PROX,$637.88,$0.00,$637.88,$287.04,$455.25,$0.00,$109.90,$0.00,$0.00,$111.69,$637.88,$0.00,$318.94,$505.20,$510.30,$0.00,$99.83,$0.00,$101.55,$0.00
74820325,SUP,HCPCS C1713,,74820325  -  SCREW BN FT 6.5MM 125MM PRLC LCK CNN SS FEM PROX,$637.88,$0.00,$637.88,$287.04,$455.25,$0.00,$109.90,$0.00,$0.00,$111.69,$637.88,$0.00,$318.94,$505.20,$510.30,$0.00,$99.83,$0.00,$101.55,$0.00
74820330,SUP,HCPCS C1713,,74820330  -  SCREW BN FT 6.5MM 130MM PRLC LCK CNN SS FEM PROX,$637.88,$0.00,$637.88,$287.04,$455.25,$0.00,$109.90,$0.00,$0.00,$111.69,$637.88,$0.00,$318.94,$505.20,$510.30,$0.00,$99.83,$0.00,$101.55,$0.00
74820402,SUP,HCPCS C1713,,74820402  -  PLATE BN 99MMX2MM LCK FEM PROX 4.5MM SCR,"$3,493.13",$0.00,"$3,493.13","$1,571.91","$2,493.04",$0.00,$601.85,$0.00,$0.00,$611.62,"$3,493.13",$0.00,"$1,746.56","$2,766.56","$2,794.50",$0.00,$546.67,$0.00,$556.11,$0.00
74820404,SUP,HCPCS C1713,,74820404  -  PLATE BN 144MM 4 HL LCK LT PROX FEM 4.5MM SCR,"$3,549.38",$0.00,"$3,549.38","$1,597.22","$2,533.19",$0.00,$611.54,$0.00,$0.00,$621.47,"$3,549.38",$0.00,"$1,774.69","$2,811.11","$2,839.50",$0.00,$555.48,$0.00,$565.06,$0.00
74820406,SUP,HCPCS C1713,,74820406  -  PLATE BN 180MMX6MM LCK FEM PROX 4.5MM SCR,"$3,611.25",$0.00,"$3,611.25","$1,625.06","$2,577.35",$0.00,$622.20,$0.00,$0.00,$632.30,"$3,611.25",$0.00,"$1,805.63","$2,860.11","$2,889.00",$0.00,$565.16,$0.00,$574.91,$0.00
74820409,SUP,HCPCS C1713,,74820409  -  PLATE BN 234MM 9 HL LCK FEM PROX 4.5MM SCR,"$3,746.25",$0.00,"$3,746.25","$1,685.81","$2,673.70",$0.00,$645.46,$0.00,$0.00,$655.94,"$3,746.25",$0.00,"$1,873.13","$2,967.03","$2,997.00",$0.00,$586.29,$0.00,$596.40,$0.00
74820412,SUP,HCPCS C1713,,74820412  -  PLATE BN 288MM 12 HL LCK LT PROX FEM 4.5MM SCR,"$4,218.75",$0.00,"$4,218.75","$1,898.44","$3,010.92",$0.00,$726.87,$0.00,$0.00,$738.67,"$4,218.75",$0.00,"$2,109.38","$3,341.25","$3,375.00",$0.00,$660.23,$0.00,$671.63,$0.00
74820502,SUP,HCPCS C1713,,74820502  -  PLATE BN 4.5MM 99MM 2 HL LCK FEM RT,"$3,493.13",$0.00,"$3,493.13","$1,571.91","$2,493.04",$0.00,$601.85,$0.00,$0.00,$611.62,"$3,493.13",$0.00,"$1,746.56","$2,766.56","$2,794.50",$0.00,$546.67,$0.00,$556.11,$0.00
74820504,SUP,HCPCS C1713,,74820504  -  PLATE BN 144MM 4 HL LCK FEM RT PROX 4.5MM SCR,"$3,549.38",$0.00,"$3,549.38","$1,597.22","$2,533.19",$0.00,$611.54,$0.00,$0.00,$621.47,"$3,549.38",$0.00,"$1,774.69","$2,811.11","$2,839.50",$0.00,$555.48,$0.00,$565.06,$0.00
74820506,SUP,HCPCS C1713,,74820506  -  PLATE BN 180MM 6 HL LCK PROX FEM RT 4.5MM SCR,"$3,611.25",$0.00,"$3,611.25","$1,625.06","$2,577.35",$0.00,$622.20,$0.00,$0.00,$632.30,"$3,611.25",$0.00,"$1,805.63","$2,860.11","$2,889.00",$0.00,$565.16,$0.00,$574.91,$0.00
74820509,SUP,HCPCS C1713,,74820509  -  PLATE BN 234MM 9 HL LCK RT PROX FEM 4.5MM SCR,"$3,746.25",$0.00,"$3,746.25","$1,685.81","$2,673.70",$0.00,$645.46,$0.00,$0.00,$655.94,"$3,746.25",$0.00,"$1,873.13","$2,967.03","$2,997.00",$0.00,$586.29,$0.00,$596.40,$0.00
74820512,SUP,HCPCS C1713,,74820512  -  PLATE BN 288MM 12 HL LCK FEM RT PROX 4.5MM SCR,"$4,218.75",$0.00,"$4,218.75","$1,898.44","$3,010.92",$0.00,$726.87,$0.00,$0.00,$738.67,"$4,218.75",$0.00,"$2,109.38","$3,341.25","$3,375.00",$0.00,$660.23,$0.00,$671.63,$0.00
75001233,SUP,HCPCS C1713,,75001233  -  PIN FX 34MM LCK DIST,$602.50,$0.00,$602.50,$271.13,$430.00,$0.00,$103.81,$0.00,$0.00,$105.49,$602.50,$0.00,$301.25,$477.18,$482.00,$0.00,$94.29,$0.00,$95.92,$0.00
75001234,SUP,HCPCS C1713,,75001234  -  PIN FX 36MM LCK DIST,$602.50,$0.00,$602.50,$271.13,$430.00,$0.00,$103.81,$0.00,$0.00,$105.49,$602.50,$0.00,$301.25,$477.18,$482.00,$0.00,$94.29,$0.00,$95.92,$0.00
75001235,SUP,HCPCS C1713,,75001235  -  PIN FX 38MM LCK DIST,$602.50,$0.00,$602.50,$271.13,$430.00,$0.00,$103.81,$0.00,$0.00,$105.49,$602.50,$0.00,$301.25,$477.18,$482.00,$0.00,$94.29,$0.00,$95.92,$0.00
75001236,SUP,HCPCS C1713,,75001236  -  PIN FX 40MM LCK DIST,$602.50,$0.00,$602.50,$271.13,$430.00,$0.00,$103.81,$0.00,$0.00,$105.49,$602.50,$0.00,$301.25,$477.18,$482.00,$0.00,$94.29,$0.00,$95.92,$0.00
75001237,SUP,HCPCS C1713,,75001237  -  PIN FX 42MM LCK DIST,$602.50,$0.00,$602.50,$271.13,$430.00,$0.00,$103.81,$0.00,$0.00,$105.49,$602.50,$0.00,$301.25,$477.18,$482.00,$0.00,$94.29,$0.00,$95.92,$0.00
75001238,SUP,HCPCS C1713,,75001238  -  PIN FX 44MM LCK DIST,$602.50,$0.00,$602.50,$271.13,$430.00,$0.00,$103.81,$0.00,$0.00,$105.49,$602.50,$0.00,$301.25,$477.18,$482.00,$0.00,$94.29,$0.00,$95.92,$0.00
75001239,SUP,HCPCS C1713,,75001239  -  PIN FX 46MM LCK DIST,$602.50,$0.00,$602.50,$271.13,$430.00,$0.00,$103.81,$0.00,$0.00,$105.49,$602.50,$0.00,$301.25,$477.18,$482.00,$0.00,$94.29,$0.00,$95.92,$0.00
75001240,SUP,HCPCS C1713,,75001240  -  PIN FX 50MM LCK DIST,$602.50,$0.00,$602.50,$271.13,$430.00,$0.00,$103.81,$0.00,$0.00,$105.49,$602.50,$0.00,$301.25,$477.18,$482.00,$0.00,$94.29,$0.00,$95.92,$0.00
75001241,SUP,HCPCS C1713,,75001241  -  PIN FX 60MM LCK DIST,$602.50,$0.00,$602.50,$271.13,$430.00,$0.00,$103.81,$0.00,$0.00,$105.49,$602.50,$0.00,$301.25,$477.18,$482.00,$0.00,$94.29,$0.00,$95.92,$0.00
75001242,SUP,HCPCS C1713,,75001242  -  PIN FX 70MM LCK DIST,$602.50,$0.00,$602.50,$271.13,$430.00,$0.00,$103.81,$0.00,$0.00,$105.49,$602.50,$0.00,$301.25,$477.18,$482.00,$0.00,$94.29,$0.00,$95.92,$0.00
75405535,SUP,HCPCS C1713,,75405535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75405540,SUP,HCPCS C1713,,75405540  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75405545,SUP,HCPCS C1713,,75405545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75406535,SUP,HCPCS C1713,,75406535  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75406540,SUP,HCPCS C1713,,75406540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75406545,SUP,HCPCS C1713,,75406545  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75407535,SUP,HCPCS C1713,,75407535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75407540,SUP,HCPCS C1713,,75407540  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75407545,SUP,HCPCS C1713,,75407545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75407550,SUP,HCPCS C1713,,75407550  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75444020,SUP,HCPCS C1713,,75444020  -  SCREW BN FLUT 4MM 20MM STRL LGC CD HZN G4 TCH MA ST LCK MECH,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75444025,SUP,HCPCS C1713,,75444025  -  SCREW BN 4MM 25MM STRL CD HZN LGC MA TI PDCL SPNE 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75444030,SUP,HCPCS C1713,,75444030  -  SCREW BN FLUT 4MM 30MM STRL LGC CD HZN G4 TCH MA ST LCK MECH,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75444040,SUP,HCPCS C1713,,75444040  -  SCREW BN FLUT 4MM 40MM STRL LGC CD HZN G4 TCH MA ST LCK MECH,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75444045,SUP,HCPCS C1713,,75444045  -  SCREW BN 4MM 45MM STRL CD HZN LGC MA TI SPNE PDCL 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75444050,SUP,HCPCS C1713,,75444050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75444520,SUP,HCPCS C1713,,75444520  -  SCREW BN FLUT 4.5MM 20MM NS CD HZN LGC MA ST RVRS ANG THRDLK,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75444525,SUP,HCPCS C1713,,75444525  -  SCREW BN FLUT 4.5MM 25MM NS CD HZN LGC MA ST RVRS ANG THRDLK,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75444530,SUP,HCPCS C1713,,75444530  -  SCREW BN FLUT 4.5MM 30MM NS CD HZN LGC MA ST RVRS ANG THRDLK,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75444535,SUP,HCPCS C1713,,75444535  -  SCREW BN FLUT 4.5MM 35MM NS CD HZN LGC MA ST RVRS ANG THRDLK,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75444540,SUP,HCPCS C1713,,75444540  -  SCREW BN FLUT 4.5MM 40MM NS CD HZN LGC MA ST RVRS ANG THRDLK,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75444545,SUP,HCPCS C1713,,75444545  -  SCREW BN FLUT 4.5MM 45MM NS CD HZN LGC MA ST RVRS ANG THRDLK,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75444550,SUP,HCPCS C1713,,75444550  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75445020,SUP,HCPCS C1713,,75445020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75445025,SUP,HCPCS C1713,,75445025  -  SCREW BN FLUT 5MM 25MM NS CD HZN LGC MA ST RVRS ANG THRDLK,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75445030,SUP,HCPCS C1713,,75445030  -  SCREW BN FLUT 5MM 30MM NS CD HZN LGC MA ST RVRS ANG THRDLK,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75445035,SUP,HCPCS C1713,,75445035  -  SCREW BN FLUT 5MM 35MM NS CD HZN LGC MA ST RVRS ANG THRDLK,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75445040,SUP,HCPCS C1713,,75445040  -  SCREW BN FLUT 5MM 40MM NS CD HZN LGC MA ST RVRS ANG THRDLK,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75445045,SUP,HCPCS C1713,,75445045  -  SCREW BN FLUT 5MM 45MM NS CD HZN LGC MA ST RVRS ANG THRDLK,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75445050,SUP,HCPCS C1713,,75445050  -  SCREW BN FLUT 5MM 50MM NS CD HZN LGC MA ST RVRS ANG THRDLK,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75445520,SUP,HCPCS C1713,,75445520  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75445525,SUP,HCPCS C1713,,75445525  -  SCREW BN FLUT 5.5MM 25MM NS CD HZN LGC MA ST RVRS ANG THRDLK,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75445530,SUP,HCPCS C1713,,75445530  -  SCREW BN FLUT 5.5MM 30MM NS CD HZN LGC MA ST RVRS ANG THRDLK,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75445535,SUP,HCPCS C1713,,75445535  -  SCREW BN FLUT 5.5MM 35MM NS CD HZN LGC MA ST RVRS ANG THRDLK,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75445540,SUP,HCPCS C1713,,75445540  -  SCREW BN FLUT 5.5MM 40MM NS CD HZN LGC MA ST RVRS ANG THRDLK,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75445545,SUP,HCPCS C1713,,75445545  -  SCREW BN FLUT 5.5MM 45MM NS CD HZN LGC MA ST RVRS ANG THRDLK,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75445550,SUP,HCPCS C1713,,75445550  -  SCREW BN FLUT 5.5MM 50MM NS CD HZN LGC MA ST RVRS ANG THRDLK,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75445555,SUP,HCPCS C1713,,75445555  -  SCREW BN FLUT 5.5MM 55MM NS CD HZN LGC MA ST RVRS ANG THRDLK,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75445560,SUP,HCPCS C1713,,75445560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75446025,SUP,HCPCS C1713,,75446025  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75446030,SUP,HCPCS C1713,,75446030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75446035,SUP,HCPCS C1713,,75446035  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75446040,SUP,HCPCS C1713,,75446040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75446045,SUP,HCPCS C1713,,75446045  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75446050,SUP,HCPCS C1713,,75446050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75446055,SUP,HCPCS C1713,,75446055  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75446060,SUP,HCPCS C1713,,75446060  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75446070,SUP,HCPCS C1713,,75446070  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75446520,SUP,HCPCS C1713,,75446520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75446525,SUP,HCPCS C1713,,75446525  -  SCREW BN FLUT 6.5MM 25MM NS CD HZN LGC MA ST RVRS ANG THRDLK,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75446530,SUP,HCPCS C1713,,75446530  -  SCREW BN FLUT 6.5MM 30MM NS CD HZN LGC MA ST RVRS ANG THRDLK,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75446535,SUP,HCPCS C1713,,75446535  -  SCREW BN FLUT 6.5MM 35MM NS CD HZN LGC MA ST RVRS ANG THRDLK,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75446540,SUP,HCPCS C1713,,75446540  -  SCREW BN FLUT 6.5MM 40MM NS CD HZN LGC MA ST RVRS ANG THRDLK,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75446545,SUP,HCPCS C1713,,75446545  -  SCREW BN FLUT 6.5MM 45MM NS CD HZN LGC MA ST RVRS ANG THRDLK,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75446550,SUP,HCPCS C1713,,75446550  -  SCREW BN FLUT 6.5MM 50MM NS CD HZN LGC MA ST RVRS ANG THRDLK,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75446555,SUP,HCPCS C1713,,75446555  -  SCREW BN FLUT 6.5MM 55MM NS CD HZN LGC MA ST RVRS ANG THRDLK,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75446560,SUP,HCPCS C1713,,75446560  -  SCREW BN FLUT 6.5MM 60MM NS CD HZN LGC MA ST RVRS ANG THRDLK,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75446565,SUP,HCPCS C1713,,75446565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75447525,SUP,HCPCS C1713,,75447525  -  SCREW BN FLUT 7.5MM 25MM NS CD HZN LGC MA ST RVRS ANG THRDLK,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75447530,SUP,HCPCS C1713,,75447530  -  SCREW BN FLUT 7.5MM 30MM NS CD HZN LGC MA ST RVRS ANG THRDLK,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75447535,SUP,HCPCS C1713,,75447535  -  SCREW BN FLUT 7.5MM 35MM NS CD HZN LGC MA ST RVRS ANG THRDLK,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75447540,SUP,HCPCS C1713,,75447540  -  SCREW BN FLUT 7.5MM 40MM NS CD HZN LGC MA ST RVRS ANG THRDLK,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75447545,SUP,HCPCS C1713,,75447545  -  SCREW BN FLUT 7.5MM 45MM NS CD HZN LGC MA ST RVRS ANG THRDLK,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75447550,SUP,HCPCS C1713,,75447550  -  SCREW BN FLUT 7.5MM 50MM NS CD HZN LGC MA ST RVRS ANG THRDLK,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75447555,SUP,HCPCS C1713,,75447555  -  SCREW BN FLUT 7.5MM 55MM NS CD HZN LGC MA ST RVRS ANG THRDLK,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75447560,SUP,HCPCS C1713,,75447560  -  SCREW BN FLUT 7.5MM 60MM NS CD HZN LGC MA ST RVRS ANG THRDLK,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75447565,SUP,HCPCS C1713,,75447565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75447570,SUP,HCPCS C1713,,75447570  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75448525,SUP,HCPCS C1713,,75448525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75448530,SUP,HCPCS C1713,,75448530  -  SCREW BN FLUT 8.5MM 30MM STRL LGC CD HZN G4 TCH MA ST LCK,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75448535,SUP,HCPCS C1713,,75448535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75448540,SUP,HCPCS C1713,,75448540  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75448545,SUP,HCPCS C1713,,75448545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75448550,SUP,HCPCS C1713,,75448550  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75448555,SUP,HCPCS C1713,,75448555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75448560,SUP,HCPCS C1713,,75448560  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75448565,SUP,HCPCS C1713,,75448565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75454020,SUP,HCPCS C1713,,75454020  -  PLATE 18MM TI BONE SPNL,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75454025,SUP,HCPCS C1713,,75454025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75454030,SUP,HCPCS C1713,,75454030  -  PLATE 18MM TI BONE SPNL,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75454035,SUP,HCPCS C1713,,75454035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75454040,SUP,HCPCS C1713,,75454040  -  PLATE 18MM TI BONE SPNL,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75454045,SUP,HCPCS C1713,,75454045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75454050,SUP,HCPCS C1713,,75454050  -  PLATE 18MM TI BONE SPNL,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75454520,SUP,HCPCS C1713,,75454520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75454525,SUP,HCPCS C1713,,75454525  -  PLATE 18MM TI BONE SPNL,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75454530,SUP,HCPCS C1713,,75454530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75454535,SUP,HCPCS C1713,,75454535  -  PLATE 18MM TI BONE SPNL,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75454540,SUP,HCPCS C1713,,75454540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75454545,SUP,HCPCS C1713,,75454545  -  PLATE 18MM TI BONE SPNL,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75454550,SUP,HCPCS C1713,,75454550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75455020,SUP,HCPCS C1713,,75455020  -  PLATE 18MM TI BONE SPNL,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75455025,SUP,HCPCS C1713,,75455025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75455030,SUP,HCPCS C1713,,75455030  -  PLATE 18MM TI BONE SPNL,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75455035,SUP,HCPCS C1713,,75455035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75455040,SUP,HCPCS C1713,,75455040  -  PLATE 18MM TI BONE SPNL,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75455045,SUP,HCPCS C1713,,75455045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75455050,SUP,HCPCS C1713,,75455050  -  PLATE 18MM TI BONE SPNL,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75455520,SUP,HCPCS C1713,,75455520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75455525,SUP,HCPCS C1713,,75455525  -  PLATE 18MM TI BONE SPNL,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75455530,SUP,HCPCS C1713,,75455530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75455535,SUP,HCPCS C1713,,75455535  -  PLATE 18MM TI BONE SPNL,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75455540,SUP,HCPCS C1713,,75455540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75455545,SUP,HCPCS C1713,,75455545  -  PLATE 18MM TI BONE SPNL,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75455550,SUP,HCPCS C1713,,75455550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75455555,SUP,HCPCS C1713,,75455555  -  PLATE 18MM TI BONE SPNL,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75455560,SUP,HCPCS C1713,,75455560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75456020,SUP,HCPCS C1713,,75456020  -  PLATE 18MM TI BONE SPNL,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75456025,SUP,HCPCS C1713,,75456025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75456030,SUP,HCPCS C1713,,75456030  -  PLATE 18MM TI BONE SPNL,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75456035,SUP,HCPCS C1713,,75456035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75456040,SUP,HCPCS C1713,,75456040  -  PLATE 18MM TI BONE SPNL,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75456045,SUP,HCPCS C1713,,75456045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75456050,SUP,HCPCS C1713,,75456050  -  PLATE 18MM TI BONE SPNL,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75456055,SUP,HCPCS C1713,,75456055  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75456060,SUP,HCPCS C1713,,75456060  -  PLATE 18MM TI BONE SPNL,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75456065,SUP,HCPCS C1713,,75456065  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75456070,SUP,HCPCS C1713,,75456070  -  PLATE 18MM TI BONE SPNL,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75456520,SUP,HCPCS C1713,,75456520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75456525,SUP,HCPCS C1713,,75456525  -  PLATE 18MM TI BONE SPNL,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75456530,SUP,HCPCS C1713,,75456530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75456535,SUP,HCPCS C1713,,75456535  -  PLATE 18MM TI BONE SPNL,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75456540,SUP,HCPCS C1713,,75456540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75456545,SUP,HCPCS C1713,,75456545  -  PLATE 18MM TI BONE SPNL,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75456550,SUP,HCPCS C1713,,75456550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75456555,SUP,HCPCS C1713,,75456555  -  PLATE 18MM TI BONE SPNL,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75456560,SUP,HCPCS C1713,,75456560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75456565,SUP,HCPCS C1713,,75456565  -  PLATE 18MM TI BONE SPNL,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75457525,SUP,HCPCS C1713,,75457525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75457530,SUP,HCPCS C1713,,75457530  -  PLATE 18MM TI BONE SPNL,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75457535,SUP,HCPCS C1713,,75457535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75457540,SUP,HCPCS C1713,,75457540  -  PLATE 18MM TI BONE SPNL,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75457545,SUP,HCPCS C1713,,75457545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75457550,SUP,HCPCS C1713,,75457550  -  PLATE 18MM TI BONE SPNL,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75457555,SUP,HCPCS C1713,,75457555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75457560,SUP,HCPCS C1713,,75457560  -  PLATE 18MM TI BONE SPNL,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75457565,SUP,HCPCS C1713,,75457565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75457570,SUP,HCPCS C1713,,75457570  -  PLATE 18MM TI BONE SPNL,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75458525,SUP,HCPCS C1713,,75458525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75458530,SUP,HCPCS C1713,,75458530  -  PLATE 18MM TI BONE SPNL,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75458535,SUP,HCPCS C1713,,75458535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75458540,SUP,HCPCS C1713,,75458540  -  PLATE 18MM TI BONE SPNL,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75458545,SUP,HCPCS C1713,,75458545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75458550,SUP,HCPCS C1713,,75458550  -  PLATE 18MM TI BONE SPNL,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75458555,SUP,HCPCS C1713,,75458555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75458560,SUP,HCPCS C1713,,75458560  -  PLATE 18MM TI BONE SPNL,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75458565,SUP,HCPCS C1713,,75458565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,643.00",$0.00,"$2,643.00","$1,189.35","$1,886.31",$0.00,$455.38,$0.00,$0.00,$462.77,"$2,643.00",$0.00,"$1,321.50","$2,093.26","$2,114.40",$0.00,$413.63,$0.00,$420.77,$0.00
75464015,SUP,HCPCS C1713,,75464015  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75464020,SUP,HCPCS C1713,,75464020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75464025,SUP,HCPCS C1713,,75464025  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75464030,SUP,HCPCS C1713,,75464030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75464035,SUP,HCPCS C1713,,75464035  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75464040,SUP,HCPCS C1713,,75464040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75464045,SUP,HCPCS C1713,,75464045  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75464050,SUP,HCPCS C1713,,75464050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75464055,SUP,HCPCS C1713,,75464055  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75464060,SUP,HCPCS C1713,,75464060  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75464515,SUP,HCPCS C1713,,75464515  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75464520,SUP,HCPCS C1713,,75464520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75464525,SUP,HCPCS C1713,,75464525  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75464530,SUP,HCPCS C1713,,75464530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75464535,SUP,HCPCS C1713,,75464535  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75464540,SUP,HCPCS C1713,,75464540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75464545,SUP,HCPCS C1713,,75464545  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75464550,SUP,HCPCS C1713,,75464550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75464555,SUP,HCPCS C1713,,75464555  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75464560,SUP,HCPCS C1713,,75464560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75465015,SUP,HCPCS C1713,,75465015  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75465020,SUP,HCPCS C1713,,75465020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75465025,SUP,HCPCS C1713,,75465025  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75465030,SUP,HCPCS C1713,,75465030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75465035,SUP,HCPCS C1713,,75465035  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75465040,SUP,HCPCS C1713,,75465040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75465045,SUP,HCPCS C1713,,75465045  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75465050,SUP,HCPCS C1713,,75465050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75465055,SUP,HCPCS C1713,,75465055  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75465060,SUP,HCPCS C1713,,75465060  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75465515,SUP,HCPCS C1713,,75465515  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75465520,SUP,HCPCS C1713,,75465520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75465525,SUP,HCPCS C1713,,75465525  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75465530,SUP,HCPCS C1713,,75465530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75470735,SUP,Custom 27803010,,75470735  -  PLATE 18MM TI BONE SPNL,$808.50,$0.00,$808.50,$0.00,$577.03,$0.00,$0.00,$0.00,$0.00,$0.00,$808.50,$0.00,$404.25,$640.33,$646.80,$0.00,$0.00,$0.00,$0.00,$0.00
75470740,SUP,Custom 27803010,,75470740  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$808.50,$0.00,$808.50,$0.00,$577.03,$0.00,$0.00,$0.00,$0.00,$0.00,$808.50,$0.00,$404.25,$640.33,$646.80,$0.00,$0.00,$0.00,$0.00,$0.00
75470745,SUP,Custom 27803010,,75470745  -  PLATE 18MM TI BONE SPNL,$808.50,$0.00,$808.50,$0.00,$577.03,$0.00,$0.00,$0.00,$0.00,$0.00,$808.50,$0.00,$404.25,$640.33,$646.80,$0.00,$0.00,$0.00,$0.00,$0.00
75470750,SUP,Custom 27803010,,75470750  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$808.50,$0.00,$808.50,$0.00,$577.03,$0.00,$0.00,$0.00,$0.00,$0.00,$808.50,$0.00,$404.25,$640.33,$646.80,$0.00,$0.00,$0.00,$0.00,$0.00
75470755,SUP,Custom 27803010,,75470755  -  PLATE 18MM TI BONE SPNL,$808.50,$0.00,$808.50,$0.00,$577.03,$0.00,$0.00,$0.00,$0.00,$0.00,$808.50,$0.00,$404.25,$640.33,$646.80,$0.00,$0.00,$0.00,$0.00,$0.00
75470760,SUP,Custom 27803010,,75470760  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$808.50,$0.00,$808.50,$0.00,$577.03,$0.00,$0.00,$0.00,$0.00,$0.00,$808.50,$0.00,$404.25,$640.33,$646.80,$0.00,$0.00,$0.00,$0.00,$0.00
75470865,SUP,Custom 27803010,,75470865  -  PLATE 18MM TI BONE SPNL,$808.50,$0.00,$808.50,$0.00,$577.03,$0.00,$0.00,$0.00,$0.00,$0.00,$808.50,$0.00,$404.25,$640.33,$646.80,$0.00,$0.00,$0.00,$0.00,$0.00
75470870,SUP,Custom 27803010,,75470870  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$808.50,$0.00,$808.50,$0.00,$577.03,$0.00,$0.00,$0.00,$0.00,$0.00,$808.50,$0.00,$404.25,$640.33,$646.80,$0.00,$0.00,$0.00,$0.00,$0.00
75470875,SUP,Custom 27803010,,75470875  -  PLATE 18MM TI BONE SPNL,$808.50,$0.00,$808.50,$0.00,$577.03,$0.00,$0.00,$0.00,$0.00,$0.00,$808.50,$0.00,$404.25,$640.33,$646.80,$0.00,$0.00,$0.00,$0.00,$0.00
75494520,SUP,HCPCS C1713,,75494520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75494525,SUP,HCPCS C1713,,75494525  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75494530,SUP,HCPCS C1713,,75494530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75494535,SUP,HCPCS C1713,,75494535  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75494540,SUP,HCPCS C1713,,75494540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75494545,SUP,HCPCS C1713,,75494545  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75494550,SUP,HCPCS C1713,,75494550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75495020,SUP,HCPCS C1713,,75495020  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75495025,SUP,HCPCS C1713,,75495025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75495030,SUP,HCPCS C1713,,75495030  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75495035,SUP,HCPCS C1713,,75495035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75495040,SUP,HCPCS C1713,,75495040  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75495045,SUP,HCPCS C1713,,75495045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75495050,SUP,HCPCS C1713,,75495050  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75495520,SUP,HCPCS C1713,,75495520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75495525,SUP,HCPCS C1713,,75495525  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75495530,SUP,HCPCS C1713,,75495530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75495535,SUP,HCPCS C1713,,75495535  -  SCREW BN 5.5MM 35MM CD HZN LGC MA RDC TI SPNE 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75495540,SUP,HCPCS C1713,,75495540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75495545,SUP,HCPCS C1713,,75495545  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75495550,SUP,HCPCS C1713,,75495550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75495555,SUP,HCPCS C1713,,75495555  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75495560,SUP,HCPCS C1713,,75495560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75496520,SUP,HCPCS C1713,,75496520  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75496525,SUP,HCPCS C1713,,75496525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75496530,SUP,HCPCS C1713,,75496530  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75496535,SUP,HCPCS C1713,,75496535  -  SCREW BN 6.5MM 35MM CD HZN LGC MA RDC TI SPNE 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75496540,SUP,HCPCS C1713,,75496540  -  SCREW BN 6.5MM 40MM CD HZN LGC MA RDC TI SPNE 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75496545,SUP,HCPCS C1713,,75496545  -  SCREW BN 6.5MM 45MM CD HZN LGC MA RDC TI SPNE 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75496550,SUP,HCPCS C1713,,75496550  -  SCREW BN 6.5MM 50MM CD HZN LGC MA RDC TI SPNE 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75496555,SUP,HCPCS C1713,,75496555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75496560,SUP,HCPCS C1713,,75496560  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75496565,SUP,HCPCS C1713,,75496565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75497525,SUP,HCPCS C1713,,75497525  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75497530,SUP,HCPCS C1713,,75497530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75497535,SUP,HCPCS C1713,,75497535  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75497540,SUP,HCPCS C1713,,75497540  -  SCREW BN 7.5MM 40MM CD HZN LGC MA RDC TI SPNE 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75497545,SUP,HCPCS C1713,,75497545  -  SCREW BN 7.5MM 45MM CD HZN LGC MA RDC TI SPNE 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75497550,SUP,HCPCS C1713,,75497550  -  SCREW BN 7.5MM 50MM CD HZN LGC MA RDC TI SPNE 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75497555,SUP,HCPCS C1713,,75497555  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75497560,SUP,HCPCS C1713,,75497560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75497565,SUP,HCPCS C1713,,75497565  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75497570,SUP,HCPCS C1713,,75497570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75498525,SUP,HCPCS C1713,,75498525  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75498530,SUP,HCPCS C1713,,75498530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75498535,SUP,HCPCS C1713,,75498535  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75498540,SUP,HCPCS C1713,,75498540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75498545,SUP,HCPCS C1713,,75498545  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75498550,SUP,HCPCS C1713,,75498550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75498555,SUP,HCPCS C1713,,75498555  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75498560,SUP,HCPCS C1713,,75498560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75498565,SUP,HCPCS C1713,,75498565  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75644020,SUP,HCPCS C1713,,75644020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75644025,SUP,HCPCS C1713,,75644025  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75644030,SUP,HCPCS C1713,,75644030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75644035,SUP,HCPCS C1713,,75644035  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75644040,SUP,HCPCS C1713,,75644040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75644045,SUP,HCPCS C1713,,75644045  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75644050,SUP,HCPCS C1713,,75644050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75644520,SUP,HCPCS C1713,,75644520  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75644525,SUP,HCPCS C1713,,75644525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75644530,SUP,HCPCS C1713,,75644530  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75644535,SUP,HCPCS C1713,,75644535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75644540,SUP,HCPCS C1713,,75644540  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75644545,SUP,HCPCS C1713,,75644545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75644550,SUP,HCPCS C1713,,75644550  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75645020,SUP,HCPCS C1713,,75645020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75645025,SUP,HCPCS C1713,,75645025  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75645030,SUP,HCPCS C1713,,75645030  -  SCREW BN FLUT 5MM 30MM NS CD HZN LGC MA ST RVRS ANG THRDLK,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75645035,SUP,HCPCS C1713,,75645035  -  SCREW BN FLUT 5MM 35MM NS CD HZN LGC MA ST RVRS ANG THRDLK,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75645040,SUP,HCPCS C1713,,75645040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75645045,SUP,HCPCS C1713,,75645045  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75645050,SUP,HCPCS C1713,,75645050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75645520,SUP,HCPCS C1713,,75645520  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75645525,SUP,HCPCS C1713,,75645525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75645530,SUP,HCPCS C1713,,75645530  -  SCREW BN FLUT 5.5MM 30MM NS CD HZN LGC MA ST RVRS ANG THRDLK,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75645535,SUP,HCPCS C1713,,75645535  -  SCREW BN FLUT 5.5MM 35MM NS CD HZN LGC MA ST RVRS ANG THRDLK,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75645540,SUP,HCPCS C1713,,75645540  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75645545,SUP,HCPCS C1713,,75645545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75645550,SUP,HCPCS C1713,,75645550  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75645555,SUP,HCPCS C1713,,75645555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75645560,SUP,HCPCS C1713,,75645560  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75646025,SUP,HCPCS C1713,,75646025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75646030,SUP,HCPCS C1713,,75646030  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75646035,SUP,HCPCS C1713,,75646035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75646040,SUP,HCPCS C1713,,75646040  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75646045,SUP,HCPCS C1713,,75646045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75646050,SUP,HCPCS C1713,,75646050  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75646055,SUP,HCPCS C1713,,75646055  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75646060,SUP,HCPCS C1713,,75646060  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75646065,SUP,HCPCS C1713,,75646065  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75646070,SUP,HCPCS C1713,,75646070  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75646520,SUP,HCPCS C1713,,75646520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75646525,SUP,HCPCS C1713,,75646525  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75646530,SUP,HCPCS C1713,,75646530  -  SCREW BN FLUT 6.5MM 30MM NS CD HZN LGC MA ST RVRS ANG THRDLK,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75646535,SUP,HCPCS C1713,,75646535  -  SCREW BN FLUT 6.5MM 35MM NS CD HZN LGC MA ST RVRS ANG THRDLK,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75646540,SUP,HCPCS C1713,,75646540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75646545,SUP,HCPCS C1713,,75646545  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75646550,SUP,HCPCS C1713,,75646550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75646555,SUP,HCPCS C1713,,75646555  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75646560,SUP,HCPCS C1713,,75646560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75646565,SUP,HCPCS C1713,,75646565  -  SCREW BN FLUT 6.5MM 65MM NS CD HZN LGC MA ST RVRS ANG THRDLK,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75647525,SUP,HCPCS C1713,,75647525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75647530,SUP,HCPCS C1713,,75647530  -  SCREW BN FLUT 7.5MM 30MM NS CD HZN LGC MA ST RVRS ANG THRDLK,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75647535,SUP,HCPCS C1713,,75647535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75647540,SUP,HCPCS C1713,,75647540  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75647545,SUP,HCPCS C1713,,75647545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75647550,SUP,HCPCS C1713,,75647550  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75647555,SUP,HCPCS C1713,,75647555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75647560,SUP,HCPCS C1713,,75647560  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75647565,SUP,HCPCS C1713,,75647565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75647570,SUP,HCPCS C1713,,75647570  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75648525,SUP,HCPCS C1713,,75648525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75648530,SUP,HCPCS C1713,,75648530  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75648535,SUP,HCPCS C1713,,75648535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75648540,SUP,HCPCS C1713,,75648540  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75648545,SUP,HCPCS C1713,,75648545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75648550,SUP,HCPCS C1713,,75648550  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75648555,SUP,HCPCS C1713,,75648555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75648560,SUP,HCPCS C1713,,75648560  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75648565,SUP,HCPCS C1713,,75648565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75654020,SUP,HCPCS C1713,,75654020  -  PLATE 18MM TI BONE SPNL,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75654025,SUP,HCPCS C1713,,75654025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75654030,SUP,HCPCS C1713,,75654030  -  PLATE 18MM TI BONE SPNL,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75654035,SUP,HCPCS C1713,,75654035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75654040,SUP,HCPCS C1713,,75654040  -  PLATE 18MM TI BONE SPNL,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75654045,SUP,HCPCS C1713,,75654045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75654050,SUP,HCPCS C1713,,75654050  -  PLATE 18MM TI BONE SPNL,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75654520,SUP,HCPCS C1713,,75654520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75654525,SUP,HCPCS C1713,,75654525  -  PLATE 18MM TI BONE SPNL,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75654530,SUP,HCPCS C1713,,75654530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75654535,SUP,HCPCS C1713,,75654535  -  PLATE 18MM TI BONE SPNL,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75654540,SUP,HCPCS C1713,,75654540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75654545,SUP,HCPCS C1713,,75654545  -  PLATE 18MM TI BONE SPNL,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75654550,SUP,HCPCS C1713,,75654550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75655020,SUP,HCPCS C1713,,75655020  -  PLATE 18MM TI BONE SPNL,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75655025,SUP,HCPCS C1713,,75655025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75655030,SUP,HCPCS C1713,,75655030  -  PLATE 18MM TI BONE SPNL,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75655035,SUP,HCPCS C1713,,75655035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75655040,SUP,HCPCS C1713,,75655040  -  PLATE 18MM TI BONE SPNL,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75655045,SUP,HCPCS C1713,,75655045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75655050,SUP,HCPCS C1713,,75655050  -  PLATE 18MM TI BONE SPNL,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75655520,SUP,HCPCS C1713,,75655520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75655525,SUP,HCPCS C1713,,75655525  -  PLATE 18MM TI BONE SPNL,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75655530,SUP,HCPCS C1713,,75655530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75655535,SUP,HCPCS C1713,,75655535  -  PLATE 18MM TI BONE SPNL,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75655540,SUP,HCPCS C1713,,75655540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75655545,SUP,HCPCS C1713,,75655545  -  PLATE 18MM TI BONE SPNL,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75655550,SUP,HCPCS C1713,,75655550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75655555,SUP,HCPCS C1713,,75655555  -  PLATE 18MM TI BONE SPNL,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75655560,SUP,HCPCS C1713,,75655560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75656020,SUP,HCPCS C1713,,75656020  -  PLATE 18MM TI BONE SPNL,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75656025,SUP,HCPCS C1713,,75656025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75656030,SUP,HCPCS C1713,,75656030  -  PLATE 18MM TI BONE SPNL,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75656035,SUP,HCPCS C1713,,75656035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75656040,SUP,HCPCS C1713,,75656040  -  PLATE 18MM TI BONE SPNL,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75656045,SUP,HCPCS C1713,,75656045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75656050,SUP,HCPCS C1713,,75656050  -  PLATE 18MM TI BONE SPNL,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75656055,SUP,HCPCS C1713,,75656055  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75656060,SUP,HCPCS C1713,,75656060  -  PLATE 18MM TI BONE SPNL,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75656065,SUP,HCPCS C1713,,75656065  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75656070,SUP,HCPCS C1713,,75656070  -  PLATE 18MM TI BONE SPNL,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75656520,SUP,HCPCS C1713,,75656520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75656525,SUP,HCPCS C1713,,75656525  -  PLATE 18MM TI BONE SPNL,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75656530,SUP,HCPCS C1713,,75656530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75656535,SUP,HCPCS C1713,,75656535  -  PLATE 18MM TI BONE SPNL,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75656540,SUP,HCPCS C1713,,75656540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75656545,SUP,HCPCS C1713,,75656545  -  PLATE 18MM TI BONE SPNL,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75656550,SUP,HCPCS C1713,,75656550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75656555,SUP,HCPCS C1713,,75656555  -  PLATE 18MM TI BONE SPNL,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75656560,SUP,HCPCS C1713,,75656560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75656565,SUP,HCPCS C1713,,75656565  -  PLATE 18MM TI BONE SPNL,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75657525,SUP,HCPCS C1713,,75657525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75657530,SUP,HCPCS C1713,,75657530  -  PLATE 18MM TI BONE SPNL,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75657535,SUP,HCPCS C1713,,75657535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75657540,SUP,HCPCS C1713,,75657540  -  PLATE 18MM TI BONE SPNL,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75657545,SUP,HCPCS C1713,,75657545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75657550,SUP,HCPCS C1713,,75657550  -  PLATE 18MM TI BONE SPNL,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75657555,SUP,HCPCS C1713,,75657555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75657560,SUP,HCPCS C1713,,75657560  -  PLATE 18MM TI BONE SPNL,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75657565,SUP,HCPCS C1713,,75657565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75657570,SUP,HCPCS C1713,,75657570  -  PLATE 18MM TI BONE SPNL,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75658525,SUP,HCPCS C1713,,75658525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75658530,SUP,HCPCS C1713,,75658530  -  PLATE 18MM TI BONE SPNL,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75658535,SUP,HCPCS C1713,,75658535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75658540,SUP,HCPCS C1713,,75658540  -  PLATE 18MM TI BONE SPNL,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75658545,SUP,HCPCS C1713,,75658545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75658550,SUP,HCPCS C1713,,75658550  -  PLATE 18MM TI BONE SPNL,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75658555,SUP,HCPCS C1713,,75658555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75658560,SUP,HCPCS C1713,,75658560  -  PLATE 18MM TI BONE SPNL,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75658565,SUP,HCPCS C1713,,75658565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,452.50",$0.00,"$2,452.50","$1,103.63","$1,750.35",$0.00,$422.55,$0.00,$0.00,$429.41,"$2,452.50",$0.00,"$1,226.25","$1,942.38","$1,962.00",$0.00,$383.82,$0.00,$390.44,$0.00
75694520,SUP,HCPCS C1713,,75694520  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75694525,SUP,HCPCS C1713,,75694525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75694530,SUP,HCPCS C1713,,75694530  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75694535,SUP,HCPCS C1713,,75694535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75694540,SUP,HCPCS C1713,,75694540  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75694545,SUP,HCPCS C1713,,75694545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75694550,SUP,HCPCS C1713,,75694550  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75695020,SUP,HCPCS C1713,,75695020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75695025,SUP,HCPCS C1713,,75695025  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75695030,SUP,HCPCS C1713,,75695030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75695035,SUP,HCPCS C1713,,75695035  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75695040,SUP,HCPCS C1713,,75695040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75695045,SUP,HCPCS C1713,,75695045  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75695050,SUP,HCPCS C1713,,75695050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75695520,SUP,HCPCS C1713,,75695520  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75695525,SUP,HCPCS C1713,,75695525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75695530,SUP,HCPCS C1713,,75695530  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75695535,SUP,HCPCS C1713,,75695535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75695540,SUP,HCPCS C1713,,75695540  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75695545,SUP,HCPCS C1713,,75695545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75695550,SUP,HCPCS C1713,,75695550  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75695555,SUP,HCPCS C1713,,75695555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75695560,SUP,HCPCS C1713,,75695560  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75696520,SUP,HCPCS C1713,,75696520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75696525,SUP,HCPCS C1713,,75696525  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75696530,SUP,HCPCS C1713,,75696530  -  SCREW BN FLUT 6.5MM 30MM CD HZN LGC MA RDC SS SPNE 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75696535,SUP,HCPCS C1713,,75696535  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75696540,SUP,HCPCS C1713,,75696540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75696545,SUP,HCPCS C1713,,75696545  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75696550,SUP,HCPCS C1713,,75696550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75696555,SUP,HCPCS C1713,,75696555  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75696560,SUP,HCPCS C1713,,75696560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75696565,SUP,HCPCS C1713,,75696565  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75697525,SUP,HCPCS C1713,,75697525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75697530,SUP,HCPCS C1713,,75697530  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75697535,SUP,HCPCS C1713,,75697535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75697540,SUP,HCPCS C1713,,75697540  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75697545,SUP,HCPCS C1713,,75697545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75697550,SUP,HCPCS C1713,,75697550  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75697555,SUP,HCPCS C1713,,75697555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75697560,SUP,HCPCS C1713,,75697560  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75697565,SUP,HCPCS C1713,,75697565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75697570,SUP,HCPCS C1713,,75697570  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75698525,SUP,HCPCS C1713,,75698525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75698530,SUP,HCPCS C1713,,75698530  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75698535,SUP,HCPCS C1713,,75698535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75698540,SUP,HCPCS C1713,,75698540  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75698545,SUP,HCPCS C1713,,75698545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75698550,SUP,HCPCS C1713,,75698550  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75698555,SUP,HCPCS C1713,,75698555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75698560,SUP,HCPCS C1713,,75698560  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
75698565,SUP,HCPCS C1713,,75698565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76440020,SUP,HCPCS C1713,,76440020  -  SCREW BONE 20MM CD HZN LGC PDCL TI MULTIAX 5.5MM ROD STRL,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
76444020,SUP,HCPCS C1713,,76444020  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76444025,SUP,HCPCS C1713,,76444025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76444030,SUP,HCPCS C1713,,76444030  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76444035,SUP,HCPCS C1713,,76444035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76444040,SUP,HCPCS C1713,,76444040  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76444045,SUP,HCPCS C1713,,76444045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76444050,SUP,HCPCS C1713,,76444050  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76444520,SUP,HCPCS C1713,,76444520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76444525,SUP,HCPCS C1713,,76444525  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76444530,SUP,HCPCS C1713,,76444530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76444535,SUP,HCPCS C1713,,76444535  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76444540,SUP,HCPCS C1713,,76444540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76444545,SUP,HCPCS C1713,,76444545  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76444550,SUP,HCPCS C1713,,76444550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76445020,SUP,HCPCS C1713,,76445020  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76445025,SUP,HCPCS C1713,,76445025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76445030,SUP,HCPCS C1713,,76445030  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76445035,SUP,HCPCS C1713,,76445035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76445040,SUP,HCPCS C1713,,76445040  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76445045,SUP,HCPCS C1713,,76445045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76445050,SUP,HCPCS C1713,,76445050  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76445520,SUP,HCPCS C1713,,76445520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76445525,SUP,HCPCS C1713,,76445525  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76445530,SUP,HCPCS C1713,,76445530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76445535,SUP,HCPCS C1713,,76445535  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76445540,SUP,HCPCS C1713,,76445540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76445545,SUP,HCPCS C1713,,76445545  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76445550,SUP,HCPCS C1713,,76445550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76445555,SUP,HCPCS C1713,,76445555  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76445560,SUP,HCPCS C1713,,76445560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76446025,SUP,HCPCS C1713,,76446025  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76446030,SUP,HCPCS C1713,,76446030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76446035,SUP,HCPCS C1713,,76446035  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76446040,SUP,HCPCS C1713,,76446040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76446045,SUP,HCPCS C1713,,76446045  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76446050,SUP,HCPCS C1713,,76446050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76446055,SUP,HCPCS C1713,,76446055  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76446060,SUP,HCPCS C1713,,76446060  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76446065,SUP,HCPCS C1713,,76446065  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76446070,SUP,HCPCS C1713,,76446070  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76446075,SUP,HCPCS C1713,,76446075  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76446520,SUP,HCPCS C1713,,76446520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76446525,SUP,HCPCS C1713,,76446525  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76446530,SUP,HCPCS C1713,,76446530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76446535,SUP,HCPCS C1713,,76446535  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76446540,SUP,HCPCS C1713,,76446540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76446545,SUP,HCPCS C1713,,76446545  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76446550,SUP,HCPCS C1713,,76446550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76446555,SUP,HCPCS C1713,,76446555  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76446560,SUP,HCPCS C1713,,76446560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76446565,SUP,HCPCS C1713,,76446565  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76446570,SUP,HCPCS C1713,,76446570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76446575,SUP,HCPCS C1713,,76446575  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76447525,SUP,HCPCS C1713,,76447525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76447530,SUP,HCPCS C1713,,76447530  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76447535,SUP,HCPCS C1713,,76447535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76447540,SUP,HCPCS C1713,,76447540  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76447545,SUP,HCPCS C1713,,76447545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76447550,SUP,HCPCS C1713,,76447550  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76447555,SUP,HCPCS C1713,,76447555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76447560,SUP,HCPCS C1713,,76447560  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76447565,SUP,HCPCS C1713,,76447565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76447570,SUP,HCPCS C1713,,76447570  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76447575,SUP,HCPCS C1713,,76447575  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76448525,SUP,HCPCS C1713,,76448525  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76448530,SUP,HCPCS C1713,,76448530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76448535,SUP,HCPCS C1713,,76448535  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76448540,SUP,HCPCS C1713,,76448540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76448545,SUP,HCPCS C1713,,76448545  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76448550,SUP,HCPCS C1713,,76448550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76448555,SUP,HCPCS C1713,,76448555  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76448560,SUP,HCPCS C1713,,76448560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76448565,SUP,HCPCS C1713,,76448565  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76448570,SUP,HCPCS C1713,,76448570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76448575,SUP,HCPCS C1713,,76448575  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76494520,SUP,HCPCS C1713,,76494520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76494525,SUP,HCPCS C1713,,76494525  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76494530,SUP,HCPCS C1713,,76494530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76494535,SUP,HCPCS C1713,,76494535  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76494540,SUP,HCPCS C1713,,76494540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76494545,SUP,HCPCS C1713,,76494545  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76494550,SUP,HCPCS C1713,,76494550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76495020,SUP,HCPCS C1713,,76495020  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76495025,SUP,HCPCS C1713,,76495025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76495030,SUP,HCPCS C1713,,76495030  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76495035,SUP,HCPCS C1713,,76495035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76495040,SUP,HCPCS C1713,,76495040  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76495045,SUP,HCPCS C1713,,76495045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76495050,SUP,HCPCS C1713,,76495050  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76495520,SUP,HCPCS C1713,,76495520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76495525,SUP,HCPCS C1713,,76495525  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76495530,SUP,HCPCS C1713,,76495530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76495535,SUP,HCPCS C1713,,76495535  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76495540,SUP,HCPCS C1713,,76495540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76495545,SUP,HCPCS C1713,,76495545  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76495550,SUP,HCPCS C1713,,76495550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76495555,SUP,HCPCS C1713,,76495555  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76495560,SUP,HCPCS C1713,,76495560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76496525,SUP,HCPCS C1713,,76496525  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76496530,SUP,HCPCS C1713,,76496530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76496535,SUP,HCPCS C1713,,76496535  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76496540,SUP,HCPCS C1713,,76496540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76496545,SUP,HCPCS C1713,,76496545  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76496550,SUP,HCPCS C1713,,76496550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76496555,SUP,HCPCS C1713,,76496555  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76496560,SUP,HCPCS C1713,,76496560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76496565,SUP,HCPCS C1713,,76496565  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76496570,SUP,HCPCS C1713,,76496570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76496575,SUP,HCPCS C1713,,76496575  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76497525,SUP,HCPCS C1713,,76497525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76497530,SUP,HCPCS C1713,,76497530  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76497535,SUP,HCPCS C1713,,76497535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76497540,SUP,HCPCS C1713,,76497540  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76497545,SUP,HCPCS C1713,,76497545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76497550,SUP,HCPCS C1713,,76497550  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76497555,SUP,HCPCS C1713,,76497555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76497560,SUP,HCPCS C1713,,76497560  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76497565,SUP,HCPCS C1713,,76497565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76497570,SUP,HCPCS C1713,,76497570  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76497575,SUP,HCPCS C1713,,76497575  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76498525,SUP,HCPCS C1713,,76498525  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76498530,SUP,HCPCS C1713,,76498530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76498535,SUP,HCPCS C1713,,76498535  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76498540,SUP,HCPCS C1713,,76498540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76498545,SUP,HCPCS C1713,,76498545  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76498550,SUP,HCPCS C1713,,76498550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76498555,SUP,HCPCS C1713,,76498555  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76498560,SUP,HCPCS C1713,,76498560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76498565,SUP,HCPCS C1713,,76498565  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76498570,SUP,HCPCS C1713,,76498570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76498575,SUP,HCPCS C1713,,76498575  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76644020,SUP,HCPCS C1713,,76644020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76644025,SUP,HCPCS C1713,,76644025  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76644030,SUP,HCPCS C1713,,76644030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76644035,SUP,HCPCS C1713,,76644035  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76644040,SUP,HCPCS C1713,,76644040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76644045,SUP,HCPCS C1713,,76644045  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76644050,SUP,HCPCS C1713,,76644050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76644520,SUP,HCPCS C1713,,76644520  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76644525,SUP,HCPCS C1713,,76644525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76644530,SUP,HCPCS C1713,,76644530  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76644535,SUP,HCPCS C1713,,76644535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76644540,SUP,HCPCS C1713,,76644540  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76644545,SUP,HCPCS C1713,,76644545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76644550,SUP,HCPCS C1713,,76644550  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76645020,SUP,HCPCS C1713,,76645020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76645025,SUP,HCPCS C1713,,76645025  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76645030,SUP,HCPCS C1713,,76645030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76645035,SUP,HCPCS C1713,,76645035  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76645040,SUP,HCPCS C1713,,76645040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76645045,SUP,HCPCS C1713,,76645045  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76645050,SUP,HCPCS C1713,,76645050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76645520,SUP,HCPCS C1713,,76645520  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76645525,SUP,HCPCS C1713,,76645525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76645530,SUP,HCPCS C1713,,76645530  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76645535,SUP,HCPCS C1713,,76645535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76645540,SUP,HCPCS C1713,,76645540  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76645545,SUP,HCPCS C1713,,76645545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76645550,SUP,HCPCS C1713,,76645550  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76645555,SUP,HCPCS C1713,,76645555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76645560,SUP,HCPCS C1713,,76645560  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76646025,SUP,HCPCS C1713,,76646025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76646030,SUP,HCPCS C1713,,76646030  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76646035,SUP,HCPCS C1713,,76646035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76646040,SUP,HCPCS C1713,,76646040  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76646045,SUP,HCPCS C1713,,76646045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76646050,SUP,HCPCS C1713,,76646050  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76646055,SUP,HCPCS C1713,,76646055  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76646060,SUP,HCPCS C1713,,76646060  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76646065,SUP,HCPCS C1713,,76646065  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76646070,SUP,HCPCS C1713,,76646070  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76646075,SUP,HCPCS C1713,,76646075  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76646525,SUP,HCPCS C1713,,76646525  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76646530,SUP,HCPCS C1713,,76646530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76646535,SUP,HCPCS C1713,,76646535  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76646540,SUP,HCPCS C1713,,76646540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76646545,SUP,HCPCS C1713,,76646545  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76646550,SUP,HCPCS C1713,,76646550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76646555,SUP,HCPCS C1713,,76646555  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76646560,SUP,HCPCS C1713,,76646560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76646565,SUP,HCPCS C1713,,76646565  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76646570,SUP,HCPCS C1713,,76646570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76646575,SUP,HCPCS C1713,,76646575  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76647525,SUP,HCPCS C1713,,76647525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76647530,SUP,HCPCS C1713,,76647530  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76647535,SUP,HCPCS C1713,,76647535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76647540,SUP,HCPCS C1713,,76647540  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76647545,SUP,HCPCS C1713,,76647545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76647550,SUP,HCPCS C1713,,76647550  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76647555,SUP,HCPCS C1713,,76647555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76647560,SUP,HCPCS C1713,,76647560  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76647565,SUP,HCPCS C1713,,76647565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76647570,SUP,HCPCS C1713,,76647570  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76647575,SUP,HCPCS C1713,,76647575  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76648525,SUP,HCPCS C1713,,76648525  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76648530,SUP,HCPCS C1713,,76648530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76648535,SUP,HCPCS C1713,,76648535  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76648540,SUP,HCPCS C1713,,76648540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76648545,SUP,HCPCS C1713,,76648545  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76648550,SUP,HCPCS C1713,,76648550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76648555,SUP,HCPCS C1713,,76648555  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76648560,SUP,HCPCS C1713,,76648560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76648565,SUP,HCPCS C1713,,76648565  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76648570,SUP,HCPCS C1713,,76648570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76648575,SUP,HCPCS C1713,,76648575  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76694520,SUP,HCPCS C1713,,76694520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76694525,SUP,HCPCS C1713,,76694525  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76694530,SUP,HCPCS C1713,,76694530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76694535,SUP,HCPCS C1713,,76694535  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76694540,SUP,HCPCS C1713,,76694540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76694545,SUP,HCPCS C1713,,76694545  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76694550,SUP,HCPCS C1713,,76694550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76695020,SUP,HCPCS C1713,,76695020  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76695025,SUP,HCPCS C1713,,76695025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76695030,SUP,HCPCS C1713,,76695030  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76695035,SUP,HCPCS C1713,,76695035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76695040,SUP,HCPCS C1713,,76695040  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76695045,SUP,HCPCS C1713,,76695045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76695050,SUP,HCPCS C1713,,76695050  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76695520,SUP,HCPCS C1713,,76695520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76695525,SUP,HCPCS C1713,,76695525  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76695530,SUP,HCPCS C1713,,76695530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76695535,SUP,HCPCS C1713,,76695535  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76695540,SUP,HCPCS C1713,,76695540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76695545,SUP,HCPCS C1713,,76695545  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76695550,SUP,HCPCS C1713,,76695550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76695555,SUP,HCPCS C1713,,76695555  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76695560,SUP,HCPCS C1713,,76695560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76696525,SUP,HCPCS C1713,,76696525  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76696530,SUP,HCPCS C1713,,76696530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76696535,SUP,HCPCS C1713,,76696535  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76696540,SUP,HCPCS C1713,,76696540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76696545,SUP,HCPCS C1713,,76696545  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76696550,SUP,HCPCS C1713,,76696550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76696555,SUP,HCPCS C1713,,76696555  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76696560,SUP,HCPCS C1713,,76696560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76696565,SUP,HCPCS C1713,,76696565  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76696570,SUP,HCPCS C1713,,76696570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76696575,SUP,HCPCS C1713,,76696575  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76697525,SUP,HCPCS C1713,,76697525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76697530,SUP,HCPCS C1713,,76697530  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76697535,SUP,HCPCS C1713,,76697535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76697540,SUP,HCPCS C1713,,76697540  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76697545,SUP,HCPCS C1713,,76697545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76697550,SUP,HCPCS C1713,,76697550  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76697555,SUP,HCPCS C1713,,76697555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76697560,SUP,HCPCS C1713,,76697560  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76697565,SUP,HCPCS C1713,,76697565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76697570,SUP,HCPCS C1713,,76697570  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76697575,SUP,HCPCS C1713,,76697575  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76698525,SUP,HCPCS C1713,,76698525  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76698530,SUP,HCPCS C1713,,76698530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76698535,SUP,HCPCS C1713,,76698535  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76698540,SUP,HCPCS C1713,,76698540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76698545,SUP,HCPCS C1713,,76698545  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76698550,SUP,HCPCS C1713,,76698550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76698555,SUP,HCPCS C1713,,76698555  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76698560,SUP,HCPCS C1713,,76698560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76698565,SUP,HCPCS C1713,,76698565  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76698570,SUP,HCPCS C1713,,76698570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
76698575,SUP,HCPCS C1713,,76698575  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
77101050,SUP,HCPCS C1762,,77101050  -  GRAFT SFT TIS ALGRF,"$6,675.00",$0.00,"$6,675.00",$0.00,"$4,763.95",$0.00,"$1,150.07",$0.00,$0.00,$0.00,"$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,"$1,044.64",$0.00,$0.00,$0.00
77101054,SUP,Custom 27803010,,77101054  -  SPACER CMNT 4D 14X12X5MM CERV SPNL BONE PLUG,"$6,675.00",$0.00,"$6,675.00",$0.00,"$4,763.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,$0.00,$0.00,$0.00,$0.00
77101060,SUP,HCPCS C1713,,77101060  -  SPACER ALGRF 0D 14X12X6MM BIO AVS OPN PLG CRV,"$6,675.00",$0.00,"$6,675.00","$3,003.75","$4,763.95",$0.00,"$1,150.07",$0.00,$0.00,"$1,168.74","$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,"$1,044.64",$0.00,"$1,062.66",$0.00
77101064,SUP,Custom 27803010,,77101064  -  SPACER CMNT 4D 14X12X6MM CERV SPNL BONE PLUG,"$6,675.00",$0.00,"$6,675.00",$0.00,"$4,763.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,$0.00,$0.00,$0.00,$0.00
77101070,SUP,HCPCS C1713,,77101070  -  PLATE 0D 8MM HOLE BONE CERV,"$6,675.00",$0.00,"$6,675.00","$3,003.75","$4,763.95",$0.00,"$1,150.07",$0.00,$0.00,"$1,168.74","$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,"$1,044.64",$0.00,"$1,062.66",$0.00
77101074,SUP,HCPCS C1713,,77101074  -  PLATE 4D 7IN HOLE BONE CERV SPN,"$6,675.00",$0.00,"$6,675.00","$3,003.75","$4,763.95",$0.00,"$1,150.07",$0.00,$0.00,"$1,168.74","$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,"$1,044.64",$0.00,"$1,062.66",$0.00
77101080,SUP,HCPCS C1713,,77101080  -  PLATE 0D 7MM HOLE BONE CERV,"$6,675.00",$0.00,"$6,675.00","$3,003.75","$4,763.95",$0.00,"$1,150.07",$0.00,$0.00,"$1,168.74","$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,"$1,044.64",$0.00,"$1,062.66",$0.00
77101084,SUP,HCPCS C1713,,77101084  -  SCREW BONE 8MM 14MM 12MM SPNL WDG,"$6,675.00",$0.00,"$6,675.00","$3,003.75","$4,763.95",$0.00,"$1,150.07",$0.00,$0.00,"$1,168.74","$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,"$1,044.64",$0.00,"$1,062.66",$0.00
77101090,SUP,HCPCS C1713,,77101090  -  PLATE 0D 9MM HOLE BONE CERV,"$6,675.00",$0.00,"$6,675.00","$3,003.75","$4,763.95",$0.00,"$1,150.07",$0.00,$0.00,"$1,168.74","$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,"$1,044.64",$0.00,"$1,062.66",$0.00
77101094,SUP,HCPCS C1713,,77101094  -  SPACER ALGRF 4D 14X12X9MM BIO AVS OPN PLG CRV,"$6,675.00",$0.00,"$6,675.00","$3,003.75","$4,763.95",$0.00,"$1,150.07",$0.00,$0.00,"$1,168.74","$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,"$1,044.64",$0.00,"$1,062.66",$0.00
77101100,SUP,Custom 27803010,,77101100  -  SPACER SPNL 14X12X10MM AVS 0D CAGE BIO,"$6,675.00",$0.00,"$6,675.00",$0.00,"$4,763.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,$0.00,$0.00,$0.00,$0.00
77102050,SUP,HCPCS C1713,,77102050  -  PLATE 0D 14X12IN N LORD CCANC 5 HOLE BONE,"$6,675.00",$0.00,"$6,675.00","$3,003.75","$4,763.95",$0.00,"$1,150.07",$0.00,$0.00,"$1,168.74","$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,"$1,044.64",$0.00,"$1,062.66",$0.00
77102054,SUP,Custom 27803010,,77102054  -  SPACER SPNL 5MM AVS 4D BONE PLUG BABSR,"$6,675.00",$0.00,"$6,675.00",$0.00,"$4,763.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,$0.00,$0.00,$0.00,$0.00
77102060,SUP,HCPCS C1713,,77102060  -  PLATE 0D 14X12IN N LORD CCANC 6 HOLE BONE,"$6,675.00",$0.00,"$6,675.00","$3,003.75","$4,763.95",$0.00,"$1,150.07",$0.00,$0.00,"$1,168.74","$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,"$1,044.64",$0.00,"$1,062.66",$0.00
77102064,SUP,Custom 27803010,,77102064  -  SPACER SPNL 6MM AVS 4D BONE PLUG BABSR,"$6,675.00",$0.00,"$6,675.00",$0.00,"$4,763.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,$0.00,$0.00,$0.00,$0.00
77102070,SUP,HCPCS C1713,,77102070  -  PLATE 0D 14X12IN N LORD CCANC 7 HOLE BONE,"$6,675.00",$0.00,"$6,675.00","$3,003.75","$4,763.95",$0.00,"$1,150.07",$0.00,$0.00,"$1,168.74","$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,"$1,044.64",$0.00,"$1,062.66",$0.00
77102074,SUP,Custom 27803010,,77102074  -  SPACER SPNL 7MM AVS 4D BONE PLUG BABSR,"$6,675.00",$0.00,"$6,675.00",$0.00,"$4,763.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,$0.00,$0.00,$0.00,$0.00
77102084,SUP,Custom 27803010,,77102084  -  SPACER SPNL 8MM AVS 4D BONE PLUG BABSR,"$6,675.00",$0.00,"$6,675.00",$0.00,"$4,763.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,$0.00,$0.00,$0.00,$0.00
77102090,SUP,HCPCS C1713,,77102090  -  PLATE 0D 14X12IN N LORD CCANC 9 HOLE BONE,"$6,675.00",$0.00,"$6,675.00","$3,003.75","$4,763.95",$0.00,"$1,150.07",$0.00,$0.00,"$1,168.74","$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,"$1,044.64",$0.00,"$1,062.66",$0.00
77102094,SUP,Custom 27803010,,77102094  -  SPACER ALGRF 4D LORDOSIS 12MM 14X9MM BIO AVS PRESERVON FRZDR,"$6,675.00",$0.00,"$6,675.00",$0.00,"$4,763.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,$0.00,$0.00,$0.00,$0.00
77102100,SUP,Custom 27803010,,77102100  -  SPACER ALGRF 4D 14X12X10MM BIO AVS OPN PLG CRV,"$6,675.00",$0.00,"$6,675.00",$0.00,"$4,763.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,$0.00,$0.00,$0.00,$0.00
77102104,SUP,HCPCS C1713,,77102104  -  SPACER ALGRF 4D LORDOSIS 12MM 14X10MM BIO AVS FRZDR C PLG 1,"$6,675.00",$0.00,"$6,675.00","$3,003.75","$4,763.95",$0.00,"$1,150.07",$0.00,$0.00,"$1,168.74","$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,"$1,044.64",$0.00,"$1,062.66",$0.00
77562815,SUP,Custom 27203010,,77562815  -  BIT DRILL FLEXIBLE 3.2MM,"$1,072.50",$0.00,"$1,072.50",$0.00,$765.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$0.00,$0.00,$0.00,$0.00
77805200,SUP,HCPCS C1887,,CATHETER GUID XB3 CURVE 7FR .078IN 100CM PTFE VSBR BLUE YLW,$139.93,$0.00,$139.93,$75.98,$99.86,$0.00,$24.11,$0.00,$0.00,$24.50,$139.93,$0.00,$69.96,$110.82,$111.94,$0.00,$21.90,$0.00,$22.28,$0.00
77805500,SUP,HCPCS C1887,,CATHETER GUID XB3.5 CURVE 7FR .078IN 100CM SH PTFE VSBR BLUE,$139.93,$0.00,$139.93,$75.98,$99.86,$0.00,$24.11,$0.00,$0.00,$24.50,$139.93,$0.00,$69.96,$110.82,$111.94,$0.00,$21.90,$0.00,$22.28,$0.00
77805600,SUP,HCPCS C1887,,CATHETER GUID XB4 CURVE 7FR .078IN 100CM PTFE VSBR BLUE YLW,$139.93,$0.00,$139.93,$75.98,$99.86,$0.00,$24.11,$0.00,$0.00,$24.50,$139.93,$0.00,$69.96,$110.82,$111.94,$0.00,$21.90,$0.00,$22.28,$0.00
77827100,SUP,HCPCS C1887,,CATHETER GUID MPA1 CURVE 7FR .078IN 100CM SH PTFE VSBR BLUE,$139.93,$0.00,$139.93,$75.98,$99.86,$0.00,$24.11,$0.00,$0.00,$24.50,$139.93,$0.00,$69.96,$110.82,$111.94,$0.00,$21.90,$0.00,$22.28,$0.00
80008455,SUP,HCPCS C1892,,612603 - INTRODUCER SHTH 7FR 19CM 16CM TRAW ADPR DILAT SET INDN SPNLK,$69.35,$0.00,$69.35,$37.66,$49.50,$0.00,$11.95,$0.00,$0.00,$12.14,$69.35,$0.00,$34.68,$54.93,$55.48,$0.00,$10.85,$0.00,$11.04,$0.00
80100100,SUP,HCPCS C1769,,80100100  -  GUIDEWIRE ORTH .045IN,$37.50,$0.00,$37.50,$20.36,$26.76,$0.00,$6.46,$0.00,$0.00,$6.57,$37.50,$0.00,$18.75,$29.70,$30.00,$0.00,$5.87,$0.00,$5.97,$0.00
80100101,SUP,HCPCS C1769,,80100101  -  GUIDEWIRE SRG .035IN,$37.50,$0.00,$37.50,$20.36,$26.76,$0.00,$6.46,$0.00,$0.00,$6.57,$37.50,$0.00,$18.75,$29.70,$30.00,$0.00,$5.87,$0.00,$5.97,$0.00
80100102,SUP,Custom 27203010,,80100102  -  WIRE FX .035IN 7IN KRSH STRG,$37.50,$0.00,$37.50,$0.00,$26.76,$0.00,$0.00,$0.00,$0.00,$0.00,$37.50,$0.00,$18.75,$29.70,$30.00,$0.00,$0.00,$0.00,$0.00,$0.00
80100103,SUP,Custom 27203010,,80100103  -  WIRE FX .035IN KRSH BIOTRACK,$37.50,$0.00,$37.50,$0.00,$26.76,$0.00,$0.00,$0.00,$0.00,$0.00,$37.50,$0.00,$18.75,$29.70,$30.00,$0.00,$0.00,$0.00,$0.00,$0.00
80100125,SUP,Custom 27203010,,80100125  -  HANDLE QRLSE SCRDRVR NONSTRL,$730.00,$0.00,$730.00,$0.00,$521.00,$0.00,$0.00,$0.00,$0.00,$0.00,$730.00,$0.00,$365.00,$578.16,$584.00,$0.00,$0.00,$0.00,$0.00,$0.00
80200102,SUP,HCPCS C1713,,80200102  -  PIN FIX 203MM 4.8MM RUSH A IM SS NONSTRL,$198.00,$0.00,$198.00,$89.10,$141.31,$0.00,$34.11,$0.00,$0.00,$34.67,$198.00,$0.00,$99.00,$156.82,$158.40,$0.00,$30.99,$0.00,$31.52,$0.00
80200103,SUP,HCPCS C1713,,80200103  -  PIN FIX 222MM 4.8MM RUSH B IM SS NONSTRL,$198.00,$0.00,"$1,183.00",$642.37,$844.31,$0.00,$203.82,$844.31,$844.31,$207.13,"$1,183.00",$0.00,$591.50,$156.82,$946.40,$0.00,$185.14,$0.00,$188.33,$0.00
80200104,SUP,HCPCS C1713,,80200104  -  PIN FIX 241MM 4.8MM RUSH C IM SS NONSTRL,$198.00,$0.00,$163.00,$88.51,$116.33,$0.00,$28.08,$116.33,$116.33,$28.54,$163.00,$0.00,$81.50,$156.82,$130.40,$0.00,$25.51,$0.00,$25.95,$0.00
80200105,SUP,HCPCS C1713,,80200105  -  PIN FIX 260MM 4.8MM RUSH D IM SS NONSTRL,$198.00,$0.00,$156.82,$47.78,$62.81,$0.00,$15.16,$62.81,$62.81,$15.41,$88.00,$0.00,$44.00,$156.82,$70.40,$0.00,$13.77,$0.00,$14.01,$0.00
80200106,SUP,HCPCS C1713,,80200106  -  PIN FIX 279MM 4.8MM RUSH E IM SS NONSTRL,$198.00,$0.00,$198.00,$89.10,$141.31,$0.00,$34.11,$0.00,$0.00,$34.67,$198.00,$0.00,$99.00,$156.82,$158.40,$0.00,$30.99,$0.00,$31.52,$0.00
80200107,SUP,HCPCS C1713,,80200107  -  PIN FIX 298MM 4.8MM RUSH F IM SS NONSTRL,$198.00,$0.00,$198.00,$89.10,$141.31,$0.00,$34.11,$0.00,$0.00,$34.67,$198.00,$0.00,$99.00,$156.82,$158.40,$0.00,$30.99,$0.00,$31.52,$0.00
80200108,SUP,HCPCS C1713,,80200108  -  PIN FIX 318MM 4.8MM RUSH G IM SS NONSTRL,$198.00,$0.00,$198.00,$89.10,$141.31,$0.00,$34.11,$0.00,$0.00,$34.67,$198.00,$0.00,$99.00,$156.82,$158.40,$0.00,$30.99,$0.00,$31.52,$0.00
80200109,SUP,HCPCS C1713,,80200109  -  PIN FIX 337MM 4.8MM RUSH H IM SS NONSTRL,$198.00,$0.00,$198.00,$89.10,$141.31,$0.00,$34.11,$0.00,$0.00,$34.67,$198.00,$0.00,$99.00,$156.82,$158.40,$0.00,$30.99,$0.00,$31.52,$0.00
80200110,SUP,HCPCS C1713,,80200110  -  PIN FIX 35.6CM 4.8MM RUSH I IM SS NONSTRL,$198.00,$0.00,$198.00,$89.10,$141.31,$0.00,$34.11,$0.00,$0.00,$34.67,$198.00,$0.00,$99.00,$156.82,$158.40,$0.00,$30.99,$0.00,$31.52,$0.00
80200111,SUP,HCPCS C1713,,80200111  -  PIN FIX 18.4CM 4.8MM RUSH A1 IM SS NONSTRL,$198.00,$0.00,$198.00,$89.10,$141.31,$0.00,$34.11,$0.00,$0.00,$34.67,$198.00,$0.00,$99.00,$156.82,$158.40,$0.00,$30.99,$0.00,$31.52,$0.00
80200112,SUP,HCPCS C1713,,80200112  -  PIN FIX 37.5CM 4.8MM RUSH J IM SS NONSTRL,$198.00,$0.00,$198.00,$89.10,$141.31,$0.00,$34.11,$0.00,$0.00,$34.67,$198.00,$0.00,$99.00,$156.82,$158.40,$0.00,$30.99,$0.00,$31.52,$0.00
80200113,SUP,HCPCS C1713,,80200113  -  PIN FIX 39.4CM 4.8MM RUSH K IM SS NONSTRL,$198.00,$0.00,$198.00,$89.10,$141.31,$0.00,$34.11,$0.00,$0.00,$34.67,$198.00,$0.00,$99.00,$156.82,$158.40,$0.00,$30.99,$0.00,$31.52,$0.00
80200114,SUP,HCPCS C1713,,80200114  -  PIN FIX 41.3CM 4.8MM RUSH L IM SS NONSTRL,$198.00,$0.00,$198.00,$89.10,$141.31,$0.00,$34.11,$0.00,$0.00,$34.67,$198.00,$0.00,$99.00,$156.82,$158.40,$0.00,$30.99,$0.00,$31.52,$0.00
80200115,SUP,HCPCS C1713,,80200115  -  PIN FIX 43.2CM 4.8MM RUSH M IM SS NONSTRL,$198.00,$0.00,$198.00,$89.10,$141.31,$0.00,$34.11,$0.00,$0.00,$34.67,$198.00,$0.00,$99.00,$156.82,$158.40,$0.00,$30.99,$0.00,$31.52,$0.00
80200116,SUP,HCPCS C1713,,80200116  -  PIN FIX 45.1CM 4.8MM RUSH N IM SS NONSTRL,$198.00,$0.00,$198.00,$89.10,$141.31,$0.00,$34.11,$0.00,$0.00,$34.67,$198.00,$0.00,$99.00,$156.82,$158.40,$0.00,$30.99,$0.00,$31.52,$0.00
80200117,SUP,HCPCS C1713,,80200117  -  PIN FIX 47CM 4.8MM RUSH O IM SS NONSTRL,$198.00,$0.00,$198.00,$89.10,$141.31,$0.00,$34.11,$0.00,$0.00,$34.67,$198.00,$0.00,$99.00,$156.82,$158.40,$0.00,$30.99,$0.00,$31.52,$0.00
80202700,SUP,HCPCS C1713,,80202700  -  SET TRAUMA FIX 4.8MM RACK RUSH NONSTRL,"$7,028.00",$0.00,"$7,028.00","$3,162.60","$5,015.88",$0.00,"$1,210.89",$0.00,$0.00,"$1,230.55","$7,028.00",$0.00,"$3,514.00","$5,566.18","$5,622.40",$0.00,"$1,099.88",$0.00,"$1,118.86",$0.00
80300102,SUP,HCPCS C1713,,80300102  -  PIN FIX 102MM 3.2MM RUSH IM,$168.30,$0.00,$168.30,$75.74,$120.12,$0.00,$29.00,$0.00,$0.00,$29.47,$168.30,$0.00,$84.15,$133.29,$134.64,$0.00,$26.34,$0.00,$26.79,$0.00
80300103,SUP,HCPCS C1713,,80300103  -  PIN FX 1/8IN 4.5IN RUSH MDLRY,$168.30,$0.00,$168.30,$75.74,$120.12,$0.00,$29.00,$0.00,$0.00,$29.47,$168.30,$0.00,$84.15,$133.29,$134.64,$0.00,$26.34,$0.00,$26.79,$0.00
80300104,SUP,HCPCS C1713,,80300104  -  PIN FIX 127MM 3.2MM RUSH C IM SS NONSTRL,$168.30,$0.00,$168.30,$75.74,$120.12,$0.00,$29.00,$0.00,$0.00,$29.47,$168.30,$0.00,$84.15,$133.29,$134.64,$0.00,$26.34,$0.00,$26.79,$0.00
80300105,SUP,HCPCS C1713,,80300105  -  PIN FIX 140MM 3.2MM RUSH D IM SS NONSTRL,$168.30,$0.00,$168.30,$75.74,$120.12,$0.00,$29.00,$0.00,$0.00,$29.47,$168.30,$0.00,$84.15,$133.29,$134.64,$0.00,$26.34,$0.00,$26.79,$0.00
80300106,SUP,HCPCS C1713,,80300106  -  PIN FIX 152MM 3.2MM RUSH E IM SS NONSTRL,$168.30,$0.00,$168.30,$75.74,$120.12,$0.00,$29.00,$0.00,$0.00,$29.47,$168.30,$0.00,$84.15,$133.29,$134.64,$0.00,$26.34,$0.00,$26.79,$0.00
80300107,SUP,HCPCS C1713,,80300107  -  PIN FIX 165MM 3.2MM RUSH F IM SS NONSTRL,$168.30,$0.00,$168.30,$75.74,$120.12,$0.00,$29.00,$0.00,$0.00,$29.47,$168.30,$0.00,$84.15,$133.29,$134.64,$0.00,$26.34,$0.00,$26.79,$0.00
80300108,SUP,HCPCS C1713,,80300108  -  PIN FIX 178MM 3.2MM RUSH G IM SS NONSTRL,$168.30,$0.00,$168.30,$75.74,$120.12,$0.00,$29.00,$0.00,$0.00,$29.47,$168.30,$0.00,$84.15,$133.29,$134.64,$0.00,$26.34,$0.00,$26.79,$0.00
80300109,SUP,HCPCS C1713,,80300109  -  PIN FIX 191MM 3.2MM RUSH H IM SS NONSTRL,$168.30,$0.00,$168.30,$75.74,$120.12,$0.00,$29.00,$0.00,$0.00,$29.47,$168.30,$0.00,$84.15,$133.29,$134.64,$0.00,$26.34,$0.00,$26.79,$0.00
80300110,SUP,HCPCS C1713,,80300110  -  PIN FIX 203MM 3.2MM RUSH I IM SS NONSTRL,$168.30,$0.00,$168.30,$75.74,$120.12,$0.00,$29.00,$0.00,$0.00,$29.47,$168.30,$0.00,$84.15,$133.29,$134.64,$0.00,$26.34,$0.00,$26.79,$0.00
80300111,SUP,HCPCS C1713,,80300111  -  PIN FIX 216MM 3.2MM RUSH J IM SS NONSTRL,$168.30,$0.00,$168.30,$75.74,$120.12,$0.00,$29.00,$0.00,$0.00,$29.47,$168.30,$0.00,$84.15,$133.29,$134.64,$0.00,$26.34,$0.00,$26.79,$0.00
80300112,SUP,HCPCS C1713,,80300112  -  PIN FIX 229MM 3.2MM RUSH K IM SS NONSTRL,$168.30,$0.00,$168.30,$75.74,$120.12,$0.00,$29.00,$0.00,$0.00,$29.47,$168.30,$0.00,$84.15,$133.29,$134.64,$0.00,$26.34,$0.00,$26.79,$0.00
80300113,SUP,HCPCS C1713,,80300113  -  PIN FIX 241MM 3.2MM RUSH L IM SS NONSTRL,$168.30,$0.00,$168.30,$75.74,$120.12,$0.00,$29.00,$0.00,$0.00,$29.47,$168.30,$0.00,$84.15,$133.29,$134.64,$0.00,$26.34,$0.00,$26.79,$0.00
80300114,SUP,HCPCS C1713,,80300114  -  PIN FIX 254MM 3.2MM RUSH M IM SS NONSTRL,$168.30,$0.00,$168.30,$75.74,$120.12,$0.00,$29.00,$0.00,$0.00,$29.47,$168.30,$0.00,$84.15,$133.29,$134.64,$0.00,$26.34,$0.00,$26.79,$0.00
80300120,SUP,HCPCS C1713,,80300120  -  PIN FIX 267MM 3.2MM RUSH N IM SS NONSTRL,$168.30,$0.00,$168.30,$75.74,$120.12,$0.00,$29.00,$0.00,$0.00,$29.47,$168.30,$0.00,$84.15,$133.29,$134.64,$0.00,$26.34,$0.00,$26.79,$0.00
80302700,SUP,HCPCS C1713,,80302700  -  SET TRAUMA FIX 3.2MM RACK RUSH NONSTRL,"$5,604.00",$0.00,"$5,604.00","$2,521.80","$3,999.57",$0.00,$965.54,$0.00,$0.00,$981.22,"$5,604.00",$0.00,"$2,802.00","$4,438.37","$4,483.20",$0.00,$877.03,$0.00,$892.16,$0.00
80322944,SUP,HCPCS C1713,,186801020  -  PLATE BN 20MM NS SKYLINE 1 LVL SPNE CRV ANT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
80400102,SUP,HCPCS C1713,,80400102  -  PIN FIX 2.5CM 2.4MM RUSH A IM SS NONSTRL,$150.70,$0.00,$150.70,$67.82,$107.55,$0.00,$25.96,$0.00,$0.00,$26.39,$150.70,$0.00,$75.35,$119.35,$120.56,$0.00,$23.58,$0.00,$23.99,$0.00
80400103,SUP,HCPCS C1713,,80400103  -  PIN FIX 3.2CM 2.4MM RUSH B IM SS NONSTRL,$150.70,$0.00,$150.70,$67.82,$107.55,$0.00,$25.96,$0.00,$0.00,$26.39,$150.70,$0.00,$75.35,$119.35,$120.56,$0.00,$23.58,$0.00,$23.99,$0.00
80400104,SUP,HCPCS C1713,,80400104  -  PIN FIX 3.8CM 2.4MM RUSH C IM SS NONSTRL,$150.70,$0.00,$150.70,$67.82,$107.55,$0.00,$25.96,$0.00,$0.00,$26.39,$150.70,$0.00,$75.35,$119.35,$120.56,$0.00,$23.58,$0.00,$23.99,$0.00
80400105,SUP,HCPCS C1713,,80400105  -  PIN FIX 4.5CM 2.4MM RUSH D IM SS NONSTRL,$150.70,$0.00,$150.70,$67.82,$107.55,$0.00,$25.96,$0.00,$0.00,$26.39,$150.70,$0.00,$75.35,$119.35,$120.56,$0.00,$23.58,$0.00,$23.99,$0.00
80400106,SUP,HCPCS C1713,,80400106  -  PIN FIX 5.1CM 2.4MM RUSH E IM SS NONSTRL,$150.70,$0.00,$150.70,$67.82,$107.55,$0.00,$25.96,$0.00,$0.00,$26.39,$150.70,$0.00,$75.35,$119.35,$120.56,$0.00,$23.58,$0.00,$23.99,$0.00
80400107,SUP,HCPCS C1713,,80400107  -  PIN FIX 5.7CM 2.4MM RUSH F IM SS NONSTRL,$150.70,$0.00,$150.70,$67.82,$107.55,$0.00,$25.96,$0.00,$0.00,$26.39,$150.70,$0.00,$75.35,$119.35,$120.56,$0.00,$23.58,$0.00,$23.99,$0.00
80400108,SUP,HCPCS C1713,,80400108  -  PIN FIX 6.4CM 2.4MM RUSH G IM SS NONSTRL,$150.70,$0.00,$150.70,$67.82,$107.55,$0.00,$25.96,$0.00,$0.00,$26.39,$150.70,$0.00,$75.35,$119.35,$120.56,$0.00,$23.58,$0.00,$23.99,$0.00
80400109,SUP,HCPCS C1713,,80400109  -  PIN FIX 7CM 2.4MM RUSH H IM SS NONSTRL,$150.70,$0.00,$150.70,$67.82,$107.55,$0.00,$25.96,$0.00,$0.00,$26.39,$150.70,$0.00,$75.35,$119.35,$120.56,$0.00,$23.58,$0.00,$23.99,$0.00
80400110,SUP,HCPCS C1713,,80400110  -  PIN FIX 7.6CM 2.4MM RUSH I IM SS NONSTRL,$150.70,$0.00,$150.70,$67.82,$107.55,$0.00,$25.96,$0.00,$0.00,$26.39,$150.70,$0.00,$75.35,$119.35,$120.56,$0.00,$23.58,$0.00,$23.99,$0.00
80400111,SUP,HCPCS C1713,,80400111  -  PIN FIX 8.3CM 2.4MM RUSH J IM SS NONSTRL,$150.70,$0.00,$150.70,$67.82,$107.55,$0.00,$25.96,$0.00,$0.00,$26.39,$150.70,$0.00,$75.35,$119.35,$120.56,$0.00,$23.58,$0.00,$23.99,$0.00
80400112,SUP,HCPCS C1713,,80400112  -  PIN FIX 8.9CM 2.4MM RUSH K IM SS NONSTRL,$150.70,$0.00,$150.70,$67.82,$107.55,$0.00,$25.96,$0.00,$0.00,$26.39,$150.70,$0.00,$75.35,$119.35,$120.56,$0.00,$23.58,$0.00,$23.99,$0.00
80400113,SUP,HCPCS C1713,,80400113  -  PIN FIX 9.5CM 2.4MM RUSH L IM SS NONSTRL,$150.70,$0.00,$150.70,$67.82,$107.55,$0.00,$25.96,$0.00,$0.00,$26.39,$150.70,$0.00,$75.35,$119.35,$120.56,$0.00,$23.58,$0.00,$23.99,$0.00
80400114,SUP,HCPCS C1713,,80400114  -  PIN FIX 10.2CM 2.4MM RUSH M IM SS NONSTRL,$150.70,$0.00,$150.70,$67.82,$107.55,$0.00,$25.96,$0.00,$0.00,$26.39,$150.70,$0.00,$75.35,$119.35,$120.56,$0.00,$23.58,$0.00,$23.99,$0.00
80402700,SUP,HCPCS C1713,,80402700  -  SET TRAUMA FIX 2.4MM RACK RUSH NONSTRL,"$8,110.00",$0.00,"$8,110.00","$3,649.50","$5,158.80",$0.00,"$1,397.31",$0.00,$0.00,"$1,420.00","$8,110.00",$0.00,"$4,055.00","$6,423.12","$6,488.00",$0.00,"$1,269.22",$0.00,"$1,291.11",$0.00
80600103,SUP,HCPCS C1713,,80600103  -  PIN FIX 11.4CM 2.4MM RUSH N LNG IM SS NONSTRL,$150.70,$0.00,$150.70,$67.82,$107.55,$0.00,$25.96,$0.00,$0.00,$26.39,$150.70,$0.00,$75.35,$119.35,$120.56,$0.00,$23.58,$0.00,$23.99,$0.00
80600104,SUP,HCPCS C1713,,80600104  -  PIN FIX 12.7CM 2.4MM RUSH O LNG IM SS NONSTRL,$150.70,$0.00,$150.70,$67.82,$107.55,$0.00,$25.96,$0.00,$0.00,$26.39,$150.70,$0.00,$75.35,$119.35,$120.56,$0.00,$23.58,$0.00,$23.99,$0.00
80600105,SUP,HCPCS C1713,,80600105  -  PIN FIX 14CM 2.4MM RUSH P LNG IM SS NONSTRL,$150.70,$0.00,$150.70,$67.82,$107.55,$0.00,$25.96,$0.00,$0.00,$26.39,$150.70,$0.00,$75.35,$119.35,$120.56,$0.00,$23.58,$0.00,$23.99,$0.00
80600106,SUP,HCPCS C1713,,80600106  -  PIN FIX 15.2CM 2.4MM RUSH Q LNG IM SS NONSTRL,$150.70,$0.00,$150.70,$67.82,$107.55,$0.00,$25.96,$0.00,$0.00,$26.39,$150.70,$0.00,$75.35,$119.35,$120.56,$0.00,$23.58,$0.00,$23.99,$0.00
80600107,SUP,HCPCS C1713,,80600107  -  PIN FIX 16.5CM 2.4MM RUSH R LNG IM SS NONSTRL,$150.70,$0.00,$150.70,$67.82,$107.55,$0.00,$25.96,$0.00,$0.00,$26.39,$150.70,$0.00,$75.35,$119.35,$120.56,$0.00,$23.58,$0.00,$23.99,$0.00
80600108,SUP,HCPCS C1713,,80600108  -  PIN FIX 17.8CM 2.4MM RUSH S LNG IM SS NONSTRL,$150.70,$0.00,$150.70,$67.82,$107.55,$0.00,$25.96,$0.00,$0.00,$26.39,$150.70,$0.00,$75.35,$119.35,$120.56,$0.00,$23.58,$0.00,$23.99,$0.00
80600109,SUP,HCPCS C1713,,80600109  -  PIN 19.1CM 2.4MM RUSH T LNG IM SS NONSTRL,$150.70,$0.00,$150.70,$67.82,$107.55,$0.00,$25.96,$0.00,$0.00,$26.39,$150.70,$0.00,$75.35,$119.35,$120.56,$0.00,$23.58,$0.00,$23.99,$0.00
80600110,SUP,HCPCS C1713,,80600110  -  PIN FIX 20.3CM 2.4MM RUSH U LNG IM SS NONSTRL,$150.70,$0.00,$150.70,$67.82,$107.55,$0.00,$25.96,$0.00,$0.00,$26.39,$150.70,$0.00,$75.35,$119.35,$120.56,$0.00,$23.58,$0.00,$23.99,$0.00
80600111,SUP,HCPCS C1713,,80600111  -  PIN FIX 21.6CM 2.4MM RUSH V LNG IM SS NONSTRL,$150.70,$0.00,$150.70,$67.82,$107.55,$0.00,$25.96,$0.00,$0.00,$26.39,$150.70,$0.00,$75.35,$119.35,$120.56,$0.00,$23.58,$0.00,$23.99,$0.00
80600112,SUP,HCPCS C1713,,80600112  -  PIN FIX 22.9CM 2.4MM RUSH W LNG IM SS NONSTRL,$150.70,$0.00,$150.70,$67.82,$107.55,$0.00,$25.96,$0.00,$0.00,$26.39,$150.70,$0.00,$75.35,$119.35,$120.56,$0.00,$23.58,$0.00,$23.99,$0.00
80600113,SUP,HCPCS C1713,,80600113  -  PIN FIX 24.1CM 2.4MM RUSH X LNG IM SS NONSTRL,$150.70,$0.00,$150.70,$67.82,$107.55,$0.00,$25.96,$0.00,$0.00,$26.39,$150.70,$0.00,$75.35,$119.35,$120.56,$0.00,$23.58,$0.00,$23.99,$0.00
80600114,SUP,HCPCS C1713,,80600114  -  PIN FIX 25.4CM 2.4MM RUSH Y LNG IM SS NONSTRL,$150.70,$0.00,$150.70,$67.82,$107.55,$0.00,$25.96,$0.00,$0.00,$26.39,$150.70,$0.00,$75.35,$119.35,$120.56,$0.00,$23.58,$0.00,$23.99,$0.00
83545201,SUP,HCPCS C1713,,83545201  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83545251,SUP,HCPCS C1713,,83545251  -  PLATE 18MM TI BONE SPNL,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83545301,SUP,HCPCS C1713,,83545301  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83545306,SUP,HCPCS C1713,,83545306  -  PLATE 18MM TI BONE SPNL,"$1,650.00",$0.00,"$1,650.00",$742.50,"$1,177.61",$0.00,$284.29,$0.00,$0.00,$288.90,"$1,650.00",$0.00,$825.00,"$1,306.80","$1,320.00",$0.00,$258.23,$0.00,$262.68,$0.00
83545309,SUP,HCPCS C1713,,83545309  -  SCREW BN 4.5MM 30MM TSRH OSTEOGRIP THNLN TI SPNE,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83545351,SUP,HCPCS C1713,,83545351  -  PLATE 18MM TI BONE SPNL,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83545356,SUP,HCPCS C1713,,83545356  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,650.00",$0.00,"$1,650.00",$742.50,"$1,177.61",$0.00,$284.29,$0.00,$0.00,$288.90,"$1,650.00",$0.00,$825.00,"$1,306.80","$1,320.00",$0.00,$258.23,$0.00,$262.68,$0.00
83545359,SUP,HCPCS C1713,,83545359  -  SCREW BN 4.5MM 35MM TSRH OSTEOGRIP THNLN TI SPNE,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83545401,SUP,HCPCS C1713,,83545401  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83545406,SUP,HCPCS C1713,,83545406  -  PLATE 18MM TI BONE SPNL,"$1,650.00",$0.00,"$1,650.00",$742.50,"$1,177.61",$0.00,$284.29,$0.00,$0.00,$288.90,"$1,650.00",$0.00,$825.00,"$1,306.80","$1,320.00",$0.00,$258.23,$0.00,$262.68,$0.00
83545409,SUP,HCPCS C1713,,83545409  -  SCREW BN 4.5MM 40MM 3DX TSRH OSTEOGRIP THNLN TI SPNE,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83545451,SUP,HCPCS C1713,,83545451  -  PLATE 18MM TI BONE SPNL,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83545456,SUP,HCPCS C1713,,83545456  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,650.00",$0.00,"$1,650.00",$742.50,"$1,177.61",$0.00,$284.29,$0.00,$0.00,$288.90,"$1,650.00",$0.00,$825.00,"$1,306.80","$1,320.00",$0.00,$258.23,$0.00,$262.68,$0.00
83545459,SUP,HCPCS C1713,,83545459  -  SCREW BN 4.5MM 45MM TSRH OSTEOGRIP THNLN SPNE,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83545501,SUP,HCPCS C1713,,83545501  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83545506,SUP,HCPCS C1713,,83545506  -  PLATE 18MM TI BONE SPNL,"$1,650.00",$0.00,"$1,650.00",$742.50,"$1,177.61",$0.00,$284.29,$0.00,$0.00,$288.90,"$1,650.00",$0.00,$825.00,"$1,306.80","$1,320.00",$0.00,$258.23,$0.00,$262.68,$0.00
83545509,SUP,HCPCS C1713,,83545509  -  SCREW BN 4.5MM 50MM TSRH OSTEOGRIP THNLN TI SPNE,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83545551,SUP,HCPCS C1713,,83545551  -  PLATE 18MM TI BONE SPNL,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83545556,SUP,HCPCS C1713,,83545556  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,650.00",$0.00,"$1,650.00",$742.50,"$1,177.61",$0.00,$284.29,$0.00,$0.00,$288.90,"$1,650.00",$0.00,$825.00,"$1,306.80","$1,320.00",$0.00,$258.23,$0.00,$262.68,$0.00
83545559,SUP,HCPCS C1713,,83545559  -  SCREW BN 4.5MM 55MM TSRH OSTEOGRIP THNLN TI SPNE,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83545601,SUP,HCPCS C1713,,83545601  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83545606,SUP,HCPCS C1713,,83545606  -  PLATE 18MM TI BONE SPNL,"$1,650.00",$0.00,"$1,650.00",$742.50,"$1,177.61",$0.00,$284.29,$0.00,$0.00,$288.90,"$1,650.00",$0.00,$825.00,"$1,306.80","$1,320.00",$0.00,$258.23,$0.00,$262.68,$0.00
83545609,SUP,HCPCS C1713,,83545609  -  SCREW BN 4.5MM 60MM TSRH OSTEOGRIP THNLN TI SPNE,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83555201,SUP,HCPCS C1713,,83555201  -  PLATE 18MM TI BONE SPNL,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83555251,SUP,HCPCS C1713,,83555251  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83555301,SUP,HCPCS C1713,,83555301  -  PLATE 18MM TI BONE SPNL,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83555306,SUP,HCPCS C1713,,83555306  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,650.00",$0.00,"$1,650.00",$742.50,"$1,177.61",$0.00,$284.29,$0.00,$0.00,$288.90,"$1,650.00",$0.00,$825.00,"$1,306.80","$1,320.00",$0.00,$258.23,$0.00,$262.68,$0.00
83555307,SUP,HCPCS C1713,,83555307  -  PLATE 18MM TI BONE SPNL,"$1,800.00",$0.00,"$1,800.00",$810.00,"$1,284.66",$0.00,$310.13,$0.00,$0.00,$315.17,"$1,800.00",$0.00,$900.00,"$1,425.60","$1,440.00",$0.00,$281.70,$0.00,$286.56,$0.00
83555308,SUP,HCPCS C1713,,83555308  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,520.88",$0.00,"$1,520.88",$684.39,"$1,085.45",$0.00,$262.04,$0.00,$0.00,$266.29,"$1,520.88",$0.00,$760.44,"$1,204.54","$1,216.70",$0.00,$238.02,$0.00,$242.12,$0.00
83555309,SUP,HCPCS C1713,,83555309  -  SCREW BN 5.5MM 30MM TSRH OSTEOGRIP THNLN TI SPNE,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83555351,SUP,HCPCS C1713,,83555351  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83555356,SUP,HCPCS C1713,,83555356  -  PLATE 18MM TI BONE SPNL,"$1,650.00",$0.00,"$1,650.00",$742.50,"$1,177.61",$0.00,$284.29,$0.00,$0.00,$288.90,"$1,650.00",$0.00,$825.00,"$1,306.80","$1,320.00",$0.00,$258.23,$0.00,$262.68,$0.00
83555357,SUP,HCPCS C1713,,83555357  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,800.00",$0.00,"$1,800.00",$810.00,"$1,284.66",$0.00,$310.13,$0.00,$0.00,$315.17,"$1,800.00",$0.00,$900.00,"$1,425.60","$1,440.00",$0.00,$281.70,$0.00,$286.56,$0.00
83555358,SUP,HCPCS C1713,,83555358  -  PLATE 18MM TI BONE SPNL,"$1,520.88",$0.00,"$1,520.88",$684.39,"$1,085.45",$0.00,$262.04,$0.00,$0.00,$266.29,"$1,520.88",$0.00,$760.44,"$1,204.54","$1,216.70",$0.00,$238.02,$0.00,$242.12,$0.00
83555359,SUP,HCPCS C1713,,83555359  -  SCREW BN 5.5MM 35MM TSRH OSTEOGRIP THNLN TI SPNE,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83555401,SUP,HCPCS C1713,,83555401  -  PLATE 18MM TI BONE SPNL,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83555406,SUP,HCPCS C1713,,83555406  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,650.00",$0.00,"$1,650.00",$742.50,"$1,177.61",$0.00,$284.29,$0.00,$0.00,$288.90,"$1,650.00",$0.00,$825.00,"$1,306.80","$1,320.00",$0.00,$258.23,$0.00,$262.68,$0.00
83555407,SUP,HCPCS C1713,,83555407  -  PLATE 18MM TI BONE SPNL,"$1,800.00",$0.00,"$1,800.00",$810.00,"$1,284.66",$0.00,$310.13,$0.00,$0.00,$315.17,"$1,800.00",$0.00,$900.00,"$1,425.60","$1,440.00",$0.00,$281.70,$0.00,$286.56,$0.00
83555408,SUP,HCPCS C1713,,83555408  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,520.88",$0.00,"$1,520.88",$684.39,"$1,085.45",$0.00,$262.04,$0.00,$0.00,$266.29,"$1,520.88",$0.00,$760.44,"$1,204.54","$1,216.70",$0.00,$238.02,$0.00,$242.12,$0.00
83555409,SUP,HCPCS C1713,,83555409  -  SCREW BN 5.5MM 40MM TSRH OSTEOGRIP THNLN TI SPNE,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83555451,SUP,HCPCS C1713,,83555451  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83555456,SUP,HCPCS C1713,,83555456  -  PLATE 18MM TI BONE SPNL,"$1,650.00",$0.00,"$1,650.00",$742.50,"$1,177.61",$0.00,$284.29,$0.00,$0.00,$288.90,"$1,650.00",$0.00,$825.00,"$1,306.80","$1,320.00",$0.00,$258.23,$0.00,$262.68,$0.00
83555457,SUP,HCPCS C1713,,83555457  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,800.00",$0.00,"$1,800.00",$810.00,"$1,284.66",$0.00,$310.13,$0.00,$0.00,$315.17,"$1,800.00",$0.00,$900.00,"$1,425.60","$1,440.00",$0.00,$281.70,$0.00,$286.56,$0.00
83555458,SUP,HCPCS C1713,,83555458  -  PLATE 18MM TI BONE SPNL,"$1,520.88",$0.00,"$1,520.88",$684.39,"$1,085.45",$0.00,$262.04,$0.00,$0.00,$266.29,"$1,520.88",$0.00,$760.44,"$1,204.54","$1,216.70",$0.00,$238.02,$0.00,$242.12,$0.00
83555459,SUP,HCPCS C1713,,83555459  -  SCREW BN 5.5MM 45MM TSRH THNLN OSTEOGRIP SPNE,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83555501,SUP,HCPCS C1713,,83555501  -  PLATE 18MM TI BONE SPNL,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83555506,SUP,HCPCS C1713,,83555506  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,650.00",$0.00,"$1,650.00",$742.50,"$1,177.61",$0.00,$284.29,$0.00,$0.00,$288.90,"$1,650.00",$0.00,$825.00,"$1,306.80","$1,320.00",$0.00,$258.23,$0.00,$262.68,$0.00
83555507,SUP,HCPCS C1713,,83555507  -  PLATE 18MM TI BONE SPNL,"$1,800.00",$0.00,"$1,800.00",$810.00,"$1,284.66",$0.00,$310.13,$0.00,$0.00,$315.17,"$1,800.00",$0.00,$900.00,"$1,425.60","$1,440.00",$0.00,$281.70,$0.00,$286.56,$0.00
83555508,SUP,HCPCS C1713,,83555508  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,520.88",$0.00,"$1,520.88",$684.39,"$1,085.45",$0.00,$262.04,$0.00,$0.00,$266.29,"$1,520.88",$0.00,$760.44,"$1,204.54","$1,216.70",$0.00,$238.02,$0.00,$242.12,$0.00
83555509,SUP,HCPCS C1713,,83555509  -  SCREW BN 5.5MM 50MM TSRH OSTEOGRIP THNLN TI SPNE,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83555551,SUP,HCPCS C1713,,83555551  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83555556,SUP,HCPCS C1713,,83555556  -  PLATE 18MM TI BONE SPNL,"$1,650.00",$0.00,"$1,650.00",$742.50,"$1,177.61",$0.00,$284.29,$0.00,$0.00,$288.90,"$1,650.00",$0.00,$825.00,"$1,306.80","$1,320.00",$0.00,$258.23,$0.00,$262.68,$0.00
83555557,SUP,HCPCS C1713,,83555557  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,800.00",$0.00,"$1,800.00",$810.00,"$1,284.66",$0.00,$310.13,$0.00,$0.00,$315.17,"$1,800.00",$0.00,$900.00,"$1,425.60","$1,440.00",$0.00,$281.70,$0.00,$286.56,$0.00
83555559,SUP,HCPCS C1713,,83555559  -  SCREW BN 5.5MM 55MM TSRH OSTEOGRIP THNLN TI SPNE,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83555601,SUP,HCPCS C1713,,83555601  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83555606,SUP,HCPCS C1713,,83555606  -  PLATE 18MM TI BONE SPNL,"$1,650.00",$0.00,"$1,650.00",$742.50,"$1,177.61",$0.00,$284.29,$0.00,$0.00,$288.90,"$1,650.00",$0.00,$825.00,"$1,306.80","$1,320.00",$0.00,$258.23,$0.00,$262.68,$0.00
83555607,SUP,HCPCS C1713,,83555607  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,800.00",$0.00,"$1,800.00",$810.00,"$1,284.66",$0.00,$310.13,$0.00,$0.00,$315.17,"$1,800.00",$0.00,$900.00,"$1,425.60","$1,440.00",$0.00,$281.70,$0.00,$286.56,$0.00
83555608,SUP,HCPCS C1713,,83555608  -  PLATE 18MM TI BONE SPNL,"$1,520.88",$0.00,"$1,520.88",$684.39,"$1,085.45",$0.00,$262.04,$0.00,$0.00,$266.29,"$1,520.88",$0.00,$760.44,"$1,204.54","$1,216.70",$0.00,$238.02,$0.00,$242.12,$0.00
83555609,SUP,HCPCS C1713,,83555609  -  SCREW BN 5.5MM 60MM TSRH OSTEOGRIP THNLN TI SPNE,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83565201,SUP,HCPCS C1713,,83565201  -  PLATE 18MM TI BONE SPNL,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83565251,SUP,HCPCS C1713,,83565251  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83565259,SUP,HCPCS C1713,,83565259  -  PLATE 18MM TI BONE SPNL,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83565301,SUP,HCPCS C1713,,83565301  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83565306,SUP,HCPCS C1713,,83565306  -  PLATE 18MM TI BONE SPNL,"$1,650.00",$0.00,"$1,650.00",$742.50,"$1,177.61",$0.00,$284.29,$0.00,$0.00,$288.90,"$1,650.00",$0.00,$825.00,"$1,306.80","$1,320.00",$0.00,$258.23,$0.00,$262.68,$0.00
83565307,SUP,HCPCS C1713,,83565307  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,800.00",$0.00,"$1,800.00",$810.00,"$1,284.66",$0.00,$310.13,$0.00,$0.00,$315.17,"$1,800.00",$0.00,$900.00,"$1,425.60","$1,440.00",$0.00,$281.70,$0.00,$286.56,$0.00
83565308,SUP,HCPCS C1713,,83565308  -  PLATE 18MM TI BONE SPNL,"$1,520.88",$0.00,"$1,520.88",$684.39,"$1,085.45",$0.00,$262.04,$0.00,$0.00,$266.29,"$1,520.88",$0.00,$760.44,"$1,204.54","$1,216.70",$0.00,$238.02,$0.00,$242.12,$0.00
83565309,SUP,HCPCS C1713,,83565309  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83565351,SUP,HCPCS C1713,,83565351  -  PLATE 18MM TI BONE SPNL,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83565356,SUP,HCPCS C1713,,83565356  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,650.00",$0.00,"$1,650.00",$742.50,"$1,177.61",$0.00,$284.29,$0.00,$0.00,$288.90,"$1,650.00",$0.00,$825.00,"$1,306.80","$1,320.00",$0.00,$258.23,$0.00,$262.68,$0.00
83565357,SUP,HCPCS C1713,,83565357  -  PLATE 18MM TI BONE SPNL,"$1,800.00",$0.00,"$1,800.00",$810.00,"$1,284.66",$0.00,$310.13,$0.00,$0.00,$315.17,"$1,800.00",$0.00,$900.00,"$1,425.60","$1,440.00",$0.00,$281.70,$0.00,$286.56,$0.00
83565358,SUP,HCPCS C1713,,83565358  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,520.88",$0.00,"$1,520.88",$684.39,"$1,085.45",$0.00,$262.04,$0.00,$0.00,$266.29,"$1,520.88",$0.00,$760.44,"$1,204.54","$1,216.70",$0.00,$238.02,$0.00,$242.12,$0.00
83565359,SUP,HCPCS C1713,,83565359  -  PLATE 18MM TI BONE SPNL,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83565401,SUP,HCPCS C1713,,83565401  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83565406,SUP,HCPCS C1713,,83565406  -  PLATE 18MM TI BONE SPNL,"$1,650.00",$0.00,"$1,650.00",$742.50,"$1,177.61",$0.00,$284.29,$0.00,$0.00,$288.90,"$1,650.00",$0.00,$825.00,"$1,306.80","$1,320.00",$0.00,$258.23,$0.00,$262.68,$0.00
83565407,SUP,HCPCS C1713,,83565407  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,800.00",$0.00,"$1,800.00",$810.00,"$1,284.66",$0.00,$310.13,$0.00,$0.00,$315.17,"$1,800.00",$0.00,$900.00,"$1,425.60","$1,440.00",$0.00,$281.70,$0.00,$286.56,$0.00
83565408,SUP,HCPCS C1713,,83565408  -  PLATE 18MM TI BONE SPNL,"$1,520.88",$0.00,"$1,520.88",$684.39,"$1,085.45",$0.00,$262.04,$0.00,$0.00,$266.29,"$1,520.88",$0.00,$760.44,"$1,204.54","$1,216.70",$0.00,$238.02,$0.00,$242.12,$0.00
83565409,SUP,HCPCS C1713,,83565409  -  SCREW BN 6.5MM 40MM TSRH OSTEOGRIP THNLN TI SPNE,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83565451,SUP,HCPCS C1713,,83565451  -  PLATE 18MM TI BONE SPNL,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83565454,SUP,HCPCS C1713,,83565454  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,520.88",$0.00,"$1,520.88",$684.39,"$1,085.45",$0.00,$262.04,$0.00,$0.00,$266.29,"$1,520.88",$0.00,$760.44,"$1,204.54","$1,216.70",$0.00,$238.02,$0.00,$242.12,$0.00
83565456,SUP,HCPCS C1713,,83565456  -  PLATE 18MM TI BONE SPNL,"$1,650.00",$0.00,"$1,650.00",$742.50,"$1,177.61",$0.00,$284.29,$0.00,$0.00,$288.90,"$1,650.00",$0.00,$825.00,"$1,306.80","$1,320.00",$0.00,$258.23,$0.00,$262.68,$0.00
83565457,SUP,HCPCS C1713,,83565457  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,800.00",$0.00,"$1,800.00",$810.00,"$1,284.66",$0.00,$310.13,$0.00,$0.00,$315.17,"$1,800.00",$0.00,$900.00,"$1,425.60","$1,440.00",$0.00,$281.70,$0.00,$286.56,$0.00
83565458,SUP,HCPCS C1713,,83565458  -  PLATE 18MM TI BONE SPNL,"$1,520.88",$0.00,"$1,520.88",$684.39,"$1,085.45",$0.00,$262.04,$0.00,$0.00,$266.29,"$1,520.88",$0.00,$760.44,"$1,204.54","$1,216.70",$0.00,$238.02,$0.00,$242.12,$0.00
83565459,SUP,HCPCS C1713,,83565459  -  SCREW BN 6.5MM 45MM TSRH OSTEOGRIP THNLN TI SPNE,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83565501,SUP,HCPCS C1713,,83565501  -  PLATE 18MM TI BONE SPNL,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83565504,SUP,HCPCS C1713,,83565504  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,520.88",$0.00,"$1,520.88",$684.39,"$1,085.45",$0.00,$262.04,$0.00,$0.00,$266.29,"$1,520.88",$0.00,$760.44,"$1,204.54","$1,216.70",$0.00,$238.02,$0.00,$242.12,$0.00
83565506,SUP,HCPCS C1713,,83565506  -  PLATE 18MM TI BONE SPNL,"$1,650.00",$0.00,"$1,650.00",$742.50,"$1,177.61",$0.00,$284.29,$0.00,$0.00,$288.90,"$1,650.00",$0.00,$825.00,"$1,306.80","$1,320.00",$0.00,$258.23,$0.00,$262.68,$0.00
83565507,SUP,HCPCS C1713,,83565507  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,800.00",$0.00,"$1,800.00",$810.00,"$1,284.66",$0.00,$310.13,$0.00,$0.00,$315.17,"$1,800.00",$0.00,$900.00,"$1,425.60","$1,440.00",$0.00,$281.70,$0.00,$286.56,$0.00
83565508,SUP,HCPCS C1713,,83565508  -  PLATE 18MM TI BONE SPNL,"$1,520.88",$0.00,"$1,520.88",$684.39,"$1,085.45",$0.00,$262.04,$0.00,$0.00,$266.29,"$1,520.88",$0.00,$760.44,"$1,204.54","$1,216.70",$0.00,$238.02,$0.00,$242.12,$0.00
83565509,SUP,HCPCS C1713,,83565509  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83565551,SUP,HCPCS C1713,,83565551  -  PLATE 18MM TI BONE SPNL,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83565554,SUP,HCPCS C1713,,83565554  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,520.88",$0.00,"$1,520.88",$684.39,"$1,085.45",$0.00,$262.04,$0.00,$0.00,$266.29,"$1,520.88",$0.00,$760.44,"$1,204.54","$1,216.70",$0.00,$238.02,$0.00,$242.12,$0.00
83565556,SUP,HCPCS C1713,,83565556  -  PLATE 18MM TI BONE SPNL,"$1,650.00",$0.00,"$1,650.00",$742.50,"$1,177.61",$0.00,$284.29,$0.00,$0.00,$288.90,"$1,650.00",$0.00,$825.00,"$1,306.80","$1,320.00",$0.00,$258.23,$0.00,$262.68,$0.00
83565557,SUP,HCPCS C1713,,83565557  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,800.00",$0.00,"$1,800.00",$810.00,"$1,284.66",$0.00,$310.13,$0.00,$0.00,$315.17,"$1,800.00",$0.00,$900.00,"$1,425.60","$1,440.00",$0.00,$281.70,$0.00,$286.56,$0.00
83565558,SUP,HCPCS C1713,,83565558  -  PLATE 18MM TI BONE SPNL,"$1,520.88",$0.00,"$1,520.88",$684.39,"$1,085.45",$0.00,$262.04,$0.00,$0.00,$266.29,"$1,520.88",$0.00,$760.44,"$1,204.54","$1,216.70",$0.00,$238.02,$0.00,$242.12,$0.00
83565559,SUP,HCPCS C1713,,83565559  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83565601,SUP,HCPCS C1713,,83565601  -  PLATE 18MM TI BONE SPNL,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83565606,SUP,HCPCS C1713,,83565606  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,650.00",$0.00,"$1,650.00",$742.50,"$1,177.61",$0.00,$284.29,$0.00,$0.00,$288.90,"$1,650.00",$0.00,$825.00,"$1,306.80","$1,320.00",$0.00,$258.23,$0.00,$262.68,$0.00
83565607,SUP,HCPCS C1713,,83565607  -  PLATE 18MM TI BONE SPNL,"$1,800.00",$0.00,"$1,800.00",$810.00,"$1,284.66",$0.00,$310.13,$0.00,$0.00,$315.17,"$1,800.00",$0.00,$900.00,"$1,425.60","$1,440.00",$0.00,$281.70,$0.00,$286.56,$0.00
83565608,SUP,HCPCS C1713,,83565608  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,520.88",$0.00,"$1,520.88",$684.39,"$1,085.45",$0.00,$262.04,$0.00,$0.00,$266.29,"$1,520.88",$0.00,$760.44,"$1,204.54","$1,216.70",$0.00,$238.02,$0.00,$242.12,$0.00
83565609,SUP,HCPCS C1713,,83565609  -  PLATE 18MM TI BONE SPNL,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83575201,SUP,HCPCS C1713,,83575201  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83575251,SUP,HCPCS C1713,,83575251  -  PLATE 18MM TI BONE SPNL,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83575301,SUP,HCPCS C1713,,83575301  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83575306,SUP,HCPCS C1713,,83575306  -  PLATE 18MM TI BONE SPNL,"$1,650.00",$0.00,"$1,650.00",$742.50,"$1,177.61",$0.00,$284.29,$0.00,$0.00,$288.90,"$1,650.00",$0.00,$825.00,"$1,306.80","$1,320.00",$0.00,$258.23,$0.00,$262.68,$0.00
83575307,SUP,HCPCS C1713,,83575307  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,800.00",$0.00,"$1,800.00",$810.00,"$1,284.66",$0.00,$310.13,$0.00,$0.00,$315.17,"$1,800.00",$0.00,$900.00,"$1,425.60","$1,440.00",$0.00,$281.70,$0.00,$286.56,$0.00
83575308,SUP,HCPCS C1713,,83575308  -  PLATE 18MM TI BONE SPNL,"$1,520.88",$0.00,"$1,520.88",$684.39,"$1,085.45",$0.00,$262.04,$0.00,$0.00,$266.29,"$1,520.88",$0.00,$760.44,"$1,204.54","$1,216.70",$0.00,$238.02,$0.00,$242.12,$0.00
83575309,SUP,HCPCS C1713,,83575309  -  SCREW BN 7.5MM 30MM TSRH OSTEOGRIP THNLN TI SPNE,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83575351,SUP,HCPCS C1713,,83575351  -  PLATE 18MM TI BONE SPNL,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83575356,SUP,HCPCS C1713,,83575356  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,650.00",$0.00,"$1,650.00",$742.50,"$1,177.61",$0.00,$284.29,$0.00,$0.00,$288.90,"$1,650.00",$0.00,$825.00,"$1,306.80","$1,320.00",$0.00,$258.23,$0.00,$262.68,$0.00
83575357,SUP,HCPCS C1713,,83575357  -  PLATE 18MM TI BONE SPNL,"$1,800.00",$0.00,"$1,800.00",$810.00,"$1,284.66",$0.00,$310.13,$0.00,$0.00,$315.17,"$1,800.00",$0.00,$900.00,"$1,425.60","$1,440.00",$0.00,$281.70,$0.00,$286.56,$0.00
83575358,SUP,HCPCS C1713,,83575358  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,520.88",$0.00,"$1,520.88",$684.39,"$1,085.45",$0.00,$262.04,$0.00,$0.00,$266.29,"$1,520.88",$0.00,$760.44,"$1,204.54","$1,216.70",$0.00,$238.02,$0.00,$242.12,$0.00
83575359,SUP,HCPCS C1713,,83575359  -  SCREW BN 7.5MM 35MM TSRH OSTEOGRIP RECON TI SPNE,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83575401,SUP,HCPCS C1713,,83575401  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83575406,SUP,HCPCS C1713,,83575406  -  PLATE 18MM TI BONE SPNL,"$1,650.00",$0.00,"$1,650.00",$742.50,"$1,177.61",$0.00,$284.29,$0.00,$0.00,$288.90,"$1,650.00",$0.00,$825.00,"$1,306.80","$1,320.00",$0.00,$258.23,$0.00,$262.68,$0.00
83575407,SUP,HCPCS C1713,,83575407  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,800.00",$0.00,"$1,800.00",$810.00,"$1,284.66",$0.00,$310.13,$0.00,$0.00,$315.17,"$1,800.00",$0.00,$900.00,"$1,425.60","$1,440.00",$0.00,$281.70,$0.00,$286.56,$0.00
83575408,SUP,HCPCS C1713,,83575408  -  PLATE 18MM TI BONE SPNL,"$1,520.88",$0.00,"$1,520.88",$684.39,"$1,085.45",$0.00,$262.04,$0.00,$0.00,$266.29,"$1,520.88",$0.00,$760.44,"$1,204.54","$1,216.70",$0.00,$238.02,$0.00,$242.12,$0.00
83575409,SUP,HCPCS C1713,,83575409  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83575451,SUP,HCPCS C1713,,83575451  -  PLATE 18MM TI BONE SPNL,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83575456,SUP,HCPCS C1713,,83575456  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,650.00",$0.00,"$1,650.00",$742.50,"$1,177.61",$0.00,$284.29,$0.00,$0.00,$288.90,"$1,650.00",$0.00,$825.00,"$1,306.80","$1,320.00",$0.00,$258.23,$0.00,$262.68,$0.00
83575457,SUP,HCPCS C1713,,83575457  -  PLATE 18MM TI BONE SPNL,"$1,800.00",$0.00,"$1,800.00",$810.00,"$1,284.66",$0.00,$310.13,$0.00,$0.00,$315.17,"$1,800.00",$0.00,$900.00,"$1,425.60","$1,440.00",$0.00,$281.70,$0.00,$286.56,$0.00
83575458,SUP,HCPCS C1713,,83575458  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,520.88",$0.00,"$1,520.88",$684.39,"$1,085.45",$0.00,$262.04,$0.00,$0.00,$266.29,"$1,520.88",$0.00,$760.44,"$1,204.54","$1,216.70",$0.00,$238.02,$0.00,$242.12,$0.00
83575459,SUP,HCPCS C1713,,83575459  -  SCREW BN 7.5MM 45MM TSRH OSTEOGRIP THNLN TI SPNE PDCL,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83575501,SUP,HCPCS C1713,,83575501  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83575506,SUP,HCPCS C1713,,83575506  -  PLATE 18MM TI BONE SPNL,"$1,650.00",$0.00,"$1,650.00",$742.50,"$1,177.61",$0.00,$284.29,$0.00,$0.00,$288.90,"$1,650.00",$0.00,$825.00,"$1,306.80","$1,320.00",$0.00,$258.23,$0.00,$262.68,$0.00
83575507,SUP,HCPCS C1713,,83575507  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,800.00",$0.00,"$1,800.00",$810.00,"$1,284.66",$0.00,$310.13,$0.00,$0.00,$315.17,"$1,800.00",$0.00,$900.00,"$1,425.60","$1,440.00",$0.00,$281.70,$0.00,$286.56,$0.00
83575508,SUP,HCPCS C1713,,83575508  -  PLATE 18MM TI BONE SPNL,"$1,520.88",$0.00,"$1,520.88",$684.39,"$1,085.45",$0.00,$262.04,$0.00,$0.00,$266.29,"$1,520.88",$0.00,$760.44,"$1,204.54","$1,216.70",$0.00,$238.02,$0.00,$242.12,$0.00
83575509,SUP,HCPCS C1713,,83575509  -  SCREW BN 7.5MM 50MM TSRH OSTEOGRIP THNLN TI SPNE,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83575551,SUP,HCPCS C1713,,83575551  -  PLATE 18MM TI BONE SPNL,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83575556,SUP,HCPCS C1713,,83575556  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,650.00",$0.00,"$1,650.00",$742.50,"$1,177.61",$0.00,$284.29,$0.00,$0.00,$288.90,"$1,650.00",$0.00,$825.00,"$1,306.80","$1,320.00",$0.00,$258.23,$0.00,$262.68,$0.00
83575557,SUP,HCPCS C1713,,83575557  -  PLATE 18MM TI BONE SPNL,"$1,800.00",$0.00,"$1,800.00",$810.00,"$1,284.66",$0.00,$310.13,$0.00,$0.00,$315.17,"$1,800.00",$0.00,$900.00,"$1,425.60","$1,440.00",$0.00,$281.70,$0.00,$286.56,$0.00
83575558,SUP,HCPCS C1713,,83575558  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,520.88",$0.00,"$1,520.88",$684.39,"$1,085.45",$0.00,$262.04,$0.00,$0.00,$266.29,"$1,520.88",$0.00,$760.44,"$1,204.54","$1,216.70",$0.00,$238.02,$0.00,$242.12,$0.00
83575559,SUP,HCPCS C1713,,83575559  -  SCREW BN 7.5MM 55MM TSRH OSTEOGRIP THNLN TI SPNE,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83575601,SUP,HCPCS C1713,,83575601  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83575606,SUP,HCPCS C1713,,83575606  -  PLATE 18MM TI BONE SPNL,"$1,650.00",$0.00,"$1,650.00",$742.50,"$1,177.61",$0.00,$284.29,$0.00,$0.00,$288.90,"$1,650.00",$0.00,$825.00,"$1,306.80","$1,320.00",$0.00,$258.23,$0.00,$262.68,$0.00
83575607,SUP,HCPCS C1713,,83575607  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,800.00",$0.00,"$1,800.00",$810.00,"$1,284.66",$0.00,$310.13,$0.00,$0.00,$315.17,"$1,800.00",$0.00,$900.00,"$1,425.60","$1,440.00",$0.00,$281.70,$0.00,$286.56,$0.00
83575608,SUP,HCPCS C1713,,83575608  -  PLATE 18MM TI BONE SPNL,"$1,520.88",$0.00,"$1,520.88",$684.39,"$1,085.45",$0.00,$262.04,$0.00,$0.00,$266.29,"$1,520.88",$0.00,$760.44,"$1,204.54","$1,216.70",$0.00,$238.02,$0.00,$242.12,$0.00
83575609,SUP,HCPCS C1713,,83575609  -  SCREW BN 7.5MM 60MM TSRH OSTEOGRIP THNLN TI SPNE,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83585201,SUP,HCPCS C1713,,83585201  -  PLATE 18MM TI BONE SPNL,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83585251,SUP,HCPCS C1713,,83585251  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83585301,SUP,HCPCS C1713,,83585301  -  PLATE 18MM TI BONE SPNL,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83585306,SUP,HCPCS C1713,,83585306  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,650.00",$0.00,"$1,650.00",$742.50,"$1,177.61",$0.00,$284.29,$0.00,$0.00,$288.90,"$1,650.00",$0.00,$825.00,"$1,306.80","$1,320.00",$0.00,$258.23,$0.00,$262.68,$0.00
83585307,SUP,HCPCS C1713,,83585307  -  PLATE 18MM TI BONE SPNL,"$1,800.00",$0.00,"$1,800.00",$810.00,"$1,284.66",$0.00,$310.13,$0.00,$0.00,$315.17,"$1,800.00",$0.00,$900.00,"$1,425.60","$1,440.00",$0.00,$281.70,$0.00,$286.56,$0.00
83585309,SUP,HCPCS C1713,,83585309  -  SCREW BN 8.5MM 30MM TSRH OSTEOGRIP THNLN TI SPNE PDCL,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83585351,SUP,HCPCS C1713,,83585351  -  PLATE 18MM TI BONE SPNL,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83585356,SUP,HCPCS C1713,,83585356  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,650.00",$0.00,"$1,650.00",$742.50,"$1,177.61",$0.00,$284.29,$0.00,$0.00,$288.90,"$1,650.00",$0.00,$825.00,"$1,306.80","$1,320.00",$0.00,$258.23,$0.00,$262.68,$0.00
83585357,SUP,HCPCS C1713,,83585357  -  PLATE 18MM TI BONE SPNL,"$1,800.00",$0.00,"$1,800.00",$810.00,"$1,284.66",$0.00,$310.13,$0.00,$0.00,$315.17,"$1,800.00",$0.00,$900.00,"$1,425.60","$1,440.00",$0.00,$281.70,$0.00,$286.56,$0.00
83585359,SUP,HCPCS C1713,,83585359  -  SCREW BN 8.5MM 35MM TSRH OSTEOGRIP THNLN SPNE,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83585401,SUP,HCPCS C1713,,83585401  -  PLATE 18MM TI BONE SPNL,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83585406,SUP,HCPCS C1713,,83585406  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,650.00",$0.00,"$1,650.00",$742.50,"$1,177.61",$0.00,$284.29,$0.00,$0.00,$288.90,"$1,650.00",$0.00,$825.00,"$1,306.80","$1,320.00",$0.00,$258.23,$0.00,$262.68,$0.00
83585407,SUP,HCPCS C1713,,83585407  -  PLATE 18MM TI BONE SPNL,"$1,800.00",$0.00,"$1,800.00",$810.00,"$1,284.66",$0.00,$310.13,$0.00,$0.00,$315.17,"$1,800.00",$0.00,$900.00,"$1,425.60","$1,440.00",$0.00,$281.70,$0.00,$286.56,$0.00
83585409,SUP,HCPCS C1713,,83585409  -  SCREW BN 8.5MM 40MM TSRH OSTEOGRIP THNLN SPNE,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83585451,SUP,HCPCS C1713,,83585451  -  PLATE 18MM TI BONE SPNL,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83585456,SUP,HCPCS C1713,,83585456  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,650.00",$0.00,"$1,650.00",$742.50,"$1,177.61",$0.00,$284.29,$0.00,$0.00,$288.90,"$1,650.00",$0.00,$825.00,"$1,306.80","$1,320.00",$0.00,$258.23,$0.00,$262.68,$0.00
83585457,SUP,HCPCS C1713,,83585457  -  PLATE 18MM TI BONE SPNL,"$1,800.00",$0.00,"$1,800.00",$810.00,"$1,284.66",$0.00,$310.13,$0.00,$0.00,$315.17,"$1,800.00",$0.00,$900.00,"$1,425.60","$1,440.00",$0.00,$281.70,$0.00,$286.56,$0.00
83585459,SUP,HCPCS C1713,,83585459  -  SCREW BN 8.5MM 45MM TSRH OSTEOGRIP THNLN TI SPNE,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83585501,SUP,HCPCS C1713,,83585501  -  PLATE 18MM TI BONE SPNL,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83585506,SUP,HCPCS C1713,,83585506  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,650.00",$0.00,"$1,650.00",$742.50,"$1,177.61",$0.00,$284.29,$0.00,$0.00,$288.90,"$1,650.00",$0.00,$825.00,"$1,306.80","$1,320.00",$0.00,$258.23,$0.00,$262.68,$0.00
83585507,SUP,HCPCS C1713,,83585507  -  PLATE 18MM TI BONE SPNL,"$1,800.00",$0.00,"$1,800.00",$810.00,"$1,284.66",$0.00,$310.13,$0.00,$0.00,$315.17,"$1,800.00",$0.00,$900.00,"$1,425.60","$1,440.00",$0.00,$281.70,$0.00,$286.56,$0.00
83585509,SUP,HCPCS C1713,,83585509  -  SCREW BN 8.5MM 50MM TSRH OSTEOGRIP THNLN TI SPNE,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83585551,SUP,HCPCS C1713,,83585551  -  PLATE 18MM TI BONE SPNL,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83585556,SUP,HCPCS C1713,,83585556  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,650.00",$0.00,"$1,650.00",$742.50,"$1,177.61",$0.00,$284.29,$0.00,$0.00,$288.90,"$1,650.00",$0.00,$825.00,"$1,306.80","$1,320.00",$0.00,$258.23,$0.00,$262.68,$0.00
83585557,SUP,HCPCS C1713,,83585557  -  PLATE 18MM TI BONE SPNL,"$1,800.00",$0.00,"$1,800.00",$810.00,"$1,284.66",$0.00,$310.13,$0.00,$0.00,$315.17,"$1,800.00",$0.00,$900.00,"$1,425.60","$1,440.00",$0.00,$281.70,$0.00,$286.56,$0.00
83585559,SUP,HCPCS C1713,,83585559  -  SCREW BN 8.5MM 55MM TSRH OSTEOGRIP THNLN TI SPNE,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83585601,SUP,HCPCS C1713,,83585601  -  PLATE 18MM TI BONE SPNL,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
83585606,SUP,HCPCS C1713,,83585606  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,650.00",$0.00,"$1,650.00",$742.50,"$1,177.61",$0.00,$284.29,$0.00,$0.00,$288.90,"$1,650.00",$0.00,$825.00,"$1,306.80","$1,320.00",$0.00,$258.23,$0.00,$262.68,$0.00
83585607,SUP,HCPCS C1713,,83585607  -  PLATE 18MM TI BONE SPNL,"$1,800.00",$0.00,"$1,800.00",$810.00,"$1,284.66",$0.00,$310.13,$0.00,$0.00,$315.17,"$1,800.00",$0.00,$900.00,"$1,425.60","$1,440.00",$0.00,$281.70,$0.00,$286.56,$0.00
83585609,SUP,HCPCS C1713,,83585609  -  SCREW BN 8.5MM 60MM TSRH OSTEOGRIP THNLN TI SPNE,"$1,072.50",$0.00,"$1,072.50",$482.63,$765.44,$0.00,$184.79,$0.00,$0.00,$187.79,"$1,072.50",$0.00,$536.25,$849.42,$858.00,$0.00,$167.85,$0.00,$170.74,$0.00
86944520,SUP,HCPCS C1713,,86944520  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86944525,SUP,HCPCS C1713,,86944525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86944530,SUP,HCPCS C1713,,86944530  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86944535,SUP,HCPCS C1713,,86944535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86944540,SUP,HCPCS C1713,,86944540  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86944545,SUP,HCPCS C1713,,86944545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86944550,SUP,HCPCS C1713,,86944550  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86945020,SUP,HCPCS C1713,,86945020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86945025,SUP,HCPCS C1713,,86945025  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86945030,SUP,HCPCS C1713,,86945030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86945035,SUP,HCPCS C1713,,86945035  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86945040,SUP,HCPCS C1713,,86945040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86945045,SUP,HCPCS C1713,,86945045  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86945050,SUP,HCPCS C1713,,86945050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86945520,SUP,HCPCS C1713,,86945520  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86945525,SUP,HCPCS C1713,,86945525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86945530,SUP,HCPCS C1713,,86945530  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86945535,SUP,HCPCS C1713,,86945535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86945540,SUP,HCPCS C1713,,86945540  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86945545,SUP,HCPCS C1713,,86945545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86945550,SUP,HCPCS C1713,,86945550  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86945555,SUP,HCPCS C1713,,86945555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86945560,SUP,HCPCS C1713,,86945560  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86945565,SUP,HCPCS C1713,,86945565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86946520,SUP,HCPCS C1713,,86946520  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86946530,SUP,HCPCS C1713,,86946530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86946535,SUP,HCPCS C1713,,86946535  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86946540,SUP,HCPCS C1713,,86946540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86946545,SUP,HCPCS C1713,,86946545  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86946550,SUP,HCPCS C1713,,86946550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86946555,SUP,HCPCS C1713,,86946555  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86946560,SUP,HCPCS C1713,,86946560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86946565,SUP,HCPCS C1713,,86946565  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86946570,SUP,HCPCS C1713,,86946570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86946575,SUP,HCPCS C1713,,86946575  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86947520,SUP,HCPCS C1713,,86947520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86947525,SUP,HCPCS C1713,,86947525  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86947530,SUP,HCPCS C1713,,86947530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86947535,SUP,HCPCS C1713,,86947535  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86947540,SUP,HCPCS C1713,,86947540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86947545,SUP,HCPCS C1713,,86947545  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86947550,SUP,HCPCS C1713,,86947550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86947555,SUP,HCPCS C1713,,86947555  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86947560,SUP,HCPCS C1713,,86947560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86947565,SUP,HCPCS C1713,,86947565  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86947570,SUP,HCPCS C1713,,86947570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86947575,SUP,HCPCS C1713,,86947575  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86948520,SUP,HCPCS C1713,,86948520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86948525,SUP,HCPCS C1713,,86948525  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86948530,SUP,HCPCS C1713,,86948530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86948535,SUP,HCPCS C1713,,86948535  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86948540,SUP,HCPCS C1713,,86948540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86948545,SUP,HCPCS C1713,,86948545  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86948550,SUP,HCPCS C1713,,86948550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86948555,SUP,HCPCS C1713,,86948555  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86948560,SUP,HCPCS C1713,,86948560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86948565,SUP,HCPCS C1713,,86948565  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86948570,SUP,HCPCS C1713,,86948570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86948575,SUP,HCPCS C1713,,86948575  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86992320,SUP,HCPCS C1713,,86992320  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86992325,SUP,HCPCS C1713,,86992325  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86992330,SUP,HCPCS C1713,,86992330  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86992335,SUP,HCPCS C1713,,86992335  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86992340,SUP,HCPCS C1713,,86992340  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86992345,SUP,HCPCS C1713,,86992345  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86992350,SUP,HCPCS C1713,,86992350  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86992420,SUP,HCPCS C1713,,86992420  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86992425,SUP,HCPCS C1713,,86992425  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86992430,SUP,HCPCS C1713,,86992430  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86992435,SUP,HCPCS C1713,,86992435  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86992440,SUP,HCPCS C1713,,86992440  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86992445,SUP,HCPCS C1713,,86992445  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86992450,SUP,HCPCS C1713,,86992450  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86992525,SUP,HCPCS C1713,,86992525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86992530,SUP,HCPCS C1713,,86992530  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86992535,SUP,HCPCS C1713,,86992535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86992540,SUP,HCPCS C1713,,86992540  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86992545,SUP,HCPCS C1713,,86992545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86992550,SUP,HCPCS C1713,,86992550  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86992555,SUP,HCPCS C1713,,86992555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86992625,SUP,HCPCS C1713,,86992625  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86992630,SUP,HCPCS C1713,,86992630  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86992635,SUP,HCPCS C1713,,86992635  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86992640,SUP,HCPCS C1713,,86992640  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86992645,SUP,HCPCS C1713,,86992645  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86992650,SUP,HCPCS C1713,,86992650  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86992655,SUP,HCPCS C1713,,86992655  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86992725,SUP,HCPCS C1713,,86992725  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86992730,SUP,HCPCS C1713,,86992730  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86992735,SUP,HCPCS C1713,,86992735  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86992740,SUP,HCPCS C1713,,86992740  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86992745,SUP,HCPCS C1713,,86992745  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
86992750,SUP,HCPCS C1713,,86992750  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
88900101,SUP,HCPCS C1713,,88900101  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
88900102,SUP,HCPCS C1713,,88900102  -  PLATE 18MM TI BONE SPNL,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
88900105,SUP,HCPCS C1713,,88900105  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
88900107,SUP,HCPCS C1713,,88900107  -  PLATE 18MM TI BONE SPNL,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
88900108,SUP,HCPCS C1713,,88900108  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
88900109,SUP,HCPCS C1713,,88900109  -  PLATE 18MM TI BONE SPNL,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
88900110,SUP,HCPCS C1713,,88900110  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
88900111,SUP,HCPCS C1713,,88900111  -  PLATE 18MM TI BONE SPNL,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
88900113,SUP,HCPCS C1713,,88900113  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
88900114,SUP,HCPCS C1713,,88900114  -  PLATE 18MM TI BONE SPNL,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
88900201,SUP,HCPCS C1713,,88900201  -  HOOK SPNL TSRH SILO LT OFST TI LMR THOR 5.5 MM ROD,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
88900202,SUP,HCPCS C1713,,88900202  -  HOOK SPNL TSRH SILO LT OFST TI LMR THOR 5.5 MM ROD,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
88900205,SUP,HCPCS C1713,,88900205  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
88900207,SUP,HCPCS C1713,,88900207  -  PLATE 18MM TI BONE SPNL,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
88900208,SUP,HCPCS C1713,,88900208  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
88900209,SUP,HCPCS C1713,,88900209  -  PLATE 18MM TI BONE SPNL,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
88900210,SUP,HCPCS C1713,,88900210  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
88900211,SUP,HCPCS C1713,,88900211  -  PLATE 18MM TI BONE SPNL,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
88900213,SUP,HCPCS C1713,,88900213  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
88900214,SUP,HCPCS C1713,,88900214  -  PLATE 18MM TI BONE SPNL,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
88901000,SUP,HCPCS C1713,,88901000  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
88905512,SUP,Custom 27803010,,88905512  -  PLATE 18MM TI BONE SPNL,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
88905522,SUP,Custom 27803010,,88905522  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
88905532,SUP,Custom 27803010,,88905532  -  PLATE 18MM TI BONE SPNL,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
88924520,SUP,HCPCS C1713,,88924520  -  SCREW BN 4.5MM 20MM TSRH SILO FA TI SPNE 5.5MM ROD,"$1,906.50",$0.00,"$1,906.50",$857.93,"$1,360.67",$0.00,$328.48,$0.00,$0.00,$333.81,"$1,906.50",$0.00,$953.25,"$1,509.95","$1,525.20",$0.00,$298.37,$0.00,$303.51,$0.00
88924525,SUP,HCPCS C1713,,88924525  -  SCREW BN 4.5MM 25MM TSRH SILO FA TI SPNE 5.5MM ROD,"$1,906.50",$0.00,"$1,906.50",$857.93,"$1,360.67",$0.00,$328.48,$0.00,$0.00,$333.81,"$1,906.50",$0.00,$953.25,"$1,509.95","$1,525.20",$0.00,$298.37,$0.00,$303.51,$0.00
88924530,SUP,HCPCS C1713,,88924530  -  SCREW BN 4.5MM 30MM TSRH SILO FA TI SPNE 5.5MM ROD,"$1,906.50",$0.00,"$1,906.50",$857.93,"$1,360.67",$0.00,$328.48,$0.00,$0.00,$333.81,"$1,906.50",$0.00,$953.25,"$1,509.95","$1,525.20",$0.00,$298.37,$0.00,$303.51,$0.00
88924535,SUP,HCPCS C1713,,88924535  -  PLATE 18MM TI BONE SPNL,"$1,906.50",$0.00,"$1,906.50",$857.93,"$1,360.67",$0.00,$328.48,$0.00,$0.00,$333.81,"$1,906.50",$0.00,$953.25,"$1,509.95","$1,525.20",$0.00,$298.37,$0.00,$303.51,$0.00
88924540,SUP,HCPCS C1713,,88924540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,906.50",$0.00,"$1,906.50",$857.93,"$1,360.67",$0.00,$328.48,$0.00,$0.00,$333.81,"$1,906.50",$0.00,$953.25,"$1,509.95","$1,525.20",$0.00,$298.37,$0.00,$303.51,$0.00
88924545,SUP,HCPCS C1713,,88924545  -  PLATE 18MM TI BONE SPNL,"$1,906.50",$0.00,"$1,906.50",$857.93,"$1,360.67",$0.00,$328.48,$0.00,$0.00,$333.81,"$1,906.50",$0.00,$953.25,"$1,509.95","$1,525.20",$0.00,$298.37,$0.00,$303.51,$0.00
88924550,SUP,HCPCS C1713,,88924550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,906.50",$0.00,"$1,906.50",$857.93,"$1,360.67",$0.00,$328.48,$0.00,$0.00,$333.81,"$1,906.50",$0.00,$953.25,"$1,509.95","$1,525.20",$0.00,$298.37,$0.00,$303.51,$0.00
88925025,SUP,HCPCS C1713,,88925025  -  PLATE 18MM TI BONE SPNL,"$1,906.50",$0.00,"$1,906.50",$857.93,"$1,360.67",$0.00,$328.48,$0.00,$0.00,$333.81,"$1,906.50",$0.00,$953.25,"$1,509.95","$1,525.20",$0.00,$298.37,$0.00,$303.51,$0.00
88925030,SUP,HCPCS C1713,,88925030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,906.50",$0.00,"$1,906.50",$857.93,"$1,360.67",$0.00,$328.48,$0.00,$0.00,$333.81,"$1,906.50",$0.00,$953.25,"$1,509.95","$1,525.20",$0.00,$298.37,$0.00,$303.51,$0.00
88925035,SUP,HCPCS C1713,,88925035  -  PLATE 18MM TI BONE SPNL,"$1,906.50",$0.00,"$1,906.50",$857.93,"$1,360.67",$0.00,$328.48,$0.00,$0.00,$333.81,"$1,906.50",$0.00,$953.25,"$1,509.95","$1,525.20",$0.00,$298.37,$0.00,$303.51,$0.00
88925040,SUP,HCPCS C1713,,88925040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,906.50",$0.00,"$1,906.50",$857.93,"$1,360.67",$0.00,$328.48,$0.00,$0.00,$333.81,"$1,906.50",$0.00,$953.25,"$1,509.95","$1,525.20",$0.00,$298.37,$0.00,$303.51,$0.00
88925045,SUP,HCPCS C1713,,88925045  -  PLATE 18MM TI BONE SPNL,"$1,906.50",$0.00,"$1,906.50",$857.93,"$1,360.67",$0.00,$328.48,$0.00,$0.00,$333.81,"$1,906.50",$0.00,$953.25,"$1,509.95","$1,525.20",$0.00,$298.37,$0.00,$303.51,$0.00
88925050,SUP,HCPCS C1713,,88925050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,906.50",$0.00,"$1,906.50",$857.93,"$1,360.67",$0.00,$328.48,$0.00,$0.00,$333.81,"$1,906.50",$0.00,$953.25,"$1,509.95","$1,525.20",$0.00,$298.37,$0.00,$303.51,$0.00
88925055,SUP,HCPCS C1713,,88925055  -  PLATE 18MM TI BONE SPNL,"$1,906.50",$0.00,"$1,906.50",$857.93,"$1,360.67",$0.00,$328.48,$0.00,$0.00,$333.81,"$1,906.50",$0.00,$953.25,"$1,509.95","$1,525.20",$0.00,$298.37,$0.00,$303.51,$0.00
88925525,SUP,HCPCS C1713,,88925525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,906.50",$0.00,"$1,906.50",$857.93,"$1,360.67",$0.00,$328.48,$0.00,$0.00,$333.81,"$1,906.50",$0.00,$953.25,"$1,509.95","$1,525.20",$0.00,$298.37,$0.00,$303.51,$0.00
88925530,SUP,HCPCS C1713,,88925530  -  PLATE 18MM TI BONE SPNL,"$1,906.50",$0.00,"$1,906.50",$857.93,"$1,360.67",$0.00,$328.48,$0.00,$0.00,$333.81,"$1,906.50",$0.00,$953.25,"$1,509.95","$1,525.20",$0.00,$298.37,$0.00,$303.51,$0.00
88925535,SUP,HCPCS C1713,,88925535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,906.50",$0.00,"$1,906.50",$857.93,"$1,360.67",$0.00,$328.48,$0.00,$0.00,$333.81,"$1,906.50",$0.00,$953.25,"$1,509.95","$1,525.20",$0.00,$298.37,$0.00,$303.51,$0.00
88925540,SUP,HCPCS C1713,,88925540  -  PLATE 18MM TI BONE SPNL,"$1,906.50",$0.00,"$1,906.50",$857.93,"$1,360.67",$0.00,$328.48,$0.00,$0.00,$333.81,"$1,906.50",$0.00,$953.25,"$1,509.95","$1,525.20",$0.00,$298.37,$0.00,$303.51,$0.00
88925545,SUP,HCPCS C1713,,88925545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,906.50",$0.00,"$1,906.50",$857.93,"$1,360.67",$0.00,$328.48,$0.00,$0.00,$333.81,"$1,906.50",$0.00,$953.25,"$1,509.95","$1,525.20",$0.00,$298.37,$0.00,$303.51,$0.00
88925550,SUP,HCPCS C1713,,88925550  -  PLATE 18MM TI BONE SPNL,"$1,906.50",$0.00,"$1,906.50",$857.93,"$1,360.67",$0.00,$328.48,$0.00,$0.00,$333.81,"$1,906.50",$0.00,$953.25,"$1,509.95","$1,525.20",$0.00,$298.37,$0.00,$303.51,$0.00
88925555,SUP,HCPCS C1713,,88925555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,906.50",$0.00,"$1,906.50",$857.93,"$1,360.67",$0.00,$328.48,$0.00,$0.00,$333.81,"$1,906.50",$0.00,$953.25,"$1,509.95","$1,525.20",$0.00,$298.37,$0.00,$303.51,$0.00
88926525,SUP,HCPCS C1713,,88926525  -  PLATE 18MM TI BONE SPNL,"$1,906.50",$0.00,"$1,906.50",$857.93,"$1,360.67",$0.00,$328.48,$0.00,$0.00,$333.81,"$1,906.50",$0.00,$953.25,"$1,509.95","$1,525.20",$0.00,$298.37,$0.00,$303.51,$0.00
88926530,SUP,HCPCS C1713,,88926530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,906.50",$0.00,"$1,906.50",$857.93,"$1,360.67",$0.00,$328.48,$0.00,$0.00,$333.81,"$1,906.50",$0.00,$953.25,"$1,509.95","$1,525.20",$0.00,$298.37,$0.00,$303.51,$0.00
88926535,SUP,HCPCS C1713,,88926535  -  PLATE 18MM TI BONE SPNL,"$1,906.50",$0.00,"$1,906.50",$857.93,"$1,360.67",$0.00,$328.48,$0.00,$0.00,$333.81,"$1,906.50",$0.00,$953.25,"$1,509.95","$1,525.20",$0.00,$298.37,$0.00,$303.51,$0.00
88926540,SUP,HCPCS C1713,,88926540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,906.50",$0.00,"$1,906.50",$857.93,"$1,360.67",$0.00,$328.48,$0.00,$0.00,$333.81,"$1,906.50",$0.00,$953.25,"$1,509.95","$1,525.20",$0.00,$298.37,$0.00,$303.51,$0.00
88926545,SUP,HCPCS C1713,,88926545  -  PLATE 18MM TI BONE SPNL,"$1,906.50",$0.00,"$1,906.50",$857.93,"$1,360.67",$0.00,$328.48,$0.00,$0.00,$333.81,"$1,906.50",$0.00,$953.25,"$1,509.95","$1,525.20",$0.00,$298.37,$0.00,$303.51,$0.00
88926550,SUP,HCPCS C1713,,88926550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,906.50",$0.00,"$1,906.50",$857.93,"$1,360.67",$0.00,$328.48,$0.00,$0.00,$333.81,"$1,906.50",$0.00,$953.25,"$1,509.95","$1,525.20",$0.00,$298.37,$0.00,$303.51,$0.00
88926555,SUP,HCPCS C1713,,88926555  -  PLATE 18MM TI BONE SPNL,"$1,906.50",$0.00,"$1,906.50",$857.93,"$1,360.67",$0.00,$328.48,$0.00,$0.00,$333.81,"$1,906.50",$0.00,$953.25,"$1,509.95","$1,525.20",$0.00,$298.37,$0.00,$303.51,$0.00
88926560,SUP,HCPCS C1713,,88926560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,906.50",$0.00,"$1,906.50",$857.93,"$1,360.67",$0.00,$328.48,$0.00,$0.00,$333.81,"$1,906.50",$0.00,$953.25,"$1,509.95","$1,525.20",$0.00,$298.37,$0.00,$303.51,$0.00
88927530,SUP,HCPCS C1713,,88927530  -  PLATE 18MM TI BONE SPNL,"$1,906.50",$0.00,"$1,906.50",$857.93,"$1,360.67",$0.00,$328.48,$0.00,$0.00,$333.81,"$1,906.50",$0.00,$953.25,"$1,509.95","$1,525.20",$0.00,$298.37,$0.00,$303.51,$0.00
88927535,SUP,HCPCS C1713,,88927535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,906.50",$0.00,"$1,906.50",$857.93,"$1,360.67",$0.00,$328.48,$0.00,$0.00,$333.81,"$1,906.50",$0.00,$953.25,"$1,509.95","$1,525.20",$0.00,$298.37,$0.00,$303.51,$0.00
88927540,SUP,HCPCS C1713,,88927540  -  PLATE 18MM TI BONE SPNL,"$1,906.50",$0.00,"$1,906.50",$857.93,"$1,360.67",$0.00,$328.48,$0.00,$0.00,$333.81,"$1,906.50",$0.00,$953.25,"$1,509.95","$1,525.20",$0.00,$298.37,$0.00,$303.51,$0.00
88927545,SUP,HCPCS C1713,,88927545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,906.50",$0.00,"$1,906.50",$857.93,"$1,360.67",$0.00,$328.48,$0.00,$0.00,$333.81,"$1,906.50",$0.00,$953.25,"$1,509.95","$1,525.20",$0.00,$298.37,$0.00,$303.51,$0.00
88927550,SUP,HCPCS C1713,,88927550  -  PLATE 18MM TI BONE SPNL,"$1,906.50",$0.00,"$1,906.50",$857.93,"$1,360.67",$0.00,$328.48,$0.00,$0.00,$333.81,"$1,906.50",$0.00,$953.25,"$1,509.95","$1,525.20",$0.00,$298.37,$0.00,$303.51,$0.00
88927555,SUP,HCPCS C1713,,88927555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,906.50",$0.00,"$1,906.50",$857.93,"$1,360.67",$0.00,$328.48,$0.00,$0.00,$333.81,"$1,906.50",$0.00,$953.25,"$1,509.95","$1,525.20",$0.00,$298.37,$0.00,$303.51,$0.00
88927560,SUP,HCPCS C1713,,88927560  -  PLATE 18MM TI BONE SPNL,"$1,906.50",$0.00,"$1,906.50",$857.93,"$1,360.67",$0.00,$328.48,$0.00,$0.00,$333.81,"$1,906.50",$0.00,$953.25,"$1,509.95","$1,525.20",$0.00,$298.37,$0.00,$303.51,$0.00
88934520,SUP,Custom 27803010,,88934520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$0.00,"$1,427.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
88934525,SUP,Custom 27803010,,88934525  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$0.00,"$1,427.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
88934530,SUP,HCPCS C1713,,88934530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
88934535,SUP,Custom 27803010,,88934535  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$0.00,"$1,427.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
88935525,SUP,HCPCS C1713,,88935525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
88935530,SUP,HCPCS C1713,,88935530  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
88935535,SUP,HCPCS C1713,,88935535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
88935540,SUP,HCPCS C1713,,88935540  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
88935545,SUP,HCPCS C1713,,88935545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
88935550,SUP,HCPCS C1713,,88935550  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
88935555,SUP,HCPCS C1713,,88935555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
88936525,SUP,HCPCS C1713,,88936525  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
88936530,SUP,HCPCS C1713,,88936530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
88936535,SUP,HCPCS C1713,,88936535  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
88936540,SUP,HCPCS C1713,,88936540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
88936545,SUP,HCPCS C1713,,88936545  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
88936550,SUP,HCPCS C1713,,88936550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
88936555,SUP,HCPCS C1713,,88936555  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
88936560,SUP,HCPCS C1713,,88936560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
88937525,SUP,HCPCS C1713,,88937525  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
88937530,SUP,HCPCS C1713,,88937530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
88937535,SUP,HCPCS C1713,,88937535  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
88937540,SUP,HCPCS C1713,,88937540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
88937545,SUP,HCPCS C1713,,88937545  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
88937550,SUP,HCPCS C1713,,88937550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
88937555,SUP,HCPCS C1713,,88937555  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
88937560,SUP,HCPCS C1713,,88937560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
88944520,SUP,HCPCS C1713,,88944520  -  PLATE 18MM TI BONE SPNL,"$2,658.00",$0.00,"$2,658.00","$1,196.10","$1,897.01",$0.00,$457.96,$0.00,$0.00,$465.39,"$2,658.00",$0.00,"$1,329.00","$2,105.14","$2,126.40",$0.00,$415.98,$0.00,$423.15,$0.00
88944525,SUP,HCPCS C1713,,88944525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,658.00",$0.00,"$2,658.00","$1,196.10","$1,897.01",$0.00,$457.96,$0.00,$0.00,$465.39,"$2,658.00",$0.00,"$1,329.00","$2,105.14","$2,126.40",$0.00,$415.98,$0.00,$423.15,$0.00
88944530,SUP,HCPCS C1713,,88944530  -  PLATE 18MM TI BONE SPNL,"$2,658.00",$0.00,"$2,658.00","$1,196.10","$1,897.01",$0.00,$457.96,$0.00,$0.00,$465.39,"$2,658.00",$0.00,"$1,329.00","$2,105.14","$2,126.40",$0.00,$415.98,$0.00,$423.15,$0.00
88944535,SUP,HCPCS C1713,,88944535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,658.00",$0.00,"$2,658.00","$1,196.10","$1,897.01",$0.00,$457.96,$0.00,$0.00,$465.39,"$2,658.00",$0.00,"$1,329.00","$2,105.14","$2,126.40",$0.00,$415.98,$0.00,$423.15,$0.00
88944540,SUP,HCPCS C1713,,88944540  -  PLATE 18MM TI BONE SPNL,"$2,658.00",$0.00,"$2,658.00","$1,196.10","$1,897.01",$0.00,$457.96,$0.00,$0.00,$465.39,"$2,658.00",$0.00,"$1,329.00","$2,105.14","$2,126.40",$0.00,$415.98,$0.00,$423.15,$0.00
88944545,SUP,HCPCS C1713,,88944545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,658.00",$0.00,"$2,658.00","$1,196.10","$1,897.01",$0.00,$457.96,$0.00,$0.00,$465.39,"$2,658.00",$0.00,"$1,329.00","$2,105.14","$2,126.40",$0.00,$415.98,$0.00,$423.15,$0.00
88944550,SUP,HCPCS C1713,,88944550  -  PLATE 18MM TI BONE SPNL,"$2,658.00",$0.00,"$2,658.00","$1,196.10","$1,897.01",$0.00,$457.96,$0.00,$0.00,$465.39,"$2,658.00",$0.00,"$1,329.00","$2,105.14","$2,126.40",$0.00,$415.98,$0.00,$423.15,$0.00
88945025,SUP,HCPCS C1713,,88945025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,658.00",$0.00,"$2,658.00","$1,196.10","$1,897.01",$0.00,$457.96,$0.00,$0.00,$465.39,"$2,658.00",$0.00,"$1,329.00","$2,105.14","$2,126.40",$0.00,$415.98,$0.00,$423.15,$0.00
88945030,SUP,HCPCS C1713,,88945030  -  PLATE 18MM TI BONE SPNL,"$2,658.00",$0.00,"$2,658.00","$1,196.10","$1,897.01",$0.00,$457.96,$0.00,$0.00,$465.39,"$2,658.00",$0.00,"$1,329.00","$2,105.14","$2,126.40",$0.00,$415.98,$0.00,$423.15,$0.00
88945035,SUP,HCPCS C1713,,88945035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,658.00",$0.00,"$2,658.00","$1,196.10","$1,897.01",$0.00,$457.96,$0.00,$0.00,$465.39,"$2,658.00",$0.00,"$1,329.00","$2,105.14","$2,126.40",$0.00,$415.98,$0.00,$423.15,$0.00
88945040,SUP,HCPCS C1713,,88945040  -  PLATE 18MM TI BONE SPNL,"$2,658.00",$0.00,"$2,658.00","$1,196.10","$1,897.01",$0.00,$457.96,$0.00,$0.00,$465.39,"$2,658.00",$0.00,"$1,329.00","$2,105.14","$2,126.40",$0.00,$415.98,$0.00,$423.15,$0.00
88945045,SUP,HCPCS C1713,,88945045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,658.00",$0.00,"$2,658.00","$1,196.10","$1,897.01",$0.00,$457.96,$0.00,$0.00,$465.39,"$2,658.00",$0.00,"$1,329.00","$2,105.14","$2,126.40",$0.00,$415.98,$0.00,$423.15,$0.00
88945050,SUP,HCPCS C1713,,88945050  -  PLATE 18MM TI BONE SPNL,"$2,658.00",$0.00,"$2,658.00","$1,196.10","$1,897.01",$0.00,$457.96,$0.00,$0.00,$465.39,"$2,658.00",$0.00,"$1,329.00","$2,105.14","$2,126.40",$0.00,$415.98,$0.00,$423.15,$0.00
88945055,SUP,HCPCS C1713,,88945055  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,658.00",$0.00,"$2,658.00","$1,196.10","$1,897.01",$0.00,$457.96,$0.00,$0.00,$465.39,"$2,658.00",$0.00,"$1,329.00","$2,105.14","$2,126.40",$0.00,$415.98,$0.00,$423.15,$0.00
88945525,SUP,HCPCS C1713,,88945525  -  PLATE 18MM TI BONE SPNL,"$2,658.00",$0.00,"$2,658.00","$1,196.10","$1,897.01",$0.00,$457.96,$0.00,$0.00,$465.39,"$2,658.00",$0.00,"$1,329.00","$2,105.14","$2,126.40",$0.00,$415.98,$0.00,$423.15,$0.00
88945530,SUP,HCPCS C1713,,88945530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,658.00",$0.00,"$2,658.00","$1,196.10","$1,897.01",$0.00,$457.96,$0.00,$0.00,$465.39,"$2,658.00",$0.00,"$1,329.00","$2,105.14","$2,126.40",$0.00,$415.98,$0.00,$423.15,$0.00
88945535,SUP,HCPCS C1713,,88945535  -  PLATE 18MM TI BONE SPNL,"$2,658.00",$0.00,"$2,658.00","$1,196.10","$1,897.01",$0.00,$457.96,$0.00,$0.00,$465.39,"$2,658.00",$0.00,"$1,329.00","$2,105.14","$2,126.40",$0.00,$415.98,$0.00,$423.15,$0.00
88945540,SUP,HCPCS C1713,,88945540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,658.00",$0.00,"$2,658.00","$1,196.10","$1,897.01",$0.00,$457.96,$0.00,$0.00,$465.39,"$2,658.00",$0.00,"$1,329.00","$2,105.14","$2,126.40",$0.00,$415.98,$0.00,$423.15,$0.00
88945545,SUP,HCPCS C1713,,88945545  -  PLATE 18MM TI BONE SPNL,"$2,658.00",$0.00,"$2,658.00","$1,196.10","$1,897.01",$0.00,$457.96,$0.00,$0.00,$465.39,"$2,658.00",$0.00,"$1,329.00","$2,105.14","$2,126.40",$0.00,$415.98,$0.00,$423.15,$0.00
88945550,SUP,HCPCS C1713,,88945550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,658.00",$0.00,"$2,658.00","$1,196.10","$1,897.01",$0.00,$457.96,$0.00,$0.00,$465.39,"$2,658.00",$0.00,"$1,329.00","$2,105.14","$2,126.40",$0.00,$415.98,$0.00,$423.15,$0.00
88945555,SUP,HCPCS C1713,,88945555  -  PLATE 18MM TI BONE SPNL,"$2,658.00",$0.00,"$2,658.00","$1,196.10","$1,897.01",$0.00,$457.96,$0.00,$0.00,$465.39,"$2,658.00",$0.00,"$1,329.00","$2,105.14","$2,126.40",$0.00,$415.98,$0.00,$423.15,$0.00
88946525,SUP,HCPCS C1713,,88946525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,658.00",$0.00,"$2,658.00","$1,196.10","$1,897.01",$0.00,$457.96,$0.00,$0.00,$465.39,"$2,658.00",$0.00,"$1,329.00","$2,105.14","$2,126.40",$0.00,$415.98,$0.00,$423.15,$0.00
88946530,SUP,HCPCS C1713,,88946530  -  PLATE 18MM TI BONE SPNL,"$2,658.00",$0.00,"$2,658.00","$1,196.10","$1,897.01",$0.00,$457.96,$0.00,$0.00,$465.39,"$2,658.00",$0.00,"$1,329.00","$2,105.14","$2,126.40",$0.00,$415.98,$0.00,$423.15,$0.00
88946535,SUP,HCPCS C1713,,88946535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,658.00",$0.00,"$2,658.00","$1,196.10","$1,897.01",$0.00,$457.96,$0.00,$0.00,$465.39,"$2,658.00",$0.00,"$1,329.00","$2,105.14","$2,126.40",$0.00,$415.98,$0.00,$423.15,$0.00
88946540,SUP,HCPCS C1713,,88946540  -  PLATE 18MM TI BONE SPNL,"$2,658.00",$0.00,"$2,658.00","$1,196.10","$1,897.01",$0.00,$457.96,$0.00,$0.00,$465.39,"$2,658.00",$0.00,"$1,329.00","$2,105.14","$2,126.40",$0.00,$415.98,$0.00,$423.15,$0.00
88946545,SUP,HCPCS C1713,,88946545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,658.00",$0.00,"$2,658.00","$1,196.10","$1,897.01",$0.00,$457.96,$0.00,$0.00,$465.39,"$2,658.00",$0.00,"$1,329.00","$2,105.14","$2,126.40",$0.00,$415.98,$0.00,$423.15,$0.00
88946550,SUP,HCPCS C1713,,88946550  -  PLATE 18MM TI BONE SPNL,"$2,658.00",$0.00,"$2,658.00","$1,196.10","$1,897.01",$0.00,$457.96,$0.00,$0.00,$465.39,"$2,658.00",$0.00,"$1,329.00","$2,105.14","$2,126.40",$0.00,$415.98,$0.00,$423.15,$0.00
88946555,SUP,HCPCS C1713,,88946555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,658.00",$0.00,"$2,658.00","$1,196.10","$1,897.01",$0.00,$457.96,$0.00,$0.00,$465.39,"$2,658.00",$0.00,"$1,329.00","$2,105.14","$2,126.40",$0.00,$415.98,$0.00,$423.15,$0.00
88946560,SUP,HCPCS C1713,,88946560  -  PLATE 18MM TI BONE SPNL,"$2,658.00",$0.00,"$2,658.00","$1,196.10","$1,897.01",$0.00,$457.96,$0.00,$0.00,$465.39,"$2,658.00",$0.00,"$1,329.00","$2,105.14","$2,126.40",$0.00,$415.98,$0.00,$423.15,$0.00
88947525,SUP,HCPCS C1713,,88947525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,658.00",$0.00,"$2,658.00","$1,196.10","$1,897.01",$0.00,$457.96,$0.00,$0.00,$465.39,"$2,658.00",$0.00,"$1,329.00","$2,105.14","$2,126.40",$0.00,$415.98,$0.00,$423.15,$0.00
88947530,SUP,HCPCS C1713,,88947530  -  PLATE 18MM TI BONE SPNL,"$2,658.00",$0.00,"$2,658.00","$1,196.10","$1,897.01",$0.00,$457.96,$0.00,$0.00,$465.39,"$2,658.00",$0.00,"$1,329.00","$2,105.14","$2,126.40",$0.00,$415.98,$0.00,$423.15,$0.00
88947535,SUP,HCPCS C1713,,88947535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,658.00",$0.00,"$2,658.00","$1,196.10","$1,897.01",$0.00,$457.96,$0.00,$0.00,$465.39,"$2,658.00",$0.00,"$1,329.00","$2,105.14","$2,126.40",$0.00,$415.98,$0.00,$423.15,$0.00
88947540,SUP,HCPCS C1713,,88947540  -  PLATE 18MM TI BONE SPNL,"$2,658.00",$0.00,"$2,658.00","$1,196.10","$1,897.01",$0.00,$457.96,$0.00,$0.00,$465.39,"$2,658.00",$0.00,"$1,329.00","$2,105.14","$2,126.40",$0.00,$415.98,$0.00,$423.15,$0.00
88947545,SUP,HCPCS C1713,,88947545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,658.00",$0.00,"$2,658.00","$1,196.10","$1,897.01",$0.00,$457.96,$0.00,$0.00,$465.39,"$2,658.00",$0.00,"$1,329.00","$2,105.14","$2,126.40",$0.00,$415.98,$0.00,$423.15,$0.00
88947550,SUP,HCPCS C1713,,88947550  -  PLATE 18MM TI BONE SPNL,"$2,658.00",$0.00,"$2,658.00","$1,196.10","$1,897.01",$0.00,$457.96,$0.00,$0.00,$465.39,"$2,658.00",$0.00,"$1,329.00","$2,105.14","$2,126.40",$0.00,$415.98,$0.00,$423.15,$0.00
88947555,SUP,HCPCS C1713,,88947555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,658.00",$0.00,"$2,658.00","$1,196.10","$1,897.01",$0.00,$457.96,$0.00,$0.00,$465.39,"$2,658.00",$0.00,"$1,329.00","$2,105.14","$2,126.40",$0.00,$415.98,$0.00,$423.15,$0.00
88947560,SUP,HCPCS C1713,,88947560  -  PLATE 18MM TI BONE SPNL,"$2,658.00",$0.00,"$2,658.00","$1,196.10","$1,897.01",$0.00,$457.96,$0.00,$0.00,$465.39,"$2,658.00",$0.00,"$1,329.00","$2,105.14","$2,126.40",$0.00,$415.98,$0.00,$423.15,$0.00
88947565,SUP,HCPCS C1713,,88947565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,658.00",$0.00,"$2,658.00","$1,196.10","$1,897.01",$0.00,$457.96,$0.00,$0.00,$465.39,"$2,658.00",$0.00,"$1,329.00","$2,105.14","$2,126.40",$0.00,$415.98,$0.00,$423.15,$0.00
88947570,SUP,HCPCS C1713,,88947570  -  PLATE 18MM TI BONE SPNL,"$2,658.00",$0.00,"$2,658.00","$1,196.10","$1,897.01",$0.00,$457.96,$0.00,$0.00,$465.39,"$2,658.00",$0.00,"$1,329.00","$2,105.14","$2,126.40",$0.00,$415.98,$0.00,$423.15,$0.00
98716200,SUP,HCPCS C1713,,98716200  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$880.50,$0.00,$880.50,$396.23,$628.41,$0.00,$151.71,$0.00,$0.00,$154.17,$880.50,$0.00,$440.25,$697.36,$704.40,$0.00,$137.80,$0.00,$140.18,$0.00
98716250,SUP,HCPCS C1713,,98716250  -  SCREW BN 6.5MM 25MM PRMD VA TI SPNE ANT,$880.50,$0.00,$880.50,$396.23,$628.41,$0.00,$151.71,$0.00,$0.00,$154.17,$880.50,$0.00,$440.25,$697.36,$704.40,$0.00,$137.80,$0.00,$140.18,$0.00
98716300,SUP,HCPCS C1713,,98716300  -  SCREW BN 6.5MM 30MM PRMD VA TI SPNE ANT,$880.50,$0.00,$880.50,$396.23,$628.41,$0.00,$151.71,$0.00,$0.00,$154.17,$880.50,$0.00,$440.25,$697.36,$704.40,$0.00,$137.80,$0.00,$140.18,$0.00
98716350,SUP,HCPCS C1713,,98716350  -  SCREW BN 6.5MM 35MM PRMD VA TI SPNE ANT,$880.50,$0.00,$880.50,$396.23,$628.41,$0.00,$151.71,$0.00,$0.00,$154.17,$880.50,$0.00,$440.25,$697.36,$704.40,$0.00,$137.80,$0.00,$140.18,$0.00
99415530,SUP,HCPCS C1713,,99415530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$966.00,$0.00,$966.00,$434.70,$689.43,$0.00,$166.44,$0.00,$0.00,$169.14,$966.00,$0.00,$483.00,$765.07,$772.80,$0.00,$151.18,$0.00,$153.79,$0.00
99415535,SUP,HCPCS C1713,,99415535  -  PLATE 18MM TI BONE SPNL,$966.00,$0.00,$966.00,$434.70,$689.43,$0.00,$166.44,$0.00,$0.00,$169.14,$966.00,$0.00,$483.00,$765.07,$772.80,$0.00,$151.18,$0.00,$153.79,$0.00
99415540,SUP,HCPCS C1713,,99415540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$966.00,$0.00,$966.00,$434.70,$689.43,$0.00,$166.44,$0.00,$0.00,$169.14,$966.00,$0.00,$483.00,$765.07,$772.80,$0.00,$151.18,$0.00,$153.79,$0.00
99415545,SUP,HCPCS C1713,,99415545  -  PLATE 18MM TI BONE SPNL,$966.00,$0.00,$966.00,$434.70,$689.43,$0.00,$166.44,$0.00,$0.00,$169.14,$966.00,$0.00,$483.00,$765.07,$772.80,$0.00,$151.18,$0.00,$153.79,$0.00
99415550,SUP,HCPCS C1713,,99415550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$966.00,$0.00,$966.00,$434.70,$689.43,$0.00,$166.44,$0.00,$0.00,$169.14,$966.00,$0.00,$483.00,$765.07,$772.80,$0.00,$151.18,$0.00,$153.79,$0.00
99415555,SUP,HCPCS C1713,,99415555  -  PLATE 18MM TI BONE SPNL,$966.00,$0.00,$966.00,$434.70,$689.43,$0.00,$166.44,$0.00,$0.00,$169.14,$966.00,$0.00,$483.00,$765.07,$772.80,$0.00,$151.18,$0.00,$153.79,$0.00
99416530,SUP,HCPCS C1713,,99416530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$966.00,$0.00,$966.00,$434.70,$689.43,$0.00,$166.44,$0.00,$0.00,$169.14,$966.00,$0.00,$483.00,$765.07,$772.80,$0.00,$151.18,$0.00,$153.79,$0.00
99416535,SUP,HCPCS C1713,,99416535  -  PLATE 18MM TI BONE SPNL,$966.00,$0.00,$966.00,$434.70,$689.43,$0.00,$166.44,$0.00,$0.00,$169.14,$966.00,$0.00,$483.00,$765.07,$772.80,$0.00,$151.18,$0.00,$153.79,$0.00
99416540,SUP,HCPCS C1713,,99416540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$966.00,$0.00,$966.00,$434.70,$689.43,$0.00,$166.44,$0.00,$0.00,$169.14,$966.00,$0.00,$483.00,$765.07,$772.80,$0.00,$151.18,$0.00,$153.79,$0.00
99416545,SUP,HCPCS C1713,,99416545  -  PLATE 18MM TI BONE SPNL,$966.00,$0.00,$966.00,$434.70,$689.43,$0.00,$166.44,$0.00,$0.00,$169.14,$966.00,$0.00,$483.00,$765.07,$772.80,$0.00,$151.18,$0.00,$153.79,$0.00
99416550,SUP,HCPCS C1713,,99416550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$966.00,$0.00,$966.00,$434.70,$689.43,$0.00,$166.44,$0.00,$0.00,$169.14,$966.00,$0.00,$483.00,$765.07,$772.80,$0.00,$151.18,$0.00,$153.79,$0.00
99417535,SUP,HCPCS C1713,,99417535  -  PLATE 18MM TI BONE SPNL,$966.00,$0.00,$966.00,$434.70,$689.43,$0.00,$166.44,$0.00,$0.00,$169.14,$966.00,$0.00,$483.00,$765.07,$772.80,$0.00,$151.18,$0.00,$153.79,$0.00
99417540,SUP,HCPCS C1713,,99417540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$966.00,$0.00,$966.00,$434.70,$689.43,$0.00,$166.44,$0.00,$0.00,$169.14,$966.00,$0.00,$483.00,$765.07,$772.80,$0.00,$151.18,$0.00,$153.79,$0.00
99417545,SUP,HCPCS C1713,,99417545  -  PLATE 18MM TI BONE SPNL,$966.00,$0.00,$966.00,$434.70,$689.43,$0.00,$166.44,$0.00,$0.00,$169.14,$966.00,$0.00,$483.00,$765.07,$772.80,$0.00,$151.18,$0.00,$153.79,$0.00
99417550,SUP,HCPCS C1713,,99417550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$966.00,$0.00,$966.00,$434.70,$689.43,$0.00,$166.44,$0.00,$0.00,$169.14,$966.00,$0.00,$483.00,$765.07,$772.80,$0.00,$151.18,$0.00,$153.79,$0.00
99435530,SUP,Custom 27803010,,99435530  -  PLATE 18MM TI BONE SPNL,"$1,647.00",$0.00,"$1,647.00",$0.00,"$1,175.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,647.00",$0.00,$823.50,"$1,304.42","$1,317.60",$0.00,$0.00,$0.00,$0.00,$0.00
99435535,SUP,Custom 27803010,,99435535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,647.00",$0.00,"$1,647.00",$0.00,"$1,175.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,647.00",$0.00,$823.50,"$1,304.42","$1,317.60",$0.00,$0.00,$0.00,$0.00,$0.00
99435540,SUP,Custom 27803010,,99435540  -  PLATE 18MM TI BONE SPNL,"$1,647.00",$0.00,"$1,647.00",$0.00,"$1,175.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,647.00",$0.00,$823.50,"$1,304.42","$1,317.60",$0.00,$0.00,$0.00,$0.00,$0.00
99435545,SUP,Custom 27803010,,99435545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,647.00",$0.00,"$1,647.00",$0.00,"$1,175.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,647.00",$0.00,$823.50,"$1,304.42","$1,317.60",$0.00,$0.00,$0.00,$0.00,$0.00
99435550,SUP,Custom 27803010,,99435550  -  PLATE 18MM TI BONE SPNL,"$1,647.00",$0.00,"$1,647.00",$0.00,"$1,175.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,647.00",$0.00,$823.50,"$1,304.42","$1,317.60",$0.00,$0.00,$0.00,$0.00,$0.00
99435555,SUP,Custom 27803010,,99435555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,647.00",$0.00,"$1,647.00",$0.00,"$1,175.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,647.00",$0.00,$823.50,"$1,304.42","$1,317.60",$0.00,$0.00,$0.00,$0.00,$0.00
99436530,SUP,Custom 27803010,,99436530  -  PLATE 18MM TI BONE SPNL,"$1,647.00",$0.00,"$1,647.00",$0.00,"$1,175.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,647.00",$0.00,$823.50,"$1,304.42","$1,317.60",$0.00,$0.00,$0.00,$0.00,$0.00
99436535,SUP,Custom 27803010,,99436535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,647.00",$0.00,"$1,647.00",$0.00,"$1,175.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,647.00",$0.00,$823.50,"$1,304.42","$1,317.60",$0.00,$0.00,$0.00,$0.00,$0.00
99436540,SUP,Custom 27803010,,99436540  -  PLATE 18MM TI BONE SPNL,"$1,647.00",$0.00,"$1,647.00",$0.00,"$1,175.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,647.00",$0.00,$823.50,"$1,304.42","$1,317.60",$0.00,$0.00,$0.00,$0.00,$0.00
99436545,SUP,Custom 27803010,,99436545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,647.00",$0.00,"$1,647.00",$0.00,"$1,175.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,647.00",$0.00,$823.50,"$1,304.42","$1,317.60",$0.00,$0.00,$0.00,$0.00,$0.00
99436550,SUP,Custom 27803010,,99436550  -  PLATE 18MM TI BONE SPNL,"$1,647.00",$0.00,"$1,647.00",$0.00,"$1,175.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,647.00",$0.00,$823.50,"$1,304.42","$1,317.60",$0.00,$0.00,$0.00,$0.00,$0.00
99436555,SUP,Custom 27803010,,99436555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,647.00",$0.00,"$1,647.00",$0.00,"$1,175.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,647.00",$0.00,$823.50,"$1,304.42","$1,317.60",$0.00,$0.00,$0.00,$0.00,$0.00
99436560,SUP,Custom 27803010,,99436560  -  PLATE 18MM TI BONE SPNL,"$1,647.00",$0.00,"$1,647.00",$0.00,"$1,175.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,647.00",$0.00,$823.50,"$1,304.42","$1,317.60",$0.00,$0.00,$0.00,$0.00,$0.00
99437535,SUP,Custom 27803010,,99437535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,647.00",$0.00,"$1,647.00",$0.00,"$1,175.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,647.00",$0.00,$823.50,"$1,304.42","$1,317.60",$0.00,$0.00,$0.00,$0.00,$0.00
99437540,SUP,HCPCS C1713,,99437540  -  PLATE 18MM TI BONE SPNL,"$1,647.00",$0.00,"$1,647.00",$741.15,"$1,175.46",$0.00,$283.77,$0.00,$0.00,$288.38,"$1,647.00",$0.00,$823.50,"$1,304.42","$1,317.60",$0.00,$257.76,$0.00,$262.20,$0.00
99437545,SUP,HCPCS C1713,,99437545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,647.00",$0.00,"$1,647.00",$741.15,"$1,175.46",$0.00,$283.77,$0.00,$0.00,$288.38,"$1,647.00",$0.00,$823.50,"$1,304.42","$1,317.60",$0.00,$257.76,$0.00,$262.20,$0.00
99437550,SUP,Custom 27803010,,99437550  -  PLATE 18MM TI BONE SPNL,"$1,647.00",$0.00,"$1,647.00",$0.00,"$1,175.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,647.00",$0.00,$823.50,"$1,304.42","$1,317.60",$0.00,$0.00,$0.00,$0.00,$0.00
99437555,SUP,Custom 27803010,,99437555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,647.00",$0.00,"$1,647.00",$0.00,"$1,175.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,647.00",$0.00,$823.50,"$1,304.42","$1,317.60",$0.00,$0.00,$0.00,$0.00,$0.00
99437560,SUP,Custom 27803010,,99437560  -  PLATE 18MM TI BONE SPNL,"$1,647.00",$0.00,"$1,647.00",$0.00,"$1,175.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,647.00",$0.00,$823.50,"$1,304.42","$1,317.60",$0.00,$0.00,$0.00,$0.00,$0.00
99453105,SUP,HCPCS C1713,,99453105  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
99453110,SUP,HCPCS C1713,,99453110  -  PLATE 18MM TI BONE SPNL,$201.00,$0.00,$201.00,$90.45,$143.45,$0.00,$34.63,$0.00,$0.00,$35.19,$201.00,$0.00,$100.50,$159.19,$160.80,$0.00,$31.46,$0.00,$32.00,$0.00
99453115,SUP,HCPCS C1713,,99453115  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
99453200,SUP,Custom 27803010,,99453200  -  PLATE 18MM TI BONE SPNL,"$1,596.43",$0.00,"$1,596.43",$0.00,"$1,139.37",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,596.43",$0.00,$798.21,"$1,264.37","$1,277.14",$0.00,$0.00,$0.00,$0.00,$0.00
99453201,SUP,Custom 27803010,,99453201  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,596.43",$0.00,"$1,596.43",$0.00,"$1,139.37",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,596.43",$0.00,$798.21,"$1,264.37","$1,277.14",$0.00,$0.00,$0.00,$0.00,$0.00
99453202,SUP,Custom 27803010,,99453202  -  PLATE 18MM TI BONE SPNL,"$1,596.43",$0.00,"$1,596.43",$0.00,"$1,139.37",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,596.43",$0.00,$798.21,"$1,264.37","$1,277.14",$0.00,$0.00,$0.00,$0.00,$0.00
99453301,SUP,HCPCS C1713,,99453301  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,596.43",$0.00,"$1,596.43",$718.39,"$1,139.37",$0.00,$275.06,$0.00,$0.00,$279.52,"$1,596.43",$0.00,$798.21,"$1,264.37","$1,277.14",$0.00,$249.84,$0.00,$254.15,$0.00
99453302,SUP,Custom 27803010,,99453302  -  PLATE 18MM TI BONE SPNL,"$1,596.43",$0.00,"$1,596.43",$0.00,"$1,139.37",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,596.43",$0.00,$798.21,"$1,264.37","$1,277.14",$0.00,$0.00,$0.00,$0.00,$0.00
99453305,SUP,Custom 27803010,,99453305  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,596.43",$0.00,"$1,596.43",$0.00,"$1,139.37",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,596.43",$0.00,$798.21,"$1,264.37","$1,277.14",$0.00,$0.00,$0.00,$0.00,$0.00
99453306,SUP,Custom 27803010,,99453306  -  PLATE 18MM TI BONE SPNL,"$1,596.43",$0.00,"$1,596.43",$0.00,"$1,139.37",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,596.43",$0.00,$798.21,"$1,264.37","$1,277.14",$0.00,$0.00,$0.00,$0.00,$0.00
99453501,SUP,Custom 27803010,,99453501  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,183.50",$0.00,"$1,183.50",$0.00,$844.66,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,183.50",$0.00,$591.75,$937.33,$946.80,$0.00,$0.00,$0.00,$0.00,$0.00
99453502,SUP,Custom 27803010,,99453502  -  PLATE 18MM TI BONE SPNL,"$1,183.50",$0.00,"$1,183.50",$0.00,$844.66,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,183.50",$0.00,$591.75,$937.33,$946.80,$0.00,$0.00,$0.00,$0.00,$0.00
99460035,SUP,HCPCS C1713,,99460035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,253.00",$0.00,"$2,253.00","$1,013.85","$1,607.97",$0.00,$388.18,$0.00,$0.00,$394.48,"$2,253.00",$0.00,"$1,126.50","$1,784.38","$1,802.40",$0.00,$352.59,$0.00,$358.68,$0.00
99460040,SUP,HCPCS C1713,,99460040  -  PLATE 18MM TI BONE SPNL,"$2,253.00",$0.00,"$2,253.00","$1,013.85","$1,607.97",$0.00,$388.18,$0.00,$0.00,$394.48,"$2,253.00",$0.00,"$1,126.50","$1,784.38","$1,802.40",$0.00,$352.59,$0.00,$358.68,$0.00
99460045,SUP,HCPCS C1713,,99460045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,253.00",$0.00,"$2,253.00","$1,013.85","$1,607.97",$0.00,$388.18,$0.00,$0.00,$394.48,"$2,253.00",$0.00,"$1,126.50","$1,784.38","$1,802.40",$0.00,$352.59,$0.00,$358.68,$0.00
99460050,SUP,HCPCS C1713,,99460050  -  PLATE 18MM TI BONE SPNL,"$2,253.00",$0.00,"$2,253.00","$1,013.85","$1,607.97",$0.00,$388.18,$0.00,$0.00,$394.48,"$2,253.00",$0.00,"$1,126.50","$1,784.38","$1,802.40",$0.00,$352.59,$0.00,$358.68,$0.00
99460055,SUP,HCPCS C1713,,99460055  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,253.00",$0.00,"$2,253.00","$1,013.85","$1,607.97",$0.00,$388.18,$0.00,$0.00,$394.48,"$2,253.00",$0.00,"$1,126.50","$1,784.38","$1,802.40",$0.00,$352.59,$0.00,$358.68,$0.00
99460060,SUP,HCPCS C1713,,99460060  -  PLATE 18MM TI BONE SPNL,"$2,253.00",$0.00,"$2,253.00","$1,013.85","$1,607.97",$0.00,$388.18,$0.00,$0.00,$394.48,"$2,253.00",$0.00,"$1,126.50","$1,784.38","$1,802.40",$0.00,$352.59,$0.00,$358.68,$0.00
99460065,SUP,HCPCS C1713,,99460065  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,253.00",$0.00,"$2,253.00","$1,013.85","$1,607.97",$0.00,$388.18,$0.00,$0.00,$394.48,"$2,253.00",$0.00,"$1,126.50","$1,784.38","$1,802.40",$0.00,$352.59,$0.00,$358.68,$0.00
99460070,SUP,HCPCS C1713,,99460070  -  PLATE 18MM TI BONE SPNL,"$2,253.00",$0.00,"$2,253.00","$1,013.85","$1,607.97",$0.00,$388.18,$0.00,$0.00,$394.48,"$2,253.00",$0.00,"$1,126.50","$1,784.38","$1,802.40",$0.00,$352.59,$0.00,$358.68,$0.00
99460075,SUP,HCPCS C1713,,99460075  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,253.00",$0.00,"$2,253.00","$1,013.85","$1,607.97",$0.00,$388.18,$0.00,$0.00,$394.48,"$2,253.00",$0.00,"$1,126.50","$1,784.38","$1,802.40",$0.00,$352.59,$0.00,$358.68,$0.00
99460080,SUP,HCPCS C1713,,99460080  -  PLATE 18MM TI BONE SPNL,"$2,253.00",$0.00,"$2,253.00","$1,013.85","$1,607.97",$0.00,$388.18,$0.00,$0.00,$394.48,"$2,253.00",$0.00,"$1,126.50","$1,784.38","$1,802.40",$0.00,$352.59,$0.00,$358.68,$0.00
99461035,SUP,HCPCS C1713,,99461035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,253.00",$0.00,"$2,253.00","$1,013.85","$1,607.97",$0.00,$388.18,$0.00,$0.00,$394.48,"$2,253.00",$0.00,"$1,126.50","$1,784.38","$1,802.40",$0.00,$352.59,$0.00,$358.68,$0.00
99461040,SUP,HCPCS C1713,,99461040  -  PLATE 18MM TI BONE SPNL,"$2,253.00",$0.00,"$2,253.00","$1,013.85","$1,607.97",$0.00,$388.18,$0.00,$0.00,$394.48,"$2,253.00",$0.00,"$1,126.50","$1,784.38","$1,802.40",$0.00,$352.59,$0.00,$358.68,$0.00
99461045,SUP,HCPCS C1713,,99461045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,253.00",$0.00,"$2,253.00","$1,013.85","$1,607.97",$0.00,$388.18,$0.00,$0.00,$394.48,"$2,253.00",$0.00,"$1,126.50","$1,784.38","$1,802.40",$0.00,$352.59,$0.00,$358.68,$0.00
99461050,SUP,HCPCS C1713,,99461050  -  PLATE 18MM TI BONE SPNL,"$2,253.00",$0.00,"$2,253.00","$1,013.85","$1,607.97",$0.00,$388.18,$0.00,$0.00,$394.48,"$2,253.00",$0.00,"$1,126.50","$1,784.38","$1,802.40",$0.00,$352.59,$0.00,$358.68,$0.00
99461055,SUP,HCPCS C1713,,99461055  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,253.00",$0.00,"$2,253.00","$1,013.85","$1,607.97",$0.00,$388.18,$0.00,$0.00,$394.48,"$2,253.00",$0.00,"$1,126.50","$1,784.38","$1,802.40",$0.00,$352.59,$0.00,$358.68,$0.00
99461060,SUP,HCPCS C1713,,99461060  -  PLATE 18MM TI BONE SPNL,"$2,253.00",$0.00,"$2,253.00","$1,013.85","$1,607.97",$0.00,$388.18,$0.00,$0.00,$394.48,"$2,253.00",$0.00,"$1,126.50","$1,784.38","$1,802.40",$0.00,$352.59,$0.00,$358.68,$0.00
99461065,SUP,HCPCS C1713,,99461065  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,253.00",$0.00,"$2,253.00","$1,013.85","$1,607.97",$0.00,$388.18,$0.00,$0.00,$394.48,"$2,253.00",$0.00,"$1,126.50","$1,784.38","$1,802.40",$0.00,$352.59,$0.00,$358.68,$0.00
99461070,SUP,HCPCS C1713,,99461070  -  PLATE 18MM TI BONE SPNL,"$2,253.00",$0.00,"$2,253.00","$1,013.85","$1,607.97",$0.00,$388.18,$0.00,$0.00,$394.48,"$2,253.00",$0.00,"$1,126.50","$1,784.38","$1,802.40",$0.00,$352.59,$0.00,$358.68,$0.00
99461075,SUP,HCPCS C1713,,99461075  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,253.00",$0.00,"$2,253.00","$1,013.85","$1,607.97",$0.00,$388.18,$0.00,$0.00,$394.48,"$2,253.00",$0.00,"$1,126.50","$1,784.38","$1,802.40",$0.00,$352.59,$0.00,$358.68,$0.00
99461080,SUP,HCPCS C1713,,99461080  -  PLATE 18MM TI BONE SPNL,"$2,253.00",$0.00,"$2,253.00","$1,013.85","$1,607.97",$0.00,$388.18,$0.00,$0.00,$394.48,"$2,253.00",$0.00,"$1,126.50","$1,784.38","$1,802.40",$0.00,$352.59,$0.00,$358.68,$0.00
99462040,SUP,HCPCS C1713,,99462040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,253.00",$0.00,"$2,253.00","$1,013.85","$1,607.97",$0.00,$388.18,$0.00,$0.00,$394.48,"$2,253.00",$0.00,"$1,126.50","$1,784.38","$1,802.40",$0.00,$352.59,$0.00,$358.68,$0.00
99462060,SUP,HCPCS C1713,,99462060  -  PLATE 18MM TI BONE SPNL,"$2,253.00",$0.00,"$2,253.00","$1,013.85","$1,607.97",$0.00,$388.18,$0.00,$0.00,$394.48,"$2,253.00",$0.00,"$1,126.50","$1,784.38","$1,802.40",$0.00,$352.59,$0.00,$358.68,$0.00
99462080,SUP,HCPCS C1713,,99462080  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,253.00",$0.00,"$2,253.00","$1,013.85","$1,607.97",$0.00,$388.18,$0.00,$0.00,$394.48,"$2,253.00",$0.00,"$1,126.50","$1,784.38","$1,802.40",$0.00,$352.59,$0.00,$358.68,$0.00
99464035,SUP,HCPCS C1713,,99464035  -  PLATE 18MM TI BONE SPNL,"$2,512.50",$0.00,"$2,512.50","$1,130.63","$1,793.17",$0.00,$432.89,$0.00,$0.00,$439.92,"$2,512.50",$0.00,"$1,256.25","$1,989.90","$2,010.00",$0.00,$393.21,$0.00,$399.99,$0.00
99464040,SUP,HCPCS C1713,,99464040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,512.50",$0.00,"$2,512.50","$1,130.63","$1,793.17",$0.00,$432.89,$0.00,$0.00,$439.92,"$2,512.50",$0.00,"$1,256.25","$1,989.90","$2,010.00",$0.00,$393.21,$0.00,$399.99,$0.00
99464050,SUP,HCPCS C1713,,99464050  -  PLATE 18MM TI BONE SPNL,"$2,512.50",$0.00,"$2,512.50","$1,130.63","$1,793.17",$0.00,$432.89,$0.00,$0.00,$439.92,"$2,512.50",$0.00,"$1,256.25","$1,989.90","$2,010.00",$0.00,$393.21,$0.00,$399.99,$0.00
99464060,SUP,HCPCS C1713,,99464060  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,512.50",$0.00,"$2,512.50","$1,130.63","$1,793.17",$0.00,$432.89,$0.00,$0.00,$439.92,"$2,512.50",$0.00,"$1,256.25","$1,989.90","$2,010.00",$0.00,$393.21,$0.00,$399.99,$0.00
99464070,SUP,HCPCS C1713,,99464070  -  PLATE 18MM TI BONE SPNL,"$2,512.50",$0.00,"$2,512.50","$1,130.63","$1,793.17",$0.00,$432.89,$0.00,$0.00,$439.92,"$2,512.50",$0.00,"$1,256.25","$1,989.90","$2,010.00",$0.00,$393.21,$0.00,$399.99,$0.00
99465106,SUP,HCPCS C1713,,99465106  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
99465115,SUP,Custom 27803010,,99465115  -  PLATE 18MM TI BONE SPNL,$192.00,$0.00,$192.00,$0.00,$137.03,$0.00,$0.00,$0.00,$0.00,$0.00,$192.00,$0.00,$96.00,$152.06,$153.60,$0.00,$0.00,$0.00,$0.00,$0.00
99465126,SUP,HCPCS C1713,,99465126  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
99465135,SUP,HCPCS C1713,,99465135  -  PLATE 18MM TI BONE SPNL,$109.50,$0.00,$109.50,$49.28,$78.15,$0.00,$18.87,$0.00,$0.00,$19.17,$109.50,$0.00,$54.75,$86.72,$87.60,$0.00,$17.14,$0.00,$17.43,$0.00
99465140,SUP,HCPCS C1713,,99465140  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$192.00,$0.00,$192.00,$86.40,$137.03,$0.00,$33.08,$0.00,$0.00,$33.62,$192.00,$0.00,$96.00,$152.06,$153.60,$0.00,$30.05,$0.00,$30.57,$0.00
99466035,SUP,HCPCS C1713,,99466035  -  PLATE 18MM TI BONE SPNL,"$2,512.50",$0.00,"$2,512.50","$1,130.63","$1,793.17",$0.00,$432.89,$0.00,$0.00,$439.92,"$2,512.50",$0.00,"$1,256.25","$1,989.90","$2,010.00",$0.00,$393.21,$0.00,$399.99,$0.00
99466040,SUP,HCPCS C1713,,99466040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,512.50",$0.00,"$2,512.50","$1,130.63","$1,793.17",$0.00,$432.89,$0.00,$0.00,$439.92,"$2,512.50",$0.00,"$1,256.25","$1,989.90","$2,010.00",$0.00,$393.21,$0.00,$399.99,$0.00
99466050,SUP,HCPCS C1713,,99466050  -  PLATE 18MM TI BONE SPNL,"$2,512.50",$0.00,"$2,512.50","$1,130.63","$1,793.17",$0.00,$432.89,$0.00,$0.00,$439.92,"$2,512.50",$0.00,"$1,256.25","$1,989.90","$2,010.00",$0.00,$393.21,$0.00,$399.99,$0.00
99466060,SUP,HCPCS C1713,,99466060  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,512.50",$0.00,"$2,512.50","$1,130.63","$1,793.17",$0.00,$432.89,$0.00,$0.00,$439.92,"$2,512.50",$0.00,"$1,256.25","$1,989.90","$2,010.00",$0.00,$393.21,$0.00,$399.99,$0.00
99466070,SUP,HCPCS C1713,,99466070  -  PLATE 18MM TI BONE SPNL,"$2,512.50",$0.00,"$2,512.50","$1,130.63","$1,793.17",$0.00,$432.89,$0.00,$0.00,$439.92,"$2,512.50",$0.00,"$1,256.25","$1,989.90","$2,010.00",$0.00,$393.21,$0.00,$399.99,$0.00
99467085,SUP,HCPCS C1713,,99467085  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,253.00",$0.00,"$2,253.00","$1,013.85","$1,607.97",$0.00,$388.18,$0.00,$0.00,$394.48,"$2,253.00",$0.00,"$1,126.50","$1,784.38","$1,802.40",$0.00,$352.59,$0.00,$358.68,$0.00
99467090,SUP,HCPCS C1713,,99467090  -  PLATE 18MM TI BONE SPNL,"$2,253.00",$0.00,"$2,253.00","$1,013.85","$1,607.97",$0.00,$388.18,$0.00,$0.00,$394.48,"$2,253.00",$0.00,"$1,126.50","$1,784.38","$1,802.40",$0.00,$352.59,$0.00,$358.68,$0.00
99467095,SUP,HCPCS C1713,,99467095  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,253.00",$0.00,"$2,253.00","$1,013.85","$1,607.97",$0.00,$388.18,$0.00,$0.00,$394.48,"$2,253.00",$0.00,"$1,126.50","$1,784.38","$1,802.40",$0.00,$352.59,$0.00,$358.68,$0.00
99467100,SUP,HCPCS C1713,,99467100  -  PLATE 18MM TI BONE SPNL,"$2,425.50",$0.00,"$2,425.50","$1,091.48","$1,731.08",$0.00,$417.90,$0.00,$0.00,$424.69,"$2,425.50",$0.00,"$1,212.75","$1,921.00","$1,940.40",$0.00,$379.59,$0.00,$386.14,$0.00
99467105,SUP,HCPCS C1713,,99467105  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,425.50",$0.00,"$2,425.50","$1,091.48","$1,731.08",$0.00,$417.90,$0.00,$0.00,$424.69,"$2,425.50",$0.00,"$1,212.75","$1,921.00","$1,940.40",$0.00,$379.59,$0.00,$386.14,$0.00
99467110,SUP,HCPCS C1713,,99467110  -  PLATE 18MM TI BONE SPNL,"$2,425.50",$0.00,"$2,425.50","$1,091.48","$1,731.08",$0.00,$417.90,$0.00,$0.00,$424.69,"$2,425.50",$0.00,"$1,212.75","$1,921.00","$1,940.40",$0.00,$379.59,$0.00,$386.14,$0.00
99467115,SUP,HCPCS C1713,,99467115  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,425.50",$0.00,"$2,425.50","$1,091.48","$1,731.08",$0.00,$417.90,$0.00,$0.00,$424.69,"$2,425.50",$0.00,"$1,212.75","$1,921.00","$1,940.40",$0.00,$379.59,$0.00,$386.14,$0.00
99467120,SUP,HCPCS C1713,,99467120  -  PLATE BN STRG 120MM TI SPNE,"$2,425.50",$0.00,"$2,425.50","$1,091.48","$1,731.08",$0.00,$417.90,$0.00,$0.00,$424.69,"$2,425.50",$0.00,"$1,212.75","$1,921.00","$1,940.40",$0.00,$379.59,$0.00,$386.14,$0.00
99467125,SUP,HCPCS C1713,,99467125  -  PLATE BN STRG 125MM TI SPNE,"$2,425.50",$0.00,"$2,425.50","$1,091.48","$1,731.08",$0.00,$417.90,$0.00,$0.00,$424.69,"$2,425.50",$0.00,"$1,212.75","$1,921.00","$1,940.40",$0.00,$379.59,$0.00,$386.14,$0.00
99467130,SUP,HCPCS C1713,,99467130  -  PLATE 18MM TI BONE SPNL,"$2,425.50",$0.00,"$2,425.50","$1,091.48","$1,731.08",$0.00,$417.90,$0.00,$0.00,$424.69,"$2,425.50",$0.00,"$1,212.75","$1,921.00","$1,940.40",$0.00,$379.59,$0.00,$386.14,$0.00
99467135,SUP,HCPCS C1713,,99467135  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,425.50",$0.00,"$2,425.50","$1,091.48","$1,731.08",$0.00,$417.90,$0.00,$0.00,$424.69,"$2,425.50",$0.00,"$1,212.75","$1,921.00","$1,940.40",$0.00,$379.59,$0.00,$386.14,$0.00
99467140,SUP,HCPCS C1713,,99467140  -  PLATE 18MM TI BONE SPNL,"$2,425.50",$0.00,"$2,425.50","$1,091.48","$1,731.08",$0.00,$417.90,$0.00,$0.00,$424.69,"$2,425.50",$0.00,"$1,212.75","$1,921.00","$1,940.40",$0.00,$379.59,$0.00,$386.14,$0.00
99467145,SUP,HCPCS C1713,,99467145  -  PLATE BN STRG 145MM TI SPNE,"$2,425.50",$0.00,"$2,425.50","$1,091.48","$1,731.08",$0.00,$417.90,$0.00,$0.00,$424.69,"$2,425.50",$0.00,"$1,212.75","$1,921.00","$1,940.40",$0.00,$379.59,$0.00,$386.14,$0.00
99467150,SUP,HCPCS C1713,,99467150  -  PLATE BN STRG 150MM TI SPNE,"$2,425.50",$0.00,"$2,425.50","$1,091.48","$1,731.08",$0.00,$417.90,$0.00,$0.00,$424.69,"$2,425.50",$0.00,"$1,212.75","$1,921.00","$1,940.40",$0.00,$379.59,$0.00,$386.14,$0.00
99467170,SUP,HCPCS C1713,,99467170  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,887.50",$0.00,"$2,887.50","$1,299.38","$2,060.81",$0.00,$497.50,$0.00,$0.00,$505.58,"$2,887.50",$0.00,"$1,443.75","$2,286.90","$2,310.00",$0.00,$451.89,$0.00,$459.69,$0.00
99467180,SUP,HCPCS C1713,,99467180  -  PLATE 18MM TI BONE SPNL,"$2,887.50",$0.00,"$2,887.50","$1,299.38","$2,060.81",$0.00,$497.50,$0.00,$0.00,$505.58,"$2,887.50",$0.00,"$1,443.75","$2,286.90","$2,310.00",$0.00,$451.89,$0.00,$459.69,$0.00
99467190,SUP,HCPCS C1713,,99467190  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,887.50",$0.00,"$2,887.50","$1,299.38","$2,060.81",$0.00,$497.50,$0.00,$0.00,$505.58,"$2,887.50",$0.00,"$1,443.75","$2,286.90","$2,310.00",$0.00,$451.89,$0.00,$459.69,$0.00
99467200,SUP,HCPCS C1713,,99467200  -  PLATE 18MM TI BONE SPNL,"$2,887.50",$0.00,"$2,887.50","$1,299.38","$2,060.81",$0.00,$497.50,$0.00,$0.00,$505.58,"$2,887.50",$0.00,"$1,443.75","$2,286.90","$2,310.00",$0.00,$451.89,$0.00,$459.69,$0.00
99468085,SUP,HCPCS C1713,,99468085  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,253.00",$0.00,"$2,253.00","$1,013.85","$1,607.97",$0.00,$388.18,$0.00,$0.00,$394.48,"$2,253.00",$0.00,"$1,126.50","$1,784.38","$1,802.40",$0.00,$352.59,$0.00,$358.68,$0.00
99468090,SUP,HCPCS C1713,,99468090  -  PLATE 18MM TI BONE SPNL,"$2,253.00",$0.00,"$2,253.00","$1,013.85","$1,607.97",$0.00,$388.18,$0.00,$0.00,$394.48,"$2,253.00",$0.00,"$1,126.50","$1,784.38","$1,802.40",$0.00,$352.59,$0.00,$358.68,$0.00
99468095,SUP,HCPCS C1713,,99468095  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,253.00",$0.00,"$2,253.00","$1,013.85","$1,607.97",$0.00,$388.18,$0.00,$0.00,$394.48,"$2,253.00",$0.00,"$1,126.50","$1,784.38","$1,802.40",$0.00,$352.59,$0.00,$358.68,$0.00
99468100,SUP,HCPCS C1713,,99468100  -  PLATE 18MM TI BONE SPNL,"$2,253.00",$0.00,"$2,253.00","$1,013.85","$1,607.97",$0.00,$388.18,$0.00,$0.00,$394.48,"$2,253.00",$0.00,"$1,126.50","$1,784.38","$1,802.40",$0.00,$352.59,$0.00,$358.68,$0.00
100003331,SUP,Custom 27203010,,100003331  -  KIT ELTRD NS LF ENSITE NAVX SRFC DISP,$450.00,$0.00,$450.00,$0.00,$321.17,$0.00,$0.00,$0.00,$0.00,$0.00,$450.00,$0.00,$225.00,$356.40,$360.00,$0.00,$0.00,$0.00,$0.00,$0.00
136521000,SUP,HCPCS C1776,,136521000  -  HEAD FEM +1MM 12/14 STD TPR 32MM STRL LF ART/EZE MTL HIP,"$2,985.00",$0.00,"$2,985.00","$1,343.25","$2,130.39",$0.00,$514.30,$0.00,$0.00,$522.65,"$2,985.00",$0.00,"$1,492.50","$2,364.12","$2,388.00",$0.00,$467.15,$0.00,$475.21,$0.00
136522000,SUP,HCPCS C1776,,136522000  -  HEAD FEM +5MM 12/14 STD TPR 32MM STRL LF ART/EZE MTL HIP,"$2,985.00",$0.00,"$2,985.00","$1,343.25","$2,130.39",$0.00,$514.30,$0.00,$0.00,$522.65,"$2,985.00",$0.00,"$1,492.50","$2,364.12","$2,388.00",$0.00,$467.15,$0.00,$475.21,$0.00
136523000,SUP,HCPCS C1776,,136523000  -  HEAD FEM +9MM 12/14 STD TPR 32MM STRL LF ART/EZE MTL HIP,"$3,045.00",$0.00,"$3,045.00","$1,370.25","$2,173.22",$0.00,$524.64,$0.00,$0.00,$533.16,"$3,045.00",$0.00,"$1,522.50","$2,411.64","$2,436.00",$0.00,$476.54,$0.00,$484.76,$0.00
154106000,SUP,HCPCS C1776,,154106000  -  STEM FEMORAL 1 HIGH OFFST 105MM CEMENTED HIP,"$14,182.50",$0.00,"$14,182.50","$6,382.13","$5,158.80",$0.00,"$2,443.57",$0.00,$0.00,"$2,483.24","$14,182.50",$0.00,"$7,091.25","$11,232.54","$11,346.00",$0.00,"$2,219.56",$0.00,"$2,257.85",$0.00
154118000,SUP,HCPCS C1776,,154118000  -  STEM FEMORAL 3 150MM CEMENTED EXTN PROSTALAC HIP RIGHT,"$14,820.00",$0.00,"$14,820.00","$6,669.00","$5,158.80",$0.00,"$2,553.41",$0.00,$0.00,"$2,594.86","$14,820.00",$0.00,"$7,410.00","$11,737.44","$11,856.00",$0.00,"$2,319.33",$0.00,"$2,359.34",$0.00
177300130,SUP,Custom 27803010,,177300130  -  CAGE SPNL 12MM STD PRLL 14X30MM NS LF BENGAL STKBL RDLCNT,"$8,790.00",$0.00,"$8,790.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,790.00",$0.00,"$4,395.00","$6,961.68","$7,032.00",$0.00,$0.00,$0.00,$0.00,$0.00
177306122,SUP,Custom 27803010,,177306122  -  CAGE SPNL 12MM STD LRDTC 14X22MM NS LF BENGAL STKBL RDLCNT,"$8,790.00",$0.00,"$8,790.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,790.00",$0.00,"$4,395.00","$6,961.68","$7,032.00",$0.00,$0.00,$0.00,$0.00,$0.00
177306124,SUP,Custom 27803010,,177306124  -  CAGE SPNL STD LRDTC 24X14X12MM NS LF BENGAL STKBL RDLCNT,"$8,790.00",$0.00,"$8,790.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,790.00",$0.00,"$4,395.00","$6,961.68","$7,032.00",$0.00,$0.00,$0.00,$0.00,$0.00
177306126,SUP,Custom 27803010,,177306126  -  CAGE SPNL 12MM STD LRDTC 14X26MM NS LF BENGAL STKBL RDLCNT,"$8,790.00",$0.00,"$8,790.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,790.00",$0.00,"$4,395.00","$6,961.68","$7,032.00",$0.00,$0.00,$0.00,$0.00,$0.00
177306128,SUP,Custom 27803010,,177306128  -  CAGE SPNL 12MM STD LRDTC 14X28MM NS LF BENGAL STKBL RDLCNT,"$8,790.00",$0.00,"$8,790.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,790.00",$0.00,"$4,395.00","$6,961.68","$7,032.00",$0.00,$0.00,$0.00,$0.00,$0.00
177306130,SUP,Custom 27803010,,177306130  -  CAGE SPNL 12MM STD LRDTC 14X30MM NS LF BENGAL STKBL RDLCNT,"$8,790.00",$0.00,"$8,790.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,790.00",$0.00,"$4,395.00","$6,961.68","$7,032.00",$0.00,$0.00,$0.00,$0.00,$0.00
179702000,SUP,HCPCS C1713,,179702000  -  SCREW SET 1 INNER MNOAX EXPEDIUM TITANIUM SPN,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
179706070,SUP,HCPCS C1713,,179706070  -  SCREW BONE 10MM 70MM T27 VIPER TITANIUM ILIUM,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
179706870,SUP,HCPCS C1713,,179706870  -  SCREW BONE 8MM 70MM VIPER TITANIUM SPN ILIUM PEDICLE T27,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
179706880,SUP,HCPCS C1713,,179706880  -  SCREW BONE 8MM 80MM VIPER TITANIUM SPN ILIUM PEDICLE T27,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
179706970,SUP,HCPCS C1713,,179706970  -  SCREW BONE 9MM 70MM VIPER TITANIUM ILIUM T27,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
179712035,SUP,HCPCS C1713,,179712035  -  SCREW BN 7.5MM 35MM NS XPDM 1 INNIE PA TI SPNE 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
179712040,SUP,HCPCS C1713,,179712040  -  SCREW BN 7.5MM 40MM NS XPDM 1 INNIE PA TI SPNE 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
179712045,SUP,HCPCS C1713,,179712045  -  SCREW BN 7.5MM 45MM NS XPDM 1 INNIE PA TI SPNE 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
179712050,SUP,HCPCS C1713,,179712050  -  SCREW BN 7.5MM 50MM NS XPDM 1 INNIE PA TI SPNE 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
179712055,SUP,HCPCS C1713,,179712055  -  SCREW BN 7.5MM 55MM NS XPDM 1 INNIE PA TI SPNE 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
179712080,SUP,HCPCS C1713,,179712080  -  SCREW BONE 7.5MM 80MM XPDM TI SPNL POLYAX 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
179712420,SUP,HCPCS C1713,,179712420  -  SCREW BONE 4.35MM 20MM XPDM TI SPNL POLYAX 1 INNIE 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
179712425,SUP,HCPCS C1713,,179712425  -  SCREW BONE 4.35MM 25MM XPDM TI SPNL POLYAX 1 INNIE 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
179712430,SUP,HCPCS C1713,,179712430  -  SCREW BONE 4.35MM 30MM 1 INNIE POLYAX EXPEDIUM TITANIUM SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
179712435,SUP,HCPCS C1713,,179712435  -  SCREW BONE 4.35MM 35MM 1 INNIE POLYAX EXPEDIUM TITANIUM SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
179712440,SUP,HCPCS C1713,,179712440  -  SCREW BONE 4.35MM 40MM 1 INNIE POLYAX EXPEDIUM TITANIUM SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
179712445,SUP,HCPCS C1713,,179712445  -  SCREW BN 4.5MM 45MM NS XPDM 1 INNIE PA TI SPNE 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
179712530,SUP,HCPCS C1713,,179712530  -  SCREW BONE 5MM 30MM XPDM TI SPNL POLYAX 1 INNIE 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
179712535,SUP,HCPCS C1713,,179712535  -  SCREW BONE 5MM 35MM 1 INNIE POLYAX EXPEDIUM SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
179712540,SUP,HCPCS C1713,,179712540  -  SCREW BONE 5MM 40MM XPDM TI SPNL POLYAX 1 INNIE 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
179712545,SUP,HCPCS C1713,,179712545  -  SCREW BONE 5MM 45MM XPDM TI SPNL POLYAX 1 INNIE 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
179712550,SUP,HCPCS C1713,,179712550  -  SCREW BONE 5MM 50MM 1 INNIE POLYAX EXPEDIUM TITANIUM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
179712630,SUP,HCPCS C1713,,179712630  -  SCREW BONE 6MM 30MM POLYAX 1 INNIE EXPEDIUM TITANIUM SPN 5.5,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
179712635,SUP,HCPCS C1713,,179712635  -  SCREW BONE 6MM 35MM XPDM TI SPNL POLYAX 1 INNIE 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
179712640,SUP,HCPCS C1713,,179712640  -  SCREW BONE 6MM 40MM XPDM TI ANT CERV SPN POLYAX 1 INNIE 5.5,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
179712645,SUP,HCPCS C1713,,179712645  -  SCREW BONE 6MM 45MM XPDM TI SPNL POLYAX 1 INNIE 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
179712650,SUP,HCPCS C1713,,179712650  -  SCREW BONE 6MM 50MM 1 INNIE POLYAX EXPEDIUM TITANIUM SPN 5.5,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
179712735,SUP,HCPCS C1713,,179712735  -  SCREW BONE 7MM 35MM XPDM TI SPNL POLYAX 1 INNIE 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
179712740,SUP,HCPCS C1713,,179712740  -  SCREW BONE 7MM 40MM XPDM TI SPNL POLYAX 1 INNIE 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
179712745,SUP,HCPCS C1713,,179712745  -  SCREW BONE 7MM 45MM XPDM TI SPNL POLYAX 1 INNIE 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
179712750,SUP,HCPCS C1713,,179712750  -  SCREW BONE 7MM 50MM XPDM TI SPNL POLYAX 1 INNIE 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
179712755,SUP,HCPCS C1713,,179712755  -  SCREW BONE 7MM 55MM XPDM TI SPNL POLYAX 1 INNIE 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
179715540,SUP,HCPCS C1713,,179715540  -  SCREW BONE 5.5MM 40MM POLYAX EXPEDIUM TITANIUM SPN 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
179715545,SUP,HCPCS C1713,,179715545  -  SCREW BONE 5.5MM 45MM POLYAX EXPEDIUM TITANIUM SPN 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
179715635,SUP,HCPCS C1713,,179715635  -  SCREW BONE 6.5MM 35MM POLYAX EXPEDIUM TITANIUM SPN 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
179715645,SUP,HCPCS C1713,,179715645  -  SCREW BONE 6.5MM 45MM 1 INNIE POLYAX EXPEDIUM TITANIUM SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
179722050,SUP,HCPCS C1713,,179722050  -  SET SCR DISTAL TI UNT,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
179722890,SUP,HCPCS C1713,,179722890  -  SCREW DI POLYAXL 8 X 90MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
179762120,SUP,HCPCS C1713,,179762120  -  ROD SPINAL 5.5MM 120MM PRECUT HEXAGONAL END EXPEDIUM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
179762300,SUP,HCPCS C1713,,179762300  -  ROD SPINAL 300MM NONSTRL,"$1,395.00",$0.00,"$1,395.00",$627.75,$995.61,$0.00,$240.35,$0.00,$0.00,$244.25,"$1,395.00",$0.00,$697.50,"$1,104.84","$1,116.00",$0.00,$218.32,$0.00,$222.08,$0.00
179762480,SUP,HCPCS C1713,,179762480  -  ROD SPINAL 5.5MM 480MM PRECUT HEXAGONAL END EXPEDIUM,"$1,395.00",$0.00,"$1,395.00",$627.75,$995.61,$0.00,$240.35,$0.00,$0.00,$244.25,"$1,395.00",$0.00,$697.50,"$1,104.84","$1,116.00",$0.00,$218.32,$0.00,$222.08,$0.00
179771055,SUP,HCPCS C1713,,179771055  -  ROD SPNL 5.5MM 55MM NS XPDM PREBNT LN TI,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
179771065,SUP,HCPCS C1713,,179771065  -  ROD SPINAL 5.5MM 65MM PRELORDOSED LINE EXPEDIUM TITANIUM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
179771075,SUP,HCPCS C1713,,179771075  -  ROD SPINAL 5.5MM 75MM PRELORDOSED LINE EXPEDIUM TITANIUM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
179771085,SUP,HCPCS C1713,,179771085  -  ROD SPINAL 5.5MM 85MM PRELORDOSED LINE EXPEDIUM TITANIUM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
179771090,SUP,HCPCS C1713,,179771090  -  ROD SPINAL 5.5MM 90MM PRELORDOSED LINE EXPEDIUM TITANIUM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
179771095,SUP,HCPCS C1713,,179771095  -  ROD SPINAL 5.5MM 95MM PRELORDOSED LINE EXPEDIUM TITANIUM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
179772045,SUP,Custom 27803010,,179772045  -  ROD SPNL 45MM 5.5MM MS M SI TI PREBNT,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
179772055,SUP,Custom 27803010,,179772055  -  ROD SPNL 55MM 5.5MM MS M SI TI PREBNT,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
179793020,SUP,HCPCS C1713,,179793020  -  CONNECTOR ROD 5.5MM 20MM OPEN FIX TITANIUM LATERAL,"$2,152.50",$0.00,"$2,152.50",$968.63,"$1,536.24",$0.00,$370.86,$0.00,$0.00,$376.89,"$2,152.50",$0.00,"$1,076.25","$1,704.78","$1,722.00",$0.00,$336.87,$0.00,$342.68,$0.00
179797020,SUP,HCPCS C1713,,179797020  -  CONNECTOR ROD 5.5MM 20MM OPEN EXPEDIUM TITANIUM ILIAC SPN,"$2,550.00",$0.00,"$2,550.00","$1,147.50","$1,819.94",$0.00,$439.35,$0.00,$0.00,$446.48,"$2,550.00",$0.00,"$1,275.00","$2,019.60","$2,040.00",$0.00,$399.08,$0.00,$405.96,$0.00
179797025,SUP,HCPCS C1713,,179797025  -  CONNECTOR ROD 5.5MM 20MM OPEN EXTENDED TAB EXPEDIUM TITANIUM,"$2,550.00",$0.00,"$2,550.00","$1,147.50","$1,819.94",$0.00,$439.35,$0.00,$0.00,$446.48,"$2,550.00",$0.00,"$1,275.00","$2,019.60","$2,040.00",$0.00,$399.08,$0.00,$405.96,$0.00
179797040,SUP,HCPCS C1713,,179797040  -  CONNECTOR ROD 5.5MM 40MM OPEN EXPEDIUM TITANIUM ILIAC SPN,"$2,550.00",$0.00,"$2,550.00","$1,147.50","$1,819.94",$0.00,$439.35,$0.00,$0.00,$446.48,"$2,550.00",$0.00,"$1,275.00","$2,019.60","$2,040.00",$0.00,$399.08,$0.00,$405.96,$0.00
179798020,SUP,HCPCS C1713,,179798020  -  CONNECTOR ROD 5.5MM 20MM XPDM CLS TI SPNE ILC,"$2,550.00",$0.00,"$2,550.00","$1,147.50","$1,819.94",$0.00,$439.35,$0.00,$0.00,$446.48,"$2,550.00",$0.00,"$1,275.00","$2,019.60","$2,040.00",$0.00,$399.08,$0.00,$405.96,$0.00
183612032,SUP,HCPCS C1713,,183612032  -  PLATE 32MM LVL 2 EGL PLUS BONE ANT CERV SPN,"$2,328.75",$0.00,"$2,328.75","$1,047.94","$1,662.03",$0.00,$401.23,$0.00,$0.00,$407.75,"$2,328.75",$0.00,"$1,164.38","$1,844.37","$1,863.00",$0.00,$364.45,$0.00,$370.74,$0.00
183651016,SUP,HCPCS C1713,,183651016  -  SCREW BONE 4.4MM 16MM EGL PLUS SWIFT PLUS ANT CERV SPN OVSZ,$388.13,$0.00,$388.13,$174.66,$277.00,$0.00,$66.87,$0.00,$0.00,$67.96,$388.13,$0.00,$194.06,$307.40,$310.50,$0.00,$60.74,$0.00,$61.79,$0.00
183656016,SUP,HCPCS C1713,,183656016  -  SCREW BONE 4.25MM 16MM EGL PLUS SWIFT PLUS ANT CERV SPN PRIM,$388.13,$0.00,$388.13,$174.66,$277.00,$0.00,$66.87,$0.00,$0.00,$67.96,$388.13,$0.00,$194.06,$307.40,$310.50,$0.00,$60.74,$0.00,$61.79,$0.00
185200320,SUP,HCPCS C1757,,185200320  -  TUBE NASOPHARYNGEAL 32FR 170MM ADJUSTABLE FLANGE ROUND TIP,$11.68,$0.00,$11.68,$0.00,$8.33,$0.00,$0.00,$0.00,$0.00,$0.00,$11.68,$0.00,$5.84,$9.25,$9.34,$0.00,$0.00,$0.00,$0.00,$0.00
186715000,SUP,HCPCS C1713,,186715000  -  SCREW SET TI SPNL 1 INNIE INR XPDM,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
186715080,SUP,HCPCS C1713,,186715080  -  SCREW BONE 7.5MM 80MM POLYAX CANN VIPER 2 TITANIUM SPN,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
186715530,SUP,HCPCS C1713,,186715530  -  SCREW BONE 5MM 30MM VPR TI SPNL POLYAX CANN MN INV SRG,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
186715535,SUP,HCPCS C1713,,186715535  -  SCREW BONE 5MM 35MM VPR TI SPNL POLYAX CANN MN INV SRG,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
186715540,SUP,HCPCS C1713,,186715540  -  SCREW BONE 5MM 40MM VPR TI SPNL POLYAX CANN MN INV SRG,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
186715635,SUP,HCPCS C1713,,186715635  -  SCREW BONE 6MM 35MM VPR TI SPNL POLYAX CANN MN INV SRG,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
186715640,SUP,HCPCS C1713,,186715640  -  SCREW BONE 6MM 40MM POLYAX CANN VIPER TITANIUM SPN MIS,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
186715645,SUP,HCPCS C1713,,186715645  -  SCREW BONE 6MM 45MM VPR TI SPNL POLYAX CANN MN INV SRG,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
186715730,SUP,HCPCS C1713,,186715730  -  SCREW BONE 7MM 30MM POLYAX CANN VIPER 2 TITANIUM SPN,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
186715855,SUP,HCPCS C1713,,186715855  -  SCREW BONE 8MM 55MM POLYAX VIPER TITANIUM SPN,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
186731530,SUP,HCPCS C1713,,186731530  -  SCREW BONE 5MM 30MM POLYAX FIX TITANIUM SPN CORTICAL 5.5MM,"$4,215.00",$0.00,"$4,215.00","$1,896.75","$3,008.25",$0.00,$726.22,$0.00,$0.00,$738.01,"$4,215.00",$0.00,"$2,107.50","$3,338.28","$3,372.00",$0.00,$659.65,$0.00,$671.03,$0.00
186731535,SUP,HCPCS C1713,,186731535  -  SCREW BONE 5MM 35MM POLYAX FIX TITANIUM SPN CORTICAL 5.5MM,"$4,215.00",$0.00,"$4,215.00","$1,896.75","$3,008.25",$0.00,$726.22,$0.00,$0.00,$738.01,"$4,215.00",$0.00,"$2,107.50","$3,338.28","$3,372.00",$0.00,$659.65,$0.00,$671.03,$0.00
186731540,SUP,HCPCS C1713,,186731540  -  SCREW BONE 5MM 40MM FIX EXPEDIUM TITANIUM SPN CORTICAL 5.5MM,"$4,215.00",$0.00,"$4,215.00","$1,896.75","$3,008.25",$0.00,$726.22,$0.00,$0.00,$738.01,"$4,215.00",$0.00,"$2,107.50","$3,338.28","$3,372.00",$0.00,$659.65,$0.00,$671.03,$0.00
186731635,SUP,HCPCS C1713,,186731635  -  SCREW BONE 6MM 35MM XPDM VPR TI SPN CORT FIX 5.5MM,"$4,215.00",$0.00,"$4,215.00","$1,896.75","$3,008.25",$0.00,$726.22,$0.00,$0.00,$738.01,"$4,215.00",$0.00,"$2,107.50","$3,338.28","$3,372.00",$0.00,$659.65,$0.00,$671.03,$0.00
186731640,SUP,HCPCS C1713,,186731640  -  SCREW BONE 6MM 40MM FIX EXPEDIUM TITANIUM SPN CORTICAL 5.5MM,"$4,215.00",$0.00,"$4,215.00","$1,896.75","$3,008.25",$0.00,$726.22,$0.00,$0.00,$738.01,"$4,215.00",$0.00,"$2,107.50","$3,338.28","$3,372.00",$0.00,$659.65,$0.00,$671.03,$0.00
186731650,SUP,HCPCS C1713,,186731650  -  SCREW BN 6MM 50MM VPR FX TI SPNE CORT 5.5MM ROD,"$4,215.00",$0.00,"$4,215.00","$1,896.75","$3,008.25",$0.00,$726.22,$0.00,$0.00,$738.01,"$4,215.00",$0.00,"$2,107.50","$3,338.28","$3,372.00",$0.00,$659.65,$0.00,$671.03,$0.00
186750030,SUP,HCPCS C1713,,186750030  -  SCREW BONE 5MM 30MM VPR 2 TI SPNL CANN XTD TAB MN INV SRG,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
186750035,SUP,HCPCS C1713,,186750035  -  SCREW BONE 5MM 35MM VPR 2 TI SPNL CANN XTD TAB MN INV SRG,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
186750040,SUP,HCPCS C1713,,186750040  -  SCREW BONE 5MM 40MM VPR 2 TI SPNL CANN XTD TAB MN INV SRG,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
186750045,SUP,HCPCS C1713,,186750045  -  SCREW BONE 5MM 45MM CANN EXTENDED TAB VIPER 2 TITANIUM SPN,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
186750050,SUP,HCPCS C1713,,186750050  -  SCREW BONE 5MM 50MM CANN EXTENDED TAB VIPER 2 TITANIUM SPN,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
186750230,SUP,HCPCS C1713,,186750230  -  SCREW BONE  5X30MM TI VIPER PRIME X-TAB,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
186750235,SUP,HCPCS C1713,,186750235  -  SCREW BONE  5X35MM TI VIPER PRIME X-TAB,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
186750250,SUP,HCPCS C1713,,186750250  -  SCREW BONE  5X50MM TI VIPER PRIME X-TAB,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
186750255,SUP,HCPCS C1713,,186750255  -  SCREW BONE  5X55MM TI VIPER PRIME X-TAB,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
186750430,SUP,HCPCS C1713,,186750430  -  SCREW BONE  5X30MM VIPER PRIME CFXFEN XTAB,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
186750435,SUP,HCPCS C1713,,186750435  -  SCREW BONE  5X35MM VIPER PRIME CFXFEN XTAB,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
186750450,SUP,HCPCS C1713,,186750450  -  SCREW BONE  5X50MM VIPER PRIME CFXFEN XTAB,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
186750455,SUP,HCPCS C1713,,186750455  -  SCREW BONE  5X55MM VIPER PRIME CFXFEN XTAB,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
186760035,SUP,HCPCS C1713,,186760035  -  SCREW BONE 6MM 35MM VPR 2 TI SPNL CANN XTD TAB MN INV SRG,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
186760040,SUP,HCPCS C1713,,186760040  -  SCREW BONE 6MM 40MM VPR 2 TI SPNL CANN XTD TAB MN INV SRG,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
186760045,SUP,HCPCS C1713,,186760045  -  SCREW BONE 6MM 45MM VPR 2 TI SPNL CANN XTD TAB MN INV SRG,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
186760050,SUP,HCPCS C1713,,186760050  -  SCREW BONE 6MM 50MM VPR 2 TI SPNL CANN XTD TAB MN INV SRG,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
186760230,SUP,HCPCS C1713,,186760230  -  SCREW BONE  6X30MM TI VIPER PRIME X-TAB,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
186760255,SUP,HCPCS C1713,,186760255  -  SCREW BONE  6X55MM TI VIPER PRIME X-TAB,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
186760430,SUP,HCPCS C1713,,186760430  -  SCREW BONE  6X30MM VIPER PRIME CFXFEN XTAB,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
186760455,SUP,HCPCS C1713,,186760455  -  SCREW BONE  6X55MM VIPER PRIME CFXFEN XTAB,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
186770035,SUP,HCPCS C1713,,186770035  -  SCREW BONE 7MM 35MM VPR 2 TI SPNL CANN XTD TAB MN INV SRG,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
186770040,SUP,HCPCS C1713,,186770040  -  SCREW BONE 7MM 40MM VPR 2 TI SPNL CANN XTD TAB MN INV SRG,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
186770045,SUP,HCPCS C1713,,186770045  -  SCREW BONE 7MM 45MM VPR 2 TI SPNL CANN XTD TAB MN INV SRG,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
186770050,SUP,HCPCS C1713,,186770050  -  SCREW BONE 7MM 50MM CANN EXTENDED TAB VIPER 2 TITANIUM SPN,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
186770230,SUP,HCPCS C1713,,186770230  -  SCREW BONE  7X30MM TI VIPER PRIME X-TAB,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
186770235,SUP,HCPCS C1713,,186770235  -  SCREW BONE  7X35MM TI VIPER PRIME X-TAB,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
186770430,SUP,HCPCS C1713,,186770430  -  SCREW BONE  7X30MM VIPER PRIME CFXFEN XTAB,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
186770435,SUP,HCPCS C1713,,186770435  -  SCREW BONE  7X35MM VIPER PRIME CFXFEN XTAB,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
186770460,SUP,HCPCS C1713,,186770460  -  SCREW BONE  7X60MM VIPER PRIME CFXFEN XTAB,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
186775235,SUP,HCPCS C1713,,186775235  -  SCREW BONE  7.5X35MM TI VIPER PRIME X-TAB,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
186775240,SUP,HCPCS C1713,,186775240  -  SCREW BONE  7.5X40MM TI VIPER PRIME X-TAB,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
186775245,SUP,HCPCS C1713,,186775245  -  SCREW BONE  7.5X45MM TI VIPER PRIME X-TAB,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
186775250,SUP,HCPCS C1713,,186775250  -  SCREW BONE  7.5X50MM TI VIPER PRIME X-TAB,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
186775255,SUP,HCPCS C1713,,186775255  -  SCREW BONE  7.5X55MM TI VIPER PRIME X-TAB,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
186787040,SUP,Custom 27803010,,186787040  -  ROD SPNL 40MM VPR 2 TI KYPHOSED MN INV SRG,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
186787080,SUP,Custom 27803010,,186787080  -  ROD SPNL 80MM VPR 2 TI KYPHOSED MN INV SRG,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
186787090,SUP,Custom 27803010,,186787090  -  ROD SPNL 90MM VPR 2 TI KYPHOSED MN INV SRG,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
186787100,SUP,Custom 27803010,,186787100  -  ROD SPNL 100MM VPR 2 TI KYPHOSED MN INV SRG,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
186787110,SUP,Custom 27803010,,186787110  -  ROD SPNL 110MM VPR 2 TI KYPHOSED MN INV SRG,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
186787200,SUP,Custom 27803010,,186787200  -  ROD SPNL 200MM VPR 2 TI KYPHOSED MN INV SRG,"$1,710.00",$0.00,"$1,710.00",$0.00,"$1,220.43",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,710.00",$0.00,$855.00,"$1,354.32","$1,368.00",$0.00,$0.00,$0.00,$0.00,$0.00
186788035,SUP,HCPCS C1713,,186788035  -  ROD SPINAL 35MM LORDOTIC VIPER 2 TITANIUM MINIMALLY INVASIVE,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
186788045,SUP,Custom 27803010,,186788045  -  ROD SPNL 45MM VPR 2 TI LRDTC MN INV SRG,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
186788065,SUP,Custom 27803010,,186788065  -  ROD SPNL 65MM VPR 2 PRELORDOTIC MN INV SRG,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
186788075,SUP,Custom 27803010,,186788075  -  ROD SPNL 75MM 5.5MM VPR 2 TI LRDTC MN INV SRG,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
186788080,SUP,Custom 27803010,,186788080  -  ROD SPNL 80MM VPR 2 TI LRDTC MN INV SRG,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
186788090,SUP,Custom 27803010,,186788090  -  ROD SPNL 90MM 5.5MM VPR 2 TI LRDTC MN INV SRG,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
186788100,SUP,Custom 27803010,,186788100  -  ROD SPNL 100MM VPR 2 TI LRDTC MN INV SRG,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
186788120,SUP,HCPCS C1713,,186788120  -  ROD SPINAL 120MM LORDOTIC VIPER 2 TITANIUM MINIMALLY,"$1,537.50",$0.00,"$1,537.50",$691.88,"$1,097.31",$0.00,$264.90,$0.00,$0.00,$269.20,"$1,537.50",$0.00,$768.75,"$1,217.70","$1,230.00",$0.00,$240.62,$0.00,$244.77,$0.00
186788150,SUP,Custom 27803010,,186788150  -  ROD SPNL 150MM VPR 2 TI LRDTC MN INV SRG,"$1,537.50",$0.00,"$1,537.50",$0.00,"$1,097.31",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,537.50",$0.00,$768.75,"$1,217.70","$1,230.00",$0.00,$0.00,$0.00,$0.00,$0.00
186789040,SUP,Custom 27803010,,186789040  -  ROD SPNL 40MM VPR 2 TI STR MN INV SRG,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
186789050,SUP,Custom 27803010,,186789050  -  ROD SPNL 50MM VPR 2 TI STR MN INV SRG,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
186789070,SUP,Custom 27803010,,186789070  -  ROD SPNL 70MM VPR 2 TI STR MN INV SRG,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
186789080,SUP,Custom 27803010,,186789080  -  ROD SPNL 80MM VPR 2 TI STR MN INV SRG,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
186789100,SUP,Custom 27803010,,186789100  -  ROD SPNL 100MM VPR 2 TI STR MN INV SRG,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
186789150,SUP,HCPCS C1713,,186789150  -  ROD SPINAL 150MM STR VIPER 2 TITANIUM MINIMALLY INVASIVE,"$1,537.50",$0.00,"$1,537.50",$691.88,"$1,097.31",$0.00,$264.90,$0.00,$0.00,$269.20,"$1,537.50",$0.00,$768.75,"$1,217.70","$1,230.00",$0.00,$240.62,$0.00,$244.77,$0.00
186789200,SUP,Custom 27803010,,186789200  -  ROD SPNL 200MM VPR 2 TI STR MN INV SRG,"$1,710.00",$0.00,"$1,710.00",$0.00,"$1,220.43",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,710.00",$0.00,$855.00,"$1,354.32","$1,368.00",$0.00,$0.00,$0.00,$0.00,$0.00
186789300,SUP,Custom 27803010,,186789300  -  ROD SPNL 300MM VPR 2 TI STR MN INV SRG,"$1,882.50",$0.00,"$1,882.50",$0.00,"$1,343.54",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,882.50",$0.00,$941.25,"$1,490.94","$1,506.00",$0.00,$0.00,$0.00,$0.00,$0.00
186789400,SUP,HCPCS C1713,,186789400  -  ROD SPINAL 400MM STR VIPER 2 TITANIUM MINIMALLY INVASIVE,"$2,055.00",$0.00,"$2,055.00",$924.75,"$1,466.65",$0.00,$354.07,$0.00,$0.00,$359.81,"$2,055.00",$0.00,"$1,027.50","$1,627.56","$1,644.00",$0.00,$321.61,$0.00,$327.16,$0.00
186789480,SUP,HCPCS C1713,,186789480  -  ROD SPINAL STR 480MM VIPER 2 TITANIUM MINIMALLY INVASIVE,"$2,055.00",$0.00,"$2,055.00",$924.75,"$1,466.65",$0.00,$354.07,$0.00,$0.00,$359.81,"$2,055.00",$0.00,"$1,027.50","$1,627.56","$1,644.00",$0.00,$321.61,$0.00,$327.16,$0.00
186801012,SUP,HCPCS C1713,,186801012  -  PLATE BONE PRELORDOTIC 19.8X16X2.5MM 12MM LEVEL 1 MEDIAL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
186801014,SUP,HCPCS C1713,,186801014  -  PLATE BONE PRELORDOTIC 21.8X16X2.5MM 14MM LEVEL 1 MEDIAL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
186801016,SUP,HCPCS C1713,,186801016  -  PLATE BONE PRELORDOTIC 23.8X16X2.5MM 16MM LEVEL 1 MEDIAL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
186801024,SUP,HCPCS C1713,,186801024  -  PLATE BN 14MM PREBNT 24X16X2.5MM NS SKYLINE 1 LVL TI SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
186801026,SUP,HCPCS C1713,,186801026  -  PLATE 26MM TI 1 LVL SKYLINE BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
186801028,SUP,HCPCS C1713,,186801028  -  PLATE 28MM TI 1 LVL SKYLINE BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
186801030,SUP,HCPCS C1713,,186801030  -  PLATE 30MM TI 1 LVL SKYLINE BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
186802028,SUP,HCPCS C1713,,186802028  -  PLATE BONE PRELORDOTIC 35.8X16X2.5MM 28MM LEVEL 2 MEDIAL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
186802030,SUP,HCPCS C1713,,186802030  -  PLATE 30MM TI 2 LVL SKYLINE BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
186802032,SUP,HCPCS C1713,,186802032  -  PLATE 32MM TI 2 LVL SKYLINE BONE SPN,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
186802036,SUP,HCPCS C1713,,186802036  -  PLATE 36MM TI 2 LVL SKYLINE BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
186803039,SUP,HCPCS C1713,,186803039  -  PLATE BN 39MM NS SKYLINE 3 LVL SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
186803042,SUP,HCPCS C1713,,186803042  -  PLATE BONE PRELORDOTIC 49.8X16X2.5MM 42MM LEVEL 3 MEDIAL,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
186803045,SUP,HCPCS C1713,,186803045  -  PLATE BONE PRELORDOTIC 52.8X16X2.5MM 45MM LEVEL 3 MEDIAL,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
186803051,SUP,HCPCS C1713,,186803051  -  PLATE BONE PRELORDOTIC 58.8X16X2.5MM 51MM LEVEL 3 MEDIAL,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
186820012,SUP,Custom 27203010,,186820012  -  14MM DRILL,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
186850012,SUP,HCPCS C1713,,186850012  -  SCREW BONE 12MM VAR ANG SELF DRILL SKYLINE TITANIUM SPN,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
186850014,SUP,HCPCS C1713,,186850014  -  SCREW BONE 0-20D 4MM 14MM VARIABLE SLFDRILL SKYLINE GOLD,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
186850016,SUP,HCPCS C1713,,186850016  -  SCREW BONE 16MM SKYLINE TI SPNL SLFDRILL VAR ANG,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
186850017,SUP,HCPCS C1713,,186850017  -  SCREW BN 0-20D 4MM 17MM LGHT GRN SKYLINE VAR SLFDRL TI ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
186850018,SUP,HCPCS C1713,,186850018  -  SCREW BONE 18MM VAR ANG SELF DRILL SKYLINE TITANIUM SPN,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
186852014,SUP,HCPCS C1713,,186852014  -  SCREW BONE 14MM SKYLINE TI SPNL SLFTAP VAR ANG,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
186852015,SUP,HCPCS C1713,,186852015  -  SCREW BONE 15MM SLFTAP VAR ANG SKYLINE TITANIUM SPN,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
186852016,SUP,HCPCS C1713,,186852016  -  SCREW BONE 16MM SKYLINE TI SPNL SLFTAP VAR ANG,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
186852017,SUP,HCPCS C1713,,186852017  -  SCREW BONE 17MM SLFTAP VAR ANG SKYLINE TITANIUM SPN,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
186852018,SUP,HCPCS C1713,,186852018  -  SCREW BONE 18MM SKYLINE TI SPNL SLFTAP VAR ANG,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
186854014,SUP,HCPCS C1713,,186854014  -  SCREW BONE LARGE DIAMETER 14MM VAR ANG SELF TAP SKYLINE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
186854016,SUP,HCPCS C1713,,186854016  -  SCREW BN OVSZ 4.5MM 16MM NS SKYLINE VAR SLF DRL TI SPNE CRV,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
186854018,SUP,HCPCS C1713,,186854018  -  SCREW BONE LARGE DIAMETER 18MM VAR ANG SELF TAP SKYLINE,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
186862014,SUP,HCPCS C1713,,186862014  -  SCREW BONE 4MM 14MM SKYLINE TI ANT CERV SPN SLFTAP CNSTRN,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
186862016,SUP,HCPCS C1713,,186862016  -  SCREW BONE 16MM SKYLINE TI SPNL SLFTAP CNSTRN,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
186864014,SUP,HCPCS C1713,,186864014  -  SCREW BONE 14MM SKYLINE TI SPNL SLFTAP CNSTRN,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
187301105,SUP,Custom 27803010,,187301105  -  CAGE SPNL 7D STD 5MM NS LF BENGAL CFRP CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
187301106,SUP,Custom 27803010,,187301106  -  CAGE SPNL 7D STD 6MM NS LF BENGAL CFRP CRV INTRBD FS,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
187301107,SUP,Custom 27803010,,187301107  -  CAGE SPNL 7D STD 7MM NS LF BENGAL CFRP CRV INTRBD FS,"$2,458.13",$0.00,"$2,458.13",$0.00,"$1,754.36",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,458.13",$0.00,"$1,229.06","$1,946.84","$1,966.50",$0.00,$0.00,$0.00,$0.00,$0.00
187301108,SUP,Custom 27803010,,187301108  -  CAGE SPNL 7D STD 8MM NS LF BENGAL CFRP CRV INTRBD FS,"$2,458.13",$0.00,"$2,458.13",$0.00,"$1,754.36",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,458.13",$0.00,"$1,229.06","$1,946.84","$1,966.50",$0.00,$0.00,$0.00,$0.00,$0.00
187301207,SUP,HCPCS C1713,,187301207  -  CAGE SPNL 7D LG LRDTC 7MM NS LF BENGAL CFBR LMBR INTRBD FS,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
187823107,SUP,HCPCS C1713,,187823107  -  CAGE SPNL PRLL BLT 23X9X7MM NS LF CNCRD,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
187823108,SUP,Custom 27803010,,187823108  -  CAGE SPNL PRLL BLT NOSE 23X9X8MM NS LF CNCRD RADOPQ CFRP,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
187823409,SUP,Custom 27803010,,187823409  -  CAGE SPNL 5D LRDTC BLT NOSE 23X9X9MM NS LF CNCRD RADOPQ CFRP,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
187823410,SUP,Custom 27803010,,187823410  -  CAGE SPNL 5D LRDTC BLT NOSE 23X9X10MM NS LF CNCRD RADOPQ,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
187827108,SUP,Custom 27803010,,187827108  -  CAGE SPNL PRLL BLT NOSE 27X9X8MM NS LF CNCRD RADOPQ CFRP,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
187827212,SUP,Custom 27803010,,187827212  -  CAGE SPNL PRLL BLT NOSE 27X11X12MM NS LF CNCRD RADOPQ CFRP,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
187827409,SUP,Custom 27803010,,187827409  -  CAGE SPNL 5D LRDTC BLT NOSE 27X9X9MM NS LF CNCRD RADOPQ CFRP,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
188311002,SUP,HCPCS C1713,,188311002  -  ROD SPINAL 3.5-5.5MM 420MM 2 OPENING MOUNTAINEER TITANIUM,"$2,145.00",$0.00,"$2,145.00",$965.25,"$1,530.89",$0.00,$369.57,$0.00,$0.00,$375.57,"$2,145.00",$0.00,"$1,072.50","$1,698.84","$1,716.00",$0.00,$335.69,$0.00,$341.48,$0.00
188311200,SUP,Custom 27803010,,188311200  -  CONCTR SPNL 3.5MM 3.5MM MTNR OCT WDBND,"$1,740.00",$0.00,"$1,740.00",$0.00,"$1,241.84",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,740.00",$0.00,$870.00,"$1,378.08","$1,392.00",$0.00,$0.00,$0.00,$0.00,$0.00
188312001,SUP,Custom 27803010,,188312001  -  CONCTR ROD MTNR OFFST ASMBLY OCT SPN LAT,"$1,342.50",$0.00,"$1,342.50",$0.00,$958.14,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,342.50",$0.00,$671.25,"$1,063.26","$1,074.00",$0.00,$0.00,$0.00,$0.00,$0.00
188312003,SUP,Custom 27803010,,188312003  -  CONCTR ROD MTNR J HOOK ASMBLY OCT SPN,"$1,170.00",$0.00,"$1,170.00",$0.00,$835.03,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,170.00",$0.00,$585.00,$926.64,$936.00,$0.00,$0.00,$0.00,$0.00,$0.00
188316030,SUP,Custom 27803010,,188316030  -  ROD SPNL 30MM 3.5MM MTNR,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
188316035,SUP,Custom 27803010,,188316035  -  ROD SPNL 35MM 3.5MM MTNR,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
188316040,SUP,Custom 27803010,,188316040  -  ROD SPNL 40MM 3.5MM MTNR,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
188316045,SUP,Custom 27803010,,188316045  -  ROD SPNL 45MM 3.5MM MTNR,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
188316050,SUP,Custom 27803010,,188316050  -  ROD SPNL 50MM 3.5MM MTNR,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
188316055,SUP,Custom 27803010,,188316055  -  ROD SPNL 55MM 3.5MM MTNR,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
188316060,SUP,Custom 27803010,,188316060  -  ROD SPNL 60MM 3.5MM MTNR TI RGD STRL,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
188316065,SUP,Custom 27803010,,188316065  -  ROD SPNL 65MM 3.5MM MTNR,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
188316070,SUP,Custom 27803010,,188316070  -  ROD SPNL 70MM 3.5MM MTNR,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
188316075,SUP,Custom 27803010,,188316075  -  ROD SPNL 75MM 3.5MM MTNR,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
188316085,SUP,HCPCS C1713,,188316085  -  ROD SPINAL 3.5MM 85MM MOUNTAINEER,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
188316100,SUP,Custom 27803010,,188316100  -  ROD SPNL 100MM 3.5MM MTNR,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
188316120,SUP,Custom 27803010,,188316120  -  ROD SPNL 120MM 3.5MM MTNR TI RGD STRL,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
188318310,SUP,HCPCS C1713,,188318310  -  SCREW BONE 3.5MM 10MM MTNR TI OCT SPN FIXANG,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
188318312,SUP,HCPCS C1713,,188318312  -  SCREW BONE 3.5MM 12MM MTNR TI OCT SPN FIXANG,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
188318314,SUP,HCPCS C1713,,188318314  -  SCREW BONE 3.5MM 14MM MTNR TI SPNL FIXANG,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
188318316,SUP,HCPCS C1713,,188318316  -  SCREW BONE 3.5MM 16MM MTNR TI OCT SPN FIXANG MDLN FIX SYS,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
188318318,SUP,HCPCS C1713,,188318318  -  SCREW BONE 3.5MM 18MM MTNR TI OCT SPN FIXANG,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
188318320,SUP,HCPCS C1713,,188318320  -  SCREW BONE 3.5MM 20MM MTNR TI OCT SPN FIXANG,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
188318324,SUP,HCPCS C1713,,188318324  -  SCREW BONE 3.5MM 24MM MTNR TI OCT SPN FIXANG,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
188318412,SUP,HCPCS C1713,,188318412  -  SCREW BONE 4MM 12MM MTNR TI OCT SPN FIXANG,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
188318414,SUP,HCPCS C1713,,188318414  -  SCREW BONE 4MM 14MM MTNR TI OCT SPN FIXANG,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
188318418,SUP,HCPCS C1713,,188318418  -  SCREW BONE 4MM 18MM MTNR TI OCT SPN FIXANG,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
188318420,SUP,HCPCS C1713,,188318420  -  SCREW BONE 4MM 20MM MTNR TI OCT SPN FIXANG,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
188318426,SUP,HCPCS C1713,,188318426  -  SCREW BONE 4MM 26MM MTNR TI OCT SPN FIXANG,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
188319310,SUP,HCPCS C1713,,188319310  -  SCREW BONE 3.5MM 10MM MTNR TI OCT SPN MDLN FIX SYS,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
188319312,SUP,HCPCS C1713,,188319312  -  SCREW BONE 3.5MM 12MM FAVOR ANGLE MINIPOLYAXIAL SELF FORM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
188319314,SUP,HCPCS C1713,,188319314  -  SCREW BONE 3.5MM 14MM FAVOR ANGLE MINIPOLYAXIAL SELF FORM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
188319316,SUP,HCPCS C1713,,188319316  -  SCREW BONE 3.5MM 16MM MTNR MDL LAT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
188319420,SUP,HCPCS C1713,,188319420  -  SCREW BONE 4MM 20MM MTNR TI OCT SPN MDLN FIX SYS,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
188319424,SUP,HCPCS C1713,,188319424  -  SCREW BONE 4MM 24MM MTNR TI OCT SPN MDLN FIX SYS,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
188319426,SUP,HCPCS C1713,,188319426  -  SCREW BONE 4MM 26MM MTNR TI OCT SPN MDLN FIX SYS,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
188319525,SUP,HCPCS C1713,,188319525  -  SCREW BONE 4.35MM 25MM MTNR TI ML OCT SPN FIXANG,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
188319530,SUP,HCPCS C1713,,188319530  -  SCREW BONE 4.35MM 30MM MTNR TI OCT SPN STRL MDLN FIX SYS,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
188319535,SUP,HCPCS C1713,,188319535  -  SCREW BONE 4.35MM 35MM FIX ANGLE MOUNTAINEER TITANIUM SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
188341021,SUP,HCPCS C1713,,188341021  -  PLATE BN 21MM NS MTNR HD TO HD CX CNCT SPNE OCT 3.5MM SCR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
188341028,SUP,HCPCS C1713,,188341028  -  PLATE BN 28MM NS MTNR HD TO HD CX CNCT SPNE OCT 3.5MM SCR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
188341035,SUP,HCPCS C1713,,188341035  -  PLATE BN 35MM NS MTNR HD TO HD CX CNCT SPNE OCT 3.5MM SCR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
188341042,SUP,HCPCS C1713,,188341042  -  PLATE BN 42MM NS MTNR HD TO HD CX CNCT SPNE OCT 3.5MM SCR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
188341100,SUP,Custom 27803010,,188341100  -  NUT OUTR MTNR OCT SPN TI HEAD TO HEAD CX CONECTION,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
188341200,SUP,HCPCS C1713,,188341200  -  SCREW BONE 3.5MM 200MM MTNR TI OCT SPN INR HEAD TO HEAD CX,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
188341300,SUP,Custom 27803010,,188341300  -  CONCTR ROD CX HEAD TO HEAD HOOK,"$2,000.00",$0.00,"$2,000.00",$0.00,"$1,427.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
188342200,SUP,HCPCS C1713,,188342200  -  SCREW BONE 3.5MM 20MM MTNR TI OCT SPN INR HEAD TO HEAD CX,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
188362006,SUP,HCPCS C1713,,188362006  -  SCREW BONE 4.5MM 6MM MTNR TI OCT SPN,$765.00,$0.00,$765.00,$344.25,$545.98,$0.00,$131.81,$0.00,$0.00,$133.95,$765.00,$0.00,$382.50,$605.88,$612.00,$0.00,$119.72,$0.00,$121.79,$0.00
188362007,SUP,HCPCS C1713,,188362007  -  SCREW BONE 4.5MM 7MM MTNR TI OCT SPN,$765.00,$0.00,$765.00,$344.25,$545.98,$0.00,$131.81,$0.00,$0.00,$133.95,$765.00,$0.00,$382.50,$605.88,$612.00,$0.00,$119.72,$0.00,$121.79,$0.00
188362008,SUP,HCPCS C1713,,188362008  -  SCREW BONE 4.5MM 8MM MTNR TI OCT SPN,$765.00,$0.00,$765.00,$344.25,$545.98,$0.00,$131.81,$0.00,$0.00,$133.95,$765.00,$0.00,$382.50,$605.88,$612.00,$0.00,$119.72,$0.00,$121.79,$0.00
188362010,SUP,HCPCS C1713,,188362010  -  SCREW BONE 4.5MM 10MM MTNR TI OCT SPN,$765.00,$0.00,$765.00,$344.25,$545.98,$0.00,$131.81,$0.00,$0.00,$133.95,$765.00,$0.00,$382.50,$605.88,$612.00,$0.00,$119.72,$0.00,$121.79,$0.00
188362012,SUP,HCPCS C1713,,188362012  -  SCREW BONE 4.5MM 12MM MTNR TI OCT SPN,$765.00,$0.00,$765.00,$344.25,$545.98,$0.00,$131.81,$0.00,$0.00,$133.95,$765.00,$0.00,$382.50,$605.88,$612.00,$0.00,$119.72,$0.00,$121.79,$0.00
188362025,SUP,HCPCS C1713,,188362025  -  SCREW BONE 4.5MM 25MM MTNR TI OCT SPN,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
188362031,SUP,HCPCS C1713,,188362031  -  PLATE BN 31MM NS MTNR SPNE OC 3.5MM SCR,"$8,130.00",$0.00,"$8,130.00","$3,658.50","$5,158.80",$0.00,"$1,400.76",$0.00,$0.00,"$1,423.50","$8,130.00",$0.00,"$4,065.00","$6,438.96","$6,504.00",$0.00,"$1,272.35",$0.00,"$1,294.30",$0.00
188362106,SUP,HCPCS C1713,,188362106  -  SCREW BONE 5.25MM 6MM MTNR TI OCT SPN,$817.50,$0.00,$817.50,$367.88,$583.45,$0.00,$140.85,$0.00,$0.00,$143.14,$817.50,$0.00,$408.75,$647.46,$654.00,$0.00,$127.94,$0.00,$130.15,$0.00
188363200,SUP,Custom 27803010,,188363200  -  ROD SPNL 120MM 3.5MM MTNR TI PREBNT STRL,$877.50,$0.00,$877.50,$0.00,$626.27,$0.00,$0.00,$0.00,$0.00,$0.00,$877.50,$0.00,$438.75,$694.98,$702.00,$0.00,$0.00,$0.00,$0.00,$0.00
188901040,SUP,Custom 27803010,,188901040  -  CAGE SPNL 0D MED 20MM 40-56MM NS LF X-MESH XPD FTPRNT TI,"$13,737.50",$0.00,"$13,737.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,737.50",$0.00,"$6,868.75","$10,880.10","$10,990.00",$0.00,$0.00,$0.00,$0.00,$0.00
188920022,SUP,Custom 27803010,,188920022  -  CAGE SPNL 0D SM 16MM 22-30MM NS LF X-MESH XPD FTPRNT TI POST,"$11,743.75",$0.00,"$11,743.75",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,743.75",$0.00,"$5,871.88","$9,301.05","$9,395.00",$0.00,$0.00,$0.00,$0.00,$0.00
189401207,SUP,Custom 27803010,,189401207  -  CONCTR ROD F7 5.5MM SFX TI MDL SPNL,"$2,000.00",$0.00,"$2,000.00",$0.00,"$1,427.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
189401208,SUP,Custom 27803010,,189401208  -  CONCTR ROD F8 5.5MM XPDM SFX CX MDL OFFST TI SPNL,"$2,000.00",$0.00,"$2,000.00",$0.00,"$1,427.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
189401209,SUP,Custom 27803010,,189401209  -  CONCTR ROD F9 5.5MM SFX TI MDL SPNL,"$2,000.00",$0.00,"$2,000.00",$0.00,"$1,427.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
189401302,SUP,HCPCS C1713,,189401302  -  CONNECTOR ROD A2 5.5MM EXPEDIUM SFX TITANIUM LATERAL SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
189401404,SUP,Custom 27803010,,189401404  -  CONCTR ROD A4 5.5MM SFX TI MDL SPNL,"$2,000.00",$0.00,"$2,000.00",$0.00,"$1,427.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
189401405,SUP,Custom 27803010,,189401405  -  CONCTR ROD A5 MED 5.5MM SFX XLNK TI SPNL,"$2,000.00",$0.00,"$2,000.00",$0.00,"$1,427.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
189401406,SUP,Custom 27803010,,189401406  -  CONCTR ROD MED A6 5.5MM SFX XLNK TI SPNL,"$2,000.00",$0.00,"$2,000.00",$0.00,"$1,427.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
189403303,SUP,Custom 27803010,,189403303  -  CONCTR ROD A3 6.35MM SFX TI LAT SPNL,"$2,000.00",$0.00,"$2,000.00",$0.00,"$1,427.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
189706012,SUP,HCPCS C1713,,189706012  -  SCREW BONE 4.6MM 12MM UNIPLATE 2 TI ANT CERV SPN SLFTAP,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
189707012,SUP,HCPCS C1713,,189707012  -  SCREW BONE 4.6MM 12MM UNIPLATE 2 TI ANT CERV SPN SLFDRILL,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
189707014,SUP,HCPCS C1713,,189707014  -  SCREW BONE 4.6MM 14MM UNIPLATE 2 TI ANT CERV SPN SLFDRILL,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
189707015,SUP,HCPCS C1713,,189707015  -  SCREW BONE 4.6MM 15MM UNIPLATE 2 TI ANT CERV SPN SLFDRILL,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
196789120,SUP,HCPCS C1713,,196789120  -  ROD SPINAL STR 120MM VIPER 2 COCR MIS,"$1,612.50",$0.00,"$1,612.50",$725.63,"$1,150.84",$0.00,$277.83,$0.00,$0.00,$282.34,"$1,612.50",$0.00,$806.25,"$1,277.10","$1,290.00",$0.00,$252.36,$0.00,$256.71,$0.00
206710000,SUP,HCPCS C1713,,0206710000  -  KIT BN CMNT STRL BIOPREP PREP PLG INSRTR BRSH CURT SCT FEM,$256.29,$0.00,$256.29,$115.33,$182.92,$0.00,$44.16,$0.00,$0.00,$44.87,$256.29,$0.00,$128.15,$202.98,$205.03,$0.00,$40.11,$0.00,$40.80,$0.00
219501200,SUP,Custom 27203010,,00219501200  -  CARRIER GRAFT 1.5 1 PLATEAU GROOVE 8X3IN RATCHET HANDLE,$81.20,$0.00,$81.20,$0.00,$57.95,$0.00,$0.00,$0.00,$0.00,$0.00,$81.20,$0.00,$40.60,$64.31,$64.96,$0.00,$0.00,$0.00,$0.00,$0.00
234020053,SUP,HCPCS C1713,,234020053  -  PIN FIX 2.4MM 12IN TROCAR TIPPED EYE LOOP LATEX FREE FEMUR,$312.50,$0.00,$312.50,$140.63,$223.03,$0.00,$53.84,$0.00,$0.00,$54.72,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$48.91,$0.00,$49.75,$0.00
234800835,SUP,HCPCS C1713,,00234800835  -  SCREW BONE 3.5MM 2.7MM 8MM SELF TAP STAINLESS STEEL,$62.10,$0.00,$62.10,$27.95,$44.32,$0.00,$10.70,$0.00,$0.00,$10.87,$62.10,$0.00,$31.05,$49.18,$49.68,$0.00,$9.72,$0.00,$9.89,$0.00
234802435,SUP,HCPCS C1713,,00234802435  -  SCREW BONE 3.5MM 2.7MM 24MM SELF TAP STAINLESS STEEL,$62.10,$0.00,$62.10,$27.95,$44.32,$0.00,$10.70,$0.00,$0.00,$10.87,$62.10,$0.00,$31.05,$49.18,$49.68,$0.00,$9.72,$0.00,$9.89,$0.00
234802835,SUP,HCPCS C1713,,00234802835  -  SCREW BONE 3.5MM 2.7MM 28MM SELF TAP STAINLESS STEEL,$62.10,$0.00,$62.10,$27.95,$44.32,$0.00,$10.70,$0.00,$0.00,$10.87,$62.10,$0.00,$31.05,$49.18,$49.68,$0.00,$9.72,$0.00,$9.89,$0.00
234803035,SUP,HCPCS C1713,,00234803035  -  SCREW BONE 3.5MM 2.7MM 30MM SELF TAP STAINLESS STEEL,$62.10,$0.00,$62.10,$27.95,$44.32,$0.00,$10.70,$0.00,$0.00,$10.87,$62.10,$0.00,$31.05,$49.18,$49.68,$0.00,$9.72,$0.00,$9.89,$0.00
234803235,SUP,HCPCS C1713,,00234803235  -  SCREW BONE 3.5MM 2.7MM 32MM SELF TAP STAINLESS STEEL,$62.10,$0.00,$62.10,$27.95,$44.32,$0.00,$10.70,$0.00,$0.00,$10.87,$62.10,$0.00,$31.05,$49.18,$49.68,$0.00,$9.72,$0.00,$9.89,$0.00
234803435,SUP,HCPCS C1713,,00234803435  -  SCREW BONE 3.5MM 2.7MM 34MM SELF TAP STAINLESS STEEL,$62.10,$0.00,$62.10,$27.95,$44.32,$0.00,$10.70,$0.00,$0.00,$10.87,$62.10,$0.00,$31.05,$49.18,$49.68,$0.00,$9.72,$0.00,$9.89,$0.00
234803635,SUP,HCPCS C1713,,00234803635  -  SCREW BONE 3.5MM 2.7MM 36MM SELF TAP STAINLESS STEEL,$62.10,$0.00,$62.10,$27.95,$44.32,$0.00,$10.70,$0.00,$0.00,$10.87,$62.10,$0.00,$31.05,$49.18,$49.68,$0.00,$9.72,$0.00,$9.89,$0.00
234803835,SUP,HCPCS C1713,,00234803835  -  SCREW BONE 3.5MM 2.7MM 38MM SELF TAP STAINLESS STEEL,$62.10,$0.00,$62.10,$27.95,$44.32,$0.00,$10.70,$0.00,$0.00,$10.87,$62.10,$0.00,$31.05,$49.18,$49.68,$0.00,$9.72,$0.00,$9.89,$0.00
234804035,SUP,HCPCS C1713,,00234804035  -  SCREW BONE 3.5MM 2.7MM 40MM SLFTAP STAINLESS STEEL,$62.10,$0.00,$62.10,$27.95,$44.32,$0.00,$10.70,$0.00,$0.00,$10.87,$62.10,$0.00,$31.05,$49.18,$49.68,$0.00,$9.72,$0.00,$9.89,$0.00
234804235,SUP,HCPCS C1713,,00234804235  -  SCREW BONE 3.5MM 2.7MM 42MM SELF TAP STAINLESS STEEL,$62.10,$0.00,$62.10,$27.95,$44.32,$0.00,$10.70,$0.00,$0.00,$10.87,$62.10,$0.00,$31.05,$49.18,$49.68,$0.00,$9.72,$0.00,$9.89,$0.00
234804435,SUP,HCPCS C1713,,00234804435  -  SCREW BONE 3.5MM 2.7MM 44MM SELF TAP STAINLESS STEEL,$62.10,$0.00,$62.10,$27.95,$44.32,$0.00,$10.70,$0.00,$0.00,$10.87,$62.10,$0.00,$31.05,$49.18,$49.68,$0.00,$9.72,$0.00,$9.89,$0.00
234804635,SUP,HCPCS C1713,,00234804635  -  SCREW BONE 3.5MM 2.7MM 46MM SELF TAP STAINLESS STEEL,$62.10,$0.00,$62.10,$27.95,$44.32,$0.00,$10.70,$0.00,$0.00,$10.87,$62.10,$0.00,$31.05,$49.18,$49.68,$0.00,$9.72,$0.00,$9.89,$0.00
234804835,SUP,HCPCS C1713,,00234804835  -  SCREW BONE 3.5MM 2.7MM 48MM SELF TAP STAINLESS STEEL,$62.10,$0.00,$62.10,$27.95,$44.32,$0.00,$10.70,$0.00,$0.00,$10.87,$62.10,$0.00,$31.05,$49.18,$49.68,$0.00,$9.72,$0.00,$9.89,$0.00
234805035,SUP,HCPCS C1713,,00234805035  -  SCREW BONE 3.5MM 2.7MM 50MM SELF TAP STAINLESS STEEL,$62.10,$0.00,$62.10,$27.95,$44.32,$0.00,$10.70,$0.00,$0.00,$10.87,$62.10,$0.00,$31.05,$49.18,$49.68,$0.00,$9.72,$0.00,$9.89,$0.00
234805235,SUP,HCPCS C1713,,00234805235  -  SCREW BONE 3.5MM 2.7MM 52MM SELF TAP STAINLESS STEEL,$62.10,$0.00,$62.10,$27.95,$44.32,$0.00,$10.70,$0.00,$0.00,$10.87,$62.10,$0.00,$31.05,$49.18,$49.68,$0.00,$9.72,$0.00,$9.89,$0.00
234805435,SUP,HCPCS C1713,,00234805435  -  SCREW BONE 3.5MM 2.7MM 54MM SELF TAP STAINLESS STEEL,$62.10,$0.00,$62.10,$27.95,$44.32,$0.00,$10.70,$0.00,$0.00,$10.87,$62.10,$0.00,$31.05,$49.18,$49.68,$0.00,$9.72,$0.00,$9.89,$0.00
234805635,SUP,HCPCS C1713,,00234805635  -  SCREW BONE 2.5MM 3.5MM 2.7MM 56MM SELF TAP LOCK STAINLESS,$62.10,$0.00,$62.10,$27.95,$44.32,$0.00,$10.70,$0.00,$0.00,$10.87,$62.10,$0.00,$31.05,$49.18,$49.68,$0.00,$9.72,$0.00,$9.89,$0.00
234805835,SUP,HCPCS C1713,,00234805835  -  SCREW BONE 3.5MM 2.7MM 58MM SELF TAP STAINLESS STEEL,$62.10,$0.00,$62.10,$27.95,$44.32,$0.00,$10.70,$0.00,$0.00,$10.87,$62.10,$0.00,$31.05,$49.18,$49.68,$0.00,$9.72,$0.00,$9.89,$0.00
234806035,SUP,HCPCS C1713,,00234806035  -  SCREW BONE 3.5MM 2.7MM 60MM SELF TAP STAINLESS STEEL,$62.10,$0.00,$62.10,$27.95,$44.32,$0.00,$10.70,$0.00,$0.00,$10.87,$62.10,$0.00,$31.05,$49.18,$49.68,$0.00,$9.72,$0.00,$9.89,$0.00
234806535,SUP,HCPCS C1713,,00234806535  -  SCREW BONE 3.5MM 2.7MM 65MM SELF TAP STAINLESS STEEL,$62.10,$0.00,$62.10,$27.95,$44.32,$0.00,$10.70,$0.00,$0.00,$10.87,$62.10,$0.00,$31.05,$49.18,$49.68,$0.00,$9.72,$0.00,$9.89,$0.00
234807035,SUP,HCPCS C1713,,00234807035  -  SCREW BONE 3.5MM 2.7MM 70MM SELF TAP STAINLESS STEEL,$62.10,$0.00,$62.10,$27.95,$44.32,$0.00,$10.70,$0.00,$0.00,$10.87,$62.10,$0.00,$31.05,$49.18,$49.68,$0.00,$9.72,$0.00,$9.89,$0.00
234807535,SUP,HCPCS C1713,,00234807535  -  SCREW BONE 3.5MM 2.7MM 75MM SELF TAP STAINLESS STEEL,$62.10,$0.00,$62.10,$27.95,$44.32,$0.00,$10.70,$0.00,$0.00,$10.87,$62.10,$0.00,$31.05,$49.18,$49.68,$0.00,$9.72,$0.00,$9.89,$0.00
234808035,SUP,HCPCS C1713,,00234808035  -  SCREW BONE 3.5MM 2.7MM 80MM SELF TAP STAINLESS STEEL,$62.10,$0.00,$62.10,$27.95,$44.32,$0.00,$10.70,$0.00,$0.00,$10.87,$62.10,$0.00,$31.05,$49.18,$49.68,$0.00,$9.72,$0.00,$9.89,$0.00
234808535,SUP,HCPCS C1713,,00234808535  -  SCREW BONE 3.5MM 2.7MM 85MM SELF TAP STAINLESS STEEL,$62.10,$0.00,$62.10,$27.95,$44.32,$0.00,$10.70,$0.00,$0.00,$10.87,$62.10,$0.00,$31.05,$49.18,$49.68,$0.00,$9.72,$0.00,$9.89,$0.00
234809035,SUP,HCPCS C1713,,00234809035  -  SCREW BONE 3.5MM 2.7MM 90MM SELF TAP STAINLESS STEEL,$62.10,$0.00,$62.10,$27.95,$44.32,$0.00,$10.70,$0.00,$0.00,$10.87,$62.10,$0.00,$31.05,$49.18,$49.68,$0.00,$9.72,$0.00,$9.89,$0.00
234809535,SUP,HCPCS C1713,,00234809535  -  SCREW BONE 3.5MM 2.7MM 95MM SELF TAP STAINLESS STEEL,$62.10,$0.00,$62.10,$27.95,$44.32,$0.00,$10.70,$0.00,$0.00,$10.87,$62.10,$0.00,$31.05,$49.18,$49.68,$0.00,$9.72,$0.00,$9.89,$0.00
234810035,SUP,HCPCS C1713,,00234810035  -  SCREW BONE 3.5MM 2.7MM 100MM SELF TAP STAINLESS STEEL,$62.10,$0.00,$62.10,$27.95,$44.32,$0.00,$10.70,$0.00,$0.00,$10.87,$62.10,$0.00,$31.05,$49.18,$49.68,$0.00,$9.72,$0.00,$9.89,$0.00
234810535,SUP,HCPCS C1713,,00234810535  -  SCREW BONE 3.5MM 2.7MM 105MM SELF TAP STAINLESS STEEL,$62.10,$0.00,$62.10,$27.95,$44.32,$0.00,$10.70,$0.00,$0.00,$10.87,$62.10,$0.00,$31.05,$49.18,$49.68,$0.00,$9.72,$0.00,$9.89,$0.00
234811035,SUP,HCPCS C1713,,00234811035  -  SCREW BONE 3.5MM 2.7MM 110MM SELF TAP STAINLESS STEEL,$62.10,$0.00,$62.10,$27.95,$44.32,$0.00,$10.70,$0.00,$0.00,$10.87,$62.10,$0.00,$31.05,$49.18,$49.68,$0.00,$9.72,$0.00,$9.89,$0.00
235701710,SUP,HCPCS C1713,,00235701710  -  PLATE BONE 158MM 10 HOLE LOCK STAINLESS STEEL FIBULA RIGHT,"$1,404.15",$0.00,"$1,404.15",$631.87,"$1,002.14",$0.00,$241.93,$0.00,$0.00,$245.86,"$1,404.15",$0.00,$702.08,"$1,112.09","$1,123.32",$0.00,$219.75,$0.00,$223.54,$0.00
235701808,SUP,HCPCS C1713,,00235701808  -  PLATE BONE 132MM 8 HOLE LOCK STAINLESS STEEL FIBULA LEFT,"$1,319.05",$0.00,"$1,319.05",$593.57,$941.41,$0.00,$227.27,$0.00,$0.00,$230.96,"$1,319.05",$0.00,$659.53,"$1,044.69","$1,055.24",$0.00,$206.43,$0.00,$209.99,$0.00
235701810,SUP,HCPCS C1713,,00235701810  -  PLATE BONE 158MM 10 HOLE LOCK STAINLESS STEEL FIBULA LEFT,"$1,404.15",$0.00,"$1,404.15",$631.87,"$1,002.14",$0.00,$241.93,$0.00,$0.00,$245.86,"$1,404.15",$0.00,$702.08,"$1,112.09","$1,123.32",$0.00,$219.75,$0.00,$223.54,$0.00
248001040,SUP,HCPCS C1713,,00248001040  -  SCREW BONE 4MM 10MM 5MM FORTE STAINLESS STEEL CANCELLOUS,$111.55,$0.00,$111.55,$50.20,$79.61,$0.00,$19.22,$0.00,$0.00,$19.53,$111.55,$0.00,$55.78,$88.35,$89.24,$0.00,$17.46,$0.00,$17.76,$0.00
248001041,SUP,HCPCS C1713,,00248001041  -  SCREW BONE FULTHD 4MM 10MM FORTE STAINLESS STEEL CANCELLOUS,$111.55,$0.00,$111.55,$50.20,$79.61,$0.00,$19.22,$0.00,$0.00,$19.53,$111.55,$0.00,$55.78,$88.35,$89.24,$0.00,$17.46,$0.00,$17.76,$0.00
248001240,SUP,HCPCS C1713,,00248001240  -  SCREW BONE 4MM 12MM 5MM FORTE STAINLESS STEEL CANCELLOUS,$111.55,$0.00,$111.55,$50.20,$79.61,$0.00,$19.22,$0.00,$0.00,$19.53,$111.55,$0.00,$55.78,$88.35,$89.24,$0.00,$17.46,$0.00,$17.76,$0.00
248001241,SUP,HCPCS C1713,,00248001241  -  SCREW BONE FULTHD 4MM 12MM FORTE STAINLESS STEEL CANCELLOUS,$111.55,$0.00,$111.55,$50.20,$79.61,$0.00,$19.22,$0.00,$0.00,$19.53,$111.55,$0.00,$55.78,$88.35,$89.24,$0.00,$17.46,$0.00,$17.76,$0.00
248001440,SUP,HCPCS C1713,,00248001440  -  SCREW BONE 4MM 14MM 5MM FORTE STAINLESS STEEL CANCELLOUS,$111.55,$0.00,$111.55,$50.20,$79.61,$0.00,$19.22,$0.00,$0.00,$19.53,$111.55,$0.00,$55.78,$88.35,$89.24,$0.00,$17.46,$0.00,$17.76,$0.00
248001441,SUP,HCPCS C1713,,00248001441  -  SCREW BONE FULTHD 4MM 14MM FORTE STAINLESS STEEL CANCELLOUS,$111.55,$0.00,$111.55,$50.20,$79.61,$0.00,$19.22,$0.00,$0.00,$19.53,$111.55,$0.00,$55.78,$88.35,$89.24,$0.00,$17.46,$0.00,$17.76,$0.00
248001640,SUP,HCPCS C1713,,00248001640  -  SCREW BONE 4MM 16MM 6MM FORTE STAINLESS STEEL CANCELLOUS,$111.55,$0.00,$111.55,$50.20,$79.61,$0.00,$19.22,$0.00,$0.00,$19.53,$111.55,$0.00,$55.78,$88.35,$89.24,$0.00,$17.46,$0.00,$17.76,$0.00
248001641,SUP,HCPCS C1713,,00248001641  -  SCREW BONE FULTHD 4MM 16MM FORTE STAINLESS STEEL,$111.55,$0.00,$111.55,$50.20,$79.61,$0.00,$19.22,$0.00,$0.00,$19.53,$111.55,$0.00,$55.78,$88.35,$89.24,$0.00,$17.46,$0.00,$17.76,$0.00
248001840,SUP,HCPCS C1713,,00248001840  -  SCREW BONE 4MM 18MM 7MM FORTE STAINLESS STEEL CANCELLOUS,$111.55,$0.00,$111.55,$50.20,$79.61,$0.00,$19.22,$0.00,$0.00,$19.53,$111.55,$0.00,$55.78,$88.35,$89.24,$0.00,$17.46,$0.00,$17.76,$0.00
248001841,SUP,HCPCS C1713,,00248001841  -  SCREW BONE FULTHD 4MM 18MM FORTE STAINLESS STEEL,$111.55,$0.00,$111.55,$50.20,$79.61,$0.00,$19.22,$0.00,$0.00,$19.53,$111.55,$0.00,$55.78,$88.35,$89.24,$0.00,$17.46,$0.00,$17.76,$0.00
248002040,SUP,HCPCS C1713,,00248002040  -  SCREW BONE 4MM 20MM 8MM FORTE STAINLESS STEEL CANCELLOUS,$111.55,$0.00,$111.55,$50.20,$79.61,$0.00,$19.22,$0.00,$0.00,$19.53,$111.55,$0.00,$55.78,$88.35,$89.24,$0.00,$17.46,$0.00,$17.76,$0.00
248002041,SUP,HCPCS C1713,,00248002041  -  SCREW BONE FULTHD 4MM 20MM FORTE STAINLESS STEEL CANCELLOUS,$111.55,$0.00,$111.55,$50.20,$79.61,$0.00,$19.22,$0.00,$0.00,$19.53,$111.55,$0.00,$55.78,$88.35,$89.24,$0.00,$17.46,$0.00,$17.76,$0.00
248002240,SUP,HCPCS C1713,,00248002240  -  SCREW BONE 4MM 22MM 9MM FORTE STAINLESS STEEL CANCELLOUS,$111.55,$0.00,$111.55,$50.20,$79.61,$0.00,$19.22,$0.00,$0.00,$19.53,$111.55,$0.00,$55.78,$88.35,$89.24,$0.00,$17.46,$0.00,$17.76,$0.00
248002241,SUP,HCPCS C1713,,00248002241  -  SCREW BONE FULTHD 4MM 22MM FORTE STAINLESS STEEL CANCELLOUS,$111.55,$0.00,$111.55,$50.20,$79.61,$0.00,$19.22,$0.00,$0.00,$19.53,$111.55,$0.00,$55.78,$88.35,$89.24,$0.00,$17.46,$0.00,$17.76,$0.00
248002440,SUP,HCPCS C1713,,00248002440  -  SCREW BONE 4MM 24MM 10MM FORTE STAINLESS STEEL CANCELLOUS,$111.55,$0.00,$111.55,$50.20,$79.61,$0.00,$19.22,$0.00,$0.00,$19.53,$111.55,$0.00,$55.78,$88.35,$89.24,$0.00,$17.46,$0.00,$17.76,$0.00
248002441,SUP,HCPCS C1713,,00248002441  -  SCREW BONE FULTHD 4MM 24MM FORTE STAINLESS STEEL CANCELLOUS,$111.55,$0.00,$111.55,$50.20,$79.61,$0.00,$19.22,$0.00,$0.00,$19.53,$111.55,$0.00,$55.78,$88.35,$89.24,$0.00,$17.46,$0.00,$17.76,$0.00
248002640,SUP,HCPCS C1713,,00248002640  -  SCREW BONE 4MM 26MM 12MM FORTE STAINLESS STEEL CANCELLOUS,$111.55,$0.00,$111.55,$50.20,$79.61,$0.00,$19.22,$0.00,$0.00,$19.53,$111.55,$0.00,$55.78,$88.35,$89.24,$0.00,$17.46,$0.00,$17.76,$0.00
248002641,SUP,HCPCS C1713,,00248002641  -  SCREW BONE FULTHD 4MM 26MM FORTE STAINLESS STEEL CANCELLOUS,$111.55,$0.00,$111.55,$50.20,$79.61,$0.00,$19.22,$0.00,$0.00,$19.53,$111.55,$0.00,$55.78,$88.35,$89.24,$0.00,$17.46,$0.00,$17.76,$0.00
248002840,SUP,HCPCS C1713,,00248002840  -  SCREW BONE 4MM 28MM 14MM FORTE STAINLESS STEEL CANCELLOUS,$111.55,$0.00,$111.55,$50.20,$79.61,$0.00,$19.22,$0.00,$0.00,$19.53,$111.55,$0.00,$55.78,$88.35,$89.24,$0.00,$17.46,$0.00,$17.76,$0.00
248002841,SUP,HCPCS C1713,,00248002841  -  SCREW BONE FULTHD 4MM 28MM FORTE STAINLESS STEEL CANCELLOUS,$111.55,$0.00,$111.55,$50.20,$79.61,$0.00,$19.22,$0.00,$0.00,$19.53,$111.55,$0.00,$55.78,$88.35,$89.24,$0.00,$17.46,$0.00,$17.76,$0.00
248003040,SUP,HCPCS C1713,,00248003040  -  SCREW BONE 4MM 30MM 14MM FORTE STAINLESS STEEL CANCELLOUS,$111.55,$0.00,$111.55,$50.20,$79.61,$0.00,$19.22,$0.00,$0.00,$19.53,$111.55,$0.00,$55.78,$88.35,$89.24,$0.00,$17.46,$0.00,$17.76,$0.00
248003041,SUP,HCPCS C1713,,00248003041  -  SCREW BONE FULTHD 4MM 30MM FORTE STAINLESS STEEL CANCELLOUS,$111.55,$0.00,$111.55,$50.20,$79.61,$0.00,$19.22,$0.00,$0.00,$19.53,$111.55,$0.00,$55.78,$88.35,$89.24,$0.00,$17.46,$0.00,$17.76,$0.00
248003240,SUP,HCPCS C1713,,00248003240  -  SCREW BONE 4MM 32MM 14MM FORTE STAINLESS STEEL CANCELLOUS,$111.55,$0.00,$111.55,$50.20,$79.61,$0.00,$19.22,$0.00,$0.00,$19.53,$111.55,$0.00,$55.78,$88.35,$89.24,$0.00,$17.46,$0.00,$17.76,$0.00
248003241,SUP,HCPCS C1713,,00248003241  -  SCREW BONE FULTHD 4MM 32MM FORTE STAINLESS STEEL CANCELLOUS,$111.55,$0.00,$111.55,$50.20,$79.61,$0.00,$19.22,$0.00,$0.00,$19.53,$111.55,$0.00,$55.78,$88.35,$89.24,$0.00,$17.46,$0.00,$17.76,$0.00
248003440,SUP,HCPCS C1713,,00248003440  -  SCREW BONE 4MM 34MM 14MM FORTE STAINLESS STEEL CANCELLOUS,$111.55,$0.00,$111.55,$50.20,$79.61,$0.00,$19.22,$0.00,$0.00,$19.53,$111.55,$0.00,$55.78,$88.35,$89.24,$0.00,$17.46,$0.00,$17.76,$0.00
248003441,SUP,HCPCS C1713,,00248003441  -  SCREW BONE FULTHD 4MM 34MM FORTE STAINLESS STEEL CANCELLOUS,$111.55,$0.00,$111.55,$50.20,$79.61,$0.00,$19.22,$0.00,$0.00,$19.53,$111.55,$0.00,$55.78,$88.35,$89.24,$0.00,$17.46,$0.00,$17.76,$0.00
248003640,SUP,HCPCS C1713,,00248003640  -  SCREW BONE 4MM 36MM 14MM FORTE STAINLESS STEEL CANCELLOUS,$111.55,$0.00,$111.55,$50.20,$79.61,$0.00,$19.22,$0.00,$0.00,$19.53,$111.55,$0.00,$55.78,$88.35,$89.24,$0.00,$17.46,$0.00,$17.76,$0.00
248003641,SUP,HCPCS C1713,,00248003641  -  SCREW BONE FULTHD 4MM 36MM FORTE STAINLESS STEEL CANCELLOUS,$111.55,$0.00,$111.55,$50.20,$79.61,$0.00,$19.22,$0.00,$0.00,$19.53,$111.55,$0.00,$55.78,$88.35,$89.24,$0.00,$17.46,$0.00,$17.76,$0.00
248003840,SUP,HCPCS C1713,,00248003840  -  SCREW BONE 4MM 38MM 14MM FORTE STAINLESS STEEL CANCELLOUS,$111.55,$0.00,$111.55,$50.20,$79.61,$0.00,$19.22,$0.00,$0.00,$19.53,$111.55,$0.00,$55.78,$88.35,$89.24,$0.00,$17.46,$0.00,$17.76,$0.00
248003841,SUP,HCPCS C1713,,00248003841  -  SCREW BONE FULTHD 4MM 38MM FORTE STAINLESS STEEL CANCELLOUS,$111.55,$0.00,$111.55,$50.20,$79.61,$0.00,$19.22,$0.00,$0.00,$19.53,$111.55,$0.00,$55.78,$88.35,$89.24,$0.00,$17.46,$0.00,$17.76,$0.00
248004040,SUP,HCPCS C1713,,00248004040  -  SCREW BONE 4MM 40MM 14MM FORTE STAINLESS STEEL CANCELLOUS,$111.55,$0.00,$111.55,$50.20,$79.61,$0.00,$19.22,$0.00,$0.00,$19.53,$111.55,$0.00,$55.78,$88.35,$89.24,$0.00,$17.46,$0.00,$17.76,$0.00
248004041,SUP,HCPCS C1713,,00248004041  -  SCREW BONE FULTHD 4MM 40MM FORTE STAINLESS STEEL CANCELLOUS,$111.55,$0.00,$111.55,$50.20,$79.61,$0.00,$19.22,$0.00,$0.00,$19.53,$111.55,$0.00,$55.78,$88.35,$89.24,$0.00,$17.46,$0.00,$17.76,$0.00
248781032,SUP,Custom 27203010,,248781032  -  STATION EYEWASH 17.5X15IN 4 SCREW HOLE SAFETY BOTTLE WALL,$141.66,$0.00,$141.66,$0.00,$101.10,$0.00,$0.00,$0.00,$0.00,$0.00,$141.66,$0.00,$70.83,$112.19,$113.33,$0.00,$0.00,$0.00,$0.00,$0.00
272350250,SUP,HCPCS C1769,,272350250  -  GUIDEWIRE ORTHOPEDIC 1.57MM SHARP,$187.50,$0.00,$187.50,$101.81,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
279351100,SUP,Custom 27203010,,0279351100  -  ELTRD ESURG 90MM 3.5MM SERFAS ENRG 90D PRB SCT ARTHRO LATEX,$507.88,$0.00,$507.88,$0.00,$362.47,$0.00,$0.00,$0.00,$0.00,$0.00,$507.88,$0.00,$253.94,$402.24,$406.30,$0.00,$0.00,$0.00,$0.00,$0.00
279351300,SUP,Custom 27203010,,0279351300  -  PROBE SCT 90MM SERFAS ENRG 3.5MM LATEX FREE,$522.75,$0.00,$522.75,$0.00,$373.09,$0.00,$0.00,$0.00,$0.00,$0.00,$522.75,$0.00,$261.38,$414.02,$418.20,$0.00,$0.00,$0.00,$0.00,$0.00
283903611,SUP,HCPCS C1894,,283903611  -  NEEDLE SPNL 11GA 6IN INTRO CNFD DMD TIP,$165.00,$0.00,$165.00,$89.60,$117.76,$0.00,$28.43,$0.00,$0.00,$28.89,$165.00,$0.00,$82.50,$130.68,$132.00,$0.00,$25.82,$0.00,$26.27,$0.00
286565001,SUP,Custom 27803010,,286565001  -  HOLDER IMPL SWIFT PIN TEMP FIX THRD,$337.50,$0.00,$337.50,$0.00,$240.87,$0.00,$0.00,$0.00,$0.00,$0.00,$337.50,$0.00,$168.75,$267.30,$270.00,$0.00,$0.00,$0.00,$0.00,$0.00
286705200,SUP,Custom 27203010,,286705200  -  GWIRE ORTH 1.37MM VPR THRD BLNT DISP,$562.50,$0.00,$562.50,$0.00,$401.46,$0.00,$0.00,$0.00,$0.00,$0.00,$562.50,$0.00,$281.25,$445.50,$450.00,$0.00,$0.00,$0.00,$0.00,$0.00
286705220,SUP,Custom 27203010,,286705220  -  GWIRE ORTH 1.45MM VPR 2 BLNT,$575.00,$0.00,$575.00,$0.00,$410.38,$0.00,$0.00,$0.00,$0.00,$0.00,$575.00,$0.00,$287.50,$455.40,$460.00,$0.00,$0.00,$0.00,$0.00,$0.00
286820012,SUP,Custom 27203010,,286820012  -  BIT DRL 2.2MM 12MM NS SKYLINE REUSE ANT CRV PLT SYS,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
286820014,SUP,Custom 27203010,,286820014  -  DRILL SURG 14MM,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
286820016,SUP,Custom 27203010,,286820016  -  BIT DRILL FLAT 16MM CHUCK SKYLINE DISPOSABLE,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
286850100,SUP,HCPCS C1713,,286850100  -  PIN FIX STR TEMPORARY SKYLINE SPN,$337.50,$0.00,$337.50,$151.88,$240.87,$0.00,$58.15,$0.00,$0.00,$59.09,$337.50,$0.00,$168.75,$267.30,$270.00,$0.00,$52.82,$0.00,$53.73,$0.00
286850200,SUP,HCPCS C1713,,286850200  -  PIN FIX 200MM 50MM THREADED TEMPORARY SKYLINE SPN,$337.50,$0.00,$337.50,$151.88,$240.87,$0.00,$58.15,$0.00,$0.00,$59.09,$337.50,$0.00,$168.75,$267.30,$270.00,$0.00,$52.82,$0.00,$53.73,$0.00
288301114,SUP,Custom 27203010,,288301114  -  GUIDE DRILL 14MM FIX,$612.50,$0.00,$612.50,$0.00,$437.14,$0.00,$0.00,$0.00,$0.00,$0.00,$612.50,$0.00,$306.25,$485.10,$490.00,$0.00,$0.00,$0.00,$0.00,$0.00
288302030,SUP,Custom 27203010,,288302030  -  TAP SURG 3MM,"$1,125.00",$0.00,"$1,125.00",$0.00,$802.91,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$0.00,$0.00,$0.00,$0.00
288302035,SUP,Custom 27203010,,288302035  -  TAP SPINAL 3.5MM STAINLESS STEEL DISPOSABLE,"$1,125.00",$0.00,"$1,125.00",$0.00,$802.91,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$0.00,$0.00,$0.00,$0.00
288302040,SUP,Custom 27203010,,288302040  -  TAP SURG 4MM MOUNTAINEER DISPOSABLE,"$1,125.00",$0.00,"$1,125.00",$0.00,$802.91,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$0.00,$0.00,$0.00,$0.00
288310035,SUP,Custom 27100030,,288310035  -  BIT DRILL 3.5MM QC,$612.50,$0.00,$612.50,$0.00,$437.14,$0.00,$0.00,$0.00,$0.00,$0.00,$612.50,$0.00,$306.25,$485.10,$490.00,$0.00,$0.00,$0.00,$0.00,$0.00
292301001,SUP,Custom 27011340,,292301001  -  HALTER TRC 19-26IN 3DHLCR HEAD,"$1,560.00",$0.00,"$1,560.00",$0.00,"$1,113.37",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,560.00",$0.00,$780.00,"$1,235.52","$1,248.00",$0.00,$0.00,$0.00,$0.00,$0.00
306573000,SUP,HCPCS C1713,,306573000  -  KIT BN CMNT ACM BWL CMNT CRTDG FEM NOZ MED PRS 180GM,$234.28,$0.00,"$1,440.03",$648.01,"$1,027.75",$0.00,$248.11,$0.00,$0.00,$252.14,"$1,440.03",$0.00,$720.01,$185.55,"$1,152.02",$0.00,$225.36,$0.00,$229.25,$0.00
306573000,SUP,HCPCS C1713,,0306573000  -  KIT BN CMNT ACM BWL CMNT CRTDG FEM NOZ MED PRS 180GM,"$1,440.03",$0.00,"$1,440.03",$648.01,"$1,027.75",$0.00,$248.11,$0.00,$0.00,$252.14,"$1,440.03",$0.00,$720.01,"$1,140.50","$1,152.02",$0.00,$225.36,$0.00,$229.25,$0.00
321500000,SUP,Custom 27203010,,AIRWAY ESPH 5 ADLT ARNC LRYNG MASK CUF CURVE UNQ LF PVC 40ML,$15.63,$0.00,$15.63,$0.00,$11.15,$0.00,$0.00,$0.00,$0.00,$0.00,$15.63,$0.00,$7.81,$12.38,$12.50,$0.00,$0.00,$0.00,$0.00,$0.00
336612008,SUP,Custom 27803010,,336612008  -  CAGE SPNL 12MM 8MM VBOSS TI THORLMBR INTRBD FS,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
336612009,SUP,Custom 27803010,,336612009  -  CAGE SPNL 12MM 9MM VBOSS TI THORLMBR INTRBD FS,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
336612010,SUP,Custom 27803010,,336612010  -  CAGE SPNL 12MM 10MM VBOSS TI THORLMBR INTRBD FS,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
336612011,SUP,Custom 27803010,,336612011  -  CAGE SPNL 12MM 11MM VBOSS TI THORLMBR INTRBD FS,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
336612012,SUP,Custom 27803010,,336612012  -  CAGE SPNL 12MM 12MM VBOSS TI THORLMBR INTRBD FS,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
336612040,SUP,Custom 27803010,,336612040  -  CAGE SPNL 12MM 40MM VBOSS TI THORLMBR INTRBD FS,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
336612080,SUP,Custom 27803010,,336612080  -  CAGE SPNL 12MM 80MM VBOSS TI THORLMBR INTRBD FS,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
336614008,SUP,Custom 27803010,,336614008  -  CAGE SPNL 14MM 8MM VBOSS TI THORLMBR INTRBD FS,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
336614009,SUP,Custom 27803010,,336614009  -  CAGE SPNL 14MM 9MM VBOSS TI THORLMBR INTRBD FS,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
336614010,SUP,Custom 27803010,,336614010  -  CAGE SPNL 14MM 10MM VBOSS TI THORLMBR INTRBD FS,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
336614011,SUP,Custom 27803010,,336614011  -  CAGE SPNL 14MM 11MM VBOSS TI THORLMBR INTRBD FS,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
336614012,SUP,Custom 27803010,,336614012  -  CAGE SPNL 14MM 12MM VBOSS TI THORLMBR INTRBD FS,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
336614040,SUP,Custom 27803010,,336614040  -  CAGE SPNL 14MM 40MM VBOSS TI THORLMBR INTRBD FS,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
336614080,SUP,Custom 27803010,,336614080  -  CAGE SPNL 14MM 80MM VBOSS TI THORLMBR INTRBD FS,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
336616040,SUP,Custom 27803010,,336616040  -  CAGE SPNL 16MM 40MM VBOSS TI THORLMBR INTRBD FS,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
336616080,SUP,Custom 27803010,,336616080  -  CAGE SPNL 16MM 80MM VBOSS TI THORLMBR INTRBD FS,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
336620040,SUP,Custom 27803010,,336620040  -  CAGE SPNL 20MM 40MM VBOSS TI THORLMBR INTRBD FS,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
336620080,SUP,Custom 27803010,,336620080  -  CAGE SPNL 20MM 80MM VBOSS TI THORLMBR INTRBD FS,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
336620120,SUP,Custom 27803010,,336620120  -  CAGE SPNL 20MM 120MM VBOSS TI THORLMBR INTRBD FS,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
336625040,SUP,Custom 27803010,,336625040  -  CAGE SPNL 25MM 40MM VBOSS TI THORLMBR INTRBD FS,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
336625080,SUP,Custom 27803010,,336625080  -  CAGE SPNL 25MM 80MM VBOSS TI THORLMBR INTRBD FS,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
336625120,SUP,Custom 27803010,,336625120  -  CAGE SPNL 25MM 120MM VBOSS TI THORLMBR INTRBD FS,"$6,250.00",$0.00,"$6,250.00",$0.00,"$4,460.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
380544150,SUP,Custom 27203010,,380544150  -  CUTTER ENDSCP ANG AGRS+ FRML 4.5MM,$238.00,$0.00,$238.00,$0.00,$169.86,$0.00,$0.00,$0.00,$0.00,$0.00,$238.00,$0.00,$119.00,$188.50,$190.40,$0.00,$0.00,$0.00,$0.00,$0.00
381003004,SUP,HCPCS C1773,,381003004  -  KIT SNR 3.2FR 2-4MM 175CM 150CM ATRIEVE VASC SNR 3 LOOP SHRT,"$1,250.00",$0.00,"$1,250.00",$678.75,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
381003008,SUP,HCPCS C1773,,381003008  -  KIT SNR 15D 3.2FR 4-8MM 175CM 150CM ATRIEVE VASC SNR 3 SHRT,"$1,250.00",$0.00,"$1,250.00",$678.75,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
382006010,SUP,HCPCS C1773,,382006010  -  KIT SNR 6-10MM 6FR .062IN 120CM 100CM ATRIEVE VASC SNR 3,$687.50,$0.00,$687.50,$373.31,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
382006015,SUP,HCPCS C1773,,382006015  -  KIT SNR 9-15MM 6FR .062IN 120CM 100CM ATRIEVE VASC SNR 3,$687.50,$0.00,$687.50,$373.31,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
382006020,SUP,HCPCS C1757,,382006020  -  SNARE VASC STD 12-20MM 6FR 120CM 100CM ENSNR CATH,$687.50,$0.00,$687.50,$0.00,$490.67,$0.00,$0.00,$0.00,$0.00,$0.00,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$0.00,$0.00,$0.00,$0.00
382007030,SUP,HCPCS C1773,,382007030  -  KIT SNR MN 18-30MM 7FR 120CM 100CM ATRIEVE VASC SNR DLV CATH,$687.50,$0.00,$687.50,$373.31,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
382007045,SUP,HCPCS C1773,,382007045  -  KIT SNR 27-45MM 7FR 120MM 100MM ATRIEVE VASC SNR DLV CATH,$687.50,$0.00,$687.50,$373.31,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
382412000,SUP,Custom 27203010,,382412000  -  KNEE  IMMOBILIZER MEDIUM,$48.24,$0.00,$48.24,$0.00,$34.43,$0.00,$0.00,$0.00,$0.00,$0.00,$48.24,$0.00,$24.12,$38.21,$38.59,$0.00,$0.00,$0.00,$0.00,$0.00
392006015,SUP,Custom 27203010,,SYSTEM SNARE 9 15MM TRIPLE LOOP STANDARD,$875.00,$0.00,$875.00,$0.00,$624.49,$0.00,$0.00,$0.00,$0.00,$0.00,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$0.00,$0.00,$0.00,$0.00
408831100,SUP,Custom 27203010,,0408831100  -  TOGA SRG XL FLYTE SURGICOOL PLWY ZP,$27.27,$0.00,$27.27,$0.00,$19.47,$0.00,$0.00,$0.00,$0.00,$0.00,$27.27,$0.00,$13.64,$21.60,$21.82,$0.00,$0.00,$0.00,$0.00,$0.00
436020300,SUP,HCPCS C1713,,436020300  -  ENDCAP 436020300 EXTNDED 20 X 30MM 0 DEG,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
436020305,SUP,HCPCS C1713,,436020305  -  ENDCAP 436020305 EXTND 20 X 30MM 15 DEG,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
436020350,SUP,HCPCS C1713,,436020350  -  ENDCAP 436020350 EXTNDED 20 X 35MM 0 DEG,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
436020355,SUP,HCPCS C1713,,436020355  -  ENDCAP 436020355 EXTND 20 X 35MM 15 DEG,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
436020400,SUP,HCPCS C1713,,436020400  -  ENDCAP 436020400 EXTNDED 20 X 40MM 0 DEG,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
436020405,SUP,HCPCS C1713,,436020405  -  ENDCAP 436020405 EXTND 20 X 40MM 15 DEG,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
436020450,SUP,HCPCS C1713,,436020450  -  ENDCAP 436020450 EXTNDED 20 X 45MM 0 DEG,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
436020455,SUP,HCPCS C1713,,436020455  -  ENDCAP 436020455 EXTND 20 X 45MM 15 DEG,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
436025300,SUP,HCPCS C1713,,436025300  -  ENDCAP 436025300 EXTNDED 25 X 30MM 0 DEG,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
436025305,SUP,HCPCS C1713,,436025305  -  ENDCAP 436025305 EXTND 25 X 30MM 15 DEG,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
436025350,SUP,HCPCS C1713,,436025350  -  ENDCAP 436025350 EXTNDED 25 X 35MM 0 DEG,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
436025355,SUP,HCPCS C1713,,436025355  -  ENDCAP 436025355 EXTND 25 X 35MM 15 DEG,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
436025400,SUP,HCPCS C1713,,436025400  -  ENDCAP 436025400 EXTNDED 25 X 40MM 0 DEG,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
436025405,SUP,HCPCS C1713,,436025405  -  ENDCAP 436025405 EXTND 25 X 40MM 15 DEG,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
436025450,SUP,HCPCS C1713,,436025450  -  ENDCAP 436025450 EXTNDED 25 X 45MM 0 DEG,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
436025455,SUP,HCPCS C1713,,436025455  -  ENDCAP 436025455 EXTND 25 X 45MM 15 DEG,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
436120300,SUP,HCPCS C1713,,436120300  -  ENDCAP 436120300 EXTENDED 20 X 30MM STER,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
436120305,SUP,HCPCS C1713,,436120305  -  ENDCAP 436120305 EXTND 20X30MM 15 DEG ST,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
436120350,SUP,HCPCS C1713,,436120350  -  ENDCAP 436120350 EXTENDED 20 X 35MM STER,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
436120355,SUP,HCPCS C1713,,436120355  -  ENDCAP 436120355 EXTND 20X35MM 15 DEG ST,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
436120400,SUP,HCPCS C1713,,436120400  -  ENDCAP 436120400 EXTENDED 20 X 40MM STER,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
436120405,SUP,HCPCS C1713,,436120405  -  ENDCAP 436120405 EXTND 20X40MM 15 DEG ST,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
436120450,SUP,HCPCS C1713,,436120450  -  ENDCAP 436120450 EXTENDED 20 X 45MM STER,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
436120455,SUP,HCPCS C1713,,436120455  -  ENDCAP 436120455 EXTND 20X45MM 15 DEG ST,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
436125300,SUP,HCPCS C1713,,436125300  -  ENDCAP 436125300 EXTENDED 25 X 30MM STER,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
436125305,SUP,HCPCS C1713,,436125305  -  ENDCAP 436125305 EXTND 25X30MM 15 DEG ST,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
436125350,SUP,HCPCS C1713,,436125350  -  ENDCAP 436125350 EXTENDED 25 X 35MM STER,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
436125355,SUP,HCPCS C1713,,436125355  -  ENDCAP 436125355 EXTND 25X35MM 15 DEG ST,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
436125400,SUP,HCPCS C1713,,436125400  -  ENDCAP 436125400 EXTENDED 25 X 40MM STER,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
436125405,SUP,HCPCS C1713,,436125405  -  ENDCAP 436125405 EXTND 25X40MM 15 DEG ST,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
436125450,SUP,HCPCS C1713,,436125450  -  ENDCAP 436125450 EXTENDED 25 X 45MM STER,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
436125455,SUP,HCPCS C1713,,436125455  -  ENDCAP 436125455 EXTND 25X45MM 15 DEG ST,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
480316022,SUP,HCPCS C1713,,480316022  -  SCREW BONE LONG STANDARD 6MM 22MM SPN THORACIC,$914.88,$0.00,$914.88,$411.69,$652.95,$0.00,$157.63,$0.00,$0.00,$160.19,$914.88,$0.00,$457.44,$724.58,$731.90,$0.00,$143.18,$0.00,$145.65,$0.00
480316025,SUP,HCPCS C1713,,480316025  -  SCREW BONE LONG STANDARD 6MM 25MM SPN THORACIC,$914.88,$0.00,$914.88,$411.69,$652.95,$0.00,$157.63,$0.00,$0.00,$160.19,$914.88,$0.00,$457.44,$724.58,$731.90,$0.00,$143.18,$0.00,$145.65,$0.00
480316028,SUP,HCPCS C1713,,480316028  -  SCREW BONE LONG STANDARD 6MM 28MM SPN THORACIC,$914.88,$0.00,$914.88,$411.69,$652.95,$0.00,$157.63,$0.00,$0.00,$160.19,$914.88,$0.00,$457.44,$724.58,$731.90,$0.00,$143.18,$0.00,$145.65,$0.00
480316031,SUP,HCPCS C1713,,480316031  -  SCREW BONE LONG STANDARD 6MM 31MM SPN THORACIC,$914.88,$0.00,$914.88,$411.69,$652.95,$0.00,$157.63,$0.00,$0.00,$160.19,$914.88,$0.00,$457.44,$724.58,$731.90,$0.00,$143.18,$0.00,$145.65,$0.00
480316034,SUP,HCPCS C1713,,480316034  -  SCREW BONE LONG STANDARD 6MM 34MM SPN THORACIC,$914.88,$0.00,$914.88,$411.69,$652.95,$0.00,$157.63,$0.00,$0.00,$160.19,$914.88,$0.00,$457.44,$724.58,$731.90,$0.00,$143.18,$0.00,$145.65,$0.00
480316037,SUP,HCPCS C1713,,480316037  -  SCREW BONE LONG STANDARD 6MM 37MM SPN THORACIC,$914.88,$0.00,$914.88,$411.69,$652.95,$0.00,$157.63,$0.00,$0.00,$160.19,$914.88,$0.00,$457.44,$724.58,$731.90,$0.00,$143.18,$0.00,$145.65,$0.00
480316040,SUP,HCPCS C1713,,480316040  -  SCREW BONE LONG STANDARD 6MM 40MM SPN THORACIC,$914.88,$0.00,$914.88,$411.69,$652.95,$0.00,$157.63,$0.00,$0.00,$160.19,$914.88,$0.00,$457.44,$724.58,$731.90,$0.00,$143.18,$0.00,$145.65,$0.00
480316043,SUP,HCPCS C1713,,480316043  -  SCREW BONE LONG STANDARD 6MM 43MM SPN THORACIC,$914.88,$0.00,$914.88,$411.69,$652.95,$0.00,$157.63,$0.00,$0.00,$160.19,$914.88,$0.00,$457.44,$724.58,$731.90,$0.00,$143.18,$0.00,$145.65,$0.00
480316046,SUP,HCPCS C1713,,480316046  -  SCREW BONE LONG STANDARD 6MM 46MM SPN THORACIC,$914.88,$0.00,$914.88,$411.69,$652.95,$0.00,$157.63,$0.00,$0.00,$160.19,$914.88,$0.00,$457.44,$724.58,$731.90,$0.00,$143.18,$0.00,$145.65,$0.00
480316049,SUP,HCPCS C1713,,480316049  -  SCREW BONE LONG STANDARD 6MM 49MM SPN THORACIC,$914.88,$0.00,$914.88,$411.69,$652.95,$0.00,$157.63,$0.00,$0.00,$160.19,$914.88,$0.00,$457.44,$724.58,$731.90,$0.00,$143.18,$0.00,$145.65,$0.00
480316052,SUP,HCPCS C1713,,480316052  -  SCREW BONE LONG STANDARD 6MM 52MM SPN THORACIC,$914.88,$0.00,$914.88,$411.69,$652.95,$0.00,$157.63,$0.00,$0.00,$160.19,$914.88,$0.00,$457.44,$724.58,$731.90,$0.00,$143.18,$0.00,$145.65,$0.00
480316055,SUP,HCPCS C1713,,480316055  -  SCREW BONE LONG STANDARD 6MM 55MM SPN THORACIC,$914.88,$0.00,$914.88,$411.69,$652.95,$0.00,$157.63,$0.00,$0.00,$160.19,$914.88,$0.00,$457.44,$724.58,$731.90,$0.00,$143.18,$0.00,$145.65,$0.00
480316058,SUP,HCPCS C1713,,480316058  -  SCREW BONE LONG STANDARD 6MM 58MM SPN THORACIC,$914.88,$0.00,$914.88,$411.69,$652.95,$0.00,$157.63,$0.00,$0.00,$160.19,$914.88,$0.00,$457.44,$724.58,$731.90,$0.00,$143.18,$0.00,$145.65,$0.00
480316061,SUP,HCPCS C1713,,480316061  -  SCREW BONE LONG STANDARD 6MM 61MM SPN THORACIC,$914.88,$0.00,$914.88,$411.69,$652.95,$0.00,$157.63,$0.00,$0.00,$160.19,$914.88,$0.00,$457.44,$724.58,$731.90,$0.00,$143.18,$0.00,$145.65,$0.00
480316064,SUP,HCPCS C1713,,480316064  -  SCREW BONE LONG STANDARD 6MM 64MM SPN THORACIC,$914.88,$0.00,$914.88,$411.69,$652.95,$0.00,$157.63,$0.00,$0.00,$160.19,$914.88,$0.00,$457.44,$724.58,$731.90,$0.00,$143.18,$0.00,$145.65,$0.00
480316067,SUP,HCPCS C1713,,480316067  -  SCREW BONE LONG STANDARD 6MM 67MM SPN THORACIC,$914.88,$0.00,$914.88,$411.69,$652.95,$0.00,$157.63,$0.00,$0.00,$160.19,$914.88,$0.00,$457.44,$724.58,$731.90,$0.00,$143.18,$0.00,$145.65,$0.00
480316522,SUP,HCPCS C1713,,480316522  -  SCREW BONE STANDARD 6.5MM 22MM SPN THORACIC,$914.88,$0.00,$914.88,$411.69,$652.95,$0.00,$157.63,$0.00,$0.00,$160.19,$914.88,$0.00,$457.44,$724.58,$731.90,$0.00,$143.18,$0.00,$145.65,$0.00
480316525,SUP,HCPCS C1713,,480316525  -  SCREW BONE STANDARD 6.5MM 25MM SPN THORACIC,$914.88,$0.00,$914.88,$411.69,$652.95,$0.00,$157.63,$0.00,$0.00,$160.19,$914.88,$0.00,$457.44,$724.58,$731.90,$0.00,$143.18,$0.00,$145.65,$0.00
480316528,SUP,HCPCS C1713,,480316528  -  SCREW BONE STANDARD 6.5MM 28MM SPN THORACIC,$914.88,$0.00,$914.88,$411.69,$652.95,$0.00,$157.63,$0.00,$0.00,$160.19,$914.88,$0.00,$457.44,$724.58,$731.90,$0.00,$143.18,$0.00,$145.65,$0.00
480316531,SUP,HCPCS C1713,,480316531  -  SCREW BONE STANDARD 6.5MM 31MM SPN THORACIC,$914.88,$0.00,$914.88,$411.69,$652.95,$0.00,$157.63,$0.00,$0.00,$160.19,$914.88,$0.00,$457.44,$724.58,$731.90,$0.00,$143.18,$0.00,$145.65,$0.00
480316534,SUP,HCPCS C1713,,480316534  -  SCREW BONE STANDARD 6.5MM 34MM SPN THORACIC,$914.88,$0.00,$914.88,$411.69,$652.95,$0.00,$157.63,$0.00,$0.00,$160.19,$914.88,$0.00,$457.44,$724.58,$731.90,$0.00,$143.18,$0.00,$145.65,$0.00
480316537,SUP,HCPCS C1713,,480316537  -  SCREW BONE STANDARD 6.5MM 37MM SPN THORACIC,$914.88,$0.00,$914.88,$411.69,$652.95,$0.00,$157.63,$0.00,$0.00,$160.19,$914.88,$0.00,$457.44,$724.58,$731.90,$0.00,$143.18,$0.00,$145.65,$0.00
480316540,SUP,HCPCS C1713,,480316540  -  SCREW BONE LONG STANDARD 6.5MM 40MM SPN THORACIC,$914.88,$0.00,$914.88,$411.69,$652.95,$0.00,$157.63,$0.00,$0.00,$160.19,$914.88,$0.00,$457.44,$724.58,$731.90,$0.00,$143.18,$0.00,$145.65,$0.00
480316543,SUP,HCPCS C1713,,480316543  -  SCREW BONE LONG STANDARD 6.5MM 43MM SPN THORACIC,$914.88,$0.00,$914.88,$411.69,$652.95,$0.00,$157.63,$0.00,$0.00,$160.19,$914.88,$0.00,$457.44,$724.58,$731.90,$0.00,$143.18,$0.00,$145.65,$0.00
480316546,SUP,HCPCS C1713,,480316546  -  SCREW BONE LONG STANDARD 6.5MM 46MM SPN THORACIC,$914.88,$0.00,$914.88,$411.69,$652.95,$0.00,$157.63,$0.00,$0.00,$160.19,$914.88,$0.00,$457.44,$724.58,$731.90,$0.00,$143.18,$0.00,$145.65,$0.00
480316549,SUP,HCPCS C1713,,480316549  -  SCREW BONE LONG STANDARD 6.5MM 49MM SPN THORACIC,$914.88,$0.00,$914.88,$411.69,$652.95,$0.00,$157.63,$0.00,$0.00,$160.19,$914.88,$0.00,$457.44,$724.58,$731.90,$0.00,$143.18,$0.00,$145.65,$0.00
480316552,SUP,HCPCS C1713,,480316552  -  SCREW BONE LONG STANDARD 6.5MM 52MM SPN THORACIC,$914.88,$0.00,$914.88,$411.69,$652.95,$0.00,$157.63,$0.00,$0.00,$160.19,$914.88,$0.00,$457.44,$724.58,$731.90,$0.00,$143.18,$0.00,$145.65,$0.00
480316555,SUP,HCPCS C1713,,480316555  -  SCREW BONE LONG STANDARD 6.5MM 55MM SPN THORACIC,$914.88,$0.00,$914.88,$411.69,$652.95,$0.00,$157.63,$0.00,$0.00,$160.19,$914.88,$0.00,$457.44,$724.58,$731.90,$0.00,$143.18,$0.00,$145.65,$0.00
480316558,SUP,HCPCS C1713,,480316558  -  SCREW BONE LONG STANDARD 6.5MM 58MM SPN THORACIC,$914.88,$0.00,$914.88,$411.69,$652.95,$0.00,$157.63,$0.00,$0.00,$160.19,$914.88,$0.00,$457.44,$724.58,$731.90,$0.00,$143.18,$0.00,$145.65,$0.00
480316561,SUP,HCPCS C1713,,480316561  -  SCREW BONE LONG STANDARD 6.5MM 61MM SPN THORACIC,$914.88,$0.00,$914.88,$411.69,$652.95,$0.00,$157.63,$0.00,$0.00,$160.19,$914.88,$0.00,$457.44,$724.58,$731.90,$0.00,$143.18,$0.00,$145.65,$0.00
480316564,SUP,HCPCS C1713,,480316564  -  SCREW BONE LONG STANDARD 6.5MM 64MM SPN THORACIC,$914.88,$0.00,$914.88,$411.69,$652.95,$0.00,$157.63,$0.00,$0.00,$160.19,$914.88,$0.00,$457.44,$724.58,$731.90,$0.00,$143.18,$0.00,$145.65,$0.00
480316567,SUP,HCPCS C1713,,480316567  -  SCREW BONE LONG STANDARD 6.5MM 67MM SPN THORACIC,$914.88,$0.00,$914.88,$411.69,$652.95,$0.00,$157.63,$0.00,$0.00,$160.19,$914.88,$0.00,$457.44,$724.58,$731.90,$0.00,$143.18,$0.00,$145.65,$0.00
481322040,SUP,HCPCS C1713,,481322040  -  ROD SPNL 4.5MM 40MM NS LF XIA PREBNT PCUT VIT SPNE,$437.50,$0.00,$437.50,$196.88,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
481322050,SUP,HCPCS C1713,,481322050  -  ROD SPNL 50MM 4.5MM XIA PREBNT VIT PCUT,$437.50,$0.00,$437.50,$196.88,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
481322070,SUP,HCPCS C1713,,481322070  -  ROD SPNL PREBNT HEX 4.5MM 70MM PCUT VITALIUM,$437.50,$0.00,$437.50,$196.88,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
482204020,SUP,HCPCS C1713,,482204020  -  SCREW BONE 4MM 20MM MNOAX XIA STAINLESS STEEL SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
482204025,SUP,HCPCS C1713,,482204025  -  SCREW BONE 4MM 25MM MNOAX XIA STAINLESS STEEL SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
482204030,SUP,HCPCS C1713,,482204030  -  SCREW BONE 4MM 30MM MNOAX XIA STAINLESS STEEL SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
482204035,SUP,HCPCS C1713,,482204035  -  SCREW BONE 4MM 35MM MNOAX XIA STAINLESS STEEL SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
482204040,SUP,HCPCS C1713,,482204040  -  SCREW BONE 4MM 40MM MNOAX XIA STAINLESS STEEL SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
482205025,SUP,HCPCS C1713,,482205025  -  SCREW BONE 5MM 25MM MNOAX XIA STAINLESS STEEL SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
482205030,SUP,HCPCS C1713,,482205030  -  SCREW BONE 5MM 30MM MNOAX XIA STAINLESS STEEL SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
482205035,SUP,HCPCS C1713,,482205035  -  SCREW BONE 5MM 35MM MNOAX XIA STAINLESS STEEL SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
482205040,SUP,HCPCS C1713,,482205040  -  SCREW BONE 5MM 40MM MNOAX XIA STAINLESS STEEL SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
482205045,SUP,HCPCS C1713,,482205045  -  SCREW BONE 5MM 45MM MNOAX XIA STAINLESS STEEL SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
482214020,SUP,HCPCS C1713,,482214020  -  SCREW BONE 4MM 20MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$5,737.50",$0.00,"$5,737.50","$2,581.88","$4,094.85",$0.00,$988.54,$0.00,$0.00,"$1,004.59","$5,737.50",$0.00,"$2,868.75","$4,544.10","$4,590.00",$0.00,$897.92,$0.00,$913.41,$0.00
482214025,SUP,HCPCS C1713,,482214025  -  SCREW BONE 4MM 25MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$5,737.50",$0.00,"$5,737.50","$2,581.88","$4,094.85",$0.00,$988.54,$0.00,$0.00,"$1,004.59","$5,737.50",$0.00,"$2,868.75","$4,544.10","$4,590.00",$0.00,$897.92,$0.00,$913.41,$0.00
482214030,SUP,HCPCS C1713,,482214030  -  SCREW BONE 4MM 30MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$5,737.50",$0.00,"$5,737.50","$2,581.88","$4,094.85",$0.00,$988.54,$0.00,$0.00,"$1,004.59","$5,737.50",$0.00,"$2,868.75","$4,544.10","$4,590.00",$0.00,$897.92,$0.00,$913.41,$0.00
482214035,SUP,HCPCS C1713,,482214035  -  SCREW BONE 4MM 35MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$5,875.00",$0.00,"$5,875.00","$2,643.75","$4,192.99",$0.00,"$1,012.23",$0.00,$0.00,"$1,028.67","$5,875.00",$0.00,"$2,937.50","$4,653.00","$4,700.00",$0.00,$919.44,$0.00,$935.30,$0.00
482214040,SUP,HCPCS C1713,,482214040  -  SCREW BONE 4MM 40MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$5,875.00",$0.00,"$5,875.00","$2,643.75","$4,192.99",$0.00,"$1,012.23",$0.00,$0.00,"$1,028.67","$5,875.00",$0.00,"$2,937.50","$4,653.00","$4,700.00",$0.00,$919.44,$0.00,$935.30,$0.00
482215025,SUP,HCPCS C1713,,482215025  -  SCREW BONE 5MM 25MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$5,287.50",$0.00,"$5,287.50","$2,379.38","$3,773.69",$0.00,$911.01,$0.00,$0.00,$925.80,"$5,287.50",$0.00,"$2,643.75","$4,187.70","$4,230.00",$0.00,$827.49,$0.00,$841.77,$0.00
482215030,SUP,HCPCS C1713,,482215030  -  SCREW BONE 5MM 30MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$5,287.50",$0.00,"$5,287.50","$2,379.38","$3,773.69",$0.00,$911.01,$0.00,$0.00,$925.80,"$5,287.50",$0.00,"$2,643.75","$4,187.70","$4,230.00",$0.00,$827.49,$0.00,$841.77,$0.00
482215035,SUP,HCPCS C1713,,482215035  -  SCREW BONE 5MM 35MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$5,287.50",$0.00,"$5,287.50","$2,379.38","$3,773.69",$0.00,$911.01,$0.00,$0.00,$925.80,"$5,287.50",$0.00,"$2,643.75","$4,187.70","$4,230.00",$0.00,$827.49,$0.00,$841.77,$0.00
482215040,SUP,HCPCS C1713,,482215040  -  SCREW BONE 5MM 40MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$4,750.00",$0.00,"$4,750.00","$2,137.50","$3,390.08",$0.00,$818.40,$0.00,$0.00,$831.69,"$4,750.00",$0.00,"$2,375.00","$3,762.00","$3,800.00",$0.00,$743.38,$0.00,$756.20,$0.00
482215045,SUP,HCPCS C1713,,482215045  -  SCREW BONE 5MM 45MM POLYAX XIA TITANIUM SPN THORACOLUMBAR,"$4,750.00",$0.00,"$4,750.00","$2,137.50","$3,390.08",$0.00,$818.40,$0.00,$0.00,$831.69,"$4,750.00",$0.00,"$2,375.00","$3,762.00","$3,800.00",$0.00,$743.38,$0.00,$756.20,$0.00
482301500,SUP,HCPCS C1713,,482301500  -  SCREW BONE 1.5MM 100MM REVISION MNOAX ILIOSACRAL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
482301540,SUP,HCPCS C1713,,482301540  -  SCREW BONE 1.5MM 40MM REVISION MNOAX ILIOSACRAL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
482301545,SUP,HCPCS C1713,,482301545  -  SCREW BONE 1.5MM 45MM REVISION MNOAX ILIOSACRAL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
482301550,SUP,HCPCS C1713,,482301550  -  SCREW BONE 1.5MM 50MM REVISION MNOAX ILIOSACRAL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
482301555,SUP,HCPCS C1713,,482301555  -  SCREW BONE 1.5MM 55MM REVISION MNOAX ILIOSACRAL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
482301560,SUP,HCPCS C1713,,482301560  -  SCREW BONE 1.5MM 60MM REVISION MNOAX ILIOSACRAL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
482301565,SUP,HCPCS C1713,,482301565  -  SCREW BONE 1.5MM 65MM REVISION MNOAX ILIOSACRAL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
482301570,SUP,HCPCS C1713,,482301570  -  SCREW BONE 1.5MM 70MM REVISION MNOAX ILIOSACRAL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
482301580,SUP,HCPCS C1713,,482301580  -  SCREW BONE 1.5MM 80MM REVISION MNOAX ILIOSACRAL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
482301590,SUP,HCPCS C1713,,482301590  -  SCREW BONE 1.5MM 90MM REVISION MNOAX ILIOSACRAL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
482304020,SUP,HCPCS C1713,,482304020  -  SCREW BONE 4MM 20MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482304025,SUP,HCPCS C1713,,482304025  -  SCREW BONE 4MM 25MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482304030,SUP,HCPCS C1713,,482304030  -  SCREW BONE 4MM 30MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482304035,SUP,HCPCS C1713,,482304035  -  SCREW BONE 4MM 35MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482304040,SUP,HCPCS C1713,,482304040  -  SCREW BONE 4MM 40MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482304045,SUP,HCPCS C1713,,482304045  -  SCREW BONE 4MM 45MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482304520,SUP,HCPCS C1713,,482304520  -  SCREW BONE 4.5MM 20MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482304525,SUP,HCPCS C1713,,482304525  -  SCREW BONE 4.5MM 25MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482304530,SUP,HCPCS C1713,,482304530  -  SCREW BONE 4.5MM 30MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482304535,SUP,HCPCS C1713,,482304535  -  SCREW BONE 4.5MM 35MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482304540,SUP,HCPCS C1713,,482304540  -  SCREW BONE 4.5MM 40MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482304545,SUP,HCPCS C1713,,482304545  -  SCREW BONE 4.5MM 45MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482305020,SUP,HCPCS C1713,,482305020  -  SCREW BONE 5MM 20MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482305025,SUP,HCPCS C1713,,482305025  -  SCREW BONE 5MM 25MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482305030,SUP,HCPCS C1713,,482305030  -  SCREW BONE 5MM 30MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482305035,SUP,HCPCS C1713,,482305035  -  SCREW BONE 5MM 35MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482305040,SUP,HCPCS C1713,,482305040  -  SCREW BONE 5MM 40MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482305045,SUP,HCPCS C1713,,482305045  -  SCREW BONE 5MM 45MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482305050,SUP,HCPCS C1713,,482305050  -  SCREW BONE 5MM 50MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482305525,SUP,HCPCS C1713,,482305525  -  SCREW BONE 5.5MM 25MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482305530,SUP,HCPCS C1713,,482305530  -  SCREW BONE 5.5MM 30MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482305535,SUP,HCPCS C1713,,482305535  -  SCREW BONE 5.5MM 35MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482305540,SUP,HCPCS C1713,,482305540  -  SCREW BONE 5.5MM 40MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482305545,SUP,HCPCS C1713,,482305545  -  SCREW BONE 5.5MM 45MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482305550,SUP,HCPCS C1713,,482305550  -  SCREW BONE 5.5MM 50MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482305555,SUP,HCPCS C1713,,482305555  -  SCREW BONE 5.5MM 55MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482306025,SUP,HCPCS C1713,,482306025  -  SCREW BONE 6MM 25MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482306030,SUP,HCPCS C1713,,482306030  -  SCREW BONE 6MM 30MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482306035,SUP,HCPCS C1713,,482306035  -  SCREW BONE 6MM 35MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482306040,SUP,HCPCS C1713,,482306040  -  SCREW BONE 6MM 40MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482306045,SUP,HCPCS C1713,,482306045  -  SCREW BONE 6MM 45MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482306050,SUP,HCPCS C1713,,482306050  -  SCREW BONE 6MM 50MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482306055,SUP,HCPCS C1713,,482306055  -  SCREW BONE 6MM 55MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482306060,SUP,HCPCS C1713,,482306060  -  SCREW BONE 6MM 60MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482306065,SUP,HCPCS C1713,,482306065  -  SCREW BONE 6MM 65MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482306070,SUP,HCPCS C1713,,482306070  -  SCREW BONE 6MM 70MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482306080,SUP,HCPCS C1713,,482306080  -  SCREW BONE 6MM 80MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482306090,SUP,HCPCS C1713,,482306090  -  SCREW BONE 6MM 90MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482306525,SUP,HCPCS C1713,,482306525  -  SCREW BONE 6.5MM 25MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482306530,SUP,HCPCS C1713,,482306530  -  SCREW BONE 6.5MM 30MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482306535,SUP,HCPCS C1713,,482306535  -  SCREW BONE 6.5MM 35MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482306540,SUP,HCPCS C1713,,482306540  -  SCREW BONE 6.5MM 40MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482306545,SUP,HCPCS C1713,,482306545  -  SCREW BONE 6.5MM 45MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482306550,SUP,HCPCS C1713,,482306550  -  SCREW BONE 6.5MM 50MM MULTIAX XIA 3 TITANIUM SPN,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482306555,SUP,HCPCS C1713,,482306555  -  SCREW BONE 6.5MM 55MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482306560,SUP,HCPCS C1713,,482306560  -  SCREW BONE 6.5MM 60MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482306565,SUP,HCPCS C1713,,482306565  -  SCREW BONE 6.5MM 65MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482306570,SUP,HCPCS C1713,,482306570  -  SCREW BONE 6.5MM 70MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482306580,SUP,HCPCS C1713,,482306580  -  SCREW BONE 6.5MM 80MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482306590,SUP,HCPCS C1713,,482306590  -  SCREW BONE 6.5MM 90MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482307025,SUP,HCPCS C1713,,482307025  -  SCREW BONE 7MM 25MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482307030,SUP,HCPCS C1713,,482307030  -  SCREW BONE 7MM 30MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482307035,SUP,HCPCS C1713,,482307035  -  SCREW BONE 7MM 35MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482307040,SUP,HCPCS C1713,,482307040  -  SCREW BONE 7MM 40MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482307045,SUP,HCPCS C1713,,482307045  -  SCREW BONE 7MM 45MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482307050,SUP,HCPCS C1713,,482307050  -  SCREW BONE 7MM 50MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482307055,SUP,HCPCS C1713,,482307055  -  SCREW BONE 7MM 55MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482307060,SUP,HCPCS C1713,,482307060  -  SCREW BONE 7MM 60MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482307065,SUP,HCPCS C1713,,482307065  -  SCREW BONE 7MM 65MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482307070,SUP,HCPCS C1713,,482307070  -  SCREW BONE 7MM 70MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482307080,SUP,HCPCS C1713,,482307080  -  SCREW BONE 7MM 80MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482307090,SUP,HCPCS C1713,,482307090  -  SCREW BONE 7MM 90MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482307525,SUP,HCPCS C1713,,482307525  -  SCREW BONE 7.5MM 25MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482307530,SUP,HCPCS C1713,,482307530  -  SCREW BONE 7.5MM 30MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482307535,SUP,HCPCS C1713,,482307535  -  SCREW BONE 7.5MM 35MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482307540,SUP,HCPCS C1713,,482307540  -  SCREW BONE 7.5MM 40MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482307545,SUP,HCPCS C1713,,482307545  -  SCREW BONE 7.5MM 45MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482307550,SUP,HCPCS C1713,,482307550  -  SCREW BONE 7.5MM 50MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482307555,SUP,HCPCS C1713,,482307555  -  SCREW BONE 7.5MM 55MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482307560,SUP,HCPCS C1713,,482307560  -  SCREW BONE 7.5MM 60MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482307565,SUP,HCPCS C1713,,482307565  -  SCREW BONE 7.5MM 65MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482307570,SUP,HCPCS C1713,,482307570  -  SCREW BONE 7.5MM 70MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482307580,SUP,HCPCS C1713,,482307580  -  SCREW BONE 7.5MM 80MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482307590,SUP,HCPCS C1713,,482307590  -  SCREW BONE 7.5MM 90MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482308500,SUP,HCPCS C1713,,482308500  -  SCREW BONE 8.5MM 100MM REVISION MNOAX ILIOSACRAL,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482308525,SUP,HCPCS C1713,,482308525  -  SCREW BONE 8.5MM 25MM REVISION MNOAX ILIOSACRAL,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482308530,SUP,HCPCS C1713,,482308530  -  SCREW BONE 8.5MM 30MM REVISION MNOAX ILIOSACRAL,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482308535,SUP,HCPCS C1713,,482308535  -  SCREW BONE 8.5MM 35MM REVISION MNOAX ILIOSACRAL,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482308540,SUP,HCPCS C1713,,482308540  -  SCREW BONE 8.5MM 40MM REVISION MNOAX ILIOSACRAL,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482308545,SUP,HCPCS C1713,,482308545  -  SCREW BONE 8.5MM 45MM REVISION MNOAX ILIOSACRAL,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482308550,SUP,HCPCS C1713,,482308550  -  SCREW BONE 8.5MM 50MM REVISION MNOAX ILIOSACRAL,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482308555,SUP,HCPCS C1713,,482308555  -  SCREW BONE 8.5MM 55MM REVISION MNOAX ILIOSACRAL,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482308560,SUP,HCPCS C1713,,482308560  -  SCREW BONE 8.5MM 60MM REVISION MNOAX ILIOSACRAL,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482308565,SUP,HCPCS C1713,,482308565  -  SCREW BONE 8.5MM 65MM REVISION MNOAX ILIOSACRAL,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482308570,SUP,HCPCS C1713,,482308570  -  SCREW BONE 8.5MM 70MM REVISION MNOAX ILIOSACRAL,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482308580,SUP,HCPCS C1713,,482308580  -  SCREW BONE 8.5MM 80MM REVISION MNOAX ILIOSACRAL,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482308590,SUP,HCPCS C1713,,482308590  -  SCREW BONE 8.5MM 90MM REVISION MNOAX ILIOSACRAL,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482309500,SUP,HCPCS C1713,,482309500  -  SCREW BONE 9.5MM 100MM REVISION MNOAX ILIOSACRAL,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482309540,SUP,HCPCS C1713,,482309540  -  SCREW BONE 9.5MM 40MM REVISION MNOAX ILIOSACRAL,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482309545,SUP,HCPCS C1713,,482309545  -  SCREW BONE 9.5MM 45MM REVISION MNOAX ILIOSACRAL,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482309550,SUP,HCPCS C1713,,482309550  -  SCREW BONE 9.5MM 50MM REVISION MNOAX ILIOSACRAL,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482309555,SUP,HCPCS C1713,,482309555  -  SCREW BONE 9.5MM 55MM REVISION MNOAX ILIOSACRAL,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482309560,SUP,HCPCS C1713,,482309560  -  SCREW BONE 9.5MM 60MM REVISION MNOAX ILIOSACRAL,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482309565,SUP,HCPCS C1713,,482309565  -  SCREW BONE 9.5MM 65MM REVISION MNOAX ILIOSACRAL,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482309570,SUP,HCPCS C1713,,482309570  -  SCREW BONE 9.5MM 70MM REVISION MNOAX ILIOSACRAL,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482309580,SUP,HCPCS C1713,,482309580  -  SCREW BONE 9.5MM 80MM REVISION MNOAX ILIOSACRAL,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482309590,SUP,HCPCS C1713,,482309590  -  SCREW BONE 9.5MM 90MM REVISION MNOAX ILIOSACRAL,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
482311500,SUP,HCPCS C1713,,482311500  -  SCREW BONE 1.5MM 100MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482311540,SUP,HCPCS C1713,,482311540  -  SCREW BONE 1.5MM 40MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482311545,SUP,HCPCS C1713,,482311545  -  SCREW BONE 1.5MM 45MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482311550,SUP,HCPCS C1713,,482311550  -  SCREW BONE 1.5MM 50MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482311555,SUP,HCPCS C1713,,482311555  -  SCREW BONE 1.5MM 55MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482311560,SUP,HCPCS C1713,,482311560  -  SCREW BONE 1.5MM 60MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482311565,SUP,HCPCS C1713,,482311565  -  SCREW BONE 1.5MM 65MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482311570,SUP,HCPCS C1713,,482311570  -  SCREW BONE 1.5MM 70MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482311580,SUP,HCPCS C1713,,482311580  -  SCREW BONE 1.5MM 80MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482311590,SUP,HCPCS C1713,,482311590  -  SCREW BONE 1.5MM 90MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482314020,SUP,HCPCS C1713,,482314020  -  SCREW BONE 4MM 20MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482314025,SUP,HCPCS C1713,,482314025  -  SCREW BONE 4MM 25MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482314030,SUP,HCPCS C1713,,482314030  -  SCREW BONE 4MM 30MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482314035,SUP,HCPCS C1713,,482314035  -  SCREW BONE 4MM 35MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482314040,SUP,HCPCS C1713,,482314040  -  SCREW BONE 4MM 40MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482314045,SUP,HCPCS C1713,,482314045  -  SCREW BONE 4MM 45MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482314520,SUP,HCPCS C1713,,482314520  -  SCREW BONE 4.5MM 20MM POLYAX XIA 3 TITANIUM SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482314525,SUP,HCPCS C1713,,482314525  -  SCREW BONE 4.5MM 25MM POLYAX XIA 3 TITANIUM SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482314530,SUP,HCPCS C1713,,482314530  -  SCREW BONE 4.5MM 30MM POLYAX XIA 3 TITANIUM SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482314535,SUP,HCPCS C1713,,482314535  -  SCREW BONE 4.5MM 35MM POLYAX XIA 3 TITANIUM SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482314540,SUP,HCPCS C1713,,482314540  -  SCREW BONE 4.5MM 40MM POLYAX XIA 3 TITANIUM SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482314545,SUP,HCPCS C1713,,482314545  -  SCREW BONE 4.5MM 45MM POLYAX XIA 3 TITANIUM SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482315020,SUP,HCPCS C1713,,482315020  -  SCREW BONE 5MM 20MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482315025,SUP,HCPCS C1713,,482315025  -  SCREW BONE 5MM 25MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482315030,SUP,HCPCS C1713,,482315030  -  SCREW BONE 5MM 30MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482315035,SUP,HCPCS C1713,,482315035  -  SCREW BONE 5MM 35MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482315040,SUP,HCPCS C1713,,482315040  -  SCREW BONE 5MM 40MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482315045,SUP,HCPCS C1713,,482315045  -  SCREW BONE 5MM 45MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482315050,SUP,HCPCS C1713,,482315050  -  SCREW BONE 5MM 50MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482315525,SUP,HCPCS C1713,,482315525  -  SCREW BONE 5.5MM 25MM POLYAX XIA 3 TITANIUM SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482315530,SUP,HCPCS C1713,,482315530  -  SCREW BONE 5.5MM 30MM POLYAX XIA 3 TITANIUM SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482315535,SUP,HCPCS C1713,,482315535  -  SCREW BONE 5.5MM 35MM POLYAX XIA 3 TITANIUM SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482315540,SUP,HCPCS C1713,,482315540  -  SCREW BONE 5.5MM 40MM POLYAX XIA 3 TITANIUM SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482315545,SUP,HCPCS C1713,,482315545  -  SCREW BONE 5.5MM 45MM POLYAX XIA 3 TITANIUM SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482315550,SUP,HCPCS C1713,,482315550  -  SCREW BONE 5.5MM 50MM POLYAX XIA 3 TITANIUM SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482315555,SUP,HCPCS C1713,,482315555  -  SCREW BONE 5.5MM 55MM POLYAX XIA 3 TITANIUM SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482316025,SUP,HCPCS C1713,,482316025  -  SCREW BONE 6MM 25MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482316030,SUP,HCPCS C1713,,482316030  -  SCREW BONE 6MM 30MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482316035,SUP,HCPCS C1713,,482316035  -  SCREW BONE 6MM 35MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482316040,SUP,HCPCS C1713,,482316040  -  SCREW BONE 6MM 40MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482316045,SUP,HCPCS C1713,,482316045  -  SCREW BN 6MM 50MM XIA 3 PA TI SPNE THORLMBR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482316050,SUP,HCPCS C1713,,482316050  -  SCREW BONE 6MM 50MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482316055,SUP,HCPCS C1713,,482316055  -  SCREW BONE 6MM 55MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482316060,SUP,HCPCS C1713,,482316060  -  SCREW BONE 6MM 60MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482316065,SUP,HCPCS C1713,,482316065  -  SCREW BN 6MM 70MM XIA 3 PA TI SPNE THORLMBR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482316070,SUP,HCPCS C1713,,482316070  -  SCREW BONE 6MM 70MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482316080,SUP,HCPCS C1713,,482316080  -  SCREW BONE 6MM 80MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482316090,SUP,HCPCS C1713,,482316090  -  SCREW BONE 6MM 90MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482316525,SUP,HCPCS C1713,,482316525  -  SCREW BONE 6.5MM 25MM POLYAX XIA 3 TITANIUM SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482316530,SUP,HCPCS C1713,,482316530  -  SCREW BONE 6.5MM 30MM POLYAX XIA 3 TITANIUM SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482316535,SUP,HCPCS C1713,,482316535  -  SCREW BONE 6.5MM 35MM POLYAX XIA 3 TITANIUM SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482316540,SUP,HCPCS C1713,,482316540  -  SCREW BONE 6.5MM 40MM POLYAX XIA 3 TITANIUM SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482316545,SUP,HCPCS C1713,,482316545  -  SCREW BONE 6.5MM 45MM POLYAX XIA 3 TITANIUM SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482316550,SUP,HCPCS C1713,,482316550  -  SCREW BONE 6.5MM 50MM POLYAX XIA 3 TITANIUM SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482316555,SUP,HCPCS C1713,,482316555  -  SCREW BONE 6.5MM 55MM POLYAX XIA 3 TITANIUM SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482316560,SUP,HCPCS C1713,,482316560  -  SCREW BONE 6.5MM 60MM POLYAX XIA 3 TITANIUM SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482316565,SUP,HCPCS C1713,,482316565  -  SCREW BONE 6.5MM 65MM POLYAX XIA 3 TITANIUM SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482316570,SUP,HCPCS C1713,,482316570  -  SCREW BONE 6.5MM 70MM POLYAX XIA 3 TITANIUM SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482316580,SUP,HCPCS C1713,,482316580  -  SCREW BONE 6.5MM 80MM POLYAX XIA 3 TITANIUM SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482316590,SUP,HCPCS C1713,,482316590  -  SCREW BONE 6.5MM 90MM POLYAX XIA 3 TITANIUM SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482317025,SUP,HCPCS C1713,,482317025  -  SCREW BONE 7MM 25MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482317030,SUP,HCPCS C1713,,482317030  -  SCREW BONE 7MM 30MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482317035,SUP,HCPCS C1713,,482317035  -  SCREW BONE 7MM 35MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482317040,SUP,HCPCS C1713,,482317040  -  SCREW BONE 7MM 40MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482317045,SUP,HCPCS C1713,,482317045  -  SCREW BONE 7MM 45MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482317050,SUP,HCPCS C1713,,482317050  -  SCREW BONE 7MM 50MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482317055,SUP,HCPCS C1713,,482317055  -  SCREW BONE 7MM 55MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482317060,SUP,HCPCS C1713,,482317060  -  SCREW BONE 7MM 60MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482317065,SUP,HCPCS C1713,,482317065  -  SCREW BONE 7MM 65MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482317070,SUP,HCPCS C1713,,482317070  -  SCREW BONE 7MM 70MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482317080,SUP,HCPCS C1713,,482317080  -  SCREW BONE 7MM 80MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482317090,SUP,HCPCS C1713,,482317090  -  SCREW BONE 7MM 90MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482317525,SUP,HCPCS C1713,,482317525  -  SCREW BONE 7.5MM 25MM POLYAX XIA 3 TITANIUM SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482317530,SUP,HCPCS C1713,,482317530  -  SCREW BONE 7.5MM 30MM POLYAX XIA 3 TITANIUM SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482317535,SUP,HCPCS C1713,,482317535  -  SCREW BONE 7.5MM 35MM POLYAX XIA 3 TITANIUM SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482317540,SUP,HCPCS C1713,,482317540  -  SCREW BONE 7.5MM 40MM POLYAX XIA 3 TITANIUM SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482317545,SUP,HCPCS C1713,,482317545  -  SCREW BONE 7.5MM 45MM POLYAX XIA 3 TITANIUM SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482317550,SUP,HCPCS C1713,,482317550  -  SCREW BONE 7.5MM 55MM CANN XIA TITANIUM SPN THORACOLUMBAR,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482317555,SUP,HCPCS C1713,,482317555  -  SCREW BONE 7.5MM 55MM POLYAX XIA 3 TITANIUM SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482317560,SUP,HCPCS C1713,,482317560  -  SCREW BONE 7.5MM 60MM POLYAX XIA 3 TITANIUM SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482317565,SUP,HCPCS C1713,,482317565  -  SCREW BONE 7.5MM 65MM POLYAX XIA 3 TITANIUM SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482317570,SUP,HCPCS C1713,,482317570  -  SCREW BONE 7.5MM 70MM POLYAX XIA 3 TITANIUM SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482317580,SUP,HCPCS C1713,,482317580  -  SCREW BONE 7.5MM 80MM POLYAX XIA 3 TITANIUM SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482317590,SUP,HCPCS C1713,,482317590  -  SCREW BONE 7.5MM 90MM POLYAX XIA 3 TITANIUM SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482318500,SUP,HCPCS C1713,,482318500  -  SCREW BONE 8.5MM 100MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482318525,SUP,HCPCS C1713,,482318525  -  SCREW BONE 8.5MM 25MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482318530,SUP,HCPCS C1713,,482318530  -  SCREW BONE 8.5MM 30MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482318535,SUP,HCPCS C1713,,482318535  -  SCREW BONE 8.5MM 35MM XIA 3 TITANIUM SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482318540,SUP,HCPCS C1713,,482318540  -  SCREW BONE 8.5MM 40MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482318545,SUP,HCPCS C1713,,482318545  -  SCREW BONE 8.5MM 45MM POLYAX REVISION SPN ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482318550,SUP,HCPCS C1713,,482318550  -  SCREW BONE 8.5MM 50MM POLYAX REVISION SPN ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482318555,SUP,HCPCS C1713,,482318555  -  SCREW BONE 8.5MM 55MM POLYAX REVISION SPN ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482318560,SUP,HCPCS C1713,,482318560  -  SCREW BONE 8.5MM 60MM REVISION POLYAX SPN PEDICLE,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482318565,SUP,HCPCS C1713,,482318565  -  SCREW BONE 8.5MM 65MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482318570,SUP,HCPCS C1713,,482318570  -  BOLT SPINAL 8.5MM 70MM POLYAX XIA ILIUM,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482318580,SUP,HCPCS C1713,,482318580  -  SCREW BONE 80MM XIA TITANIUM SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482318590,SUP,HCPCS C1713,,482318590  -  SCREW BN 9.5MM 100MM REV PA ILSCRL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482319500,SUP,HCPCS C1713,,482319500  -  SCREW BONE 9.5MM 100MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482319540,SUP,HCPCS C1713,,482319540  -  SCREW BONE 9.5MM 40MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482319545,SUP,HCPCS C1713,,482319545  -  SCREW BONE 9.5MM 45MM POLYAX REVISION SPN ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482319550,SUP,HCPCS C1713,,482319550  -  SCREW BONE 9.5MM 50MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482319555,SUP,HCPCS C1713,,482319555  -  SCREW BONE 9.5MM 55MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482319560,SUP,HCPCS C1713,,482319560  -  SCREW BONE 9.5MM 60MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482319565,SUP,HCPCS C1713,,482319565  -  SCREW BONE 9.5MM 65MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482319570,SUP,HCPCS C1713,,482319570  -  SCREW BONE 9.5MM 70MM POLYAX RED PROFILE REVISION XIA SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482319580,SUP,HCPCS C1713,,482319580  -  SCREW BONE 9.5MM 80MM POLYAX RED PROFILE REVISION XIA SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482319590,SUP,HCPCS C1713,,482319590  -  SCREW BONE 9.5MM 90MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482326500,SUP,HCPCS C1713,,482326500  -  SCREW BONE 6.5MM 100MM REVISION MNOAX ILIOSACRAL,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482326530,SUP,HCPCS C1713,,482326530  -  SCREW BONE 6.5MM 30MM REVISION MNOAX ILIOSACRAL,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482326535,SUP,HCPCS C1713,,482326535  -  SCREW BONE 6.5MM 35MM REVISION MNOAX ILIOSACRAL,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482326540,SUP,HCPCS C1713,,482326540  -  SCREW BONE 6.5MM 40MM REVISION MNOAX ILIOSACRAL,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482326545,SUP,HCPCS C1713,,482326545  -  SCREW BONE 6.5MM 45MM REVISION MNOAX ILIOSACRAL,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482326550,SUP,HCPCS C1713,,482326550  -  SCREW BONE 6.5MM 50MM REVISION MNOAX ILIOSACRAL,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482326555,SUP,HCPCS C1713,,482326555  -  SCREW BONE 6.5MM 55MM REVISION MNOAX ILIOSACRAL,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482326560,SUP,HCPCS C1713,,482326560  -  SCREW BONE 6.5MM 60MM REVISION MNOAX ILIOSACRAL,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482326565,SUP,HCPCS C1713,,482326565  -  SCREW BONE 6.5MM 65MM REVISION MNOAX ILIOSACRAL,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482326570,SUP,HCPCS C1713,,482326570  -  SCREW BONE 6.5MM 70MM REVISION MNOAX ILIOSACRAL,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482326580,SUP,HCPCS C1713,,482326580  -  SCREW BONE 6.5MM 80MM REVISION MNOAX ILIOSACRAL,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482326590,SUP,HCPCS C1713,,482326590  -  SCREW BONE 6.5MM 90MM REVISION MNOAX ILIOSACRAL,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482327500,SUP,HCPCS C1713,,482327500  -  SCREW BONE 7.5MM 100MM REVISION MNOAX ILIOSACRAL,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482327530,SUP,HCPCS C1713,,482327530  -  SCREW BONE 7.5MM 30MM REVISION MNOAX ILIOSACRAL,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482327535,SUP,HCPCS C1713,,482327535  -  SCREW BONE 7.5MM 35MM REVISION MNOAX ILIOSACRAL,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482327540,SUP,HCPCS C1713,,482327540  -  SCREW BONE 7.5MM 40MM REVISION MNOAX ILIOSACRAL,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482327545,SUP,HCPCS C1713,,482327545  -  SCREW BONE 7.5MM 45MM REVISION MNOAX ILIOSACRAL,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482327550,SUP,HCPCS C1713,,482327550  -  SCREW BONE 7.5MM 50MM REVISION MNOAX ILIOSACRAL,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482327555,SUP,HCPCS C1713,,482327555  -  SCREW BONE 7.5MM 55MM REVISION MNOAX ILIOSACRAL,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482327560,SUP,HCPCS C1713,,482327560  -  SCREW BONE 7.5MM 60MM REVISION MNOAX ILIOSACRAL,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482327565,SUP,HCPCS C1713,,482327565  -  SCREW BONE 7.5MM 65MM REVISION MNOAX ILIOSACRAL,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482327570,SUP,HCPCS C1713,,482327570  -  SCREW BONE 7.5MM 70MM REVISION MNOAX ILIOSACRAL,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482327580,SUP,HCPCS C1713,,482327580  -  SCREW BONE 7.5MM 80MM REVISION MNOAX ILIOSACRAL,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482327590,SUP,HCPCS C1713,,482327590  -  SCREW BONE 7.5MM 90MM REVISION MNOAX ILIOSACRAL,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482328500,SUP,HCPCS C1713,,482328500  -  SCREW BONE 8.5MM 100MM REVISION MNOAX ILIOSACRAL,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482328530,SUP,HCPCS C1713,,482328530  -  SCREW BONE 8.5MM 30MM REVISION MNOAX ILIOSACRAL,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482328535,SUP,HCPCS C1713,,482328535  -  SCREW BONE 8.5MM 35MM REVISION MNOAX ILIOSACRAL,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482328540,SUP,HCPCS C1713,,482328540  -  SCREW BONE 8.5MM 40MM REVISION MNOAX ILIOSACRAL,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482328545,SUP,HCPCS C1713,,482328545  -  SCREW BONE 8.5MM 45MM REVISION MNOAX ILIOSACRAL,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482328550,SUP,HCPCS C1713,,482328550  -  SCREW BONE 8.5MM 50MM REVISION MNOAX ILIOSACRAL,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482328555,SUP,HCPCS C1713,,482328555  -  SCREW BONE 8.5MM 55MM REVISION MNOAX ILIOSACRAL,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482328560,SUP,HCPCS C1713,,482328560  -  SCREW BONE 8.5MM 60MM REVISION MNOAX ILIOSACRAL,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482328565,SUP,HCPCS C1713,,482328565  -  SCREW BONE 8.5MM 65MM REVISION MNOAX ILIOSACRAL,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482328570,SUP,HCPCS C1713,,482328570  -  SCREW BONE 8.5MM 70MM REVISION MNOAX ILIOSACRAL,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482328580,SUP,HCPCS C1713,,482328580  -  SCREW BONE 8.5MM 80MM REVISION MNOAX ILIOSACRAL,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482328590,SUP,HCPCS C1713,,482328590  -  SCREW BONE 8.5MM 90MM REVISION MNOAX ILIOSACRAL,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482329500,SUP,HCPCS C1713,,482329500  -  SCREW BONE 9.5MM 100MM REVISION MNOAX ILIOSACRAL,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482329530,SUP,HCPCS C1713,,482329530  -  SCREW BONE 9.5MM 30MM REVISION MNOAX ILIOSACRAL,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482329535,SUP,HCPCS C1713,,482329535  -  SCREW BONE 9.5MM 35MM REVISION MNOAX ILIOSACRAL,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482329540,SUP,HCPCS C1713,,482329540  -  SCREW BONE 9.5MM 40MM REVISION MNOAX ILIOSACRAL,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482329545,SUP,HCPCS C1713,,482329545  -  SCREW BONE 9.5MM 45MM REVISION MNOAX ILIOSACRAL,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482329550,SUP,HCPCS C1713,,482329550  -  SCREW BONE 9.5MM 50MM REVISION MNOAX ILIOSACRAL,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482329555,SUP,HCPCS C1713,,482329555  -  SCREW BONE 9.5MM 55MM REVISION MNOAX ILIOSACRAL,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482329560,SUP,HCPCS C1713,,482329560  -  SCREW BONE 9.5MM 60MM REVISION MNOAX ILIOSACRAL,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482329565,SUP,HCPCS C1713,,482329565  -  SCREW BONE 9.5MM 65MM REVISION MNOAX ILIOSACRAL,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482329570,SUP,HCPCS C1713,,482329570  -  SCREW BONE 9.5MM 70MM REVISION MNOAX ILIOSACRAL,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482329580,SUP,HCPCS C1713,,482329580  -  SCREW BONE 9.5MM 80MM REVISION MNOAX ILIOSACRAL,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482329590,SUP,HCPCS C1713,,482329590  -  SCREW BONE 9.5MM 90MM REVISION MNOAX ILIOSACRAL,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482335020,SUP,HCPCS C1713,,482335020  -  SCREW BONE 5MM 20MM UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482335025,SUP,HCPCS C1713,,482335025  -  SCREW BONE 5MM 25MM UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482335030,SUP,HCPCS C1713,,482335030  -  SCREW BONE 5MM 30MM UNIPLNR XIA SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482335035,SUP,HCPCS C1713,,482335035  -  SCREW BONE 5MM 35MM UNIPLNR XIA SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482335040,SUP,HCPCS C1713,,482335040  -  SCREW BONE 5MM 40MM UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482335045,SUP,HCPCS C1713,,482335045  -  SCREW BONE 5MM 45MM UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482336025,SUP,HCPCS C1713,,482336025  -  SCREW BONE 6MM 25MM UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482336030,SUP,HCPCS C1713,,482336030  -  SCREW BONE 6MM 30MM UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482336035,SUP,HCPCS C1713,,482336035  -  SCREW BONE 6MM 35MM UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482336040,SUP,HCPCS C1713,,482336040  -  SCREW BONE 6MM 40MM UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482336045,SUP,HCPCS C1713,,482336045  -  SCREW BONE 6MM 45MM UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482336050,SUP,HCPCS C1713,,482336050  -  SCREW BONE 6MM 50MM UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482336055,SUP,HCPCS C1713,,482336055  -  SCREW BONE 6MM 55MM UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482336060,SUP,HCPCS C1713,,482336060  -  SCREW BONE 6MM 60MM UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482337030,SUP,HCPCS C1713,,482337030  -  SCREW BONE 7MM 30MM UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482337035,SUP,HCPCS C1713,,482337035  -  SCREW BONE 7MM 35MM UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482337040,SUP,HCPCS C1713,,482337040  -  SCREW BONE 7MM 40MM UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482337045,SUP,HCPCS C1713,,482337045  -  SCREW BONE 7MM 45MM UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482337050,SUP,HCPCS C1713,,482337050  -  SCREW BONE 7MM 50MM UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482337055,SUP,HCPCS C1713,,482337055  -  SCREW BONE 7MM 55MM UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482337060,SUP,HCPCS C1713,,482337060  -  SCREW BONE 7MM 60MM UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482364520,SUP,HCPCS C1713,,482364520  -  SCREW BONE 4.5MM 20MM REDX UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482364525,SUP,HCPCS C1713,,482364525  -  SCREW BONE 4.5MM 25MM REDX UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482364530,SUP,HCPCS C1713,,482364530  -  SCREW BONE 4.5MM 30MM REDX UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482364535,SUP,HCPCS C1713,,482364535  -  SCREW BONE 4.5MM 35MM REDX UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482364540,SUP,HCPCS C1713,,482364540  -  SCREW BONE 4.5MM 40MM REDX UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482364545,SUP,HCPCS C1713,,482364545  -  SCREW BONE 4.5MM 45MM REDX UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482365020,SUP,HCPCS C1713,,482365020  -  SCREW BONE 5MM 20MM REDX UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482365025,SUP,HCPCS C1713,,482365025  -  SCREW BONE 5MM 25MM REDX UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482365030,SUP,HCPCS C1713,,482365030  -  SCREW BONE 5MM 30MM REDX UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482365035,SUP,HCPCS C1713,,482365035  -  SCREW BONE 5MM 35MM REDX UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482365040,SUP,HCPCS C1713,,482365040  -  SCREW BONE 5MM 40MM REDX UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482365045,SUP,HCPCS C1713,,482365045  -  SCREW BONE 5MM 45MM REDX UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482365520,SUP,HCPCS C1713,,482365520  -  SCREW BONE 5.5MM 20MM REDX UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482365525,SUP,HCPCS C1713,,482365525  -  SCREW BONE 5.5MM 25MM REDX UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482365530,SUP,HCPCS C1713,,482365530  -  SCREW BONE 5.5MM 30MM REDX UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482365535,SUP,HCPCS C1713,,482365535  -  SCREW BONE 5.5MM 35MM REDX UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482365540,SUP,HCPCS C1713,,482365540  -  SCREW BONE 5.5MM 40MM REDX UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482365545,SUP,HCPCS C1713,,482365545  -  SCREW BONE 5.5MM 45MM REDX UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482365550,SUP,HCPCS C1713,,482365550  -  SCREW BONE 5.5MM 50MM REDX UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482365555,SUP,HCPCS C1713,,482365555  -  SCREW BONE 5.5MM 55MM REDX UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482366025,SUP,HCPCS C1713,,482366025  -  SCREW BONE 6MM 25MM REDX UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482366030,SUP,HCPCS C1713,,482366030  -  SCREW BONE 6MM 30MM REDX UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482366035,SUP,HCPCS C1713,,482366035  -  SCREW BONE 6MM 35MM REDX UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482366040,SUP,HCPCS C1713,,482366040  -  SCREW BONE 6MM 40MM REDX UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482366045,SUP,HCPCS C1713,,482366045  -  SCREW BONE 6MM 45MM REDX UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482366050,SUP,HCPCS C1713,,482366050  -  SCREW BONE 6MM 50MM REDX UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482366055,SUP,HCPCS C1713,,482366055  -  SCREW BONE 6MM 55MM REDX UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482366060,SUP,HCPCS C1713,,482366060  -  SCREW BONE 6MM 60MM REDX UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482366525,SUP,HCPCS C1713,,482366525  -  SCREW BONE 6.5MM 25MM REDX UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482366530,SUP,HCPCS C1713,,482366530  -  SCREW BONE 6.5MM 30MM REDX UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482366535,SUP,HCPCS C1713,,482366535  -  SCREW BONE 6.5MM 35MM REDX UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482366540,SUP,HCPCS C1713,,482366540  -  SCREW BONE 6.5MM 40MM REDX UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482366545,SUP,HCPCS C1713,,482366545  -  SCREW BONE 6.5MM 45MM REDX UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482366550,SUP,HCPCS C1713,,482366550  -  SCREW BONE 6.5MM 50MM REDX UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482366555,SUP,HCPCS C1713,,482366555  -  SCREW BONE 6.5MM 55MM REDX UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482366560,SUP,HCPCS C1713,,482366560  -  SCREW BONE 6.5MM 60MM REDX UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482367030,SUP,HCPCS C1713,,482367030  -  SCREW BONE 7MM 30MM REDX UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482367035,SUP,HCPCS C1713,,482367035  -  SCREW BONE 7MM 35MM REDX UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482367040,SUP,HCPCS C1713,,482367040  -  SCREW BONE 7MM 40MM REDX UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482367045,SUP,HCPCS C1713,,482367045  -  SCREW BONE 7MM 45MM REDX UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482367050,SUP,HCPCS C1713,,482367050  -  SCREW BONE 7MM 50MM REDX UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482367055,SUP,HCPCS C1713,,482367055  -  SCREW BONE 7MM 55MM REDX UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482367060,SUP,HCPCS C1713,,482367060  -  SCREW BONE 7MM 60MM REDX UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482367530,SUP,HCPCS C1713,,482367530  -  SCREW BONE 7.5MM 30MM REDX UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482367535,SUP,HCPCS C1713,,482367535  -  SCREW BONE 7.5MM 35MM REDX UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482367540,SUP,HCPCS C1713,,482367540  -  SCREW BONE 7.5MM 40MM REDX UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482367545,SUP,HCPCS C1713,,482367545  -  SCREW BONE 7.5MM 45MM REDX UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482367550,SUP,HCPCS C1713,,482367550  -  SCREW BONE 7.5MM 50MM REDX UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482367555,SUP,HCPCS C1713,,482367555  -  SCREW BONE 7.5MM 55MM REDX UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482367560,SUP,HCPCS C1713,,482367560  -  SCREW BONE 7.5MM 60MM REDX UNIPLNR XIA 3 SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482376500,SUP,HCPCS C1713,,482376500  -  SCREW BONE 6.5MM 100MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482376530,SUP,HCPCS C1713,,482376530  -  SCREW BONE 6.5MM 30MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482376535,SUP,HCPCS C1713,,482376535  -  SCREW BONE 6.5MM 35MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482376540,SUP,HCPCS C1713,,482376540  -  SCREW BONE 6.5MM 40MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482376545,SUP,HCPCS C1713,,482376545  -  SCREW BONE 6.5MM 45MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482376550,SUP,HCPCS C1713,,482376550  -  SCREW BONE 6.5MM 50MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482376555,SUP,HCPCS C1713,,482376555  -  SCREW BONE 6.5MM 55MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482376560,SUP,HCPCS C1713,,482376560  -  SCREW BONE 6.5MM 60MM REVISION POLYAX CLOSE HEAD ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482376565,SUP,HCPCS C1713,,482376565  -  SCREW BONE 6.5MM 65MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482376570,SUP,HCPCS C1713,,482376570  -  SCREW BONE 6.5MM 70MM REVISION POLYAX CLOSE HEAD ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482376580,SUP,HCPCS C1713,,482376580  -  SCREW BONE 6.5MM 80MM REVISION POLYAX CLOSE HEAD ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482376590,SUP,HCPCS C1713,,482376590  -  SCREW BONE 6.5MM 90MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482377500,SUP,HCPCS C1713,,482377500  -  SCREW BONE 7.5MM 100MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482377530,SUP,HCPCS C1713,,482377530  -  SCREW BONE 7.5MM 30MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482377535,SUP,HCPCS C1713,,482377535  -  SCREW BONE 7.5MM 35MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482377540,SUP,HCPCS C1713,,482377540  -  SCREW BONE 7.5MM 40MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482377545,SUP,HCPCS C1713,,482377545  -  SCREW BONE 7.5MM 45MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482377550,SUP,HCPCS C1713,,482377550  -  SCREW BONE 7.5MM 50MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482377555,SUP,HCPCS C1713,,482377555  -  SCREW BONE 7.5MM 55MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482377560,SUP,HCPCS C1713,,482377560  -  SCREW BONE 7.5MM 60MM REVISION POLYAX CLOSE HEAD ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482377565,SUP,HCPCS C1713,,482377565  -  SCREW BONE 7.5MM 65MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482377570,SUP,HCPCS C1713,,482377570  -  SCREW BONE 7.5MM 70MM REVISION POLYAX CLOSE HEAD ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482377580,SUP,HCPCS C1713,,482377580  -  SCREW BONE 7.5MM 80MM REVISION POLYAX CLOSE HEAD ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482377590,SUP,HCPCS C1713,,482377590  -  SCREW BONE 7.5MM 90MM REVISION POLYAX CLOSE HEAD ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482378500,SUP,HCPCS C1713,,482378500  -  SCREW BONE 8.5MM 100MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482378530,SUP,HCPCS C1713,,482378530  -  SCREW BONE 8.5MM 30MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482378535,SUP,HCPCS C1713,,482378535  -  SCREW BONE 8.5MM 35MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482378540,SUP,HCPCS C1713,,482378540  -  SCREW BONE 8.5MM 40MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482378545,SUP,HCPCS C1713,,482378545  -  SCREW BONE 8.5MM 45MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482378550,SUP,HCPCS C1713,,482378550  -  SCREW BONE 8.5MM 50MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482378555,SUP,HCPCS C1713,,482378555  -  SCREW BONE 8.5MM 55MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482378560,SUP,HCPCS C1713,,482378560  -  SCREW BONE 8.5MM 60MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482378565,SUP,HCPCS C1713,,482378565  -  SCREW BONE 8.5MM 65MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482378570,SUP,HCPCS C1713,,482378570  -  SCREW BONE 8.5MM 70MM REVISION POLYAX CLOSE HEAD ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482378580,SUP,HCPCS C1713,,482378580  -  SCREW BONE 8.5MM 80MM REVISION POLYAX CLOSE HEAD ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482378590,SUP,HCPCS C1713,,482378590  -  SCREW BONE 8.5MM 90MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482379500,SUP,HCPCS C1713,,482379500  -  SCREW BONE 9.5MM 100MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482379530,SUP,HCPCS C1713,,482379530  -  SCREW BONE 9.5MM 30MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482379535,SUP,HCPCS C1713,,482379535  -  SCREW BONE 9.5MM 35MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482379540,SUP,HCPCS C1713,,482379540  -  SCREW BONE 9.5MM 40MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482379545,SUP,HCPCS C1713,,482379545  -  SCREW BONE 9.5MM 45MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482379550,SUP,HCPCS C1713,,482379550  -  SCREW BONE 9.5MM 50MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482379555,SUP,HCPCS C1713,,482379555  -  SCREW BONE 9.5MM 55MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482379560,SUP,HCPCS C1713,,482379560  -  SCREW BONE 9.5MM 60MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482379565,SUP,HCPCS C1713,,482379565  -  SCREW BONE 9.5MM 65MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482379570,SUP,HCPCS C1713,,482379570  -  SCREW BONE 9.5MM 70MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482379580,SUP,HCPCS C1713,,482379580  -  SCREW BONE 9.5MM 80MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482379590,SUP,HCPCS C1713,,482379590  -  SCREW BONE 9.5MM 90MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482384020,SUP,HCPCS C1713,,482384020  -  SCREW BONE 4MM 20MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482384025,SUP,HCPCS C1713,,482384025  -  SCREW BONE 4MM 25MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482384030,SUP,HCPCS C1713,,482384030  -  SCREW BONE 4MM 30MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482384035,SUP,HCPCS C1713,,482384035  -  SCREW BONE 4MM 35MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482384040,SUP,HCPCS C1713,,482384040  -  SCREW BONE 4MM 40MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482384045,SUP,HCPCS C1713,,482384045  -  SCREW BONE 4MM 45MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482384520,SUP,HCPCS C1713,,482384520  -  SCREW BONE 4.5MM 20MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482384525,SUP,HCPCS C1713,,482384525  -  SCREW BONE 4.5MM 25MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482384530,SUP,HCPCS C1713,,482384530  -  SCREW BONE 4.5MM 30MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482384535,SUP,HCPCS C1713,,482384535  -  SCREW BONE 4.5MM 35MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482384540,SUP,HCPCS C1713,,482384540  -  SCREW BONE 4.5MM 40MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482384545,SUP,HCPCS C1713,,482384545  -  SCREW BONE 4.5MM 45MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482385020,SUP,Custom 27803010,,482385020  -  CONNECTOR ROD 5MM 20MM ROD TO ROD RAD SPN,"$1,375.00",$0.00,"$1,375.00",$0.00,$981.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
482385025,SUP,HCPCS C1713,,482385025  -  SCREW BONE 5MM 25MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482385030,SUP,HCPCS C1713,,482385030  -  SCREW BONE 5MM 30MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482385035,SUP,HCPCS C1713,,482385035  -  SCREW BONE 5MM 35MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482385040,SUP,HCPCS C1713,,482385040  -  SCREW BONE 5MM 40MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482385045,SUP,HCPCS C1713,,482385045  -  SCREW BONE 5MM 45MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482385050,SUP,HCPCS C1713,,482385050  -  SCREW BONE 5MM 50MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482385525,SUP,HCPCS C1713,,482385525  -  SCREW BONE 5.5MM 25MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482385530,SUP,HCPCS C1713,,482385530  -  SCREW BONE 5.5MM 30MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482385535,SUP,HCPCS C1713,,482385535  -  SCREW BONE 5.5MM 35MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482385540,SUP,HCPCS C1713,,482385540  -  SCREW BONE 5.5MM 40MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482385545,SUP,HCPCS C1713,,482385545  -  SCREW BONE 5.5MM 45MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482385550,SUP,HCPCS C1713,,482385550  -  SCREW BONE 5.5MM 50MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482385555,SUP,HCPCS C1713,,482385555  -  SCREW BONE 5.5MM 55MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482386525,SUP,HCPCS C1713,,482386525  -  SCREW BONE 6.5MM 25MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482386530,SUP,HCPCS C1713,,482386530  -  SCREW BONE 6.5MM 30MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482386535,SUP,HCPCS C1713,,482386535  -  SCREW BONE 6.5MM 35MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482386540,SUP,HCPCS C1713,,482386540  -  SCREW BONE 6.5MM 40MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482386545,SUP,HCPCS C1713,,482386545  -  SCREW BONE 6.5MM 45MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482386550,SUP,HCPCS C1713,,482386550  -  SCREW BONE 6.5MM 50MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482386555,SUP,HCPCS C1713,,482386555  -  SCREW BONE 6.5MM 55MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482386560,SUP,HCPCS C1713,,482386560  -  SCREW BONE 6.5MM 60MM REVISION POLYAX BIASED ANGLE,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482386565,SUP,HCPCS C1713,,482386565  -  SCREW BONE 6.5MM 65MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482386570,SUP,HCPCS C1713,,482386570  -  SCREW BONE 6.5MM 70MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482386580,SUP,HCPCS C1713,,482386580  -  SCREW BONE 6.5MM 80MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482386590,SUP,HCPCS C1713,,482386590  -  SCREW BONE 6.5MM 90MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482387525,SUP,HCPCS C1713,,482387525  -  SCREW BONE 7.5MM 25MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482387530,SUP,HCPCS C1713,,482387530  -  SCREW BONE 7.5MM 30MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482387535,SUP,HCPCS C1713,,482387535  -  SCREW BONE 7.5MM 35MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482387540,SUP,HCPCS C1713,,482387540  -  SCREW BONE 7.5MM 40MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482387545,SUP,HCPCS C1713,,482387545  -  SCREW BONE 7.5MM 45MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482387550,SUP,HCPCS C1713,,482387550  -  SCREW BONE 7.5MM 50MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482387555,SUP,HCPCS C1713,,482387555  -  SCREW BONE 7.5MM 55MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482387560,SUP,HCPCS C1713,,482387560  -  SCREW BONE 7.5MM 60MM REVISION POLYAX BIASED ANGLE,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482387565,SUP,HCPCS C1713,,482387565  -  SCREW BONE 7.5MM 65MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482387570,SUP,HCPCS C1713,,482387570  -  SCREW BONE 7.5MM 70MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482387580,SUP,HCPCS C1713,,482387580  -  SCREW BONE 7.5MM 80MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482387590,SUP,HCPCS C1713,,482387590  -  SCREW BONE 7.5MM 90MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482388500,SUP,HCPCS C1713,,482388500  -  SCREW BONE 8.5MM 100MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482388560,SUP,HCPCS C1713,,482388560  -  SCREW BONE 8.5MM 60MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482388570,SUP,HCPCS C1713,,482388570  -  SCREW BONE 8.5MM 70MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482388580,SUP,HCPCS C1713,,482388580  -  SCREW BONE 8.5MM 80MM REVISION POLYAX BIASED ANGLE,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482388590,SUP,HCPCS C1713,,482388590  -  SCREW BONE 8.5MM 90MM REVISION POLYAX BIASED ANGLE,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482389500,SUP,HCPCS C1713,,482389500  -  SCREW BONE 9.5MM 100MM REVISION POLYAX BIASED ANGLE,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482389560,SUP,HCPCS C1713,,482389560  -  SCREW BONE 9.5MM 60MM REVISION POLYAX BIASED ANGLE,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482389570,SUP,HCPCS C1713,,482389570  -  SCREW BONE 9.5MM 70MM REVISION POLYAX BIASED ANGLE,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482389580,SUP,HCPCS C1713,,482389580  -  SCREW BONE 9.5MM 80MM REVISION POLYAX BIASED ANGLE,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482389590,SUP,HCPCS C1713,,482389590  -  SCREW BONE 9.5MM 90MM REVISION POLYAX BIASED ANGLE,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
482396500,SUP,HCPCS C1713,,482396500  -  SCREW BONE 6.5MM 100MM REVISION MNOAX ILIOSACRAL,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482396560,SUP,HCPCS C1713,,482396560  -  SCREW BONE 6.5MM 60MM REVISION MNOAX ILIOSACRAL,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482396570,SUP,HCPCS C1713,,482396570  -  SCREW BONE 6.5MM 70MM REVISION MNOAX ILIOSACRAL,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482396580,SUP,HCPCS C1713,,482396580  -  SCREW BONE 6.5MM 80MM REVISION MNOAX ILIOSACRAL,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482396590,SUP,HCPCS C1713,,482396590  -  SCREW BONE 6.5MM 90MM REVISION MNOAX ILIOSACRAL,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482397500,SUP,HCPCS C1713,,482397500  -  SCREW BONE 7.5MM 100MM REVISION MNOAX ILIOSACRAL,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482397560,SUP,HCPCS C1713,,482397560  -  SCREW BONE 7.5MM 60MM REVISION MNOAX ILIOSACRAL,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482397570,SUP,HCPCS C1713,,482397570  -  SCREW BONE 15D 7.5MM 70MM REVISION MNOAX BIASED ANGLE,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482397580,SUP,HCPCS C1713,,482397580  -  SCREW BONE 15D 7.5MM 80MM REVISION MNOAX BIASED ANGLE,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482397590,SUP,HCPCS C1713,,482397590  -  SCREW BONE 7.5MM 90MM REVISION MNOAX ILIOSACRAL,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482398500,SUP,HCPCS C1713,,482398500  -  SCREW BONE 8.5MM 100MM REVISION MNOAX ILIOSACRAL,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482398560,SUP,HCPCS C1713,,482398560  -  SCREW BONE 8.5MM 60MM REVISION MNOAX ILIOSACRAL,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482398570,SUP,HCPCS C1713,,482398570  -  SCREW BONE 8.5MM 70MM REVISION MNOAX ILIOSACRAL,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482398580,SUP,HCPCS C1713,,482398580  -  SCREW BONE 8.5MM 80MM REVISION MNOAX ILIOSACRAL,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482398590,SUP,HCPCS C1713,,482398590  -  SCREW BONE 8.5MM 90MM REVISION MNOAX ILIOSACRAL,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482399500,SUP,HCPCS C1713,,482399500  -  SCREW BONE 9.5MM 100MM REVISION MNOAX ILIOSACRAL,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482399560,SUP,HCPCS C1713,,482399560  -  SCREW BONE 9.5MM 60MM REVISION MNOAX ILIOSACRAL,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482399570,SUP,HCPCS C1713,,482399570  -  SCREW BONE 9.5MM 70MM REVISION MNOAX ILIOSACRAL,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482399580,SUP,HCPCS C1713,,482399580  -  SCREW BONE 9.5MM 80MM REVISION MNOAX ILIOSACRAL,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482399590,SUP,HCPCS C1713,,482399590  -  SCREW BONE 9.5MM 90MM REVISION MNOAX ILIOSACRAL,"$3,654.83",$0.00,"$3,654.83","$1,644.67","$2,608.45",$0.00,$629.71,$0.00,$0.00,$639.93,"$3,654.83",$0.00,"$1,827.41","$2,894.63","$2,923.86",$0.00,$571.98,$0.00,$581.85,$0.00
482700601,SUP,HCPCS C1713,,00482700601  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 6MM SELF TAP STAINLESS,$36.80,$0.00,$36.80,$16.56,$26.26,$0.00,$6.34,$0.00,$0.00,$6.44,$36.80,$0.00,$18.40,$29.15,$29.44,$0.00,$5.76,$0.00,$5.86,$0.00
482700701,SUP,HCPCS C1713,,00482700701  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 7MM SELF TAP STAINLESS,$36.80,$0.00,$36.80,$16.56,$26.26,$0.00,$6.34,$0.00,$0.00,$6.44,$36.80,$0.00,$18.40,$29.15,$29.44,$0.00,$5.76,$0.00,$5.86,$0.00
482700800,SUP,HCPCS C1713,,00482700800  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 8MM STAINLESS STEEL,$32.20,$0.00,$32.20,$14.49,$22.98,$0.00,$5.55,$0.00,$0.00,$5.64,$32.20,$0.00,$16.10,$25.50,$25.76,$0.00,$5.04,$0.00,$5.13,$0.00
482700801,SUP,HCPCS C1713,,00482700801  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 8MM SELF TAP STAINLESS,$36.80,$0.00,$36.80,$16.56,$26.26,$0.00,$6.34,$0.00,$0.00,$6.44,$36.80,$0.00,$18.40,$29.15,$29.44,$0.00,$5.76,$0.00,$5.86,$0.00
482700901,SUP,HCPCS C1713,,00482700901  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 9MM SELF TAP STAINLESS,$36.80,$0.00,$36.80,$16.56,$26.26,$0.00,$6.34,$0.00,$0.00,$6.44,$36.80,$0.00,$18.40,$29.15,$29.44,$0.00,$5.76,$0.00,$5.86,$0.00
482701000,SUP,HCPCS C1713,,00482701000  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 10MM STAINLESS STEEL,$32.20,$0.00,$32.20,$14.49,$22.98,$0.00,$5.55,$0.00,$0.00,$5.64,$32.20,$0.00,$16.10,$25.50,$25.76,$0.00,$5.04,$0.00,$5.13,$0.00
482701001,SUP,HCPCS C1713,,00482701001  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 10MM SELF TAP STAINLESS,$36.80,$0.00,$36.80,$16.56,$26.26,$0.00,$6.34,$0.00,$0.00,$6.44,$36.80,$0.00,$18.40,$29.15,$29.44,$0.00,$5.76,$0.00,$5.86,$0.00
482701200,SUP,HCPCS C1713,,00482701200  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 12MM STAINLESS STEEL,$32.20,$0.00,$32.20,$14.49,$22.98,$0.00,$5.55,$0.00,$0.00,$5.64,$32.20,$0.00,$16.10,$25.50,$25.76,$0.00,$5.04,$0.00,$5.13,$0.00
482701201,SUP,HCPCS C1713,,00482701201  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 12MM SELF TAP STAINLESS,$36.80,$0.00,$36.80,$16.56,$26.26,$0.00,$6.34,$0.00,$0.00,$6.44,$36.80,$0.00,$18.40,$29.15,$29.44,$0.00,$5.76,$0.00,$5.86,$0.00
482701400,SUP,HCPCS C1713,,00482701400  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 14MM STAINLESS STEEL,$32.20,$0.00,$32.20,$14.49,$22.98,$0.00,$5.55,$0.00,$0.00,$5.64,$32.20,$0.00,$16.10,$25.50,$25.76,$0.00,$5.04,$0.00,$5.13,$0.00
482701401,SUP,HCPCS C1713,,00482701401  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 14MM SELF TAP STAINLESS,$36.80,$0.00,$36.80,$16.56,$26.26,$0.00,$6.34,$0.00,$0.00,$6.44,$36.80,$0.00,$18.40,$29.15,$29.44,$0.00,$5.76,$0.00,$5.86,$0.00
482701600,SUP,HCPCS C1713,,00482701600  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 16MM STAINLESS STEEL,$32.20,$0.00,$32.20,$14.49,$22.98,$0.00,$5.55,$0.00,$0.00,$5.64,$32.20,$0.00,$16.10,$25.50,$25.76,$0.00,$5.04,$0.00,$5.13,$0.00
482701601,SUP,HCPCS C1713,,00482701601  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 16MM SELF TAP STAINLESS,$36.80,$0.00,$36.80,$16.56,$26.26,$0.00,$6.34,$0.00,$0.00,$6.44,$36.80,$0.00,$18.40,$29.15,$29.44,$0.00,$5.76,$0.00,$5.86,$0.00
482701800,SUP,HCPCS C1713,,00482701800  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 18MM STAINLESS STEEL,$32.20,$0.00,$32.20,$14.49,$22.98,$0.00,$5.55,$0.00,$0.00,$5.64,$32.20,$0.00,$16.10,$25.50,$25.76,$0.00,$5.04,$0.00,$5.13,$0.00
482701801,SUP,HCPCS C1713,,00482701801  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 18MM SELF TAP STAINLESS,$36.80,$0.00,$36.80,$16.56,$26.26,$0.00,$6.34,$0.00,$0.00,$6.44,$36.80,$0.00,$18.40,$29.15,$29.44,$0.00,$5.76,$0.00,$5.86,$0.00
482702000,SUP,HCPCS C1713,,00482702000  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 20MM STAINLESS STEEL,$32.20,$0.00,$32.20,$14.49,$22.98,$0.00,$5.55,$0.00,$0.00,$5.64,$32.20,$0.00,$16.10,$25.50,$25.76,$0.00,$5.04,$0.00,$5.13,$0.00
482702200,SUP,HCPCS C1713,,00482702200  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 22MM STAINLESS STEEL,$32.20,$0.00,$32.20,$14.49,$22.98,$0.00,$5.55,$0.00,$0.00,$5.64,$32.20,$0.00,$16.10,$25.50,$25.76,$0.00,$5.04,$0.00,$5.13,$0.00
482702201,SUP,HCPCS C1713,,00482702201  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 22MM SELF TAP STAINLESS,$36.80,$0.00,$36.80,$16.56,$26.26,$0.00,$6.34,$0.00,$0.00,$6.44,$36.80,$0.00,$18.40,$29.15,$29.44,$0.00,$5.76,$0.00,$5.86,$0.00
482702400,SUP,HCPCS C1713,,00482702400  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 24MM STAINLESS STEEL,$32.20,$0.00,$32.20,$14.49,$22.98,$0.00,$5.55,$0.00,$0.00,$5.64,$32.20,$0.00,$16.10,$25.50,$25.76,$0.00,$5.04,$0.00,$5.13,$0.00
482702401,SUP,HCPCS C1713,,00482702401  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 24MM SELF TAP STAINLESS,$36.80,$0.00,$36.80,$16.56,$26.26,$0.00,$6.34,$0.00,$0.00,$6.44,$36.80,$0.00,$18.40,$29.15,$29.44,$0.00,$5.76,$0.00,$5.86,$0.00
482702600,SUP,HCPCS C1713,,00482702600  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 26MM STAINLESS STEEL,$32.20,$0.00,$32.20,$14.49,$22.98,$0.00,$5.55,$0.00,$0.00,$5.64,$32.20,$0.00,$16.10,$25.50,$25.76,$0.00,$5.04,$0.00,$5.13,$0.00
482702601,SUP,HCPCS C1713,,00482702601  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 26MM SELF TAP STAINLESS,$36.80,$0.00,$36.80,$16.56,$26.26,$0.00,$6.34,$0.00,$0.00,$6.44,$36.80,$0.00,$18.40,$29.15,$29.44,$0.00,$5.76,$0.00,$5.86,$0.00
482702800,SUP,HCPCS C1713,,00482702800  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 28MM STAINLESS STEEL,$32.20,$0.00,$32.20,$14.49,$22.98,$0.00,$5.55,$0.00,$0.00,$5.64,$32.20,$0.00,$16.10,$25.50,$25.76,$0.00,$5.04,$0.00,$5.13,$0.00
482702801,SUP,HCPCS C1713,,00482702801  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 28MM SELF TAP STAINLESS,$36.80,$0.00,$36.80,$16.56,$26.26,$0.00,$6.34,$0.00,$0.00,$6.44,$36.80,$0.00,$18.40,$29.15,$29.44,$0.00,$5.76,$0.00,$5.86,$0.00
482703000,SUP,HCPCS C1713,,00482703000  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 30MM STAINLESS STEEL,$32.20,$0.00,$32.20,$14.49,$22.98,$0.00,$5.55,$0.00,$0.00,$5.64,$32.20,$0.00,$16.10,$25.50,$25.76,$0.00,$5.04,$0.00,$5.13,$0.00
482703001,SUP,HCPCS C1713,,00482703001  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 30MM SELF TAP STAINLESS,$36.80,$0.00,$36.80,$16.56,$26.26,$0.00,$6.34,$0.00,$0.00,$6.44,$36.80,$0.00,$18.40,$29.15,$29.44,$0.00,$5.76,$0.00,$5.86,$0.00
482703200,SUP,HCPCS C1713,,00482703200  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 32MM STAINLESS STEEL,$32.20,$0.00,$32.20,$14.49,$22.98,$0.00,$5.55,$0.00,$0.00,$5.64,$32.20,$0.00,$16.10,$25.50,$25.76,$0.00,$5.04,$0.00,$5.13,$0.00
482703201,SUP,HCPCS C1713,,00482703201  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 32MM SELF TAP STAINLESS,$36.80,$0.00,$36.80,$16.56,$26.26,$0.00,$6.34,$0.00,$0.00,$6.44,$36.80,$0.00,$18.40,$29.15,$29.44,$0.00,$5.76,$0.00,$5.86,$0.00
482703400,SUP,HCPCS C1713,,00482703400  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 34MM STAINLESS STEEL,$32.20,$0.00,$32.20,$14.49,$22.98,$0.00,$5.55,$0.00,$0.00,$5.64,$32.20,$0.00,$16.10,$25.50,$25.76,$0.00,$5.04,$0.00,$5.13,$0.00
482703401,SUP,HCPCS C1713,,00482703401  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 34MM SELF TAP STAINLESS,$36.80,$0.00,$36.80,$16.56,$26.26,$0.00,$6.34,$0.00,$0.00,$6.44,$36.80,$0.00,$18.40,$29.15,$29.44,$0.00,$5.76,$0.00,$5.86,$0.00
482703600,SUP,HCPCS C1713,,00482703600  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 36MM STAINLESS STEEL,$32.20,$0.00,$32.20,$14.49,$22.98,$0.00,$5.55,$0.00,$0.00,$5.64,$32.20,$0.00,$16.10,$25.50,$25.76,$0.00,$5.04,$0.00,$5.13,$0.00
482703601,SUP,HCPCS C1713,,00482703601  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 36MM SELF TAP STAINLESS,$36.80,$0.00,$36.80,$16.56,$26.26,$0.00,$6.34,$0.00,$0.00,$6.44,$36.80,$0.00,$18.40,$29.15,$29.44,$0.00,$5.76,$0.00,$5.86,$0.00
482703800,SUP,HCPCS C1713,,00482703800  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 38MM STAINLESS STEEL,$32.20,$0.00,$32.20,$14.49,$22.98,$0.00,$5.55,$0.00,$0.00,$5.64,$32.20,$0.00,$16.10,$25.50,$25.76,$0.00,$5.04,$0.00,$5.13,$0.00
482703801,SUP,HCPCS C1713,,00482703801  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 38MM SELF TAP STAINLESS,$36.80,$0.00,$36.80,$16.56,$26.26,$0.00,$6.34,$0.00,$0.00,$6.44,$36.80,$0.00,$18.40,$29.15,$29.44,$0.00,$5.76,$0.00,$5.86,$0.00
482704000,SUP,HCPCS C1713,,00482704000  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 40MM STAINLESS STEEL,$32.20,$0.00,$32.20,$14.49,$22.98,$0.00,$5.55,$0.00,$0.00,$5.64,$32.20,$0.00,$16.10,$25.50,$25.76,$0.00,$5.04,$0.00,$5.13,$0.00
482704001,SUP,HCPCS C1713,,00482704001  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 40MM SELF TAP STAINLESS,$36.80,$0.00,$36.80,$16.56,$26.26,$0.00,$6.34,$0.00,$0.00,$6.44,$36.80,$0.00,$18.40,$29.15,$29.44,$0.00,$5.76,$0.00,$5.86,$0.00
482704201,SUP,HCPCS C1713,,00482704201  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 42MM SELF TAP STAINLESS,$36.80,$0.00,$36.80,$16.56,$26.26,$0.00,$6.34,$0.00,$0.00,$6.44,$36.80,$0.00,$18.40,$29.15,$29.44,$0.00,$5.76,$0.00,$5.86,$0.00
482704401,SUP,HCPCS C1713,,00482704401  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 44MM SELF TAP STAINLESS,$36.80,$0.00,$36.80,$16.56,$26.26,$0.00,$6.34,$0.00,$0.00,$6.44,$36.80,$0.00,$18.40,$29.15,$29.44,$0.00,$5.76,$0.00,$5.86,$0.00
482704500,SUP,HCPCS C1713,,00482704500  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 45MM STAINLESS STEEL,$32.20,$0.00,$32.20,$14.49,$22.98,$0.00,$5.55,$0.00,$0.00,$5.64,$32.20,$0.00,$16.10,$25.50,$25.76,$0.00,$5.04,$0.00,$5.13,$0.00
482704501,SUP,HCPCS C1713,,00482704501  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 45MM SELF TAP STAINLESS,$36.80,$0.00,$36.80,$16.56,$26.26,$0.00,$6.34,$0.00,$0.00,$6.44,$36.80,$0.00,$18.40,$29.15,$29.44,$0.00,$5.76,$0.00,$5.86,$0.00
482704601,SUP,HCPCS C1713,,00482704601  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 46MM SELF TAP STAINLESS,$36.80,$0.00,$36.80,$16.56,$26.26,$0.00,$6.34,$0.00,$0.00,$6.44,$36.80,$0.00,$18.40,$29.15,$29.44,$0.00,$5.76,$0.00,$5.86,$0.00
482704801,SUP,HCPCS C1713,,00482704801  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 48MM SELF TAP STAINLESS,$36.80,$0.00,$36.80,$16.56,$26.26,$0.00,$6.34,$0.00,$0.00,$6.44,$36.80,$0.00,$18.40,$29.15,$29.44,$0.00,$5.76,$0.00,$5.86,$0.00
482705000,SUP,HCPCS C1713,,00482705000  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 50MM STAINLESS STEEL,$32.20,$0.00,$32.20,$14.49,$22.98,$0.00,$5.55,$0.00,$0.00,$5.64,$32.20,$0.00,$16.10,$25.50,$25.76,$0.00,$5.04,$0.00,$5.13,$0.00
482705001,SUP,HCPCS C1713,,00482705001  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 50MM SELF TAP STAINLESS,$36.80,$0.00,$36.80,$16.56,$26.26,$0.00,$6.34,$0.00,$0.00,$6.44,$36.80,$0.00,$18.40,$29.15,$29.44,$0.00,$5.76,$0.00,$5.86,$0.00
482705201,SUP,HCPCS C1713,,00482705201  -  SCREW BONE SMALL HEXAGON 2.7MM 52MM SELF TAP CORTICAL,$36.80,$0.00,$36.80,$16.56,$26.26,$0.00,$6.34,$0.00,$0.00,$6.44,$36.80,$0.00,$18.40,$29.15,$29.44,$0.00,$5.76,$0.00,$5.86,$0.00
482705401,SUP,HCPCS C1713,,00482705401  -  SCREW BONE SMALL HEXAGON 2.7MM 54MM SELF TAP CORTICAL,$36.80,$0.00,$36.80,$16.56,$26.26,$0.00,$6.34,$0.00,$0.00,$6.44,$36.80,$0.00,$18.40,$29.15,$29.44,$0.00,$5.76,$0.00,$5.86,$0.00
482705500,SUP,HCPCS C1713,,00482705500  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 55MM STAINLESS STEEL,$32.20,$0.00,$32.20,$14.49,$22.98,$0.00,$5.55,$0.00,$0.00,$5.64,$32.20,$0.00,$16.10,$25.50,$25.76,$0.00,$5.04,$0.00,$5.13,$0.00
482705501,SUP,HCPCS C1713,,00482705501  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 55MM SELF TAP STAINLESS,$36.80,$0.00,$36.80,$16.56,$26.26,$0.00,$6.34,$0.00,$0.00,$6.44,$36.80,$0.00,$18.40,$29.15,$29.44,$0.00,$5.76,$0.00,$5.86,$0.00
482705601,SUP,HCPCS C1713,,00482705601  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 56MM SELF TAP STAINLESS,$36.80,$0.00,$36.80,$16.56,$26.26,$0.00,$6.34,$0.00,$0.00,$6.44,$36.80,$0.00,$18.40,$29.15,$29.44,$0.00,$5.76,$0.00,$5.86,$0.00
482705801,SUP,HCPCS C1713,,00482705801  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 58MM SELF TAP STAINLESS,$36.80,$0.00,$36.80,$16.56,$26.26,$0.00,$6.34,$0.00,$0.00,$6.44,$36.80,$0.00,$18.40,$29.15,$29.44,$0.00,$5.76,$0.00,$5.86,$0.00
482706000,SUP,HCPCS C1713,,00482706000  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 60MM STAINLESS STEEL,$32.20,$0.00,$32.20,$14.49,$22.98,$0.00,$5.55,$0.00,$0.00,$5.64,$32.20,$0.00,$16.10,$25.50,$25.76,$0.00,$5.04,$0.00,$5.13,$0.00
482706001,SUP,HCPCS C1713,,00482706001  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 60MM SELF TAP STAINLESS,$36.80,$0.00,$36.80,$16.56,$26.26,$0.00,$6.34,$0.00,$0.00,$6.44,$36.80,$0.00,$18.40,$29.15,$29.44,$0.00,$5.76,$0.00,$5.86,$0.00
482706500,SUP,HCPCS C1713,,00482706500  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 65MM STAINLESS STEEL,$32.20,$0.00,$32.20,$14.49,$22.98,$0.00,$5.55,$0.00,$0.00,$5.64,$32.20,$0.00,$16.10,$25.50,$25.76,$0.00,$5.04,$0.00,$5.13,$0.00
482706501,SUP,HCPCS C1713,,00482706501  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 65MM SELF TAP STAINLESS,$36.80,$0.00,$36.80,$16.56,$26.26,$0.00,$6.34,$0.00,$0.00,$6.44,$36.80,$0.00,$18.40,$29.15,$29.44,$0.00,$5.76,$0.00,$5.86,$0.00
482707000,SUP,HCPCS C1713,,00482707000  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 70MM STAINLESS STEEL,$32.20,$0.00,$32.20,$14.49,$22.98,$0.00,$5.55,$0.00,$0.00,$5.64,$32.20,$0.00,$16.10,$25.50,$25.76,$0.00,$5.04,$0.00,$5.13,$0.00
482707001,SUP,HCPCS C1713,,00482707001  -  SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 70MM SELF TAP STAINLESS,$36.80,$0.00,$36.80,$16.56,$26.26,$0.00,$6.34,$0.00,$0.00,$6.44,$36.80,$0.00,$18.40,$29.15,$29.44,$0.00,$5.76,$0.00,$5.86,$0.00
482802540,SUP,HCPCS C1713,,482802540  -  SCREW BONE 5.5MM 40MM 15MM ES2 LT XIA 3 SHRT BLADE,"$1,875.00",$0.00,"$1,875.00",$843.75,"$1,338.19",$0.00,$323.05,$0.00,$0.00,$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
482802640,SUP,HCPCS C1713,,482802640  -  SCREW BONE 6.5MM 40MM 15MM ES2 LT XIA 3 SHRT BLADE,"$1,875.00",$0.00,"$1,875.00",$843.75,"$1,338.19",$0.00,$323.05,$0.00,$0.00,$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
482802645,SUP,HCPCS C1713,,482802645  -  SCREW BONE 6.5MM 45MM 15MM ES2 LT XIA 3 SHRT BLADE,"$1,875.00",$0.00,"$1,875.00",$843.75,"$1,338.19",$0.00,$323.05,$0.00,$0.00,$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
482802650,SUP,HCPCS C1713,,482802650  -  SCREW BN SHRT BLDE LOPRFL 6.5MM 50MM 15MM ES2 LT XIA 3 6 PNT,"$1,875.00",$0.00,"$1,875.00",$843.75,"$1,338.19",$0.00,$323.05,$0.00,$0.00,$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
482802745,SUP,HCPCS C1713,,482802745  -  SCREW BN SHRT BLDE LOPRFL 7.5MM 45MM 15MM ES2 LT XIA 3 6 PNT,"$1,875.00",$0.00,"$1,875.00",$843.75,"$1,338.19",$0.00,$323.05,$0.00,$0.00,$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
482804545,SUP,HCPCS C1713,,482804545  -  SCREW BN LNG BLDE LOPRFL 5.5MM 45MM 15MM ES2 LT XIA 3 6 PNT,"$1,875.00",$0.00,"$1,875.00",$843.75,"$1,338.19",$0.00,$323.05,$0.00,$0.00,$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
482804645,SUP,HCPCS C1713,,482804645  -  SCREW BN LNG BLDE LOPRFL 6.5MM 45MM 15MM ES2 LT XIA 3 6 PNT,"$1,875.00",$0.00,"$1,875.00",$843.75,"$1,338.19",$0.00,$323.05,$0.00,$0.00,$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
482804650,SUP,HCPCS C1713,,482804650  -  SCREW BN LNG BLDE LOPRFL 6.5MM 50MM 15MM ES2 LT XIA 3 6 PNT,"$1,875.00",$0.00,"$1,875.00",$843.75,"$1,338.19",$0.00,$323.05,$0.00,$0.00,$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
482804750,SUP,HCPCS C1713,,482804750  -  SCREW BN LNG BLDE LOPRFL 7.5MM 50MM 15MM ES2 LT XIA 3 6 PNT,"$1,875.00",$0.00,"$1,875.00",$843.75,"$1,338.19",$0.00,$323.05,$0.00,$0.00,$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
482806050,SUP,HCPCS C1713,,482806050  -  ROD SPNL HEX 5.5MM 50MM ES2 RDS TI,$437.50,$0.00,$437.50,$196.88,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
482806055,SUP,HCPCS C1713,,482806055  -  ROD SPNL HEX 5.5MM 55MM ES2 RDS TI,$437.50,$0.00,$437.50,$196.88,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
482807060,SUP,HCPCS C1713,,"482807060  -  TITANIUM STRAIGHT ROD, 5.5X60MM",$437.50,$0.00,$437.50,$196.88,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
482807090,SUP,HCPCS C1713,,482807090  -  ROD SPNL 90MM 5.5MM ES2 STR HEX TI,$437.50,$0.00,$437.50,$196.88,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
482911180,SUP,HCPCS C1713,,482911180  -  ENDCAP SPNL 18MM 0D,$746.78,$0.00,$746.78,$336.05,$532.97,$0.00,$128.67,$0.00,$0.00,$130.75,$746.78,$0.00,$373.39,$591.45,$597.42,$0.00,$116.87,$0.00,$118.89,$0.00
483510098,SUP,Custom 27803010,,483510098  -  SPACER SPNL 8D LRDTC WDG NOSE 20X11X9MM AVS UNILIF HLW,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
483510108,SUP,Custom 27803010,,483510108  -  SPACER SPNL 8D LRDTC WDG NOSE 20X11X10MM AVS UNILIF HLW,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
483510118,SUP,Custom 27803010,,483510118  -  SPACER SPNL 8D LRDTC WDG NOSE 20X11X11MM AVS UNILIF HLW,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
483510128,SUP,Custom 27803010,,483510128  -  SPACER SPNL 8D LRDTC WDG NOSE 20X11X12MM AVS UNILIF HLW,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
483510138,SUP,Custom 27803010,,483510138  -  SPACER SPNL 8D LRDTC WDG NOSE 20X11X13MM AVS UNILIF HLW,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
483510140,SUP,Custom 27803010,,483510140  -  SPACER SPNL 0D WDG NOSE 20X11X14MM AVS UNILIF HLW PEEK-OPTM,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
483510144,SUP,Custom 27803010,,483510144  -  SPACER SPNL 4D LRDTC WDG NOSE 20X11X14MM AVS UNILIF HLW,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
483510148,SUP,Custom 27803010,,483510148  -  SPACER SPNL 8D LRDTC WDG NOSE 20X11X14MM AVS UNILIF HLW,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
483510150,SUP,Custom 27803010,,483510150  -  SPACER SPNL 0D WDG NOSE 20X11X15MM AVS UNILIF HLW PEEK-OPTM,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
483510154,SUP,Custom 27803010,,483510154  -  SPACER SPNL 4D LRDTC WDG NOSE 20X11X15MM AVS UNILIF HLW,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
483510158,SUP,Custom 27803010,,483510158  -  SPACER SPNL 8D LRDTC WDG NOSE 20X11X15MM AVS UNILIF HLW,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
483510168,SUP,Custom 27803010,,483510168  -  SPACER SPNL 8D LRDTC WDG NOSE 20X11X16MM AVS UNILIF HLW,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
483515098,SUP,Custom 27803010,,483515098  -  SPACER SPNL 8D WDG 25X11X9MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
483515108,SUP,Custom 27803010,,483515108  -  SPACER SPNL 8D WDG 25X11X10MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
483515118,SUP,Custom 27803010,,483515118  -  SPACER SPNL 8D WDG 25X11X11MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
483515128,SUP,Custom 27803010,,483515128  -  SPACER SPNL 8D WDG 25X11X12MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
483515138,SUP,Custom 27803010,,483515138  -  SPACER SPNL 8D WDG 25X11X13MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
483515140,SUP,Custom 27803010,,483515140  -  SPACER SPNL 0D RECT 25X11X14MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
483515144,SUP,Custom 27803010,,483515144  -  SPACER SPNL 4D WDG 25X11X14MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
483515148,SUP,Custom 27803010,,483515148  -  SPACER SPNL 8D WDG 25X11X14MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
483515150,SUP,Custom 27803010,,483515150  -  SPACER SPNL 0D RECT 25X11X15MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
483515154,SUP,Custom 27803010,,483515154  -  SPACER SPNL 4D WDG 25X11X15MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
483515158,SUP,Custom 27803010,,483515158  -  SPACER SPNL 8D WDG 25X11X15MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
483515168,SUP,Custom 27803010,,483515168  -  SPACER SPNL 8D WDG 25X11X16MM AVS PL HLW PEEK PLIF,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
486610000,SUP,HCPCS C1713,,486610000  -  CAP LOCKING SPN,$125.00,$0.00,$125.00,$56.25,$89.21,$0.00,$21.54,$0.00,$0.00,$21.89,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$19.56,$0.00,$19.90,$0.00
486610425,SUP,HCPCS C1713,,486610425  -  SCREW BONE STANDARD 4.75MM 25MM RAD SPN,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
486610430,SUP,HCPCS C1713,,486610430  -  SCREW BONE STANDARD 4.75MM 30MM RAD SPN,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
486610435,SUP,HCPCS C1713,,486610435  -  SCREW BONE STANDARD 4.75MM 35MM RAD SPN,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
486610440,SUP,HCPCS C1713,,486610440  -  SCREW BONE STANDARD 4.75MM 40MM RAD SPN,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
486610445,SUP,HCPCS C1713,,486610445  -  SCREW BONE STANDARD 4.75MM 45MM RAD SPN,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
486610450,SUP,HCPCS C1713,,486610450  -  SCREW BONE 4.75MM 50MM RADSTD SPNL,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
486610455,SUP,HCPCS C1713,,486610455  -  SCREW BONE 4.75MM 55MM RADSTD SPNL,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
486610525,SUP,HCPCS C1713,,486610525  -  SCREW BONE 5.75MM 25MM RADSTD SPNL,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
486610530,SUP,HCPCS C1713,,486610530  -  SCREW BONE STANDARD 5.75MM 30MM RAD SPN,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
486610535,SUP,HCPCS C1713,,486610535  -  SCREW BONE STANDARD 5.75MM 35MM RAD SPN,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
486610540,SUP,HCPCS C1713,,486610540  -  SCREW BONE STANDARD 5.75MM 40MM RAD SPN,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
486610545,SUP,HCPCS C1713,,486610545  -  SCREW BONE STANDARD 5.75MM 45MM RAD SPN,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
486610550,SUP,HCPCS C1713,,486610550  -  SCREW BONE 5.75MM 50MM RADSTD SPNL,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
486610555,SUP,HCPCS C1713,,486610555  -  SCREW BONE 5.75MM 55MM RADSTD SPNL,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
486610560,SUP,HCPCS C1713,,486610560  -  SCREW BONE 5.75MM 60MM RADSTD SPNL,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
486610565,SUP,HCPCS C1713,,486610565  -  SCREW BONE 5.75MM 65MM RADSTD SPNL,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
486610600,SUP,HCPCS C1713,,486610600  -  SCREW BONE 6.75MM 100MM RADSTD SPNL,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
486610625,SUP,HCPCS C1713,,486610625  -  SCREW BONE 6.75MM 25MM RADSTD SPNL,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
486610630,SUP,HCPCS C1713,,486610630  -  SCREW BONE STANDARD 6.75MM 30MM RAD SPN,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
486610635,SUP,HCPCS C1713,,486610635  -  SCREW BONE STANDARD 6.75MM 35MM RAD SPN,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
486610640,SUP,HCPCS C1713,,486610640  -  SCREW BONE STANDARD 6.75MM 40MM RAD SPN,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
486610645,SUP,HCPCS C1713,,486610645  -  SCREW BONE STANDARD 6.75MM 45MM RAD SPN,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
486610650,SUP,HCPCS C1713,,486610650  -  SCREW BONE STANDARD 6.75MM 50MM RAD SPN,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
486610655,SUP,HCPCS C1713,,486610655  -  SCREW BONE 6.75MM 55MM RADSTD SPNL,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
486610660,SUP,HCPCS C1713,,486610660  -  SCREW BONE 6.75MM 60MM SPNL,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
486610665,SUP,HCPCS C1713,,486610665  -  SCREW BONE 6.75MM 65MM RADSTD SPNL,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
486610670,SUP,HCPCS C1713,,486610670  -  SCREW BONE 6.75MM 70MM RADSTD SPNL,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
486610680,SUP,HCPCS C1713,,486610680  -  SCREW BONE 6.75MM 80MM RADSTD SPNL,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
486610690,SUP,HCPCS C1713,,486610690  -  SCREW BONE 6.75MM 90MM RADSTD SPNL,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
486610700,SUP,HCPCS C1713,,486610700  -  SCREW BONE 7.75MM 100MM RADSTD SPNL,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
486610725,SUP,HCPCS C1713,,486610725  -  SCREW BONE 7.75MM 25MM RADSTD SPNL,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
486610730,SUP,HCPCS C1713,,486610730  -  SCREW BONE 7.75MM 30MM RADSTD SPNL,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
486610735,SUP,HCPCS C1713,,486610735  -  SCREW BONE 7.75MM 35MM RADSTD,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
486610740,SUP,HCPCS C1713,,486610740  -  SCREW BONE 7.75MM 40MM RADSTD SPNL,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
486610745,SUP,HCPCS C1713,,486610745  -  SCREW BONE 7.75MM 45MM RADSTD SPNL,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
486610750,SUP,HCPCS C1713,,486610750  -  SCREW BONE 7.75MM 50MM SPNL,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
486610755,SUP,HCPCS C1713,,486610755  -  SCREW BONE 7.75MM 55MM RADSTD SPNL,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
486610760,SUP,HCPCS C1713,,486610760  -  SCREW BONE 7.75MM 60MM RADSTD SPNL,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
486610765,SUP,HCPCS C1713,,486610765  -  SCREW BONE 7.75MM 65MM RADSTD SPNL,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
486610770,SUP,HCPCS C1713,,486610770  -  SCREW BONE 7.75MM 70MM RADSTD SPNL,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
486610780,SUP,HCPCS C1713,,486610780  -  SCREW BONE 7.75MM 80MM RADSTD SPNL,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
486610790,SUP,HCPCS C1713,,486610790  -  SCREW BONE 7.75MM 90MM RADSTD SPNL,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
486610800,SUP,HCPCS C1713,,486610800  -  SCREW BONE 8.75MM 100MM RADSTD SPNL,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
486610830,SUP,HCPCS C1713,,486610830  -  SCREW BONE 8.75MM 30MM RADSTD SPNL,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
486610835,SUP,HCPCS C1713,,486610835  -  SCREW BONE 8.75MM 35MM RADSTD SPNL,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
486610840,SUP,HCPCS C1713,,486610840  -  SCREW BONE 8.75MM 40MM RADSTD SPNL,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
486610845,SUP,HCPCS C1713,,486610845  -  SCREW BONE 8.75MM 45MM RADSTD SPNL,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
486610850,SUP,HCPCS C1713,,486610850  -  SCREW BONE 8.75MM 50MM RADSTD SPNL,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
486610855,SUP,HCPCS C1713,,486610855  -  SCREW BONE 8.75MM 55MM RADSTD SPNL,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
486610860,SUP,HCPCS C1713,,486610860  -  SCREW BONE 8.75MM 60MM RADSTD SPNL,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
486610865,SUP,HCPCS C1713,,486610865  -  SCREW BONE 8.75MM 65MM RADSTD SPNL,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
486610870,SUP,HCPCS C1713,,486610870  -  SCREW BONE 8.75MM 70MM RADSTD SPNL,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
486610880,SUP,HCPCS C1713,,486610880  -  SCREW BONE 8.75MM 80MM RADSTD SPNL,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
486610890,SUP,HCPCS C1713,,486610890  -  SCREW BONE 8.75MM 90MM RADSTD SPNL,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
486610900,SUP,HCPCS C1713,,486610900  -  SCREW BONE 9.75MM 100MM RADSTD SPNL,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
486610960,SUP,HCPCS C1713,,486610960  -  SCREW BONE 9.75MM 60MM RADSTD SPNL,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
486610970,SUP,HCPCS C1713,,486610970  -  SCREW BONE 9.75MM 70MM RADSTD SPNL,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
486610980,SUP,HCPCS C1713,,486610980  -  SCREW BONE 9.75MM 80MM RADSTD SPNL,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
486610990,SUP,HCPCS C1713,,486610990  -  SCREW BONE 9.75MM 90MM RADSTD SPNL,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
486611425,SUP,HCPCS C1713,,486611425  -  SCREW BONE 4.75MM 25MM MULTIANG RAD SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
486611430,SUP,HCPCS C1713,,486611430  -  SCREW BONE 4.75MM 30MM MULTIANG RAD SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
486611435,SUP,HCPCS C1713,,486611435  -  SCREW BONE 4.75MM 35MM MULTIANG RAD SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
486611440,SUP,HCPCS C1713,,486611440  -  SCREW BONE 4.75MM 40MM MULTIANG TITANIUM SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
486611445,SUP,HCPCS C1713,,486611445  -  SCREW BONE 4.75MM 45MM MULTIANG RAD SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
486611450,SUP,HCPCS C1713,,486611450  -  SCREW BONE 4.75MM 50MM MULTIANG TITANIUM SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
486611455,SUP,HCPCS C1713,,486611455  -  SCREW BONE 4.75MM 55MM MULTIANG RAD SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
486611525,SUP,HCPCS C1713,,486611525  -  SCREW BONE 5.75MM 25MM MULTIANG RAD SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
486611530,SUP,HCPCS C1713,,486611530  -  SCREW BONE 5.75MM 30MM MULTIANG RAD SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
486611535,SUP,HCPCS C1713,,486611535  -  SCREW BONE 5.75MM 35MM MULTIANG RAD SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
486611540,SUP,HCPCS C1713,,486611540  -  SCREW BONE 5MM 40MM MULTIANG TITANIUM SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
486611545,SUP,HCPCS C1713,,486611545  -  SCREW BONE 5.75MM 45MM MULTIANG RAD SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
486611550,SUP,HCPCS C1713,,486611550  -  SCREW BONE 5.75MM 50MM MULTIANG RAD SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
486611555,SUP,HCPCS C1713,,486611555  -  SCREW BONE 5MM 55MM MULTIANG TITANIUM SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
486611560,SUP,HCPCS C1713,,486611560  -  SCREW BONE 5.75MM 60MM MULTIANG RAD SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
486611565,SUP,HCPCS C1713,,486611565  -  SCREW BONE 5.75MM 65MM MULTIANG RAD SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
486611600,SUP,HCPCS C1713,,486611600  -  SCREW BONE 6.75MM 100MM MULTIANG RAD SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
486611625,SUP,HCPCS C1713,,486611625  -  SCREW BONE 6.75MM 25MM MULTIANG RAD SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
486611630,SUP,HCPCS C1713,,486611630  -  SCREW BONE 6.75MM 30MM MULTIANG TITANIUM SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
486611635,SUP,HCPCS C1713,,486611635  -  SCREW BONE 6.75MM 35MM MULTIANG TITANIUM SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
486611640,SUP,HCPCS C1713,,486611640  -  SCREW BONE 6.75MM 40MM MULTIANG RAD SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
486611645,SUP,HCPCS C1713,,486611645  -  SCREW BONE 6.75MM 45MM MULTIANG RAD SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
486611650,SUP,HCPCS C1713,,486611650  -  SCREW BONE 6.75MM 50MM MULTIANG RAD SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
486611655,SUP,HCPCS C1713,,486611655  -  SCREW BONE 6.75MM 55MM MULTIANG RAD SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
486611660,SUP,HCPCS C1713,,486611660  -  SCREW BONE 6.75MM 60MM MULTIANG RAD SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
486611665,SUP,HCPCS C1713,,486611665  -  SCREW BONE 6.75MM 65MM MULTIANG RAD SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
486611670,SUP,HCPCS C1713,,486611670  -  SCREW BONE 6.75MM 70MM MULTIANG RAD SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
486611680,SUP,HCPCS C1713,,486611680  -  SCREW BONE 6.75MM 80MM MULTIANG RAD SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
486611690,SUP,HCPCS C1713,,486611690  -  SCREW BONE 6.75MM 90MM MULTIANG RAD SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
486611700,SUP,HCPCS C1713,,486611700  -  SCREW BONE 7.75MM 100MM MULTIANG RAD SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
486611725,SUP,HCPCS C1713,,486611725  -  SCREW BONE 7.75MM 25MM MULTIANG RAD SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
486611730,SUP,HCPCS C1713,,486611730  -  SCREW BONE 7.75MM 30MM MULTIANG TITANIUM SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
486611735,SUP,HCPCS C1713,,486611735  -  SCREW BONE 7.75MM 35MM MULTIANG TITANIUM SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
486611740,SUP,HCPCS C1713,,486611740  -  SCREW BONE 7.75MM 40MM MULTIANG TITANIUM SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
486611745,SUP,HCPCS C1713,,486611745  -  SCREW BONE 7.75MM 45MM MULTIANG RAD SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
486611750,SUP,HCPCS C1713,,486611750  -  SCREW BONE 7.75MM 50MM MULTIANG RAD SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
486611755,SUP,HCPCS C1713,,486611755  -  SCREW BONE 7.75MM 55MM MULTIANG RAD SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
486611760,SUP,HCPCS C1713,,486611760  -  SCREW BONE 7.75MM 60MM MULTIANG RAD SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
486611765,SUP,HCPCS C1713,,486611765  -  SCREW BONE 7.75MM 65MM MULTIANG RAD SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
486611770,SUP,HCPCS C1713,,486611770  -  SCREW BONE 7.75MM 70MM MULTIANG RAD SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
486611780,SUP,HCPCS C1713,,486611780  -  SCREW BONE 7.75MM 80MM MULTIANG RAD SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
486611790,SUP,HCPCS C1713,,486611790  -  SCREW BONE 7.75MM 90MM MULTIANG RAD SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
486611800,SUP,HCPCS C1713,,486611800  -  SCREW BONE 8.75MM 100MM MULTIANG RAD SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
486611830,SUP,HCPCS C1713,,486611830  -  SCREW BONE 8.75MM 30MM MULTIANG RAD SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
486611835,SUP,HCPCS C1713,,486611835  -  SCREW BONE 8.75MM 35MM MULTIANG RAD SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
486611840,SUP,HCPCS C1713,,486611840  -  SCREW BONE 8.75MM 40MM MULTIANG RAD SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
486611845,SUP,HCPCS C1713,,486611845  -  SCREW BONE 8.75MM 45MM MULTIANG RAD SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
486611850,SUP,HCPCS C1713,,486611850  -  SCREW BONE 8.75MM 50MM MULTIANG RAD SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
486611855,SUP,HCPCS C1713,,486611855  -  SCREW BONE 8.75MM 55MM MULTIANG RAD SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
486611860,SUP,HCPCS C1713,,486611860  -  SCREW BONE 8.75MM 60MM MULTIANG RAD SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
486611865,SUP,HCPCS C1713,,486611865  -  SCREW BONE 8.75MM 65MM MULTIANG RAD SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
486611870,SUP,HCPCS C1713,,486611870  -  SCREW BONE 8.75MM 70MM MULTIANG RAD SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
486611880,SUP,HCPCS C1713,,486611880  -  SCREW BONE 8.75MM 80MM MULTIANG RAD SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
486611890,SUP,HCPCS C1713,,486611890  -  SCREW BONE 8.75MM 90MM MULTIANG RAD SPN,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
486611900,SUP,HCPCS C1713,,486611900  -  SCREW BONE 9.75MM 100MM RAD SPNL MULTIANG,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
486611960,SUP,HCPCS C1713,,486611960  -  SCREW BONE 9.75MM 60MM RADL SPNL MULTIANG,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
486611970,SUP,HCPCS C1713,,486611970  -  SCREW BONE 9.75MM 70MM RAD SPNL CANN,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
486611980,SUP,HCPCS C1713,,486611980  -  SCREW BONE 9.75MM 80MM RAD SPNL MULTIANG,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
486611990,SUP,HCPCS C1713,,486611990  -  SCREW BONE 9.75MM 90MM RAD SPNL MULTIANG,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
486612535,SUP,HCPCS C1713,,486612535  -  SCREW BONE 5.75MM 35MM MULTIANG CANN RAD SPN,"$1,875.00",$0.00,"$1,875.00",$843.75,"$1,338.19",$0.00,$323.05,$0.00,$0.00,$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
486612540,SUP,HCPCS C1713,,486612540  -  SCREW BONE 5.75MM 40MM MULTIANG CANN RAD SPN,"$1,875.00",$0.00,"$1,875.00",$843.75,"$1,338.19",$0.00,$323.05,$0.00,$0.00,$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
486612545,SUP,HCPCS C1713,,486612545  -  SCREW BONE 5.75MM 45MM MULTIANG CANN RAD SPN,"$1,875.00",$0.00,"$1,875.00",$843.75,"$1,338.19",$0.00,$323.05,$0.00,$0.00,$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
486612550,SUP,HCPCS C1713,,486612550  -  SCREW BONE 5.75MM 50MM MULTIANG CANN RAD SPN,"$1,875.00",$0.00,"$1,875.00",$843.75,"$1,338.19",$0.00,$323.05,$0.00,$0.00,$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
486612630,SUP,HCPCS C1713,,486612630  -  SCREW BONE 6.75MM 30MM MULTIANG CANN RAD SPN,"$1,875.00",$0.00,"$1,875.00",$843.75,"$1,338.19",$0.00,$323.05,$0.00,$0.00,$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
486612635,SUP,Custom 27203010,,486612635  -  SCREW BONE 6.75MM 35MM MULTIANG CANN RAD SPN,"$1,875.00",$0.00,"$1,875.00",$0.00,"$1,338.19",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$0.00,$0.00,$0.00,$0.00
486612640,SUP,HCPCS C1713,,486612640  -  SCREW BONE 6.75MM 40MM MULTIANG CANN RAD SPN,"$1,875.00",$0.00,"$1,875.00",$843.75,"$1,338.19",$0.00,$323.05,$0.00,$0.00,$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
486612645,SUP,HCPCS C1713,,486612645  -  SCREW BONE 6.75MM 45MM MULTIANG CANN RAD SPN,"$1,875.00",$0.00,"$1,875.00",$843.75,"$1,338.19",$0.00,$323.05,$0.00,$0.00,$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
486612650,SUP,HCPCS C1713,,486612650  -  SCREW BONE 6.75MM 50MM MULTIANG CANN RAD SPN,"$1,875.00",$0.00,"$1,875.00",$843.75,"$1,338.19",$0.00,$323.05,$0.00,$0.00,$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
486612655,SUP,HCPCS C1713,,486612655  -  SCREW BONE 6.75MM 55MM MULTIANG CANN RAD SPN,"$1,875.00",$0.00,"$1,875.00",$843.75,"$1,338.19",$0.00,$323.05,$0.00,$0.00,$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
486612730,SUP,HCPCS C1713,,486612730  -  SCREW BONE 7.75MM 30MM MULTIANG CANN RAD SPN,"$1,875.00",$0.00,"$1,875.00",$843.75,"$1,338.19",$0.00,$323.05,$0.00,$0.00,$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
486612735,SUP,HCPCS C1713,,486612735  -  SCREW BONE 7.75MM 35MM MULTIANG CANN RAD SPN,"$1,875.00",$0.00,"$1,875.00",$843.75,"$1,338.19",$0.00,$323.05,$0.00,$0.00,$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
486612740,SUP,HCPCS C1713,,486612740  -  SCREW BONE 7.75MM 40MM MULTIANG CANN RAD SPN,"$1,875.00",$0.00,"$1,875.00",$843.75,"$1,338.19",$0.00,$323.05,$0.00,$0.00,$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
486612745,SUP,HCPCS C1713,,486612745  -  SCREW BONE 7.75MM 45MM MULTIANG CANN RAD SPN,"$1,875.00",$0.00,"$1,875.00",$843.75,"$1,338.19",$0.00,$323.05,$0.00,$0.00,$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
486612750,SUP,HCPCS C1713,,486612750  -  SCREW BONE 7.75MM 50MM MULTIANG CANN RAD SPN,"$1,875.00",$0.00,"$1,875.00",$843.75,"$1,338.19",$0.00,$323.05,$0.00,$0.00,$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
486612755,SUP,HCPCS C1713,,486612755  -  SCREW BONE 7.75MM 55MM MULTIANG CANN RAD SPN,"$1,875.00",$0.00,"$1,875.00",$843.75,"$1,338.19",$0.00,$323.05,$0.00,$0.00,$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
486613000,SUP,Custom 27803010,,486613000  -  ROD SPINAL 5.5MM 100MM NONHEXAGONAL TITANIUM RAD,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
486613003,SUP,Custom 27803010,,486613003  -  ROD SPINAL 5.5MM 30MM W/O HEXAGONAL RAD,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
486613004,SUP,Custom 27803010,,486613004  -  ROD SPINAL 40MM,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
486613005,SUP,Custom 27803010,,486613005  -  ROD SPINAL 5.5MM 50MM NONHEXAGONAL RAD TITANIUM,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
486613006,SUP,Custom 27803010,,486613006  -  ROD SPINAL 5.5MM 60MM W/O HEXAGONAL RAD,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
486613007,SUP,Custom 27803010,,486613007  -  ROD SPNL 5.5MM 70MM RDS NONHEXAGONAL,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
486613008,SUP,Custom 27803010,,486613008  -  ROD SPINAL 5.5MM 80MM W/O HEXAGONAL RAD,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
486613009,SUP,Custom 27803010,,486613009  -  ROD SPINAL 5.5MM 90MM NONHEXAGONAL RAD TITANIUM,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
486613010,SUP,Custom 27803010,,486613010  -  ROD SPINAL 5.5MM 110MM W/O HEXAGONAL RAD,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
486613020,SUP,Custom 27803010,,486613020  -  ROD SPINAL 5.5MM 120MM RAD W/O HEXAGONAL,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
486613050,SUP,Custom 27803010,,486613050  -  ROD SPINAL 5.5MM 50MM HEXAGON RAD,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
486613053,SUP,Custom 27803010,,486613053  -  ROD SPINAL 5.5MM 35MM RAD NONHEXAGONAL,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
486613054,SUP,Custom 27803010,,486613054  -  ROD SPINAL 5.5MM 45MM NONHEXAGONAL RAD TITANIUM,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
486613060,SUP,Custom 27803010,,486613060  -  ROD SPINAL 5.5MM 60MM HEXAGON RAD,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
486613070,SUP,Custom 27803010,,486613070  -  ROD SPINAL 5.5MM 70MM HEXAGON RAD,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
486613080,SUP,Custom 27803010,,486613080  -  ROD SPINAL 5.5MM 80MM HEXAGON RAD,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
486613090,SUP,Custom 27803010,,486613090  -  ROD SPINAL 5.5MM 90MM HEXAGON RAD,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
486613100,SUP,Custom 27803010,,486613100  -  ROD SPINAL 5.5MM 100MM HEXAGON RAD,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
486613110,SUP,Custom 27803010,,486613110  -  ROD SPINAL 5.5MM 110MM HEXAGON RAD,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
486613120,SUP,Custom 27803010,,486613120  -  ROD SPINAL 5.5MM 120MM HEXAGONAL RAD,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
486613140,SUP,Custom 27803010,,486613140  -  ROD SPINAL 5.5MM 140MM HEXAGON RAD,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
486613160,SUP,Custom 27803010,,486613160  -  ROD SPINAL 5.5MM 160MM HEXAGON RAD,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
486613180,SUP,Custom 27803010,,486613180  -  ROD SPINAL 5.5MM 180MM HEXAGONAL RAD,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
486613200,SUP,Custom 27803010,,486613200  -  ROD SPINAL 5.5MM 200MM HEXAGON RAD,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
486613220,SUP,Custom 27803010,,486613220  -  ROD SPINAL 5.5MM 220MM RAD HEXAGONAL,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
486613240,SUP,Custom 27803010,,486613240  -  ROD SPINAL 5.5MM 240MM HEXAGON RAD,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
486613260,SUP,Custom 27803010,,486613260  -  ROD SPINAL 5.5MM 260MM HEXAGON RAD,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
486613280,SUP,Custom 27803010,,486613280  -  ROD SPINAL 5.5MM 280MM HEXAGON RAD,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
486613300,SUP,Custom 27803010,,486613300  -  ROD SPINAL 5.5MM 300MM HEXAGONAL RAD,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
486613320,SUP,Custom 27803010,,486613320  -  ROD SPINAL 5.5MM 320MM HEXAGON RAD,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
486613340,SUP,Custom 27803010,,486613340  -  ROD SPINAL 5.5MM 340MM HEXAGON RAD,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
486613360,SUP,Custom 27803010,,486613360  -  ROD SPINAL 5.5MM 360MM HEXAGON RAD,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
486613380,SUP,Custom 27803010,,486613380  -  ROD SPINAL 5.5MM 380MM HEXAGON RAD,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
486613400,SUP,Custom 27803010,,486613400  -  ROD SPINAL 5.5MM 400MM RAD HEXAGONAL,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
486613600,SUP,Custom 27803010,,486613600  -  ROD SPINAL 5.5MM 600MM HEXAGONAL RAD,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
486613601,SUP,Custom 27803010,,486613601  -  ROD SPINAL 6.5MM 600MM RAD VITALLIUM PEDICLE,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
486613602,SUP,Custom 27803010,,486613602  -  ROD SPINAL 5.5MM HEXAGON VITALLIUM,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
486614022,SUP,Custom 27803010,,486614022  -  CONNECTOR ROD 22MM CROSS RAD SPN,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
486614024,SUP,Custom 27803010,,486614024  -  CONNECTOR ROD 24MM CROSS RAD SPN,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
486614026,SUP,Custom 27803010,,486614026  -  CONNECTOR ROD 26MM CROSS RAD SPN,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
486614028,SUP,Custom 27803010,,486614028  -  CONNECTOR ROD 28MM CROSS RAD SPN,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
486614030,SUP,Custom 27803010,,486614030  -  CONNECTOR ROD 30MM CROSS RAD SPN,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
486614032,SUP,Custom 27803010,,486614032  -  CONNECTOR ROD 32MM CROSS RAD SPN,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
486614034,SUP,Custom 27803010,,486614034  -  CONNECTOR ROD 34MM CROSS RAD SPN,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
486614036,SUP,Custom 27803010,,486614036  -  CONNECTOR ROD 36MM CROSS RAD SPN,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
486614100,SUP,Custom 27803010,,486614100  -  CONNECTOR ROD SHORT CROSS VARIABLE RAD SPN,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
486614110,SUP,Custom 27803010,,486614110  -  CONNECTOR ROD MEDIUM CROSS RAD VARIABLE,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
486614120,SUP,Custom 27803010,,486614120  -  CONNECTOR ROD LONG CROSS VARIABLE RAD SPN,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
486614130,SUP,Custom 27803010,,486614130  -  CONNECTOR ROD MEDIUM CROSS CVD RAD VARIABLE,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
486614140,SUP,Custom 27803010,,486614140  -  CONNECTOR ROD LONG VARIABLE CROSS CVD RAD MA,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
486614170,SUP,Custom 27803010,,486614170  -  CONNECTOR ROD MEDIUM CROSS MULTIANGLED RAD VARIABLE,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
486614180,SUP,Custom 27803010,,486614180  -  CONNECTOR ROD LONG POLYAX CROSS VAR ANG RAD SPN,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
486614215,SUP,Custom 27803010,,486614215  -  CONNECTOR ROD 15MM CROSS RAD SPN,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
486614216,SUP,Custom 27803010,,486614216  -  CONNECTOR ROD 16MM CROSS RAD SPN,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
486614217,SUP,Custom 27803010,,486614217  -  CONNECTOR ROD 18MM CROSS RAD SPN,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
486614218,SUP,Custom 27803010,,486614218  -  CONNECTOR ROD 18MM CROSS RAD SPN,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
486614219,SUP,Custom 27803010,,486614219  -  CONNECTOR ROD 19MM CROSS RAD SPN,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
486614220,SUP,Custom 27803010,,486614220  -  CONNECTOR ROD 20MM CROSS RAD SPN,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
486614300,SUP,Custom 27803010,,486614300  -  CONNECTOR ROD 0D SMALL ROD TO ROD RAD SPN,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
486614305,SUP,Custom 27803010,,486614305  -  CONNECTOR ROD 105D OFFST RAD BEN,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
486614310,SUP,Custom 27803010,,486614310  -  CONNECTOR ROD NEUTRAL OFFST RAD,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
486614320,SUP,Custom 27803010,,486614320  -  CONNECTOR ROD NEUTRAL LONG OFFST RAD SPN,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
486614330,SUP,Custom 27803010,,486614330  -  CONNECTOR ROD 30D SMALL ROD TO ROD RAD SPN,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
486614375,SUP,Custom 27803010,,486614375  -  CONNECTOR ROD 75D SMALL ROD TO ROD RAD SPN,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
486614400,SUP,Custom 27803010,,486614400  -  CONNECTOR ROD 10D LARGE ROD TO ROD RAD SPN,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
486614430,SUP,Custom 27803010,,486614430  -  CONNECTOR ROD 10D LARGE ROD TO ROD RAD SPN,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
486614530,SUP,Custom 27803010,,486614530  -  CONCTR ROD 5MM RAD ROD TO ROD SPNL,"$2,076.80",$0.00,"$2,076.80",$0.00,"$1,482.21",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,076.80",$0.00,"$1,038.40","$1,644.83","$1,661.44",$0.00,$0.00,$0.00,$0.00,$0.00
486614550,SUP,Custom 27803010,,486614550  -  CONNECTOR ROD 5MM ROD TO ROD RAD SPN,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
486614555,SUP,Custom 27803010,,486614555  -  CONNECTOR ROD ROD TO ROD POLYAX RAD SPN,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
486614560,SUP,Custom 27803010,,486614560  -  CONNECTOR ROD 5MM ROD TO ROD RAD SPN,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
486614565,SUP,Custom 27803010,,486614565  -  CONNECTOR ROD OFFST RAD SPN,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
486615000,SUP,Custom 27803010,,486615000  -  ROD SPINAL 5.5MM 100MM RAD,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
486615010,SUP,Custom 27803010,,486615010  -  ROD SPINAL 5.5MM 110MM RAD,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
486615020,SUP,Custom 27803010,,486615020  -  ROD SPINAL 5.5MM 120MM RAD,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
486615030,SUP,Custom 27803010,,486615030  -  ROD SPINAL 5.5MM 30MM RAD,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
486615035,SUP,Custom 27803010,,486615035  -  ROD SPNL 35MM BN,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
486615040,SUP,Custom 27803010,,486615040  -  ROD SPINAL 5.5MM 40MM TITANIUM,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
486615045,SUP,Custom 27803010,,486615045  -  ROD SPINAL 5.5MM 45MM TITANIUM,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
486615050,SUP,Custom 27803010,,486615050  -  ROD SPINAL 50X5.5MM RAD,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
486615060,SUP,Custom 27803010,,486615060  -  ROD SPINAL 60X5.5MM RAD,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
486615070,SUP,Custom 27803010,,486615070  -  ROD SPINAL 70X5.5MM RAD,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
486615080,SUP,Custom 27803010,,486615080  -  ROD SPNL 5.5MM 80MM SPRL RDS,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
486615090,SUP,Custom 27803010,,486615090  -  ROD SPINAL 5.5MM 90MM TITANIUM,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
486615500,SUP,Custom 27803010,,486615500  -  ROD SPINAL 5.5MM 100MM RAD,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
486615510,SUP,Custom 27803010,,486615510  -  ROD SPINAL 5.5MM 110MM MAX RAD,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
486615520,SUP,Custom 27803010,,486615520  -  ROD SPINAL 5.5MM 120MM RAD MAX,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
486615550,SUP,Custom 27803010,,486615550  -  ROD SPINAL 5.5MM 50MM RAD MAX,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
486615560,SUP,Custom 27803010,,486615560  -  ROD SPNL 60MM ISOBAR,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
486615570,SUP,Custom 27803010,,486615570  -  ROD SPNL 5.5MM 70MM MAX,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
486615580,SUP,Custom 27803010,,486615580  -  ROD SPINAL 5.5MM 80MM MAX RAD,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
486615590,SUP,Custom 27803010,,486615590  -  ROD SPINAL 5.5MM 90MM MAX RAD,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
486616000,SUP,Custom 27803010,,486616000  -  HOOK SPNL RADSM LMNR STR BLADE,"$2,392.80",$0.00,"$2,392.80",$0.00,"$1,707.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,392.80",$0.00,"$1,196.40","$1,895.10","$1,914.24",$0.00,$0.00,$0.00,$0.00,$0.00
486616001,SUP,Custom 27803010,,486616001  -  HOOK SPNL RADSM LMNR NAR BLADE,"$2,392.80",$0.00,"$2,392.80",$0.00,"$1,707.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,392.80",$0.00,"$1,196.40","$1,895.10","$1,914.24",$0.00,$0.00,$0.00,$0.00,$0.00
486616002,SUP,Custom 27803010,,486616002  -  HOOK SPNL RADLG LMNR STR BLADE,"$2,392.80",$0.00,"$2,392.80",$0.00,"$1,707.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,392.80",$0.00,"$1,196.40","$1,895.10","$1,914.24",$0.00,$0.00,$0.00,$0.00,$0.00
486616003,SUP,Custom 27803010,,486616003  -  HOOK SPNL RADLG LMNR NAR BLADE,"$2,392.80",$0.00,"$2,392.80",$0.00,"$1,707.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,392.80",$0.00,"$1,196.40","$1,895.10","$1,914.24",$0.00,$0.00,$0.00,$0.00,$0.00
486616004,SUP,Custom 27803010,,486616004  -  HOOK SPNL RAD LMNR XTD BLADE,"$2,392.80",$0.00,"$2,392.80",$0.00,"$1,707.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,392.80",$0.00,"$1,196.40","$1,895.10","$1,914.24",$0.00,$0.00,$0.00,$0.00,$0.00
486616005,SUP,Custom 27803010,,486616005  -  HOOK SPNL RADLG LMNR RIGHT OFFST,"$2,392.80",$0.00,"$2,392.80",$0.00,"$1,707.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,392.80",$0.00,"$1,196.40","$1,895.10","$1,914.24",$0.00,$0.00,$0.00,$0.00,$0.00
486616006,SUP,Custom 27803010,,486616006  -  HOOK SPNL RADLG LMNR LEFT OFFST,"$2,392.80",$0.00,"$2,392.80",$0.00,"$1,707.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,392.80",$0.00,"$1,196.40","$1,895.10","$1,914.24",$0.00,$0.00,$0.00,$0.00,$0.00
486616007,SUP,Custom 27803010,,486616007  -  HOOK SPNL RAD LMNR ANG BLADE,"$2,392.80",$0.00,"$2,392.80",$0.00,"$1,707.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,392.80",$0.00,"$1,196.40","$1,895.10","$1,914.24",$0.00,$0.00,$0.00,$0.00,$0.00
486616008,SUP,Custom 27803010,,486616008  -  HOOK SPNL RAD LMNR THOR,"$2,392.80",$0.00,"$2,392.80",$0.00,"$1,707.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,392.80",$0.00,"$1,196.40","$1,895.10","$1,914.24",$0.00,$0.00,$0.00,$0.00,$0.00
486616009,SUP,Custom 27803010,,486616009  -  HOOK SPNL RAD LMNR THOR,"$2,392.80",$0.00,"$2,392.80",$0.00,"$1,707.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,392.80",$0.00,"$1,196.40","$1,895.10","$1,914.24",$0.00,$0.00,$0.00,$0.00,$0.00
486616010,SUP,Custom 27803010,,486616010  -  HOOK SPNL RAD LMNR THOR,"$2,392.80",$0.00,"$2,392.80",$0.00,"$1,707.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,392.80",$0.00,"$1,196.40","$1,895.10","$1,914.24",$0.00,$0.00,$0.00,$0.00,$0.00
486616011,SUP,Custom 27803010,,486616011  -  HOOK SPNL RAD LMNR THOR,"$2,392.80",$0.00,"$2,392.80",$0.00,"$1,707.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,392.80",$0.00,"$1,196.40","$1,895.10","$1,914.24",$0.00,$0.00,$0.00,$0.00,$0.00
486616012,SUP,Custom 27803010,,486616012  -  HOOK SPNL RAD LMNR THOR,"$2,392.80",$0.00,"$2,392.80",$0.00,"$1,707.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,392.80",$0.00,"$1,196.40","$1,895.10","$1,914.24",$0.00,$0.00,$0.00,$0.00,$0.00
486616013,SUP,Custom 27803010,,486616013  -  HOOK SPNL RAD LMNR THOR,"$2,392.80",$0.00,"$2,392.80",$0.00,"$1,707.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,392.80",$0.00,"$1,196.40","$1,895.10","$1,914.24",$0.00,$0.00,$0.00,$0.00,$0.00
486616014,SUP,Custom 27803010,,486616014  -  HOOK SPNL RADSM PDCL,"$2,392.80",$0.00,"$2,392.80",$0.00,"$1,707.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,392.80",$0.00,"$1,196.40","$1,895.10","$1,914.24",$0.00,$0.00,$0.00,$0.00,$0.00
486616015,SUP,Custom 27803010,,486616015  -  HOOK SPNL RADLG PDCL,"$2,392.80",$0.00,"$2,392.80",$0.00,"$1,707.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,392.80",$0.00,"$1,196.40","$1,895.10","$1,914.24",$0.00,$0.00,$0.00,$0.00,$0.00
486616016,SUP,Custom 27803010,,486616016  -  HOOK SPNL RAD RIGHT TRNSVRS PRC,"$2,392.80",$0.00,"$2,392.80",$0.00,"$1,707.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,392.80",$0.00,"$1,196.40","$1,895.10","$1,914.24",$0.00,$0.00,$0.00,$0.00,$0.00
486616017,SUP,Custom 27803010,,486616017  -  HOOK SPNL RAD LEFT TRNSVRS PRC,"$2,392.80",$0.00,"$2,392.80",$0.00,"$1,707.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,392.80",$0.00,"$1,196.40","$1,895.10","$1,914.24",$0.00,$0.00,$0.00,$0.00,$0.00
486616018,SUP,Custom 27803010,,486616018  -  HOOK SPNL RAD LMNR NAR BLADE,"$2,686.30",$0.00,"$2,686.30",$0.00,"$1,917.21",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,686.30",$0.00,"$1,343.15","$2,127.55","$2,149.04",$0.00,$0.00,$0.00,$0.00,$0.00
486616019,SUP,Custom 27803010,,486616019  -  HOOK SPNL RAD LMNR STD BLADE,"$2,686.30",$0.00,"$2,686.30",$0.00,"$1,917.21",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,686.30",$0.00,"$1,343.15","$2,127.55","$2,149.04",$0.00,$0.00,$0.00,$0.00,$0.00
486616020,SUP,Custom 27803010,,486616020  -  HOOK SPNL RAD LMNR ANG BLADE,"$2,686.30",$0.00,"$2,686.30",$0.00,"$1,917.21",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,686.30",$0.00,"$1,343.15","$2,127.55","$2,149.04",$0.00,$0.00,$0.00,$0.00,$0.00
486616021,SUP,Custom 27803010,,486616021  -  HOOK SPNL RAD LMNR THOR,"$2,686.30",$0.00,"$2,686.30",$0.00,"$1,917.21",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,686.30",$0.00,"$1,343.15","$2,127.55","$2,149.04",$0.00,$0.00,$0.00,$0.00,$0.00
486616022,SUP,Custom 27803010,,486616022  -  HOOK SPNL RAD PDCL,"$2,686.30",$0.00,"$2,686.30",$0.00,"$1,917.21",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,686.30",$0.00,"$1,343.15","$2,127.55","$2,149.04",$0.00,$0.00,$0.00,$0.00,$0.00
486617005,SUP,HCPCS C1713,,486617005  -  STAPLE BONE DUAL RSTRL RADXS,"$2,493.88",$0.00,"$2,493.88","$1,122.24","$1,779.88",$0.00,$429.68,$0.00,$0.00,$436.66,"$2,493.88",$0.00,"$1,246.94","$1,975.15","$1,995.10",$0.00,$390.29,$0.00,$397.02,$0.00
486617006,SUP,HCPCS C1713,,486617006  -  STAPLE BONE DUAL CDL RADXS,"$2,493.88",$0.00,"$2,493.88","$1,122.24","$1,779.88",$0.00,$429.68,$0.00,$0.00,$436.66,"$2,493.88",$0.00,"$1,246.94","$1,975.15","$1,995.10",$0.00,$390.29,$0.00,$397.02,$0.00
486617010,SUP,HCPCS C1713,,486617010  -  STAPLE BONE DUAL CDL RADSM,"$2,493.88",$0.00,"$2,493.88","$1,122.24","$1,779.88",$0.00,$429.68,$0.00,$0.00,$436.66,"$2,493.88",$0.00,"$1,246.94","$1,975.15","$1,995.10",$0.00,$390.29,$0.00,$397.02,$0.00
486617015,SUP,HCPCS C1713,,486617015  -  STAPLE BONE DUAL RSTRL RADSM,"$2,493.88",$0.00,"$2,493.88","$1,122.24","$1,779.88",$0.00,$429.68,$0.00,$0.00,$436.66,"$2,493.88",$0.00,"$1,246.94","$1,975.15","$1,995.10",$0.00,$390.29,$0.00,$397.02,$0.00
486617020,SUP,HCPCS C1713,,486617020  -  STAPLE BONE DUAL CDL RADMED,"$2,493.88",$0.00,"$2,493.88","$1,122.24","$1,779.88",$0.00,$429.68,$0.00,$0.00,$436.66,"$2,493.88",$0.00,"$1,246.94","$1,975.15","$1,995.10",$0.00,$390.29,$0.00,$397.02,$0.00
486617025,SUP,HCPCS C1713,,486617025  -  STAPLE BONE DUAL RSTRL RADMED,"$2,493.88",$0.00,"$2,493.88","$1,122.24","$1,779.88",$0.00,$429.68,$0.00,$0.00,$436.66,"$2,493.88",$0.00,"$1,246.94","$1,975.15","$1,995.10",$0.00,$390.29,$0.00,$397.02,$0.00
486617030,SUP,HCPCS C1713,,486617030  -  STAPLE BONE DUAL CDL RADLG,"$2,493.88",$0.00,"$2,493.88","$1,122.24","$1,779.88",$0.00,$429.68,$0.00,$0.00,$436.66,"$2,493.88",$0.00,"$1,246.94","$1,975.15","$1,995.10",$0.00,$390.29,$0.00,$397.02,$0.00
486617035,SUP,HCPCS C1713,,486617035  -  STAPLE BONE DUAL RSTRL RADLG,"$2,493.88",$0.00,"$2,493.88","$1,122.24","$1,779.88",$0.00,$429.68,$0.00,$0.00,$436.66,"$2,493.88",$0.00,"$1,246.94","$1,975.15","$1,995.10",$0.00,$390.29,$0.00,$397.02,$0.00
486617040,SUP,HCPCS C1713,,486617040  -  STAPLE BONE SGL TI RAD,"$1,031.95",$0.00,"$1,031.95",$464.38,$736.50,$0.00,$177.80,$0.00,$0.00,$180.69,"$1,031.95",$0.00,$515.98,$817.30,$825.56,$0.00,$161.50,$0.00,$164.29,$0.00
486617045,SUP,HCPCS C1713,,486617045  -  WASHER RAD ORTH,$780.43,$0.00,$780.43,$351.19,$556.99,$0.00,$134.46,$0.00,$0.00,$136.65,$780.43,$0.00,$390.21,$618.10,$624.34,$0.00,$122.14,$0.00,$124.24,$0.00
486617050,SUP,HCPCS C1713,,486617050  -  WASHER 4.75MM RADTALL ORTH,$795.48,$0.00,$795.48,$357.96,$567.73,$0.00,$137.06,$0.00,$0.00,$139.28,$795.48,$0.00,$397.74,$630.02,$636.38,$0.00,$124.49,$0.00,$126.64,$0.00
486617051,SUP,HCPCS C1713,,486617051  -  WASHER 5.75MM RADTALL ORTH,$795.48,$0.00,$795.48,$357.96,$567.73,$0.00,$137.06,$0.00,$0.00,$139.28,$795.48,$0.00,$397.74,$630.02,$636.38,$0.00,$124.49,$0.00,$126.64,$0.00
486617052,SUP,HCPCS C1713,,486617052  -  WASHER 6.75MM RADTALL ORTH,$795.48,$0.00,$795.48,$357.96,$567.73,$0.00,$137.06,$0.00,$0.00,$139.28,$795.48,$0.00,$397.74,$630.02,$636.38,$0.00,$124.49,$0.00,$126.64,$0.00
486617053,SUP,HCPCS C1713,,486617053  -  WASHER 7.75MM RADTALL ORTH,$795.48,$0.00,$795.48,$357.96,$567.73,$0.00,$137.06,$0.00,$0.00,$139.28,$795.48,$0.00,$397.74,$630.02,$636.38,$0.00,$124.49,$0.00,$126.64,$0.00
486617054,SUP,HCPCS C1713,,486617054  -  WASHER 8.75MM RADTALL ORTH,$795.48,$0.00,$795.48,$357.96,$567.73,$0.00,$137.06,$0.00,$0.00,$139.28,$795.48,$0.00,$397.74,$630.02,$636.38,$0.00,$124.49,$0.00,$126.64,$0.00
488514535,SUP,HCPCS C1713,,488514535  -  SCREW BN 4.5MM 35MM STRL XIA PA SPNE LMBR CORT,"$1,875.00",$0.00,"$1,875.00",$843.75,"$1,338.19",$0.00,$323.05,$0.00,$0.00,$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
488515035,SUP,HCPCS C1713,,488515035  -  SCREW BN 5MM 35MM XIA CT PA SPNE CORT,"$1,875.00",$0.00,"$1,875.00",$843.75,"$1,338.19",$0.00,$323.05,$0.00,$0.00,$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
488515540,SUP,HCPCS C1713,,488515540  -  SCREW BN 5.5MM 40MM STRL XIA PA SPNE LMBR CORT,"$1,875.00",$0.00,"$1,875.00",$843.75,"$1,338.19",$0.00,$323.05,$0.00,$0.00,$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
540133500,SUP,Custom 27803010,,540133500  -  SYSTEM BONE CEMENT CARTRIDGE SELF CLEAN MIXING PADDLES SNAP,$920.42,$0.00,$920.42,$0.00,$656.90,$0.00,$0.00,$0.00,$0.00,$0.00,$920.42,$0.00,$460.21,$728.97,$736.34,$0.00,$0.00,$0.00,$0.00,$0.00
582010140,SUP,Custom 27203010,,582010140  -  BURR SURG ROUND 4MM ROUND SOFT TOUCH LATEX FREE ELITE,$310.50,$0.00,$310.50,$0.00,$221.60,$0.00,$0.00,$0.00,$0.00,$0.00,$310.50,$0.00,$155.25,$245.92,$248.40,$0.00,$0.00,$0.00,$0.00,$0.00
606004102,SUP,HCPCS Q4130,,606004102  -  MATRIX TISS THK1MM RECT 20X10CM STRL SURGIMEND PRS,"$11,750.00",$0.00,"$11,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,750.00",$0.00,"$5,875.00","$9,306.00","$9,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
606200006,SUP,HCPCS C1713,,606200006  -  SCREW BONE 2.7MM 16MM SPN SNPOF,"$8,625.00",$0.00,"$8,625.00","$3,881.25","$5,158.80",$0.00,"$1,486.04",$0.00,$0.00,"$1,510.17","$8,625.00",$0.00,"$4,312.50","$6,831.00","$6,900.00",$0.00,"$1,349.81",$0.00,"$1,373.10",$0.00
630505036,SUP,HCPCS C1776,,630505036  -  LINER ACETAB STANDARD NEUTRAL 50/52/54MM 36MM 6.8MM PRIM,"$2,978.75",$0.00,"$2,978.75","$1,340.44","$2,125.93",$0.00,$513.22,$0.00,$0.00,$521.56,"$2,978.75",$0.00,"$1,489.38","$2,359.17","$2,383.00",$0.00,$466.17,$0.00,$474.22,$0.00
630505636,SUP,HCPCS C1776,,630505636  -  LINER ACETAB STANDARD NEUTRAL 56MM 36MM 7.9MM PRIM MODULAR,"$4,007.50",$0.00,"$4,007.50","$1,803.38","$2,860.15",$0.00,$690.47,$0.00,$0.00,$701.68,"$4,007.50",$0.00,"$2,003.75","$3,173.94","$3,206.00",$0.00,$627.17,$0.00,$637.99,$0.00
641003030,SUP,HCPCS C1713,,641003030  -  ROD SPNL 30MM 4.75MM CD HZN COCRMO CAP,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
641003035,SUP,HCPCS C1713,,641003035  -  ROD SPNL 35MM 4.75MM CD HZN COCRMO CAP,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
641003040,SUP,HCPCS C1713,,641003040  -  ROD SPNL 40MM 4.75MM CD HZN COCRMO CAP,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
641003045,SUP,HCPCS C1713,,641003045  -  ROD SPNL 45MM 4.75MM CD HZN COCRMO CAP,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
641003050,SUP,HCPCS C1713,,641003050  -  ROD SPNL 50MM 4.75MM CD HZN COCRMO CAP,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
641003055,SUP,HCPCS C1713,,641003055  -  ROD SPNL 55MM 4.75MM CD HZN COCRMO CAP,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
641003060,SUP,HCPCS C1713,,641003060  -  ROD SPNL 60MM 4.75MM CD HZN COCRMO CAP,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
641003065,SUP,HCPCS C1713,,641003065  -  ROD SPNL 65MM 4.75MM CD HZN COCRMO CAP,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
641003070,SUP,HCPCS C1713,,641003070  -  ROD SPNL 70MM 4.75MM CD HZN COCRMO CAP,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
641003075,SUP,HCPCS C1713,,641003075  -  ROD SPNL 75MM 4.75MM CD HZN CAP,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
641003080,SUP,HCPCS C1713,,641003080  -  ROD SPNL 80MM 4.75MM CD HZN COCRMO CAP,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
641003085,SUP,HCPCS C1713,,641003085  -  ROD SPNL 85MM 4.75MM CD HZN COCRMO CAP STRL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
641003090,SUP,HCPCS C1713,,641003090  -  ROD SPNL 90MM 4.75MM CD HZN COCRMO CAP STRL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
641003095,SUP,HCPCS C1713,,641003095  -  ROD SPNL 95MM 4.75MM CD HZN COCRMO CAP STRL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
651506000,SUP,HCPCS C1894,,651506000  -  SYSTEM INTRO .018IN 80CM SKTR GW SS,$202.50,$0.00,$202.50,$109.96,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
654000100,SUP,HCPCS C1713,,654000100  -  ROD SPNL 5.5MM 100MM NS CD HZN SOLERA TI PERC,"$3,425.00",$0.00,"$3,425.00","$1,541.25","$2,444.42",$0.00,$590.11,$0.00,$0.00,$599.69,"$3,425.00",$0.00,"$1,712.50","$2,712.60","$2,740.00",$0.00,$536.01,$0.00,$545.26,$0.00
673395000,SUP,Custom 27203010,,ADAPTER QCK 800 SER ANALY,$39.38,$0.00,$39.38,$0.00,$28.10,$0.00,$0.00,$0.00,$0.00,$0.00,$39.38,$0.00,$19.69,$31.19,$31.50,$0.00,$0.00,$0.00,$0.00,$0.00
703046000,SUP,Custom 27203010,,"0703046000  -  CTRY,PENCIL,PUSH BUTTON,SMOKE EVAC,70MM",$75.70,$0.00,$75.70,$0.00,$54.03,$0.00,$0.00,$0.00,$0.00,$0.00,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$0.00,$0.00,$0.00,$0.00
755308040,SUP,HCPCS C1729,,755308040  -  CATHETER DRN 8FR 40CM STRL LF SKTR LCK PGTL RADOPQ BAND PU,$227.50,$0.00,$227.50,$123.53,$162.37,$0.00,$39.20,$0.00,$0.00,$39.83,$227.50,$0.00,$113.75,$180.18,$182.00,$0.00,$35.60,$0.00,$36.22,$0.00
755608035,SUP,HCPCS C1729,,755608035  -  CATHETER NPHSTM PGTL CRV LOPRFL 8FR 35CM SKTR LCK KINK RST,$237.50,$0.00,$237.50,$128.96,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
755610035,SUP,HCPCS C1729,,755610035  -  CATHETER NPHSTM .038IN PGTL CRV 10FR 35CM SKTR LCK GW PU BIL,$225.00,$0.00,$225.00,$122.18,$160.58,$0.00,$38.77,$0.00,$0.00,$39.40,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$35.21,$0.00,$35.82,$0.00
756506020,SUP,HCPCS C1729,,756506020  -  CATHETER DRN 6FR 20CM SKTR CHC LCK AP LOPRFL TROC STY,$240.00,$0.00,$240.00,$130.32,$171.29,$0.00,$41.35,$0.00,$0.00,$42.02,$240.00,$0.00,$120.00,$190.08,$192.00,$0.00,$37.56,$0.00,$38.21,$0.00
756510025,SUP,HCPCS C1729,,756510025  -  CATHETER DRN PGTL CRV 10FR 25CM SKTR CHC LCK LCK TROC STY LG,$234.95,$0.00,$234.95,$127.58,$167.68,$0.00,$40.48,$0.00,$0.00,$41.14,$234.95,$0.00,$117.47,$186.08,$187.96,$0.00,$36.77,$0.00,$37.40,$0.00
756512025,SUP,HCPCS C1729,,756512025  -  CATHETER DRN PGTL CRV 12FR 25CM SKTR CHC LCK LCK TROC STY LG,"$1,174.73",$0.00,"$1,174.73",$637.88,$838.40,$0.00,$202.40,$0.00,$0.00,$205.68,"$1,174.73",$0.00,$587.36,$930.39,$939.78,$0.00,$183.84,$0.00,$187.02,$0.00
756514025,SUP,HCPCS C1729,,756514025  -  CATHETER DRN PGTL CRV 14FR 25CM SKTR CHC LCK LCK TROC STY LG,"$1,135.00",$0.00,"$1,135.00",$616.31,$810.05,$0.00,$195.55,$0.00,$0.00,$198.73,"$1,135.00",$0.00,$567.50,$898.92,$908.00,$0.00,$177.63,$0.00,$180.69,$0.00
771600010,SUP,Custom 27203010,,00771600010  -  CARRIER GRAFT 16X4IN BOARD LATEX FREE MESHGRAFT,$126.88,$0.00,$126.88,$0.00,$90.55,$0.00,$0.00,$0.00,$0.00,$0.00,$126.88,$0.00,$63.44,$100.49,$101.50,$0.00,$0.00,$0.00,$0.00,$0.00
778114545,SUP,Custom 27803010,,778114545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,346.10",$0.00,"$2,346.10",$0.00,"$1,674.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,346.10",$0.00,"$1,173.05","$1,858.11","$1,876.88",$0.00,$0.00,$0.00,$0.00,$0.00
778114555,SUP,Custom 27803010,,778114555  -  PLATE 18MM TI BONE SPNL,"$2,118.45",$0.00,"$2,118.45",$0.00,"$1,511.94",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,118.45",$0.00,"$1,059.23","$1,677.81","$1,694.76",$0.00,$0.00,$0.00,$0.00,$0.00
778114565,SUP,Custom 27803010,,778114565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,118.45",$0.00,"$2,118.45",$0.00,"$1,511.94",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,118.45",$0.00,"$1,059.23","$1,677.81","$1,694.76",$0.00,$0.00,$0.00,$0.00,$0.00
778115545,SUP,Custom 27803010,,778115545  -  PLATE 18MM TI BONE SPNL,"$2,346.10",$0.00,"$2,346.10",$0.00,"$1,674.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,346.10",$0.00,"$1,173.05","$1,858.11","$1,876.88",$0.00,$0.00,$0.00,$0.00,$0.00
778115555,SUP,Custom 27803010,,778115555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,346.10",$0.00,"$2,346.10",$0.00,"$1,674.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,346.10",$0.00,"$1,173.05","$1,858.11","$1,876.88",$0.00,$0.00,$0.00,$0.00,$0.00
778115565,SUP,Custom 27803010,,778115565  -  PLATE 18MM TI BONE SPNL,"$2,118.45",$0.00,"$2,118.45",$0.00,"$1,511.94",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,118.45",$0.00,"$1,059.23","$1,677.81","$1,694.76",$0.00,$0.00,$0.00,$0.00,$0.00
778116545,SUP,Custom 27803010,,778116545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,346.10",$0.00,"$2,346.10",$0.00,"$1,674.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,346.10",$0.00,"$1,173.05","$1,858.11","$1,876.88",$0.00,$0.00,$0.00,$0.00,$0.00
778116555,SUP,Custom 27803010,,778116555  -  PLATE 18MM TI BONE SPNL,"$2,346.10",$0.00,"$2,346.10",$0.00,"$1,674.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,346.10",$0.00,"$1,173.05","$1,858.11","$1,876.88",$0.00,$0.00,$0.00,$0.00,$0.00
778116565,SUP,Custom 27803010,,778116565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,346.10",$0.00,"$2,346.10",$0.00,"$1,674.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,346.10",$0.00,"$1,173.05","$1,858.11","$1,876.88",$0.00,$0.00,$0.00,$0.00,$0.00
778124545,SUP,Custom 27803010,,778124545  -  PLATE 18MM TI BONE SPNL,"$2,574.00",$0.00,"$2,574.00",$0.00,"$1,837.06",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,574.00",$0.00,"$1,287.00","$2,038.61","$2,059.20",$0.00,$0.00,$0.00,$0.00,$0.00
778124555,SUP,Custom 27803010,,778124555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,574.00",$0.00,"$2,574.00",$0.00,"$1,837.06",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,574.00",$0.00,"$1,287.00","$2,038.61","$2,059.20",$0.00,$0.00,$0.00,$0.00,$0.00
778124565,SUP,Custom 27803010,,778124565  -  PLATE 18MM TI BONE SPNL,"$2,052.75",$0.00,"$2,052.75",$0.00,"$1,465.05",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,052.75",$0.00,"$1,026.38","$1,625.78","$1,642.20",$0.00,$0.00,$0.00,$0.00,$0.00
778125555,SUP,Custom 27803010,,778125555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,574.00",$0.00,"$2,574.00",$0.00,"$1,837.06",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,574.00",$0.00,"$1,287.00","$2,038.61","$2,059.20",$0.00,$0.00,$0.00,$0.00,$0.00
778125565,SUP,Custom 27803010,,778125565  -  PLATE 18MM TI BONE SPNL,"$2,574.00",$0.00,"$2,574.00",$0.00,"$1,837.06",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,574.00",$0.00,"$1,287.00","$2,038.61","$2,059.20",$0.00,$0.00,$0.00,$0.00,$0.00
778126565,SUP,Custom 27803010,,778126565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,574.00",$0.00,"$2,574.00",$0.00,"$1,837.06",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,574.00",$0.00,"$1,287.00","$2,038.61","$2,059.20",$0.00,$0.00,$0.00,$0.00,$0.00
778144545,SUP,Custom 27803010,,778144545  -  PLATE 18MM TI BONE SPNL,"$2,175.95",$0.00,"$2,175.95",$0.00,"$1,552.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,175.95",$0.00,"$1,087.98","$1,723.35","$1,740.76",$0.00,$0.00,$0.00,$0.00,$0.00
778144565,SUP,Custom 27803010,,778144565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,981.85",$0.00,"$1,981.85",$0.00,"$1,414.45",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,981.85",$0.00,$990.93,"$1,569.63","$1,585.48",$0.00,$0.00,$0.00,$0.00,$0.00
778145545,SUP,Custom 27803010,,778145545  -  PLATE 18MM TI BONE SPNL,"$2,175.95",$0.00,"$2,175.95",$0.00,"$1,552.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,175.95",$0.00,"$1,087.98","$1,723.35","$1,740.76",$0.00,$0.00,$0.00,$0.00,$0.00
778145555,SUP,Custom 27803010,,778145555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,175.95",$0.00,"$2,175.95",$0.00,"$1,552.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,175.95",$0.00,"$1,087.98","$1,723.35","$1,740.76",$0.00,$0.00,$0.00,$0.00,$0.00
778145565,SUP,Custom 27803010,,778145565  -  PLATE 18MM TI BONE SPNL,"$1,981.85",$0.00,"$1,981.85",$0.00,"$1,414.45",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,981.85",$0.00,$990.93,"$1,569.63","$1,585.48",$0.00,$0.00,$0.00,$0.00,$0.00
778146545,SUP,Custom 27803010,,778146545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,574.00",$0.00,"$2,574.00",$0.00,"$1,837.06",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,574.00",$0.00,"$1,287.00","$2,038.61","$2,059.20",$0.00,$0.00,$0.00,$0.00,$0.00
778146555,SUP,Custom 27803010,,778146555  -  PLATE 18MM TI BONE SPNL,"$2,574.00",$0.00,"$2,574.00",$0.00,"$1,837.06",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,574.00",$0.00,"$1,287.00","$2,038.61","$2,059.20",$0.00,$0.00,$0.00,$0.00,$0.00
778146565,SUP,Custom 27803010,,778146565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,175.95",$0.00,"$2,175.95",$0.00,"$1,552.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,175.95",$0.00,"$1,087.98","$1,723.35","$1,740.76",$0.00,$0.00,$0.00,$0.00,$0.00
778161045,SUP,HCPCS C1713,,778161045  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
778161065,SUP,HCPCS C1713,,778161065  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
778162045,SUP,HCPCS C1713,,778162045  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
778162055,SUP,HCPCS C1713,,778162055  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
778162065,SUP,HCPCS C1713,,778162065  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
778164045,SUP,HCPCS C1713,,778164045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
778164065,SUP,HCPCS C1713,,778164065  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
778167045,SUP,HCPCS C1713,,778167045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
778167055,SUP,HCPCS C1713,,778167055  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
778167065,SUP,HCPCS C1713,,778167065  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
778170001,SUP,HCPCS C1713,,778170001  -  PLATE 18MM TI BONE SPNL,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
778214545,SUP,Custom 27803010,,778214545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,118.45",$0.00,"$2,118.45",$0.00,"$1,511.94",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,118.45",$0.00,"$1,059.23","$1,677.81","$1,694.76",$0.00,$0.00,$0.00,$0.00,$0.00
778214555,SUP,Custom 27803010,,778214555  -  PLATE 18MM TI BONE SPNL,"$2,346.10",$0.00,"$2,346.10",$0.00,"$1,674.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,346.10",$0.00,"$1,173.05","$1,858.11","$1,876.88",$0.00,$0.00,$0.00,$0.00,$0.00
778214565,SUP,Custom 27803010,,778214565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,346.10",$0.00,"$2,346.10",$0.00,"$1,674.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,346.10",$0.00,"$1,173.05","$1,858.11","$1,876.88",$0.00,$0.00,$0.00,$0.00,$0.00
778215545,SUP,Custom 27803010,,778215545  -  PLATE 18MM TI BONE SPNL,"$2,118.45",$0.00,"$2,118.45",$0.00,"$1,511.94",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,118.45",$0.00,"$1,059.23","$1,677.81","$1,694.76",$0.00,$0.00,$0.00,$0.00,$0.00
778215555,SUP,Custom 27803010,,778215555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,118.45",$0.00,"$2,118.45",$0.00,"$1,511.94",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,118.45",$0.00,"$1,059.23","$1,677.81","$1,694.76",$0.00,$0.00,$0.00,$0.00,$0.00
778215565,SUP,Custom 27803010,,778215565  -  PLATE 18MM TI BONE SPNL,"$2,346.10",$0.00,"$2,346.10",$0.00,"$1,674.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,346.10",$0.00,"$1,173.05","$1,858.11","$1,876.88",$0.00,$0.00,$0.00,$0.00,$0.00
778216545,SUP,Custom 27803010,,778216545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,118.45",$0.00,"$2,118.45",$0.00,"$1,511.94",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,118.45",$0.00,"$1,059.23","$1,677.81","$1,694.76",$0.00,$0.00,$0.00,$0.00,$0.00
778216555,SUP,Custom 27803010,,778216555  -  PLATE 18MM TI BONE SPNL,"$2,118.45",$0.00,"$2,118.45",$0.00,"$1,511.94",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,118.45",$0.00,"$1,059.23","$1,677.81","$1,694.76",$0.00,$0.00,$0.00,$0.00,$0.00
778216565,SUP,Custom 27803010,,778216565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,118.45",$0.00,"$2,118.45",$0.00,"$1,511.94",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,118.45",$0.00,"$1,059.23","$1,677.81","$1,694.76",$0.00,$0.00,$0.00,$0.00,$0.00
778224545,SUP,Custom 27803010,,778224545  -  PLATE 18MM TI BONE SPNL,"$1,969.50",$0.00,"$1,969.50",$0.00,"$1,405.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,969.50",$0.00,$984.75,"$1,559.84","$1,575.60",$0.00,$0.00,$0.00,$0.00,$0.00
778224555,SUP,Custom 27803010,,778224555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,969.50",$0.00,"$1,969.50",$0.00,"$1,405.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,969.50",$0.00,$984.75,"$1,559.84","$1,575.60",$0.00,$0.00,$0.00,$0.00,$0.00
778224565,SUP,Custom 27803010,,778224565  -  PLATE 18MM TI BONE SPNL,"$2,251.70",$0.00,"$2,251.70",$0.00,"$1,607.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,251.70",$0.00,"$1,125.85","$1,783.35","$1,801.36",$0.00,$0.00,$0.00,$0.00,$0.00
778225555,SUP,Custom 27803010,,778225555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,969.50",$0.00,"$1,969.50",$0.00,"$1,405.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,969.50",$0.00,$984.75,"$1,559.84","$1,575.60",$0.00,$0.00,$0.00,$0.00,$0.00
778225565,SUP,Custom 27803010,,778225565  -  PLATE 18MM TI BONE SPNL,"$1,969.50",$0.00,"$1,969.50",$0.00,"$1,405.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,969.50",$0.00,$984.75,"$1,559.84","$1,575.60",$0.00,$0.00,$0.00,$0.00,$0.00
778226565,SUP,Custom 27803010,,778226565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,969.50",$0.00,"$1,969.50",$0.00,"$1,405.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,969.50",$0.00,$984.75,"$1,559.84","$1,575.60",$0.00,$0.00,$0.00,$0.00,$0.00
778244545,SUP,Custom 27803010,,778244545  -  PLATE 18MM TI BONE SPNL,"$1,981.85",$0.00,"$1,981.85",$0.00,"$1,414.45",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,981.85",$0.00,$990.93,"$1,569.63","$1,585.48",$0.00,$0.00,$0.00,$0.00,$0.00
778244555,SUP,Custom 27803010,,778244555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,175.95",$0.00,"$2,175.95",$0.00,"$1,552.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,175.95",$0.00,"$1,087.98","$1,723.35","$1,740.76",$0.00,$0.00,$0.00,$0.00,$0.00
778244565,SUP,Custom 27803010,,778244565  -  PLATE 18MM TI BONE SPNL,"$2,175.95",$0.00,"$2,175.95",$0.00,"$1,552.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,175.95",$0.00,"$1,087.98","$1,723.35","$1,740.76",$0.00,$0.00,$0.00,$0.00,$0.00
778245545,SUP,Custom 27803010,,778245545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,981.85",$0.00,"$1,981.85",$0.00,"$1,414.45",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,981.85",$0.00,$990.93,"$1,569.63","$1,585.48",$0.00,$0.00,$0.00,$0.00,$0.00
778245555,SUP,Custom 27803010,,778245555  -  PLATE 18MM TI BONE SPNL,"$1,981.85",$0.00,"$1,981.85",$0.00,"$1,414.45",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,981.85",$0.00,$990.93,"$1,569.63","$1,585.48",$0.00,$0.00,$0.00,$0.00,$0.00
778245565,SUP,Custom 27803010,,778245565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,175.95",$0.00,"$2,175.95",$0.00,"$1,552.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,175.95",$0.00,"$1,087.98","$1,723.35","$1,740.76",$0.00,$0.00,$0.00,$0.00,$0.00
778246545,SUP,Custom 27803010,,778246545  -  PLATE 18MM TI BONE SPNL,"$2,052.75",$0.00,"$2,052.75",$0.00,"$1,465.05",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,052.75",$0.00,"$1,026.38","$1,625.78","$1,642.20",$0.00,$0.00,$0.00,$0.00,$0.00
778246555,SUP,Custom 27803010,,778246555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,052.75",$0.00,"$2,052.75",$0.00,"$1,465.05",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,052.75",$0.00,"$1,026.38","$1,625.78","$1,642.20",$0.00,$0.00,$0.00,$0.00,$0.00
778246565,SUP,Custom 27803010,,778246565  -  PLATE 18MM TI BONE SPNL,"$1,981.85",$0.00,"$1,981.85",$0.00,"$1,414.45",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,981.85",$0.00,$990.93,"$1,569.63","$1,585.48",$0.00,$0.00,$0.00,$0.00,$0.00
778261045,SUP,HCPCS C1713,,778261045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
778261055,SUP,HCPCS C1713,,778261055  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
778261065,SUP,HCPCS C1713,,778261065  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
778262045,SUP,HCPCS C1713,,778262045  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
778262055,SUP,HCPCS C1713,,778262055  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
778262065,SUP,HCPCS C1713,,778262065  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
778264045,SUP,HCPCS C1713,,778264045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
778264055,SUP,HCPCS C1713,,778264055  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
778264065,SUP,HCPCS C1713,,778264065  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
778267045,SUP,HCPCS C1713,,778267045  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
778267055,SUP,HCPCS C1713,,778267055  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
778267065,SUP,HCPCS C1713,,778267065  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
778270001,SUP,HCPCS C1713,,778270001  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
779115545,SUP,Custom 27803010,,779115545  -  PLATE 18MM TI BONE SPNL,"$2,346.10",$0.00,"$2,346.10",$0.00,"$1,674.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,346.10",$0.00,"$1,173.05","$1,858.11","$1,876.88",$0.00,$0.00,$0.00,$0.00,$0.00
779115555,SUP,Custom 27803010,,779115555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,346.10",$0.00,"$2,346.10",$0.00,"$1,674.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,346.10",$0.00,"$1,173.05","$1,858.11","$1,876.88",$0.00,$0.00,$0.00,$0.00,$0.00
779115565,SUP,Custom 27803010,,779115565  -  PLATE 18MM TI BONE SPNL,"$2,574.00",$0.00,"$2,574.00",$0.00,"$1,837.06",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,574.00",$0.00,"$1,287.00","$2,038.61","$2,059.20",$0.00,$0.00,$0.00,$0.00,$0.00
779124555,SUP,Custom 27803010,,779124555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,251.70",$0.00,"$2,251.70",$0.00,"$1,607.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,251.70",$0.00,"$1,125.85","$1,783.35","$1,801.36",$0.00,$0.00,$0.00,$0.00,$0.00
779125555,SUP,Custom 27803010,,779125555  -  PLATE 18MM TI BONE SPNL,"$2,251.70",$0.00,"$2,251.70",$0.00,"$1,607.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,251.70",$0.00,"$1,125.85","$1,783.35","$1,801.36",$0.00,$0.00,$0.00,$0.00,$0.00
779125565,SUP,Custom 27803010,,779125565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,251.70",$0.00,"$2,251.70",$0.00,"$1,607.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,251.70",$0.00,"$1,125.85","$1,783.35","$1,801.36",$0.00,$0.00,$0.00,$0.00,$0.00
779144555,SUP,Custom 27803010,,779144555  -  PLATE 18MM TI BONE SPNL,"$2,251.70",$0.00,"$2,251.70",$0.00,"$1,607.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,251.70",$0.00,"$1,125.85","$1,783.35","$1,801.36",$0.00,$0.00,$0.00,$0.00,$0.00
779145555,SUP,Custom 27803010,,779145555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,251.70",$0.00,"$2,251.70",$0.00,"$1,607.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,251.70",$0.00,"$1,125.85","$1,783.35","$1,801.36",$0.00,$0.00,$0.00,$0.00,$0.00
779146555,SUP,Custom 27803010,,779146555  -  PLATE 18MM TI BONE SPNL,"$2,251.70",$0.00,"$2,251.70",$0.00,"$1,607.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,251.70",$0.00,"$1,125.85","$1,783.35","$1,801.36",$0.00,$0.00,$0.00,$0.00,$0.00
779170005,SUP,HCPCS C1713,,779170005  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
880000010,SUP,Custom 27203010,,00880000010  -  BLADE DERMATOME 1.25-4.25IN STERILE,$121.25,$0.00,$121.25,$0.00,$86.54,$0.00,$0.00,$0.00,$0.00,$0.00,$121.25,$0.00,$60.63,$96.03,$97.00,$0.00,$0.00,$0.00,$0.00,$0.00
998604014,SUP,HCPCS C1776,,998604014  -  SET TOT JOINT 11MM 8IN TREPHINE MRI NONSTRL,"$2,037.50",$0.00,"$2,037.50",$916.88,"$1,454.16",$0.00,$351.05,$0.00,$0.00,$356.75,"$2,037.50",$0.00,"$1,018.75","$1,613.70","$1,630.00",$0.00,$318.87,$0.00,$324.37,$0.00
1474000500,SUP,HCPCS C1713,,1474000500  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1475000500,SUP,HCPCS C1713,,1475000500  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1475001030,SUP,HCPCS C1713,,1475001030  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1475001035,SUP,HCPCS C1713,,1475001035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1475001040,SUP,HCPCS C1713,,1475001040  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1475001045,SUP,HCPCS C1713,,1475001045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1475001050,SUP,HCPCS C1713,,1475001050  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1475001055,SUP,HCPCS C1713,,1475001055  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1475001060,SUP,HCPCS C1713,,1475001060  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1475001065,SUP,HCPCS C1713,,1475001065  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1475001070,SUP,HCPCS C1713,,1475001070  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1475001075,SUP,HCPCS C1713,,1475001075  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1475001080,SUP,HCPCS C1713,,1475001080  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1475001085,SUP,HCPCS C1713,,1475001085  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1475001090,SUP,HCPCS C1713,,1475001090  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1475001100,SUP,HCPCS C1713,,1475001100  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1475001110,SUP,HCPCS C1713,,1475001110  -  ROD SPNL CRV PREBNT 4.75MM 110MM NS SOLERA CD HZN CCM,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1475001120,SUP,HCPCS C1713,,1475001120  -  ROD SPNL CRV 4.75MM 120MM NS SOLERA CD HZN COCR MLBDN,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1475005040,SUP,HCPCS C1713,,1475005040  -  ROD SPNL CRV 4.75MM 40MM NS SXTNT COCR MLBDN,"$2,820.00",$0.00,"$2,820.00","$1,269.00","$2,012.63",$0.00,$485.87,$0.00,$0.00,$493.76,"$2,820.00",$0.00,"$1,410.00","$2,233.44","$2,256.00",$0.00,$441.33,$0.00,$448.94,$0.00
1475005050,SUP,HCPCS C1713,,1475005050  -  ROD SPINAL CURVE 4.75MM 50MM SEXTANT COCR,"$2,820.00",$0.00,"$2,820.00","$1,269.00","$2,012.63",$0.00,$485.87,$0.00,$0.00,$493.76,"$2,820.00",$0.00,"$1,410.00","$2,233.44","$2,256.00",$0.00,$441.33,$0.00,$448.94,$0.00
1475200500,SUP,HCPCS C1713,,1475200500  -  ROD SPINAL 500MM LINE STR COCR MOLYBDENUM 4.75MM,"$2,125.50",$0.00,"$2,125.50",$956.48,"$1,516.97",$0.00,$366.21,$0.00,$0.00,$372.16,"$2,125.50",$0.00,"$1,062.75","$1,683.40","$1,700.40",$0.00,$332.64,$0.00,$338.38,$0.00
1475501030,SUP,HCPCS C1713,,1475501030  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1475501035,SUP,HCPCS C1713,,1475501035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1475501040,SUP,HCPCS C1713,,1475501040  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1475501045,SUP,HCPCS C1713,,1475501045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1475501050,SUP,HCPCS C1713,,1475501050  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1475501055,SUP,HCPCS C1713,,1475501055  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1475501060,SUP,HCPCS C1713,,1475501060  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1475501065,SUP,HCPCS C1713,,1475501065  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1475501070,SUP,HCPCS C1713,,1475501070  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1475501075,SUP,HCPCS C1713,,1475501075  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1475501080,SUP,HCPCS C1713,,1475501080  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1475501085,SUP,HCPCS C1713,,1475501085  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1475501090,SUP,HCPCS C1713,,1475501090  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1475501095,SUP,HCPCS C1713,,1475501095  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1475501100,SUP,HCPCS C1713,,1475501100  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1475501105,SUP,HCPCS C1713,,1475501105  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1475501110,SUP,HCPCS C1713,,1475501110  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1475501115,SUP,HCPCS C1713,,1475501115  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1475501120,SUP,HCPCS C1713,,1475501120  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1476000500,SUP,HCPCS C1713,,1476000500  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1476006040,SUP,HCPCS C1713,,1476006040  -  ROD SPNL 40MM 4.75MM LNGT II STR CCM PLUS PERC,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1476006070,SUP,HCPCS C1713,,1476006070  -  ROD SPINAL 70MM STR CCM PLUS 4.75MM PERCUTANEOUS,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1476006080,SUP,HCPCS C1713,,1476006080  -  ROD SPINAL 80MM STR CCM PLUS 4.75MM PERCUTANEOUS,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1476006090,SUP,HCPCS C1713,,1476006090  -  ROD SPINAL STR 4.75MM 90MM CCM PLUS PERCUTANEOUS,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1476006100,SUP,HCPCS C1713,,1476006100  -  ROD SPINAL 100MM STR CCM PLUS 4.75MM PERCUTANEOUS,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1476006110,SUP,HCPCS C1713,,1476006110  -  ROD SPINAL 110MM STR COCR 4.75MM PERCUTANEOUS,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1476006120,SUP,HCPCS C1713,,1476006120  -  ROD SPINAL 120MM STR CCM PLUS 4.75MM PERCUTANEOUS,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1476006130,SUP,HCPCS C1713,,1476006130  -  ROD SPINAL STR 4.75MM 130MM CCM PLUS PERCUTANEOUS,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1476006140,SUP,HCPCS C1713,,1476006140  -  ROD SPINAL 140MM STR CCM PLUS 4.75MM PERCUTANEOUS,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1476006150,SUP,HCPCS C1713,,1476006150  -  ROD SPINAL 150MM STR CCM PLUS 4.75MM PERCUTANEOUS,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1476006160,SUP,HCPCS C1713,,1476006160  -  ROD SPINAL 160MM STR CCM PLUS 4.75MM PERCUTANEOUS,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1476006170,SUP,HCPCS C1713,,1476006170  -  ROD SPINAL 170MM SOLERA STR COCR MOLYBDENUM 4.75MM,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1476006180,SUP,HCPCS C1713,,1476006180  -  ROD SPINAL 180MM STR CCM PLUS 4.75MM PERCUTANEOUS,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1476006200,SUP,HCPCS C1713,,1476006200  -  ROD SPINAL 200MM STR CCM PLUS 4.75MM PERCUTANEOUS,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1476006220,SUP,HCPCS C1713,,1476006220  -  ROD SPNL STRG 4.75MM 220MM CCM + PERC,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1476200500,SUP,HCPCS C1713,,1476200500  -  ROD SPINAL 500MM LINE CD HORIZON CURVE COBALT 5.5MM STERILE,"$2,125.50",$0.00,"$2,125.50",$956.48,"$1,516.97",$0.00,$366.21,$0.00,$0.00,$372.16,"$2,125.50",$0.00,"$1,062.75","$1,683.40","$1,700.40",$0.00,$332.64,$0.00,$338.38,$0.00
1553200500,SUP,HCPCS C1713,,1553200500  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1553201030,SUP,HCPCS C1713,,1553201030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1553201035,SUP,HCPCS C1713,,1553201035  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1553201040,SUP,HCPCS C1713,,1553201040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1553201045,SUP,HCPCS C1713,,1553201045  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1553201050,SUP,HCPCS C1713,,1553201050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1553201055,SUP,HCPCS C1713,,1553201055  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1553201060,SUP,HCPCS C1713,,1553201060  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1553201070,SUP,HCPCS C1713,,1553201070  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1553201080,SUP,HCPCS C1713,,1553201080  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1553201090,SUP,HCPCS C1713,,1553201090  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1553201100,SUP,HCPCS C1713,,1553201100  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1553201110,SUP,HCPCS C1713,,1553201110  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1553201120,SUP,HCPCS C1713,,1553201120  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1554200500,SUP,HCPCS C1713,,1554200500  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1555000500,SUP,HCPCS C1713,,1555000500  -  ROD SPNL STRG 5.5MM 500MM NS CD HZN COCRMO,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1555006100,SUP,HCPCS C1713,,1555006100  -  ROD SPINAL 100MM PRECUT CD HORIZON STR COCR 5.5MM,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1555006110,SUP,HCPCS C1713,,1555006110  -  ROD SPNL STRG 5.5MM 110MM CCM PERC,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1555006120,SUP,HCPCS C1713,,1555006120  -  ROD SPINAL 120MM STR CCM 5.5MM PERCUTANEOUS,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1555006170,SUP,HCPCS C1713,,1555006170  -  ROD SPINAL 170MM PRECUT CD HORIZON STR COCR 5.5MM,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1555501030,SUP,HCPCS C1713,,1555501030  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1555501035,SUP,HCPCS C1713,,1555501035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1555501040,SUP,HCPCS C1713,,1555501040  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1555501045,SUP,HCPCS C1713,,1555501045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1555501050,SUP,HCPCS C1713,,1555501050  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1555501055,SUP,HCPCS C1713,,1555501055  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1555501060,SUP,HCPCS C1713,,1555501060  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1555501070,SUP,HCPCS C1713,,1555501070  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1555501080,SUP,HCPCS C1713,,1555501080  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1555501090,SUP,HCPCS C1713,,1555501090  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1555501100,SUP,HCPCS C1713,,1555501100  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1555501110,SUP,HCPCS C1713,,1555501110  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1555501120,SUP,HCPCS C1713,,1555501120  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1556000500,SUP,HCPCS C1713,,1556000500  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1556000600,SUP,HCPCS C1713,,1556000600  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1556001030,SUP,HCPCS C1713,,1556001030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1556001035,SUP,HCPCS C1713,,1556001035  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1556001040,SUP,HCPCS C1713,,1556001040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1556001045,SUP,HCPCS C1713,,1556001045  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1556001050,SUP,HCPCS C1713,,1556001050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1556001055,SUP,HCPCS C1713,,1556001055  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1556001060,SUP,HCPCS C1713,,1556001060  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1556001065,SUP,HCPCS C1713,,1556001065  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1556001070,SUP,HCPCS C1713,,1556001070  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1556001075,SUP,HCPCS C1713,,1556001075  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1556001080,SUP,HCPCS C1713,,1556001080  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1556001085,SUP,HCPCS C1713,,1556001085  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1556001090,SUP,HCPCS C1713,,1556001090  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1556001095,SUP,HCPCS C1713,,1556001095  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1556001100,SUP,HCPCS C1713,,1556001100  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1556001105,SUP,HCPCS C1713,,1556001105  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1556001110,SUP,HCPCS C1713,,1556001110  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1556001115,SUP,HCPCS C1713,,1556001115  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1603200500,SUP,HCPCS C1713,,1603200500  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1604200500,SUP,HCPCS C1713,,1604200500  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1605000500,SUP,HCPCS C1713,,1605000500  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1606000500,SUP,HCPCS C1713,,1606000500  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1606000600,SUP,HCPCS C1713,,1606000600  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1606000700,SUP,HCPCS C1713,,1606000700  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1606200500,SUP,HCPCS C1713,,1606200500  -  ROD SPINAL 500MM LINE STR RED CCM PLUS 6MM,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
1607002003,SUP,Custom 27203010,,1607002003  -  BURR SURG BARREL EGG 6MM STERILE,$145.75,$0.00,$145.75,$0.00,$104.02,$0.00,$0.00,$0.00,$0.00,$0.00,$145.75,$0.00,$72.88,$115.43,$116.60,$0.00,$0.00,$0.00,$0.00,$0.00
1608002005,SUP,Custom 27203010,,1608002005  -  BURR SURG 6.1MM 54MM 9.5MM PEAR HEAD STAINLESS STEEL STERILE,$145.75,$0.00,$145.75,$0.00,$104.02,$0.00,$0.00,$0.00,$0.00,$0.00,$145.75,$0.00,$72.88,$115.43,$116.60,$0.00,$0.00,$0.00,$0.00,$0.00
1705015006,SUP,Custom 27203010,,1705015006  -  PATCH CV THK.6MM 15X5CM STRL GRTX,"$1,555.00",$0.00,"$1,555.00",$0.00,"$1,109.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,555.00",$0.00,$777.50,"$1,231.56","$1,244.00",$0.00,$0.00,$0.00,$0.00,$0.00
3571129240,SUP,HCPCS C1713,,3571129240  -  SCREW BN 4.5MM 40MM ST HEX HD HIP,$50.88,$0.00,$50.88,$22.89,$36.31,$0.00,$8.77,$0.00,$0.00,$8.91,$50.88,$0.00,$25.44,$40.30,$40.70,$0.00,$7.96,$0.00,$8.10,$0.00
3571140003,SUP,HCPCS C1713,,3571140003  -  PLATE BN 45MM 3 HL RECON PLVC 4.5MM SCR,$798.00,$0.00,$798.00,$359.10,$569.53,$0.00,$137.49,$0.00,$0.00,$139.72,$798.00,$0.00,$399.00,$632.02,$638.40,$0.00,$124.89,$0.00,$127.04,$0.00
3571140004,SUP,HCPCS C1713,,3571140004  -  PLATE BN 61MM 4 HL RECON PLVC 4.5MM SCR,$846.30,$0.00,$846.30,$380.84,$604.00,$0.00,$145.81,$0.00,$0.00,$148.18,$846.30,$0.00,$423.15,$670.27,$677.04,$0.00,$132.45,$0.00,$134.73,$0.00
3571140005,SUP,HCPCS C1713,,3571140005  -  PLATE BN 77MM STRL 5 HL RECON PLVC 4.5MM SCR,$910.35,$0.00,$910.35,$409.66,$649.72,$0.00,$156.85,$0.00,$0.00,$159.40,$910.35,$0.00,$455.18,$721.00,$728.28,$0.00,$142.47,$0.00,$144.93,$0.00
3571140006,SUP,HCPCS C1713,,3571140006  -  PLATE BN 93MM STRL 6 HL RECON PLVC 4.5MM SCR,$972.30,$0.00,$972.30,$437.54,$693.93,$0.00,$167.52,$0.00,$0.00,$170.24,$972.30,$0.00,$486.15,$770.06,$777.84,$0.00,$152.16,$0.00,$154.79,$0.00
3571140007,SUP,HCPCS C1713,,3571140007  -  PLATE BN 109MM STRL 7 HL RECON PLVC 4.5MM SCR,"$1,025.85",$0.00,"$1,025.85",$461.63,$732.15,$0.00,$176.75,$0.00,$0.00,$179.62,"$1,025.85",$0.00,$512.93,$812.47,$820.68,$0.00,$160.55,$0.00,$163.32,$0.00
3571140008,SUP,HCPCS C1713,,3571140008  -  PLATE BN 125MM STRL 8 HL RECON PLVC 4.5MM SCR,"$1,302.00",$0.00,"$1,302.00",$585.90,$929.24,$0.00,$224.33,$0.00,$0.00,$227.97,"$1,302.00",$0.00,$651.00,"$1,031.18","$1,041.60",$0.00,$203.76,$0.00,$207.28,$0.00
3571140009,SUP,HCPCS C1713,,3571140009  -  PLATE BN 141MM STRL 9 HL RECON PLVC 4.5MM SCR,"$1,391.25",$0.00,"$1,391.25",$626.06,$992.94,$0.00,$239.71,$0.00,$0.00,$243.60,"$1,391.25",$0.00,$695.63,"$1,101.87","$1,113.00",$0.00,$217.73,$0.00,$221.49,$0.00
3571140010,SUP,HCPCS C1713,,3571140010  -  PLATE BN 157MM STRL 10 HL RECON PLVC 4.5MM SCR,"$1,464.75",$0.00,"$1,464.75",$659.14,"$1,045.39",$0.00,$252.37,$0.00,$0.00,$256.47,"$1,464.75",$0.00,$732.38,"$1,160.08","$1,171.80",$0.00,$229.23,$0.00,$233.19,$0.00
3571140011,SUP,HCPCS C1713,,3571140011  -  PLATE BN 173MM STRL 11 HL RECON PLVC 4.5MM SCR,"$1,506.75",$0.00,"$1,506.75",$678.04,"$1,075.37",$0.00,$259.61,$0.00,$0.00,$263.82,"$1,506.75",$0.00,$753.38,"$1,193.35","$1,205.40",$0.00,$235.81,$0.00,$239.87,$0.00
3571140012,SUP,HCPCS C1713,,3571140012  -  PLATE BN 189MM STRL 12 HL RECON PLVC 4.5MM SCR,"$1,302.00",$0.00,"$1,302.00",$585.90,$929.24,$0.00,$224.33,$0.00,$0.00,$227.97,"$1,302.00",$0.00,$651.00,"$1,031.18","$1,041.60",$0.00,$203.76,$0.00,$207.28,$0.00
3571140013,SUP,HCPCS C1713,,3571140013  -  PLATE BN 205MM STRL 13 HL RECON PLVC 4.5MM SCR,"$1,701.00",$0.00,"$1,701.00",$765.45,"$1,214.00",$0.00,$293.07,$0.00,$0.00,$297.83,"$1,701.00",$0.00,$850.50,"$1,347.19","$1,360.80",$0.00,$266.21,$0.00,$270.80,$0.00
3571140014,SUP,HCPCS C1713,,3571140014  -  PLATE BN 221MM 14 HL RECON PLVC 4.5MM SCR,"$1,422.75",$0.00,"$1,422.75",$640.24,"$1,015.42",$0.00,$245.13,$0.00,$0.00,$249.11,"$1,422.75",$0.00,$711.38,"$1,126.82","$1,138.20",$0.00,$222.66,$0.00,$226.50,$0.00
3571140015,SUP,HCPCS C1713,,3571140015  -  PLATE BN 237MM STRL 15 HL RECON PLVC 4.5MM SCR,"$1,806.00",$0.00,"$1,806.00",$812.70,"$1,288.94",$0.00,$311.16,$0.00,$0.00,$316.22,"$1,806.00",$0.00,$903.00,"$1,430.35","$1,444.80",$0.00,$282.64,$0.00,$287.52,$0.00
3571140016,SUP,HCPCS C1713,,3571140016  -  PLATE BN 253MM STRL 16 HL RECON PLVC 4.5MM SCR,"$1,869.00",$0.00,"$1,869.00",$841.05,"$1,333.91",$0.00,$322.02,$0.00,$0.00,$327.25,"$1,869.00",$0.00,$934.50,"$1,480.25","$1,495.20",$0.00,$292.50,$0.00,$297.54,$0.00
3571140104,SUP,HCPCS C1713,,3571140104  -  PLATE BN 46MM STRL 4 HL RECON PLVC 3.5MM SCR,$875.70,$0.00,$875.70,$394.07,$624.99,$0.00,$150.88,$0.00,$0.00,$153.33,$875.70,$0.00,$437.85,$693.55,$700.56,$0.00,$137.05,$0.00,$139.41,$0.00
3571140105,SUP,HCPCS C1713,,3571140105  -  PLATE BN 58MM 5 HL RECON PLVC 3.5MM SCR,$812.70,$0.00,$812.70,$365.72,$580.02,$0.00,$140.02,$0.00,$0.00,$142.30,$812.70,$0.00,$406.35,$643.66,$650.16,$0.00,$127.19,$0.00,$129.38,$0.00
3571140106,SUP,HCPCS C1713,,3571140106  -  PLATE BN 70MM 6 HL RECON PLVC 3.5MM SCR,"$1,022.70",$0.00,"$1,022.70",$460.22,$729.90,$0.00,$176.21,$0.00,$0.00,$179.07,"$1,022.70",$0.00,$511.35,$809.98,$818.16,$0.00,$160.05,$0.00,$162.81,$0.00
3571140107,SUP,HCPCS C1713,,3571140107  -  PLATE BN 82MM 7 HL RECON PLVC 3.5MM SCR,$974.40,$0.00,$974.40,$438.48,$695.43,$0.00,$167.88,$0.00,$0.00,$170.61,$974.40,$0.00,$487.20,$771.72,$779.52,$0.00,$152.49,$0.00,$155.12,$0.00
3571140108,SUP,HCPCS C1713,,3571140108  -  PLATE BN 94MM 8 HL RECON PLVC 3.5MM SCR,"$1,118.25",$0.00,"$1,118.25",$503.21,$798.10,$0.00,$192.67,$0.00,$0.00,$195.80,"$1,118.25",$0.00,$559.13,$885.65,$894.60,$0.00,$175.01,$0.00,$178.03,$0.00
3571140109,SUP,HCPCS C1713,,3571140109  -  PLATE BN 106MM 9 HL RECON PLVC 3.5MM SCR,"$1,050.00",$0.00,"$1,050.00",$472.50,$749.39,$0.00,$180.91,$0.00,$0.00,$183.85,"$1,050.00",$0.00,$525.00,$831.60,$840.00,$0.00,$164.33,$0.00,$167.16,$0.00
3571140110,SUP,HCPCS C1713,,3571140110  -  PLATE BN 118MM 10 HL RECON PLVC 3.5MM SCR,"$1,149.75",$0.00,"$1,149.75",$517.39,$820.58,$0.00,$198.10,$0.00,$0.00,$201.31,"$1,149.75",$0.00,$574.88,$910.60,$919.80,$0.00,$179.94,$0.00,$183.04,$0.00
3571140111,SUP,HCPCS C1713,,3571140111  -  PLATE BN 130MM STRL 11 HL RECON PLVC 3.5MM SCR,"$1,118.25",$0.00,"$1,118.25",$503.21,$798.10,$0.00,$192.67,$0.00,$0.00,$195.80,"$1,118.25",$0.00,$559.13,$885.65,$894.60,$0.00,$175.01,$0.00,$178.03,$0.00
3571140112,SUP,HCPCS C1713,,3571140112  -  PLATE BN 142MM 12 HL RECON PLVC 3.5MM SCR,"$1,260.00",$0.00,"$1,260.00",$567.00,$899.26,$0.00,$217.09,$0.00,$0.00,$220.62,"$1,260.00",$0.00,$630.00,$997.92,"$1,008.00",$0.00,$197.19,$0.00,$200.59,$0.00
3571140113,SUP,HCPCS C1713,,3571140113  -  PLATE BN 154MM STRL 13 HL RECON PLVC 3.5MM SCR,"$1,496.25",$0.00,"$1,496.25",$673.31,"$1,067.87",$0.00,$257.80,$0.00,$0.00,$261.98,"$1,496.25",$0.00,$748.13,"$1,185.03","$1,197.00",$0.00,$234.16,$0.00,$238.20,$0.00
3571140114,SUP,HCPCS C1713,,3571140114  -  PLATE BN 166MM 14 HL RECON PLVC 3.5MM SCR,"$1,380.75",$0.00,"$1,380.75",$621.34,$985.44,$0.00,$237.90,$0.00,$0.00,$241.76,"$1,380.75",$0.00,$690.38,"$1,093.55","$1,104.60",$0.00,$216.09,$0.00,$219.82,$0.00
3571140115,SUP,HCPCS C1713,,3571140115  -  PLATE BN 178MM STRL 15 HL RECON PLVC 3.5MM SCR,"$1,648.50",$0.00,"$1,648.50",$741.83,"$1,176.53",$0.00,$284.03,$0.00,$0.00,$288.64,"$1,648.50",$0.00,$824.25,"$1,305.61","$1,318.80",$0.00,$257.99,$0.00,$262.44,$0.00
3571140116,SUP,HCPCS C1713,,3571140116  -  PLATE BN 190MM 16 HL RECON PLVC 3.5MM SCR,"$1,407.00",$0.00,"$1,407.00",$633.15,"$1,004.18",$0.00,$242.42,$0.00,$0.00,$246.35,"$1,407.00",$0.00,$703.50,"$1,114.34","$1,125.60",$0.00,$220.20,$0.00,$223.99,$0.00
3571140118,SUP,HCPCS C1713,,3571140118  -  PLATE BN 214MM 18 HL RECON PLVC 3.5MM SCR,"$1,480.50",$0.00,"$1,480.50",$666.23,"$1,056.63",$0.00,$255.08,$0.00,$0.00,$259.22,"$1,480.50",$0.00,$740.25,"$1,172.56","$1,184.40",$0.00,$231.70,$0.00,$235.70,$0.00
3571140120,SUP,HCPCS C1713,,3571140120  -  PLATE BN 238MM STRL 20 HL RECON PLVC 3.5MM SCR,"$1,800.75",$0.00,"$1,800.75",$810.34,"$1,285.20",$0.00,$310.26,$0.00,$0.00,$315.30,"$1,800.75",$0.00,$900.38,"$1,426.19","$1,440.60",$0.00,$281.82,$0.00,$286.68,$0.00
3571140122,SUP,HCPCS C1713,,3571140122  -  PLATE BN 263MM STRL 22 HL RECON PLVC 3.5MM SCR,"$2,283.75",$0.00,"$2,283.75","$1,027.69","$1,629.91",$0.00,$393.48,$0.00,$0.00,$399.87,"$2,283.75",$0.00,"$1,141.88","$1,808.73","$1,827.00",$0.00,$357.41,$0.00,$363.57,$0.00
3571140202,SUP,HCPCS C1713,,3571140202  -  PLATE BN 25MM STRL 2 HL 3.5MM SCR SM FRAG,$296.10,$0.00,$296.10,$133.25,$211.33,$0.00,$51.02,$0.00,$0.00,$51.84,$296.10,$0.00,$148.05,$234.51,$236.88,$0.00,$46.34,$0.00,$47.14,$0.00
3571140203,SUP,HCPCS C1713,,3571140203  -  PLATE BN 37MM STRL 3 HL 3.5MM SCR SM FRAG,$309.75,$0.00,$309.75,$139.39,$221.07,$0.00,$53.37,$0.00,$0.00,$54.23,$309.75,$0.00,$154.88,$245.32,$247.80,$0.00,$48.48,$0.00,$49.31,$0.00
3571140204,SUP,HCPCS C1713,,3571140204  -  PLATE BN 49MM STRL 4 HL 3.5MM SCR SM FRAG,$316.05,$0.00,$316.05,$142.22,$225.56,$0.00,$54.45,$0.00,$0.00,$55.34,$316.05,$0.00,$158.03,$250.31,$252.84,$0.00,$49.46,$0.00,$50.32,$0.00
3571140205,SUP,HCPCS C1713,,3571140205  -  PLATE BN 61MM STRL 5 HL 3.5MM SCR SM FRAG,$345.45,$0.00,$345.45,$155.45,$246.55,$0.00,$59.52,$0.00,$0.00,$60.49,$345.45,$0.00,$172.73,$273.60,$276.36,$0.00,$54.06,$0.00,$55.00,$0.00
3571140206,SUP,HCPCS C1713,,3571140206  -  PLATE BN 73MM STRL 6 HL 3.5MM SCR SM FRAG,$361.20,$0.00,$361.20,$162.54,$257.79,$0.00,$62.23,$0.00,$0.00,$63.24,$361.20,$0.00,$180.60,$286.07,$288.96,$0.00,$56.53,$0.00,$57.50,$0.00
3571140207,SUP,HCPCS C1713,,3571140207  -  PLATE BN 85MM STRL 7 HL 3.5MM SCR SM FRAG,$378.00,$0.00,$378.00,$170.10,$269.78,$0.00,$65.13,$0.00,$0.00,$66.18,$378.00,$0.00,$189.00,$299.38,$302.40,$0.00,$59.16,$0.00,$60.18,$0.00
3571140208,SUP,HCPCS C1713,,3571140208  -  PLATE BN 97MM STRL 8 HL 3.5MM SCR SM FRAG,$405.30,$0.00,$405.30,$182.39,$289.26,$0.00,$69.83,$0.00,$0.00,$70.96,$405.30,$0.00,$202.65,$321.00,$324.24,$0.00,$63.43,$0.00,$64.52,$0.00
3571140209,SUP,HCPCS C1713,,3571140209  -  PLATE BN 109MM STRL 9 HL 3.5MM SCR SM FRAG,$414.75,$0.00,$414.75,$186.64,$296.01,$0.00,$71.46,$0.00,$0.00,$72.62,$414.75,$0.00,$207.38,$328.48,$331.80,$0.00,$64.91,$0.00,$66.03,$0.00
3571140210,SUP,HCPCS C1713,,3571140210  -  PLATE BN 121MM STRL 10 HL 3.5MM SCR SM FRAG,$426.30,$0.00,$426.30,$191.84,$304.25,$0.00,$73.45,$0.00,$0.00,$74.64,$426.30,$0.00,$213.15,$337.63,$341.04,$0.00,$66.72,$0.00,$67.87,$0.00
3571140212,SUP,HCPCS C1713,,3571140212  -  PLATE BN 145MM STRL 12 HL 3.5MM SCR SM FRAG,$473.55,$0.00,$473.55,$213.10,$337.97,$0.00,$81.59,$0.00,$0.00,$82.91,$473.55,$0.00,$236.78,$375.05,$378.84,$0.00,$74.11,$0.00,$75.39,$0.00
3571140214,SUP,HCPCS C1713,,3571140214  -  PLATE BN 169MM STRL 14 HL 3.5MM SCR SM FRAG,$889.35,$0.00,$889.35,$400.21,$634.73,$0.00,$153.23,$0.00,$0.00,$155.72,$889.35,$0.00,$444.68,$704.37,$711.48,$0.00,$139.18,$0.00,$141.58,$0.00
3571140216,SUP,HCPCS C1713,,3571140216  -  PLATE BN 194MM STRL 16 HL 3.5MM SCR SM FRAG,"$1,025.85",$0.00,"$1,025.85",$461.63,$732.15,$0.00,$176.75,$0.00,$0.00,$179.62,"$1,025.85",$0.00,$512.93,$812.47,$820.68,$0.00,$160.55,$0.00,$163.32,$0.00
3571140218,SUP,HCPCS C1713,,3571140218  -  PLATE BN 217MM STRL 18 HL 3.5MM SCR SM FRAG,"$1,380.75",$0.00,"$1,380.75",$621.34,$985.44,$0.00,$237.90,$0.00,$0.00,$241.76,"$1,380.75",$0.00,$690.38,"$1,093.55","$1,104.60",$0.00,$216.09,$0.00,$219.82,$0.00
3571140220,SUP,HCPCS C1713,,3571140220  -  PLATE BN 242MM STRL 20 HL 3.5MM SCR SM FRAG,"$1,270.50",$0.00,"$1,270.50",$571.73,$906.76,$0.00,$218.90,$0.00,$0.00,$222.45,"$1,270.50",$0.00,$635.25,"$1,006.24","$1,016.40",$0.00,$198.83,$0.00,$202.26,$0.00
3571140222,SUP,HCPCS C1713,,3571140222  -  PLATE BN 265MM STRL 22 HL 3.5MM SCR SM FRAG,"$1,701.00",$0.00,"$1,701.00",$765.45,"$1,214.00",$0.00,$293.07,$0.00,$0.00,$297.83,"$1,701.00",$0.00,$850.50,"$1,347.19","$1,360.80",$0.00,$266.21,$0.00,$270.80,$0.00
3571140302,SUP,HCPCS C1713,,3571140302  -  PLATE BN 25MM STRL 1/3 TBLR 2 HL COLR,$169.05,$0.00,$169.05,$76.07,$120.65,$0.00,$29.13,$0.00,$0.00,$29.60,$169.05,$0.00,$84.53,$133.89,$135.24,$0.00,$26.46,$0.00,$26.91,$0.00
3571140303,SUP,HCPCS C1713,,3571140303  -  PLATE BN 37MM STRL 1/3 TBLR 3 HL COLR,$143.85,$0.00,$143.85,$64.73,$102.67,$0.00,$24.78,$0.00,$0.00,$25.19,$143.85,$0.00,$71.93,$113.93,$115.08,$0.00,$22.51,$0.00,$22.90,$0.00
3571140304,SUP,HCPCS C1713,,3571140304  -  PLATE BN 49MM STRL 1/3 TBLR 4 HL COLR,$169.05,$0.00,$169.05,$76.07,$120.65,$0.00,$29.13,$0.00,$0.00,$29.60,$169.05,$0.00,$84.53,$133.89,$135.24,$0.00,$26.46,$0.00,$26.91,$0.00
3571140305,SUP,HCPCS C1713,,3571140305  -  PLATE BN 61MM STRL 1/3 TBLR 5 HL COLR,$211.05,$0.00,$211.05,$94.97,$150.63,$0.00,$36.36,$0.00,$0.00,$36.95,$211.05,$0.00,$105.53,$167.15,$168.84,$0.00,$33.03,$0.00,$33.60,$0.00
3571140306,SUP,HCPCS C1713,,3571140306  -  PLATE BN 73MM STRL 1/3 TBLR 6 HL COLR DIST FIB,$175.35,$0.00,$175.35,$78.91,$125.15,$0.00,$30.21,$0.00,$0.00,$30.70,$175.35,$0.00,$87.68,$138.88,$140.28,$0.00,$27.44,$0.00,$27.92,$0.00
3571140307,SUP,HCPCS C1713,,3571140307  -  PLATE BN 85MM STRL 1/3 TBLR 7 HL COLR DIST FIB,$175.35,$0.00,$175.35,$78.91,$125.15,$0.00,$30.21,$0.00,$0.00,$30.70,$175.35,$0.00,$87.68,$138.88,$140.28,$0.00,$27.44,$0.00,$27.92,$0.00
3571140308,SUP,HCPCS C1713,,3571140308  -  PLATE BN 97MM STRL 1/3 TBLR 8 HL COLR DIST FIB,$177.45,$0.00,$177.45,$79.85,$126.65,$0.00,$30.57,$0.00,$0.00,$31.07,$177.45,$0.00,$88.73,$140.54,$141.96,$0.00,$27.77,$0.00,$28.25,$0.00
3571140309,SUP,HCPCS C1713,,3571140309  -  PLATE BN 109MM STRL 1/3 TBLR 9 HL COLR DIST FIB,$177.45,$0.00,$177.45,$79.85,$126.65,$0.00,$30.57,$0.00,$0.00,$31.07,$177.45,$0.00,$88.73,$140.54,$141.96,$0.00,$27.77,$0.00,$28.25,$0.00
3571140310,SUP,HCPCS C1713,,3571140310  -  PLATE BN 121MM STRL 1/3 TBLR 10 HL COLR DIST FIB,$177.45,$0.00,$177.45,$79.85,$126.65,$0.00,$30.57,$0.00,$0.00,$31.07,$177.45,$0.00,$88.73,$140.54,$141.96,$0.00,$27.77,$0.00,$28.25,$0.00
3571140312,SUP,HCPCS C1713,,3571140312  -  PLATE BN 145MM STRL 1/3 TBLR 12 HL COLR DIST FIB,$181.65,$0.00,$181.65,$81.74,$129.64,$0.00,$31.30,$0.00,$0.00,$31.81,$181.65,$0.00,$90.83,$143.87,$145.32,$0.00,$28.43,$0.00,$28.92,$0.00
3571140403,SUP,HCPCS C1713,,3571140403  -  PLATE BN T RT ANG 50MM STRL 3X3 HL,$313.95,$0.00,$313.95,$141.28,$224.07,$0.00,$54.09,$0.00,$0.00,$54.97,$313.95,$0.00,$156.98,$248.65,$251.16,$0.00,$49.13,$0.00,$49.98,$0.00
3571140404,SUP,HCPCS C1713,,3571140404  -  PLATE BN T RT ANG 56MM STRL 4X4 HL,$320.25,$0.00,$320.25,$144.11,$228.56,$0.00,$55.18,$0.00,$0.00,$56.07,$320.25,$0.00,$160.13,$253.64,$256.20,$0.00,$50.12,$0.00,$50.98,$0.00
3571140405,SUP,HCPCS C1713,,3571140405  -  PLATE BN T RT ANG 67MM STRL 3X5 HL,$360.15,$0.00,$360.15,$162.07,$257.04,$0.00,$62.05,$0.00,$0.00,$63.06,$360.15,$0.00,$180.08,$285.24,$288.12,$0.00,$56.36,$0.00,$57.34,$0.00
3571140406,SUP,HCPCS C1713,,3571140406  -  PLATE BN T RT ANG 78MM STRL 4X6 HL,$414.75,$0.00,$414.75,$186.64,$296.01,$0.00,$71.46,$0.00,$0.00,$72.62,$414.75,$0.00,$207.38,$328.48,$331.80,$0.00,$64.91,$0.00,$66.03,$0.00
3571140503,SUP,HCPCS C1713,,3571140503  -  PLATE BN T 53MM STRL 3X3 HL OBLQ,$563.85,$0.00,$563.85,$253.73,$402.42,$0.00,$97.15,$0.00,$0.00,$98.73,$563.85,$0.00,$281.93,$446.57,$451.08,$0.00,$88.24,$0.00,$89.76,$0.00
3571140504,SUP,HCPCS C1713,,3571140504  -  PLATE BN T 63MM STRL 3X4 HL OBLQ,$588.00,$0.00,$588.00,$264.60,$419.66,$0.00,$101.31,$0.00,$0.00,$102.95,$588.00,$0.00,$294.00,$465.70,$470.40,$0.00,$92.02,$0.00,$93.61,$0.00
3571140505,SUP,HCPCS C1713,,3571140505  -  PLATE BN T 73MM STRL 5X4 HL OBLQ,$609.00,$0.00,$609.00,$274.05,$434.64,$0.00,$104.93,$0.00,$0.00,$106.63,$609.00,$0.00,$304.50,$482.33,$487.20,$0.00,$95.31,$0.00,$96.95,$0.00
3571140603,SUP,HCPCS C1713,,3571140603  -  PLATE BN CLVRLF 88MM STRL 3 HL,$744.45,$0.00,$744.45,$335.00,$531.31,$0.00,$128.27,$0.00,$0.00,$130.35,$744.45,$0.00,$372.23,$589.60,$595.56,$0.00,$116.51,$0.00,$118.52,$0.00
3571140604,SUP,HCPCS C1713,,3571140604  -  PLATE BN CLVRLF 104MM STRL 4 HL,$798.00,$0.00,$798.00,$359.10,$569.53,$0.00,$137.49,$0.00,$0.00,$139.72,$798.00,$0.00,$399.00,$632.02,$638.40,$0.00,$124.89,$0.00,$127.04,$0.00
3571140606,SUP,HCPCS C1713,,3571140606  -  PLATE BN CRV 70MM 6 HL RECON SS 3.5MM SCR,"$1,039.50",$0.00,"$1,039.50",$467.78,$741.89,$0.00,$179.10,$0.00,$0.00,$182.01,"$1,039.50",$0.00,$519.75,$823.28,$831.60,$0.00,$162.68,$0.00,$165.49,$0.00
3571140608,SUP,HCPCS C1713,,3571140608  -  PLATE BN CRV 94MM 8 HL RECON SS 3.5MM SCR,"$1,134.00",$0.00,"$1,134.00",$510.30,$809.34,$0.00,$195.38,$0.00,$0.00,$198.55,"$1,134.00",$0.00,$567.00,$898.13,$907.20,$0.00,$177.47,$0.00,$180.53,$0.00
3571140610,SUP,HCPCS C1713,,3571140610  -  PLATE BN CRV 118MM 10 HL RECON SS 3.5MM SCR,"$1,186.50",$0.00,"$1,186.50",$533.93,$846.81,$0.00,$204.43,$0.00,$0.00,$207.75,"$1,186.50",$0.00,$593.25,$939.71,$949.20,$0.00,$185.69,$0.00,$188.89,$0.00
3571140612,SUP,HCPCS C1713,,3571140612  -  PLATE BN CRV 142MM 12 HL RECON SS 3.5MM SCR,"$1,244.25",$0.00,"$1,244.25",$559.91,$888.02,$0.00,$214.38,$0.00,$0.00,$217.86,"$1,244.25",$0.00,$622.13,$985.45,$995.40,$0.00,$194.73,$0.00,$198.08,$0.00
3571140614,SUP,HCPCS C1713,,3571140614  -  PLATE BN CRV 166MM 14 HL RECON SS 3.5MM SCR,"$1,401.75",$0.00,"$1,401.75",$630.79,"$1,000.43",$0.00,$241.51,$0.00,$0.00,$245.44,"$1,401.75",$0.00,$700.88,"$1,110.19","$1,121.40",$0.00,$219.37,$0.00,$223.16,$0.00
3571140616,SUP,HCPCS C1713,,3571140616  -  PLATE BN CRV 190MM 16 HL RECON SS 3.5MM SCR,"$1,485.75",$0.00,"$1,485.75",$668.59,"$1,060.38",$0.00,$255.99,$0.00,$0.00,$260.14,"$1,485.75",$0.00,$742.88,"$1,176.71","$1,188.60",$0.00,$232.52,$0.00,$236.53,$0.00
3571140618,SUP,HCPCS C1713,,3571140618  -  PLATE BN CRV 214MM STRL 18 HL RECON SS 3.5MM SCR,"$1,601.25",$0.00,"$1,601.25",$720.56,"$1,142.81",$0.00,$275.89,$0.00,$0.00,$280.37,"$1,601.25",$0.00,$800.63,"$1,268.19","$1,281.00",$0.00,$250.60,$0.00,$254.92,$0.00
3571140704,SUP,HCPCS C1713,,3571140704  -  PLATE BN 80MM STRL 4 HL TBTRS,$926.10,$0.00,$926.10,$416.75,$660.96,$0.00,$159.56,$0.00,$0.00,$162.15,$926.10,$0.00,$463.05,$733.47,$740.88,$0.00,$144.93,$0.00,$147.44,$0.00
3571140705,SUP,HCPCS C1713,,3571140705  -  PLATE BN 96MM STRL 5 HL TBTRS,"$1,149.75",$0.00,"$1,149.75",$517.39,$820.58,$0.00,$198.10,$0.00,$0.00,$201.31,"$1,149.75",$0.00,$574.88,$910.60,$919.80,$0.00,$179.94,$0.00,$183.04,$0.00
3571140706,SUP,HCPCS C1713,,3571140706  -  PLATE BN 112MM STRL 6 HL TBTRS,"$1,249.50",$0.00,"$1,249.50",$562.28,$891.77,$0.00,$215.28,$0.00,$0.00,$218.78,"$1,249.50",$0.00,$624.75,$989.60,$999.60,$0.00,$195.55,$0.00,$198.92,$0.00
3571140804,SUP,HCPCS C1713,,3571140804  -  PLATE BN 86MM STRL 4 HL L BTRS TIB LT,$828.45,$0.00,$828.45,$372.80,$591.26,$0.00,$142.74,$0.00,$0.00,$145.05,$828.45,$0.00,$414.23,$656.13,$662.76,$0.00,$129.65,$0.00,$131.89,$0.00
3571140904,SUP,HCPCS C1713,,3571140904  -  PLATE BN 86MM STRL 4 HL L BTRS TIB RT,$828.45,$0.00,$828.45,$372.80,$591.26,$0.00,$142.74,$0.00,$0.00,$145.05,$828.45,$0.00,$414.23,$656.13,$662.76,$0.00,$129.65,$0.00,$131.89,$0.00
3571141003,SUP,HCPCS C1713,,3571141003  -  PLATE BN STRL 3 HL BTRS TIBHD RL,"$1,422.75",$0.00,"$1,422.75",$640.24,"$1,015.42",$0.00,$245.13,$0.00,$0.00,$249.11,"$1,422.75",$0.00,$711.38,"$1,126.82","$1,138.20",$0.00,$222.66,$0.00,$226.50,$0.00
3571141005,SUP,HCPCS C1713,,3571141005  -  PLATE BN 118MM STRL 5 HL BTRS TIBHD RL,"$1,669.50",$0.00,"$1,669.50",$751.28,"$1,191.52",$0.00,$287.65,$0.00,$0.00,$292.32,"$1,669.50",$0.00,$834.75,"$1,322.24","$1,335.60",$0.00,$261.28,$0.00,$265.78,$0.00
3571141007,SUP,HCPCS C1713,,3571141007  -  PLATE BN 149MM STRL 7 HL BTRS TIBHD RL,"$1,785.00",$0.00,"$1,785.00",$803.25,"$1,273.95",$0.00,$307.55,$0.00,$0.00,$312.54,"$1,785.00",$0.00,$892.50,"$1,413.72","$1,428.00",$0.00,$279.35,$0.00,$284.17,$0.00
3571141009,SUP,HCPCS C1713,,3571141009  -  PLATE BN 181MM STRL 9 HL BTRS TIBHD RL,"$1,905.75",$0.00,"$1,905.75",$857.59,"$1,360.13",$0.00,$328.35,$0.00,$0.00,$333.68,"$1,905.75",$0.00,$952.88,"$1,509.35","$1,524.60",$0.00,$298.25,$0.00,$303.40,$0.00
3571141011,SUP,HCPCS C1713,,3571141011  -  PLATE BN 214MM STRL 11 HL BTRS TIBHD RL,"$2,499.00",$0.00,"$2,499.00","$1,124.55","$1,783.54",$0.00,$430.57,$0.00,$0.00,$437.55,"$2,499.00",$0.00,"$1,249.50","$1,979.21","$1,999.20",$0.00,$391.09,$0.00,$397.84,$0.00
3571141013,SUP,HCPCS C1713,,3571141013  -  PLATE BN 246MM STRL 13 HL BTRS TIBHD RL,"$2,593.50",$0.00,"$2,593.50","$1,167.08","$1,850.98",$0.00,$446.85,$0.00,$0.00,$454.10,"$2,593.50",$0.00,"$1,296.75","$2,054.05","$2,074.80",$0.00,$405.88,$0.00,$412.89,$0.00
3571141103,SUP,HCPCS C1713,,3571141103  -  PLATE BN STRL 3 HL BTRS TIBHD L/L,"$1,422.75",$0.00,"$1,422.75",$640.24,"$1,015.42",$0.00,$245.13,$0.00,$0.00,$249.11,"$1,422.75",$0.00,$711.38,"$1,126.82","$1,138.20",$0.00,$222.66,$0.00,$226.50,$0.00
3571141105,SUP,HCPCS C1713,,3571141105  -  PLATE BN 118MM STRL 5 HL BTRS TIBHD L/L,"$1,669.50",$0.00,"$1,669.50",$751.28,"$1,191.52",$0.00,$287.65,$0.00,$0.00,$292.32,"$1,669.50",$0.00,$834.75,"$1,322.24","$1,335.60",$0.00,$261.28,$0.00,$265.78,$0.00
3571141107,SUP,HCPCS C1713,,3571141107  -  PLATE BN 149MM STRL 7 HL BTRS TIBHD L/L,"$1,785.00",$0.00,"$1,785.00",$803.25,"$1,273.95",$0.00,$307.55,$0.00,$0.00,$312.54,"$1,785.00",$0.00,$892.50,"$1,413.72","$1,428.00",$0.00,$279.35,$0.00,$284.17,$0.00
3571141109,SUP,HCPCS C1713,,3571141109  -  PLATE BN 181MM STRL 9 HL BTRS TIBHD L/L,"$1,905.75",$0.00,"$1,905.75",$857.59,"$1,360.13",$0.00,$328.35,$0.00,$0.00,$333.68,"$1,905.75",$0.00,$952.88,"$1,509.35","$1,524.60",$0.00,$298.25,$0.00,$303.40,$0.00
3571141111,SUP,HCPCS C1713,,3571141111  -  PLATE BN 214MM STRL 11 HL BTRS TIBHD L/L,"$2,499.00",$0.00,"$2,499.00","$1,124.55","$1,783.54",$0.00,$430.57,$0.00,$0.00,$437.55,"$2,499.00",$0.00,"$1,249.50","$1,979.21","$1,999.20",$0.00,$391.09,$0.00,$397.84,$0.00
3571141113,SUP,HCPCS C1713,,3571141113  -  PLATE BN 246MM STRL 13 HL BTRS TIBHD L/L,"$2,593.50",$0.00,"$2,593.50","$1,167.08","$1,850.98",$0.00,$446.85,$0.00,$0.00,$454.10,"$2,593.50",$0.00,"$1,296.75","$2,054.05","$2,074.80",$0.00,$405.88,$0.00,$412.89,$0.00
3571141206,SUP,HCPCS C1713,,3571141206  -  PLATE BN BRD 103MM STRL 6 HL 4.5MM SCR,$546.00,$0.00,$546.00,$245.70,$389.68,$0.00,$94.07,$0.00,$0.00,$95.60,$546.00,$0.00,$273.00,$432.43,$436.80,$0.00,$85.45,$0.00,$86.92,$0.00
3571141207,SUP,HCPCS C1713,,3571141207  -  PLATE BN BRD 119MM STRL 7 HL 4.5MM SCR,$546.00,$0.00,$546.00,$245.70,$389.68,$0.00,$94.07,$0.00,$0.00,$95.60,$546.00,$0.00,$273.00,$432.43,$436.80,$0.00,$85.45,$0.00,$86.92,$0.00
3571141208,SUP,HCPCS C1713,,3571141208  -  PLATE BN BRD 135MM STRL 8 HL 4.5MM SCR,$680.40,$0.00,$680.40,$306.18,$485.60,$0.00,$117.23,$0.00,$0.00,$119.13,$680.40,$0.00,$340.20,$538.88,$544.32,$0.00,$106.48,$0.00,$108.32,$0.00
3571141209,SUP,HCPCS C1713,,3571141209  -  PLATE BN BRD 151MM STRL 9 HL 4.5MM SCR,$680.40,$0.00,$680.40,$306.18,$485.60,$0.00,$117.23,$0.00,$0.00,$119.13,$680.40,$0.00,$340.20,$538.88,$544.32,$0.00,$106.48,$0.00,$108.32,$0.00
3571141210,SUP,HCPCS C1713,,3571141210  -  PLATE BN BRD 167MM STRL 10 HL 4.5MM SCR,$680.40,$0.00,$680.40,$306.18,$485.60,$0.00,$117.23,$0.00,$0.00,$119.13,$680.40,$0.00,$340.20,$538.88,$544.32,$0.00,$106.48,$0.00,$108.32,$0.00
3571141212,SUP,HCPCS C1713,,3571141212  -  PLATE BN BRD 199MM STRL 12 HL 4.5MM SCR,$731.85,$0.00,$731.85,$329.33,$522.32,$0.00,$126.09,$0.00,$0.00,$128.14,$731.85,$0.00,$365.93,$579.63,$585.48,$0.00,$114.53,$0.00,$116.51,$0.00
3571141214,SUP,HCPCS C1713,,3571141214  -  PLATE BN BRD 231MM STRL 14 HL 4.5MM SCR,$731.85,$0.00,$731.85,$329.33,$522.32,$0.00,$126.09,$0.00,$0.00,$128.14,$731.85,$0.00,$365.93,$579.63,$585.48,$0.00,$114.53,$0.00,$116.51,$0.00
3571141216,SUP,HCPCS C1713,,3571141216  -  PLATE BN BRD 263MM STRL 16 HL 4.5MM SCR,$926.10,$0.00,$926.10,$416.75,$660.96,$0.00,$159.56,$0.00,$0.00,$162.15,$926.10,$0.00,$463.05,$733.47,$740.88,$0.00,$144.93,$0.00,$147.44,$0.00
3571141218,SUP,HCPCS C1713,,3571141218  -  PLATE BN BRD 295MM STRL 18 HL 4.5MM SCR,"$1,022.70",$0.00,"$1,022.70",$460.22,$729.90,$0.00,$176.21,$0.00,$0.00,$179.07,"$1,022.70",$0.00,$511.35,$809.98,$818.16,$0.00,$160.05,$0.00,$162.81,$0.00
3571141220,SUP,HCPCS C1713,,3571141220  -  PLATE BN BRD 326MM STRL 20 HL 4.5MM SCR,"$1,459.50",$0.00,"$1,459.50",$656.78,"$1,041.65",$0.00,$251.46,$0.00,$0.00,$255.55,"$1,459.50",$0.00,$729.75,"$1,155.92","$1,167.60",$0.00,$228.41,$0.00,$232.35,$0.00
3571141222,SUP,HCPCS C1713,,3571141222  -  PLATE BN BRD 358MM STRL 22 HL 4.5MM SCR,"$1,543.50",$0.00,"$1,543.50",$694.58,"$1,101.60",$0.00,$265.94,$0.00,$0.00,$270.25,"$1,543.50",$0.00,$771.75,"$1,222.45","$1,234.80",$0.00,$241.56,$0.00,$245.73,$0.00
3571141224,SUP,HCPCS C1713,,3571141224  -  PLATE BN BRD 390MM STRL 24 HL 4.5MM SCR,"$1,711.50",$0.00,"$1,711.50",$770.18,"$1,221.50",$0.00,$294.88,$0.00,$0.00,$299.67,"$1,711.50",$0.00,$855.75,"$1,355.51","$1,369.20",$0.00,$267.85,$0.00,$272.47,$0.00
3571141302,SUP,HCPCS C1713,,3571141302  -  PLATE BN 39MM STRL 2 HL SMTB,$142.80,$0.00,$142.80,$64.26,$101.92,$0.00,$24.60,$0.00,$0.00,$25.00,$142.80,$0.00,$71.40,$113.10,$114.24,$0.00,$22.35,$0.00,$22.73,$0.00
3571141303,SUP,HCPCS C1713,,3571141303  -  PLATE BN 55MM STRL 3 HL SMTB,$147.00,$0.00,$147.00,$66.15,$104.91,$0.00,$25.33,$0.00,$0.00,$25.74,$147.00,$0.00,$73.50,$116.42,$117.60,$0.00,$23.01,$0.00,$23.40,$0.00
3571141304,SUP,HCPCS C1713,,3571141304  -  PLATE BN 71MM STRL 4 HL SMTB,$159.60,$0.00,$159.60,$71.82,$113.91,$0.00,$27.50,$0.00,$0.00,$27.94,$159.60,$0.00,$79.80,$126.40,$127.68,$0.00,$24.98,$0.00,$25.41,$0.00
3571141305,SUP,HCPCS C1713,,3571141305  -  PLATE BN 87MM STRL 5 HL SMTB,$166.95,$0.00,$166.95,$75.13,$119.15,$0.00,$28.76,$0.00,$0.00,$29.23,$166.95,$0.00,$83.48,$132.22,$133.56,$0.00,$26.13,$0.00,$26.58,$0.00
3571141306,SUP,HCPCS C1713,,3571141306  -  PLATE BN 103MM STRL 6 HL SMTB,$177.45,$0.00,$177.45,$79.85,$126.65,$0.00,$30.57,$0.00,$0.00,$31.07,$177.45,$0.00,$88.73,$140.54,$141.96,$0.00,$27.77,$0.00,$28.25,$0.00
3571141307,SUP,HCPCS C1713,,3571141307  -  PLATE BN 119MM STRL 7 HL SMTB,$192.15,$0.00,$192.15,$86.47,$137.14,$0.00,$33.11,$0.00,$0.00,$33.64,$192.15,$0.00,$96.08,$152.18,$153.72,$0.00,$30.07,$0.00,$30.59,$0.00
3571141308,SUP,HCPCS C1713,,3571141308  -  PLATE BN 135MM STRL 8 HL SMTB,$246.75,$0.00,$246.75,$111.04,$176.11,$0.00,$42.51,$0.00,$0.00,$43.20,$246.75,$0.00,$123.38,$195.43,$197.40,$0.00,$38.62,$0.00,$39.28,$0.00
3571141309,SUP,HCPCS C1713,,3571141309  -  PLATE BN 151MM STRL 9 HL SMTB,$218.40,$0.00,$218.40,$98.28,$155.87,$0.00,$37.63,$0.00,$0.00,$38.24,$218.40,$0.00,$109.20,$172.97,$174.72,$0.00,$34.18,$0.00,$34.77,$0.00
3571141310,SUP,HCPCS C1713,,3571141310  -  PLATE BN 167MM STRL 10 HL SMTB,$270.90,$0.00,$270.90,$121.91,$193.34,$0.00,$46.67,$0.00,$0.00,$47.43,$270.90,$0.00,$135.45,$214.55,$216.72,$0.00,$42.40,$0.00,$43.13,$0.00
3571141311,SUP,HCPCS C1713,,3571141311  -  PLATE BN 183MM STRL 11 HL SMTB,$282.45,$0.00,$282.45,$127.10,$201.58,$0.00,$48.66,$0.00,$0.00,$49.45,$282.45,$0.00,$141.23,$223.70,$225.96,$0.00,$44.20,$0.00,$44.97,$0.00
3571141312,SUP,HCPCS C1713,,3571141312  -  PLATE BN 199MM STRL 12 HL SMTB,$288.75,$0.00,$288.75,$129.94,$206.08,$0.00,$49.75,$0.00,$0.00,$50.56,$288.75,$0.00,$144.38,$228.69,$231.00,$0.00,$45.19,$0.00,$45.97,$0.00
3571141402,SUP,HCPCS C1713,,3571141402  -  PLATE BN NAR 39MM 2 HL SS 4.5MM SCR,$336.00,$0.00,$336.00,$151.20,$239.80,$0.00,$57.89,$0.00,$0.00,$58.83,$336.00,$0.00,$168.00,$266.11,$268.80,$0.00,$52.58,$0.00,$53.49,$0.00
3571141403,SUP,HCPCS C1713,,3571141403  -  PLATE BN NAR 55MM 3 HL SS 4.5MM SCR,$352.80,$0.00,$352.80,$158.76,$251.79,$0.00,$60.79,$0.00,$0.00,$61.77,$352.80,$0.00,$176.40,$279.42,$282.24,$0.00,$55.21,$0.00,$56.17,$0.00
3571141404,SUP,HCPCS C1713,,3571141404  -  PLATE BN NAR 71MM STRL 4 HL 4.5MM SCR,$368.55,$0.00,$368.55,$165.85,$263.03,$0.00,$63.50,$0.00,$0.00,$64.53,$368.55,$0.00,$184.28,$291.89,$294.84,$0.00,$57.68,$0.00,$58.67,$0.00
3571141405,SUP,HCPCS C1713,,3571141405  -  PLATE BN NAR 87MM STRL 5 HL 4.5MM SCR,$368.55,$0.00,$368.55,$165.85,$263.03,$0.00,$63.50,$0.00,$0.00,$64.53,$368.55,$0.00,$184.28,$291.89,$294.84,$0.00,$57.68,$0.00,$58.67,$0.00
3571141406,SUP,HCPCS C1713,,3571141406  -  PLATE BN NAR 103MM STRL 6 HL 4.5MM SCR,$410.55,$0.00,$410.55,$184.75,$293.01,$0.00,$70.74,$0.00,$0.00,$71.88,$410.55,$0.00,$205.28,$325.16,$328.44,$0.00,$64.25,$0.00,$65.36,$0.00
3571141407,SUP,HCPCS C1713,,3571141407  -  PLATE BN NAR 119MM STRL 7 HL 4.5MM SCR,$410.55,$0.00,$410.55,$184.75,$293.01,$0.00,$70.74,$0.00,$0.00,$71.88,$410.55,$0.00,$205.28,$325.16,$328.44,$0.00,$64.25,$0.00,$65.36,$0.00
3571141408,SUP,HCPCS C1713,,3571141408  -  PLATE BN NAR 135MM STRL 8 HL 4.5MM SCR,$410.55,$0.00,$410.55,$184.75,$293.01,$0.00,$70.74,$0.00,$0.00,$71.88,$410.55,$0.00,$205.28,$325.16,$328.44,$0.00,$64.25,$0.00,$65.36,$0.00
3571141409,SUP,HCPCS C1713,,3571141409  -  PLATE BN NAR 151MM STRL 9 HL 4.5MM SCR,$410.55,$0.00,$410.55,$184.75,$293.01,$0.00,$70.74,$0.00,$0.00,$71.88,$410.55,$0.00,$205.28,$325.16,$328.44,$0.00,$64.25,$0.00,$65.36,$0.00
3571141410,SUP,HCPCS C1713,,3571141410  -  PLATE BN NAR 167MM STRL 10 HL 4.5MM SCR,$535.50,$0.00,$535.50,$240.98,$382.19,$0.00,$92.26,$0.00,$0.00,$93.76,$535.50,$0.00,$267.75,$424.12,$428.40,$0.00,$83.81,$0.00,$85.25,$0.00
3571141411,SUP,HCPCS C1713,,3571141411  -  PLATE BN NAR 183MM STRL 11 HL 4.5MM SCR,$535.50,$0.00,$535.50,$240.98,$382.19,$0.00,$92.26,$0.00,$0.00,$93.76,$535.50,$0.00,$267.75,$424.12,$428.40,$0.00,$83.81,$0.00,$85.25,$0.00
3571141412,SUP,HCPCS C1713,,3571141412  -  PLATE BN NAR 199MM STRL 12 HL 4.5MM SCR,$535.50,$0.00,$535.50,$240.98,$382.19,$0.00,$92.26,$0.00,$0.00,$93.76,$535.50,$0.00,$267.75,$424.12,$428.40,$0.00,$83.81,$0.00,$85.25,$0.00
3571141413,SUP,HCPCS C1713,,3571141413  -  PLATE BN NAR 215MM STRL 13 HL 4.5MM SCR,$630.00,$0.00,$630.00,$283.50,$449.63,$0.00,$108.55,$0.00,$0.00,$110.31,$630.00,$0.00,$315.00,$498.96,$504.00,$0.00,$98.60,$0.00,$100.30,$0.00
3571141414,SUP,HCPCS C1713,,3571141414  -  PLATE BN NAR 231MM STRL 14 HL 4.5MM SCR,$763.35,$0.00,$763.35,$343.51,$544.80,$0.00,$131.52,$0.00,$0.00,$133.66,$763.35,$0.00,$381.68,$604.57,$610.68,$0.00,$119.46,$0.00,$121.53,$0.00
3571141415,SUP,HCPCS C1713,,3571141415  -  PLATE BN NAR 247MM STRL 15 HL 4.5MM SCR,$805.35,$0.00,$805.35,$362.41,$574.78,$0.00,$138.76,$0.00,$0.00,$141.01,$805.35,$0.00,$402.68,$637.84,$644.28,$0.00,$126.04,$0.00,$128.21,$0.00
3571141416,SUP,HCPCS C1713,,3571141416  -  PLATE BN NAR 263MM STRL 16 HL 4.5MM SCR,$805.35,$0.00,$805.35,$362.41,$574.78,$0.00,$138.76,$0.00,$0.00,$141.01,$805.35,$0.00,$402.68,$637.84,$644.28,$0.00,$126.04,$0.00,$128.21,$0.00
3571141418,SUP,HCPCS C1713,,3571141418  -  PLATE BN NAR 295MM STRL 18 HL 4.5MM SCR,"$1,149.75",$0.00,"$1,149.75",$517.39,$820.58,$0.00,$198.10,$0.00,$0.00,$201.31,"$1,149.75",$0.00,$574.88,$910.60,$919.80,$0.00,$179.94,$0.00,$183.04,$0.00
3571141420,SUP,HCPCS C1713,,3571141420  -  PLATE BN NAR 326MM STRL 20 HL 4.5MM SCR,"$1,038.45",$0.00,"$1,038.45",$467.30,$741.14,$0.00,$178.92,$0.00,$0.00,$181.82,"$1,038.45",$0.00,$519.23,$822.45,$830.76,$0.00,$162.52,$0.00,$165.32,$0.00
3571141422,SUP,HCPCS C1713,,3571141422  -  PLATE BN NAR 358MM STRL 22 HL 4.5MM SCR,"$1,401.75",$0.00,"$1,401.75",$630.79,"$1,000.43",$0.00,$241.51,$0.00,$0.00,$245.44,"$1,401.75",$0.00,$700.88,"$1,110.19","$1,121.40",$0.00,$219.37,$0.00,$223.16,$0.00
3571141424,SUP,HCPCS C1713,,3571141424  -  PLATE BN NAR 390MM STRL 24 HL 4.5MM SCR,"$1,517.25",$0.00,"$1,517.25",$682.76,"$1,082.86",$0.00,$261.41,$0.00,$0.00,$265.66,"$1,517.25",$0.00,$758.63,"$1,201.66","$1,213.80",$0.00,$237.45,$0.00,$241.55,$0.00
3571141603,SUP,HCPCS C1713,,3571141603  -  PLATE BN T 68MM STRL 3 HL,$568.05,$0.00,$568.05,$255.62,$405.42,$0.00,$97.87,$0.00,$0.00,$99.46,$568.05,$0.00,$284.03,$449.90,$454.44,$0.00,$88.90,$0.00,$90.43,$0.00
3571141604,SUP,HCPCS C1713,,3571141604  -  PLATE BN T 84MM STRL 4 HL,$631.05,$0.00,$631.05,$283.97,$450.38,$0.00,$108.73,$0.00,$0.00,$110.49,$631.05,$0.00,$315.53,$499.79,$504.84,$0.00,$98.76,$0.00,$100.46,$0.00
3571141605,SUP,HCPCS C1713,,3571141605  -  PLATE BN T 100MM STRL 5 HL,$670.95,$0.00,$670.95,$301.93,$478.86,$0.00,$115.60,$0.00,$0.00,$117.48,$670.95,$0.00,$335.48,$531.39,$536.76,$0.00,$105.00,$0.00,$106.82,$0.00
3571141606,SUP,HCPCS C1713,,3571141606  -  PLATE BN T 116MM STRL 6 HL,$742.35,$0.00,$742.35,$334.06,$529.82,$0.00,$127.90,$0.00,$0.00,$129.98,$742.35,$0.00,$371.18,$587.94,$593.88,$0.00,$116.18,$0.00,$118.18,$0.00
3571141608,SUP,HCPCS C1713,,3571141608  -  PLATE BN T 148MM STRL 8 HL,"$1,025.85",$0.00,"$1,025.85",$461.63,$732.15,$0.00,$176.75,$0.00,$0.00,$179.62,"$1,025.85",$0.00,$512.93,$812.47,$820.68,$0.00,$160.55,$0.00,$163.32,$0.00
3571142007,SUP,HCPCS C1713,,3571142007  -  PLATE BN 158MM STRL 7 HL BTRS CNDYL,"$1,953.00",$0.00,"$1,953.00",$878.85,"$1,393.86",$0.00,$336.49,$0.00,$0.00,$341.95,"$1,953.00",$0.00,$976.50,"$1,546.78","$1,562.40",$0.00,$305.64,$0.00,$310.92,$0.00
3571142009,SUP,HCPCS C1713,,3571142009  -  PLATE BN 190MM STRL 9 HL BTRS CNDYL,"$2,026.50",$0.00,"$2,026.50",$911.93,"$1,446.31",$0.00,$349.16,$0.00,$0.00,$354.82,"$2,026.50",$0.00,"$1,013.25","$1,604.99","$1,621.20",$0.00,$317.15,$0.00,$322.62,$0.00
3571142011,SUP,HCPCS C1713,,3571142011  -  PLATE BN 221MM STRL 11 HL BTRS CNDYL,"$2,541.00",$0.00,"$2,541.00","$1,143.45","$1,813.51",$0.00,$437.80,$0.00,$0.00,$444.91,"$2,541.00",$0.00,"$1,270.50","$2,012.47","$2,032.80",$0.00,$397.67,$0.00,$404.53,$0.00
3571142013,SUP,HCPCS C1713,,3571142013  -  PLATE BN 253MM STRL 13 HL BTRS CNDYL,"$2,136.75",$0.00,"$2,136.75",$961.54,"$1,525.00",$0.00,$368.15,$0.00,$0.00,$374.13,"$2,136.75",$0.00,"$1,068.38","$1,692.31","$1,709.40",$0.00,$334.40,$0.00,$340.17,$0.00
3571142015,SUP,HCPCS C1713,,3571142015  -  PLATE BN 285MM STRL 15 HL BTRS CNDYL,"$2,682.75",$0.00,"$2,682.75","$1,207.24","$1,914.68",$0.00,$462.22,$0.00,$0.00,$469.73,"$2,682.75",$0.00,"$1,341.38","$2,124.74","$2,146.20",$0.00,$419.85,$0.00,$427.09,$0.00
3571142107,SUP,HCPCS C1713,,3571142107  -  PLATE BN 158MM STRL 7 HL BTRS CNDYL,"$2,367.75",$0.00,"$2,367.75","$1,065.49","$1,689.86",$0.00,$407.95,$0.00,$0.00,$414.57,"$2,367.75",$0.00,"$1,183.88","$1,875.26","$1,894.20",$0.00,$370.55,$0.00,$376.95,$0.00
3571142109,SUP,HCPCS C1713,,3571142109  -  PLATE BN 190MM STRL 9 HL BTRS CNDYL,"$2,026.50",$0.00,"$2,026.50",$911.93,"$1,446.31",$0.00,$349.16,$0.00,$0.00,$354.82,"$2,026.50",$0.00,"$1,013.25","$1,604.99","$1,621.20",$0.00,$317.15,$0.00,$322.62,$0.00
3571142111,SUP,HCPCS C1713,,3571142111  -  PLATE BN 221MM STRL 11 HL BTRS CNDYL,"$2,541.00",$0.00,"$2,541.00","$1,143.45","$1,813.51",$0.00,$437.80,$0.00,$0.00,$444.91,"$2,541.00",$0.00,"$1,270.50","$2,012.47","$2,032.80",$0.00,$397.67,$0.00,$404.53,$0.00
3571142113,SUP,HCPCS C1713,,3571142113  -  PLATE BN 253MM STRL 13 HL BTRS CNDYL,"$2,604.00",$0.00,"$2,604.00","$1,171.80","$1,858.47",$0.00,$448.66,$0.00,$0.00,$455.94,"$2,604.00",$0.00,"$1,302.00","$2,062.37","$2,083.20",$0.00,$407.53,$0.00,$414.56,$0.00
3571142115,SUP,HCPCS C1713,,3571142115  -  PLATE BN 285MM STRL 15 HL BTRS CNDYL,"$2,682.75",$0.00,"$2,682.75","$1,207.24","$1,914.68",$0.00,$462.22,$0.00,$0.00,$469.73,"$2,682.75",$0.00,"$1,341.38","$2,124.74","$2,146.20",$0.00,$419.85,$0.00,$427.09,$0.00
3571143113,SUP,HCPCS C1713,,3571143113  -  WASHER BN 13MM SS,$85.20,$0.00,$85.20,$38.34,$60.81,$0.00,$14.68,$0.00,$0.00,$14.92,$85.20,$0.00,$42.60,$67.48,$68.16,$0.00,$13.33,$0.00,$13.56,$0.00
3571145020,SUP,HCPCS C1713,,3571145020  -  PLATE BN STRG STRL 20 HL SS CNDYL 1.5MM SCR,$570.15,$0.00,$570.15,$256.57,$406.92,$0.00,$98.23,$0.00,$0.00,$99.83,$570.15,$0.00,$285.08,$451.56,$456.12,$0.00,$89.23,$0.00,$90.77,$0.00
3571145022,SUP,HCPCS C1713,,3571145022  -  PLATE BN T 3X9 HL SS CNDYL 1.5MM SCR,$504.00,$0.00,$504.00,$226.80,$359.70,$0.00,$86.84,$0.00,$0.00,$88.25,$504.00,$0.00,$252.00,$399.17,$403.20,$0.00,$78.88,$0.00,$80.24,$0.00
3571145024,SUP,HCPCS C1713,,3571145024  -  PLATE BN T 4X9 HL SS CNDYL 1.5MM SCR,$534.45,$0.00,$534.45,$240.50,$381.44,$0.00,$92.08,$0.00,$0.00,$93.58,$534.45,$0.00,$267.23,$423.28,$427.56,$0.00,$83.64,$0.00,$85.08,$0.00
3571145026,SUP,HCPCS C1713,,3571145026  -  PLATE BN 6 HL SS CNDYL LT 1.5 MM SCR,$708.75,$0.00,$708.75,$318.94,$505.83,$0.00,$122.11,$0.00,$0.00,$124.10,$708.75,$0.00,$354.38,$561.33,$567.00,$0.00,$110.92,$0.00,$112.83,$0.00
3571145028,SUP,HCPCS C1713,,3571145028  -  PLATE BN 6 HL SS CNDYL RT 1.5 MM SCR,$708.75,$0.00,$708.75,$318.94,$505.83,$0.00,$122.11,$0.00,$0.00,$124.10,$708.75,$0.00,$354.38,$561.33,$567.00,$0.00,$110.92,$0.00,$112.83,$0.00
3571145030,SUP,HCPCS C1713,,3571145030  -  PLATE BN H STRL 4 HL CNDYL 1.5MM SCR,$406.35,$0.00,$406.35,$182.86,$290.01,$0.00,$70.01,$0.00,$0.00,$71.15,$406.35,$0.00,$203.18,$321.83,$325.08,$0.00,$63.59,$0.00,$64.69,$0.00
3571146020,SUP,HCPCS C1713,,3571146020  -  PLATE BN STRG 3 HL SS CNDYL 2MM SCR,$134.40,$0.00,$134.40,$60.48,$95.92,$0.00,$23.16,$0.00,$0.00,$23.53,$134.40,$0.00,$67.20,$106.44,$107.52,$0.00,$21.03,$0.00,$21.40,$0.00
3571146022,SUP,HCPCS C1713,,3571146022  -  PLATE BN STRG 4 HL SS CNDYL 2MM SCR,$148.05,$0.00,$148.05,$66.62,$105.66,$0.00,$25.51,$0.00,$0.00,$25.92,$148.05,$0.00,$74.03,$117.26,$118.44,$0.00,$23.17,$0.00,$23.57,$0.00
3571146024,SUP,HCPCS C1713,,3571146024  -  PLATE BN STRG 5 HL SS CNDYL 2MM SCR,$159.60,$0.00,$159.60,$71.82,$113.91,$0.00,$27.50,$0.00,$0.00,$27.94,$159.60,$0.00,$79.80,$126.40,$127.68,$0.00,$24.98,$0.00,$25.41,$0.00
3571146026,SUP,HCPCS C1713,,3571146026  -  PLATE BN STRG STRL 6 HL CNDYL 2MM SCR,$177.45,$0.00,$177.45,$79.85,$126.65,$0.00,$30.57,$0.00,$0.00,$31.07,$177.45,$0.00,$88.73,$140.54,$141.96,$0.00,$27.77,$0.00,$28.25,$0.00
3571146028,SUP,HCPCS C1713,,3571146028  -  PLATE BN STRG 20 HL SS CNDYL 2MM SCR,$568.05,$0.00,$568.05,$255.62,$405.42,$0.00,$97.87,$0.00,$0.00,$99.46,$568.05,$0.00,$284.03,$449.90,$454.44,$0.00,$88.90,$0.00,$90.43,$0.00
3571146030,SUP,HCPCS C1713,,3571146030  -  PLATE BN T 3X9 HL SS CNDYL 2MM SCR,$504.00,$0.00,$504.00,$226.80,$359.70,$0.00,$86.84,$0.00,$0.00,$88.25,$504.00,$0.00,$252.00,$399.17,$403.20,$0.00,$78.88,$0.00,$80.24,$0.00
3571146032,SUP,HCPCS C1713,,3571146032  -  PLATE BN T 4X9 HL SS CNDYL 2MM SCR,$534.45,$0.00,$534.45,$240.50,$381.44,$0.00,$92.08,$0.00,$0.00,$93.58,$534.45,$0.00,$267.23,$423.28,$427.56,$0.00,$83.64,$0.00,$85.08,$0.00
3571146034,SUP,HCPCS C1713,,3571146034  -  PLATE BN T 2X2 HL SS CNDYL 2MM SCR,$134.40,$0.00,$134.40,$60.48,$95.92,$0.00,$23.16,$0.00,$0.00,$23.53,$134.40,$0.00,$67.20,$106.44,$107.52,$0.00,$21.03,$0.00,$21.40,$0.00
3571146036,SUP,HCPCS C1713,,3571146036  -  PLATE BN L 3 HL OBLQ SS CNDYL RT 2MM SCR,$134.40,$0.00,$134.40,$60.48,$95.92,$0.00,$23.16,$0.00,$0.00,$23.53,$134.40,$0.00,$67.20,$106.44,$107.52,$0.00,$21.03,$0.00,$21.40,$0.00
3571146038,SUP,HCPCS C1713,,3571146038  -  PLATE BN L 3 HL OBLQ SS CNDYL LT 2MM SCR,$134.40,$0.00,$134.40,$60.48,$95.92,$0.00,$23.16,$0.00,$0.00,$23.53,$134.40,$0.00,$67.20,$106.44,$107.52,$0.00,$21.03,$0.00,$21.40,$0.00
3571146040,SUP,HCPCS C1713,,3571146040  -  PLATE BN 6 HL OBLQ SS CNDYL LT 2 MM SCR,$678.30,$0.00,$678.30,$305.24,$484.10,$0.00,$116.87,$0.00,$0.00,$118.76,$678.30,$0.00,$339.15,$537.21,$542.64,$0.00,$106.15,$0.00,$107.99,$0.00
3571146042,SUP,HCPCS C1713,,3571146042  -  PLATE BN 6 HL OBLQ SS CNDYL RT 2 MM SCR,$678.30,$0.00,$678.30,$305.24,$484.10,$0.00,$116.87,$0.00,$0.00,$118.76,$678.30,$0.00,$339.15,$537.21,$542.64,$0.00,$106.15,$0.00,$107.99,$0.00
3571146048,SUP,HCPCS C1713,,3571146048  -  PLATE BN H STRL 4 HL CNDYL 2MM SCR,$406.35,$0.00,$406.35,$182.86,$290.01,$0.00,$70.01,$0.00,$0.00,$71.15,$406.35,$0.00,$203.18,$321.83,$325.08,$0.00,$63.59,$0.00,$64.69,$0.00
3571147001,SUP,HCPCS C1713,,3571147001  -  PLATE BN L STRL CNDYL RT 2.7MM SCR,$142.80,$0.00,$142.80,$64.26,$101.92,$0.00,$24.60,$0.00,$0.00,$25.00,$142.80,$0.00,$71.40,$113.10,$114.24,$0.00,$22.35,$0.00,$22.73,$0.00
3571147002,SUP,HCPCS C1713,,3571147002  -  PLATE BN L 3 HL OBLQ SS CNDYL LT 2.7MM SCR,$142.80,$0.00,$142.80,$64.26,$101.92,$0.00,$24.60,$0.00,$0.00,$25.00,$142.80,$0.00,$71.40,$113.10,$114.24,$0.00,$22.35,$0.00,$22.73,$0.00
3571147003,SUP,HCPCS C1713,,3571147003  -  PLATE BN L STRL CNDYL LT 2.7MM SCR,$142.80,$0.00,$142.80,$64.26,$101.92,$0.00,$24.60,$0.00,$0.00,$25.00,$142.80,$0.00,$71.40,$113.10,$114.24,$0.00,$22.35,$0.00,$22.73,$0.00
3571147004,SUP,HCPCS C1713,,3571147004  -  PLATE BN L 3 HL OBLQ SS CNDYL RT 2.7MM SCR,$142.80,$0.00,$142.80,$64.26,$101.92,$0.00,$24.60,$0.00,$0.00,$25.00,$142.80,$0.00,$71.40,$113.10,$114.24,$0.00,$22.35,$0.00,$22.73,$0.00
3571147006,SUP,HCPCS C1713,,3571147006  -  PLATE BN T 3 HL SS CNDYL 2.7MM SCR,$142.80,$0.00,$142.80,$64.26,$101.92,$0.00,$24.60,$0.00,$0.00,$25.00,$142.80,$0.00,$71.40,$113.10,$114.24,$0.00,$22.35,$0.00,$22.73,$0.00
3571147008,SUP,HCPCS C1713,,3571147008  -  PLATE BN 6 HL SS CNDYL LT 2.7 MM SCR,$720.30,$0.00,$720.30,$324.14,$514.08,$0.00,$124.10,$0.00,$0.00,$126.12,$720.30,$0.00,$360.15,$570.48,$576.24,$0.00,$112.73,$0.00,$114.67,$0.00
3571147010,SUP,HCPCS C1713,,3571147010  -  PLATE BN 6 HL SS CNDYL RT 2.7 MM SCR,$720.30,$0.00,$720.30,$324.14,$514.08,$0.00,$124.10,$0.00,$0.00,$126.12,$720.30,$0.00,$360.15,$570.48,$576.24,$0.00,$112.73,$0.00,$114.67,$0.00
3571147012,SUP,HCPCS C1713,,3571147012  -  PLATE BN STRL 7 HL MLT FRAG CNDYL 2.7 MM SCR,$169.05,$0.00,$169.05,$76.07,$120.65,$0.00,$29.13,$0.00,$0.00,$29.60,$169.05,$0.00,$84.53,$133.89,$135.24,$0.00,$26.46,$0.00,$26.91,$0.00
3571148003,SUP,HCPCS C1713,,3571148003  -  PLATE BN STRL 3 HL QT TBLR SS CNDYL,$159.60,$0.00,$159.60,$71.82,$113.91,$0.00,$27.50,$0.00,$0.00,$27.94,$159.60,$0.00,$79.80,$126.40,$127.68,$0.00,$24.98,$0.00,$25.41,$0.00
3571148004,SUP,HCPCS C1713,,3571148004  -  PLATE BN 4 HL QT TBLR SS CNDYL,$175.35,$0.00,$175.35,$78.91,$125.15,$0.00,$30.21,$0.00,$0.00,$30.70,$175.35,$0.00,$87.68,$138.88,$140.28,$0.00,$27.44,$0.00,$27.92,$0.00
3571148005,SUP,HCPCS C1713,,3571148005  -  PLATE BN 5 HL QT TBLR SS CNDYL,$185.85,$0.00,$185.85,$83.63,$132.64,$0.00,$32.02,$0.00,$0.00,$32.54,$185.85,$0.00,$92.93,$147.19,$148.68,$0.00,$29.09,$0.00,$29.59,$0.00
3571148006,SUP,HCPCS C1713,,3571148006  -  PLATE BN 6 HL QT TBLR SS CNDYL,$205.80,$0.00,$205.80,$92.61,$146.88,$0.00,$35.46,$0.00,$0.00,$36.03,$205.80,$0.00,$102.90,$162.99,$164.64,$0.00,$32.21,$0.00,$32.76,$0.00
3571148007,SUP,HCPCS C1713,,3571148007  -  PLATE BN STRL 7 HL QT TBLR CNDYL,$214.20,$0.00,$214.20,$96.39,$152.87,$0.00,$36.91,$0.00,$0.00,$37.50,$214.20,$0.00,$107.10,$169.65,$171.36,$0.00,$33.52,$0.00,$34.10,$0.00
3571148008,SUP,HCPCS C1713,,3571148008  -  PLATE BN STRL 8 HL QT TBLR CNDYL,$227.85,$0.00,$227.85,$102.53,$162.62,$0.00,$39.26,$0.00,$0.00,$39.89,$227.85,$0.00,$113.93,$180.46,$182.28,$0.00,$35.66,$0.00,$36.27,$0.00
3571149106,SUP,HCPCS C1713,,3571149106  -  SCREW BN 1.5MM 6MM STRL TC100 HEX HD ST SS CORT,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
3571149107,SUP,HCPCS C1713,,3571149107  -  SCREW BN 1.5MM 7MM STRL TC100 HEX HD ST SS CORT,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
3571149108,SUP,HCPCS C1713,,3571149108  -  SCREW BN 1.5MM 8MM STRL TC100 HEX HD ST SS CORT,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
3571149109,SUP,HCPCS C1713,,3571149109  -  SCREW BN 1.5MM 9MM STRL TC100 HEX HD ST SS CORT,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
3571149110,SUP,HCPCS C1713,,3571149110  -  SCREW BN 1.5MM 10MM STRL TC100 HEX HD ST SS CORT,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
3571149111,SUP,HCPCS C1713,,3571149111  -  SCREW BN 1.5MM 11MM STRL TC100 HEX HD ST SS CORT,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
3571149112,SUP,HCPCS C1713,,3571149112  -  SCREW BN 1.5MM 12MM STRL TC100 HEX HD ST SS CORT,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
3571149114,SUP,HCPCS C1713,,3571149114  -  SCREW BN 1.5MM 14MM STRL TC100 HEX HD ST SS CORT,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
3571149116,SUP,HCPCS C1713,,3571149116  -  SCREW BN 1.5MM 16MM STRL TC100 HEX HD ST SS CORT,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
3571149118,SUP,HCPCS C1713,,3571149118  -  SCREW BN 1.5MM 18MM STRL TC100 HEX HD ST SS CORT,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
3571149120,SUP,HCPCS C1713,,3571149120  -  SCREW BN 1.5MM 20MM STRL TC100 HEX HD ST SS CORT,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
3571149122,SUP,HCPCS C1713,,3571149122  -  SCREW BN 1.5MM 22MM STRL TC100 HEX HD ST SS CORT,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
3571149124,SUP,HCPCS C1713,,3571149124  -  SCREW BN 1.5MM 24MM STRL TC100 HEX HD ST SS CORT,$77.55,$0.00,$77.55,$34.90,$55.35,$0.00,$13.36,$0.00,$0.00,$13.58,$77.55,$0.00,$38.78,$61.42,$62.04,$0.00,$12.14,$0.00,$12.35,$0.00
3571149306,SUP,HCPCS C1713,,3571149306  -  SCREW BN 2MM 6MM STRL TC100 HEX HD ST SS CORT,$79.43,$0.00,$79.43,$35.74,$56.69,$0.00,$13.68,$0.00,$0.00,$13.91,$79.43,$0.00,$39.71,$62.91,$63.54,$0.00,$12.43,$0.00,$12.64,$0.00
3571149308,SUP,HCPCS C1713,,3571149308  -  SCREW BN 2MM 8MM STRL TC100 HEX HD ST SS CORT,$79.43,$0.00,$79.43,$35.74,$56.69,$0.00,$13.68,$0.00,$0.00,$13.91,$79.43,$0.00,$39.71,$62.91,$63.54,$0.00,$12.43,$0.00,$12.64,$0.00
3571149310,SUP,HCPCS C1713,,3571149310  -  SCREW BN 2MM 10MM STRL TC100 HEX HD ST SS CORT,$79.43,$0.00,$79.43,$35.74,$56.69,$0.00,$13.68,$0.00,$0.00,$13.91,$79.43,$0.00,$39.71,$62.91,$63.54,$0.00,$12.43,$0.00,$12.64,$0.00
3571149312,SUP,HCPCS C1713,,3571149312  -  SCREW BN 2MM 12MM STRL TC100 HEX HD ST SS CORT,$79.43,$0.00,$79.43,$35.74,$56.69,$0.00,$13.68,$0.00,$0.00,$13.91,$79.43,$0.00,$39.71,$62.91,$63.54,$0.00,$12.43,$0.00,$12.64,$0.00
3571149314,SUP,HCPCS C1713,,3571149314  -  SCREW BN 2MM 14MM STRL TC100 HEX HD ST SS CORT,$79.43,$0.00,$79.43,$35.74,$56.69,$0.00,$13.68,$0.00,$0.00,$13.91,$79.43,$0.00,$39.71,$62.91,$63.54,$0.00,$12.43,$0.00,$12.64,$0.00
3571149316,SUP,HCPCS C1713,,3571149316  -  SCREW BN 2MM 16MM STRL TC100 HEX HD ST SS CORT,$79.43,$0.00,$79.43,$35.74,$56.69,$0.00,$13.68,$0.00,$0.00,$13.91,$79.43,$0.00,$39.71,$62.91,$63.54,$0.00,$12.43,$0.00,$12.64,$0.00
3571149318,SUP,HCPCS C1713,,3571149318  -  SCREW BN 2MM 18MM STRL TC100 HEX HD ST SS CORT,$79.43,$0.00,$79.43,$35.74,$56.69,$0.00,$13.68,$0.00,$0.00,$13.91,$79.43,$0.00,$39.71,$62.91,$63.54,$0.00,$12.43,$0.00,$12.64,$0.00
3571149320,SUP,HCPCS C1713,,3571149320  -  SCREW BN 2MM 20MM STRL TC100 HEX HD ST SS CORT,$79.43,$0.00,$79.43,$35.74,$56.69,$0.00,$13.68,$0.00,$0.00,$13.91,$79.43,$0.00,$39.71,$62.91,$63.54,$0.00,$12.43,$0.00,$12.64,$0.00
3571149322,SUP,HCPCS C1713,,3571149322  -  SCREW BN 2MM 22MM STRL TC100 HEX HD ST SS CORT,$79.43,$0.00,$79.43,$35.74,$56.69,$0.00,$13.68,$0.00,$0.00,$13.91,$79.43,$0.00,$39.71,$62.91,$63.54,$0.00,$12.43,$0.00,$12.64,$0.00
3571149324,SUP,HCPCS C1713,,3571149324  -  SCREW BN 2MM 24MM STRL TC100 HEX HD ST SS CORT,$79.43,$0.00,$79.43,$35.74,$56.69,$0.00,$13.68,$0.00,$0.00,$13.91,$79.43,$0.00,$39.71,$62.91,$63.54,$0.00,$12.43,$0.00,$12.64,$0.00
3571149326,SUP,HCPCS C1713,,3571149326  -  SCREW BN 2MM 26MM STRL TC100 HEX HD ST SS CORT,$79.43,$0.00,$79.43,$35.74,$56.69,$0.00,$13.68,$0.00,$0.00,$13.91,$79.43,$0.00,$39.71,$62.91,$63.54,$0.00,$12.43,$0.00,$12.64,$0.00
3571149328,SUP,HCPCS C1713,,3571149328  -  SCREW BN 2MM 28MM STRL TC100 HEX HD ST SS CORT,$79.43,$0.00,$79.43,$35.74,$56.69,$0.00,$13.68,$0.00,$0.00,$13.91,$79.43,$0.00,$39.71,$62.91,$63.54,$0.00,$12.43,$0.00,$12.64,$0.00
3571149330,SUP,HCPCS C1713,,3571149330  -  SCREW BN 2MM 30MM STRL TC100 HEX HD ST SS CORT,$79.43,$0.00,$79.43,$35.74,$56.69,$0.00,$13.68,$0.00,$0.00,$13.91,$79.43,$0.00,$39.71,$62.91,$63.54,$0.00,$12.43,$0.00,$12.64,$0.00
3571149406,SUP,HCPCS C1713,,3571149406  -  SCREW BN 2.7MM 6MM STRL TC100 HEX HD ST SS CORT,$69.73,$0.00,$69.73,$31.38,$49.76,$0.00,$12.01,$0.00,$0.00,$12.21,$69.73,$0.00,$34.86,$55.23,$55.78,$0.00,$10.91,$0.00,$11.10,$0.00
3571149408,SUP,HCPCS C1713,,3571149408  -  SCREW BN 2.7MM 8MM STRL TC100 HEX HD ST SS CORT,$69.73,$0.00,$69.73,$31.38,$49.76,$0.00,$12.01,$0.00,$0.00,$12.21,$69.73,$0.00,$34.86,$55.23,$55.78,$0.00,$10.91,$0.00,$11.10,$0.00
3571149410,SUP,HCPCS C1713,,3571149410  -  SCREW BN 2.7MM 10MM STRL TC100 HEX HD ST SS CORT,$69.73,$0.00,$69.73,$31.38,$49.76,$0.00,$12.01,$0.00,$0.00,$12.21,$69.73,$0.00,$34.86,$55.23,$55.78,$0.00,$10.91,$0.00,$11.10,$0.00
3571149412,SUP,HCPCS C1713,,3571149412  -  SCREW BN 2.7MM 12MM STRL TC100 HEX HD ST SS CORT,$69.73,$0.00,$69.73,$31.38,$49.76,$0.00,$12.01,$0.00,$0.00,$12.21,$69.73,$0.00,$34.86,$55.23,$55.78,$0.00,$10.91,$0.00,$11.10,$0.00
3571149414,SUP,HCPCS C1713,,3571149414  -  SCREW BN 2.7MM 14MM STRL TC100 HEX HD ST SS CORT,$69.73,$0.00,$69.73,$31.38,$49.76,$0.00,$12.01,$0.00,$0.00,$12.21,$69.73,$0.00,$34.86,$55.23,$55.78,$0.00,$10.91,$0.00,$11.10,$0.00
3571149416,SUP,HCPCS C1713,,3571149416  -  SCREW BN 2.7MM 16MM STRL TC100 HEX HD ST SS CORT,$69.73,$0.00,$69.73,$31.38,$49.76,$0.00,$12.01,$0.00,$0.00,$12.21,$69.73,$0.00,$34.86,$55.23,$55.78,$0.00,$10.91,$0.00,$11.10,$0.00
3571149418,SUP,HCPCS C1713,,3571149418  -  SCREW BN 2.7MM 18MM STRL TC100 HEX HD ST SS CORT,$69.73,$0.00,$69.73,$31.38,$49.76,$0.00,$12.01,$0.00,$0.00,$12.21,$69.73,$0.00,$34.86,$55.23,$55.78,$0.00,$10.91,$0.00,$11.10,$0.00
3571149420,SUP,HCPCS C1713,,3571149420  -  SCREW BN 2.7MM 20MM STRL TC100 HEX HD ST SS CORT,$69.73,$0.00,$69.73,$31.38,$49.76,$0.00,$12.01,$0.00,$0.00,$12.21,$69.73,$0.00,$34.86,$55.23,$55.78,$0.00,$10.91,$0.00,$11.10,$0.00
3571149422,SUP,HCPCS C1713,,3571149422  -  SCREW BN 2.7MM 22MM STRL TC100 HEX HD ST SS CORT,$69.73,$0.00,$69.73,$31.38,$49.76,$0.00,$12.01,$0.00,$0.00,$12.21,$69.73,$0.00,$34.86,$55.23,$55.78,$0.00,$10.91,$0.00,$11.10,$0.00
3571149424,SUP,HCPCS C1713,,3571149424  -  SCREW BN 2.7MM 24MM STRL TC100 HEX HD ST SS CORT,$69.73,$0.00,$69.73,$31.38,$49.76,$0.00,$12.01,$0.00,$0.00,$12.21,$69.73,$0.00,$34.86,$55.23,$55.78,$0.00,$10.91,$0.00,$11.10,$0.00
3571149426,SUP,HCPCS C1713,,3571149426  -  SCREW BN 2.7MM 26MM STRL TC100 HEX HD ST SS CORT,$69.73,$0.00,$69.73,$31.38,$49.76,$0.00,$12.01,$0.00,$0.00,$12.21,$69.73,$0.00,$34.86,$55.23,$55.78,$0.00,$10.91,$0.00,$11.10,$0.00
3571149428,SUP,HCPCS C1713,,3571149428  -  SCREW BN 2.7MM 28MM STRL TC100 HEX HD ST SS CORT,$69.73,$0.00,$69.73,$31.38,$49.76,$0.00,$12.01,$0.00,$0.00,$12.21,$69.73,$0.00,$34.86,$55.23,$55.78,$0.00,$10.91,$0.00,$11.10,$0.00
3571149430,SUP,HCPCS C1713,,3571149430  -  SCREW BN 2.7MM 30MM STRL TC100 HEX HD ST SS CORT,$69.73,$0.00,$69.73,$31.38,$49.76,$0.00,$12.01,$0.00,$0.00,$12.21,$69.73,$0.00,$34.86,$55.23,$55.78,$0.00,$10.91,$0.00,$11.10,$0.00
3571149432,SUP,HCPCS C1713,,3571149432  -  SCREW BN 2.7MM 32MM STRL TC100 HEX HD ST SS CORT,$69.73,$0.00,$69.73,$31.38,$49.76,$0.00,$12.01,$0.00,$0.00,$12.21,$69.73,$0.00,$34.86,$55.23,$55.78,$0.00,$10.91,$0.00,$11.10,$0.00
3571149434,SUP,HCPCS C1713,,3571149434  -  SCREW BN 2.7MM 34MM STRL TC100 HEX HD ST SS CORT,$69.73,$0.00,$69.73,$31.38,$49.76,$0.00,$12.01,$0.00,$0.00,$12.21,$69.73,$0.00,$34.86,$55.23,$55.78,$0.00,$10.91,$0.00,$11.10,$0.00
3571149436,SUP,HCPCS C1713,,3571149436  -  SCREW BN 2.7MM 36MM STRL TC100 HEX HD ST SS CORT,$69.73,$0.00,$69.73,$31.38,$49.76,$0.00,$12.01,$0.00,$0.00,$12.21,$69.73,$0.00,$34.86,$55.23,$55.78,$0.00,$10.91,$0.00,$11.10,$0.00
3571149440,SUP,HCPCS C1713,,3571149440  -  SCREW BN 2.7MM 40MM STRL TC100 HEX HD ST SS CORT,$69.73,$0.00,$69.73,$31.38,$49.76,$0.00,$12.01,$0.00,$0.00,$12.21,$69.73,$0.00,$34.86,$55.23,$55.78,$0.00,$10.91,$0.00,$11.10,$0.00
3571149445,SUP,HCPCS C1713,,3571149445  -  SCREW BN 2.7MM 45MM STRL HEX HD ST CORT,$69.73,$0.00,$69.73,$31.38,$49.76,$0.00,$12.01,$0.00,$0.00,$12.21,$69.73,$0.00,$34.86,$55.23,$55.78,$0.00,$10.91,$0.00,$11.10,$0.00
3571149450,SUP,HCPCS C1713,,3571149450  -  SCREW BN 2.7MM 50MM STRL HEX HD ST CORT,$69.73,$0.00,$69.73,$31.38,$49.76,$0.00,$12.01,$0.00,$0.00,$12.21,$69.73,$0.00,$34.86,$55.23,$55.78,$0.00,$10.91,$0.00,$11.10,$0.00
3571149455,SUP,HCPCS C1713,,3571149455  -  SCREW BN 2.7MM 55MM STRL HEX HD ST CORT,$69.73,$0.00,$69.73,$31.38,$49.76,$0.00,$12.01,$0.00,$0.00,$12.21,$69.73,$0.00,$34.86,$55.23,$55.78,$0.00,$10.91,$0.00,$11.10,$0.00
3571149510,SUP,HCPCS C1713,,3571149510  -  SCREW BN 3.5MM 10MM STRL HEX HD ST CORT,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
3571149512,SUP,HCPCS C1713,,3571149512  -  SCREW BN 3.5MM 12MM STRL HEX HD ST CORT,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
3571149514,SUP,HCPCS C1713,,3571149514  -  SCREW BN 3.5MM 14MM STRL HEX HD ST CORT,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
3571149516,SUP,HCPCS C1713,,3571149516  -  SCREW BN 3.5MM 16MM STRL HEX HD ST CORT,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
3571149518,SUP,HCPCS C1713,,3571149518  -  SCREW BN 3.5MM 18MM STRL HEX HD ST CORT,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
3571149520,SUP,HCPCS C1713,,3571149520  -  SCREW BN 3.5MM 20MM STRL HEX HD ST CORT,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
3571149522,SUP,HCPCS C1713,,3571149522  -  SCREW BN 3.5MM 22MM STRL HEX HD ST CORT,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
3571149524,SUP,HCPCS C1713,,3571149524  -  SCREW BN 3.5MM 24MM STRL HEX HD ST CORT,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
3571149526,SUP,HCPCS C1713,,3571149526  -  SCREW BN 3.5MM 26MM STRL HEX HD ST CORT,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
3571149528,SUP,HCPCS C1713,,3571149528  -  SCREW BN 3.5MM 28MM STRL HEX HD ST CORT,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
3571149530,SUP,HCPCS C1713,,3571149530  -  SCREW BN 3.5MM 30MM STRL HEX HD ST CORT,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
3571149532,SUP,HCPCS C1713,,3571149532  -  SCREW BN 3.5MM 32MM STRL HEX HD ST CORT,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
3571149534,SUP,HCPCS C1713,,3571149534  -  SCREW BN 3.5MM 34MM STRL HEX HD ST CORT,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
3571149536,SUP,HCPCS C1713,,3571149536  -  SCREW BN 3.5MM 36MM STRL HEX HD ST CORT,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
3571149538,SUP,HCPCS C1713,,3571149538  -  SCREW BN 3.5MM 38MM STRL HEX HD ST CORT,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
3571149540,SUP,HCPCS C1713,,3571149540  -  SCREW BN 3.5MM 40MM STRL HEX HD ST CORT,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
3571149545,SUP,HCPCS C1713,,3571149545  -  SCREW BN 3.5MM 45MM STRL HEX HD ST CORT,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
3571149550,SUP,HCPCS C1713,,3571149550  -  SCREW BN 3.5MM 50MM STRL HEX HD ST CORT,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
3571149555,SUP,HCPCS C1713,,3571149555  -  SCREW BN 3.5MM 55MM STRL HEX HD ST CORT,$91.45,$0.00,$91.45,$41.15,$65.27,$0.00,$15.76,$0.00,$0.00,$16.01,$91.45,$0.00,$45.73,$72.43,$73.16,$0.00,$14.31,$0.00,$14.56,$0.00
3571149560,SUP,HCPCS C1713,,3571149560  -  SCREW BN 3.5MM 60MM STRL HEX HD ST CORT,$91.45,$0.00,$91.45,$41.15,$65.27,$0.00,$15.76,$0.00,$0.00,$16.01,$91.45,$0.00,$45.73,$72.43,$73.16,$0.00,$14.31,$0.00,$14.56,$0.00
3571149565,SUP,HCPCS C1713,,3571149565  -  SCREW BN 3.5MM 65MM STRL HEX HD ST CORT,$91.45,$0.00,$91.45,$41.15,$65.27,$0.00,$15.76,$0.00,$0.00,$16.01,$91.45,$0.00,$45.73,$72.43,$73.16,$0.00,$14.31,$0.00,$14.56,$0.00
3571149570,SUP,HCPCS C1713,,3571149570  -  SCREW BN 3.5MM 70MM STRL HEX HD ST CORT,$91.45,$0.00,$91.45,$41.15,$65.27,$0.00,$15.76,$0.00,$0.00,$16.01,$91.45,$0.00,$45.73,$72.43,$73.16,$0.00,$14.31,$0.00,$14.56,$0.00
3571149575,SUP,HCPCS C1713,,3571149575  -  SCREW BN 3.5MM 75MM STRL HEX HD ST CORT,$91.45,$0.00,$91.45,$41.15,$65.27,$0.00,$15.76,$0.00,$0.00,$16.01,$91.45,$0.00,$45.73,$72.43,$73.16,$0.00,$14.31,$0.00,$14.56,$0.00
3571149580,SUP,HCPCS C1713,,3571149580  -  SCREW BN 3.5MM 80MM STRL HEX HD ST CORT,$91.45,$0.00,$91.45,$41.15,$65.27,$0.00,$15.76,$0.00,$0.00,$16.01,$91.45,$0.00,$45.73,$72.43,$73.16,$0.00,$14.31,$0.00,$14.56,$0.00
3571149585,SUP,HCPCS C1713,,3571149585  -  SCREW BN 3.5MM 85MM STRL HEX HD ST CORT,$91.45,$0.00,$91.45,$41.15,$65.27,$0.00,$15.76,$0.00,$0.00,$16.01,$91.45,$0.00,$45.73,$72.43,$73.16,$0.00,$14.31,$0.00,$14.56,$0.00
3571149590,SUP,HCPCS C1713,,3571149590  -  SCREW BN 3.5MM 90MM STRL HEX HD ST CORT,$91.45,$0.00,$91.45,$41.15,$65.27,$0.00,$15.76,$0.00,$0.00,$16.01,$91.45,$0.00,$45.73,$72.43,$73.16,$0.00,$14.31,$0.00,$14.56,$0.00
3571149595,SUP,HCPCS C1713,,3571149595  -  SCREW BN 3.5MM 95MM STRL HEX HD ST CORT,$91.45,$0.00,$91.45,$41.15,$65.27,$0.00,$15.76,$0.00,$0.00,$16.01,$91.45,$0.00,$45.73,$72.43,$73.16,$0.00,$14.31,$0.00,$14.56,$0.00
3571149600,SUP,HCPCS C1713,,3571149600  -  SCREW BN 3.5MM 100MM STRL HEX HD ST CORT,$91.45,$0.00,$91.45,$41.15,$65.27,$0.00,$15.76,$0.00,$0.00,$16.01,$91.45,$0.00,$45.73,$72.43,$73.16,$0.00,$14.31,$0.00,$14.56,$0.00
3571149605,SUP,HCPCS C1713,,3571149605  -  SCREW BN 3.5MM 105MM STRL HEX HD ST CORT,$91.45,$0.00,$91.45,$41.15,$65.27,$0.00,$15.76,$0.00,$0.00,$16.01,$91.45,$0.00,$45.73,$72.43,$73.16,$0.00,$14.31,$0.00,$14.56,$0.00
3571149610,SUP,HCPCS C1713,,3571149610  -  SCREW BN 3.5MM 110MM STRL HEX HD ST CORT,$91.45,$0.00,$91.45,$41.15,$65.27,$0.00,$15.76,$0.00,$0.00,$16.01,$91.45,$0.00,$45.73,$72.43,$73.16,$0.00,$14.31,$0.00,$14.56,$0.00
3571149615,SUP,HCPCS C1713,,3571149615  -  SCREW BN 3.5MM 115MM STRL HEX HD ST CORT,$93.35,$0.00,$93.35,$42.01,$66.62,$0.00,$16.08,$0.00,$0.00,$16.34,$93.35,$0.00,$46.68,$73.93,$74.68,$0.00,$14.61,$0.00,$14.86,$0.00
3571149620,SUP,HCPCS C1713,,3571149620  -  SCREW BN 3.5MM 120MM STRL HEX HD ST CORT,$93.35,$0.00,$93.35,$42.01,$66.62,$0.00,$16.08,$0.00,$0.00,$16.34,$93.35,$0.00,$46.68,$73.93,$74.68,$0.00,$14.61,$0.00,$14.86,$0.00
3571149625,SUP,HCPCS C1713,,3571149625  -  SCREW BN 3.5MM 125MM STRL HEX HD ST CORT,$93.35,$0.00,$93.35,$42.01,$66.62,$0.00,$16.08,$0.00,$0.00,$16.34,$93.35,$0.00,$46.68,$73.93,$74.68,$0.00,$14.61,$0.00,$14.86,$0.00
3571149630,SUP,HCPCS C1713,,3571149630  -  SCREW BN 3.5MM 130MM STRL HEX HD ST CORT,$93.35,$0.00,$93.35,$42.01,$66.62,$0.00,$16.08,$0.00,$0.00,$16.34,$93.35,$0.00,$46.68,$73.93,$74.68,$0.00,$14.61,$0.00,$14.86,$0.00
3571149714,SUP,HCPCS C1713,,3571149714  -  SCREW BN 4.5MM 14MM STRL HEX HD ST CORT,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
3571149716,SUP,HCPCS C1713,,3571149716  -  SCREW BN 4.5MM 16MM STRL HEX HD ST CORT,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
3571149718,SUP,HCPCS C1713,,3571149718  -  SCREW BN 4.5MM 18MM STRL HEX HD ST CORT,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
3571149720,SUP,HCPCS C1713,,3571149720  -  SCREW BN 4.5MM 20MM STRL HEX HD ST CORT,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
3571149722,SUP,HCPCS C1713,,3571149722  -  SCREW BN 4.5MM 22MM STRL HEX HD ST CORT,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
3571149724,SUP,HCPCS C1713,,3571149724  -  SCREW BN 4.5MM 24MM STRL HEX HD ST CORT,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
3571149726,SUP,HCPCS C1713,,3571149726  -  SCREW BN 4.5MM 26MM STRL HEX HD ST CORT,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
3571149728,SUP,HCPCS C1713,,3571149728  -  SCREW BN 4.5MM 28MM STRL HEX HD ST CORT,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
3571149730,SUP,HCPCS C1713,,3571149730  -  SCREW BN 4.5MM 30MM STRL HEX HD ST CORT,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
3571149732,SUP,HCPCS C1713,,3571149732  -  SCREW BN 4.5MM 32MM STRL HEX HD ST CORT,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
3571149734,SUP,HCPCS C1713,,3571149734  -  SCREW BN 4.5MM 34MM STRL HEX HD ST CORT,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
3571149736,SUP,HCPCS C1713,,3571149736  -  SCREW BN 4.5MM 36MM STRL HEX HD ST CORT,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
3571149738,SUP,HCPCS C1713,,3571149738  -  SCREW BN 4.5MM 38MM STRL HEX HD ST CORT,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
3571149740,SUP,HCPCS C1713,,3571149740  -  SCREW BN 4.5MM 40MM STRL HEX HD ST CORT,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
3571149742,SUP,HCPCS C1713,,3571149742  -  SCREW BN 4.5MM 42MM STRL HEX HD ST CORT,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
3571149744,SUP,HCPCS C1713,,3571149744  -  SCREW BN 4.5MM 44MM STRL HEX HD ST CORT,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
3571149746,SUP,HCPCS C1713,,3571149746  -  SCREW BN 4.5MM 46MM STRL HEX HD ST CORT,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
3571149748,SUP,HCPCS C1713,,3571149748  -  SCREW BN 4.5MM 48MM STRL HEX HD ST CORT,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
3571149750,SUP,HCPCS C1713,,3571149750  -  SCREW BN 4.5MM 50MM STRL HEX HD ST CORT,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
3571149752,SUP,HCPCS C1713,,3571149752  -  SCREW BN 4.5MM 52MM STRL HEX HD ST CORT,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
3571149754,SUP,HCPCS C1713,,3571149754  -  SCREW BN 4.5MM 54MM STRL HEX HD ST CORT,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
3571149756,SUP,HCPCS C1713,,3571149756  -  SCREW BN 4.5MM 56MM STRL HEX HD ST CORT,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
3571149758,SUP,HCPCS C1713,,3571149758  -  SCREW BN 4.5MM 58MM STRL HEX HD ST CORT,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
3571149760,SUP,HCPCS C1713,,3571149760  -  SCREW BN 4.5MM 60MM STRL HEX HD ST CORT,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
3571149762,SUP,HCPCS C1713,,3571149762  -  SCREW BN 4.5MM 62MM STRL HEX HD ST CORT,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
3571149764,SUP,HCPCS C1713,,3571149764  -  SCREW BN 4.5MM 64MM STRL HEX HD ST CORT,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
3571149766,SUP,HCPCS C1713,,3571149766  -  SCREW BN 4.5MM 66MM STRL HEX HD ST CORT,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
3571149768,SUP,HCPCS C1713,,3571149768  -  SCREW BN 4.5MM 68MM STRL HEX HD ST CORT,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
3571149770,SUP,HCPCS C1713,,3571149770  -  SCREW BN 4.5MM 70MM STRL HEX HD ST CORT,$75.70,$0.00,$75.70,$34.07,$54.03,$0.00,$13.04,$0.00,$0.00,$13.25,$75.70,$0.00,$37.85,$59.95,$60.56,$0.00,$11.85,$0.00,$12.05,$0.00
3571149772,SUP,HCPCS C1713,,3571149772  -  SCREW BN 4.5MM 72MM STRL HEX HD ST CORT,$126.00,$0.00,$126.00,$56.70,$89.93,$0.00,$21.71,$0.00,$0.00,$22.06,$126.00,$0.00,$63.00,$99.79,$100.80,$0.00,$19.72,$0.00,$20.06,$0.00
3571149776,SUP,HCPCS C1713,,3571149776  -  SCREW BN 4.5MM 76MM STRL HEX HD ST CORT,$126.00,$0.00,$126.00,$56.70,$89.93,$0.00,$21.71,$0.00,$0.00,$22.06,$126.00,$0.00,$63.00,$99.79,$100.80,$0.00,$19.72,$0.00,$20.06,$0.00
3571149780,SUP,HCPCS C1713,,3571149780  -  SCREW BN 4.5MM 80MM STRL HEX HD ST CORT,$126.00,$0.00,$126.00,$56.70,$89.93,$0.00,$21.71,$0.00,$0.00,$22.06,$126.00,$0.00,$63.00,$99.79,$100.80,$0.00,$19.72,$0.00,$20.06,$0.00
3571149785,SUP,HCPCS C1713,,3571149785  -  SCREW BN 4.5MM 85MM STRL HEX HD ST CORT,$126.00,$0.00,$126.00,$56.70,$89.93,$0.00,$21.71,$0.00,$0.00,$22.06,$126.00,$0.00,$63.00,$99.79,$100.80,$0.00,$19.72,$0.00,$20.06,$0.00
3571149790,SUP,HCPCS C1713,,3571149790  -  SCREW BN 4.5MM 90MM STRL HEX HD ST CORT,$126.00,$0.00,$126.00,$56.70,$89.93,$0.00,$21.71,$0.00,$0.00,$22.06,$126.00,$0.00,$63.00,$99.79,$100.80,$0.00,$19.72,$0.00,$20.06,$0.00
3571149795,SUP,HCPCS C1713,,3571149795  -  SCREW BN 4.5MM 95MM STRL HEX HD ST CORT,$126.00,$0.00,$126.00,$56.70,$89.93,$0.00,$21.71,$0.00,$0.00,$22.06,$126.00,$0.00,$63.00,$99.79,$100.80,$0.00,$19.72,$0.00,$20.06,$0.00
3571149800,SUP,HCPCS C1713,,3571149800  -  SCREW BN 4.5MM 100MM STRL HEX HD ST CORT,$126.00,$0.00,$126.00,$56.70,$89.93,$0.00,$21.71,$0.00,$0.00,$22.06,$126.00,$0.00,$63.00,$99.79,$100.80,$0.00,$19.72,$0.00,$20.06,$0.00
3571149805,SUP,HCPCS C1713,,3571149805  -  SCREW BN 4.5MM 105MM STRL HEX HD ST CORT,$126.00,$0.00,$126.00,$56.70,$89.93,$0.00,$21.71,$0.00,$0.00,$22.06,$126.00,$0.00,$63.00,$99.79,$100.80,$0.00,$19.72,$0.00,$20.06,$0.00
3571149810,SUP,HCPCS C1713,,3571149810  -  SCREW BN 4.5MM 110MM STRL HEX HD ST CORT,$126.00,$0.00,$126.00,$56.70,$89.93,$0.00,$21.71,$0.00,$0.00,$22.06,$126.00,$0.00,$63.00,$99.79,$100.80,$0.00,$19.72,$0.00,$20.06,$0.00
3571149815,SUP,HCPCS C1713,,3571149815  -  SCREW BN 4.5MM 115MM STRL HEX HD ST CORT,$126.00,$0.00,$126.00,$56.70,$89.93,$0.00,$21.71,$0.00,$0.00,$22.06,$126.00,$0.00,$63.00,$99.79,$100.80,$0.00,$19.72,$0.00,$20.06,$0.00
3571149820,SUP,HCPCS C1713,,3571149820  -  SCREW BN 4.5MM 120MM STRL HEX HD ST CORT,$126.00,$0.00,$126.00,$56.70,$89.93,$0.00,$21.71,$0.00,$0.00,$22.06,$126.00,$0.00,$63.00,$99.79,$100.80,$0.00,$19.72,$0.00,$20.06,$0.00
3571149825,SUP,HCPCS C1713,,3571149825  -  SCREW BN 4.5MM 125MM STRL HEX HD ST CORT,$126.00,$0.00,$126.00,$56.70,$89.93,$0.00,$21.71,$0.00,$0.00,$22.06,$126.00,$0.00,$63.00,$99.79,$100.80,$0.00,$19.72,$0.00,$20.06,$0.00
3571149830,SUP,HCPCS C1713,,3571149830  -  SCREW BN 4.5MM 130MM STRL HEX HD ST CORT,$126.00,$0.00,$126.00,$56.70,$89.93,$0.00,$21.71,$0.00,$0.00,$22.06,$126.00,$0.00,$63.00,$99.79,$100.80,$0.00,$19.72,$0.00,$20.06,$0.00
3571149835,SUP,HCPCS C1713,,3571149835  -  SCREW BN 4.5MM 135MM STRL HEX HD ST CORT,$126.00,$0.00,$126.00,$56.70,$89.93,$0.00,$21.71,$0.00,$0.00,$22.06,$126.00,$0.00,$63.00,$99.79,$100.80,$0.00,$19.72,$0.00,$20.06,$0.00
3571149840,SUP,HCPCS C1713,,3571149840  -  SCREW BN 4.5MM 140MM STRL HEX HD ST CORT,$126.00,$0.00,$126.00,$56.70,$89.93,$0.00,$21.71,$0.00,$0.00,$22.06,$126.00,$0.00,$63.00,$99.79,$100.80,$0.00,$19.72,$0.00,$20.06,$0.00
3571149845,SUP,HCPCS C1713,,3571149845  -  SCREW BN 4.5MM 145MM STRL HEX HD ST CORT,$126.00,$0.00,$126.00,$56.70,$89.93,$0.00,$21.71,$0.00,$0.00,$22.06,$126.00,$0.00,$63.00,$99.79,$100.80,$0.00,$19.72,$0.00,$20.06,$0.00
3571223010,SUP,HCPCS C1713,,3571223010  -  SCREW BN FT 4MM 10MM STRL CANC,$57.03,$0.00,$57.03,$25.66,$40.70,$0.00,$9.83,$0.00,$0.00,$9.98,$57.03,$0.00,$28.51,$45.17,$45.62,$0.00,$8.92,$0.00,$9.08,$0.00
3571223012,SUP,HCPCS C1713,,3571223012  -  SCREW BN FT 4MM 12MM STRL CANC,$57.03,$0.00,$57.03,$25.66,$40.70,$0.00,$9.83,$0.00,$0.00,$9.98,$57.03,$0.00,$28.51,$45.17,$45.62,$0.00,$8.92,$0.00,$9.08,$0.00
3571223014,SUP,HCPCS C1713,,3571223014  -  SCREW BN FT 4MM 14MM STRL CANC,$57.03,$0.00,$57.03,$25.66,$40.70,$0.00,$9.83,$0.00,$0.00,$9.98,$57.03,$0.00,$28.51,$45.17,$45.62,$0.00,$8.92,$0.00,$9.08,$0.00
3571223016,SUP,HCPCS C1713,,3571223016  -  SCREW BN FT 4MM 16MM STRL CANC,$57.03,$0.00,$57.03,$25.66,$40.70,$0.00,$9.83,$0.00,$0.00,$9.98,$57.03,$0.00,$28.51,$45.17,$45.62,$0.00,$8.92,$0.00,$9.08,$0.00
3571223018,SUP,HCPCS C1713,,3571223018  -  SCREW BN FT 4MM 18MM STRL CANC,$57.03,$0.00,$57.03,$25.66,$40.70,$0.00,$9.83,$0.00,$0.00,$9.98,$57.03,$0.00,$28.51,$45.17,$45.62,$0.00,$8.92,$0.00,$9.08,$0.00
3571223020,SUP,HCPCS C1713,,3571223020  -  SCREW BN FT 4MM 20MM STRL CANC,$57.03,$0.00,$57.03,$25.66,$40.70,$0.00,$9.83,$0.00,$0.00,$9.98,$57.03,$0.00,$28.51,$45.17,$45.62,$0.00,$8.92,$0.00,$9.08,$0.00
3571223022,SUP,HCPCS C1713,,3571223022  -  SCREW BN FT 4MM 22MM STRL CANC,$57.03,$0.00,$57.03,$25.66,$40.70,$0.00,$9.83,$0.00,$0.00,$9.98,$57.03,$0.00,$28.51,$45.17,$45.62,$0.00,$8.92,$0.00,$9.08,$0.00
3571223024,SUP,HCPCS C1713,,3571223024  -  SCREW BN FT 4MM 24MM STRL CANC,$57.03,$0.00,$57.03,$25.66,$40.70,$0.00,$9.83,$0.00,$0.00,$9.98,$57.03,$0.00,$28.51,$45.17,$45.62,$0.00,$8.92,$0.00,$9.08,$0.00
3571223026,SUP,HCPCS C1713,,3571223026  -  SCREW BN FT 4MM 26MM STRL CANC,$57.03,$0.00,$57.03,$25.66,$40.70,$0.00,$9.83,$0.00,$0.00,$9.98,$57.03,$0.00,$28.51,$45.17,$45.62,$0.00,$8.92,$0.00,$9.08,$0.00
3571223028,SUP,HCPCS C1713,,3571223028  -  SCREW BN FT 4MM 28MM STRL CANC,$57.03,$0.00,$57.03,$25.66,$40.70,$0.00,$9.83,$0.00,$0.00,$9.98,$57.03,$0.00,$28.51,$45.17,$45.62,$0.00,$8.92,$0.00,$9.08,$0.00
3571223030,SUP,HCPCS C1713,,3571223030  -  SCREW BN FT 4MM 30MM STRL CANC,$57.03,$0.00,$57.03,$25.66,$40.70,$0.00,$9.83,$0.00,$0.00,$9.98,$57.03,$0.00,$28.51,$45.17,$45.62,$0.00,$8.92,$0.00,$9.08,$0.00
3571223035,SUP,HCPCS C1713,,3571223035  -  SCREW BN FT 4MM 35MM STRL CANC,$57.03,$0.00,$57.03,$25.66,$40.70,$0.00,$9.83,$0.00,$0.00,$9.98,$57.03,$0.00,$28.51,$45.17,$45.62,$0.00,$8.92,$0.00,$9.08,$0.00
3571223040,SUP,HCPCS C1713,,3571223040  -  SCREW BN FT 4MM 40MM STRL CANC,$57.03,$0.00,$57.03,$25.66,$40.70,$0.00,$9.83,$0.00,$0.00,$9.98,$57.03,$0.00,$28.51,$45.17,$45.62,$0.00,$8.92,$0.00,$9.08,$0.00
3571223045,SUP,HCPCS C1713,,3571223045  -  SCREW BN FT 4MM 45MM STRL CANC,$57.03,$0.00,$57.03,$25.66,$40.70,$0.00,$9.83,$0.00,$0.00,$9.98,$57.03,$0.00,$28.51,$45.17,$45.62,$0.00,$8.92,$0.00,$9.08,$0.00
3571223050,SUP,HCPCS C1713,,3571223050  -  SCREW BN FT 4MM 50MM STRL CANC,$57.03,$0.00,$57.03,$25.66,$40.70,$0.00,$9.83,$0.00,$0.00,$9.98,$57.03,$0.00,$28.51,$45.17,$45.62,$0.00,$8.92,$0.00,$9.08,$0.00
3571223055,SUP,HCPCS C1713,,3571223055  -  SCREW BN FT 4MM 55MM STRL CANC,$57.03,$0.00,$57.03,$25.66,$40.70,$0.00,$9.83,$0.00,$0.00,$9.98,$57.03,$0.00,$28.51,$45.17,$45.62,$0.00,$8.92,$0.00,$9.08,$0.00
3571223060,SUP,HCPCS C1713,,3571223060  -  SCREW BN FT 4MM 60MM STRL CANC,$57.03,$0.00,$57.03,$25.66,$40.70,$0.00,$9.83,$0.00,$0.00,$9.98,$57.03,$0.00,$28.51,$45.17,$45.62,$0.00,$8.92,$0.00,$9.08,$0.00
3571223210,SUP,HCPCS C1713,,3571223210  -  SCREW BN P/T 4MM 10MM STRL CANC,$55.08,$0.00,$55.08,$24.78,$39.31,$0.00,$9.49,$0.00,$0.00,$9.64,$55.08,$0.00,$27.54,$43.62,$44.06,$0.00,$8.62,$0.00,$8.77,$0.00
3571223212,SUP,HCPCS C1713,,3571223212  -  SCREW BN P/T 4MM 12MM STRL CANC,$55.08,$0.00,$55.08,$24.78,$39.31,$0.00,$9.49,$0.00,$0.00,$9.64,$55.08,$0.00,$27.54,$43.62,$44.06,$0.00,$8.62,$0.00,$8.77,$0.00
3571223214,SUP,HCPCS C1713,,3571223214  -  SCREW BN P/T 4MM 14MM STRL CANC,$36.75,$0.00,$36.75,$16.54,$26.23,$0.00,$6.33,$0.00,$0.00,$6.43,$36.75,$0.00,$18.38,$29.11,$29.40,$0.00,$5.75,$0.00,$5.85,$0.00
3571223216,SUP,HCPCS C1713,,3571223216  -  SCREW BN P/T 4MM 16MM STRL CANC,$36.75,$0.00,$36.75,$16.54,$26.23,$0.00,$6.33,$0.00,$0.00,$6.43,$36.75,$0.00,$18.38,$29.11,$29.40,$0.00,$5.75,$0.00,$5.85,$0.00
3571223218,SUP,HCPCS C1713,,3571223218  -  SCREW BN P/T 4MM 18MM STRL CANC,$36.75,$0.00,$36.75,$16.54,$26.23,$0.00,$6.33,$0.00,$0.00,$6.43,$36.75,$0.00,$18.38,$29.11,$29.40,$0.00,$5.75,$0.00,$5.85,$0.00
3571223220,SUP,HCPCS C1713,,3571223220  -  SCREW BN P/T 4MM 20MM STRL CANC,$36.75,$0.00,$36.75,$16.54,$26.23,$0.00,$6.33,$0.00,$0.00,$6.43,$36.75,$0.00,$18.38,$29.11,$29.40,$0.00,$5.75,$0.00,$5.85,$0.00
3571223222,SUP,HCPCS C1713,,3571223222  -  SCREW BN P/T 4MM 22MM STRL CANC,$36.75,$0.00,$36.75,$16.54,$26.23,$0.00,$6.33,$0.00,$0.00,$6.43,$36.75,$0.00,$18.38,$29.11,$29.40,$0.00,$5.75,$0.00,$5.85,$0.00
3571223226,SUP,HCPCS C1713,,3571223226  -  SCREW BN P/T 4MM 26MM STRL CANC,$36.75,$0.00,$36.75,$16.54,$26.23,$0.00,$6.33,$0.00,$0.00,$6.43,$36.75,$0.00,$18.38,$29.11,$29.40,$0.00,$5.75,$0.00,$5.85,$0.00
3571223228,SUP,HCPCS C1713,,3571223228  -  SCREW BN P/T 4MM 28MM STRL CANC,$36.75,$0.00,$36.75,$16.54,$26.23,$0.00,$6.33,$0.00,$0.00,$6.43,$36.75,$0.00,$18.38,$29.11,$29.40,$0.00,$5.75,$0.00,$5.85,$0.00
3571223230,SUP,HCPCS C1713,,3571223230  -  SCREW BN P/T 4MM 30MM STRL CANC,$36.75,$0.00,$36.75,$16.54,$26.23,$0.00,$6.33,$0.00,$0.00,$6.43,$36.75,$0.00,$18.38,$29.11,$29.40,$0.00,$5.75,$0.00,$5.85,$0.00
3571223235,SUP,HCPCS C1713,,3571223235  -  SCREW BN P/T 4MM 35MM STRL CANC,$36.75,$0.00,$36.75,$16.54,$26.23,$0.00,$6.33,$0.00,$0.00,$6.43,$36.75,$0.00,$18.38,$29.11,$29.40,$0.00,$5.75,$0.00,$5.85,$0.00
3571223240,SUP,HCPCS C1713,,3571223240  -  SCREW BN P/T 4MM 40MM STRL CANC,$36.75,$0.00,$36.75,$16.54,$26.23,$0.00,$6.33,$0.00,$0.00,$6.43,$36.75,$0.00,$18.38,$29.11,$29.40,$0.00,$5.75,$0.00,$5.85,$0.00
3571223245,SUP,HCPCS C1713,,3571223245  -  SCREW BN P/T 4MM 45MM STRL CANC,$36.75,$0.00,$36.75,$16.54,$26.23,$0.00,$6.33,$0.00,$0.00,$6.43,$36.75,$0.00,$18.38,$29.11,$29.40,$0.00,$5.75,$0.00,$5.85,$0.00
3571223250,SUP,HCPCS C1713,,3571223250  -  SCREW BN P/T 4MM 50MM STRL CANC,$36.75,$0.00,$36.75,$16.54,$26.23,$0.00,$6.33,$0.00,$0.00,$6.43,$36.75,$0.00,$18.38,$29.11,$29.40,$0.00,$5.75,$0.00,$5.85,$0.00
3571226030,SUP,HCPCS C1713,,3571226030  -  SCREW BN 6.5MM 30MM STRL 16MM THRD CANC,$113.40,$0.00,$113.40,$51.03,$80.93,$0.00,$19.54,$0.00,$0.00,$19.86,$113.40,$0.00,$56.70,$89.81,$90.72,$0.00,$17.75,$0.00,$18.05,$0.00
3571226035,SUP,HCPCS C1713,,3571226035  -  SCREW BN 6.5MM 35MM STRL 16MM THRD CANC,$113.40,$0.00,$113.40,$51.03,$80.93,$0.00,$19.54,$0.00,$0.00,$19.86,$113.40,$0.00,$56.70,$89.81,$90.72,$0.00,$17.75,$0.00,$18.05,$0.00
3571226040,SUP,HCPCS C1713,,3571226040  -  SCREW BN 6.5MM 40MM STRL 16MM THRD CANC,$113.40,$0.00,$113.40,$51.03,$80.93,$0.00,$19.54,$0.00,$0.00,$19.86,$113.40,$0.00,$56.70,$89.81,$90.72,$0.00,$17.75,$0.00,$18.05,$0.00
3571226045,SUP,HCPCS C1713,,3571226045  -  SCREW BN 6.5MM 45MM STRL 16MM THRD CANC,$113.40,$0.00,$113.40,$51.03,$80.93,$0.00,$19.54,$0.00,$0.00,$19.86,$113.40,$0.00,$56.70,$89.81,$90.72,$0.00,$17.75,$0.00,$18.05,$0.00
3571226050,SUP,HCPCS C1713,,3571226050  -  SCREW BN 6.5MM 50MM STRL 16MM THRD CANC,$113.40,$0.00,$113.40,$51.03,$80.93,$0.00,$19.54,$0.00,$0.00,$19.86,$113.40,$0.00,$56.70,$89.81,$90.72,$0.00,$17.75,$0.00,$18.05,$0.00
3571226055,SUP,HCPCS C1713,,3571226055  -  SCREW BN 6.5MM 55MM STRL 16MM THRD CANC,$113.40,$0.00,$113.40,$51.03,$80.93,$0.00,$19.54,$0.00,$0.00,$19.86,$113.40,$0.00,$56.70,$89.81,$90.72,$0.00,$17.75,$0.00,$18.05,$0.00
3571226060,SUP,HCPCS C1713,,3571226060  -  SCREW BN 6.5MM 60MM STRL 16MM THRD CANC,$113.40,$0.00,$113.40,$51.03,$80.93,$0.00,$19.54,$0.00,$0.00,$19.86,$113.40,$0.00,$56.70,$89.81,$90.72,$0.00,$17.75,$0.00,$18.05,$0.00
3571226065,SUP,HCPCS C1713,,3571226065  -  SCREW BN 6.5MM 65MM STRL 16MM THRD CANC,$113.40,$0.00,$113.40,$51.03,$80.93,$0.00,$19.54,$0.00,$0.00,$19.86,$113.40,$0.00,$56.70,$89.81,$90.72,$0.00,$17.75,$0.00,$18.05,$0.00
3571226070,SUP,HCPCS C1713,,3571226070  -  SCREW BN 6.5MM 70MM STRL 16MM THRD CANC,$113.40,$0.00,$113.40,$51.03,$80.93,$0.00,$19.54,$0.00,$0.00,$19.86,$113.40,$0.00,$56.70,$89.81,$90.72,$0.00,$17.75,$0.00,$18.05,$0.00
3571226075,SUP,HCPCS C1713,,3571226075  -  SCREW BN 6.5MM 75MM STRL 16MM THRD CANC,$113.40,$0.00,$113.40,$51.03,$80.93,$0.00,$19.54,$0.00,$0.00,$19.86,$113.40,$0.00,$56.70,$89.81,$90.72,$0.00,$17.75,$0.00,$18.05,$0.00
3571226080,SUP,HCPCS C1713,,3571226080  -  SCREW BN 6.5MM 80MM STRL 16MM THRD CANC,$113.40,$0.00,$113.40,$51.03,$80.93,$0.00,$19.54,$0.00,$0.00,$19.86,$113.40,$0.00,$56.70,$89.81,$90.72,$0.00,$17.75,$0.00,$18.05,$0.00
3571226085,SUP,HCPCS C1713,,3571226085  -  SCREW BN 6.5MM 85MM STRL 16MM THRD CANC,$124.95,$0.00,$124.95,$56.23,$89.18,$0.00,$21.53,$0.00,$0.00,$21.88,$124.95,$0.00,$62.48,$98.96,$99.96,$0.00,$19.55,$0.00,$19.89,$0.00
3571226090,SUP,HCPCS C1713,,3571226090  -  SCREW BN 6.5MM 90MM STRL 16MM THRD CANC,$124.95,$0.00,$124.95,$56.23,$89.18,$0.00,$21.53,$0.00,$0.00,$21.88,$124.95,$0.00,$62.48,$98.96,$99.96,$0.00,$19.55,$0.00,$19.89,$0.00
3571226095,SUP,HCPCS C1713,,3571226095  -  SCREW BN 6.5MM 95MM STRL 16MM THRD CANC,$124.95,$0.00,$124.95,$56.23,$89.18,$0.00,$21.53,$0.00,$0.00,$21.88,$124.95,$0.00,$62.48,$98.96,$99.96,$0.00,$19.55,$0.00,$19.89,$0.00
3571226100,SUP,HCPCS C1713,,3571226100  -  SCREW BN 6.5MM 100MM STRL 16MM THRD CANC,$124.95,$0.00,$124.95,$56.23,$89.18,$0.00,$21.53,$0.00,$0.00,$21.88,$124.95,$0.00,$62.48,$98.96,$99.96,$0.00,$19.55,$0.00,$19.89,$0.00
3571226105,SUP,HCPCS C1713,,3571226105  -  SCREW BN 6.5MM 105MM STRL 16MM THRD CANC,$124.95,$0.00,$124.95,$56.23,$89.18,$0.00,$21.53,$0.00,$0.00,$21.88,$124.95,$0.00,$62.48,$98.96,$99.96,$0.00,$19.55,$0.00,$19.89,$0.00
3571226110,SUP,HCPCS C1713,,3571226110  -  SCREW BN 6.5MM 110MM STRL 16MM THRD CANC,$124.95,$0.00,$124.95,$56.23,$89.18,$0.00,$21.53,$0.00,$0.00,$21.88,$124.95,$0.00,$62.48,$98.96,$99.96,$0.00,$19.55,$0.00,$19.89,$0.00
3571228045,SUP,HCPCS C1713,,3571228045  -  SCREW BN 6.5MM 45MM STRL 32MM THRD CANC,$113.40,$0.00,$113.40,$51.03,$80.93,$0.00,$19.54,$0.00,$0.00,$19.86,$113.40,$0.00,$56.70,$89.81,$90.72,$0.00,$17.75,$0.00,$18.05,$0.00
3571228050,SUP,HCPCS C1713,,3571228050  -  SCREW BN 6.5MM 50MM STRL 32MM THRD CANC,$113.40,$0.00,$113.40,$51.03,$80.93,$0.00,$19.54,$0.00,$0.00,$19.86,$113.40,$0.00,$56.70,$89.81,$90.72,$0.00,$17.75,$0.00,$18.05,$0.00
3571228055,SUP,HCPCS C1713,,3571228055  -  SCREW BN 6.5MM 55MM STRL 32MM THRD CANC,$113.40,$0.00,$113.40,$51.03,$80.93,$0.00,$19.54,$0.00,$0.00,$19.86,$113.40,$0.00,$56.70,$89.81,$90.72,$0.00,$17.75,$0.00,$18.05,$0.00
3571228060,SUP,HCPCS C1713,,3571228060  -  SCREW BN 6.5MM 60MM STRL 32MM THRD CANC,$113.40,$0.00,$113.40,$51.03,$80.93,$0.00,$19.54,$0.00,$0.00,$19.86,$113.40,$0.00,$56.70,$89.81,$90.72,$0.00,$17.75,$0.00,$18.05,$0.00
3571228065,SUP,HCPCS C1713,,3571228065  -  SCREW BN 6.5MM 65MM STRL 32MM THRD CANC,$113.40,$0.00,$113.40,$51.03,$80.93,$0.00,$19.54,$0.00,$0.00,$19.86,$113.40,$0.00,$56.70,$89.81,$90.72,$0.00,$17.75,$0.00,$18.05,$0.00
3571228070,SUP,HCPCS C1713,,3571228070  -  SCREW BN 6.5MM 70MM STRL 32MM THRD CANC,$113.40,$0.00,$113.40,$51.03,$80.93,$0.00,$19.54,$0.00,$0.00,$19.86,$113.40,$0.00,$56.70,$89.81,$90.72,$0.00,$17.75,$0.00,$18.05,$0.00
3571228075,SUP,HCPCS C1713,,3571228075  -  SCREW BN 6.5MM 75MM STRL 32MM THRD CANC,$113.40,$0.00,$113.40,$51.03,$80.93,$0.00,$19.54,$0.00,$0.00,$19.86,$113.40,$0.00,$56.70,$89.81,$90.72,$0.00,$17.75,$0.00,$18.05,$0.00
3571228080,SUP,HCPCS C1713,,3571228080  -  SCREW BN 6.5MM 80MM STRL 32MM THRD CANC,$113.40,$0.00,$113.40,$51.03,$80.93,$0.00,$19.54,$0.00,$0.00,$19.86,$113.40,$0.00,$56.70,$89.81,$90.72,$0.00,$17.75,$0.00,$18.05,$0.00
3571228085,SUP,HCPCS C1713,,3571228085  -  SCREW BN 6.5MM 85MM STRL 32MM THRD CANC,$124.95,$0.00,$124.95,$56.23,$89.18,$0.00,$21.53,$0.00,$0.00,$21.88,$124.95,$0.00,$62.48,$98.96,$99.96,$0.00,$19.55,$0.00,$19.89,$0.00
3571228090,SUP,HCPCS C1713,,3571228090  -  SCREW BN 6.5MM 90MM STRL 32MM THRD CANC,$124.95,$0.00,$124.95,$56.23,$89.18,$0.00,$21.53,$0.00,$0.00,$21.88,$124.95,$0.00,$62.48,$98.96,$99.96,$0.00,$19.55,$0.00,$19.89,$0.00
3571228095,SUP,HCPCS C1713,,3571228095  -  SCREW BN 6.5MM 95MM STRL 32MM THRD CANC,$124.95,$0.00,$124.95,$56.23,$89.18,$0.00,$21.53,$0.00,$0.00,$21.88,$124.95,$0.00,$62.48,$98.96,$99.96,$0.00,$19.55,$0.00,$19.89,$0.00
3571228100,SUP,HCPCS C1713,,3571228100  -  SCREW BN 6.5MM 100MM STRL 32MM THRD CANC,$124.95,$0.00,$124.95,$56.23,$89.18,$0.00,$21.53,$0.00,$0.00,$21.88,$124.95,$0.00,$62.48,$98.96,$99.96,$0.00,$19.55,$0.00,$19.89,$0.00
3571228105,SUP,HCPCS C1713,,3571228105  -  SCREW BN 6.5MM 105MM STRL 32MM THRD CANC,$124.95,$0.00,$124.95,$56.23,$89.18,$0.00,$21.53,$0.00,$0.00,$21.88,$124.95,$0.00,$62.48,$98.96,$99.96,$0.00,$19.55,$0.00,$19.89,$0.00
3571228110,SUP,HCPCS C1713,,3571228110  -  SCREW BN 6.5MM 110MM STRL 32MM THRD CANC,$124.95,$0.00,$124.95,$56.23,$89.18,$0.00,$21.53,$0.00,$0.00,$21.88,$124.95,$0.00,$62.48,$98.96,$99.96,$0.00,$19.55,$0.00,$19.89,$0.00
3571229025,SUP,HCPCS C1713,,3571229025  -  SCREW BN FT 6.5MM 25MM STRL CANC,$113.40,$0.00,$113.40,$51.03,$80.93,$0.00,$19.54,$0.00,$0.00,$19.86,$113.40,$0.00,$56.70,$89.81,$90.72,$0.00,$17.75,$0.00,$18.05,$0.00
3571229030,SUP,HCPCS C1713,,3571229030  -  SCREW BN FT 6.5MM 30MM STRL CANC,$113.40,$0.00,$113.40,$51.03,$80.93,$0.00,$19.54,$0.00,$0.00,$19.86,$113.40,$0.00,$56.70,$89.81,$90.72,$0.00,$17.75,$0.00,$18.05,$0.00
3571229035,SUP,HCPCS C1713,,3571229035  -  SCREW BN FT 6.5MM 35MM STRL CANC,$113.40,$0.00,$113.40,$51.03,$80.93,$0.00,$19.54,$0.00,$0.00,$19.86,$113.40,$0.00,$56.70,$89.81,$90.72,$0.00,$17.75,$0.00,$18.05,$0.00
3571229040,SUP,HCPCS C1713,,3571229040  -  SCREW BN FT 6.5MM 40MM STRL CANC,$113.40,$0.00,$113.40,$51.03,$80.93,$0.00,$19.54,$0.00,$0.00,$19.86,$113.40,$0.00,$56.70,$89.81,$90.72,$0.00,$17.75,$0.00,$18.05,$0.00
3571229045,SUP,HCPCS C1713,,3571229045  -  SCREW BN FT 6.5MM 45MM STRL CANC,$113.40,$0.00,$113.40,$51.03,$80.93,$0.00,$19.54,$0.00,$0.00,$19.86,$113.40,$0.00,$56.70,$89.81,$90.72,$0.00,$17.75,$0.00,$18.05,$0.00
3571229050,SUP,HCPCS C1713,,3571229050  -  SCREW BN FT 6.5MM 50MM STRL CANC,$113.40,$0.00,$113.40,$51.03,$80.93,$0.00,$19.54,$0.00,$0.00,$19.86,$113.40,$0.00,$56.70,$89.81,$90.72,$0.00,$17.75,$0.00,$18.05,$0.00
3571229055,SUP,HCPCS C1713,,3571229055  -  SCREW BN FT 6.5MM 55MM STRL CANC,$113.40,$0.00,$113.40,$51.03,$80.93,$0.00,$19.54,$0.00,$0.00,$19.86,$113.40,$0.00,$56.70,$89.81,$90.72,$0.00,$17.75,$0.00,$18.05,$0.00
3571229060,SUP,HCPCS C1713,,3571229060  -  SCREW BN FT 6.5MM 60MM STRL CANC,$113.40,$0.00,$113.40,$51.03,$80.93,$0.00,$19.54,$0.00,$0.00,$19.86,$113.40,$0.00,$56.70,$89.81,$90.72,$0.00,$17.75,$0.00,$18.05,$0.00
4823714020,SUP,HCPCS C1713,,4823714020  -  SCREW BONE 4MM 20MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
4823714025,SUP,HCPCS C1713,,4823714025  -  SCREW BONE 4MM 25MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
4823714030,SUP,HCPCS C1713,,4823714030  -  SCREW BONE 4MM 30MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
4823714035,SUP,HCPCS C1713,,4823714035  -  SCREW BONE 4MM 35MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
4823714040,SUP,HCPCS C1713,,4823714040  -  SCREW BONE 4MM 40MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
4823714045,SUP,HCPCS C1713,,4823714045  -  SCREW BONE 4MM 45MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
4823714520,SUP,HCPCS C1713,,4823714520  -  SCREW BONE 4.5MM 20MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
4823714525,SUP,HCPCS C1713,,4823714525  -  SCREW BONE 4.5MM 25MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
4823714530,SUP,HCPCS C1713,,4823714530  -  SCREW BONE 4.5MM 30MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
4823714535,SUP,HCPCS C1713,,4823714535  -  SCREW BONE 4.5MM 35MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
4823714540,SUP,HCPCS C1713,,4823714540  -  SCREW BONE 4.5MM 40MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
4823714545,SUP,HCPCS C1713,,4823714545  -  SCREW BONE 4.5MM 45MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
4823715020,SUP,HCPCS C1713,,4823715020  -  SCREW BONE 5MM 20MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
4823715025,SUP,HCPCS C1713,,4823715025  -  SCREW BONE 5MM 25MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
4823715030,SUP,HCPCS C1713,,4823715030  -  SCREW BONE 5MM 30MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
4823715035,SUP,HCPCS C1713,,4823715035  -  SCREW BONE 5MM 35MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
4823715040,SUP,HCPCS C1713,,4823715040  -  SCREW BONE 5MM 40MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
4823715045,SUP,HCPCS C1713,,4823715045  -  SCREW BONE 5MM 45MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
4823715050,SUP,HCPCS C1713,,4823715050  -  SCREW BONE 5MM 50MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
4823715525,SUP,HCPCS C1713,,4823715525  -  SCREW BONE 5.5MM 25MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
4823715530,SUP,HCPCS C1713,,4823715530  -  SCREW BONE 5.5MM 30MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
4823715535,SUP,HCPCS C1713,,4823715535  -  SCREW BONE 5.5MM 35MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
4823715540,SUP,HCPCS C1713,,4823715540  -  SCREW BONE 5.5MM 40MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
4823715545,SUP,HCPCS C1713,,4823715545  -  SCREW BONE 5.5MM 45MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
4823715550,SUP,HCPCS C1713,,4823715550  -  SCREW BONE 5.5MM 50MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
4823715555,SUP,HCPCS C1713,,4823715555  -  SCREW BONE 5.5MM 55MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
4823716525,SUP,HCPCS C1713,,4823716525  -  SCREW BONE 6.5MM 25MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
4823716530,SUP,HCPCS C1713,,4823716530  -  SCREW BONE 6.5MM 30MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
4823716535,SUP,HCPCS C1713,,4823716535  -  SCREW BONE 6.5MM 35MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
4823716540,SUP,HCPCS C1713,,4823716540  -  SCREW BONE 6.5MM 40MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
4823716545,SUP,HCPCS C1713,,4823716545  -  SCREW BONE 6.5MM 45MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
4823716550,SUP,HCPCS C1713,,4823716550  -  SCREW BONE 6.5MM 50MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
4823716555,SUP,HCPCS C1713,,4823716555  -  SCREW BONE 6.5MM 55MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
4823716560,SUP,HCPCS C1713,,4823716560  -  SCREW BONE 6.5MM 60MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
4823716565,SUP,HCPCS C1713,,4823716565  -  SCREW BONE 6.5MM 65MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
4823716570,SUP,HCPCS C1713,,4823716570  -  SCREW BONE 6.5MM 70MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
4823716580,SUP,HCPCS C1713,,4823716580  -  SCREW BONE 6.5MM 80MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
4823716590,SUP,HCPCS C1713,,4823716590  -  SCREW BONE 6.5MM 90MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
4823717525,SUP,HCPCS C1713,,4823717525  -  SCREW BONE 7.5MM 25MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
4823717530,SUP,HCPCS C1713,,4823717530  -  SCREW BONE 7.5MM 30MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
4823717535,SUP,HCPCS C1713,,4823717535  -  SCREW BONE 7.5MM 35MM REVISION POLYAX MEDIAL BIASED,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
4823717540,SUP,HCPCS C1713,,4823717540  -  SCREW BONE 7.5MM 40MM REVISION POLYAX MEDIAL BIASED,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
4823717545,SUP,HCPCS C1713,,4823717545  -  SCREW BONE 7.5MM 45MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
4823717550,SUP,HCPCS C1713,,4823717550  -  SCREW BONE 7.5MM 50MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
4823717555,SUP,HCPCS C1713,,4823717555  -  SCREW BONE 7.5MM 55MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
4823717560,SUP,HCPCS C1713,,4823717560  -  SCREW BONE 7.5MM 60MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
4823717565,SUP,HCPCS C1713,,4823717565  -  SCREW BONE 7.5MM 65MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
4823717570,SUP,HCPCS C1713,,4823717570  -  SCREW BONE 7.5MM 70MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
4823717580,SUP,HCPCS C1713,,4823717580  -  SCREW BONE 7.5MM 80MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
4823717590,SUP,HCPCS C1713,,4823717590  -  SCREW BONE 7.5MM 90MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
4823718500,SUP,HCPCS C1713,,4823718500  -  SCREW BONE 8.5MM 100MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
4823718560,SUP,HCPCS C1713,,4823718560  -  SCREW BONE 8.5MM 60MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
4823718570,SUP,HCPCS C1713,,4823718570  -  SCREW BONE 8.5MM 70MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
4823718580,SUP,HCPCS C1713,,4823718580  -  SCREW BONE 8.5MM 80MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
4823718590,SUP,HCPCS C1713,,4823718590  -  SCREW BONE 8.5MM 90MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
4823719500,SUP,HCPCS C1713,,4823719500  -  SCREW BONE 9.5MM 100MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
4823719560,SUP,HCPCS C1713,,4823719560  -  SCREW BONE 9.5MM 60MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
4823719570,SUP,HCPCS C1713,,4823719570  -  SCREW BONE 9.5MM 70MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
4823719580,SUP,HCPCS C1713,,4823719580  -  SCREW BONE 9.5MM 80MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
4823719590,SUP,HCPCS C1713,,4823719590  -  SCREW BONE 9.5MM 90MM REVISION POLYAX ILIOSACRAL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
5100060001,SUP,Custom 27203010,,5100060001  -  BIT DRILL LARGE 14MM PERFORATOR HUDSON END SHARP CRANIAL,$474.38,$0.00,$474.38,$0.00,$338.56,$0.00,$0.00,$0.00,$0.00,$0.00,$474.38,$0.00,$237.19,$375.71,$379.50,$0.00,$0.00,$0.00,$0.00,$0.00
5130020060,SUP,Custom 27203010,,5130020060  -  BURR SURG LONG 6MM 7.9MM DRUM FLUTED,$244.38,$0.00,$244.38,$0.00,$174.41,$0.00,$0.00,$0.00,$0.00,$0.00,$244.38,$0.00,$122.19,$193.55,$195.50,$0.00,$0.00,$0.00,$0.00,$0.00
5130130250,SUP,Custom 27203010,,5130130250  -  BURR SURG LONG .8MM 25.4MM DISK DIAMOND STERILE,$310.50,$0.00,$310.50,$0.00,$221.60,$0.00,$0.00,$0.00,$0.00,$0.00,$310.50,$0.00,$155.25,$245.92,$248.40,$0.00,$0.00,$0.00,$0.00,$0.00
5220030575,SUP,Custom 27203010,,5220030575  -  BURR SURG MEDIUM 7.5MM PRECISION ACORN,$488.75,$0.00,$488.75,$0.00,$348.82,$0.00,$0.00,$0.00,$0.00,$0.00,$488.75,$0.00,$244.38,$387.09,$391.00,$0.00,$0.00,$0.00,$0.00,$0.00
5450800303,SUP,Custom 27203010,,5450800303  -  TIP ASPIRAT 25KHZ SUPERLONG SPETZLER MICRO CLAW BONE,"$10,675.00",$0.00,"$10,675.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$10,675.00",$0.00,"$5,337.50","$8,454.60","$8,540.00",$0.00,$0.00,$0.00,$0.00,$0.00
5450800306,SUP,Custom 27203010,,5450800306  -  TIP ASPIRAT 25KHZ UNIVERSAL ULTRASONIC LARGE DIAMETER SOFT,"$8,455.28",$0.00,"$8,455.28",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,455.28",$0.00,"$4,227.64","$6,696.58","$6,764.22",$0.00,$0.00,$0.00,$0.00,$0.00
5450800307,SUP,Custom 27203010,,5450800307  -  TIP ASPIRAT 25KHZ UNIVERSAL STR SONOPET DISPOSABLE,"$7,750.00",$0.00,"$7,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,750.00",$0.00,"$3,875.00","$6,138.00","$6,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
5450800308,SUP,Custom 27203010,,5450800308  -  TIP ASP LG DIA STRG 4.6IN STRL LF SONOPET SFT TIS DISP,"$1,649.99",$0.00,"$1,649.99",$0.00,"$1,177.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,649.99",$0.00,$825.00,"$1,306.79","$1,320.00",$0.00,$0.00,$0.00,$0.00,$0.00
5820009060,SUP,Custom 27203010,,5820009060  -  BURR SURG ROUND 6MM PRECISION,$505.88,$0.00,$505.88,$0.00,$361.04,$0.00,$0.00,$0.00,$0.00,$0.00,$505.88,$0.00,$252.94,$400.66,$404.70,$0.00,$0.00,$0.00,$0.00,$0.00
5820009075,SUP,Custom 27203010,,5820009075  -  BURR SURG ROUND 7.5MM RIM GLIDE PRECISION,$562.50,$0.00,$562.50,$0.00,$401.46,$0.00,$0.00,$0.00,$0.00,$0.00,$562.50,$0.00,$281.25,$445.50,$450.00,$0.00,$0.00,$0.00,$0.00,$0.00
5820010010,SUP,Custom 27203010,,5820010010  -  BURR SURG ROUND FLUTE 1MM TPS ELITE,$310.50,$0.00,$310.50,$0.00,$221.60,$0.00,$0.00,$0.00,$0.00,$0.00,$310.50,$0.00,$155.25,$245.92,$248.40,$0.00,$0.00,$0.00,$0.00,$0.00
5820010125,SUP,Custom 27203010,,5820010125  -  BURR SURG 2.5MM ROUND SOFT TOUCH FLUTED ELITE STERILE,$310.50,$0.00,$310.50,$0.00,$221.60,$0.00,$0.00,$0.00,$0.00,$0.00,$310.50,$0.00,$155.25,$245.92,$248.40,$0.00,$0.00,$0.00,$0.00,$0.00
5820010130,SUP,Custom 27203010,,5820010130  -  BURR SURG 3MM TPS ELT OSTN RND FLUT SFTCH 5 NTCH,$310.50,$0.00,$310.50,$0.00,$221.60,$0.00,$0.00,$0.00,$0.00,$0.00,$310.50,$0.00,$155.25,$245.92,$248.40,$0.00,$0.00,$0.00,$0.00,$0.00
5820010150,SUP,Custom 27203010,,5820010150  -  BURR SURG ROUND FLUTE 5MM 5 NOTCH SOFT TOUCH SMOOTH CUT GOOD,$310.50,$0.00,$310.50,$0.00,$221.60,$0.00,$0.00,$0.00,$0.00,$0.00,$310.50,$0.00,$155.25,$245.92,$248.40,$0.00,$0.00,$0.00,$0.00,$0.00
5820010160,SUP,Custom 27203010,,5820010160  -  BURR SURG ROUND FLUTE 6MM SOFT TOUCH ROUND FLUTED AGGRESSIVE,$310.50,$0.00,$310.50,$0.00,$221.60,$0.00,$0.00,$0.00,$0.00,$0.00,$310.50,$0.00,$155.25,$245.92,$248.40,$0.00,$0.00,$0.00,$0.00,$0.00
5820010170,SUP,Custom 27203010,,5820010170  -  BURR SURG 7MM ROUND SOFT TOUCH ELITE STERILE,$310.50,$0.00,$310.50,$0.00,$221.60,$0.00,$0.00,$0.00,$0.00,$0.00,$310.50,$0.00,$155.25,$245.92,$248.40,$0.00,$0.00,$0.00,$0.00,$0.00
5820012010,SUP,Custom 27203010,,5820012010  -  BURR SURG ROUND 1MM ROUND HEAD CUTTING TPS ELITE DIAMOND,$310.50,$0.00,$310.50,$0.00,$221.60,$0.00,$0.00,$0.00,$0.00,$0.00,$310.50,$0.00,$155.25,$245.92,$248.40,$0.00,$0.00,$0.00,$0.00,$0.00
5820012020,SUP,Custom 27203010,,5820012020  -  BURR SRG RND 2MM TPS ELT DMD,$288.75,$0.00,$288.75,$0.00,$206.08,$0.00,$0.00,$0.00,$0.00,$0.00,$288.75,$0.00,$144.38,$228.69,$231.00,$0.00,$0.00,$0.00,$0.00,$0.00
5820012025,SUP,Custom 27203010,,5820012025  -  BURR SURG ROUND 2.5MM TPS ELITE DIAMOND,$310.50,$0.00,$310.50,$0.00,$221.60,$0.00,$0.00,$0.00,$0.00,$0.00,$310.50,$0.00,$155.25,$245.92,$248.40,$0.00,$0.00,$0.00,$0.00,$0.00
5820012050,SUP,Custom 27203010,,5820012050  -  BURR SURG DIAMOND 5MM 5 STEP NOTCH NUMBER SAFETY MARK CUT,$288.75,$0.00,$288.75,$0.00,$206.08,$0.00,$0.00,$0.00,$0.00,$0.00,$288.75,$0.00,$144.38,$228.69,$231.00,$0.00,$0.00,$0.00,$0.00,$0.00
5820012060,SUP,Custom 27203010,,5820012060  -  BURR SURG ROUND 6MM LATEX FREE ELITE DIAMOND STERILE,$288.75,$0.00,$288.75,$0.00,$206.08,$0.00,$0.00,$0.00,$0.00,$0.00,$288.75,$0.00,$144.38,$228.69,$231.00,$0.00,$0.00,$0.00,$0.00,$0.00
5820013060,SUP,Custom 27203010,,5820013060  -  BURR SRG RND CRS DMD 6MM STRL LF TPS ELT DISP,$777.50,$0.00,$777.50,$0.00,$554.90,$0.00,$0.00,$0.00,$0.00,$0.00,$777.50,$0.00,$388.75,$615.78,$622.00,$0.00,$0.00,$0.00,$0.00,$0.00
5820070011,SUP,Custom 27203010,,5820070011  -  BURR SURG STR 1.1MM 6MM ROUTER STR,$310.50,$0.00,$310.50,$0.00,$221.60,$0.00,$0.00,$0.00,$0.00,$0.00,$310.50,$0.00,$155.25,$245.92,$248.40,$0.00,$0.00,$0.00,$0.00,$0.00
5820107020,SUP,Custom 27203010,,5820107020  -  BURR SRG 2MM 3.1MM STRL LF MTCH HD SFTCH DISP NEURO,$288.75,$0.00,$288.75,$0.00,$206.08,$0.00,$0.00,$0.00,$0.00,$0.00,$288.75,$0.00,$144.38,$228.69,$231.00,$0.00,$0.00,$0.00,$0.00,$0.00
5820107120,SUP,Custom 27203010,,5820107120  -  BURR SURG 2MM 3.1MM DIAMOND NEURO ELITE STERILE,$310.50,$0.00,$310.50,$0.00,$221.60,$0.00,$0.00,$0.00,$0.00,$0.00,$310.50,$0.00,$155.25,$245.92,$248.40,$0.00,$0.00,$0.00,$0.00,$0.00
5820107125,SUP,Custom 27203010,,5820107125  -  BIT DRILL 2.5MM 3.4MM NEURO ELITE STERILE,$288.75,$0.00,$288.75,$0.00,$206.08,$0.00,$0.00,$0.00,$0.00,$0.00,$288.75,$0.00,$144.38,$228.69,$231.00,$0.00,$0.00,$0.00,$0.00,$0.00
5820107130,SUP,Custom 27203010,,5820107130  -  BURR SURG 3MM 3.8MM DIAMOND NEURO ELITE STERILE,$288.75,$0.00,$288.75,$0.00,$206.08,$0.00,$0.00,$0.00,$0.00,$0.00,$288.75,$0.00,$144.38,$228.69,$231.00,$0.00,$0.00,$0.00,$0.00,$0.00
6279409577,SUP,Custom 27203010,,6279409577  -  DRESSING BURN ADH SIL NYL 15X10IN BBRN,$248.05,$0.00,$248.05,$0.00,$177.03,$0.00,$0.00,$0.00,$0.00,$0.00,$248.05,$0.00,$124.03,$196.46,$198.44,$0.00,$0.00,$0.00,$0.00,$0.00
6770200005,SUP,Custom 27203010,,6770200005  -  FORCEPS BP .5MM 8IN SPTZLR MLS 2 IRR DISP,"$1,209.99",$0.00,"$1,209.99",$0.00,$863.57,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,209.99",$0.00,$605.00,$958.31,$967.99,$0.00,$0.00,$0.00,$0.00,$0.00
6770200010,SUP,Custom 27203010,,6770200010  -  FORCEPS BP 1MM 8IN SPTZLR MLS 2 IRR DISP,"$1,135.50",$0.00,"$1,135.50",$0.00,$810.41,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,135.50",$0.00,$567.75,$899.32,$908.40,$0.00,$0.00,$0.00,$0.00,$0.00
8065149527,SUP,Custom 27203010,,8065149527  -  CANNULA OPHTHALMIC SHORT 23GA SOFT TIP STERILE DISPOSABLE,$450.00,$0.00,$450.00,$0.00,$321.17,$0.00,$0.00,$0.00,$0.00,$0.00,$450.00,$0.00,$225.00,$356.40,$360.00,$0.00,$0.00,$0.00,$0.00,$0.00
8065149530,SUP,Custom 27203010,,8065149530  -  CANNULA OPTH SHRT 25GA .8MM STRL GRSHBR SFTP DISP,$45.00,$0.00,$45.00,$0.00,$32.12,$0.00,$0.00,$0.00,$0.00,$0.00,$45.00,$0.00,$22.50,$35.64,$36.00,$0.00,$0.00,$0.00,$0.00,$0.00
8065740632,SUP,Custom 27203010,,8065740632  -  PACK PHACO 30D RND .9MM STRL LF ABS LGC MXV DISP,$220.00,$0.00,$220.00,$0.00,$157.01,$0.00,$0.00,$0.00,$0.00,$0.00,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$0.00,$0.00,$0.00,$0.00
8065741080,SUP,Custom 27203010,,8065741080  -  PACK PHACO US BSC,$113.55,$0.00,$113.55,$0.00,$81.04,$0.00,$0.00,$0.00,$0.00,$0.00,$113.55,$0.00,$56.78,$89.93,$90.84,$0.00,$0.00,$0.00,$0.00,$0.00
8065741089,SUP,Custom 27203010,,8065741089  -  PACK PHACO 30D 1.1MM STRL INFNT RND US ABS TIP FLD MGMT SYS,$342.50,$0.00,$342.50,$0.00,$244.44,$0.00,$0.00,$0.00,$0.00,$0.00,$342.50,$0.00,$171.25,$271.26,$274.00,$0.00,$0.00,$0.00,$0.00,$0.00
8065750157,SUP,Custom 27203010,,8065750157  -  PACK VITRECTOMY INFINITI ANTERIOR STERILE DISPOSABLE,$434.00,$0.00,$434.00,$0.00,$309.75,$0.00,$0.00,$0.00,$0.00,$0.00,$434.00,$0.00,$217.00,$343.73,$347.20,$0.00,$0.00,$0.00,$0.00,$0.00
8065750159,SUP,Custom 27203010,,8065750159  -  KIT PHACOEMULSIFICATION .9MM SMALL PART MICROSMOOTH STERILE,$52.50,$0.00,$52.50,$0.00,$37.47,$0.00,$0.00,$0.00,$0.00,$0.00,$52.50,$0.00,$26.25,$41.58,$42.00,$0.00,$0.00,$0.00,$0.00,$0.00
8065751176,SUP,Custom 27203010,,8065751176  -  TIP 30 DEG OZIL 12 PHACO,$144.38,$0.00,$144.38,$0.00,$103.04,$0.00,$0.00,$0.00,$0.00,$0.00,$144.38,$0.00,$72.19,$114.35,$115.50,$0.00,$0.00,$0.00,$0.00,$0.00
8065751177,SUP,Custom 27203010,,8065751177  -  TIP PHACOEMULSIFICATION 45D .9MM 12MM MINIFLARE OZIL,$144.38,$0.00,$144.38,$0.00,$103.04,$0.00,$0.00,$0.00,$0.00,$0.00,$144.38,$0.00,$72.19,$114.35,$115.50,$0.00,$0.00,$0.00,$0.00,$0.00
8065751576,SUP,Custom 27203010,,8065751576  -  PROBE LASER 23GA ILLUMINATED PIK RFID,"$3,570.90",$0.00,"$3,570.90",$0.00,"$2,548.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,570.90",$0.00,"$1,785.45","$2,828.15","$2,856.72",$0.00,$0.00,$0.00,$0.00,$0.00
8065751577,SUP,Custom 27203010,,8065751577  -  ILLUMINATOR OPHTHALMIC 25GA RADIO FREQUENCY IDENTIFICATION,"$3,731.10",$0.00,"$3,731.10",$0.00,"$2,662.89",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,731.10",$0.00,"$1,865.55","$2,955.03","$2,984.88",$0.00,$0.00,$0.00,$0.00,$0.00
8065751592,SUP,Custom 27203010,,8065751592  -  PROBE LASER 78D 23GA 2IN ILLUMINATION CURVE TIP LARGE,"$2,760.00",$0.00,"$2,760.00",$0.00,"$1,969.81",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,760.00",$0.00,"$1,380.00","$2,185.92","$2,208.00",$0.00,$0.00,$0.00,$0.00,$0.00
8065751593,SUP,Custom 27203010,,8065751593  -  PROBE LASER 78D 25GA 2IN ILLUMINATION CURVE TIP LARGE,"$3,244.50",$0.00,"$3,244.50",$0.00,"$2,315.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,244.50",$0.00,"$1,622.25","$2,569.64","$2,595.60",$0.00,$0.00,$0.00,$0.00,$0.00
8065751922,SUP,Custom 27203010,,8065751922  -  SET OPHTHALMIC INTREPID IRRIGATION ASPIRATION BIMANUAL HANDP,$270.00,$0.00,$270.00,$0.00,$192.70,$0.00,$0.00,$0.00,$0.00,$0.00,$270.00,$0.00,$135.00,$213.84,$216.00,$0.00,$0.00,$0.00,$0.00,$0.00
8065752201,SUP,Custom 27203010,,8065752201  -  PACK PHACO 45D .9MM STRL ABS TIP FLD MGMT SYS ULT SLV DISP,"$1,663.65",$0.00,"$1,663.65",$0.00,"$1,187.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,663.65",$0.00,$831.83,"$1,317.61","$1,330.92",$0.00,$0.00,$0.00,$0.00,$0.00
8065754003,SUP,HCPCS L8610,,8065754003  -  SHUNT GLCM STRL LF CYPASS,"$3,962.50",$0.00,"$3,962.50","$1,783.13","$2,828.04",$0.00,$482.85,$0.00,$0.00,$693.80,"$3,962.50",$0.00,"$1,981.25","$3,138.30","$3,170.00",$0.00,$620.13,$0.00,$630.83,$0.00
8065817001,SUP,Custom 27203010,,8065817001  -  TIP IRR/ASPIRAT .3MM ULFL 1 PC STR,"$1,650.00",$0.00,"$1,650.00",$0.00,"$1,177.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,650.00",$0.00,$825.00,"$1,306.80","$1,320.00",$0.00,$0.00,$0.00,$0.00,$0.00
8065900163,SUP,Custom 27203010,,8065900163  -  KIT ACCESSORY PROCEDURAL LIQUID PERFLUORON,"$3,049.88",$0.00,"$3,049.88",$0.00,"$2,176.70",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,049.88",$0.00,"$1,524.94","$2,415.50","$2,439.90",$0.00,$0.00,$0.00,$0.00,$0.00
8065992747,SUP,Custom 27203010,,8065992747  -  KNIFE OPHTHALMIC ANGLE 2 BEVEL 2.75MM SLIT SATIN FINISH FULL,$46.13,$0.00,$46.13,$0.00,$32.92,$0.00,$0.00,$0.00,$0.00,$0.00,$46.13,$0.00,$23.06,$36.53,$36.90,$0.00,$0.00,$0.00,$0.00,$0.00
8065997001,SUP,HCPCS C1713,,8065997001  -  SCREW BN 2.3MM STRL IKNF II STNCRSNT TIP STRG DISP,$41.58,$0.00,$41.58,$18.71,$29.67,$0.00,$7.16,$0.00,$0.00,$7.28,$41.58,$0.00,$20.79,$32.93,$33.26,$0.00,$6.51,$0.00,$6.62,$0.00
8450107030,SUP,Custom 27203010,,8450107030  -  BURR SURG 3MM MATCH HEAD LATEX FREE,$466.35,$0.00,$466.35,$0.00,$332.83,$0.00,$0.00,$0.00,$0.00,$0.00,$466.35,$0.00,$233.18,$369.35,$373.08,$0.00,$0.00,$0.00,$0.00,$0.00
8815668007,SUP,Custom 27203010,,TRAY CATH 19.5CM 11.5FR MHRKR DUAL STRG NDLHLDR GZE SPNG SH,$314.88,$0.00,$314.88,$0.00,$224.73,$0.00,$0.00,$0.00,$0.00,$0.00,$314.88,$0.00,$157.44,$249.38,$251.90,$0.00,$0.00,$0.00,$0.00,$0.00
8831663001,SUP,Custom 27203010,,TRAY CATH MHRKR INS 2LUM STRG EXTN,$314.88,$0.00,$314.88,$0.00,$224.73,$0.00,$0.00,$0.00,$0.00,$0.00,$314.88,$0.00,$157.44,$249.38,$251.90,$0.00,$0.00,$0.00,$0.00,$0.00
8884200026,SUP,Custom 27203010,,PROBE THRMTR ORAL CORD ADLT FLC 2000 REUSE,$114.85,$0.00,$114.85,$0.00,$81.97,$0.00,$0.00,$0.00,$0.00,$0.00,$114.85,$0.00,$57.43,$90.96,$91.88,$0.00,$0.00,$0.00,$0.00,$0.00
8886808300,SUP,Custom 27803010,,8886808300  -  RING ANSTM 2MM 25MM STRL VALTRAC RADOPQ BFRG MECH LCK CNCT,$829.45,$0.00,$829.45,$0.00,$591.98,$0.00,$0.00,$0.00,$0.00,$0.00,$829.45,$0.00,$414.72,$656.92,$663.56,$0.00,$0.00,$0.00,$0.00,$0.00
8886808800,SUP,Custom 27803010,,8886808800  -  RING ANSTM 2MM 28MM STRL VALTRAC RADOPQ BFRG MECH LCK CNCT,$777.13,$0.00,$777.13,$0.00,$554.63,$0.00,$0.00,$0.00,$0.00,$0.00,$777.13,$0.00,$388.56,$615.49,$621.70,$0.00,$0.00,$0.00,$0.00,$0.00
8887654088,SUP,HCPCS C1729,,CATHETER URTH DOV 8FR 2W FOLEY BLN SIL-EL 3ML LTX PED,$10.33,$0.00,$10.33,$5.61,$7.37,$0.00,$1.78,$0.00,$0.00,$1.81,$10.33,$0.00,$5.16,$8.18,$8.26,$0.00,$1.62,$0.00,$1.64,$0.00
8887654104,SUP,HCPCS C1729,,CATHETER URTH DOV 10FR FOLEY 2W SIL-EL 3ML LTX PED,$10.33,$0.00,$10.33,$5.61,$7.37,$0.00,$1.78,$0.00,$0.00,$1.81,$10.33,$0.00,$5.16,$8.18,$8.26,$0.00,$1.62,$0.00,$1.64,$0.00
8888119362,SUP,HCPCS C1750,,8888119362  -  CATHETER HMDIAL 14.5FR 19CM MH MXD SPORTPACK 2 LUM KINK RST,$210.68,$0.00,$210.68,$94.81,$150.36,$0.00,$36.30,$0.00,$0.00,$36.89,$210.68,$0.00,$105.34,$166.86,$168.54,$0.00,$32.97,$0.00,$33.54,$0.00
8888160333,SUP,Custom 27203010,,8888160333  -  CATHETER UMB 3.5FR 15IN .15ML CLR STRL LF ARG 1 LUM LL HUB,$35.34,$0.00,$33.84,$0.00,$24.15,$0.00,$0.00,$0.00,$0.00,$0.00,$33.84,$0.00,$16.92,$27.99,$27.07,$0.00,$0.00,$0.00,$0.00,$0.00
8888160341,SUP,Custom 27203010,,8888160341  -  CAP TUBE 13MM BLU EZTPR DBL FLNG SL THB TAB PE,$35.34,$0.00,$33.84,$0.00,$24.15,$0.00,$0.00,$0.00,$0.00,$0.00,$33.84,$0.00,$16.92,$27.99,$27.07,$0.00,$0.00,$0.00,$0.00,$0.00
8888160358,SUP,HCPCS C1729,,CATHETER UMB 3.5FR 15IN FLXB SMTH LUER LOCK LOCK HUB WNG ARG,$33.33,$0.00,$33.33,$18.10,$23.78,$0.00,$5.74,$0.00,$0.00,$5.83,$33.33,$0.00,$16.66,$26.40,$26.66,$0.00,$5.22,$0.00,$5.31,$0.00
8888160408,SUP,Custom 27203010,,8888160408  -  TRAY CATH LF A NEOS 2 TIER DSGN FN TIP FCP INS DEPH FR MGLN,$132.28,$0.00,$126.66,$0.00,$90.40,$0.00,$0.00,$0.00,$0.00,$0.00,$126.66,$0.00,$63.33,$104.77,$101.33,$0.00,$0.00,$0.00,$0.00,$0.00
8888265108,SUP,Custom 27203010,,TUBE NG 36IN 10FR SNTNL LN A SLM SM SIL,$28.73,$0.00,$28.73,$0.00,$20.50,$0.00,$0.00,$0.00,$0.00,$0.00,$28.73,$0.00,$14.36,$22.75,$22.98,$0.00,$0.00,$0.00,$0.00,$0.00
8888492120,SUP,HCPCS C1758,,8888492120  -  CATH URTH DV RBNL 20FR 16IN PVC STRL LATEX FREE,$1.38,$0.00,$1.38,$0.75,$0.99,$0.00,$0.24,$0.00,$0.00,$0.24,$1.38,$0.00,$0.69,$1.09,$1.11,$0.00,$0.22,$0.00,$0.22,$0.00
8888560805,SUP,HCPCS C1729,,8888560805  -  CATHETER DRAIN 8FR 9IN SHARP TROCAR TIP RADIOPQ DEPTH MARK,$36.23,$0.00,$36.23,$19.67,$25.85,$0.00,$6.24,$0.00,$0.00,$6.34,$36.23,$0.00,$18.11,$28.69,$28.98,$0.00,$5.67,$0.00,$5.77,$0.00
8888561019,SUP,HCPCS C1729,,8888561019  -  CATHETER DRN 10FR 3.3MM 9IN TROC STRG SFT PVC THOR,$36.23,$0.00,$34.69,$18.84,$24.76,$0.00,$6.24,$0.00,$0.00,$6.34,$34.69,$0.00,$17.34,$28.69,$27.75,$0.00,$5.67,$0.00,$5.52,$0.00
8888561027,SUP,HCPCS C1729,,8888561027  -  CATHETER DRAIN 12FR 9IN SHARP TROCAR TIP RADIOPQ DEPTH MARK,$36.23,$0.00,$34.69,$18.84,$24.76,$0.00,$6.24,$0.00,$0.00,$6.34,$34.69,$0.00,$17.34,$28.69,$27.75,$0.00,$5.67,$0.00,$5.52,$0.00
8888570515,SUP,HCPCS C1725,,CATHETER DRAIN 16FR 5.3MM 20IN 4 SD EYE STRG THOR THRMSNS,$12.63,$0.00,$12.63,$6.86,$9.01,$0.00,$2.18,$0.00,$0.00,$2.21,$12.63,$0.00,$6.31,$10.00,$10.10,$0.00,$1.98,$0.00,$2.01,$0.00
8888570523,SUP,HCPCS C1725,,CATHETER DRAIN 20FR 6.7MM 20IN EYLT RT ANG THRMSNS DEPTH,$12.63,$0.00,$12.63,$6.86,$9.01,$0.00,$2.18,$0.00,$0.00,$2.21,$12.63,$0.00,$6.31,$10.00,$10.10,$0.00,$1.98,$0.00,$2.01,$0.00
8888570572,SUP,HCPCS C1729,,8888570572  -  CATH DRAIN 40FR 20IN ARG 6 EYLT STR THRMSNS DEPTH MARK,$123.13,$0.00,$123.13,$66.86,$87.87,$0.00,$21.21,$0.00,$0.00,$21.56,$123.13,$0.00,$61.56,$97.52,$98.50,$0.00,$19.27,$0.00,$19.60,$0.00
8888571042,SUP,HCPCS C1729,,8888571042  -  CATHETER DRAIN RIGHT ANG 28FR 20IN 6 SIDE EYE RADIOPQ TUBE,$196.13,$0.00,$187.80,$101.98,$134.03,$0.00,$33.79,$0.00,$0.00,$34.34,$187.80,$0.00,$93.90,$155.33,$150.24,$0.00,$30.69,$0.00,$29.90,$0.00
8888577700,SUP,Custom 27803010,,8888577700  -  SHUNT CARDIO 11IN 8FR ARG CRTD 4 TUBE KIT PLSH TPR END,$86.51,$0.00,$86.51,$0.00,$61.74,$0.00,$0.00,$0.00,$0.00,$0.00,$86.51,$0.00,$43.25,$68.52,$69.20,$0.00,$0.00,$0.00,$0.00,$0.00
8888577775,SUP,HCPCS C1877,,8888577775  -  SHUNT CARDIO 6IN 8-14FR ARG CRTD 4 TUBE KT PLSH TPR END,$87.91,$0.00,$87.91,$39.56,$62.74,$0.00,$15.15,$0.00,$0.00,$15.39,$87.91,$0.00,$43.95,$69.62,$70.33,$0.00,$13.76,$0.00,$13.99,$0.00
8888590018,SUP,HCPCS C1725,,CATHETER DRAIN 20IN 18FR FERG VNTRC PVC 4 EYLT VNT STRL LF,$74.68,$0.00,$74.68,$40.55,$53.30,$0.00,$12.87,$0.00,$0.00,$13.07,$74.68,$0.00,$37.34,$59.15,$59.74,$0.00,$11.69,$0.00,$11.89,$0.00
54410004020,SUP,HCPCS C1713,,54410004020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
54410004025,SUP,HCPCS C1713,,54410004025  -  PLATE 18MM TI BONE SPNL,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
54410004030,SUP,HCPCS C1713,,54410004030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
54410004035,SUP,HCPCS C1713,,54410004035  -  PLATE 18MM TI BONE SPNL,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
54410004040,SUP,HCPCS C1713,,54410004040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
54410004045,SUP,HCPCS C1713,,54410004045  -  PLATE 18MM TI BONE SPNL,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
54410004520,SUP,HCPCS C1713,,54410004520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
54410004525,SUP,HCPCS C1713,,54410004525  -  PLATE 18MM TI BONE SPNL,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
54410004530,SUP,HCPCS C1713,,54410004530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
54410004535,SUP,HCPCS C1713,,54410004535  -  PLATE 18MM TI BONE SPNL,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
54410004540,SUP,HCPCS C1713,,54410004540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
54410004545,SUP,HCPCS C1713,,54410004545  -  PLATE 18MM TI BONE SPNL,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
54410005020,SUP,HCPCS C1713,,54410005020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
54410005025,SUP,HCPCS C1713,,54410005025  -  PLATE 18MM TI BONE SPNL,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
54410005030,SUP,HCPCS C1713,,54410005030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
54410005035,SUP,HCPCS C1713,,54410005035  -  PLATE 18MM TI BONE SPNL,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
54410005040,SUP,HCPCS C1713,,54410005040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
54410005045,SUP,HCPCS C1713,,54410005045  -  PLATE 18MM TI BONE SPNL,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
54410005050,SUP,HCPCS C1713,,54410005050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
54410005520,SUP,HCPCS C1713,,54410005520  -  PLATE 18MM TI BONE SPNL,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
54410005525,SUP,HCPCS C1713,,54410005525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
54410005530,SUP,HCPCS C1713,,54410005530  -  PLATE 18MM TI BONE SPNL,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
54410005535,SUP,HCPCS C1713,,54410005535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
54410005540,SUP,HCPCS C1713,,54410005540  -  PLATE 18MM TI BONE SPNL,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
54410005545,SUP,HCPCS C1713,,54410005545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
54410005550,SUP,HCPCS C1713,,54410005550  -  PLATE 18MM TI BONE SPNL,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
54410005555,SUP,HCPCS C1713,,54410005555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
54410006025,SUP,HCPCS C1713,,54410006025  -  PLATE 18MM TI BONE SPNL,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
54410006030,SUP,HCPCS C1713,,54410006030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
54410006035,SUP,HCPCS C1713,,54410006035  -  PLATE 18MM TI BONE SPNL,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
54410006040,SUP,HCPCS C1713,,54410006040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
54410006045,SUP,HCPCS C1713,,54410006045  -  PLATE 18MM TI BONE SPNL,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
54410006050,SUP,HCPCS C1713,,54410006050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
54410006055,SUP,HCPCS C1713,,54410006055  -  PLATE 18MM TI BONE SPNL,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
54410006520,SUP,HCPCS C1713,,54410006520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
54410006525,SUP,HCPCS C1713,,54410006525  -  PLATE 18MM TI BONE SPNL,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
54410006530,SUP,HCPCS C1713,,54410006530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
54410006535,SUP,HCPCS C1713,,54410006535  -  PLATE 18MM TI BONE SPNL,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
54410006540,SUP,HCPCS C1713,,54410006540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
54410006545,SUP,HCPCS C1713,,54410006545  -  PLATE 18MM TI BONE SPNL,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
54410006550,SUP,HCPCS C1713,,54410006550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
54410006555,SUP,HCPCS C1713,,54410006555  -  PLATE 18MM TI BONE SPNL,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
54410006560,SUP,HCPCS C1713,,54410006560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
54410007530,SUP,HCPCS C1713,,54410007530  -  PLATE 18MM TI BONE SPNL,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
54410007535,SUP,HCPCS C1713,,54410007535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
54410007540,SUP,HCPCS C1713,,54410007540  -  PLATE 18MM TI BONE SPNL,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
54410007545,SUP,HCPCS C1713,,54410007545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
54410007550,SUP,HCPCS C1713,,54410007550  -  PLATE 18MM TI BONE SPNL,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
54410007555,SUP,HCPCS C1713,,54410007555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
54410007560,SUP,HCPCS C1713,,54410007560  -  PLATE 18MM TI BONE SPNL,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
54740044520,SUP,HCPCS C1713,,54740044520  -  SCREW BONE 4.5MM 20MM ATS SPN MULTIAX 4.75MM ROD ST,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54740044525,SUP,HCPCS C1713,,54740044525  -  SCREW BONE 4.5MM 25MM ATS SPN MULTIAX 4.75MM ROD ST,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54740044530,SUP,HCPCS C1713,,54740044530  -  SCREW BONE 4.5MM 30MM ATS SPN MULTIAX 4.75MM ROD ST,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54740044535,SUP,HCPCS C1713,,54740044535  -  SCREW BONE 4.5MM 35MM ATS SPN MULTIAX 4.75MM ROD ST,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54740044540,SUP,HCPCS C1713,,54740044540  -  SCREW BONE 4.5MM 40MM ATS SPN MULTIAX 4.75MM ROD ST,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54740044545,SUP,HCPCS C1713,,54740044545  -  SCREW BONE 4.5MM 45MM ATS SPN MULTIAX 4.75MM ROD ST,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54740044550,SUP,HCPCS C1713,,54740044550  -  SCREW BONE 4.5MM 50MM ATS SPN MULTIAX 4.75MM ROD ST,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54740044555,SUP,HCPCS C1713,,54740044555  -  SCREW BONE 4.5MM 55MM ATS SPN MULTIAX 4.75MM ROD ST,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54740044560,SUP,HCPCS C1713,,54740044560  -  SCREW BONE 4.5MM 60MM ATS SPN MULTIAX 4.75MM ROD ST,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54740045520,SUP,HCPCS C1713,,54740045520  -  SCREW BONE 5.5MM 20MM ATS SPN MULTIAX 4.75MM ROD ST,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54740045525,SUP,HCPCS C1713,,54740045525  -  SCREW BONE 5.5MM 25MM ATS SPN MULTIAX 4.75MM ROD ST,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54740045530,SUP,HCPCS C1713,,54740045530  -  SCREW BONE 5.5MM 30MM ATS SPN MULTIAX 4.75MM ROD ST,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54740045535,SUP,HCPCS C1713,,54740045535  -  SCREW BONE 5.5MM 35MM ATS SPN MULTIAX 4.75MM ROD ST,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54740045540,SUP,HCPCS C1713,,54740045540  -  SCREW BONE 5.5MM 40MM ATS SPN MULTIAX 4.75MM ROD ST,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54740045545,SUP,HCPCS C1713,,54740045545  -  SCREW BONE 5.5MM 45MM ATS SPN MULTIAX 4.75MM ROD ST,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54740045550,SUP,HCPCS C1713,,54740045550  -  SCREW BONE 5.5MM 50MM ATS SPN MULTIAX 4.75MM ROD ST,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54740045555,SUP,HCPCS C1713,,54740045555  -  SCREW BONE 5.5MM 55MM ATS SPN MULTIAX 4.75MM ROD ST,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54740045560,SUP,HCPCS C1713,,54740045560  -  SCREW BONE 5.5MM 60MM ATS SPN MULTIAX 4.75MM ROD ST,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54740046520,SUP,HCPCS C1713,,54740046520  -  SCREW BONE 6.5MM 20MM ATS SPN MULTIAX 4.75MM ROD ST,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54740046525,SUP,HCPCS C1713,,54740046525  -  SCREW BONE 6.5MM 25MM ATS SPN MULTIAX 4.75MM ROD ST,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54740046530,SUP,HCPCS C1713,,54740046530  -  SCREW BONE 6.5MM 30MM ATS SPN MULTIAX 4.75MM ROD ST,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54740046535,SUP,HCPCS C1713,,54740046535  -  SCREW BONE 6.5MM 35MM ATS SPN MULTIAX 4.75MM ROD ST,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54740046540,SUP,HCPCS C1713,,54740046540  -  SCREW BONE 6.5MM 40MM ATS SPN MULTIAX 4.75MM ROD ST,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54740046545,SUP,HCPCS C1713,,54740046545  -  SCREW BONE 6.5MM 45MM ATS SPN MULTIAX 4.75MM ROD ST,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54740046550,SUP,HCPCS C1713,,54740046550  -  SCREW BONE 6.5MM 50MM ATS SPN MULTIAX 4.75MM ROD ST,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54740046555,SUP,HCPCS C1713,,54740046555  -  SCREW BONE 6.5MM 55MM ATS SPN MULTIAX 4.75MM ROD ST,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54740046560,SUP,HCPCS C1713,,54740046560  -  SCREW BONE 6.5MM 60MM ATS SPN MULTIAX 4.75MM ROD ST,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54740047520,SUP,HCPCS C1713,,54740047520  -  SCREW BONE 7.5MM 20MM ATS SPN MULTIAX 4.75MM ROD ST,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54740047525,SUP,HCPCS C1713,,54740047525  -  SCREW BONE 7.5MM 25MM ATS SPN MULTIAX 4.75MM ROD ST,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54740047530,SUP,HCPCS C1713,,54740047530  -  SCREW BONE 7.5MM 30MM ATS SPN MULTIAX 4.75MM ROD ST,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54740047535,SUP,HCPCS C1713,,54740047535  -  SCREW BONE 7.5MM 35MM ATS SPN MULTIAX 4.75MM ROD ST,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54740047540,SUP,HCPCS C1713,,54740047540  -  SCREW BONE 7.5MM 40MM ATS SPN MULTIAX 4.75MM ROD ST,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54740047545,SUP,HCPCS C1713,,54740047545  -  SCREW BONE 7.5MM 45MM ATS SPN MULTIAX 4.75MM ROD ST,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54740047550,SUP,HCPCS C1713,,54740047550  -  SCREW BONE 7.5MM 50MM ATS SPN MULTIAX 4.75MM ROD ST,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54740047555,SUP,HCPCS C1713,,54740047555  -  SCREW BONE 7.5MM 55MM ATS SPN MULTIAX 4.75MM ROD ST,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54740047560,SUP,HCPCS C1713,,54740047560  -  SCREW BONE 7.5MM 60MM ATS SPN MULTIAX 4.75MM ROD ST,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54740105515,SUP,HCPCS C1713,,54740105515  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740105520,SUP,HCPCS C1713,,54740105520  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740105525,SUP,HCPCS C1713,,54740105525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740105530,SUP,HCPCS C1713,,54740105530  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740105535,SUP,HCPCS C1713,,54740105535  -  SCREW BN 5.5MM 35MM CD HZN SOLERA MA CNN COCR HA SPNE PDCL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740105540,SUP,HCPCS C1713,,54740105540  -  SCREW BN 5.5MM 40MM CD HZN SOLERA MA CNN COCR HA SPNE PDCL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740105545,SUP,HCPCS C1713,,54740105545  -  SCREW BN 5.5MM 45MM CD HZN SOLERA MA CNN COCR HA SPNE PDCL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740105550,SUP,HCPCS C1713,,54740105550  -  SCREW BN 5.5MM 50MM CD HZN SOLERA MA CNN COCR HA SPNE PDCL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740105555,SUP,HCPCS C1713,,54740105555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740105560,SUP,HCPCS C1713,,54740105560  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740105565,SUP,HCPCS C1713,,54740105565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740105570,SUP,HCPCS C1713,,54740105570  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740105575,SUP,HCPCS C1713,,54740105575  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740105580,SUP,HCPCS C1713,,54740105580  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740106015,SUP,HCPCS C1713,,54740106015  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740106020,SUP,HCPCS C1713,,54740106020  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740106025,SUP,HCPCS C1713,,54740106025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740106030,SUP,HCPCS C1713,,54740106030  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740106035,SUP,HCPCS C1713,,54740106035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740106040,SUP,HCPCS C1713,,54740106040  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740106045,SUP,HCPCS C1713,,54740106045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740106050,SUP,HCPCS C1713,,54740106050  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740106055,SUP,HCPCS C1713,,54740106055  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740106060,SUP,HCPCS C1713,,54740106060  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740106065,SUP,HCPCS C1713,,54740106065  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740106070,SUP,HCPCS C1713,,54740106070  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740106075,SUP,HCPCS C1713,,54740106075  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740106080,SUP,HCPCS C1713,,54740106080  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740106515,SUP,HCPCS C1713,,54740106515  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740106520,SUP,HCPCS C1713,,54740106520  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740106525,SUP,HCPCS C1713,,54740106525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740106530,SUP,HCPCS C1713,,54740106530  -  SCREW BN 6.5MM 30MM CD HZN SOLERA MA CNN COCR HA SPNE PDCL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740106535,SUP,HCPCS C1713,,54740106535  -  SCREW BN 6.5MM 35MM CD HZN SOLERA MA CNN COCR HA SPNE PDCL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740106540,SUP,HCPCS C1713,,54740106540  -  SCREW BN 6.5MM 40MM CD HZN SOLERA MA CNN COCR HA SPNE PDCL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740106545,SUP,HCPCS C1713,,54740106545  -  SCREW BN 6.5MM 45MM CD HZN SOLERA MA CNN COCR HA SPNE PDCL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740106550,SUP,HCPCS C1713,,54740106550  -  SCREW BN 6.5MM 50MM CD HZN SOLERA MA CNN COCR HA SPNE PDCL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740106555,SUP,HCPCS C1713,,54740106555  -  SCREW BN 6.5MM 55MM CD HZN SOLERA MA CNN COCR HA SPNE PDCL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740106560,SUP,HCPCS C1713,,54740106560  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740106565,SUP,HCPCS C1713,,54740106565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740106570,SUP,HCPCS C1713,,54740106570  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740106575,SUP,HCPCS C1713,,54740106575  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740106580,SUP,HCPCS C1713,,54740106580  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740107020,SUP,HCPCS C1713,,54740107020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740107025,SUP,HCPCS C1713,,54740107025  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740107030,SUP,HCPCS C1713,,54740107030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740107035,SUP,HCPCS C1713,,54740107035  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740107040,SUP,HCPCS C1713,,54740107040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740107045,SUP,HCPCS C1713,,54740107045  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740107050,SUP,HCPCS C1713,,54740107050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740107055,SUP,HCPCS C1713,,54740107055  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740107060,SUP,HCPCS C1713,,54740107060  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740107065,SUP,HCPCS C1713,,54740107065  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740107070,SUP,HCPCS C1713,,54740107070  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740107075,SUP,HCPCS C1713,,54740107075  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740107080,SUP,HCPCS C1713,,54740107080  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740107500,SUP,HCPCS C1713,,54740107500  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740107511,SUP,HCPCS C1713,,54740107511  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740107520,SUP,HCPCS C1713,,54740107520  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740107525,SUP,HCPCS C1713,,54740107525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740107530,SUP,HCPCS C1713,,54740107530  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740107535,SUP,HCPCS C1713,,54740107535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740107540,SUP,HCPCS C1713,,54740107540  -  SCREW BN 7.5MM 40MM CD HZN SOLERA MA CNN COCR HA SPNE PDCL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740107545,SUP,HCPCS C1713,,54740107545  -  SCREW BN 7.5MM 45MM CD HZN SOLERA MA CNN COCR HA SPNE PDCL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740107550,SUP,HCPCS C1713,,54740107550  -  SCREW BN 7.5MM 50MM CD HZN SOLERA MA CNN COCR HA SPNE PDCL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740107555,SUP,HCPCS C1713,,54740107555  -  SCREW BN 7.5MM 55MM CD HZN SOLERA MA CNN COCR HA SPNE PDCL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740107560,SUP,HCPCS C1713,,54740107560  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740107565,SUP,HCPCS C1713,,54740107565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740107570,SUP,HCPCS C1713,,54740107570  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740107575,SUP,HCPCS C1713,,54740107575  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740107580,SUP,HCPCS C1713,,54740107580  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740107585,SUP,HCPCS C1713,,54740107585  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740107590,SUP,HCPCS C1713,,54740107590  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740107595,SUP,HCPCS C1713,,54740107595  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740108000,SUP,HCPCS C1713,,54740108000  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740108011,SUP,HCPCS C1713,,54740108011  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740108020,SUP,HCPCS C1713,,54740108020  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740108025,SUP,HCPCS C1713,,54740108025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740108030,SUP,HCPCS C1713,,54740108030  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740108035,SUP,HCPCS C1713,,54740108035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740108040,SUP,HCPCS C1713,,54740108040  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740108045,SUP,HCPCS C1713,,54740108045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740108050,SUP,HCPCS C1713,,54740108050  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740108055,SUP,HCPCS C1713,,54740108055  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740108060,SUP,HCPCS C1713,,54740108060  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740108065,SUP,HCPCS C1713,,54740108065  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740108070,SUP,HCPCS C1713,,54740108070  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740108075,SUP,HCPCS C1713,,54740108075  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740108080,SUP,HCPCS C1713,,54740108080  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740108085,SUP,HCPCS C1713,,54740108085  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740108090,SUP,HCPCS C1713,,54740108090  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740108095,SUP,HCPCS C1713,,54740108095  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740108500,SUP,HCPCS C1713,,54740108500  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740108511,SUP,HCPCS C1713,,54740108511  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740108520,SUP,HCPCS C1713,,54740108520  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740108525,SUP,HCPCS C1713,,54740108525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740108530,SUP,HCPCS C1713,,54740108530  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740108535,SUP,HCPCS C1713,,54740108535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740108540,SUP,HCPCS C1713,,54740108540  -  SCREW BN 8.5MM 40MM CD HZN SOLERA MA CNN COCR HA SPNE PDCL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740108545,SUP,HCPCS C1713,,54740108545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740108550,SUP,HCPCS C1713,,54740108550  -  SCREW BN 8.5MM 50MM CD HZN SOLERA MA CNN COCR HA SPNE PDCL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740108555,SUP,HCPCS C1713,,54740108555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740108560,SUP,HCPCS C1713,,54740108560  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740108565,SUP,HCPCS C1713,,54740108565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740108570,SUP,HCPCS C1713,,54740108570  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740108575,SUP,HCPCS C1713,,54740108575  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740108580,SUP,HCPCS C1713,,54740108580  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740108585,SUP,HCPCS C1713,,54740108585  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740108590,SUP,HCPCS C1713,,54740108590  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740108595,SUP,HCPCS C1713,,54740108595  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740109500,SUP,HCPCS C1713,,54740109500  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740109511,SUP,HCPCS C1713,,54740109511  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740109520,SUP,HCPCS C1713,,54740109520  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740109525,SUP,HCPCS C1713,,54740109525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740109530,SUP,HCPCS C1713,,54740109530  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740109535,SUP,HCPCS C1713,,54740109535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740109540,SUP,HCPCS C1713,,54740109540  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740109545,SUP,HCPCS C1713,,54740109545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740109550,SUP,HCPCS C1713,,54740109550  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740109555,SUP,HCPCS C1713,,54740109555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740109560,SUP,HCPCS C1713,,54740109560  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740109565,SUP,HCPCS C1713,,54740109565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740109570,SUP,HCPCS C1713,,54740109570  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740109575,SUP,HCPCS C1713,,54740109575  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740109580,SUP,HCPCS C1713,,54740109580  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740109585,SUP,HCPCS C1713,,54740109585  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740109590,SUP,HCPCS C1713,,54740109590  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54740109595,SUP,HCPCS C1713,,54740109595  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54750014525,SUP,HCPCS C1713,,54750014525  -  SCREW BONE 4.5MM 25MM CD HZN SPN MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54750014530,SUP,HCPCS C1713,,54750014530  -  SCREW BONE 4.5MM 30MM CD HZN SPN MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54750014535,SUP,HCPCS C1713,,54750014535  -  SCREW BONE 4.5MM 35MM CD HZN SPN MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54750014540,SUP,HCPCS C1713,,54750014540  -  SCREW BONE 4.5MM 40MM CD HZN SPN MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54750014545,SUP,HCPCS C1713,,54750014545  -  SCREW BONE 4.5MM 45MM CD HZN SPN MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54750014550,SUP,HCPCS C1713,,54750014550  -  SCREW BONE 4.5MM 50MM CD HZN SPN MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54750014555,SUP,HCPCS C1713,,54750014555  -  SCREW BONE 4.5MM 55MM CD HZN SPN MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54750015525,SUP,HCPCS C1713,,54750015525  -  SCREW BONE 5.5MM 25MM CD HZN SPN MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54750015530,SUP,HCPCS C1713,,54750015530  -  SCREW BONE 5.5MM 30MM CD HZN SPN MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54750015535,SUP,HCPCS C1713,,54750015535  -  SCREW BONE 5.5MM 35MM CD HZN SPN MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54750015540,SUP,HCPCS C1713,,54750015540  -  SCREW BONE 5.5MM 40MM CD HZN SPN MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54750015545,SUP,HCPCS C1713,,54750015545  -  SCREW BONE 5.5MM 45MM CD HZN SPN MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54750015550,SUP,HCPCS C1713,,54750015550  -  SCREW BONE 5.5MM 50MM CD HZN SPN MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54750015555,SUP,HCPCS C1713,,54750015555  -  SCREW BONE 5.5MM 55MM CD HZN SPN MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54750015560,SUP,HCPCS C1713,,54750015560  -  SCREW BONE 5.5MM 60MM CD HZN SPN MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54750015565,SUP,HCPCS C1713,,54750015565  -  SCREW BONE 5.5MM 65MM CD HZN SPN MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54750016530,SUP,HCPCS C1713,,54750016530  -  SCREW BONE 6.5MM 30MM CD HZN SPN MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54750016535,SUP,HCPCS C1713,,54750016535  -  SCREW BONE 6.5MM 35MM CD HZN SPN MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54750016540,SUP,HCPCS C1713,,54750016540  -  SCREW BONE 6.5MM 40MM CD HZN SPN MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54750016545,SUP,HCPCS C1713,,54750016545  -  SCREW BONE 6.5MM 45MM CD HZN SPN MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54750016550,SUP,HCPCS C1713,,54750016550  -  SCREW BONE 6.5MM 50MM CD HZN SPN MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54750016555,SUP,HCPCS C1713,,54750016555  -  SCREW BONE 6.5MM 55MM CD HZN SPN MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54750016560,SUP,HCPCS C1713,,54750016560  -  SCREW BONE 6.5MM 60MM CD HZN SPN MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54750016565,SUP,HCPCS C1713,,54750016565  -  SCREW BONE 6.5MM 65MM CD HZN SPN MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54750017530,SUP,HCPCS C1713,,54750017530  -  SCREW BONE 7.5MM 30MM CD HZN SPN MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54750017535,SUP,HCPCS C1713,,54750017535  -  SCREW BONE 7.5MM 35MM CD HZN SPN MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54750017540,SUP,HCPCS C1713,,54750017540  -  SCREW BONE 7.5MM 40MM CD HZN SPN MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54750017545,SUP,HCPCS C1713,,54750017545  -  SCREW BONE 7.5MM 45MM CD HZN SPN MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54750017550,SUP,HCPCS C1713,,54750017550  -  SCREW BONE 7.5MM 50MM CD HZN SPN MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54750017555,SUP,HCPCS C1713,,54750017555  -  SCREW BONE 7.5MM 55MM CD HZN SPN MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54750017560,SUP,HCPCS C1713,,54750017560  -  SCREW BONE 7.5MM 60MM CD HZN SPN MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54750017565,SUP,HCPCS C1713,,54750017565  -  SCREW BONE 7.5MM 65MM CD HZN SPN MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54750017570,SUP,HCPCS C1713,,54750017570  -  SCREW BONE 7.5MM 70MM CD HZN SPN MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54750018530,SUP,HCPCS C1713,,54750018530  -  SCREW BONE 8.5MM 30MM CD HZN SPN MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54750018535,SUP,HCPCS C1713,,54750018535  -  SCREW BONE 8.5MM 35MM CD HZN SPN MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54750018540,SUP,HCPCS C1713,,54750018540  -  SCREW BONE 8.5MM 40MM CD HZN SPN MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54750018545,SUP,HCPCS C1713,,54750018545  -  SCREW BONE 8.5MM 45MM CD HZN SPN MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54750018550,SUP,HCPCS C1713,,54750018550  -  SCREW BONE 8.5MM 50MM CD HZN SPN MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54750018555,SUP,HCPCS C1713,,54750018555  -  SCREW BONE 8.5MM 55MM CD HZN SPN MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54750018560,SUP,HCPCS C1713,,54750018560  -  SCREW BONE 8.5MM 60MM CD HZN SPN MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54750018565,SUP,HCPCS C1713,,54750018565  -  SCREW BONE 8.5MM 65MM CD HZN SPN MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54750018570,SUP,HCPCS C1713,,54750018570  -  SCREW BONE 8.5MM 70MM CD HZN SPN MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54840004020,SUP,HCPCS C1713,,54840004020  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840004025,SUP,HCPCS C1713,,54840004025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840004030,SUP,HCPCS C1713,,54840004030  -  SCREW BN 4MM 30MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840004035,SUP,HCPCS C1713,,54840004035  -  SCREW BN 4MM 35MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840004040,SUP,HCPCS C1713,,54840004040  -  SCREW BN 4MM 40MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840004045,SUP,HCPCS C1713,,54840004045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840004050,SUP,HCPCS C1713,,54840004050  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840004055,SUP,HCPCS C1713,,54840004055  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840004520,SUP,HCPCS C1713,,54840004520  -  SCREW BN 4.5MM 20MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840004525,SUP,HCPCS C1713,,54840004525  -  SCREW BN 4.5MM 25MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840004530,SUP,HCPCS C1713,,54840004530  -  SCREW BN 4.5MM 30MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840004535,SUP,HCPCS C1713,,54840004535  -  SCREW BN 4.5MM 35MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840004540,SUP,HCPCS C1713,,54840004540  -  SCREW BN 4.5MM 40MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840004545,SUP,HCPCS C1713,,54840004545  -  SCREW BN 4.5MM 45MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840004550,SUP,HCPCS C1713,,54840004550  -  SCREW BN 4.5MM 50MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840004555,SUP,HCPCS C1713,,54840004555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840005020,SUP,HCPCS C1713,,54840005020  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840005025,SUP,HCPCS C1713,,54840005025  -  SCREW BN 5MM 25MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840005030,SUP,HCPCS C1713,,54840005030  -  SCREW BN 5MM 30MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840005035,SUP,HCPCS C1713,,54840005035  -  SCREW BN 5MM 35MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840005040,SUP,HCPCS C1713,,54840005040  -  SCREW BN 5MM 40MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840005045,SUP,HCPCS C1713,,54840005045  -  SCREW BN 5MM 45MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840005050,SUP,HCPCS C1713,,54840005050  -  SCREW BN 5MM 50MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840005055,SUP,HCPCS C1713,,54840005055  -  SCREW BN 5MM 55MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840005520,SUP,HCPCS C1713,,54840005520  -  SCREW BN 5.5MM 20MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840005525,SUP,HCPCS C1713,,54840005525  -  SCREW BN 5.5MM 25MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840005530,SUP,HCPCS C1713,,54840005530  -  SCREW BN 5.5MM 30MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840005535,SUP,HCPCS C1713,,54840005535  -  SCREW BN 5.5MM 35MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840005540,SUP,HCPCS C1713,,54840005540  -  SCREW BN 5.5MM 40MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840005545,SUP,HCPCS C1713,,54840005545  -  SCREW BN 5.5MM 45MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840005550,SUP,HCPCS C1713,,54840005550  -  SCREW BN 5.5MM 50MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840005555,SUP,HCPCS C1713,,54840005555  -  SCREW BN 5.5MM 55MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840005560,SUP,HCPCS C1713,,54840005560  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840006020,SUP,HCPCS C1713,,54840006020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840006025,SUP,HCPCS C1713,,54840006025  -  SCREW BN 6MM 25MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840006030,SUP,HCPCS C1713,,54840006030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840006035,SUP,HCPCS C1713,,54840006035  -  SCREW BN 6MM 35MM NS CD HZN MA COCR SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840006040,SUP,HCPCS C1713,,54840006040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840006045,SUP,HCPCS C1713,,54840006045  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840006050,SUP,HCPCS C1713,,54840006050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840006055,SUP,HCPCS C1713,,54840006055  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840006060,SUP,HCPCS C1713,,54840006060  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840006520,SUP,HCPCS C1713,,54840006520  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840006525,SUP,HCPCS C1713,,54840006525  -  SCREW BN 6.5MM 25MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840006530,SUP,HCPCS C1713,,54840006530  -  SCREW BN 6.5MM 30MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840006535,SUP,HCPCS C1713,,54840006535  -  SCREW BN 6.5MM 35MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840006540,SUP,HCPCS C1713,,54840006540  -  SCREW BN 6.5MM 40MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840006545,SUP,HCPCS C1713,,54840006545  -  SCREW BN 6.5MM 45MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840006550,SUP,HCPCS C1713,,54840006550  -  SCREW BN 6.5MM 50MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840006555,SUP,HCPCS C1713,,54840006555  -  SCREW BN 6.5MM 55MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840006560,SUP,HCPCS C1713,,54840006560  -  SCREW BN 6.5MM 60MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840006565,SUP,HCPCS C1713,,54840006565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840006570,SUP,HCPCS C1713,,54840006570  -  SCREW BN 6.5MM 70MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840006580,SUP,HCPCS C1713,,54840006580  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840007500,SUP,HCPCS C1713,,54840007500  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840007520,SUP,HCPCS C1713,,54840007520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840007525,SUP,HCPCS C1713,,54840007525  -  SCREW BN 7.5MM 25MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840007530,SUP,HCPCS C1713,,54840007530  -  SCREW BN 7.5MM 30MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840007535,SUP,HCPCS C1713,,54840007535  -  SCREW BN 7.5MM 35MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840007540,SUP,HCPCS C1713,,54840007540  -  SCREW BN 7.5MM 40MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840007545,SUP,HCPCS C1713,,54840007545  -  SCREW BN 7.5MM 45MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840007550,SUP,HCPCS C1713,,54840007550  -  SCREW BN 7.5MM 50MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840007555,SUP,HCPCS C1713,,54840007555  -  SCREW BN 7.5MM 55MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840007560,SUP,HCPCS C1713,,54840007560  -  SCREW BN 7.5MM 60MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840007565,SUP,HCPCS C1713,,54840007565  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840007570,SUP,HCPCS C1713,,54840007570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840007580,SUP,HCPCS C1713,,54840007580  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840007590,SUP,HCPCS C1713,,54840007590  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840008500,SUP,HCPCS C1713,,54840008500  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840008525,SUP,HCPCS C1713,,54840008525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840008530,SUP,HCPCS C1713,,54840008530  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840008535,SUP,HCPCS C1713,,54840008535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840008540,SUP,HCPCS C1713,,54840008540  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840008545,SUP,HCPCS C1713,,54840008545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840008550,SUP,HCPCS C1713,,54840008550  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840008555,SUP,HCPCS C1713,,54840008555  -  SCREW BN 8.5MM 55MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840008560,SUP,HCPCS C1713,,54840008560  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840008565,SUP,HCPCS C1713,,54840008565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840008570,SUP,HCPCS C1713,,54840008570  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840008580,SUP,HCPCS C1713,,54840008580  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840008590,SUP,HCPCS C1713,,54840008590  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840009500,SUP,HCPCS C1713,,54840009500  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840009525,SUP,HCPCS C1713,,54840009525  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840009530,SUP,HCPCS C1713,,54840009530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840009535,SUP,HCPCS C1713,,54840009535  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840009540,SUP,HCPCS C1713,,54840009540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840009545,SUP,HCPCS C1713,,54840009545  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840009550,SUP,HCPCS C1713,,54840009550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840009555,SUP,HCPCS C1713,,54840009555  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840009560,SUP,HCPCS C1713,,54840009560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840009565,SUP,HCPCS C1713,,54840009565  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840009570,SUP,HCPCS C1713,,54840009570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840009580,SUP,HCPCS C1713,,54840009580  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840009590,SUP,HCPCS C1713,,54840009590  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54840014530,SUP,HCPCS C1713,,54840014530  -  SCREW BONE 30MM MULTIAX CANN SOLERA CD HORIZON COCR 4.5MM,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54840014535,SUP,HCPCS C1713,,54840014535  -  SCREW BONE 35MM MULTIAX CANN SOLERA CD HORIZON COCR 4.5MM,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54840014540,SUP,HCPCS C1713,,54840014540  -  SCREW BONE 40MM MULTIAX CANN SOLERA CD HORIZON COCR 4.5MM,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54840014545,SUP,HCPCS C1713,,54840014545  -  SCREW BONE 4.5MM 45MM MULTIAX CANN SOLERA CD HORIZON COCR,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54840015535,SUP,HCPCS C1713,,54840015535  -  SCREW BONE 5.5MM 35MM MULTIAX CANN COCR SPN,"$6,492.50",$0.00,"$6,492.50","$2,921.63","$4,633.70",$0.00,"$1,118.63",$0.00,$0.00,"$1,136.78","$6,492.50",$0.00,"$3,246.25","$5,142.06","$5,194.00",$0.00,"$1,016.08",$0.00,"$1,033.61",$0.00
54840015540,SUP,HCPCS C1713,,54840015540  -  SCREW BONE 5.5MM 40MM MULTIAX CANN SOLERA CD HORIZON COCR,"$6,492.50",$0.00,"$6,492.50","$2,921.63","$4,633.70",$0.00,"$1,118.63",$0.00,$0.00,"$1,136.78","$6,492.50",$0.00,"$3,246.25","$5,142.06","$5,194.00",$0.00,"$1,016.08",$0.00,"$1,033.61",$0.00
54840015545,SUP,HCPCS C1713,,54840015545  -  SCREW BONE 5.5MM 45MM MULTIAX CANN SOLERA CD HORIZON,"$6,492.50",$0.00,"$6,492.50","$2,921.63","$4,633.70",$0.00,"$1,118.63",$0.00,$0.00,"$1,136.78","$6,492.50",$0.00,"$3,246.25","$5,142.06","$5,194.00",$0.00,"$1,016.08",$0.00,"$1,033.61",$0.00
54840015550,SUP,HCPCS C1713,,54840015550  -  SCREW BONE 5.5MM 50MM MULTIAX CANN SOLERA CD HORIZON,"$6,492.50",$0.00,"$6,492.50","$2,921.63","$4,633.70",$0.00,"$1,118.63",$0.00,$0.00,"$1,136.78","$6,492.50",$0.00,"$3,246.25","$5,142.06","$5,194.00",$0.00,"$1,016.08",$0.00,"$1,033.61",$0.00
54840016535,SUP,HCPCS C1713,,54840016535  -  SCREW BONE LP 6.5MM 35MM 2 LEAD MULTIAX CANN COLOR CODED,"$6,492.50",$0.00,"$6,492.50","$2,921.63","$4,633.70",$0.00,"$1,118.63",$0.00,$0.00,"$1,136.78","$6,492.50",$0.00,"$3,246.25","$5,142.06","$5,194.00",$0.00,"$1,016.08",$0.00,"$1,033.61",$0.00
54840016540,SUP,HCPCS C1713,,54840016540  -  SCREW BN 6.5MM 40MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM,"$6,492.50",$0.00,"$6,492.50","$2,921.63","$4,633.70",$0.00,"$1,118.63",$0.00,$0.00,"$1,136.78","$6,492.50",$0.00,"$3,246.25","$5,142.06","$5,194.00",$0.00,"$1,016.08",$0.00,"$1,033.61",$0.00
54840016545,SUP,HCPCS C1713,,54840016545  -  SCREW BN 6.5MM 45MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM,"$6,492.50",$0.00,"$6,492.50","$2,921.63","$4,633.70",$0.00,"$1,118.63",$0.00,$0.00,"$1,136.78","$6,492.50",$0.00,"$3,246.25","$5,142.06","$5,194.00",$0.00,"$1,016.08",$0.00,"$1,033.61",$0.00
54840016550,SUP,HCPCS C1713,,54840016550  -  SCREW BN 6.5MM 50MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM,"$6,492.50",$0.00,"$6,492.50","$2,921.63","$4,633.70",$0.00,"$1,118.63",$0.00,$0.00,"$1,136.78","$6,492.50",$0.00,"$3,246.25","$5,142.06","$5,194.00",$0.00,"$1,016.08",$0.00,"$1,033.61",$0.00
54840016555,SUP,HCPCS C1713,,54840016555  -  SCREW BONE 6.5MM 55MM SOLERA CD HZN OSTEOGRIP TI,"$6,492.50",$0.00,"$6,492.50","$2,921.63","$4,633.70",$0.00,"$1,118.63",$0.00,$0.00,"$1,136.78","$6,492.50",$0.00,"$3,246.25","$5,142.06","$5,194.00",$0.00,"$1,016.08",$0.00,"$1,033.61",$0.00
54840017540,SUP,HCPCS C1713,,54840017540  -  SCREW BONE 7.5MM 40MM MULTIAX CANN COCR SPN,"$6,492.50",$0.00,"$6,492.50","$2,921.63","$4,633.70",$0.00,"$1,118.63",$0.00,$0.00,"$1,136.78","$6,492.50",$0.00,"$3,246.25","$5,142.06","$5,194.00",$0.00,"$1,016.08",$0.00,"$1,033.61",$0.00
54840017545,SUP,HCPCS C1713,,54840017545  -  SCREW BONE 7.5MM 45MM MULTIAX CANN SOLERA CD HORIZON COCR,"$6,492.50",$0.00,"$6,492.50","$2,921.63","$4,633.70",$0.00,"$1,118.63",$0.00,$0.00,"$1,136.78","$6,492.50",$0.00,"$3,246.25","$5,142.06","$5,194.00",$0.00,"$1,016.08",$0.00,"$1,033.61",$0.00
54840044520,SUP,HCPCS C1713,,54840044520  -  SCREW BONE 4.5MM 20MM ATS SPN MULTIAX 4.75MM ROD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54840044525,SUP,HCPCS C1713,,54840044525  -  SCREW BONE 4.5MM 25MM ATS SPN MULTIAX 4.75MM ROD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54840044530,SUP,HCPCS C1713,,54840044530  -  SCREW BONE 4.5MM 30MM ATS SPN MULTIAX 4.75MM ROD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54840044535,SUP,HCPCS C1713,,54840044535  -  SCREW BONE 4.5MM 35MM ATS SPN MULTIAX 4.75MM ROD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54840044540,SUP,HCPCS C1713,,54840044540  -  SCREW BONE 4.5MM 40MM MULTIAX ATS SPN 4.75MM ROD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54840044545,SUP,HCPCS C1713,,54840044545  -  SCREW BONE 4.5MM 45MM ATS SPN MULTIAX 4.75MM ROD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54840044550,SUP,HCPCS C1713,,54840044550  -  SCREW BONE 4.5MM 50MM ATS SPN MULTIAX 4.75MM ROD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54840044555,SUP,HCPCS C1713,,54840044555  -  SCREW BONE 4.5MM 55MM ATS SPN MULTIAX 4.75MM ROD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54840044560,SUP,HCPCS C1713,,54840044560  -  SCREW BONE 4.5MM 60MM ATS SPN MULTIAX 4.75MM ROD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54840045520,SUP,HCPCS C1713,,54840045520  -  SCREW BONE 5.5MM 20MM ATS SPN MULTIAX 4.75MM ROD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54840045525,SUP,HCPCS C1713,,54840045525  -  SCREW BONE 5.5MM 25MM ATS SPN MULTIAX 4.75MM ROD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54840045530,SUP,HCPCS C1713,,54840045530  -  SCREW BONE 5.5MM 30MM ATS SPN MULTIAX 4.75MM ROD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54840045535,SUP,HCPCS C1713,,54840045535  -  SCREW BONE 5.5MM 35MM MULTIAX ATS SPN 4.75MM ROD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54840045540,SUP,HCPCS C1713,,54840045540  -  SCREW BONE 5.5MM 40MM ATS SPN MULTIAX 4.75MM ROD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54840045545,SUP,HCPCS C1713,,54840045545  -  SCREW BONE 5.5MM 45MM MULTIAX ATS SPN 4.75MM ROD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54840045550,SUP,HCPCS C1713,,54840045550  -  SCREW BONE 5.5MM 50MM ATS SPN MULTIAX 4.75MM ROD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54840045555,SUP,HCPCS C1713,,54840045555  -  SCREW BONE 5.5MM 55MM ATS SPN MULTIAX 4.75MM ROD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54840045560,SUP,HCPCS C1713,,54840045560  -  SCREW BONE 5.5MM 60MM ATS SPN MULTIAX 4.75MM ROD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54840046520,SUP,HCPCS C1713,,54840046520  -  SCREW BONE 6.5MM 20MM ATS SPN MULTIAX 4.75MM ROD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54840046525,SUP,HCPCS C1713,,54840046525  -  SCREW BONE 6.5MM 25MM ATS SPN MULTIAX 4.75MM ROD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54840046530,SUP,HCPCS C1713,,54840046530  -  SCREW BONE 6.5MM 30MM ATS SPN MULTIAX 4.75MM ROD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54840046535,SUP,HCPCS C1713,,54840046535  -  SCREW BONE 6.5MM 35MM MULTIAX ATS SPN 4.75MM ROD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54840046540,SUP,HCPCS C1713,,54840046540  -  SCREW BONE 6.5MM 40MM ATS SPN MULTIAX 4.75MM ROD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54840046545,SUP,HCPCS C1713,,54840046545  -  SCREW BONE 6.5MM 45MM ATS SPN MULTIAX 4.75MM ROD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54840046550,SUP,HCPCS C1713,,54840046550  -  SCREW BONE 6.5MM 50MM ATS SPN MULTIAX 4.75MM ROD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54840046555,SUP,HCPCS C1713,,54840046555  -  SCREW BONE 6.5MM 55MM ATS SPN MULTIAX 4.75MM ROD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54840046560,SUP,HCPCS C1713,,54840046560  -  SCREW BONE 6.5MM 60MM ATS SPN MULTIAX 4.75MM ROD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54840047520,SUP,HCPCS C1713,,54840047520  -  SCREW BONE 7.5MM 20MM ATS SPN MULTIAX 4.75MM ROD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54840047525,SUP,HCPCS C1713,,54840047525  -  SCREW BONE 7.5MM 25MM ATS SPN MULTIAX 4.75MM ROD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54840047530,SUP,HCPCS C1713,,54840047530  -  SCREW BONE 7.5MM 30MM ATS SPN MULTIAX 4.75MM ROD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54840047535,SUP,HCPCS C1713,,54840047535  -  SCREW BONE 7.5MM 35MM ATS SPN MULTIAX 4.75MM ROD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54840047540,SUP,HCPCS C1713,,54840047540  -  SCREW BONE 7.5MM 40MM ATS SPN MULTIAX 4.75MM ROD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54840047545,SUP,HCPCS C1713,,54840047545  -  SCREW BONE 7.5MM 45MM ATS SPN MULTIAX 4.75MM ROD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54840047550,SUP,HCPCS C1713,,54840047550  -  SCREW BONE 7.5MM 50MM ATS SPN MULTIAX 4.75MM ROD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54840047555,SUP,HCPCS C1713,,54840047555  -  SCREW BONE 7.5MM 55MM ATS SPN MULTIAX 4.75MM ROD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54840047560,SUP,HCPCS C1713,,54840047560  -  SCREW BONE 7.5MM 60MM ATS SPN MULTIAX 4.75MM ROD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54850014530,SUP,HCPCS C1713,,54850014530  -  SCREW BONE 4.5MM 30MM CD HZN SPNL MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54850014535,SUP,HCPCS C1713,,54850014535  -  SCREW BN 4.5MM 35MM MAS CNN XTN TAB SPNE 4.75MM ROD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54850014540,SUP,HCPCS C1713,,54850014540  -  SCREW BN 4.5MM 40MM MAS CNN XTN TAB SPNE 4.75MM ROD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54850014545,SUP,HCPCS C1713,,54850014545  -  SCREW BN 4.5MM 45MM MAS CNN XTN TAB SPNE 4.75MM ROD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54850014550,SUP,HCPCS C1713,,54850014550  -  SCREW BONE 4.5MM 50MM CD HZN SPNL MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54850014555,SUP,HCPCS C1713,,54850014555  -  SCREW BONE 4.5MM 55MM CD HZN SPNL MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54850014560,SUP,HCPCS C1713,,54850014560  -  SCREW BONE 4.5MM 60MM CD HZN SPNL MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54850014565,SUP,HCPCS C1713,,54850014565  -  SCREW BONE 4.5MM 65MM CD HZN SPNL MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54850014570,SUP,HCPCS C1713,,54850014570  -  SCREW BONE 4.5MM 70MM CD HZN SPNL MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54850014575,SUP,HCPCS C1713,,54850014575  -  SCREW BONE 4.5MM 75MM CD HZN SPNL MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54850015530,SUP,HCPCS C1713,,54850015530  -  SCREW BONE 5.5MM 30MM CD HZN SPNL MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54850015535,SUP,HCPCS C1713,,54850015535  -  SCREW BN 5.5MM 35MM MAS CNN XTN TAB SPNE 4.75MM ROD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54850015540,SUP,HCPCS C1713,,54850015540  -  SCREW BN 5.5MM 40MM NS SOLERA CD HZN MA CNN XTD TAB SPNE,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54850015545,SUP,HCPCS C1713,,54850015545  -  SCREW BN 5.5MM 45MM NS SOLERA CD HZN MA CNN XTD TAB SPNE,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54850015550,SUP,HCPCS C1713,,54850015550  -  SCREW BN 5.5MM 50MM NS SOLERA CD HZN MA CNN XTD TAB SPNE,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54850015555,SUP,HCPCS C1713,,54850015555  -  SCREW BONE 5.5MM 55MM CD HZN SPNL MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54850015560,SUP,HCPCS C1713,,54850015560  -  SCREW BONE 5.5MM 60MM CD HZN SPNL MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54850015565,SUP,HCPCS C1713,,54850015565  -  SCREW BONE 5.5MM 65MM CD HZN SPNL MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54850015570,SUP,HCPCS C1713,,54850015570  -  SCREW BONE 5.5MM 70MM CD HZN SPNL MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54850015575,SUP,HCPCS C1713,,54850015575  -  SCREW BONE 5.5MM 75MM CD HZN SPNL MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54850016530,SUP,HCPCS C1713,,54850016530  -  SCREW BONE 6.5MM 30MM CD HZN SPNL MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54850016535,SUP,HCPCS C1713,,54850016535  -  SCREW BN 6.5MM 35MM NS SOLERA CD HZN MA CNN XTD TAB SPNE,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54850016540,SUP,HCPCS C1713,,54850016540  -  SCREW BN 6.5MM 40MM NS SOLERA CD HZN MA CNN XTD TAB SPNE,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54850016545,SUP,HCPCS C1713,,54850016545  -  SCREW BN 6.5MM 45MM NS SOLERA CD HZN MA CNN XTD TAB SPNE,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54850016550,SUP,HCPCS C1713,,54850016550  -  SCREW BN 6.5MM 50MM NS SOLERA CD HZN MA CNN XTD TAB SPNE,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54850016555,SUP,HCPCS C1713,,54850016555  -  SCREW BN 6.5MM 55MM NS SOLERA CD HZN MA CNN XTD TAB SPNE,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54850016560,SUP,HCPCS C1713,,54850016560  -  SCREW BONE 6.5MM 60MM CD HZN SPNL MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54850016565,SUP,HCPCS C1713,,54850016565  -  SCREW BONE 6.5MM 65MM CD HZN SPNL MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54850017530,SUP,HCPCS C1713,,54850017530  -  SCREW BONE 7.5MM 30MM CD HZN SPNL MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54850017535,SUP,HCPCS C1713,,54850017535  -  SCREW BONE 7.5MM 35MM CD HZN SPNL MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54850017540,SUP,HCPCS C1713,,54850017540  -  SCREW BN 7.5MM 40MM MAS CNN XTN TAB SPNE 4.75MM ROD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54850017545,SUP,HCPCS C1713,,54850017545  -  SCREW BN 7.5MM 45MM NS SOLERA CD HZN MA CNN XTD TAB SPNE,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54850017550,SUP,HCPCS C1713,,54850017550  -  SCREW BN 7.5MM 50MM NS SOLERA CD HZN MA CNN XTD TAB SPNE,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54850017555,SUP,HCPCS C1713,,54850017555  -  SCREW BN 7.5MM 55MM NS SOLERA CD HZN MA CNN XTD TAB SPNE,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54850017560,SUP,HCPCS C1713,,54850017560  -  SCREW BN 7.5MM 60MM NS SOLERA CD HZN MA CNN XTD TAB SPNE,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54850017565,SUP,HCPCS C1713,,54850017565  -  SCREW BONE 7.5MM 65MM CD HZN SPNL MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54850018530,SUP,HCPCS C1713,,54850018530  -  SCREW BONE 8.5MM 30MM CD HZN SPNL MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54850018535,SUP,HCPCS C1713,,54850018535  -  SCREW BONE 8.5MM 35MM CD HZN SPNL MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54850018540,SUP,HCPCS C1713,,54850018540  -  SCREW BONE 8.5MM 40MM CD HZN SPNL MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54850018545,SUP,HCPCS C1713,,54850018545  -  SCREW BONE 8.5MM 45MM CD HZN SPNL MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54850018550,SUP,HCPCS C1713,,54850018550  -  SCREW BONE 8.5MM 50MM CD HZN SPNL MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54850018555,SUP,HCPCS C1713,,54850018555  -  SCREW BONE 8.5MM 55MM CD HZN SPNL MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54850018560,SUP,HCPCS C1713,,54850018560  -  SCREW BONE 8.5MM 60MM CD HZN SPNL MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54850018565,SUP,HCPCS C1713,,54850018565  -  SCREW BONE 8.5MM 65MM CD HZN SPNL MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54850018570,SUP,HCPCS C1713,,54850018570  -  SCREW BONE 8.5MM 70MM CD HZN SPNL MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54850018575,SUP,HCPCS C1713,,54850018575  -  SCREW BONE 8.5MM 75MM CD HZN SPNL MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54850018580,SUP,HCPCS C1713,,54850018580  -  SCREW BONE 8.5MM 80MM CD HZN SPNL MULTIAX CANN XTD,"$3,895.50",$0.00,"$3,895.50","$1,752.98","$2,780.22",$0.00,$671.18,$0.00,$0.00,$682.07,"$3,895.50",$0.00,"$1,947.75","$3,085.24","$3,116.40",$0.00,$609.65,$0.00,$620.16,$0.00
54890004525,SUP,HCPCS C1713,,54890004525  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54890004530,SUP,HCPCS C1713,,54890004530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54890004535,SUP,HCPCS C1713,,54890004535  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54890004540,SUP,HCPCS C1713,,54890004540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54890005525,SUP,HCPCS C1713,,54890005525  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54890005530,SUP,HCPCS C1713,,54890005530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54890005535,SUP,HCPCS C1713,,54890005535  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54890005540,SUP,HCPCS C1713,,54890005540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54890005545,SUP,HCPCS C1713,,54890005545  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54890005550,SUP,HCPCS C1713,,54890005550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54890006530,SUP,HCPCS C1713,,54890006530  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54890006535,SUP,HCPCS C1713,,54890006535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54890006540,SUP,HCPCS C1713,,54890006540  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54890006545,SUP,HCPCS C1713,,54890006545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54890006550,SUP,HCPCS C1713,,54890006550  -  SCREW BN 6.5MM 50MM NS SOLERA CD HZN MA RDC COCR SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54890006555,SUP,HCPCS C1713,,54890006555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54890007535,SUP,HCPCS C1713,,54890007535  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54890007540,SUP,HCPCS C1713,,54890007540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54890007545,SUP,HCPCS C1713,,54890007545  -  SCREW BN 7.5MM 45MM NS SOLERA CD HZN MA RDC COCR SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54890007550,SUP,HCPCS C1713,,54890007550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
54890007555,SUP,HCPCS C1713,,54890007555  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55410004020,SUP,HCPCS C1713,,55410004020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
55410004025,SUP,HCPCS C1713,,55410004025  -  PLATE 18MM TI BONE SPNL,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
55410004030,SUP,HCPCS C1713,,55410004030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
55410004035,SUP,HCPCS C1713,,55410004035  -  PLATE 18MM TI BONE SPNL,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
55410004040,SUP,HCPCS C1713,,55410004040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
55410004045,SUP,HCPCS C1713,,55410004045  -  PLATE 18MM TI BONE SPNL,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
55410004520,SUP,HCPCS C1713,,55410004520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
55410004525,SUP,HCPCS C1713,,55410004525  -  PLATE 18MM TI BONE SPNL,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
55410004530,SUP,HCPCS C1713,,55410004530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
55410004535,SUP,HCPCS C1713,,55410004535  -  PLATE 18MM TI BONE SPNL,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
55410004540,SUP,HCPCS C1713,,55410004540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
55410004545,SUP,HCPCS C1713,,55410004545  -  PLATE 18MM TI BONE SPNL,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
55410005020,SUP,HCPCS C1713,,55410005020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
55410005025,SUP,HCPCS C1713,,55410005025  -  PLATE 18MM TI BONE SPNL,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
55410005030,SUP,HCPCS C1713,,55410005030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
55410005035,SUP,HCPCS C1713,,55410005035  -  PLATE 18MM TI BONE SPNL,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
55410005040,SUP,HCPCS C1713,,55410005040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
55410005045,SUP,HCPCS C1713,,55410005045  -  PLATE 18MM TI BONE SPNL,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
55410005520,SUP,HCPCS C1713,,55410005520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
55410005525,SUP,HCPCS C1713,,55410005525  -  PLATE 18MM TI BONE SPNL,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
55410005530,SUP,HCPCS C1713,,55410005530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
55410005535,SUP,HCPCS C1713,,55410005535  -  PLATE 18MM TI BONE SPNL,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
55410005540,SUP,HCPCS C1713,,55410005540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
55410005545,SUP,HCPCS C1713,,55410005545  -  PLATE 18MM TI BONE SPNL,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
55410005550,SUP,HCPCS C1713,,55410005550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
55410006025,SUP,HCPCS C1713,,55410006025  -  PLATE 18MM TI BONE SPNL,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
55410006030,SUP,HCPCS C1713,,55410006030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
55410006035,SUP,HCPCS C1713,,55410006035  -  PLATE 18MM TI BONE SPNL,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
55410006040,SUP,HCPCS C1713,,55410006040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
55410006045,SUP,HCPCS C1713,,55410006045  -  PLATE 18MM TI BONE SPNL,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
55410006050,SUP,HCPCS C1713,,55410006050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
55410006055,SUP,HCPCS C1713,,55410006055  -  PLATE 18MM TI BONE SPNL,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
55410006520,SUP,HCPCS C1713,,55410006520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
55410006525,SUP,HCPCS C1713,,55410006525  -  PLATE 18MM TI BONE SPNL,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
55410006530,SUP,HCPCS C1713,,55410006530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
55410006535,SUP,HCPCS C1713,,55410006535  -  PLATE 18MM TI BONE SPNL,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
55410006540,SUP,HCPCS C1713,,55410006540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
55410006545,SUP,HCPCS C1713,,55410006545  -  PLATE 18MM TI BONE SPNL,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
55410006550,SUP,HCPCS C1713,,55410006550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
55410006555,SUP,HCPCS C1713,,55410006555  -  PLATE 18MM TI BONE SPNL,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
55410007535,SUP,HCPCS C1713,,55410007535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
55410007540,SUP,HCPCS C1713,,55410007540  -  PLATE 18MM TI BONE SPNL,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
55410007545,SUP,HCPCS C1713,,55410007545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
55410007550,SUP,HCPCS C1713,,55410007550  -  PLATE 18MM TI BONE SPNL,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
55410007555,SUP,HCPCS C1713,,55410007555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,990.50",$0.00,"$1,990.50",$895.73,"$1,420.62",$0.00,$342.95,$0.00,$0.00,$348.52,"$1,990.50",$0.00,$995.25,"$1,576.48","$1,592.40",$0.00,$311.51,$0.00,$316.89,$0.00
55740105535,SUP,HCPCS C1713,,55740105535  -  SCREW BN 5.5MM 35MM SOLERA CD HZN MA HA SPNE 5/6MM ROD,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55740105540,SUP,HCPCS C1713,,55740105540  -  SCREW BN 5.5MM 40MM SOLERA CD HZN MA HA SPNE 5/6MM ROD,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55740105545,SUP,HCPCS C1713,,55740105545  -  SCREW BN 5.5MM 45MM SOLERA CD HZN MA HA SPNE 5/6MM ROD,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55740105550,SUP,HCPCS C1713,,55740105550  -  SCREW BN 5.5MM 50MM SOLERA CD HZN MA HA SPNE 5/6MM ROD,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55740106540,SUP,HCPCS C1713,,55740106540  -  SCREW BN 6.5MM 40MM SOLERA CD HZN MA HA SPNE 5/6MM ROD,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55740106545,SUP,HCPCS C1713,,55740106545  -  SCREW BN 6.5MM 45MM SOLERA CD HZN MA HA SPNE 5/6MM ROD,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55740106550,SUP,HCPCS C1713,,55740106550  -  SCREW BN 6.5MM 50MM SOLERA CD HZN MA HA SPNE 5/6MM ROD,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55740106555,SUP,HCPCS C1713,,55740106555  -  SCREW BN 6.5MM 55MM SOLERA CD HZN MA HA SPNE 5/6MM ROD,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55740107540,SUP,HCPCS C1713,,55740107540  -  SCREW BN 7.5MM 40MM SOLERA CD HZN MA HA SPNE 5/6MM ROD,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55740107545,SUP,HCPCS C1713,,55740107545  -  SCREW BN 7.5MM 45MM SOLERA CD HZN MA HA SPNE 5/6MM ROD,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55740107550,SUP,HCPCS C1713,,55740107550  -  SCREW BN 7.5MM 50MM SOLERA CD HZN MA HA SPNE 5/6MM ROD,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55740107555,SUP,HCPCS C1713,,55740107555  -  SCREW BN 7.5MM 55MM SOLERA CD HZN MA HA SPNE 5/6MM ROD,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55740108535,SUP,HCPCS C1713,,55740108535  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55740108540,SUP,HCPCS C1713,,55740108540  -  SCREW BN 8.5MM 40MM SOLERA CD HZN MA HA SPNE 5/6MM ROD,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55740108545,SUP,HCPCS C1713,,55740108545  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55740108550,SUP,HCPCS C1713,,55740108550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55811004025,SUP,HCPCS C1713,,55811004025  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55811004030,SUP,HCPCS C1713,,55811004030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55811004035,SUP,HCPCS C1713,,55811004035  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55811004040,SUP,HCPCS C1713,,55811004040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55811004045,SUP,HCPCS C1713,,55811004045  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55811004520,SUP,HCPCS C1713,,55811004520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55811004525,SUP,HCPCS C1713,,55811004525  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55811004530,SUP,HCPCS C1713,,55811004530  -  SCREW BN 4.5MM 30MM SOLERA CD HZN SGTL ADJ COCR SPNE 5.5MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55811004535,SUP,HCPCS C1713,,55811004535  -  SCREW BN 4.5MM 35MM SOLERA CD HZN SGTL ADJ COCR SPNE 5.5MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55811004540,SUP,HCPCS C1713,,55811004540  -  SCREW BN 4.5MM 40MM SOLERA CD HZN SGTL ADJ COCR SPNE 5.5MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55811004545,SUP,HCPCS C1713,,55811004545  -  SCREW BN 4.5MM 45MM SOLERA CD HZN SGTL ADJ COCR SPNE 5.5MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55811005020,SUP,HCPCS C1713,,55811005020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55811005025,SUP,HCPCS C1713,,55811005025  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55811005030,SUP,HCPCS C1713,,55811005030  -  SCREW BN 5MM 30MM SOLERA CD HZN SGTL ADJ COCR SPNE 5.5MM ROD,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55811005035,SUP,HCPCS C1713,,55811005035  -  SCREW BN 5MM 35MM SOLERA CD HZN SGTL ADJ COCR SPNE 5.5MM ROD,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55811005040,SUP,HCPCS C1713,,55811005040  -  SCREW BN 5MM 40MM SOLERA CD HZN SGTL ADJ COCR SPNE 5.5MM ROD,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55811005045,SUP,HCPCS C1713,,55811005045  -  SCREW BN 5MM 45MM SOLERA CD HZN SGTL ADJ COCR SPNE 5.5MM ROD,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55811005050,SUP,HCPCS C1713,,55811005050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55811005520,SUP,HCPCS C1713,,55811005520  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55811005525,SUP,HCPCS C1713,,55811005525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55811005530,SUP,HCPCS C1713,,55811005530  -  SCREW BN 5.5MM 30MM SOLERA CD HZN SGTL ADJ COCR SPNE 5.5MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55811005535,SUP,HCPCS C1713,,55811005535  -  SCREW BN 5.5MM 35MM SOLERA CD HZN SGTL ADJ COCR SPNE 5.5MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55811005540,SUP,HCPCS C1713,,55811005540  -  SCREW BN 5.5MM 40MM SOLERA CD HZN SGTL ADJ COCR SPNE 5.5MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55811005545,SUP,HCPCS C1713,,55811005545  -  SCREW BN 5.5MM 45MM SOLERA CD HZN SGTL ADJ COCR SPNE 5.5MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55811005550,SUP,HCPCS C1713,,55811005550  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55811005555,SUP,HCPCS C1713,,55811005555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55811006030,SUP,HCPCS C1713,,55811006030  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55811006035,SUP,HCPCS C1713,,55811006035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55811006040,SUP,HCPCS C1713,,55811006040  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55811006045,SUP,HCPCS C1713,,55811006045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55811006050,SUP,HCPCS C1713,,55811006050  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55811006525,SUP,HCPCS C1713,,55811006525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55811006530,SUP,HCPCS C1713,,55811006530  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55811006535,SUP,HCPCS C1713,,55811006535  -  SCREW BN 6.5MM 35MM SOLERA CD HZN SGTL ADJ COCR SPNE 5.5MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55811006540,SUP,HCPCS C1713,,55811006540  -  SCREW BN 6.5MM 40MM SOLERA CD HZN SGTL ADJ COCR SPNE 5.5MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55811006545,SUP,HCPCS C1713,,55811006545  -  SCREW BN 6.5MM 45MM SOLERA CD HZN SGTL ADJ COCR SPNE 5.5MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55811006550,SUP,HCPCS C1713,,55811006550  -  SCREW BN 6.5MM 50MM SOLERA CD HZN SGTL ADJ COCR SPNE 5.5MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55811006555,SUP,HCPCS C1713,,55811006555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55811006560,SUP,HCPCS C1713,,55811006560  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55811007535,SUP,HCPCS C1713,,55811007535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55811007540,SUP,HCPCS C1713,,55811007540  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55811007545,SUP,HCPCS C1713,,55811007545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55811007550,SUP,HCPCS C1713,,55811007550  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55811007555,SUP,HCPCS C1713,,55811007555  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55811008540,SUP,HCPCS C1713,,55811008540  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55811008545,SUP,HCPCS C1713,,55811008545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55811008550,SUP,HCPCS C1713,,55811008550  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840001540,SUP,HCPCS C1713,,55840001540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840001545,SUP,HCPCS C1713,,55840001545  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840001550,SUP,HCPCS C1713,,55840001550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840001555,SUP,HCPCS C1713,,55840001555  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840004020,SUP,HCPCS C1713,,55840004020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840004025,SUP,HCPCS C1713,,55840004025  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840004030,SUP,HCPCS C1713,,55840004030  -  SCREW BN 4MM 30MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840004035,SUP,HCPCS C1713,,55840004035  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840004040,SUP,HCPCS C1713,,55840004040  -  SCREW BN 4MM 40MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840004045,SUP,HCPCS C1713,,55840004045  -  SCREW BN 4MM 45MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840004050,SUP,HCPCS C1713,,55840004050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840004055,SUP,HCPCS C1713,,55840004055  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840004520,SUP,HCPCS C1713,,55840004520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840004525,SUP,HCPCS C1713,,55840004525  -  SCREW BN 4.5MM 25MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840004530,SUP,HCPCS C1713,,55840004530  -  SCREW BN 4.5MM 30MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840004535,SUP,HCPCS C1713,,55840004535  -  SCREW BN 4.5MM 35MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840004540,SUP,HCPCS C1713,,55840004540  -  SCREW BN 4.5MM 40MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840004545,SUP,HCPCS C1713,,55840004545  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840004550,SUP,HCPCS C1713,,55840004550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840004555,SUP,HCPCS C1713,,55840004555  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840005020,SUP,HCPCS C1713,,55840005020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840005025,SUP,HCPCS C1713,,55840005025  -  SCREW BN 5MM 25MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840005030,SUP,HCPCS C1713,,55840005030  -  SCREW BN 5MM 30MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840005035,SUP,HCPCS C1713,,55840005035  -  SCREW BN 5MM 35MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840005040,SUP,HCPCS C1713,,55840005040  -  SCREW BN 5MM 40MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840005045,SUP,HCPCS C1713,,55840005045  -  SCREW BN 5MM 45MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840005050,SUP,HCPCS C1713,,55840005050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840005055,SUP,HCPCS C1713,,55840005055  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840005520,SUP,HCPCS C1713,,55840005520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840005525,SUP,HCPCS C1713,,55840005525  -  SCREW BN 5.5MM 25MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840005530,SUP,HCPCS C1713,,55840005530  -  SCREW BN 5.5MM 30MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840005535,SUP,HCPCS C1713,,55840005535  -  SCREW BN 5.5MM 35MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840005540,SUP,HCPCS C1713,,55840005540  -  SCREW BN 5.5MM 40MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840005545,SUP,HCPCS C1713,,55840005545  -  SCREW BN 5.5MM 45MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840005550,SUP,HCPCS C1713,,55840005550  -  SCREW BN 5.5MM 50MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840005555,SUP,HCPCS C1713,,55840005555  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840005560,SUP,HCPCS C1713,,55840005560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840006020,SUP,HCPCS C1713,,55840006020  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840006025,SUP,HCPCS C1713,,55840006025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840006030,SUP,HCPCS C1713,,55840006030  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840006035,SUP,HCPCS C1713,,55840006035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840006040,SUP,HCPCS C1713,,55840006040  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840006045,SUP,HCPCS C1713,,55840006045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840006050,SUP,HCPCS C1713,,55840006050  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840006055,SUP,HCPCS C1713,,55840006055  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840006060,SUP,HCPCS C1713,,55840006060  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840006500,SUP,HCPCS C1713,,55840006500  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840006520,SUP,HCPCS C1713,,55840006520  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840006525,SUP,HCPCS C1713,,55840006525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840006530,SUP,HCPCS C1713,,55840006530  -  SCREW BN 6.5MM 30MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840006535,SUP,HCPCS C1713,,55840006535  -  SCREW BN 6.5MM 35MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840006540,SUP,HCPCS C1713,,55840006540  -  SCREW BN 6.5MM 40MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840006545,SUP,HCPCS C1713,,55840006545  -  SCREW BN 6.5MM 45MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840006550,SUP,HCPCS C1713,,55840006550  -  SCREW BN 6.5MM 50MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840006555,SUP,HCPCS C1713,,55840006555  -  SCREW BN 6.5MM 55MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840006560,SUP,HCPCS C1713,,55840006560  -  SCREW BN 6.5MM 60MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840006565,SUP,HCPCS C1713,,55840006565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840006570,SUP,HCPCS C1713,,55840006570  -  SCREW BN 6.5MM 70MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840006580,SUP,HCPCS C1713,,55840006580  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840006590,SUP,HCPCS C1713,,55840006590  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840007500,SUP,HCPCS C1713,,55840007500  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840007525,SUP,HCPCS C1713,,55840007525  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840007530,SUP,HCPCS C1713,,55840007530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840007535,SUP,HCPCS C1713,,55840007535  -  SCREW BN 7.5MM 35MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840007540,SUP,HCPCS C1713,,55840007540  -  SCREW BN 7.5MM 40MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
55840007545,SUP,HCPCS C1713,,55840007545  -  SCREW BN 7.5MM 45MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840007550,SUP,HCPCS C1713,,55840007550  -  SCREW BN 7.5MM 50MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840007555,SUP,HCPCS C1713,,55840007555  -  SCREW BN 7.5MM 55MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840007560,SUP,HCPCS C1713,,55840007560  -  SCREW BN 7.5MM 60MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840007565,SUP,HCPCS C1713,,55840007565  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840007570,SUP,HCPCS C1713,,55840007570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840007580,SUP,HCPCS C1713,,55840007580  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840007590,SUP,HCPCS C1713,,55840007590  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840008500,SUP,HCPCS C1713,,55840008500  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840008525,SUP,HCPCS C1713,,55840008525  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840008530,SUP,HCPCS C1713,,55840008530  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840008535,SUP,HCPCS C1713,,55840008535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840008540,SUP,HCPCS C1713,,55840008540  -  SCREW BN 8.5MM 40MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840008545,SUP,HCPCS C1713,,55840008545  -  SCREW BN 8.5MM 45MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840008550,SUP,HCPCS C1713,,55840008550  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840008555,SUP,HCPCS C1713,,55840008555  -  SCREW BN 8.5MM 55MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840008560,SUP,HCPCS C1713,,55840008560  -  SCREW BN 8.5MM 60MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840008565,SUP,HCPCS C1713,,55840008565  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840008570,SUP,HCPCS C1713,,55840008570  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840008580,SUP,HCPCS C1713,,55840008580  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840008590,SUP,HCPCS C1713,,55840008590  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840009500,SUP,HCPCS C1713,,55840009500  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840009525,SUP,HCPCS C1713,,55840009525  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840009530,SUP,HCPCS C1713,,55840009530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840009535,SUP,HCPCS C1713,,55840009535  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840009540,SUP,HCPCS C1713,,55840009540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840009545,SUP,HCPCS C1713,,55840009545  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840009550,SUP,HCPCS C1713,,55840009550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840009555,SUP,HCPCS C1713,,55840009555  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840009560,SUP,HCPCS C1713,,55840009560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840009565,SUP,HCPCS C1713,,55840009565  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840009570,SUP,HCPCS C1713,,55840009570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840009580,SUP,HCPCS C1713,,55840009580  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840009590,SUP,HCPCS C1713,,55840009590  -  SCREW BN 9.5MM 90MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55840015545,SUP,HCPCS C1713,,55840015545  -  SCREW BONE 5.5MM 45MM MULTIAX CANN SOLERA COCR SPN 5.5/6MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
55840015550,SUP,HCPCS C1713,,55840015550  -  SCREW BONE 5.5MM 50MM CANN MULTIAX COCR SPN 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
55840016550,SUP,HCPCS C1713,,55840016550  -  SCREW BONE 6.5MM 50MM MULTIAX CANN SOLERA COCR SPN 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
55840016555,SUP,HCPCS C1713,,55840016555  -  SCREW BONE 6.5MM 55MM MULTIAX CANN COCR SPN 5.5 ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
55890004015,SUP,HCPCS C1713,,55890004015  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890004020,SUP,HCPCS C1713,,55890004020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890004025,SUP,HCPCS C1713,,55890004025  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890004030,SUP,HCPCS C1713,,55890004030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890004035,SUP,HCPCS C1713,,55890004035  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890004040,SUP,HCPCS C1713,,55890004040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890004045,SUP,HCPCS C1713,,55890004045  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890004050,SUP,HCPCS C1713,,55890004050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890004055,SUP,HCPCS C1713,,55890004055  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890004060,SUP,HCPCS C1713,,55890004060  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890004065,SUP,HCPCS C1713,,55890004065  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890004070,SUP,HCPCS C1713,,55890004070  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890004075,SUP,HCPCS C1713,,55890004075  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890004080,SUP,HCPCS C1713,,55890004080  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890004515,SUP,HCPCS C1713,,55890004515  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890004520,SUP,HCPCS C1713,,55890004520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890004525,SUP,HCPCS C1713,,55890004525  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890004530,SUP,HCPCS C1713,,55890004530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890004535,SUP,HCPCS C1713,,55890004535  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890004540,SUP,HCPCS C1713,,55890004540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890004545,SUP,HCPCS C1713,,55890004545  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890004550,SUP,HCPCS C1713,,55890004550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890004555,SUP,HCPCS C1713,,55890004555  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890004560,SUP,HCPCS C1713,,55890004560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890004565,SUP,HCPCS C1713,,55890004565  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890004570,SUP,HCPCS C1713,,55890004570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890004575,SUP,HCPCS C1713,,55890004575  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890004580,SUP,HCPCS C1713,,55890004580  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890005015,SUP,HCPCS C1713,,55890005015  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890005020,SUP,HCPCS C1713,,55890005020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890005025,SUP,HCPCS C1713,,55890005025  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890005030,SUP,HCPCS C1713,,55890005030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890005035,SUP,HCPCS C1713,,55890005035  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890005040,SUP,HCPCS C1713,,55890005040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890005045,SUP,HCPCS C1713,,55890005045  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890005050,SUP,HCPCS C1713,,55890005050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890005055,SUP,HCPCS C1713,,55890005055  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890005060,SUP,HCPCS C1713,,55890005060  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890005065,SUP,HCPCS C1713,,55890005065  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890005070,SUP,HCPCS C1713,,55890005070  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890005075,SUP,HCPCS C1713,,55890005075  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890005080,SUP,HCPCS C1713,,55890005080  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890005085,SUP,HCPCS C1713,,55890005085  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890005090,SUP,HCPCS C1713,,55890005090  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890005515,SUP,HCPCS C1713,,55890005515  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890005520,SUP,HCPCS C1713,,55890005520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890005525,SUP,HCPCS C1713,,55890005525  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890005530,SUP,HCPCS C1713,,55890005530  -  SCREW BN 5.5MM 30MM SOLERA CD HZN RDC MA COCR SPNE 5.5/6MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890005535,SUP,HCPCS C1713,,55890005535  -  SCREW BN 5.5MM 35MM SOLERA CD HZN RDC MA COCR SPNE 5.5/6MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890005540,SUP,HCPCS C1713,,55890005540  -  SCREW BN 5.5MM 40MM SOLERA CD HZN RDC MA COCR SPNE 5.5/6MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890005545,SUP,HCPCS C1713,,55890005545  -  SCREW BN 5.5MM 45MM SOLERA CD HZN RDC MA COCR SPNE 5.5/6MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890005550,SUP,HCPCS C1713,,55890005550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890005555,SUP,HCPCS C1713,,55890005555  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890005560,SUP,HCPCS C1713,,55890005560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890005565,SUP,HCPCS C1713,,55890005565  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890005570,SUP,HCPCS C1713,,55890005570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890005575,SUP,HCPCS C1713,,55890005575  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890005580,SUP,HCPCS C1713,,55890005580  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890006015,SUP,HCPCS C1713,,55890006015  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890006020,SUP,HCPCS C1713,,55890006020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890006025,SUP,HCPCS C1713,,55890006025  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890006030,SUP,HCPCS C1713,,55890006030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890006035,SUP,HCPCS C1713,,55890006035  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890006040,SUP,HCPCS C1713,,55890006040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890006045,SUP,HCPCS C1713,,55890006045  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890006050,SUP,HCPCS C1713,,55890006050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890006055,SUP,HCPCS C1713,,55890006055  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890006060,SUP,HCPCS C1713,,55890006060  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890006065,SUP,HCPCS C1713,,55890006065  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890006070,SUP,HCPCS C1713,,55890006070  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890006075,SUP,HCPCS C1713,,55890006075  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890006080,SUP,HCPCS C1713,,55890006080  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890006515,SUP,HCPCS C1713,,55890006515  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890006520,SUP,HCPCS C1713,,55890006520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890006525,SUP,HCPCS C1713,,55890006525  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890006530,SUP,HCPCS C1713,,55890006530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890006535,SUP,HCPCS C1713,,55890006535  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890006540,SUP,HCPCS C1713,,55890006540  -  SCREW BN 6.5MM 40MM SOLERA CD HZN RDC MA COCR SPNE 5.5/6MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890006545,SUP,HCPCS C1713,,55890006545  -  SCREW BN 6.5MM 45MM SOLERA CD HZN RDC MA COCR SPNE 5.5/6MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890006550,SUP,HCPCS C1713,,55890006550  -  SCREW BN 6.5MM 50MM SOLERA CD HZN RDC MA COCR SPNE 5.5/6MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890006555,SUP,HCPCS C1713,,55890006555  -  SCREW BN 6.5MM 55MM SOLERA CD HZN RDC MA COCR SPNE 5.5/6MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890006560,SUP,HCPCS C1713,,55890006560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890006565,SUP,HCPCS C1713,,55890006565  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890006570,SUP,HCPCS C1713,,55890006570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890006575,SUP,HCPCS C1713,,55890006575  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890006580,SUP,HCPCS C1713,,55890006580  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890007015,SUP,HCPCS C1713,,55890007015  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890007020,SUP,HCPCS C1713,,55890007020  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890007025,SUP,HCPCS C1713,,55890007025  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890007030,SUP,HCPCS C1713,,55890007030  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890007035,SUP,HCPCS C1713,,55890007035  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890007040,SUP,HCPCS C1713,,55890007040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890007045,SUP,HCPCS C1713,,55890007045  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890007050,SUP,HCPCS C1713,,55890007050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890007055,SUP,HCPCS C1713,,55890007055  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890007060,SUP,HCPCS C1713,,55890007060  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890007065,SUP,HCPCS C1713,,55890007065  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890007070,SUP,HCPCS C1713,,55890007070  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890007075,SUP,HCPCS C1713,,55890007075  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890007080,SUP,HCPCS C1713,,55890007080  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890007500,SUP,HCPCS C1713,,55890007500  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890007511,SUP,HCPCS C1713,,55890007511  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890007515,SUP,HCPCS C1713,,55890007515  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890007520,SUP,HCPCS C1713,,55890007520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890007525,SUP,HCPCS C1713,,55890007525  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890007530,SUP,HCPCS C1713,,55890007530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890007535,SUP,HCPCS C1713,,55890007535  -  SCREW BN 7.5MM 35MM SOLERA CD HZN RDC MA COCR SPNE 5.5/6MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890007540,SUP,HCPCS C1713,,55890007540  -  SCREW BN 7.5MM 40MM SOLERA CD HZN RDC MA COCR SPNE 5.5/6MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890007545,SUP,HCPCS C1713,,55890007545  -  SCREW BN 7.5MM 45MM SOLERA CD HZN RDC MA COCR SPNE 5.5/6MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890007550,SUP,HCPCS C1713,,55890007550  -  SCREW BN 7.5MM 50MM SOLERA CD HZN RDC MA COCR SPNE 5.5/6MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890007555,SUP,HCPCS C1713,,55890007555  -  SCREW BN 7.5MM 55MM SOLERA CD HZN RDC MA COCR SPNE 5.5/6MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890007560,SUP,HCPCS C1713,,55890007560  -  SCREW BN 7.5MM 60MM SOLERA CD HZN RDC MA COCR SPNE 5.5/6MM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890007565,SUP,HCPCS C1713,,55890007565  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890007570,SUP,HCPCS C1713,,55890007570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890007575,SUP,HCPCS C1713,,55890007575  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890007580,SUP,HCPCS C1713,,55890007580  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890007585,SUP,HCPCS C1713,,55890007585  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890007590,SUP,HCPCS C1713,,55890007590  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890007595,SUP,HCPCS C1713,,55890007595  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890008000,SUP,HCPCS C1713,,55890008000  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890008011,SUP,HCPCS C1713,,55890008011  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890008015,SUP,HCPCS C1713,,55890008015  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890008020,SUP,HCPCS C1713,,55890008020  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890008025,SUP,HCPCS C1713,,55890008025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890008030,SUP,HCPCS C1713,,55890008030  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890008035,SUP,HCPCS C1713,,55890008035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890008040,SUP,HCPCS C1713,,55890008040  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890008045,SUP,HCPCS C1713,,55890008045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890008050,SUP,HCPCS C1713,,55890008050  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890008055,SUP,HCPCS C1713,,55890008055  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890008060,SUP,HCPCS C1713,,55890008060  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890008065,SUP,HCPCS C1713,,55890008065  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890008070,SUP,HCPCS C1713,,55890008070  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890008075,SUP,HCPCS C1713,,55890008075  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890008080,SUP,HCPCS C1713,,55890008080  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890008085,SUP,HCPCS C1713,,55890008085  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890008090,SUP,HCPCS C1713,,55890008090  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890008095,SUP,HCPCS C1713,,55890008095  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890008500,SUP,HCPCS C1713,,55890008500  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890008511,SUP,HCPCS C1713,,55890008511  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890008515,SUP,HCPCS C1713,,55890008515  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890008520,SUP,HCPCS C1713,,55890008520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890008525,SUP,HCPCS C1713,,55890008525  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890008530,SUP,HCPCS C1713,,55890008530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890008535,SUP,HCPCS C1713,,55890008535  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890008540,SUP,HCPCS C1713,,55890008540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890008545,SUP,HCPCS C1713,,55890008545  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890008550,SUP,HCPCS C1713,,55890008550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890008555,SUP,HCPCS C1713,,55890008555  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890008560,SUP,HCPCS C1713,,55890008560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890008565,SUP,HCPCS C1713,,55890008565  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890008570,SUP,HCPCS C1713,,55890008570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890008575,SUP,HCPCS C1713,,55890008575  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890008580,SUP,HCPCS C1713,,55890008580  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890008585,SUP,HCPCS C1713,,55890008585  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890008590,SUP,HCPCS C1713,,55890008590  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890008595,SUP,HCPCS C1713,,55890008595  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890009000,SUP,HCPCS C1713,,55890009000  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890009011,SUP,HCPCS C1713,,55890009011  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890009015,SUP,HCPCS C1713,,55890009015  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890009020,SUP,HCPCS C1713,,55890009020  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890009025,SUP,HCPCS C1713,,55890009025  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890009030,SUP,HCPCS C1713,,55890009030  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890009035,SUP,HCPCS C1713,,55890009035  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890009040,SUP,HCPCS C1713,,55890009040  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890009045,SUP,HCPCS C1713,,55890009045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890009050,SUP,HCPCS C1713,,55890009050  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890009055,SUP,HCPCS C1713,,55890009055  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890009060,SUP,HCPCS C1713,,55890009060  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890009065,SUP,HCPCS C1713,,55890009065  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890009070,SUP,HCPCS C1713,,55890009070  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890009075,SUP,HCPCS C1713,,55890009075  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890009080,SUP,HCPCS C1713,,55890009080  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890009085,SUP,HCPCS C1713,,55890009085  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890009090,SUP,HCPCS C1713,,55890009090  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890009095,SUP,HCPCS C1713,,55890009095  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890009500,SUP,HCPCS C1713,,55890009500  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890009511,SUP,HCPCS C1713,,55890009511  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890009515,SUP,HCPCS C1713,,55890009515  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890009520,SUP,HCPCS C1713,,55890009520  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890009525,SUP,HCPCS C1713,,55890009525  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890009530,SUP,HCPCS C1713,,55890009530  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890009535,SUP,HCPCS C1713,,55890009535  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890009540,SUP,HCPCS C1713,,55890009540  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890009545,SUP,HCPCS C1713,,55890009545  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890009550,SUP,HCPCS C1713,,55890009550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890009555,SUP,HCPCS C1713,,55890009555  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890009560,SUP,HCPCS C1713,,55890009560  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890009565,SUP,HCPCS C1713,,55890009565  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890009570,SUP,HCPCS C1713,,55890009570  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890009575,SUP,HCPCS C1713,,55890009575  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890009580,SUP,HCPCS C1713,,55890009580  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890009585,SUP,HCPCS C1713,,55890009585  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890009590,SUP,HCPCS C1713,,55890009590  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55890009595,SUP,HCPCS C1713,,55890009595  -  PLATE 18MM TI BONE SPNL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
60181210100,SUP,Custom 27203010,,ADAPTER TRNQT 36IN DUAL EXTN CPC CONNCTR STRL LF,$50.83,$0.00,$50.83,$0.00,$36.27,$0.00,$0.00,$0.00,$0.00,$0.00,$50.83,$0.00,$25.41,$40.26,$40.66,$0.00,$0.00,$0.00,$0.00,$0.00
60707010400,SUP,Custom 27203010,,60707010400  -  CUFF TRNQT 24X4IN 2 PORT 1 BLDR W/O SLV ATS STRL LATEX FREE,$73.39,$0.00,$73.39,$0.00,$52.38,$0.00,$0.00,$0.00,$0.00,$0.00,$73.39,$0.00,$36.69,$58.12,$58.71,$0.00,$0.00,$0.00,$0.00,$0.00
60707010500,SUP,Custom 27203010,,60707010500  -  CUFF TRNQT 30X4IN 2 PORT 1 BLDR W/O SLV ATS STRL LATEX FREE,$78.02,$0.00,$78.02,$0.00,$55.68,$0.00,$0.00,$0.00,$0.00,$0.00,$78.02,$0.00,$39.01,$61.79,$62.42,$0.00,$0.00,$0.00,$0.00,$0.00
60707010600,SUP,Custom 27203010,,60707010600  -  CUFF TRNQT 34X4IN 2 PORT 1 BLDR W/O SLV ATS STRL LATEX FREE,$84.46,$0.00,$84.46,$0.00,$60.28,$0.00,$0.00,$0.00,$0.00,$0.00,$84.46,$0.00,$42.23,$66.89,$67.57,$0.00,$0.00,$0.00,$0.00,$0.00
60707010700,SUP,Custom 27203010,,60707010700  -  CUFF TRNQT CYL 42X4IN RUBY STRL LF ATS 3K 2 PORT BLDR POS,$217.50,$0.00,$217.50,$0.00,$155.23,$0.00,$0.00,$0.00,$0.00,$0.00,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$0.00,$0.00,$0.00,$0.00
9.89803E+11,SUP,Custom 27203010,,989803104341  -  TUBING MONITR SMALL STATURE 10FT NIBP LATEX FREE REUSABLE,$124.31,$0.00,$124.31,$0.00,$88.72,$0.00,$0.00,$0.00,$0.00,$0.00,$124.31,$0.00,$62.16,$98.45,$99.45,$0.00,$0.00,$0.00,$0.00,$0.00
0.8P8,SUP,Custom 27803010,,0.8P8  -  PATCH VASCULAR 8X.8CM BIOLOGIC XENOSURE THK.45MM TAPER,$400.00,$0.00,$400.00,$0.00,$285.48,$0.00,$0.00,$0.00,$0.00,$0.00,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$0.00,$0.00,$0.00,$0.00
00-0114-006-00,SUP,Custom 27203010,,00-0114-006-00  -  HOLDER PIN 3/16IN 21X11CM LF BHLR-STNM THB SCR SS SKL TRX,$442.00,$0.00,$442.00,$0.00,$315.46,$0.00,$0.00,$0.00,$0.00,$0.00,$442.00,$0.00,$221.00,$350.06,$353.60,$0.00,$0.00,$0.00,$0.00,$0.00
000-2090,SUP,HCPCS C1781,,000-2090  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,277.13",$0.00,"$1,277.13",$574.71,$911.48,$0.00,$220.04,$0.00,$0.00,$223.61,"$1,277.13",$0.00,$638.56,"$1,011.49","$1,021.70",$0.00,$199.87,$0.00,$203.32,$0.00
00085-4602-02,SUP,HCPCS C2626,,00085-4602-02  -  SCREW SYSTEM INSPIREASE DRUG DELIVERY EA,$111.93,$0.00,$111.93,$0.00,$79.88,$0.00,$0.00,$0.00,$0.00,$0.00,$111.93,$0.00,$55.97,$88.65,$89.54,$0.00,$0.00,$0.00,$0.00,$0.00
0010DTR,SUP,Custom 27203010,,BAG LNDR RD 38X38IN DRAWTAPE 40GL,$1.40,$0.00,$1.40,$0.00,$1.00,$0.00,$0.00,$0.00,$0.00,$0.00,$1.40,$0.00,$0.70,$1.11,$1.12,$0.00,$0.00,$0.00,$0.00,$0.00
00208-00,SUP,Custom 27203010,,ASSEMBLY ANTICOAGULATION/ASPIRATION TUBING FOR CELL SAVER PA,$63.38,$0.00,$63.38,$0.00,$45.23,$0.00,$0.00,$0.00,$0.00,$0.00,$63.38,$0.00,$31.69,$50.20,$50.70,$0.00,$0.00,$0.00,$0.00,$0.00
00-2348-010-35,SUP,HCPCS C1713,,00-2348-010-35  -  SCREW BONE 3.5MM 10MM SS 2.7MM HEAD CORT PERIART SLFTAP,$74.75,$0.00,$74.75,$33.64,$53.35,$0.00,$12.88,$0.00,$0.00,$13.09,$74.75,$0.00,$37.38,$59.20,$59.80,$0.00,$11.70,$0.00,$11.90,$0.00
00-2348-012-35,SUP,HCPCS C1713,,00-2348-012-35  -  SCREW BONE 3.5MM 2.7MM 12MM SS 2.7MM HEAD PERIART SLFTAP,$74.75,$0.00,$74.75,$33.64,$53.35,$0.00,$12.88,$0.00,$0.00,$13.09,$74.75,$0.00,$37.38,$59.20,$59.80,$0.00,$11.70,$0.00,$11.90,$0.00
00-2348-014-35,SUP,HCPCS C1713,,00-2348-014-35  -  SCREW BONE 3.5MM 2.7MM 14MM SS 2.7MM HEAD CORT PERIART,$74.75,$0.00,$74.75,$33.64,$53.35,$0.00,$12.88,$0.00,$0.00,$13.09,$74.75,$0.00,$37.38,$59.20,$59.80,$0.00,$11.70,$0.00,$11.90,$0.00
00-2348-016-35,SUP,HCPCS C1713,,00-2348-016-35  -  SCREW BONE 3.5MM 2.7MM 16MM SS 2.7MM HEAD CORT PERIART,$74.75,$0.00,$74.75,$33.64,$53.35,$0.00,$12.88,$0.00,$0.00,$13.09,$74.75,$0.00,$37.38,$59.20,$59.80,$0.00,$11.70,$0.00,$11.90,$0.00
00-2348-018-35,SUP,HCPCS C1713,,00-2348-018-35  -  SCREW BONE 3.5MM 2.7MM 18MM SS 2.7MM HEAD CORT PERIART,$74.75,$0.00,$74.75,$33.64,$53.35,$0.00,$12.88,$0.00,$0.00,$13.09,$74.75,$0.00,$37.38,$59.20,$59.80,$0.00,$11.70,$0.00,$11.90,$0.00
00-2348-020-35,SUP,HCPCS C1713,,00-2348-020-35  -  SCREW BONE 3.5MM 2.7MM 20MM SS 2.7MM HEAD CORT PERIART,$74.75,$0.00,$74.75,$33.64,$53.35,$0.00,$12.88,$0.00,$0.00,$13.09,$74.75,$0.00,$37.38,$59.20,$59.80,$0.00,$11.70,$0.00,$11.90,$0.00
00-2348-022-35,SUP,HCPCS C1713,,00-2348-022-35  -  SCREW BONE 3.5MM 2.7MM 22MM SS 2.7MM HEAD CORT PERIART,$74.75,$0.00,$74.75,$33.64,$53.35,$0.00,$12.88,$0.00,$0.00,$13.09,$74.75,$0.00,$37.38,$59.20,$59.80,$0.00,$11.70,$0.00,$11.90,$0.00
00-2348-026-35,SUP,HCPCS C1713,,00-2348-026-35  -  SCREW BONE 3.5MM 2.7MM 26MM SS 2.7MM HEAD CORT PERIART,$74.75,$0.00,$74.75,$33.64,$53.35,$0.00,$12.88,$0.00,$0.00,$13.09,$74.75,$0.00,$37.38,$59.20,$59.80,$0.00,$11.70,$0.00,$11.90,$0.00
00-2357-017-04,SUP,HCPCS C1713,,00-2357-017-04  -  PLATE 80MM 4 HOLE LCK BONE RIGHT DISTAL LAT FIB,"$1,378.00",$0.00,"$1,378.00",$620.10,$983.48,$0.00,$237.42,$0.00,$0.00,$241.28,"$1,378.00",$0.00,$689.00,"$1,091.38","$1,102.40",$0.00,$215.66,$0.00,$219.38,$0.00
00-2357-017-06,SUP,HCPCS C1713,,00-2357-017-06  -  PLATE 106MM 6 HOLE LCK BONE RIGHT DISTAL LAT FIB,"$1,478.75",$0.00,"$1,478.75",$665.44,"$1,055.38",$0.00,$254.78,$0.00,$0.00,$258.92,"$1,478.75",$0.00,$739.38,"$1,171.17","$1,183.00",$0.00,$231.42,$0.00,$235.42,$0.00
00-2357-017-08,SUP,HCPCS C1713,,00-2357-017-08  -  PLATE 132MM 8 HOLE LCK BONE RL DISTAL FIB,"$1,579.50",$0.00,"$1,579.50",$710.78,"$1,127.29",$0.00,$272.14,$0.00,$0.00,$276.56,"$1,579.50",$0.00,$789.75,"$1,250.96","$1,263.60",$0.00,$247.19,$0.00,$251.46,$0.00
00-2357-018-04,SUP,HCPCS C1713,,00-2357-018-04  -  PLATE 40 HOLE BONE RIGHT FIB,"$1,378.00",$0.00,"$1,378.00",$620.10,$983.48,$0.00,$237.42,$0.00,$0.00,$241.28,"$1,378.00",$0.00,$689.00,"$1,091.38","$1,102.40",$0.00,$215.66,$0.00,$219.38,$0.00
00-2357-018-06,SUP,HCPCS C1713,,00-2357-018-06  -  PLATE 106MM 6 HOLE LCK BONE LEFT DISTAL LAT FIB,"$1,478.75",$0.00,"$1,478.75",$665.44,"$1,055.38",$0.00,$254.78,$0.00,$0.00,$258.92,"$1,478.75",$0.00,$739.38,"$1,171.17","$1,183.00",$0.00,$231.42,$0.00,$235.42,$0.00
00-2359-012-38,SUP,HCPCS C1713,,00-2359-012-38  -  SCREW BONE 3.5MM 2.7MM 12MM SS PERIART LCK HEAD NONSTRL,$201.50,$0.00,$201.50,$90.68,$143.81,$0.00,$34.72,$0.00,$0.00,$35.28,$201.50,$0.00,$100.75,$159.59,$161.20,$0.00,$31.53,$0.00,$32.08,$0.00
00-2359-014-38,SUP,HCPCS C1713,,00-2359-014-38  -  SCREW BONE 3.5MM 2.7MM 14MM SS PERIART LCK NONSTRL,$201.50,$0.00,$201.50,$90.68,$143.81,$0.00,$34.72,$0.00,$0.00,$35.28,$201.50,$0.00,$100.75,$159.59,$161.20,$0.00,$31.53,$0.00,$32.08,$0.00
00-2359-016-26,SUP,HCPCS C1713,,00-2359-016-26  -  SCREW BONE 2.7MM 16MM SS CONICAL NONSTRL,$113.75,$0.00,$113.75,$51.19,$81.18,$0.00,$19.60,$0.00,$0.00,$19.92,$113.75,$0.00,$56.88,$90.09,$91.00,$0.00,$17.80,$0.00,$18.11,$0.00
00-2359-016-38,SUP,HCPCS C1713,,00-2359-016-38  -  SCREW BONE 3.5MM 2.7MM 16MM SS PERIART LCK NONSTRL,$201.50,$0.00,$201.50,$90.68,$143.81,$0.00,$34.72,$0.00,$0.00,$35.28,$201.50,$0.00,$100.75,$159.59,$161.20,$0.00,$31.53,$0.00,$32.08,$0.00
00-2359-018-35,SUP,HCPCS C1713,,00-2359-018-35  -  SCREW BONE 3.5MM 18MM SS PERIART LCK NONSTRL,$217.75,$0.00,$217.75,$97.99,$155.41,$0.00,$37.52,$0.00,$0.00,$38.13,$217.75,$0.00,$108.88,$172.46,$174.20,$0.00,$34.08,$0.00,$34.67,$0.00
00-2359-018-38,SUP,HCPCS C1713,,00-2359-018-38  -  SCREW BONE 3.5MM 2.7MM 18MM SS 2.7MM HEAD PERIART LCK,$201.50,$0.00,$201.50,$90.68,$143.81,$0.00,$34.72,$0.00,$0.00,$35.28,$201.50,$0.00,$100.75,$159.59,$161.20,$0.00,$31.53,$0.00,$32.08,$0.00
00-2359-040-35,SUP,HCPCS C1713,,00-2359-040-35  -  SCREW BONE 3.5MM 40MM PRLC SS PERIART LCK NCLNLT NONSTRL PLT,$217.75,$0.00,$217.75,$97.99,$155.41,$0.00,$37.52,$0.00,$0.00,$38.13,$217.75,$0.00,$108.88,$172.46,$174.20,$0.00,$34.08,$0.00,$34.67,$0.00
00-2359-044-35,SUP,HCPCS C1713,,00-2359-044-35  -  SCREW BONE 3.5MM 44MM SS PERIART LCK NCLNLT NONSTRL PLT SYS,$217.75,$0.00,$217.75,$97.99,$155.41,$0.00,$37.52,$0.00,$0.00,$38.13,$217.75,$0.00,$108.88,$172.46,$174.20,$0.00,$34.08,$0.00,$34.67,$0.00
00-2359-046-35,SUP,HCPCS C1713,,00-2359-046-35  -  SCREW BONE 3.5MM 46MM SS PERIART NON CANN LCK NONSTRL PLT,$217.75,$0.00,$217.75,$97.99,$155.41,$0.00,$37.52,$0.00,$0.00,$38.13,$217.75,$0.00,$108.88,$172.46,$174.20,$0.00,$34.08,$0.00,$34.67,$0.00
00-2359-048-35,SUP,HCPCS C1713,,00-2359-048-35  -  SCREW BONE 3.5MM 48MM SS PERIART NCLNLT LCK NONSTRL PLT SYS,$217.75,$0.00,$217.75,$97.99,$155.41,$0.00,$37.52,$0.00,$0.00,$38.13,$217.75,$0.00,$108.88,$172.46,$174.20,$0.00,$34.08,$0.00,$34.67,$0.00
00-2359-050-37,SUP,HCPCS C1713,,00-2359-050-37  -  SCREW BONE 3.5MM 50MM PRLC SS PERIART CANN CONICAL LCK,$191.75,$0.00,$191.75,$86.29,$136.85,$0.00,$33.04,$0.00,$0.00,$33.57,$191.75,$0.00,$95.88,$151.87,$153.40,$0.00,$30.01,$0.00,$30.53,$0.00
00-2410-029-00,SUP,Custom 27203010,,00-2410-029-00  -  BIT DRL 2.5MM 220MM QCK CNCT,$175.00,$0.00,$175.00,$0.00,$124.90,$0.00,$0.00,$0.00,$0.00,$0.00,$175.00,$0.00,$87.50,$138.60,$140.00,$0.00,$0.00,$0.00,$0.00,$0.00
00-2490-012-30,SUP,HCPCS C1713,,00-2490-012-30  -  PIN EXFIX 305MM 3MM NTR NAIL THRD,$211.25,$0.00,$211.25,$95.06,$150.77,$0.00,$36.40,$0.00,$0.00,$36.99,$211.25,$0.00,$105.63,$167.31,$169.00,$0.00,$33.06,$0.00,$33.63,$0.00
00-2490-034-49,SUP,Custom 27203010,,00-2490-034-49  -  DRILL SRG 4.9MM RTRGD CLBRT FEM,$955.50,$0.00,$955.50,$0.00,$681.94,$0.00,$0.00,$0.00,$0.00,$0.00,$955.50,$0.00,$477.75,$756.76,$764.40,$0.00,$0.00,$0.00,$0.00,$0.00
00-2490-046-30,SUP,HCPCS C1713,,00-2490-046-30  -  PIN 3MM NTR NAIL THRD STD IM NAIL,$227.50,$0.00,$227.50,$102.38,$162.37,$0.00,$39.20,$0.00,$0.00,$39.83,$227.50,$0.00,$113.75,$180.18,$182.00,$0.00,$35.60,$0.00,$36.22,$0.00
00-2490-047-30,SUP,HCPCS C1713,,00-2490-047-30  -  PIN FIX 355MM 3MM NTR NAIL NTHRD,$253.50,$0.00,$253.50,$114.08,$180.92,$0.00,$43.68,$0.00,$0.00,$44.39,$253.50,$0.00,$126.75,$200.77,$202.80,$0.00,$39.67,$0.00,$40.36,$0.00
00-4806-100-20,SUP,Custom 27203010,,00-4806-100-20  -  BIT DRL 2MM 100MM QCK CNCT,$139.75,$0.00,$139.75,$0.00,$99.74,$0.00,$0.00,$0.00,$0.00,$0.00,$139.75,$0.00,$69.88,$110.68,$111.80,$0.00,$0.00,$0.00,$0.00,$0.00
00-4806-110-25,SUP,Custom 27203010,,00-4806-110-25  -  BIT DRL 2.5MM 110MM QCK CNCT,$139.75,$0.00,$139.75,$0.00,$99.74,$0.00,$0.00,$0.00,$0.00,$0.00,$139.75,$0.00,$69.88,$110.68,$111.80,$0.00,$0.00,$0.00,$0.00,$0.00
00-4806-110-35,SUP,Custom 27203010,,00-4806-110-35  -  BIT DRL 3.5MM,$139.75,$0.00,$139.75,$0.00,$99.74,$0.00,$0.00,$0.00,$0.00,$0.00,$139.75,$0.00,$69.88,$110.68,$111.80,$0.00,$0.00,$0.00,$0.00,$0.00
00-4827-020-01,SUP,HCPCS C1713,,00-4827-020-01  -  SCREW BONE 2.7MM 20MM ZPS SS SM CORT SLFTAP SM HEX RECESS,$45.50,$0.00,$45.50,$20.48,$32.47,$0.00,$7.84,$0.00,$0.00,$7.97,$45.50,$0.00,$22.75,$36.04,$36.40,$0.00,$7.12,$0.00,$7.24,$0.00
00-4828-012-02,SUP,HCPCS C1713,,00-4828-012-02  -  SCREW BONE 2.7MM 12MM SS UNV LCK NONSTRL,$217.75,$0.00,$217.75,$97.99,$155.41,$0.00,$37.52,$0.00,$0.00,$38.13,$217.75,$0.00,$108.88,$172.46,$174.20,$0.00,$34.08,$0.00,$34.67,$0.00
00-4828-014-02,SUP,HCPCS C1713,,00-4828-014-02  -  SCREW BONE 2.7MM 14MM SS UNV LCK NONSTRL,$217.75,$0.00,$217.75,$97.99,$155.41,$0.00,$37.52,$0.00,$0.00,$38.13,$217.75,$0.00,$108.88,$172.46,$174.20,$0.00,$34.08,$0.00,$34.67,$0.00
00-4828-016-02,SUP,HCPCS C1713,,00-4828-016-02  -  SCREW BONE 2.7MM 16MM ORTH,$217.75,$0.00,$217.75,$97.99,$155.41,$0.00,$37.52,$0.00,$0.00,$38.13,$217.75,$0.00,$108.88,$172.46,$174.20,$0.00,$34.08,$0.00,$34.67,$0.00
00-4828-018-02,SUP,HCPCS C1713,,00-4828-018-02  -  SCREW BONE 2.7MM 18MM SS UNV LCK NONSTRL,$217.75,$0.00,$217.75,$97.99,$155.41,$0.00,$37.52,$0.00,$0.00,$38.13,$217.75,$0.00,$108.88,$172.46,$174.20,$0.00,$34.08,$0.00,$34.67,$0.00
00-4828-020-02,SUP,HCPCS C1713,,00-4828-020-02  -  SCREW BONE 2.7MM 20MM SS UNV PERIART ELB LCK NONSTRL,$217.75,$0.00,$217.75,$97.99,$155.41,$0.00,$37.52,$0.00,$0.00,$38.13,$217.75,$0.00,$108.88,$172.46,$174.20,$0.00,$34.08,$0.00,$34.67,$0.00
00-4835-016-01,SUP,HCPCS C1713,,00-4835-016-01  -  SCREW BONE 3.5MM 16MM ZPS SS SM CORT SLFTAP SM HEX RECESS,$52.00,$0.00,$52.00,$23.40,$37.11,$0.00,$8.96,$0.00,$0.00,$9.10,$52.00,$0.00,$26.00,$41.18,$41.60,$0.00,$8.14,$0.00,$8.28,$0.00
00-4835-018-01,SUP,HCPCS C1713,,00-4835-018-01  -  SCREW BONE 3.5MM 18MM ZPS SS LNG CORT SLFTAP SM HEX RECESS,$52.00,$0.00,$52.00,$23.40,$37.11,$0.00,$8.96,$0.00,$0.00,$9.10,$52.00,$0.00,$26.00,$41.18,$41.60,$0.00,$8.14,$0.00,$8.28,$0.00
00-4835-026-01,SUP,HCPCS C1713,,00-4835-026-01  -  SCREW BONE 3.5MM 26MM ZPS SS CORT SLFTAP SM HEX RECESS,$52.00,$0.00,$52.00,$23.40,$37.11,$0.00,$8.96,$0.00,$0.00,$9.10,$52.00,$0.00,$26.00,$41.18,$41.60,$0.00,$8.14,$0.00,$8.28,$0.00
00-4835-040-01,SUP,HCPCS C1713,,00-4835-040-01  -  SCREW BONE 3.5MM 40MM ZPS SS CORT SLFTAP SM HEX RECESS SM,$52.00,$0.00,$52.00,$23.40,$37.11,$0.00,$8.96,$0.00,$0.00,$9.10,$52.00,$0.00,$26.00,$41.18,$41.60,$0.00,$8.14,$0.00,$8.28,$0.00
00-4840-040-00,SUP,HCPCS C1713,,00-4840-040-00  -  SCREW BONE 4MM 40MM 14MM ZPS SS PTHRD CANC SM HEX RECESS,$42.25,$0.00,$42.25,$19.01,$30.15,$0.00,$7.28,$0.00,$0.00,$7.40,$42.25,$0.00,$21.13,$33.46,$33.80,$0.00,$6.61,$0.00,$6.73,$0.00
00-4840-050-00,SUP,HCPCS C1713,,00-4840-050-00  -  SCREW BONE 4MM 50MM ZPS SS FULTHD CANC SM HEX RECESS NONSTRL,$42.25,$0.00,$42.25,$19.01,$30.15,$0.00,$7.28,$0.00,$0.00,$7.40,$42.25,$0.00,$21.13,$33.46,$33.80,$0.00,$6.61,$0.00,$6.73,$0.00
00-4840-050-01,SUP,HCPCS C1713,,00-4840-050-01  -  SCREW BONE 4MM 15MM ZPS SS CANC PTTHRD SM HEX RECESS FRAG,$42.25,$0.00,$42.25,$19.01,$30.15,$0.00,$7.28,$0.00,$0.00,$7.40,$42.25,$0.00,$21.13,$33.46,$33.80,$0.00,$6.61,$0.00,$6.73,$0.00
00-4901-016-15,SUP,Custom 27203010,,00-4901-016-15  -  WIRE 1.6MM .063IN 15.2CM KWIRE ZPS SS 1 END TROCAR PNT,$16.58,$0.00,$16.58,$0.00,$11.83,$0.00,$0.00,$0.00,$0.00,$0.00,$16.58,$0.00,$8.29,$13.13,$13.26,$0.00,$0.00,$0.00,$0.00,$0.00
005280-901,SUP,Custom 27203010,,005280-901  -  LGTR 8MM FRNG FLLPN TUBE BAND STRL DISP ENDSCP LATEX FREE,$36.09,$0.00,$36.09,$0.00,$25.76,$0.00,$0.00,$0.00,$0.00,$0.00,$36.09,$0.00,$18.05,$28.58,$28.88,$0.00,$0.00,$0.00,$0.00,$0.00
00-6202-066-20,SUP,HCPCS C1776,,00-6202-066-20  -  SHELL ACETAB 66MM HIP MLHL PRIM MDLR REV TRB MTL STRL,"$7,315.00",$0.00,"$7,315.00","$3,291.75","$5,158.80",$0.00,"$1,260.34",$0.00,$0.00,"$1,280.80","$7,315.00",$0.00,"$3,657.50","$5,793.48","$5,852.00",$0.00,"$1,144.80",$0.00,"$1,164.55",$0.00
00-6250-65-20,SUP,HCPCS C1713,,00-6250-65-20  -  SCREW BN 6.5MM 20MM TRLG ST,$475.00,$0.00,$475.00,$213.75,$339.01,$0.00,$81.84,$0.00,$0.00,$83.17,$475.00,$0.00,$237.50,$376.20,$380.00,$0.00,$74.34,$0.00,$75.62,$0.00
00-6250-65-35,SUP,HCPCS C1713,,00-6250-65-35  -  SCREW BN 6.5MM 35MM TRLG ST,$475.00,$0.00,$475.00,$213.75,$339.01,$0.00,$81.84,$0.00,$0.00,$83.17,$475.00,$0.00,$237.50,$376.20,$380.00,$0.00,$74.34,$0.00,$75.62,$0.00
00-6334-050-28,SUP,HCPCS C1776,,00-6334-050-28  -  LINER ACETAB TRLG 8.3MM 50/52/54MM 28MM LNGVT HIP,"$14,925.00",$0.00,"$14,925.00","$6,716.25","$5,158.80",$0.00,"$2,571.50",$0.00,$0.00,"$2,613.25","$14,925.00",$0.00,"$7,462.50","$11,820.60","$11,940.00",$0.00,"$2,335.76",$0.00,"$2,376.06",$0.00
00-7708-000-10,SUP,Custom 27203010,,00-7708-000-10  -  CRR GFT 8IN SKIN PVC BRD CRR STRL LATEX FREE,$67.79,$0.00,$67.79,$0.00,$48.38,$0.00,$0.00,$0.00,$0.00,$0.00,$67.79,$0.00,$33.89,$53.69,$54.23,$0.00,$0.00,$0.00,$0.00,$0.00
008556P,SUP,HCPCS C1733,,008556P  -  CATHETER EP 5FR 110CM BP TEMP PCNG BLN FLW AST,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$0.00,$0.00,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
01-0001-S,SUP,Custom 27803010,,01-0001-S  -  CBL SLV ORTH 850MM 2MM HIP COCR SET STRL,"$1,047.50",$0.00,"$1,047.50",$0.00,$747.60,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,047.50",$0.00,$523.75,$829.62,$838.00,$0.00,$0.00,$0.00,$0.00,$0.00
01-0002-S,SUP,Custom 27203010,,01-0002-S  -  SLEEVE CABLE 850MM 1.6MM ORTH COCR STRL,"$1,047.50",$0.00,"$1,047.50",$0.00,$747.60,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,047.50",$0.00,$523.75,$829.62,$838.00,$0.00,$0.00,$0.00,$0.00,$0.00
01-0011-S,SUP,Custom 27803010,,01-0011-S  -  CABLE ORTH COCR 2MM 850MM,$715.00,$0.00,$715.00,$0.00,$510.30,$0.00,$0.00,$0.00,$0.00,$0.00,$715.00,$0.00,$357.50,$566.28,$572.00,$0.00,$0.00,$0.00,$0.00,$0.00
01-0012-S,SUP,Custom 27803010,,01-0012-S  -  CABLE ORTH COCR 1.6MM 850MM STRL,$715.00,$0.00,$715.00,$0.00,$510.30,$0.00,$0.00,$0.00,$0.00,$0.00,$715.00,$0.00,$357.50,$566.28,$572.00,$0.00,$0.00,$0.00,$0.00,$0.00
01-0013-S,SUP,Custom 27203010,,01-0013-S  -  SLEEVE CABLE 2MM COCR STRL,$335.00,$0.00,$335.00,$0.00,$239.09,$0.00,$0.00,$0.00,$0.00,$0.00,$335.00,$0.00,$167.50,$265.32,$268.00,$0.00,$0.00,$0.00,$0.00,$0.00
01-0014-S,SUP,Custom 27203010,,01-0014-S  -  SLEEVE CABLE 1.6MM COCR STRL,$335.00,$0.00,$335.00,$0.00,$239.09,$0.00,$0.00,$0.00,$0.00,$0.00,$335.00,$0.00,$167.50,$265.32,$268.00,$0.00,$0.00,$0.00,$0.00,$0.00
01-0020-S,SUP,Custom 27203010,,01-0020-S  -  SLEEVE CABLE 850MM 2MM SS STRL,"$1,047.50",$0.00,"$1,047.50",$0.00,$747.60,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,047.50",$0.00,$523.75,$829.62,$838.00,$0.00,$0.00,$0.00,$0.00,$0.00
01-0022-S,SUP,Custom 27203010,,01-0022-S  -  SLEEVE CMPR SS 2MM,$335.00,$0.00,$335.00,$0.00,$239.09,$0.00,$0.00,$0.00,$0.00,$0.00,$335.00,$0.00,$167.50,$265.32,$268.00,$0.00,$0.00,$0.00,$0.00,$0.00
010-0604,SUP,Custom 27203010,,010-0604  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$225.25,$0.00,$225.25,$0.00,$160.76,$0.00,$0.00,$0.00,$0.00,$0.00,$225.25,$0.00,$112.63,$178.40,$180.20,$0.00,$0.00,$0.00,$0.00,$0.00
010-0806,SUP,Custom 27203010,,010-0806  -  PLATE 18MM TI BONE SPNL,$272.00,$0.00,$272.00,$0.00,$194.13,$0.00,$0.00,$0.00,$0.00,$0.00,$272.00,$0.00,$136.00,$215.42,$217.60,$0.00,$0.00,$0.00,$0.00,$0.00
010-103L,SUP,HCPCS C1713,,010-103L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$408.00,$0.00,$408.00,$183.60,$291.19,$0.00,$70.30,$0.00,$0.00,$71.44,$408.00,$0.00,$204.00,$323.14,$326.40,$0.00,$63.85,$0.00,$64.95,$0.00
010-103R,SUP,HCPCS C1713,,010-103R  -  PLATE 18MM TI BONE SPNL,$408.00,$0.00,$408.00,$183.60,$291.19,$0.00,$70.30,$0.00,$0.00,$71.44,$408.00,$0.00,$204.00,$323.14,$326.40,$0.00,$63.85,$0.00,$64.95,$0.00
010-2001-5,SUP,HCPCS C1781,,010-2001-5  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,606.50",$0.00,"$1,606.50",$722.93,"$1,146.56",$0.00,$276.79,$0.00,$0.00,$281.29,"$1,606.50",$0.00,$803.25,"$1,272.35","$1,285.20",$0.00,$251.42,$0.00,$255.75,$0.00
010-2010,SUP,HCPCS C1781,,010-2010  -  PLATE 18MM TI BONE SPNL,"$1,115.63",$0.00,"$1,115.63",$502.03,$796.22,$0.00,$192.22,$0.00,$0.00,$195.34,"$1,115.63",$0.00,$557.81,$883.58,$892.50,$0.00,$174.60,$0.00,$177.61,$0.00
010-234,SUP,HCPCS C1713,,010-234  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$408.00,$0.00,$408.00,$183.60,$291.19,$0.00,$70.30,$0.00,$0.00,$71.44,$408.00,$0.00,$204.00,$323.14,$326.40,$0.00,$63.85,$0.00,$64.95,$0.00
01-02950,SUP,Custom 27803010,,01-02950  -  BAR ARCH 5IN ERICH SS FACE FX,$32.50,$0.00,$32.50,$0.00,$23.20,$0.00,$0.00,$0.00,$0.00,$0.00,$32.50,$0.00,$16.25,$25.74,$26.00,$0.00,$0.00,$0.00,$0.00,$0.00
01-0298,SUP,HCPCS C1713,,01-0298  -  BAR ARCH PREFORM OMNIMAX MMF SYSTEM,"$1,487.50",$0.00,"$1,487.50",$669.38,"$1,061.63",$0.00,$256.29,$0.00,$0.00,$260.45,"$1,487.50",$0.00,$743.75,"$1,178.10","$1,190.00",$0.00,$232.79,$0.00,$236.81,$0.00
01-0299,SUP,Custom 27203010,,01-0299  -  BAR ARCH 1MR ROLL WIRE INSTR ERICH,$175.00,$0.00,$175.00,$0.00,$124.90,$0.00,$0.00,$0.00,$0.00,$0.00,$175.00,$0.00,$87.50,$138.60,$140.00,$0.00,$0.00,$0.00,$0.00,$0.00
0102L12,SUP,HCPCS C1729,,0102L12  -  CATHETER URETHRAL 12FR 2 WAY 1 DRAIN EYE FOLEY MEDIUM OLIVE,$25.50,$0.00,$25.50,$13.85,$18.20,$0.00,$4.39,$0.00,$0.00,$4.47,$25.50,$0.00,$12.75,$20.20,$20.40,$0.00,$3.99,$0.00,$4.06,$0.00
0102L14,SUP,HCPCS C1729,,0102L14  -  CATH URTH BDX LBR 14FR FOLEY 2W CDE RADIOPQ DDRGL 5ML STRL,$26.15,$0.00,$26.15,$14.20,$18.66,$0.00,$4.50,$0.00,$0.00,$4.58,$26.15,$0.00,$13.07,$20.71,$20.92,$0.00,$4.09,$0.00,$4.16,$0.00
0102L16,SUP,HCPCS C1729,,0102L16  -  CATH URTH BDX LBR 16FR FOLEY 2W CDE 1 EYE DDRGL 5ML STRL,$26.15,$0.00,$26.15,$14.20,$18.66,$0.00,$4.50,$0.00,$0.00,$4.58,$26.15,$0.00,$13.07,$20.71,$20.92,$0.00,$4.09,$0.00,$4.16,$0.00
0102L18,SUP,HCPCS C1729,,0102L18  -  CATH URTH BDX LBR 18FR FOLEY 2W CDE RADIOPQ DDRGL 5ML STRL,$26.14,$0.00,$26.14,$14.20,$18.66,$0.00,$4.50,$0.00,$0.00,$4.58,$26.14,$0.00,$13.07,$20.70,$20.92,$0.00,$4.09,$0.00,$4.16,$0.00
0102L20,SUP,HCPCS C1729,,0102L20  -  CATH URTH BDX LBR 20FR FOLEY 2W CDE 1 EYE DDRGL 5ML STRL,$26.14,$0.00,$26.14,$14.20,$18.66,$0.00,$4.50,$0.00,$0.00,$4.58,$26.14,$0.00,$13.07,$20.70,$20.92,$0.00,$4.09,$0.00,$4.16,$0.00
0102L22,SUP,Custom 27203010,,0102L22  -  CATHETER URETHRAL 22FR 2 WAY 1 DRAIN EYE FOLEY MEDIUM OLIVE,$25.13,$0.00,$25.13,$0.00,$17.93,$0.00,$0.00,$0.00,$0.00,$0.00,$25.13,$0.00,$12.56,$19.90,$20.10,$0.00,$0.00,$0.00,$0.00,$0.00
0102L24,SUP,Custom 27203010,,0102L24  -  CATHETER URETHRAL 24FR 2 WAY 1 DRAIN EYE FOLEY MEDIUM OLIVE,$25.13,$0.00,$25.13,$0.00,$17.93,$0.00,$0.00,$0.00,$0.00,$0.00,$25.13,$0.00,$12.56,$19.90,$20.10,$0.00,$0.00,$0.00,$0.00,$0.00
0102SI16,SUP,Custom 27203010,,0102SI16  -  CATHETER URTH 16FR 5CC RD STRL LTX BDX IC 2W FL MED OLV CDE,$35.13,$0.00,$35.13,$0.00,$25.07,$0.00,$0.00,$0.00,$0.00,$0.00,$35.13,$0.00,$17.56,$27.82,$28.10,$0.00,$0.00,$0.00,$0.00,$0.00
0102SI18,SUP,Custom 27203010,,0102SI18  -  CATHETER URTH 18FR 5CC RD STRL LTX BDX IC 2W FL MED OLV CDE,$35.13,$0.00,$35.13,$0.00,$25.07,$0.00,$0.00,$0.00,$0.00,$0.00,$35.13,$0.00,$17.56,$27.82,$28.10,$0.00,$0.00,$0.00,$0.00,$0.00
0102SI20,SUP,Custom 27203010,,0102SI20  -  CATHETER URTH 20FR 5CC RD STRL LTX BDX IC 2W FL INFCT CNTRL,$35.13,$0.00,$35.13,$0.00,$25.07,$0.00,$0.00,$0.00,$0.00,$0.00,$35.13,$0.00,$17.56,$27.82,$28.10,$0.00,$0.00,$0.00,$0.00,$0.00
0102SI22,SUP,Custom 27203010,,0102SI22  -  CATHETER URTH 22FR 5CC RD STRL LTX BDX IC 2W FL MED OLV CDE,$35.13,$0.00,$35.13,$0.00,$25.07,$0.00,$0.00,$0.00,$0.00,$0.00,$35.13,$0.00,$17.56,$27.82,$28.10,$0.00,$0.00,$0.00,$0.00,$0.00
0102SI24,SUP,Custom 27203010,,0102SI24  -  CATHETER URTH 24FR 5CC RD STRL LTX BDX IC 2W FL INFCT CNTRL,$35.13,$0.00,$35.13,$0.00,$25.07,$0.00,$0.00,$0.00,$0.00,$0.00,$35.13,$0.00,$17.56,$27.82,$28.10,$0.00,$0.00,$0.00,$0.00,$0.00
01-0301,SUP,Custom 27203010,,01-0301  -  BAND RUBBER SMALL 4MM ARCH BAR,$45.00,$0.00,$45.00,$0.00,$32.12,$0.00,$0.00,$0.00,$0.00,$0.00,$45.00,$0.00,$22.50,$35.64,$36.00,$0.00,$0.00,$0.00,$0.00,$0.00
01-03490,SUP,Custom 27203010,,01-03490  -  WIRE FX .5MM 160MM LGT BLNT,$30.00,$0.00,$30.00,$0.00,$21.41,$0.00,$0.00,$0.00,$0.00,$0.00,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$0.00,$0.00,$0.00,$0.00
01-03492,SUP,Custom 27203010,,01-03492  -  WIRE FX .64MM 160MM LGT BLNT,$62.50,$0.00,$62.50,$0.00,$44.61,$0.00,$0.00,$0.00,$0.00,$0.00,$62.50,$0.00,$31.25,$49.50,$50.00,$0.00,$0.00,$0.00,$0.00,$0.00
0104-07,SUP,Custom 27203010,,MEDIA CULT TETRATHIONATE BROTH BASE 2KG,$547.50,$0.00,$547.50,$0.00,$390.75,$0.00,$0.00,$0.00,$0.00,$0.00,$547.50,$0.00,$273.75,$433.62,$438.00,$0.00,$0.00,$0.00,$0.00,$0.00
0112-18,SUP,Custom 27203010,,0112-18  -  TUBE GSTRM Y 18FR ORNG LF MGNPRT BLN RND SKN DISK DEHP-FR,$66.61,$0.00,$66.61,$0.00,$47.54,$0.00,$0.00,$0.00,$0.00,$0.00,$66.61,$0.00,$33.31,$52.76,$53.29,$0.00,$0.00,$0.00,$0.00,$0.00
0112-20,SUP,HCPCS B4087,,0112-20  -  TUBE GSTRM UNV 20FR 7-10ML STRL ASMB VAL G SIL ENTRL,$45.31,$0.00,$45.31,$0.00,$32.34,$0.00,$0.00,$0.00,$0.00,$0.00,$45.31,$0.00,$22.65,$35.89,$36.25,$0.00,$0.00,$0.00,$0.00,$0.00
0112-22,SUP,HCPCS B4087,,0112-22  -  TUBE GSTRM 22FR 14IN BLU LF MGNPRT YPRT BLN CNCT SIL DISP,$45.31,$0.00,$45.31,$0.00,$32.34,$0.00,$0.00,$0.00,$0.00,$0.00,$45.31,$0.00,$22.65,$35.89,$36.25,$0.00,$0.00,$0.00,$0.00,$0.00
0112-24,SUP,HCPCS B4087,,0112-24  -  TUBE GSTRM 24FR 14IN PEACH LF MGNPRT SDPRT BLN REPL SIL,$45.31,$0.00,$45.31,$0.00,$32.34,$0.00,$0.00,$0.00,$0.00,$0.00,$45.31,$0.00,$22.65,$35.89,$36.25,$0.00,$0.00,$0.00,$0.00,$0.00
0119L22,SUP,Custom 27203010,,0119L22  -  CATHETER URETHRAL STANDARD 22FR 3 WAY 2 OPPOSING DRAIN EYE,$21.05,$0.00,$21.05,$0.00,$15.02,$0.00,$0.00,$0.00,$0.00,$0.00,$21.05,$0.00,$10.53,$16.67,$16.84,$0.00,$0.00,$0.00,$0.00,$0.00
0119SI18,SUP,Custom 27203010,,0119SI18  -  CATHETER URTH 18FR 5CC AMBR STRL LTX BDX IC 3W FL BLN INFCT,$1.00,$0.00,$1.00,$0.00,$0.71,$0.00,$0.00,$0.00,$0.00,$0.00,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.00,$0.00,$0.00,$0.00
0120-14-1.7,SUP,Custom 27203010,,0120-14-1.7  -  KIT GASTROSTOMY LP TAPER 14FR 1.7CM 12IN ENTERAL FEED TUBE,$263.98,$0.00,$259.94,$0.00,$185.52,$0.00,$0.00,$0.00,$0.00,$0.00,$259.94,$0.00,$129.97,$209.07,$207.95,$0.00,$0.00,$0.00,$0.00,$0.00
0120-18-2.3,SUP,HCPCS C1713,,0120-18-2.3  -  KIT GASTROSTOMY 18FR 2.3CM INTERNAL RETENTION BALLOON,$260.08,$0.00,$260.08,$117.03,$185.62,$0.00,$44.81,$0.00,$0.00,$45.54,$260.08,$0.00,$130.04,$205.98,$208.06,$0.00,$40.70,$0.00,$41.40,$0.00
0120-18-2.5,SUP,Custom 27203010,,0120-18-2.5  -  KIT GASTROSTOMY LP TAPER 18FR 2.5CM ENTERAL FEED TUBE DEHP,$263.98,$0.00,$259.94,$0.00,$185.52,$0.00,$0.00,$0.00,$0.00,$0.00,$259.94,$0.00,$129.97,$209.07,$207.95,$0.00,$0.00,$0.00,$0.00,$0.00
0120-18-4.5,SUP,HCPCS C1713,,0120-18-4.5  -  KIT GASTROSTOMY LP TAPER 18FR 4.5CM ENTERAL FEED TUBE DEHP,$260.08,$0.00,$260.08,$117.03,$185.62,$0.00,$44.81,$0.00,$0.00,$45.54,$260.08,$0.00,$130.04,$205.98,$208.06,$0.00,$40.70,$0.00,$41.40,$0.00
012DTC,SUP,Custom 27203010,,012DTC  -  BAG DRAWTAPE 38 X38 CLEAR,$175.00,$0.00,$175.00,$0.00,$124.90,$0.00,$0.00,$0.00,$0.00,$0.00,$175.00,$0.00,$87.50,$138.60,$140.00,$0.00,$0.00,$0.00,$0.00,$0.00
015-016,SUP,HCPCS C1713,,015-016  -  PLATE 18MM TI BONE SPNL,$452.63,$0.00,$452.63,$203.68,$323.04,$0.00,$77.99,$0.00,$0.00,$79.25,$452.63,$0.00,$226.31,$358.48,$362.10,$0.00,$70.84,$0.00,$72.06,$0.00
015-016-C,SUP,HCPCS C1713,,015-016-C  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$488.75,$0.00,$488.75,$219.94,$348.82,$0.00,$84.21,$0.00,$0.00,$85.58,$488.75,$0.00,$244.38,$387.09,$391.00,$0.00,$76.49,$0.00,$77.81,$0.00
015-017,SUP,HCPCS C1713,,015-017  -  PLATE 18MM TI BONE SPNL,$435.63,$0.00,$435.63,$196.03,$310.91,$0.00,$75.06,$0.00,$0.00,$76.27,$435.63,$0.00,$217.81,$345.02,$348.50,$0.00,$68.18,$0.00,$69.35,$0.00
015-017-C,SUP,HCPCS C1713,,015-017-C  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$463.25,$0.00,$463.25,$208.46,$330.62,$0.00,$79.82,$0.00,$0.00,$81.11,$463.25,$0.00,$231.63,$366.89,$370.60,$0.00,$72.50,$0.00,$73.75,$0.00
015-018,SUP,HCPCS C1713,,015-018  -  PLATE 18MM TI BONE SPNL,$461.13,$0.00,$461.13,$207.51,$329.10,$0.00,$79.45,$0.00,$0.00,$80.74,$461.13,$0.00,$230.56,$365.21,$368.90,$0.00,$72.17,$0.00,$73.41,$0.00
015-018-C,SUP,HCPCS C1713,,015-018-C  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$463.25,$0.00,$463.25,$208.46,$330.62,$0.00,$79.82,$0.00,$0.00,$81.11,$463.25,$0.00,$231.63,$366.89,$370.60,$0.00,$72.50,$0.00,$73.75,$0.00
015-032,SUP,HCPCS C1713,,015-032  -  PLATE 18MM TI BONE SPNL,$654.50,$0.00,$654.50,$294.53,$467.12,$0.00,$112.77,$0.00,$0.00,$114.60,$654.50,$0.00,$327.25,$518.36,$523.60,$0.00,$102.43,$0.00,$104.20,$0.00
015-040,SUP,HCPCS C1713,,015-040  -  PLATE BN STD STRG 4MM TIMESH 2 HL TI CRNL 1.5MM SCR,$93.50,$0.00,$93.50,$42.08,$66.73,$0.00,$16.11,$0.00,$0.00,$16.37,$93.50,$0.00,$46.75,$74.05,$74.80,$0.00,$14.63,$0.00,$14.89,$0.00
015-040-C,SUP,HCPCS C1713,,015-040-C  -  PLATE 18MM TI BONE SPNL,$95.63,$0.00,$95.63,$43.03,$68.25,$0.00,$16.48,$0.00,$0.00,$16.74,$95.63,$0.00,$47.81,$75.74,$76.50,$0.00,$14.97,$0.00,$15.22,$0.00
015-042,SUP,HCPCS C1713,,015-042  -  PLATE BN STD STRG 8MM TIMESH 2 HL TI CRNL 1.5MM SCR,$95.63,$0.00,$95.63,$43.03,$68.25,$0.00,$16.48,$0.00,$0.00,$16.74,$95.63,$0.00,$47.81,$75.74,$76.50,$0.00,$14.97,$0.00,$15.22,$0.00
015-042-C,SUP,HCPCS C1713,,015-042-C  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$95.63,$0.00,$95.63,$43.03,$68.25,$0.00,$16.48,$0.00,$0.00,$16.74,$95.63,$0.00,$47.81,$75.74,$76.50,$0.00,$14.97,$0.00,$15.22,$0.00
015-044,SUP,HCPCS C1713,,015-044  -  PLATE 18MM TI BONE SPNL,$93.50,$0.00,$93.50,$42.08,$66.73,$0.00,$16.11,$0.00,$0.00,$16.37,$93.50,$0.00,$46.75,$74.05,$74.80,$0.00,$14.63,$0.00,$14.89,$0.00
015-044-C,SUP,HCPCS C1713,,015-044-C  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$102.00,$0.00,$102.00,$45.90,$72.80,$0.00,$17.57,$0.00,$0.00,$17.86,$102.00,$0.00,$51.00,$80.78,$81.60,$0.00,$15.96,$0.00,$16.24,$0.00
015-090,SUP,HCPCS C1713,,015-090  -  PLATE BN STD CRV TIMESH 12 HL TI CRNL,$486.63,$0.00,$486.63,$218.98,$347.30,$0.00,$83.84,$0.00,$0.00,$85.20,$486.63,$0.00,$243.31,$385.41,$389.30,$0.00,$76.16,$0.00,$77.47,$0.00
015-090-C,SUP,HCPCS C1713,,015-090-C  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$486.63,$0.00,$486.63,$218.98,$347.30,$0.00,$83.84,$0.00,$0.00,$85.20,$486.63,$0.00,$243.31,$385.41,$389.30,$0.00,$76.16,$0.00,$77.47,$0.00
015-1006,SUP,Custom 27203010,,015-1006  -  PLATE 18MM TI BONE SPNL,$265.63,$0.00,$265.63,$0.00,$189.58,$0.00,$0.00,$0.00,$0.00,$0.00,$265.63,$0.00,$132.81,$210.38,$212.50,$0.00,$0.00,$0.00,$0.00,$0.00
015-102L,SUP,HCPCS C1713,,015-102L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$408.00,$0.00,$408.00,$183.60,$291.19,$0.00,$70.30,$0.00,$0.00,$71.44,$408.00,$0.00,$204.00,$323.14,$326.40,$0.00,$63.85,$0.00,$64.95,$0.00
015-102R,SUP,HCPCS C1713,,015-102R  -  PLATE 18MM TI BONE SPNL,$408.00,$0.00,$408.00,$183.60,$291.19,$0.00,$70.30,$0.00,$0.00,$71.44,$408.00,$0.00,$204.00,$323.14,$326.40,$0.00,$63.85,$0.00,$64.95,$0.00
015-104L,SUP,HCPCS C1713,,015-104L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$408.00,$0.00,$408.00,$183.60,$291.19,$0.00,$70.30,$0.00,$0.00,$71.44,$408.00,$0.00,$204.00,$323.14,$326.40,$0.00,$63.85,$0.00,$64.95,$0.00
015-104R,SUP,HCPCS C1713,,015-104R  -  PLATE 18MM TI BONE SPNL,$408.00,$0.00,$408.00,$183.60,$291.19,$0.00,$70.30,$0.00,$0.00,$71.44,$408.00,$0.00,$204.00,$323.14,$326.40,$0.00,$63.85,$0.00,$64.95,$0.00
015-105L,SUP,HCPCS C1713,,015-105L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$403.75,$0.00,$403.75,$181.69,$288.16,$0.00,$69.56,$0.00,$0.00,$70.69,$403.75,$0.00,$201.88,$319.77,$323.00,$0.00,$63.19,$0.00,$64.28,$0.00
015-105R,SUP,HCPCS C1713,,015-105R  -  PLATE 18MM TI BONE SPNL,$403.75,$0.00,$403.75,$181.69,$288.16,$0.00,$69.56,$0.00,$0.00,$70.69,$403.75,$0.00,$201.88,$319.77,$323.00,$0.00,$63.19,$0.00,$64.28,$0.00
015-106L,SUP,HCPCS C1713,,015-106L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$408.00,$0.00,$408.00,$183.60,$291.19,$0.00,$70.30,$0.00,$0.00,$71.44,$408.00,$0.00,$204.00,$323.14,$326.40,$0.00,$63.85,$0.00,$64.95,$0.00
015-106R,SUP,HCPCS C1713,,015-106R  -  PLATE 18MM TI BONE SPNL,$408.00,$0.00,$408.00,$183.60,$291.19,$0.00,$70.30,$0.00,$0.00,$71.44,$408.00,$0.00,$204.00,$323.14,$326.40,$0.00,$63.85,$0.00,$64.95,$0.00
015-107R,SUP,HCPCS C1713,,015-107R  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$408.00,$0.00,$408.00,$183.60,$291.19,$0.00,$70.30,$0.00,$0.00,$71.44,$408.00,$0.00,$204.00,$323.14,$326.40,$0.00,$63.85,$0.00,$64.95,$0.00
015-1206,SUP,Custom 27203010,,015-1206  -  PLATE 18MM TI BONE SPNL,$267.75,$0.00,$267.75,$0.00,$191.09,$0.00,$0.00,$0.00,$0.00,$0.00,$267.75,$0.00,$133.88,$212.06,$214.20,$0.00,$0.00,$0.00,$0.00,$0.00
015-1208,SUP,Custom 27203010,,015-1208  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$267.75,$0.00,$267.75,$0.00,$191.09,$0.00,$0.00,$0.00,$0.00,$0.00,$267.75,$0.00,$133.88,$212.06,$214.20,$0.00,$0.00,$0.00,$0.00,$0.00
015-130,SUP,HCPCS C1713,,015-130  -  PLATE 18MM TI BONE SPNL,$403.75,$0.00,$403.75,$181.69,$288.16,$0.00,$69.56,$0.00,$0.00,$70.69,$403.75,$0.00,$201.88,$319.77,$323.00,$0.00,$63.19,$0.00,$64.28,$0.00
015-1304,SUP,Custom 27203010,,015-1304  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$252.88,$0.00,$252.88,$0.00,$180.48,$0.00,$0.00,$0.00,$0.00,$0.00,$252.88,$0.00,$126.44,$200.28,$202.30,$0.00,$0.00,$0.00,$0.00,$0.00
015-1306,SUP,Custom 27203010,,015-1306  -  PLATE 18MM TI BONE SPNL,$252.88,$0.00,$252.88,$0.00,$180.48,$0.00,$0.00,$0.00,$0.00,$0.00,$252.88,$0.00,$126.44,$200.28,$202.30,$0.00,$0.00,$0.00,$0.00,$0.00
015-1308,SUP,Custom 27203010,,015-1308  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$267.75,$0.00,$267.75,$0.00,$191.09,$0.00,$0.00,$0.00,$0.00,$0.00,$267.75,$0.00,$133.88,$212.06,$214.20,$0.00,$0.00,$0.00,$0.00,$0.00
015-1312,SUP,Custom 27203010,,015-1312  -  PLATE 18MM TI BONE SPNL,$225.25,$0.00,$225.25,$0.00,$160.76,$0.00,$0.00,$0.00,$0.00,$0.00,$225.25,$0.00,$112.63,$178.40,$180.20,$0.00,$0.00,$0.00,$0.00,$0.00
015-132,SUP,HCPCS C1713,,015-132  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$403.75,$0.00,$403.75,$181.69,$288.16,$0.00,$69.56,$0.00,$0.00,$70.69,$403.75,$0.00,$201.88,$319.77,$323.00,$0.00,$63.19,$0.00,$64.28,$0.00
015-160,SUP,HCPCS C1713,,015-160  -  PLATE 18MM TI BONE SPNL,$403.75,$0.00,$403.75,$181.69,$288.16,$0.00,$69.56,$0.00,$0.00,$70.69,$403.75,$0.00,$201.88,$319.77,$323.00,$0.00,$63.19,$0.00,$64.28,$0.00
015-161,SUP,HCPCS C1713,,015-161  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$403.75,$0.00,$403.75,$181.69,$288.16,$0.00,$69.56,$0.00,$0.00,$70.69,$403.75,$0.00,$201.88,$319.77,$323.00,$0.00,$63.19,$0.00,$64.28,$0.00
015-2001-4,SUP,HCPCS C1781,,015-2001-4  -  PLATE 18MM TI BONE SPNL,"$1,519.38",$0.00,"$1,519.38",$683.72,"$1,084.38",$0.00,$261.78,$0.00,$0.00,$266.03,"$1,519.38",$0.00,$759.69,"$1,203.35","$1,215.50",$0.00,$237.78,$0.00,$241.88,$0.00
015-2001-4-C,SUP,HCPCS C1713,,015-2001-4-C  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,468.38",$0.00,"$1,468.38",$660.77,"$1,047.98",$0.00,$252.99,$0.00,$0.00,$257.10,"$1,468.38",$0.00,$734.19,"$1,162.96","$1,174.70",$0.00,$229.80,$0.00,$233.77,$0.00
015-2001-5,SUP,HCPCS C1713,,015-2001-5  -  PLATE BN 11CMX7.5CMX5MM GRIDMESH TI CRNM HERNIATED CRV DISK,"$1,489.63",$0.00,"$1,489.63",$670.33,"$1,063.15",$0.00,$256.65,$0.00,$0.00,$260.82,"$1,489.63",$0.00,$744.81,"$1,179.79","$1,191.70",$0.00,$233.13,$0.00,$237.15,$0.00
015-2001-5-C,SUP,HCPCS C1713,,015-2001-5-C  -  PLATE 18MM TI BONE SPNL,"$1,538.50",$0.00,"$1,538.50",$692.33,"$1,098.03",$0.00,$265.08,$0.00,$0.00,$269.38,"$1,538.50",$0.00,$769.25,"$1,218.49","$1,230.80",$0.00,$240.78,$0.00,$244.93,$0.00
015-2010,SUP,HCPCS C1713,,015-2010  -  PLATE BN SQ RECT 8MM TIMESH MESH TI CRNM 1.5MM SCR,"$1,230.38",$0.00,"$1,230.38",$553.67,$878.12,$0.00,$211.99,$0.00,$0.00,$215.43,"$1,230.38",$0.00,$615.19,$974.46,$984.30,$0.00,$192.55,$0.00,$195.88,$0.00
0152-0218S,SUP,Custom 27803010,,0152-0218S  -  WIRE FX 1.8MM 310MM STRL KRSH CNDYL SCR,$207.63,$0.00,$207.63,$0.00,$148.18,$0.00,$0.00,$0.00,$0.00,$0.00,$207.63,$0.00,$103.81,$164.44,$166.10,$0.00,$0.00,$0.00,$0.00,$0.00
015-2050,SUP,Custom 27203010,,015-2050  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,241.00",$0.00,"$1,241.00",$0.00,$885.70,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,241.00",$0.00,$620.50,$982.87,$992.80,$0.00,$0.00,$0.00,$0.00,$0.00
015-230,SUP,HCPCS C1713,,015-230  -  PLATE 18MM TI BONE SPNL,$384.63,$0.00,$384.63,$173.08,$274.51,$0.00,$66.27,$0.00,$0.00,$67.34,$384.63,$0.00,$192.31,$304.63,$307.70,$0.00,$60.19,$0.00,$61.23,$0.00
015-233,SUP,HCPCS C1713,,015-233  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$384.63,$0.00,$384.63,$173.08,$274.51,$0.00,$66.27,$0.00,$0.00,$67.34,$384.63,$0.00,$192.31,$304.63,$307.70,$0.00,$60.19,$0.00,$61.23,$0.00
015-234,SUP,HCPCS C1713,,015-234  -  PLATE 18MM TI BONE SPNL,$384.63,$0.00,$384.63,$173.08,$274.51,$0.00,$66.27,$0.00,$0.00,$67.34,$384.63,$0.00,$192.31,$304.63,$307.70,$0.00,$60.19,$0.00,$61.23,$0.00
015-236,SUP,HCPCS C1713,,015-236  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$363.38,$0.00,$363.38,$163.52,$259.34,$0.00,$62.61,$0.00,$0.00,$63.62,$363.38,$0.00,$181.69,$287.80,$290.70,$0.00,$56.87,$0.00,$57.85,$0.00
015-237,SUP,HCPCS C1713,,015-237  -  PLATE BN 2Y 5MM TIMESH 3X3 HL TI CRNL 1.5MM SCR,$376.13,$0.00,$376.13,$169.26,$268.44,$0.00,$64.80,$0.00,$0.00,$65.86,$376.13,$0.00,$188.06,$297.89,$300.90,$0.00,$58.86,$0.00,$59.88,$0.00
015-246,SUP,HCPCS C1713,,015-246  -  PLATE 18MM TI BONE SPNL,$233.75,$0.00,$233.75,$105.19,$166.83,$0.00,$40.27,$0.00,$0.00,$40.93,$233.75,$0.00,$116.88,$185.13,$187.00,$0.00,$36.58,$0.00,$37.21,$0.00
015-247,SUP,HCPCS C1713,,015-247  -  PLATE BN STRG 5MM TIMESH 2X2 HL TI CRNMXF 1.5MM SCR,$233.75,$0.00,$233.75,$105.19,$166.83,$0.00,$40.27,$0.00,$0.00,$40.93,$233.75,$0.00,$116.88,$185.13,$187.00,$0.00,$36.58,$0.00,$37.21,$0.00
015-255,SUP,HCPCS C1713,,015-255  -  PLATE BN X TIMESH TI CRNM 1.5MM SCR,$384.63,$0.00,$384.63,$173.08,$274.51,$0.00,$66.27,$0.00,$0.00,$67.34,$384.63,$0.00,$192.31,$304.63,$307.70,$0.00,$60.19,$0.00,$61.23,$0.00
015-257,SUP,HCPCS C1713,,015-257  -  PLATE BN STD SM SQ TIMESH 4 HL TI CRNL 1.5MM SCR,$393.13,$0.00,$393.13,$176.91,$280.57,$0.00,$67.73,$0.00,$0.00,$68.83,$393.13,$0.00,$196.56,$311.36,$314.50,$0.00,$61.52,$0.00,$62.59,$0.00
015-257-C,SUP,HCPCS C1713,,015-257-C  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$414.38,$0.00,$414.38,$186.47,$295.74,$0.00,$71.39,$0.00,$0.00,$72.55,$414.38,$0.00,$207.19,$328.19,$331.50,$0.00,$64.85,$0.00,$65.97,$0.00
015-258,SUP,HCPCS C1713,,015-258  -  PLATE 18MM TI BONE SPNL,$401.63,$0.00,$401.63,$180.73,$286.64,$0.00,$69.20,$0.00,$0.00,$70.32,$401.63,$0.00,$200.81,$318.09,$321.30,$0.00,$62.85,$0.00,$63.94,$0.00
015-260-11,SUP,HCPCS C1781,,015-260-11  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$431.38,$0.00,$431.38,$194.12,$307.87,$0.00,$74.32,$0.00,$0.00,$75.53,$431.38,$0.00,$215.69,$341.65,$345.10,$0.00,$67.51,$0.00,$68.67,$0.00
015-260-14,SUP,HCPCS C1781,,015-260-14  -  PLATE 18MM TI BONE SPNL,$431.38,$0.00,$431.38,$194.12,$307.87,$0.00,$74.32,$0.00,$0.00,$75.53,$431.38,$0.00,$215.69,$341.65,$345.10,$0.00,$67.51,$0.00,$68.67,$0.00
015-260-18,SUP,HCPCS C1781,,015-260-18  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$465.38,$0.00,$465.38,$209.42,$332.14,$0.00,$80.18,$0.00,$0.00,$81.48,$465.38,$0.00,$232.69,$368.58,$372.30,$0.00,$72.83,$0.00,$74.09,$0.00
015-260-25,SUP,Custom 27803010,,015-260-25  -  PLATE 18MM TI BONE SPNL,$558.88,$0.00,$558.88,$0.00,$398.87,$0.00,$0.00,$0.00,$0.00,$0.00,$558.88,$0.00,$279.44,$442.63,$447.10,$0.00,$0.00,$0.00,$0.00,$0.00
015-262-14,SUP,Custom 27803010,,015-262-14  -  COVER BUR HL 14MM TIMESH FAN BLDE TI CRNL,$431.38,$0.00,$431.38,$0.00,$307.87,$0.00,$0.00,$0.00,$0.00,$0.00,$431.38,$0.00,$215.69,$341.65,$345.10,$0.00,$0.00,$0.00,$0.00,$0.00
015-262-16,SUP,Custom 27803010,,015-262-16  -  LG BURR HOLE CVR.,$320.63,$0.00,$320.63,$0.00,$228.83,$0.00,$0.00,$0.00,$0.00,$0.00,$320.63,$0.00,$160.31,$253.94,$256.50,$0.00,$0.00,$0.00,$0.00,$0.00
015-262-18,SUP,Custom 27803010,,015-262-18  -  COVER BUR HL 18MM TIMESH FAN BLDE TI CRNMXF 1.5MM SCR,$439.88,$0.00,$439.88,$0.00,$313.94,$0.00,$0.00,$0.00,$0.00,$0.00,$439.88,$0.00,$219.94,$348.38,$351.90,$0.00,$0.00,$0.00,$0.00,$0.00
015-273,SUP,HCPCS C1713,,015-273  -  PLATE 18MM TI BONE SPNL,$618.38,$0.00,$618.38,$278.27,$441.33,$0.00,$106.54,$0.00,$0.00,$108.27,$618.38,$0.00,$309.19,$489.76,$494.70,$0.00,$96.78,$0.00,$98.45,$0.00
015-275,SUP,HCPCS C1713,,015-275  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$433.50,$0.00,$433.50,$195.08,$309.39,$0.00,$74.69,$0.00,$0.00,$75.90,$433.50,$0.00,$216.75,$343.33,$346.80,$0.00,$67.84,$0.00,$69.01,$0.00
015-276,SUP,HCPCS C1713,,015-276  -  PLATE 18MM TI BONE SPNL,$454.75,$0.00,$454.75,$204.64,$324.56,$0.00,$78.35,$0.00,$0.00,$79.62,$454.75,$0.00,$227.38,$360.16,$363.80,$0.00,$71.17,$0.00,$72.40,$0.00
016-100,SUP,Custom 27803010,,016-100  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,436.50",$0.00,"$1,436.50",$0.00,"$1,025.23",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,436.50",$0.00,$718.25,"$1,137.71","$1,149.20",$0.00,$0.00,$0.00,$0.00,$0.00
016-120,SUP,Custom 27803010,,016-120  -  PLATE 18MM TI BONE SPNL,"$1,967.75",$0.00,"$1,967.75",$0.00,"$1,404.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,967.75",$0.00,$983.88,"$1,558.46","$1,574.20",$0.00,$0.00,$0.00,$0.00,$0.00
016-128,SUP,Custom 27803010,,016-128  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,646.88",$0.00,"$1,646.88",$0.00,"$1,175.37",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,646.88",$0.00,$823.44,"$1,304.33","$1,317.50",$0.00,$0.00,$0.00,$0.00,$0.00
016-152,SUP,Custom 27803010,,016-152  -  PLATE 18MM TI BONE SPNL,"$2,171.75",$0.00,"$2,171.75",$0.00,"$1,549.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,171.75",$0.00,"$1,085.88","$1,720.03","$1,737.40",$0.00,$0.00,$0.00,$0.00,$0.00
016-200,SUP,Custom 27803010,,016-200  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$4,069.38",$0.00,"$4,069.38",$0.00,"$2,904.31",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,069.38",$0.00,"$2,034.69","$3,222.95","$3,255.50",$0.00,$0.00,$0.00,$0.00,$0.00
0166L30,SUP,HCPCS C1729,,CATHETER URINARY BARDEX LUBRICATH FOLEY 30FR 30ML 2 WAY 2 ST,$9.58,$0.00,$9.58,$5.20,$6.83,$0.00,$1.65,$0.00,$0.00,$1.68,$9.58,$0.00,$4.79,$7.59,$7.66,$0.00,$1.50,$0.00,$1.52,$0.00
0166SI20,SUP,Custom 27203010,,0166SI20  -  CATHETER URTH 20FR 30CC STRL LTX BDX IC 2W FL BLN ATRM INS,$1.00,$0.00,$1.00,$0.00,$0.71,$0.00,$0.00,$0.00,$0.00,$0.00,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.00,$0.00,$0.00,$0.00
0166SI28,SUP,Custom 27203010,,0166SI28  -  CATHETER URTH 28FR 30CC STRL LTX BDX IC 2W FL BLN ATRM INS,$1.00,$0.00,$1.00,$0.00,$0.71,$0.00,$0.00,$0.00,$0.00,$0.00,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.00,$0.00,$0.00,$0.00
0167L18,SUP,Custom 27203010,,0167L18  -  CATHETER URETHRAL 18FR FOLEY 3 WAY ROUND TIP 2 STAGGERED EYE,$21.20,$0.00,$21.20,$0.00,$15.13,$0.00,$0.00,$0.00,$0.00,$0.00,$21.20,$0.00,$10.60,$16.79,$16.96,$0.00,$0.00,$0.00,$0.00,$0.00
0167L20,SUP,Custom 27203010,,0167L20  -  CATHETER URETHRAL STANDARD 20FR 3 WAY 2 STAGGER DRAIN EYE,$21.20,$0.00,$21.20,$0.00,$15.13,$0.00,$0.00,$0.00,$0.00,$0.00,$21.20,$0.00,$10.60,$16.79,$16.96,$0.00,$0.00,$0.00,$0.00,$0.00
0167L22,SUP,Custom 27203010,,0167L22  -  CATHETER URETHRAL STANDARD 22FR 3 WAY 2 STAGGER DRAIN EYE,$21.20,$0.00,$21.20,$0.00,$15.13,$0.00,$0.00,$0.00,$0.00,$0.00,$21.20,$0.00,$10.60,$16.79,$16.96,$0.00,$0.00,$0.00,$0.00,$0.00
0196L16,SUP,Custom 27203010,,0196L16  -  CATHETER URTH 16FR 5CC RD STRL LTX BDX LBR 2W FL 2 OPPS DRN,$31.03,$0.00,$31.03,$0.00,$22.14,$0.00,$0.00,$0.00,$0.00,$0.00,$31.03,$0.00,$15.51,$24.58,$24.82,$0.00,$0.00,$0.00,$0.00,$0.00
0196L18,SUP,Custom 27203010,,0196L18  -  CATHETER URTH 18FR 5CC RD STRL LTX BDX LBR 2W FL 2 OPPS DRN,$29.40,$0.00,$29.40,$0.00,$20.98,$0.00,$0.00,$0.00,$0.00,$0.00,$29.40,$0.00,$14.70,$23.28,$23.52,$0.00,$0.00,$0.00,$0.00,$0.00
0196L20,SUP,Custom 27203010,,0196L20  -  CATHETER URTH 20FR 5CC RD STRL LTX BDX LBR 2W FL 2 OPPS DRN,$29.55,$0.00,$29.55,$0.00,$21.09,$0.00,$0.00,$0.00,$0.00,$0.00,$29.55,$0.00,$14.78,$23.40,$23.64,$0.00,$0.00,$0.00,$0.00,$0.00
0196L22,SUP,Custom 27203010,,0196L22  -  CATHETER URTH 22FR 5CC RD STRL LTX BDX LBR 2W FL 2 OPPS DRN,$29.40,$0.00,$29.40,$0.00,$20.98,$0.00,$0.00,$0.00,$0.00,$0.00,$29.40,$0.00,$14.70,$23.28,$23.52,$0.00,$0.00,$0.00,$0.00,$0.00
02.00024.001,SUP,Custom 27203010,,02.00024.001  -  BIT DRILL 145MM 4.3MM NCB SHRT STD FEM SS QC NONSTRL,$230.75,$0.00,$230.75,$0.00,$164.69,$0.00,$0.00,$0.00,$0.00,$0.00,$230.75,$0.00,$115.38,$182.75,$184.60,$0.00,$0.00,$0.00,$0.00,$0.00
02.001.300,SUP,HCPCS C1713,,02.001.300  -  PLATE BONE CURVE 242X17.5X5.2MM 10 HOLE LP PRECONTOUR,"$2,990.18",$0.00,"$2,990.18","$1,345.58","$2,134.09",$0.00,$500.19,$0.00,$0.00,$523.56,"$2,990.18",$0.00,"$1,495.09","$2,368.22","$2,392.14",$0.00,$454.33,$0.00,$476.04,$0.00
02.001.300S,SUP,HCPCS C1713,,02.001.300S  -  PLATE 242MM SS 4.5MM SCR 10 HOLE CVD LCP BONE LEFT CNDYLR,"$3,609.93",$0.00,"$3,609.93","$1,624.47","$2,576.40",$0.00,$621.97,$0.00,$0.00,$632.07,"$3,609.93",$0.00,"$1,804.96","$2,859.06","$2,887.94",$0.00,$564.95,$0.00,$574.70,$0.00
02.001.302,SUP,HCPCS C1713,,02.001.302  -  PLATE BN CRV 278X17.5X5.2MM NS LCP CMBN 12 HL LOPRFL,"$3,052.95",$0.00,"$3,052.95","$1,373.83","$2,178.89",$0.00,$510.69,$0.00,$0.00,$534.55,"$3,052.95",$0.00,"$1,526.48","$2,417.94","$2,442.36",$0.00,$463.87,$0.00,$486.03,$0.00
02.001.304,SUP,HCPCS C1713,,02.001.304  -  PLATE BN CRV 314X17.5X5.2MM NS LCP CMBN 14 HL LOPRFL,"$3,117.10",$0.00,"$3,117.10","$1,402.70","$2,224.67",$0.00,$521.42,$0.00,$0.00,$545.78,"$3,117.10",$0.00,"$1,558.55","$2,468.74","$2,493.68",$0.00,$473.62,$0.00,$496.24,$0.00
02.001.304S,SUP,HCPCS C1713,,02.001.304S  -  PLATE 314MM SS 4.5MM SCR 14 HOLE CVD LCK LCP BONE LEFT,"$3,759.18",$0.00,"$3,759.18","$1,691.63","$2,682.92",$0.00,$647.69,$0.00,$0.00,$658.20,"$3,759.18",$0.00,"$1,879.59","$2,977.27","$3,007.34",$0.00,$588.31,$0.00,$598.46,$0.00
02.001.306,SUP,HCPCS C1713,,02.001.306  -  PLATE BN CRV 350X17.5X5.2MM NS LCP CMBN 16 HL LOPRFL,"$3,177.15",$0.00,"$3,177.15","$1,429.72","$2,267.53",$0.00,$531.46,$0.00,$0.00,$556.29,"$3,177.15",$0.00,"$1,588.58","$2,516.30","$2,541.72",$0.00,$482.74,$0.00,$505.80,$0.00
02.001.308,SUP,HCPCS C1713,,02.001.308  -  PLATE BN CRV 386X17.5X5.2MM NS LCP CMBN 18 HL LOPRFL,"$3,353.20",$0.00,"$3,353.20","$1,508.94","$2,393.18",$0.00,$560.91,$0.00,$0.00,$587.12,"$3,353.20",$0.00,"$1,676.60","$2,655.73","$2,682.56",$0.00,$509.49,$0.00,$533.83,$0.00
02.001.308S,SUP,HCPCS C1713,,02.001.308S  -  PLATE 386MM SS 4.5MM SCR 18 HOLE CVD LCK LCP BONE LEFT,"$3,908.45",$0.00,"$3,908.45","$1,758.80","$2,789.46",$0.00,$673.41,$0.00,$0.00,$684.34,"$3,908.45",$0.00,"$1,954.23","$3,095.49","$3,126.76",$0.00,$611.67,$0.00,$622.23,$0.00
02.001.320,SUP,HCPCS C1713,,02.001.320  -  PLATE BN CRV 242X17.5X5.2MM NS LCP CMBN 10 HL LOPRFL,"$2,990.18",$0.00,"$2,990.18","$1,345.58","$2,134.09",$0.00,$500.19,$0.00,$0.00,$523.56,"$2,990.18",$0.00,"$1,495.09","$2,368.22","$2,392.14",$0.00,$454.33,$0.00,$476.04,$0.00
02.001.322,SUP,HCPCS C1713,,02.001.322  -  PLATE BN CRV 278X17.5X5.2MM NS LCP CMBN 12 HL LOPRFL,"$3,052.95",$0.00,"$3,052.95","$1,373.83","$2,178.89",$0.00,$510.69,$0.00,$0.00,$534.55,"$3,052.95",$0.00,"$1,526.48","$2,417.94","$2,442.36",$0.00,$463.87,$0.00,$486.03,$0.00
02.001.324,SUP,HCPCS C1713,,02.001.324  -  PLATE BN CRV 314X17.5X5.2MM NS LCP CMBN 14 HL LOPRFL,"$3,117.10",$0.00,"$3,117.10","$1,402.70","$2,224.67",$0.00,$521.42,$0.00,$0.00,$545.78,"$3,117.10",$0.00,"$1,558.55","$2,468.74","$2,493.68",$0.00,$473.62,$0.00,$496.24,$0.00
02.001.326,SUP,HCPCS C1713,,02.001.326  -  PLATE BN CRV 350X17.5X5.2MM NS LCP CMBN 16 HL LOPRFL,"$3,177.15",$0.00,"$3,177.15","$1,429.72","$2,267.53",$0.00,$531.46,$0.00,$0.00,$556.29,"$3,177.15",$0.00,"$1,588.58","$2,516.30","$2,541.72",$0.00,$482.74,$0.00,$505.80,$0.00
02.001.328,SUP,HCPCS C1713,,02.001.328  -  PLATE BN CRV 386X17.5X5.2MM NS LCP CMBN 18 HL LOPRFL,"$3,353.20",$0.00,"$3,353.20","$1,508.94","$2,393.18",$0.00,$560.91,$0.00,$0.00,$587.12,"$3,353.20",$0.00,"$1,676.60","$2,655.73","$2,682.56",$0.00,$509.49,$0.00,$533.83,$0.00
02.001.330S,SUP,HCPCS C1713,,02.001.330S  -  PLATE BN CRV 422X17.5X5.2MM STRL LCP CMBN 20 HL LOPRFL,"$3,492.40",$0.00,"$3,492.40","$1,571.58","$2,492.53",$0.00,$584.20,$0.00,$0.00,$611.49,"$3,492.40",$0.00,"$1,746.20","$2,765.98","$2,793.92",$0.00,$530.64,$0.00,$555.99,$0.00
02.001.332S,SUP,HCPCS C1713,,02.001.332S  -  PLATE BN CRV 458X17.5X5.2MM STRL LCP CMBN 22 HL LOPRFL,"$3,548.35",$0.00,"$3,548.35","$1,596.76","$2,532.46",$0.00,$593.56,$0.00,$0.00,$621.29,"$3,548.35",$0.00,"$1,774.18","$2,810.29","$2,838.68",$0.00,$539.14,$0.00,$564.90,$0.00
02.007.000S,SUP,Custom 27203010,,02.007.000S  -  NAIL INTRAMEDULLARY END CAP STAINLESS STEEL OLECRANON,"$1,175.05",$0.00,"$1,175.05",$0.00,$838.63,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,175.05",$0.00,$587.53,$930.64,$940.04,$0.00,$0.00,$0.00,$0.00,$0.00
02.007.001,SUP,HCPCS C1713,,02.007.001  -  NAIL INTRAMEDULLARY OSTMY IMPLANT STAINLESS STEEL OLECRANON,$684.75,$0.00,$684.75,$308.14,$488.71,$0.00,$117.98,$0.00,$0.00,$119.89,$684.75,$0.00,$342.38,$542.32,$547.80,$0.00,$107.16,$0.00,$109.01,$0.00
02.03150.044,SUP,HCPCS C1713,,02.03150.044  -  SCREW BONE 44MM CORT,$344.50,$0.00,$344.50,$155.03,$245.87,$0.00,$59.36,$0.00,$0.00,$60.32,$344.50,$0.00,$172.25,$272.84,$275.60,$0.00,$53.91,$0.00,$54.84,$0.00
02.03150.048,SUP,HCPCS C1713,,02.03150.048  -  SCREW BONE 48MM TI CORT,$344.50,$0.00,$344.50,$155.03,$245.87,$0.00,$59.36,$0.00,$0.00,$60.32,$344.50,$0.00,$172.25,$272.84,$275.60,$0.00,$53.91,$0.00,$54.84,$0.00
02.03150.055,SUP,HCPCS C1713,,02.03150.055  -  SCREW BONE 55MM CORT,$344.50,$0.00,$344.50,$155.03,$245.87,$0.00,$59.36,$0.00,$0.00,$60.32,$344.50,$0.00,$172.25,$272.84,$275.60,$0.00,$53.91,$0.00,$54.84,$0.00
02.03150.300,SUP,HCPCS C1713,,02.03150.300  -  SCREW BONE 3.5MM 8MM NCB M8 PROX HUM PROTASUL-64 LCK IM NAIL,$318.50,$0.00,$318.50,$143.33,$227.31,$0.00,$54.88,$0.00,$0.00,$55.77,$318.50,$0.00,$159.25,$252.25,$254.80,$0.00,$49.85,$0.00,$50.71,$0.00
02.03152.055,SUP,HCPCS C1713,,02.03152.055  -  SCREW BONE 5MM 55MM 32MM NCB PROTASUL 64 CANC FEM SLFTAP,$295.75,$0.00,$295.75,$133.09,$211.08,$0.00,$50.96,$0.00,$0.00,$51.78,$295.75,$0.00,$147.88,$234.23,$236.60,$0.00,$46.28,$0.00,$47.08,$0.00
02.03152.065,SUP,HCPCS C1713,,02.03152.065  -  SCREW BONE 5MM 65MM 32MM NCB PROTASUL-64 CANC SLFTAP NONSTRL,$295.75,$0.00,$295.75,$133.09,$211.08,$0.00,$50.96,$0.00,$0.00,$51.78,$295.75,$0.00,$147.88,$234.23,$236.60,$0.00,$46.28,$0.00,$47.08,$0.00
02.03152.080,SUP,HCPCS C1713,,02.03152.080  -  SCREW BONE 5MM 80MM 32MM NCB PROTASUL-64 CANC SLFTAP NONSTRL,$295.75,$0.00,$295.75,$133.09,$211.08,$0.00,$50.96,$0.00,$0.00,$51.78,$295.75,$0.00,$147.88,$234.23,$236.60,$0.00,$46.28,$0.00,$47.08,$0.00
02.03152.085,SUP,HCPCS C1713,,02.03152.085  -  SCREW BONE 5MM 85MM 32MM NCB PROTASUL-64 CANC SLFTAP NONSTRL,$295.75,$0.00,$295.75,$133.09,$211.08,$0.00,$50.96,$0.00,$0.00,$51.78,$295.75,$0.00,$147.88,$234.23,$236.60,$0.00,$46.28,$0.00,$47.08,$0.00
02.03260.109,SUP,HCPCS C1713,,02.03260.109  -  PLATE 246MM PROTASUL-64 9 HOLE NCB-DF BONE LEFT FEM NONSTRL,"$2,957.50",$0.00,"$2,957.50","$1,330.88","$2,110.77",$0.00,$509.56,$0.00,$0.00,$517.83,"$2,957.50",$0.00,"$1,478.75","$2,342.34","$2,366.00",$0.00,$462.85,$0.00,$470.83,$0.00
02.100.004,SUP,HCPCS C1713,,02.100.004  -  PLATE BN 57X10X3.4MM NS CMBN 4 HL LCK LOPRFL COAX SS PUBIC,"$1,435.73",$0.00,"$1,435.73",$646.08,"$1,024.68",$0.00,$240.16,$0.00,$0.00,$251.38,"$1,435.73",$0.00,$717.86,"$1,137.10","$1,148.58",$0.00,$218.15,$0.00,$228.57,$0.00
02.100.006,SUP,HCPCS C1713,,02.100.006  -  PLATE BN 78X10X3.4MM NS CMBN 6 HL LCK LOPRFL COAX SS PUBIC,"$1,573.55",$0.00,"$1,573.55",$708.10,"$1,123.04",$0.00,$263.22,$0.00,$0.00,$275.52,"$1,573.55",$0.00,$786.78,"$1,246.25","$1,258.84",$0.00,$239.09,$0.00,$250.51,$0.00
02.100.014,SUP,HCPCS C1713,,02.100.014  -  PLATE BONE 57MM 4 HOLE LP STAINLESS STEEL PUBIC SYMPHYSIS,"$1,576.28",$0.00,"$1,576.28",$709.32,"$1,124.99",$0.00,$263.68,$0.00,$0.00,$275.99,"$1,576.28",$0.00,$788.14,"$1,248.41","$1,261.02",$0.00,$239.50,$0.00,$250.94,$0.00
02.100.016,SUP,HCPCS C1713,,02.100.016  -  PLATE BONE 78MM 6 HOLE LP STAINLESS STEEL PUBIC SYMPHYSIS,"$1,729.15",$0.00,"$1,729.15",$778.12,"$1,234.09",$0.00,$289.24,$0.00,$0.00,$302.76,"$1,729.15",$0.00,$864.58,"$1,369.49","$1,383.32",$0.00,$262.73,$0.00,$275.28,$0.00
02.100.020,SUP,HCPCS C1713,,02.100.020  -  PLATE BONE LOCK LCP STAINLESS STEEL NAVICULAR NONSTRL,"$1,422.08",$0.00,"$1,422.08",$639.93,"$1,014.93",$0.00,$237.88,$0.00,$0.00,$248.99,"$1,422.08",$0.00,$711.04,"$1,126.29","$1,137.66",$0.00,$216.07,$0.00,$226.39,$0.00
02.100.021,SUP,HCPCS C1713,,02.100.021  -  PLATE BONE LOCK STAINLESS STEEL LEFT CUBOID NONSTRL 2.4/2.7,"$1,383.85",$0.00,"$1,383.85",$622.73,$987.65,$0.00,$231.49,$0.00,$0.00,$242.30,"$1,383.85",$0.00,$691.93,"$1,096.01","$1,107.08",$0.00,$210.27,$0.00,$220.31,$0.00
02.100.022,SUP,HCPCS C1713,,02.100.022  -  PLATE BONE LOCK STAINLESS STEEL RIGHT CUBOID NONSTRL 2.4/2.7,"$1,383.85",$0.00,"$1,383.85",$622.73,$987.65,$0.00,$231.49,$0.00,$0.00,$242.30,"$1,383.85",$0.00,$691.93,"$1,096.01","$1,107.08",$0.00,$210.27,$0.00,$220.31,$0.00
02.100.023,SUP,HCPCS C1713,,02.100.023  -  PLATE BONE LOCK STAINLESS STEEL TALAR NONSTRL 2.4/2.7 MM,"$1,367.48",$0.00,"$1,367.48",$615.36,$975.97,$0.00,$228.75,$0.00,$0.00,$239.43,"$1,367.48",$0.00,$683.74,"$1,083.04","$1,093.98",$0.00,$207.78,$0.00,$217.70,$0.00
02.100.032S,SUP,HCPCS C1713,,02.100.032S  -  PLATE BN 100MM STRL LCP CMBN 6 HL SS ANKL ANT 4.5MM CORT,"$1,957.25",$0.00,"$1,957.25",$880.76,"$1,396.89",$0.00,$327.40,$0.00,$0.00,$342.70,"$1,957.25",$0.00,$978.63,"$1,550.14","$1,565.80",$0.00,$297.39,$0.00,$311.59,$0.00
02.100.033S,SUP,HCPCS C1713,,02.100.033S  -  PLATE BONE 116MM 7 HOLE LCP STAINLESS STEEL ANTERIOR ANKLE,"$2,009.65",$0.00,"$2,009.65",$904.34,"$1,434.29",$0.00,$336.17,$0.00,$0.00,$351.87,"$2,009.65",$0.00,"$1,004.83","$1,591.64","$1,607.72",$0.00,$305.35,$0.00,$319.94,$0.00
02.100.103,SUP,HCPCS C1713,,02.100.103  -  PLATE BN STRG 39X10.1X3.7MM NS CMBN 3 HL LCK LOPRFL RECON SS,$955.33,$0.00,$955.33,$429.90,$681.82,$0.00,$159.80,$0.00,$0.00,$167.27,$955.33,$0.00,$477.66,$756.62,$764.26,$0.00,$145.15,$0.00,$152.09,$0.00
02.100.104,SUP,HCPCS C1713,,02.100.104  -  PLATE BN STRG 52X10.1X3.7MM NS CMBN 4 HL LCK LOPRFL RECON SS,"$1,003.10",$0.00,"$1,003.10",$451.40,$715.91,$0.00,$167.79,$0.00,$0.00,$175.63,"$1,003.10",$0.00,$501.55,$794.46,$802.48,$0.00,$152.41,$0.00,$159.69,$0.00
02.100.105,SUP,HCPCS C1713,,02.100.105  -  PLATE BN STRG 65X10.1X3.7MM NS CMBN 5 HL LCK LOPRFL RECON SS,"$1,048.13",$0.00,"$1,048.13",$471.66,$748.05,$0.00,$175.33,$0.00,$0.00,$183.52,"$1,048.13",$0.00,$524.06,$830.12,$838.50,$0.00,$159.25,$0.00,$166.86,$0.00
02.100.106,SUP,HCPCS C1713,,02.100.106  -  PLATE BN STRG 78X10.1X3.7MM NS CMBN 6 HL LCK LOPRFL RECON SS,"$1,091.80",$0.00,"$1,091.80",$491.31,$779.22,$0.00,$182.63,$0.00,$0.00,$191.17,"$1,091.80",$0.00,$545.90,$864.71,$873.44,$0.00,$165.89,$0.00,$173.81,$0.00
02.100.107,SUP,HCPCS C1713,,02.100.107  -  PLATE BN STRG 91X10.1X3.7MM NS CMBN 7 HL LCK LOPRFL RECON SS,"$1,134.10",$0.00,"$1,134.10",$510.35,$809.41,$0.00,$189.71,$0.00,$0.00,$198.57,"$1,134.10",$0.00,$567.05,$898.21,$907.28,$0.00,$172.32,$0.00,$180.55,$0.00
02.100.108,SUP,HCPCS C1713,,02.100.108  -  PLATE BN STRG 104X10.1X3.7MM NS CMBN 8 HL LCK LOPRFL RECON,"$1,177.78",$0.00,"$1,177.78",$530.00,$840.58,$0.00,$197.02,$0.00,$0.00,$206.22,"$1,177.78",$0.00,$588.89,$932.80,$942.22,$0.00,$178.95,$0.00,$187.50,$0.00
02.100.109,SUP,HCPCS C1713,,02.100.109  -  PLATE BN STRG 117X10.1X3.7MM NS CMBN 9 HL LCK LOPRFL RECON,"$1,221.45",$0.00,"$1,221.45",$549.65,$871.75,$0.00,$204.32,$0.00,$0.00,$213.87,"$1,221.45",$0.00,$610.73,$967.39,$977.16,$0.00,$185.59,$0.00,$194.45,$0.00
02.100.110,SUP,HCPCS C1713,,02.100.110  -  PLATE BN STRG 130X10.1X3.7MM NS CMBN 10 HL LCK LOPRFL RECON,"$1,266.50",$0.00,"$1,266.50",$569.93,$903.90,$0.00,$211.85,$0.00,$0.00,$221.75,"$1,266.50",$0.00,$633.25,"$1,003.07","$1,013.20",$0.00,$192.43,$0.00,$201.63,$0.00
02.100.111,SUP,HCPCS C1713,,02.100.111  -  PLATE BN STRG 143X10.1X3.7MM NS CMBN 11 HL LCK LOPRFL RECON,"$1,310.15",$0.00,"$1,310.15",$589.57,$935.05,$0.00,$219.16,$0.00,$0.00,$229.40,"$1,310.15",$0.00,$655.08,"$1,037.64","$1,048.12",$0.00,$199.07,$0.00,$208.58,$0.00
02.100.112,SUP,HCPCS C1713,,02.100.112  -  PLATE BN STRG 156X10.1X3.7MM NS CMBN 12 HL LCK LOPRFL RECON,"$1,352.48",$0.00,"$1,352.48",$608.61,$965.26,$0.00,$226.24,$0.00,$0.00,$236.81,"$1,352.48",$0.00,$676.24,"$1,071.16","$1,081.98",$0.00,$205.50,$0.00,$215.31,$0.00
02.100.113,SUP,HCPCS C1713,,02.100.113  -  PLATE BN STRG 169X10.1X3.7MM NS CMBN 13 HL LCK LOPRFL RECON,"$1,397.50",$0.00,"$1,397.50",$628.88,$997.40,$0.00,$233.77,$0.00,$0.00,$244.69,"$1,397.50",$0.00,$698.75,"$1,106.82","$1,118.00",$0.00,$212.34,$0.00,$222.48,$0.00
02.100.114,SUP,HCPCS C1713,,02.100.114  -  PLATE BN STRG 182X10.1X3.7MM NS CMBN 14 HL LCK LOPRFL RECON,"$1,443.90",$0.00,"$1,443.90",$649.76,"$1,030.51",$0.00,$241.53,$0.00,$0.00,$252.82,"$1,443.90",$0.00,$721.95,"$1,143.57","$1,155.12",$0.00,$219.39,$0.00,$229.87,$0.00
02.100.115,SUP,HCPCS C1713,,02.100.115  -  PLATE BN STRG 195X10.1X3.7MM NS CMBN 15 HL LCK LOPRFL RECON,"$1,487.58",$0.00,"$1,487.58",$669.41,"$1,061.68",$0.00,$248.84,$0.00,$0.00,$260.46,"$1,487.58",$0.00,$743.79,"$1,178.16","$1,190.06",$0.00,$226.03,$0.00,$236.82,$0.00
02.100.116,SUP,HCPCS C1713,,02.100.116  -  PLATE BN STRG 208X10.1X3.7MM NS CMBN 16 HL LCK LOPRFL RECON,"$1,531.25",$0.00,"$1,531.25",$689.06,"$1,092.85",$0.00,$256.14,$0.00,$0.00,$268.11,"$1,531.25",$0.00,$765.63,"$1,212.75","$1,225.00",$0.00,$232.66,$0.00,$243.78,$0.00
02.100.118,SUP,HCPCS C1713,,02.100.118  -  PLATE BN STRG 234X10.1X3.7MM NS CMBN 18 HL LCK LOPRFL RECON,"$1,574.93",$0.00,"$1,574.93",$708.72,"$1,124.02",$0.00,$263.45,$0.00,$0.00,$275.76,"$1,574.93",$0.00,$787.46,"$1,247.34","$1,259.94",$0.00,$239.30,$0.00,$250.73,$0.00
02.100.120,SUP,HCPCS C1713,,02.100.120  -  PLATE BN STRG 260X10.1X3.7MM NS CMBN 20 HL LCK LOPRFL RECON,"$1,621.33",$0.00,"$1,621.33",$729.60,"$1,157.14",$0.00,$271.21,$0.00,$0.00,$283.88,"$1,621.33",$0.00,$810.66,"$1,284.09","$1,297.06",$0.00,$246.35,$0.00,$258.11,$0.00
02.100.203,SUP,HCPCS C1713,,02.100.203  -  PLATE BONE WIDE ANGLE LP 39MM 3 HOLE RECONSTRUCTION,$589.58,$0.00,$589.58,$265.31,$420.78,$0.00,$98.62,$0.00,$0.00,$103.23,$589.58,$0.00,$294.79,$466.95,$471.66,$0.00,$89.58,$0.00,$93.86,$0.00
02.100.204,SUP,HCPCS C1713,,02.100.204  -  PLATE BONE WIDE ANGLE LP 52MM 4 HOLE RECONSTRUCTION,$616.88,$0.00,$616.88,$277.59,$440.26,$0.00,$103.19,$0.00,$0.00,$108.01,$616.88,$0.00,$308.44,$488.57,$493.50,$0.00,$93.73,$0.00,$98.21,$0.00
02.100.205,SUP,HCPCS C1713,,02.100.205  -  PLATE BONE WIDE ANGLE LP 65MM 5 HOLE RECONSTRUCTION,$642.80,$0.00,$642.80,$289.26,$458.77,$0.00,$107.53,$0.00,$0.00,$112.55,$642.80,$0.00,$321.40,$509.10,$514.24,$0.00,$97.67,$0.00,$102.33,$0.00
02.100.206,SUP,HCPCS C1713,,02.100.206  -  PLATE BONE WIDE ANGLE LP 78MM 6 HOLE RECONSTRUCTION,$672.83,$0.00,$672.83,$302.77,$480.20,$0.00,$112.55,$0.00,$0.00,$117.81,$672.83,$0.00,$336.41,$532.88,$538.26,$0.00,$102.23,$0.00,$107.11,$0.00
02.100.207,SUP,HCPCS C1713,,02.100.207  -  PLATE BONE WIDE ANGLE LP 91MM 7 HOLE RECONSTRUCTION,$700.13,$0.00,$700.13,$315.06,$499.68,$0.00,$117.11,$0.00,$0.00,$122.59,$700.13,$0.00,$350.06,$554.50,$560.10,$0.00,$106.38,$0.00,$111.46,$0.00
02.100.208,SUP,HCPCS C1713,,02.100.208  -  PLATE BONE WIDE ANGLE 104MM 8 HOLE LP STAINLESS STEEL PELVIS,$726.05,$0.00,$726.05,$326.72,$518.18,$0.00,$121.45,$0.00,$0.00,$127.13,$726.05,$0.00,$363.03,$575.03,$580.84,$0.00,$110.32,$0.00,$115.59,$0.00
02.100.209,SUP,HCPCS C1713,,02.100.209  -  PLATE BONE WIDE ANGLE LP 117MM 9 HOLE RECONSTRUCTION,$756.08,$0.00,$756.08,$340.23,$539.61,$0.00,$126.47,$0.00,$0.00,$132.38,$756.08,$0.00,$378.04,$598.82,$604.86,$0.00,$114.88,$0.00,$120.37,$0.00
02.100.210,SUP,HCPCS C1713,,02.100.210  -  PLATE BONE WIDE ANGLE LP 130MM 10 HOLE RECONSTRUCTION,$784.73,$0.00,$784.73,$353.13,$560.06,$0.00,$131.27,$0.00,$0.00,$137.40,$784.73,$0.00,$392.36,$621.51,$627.78,$0.00,$119.23,$0.00,$124.93,$0.00
02.100.211,SUP,HCPCS C1713,,02.100.211  -  PLATE BONE WIDE ANGLE LP 143MM 11 HOLE RECONSTRUCTION,$825.68,$0.00,$825.68,$371.55,$589.28,$0.00,$138.12,$0.00,$0.00,$144.57,$825.68,$0.00,$412.84,$653.94,$660.54,$0.00,$125.45,$0.00,$131.45,$0.00
02.100.212,SUP,HCPCS C1713,,02.100.212  -  PLATE BN WA 156X10.1X3.85MM NS CMBN 12 HL RECON LOPRFL SS,$872.08,$0.00,$872.08,$392.43,$622.40,$0.00,$145.88,$0.00,$0.00,$152.69,$872.08,$0.00,$436.04,$690.69,$697.66,$0.00,$132.50,$0.00,$138.83,$0.00
02.100.213,SUP,HCPCS C1713,,02.100.213  -  PLATE BONE WIDE ANGLE LP 169MM 13 HOLE RECONSTRUCTION,$917.10,$0.00,$917.10,$412.70,$654.53,$0.00,$153.41,$0.00,$0.00,$160.58,$917.10,$0.00,$458.55,$726.34,$733.68,$0.00,$139.35,$0.00,$146.00,$0.00
02.100.214,SUP,HCPCS C1713,,02.100.214  -  PLATE BONE WIDE ANGLE LP 182MM 14 HOLE RECONSTRUCTION,$956.70,$0.00,$956.70,$430.52,$682.80,$0.00,$160.03,$0.00,$0.00,$167.51,$956.70,$0.00,$478.35,$757.71,$765.36,$0.00,$145.36,$0.00,$152.31,$0.00
02.100.215,SUP,HCPCS C1713,,02.100.215  -  PLATE BONE WIDE ANGLE LP 195MM 15 HOLE RECONSTRUCTION,"$1,004.45",$0.00,"$1,004.45",$452.00,$716.88,$0.00,$168.02,$0.00,$0.00,$175.87,"$1,004.45",$0.00,$502.23,$795.52,$803.56,$0.00,$152.62,$0.00,$159.91,$0.00
02.100.216,SUP,HCPCS C1713,,02.100.216  -  PLATE BONE WIDE ANGLE LP 208MM 16 HOLE RECONSTRUCTION,"$1,049.50",$0.00,"$1,049.50",$472.28,$749.03,$0.00,$175.56,$0.00,$0.00,$183.76,"$1,049.50",$0.00,$524.75,$831.20,$839.60,$0.00,$159.46,$0.00,$167.08,$0.00
02.100.218,SUP,HCPCS C1713,,02.100.218  -  PLATE BONE WIDE ANGLE LP 234MM 18 HOLE RECONSTRUCTION,"$1,094.53",$0.00,"$1,094.53",$492.54,$781.16,$0.00,$183.09,$0.00,$0.00,$191.64,"$1,094.53",$0.00,$547.26,$866.87,$875.62,$0.00,$166.30,$0.00,$174.25,$0.00
02.100.220,SUP,HCPCS C1713,,02.100.220  -  PLATE BONE WIDE ANGLE LP 260MM 20 HOLE RECONSTRUCTION,"$1,135.48",$0.00,"$1,135.48",$510.96,$810.39,$0.00,$189.94,$0.00,$0.00,$198.81,"$1,135.48",$0.00,$567.74,$899.30,$908.38,$0.00,$172.53,$0.00,$180.77,$0.00
02.100.301,SUP,HCPCS C1713,,02.100.301  -  PLATE BONE 1 HOLE SPRING LCP STAINLESS STEEL PELVIC NONSTRL,$412.15,$0.00,$412.15,$185.47,$294.15,$0.00,$68.94,$0.00,$0.00,$72.16,$412.15,$0.00,$206.08,$326.42,$329.72,$0.00,$62.62,$0.00,$65.61,$0.00
02.100.302,SUP,HCPCS C1713,,02.100.302  -  PLATE BONE 2 HOLE SPRING LCP STAINLESS STEEL PELVIC NONSTRL,$447.65,$0.00,$447.65,$201.44,$319.49,$0.00,$74.88,$0.00,$0.00,$78.38,$447.65,$0.00,$223.83,$354.54,$358.12,$0.00,$68.01,$0.00,$71.27,$0.00
02.100.303,SUP,HCPCS C1713,,02.100.303  -  PLATE BONE 3 HOLE SPRING LCP STAINLESS STEEL PELVIC NONSTRL,$491.30,$0.00,$491.30,$221.09,$350.64,$0.00,$82.18,$0.00,$0.00,$86.02,$491.30,$0.00,$245.65,$389.11,$393.04,$0.00,$74.65,$0.00,$78.21,$0.00
02.100.325S,SUP,HCPCS C1713,,02.100.325S  -  PLATE BONE STANDARD QUADRILATERAL SURFACE STAINLESS STEEL,$715.13,$0.00,$715.13,$321.81,$510.38,$0.00,$119.62,$0.00,$0.00,$125.21,$715.13,$0.00,$357.56,$566.38,$572.10,$0.00,$108.66,$0.00,$113.85,$0.00
02.100.326S,SUP,HCPCS C1713,,02.100.326S  -  PLATE BONE LONG QUADRILATERAL SURFACE STAINLESS STEEL PELVIS,$787.45,$0.00,$787.45,$354.35,$562.00,$0.00,$131.72,$0.00,$0.00,$137.88,$787.45,$0.00,$393.73,$623.66,$629.96,$0.00,$119.65,$0.00,$125.36,$0.00
02.100.327S,SUP,HCPCS C1713,,02.100.327S  -  PLATE BONE SHORT LP QUADRILATERAL SURFACE STAINLESS STEEL,$649.63,$0.00,$649.63,$292.33,$463.64,$0.00,$108.67,$0.00,$0.00,$113.74,$649.63,$0.00,$324.81,$514.51,$519.70,$0.00,$98.70,$0.00,$103.42,$0.00
02.100.360,SUP,HCPCS C1713,,02.100.360  -  PLATE BONE J CVD 130X10.1X3.7MM 10 HOLE LOCKING COAXIAL,"$1,316.98",$0.00,"$1,316.98",$592.64,$939.93,$0.00,$220.30,$0.00,$0.00,$230.59,"$1,316.98",$0.00,$658.49,"$1,043.05","$1,053.58",$0.00,$200.10,$0.00,$209.66,$0.00
02.100.361,SUP,HCPCS C1713,,02.100.361  -  PLATE BN 88MM RDS J 130X10.1X3.7MM NS CMBN 10 HL LCK LOPRFL,"$1,316.98",$0.00,"$1,316.98",$592.64,$939.93,$0.00,$220.30,$0.00,$0.00,$230.59,"$1,316.98",$0.00,$658.49,"$1,043.05","$1,053.58",$0.00,$200.10,$0.00,$209.66,$0.00
02.100.362,SUP,HCPCS C1713,,02.100.362  -  PLATE BONE 156MM 12 HOLE J LOCKING LP RECONSTRUCTION LCP,"$1,390.68",$0.00,"$1,390.68",$625.80,$992.52,$0.00,$232.63,$0.00,$0.00,$243.50,"$1,390.68",$0.00,$695.34,"$1,101.42","$1,112.54",$0.00,$211.30,$0.00,$221.40,$0.00
02.100.363,SUP,HCPCS C1713,,02.100.363  -  PLATE BONE J CVD 156X10.1X3.7MM 12 HOLE LOCKING COAXIAL,"$1,390.68",$0.00,"$1,390.68",$625.80,$992.52,$0.00,$232.63,$0.00,$0.00,$243.50,"$1,390.68",$0.00,$695.34,"$1,101.42","$1,112.54",$0.00,$211.30,$0.00,$221.40,$0.00
02.100.364,SUP,HCPCS C1713,,02.100.364  -  PLATE BONE J CVD 182X10.1X3.7MM 14 HOLE LOCKING COAXIAL,"$1,465.75",$0.00,"$1,465.75",$659.59,"$1,046.11",$0.00,$245.18,$0.00,$0.00,$256.64,"$1,465.75",$0.00,$732.88,"$1,160.87","$1,172.60",$0.00,$222.71,$0.00,$233.35,$0.00
02.100.365,SUP,HCPCS C1713,,02.100.365  -  PLATE BONE 182MM 14 HOLE J LOCKING LP RECONSTRUCTION LCP,"$1,465.75",$0.00,"$1,465.75",$659.59,"$1,046.11",$0.00,$245.18,$0.00,$0.00,$256.64,"$1,465.75",$0.00,$732.88,"$1,160.87","$1,172.60",$0.00,$222.71,$0.00,$233.35,$0.00
02.100.366,SUP,HCPCS C1713,,02.100.366  -  PLATE BN 88MM RDS J 208X10.1X3.7MM NS CMBN 16 HL LCK LOPRFL,"$1,550.35",$0.00,"$1,550.35",$697.66,"$1,106.48",$0.00,$259.34,$0.00,$0.00,$271.45,"$1,550.35",$0.00,$775.18,"$1,227.88","$1,240.28",$0.00,$235.56,$0.00,$246.82,$0.00
02.100.367,SUP,HCPCS C1713,,02.100.367  -  PLATE BN 88MM RDS J 208X10.1X3.7MM NS CMBN 16 HL LCK LOPRFL,"$1,550.35",$0.00,"$1,550.35",$697.66,"$1,106.48",$0.00,$259.34,$0.00,$0.00,$271.45,"$1,550.35",$0.00,$775.18,"$1,227.88","$1,240.28",$0.00,$235.56,$0.00,$246.82,$0.00
02.102.001,SUP,HCPCS C1713,,02.102.001  -  PLATE BONE UNIVERSAL 131MM LOCKING STABILIZATION LCP,"$1,198.25",$0.00,"$1,198.25",$539.21,$855.19,$0.00,$200.44,$0.00,$0.00,$209.80,"$1,198.25",$0.00,$599.13,$949.01,$958.60,$0.00,$182.06,$0.00,$190.76,$0.00
02.104.004,SUP,HCPCS C1713,,02.104.004  -  PLATE BN 122MM NS LCP CMBN 4 HL PRECONTOUR LMT CNTCT TPR HD,"$2,225.90",$0.00,"$2,225.90","$1,001.66","$1,588.62",$0.00,$372.34,$0.00,$0.00,$389.74,"$2,225.90",$0.00,"$1,112.95","$1,762.91","$1,780.72",$0.00,$338.21,$0.00,$354.36,$0.00
02.104.006,SUP,HCPCS C1713,,02.104.006  -  PLATE BONE 158MM 6 HOLE LCP STAINLESS STEEL RIGHT DISTAL,"$2,546.63",$0.00,"$2,546.63","$1,145.98","$1,817.53",$0.00,$425.99,$0.00,$0.00,$445.89,"$2,546.63",$0.00,"$1,273.31","$2,016.93","$2,037.30",$0.00,$386.94,$0.00,$405.42,$0.00
02.104.008,SUP,HCPCS C1713,,02.104.008  -  PLATE BONE 194MM 8 HOLE LOCKING TAPER HEAD LIMIT CONTACT,"$2,702.20",$0.00,"$2,702.20","$1,215.99","$1,928.56",$0.00,$452.02,$0.00,$0.00,$473.13,"$2,702.20",$0.00,"$1,351.10","$2,140.14","$2,161.76",$0.00,$410.58,$0.00,$430.19,$0.00
02.104.010,SUP,HCPCS C1713,,02.104.010  -  PLATE BONE 230MM 10 HOLE LCP STAINLESS STEEL EXTART RIGHT,"$2,860.53",$0.00,"$2,860.53","$1,287.24","$2,041.56",$0.00,$478.50,$0.00,$0.00,$500.86,"$2,860.53",$0.00,"$1,430.26","$2,265.54","$2,288.42",$0.00,$434.63,$0.00,$455.40,$0.00
02.104.012,SUP,HCPCS C1713,,02.104.012  -  PLATE BN 266MM NS LCP CMBN 12 HL PRECONTOUR LMT CNTCT TPR HD,"$3,268.58",$0.00,"$3,268.58","$1,470.86","$2,332.78",$0.00,$546.76,$0.00,$0.00,$572.30,"$3,268.58",$0.00,"$1,634.29","$2,588.72","$2,614.86",$0.00,$496.63,$0.00,$520.36,$0.00
02.104.014,SUP,HCPCS C1713,,02.104.014  -  PLATE BN 302MM NS LCP CMBN 14 HL PRECONTOUR LMT CNTCT TPR HD,"$3,597.48",$0.00,"$3,597.48","$1,618.86","$2,567.52",$0.00,$601.77,$0.00,$0.00,$629.89,"$3,597.48",$0.00,"$1,798.74","$2,849.20","$2,877.98",$0.00,$546.61,$0.00,$572.72,$0.00
02.104.024,SUP,HCPCS C1713,,02.104.024  -  PLATE BN 122MM NS LCP CMBN 4 HL PRECONTOUR LMT CNTCT TPR HD,"$2,225.90",$0.00,"$2,225.90","$1,001.66","$1,588.62",$0.00,$372.34,$0.00,$0.00,$389.74,"$2,225.90",$0.00,"$1,112.95","$1,762.91","$1,780.72",$0.00,$338.21,$0.00,$354.36,$0.00
02.104.026,SUP,HCPCS C1713,,02.104.026  -  PLATE BONE 158MM 6 HOLE LCP STAINLESS STEEL LEFT DISTAL,"$2,546.63",$0.00,"$2,546.63","$1,145.98","$1,817.53",$0.00,$425.99,$0.00,$0.00,$445.89,"$2,546.63",$0.00,"$1,273.31","$2,016.93","$2,037.30",$0.00,$386.94,$0.00,$405.42,$0.00
02.104.028,SUP,HCPCS C1713,,02.104.028  -  PLATE BONE 194MM 8 HOLE LCP STAINLESS STEEL LEFT DISTAL,"$2,702.20",$0.00,"$2,702.20","$1,215.99","$1,928.56",$0.00,$452.02,$0.00,$0.00,$473.13,"$2,702.20",$0.00,"$1,351.10","$2,140.14","$2,161.76",$0.00,$410.58,$0.00,$430.19,$0.00
02.104.030,SUP,HCPCS C1713,,02.104.030  -  PLATE BONE 230MM 10 HOLE LCP STAINLESS STEEL LEFT DISTAL,"$2,860.53",$0.00,"$2,860.53","$1,287.24","$2,041.56",$0.00,$478.50,$0.00,$0.00,$500.86,"$2,860.53",$0.00,"$1,430.26","$2,265.54","$2,288.42",$0.00,$434.63,$0.00,$455.40,$0.00
02.104.032,SUP,HCPCS C1713,,02.104.032  -  PLATE BN 266MM NS LCP CMBN 12 HL PRECONTOUR LMT CNTCT TPR HD,"$3,268.58",$0.00,"$3,268.58","$1,470.86","$2,332.78",$0.00,$546.76,$0.00,$0.00,$572.30,"$3,268.58",$0.00,"$1,634.29","$2,588.72","$2,614.86",$0.00,$496.63,$0.00,$520.36,$0.00
02.104.034,SUP,HCPCS C1713,,02.104.034  -  PLATE BN 302MM NS LCP CMBN 14 HL PRECONTOUR LMT CNTCT TPR HD,"$3,597.48",$0.00,"$3,597.48","$1,618.86","$2,567.52",$0.00,$601.77,$0.00,$0.00,$629.89,"$3,597.48",$0.00,"$1,798.74","$2,849.20","$2,877.98",$0.00,$546.61,$0.00,$572.72,$0.00
02.107.002,SUP,HCPCS C1713,,02.107.002  -  PLATE BN 73MM NS LCP CMBN 2 HL VA TPR TIP RND PRFL SS OLCRN,"$1,680.00",$0.00,"$1,680.00",$756.00,"$1,199.02",$0.00,$281.03,$0.00,$0.00,$294.15,"$1,680.00",$0.00,$840.00,"$1,330.56","$1,344.00",$0.00,$255.26,$0.00,$267.46,$0.00
02.107.002S,SUP,HCPCS C1713,,02.107.002S  -  PLATE BONE 73MM 2 HOLE VAR ANG LCP STAINLESS STEEL RIGHT,"$1,768.73",$0.00,"$1,768.73",$795.93,"$1,262.34",$0.00,$295.86,$0.00,$0.00,$309.69,"$1,768.73",$0.00,$884.36,"$1,400.83","$1,414.98",$0.00,$268.74,$0.00,$281.58,$0.00
02.107.102,SUP,HCPCS C1713,,02.107.102  -  PLATE BONE 73MM 2 HOLE VAR ANG LCP STAINLESS STEEL ELBOW,"$1,680.00",$0.00,"$1,680.00",$756.00,"$1,199.02",$0.00,$281.03,$0.00,$0.00,$294.15,"$1,680.00",$0.00,$840.00,"$1,330.56","$1,344.00",$0.00,$255.26,$0.00,$267.46,$0.00
02.107.102S,SUP,HCPCS C1713,,02.107.102S  -  PLATE BN 73MM STRL LCP CMBN 2 HL VA TPR TIP RND PRFL SS,"$1,768.73",$0.00,"$1,768.73",$795.93,"$1,262.34",$0.00,$295.86,$0.00,$0.00,$309.69,"$1,768.73",$0.00,$884.36,"$1,400.83","$1,414.98",$0.00,$268.74,$0.00,$281.58,$0.00
02.107.202S,SUP,HCPCS C1713,,02.107.202S  -  PLATE BONE 90MM 2 HOLE VAR ANG LCP STAINLESS STEEL RIGHT,"$1,977.53",$0.00,"$1,977.53",$889.89,"$1,411.36",$0.00,$330.79,$0.00,$0.00,$346.25,"$1,977.53",$0.00,$988.76,"$1,566.20","$1,582.02",$0.00,$300.47,$0.00,$314.82,$0.00
02.107.204,SUP,HCPCS C1713,,02.107.204  -  PLATE BN 116MM NS LCP CMBN 4 HL VA TPR TIP RND PRFL SS OLCRN,"$1,888.83",$0.00,"$1,888.83",$849.97,"$1,348.05",$0.00,$315.95,$0.00,$0.00,$330.72,"$1,888.83",$0.00,$944.41,"$1,495.95","$1,511.06",$0.00,$286.99,$0.00,$300.70,$0.00
02.107.204S,SUP,HCPCS C1713,,02.107.204S  -  PLATE BONE 116MM 4 HOLE VAR ANG LCP STAINLESS STEEL RIGHT,"$1,977.53",$0.00,"$1,977.53",$889.89,"$1,411.36",$0.00,$330.79,$0.00,$0.00,$346.25,"$1,977.53",$0.00,$988.76,"$1,566.20","$1,582.02",$0.00,$300.47,$0.00,$314.82,$0.00
02.107.206S,SUP,HCPCS C1713,,02.107.206S  -  PLATE BONE 142MM 2 HOLE VAR ANG RECONSTRUCTION SEGMENT,"$1,977.53",$0.00,"$1,977.53",$889.89,"$1,411.36",$0.00,$330.79,$0.00,$0.00,$346.25,"$1,977.53",$0.00,$988.76,"$1,566.20","$1,582.02",$0.00,$300.47,$0.00,$314.82,$0.00
02.107.208S,SUP,HCPCS C1713,,02.107.208S  -  PLATE BN 169MM STRL LCP CMBN 8 HL VA TPR TIP RND PRFL SS,"$1,977.53",$0.00,"$1,977.53",$889.89,"$1,411.36",$0.00,$330.79,$0.00,$0.00,$346.25,"$1,977.53",$0.00,$988.76,"$1,566.20","$1,582.02",$0.00,$300.47,$0.00,$314.82,$0.00
02.107.302S,SUP,HCPCS C1713,,02.107.302S  -  PLATE BONE 90MM 2 HOLE VAR ANG LCP STAINLESS STEEL LEFT,"$1,977.53",$0.00,"$1,977.53",$889.89,"$1,411.36",$0.00,$330.79,$0.00,$0.00,$346.25,"$1,977.53",$0.00,$988.76,"$1,566.20","$1,582.02",$0.00,$300.47,$0.00,$314.82,$0.00
02.107.304,SUP,HCPCS C1713,,02.107.304  -  PLATE BN 116MM NS LCP CMBN 4 HL VA TPR TIP RND PRFL SS OLCRN,"$1,888.83",$0.00,"$1,888.83",$849.97,"$1,348.05",$0.00,$315.95,$0.00,$0.00,$330.72,"$1,888.83",$0.00,$944.41,"$1,495.95","$1,511.06",$0.00,$286.99,$0.00,$300.70,$0.00
02.107.304S,SUP,HCPCS C1713,,02.107.304S  -  PLATE BONE 116MM 4 HOLE VAR ANG RECONSTRUCTION SEGMENT,"$1,977.53",$0.00,"$1,977.53",$889.89,"$1,411.36",$0.00,$330.79,$0.00,$0.00,$346.25,"$1,977.53",$0.00,$988.76,"$1,566.20","$1,582.02",$0.00,$300.47,$0.00,$314.82,$0.00
02.107.306S,SUP,HCPCS C1713,,02.107.306S  -  PLATE BONE 142MM 6 HOLE VAR ANG STAINLESS STEEL LEFT,"$1,977.53",$0.00,"$1,977.53",$889.89,"$1,411.36",$0.00,$330.79,$0.00,$0.00,$346.25,"$1,977.53",$0.00,$988.76,"$1,566.20","$1,582.02",$0.00,$300.47,$0.00,$314.82,$0.00
02.107.308S,SUP,HCPCS C1713,,02.107.308S  -  PLATE BN 169MM STRL LCP CMBN 8 HL VA TPR TIP RND PRFL SS,"$1,977.53",$0.00,"$1,977.53",$889.89,"$1,411.36",$0.00,$330.79,$0.00,$0.00,$346.25,"$1,977.53",$0.00,$988.76,"$1,566.20","$1,582.02",$0.00,$300.47,$0.00,$314.82,$0.00
02.107.408S,SUP,HCPCS C1713,,02.107.408S  -  PLATE BONE 157MM 8 HOLE VAR ANG RECONSTRUCTION SEGMENT,"$2,261.40",$0.00,"$2,261.40","$1,017.63","$1,613.96",$0.00,$378.28,$0.00,$0.00,$395.95,"$2,261.40",$0.00,"$1,130.70","$1,791.03","$1,809.12",$0.00,$343.60,$0.00,$360.01,$0.00
02.107.506S,SUP,HCPCS C1713,,02.107.506S  -  PLATE BN 131MM STRL LCP CMBN 6 HL VA TPR TIP RND PRFL SS,"$2,261.40",$0.00,"$2,261.40","$1,017.63","$1,613.96",$0.00,$378.28,$0.00,$0.00,$395.95,"$2,261.40",$0.00,"$1,130.70","$1,791.03","$1,809.12",$0.00,$343.60,$0.00,$360.01,$0.00
02.107.508,SUP,HCPCS C1713,,02.107.508  -  PLATE BN 157MM NS LCP CMBN 8 HL VA TPR TIP RND PRFL SS ULNA,"$2,172.68",$0.00,"$2,172.68",$977.70,"$1,550.64",$0.00,$363.44,$0.00,$0.00,$380.42,"$2,172.68",$0.00,"$1,086.34","$1,720.76","$1,738.14",$0.00,$330.12,$0.00,$345.89,$0.00
02.107.508S,SUP,HCPCS C1713,,02.107.508S  -  PLATE BONE 157MM 8 HOLE VAR ANG RECONSTRUCTION SEGMENT,"$2,261.40",$0.00,"$2,261.40","$1,017.63","$1,613.96",$0.00,$378.28,$0.00,$0.00,$395.95,"$2,261.40",$0.00,"$1,130.70","$1,791.03","$1,809.12",$0.00,$343.60,$0.00,$360.01,$0.00
02.107.512S,SUP,HCPCS C1713,,02.107.512S  -  PLATE BONE 211MM 12 HOLE VAR ANG RECONSTRUCTION SEGMENT,"$2,261.40",$0.00,"$2,261.40","$1,017.63","$1,613.96",$0.00,$378.28,$0.00,$0.00,$395.95,"$2,261.40",$0.00,"$1,130.70","$1,791.03","$1,809.12",$0.00,$343.60,$0.00,$360.01,$0.00
02.108.200,SUP,Custom 27203010,,02.108.200  -  GUIDEWIRE ORTHOPEDIC THREAD 3MM 230MM DRILL TIP NONSTRL,$35.08,$0.00,$35.08,$0.00,$25.03,$0.00,$0.00,$0.00,$0.00,$0.00,$35.08,$0.00,$17.54,$27.78,$28.06,$0.00,$0.00,$0.00,$0.00,$0.00
02.108.310,SUP,HCPCS C1713,,02.108.310  -  PLATE BONE 100D 3 HOLE LCP STAINLESS STEEL PEDIATRIC HIP,$975.80,$0.00,$975.80,$439.11,$696.43,$0.00,$163.23,$0.00,$0.00,$170.85,$975.80,$0.00,$487.90,$772.83,$780.64,$0.00,$148.26,$0.00,$155.35,$0.00
02.108.311,SUP,HCPCS C1713,,02.108.311  -  PLATE BONE 110D 3 HOLE LCP STAINLESS STEEL PEDIATRIC HIP,$975.80,$0.00,$975.80,$439.11,$696.43,$0.00,$163.23,$0.00,$0.00,$170.85,$975.80,$0.00,$487.90,$772.83,$780.64,$0.00,$148.26,$0.00,$155.35,$0.00
02.108.313,SUP,HCPCS C1713,,02.108.313  -  PLATE BN 120D 75X19-12MM NS LCP 4 HL SHFT SS PED HIP 3.5MM,$975.80,$0.00,$975.80,$439.11,$696.43,$0.00,$163.23,$0.00,$0.00,$170.85,$975.80,$0.00,$487.90,$772.83,$780.64,$0.00,$148.26,$0.00,$155.35,$0.00
02.108.315,SUP,HCPCS C1713,,02.108.315  -  PLATE BONE 150D 60X18.5MM 3 HOLE LCP STAINLESS STEEL,$975.80,$0.00,$975.80,$439.11,$696.43,$0.00,$163.23,$0.00,$0.00,$170.85,$975.80,$0.00,$487.90,$772.83,$780.64,$0.00,$148.26,$0.00,$155.35,$0.00
02.108.320,SUP,HCPCS C1713,,02.108.320  -  PLATE BONE 100D 3 HOLE LCP STAINLESS STEEL PEDIATRIC HIP,"$1,014.00",$0.00,"$1,014.00",$456.30,$723.69,$0.00,$169.62,$0.00,$0.00,$177.54,"$1,014.00",$0.00,$507.00,$803.09,$811.20,$0.00,$154.07,$0.00,$161.43,$0.00
02.108.321,SUP,HCPCS C1713,,02.108.321  -  PLATE BONE 110D 5 HOLE LCP STAINLESS STEEL PEDIATRIC HIP,"$1,014.00",$0.00,"$1,014.00",$456.30,$723.69,$0.00,$169.62,$0.00,$0.00,$177.54,"$1,014.00",$0.00,$507.00,$803.09,$811.20,$0.00,$154.07,$0.00,$161.43,$0.00
02.108.323,SUP,HCPCS C1713,,02.108.323  -  PLATE BN 120D 95X23-15MM NS LCP 4 HL SHFT SS PED HIP 5MM SCR,"$1,014.00",$0.00,"$1,014.00",$456.30,$723.69,$0.00,$169.62,$0.00,$0.00,$177.54,"$1,014.00",$0.00,$507.00,$803.09,$811.20,$0.00,$154.07,$0.00,$161.43,$0.00
02.108.325,SUP,HCPCS C1713,,02.108.325  -  PLATE BONE 150D 3 HOLE LCP STAINLESS STEEL PEDIATRIC HIP,"$1,014.00",$0.00,"$1,014.00",$456.30,$723.69,$0.00,$169.62,$0.00,$0.00,$177.54,"$1,014.00",$0.00,$507.00,$803.09,$811.20,$0.00,$154.07,$0.00,$161.43,$0.00
02.110.005,SUP,HCPCS C1713,,02.110.005  -  PLATE BN NS LCP 5 HL SHFT SS RDS RT VOLR DIST,"$2,835.95",$0.00,"$2,835.95","$1,276.18","$2,024.02",$0.00,$474.39,$0.00,$0.00,$496.55,"$2,835.95",$0.00,"$1,417.98","$2,246.07","$2,268.76",$0.00,$430.90,$0.00,$451.48,$0.00
02.110.007,SUP,HCPCS C1713,,02.110.007  -  PLATE BN NS LCP 7 HL SHFT SS RDS RT VOLR DIST,"$2,905.55",$0.00,"$2,905.55","$1,307.50","$2,073.69",$0.00,$486.03,$0.00,$0.00,$508.74,"$2,905.55",$0.00,"$1,452.78","$2,301.20","$2,324.44",$0.00,$441.47,$0.00,$462.56,$0.00
02.110.009,SUP,HCPCS C1713,,02.110.009  -  PLATE BN NS LCP 9 HL SHFT SS RDS RT VOLR DIST,"$2,973.80",$0.00,"$2,973.80","$1,338.21","$2,122.40",$0.00,$497.45,$0.00,$0.00,$520.69,"$2,973.80",$0.00,"$1,486.90","$2,355.25","$2,379.04",$0.00,$451.84,$0.00,$473.43,$0.00
02.110.011,SUP,HCPCS C1713,,02.110.011  -  PLATE BN NS LCP 11 HL SHFT SS RDS RT VOLR DIST,"$3,156.68",$0.00,"$3,156.68","$1,420.50","$2,252.92",$0.00,$528.04,$0.00,$0.00,$552.71,"$3,156.68",$0.00,"$1,578.34","$2,500.09","$2,525.34",$0.00,$479.63,$0.00,$502.54,$0.00
02.110.013S,SUP,HCPCS C1713,,02.110.013S  -  PLATE BONE 13 HOLE LCP STAINLESS STEEL RIGHT DIAPHYSIS,"$3,332.73",$0.00,"$3,332.73","$1,499.73","$2,378.57",$0.00,$557.49,$0.00,$0.00,$583.53,"$3,332.73",$0.00,"$1,666.36","$2,639.52","$2,666.18",$0.00,$506.38,$0.00,$530.57,$0.00
02.110.015S,SUP,HCPCS C1713,,02.110.015S  -  PLATE BONE 15 HOLE LCP STAINLESS STEEL RIGHT DIAPHYSIS,"$3,506.05",$0.00,"$3,506.05","$1,577.72","$2,502.27",$0.00,$586.48,$0.00,$0.00,$613.88,"$3,506.05",$0.00,"$1,753.03","$2,776.79","$2,804.84",$0.00,$532.71,$0.00,$558.16,$0.00
02.110.105,SUP,HCPCS C1713,,02.110.105  -  PLATE BN NS LCP 5 HL SHFT SS RDS LT VOLR DIST,"$2,835.95",$0.00,"$2,835.95","$1,276.18","$2,024.02",$0.00,$474.39,$0.00,$0.00,$496.55,"$2,835.95",$0.00,"$1,417.98","$2,246.07","$2,268.76",$0.00,$430.90,$0.00,$451.48,$0.00
02.110.107,SUP,HCPCS C1713,,02.110.107  -  PLATE BN NS LCP 7 HL SHFT SS RDS LT VOLR DIST,"$2,905.55",$0.00,"$2,905.55","$1,307.50","$2,073.69",$0.00,$486.03,$0.00,$0.00,$508.74,"$2,905.55",$0.00,"$1,452.78","$2,301.20","$2,324.44",$0.00,$441.47,$0.00,$462.56,$0.00
02.110.109,SUP,HCPCS C1713,,02.110.109  -  PLATE BN NS LCP 9 HL SHFT SS RDS LT VOLR DIST,"$2,973.80",$0.00,"$2,973.80","$1,338.21","$2,122.40",$0.00,$497.45,$0.00,$0.00,$520.69,"$2,973.80",$0.00,"$1,486.90","$2,355.25","$2,379.04",$0.00,$451.84,$0.00,$473.43,$0.00
02.110.111,SUP,HCPCS C1713,,02.110.111  -  PLATE BN NS LCP 11 HL SHFT SS RDS LT VOLR DIST,"$3,042.03",$0.00,"$3,042.03","$1,368.91","$2,171.09",$0.00,$508.86,$0.00,$0.00,$532.63,"$3,042.03",$0.00,"$1,521.01","$2,409.29","$2,433.62",$0.00,$462.21,$0.00,$484.29,$0.00
02.110.113S,SUP,HCPCS C1713,,02.110.113S  -  PLATE BONE 13 HOLE LCP STAINLESS STEEL LEFT DISTAL VOLAR,"$3,395.50",$0.00,"$3,395.50","$1,527.98","$2,423.37",$0.00,$567.99,$0.00,$0.00,$594.52,"$3,395.50",$0.00,"$1,697.75","$2,689.24","$2,716.40",$0.00,$515.92,$0.00,$540.56,$0.00
02.110.115S,SUP,HCPCS C1713,,02.110.115S  -  PLATE BONE 15 HOLE LCP STAINLESS STEEL LEFT DISTAL VOLAR,"$3,506.05",$0.00,"$3,506.05","$1,577.72","$2,502.27",$0.00,$586.48,$0.00,$0.00,$613.88,"$3,506.05",$0.00,"$1,753.03","$2,776.79","$2,804.84",$0.00,$532.71,$0.00,$558.16,$0.00
02.110.150,SUP,HCPCS C1713,,02.110.150  -  PLATE BN STD BND 118MM NS LCP FSN SS WRST,"$3,054.30",$0.00,"$3,054.30","$1,374.44","$2,179.85",$0.00,$510.91,$0.00,$0.00,$534.78,"$3,054.30",$0.00,"$1,527.15","$2,419.01","$2,443.44",$0.00,$464.08,$0.00,$486.24,$0.00
02.110.151,SUP,HCPCS C1713,,02.110.151  -  PLATE BN SHRT BND 118MM NS LCP FSN SS WRST,"$3,054.30",$0.00,"$3,054.30","$1,374.44","$2,179.85",$0.00,$510.91,$0.00,$0.00,$534.78,"$3,054.30",$0.00,"$1,527.15","$2,419.01","$2,443.44",$0.00,$464.08,$0.00,$486.24,$0.00
02.110.152,SUP,HCPCS C1713,,02.110.152  -  PLATE BONE STR 112MM FUSION LCP STAINLESS STEEL WRIST,"$3,054.30",$0.00,"$3,054.30","$1,374.44","$2,179.85",$0.00,$510.91,$0.00,$0.00,$534.78,"$3,054.30",$0.00,"$1,527.15","$2,419.01","$2,443.44",$0.00,$464.08,$0.00,$486.24,$0.00
02.110.201,SUP,HCPCS C1713,,02.110.201  -  PLATE BN 48MM NS LCP CMBN 5 HLE/HD 3 HL SHFT VA SS RDS RT,"$1,819.20",$0.00,"$1,819.20",$818.64,"$1,298.36",$0.00,$304.31,$0.00,$0.00,$318.53,"$1,819.20",$0.00,$909.60,"$1,440.81","$1,455.36",$0.00,$276.41,$0.00,$289.62,$0.00
02.110.202,SUP,HCPCS C1713,,02.110.202  -  PLATE BN 66MM NS LCP CMBN 5 HLE/HD 5 HL SHFT VA SS RDS RT,"$1,957.05",$0.00,"$1,957.05",$880.67,"$1,396.75",$0.00,$327.37,$0.00,$0.00,$342.66,"$1,957.05",$0.00,$978.53,"$1,549.98","$1,565.64",$0.00,$297.36,$0.00,$311.56,$0.00
02.110.203,SUP,HCPCS C1713,,02.110.203  -  PLATE BN 48MM NS LCP CMBN 5 HLE/HD 3 HL SHFT VA SS RDS LT,"$1,819.20",$0.00,"$1,819.20",$818.64,"$1,298.36",$0.00,$304.31,$0.00,$0.00,$318.53,"$1,819.20",$0.00,$909.60,"$1,440.81","$1,455.36",$0.00,$276.41,$0.00,$289.62,$0.00
02.110.204,SUP,HCPCS C1713,,02.110.204  -  PLATE BN 66MM NS LCP CMBN 5 HLE/HD 5 HL SHFT VA SS RDS LT,"$1,957.05",$0.00,"$1,957.05",$880.67,"$1,396.75",$0.00,$327.37,$0.00,$0.00,$342.66,"$1,957.05",$0.00,$978.53,"$1,549.98","$1,565.64",$0.00,$297.36,$0.00,$311.56,$0.00
02.110.205,SUP,HCPCS C1713,,02.110.205  -  PLATE BN 45MM NS LCP CMBN 4 HLE/HD 3 HL SHFT VA SS RDS RT,"$1,819.20",$0.00,"$1,819.20",$818.64,"$1,298.36",$0.00,$304.31,$0.00,$0.00,$318.53,"$1,819.20",$0.00,$909.60,"$1,440.81","$1,455.36",$0.00,$276.41,$0.00,$289.62,$0.00
02.110.206,SUP,HCPCS C1713,,02.110.206  -  PLATE BN 65MM NS LCP CMBN 4 HLE/HD 5 HL SHFT VA SS RDS RT,"$1,957.05",$0.00,"$1,957.05",$880.67,"$1,396.75",$0.00,$327.37,$0.00,$0.00,$342.66,"$1,957.05",$0.00,$978.53,"$1,549.98","$1,565.64",$0.00,$297.36,$0.00,$311.56,$0.00
02.110.207,SUP,HCPCS C1713,,02.110.207  -  PLATE BN 45MM NS LCP CMBN 4 HLE/HD 3 HL SHFT VA SS RDS LT,"$1,819.20",$0.00,"$1,819.20",$818.64,"$1,298.36",$0.00,$304.31,$0.00,$0.00,$318.53,"$1,819.20",$0.00,$909.60,"$1,440.81","$1,455.36",$0.00,$276.41,$0.00,$289.62,$0.00
02.110.208,SUP,HCPCS C1713,,02.110.208  -  PLATE BN 65MM NS LCP CMBN 4 HLE/HD 5 HL SHFT VA SS RDS LT,"$1,957.05",$0.00,"$1,957.05",$880.67,"$1,396.75",$0.00,$327.37,$0.00,$0.00,$342.66,"$1,957.05",$0.00,$978.53,"$1,549.98","$1,565.64",$0.00,$297.36,$0.00,$311.56,$0.00
02.110.300,SUP,Custom 27203010,,02.110.300  -  WIRE FIX 1.8MM 150MM TROCAR POINT KWIRE STAINLESS STEEL,$14.74,$0.00,$14.74,$0.00,$10.52,$0.00,$0.00,$0.00,$0.00,$0.00,$14.74,$0.00,$7.37,$11.67,$11.79,$0.00,$0.00,$0.00,$0.00,$0.00
02.110.330,SUP,HCPCS C1713,,02.110.330  -  PLATE BN CNTR 50.5MM NS LCP CMBN 9 HLE/HD 3 HL SHFT CLMN RND,"$1,524.43",$0.00,"$1,524.43",$685.99,"$1,087.98",$0.00,$255.00,$0.00,$0.00,$266.91,"$1,524.43",$0.00,$762.21,"$1,207.35","$1,219.54",$0.00,$231.62,$0.00,$242.69,$0.00
02.110.331,SUP,HCPCS C1713,,02.110.331  -  PLATE BN CNTR 50.5MM NS LCP CMBN 9 HLE/HD 3 HL SHFT CLMN RND,"$1,524.43",$0.00,"$1,524.43",$685.99,"$1,087.98",$0.00,$255.00,$0.00,$0.00,$266.91,"$1,524.43",$0.00,$762.21,"$1,207.35","$1,219.54",$0.00,$231.62,$0.00,$242.69,$0.00
02.110.340,SUP,HCPCS C1713,,02.110.340  -  PLATE BN CNTR 59.5MM NS LCP CMBN 9 HLE/HD 4 HL SHFT CLMN RND,"$1,572.20",$0.00,"$1,572.20",$707.49,"$1,122.08",$0.00,$262.99,$0.00,$0.00,$275.28,"$1,572.20",$0.00,$786.10,"$1,245.18","$1,257.76",$0.00,$238.88,$0.00,$250.29,$0.00
02.110.341,SUP,HCPCS C1713,,02.110.341  -  PLATE BN CNTR 59.5MM NS LCP CMBN 9 HLE/HD 4 HL SHFT CLMN RND,"$1,572.20",$0.00,"$1,572.20",$707.49,"$1,122.08",$0.00,$262.99,$0.00,$0.00,$275.28,"$1,572.20",$0.00,$786.10,"$1,245.18","$1,257.76",$0.00,$238.88,$0.00,$250.29,$0.00
02.110.350,SUP,HCPCS C1713,,02.110.350  -  PLATE BN CNTR 68.5MM NS LCP CMBN 9 HLE/HD 5 HL SHFT CLMN RND,"$1,618.60",$0.00,"$1,618.60",$728.37,"$1,155.19",$0.00,$270.75,$0.00,$0.00,$283.40,"$1,618.60",$0.00,$809.30,"$1,281.93","$1,294.88",$0.00,$245.93,$0.00,$257.68,$0.00
02.110.351,SUP,HCPCS C1713,,02.110.351  -  PLATE BN CNTR 68.5MM NS LCP CMBN 9 HLE/HD 5 HL SHFT CLMN RND,"$1,618.60",$0.00,"$1,618.60",$728.37,"$1,155.19",$0.00,$270.75,$0.00,$0.00,$283.40,"$1,618.60",$0.00,$809.30,"$1,281.93","$1,294.88",$0.00,$245.93,$0.00,$257.68,$0.00
02.110.430,SUP,HCPCS C1713,,02.110.430  -  PLATE BN CNTR 50.5MM NS LCP CMBN 8 HLE/HD 3 HL SHFT CLMN RND,"$1,524.43",$0.00,"$1,524.43",$685.99,"$1,087.98",$0.00,$255.00,$0.00,$0.00,$266.91,"$1,524.43",$0.00,$762.21,"$1,207.35","$1,219.54",$0.00,$231.62,$0.00,$242.69,$0.00
02.110.431,SUP,HCPCS C1713,,02.110.431  -  PLATE BN CNTR 50.5MM NS LCP CMBN 8 HLE/HD 3 HL SHFT CLMN RND,"$1,524.43",$0.00,"$1,524.43",$685.99,"$1,087.98",$0.00,$255.00,$0.00,$0.00,$266.91,"$1,524.43",$0.00,$762.21,"$1,207.35","$1,219.54",$0.00,$231.62,$0.00,$242.69,$0.00
02.110.440,SUP,HCPCS C1713,,02.110.440  -  PLATE BN CNTR 59.5MM NS LCP CMBN 8 HLE/HD 4 HL SHFT CLMN RND,"$1,572.20",$0.00,"$1,572.20",$707.49,"$1,122.08",$0.00,$262.99,$0.00,$0.00,$275.28,"$1,572.20",$0.00,$786.10,"$1,245.18","$1,257.76",$0.00,$238.88,$0.00,$250.29,$0.00
02.110.441,SUP,HCPCS C1713,,02.110.441  -  PLATE BN CNTR 59.5MM NS LCP CMBN 8 HLE/HD 4 HL SHFT CLMN RND,"$1,572.20",$0.00,"$1,572.20",$707.49,"$1,122.08",$0.00,$262.99,$0.00,$0.00,$275.28,"$1,572.20",$0.00,$786.10,"$1,245.18","$1,257.76",$0.00,$238.88,$0.00,$250.29,$0.00
02.110.450,SUP,HCPCS C1713,,02.110.450  -  PLATE BN CNTR 68.5MM NS LCP CMBN 8 HLE/HD 5 HL SHFT CLMN RND,"$1,618.60",$0.00,"$1,618.60",$728.37,"$1,155.19",$0.00,$270.75,$0.00,$0.00,$283.40,"$1,618.60",$0.00,$809.30,"$1,281.93","$1,294.88",$0.00,$245.93,$0.00,$257.68,$0.00
02.110.451,SUP,HCPCS C1713,,02.110.451  -  PLATE BN CNTR 68.5MM NS LCP CMBN 8 HLE/HD 5 HL SHFT CLMN RND,"$1,618.60",$0.00,"$1,618.60",$728.37,"$1,155.19",$0.00,$270.75,$0.00,$0.00,$283.40,"$1,618.60",$0.00,$809.30,"$1,281.93","$1,294.88",$0.00,$245.93,$0.00,$257.68,$0.00
02.110.730,SUP,HCPCS C1713,,02.110.730  -  PLATE BN CNTR 45MM NS LCP CMBN 6 HLE/HD 3 HL SHFT CLMN RND,"$1,524.43",$0.00,"$1,524.43",$685.99,"$1,087.98",$0.00,$255.00,$0.00,$0.00,$266.91,"$1,524.43",$0.00,$762.21,"$1,207.35","$1,219.54",$0.00,$231.62,$0.00,$242.69,$0.00
02.110.731,SUP,HCPCS C1713,,02.110.731  -  PLATE BN CNTR 45MM NS LCP CMBN 6 HLE/HD 3 HL SHFT CLMN RND,"$1,524.43",$0.00,"$1,524.43",$685.99,"$1,087.98",$0.00,$255.00,$0.00,$0.00,$266.91,"$1,524.43",$0.00,$762.21,"$1,207.35","$1,219.54",$0.00,$231.62,$0.00,$242.69,$0.00
02.110.740,SUP,HCPCS C1713,,02.110.740  -  PLATE BN CNTR 54MM NS LCP CMBN 6 HLE/HD 4 HL SHFT CLMN RND,"$1,572.20",$0.00,"$1,572.20",$707.49,"$1,122.08",$0.00,$262.99,$0.00,$0.00,$275.28,"$1,572.20",$0.00,$786.10,"$1,245.18","$1,257.76",$0.00,$238.88,$0.00,$250.29,$0.00
02.110.741,SUP,HCPCS C1713,,02.110.741  -  PLATE BN CNTR 54MM NS LCP CMBN 6 HLE/HD 4 HL SHFT CLMN RND,"$1,572.20",$0.00,"$1,572.20",$707.49,"$1,122.08",$0.00,$262.99,$0.00,$0.00,$275.28,"$1,572.20",$0.00,$786.10,"$1,245.18","$1,257.76",$0.00,$238.88,$0.00,$250.29,$0.00
02.110.750,SUP,HCPCS C1713,,02.110.750  -  PLATE BN CNTR 63MM NS LCP CMBN 6 HLE/HD 5 HL SHFT CLMN RND,"$1,618.60",$0.00,"$1,618.60",$728.37,"$1,155.19",$0.00,$270.75,$0.00,$0.00,$283.40,"$1,618.60",$0.00,$809.30,"$1,281.93","$1,294.88",$0.00,$245.93,$0.00,$257.68,$0.00
02.110.751,SUP,HCPCS C1713,,02.110.751  -  PLATE BN CNTR 63MM NS LCP CMBN 6 HLE/HD 5 HL SHFT CLMN RND,"$1,618.60",$0.00,"$1,618.60",$728.37,"$1,155.19",$0.00,$270.75,$0.00,$0.00,$283.40,"$1,618.60",$0.00,$809.30,"$1,281.93","$1,294.88",$0.00,$245.93,$0.00,$257.68,$0.00
02.110.830,SUP,HCPCS C1713,,02.110.830  -  PLATE BN CNTR 45MM NS LCP CMBN 7 HLE/HD 3 HL SHFT CLMN RND,"$1,524.43",$0.00,"$1,524.43",$685.99,"$1,087.98",$0.00,$255.00,$0.00,$0.00,$266.91,"$1,524.43",$0.00,$762.21,"$1,207.35","$1,219.54",$0.00,$231.62,$0.00,$242.69,$0.00
02.110.831,SUP,HCPCS C1713,,02.110.831  -  PLATE BN CNTR 45MM NS LCP CMBN 7 HLE/HD 3 HL SHFT CLMN RND,"$1,524.43",$0.00,"$1,524.43",$685.99,"$1,087.98",$0.00,$255.00,$0.00,$0.00,$266.91,"$1,524.43",$0.00,$762.21,"$1,207.35","$1,219.54",$0.00,$231.62,$0.00,$242.69,$0.00
02.110.840,SUP,HCPCS C1713,,02.110.840  -  PLATE BN CNTR 54MM NS LCP CMBN 7 HLE/HD 4 HL SHFT CLMN RND,"$1,572.20",$0.00,"$1,572.20",$707.49,"$1,122.08",$0.00,$262.99,$0.00,$0.00,$275.28,"$1,572.20",$0.00,$786.10,"$1,245.18","$1,257.76",$0.00,$238.88,$0.00,$250.29,$0.00
02.110.841,SUP,HCPCS C1713,,02.110.841  -  PLATE BN CNTR 54MM NS LCP CMBN 7 HLE/HD 4 HL SHFT CLMN RND,"$1,572.20",$0.00,"$1,572.20",$707.49,"$1,122.08",$0.00,$262.99,$0.00,$0.00,$275.28,"$1,572.20",$0.00,$786.10,"$1,245.18","$1,257.76",$0.00,$238.88,$0.00,$250.29,$0.00
02.110.850,SUP,HCPCS C1713,,02.110.850  -  PLATE BN CNTR 63MM NS LCP CMBN 7 HLE/HD 5 HL SHFT CLMN RND,"$1,618.60",$0.00,"$1,618.60",$728.37,"$1,155.19",$0.00,$270.75,$0.00,$0.00,$283.40,"$1,618.60",$0.00,$809.30,"$1,281.93","$1,294.88",$0.00,$245.93,$0.00,$257.68,$0.00
02.110.851,SUP,HCPCS C1713,,02.110.851  -  PLATE BN CNTR 63MM NS LCP CMBN 7 HLE/HD 5 HL SHFT CLMN RND,"$1,618.60",$0.00,"$1,618.60",$728.37,"$1,155.19",$0.00,$270.75,$0.00,$0.00,$283.40,"$1,618.60",$0.00,$809.30,"$1,281.93","$1,294.88",$0.00,$245.93,$0.00,$257.68,$0.00
02.111.500.01S,SUP,HCPCS C1713,,02.111.500.01S  -  PLATE BONE 1.25MM 150MM REDX SMALL STOP WIRE THREADED,$63.13,$0.00,$63.13,$28.41,$45.05,$0.00,$10.56,$0.00,$0.00,$11.05,$63.13,$0.00,$31.56,$50.00,$50.50,$0.00,$9.59,$0.00,$10.05,$0.00
02.111.500.10,SUP,HCPCS C1713,,02.111.500.10  -  WIRE REDX SMALL 1.25MM 150MM THREAD STOP STAINLESS STEEL,$31.25,$0.00,$31.25,$14.06,$22.30,$0.00,$5.23,$0.00,$0.00,$5.47,$31.25,$0.00,$15.63,$24.75,$25.00,$0.00,$4.75,$0.00,$4.98,$0.00
02.111.501.01S,SUP,HCPCS C1713,,02.111.501.01S  -  PLATE BONE 1.25MM REDX WIRE LARGE STOP THREADED TIP LCP,$63.13,$0.00,$63.13,$28.41,$45.05,$0.00,$10.56,$0.00,$0.00,$11.05,$63.13,$0.00,$31.56,$50.00,$50.50,$0.00,$9.59,$0.00,$10.05,$0.00
02.111.501.10,SUP,HCPCS C1713,,02.111.501.10  -  WIRE REDX 1.25MM 150MM THREAD TIP LARGE STOP STAINLESS STEEL,$31.25,$0.00,$31.25,$14.06,$22.30,$0.00,$5.23,$0.00,$0.00,$5.47,$31.25,$0.00,$15.63,$24.75,$25.00,$0.00,$4.75,$0.00,$4.98,$0.00
02.111.520,SUP,HCPCS C1713,,02.111.520  -  PLATE BONE 42MM 6X2 HOLE 2 COLUMN VAR ANG LCP STAINLESS,"$1,749.60",$0.00,"$1,749.60",$787.32,"$1,248.69",$0.00,$292.67,$0.00,$0.00,$306.34,"$1,749.60",$0.00,$874.80,"$1,385.68","$1,399.68",$0.00,$265.84,$0.00,$278.54,$0.00
02.111.521,SUP,HCPCS C1713,,02.111.521  -  PLATE BN NAR 42MM NS LCP CMBN 6 HLE/HD 2 HL SHFT 2 CLMN VA,"$1,749.60",$0.00,"$1,749.60",$787.32,"$1,248.69",$0.00,$292.67,$0.00,$0.00,$306.34,"$1,749.60",$0.00,$874.80,"$1,385.68","$1,399.68",$0.00,$265.84,$0.00,$278.54,$0.00
02.111.530,SUP,HCPCS C1713,,02.111.530  -  PLATE BN NAR 51MM NS LCP CMBN 6 HLE/HD 3 HL SHFT 2 CLMN VA,"$1,819.20",$0.00,"$1,819.20",$818.64,"$1,298.36",$0.00,$304.31,$0.00,$0.00,$318.53,"$1,819.20",$0.00,$909.60,"$1,440.81","$1,455.36",$0.00,$276.41,$0.00,$289.62,$0.00
02.111.531,SUP,HCPCS C1713,,02.111.531  -  PLATE BONE NARROW 51MM 6X3 HOLE 2 COLUMN VAR ANG LCP,"$1,819.20",$0.00,"$1,819.20",$818.64,"$1,298.36",$0.00,$304.31,$0.00,$0.00,$318.53,"$1,819.20",$0.00,$909.60,"$1,440.81","$1,455.36",$0.00,$276.41,$0.00,$289.62,$0.00
02.111.540,SUP,HCPCS C1713,,02.111.540  -  PLATE BONE NARROW 63MM 6X4 HOLE 2 COLUMN VAR ANG SET LCP,"$1,887.45",$0.00,"$1,887.45",$849.35,"$1,347.07",$0.00,$315.73,$0.00,$0.00,$330.48,"$1,887.45",$0.00,$943.73,"$1,494.86","$1,509.96",$0.00,$286.78,$0.00,$300.48,$0.00
02.111.541,SUP,HCPCS C1713,,02.111.541  -  PLATE BONE NARROW 63MM 6X4 HOLE 2 COLUMN VAR ANG LCP,"$1,887.45",$0.00,"$1,887.45",$849.35,"$1,347.07",$0.00,$315.73,$0.00,$0.00,$330.48,"$1,887.45",$0.00,$943.73,"$1,494.86","$1,509.96",$0.00,$286.78,$0.00,$300.48,$0.00
02.111.550,SUP,HCPCS C1713,,02.111.550  -  PLATE BONE NARROW 72MM 6X5 HOLE 2 COLUMN VAR ANG LCP,"$1,957.05",$0.00,"$1,957.05",$880.67,"$1,396.75",$0.00,$327.37,$0.00,$0.00,$342.66,"$1,957.05",$0.00,$978.53,"$1,549.98","$1,565.64",$0.00,$297.36,$0.00,$311.56,$0.00
02.111.551,SUP,HCPCS C1713,,02.111.551  -  PLATE BONE NARROW 72MM 6X5 HOLE 2 COLUMN VAR ANG SET LCP,"$1,957.05",$0.00,"$1,957.05",$880.67,"$1,396.75",$0.00,$327.37,$0.00,$0.00,$342.66,"$1,957.05",$0.00,$978.53,"$1,549.98","$1,565.64",$0.00,$297.36,$0.00,$311.56,$0.00
02.111.620,SUP,HCPCS C1713,,02.111.620  -  PLATE BN STD 45MM NS LCP CMBN 6 HLE/HD 2 HL SHFT 2 CLMN VA,"$1,749.60",$0.00,"$1,749.60",$787.32,"$1,248.69",$0.00,$292.67,$0.00,$0.00,$306.34,"$1,749.60",$0.00,$874.80,"$1,385.68","$1,399.68",$0.00,$265.84,$0.00,$278.54,$0.00
02.111.621,SUP,HCPCS C1713,,02.111.621  -  PLATE BN STD 45MM NS LCP CMBN 6 HLE/HD 2 HL SHFT 2 CLMN VA,"$1,749.60",$0.00,"$1,749.60",$787.32,"$1,248.69",$0.00,$292.67,$0.00,$0.00,$306.34,"$1,749.60",$0.00,$874.80,"$1,385.68","$1,399.68",$0.00,$265.84,$0.00,$278.54,$0.00
02.111.630,SUP,HCPCS C1713,,02.111.630  -  PLATE BN STD 54MM NS LCP CMBN 6 HLE/HD 3 HL SHFT 2 CLMN VA,"$1,819.20",$0.00,"$1,819.20",$818.64,"$1,298.36",$0.00,$304.31,$0.00,$0.00,$318.53,"$1,819.20",$0.00,$909.60,"$1,440.81","$1,455.36",$0.00,$276.41,$0.00,$289.62,$0.00
02.111.630S,SUP,HCPCS C1713,,02.111.630S  -  PLATE BONE 58MM 6X3 HOLE 2 COLUMN VAR ANG LCP STAINLESS,"$1,907.93",$0.00,"$1,907.93",$858.57,"$1,361.69",$0.00,$319.15,$0.00,$0.00,$334.06,"$1,907.93",$0.00,$953.96,"$1,511.08","$1,526.34",$0.00,$289.89,$0.00,$303.74,$0.00
02.111.631,SUP,HCPCS C1713,,02.111.631  -  PLATE BN STD 54MM NS LCP CMBN 6 HLE/HD 3 HL SHFT 2 CLMN VA,"$1,819.20",$0.00,"$1,819.20",$818.64,"$1,298.36",$0.00,$304.31,$0.00,$0.00,$318.53,"$1,819.20",$0.00,$909.60,"$1,440.81","$1,455.36",$0.00,$276.41,$0.00,$289.62,$0.00
02.111.631S,SUP,HCPCS C1713,,02.111.631S  -  PLATE BONE 54MM 6X3 HOLE 2 COLUMN VAR ANG LCP STAINLESS,"$1,907.93",$0.00,"$1,907.93",$858.57,"$1,361.69",$0.00,$319.15,$0.00,$0.00,$334.06,"$1,907.93",$0.00,$953.96,"$1,511.08","$1,526.34",$0.00,$289.89,$0.00,$303.74,$0.00
02.111.640,SUP,HCPCS C1713,,02.111.640  -  PLATE BN STD 66MM NS LCP CMBN 6 HLE/HD 4 HL SHFT 2 CLMN VA,"$1,887.45",$0.00,"$1,887.45",$849.35,"$1,347.07",$0.00,$315.73,$0.00,$0.00,$330.48,"$1,887.45",$0.00,$943.73,"$1,494.86","$1,509.96",$0.00,$286.78,$0.00,$300.48,$0.00
02.111.641,SUP,HCPCS C1713,,02.111.641  -  PLATE BN STD 66MM NS LCP CMBN 6 HLE/HD 4 HL SHFT 2 CLMN VA,"$1,887.45",$0.00,"$1,887.45",$849.35,"$1,347.07",$0.00,$315.73,$0.00,$0.00,$330.48,"$1,887.45",$0.00,$943.73,"$1,494.86","$1,509.96",$0.00,$286.78,$0.00,$300.48,$0.00
02.111.650,SUP,HCPCS C1713,,02.111.650  -  PLATE BN STD 75MM NS LCP CMBN 6 HLE/HD 5 HL SHFT 2 CLMN VA,"$1,957.05",$0.00,"$1,957.05",$880.67,"$1,396.75",$0.00,$327.37,$0.00,$0.00,$342.66,"$1,957.05",$0.00,$978.53,"$1,549.98","$1,565.64",$0.00,$297.36,$0.00,$311.56,$0.00
02.111.651,SUP,HCPCS C1713,,02.111.651  -  PLATE BN STD 75MM NS LCP CMBN 6 HLE/HD 5 HL SHFT 2 CLMN VA,"$1,957.05",$0.00,"$1,957.05",$880.67,"$1,396.75",$0.00,$327.37,$0.00,$0.00,$342.66,"$1,957.05",$0.00,$978.53,"$1,549.98","$1,565.64",$0.00,$297.36,$0.00,$311.56,$0.00
02.111.720,SUP,HCPCS C1713,,02.111.720  -  PLATE BN STD 47MM NS LCP CMBN 7 HLE/HD 2 HL SHFT 2 CLMN VA,"$1,749.60",$0.00,"$1,749.60",$787.32,"$1,248.69",$0.00,$292.67,$0.00,$0.00,$306.34,"$1,749.60",$0.00,$874.80,"$1,385.68","$1,399.68",$0.00,$265.84,$0.00,$278.54,$0.00
02.111.721,SUP,HCPCS C1713,,02.111.721  -  PLATE BN STD 47MM NS LCP CMBN 7 HLE/HD 2 HL SHFT 2 CLMN VA,"$1,749.60",$0.00,"$1,749.60",$787.32,"$1,248.69",$0.00,$292.67,$0.00,$0.00,$306.34,"$1,749.60",$0.00,$874.80,"$1,385.68","$1,399.68",$0.00,$265.84,$0.00,$278.54,$0.00
02.111.730,SUP,HCPCS C1713,,02.111.730  -  PLATE BN STD 55MM NS LCP CMBN 7 HLE/HD 3 HL SHFT 2 CLMN VA,"$1,819.20",$0.00,"$1,819.20",$818.64,"$1,298.36",$0.00,$304.31,$0.00,$0.00,$318.53,"$1,819.20",$0.00,$909.60,"$1,440.81","$1,455.36",$0.00,$276.41,$0.00,$289.62,$0.00
02.111.731,SUP,HCPCS C1713,,02.111.731  -  PLATE BN STD 55MM NS LCP CMBN 7 HLE/HD 3 HL SHFT 2 CLMN VA,"$1,819.20",$0.00,"$1,819.20",$818.64,"$1,298.36",$0.00,$304.31,$0.00,$0.00,$318.53,"$1,819.20",$0.00,$909.60,"$1,440.81","$1,455.36",$0.00,$276.41,$0.00,$289.62,$0.00
02.111.740,SUP,HCPCS C1713,,02.111.740  -  PLATE BN STD 68MM NS LCP CMBN 7 HLE/HD 4 HL SHFT 2 CLMN VA,"$1,887.45",$0.00,"$1,887.45",$849.35,"$1,347.07",$0.00,$315.73,$0.00,$0.00,$330.48,"$1,887.45",$0.00,$943.73,"$1,494.86","$1,509.96",$0.00,$286.78,$0.00,$300.48,$0.00
02.111.741,SUP,HCPCS C1713,,02.111.741  -  PLATE BN STD 68MM NS LCP CMBN 7 HLE/HD 4 HL SHFT 2 CLMN VA,"$1,887.45",$0.00,"$1,887.45",$849.35,"$1,347.07",$0.00,$315.73,$0.00,$0.00,$330.48,"$1,887.45",$0.00,$943.73,"$1,494.86","$1,509.96",$0.00,$286.78,$0.00,$300.48,$0.00
02.111.750,SUP,HCPCS C1713,,02.111.750  -  PLATE BN STD 77MM NS LCP CMBN 7 HLE/HD 5 HL SHFT 2 CLMN VA,"$1,957.05",$0.00,"$1,957.05",$880.67,"$1,396.75",$0.00,$327.37,$0.00,$0.00,$342.66,"$1,957.05",$0.00,$978.53,"$1,549.98","$1,565.64",$0.00,$297.36,$0.00,$311.56,$0.00
02.111.751,SUP,HCPCS C1713,,02.111.751  -  PLATE BN STD 77MM NS LCP CMBN 7 HLE/HD 5 HL SHFT 2 CLMN VA,"$1,957.05",$0.00,"$1,957.05",$880.67,"$1,396.75",$0.00,$327.37,$0.00,$0.00,$342.66,"$1,957.05",$0.00,$978.53,"$1,549.98","$1,565.64",$0.00,$297.36,$0.00,$311.56,$0.00
02.112.006,SUP,HCPCS C1713,,02.112.006  -  PLATE BN 69MM NS LCP CMBN 3 HL LAT XTN PRECONTOUR LMT CNTCT,"$1,576.28",$0.00,"$1,576.28",$709.32,"$1,124.99",$0.00,$263.68,$0.00,$0.00,$275.99,"$1,576.28",$0.00,$788.14,"$1,248.41","$1,261.02",$0.00,$239.50,$0.00,$250.94,$0.00
02.112.007,SUP,HCPCS C1713,,02.112.007  -  PLATE BN 69MM NS LCP CMBN 3 HL LAT XTN PRECONTOUR LMT CNTCT,"$1,576.28",$0.00,"$1,576.28",$709.32,"$1,124.99",$0.00,$263.68,$0.00,$0.00,$275.99,"$1,576.28",$0.00,$788.14,"$1,248.41","$1,261.02",$0.00,$239.50,$0.00,$250.94,$0.00
02.112.008,SUP,HCPCS C1713,,02.112.008  -  PLATE BN 108MM NS LCP CMBN 6 HL LAT XTN PRECONTOUR LMT CNTCT,"$1,645.90",$0.00,"$1,645.90",$740.66,"$1,174.68",$0.00,$275.32,$0.00,$0.00,$288.18,"$1,645.90",$0.00,$822.95,"$1,303.55","$1,316.72",$0.00,$250.08,$0.00,$262.03,$0.00
02.112.009,SUP,HCPCS C1713,,02.112.009  -  PLATE BN 108MM NS LCP CMBN 6 HL LAT XTN PRECONTOUR LMT CNTCT,"$1,645.90",$0.00,"$1,645.90",$740.66,"$1,174.68",$0.00,$275.32,$0.00,$0.00,$288.18,"$1,645.90",$0.00,$822.95,"$1,303.55","$1,316.72",$0.00,$250.08,$0.00,$262.03,$0.00
02.112.010,SUP,HCPCS C1713,,02.112.010  -  PLATE BN 81MM NS LCP CMBN 4 HL LAT XTN PRECONTOUR LMT CNTCT,"$1,600.85",$0.00,"$1,600.85",$720.38,"$1,142.53",$0.00,$267.79,$0.00,$0.00,$280.30,"$1,600.85",$0.00,$800.43,"$1,267.87","$1,280.68",$0.00,$243.24,$0.00,$254.86,$0.00
02.112.011,SUP,HCPCS C1713,,02.112.011  -  PLATE BN 81MM NS LCP CMBN 4 HL LAT XTN PRECONTOUR LMT CNTCT,"$1,600.85",$0.00,"$1,600.85",$720.38,"$1,142.53",$0.00,$267.79,$0.00,$0.00,$280.30,"$1,600.85",$0.00,$800.43,"$1,267.87","$1,280.68",$0.00,$243.24,$0.00,$254.86,$0.00
02.112.012,SUP,HCPCS C1713,,02.112.012  -  PLATE BN 94MM NS LCP CMBN 5 HL LAT XTN PRECONTOUR LMT CNTCT,"$1,628.15",$0.00,"$1,628.15",$732.67,"$1,162.01",$0.00,$272.35,$0.00,$0.00,$285.08,"$1,628.15",$0.00,$814.08,"$1,289.49","$1,302.52",$0.00,$247.38,$0.00,$259.20,$0.00
02.112.013,SUP,HCPCS C1713,,02.112.013  -  PLATE BN 94MM NS LCP CMBN 5 HL LAT XTN PRECONTOUR LMT CNTCT,"$1,628.15",$0.00,"$1,628.15",$732.67,"$1,162.01",$0.00,$272.35,$0.00,$0.00,$285.08,"$1,628.15",$0.00,$814.08,"$1,289.49","$1,302.52",$0.00,$247.38,$0.00,$259.20,$0.00
02.112.018,SUP,HCPCS C1713,,02.112.018  -  PLATE BN 123MM NS LCP CMBN 7 HL LAT XTN PRECONTOUR LMT CNTCT,"$1,689.55",$0.00,"$1,689.55",$760.30,"$1,205.83",$0.00,$282.62,$0.00,$0.00,$295.83,"$1,689.55",$0.00,$844.78,"$1,338.12","$1,351.64",$0.00,$256.71,$0.00,$268.98,$0.00
02.112.019,SUP,HCPCS C1713,,02.112.019  -  PLATE BN 123MM NS LCP CMBN 7 HL LAT XTN PRECONTOUR LMT CNTCT,"$1,689.55",$0.00,"$1,689.55",$760.30,"$1,205.83",$0.00,$282.62,$0.00,$0.00,$295.83,"$1,689.55",$0.00,$844.78,"$1,338.12","$1,351.64",$0.00,$256.71,$0.00,$268.98,$0.00
02.112.020,SUP,HCPCS C1713,,02.112.020  -  PLATE BN 135MM NS LCP CMBN 8 HL LAT XTN PRECONTOUR LMT CNTCT,"$1,733.23",$0.00,"$1,733.23",$779.95,"$1,237.00",$0.00,$289.93,$0.00,$0.00,$303.47,"$1,733.23",$0.00,$866.61,"$1,372.72","$1,386.58",$0.00,$263.35,$0.00,$275.93,$0.00
02.112.021,SUP,HCPCS C1713,,02.112.021  -  PLATE BN 135MM NS LCP CMBN 8 HL LAT XTN PRECONTOUR LMT CNTCT,"$1,733.23",$0.00,"$1,733.23",$779.95,"$1,237.00",$0.00,$289.93,$0.00,$0.00,$303.47,"$1,733.23",$0.00,$866.61,"$1,372.72","$1,386.58",$0.00,$263.35,$0.00,$275.93,$0.00
02.112.026,SUP,HCPCS C1713,,02.112.026  -  PLATE BN 94MM NS LCP CMBN 6 HL PRECONTOUR LMT CNTCT TPR TIP,"$1,645.90",$0.00,"$1,645.90",$740.66,"$1,174.68",$0.00,$275.32,$0.00,$0.00,$288.18,"$1,645.90",$0.00,$822.95,"$1,303.55","$1,316.72",$0.00,$250.08,$0.00,$262.03,$0.00
02.112.027,SUP,HCPCS C1713,,02.112.027  -  PLATE BN 94MM NS LCP CMBN 6 HL PRECONTOUR LMT CNTCT TPR TIP,"$1,645.90",$0.00,"$1,645.90",$740.66,"$1,174.68",$0.00,$275.32,$0.00,$0.00,$288.18,"$1,645.90",$0.00,$822.95,"$1,303.55","$1,316.72",$0.00,$250.08,$0.00,$262.03,$0.00
02.112.028,SUP,HCPCS C1713,,02.112.028  -  PLATE BN 110MM NS LCP CMBN 7 HL PRECONTOUR LMT CNTCT TPR TIP,"$1,689.55",$0.00,"$1,689.55",$760.30,"$1,205.83",$0.00,$282.62,$0.00,$0.00,$295.83,"$1,689.55",$0.00,$844.78,"$1,338.12","$1,351.64",$0.00,$256.71,$0.00,$268.98,$0.00
02.112.029,SUP,HCPCS C1713,,02.112.029  -  PLATE BN 110MM NS LCP CMBN 7 HL PRECONTOUR LMT CNTCT TPR TIP,"$1,689.55",$0.00,"$1,689.55",$760.30,"$1,205.83",$0.00,$282.62,$0.00,$0.00,$295.83,"$1,689.55",$0.00,$844.78,"$1,338.12","$1,351.64",$0.00,$256.71,$0.00,$268.98,$0.00
02.112.030,SUP,HCPCS C1713,,02.112.030  -  PLATE BN 120MM NS LCP CMBN 8 HL PRECONTOUR LMT CNTCT TPR TIP,"$1,733.23",$0.00,"$1,733.23",$779.95,"$1,237.00",$0.00,$289.93,$0.00,$0.00,$303.47,"$1,733.23",$0.00,$866.61,"$1,372.72","$1,386.58",$0.00,$263.35,$0.00,$275.93,$0.00
02.112.031,SUP,HCPCS C1713,,02.112.031  -  PLATE BN 120MM NS LCP CMBN 8 HL PRECONTOUR LMT CNTCT TPR TIP,"$1,733.23",$0.00,"$1,733.23",$779.95,"$1,237.00",$0.00,$289.93,$0.00,$0.00,$303.47,"$1,733.23",$0.00,$866.61,"$1,372.72","$1,386.58",$0.00,$263.35,$0.00,$275.93,$0.00
02.112.040,SUP,HCPCS C1713,,02.112.040  -  PLATE BONE 79MM 6 HOLE LCP STAINLESS STEEL ANTERIOR MEDIAL,"$1,733.23",$0.00,"$1,733.23",$779.95,"$1,237.00",$0.00,$289.93,$0.00,$0.00,$303.47,"$1,733.23",$0.00,$866.61,"$1,372.72","$1,386.58",$0.00,$263.35,$0.00,$275.93,$0.00
02.112.041,SUP,HCPCS C1713,,02.112.041  -  PLATE BONE 91MM 7 HOLE LCP STAINLESS STEEL MEDIAL ANTERIOR,"$1,733.23",$0.00,"$1,733.23",$779.95,"$1,237.00",$0.00,$289.93,$0.00,$0.00,$303.47,"$1,733.23",$0.00,$866.61,"$1,372.72","$1,386.58",$0.00,$263.35,$0.00,$275.93,$0.00
02.112.042,SUP,HCPCS C1713,,02.112.042  -  PLATE BONE 8 HOLE LCP STAINLESS STEEL MEDIAL ANTERIOR,"$1,733.23",$0.00,"$1,733.23",$779.95,"$1,237.00",$0.00,$289.93,$0.00,$0.00,$303.47,"$1,733.23",$0.00,$866.61,"$1,372.72","$1,386.58",$0.00,$263.35,$0.00,$275.93,$0.00
02.112.045,SUP,HCPCS C1713,,02.112.045  -  PLATE BONE 77MM 7 HOLE VAR ANG LCP STAINLESS STEEL LATERAL,"$1,733.23",$0.00,"$1,733.23",$779.95,"$1,237.00",$0.00,$289.93,$0.00,$0.00,$303.47,"$1,733.23",$0.00,$866.61,"$1,372.72","$1,386.58",$0.00,$263.35,$0.00,$275.93,$0.00
02.112.046,SUP,HCPCS C1713,,02.112.046  -  PLATE BONE 89MM 9 HOLE VAR ANG LCP STAINLESS STEEL LATERAL,"$1,733.23",$0.00,"$1,733.23",$779.95,"$1,237.00",$0.00,$289.93,$0.00,$0.00,$303.47,"$1,733.23",$0.00,$866.61,"$1,372.72","$1,386.58",$0.00,$263.35,$0.00,$275.93,$0.00
02.112.047,SUP,HCPCS C1713,,02.112.047  -  PLATE BONE 101MM 10 HOLE VAR ANG LCP STAINLESS STEEL LATERAL,"$1,733.23",$0.00,"$1,733.23",$779.95,"$1,237.00",$0.00,$289.93,$0.00,$0.00,$303.47,"$1,733.23",$0.00,$866.61,"$1,372.72","$1,386.58",$0.00,$263.35,$0.00,$275.93,$0.00
02.112.048,SUP,HCPCS C1713,,02.112.048  -  PLATE BONE 113MM 11 HOLE VAR ANG LCP STAINLESS STEEL LATERAL,"$1,733.23",$0.00,"$1,733.23",$779.95,"$1,237.00",$0.00,$289.93,$0.00,$0.00,$303.47,"$1,733.23",$0.00,$866.61,"$1,372.72","$1,386.58",$0.00,$263.35,$0.00,$275.93,$0.00
02.112.049,SUP,HCPCS C1713,,02.112.049  -  PLATE BONE 12 HOLE LCP STAINLESS STEEL LATERAL VOLAR,"$1,733.23",$0.00,"$1,733.23",$779.95,"$1,237.00",$0.00,$289.93,$0.00,$0.00,$303.47,"$1,733.23",$0.00,$866.61,"$1,372.72","$1,386.58",$0.00,$263.35,$0.00,$275.93,$0.00
02.112.080,SUP,HCPCS C1713,,02.112.080  -  PLATE BN 85MM NS LCP CMBN 6 HL PRECONTOUR LMT CNTCT TPR TIP,"$1,645.90",$0.00,"$1,645.90",$740.66,"$1,174.68",$0.00,$275.32,$0.00,$0.00,$288.18,"$1,645.90",$0.00,$822.95,"$1,303.55","$1,316.72",$0.00,$250.08,$0.00,$262.03,$0.00
02.112.081,SUP,HCPCS C1713,,02.112.081  -  PLATE BN 85MM NS LCP CMBN 6 HL PRECONTOUR LMT CNTCT TPR TIP,"$1,645.90",$0.00,"$1,645.90",$740.66,"$1,174.68",$0.00,$275.32,$0.00,$0.00,$288.18,"$1,645.90",$0.00,$822.95,"$1,303.55","$1,316.72",$0.00,$250.08,$0.00,$262.03,$0.00
02.112.082,SUP,HCPCS C1713,,02.112.082  -  PLATE BN 100MM NS LCP CMBN 7 HL PRECONTOUR LMT CNTCT TPR TIP,"$1,689.55",$0.00,"$1,689.55",$760.30,"$1,205.83",$0.00,$282.62,$0.00,$0.00,$295.83,"$1,689.55",$0.00,$844.78,"$1,338.12","$1,351.64",$0.00,$256.71,$0.00,$268.98,$0.00
02.112.083,SUP,HCPCS C1713,,02.112.083  -  PLATE BN 100MM NS LCP CMBN 7 HL PRECONTOUR LMT CNTCT TPR TIP,"$1,689.55",$0.00,"$1,689.55",$760.30,"$1,205.83",$0.00,$282.62,$0.00,$0.00,$295.83,"$1,689.55",$0.00,$844.78,"$1,338.12","$1,351.64",$0.00,$256.71,$0.00,$268.98,$0.00
02.112.084,SUP,HCPCS C1713,,02.112.084  -  PLATE BN 115MM NS LCP CMBN 8 HL PRECONTOUR LMT CNTCT TPR TIP,"$1,733.23",$0.00,"$1,733.23",$779.95,"$1,237.00",$0.00,$289.93,$0.00,$0.00,$303.47,"$1,733.23",$0.00,$866.61,"$1,372.72","$1,386.58",$0.00,$263.35,$0.00,$275.93,$0.00
02.112.085,SUP,HCPCS C1713,,02.112.085  -  PLATE BN 115MM NS LCP CMBN 8 HL PRECONTOUR LMT CNTCT TPR TIP,"$1,733.23",$0.00,"$1,733.23",$779.95,"$1,237.00",$0.00,$289.93,$0.00,$0.00,$303.47,"$1,733.23",$0.00,$866.61,"$1,372.72","$1,386.58",$0.00,$263.35,$0.00,$275.93,$0.00
02.112.090,SUP,HCPCS C1713,,02.112.090  -  PLATE BN 105MM NS LCP CMBN 6 HL LAT XTN PRECONTOUR LMT CNTCT,"$1,645.90",$0.00,"$1,645.90",$740.66,"$1,174.68",$0.00,$275.32,$0.00,$0.00,$288.18,"$1,645.90",$0.00,$822.95,"$1,303.55","$1,316.72",$0.00,$250.08,$0.00,$262.03,$0.00
02.112.091,SUP,HCPCS C1713,,02.112.091  -  PLATE BN 105MM NS LCP CMBN 6 HL LAT XTN PRECONTOUR LMT CNTCT,"$1,645.90",$0.00,"$1,645.90",$740.66,"$1,174.68",$0.00,$275.32,$0.00,$0.00,$288.18,"$1,645.90",$0.00,$822.95,"$1,303.55","$1,316.72",$0.00,$250.08,$0.00,$262.03,$0.00
02.112.092,SUP,HCPCS C1713,,02.112.092  -  PLATE BN 120MM NS LCP CMBN 7 HL LAT XTN PRECONTOUR LMT CNTCT,"$1,689.55",$0.00,"$1,689.55",$760.30,"$1,205.83",$0.00,$282.62,$0.00,$0.00,$295.83,"$1,689.55",$0.00,$844.78,"$1,338.12","$1,351.64",$0.00,$256.71,$0.00,$268.98,$0.00
02.112.093,SUP,HCPCS C1713,,02.112.093  -  PLATE BN 120MM NS LCP CMBN 7 HL LAT XTN PRECONTOUR LMT CNTCT,"$1,689.55",$0.00,"$1,689.55",$760.30,"$1,205.83",$0.00,$282.62,$0.00,$0.00,$295.83,"$1,689.55",$0.00,$844.78,"$1,338.12","$1,351.64",$0.00,$256.71,$0.00,$268.98,$0.00
02.112.094,SUP,HCPCS C1713,,02.112.094  -  PLATE BN 130MM NS LCP CMBN 8 HL LAT XTN PRECONTOUR LMT CNTCT,"$1,733.23",$0.00,"$1,733.23",$779.95,"$1,237.00",$0.00,$289.93,$0.00,$0.00,$303.47,"$1,733.23",$0.00,$866.61,"$1,372.72","$1,386.58",$0.00,$263.35,$0.00,$275.93,$0.00
02.112.095,SUP,HCPCS C1713,,02.112.095  -  PLATE BN 130MM NS LCP CMBN 8 HL LAT XTN PRECONTOUR LMT CNTCT,"$1,733.23",$0.00,"$1,733.23",$779.95,"$1,237.00",$0.00,$289.93,$0.00,$0.00,$303.47,"$1,733.23",$0.00,$866.61,"$1,372.72","$1,386.58",$0.00,$263.35,$0.00,$275.93,$0.00
02.112.106,SUP,HCPCS C1713,,02.112.106  -  PLATE BONE 77MM 3 HOLE LCP STAINLESS STEEL RIGHT DISTAL,"$1,151.85",$0.00,"$1,151.85",$518.33,$822.08,$0.00,$192.68,$0.00,$0.00,$201.68,"$1,151.85",$0.00,$575.93,$912.27,$921.48,$0.00,$175.01,$0.00,$183.37,$0.00
02.112.107,SUP,HCPCS C1713,,02.112.107  -  PLATE BONE 77MM 3 HOLE LCP STAINLESS STEEL LEFT DISTAL,"$1,151.85",$0.00,"$1,151.85",$518.33,$822.08,$0.00,$192.68,$0.00,$0.00,$201.68,"$1,151.85",$0.00,$575.93,$912.27,$921.48,$0.00,$175.01,$0.00,$183.37,$0.00
02.112.108,SUP,HCPCS C1713,,02.112.108  -  PLATE BONE 9CM 4 HOLE LCP STAINLESS STEEL RIGHT POSTLAT,"$1,170.95",$0.00,"$1,170.95",$526.93,$835.71,$0.00,$195.87,$0.00,$0.00,$205.02,"$1,170.95",$0.00,$585.48,$927.39,$936.76,$0.00,$177.92,$0.00,$186.42,$0.00
02.112.109,SUP,HCPCS C1713,,02.112.109  -  PLATE BONE 9CM 4 HOLE LCP STAINLESS STEEL LEFT POSTLAT,"$1,170.95",$0.00,"$1,170.95",$526.93,$835.71,$0.00,$195.87,$0.00,$0.00,$205.02,"$1,170.95",$0.00,$585.48,$927.39,$936.76,$0.00,$177.92,$0.00,$186.42,$0.00
02.112.110,SUP,HCPCS C1713,,02.112.110  -  PLATE BONE 103MM 5 HOLE LCP STAINLESS STEEL RIGHT DISTAL,"$1,185.98",$0.00,"$1,185.98",$533.69,$846.43,$0.00,$198.38,$0.00,$0.00,$207.65,"$1,185.98",$0.00,$592.99,$939.30,$948.78,$0.00,$180.20,$0.00,$188.81,$0.00
02.112.111,SUP,HCPCS C1713,,02.112.111  -  PLATE BONE 103MM 5 HOLE LCP STAINLESS STEEL LEFT POSTLAT,"$1,185.98",$0.00,"$1,185.98",$533.69,$846.43,$0.00,$198.38,$0.00,$0.00,$207.65,"$1,185.98",$0.00,$592.99,$939.30,$948.78,$0.00,$180.20,$0.00,$188.81,$0.00
02.112.112,SUP,HCPCS C1713,,02.112.112  -  PLATE BONE 112MM 6 HOLE LCP STAINLESS STEEL RIGHT POSTLAT,"$1,205.08",$0.00,"$1,205.08",$542.28,$860.06,$0.00,$201.58,$0.00,$0.00,$211.00,"$1,205.08",$0.00,$602.54,$954.42,$964.06,$0.00,$183.10,$0.00,$191.85,$0.00
02.112.113,SUP,HCPCS C1713,,02.112.113  -  PLATE BONE 112MM 6 HOLE LCP STAINLESS STEEL LEFT POSTLAT,"$1,205.08",$0.00,"$1,205.08",$542.28,$860.06,$0.00,$201.58,$0.00,$0.00,$211.00,"$1,205.08",$0.00,$602.54,$954.42,$964.06,$0.00,$183.10,$0.00,$191.85,$0.00
02.112.114,SUP,HCPCS C1713,,02.112.114  -  PLATE BONE 12.9CM 7 HOLE LCP STAINLESS STEEL RIGHT POSTLAT,"$1,221.45",$0.00,"$1,221.45",$549.65,$871.75,$0.00,$204.32,$0.00,$0.00,$213.87,"$1,221.45",$0.00,$610.73,$967.39,$977.16,$0.00,$185.59,$0.00,$194.45,$0.00
02.112.115,SUP,HCPCS C1713,,02.112.115  -  PLATE BONE 12.9CM 7 HOLE LCP STAINLESS STEEL LEFT POSTLAT,"$1,221.45",$0.00,"$1,221.45",$549.65,$871.75,$0.00,$204.32,$0.00,$0.00,$213.87,"$1,221.45",$0.00,$610.73,$967.39,$977.16,$0.00,$185.59,$0.00,$194.45,$0.00
02.112.118,SUP,HCPCS C1713,,02.112.118  -  PLATE BONE 151MM 9 HOLE LCP STAINLESS STEEL RIGHT POSTLAT,"$1,239.20",$0.00,"$1,239.20",$557.64,$884.42,$0.00,$207.29,$0.00,$0.00,$216.97,"$1,239.20",$0.00,$619.60,$981.45,$991.36,$0.00,$188.29,$0.00,$197.28,$0.00
02.112.119,SUP,HCPCS C1713,,02.112.119  -  PLATE BONE 151MM 9 HOLE LCP STAINLESS STEEL LEFT POSTLAT,"$1,239.20",$0.00,"$1,239.20",$557.64,$884.42,$0.00,$207.29,$0.00,$0.00,$216.97,"$1,239.20",$0.00,$619.60,$981.45,$991.36,$0.00,$188.29,$0.00,$197.28,$0.00
02.112.122,SUP,HCPCS C1713,,02.112.122  -  PLATE BONE 177MM 11 HOLE LCP STAINLESS STEEL RIGHT POSTLAT,"$1,258.30",$0.00,"$1,258.30",$566.24,$898.05,$0.00,$210.48,$0.00,$0.00,$220.32,"$1,258.30",$0.00,$629.15,$996.57,"$1,006.64",$0.00,$191.19,$0.00,$200.32,$0.00
02.112.123,SUP,HCPCS C1713,,02.112.123  -  PLATE BONE 177MM 11 HOLE LCP STAINLESS STEEL LEFT POSTLAT,"$1,258.30",$0.00,"$1,258.30",$566.24,$898.05,$0.00,$210.48,$0.00,$0.00,$220.32,"$1,258.30",$0.00,$629.15,$996.57,"$1,006.64",$0.00,$191.19,$0.00,$200.32,$0.00
02.112.126,SUP,HCPCS C1713,,02.112.126  -  PLATE BONE 126MM 13 HOLE LCP STAINLESS STEEL RIGHT POSTLAT,"$1,274.68",$0.00,"$1,274.68",$573.60,$909.74,$0.00,$213.22,$0.00,$0.00,$223.19,"$1,274.68",$0.00,$637.34,"$1,009.55","$1,019.74",$0.00,$193.68,$0.00,$202.93,$0.00
02.112.127,SUP,HCPCS C1713,,02.112.127  -  PLATE BONE 127MM 13 HOLE LCP STAINLESS STEEL LEFT POSTLAT,"$1,274.68",$0.00,"$1,274.68",$573.60,$909.74,$0.00,$213.22,$0.00,$0.00,$223.19,"$1,274.68",$0.00,$637.34,"$1,009.55","$1,019.74",$0.00,$193.68,$0.00,$202.93,$0.00
02.112.130,SUP,HCPCS C1713,,02.112.130  -  PLATE BONE 233MM 15 HOLE LCP STAINLESS STEEL RIGHT DISTAL,"$1,291.05",$0.00,"$1,291.05",$580.97,$921.42,$0.00,$215.96,$0.00,$0.00,$226.05,"$1,291.05",$0.00,$645.53,"$1,022.51","$1,032.84",$0.00,$196.16,$0.00,$205.54,$0.00
02.112.131,SUP,HCPCS C1713,,02.112.131  -  PLATE BONE 233MM 15 HOLE LCP STAINLESS STEEL LEFT POSTLAT,"$1,291.05",$0.00,"$1,291.05",$580.97,$921.42,$0.00,$215.96,$0.00,$0.00,$226.05,"$1,291.05",$0.00,$645.53,"$1,022.51","$1,032.84",$0.00,$196.16,$0.00,$205.54,$0.00
02.112.136,SUP,HCPCS C1713,,02.112.136  -  PLATE BN CNTR 73MM NS LCP CMBN 3 HL SS FIB RT DIST LAT,"$1,113.63",$0.00,"$1,113.63",$501.13,$794.79,$0.00,$186.29,$0.00,$0.00,$194.99,"$1,113.63",$0.00,$556.81,$881.99,$890.90,$0.00,$169.21,$0.00,$177.29,$0.00
02.112.137,SUP,HCPCS C1713,,02.112.137  -  PLATE BN CNTR 73MM NS LCP CMBN 3 HL SS FIB LT DIST LAT,"$1,113.63",$0.00,"$1,113.63",$501.13,$794.79,$0.00,$186.29,$0.00,$0.00,$194.99,"$1,113.63",$0.00,$556.81,$881.99,$890.90,$0.00,$169.21,$0.00,$177.29,$0.00
02.112.138,SUP,HCPCS C1713,,02.112.138  -  PLATE BN CNTR 86MM NS LCP CMBN 4 HL SS FIB RT DIST LAT,"$1,132.75",$0.00,"$1,132.75",$509.74,$808.44,$0.00,$189.48,$0.00,$0.00,$198.34,"$1,132.75",$0.00,$566.38,$897.14,$906.20,$0.00,$172.11,$0.00,$180.33,$0.00
02.112.138S,SUP,HCPCS C1713,,02.112.138S  -  PLATE BONE 86MM 4 HOLE LOCKING COMPRESSION LCP STAINLESS,"$1,221.45",$0.00,"$1,221.45",$549.65,$871.75,$0.00,$204.32,$0.00,$0.00,$213.87,"$1,221.45",$0.00,$610.73,$967.39,$977.16,$0.00,$185.59,$0.00,$194.45,$0.00
02.112.139,SUP,HCPCS C1713,,02.112.139  -  PLATE BN CNTR 86MM NS LCP CMBN 4 HL SS FIB LT DIST LAT,"$1,132.75",$0.00,"$1,132.75",$509.74,$808.44,$0.00,$189.48,$0.00,$0.00,$198.34,"$1,132.75",$0.00,$566.38,$897.14,$906.20,$0.00,$172.11,$0.00,$180.33,$0.00
02.112.140,SUP,HCPCS C1713,,02.112.140  -  PLATE BN CNTR 99MM NS LCP CMBN 5 HL SS FIB RT DIST LAT,"$1,147.75",$0.00,"$1,147.75",$516.49,$819.15,$0.00,$191.99,$0.00,$0.00,$200.96,"$1,147.75",$0.00,$573.88,$909.02,$918.20,$0.00,$174.39,$0.00,$182.72,$0.00
02.112.141,SUP,HCPCS C1713,,02.112.141  -  PLATE BN CNTR 99MM NS LCP CMBN 5 HL SS FIB LT DIST LAT,"$1,147.75",$0.00,"$1,147.75",$516.49,$819.15,$0.00,$191.99,$0.00,$0.00,$200.96,"$1,147.75",$0.00,$573.88,$909.02,$918.20,$0.00,$174.39,$0.00,$182.72,$0.00
02.112.142,SUP,HCPCS C1713,,02.112.142  -  PLATE BN CNTR 112MM NS LCP CMBN 6 HL SS FIB RT DIST LAT,"$1,165.50",$0.00,"$1,165.50",$524.48,$831.82,$0.00,$194.96,$0.00,$0.00,$204.07,"$1,165.50",$0.00,$582.75,$923.08,$932.40,$0.00,$177.09,$0.00,$185.55,$0.00
02.112.143,SUP,HCPCS C1713,,02.112.143  -  PLATE BN CNTR 112MM NS LCP CMBN 6 HL SS FIB LT DIST LAT,"$1,165.50",$0.00,"$1,165.50",$524.48,$831.82,$0.00,$194.96,$0.00,$0.00,$204.07,"$1,165.50",$0.00,$582.75,$923.08,$932.40,$0.00,$177.09,$0.00,$185.55,$0.00
02.112.144,SUP,HCPCS C1713,,02.112.144  -  PLATE BONE 125MM 7 HOLE LCP STAINLESS STEEL RIGHT DISTAL,"$1,181.88",$0.00,"$1,181.88",$531.84,$843.50,$0.00,$197.70,$0.00,$0.00,$206.94,"$1,181.88",$0.00,$590.94,$936.05,$945.50,$0.00,$179.58,$0.00,$188.15,$0.00
02.112.145,SUP,HCPCS C1713,,02.112.145  -  PLATE BN CNTR 125MM NS LCP CMBN 7 HL SS FIB LT DIST LAT,"$1,181.88",$0.00,"$1,181.88",$531.84,$843.50,$0.00,$197.70,$0.00,$0.00,$206.94,"$1,181.88",$0.00,$590.94,$936.05,$945.50,$0.00,$179.58,$0.00,$188.15,$0.00
02.112.148,SUP,HCPCS C1713,,02.112.148  -  PLATE BONE 151MM 9 HOLE ANATOMICALLY CNTOUR LCP STAINLESS,"$1,239.20",$0.00,"$1,239.20",$557.64,$884.42,$0.00,$207.29,$0.00,$0.00,$216.97,"$1,239.20",$0.00,$619.60,$981.45,$991.36,$0.00,$188.29,$0.00,$197.28,$0.00
02.112.149,SUP,HCPCS C1713,,02.112.149  -  PLATE BONE 151MM 9 HOLE LCP STAINLESS STEEL LEFT DISTAL,"$1,239.20",$0.00,"$1,239.20",$557.64,$884.42,$0.00,$207.29,$0.00,$0.00,$216.97,"$1,239.20",$0.00,$619.60,$981.45,$991.36,$0.00,$188.29,$0.00,$197.28,$0.00
02.112.152,SUP,HCPCS C1713,,02.112.152  -  PLATE BONE 177MM 11 HOLE LCP STAINLESS STEEL RIGHT LATERAL,"$1,258.30",$0.00,"$1,258.30",$566.24,$898.05,$0.00,$210.48,$0.00,$0.00,$220.32,"$1,258.30",$0.00,$629.15,$996.57,"$1,006.64",$0.00,$191.19,$0.00,$200.32,$0.00
02.112.153,SUP,HCPCS C1713,,02.112.153  -  PLATE BONE 177MM 11 HOLE LCP STAINLESS STEEL LEFT LATERAL,"$1,258.30",$0.00,"$1,258.30",$566.24,$898.05,$0.00,$210.48,$0.00,$0.00,$220.32,"$1,258.30",$0.00,$629.15,$996.57,"$1,006.64",$0.00,$191.19,$0.00,$200.32,$0.00
02.112.156,SUP,HCPCS C1713,,02.112.156  -  PLATE BONE 203MM 13 HOLE LCP STAINLESS STEEL RIGHT LATERAL,"$1,311.53",$0.00,"$1,311.53",$590.19,$936.04,$0.00,$219.39,$0.00,$0.00,$229.64,"$1,311.53",$0.00,$655.76,"$1,038.73","$1,049.22",$0.00,$199.28,$0.00,$208.79,$0.00
02.112.157,SUP,HCPCS C1713,,02.112.157  -  PLATE BONE 203MM 13 HOLE LCP STAINLESS STEEL LEFT LATERAL,"$1,311.53",$0.00,"$1,311.53",$590.19,$936.04,$0.00,$219.39,$0.00,$0.00,$229.64,"$1,311.53",$0.00,$655.76,"$1,038.73","$1,049.22",$0.00,$199.28,$0.00,$208.79,$0.00
02.112.160,SUP,HCPCS C1713,,02.112.160  -  PLATE BONE 299MM 15 HOLE LCP STAINLESS STEEL RIGHT LATERAL,"$1,330.63",$0.00,"$1,330.63",$598.78,$949.67,$0.00,$222.58,$0.00,$0.00,$232.98,"$1,330.63",$0.00,$665.31,"$1,053.86","$1,064.50",$0.00,$202.18,$0.00,$211.84,$0.00
02.112.161,SUP,HCPCS C1713,,02.112.161  -  PLATE BONE 229MM 15 HOLE LCP STAINLESS STEEL LEFT LATERAL,"$1,330.63",$0.00,"$1,330.63",$598.78,$949.67,$0.00,$222.58,$0.00,$0.00,$232.98,"$1,330.63",$0.00,$665.31,"$1,053.86","$1,064.50",$0.00,$202.18,$0.00,$211.84,$0.00
02.112.203,SUP,HCPCS C1713,,02.112.203  -  PLATE BONE T 64MM 3 HOLE LCP STAINLESS STEEL DISTAL TIBIA,"$1,344.28",$0.00,"$1,344.28",$604.92,$959.41,$0.00,$224.87,$0.00,$0.00,$235.37,"$1,344.28",$0.00,$672.14,"$1,064.67","$1,075.42",$0.00,$204.25,$0.00,$214.01,$0.00
02.112.205S,SUP,HCPCS C1713,,02.112.205S  -  PLATE BONE T 90X4.5X1.5MM 5 HOLE 4 LOCKING ANGULAR STABILITY,"$1,486.23",$0.00,"$1,486.23",$668.80,"$1,060.72",$0.00,$248.61,$0.00,$0.00,$260.23,"$1,486.23",$0.00,$743.11,"$1,177.09","$1,188.98",$0.00,$225.82,$0.00,$236.61,$0.00
02.112.208,SUP,HCPCS C1713,,02.112.208  -  PLATE BONE T 13.2CM 8 HOLE LCP STAINLESS STEEL POSTERIOR,"$2,326.90",$0.00,"$2,326.90","$1,047.11","$1,660.71",$0.00,$389.24,$0.00,$0.00,$407.42,"$2,326.90",$0.00,"$1,163.45","$1,842.90","$1,861.52",$0.00,$353.55,$0.00,$370.44,$0.00
02.112.212,SUP,HCPCS C1713,,02.112.212  -  PLATE BONE T 184MM 4 LOCKING 12 HOLE SHAFT PROFILE ANGULAR,"$2,483.85",$0.00,"$2,483.85","$1,117.73","$1,772.72",$0.00,$415.49,$0.00,$0.00,$434.90,"$2,483.85",$0.00,"$1,241.93","$1,967.21","$1,987.08",$0.00,$377.40,$0.00,$395.43,$0.00
02.112.216,SUP,HCPCS C1713,,02.112.216  -  PLATE BONE T 236MM 4 LOCKING 16 HOLE SHAFT PROFILE ANGULAR,"$2,575.28",$0.00,"$2,575.28","$1,158.87","$1,837.97",$0.00,$430.78,$0.00,$0.00,$450.91,"$2,575.28",$0.00,"$1,287.64","$2,039.62","$2,060.22",$0.00,$391.29,$0.00,$409.98,$0.00
02.112.510,SUP,HCPCS C1713,,02.112.510  -  PLATE BN LO BND 109MM NS LCP CMBN 4 HL LOPRFL RND EDG SS TIB,"$2,522.05",$0.00,"$2,522.05","$1,134.92","$1,799.99",$0.00,$421.88,$0.00,$0.00,$441.59,"$2,522.05",$0.00,"$1,261.03","$1,997.46","$2,017.64",$0.00,$383.21,$0.00,$401.51,$0.00
02.112.511,SUP,HCPCS C1713,,02.112.511  -  PLATE BN LO BND 109MM NS LCP CMBN 4 HL LOPRFL RND EDG SS TIB,"$2,522.05",$0.00,"$2,522.05","$1,134.92","$1,799.99",$0.00,$421.88,$0.00,$0.00,$441.59,"$2,522.05",$0.00,"$1,261.03","$1,997.46","$2,017.64",$0.00,$383.21,$0.00,$401.51,$0.00
02.112.514,SUP,HCPCS C1713,,02.112.514  -  PLATE BN LO BND 135MM NS LCP CMBN 6 HL LOPRFL RND EDG SS TIB,"$2,550.73",$0.00,"$2,550.73","$1,147.83","$1,820.45",$0.00,$426.68,$0.00,$0.00,$446.61,"$2,550.73",$0.00,"$1,275.36","$2,020.18","$2,040.58",$0.00,$387.56,$0.00,$406.08,$0.00
02.112.514S,SUP,HCPCS C1713,,02.112.514S  -  PLATE BN 135MM STRL LCP CMBN 6 HL LO BND LOPRFL RND EDG SS,"$2,639.43",$0.00,"$2,639.43","$1,187.74","$1,883.76",$0.00,$441.51,$0.00,$0.00,$462.14,"$2,639.43",$0.00,"$1,319.71","$2,090.43","$2,111.54",$0.00,$401.04,$0.00,$420.20,$0.00
02.112.515,SUP,HCPCS C1713,,02.112.515  -  PLATE BONE 135MM 6 HOLE LOW BEND LP HEAD ROUNDED EDGE LCP,"$2,550.73",$0.00,"$2,550.73","$1,147.83","$1,820.45",$0.00,$426.68,$0.00,$0.00,$446.61,"$2,550.73",$0.00,"$1,275.36","$2,020.18","$2,040.58",$0.00,$387.56,$0.00,$406.08,$0.00
02.112.518,SUP,HCPCS C1713,,02.112.518  -  PLATE BN 161MM NS LCP CMBN 8 HL LO BND LOPRFL RND EDG SS TIB,"$2,575.28",$0.00,"$2,575.28","$1,158.87","$1,837.97",$0.00,$430.78,$0.00,$0.00,$450.91,"$2,575.28",$0.00,"$1,287.64","$2,039.62","$2,060.22",$0.00,$391.29,$0.00,$409.98,$0.00
02.112.519,SUP,HCPCS C1713,,02.112.519  -  PLATE BONE 161MM 8 HOLE LOW BEND ROUNDED EDGE LP LCP,"$2,575.28",$0.00,"$2,575.28","$1,158.87","$1,837.97",$0.00,$430.78,$0.00,$0.00,$450.91,"$2,575.28",$0.00,"$1,287.64","$2,039.62","$2,060.22",$0.00,$391.29,$0.00,$409.98,$0.00
02.112.522,SUP,HCPCS C1713,,02.112.522  -  PLATE BONE 187MM 10 HOLE LOW BEND ROUNDED EDGE LP LCP,"$2,602.58",$0.00,"$2,602.58","$1,171.16","$1,857.46",$0.00,$435.35,$0.00,$0.00,$455.69,"$2,602.58",$0.00,"$1,301.29","$2,061.24","$2,082.06",$0.00,$395.44,$0.00,$414.33,$0.00
02.112.523,SUP,HCPCS C1713,,02.112.523  -  PLATE BONE 187MM 10 HOLE LOW BEND ROUNDED EDGE LP LCP,"$2,602.58",$0.00,"$2,602.58","$1,171.16","$1,857.46",$0.00,$435.35,$0.00,$0.00,$455.69,"$2,602.58",$0.00,"$1,301.29","$2,061.24","$2,082.06",$0.00,$395.44,$0.00,$414.33,$0.00
02.112.526,SUP,HCPCS C1713,,02.112.526  -  PLATE BONE 213MM 12 HOLE LOW BEND LCP STAINLESS STEEL TIBIA,"$2,631.25",$0.00,"$2,631.25","$1,184.06","$1,877.92",$0.00,$440.14,$0.00,$0.00,$460.71,"$2,631.25",$0.00,"$1,315.63","$2,083.95","$2,105.00",$0.00,$399.79,$0.00,$418.90,$0.00
02.112.527,SUP,HCPCS C1713,,02.112.527  -  PLATE BONE 213MM 12 HOLE LOW BEND LCP STAINLESS STEEL TIBIA,"$2,631.25",$0.00,"$2,631.25","$1,184.06","$1,877.92",$0.00,$440.14,$0.00,$0.00,$460.71,"$2,631.25",$0.00,"$1,315.63","$2,083.95","$2,105.00",$0.00,$399.79,$0.00,$418.90,$0.00
02.112.530,SUP,HCPCS C1713,,02.112.530  -  PLATE BONE 239MM 14 HOLE LOW BEND LCP STAINLESS STEEL RIGHT,"$2,665.35",$0.00,"$2,665.35","$1,199.41","$1,902.26",$0.00,$445.85,$0.00,$0.00,$466.68,"$2,665.35",$0.00,"$1,332.68","$2,110.96","$2,132.28",$0.00,$404.98,$0.00,$424.32,$0.00
02.112.531,SUP,HCPCS C1713,,02.112.531  -  PLATE BONE 239MM 14 HOLE LOW BEND LCP STAINLESS STEEL TIBIA,"$2,665.35",$0.00,"$2,665.35","$1,199.41","$1,902.26",$0.00,$445.85,$0.00,$0.00,$466.68,"$2,665.35",$0.00,"$1,332.68","$2,110.96","$2,132.28",$0.00,$404.98,$0.00,$424.32,$0.00
02.113.001,SUP,Custom 27203010,,02.113.001  -  GUIDEWIRE ORTHOPEDIC 1.6MM 200MM DRILL TIP LCP STAINLESS,$67.55,$0.00,$67.55,$0.00,$48.21,$0.00,$0.00,$0.00,$0.00,$0.00,$67.55,$0.00,$33.78,$53.50,$54.04,$0.00,$0.00,$0.00,$0.00,$0.00
02.113.103,SUP,HCPCS C1713,,02.113.103  -  PLATE BONE 62MM 3 HOLE SHARP HOOK LP PRECONTOUR SCALLOPED,$989.45,$0.00,$989.45,$445.25,$706.17,$0.00,$165.51,$0.00,$0.00,$173.24,$989.45,$0.00,$494.73,$783.64,$791.56,$0.00,$150.34,$0.00,$157.52,$0.00
02.114.002,SUP,HCPCS C1713,,02.114.002  -  PLATE BONE 23MM 4 HOLE LCP STAINLESS STEEL NONSTRL 1.5MM,$398.50,$0.00,$398.50,$179.33,$284.41,$0.00,$66.66,$0.00,$0.00,$69.77,$398.50,$0.00,$199.25,$315.61,$318.80,$0.00,$60.55,$0.00,$63.44,$0.00
02.114.003,SUP,HCPCS C1713,,02.114.003  -  PLATE BONE 29MM 6 HOLE ADAPTION LCP STAINLESS STEEL HAND,$730.15,$0.00,$730.15,$328.57,$521.11,$0.00,$122.14,$0.00,$0.00,$127.84,$730.15,$0.00,$365.08,$578.28,$584.12,$0.00,$110.94,$0.00,$116.24,$0.00
02.114.004,SUP,HCPCS C1713,,02.114.004  -  PLATE BONE 36MM 6 HOLE LCP STAINLESS STEEL NONSTRL 1.5MM,$398.50,$0.00,$398.50,$179.33,$284.41,$0.00,$66.66,$0.00,$0.00,$69.77,$398.50,$0.00,$199.25,$315.61,$318.80,$0.00,$60.55,$0.00,$63.44,$0.00
02.114.005,SUP,HCPCS C1713,,02.114.005  -  PLATE BONE 59MM 12 HOLE ADAPTION LCP STAINLESS STEEL NONSTRL,$730.15,$0.00,$730.15,$328.57,$521.11,$0.00,$122.14,$0.00,$0.00,$127.84,$730.15,$0.00,$365.08,$578.28,$584.12,$0.00,$110.94,$0.00,$116.24,$0.00
02.114.006,SUP,HCPCS C1713,,02.114.006  -  PLATE BONE 3X8 HOLE T LCP STAINLESS STEEL NONSTRL 1.5 MM,$767.00,$0.00,$767.00,$345.15,$547.41,$0.00,$128.30,$0.00,$0.00,$134.30,$767.00,$0.00,$383.50,$607.46,$613.60,$0.00,$116.54,$0.00,$122.11,$0.00
02.114.007,SUP,HCPCS C1713,,02.114.007  -  PLATE BONE 4X8 HOLE T LCP STAINLESS STEEL NONSTRL 1.5 MM,$767.00,$0.00,$767.00,$345.15,$547.41,$0.00,$128.30,$0.00,$0.00,$134.30,$767.00,$0.00,$383.50,$607.46,$613.60,$0.00,$116.54,$0.00,$122.11,$0.00
02.114.009,SUP,HCPCS C1713,,02.114.009  -  PLATE BONE H EXTENDED LCP STAINLESS STEEL LEFT NONSTRL 1.5,$738.33,$0.00,$738.33,$332.25,$526.94,$0.00,$123.51,$0.00,$0.00,$129.27,$738.33,$0.00,$369.16,$584.76,$590.66,$0.00,$112.18,$0.00,$117.54,$0.00
02.114.010,SUP,HCPCS C1713,,02.114.010  -  PLATE BONE H EXTENDED LCP STAINLESS STEEL RIGHT NONSTRL 1.5,$738.33,$0.00,$738.33,$332.25,$526.94,$0.00,$123.51,$0.00,$0.00,$129.27,$738.33,$0.00,$369.16,$584.76,$590.66,$0.00,$112.18,$0.00,$117.54,$0.00
02.114.013,SUP,HCPCS C1713,,02.114.013  -  PLATE BONE 3X8 HOLE Y LCP STAINLESS STEEL NONSTRL 1.5 MM,$738.33,$0.00,$738.33,$332.25,$526.94,$0.00,$123.51,$0.00,$0.00,$129.27,$738.33,$0.00,$369.16,$584.76,$590.66,$0.00,$112.18,$0.00,$117.54,$0.00
02.114.014,SUP,HCPCS C1713,,02.114.014  -  PLATE BONE 6 HOLE LCP STAINLESS STEEL CONDYLE NONSTRL 1.5 MM,$917.10,$0.00,$917.10,$412.70,$654.53,$0.00,$153.41,$0.00,$0.00,$160.58,$917.10,$0.00,$458.55,$726.34,$733.68,$0.00,$139.35,$0.00,$146.00,$0.00
02.114.502,SUP,HCPCS C1713,,02.114.502  -  PLATE BONE 2.3CM 4 HOLE SHORT THREADED DRILL GUIDE LP CUT TO,$476.30,$0.00,$476.30,$214.34,$339.94,$0.00,$79.67,$0.00,$0.00,$83.40,$476.30,$0.00,$238.15,$377.23,$381.04,$0.00,$72.37,$0.00,$75.83,$0.00
02.114.503,SUP,HCPCS C1713,,02.114.503  -  PLATE BONE 2.9CM 6 HOLE SHORT THREADED DRILL GUIDE ADAPTION,$812.03,$0.00,$812.03,$365.41,$579.54,$0.00,$135.83,$0.00,$0.00,$142.18,$812.03,$0.00,$406.01,$643.13,$649.62,$0.00,$123.38,$0.00,$129.27,$0.00
02.114.504,SUP,HCPCS C1713,,02.114.504  -  PLATE BONE 3.6CM 6 HOLE SHORT THREADED DRILL GUIDE LP CUT TO,$476.30,$0.00,$476.30,$214.34,$339.94,$0.00,$79.67,$0.00,$0.00,$83.40,$476.30,$0.00,$238.15,$377.23,$381.04,$0.00,$72.37,$0.00,$75.83,$0.00
02.114.505,SUP,HCPCS C1713,,02.114.505  -  PLATE BONE 5.9CM 12 HOLE SHORT THREADED DRILL GUIDE ADAPTION,$812.03,$0.00,$812.03,$365.41,$579.54,$0.00,$135.83,$0.00,$0.00,$142.18,$812.03,$0.00,$406.01,$643.13,$649.62,$0.00,$123.38,$0.00,$129.27,$0.00
02.114.506,SUP,HCPCS C1713,,02.114.506  -  PLATE BONE T 3X8 HOLE SHORT THREADED DRILL GUIDE LP CUT TO,$859.80,$0.00,$859.80,$386.91,$613.64,$0.00,$143.82,$0.00,$0.00,$150.54,$859.80,$0.00,$429.90,$680.96,$687.84,$0.00,$130.64,$0.00,$136.88,$0.00
02.114.507,SUP,HCPCS C1713,,02.114.507  -  PLATE BONE T 4 HOLE HEAD 8 HOLE SHAFT LP CUT TO LENGTH LCP,$859.80,$0.00,$859.80,$386.91,$613.64,$0.00,$143.82,$0.00,$0.00,$150.54,$859.80,$0.00,$429.90,$680.96,$687.84,$0.00,$130.64,$0.00,$136.88,$0.00
02.114.509,SUP,HCPCS C1713,,02.114.509  -  PLATE BONE H EXTENDED PRELOADED DRILL GUIDE LP CUT TO LENGTH,$821.58,$0.00,$821.58,$369.71,$586.36,$0.00,$137.43,$0.00,$0.00,$143.85,$821.58,$0.00,$410.79,$650.69,$657.26,$0.00,$124.83,$0.00,$130.79,$0.00
02.114.510,SUP,HCPCS C1713,,02.114.510  -  PLATE BONE H EXTENDED PRELOADED DRILL GUIDE LP CUT TO LENGTH,$821.58,$0.00,$821.58,$369.71,$586.36,$0.00,$137.43,$0.00,$0.00,$143.85,$821.58,$0.00,$410.79,$650.69,$657.26,$0.00,$124.83,$0.00,$130.79,$0.00
02.114.513,SUP,HCPCS C1713,,02.114.513  -  PLATE BONE Y 3X8 HOLE LP SHORT THREADED DRILL GUIDE CUT TO,$821.58,$0.00,$821.58,$369.71,$586.36,$0.00,$137.43,$0.00,$0.00,$143.85,$821.58,$0.00,$410.79,$650.69,$657.26,$0.00,$124.83,$0.00,$130.79,$0.00
02.114.514,SUP,HCPCS C1713,,02.114.514  -  PLATE BONE 6 HOLE LP SHORT THREADED DRILL GUIDE CUT TO,"$1,000.35",$0.00,"$1,000.35",$450.16,$713.95,$0.00,$167.34,$0.00,$0.00,$175.15,"$1,000.35",$0.00,$500.18,$792.28,$800.28,$0.00,$152.00,$0.00,$159.26,$0.00
02.115.130,SUP,HCPCS C1713,,02.115.130  -  PLATE BONE 90D L 37MM 2X3 HOLE VAR ANG LCP STAINLESS STEEL,$996.28,$0.00,$996.28,$448.32,$711.04,$0.00,$166.65,$0.00,$0.00,$174.44,$996.28,$0.00,$498.14,$789.05,$797.02,$0.00,$151.37,$0.00,$158.61,$0.00
02.115.131,SUP,HCPCS C1713,,02.115.131  -  PLATE BONE -90D L 37MM 2X3 HOLE VAR ANG LCP STAINLESS STEEL,$996.28,$0.00,$996.28,$448.32,$711.04,$0.00,$166.65,$0.00,$0.00,$174.44,$996.28,$0.00,$498.14,$789.05,$797.02,$0.00,$151.37,$0.00,$158.61,$0.00
02.115.150,SUP,HCPCS C1713,,02.115.150  -  PLATE BONE 90+ D L 51MM 2 HOLE HEAD 5 HOLE SHAFT VAR ANG LCP,"$1,046.78",$0.00,"$1,046.78",$471.05,$747.08,$0.00,$175.10,$0.00,$0.00,$183.28,"$1,046.78",$0.00,$523.39,$829.05,$837.42,$0.00,$159.05,$0.00,$166.65,$0.00
02.115.150S,SUP,HCPCS C1713,,02.115.150S  -  PLATE BN +90D L 51MM STRL LCP CMBN 2 HLE/HD 5 HL SHFT VA SS,"$1,135.48",$0.00,"$1,135.48",$510.96,$810.39,$0.00,$189.94,$0.00,$0.00,$198.81,"$1,135.48",$0.00,$567.74,$899.30,$908.38,$0.00,$172.53,$0.00,$180.77,$0.00
02.115.151,SUP,HCPCS C1713,,02.115.151  -  PLATE BONE -90D 51MM 2X5 HOLE L VAR ANG LCP STAINLESS STEEL,"$1,046.78",$0.00,"$1,046.78",$471.05,$747.08,$0.00,$175.10,$0.00,$0.00,$183.28,"$1,046.78",$0.00,$523.39,$829.05,$837.42,$0.00,$159.05,$0.00,$166.65,$0.00
02.115.230,SUP,HCPCS C1713,,02.115.230  -  PLATE BONE +90D L 37MM 3X3 HOLE VAR ANG LCP STAINLESS STEEL,$996.28,$0.00,$996.28,$448.32,$711.04,$0.00,$166.65,$0.00,$0.00,$174.44,$996.28,$0.00,$498.14,$789.05,$797.02,$0.00,$151.37,$0.00,$158.61,$0.00
02.115.231,SUP,HCPCS C1713,,02.115.231  -  PLATE BONE -90D 37MM 3X3 HOLE L VAR ANG LCP STAINLESS STEEL,$996.28,$0.00,$996.28,$448.32,$711.04,$0.00,$166.65,$0.00,$0.00,$174.44,$996.28,$0.00,$498.14,$789.05,$797.02,$0.00,$151.37,$0.00,$158.61,$0.00
02.115.250,SUP,HCPCS C1713,,02.115.250  -  PLATE BONE +90D 51MM 3X5 HOLE L VAR ANG LCP STAINLESS STEEL,"$1,046.78",$0.00,"$1,046.78",$471.05,$747.08,$0.00,$175.10,$0.00,$0.00,$183.28,"$1,046.78",$0.00,$523.39,$829.05,$837.42,$0.00,$159.05,$0.00,$166.65,$0.00
02.115.251,SUP,HCPCS C1713,,02.115.251  -  PLATE BONE -90D 51MM 3X5 HOLE L VAR ANG LCP STAINLESS STEEL,"$1,046.78",$0.00,"$1,046.78",$471.05,$747.08,$0.00,$175.10,$0.00,$0.00,$183.28,"$1,046.78",$0.00,$523.39,$829.05,$837.42,$0.00,$159.05,$0.00,$166.65,$0.00
02.115.330,SUP,HCPCS C1713,,02.115.330  -  PLATE BONE 37MM 3X3 HOLE T VAR ANG LCP STAINLESS STEEL,"$1,029.03",$0.00,"$1,029.03",$463.06,$734.42,$0.00,$172.13,$0.00,$0.00,$180.17,"$1,029.03",$0.00,$514.51,$814.99,$823.22,$0.00,$156.35,$0.00,$163.82,$0.00
02.115.350,SUP,HCPCS C1713,,02.115.350  -  PLATE BONE 51MM 3X5 HOLE T VAR ANG LCP STAINLESS STEEL,"$1,074.05",$0.00,"$1,074.05",$483.32,$766.55,$0.00,$179.66,$0.00,$0.00,$188.06,"$1,074.05",$0.00,$537.03,$850.65,$859.24,$0.00,$163.19,$0.00,$170.99,$0.00
02.115.430,SUP,HCPCS C1713,,02.115.430  -  PLATE BONE 20D 41MM 3X3 HOLE L VAR ANG OBLIQUE LCP STAINLESS,$996.28,$0.00,$996.28,$448.32,$711.04,$0.00,$166.65,$0.00,$0.00,$174.44,$996.28,$0.00,$498.14,$789.05,$797.02,$0.00,$151.37,$0.00,$158.61,$0.00
02.115.430S,SUP,HCPCS C1713,,02.115.430S  -  PLATE BN +20D OBLQ L 41MM STRL LCP CMBN 3 HLE/HD 3 HL SHFT,"$1,084.98",$0.00,"$1,084.98",$488.24,$774.35,$0.00,$181.49,$0.00,$0.00,$189.97,"$1,084.98",$0.00,$542.49,$859.30,$867.98,$0.00,$164.85,$0.00,$172.73,$0.00
02.115.431,SUP,HCPCS C1713,,02.115.431  -  PLATE BONE -20D L 41MM 3X3 HOLE VAR ANG OBLIQUE LCP,$996.28,$0.00,$996.28,$448.32,$711.04,$0.00,$166.65,$0.00,$0.00,$174.44,$996.28,$0.00,$498.14,$789.05,$797.02,$0.00,$151.37,$0.00,$158.61,$0.00
02.115.431S,SUP,HCPCS C1713,,02.115.431S  -  PLATE BN -20D OBLQ L 41MM STRL LCP CMBN 3 HLE/HD 3 HL SHFT,"$1,084.98",$0.00,"$1,084.98",$488.24,$774.35,$0.00,$181.49,$0.00,$0.00,$189.97,"$1,084.98",$0.00,$542.49,$859.30,$867.98,$0.00,$164.85,$0.00,$172.73,$0.00
02.115.450,SUP,HCPCS C1713,,02.115.450  -  PLATE BONE +20D 55MM 3X5 HOLE L VAR ANG OBLIQUE LCP,"$1,046.78",$0.00,"$1,046.78",$471.05,$747.08,$0.00,$175.10,$0.00,$0.00,$183.28,"$1,046.78",$0.00,$523.39,$829.05,$837.42,$0.00,$159.05,$0.00,$166.65,$0.00
02.115.451,SUP,HCPCS C1713,,02.115.451  -  PLATE BONE -20D 55MM 3X5 HOLE L VAR ANG OBLIQUE LCP,"$1,046.78",$0.00,"$1,046.78",$471.05,$747.08,$0.00,$175.10,$0.00,$0.00,$183.28,"$1,046.78",$0.00,$523.39,$829.05,$837.42,$0.00,$159.05,$0.00,$166.65,$0.00
02.115.530,SUP,HCPCS C1713,,02.115.530  -  PLATE BONE 46MM 5 HOLE VAR ANG COLUMN LCP STAINLESS STEEL,$977.15,$0.00,$977.15,$439.72,$697.39,$0.00,$163.46,$0.00,$0.00,$171.09,$977.15,$0.00,$488.58,$773.90,$781.72,$0.00,$148.47,$0.00,$155.56,$0.00
02.115.540,SUP,HCPCS C1713,,02.115.540  -  PLATE BONE 57MM 6 HOLE VAR ANG COLUMN LCP STAINLESS STEEL,"$1,029.03",$0.00,"$1,029.03",$463.06,$734.42,$0.00,$172.13,$0.00,$0.00,$180.17,"$1,029.03",$0.00,$514.51,$814.99,$823.22,$0.00,$156.35,$0.00,$163.82,$0.00
02.115.630,SUP,HCPCS C1713,,02.115.630  -  PLATE BONE 90D 41MM 3 HOLE VAR ANG INTERMEDIATE COLUMN LCP,"$1,074.05",$0.00,"$1,074.05",$483.32,$766.55,$0.00,$179.66,$0.00,$0.00,$188.06,"$1,074.05",$0.00,$537.03,$850.65,$859.24,$0.00,$163.19,$0.00,$170.99,$0.00
02.115.631,SUP,HCPCS C1713,,02.115.631  -  PLATE BONE -90D 41MM 3 HOLE VAR ANG INTERMEDIATE COLUMN LCP,"$1,074.05",$0.00,"$1,074.05",$483.32,$766.55,$0.00,$179.66,$0.00,$0.00,$188.06,"$1,074.05",$0.00,$537.03,$850.65,$859.24,$0.00,$163.19,$0.00,$170.99,$0.00
02.115.640,SUP,HCPCS C1713,,02.115.640  -  PLATE BONE +90D 49MM 4 HOLE VAR ANG INTERMEDIATE COLUMN LCP,"$1,113.63",$0.00,"$1,113.63",$501.13,$794.79,$0.00,$186.29,$0.00,$0.00,$194.99,"$1,113.63",$0.00,$556.81,$881.99,$890.90,$0.00,$169.21,$0.00,$177.29,$0.00
02.115.641,SUP,HCPCS C1713,,02.115.641  -  PLATE BONE -90D 49MM 4 HOLE VAR ANG INTERMEDIATE COLUMN LCP,"$1,113.63",$0.00,"$1,113.63",$501.13,$794.79,$0.00,$186.29,$0.00,$0.00,$194.99,"$1,113.63",$0.00,$556.81,$881.99,$890.90,$0.00,$169.21,$0.00,$177.29,$0.00
02.115.751S,SUP,HCPCS C1713,,02.115.751S  -  PLATE BN 57MM STRL LCP CMBN 6 HLE/HD 5 HL SHFT VA SS RDS LT,"$1,834.23",$0.00,"$1,834.23",$825.40,"$1,309.09",$0.00,$306.82,$0.00,$0.00,$321.16,"$1,834.23",$0.00,$917.11,"$1,452.71","$1,467.38",$0.00,$278.70,$0.00,$292.01,$0.00
02.117.003S,SUP,HCPCS C1713,,02.117.003S  -  PLATE BN SHRT 75MM STRL LCP CMBN 3 HL VA TPR TIP LAT SPRT SS,"$2,228.63",$0.00,"$2,228.63","$1,002.88","$1,590.57",$0.00,$372.80,$0.00,$0.00,$390.21,"$2,228.63",$0.00,"$1,114.31","$1,765.07","$1,782.90",$0.00,$338.62,$0.00,$354.80,$0.00
02.117.004S,SUP,HCPCS C1713,,02.117.004S  -  PLATE BONE MEDIUM 88MM 4 HOLE VAR ANG LATERAL SUPPORT,"$2,228.63",$0.00,"$2,228.63","$1,002.88","$1,590.57",$0.00,$372.80,$0.00,$0.00,$390.21,"$2,228.63",$0.00,"$1,114.31","$1,765.07","$1,782.90",$0.00,$338.62,$0.00,$354.80,$0.00
02.117.007S,SUP,HCPCS C1713,,02.117.007S  -  PLATE BONE LONG 127MM 7 HOLE VAR ANG TAPER TIP LATERAL,"$2,228.63",$0.00,"$2,228.63","$1,002.88","$1,590.57",$0.00,$372.80,$0.00,$0.00,$390.21,"$2,228.63",$0.00,"$1,114.31","$1,765.07","$1,782.90",$0.00,$338.62,$0.00,$354.80,$0.00
02.117.009S,SUP,HCPCS C1713,,02.117.009S  -  PLATE BONE XLONG 153MM 9 HOLE VAR ANG LATERAL SUPPORT,"$2,228.63",$0.00,"$2,228.63","$1,002.88","$1,590.57",$0.00,$372.80,$0.00,$0.00,$390.21,"$2,228.63",$0.00,"$1,114.31","$1,765.07","$1,782.90",$0.00,$338.62,$0.00,$354.80,$0.00
02.117.103S,SUP,HCPCS C1713,,02.117.103S  -  PLATE BONE SHORT 75MM 3 HOLE VAR ANG LATERAL SUPPORT LCP,"$2,228.63",$0.00,"$2,228.63","$1,002.88","$1,590.57",$0.00,$372.80,$0.00,$0.00,$390.21,"$2,228.63",$0.00,"$1,114.31","$1,765.07","$1,782.90",$0.00,$338.62,$0.00,$354.80,$0.00
02.117.104,SUP,HCPCS C1713,,02.117.104  -  PLATE BN MED 88MM NS LCP CMBN 4 HL VA TPR TIP LAT SPRT SS,"$2,139.93",$0.00,"$2,139.93",$962.97,"$1,527.26",$0.00,$357.96,$0.00,$0.00,$374.68,"$2,139.93",$0.00,"$1,069.96","$1,694.82","$1,711.94",$0.00,$325.14,$0.00,$340.68,$0.00
02.117.104S,SUP,HCPCS C1713,,02.117.104S  -  PLATE BONE MEDIUM 88MM 4 HOLE VAR ANG LATERAL SUPPORT,"$2,228.63",$0.00,"$2,228.63","$1,002.88","$1,590.57",$0.00,$372.80,$0.00,$0.00,$390.21,"$2,228.63",$0.00,"$1,114.31","$1,765.07","$1,782.90",$0.00,$338.62,$0.00,$354.80,$0.00
02.117.107S,SUP,HCPCS C1713,,02.117.107S  -  PLATE BONE LONG 127MM 7 HOLE VAR ANG LATERAL SUPPORT TAPERED,"$2,228.63",$0.00,"$2,228.63","$1,002.88","$1,590.57",$0.00,$372.80,$0.00,$0.00,$390.21,"$2,228.63",$0.00,"$1,114.31","$1,765.07","$1,782.90",$0.00,$338.62,$0.00,$354.80,$0.00
02.117.203S,SUP,HCPCS C1713,,02.117.203S  -  PLATE SHRT 75MM SS 2.7/3.5MM SCR 3 HOLE VAR ANG,"$2,164.50",$0.00,"$2,164.50",$974.03,"$1,544.80",$0.00,$362.07,$0.00,$0.00,$378.99,"$2,164.50",$0.00,"$1,082.25","$1,714.28","$1,731.60",$0.00,$328.88,$0.00,$344.59,$0.00
02.117.204S,SUP,HCPCS C1713,,02.117.204S  -  PLATE BN MED 88MM STRL LCP CMBN 4 HL VA TPR TIP RND PRFL SS,"$2,164.50",$0.00,"$2,164.50",$974.03,"$1,544.80",$0.00,$362.07,$0.00,$0.00,$378.99,"$2,164.50",$0.00,"$1,082.25","$1,714.28","$1,731.60",$0.00,$328.88,$0.00,$344.59,$0.00
02.117.207S,SUP,HCPCS C1713,,02.117.207S  -  PLATE BN LNG 127MM STRL LCP CMBN 7 HL VA TPR TIP RND PRFL SS,"$2,164.50",$0.00,"$2,164.50",$974.03,"$1,544.80",$0.00,$362.07,$0.00,$0.00,$378.99,"$2,164.50",$0.00,"$1,082.25","$1,714.28","$1,731.60",$0.00,$328.88,$0.00,$344.59,$0.00
02.117.303S,SUP,HCPCS C1713,,02.117.303S  -  PLATE BONE SHORT 75MM 3 HOLE VAR ANG ROUND PROFILE TAPERED,"$2,164.50",$0.00,"$2,164.50",$974.03,"$1,544.80",$0.00,$362.07,$0.00,$0.00,$378.99,"$2,164.50",$0.00,"$1,082.25","$1,714.28","$1,731.60",$0.00,$328.88,$0.00,$344.59,$0.00
02.117.304S,SUP,HCPCS C1713,,02.117.304S  -  PLATE BONE MEDIUM 88MM 4 HOLE VAR ANG ROUND PROFILE TAPERED,"$2,164.50",$0.00,"$2,164.50",$974.03,"$1,544.80",$0.00,$362.07,$0.00,$0.00,$378.99,"$2,164.50",$0.00,"$1,082.25","$1,714.28","$1,731.60",$0.00,$328.88,$0.00,$344.59,$0.00
02.117.307S,SUP,HCPCS C1713,,02.117.307S  -  PLATE BN LNG 127MM STRL LCP CMBN 7 HL VA TPR TIP RND PRFL SS,"$2,164.50",$0.00,"$2,164.50",$974.03,"$1,544.80",$0.00,$362.07,$0.00,$0.00,$378.99,"$2,164.50",$0.00,"$1,082.25","$1,714.28","$1,731.60",$0.00,$328.88,$0.00,$344.59,$0.00
02.117.309S,SUP,HCPCS C1713,,02.117.309S  -  PLATE BONE XLONG 153MM 9 HOLE VAR ANG ROUND PROFILE TAPERED,"$2,164.50",$0.00,"$2,164.50",$974.03,"$1,544.80",$0.00,$362.07,$0.00,$0.00,$378.99,"$2,164.50",$0.00,"$1,082.25","$1,714.28","$1,731.60",$0.00,$328.88,$0.00,$344.59,$0.00
02.117.401S,SUP,HCPCS C1713,,02.117.401S  -  PLATE BONE SHORT 69MM 1 HOLE VAR ANG ROUND PROFILE TAPERED,"$2,164.50",$0.00,"$2,164.50",$974.03,"$1,544.80",$0.00,$362.07,$0.00,$0.00,$378.99,"$2,164.50",$0.00,"$1,082.25","$1,714.28","$1,731.60",$0.00,$328.88,$0.00,$344.59,$0.00
02.117.402S,SUP,HCPCS C1713,,02.117.402S  -  PLATE BN MED 82MM STRL LCP CMBN 2 HL VA TPR TIP RND PRFL SS,"$2,164.50",$0.00,"$2,164.50",$974.03,"$1,544.80",$0.00,$362.07,$0.00,$0.00,$378.99,"$2,164.50",$0.00,"$1,082.25","$1,714.28","$1,731.60",$0.00,$328.88,$0.00,$344.59,$0.00
02.117.404S,SUP,HCPCS C1713,,02.117.404S  -  PLATE BONE LONG 108MM 4 HOLE VAR ANG TAPER TIP ROUND PROFILE,"$2,164.50",$0.00,"$2,164.50",$974.03,"$1,544.80",$0.00,$362.07,$0.00,$0.00,$378.99,"$2,164.50",$0.00,"$1,082.25","$1,714.28","$1,731.60",$0.00,$328.88,$0.00,$344.59,$0.00
02.117.406S,SUP,HCPCS C1713,,02.117.406S  -  PLATE BONE XLONG 134MM 6 HOLE VAR ANG TAPER TIP ROUND,"$2,164.50",$0.00,"$2,164.50",$974.03,"$1,544.80",$0.00,$362.07,$0.00,$0.00,$378.99,"$2,164.50",$0.00,"$1,082.25","$1,714.28","$1,731.60",$0.00,$328.88,$0.00,$344.59,$0.00
02.117.501S,SUP,HCPCS C1713,,02.117.501S  -  PLATE BONE SHORT 69MM 1 HOLE VAR ANG ROUND PROFILE TAPERED,"$2,164.50",$0.00,"$2,164.50",$974.03,"$1,544.80",$0.00,$362.07,$0.00,$0.00,$378.99,"$2,164.50",$0.00,"$1,082.25","$1,714.28","$1,731.60",$0.00,$328.88,$0.00,$344.59,$0.00
02.117.502,SUP,HCPCS C1713,,02.117.502  -  PLATE BONE MEDIUM 82MM 2 HOLE VAR ANG LCP STAINLESS STEEL,"$2,075.78",$0.00,"$2,075.78",$934.10,"$1,481.48",$0.00,$347.23,$0.00,$0.00,$363.45,"$2,075.78",$0.00,"$1,037.89","$1,644.02","$1,660.62",$0.00,$315.40,$0.00,$330.46,$0.00
02.117.502S,SUP,HCPCS C1713,,02.117.502S  -  PLATE BONE MEDIUM 82MM 2 HOLE VAR ANG ROUND PROFILE TAPERED,"$2,164.50",$0.00,"$2,164.50",$974.03,"$1,544.80",$0.00,$362.07,$0.00,$0.00,$378.99,"$2,164.50",$0.00,"$1,082.25","$1,714.28","$1,731.60",$0.00,$328.88,$0.00,$344.59,$0.00
02.117.504,SUP,HCPCS C1713,,02.117.504  -  PLATE BN LNG 108MM NS LCP CMBN 4 HL VA TPR TIP RND PRFL SS,"$2,075.78",$0.00,"$2,075.78",$934.10,"$1,481.48",$0.00,$347.23,$0.00,$0.00,$363.45,"$2,075.78",$0.00,"$1,037.89","$1,644.02","$1,660.62",$0.00,$315.40,$0.00,$330.46,$0.00
02.117.504S,SUP,HCPCS C1713,,02.117.504S  -  PLATE BONE LONG 108MM 4 HOLE VAR ANG ROUND PROFILE TAPERED,"$2,164.50",$0.00,"$2,164.50",$974.03,"$1,544.80",$0.00,$362.07,$0.00,$0.00,$378.99,"$2,164.50",$0.00,"$1,082.25","$1,714.28","$1,731.60",$0.00,$328.88,$0.00,$344.59,$0.00
02.117.506,SUP,HCPCS C1713,,02.117.506  -  PLATE BN XLNG 134MM NS LCP CMBN 6 HL VA TPR TIP RND PRFL SS,"$2,075.78",$0.00,"$2,075.78",$934.10,"$1,481.48",$0.00,$347.23,$0.00,$0.00,$363.45,"$2,075.78",$0.00,"$1,037.89","$1,644.02","$1,660.62",$0.00,$315.40,$0.00,$330.46,$0.00
02.117.506S,SUP,HCPCS C1713,,02.117.506S  -  PLATE BN XLNG 134MM STRL LCP CMBN 6 HL VA TPR TIP RND PRFL,"$2,164.50",$0.00,"$2,164.50",$974.03,"$1,544.80",$0.00,$362.07,$0.00,$0.00,$378.99,"$2,164.50",$0.00,"$1,082.25","$1,714.28","$1,731.60",$0.00,$328.88,$0.00,$344.59,$0.00
02.117.601S,SUP,HCPCS C1713,,02.117.601S  -  PLATE BONE LCP COMBI STAINLESS STEEL SHORT L72 MM HUMERUS RI,"$2,228.63",$0.00,"$2,228.63","$1,002.88","$1,590.57",$0.00,$372.80,$0.00,$0.00,$390.21,"$2,228.63",$0.00,"$1,114.31","$1,765.07","$1,782.90",$0.00,$338.62,$0.00,$354.80,$0.00
02.117.602,SUP,HCPCS C1713,,02.117.602  -  PLATE BONE MEDIUM 85MM 2 HOLE EXTENDED VAR ANG LCP STAINLESS,"$2,139.93",$0.00,"$2,139.93",$962.97,"$1,527.26",$0.00,$357.96,$0.00,$0.00,$374.68,"$2,139.93",$0.00,"$1,069.96","$1,694.82","$1,711.94",$0.00,$325.14,$0.00,$340.68,$0.00
02.117.602S,SUP,HCPCS C1713,,02.117.602S  -  PLATE BONE LCP COMBI STAINLESS STEEL MEDIUM L85 MM HUMERUS R,"$2,228.63",$0.00,"$2,228.63","$1,002.88","$1,590.57",$0.00,$372.80,$0.00,$0.00,$390.21,"$2,228.63",$0.00,"$1,114.31","$1,765.07","$1,782.90",$0.00,$338.62,$0.00,$354.80,$0.00
02.117.604,SUP,HCPCS C1713,,02.117.604  -  PLATE BN LNG 111MM NS LCP CMBN 4 HL VA TPR TIP XTD SS HUM RT,"$2,139.93",$0.00,"$2,139.93",$962.97,"$1,527.26",$0.00,$357.96,$0.00,$0.00,$374.68,"$2,139.93",$0.00,"$1,069.96","$1,694.82","$1,711.94",$0.00,$325.14,$0.00,$340.68,$0.00
02.117.604S,SUP,HCPCS C1713,,02.117.604S  -  PLATE BONE LONG 111MM 4 HOLE EXTENDED VAR ANG ROUND PROFILE,"$2,228.63",$0.00,"$2,228.63","$1,002.88","$1,590.57",$0.00,$372.80,$0.00,$0.00,$390.21,"$2,228.63",$0.00,"$1,114.31","$1,765.07","$1,782.90",$0.00,$338.62,$0.00,$354.80,$0.00
02.117.606S,SUP,HCPCS C1713,,02.117.606S  -  PLATE BN XLNG 137MM STRL LCP CMBN 6 HL VA TPR TIP XTD SS HUM,"$2,228.63",$0.00,"$2,228.63","$1,002.88","$1,590.57",$0.00,$372.80,$0.00,$0.00,$390.21,"$2,228.63",$0.00,"$1,114.31","$1,765.07","$1,782.90",$0.00,$338.62,$0.00,$354.80,$0.00
02.117.701S,SUP,HCPCS C1713,,02.117.701S  -  PLATE BONE SHORT 72MM 1 HOLE VAR ANG EXTENDED LCP STAINLESS,"$2,228.63",$0.00,"$2,228.63","$1,002.88","$1,590.57",$0.00,$372.80,$0.00,$0.00,$390.21,"$2,228.63",$0.00,"$1,114.31","$1,765.07","$1,782.90",$0.00,$338.62,$0.00,$354.80,$0.00
02.117.702S,SUP,HCPCS C1713,,02.117.702S  -  PLATE BONE MEDIUM 85MM 2 HOLE EXTENDED VAR ANG ROUND PROFILE,"$2,228.63",$0.00,"$2,228.63","$1,002.88","$1,590.57",$0.00,$372.80,$0.00,$0.00,$390.21,"$2,228.63",$0.00,"$1,114.31","$1,765.07","$1,782.90",$0.00,$338.62,$0.00,$354.80,$0.00
02.117.704,SUP,HCPCS C1713,,02.117.704  -  PLATE BN LNG 111MM NS LCP CMBN 4 HL VA TPR TIP XTD SS HUM LT,"$2,139.93",$0.00,"$2,139.93",$962.97,"$1,527.26",$0.00,$357.96,$0.00,$0.00,$374.68,"$2,139.93",$0.00,"$1,069.96","$1,694.82","$1,711.94",$0.00,$325.14,$0.00,$340.68,$0.00
02.117.704S,SUP,HCPCS C1713,,02.117.704S  -  PLATE BN LNG 111MM STRL LCP CMBN 4 HL VA TPR TIP XTD SS HUM,"$2,228.63",$0.00,"$2,228.63","$1,002.88","$1,590.57",$0.00,$372.80,$0.00,$0.00,$390.21,"$2,228.63",$0.00,"$1,114.31","$1,765.07","$1,782.90",$0.00,$338.62,$0.00,$354.80,$0.00
02.117.706,SUP,HCPCS C1713,,02.117.706  -  PLATE BN XLNG 137MM NS LCP CMBN 6 HL VA TPR TIP XTD SS HUM,"$2,139.93",$0.00,"$2,139.93",$962.97,"$1,527.26",$0.00,$357.96,$0.00,$0.00,$374.68,"$2,139.93",$0.00,"$1,069.96","$1,694.82","$1,711.94",$0.00,$325.14,$0.00,$340.68,$0.00
02.117.706S,SUP,HCPCS C1713,,02.117.706S  -  PLATE BONE XLONG 137MM 6 HOLE VAR ANG TAPER TIP EXTEND LCP,"$2,228.63",$0.00,"$2,228.63","$1,002.88","$1,590.57",$0.00,$372.80,$0.00,$0.00,$390.21,"$2,228.63",$0.00,"$1,114.31","$1,765.07","$1,782.90",$0.00,$338.62,$0.00,$354.80,$0.00
02.117.802,SUP,HCPCS C1713,,02.117.802  -  PLATE BONE MEDIUM 82MM 2 HOLE VAR ANG LCP STAINLESS STEEL,"$2,075.78",$0.00,"$2,075.78",$934.10,"$1,481.48",$0.00,$347.23,$0.00,$0.00,$363.45,"$2,075.78",$0.00,"$1,037.89","$1,644.02","$1,660.62",$0.00,$315.40,$0.00,$330.46,$0.00
02.117.802S,SUP,HCPCS C1713,,02.117.802S  -  PLATE BONE MEDIUM 82MM 2 HOLE VAR ANG ROUND PROFILE TAPERED,"$2,164.50",$0.00,"$2,164.50",$974.03,"$1,544.80",$0.00,$362.07,$0.00,$0.00,$378.99,"$2,164.50",$0.00,"$1,082.25","$1,714.28","$1,731.60",$0.00,$328.88,$0.00,$344.59,$0.00
02.117.805S,SUP,HCPCS C1713,,02.117.805S  -  PLATE BONE LONG 121MM 5 HOLE VAR ANG ROUND PROFILE TAPERED,"$2,164.50",$0.00,"$2,164.50",$974.03,"$1,544.80",$0.00,$362.07,$0.00,$0.00,$378.99,"$2,164.50",$0.00,"$1,082.25","$1,714.28","$1,731.60",$0.00,$328.88,$0.00,$344.59,$0.00
02.117.807S,SUP,HCPCS C1713,,02.117.807S  -  PLATE BONE LCP COMBI STAINLESS STEEL XLONG L147 MM HUMERUS R,"$2,164.50",$0.00,"$2,164.50",$974.03,"$1,544.80",$0.00,$362.07,$0.00,$0.00,$378.99,"$2,164.50",$0.00,"$1,082.25","$1,714.28","$1,731.60",$0.00,$328.88,$0.00,$344.59,$0.00
02.117.902,SUP,HCPCS C1713,,02.117.902  -  PLATE BN MED 82MM NS LCP CMBN 2 HL VA TPR TIP RND PRFL SS,"$2,075.78",$0.00,"$2,075.78",$934.10,"$1,481.48",$0.00,$347.23,$0.00,$0.00,$363.45,"$2,075.78",$0.00,"$1,037.89","$1,644.02","$1,660.62",$0.00,$315.40,$0.00,$330.46,$0.00
02.117.902S,SUP,HCPCS C1713,,02.117.902S  -  PLATE BONE MEDIUM 82MM 2 HOLE VAR ANG EXTENDED LCP STAINLESS,"$2,164.50",$0.00,"$2,164.50",$974.03,"$1,544.80",$0.00,$362.07,$0.00,$0.00,$378.99,"$2,164.50",$0.00,"$1,082.25","$1,714.28","$1,731.60",$0.00,$328.88,$0.00,$344.59,$0.00
02.117.905,SUP,HCPCS C1713,,02.117.905  -  PLATE BN LNG 121MM NS LCP CMBN 5 HL VA TPR TIP RND PRFL SS,"$2,075.78",$0.00,"$2,075.78",$934.10,"$1,481.48",$0.00,$347.23,$0.00,$0.00,$363.45,"$2,075.78",$0.00,"$1,037.89","$1,644.02","$1,660.62",$0.00,$315.40,$0.00,$330.46,$0.00
02.117.905S,SUP,HCPCS C1713,,02.117.905S  -  PLATE BONE LONG 121MM 5 HOLE VAR ANG ROUND PROFILE TAPERED,"$2,164.50",$0.00,"$2,164.50",$974.03,"$1,544.80",$0.00,$362.07,$0.00,$0.00,$378.99,"$2,164.50",$0.00,"$1,082.25","$1,714.28","$1,731.60",$0.00,$328.88,$0.00,$344.59,$0.00
02.117.909S,SUP,HCPCS C1713,,02.117.909S  -  PLATE BN 173MM STRL LCP CMBN 9 HL VA TPR TIP RND PRFL SS HUM,"$2,164.50",$0.00,"$2,164.50",$974.03,"$1,544.80",$0.00,$362.07,$0.00,$0.00,$378.99,"$2,164.50",$0.00,"$1,082.25","$1,714.28","$1,731.60",$0.00,$328.88,$0.00,$344.59,$0.00
02.118.003S,SUP,HCPCS C1713,,02.118.003S  -  PLATE BN 112MM STRL LCP CMBN 4 HL VA LOPRFL SS TIB LT DIST,"$2,774.53",$0.00,"$2,774.53","$1,248.54","$1,980.18",$0.00,$464.12,$0.00,$0.00,$485.80,"$2,774.53",$0.00,"$1,387.26","$2,197.43","$2,219.62",$0.00,$421.57,$0.00,$441.70,$0.00
02.118.005S,SUP,HCPCS C1713,,02.118.005S  -  PLATE BN 142MM STRL LCP CMBN 6 HL VA LOPRFL SS TIB LT DIST,"$2,804.55",$0.00,"$2,804.55","$1,262.05","$2,001.61",$0.00,$469.14,$0.00,$0.00,$491.05,"$2,804.55",$0.00,"$1,402.28","$2,221.20","$2,243.64",$0.00,$426.13,$0.00,$446.48,$0.00
02.118.006S,SUP,HCPCS C1713,,02.118.006S  -  PLATE BN 172MM STRL LCP CMBN 8 HL VA LOPRFL SS TIB RT DIST,"$2,831.85",$0.00,"$2,831.85","$1,274.33","$2,021.09",$0.00,$473.70,$0.00,$0.00,$495.83,"$2,831.85",$0.00,"$1,415.93","$2,242.83","$2,265.48",$0.00,$430.28,$0.00,$450.83,$0.00
02.118.007S,SUP,HCPCS C1713,,02.118.007S  -  PLATE BN 172MM STRL LCP CMBN 8 HL VA LOPRFL SS TIB LT DIST,"$2,831.85",$0.00,"$2,831.85","$1,274.33","$2,021.09",$0.00,$473.70,$0.00,$0.00,$495.83,"$2,831.85",$0.00,"$1,415.93","$2,242.83","$2,265.48",$0.00,$430.28,$0.00,$450.83,$0.00
02.118.011S,SUP,HCPCS C1713,,02.118.011S  -  PLATE BN 232MM STRL LCP CMBN 12 HL VA LOPRFL SS TIB LT DIST,"$3,323.18",$0.00,"$3,323.18","$1,495.43","$2,371.75",$0.00,$555.89,$0.00,$0.00,$581.86,"$3,323.18",$0.00,"$1,661.59","$2,631.96","$2,658.54",$0.00,$504.93,$0.00,$529.05,$0.00
02.118.510,SUP,HCPCS C1713,,02.118.510  -  SCREW BN T8 2.7MM 10MM NS LCP ST STRDR LOPRFL SS ELB MTPHSL,$83.25,$0.00,$83.25,$37.46,$59.42,$0.00,$13.93,$0.00,$0.00,$14.58,$83.25,$0.00,$41.63,$65.93,$66.60,$0.00,$12.65,$0.00,$13.25,$0.00
02.118.512,SUP,HCPCS C1713,,02.118.512  -  SCREW BONE T8 LP 2.7MM 12MM VAR ANG SELF TAP STARDRIVE LCP,$83.25,$0.00,$83.25,$37.46,$59.42,$0.00,$13.93,$0.00,$0.00,$14.58,$83.25,$0.00,$41.63,$65.93,$66.60,$0.00,$12.65,$0.00,$13.25,$0.00
02.118.514,SUP,HCPCS C1713,,02.118.514  -  SCREW BONE T8 LP 2.7MM 14MM VAR ANG SELF TAP STARDRIVE LCP,$83.25,$0.00,$83.25,$37.46,$59.42,$0.00,$13.93,$0.00,$0.00,$14.58,$83.25,$0.00,$41.63,$65.93,$66.60,$0.00,$12.65,$0.00,$13.25,$0.00
02.118.516,SUP,HCPCS C1713,,02.118.516  -  SCREW BONE T8 LP 2.7MM 16MM VAR ANG SELF TAP STARDRIVE LCP,$83.25,$0.00,$83.25,$37.46,$59.42,$0.00,$13.93,$0.00,$0.00,$14.58,$83.25,$0.00,$41.63,$65.93,$66.60,$0.00,$12.65,$0.00,$13.25,$0.00
02.118.518,SUP,HCPCS C1713,,02.118.518  -  SCREW BONE T8 LP 2.7MM 18MM VAR ANG SELF TAP STARDRIVE LCP,$83.25,$0.00,$83.25,$37.46,$59.42,$0.00,$13.93,$0.00,$0.00,$14.58,$83.25,$0.00,$41.63,$65.93,$66.60,$0.00,$12.65,$0.00,$13.25,$0.00
02.118.520,SUP,HCPCS C1713,,02.118.520  -  SCREW BONE T8 LP 2.7MM 20MM VAR ANG SELF TAP STARDRIVE LCP,$83.25,$0.00,$83.25,$37.46,$59.42,$0.00,$13.93,$0.00,$0.00,$14.58,$83.25,$0.00,$41.63,$65.93,$66.60,$0.00,$12.65,$0.00,$13.25,$0.00
02.118.522,SUP,HCPCS C1713,,02.118.522  -  SCREW BONE T8 LP 2.7MM 22MM VAR ANG SELF TAP STARDRIVE LCP,$83.25,$0.00,$83.25,$37.46,$59.42,$0.00,$13.93,$0.00,$0.00,$14.58,$83.25,$0.00,$41.63,$65.93,$66.60,$0.00,$12.65,$0.00,$13.25,$0.00
02.118.524,SUP,HCPCS C1713,,02.118.524  -  SCREW BONE T8 2.7MM 24MM SELF TAP STARDRIVE LP LCP STAINLESS,$83.25,$0.00,$83.25,$37.46,$59.42,$0.00,$13.93,$0.00,$0.00,$14.58,$83.25,$0.00,$41.63,$65.93,$66.60,$0.00,$12.65,$0.00,$13.25,$0.00
02.118.526,SUP,HCPCS C1713,,02.118.526  -  SCREW BONE 2.7MM 26MM VAR ANG SELF TAP T8 STARDRIVE LP HEAD,$83.25,$0.00,$83.25,$37.46,$59.42,$0.00,$13.93,$0.00,$0.00,$14.58,$83.25,$0.00,$41.63,$65.93,$66.60,$0.00,$12.65,$0.00,$13.25,$0.00
02.118.528,SUP,HCPCS C1713,,02.118.528  -  SCREW BONE T8 LP 2.7MM 28MM VAR ANG SELF TAP STARDRIVE LCP,$83.25,$0.00,$83.25,$37.46,$59.42,$0.00,$13.93,$0.00,$0.00,$14.58,$83.25,$0.00,$41.63,$65.93,$66.60,$0.00,$12.65,$0.00,$13.25,$0.00
02.118.530,SUP,HCPCS C1713,,02.118.530  -  SCREW BONE T8 LP 2.7MM 30MM VAR ANG SELF TAP STARDRIVE LCP,$83.25,$0.00,$83.25,$37.46,$59.42,$0.00,$13.93,$0.00,$0.00,$14.58,$83.25,$0.00,$41.63,$65.93,$66.60,$0.00,$12.65,$0.00,$13.25,$0.00
02.118.532,SUP,HCPCS C1713,,02.118.532  -  SCREW BONE T8 LP 2.7MM 32MM VAR ANG SELF TAP STARDRIVE LCP,$83.25,$0.00,$83.25,$37.46,$59.42,$0.00,$13.93,$0.00,$0.00,$14.58,$83.25,$0.00,$41.63,$65.93,$66.60,$0.00,$12.65,$0.00,$13.25,$0.00
02.118.534,SUP,HCPCS C1713,,02.118.534  -  SCREW BONE T8 LP 2.7MM 34MM VAR ANG SELF TAP STARDRIVE LCP,$83.25,$0.00,$83.25,$37.46,$59.42,$0.00,$13.93,$0.00,$0.00,$14.58,$83.25,$0.00,$41.63,$65.93,$66.60,$0.00,$12.65,$0.00,$13.25,$0.00
02.118.536,SUP,HCPCS C1713,,02.118.536  -  SCREW BN T8 2.7MM 36MM NS ST STRDR LOPRFL HD SS MTPHSL,$83.25,$0.00,$83.25,$37.46,$59.42,$0.00,$13.93,$0.00,$0.00,$14.58,$83.25,$0.00,$41.63,$65.93,$66.60,$0.00,$12.65,$0.00,$13.25,$0.00
02.118.538,SUP,HCPCS C1713,,02.118.538  -  SCREW BONE T8 LP 2.7MM 38MM VAR ANG SELF TAP STARDRIVE LCP,$83.25,$0.00,$83.25,$37.46,$59.42,$0.00,$13.93,$0.00,$0.00,$14.58,$83.25,$0.00,$41.63,$65.93,$66.60,$0.00,$12.65,$0.00,$13.25,$0.00
02.118.540,SUP,HCPCS C1713,,02.118.540  -  SCREW BN T8 2.7MM 40MM NS LCP ST STRDR LOPRFL SS ELB MTPHSL,$83.25,$0.00,$83.25,$37.46,$59.42,$0.00,$13.93,$0.00,$0.00,$14.58,$83.25,$0.00,$41.63,$65.93,$66.60,$0.00,$12.65,$0.00,$13.25,$0.00
02.118.542,SUP,HCPCS C1713,,02.118.542  -  SCREW BONE T8 2.7MM 42MM SELF TAP STARDRIVE LP LCP STAINLESS,$83.25,$0.00,$83.25,$37.46,$59.42,$0.00,$13.93,$0.00,$0.00,$14.58,$83.25,$0.00,$41.63,$65.93,$66.60,$0.00,$12.65,$0.00,$13.25,$0.00
02.118.544,SUP,HCPCS C1713,,02.118.544  -  SCREW BONE 2.7MM 44MM VAR ANG SELF TAP T8 STARDRIVE LP HEAD,$83.25,$0.00,$83.25,$37.46,$59.42,$0.00,$13.93,$0.00,$0.00,$14.58,$83.25,$0.00,$41.63,$65.93,$66.60,$0.00,$12.65,$0.00,$13.25,$0.00
02.118.546,SUP,HCPCS C1713,,02.118.546  -  SCREW BONE T8 LP 2.7MM 46MM VAR ANG SELF TAP STARDRIVE LCP,$83.25,$0.00,$83.25,$37.46,$59.42,$0.00,$13.93,$0.00,$0.00,$14.58,$83.25,$0.00,$41.63,$65.93,$66.60,$0.00,$12.65,$0.00,$13.25,$0.00
02.118.548,SUP,HCPCS C1713,,02.118.548  -  SCREW BONE T8 LP 2.7MM 48MM VAR ANG SELF TAP STARDRIVE LCP,$83.25,$0.00,$83.25,$37.46,$59.42,$0.00,$13.93,$0.00,$0.00,$14.58,$83.25,$0.00,$41.63,$65.93,$66.60,$0.00,$12.65,$0.00,$13.25,$0.00
02.118.550,SUP,HCPCS C1713,,02.118.550  -  SCREW BONE T8 LP 2.7MM 50MM VAR ANG SELF TAP STARDRIVE LCP,$83.25,$0.00,$83.25,$37.46,$59.42,$0.00,$13.93,$0.00,$0.00,$14.58,$83.25,$0.00,$41.63,$65.93,$66.60,$0.00,$12.65,$0.00,$13.25,$0.00
02.118.552,SUP,HCPCS C1713,,02.118.552  -  SCREW BONE 2.7MM 52MM VAR ANG SELF TAP T8 STARDRIVE LCP,$83.25,$0.00,$83.25,$37.46,$59.42,$0.00,$13.93,$0.00,$0.00,$14.58,$83.25,$0.00,$41.63,$65.93,$66.60,$0.00,$12.65,$0.00,$13.25,$0.00
02.118.554,SUP,HCPCS C1713,,02.118.554  -  SCREW BONE T8 LP 2.7MM 54MM VAR ANG SELF TAP STARDRIVE LCP,$83.25,$0.00,$83.25,$37.46,$59.42,$0.00,$13.93,$0.00,$0.00,$14.58,$83.25,$0.00,$41.63,$65.93,$66.60,$0.00,$12.65,$0.00,$13.25,$0.00
02.118.556,SUP,HCPCS C1713,,02.118.556  -  SCREW BONE T8 LP 2.7MM 56MM VAR ANG SELF TAP STARDRIVE LCP,$83.25,$0.00,$83.25,$37.46,$59.42,$0.00,$13.93,$0.00,$0.00,$14.58,$83.25,$0.00,$41.63,$65.93,$66.60,$0.00,$12.65,$0.00,$13.25,$0.00
02.118.558,SUP,HCPCS C1713,,02.118.558  -  SCREW BONE T8 LP 2.7MM 58MM VAR ANG SELF TAP STARDRIVE LCP,$83.25,$0.00,$83.25,$37.46,$59.42,$0.00,$13.93,$0.00,$0.00,$14.58,$83.25,$0.00,$41.63,$65.93,$66.60,$0.00,$12.65,$0.00,$13.25,$0.00
02.118.560,SUP,HCPCS C1713,,02.118.560  -  SCREW BONE T8 LP 2.7MM 60MM VAR ANG SELF TAP STARDRIVE LCP,$83.25,$0.00,$83.25,$37.46,$59.42,$0.00,$13.93,$0.00,$0.00,$14.58,$83.25,$0.00,$41.63,$65.93,$66.60,$0.00,$12.65,$0.00,$13.25,$0.00
02.118.562,SUP,HCPCS C1713,,02.118.562  -  SCREW BONE T8 LP 2.7MM 62MM VAR ANG SELF TAP STARDRIVE LCP,$83.25,$0.00,$83.25,$37.46,$59.42,$0.00,$13.93,$0.00,$0.00,$14.58,$83.25,$0.00,$41.63,$65.93,$66.60,$0.00,$12.65,$0.00,$13.25,$0.00
02.118.564,SUP,HCPCS C1713,,02.118.564  -  SCREW BONE T8 LP 2.7MM 64MM VAR ANG SELF TAP STARDRIVE LCP,$83.25,$0.00,$83.25,$37.46,$59.42,$0.00,$13.93,$0.00,$0.00,$14.58,$83.25,$0.00,$41.63,$65.93,$66.60,$0.00,$12.65,$0.00,$13.25,$0.00
02.118.566,SUP,HCPCS C1713,,02.118.566  -  SCREW BONE T8 LP 2.7MM 66MM VAR ANG SELF TAP STARDRIVE LCP,$83.25,$0.00,$83.25,$37.46,$59.42,$0.00,$13.93,$0.00,$0.00,$14.58,$83.25,$0.00,$41.63,$65.93,$66.60,$0.00,$12.65,$0.00,$13.25,$0.00
02.118.568,SUP,HCPCS C1713,,02.118.568  -  SCREW BONE T8 LP 2.7MM 68MM VAR ANG SELF TAP STARDRIVE LCP,$83.25,$0.00,$83.25,$37.46,$59.42,$0.00,$13.93,$0.00,$0.00,$14.58,$83.25,$0.00,$41.63,$65.93,$66.60,$0.00,$12.65,$0.00,$13.25,$0.00
02.118.570,SUP,HCPCS C1713,,02.118.570  -  SCREW BONE T8 LP 2.7MM 70MM VAR ANG SELF TAP STARDRIVE LCP,$83.25,$0.00,$83.25,$37.46,$59.42,$0.00,$13.93,$0.00,$0.00,$14.58,$83.25,$0.00,$41.63,$65.93,$66.60,$0.00,$12.65,$0.00,$13.25,$0.00
02.118.575S,SUP,HCPCS C1713,,02.118.575S  -  SCREW BN 2.7MM 75MM STRL LCP T8 STRDR RCS ST LOPRFL SS,$171.95,$0.00,$171.95,$77.38,$122.72,$0.00,$28.76,$0.00,$0.00,$30.11,$171.95,$0.00,$85.98,$136.18,$137.56,$0.00,$26.13,$0.00,$27.37,$0.00
02.120.601,SUP,HCPCS C1713,,02.120.601  -  PLATE BONE 4 HOLE LOCKING LCP STAINLESS STEEL FEMUR PROXIMAL,$913.03,$0.00,$913.03,$410.86,$651.63,$0.00,$152.73,$0.00,$0.00,$159.86,$913.03,$0.00,$456.51,$723.12,$730.42,$0.00,$138.73,$0.00,$145.35,$0.00
02.120.602,SUP,HCPCS C1713,,02.120.602  -  PLATE BONE 8 HOLE ATTCH LOCKING LCP STAINLESS STEEL FEMUR,"$1,000.35",$0.00,"$1,000.35",$450.16,$713.95,$0.00,$167.34,$0.00,$0.00,$175.15,"$1,000.35",$0.00,$500.18,$792.28,$800.28,$0.00,$152.00,$0.00,$159.26,$0.00
02.120.603,SUP,HCPCS C1713,,02.120.603  -  PLATE BONE 4.5MM 4 HOLE ATTCH LOCKING LCP STAINLESS STEEL,$913.03,$0.00,$913.03,$410.86,$651.63,$0.00,$152.73,$0.00,$0.00,$159.86,$913.03,$0.00,$456.51,$723.12,$730.42,$0.00,$138.73,$0.00,$145.35,$0.00
02.120.604,SUP,HCPCS C1713,,02.120.604  -  PLATE BONE 4.5MM 8 HOLE ATTCH LOCKING LCP STAINLESS STEEL,"$1,000.35",$0.00,"$1,000.35",$450.16,$713.95,$0.00,$167.34,$0.00,$0.00,$175.15,"$1,000.35",$0.00,$500.18,$792.28,$800.28,$0.00,$152.00,$0.00,$159.26,$0.00
02.120.606,SUP,HCPCS C1713,,02.120.606  -  SCREW BONE 2 PART CONNECT STARDRIVE LCP STAINLESS STEEL,$294.78,$0.00,$294.78,$132.65,$210.38,$0.00,$49.31,$0.00,$0.00,$51.61,$294.78,$0.00,$147.39,$233.47,$235.82,$0.00,$44.79,$0.00,$46.93,$0.00
02.120.701,SUP,HCPCS C1713,,02.120.701  -  PLATE BONE 69MM 1 HOLE SET W/O CASE LCP STAINLESS STEEL,"$1,699.13",$0.00,"$1,699.13",$764.61,"$1,212.67",$0.00,$284.22,$0.00,$0.00,$297.50,"$1,699.13",$0.00,$849.56,"$1,345.71","$1,359.30",$0.00,$258.17,$0.00,$270.50,$0.00
02.120.702,SUP,HCPCS C1713,,02.120.702  -  PLATE BONE 79MM 2 HOLE SET W/O CASE LCP STAINLESS STEEL,"$1,718.23",$0.00,"$1,718.23",$773.20,"$1,226.30",$0.00,$287.42,$0.00,$0.00,$300.85,"$1,718.23",$0.00,$859.11,"$1,360.84","$1,374.58",$0.00,$261.07,$0.00,$273.54,$0.00
02.120.704,SUP,HCPCS C1713,,02.120.704  -  PLATE BONE 105MM 4 HOLE LCP STAINLESS STEEL TIBIA,"$1,735.95",$0.00,"$1,735.95",$781.18,"$1,238.95",$0.00,$290.39,$0.00,$0.00,$303.95,"$1,735.95",$0.00,$867.98,"$1,374.87","$1,388.76",$0.00,$263.77,$0.00,$276.36,$0.00
02.120.706,SUP,HCPCS C1713,,02.120.706  -  PLATE BONE 131MM 6 HOLE LCP STAINLESS STEEL TIBIA,"$1,752.35",$0.00,"$1,752.35",$788.56,"$1,250.65",$0.00,$293.13,$0.00,$0.00,$306.82,"$1,752.35",$0.00,$876.18,"$1,387.86","$1,401.88",$0.00,$266.25,$0.00,$278.97,$0.00
02.120.708,SUP,HCPCS C1713,,02.120.708  -  PLATE BONE 157MM 8 HOLE SET W/O CASE LCP STAINLESS STEEL,"$1,821.95",$0.00,"$1,821.95",$819.88,"$1,300.33",$0.00,$304.77,$0.00,$0.00,$319.01,"$1,821.95",$0.00,$910.98,"$1,442.98","$1,457.56",$0.00,$276.83,$0.00,$290.05,$0.00
02.120.710,SUP,HCPCS C1713,,02.120.710  -  PLATE BONE 183MM 10 HOLE SET W/O CASE LCP STAINLESS STEEL,"$1,841.05",$0.00,"$1,841.05",$828.47,"$1,313.96",$0.00,$307.96,$0.00,$0.00,$322.35,"$1,841.05",$0.00,$920.53,"$1,458.11","$1,472.84",$0.00,$279.73,$0.00,$293.10,$0.00
02.123.020,SUP,HCPCS C1713,,02.123.020  -  PLATE BN CNTR 91MM NS LCP CMBN 2 HL LMT CNTCT TPR TIP SS HUM,"$2,774.53",$0.00,"$2,774.53","$1,248.54","$1,980.18",$0.00,$464.12,$0.00,$0.00,$485.80,"$2,774.53",$0.00,"$1,387.26","$2,197.43","$2,219.62",$0.00,$421.57,$0.00,$441.70,$0.00
02.123.021,SUP,HCPCS C1713,,02.123.021  -  PLATE BN CNTR 91MM NS LCP CMBN 2 HL LMT CNTCT TPR TIP SS HUM,"$2,774.53",$0.00,"$2,774.53","$1,248.54","$1,980.18",$0.00,$464.12,$0.00,$0.00,$485.80,"$2,774.53",$0.00,"$1,387.26","$2,197.43","$2,219.62",$0.00,$421.57,$0.00,$441.70,$0.00
02.123.022,SUP,HCPCS C1713,,02.123.022  -  PLATE BONE 91MM 4 HOLE LCP STAINLESS STEEL PERIARTICULAR,"$2,857.78",$0.00,"$2,857.78","$1,286.00","$2,039.59",$0.00,$478.04,$0.00,$0.00,$500.37,"$2,857.78",$0.00,"$1,428.89","$2,263.36","$2,286.22",$0.00,$434.22,$0.00,$454.96,$0.00
02.123.023,SUP,HCPCS C1713,,02.123.023  -  PLATE BN CNTR 127MM NS LCP CMBN 4 HL LMT CNTCT TPR TIP SS,"$2,857.78",$0.00,"$2,857.78","$1,286.00","$2,039.59",$0.00,$478.04,$0.00,$0.00,$500.37,"$2,857.78",$0.00,"$1,428.89","$2,263.36","$2,286.22",$0.00,$434.22,$0.00,$454.96,$0.00
02.123.024,SUP,HCPCS C1713,,02.123.024  -  PLATE BONE 163MM 6 HOLE LCP STAINLESS STEEL PERIARTICULAR,"$3,010.65",$0.00,"$3,010.65","$1,354.79","$2,148.70",$0.00,$503.61,$0.00,$0.00,$527.14,"$3,010.65",$0.00,"$1,505.33","$2,384.43","$2,408.52",$0.00,$457.44,$0.00,$479.30,$0.00
02.123.025,SUP,HCPCS C1713,,02.123.025  -  PLATE BONE 163MM 6 HOLE LCP STAINLESS STEEL LEFT PROXIMAL,"$3,010.65",$0.00,"$3,010.65","$1,354.79","$2,148.70",$0.00,$503.61,$0.00,$0.00,$527.14,"$3,010.65",$0.00,"$1,505.33","$2,384.43","$2,408.52",$0.00,$457.44,$0.00,$479.30,$0.00
02.123.026,SUP,HCPCS C1713,,02.123.026  -  PLATE BN CNTR 199MM NS LCP CMBN 8 HL LMT CNTCT TPR TIP SS,"$3,126.65",$0.00,"$3,126.65","$1,406.99","$2,231.49",$0.00,$523.01,$0.00,$0.00,$547.45,"$3,126.65",$0.00,"$1,563.33","$2,476.31","$2,501.32",$0.00,$475.07,$0.00,$497.76,$0.00
02.123.027,SUP,HCPCS C1713,,02.123.027  -  PLATE BN CNTR 199MM NS LCP CMBN 8 HL LMT CNTCT TPR TIP SS,"$3,126.65",$0.00,"$3,126.65","$1,406.99","$2,231.49",$0.00,$523.01,$0.00,$0.00,$547.45,"$3,126.65",$0.00,"$1,563.33","$2,476.31","$2,501.32",$0.00,$475.07,$0.00,$497.76,$0.00
02.123.028,SUP,HCPCS C1713,,02.123.028  -  PLATE BN CNTR 235MM NS LCP CMBN 10 HL LMT CNTCT TPR TIP SS,"$3,244.00",$0.00,"$3,244.00","$1,459.80","$2,315.24",$0.00,$542.65,$0.00,$0.00,$568.00,"$3,244.00",$0.00,"$1,622.00","$2,569.25","$2,595.20",$0.00,$492.90,$0.00,$516.44,$0.00
02.123.029,SUP,HCPCS C1713,,02.123.029  -  PLATE BONE 235MM 10 HOLE LCP STAINLESS STEEL LEFT PROXIMAL,"$3,244.00",$0.00,"$3,244.00","$1,459.80","$2,315.24",$0.00,$542.65,$0.00,$0.00,$568.00,"$3,244.00",$0.00,"$1,622.00","$2,569.25","$2,595.20",$0.00,$492.90,$0.00,$516.44,$0.00
02.123.030,SUP,HCPCS C1713,,02.123.030  -  PLATE BN CNTR 271MM NS LCP CMBN 12 HL LMT CNTCT TPR TIP SS,"$3,347.73",$0.00,"$3,347.73","$1,506.48","$2,389.27",$0.00,$560.00,$0.00,$0.00,$586.16,"$3,347.73",$0.00,"$1,673.86","$2,651.40","$2,678.18",$0.00,$508.66,$0.00,$532.96,$0.00
02.123.031,SUP,HCPCS C1713,,02.123.031  -  PLATE BONE 271MM 12 HOLE LCP STAINLESS STEEL PERIARTICULAR,"$3,347.73",$0.00,"$3,347.73","$1,506.48","$2,389.27",$0.00,$560.00,$0.00,$0.00,$586.16,"$3,347.73",$0.00,"$1,673.86","$2,651.40","$2,678.18",$0.00,$508.66,$0.00,$532.96,$0.00
02.123.032S,SUP,HCPCS C1713,,02.123.032S  -  PLATE BONE 307MM 14 HOLE LCP STAINLESS STEEL PERIARTICULAR,"$3,657.53",$0.00,"$3,657.53","$1,645.89","$2,610.38",$0.00,$611.82,$0.00,$0.00,$640.40,"$3,657.53",$0.00,"$1,828.76","$2,896.76","$2,926.02",$0.00,$555.73,$0.00,$582.28,$0.00
02.123.033S,SUP,HCPCS C1713,,02.123.033S  -  PLATE BONE 307MM 14 HOLE LCP STAINLESS STEEL PERIARTICULAR,"$3,657.53",$0.00,"$3,657.53","$1,645.89","$2,610.38",$0.00,$611.82,$0.00,$0.00,$640.40,"$3,657.53",$0.00,"$1,828.76","$2,896.76","$2,926.02",$0.00,$555.73,$0.00,$582.28,$0.00
02.123.040,SUP,HCPCS C1713,,02.123.040  -  PLATE BONE 109MM 3 HOLE LCP STAINLESS STEEL RIGHT PROXIMAL,"$2,814.13",$0.00,"$2,814.13","$1,266.36","$2,008.44",$0.00,$470.74,$0.00,$0.00,$492.73,"$2,814.13",$0.00,"$1,407.06","$2,228.79","$2,251.30",$0.00,$427.58,$0.00,$448.01,$0.00
02.123.041,SUP,HCPCS C1713,,02.123.041  -  PLATE BN CNTR 109MM NS LCP CMBN 3 HL LMT CNTCT TPR TIP SS,"$2,814.13",$0.00,"$2,814.13","$1,266.36","$2,008.44",$0.00,$470.74,$0.00,$0.00,$492.73,"$2,814.13",$0.00,"$1,407.06","$2,228.79","$2,251.30",$0.00,$427.58,$0.00,$448.01,$0.00
02.123.042,SUP,HCPCS C1713,,02.123.042  -  PLATE BN CNTR 145MM NS LCP CMBN 5 HL LMT CNTCT TPR TIP SS,"$2,928.75",$0.00,"$2,928.75","$1,317.94","$2,090.25",$0.00,$489.91,$0.00,$0.00,$512.80,"$2,928.75",$0.00,"$1,464.38","$2,319.57","$2,343.00",$0.00,$445.00,$0.00,$466.26,$0.00
02.123.043,SUP,HCPCS C1713,,02.123.043  -  PLATE BONE 14.5CM 5 HOLE SET LCP STAINLESS STEEL LEFT,"$2,928.75",$0.00,"$2,928.75","$1,317.94","$2,090.25",$0.00,$489.91,$0.00,$0.00,$512.80,"$2,928.75",$0.00,"$1,464.38","$2,319.57","$2,343.00",$0.00,$445.00,$0.00,$466.26,$0.00
02.124.030S,SUP,HCPCS C1713,,02.124.030S  -  PLATE BONE 356MM 15 HOLE ANATOMIC LCP STAINLESS STEEL FEMUR,"$3,222.18",$0.00,"$3,222.18","$1,449.98","$2,299.67",$0.00,$538.99,$0.00,$0.00,$564.18,"$3,222.18",$0.00,"$1,611.09","$2,551.97","$2,577.74",$0.00,$489.58,$0.00,$512.97,$0.00
02.124.031S,SUP,HCPCS C1713,,02.124.031S  -  PLATE BONE 356MM 15 HOLE ANATOMIC LCP STAINLESS STEEL FEMUR,"$3,222.18",$0.00,"$3,222.18","$1,449.98","$2,299.67",$0.00,$538.99,$0.00,$0.00,$564.18,"$3,222.18",$0.00,"$1,611.09","$2,551.97","$2,577.74",$0.00,$489.58,$0.00,$512.97,$0.00
02.124.034S,SUP,HCPCS C1713,,02.124.034S  -  PLATE BN 396MM STRL LCP CMBN 17 HL PSHP RND TIP LOPRFL SS,"$3,280.85",$0.00,"$3,280.85","$1,476.38","$2,341.54",$0.00,$548.81,$0.00,$0.00,$574.45,"$3,280.85",$0.00,"$1,640.43","$2,598.43","$2,624.68",$0.00,$498.50,$0.00,$522.31,$0.00
02.124.035S,SUP,HCPCS C1713,,02.124.035S  -  PLATE BONE 396MM 17 HOLE ANATOMIC LCP STAINLESS STEEL FEMUR,"$3,280.85",$0.00,"$3,280.85","$1,476.38","$2,341.54",$0.00,$548.81,$0.00,$0.00,$574.45,"$3,280.85",$0.00,"$1,640.43","$2,598.43","$2,624.68",$0.00,$498.50,$0.00,$522.31,$0.00
02.124.038S,SUP,HCPCS C1713,,02.124.038S  -  PLATE BONE 436MM 19 HOLE ANATOMIC LCP STAINLESS STEEL FEMUR,"$3,340.90",$0.00,"$3,340.90","$1,503.41","$2,384.40",$0.00,$558.86,$0.00,$0.00,$584.96,"$3,340.90",$0.00,"$1,670.45","$2,645.99","$2,672.72",$0.00,$507.62,$0.00,$531.87,$0.00
02.124.039S,SUP,HCPCS C1713,,02.124.039S  -  PLATE BONE 436MM 19 HOLE ANATOMIC LCP STAINLESS STEEL FEMUR,"$3,340.90",$0.00,"$3,340.90","$1,503.41","$2,384.40",$0.00,$558.86,$0.00,$0.00,$584.96,"$3,340.90",$0.00,"$1,670.45","$2,645.99","$2,672.72",$0.00,$507.62,$0.00,$531.87,$0.00
02.124.200,SUP,HCPCS C1713,,02.124.200  -  PLATE BN CNTR LO BND 76MM NS LCP CMBN 4 HL LMT CNTCT SS TIB,"$2,586.20",$0.00,"$2,586.20","$1,163.79","$1,845.77",$0.00,$432.61,$0.00,$0.00,$452.82,"$2,586.20",$0.00,"$1,293.10","$2,048.27","$2,068.96",$0.00,$392.95,$0.00,$411.72,$0.00
02.124.200S,SUP,HCPCS C1713,,02.124.200S  -  PLATE BN 76MM STRL LCP CMBN 4 HL LO BND LMT CNTCT SS TIB RT,"$2,674.90",$0.00,"$2,674.90","$1,203.71","$1,909.08",$0.00,$447.45,$0.00,$0.00,$468.35,"$2,674.90",$0.00,"$1,337.45","$2,118.52","$2,139.92",$0.00,$406.43,$0.00,$425.84,$0.00
02.124.201,SUP,HCPCS C1713,,02.124.201  -  PLATE BN CNTR LO BND 76MM NS LCP CMBN 4 HL LMT CNTCT SS TIB,"$2,586.20",$0.00,"$2,586.20","$1,163.79","$1,845.77",$0.00,$432.61,$0.00,$0.00,$452.82,"$2,586.20",$0.00,"$1,293.10","$2,048.27","$2,068.96",$0.00,$392.95,$0.00,$411.72,$0.00
02.124.201S,SUP,HCPCS C1713,,02.124.201S  -  PLATE BN 76MM STRL LCP CMBN 4 HL LO BND LMT CNTCT SS TIB LT,"$2,674.90",$0.00,"$2,674.90","$1,203.71","$1,909.08",$0.00,$447.45,$0.00,$0.00,$468.35,"$2,674.90",$0.00,"$1,337.45","$2,118.52","$2,139.92",$0.00,$406.43,$0.00,$425.84,$0.00
02.124.204,SUP,HCPCS C1713,,02.124.204  -  PLATE BN CNTR LO BND 102MM NS LCP CMBN 6 HL LMT CNTCT SS TIB,"$2,617.60",$0.00,"$2,617.60","$1,177.92","$1,868.18",$0.00,$437.86,$0.00,$0.00,$458.32,"$2,617.60",$0.00,"$1,308.80","$2,073.14","$2,094.08",$0.00,$397.72,$0.00,$416.72,$0.00
02.124.205,SUP,HCPCS C1713,,02.124.205  -  PLATE BN CNTR LO BND 102MM NS LCP CMBN 6 HL LMT CNTCT SS TIB,"$2,617.60",$0.00,"$2,617.60","$1,177.92","$1,868.18",$0.00,$437.86,$0.00,$0.00,$458.32,"$2,617.60",$0.00,"$1,308.80","$2,073.14","$2,094.08",$0.00,$397.72,$0.00,$416.72,$0.00
02.124.205S,SUP,HCPCS C1713,,02.124.205S  -  PLATE BN 102MM STRL LCP CMBN 6 HL LO BND LMT CNTCT SS TIB LT,"$2,706.30",$0.00,"$2,706.30","$1,217.84","$1,931.49",$0.00,$452.70,$0.00,$0.00,$473.85,"$2,706.30",$0.00,"$1,353.15","$2,143.39","$2,165.04",$0.00,$411.20,$0.00,$430.84,$0.00
02.124.208,SUP,HCPCS C1713,,02.124.208  -  PLATE BN CNTR LO BND 128MM NS LCP CMBN 8 HL LMT CNTCT SS TIB,"$2,647.63",$0.00,"$2,647.63","$1,191.43","$1,889.61",$0.00,$442.88,$0.00,$0.00,$463.58,"$2,647.63",$0.00,"$1,323.81","$2,096.92","$2,118.10",$0.00,$402.28,$0.00,$421.50,$0.00
02.124.209,SUP,HCPCS C1713,,02.124.209  -  PLATE BN CNTR LO BND 128MM NS LCP CMBN 8 HL LMT CNTCT SS TIB,"$2,647.63",$0.00,"$2,647.63","$1,191.43","$1,889.61",$0.00,$442.88,$0.00,$0.00,$463.58,"$2,647.63",$0.00,"$1,323.81","$2,096.92","$2,118.10",$0.00,$402.28,$0.00,$421.50,$0.00
02.124.212,SUP,HCPCS C1713,,02.124.212  -  PLATE BN CNTR LO BND 154MM NS LCP CMBN 10 HL LMT CNTCT SS,"$2,676.28",$0.00,"$2,676.28","$1,204.32","$1,910.06",$0.00,$447.68,$0.00,$0.00,$468.59,"$2,676.28",$0.00,"$1,338.14","$2,119.61","$2,141.02",$0.00,$406.64,$0.00,$426.06,$0.00
02.124.213,SUP,HCPCS C1713,,02.124.213  -  PLATE BN CNTR LO BND 154MM NS LCP CMBN 10 HL LMT CNTCT SS,"$2,676.28",$0.00,"$2,676.28","$1,204.32","$1,910.06",$0.00,$447.68,$0.00,$0.00,$468.59,"$2,676.28",$0.00,"$1,338.14","$2,119.61","$2,141.02",$0.00,$406.64,$0.00,$426.06,$0.00
02.124.216,SUP,HCPCS C1713,,02.124.216  -  PLATE BN CNTR LO BND 180MM NS LCP CMBN 12 HL LMT CNTCT SS,"$2,803.20",$0.00,"$2,803.20","$1,261.44","$2,000.64",$0.00,$468.91,$0.00,$0.00,$490.82,"$2,803.20",$0.00,"$1,401.60","$2,220.13","$2,242.56",$0.00,$425.92,$0.00,$446.27,$0.00
02.124.217,SUP,HCPCS C1713,,02.124.217  -  PLATE BN CNTR LO BND 180MM NS LCP CMBN 12 HL LMT CNTCT SS,"$2,803.20",$0.00,"$2,803.20","$1,261.44","$2,000.64",$0.00,$468.91,$0.00,$0.00,$490.82,"$2,803.20",$0.00,"$1,401.60","$2,220.13","$2,242.56",$0.00,$425.92,$0.00,$446.27,$0.00
02.124.220,SUP,HCPCS C1713,,02.124.220  -  PLATE BN CNTR LO BND 206MM NS LCP CMBN 14 HL LMT CNTCT SS,"$2,833.23",$0.00,"$2,833.23","$1,274.95","$2,022.07",$0.00,$473.93,$0.00,$0.00,$496.08,"$2,833.23",$0.00,"$1,416.61","$2,243.92","$2,266.58",$0.00,$430.48,$0.00,$451.05,$0.00
02.124.220S,SUP,HCPCS C1713,,02.124.220S  -  PLATE BN 206MM STRL LCP CMBN 14 HL LO BND LMT CNTCT SS TIB,"$2,921.93",$0.00,"$2,921.93","$1,314.87","$2,085.38",$0.00,$488.77,$0.00,$0.00,$511.61,"$2,921.93",$0.00,"$1,460.96","$2,314.17","$2,337.54",$0.00,$443.96,$0.00,$465.17,$0.00
02.124.221,SUP,HCPCS C1713,,02.124.221  -  PLATE BN CNTR LO BND 206MM NS LCP CMBN 14 HL LMT CNTCT SS,"$2,833.23",$0.00,"$2,833.23","$1,274.95","$2,022.07",$0.00,$473.93,$0.00,$0.00,$496.08,"$2,833.23",$0.00,"$1,416.61","$2,243.92","$2,266.58",$0.00,$430.48,$0.00,$451.05,$0.00
02.124.224,SUP,HCPCS C1713,,02.124.224  -  PLATE BN CNTR LO BND 232MM NS LCP CMBN 16 HL LMT CNTCT SS,"$2,932.85",$0.00,"$2,932.85","$1,319.78","$2,093.18",$0.00,$490.60,$0.00,$0.00,$513.52,"$2,932.85",$0.00,"$1,466.43","$2,322.82","$2,346.28",$0.00,$445.62,$0.00,$466.91,$0.00
02.124.225,SUP,HCPCS C1713,,02.124.225  -  PLATE BN CNTR LO BND 232MM NS LCP CMBN 16 HL LMT CNTCT SS,"$2,932.85",$0.00,"$2,932.85","$1,319.78","$2,093.18",$0.00,$490.60,$0.00,$0.00,$513.52,"$2,932.85",$0.00,"$1,466.43","$2,322.82","$2,346.28",$0.00,$445.62,$0.00,$466.91,$0.00
02.124.408S,SUP,HCPCS C1713,,02.124.408S  -  PLATE CURVE 195MM SS 4.5MM SCR 8 HOLE 4 CLMN THRD,"$3,186.70",$0.00,"$3,186.70","$1,434.02","$2,274.35",$0.00,$533.06,$0.00,$0.00,$557.97,"$3,186.70",$0.00,"$1,593.35","$2,523.87","$2,549.36",$0.00,$484.19,$0.00,$507.32,$0.00
02.124.410S,SUP,HCPCS C1713,,02.124.410S  -  PLATE BONE CURVE 230MM 10 HOLE VAR ANG LCP COMBI STAINLESS,"$3,331.35",$0.00,"$3,331.35","$1,499.11","$2,377.58",$0.00,$557.26,$0.00,$0.00,$583.29,"$3,331.35",$0.00,"$1,665.68","$2,638.43","$2,665.08",$0.00,$506.17,$0.00,$530.35,$0.00
02.124.411,SUP,HCPCS C1713,,02.124.411  -  PLATE BONE CURVE 23CM 10 HOLE VAR ANG LCP STAINLESS STEEL,"$3,242.65",$0.00,"$3,242.65","$1,459.19","$2,314.28",$0.00,$542.42,$0.00,$0.00,$567.76,"$3,242.65",$0.00,"$1,621.33","$2,568.18","$2,594.12",$0.00,$492.69,$0.00,$516.23,$0.00
02.124.412,SUP,HCPCS C1713,,02.124.412  -  PLATE BONE 267MM 12 HOLE VAR ANG CVD LCP STAINLESS STEEL,"$3,310.88",$0.00,"$3,310.88","$1,489.89","$2,362.97",$0.00,$553.83,$0.00,$0.00,$579.71,"$3,310.88",$0.00,"$1,655.44","$2,622.22","$2,648.70",$0.00,$503.06,$0.00,$527.09,$0.00
02.124.412S,SUP,HCPCS C1713,,02.124.412S  -  PLATE BN CRV 266MM STRL LCP CMBN 12 HL 4 CLMN THRD VA SS,"$3,300.58",$0.00,"$3,300.58","$1,485.26","$2,355.62",$0.00,$568.67,$0.00,$0.00,$577.90,"$3,300.58",$0.00,"$1,650.29","$2,614.06","$2,640.46",$0.00,$516.54,$0.00,$525.45,$0.00
02.124.413,SUP,HCPCS C1713,,02.124.413  -  PLATE BN CRV 266MM NS LCP CMBN 12 HL 4 CLMN THRD VA SS CNDRL,"$3,310.88",$0.00,"$3,310.88","$1,489.89","$2,362.97",$0.00,$553.83,$0.00,$0.00,$579.71,"$3,310.88",$0.00,"$1,655.44","$2,622.22","$2,648.70",$0.00,$503.06,$0.00,$527.09,$0.00
02.124.413S,SUP,HCPCS C1713,,02.124.413S  -  PLATE BN CRV 266MM STRL LCP CMBN 12 HL 4 CLMN THRD VA SS,"$3,399.60",$0.00,"$3,399.60","$1,529.82","$2,426.29",$0.00,$568.67,$0.00,$0.00,$595.24,"$3,399.60",$0.00,"$1,699.80","$2,692.48","$2,719.68",$0.00,$516.54,$0.00,$541.22,$0.00
02.124.414S,SUP,HCPCS C1713,,02.124.414S  -  PLATE BN CRV 301MM STRL LCP CMBN 14 HL 4 CLMN THRD VA SS,"$3,622.05",$0.00,"$3,622.05","$1,629.92","$2,585.06",$0.00,$605.88,$0.00,$0.00,$634.19,"$3,622.05",$0.00,"$1,811.03","$2,868.66","$2,897.64",$0.00,$550.34,$0.00,$576.63,$0.00
02.124.415,SUP,HCPCS C1713,,02.124.415  -  PLATE BN CRV 301MM NS LCP CMBN 14 HL 4 CLMN THRD VA SS CNDRL,"$3,533.35",$0.00,"$3,533.35","$1,590.01","$2,521.75",$0.00,$591.05,$0.00,$0.00,$618.66,"$3,533.35",$0.00,"$1,766.68","$2,798.41","$2,826.68",$0.00,$536.86,$0.00,$562.51,$0.00
02.124.416,SUP,HCPCS C1713,,02.124.416  -  PLATE BONE CURVE 336MM 16 HOLE LCP STAINLESS STEEL RIGHT,"$3,601.58",$0.00,"$3,601.58","$1,620.71","$2,570.44",$0.00,$602.46,$0.00,$0.00,$630.61,"$3,601.58",$0.00,"$1,800.79","$2,852.45","$2,881.26",$0.00,$547.23,$0.00,$573.37,$0.00
02.124.416S,SUP,HCPCS C1713,,02.124.416S  -  PLATE CURVE 336MM SS 4.5MM SCR 16 HOLE 4 CLMN THRD,"$3,690.28",$0.00,"$3,690.28","$1,660.62","$2,633.75",$0.00,$617.30,$0.00,$0.00,$646.14,"$3,690.28",$0.00,"$1,845.14","$2,922.70","$2,952.22",$0.00,$560.71,$0.00,$587.49,$0.00
02.124.417S,SUP,HCPCS C1713,,02.124.417S  -  PLATE BONE CURVE 336MM 16 HOLE VAR ANG LCP STAINLESS STEEL,"$3,690.28",$0.00,"$3,690.28","$1,660.62","$2,633.75",$0.00,$617.30,$0.00,$0.00,$646.14,"$3,690.28",$0.00,"$1,845.14","$2,922.70","$2,952.22",$0.00,$560.71,$0.00,$587.49,$0.00
02.124.419,SUP,HCPCS C1713,,02.124.419  -  PLATE BONE 375MM 18 HOLE VAR ANG CVD LCP STAINLESS STEEL,"$3,836.30",$0.00,"$3,836.30","$1,726.34","$2,737.97",$0.00,$641.73,$0.00,$0.00,$671.71,"$3,836.30",$0.00,"$1,918.15","$3,038.35","$3,069.04",$0.00,$582.90,$0.00,$610.74,$0.00
02.130.004,SUP,HCPCS C1713,,02.130.004  -  SCREW BN T4 1.3MM 4MM SLFRET ST TIP STRDR SS CORT,$79.15,$0.00,$79.15,$35.62,$56.49,$0.00,$13.24,$0.00,$0.00,$13.86,$79.15,$0.00,$39.58,$62.69,$63.32,$0.00,$12.03,$0.00,$12.60,$0.00
02.130.005,SUP,HCPCS C1713,,02.130.005  -  SCREW BN T4 1.3MM 5MM SLFRET ST TIP STRDR SS CORT,$79.15,$0.00,$79.15,$35.62,$56.49,$0.00,$13.24,$0.00,$0.00,$13.86,$79.15,$0.00,$39.58,$62.69,$63.32,$0.00,$12.03,$0.00,$12.60,$0.00
02.130.006,SUP,HCPCS C1713,,02.130.006  -  SCREW BN T4 1.3MM 6MM SLFRET ST TIP STRDR SS CORT,$79.15,$0.00,$79.15,$35.62,$56.49,$0.00,$13.24,$0.00,$0.00,$13.86,$79.15,$0.00,$39.58,$62.69,$63.32,$0.00,$12.03,$0.00,$12.60,$0.00
02.130.007,SUP,HCPCS C1713,,02.130.007  -  SCREW BN T4 1.3MM 7MM SLFRET ST TIP STRDR SS CORT,$79.15,$0.00,$79.15,$35.62,$56.49,$0.00,$13.24,$0.00,$0.00,$13.86,$79.15,$0.00,$39.58,$62.69,$63.32,$0.00,$12.03,$0.00,$12.60,$0.00
02.130.008,SUP,HCPCS C1713,,02.130.008  -  SCREW BN T4 1.3MM 8MM SLFRET ST TIP STRDR SS CORT,$79.15,$0.00,$79.15,$35.62,$56.49,$0.00,$13.24,$0.00,$0.00,$13.86,$79.15,$0.00,$39.58,$62.69,$63.32,$0.00,$12.03,$0.00,$12.60,$0.00
02.130.009,SUP,HCPCS C1713,,02.130.009  -  SCREW BN T4 1.3MM 9MM SLFRET ST TIP STRDR SS CORT,$79.15,$0.00,$79.15,$35.62,$56.49,$0.00,$13.24,$0.00,$0.00,$13.86,$79.15,$0.00,$39.58,$62.69,$63.32,$0.00,$12.03,$0.00,$12.60,$0.00
02.130.010,SUP,HCPCS C1713,,02.130.010  -  SCREW BN T4 1.3MM 10MM SLFRET ST TIP STRDR SS CORT,$79.15,$0.00,$79.15,$35.62,$56.49,$0.00,$13.24,$0.00,$0.00,$13.86,$79.15,$0.00,$39.58,$62.69,$63.32,$0.00,$12.03,$0.00,$12.60,$0.00
02.130.011,SUP,HCPCS C1713,,02.130.011  -  SCREW BN T4 1.3MM 11MM NS SLFRET ST TIP STRDR SS CORT,$79.15,$0.00,$79.15,$35.62,$56.49,$0.00,$13.24,$0.00,$0.00,$13.86,$79.15,$0.00,$39.58,$62.69,$63.32,$0.00,$12.03,$0.00,$12.60,$0.00
02.130.012,SUP,HCPCS C1713,,02.130.012  -  SCREW BN T4 1.3MM 12MM NS SLFRET ST TIP STRDR SS CORT,$79.15,$0.00,$79.15,$35.62,$56.49,$0.00,$13.24,$0.00,$0.00,$13.86,$79.15,$0.00,$39.58,$62.69,$63.32,$0.00,$12.03,$0.00,$12.60,$0.00
02.130.013,SUP,HCPCS C1713,,02.130.013  -  SCREW BN T4 1.3MM 13MM SLFRET ST TIP STRDR SS CORT,$79.15,$0.00,$79.15,$35.62,$56.49,$0.00,$13.24,$0.00,$0.00,$13.86,$79.15,$0.00,$39.58,$62.69,$63.32,$0.00,$12.03,$0.00,$12.60,$0.00
02.130.014,SUP,HCPCS C1713,,02.130.014  -  SCREW BN T4 1.3MM 14MM SLFRET ST TIP STRDR SS CORT,$79.15,$0.00,$79.15,$35.62,$56.49,$0.00,$13.24,$0.00,$0.00,$13.86,$79.15,$0.00,$39.58,$62.69,$63.32,$0.00,$12.03,$0.00,$12.60,$0.00
02.130.015,SUP,HCPCS C1713,,02.130.015  -  SCREW BN T4 1.3MM 15MM SLFRET ST STRDR SS CORT,$79.15,$0.00,$79.15,$35.62,$56.49,$0.00,$13.24,$0.00,$0.00,$13.86,$79.15,$0.00,$39.58,$62.69,$63.32,$0.00,$12.03,$0.00,$12.60,$0.00
02.130.016,SUP,HCPCS C1713,,02.130.016  -  SCREW BN T4 1.3MM 16MM ST TIP SLFRET STRDR SS CORT,$79.15,$0.00,$79.15,$35.62,$56.49,$0.00,$13.24,$0.00,$0.00,$13.86,$79.15,$0.00,$39.58,$62.69,$63.32,$0.00,$12.03,$0.00,$12.60,$0.00
02.130.018,SUP,HCPCS C1713,,02.130.018  -  SCREW BN T4 1.3MM 18MM ST TIP SLFRET LCK STRDR SS CORT,$79.15,$0.00,$79.15,$35.62,$56.49,$0.00,$13.24,$0.00,$0.00,$13.86,$79.15,$0.00,$39.58,$62.69,$63.32,$0.00,$12.03,$0.00,$12.60,$0.00
02.130.104,SUP,HCPCS C1713,,02.130.104  -  SCREW BN T4 1.3MM 4MM ST TIP SLFRET LCK STRDR SS HND,$208.80,$0.00,$208.80,$93.96,$149.02,$0.00,$34.93,$0.00,$0.00,$36.56,$208.80,$0.00,$104.40,$165.37,$167.04,$0.00,$31.73,$0.00,$33.24,$0.00
02.130.105,SUP,HCPCS C1713,,02.130.105  -  SCREW BN T4 1.3MM 5MM ST TIP SLFRET LCK STRDR SS HND,$208.80,$0.00,$208.80,$93.96,$149.02,$0.00,$34.93,$0.00,$0.00,$36.56,$208.80,$0.00,$104.40,$165.37,$167.04,$0.00,$31.73,$0.00,$33.24,$0.00
02.130.106,SUP,HCPCS C1713,,02.130.106  -  SCREW BN T4 1.3MM 6MM ST TIP SLFRET LCK STRDR SS HND,$208.80,$0.00,$208.80,$93.96,$149.02,$0.00,$34.93,$0.00,$0.00,$36.56,$208.80,$0.00,$104.40,$165.37,$167.04,$0.00,$31.73,$0.00,$33.24,$0.00
02.130.107,SUP,HCPCS C1713,,02.130.107  -  SCREW BN T4 1.3MM 7MM ST TIP SLFRET LCK STRDR SS HND,$208.80,$0.00,$208.80,$93.96,$149.02,$0.00,$34.93,$0.00,$0.00,$36.56,$208.80,$0.00,$104.40,$165.37,$167.04,$0.00,$31.73,$0.00,$33.24,$0.00
02.130.108,SUP,HCPCS C1713,,02.130.108  -  SCREW BN T4 1.3MM 8MM ST TIP SLFRET LCK STRDR SS HND,$208.80,$0.00,$208.80,$93.96,$149.02,$0.00,$34.93,$0.00,$0.00,$36.56,$208.80,$0.00,$104.40,$165.37,$167.04,$0.00,$31.73,$0.00,$33.24,$0.00
02.130.109,SUP,HCPCS C1713,,02.130.109  -  SCREW BN T4 1.3MM 9MM ST TIP SLFRET LCK STRDR SS HND,$208.80,$0.00,$208.80,$93.96,$149.02,$0.00,$34.93,$0.00,$0.00,$36.56,$208.80,$0.00,$104.40,$165.37,$167.04,$0.00,$31.73,$0.00,$33.24,$0.00
02.130.110,SUP,HCPCS C1713,,02.130.110  -  SCREW BN T4 1.3MM 10MM ST TIP SLFRET LCK STRDR SS HND,$208.80,$0.00,$208.80,$93.96,$149.02,$0.00,$34.93,$0.00,$0.00,$36.56,$208.80,$0.00,$104.40,$165.37,$167.04,$0.00,$31.73,$0.00,$33.24,$0.00
02.130.111,SUP,HCPCS C1713,,02.130.111  -  SCREW BN T4 1.3MM 11MM ST TIP SLFRET LCK STRDR SS HND,$208.80,$0.00,$208.80,$93.96,$149.02,$0.00,$34.93,$0.00,$0.00,$36.56,$208.80,$0.00,$104.40,$165.37,$167.04,$0.00,$31.73,$0.00,$33.24,$0.00
02.130.112,SUP,HCPCS C1713,,02.130.112  -  SCREW BN T4 1.3MM 12MM ST TIP SLFRET LCK STRDR SS HND,$208.80,$0.00,$208.80,$93.96,$149.02,$0.00,$34.93,$0.00,$0.00,$36.56,$208.80,$0.00,$104.40,$165.37,$167.04,$0.00,$31.73,$0.00,$33.24,$0.00
02.130.113,SUP,HCPCS C1713,,02.130.113  -  SCREW BN T4 1.3MM 13MM ST TIP SLFRET LCK STRDR SS HND,$208.80,$0.00,$208.80,$93.96,$149.02,$0.00,$34.93,$0.00,$0.00,$36.56,$208.80,$0.00,$104.40,$165.37,$167.04,$0.00,$31.73,$0.00,$33.24,$0.00
02.130.114,SUP,HCPCS C1713,,02.130.114  -  SCREW BN T4 1.3MM 14MM SLFRET ST TIP LCK STRDR SS HND,$208.80,$0.00,$208.80,$93.96,$149.02,$0.00,$34.93,$0.00,$0.00,$36.56,$208.80,$0.00,$104.40,$165.37,$167.04,$0.00,$31.73,$0.00,$33.24,$0.00
02.130.115,SUP,HCPCS C1713,,02.130.115  -  SCREW BN T4 1.3MM 15MM ST TIP SLFRET LCK STRDR SS HND,$208.80,$0.00,$208.80,$93.96,$149.02,$0.00,$34.93,$0.00,$0.00,$36.56,$208.80,$0.00,$104.40,$165.37,$167.04,$0.00,$31.73,$0.00,$33.24,$0.00
02.130.116,SUP,HCPCS C1713,,02.130.116  -  SCREW BN T4 1.3MM 16MM ST TIP SLFRET LCK STRDR SS HND,$208.80,$0.00,$208.80,$93.96,$149.02,$0.00,$34.93,$0.00,$0.00,$36.56,$208.80,$0.00,$104.40,$165.37,$167.04,$0.00,$31.73,$0.00,$33.24,$0.00
02.130.118,SUP,HCPCS C1713,,02.130.118  -  SCREW BN T4 1.3MM 18MM ST SLF RTN LCK STRDR SS,$208.80,$0.00,$208.80,$93.96,$149.02,$0.00,$34.93,$0.00,$0.00,$36.56,$208.80,$0.00,$104.40,$165.37,$167.04,$0.00,$31.73,$0.00,$33.24,$0.00
02.130.150,SUP,HCPCS C1713,,02.130.150  -  PLATE BN STRG .75MM LCK 6 HL LOPRFL PRECONTOUR SS HND 1.3MM,$702.85,$0.00,$702.85,$316.28,$501.62,$0.00,$117.57,$0.00,$0.00,$123.06,$702.85,$0.00,$351.43,$556.66,$562.28,$0.00,$106.79,$0.00,$111.89,$0.00
02.130.151,SUP,HCPCS C1713,,02.130.151  -  PLATE BN STRG .75MM LCK 12 HL LOPRFL PRECONTOUR SS HND 1.3MM,$771.08,$0.00,$771.08,$346.98,$550.32,$0.00,$128.98,$0.00,$0.00,$135.01,$771.08,$0.00,$385.54,$610.70,$616.86,$0.00,$117.16,$0.00,$122.76,$0.00
02.130.152,SUP,HCPCS C1713,,02.130.152  -  PLATE BN T .75MM LCK 3 HLE/HD 5 HL SHFT LOPRFL SS HND 1.3MM,$771.08,$0.00,$771.08,$346.98,$550.32,$0.00,$128.98,$0.00,$0.00,$135.01,$771.08,$0.00,$385.54,$610.70,$616.86,$0.00,$117.16,$0.00,$122.76,$0.00
02.130.153,SUP,HCPCS C1713,,02.130.153  -  PLATE BN Y .75MM LCK 3 HLE/HD 5 HL SHFT LOPRFL SS HND 1.3MM,$771.08,$0.00,$771.08,$346.98,$550.32,$0.00,$128.98,$0.00,$0.00,$135.01,$771.08,$0.00,$385.54,$610.70,$616.86,$0.00,$117.16,$0.00,$122.76,$0.00
02.130.154,SUP,HCPCS C1713,,02.130.154  -  PLATE BN .75MM LCK 2 HLE/HD 5 HL SHFT LOPRFL SS PHLNG BS 1.3,$878.90,$0.00,$878.90,$395.51,$627.27,$0.00,$147.02,$0.00,$0.00,$153.89,$878.90,$0.00,$439.45,$696.09,$703.12,$0.00,$133.54,$0.00,$139.92,$0.00
02.130.156,SUP,HCPCS C1713,,02.130.156  -  PLATE BN CRV .75MM LCK LOPRFL PRECONTOUR SS PHLNG HD RT 1.3,$878.90,$0.00,$878.90,$395.51,$627.27,$0.00,$147.02,$0.00,$0.00,$153.89,$878.90,$0.00,$439.45,$696.09,$703.12,$0.00,$133.54,$0.00,$139.92,$0.00
02.130.157,SUP,HCPCS C1713,,02.130.157  -  PLATE BN CRV .75MM LCK LOPRFL PRECONTOUR SS PHLNG HD LT 1.3,$878.90,$0.00,$878.90,$395.51,$627.27,$0.00,$147.02,$0.00,$0.00,$153.89,$878.90,$0.00,$439.45,$696.09,$703.12,$0.00,$133.54,$0.00,$139.92,$0.00
02.130.158,SUP,HCPCS C1713,,02.130.158  -  PLATE BN STRUT OBLQ .75MM 8 HL LCK LOPRFL PRECONTOUR SS HND,$771.08,$0.00,$771.08,$346.98,$550.32,$0.00,$128.98,$0.00,$0.00,$135.01,$771.08,$0.00,$385.54,$610.70,$616.86,$0.00,$117.16,$0.00,$122.76,$0.00
02.130.159,SUP,HCPCS C1713,,02.130.159  -  PLATE BN STRUT OBLQ .75MM 8 HL LCK LOPRFL PRECONTOUR SS HND,$771.08,$0.00,$771.08,$346.98,$550.32,$0.00,$128.98,$0.00,$0.00,$135.01,$771.08,$0.00,$385.54,$610.70,$616.86,$0.00,$117.16,$0.00,$122.76,$0.00
02.130.161,SUP,HCPCS C1713,,02.130.161  -  PLATE BN WEB .75MM 14 HL LCK LOPRFL PRECONTOUR SS HND 1.3MM,$812.03,$0.00,$812.03,$365.41,$579.54,$0.00,$135.83,$0.00,$0.00,$142.18,$812.03,$0.00,$406.01,$643.13,$649.62,$0.00,$123.38,$0.00,$129.27,$0.00
02.130.204,SUP,HCPCS C1713,,02.130.204  -  SCREW BN T4 1.5MM 4MM PUR ST TIP VA LCK STRDR SS HND,$232.00,$0.00,$232.00,$104.40,$165.58,$0.00,$38.81,$0.00,$0.00,$40.62,$232.00,$0.00,$116.00,$183.74,$185.60,$0.00,$35.25,$0.00,$36.93,$0.00
02.130.205,SUP,HCPCS C1713,,02.130.205  -  SCREW BN T4 1.5MM 5MM PUR ST TIP VA LCK STRDR SS HND,$232.00,$0.00,$232.00,$104.40,$165.58,$0.00,$38.81,$0.00,$0.00,$40.62,$232.00,$0.00,$116.00,$183.74,$185.60,$0.00,$35.25,$0.00,$36.93,$0.00
02.130.206,SUP,HCPCS C1713,,02.130.206  -  SCREW BN T4 1.5MM 6MM PUR ST TIP VA LCK STRDR SS HND,$232.00,$0.00,$232.00,$104.40,$165.58,$0.00,$38.81,$0.00,$0.00,$40.62,$232.00,$0.00,$116.00,$183.74,$185.60,$0.00,$35.25,$0.00,$36.93,$0.00
02.130.207,SUP,HCPCS C1713,,02.130.207  -  SCREW BN T4 1.5MM 7MM PUR ST VA LCK STRDR SS HND,$232.00,$0.00,$232.00,$104.40,$165.58,$0.00,$38.81,$0.00,$0.00,$40.62,$232.00,$0.00,$116.00,$183.74,$185.60,$0.00,$35.25,$0.00,$36.93,$0.00
02.130.208,SUP,HCPCS C1713,,02.130.208  -  SCREW BN T4 1.5MM 8MM ST LCK VA STRDR SS HND,$232.00,$0.00,$232.00,$104.40,$165.58,$0.00,$38.81,$0.00,$0.00,$40.62,$232.00,$0.00,$116.00,$183.74,$185.60,$0.00,$35.25,$0.00,$36.93,$0.00
02.130.209,SUP,HCPCS C1713,,02.130.209  -  SCREW BN T4 1.5MM 9MM PUR ST TIP VA LCK STRDR SS HND,$232.00,$0.00,$232.00,$104.40,$165.58,$0.00,$38.81,$0.00,$0.00,$40.62,$232.00,$0.00,$116.00,$183.74,$185.60,$0.00,$35.25,$0.00,$36.93,$0.00
02.130.210,SUP,HCPCS C1713,,02.130.210  -  SCREW BN T4 1.5MM 10MM PUR ST TIP VA LCK STRDR SS HND,$232.00,$0.00,$232.00,$104.40,$165.58,$0.00,$38.81,$0.00,$0.00,$40.62,$232.00,$0.00,$116.00,$183.74,$185.60,$0.00,$35.25,$0.00,$36.93,$0.00
02.130.211,SUP,HCPCS C1713,,02.130.211  -  SCREW BN T4 1.5MM 11MM ST LCK VA STRDR SS HND,$232.00,$0.00,$232.00,$104.40,$165.58,$0.00,$38.81,$0.00,$0.00,$40.62,$232.00,$0.00,$116.00,$183.74,$185.60,$0.00,$35.25,$0.00,$36.93,$0.00
02.130.212,SUP,HCPCS C1713,,02.130.212  -  SCREW BN T4 1.5MM 12MM ST LCK VA STRDR SS HND,$232.00,$0.00,$232.00,$104.40,$165.58,$0.00,$38.81,$0.00,$0.00,$40.62,$232.00,$0.00,$116.00,$183.74,$185.60,$0.00,$35.25,$0.00,$36.93,$0.00
02.130.213,SUP,HCPCS C1713,,02.130.213  -  SCREW BN T4 1.5MM 13MM PUR ST TIP VA LCK STRDR SS HND,$232.00,$0.00,$232.00,$104.40,$165.58,$0.00,$38.81,$0.00,$0.00,$40.62,$232.00,$0.00,$116.00,$183.74,$185.60,$0.00,$35.25,$0.00,$36.93,$0.00
02.130.214,SUP,HCPCS C1713,,02.130.214  -  SCREW BN T4 1.5MM 14MM PUR ST TIP LCK VA STRDR SS HND,$232.00,$0.00,$232.00,$104.40,$165.58,$0.00,$38.81,$0.00,$0.00,$40.62,$232.00,$0.00,$116.00,$183.74,$185.60,$0.00,$35.25,$0.00,$36.93,$0.00
02.130.215,SUP,HCPCS C1713,,02.130.215  -  SCREW BN T4 1.5MM 15MM PUR ST TIP VA LCK STRDR SS HND,$232.00,$0.00,$232.00,$104.40,$165.58,$0.00,$38.81,$0.00,$0.00,$40.62,$232.00,$0.00,$116.00,$183.74,$185.60,$0.00,$35.25,$0.00,$36.93,$0.00
02.130.216,SUP,HCPCS C1713,,02.130.216  -  SCREW BN T4 1.5MM 16MM PUR ST TIP LCK VA STRDR SS HND,$232.00,$0.00,$232.00,$104.40,$165.58,$0.00,$38.81,$0.00,$0.00,$40.62,$232.00,$0.00,$116.00,$183.74,$185.60,$0.00,$35.25,$0.00,$36.93,$0.00
02.130.218,SUP,HCPCS C1713,,02.130.218  -  SCREW BN T4 1.5MM 18MM PUR ST TIP VA LCK STRDR SS HND,$232.00,$0.00,$232.00,$104.40,$165.58,$0.00,$38.81,$0.00,$0.00,$40.62,$232.00,$0.00,$116.00,$183.74,$185.60,$0.00,$35.25,$0.00,$36.93,$0.00
02.130.220,SUP,HCPCS C1713,,02.130.220  -  SCREW BN T4 1.5MM 20MM PUR ST TIP VA LCK STRDR SS HND,$232.00,$0.00,$232.00,$104.40,$165.58,$0.00,$38.81,$0.00,$0.00,$40.62,$232.00,$0.00,$116.00,$183.74,$185.60,$0.00,$35.25,$0.00,$36.93,$0.00
02.130.222,SUP,HCPCS C1713,,02.130.222  -  SCREW BN T4 1.5MM 22MM PUR ST TIP VA LCK STRDR SS HND,$232.00,$0.00,$232.00,$104.40,$165.58,$0.00,$38.81,$0.00,$0.00,$40.62,$232.00,$0.00,$116.00,$183.74,$185.60,$0.00,$35.25,$0.00,$36.93,$0.00
02.130.224,SUP,HCPCS C1713,,02.130.224  -  SCREW BN T4 1.5MM 24MM PUR ST TIP VA LCK STRDR SS HND,$232.00,$0.00,$232.00,$104.40,$165.58,$0.00,$38.81,$0.00,$0.00,$40.62,$232.00,$0.00,$116.00,$183.74,$185.60,$0.00,$35.25,$0.00,$36.93,$0.00
02.130.250,SUP,HCPCS C1713,,02.130.250  -  PLATE BN STRG 1MM 6 HL VA LCK LOPRFL SS 1.5MM SCR,$790.20,$0.00,$790.20,$355.59,$563.97,$0.00,$132.18,$0.00,$0.00,$138.36,$790.20,$0.00,$395.10,$625.84,$632.16,$0.00,$120.06,$0.00,$125.80,$0.00
02.130.251,SUP,HCPCS C1713,,02.130.251  -  PLATE BN STRG 1MM NS 12 HL VA LCK LOPRFL SS 1.5MM SCR,$858.43,$0.00,$858.43,$386.29,$612.66,$0.00,$143.59,$0.00,$0.00,$150.30,$858.43,$0.00,$429.21,$679.88,$686.74,$0.00,$130.43,$0.00,$136.66,$0.00
02.130.252,SUP,HCPCS C1713,,02.130.252  -  PLATE BN T 1MM 3 HLE/HD 7 HL SHFT VA LCK SS 1.5MM SCR,$858.43,$0.00,$858.43,$386.29,$612.66,$0.00,$143.59,$0.00,$0.00,$150.30,$858.43,$0.00,$429.21,$679.88,$686.74,$0.00,$130.43,$0.00,$136.66,$0.00
02.130.253,SUP,HCPCS C1713,,02.130.253  -  PLATE BN Y 1MM 3 HLE/HD 7 HL SHFT VA LCK SS 1.5MM SCR,$858.43,$0.00,$858.43,$386.29,$612.66,$0.00,$143.59,$0.00,$0.00,$150.30,$858.43,$0.00,$429.21,$679.88,$686.74,$0.00,$130.43,$0.00,$136.66,$0.00
02.130.254,SUP,HCPCS C1713,,02.130.254  -  PLATE BN 1MM 2 HLE/HD 6 HL SHFT VA LCK PHLNG BS 1.5MM SCR,$941.68,$0.00,$941.68,$423.75,$672.07,$0.00,$157.52,$0.00,$0.00,$164.88,$941.68,$0.00,$470.84,$745.81,$753.34,$0.00,$143.08,$0.00,$149.91,$0.00
02.130.255,SUP,HCPCS C1713,,02.130.255  -  PLATE BN STRG 1MM 2 HLE/HD 6 HL SHFT VA LCK SS CNDRL 1.5MM,$900.73,$0.00,$900.73,$405.33,$642.85,$0.00,$150.67,$0.00,$0.00,$157.71,$900.73,$0.00,$450.36,$713.38,$720.58,$0.00,$136.86,$0.00,$143.40,$0.00
02.130.256,SUP,HCPCS C1713,,02.130.256  -  PLATE BN CRV 1MM VA LCK LOPRFL PRECONTOUR SS PHLNG HD RT 1.5,$941.68,$0.00,$941.68,$423.75,$672.07,$0.00,$157.52,$0.00,$0.00,$164.88,$941.68,$0.00,$470.84,$745.81,$753.34,$0.00,$143.08,$0.00,$149.91,$0.00
02.130.257,SUP,HCPCS C1713,,02.130.257  -  PLATE BN CRV 1MM VA LCK LOPRFL PRECONTOUR SS PHLNG HD LT 1.5,$941.68,$0.00,$941.68,$423.75,$672.07,$0.00,$157.52,$0.00,$0.00,$164.88,$941.68,$0.00,$470.84,$745.81,$753.34,$0.00,$143.08,$0.00,$149.91,$0.00
02.130.258,SUP,HCPCS C1713,,02.130.258  -  PLATE BN STRUT OBLQ 1MM VA LCK 8 HL LOPRFL SS HND RT 1.5MM,$858.43,$0.00,$858.43,$386.29,$612.66,$0.00,$143.59,$0.00,$0.00,$150.30,$858.43,$0.00,$429.21,$679.88,$686.74,$0.00,$130.43,$0.00,$136.66,$0.00
02.130.259,SUP,HCPCS C1713,,02.130.259  -  PLATE BN STRUT OBLQ 1MM VA LCK 8 HL LOPRFL SS HND LT 1.5MM,$858.43,$0.00,$858.43,$386.29,$612.66,$0.00,$143.59,$0.00,$0.00,$150.30,$858.43,$0.00,$429.21,$679.88,$686.74,$0.00,$130.43,$0.00,$136.66,$0.00
02.130.260,SUP,HCPCS C1713,,02.130.260  -  PLATE BN STRUT 1MM VA LCK 12 HL LOPRFL SS HND 1.5MM SCR,$941.68,$0.00,$941.68,$423.75,$672.07,$0.00,$157.52,$0.00,$0.00,$164.88,$941.68,$0.00,$470.84,$745.81,$753.34,$0.00,$143.08,$0.00,$149.91,$0.00
02.130.261,SUP,HCPCS C1713,,02.130.261  -  PLATE BN WEB 1MM VA LCK 14 HL LOPRFL SS HND 1.5MM SCR,$858.43,$0.00,$858.43,$386.29,$612.66,$0.00,$143.59,$0.00,$0.00,$150.30,$858.43,$0.00,$429.21,$679.88,$686.74,$0.00,$130.43,$0.00,$136.66,$0.00
02.130.263,SUP,HCPCS C1713,,02.130.263  -  PLATE BN CNTR 1MM VA LCK LOPRFL SS 1ST MTCRPL DRSL 1.5MM SCR,$914.38,$0.00,$914.38,$411.47,$652.59,$0.00,$152.95,$0.00,$0.00,$160.10,$914.38,$0.00,$457.19,$724.19,$731.50,$0.00,$138.93,$0.00,$145.57,$0.00
02.130.264,SUP,HCPCS C1713,,02.130.264  -  PLATE BN Y 1MM VA LCK ELONGATE HL SS 1ST MTCRPL RL 1.5MM SCR,"$1,200.98",$0.00,"$1,200.98",$540.44,$857.14,$0.00,$200.90,$0.00,$0.00,$210.28,"$1,200.98",$0.00,$600.49,$951.18,$960.78,$0.00,$182.48,$0.00,$191.20,$0.00
02.130.265,SUP,HCPCS C1713,,02.130.265  -  PLATE BN Y 1MM VA LCK ELONGATE HL SS 1ST MATECARPAL L/L 1.5,"$1,200.98",$0.00,"$1,200.98",$540.44,$857.14,$0.00,$200.90,$0.00,$0.00,$210.28,"$1,200.98",$0.00,$600.49,$951.18,$960.78,$0.00,$182.48,$0.00,$191.20,$0.00
02.130.266,SUP,HCPCS C1713,,02.130.266  -  PLATE BN 1MM VA LCK 6 HL ROT CRRT SS MTCRPL PHALANGE 1.5MM,"$1,200.98",$0.00,"$1,200.98",$540.44,$857.14,$0.00,$200.90,$0.00,$0.00,$210.28,"$1,200.98",$0.00,$600.49,$951.18,$960.78,$0.00,$182.48,$0.00,$191.20,$0.00
02.130.268,SUP,HCPCS C1713,,02.130.268  -  PLATE BN 1MM VA LCK KWR HL SS MTCRPL NK 1.5MM SCR,"$1,200.98",$0.00,"$1,200.98",$540.44,$857.14,$0.00,$200.90,$0.00,$0.00,$210.28,"$1,200.98",$0.00,$600.49,$951.18,$960.78,$0.00,$182.48,$0.00,$191.20,$0.00
02.130.306,SUP,HCPCS C1713,,02.130.306  -  SCREW BN T6 2MM 6MM PUR ST TIP VA LCK STRDR SS HND,$240.20,$0.00,$240.20,$108.09,$171.43,$0.00,$40.18,$0.00,$0.00,$42.06,$240.20,$0.00,$120.10,$190.24,$192.16,$0.00,$36.50,$0.00,$38.24,$0.00
02.130.307,SUP,HCPCS C1713,,02.130.307  -  SCREW BN T6 2MM 7MM PUR ST TIP VA LCK STRDR SS HND,$240.20,$0.00,$240.20,$108.09,$171.43,$0.00,$40.18,$0.00,$0.00,$42.06,$240.20,$0.00,$120.10,$190.24,$192.16,$0.00,$36.50,$0.00,$38.24,$0.00
02.130.308,SUP,HCPCS C1713,,02.130.308  -  SCREW BN T6 2MM 8MM PUR ST TIP VA LCK STRDR SS HND,$240.20,$0.00,$240.20,$108.09,$171.43,$0.00,$40.18,$0.00,$0.00,$42.06,$240.20,$0.00,$120.10,$190.24,$192.16,$0.00,$36.50,$0.00,$38.24,$0.00
02.130.309,SUP,HCPCS C1713,,02.130.309  -  SCREW BN T6 2MM 9MM PUR ST TIP VA LCK STRDR SS HND,$240.20,$0.00,$240.20,$108.09,$171.43,$0.00,$40.18,$0.00,$0.00,$42.06,$240.20,$0.00,$120.10,$190.24,$192.16,$0.00,$36.50,$0.00,$38.24,$0.00
02.130.310,SUP,HCPCS C1713,,02.130.310  -  SCREW BN T6 2MM 10MM PUR ST TIP VA LCK STRDR SS HND,$240.20,$0.00,$240.20,$108.09,$171.43,$0.00,$40.18,$0.00,$0.00,$42.06,$240.20,$0.00,$120.10,$190.24,$192.16,$0.00,$36.50,$0.00,$38.24,$0.00
02.130.311,SUP,HCPCS C1713,,02.130.311  -  SCREW BN T6 2MM 11MM PUR VA LCK ST TIP STRDR SS HND,$240.20,$0.00,$240.20,$108.09,$171.43,$0.00,$40.18,$0.00,$0.00,$42.06,$240.20,$0.00,$120.10,$190.24,$192.16,$0.00,$36.50,$0.00,$38.24,$0.00
02.130.312,SUP,HCPCS C1713,,02.130.312  -  SCREW BN T6 2MM 12MM PUR STRDR VA ST LCK SS HND,$240.20,$0.00,$240.20,$108.09,$171.43,$0.00,$40.18,$0.00,$0.00,$42.06,$240.20,$0.00,$120.10,$190.24,$192.16,$0.00,$36.50,$0.00,$38.24,$0.00
02.130.313,SUP,HCPCS C1713,,02.130.313  -  SCREW BN T6 2MM 13MM PUR ST TIP VA LCK STRDR SS HND,$240.20,$0.00,$240.20,$108.09,$171.43,$0.00,$40.18,$0.00,$0.00,$42.06,$240.20,$0.00,$120.10,$190.24,$192.16,$0.00,$36.50,$0.00,$38.24,$0.00
02.130.314,SUP,HCPCS C1713,,02.130.314  -  SCREW BN T6 2MM 14MM PUR NS STRDR ST LCK VA SS,$240.20,$0.00,$240.20,$108.09,$171.43,$0.00,$40.18,$0.00,$0.00,$42.06,$240.20,$0.00,$120.10,$190.24,$192.16,$0.00,$36.50,$0.00,$38.24,$0.00
02.130.315,SUP,HCPCS C1713,,02.130.315  -  SCREW BN T6 2MM 15MM PUR ST TIP VA LCK STRDR SS HND,$240.20,$0.00,$240.20,$108.09,$171.43,$0.00,$40.18,$0.00,$0.00,$42.06,$240.20,$0.00,$120.10,$190.24,$192.16,$0.00,$36.50,$0.00,$38.24,$0.00
02.130.316,SUP,HCPCS C1713,,02.130.316  -  SCREW BN T6 2MM 16MM PUR ST TIP VA LCK STRDR SS HND,$240.20,$0.00,$240.20,$108.09,$171.43,$0.00,$40.18,$0.00,$0.00,$42.06,$240.20,$0.00,$120.10,$190.24,$192.16,$0.00,$36.50,$0.00,$38.24,$0.00
02.130.318,SUP,HCPCS C1713,,02.130.318  -  SCREW BN T6 2MM 18MM PUR STRDR VA ST LCK SS HND,$240.20,$0.00,$240.20,$108.09,$171.43,$0.00,$40.18,$0.00,$0.00,$42.06,$240.20,$0.00,$120.10,$190.24,$192.16,$0.00,$36.50,$0.00,$38.24,$0.00
02.130.320,SUP,HCPCS C1713,,02.130.320  -  SCREW BN T6 2MM 20MM PUR ST TIP VA LCK STRDR SS HND,$240.20,$0.00,$240.20,$108.09,$171.43,$0.00,$40.18,$0.00,$0.00,$42.06,$240.20,$0.00,$120.10,$190.24,$192.16,$0.00,$36.50,$0.00,$38.24,$0.00
02.130.322,SUP,HCPCS C1713,,02.130.322  -  SCREW BN T6 2MM 22MM PUR ST TIP VA LCK STRDR SS HND,$240.20,$0.00,$240.20,$108.09,$171.43,$0.00,$40.18,$0.00,$0.00,$42.06,$240.20,$0.00,$120.10,$190.24,$192.16,$0.00,$36.50,$0.00,$38.24,$0.00
02.130.324,SUP,HCPCS C1713,,02.130.324  -  SCREW BN T6 2MM 24MM PUR ST TIP VA LCK STRDR SS HND,$240.20,$0.00,$240.20,$108.09,$171.43,$0.00,$40.18,$0.00,$0.00,$42.06,$240.20,$0.00,$120.10,$190.24,$192.16,$0.00,$36.50,$0.00,$38.24,$0.00
02.130.350,SUP,HCPCS C1713,,02.130.350  -  PLATE BN STRG 1.3MM 6 HL LCK VA LOPRFL HND 2MM SCR,$921.20,$0.00,$921.20,$414.54,$657.46,$0.00,$154.10,$0.00,$0.00,$161.29,$921.20,$0.00,$460.60,$729.59,$736.96,$0.00,$139.97,$0.00,$146.66,$0.00
02.130.351,SUP,HCPCS C1713,,02.130.351  -  PLATE BN FT STRG 1.3MM 12 HL VA LCK COAX SS HND 2MM SCR,$989.45,$0.00,$989.45,$445.25,$706.17,$0.00,$165.51,$0.00,$0.00,$173.24,$989.45,$0.00,$494.73,$783.64,$791.56,$0.00,$150.34,$0.00,$157.52,$0.00
02.130.352,SUP,HCPCS C1713,,02.130.352  -  PLATE BN FT T 1.3MM 3 HLE/HD 7 HL SHFT VA LCK SS HND 2MM SCR,$989.45,$0.00,$989.45,$445.25,$706.17,$0.00,$165.51,$0.00,$0.00,$173.24,$989.45,$0.00,$494.73,$783.64,$791.56,$0.00,$150.34,$0.00,$157.52,$0.00
02.130.353,SUP,HCPCS C1713,,02.130.353  -  PLATE BN Y 1.3MM 3 HLE/HD 7 HL SHFT LCK VA SS HND 2MM SCR,$989.45,$0.00,$989.45,$445.25,$706.17,$0.00,$165.51,$0.00,$0.00,$173.24,$989.45,$0.00,$494.73,$783.64,$791.56,$0.00,$150.34,$0.00,$157.52,$0.00
02.130.354,SUP,HCPCS C1713,,02.130.354  -  PLATE BN CNTR 1.3MM 2 HLE/HD 6 HL SHFT LCK ELONGATE HL SS,"$1,084.98",$0.00,"$1,084.98",$488.24,$774.35,$0.00,$181.49,$0.00,$0.00,$189.97,"$1,084.98",$0.00,$542.49,$859.30,$867.98,$0.00,$164.85,$0.00,$172.73,$0.00
02.130.355,SUP,HCPCS C1713,,02.130.355  -  PLATE BN 1.3MM 2 HLE/HD 6 HL SHFT LCK VA SS CNDRL 2MM SCR,"$1,057.68",$0.00,"$1,057.68",$475.95,$754.86,$0.00,$176.93,$0.00,$0.00,$185.19,"$1,057.68",$0.00,$528.84,$837.68,$846.14,$0.00,$160.71,$0.00,$168.38,$0.00
02.130.360,SUP,HCPCS C1713,,02.130.360  -  PLATE BN STRUT 1.3MM 12 HL LCK VA LOPRFL SS HND 2MM SCR,"$1,084.98",$0.00,"$1,084.98",$488.24,$774.35,$0.00,$181.49,$0.00,$0.00,$189.97,"$1,084.98",$0.00,$542.49,$859.30,$867.98,$0.00,$164.85,$0.00,$172.73,$0.00
02.130.363,SUP,HCPCS C1713,,02.130.363  -  PLATE BN 1.3MM LCK VA LOPRFL ANTM CNTR SS 1ST MTCRPL DRSL 2,"$1,357.93",$0.00,"$1,357.93",$611.07,$969.15,$0.00,$227.15,$0.00,$0.00,$237.76,"$1,357.93",$0.00,$678.96,"$1,075.48","$1,086.34",$0.00,$206.33,$0.00,$216.18,$0.00
02.130.366,SUP,HCPCS C1713,,02.130.366  -  PLATE BN 1.3MM 6 HL LCK VA ROT CRRT SS HND 2MM SCR,"$1,357.93",$0.00,"$1,357.93",$611.07,$969.15,$0.00,$227.15,$0.00,$0.00,$237.76,"$1,357.93",$0.00,$678.96,"$1,075.48","$1,086.34",$0.00,$206.33,$0.00,$216.18,$0.00
02.161.210,SUP,HCPCS C1713,,02.161.210  -  PLATE BONE NARROW 10 HOLE CVD LCP STAINLESS STEEL NONSTRL,$683.75,$0.00,$683.75,$307.69,$487.99,$0.00,$114.37,$0.00,$0.00,$119.72,$683.75,$0.00,$341.88,$541.53,$547.00,$0.00,$103.89,$0.00,$108.85,$0.00
02.161.212,SUP,HCPCS C1713,,02.161.212  -  PLATE BONE NARROW CVD 12 HOLE LCP STAINLESS STEEL HUMERUS,"$1,041.30",$0.00,"$1,041.30",$468.59,$743.18,$0.00,$174.19,$0.00,$0.00,$182.32,"$1,041.30",$0.00,$520.65,$824.71,$833.04,$0.00,$158.22,$0.00,$165.77,$0.00
02.161.214,SUP,HCPCS C1713,,02.161.214  -  PLATE BONE NARROW 14 HOLE CVD LCP STAINLESS STEEL NONSTRL,"$1,205.08",$0.00,"$1,205.08",$542.28,$860.06,$0.00,$201.58,$0.00,$0.00,$211.00,"$1,205.08",$0.00,$602.54,$954.42,$964.06,$0.00,$183.10,$0.00,$191.85,$0.00
02.161.216,SUP,HCPCS C1713,,02.161.216  -  PLATE BONE NARROW 16 HOLE CVD LCP STAINLESS STEEL NONSTRL,"$1,301.98",$0.00,"$1,301.98",$585.89,$929.22,$0.00,$217.79,$0.00,$0.00,$227.97,"$1,301.98",$0.00,$650.99,"$1,031.17","$1,041.58",$0.00,$197.82,$0.00,$207.27,$0.00
02.161.218,SUP,HCPCS C1713,,02.161.218  -  PLATE BONE NARROW 18 HOLE CVD LCP STAINLESS STEEL NONSTRL,"$1,465.75",$0.00,"$1,465.75",$659.59,"$1,046.11",$0.00,$245.18,$0.00,$0.00,$256.64,"$1,465.75",$0.00,$732.88,"$1,160.87","$1,172.60",$0.00,$222.71,$0.00,$233.35,$0.00
02.161.220,SUP,HCPCS C1713,,02.161.220  -  PLATE BONE NARROW 20 HOLE CVD LCP STAINLESS STEEL NONSTRL,"$1,626.78",$0.00,"$1,626.78",$732.05,"$1,161.03",$0.00,$272.12,$0.00,$0.00,$284.84,"$1,626.78",$0.00,$813.39,"$1,288.41","$1,301.42",$0.00,$247.18,$0.00,$258.98,$0.00
02.161.222,SUP,HCPCS C1713,,02.161.222  -  PLATE BONE NARROW 22 HOLE CVD LCP STAINLESS STEEL NONSTRL,"$1,626.78",$0.00,"$1,626.78",$732.05,"$1,161.03",$0.00,$272.12,$0.00,$0.00,$284.84,"$1,626.78",$0.00,$813.39,"$1,288.41","$1,301.42",$0.00,$247.18,$0.00,$258.98,$0.00
02.161.240,SUP,HCPCS C1713,,02.161.240  -  PLATE BONE NARROW 10 HOLE CVD LCP STAINLESS STEEL NONSTRL,"$1,131.38",$0.00,"$1,131.38",$509.12,$807.46,$0.00,$189.25,$0.00,$0.00,$198.09,"$1,131.38",$0.00,$565.69,$896.05,$905.10,$0.00,$171.90,$0.00,$180.11,$0.00
02.161.242,SUP,HCPCS C1713,,02.161.242  -  PLATE BONE NARROW 12 HOLE CVD LCP STAINLESS STEEL NONSTRL,"$1,306.08",$0.00,"$1,306.08",$587.73,$932.15,$0.00,$218.47,$0.00,$0.00,$228.68,"$1,306.08",$0.00,$653.04,"$1,034.42","$1,044.86",$0.00,$198.45,$0.00,$207.93,$0.00
02.161.244,SUP,HCPCS C1713,,02.161.244  -  PLATE BONE NARROW 14 HOLE CVD LCP STAINLESS STEEL NONSTRL,"$1,393.40",$0.00,"$1,393.40",$627.03,$994.47,$0.00,$233.08,$0.00,$0.00,$243.97,"$1,393.40",$0.00,$696.70,"$1,103.57","$1,114.72",$0.00,$211.72,$0.00,$221.83,$0.00
02.161.246,SUP,HCPCS C1713,,02.161.246  -  PLATE BONE NARROW 16 HOLE CVD LCP STAINLESS STEEL NONSTRL,"$1,566.73",$0.00,"$1,566.73",$705.03,"$1,118.17",$0.00,$262.08,$0.00,$0.00,$274.32,"$1,566.73",$0.00,$783.36,"$1,240.85","$1,253.38",$0.00,$238.05,$0.00,$249.42,$0.00
02.161.248,SUP,HCPCS C1713,,02.161.248  -  PLATE BONE NARROW 18 HOLE CVD LCP STAINLESS STEEL NONSTRL,"$1,912.03",$0.00,"$1,912.03",$860.41,"$1,364.61",$0.00,$319.84,$0.00,$0.00,$334.78,"$1,912.03",$0.00,$956.01,"$1,514.33","$1,529.62",$0.00,$290.51,$0.00,$304.39,$0.00
02.161.250,SUP,HCPCS C1713,,02.161.250  -  PLATE BONE NARROW 20 HOLE CVD LCP STAINLESS STEEL NONSTRL,"$2,261.40",$0.00,"$2,261.40","$1,017.63","$1,613.96",$0.00,$378.28,$0.00,$0.00,$395.95,"$2,261.40",$0.00,"$1,130.70","$1,791.03","$1,809.12",$0.00,$343.60,$0.00,$360.01,$0.00
02.161.252,SUP,HCPCS C1713,,02.161.252  -  PLATE BONE NARROW 22 HOLE CVD LCP STAINLESS STEEL NONSTRL,"$2,522.05",$0.00,"$2,522.05","$1,134.92","$1,799.99",$0.00,$421.88,$0.00,$0.00,$441.59,"$2,522.05",$0.00,"$1,261.03","$1,997.46","$2,017.64",$0.00,$383.21,$0.00,$401.51,$0.00
02.161.270,SUP,HCPCS C1713,,02.161.270  -  PLATE BONE BROAD 10 HOLE CVD LCP STAINLESS STEEL NONSTRL 3.5,$863.88,$0.00,$863.88,$388.74,$616.55,$0.00,$144.51,$0.00,$0.00,$151.26,$863.88,$0.00,$431.94,$684.19,$691.10,$0.00,$131.26,$0.00,$137.53,$0.00
02.161.272,SUP,HCPCS C1713,,02.161.272  -  PLATE BONE BROAD CVD 12 HOLE LCP STAINLESS STEEL TIBIA,"$1,123.20",$0.00,"$1,123.20",$505.44,$801.63,$0.00,$187.88,$0.00,$0.00,$196.66,"$1,123.20",$0.00,$561.60,$889.57,$898.56,$0.00,$170.66,$0.00,$178.81,$0.00
02.161.274,SUP,HCPCS C1713,,02.161.274  -  PLATE BONE BROAD 14 HOLE CVD LCP STAINLESS STEEL NONSTRL 3.5,"$1,205.08",$0.00,"$1,205.08",$542.28,$860.06,$0.00,$201.58,$0.00,$0.00,$211.00,"$1,205.08",$0.00,$602.54,$954.42,$964.06,$0.00,$183.10,$0.00,$191.85,$0.00
02.161.276,SUP,HCPCS C1713,,02.161.276  -  PLATE BN BRD CRV NS LCP CMBN 16 HL LMT CNTCT TPR END SS,"$1,301.98",$0.00,"$1,301.98",$585.89,$929.22,$0.00,$217.79,$0.00,$0.00,$227.97,"$1,301.98",$0.00,$650.99,"$1,031.17","$1,041.58",$0.00,$197.82,$0.00,$207.27,$0.00
02.161.278,SUP,HCPCS C1713,,02.161.278  -  PLATE BONE BROAD 18 HOLE CVD LCP STAINLESS STEEL NONSTRL 3.5,"$1,465.75",$0.00,"$1,465.75",$659.59,"$1,046.11",$0.00,$245.18,$0.00,$0.00,$256.64,"$1,465.75",$0.00,$732.88,"$1,160.87","$1,172.60",$0.00,$222.71,$0.00,$233.35,$0.00
02.161.280,SUP,HCPCS C1713,,02.161.280  -  PLATE BONE BROAD 20 HOLE CVD LCP STAINLESS STEEL NONSTRL 3.5,"$1,561.28",$0.00,"$1,561.28",$702.57,"$1,114.28",$0.00,$261.16,$0.00,$0.00,$273.37,"$1,561.28",$0.00,$780.64,"$1,236.53","$1,249.02",$0.00,$237.22,$0.00,$248.55,$0.00
02.161.282,SUP,HCPCS C1713,,02.161.282  -  PLATE BONE BROAD 22 HOLE CVD LCP STAINLESS STEEL NONSTRL 3.5,"$1,643.15",$0.00,"$1,643.15",$739.42,"$1,172.72",$0.00,$274.86,$0.00,$0.00,$287.70,"$1,643.15",$0.00,$821.58,"$1,301.37","$1,314.52",$0.00,$249.66,$0.00,$261.59,$0.00
02.161.284,SUP,HCPCS C1713,,02.161.284  -  PLATE BONE BROAD 24 HOLE CVD LCP STAINLESS STEEL NONSTRL 3.5,"$1,643.15",$0.00,"$1,643.15",$739.42,"$1,172.72",$0.00,$274.86,$0.00,$0.00,$287.70,"$1,643.15",$0.00,$821.58,"$1,301.37","$1,314.52",$0.00,$249.66,$0.00,$261.59,$0.00
02.161.286,SUP,HCPCS C1713,,02.161.286  -  PLATE BONE BROAD 26 HOLE CVD LCP STAINLESS STEEL NONSTRL 3.5,"$1,742.78",$0.00,"$1,742.78",$784.25,"$1,243.82",$0.00,$291.53,$0.00,$0.00,$305.15,"$1,742.78",$0.00,$871.39,"$1,380.28","$1,394.22",$0.00,$264.80,$0.00,$277.45,$0.00
02.161.288,SUP,HCPCS C1713,,02.161.288  -  PLATE BONE BROAD 28 HOLE CVD LCP STAINLESS STEEL NONSTRL 3.5,"$1,916.10",$0.00,"$1,916.10",$862.25,"$1,367.52",$0.00,$320.52,$0.00,$0.00,$335.49,"$1,916.10",$0.00,$958.05,"$1,517.55","$1,532.88",$0.00,$291.14,$0.00,$305.04,$0.00
02.161.290,SUP,HCPCS C1713,,02.161.290  -  PLATE BONE BROAD 30 HOLE CVD LCP STAINLESS STEEL NONSTRL 3.5,"$2,090.80",$0.00,"$2,090.80",$940.86,"$1,492.20",$0.00,$349.74,$0.00,$0.00,$366.08,"$2,090.80",$0.00,"$1,045.40","$1,655.91","$1,672.64",$0.00,$317.68,$0.00,$332.86,$0.00
02.200.003,SUP,HCPCS C1713,,02.200.003  -  PLUG PLT 3.5MM NS LCP THRD STRDR RCS SS LOPRFL PLVC SYS,$197.90,$0.00,$197.90,$89.06,$141.24,$0.00,$33.10,$0.00,$0.00,$34.65,$197.90,$0.00,$98.95,$156.74,$158.32,$0.00,$30.07,$0.00,$31.51,$0.00
02.200.010,SUP,HCPCS C1713,,02.200.010  -  SCREW BONE T15 LP 3.5MM 6MM 10MM SELF TAP STARDRIVE LCP,$46.05,$0.00,$46.05,$20.72,$32.87,$0.00,$7.70,$0.00,$0.00,$8.06,$46.05,$0.00,$23.03,$36.47,$36.84,$0.00,$7.00,$0.00,$7.33,$0.00
02.200.012,SUP,HCPCS C1713,,02.200.012  -  SCREW BONE FULTHD 3.5MM 6MM 12MM T15 STARDRIVE SELF TAP LP,$46.05,$0.00,$46.05,$20.72,$32.87,$0.00,$7.70,$0.00,$0.00,$8.06,$46.05,$0.00,$23.03,$36.47,$36.84,$0.00,$7.00,$0.00,$7.33,$0.00
02.200.014,SUP,HCPCS C1713,,02.200.014  -  SCREW BONE T15 LP 3.5MM 6MM 14MM SELF TAP STARDRIVE LCP,$46.05,$0.00,$46.05,$20.72,$32.87,$0.00,$7.70,$0.00,$0.00,$8.06,$46.05,$0.00,$23.03,$36.47,$36.84,$0.00,$7.00,$0.00,$7.33,$0.00
02.200.016,SUP,HCPCS C1713,,02.200.016  -  SCREW BONE T15 LP 3.5MM 6MM 16MM SELF TAP STARDRIVE LCP,$46.05,$0.00,$46.05,$20.72,$32.87,$0.00,$7.70,$0.00,$0.00,$8.06,$46.05,$0.00,$23.03,$36.47,$36.84,$0.00,$7.00,$0.00,$7.33,$0.00
02.200.018,SUP,HCPCS C1713,,02.200.018  -  SCREW BONE T15 LP 3.5MM 6MM 18MM SELF TAP STARDRIVE LCP,$46.05,$0.00,$46.05,$20.72,$32.87,$0.00,$7.70,$0.00,$0.00,$8.06,$46.05,$0.00,$23.03,$36.47,$36.84,$0.00,$7.00,$0.00,$7.33,$0.00
02.200.020,SUP,HCPCS C1713,,02.200.020  -  SCREW BONE FULTHD 3.5MM 20MM T15 STARDRIVE RECESS SLFTAP LCP,$46.05,$0.00,$46.05,$20.72,$32.87,$0.00,$7.70,$0.00,$0.00,$8.06,$46.05,$0.00,$23.03,$36.47,$36.84,$0.00,$7.00,$0.00,$7.33,$0.00
02.200.022,SUP,HCPCS C1713,,02.200.022  -  SCREW BONE T15 LP 3.5MM 6MM 22MM SELF TAP STARDRIVE LCP,$46.05,$0.00,$46.05,$20.72,$32.87,$0.00,$7.70,$0.00,$0.00,$8.06,$46.05,$0.00,$23.03,$36.47,$36.84,$0.00,$7.00,$0.00,$7.33,$0.00
02.200.024,SUP,HCPCS C1713,,02.200.024  -  SCREW BONE T15 LP 3.5MM 6MM 24MM SELF TAP STARDRIVE LCP,$46.05,$0.00,$46.05,$20.72,$32.87,$0.00,$7.70,$0.00,$0.00,$8.06,$46.05,$0.00,$23.03,$36.47,$36.84,$0.00,$7.00,$0.00,$7.33,$0.00
02.200.026,SUP,HCPCS C1713,,02.200.026  -  SCREW BONE T15 LP 3.5MM 6MM 26MM SELF TAP STARDRIVE LCP,$46.05,$0.00,$46.05,$20.72,$32.87,$0.00,$7.70,$0.00,$0.00,$8.06,$46.05,$0.00,$23.03,$36.47,$36.84,$0.00,$7.00,$0.00,$7.33,$0.00
02.200.028,SUP,HCPCS C1713,,02.200.028  -  SCREW BONE T15 LP 3.5MM 6MM 28MM SELF TAP STARDRIVE LCP,$46.05,$0.00,$46.05,$20.72,$32.87,$0.00,$7.70,$0.00,$0.00,$8.06,$46.05,$0.00,$23.03,$36.47,$36.84,$0.00,$7.00,$0.00,$7.33,$0.00
02.200.030,SUP,HCPCS C1713,,02.200.030  -  SCREW BONE FULTHD 3.5MM 6MM 30MM T15 STARDRIVE RECESS SLFTAP,$46.05,$0.00,$46.05,$20.72,$32.87,$0.00,$7.70,$0.00,$0.00,$8.06,$46.05,$0.00,$23.03,$36.47,$36.84,$0.00,$7.00,$0.00,$7.33,$0.00
02.200.032,SUP,HCPCS C1713,,02.200.032  -  SCREW BONE T15 LP 3.5MM 6MM 32MM SELF TAP STARDRIVE LCP,$46.05,$0.00,$46.05,$20.72,$32.87,$0.00,$7.70,$0.00,$0.00,$8.06,$46.05,$0.00,$23.03,$36.47,$36.84,$0.00,$7.00,$0.00,$7.33,$0.00
02.200.034,SUP,HCPCS C1713,,02.200.034  -  SCREW BONE T15 LP 3.5MM 6MM 34MM SELF TAP STARDRIVE LCP,$46.05,$0.00,$46.05,$20.72,$32.87,$0.00,$7.70,$0.00,$0.00,$8.06,$46.05,$0.00,$23.03,$36.47,$36.84,$0.00,$7.00,$0.00,$7.33,$0.00
02.200.036,SUP,HCPCS C1713,,02.200.036  -  SCREW BONE T15 LP 3.5MM 6MM 36MM SELF TAP STARDRIVE LCP,$46.05,$0.00,$46.05,$20.72,$32.87,$0.00,$7.70,$0.00,$0.00,$8.06,$46.05,$0.00,$23.03,$36.47,$36.84,$0.00,$7.00,$0.00,$7.33,$0.00
02.200.038,SUP,HCPCS C1713,,02.200.038  -  SCREW BONE FULTHD LP 3.5MM 6MM 38MM SELF TAP T15 STARDRIVE,$46.05,$0.00,$46.05,$20.72,$32.87,$0.00,$7.70,$0.00,$0.00,$8.06,$46.05,$0.00,$23.03,$36.47,$36.84,$0.00,$7.00,$0.00,$7.33,$0.00
02.200.040,SUP,HCPCS C1713,,02.200.040  -  SCREW BONE T15 LP 3.5MM 6MM 40MM SELF TAP STARDRIVE LCP,$46.05,$0.00,$46.05,$20.72,$32.87,$0.00,$7.70,$0.00,$0.00,$8.06,$46.05,$0.00,$23.03,$36.47,$36.84,$0.00,$7.00,$0.00,$7.33,$0.00
02.200.042,SUP,HCPCS C1713,,02.200.042  -  SCREW BONE T15 LP 3.5MM 6MM 42MM SELF TAP STARDRIVE LCP,$46.05,$0.00,$46.05,$20.72,$32.87,$0.00,$7.70,$0.00,$0.00,$8.06,$46.05,$0.00,$23.03,$36.47,$36.84,$0.00,$7.00,$0.00,$7.33,$0.00
02.200.044,SUP,HCPCS C1713,,02.200.044  -  SCREW BONE T15 LP 3.5MM 6MM 44MM SELF TAP STARDRIVE LCP,$46.05,$0.00,$46.05,$20.72,$32.87,$0.00,$7.70,$0.00,$0.00,$8.06,$46.05,$0.00,$23.03,$36.47,$36.84,$0.00,$7.00,$0.00,$7.33,$0.00
02.200.045,SUP,HCPCS C1713,,02.200.045  -  SCREW BONE 3.5MM 45MM SLFTAP LP STARDRIVE RECESS STAINLESS,$46.05,$0.00,$46.05,$20.72,$32.87,$0.00,$7.70,$0.00,$0.00,$8.06,$46.05,$0.00,$23.03,$36.47,$36.84,$0.00,$7.00,$0.00,$7.33,$0.00
02.200.046,SUP,HCPCS C1713,,02.200.046  -  SCREW BONE T15 LP 3.5MM 6MM 46MM SELF TAP STARDRIVE LCP,$46.05,$0.00,$46.05,$20.72,$32.87,$0.00,$7.70,$0.00,$0.00,$8.06,$46.05,$0.00,$23.03,$36.47,$36.84,$0.00,$7.00,$0.00,$7.33,$0.00
02.200.048,SUP,HCPCS C1713,,02.200.048  -  SCREW BONE 3.5MM 48MM SLFTAP LP STARDRIVE RECESS STAINLESS,$46.05,$0.00,$46.05,$20.72,$32.87,$0.00,$7.70,$0.00,$0.00,$8.06,$46.05,$0.00,$23.03,$36.47,$36.84,$0.00,$7.00,$0.00,$7.33,$0.00
02.200.050,SUP,HCPCS C1713,,02.200.050  -  SCREW BONE T15 LP 3.5MM 6MM 50MM SELF TAP STARDRIVE LCP,$46.05,$0.00,$46.05,$20.72,$32.87,$0.00,$7.70,$0.00,$0.00,$8.06,$46.05,$0.00,$23.03,$36.47,$36.84,$0.00,$7.00,$0.00,$7.33,$0.00
02.200.055,SUP,HCPCS C1713,,02.200.055  -  SCREW BONE T15 LP 3.5MM 6MM 55MM SELF TAP STARDRIVE LCP,$46.05,$0.00,$46.05,$20.72,$32.87,$0.00,$7.70,$0.00,$0.00,$8.06,$46.05,$0.00,$23.03,$36.47,$36.84,$0.00,$7.00,$0.00,$7.33,$0.00
02.200.060,SUP,HCPCS C1713,,02.200.060  -  SCREW BONE 3.5MM 60MM SLFTAP LP STARDRIVE RECESS STAINLESS,$46.05,$0.00,$46.05,$20.72,$32.87,$0.00,$7.70,$0.00,$0.00,$8.06,$46.05,$0.00,$23.03,$36.47,$36.84,$0.00,$7.00,$0.00,$7.33,$0.00
02.200.065,SUP,HCPCS C1713,,02.200.065  -  SCREW BONE 3.5MM 65MM SLFTAP LP STARDRIVE RECESS STAINLESS,$46.05,$0.00,$46.05,$20.72,$32.87,$0.00,$7.70,$0.00,$0.00,$8.06,$46.05,$0.00,$23.03,$36.47,$36.84,$0.00,$7.00,$0.00,$7.33,$0.00
02.200.070,SUP,HCPCS C1713,,02.200.070  -  SCREW BONE 3.5MM 70MM SLFTAP LP STARDRIVE RECESS STAINLESS,$46.05,$0.00,$46.05,$20.72,$32.87,$0.00,$7.70,$0.00,$0.00,$8.06,$46.05,$0.00,$23.03,$36.47,$36.84,$0.00,$7.00,$0.00,$7.33,$0.00
02.200.075,SUP,HCPCS C1713,,02.200.075  -  SCREW BONE 3.5MM 75MM SLFTAP LP STARDRIVE RECESS STAINLESS,$46.05,$0.00,$46.05,$20.72,$32.87,$0.00,$7.70,$0.00,$0.00,$8.06,$46.05,$0.00,$23.03,$36.47,$36.84,$0.00,$7.00,$0.00,$7.33,$0.00
02.200.080,SUP,HCPCS C1713,,02.200.080  -  SCREW BONE 3.5MM 80MM SLFTAP LP STARDRIVE RECESS STAINLESS,$46.05,$0.00,$46.05,$20.72,$32.87,$0.00,$7.70,$0.00,$0.00,$8.06,$46.05,$0.00,$23.03,$36.47,$36.84,$0.00,$7.00,$0.00,$7.33,$0.00
02.200.085,SUP,HCPCS C1713,,02.200.085  -  SCREW BONE T15 LP 3.5MM 6MM 85MM SELF TAP STARDRIVE LCP,$46.05,$0.00,$46.05,$20.72,$32.87,$0.00,$7.70,$0.00,$0.00,$8.06,$46.05,$0.00,$23.03,$36.47,$36.84,$0.00,$7.00,$0.00,$7.33,$0.00
02.200.090,SUP,HCPCS C1713,,02.200.090  -  SCREW BONE 3.5MM 90MM SLFTAP LP STARDRIVE RECESS STAINLESS,$46.05,$0.00,$46.05,$20.72,$32.87,$0.00,$7.70,$0.00,$0.00,$8.06,$46.05,$0.00,$23.03,$36.47,$36.84,$0.00,$7.00,$0.00,$7.33,$0.00
02.200.095,SUP,HCPCS C1713,,02.200.095  -  SCREW BONE 3.5MM 95MM SLFTAP LP STARDRIVE RECESS STAINLESS,$46.05,$0.00,$46.05,$20.72,$32.87,$0.00,$7.70,$0.00,$0.00,$8.06,$46.05,$0.00,$23.03,$36.47,$36.84,$0.00,$7.00,$0.00,$7.33,$0.00
02.200.100,SUP,HCPCS C1713,,02.200.100  -  SCREW BONE 3.5MM 100MM SLFTAP LP STARDRIVE RECESS STAINLESS,$57.33,$0.00,$57.33,$25.80,$40.91,$0.00,$9.59,$0.00,$0.00,$10.04,$57.33,$0.00,$28.66,$45.41,$45.86,$0.00,$8.71,$0.00,$9.13,$0.00
02.200.105,SUP,HCPCS C1713,,02.200.105  -  SCREW BONE 3.5MM 105MM SLFTAP LP STARDRIVE RECESS STAINLESS,$57.33,$0.00,$57.33,$25.80,$40.91,$0.00,$9.59,$0.00,$0.00,$10.04,$57.33,$0.00,$28.66,$45.41,$45.86,$0.00,$8.71,$0.00,$9.13,$0.00
02.200.110,SUP,HCPCS C1713,,02.200.110  -  SCREW BONE 3.5MM 110MM SLFTAP LP STARDRIVE RECESS STAINLESS,$57.33,$0.00,$57.33,$25.80,$40.91,$0.00,$9.59,$0.00,$0.00,$10.04,$57.33,$0.00,$28.66,$45.41,$45.86,$0.00,$8.71,$0.00,$9.13,$0.00
02.200.115,SUP,HCPCS C1713,,02.200.115  -  SCREW BONE 3.5MM 115MM SLFTAP LP STARDRIVE RECESS STAINLESS,$57.33,$0.00,$57.33,$25.80,$40.91,$0.00,$9.59,$0.00,$0.00,$10.04,$57.33,$0.00,$28.66,$45.41,$45.86,$0.00,$8.71,$0.00,$9.13,$0.00
02.200.120,SUP,HCPCS C1713,,02.200.120  -  SCREW BONE 3.5MM 120MM SLFTAP LP STARDRIVE RECESS STAINLESS,$57.33,$0.00,$57.33,$25.80,$40.91,$0.00,$9.59,$0.00,$0.00,$10.04,$57.33,$0.00,$28.66,$45.41,$45.86,$0.00,$8.71,$0.00,$9.13,$0.00
02.200.125,SUP,HCPCS C1713,,02.200.125  -  SCREW BONE 3.5MM 125MM SLFTAP LP STARDRIVE RECESS STAINLESS,$57.33,$0.00,$57.33,$25.80,$40.91,$0.00,$9.59,$0.00,$0.00,$10.04,$57.33,$0.00,$28.66,$45.41,$45.86,$0.00,$8.71,$0.00,$9.13,$0.00
02.200.130,SUP,HCPCS C1713,,02.200.130  -  SCREW BONE 3.5MM 130MM SLFTAP LP STARDRIVE RECESS STAINLESS,$185.60,$0.00,$185.60,$83.52,$132.46,$0.00,$31.05,$0.00,$0.00,$32.50,$185.60,$0.00,$92.80,$147.00,$148.48,$0.00,$28.20,$0.00,$29.55,$0.00
02.200.135,SUP,HCPCS C1713,,02.200.135  -  SCREW BONE 3.5MM 135MM SLFTAP LP STARDRIVE RECESS STAINLESS,$185.60,$0.00,$185.60,$83.52,$132.46,$0.00,$31.05,$0.00,$0.00,$32.50,$185.60,$0.00,$92.80,$147.00,$148.48,$0.00,$28.20,$0.00,$29.55,$0.00
02.200.140,SUP,HCPCS C1713,,02.200.140  -  SCREW BONE 3.5MM 140MM SLFTAP LP STARDRIVE RECESS STAINLESS,$185.60,$0.00,$185.60,$83.52,$132.46,$0.00,$31.05,$0.00,$0.00,$32.50,$185.60,$0.00,$92.80,$147.00,$148.48,$0.00,$28.20,$0.00,$29.55,$0.00
02.200.145,SUP,HCPCS C1713,,02.200.145  -  SCREW BONE 3.5MM 145MM SLFTAP LP STARDRIVE RECESS STAINLESS,$185.60,$0.00,$185.60,$83.52,$132.46,$0.00,$31.05,$0.00,$0.00,$32.50,$185.60,$0.00,$92.80,$147.00,$148.48,$0.00,$28.20,$0.00,$29.55,$0.00
02.200.150,SUP,HCPCS C1713,,02.200.150  -  SCREW BONE 3.5MM 150MM SLFTAP LP STARDRIVE RECESS STAINLESS,$185.60,$0.00,$185.60,$83.52,$132.46,$0.00,$31.05,$0.00,$0.00,$32.50,$185.60,$0.00,$92.80,$147.00,$148.48,$0.00,$28.20,$0.00,$29.55,$0.00
02.204.014,SUP,HCPCS C1713,,02.204.014  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 14MM FIX ANGLE SELF TAP,$262.03,$0.00,$262.03,$117.91,$187.01,$0.00,$43.83,$0.00,$0.00,$45.88,$262.03,$0.00,$131.01,$207.53,$209.62,$0.00,$39.81,$0.00,$41.71,$0.00
02.204.016,SUP,HCPCS C1713,,02.204.016  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 16MM FIX ANGLE SELF TAP,$262.03,$0.00,$262.03,$117.91,$187.01,$0.00,$43.83,$0.00,$0.00,$45.88,$262.03,$0.00,$131.01,$207.53,$209.62,$0.00,$39.81,$0.00,$41.71,$0.00
02.204.018,SUP,HCPCS C1713,,02.204.018  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 18MM FIX ANGLE SELF TAP,$262.03,$0.00,$262.03,$117.91,$187.01,$0.00,$43.83,$0.00,$0.00,$45.88,$262.03,$0.00,$131.01,$207.53,$209.62,$0.00,$39.81,$0.00,$41.71,$0.00
02.204.020,SUP,HCPCS C1713,,02.204.020  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 20MM FIX ANGLE SELF TAP,$262.03,$0.00,$262.03,$117.91,$187.01,$0.00,$43.83,$0.00,$0.00,$45.88,$262.03,$0.00,$131.01,$207.53,$209.62,$0.00,$39.81,$0.00,$41.71,$0.00
02.204.022,SUP,HCPCS C1713,,02.204.022  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 22MM FIX ANGLE SELF TAP,$262.03,$0.00,$262.03,$117.91,$187.01,$0.00,$43.83,$0.00,$0.00,$45.88,$262.03,$0.00,$131.01,$207.53,$209.62,$0.00,$39.81,$0.00,$41.71,$0.00
02.204.024,SUP,HCPCS C1713,,02.204.024  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 24MM FIX ANGLE SELF TAP,$262.03,$0.00,$262.03,$117.91,$187.01,$0.00,$43.83,$0.00,$0.00,$45.88,$262.03,$0.00,$131.01,$207.53,$209.62,$0.00,$39.81,$0.00,$41.71,$0.00
02.204.026,SUP,HCPCS C1713,,02.204.026  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 26MM FIX ANGLE SELF TAP,$262.03,$0.00,$262.03,$117.91,$187.01,$0.00,$43.83,$0.00,$0.00,$45.88,$262.03,$0.00,$131.01,$207.53,$209.62,$0.00,$39.81,$0.00,$41.71,$0.00
02.204.028,SUP,HCPCS C1713,,02.204.028  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 28MM FIX ANGLE SELF TAP,$262.03,$0.00,$262.03,$117.91,$187.01,$0.00,$43.83,$0.00,$0.00,$45.88,$262.03,$0.00,$131.01,$207.53,$209.62,$0.00,$39.81,$0.00,$41.71,$0.00
02.204.030,SUP,HCPCS C1713,,02.204.030  -  SCREW BONE FULTHD 4MM 30MM T25 STARDRIVE RECESS SLFTAP TIP,$262.03,$0.00,$262.03,$117.91,$187.01,$0.00,$43.83,$0.00,$0.00,$45.88,$262.03,$0.00,$131.01,$207.53,$209.62,$0.00,$39.81,$0.00,$41.71,$0.00
02.204.032,SUP,HCPCS C1713,,02.204.032  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 32MM FIX ANGLE SELF TAP,$262.03,$0.00,$262.03,$117.91,$187.01,$0.00,$43.83,$0.00,$0.00,$45.88,$262.03,$0.00,$131.01,$207.53,$209.62,$0.00,$39.81,$0.00,$41.71,$0.00
02.204.034,SUP,HCPCS C1713,,02.204.034  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 34MM FIX ANGLE SELF TAP,$262.03,$0.00,$262.03,$117.91,$187.01,$0.00,$43.83,$0.00,$0.00,$45.88,$262.03,$0.00,$131.01,$207.53,$209.62,$0.00,$39.81,$0.00,$41.71,$0.00
02.204.036,SUP,HCPCS C1713,,02.204.036  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 36MM FIX ANGLE SELF TAP,$262.03,$0.00,$262.03,$117.91,$187.01,$0.00,$43.83,$0.00,$0.00,$45.88,$262.03,$0.00,$131.01,$207.53,$209.62,$0.00,$39.81,$0.00,$41.71,$0.00
02.204.038,SUP,HCPCS C1713,,02.204.038  -  SCREW BONE FULTHD 4MM 38MM T25 STARDRIVE SELF TAP TIP LOCK,$262.03,$0.00,$262.03,$117.91,$187.01,$0.00,$43.83,$0.00,$0.00,$45.88,$262.03,$0.00,$131.01,$207.53,$209.62,$0.00,$39.81,$0.00,$41.71,$0.00
02.204.040,SUP,HCPCS C1713,,02.204.040  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 40MM FIX ANGLE SELF TAP,$262.03,$0.00,$262.03,$117.91,$187.01,$0.00,$43.83,$0.00,$0.00,$45.88,$262.03,$0.00,$131.01,$207.53,$209.62,$0.00,$39.81,$0.00,$41.71,$0.00
02.204.042,SUP,HCPCS C1713,,02.204.042  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 42MM FIX ANGLE SELF TAP,$262.03,$0.00,$262.03,$117.91,$187.01,$0.00,$43.83,$0.00,$0.00,$45.88,$262.03,$0.00,$131.01,$207.53,$209.62,$0.00,$39.81,$0.00,$41.71,$0.00
02.204.044,SUP,HCPCS C1713,,02.204.044  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 44MM FIX ANGLE SELF TAP,$262.03,$0.00,$262.03,$117.91,$187.01,$0.00,$43.83,$0.00,$0.00,$45.88,$262.03,$0.00,$131.01,$207.53,$209.62,$0.00,$39.81,$0.00,$41.71,$0.00
02.204.046,SUP,HCPCS C1713,,02.204.046  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 46MM FIX ANGLE SELF TAP,$262.03,$0.00,$262.03,$117.91,$187.01,$0.00,$43.83,$0.00,$0.00,$45.88,$262.03,$0.00,$131.01,$207.53,$209.62,$0.00,$39.81,$0.00,$41.71,$0.00
02.204.048,SUP,HCPCS C1713,,02.204.048  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 48MM FIX ANGLE SELF TAP,$262.03,$0.00,$262.03,$117.91,$187.01,$0.00,$43.83,$0.00,$0.00,$45.88,$262.03,$0.00,$131.01,$207.53,$209.62,$0.00,$39.81,$0.00,$41.71,$0.00
02.204.050,SUP,HCPCS C1713,,02.204.050  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 50MM FIX ANGLE SELF TAP,$262.03,$0.00,$262.03,$117.91,$187.01,$0.00,$43.83,$0.00,$0.00,$45.88,$262.03,$0.00,$131.01,$207.53,$209.62,$0.00,$39.81,$0.00,$41.71,$0.00
02.204.052,SUP,HCPCS C1713,,02.204.052  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 52MM FIX ANGLE SELF TAP,$262.03,$0.00,$262.03,$117.91,$187.01,$0.00,$43.83,$0.00,$0.00,$45.88,$262.03,$0.00,$131.01,$207.53,$209.62,$0.00,$39.81,$0.00,$41.71,$0.00
02.204.054,SUP,HCPCS C1713,,02.204.054  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 54MM FIX ANGLE SELF TAP,$262.03,$0.00,$262.03,$117.91,$187.01,$0.00,$43.83,$0.00,$0.00,$45.88,$262.03,$0.00,$131.01,$207.53,$209.62,$0.00,$39.81,$0.00,$41.71,$0.00
02.204.056,SUP,HCPCS C1713,,02.204.056  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 56MM FIX ANGLE SELF TAP,$262.03,$0.00,$262.03,$117.91,$187.01,$0.00,$43.83,$0.00,$0.00,$45.88,$262.03,$0.00,$131.01,$207.53,$209.62,$0.00,$39.81,$0.00,$41.71,$0.00
02.204.058,SUP,HCPCS C1713,,02.204.058  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 58MM FIX ANGLE SELF TAP,$262.03,$0.00,$262.03,$117.91,$187.01,$0.00,$43.83,$0.00,$0.00,$45.88,$262.03,$0.00,$131.01,$207.53,$209.62,$0.00,$39.81,$0.00,$41.71,$0.00
02.204.060,SUP,HCPCS C1713,,02.204.060  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 60MM FIX ANGLE SELF TAP,$262.03,$0.00,$262.03,$117.91,$187.01,$0.00,$43.83,$0.00,$0.00,$45.88,$262.03,$0.00,$131.01,$207.53,$209.62,$0.00,$39.81,$0.00,$41.71,$0.00
02.204.062,SUP,HCPCS C1713,,02.204.062  -  SCREW BONE T25 FULTHD CONE 4MM 3.4MM 62MM FIX ANGLE SELF TAP,$262.03,$0.00,$262.03,$117.91,$187.01,$0.00,$43.83,$0.00,$0.00,$45.88,$262.03,$0.00,$131.01,$207.53,$209.62,$0.00,$39.81,$0.00,$41.71,$0.00
02.204.420,SUP,HCPCS C1713,,02.204.420  -  SCREW BONE 4MM 20MM LOCK STAINLESS STEEL PERIARTICULAR,$254.40,$0.00,$254.40,$114.48,$181.57,$0.00,$43.83,$0.00,$0.00,$44.54,$254.40,$0.00,$127.20,$201.48,$203.52,$0.00,$39.81,$0.00,$40.50,$0.00
02.204.424,SUP,HCPCS C1713,,02.204.424  -  SCREW BONE 4MM 24MM LOCK STAINLESS STEEL PERIARTICULAR,$254.40,$0.00,$254.40,$114.48,$181.57,$0.00,$43.83,$0.00,$0.00,$44.54,$254.40,$0.00,$127.20,$201.48,$203.52,$0.00,$39.81,$0.00,$40.50,$0.00
02.204.428,SUP,HCPCS C1713,,02.204.428  -  SCREW BONE 4MM 3.4MM 28MM LOCKING SLFTAP TIP THREADED,$254.40,$0.00,$254.40,$114.48,$181.57,$0.00,$43.83,$0.00,$0.00,$44.54,$254.40,$0.00,$127.20,$201.48,$203.52,$0.00,$39.81,$0.00,$40.50,$0.00
02.204.432,SUP,HCPCS C1713,,02.204.432  -  SCREW BONE 4MM 32MM LOCKING SLFTAP TIP THREADED CONICAL HEAD,$254.40,$0.00,$254.40,$114.48,$181.57,$0.00,$43.83,$0.00,$0.00,$44.54,$254.40,$0.00,$127.20,$201.48,$203.52,$0.00,$39.81,$0.00,$40.50,$0.00
02.204.436,SUP,HCPCS C1713,,02.204.436  -  SCREW BONE 4MM 36MM LOCKING SLFTAP TIP THREADED CONICAL HEAD,$254.40,$0.00,$254.40,$114.48,$181.57,$0.00,$43.83,$0.00,$0.00,$44.54,$254.40,$0.00,$127.20,$201.48,$203.52,$0.00,$39.81,$0.00,$40.50,$0.00
02.204.440,SUP,HCPCS C1713,,02.204.440  -  SCREW BONE 4MM 40MM LOCKING SLFTAP TIP THREADED CONICAL HEAD,$254.40,$0.00,$254.40,$114.48,$181.57,$0.00,$43.83,$0.00,$0.00,$44.54,$254.40,$0.00,$127.20,$201.48,$203.52,$0.00,$39.81,$0.00,$40.50,$0.00
02.204.444,SUP,HCPCS C1713,,02.204.444  -  SCREW BONE 4MM 44MM LOCKING SLFTAP TIP THREADED CONICAL HEAD,$254.40,$0.00,$254.40,$114.48,$181.57,$0.00,$43.83,$0.00,$0.00,$44.54,$254.40,$0.00,$127.20,$201.48,$203.52,$0.00,$39.81,$0.00,$40.50,$0.00
02.204.448,SUP,HCPCS C1713,,02.204.448  -  SCREW BONE 4MM 48MM LOCKING HEX RECESS STAINLESS STEEL,$254.40,$0.00,$254.40,$114.48,$181.57,$0.00,$43.83,$0.00,$0.00,$44.54,$254.40,$0.00,$127.20,$201.48,$203.52,$0.00,$39.81,$0.00,$40.50,$0.00
02.204.452,SUP,HCPCS C1713,,02.204.452  -  SCREW BONE 4MM 52MM LOCKING HEX RECESS STAINLESS STEEL,$254.40,$0.00,$254.40,$114.48,$181.57,$0.00,$43.83,$0.00,$0.00,$44.54,$254.40,$0.00,$127.20,$201.48,$203.52,$0.00,$39.81,$0.00,$40.50,$0.00
02.204.456,SUP,HCPCS C1713,,02.204.456  -  SCREW BONE 4MM 56MM LOCKING HEX RECESS STAINLESS STEEL,$254.40,$0.00,$254.40,$114.48,$181.57,$0.00,$43.83,$0.00,$0.00,$44.54,$254.40,$0.00,$127.20,$201.48,$203.52,$0.00,$39.81,$0.00,$40.50,$0.00
02.204.460,SUP,HCPCS C1713,,02.204.460  -  SCREW BONE 4MM 60MM LOCKING HEX RECESS STAINLESS STEEL,$254.40,$0.00,$254.40,$114.48,$181.57,$0.00,$43.83,$0.00,$0.00,$44.54,$254.40,$0.00,$127.20,$201.48,$203.52,$0.00,$39.81,$0.00,$40.50,$0.00
02.205.025,SUP,HCPCS C1713,,02.205.025  -  SCREW BONE 4MM FULTHD 5MM 4.4MM 25MM SELF DRILL SELF TAP,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
02.205.030,SUP,HCPCS C1713,,02.205.030  -  SCREW BONE 4MM FULTHD 5MM 4.4MM 30MM SELF DRILL SELF TAP,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
02.205.035,SUP,HCPCS C1713,,02.205.035  -  SCREW BONE 4MM FULTHD 5MM 4.4MM 35MM SELF DRILL SELF TAP,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
02.205.040,SUP,HCPCS C1713,,02.205.040  -  SCREW BONE 4MM FULTHD 5MM 4.4MM 40MM CANN LOCKING SLFDRILL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
02.205.045,SUP,HCPCS C1713,,02.205.045  -  SCREW BONE 4MM FULTHD 5MM 4.4MM 45MM SELF DRILL SELF TAP,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
02.205.050,SUP,HCPCS C1713,,02.205.050  -  SCREW BONE 4MM FULTHD 5MM 4.4MM 50MM SELF DRILL SELF TAP,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
02.205.055,SUP,HCPCS C1713,,02.205.055  -  SCREW BONE 4MM FULTHD 5MM 4.4MM 55MM CANN LOCK DRILL SELF,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
02.205.060,SUP,HCPCS C1713,,02.205.060  -  SCREW BONE 4MM FULTHD 5MM 4.4MM 60MM SELF DRILL SELF TAP,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
02.205.065,SUP,HCPCS C1713,,02.205.065  -  SCREW BONE 4MM FULTHD 5MM 4.4MM 65MM CANN LOCK DRILL SELF,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
02.205.070,SUP,HCPCS C1713,,02.205.070  -  SCREW BONE 4MM FULTHD 5MM 4.4MM 70MM SELF DRILL SELF TAP,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
02.205.075,SUP,HCPCS C1713,,02.205.075  -  SCREW BONE 4MM FULTHD 5MM 4.4MM 75MM SELF DRILL SELF TAP,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
02.205.080,SUP,HCPCS C1713,,02.205.080  -  SCREW BONE 4MM FULTHD 5MM 4.4MM 80MM SELF DRILL SELF TAP,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
02.205.085,SUP,HCPCS C1713,,02.205.085  -  SCREW BONE 4MM FULTHD 5MM 4.4MM 85MM CANN LOCKING SLFDRILL,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
02.205.090,SUP,HCPCS C1713,,02.205.090  -  SCREW BONE 4MM FULTHD 5MM 4.4MM 90MM SELF DRILL SELF TAP,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
02.205.095,SUP,HCPCS C1713,,02.205.095  -  SCREW BONE 4MM FULTHD 5MM 4.4MM 95MM CANN LOCK DRILL SELF,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
02.205.100,SUP,HCPCS C1713,,02.205.100  -  SCREW BONE FULTHD 5MM 100MM SELF TAP SELF DRILL CANN LOCK,$368.48,$0.00,$368.48,$165.81,$262.98,$0.00,$61.64,$0.00,$0.00,$64.52,$368.48,$0.00,$184.24,$291.84,$294.78,$0.00,$55.99,$0.00,$58.66,$0.00
02.205.105,SUP,HCPCS C1713,,02.205.105  -  SCREW BONE FULTHD 5MM 105MM SELF TAP SELF DRILL CANN LOCK,$368.48,$0.00,$368.48,$165.81,$262.98,$0.00,$61.64,$0.00,$0.00,$64.52,$368.48,$0.00,$184.24,$291.84,$294.78,$0.00,$55.99,$0.00,$58.66,$0.00
02.205.110,SUP,HCPCS C1713,,02.205.110  -  SCREW BONE 4MM FULTHD 5MM 4.4MM 110MM SELF DRILL SELF TAP,$368.48,$0.00,$368.48,$165.81,$262.98,$0.00,$61.64,$0.00,$0.00,$64.52,$368.48,$0.00,$184.24,$291.84,$294.78,$0.00,$55.99,$0.00,$58.66,$0.00
02.205.115,SUP,HCPCS C1713,,02.205.115  -  SCREW BONE FULTHD 5MM 115MM SELF TAP TIP SELF DRILL CANN,$368.48,$0.00,$368.48,$165.81,$262.98,$0.00,$61.64,$0.00,$0.00,$64.52,$368.48,$0.00,$184.24,$291.84,$294.78,$0.00,$55.99,$0.00,$58.66,$0.00
02.205.120,SUP,HCPCS C1713,,02.205.120  -  SCREW BONE FULTHD 5MM 120MM SELF TAP SELF DRILL CANN LOCK,$368.48,$0.00,$368.48,$165.81,$262.98,$0.00,$61.64,$0.00,$0.00,$64.52,$368.48,$0.00,$184.24,$291.84,$294.78,$0.00,$55.99,$0.00,$58.66,$0.00
02.205.125,SUP,HCPCS C1713,,02.205.125  -  SCREW BONE FULTHD 5MM 125MM SELF TAP SELF DRILL CANN LOCK,$368.48,$0.00,$368.48,$165.81,$262.98,$0.00,$61.64,$0.00,$0.00,$64.52,$368.48,$0.00,$184.24,$291.84,$294.78,$0.00,$55.99,$0.00,$58.66,$0.00
02.205.130,SUP,HCPCS C1713,,02.205.130  -  SCREW BONE FULTHD 5MM 130MM SELF TAP SELF DRILL CANN LOCK,$368.48,$0.00,$368.48,$165.81,$262.98,$0.00,$61.64,$0.00,$0.00,$64.52,$368.48,$0.00,$184.24,$291.84,$294.78,$0.00,$55.99,$0.00,$58.66,$0.00
02.205.135,SUP,HCPCS C1713,,02.205.135  -  SCREW BONE FULTHD 5MM 135MM SELF TAP SELF DRILL CANN LOCK,$368.48,$0.00,$368.48,$165.81,$262.98,$0.00,$61.64,$0.00,$0.00,$64.52,$368.48,$0.00,$184.24,$291.84,$294.78,$0.00,$55.99,$0.00,$58.66,$0.00
02.205.140,SUP,HCPCS C1713,,02.205.140  -  SCREW BONE FULTHD 5MM 140MM SELF TAP SELF DRILL CANN LOCK,$368.48,$0.00,$368.48,$165.81,$262.98,$0.00,$61.64,$0.00,$0.00,$64.52,$368.48,$0.00,$184.24,$291.84,$294.78,$0.00,$55.99,$0.00,$58.66,$0.00
02.205.145,SUP,HCPCS C1713,,02.205.145  -  SCREW BONE 4MM FULTHD 5MM 4.4MM 145MM SELF DRILL SELF TAP,$368.48,$0.00,$368.48,$165.81,$262.98,$0.00,$61.64,$0.00,$0.00,$64.52,$368.48,$0.00,$184.24,$291.84,$294.78,$0.00,$55.99,$0.00,$58.66,$0.00
02.205.240,SUP,HCPCS C1713,,02.205.240  -  SCREW BONE 4MM PTHRD CONE HEXAGON 5MM 4.4MM 40MM SELF DRILL,$316.63,$0.00,$316.63,$142.48,$225.98,$0.00,$52.96,$0.00,$0.00,$55.44,$316.63,$0.00,$158.31,$250.77,$253.30,$0.00,$48.11,$0.00,$50.41,$0.00
02.205.245,SUP,HCPCS C1713,,02.205.245  -  SCREW BONE 4MM PTHRD CONE HEXAGON 5MM 4.4MM 45MM SELF DRILL,$316.63,$0.00,$316.63,$142.48,$225.98,$0.00,$52.96,$0.00,$0.00,$55.44,$316.63,$0.00,$158.31,$250.77,$253.30,$0.00,$48.11,$0.00,$50.41,$0.00
02.205.250,SUP,HCPCS C1713,,02.205.250  -  SCREW BONE 4MM PTHRD CONE HEXAGON 5MM 4.4MM 50MM SELF DRILL,$316.63,$0.00,$316.63,$142.48,$225.98,$0.00,$52.96,$0.00,$0.00,$55.44,$316.63,$0.00,$158.31,$250.77,$253.30,$0.00,$48.11,$0.00,$50.41,$0.00
02.205.255,SUP,HCPCS C1713,,02.205.255  -  SCREW BONE 4MM PTHRD CONE HEXAGON 5MM 4.4MM 55MM SELF DRILL,$316.63,$0.00,$316.63,$142.48,$225.98,$0.00,$52.96,$0.00,$0.00,$55.44,$316.63,$0.00,$158.31,$250.77,$253.30,$0.00,$48.11,$0.00,$50.41,$0.00
02.205.260,SUP,HCPCS C1713,,02.205.260  -  SCREW BONE 4MM PTHRD CONE HEXAGON 5MM 4.4MM 60MM SELF DRILL,$316.63,$0.00,$316.63,$142.48,$225.98,$0.00,$52.96,$0.00,$0.00,$55.44,$316.63,$0.00,$158.31,$250.77,$253.30,$0.00,$48.11,$0.00,$50.41,$0.00
02.205.265,SUP,HCPCS C1713,,02.205.265  -  SCREW BONE 4MM PTHRD CONE HEXAGON 5MM 4.4MM 65MM SELF DRILL,$316.63,$0.00,$316.63,$142.48,$225.98,$0.00,$52.96,$0.00,$0.00,$55.44,$316.63,$0.00,$158.31,$250.77,$253.30,$0.00,$48.11,$0.00,$50.41,$0.00
02.205.270,SUP,HCPCS C1713,,02.205.270  -  SCREW BONE 4MM PTHRD CONE HEXAGON 5MM 4.4MM 70MM SELF DRILL,$316.63,$0.00,$316.63,$142.48,$225.98,$0.00,$52.96,$0.00,$0.00,$55.44,$316.63,$0.00,$158.31,$250.77,$253.30,$0.00,$48.11,$0.00,$50.41,$0.00
02.205.275,SUP,HCPCS C1713,,02.205.275  -  SCREW BONE 4MM PTHRD CONE HEXAGON 5MM 4.4MM 75MM SELF DRILL,$316.63,$0.00,$316.63,$142.48,$225.98,$0.00,$52.96,$0.00,$0.00,$55.44,$316.63,$0.00,$158.31,$250.77,$253.30,$0.00,$48.11,$0.00,$50.41,$0.00
02.205.280,SUP,HCPCS C1713,,02.205.280  -  SCREW BONE 4MM PTHRD CONE HEXAGON 5MM 4.4MM 80MM SELF DRILL,$316.63,$0.00,$316.63,$142.48,$225.98,$0.00,$52.96,$0.00,$0.00,$55.44,$316.63,$0.00,$158.31,$250.77,$253.30,$0.00,$48.11,$0.00,$50.41,$0.00
02.205.285,SUP,HCPCS C1713,,02.205.285  -  SCREW BONE 4MM PTHRD CONE HEXAGON 5MM 4.4MM 85MM SELF DRILL,$316.63,$0.00,$316.63,$142.48,$225.98,$0.00,$52.96,$0.00,$0.00,$55.44,$316.63,$0.00,$158.31,$250.77,$253.30,$0.00,$48.11,$0.00,$50.41,$0.00
02.205.290,SUP,HCPCS C1713,,02.205.290  -  SCREW BONE 4MM PTHRD CONE HEXAGON 5MM 4.4MM 90MM SELF DRILL,$316.63,$0.00,$316.63,$142.48,$225.98,$0.00,$52.96,$0.00,$0.00,$55.44,$316.63,$0.00,$158.31,$250.77,$253.30,$0.00,$48.11,$0.00,$50.41,$0.00
02.205.295,SUP,HCPCS C1713,,02.205.295  -  SCREW BONE 4MM PTHRD CONE HEXAGON 5MM 4.4MM 95MM SELF DRILL,$316.63,$0.00,$316.63,$142.48,$225.98,$0.00,$52.96,$0.00,$0.00,$55.44,$316.63,$0.00,$158.31,$250.77,$253.30,$0.00,$48.11,$0.00,$50.41,$0.00
02.206.214,SUP,HCPCS C1713,,02.206.214  -  SCREW BONE T15 3.5MM 14MM LP HEAD STARDRIVE SELF TAP TIP,$65.50,$0.00,$65.50,$29.48,$46.75,$0.00,$10.96,$0.00,$0.00,$11.47,$65.50,$0.00,$32.75,$51.88,$52.40,$0.00,$9.95,$0.00,$10.43,$0.00
02.206.216,SUP,HCPCS C1713,,02.206.216  -  SCREW BONE T15 3.5MM 16MM SELF TAP LP STARDRIVE STAINLESS,$65.50,$0.00,$65.50,$29.48,$46.75,$0.00,$10.96,$0.00,$0.00,$11.47,$65.50,$0.00,$32.75,$51.88,$52.40,$0.00,$9.95,$0.00,$10.43,$0.00
02.206.218,SUP,HCPCS C1713,,02.206.218  -  SCREW BONE T15 LP 3.5MM 18MM SELF TAP STAINLESS STEEL,$65.50,$0.00,$65.50,$29.48,$46.75,$0.00,$10.96,$0.00,$0.00,$11.47,$65.50,$0.00,$32.75,$51.88,$52.40,$0.00,$9.95,$0.00,$10.43,$0.00
02.206.228,SUP,HCPCS C1713,,02.206.228  -  SCREW BONE T15 3.5MM 28MM LP HEAD STARDRIVE SELF TAP TIP,$65.50,$0.00,$65.50,$29.48,$46.75,$0.00,$10.96,$0.00,$0.00,$11.47,$65.50,$0.00,$32.75,$51.88,$52.40,$0.00,$9.95,$0.00,$10.43,$0.00
02.206.230,SUP,Custom 27203010,,02.206.230  -  SCREW BONE 3.5MM 30MM LCP SS MIDFT HINDFOOT TIB,$65.50,$0.00,$65.50,$0.00,$46.75,$0.00,$0.00,$0.00,$0.00,$0.00,$65.50,$0.00,$32.75,$51.88,$52.40,$0.00,$0.00,$0.00,$0.00,$0.00
02.206.232,SUP,HCPCS C1713,,02.206.232  -  SCREW BONE 3.5MM 32MM SS T15 LP CLVCL FEM HUM TIB,$65.50,$0.00,$65.50,$29.48,$46.75,$0.00,$10.96,$0.00,$0.00,$11.47,$65.50,$0.00,$32.75,$51.88,$52.40,$0.00,$9.95,$0.00,$10.43,$0.00
02.206.238,SUP,HCPCS C1713,,02.206.238  -  SCREW BONE T15 3.5MM 38MM LP HEAD STARDRIVE SELF TAP TIP,$65.50,$0.00,$65.50,$29.48,$46.75,$0.00,$10.96,$0.00,$0.00,$11.47,$65.50,$0.00,$32.75,$51.88,$52.40,$0.00,$9.95,$0.00,$10.43,$0.00
02.206.240,SUP,HCPCS C1713,,02.206.240  -  SCREW BONE 3.5MM 40MM SELF TAP LP HEAD TI5 STARDRIVE LCP,$65.50,$0.00,$65.50,$29.48,$46.75,$0.00,$10.96,$0.00,$0.00,$11.47,$65.50,$0.00,$32.75,$51.88,$52.40,$0.00,$9.95,$0.00,$10.43,$0.00
02.207.001,SUP,HCPCS C1769,,02.207.001  -  GUIDEWIRE ORTHOPEDIC FLUTE 2.8MM 450MM NONSTRL,$162.40,$0.00,$162.40,$88.18,$115.90,$0.00,$27.17,$0.00,$0.00,$28.43,$162.40,$0.00,$81.20,$128.62,$129.92,$0.00,$24.68,$0.00,$25.85,$0.00
02.207.020,SUP,HCPCS C1713,,02.207.020  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 20MM SELF DRILL SELF TAP,$530.90,$0.00,$530.90,$238.91,$378.90,$0.00,$88.81,$0.00,$0.00,$92.96,$530.90,$0.00,$265.45,$420.47,$424.72,$0.00,$80.66,$0.00,$84.52,$0.00
02.207.025,SUP,HCPCS C1713,,02.207.025  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 25MM SELF DRILL SELF TAP,$530.90,$0.00,$530.90,$238.91,$378.90,$0.00,$88.81,$0.00,$0.00,$92.96,$530.90,$0.00,$265.45,$420.47,$424.72,$0.00,$80.66,$0.00,$84.52,$0.00
02.207.030,SUP,HCPCS C1713,,02.207.030  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 30MM SELF DRILL SELF TAP,$530.90,$0.00,$530.90,$238.91,$378.90,$0.00,$88.81,$0.00,$0.00,$92.96,$530.90,$0.00,$265.45,$420.47,$424.72,$0.00,$80.66,$0.00,$84.52,$0.00
02.207.035,SUP,HCPCS C1713,,02.207.035  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 35MM SELF DRILL SELF TAP,$530.90,$0.00,$530.90,$238.91,$378.90,$0.00,$88.81,$0.00,$0.00,$92.96,$530.90,$0.00,$265.45,$420.47,$424.72,$0.00,$80.66,$0.00,$84.52,$0.00
02.207.040,SUP,HCPCS C1713,,02.207.040  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 40MM SELF DRILL SELF TAP,$530.90,$0.00,$530.90,$238.91,$378.90,$0.00,$88.81,$0.00,$0.00,$92.96,$530.90,$0.00,$265.45,$420.47,$424.72,$0.00,$80.66,$0.00,$84.52,$0.00
02.207.045,SUP,HCPCS C1713,,02.207.045  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 45MM SELF DRILL SELF TAP,$530.90,$0.00,$530.90,$238.91,$378.90,$0.00,$88.81,$0.00,$0.00,$92.96,$530.90,$0.00,$265.45,$420.47,$424.72,$0.00,$80.66,$0.00,$84.52,$0.00
02.207.050,SUP,HCPCS C1713,,02.207.050  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 50MM SELF DRILL SELF TAP,$530.90,$0.00,$530.90,$238.91,$378.90,$0.00,$88.81,$0.00,$0.00,$92.96,$530.90,$0.00,$265.45,$420.47,$424.72,$0.00,$80.66,$0.00,$84.52,$0.00
02.207.055,SUP,HCPCS C1713,,02.207.055  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 55MM SELF DRILL SELF TAP,$530.90,$0.00,$530.90,$238.91,$378.90,$0.00,$88.81,$0.00,$0.00,$92.96,$530.90,$0.00,$265.45,$420.47,$424.72,$0.00,$80.66,$0.00,$84.52,$0.00
02.207.060,SUP,HCPCS C1713,,02.207.060  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 60MM SELF DRILL SELF TAP,$530.90,$0.00,$530.90,$238.91,$378.90,$0.00,$88.81,$0.00,$0.00,$92.96,$530.90,$0.00,$265.45,$420.47,$424.72,$0.00,$80.66,$0.00,$84.52,$0.00
02.207.065,SUP,HCPCS C1713,,02.207.065  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 65MM SELF DRILL SELF TAP,$530.90,$0.00,$530.90,$238.91,$378.90,$0.00,$88.81,$0.00,$0.00,$92.96,$530.90,$0.00,$265.45,$420.47,$424.72,$0.00,$80.66,$0.00,$84.52,$0.00
02.207.070,SUP,HCPCS C1713,,02.207.070  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 70MM SELF DRILL SELF TAP,$530.90,$0.00,$530.90,$238.91,$378.90,$0.00,$88.81,$0.00,$0.00,$92.96,$530.90,$0.00,$265.45,$420.47,$424.72,$0.00,$80.66,$0.00,$84.52,$0.00
02.207.075,SUP,HCPCS C1713,,02.207.075  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 75MM SELF DRILL SELF TAP,$530.90,$0.00,$530.90,$238.91,$378.90,$0.00,$88.81,$0.00,$0.00,$92.96,$530.90,$0.00,$265.45,$420.47,$424.72,$0.00,$80.66,$0.00,$84.52,$0.00
02.207.080,SUP,HCPCS C1713,,02.207.080  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 80MM SELF DRILL SELF TAP,$530.90,$0.00,$530.90,$238.91,$378.90,$0.00,$88.81,$0.00,$0.00,$92.96,$530.90,$0.00,$265.45,$420.47,$424.72,$0.00,$80.66,$0.00,$84.52,$0.00
02.207.085,SUP,HCPCS C1713,,02.207.085  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 85MM SLFTAP TIP SLFDRILL,$530.90,$0.00,$530.90,$238.91,$378.90,$0.00,$88.81,$0.00,$0.00,$92.96,$530.90,$0.00,$265.45,$420.47,$424.72,$0.00,$80.66,$0.00,$84.52,$0.00
02.207.090,SUP,HCPCS C1713,,02.207.090  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 90MM SELF DRILL SELF TAP,$530.90,$0.00,$530.90,$238.91,$378.90,$0.00,$88.81,$0.00,$0.00,$92.96,$530.90,$0.00,$265.45,$420.47,$424.72,$0.00,$80.66,$0.00,$84.52,$0.00
02.207.095,SUP,HCPCS C1713,,02.207.095  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 95MM SELF DRILL SELF TAP,$530.90,$0.00,$530.90,$238.91,$378.90,$0.00,$88.81,$0.00,$0.00,$92.96,$530.90,$0.00,$265.45,$420.47,$424.72,$0.00,$80.66,$0.00,$84.52,$0.00
02.207.100,SUP,HCPCS C1713,,02.207.100  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 100MM SELF DRILL SELF TAP,$543.18,$0.00,$543.18,$244.43,$387.66,$0.00,$90.86,$0.00,$0.00,$95.11,$543.18,$0.00,$271.59,$430.20,$434.54,$0.00,$82.53,$0.00,$86.47,$0.00
02.207.105,SUP,HCPCS C1713,,02.207.105  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 105MM SELF DRILL SELF TAP,$543.18,$0.00,$543.18,$244.43,$387.66,$0.00,$90.86,$0.00,$0.00,$95.11,$543.18,$0.00,$271.59,$430.20,$434.54,$0.00,$82.53,$0.00,$86.47,$0.00
02.207.110,SUP,HCPCS C1713,,02.207.110  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 110MM SELF DRILL SELF TAP,$543.18,$0.00,$543.18,$244.43,$387.66,$0.00,$90.86,$0.00,$0.00,$95.11,$543.18,$0.00,$271.59,$430.20,$434.54,$0.00,$82.53,$0.00,$86.47,$0.00
02.207.115,SUP,HCPCS C1713,,02.207.115  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 115MM SELF DRILL SELF TAP,$543.18,$0.00,$543.18,$244.43,$387.66,$0.00,$90.86,$0.00,$0.00,$95.11,$543.18,$0.00,$271.59,$430.20,$434.54,$0.00,$82.53,$0.00,$86.47,$0.00
02.207.120,SUP,HCPCS C1713,,02.207.120  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 120MM SELF DRILL SELF TAP,$543.18,$0.00,$543.18,$244.43,$387.66,$0.00,$90.86,$0.00,$0.00,$95.11,$543.18,$0.00,$271.59,$430.20,$434.54,$0.00,$82.53,$0.00,$86.47,$0.00
02.207.125,SUP,HCPCS C1713,,02.207.125  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 125MM SELF DRILL SELF TAP,$543.18,$0.00,$543.18,$244.43,$387.66,$0.00,$90.86,$0.00,$0.00,$95.11,$543.18,$0.00,$271.59,$430.20,$434.54,$0.00,$82.53,$0.00,$86.47,$0.00
02.207.130,SUP,HCPCS C1713,,02.207.130  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 130MM SELF DRILL SELF TAP,$543.18,$0.00,$543.18,$244.43,$387.66,$0.00,$90.86,$0.00,$0.00,$95.11,$543.18,$0.00,$271.59,$430.20,$434.54,$0.00,$82.53,$0.00,$86.47,$0.00
02.207.135,SUP,HCPCS C1713,,02.207.135  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 135MM SELF DRILL SELF TAP,$543.18,$0.00,$543.18,$244.43,$387.66,$0.00,$90.86,$0.00,$0.00,$95.11,$543.18,$0.00,$271.59,$430.20,$434.54,$0.00,$82.53,$0.00,$86.47,$0.00
02.207.140,SUP,HCPCS C1713,,02.207.140  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 140MM SELF DRILL SELF TAP,$543.18,$0.00,$543.18,$244.43,$387.66,$0.00,$90.86,$0.00,$0.00,$95.11,$543.18,$0.00,$271.59,$430.20,$434.54,$0.00,$82.53,$0.00,$86.47,$0.00
02.207.145,SUP,HCPCS C1713,,02.207.145  -  SCREW BONE 4MM FULTHD 7.3MM 5MM 145MM SELF DRILL SELF TAP,$543.18,$0.00,$543.18,$244.43,$387.66,$0.00,$90.86,$0.00,$0.00,$95.11,$543.18,$0.00,$271.59,$430.20,$434.54,$0.00,$82.53,$0.00,$86.47,$0.00
02.207.250,SUP,HCPCS C1713,,02.207.250  -  SCREW BONE 4MM FULTHD CONE HEXAGON 7.3MM 5MM 50MM SELF DRILL,$473.58,$0.00,$473.58,$213.11,$337.99,$0.00,$79.22,$0.00,$0.00,$82.92,$473.58,$0.00,$236.79,$375.08,$378.86,$0.00,$71.95,$0.00,$75.39,$0.00
02.207.255,SUP,HCPCS C1713,,02.207.255  -  SCREW BONE 4MM FULTHD CONE HEXAGON 7.3MM 5MM 55MM SELF DRILL,$473.58,$0.00,$473.58,$213.11,$337.99,$0.00,$79.22,$0.00,$0.00,$82.92,$473.58,$0.00,$236.79,$375.08,$378.86,$0.00,$71.95,$0.00,$75.39,$0.00
02.207.260,SUP,HCPCS C1713,,02.207.260  -  SCREW BONE 4MM FULTHD CONE HEXAGON 7.3MM 5MM 60MM SELF DRILL,$473.58,$0.00,$473.58,$213.11,$337.99,$0.00,$79.22,$0.00,$0.00,$82.92,$473.58,$0.00,$236.79,$375.08,$378.86,$0.00,$71.95,$0.00,$75.39,$0.00
02.207.265,SUP,HCPCS C1713,,02.207.265  -  SCREW BONE 4MM FULTHD CONE HEXAGON 7.3MM 5MM 65MM SELF DRILL,$473.58,$0.00,$473.58,$213.11,$337.99,$0.00,$79.22,$0.00,$0.00,$82.92,$473.58,$0.00,$236.79,$375.08,$378.86,$0.00,$71.95,$0.00,$75.39,$0.00
02.207.270,SUP,HCPCS C1713,,02.207.270  -  SCREW BONE 4MM FULTHD CONE HEXAGON 7.3MM 5MM 70MM SELF DRILL,$473.58,$0.00,$473.58,$213.11,$337.99,$0.00,$79.22,$0.00,$0.00,$82.92,$473.58,$0.00,$236.79,$375.08,$378.86,$0.00,$71.95,$0.00,$75.39,$0.00
02.207.275,SUP,HCPCS C1713,,02.207.275  -  SCREW BONE 4MM FULTHD CONE HEXAGON 7.3MM 5MM 75MM SELF DRILL,$473.58,$0.00,$473.58,$213.11,$337.99,$0.00,$79.22,$0.00,$0.00,$82.92,$473.58,$0.00,$236.79,$375.08,$378.86,$0.00,$71.95,$0.00,$75.39,$0.00
02.207.280,SUP,HCPCS C1713,,02.207.280  -  SCREW BONE 4MM FULTHD CONE HEXAGON 7.3MM 5MM 80MM SELF DRILL,$473.58,$0.00,$473.58,$213.11,$337.99,$0.00,$79.22,$0.00,$0.00,$82.92,$473.58,$0.00,$236.79,$375.08,$378.86,$0.00,$71.95,$0.00,$75.39,$0.00
02.207.285,SUP,HCPCS C1713,,02.207.285  -  SCREW BONE 4MM FULTHD CONE HEXAGON 7.3MM 5MM 85MM SELF DRILL,$473.58,$0.00,$473.58,$213.11,$337.99,$0.00,$79.22,$0.00,$0.00,$82.92,$473.58,$0.00,$236.79,$375.08,$378.86,$0.00,$71.95,$0.00,$75.39,$0.00
02.207.290,SUP,HCPCS C1713,,02.207.290  -  SCREW BONE 4MM FULTHD CONE HEXAGON 7.3MM 5MM 90MM SELF DRILL,$473.58,$0.00,$473.58,$213.11,$337.99,$0.00,$79.22,$0.00,$0.00,$82.92,$473.58,$0.00,$236.79,$375.08,$378.86,$0.00,$71.95,$0.00,$75.39,$0.00
02.207.295,SUP,HCPCS C1713,,02.207.295  -  SCREW BONE 4MM FULTHD CONE HEXAGON 7.3MM 5MM 95MM SELF DRILL,$473.58,$0.00,$473.58,$213.11,$337.99,$0.00,$79.22,$0.00,$0.00,$82.92,$473.58,$0.00,$236.79,$375.08,$378.86,$0.00,$71.95,$0.00,$75.39,$0.00
02.207.450,SUP,HCPCS C1713,,02.207.450  -  SCREW BONE CONICAL PTHRD 7.3MM 5MM 50MM SELF TAP SELF DRILL,$473.58,$0.00,$473.58,$213.11,$337.99,$0.00,$79.22,$0.00,$0.00,$82.92,$473.58,$0.00,$236.79,$375.08,$378.86,$0.00,$71.95,$0.00,$75.39,$0.00
02.207.455,SUP,HCPCS C1713,,02.207.455  -  SCREW BONE 95D PTHRD CONE 7.3MM 5MM 55MM SELF DRILL SELF TAP,$473.58,$0.00,$473.58,$213.11,$337.99,$0.00,$79.22,$0.00,$0.00,$82.92,$473.58,$0.00,$236.79,$375.08,$378.86,$0.00,$71.95,$0.00,$75.39,$0.00
02.207.460,SUP,HCPCS C1713,,02.207.460  -  SCREW BONE 95D PTHRD CONE 7.3MM 5MM 60MM SELF DRILL SELF TAP,$473.58,$0.00,$473.58,$213.11,$337.99,$0.00,$79.22,$0.00,$0.00,$82.92,$473.58,$0.00,$236.79,$375.08,$378.86,$0.00,$71.95,$0.00,$75.39,$0.00
02.207.465,SUP,HCPCS C1713,,02.207.465  -  SCREW BONE 95D PTHRD CONE 7.3MM 5MM 65MM SELF DRILL SELF TAP,$473.58,$0.00,$473.58,$213.11,$337.99,$0.00,$79.22,$0.00,$0.00,$82.92,$473.58,$0.00,$236.79,$375.08,$378.86,$0.00,$71.95,$0.00,$75.39,$0.00
02.207.470,SUP,HCPCS C1713,,02.207.470  -  SCREW BONE 95D PTHRD CONE 7.3MM 5MM 70MM SELF DRILL SELF TAP,$473.58,$0.00,$473.58,$213.11,$337.99,$0.00,$79.22,$0.00,$0.00,$82.92,$473.58,$0.00,$236.79,$375.08,$378.86,$0.00,$71.95,$0.00,$75.39,$0.00
02.207.475,SUP,HCPCS C1713,,02.207.475  -  SCREW BONE 95D PTHRD CONE 7.3MM 5MM 75MM SELF DRILL SELF TAP,$473.58,$0.00,$473.58,$213.11,$337.99,$0.00,$79.22,$0.00,$0.00,$82.92,$473.58,$0.00,$236.79,$375.08,$378.86,$0.00,$71.95,$0.00,$75.39,$0.00
02.207.480,SUP,HCPCS C1713,,02.207.480  -  SCREW BONE 95D PTHRD CONE 7.3MM 5MM 80MM SELF DRILL SELF TAP,$473.58,$0.00,$473.58,$213.11,$337.99,$0.00,$79.22,$0.00,$0.00,$82.92,$473.58,$0.00,$236.79,$375.08,$378.86,$0.00,$71.95,$0.00,$75.39,$0.00
02.207.485,SUP,HCPCS C1713,,02.207.485  -  SCREW BONE 95D PTHRD CONE 7.3MM 5MM 85MM SELF DRILL SELF TAP,$473.58,$0.00,$473.58,$213.11,$337.99,$0.00,$79.22,$0.00,$0.00,$82.92,$473.58,$0.00,$236.79,$375.08,$378.86,$0.00,$71.95,$0.00,$75.39,$0.00
02.207.490,SUP,HCPCS C1713,,02.207.490  -  SCREW BONE 95D PTHRD CONE 7.3MM 5MM 90MM SELF DRILL SELF TAP,$473.58,$0.00,$473.58,$213.11,$337.99,$0.00,$79.22,$0.00,$0.00,$82.92,$473.58,$0.00,$236.79,$375.08,$378.86,$0.00,$71.95,$0.00,$75.39,$0.00
02.207.495,SUP,HCPCS C1713,,02.207.495  -  SCREW BONE 95D PTHRD CONE 7.3MM 5MM 95MM SELF DRILL SELF TAP,$473.58,$0.00,$473.58,$213.11,$337.99,$0.00,$79.22,$0.00,$0.00,$82.92,$473.58,$0.00,$236.79,$375.08,$378.86,$0.00,$71.95,$0.00,$75.39,$0.00
02.207.500,SUP,HCPCS C1713,,02.207.500  -  SCREW BONE PTHRD 7.3MM 100MM CANN SMOOTH CONICAL HEAD,$503.60,$0.00,$503.60,$226.62,$359.42,$0.00,$84.24,$0.00,$0.00,$88.18,$503.60,$0.00,$251.80,$398.85,$402.88,$0.00,$76.52,$0.00,$80.17,$0.00
02.207.505,SUP,HCPCS C1713,,02.207.505  -  SCREW BONE PTHRD 7.3MM 105MM CANN SMOOTH CONICAL HEAD,$503.60,$0.00,$503.60,$226.62,$359.42,$0.00,$84.24,$0.00,$0.00,$88.18,$503.60,$0.00,$251.80,$398.85,$402.88,$0.00,$76.52,$0.00,$80.17,$0.00
02.207.510,SUP,HCPCS C1713,,02.207.510  -  SCREW BONE PTHRD 7.3MM 110MM CANN SMOOTH CONICAL HEAD,$503.60,$0.00,$503.60,$226.62,$359.42,$0.00,$84.24,$0.00,$0.00,$88.18,$503.60,$0.00,$251.80,$398.85,$402.88,$0.00,$76.52,$0.00,$80.17,$0.00
02.207.515,SUP,HCPCS C1713,,02.207.515  -  SCREW BONE PTHRD 7.3MM 115MM CANN SMOOTH CONICAL HEAD,$503.60,$0.00,$503.60,$226.62,$359.42,$0.00,$84.24,$0.00,$0.00,$88.18,$503.60,$0.00,$251.80,$398.85,$402.88,$0.00,$76.52,$0.00,$80.17,$0.00
02.207.520,SUP,HCPCS C1713,,02.207.520  -  SCREW BONE PTHRD 7.3MM 120MM CANN SMOOTH CONICAL HEAD,$503.60,$0.00,$503.60,$226.62,$359.42,$0.00,$84.24,$0.00,$0.00,$88.18,$503.60,$0.00,$251.80,$398.85,$402.88,$0.00,$76.52,$0.00,$80.17,$0.00
02.207.525,SUP,HCPCS C1713,,02.207.525  -  SCREW BONE PTHRD 7.3MM 125MM CANN SMOOTH CONICAL HEAD,$503.60,$0.00,$503.60,$226.62,$359.42,$0.00,$84.24,$0.00,$0.00,$88.18,$503.60,$0.00,$251.80,$398.85,$402.88,$0.00,$76.52,$0.00,$80.17,$0.00
02.207.530,SUP,HCPCS C1713,,02.207.530  -  SCREW BONE PTHRD 7.3MM 130MM CANN SMOOTH CONICAL HEAD,$503.60,$0.00,$503.60,$226.62,$359.42,$0.00,$84.24,$0.00,$0.00,$88.18,$503.60,$0.00,$251.80,$398.85,$402.88,$0.00,$76.52,$0.00,$80.17,$0.00
02.207.535,SUP,HCPCS C1713,,02.207.535  -  SCREW BONE PTHRD 7.3MM 135MM CANN SMOOTH CONICAL HEAD,$503.60,$0.00,$503.60,$226.62,$359.42,$0.00,$84.24,$0.00,$0.00,$88.18,$503.60,$0.00,$251.80,$398.85,$402.88,$0.00,$76.52,$0.00,$80.17,$0.00
02.207.540,SUP,HCPCS C1713,,02.207.540  -  SCREW BONE PTHRD 7.3MM 140MM CANN SMOOTH CONICAL HEAD,$503.60,$0.00,$503.60,$226.62,$359.42,$0.00,$84.24,$0.00,$0.00,$88.18,$503.60,$0.00,$251.80,$398.85,$402.88,$0.00,$76.52,$0.00,$80.17,$0.00
02.207.545,SUP,HCPCS C1713,,02.207.545  -  SCREW BONE PTHRD 7.3MM 145MM CANN SMOOTH CONICAL HEAD,$503.60,$0.00,$503.60,$226.62,$359.42,$0.00,$84.24,$0.00,$0.00,$88.18,$503.60,$0.00,$251.80,$398.85,$402.88,$0.00,$76.52,$0.00,$80.17,$0.00
02.207.600,SUP,HCPCS C1713,,02.207.600  -  SCREW BONE 7.3MM 45MM 10MM CANN THREADED SCFE STAINLESS,$544.53,$0.00,$544.53,$245.04,$388.63,$0.00,$91.09,$0.00,$0.00,$95.34,$544.53,$0.00,$272.26,$431.27,$435.62,$0.00,$82.74,$0.00,$86.69,$0.00
02.207.601,SUP,HCPCS C1713,,02.207.601  -  SCREW BONE 7.3MM 50MM 10MM CANN THREADED SCFE STAINLESS,$544.53,$0.00,$544.53,$245.04,$388.63,$0.00,$91.09,$0.00,$0.00,$95.34,$544.53,$0.00,$272.26,$431.27,$435.62,$0.00,$82.74,$0.00,$86.69,$0.00
02.207.602,SUP,HCPCS C1713,,02.207.602  -  SCREW BONE 7.3MM 55MM 10MM CANN THREADED SCFE STAINLESS,$544.53,$0.00,$544.53,$245.04,$388.63,$0.00,$91.09,$0.00,$0.00,$95.34,$544.53,$0.00,$272.26,$431.27,$435.62,$0.00,$82.74,$0.00,$86.69,$0.00
02.207.603,SUP,HCPCS C1713,,02.207.603  -  SCREW BONE 7.3MM 60MM 10MM CANN THREADED SCFE STAINLESS,$544.53,$0.00,$544.53,$245.04,$388.63,$0.00,$91.09,$0.00,$0.00,$95.34,$544.53,$0.00,$272.26,$431.27,$435.62,$0.00,$82.74,$0.00,$86.69,$0.00
02.207.604,SUP,HCPCS C1713,,02.207.604  -  SCREW BONE 7.3MM 65MM 10MM CANN THREADED SCFE STAINLESS,$544.53,$0.00,$544.53,$245.04,$388.63,$0.00,$91.09,$0.00,$0.00,$95.34,$544.53,$0.00,$272.26,$431.27,$435.62,$0.00,$82.74,$0.00,$86.69,$0.00
02.207.605,SUP,HCPCS C1713,,02.207.605  -  SCREW BONE 7.3MM 70MM 10MM CANN THREADED SCFE STAINLESS,$544.53,$0.00,$544.53,$245.04,$388.63,$0.00,$91.09,$0.00,$0.00,$95.34,$544.53,$0.00,$272.26,$431.27,$435.62,$0.00,$82.74,$0.00,$86.69,$0.00
02.207.606,SUP,HCPCS C1713,,02.207.606  -  SCREW BONE 7.3MM 75MM 10MM CANN THREADED SCFE STAINLESS,$544.53,$0.00,$544.53,$245.04,$388.63,$0.00,$91.09,$0.00,$0.00,$95.34,$544.53,$0.00,$272.26,$431.27,$435.62,$0.00,$82.74,$0.00,$86.69,$0.00
02.207.607,SUP,HCPCS C1713,,02.207.607  -  SCREW BONE 7.3MM 80MM 10MM CANN THREADED SCFE STAINLESS,$544.53,$0.00,$544.53,$245.04,$388.63,$0.00,$91.09,$0.00,$0.00,$95.34,$544.53,$0.00,$272.26,$431.27,$435.62,$0.00,$82.74,$0.00,$86.69,$0.00
02.207.608,SUP,HCPCS C1713,,02.207.608  -  SCREW BONE 7.3MM 85MM 10MM CANN THREADED SCFE STAINLESS,$544.53,$0.00,$544.53,$245.04,$388.63,$0.00,$91.09,$0.00,$0.00,$95.34,$544.53,$0.00,$272.26,$431.27,$435.62,$0.00,$82.74,$0.00,$86.69,$0.00
02.207.609,SUP,HCPCS C1713,,02.207.609  -  SCREW BONE 7.3MM 90MM 10MM CANN THREADED SCFE STAINLESS,$544.53,$0.00,$544.53,$245.04,$388.63,$0.00,$91.09,$0.00,$0.00,$95.34,$544.53,$0.00,$272.26,$431.27,$435.62,$0.00,$82.74,$0.00,$86.69,$0.00
02.207.610,SUP,HCPCS C1713,,02.207.610  -  SCREW BONE 7.3MM 95MM 10MM CANN THREADED SCFE STAINLESS,$544.53,$0.00,$544.53,$245.04,$388.63,$0.00,$91.09,$0.00,$0.00,$95.34,$544.53,$0.00,$272.26,$431.27,$435.62,$0.00,$82.74,$0.00,$86.69,$0.00
02.207.611,SUP,HCPCS C1713,,02.207.611  -  SCREW BONE 7.3MM 100MM 10MM CANN THREADED SCFE STAINLESS,$544.53,$0.00,$544.53,$245.04,$388.63,$0.00,$91.09,$0.00,$0.00,$95.34,$544.53,$0.00,$272.26,$431.27,$435.62,$0.00,$82.74,$0.00,$86.69,$0.00
02.207.612,SUP,HCPCS C1713,,02.207.612  -  SCREW BONE 7.3MM 105MM 10MM CANN THREADED SCFE STAINLESS,$544.53,$0.00,$544.53,$245.04,$388.63,$0.00,$91.09,$0.00,$0.00,$95.34,$544.53,$0.00,$272.26,$431.27,$435.62,$0.00,$82.74,$0.00,$86.69,$0.00
02.207.613,SUP,HCPCS C1713,,02.207.613  -  SCREW BONE 7.3MM 110MM 10MM CANN THREADED SCFE STAINLESS,$544.53,$0.00,$544.53,$245.04,$388.63,$0.00,$91.09,$0.00,$0.00,$95.34,$544.53,$0.00,$272.26,$431.27,$435.62,$0.00,$82.74,$0.00,$86.69,$0.00
02.207.614,SUP,HCPCS C1713,,02.207.614  -  SCREW BONE 7.3MM 115MM 10MM CANN THREADED SCFE STAINLESS,$544.53,$0.00,$544.53,$245.04,$388.63,$0.00,$91.09,$0.00,$0.00,$95.34,$544.53,$0.00,$272.26,$431.27,$435.62,$0.00,$82.74,$0.00,$86.69,$0.00
02.207.615,SUP,HCPCS C1713,,02.207.615  -  SCREW BONE 7.3MM 120MM 10MM CANN THREADED SCFE STAINLESS,$544.53,$0.00,$544.53,$245.04,$388.63,$0.00,$91.09,$0.00,$0.00,$95.34,$544.53,$0.00,$272.26,$431.27,$435.62,$0.00,$82.74,$0.00,$86.69,$0.00
02.207.616,SUP,HCPCS C1713,,02.207.616  -  SCREW BONE 7.3MM 125MM 10MM CANN THREADED SCFE STAINLESS,$544.53,$0.00,$544.53,$245.04,$388.63,$0.00,$91.09,$0.00,$0.00,$95.34,$544.53,$0.00,$272.26,$431.27,$435.62,$0.00,$82.74,$0.00,$86.69,$0.00
02.207.617,SUP,HCPCS C1713,,02.207.617  -  SCREW BONE 7.3MM 103MM 10MM CANN THREADED SCFE STAINLESS,$544.53,$0.00,$544.53,$245.04,$388.63,$0.00,$91.09,$0.00,$0.00,$95.34,$544.53,$0.00,$272.26,$431.27,$435.62,$0.00,$82.74,$0.00,$86.69,$0.00
02.207.618,SUP,HCPCS C1713,,02.207.618  -  SCREW BONE 7.3MM 45MM 20MM CANN THREADED SCFE STAINLESS,$544.53,$0.00,$544.53,$245.04,$388.63,$0.00,$91.09,$0.00,$0.00,$95.34,$544.53,$0.00,$272.26,$431.27,$435.62,$0.00,$82.74,$0.00,$86.69,$0.00
02.207.619,SUP,HCPCS C1713,,02.207.619  -  SCREW BONE 7.3MM 50MM 20MM CANN THREADED SCFE STAINLESS,$544.53,$0.00,$544.53,$245.04,$388.63,$0.00,$91.09,$0.00,$0.00,$95.34,$544.53,$0.00,$272.26,$431.27,$435.62,$0.00,$82.74,$0.00,$86.69,$0.00
02.207.620,SUP,HCPCS C1713,,02.207.620  -  SCREW BONE 7.3MM 55MM 20MM CANN THREADED SCFE STAINLESS,$544.53,$0.00,$544.53,$245.04,$388.63,$0.00,$91.09,$0.00,$0.00,$95.34,$544.53,$0.00,$272.26,$431.27,$435.62,$0.00,$82.74,$0.00,$86.69,$0.00
02.207.621,SUP,HCPCS C1713,,02.207.621  -  SCREW BONE 7.3MM 60MM 20MM CANN THREADED SCFE STAINLESS,$544.53,$0.00,$544.53,$245.04,$388.63,$0.00,$91.09,$0.00,$0.00,$95.34,$544.53,$0.00,$272.26,$431.27,$435.62,$0.00,$82.74,$0.00,$86.69,$0.00
02.207.622,SUP,HCPCS C1713,,02.207.622  -  SCREW BONE 7.3MM 65MM 20MM CANN THREADED SCFE STAINLESS,$544.53,$0.00,$544.53,$245.04,$388.63,$0.00,$91.09,$0.00,$0.00,$95.34,$544.53,$0.00,$272.26,$431.27,$435.62,$0.00,$82.74,$0.00,$86.69,$0.00
02.207.623,SUP,HCPCS C1713,,02.207.623  -  SCREW BONE 7.3MM 70MM 20MM CANN THREADED SCFE STAINLESS,$544.53,$0.00,$544.53,$245.04,$388.63,$0.00,$91.09,$0.00,$0.00,$95.34,$544.53,$0.00,$272.26,$431.27,$435.62,$0.00,$82.74,$0.00,$86.69,$0.00
02.207.624,SUP,HCPCS C1713,,02.207.624  -  SCREW BONE 7.3MM 75MM 20MM CANN THREADED SCFE STAINLESS,$544.53,$0.00,$544.53,$245.04,$388.63,$0.00,$91.09,$0.00,$0.00,$95.34,$544.53,$0.00,$272.26,$431.27,$435.62,$0.00,$82.74,$0.00,$86.69,$0.00
02.207.625,SUP,HCPCS C1713,,02.207.625  -  SCREW BONE 7.3MM 80MM 20MM CANN THREADED SCFE STAINLESS,$544.53,$0.00,$544.53,$245.04,$388.63,$0.00,$91.09,$0.00,$0.00,$95.34,$544.53,$0.00,$272.26,$431.27,$435.62,$0.00,$82.74,$0.00,$86.69,$0.00
02.207.626,SUP,HCPCS C1713,,02.207.626  -  SCREW BONE 7.3MM 85MM 20MM CANN THREADED SCFE STAINLESS,$544.53,$0.00,$544.53,$245.04,$388.63,$0.00,$91.09,$0.00,$0.00,$95.34,$544.53,$0.00,$272.26,$431.27,$435.62,$0.00,$82.74,$0.00,$86.69,$0.00
02.207.627,SUP,HCPCS C1713,,02.207.627  -  SCREW BONE 7.3MM 90MM 20MM CANN THREADED SCFE STAINLESS,$544.53,$0.00,$544.53,$245.04,$388.63,$0.00,$91.09,$0.00,$0.00,$95.34,$544.53,$0.00,$272.26,$431.27,$435.62,$0.00,$82.74,$0.00,$86.69,$0.00
02.207.628,SUP,HCPCS C1713,,02.207.628  -  SCREW BONE 7.3MM 95MM 20MM CANN THREADED SCFE STAINLESS,$544.53,$0.00,$544.53,$245.04,$388.63,$0.00,$91.09,$0.00,$0.00,$95.34,$544.53,$0.00,$272.26,$431.27,$435.62,$0.00,$82.74,$0.00,$86.69,$0.00
02.207.629,SUP,HCPCS C1713,,02.207.629  -  SCREW BONE 7.3MM 100MM 20MM CANN THREADED SCFE STAINLESS,$544.53,$0.00,$544.53,$245.04,$388.63,$0.00,$91.09,$0.00,$0.00,$95.34,$544.53,$0.00,$272.26,$431.27,$435.62,$0.00,$82.74,$0.00,$86.69,$0.00
02.207.630,SUP,HCPCS C1713,,02.207.630  -  SCREW BONE 7.3MM 105MM 20MM CANN THREADED SCFE STAINLESS,$544.53,$0.00,$544.53,$245.04,$388.63,$0.00,$91.09,$0.00,$0.00,$95.34,$544.53,$0.00,$272.26,$431.27,$435.62,$0.00,$82.74,$0.00,$86.69,$0.00
02.207.631,SUP,HCPCS C1713,,02.207.631  -  SCREW BONE 7.3MM 110MM 20MM CANN THREADED SCFE STAINLESS,$544.53,$0.00,$544.53,$245.04,$388.63,$0.00,$91.09,$0.00,$0.00,$95.34,$544.53,$0.00,$272.26,$431.27,$435.62,$0.00,$82.74,$0.00,$86.69,$0.00
02.207.632,SUP,HCPCS C1713,,02.207.632  -  SCREW BONE 7.3MM 115MM 20MM CANN THREADED SCFE STAINLESS,$544.53,$0.00,$544.53,$245.04,$388.63,$0.00,$91.09,$0.00,$0.00,$95.34,$544.53,$0.00,$272.26,$431.27,$435.62,$0.00,$82.74,$0.00,$86.69,$0.00
02.207.633,SUP,HCPCS C1713,,02.207.633  -  SCREW BONE 7.3MM 120MM 20MM CANN THREADED SCFE STAINLESS,$544.53,$0.00,$544.53,$245.04,$388.63,$0.00,$91.09,$0.00,$0.00,$95.34,$544.53,$0.00,$272.26,$431.27,$435.62,$0.00,$82.74,$0.00,$86.69,$0.00
02.207.634,SUP,HCPCS C1713,,02.207.634  -  SCREW BONE 7.3MM 125MM 20MM CANN THREADED SCFE STAINLESS,$544.53,$0.00,$544.53,$245.04,$388.63,$0.00,$91.09,$0.00,$0.00,$95.34,$544.53,$0.00,$272.26,$431.27,$435.62,$0.00,$82.74,$0.00,$86.69,$0.00
02.207.635,SUP,HCPCS C1713,,02.207.635  -  SCREW BONE 7.3MM 130MM 20MM CANN THREADED SCFE STAINLESS,$544.53,$0.00,$544.53,$245.04,$388.63,$0.00,$91.09,$0.00,$0.00,$95.34,$544.53,$0.00,$272.26,$431.27,$435.62,$0.00,$82.74,$0.00,$86.69,$0.00
02.207.636,SUP,Custom 27803010,,02.207.636  -  WASHER ORTHOPEDIC OVAL 1MM STAINLESS STEEL FEMUR NONSTRL,$156.95,$0.00,$156.95,$0.00,$112.02,$0.00,$0.00,$0.00,$0.00,$0.00,$156.95,$0.00,$78.48,$124.30,$125.56,$0.00,$0.00,$0.00,$0.00,$0.00
02.207.637,SUP,Custom 27803010,,02.207.637  -  WASHER ORTHOPEDIC OVAL 2MM STAINLESS STEEL FEMUR NONSTRL,$156.95,$0.00,$156.95,$0.00,$112.02,$0.00,$0.00,$0.00,$0.00,$0.00,$156.95,$0.00,$78.48,$124.30,$125.56,$0.00,$0.00,$0.00,$0.00,$0.00
02.210.078,SUP,HCPCS C1713,,02.210.078  -  PIN FIX 1.8MM 8MM T8 STARDRIVE RECESS VAR ANG LOCKING,$247.03,$0.00,$247.03,$111.16,$176.30,$0.00,$41.32,$0.00,$0.00,$43.25,$247.03,$0.00,$123.51,$195.65,$197.62,$0.00,$37.53,$0.00,$39.33,$0.00
02.210.080,SUP,HCPCS C1713,,02.210.080  -  PIN FIX 1.8MM 10MM BUTTRESS VAR ANG LOCKING T8 STARDRIVE,$247.03,$0.00,$247.03,$111.16,$176.30,$0.00,$41.32,$0.00,$0.00,$43.25,$247.03,$0.00,$123.51,$195.65,$197.62,$0.00,$37.53,$0.00,$39.33,$0.00
02.210.082,SUP,HCPCS C1713,,02.210.082  -  PIN FIX 1.8MM 12MM T8 STARDRIVE RECESS BUTTRESS VAR ANG,$247.03,$0.00,$247.03,$111.16,$176.30,$0.00,$41.32,$0.00,$0.00,$43.25,$247.03,$0.00,$123.51,$195.65,$197.62,$0.00,$37.53,$0.00,$39.33,$0.00
02.210.084,SUP,HCPCS C1713,,02.210.084  -  PIN FIX 1.8MM 14MM T8 STARDRIVE RECESS BUTTRESS VAR ANG,$247.03,$0.00,$247.03,$111.16,$176.30,$0.00,$41.32,$0.00,$0.00,$43.25,$247.03,$0.00,$123.51,$195.65,$197.62,$0.00,$37.53,$0.00,$39.33,$0.00
02.210.086,SUP,Custom 27203010,,02.210.086  -  PIN FIX 1.8MM 16MM T8 STARDRIVE RECESS BUTTRESS VAR ANG,$247.03,$0.00,$247.03,$0.00,$176.30,$0.00,$0.00,$0.00,$0.00,$0.00,$247.03,$0.00,$123.51,$195.65,$197.62,$0.00,$0.00,$0.00,$0.00,$0.00
02.210.088,SUP,Custom 27203010,,02.210.088  -  PIN FIX 1.8MM 18MM T8 STARDRIVE RECESS BUTTRESS VAR ANG,$247.03,$0.00,$247.03,$0.00,$176.30,$0.00,$0.00,$0.00,$0.00,$0.00,$247.03,$0.00,$123.51,$195.65,$197.62,$0.00,$0.00,$0.00,$0.00,$0.00
02.210.090,SUP,HCPCS C1713,,02.210.090  -  PIN FIX 1.8MM 20MM T8 STARDRIVE RECESS BUTTRESS VAR ANG,$247.03,$0.00,$247.03,$111.16,$176.30,$0.00,$41.32,$0.00,$0.00,$43.25,$247.03,$0.00,$123.51,$195.65,$197.62,$0.00,$37.53,$0.00,$39.33,$0.00
02.210.092,SUP,Custom 27203010,,02.210.092  -  PIN FIX 1.8MM 22MM T8 STARDRIVE RECESS BUTTRESS VAR ANG,$247.03,$0.00,$247.03,$0.00,$176.30,$0.00,$0.00,$0.00,$0.00,$0.00,$247.03,$0.00,$123.51,$195.65,$197.62,$0.00,$0.00,$0.00,$0.00,$0.00
02.210.094,SUP,HCPCS C1713,,02.210.094  -  PIN FIX 1.8MM 24MM T8 STARDRIVE RECESS BUTTRESS VAR ANG,$247.03,$0.00,$247.03,$111.16,$176.30,$0.00,$41.32,$0.00,$0.00,$43.25,$247.03,$0.00,$123.51,$195.65,$197.62,$0.00,$37.53,$0.00,$39.33,$0.00
02.210.096,SUP,HCPCS C1713,,02.210.096  -  PIN FIX 1.8MM 26MM T8 STARDRIVE RECESS BUTTRESS VAR ANG,$247.03,$0.00,$247.03,$111.16,$176.30,$0.00,$41.32,$0.00,$0.00,$43.25,$247.03,$0.00,$123.51,$195.65,$197.62,$0.00,$37.53,$0.00,$39.33,$0.00
02.210.098,SUP,HCPCS C1713,,02.210.098  -  PIN FIX 1.8MM 28MM T8 STARDRIVE RECESS BUTTRESS VAR ANG,$247.03,$0.00,$247.03,$111.16,$176.30,$0.00,$41.32,$0.00,$0.00,$43.25,$247.03,$0.00,$123.51,$195.65,$197.62,$0.00,$37.53,$0.00,$39.33,$0.00
02.210.100,SUP,HCPCS C1713,,02.210.100  -  PIN FIX 1.8MM 30MM T8 STARDRIVE RECESS VAR ANG LOCKING,$247.03,$0.00,$247.03,$111.16,$176.30,$0.00,$41.32,$0.00,$0.00,$43.25,$247.03,$0.00,$123.51,$195.65,$197.62,$0.00,$37.53,$0.00,$39.33,$0.00
02.210.107,SUP,HCPCS C1713,,02.210.107  -  SCREW BONE 2.4MM 7MM STARDRIVE VAR ANG SLFTAP LOCKING LCP,$247.03,$0.00,$247.03,$111.16,$176.30,$0.00,$41.32,$0.00,$0.00,$43.25,$247.03,$0.00,$123.51,$195.65,$197.62,$0.00,$37.53,$0.00,$39.33,$0.00
02.210.108,SUP,HCPCS C1713,,02.210.108  -  SCREW BONE T8 2.4MM 8MM VAR ANG SELF TAP THREAD STARDRIVE,$247.03,$0.00,$247.03,$111.16,$176.30,$0.00,$41.32,$0.00,$0.00,$43.25,$247.03,$0.00,$123.51,$195.65,$197.62,$0.00,$37.53,$0.00,$39.33,$0.00
02.210.109,SUP,HCPCS C1713,,02.210.109  -  SCREW BONE 2.4MM 9MM STARDRIVE VAR ANG SLFTAP LOCKING LCP,$247.03,$0.00,$247.03,$111.16,$176.30,$0.00,$41.32,$0.00,$0.00,$43.25,$247.03,$0.00,$123.51,$195.65,$197.62,$0.00,$37.53,$0.00,$39.33,$0.00
02.210.110,SUP,HCPCS C1713,,02.210.110  -  SCREW BONE T8 2.4MM 10MM VAR ANG SELF TAP THREAD STARDRIVE,$247.03,$0.00,$247.03,$111.16,$176.30,$0.00,$41.32,$0.00,$0.00,$43.25,$247.03,$0.00,$123.51,$195.65,$197.62,$0.00,$37.53,$0.00,$39.33,$0.00
02.210.111,SUP,HCPCS C1713,,02.210.111  -  SCREW BONE 2.4MM 11MM STARDRIVE VAR ANG SLFTAP LOCKING LCP,$247.03,$0.00,$247.03,$111.16,$176.30,$0.00,$41.32,$0.00,$0.00,$43.25,$247.03,$0.00,$123.51,$195.65,$197.62,$0.00,$37.53,$0.00,$39.33,$0.00
02.210.112,SUP,HCPCS C1713,,02.210.112  -  SCREW BONE T8 2.4MM 12MM VAR ANG SELF TAP THREAD STARDRIVE,$247.03,$0.00,$247.03,$111.16,$176.30,$0.00,$41.32,$0.00,$0.00,$43.25,$247.03,$0.00,$123.51,$195.65,$197.62,$0.00,$37.53,$0.00,$39.33,$0.00
02.210.113,SUP,HCPCS C1713,,02.210.113  -  SCREW BONE 2.4MM 13MM STARDRIVE VAR ANG SLFTAP LOCKING LCP,$247.03,$0.00,$247.03,$111.16,$176.30,$0.00,$41.32,$0.00,$0.00,$43.25,$247.03,$0.00,$123.51,$195.65,$197.62,$0.00,$37.53,$0.00,$39.33,$0.00
02.210.114,SUP,HCPCS C1713,,02.210.114  -  SCREW BONE T8 2.4MM 14MM VAR ANG SELF TAP THREAD STARDRIVE,$247.03,$0.00,$247.03,$111.16,$176.30,$0.00,$41.32,$0.00,$0.00,$43.25,$247.03,$0.00,$123.51,$195.65,$197.62,$0.00,$37.53,$0.00,$39.33,$0.00
02.210.116,SUP,HCPCS C1713,,02.210.116  -  SCREW BONE T8 2.4MM 16MM VAR ANG SELF TAP THREAD STARDRIVE,$247.03,$0.00,$247.03,$111.16,$176.30,$0.00,$41.32,$0.00,$0.00,$43.25,$247.03,$0.00,$123.51,$195.65,$197.62,$0.00,$37.53,$0.00,$39.33,$0.00
02.210.118,SUP,HCPCS C1713,,02.210.118  -  SCREW BONE T8 2.4MM 18MM VAR ANG SELF TAP THREAD STARDRIVE,$247.03,$0.00,$247.03,$111.16,$176.30,$0.00,$41.32,$0.00,$0.00,$43.25,$247.03,$0.00,$123.51,$195.65,$197.62,$0.00,$37.53,$0.00,$39.33,$0.00
02.210.120,SUP,HCPCS C1713,,02.210.120  -  SCREW BONE 2.4MM 20MM T8 STARDRIVE RECESS LOCKING VAR ANG,$247.03,$0.00,$247.03,$111.16,$176.30,$0.00,$41.32,$0.00,$0.00,$43.25,$247.03,$0.00,$123.51,$195.65,$197.62,$0.00,$37.53,$0.00,$39.33,$0.00
02.210.122,SUP,HCPCS C1713,,02.210.122  -  SCREW BONE 2.4MM 22MM VAR ANG SELF TAP THREAD T8 STARDRIVE,$247.03,$0.00,$247.03,$111.16,$176.30,$0.00,$41.32,$0.00,$0.00,$43.25,$247.03,$0.00,$123.51,$195.65,$197.62,$0.00,$37.53,$0.00,$39.33,$0.00
02.210.124,SUP,HCPCS C1713,,02.210.124  -  SCREW BONE T8 2.4MM 24MM VAR ANG SELF TAP THREAD STARDRIVE,$247.03,$0.00,$247.03,$111.16,$176.30,$0.00,$41.32,$0.00,$0.00,$43.25,$247.03,$0.00,$123.51,$195.65,$197.62,$0.00,$37.53,$0.00,$39.33,$0.00
02.210.126,SUP,HCPCS C1713,,02.210.126  -  SCREW BONE T8 2.4MM 26MM VAR ANG SELF TAP THREAD STARDRIVE,$247.03,$0.00,$247.03,$111.16,$176.30,$0.00,$41.32,$0.00,$0.00,$43.25,$247.03,$0.00,$123.51,$195.65,$197.62,$0.00,$37.53,$0.00,$39.33,$0.00
02.210.128,SUP,HCPCS C1713,,02.210.128  -  SCREW BONE T8 2.4MM 28MM VAR ANG SELF TAP THREAD STARDRIVE,$247.03,$0.00,$247.03,$111.16,$176.30,$0.00,$41.32,$0.00,$0.00,$43.25,$247.03,$0.00,$123.51,$195.65,$197.62,$0.00,$37.53,$0.00,$39.33,$0.00
02.210.130,SUP,HCPCS C1713,,02.210.130  -  SCREW BONE T8 2.4MM 30MM VAR ANG SELF TAP THREAD STARDRIVE,$247.03,$0.00,$247.03,$111.16,$176.30,$0.00,$41.32,$0.00,$0.00,$43.25,$247.03,$0.00,$123.51,$195.65,$197.62,$0.00,$37.53,$0.00,$39.33,$0.00
02.210.132,SUP,HCPCS C1713,,02.210.132  -  SCREW BONE 2.4MM 32MM T8 STARDRIVE RECESS SLFTAP LOCKING VAR,$247.03,$0.00,$247.03,$111.16,$176.30,$0.00,$41.32,$0.00,$0.00,$43.25,$247.03,$0.00,$123.51,$195.65,$197.62,$0.00,$37.53,$0.00,$39.33,$0.00
02.210.134,SUP,HCPCS C1713,,02.210.134  -  SCREW BONE 2.4MM 34MM SLFTAP LOCKING VAR ANG T8 STARDRIVE,$247.03,$0.00,$247.03,$111.16,$176.30,$0.00,$41.32,$0.00,$0.00,$43.25,$247.03,$0.00,$123.51,$195.65,$197.62,$0.00,$37.53,$0.00,$39.33,$0.00
02.210.136,SUP,HCPCS C1713,,02.210.136  -  SCREW BONE 2.4MM 36MM T8 STARDRIVE RECESS SLFTAP LOCKING VAR,$247.03,$0.00,$247.03,$111.16,$176.30,$0.00,$41.32,$0.00,$0.00,$43.25,$247.03,$0.00,$123.51,$195.65,$197.62,$0.00,$37.53,$0.00,$39.33,$0.00
02.210.138,SUP,HCPCS C1713,,02.210.138  -  SCREW BONE 2.4MM 38MM T8 STARDRIVE RECESS SLFTAP LOCKING VAR,$247.03,$0.00,$247.03,$111.16,$176.30,$0.00,$41.32,$0.00,$0.00,$43.25,$247.03,$0.00,$123.51,$195.65,$197.62,$0.00,$37.53,$0.00,$39.33,$0.00
02.210.140,SUP,HCPCS C1713,,02.210.140  -  SCREW BONE 2.4MM 40MM T8 STARDRIVE RECESS SLFTAP LOCKING VAR,$247.03,$0.00,$247.03,$111.16,$176.30,$0.00,$41.32,$0.00,$0.00,$43.25,$247.03,$0.00,$123.51,$195.65,$197.62,$0.00,$37.53,$0.00,$39.33,$0.00
02.210.142,SUP,HCPCS C1713,,02.210.142  -  SCREW BONE 2.4MM 42MM T8 STARDRIVE RECESS SLFTAP LOCKING VAR,$247.03,$0.00,$247.03,$111.16,$176.30,$0.00,$41.32,$0.00,$0.00,$43.25,$247.03,$0.00,$123.51,$195.65,$197.62,$0.00,$37.53,$0.00,$39.33,$0.00
02.210.144,SUP,HCPCS C1713,,02.210.144  -  SCREW BONE 2.4MM 44MM SLFTAP LOCKING VAR ANG T8 STARDRIVE,$247.03,$0.00,$247.03,$111.16,$176.30,$0.00,$41.32,$0.00,$0.00,$43.25,$247.03,$0.00,$123.51,$195.65,$197.62,$0.00,$37.53,$0.00,$39.33,$0.00
02.210.146,SUP,HCPCS C1713,,02.210.146  -  SCREW BONE 2.4MM 46MM SLFTAP LOCKING VAR ANG T8 STARDRIVE,$247.03,$0.00,$247.03,$111.16,$176.30,$0.00,$41.32,$0.00,$0.00,$43.25,$247.03,$0.00,$123.51,$195.65,$197.62,$0.00,$37.53,$0.00,$39.33,$0.00
02.210.148,SUP,HCPCS C1713,,02.210.148  -  SCREW BONE 2.4MM 48MM T8 STARDRIVE RECESS SLFTAP LOCKING VAR,$247.03,$0.00,$247.03,$111.16,$176.30,$0.00,$41.32,$0.00,$0.00,$43.25,$247.03,$0.00,$123.51,$195.65,$197.62,$0.00,$37.53,$0.00,$39.33,$0.00
02.210.150,SUP,HCPCS C1713,,02.210.150  -  SCREW BONE 2.4MM 50MM T8 STARDRIVE RECESS SLFTAP LOCKING VAR,$247.03,$0.00,$247.03,$111.16,$176.30,$0.00,$41.32,$0.00,$0.00,$43.25,$247.03,$0.00,$123.51,$195.65,$197.62,$0.00,$37.53,$0.00,$39.33,$0.00
02.210.152,SUP,HCPCS C1713,,02.210.152  -  SCREW BONE 2.4MM 52MM SLFTAP LOCKING VAR ANG T8 STARDRIVE,$247.03,$0.00,$247.03,$111.16,$176.30,$0.00,$41.32,$0.00,$0.00,$43.25,$247.03,$0.00,$123.51,$195.65,$197.62,$0.00,$37.53,$0.00,$39.33,$0.00
02.210.154,SUP,HCPCS C1713,,02.210.154  -  SCREW BONE 2.4MM 54MM SLFTAP LOCKING VAR ANG T8 STARDRIVE,$247.03,$0.00,$247.03,$111.16,$176.30,$0.00,$41.32,$0.00,$0.00,$43.25,$247.03,$0.00,$123.51,$195.65,$197.62,$0.00,$37.53,$0.00,$39.33,$0.00
02.210.156,SUP,HCPCS C1713,,02.210.156  -  SCREW BONE 2.4MM 56MM SLFTAP LOCKING VAR ANG T8 STARDRIVE,$247.03,$0.00,$247.03,$111.16,$176.30,$0.00,$41.32,$0.00,$0.00,$43.25,$247.03,$0.00,$123.51,$195.65,$197.62,$0.00,$37.53,$0.00,$39.33,$0.00
02.210.158,SUP,HCPCS C1713,,02.210.158  -  SCREW BONE 2.4MM 58MM STARDRIVE SLFTAP LOCKING VAR ANG,$247.03,$0.00,$247.03,$111.16,$176.30,$0.00,$41.32,$0.00,$0.00,$43.25,$247.03,$0.00,$123.51,$195.65,$197.62,$0.00,$37.53,$0.00,$39.33,$0.00
02.210.160,SUP,HCPCS C1713,,02.210.160  -  SCREW BONE 2.4MM 60MM STARDRIVE SLFTAP LOCKING VAR ANG,$247.03,$0.00,$247.03,$111.16,$176.30,$0.00,$41.32,$0.00,$0.00,$43.25,$247.03,$0.00,$123.51,$195.65,$197.62,$0.00,$37.53,$0.00,$39.33,$0.00
02.210.942,SUP,HCPCS C1713,,02.210.942  -  SCREW BONE T8 2.4MM 42MM SLFTAP STARDRIVE RECESS STAINLESS,$101.65,$0.00,$101.65,$45.74,$72.55,$0.00,$17.01,$0.00,$0.00,$17.80,$101.65,$0.00,$50.83,$80.51,$81.32,$0.00,$15.45,$0.00,$16.18,$0.00
02.210.944,SUP,HCPCS C1713,,02.210.944  -  SCREW BONE 2.4MM 44MM T8 STARDRIVE RECESS SLFTAP LCP,$101.65,$0.00,$101.65,$45.74,$72.55,$0.00,$17.01,$0.00,$0.00,$17.80,$101.65,$0.00,$50.83,$80.51,$81.32,$0.00,$15.45,$0.00,$16.18,$0.00
02.210.946,SUP,HCPCS C1713,,02.210.946  -  SCREW BONE 2.4MM 46MM T8 STARDRIVE RECESS SLFTAP LCP,$101.65,$0.00,$101.65,$45.74,$72.55,$0.00,$17.01,$0.00,$0.00,$17.80,$101.65,$0.00,$50.83,$80.51,$81.32,$0.00,$15.45,$0.00,$16.18,$0.00
02.210.948,SUP,HCPCS C1713,,02.210.948  -  SCREW BONE 2.4MM 48MM T8 STARDRIVE RECESS SLFTAP LCP,$101.65,$0.00,$101.65,$45.74,$72.55,$0.00,$17.01,$0.00,$0.00,$17.80,$101.65,$0.00,$50.83,$80.51,$81.32,$0.00,$15.45,$0.00,$16.18,$0.00
02.210.950,SUP,HCPCS C1713,,02.210.950  -  SCREW BONE 2.4MM 50MM T8 STARDRIVE RECESS SLFTAP LCP,$101.65,$0.00,$101.65,$45.74,$72.55,$0.00,$17.01,$0.00,$0.00,$17.80,$101.65,$0.00,$50.83,$80.51,$81.32,$0.00,$15.45,$0.00,$16.18,$0.00
02.210.952,SUP,HCPCS C1713,,02.210.952  -  SCREW BONE T8 2.4MM 52MM SELF TAP STARDRIVE LCP STAINLESS,$101.65,$0.00,$101.65,$45.74,$72.55,$0.00,$17.01,$0.00,$0.00,$17.80,$101.65,$0.00,$50.83,$80.51,$81.32,$0.00,$15.45,$0.00,$16.18,$0.00
02.210.954,SUP,HCPCS C1713,,02.210.954  -  SCREW BONE 2.4MM 54MM T8 STARDRIVE RECESS SLFTAP LCP,$101.65,$0.00,$101.65,$45.74,$72.55,$0.00,$17.01,$0.00,$0.00,$17.80,$101.65,$0.00,$50.83,$80.51,$81.32,$0.00,$15.45,$0.00,$16.18,$0.00
02.210.956,SUP,HCPCS C1713,,02.210.956  -  SCREW BONE T8 2.4MM 56MM SELF TAP STARDRIVE LCP STAINLESS,$101.65,$0.00,$101.65,$45.74,$72.55,$0.00,$17.01,$0.00,$0.00,$17.80,$101.65,$0.00,$50.83,$80.51,$81.32,$0.00,$15.45,$0.00,$16.18,$0.00
02.210.958,SUP,HCPCS C1713,,02.210.958  -  SCREW BONE 2.4MM 58MM T8 STARDRIVE SLFTAP STAINLESS STEEL,$101.65,$0.00,$101.65,$45.74,$72.55,$0.00,$17.01,$0.00,$0.00,$17.80,$101.65,$0.00,$50.83,$80.51,$81.32,$0.00,$15.45,$0.00,$16.18,$0.00
02.210.960,SUP,HCPCS C1713,,02.210.960  -  SCREW BONE 2.4MM 60MM T8 STARDRIVE SLFTAP STAINLESS STEEL,$101.65,$0.00,$101.65,$45.74,$72.55,$0.00,$17.01,$0.00,$0.00,$17.80,$101.65,$0.00,$50.83,$80.51,$81.32,$0.00,$15.45,$0.00,$16.18,$0.00
02.211.008,SUP,HCPCS C1713,,02.211.008  -  SCREW BONE 2.7MM 8MM T8 STARDRIVE RECESS VAR ANG SLFTAP,$259.30,$0.00,$259.30,$116.69,$185.06,$0.00,$43.38,$0.00,$0.00,$45.40,$259.30,$0.00,$129.65,$205.37,$207.44,$0.00,$39.40,$0.00,$41.28,$0.00
02.211.009,SUP,HCPCS C1713,,02.211.009  -  SCREW BONE 2.7MM 9MM T8 STARDRIVE RECESS VAR ANG SLFTAP,$259.30,$0.00,$259.30,$116.69,$185.06,$0.00,$43.38,$0.00,$0.00,$45.40,$259.30,$0.00,$129.65,$205.37,$207.44,$0.00,$39.40,$0.00,$41.28,$0.00
02.211.010,SUP,HCPCS C1713,,02.211.010  -  SCREW BONE T8 2.7MM 10MM VAR ANG SELF TAP STARDRIVE LCP,$259.30,$0.00,$259.30,$116.69,$185.06,$0.00,$43.38,$0.00,$0.00,$45.40,$259.30,$0.00,$129.65,$205.37,$207.44,$0.00,$39.40,$0.00,$41.28,$0.00
02.211.011,SUP,HCPCS C1713,,02.211.011  -  SCREW BONE 2.7MM 11MM T8 STARDRIVE RECESS VAR ANG SLFTAP,$259.30,$0.00,$259.30,$116.69,$185.06,$0.00,$43.38,$0.00,$0.00,$45.40,$259.30,$0.00,$129.65,$205.37,$207.44,$0.00,$39.40,$0.00,$41.28,$0.00
02.211.012,SUP,HCPCS C1713,,02.211.012  -  SCREW BONE T8 2.7MM 12MM VAR ANG SELF TAP STARDRIVE LCP,$259.30,$0.00,$259.30,$116.69,$185.06,$0.00,$43.38,$0.00,$0.00,$45.40,$259.30,$0.00,$129.65,$205.37,$207.44,$0.00,$39.40,$0.00,$41.28,$0.00
02.211.013,SUP,HCPCS C1713,,02.211.013  -  SCREW BONE 2.7MM 13MM T8 STARDRIVE RECESS VAR ANG SLFTAP,$259.30,$0.00,$259.30,$116.69,$185.06,$0.00,$43.38,$0.00,$0.00,$45.40,$259.30,$0.00,$129.65,$205.37,$207.44,$0.00,$39.40,$0.00,$41.28,$0.00
02.211.014,SUP,HCPCS C1713,,02.211.014  -  SCREW BONE T8 2.7MM 14MM VAR ANG SELF TAP STARDRIVE LCP,$259.30,$0.00,$259.30,$116.69,$185.06,$0.00,$43.38,$0.00,$0.00,$45.40,$259.30,$0.00,$129.65,$205.37,$207.44,$0.00,$39.40,$0.00,$41.28,$0.00
02.211.016,SUP,HCPCS C1713,,02.211.016  -  SCREW BONE T8 2.7MM 16MM VAR ANG SELF TAP STARDRIVE LCP,$259.30,$0.00,$259.30,$116.69,$185.06,$0.00,$43.38,$0.00,$0.00,$45.40,$259.30,$0.00,$129.65,$205.37,$207.44,$0.00,$39.40,$0.00,$41.28,$0.00
02.211.018,SUP,HCPCS C1713,,02.211.018  -  SCREW BONE T8 2.7MM 18MM VAR ANG SELF TAP STARDRIVE LCP,$259.30,$0.00,$259.30,$116.69,$185.06,$0.00,$43.38,$0.00,$0.00,$45.40,$259.30,$0.00,$129.65,$205.37,$207.44,$0.00,$39.40,$0.00,$41.28,$0.00
02.211.020,SUP,HCPCS C1713,,02.211.020  -  SCREW BONE T8 2.7MM 20MM VAR ANG SELF TAP STARDRIVE LCP,$259.30,$0.00,$259.30,$116.69,$185.06,$0.00,$43.38,$0.00,$0.00,$45.40,$259.30,$0.00,$129.65,$205.37,$207.44,$0.00,$39.40,$0.00,$41.28,$0.00
02.211.022,SUP,HCPCS C1713,,02.211.022  -  SCREW BONE T8 2.7MM 22MM VAR ANG SELF TAP STARDRIVE LCP,$259.30,$0.00,$259.30,$116.69,$185.06,$0.00,$43.38,$0.00,$0.00,$45.40,$259.30,$0.00,$129.65,$205.37,$207.44,$0.00,$39.40,$0.00,$41.28,$0.00
02.211.024,SUP,HCPCS C1713,,02.211.024  -  SCREW BONE T8 2.7MM 24MM VAR ANG SELF TAP STARDRIVE LCP,$259.30,$0.00,$259.30,$116.69,$185.06,$0.00,$43.38,$0.00,$0.00,$45.40,$259.30,$0.00,$129.65,$205.37,$207.44,$0.00,$39.40,$0.00,$41.28,$0.00
02.211.026,SUP,HCPCS C1713,,02.211.026  -  SCREW BONE T8 2.7MM 26MM VAR ANG SELF TAP STARDRIVE LCP,$259.30,$0.00,$259.30,$116.69,$185.06,$0.00,$43.38,$0.00,$0.00,$45.40,$259.30,$0.00,$129.65,$205.37,$207.44,$0.00,$39.40,$0.00,$41.28,$0.00
02.211.028,SUP,HCPCS C1713,,02.211.028  -  SCREW BONE T8 2.7MM 28MM VAR ANG SELF TAP STARDRIVE LCP,$259.30,$0.00,$259.30,$116.69,$185.06,$0.00,$43.38,$0.00,$0.00,$45.40,$259.30,$0.00,$129.65,$205.37,$207.44,$0.00,$39.40,$0.00,$41.28,$0.00
02.211.030,SUP,HCPCS C1713,,02.211.030  -  SCREW BONE 2.7MM 30MM LOCK VAR ANG SELF TAP T8 STARDRIVE,$259.30,$0.00,$259.30,$116.69,$185.06,$0.00,$43.38,$0.00,$0.00,$45.40,$259.30,$0.00,$129.65,$205.37,$207.44,$0.00,$39.40,$0.00,$41.28,$0.00
02.211.032,SUP,HCPCS C1713,,02.211.032  -  SCREW BONE T8 2.7MM 32MM VAR ANG SELF TAP STARDRIVE LCP,$259.30,$0.00,$259.30,$116.69,$185.06,$0.00,$43.38,$0.00,$0.00,$45.40,$259.30,$0.00,$129.65,$205.37,$207.44,$0.00,$39.40,$0.00,$41.28,$0.00
02.211.034,SUP,HCPCS C1713,,02.211.034  -  SCREW BONE T8 2.7MM 34MM VAR ANG SELF TAP STARDRIVE LCP,$259.30,$0.00,$259.30,$116.69,$185.06,$0.00,$43.38,$0.00,$0.00,$45.40,$259.30,$0.00,$129.65,$205.37,$207.44,$0.00,$39.40,$0.00,$41.28,$0.00
02.211.036,SUP,HCPCS C1713,,02.211.036  -  SCREW BONE 2.7MM 36MM LOCK VAR ANG SELF TAP T8 STARDRIVE,$259.30,$0.00,$259.30,$116.69,$185.06,$0.00,$43.38,$0.00,$0.00,$45.40,$259.30,$0.00,$129.65,$205.37,$207.44,$0.00,$39.40,$0.00,$41.28,$0.00
02.211.038,SUP,HCPCS C1713,,02.211.038  -  SCREW BONE T8 2.7MM 38MM VAR ANG SELF TAP STARDRIVE LCP,$259.30,$0.00,$259.30,$116.69,$185.06,$0.00,$43.38,$0.00,$0.00,$45.40,$259.30,$0.00,$129.65,$205.37,$207.44,$0.00,$39.40,$0.00,$41.28,$0.00
02.211.040,SUP,HCPCS C1713,,02.211.040  -  SCREW BONE T8 2.7MM 40MM VAR ANG SELF TAP STARDRIVE LCP,$259.30,$0.00,$259.30,$116.69,$185.06,$0.00,$43.38,$0.00,$0.00,$45.40,$259.30,$0.00,$129.65,$205.37,$207.44,$0.00,$39.40,$0.00,$41.28,$0.00
02.211.042,SUP,HCPCS C1713,,02.211.042  -  SCREW BONE 2.7MM 42MM VAR ANG SELF TAP T8 STARDRIVE LCP,$259.30,$0.00,$259.30,$116.69,$185.06,$0.00,$43.38,$0.00,$0.00,$45.40,$259.30,$0.00,$129.65,$205.37,$207.44,$0.00,$39.40,$0.00,$41.28,$0.00
02.211.044,SUP,HCPCS C1713,,02.211.044  -  SCREW BONE T8 2.7MM 44MM VAR ANG SELF TAP STARDRIVE LCP,$259.30,$0.00,$259.30,$116.69,$185.06,$0.00,$43.38,$0.00,$0.00,$45.40,$259.30,$0.00,$129.65,$205.37,$207.44,$0.00,$39.40,$0.00,$41.28,$0.00
02.211.046,SUP,HCPCS C1713,,02.211.046  -  SCREW BONE T8 2.7MM 46MM VAR ANG SELF TAP STARDRIVE LCP,$259.30,$0.00,$259.30,$116.69,$185.06,$0.00,$43.38,$0.00,$0.00,$45.40,$259.30,$0.00,$129.65,$205.37,$207.44,$0.00,$39.40,$0.00,$41.28,$0.00
02.211.048,SUP,HCPCS C1713,,02.211.048  -  SCREW BONE T8 2.7MM 48MM VAR ANG SELF TAP STARDRIVE LCP,$259.30,$0.00,$259.30,$116.69,$185.06,$0.00,$43.38,$0.00,$0.00,$45.40,$259.30,$0.00,$129.65,$205.37,$207.44,$0.00,$39.40,$0.00,$41.28,$0.00
02.211.050,SUP,HCPCS C1713,,02.211.050  -  SCREW BONE T8 2.7MM 50MM VAR ANG SELF TAP STARDRIVE LCP,$259.30,$0.00,$259.30,$116.69,$185.06,$0.00,$43.38,$0.00,$0.00,$45.40,$259.30,$0.00,$129.65,$205.37,$207.44,$0.00,$39.40,$0.00,$41.28,$0.00
02.211.052,SUP,HCPCS C1713,,02.211.052  -  SCREW BONE T8 2.7MM 52MM VAR ANG SELF TAP STARDRIVE LCP,$259.30,$0.00,$259.30,$116.69,$185.06,$0.00,$43.38,$0.00,$0.00,$45.40,$259.30,$0.00,$129.65,$205.37,$207.44,$0.00,$39.40,$0.00,$41.28,$0.00
02.211.054,SUP,HCPCS C1713,,02.211.054  -  SCREW BONE T8 2.7MM 54MM VAR ANG SELF TAP STARDRIVE LCP,$259.30,$0.00,$259.30,$116.69,$185.06,$0.00,$43.38,$0.00,$0.00,$45.40,$259.30,$0.00,$129.65,$205.37,$207.44,$0.00,$39.40,$0.00,$41.28,$0.00
02.211.056,SUP,HCPCS C1713,,02.211.056  -  SCREW BONE T8 2.7MM 56MM VAR ANG SELF TAP STARDRIVE LCP,$259.30,$0.00,$259.30,$116.69,$185.06,$0.00,$43.38,$0.00,$0.00,$45.40,$259.30,$0.00,$129.65,$205.37,$207.44,$0.00,$39.40,$0.00,$41.28,$0.00
02.211.058,SUP,HCPCS C1713,,02.211.058  -  SCREW BONE T8 2.7MM 58MM VAR ANG SELF TAP STARDRIVE LCP,$259.30,$0.00,$259.30,$116.69,$185.06,$0.00,$43.38,$0.00,$0.00,$45.40,$259.30,$0.00,$129.65,$205.37,$207.44,$0.00,$39.40,$0.00,$41.28,$0.00
02.211.060,SUP,HCPCS C1713,,02.211.060  -  SCREW BONE T8 2.7MM 60MM VAR ANG SELF TAP STARDRIVE LCP,$259.30,$0.00,$259.30,$116.69,$185.06,$0.00,$43.38,$0.00,$0.00,$45.40,$259.30,$0.00,$129.65,$205.37,$207.44,$0.00,$39.40,$0.00,$41.28,$0.00
02.211.201,SUP,HCPCS C1713,,02.211.201  -  PLATE BN XS X 24MM NS LCP VA LCK LOPRFL CMPR WRE HL SS,"$1,720.95",$0.00,"$1,720.95",$774.43,"$1,228.24",$0.00,$287.87,$0.00,$0.00,$301.32,"$1,720.95",$0.00,$860.48,"$1,362.99","$1,376.76",$0.00,$261.48,$0.00,$273.98,$0.00
02.211.202,SUP,HCPCS C1713,,02.211.202  -  PLATE BN SM X 27MM NS LCP VA LCK LOPRFL CMPR WRE HL SS,"$1,720.95",$0.00,"$1,720.95",$774.43,"$1,228.24",$0.00,$287.87,$0.00,$0.00,$301.32,"$1,720.95",$0.00,$860.48,"$1,362.99","$1,376.76",$0.00,$261.48,$0.00,$273.98,$0.00
02.211.203,SUP,HCPCS C1713,,02.211.203  -  PLATE BN MED X 32MM NS LCP VA LCK LOPRFL CMPR WRE HL SS,"$1,720.95",$0.00,"$1,720.95",$774.43,"$1,228.24",$0.00,$287.87,$0.00,$0.00,$301.32,"$1,720.95",$0.00,$860.48,"$1,362.99","$1,376.76",$0.00,$261.48,$0.00,$273.98,$0.00
02.211.204,SUP,HCPCS C1713,,02.211.204  -  PLATE BN LG X 36MM NS LCP VA LCK LOPRFL CMPR WRE HL SS,"$1,768.73",$0.00,"$1,768.73",$795.93,"$1,262.34",$0.00,$295.86,$0.00,$0.00,$309.69,"$1,768.73",$0.00,$884.36,"$1,400.83","$1,414.98",$0.00,$268.74,$0.00,$281.58,$0.00
02.211.210,SUP,HCPCS C1713,,02.211.210  -  PLATE BONE LP OPENING WEDGE LOCKING VAR ANG ANATOMIC LCP,"$1,726.40",$0.00,"$1,726.40",$776.88,"$1,232.13",$0.00,$288.79,$0.00,$0.00,$302.28,"$1,726.40",$0.00,$863.20,"$1,367.31","$1,381.12",$0.00,$262.31,$0.00,$274.84,$0.00
02.211.211,SUP,HCPCS C1713,,02.211.211  -  PLATE BONE 3MM SPACER OPENING WEDGE LOCKING VAR ANG LCP,"$1,680.00",$0.00,"$1,680.00",$756.00,"$1,199.02",$0.00,$281.03,$0.00,$0.00,$294.15,"$1,680.00",$0.00,$840.00,"$1,330.56","$1,344.00",$0.00,$255.26,$0.00,$267.46,$0.00
02.211.212,SUP,HCPCS C1713,,02.211.212  -  PLATE BONE 4MM SPACER OPENING WEDGE LOCKING VAR ANG LCP,"$1,680.00",$0.00,"$1,680.00",$756.00,"$1,199.02",$0.00,$281.03,$0.00,$0.00,$294.15,"$1,680.00",$0.00,$840.00,"$1,330.56","$1,344.00",$0.00,$255.26,$0.00,$267.46,$0.00
02.211.213,SUP,HCPCS C1713,,02.211.213  -  PLATE BONE 5MM SPACER OPENING WEDGE LOCKING VAR ANG LCP,"$1,680.00",$0.00,"$1,680.00",$756.00,"$1,199.02",$0.00,$281.03,$0.00,$0.00,$294.15,"$1,680.00",$0.00,$840.00,"$1,330.56","$1,344.00",$0.00,$255.26,$0.00,$267.46,$0.00
02.211.214,SUP,HCPCS C1713,,02.211.214  -  PLATE BONE 6MM SPACER OPENING WEDGE VAR ANG LOCKING LCP,"$1,726.40",$0.00,"$1,726.40",$776.88,"$1,232.13",$0.00,$288.79,$0.00,$0.00,$302.28,"$1,726.40",$0.00,$863.20,"$1,367.31","$1,381.12",$0.00,$262.31,$0.00,$274.84,$0.00
02.211.215,SUP,HCPCS C1713,,02.211.215  -  PLATE BONE 7MM SPACER OPENING WEDGE VAR ANG LOCKING LCP,"$1,726.40",$0.00,"$1,726.40",$776.88,"$1,232.13",$0.00,$288.79,$0.00,$0.00,$302.28,"$1,726.40",$0.00,$863.20,"$1,367.31","$1,381.12",$0.00,$262.31,$0.00,$274.84,$0.00
02.211.220,SUP,HCPCS C1713,,02.211.220  -  PLATE BN CNTR NS LCP VA LCK LOPRFL SS NAVICULAR 2.4/2.7MM,"$2,048.50",$0.00,"$2,048.50",$921.83,"$1,462.01",$0.00,$342.66,$0.00,$0.00,$358.68,"$2,048.50",$0.00,"$1,024.25","$1,622.41","$1,638.80",$0.00,$311.25,$0.00,$326.12,$0.00
02.211.221,SUP,HCPCS C1713,,02.211.221  -  PLATE BN CNTR NS LCP VA LCK LOPRFL SS CUBOID LT 2.4/2.7MM,"$2,048.50",$0.00,"$2,048.50",$921.83,"$1,462.01",$0.00,$342.66,$0.00,$0.00,$358.68,"$2,048.50",$0.00,"$1,024.25","$1,622.41","$1,638.80",$0.00,$311.25,$0.00,$326.12,$0.00
02.211.222,SUP,HCPCS C1713,,02.211.222  -  PLATE BN CNTR NS LCP VA LCK LOPRFL SS CUBOID RT 2.4/2.7MM,"$2,048.50",$0.00,"$2,048.50",$921.83,"$1,462.01",$0.00,$342.66,$0.00,$0.00,$358.68,"$2,048.50",$0.00,"$1,024.25","$1,622.41","$1,638.80",$0.00,$311.25,$0.00,$326.12,$0.00
02.211.224,SUP,HCPCS C1713,,02.211.224  -  PLATE BONE 5X12 HOLE VAR ANG LOCK MESH LCP STAINLESS STEEL,"$2,885.08",$0.00,"$2,885.08","$1,298.28","$2,059.08",$0.00,$482.61,$0.00,$0.00,$505.15,"$2,885.08",$0.00,"$1,442.54","$2,284.98","$2,308.06",$0.00,$438.36,$0.00,$459.30,$0.00
02.211.230,SUP,HCPCS C1713,,02.211.230  -  PLATE BN 0D SM 42MM NS LCP VA FSN LOPRFL CMPR WRE HL SS 1ST,"$1,801.48",$0.00,"$1,801.48",$810.66,"$1,285.71",$0.00,$301.34,$0.00,$0.00,$315.42,"$1,801.48",$0.00,$900.74,"$1,426.77","$1,441.18",$0.00,$273.72,$0.00,$286.79,$0.00
02.211.231,SUP,HCPCS C1713,,02.211.231  -  PLATE BN 0D SM 42MM NS LCP VA FSN LOPRFL CMPR WRE HL SS 1ST,"$1,801.48",$0.00,"$1,801.48",$810.66,"$1,285.71",$0.00,$301.34,$0.00,$0.00,$315.42,"$1,801.48",$0.00,$900.74,"$1,426.77","$1,441.18",$0.00,$273.72,$0.00,$286.79,$0.00
02.211.232,SUP,HCPCS C1713,,02.211.232  -  PLATE BN 5D SM 42MM NS LCP VA FSN LOPRFL CMPR WRE HL SS 1ST,"$1,801.48",$0.00,"$1,801.48",$810.66,"$1,285.71",$0.00,$301.34,$0.00,$0.00,$315.42,"$1,801.48",$0.00,$900.74,"$1,426.77","$1,441.18",$0.00,$273.72,$0.00,$286.79,$0.00
02.211.233,SUP,HCPCS C1713,,02.211.233  -  PLATE BN 5D SM 42MM NS LCP VA FSN LOPRFL CMPR WRE HL SS 1ST,"$1,801.48",$0.00,"$1,801.48",$810.66,"$1,285.71",$0.00,$301.34,$0.00,$0.00,$315.42,"$1,801.48",$0.00,$900.74,"$1,426.77","$1,441.18",$0.00,$273.72,$0.00,$286.79,$0.00
02.211.234,SUP,HCPCS C1713,,02.211.234  -  PLATE BN 10D SM 42MM NS LCP VA FSN LOPRFL CMPR WRE HL SS 1ST,"$1,801.48",$0.00,"$1,801.48",$810.66,"$1,285.71",$0.00,$301.34,$0.00,$0.00,$315.42,"$1,801.48",$0.00,$900.74,"$1,426.77","$1,441.18",$0.00,$273.72,$0.00,$286.79,$0.00
02.211.235,SUP,HCPCS C1713,,02.211.235  -  PLATE BN 10D SM 42MM NS LCP VA FSN LOPRFL CMPR WRE HL SS 1ST,"$1,801.48",$0.00,"$1,801.48",$810.66,"$1,285.71",$0.00,$301.34,$0.00,$0.00,$315.42,"$1,801.48",$0.00,$900.74,"$1,426.77","$1,441.18",$0.00,$273.72,$0.00,$286.79,$0.00
02.211.236,SUP,HCPCS C1713,,02.211.236  -  PLATE BN 0D MED 52MM NS LCP VA FSN LOPRFL CMPR WRE HL SS 1ST,"$1,801.48",$0.00,"$1,801.48",$810.66,"$1,285.71",$0.00,$301.34,$0.00,$0.00,$315.42,"$1,801.48",$0.00,$900.74,"$1,426.77","$1,441.18",$0.00,$273.72,$0.00,$286.79,$0.00
02.211.237,SUP,HCPCS C1713,,02.211.237  -  PLATE BN 0D MED 52MM NS LCP VA FSN LOPRFL CMPR WRE HL SS 1ST,"$1,801.48",$0.00,"$1,801.48",$810.66,"$1,285.71",$0.00,$301.34,$0.00,$0.00,$315.42,"$1,801.48",$0.00,$900.74,"$1,426.77","$1,441.18",$0.00,$273.72,$0.00,$286.79,$0.00
02.211.238,SUP,HCPCS C1713,,02.211.238  -  PLATE BN 5D MED 52MM NS LCP VA FSN LOPRFL CMPR WRE HL SS 1ST,"$1,801.48",$0.00,"$1,801.48",$810.66,"$1,285.71",$0.00,$301.34,$0.00,$0.00,$315.42,"$1,801.48",$0.00,$900.74,"$1,426.77","$1,441.18",$0.00,$273.72,$0.00,$286.79,$0.00
02.211.239,SUP,HCPCS C1713,,02.211.239  -  PLATE BN 5D MED 52MM NS LCP VA FSN LOPRFL CMPR WRE HL SS 1ST,"$1,801.48",$0.00,"$1,801.48",$810.66,"$1,285.71",$0.00,$301.34,$0.00,$0.00,$315.42,"$1,801.48",$0.00,$900.74,"$1,426.77","$1,441.18",$0.00,$273.72,$0.00,$286.79,$0.00
02.211.240,SUP,HCPCS C1713,,02.211.240  -  PLATE BN 10D MED 52MM NS LCP VA FSN LOPRFL CMPR WRE HL SS 1,"$1,801.48",$0.00,"$1,801.48",$810.66,"$1,285.71",$0.00,$301.34,$0.00,$0.00,$315.42,"$1,801.48",$0.00,$900.74,"$1,426.77","$1,441.18",$0.00,$273.72,$0.00,$286.79,$0.00
02.211.241,SUP,HCPCS C1713,,02.211.241  -  PLATE BN 10D MED 52MM NS LCP VA FSN LOPRFL CMPR WRE HL SS 1,"$1,801.48",$0.00,"$1,801.48",$810.66,"$1,285.71",$0.00,$301.34,$0.00,$0.00,$315.42,"$1,801.48",$0.00,$900.74,"$1,426.77","$1,441.18",$0.00,$273.72,$0.00,$286.79,$0.00
02.211.242,SUP,HCPCS C1713,,02.211.242  -  PLATE BN 5D LG 57MM NS LCP VA FSN LOPRFL CMPR WRE HL SS 1ST,"$2,048.50",$0.00,"$2,048.50",$921.83,"$1,462.01",$0.00,$342.66,$0.00,$0.00,$358.68,"$2,048.50",$0.00,"$1,024.25","$1,622.41","$1,638.80",$0.00,$311.25,$0.00,$326.12,$0.00
02.211.243,SUP,HCPCS C1713,,02.211.243  -  PLATE BN 5D LG 57MM NS LCP VA FSN LOPRFL CMPR WRE HL SS 1ST,"$2,048.50",$0.00,"$2,048.50",$921.83,"$1,462.01",$0.00,$342.66,$0.00,$0.00,$358.68,"$2,048.50",$0.00,"$1,024.25","$1,622.41","$1,638.80",$0.00,$311.25,$0.00,$326.12,$0.00
02.211.244,SUP,HCPCS C1713,,02.211.244  -  PLATE BONE 0D 53MM VAR ANG FUSION REVISION DORSIFLEXION LCP,"$2,273.68",$0.00,"$2,273.68","$1,023.15","$1,622.72",$0.00,$380.33,$0.00,$0.00,$398.10,"$2,273.68",$0.00,"$1,136.84","$1,800.75","$1,818.94",$0.00,$345.47,$0.00,$361.97,$0.00
02.211.245,SUP,HCPCS C1713,,02.211.245  -  PLATE BONE 0D 53MM VAR ANG FUSION REVISION DORSIFLEXION LCP,"$2,273.68",$0.00,"$2,273.68","$1,023.15","$1,622.72",$0.00,$380.33,$0.00,$0.00,$398.10,"$2,273.68",$0.00,"$1,136.84","$1,800.75","$1,818.94",$0.00,$345.47,$0.00,$361.97,$0.00
02.211.246,SUP,HCPCS C1713,,02.211.246  -  PLATE BN STD 39MM NS LCP VA FSN LOPRFL PRECONTOUR SS 1ST,"$1,801.48",$0.00,"$1,801.48",$810.66,"$1,285.71",$0.00,$301.34,$0.00,$0.00,$315.42,"$1,801.48",$0.00,$900.74,"$1,426.77","$1,441.18",$0.00,$273.72,$0.00,$286.79,$0.00
02.211.247,SUP,HCPCS C1713,,02.211.247  -  PLATE BN LNG 48MM NS LCP VA FSN LOPRFL PRECONTOUR SS 1ST,"$1,801.48",$0.00,"$1,801.48",$810.66,"$1,285.71",$0.00,$301.34,$0.00,$0.00,$315.42,"$1,801.48",$0.00,$900.74,"$1,426.77","$1,441.18",$0.00,$273.72,$0.00,$286.79,$0.00
02.211.250,SUP,HCPCS C1713,,02.211.250  -  PLATE BN SHRT CLVRLF 38MM NS LCP VA FSN LOPRFL CMPR WRE HL,"$1,557.18",$0.00,"$1,557.18",$700.73,"$1,111.36",$0.00,$260.48,$0.00,$0.00,$272.65,"$1,557.18",$0.00,$778.59,"$1,233.29","$1,245.74",$0.00,$236.60,$0.00,$247.90,$0.00
02.211.251,SUP,HCPCS C1713,,02.211.251  -  PLATE BN STD CLVRLF 45MM NS LCP VA FSN LOPRFL CMPR WRE HL SS,"$1,598.13",$0.00,"$1,598.13",$719.16,"$1,140.58",$0.00,$267.33,$0.00,$0.00,$279.82,"$1,598.13",$0.00,$799.06,"$1,265.72","$1,278.50",$0.00,$242.82,$0.00,$254.42,$0.00
02.211.252,SUP,HCPCS C1713,,02.211.252  -  PLATE BN LNG CLVRLF 64MM NS LCP VA FSN LOPRFL CMPR WRE HL SS,"$1,637.70",$0.00,"$1,637.70",$736.97,"$1,168.83",$0.00,$273.95,$0.00,$0.00,$286.75,"$1,637.70",$0.00,$818.85,"$1,297.06","$1,310.16",$0.00,$248.84,$0.00,$260.72,$0.00
02.211.253,SUP,HCPCS C1713,,02.211.253  -  PLATE BONE T SHORT 35MM 2 HOLE FUSION VAR ANG LCP STAINLESS,"$1,557.18",$0.00,"$1,557.18",$700.73,"$1,111.36",$0.00,$260.48,$0.00,$0.00,$272.65,"$1,557.18",$0.00,$778.59,"$1,233.29","$1,245.74",$0.00,$236.60,$0.00,$247.90,$0.00
02.211.254,SUP,HCPCS C1713,,02.211.254  -  PLATE BONE STANDARD 42MM 2 HOLE T FUSION VAR ANG LCP,"$1,598.13",$0.00,"$1,598.13",$719.16,"$1,140.58",$0.00,$267.33,$0.00,$0.00,$279.82,"$1,598.13",$0.00,$799.06,"$1,265.72","$1,278.50",$0.00,$242.82,$0.00,$254.42,$0.00
02.211.255,SUP,HCPCS C1713,,02.211.255  -  PLATE BONE T LONG 6.1CM 2 HOLE VAR ANG LCP STAINLESS STEEL,"$1,637.70",$0.00,"$1,637.70",$736.97,"$1,168.83",$0.00,$273.95,$0.00,$0.00,$286.75,"$1,637.70",$0.00,$818.85,"$1,297.06","$1,310.16",$0.00,$248.84,$0.00,$260.72,$0.00
02.211.256,SUP,HCPCS C1713,,02.211.256  -  PLATE BN SHRT L 37MM NS LCP VA FSN LOPRFL CMPR WRE HL SS,"$1,600.85",$0.00,"$1,600.85",$720.38,"$1,142.53",$0.00,$267.79,$0.00,$0.00,$280.30,"$1,600.85",$0.00,$800.43,"$1,267.87","$1,280.68",$0.00,$243.24,$0.00,$254.86,$0.00
02.211.257,SUP,HCPCS C1713,,02.211.257  -  PLATE BN SHRT L 37MM NS LCP VA FSN LOPRFL CMPR WRE HL SS,"$1,557.18",$0.00,"$1,557.18",$700.73,"$1,111.36",$0.00,$260.48,$0.00,$0.00,$272.65,"$1,557.18",$0.00,$778.59,"$1,233.29","$1,245.74",$0.00,$236.60,$0.00,$247.90,$0.00
02.211.258,SUP,HCPCS C1713,,02.211.258  -  PLATE BN STD L 44MM NS LCP VA FSN LOPRFL CMPR WRE HL SS,"$1,643.15",$0.00,"$1,643.15",$739.42,"$1,172.72",$0.00,$274.86,$0.00,$0.00,$287.70,"$1,643.15",$0.00,$821.58,"$1,301.37","$1,314.52",$0.00,$249.66,$0.00,$261.59,$0.00
02.211.259,SUP,HCPCS C1713,,02.211.259  -  PLATE BN STD L 44MM NS LCP VA FSN LOPRFL CMPR WRE HL SS,"$1,643.15",$0.00,"$1,643.15",$739.42,"$1,172.72",$0.00,$274.86,$0.00,$0.00,$287.70,"$1,643.15",$0.00,$821.58,"$1,301.37","$1,314.52",$0.00,$249.66,$0.00,$261.59,$0.00
02.211.260,SUP,HCPCS C1713,,02.211.260  -  PLATE BN LNG L 62MM NS LCP VA FSN LOPRFL CMPR WRE HL SS,"$1,684.10",$0.00,"$1,684.10",$757.85,"$1,201.94",$0.00,$281.71,$0.00,$0.00,$294.87,"$1,684.10",$0.00,$842.05,"$1,333.81","$1,347.28",$0.00,$255.89,$0.00,$268.11,$0.00
02.211.261,SUP,HCPCS C1713,,02.211.261  -  PLATE BN LNG L 62MM NS LCP VA FSN LOPRFL CMPR WRE HL SS,"$1,684.10",$0.00,"$1,684.10",$757.85,"$1,201.94",$0.00,$281.71,$0.00,$0.00,$294.87,"$1,684.10",$0.00,$842.05,"$1,333.81","$1,347.28",$0.00,$255.89,$0.00,$268.11,$0.00
02.211.262,SUP,HCPCS C1713,,02.211.262  -  PLATE BONE 27MM 2 HOLE STR FUSION VAR ANG LOCKING LCP,"$1,393.40",$0.00,"$1,393.40",$627.03,$994.47,$0.00,$233.08,$0.00,$0.00,$243.97,"$1,393.40",$0.00,$696.70,"$1,103.57","$1,114.72",$0.00,$211.72,$0.00,$221.83,$0.00
02.211.263,SUP,HCPCS C1713,,02.211.263  -  PLATE BONE 43MM 4 HOLE STR FUSION VAR ANG LOCKING LCP,"$1,473.93",$0.00,"$1,473.93",$663.27,"$1,051.94",$0.00,$246.55,$0.00,$0.00,$258.07,"$1,473.93",$0.00,$736.96,"$1,167.35","$1,179.14",$0.00,$223.95,$0.00,$234.65,$0.00
02.211.265,SUP,HCPCS C1713,,02.211.265  -  PLATE BONE XLONG 92MM 3 HOLE T FUSION VAR ANG LCP STAINLESS,"$2,048.50",$0.00,"$2,048.50",$921.83,"$1,462.01",$0.00,$342.66,$0.00,$0.00,$358.68,"$2,048.50",$0.00,"$1,024.25","$1,622.41","$1,638.80",$0.00,$311.25,$0.00,$326.12,$0.00
02.211.266,SUP,HCPCS C1713,,02.211.266  -  PLATE BN 43MM NS LCP VA FSN LOPRFL PRECONTOUR SS,"$1,637.70",$0.00,"$1,637.70",$736.97,"$1,168.83",$0.00,$273.95,$0.00,$0.00,$286.75,"$1,637.70",$0.00,$818.85,"$1,297.06","$1,310.16",$0.00,$248.84,$0.00,$260.72,$0.00
02.211.412S,SUP,HCPCS C1713,,02.211.412S  -  PLATE BN LNG 56MM STRL LCP VA LCK LOPRFL PRECONTOUR SS CALC,"$1,982.98",$0.00,"$1,982.98",$892.34,"$1,415.25",$0.00,$331.71,$0.00,$0.00,$347.20,"$1,982.98",$0.00,$991.49,"$1,570.52","$1,586.38",$0.00,$301.30,$0.00,$315.69,$0.00
02.212.054,SUP,HCPCS C1713,,02.212.054  -  SCREW BONE T15 3.5MM 54MM SELF TAP STARDRIVE LCP STAINLESS,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
02.212.056,SUP,HCPCS C1713,,02.212.056  -  SCREW BONE T15 3.5MM 56MM SELF TAP STARDRIVE LCP STAINLESS,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
02.212.058,SUP,HCPCS C1713,,02.212.058  -  SCREW BONE T15 3.5MM 58MM SELF TAP STARDRIVE LCP STAINLESS,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
02.214.006,SUP,HCPCS C1713,,02.214.006  -  SCREW BONE 1.5MM 6MM T4 STARDRIVE RECESS LOCKING SLFTAP,$201.98,$0.00,$201.98,$90.89,$144.15,$0.00,$33.79,$0.00,$0.00,$35.36,$201.98,$0.00,$100.99,$159.97,$161.58,$0.00,$30.69,$0.00,$32.15,$0.00
02.214.007,SUP,HCPCS C1713,,02.214.007  -  SCREW BONE T4 LP 1.5MM 7MM SELF TAP SELF RETAINING THREAD,$201.98,$0.00,$201.98,$90.89,$144.15,$0.00,$33.79,$0.00,$0.00,$35.36,$201.98,$0.00,$100.99,$159.97,$161.58,$0.00,$30.69,$0.00,$32.15,$0.00
02.214.008,SUP,HCPCS C1713,,02.214.008  -  SCREW BONE T4 LP 1.5MM 8MM SELF TAP SELF RETAINING THREAD,$201.98,$0.00,$201.98,$90.89,$144.15,$0.00,$33.79,$0.00,$0.00,$35.36,$201.98,$0.00,$100.99,$159.97,$161.58,$0.00,$30.69,$0.00,$32.15,$0.00
02.214.009,SUP,HCPCS C1713,,02.214.009  -  SCREW BONE T4 LP 1.5MM 9MM SELF TAP SELF RETAINING THREAD,$201.98,$0.00,$201.98,$90.89,$144.15,$0.00,$33.79,$0.00,$0.00,$35.36,$201.98,$0.00,$100.99,$159.97,$161.58,$0.00,$30.69,$0.00,$32.15,$0.00
02.214.010,SUP,HCPCS C1713,,02.214.010  -  SCREW BONE T4 1.5MM 10MM SELF TAP SELF RETAINING LP,$201.98,$0.00,$201.98,$90.89,$144.15,$0.00,$33.79,$0.00,$0.00,$35.36,$201.98,$0.00,$100.99,$159.97,$161.58,$0.00,$30.69,$0.00,$32.15,$0.00
02.214.011,SUP,HCPCS C1713,,02.214.011  -  SCREW BONE T4 LP 1.5MM 11MM SELF TAP SELF RETAINING THREAD,$201.98,$0.00,$201.98,$90.89,$144.15,$0.00,$33.79,$0.00,$0.00,$35.36,$201.98,$0.00,$100.99,$159.97,$161.58,$0.00,$30.69,$0.00,$32.15,$0.00
02.214.012,SUP,HCPCS C1713,,02.214.012  -  SCREW BONE T4 LP 1.5MM 12MM SELF TAP SELF RETAINING THREAD,$201.98,$0.00,$201.98,$90.89,$144.15,$0.00,$33.79,$0.00,$0.00,$35.36,$201.98,$0.00,$100.99,$159.97,$161.58,$0.00,$30.69,$0.00,$32.15,$0.00
02.214.013,SUP,HCPCS C1713,,02.214.013  -  SCREW BONE T4 LP 1.5MM 13MM SELF TAP SELF RETAINING THREAD,$201.98,$0.00,$201.98,$90.89,$144.15,$0.00,$33.79,$0.00,$0.00,$35.36,$201.98,$0.00,$100.99,$159.97,$161.58,$0.00,$30.69,$0.00,$32.15,$0.00
02.214.014,SUP,HCPCS C1713,,02.214.014  -  SCREW BONE 1.5MM 14MM LOCK SELF TAP MODULAR T4 STARDRIVE LCP,$201.98,$0.00,$201.98,$90.89,$144.15,$0.00,$33.79,$0.00,$0.00,$35.36,$201.98,$0.00,$100.99,$159.97,$161.58,$0.00,$30.69,$0.00,$32.15,$0.00
02.214.015,SUP,HCPCS C1713,,02.214.015  -  SCREW BONE T4 LP 1.5MM 15MM SELF TAP SELF RETAINING THREAD,$201.98,$0.00,$201.98,$90.89,$144.15,$0.00,$33.79,$0.00,$0.00,$35.36,$201.98,$0.00,$100.99,$159.97,$161.58,$0.00,$30.69,$0.00,$32.15,$0.00
02.214.016,SUP,HCPCS C1713,,02.214.016  -  SCREW BONE T4 LP 1.5MM 16MM SELF TAP SELF RETAINING THREAD,$201.98,$0.00,$201.98,$90.89,$144.15,$0.00,$33.79,$0.00,$0.00,$35.36,$201.98,$0.00,$100.99,$159.97,$161.58,$0.00,$30.69,$0.00,$32.15,$0.00
02.214.018,SUP,HCPCS C1713,,02.214.018  -  SCREW BONE T4 LP 1.5MM 18MM SELF TAP SELF RETAINING THREAD,$201.98,$0.00,$201.98,$90.89,$144.15,$0.00,$33.79,$0.00,$0.00,$35.36,$201.98,$0.00,$100.99,$159.97,$161.58,$0.00,$30.69,$0.00,$32.15,$0.00
02.214.020,SUP,HCPCS C1713,,02.214.020  -  SCREW BONE T4 LP 1.5MM 20MM SELF TAP SELF RETAINING THREAD,$201.98,$0.00,$201.98,$90.89,$144.15,$0.00,$33.79,$0.00,$0.00,$35.36,$201.98,$0.00,$100.99,$159.97,$161.58,$0.00,$30.69,$0.00,$32.15,$0.00
02.214.022,SUP,HCPCS C1713,,02.214.022  -  SCREW BONE T4 LP 1.5MM 22MM SELF TAP SELF RETAINING THREAD,$201.98,$0.00,$201.98,$90.89,$144.15,$0.00,$33.79,$0.00,$0.00,$35.36,$201.98,$0.00,$100.99,$159.97,$161.58,$0.00,$30.69,$0.00,$32.15,$0.00
02.214.024,SUP,HCPCS C1713,,02.214.024  -  SCREW BONE T4 LP 1.5MM 24MM SELF TAP SELF RETAINING THREAD,$201.98,$0.00,$201.98,$90.89,$144.15,$0.00,$33.79,$0.00,$0.00,$35.36,$201.98,$0.00,$100.99,$159.97,$161.58,$0.00,$30.69,$0.00,$32.15,$0.00
02.214.104,SUP,HCPCS C1713,,02.214.104  -  SCREW BN T4 1.5MM 4MM ST TIP VA LCK STRDR SS CORT,$84.63,$0.00,$84.63,$38.08,$60.40,$0.00,$14.15,$0.00,$0.00,$14.82,$84.63,$0.00,$42.31,$67.03,$67.70,$0.00,$12.86,$0.00,$13.47,$0.00
02.214.105,SUP,HCPCS C1713,,02.214.105  -  SCREW BN T4 1.5MM 5MM SLFRET ST STRDR SS HND CORT VA LCK SYS,$84.63,$0.00,$84.63,$38.08,$60.40,$0.00,$14.15,$0.00,$0.00,$14.82,$84.63,$0.00,$42.31,$67.03,$67.70,$0.00,$12.86,$0.00,$13.47,$0.00
02.214.106,SUP,HCPCS C1713,,02.214.106  -  SCREW BONE T4 LP 1.5MM 6MM SELF TAP SELF RETAINING THREAD,$81.88,$0.00,$81.88,$36.84,$58.43,$0.00,$13.70,$0.00,$0.00,$14.34,$81.88,$0.00,$40.94,$64.85,$65.50,$0.00,$12.44,$0.00,$13.03,$0.00
02.214.107,SUP,HCPCS C1713,,02.214.107  -  SCREW BONE T4 LP 1.5MM 7MM SELF TAP SELF RETAINING THREAD,$81.88,$0.00,$81.88,$36.84,$58.43,$0.00,$13.70,$0.00,$0.00,$14.34,$81.88,$0.00,$40.94,$64.85,$65.50,$0.00,$12.44,$0.00,$13.03,$0.00
02.214.108,SUP,HCPCS C1713,,02.214.108  -  SCREW BONE T4 LP 1.5MM 8MM SELF TAP SELF RETAINING THREAD,$81.88,$0.00,$81.88,$36.84,$58.43,$0.00,$13.70,$0.00,$0.00,$14.34,$81.88,$0.00,$40.94,$64.85,$65.50,$0.00,$12.44,$0.00,$13.03,$0.00
02.214.109,SUP,HCPCS C1713,,02.214.109  -  SCREW BONE T4 LP 1.5MM 9MM SELF TAP SELF RETAINING THREAD,$81.88,$0.00,$81.88,$36.84,$58.43,$0.00,$13.70,$0.00,$0.00,$14.34,$81.88,$0.00,$40.94,$64.85,$65.50,$0.00,$12.44,$0.00,$13.03,$0.00
02.214.110,SUP,HCPCS C1713,,02.214.110  -  SCREW BONE T4 LP 1.5MM 10MM SELF TAP SELF RETAINING THREAD,$81.88,$0.00,$81.88,$36.84,$58.43,$0.00,$13.70,$0.00,$0.00,$14.34,$81.88,$0.00,$40.94,$64.85,$65.50,$0.00,$12.44,$0.00,$13.03,$0.00
02.214.111,SUP,HCPCS C1713,,02.214.111  -  SCREW BONE T4 LP 1.5MM 11MM SELF TAP SELF RETAINING THREAD,$81.88,$0.00,$81.88,$36.84,$58.43,$0.00,$13.70,$0.00,$0.00,$14.34,$81.88,$0.00,$40.94,$64.85,$65.50,$0.00,$12.44,$0.00,$13.03,$0.00
02.214.112,SUP,HCPCS C1713,,02.214.112  -  SCREW BONE T4 LP 1.5MM 12MM SELF TAP SELF RETAINING THREAD,$81.88,$0.00,$81.88,$36.84,$58.43,$0.00,$13.70,$0.00,$0.00,$14.34,$81.88,$0.00,$40.94,$64.85,$65.50,$0.00,$12.44,$0.00,$13.03,$0.00
02.214.113,SUP,HCPCS C1713,,02.214.113  -  SCREW BONE T4 LP 1.5MM 13MM SELF TAP SELF RETAINING THREAD,$81.88,$0.00,$81.88,$36.84,$58.43,$0.00,$13.70,$0.00,$0.00,$14.34,$81.88,$0.00,$40.94,$64.85,$65.50,$0.00,$12.44,$0.00,$13.03,$0.00
02.214.114,SUP,HCPCS C1713,,02.214.114  -  SCREW BONE T4 LP 1.5MM 14MM SELF TAP SELF RETAINING THREAD,$81.88,$0.00,$81.88,$36.84,$58.43,$0.00,$13.70,$0.00,$0.00,$14.34,$81.88,$0.00,$40.94,$64.85,$65.50,$0.00,$12.44,$0.00,$13.03,$0.00
02.214.115,SUP,HCPCS C1713,,02.214.115  -  SCREW BONE T4 LP 1.5MM 15MM SELF TAP SELF RETAINING THREAD,$81.88,$0.00,$81.88,$36.84,$58.43,$0.00,$13.70,$0.00,$0.00,$14.34,$81.88,$0.00,$40.94,$64.85,$65.50,$0.00,$12.44,$0.00,$13.03,$0.00
02.214.116,SUP,HCPCS C1713,,02.214.116  -  SCREW BONE T4 LP 1.5MM 16MM SELF TAP SELF RETAINING THREAD,$81.88,$0.00,$81.88,$36.84,$58.43,$0.00,$13.70,$0.00,$0.00,$14.34,$81.88,$0.00,$40.94,$64.85,$65.50,$0.00,$12.44,$0.00,$13.03,$0.00
02.214.118,SUP,HCPCS C1713,,02.214.118  -  SCREW BONE T4 LP 1.5MM 18MM SELF TAP SELF RETAINING THREAD,$81.88,$0.00,$81.88,$36.84,$58.43,$0.00,$13.70,$0.00,$0.00,$14.34,$81.88,$0.00,$40.94,$64.85,$65.50,$0.00,$12.44,$0.00,$13.03,$0.00
02.214.120,SUP,HCPCS C1713,,02.214.120  -  SCREW BONE T4 LP 1.5MM 20MM SELF TAP SELF RETAINING THREAD,$81.88,$0.00,$81.88,$36.84,$58.43,$0.00,$13.70,$0.00,$0.00,$14.34,$81.88,$0.00,$40.94,$64.85,$65.50,$0.00,$12.44,$0.00,$13.03,$0.00
02.214.122,SUP,HCPCS C1713,,02.214.122  -  SCREW BONE T4 LP 1.5MM 22MM SELF TAP SELF RETAINING THREAD,$81.88,$0.00,$81.88,$36.84,$58.43,$0.00,$13.70,$0.00,$0.00,$14.34,$81.88,$0.00,$40.94,$64.85,$65.50,$0.00,$12.44,$0.00,$13.03,$0.00
02.214.124,SUP,HCPCS C1713,,02.214.124  -  SCREW BONE T4 LP 1.5MM 24MM SELF TAP SELF RETAINING THREAD,$81.88,$0.00,$81.88,$36.84,$58.43,$0.00,$13.70,$0.00,$0.00,$14.34,$81.88,$0.00,$40.94,$64.85,$65.50,$0.00,$12.44,$0.00,$13.03,$0.00
02.221.002S,SUP,Custom 27803010,,02.221.002S  -  BUTTON CERCLAGE 2.5MM T15 STARDRIVE STAINLESS STEEL STERILE,$333.00,$0.00,$333.00,$0.00,$237.66,$0.00,$0.00,$0.00,$0.00,$0.00,$333.00,$0.00,$166.50,$263.74,$266.40,$0.00,$0.00,$0.00,$0.00,$0.00
02.221.003S,SUP,Custom 27803010,,02.221.003S  -  BUTTON FIX 3.5MM 3.5MM T25 STARDRIVE/HEXAGONAL RECESS,$333.00,$0.00,$333.00,$0.00,$237.66,$0.00,$0.00,$0.00,$0.00,$0.00,$333.00,$0.00,$166.50,$263.74,$266.40,$0.00,$0.00,$0.00,$0.00,$0.00
02.221.004S,SUP,Custom 27803010,,02.221.004S  -  BUTTON FIX 4MM CERCLAGE HEXAGONAL CANN STAINLESS STEEL,$333.00,$0.00,$333.00,$0.00,$237.66,$0.00,$0.00,$0.00,$0.00,$0.00,$333.00,$0.00,$166.50,$263.74,$266.40,$0.00,$0.00,$0.00,$0.00,$0.00
02.221.005S,SUP,Custom 27803010,,02.221.005S  -  PIN POSITIONING 5MM CRIMP STAINLESS STEEL STERILE,$500.88,$0.00,$500.88,$0.00,$357.47,$0.00,$0.00,$0.00,$0.00,$0.00,$500.88,$0.00,$250.44,$396.70,$400.70,$0.00,$0.00,$0.00,$0.00,$0.00
02.221.006S,SUP,HCPCS C1713,,02.221.006S  -  PIN POSITIONING 7.3MM CRIMP STAINLESS STEEL STERILE,$500.88,$0.00,$500.88,$225.39,$357.47,$0.00,$83.78,$0.00,$0.00,$87.70,$500.88,$0.00,$250.44,$396.70,$400.70,$0.00,$76.10,$0.00,$79.74,$0.00
02.221.458,SUP,HCPCS C1713,,02.221.458  -  SCREW BONE 5MM 8MM SLFTAP LOCKING LCP STAINLESS STEEL DISTAL,$386.23,$0.00,$386.23,$173.80,$275.65,$0.00,$64.61,$0.00,$0.00,$67.62,$386.23,$0.00,$193.11,$305.89,$308.98,$0.00,$58.68,$0.00,$61.49,$0.00
02.221.460,SUP,HCPCS C1713,,02.221.460  -  SCREW BONE 5MM 10MM SLFTAP LOCKING LCP STAINLESS STEEL,$386.23,$0.00,$386.23,$173.80,$275.65,$0.00,$64.61,$0.00,$0.00,$67.62,$386.23,$0.00,$193.11,$305.89,$308.98,$0.00,$58.68,$0.00,$61.49,$0.00
02.221.462,SUP,HCPCS C1713,,02.221.462  -  SCREW BONE 5MM 12MM SLFTAP LOCKING LCP STAINLESS STEEL,$386.23,$0.00,$386.23,$173.80,$275.65,$0.00,$64.61,$0.00,$0.00,$67.62,$386.23,$0.00,$193.11,$305.89,$308.98,$0.00,$58.68,$0.00,$61.49,$0.00
02.221.508,SUP,HCPCS C1713,,02.221.508  -  SCREW BONE T25 BLUNT CONE 5MM 4.4MM 8MM SELF TAP THREAD HEAD,$386.23,$0.00,$386.23,$173.80,$275.65,$0.00,$64.61,$0.00,$0.00,$67.62,$386.23,$0.00,$193.11,$305.89,$308.98,$0.00,$58.68,$0.00,$61.49,$0.00
02.221.510,SUP,HCPCS C1713,,02.221.510  -  SCREW BONE FULTHD 5MM 4.4MM 10MM T25 STARDRIVE RECESS,$386.23,$0.00,$386.23,$173.80,$275.65,$0.00,$64.61,$0.00,$0.00,$67.62,$386.23,$0.00,$193.11,$305.89,$308.98,$0.00,$58.68,$0.00,$61.49,$0.00
02.221.510S,SUP,HCPCS C1713,,02.221.510S  -  SCREW BONE 5MM 10MM LCP SS PROX MDL PERIART FEM/TIB,$531.55,$0.00,$531.55,$239.20,$379.37,$0.00,$91.58,$0.00,$0.00,$93.07,$531.55,$0.00,$265.78,$420.99,$425.24,$0.00,$83.19,$0.00,$84.62,$0.00
02.221.512,SUP,HCPCS C1713,,02.221.512  -  SCREW BONE T25 BLUNT CONE 5MM 4.4MM 12MM SELF TAP THREAD,$386.23,$0.00,$386.23,$173.80,$275.65,$0.00,$64.61,$0.00,$0.00,$67.62,$386.23,$0.00,$193.11,$305.89,$308.98,$0.00,$58.68,$0.00,$61.49,$0.00
02.221.514,SUP,HCPCS C1713,,02.221.514  -  SCREW BONE 5MM 14MM SLFTAP LOCKING STARDRIVE RECESS LCP,$386.23,$0.00,$386.23,$173.80,$275.65,$0.00,$64.61,$0.00,$0.00,$67.62,$386.23,$0.00,$193.11,$305.89,$308.98,$0.00,$58.68,$0.00,$61.49,$0.00
02.221.518,SUP,HCPCS C1713,,02.221.518  -  SCREW BONE 5MM 18MM SLFTAP LOCKING STARDRIVE RECESS LCP,$386.23,$0.00,$386.23,$173.80,$275.65,$0.00,$64.61,$0.00,$0.00,$67.62,$386.23,$0.00,$193.11,$305.89,$308.98,$0.00,$58.68,$0.00,$61.49,$0.00
02.224.030S,SUP,HCPCS C1713,,02.224.030S  -  SCREW BONE HELIX 30MM LCP DHHS STAINLESS STEEL HIP STERILE,$168.53,$0.00,$168.53,$75.84,$120.28,$0.00,$28.19,$0.00,$0.00,$29.51,$168.53,$0.00,$84.26,$133.48,$134.82,$0.00,$25.61,$0.00,$26.83,$0.00
02.226.000,SUP,HCPCS C1713,,02.226.000  -  GUIDEWIRE ORTHOPEDIC 1.6MM 220MM TROCAR POINT THREADED,$68.90,$0.00,$68.90,$31.01,$49.17,$0.00,$11.53,$0.00,$0.00,$12.06,$68.90,$0.00,$34.45,$54.57,$55.12,$0.00,$10.47,$0.00,$10.97,$0.00
02.226.001,SUP,HCPCS C1713,,02.226.001  -  GUIDEWIRE ORTHOPEDIC 1.6MM 220MM TROCAR POINT NONTHREADED,$68.25,$0.00,$68.25,$30.71,$48.71,$0.00,$11.41,$0.00,$0.00,$11.95,$68.25,$0.00,$34.13,$54.05,$54.60,$0.00,$10.37,$0.00,$10.87,$0.00
02.226.010,SUP,HCPCS C1713,,02.226.010  -  SCREW BONE T8 3MM 2MM 1.1MM 10MM 4MM SELF DRILL SELF TAP,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.011,SUP,HCPCS C1713,,02.226.011  -  SCREW BONE T8 3MM 2MM 1.1MM 11MM 4MM SELF DRILL SELF TAP,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.012,SUP,HCPCS C1713,,02.226.012  -  SCREW BONE T8 3MM 2MM 1.1MM 12MM 4MM SELF DRILL SELF TAP,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.013,SUP,HCPCS C1713,,02.226.013  -  SCREW BONE T8 3MM 2MM 1.1MM 13MM 4MM SELF DRILL SELF TAP,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.014,SUP,HCPCS C1713,,02.226.014  -  SCREW BONE T8 3MM 2MM 1.1MM 14MM 4MM SELF DRILL SELF TAP,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.015,SUP,HCPCS C1713,,02.226.015  -  SCREW BONE T8 3MM 2MM 1.1MM 15MM 4MM SELF DRILL SELF TAP,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.016,SUP,HCPCS C1713,,02.226.016  -  SCREW BONE T8 3MM 2MM 1.1MM 16MM 4MM SELF DRILL SELF TAP,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.017,SUP,HCPCS C1713,,02.226.017  -  SCREW BONE T8 3MM 2MM 1.1MM 17MM 4MM SELF DRILL SELF TAP,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.018,SUP,HCPCS C1713,,02.226.018  -  SCREW BONE 1.1MM SHORT THREAD 3MM 2MM 18MM 4MM T8 STARDRIVE,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.019,SUP,HCPCS C1713,,02.226.019  -  SCREW BONE T8 3MM 2MM 1.1MM 19MM 4MM SELF DRILL SELF TAP,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.020,SUP,HCPCS C1713,,02.226.020  -  SCREW BONE T8 3MM 2MM 1.1MM 20MM 4MM SELF DRILL SELF TAP,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.021,SUP,HCPCS C1713,,02.226.021  -  SCREW BONE T8 3MM 2MM 1.1MM 21MM 4MM SELF DRILL SELF TAP,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.022,SUP,HCPCS C1713,,02.226.022  -  SCREW BONE T8 3MM 2MM 1.1MM 22MM 4MM SELF DRILL SELF TAP,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.023,SUP,HCPCS C1713,,02.226.023  -  SCREW BONE T8 3MM 2MM 1.1MM 23MM 4MM SELF DRILL SELF TAP,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.024,SUP,HCPCS C1713,,02.226.024  -  SCREW BONE T8 3MM 2MM 1.1MM 24MM 5MM SELF DRILL SELF TAP,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.025,SUP,HCPCS C1713,,02.226.025  -  SCREW BONE T8 3MM 2MM 1.1MM 25MM 5MM SELF DRILL SELF TAP,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.026,SUP,HCPCS C1713,,02.226.026  -  SCREW BONE T8 3MM 2MM 1.1MM 26MM 5MM SELF DRILL SELF TAP,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.027,SUP,HCPCS C1713,,02.226.027  -  SCREW BONE T8 3MM 2MM 1.1MM 27MM 6MM SELF DRILL SELF TAP,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.028,SUP,HCPCS C1713,,02.226.028  -  SCREW BONE T8 3MM 2MM 1.1MM 28MM 6MM SELF DRILL SELF TAP,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.029,SUP,HCPCS C1713,,02.226.029  -  SCREW BONE T8 3MM 2MM 1.1MM 29MM 6MM SELF DRILL SELF TAP,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.030,SUP,HCPCS C1713,,02.226.030  -  SCREW BONE T8 3MM 2MM 1.1MM 30MM 7MM SELF DRILL SELF TAP,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.032,SUP,HCPCS C1713,,02.226.032  -  SCREW BONE T8 3MM 2MM 1.1MM 32MM 7MM SELF DRILL SELF TAP,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.034,SUP,HCPCS C1713,,02.226.034  -  SCREW BONE T8 3MM 2MM 1.1MM 34MM 8MM SELF DRILL SELF TAP,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.036,SUP,HCPCS C1713,,02.226.036  -  SCREW BONE 1.1MM SHORT THREAD 3MM 2MM 36MM 9MM T8 STARDRIVE,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.038,SUP,HCPCS C1713,,02.226.038  -  SCREW BONE T8 3MM 2MM 1.1MM 38MM 9MM SELF DRILL SELF TAP,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.040,SUP,HCPCS C1713,,02.226.040  -  SCREW BONE T8 3MM 2MM 1.1MM 40MM 10MM SELF DRILL SELF TAP,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.116,SUP,HCPCS C1713,,02.226.116  -  SCREW BONE LNGTHRD 3MM 2MM 16MM 5MM SELF TAP DRILL,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.117,SUP,HCPCS C1713,,02.226.117  -  SCREW BONE LNGTHRD 3MM 2MM 17MM 6MM T8 STARDRIVE CANN SELF,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.118,SUP,HCPCS C1713,,02.226.118  -  SCREW BONE LNGTHRD 3MM 2MM 1.1MM 18MM 6MM T8 STARDRIVE CANN,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.119,SUP,HCPCS C1713,,02.226.119  -  SCREW BONE LNGTHRD 3MM 2MM 1.1MM 19MM 7MM T8 STARDRIVE CANN,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.120,SUP,HCPCS C1713,,02.226.120  -  SCREW BONE LNGTHRD 3MM 2MM 20MM 7MM T8 STARDRIVE CANN SELF,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.121,SUP,HCPCS C1713,,02.226.121  -  SCREW BONE LNGTHRD 3MM 2MM 1.1MM 21MM 8MM T8 STARDRIVE CANN,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.122,SUP,HCPCS C1713,,02.226.122  -  SCREW BONE T8 3MM 2MM 1.1MM 22MM 8MM SELF DRILL SELF TAP,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.123,SUP,HCPCS C1713,,02.226.123  -  SCREW BONE LNGTHRD 3MM 2MM 1.1MM 23MM 8MM T8 STARDRIVE CANN,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.124,SUP,HCPCS C1713,,02.226.124  -  SCREW BONE LNGTHRD 3MM 2MM 1.1MM 24MM 8MM T8 STARDRIVE CANN,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.125,SUP,HCPCS C1713,,02.226.125  -  SCREW BONE T8 3MM 2MM 1.1MM 25MM 8MM SELF DRILL SELF TAP,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.126,SUP,HCPCS C1713,,02.226.126  -  SCREW BONE 1.1MM LNGTHRD 3MM 2MM 26MM 10MM T8 STARDRIVE,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.127,SUP,HCPCS C1713,,02.226.127  -  SCREW BONE T8 3MM 2MM 1.1MM 27MM 10MM SELF DRILL SELF TAP,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.128,SUP,HCPCS C1713,,02.226.128  -  SCREW BONE T8 3MM 2MM 1.1MM 28MM 10MM SELF DRILL SELF TAP,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.129,SUP,HCPCS C1713,,02.226.129  -  SCREW BONE LNGTHRD 3MM 2MM 1.1MM 29MM 10MM T8 STARDRIVE CANN,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.130,SUP,HCPCS C1713,,02.226.130  -  SCREW BONE T8 3MM 2MM 1.1MM 30MM 12MM SELF DRILL SELF TAP,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.132,SUP,HCPCS C1713,,02.226.132  -  SCREW BONE 1.1MM LNGTHRD 3MM 2MM 32MM 12MM COMPRESSION CANN,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.134,SUP,HCPCS C1713,,02.226.134  -  SCREW BONE T8 3MM 2MM 1.1MM 34MM 14MM SELF DRILL SELF TAP,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.136,SUP,HCPCS C1713,,02.226.136  -  SCREW BONE LNGTHRD 3MM 2MM 36MM 14MM COMPRESSION CANN T8,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.138,SUP,HCPCS C1713,,02.226.138  -  SCREW BN T8 L/T FLUT 3MM 2MM 38MM NS 16MM CMPR CNN ST HDLS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.140,SUP,HCPCS C1713,,02.226.140  -  SCREW BONE T8 3MM 2MM 1.1MM 40MM 16MM SELF DRILL SELF TAP,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.209,SUP,HCPCS C1713,,02.226.209  -  SCREW BONE SHORT THREAD 2.4MM 9MM 4MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.210,SUP,HCPCS C1713,,02.226.210  -  SCREW BONE T8 2.4MM 10MM 4MM SELF DRILL SELF TAP CANN,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.211,SUP,HCPCS C1713,,02.226.211  -  SCREW BONE T8 2.4MM 11MM 4MM SELF DRILL SELF TAP CANN,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.212,SUP,HCPCS C1713,,02.226.212  -  SCREW BONE T8 2.4MM 12MM 4MM SELF DRILL SELF TAP CANN,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.213,SUP,HCPCS C1713,,02.226.213  -  SCREW BONE T8 2.4MM 13MM 4MM SELF DRILL SELF TAP CANN,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.214,SUP,HCPCS C1713,,02.226.214  -  SCREW BONE T8 2.4MM 14MM 4MM SELF DRILL SELF TAP CANN,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.215,SUP,HCPCS C1713,,02.226.215  -  SCREW BONE T8 2.4MM 15MM 4MM SELF DRILL SELF TAP CANN,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.216,SUP,HCPCS C1713,,02.226.216  -  SCREW BONE T8 2.4MM 16MM 4MM SELF DRILL SELF TAP CANN,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.217,SUP,HCPCS C1713,,02.226.217  -  SCREW BONE T8 2.4MM 17MM 4MM SELF DRILL SELF TAP CANN,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.218,SUP,HCPCS C1713,,02.226.218  -  SCREW BONE T8 2.4MM 18MM 4MM SELF DRILL SELF TAP CANN,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.219,SUP,HCPCS C1713,,02.226.219  -  SCREW BONE T8 2.4MM 19MM 4MM SELF DRILL SELF TAP CANN,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.220,SUP,HCPCS C1713,,02.226.220  -  SCREW BONE T8 2.4MM 20MM 4MM SELF DRILL SELF TAP CANN,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.221,SUP,HCPCS C1713,,02.226.221  -  SCREW BONE T8 2.4MM 21MM 4MM SELF DRILL SELF TAP CANN,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.222,SUP,HCPCS C1713,,02.226.222  -  SCREW BONE T8 2.4MM 22MM 4MM SELF DRILL SELF TAP CANN,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.223,SUP,HCPCS C1713,,02.226.223  -  SCREW BONE T8 2.4MM 23MM 4MM SELF DRILL SELF TAP CANN,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.224,SUP,HCPCS C1713,,02.226.224  -  SCREW BONE T8 2.4MM 24MM 5MM SELF DRILL SELF TAP CANN,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.225,SUP,HCPCS C1713,,02.226.225  -  SCREW BONE T8 2.4MM 25MM 5MM SELF DRILL SELF TAP CANN,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.226,SUP,HCPCS C1713,,02.226.226  -  SCREW BONE T8 2.4MM 26MM 5MM SELF DRILL SELF TAP CANN,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.227,SUP,HCPCS C1713,,02.226.227  -  SCREW BONE T8 2.4MM 27MM 6MM SELF DRILL SELF TAP CANN,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.228,SUP,HCPCS C1713,,02.226.228  -  SCREW BONE T8 2.4MM 28MM 6MM SELF DRILL SELF TAP CANN,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.229,SUP,HCPCS C1713,,02.226.229  -  SCREW BONE T8 2.4MM 29MM 6MM SELF DRILL SELF TAP CANN,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.230,SUP,HCPCS C1713,,02.226.230  -  SCREW BONE T8 2.4MM 30MM 7MM SELF DRILL SELF TAP CANN,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.232,SUP,HCPCS C1713,,02.226.232  -  SCREW BONE T8 2.4MM 32MM 7MM SELF DRILL SELF TAP CANN,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.234,SUP,HCPCS C1713,,02.226.234  -  SCREW BONE T8 2.4MM 34MM 8MM SELF DRILL SELF TAP CANN,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.236,SUP,HCPCS C1713,,02.226.236  -  SCREW BONE T8 2.4MM 36MM 9MM SELF DRILL SELF TAP CANN,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.238,SUP,HCPCS C1713,,02.226.238  -  SCREW BONE T8 2.4MM 38MM 9MM SELF DRILL SELF TAP CANN,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.240,SUP,HCPCS C1713,,02.226.240  -  SCREW BONE T8 2.4MM 40MM 10MM SELF DRILL SELF TAP CANN,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.317,SUP,HCPCS C1713,,02.226.317  -  SCREW BONE T8 2.4MM 17MM 6MM SELF DRILL SELF TAP CANN,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.318,SUP,HCPCS C1713,,02.226.318  -  SCREW BONE T8 2.4MM 18MM 6MM SELF DRILL SELF TAP CANN,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.319,SUP,HCPCS C1713,,02.226.319  -  SCREW BONE T8 2.4MM 19MM 7MM SELF DRILL SELF TAP CANN,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.320,SUP,HCPCS C1713,,02.226.320  -  SCREW BONE T8 2.4MM 20MM 7MM SELF DRILL SELF TAP CANN,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.321,SUP,HCPCS C1713,,02.226.321  -  SCREW BONE T8 2.4MM 21MM 8MM SELF DRILL SELF TAP CANN,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.322,SUP,HCPCS C1713,,02.226.322  -  SCREW BONE T8 2.4MM 22MM 8MM SELF DRILL SELF TAP CANN,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.323,SUP,HCPCS C1713,,02.226.323  -  SCREW BONE T8 2.4MM 23MM 8MM SELF DRILL SELF TAP CANN,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.324,SUP,HCPCS C1713,,02.226.324  -  SCREW BONE T8 2.4MM 24MM 8MM SELF DRILL SELF TAP CANN,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.325,SUP,HCPCS C1713,,02.226.325  -  SCREW BONE T8 2.4MM 25MM 8MM SELF DRILL SELF TAP CANN,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.326,SUP,HCPCS C1713,,02.226.326  -  SCREW BONE T8 2.4MM 26MM 10MM SELF DRILL SELF TAP CANN,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.327,SUP,HCPCS C1713,,02.226.327  -  SCREW BONE T8 2.4MM 27MM 10MM SELF DRILL SELF TAP CANN,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.328,SUP,HCPCS C1713,,02.226.328  -  SCREW BONE T8 2.4MM 28MM 10MM SELF DRILL SELF TAP CANN,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.329,SUP,HCPCS C1713,,02.226.329  -  SCREW BONE T8 2.4MM 29MM 10MM SELF DRILL SELF TAP CANN,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.330,SUP,HCPCS C1713,,02.226.330  -  SCREW BONE T8 2.4MM 30MM 12MM SELF DRILL SELF TAP CANN,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.332,SUP,HCPCS C1713,,02.226.332  -  SCREW BONE T8 2.4MM 32MM 12MM SELF DRILL SELF TAP CANN,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.334,SUP,HCPCS C1713,,02.226.334  -  SCREW BONE T8 2.4MM 34MM 14MM SELF DRILL SELF TAP CANN,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.336,SUP,HCPCS C1713,,02.226.336  -  SCREW BONE T8 2.4MM 36MM 14MM SELF DRILL SELF TAP CANN,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.338,SUP,HCPCS C1713,,02.226.338  -  SCREW BONE T8 2.4MM 38MM 16MM SELF DRILL SELF TAP CANN,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.340,SUP,HCPCS C1713,,02.226.340  -  SCREW BONE T8 2.4MM 40MM 16MM SELF DRILL SELF TAP CANN,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
02.226.620,SUP,HCPCS C1713,,02.226.620  -  SCREW BONE T15 4.5MM 20MM 7MM SELF DRILL SELF TAP,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.226.622,SUP,HCPCS C1713,,02.226.622  -  SCREW BONE T15 4.5MM 22MM 7MM SELF DRILL SELF TAP,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.226.624,SUP,HCPCS C1713,,02.226.624  -  SCREW BONE T15 4.5MM 24MM 7MM SELF DRILL SELF TAP,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.226.626,SUP,HCPCS C1713,,02.226.626  -  SCREW BONE T15 4.5MM 26MM 7MM SELF DRILL SELF TAP,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.226.628,SUP,HCPCS C1713,,02.226.628  -  SCREW BONE T15 4.5MM 28MM 7MM SELF DRILL SELF TAP,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.226.630,SUP,HCPCS C1713,,02.226.630  -  SCREW BONE SHORT THREAD 4.5MM 30MM 7MM COMPRESSION HEADLESS,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.226.632,SUP,HCPCS C1713,,02.226.632  -  SCREW BONE T15 4.5MM 32MM 7MM SELF DRILL SELF TAP,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.226.634,SUP,HCPCS C1713,,02.226.634  -  SCREW BONE T15 4.5MM 34MM 7MM SELF DRILL SELF TAP,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.226.636,SUP,HCPCS C1713,,02.226.636  -  SCREW BONE T15 4.5MM 36MM 7MM SELF DRILL SELF TAP,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.226.638,SUP,HCPCS C1713,,02.226.638  -  SCREW BONE T15 4.5MM 38MM 7MM SELF DRILL SELF TAP,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.226.640,SUP,HCPCS C1713,,02.226.640  -  SCREW BONE T15 4.5MM 40MM 8MM SELF DRILL SELF TAP,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.226.642,SUP,HCPCS C1713,,02.226.642  -  SCREW BONE T15 4.5MM 42MM 8MM SELF DRILL SELF TAP,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.226.644,SUP,HCPCS C1713,,02.226.644  -  SCREW BONE T15 4.5MM 44MM 9MM SELF DRILL SELF TAP,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.226.646,SUP,HCPCS C1713,,02.226.646  -  SCREW BONE T15 4.5MM 46MM 9MM SELF DRILL SELF TAP,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.226.648,SUP,HCPCS C1713,,02.226.648  -  SCREW BONE T15 4.5MM 48MM 9MM SELF DRILL SELF TAP,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.226.650,SUP,HCPCS C1713,,02.226.650  -  SCREW BONE T15 4.5MM 50MM 10MM SELF DRILL SELF TAP,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.226.652,SUP,HCPCS C1713,,02.226.652  -  SCREW BONE T15 4.5MM 52MM 10MM SELF DRILL SELF TAP,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.226.654,SUP,HCPCS C1713,,02.226.654  -  SCREW BONE T15 4.5MM 54MM 11MM SELF DRILL SELF TAP,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.226.656,SUP,HCPCS C1713,,02.226.656  -  SCREW BONE T15 4.5MM 56MM 11MM SELF DRILL SELF TAP,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.226.658,SUP,HCPCS C1713,,02.226.658  -  SCREW BONE T15 4.5MM 58MM 11MM SELF DRILL SELF TAP,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.226.660,SUP,HCPCS C1713,,02.226.660  -  SCREW BONE T15 4.5MM 60MM 12MM SELF DRILL SELF TAP,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.226.665,SUP,HCPCS C1713,,02.226.665  -  SCREW BONE T15 4.5MM 65MM 13MM SELF DRILL SELF TAP,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.226.670,SUP,HCPCS C1713,,02.226.670  -  SCREW BONE T15 4.5MM 70MM 14MM SELF DRILL SELF TAP,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.226.675,SUP,HCPCS C1713,,02.226.675  -  SCREW BONE T15 4.5MM 75MM 15MM SELF DRILL SELF TAP,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.226.680,SUP,HCPCS C1713,,02.226.680  -  SCREW BONE T15 4.5MM 80MM 16MM SELF DRILL SELF TAP,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.226.685,SUP,HCPCS C1713,,02.226.685  -  SCREW BONE T15 4.5MM 85MM 17MM SELF DRILL SELF TAP,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.226.690,SUP,HCPCS C1713,,02.226.690  -  SCREW BONE T15 4.5MM 90MM 18MM SELF DRILL SELF TAP,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.226.695,SUP,HCPCS C1713,,02.226.695  -  SCREW BONE T15 4.5MM 95MM 19MM SELF DRILL SELF TAP,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.226.700,SUP,HCPCS C1713,,02.226.700  -  SCREW BONE T15 4.5MM 100MM 20MM SELF DRILL SELF TAP,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.226.730,SUP,HCPCS C1713,,02.226.730  -  SCREW BONE T15 4.5MM 30MM 12MM SELF DRILL SELF TAP,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.226.732,SUP,HCPCS C1713,,02.226.732  -  SCREW BONE T15 4.5MM 32MM 12MM SELF DRILL SELF TAP,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.226.734,SUP,HCPCS C1713,,02.226.734  -  SCREW BONE T15 4.5MM 34MM 12MM SELF DRILL SELF TAP,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.226.736,SUP,HCPCS C1713,,02.226.736  -  SCREW BONE T15 4.5MM 36MM 14MM SELF DRILL SELF TAP,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.226.738,SUP,HCPCS C1713,,02.226.738  -  SCREW BONE T15 4.5MM 38MM 14MM SELF DRILL SELF TAP,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.226.740,SUP,HCPCS C1713,,02.226.740  -  SCREW BONE T15 4.5MM 40MM 16MM SELF DRILL SELF TAP,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.226.742,SUP,HCPCS C1713,,02.226.742  -  SCREW BONE T15 4.5MM 42MM 16MM SELF DRILL SELF TAP,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.226.744,SUP,HCPCS C1713,,02.226.744  -  SCREW BONE T15 4.5MM 44MM 18MM SELF DRILL SELF TAP,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.226.746,SUP,HCPCS C1713,,02.226.746  -  SCREW BONE T15 4.5MM 46MM 18MM SELF DRILL SELF TAP,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.226.748,SUP,HCPCS C1713,,02.226.748  -  SCREW BONE T15 4.5MM 48MM 18MM SELF DRILL SELF TAP,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.226.750,SUP,HCPCS C1713,,02.226.750  -  SCREW BONE T15 4.5MM 50MM 20MM SELF DRILL SELF TAP,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.226.752,SUP,HCPCS C1713,,02.226.752  -  SCREW BONE T15 4.5MM 52MM 20MM SELF DRILL SELF TAP,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.226.754,SUP,HCPCS C1713,,02.226.754  -  SCREW BONE T15 4.5MM 54MM 22MM SELF DRILL SELF TAP,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.226.756,SUP,HCPCS C1713,,02.226.756  -  SCREW BONE LNGTHRD 4.5MM 56MM 22MM SLFDRILL SLFTAP,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.226.758,SUP,HCPCS C1713,,02.226.758  -  SCREW BONE T15 4.5MM 58MM 22MM SELF DRILL SELF TAP,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.226.760,SUP,HCPCS C1713,,02.226.760  -  SCREW BONE T15 4.5MM 60MM 24MM SELF DRILL SELF TAP,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.226.765,SUP,HCPCS C1713,,02.226.765  -  SCREW BONE T15 4.5MM 65MM 26MM SELF DRILL SELF TAP,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.226.770,SUP,HCPCS C1713,,02.226.770  -  SCREW BONE T15 4.5MM 70MM 28MM SELF DRILL SELF TAP,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.226.775,SUP,HCPCS C1713,,02.226.775  -  SCREW BONE T15 4.5MM 75MM 30MM SELF DRILL SELF TAP,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.226.780,SUP,HCPCS C1713,,02.226.780  -  SCREW BONE T15 4.5MM 80MM 32MM SELF DRILL SELF TAP,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.226.785,SUP,HCPCS C1713,,02.226.785  -  SCREW BONE T15 4.5MM 85MM 34MM SELF DRILL SELF TAP,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.226.790,SUP,HCPCS C1713,,02.226.790  -  SCREW BONE T15 4.5MM 90MM 36MM SELF DRILL SELF TAP,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.226.795,SUP,HCPCS C1713,,02.226.795  -  SCREW BONE T15 4.5MM 95MM 38MM SELF DRILL SELF TAP,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.226.800,SUP,HCPCS C1713,,02.226.800  -  SCREW BONE T15 4.5MM 100MM 40MM SELF DRILL SELF TAP,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.227.001,SUP,HCPCS C1713,,02.227.001  -  GUIDEWIRE ORTHOPEDIC 2.8MM 300MM NONTHREADED TROCAR POINT,$77.10,$0.00,$77.10,$34.70,$55.03,$0.00,$12.90,$0.00,$0.00,$13.50,$77.10,$0.00,$38.55,$61.06,$61.68,$0.00,$11.71,$0.00,$12.27,$0.00
02.227.030,SUP,HCPCS C1713,,02.227.030  -  SCREW BONE 6.5MM 30MM 16MM SELF DRILL SELF TAP COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.227.035,SUP,HCPCS C1713,,02.227.035  -  SCREW BONE 6.5MM 35MM 16MM SELF DRILL SELF TAP COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.227.040,SUP,HCPCS C1713,,02.227.040  -  SCREW BONE 6.5MM 40MM 16MM SELF DRILL SELF TAP COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.227.045,SUP,HCPCS C1713,,02.227.045  -  SCREW BONE 6.5MM 45MM 16MM SELF DRILL SELF TAP COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.227.050,SUP,HCPCS C1713,,02.227.050  -  SCREW BONE 6.5MM 50MM 16MM SELF DRILL SELF TAP COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.227.055,SUP,HCPCS C1713,,02.227.055  -  SCREW BONE 6.5MM 55MM 16MM SELF DRILL SELF TAP COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.227.060,SUP,HCPCS C1713,,02.227.060  -  SCREW BONE 6.5MM 60MM 16MM SELF DRILL SELF TAP COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.227.065,SUP,HCPCS C1713,,02.227.065  -  SCREW BONE 6.5MM 65MM 16MM SELF DRILL SELF TAP COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.227.070,SUP,HCPCS C1713,,02.227.070  -  SCREW BONE 6.5MM 70MM 16MM SELF DRILL SELF TAP COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.227.075,SUP,HCPCS C1713,,02.227.075  -  SCREW BONE 6.5MM 75MM 16MM SELF DRILL SELF TAP COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.227.080,SUP,HCPCS C1713,,02.227.080  -  SCREW BONE 6.5MM 80MM 16MM SELF DRILL SELF TAP COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.227.085,SUP,HCPCS C1713,,02.227.085  -  SCREW BONE 6.5MM 85MM 16MM SELF DRILL SELF TAP COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.227.090,SUP,HCPCS C1713,,02.227.090  -  SCREW BONE 6.5MM 90MM 16MM SELF DRILL SELF TAP COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.227.095,SUP,HCPCS C1713,,02.227.095  -  SCREW BONE 6.5MM 95MM 16MM SELF DRILL SELF TAP COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.227.100,SUP,HCPCS C1713,,02.227.100  -  SCREW BONE 6.5MM 100MM 16MM SELF DRILL SELF TAP COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.227.105,SUP,HCPCS C1713,,02.227.105  -  SCREW BONE 6.5MM 105MM 16MM SELF DRILL SELF TAP COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.227.110,SUP,HCPCS C1713,,02.227.110  -  SCREW BONE 6.5MM 110MM 16MM SELF DRILL SELF TAP COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.227.115,SUP,HCPCS C1713,,02.227.115  -  SCREW BONE 6.5MM 115MM 16MM SELF DRILL SELF TAP COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.227.120,SUP,HCPCS C1713,,02.227.120  -  SCREW BONE 6.5MM 120MM 16MM SELF DRILL SELF TAP COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.227.125,SUP,HCPCS C1713,,02.227.125  -  SCREW BONE 6.5MM 125MM 16MM SELF DRILL SELF TAP COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.227.130,SUP,HCPCS C1713,,02.227.130  -  SCREW BONE 6.5MM 130MM 16MM SELF DRILL SELF TAP COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.227.135,SUP,HCPCS C1713,,02.227.135  -  SCREW BONE 6.5MM 135MM 16MM SELF DRILL SELF TAP COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.227.140,SUP,HCPCS C1713,,02.227.140  -  SCREW BONE 6.5MM 140MM 16MM SELF DRILL SELF TAP COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.227.145,SUP,HCPCS C1713,,02.227.145  -  SCREW BONE 6.5MM 145MM 16MM SELF DRILL SELF TAP COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.227.150,SUP,HCPCS C1713,,02.227.150  -  SCREW BONE 6.5MM 150MM 16MM SELF DRILL SELF TAP COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.227.245,SUP,HCPCS C1713,,02.227.245  -  SCREW BONE 6.5MM 45MM 32MM SELF DRILL SELF TAP COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.227.250,SUP,HCPCS C1713,,02.227.250  -  SCREW BONE 6.5MM 50MM 32MM SELF DRILL SELF TAP COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.227.255,SUP,HCPCS C1713,,02.227.255  -  SCREW BONE 6.5MM 55MM 32MM SELF DRILL SELF TAP COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.227.260,SUP,HCPCS C1713,,02.227.260  -  SCREW BONE 6.5MM 60MM 32MM SELF DRILL SELF TAP COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.227.265,SUP,HCPCS C1713,,02.227.265  -  SCREW BONE 6.5MM 65MM 32MM SELF DRILL SELF TAP COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.227.270,SUP,HCPCS C1713,,02.227.270  -  SCREW BONE 6.5MM 70MM 32MM SELF DRILL SELF TAP COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.227.275,SUP,HCPCS C1713,,02.227.275  -  SCREW BONE 6.5MM 75MM 32MM SELF DRILL SELF TAP COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.227.280,SUP,HCPCS C1713,,02.227.280  -  SCREW BONE 6.5MM 80MM 32MM SELF DRILL SELF TAP COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.227.285,SUP,HCPCS C1713,,02.227.285  -  SCREW BONE 6.5MM 7.5MM 85MM 32MM 2 LEAD COMPRESSION SLFTAP,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.227.290,SUP,HCPCS C1713,,02.227.290  -  SCREW BN 6.5MM 7.5MM 90MM NS 32MM CMPR ST SLF DRL HDLS SS,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.227.295,SUP,HCPCS C1713,,02.227.295  -  SCREW BONE 6.5MM 95MM 32MM COMPRESSION HEADLESS STAINLESS,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.227.300,SUP,HCPCS C1713,,02.227.300  -  SCREW BONE 6.5MM 100MM 32MM COMPRESSION HEADLESS STAINLESS,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.227.305,SUP,HCPCS C1713,,02.227.305  -  SCREW BONE FLUTE 6.5MM 7.5MM 105MM 32MM 2 LEAD SELF TAP SELF,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.227.310,SUP,HCPCS C1713,,02.227.310  -  SCREW BONE FLUTE 6.5MM 7.5MM 110MM 32MM 2 LEAD SELF TAP SELF,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.227.315,SUP,HCPCS C1713,,02.227.315  -  SCREW BONE FLUTE 6.5MM 7.5MM 115MM 32MM 2 LEAD SELF TAP SELF,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.227.320,SUP,HCPCS C1713,,02.227.320  -  SCREW BN 4MM FLUT 6.5MM 7.5MM 120MM NS 32MM 2 LD ST SLF DRL,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.227.325,SUP,HCPCS C1713,,02.227.325  -  SCREW BN 4MM FLUT 6.5MM 7.5MM 125MM NS 32MM 2 LD ST SLF DRL,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.227.330,SUP,HCPCS C1713,,02.227.330  -  SCREW BONE FLUTE 6.5MM 7.5MM 130MM 32MM 2 LEAD SELF TAP SELF,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.227.335,SUP,HCPCS C1713,,02.227.335  -  SCREW BONE 6.5MM 135MM 32MM SELF DRILL SELF TAP COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.227.340,SUP,HCPCS C1713,,02.227.340  -  SCREW BONE 6.5MM 140MM 32MM SELF DRILL SELF TAP COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.227.345,SUP,HCPCS C1713,,02.227.345  -  SCREW BONE 6.5MM 145MM 32MM SELF DRILL SELF TAP COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.227.350,SUP,HCPCS C1713,,02.227.350  -  SCREW BONE 6.5MM 150MM 32MM SELF DRILL SELF TAP COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
02.230.109,SUP,HCPCS C1713,,02.230.109  -  SCREW BONE T4 1.5MM 9MM 4MM SELF DRILL SELF TAP COMPRESSION,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
02.230.110,SUP,HCPCS C1713,,02.230.110  -  SCREW BONE T4 1.5MM 10MM 4MM SELF DRILL SELF TAP COMPRESSION,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
02.230.111,SUP,HCPCS C1713,,02.230.111  -  SCREW BONE T4 1.5MM 11MM 4MM SELF DRILL SELF TAP COMPRESSION,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
02.230.112,SUP,HCPCS C1713,,02.230.112  -  SCREW BONE T4 1.5MM 12MM 4MM SELF DRILL SELF TAP COMPRESSION,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
02.230.113,SUP,HCPCS C1713,,02.230.113  -  SCREW BONE T4 1.5MM 13MM 4MM SELF DRILL SELF TAP COMPRESSION,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
02.230.114,SUP,HCPCS C1713,,02.230.114  -  SCREW BONE 1.5MM 1MM 14MM 4MM COMPRESSION THREAD HEADLESS T4,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
02.230.115,SUP,HCPCS C1713,,02.230.115  -  SCREW BONE T4 1.5MM 15MM 4MM SELF DRILL SELF TAP COMPRESSION,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
02.230.116,SUP,HCPCS C1713,,02.230.116  -  SCREW BONE T4 1.5MM 16MM 5MM SELF DRILL SELF TAP COMPRESSION,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
02.230.117,SUP,HCPCS C1713,,02.230.117  -  SCREW BONE T4 1.5MM 17MM 5MM SELF DRILL SELF TAP COMPRESSION,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
02.230.118,SUP,HCPCS C1713,,02.230.118  -  SCREW BONE T4 1.5MM 18MM 5MM SELF DRILL SELF TAP COMPRESSION,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
02.230.119,SUP,HCPCS C1713,,02.230.119  -  SCREW BONE T4 1.5MM 19MM 5MM SELF DRILL SELF TAP COMPRESSION,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
02.230.120,SUP,HCPCS C1713,,02.230.120  -  SCREW BONE T4 1.5MM 20MM 6MM SELF DRILL SELF TAP COMPRESSION,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
02.231.012,SUP,HCPCS C1713,,02.231.012  -  SCREW BONE T25 5MM 12MM VAR ANG SELF TAP STARDRIVE LCP,$465.38,$0.00,$465.38,$209.42,$332.14,$0.00,$77.85,$0.00,$0.00,$81.48,$465.38,$0.00,$232.69,$368.58,$372.30,$0.00,$70.71,$0.00,$74.09,$0.00
02.231.016,SUP,HCPCS C1713,,02.231.016  -  SCREW BONE T25 5MM 16MM VAR ANG SELF TAP STARDRIVE LCP,$465.38,$0.00,$465.38,$209.42,$332.14,$0.00,$77.85,$0.00,$0.00,$81.48,$465.38,$0.00,$232.69,$368.58,$372.30,$0.00,$70.71,$0.00,$74.09,$0.00
02.231.018S,SUP,HCPCS C1713,,02.231.018S  -  SCREW BN T25 5MM 18MM STRL ST LCK VA THRD RND HD SS CNDRL,$554.10,$0.00,$554.10,$249.35,$395.46,$0.00,$92.69,$0.00,$0.00,$97.02,$554.10,$0.00,$277.05,$438.85,$443.28,$0.00,$84.19,$0.00,$88.21,$0.00
02.231.220,SUP,HCPCS C1713,,02.231.220  -  SCREW BONE T25 5MM 20MM VAR ANG SELF TAP STARDRIVE LCP,$331.63,$0.00,$331.63,$149.23,$236.68,$0.00,$55.47,$0.00,$0.00,$58.06,$331.63,$0.00,$165.81,$262.65,$265.30,$0.00,$50.39,$0.00,$52.79,$0.00
02.231.222,SUP,HCPCS C1713,,02.231.222  -  SCREW BONE T25 5MM 22MM VAR ANG SELF TAP STARDRIVE LCP,$331.63,$0.00,$331.63,$149.23,$236.68,$0.00,$55.47,$0.00,$0.00,$58.06,$331.63,$0.00,$165.81,$262.65,$265.30,$0.00,$50.39,$0.00,$52.79,$0.00
02.231.224,SUP,HCPCS C1713,,02.231.224  -  SCREW BONE T25 5MM 24MM VAR ANG SELF TAP STARDRIVE LCP,$331.63,$0.00,$331.63,$149.23,$236.68,$0.00,$55.47,$0.00,$0.00,$58.06,$331.63,$0.00,$165.81,$262.65,$265.30,$0.00,$50.39,$0.00,$52.79,$0.00
02.231.226,SUP,HCPCS C1713,,02.231.226  -  SCREW BONE T25 5MM 26MM VAR ANG SELF TAP STARDRIVE LCP,$331.63,$0.00,$331.63,$149.23,$236.68,$0.00,$55.47,$0.00,$0.00,$58.06,$331.63,$0.00,$165.81,$262.65,$265.30,$0.00,$50.39,$0.00,$52.79,$0.00
02.231.228,SUP,HCPCS C1713,,02.231.228  -  SCREW BONE T25 5MM 28MM VAR ANG SELF TAP STARDRIVE LCP,$331.63,$0.00,$331.63,$149.23,$236.68,$0.00,$55.47,$0.00,$0.00,$58.06,$331.63,$0.00,$165.81,$262.65,$265.30,$0.00,$50.39,$0.00,$52.79,$0.00
02.231.230,SUP,HCPCS C1713,,02.231.230  -  SCREW BONE T25 5MM 30MM VAR ANG SELF TAP STARDRIVE LCP,$331.63,$0.00,$331.63,$149.23,$236.68,$0.00,$55.47,$0.00,$0.00,$58.06,$331.63,$0.00,$165.81,$262.65,$265.30,$0.00,$50.39,$0.00,$52.79,$0.00
02.231.234,SUP,HCPCS C1713,,02.231.234  -  SCREW BONE T25 5MM 34MM VAR ANG SELF TAP STARDRIVE LCP,$331.63,$0.00,$331.63,$149.23,$236.68,$0.00,$55.47,$0.00,$0.00,$58.06,$331.63,$0.00,$165.81,$262.65,$265.30,$0.00,$50.39,$0.00,$52.79,$0.00
02.231.236,SUP,HCPCS C1713,,02.231.236  -  SCREW BONE T25 5MM 36MM VAR ANG SELF TAP STARDRIVE LCP,$331.63,$0.00,$331.63,$149.23,$236.68,$0.00,$55.47,$0.00,$0.00,$58.06,$331.63,$0.00,$165.81,$262.65,$265.30,$0.00,$50.39,$0.00,$52.79,$0.00
02.231.238,SUP,HCPCS C1713,,02.231.238  -  SCREW BONE T25 5MM 38MM VAR ANG SELF TAP STARDRIVE LCP,$331.63,$0.00,$331.63,$149.23,$236.68,$0.00,$55.47,$0.00,$0.00,$58.06,$331.63,$0.00,$165.81,$262.65,$265.30,$0.00,$50.39,$0.00,$52.79,$0.00
02.231.240,SUP,HCPCS C1713,,02.231.240  -  SCREW BONE T25 5MM 40MM VAR ANG SELF TAP STARDRIVE LCP,$331.63,$0.00,$331.63,$149.23,$236.68,$0.00,$55.47,$0.00,$0.00,$58.06,$331.63,$0.00,$165.81,$262.65,$265.30,$0.00,$50.39,$0.00,$52.79,$0.00
02.231.280,SUP,HCPCS C1713,,02.231.280  -  SCREW BONE T25 5MM 80MM VAR ANG SELF TAP STARDRIVE LCP,$331.63,$0.00,$331.63,$149.23,$236.68,$0.00,$55.47,$0.00,$0.00,$58.06,$331.63,$0.00,$165.81,$262.65,$265.30,$0.00,$50.39,$0.00,$52.79,$0.00
02.231.285,SUP,HCPCS C1713,,02.231.285  -  SCREW BONE T25 5MM 85MM VAR ANG SELF TAP STARDRIVE LCP,$331.63,$0.00,$331.63,$149.23,$236.68,$0.00,$55.47,$0.00,$0.00,$58.06,$331.63,$0.00,$165.81,$262.65,$265.30,$0.00,$50.39,$0.00,$52.79,$0.00
02.231.295S,SUP,HCPCS C1713,,02.231.295S  -  SCREW BN 5MM 95MM STRL LCP T25 STRDR RCS LCK VA ST SS CNDYL,$423.08,$0.00,$423.08,$190.38,$301.95,$0.00,$70.77,$0.00,$0.00,$74.08,$423.08,$0.00,$211.54,$335.08,$338.46,$0.00,$64.28,$0.00,$67.35,$0.00
02.231.300S,SUP,HCPCS C1713,,02.231.300S  -  SCREW BN 5MM 100MM STRL LCP T25 STRDR RCS LCK VA ST SS CNDYL,$423.08,$0.00,$423.08,$190.38,$301.95,$0.00,$70.77,$0.00,$0.00,$74.08,$423.08,$0.00,$211.54,$335.08,$338.46,$0.00,$64.28,$0.00,$67.35,$0.00
02.231.640,SUP,HCPCS C1713,,02.231.640  -  SCREW BONE 3.5MM HEXAGON FLUTE 5MM 40MM VAR ANG SELF DRILL,$450.38,$0.00,$450.38,$202.67,$321.43,$0.00,$75.34,$0.00,$0.00,$78.86,$450.38,$0.00,$225.19,$356.70,$360.30,$0.00,$68.43,$0.00,$71.70,$0.00
02.231.675,SUP,HCPCS C1713,,02.231.675  -  SCREW BONE 3.5MM HEXAGON FLUTE 5MM 75MM VAR ANG SELF DRILL,$450.38,$0.00,$450.38,$202.67,$321.43,$0.00,$75.34,$0.00,$0.00,$78.86,$450.38,$0.00,$225.19,$356.70,$360.30,$0.00,$68.43,$0.00,$71.70,$0.00
02.231.680,SUP,HCPCS C1713,,02.231.680  -  SCREW BONE 3.5MM HEXAGON FLUTE 5MM 80MM VAR ANG SELF DRILL,$450.38,$0.00,$450.38,$202.67,$321.43,$0.00,$55.47,$0.00,$0.00,$78.86,$450.38,$0.00,$225.19,$356.70,$360.30,$0.00,$50.39,$0.00,$71.70,$0.00
02.231.685,SUP,HCPCS C1713,,02.231.685  -  SCREW BONE 3.5MM HEXAGON FLUTE 5MM 85MM VAR ANG SELF DRILL,$450.38,$0.00,$450.38,$202.67,$321.43,$0.00,$75.34,$0.00,$0.00,$78.86,$450.38,$0.00,$225.19,$356.70,$360.30,$0.00,$68.43,$0.00,$71.70,$0.00
02.231.690,SUP,HCPCS C1713,,02.231.690  -  SCREW BONE 3.5MM HEXAGON FLUTE 5MM 90MM VAR ANG SELF DRILL,$450.38,$0.00,$450.38,$202.67,$321.43,$0.00,$75.34,$0.00,$0.00,$78.86,$450.38,$0.00,$225.19,$356.70,$360.30,$0.00,$68.43,$0.00,$71.70,$0.00
02.231.695S,SUP,HCPCS C1713,,02.231.695S  -  SCREW BN 5MM 3.5MM 95MM STRL VA ST TIP LCK CNN SS CNDRL,$544.53,$0.00,$544.53,$245.04,$388.63,$0.00,$91.09,$0.00,$0.00,$95.34,$544.53,$0.00,$272.26,$431.27,$435.62,$0.00,$82.74,$0.00,$86.69,$0.00
02.240.010,SUP,HCPCS C1713,,02.240.010  -  SCREW BONE T15 FULTHD 3.7MM 10MM SELF DRILL SELF TAP LOCK,$348.00,$0.00,$348.00,$156.60,$248.37,$0.00,$58.21,$0.00,$0.00,$60.93,$348.00,$0.00,$174.00,$275.62,$278.40,$0.00,$52.88,$0.00,$55.40,$0.00
02.240.012,SUP,HCPCS C1713,,02.240.012  -  SCREW BONE T15 FULTHD 3.7MM 12MM SELF DRILL SELF TAP LOCK,$348.00,$0.00,$348.00,$156.60,$248.37,$0.00,$58.21,$0.00,$0.00,$60.93,$348.00,$0.00,$174.00,$275.62,$278.40,$0.00,$52.88,$0.00,$55.40,$0.00
02.240.014,SUP,HCPCS C1713,,02.240.014  -  SCREW BONE T15 FULTHD 3.7MM 14MM SELF DRILL SELF TAP LOCK,$348.00,$0.00,$348.00,$156.60,$248.37,$0.00,$58.21,$0.00,$0.00,$60.93,$348.00,$0.00,$174.00,$275.62,$278.40,$0.00,$52.88,$0.00,$55.40,$0.00
02.240.016,SUP,HCPCS C1713,,02.240.016  -  SCREW BONE T15 FULTHD 3.7MM 16MM SELF DRILL SELF TAP LOCK,$348.00,$0.00,$348.00,$156.60,$248.37,$0.00,$58.21,$0.00,$0.00,$60.93,$348.00,$0.00,$174.00,$275.62,$278.40,$0.00,$52.88,$0.00,$55.40,$0.00
02.240.018,SUP,HCPCS C1713,,02.240.018  -  SCREW BONE T15 FULTHD 3.7MM 18MM SELF DRILL SELF TAP LOCK,$348.00,$0.00,$348.00,$156.60,$248.37,$0.00,$58.21,$0.00,$0.00,$60.93,$348.00,$0.00,$174.00,$275.62,$278.40,$0.00,$52.88,$0.00,$55.40,$0.00
02.240.020,SUP,HCPCS C1713,,02.240.020  -  SCREW BONE T15 FULTHD 3.7MM 20MM SELF DRILL SELF TAP LOCK,$348.00,$0.00,$348.00,$156.60,$248.37,$0.00,$58.21,$0.00,$0.00,$60.93,$348.00,$0.00,$174.00,$275.62,$278.40,$0.00,$52.88,$0.00,$55.40,$0.00
02.240.022,SUP,HCPCS C1713,,02.240.022  -  SCREW BONE T15 FULTHD 3.7MM 22MM SELF DRILL SELF TAP LOCK,$348.00,$0.00,$348.00,$156.60,$248.37,$0.00,$58.21,$0.00,$0.00,$60.93,$348.00,$0.00,$174.00,$275.62,$278.40,$0.00,$52.88,$0.00,$55.40,$0.00
02.240.024,SUP,HCPCS C1713,,02.240.024  -  SCREW BONE T15 FULTHD 3.7MM 24MM SELF DRILL SELF TAP LOCK,$348.00,$0.00,$348.00,$156.60,$248.37,$0.00,$58.21,$0.00,$0.00,$60.93,$348.00,$0.00,$174.00,$275.62,$278.40,$0.00,$52.88,$0.00,$55.40,$0.00
02.240.026,SUP,HCPCS C1713,,02.240.026  -  SCREW BONE T15 FULTHD 3.7MM 26MM SELF DRILL SELF TAP LOCK,$348.00,$0.00,$348.00,$156.60,$248.37,$0.00,$58.21,$0.00,$0.00,$60.93,$348.00,$0.00,$174.00,$275.62,$278.40,$0.00,$52.88,$0.00,$55.40,$0.00
02.240.028,SUP,HCPCS C1713,,02.240.028  -  SCREW BONE T15 FULTHD 3.7MM 28MM SELF DRILL SELF TAP LOCK,$348.00,$0.00,$348.00,$156.60,$248.37,$0.00,$58.21,$0.00,$0.00,$60.93,$348.00,$0.00,$174.00,$275.62,$278.40,$0.00,$52.88,$0.00,$55.40,$0.00
02.240.030,SUP,HCPCS C1713,,02.240.030  -  SCREW BONE T15 FULTHD 3.7MM 30MM SELF DRILL SELF TAP LOCK,$348.00,$0.00,$348.00,$156.60,$248.37,$0.00,$58.21,$0.00,$0.00,$60.93,$348.00,$0.00,$174.00,$275.62,$278.40,$0.00,$52.88,$0.00,$55.40,$0.00
02.240.032,SUP,HCPCS C1713,,02.240.032  -  SCREW BONE T15 FULTHD 3.7MM 32MM SELF DRILL SELF TAP LOCK,$348.00,$0.00,$348.00,$156.60,$248.37,$0.00,$58.21,$0.00,$0.00,$60.93,$348.00,$0.00,$174.00,$275.62,$278.40,$0.00,$52.88,$0.00,$55.40,$0.00
02.240.034,SUP,HCPCS C1713,,02.240.034  -  SCREW BONE T15 FULTHD 3.7MM 34MM SELF DRILL SELF TAP LOCK,$348.00,$0.00,$348.00,$156.60,$248.37,$0.00,$58.21,$0.00,$0.00,$60.93,$348.00,$0.00,$174.00,$275.62,$278.40,$0.00,$52.88,$0.00,$55.40,$0.00
02.240.036,SUP,HCPCS C1713,,02.240.036  -  SCREW BONE T15 FULTHD 3.7MM 36MM SELF DRILL SELF TAP LOCK,$348.00,$0.00,$348.00,$156.60,$248.37,$0.00,$58.21,$0.00,$0.00,$60.93,$348.00,$0.00,$174.00,$275.62,$278.40,$0.00,$52.88,$0.00,$55.40,$0.00
02.240.038,SUP,HCPCS C1713,,02.240.038  -  SCREW BONE T15 FULTHD 3.7MM 38MM SELF DRILL SELF TAP LOCK,$348.00,$0.00,$348.00,$156.60,$248.37,$0.00,$58.21,$0.00,$0.00,$60.93,$348.00,$0.00,$174.00,$275.62,$278.40,$0.00,$52.88,$0.00,$55.40,$0.00
02.240.040,SUP,HCPCS C1713,,02.240.040  -  SCREW BONE T15 FULTHD 3.7MM 40MM SELF DRILL SELF TAP LOCK,$348.00,$0.00,$348.00,$156.60,$248.37,$0.00,$58.21,$0.00,$0.00,$60.93,$348.00,$0.00,$174.00,$275.62,$278.40,$0.00,$52.88,$0.00,$55.40,$0.00
02.240.042,SUP,HCPCS C1713,,02.240.042  -  SCREW BONE T15 FULTHD 3.7MM 42MM SELF DRILL SELF TAP LOCK,$348.00,$0.00,$348.00,$156.60,$248.37,$0.00,$58.21,$0.00,$0.00,$60.93,$348.00,$0.00,$174.00,$275.62,$278.40,$0.00,$52.88,$0.00,$55.40,$0.00
02.240.044,SUP,HCPCS C1713,,02.240.044  -  SCREW BONE T15 FULTHD 3.7MM 44MM SELF DRILL SELF TAP LOCK,$348.00,$0.00,$348.00,$156.60,$248.37,$0.00,$58.21,$0.00,$0.00,$60.93,$348.00,$0.00,$174.00,$275.62,$278.40,$0.00,$52.88,$0.00,$55.40,$0.00
02.240.046,SUP,HCPCS C1713,,02.240.046  -  SCREW BONE T15 FULTHD 3.7MM 46MM SELF DRILL SELF TAP LOCK,$348.00,$0.00,$348.00,$156.60,$248.37,$0.00,$58.21,$0.00,$0.00,$60.93,$348.00,$0.00,$174.00,$275.62,$278.40,$0.00,$52.88,$0.00,$55.40,$0.00
02.240.048,SUP,HCPCS C1713,,02.240.048  -  SCREW BONE T15 FULTHD 3.7MM 48MM SELF DRILL SELF TAP LOCK,$348.00,$0.00,$348.00,$156.60,$248.37,$0.00,$58.21,$0.00,$0.00,$60.93,$348.00,$0.00,$174.00,$275.62,$278.40,$0.00,$52.88,$0.00,$55.40,$0.00
02.240.050,SUP,HCPCS C1713,,02.240.050  -  SCREW BONE T15 FULTHD 3.7MM 50MM SELF DRILL SELF TAP LOCK,$348.00,$0.00,$348.00,$156.60,$248.37,$0.00,$58.21,$0.00,$0.00,$60.93,$348.00,$0.00,$174.00,$275.62,$278.40,$0.00,$52.88,$0.00,$55.40,$0.00
02.240.052,SUP,HCPCS C1713,,02.240.052  -  SCREW BONE T15 FULTHD 3.7MM 52MM SELF DRILL SELF TAP LOCK,$348.00,$0.00,$348.00,$156.60,$248.37,$0.00,$58.21,$0.00,$0.00,$60.93,$348.00,$0.00,$174.00,$275.62,$278.40,$0.00,$52.88,$0.00,$55.40,$0.00
02.240.054,SUP,HCPCS C1713,,02.240.054  -  SCREW BONE T15 FULTHD 3.7MM 54MM SELF DRILL SELF TAP LOCK,$348.00,$0.00,$348.00,$156.60,$248.37,$0.00,$58.21,$0.00,$0.00,$60.93,$348.00,$0.00,$174.00,$275.62,$278.40,$0.00,$52.88,$0.00,$55.40,$0.00
02.240.056,SUP,HCPCS C1713,,02.240.056  -  SCREW BONE T15 FULTHD 3.7MM 56MM SELF DRILL SELF TAP LOCK,$348.00,$0.00,$348.00,$156.60,$248.37,$0.00,$58.21,$0.00,$0.00,$60.93,$348.00,$0.00,$174.00,$275.62,$278.40,$0.00,$52.88,$0.00,$55.40,$0.00
02.240.058,SUP,HCPCS C1713,,02.240.058  -  SCREW BONE T15 FULTHD 3.7MM 58MM SELF DRILL SELF TAP LOCK,$348.00,$0.00,$348.00,$156.60,$248.37,$0.00,$58.21,$0.00,$0.00,$60.93,$348.00,$0.00,$174.00,$275.62,$278.40,$0.00,$52.88,$0.00,$55.40,$0.00
02.240.060,SUP,HCPCS C1713,,02.240.060  -  SCREW BONE T15 FULTHD 3.7MM 60MM SELF DRILL SELF TAP LOCK,$348.00,$0.00,$348.00,$156.60,$248.37,$0.00,$58.21,$0.00,$0.00,$60.93,$348.00,$0.00,$174.00,$275.62,$278.40,$0.00,$52.88,$0.00,$55.40,$0.00
02.240.065,SUP,HCPCS C1713,,02.240.065  -  SCREW BONE T15 FULTHD 3.7MM 65MM SELF DRILL SELF TAP LOCK,$348.00,$0.00,$348.00,$156.60,$248.37,$0.00,$58.21,$0.00,$0.00,$60.93,$348.00,$0.00,$174.00,$275.62,$278.40,$0.00,$52.88,$0.00,$55.40,$0.00
02.240.070,SUP,HCPCS C1713,,02.240.070  -  SCREW BONE T15 FULTHD 3.7MM 70MM SELF DRILL SELF TAP LOCK,$348.00,$0.00,$348.00,$156.60,$248.37,$0.00,$58.21,$0.00,$0.00,$60.93,$348.00,$0.00,$174.00,$275.62,$278.40,$0.00,$52.88,$0.00,$55.40,$0.00
02.240.075,SUP,HCPCS C1713,,02.240.075  -  SCREW BONE T15 FULTHD 3.7MM 75MM SELF DRILL SELF TAP LOCK,$348.00,$0.00,$348.00,$156.60,$248.37,$0.00,$58.21,$0.00,$0.00,$60.93,$348.00,$0.00,$174.00,$275.62,$278.40,$0.00,$52.88,$0.00,$55.40,$0.00
02.240.080,SUP,HCPCS C1713,,02.240.080  -  SCREW BONE T15 FULTHD 3.7MM 80MM SELF DRILL SELF TAP LOCK,$348.00,$0.00,$348.00,$156.60,$248.37,$0.00,$58.21,$0.00,$0.00,$60.93,$348.00,$0.00,$174.00,$275.62,$278.40,$0.00,$52.88,$0.00,$55.40,$0.00
02.240.085,SUP,HCPCS C1713,,02.240.085  -  SCREW BONE T15 FULTHD 3.7MM 85MM SELF DRILL SELF TAP LOCK,$348.00,$0.00,$348.00,$156.60,$248.37,$0.00,$58.21,$0.00,$0.00,$60.93,$348.00,$0.00,$174.00,$275.62,$278.40,$0.00,$52.88,$0.00,$55.40,$0.00
02.240.090,SUP,HCPCS C1713,,02.240.090  -  SCREW BONE T15 FULTHD 3.7MM 90MM SELF DRILL SELF TAP LOCK,$348.00,$0.00,$348.00,$156.60,$248.37,$0.00,$58.21,$0.00,$0.00,$60.93,$348.00,$0.00,$174.00,$275.62,$278.40,$0.00,$52.88,$0.00,$55.40,$0.00
02.240.095,SUP,HCPCS C1713,,02.240.095  -  SCREW BONE T15 FULTHD 3.7MM 95MM SELF DRILL SELF TAP LOCK,$348.00,$0.00,$348.00,$156.60,$248.37,$0.00,$58.21,$0.00,$0.00,$60.93,$348.00,$0.00,$174.00,$275.62,$278.40,$0.00,$52.88,$0.00,$55.40,$0.00
02.240.210,SUP,HCPCS C1713,,02.240.210  -  SCREW BONE CONE 3.7MM 10MM 6MM SELF DRILL SELF TAP LOCK CANN,$304.35,$0.00,$304.35,$136.96,$217.21,$0.00,$50.91,$0.00,$0.00,$53.29,$304.35,$0.00,$152.18,$241.05,$243.48,$0.00,$46.24,$0.00,$48.45,$0.00
02.240.212,SUP,HCPCS C1713,,02.240.212  -  SCREW BONE CONE 3.7MM 12MM 8MM SELF DRILL SELF TAP LOCK CANN,$304.35,$0.00,$304.35,$136.96,$217.21,$0.00,$50.91,$0.00,$0.00,$53.29,$304.35,$0.00,$152.18,$241.05,$243.48,$0.00,$46.24,$0.00,$48.45,$0.00
02.240.214,SUP,HCPCS C1713,,02.240.214  -  SCREW BONE CONE 3.7MM 14MM 8MM SELF DRILL SELF TAP LOCK CANN,$304.35,$0.00,$304.35,$136.96,$217.21,$0.00,$50.91,$0.00,$0.00,$53.29,$304.35,$0.00,$152.18,$241.05,$243.48,$0.00,$46.24,$0.00,$48.45,$0.00
02.240.216,SUP,HCPCS C1713,,02.240.216  -  SCREW BONE CONE 3.7MM 16MM 8MM SELF DRILL SELF TAP LOCK CANN,$304.35,$0.00,$304.35,$136.96,$217.21,$0.00,$50.91,$0.00,$0.00,$53.29,$304.35,$0.00,$152.18,$241.05,$243.48,$0.00,$46.24,$0.00,$48.45,$0.00
02.240.218,SUP,HCPCS C1713,,02.240.218  -  SCREW BONE CONE 3.7MM 18MM 8MM SELF DRILL SELF TAP LOCK CANN,$304.35,$0.00,$304.35,$136.96,$217.21,$0.00,$50.91,$0.00,$0.00,$53.29,$304.35,$0.00,$152.18,$241.05,$243.48,$0.00,$46.24,$0.00,$48.45,$0.00
02.240.220,SUP,HCPCS C1713,,02.240.220  -  SCREW BONE CONE 3.7MM 20MM 15MM SELF DRILL SELF TAP LOCK,$304.35,$0.00,$304.35,$136.96,$217.21,$0.00,$50.91,$0.00,$0.00,$53.29,$304.35,$0.00,$152.18,$241.05,$243.48,$0.00,$46.24,$0.00,$48.45,$0.00
02.240.222,SUP,HCPCS C1713,,02.240.222  -  SCREW BONE CONE 3.7MM 22MM 15MM SELF DRILL SELF TAP LOCK,$304.35,$0.00,$304.35,$136.96,$217.21,$0.00,$50.91,$0.00,$0.00,$53.29,$304.35,$0.00,$152.18,$241.05,$243.48,$0.00,$46.24,$0.00,$48.45,$0.00
02.240.224,SUP,HCPCS C1713,,02.240.224  -  SCREW BONE CONE 3.7MM 24MM 15MM SELF DRILL SELF TAP LOCK,$304.35,$0.00,$304.35,$136.96,$217.21,$0.00,$50.91,$0.00,$0.00,$53.29,$304.35,$0.00,$152.18,$241.05,$243.48,$0.00,$46.24,$0.00,$48.45,$0.00
02.240.226,SUP,HCPCS C1713,,02.240.226  -  SCREW BONE CONE 3.7MM 26MM 15MM SELF DRILL SELF TAP LOCK,$304.35,$0.00,$304.35,$136.96,$217.21,$0.00,$50.91,$0.00,$0.00,$53.29,$304.35,$0.00,$152.18,$241.05,$243.48,$0.00,$46.24,$0.00,$48.45,$0.00
02.240.228,SUP,HCPCS C1713,,02.240.228  -  SCREW BONE CONE 3.7MM 28MM 15MM SELF DRILL SELF TAP LOCK,$304.35,$0.00,$304.35,$136.96,$217.21,$0.00,$50.91,$0.00,$0.00,$53.29,$304.35,$0.00,$152.18,$241.05,$243.48,$0.00,$46.24,$0.00,$48.45,$0.00
02.240.230,SUP,HCPCS C1713,,02.240.230  -  SCREW BONE CONE 3.7MM 30MM 15MM SELF DRILL SELF TAP LOCK,$304.35,$0.00,$304.35,$136.96,$217.21,$0.00,$50.91,$0.00,$0.00,$53.29,$304.35,$0.00,$152.18,$241.05,$243.48,$0.00,$46.24,$0.00,$48.45,$0.00
02.240.232,SUP,HCPCS C1713,,02.240.232  -  SCREW BONE CONE 3.7MM 32MM 25MM SELF DRILL SELF TAP LOCK,$304.35,$0.00,$304.35,$136.96,$217.21,$0.00,$50.91,$0.00,$0.00,$53.29,$304.35,$0.00,$152.18,$241.05,$243.48,$0.00,$46.24,$0.00,$48.45,$0.00
02.240.234,SUP,HCPCS C1713,,02.240.234  -  SCREW BONE CONE 3.7MM 34MM 25MM SELF DRILL SELF TAP LOCK,$304.35,$0.00,$304.35,$136.96,$217.21,$0.00,$50.91,$0.00,$0.00,$53.29,$304.35,$0.00,$152.18,$241.05,$243.48,$0.00,$46.24,$0.00,$48.45,$0.00
02.240.236,SUP,HCPCS C1713,,02.240.236  -  SCREW BONE CONE 3.7MM 36MM 25MM SELF DRILL SELF TAP LOCK,$304.35,$0.00,$304.35,$136.96,$217.21,$0.00,$50.91,$0.00,$0.00,$53.29,$304.35,$0.00,$152.18,$241.05,$243.48,$0.00,$46.24,$0.00,$48.45,$0.00
02.240.238,SUP,HCPCS C1713,,02.240.238  -  SCREW BONE CONE 3.7MM 38MM 25MM SELF DRILL SELF TAP LOCK,$304.35,$0.00,$304.35,$136.96,$217.21,$0.00,$50.91,$0.00,$0.00,$53.29,$304.35,$0.00,$152.18,$241.05,$243.48,$0.00,$46.24,$0.00,$48.45,$0.00
02.240.240,SUP,HCPCS C1713,,02.240.240  -  SCREW BONE CONE 3.7MM 40MM 25MM SELF DRILL SELF TAP LOCK,$304.35,$0.00,$304.35,$136.96,$217.21,$0.00,$50.91,$0.00,$0.00,$53.29,$304.35,$0.00,$152.18,$241.05,$243.48,$0.00,$46.24,$0.00,$48.45,$0.00
02.240.242,SUP,HCPCS C1713,,02.240.242  -  SCREW BONE CONE 3.7MM 42MM 25MM SELF DRILL SELF TAP LOCK,$304.35,$0.00,$304.35,$136.96,$217.21,$0.00,$50.91,$0.00,$0.00,$53.29,$304.35,$0.00,$152.18,$241.05,$243.48,$0.00,$46.24,$0.00,$48.45,$0.00
02.240.244,SUP,HCPCS C1713,,02.240.244  -  SCREW BONE CONE 3.7MM 44MM 25MM SELF DRILL SELF TAP LOCK,$304.35,$0.00,$304.35,$136.96,$217.21,$0.00,$50.91,$0.00,$0.00,$53.29,$304.35,$0.00,$152.18,$241.05,$243.48,$0.00,$46.24,$0.00,$48.45,$0.00
02.240.246,SUP,HCPCS C1713,,02.240.246  -  SCREW BONE CONE 3.7MM 46MM 25MM SELF DRILL SELF TAP LOCK,$304.35,$0.00,$304.35,$136.96,$217.21,$0.00,$50.91,$0.00,$0.00,$53.29,$304.35,$0.00,$152.18,$241.05,$243.48,$0.00,$46.24,$0.00,$48.45,$0.00
02.240.248,SUP,HCPCS C1713,,02.240.248  -  SCREW BONE CONE 3.7MM 48MM 25MM SELF DRILL SELF TAP LOCK,$304.35,$0.00,$304.35,$136.96,$217.21,$0.00,$50.91,$0.00,$0.00,$53.29,$304.35,$0.00,$152.18,$241.05,$243.48,$0.00,$46.24,$0.00,$48.45,$0.00
02.240.250,SUP,HCPCS C1713,,02.240.250  -  SCREW BONE CONE 3.7MM 50MM 25MM SELF DRILL SELF TAP LOCK,$304.35,$0.00,$304.35,$136.96,$217.21,$0.00,$50.91,$0.00,$0.00,$53.29,$304.35,$0.00,$152.18,$241.05,$243.48,$0.00,$46.24,$0.00,$48.45,$0.00
02.240.252,SUP,HCPCS C1713,,02.240.252  -  SCREW BONE CONE 3.7MM 52MM 25MM SELF DRILL SELF TAP LOCK,$304.35,$0.00,$304.35,$136.96,$217.21,$0.00,$50.91,$0.00,$0.00,$53.29,$304.35,$0.00,$152.18,$241.05,$243.48,$0.00,$46.24,$0.00,$48.45,$0.00
02.240.254,SUP,HCPCS C1713,,02.240.254  -  SCREW BONE CONE 3.7MM 54MM 25MM SELF DRILL SELF TAP LOCK,$304.35,$0.00,$304.35,$136.96,$217.21,$0.00,$50.91,$0.00,$0.00,$53.29,$304.35,$0.00,$152.18,$241.05,$243.48,$0.00,$46.24,$0.00,$48.45,$0.00
02.240.256,SUP,HCPCS C1713,,02.240.256  -  SCREW BONE CONE 3.7MM 56MM 25MM SELF DRILL SELF TAP LOCK,$304.35,$0.00,$304.35,$136.96,$217.21,$0.00,$50.91,$0.00,$0.00,$53.29,$304.35,$0.00,$152.18,$241.05,$243.48,$0.00,$46.24,$0.00,$48.45,$0.00
02.240.258,SUP,HCPCS C1713,,02.240.258  -  SCREW BONE CONE 3.7MM 58MM 25MM SELF DRILL SELF TAP LOCK,$304.35,$0.00,$304.35,$136.96,$217.21,$0.00,$50.91,$0.00,$0.00,$53.29,$304.35,$0.00,$152.18,$241.05,$243.48,$0.00,$46.24,$0.00,$48.45,$0.00
02.240.260,SUP,HCPCS C1713,,02.240.260  -  SCREW BONE CONE 3.7MM 60MM 25MM SELF DRILL SELF TAP LOCK,$304.35,$0.00,$304.35,$136.96,$217.21,$0.00,$50.91,$0.00,$0.00,$53.29,$304.35,$0.00,$152.18,$241.05,$243.48,$0.00,$46.24,$0.00,$48.45,$0.00
02.240.265,SUP,HCPCS C1713,,02.240.265  -  SCREW BONE CONE 3.7MM 65MM 25MM SELF DRILL SELF TAP LOCK,$304.35,$0.00,$304.35,$136.96,$217.21,$0.00,$50.91,$0.00,$0.00,$53.29,$304.35,$0.00,$152.18,$241.05,$243.48,$0.00,$46.24,$0.00,$48.45,$0.00
02.240.270,SUP,HCPCS C1713,,02.240.270  -  SCREW BONE CONE 3.7MM 70MM 25MM SELF DRILL SELF TAP LOCK,$304.35,$0.00,$304.35,$136.96,$217.21,$0.00,$50.91,$0.00,$0.00,$53.29,$304.35,$0.00,$152.18,$241.05,$243.48,$0.00,$46.24,$0.00,$48.45,$0.00
02.240.275,SUP,HCPCS C1713,,02.240.275  -  SCREW BONE CONE 3.7MM 75MM 25MM SELF DRILL SELF TAP LOCK,$304.35,$0.00,$304.35,$136.96,$217.21,$0.00,$50.91,$0.00,$0.00,$53.29,$304.35,$0.00,$152.18,$241.05,$243.48,$0.00,$46.24,$0.00,$48.45,$0.00
02.240.280,SUP,HCPCS C1713,,02.240.280  -  SCREW BONE CONE 3.7MM 80MM 25MM SELF DRILL SELF TAP LOCK,$304.35,$0.00,$304.35,$136.96,$217.21,$0.00,$50.91,$0.00,$0.00,$53.29,$304.35,$0.00,$152.18,$241.05,$243.48,$0.00,$46.24,$0.00,$48.45,$0.00
02.240.285,SUP,HCPCS C1713,,02.240.285  -  SCREW BONE CONE 3.7MM 85MM 25MM SELF DRILL SELF TAP LOCK,$304.35,$0.00,$304.35,$136.96,$217.21,$0.00,$50.91,$0.00,$0.00,$53.29,$304.35,$0.00,$152.18,$241.05,$243.48,$0.00,$46.24,$0.00,$48.45,$0.00
02.240.290,SUP,HCPCS C1713,,02.240.290  -  SCREW BONE CONE 3.7MM 90MM 25MM SELF DRILL SELF TAP LOCK,$304.35,$0.00,$304.35,$136.96,$217.21,$0.00,$50.91,$0.00,$0.00,$53.29,$304.35,$0.00,$152.18,$241.05,$243.48,$0.00,$46.24,$0.00,$48.45,$0.00
02.240.295,SUP,HCPCS C1713,,02.240.295  -  SCREW BONE CONE 3.7MM 95MM 25MM SELF DRILL SELF TAP LOCK,$304.35,$0.00,$304.35,$136.96,$217.21,$0.00,$50.91,$0.00,$0.00,$53.29,$304.35,$0.00,$152.18,$241.05,$243.48,$0.00,$46.24,$0.00,$48.45,$0.00
02.306.006,SUP,HCPCS C1713,,02.306.006  -  NAIL INTRAMEDULLARY SHORT CANN ORTHOPEDIC NONSTRL PELVIC,$938.95,$0.00,$938.95,$422.53,$670.13,$0.00,$157.06,$0.00,$0.00,$164.40,$938.95,$0.00,$469.48,$743.65,$751.16,$0.00,$142.67,$0.00,$149.48,$0.00
02.306.007,SUP,HCPCS C1713,,02.306.007  -  NAIL INTRAMEDULLARY LONG CANN ORTHOPEDIC NONSTRL PELVIC,$938.95,$0.00,$938.95,$422.53,$670.13,$0.00,$157.06,$0.00,$0.00,$164.40,$938.95,$0.00,$469.48,$743.65,$751.16,$0.00,$142.67,$0.00,$149.48,$0.00
02.600.020,SUP,Custom 27203010,,02.600.020  -  WIRE FX 1.6MM 400MM NS KRSH TROC PNT SS,$122.50,$0.00,$122.50,$0.00,$87.43,$0.00,$0.00,$0.00,$0.00,$0.00,$122.50,$0.00,$61.25,$97.02,$98.00,$0.00,$0.00,$0.00,$0.00,$0.00
02.600.022.02S,SUP,HCPCS C1713,,02.600.022.02S  -  PIN 12MM DSTRCT STRL,$204.75,$0.00,$204.75,$92.14,$146.13,$0.00,$35.28,$0.00,$0.00,$35.85,$204.75,$0.00,$102.38,$162.16,$163.80,$0.00,$32.04,$0.00,$32.60,$0.00
0200-12LV,SUP,Custom 27203010,,0200-12LV  -  TUBE JJNSTM 12FR 2-3ML STRL LF MC SLK MED PORT RADOPQ STRP,$337.35,$0.00,$337.35,$0.00,$240.77,$0.00,$0.00,$0.00,$0.00,$0.00,$337.35,$0.00,$168.68,$267.18,$269.88,$0.00,$0.00,$0.00,$0.00,$0.00
0200-18,SUP,Custom 27203010,,0200-18  -  TUBE JEJUNOSTOMY STANDARD J 18FR TRIMMABLE DISTAL TIP,$342.41,$0.00,$342.41,$0.00,$244.38,$0.00,$0.00,$0.00,$0.00,$0.00,$342.41,$0.00,$171.21,$271.19,$273.93,$0.00,$0.00,$0.00,$0.00,$0.00
022-001,SUP,Custom 27203010,,022-001  -  WIRE PACING 2-0 TAPER LOOP 1/8IN 61CM 89MM 1 ARM SNAP OFF,$49.32,$0.00,$49.32,$0.00,$35.20,$0.00,$0.00,$0.00,$0.00,$0.00,$49.32,$0.00,$24.66,$39.06,$39.46,$0.00,$0.00,$0.00,$0.00,$0.00
02-2005-S,SUP,HCPCS C1713,,02-2005-S  -  PLATE SS 5 HOLE CMPR BONE 6MM STRL,"$1,342.50",$0.00,"$1,342.50",$604.13,$958.14,$0.00,$231.31,$0.00,$0.00,$235.06,"$1,342.50",$0.00,$671.25,"$1,063.26","$1,074.00",$0.00,$210.10,$0.00,$213.73,$0.00
02-2007-S,SUP,HCPCS C1713,,02-2007-S  -  PLATE 203.2MM SS 7 HOLE 8 GRV CMPR BONE ORTH STRL,"$1,342.50",$0.00,"$1,342.50",$604.13,$958.14,$0.00,$231.31,$0.00,$0.00,$235.06,"$1,342.50",$0.00,$671.25,"$1,063.26","$1,074.00",$0.00,$210.10,$0.00,$213.73,$0.00
02-2009-S,SUP,HCPCS C1713,,02-2009-S  -  PLATE 6 SS 9 HOLE CMPR BONE 10MM STRL,"$1,440.00",$0.00,"$1,440.00",$648.00,"$1,027.73",$0.00,$248.10,$0.00,$0.00,$252.13,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$225.36,$0.00,$229.25,$0.00
02-2011-S,SUP,HCPCS C1713,,02-2011-S  -  PLATE 6 12IN SS 11 HOLE 12 GRV CMPR BONE 12MM STRL,"$1,440.00",$0.00,"$1,440.00",$648.00,"$1,027.73",$0.00,$248.10,$0.00,$0.00,$252.13,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$225.36,$0.00,$229.25,$0.00
02-205-085,SUP,HCPCS C1713,,02-205-085  -  SCREW BONE 5MM 85MM LCP SS PROX FEM CANN LCK NONSTRL,$415.40,$0.00,$415.40,$186.93,$296.47,$0.00,$71.57,$0.00,$0.00,$72.73,$415.40,$0.00,$207.70,$329.00,$332.32,$0.00,$65.01,$0.00,$66.13,$0.00
02-205-280,SUP,HCPCS C1713,,02-205-280  -  SCREW BONE 5MM 80MM LCP SS PERIART FEM/TIB CANN CONICAL,$354.75,$0.00,$354.75,$159.64,$253.19,$0.00,$61.12,$0.00,$0.00,$62.11,$354.75,$0.00,$177.38,$280.96,$283.80,$0.00,$55.52,$0.00,$56.48,$0.00
02-210-122,SUP,HCPCS C1713,,02-210-122  -  SCREW BONE 2.4MM 22MM LCP SS DISTAL RADL LCK VAR ANG,$295.63,$0.00,$295.63,$133.03,$210.99,$0.00,$50.93,$0.00,$0.00,$51.76,$295.63,$0.00,$147.81,$234.14,$236.50,$0.00,$46.27,$0.00,$47.06,$0.00
023-001,SUP,Custom 27203010,,KIT IMMUN TST ELISA ANCRDLPN IGG IGM 96 TST,$962.50,$0.00,$962.50,$0.00,$686.94,$0.00,$0.00,$0.00,$0.00,$0.00,$962.50,$0.00,$481.25,$762.30,$770.00,$0.00,$0.00,$0.00,$0.00,$0.00
0250-18,SUP,HCPCS B4088,,0250-18  -  TUBE JJNSTM 18FR 45CM 7-10ML STRL LF MC SLK RADOPQ STRP RTNT,$564.68,$0.00,$564.68,$0.00,$403.01,$0.00,$0.00,$0.00,$0.00,$0.00,$564.68,$0.00,$282.34,$447.23,$451.74,$0.00,$0.00,$0.00,$0.00,$0.00
0250-22,SUP,HCPCS B4088,,0250-22  -  TUBE JJNSTM 22FR 45CM 7-10ML STRL LF MC SLK RADOPQ STRP RTNT,$564.68,$0.00,$564.68,$0.00,$403.01,$0.00,$0.00,$0.00,$0.00,$0.00,$564.68,$0.00,$282.34,$447.23,$451.74,$0.00,$0.00,$0.00,$0.00,$0.00
025-200,SUP,Custom 27203010,,025-200  -  WIRE PACING 2-0 26MM .5 CIR CURVE TAPER 61CM 89MM M25 STYLE,$32.29,$0.00,$32.29,$0.00,$23.05,$0.00,$0.00,$0.00,$0.00,$0.00,$32.29,$0.00,$16.15,$25.57,$25.83,$0.00,$0.00,$0.00,$0.00,$0.00
0270-0626,SUP,Custom 27203010,,LARYNGOSCOPE VID 3 STAT GVL GLIDESCOPE DISP,$35.73,$0.00,$35.73,$0.00,$25.50,$0.00,$0.00,$0.00,$0.00,$0.00,$35.73,$0.00,$17.86,$28.30,$28.58,$0.00,$0.00,$0.00,$0.00,$0.00
0270-0628,SUP,Custom 27203010,,LARYNGOSCOPE VID 4 LG GLIDESCOPE,$35.73,$0.00,$35.73,$0.00,$25.50,$0.00,$0.00,$0.00,$0.00,$0.00,$35.73,$0.00,$17.86,$28.30,$28.58,$0.00,$0.00,$0.00,$0.00,$0.00
0277082085S5,SUP,Custom 27203010,,0277082085S5  -  BIT DRILL 7/64IN 128MM,$722.50,$0.00,$722.50,$0.00,$515.65,$0.00,$0.00,$0.00,$0.00,$0.00,$722.50,$0.00,$361.25,$572.22,$578.00,$0.00,$0.00,$0.00,$0.00,$0.00
028506-CE,SUP,HCPCS C1729,,028506-CE  -  CATH URTH 6FR 25CM 2W FOLEY CLOSE END RND SIL 1.5ML,$49.75,$0.00,$49.75,$27.01,$35.51,$0.00,$8.57,$0.00,$0.00,$8.71,$49.75,$0.00,$24.88,$39.40,$39.80,$0.00,$7.79,$0.00,$7.92,$0.00
0298-097-100,SUP,Custom 27203010,,0298-097-100  -  BLADE SAW THK.031IN 32MM CUT EDGE HEAVY DUTY STERNUM,$57.13,$0.00,$57.13,$0.00,$40.77,$0.00,$0.00,$0.00,$0.00,$0.00,$57.13,$0.00,$28.56,$45.25,$45.70,$0.00,$0.00,$0.00,$0.00,$0.00
02B002,SUP,HCPCS C1776,,02B002  -  GRAFT SFT TIS STRUT AT,"$4,592.50",$0.00,"$4,592.50","$2,066.63","$3,277.67",$0.00,$791.26,$0.00,$0.00,$804.11,"$4,592.50",$0.00,"$2,296.25","$3,637.26","$3,674.00",$0.00,$718.73,$0.00,$731.13,$0.00
02B003,SUP,Custom 27804086,,02B003  -  FILLER BN VOID BLCK .5-1MM 4.5X5X10MM .3ML STRL PO 200R RSRB,"$6,170.00",$0.00,"$6,170.00",$0.00,"$4,403.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,170.00",$0.00,"$3,085.00","$4,886.64","$4,936.00",$0.00,$0.00,$0.00,$0.00,$0.00
03.000.409.98S,SUP,Custom 27203010,,03.000.409.98S  -  CUTTER SRG THK.6MM 24.6X12.85X2.6MM STRL DMD PIEZOELECTRIC,$623.25,$0.00,$623.25,$0.00,$444.81,$0.00,$0.00,$0.00,$0.00,$0.00,$623.25,$0.00,$311.63,$493.61,$498.60,$0.00,$0.00,$0.00,$0.00,$0.00
03.000.410.98S,SUP,Custom 27203010,,03.000.410.98S  -  CUTTER SRG THK.6MM RND 21.9X12.4X1.8MM STRL DMD,$623.25,$0.00,$623.25,$0.00,$444.81,$0.00,$0.00,$0.00,$0.00,$0.00,$623.25,$0.00,$311.63,$493.61,$498.60,$0.00,$0.00,$0.00,$0.00,$0.00
03.000.411.98S,SUP,Custom 27803010,,03.000.411.98S  -  SINUS LIFT 22.9X10.1X5X0.4MM FOR PIEZOELECTRIC SYSTEM-STER,$623.25,$0.00,$623.25,$0.00,$444.81,$0.00,$0.00,$0.00,$0.00,$0.00,$623.25,$0.00,$311.63,$493.61,$498.60,$0.00,$0.00,$0.00,$0.00,$0.00
03.007.020,SUP,HCPCS C1769,,03.007.020  -  GUIDEWIRE ORTHOPEDIC 2.8MM 180MM 10MM TROCAR NONSTRL,$113.95,$0.00,$113.95,$61.87,$81.33,$0.00,$19.06,$0.00,$0.00,$19.95,$113.95,$0.00,$56.98,$90.25,$91.16,$0.00,$17.31,$0.00,$18.14,$0.00
03.010.015,SUP,Custom 27203010,,03.010.015  -  SET TRAUMA FIX CANN COMPRESSION DEVICE TITANIUM TIBIA,$849.75,$0.00,$849.75,$0.00,$606.47,$0.00,$0.00,$0.00,$0.00,$0.00,$849.75,$0.00,$424.88,$673.00,$679.80,$0.00,$0.00,$0.00,$0.00,$0.00
03.010.025,SUP,HCPCS C1713,,03.010.025  -  WIRE FIX 2MM 240MM TROCAR POINT KWIRE NONSTRL EXPERT CANN,$64.08,$0.00,$64.08,$28.83,$45.73,$0.00,$10.72,$0.00,$0.00,$11.22,$64.08,$0.00,$32.04,$50.75,$51.26,$0.00,$9.73,$0.00,$10.20,$0.00
03.010.028,SUP,Custom 27203010,,03.010.028  -  BIT DRL 15MM 280MM NS CNN LG QC,$943.23,$0.00,$943.23,$0.00,$673.18,$0.00,$0.00,$0.00,$0.00,$0.00,$943.23,$0.00,$471.61,$747.04,$754.58,$0.00,$0.00,$0.00,$0.00,$0.00
03.010.029,SUP,Custom 27203010,,03.010.029  -  BIT DRILL LARGE 17MM 280MM QUICK COUPLING CANN NONSTRL,"$1,179.73",$0.00,"$1,179.73",$0.00,$841.97,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,179.73",$0.00,$589.86,$934.35,$943.78,$0.00,$0.00,$0.00,$0.00,$0.00
03.010.034,SUP,Custom 27203010,,03.010.034  -  BIT DRL 13MM 465MM NS CNN LG QC FLXB,"$1,325.60",$0.00,"$1,325.60",$0.00,$946.08,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,325.60",$0.00,$662.80,"$1,049.88","$1,060.48",$0.00,$0.00,$0.00,$0.00,$0.00
03.010.036,SUP,Custom 27203010,,03.010.036  -  BIT DRILL LARGE 12MM 190MM CANN LARGE QUICK COUPLING EXPERT,$995.63,$0.00,$995.63,$0.00,$710.58,$0.00,$0.00,$0.00,$0.00,$0.00,$995.63,$0.00,$497.81,$788.54,$796.50,$0.00,$0.00,$0.00,$0.00,$0.00
03.010.044,SUP,HCPCS C1713,,03.010.044  -  SCREW INSERTION HANDLE CANN CONNCTNG EXPERT NONSTRL TIBIAL,$580.68,$0.00,$580.68,$261.30,$414.43,$0.00,$97.13,$0.00,$0.00,$101.67,$580.68,$0.00,$290.34,$459.90,$464.54,$0.00,$88.23,$0.00,$92.44,$0.00
03.010.060,SUP,Custom 27203010,,03.010.060  -  BIT DRL 100MM 3 FLUT 3.2MM 330MM NS CLBRT QC,$448.95,$0.00,$448.95,$0.00,$320.42,$0.00,$0.00,$0.00,$0.00,$0.00,$448.95,$0.00,$224.48,$355.57,$359.16,$0.00,$0.00,$0.00,$0.00,$0.00
03.010.061,SUP,Custom 27203010,,03.010.061  -  BIT DRL 100MM 3 FLUT 4.2MM 330MM NS CLBRT QC,$448.95,$0.00,$448.95,$0.00,$320.42,$0.00,$0.00,$0.00,$0.00,$0.00,$448.95,$0.00,$224.48,$355.57,$359.16,$0.00,$0.00,$0.00,$0.00,$0.00
03.010.062,SUP,Custom 27203010,,03.010.062  -  BIT DRL 100MM 3 FLUT 5MM 330MM NS CLBRT QC,$448.95,$0.00,$448.95,$0.00,$320.42,$0.00,$0.00,$0.00,$0.00,$0.00,$448.95,$0.00,$224.48,$355.57,$359.16,$0.00,$0.00,$0.00,$0.00,$0.00
03.010.078,SUP,Custom 27203010,,03.010.078  -  BIT DRL 4.5-6.5MM 485MM NS LG QC STP,$951.73,$0.00,$951.73,$0.00,$679.25,$0.00,$0.00,$0.00,$0.00,$0.00,$951.73,$0.00,$475.86,$753.77,$761.38,$0.00,$0.00,$0.00,$0.00,$0.00
03.010.089,SUP,Custom 27203010,,03.010.089  -  BIT DRL 135MM 4.5MM 165MM NS CNN JCHK STP,$672.73,$0.00,$672.73,$0.00,$480.12,$0.00,$0.00,$0.00,$0.00,$0.00,$672.73,$0.00,$336.36,$532.80,$538.18,$0.00,$0.00,$0.00,$0.00,$0.00
03.010.089S,SUP,Custom 27203010,,03.010.089S  -  BIT DRILL 165MM 4.5MM CANN JCHK STOP 135MM STRL,$849.48,$0.00,$849.48,$0.00,$606.27,$0.00,$0.00,$0.00,$0.00,$0.00,$849.48,$0.00,$424.74,$672.79,$679.58,$0.00,$0.00,$0.00,$0.00,$0.00
03.010.100,SUP,Custom 27203010,,03.010.100  -  BIT DRILL 3.2MM 145MM 3 FLUTED QUICK COUPLING NEEDLE POINT,$446.13,$0.00,$446.13,$0.00,$318.40,$0.00,$0.00,$0.00,$0.00,$0.00,$446.13,$0.00,$223.06,$353.33,$356.90,$0.00,$0.00,$0.00,$0.00,$0.00
03.010.101,SUP,Custom 27203010,,03.010.101  -  BIT DRILL 4.2MM 145MM 3 FLUTED QUICK COUPLING NEEDLE POINT,$446.13,$0.00,$446.13,$0.00,$318.40,$0.00,$0.00,$0.00,$0.00,$0.00,$446.13,$0.00,$223.06,$353.33,$356.90,$0.00,$0.00,$0.00,$0.00,$0.00
03.010.102,SUP,Custom 27203010,,03.010.102  -  BIT DRILL 5MM 145MM QUICK COUPLING 3 FLUTED NONSTRL,$446.13,$0.00,$446.13,$0.00,$318.40,$0.00,$0.00,$0.00,$0.00,$0.00,$446.13,$0.00,$223.06,$353.33,$356.90,$0.00,$0.00,$0.00,$0.00,$0.00
03.010.103,SUP,Custom 27203010,,03.010.103  -  BIT DRL 3 FLUT 3.2MM 145MM NS QC,$320.08,$0.00,$320.08,$0.00,$228.44,$0.00,$0.00,$0.00,$0.00,$0.00,$320.08,$0.00,$160.04,$253.50,$256.06,$0.00,$0.00,$0.00,$0.00,$0.00
03.010.104,SUP,Custom 27203010,,03.010.104  -  BIT DRL 3 FLUT 4.2MM 145MM NS QC NDL PNT,$320.08,$0.00,$320.08,$0.00,$228.44,$0.00,$0.00,$0.00,$0.00,$0.00,$320.08,$0.00,$160.04,$253.50,$256.06,$0.00,$0.00,$0.00,$0.00,$0.00
03.010.105,SUP,Custom 27203010,,03.010.105  -  BIT DRILL SHORT 5MM 145MM 3 FLUTED QUICK COUPLING NEEDLE,$320.08,$0.00,$320.08,$0.00,$228.44,$0.00,$0.00,$0.00,$0.00,$0.00,$320.08,$0.00,$160.04,$253.50,$256.06,$0.00,$0.00,$0.00,$0.00,$0.00
03.010.115,SUP,HCPCS C1769,,03.010.115  -  GUIDEWIRE ORTHOPEDIC 3.2MM 290MM THREAD NONSTRL TITANIUM,$178.45,$0.00,$178.45,$96.90,$127.36,$0.00,$29.85,$0.00,$0.00,$31.25,$178.45,$0.00,$89.23,$141.33,$142.76,$0.00,$27.11,$0.00,$28.41,$0.00
03.010.165,SUP,Custom 27203010,,03.010.165  -  BIT DRILL LARGE 15MM 310MM LARGE QUICK COUPLING CANN,"$1,297.28",$0.00,"$1,297.28",$0.00,$925.87,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,297.28",$0.00,$648.64,"$1,027.45","$1,037.82",$0.00,$0.00,$0.00,$0.00,$0.00
03.010.167,SUP,Custom 27203010,,03.010.167  -  BIT DRILL LARGE 17MM 310MM LARGE QUICK COUPLING CANN,"$1,387.93",$0.00,"$1,387.93",$0.00,$990.56,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,387.93",$0.00,$693.96,"$1,099.24","$1,110.34",$0.00,$0.00,$0.00,$0.00,$0.00
03.010.228,SUP,Custom 27203010,,03.010.228  -  BIT DRILL LARGE 3.2MM 474MM 3 FLUTE CALIBRATED NONSTRL 5MM,$803.85,$0.00,$803.85,$0.00,$573.71,$0.00,$0.00,$0.00,$0.00,$0.00,$803.85,$0.00,$401.93,$636.65,$643.08,$0.00,$0.00,$0.00,$0.00,$0.00
03.010.437S,SUP,Custom 27203010,,03.010.437S  -  SLEEVE PROTECTION 12MM STERILE SUPRAPATELLAR,$189.78,$0.00,$189.78,$0.00,$135.44,$0.00,$0.00,$0.00,$0.00,$0.00,$189.78,$0.00,$94.89,$150.31,$151.82,$0.00,$0.00,$0.00,$0.00,$0.00
03.010.439,SUP,Custom 27203010,,03.010.439  -  BIT DRILL LARGE 12MM 270MM QUICK COUPLING CANN NAIL-EX,$907.83,$0.00,$907.83,$0.00,$647.91,$0.00,$0.00,$0.00,$0.00,$0.00,$907.83,$0.00,$453.91,$719.00,$726.26,$0.00,$0.00,$0.00,$0.00,$0.00
03.019.003,SUP,Custom 27203010,,03.019.003  -  BIT DRILL 10MM HOLLOW NONSTRL OPEN MEDULLARY CANAL MULTILOC,$535.35,$0.00,$535.35,$0.00,$382.08,$0.00,$0.00,$0.00,$0.00,$0.00,$535.35,$0.00,$267.68,$424.00,$428.28,$0.00,$0.00,$0.00,$0.00,$0.00
03.019.016,SUP,Custom 27203010,,03.019.016  -  BIT DRL 3 FLUT 3.8MM 270MM NS QC CLBRT,$396.55,$0.00,$396.55,$0.00,$283.02,$0.00,$0.00,$0.00,$0.00,$0.00,$396.55,$0.00,$198.28,$314.07,$317.24,$0.00,$0.00,$0.00,$0.00,$0.00
03.019.026,SUP,HCPCS C1713,,03.019.026  -  GUIDE ROD ORTH 2.5MM 230MM NS MULTILOC STP TROC TIP SS HLW,$38.25,$0.00,$38.25,$17.21,$27.30,$0.00,$6.40,$0.00,$0.00,$6.70,$38.25,$0.00,$19.13,$30.29,$30.60,$0.00,$5.81,$0.00,$6.09,$0.00
03.019.026S,SUP,HCPCS C1713,,03.019.026S  -  GUIDE ROD ORTH 2.5MM 230MM STRL STP TROC TIP SS HLW DRL,$130.30,$0.00,$130.30,$58.64,$93.00,$0.00,$21.80,$0.00,$0.00,$22.81,$130.30,$0.00,$65.15,$103.20,$104.24,$0.00,$19.80,$0.00,$20.74,$0.00
03.100.034,SUP,HCPCS C1713,,03.100.034  -  TEMPLATE SIZING 20 HOLE PELVIS 3.5 MM LP RECONSTRUCTION,$180.15,$0.00,$180.15,$81.07,$128.57,$0.00,$30.13,$0.00,$0.00,$31.54,$180.15,$0.00,$90.08,$142.68,$144.12,$0.00,$27.37,$0.00,$28.68,$0.00
03.100.036,SUP,HCPCS C1713,,03.100.036  -  TEMPLATE BENDING 88MM 16 HOLE PELVIS 3.5MM LP CVD,$204.73,$0.00,$204.73,$92.13,$146.11,$0.00,$34.24,$0.00,$0.00,$35.85,$204.73,$0.00,$102.36,$162.15,$163.78,$0.00,$31.10,$0.00,$32.59,$0.00
03.100.037,SUP,HCPCS C1713,,03.100.037  -  TEMPLATE BENDING 108MM RAD 16 HOLE PELVIS NONSTRL 3.5MM LP,$204.73,$0.00,$204.73,$92.13,$146.11,$0.00,$34.24,$0.00,$0.00,$35.85,$204.73,$0.00,$102.36,$162.15,$163.78,$0.00,$31.10,$0.00,$32.59,$0.00
03.111.002,SUP,Custom 27203010,,03.111.002  -  BIT DRILL 5MM 300MM 200MM 3 FLUTED CANN CALIBRATION NONSTRL,$713.78,$0.00,$713.78,$0.00,$509.42,$0.00,$0.00,$0.00,$0.00,$0.00,$713.78,$0.00,$356.89,$565.31,$571.02,$0.00,$0.00,$0.00,$0.00,$0.00
03.112.003,SUP,Custom 27203010,,03.112.003  -  BIT DRILL SHORT 2.8MM CALIBRATED STOP NONSTRL,$226.55,$0.00,$226.55,$0.00,$161.69,$0.00,$0.00,$0.00,$0.00,$0.00,$226.55,$0.00,$113.28,$179.43,$181.24,$0.00,$0.00,$0.00,$0.00,$0.00
03.114.007,SUP,Custom 27203010,,03.114.007  -  BIT DRL 2 FLUT 1.1MM 75MM NS 61MM MNQK CPLNG 1.5MM CORT SCR,$163.78,$0.00,$163.78,$0.00,$116.89,$0.00,$0.00,$0.00,$0.00,$0.00,$163.78,$0.00,$81.89,$129.71,$131.02,$0.00,$0.00,$0.00,$0.00,$0.00
03.120.023,SUP,Custom 27203010,,03.120.023  -  DEVICE XTRNFX PUL RDC 4.3 MM PERC DRL GD,$951.23,$0.00,$951.23,$0.00,$678.89,$0.00,$0.00,$0.00,$0.00,$0.00,$951.23,$0.00,$475.61,$753.37,$760.98,$0.00,$0.00,$0.00,$0.00,$0.00
03.120.026,SUP,Custom 27203010,,03.120.026  -  GUIDEWIRE ORTHOPEDIC 2.5MM 300MM DRILL TIP NONSTRL,$124.20,$0.00,$124.20,$0.00,$88.64,$0.00,$0.00,$0.00,$0.00,$0.00,$124.20,$0.00,$62.10,$98.37,$99.36,$0.00,$0.00,$0.00,$0.00,$0.00
03.122.002,SUP,Custom 27203010,,03.122.002  -  BIT DRL 95MM 2.8MM 248MM NS QC CLBRT,$287.95,$0.00,$287.95,$0.00,$205.51,$0.00,$0.00,$0.00,$0.00,$0.00,$287.95,$0.00,$143.98,$228.06,$230.36,$0.00,$0.00,$0.00,$0.00,$0.00
03.122.056,SUP,Custom 27203010,,03.122.056  -  DEVICE MEASURING AIMING NOSE PHILOS NONSTRL,"$2,665.35",$0.00,"$2,665.35",$0.00,"$1,902.26",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,665.35",$0.00,"$1,332.68","$2,110.96","$2,132.28",$0.00,$0.00,$0.00,$0.00,$0.00
03.130.100,SUP,Custom 27203010,,03.130.100  -  BIT DRL 1MM 75MM KRSH THRD HL WRE HND 1.3MM SCR,$156.95,$0.00,$156.95,$0.00,$112.02,$0.00,$0.00,$0.00,$0.00,$0.00,$156.95,$0.00,$78.48,$124.30,$125.56,$0.00,$0.00,$0.00,$0.00,$0.00
03.130.102,SUP,Custom 27203010,,03.130.102  -  BIT DRL 1MM 61MM MNQK CPLNG THRD HL,$156.95,$0.00,$156.95,$0.00,$112.02,$0.00,$0.00,$0.00,$0.00,$0.00,$156.95,$0.00,$78.48,$124.30,$125.56,$0.00,$0.00,$0.00,$0.00,$0.00
03.130.110,SUP,Custom 27203010,,03.130.110  -  BIT DRL 1.3MM 60MM KRSH THRD HL WRE GLD HND,$156.95,$0.00,$156.95,$0.00,$112.02,$0.00,$0.00,$0.00,$0.00,$0.00,$156.95,$0.00,$78.48,$124.30,$125.56,$0.00,$0.00,$0.00,$0.00,$0.00
03.130.112,SUP,Custom 27203010,,03.130.112  -  BIT DRL 1.3MM 46MM MNQK CPLNG GLD HL,$156.95,$0.00,$156.95,$0.00,$112.02,$0.00,$0.00,$0.00,$0.00,$0.00,$156.95,$0.00,$78.48,$124.30,$125.56,$0.00,$0.00,$0.00,$0.00,$0.00
03.130.120,SUP,Custom 27203010,,03.130.120  -  GUIDE DRL 1MM THRD 1.3MM LCK PLT,$484.48,$0.00,$484.48,$0.00,$345.77,$0.00,$0.00,$0.00,$0.00,$0.00,$484.48,$0.00,$242.24,$383.71,$387.58,$0.00,$0.00,$0.00,$0.00,$0.00
03.130.125,SUP,Custom 27203010,,03.130.125  -  SLEEVE DRL 1.3MM 1MM YLW 2 1.3MM CORT SCR,$600.50,$0.00,$600.50,$0.00,$428.58,$0.00,$0.00,$0.00,$0.00,$0.00,$600.50,$0.00,$300.25,$475.60,$480.40,$0.00,$0.00,$0.00,$0.00,$0.00
03.130.130,SUP,HCPCS C1713,,03.130.130  -  HOLDER PLT 1.3-2 MM,$514.50,$0.00,$514.50,$231.53,$367.20,$0.00,$86.07,$0.00,$0.00,$90.08,$514.50,$0.00,$257.25,$407.48,$411.60,$0.00,$78.18,$0.00,$81.91,$0.00
03.130.140,SUP,HCPCS C1713,,03.130.140  -  PIN BNDRG 1.3MM LCK PLT,$484.48,$0.00,$484.48,$218.01,$345.77,$0.00,$81.04,$0.00,$0.00,$84.83,$484.48,$0.00,$242.24,$383.71,$387.58,$0.00,$73.61,$0.00,$77.13,$0.00
03.130.200,SUP,Custom 27203010,,03.130.200  -  BIT DRL 1.1MM 70MM KWR 1.5MM SCR THRD HL,$156.95,$0.00,$156.95,$0.00,$112.02,$0.00,$0.00,$0.00,$0.00,$0.00,$156.95,$0.00,$78.48,$124.30,$125.56,$0.00,$0.00,$0.00,$0.00,$0.00
03.130.202,SUP,Custom 27203010,,03.130.202  -  BIT DRL 1.1MM 56MM MNQK CPLNG THRD HL,$156.95,$0.00,$156.95,$0.00,$112.02,$0.00,$0.00,$0.00,$0.00,$0.00,$156.95,$0.00,$78.48,$124.30,$125.56,$0.00,$0.00,$0.00,$0.00,$0.00
03.130.210,SUP,Custom 27203010,,03.130.210  -  BIT DRL 1.5MM 62MM BLU KWR ATCH 2MM SCR GLD HL,$156.95,$0.00,$156.95,$0.00,$112.02,$0.00,$0.00,$0.00,$0.00,$0.00,$156.95,$0.00,$78.48,$124.30,$125.56,$0.00,$0.00,$0.00,$0.00,$0.00
03.130.212,SUP,Custom 27203010,,03.130.212  -  BIT DRL 1.5MM 48MM MNQK CPLNG GLD HL,$156.95,$0.00,$156.95,$0.00,$112.02,$0.00,$0.00,$0.00,$0.00,$0.00,$156.95,$0.00,$78.48,$124.30,$125.56,$0.00,$0.00,$0.00,$0.00,$0.00
03.130.215,SUP,Custom 27203010,,03.130.215  -  COUNTERSINK DRL 1.3 MM 1.5 MM 2 MM SCR,$402.60,$0.00,$402.60,$0.00,$287.34,$0.00,$0.00,$0.00,$0.00,$0.00,$402.60,$0.00,$201.30,$318.86,$322.08,$0.00,$0.00,$0.00,$0.00,$0.00
03.130.221,SUP,Custom 27203010,,03.130.221  -  GUIDE DRL 1.1MM 2 VA FRHD 1.5MM LCK PLT,"$1,198.25",$0.00,"$1,198.25",$0.00,$855.19,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,198.25",$0.00,$599.13,$949.01,$958.60,$0.00,$0.00,$0.00,$0.00,$0.00
03.130.225,SUP,Custom 27203010,,03.130.225  -  SLEEVE DRL 1.5MM 1.1MM RD 2 1.5MM CORT SCR,$600.50,$0.00,$600.50,$0.00,$428.58,$0.00,$0.00,$0.00,$0.00,$0.00,$600.50,$0.00,$300.25,$475.60,$480.40,$0.00,$0.00,$0.00,$0.00,$0.00
03.130.250,SUP,Custom 27203010,,03.130.250  -  GAUGE D 1.3/1.5/2 MM SCR,"$2,176.78",$0.00,"$2,176.78",$0.00,"$1,553.56",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,176.78",$0.00,"$1,088.39","$1,724.01","$1,741.42",$0.00,$0.00,$0.00,$0.00,$0.00
03.130.260,SUP,HCPCS C1713,,03.130.260  -  PLIERS PLT BNDRG RT 1.3 MM LCK 1.5/2 MM VA PLT,$809.30,$0.00,$809.30,$364.19,$577.60,$0.00,$135.38,$0.00,$0.00,$141.70,$809.30,$0.00,$404.65,$640.97,$647.44,$0.00,$122.97,$0.00,$128.84,$0.00
03.130.261,SUP,HCPCS C1713,,03.130.261  -  PLIERS PLT BNDRG LT 1.3 MM LCK 1.5/2 MM VA PLT,$809.30,$0.00,$809.30,$364.19,$577.60,$0.00,$135.38,$0.00,$0.00,$141.70,$809.30,$0.00,$404.65,$640.97,$647.44,$0.00,$122.97,$0.00,$128.84,$0.00
03.130.292,SUP,Custom 27203010,,03.130.292  -  GUIDE DRL YLW INS 1MM BIT,$211.53,$0.00,$211.53,$0.00,$150.97,$0.00,$0.00,$0.00,$0.00,$0.00,$211.53,$0.00,$105.76,$167.53,$169.22,$0.00,$0.00,$0.00,$0.00,$0.00
03.130.293,SUP,Custom 27203010,,03.130.293  -  GUIDE DRL RD INS 1.1MM BIT,$211.53,$0.00,$211.53,$0.00,$150.97,$0.00,$0.00,$0.00,$0.00,$0.00,$211.53,$0.00,$105.76,$167.53,$169.22,$0.00,$0.00,$0.00,$0.00,$0.00
03.130.294,SUP,Custom 27203010,,03.130.294  -  GUIDE DRL YLW INS 1.3MM BIT,$211.53,$0.00,$211.53,$0.00,$150.97,$0.00,$0.00,$0.00,$0.00,$0.00,$211.53,$0.00,$105.76,$167.53,$169.22,$0.00,$0.00,$0.00,$0.00,$0.00
03.130.295,SUP,Custom 27203010,,03.130.295  -  GUIDE DRL RD INS 1.5MM BIT,$211.53,$0.00,$211.53,$0.00,$150.97,$0.00,$0.00,$0.00,$0.00,$0.00,$211.53,$0.00,$105.76,$167.53,$169.22,$0.00,$0.00,$0.00,$0.00,$0.00
03.130.296,SUP,Custom 27203010,,03.130.296  -  GUIDE DRL BLU INS 1.5MM BIT,$211.53,$0.00,$211.53,$0.00,$150.97,$0.00,$0.00,$0.00,$0.00,$0.00,$211.53,$0.00,$105.76,$167.53,$169.22,$0.00,$0.00,$0.00,$0.00,$0.00
03.130.297,SUP,Custom 27203010,,03.130.297  -  GUIDE DRL BLU INS 2MM BIT,$211.53,$0.00,$211.53,$0.00,$150.97,$0.00,$0.00,$0.00,$0.00,$0.00,$211.53,$0.00,$105.76,$167.53,$169.22,$0.00,$0.00,$0.00,$0.00,$0.00
03.130.300,SUP,Custom 27203010,,03.130.300  -  BIT DRL 1.5MM 88MM BLU KRSH WRE ATCH 2MM SCR,$156.95,$0.00,$156.95,$0.00,$112.02,$0.00,$0.00,$0.00,$0.00,$0.00,$156.95,$0.00,$78.48,$124.30,$125.56,$0.00,$0.00,$0.00,$0.00,$0.00
03.130.302,SUP,Custom 27203010,,03.130.302  -  BIT DRL 1.5MM 74MM 57MM CLR CD PILT HL MNQK CPLNG,$156.95,$0.00,$156.95,$0.00,$112.02,$0.00,$0.00,$0.00,$0.00,$0.00,$156.95,$0.00,$78.48,$124.30,$125.56,$0.00,$0.00,$0.00,$0.00,$0.00
03.130.310,SUP,Custom 27203010,,03.130.310  -  BIT DRL 2MM 71MM 41MM CLR CD GLD HL JCHK,$156.95,$0.00,$156.95,$0.00,$112.02,$0.00,$0.00,$0.00,$0.00,$0.00,$156.95,$0.00,$78.48,$124.30,$125.56,$0.00,$0.00,$0.00,$0.00,$0.00
03.130.312,SUP,Custom 27203010,,03.130.312  -  BIT DRL 2MM 57MM MNQK CPLNG GLD HL,$156.95,$0.00,$156.95,$0.00,$112.02,$0.00,$0.00,$0.00,$0.00,$0.00,$156.95,$0.00,$78.48,$124.30,$125.56,$0.00,$0.00,$0.00,$0.00,$0.00
03.130.321,SUP,Custom 27203010,,03.130.321  -  GUIDE DRL 1.5MM 2 VA LCK FR HND 2MM PLT,"$1,198.25",$0.00,"$1,198.25",$0.00,$855.19,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,198.25",$0.00,$599.13,$949.01,$958.60,$0.00,$0.00,$0.00,$0.00,$0.00
03.130.325,SUP,Custom 27203010,,03.130.325  -  SLEEVE DRL 1.5MM BLU 2 2MM CORT SCR,$600.50,$0.00,$600.50,$0.00,$428.58,$0.00,$0.00,$0.00,$0.00,$0.00,$600.50,$0.00,$300.25,$475.60,$480.40,$0.00,$0.00,$0.00,$0.00,$0.00
03.161.024,SUP,Custom 27203010,,03.161.024  -  BIT DRL 3.2MM NS OCPTL CRV FSN SYS,"$1,060.00",$0.00,"$1,060.00",$0.00,$756.52,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,060.00",$0.00,$530.00,$839.52,$848.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.161.026,SUP,HCPCS C1713,,03.161.026  -  TAP SURG NONSTRL 4.5 MM OCCPTL SCREW,"$1,275.00",$0.00,"$1,275.00",$573.75,$909.97,$0.00,$219.68,$0.00,$0.00,$223.24,"$1,275.00",$0.00,$637.50,"$1,009.80","$1,020.00",$0.00,$199.54,$0.00,$202.98,$0.00
03.161.027,SUP,Custom 27203010,,03.161.027  -  SCREWDRIVER SURG UNIVERSAL JOINT 4 MM OCCPTL SCREW,"$3,267.50",$0.00,"$3,267.50",$0.00,"$2,332.01",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,267.50",$0.00,"$1,633.75","$2,587.86","$2,614.00",$0.00,$0.00,$0.00,$0.00,$0.00
03.211.410,SUP,Custom 27203010,,03.211.410  -  WIRE FX 1.6MM 150MM NS 10MM LCP CMPR THRD,$83.25,$0.00,$83.25,$0.00,$59.42,$0.00,$0.00,$0.00,$0.00,$0.00,$83.25,$0.00,$41.63,$65.93,$66.60,$0.00,$0.00,$0.00,$0.00,$0.00
03.211.415,SUP,Custom 27203010,,03.211.415  -  WIRE FX 1.6MM 150MM NS 15MM LCP CMPR THRD,$83.25,$0.00,$83.25,$0.00,$59.42,$0.00,$0.00,$0.00,$0.00,$0.00,$83.25,$0.00,$41.63,$65.93,$66.60,$0.00,$0.00,$0.00,$0.00,$0.00
03.211.420,SUP,Custom 27203010,,03.211.420  -  WIRE FX 1.6MM 150MM NS 20MM LCP CMPR THRD,$83.25,$0.00,$83.25,$0.00,$59.42,$0.00,$0.00,$0.00,$0.00,$0.00,$83.25,$0.00,$41.63,$65.93,$66.60,$0.00,$0.00,$0.00,$0.00,$0.00
03.211.425,SUP,Custom 27203010,,03.211.425  -  WIRE FX 1.6MM 150MM NS 25MM LCP CMPR THRD,$83.25,$0.00,$83.25,$0.00,$59.42,$0.00,$0.00,$0.00,$0.00,$0.00,$83.25,$0.00,$41.63,$65.93,$66.60,$0.00,$0.00,$0.00,$0.00,$0.00
03.211.430,SUP,Custom 27203010,,03.211.430  -  WIRE FX 1.6MM 150MM NS 30MM LCP CMPR THRD,$83.25,$0.00,$83.25,$0.00,$59.42,$0.00,$0.00,$0.00,$0.00,$0.00,$83.25,$0.00,$41.63,$65.93,$66.60,$0.00,$0.00,$0.00,$0.00,$0.00
03.211.435,SUP,Custom 27203010,,03.211.435  -  WIRE FX 1.6MM 150MM NS 35MM LCP CMPR THRD,$85.98,$0.00,$85.98,$0.00,$61.36,$0.00,$0.00,$0.00,$0.00,$0.00,$85.98,$0.00,$42.99,$68.10,$68.78,$0.00,$0.00,$0.00,$0.00,$0.00
03.211.440,SUP,Custom 27203010,,03.211.440  -  WIRE FX 1.6MM 150MM NS 40MM LCP CMPR THRD,$85.98,$0.00,$85.98,$0.00,$61.36,$0.00,$0.00,$0.00,$0.00,$0.00,$85.98,$0.00,$42.99,$68.10,$68.78,$0.00,$0.00,$0.00,$0.00,$0.00
03.226.039,SUP,Custom 27203010,,03.226.039  -  BIT DRILL 3.2MM CANN NONSTRL 4.5MM SCREW,$731.50,$0.00,$731.50,$0.00,$522.07,$0.00,$0.00,$0.00,$0.00,$0.00,$731.50,$0.00,$365.75,$579.35,$585.20,$0.00,$0.00,$0.00,$0.00,$0.00
03.226.042,SUP,Custom 27203010,,03.226.042  -  BIT DRILL 4MM DEVICE CANN,$787.45,$0.00,$787.45,$0.00,$562.00,$0.00,$0.00,$0.00,$0.00,$0.00,$787.45,$0.00,$393.73,$623.66,$629.96,$0.00,$0.00,$0.00,$0.00,$0.00
03.227.042,SUP,Custom 27203010,,03.227.042  -  BIT DRILL 6MM CANN NONSTRL 6.5MM HEADLESS COMPRESSION SCREW,$750.63,$0.00,$750.63,$0.00,$535.72,$0.00,$0.00,$0.00,$0.00,$0.00,$750.63,$0.00,$375.31,$594.50,$600.50,$0.00,$0.00,$0.00,$0.00,$0.00
03.301.010S,SUP,Custom 27203010,,03.301.010S  -  SET EXFIX LARGE FRAME ANKLE STERILE,"$5,593.53",$0.00,"$5,593.53",$0.00,"$3,992.10",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,593.53",$0.00,"$2,796.76","$4,430.08","$4,474.82",$0.00,$0.00,$0.00,$0.00,$0.00
03.301.011S,SUP,Custom 27203010,,03.301.011S  -  KIT TRAUMA LARGE EXFIX STERILE,"$5,861.73",$0.00,"$5,861.73",$0.00,"$4,183.51",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,861.73",$0.00,"$2,930.86","$4,642.49","$4,689.38",$0.00,$0.00,$0.00,$0.00,$0.00
03.301.012S,SUP,Custom 27203010,,03.301.012S  -  KIT FRAME LARGE EXFIX PELVIC STERILE,"$7,859.25",$0.00,"$7,859.25",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,859.25",$0.00,"$3,929.63","$6,224.53","$6,287.40",$0.00,$0.00,$0.00,$0.00,$0.00
03.304.220S,SUP,HCPCS C1713,,03.304.220S  -  FIXATOR XTRNFX 2.5MM 4MM 200MM STRL LF SCHNZ LOPRFL ROD CFBR,"$1,611.43",$0.00,"$1,611.43",$725.14,"$1,150.07",$0.00,$269.56,$0.00,$0.00,$282.15,"$1,611.43",$0.00,$805.71,"$1,276.25","$1,289.14",$0.00,$244.84,$0.00,$256.54,$0.00
03.304.222S,SUP,HCPCS C1713,,03.304.222S  -  FIXATOR XTRNFX 2.5-4MM 220MM STRL LOPRFL ROD CFBR WRST,"$1,611.43",$0.00,"$1,611.43",$725.14,"$1,150.07",$0.00,$269.56,$0.00,$0.00,$282.15,"$1,611.43",$0.00,$805.71,"$1,276.25","$1,289.14",$0.00,$244.84,$0.00,$256.54,$0.00
03.304.320S,SUP,Custom 27203010,,03.304.320S  -  FIXATOR XTRNFX 3MM 4MM 200MM STRL LF SCHNZ ROD LOPRFL SLF,"$2,045.13",$0.00,"$2,045.13",$0.00,"$1,459.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,045.13",$0.00,"$1,022.56","$1,619.74","$1,636.10",$0.00,$0.00,$0.00,$0.00,$0.00
03.304.322S,SUP,Custom 27203010,,03.304.322S  -  ROD EXFIX 220MM MRI SAFE LOW-PROFILE WRIST FIXATOR,"$2,045.13",$0.00,"$2,045.13",$0.00,"$1,459.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,045.13",$0.00,"$1,022.56","$1,619.74","$1,636.10",$0.00,$0.00,$0.00,$0.00,$0.00
03.305.004,SUP,Custom 27203010,,03.305.004  -  BIT DRL 24MM 1.8/4MM NS MATRIXRIB JLTCH CPLNG STP STRYK,$630.00,$0.00,$630.00,$0.00,$449.63,$0.00,$0.00,$0.00,$0.00,$0.00,$630.00,$0.00,$315.00,$498.96,$504.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.305.006,SUP,Custom 27203010,,03.305.006  -  CLAMP XTRNFX NS ADJ MNDB XTRNFXTR II,"$1,392.50",$0.00,"$1,392.50",$0.00,$993.83,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,392.50",$0.00,$696.25,"$1,102.86","$1,114.00",$0.00,$0.00,$0.00,$0.00,$0.00
03.305.009,SUP,Custom 27203010,,03.305.009  -  TEMPLATE SIZING 4MM ROD,$917.50,$0.00,$917.50,$0.00,$654.82,$0.00,$0.00,$0.00,$0.00,$0.00,$917.50,$0.00,$458.75,$726.66,$734.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.305.500,SUP,Custom 27203010,,03.305.500  -  ROD EXFIX 500MM NONSTRL MANDIB FIXATOR,"$4,300.00",$0.00,"$4,300.00",$0.00,"$3,068.91",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,300.00",$0.00,"$2,150.00","$3,405.60","$3,440.00",$0.00,$0.00,$0.00,$0.00,$0.00
03.306.010,SUP,Custom 27203010,,03.306.010  -  SET ORTHOPEDIC C CLMP II PELVIC,"$12,989.70",$0.00,"$12,989.70",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$12,989.70",$0.00,"$6,494.85","$10,287.84","$10,391.76",$0.00,$0.00,$0.00,$0.00,$0.00
03.307.001,SUP,Custom 27203010,,03.307.001  -  CLAMP EXFIX WIRE FIX EXTERNAL MIDFAC DISTRCT,$632.50,$0.00,$632.50,$0.00,$451.42,$0.00,$0.00,$0.00,$0.00,$0.00,$632.50,$0.00,$316.25,$500.94,$506.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.307.010,SUP,Custom 27203010,,03.307.010  -  ROD EXFIX 100MM CARFBR NONSTRL MIDFAC DISTRCT,$515.00,$0.00,$515.00,$0.00,$367.56,$0.00,$0.00,$0.00,$0.00,$0.00,$515.00,$0.00,$257.50,$407.88,$412.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.307.105,SUP,Custom 27203010,,03.307.105  -  BAR EXFIX 50MM CONNCTNG EXTERNAL MIDFAC DISTRCT,$390.00,$0.00,$390.00,$0.00,$278.34,$0.00,$0.00,$0.00,$0.00,$0.00,$390.00,$0.00,$195.00,$308.88,$312.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.307.112,SUP,Custom 27203010,,03.307.112  -  BAR EXFIX 120MM CONNCTNG EXTERNAL MIDFAC DISTRCT,$390.00,$0.00,$390.00,$0.00,$278.34,$0.00,$0.00,$0.00,$0.00,$0.00,$390.00,$0.00,$195.00,$308.88,$312.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.011,SUP,Custom 27203010,,03.311.011  -  CLAMP EXFIX SCREW MR SAFE PIVOT SCHANZ NONSTRL,$660.80,$0.00,$660.80,$0.00,$471.61,$0.00,$0.00,$0.00,$0.00,$0.00,$660.80,$0.00,$330.40,$523.35,$528.64,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.012,SUP,Custom 27803010,,03.311.012  -  HINGE XTRNFX NS LCK MRI SAFE,$330.95,$0.00,$330.95,$0.00,$236.20,$0.00,$0.00,$0.00,$0.00,$0.00,$330.95,$0.00,$165.48,$262.11,$264.76,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.022,SUP,HCPCS C1713,,03.311.022  -  PLATE EXFIX 90D 2 HOLE OFFST CONNCTNG NONSTRL,$152.50,$0.00,$152.50,$68.63,$108.84,$0.00,$25.51,$0.00,$0.00,$26.70,$152.50,$0.00,$76.25,$120.78,$122.00,$0.00,$23.17,$0.00,$24.28,$0.00
03.311.023,SUP,HCPCS C1713,,03.311.023  -  PLATE EXFIX 90D 3 HOLE OFFST CONNCTNG NONSTRL,$163.30,$0.00,$163.30,$73.49,$116.55,$0.00,$27.32,$0.00,$0.00,$28.59,$163.30,$0.00,$81.65,$129.33,$130.64,$0.00,$24.81,$0.00,$26.00,$0.00
03.311.024,SUP,HCPCS C1713,,03.311.024  -  PLATE EXFIX 90D 4 HOLE OFFST CONNCTNG NONSTRL,$175.20,$0.00,$175.20,$78.84,$125.04,$0.00,$29.31,$0.00,$0.00,$30.68,$175.20,$0.00,$87.60,$138.76,$140.16,$0.00,$26.62,$0.00,$27.89,$0.00
03.311.025,SUP,HCPCS C1713,,03.311.025  -  PLATE EXFIX 90D 5 HOLE OFFST CONNCTNG NONSTRL,$187.10,$0.00,$187.10,$84.20,$133.53,$0.00,$31.30,$0.00,$0.00,$32.76,$187.10,$0.00,$93.55,$148.18,$149.68,$0.00,$28.43,$0.00,$29.79,$0.00
03.311.031,SUP,Custom 27203010,,03.311.031  -  EXTRACTOR SRG 1.5MM 400MM NS SMTH MR SF DSTRCT OSTEOGENESIS,$115.73,$0.00,$115.73,$0.00,$82.59,$0.00,$0.00,$0.00,$0.00,$0.00,$115.73,$0.00,$57.86,$91.66,$92.58,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.032,SUP,Custom 27203010,,03.311.032  -  WIRE FIX 1.8MM 400MM SMOOTH MRI SAFE NONSTRL,$115.73,$0.00,$115.73,$0.00,$82.59,$0.00,$0.00,$0.00,$0.00,$0.00,$115.73,$0.00,$57.86,$91.66,$92.58,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.033,SUP,Custom 27203010,,03.311.033  -  WIRE FX 2MM 400MM NS SMTH MRI SAFE,$115.73,$0.00,$115.73,$0.00,$82.59,$0.00,$0.00,$0.00,$0.00,$0.00,$115.73,$0.00,$57.86,$91.66,$92.58,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.036,SUP,Custom 27203010,,03.311.036  -  WIRE XTRNFX 1.5MM SMTH HLF PNT TIP MRI SAFE,$115.73,$0.00,$115.73,$0.00,$82.59,$0.00,$0.00,$0.00,$0.00,$0.00,$115.73,$0.00,$57.86,$91.66,$92.58,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.037,SUP,Custom 27203010,,03.311.037  -  WIRE XTRNFX 1.8MM SMTH HLF PNT TIP MRI SAFE,$115.73,$0.00,$115.73,$0.00,$82.59,$0.00,$0.00,$0.00,$0.00,$0.00,$115.73,$0.00,$57.86,$91.66,$92.58,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.038,SUP,Custom 27203010,,03.311.038  -  WIRE XTRNFX 2MM SMTH HLF PNT TIP MRI SAFE,$115.73,$0.00,$115.73,$0.00,$82.59,$0.00,$0.00,$0.00,$0.00,$0.00,$115.73,$0.00,$57.86,$91.66,$92.58,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.041,SUP,Custom 27203010,,03.311.041  -  WIRE XTRNFX 1.5MM 400MM RDC MRI SAFE,$360.15,$0.00,$360.15,$0.00,$257.04,$0.00,$0.00,$0.00,$0.00,$0.00,$360.15,$0.00,$180.08,$285.24,$288.12,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.042,SUP,Custom 27203010,,03.311.042  -  WIRE XTRNFX 1.8MM 400MM RDC MRI SAFE,$360.15,$0.00,$360.15,$0.00,$257.04,$0.00,$0.00,$0.00,$0.00,$0.00,$360.15,$0.00,$180.08,$285.24,$288.12,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.043,SUP,Custom 27203010,,03.311.043  -  WIRE FX 2MM 400MM NS SMTH MRI SAFE,$360.15,$0.00,$360.15,$0.00,$257.04,$0.00,$0.00,$0.00,$0.00,$0.00,$360.15,$0.00,$180.08,$285.24,$288.12,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.046,SUP,Custom 27203010,,03.311.046  -  WIRE XTRNFX 1.5MM RDC HLF PNT TIP MRI SAFE,$360.15,$0.00,$360.15,$0.00,$257.04,$0.00,$0.00,$0.00,$0.00,$0.00,$360.15,$0.00,$180.08,$285.24,$288.12,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.047,SUP,Custom 27203010,,03.311.047  -  WIRE XTRNFX 1.8MM RDC HLF PNT TIP MRI SAFE,$360.15,$0.00,$360.15,$0.00,$257.04,$0.00,$0.00,$0.00,$0.00,$0.00,$360.15,$0.00,$180.08,$285.24,$288.12,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.048,SUP,Custom 27203010,,03.311.048  -  WIRE XTRNFX 2MM RDC HLF PNT TIP MRI SAFE,$360.15,$0.00,$360.15,$0.00,$257.04,$0.00,$0.00,$0.00,$0.00,$0.00,$360.15,$0.00,$180.08,$285.24,$288.12,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.060,SUP,Custom 27203010,,03.311.060  -  NUT XTRNFX SQ MRI SAFE,$123.30,$0.00,$123.30,$0.00,$88.00,$0.00,$0.00,$0.00,$0.00,$0.00,$123.30,$0.00,$61.65,$97.65,$98.64,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.061.10,SUP,Custom 27203010,,03.311.061.10  -  NUT XTRNFX NS LF DISP,$6.09,$0.00,$6.09,$0.00,$4.35,$0.00,$0.00,$0.00,$0.00,$0.00,$6.09,$0.00,$3.05,$4.82,$4.87,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.062,SUP,Custom 27803010,,03.311.062  -  NUT ORTHOPEDIC MRI SAFE NONSTRL,$239.00,$0.00,$239.00,$0.00,$170.57,$0.00,$0.00,$0.00,$0.00,$0.00,$239.00,$0.00,$119.50,$189.29,$191.20,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.070,SUP,Custom 27203010,,03.311.070  -  POST EXFIX SHORT WIRE MRI SAFE NONSTRL,$296.33,$0.00,$296.33,$0.00,$211.49,$0.00,$0.00,$0.00,$0.00,$0.00,$296.33,$0.00,$148.16,$234.69,$237.06,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.071,SUP,Custom 27203010,,03.311.071  -  POST XTRNFX TLL NS WRE MRI SAFE,$336.35,$0.00,$336.35,$0.00,$240.05,$0.00,$0.00,$0.00,$0.00,$0.00,$336.35,$0.00,$168.18,$266.39,$269.08,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.090,SUP,Custom 27803010,,03.311.090  -  WASHER XTRNFX SPHRCL CPLNG MRI SAFE,$52.45,$0.00,$52.45,$0.00,$37.43,$0.00,$0.00,$0.00,$0.00,$0.00,$52.45,$0.00,$26.23,$41.54,$41.96,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.091,SUP,Custom 27203010,,03.311.091  -  SUPPORT XTRNFX OBLQ NS,$834.93,$0.00,$834.93,$0.00,$595.89,$0.00,$0.00,$0.00,$0.00,$0.00,$834.93,$0.00,$417.46,$661.26,$667.94,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.106,SUP,HCPCS C1713,,03.311.106  -  ROD EXFIX 60MM THREAD SLOT MR SAFE NONSTRL DISTRACTION,$101.65,$0.00,$101.65,$45.74,$72.55,$0.00,$17.01,$0.00,$0.00,$17.80,$101.65,$0.00,$50.83,$80.51,$81.32,$0.00,$15.45,$0.00,$16.18,$0.00
03.311.108,SUP,HCPCS C1713,,03.311.108  -  ROD EXFIX 80MM THREAD SLOT MR SAFE NONSTRL DISTRACTION,$101.65,$0.00,$101.65,$45.74,$72.55,$0.00,$17.01,$0.00,$0.00,$17.80,$101.65,$0.00,$50.83,$80.51,$81.32,$0.00,$15.45,$0.00,$16.18,$0.00
03.311.110,SUP,Custom 27203010,,03.311.110  -  ROD EXFIX 100MM THREAD SLOT MR SAFE NONSTRL DISTRACTION,$101.65,$0.00,$101.65,$0.00,$72.55,$0.00,$0.00,$0.00,$0.00,$0.00,$101.65,$0.00,$50.83,$80.51,$81.32,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.112,SUP,HCPCS C1713,,03.311.112  -  ROD EXFIX 120MM THREAD MR SAFE NONSTRL DISTRACTION,$101.65,$0.00,$101.65,$45.74,$72.55,$0.00,$17.01,$0.00,$0.00,$17.80,$101.65,$0.00,$50.83,$80.51,$81.32,$0.00,$15.45,$0.00,$16.18,$0.00
03.311.115,SUP,HCPCS C1713,,03.311.115  -  ROD EXFIX 150MM THREAD MR SAFE NONSTRL DISTRACTION,$101.65,$0.00,$101.65,$45.74,$72.55,$0.00,$17.01,$0.00,$0.00,$17.80,$101.65,$0.00,$50.83,$80.51,$81.32,$0.00,$15.45,$0.00,$16.18,$0.00
03.311.120,SUP,Custom 27203010,,03.311.120  -  ROD EXFIX 200MM THREAD MR SAFE NONSTRL DISTRACTION,$110.33,$0.00,$110.33,$0.00,$78.74,$0.00,$0.00,$0.00,$0.00,$0.00,$110.33,$0.00,$55.16,$87.38,$88.26,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.125,SUP,Custom 27203010,,03.311.125  -  ROD EXFIX 250MM THREAD MR SAFE NONSTRL DISTRACTION,$110.33,$0.00,$110.33,$0.00,$78.74,$0.00,$0.00,$0.00,$0.00,$0.00,$110.33,$0.00,$55.16,$87.38,$88.26,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.130,SUP,Custom 27203010,,03.311.130  -  ROD EXFIX 300MM THREAD MR SAFE NONSTRL DISTRACTION,$127.63,$0.00,$127.63,$0.00,$91.09,$0.00,$0.00,$0.00,$0.00,$0.00,$127.63,$0.00,$63.81,$101.08,$102.10,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.135,SUP,Custom 27203010,,03.311.135  -  ROD EXFIX 350MM THREAD MR SAFE NONSTRL DISTRACTION,$127.63,$0.00,$127.63,$0.00,$91.09,$0.00,$0.00,$0.00,$0.00,$0.00,$127.63,$0.00,$63.81,$101.08,$102.10,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.140,SUP,Custom 27203010,,03.311.140  -  ROD EXFIX 400MM THREAD MR SAFE NONSTRL DISTRACTION,$167.63,$0.00,$167.63,$0.00,$119.63,$0.00,$0.00,$0.00,$0.00,$0.00,$167.63,$0.00,$83.81,$132.76,$134.10,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.171,SUP,Custom 27203010,,03.311.171  -  POST XTRNFX NS 1 HL WRE FEM,$323.38,$0.00,$323.38,$0.00,$230.79,$0.00,$0.00,$0.00,$0.00,$0.00,$323.38,$0.00,$161.69,$256.12,$258.70,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.172,SUP,Custom 27203010,,03.311.172  -  POST XTRNFX NS 2 HL WRE FEM,$336.35,$0.00,$336.35,$0.00,$240.05,$0.00,$0.00,$0.00,$0.00,$0.00,$336.35,$0.00,$168.18,$266.39,$269.08,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.173,SUP,Custom 27203010,,03.311.173  -  POST XTRNFX NS 3 HL WRE FEM,$348.25,$0.00,$348.25,$0.00,$248.55,$0.00,$0.00,$0.00,$0.00,$0.00,$348.25,$0.00,$174.13,$275.81,$278.60,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.174,SUP,Custom 27203010,,03.311.174  -  POST XTRNFX NS 4 HL WRE FEM,$362.30,$0.00,$362.30,$0.00,$258.57,$0.00,$0.00,$0.00,$0.00,$0.00,$362.30,$0.00,$181.15,$286.94,$289.84,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.175,SUP,Custom 27203010,,03.311.175  -  POST XTRNFX NS 5 HL WRE FEM,$374.20,$0.00,$374.20,$0.00,$267.07,$0.00,$0.00,$0.00,$0.00,$0.00,$374.20,$0.00,$187.10,$296.37,$299.36,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.200,SUP,HCPCS C1713,,03.311.200  -  PLATE XTRNFX FLT NS 1 HL CNCT MRI SAFE FEM CFBR RING,$114.65,$0.00,$114.65,$51.59,$81.83,$0.00,$19.18,$0.00,$0.00,$20.07,$114.65,$0.00,$57.33,$90.80,$91.72,$0.00,$17.42,$0.00,$18.25,$0.00
03.311.201,SUP,HCPCS C1713,,03.311.201  -  PLATE XTRNFX NS 1 HL CNCT MRI SAFE FEM CFBR RING,$114.65,$0.00,$114.65,$51.59,$81.83,$0.00,$19.18,$0.00,$0.00,$20.07,$114.65,$0.00,$57.33,$90.80,$91.72,$0.00,$17.42,$0.00,$18.25,$0.00
03.311.202,SUP,HCPCS C1713,,03.311.202  -  PLATE XTRNFX NS 2 HL CNCT MRI SAFE FEM CFBR RING,$123.30,$0.00,$123.30,$55.49,$88.00,$0.00,$20.62,$0.00,$0.00,$21.59,$123.30,$0.00,$61.65,$97.65,$98.64,$0.00,$18.73,$0.00,$19.63,$0.00
03.311.203,SUP,HCPCS C1713,,03.311.203  -  PLATE XTRNFX NS 3 HL CNCT MRI SAFE FEM CFBR RING,$127.63,$0.00,$127.63,$57.43,$91.09,$0.00,$21.35,$0.00,$0.00,$22.35,$127.63,$0.00,$63.81,$101.08,$102.10,$0.00,$19.39,$0.00,$20.32,$0.00
03.311.204,SUP,HCPCS C1713,,03.311.204  -  PLATE XTRNFX NS 4 HL CNCT MRI SAFE FEM CFBR RING,$144.93,$0.00,$144.93,$65.22,$103.43,$0.00,$24.24,$0.00,$0.00,$25.38,$144.93,$0.00,$72.46,$114.78,$115.94,$0.00,$22.02,$0.00,$23.07,$0.00
03.311.205,SUP,HCPCS C1713,,03.311.205  -  PLATE XTRNFX NS 5 HL CNCT MRI SAFE FEM CFBR RING,$167.63,$0.00,$167.63,$75.43,$119.63,$0.00,$28.04,$0.00,$0.00,$29.35,$167.63,$0.00,$83.81,$132.76,$134.10,$0.00,$25.47,$0.00,$26.69,$0.00
03.311.212,SUP,HCPCS C1713,,03.311.212  -  PLATE XTRNFX NS 2 HL CNCT,$122.20,$0.00,$122.20,$54.99,$87.21,$0.00,$20.44,$0.00,$0.00,$21.40,$122.20,$0.00,$61.10,$96.78,$97.76,$0.00,$18.57,$0.00,$19.45,$0.00
03.311.213,SUP,HCPCS C1713,,03.311.213  -  PLATE XTRNFX NS 3 HL CNCT,$135.20,$0.00,$135.20,$60.84,$96.49,$0.00,$22.61,$0.00,$0.00,$23.67,$135.20,$0.00,$67.60,$107.08,$108.16,$0.00,$20.54,$0.00,$21.52,$0.00
03.311.214,SUP,HCPCS C1713,,03.311.214  -  PLATE XTRNFX NS 4 HL CNCT,$146.00,$0.00,$146.00,$65.70,$104.20,$0.00,$24.42,$0.00,$0.00,$25.56,$146.00,$0.00,$73.00,$115.63,$116.80,$0.00,$22.18,$0.00,$23.24,$0.00
03.311.215,SUP,HCPCS C1713,,03.311.215  -  PLATE XTRNFX NS 5 HL CNCT,$157.90,$0.00,$157.90,$71.06,$112.69,$0.00,$26.41,$0.00,$0.00,$27.65,$157.90,$0.00,$78.95,$125.06,$126.32,$0.00,$23.99,$0.00,$25.14,$0.00
03.311.220,SUP,Custom 27203010,,03.311.220  -  SPACER XTRNFX 20MM NS STNDOF MRI SAFE DSTRCT OSTEOGENESIS,$70.85,$0.00,$70.85,$0.00,$50.57,$0.00,$0.00,$0.00,$0.00,$0.00,$70.85,$0.00,$35.43,$56.11,$56.68,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.230,SUP,Custom 27803010,,03.311.230  -  SPACER XTRNFX 30MM NS STNDOF MRI SAFE DSTRCT OSTEOGENESIS,$76.78,$0.00,$76.78,$0.00,$54.79,$0.00,$0.00,$0.00,$0.00,$0.00,$76.78,$0.00,$38.39,$60.81,$61.42,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.240,SUP,Custom 27203010,,03.311.240  -  SPACER XTRNFX 40MM NS STNDOF MRI SAFE DSTRCT OSTEOGENESIS,$84.90,$0.00,$84.90,$0.00,$60.59,$0.00,$0.00,$0.00,$0.00,$0.00,$84.90,$0.00,$42.45,$67.24,$67.92,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.250,SUP,Custom 27203010,,03.311.250  -  SPACER XTRNFX 50MM NS STNDOF MRI SAFE DSTRCT OSTEOGENESIS,$114.65,$0.00,$114.65,$0.00,$81.83,$0.00,$0.00,$0.00,$0.00,$0.00,$114.65,$0.00,$57.33,$90.80,$91.72,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.308,SUP,Custom 27203010,,03.311.308  -  RING EXFIX HALF 80MM TITANIUM NONSTRL DISTRACTION,$561.30,$0.00,$561.30,$0.00,$400.60,$0.00,$0.00,$0.00,$0.00,$0.00,$561.30,$0.00,$280.65,$444.55,$449.04,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.310,SUP,Custom 27203010,,03.311.310  -  RING EXFIX HALF 100MM TITANIUM NONSTRL DISTRACTION,$605.65,$0.00,$605.65,$0.00,$432.25,$0.00,$0.00,$0.00,$0.00,$0.00,$605.65,$0.00,$302.83,$479.67,$484.52,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.311,SUP,Custom 27203010,,03.311.311  -  RING EXFIX HALF 110MM TITANIUM NONSTRL DISTRACTION,$620.78,$0.00,$620.78,$0.00,$443.05,$0.00,$0.00,$0.00,$0.00,$0.00,$620.78,$0.00,$310.39,$491.66,$496.62,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.312,SUP,Custom 27203010,,03.311.312  -  RING EXFIX HALF 120MM TITANIUM NONSTRL DISTRACTION,$646.73,$0.00,$646.73,$0.00,$461.57,$0.00,$0.00,$0.00,$0.00,$0.00,$646.73,$0.00,$323.36,$512.21,$517.38,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.313,SUP,Custom 27203010,,03.311.313  -  RING EXFIX HALF 130MM TITANIUM NONSTRL DISTRACTION,$662.95,$0.00,$662.95,$0.00,$473.15,$0.00,$0.00,$0.00,$0.00,$0.00,$662.95,$0.00,$331.48,$525.06,$530.36,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.314,SUP,Custom 27203010,,03.311.314  -  RING EXFIX HALF 140MM TITANIUM NONSTRL DISTRACTION,$688.93,$0.00,$688.93,$0.00,$491.69,$0.00,$0.00,$0.00,$0.00,$0.00,$688.93,$0.00,$344.46,$545.63,$551.14,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.315,SUP,Custom 27203010,,03.311.315  -  RING EXFIX HALF 150MM TITANIUM NONSTRL DISTRACTION,$733.25,$0.00,$733.25,$0.00,$523.32,$0.00,$0.00,$0.00,$0.00,$0.00,$733.25,$0.00,$366.63,$580.73,$586.60,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.316,SUP,Custom 27203010,,03.311.316  -  RING EXFIX HALF 160MM TITANIUM NONSTRL DISTRACTION,$799.23,$0.00,$799.23,$0.00,$570.41,$0.00,$0.00,$0.00,$0.00,$0.00,$799.23,$0.00,$399.61,$632.99,$639.38,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.318,SUP,Custom 27203010,,03.311.318  -  RING EXFIX HALF 180MM TITANIUM NONSTRL DISTRACTION,$858.70,$0.00,$858.70,$0.00,$612.85,$0.00,$0.00,$0.00,$0.00,$0.00,$858.70,$0.00,$429.35,$680.09,$686.96,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.320,SUP,Custom 27203010,,03.311.320  -  RING EXFIX HALF 200MM TITANIUM NONSTRL DISTRACTION,$930.10,$0.00,$930.10,$0.00,$663.81,$0.00,$0.00,$0.00,$0.00,$0.00,$930.10,$0.00,$465.05,$736.64,$744.08,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.322,SUP,Custom 27203010,,03.311.322  -  RING EXFIX HALF 220MM TITANIUM NONSTRL DISTRACTION,$989.58,$0.00,$989.58,$0.00,$706.26,$0.00,$0.00,$0.00,$0.00,$0.00,$989.58,$0.00,$494.79,$783.75,$791.66,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.324,SUP,Custom 27203010,,03.311.324  -  RING EXFIX HALF 240MM TITANIUM NONSTRL DISTRACTION,"$1,032.83",$0.00,"$1,032.83",$0.00,$737.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,032.83",$0.00,$516.41,$818.00,$826.26,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.344,SUP,Custom 27203010,,03.311.344  -  RING EXFIX FULL 140MM TITANIUM NONSTRL DISTRACTION,"$1,373.50",$0.00,"$1,373.50",$0.00,$980.27,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,373.50",$0.00,$686.75,"$1,087.81","$1,098.80",$0.00,$0.00,$0.00,$0.00,$0.00
03.311.346,SUP,Custom 27203010,,03.311.346  -  RING EXFIX FULL 160MM TITANIUM NONSTRL DISTRACTION,"$1,597.38",$0.00,"$1,597.38",$0.00,"$1,140.05",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,597.38",$0.00,$798.69,"$1,265.12","$1,277.90",$0.00,$0.00,$0.00,$0.00,$0.00
03.311.348,SUP,Custom 27203010,,03.311.348  -  RING EXFIX FULL 180MM TITANIUM NONSTRL DISTRACTION,"$1,717.43",$0.00,"$1,717.43",$0.00,"$1,225.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,717.43",$0.00,$858.71,"$1,360.20","$1,373.94",$0.00,$0.00,$0.00,$0.00,$0.00
03.311.350,SUP,Custom 27203010,,03.311.350  -  RING EXFIX FULL 200MM TITANIUM NONSTRL DISTRACTION,"$1,864.50",$0.00,"$1,864.50",$0.00,"$1,330.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,864.50",$0.00,$932.25,"$1,476.68","$1,491.60",$0.00,$0.00,$0.00,$0.00,$0.00
03.311.373,SUP,Custom 27203010,,03.311.373  -  RING EXFIX 5/8 130MM TITANIUM NONSTRL DISTRACTION,$903.05,$0.00,$903.05,$0.00,$644.51,$0.00,$0.00,$0.00,$0.00,$0.00,$903.05,$0.00,$451.53,$715.22,$722.44,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.375,SUP,Custom 27203010,,03.311.375  -  RING EXFIX 5/8 150MM TITANIUM NONSTRL DISTRACTION,$989.58,$0.00,$989.58,$0.00,$706.26,$0.00,$0.00,$0.00,$0.00,$0.00,$989.58,$0.00,$494.79,$783.75,$791.66,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.376,SUP,Custom 27203010,,03.311.376  -  RING EXFIX 5/8 160MM TITANIUM NONSTRL DISTRACTION,"$1,073.93",$0.00,"$1,073.93",$0.00,$766.46,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,073.93",$0.00,$536.96,$850.55,$859.14,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.378,SUP,Custom 27203010,,03.311.378  -  RING EXFIX 5/8 180MM TITANIUM NONSTRL DISTRACTION,"$1,246.98",$0.00,"$1,246.98",$0.00,$889.97,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,246.98",$0.00,$623.49,$987.61,$997.58,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.380,SUP,Custom 27203010,,03.311.380  -  RING EXFIX 5/8 200MM TITANIUM NONSTRL DISTRACTION,"$1,289.15",$0.00,"$1,289.15",$0.00,$920.07,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,289.15",$0.00,$644.58,"$1,021.01","$1,031.32",$0.00,$0.00,$0.00,$0.00,$0.00
03.311.391,SUP,HCPCS C1713,,03.311.391  -  PLATE XTRNFX 90D ARCH 180MM NS TI FEM DSTRCT OSTEOGENESIS,"$1,546.55",$0.00,"$1,546.55",$695.95,"$1,103.77",$0.00,$258.70,$0.00,$0.00,$270.79,"$1,546.55",$0.00,$773.28,"$1,224.87","$1,237.24",$0.00,$234.98,$0.00,$246.21,$0.00
03.311.392,SUP,HCPCS C1713,,03.311.392  -  PLATE XTRNFX 120D ARCH 180MM NS TI FEM DSTRCT OSTEOGENESIS,"$1,588.73",$0.00,"$1,588.73",$714.93,"$1,133.87",$0.00,$265.76,$0.00,$0.00,$278.17,"$1,588.73",$0.00,$794.36,"$1,258.27","$1,270.98",$0.00,$241.39,$0.00,$252.93,$0.00
03.311.396,SUP,HCPCS C1713,,03.311.396  -  PLATE XTRNFX 90D ARCH 240MM NS TI FEM DSTRCT OSTEOGENESIS,"$1,677.40",$0.00,"$1,677.40",$754.83,"$1,197.16",$0.00,$280.59,$0.00,$0.00,$293.70,"$1,677.40",$0.00,$838.70,"$1,328.50","$1,341.92",$0.00,$254.87,$0.00,$267.04,$0.00
03.311.397,SUP,HCPCS C1713,,03.311.397  -  PLATE XTRNFX 120D ARCH 240MM NS TI FEM DSTRCT OSTEOGENESIS,"$1,717.43",$0.00,"$1,717.43",$772.84,"$1,225.73",$0.00,$287.28,$0.00,$0.00,$300.71,"$1,717.43",$0.00,$858.71,"$1,360.20","$1,373.94",$0.00,$260.95,$0.00,$273.41,$0.00
03.311.406,SUP,Custom 27803010,,03.311.406  -  DISTRACTOR SURG 60MM 25MM LINEAR NONSTRL,$989.58,$0.00,$989.58,$0.00,$706.26,$0.00,$0.00,$0.00,$0.00,$0.00,$989.58,$0.00,$494.79,$783.75,$791.66,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.412,SUP,Custom 27803010,,03.311.412  -  DISTRACTOR SURG 85MM TRAVEL 120MM LINEAR MRI SAFE NONSTRL,"$1,073.93",$0.00,"$1,073.93",$0.00,$766.46,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,073.93",$0.00,$536.96,$850.55,$859.14,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.418,SUP,Custom 27803010,,03.311.418  -  DISTRACTOR SURG 180MM LINEAR MRI SAFE NONSTRL,"$1,203.70",$0.00,"$1,203.70",$0.00,$859.08,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,203.70",$0.00,$601.85,$953.33,$962.96,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.425,SUP,Custom 27803010,,03.311.425  -  DISTRACTOR SURG 215MM TRAVEL 250MM LINEAR MRI SAFE NONSTRL,"$1,461.10",$0.00,"$1,461.10",$0.00,"$1,042.79",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,461.10",$0.00,$730.55,"$1,157.19","$1,168.88",$0.00,$0.00,$0.00,$0.00,$0.00
03.311.450,SUP,Custom 27803010,,03.311.450  -  DISTRACTOR SURG ANGLE NONSTRL,$961.45,$0.00,$961.45,$0.00,$686.19,$0.00,$0.00,$0.00,$0.00,$0.00,$961.45,$0.00,$480.73,$761.47,$769.16,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.451,SUP,Custom 27803010,,03.311.451  -  DISTRACTOR SURG ANGLE PIVOT NONSTRL,$419.63,$0.00,$419.63,$0.00,$299.49,$0.00,$0.00,$0.00,$0.00,$0.00,$419.63,$0.00,$209.81,$332.35,$335.70,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.810,SUP,Custom 27203010,,03.311.810  -  RING EXFIX .5 100MM MRI SAFE CARFBR NONSTRL,$688.93,$0.00,$688.93,$0.00,$491.69,$0.00,$0.00,$0.00,$0.00,$0.00,$688.93,$0.00,$344.46,$545.63,$551.14,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.812,SUP,Custom 27203010,,03.311.812  -  RING EXFIX .5 120MM MRI SAFE CARFBR NONSTRL,$733.25,$0.00,$733.25,$0.00,$523.32,$0.00,$0.00,$0.00,$0.00,$0.00,$733.25,$0.00,$366.63,$580.73,$586.60,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.814,SUP,Custom 27203010,,03.311.814  -  RING EXFIX .5 140MM MRI SAFE CARFBR NONSTRL,$775.43,$0.00,$775.43,$0.00,$553.42,$0.00,$0.00,$0.00,$0.00,$0.00,$775.43,$0.00,$387.71,$614.14,$620.34,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.816,SUP,Custom 27203010,,03.311.816  -  RING EXFIX .5 160MM MRI SAFE CARFBR NONSTRL,$858.70,$0.00,$858.70,$0.00,$612.85,$0.00,$0.00,$0.00,$0.00,$0.00,$858.70,$0.00,$429.35,$680.09,$686.96,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.818,SUP,Custom 27203010,,03.311.818  -  RING EXFIX .5 180MM MRI SAFE CARFBR NONSTRL,$903.05,$0.00,$903.05,$0.00,$644.51,$0.00,$0.00,$0.00,$0.00,$0.00,$903.05,$0.00,$451.53,$715.22,$722.44,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.820,SUP,Custom 27203010,,03.311.820  -  RING EXFIX .5 200MM MRI SAFE CARFBR NONSTRL,$946.33,$0.00,$946.33,$0.00,$675.39,$0.00,$0.00,$0.00,$0.00,$0.00,$946.33,$0.00,$473.16,$749.49,$757.06,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.844,SUP,Custom 27203010,,03.311.844  -  RING EXFIX 140MM FULL RING MRI SAFE CARFBR,"$1,546.55",$0.00,"$1,546.55",$0.00,"$1,103.77",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,546.55",$0.00,$773.28,"$1,224.87","$1,237.24",$0.00,$0.00,$0.00,$0.00,$0.00
03.311.846,SUP,Custom 27203010,,03.311.846  -  RING EXFIX FULL 160MM FULL RING MRI SAFE CARFBR NONSTRL,"$1,717.43",$0.00,"$1,717.43",$0.00,"$1,225.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,717.43",$0.00,$858.71,"$1,360.20","$1,373.94",$0.00,$0.00,$0.00,$0.00,$0.00
03.311.848,SUP,Custom 27203010,,03.311.848  -  RING EXFIX 180MM FULL RING MRI SAFE CARFBR,"$1,890.45",$0.00,"$1,890.45",$0.00,"$1,349.21",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,890.45",$0.00,$945.23,"$1,497.24","$1,512.36",$0.00,$0.00,$0.00,$0.00,$0.00
03.311.850,SUP,Custom 27203010,,03.311.850  -  RING EXFIX 200MM FULL RING MRI SAFE CARFBR,"$2,060.25",$0.00,"$2,060.25",$0.00,"$1,470.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,060.25",$0.00,"$1,030.13","$1,631.72","$1,648.20",$0.00,$0.00,$0.00,$0.00,$0.00
03.311.874,SUP,Custom 27203010,,03.311.874  -  RING EXFIX 5/8 140MM MRI SAFE CARFBR NONSTRL,$903.05,$0.00,$903.05,$0.00,$644.51,$0.00,$0.00,$0.00,$0.00,$0.00,$903.05,$0.00,$451.53,$715.22,$722.44,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.876,SUP,Custom 27203010,,03.311.876  -  RING EXFIX 5/8 160MM MRI SAFE CARFBR NONSTRL,$946.33,$0.00,$946.33,$0.00,$675.39,$0.00,$0.00,$0.00,$0.00,$0.00,$946.33,$0.00,$473.16,$749.49,$757.06,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.878,SUP,Custom 27203010,,03.311.878  -  RING EXFIX 5/8 180MM MRI SAFE CARFBR NONSTRL,$989.58,$0.00,$989.58,$0.00,$706.26,$0.00,$0.00,$0.00,$0.00,$0.00,$989.58,$0.00,$494.79,$783.75,$791.66,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.880,SUP,Custom 27203010,,03.311.880  -  RING EXFIX 5/8 200MM MRI SAFE CARFBR NONSTRL,"$1,032.83",$0.00,"$1,032.83",$0.00,$737.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,032.83",$0.00,$516.41,$818.00,$826.26,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.891,SUP,HCPCS C1713,,03.311.891  -  PLATE XTRNFX 90D ARCH 180MM NS MRI SAFE CFBR FEM,"$1,420.00",$0.00,"$1,420.00",$639.00,"$1,013.45",$0.00,$237.53,$0.00,$0.00,$248.63,"$1,420.00",$0.00,$710.00,"$1,124.64","$1,136.00",$0.00,$215.76,$0.00,$226.06,$0.00
03.311.892,SUP,HCPCS C1713,,03.311.892  -  PLATE XTRNFX 120D ARCH 180MM NS MRI SAFE CFBR FEM,"$1,467.60",$0.00,"$1,467.60",$660.42,"$1,047.43",$0.00,$245.49,$0.00,$0.00,$256.97,"$1,467.60",$0.00,$733.80,"$1,162.34","$1,174.08",$0.00,$222.99,$0.00,$233.64,$0.00
03.311.896,SUP,HCPCS C1713,,03.311.896  -  PLATE XTRNFX 90D ARCH 240MM NS MRI SAFE CFBR FEM,"$1,510.85",$0.00,"$1,510.85",$679.88,"$1,078.29",$0.00,$252.73,$0.00,$0.00,$264.54,"$1,510.85",$0.00,$755.43,"$1,196.59","$1,208.68",$0.00,$229.56,$0.00,$240.53,$0.00
03.311.897,SUP,HCPCS C1713,,03.311.897  -  PLATE XTRNFX 120D ARCH 240MM NS MRI SAFE CFBR FEM,"$1,598.45",$0.00,"$1,598.45",$719.30,"$1,140.81",$0.00,$267.38,$0.00,$0.00,$279.88,"$1,598.45",$0.00,$799.23,"$1,265.97","$1,278.76",$0.00,$242.87,$0.00,$254.47,$0.00
03.311.910,SUP,Custom 27203010,,03.311.910  -  RING EXFIX SHORT 100MM MRI SAFE CARFBR FT,"$1,110.70",$0.00,"$1,110.70",$0.00,$792.71,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,110.70",$0.00,$555.35,$879.67,$888.56,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.914,SUP,Custom 27203010,,03.311.914  -  RING EXFIX SHORT 140MM MRI SAFE CARFBR FT,"$1,155.05",$0.00,"$1,155.05",$0.00,$824.36,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,155.05",$0.00,$577.53,$914.80,$924.04,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.916,SUP,Custom 27203010,,03.311.916  -  RING EXFIX SHORT 160MM FT RING MRI SAFE CARFBR,"$1,200.48",$0.00,"$1,200.48",$0.00,$856.78,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.48",$0.00,$600.24,$950.78,$960.38,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.918,SUP,Custom 27203010,,03.311.918  -  RING EXFIX SHORT 180MM MRI SAFE CARFBR FT,"$1,244.80",$0.00,"$1,244.80",$0.00,$888.41,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,244.80",$0.00,$622.40,$985.88,$995.84,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.940,SUP,Custom 27203010,,03.311.940  -  RING EXFIX LONG 100MM MRI SAFE CARFBR FT,"$1,110.70",$0.00,"$1,110.70",$0.00,$792.71,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,110.70",$0.00,$555.35,$879.67,$888.56,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.944,SUP,Custom 27203010,,03.311.944  -  RING EXFIX LONG 140MM MRI SAFE CARFBR FT,"$1,155.05",$0.00,"$1,155.05",$0.00,$824.36,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,155.05",$0.00,$577.53,$914.80,$924.04,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.946,SUP,Custom 27203010,,03.311.946  -  RING EXFIX 160MM MRI SAFE CARFBR FT,"$1,200.48",$0.00,"$1,200.48",$0.00,$856.78,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.48",$0.00,$600.24,$950.78,$960.38,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.948,SUP,Custom 27203010,,03.311.948  -  RING EXFIX LONG 180MM MRI SAFE CARFBR FT,"$1,244.80",$0.00,"$1,244.80",$0.00,$888.41,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,244.80",$0.00,$622.40,$985.88,$995.84,$0.00,$0.00,$0.00,$0.00,$0.00
03.311.960,SUP,Custom 27203010,,03.311.960  -  RING EXFIX SHORT 100MM MRI SAFE TITANIUM FT NONSTRL,"$1,461.10",$0.00,"$1,461.10",$0.00,"$1,042.79",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,461.10",$0.00,$730.55,"$1,157.19","$1,168.88",$0.00,$0.00,$0.00,$0.00,$0.00
03.311.964,SUP,Custom 27203010,,03.311.964  -  RING EXFIX SHORT 140MM MRI SAFE TITANIUM FT NONSTRL,"$1,520.60",$0.00,"$1,520.60",$0.00,"$1,085.25",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,520.60",$0.00,$760.30,"$1,204.32","$1,216.48",$0.00,$0.00,$0.00,$0.00,$0.00
03.311.966,SUP,Custom 27203010,,03.311.966  -  RING EXFIX SHORT 160MM MRI SAFE TITANIUM FT NONSTRL,"$1,581.15",$0.00,"$1,581.15",$0.00,"$1,128.47",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,581.15",$0.00,$790.58,"$1,252.27","$1,264.92",$0.00,$0.00,$0.00,$0.00,$0.00
03.311.968,SUP,Custom 27203010,,03.311.968  -  RING EXFIX SHORT 180MM MRI SAFE TITANIUM FT NONSTRL,"$1,640.63",$0.00,"$1,640.63",$0.00,"$1,170.91",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,640.63",$0.00,$820.31,"$1,299.38","$1,312.50",$0.00,$0.00,$0.00,$0.00,$0.00
03.311.970,SUP,Custom 27203010,,03.311.970  -  RING EXFIX SHORT 200MM MRI SAFE TITANIUM FT NONSTRL,"$1,699.03",$0.00,"$1,699.03",$0.00,"$1,212.59",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,699.03",$0.00,$849.51,"$1,345.63","$1,359.22",$0.00,$0.00,$0.00,$0.00,$0.00
03.311.980,SUP,Custom 27203010,,03.311.980  -  RING EXFIX LONG 100MM MRI SAFE TITANIUM FT NONSTRL,"$1,461.10",$0.00,"$1,461.10",$0.00,"$1,042.79",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,461.10",$0.00,$730.55,"$1,157.19","$1,168.88",$0.00,$0.00,$0.00,$0.00,$0.00
03.311.984,SUP,Custom 27203010,,03.311.984  -  RING EXFIX LONG 140MM MRI SAFE TITANIUM FT NONSTRL,"$1,520.60",$0.00,"$1,520.60",$0.00,"$1,085.25",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,520.60",$0.00,$760.30,"$1,204.32","$1,216.48",$0.00,$0.00,$0.00,$0.00,$0.00
03.311.986,SUP,Custom 27203010,,03.311.986  -  RING EXFIX LONG 160MM MRI SAFE TITANIUM FT NONSTRL,"$1,581.15",$0.00,"$1,581.15",$0.00,"$1,128.47",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,581.15",$0.00,$790.58,"$1,252.27","$1,264.92",$0.00,$0.00,$0.00,$0.00,$0.00
03.311.988,SUP,Custom 27203010,,03.311.988  -  RING EXFIX LONG 180+ MM MRI SAFE TITANIUM FT NONSTRL,"$1,640.63",$0.00,"$1,640.63",$0.00,"$1,170.91",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,640.63",$0.00,$820.31,"$1,299.38","$1,312.50",$0.00,$0.00,$0.00,$0.00,$0.00
03.311.990,SUP,Custom 27203010,,03.311.990  -  RING EXFIX LONG 200+ MM MRI SAFE TITANIUM FT NONSTRL,"$1,699.03",$0.00,"$1,699.03",$0.00,"$1,212.59",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,699.03",$0.00,$849.51,"$1,345.63","$1,359.22",$0.00,$0.00,$0.00,$0.00,$0.00
03.390.052S,SUP,HCPCS C1713,,03.390.052S  -  FIXATOR XTRNFX 200MM STRL SCHNZ PREASSEMBLE FRM SLF DRL CFBR,"$4,040.48",$0.00,"$4,040.48","$1,818.21","$2,883.69",$0.00,$675.88,$0.00,$0.00,$707.45,"$4,040.48",$0.00,"$2,020.24","$3,200.06","$3,232.38",$0.00,$613.92,$0.00,$643.24,$0.00
03.390.053S,SUP,Custom 27203010,,03.390.053S  -  SET EXFIX 220MM SCREW ROD MRI SAFE DISTAL RAD NONSTRL,"$4,040.48",$0.00,"$4,040.48",$0.00,"$2,883.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,040.48",$0.00,"$2,020.24","$3,200.06","$3,232.38",$0.00,$0.00,$0.00,$0.00,$0.00
03.390.054S,SUP,HCPCS C1713,,03.390.054S  -  FIXATOR XTRNFX 240MM STRL SCHNZ PREASSEMBLE FRM SLF DRL CFBR,"$4,040.48",$0.00,"$4,040.48","$1,818.21","$2,883.69",$0.00,$675.88,$0.00,$0.00,$707.45,"$4,040.48",$0.00,"$2,020.24","$3,200.06","$3,232.38",$0.00,$613.92,$0.00,$643.24,$0.00
03.390.055S,SUP,HCPCS C1713,,03.390.055S  -  FIXATOR EXFIX 200MM SLFDRILL SCHANZ SCREW ROD MRI SAFE,"$4,317.35",$0.00,"$4,317.35","$1,942.81","$3,081.29",$0.00,$722.19,$0.00,$0.00,$755.93,"$4,317.35",$0.00,"$2,158.68","$3,419.34","$3,453.88",$0.00,$655.99,$0.00,$687.32,$0.00
03.390.056S,SUP,HCPCS C1713,,03.390.056S  -  FIXATOR EXFIX 220MM SLFDRILL SCHANZ SCREW ROD MRI SAFE,"$4,317.35",$0.00,"$4,317.35","$1,942.81","$3,081.29",$0.00,$722.19,$0.00,$0.00,$755.93,"$4,317.35",$0.00,"$2,158.68","$3,419.34","$3,453.88",$0.00,$655.99,$0.00,$687.32,$0.00
03.390.057S,SUP,Custom 27203010,,03.390.057S  -  SET EXFIX SLFDRILL SCHANZ SCREW CARFBR ROD MR SAFE TITANIUM,"$4,317.35",$0.00,"$4,317.35",$0.00,"$3,081.29",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,317.35",$0.00,"$2,158.68","$3,419.34","$3,453.88",$0.00,$0.00,$0.00,$0.00,$0.00
03.500.004,SUP,Custom 27203010,,03.500.004  -  BIT DRILL 44.5MM 1.25MM TI JLTCH STOP 4MM OTHDNTC BONE ANCH,$355.50,$0.00,$355.50,$0.00,$253.72,$0.00,$0.00,$0.00,$0.00,$0.00,$355.50,$0.00,$177.75,$281.56,$284.40,$0.00,$0.00,$0.00,$0.00,$0.00
03.500.006,SUP,Custom 27203010,,03.500.006  -  BIT DRILL 44.5MM 1.25MM TI JLTCH STOP 6MM OTHDNTC BONE ANCH,$355.50,$0.00,$355.50,$0.00,$253.72,$0.00,$0.00,$0.00,$0.00,$0.00,$355.50,$0.00,$177.75,$281.56,$284.40,$0.00,$0.00,$0.00,$0.00,$0.00
03.500.008,SUP,Custom 27203010,,03.500.008  -  1.25MM DRILL BIT J-LATCH/8MM STOP/44.5MM,$355.50,$0.00,$355.50,$0.00,$253.72,$0.00,$0.00,$0.00,$0.00,$0.00,$355.50,$0.00,$177.75,$281.56,$284.40,$0.00,$0.00,$0.00,$0.00,$0.00
03.500.010,SUP,Custom 27203010,,03.500.010  -  1.25MM DRILL BIT J-LATCH/10MM STOP/44.5MM,$355.50,$0.00,$355.50,$0.00,$253.72,$0.00,$0.00,$0.00,$0.00,$0.00,$355.50,$0.00,$177.75,$281.56,$284.40,$0.00,$0.00,$0.00,$0.00,$0.00
03.500.018,SUP,Custom 27203010,,03.500.018  -  TEMPLATE BENDING STR NONSTRL CURVILINEAR DISTRCT,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.500.030,SUP,Custom 27203010,,03.500.030  -  TEMPLATE BENDING 30MM RAD RIGHT NONSTRL CURVILINEAR DISTRCT,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.500.031,SUP,Custom 27203010,,03.500.031  -  TEMPLATE BENDING 30MM RAD LEFT NONSTRL CURVILINEAR DISTRCT,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.500.040,SUP,Custom 27203010,,03.500.040  -  TEMPLATE BENDING 40MM RAD RIGHT NONSTRL CURVILINEAR DISTRCT,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.500.041,SUP,Custom 27203010,,03.500.041  -  TEMPLATE BENDING 40MM RAD LEFT NONSTRL CURVILINEAR DISTRCT,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.500.050,SUP,Custom 27203010,,03.500.050  -  TEMPLATE BENDING 50MM RAD RIGHT NONSTRL CURVILINEAR DISTRCT,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.500.051,SUP,Custom 27203010,,03.500.051  -  TEMPLATE BENDING 50MM RAD LEFT NONSTRL CURVILINEAR DISTRCT,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.500.070,SUP,Custom 27203010,,03.500.070  -  TEMPLATE BENDING 70MM RAD RIGHT NONSTRL CURVILINEAR DISTRCT,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.500.071,SUP,Custom 27203010,,03.500.071  -  TEMPLATE BENDING 70MM RAD LEFT NONSTRL CURVILINEAR DISTRCT,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.500.100,SUP,Custom 27203010,,03.500.100  -  TEMPLATE BENDING 100MM RAD RIGHT NONSTRL CURVILINEAR DISTRCT,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.500.101,SUP,Custom 27203010,,03.500.101  -  TEMPLATE BENDING 100MM RAD LEFT NONSTRL CURVILINEAR DISTRCT,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.501.008,SUP,Custom 27203010,,03.501.008  -  BIT DRILL 8MM STOP 1.5MM 82MM J LATCH COUPLING 2 FLUTED,$502.50,$0.00,$502.50,$0.00,$358.63,$0.00,$0.00,$0.00,$0.00,$0.00,$502.50,$0.00,$251.25,$397.98,$402.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.501.010,SUP,Custom 27203010,,03.501.010  -  BIT DRILL 10MM STOP 82MM J LATCH TITANIUM NONSTRL,$502.50,$0.00,$502.50,$0.00,$358.63,$0.00,$0.00,$0.00,$0.00,$0.00,$502.50,$0.00,$251.25,$397.98,$402.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.501.012,SUP,Custom 27203010,,03.501.012  -  BIT DRILL 12MM STOP 1.5MM 82MM J LATCH COUPLING 2 FLUTED,$502.50,$0.00,$502.50,$0.00,$358.63,$0.00,$0.00,$0.00,$0.00,$0.00,$502.50,$0.00,$251.25,$397.98,$402.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.501.014,SUP,Custom 27203010,,03.501.014  -  BIT DRILL 1.5MM 82MM 14MM J LATCH COUPLING SELF STOP,$572.50,$0.00,$572.50,$0.00,$408.59,$0.00,$0.00,$0.00,$0.00,$0.00,$572.50,$0.00,$286.25,$453.42,$458.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.501.016,SUP,Custom 27203010,,03.501.016  -  BIT DRILL 16MM STOP 1.5MM 82MM J LATCH STERNUM NONSTRL,$572.50,$0.00,$572.50,$0.00,$408.59,$0.00,$0.00,$0.00,$0.00,$0.00,$572.50,$0.00,$286.25,$453.42,$458.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.501.018,SUP,Custom 27203010,,03.501.018  -  BIT DRILL 18MM STOP 1.5MM 82MM J LATCH STERNUM NONSTRL,$502.50,$0.00,$502.50,$0.00,$358.63,$0.00,$0.00,$0.00,$0.00,$0.00,$502.50,$0.00,$251.25,$397.98,$402.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.501.020,SUP,Custom 27203010,,03.501.020  -  BIT DRILL 20MM STOP 1.5MM 88MM J LATCH,$502.50,$0.00,$502.50,$0.00,$358.63,$0.00,$0.00,$0.00,$0.00,$0.00,$502.50,$0.00,$251.25,$397.98,$402.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.501.022,SUP,Custom 27203010,,03.501.022  -  BIT DRILL 1.5MM 88MM 22MM J LATCH COUPLING SELF STOP,$502.50,$0.00,$502.50,$0.00,$358.63,$0.00,$0.00,$0.00,$0.00,$0.00,$502.50,$0.00,$251.25,$397.98,$402.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.501.024,SUP,Custom 27203010,,03.501.024  -  BIT DRILL 88MM 1.5MM STRNL TI STOP JLTCH 24MM NONSTRL,$378.00,$0.00,$378.00,$0.00,$269.78,$0.00,$0.00,$0.00,$0.00,$0.00,$378.00,$0.00,$189.00,$299.38,$302.40,$0.00,$0.00,$0.00,$0.00,$0.00
03.501.036,SUP,Custom 27203010,,03.501.036  -  BIT DRILL 135MM 2.2MM JLTCH STOP 6MM STRYK,$416.25,$0.00,$416.25,$0.00,$297.08,$0.00,$0.00,$0.00,$0.00,$0.00,$416.25,$0.00,$208.13,$329.67,$333.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.501.038,SUP,Custom 27203010,,03.501.038  -  BIT DRL 8MM 2.2MM 135MM NS MATRIXRIB JLTCH CPLNG STP STRYK,$416.25,$0.00,$416.25,$0.00,$297.08,$0.00,$0.00,$0.00,$0.00,$0.00,$416.25,$0.00,$208.13,$329.67,$333.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.501.040,SUP,Custom 27203010,,03.501.040  -  BIT DRILL 135MM 2.2MM JLTCH STOP 10MM,$416.25,$0.00,$416.25,$0.00,$297.08,$0.00,$0.00,$0.00,$0.00,$0.00,$416.25,$0.00,$208.13,$329.67,$333.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.501.042,SUP,Custom 27203010,,03.501.042  -  BIT DRL 12MM 2.2MM 135MM NS MATRIXRIB JLTCH CPLNG STP STRYK,$416.25,$0.00,$416.25,$0.00,$297.08,$0.00,$0.00,$0.00,$0.00,$0.00,$416.25,$0.00,$208.13,$329.67,$333.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.501.044,SUP,Custom 27203010,,03.501.044  -  BIT DRILL 135MM 2.2MM JLTCH STOP 14MM STRYK,$416.25,$0.00,$416.25,$0.00,$297.08,$0.00,$0.00,$0.00,$0.00,$0.00,$416.25,$0.00,$208.13,$329.67,$333.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.501.046,SUP,Custom 27203010,,03.501.046  -  BIT DRL 16MM 2.2MM 135MM NS MATRIXRIB JLTCH CPLNG STP STRYK,$416.25,$0.00,$416.25,$0.00,$297.08,$0.00,$0.00,$0.00,$0.00,$0.00,$416.25,$0.00,$208.13,$329.67,$333.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.501.048,SUP,Custom 27203010,,03.501.048  -  BIT DRL 18MM 2.2MM 135MM NS MATRIXRIB JLTCH CPLNG STP STRYK,$416.25,$0.00,$416.25,$0.00,$297.08,$0.00,$0.00,$0.00,$0.00,$0.00,$416.25,$0.00,$208.13,$329.67,$333.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.501.072,SUP,HCPCS C1713,,03.501.072  -  TEMPLATE BENDING CNTOUR NONSTRL MATRIXRIB LOCK PLATE,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
03.501.210,SUP,Custom 27203010,,03.501.210  -  1.8MM DRILL BIT STRYKER J-LATCH/10MM STOP/82MM,$416.25,$0.00,$416.25,$0.00,$297.08,$0.00,$0.00,$0.00,$0.00,$0.00,$416.25,$0.00,$208.13,$329.67,$333.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.501.212,SUP,Custom 27203010,,03.501.212  -  BIT DRILL 82MM 1.8MM 12MM STOP JLTCH NONSTRL,$416.25,$0.00,$416.25,$0.00,$297.08,$0.00,$0.00,$0.00,$0.00,$0.00,$416.25,$0.00,$208.13,$329.67,$333.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.501.214,SUP,Custom 27203010,,03.501.214  -  BIT DRILL 82MM 1.8MM 14MM STOP STRNL JLTCH STRYK,$416.25,$0.00,$416.25,$0.00,$297.08,$0.00,$0.00,$0.00,$0.00,$0.00,$416.25,$0.00,$208.13,$329.67,$333.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.501.216,SUP,Custom 27203010,,03.501.216  -  BIT DRILL 82MM 1.8MM 16MM STOP STRNL JLTCH STRYK,$416.25,$0.00,$416.25,$0.00,$297.08,$0.00,$0.00,$0.00,$0.00,$0.00,$416.25,$0.00,$208.13,$329.67,$333.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.501.218,SUP,Custom 27203010,,03.501.218  -  BIT DRILL 82MM 1.8MM JLTCH STOP 18MM,$416.25,$0.00,$416.25,$0.00,$297.08,$0.00,$0.00,$0.00,$0.00,$0.00,$416.25,$0.00,$208.13,$329.67,$333.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.501.220,SUP,Custom 27203010,,03.501.220  -  BIT DRILL 88MM 1.8MM JLTCH FIX STOP 20MM STRYK,$416.25,$0.00,$416.25,$0.00,$297.08,$0.00,$0.00,$0.00,$0.00,$0.00,$416.25,$0.00,$208.13,$329.67,$333.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.501.222,SUP,Custom 27203010,,03.501.222  -  BIT DRILL 88MM 1.8MM JLTCH FIX STOP 22MM STRYK,$416.25,$0.00,$416.25,$0.00,$297.08,$0.00,$0.00,$0.00,$0.00,$0.00,$416.25,$0.00,$208.13,$329.67,$333.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.501.224,SUP,Custom 27203010,,03.501.224  -  1.8MM DRILL BIT STRYKER J-LATCH/24MM STOP/88MM,$398.25,$0.00,$398.25,$0.00,$284.23,$0.00,$0.00,$0.00,$0.00,$0.00,$398.25,$0.00,$199.13,$315.41,$318.60,$0.00,$0.00,$0.00,$0.00,$0.00
03.501.410,SUP,Custom 27203010,,03.501.410  -  BIT DRILL 82MM 1.5MM 10MM STOP HEX CPLNG NONSTRL,$416.25,$0.00,$416.25,$0.00,$297.08,$0.00,$0.00,$0.00,$0.00,$0.00,$416.25,$0.00,$208.13,$329.67,$333.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.501.412,SUP,Custom 27203010,,03.501.412  -  BIT DRILL 82MM 1.5MM 12MM STOP HEX CPLNG NONSTRL,$416.25,$0.00,$416.25,$0.00,$297.08,$0.00,$0.00,$0.00,$0.00,$0.00,$416.25,$0.00,$208.13,$329.67,$333.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.501.414,SUP,Custom 27203010,,03.501.414  -  1.5MM DRILL BIT HEX COUPLING WITH 14MM STOP/82MM,$416.25,$0.00,$416.25,$0.00,$297.08,$0.00,$0.00,$0.00,$0.00,$0.00,$416.25,$0.00,$208.13,$329.67,$333.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.501.416,SUP,Custom 27203010,,03.501.416  -  BIT DRILL 82MM 1.5MM STRNL TI STOP HEX COULPLING FIX 16MM,$416.25,$0.00,$416.25,$0.00,$297.08,$0.00,$0.00,$0.00,$0.00,$0.00,$416.25,$0.00,$208.13,$329.67,$333.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.501.418,SUP,Custom 27203010,,03.501.418  -  BIT DRILL 82MM 1.5MM 18MM STOP HEX CPLNG NONSTRL,$416.25,$0.00,$416.25,$0.00,$297.08,$0.00,$0.00,$0.00,$0.00,$0.00,$416.25,$0.00,$208.13,$329.67,$333.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.501.420,SUP,Custom 27203010,,03.501.420  -  BIT DRILL 88MM 1.5MM 20MM STOP HEX CPLNG NONSTRL,$416.25,$0.00,$416.25,$0.00,$297.08,$0.00,$0.00,$0.00,$0.00,$0.00,$416.25,$0.00,$208.13,$329.67,$333.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.501.422,SUP,Custom 27203010,,03.501.422  -  1.5MM DRILL BIT HEX COUPLING WITH 22MM STOP/88MM,$416.25,$0.00,$416.25,$0.00,$297.08,$0.00,$0.00,$0.00,$0.00,$0.00,$416.25,$0.00,$208.13,$329.67,$333.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.501.424,SUP,Custom 27203010,,03.501.424  -  1.5MM DRILL BIT HEX COUPLING WITH 24MM STOP/88MM,$398.25,$0.00,$398.25,$0.00,$284.23,$0.00,$0.00,$0.00,$0.00,$0.00,$398.25,$0.00,$199.13,$315.41,$318.60,$0.00,$0.00,$0.00,$0.00,$0.00
03.501.510,SUP,Custom 27203010,,03.501.510  -  BIT DRILL 82MM 1.8MM STRNL TI STOP HEX COULPLING FIX 10MM,$416.25,$0.00,$416.25,$0.00,$297.08,$0.00,$0.00,$0.00,$0.00,$0.00,$416.25,$0.00,$208.13,$329.67,$333.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.501.512,SUP,Custom 27203010,,03.501.512  -  BIT DRILL 82MM 1.8MM 12MM STOP HEX CPLNG NONSTRL,$416.25,$0.00,$416.25,$0.00,$297.08,$0.00,$0.00,$0.00,$0.00,$0.00,$416.25,$0.00,$208.13,$329.67,$333.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.501.514,SUP,Custom 27203010,,03.501.514  -  BIT DRILL 82MM 1.8MM STRNL TI STOP HEX COULPLING FIX 14MM,$416.25,$0.00,$416.25,$0.00,$297.08,$0.00,$0.00,$0.00,$0.00,$0.00,$416.25,$0.00,$208.13,$329.67,$333.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.501.516,SUP,Custom 27203010,,03.501.516  -  1.8MM DRILL BIT HEX COUPLING WITH 16MM STOP/82MM,$416.25,$0.00,$416.25,$0.00,$297.08,$0.00,$0.00,$0.00,$0.00,$0.00,$416.25,$0.00,$208.13,$329.67,$333.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.501.518,SUP,Custom 27203010,,03.501.518  -  1.8MM DRILL BIT HEX COUPLING WITH 18MM STOP/82MM,$416.25,$0.00,$416.25,$0.00,$297.08,$0.00,$0.00,$0.00,$0.00,$0.00,$416.25,$0.00,$208.13,$329.67,$333.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.501.520,SUP,Custom 27203010,,03.501.520  -  1.8MM DRILL BIT HEX COUPLING WITH 20MM STOP/88MM,$416.25,$0.00,$416.25,$0.00,$297.08,$0.00,$0.00,$0.00,$0.00,$0.00,$416.25,$0.00,$208.13,$329.67,$333.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.501.522,SUP,Custom 27203010,,03.501.522  -  BIT DRILL 88MM 1.8MM STRNL TI STOP HEX COULPLING FIX 22MM,$416.25,$0.00,$416.25,$0.00,$297.08,$0.00,$0.00,$0.00,$0.00,$0.00,$416.25,$0.00,$208.13,$329.67,$333.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.501.524,SUP,Custom 27203010,,03.501.524  -  1.8MM DRILL BIT HEX COUPLING WITH 24MM STOP/88MM,$398.25,$0.00,$398.25,$0.00,$284.23,$0.00,$0.00,$0.00,$0.00,$0.00,$398.25,$0.00,$199.13,$315.41,$318.60,$0.00,$0.00,$0.00,$0.00,$0.00
03.501.612,SUP,Custom 27203010,,03.501.612  -  BIT DRL 2.2MM 135MM NS 12MM MATRIXRIB AO QC STP STRNM,$486.63,$0.00,$486.63,$0.00,$347.30,$0.00,$0.00,$0.00,$0.00,$0.00,$486.63,$0.00,$243.31,$385.41,$389.30,$0.00,$0.00,$0.00,$0.00,$0.00
03.501.614,SUP,Custom 27203010,,03.501.614  -  BIT DRL 2.2MM 135MM NS 14MM MATRIXRIB AO QC STP STRNM,$398.25,$0.00,$398.25,$0.00,$284.23,$0.00,$0.00,$0.00,$0.00,$0.00,$398.25,$0.00,$199.13,$315.41,$318.60,$0.00,$0.00,$0.00,$0.00,$0.00
03.501.764,SUP,Custom 27203010,,03.501.764  -  BIT DRL 2 FLUT 2.2MM 14MM NS MATRIXRIB STP 90D SCRDRVR,$398.25,$0.00,$398.25,$0.00,$284.23,$0.00,$0.00,$0.00,$0.00,$0.00,$398.25,$0.00,$199.13,$315.41,$318.60,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.103,SUP,Custom 27203010,,03.503.103  -  MATRIXMIDFACE 1.25MM DRILL BIT J-LATCH/3MM STOP/44.5MM,$425.25,$0.00,$425.25,$0.00,$303.50,$0.00,$0.00,$0.00,$0.00,$0.00,$425.25,$0.00,$212.63,$336.80,$340.20,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.104,SUP,HCPCS C1713,,03.503.104  -  PLATE 44.5X4MM MIDFAC STOP BONE NONSTRL,$425.25,$0.00,$425.25,$191.36,$303.50,$0.00,$73.27,$0.00,$0.00,$74.46,$425.25,$0.00,$212.63,$336.80,$340.20,$0.00,$66.55,$0.00,$67.70,$0.00
03.503.106,SUP,Custom 27203010,,03.503.106  -  BIT DRILL 44.5MM 1.25MM STOP JLTCH 6MM NONSTRL,$425.25,$0.00,$425.25,$0.00,$303.50,$0.00,$0.00,$0.00,$0.00,$0.00,$425.25,$0.00,$212.63,$336.80,$340.20,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.108,SUP,Custom 27203010,,03.503.108  -  BIT DRILL 44.5MM 1.25MM JLTCH STOP 8MM NONSTRL,$425.25,$0.00,$425.25,$0.00,$303.50,$0.00,$0.00,$0.00,$0.00,$0.00,$425.25,$0.00,$212.63,$336.80,$340.20,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.110,SUP,Custom 27203010,,03.503.110  -  BIT DRILL 44.5MM 1.25MM MTRXMDFACE 10MM STOP JLTCH,$425.25,$0.00,$425.25,$0.00,$303.50,$0.00,$0.00,$0.00,$0.00,$0.00,$425.25,$0.00,$212.63,$336.80,$340.20,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.112,SUP,Custom 27203010,,03.503.112  -  BIT DRILL 12MM 44.5MM 1.25MM MTRXMDFACE CRNMXF JLTCH CPLNG,$425.25,$0.00,$425.25,$0.00,$303.50,$0.00,$0.00,$0.00,$0.00,$0.00,$425.25,$0.00,$212.63,$336.80,$340.20,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.118,SUP,Custom 27203010,,03.503.118  -  BIT DRILL 18MM 44.5MM 1.25MM MTRXMDFACE CRNMXF JLTCH CPLNG,$425.25,$0.00,$425.25,$0.00,$303.50,$0.00,$0.00,$0.00,$0.00,$0.00,$425.25,$0.00,$212.63,$336.80,$340.20,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.120,SUP,Custom 27203010,,03.503.120  -  BIT DRL 1.25MM 80MM NS MATRIXMIDFACE JLTCH CPLNG WO STP,$425.25,$0.00,$425.25,$0.00,$303.50,$0.00,$0.00,$0.00,$0.00,$0.00,$425.25,$0.00,$212.63,$336.80,$340.20,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.121,SUP,Custom 27203010,,03.503.121  -  BIT DRILL 125MM 1.25MM MTRXMDFACE W/O STOP NONSTRL,$425.25,$0.00,$425.25,$0.00,$303.50,$0.00,$0.00,$0.00,$0.00,$0.00,$425.25,$0.00,$212.63,$336.80,$340.20,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.122,SUP,Custom 27203010,,03.503.122  -  BIT DRILL 125MM 1.25MM MTRXMDFACE JLTCH STOP 8MM PLT SYS,$425.25,$0.00,$425.25,$0.00,$303.50,$0.00,$0.00,$0.00,$0.00,$0.00,$425.25,$0.00,$212.63,$336.80,$340.20,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.123,SUP,Custom 27203010,,03.503.123  -  BIT DRILL 125MM 1.25MM MTRXMDFACE STOP JLTCH 18MM NONSTRL,$425.25,$0.00,$425.25,$0.00,$303.50,$0.00,$0.00,$0.00,$0.00,$0.00,$425.25,$0.00,$212.63,$336.80,$340.20,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.133,SUP,Custom 27203010,,03.503.133  -  MATRIXMIDFACE 1.25MM DRILL BIT MQC/3MM STOP/44.5MM,$425.25,$0.00,$425.25,$0.00,$303.50,$0.00,$0.00,$0.00,$0.00,$0.00,$425.25,$0.00,$212.63,$336.80,$340.20,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.136,SUP,Custom 27203010,,03.503.136  -  MATRIXMIDFACE 1.25MM DRILL BIT MQC/6MM STOP/44.5MM,$425.25,$0.00,$425.25,$0.00,$303.50,$0.00,$0.00,$0.00,$0.00,$0.00,$425.25,$0.00,$212.63,$336.80,$340.20,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.140,SUP,Custom 27203010,,03.503.140  -  BIT DRILL 44.5MM 1.25MM MTRXMDFACE MINI STOP QC 10MM NONSTRL,$425.25,$0.00,$425.25,$0.00,$303.50,$0.00,$0.00,$0.00,$0.00,$0.00,$425.25,$0.00,$212.63,$336.80,$340.20,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.142,SUP,Custom 27203010,,03.503.142  -  BIT DRILL 44.5MM 1.25MM MTRXMDFACE MINI STOP QC 12MM NONSTRL,$425.25,$0.00,$425.25,$0.00,$303.50,$0.00,$0.00,$0.00,$0.00,$0.00,$425.25,$0.00,$212.63,$336.80,$340.20,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.148,SUP,Custom 27203010,,03.503.148  -  BIT DRILL 44.5MM 1.25MM MTRXMDFACE MINI STOP QC 18MM NONSTRL,$425.25,$0.00,$425.25,$0.00,$303.50,$0.00,$0.00,$0.00,$0.00,$0.00,$425.25,$0.00,$212.63,$336.80,$340.20,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.150,SUP,Custom 27203010,,03.503.150  -  BIT DRILL 80MM 1.25MM MTRXMDFACE 2 FLUT MNQK CPLNG NONSTRL,$425.25,$0.00,$425.25,$0.00,$303.50,$0.00,$0.00,$0.00,$0.00,$0.00,$425.25,$0.00,$212.63,$336.80,$340.20,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.151,SUP,Custom 27203010,,03.503.151  -  BIT DRILL 125MM 1.25MM MTRXMDFACE 2 FLUT MNQK CPLNG NONSTRL,$425.25,$0.00,$425.25,$0.00,$303.50,$0.00,$0.00,$0.00,$0.00,$0.00,$425.25,$0.00,$212.63,$336.80,$340.20,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.152,SUP,Custom 27203010,,03.503.152  -  BIT DRILL 125MM 1.25MM MTRXMDFACE MINI STOP QC 8MM NONSTRL,$425.25,$0.00,$425.25,$0.00,$303.50,$0.00,$0.00,$0.00,$0.00,$0.00,$425.25,$0.00,$212.63,$336.80,$340.20,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.153,SUP,Custom 27203010,,03.503.153  -  BIT DRILL 125MM 1.25MM MTRXMDFACE MINI STOP QC 18MM NONSTRL,$425.25,$0.00,$425.25,$0.00,$303.50,$0.00,$0.00,$0.00,$0.00,$0.00,$425.25,$0.00,$212.63,$336.80,$340.20,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.160,SUP,Custom 27203010,,03.503.160  -  TMPLT BNDRG MTRXMAND NAR TNSNBND PLT NONSTRL,$171.00,$0.00,$171.00,$0.00,$122.04,$0.00,$0.00,$0.00,$0.00,$0.00,$171.00,$0.00,$85.50,$135.43,$136.80,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.161,SUP,Custom 27203010,,03.503.161  -  TMPLT BNDRG MTRX MANDIB 1 MM BRD TNSNBND PLT NONSTRL,$171.00,$0.00,$171.00,$0.00,$122.04,$0.00,$0.00,$0.00,$0.00,$0.00,$171.00,$0.00,$85.50,$135.43,$136.80,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.162,SUP,Custom 27203010,,03.503.162  -  TMPLT BNDRG MTRXMAND 1 MM THK ADP PLT NONSTRL,$171.00,$0.00,$171.00,$0.00,$122.04,$0.00,$0.00,$0.00,$0.00,$0.00,$171.00,$0.00,$85.50,$135.43,$136.80,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.163,SUP,Custom 27203010,,03.503.163  -  TMPLT BNDRG MTRXMAND 1.25 MM THK STR PLT NONSTRL,$171.00,$0.00,$171.00,$0.00,$122.04,$0.00,$0.00,$0.00,$0.00,$0.00,$171.00,$0.00,$85.50,$135.43,$136.80,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.164,SUP,Custom 27203010,,03.503.164  -  TMPLT BNDRG MTRXMAND 1.25 MM 2X2 HOLE THK CRSNT PLT NONSTRL,$171.00,$0.00,$171.00,$0.00,$122.04,$0.00,$0.00,$0.00,$0.00,$0.00,$171.00,$0.00,$85.50,$135.43,$136.80,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.165,SUP,Custom 27203010,,03.503.165  -  TMPLT BNDRG MTRXMAND 1.25 MM THK CRSNT PLT 3X3 HOLE NONSTRL,$171.00,$0.00,$171.00,$0.00,$122.04,$0.00,$0.00,$0.00,$0.00,$0.00,$171.00,$0.00,$85.50,$135.43,$136.80,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.166,SUP,Custom 27203010,,03.503.166  -  TMPLT BNDRG MTRXMAND 1.25MM NONSTRL,$171.00,$0.00,$171.00,$0.00,$122.04,$0.00,$0.00,$0.00,$0.00,$0.00,$171.00,$0.00,$85.50,$135.43,$136.80,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.167,SUP,Custom 27203010,,03.503.167  -  TMPLT BNDRG MTRXMAND 1.25 MM THK ADP PLT NONSTRL,$171.00,$0.00,$171.00,$0.00,$122.04,$0.00,$0.00,$0.00,$0.00,$0.00,$171.00,$0.00,$85.50,$135.43,$136.80,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.168,SUP,Custom 27203010,,03.503.168  -  TMPLT BNDRG MTRXMAND,$171.00,$0.00,$171.00,$0.00,$122.04,$0.00,$0.00,$0.00,$0.00,$0.00,$171.00,$0.00,$85.50,$135.43,$136.80,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.169,SUP,Custom 27203010,,03.503.169  -  TMPLT BNDRG MTRXMAND 1.5 MM PLT NONSTRL,$171.00,$0.00,$171.00,$0.00,$122.04,$0.00,$0.00,$0.00,$0.00,$0.00,$171.00,$0.00,$85.50,$135.43,$136.80,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.170,SUP,Custom 27203010,,03.503.170  -  TMPLT BNDRG MTRXMAND THK1.5MM 3X3 HOLE ANG PLT,$171.00,$0.00,$171.00,$0.00,$122.04,$0.00,$0.00,$0.00,$0.00,$0.00,$171.00,$0.00,$85.50,$135.43,$136.80,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.171,SUP,Custom 27203010,,03.503.171  -  TMPLT BNDRG MTRXMAND THK1.5MM CRSNT PLT 6 HOLE,$171.00,$0.00,$171.00,$0.00,$122.04,$0.00,$0.00,$0.00,$0.00,$0.00,$171.00,$0.00,$85.50,$135.43,$136.80,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.172,SUP,Custom 27203010,,03.503.172  -  TMPLT BNDRG MTRXMAND THK1.5MM 2X2 HOLE 3X3 HOLE BRD NONSTRL,$171.00,$0.00,$171.00,$0.00,$122.04,$0.00,$0.00,$0.00,$0.00,$0.00,$171.00,$0.00,$85.50,$135.43,$136.80,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.173,SUP,Custom 27203010,,03.503.173  -  TMPLT BNDRG 2MM MTRXMAND BRD CRSNT PLT,$171.00,$0.00,$171.00,$0.00,$122.04,$0.00,$0.00,$0.00,$0.00,$0.00,$171.00,$0.00,$85.50,$135.43,$136.80,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.174,SUP,Custom 27203010,,03.503.174  -  TMPLT BNDRG MTRXMAND 1.25MM NONSTRL,$171.00,$0.00,$171.00,$0.00,$122.04,$0.00,$0.00,$0.00,$0.00,$0.00,$171.00,$0.00,$85.50,$135.43,$136.80,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.175,SUP,Custom 27203010,,03.503.175  -  TMPLT BNDRG MTRXMAND 2MM 3X3 HOLE BRD ANG PLT,$171.00,$0.00,$171.00,$0.00,$122.04,$0.00,$0.00,$0.00,$0.00,$0.00,$171.00,$0.00,$85.50,$135.43,$136.80,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.176,SUP,HCPCS C1713,,03.503.176  -  TEMPLATE BNDRG NS MATRIXMANDIBLE 2 MM ANG RECON PLT,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
03.503.177,SUP,Custom 27203010,,03.503.177  -  TMPLT BNDRG MTRXMAND 2 MM 2 ANG RECON SM PLT NONSTRL,$202.50,$0.00,$202.50,$0.00,$144.52,$0.00,$0.00,$0.00,$0.00,$0.00,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.178,SUP,Custom 27203010,,03.503.178  -  TMPLT BNDRG MTRXMAND 2 MM 2 ANG RECON MED PLT NONSTRL,$202.50,$0.00,$202.50,$0.00,$144.52,$0.00,$0.00,$0.00,$0.00,$0.00,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.179,SUP,Custom 27203010,,03.503.179  -  TMPLT BNDRG MTRXMAND 2 MM 2 ANG RECON LG PLT NONSTRL,$202.50,$0.00,$202.50,$0.00,$144.52,$0.00,$0.00,$0.00,$0.00,$0.00,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.180,SUP,Custom 27203010,,03.503.180  -  TMPLT BNDRG MATRIXMANDIBULAR RECON PLT,$202.50,$0.00,$202.50,$0.00,$144.52,$0.00,$0.00,$0.00,$0.00,$0.00,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.181,SUP,Custom 27203010,,03.503.181  -  TMPLT BNDRG 2.5-2.8MM RECON,$202.50,$0.00,$202.50,$0.00,$144.52,$0.00,$0.00,$0.00,$0.00,$0.00,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.182,SUP,Custom 27203010,,03.503.182  -  TMPLT BNDRG MTRXMAND PLT,$202.50,$0.00,$202.50,$0.00,$144.52,$0.00,$0.00,$0.00,$0.00,$0.00,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.183,SUP,Custom 27203010,,03.503.183  -  TMPLT BNDRG MTRXMAND 2 ANG 2.5 MM RECON PLT NONSTRL,$202.50,$0.00,$202.50,$0.00,$144.52,$0.00,$0.00,$0.00,$0.00,$0.00,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.184,SUP,Custom 27203010,,03.503.184  -  TMPLT BNDRG MTRXMAND 2.5 MM 2 ANG RECON LG PLT NONSTRL,$202.50,$0.00,$202.50,$0.00,$144.52,$0.00,$0.00,$0.00,$0.00,$0.00,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.201,SUP,Custom 27203010,,03.503.201  -  BLADE SHRT HEX CPLNG SLFRET 52MM MTRXMDFACE SCRDRVR NONSTRL,"$1,586.25",$0.00,"$1,586.25",$0.00,"$1,132.11",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,586.25",$0.00,$793.13,"$1,256.31","$1,269.00",$0.00,$0.00,$0.00,$0.00,$0.00
03.503.202,SUP,Custom 27203010,,03.503.202  -  BLADE MED HEX CPLNG SLFRET 76MM MTRXMDFACE SCRDRVR CRNMXF,"$1,586.25",$0.00,"$1,586.25",$0.00,"$1,132.11",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,586.25",$0.00,$793.13,"$1,256.31","$1,269.00",$0.00,$0.00,$0.00,$0.00,$0.00
03.503.203,SUP,Custom 27203010,,03.503.203  -  BLADE LNG HEX CPLNG SLFRET 96MM MTRXMDFACE SCRDRVR CRNMXF,"$1,586.25",$0.00,"$1,586.25",$0.00,"$1,132.11",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,586.25",$0.00,$793.13,"$1,256.31","$1,269.00",$0.00,$0.00,$0.00,$0.00,$0.00
03.503.244,SUP,Custom 27203010,,03.503.244  -  BIT DRILL 44.5MM 1.1MM MTRXMDFACE CRNMXF JLTCH CPLNG STOP 4,$378.00,$0.00,$378.00,$0.00,$269.78,$0.00,$0.00,$0.00,$0.00,$0.00,$378.00,$0.00,$189.00,$299.38,$302.40,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.246,SUP,Custom 27203010,,03.503.246  -  BIT DRL 6MM 1.1MM 44.5MM NS MTRX JLTCH CPLNG STP STRYK,$378.00,$0.00,$378.00,$0.00,$269.78,$0.00,$0.00,$0.00,$0.00,$0.00,$378.00,$0.00,$189.00,$299.38,$302.40,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.248,SUP,Custom 27203010,,03.503.248  -  BIT DRL 8MM 1.1MM 44.5MM NS MTRX JLTCH CPLNG STP STRYK,$378.00,$0.00,$378.00,$0.00,$269.78,$0.00,$0.00,$0.00,$0.00,$0.00,$378.00,$0.00,$189.00,$299.38,$302.40,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.264,SUP,Custom 27203010,,03.503.264  -  MATRIX 1.1MM DRILL BIT/HXC 4MM STOP/52MM,$378.00,$0.00,$378.00,$0.00,$269.78,$0.00,$0.00,$0.00,$0.00,$0.00,$378.00,$0.00,$189.00,$299.38,$302.40,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.360,SUP,Custom 27203010,,03.503.360  -  BENDING TEMPLATE F/ORBITAL FLR PL/ANATOMIC/SM/MATRIXMIDFACE,$515.25,$0.00,$515.25,$0.00,$367.73,$0.00,$0.00,$0.00,$0.00,$0.00,$515.25,$0.00,$257.63,$408.08,$412.20,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.361,SUP,Custom 27203010,,03.503.361  -  BENDING TEMPLATE F/ORBITAL FLR PL/ANATOMIC/MED/MATRIXMIDFACE,$515.25,$0.00,$515.25,$0.00,$367.73,$0.00,$0.00,$0.00,$0.00,$0.00,$515.25,$0.00,$257.63,$408.08,$412.20,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.362,SUP,Custom 27203010,,03.503.362  -  BENDING TEMPLATE F/ORBITAL FLR PL/ANATOMIC/LRG/MATRIXMIDFACE,$515.25,$0.00,$515.25,$0.00,$367.73,$0.00,$0.00,$0.00,$0.00,$0.00,$515.25,$0.00,$257.63,$408.08,$412.20,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.363,SUP,Custom 27203010,,03.503.363  -  BENDING TEMPLATE F/UNIVERSAL ORBITAL FLR PL/MATRIXMIDFACE,$515.25,$0.00,$515.25,$0.00,$367.73,$0.00,$0.00,$0.00,$0.00,$0.00,$515.25,$0.00,$257.63,$408.08,$412.20,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.364,SUP,Custom 27203010,,03.503.364  -  BENDING TEMPLATE F/UNIVERSAL MEDIAL WALL PL/MATRIXMIDFACE,$515.25,$0.00,$515.25,$0.00,$367.73,$0.00,$0.00,$0.00,$0.00,$0.00,$515.25,$0.00,$257.63,$408.08,$412.20,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.365,SUP,Custom 27203010,,03.503.365  -  TMPLT BNDRG ORBTL MESH PLT MTRXMDFACE PLT SYS NONSTRL,$515.25,$0.00,$515.25,$0.00,$367.73,$0.00,$0.00,$0.00,$0.00,$0.00,$515.25,$0.00,$257.63,$408.08,$412.20,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.366,SUP,Custom 27203010,,03.503.366  -  BENDING TEMPLATE F/ADAPTION PLATES/MATRIXMIDFACE,$124.88,$0.00,$124.88,$0.00,$89.12,$0.00,$0.00,$0.00,$0.00,$0.00,$124.88,$0.00,$62.44,$98.90,$99.90,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.367,SUP,Custom 27203010,,03.503.367  -  BENDING TEMPLATE F/ORBITAL RIM PLATES/MATRIXMIDFACE,$124.88,$0.00,$124.88,$0.00,$89.12,$0.00,$0.00,$0.00,$0.00,$0.00,$124.88,$0.00,$62.44,$98.90,$99.90,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.368,SUP,Custom 27203010,,03.503.368  -  BENDING TEMPLATE F/OBLIQUE L PLATES/2X3/MATRIXMIDFACE,$124.88,$0.00,$124.88,$0.00,$89.12,$0.00,$0.00,$0.00,$0.00,$0.00,$124.88,$0.00,$62.44,$98.90,$99.90,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.369,SUP,Custom 27203010,,03.503.369  -  BENDING TEMPLATE F/OBLIQUE L PLATES/3X4/MATRIXMIDFACE,$124.88,$0.00,$124.88,$0.00,$89.12,$0.00,$0.00,$0.00,$0.00,$0.00,$124.88,$0.00,$62.44,$98.90,$99.90,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.370,SUP,Custom 27203010,,03.503.370  -  TMPLT THK.5MM BNDRG 4X6 OBLQ L PLT MTRXMDFACE NONSTRL,$124.88,$0.00,$124.88,$0.00,$89.12,$0.00,$0.00,$0.00,$0.00,$0.00,$124.88,$0.00,$62.44,$98.90,$99.90,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.371,SUP,Custom 27203010,,03.503.371  -  BENDING TEMPLATE F/Y-PLATES 1X3/MATRIXMIDFACE,$124.88,$0.00,$124.88,$0.00,$89.12,$0.00,$0.00,$0.00,$0.00,$0.00,$124.88,$0.00,$62.44,$98.90,$99.90,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.372,SUP,Custom 27203010,,03.503.372  -  BENDING TEMPLATE F/X-PLATES MATRIXMIDFACE,$124.88,$0.00,$124.88,$0.00,$89.12,$0.00,$0.00,$0.00,$0.00,$0.00,$124.88,$0.00,$62.44,$98.90,$99.90,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.373,SUP,Custom 27203010,,03.503.373  -  BENDING TEMPLATE F/H-PLATES MATRIXMIDFACE,$124.88,$0.00,$124.88,$0.00,$89.12,$0.00,$0.00,$0.00,$0.00,$0.00,$124.88,$0.00,$62.44,$98.90,$99.90,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.374,SUP,Custom 27203010,,03.503.374  -  BENDING TEMPLATE F/T-PLATES MATRIXMIDFACE,$124.88,$0.00,$124.88,$0.00,$89.12,$0.00,$0.00,$0.00,$0.00,$0.00,$124.88,$0.00,$62.44,$98.90,$99.90,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.375,SUP,Custom 27203010,,03.503.375  -  BENDING TEMPLATE F/BOX PLATES 5MMX10MM/MATRIXMIDFACE,$124.88,$0.00,$124.88,$0.00,$89.12,$0.00,$0.00,$0.00,$0.00,$0.00,$124.88,$0.00,$62.44,$98.90,$99.90,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.376,SUP,Custom 27203010,,03.503.376  -  TMPLT 10X10MM BNDRG,$124.88,$0.00,$124.88,$0.00,$89.12,$0.00,$0.00,$0.00,$0.00,$0.00,$124.88,$0.00,$62.44,$98.90,$99.90,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.377,SUP,Custom 27203010,,03.503.377  -  BENDING TEMPLATE F/STRUT PLATES/MATRIXMIDFACE,$124.88,$0.00,$124.88,$0.00,$89.12,$0.00,$0.00,$0.00,$0.00,$0.00,$124.88,$0.00,$62.44,$98.90,$99.90,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.378,SUP,Custom 27203010,,03.503.378  -  BENDING TEMPLATE F/SILVER DOUBLE Y-PLATE/MATRIXMIDFACE,$124.88,$0.00,$124.88,$0.00,$89.12,$0.00,$0.00,$0.00,$0.00,$0.00,$124.88,$0.00,$62.44,$98.90,$99.90,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.379,SUP,Custom 27203010,,03.503.379  -  BENDING TEMPLATE F/BLUE DOUBLE Y-PLATE/MATRIXMIDFACE,$124.88,$0.00,$124.88,$0.00,$89.12,$0.00,$0.00,$0.00,$0.00,$0.00,$124.88,$0.00,$62.44,$98.90,$99.90,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.380,SUP,Custom 27203010,,03.503.380  -  BENDING TEMPLATE F/PINK DOUBLE Y-PLATE/MATRIXMIDFACE,$124.88,$0.00,$124.88,$0.00,$89.12,$0.00,$0.00,$0.00,$0.00,$0.00,$124.88,$0.00,$62.44,$98.90,$99.90,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.404,SUP,Custom 27203010,,03.503.404  -  BIT DRL 4MM 1.5MM 50MM NS MATRIXMANDIBLE JLTCH CPLNG STP,$380.25,$0.00,$380.25,$0.00,$271.38,$0.00,$0.00,$0.00,$0.00,$0.00,$380.25,$0.00,$190.13,$301.16,$304.20,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.406,SUP,Custom 27203010,,03.503.406  -  MATRIXMANDIBLE 1.5MM DRILL BIT J-LATCH W/6MM STOP/50MM,$380.25,$0.00,$380.25,$0.00,$271.38,$0.00,$0.00,$0.00,$0.00,$0.00,$380.25,$0.00,$190.13,$301.16,$304.20,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.408,SUP,Custom 27203010,,03.503.408  -  BIT DRL 8MM 1.5MM 50MM NS MATRIXMANDIBLE JLTCH CPLNG STP,$380.25,$0.00,$380.25,$0.00,$271.38,$0.00,$0.00,$0.00,$0.00,$0.00,$380.25,$0.00,$190.13,$301.16,$304.20,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.412,SUP,Custom 27203010,,03.503.412  -  BIT DRILL 50MM MTRXMAND STOP JLTCH 12MM STRL,$380.25,$0.00,$380.25,$0.00,$271.38,$0.00,$0.00,$0.00,$0.00,$0.00,$380.25,$0.00,$190.13,$301.16,$304.20,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.451,SUP,Custom 27203010,,03.503.451  -  BIT DRL 1.5MM 90MM NS MATRIXMANDIBLE JLTCH CPLNG STRYK,$405.00,$0.00,$405.00,$0.00,$289.05,$0.00,$0.00,$0.00,$0.00,$0.00,$405.00,$0.00,$202.50,$320.76,$324.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.452,SUP,Custom 27203010,,03.503.452  -  BIT DRILL 1.5MM MTRXMAND,$405.00,$0.00,$405.00,$0.00,$289.05,$0.00,$0.00,$0.00,$0.00,$0.00,$405.00,$0.00,$202.50,$320.76,$324.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.461,SUP,Custom 27203010,,03.503.461  -  BIT DRILL 90MM 1.8MM JLTCH NSTRL,$405.00,$0.00,$405.00,$0.00,$289.05,$0.00,$0.00,$0.00,$0.00,$0.00,$405.00,$0.00,$202.50,$320.76,$324.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.462,SUP,Custom 27203010,,03.503.462  -  BIT DRILL 145MM 1.8MM JLTCH,$405.00,$0.00,$405.00,$0.00,$289.05,$0.00,$0.00,$0.00,$0.00,$0.00,$405.00,$0.00,$202.50,$320.76,$324.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.471,SUP,Custom 27203010,,03.503.471  -  BIT DRL 2.4MM 90MM NS MATRIXMANDIBLE JLTCH CPLNG STRYK,$405.00,$0.00,$405.00,$0.00,$289.05,$0.00,$0.00,$0.00,$0.00,$0.00,$405.00,$0.00,$202.50,$320.76,$324.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.472,SUP,Custom 27203010,,03.503.472  -  BIT DRILL 90MM 2.4MM CLBRT,$405.00,$0.00,$405.00,$0.00,$289.05,$0.00,$0.00,$0.00,$0.00,$0.00,$405.00,$0.00,$202.50,$320.76,$324.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.476,SUP,Custom 27203010,,03.503.476  -  BIT DRL 1.5MM 125MM NS MATRIXMANDIBLE JLTCH CPLNG CLBRT,$468.00,$0.00,$468.00,$0.00,$334.01,$0.00,$0.00,$0.00,$0.00,$0.00,$468.00,$0.00,$234.00,$370.66,$374.40,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.477,SUP,Custom 27203010,,03.503.477  -  BIT DRL 1.8MM 125MM NS MATRIXMANDIBLE JLTCH CPLNG CLBRT,$468.00,$0.00,$468.00,$0.00,$334.01,$0.00,$0.00,$0.00,$0.00,$0.00,$468.00,$0.00,$234.00,$370.66,$374.40,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.478,SUP,Custom 27203010,,03.503.478  -  BIT DRL 2.4MM 125MM NS MATRIXMANDIBLE JLTCH CPLNG CLBRT,$468.00,$0.00,$468.00,$0.00,$334.01,$0.00,$0.00,$0.00,$0.00,$0.00,$468.00,$0.00,$234.00,$370.66,$374.40,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.479,SUP,Custom 27203010,,03.503.479  -  BIT DRILL 125MM 1.5MM MTRXMAND MINI CPLNG QC CLBRT NONSTRL,$405.00,$0.00,$405.00,$0.00,$289.05,$0.00,$0.00,$0.00,$0.00,$0.00,$405.00,$0.00,$202.50,$320.76,$324.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.480,SUP,Custom 27203010,,03.503.480  -  BIT DRILL 125MM 1.8MM MTRXMAND CLBRT,$405.00,$0.00,$405.00,$0.00,$289.05,$0.00,$0.00,$0.00,$0.00,$0.00,$405.00,$0.00,$202.50,$320.76,$324.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.481,SUP,Custom 27203010,,03.503.481  -  BIT DRILL 125MM 2.4MM MTRXMAND MINI CLBRT QC NONSTRL,$405.00,$0.00,$405.00,$0.00,$289.05,$0.00,$0.00,$0.00,$0.00,$0.00,$405.00,$0.00,$202.50,$320.76,$324.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.504,SUP,Custom 27203010,,03.503.504  -  MATRIXMANDIBLE 1.5MM DRILL BIT MQC W/4MM STOP/50MM,$380.25,$0.00,$380.25,$0.00,$271.38,$0.00,$0.00,$0.00,$0.00,$0.00,$380.25,$0.00,$190.13,$301.16,$304.20,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.506,SUP,Custom 27203010,,03.503.506  -  MATRIXMANDIBLE 1.5MM DRILL BIT MQC W/6MM STOP/50MM,$380.25,$0.00,$380.25,$0.00,$271.38,$0.00,$0.00,$0.00,$0.00,$0.00,$380.25,$0.00,$190.13,$301.16,$304.20,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.508,SUP,Custom 27203010,,03.503.508  -  MATRIXMANDIBLE 1.5MM DRILL BIT MQC W/8MM STOP/50MM,$380.25,$0.00,$380.25,$0.00,$271.38,$0.00,$0.00,$0.00,$0.00,$0.00,$380.25,$0.00,$190.13,$301.16,$304.20,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.512,SUP,Custom 27203010,,03.503.512  -  MATRIXMANDIBLE 1.5MM DRILL BIT MQC W/12MM STOP/50MM,$380.25,$0.00,$380.25,$0.00,$271.38,$0.00,$0.00,$0.00,$0.00,$0.00,$380.25,$0.00,$190.13,$301.16,$304.20,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.551,SUP,Custom 27203010,,03.503.551  -  BIT DRILL MTRXMAND MINI QC,$405.00,$0.00,$405.00,$0.00,$289.05,$0.00,$0.00,$0.00,$0.00,$0.00,$405.00,$0.00,$202.50,$320.76,$324.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.552,SUP,Custom 27203010,,03.503.552  -  MATRIXMANDIBLE 1.5MM DRILL BIT MQC/145MM F/03.503.042,$405.00,$0.00,$405.00,$0.00,$289.05,$0.00,$0.00,$0.00,$0.00,$0.00,$405.00,$0.00,$202.50,$320.76,$324.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.561,SUP,Custom 27203010,,03.503.561  -  MATRIXMANDIBLE 1.8MM DRILL BIT MQC/90MM FOR 03.503.044,$405.00,$0.00,$405.00,$0.00,$289.05,$0.00,$0.00,$0.00,$0.00,$0.00,$405.00,$0.00,$202.50,$320.76,$324.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.562,SUP,Custom 27203010,,03.503.562  -  MATRIXMANDIBLE 1.8MM DRILL BIT MQC/145MM F/03.503.042,$405.00,$0.00,$405.00,$0.00,$289.05,$0.00,$0.00,$0.00,$0.00,$0.00,$405.00,$0.00,$202.50,$320.76,$324.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.571,SUP,Custom 27203010,,03.503.571  -  MATRIXMANDIBLE 2.4MM DRILL BIT MQC/90MM FOR 03.503.046,$405.00,$0.00,$405.00,$0.00,$289.05,$0.00,$0.00,$0.00,$0.00,$0.00,$405.00,$0.00,$202.50,$320.76,$324.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.503.572,SUP,Custom 27203010,,03.503.572  -  MATRIXMANDIBLE 2.4MM DRILL BIT MQC/145MM F/03.503.042,$405.00,$0.00,$405.00,$0.00,$289.05,$0.00,$0.00,$0.00,$0.00,$0.00,$405.00,$0.00,$202.50,$320.76,$324.00,$0.00,$0.00,$0.00,$0.00,$0.00
03.507.002S,SUP,Custom 27203010,,03.507.002S  -  TOOL REDX HEXGAON 2.4MM 78MM THREADED SLFDRILL COUPLING,$384.75,$0.00,$384.75,$0.00,$274.60,$0.00,$0.00,$0.00,$0.00,$0.00,$384.75,$0.00,$192.38,$304.72,$307.80,$0.00,$0.00,$0.00,$0.00,$0.00
03.507.003,SUP,Custom 27203010,,03.507.003  -  BIT DRILL 78MM 3.5MM SLFTAP REDX TL 3.5MM SCR NONSTRL,$614.25,$0.00,$614.25,$0.00,$438.39,$0.00,$0.00,$0.00,$0.00,$0.00,$614.25,$0.00,$307.13,$486.49,$491.40,$0.00,$0.00,$0.00,$0.00,$0.00
03.614.015,SUP,HCPCS C1713,,03.614.015  -  TAP SURG 4.5MM 205MM 50MM CALIBRATED CANCELLOUS,$545.00,$0.00,$545.00,$245.25,$388.97,$0.00,$93.90,$0.00,$0.00,$95.43,$545.00,$0.00,$272.50,$431.64,$436.00,$0.00,$85.29,$0.00,$86.76,$0.00
03.620.104,SUP,HCPCS C1713,,03.620.104  -  TAP 6MM HEX CPLNG SURG 4MM DUAL CORE SCR NONSTRL,$628.25,$0.00,$628.25,$282.71,$448.38,$0.00,$108.24,$0.00,$0.00,$110.00,$628.25,$0.00,$314.13,$497.57,$502.60,$0.00,$98.32,$0.00,$100.02,$0.00
03.620.105,SUP,HCPCS C1713,,03.620.105  -  TAP 5MM 6MM HEX CPLNG SPNL DUAL CORE SCR NONSTRL,$628.25,$0.00,$628.25,$282.71,$448.38,$0.00,$108.24,$0.00,$0.00,$110.00,$628.25,$0.00,$314.13,$497.57,$502.60,$0.00,$98.32,$0.00,$100.02,$0.00
03.620.106,SUP,HCPCS C1713,,03.620.106  -  TAP 6MM HEX CPLNG SURG NONSTRL,$628.25,$0.00,$628.25,$282.71,$448.38,$0.00,$108.24,$0.00,$0.00,$110.00,$628.25,$0.00,$314.13,$497.57,$502.60,$0.00,$98.32,$0.00,$100.02,$0.00
0301-14,SUP,Custom 27203010,,0301-14  -  TUBE JJNSTM 14FR 9FR STRL LF MIC LL RADOPQ STRP TRM DIST TIP,$710.89,$0.00,$563.02,$0.00,$342.14,$0.00,$0.00,$0.00,$0.00,$0.00,$479.38,$0.00,$239.69,$563.02,$383.51,$0.00,$0.00,$0.00,$0.00,$0.00
03-10-0110,SUP,HCPCS C1713,,03-10-0110  -  PLATE BONE 10MM LEVEL 1 TETHER TITANIUM SPN CERV ANTERIOR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
03-10-0112,SUP,HCPCS C1713,,03-10-0112  -  PLATE BONE 12MM LEVEL 1 TETHER TITANIUM SPN CERV ANTERIOR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
03-10-0114,SUP,HCPCS C1713,,03-10-0114  -  PLATE BONE 14MM LEVEL 1 TETHER TITANIUM SPN CERV ANTERIOR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
03-10-0116,SUP,HCPCS C1713,,03-10-0116  -  PLATE BONE 16MM LEVEL 1 TETHER TITANIUM SPN CERV ANTERIOR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
03-10-0118,SUP,HCPCS C1713,,03-10-0118  -  PLATE BONE 18MM LEVEL 1 TETHER TITANIUM SPN CERV ANTERIOR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
03-10-0120,SUP,HCPCS C1713,,03-10-0120  -  PLATE BONE 20MM LEVEL 1 TETHER TITANIUM SPN CERV ANTERIOR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
03-10-0122,SUP,HCPCS C1713,,03-10-0122  -  PLATE BONE 22MM LEVEL 1 TETHER TITANIUM SPN CERV ANTERIOR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
03-10-0124,SUP,HCPCS C1713,,03-10-0124  -  PLATE BONE 24MM LEVEL 1 TETHER TITANIUM SPN CERV ANTERIOR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
03-10-0126,SUP,HCPCS C1713,,03-10-0126  -  PLATE BONE 26MM LEVEL 1 TETHER TITANIUM SPN CERV ANTERIOR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
03-10-0229,SUP,HCPCS C1713,,03-10-0229  -  PLATE 29MM TI 2 LVL BONE ANT CERV SPN,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
03-10-0232,SUP,HCPCS C1713,,03-10-0232  -  PLATE 32MM TI 2 LVL BONE ANT CERV SPN,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
03-10-0235,SUP,HCPCS C1713,,03-10-0235  -  PLATE 35MM TI 2 LVL BONE ANT CERV SPN,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
03-10-0238,SUP,HCPCS C1713,,03-10-0238  -  PLATE 38MM TI 2 LVL BONE ANT CERV SPN,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
03-10-0241,SUP,HCPCS C1713,,03-10-0241  -  PLATE 41MM TI 2 LVL BONE ANT CERV SPN,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
03-10-0244,SUP,HCPCS C1713,,03-10-0244  -  PLATE 44MM TI 2 LVL BONE ANT CERV SPN,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
03-10-0343,SUP,HCPCS C1713,,03-10-0343  -  PLATE BONE 43MM LEVEL 3 TETHER TITANIUM SPN CERV ANTERIOR,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
03-10-0346,SUP,HCPCS C1713,,03-10-0346  -  PLATE BONE 46MM LEVEL 3 TETHER TITANIUM SPN CERV ANTERIOR,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
03-10-0349,SUP,HCPCS C1713,,03-10-0349  -  PLATE BONE 49MM LEVEL 3 TETHER TITANIUM SPN CERV ANTERIOR,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
03-10-0352,SUP,HCPCS C1713,,03-10-0352  -  PLATE BONE 52MM LEVEL 3 TETHER TITANIUM SPN CERV ANTERIOR,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
03-10-0355,SUP,HCPCS C1713,,03-10-0355  -  PLATE BONE 55MM LEVEL 3 TETHER TITANIUM SPN CERV ANTERIOR,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
03-10-0358,SUP,HCPCS C1713,,03-10-0358  -  PLATE BONE 58MM LEVEL 3 TETHER TITANIUM SPN CERV ANTERIOR,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
03-10-0362,SUP,HCPCS C1713,,03-10-0362  -  PLATE BONE 62MM LEVEL 3 TETHER TITANIUM SPN CERV ANTERIOR,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
03-10-0366,SUP,HCPCS C1713,,03-10-0366  -  PLATE BONE 66MM LEVEL 3 TETHER TITANIUM SPN CERV ANTERIOR,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
03-10-0460,SUP,HCPCS C1713,,03-10-0460  -  PLATE BONE 60MM LEVEL 4 TETHER TITANIUM SPN CERV ANTERIOR,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
03-10-0464,SUP,HCPCS C1713,,03-10-0464  -  PLATE BONE 64MM LEVEL 4 TETHER TITANIUM SPN CERV ANTERIOR,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
03-10-0468,SUP,HCPCS C1713,,03-10-0468  -  PLATE BONE 68MM LEVEL 4 TETHER TITANIUM SPN CERV ANTERIOR,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
03-10-0472,SUP,HCPCS C1713,,03-10-0472  -  PLATE BONE 72MM LEVEL 4 TETHER TITANIUM SPN CERV ANTERIOR,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
03-10-0476,SUP,HCPCS C1713,,03-10-0476  -  PLATE BONE 76MM LEVEL 4 TETHER TITANIUM SPN CERV ANTERIOR,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
03-10-0480,SUP,HCPCS C1713,,03-10-0480  -  PLATE BONE 80MM LEVEL 4 TETHER TITANIUM SPN CERV ANTERIOR,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
03-10-0484,SUP,HCPCS C1713,,03-10-0484  -  PLATE BONE 84MM LEVEL 4 TETHER TITANIUM SPN CERV ANTERIOR,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
03-503-246,SUP,Custom 27203010,,03-503-246  -  BIT DRILL 44.5MM 1.1MM MTRX 6MM STOP JLTCH CPLNG NONSTRL,$285.75,$0.00,$285.75,$0.00,$203.94,$0.00,$0.00,$0.00,$0.00,$0.00,$285.75,$0.00,$142.88,$226.31,$228.60,$0.00,$0.00,$0.00,$0.00,$0.00
038-001,SUP,Custom 27203010,,KIT IMMUN TST ELISA B2-GLYPRTN 1 IGG 96 TST 038-001,$962.50,$0.00,$962.50,$0.00,$686.94,$0.00,$0.00,$0.00,$0.00,$0.00,$962.50,$0.00,$481.25,$762.30,$770.00,$0.00,$0.00,$0.00,$0.00,$0.00
0382-1425,SUP,HCPCS C1713,,0382-1425  -  SCREW BONE 4.5MM 25MM POLYAX XIA II TITANIUM SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
0382-1430,SUP,HCPCS C1713,,0382-1430  -  SCREW BONE 4.5MM 30MM POLYAX XIA II TITANIUM SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
0382-1445,SUP,HCPCS C1713,,0382-1445  -  SCREW BN 4.5MM 45MM X2 PA TI SPNE THORLMBR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
0382-1525,SUP,HCPCS C1713,,0382-1525  -  SCREW BONE 5.5MM 25MM POLYAX XIA II TITANIUM SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
0382-1535,SUP,HCPCS C1713,,0382-1535  -  SCREW BONE 5.5MM 35MM POLYAX XIA II TITANIUM SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
0382-1650,SUP,HCPCS C1713,,0382-1650  -  SCREW BONE 6.5MM 50MM POLYAX XIA II TITANIUM SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
04.001.000,SUP,HCPCS C1713,,04.001.000  -  CAP END 0MM HUM XTD STARDRIVE RECESS CANN IM NAIL TI NONSTRL,$330.25,$0.00,$330.25,$148.61,$235.70,$0.00,$56.90,$0.00,$0.00,$57.82,$330.25,$0.00,$165.13,$261.56,$264.20,$0.00,$51.68,$0.00,$52.58,$0.00
04.001.000S,SUP,Custom 27803010,,04.001.000S  -  CAP END 0MM EXTENDED SPIRAL BLADE SELF HOLDING T25 STARDRIVE,$378.15,$0.00,$378.15,$0.00,$269.89,$0.00,$0.00,$0.00,$0.00,$0.00,$378.15,$0.00,$189.08,$299.49,$302.52,$0.00,$0.00,$0.00,$0.00,$0.00
04.001.001S,SUP,Custom 27803010,,04.001.001S  -  CAP END 5MM EXTENDED SPIRAL BLADE SELF HOLDING T25 STARDRIVE,$378.15,$0.00,$378.15,$0.00,$269.89,$0.00,$0.00,$0.00,$0.00,$0.00,$378.15,$0.00,$189.08,$299.49,$302.52,$0.00,$0.00,$0.00,$0.00,$0.00
04.001.002S,SUP,Custom 27803010,,04.001.002S  -  CAP END 10MM EXTENDED STARDRIVE RECESS NAIL-EX TITANIUM,$378.15,$0.00,$378.15,$0.00,$269.89,$0.00,$0.00,$0.00,$0.00,$0.00,$378.15,$0.00,$189.08,$299.49,$302.52,$0.00,$0.00,$0.00,$0.00,$0.00
04.001.003S,SUP,Custom 27803010,,04.001.003S  -  CAP END 15MM 15MM EXTENDED SPIRAL BLADE SELF HOLDING T25,$378.15,$0.00,$378.15,$0.00,$269.89,$0.00,$0.00,$0.00,$0.00,$0.00,$378.15,$0.00,$189.08,$299.49,$302.52,$0.00,$0.00,$0.00,$0.00,$0.00
04.001.210S,SUP,HCPCS C1713,,04.001.210S  -  NAIL INTRAMEDULLARY ROUND BARREL UNIVERSAL 7MM 15CM CANN,"$3,485.40",$0.00,"$3,485.40","$1,568.43","$2,487.53",$0.00,$583.02,$0.00,$0.00,$610.27,"$3,485.40",$0.00,"$1,742.70","$2,760.44","$2,788.32",$0.00,$529.58,$0.00,$554.88,$0.00
04.001.218S,SUP,HCPCS C1713,,04.001.218S  -  NAIL INTRAMEDULLARY ROUND BARREL UNIVERSAL 7MM 19CM CANN,"$3,590.20",$0.00,"$3,590.20","$1,615.59","$2,562.33",$0.00,$600.56,$0.00,$0.00,$628.62,"$3,590.20",$0.00,"$1,795.10","$2,843.44","$2,872.16",$0.00,$545.50,$0.00,$571.56,$0.00
04.001.220S,SUP,HCPCS C1713,,04.001.220S  -  NAIL INTRAMEDULLARY ROUND BARREL UNIVERSAL 7MM 20CM CANN,"$3,590.20",$0.00,"$3,590.20","$1,615.59","$2,562.33",$0.00,$600.56,$0.00,$0.00,$628.62,"$3,590.20",$0.00,"$1,795.10","$2,843.44","$2,872.16",$0.00,$545.50,$0.00,$571.56,$0.00
04.001.222S,SUP,HCPCS C1713,,04.001.222S  -  NAIL INTRAMEDULLARY UNIVERSAL 7MM 210MM SOLID CANN EXPERT,"$3,590.20",$0.00,"$3,590.20","$1,615.59","$2,562.33",$0.00,$600.56,$0.00,$0.00,$628.62,"$3,590.20",$0.00,"$1,795.10","$2,843.44","$2,872.16",$0.00,$545.50,$0.00,$571.56,$0.00
04.001.224S,SUP,HCPCS C1713,,04.001.224S  -  NAIL INTRAMEDULLARY UNIVERSAL 7MM 220MM CANN ROUND BARREL,"$3,485.40",$0.00,"$3,485.40","$1,568.43","$2,487.53",$0.00,$583.02,$0.00,$0.00,$610.27,"$3,485.40",$0.00,"$1,742.70","$2,760.44","$2,788.32",$0.00,$529.58,$0.00,$554.88,$0.00
04.001.226S,SUP,HCPCS C1713,,04.001.226S  -  NAIL INTRAMEDULLARY 7MM 230MM CANN NAIL-EX BLUE TITANIUM,"$3,485.40",$0.00,"$3,485.40","$1,568.43","$2,487.53",$0.00,$583.02,$0.00,$0.00,$610.27,"$3,485.40",$0.00,"$1,742.70","$2,760.44","$2,788.32",$0.00,$529.58,$0.00,$554.88,$0.00
04.001.228S,SUP,HCPCS C1713,,04.001.228S  -  NAIL INTRAMEDULLARY ROUND BARREL UNIVERSAL 7MM 24CM CANN,"$3,485.40",$0.00,"$3,485.40","$1,568.43","$2,487.53",$0.00,$583.02,$0.00,$0.00,$610.27,"$3,485.40",$0.00,"$1,742.70","$2,760.44","$2,788.32",$0.00,$529.58,$0.00,$554.88,$0.00
04.001.230S,SUP,HCPCS C1713,,04.001.230S  -  NAIL INTRAMEDULLARY UNIVERSAL 7MM 250MM SOLID CANN EXPERT,"$3,485.40",$0.00,"$3,485.40","$1,568.43","$2,487.53",$0.00,$583.02,$0.00,$0.00,$610.27,"$3,485.40",$0.00,"$1,742.70","$2,760.44","$2,788.32",$0.00,$529.58,$0.00,$554.88,$0.00
04.001.232S,SUP,HCPCS C1713,,04.001.232S  -  NAIL INTRAMEDULLARY ROUND BARREL UNIVERSAL 7MM 26CM CANN,"$3,485.40",$0.00,"$3,485.40","$1,568.43","$2,487.53",$0.00,$583.02,$0.00,$0.00,$610.27,"$3,485.40",$0.00,"$1,742.70","$2,760.44","$2,788.32",$0.00,$529.58,$0.00,$554.88,$0.00
04.001.234S,SUP,HCPCS C1713,,04.001.234S  -  NAIL INTRAMEDULLARY ROUND BARREL UNIVERSAL 7MM 27CM CANN,"$3,485.40",$0.00,"$3,485.40","$1,568.43","$2,487.53",$0.00,$583.02,$0.00,$0.00,$610.27,"$3,485.40",$0.00,"$1,742.70","$2,760.44","$2,788.32",$0.00,$529.58,$0.00,$554.88,$0.00
04.001.236S,SUP,HCPCS C1713,,04.001.236S  -  NAIL INTRAMEDULLARY ROUND BARREL UNIVERSAL 7MM 28CM CANN,"$3,590.20",$0.00,"$3,590.20","$1,615.59","$2,562.33",$0.00,$600.56,$0.00,$0.00,$628.62,"$3,590.20",$0.00,"$1,795.10","$2,843.44","$2,872.16",$0.00,$545.50,$0.00,$571.56,$0.00
04.001.238S,SUP,HCPCS C1713,,04.001.238S  -  NAIL INTRAMEDULLARY ROUND BARREL UNIVERSAL 7MM 29CM CANN,"$3,590.20",$0.00,"$3,590.20","$1,615.59","$2,562.33",$0.00,$600.56,$0.00,$0.00,$628.62,"$3,590.20",$0.00,"$1,795.10","$2,843.44","$2,872.16",$0.00,$545.50,$0.00,$571.56,$0.00
04.001.240S,SUP,HCPCS C1713,,04.001.240S  -  NAIL INTRAMEDULLARY 7MM 300MM SOLID CANN EXPERT BLUE,"$3,590.20",$0.00,"$3,590.20","$1,615.59","$2,562.33",$0.00,$600.56,$0.00,$0.00,$628.62,"$3,590.20",$0.00,"$1,795.10","$2,843.44","$2,872.16",$0.00,$545.50,$0.00,$571.56,$0.00
04.001.242S,SUP,HCPCS C1713,,04.001.242S  -  NAIL INTRAMEDULLARY 7MM 310MM CANN NAIL-EX BLUE TITANIUM,"$3,590.20",$0.00,"$3,590.20","$1,615.59","$2,562.33",$0.00,$600.56,$0.00,$0.00,$628.62,"$3,590.20",$0.00,"$1,795.10","$2,843.44","$2,872.16",$0.00,$545.50,$0.00,$571.56,$0.00
04.001.244S,SUP,HCPCS C1713,,04.001.244S  -  NAIL INTRAMEDULLARY 7MM 320MM SOLID CANN EXPERT BLUE,"$3,590.20",$0.00,"$3,590.20","$1,615.59","$2,562.33",$0.00,$600.56,$0.00,$0.00,$628.62,"$3,590.20",$0.00,"$1,795.10","$2,843.44","$2,872.16",$0.00,$545.50,$0.00,$571.56,$0.00
04.001.410S,SUP,HCPCS C1713,,04.001.410S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 150MM CANN ROUND BARREL,"$3,485.40",$0.00,"$3,485.40","$1,568.43","$2,487.53",$0.00,$583.02,$0.00,$0.00,$610.27,"$3,485.40",$0.00,"$1,742.70","$2,760.44","$2,788.32",$0.00,$529.58,$0.00,$554.88,$0.00
04.001.418S,SUP,HCPCS C1713,,04.001.418S  -  NAIL INTRAMEDULLARY ROUND BARREL UNIVERSAL 9MM 19CM CANN,"$3,590.20",$0.00,"$3,590.20","$1,615.59","$2,562.33",$0.00,$600.56,$0.00,$0.00,$628.62,"$3,590.20",$0.00,"$1,795.10","$2,843.44","$2,872.16",$0.00,$545.50,$0.00,$571.56,$0.00
04.001.420S,SUP,HCPCS C1713,,04.001.420S  -  NAIL INTRAMEDULLARY ROUND BARREL UNIVERSAL 9MM 20CM CANN,"$3,590.20",$0.00,"$3,590.20","$1,615.59","$2,562.33",$0.00,$600.56,$0.00,$0.00,$628.62,"$3,590.20",$0.00,"$1,795.10","$2,843.44","$2,872.16",$0.00,$545.50,$0.00,$571.56,$0.00
04.001.422S,SUP,HCPCS C1713,,04.001.422S  -  NAIL INTRAMEDULLARY 9MM 210MM SOLID CANN EXPERT BLUE,"$3,590.20",$0.00,"$3,590.20","$1,615.59","$2,562.33",$0.00,$600.56,$0.00,$0.00,$628.62,"$3,590.20",$0.00,"$1,795.10","$2,843.44","$2,872.16",$0.00,$545.50,$0.00,$571.56,$0.00
04.001.424S,SUP,HCPCS C1713,,04.001.424S  -  NAIL INTRAMEDULLARY ROUND BARREL UNIVERSAL 9MM 220MM CANN,"$3,485.40",$0.00,"$3,485.40","$1,568.43","$2,487.53",$0.00,$583.02,$0.00,$0.00,$610.27,"$3,485.40",$0.00,"$1,742.70","$2,760.44","$2,788.32",$0.00,$529.58,$0.00,$554.88,$0.00
04.001.426S,SUP,HCPCS C1713,,04.001.426S  -  NAIL INTRAMEDULLARY 9MM 230MM CANN IMPLANT NAIL-EX TITANIUM,"$3,485.40",$0.00,"$3,485.40","$1,568.43","$2,487.53",$0.00,$583.02,$0.00,$0.00,$610.27,"$3,485.40",$0.00,"$1,742.70","$2,760.44","$2,788.32",$0.00,$529.58,$0.00,$554.88,$0.00
04.001.428S,SUP,HCPCS C1713,,04.001.428S  -  NAIL INTRAMEDULLARY ROUND BARREL UNIVERSAL 9MM 24CM CANN,"$3,485.40",$0.00,"$3,485.40","$1,568.43","$2,487.53",$0.00,$583.02,$0.00,$0.00,$610.27,"$3,485.40",$0.00,"$1,742.70","$2,760.44","$2,788.32",$0.00,$529.58,$0.00,$554.88,$0.00
04.001.430S,SUP,HCPCS C1713,,04.001.430S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 250MM SOLID CANN EXPERT,"$3,485.40",$0.00,"$3,485.40","$1,568.43","$2,487.53",$0.00,$583.02,$0.00,$0.00,$610.27,"$3,485.40",$0.00,"$1,742.70","$2,760.44","$2,788.32",$0.00,$529.58,$0.00,$554.88,$0.00
04.001.432S,SUP,HCPCS C1713,,04.001.432S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 260MM SOLID CANN EXPERT,"$3,485.40",$0.00,"$3,485.40","$1,568.43","$2,487.53",$0.00,$583.02,$0.00,$0.00,$610.27,"$3,485.40",$0.00,"$1,742.70","$2,760.44","$2,788.32",$0.00,$529.58,$0.00,$554.88,$0.00
04.001.434S,SUP,HCPCS C1713,,04.001.434S  -  NAIL INTRAMEDULLARY 9MM 270MM SOLID CANN EXPERT BLUE,"$3,485.40",$0.00,"$3,485.40","$1,568.43","$2,487.53",$0.00,$583.02,$0.00,$0.00,$610.27,"$3,485.40",$0.00,"$1,742.70","$2,760.44","$2,788.32",$0.00,$529.58,$0.00,$554.88,$0.00
04.001.436S,SUP,HCPCS C1713,,04.001.436S  -  NAIL INTRAMEDULLARY 9MM 280MM SOLID CANN EXPERT BLUE,"$3,590.20",$0.00,"$3,590.20","$1,615.59","$2,562.33",$0.00,$600.56,$0.00,$0.00,$628.62,"$3,590.20",$0.00,"$1,795.10","$2,843.44","$2,872.16",$0.00,$545.50,$0.00,$571.56,$0.00
04.001.438S,SUP,HCPCS C1713,,04.001.438S  -  NAIL INTRAMEDULLARY 9MM 290MM CANN NAIL-EX BLUE TITANIUM,"$3,590.20",$0.00,"$3,590.20","$1,615.59","$2,562.33",$0.00,$600.56,$0.00,$0.00,$628.62,"$3,590.20",$0.00,"$1,795.10","$2,843.44","$2,872.16",$0.00,$545.50,$0.00,$571.56,$0.00
04.001.440S,SUP,HCPCS C1713,,04.001.440S  -  NAIL INTRAMEDULLARY 9MM 300MM SOLID CANN EXPERT BLUE,"$3,590.20",$0.00,"$3,590.20","$1,615.59","$2,562.33",$0.00,$600.56,$0.00,$0.00,$628.62,"$3,590.20",$0.00,"$1,795.10","$2,843.44","$2,872.16",$0.00,$545.50,$0.00,$571.56,$0.00
04.001.442S,SUP,HCPCS C1713,,04.001.442S  -  NAIL INTRAMEDULLARY 9MM 310MM CANN NAIL-EX BLUE TITANIUM,"$3,590.20",$0.00,"$3,590.20","$1,615.59","$2,562.33",$0.00,$600.56,$0.00,$0.00,$628.62,"$3,590.20",$0.00,"$1,795.10","$2,843.44","$2,872.16",$0.00,$545.50,$0.00,$571.56,$0.00
04.001.444S,SUP,HCPCS C1713,,04.001.444S  -  NAIL INTRAMEDULLARY 9MM 320MM SOLID CANN EXPERT BLUE,"$3,590.20",$0.00,"$3,590.20","$1,615.59","$2,562.33",$0.00,$600.56,$0.00,$0.00,$628.62,"$3,590.20",$0.00,"$1,795.10","$2,843.44","$2,872.16",$0.00,$545.50,$0.00,$571.56,$0.00
04.001.610S,SUP,HCPCS C1713,,04.001.610S  -  NAIL INTRAMEDULLARY 11MM 150MM CANN EXPERT BLUE TITANIUM,"$3,590.20",$0.00,"$3,590.20","$1,615.59","$2,562.33",$0.00,$600.56,$0.00,$0.00,$628.62,"$3,590.20",$0.00,"$1,795.10","$2,843.44","$2,872.16",$0.00,$545.50,$0.00,$571.56,$0.00
04.001.618S,SUP,HCPCS C1713,,04.001.618S  -  NAIL INTRAMEDULLARY 11MM 19CM CANN NAIL-EX TITANIUM HUMERUS,"$3,712.00",$0.00,"$3,712.00","$1,670.40","$2,649.25",$0.00,$620.93,$0.00,$0.00,$649.94,"$3,712.00",$0.00,"$1,856.00","$2,939.90","$2,969.60",$0.00,$564.01,$0.00,$590.95,$0.00
04.001.620S,SUP,HCPCS C1713,,04.001.620S  -  NAIL INTRAMEDULLARY 11MM 20CM CANN NAIL-EX TITANIUM HUMERUS,"$3,712.00",$0.00,"$3,712.00","$1,670.40","$2,649.25",$0.00,$620.93,$0.00,$0.00,$649.94,"$3,712.00",$0.00,"$1,856.00","$2,939.90","$2,969.60",$0.00,$564.01,$0.00,$590.95,$0.00
04.001.622S,SUP,HCPCS C1713,,04.001.622S  -  NAIL INTRAMEDULLARY 11MM 21CM CANN NAIL-EX TITANIUM HUMERUS,"$3,712.00",$0.00,"$3,712.00","$1,670.40","$2,649.25",$0.00,$620.93,$0.00,$0.00,$649.94,"$3,712.00",$0.00,"$1,856.00","$2,939.90","$2,969.60",$0.00,$564.01,$0.00,$590.95,$0.00
04.001.624S,SUP,HCPCS C1713,,04.001.624S  -  NAIL INTRAMEDULLARY 11MM 22CM CANN NAIL-EX TITANIUM HUMERUS,"$3,712.00",$0.00,"$3,712.00","$1,670.40","$2,649.25",$0.00,$620.93,$0.00,$0.00,$649.94,"$3,712.00",$0.00,"$1,856.00","$2,939.90","$2,969.60",$0.00,$564.01,$0.00,$590.95,$0.00
04.001.626S,SUP,HCPCS C1713,,04.001.626S  -  NAIL INTRAMEDULLARY 11MM 23CM CANN NAIL-EX TITANIUM HUMERUS,"$3,712.00",$0.00,"$3,712.00","$1,670.40","$2,649.25",$0.00,$620.93,$0.00,$0.00,$649.94,"$3,712.00",$0.00,"$1,856.00","$2,939.90","$2,969.60",$0.00,$564.01,$0.00,$590.95,$0.00
04.001.628S,SUP,HCPCS C1713,,04.001.628S  -  NAIL INTRAMEDULLARY 11MM 24CM CANN NAIL-EX TITANIUM HUMERUS,"$3,712.00",$0.00,"$3,712.00","$1,670.40","$2,649.25",$0.00,$620.93,$0.00,$0.00,$649.94,"$3,712.00",$0.00,"$1,856.00","$2,939.90","$2,969.60",$0.00,$564.01,$0.00,$590.95,$0.00
04.001.630S,SUP,HCPCS C1713,,04.001.630S  -  NAIL INTRAMEDULLARY 11MM 25CM CANN NAIL-EX TITANIUM HUMERUS,"$3,712.00",$0.00,"$3,712.00","$1,670.40","$2,649.25",$0.00,$620.93,$0.00,$0.00,$649.94,"$3,712.00",$0.00,"$1,856.00","$2,939.90","$2,969.60",$0.00,$564.01,$0.00,$590.95,$0.00
04.001.632S,SUP,HCPCS C1713,,04.001.632S  -  NAIL INTRAMEDULLARY 11MM 26CM CANN NAIL-EX TITANIUM HUMERUS,"$3,712.00",$0.00,"$3,712.00","$1,670.40","$2,649.25",$0.00,$620.93,$0.00,$0.00,$649.94,"$3,712.00",$0.00,"$1,856.00","$2,939.90","$2,969.60",$0.00,$564.01,$0.00,$590.95,$0.00
04.001.634S,SUP,HCPCS C1713,,04.001.634S  -  NAIL INTRAMEDULLARY 11MM 270MM CANN NAIL-EX TITANIUM HUMERUS,"$3,712.00",$0.00,"$3,712.00","$1,670.40","$2,649.25",$0.00,$620.93,$0.00,$0.00,$649.94,"$3,712.00",$0.00,"$1,856.00","$2,939.90","$2,969.60",$0.00,$564.01,$0.00,$590.95,$0.00
04.001.636S,SUP,HCPCS C1713,,04.001.636S  -  NAIL INTRAMEDULLARY 11MM 28CM CANN NAIL-EX TITANIUM HUMERUS,"$3,712.00",$0.00,"$3,712.00","$1,670.40","$2,649.25",$0.00,$620.93,$0.00,$0.00,$649.94,"$3,712.00",$0.00,"$1,856.00","$2,939.90","$2,969.60",$0.00,$564.01,$0.00,$590.95,$0.00
04.001.638S,SUP,HCPCS C1713,,04.001.638S  -  NAIL INTRAMEDULLARY 11MM 29CM CANN NAIL-EX TITANIUM HUMERUS,"$3,712.00",$0.00,"$3,712.00","$1,670.40","$2,649.25",$0.00,$620.93,$0.00,$0.00,$649.94,"$3,712.00",$0.00,"$1,856.00","$2,939.90","$2,969.60",$0.00,$564.01,$0.00,$590.95,$0.00
04.001.640S,SUP,HCPCS C1713,,04.001.640S  -  NAIL INTRAMEDULLARY 11MM 30CM CANN NAIL-EX TITANIUM HUMERUS,"$3,712.00",$0.00,"$3,712.00","$1,670.40","$2,649.25",$0.00,$620.93,$0.00,$0.00,$649.94,"$3,712.00",$0.00,"$1,856.00","$2,939.90","$2,969.60",$0.00,$564.01,$0.00,$590.95,$0.00
04.001.642S,SUP,HCPCS C1713,,04.001.642S  -  NAIL INTRAMEDULLARY 11MM 31CM CANN NAIL-EX TITANIUM HUMERUS,"$3,712.00",$0.00,"$3,712.00","$1,670.40","$2,649.25",$0.00,$620.93,$0.00,$0.00,$649.94,"$3,712.00",$0.00,"$1,856.00","$2,939.90","$2,969.60",$0.00,$564.01,$0.00,$590.95,$0.00
04.001.644S,SUP,HCPCS C1713,,04.001.644S  -  NAIL INTRAMEDULLARY 11MM 32CM CANN NAIL-EX TITANIUM HUMERUS,"$3,712.00",$0.00,"$3,712.00","$1,670.40","$2,649.25",$0.00,$620.93,$0.00,$0.00,$649.94,"$3,712.00",$0.00,"$1,856.00","$2,939.90","$2,969.60",$0.00,$564.01,$0.00,$590.95,$0.00
04.003.000S,SUP,Custom 27803010,,04.003.000S  -  CAP END 0MM T40 STARDRIVE RECESS CANN FLUSH SELF RETAINING,$402.23,$0.00,$402.23,$0.00,$287.07,$0.00,$0.00,$0.00,$0.00,$0.00,$402.23,$0.00,$201.11,$318.57,$321.78,$0.00,$0.00,$0.00,$0.00,$0.00
04.003.001S,SUP,Custom 27803010,,04.003.001S  -  CAP END 5MM T40 STARDRIVE RECESS CANN SELF RETAINING LATERAL,$402.23,$0.00,$402.23,$0.00,$287.07,$0.00,$0.00,$0.00,$0.00,$0.00,$402.23,$0.00,$201.11,$318.57,$321.78,$0.00,$0.00,$0.00,$0.00,$0.00
04.003.002S,SUP,Custom 27803010,,04.003.002S  -  CAP END 10MM T40 STARDRIVE RECESS CANN SELF RETAINING,$402.23,$0.00,$402.23,$0.00,$287.07,$0.00,$0.00,$0.00,$0.00,$0.00,$402.23,$0.00,$201.11,$318.57,$321.78,$0.00,$0.00,$0.00,$0.00,$0.00
04.003.003S,SUP,Custom 27803010,,04.003.003S  -  CAP END 15MM 12MM T40 STARDRIVE RECESS CANN SELF RETAINING,$402.23,$0.00,$402.23,$0.00,$287.07,$0.00,$0.00,$0.00,$0.00,$0.00,$402.23,$0.00,$201.11,$318.57,$321.78,$0.00,$0.00,$0.00,$0.00,$0.00
04.003.004S,SUP,Custom 27803010,,04.003.004S  -  CAP END 20MM T40 STARDRIVE RECESS CANN SELF RETAINING,$402.23,$0.00,$402.23,$0.00,$287.07,$0.00,$0.00,$0.00,$0.00,$0.00,$402.23,$0.00,$201.11,$318.57,$321.78,$0.00,$0.00,$0.00,$0.00,$0.00
04.003.006S,SUP,Custom 27803010,,04.003.006S  -  CAP END 5MM 16MM T40 STARDRIVE RECESS CANN SELF RETAINING,$402.23,$0.00,$402.23,$0.00,$287.07,$0.00,$0.00,$0.00,$0.00,$0.00,$402.23,$0.00,$201.11,$318.57,$321.78,$0.00,$0.00,$0.00,$0.00,$0.00
04.003.007S,SUP,Custom 27803010,,04.003.007S  -  CAP END 10MM 16MM T40 STARDRIVE RECESS CANN SELF RETAINING,$402.23,$0.00,$402.23,$0.00,$287.07,$0.00,$0.00,$0.00,$0.00,$0.00,$402.23,$0.00,$201.11,$318.57,$321.78,$0.00,$0.00,$0.00,$0.00,$0.00
04.003.008S,SUP,Custom 27803010,,04.003.008S  -  CAP END 15MM 16MM T40 STARDRIVE RECESS CANN SELF RETAINING,$402.23,$0.00,$402.23,$0.00,$287.07,$0.00,$0.00,$0.00,$0.00,$0.00,$402.23,$0.00,$201.11,$318.57,$321.78,$0.00,$0.00,$0.00,$0.00,$0.00
04.003.009S,SUP,Custom 27803010,,04.003.009S  -  CAP END 20MM 16MM T40 STARDRIVE RECESS CANN SELF RETAINING,$402.23,$0.00,$402.23,$0.00,$287.07,$0.00,$0.00,$0.00,$0.00,$0.00,$402.23,$0.00,$201.11,$318.57,$321.78,$0.00,$0.00,$0.00,$0.00,$0.00
04.003.022,SUP,HCPCS C1713,,04.003.022  -  SCREW BONE 6.5MM 60MM TI FEM SLFTAP TIP RECON T25 STARDRIVE,$400.38,$0.00,$400.38,$180.17,$285.75,$0.00,$68.98,$0.00,$0.00,$70.10,$400.38,$0.00,$200.19,$317.10,$320.30,$0.00,$62.66,$0.00,$63.74,$0.00
04.003.022S,SUP,HCPCS C1713,,04.003.022S  -  SCREW BN T25 6.5MM 60MM AU STRL ST BLNT TIP STRDR TI FEM LAT,$437.63,$0.00,$437.63,$196.93,$312.33,$0.00,$73.20,$0.00,$0.00,$76.62,$437.63,$0.00,$218.81,$346.60,$350.10,$0.00,$66.49,$0.00,$69.67,$0.00
04.003.023,SUP,HCPCS C1713,,04.003.023  -  SCREW BONE 6.5MM 65MM TI FEM SLFTAP TIP RECON T25 STARDRIVE,$400.38,$0.00,$400.38,$180.17,$285.75,$0.00,$68.98,$0.00,$0.00,$70.10,$400.38,$0.00,$200.19,$317.10,$320.30,$0.00,$62.66,$0.00,$63.74,$0.00
04.003.023S,SUP,HCPCS C1713,,04.003.023S  -  SCREW BN T25 6.5MM 65MM AU STRL ST BLNT TIP STRDR TI FEM LAT,$437.63,$0.00,$437.63,$196.93,$312.33,$0.00,$73.20,$0.00,$0.00,$76.62,$437.63,$0.00,$218.81,$346.60,$350.10,$0.00,$66.49,$0.00,$69.67,$0.00
04.003.024,SUP,HCPCS C1713,,04.003.024  -  SCREW BONE 6.5MM 70MM TI FEM T25 STARDRIVE RECESS SLFTAP,$400.38,$0.00,$400.38,$180.17,$285.75,$0.00,$68.98,$0.00,$0.00,$70.10,$400.38,$0.00,$200.19,$317.10,$320.30,$0.00,$62.66,$0.00,$63.74,$0.00
04.003.024S,SUP,HCPCS C1713,,04.003.024S  -  SCREW BN T25 6.5MM 70MM AU STRL ST BLNT TIP STRDR TI FEM LAT,$437.63,$0.00,$437.63,$196.93,$312.33,$0.00,$73.20,$0.00,$0.00,$76.62,$437.63,$0.00,$218.81,$346.60,$350.10,$0.00,$66.49,$0.00,$69.67,$0.00
04.003.025,SUP,HCPCS C1713,,04.003.025  -  SCREW BONE 6.5MM 75MM TI FEM SLFTAP TIP RECON T25 STARDRIVE,$400.38,$0.00,$400.38,$180.17,$285.75,$0.00,$68.98,$0.00,$0.00,$70.10,$400.38,$0.00,$200.19,$317.10,$320.30,$0.00,$62.66,$0.00,$63.74,$0.00
04.003.025S,SUP,HCPCS C1713,,04.003.025S  -  SCREW BN T25 6.5MM 75MM AU STRL ST BLNT TIP STRDR TI FEM LAT,$437.63,$0.00,$437.63,$196.93,$312.33,$0.00,$73.20,$0.00,$0.00,$76.62,$437.63,$0.00,$218.81,$346.60,$350.10,$0.00,$66.49,$0.00,$69.67,$0.00
04.003.026,SUP,HCPCS C1713,,04.003.026  -  SCREW BONE 6.5MM 80MM TI FEM SLFTAP RECON STARDRIVE RECESS,$400.38,$0.00,$400.38,$180.17,$285.75,$0.00,$68.98,$0.00,$0.00,$70.10,$400.38,$0.00,$200.19,$317.10,$320.30,$0.00,$62.66,$0.00,$63.74,$0.00
04.003.026S,SUP,HCPCS C1713,,04.003.026S  -  SCREW BN T25 6.5MM 80MM AU STRL ST BLNT TIP STRDR TI FEM LAT,$437.63,$0.00,$437.63,$196.93,$312.33,$0.00,$73.20,$0.00,$0.00,$76.62,$437.63,$0.00,$218.81,$346.60,$350.10,$0.00,$66.49,$0.00,$69.67,$0.00
04.003.027,SUP,HCPCS C1713,,04.003.027  -  SCREW BONE 6.5MM 85MM TI FEM SLFTAP TIP RECON T25 STARDRIVE,$400.38,$0.00,$400.38,$180.17,$285.75,$0.00,$68.98,$0.00,$0.00,$70.10,$400.38,$0.00,$200.19,$317.10,$320.30,$0.00,$62.66,$0.00,$63.74,$0.00
04.003.027S,SUP,HCPCS C1713,,04.003.027S  -  SCREW BN T25 6.5MM 85MM AU STRL ST BLNT TIP STRDR TI FEM LAT,$437.63,$0.00,$437.63,$196.93,$312.33,$0.00,$73.20,$0.00,$0.00,$76.62,$437.63,$0.00,$218.81,$346.60,$350.10,$0.00,$66.49,$0.00,$69.67,$0.00
04.003.028,SUP,HCPCS C1713,,04.003.028  -  SCREW BONE 6.5MM 90MM TI FEM SLFTAP TIP RECON T25 STARDRIVE,$424.75,$0.00,$424.75,$191.14,$303.14,$0.00,$73.18,$0.00,$0.00,$74.37,$424.75,$0.00,$212.38,$336.40,$339.80,$0.00,$66.47,$0.00,$67.62,$0.00
04.003.028S,SUP,HCPCS C1713,,04.003.028S  -  SCREW BN T25 6.5MM 90MM AU STRL ST BLNT TIP STRDR TI FEM LAT,$437.63,$0.00,$437.63,$196.93,$312.33,$0.00,$73.20,$0.00,$0.00,$76.62,$437.63,$0.00,$218.81,$346.60,$350.10,$0.00,$66.49,$0.00,$69.67,$0.00
04.003.029,SUP,HCPCS C1713,,04.003.029  -  SCREW BONE 6.5MM 95MM TI FEM SLFTAP TIP RECON T25 STARDRIVE,$424.75,$0.00,$424.75,$191.14,$303.14,$0.00,$73.18,$0.00,$0.00,$74.37,$424.75,$0.00,$212.38,$336.40,$339.80,$0.00,$66.47,$0.00,$67.62,$0.00
04.003.029S,SUP,HCPCS C1713,,04.003.029S  -  SCREW BN T25 6.5MM 95MM AU STRL ST BLNT TIP STRDR TI FEM LAT,$437.63,$0.00,$437.63,$196.93,$312.33,$0.00,$73.20,$0.00,$0.00,$76.62,$437.63,$0.00,$218.81,$346.60,$350.10,$0.00,$66.49,$0.00,$69.67,$0.00
04.003.030,SUP,HCPCS C1713,,04.003.030  -  SCREW BONE NONSTRL 6.5MM 100MM TI FEM T25 STARDRIVE RECESS,$400.38,$0.00,$400.38,$180.17,$285.75,$0.00,$68.98,$0.00,$0.00,$70.10,$400.38,$0.00,$200.19,$317.10,$320.30,$0.00,$62.66,$0.00,$63.74,$0.00
04.003.030S,SUP,HCPCS C1713,,04.003.030S  -  SCREW BN T25 6.5MM 100MM AU STRL ST BLNT TIP STRDR TI FEM,$437.63,$0.00,$437.63,$196.93,$312.33,$0.00,$73.20,$0.00,$0.00,$76.62,$437.63,$0.00,$218.81,$346.60,$350.10,$0.00,$66.49,$0.00,$69.67,$0.00
04.003.031,SUP,HCPCS C1713,,04.003.031  -  SCREW BONE 6.5MM 105MM TI FEM T25 STARDRIVE RECESS RECON,$424.75,$0.00,$424.75,$191.14,$303.14,$0.00,$73.18,$0.00,$0.00,$74.37,$424.75,$0.00,$212.38,$336.40,$339.80,$0.00,$66.47,$0.00,$67.62,$0.00
04.003.031S,SUP,HCPCS C1713,,04.003.031S  -  SCREW BN T25 6.5MM 105MM AU STRL ST BLNT TIP STRDR TI FEM,$437.63,$0.00,$437.63,$196.93,$312.33,$0.00,$73.20,$0.00,$0.00,$76.62,$437.63,$0.00,$218.81,$346.60,$350.10,$0.00,$66.49,$0.00,$69.67,$0.00
04.003.032,SUP,HCPCS C1713,,04.003.032  -  SCREW BONE 6.5MM 110MM TI FEM T25 STARDRIVE RECESS SLFTAP,$400.38,$0.00,$400.38,$180.17,$285.75,$0.00,$68.98,$0.00,$0.00,$70.10,$400.38,$0.00,$200.19,$317.10,$320.30,$0.00,$62.66,$0.00,$63.74,$0.00
04.003.032S,SUP,HCPCS C1713,,04.003.032S  -  SCREW BN T25 6.5MM 110MM AU STRL ST BLNT TIP STRDR TI FEM,$437.63,$0.00,$437.63,$196.93,$312.33,$0.00,$73.20,$0.00,$0.00,$76.62,$437.63,$0.00,$218.81,$346.60,$350.10,$0.00,$66.49,$0.00,$69.67,$0.00
04.003.033,SUP,HCPCS C1713,,04.003.033  -  SCREW BONE 6.5MM 115MM TI FEM T25 STARDRIVE RECESS SLFTAP,$400.38,$0.00,$400.38,$180.17,$285.75,$0.00,$68.98,$0.00,$0.00,$70.10,$400.38,$0.00,$200.19,$317.10,$320.30,$0.00,$62.66,$0.00,$63.74,$0.00
04.003.033S,SUP,HCPCS C1713,,04.003.033S  -  SCREW BN T25 6.5MM 115MM AU STRL ST BLNT TIP STRDR TI FEM,$437.63,$0.00,$437.63,$196.93,$312.33,$0.00,$73.20,$0.00,$0.00,$76.62,$437.63,$0.00,$218.81,$346.60,$350.10,$0.00,$66.49,$0.00,$69.67,$0.00
04.003.034,SUP,HCPCS C1713,,04.003.034  -  SCREW BONE 6.5MM 120MM TI FEM T25 STARDRIVE RECESS SLFTAP,$400.38,$0.00,$400.38,$180.17,$285.75,$0.00,$68.98,$0.00,$0.00,$70.10,$400.38,$0.00,$200.19,$317.10,$320.30,$0.00,$62.66,$0.00,$63.74,$0.00
04.003.034S,SUP,HCPCS C1713,,04.003.034S  -  SCREW BN T25 6.5MM 120MM AU STRL ST BLNT TIP STRDR TI FEM,$437.63,$0.00,$437.63,$196.93,$312.33,$0.00,$73.20,$0.00,$0.00,$76.62,$437.63,$0.00,$218.81,$346.60,$350.10,$0.00,$66.49,$0.00,$69.67,$0.00
04.003.035,SUP,HCPCS C1713,,04.003.035  -  SCREW BONE 6.5MM 125MM TI FEM T25 STARDRIVE RECESS SLFTAP,$400.38,$0.00,$400.38,$180.17,$285.75,$0.00,$68.98,$0.00,$0.00,$70.10,$400.38,$0.00,$200.19,$317.10,$320.30,$0.00,$62.66,$0.00,$63.74,$0.00
04.003.035S,SUP,HCPCS C1713,,04.003.035S  -  SCREW BN T25 6.5MM 125MM AU STRL ST BLNT TIP STRDR TI FEM,$437.63,$0.00,$437.63,$196.93,$312.33,$0.00,$73.20,$0.00,$0.00,$76.62,$437.63,$0.00,$218.81,$346.60,$350.10,$0.00,$66.49,$0.00,$69.67,$0.00
04.003.036,SUP,HCPCS C1713,,04.003.036  -  SCREW BONE 6.5MM 130MM TI FEM T25 STARDRIVE RECESS SLFTAP,$400.38,$0.00,$400.38,$180.17,$285.75,$0.00,$68.98,$0.00,$0.00,$70.10,$400.38,$0.00,$200.19,$317.10,$320.30,$0.00,$62.66,$0.00,$63.74,$0.00
04.003.036S,SUP,HCPCS C1713,,04.003.036S  -  SCREW BN T25 6.5MM 130MM AU STRL ST BLNT TIP STRDR TI FEM,$437.63,$0.00,$437.63,$196.93,$312.33,$0.00,$73.20,$0.00,$0.00,$76.62,$437.63,$0.00,$218.81,$346.60,$350.10,$0.00,$66.49,$0.00,$69.67,$0.00
04.003.240S,SUP,HCPCS C1713,,04.003.240S  -  NAIL INTRAMEDULLARY 9MM 300MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.241S,SUP,HCPCS C1713,,04.003.241S  -  NAIL INTRAMEDULLARY 9MM 300MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.244S,SUP,HCPCS C1713,,04.003.244S  -  NAIL INTRAMEDULLARY 9MM 320MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.245S,SUP,HCPCS C1713,,04.003.245S  -  NAIL INTRAMEDULLARY 9MM 320MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.248S,SUP,HCPCS C1713,,04.003.248S  -  NAIL INTRAMEDULLARY 9MM 340MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.249S,SUP,HCPCS C1713,,04.003.249S  -  NAIL INTRAMEDULLARY 9MM 340MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.252S,SUP,HCPCS C1713,,04.003.252S  -  NAIL INTRAMEDULLARY 9MM 360MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.253S,SUP,HCPCS C1713,,04.003.253S  -  NAIL INTRAMEDULLARY 9MM 360MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.256S,SUP,HCPCS C1713,,04.003.256S  -  NAIL INTRAMEDULLARY 9MM 380MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.257S,SUP,HCPCS C1713,,04.003.257S  -  NAIL INTRAMEDULLARY 9MM 380MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.260S,SUP,HCPCS C1713,,04.003.260S  -  NAIL INTRAMEDULLARY 9MM 400MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.261S,SUP,HCPCS C1713,,04.003.261S  -  NAIL INTRAMEDULLARY 9MM 400MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.264S,SUP,HCPCS C1713,,04.003.264S  -  NAIL INTRAMEDULLARY 9MM 420MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.265S,SUP,HCPCS C1713,,04.003.265S  -  NAIL INTRAMEDULLARY 9MM 420MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.268S,SUP,HCPCS C1713,,04.003.268S  -  NAIL INTRAMEDULLARY 9MM 440MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.269S,SUP,HCPCS C1713,,04.003.269S  -  NAIL INTRAMEDULLARY 9MM 440MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.272S,SUP,HCPCS C1713,,04.003.272S  -  NAIL INTRAMEDULLARY 9MM 460MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.273S,SUP,HCPCS C1713,,04.003.273S  -  NAIL INTRAMEDULLARY 9MM 460MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.276S,SUP,HCPCS C1713,,04.003.276S  -  NAIL INTRAMEDULLARY 9MM 480MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.277S,SUP,HCPCS C1713,,04.003.277S  -  NAIL INTRAMEDULLARY 9MM 480MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.340S,SUP,HCPCS C1713,,04.003.340S  -  NAIL INTRAMEDULLARY 10MM 300MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.341S,SUP,HCPCS C1713,,04.003.341S  -  NAIL INTRAMEDULLARY 10MM 300MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.344S,SUP,HCPCS C1713,,04.003.344S  -  NAIL INTRAMEDULLARY 10MM 320MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.345S,SUP,HCPCS C1713,,04.003.345S  -  NAIL INTRAMEDULLARY 10MM 320MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.348S,SUP,HCPCS C1713,,04.003.348S  -  NAIL INTRAMEDULLARY 10MM 340MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.349S,SUP,HCPCS C1713,,04.003.349S  -  NAIL INTRAMEDULLARY 10MM 340MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.352S,SUP,HCPCS C1713,,04.003.352S  -  NAIL INTRAMEDULLARY 10MM 360MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.353S,SUP,HCPCS C1713,,04.003.353S  -  NAIL INTRAMEDULLARY 10MM 360MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.356S,SUP,HCPCS C1713,,04.003.356S  -  NAIL INTRAMEDULLARY 10MM 380MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.357S,SUP,HCPCS C1713,,04.003.357S  -  NAIL INTRAMEDULLARY 10MM 380MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.360S,SUP,HCPCS C1713,,04.003.360S  -  NAIL INTRAMEDULLARY 10MM 400MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.361S,SUP,HCPCS C1713,,04.003.361S  -  NAIL INTRAMEDULLARY 10MM 400MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$654.06,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$594.10,$0.00,$484.76,$0.00
04.003.364S,SUP,HCPCS C1713,,04.003.364S  -  NAIL INTRAMEDULLARY 10MM 420MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.365S,SUP,HCPCS C1713,,04.003.365S  -  NAIL INTRAMEDULLARY 10MM 420MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.368S,SUP,HCPCS C1713,,04.003.368S  -  NAIL INTRAMEDULLARY 10MM 440MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.369S,SUP,HCPCS C1713,,04.003.369S  -  NAIL INTRAMEDULLARY 10MM 440MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.372S,SUP,HCPCS C1713,,04.003.372S  -  NAIL INTRAMEDULLARY 10MM 460MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.373S,SUP,HCPCS C1713,,04.003.373S  -  NAIL INTRAMEDULLARY 10MM 460MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.376S,SUP,HCPCS C1713,,04.003.376S  -  NAIL INTRAMEDULLARY 10MM 480MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.377S,SUP,HCPCS C1713,,04.003.377S  -  NAIL INTRAMEDULLARY 10MM 480MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.440S,SUP,HCPCS C1713,,04.003.440S  -  NAIL INTRAMEDULLARY 11MM 300MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.441S,SUP,HCPCS C1713,,04.003.441S  -  NAIL INTRAMEDULLARY 11MM 300MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.444S,SUP,HCPCS C1713,,04.003.444S  -  NAIL INTRAMEDULLARY 11MM 320MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.445S,SUP,HCPCS C1713,,04.003.445S  -  NAIL INTRAMEDULLARY 11MM 320MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.448S,SUP,HCPCS C1713,,04.003.448S  -  NAIL INTRAMEDULLARY 11MM 340MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.449S,SUP,HCPCS C1713,,04.003.449S  -  NAIL INTRAMEDULLARY 11MM 340MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.452S,SUP,HCPCS C1713,,04.003.452S  -  NAIL INTRAMEDULLARY 11MM 360MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.453S,SUP,HCPCS C1713,,04.003.453S  -  NAIL INTRAMEDULLARY 11MM 360MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.456S,SUP,HCPCS C1713,,04.003.456S  -  NAIL INTRAMEDULLARY 11MM 380MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.457S,SUP,HCPCS C1713,,04.003.457S  -  NAIL INTRAMEDULLARY 11MM 340MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.460S,SUP,HCPCS C1713,,04.003.460S  -  NAIL INTRAMEDULLARY 11MM 400MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.461S,SUP,HCPCS C1713,,04.003.461S  -  NAIL INTRAMEDULLARY 11MM 400MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.464S,SUP,HCPCS C1713,,04.003.464S  -  NAIL INTRAMEDULLARY 11MM 420MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.465S,SUP,HCPCS C1713,,04.003.465S  -  NAIL INTRAMEDULLARY 11MM 420MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.468S,SUP,HCPCS C1713,,04.003.468S  -  NAIL INTRAMEDULLARY 11MM 440MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.469S,SUP,HCPCS C1713,,04.003.469S  -  NAIL INTRAMEDULLARY 11MM 440MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.472S,SUP,HCPCS C1713,,04.003.472S  -  NAIL INTRAMEDULLARY 11MM 460MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.473S,SUP,HCPCS C1713,,04.003.473S  -  NAIL INTRAMEDULLARY 11MM 460MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.476S,SUP,HCPCS C1713,,04.003.476S  -  NAIL INTRAMEDULLARY 11MM 480MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.477S,SUP,HCPCS C1713,,04.003.477S  -  NAIL INTRAMEDULLARY 11MM 480MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.540S,SUP,HCPCS C1713,,04.003.540S  -  NAIL INTRAMEDULLARY 12MM 300MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.541S,SUP,HCPCS C1713,,04.003.541S  -  NAIL INTRAMEDULLARY 12MM 300MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.544S,SUP,HCPCS C1713,,04.003.544S  -  NAIL INTRAMEDULLARY 12MM 320MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.545S,SUP,HCPCS C1713,,04.003.545S  -  NAIL INTRAMEDULLARY 12MM 320MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.548S,SUP,HCPCS C1713,,04.003.548S  -  NAIL INTRAMEDULLARY 12MM 340MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.549S,SUP,HCPCS C1713,,04.003.549S  -  NAIL INTRAMEDULLARY 12MM 340MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.552S,SUP,HCPCS C1713,,04.003.552S  -  NAIL INTRAMEDULLARY 12MM 360MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.553S,SUP,HCPCS C1713,,04.003.553S  -  NAIL INTRAMEDULLARY 12MM 360MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.556S,SUP,HCPCS C1713,,04.003.556S  -  NAIL INTRAMEDULLARY 12MM 380MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.557S,SUP,HCPCS C1713,,04.003.557S  -  NAIL INTRAMEDULLARY 12MM 380MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.560S,SUP,HCPCS C1713,,04.003.560S  -  NAIL INTRAMEDULLARY 12MM 400MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.561S,SUP,HCPCS C1713,,04.003.561S  -  NAIL INTRAMEDULLARY 12MM 400MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.564S,SUP,HCPCS C1713,,04.003.564S  -  NAIL INTRAMEDULLARY 12MM 420MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.565S,SUP,HCPCS C1713,,04.003.565S  -  NAIL INTRAMEDULLARY 12MM 420MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.568S,SUP,HCPCS C1713,,04.003.568S  -  NAIL INTRAMEDULLARY 12MM 440MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.569S,SUP,HCPCS C1713,,04.003.569S  -  NAIL INTRAMEDULLARY 12MM 440MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.572S,SUP,HCPCS C1713,,04.003.572S  -  NAIL INTRAMEDULLARY 12MM 460MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.573S,SUP,HCPCS C1713,,04.003.573S  -  NAIL INTRAMEDULLARY 12MM 460MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.576S,SUP,HCPCS C1713,,04.003.576S  -  NAIL INTRAMEDULLARY 12MM 480MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.577S,SUP,HCPCS C1713,,04.003.577S  -  NAIL INTRAMEDULLARY 12MM 480MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.640S,SUP,HCPCS C1713,,04.003.640S  -  NAIL INTRAMEDULLARY 13MM 300MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.641S,SUP,HCPCS C1713,,04.003.641S  -  NAIL INTRAMEDULLARY 13MM 300MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.644S,SUP,HCPCS C1713,,04.003.644S  -  NAIL INTRAMEDULLARY 13MM 320MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.645S,SUP,HCPCS C1713,,04.003.645S  -  NAIL INTRAMEDULLARY 13MM 320MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.648S,SUP,HCPCS C1713,,04.003.648S  -  NAIL INTRAMEDULLARY 13MM 340MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.649S,SUP,HCPCS C1713,,04.003.649S  -  NAIL INTRAMEDULLARY 13MM 340MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.652S,SUP,HCPCS C1713,,04.003.652S  -  NAIL INTRAMEDULLARY 13MM 360MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.653S,SUP,HCPCS C1713,,04.003.653S  -  NAIL INTRAMEDULLARY 13MM 360MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.656S,SUP,HCPCS C1713,,04.003.656S  -  NAIL INTRAMEDULLARY 13MM 380MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.657S,SUP,HCPCS C1713,,04.003.657S  -  NAIL INTRAMEDULLARY 13MM 380MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.660S,SUP,HCPCS C1713,,04.003.660S  -  NAIL INTRAMEDULLARY 13MM 400MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.661S,SUP,HCPCS C1713,,04.003.661S  -  NAIL INTRAMEDULLARY 13MM 400MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.664S,SUP,HCPCS C1713,,04.003.664S  -  NAIL INTRAMEDULLARY 13MM 420MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.665S,SUP,HCPCS C1713,,04.003.665S  -  NAIL INTRAMEDULLARY 13MM 420MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.668S,SUP,HCPCS C1713,,04.003.668S  -  NAIL INTRAMEDULLARY 13MM 440MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.669S,SUP,HCPCS C1713,,04.003.669S  -  NAIL INTRAMEDULLARY 13MM 440MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.672S,SUP,HCPCS C1713,,04.003.672S  -  NAIL INTRAMEDULLARY 13MM 460MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.673S,SUP,HCPCS C1713,,04.003.673S  -  NAIL INTRAMEDULLARY 13MM 460MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.676S,SUP,HCPCS C1713,,04.003.676S  -  NAIL INTRAMEDULLARY 13MM 480MM ANATOMIC CANN HELICAL FLUTED,"$3,044.95",$0.00,"$3,044.95","$1,370.23","$2,173.18",$0.00,$509.35,$0.00,$0.00,$533.15,"$3,044.95",$0.00,"$1,522.48","$2,411.60","$2,435.96",$0.00,$462.65,$0.00,$484.76,$0.00
04.003.677S,SUP,HCPCS C1713,,04.003.677S  -  NAIL INTRAMEDULLARY 13MM 480MM ANATOMIC CANN HELICAL FLUTED,"$3,148.33",$0.00,"$3,148.33","$1,416.75","$2,246.96",$0.00,$526.64,$0.00,$0.00,$551.25,"$3,148.33",$0.00,"$1,574.16","$2,493.48","$2,518.66",$0.00,$478.36,$0.00,$501.21,$0.00
04.003.740S,SUP,HCPCS C1713,,04.003.740S  -  NAIL INTRAMEDULLARY 14MM 300MM ANATOMIC CANN HELICAL FLUTED,"$3,243.23",$0.00,"$3,243.23","$1,459.45","$2,314.69",$0.00,$542.51,$0.00,$0.00,$567.86,"$3,243.23",$0.00,"$1,621.61","$2,568.64","$2,594.58",$0.00,$492.78,$0.00,$516.32,$0.00
04.003.741S,SUP,HCPCS C1713,,04.003.741S  -  NAIL INTRAMEDULLARY 14MM 300MM ANATOMIC CANN HELICAL FLUTED,"$3,243.23",$0.00,"$3,243.23","$1,459.45","$2,314.69",$0.00,$542.51,$0.00,$0.00,$567.86,"$3,243.23",$0.00,"$1,621.61","$2,568.64","$2,594.58",$0.00,$492.78,$0.00,$516.32,$0.00
04.003.744S,SUP,HCPCS C1713,,04.003.744S  -  NAIL INTRAMEDULLARY 14MM 320MM ANATOMIC CANN HELICAL FLUTED,"$3,243.23",$0.00,"$3,243.23","$1,459.45","$2,314.69",$0.00,$542.51,$0.00,$0.00,$567.86,"$3,243.23",$0.00,"$1,621.61","$2,568.64","$2,594.58",$0.00,$492.78,$0.00,$516.32,$0.00
04.003.745S,SUP,HCPCS C1713,,04.003.745S  -  NAIL INTRAMEDULLARY 14MM 320MM ANATOMIC CANN HELICAL FLUTED,"$3,243.23",$0.00,"$3,243.23","$1,459.45","$2,314.69",$0.00,$542.51,$0.00,$0.00,$567.86,"$3,243.23",$0.00,"$1,621.61","$2,568.64","$2,594.58",$0.00,$492.78,$0.00,$516.32,$0.00
04.003.748S,SUP,HCPCS C1713,,04.003.748S  -  NAIL INTRAMEDULLARY 14MM 340MM ANATOMIC CANN HELICAL FLUTED,"$3,243.23",$0.00,"$3,243.23","$1,459.45","$2,314.69",$0.00,$542.51,$0.00,$0.00,$567.86,"$3,243.23",$0.00,"$1,621.61","$2,568.64","$2,594.58",$0.00,$492.78,$0.00,$516.32,$0.00
04.003.749S,SUP,HCPCS C1713,,04.003.749S  -  NAIL INTRAMEDULLARY 14MM 340MM ANATOMIC CANN HELICAL FLUTED,"$3,243.23",$0.00,"$3,243.23","$1,459.45","$2,314.69",$0.00,$542.51,$0.00,$0.00,$567.86,"$3,243.23",$0.00,"$1,621.61","$2,568.64","$2,594.58",$0.00,$492.78,$0.00,$516.32,$0.00
04.003.752S,SUP,HCPCS C1713,,04.003.752S  -  NAIL INTRAMEDULLARY 14MM 360MM ANATOMIC CANN HELICAL FLUTED,"$3,243.23",$0.00,"$3,243.23","$1,459.45","$2,314.69",$0.00,$542.51,$0.00,$0.00,$567.86,"$3,243.23",$0.00,"$1,621.61","$2,568.64","$2,594.58",$0.00,$492.78,$0.00,$516.32,$0.00
04.003.753S,SUP,HCPCS C1713,,04.003.753S  -  NAIL INTRAMEDULLARY 14MM 360MM ANATOMIC CANN HELICAL FLUTED,"$3,243.23",$0.00,"$3,243.23","$1,459.45","$2,314.69",$0.00,$542.51,$0.00,$0.00,$567.86,"$3,243.23",$0.00,"$1,621.61","$2,568.64","$2,594.58",$0.00,$492.78,$0.00,$516.32,$0.00
04.003.756S,SUP,HCPCS C1713,,04.003.756S  -  NAIL INTRAMEDULLARY 14MM 380MM ANATOMIC CANN HELICAL FLUTED,"$3,243.23",$0.00,"$3,243.23","$1,459.45","$2,314.69",$0.00,$542.51,$0.00,$0.00,$567.86,"$3,243.23",$0.00,"$1,621.61","$2,568.64","$2,594.58",$0.00,$492.78,$0.00,$516.32,$0.00
04.003.757S,SUP,HCPCS C1713,,04.003.757S  -  NAIL INTRAMEDULLARY 14MM 380MM ANATOMIC CANN HELICAL FLUTED,"$3,243.23",$0.00,"$3,243.23","$1,459.45","$2,314.69",$0.00,$542.51,$0.00,$0.00,$567.86,"$3,243.23",$0.00,"$1,621.61","$2,568.64","$2,594.58",$0.00,$492.78,$0.00,$516.32,$0.00
04.003.760S,SUP,HCPCS C1713,,04.003.760S  -  NAIL INTRAMEDULLARY 14MM 400MM ANATOMIC CANN HELICAL FLUTED,"$3,243.23",$0.00,"$3,243.23","$1,459.45","$2,314.69",$0.00,$542.51,$0.00,$0.00,$567.86,"$3,243.23",$0.00,"$1,621.61","$2,568.64","$2,594.58",$0.00,$492.78,$0.00,$516.32,$0.00
04.003.761S,SUP,HCPCS C1713,,04.003.761S  -  NAIL INTRAMEDULLARY 14MM 400MM ANATOMIC CANN HELICAL FLUTED,"$3,243.23",$0.00,"$3,243.23","$1,459.45","$2,314.69",$0.00,$542.51,$0.00,$0.00,$567.86,"$3,243.23",$0.00,"$1,621.61","$2,568.64","$2,594.58",$0.00,$492.78,$0.00,$516.32,$0.00
04.003.764S,SUP,HCPCS C1713,,04.003.764S  -  NAIL INTRAMEDULLARY 14MM 420MM ANATOMIC CANN HELICAL FLUTED,"$3,243.23",$0.00,"$3,243.23","$1,459.45","$2,314.69",$0.00,$542.51,$0.00,$0.00,$567.86,"$3,243.23",$0.00,"$1,621.61","$2,568.64","$2,594.58",$0.00,$492.78,$0.00,$516.32,$0.00
04.003.765S,SUP,HCPCS C1713,,04.003.765S  -  NAIL INTRAMEDULLARY 14MM 420MM ANATOMIC CANN HELICAL FLUTED,"$3,243.23",$0.00,"$3,243.23","$1,459.45","$2,314.69",$0.00,$542.51,$0.00,$0.00,$567.86,"$3,243.23",$0.00,"$1,621.61","$2,568.64","$2,594.58",$0.00,$492.78,$0.00,$516.32,$0.00
04.003.768S,SUP,HCPCS C1713,,04.003.768S  -  NAIL INTRAMEDULLARY 14MM 440MM ANATOMIC CANN HELICAL FLUTED,"$3,243.23",$0.00,"$3,243.23","$1,459.45","$2,314.69",$0.00,$542.51,$0.00,$0.00,$567.86,"$3,243.23",$0.00,"$1,621.61","$2,568.64","$2,594.58",$0.00,$492.78,$0.00,$516.32,$0.00
04.003.769S,SUP,HCPCS C1713,,04.003.769S  -  NAIL INTRAMEDULLARY 14MM 440MM ANATOMIC CANN HELICAL FLUTED,"$3,243.23",$0.00,"$3,243.23","$1,459.45","$2,314.69",$0.00,$542.51,$0.00,$0.00,$567.86,"$3,243.23",$0.00,"$1,621.61","$2,568.64","$2,594.58",$0.00,$492.78,$0.00,$516.32,$0.00
04.003.772S,SUP,HCPCS C1713,,04.003.772S  -  NAIL INTRAMEDULLARY 14MM 460MM ANATOMIC CANN HELICAL FLUTED,"$3,243.23",$0.00,"$3,243.23","$1,459.45","$2,314.69",$0.00,$542.51,$0.00,$0.00,$567.86,"$3,243.23",$0.00,"$1,621.61","$2,568.64","$2,594.58",$0.00,$492.78,$0.00,$516.32,$0.00
04.003.773S,SUP,HCPCS C1713,,04.003.773S  -  NAIL INTRAMEDULLARY 14MM 460MM ANATOMIC CANN HELICAL FLUTED,"$3,243.23",$0.00,"$3,243.23","$1,459.45","$2,314.69",$0.00,$542.51,$0.00,$0.00,$567.86,"$3,243.23",$0.00,"$1,621.61","$2,568.64","$2,594.58",$0.00,$492.78,$0.00,$516.32,$0.00
04.003.776S,SUP,HCPCS C1713,,04.003.776S  -  NAIL INTRAMEDULLARY 14MM 480MM ANATOMIC CANN HELICAL FLUTED,"$3,243.23",$0.00,"$3,243.23","$1,459.45","$2,314.69",$0.00,$542.51,$0.00,$0.00,$567.86,"$3,243.23",$0.00,"$1,621.61","$2,568.64","$2,594.58",$0.00,$492.78,$0.00,$516.32,$0.00
04.003.777S,SUP,HCPCS C1713,,04.003.777S  -  NAIL INTRAMEDULLARY 14MM 480MM ANATOMIC CANN HELICAL FLUTED,"$3,243.23",$0.00,"$3,243.23","$1,459.45","$2,314.69",$0.00,$542.51,$0.00,$0.00,$567.86,"$3,243.23",$0.00,"$1,621.61","$2,568.64","$2,594.58",$0.00,$492.78,$0.00,$516.32,$0.00
04.003.840S,SUP,HCPCS C1713,,04.003.840S  -  NAIL INTRAMEDULLARY 15MM 300MM ANATOMIC CANN HELICAL FLUTED,"$3,243.23",$0.00,"$3,243.23","$1,459.45","$2,314.69",$0.00,$542.51,$0.00,$0.00,$567.86,"$3,243.23",$0.00,"$1,621.61","$2,568.64","$2,594.58",$0.00,$492.78,$0.00,$516.32,$0.00
04.003.841S,SUP,HCPCS C1713,,04.003.841S  -  NAIL INTRAMEDULLARY 15MM 300MM ANATOMIC CANN HELICAL FLUTED,"$3,243.23",$0.00,"$3,243.23","$1,459.45","$2,314.69",$0.00,$542.51,$0.00,$0.00,$567.86,"$3,243.23",$0.00,"$1,621.61","$2,568.64","$2,594.58",$0.00,$492.78,$0.00,$516.32,$0.00
04.003.844S,SUP,HCPCS C1713,,04.003.844S  -  NAIL INTRAMEDULLARY 15MM 320MM ANATOMIC CANN HELICAL FLUTED,"$3,243.23",$0.00,"$3,243.23","$1,459.45","$2,314.69",$0.00,$542.51,$0.00,$0.00,$567.86,"$3,243.23",$0.00,"$1,621.61","$2,568.64","$2,594.58",$0.00,$492.78,$0.00,$516.32,$0.00
04.003.845S,SUP,HCPCS C1713,,04.003.845S  -  NAIL INTRAMEDULLARY 15MM 320MM ANATOMIC CANN HELICAL FLUTED,"$3,243.23",$0.00,"$3,243.23","$1,459.45","$2,314.69",$0.00,$542.51,$0.00,$0.00,$567.86,"$3,243.23",$0.00,"$1,621.61","$2,568.64","$2,594.58",$0.00,$492.78,$0.00,$516.32,$0.00
04.003.848S,SUP,HCPCS C1713,,04.003.848S  -  NAIL INTRAMEDULLARY 15MM 340MM ANATOMIC CANN HELICAL FLUTED,"$3,243.23",$0.00,"$3,243.23","$1,459.45","$2,314.69",$0.00,$542.51,$0.00,$0.00,$567.86,"$3,243.23",$0.00,"$1,621.61","$2,568.64","$2,594.58",$0.00,$492.78,$0.00,$516.32,$0.00
04.003.849S,SUP,HCPCS C1713,,04.003.849S  -  NAIL INTRAMEDULLARY 15MM 340MM RECONSTRUCTION ANATOMIC CANN,"$3,243.23",$0.00,"$3,243.23","$1,459.45","$2,314.69",$0.00,$542.51,$0.00,$0.00,$567.86,"$3,243.23",$0.00,"$1,621.61","$2,568.64","$2,594.58",$0.00,$492.78,$0.00,$516.32,$0.00
04.003.852S,SUP,HCPCS C1713,,04.003.852S  -  NAIL INTRAMEDULLARY 15MM 360MM ANATOMIC CANN HELICAL FLUTED,"$3,243.23",$0.00,"$3,243.23","$1,459.45","$2,314.69",$0.00,$542.51,$0.00,$0.00,$567.86,"$3,243.23",$0.00,"$1,621.61","$2,568.64","$2,594.58",$0.00,$492.78,$0.00,$516.32,$0.00
04.003.853S,SUP,HCPCS C1713,,04.003.853S  -  NAIL INTRAMEDULLARY 15MM 360MM ANATOMIC CANN HELICAL FLUTED,"$3,243.23",$0.00,"$3,243.23","$1,459.45","$2,314.69",$0.00,$542.51,$0.00,$0.00,$567.86,"$3,243.23",$0.00,"$1,621.61","$2,568.64","$2,594.58",$0.00,$492.78,$0.00,$516.32,$0.00
04.003.856S,SUP,HCPCS C1713,,04.003.856S  -  NAIL INTRAMEDULLARY 15MM 380MM ANATOMIC CANN HELICAL FLUTED,"$3,243.23",$0.00,"$3,243.23","$1,459.45","$2,314.69",$0.00,$542.51,$0.00,$0.00,$567.86,"$3,243.23",$0.00,"$1,621.61","$2,568.64","$2,594.58",$0.00,$492.78,$0.00,$516.32,$0.00
04.003.857S,SUP,HCPCS C1713,,04.003.857S  -  NAIL INTRAMEDULLARY 15MM 380MM ANATOMIC CANN HELICAL FLUTED,"$3,243.23",$0.00,"$3,243.23","$1,459.45","$2,314.69",$0.00,$542.51,$0.00,$0.00,$567.86,"$3,243.23",$0.00,"$1,621.61","$2,568.64","$2,594.58",$0.00,$492.78,$0.00,$516.32,$0.00
04.003.860S,SUP,HCPCS C1713,,04.003.860S  -  NAIL INTRAMEDULLARY 15MM 400MM ANATOMIC CANN HELICAL FLUTED,"$3,243.23",$0.00,"$3,243.23","$1,459.45","$2,314.69",$0.00,$542.51,$0.00,$0.00,$567.86,"$3,243.23",$0.00,"$1,621.61","$2,568.64","$2,594.58",$0.00,$492.78,$0.00,$516.32,$0.00
04.003.861S,SUP,HCPCS C1713,,04.003.861S  -  NAIL INTRAMEDULLARY 15MM 400MM ANATOMIC CANN HELICAL FLUTED,"$3,243.23",$0.00,"$3,243.23","$1,459.45","$2,314.69",$0.00,$542.51,$0.00,$0.00,$567.86,"$3,243.23",$0.00,"$1,621.61","$2,568.64","$2,594.58",$0.00,$492.78,$0.00,$516.32,$0.00
04.003.864S,SUP,HCPCS C1713,,04.003.864S  -  NAIL INTRAMEDULLARY 15MM 420MM ANATOMIC CANN HELICAL FLUTED,"$3,243.23",$0.00,"$3,243.23","$1,459.45","$2,314.69",$0.00,$542.51,$0.00,$0.00,$567.86,"$3,243.23",$0.00,"$1,621.61","$2,568.64","$2,594.58",$0.00,$492.78,$0.00,$516.32,$0.00
04.003.865S,SUP,HCPCS C1713,,04.003.865S  -  NAIL INTRAMEDULLARY 15MM 420MM ANATOMIC CANN HELICAL FLUTED,"$3,243.23",$0.00,"$3,243.23","$1,459.45","$2,314.69",$0.00,$542.51,$0.00,$0.00,$567.86,"$3,243.23",$0.00,"$1,621.61","$2,568.64","$2,594.58",$0.00,$492.78,$0.00,$516.32,$0.00
04.003.868S,SUP,HCPCS C1713,,04.003.868S  -  NAIL INTRAMEDULLARY 15MM 440MM ANATOMIC CANN HELICAL FLUTED,"$3,243.23",$0.00,"$3,243.23","$1,459.45","$2,314.69",$0.00,$542.51,$0.00,$0.00,$567.86,"$3,243.23",$0.00,"$1,621.61","$2,568.64","$2,594.58",$0.00,$492.78,$0.00,$516.32,$0.00
04.003.869S,SUP,HCPCS C1713,,04.003.869S  -  NAIL INTRAMEDULLARY 15MM 440MM ANATOMIC CANN HELICAL FLUTED,"$3,243.23",$0.00,"$3,243.23","$1,459.45","$2,314.69",$0.00,$542.51,$0.00,$0.00,$567.86,"$3,243.23",$0.00,"$1,621.61","$2,568.64","$2,594.58",$0.00,$492.78,$0.00,$516.32,$0.00
04.003.872S,SUP,HCPCS C1713,,04.003.872S  -  NAIL INTRAMEDULLARY 15MM 460MM ANATOMIC CANN HELICAL FLUTED,"$3,243.23",$0.00,"$3,243.23","$1,459.45","$2,314.69",$0.00,$542.51,$0.00,$0.00,$567.86,"$3,243.23",$0.00,"$1,621.61","$2,568.64","$2,594.58",$0.00,$492.78,$0.00,$516.32,$0.00
04.003.873S,SUP,HCPCS C1713,,04.003.873S  -  NAIL INTRAMEDULLARY 15MM 460MM ANATOMIC CANN HELICAL FLUTED,"$3,243.23",$0.00,"$3,243.23","$1,459.45","$2,314.69",$0.00,$542.51,$0.00,$0.00,$567.86,"$3,243.23",$0.00,"$1,621.61","$2,568.64","$2,594.58",$0.00,$492.78,$0.00,$516.32,$0.00
04.003.876S,SUP,HCPCS C1713,,04.003.876S  -  NAIL INTRAMEDULLARY 15MM 480MM ANATOMIC CANN HELICAL FLUTED,"$3,243.23",$0.00,"$3,243.23","$1,459.45","$2,314.69",$0.00,$542.51,$0.00,$0.00,$567.86,"$3,243.23",$0.00,"$1,621.61","$2,568.64","$2,594.58",$0.00,$492.78,$0.00,$516.32,$0.00
04.003.877S,SUP,HCPCS C1713,,04.003.877S  -  NAIL INTRAMEDULLARY 15MM 480MM ANATOMIC CANN HELICAL FLUTED,"$3,243.23",$0.00,"$3,243.23","$1,459.45","$2,314.69",$0.00,$542.51,$0.00,$0.00,$567.86,"$3,243.23",$0.00,"$1,621.61","$2,568.64","$2,594.58",$0.00,$492.78,$0.00,$516.32,$0.00
04.003.940S,SUP,HCPCS C1713,,04.003.940S  -  NAIL INTRAMEDULLARY 16MM 300MM ANATOMIC CANN HELICAL FLUTED,"$3,243.23",$0.00,"$3,243.23","$1,459.45","$2,314.69",$0.00,$542.51,$0.00,$0.00,$567.86,"$3,243.23",$0.00,"$1,621.61","$2,568.64","$2,594.58",$0.00,$492.78,$0.00,$516.32,$0.00
04.003.941S,SUP,HCPCS C1713,,04.003.941S  -  NAIL INTRAMEDULLARY 16MM 300MM ANATOMIC CANN HELICAL FLUTED,"$3,243.23",$0.00,"$3,243.23","$1,459.45","$2,314.69",$0.00,$542.51,$0.00,$0.00,$567.86,"$3,243.23",$0.00,"$1,621.61","$2,568.64","$2,594.58",$0.00,$492.78,$0.00,$516.32,$0.00
04.003.944S,SUP,HCPCS C1713,,04.003.944S  -  NAIL INTRAMEDULLARY 16MM 320MM ANATOMIC CANN HELICAL FLUTED,"$3,243.23",$0.00,"$3,243.23","$1,459.45","$2,314.69",$0.00,$542.51,$0.00,$0.00,$567.86,"$3,243.23",$0.00,"$1,621.61","$2,568.64","$2,594.58",$0.00,$492.78,$0.00,$516.32,$0.00
04.003.945S,SUP,HCPCS C1713,,04.003.945S  -  NAIL INTRAMEDULLARY 16MM 320MM ANATOMIC CANN HELICAL FLUTED,"$3,243.23",$0.00,"$3,243.23","$1,459.45","$2,314.69",$0.00,$542.51,$0.00,$0.00,$567.86,"$3,243.23",$0.00,"$1,621.61","$2,568.64","$2,594.58",$0.00,$492.78,$0.00,$516.32,$0.00
04.003.948S,SUP,HCPCS C1713,,04.003.948S  -  NAIL INTRAMEDULLARY 16MM 340MM ANATOMIC CANN HELICAL FLUTED,"$3,243.23",$0.00,"$3,243.23","$1,459.45","$2,314.69",$0.00,$542.51,$0.00,$0.00,$567.86,"$3,243.23",$0.00,"$1,621.61","$2,568.64","$2,594.58",$0.00,$492.78,$0.00,$516.32,$0.00
04.003.949S,SUP,HCPCS C1713,,04.003.949S  -  NAIL INTRAMEDULLARY 16MM 340MM ANATOMIC CANN HELICAL FLUTED,"$3,243.23",$0.00,"$3,243.23","$1,459.45","$2,314.69",$0.00,$542.51,$0.00,$0.00,$567.86,"$3,243.23",$0.00,"$1,621.61","$2,568.64","$2,594.58",$0.00,$492.78,$0.00,$516.32,$0.00
04.003.952S,SUP,HCPCS C1713,,04.003.952S  -  NAIL INTRAMEDULLARY 16MM 360MM ANATOMIC CANN HELICAL FLUTED,"$3,243.23",$0.00,"$3,243.23","$1,459.45","$2,314.69",$0.00,$542.51,$0.00,$0.00,$567.86,"$3,243.23",$0.00,"$1,621.61","$2,568.64","$2,594.58",$0.00,$492.78,$0.00,$516.32,$0.00
04.003.953S,SUP,HCPCS C1713,,04.003.953S  -  NAIL INTRAMEDULLARY 16MM 360MM ANATOMIC CANN HELICAL FLUTED,"$3,243.23",$0.00,"$3,243.23","$1,459.45","$2,314.69",$0.00,$542.51,$0.00,$0.00,$567.86,"$3,243.23",$0.00,"$1,621.61","$2,568.64","$2,594.58",$0.00,$492.78,$0.00,$516.32,$0.00
04.003.956S,SUP,HCPCS C1713,,04.003.956S  -  NAIL INTRAMEDULLARY 16MM 380MM ANATOMIC CANN HELICAL FLUTED,"$3,243.23",$0.00,"$3,243.23","$1,459.45","$2,314.69",$0.00,$542.51,$0.00,$0.00,$567.86,"$3,243.23",$0.00,"$1,621.61","$2,568.64","$2,594.58",$0.00,$492.78,$0.00,$516.32,$0.00
04.003.957S,SUP,HCPCS C1713,,04.003.957S  -  NAIL INTRAMEDULLARY 16MM 380MM ANATOMIC CANN HELICAL FLUTED,"$3,243.23",$0.00,"$3,243.23","$1,459.45","$2,314.69",$0.00,$542.51,$0.00,$0.00,$567.86,"$3,243.23",$0.00,"$1,621.61","$2,568.64","$2,594.58",$0.00,$492.78,$0.00,$516.32,$0.00
04.003.960S,SUP,HCPCS C1713,,04.003.960S  -  NAIL INTRAMEDULLARY 16MM 400MM ANATOMIC CANN HELICAL FLUTED,"$3,243.23",$0.00,"$3,243.23","$1,459.45","$2,314.69",$0.00,$542.51,$0.00,$0.00,$567.86,"$3,243.23",$0.00,"$1,621.61","$2,568.64","$2,594.58",$0.00,$492.78,$0.00,$516.32,$0.00
04.003.961S,SUP,HCPCS C1713,,04.003.961S  -  NAIL INTRAMEDULLARY 16MM 400MM ANATOMIC CANN HELICAL FLUTED,"$3,243.23",$0.00,"$3,243.23","$1,459.45","$2,314.69",$0.00,$542.51,$0.00,$0.00,$567.86,"$3,243.23",$0.00,"$1,621.61","$2,568.64","$2,594.58",$0.00,$492.78,$0.00,$516.32,$0.00
04.003.964S,SUP,HCPCS C1713,,04.003.964S  -  NAIL INTRAMEDULLARY 16MM 420MM ANATOMIC CANN HELICAL FLUTED,"$3,243.23",$0.00,"$3,243.23","$1,459.45","$2,314.69",$0.00,$542.51,$0.00,$0.00,$567.86,"$3,243.23",$0.00,"$1,621.61","$2,568.64","$2,594.58",$0.00,$492.78,$0.00,$516.32,$0.00
04.003.965S,SUP,HCPCS C1713,,04.003.965S  -  NAIL INTRAMEDULLARY 16MM 420MM ANATOMIC CANN HELICAL FLUTED,"$3,243.23",$0.00,"$3,243.23","$1,459.45","$2,314.69",$0.00,$542.51,$0.00,$0.00,$567.86,"$3,243.23",$0.00,"$1,621.61","$2,568.64","$2,594.58",$0.00,$492.78,$0.00,$516.32,$0.00
04.003.968S,SUP,HCPCS C1713,,04.003.968S  -  NAIL INTRAMEDULLARY 16MM 440MM CANN LATERAL ENTRY,"$3,243.23",$0.00,"$3,243.23","$1,459.45","$2,314.69",$0.00,$542.51,$0.00,$0.00,$567.86,"$3,243.23",$0.00,"$1,621.61","$2,568.64","$2,594.58",$0.00,$492.78,$0.00,$516.32,$0.00
04.003.969S,SUP,HCPCS C1713,,04.003.969S  -  NAIL INTRAMEDULLARY 16MM 440MM ANATOMIC CANN HELICAL FLUTED,"$3,243.23",$0.00,"$3,243.23","$1,459.45","$2,314.69",$0.00,$542.51,$0.00,$0.00,$567.86,"$3,243.23",$0.00,"$1,621.61","$2,568.64","$2,594.58",$0.00,$492.78,$0.00,$516.32,$0.00
04.003.972S,SUP,HCPCS C1713,,04.003.972S  -  NAIL INTRAMEDULLARY 16MM 460MM ANATOMIC CANN HELICAL FLUTED,"$3,243.23",$0.00,"$3,243.23","$1,459.45","$2,314.69",$0.00,$542.51,$0.00,$0.00,$567.86,"$3,243.23",$0.00,"$1,621.61","$2,568.64","$2,594.58",$0.00,$492.78,$0.00,$516.32,$0.00
04.003.973S,SUP,HCPCS C1713,,04.003.973S  -  NAIL INTRAMEDULLARY 16MM 460MM ANATOMIC CANN HELICAL FLUTED,"$3,243.23",$0.00,"$3,243.23","$1,459.45","$2,314.69",$0.00,$542.51,$0.00,$0.00,$567.86,"$3,243.23",$0.00,"$1,621.61","$2,568.64","$2,594.58",$0.00,$492.78,$0.00,$516.32,$0.00
04.003.976S,SUP,HCPCS C1713,,04.003.976S  -  NAIL INTRAMEDULLARY 16MM 480MM ANATOMIC CANN HELICAL FLUTED,"$3,243.23",$0.00,"$3,243.23","$1,459.45","$2,314.69",$0.00,$542.51,$0.00,$0.00,$567.86,"$3,243.23",$0.00,"$1,621.61","$2,568.64","$2,594.58",$0.00,$492.78,$0.00,$516.32,$0.00
04.003.977S,SUP,HCPCS C1713,,04.003.977S  -  NAIL INTRAMEDULLARY 16MM 480MM ANATOMIC CANN HELICAL FLUTED,"$3,243.23",$0.00,"$3,243.23","$1,459.45","$2,314.69",$0.00,$542.51,$0.00,$0.00,$567.86,"$3,243.23",$0.00,"$1,621.61","$2,568.64","$2,594.58",$0.00,$492.78,$0.00,$516.32,$0.00
04.004.000S,SUP,Custom 27803010,,04.004.000S  -  CAP END 5MM T40 STARDRIVE RECESS EXTENDED NAIL-EX GOLD,$402.23,$0.00,$402.23,$0.00,$287.07,$0.00,$0.00,$0.00,$0.00,$0.00,$402.23,$0.00,$201.11,$318.57,$321.78,$0.00,$0.00,$0.00,$0.00,$0.00
04.004.001S,SUP,Custom 27803010,,04.004.001S  -  CAP END 5MM STARDRIVE T40 RECESS EXTENDED EXPERT GOLD,$490.03,$0.00,$490.03,$0.00,$349.73,$0.00,$0.00,$0.00,$0.00,$0.00,$490.03,$0.00,$245.01,$388.10,$392.02,$0.00,$0.00,$0.00,$0.00,$0.00
04.004.002S,SUP,Custom 27803010,,04.004.002S  -  CAP END 10MM EXTN T40 STARDRIVE RECESS EXPERT GOLD TITANIUM,$490.03,$0.00,$490.03,$0.00,$349.73,$0.00,$0.00,$0.00,$0.00,$0.00,$490.03,$0.00,$245.01,$388.10,$392.02,$0.00,$0.00,$0.00,$0.00,$0.00
04.004.003S,SUP,Custom 27803010,,04.004.003S  -  CAP END 15MM EXTN T40 STARDRIVE RECESS EXPERT GOLD TITANIUM,$490.03,$0.00,$490.03,$0.00,$349.73,$0.00,$0.00,$0.00,$0.00,$0.00,$490.03,$0.00,$245.01,$388.10,$392.02,$0.00,$0.00,$0.00,$0.00,$0.00
04.004.008S,SUP,Custom 27803010,,04.004.008S  -  CAP END 0MM T40 STARDRIVE RECESS EXTENDED NAIL-EX GRAY,$402.23,$0.00,$402.23,$0.00,$287.07,$0.00,$0.00,$0.00,$0.00,$0.00,$402.23,$0.00,$201.11,$318.57,$321.78,$0.00,$0.00,$0.00,$0.00,$0.00
04.004.009S,SUP,Custom 27803010,,04.004.009S  -  CAP END 5MM EXTENDED T40 STARDRIVE RECESS LOCKING HOLE,$490.03,$0.00,$490.03,$0.00,$349.73,$0.00,$0.00,$0.00,$0.00,$0.00,$490.03,$0.00,$245.01,$388.10,$392.02,$0.00,$0.00,$0.00,$0.00,$0.00
04.004.010S,SUP,Custom 27803010,,04.004.010S  -  CAP END 10MM EXTENDED T40 STARDRIVE RECESS LOCKING HOLE,$490.03,$0.00,$490.03,$0.00,$349.73,$0.00,$0.00,$0.00,$0.00,$0.00,$490.03,$0.00,$245.01,$388.10,$392.02,$0.00,$0.00,$0.00,$0.00,$0.00
04.004.011S,SUP,Custom 27803010,,04.004.011S  -  CAP END 15MM EXTN T40 STARDRIVE RECESS EXPERT GRAY TITANIUM,$490.03,$0.00,$490.03,$0.00,$349.73,$0.00,$0.00,$0.00,$0.00,$0.00,$490.03,$0.00,$245.01,$388.10,$392.02,$0.00,$0.00,$0.00,$0.00,$0.00
04.004.231S,SUP,HCPCS C1713,,04.004.231S  -  NAIL INTRAMEDULLARY 8MM 25.5CM CANN NAIL-EX TITANIUM TIBIA,"$2,928.80",$0.00,"$2,928.80","$1,317.96","$2,090.28",$0.00,$489.92,$0.00,$0.00,$512.81,"$2,928.80",$0.00,"$1,464.40","$2,319.61","$2,343.04",$0.00,$445.01,$0.00,$466.26,$0.00
04.004.234S,SUP,HCPCS C1713,,04.004.234S  -  NAIL INTRAMEDULLARY UNIVERSAL 8MM 270MM CANN ROUND BARREL,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.004.237S,SUP,HCPCS C1713,,04.004.237S  -  NAIL INTRAMEDULLARY UNIVERSAL 8MM 285MM CANN ROUND BARREL,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.004.240S,SUP,HCPCS C1713,,04.004.240S  -  NAIL INTRAMEDULLARY UNIVERSAL 8MM 300MM CANN ROUND BARREL,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.004.243S,SUP,HCPCS C1713,,04.004.243S  -  NAIL INTRAMEDULLARY UNIVERSAL 8MM 315MM CANN ROUND BARREL,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.004.246S,SUP,HCPCS C1713,,04.004.246S  -  NAIL INTRAMEDULLARY UNIVERSAL 8MM 330MM CANN ROUND BARREL,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.004.249S,SUP,HCPCS C1713,,04.004.249S  -  NAIL INTRAMEDULLARY UNIVERSAL 8MM 345MM CANN ROUND BARREL,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.004.252S,SUP,HCPCS C1713,,04.004.252S  -  NAIL INTRAMEDULLARY UNIVERSAL 8MM 360MM CANN ROUND BARREL,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.004.255S,SUP,HCPCS C1713,,04.004.255S  -  NAIL INTRAMEDULLARY UNIVERSAL 8MM 375MM CANN ROUND BARREL,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.004.258S,SUP,HCPCS C1713,,04.004.258S  -  NAIL INTRAMEDULLARY UNIVERSAL 8MM 390MM CANN ROUND BARREL,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.004.261S,SUP,HCPCS C1713,,04.004.261S  -  NAIL INTRAMEDULLARY 8MM 40.5CM CANN NAIL-EX TITANIUM TIBIA,"$2,832.50",$0.00,"$2,832.50","$1,274.63","$2,021.56",$0.00,$473.81,$0.00,$0.00,$495.95,"$2,832.50",$0.00,"$1,416.25","$2,243.34","$2,266.00",$0.00,$430.38,$0.00,$450.93,$0.00
04.004.264S,SUP,HCPCS C1713,,04.004.264S  -  NAIL INTRAMEDULLARY 8MM 42CM CANN NAIL-EX TITANIUM TIBIA,"$2,832.50",$0.00,"$2,832.50","$1,274.63","$2,021.56",$0.00,$473.81,$0.00,$0.00,$495.95,"$2,832.50",$0.00,"$1,416.25","$2,243.34","$2,266.00",$0.00,$430.38,$0.00,$450.93,$0.00
04.004.267S,SUP,HCPCS C1713,,04.004.267S  -  NAIL INTRAMEDULLARY 8MM 43.5CM CANN NAIL-EX TITANIUM TIBIA,"$2,928.80",$0.00,"$2,928.80","$1,317.96","$2,090.28",$0.00,$489.92,$0.00,$0.00,$512.81,"$2,928.80",$0.00,"$1,464.40","$2,319.61","$2,343.04",$0.00,$445.01,$0.00,$466.26,$0.00
04.004.331S,SUP,HCPCS C1713,,04.004.331S  -  NAIL INTRAMEDULLARY 9MM 25.5CM CANN NAIL-EX TITANIUM TIBIA,"$2,842.43",$0.00,"$2,842.43","$1,279.09","$2,028.64",$0.00,$475.47,$0.00,$0.00,$497.69,"$2,842.43",$0.00,"$1,421.21","$2,251.20","$2,273.94",$0.00,$431.88,$0.00,$452.51,$0.00
04.004.334S,SUP,HCPCS C1713,,04.004.334S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 270MM CANN ROUND BARREL,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.004.337S,SUP,HCPCS C1713,,04.004.337S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 285MM CANN ROUND BARREL,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.004.340S,SUP,HCPCS C1713,,04.004.340S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 300MM CANN ROUND BARREL,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.004.343S,SUP,HCPCS C1713,,04.004.343S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 315MM CANN ROUND BARREL,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.004.346S,SUP,HCPCS C1713,,04.004.346S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 330MM CANN ROUND BARREL,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.004.349S,SUP,HCPCS C1713,,04.004.349S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 345MM CANN ROUND BARREL,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.004.352S,SUP,HCPCS C1713,,04.004.352S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 360MM CANN ROUND BARREL,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.004.355S,SUP,HCPCS C1713,,04.004.355S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 375MM CANN ROUND BARREL,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.004.358S,SUP,HCPCS C1713,,04.004.358S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 390MM CANN ROUND BARREL,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.004.361S,SUP,HCPCS C1713,,04.004.361S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 405MM CANN ROUND BARREL,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.004.364S,SUP,HCPCS C1713,,04.004.364S  -  NAIL INTRAMEDULLARY 9MM 42CM CANN NAIL-EX TITANIUM TIBIA,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.004.367S,SUP,HCPCS C1713,,04.004.367S  -  NAIL INTRAMEDULLARY 9MM 43.5CM CANN NAIL-EX TITANIUM TIBIA,"$2,928.80",$0.00,"$2,928.80","$1,317.96","$2,090.28",$0.00,$489.92,$0.00,$0.00,$512.81,"$2,928.80",$0.00,"$1,464.40","$2,319.61","$2,343.04",$0.00,$445.01,$0.00,$466.26,$0.00
04.004.431S,SUP,HCPCS C1713,,04.004.431S  -  NAIL INTRAMEDULLARY 10MM 25.5CM CANN NAIL-EX TITANIUM TIBIA,"$2,832.50",$0.00,"$2,832.50","$1,274.63","$2,021.56",$0.00,$473.81,$0.00,$0.00,$495.95,"$2,832.50",$0.00,"$1,416.25","$2,243.34","$2,266.00",$0.00,$430.38,$0.00,$450.93,$0.00
04.004.434S,SUP,HCPCS C1713,,04.004.434S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 270MM CANN ROUND BARREL,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.004.437S,SUP,HCPCS C1713,,04.004.437S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 285MM CANN ROUND BARREL,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.004.440S,SUP,HCPCS C1713,,04.004.440S  -  NAIL INTRAMEDULLARY UNIVERSAL ROUND BARREL 10MM 300MM CANN,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.004.443S,SUP,HCPCS C1713,,04.004.443S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 315MM CANN ROUND BARREL,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.004.446S,SUP,HCPCS C1713,,04.004.446S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 33CM CANN EXPERT LIGHT,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.004.449S,SUP,HCPCS C1713,,04.004.449S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 34.5CM CANN EXPERT LIGHT,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.004.452S,SUP,HCPCS C1713,,04.004.452S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 360MM CANN ROUND BARREL,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.004.455S,SUP,HCPCS C1713,,04.004.455S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 375MM CANN ROUND BARREL,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.004.458S,SUP,HCPCS C1713,,04.004.458S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 390MM CANN ROUND BARREL,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.004.461S,SUP,HCPCS C1713,,04.004.461S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 405MM CANN ROUND BARREL,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.004.464S,SUP,HCPCS C1713,,04.004.464S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 420MM CANN ROUND BARREL,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.004.467S,SUP,HCPCS C1713,,04.004.467S  -  NAIL INTRAMEDULLARY 10MM 43.5CM CANN NAIL-EX TITANIUM TIBIA,"$2,842.43",$0.00,"$2,842.43","$1,279.09","$2,028.64",$0.00,$475.47,$0.00,$0.00,$497.69,"$2,842.43",$0.00,"$1,421.21","$2,251.20","$2,273.94",$0.00,$431.88,$0.00,$452.51,$0.00
04.004.531S,SUP,HCPCS C1713,,04.004.531S  -  NAIL INTRAMEDULLARY 11MM 25.5CM CANN NAIL-EX TITANIUM TIBIA,"$2,928.80",$0.00,"$2,928.80","$1,317.96","$2,090.28",$0.00,$489.92,$0.00,$0.00,$512.81,"$2,928.80",$0.00,"$1,464.40","$2,319.61","$2,343.04",$0.00,$445.01,$0.00,$466.26,$0.00
04.004.534S,SUP,HCPCS C1713,,04.004.534S  -  NAIL INTRAMEDULLARY 11MM 27CM CANN NAIL-EX TITANIUM TIBIA,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.004.537S,SUP,HCPCS C1713,,04.004.537S  -  NAIL INTRAMEDULLARY 11MM 28.5CM CANN NAIL-EX TITANIUM TIBIA,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.004.540S,SUP,HCPCS C1713,,04.004.540S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 300MM CANN FLUTED BARREL,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.004.543S,SUP,HCPCS C1713,,04.004.543S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 315MM CANN FLUTED BARREL,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.004.546S,SUP,HCPCS C1713,,04.004.546S  -  NAIL INTRAMEDULLARY 11MM 330MM CANN NAIL-EX LIGHT GREEN,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.004.549S,SUP,HCPCS C1713,,04.004.549S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 345MM CANN FLUTED BARREL,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.004.552S,SUP,HCPCS C1713,,04.004.552S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 360MM CANN FLUTED BARREL,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.004.555S,SUP,HCPCS C1713,,04.004.555S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 375MM CANN FLUTED BARREL,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.004.558S,SUP,HCPCS C1713,,04.004.558S  -  NAIL INTRAMEDULLARY UNIVERSAL FLUTE BARREL 11MM 390MM CANN,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.004.561S,SUP,HCPCS C1713,,04.004.561S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 405MM CANN FLUTED BARREL,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.004.564S,SUP,HCPCS C1713,,04.004.564S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 420MM CANN FLUTED BARREL,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.004.567S,SUP,HCPCS C1713,,04.004.567S  -  NAIL INTRAMEDULLARY 11MM 43.5CM CANN NAIL-EX TITANIUM TIBIA,"$2,928.80",$0.00,"$2,928.80","$1,317.96","$2,090.28",$0.00,$489.92,$0.00,$0.00,$512.81,"$2,928.80",$0.00,"$1,464.40","$2,319.61","$2,343.04",$0.00,$445.01,$0.00,$466.26,$0.00
04.004.631S,SUP,HCPCS C1713,,04.004.631S  -  NAIL INTRAMEDULLARY 12MM 25.5CM CANN NAIL-EX TITANIUM TIBIA,"$2,928.80",$0.00,"$2,928.80","$1,317.96","$2,090.28",$0.00,$489.92,$0.00,$0.00,$512.81,"$2,928.80",$0.00,"$1,464.40","$2,319.61","$2,343.04",$0.00,$445.01,$0.00,$466.26,$0.00
04.004.634S,SUP,HCPCS C1713,,04.004.634S  -  NAIL INTRAMEDULLARY 12MM 27CM CANN NAIL-EX TITANIUM TIBIA,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.004.637S,SUP,HCPCS C1713,,04.004.637S  -  NAIL INTRAMEDULLARY 12MM 28.5CM CANN NAIL-EX TITANIUM TIBIA,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.004.640S,SUP,HCPCS C1713,,04.004.640S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 300MM CANN FLUTED BARREL,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.004.643S,SUP,HCPCS C1713,,04.004.643S  -  NAIL INTRAMEDULLARY UNIVERSAL FLUTE 12MM 315MM CANN EXPERT,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.004.646S,SUP,HCPCS C1713,,04.004.646S  -  NAIL INTRAMEDULLARY UNIVERSAL FLUTE BARREL 12MM 330MM CANN,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.004.649S,SUP,HCPCS C1713,,04.004.649S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 345MM CANN FLUTED BARREL,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.004.652S,SUP,HCPCS C1713,,04.004.652S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 360MM CANN FLUTED BARREL,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.004.655S,SUP,HCPCS C1713,,04.004.655S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 375MM CANN FLUTED BARREL,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.004.658S,SUP,HCPCS C1713,,04.004.658S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 390MM CANN EXPERT LIGHT,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.004.661S,SUP,HCPCS C1713,,04.004.661S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 405MM CANN FLUTED BARREL,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.004.664S,SUP,HCPCS C1713,,04.004.664S  -  NAIL INTRAMEDULLARY 12MM 42CM CANN NAIL-EX TITANIUM TIBIA,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.004.667S,SUP,HCPCS C1713,,04.004.667S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 435MM CANN FLUTED BARREL,"$2,928.80",$0.00,"$2,928.80","$1,317.96","$2,090.28",$0.00,$489.92,$0.00,$0.00,$512.81,"$2,928.80",$0.00,"$1,464.40","$2,319.61","$2,343.04",$0.00,$445.01,$0.00,$466.26,$0.00
04.004.731S,SUP,HCPCS C1713,,04.004.731S  -  NAIL INTRAMEDULLARY 13MM 25.5CM CANN NAIL-EX TITANIUM TIBIA,"$2,928.80",$0.00,"$2,928.80","$1,317.96","$2,090.28",$0.00,$489.92,$0.00,$0.00,$512.81,"$2,928.80",$0.00,"$1,464.40","$2,319.61","$2,343.04",$0.00,$445.01,$0.00,$466.26,$0.00
04.004.734S,SUP,HCPCS C1713,,04.004.734S  -  NAIL INTRAMEDULLARY 13MM 27CM CANN NAIL-EX TITANIUM TIBIA,"$2,928.80",$0.00,"$2,928.80","$1,317.96","$2,090.28",$0.00,$489.92,$0.00,$0.00,$512.81,"$2,928.80",$0.00,"$1,464.40","$2,319.61","$2,343.04",$0.00,$445.01,$0.00,$466.26,$0.00
04.004.737S,SUP,HCPCS C1713,,04.004.737S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 285MM CANN FLUTED BARREL,"$2,842.43",$0.00,"$2,842.43","$1,279.09","$2,028.64",$0.00,$475.47,$0.00,$0.00,$497.69,"$2,842.43",$0.00,"$1,421.21","$2,251.20","$2,273.94",$0.00,$431.88,$0.00,$452.51,$0.00
04.004.740S,SUP,HCPCS C1713,,04.004.740S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 300MM CANN FLUTED BARREL,"$2,842.43",$0.00,"$2,842.43","$1,279.09","$2,028.64",$0.00,$475.47,$0.00,$0.00,$497.69,"$2,842.43",$0.00,"$1,421.21","$2,251.20","$2,273.94",$0.00,$431.88,$0.00,$452.51,$0.00
04.004.743S,SUP,HCPCS C1713,,04.004.743S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 315MM CANN FLUTED BARREL,"$2,842.43",$0.00,"$2,842.43","$1,279.09","$2,028.64",$0.00,$475.47,$0.00,$0.00,$497.69,"$2,842.43",$0.00,"$1,421.21","$2,251.20","$2,273.94",$0.00,$431.88,$0.00,$452.51,$0.00
04.004.746S,SUP,HCPCS C1713,,04.004.746S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 330MM CANN FLUTED BARREL,"$2,842.43",$0.00,"$2,842.43","$1,279.09","$2,028.64",$0.00,$475.47,$0.00,$0.00,$497.69,"$2,842.43",$0.00,"$1,421.21","$2,251.20","$2,273.94",$0.00,$431.88,$0.00,$452.51,$0.00
04.004.749S,SUP,HCPCS C1713,,04.004.749S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 345MM CANN FLUTED BARREL,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.004.752S,SUP,HCPCS C1713,,04.004.752S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 360MM CANN FLUTED BARREL,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.004.755S,SUP,HCPCS C1713,,04.004.755S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 375MM CANN FLUTED BARREL,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.004.758S,SUP,HCPCS C1713,,04.004.758S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 390MM CANN FLUTED BARREL,"$2,842.43",$0.00,"$2,842.43","$1,279.09","$2,028.64",$0.00,$475.47,$0.00,$0.00,$497.69,"$2,842.43",$0.00,"$1,421.21","$2,251.20","$2,273.94",$0.00,$431.88,$0.00,$452.51,$0.00
04.004.761S,SUP,HCPCS C1713,,04.004.761S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 405MM CANN FLUTED BARREL,"$2,928.80",$0.00,"$2,928.80","$1,317.96","$2,090.28",$0.00,$489.92,$0.00,$0.00,$512.81,"$2,928.80",$0.00,"$1,464.40","$2,319.61","$2,343.04",$0.00,$445.01,$0.00,$466.26,$0.00
04.004.764S,SUP,HCPCS C1713,,04.004.764S  -  NAIL INTRAMEDULLARY 13MM 42CM CANN NAIL-EX TITANIUM TIBIA,"$2,928.80",$0.00,"$2,928.80","$1,317.96","$2,090.28",$0.00,$489.92,$0.00,$0.00,$512.81,"$2,928.80",$0.00,"$1,464.40","$2,319.61","$2,343.04",$0.00,$445.01,$0.00,$466.26,$0.00
04.004.767S,SUP,HCPCS C1713,,04.004.767S  -  NAIL INTRAMEDULLARY 13MM 43.5CM CANN NAIL-EX TITANIUM TIBIA,"$2,928.80",$0.00,"$2,928.80","$1,317.96","$2,090.28",$0.00,$489.92,$0.00,$0.00,$512.81,"$2,928.80",$0.00,"$1,464.40","$2,319.61","$2,343.04",$0.00,$445.01,$0.00,$466.26,$0.00
04.005.408,SUP,HCPCS C1713,,04.005.408  -  SCREW BONE NONSTRL 4MM 18MM NLEX TI FULTHD HUM TIB SLFTAP,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
04.005.408S,SUP,HCPCS C1713,,04.005.408S  -  SCREW BN T25 FT 4MM 3.3MM 18MM BLU STRL LCK ST BLNT TIP 2 LD,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.410,SUP,HCPCS C1713,,04.005.410  -  SCREW BONE NONSTRL 4MM 20MM NLEX TI FULTHD HUM TIB SLFTAP,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
04.005.410S,SUP,HCPCS C1713,,04.005.410S  -  SCREW BN T25 FT 4MM 3.3MM 20MM BLU STRL LCK ST BLNT TIP 2 LD,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.412,SUP,HCPCS C1713,,04.005.412  -  SCREW BONE NONSTRL 4MM 22MM NLEX TI FULTHD HUM TIB SLFTAP,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
04.005.412S,SUP,HCPCS C1713,,04.005.412S  -  SCREW BN T25 FT 4MM 3.3MM 22MM BLU STRL LCK ST BLNT TIP 2 LD,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.414,SUP,HCPCS C1713,,04.005.414  -  SCREW BONE NONSTRL 4MM 24MM NLEX TI FULTHD HUM TIB SLFTAP,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
04.005.414S,SUP,HCPCS C1713,,04.005.414S  -  SCREW BN T25 FT 4MM 3.3MM 24MM BLU STRL LCK ST BLNT TIP 2 LD,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.416,SUP,HCPCS C1713,,04.005.416  -  SCREW BONE NONSTRL 4MM 26MM NLEX TI FULTHD HUM TIB SLFTAP,$307.65,$0.00,$307.65,$138.44,$219.57,$0.00,$53.01,$0.00,$0.00,$53.87,$307.65,$0.00,$153.83,$243.66,$246.12,$0.00,$48.15,$0.00,$48.98,$0.00
04.005.416S,SUP,HCPCS C1713,,04.005.416S  -  SCREW BN T25 FT 4MM 3.3MM 26MM BLU STRL LCK ST BLNT TIP 2 LD,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.418,SUP,HCPCS C1713,,04.005.418  -  SCREW BONE 4MM 28MM NLEX TI HUM TIB LCK STARDRIVE RECESS,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
04.005.418S,SUP,HCPCS C1713,,04.005.418S  -  SCREW BONE T25 FULTHD BLUNT 4MM 8MM 28MM 2 LEAD SELF TAP,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.420,SUP,HCPCS C1713,,04.005.420  -  SCREW BONE 4MM 30MM NLEX TI HUM TIB LCK STARDRIVE RECESS,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
04.005.420S,SUP,HCPCS C1713,,04.005.420S  -  SCREW BONE T25 FULTHD BLUNT 4MM 8MM 30MM 2 LEAD SELF TAP,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.422,SUP,HCPCS C1713,,04.005.422  -  SCREW BONE 4MM 32MM NLEX TI HUM TIB LCK STARDRIVE RECESS,$307.65,$0.00,$307.65,$138.44,$219.57,$0.00,$53.01,$0.00,$0.00,$53.87,$307.65,$0.00,$153.83,$243.66,$246.12,$0.00,$48.15,$0.00,$48.98,$0.00
04.005.422S,SUP,HCPCS C1713,,04.005.422S  -  SCREW BONE T25 FULTHD BLUNT 4MM 8MM 32MM 2 LEAD SELF TAP,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.424,SUP,HCPCS C1713,,04.005.424  -  SCREW BONE NONSTRL 4MM 34MM NLEX TI FULTHD HUM TIB SLFTAP,$307.65,$0.00,$307.65,$138.44,$219.57,$0.00,$53.01,$0.00,$0.00,$53.87,$307.65,$0.00,$153.83,$243.66,$246.12,$0.00,$48.15,$0.00,$48.98,$0.00
04.005.424S,SUP,HCPCS C1713,,04.005.424S  -  SCREW BN T25 FT 4MM 3.3MM 34MM BLU STRL LCK ST BLNT TIP 2 LD,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.426,SUP,HCPCS C1713,,04.005.426  -  SCREW BONE NONSTRL 4MM 36MM NLEX TI FULTHD HUM TIB SLFTAP,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
04.005.426S,SUP,HCPCS C1713,,04.005.426S  -  SCREW BN T25 FT 4MM 3.3MM 36MM BLU STRL LCK ST BLNT TIP 2 LD,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.428,SUP,HCPCS C1713,,04.005.428  -  SCREW BONE NONSTRL 4MM 38MM NLEX TI FULTHD HUM TIB SLFTAP,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
04.005.428S,SUP,HCPCS C1713,,04.005.428S  -  SCREW BONE T25 FULTHD BLUNT 4MM 8MM 38MM 2 LEAD SELF TAP,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.430,SUP,HCPCS C1713,,04.005.430  -  SCREW BONE NONSTRL 4MM 40MM NLEX TI FULTHD HUM TIB SLFTAP,$307.65,$0.00,$307.65,$138.44,$219.57,$0.00,$53.01,$0.00,$0.00,$53.87,$307.65,$0.00,$153.83,$243.66,$246.12,$0.00,$48.15,$0.00,$48.98,$0.00
04.005.430S,SUP,HCPCS C1713,,04.005.430S  -  SCREW BONE T25 FULTHD BLUNT 4MM 8MM 40MM 2 LEAD SELF TAP,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.432,SUP,HCPCS C1713,,04.005.432  -  SCREW BONE NONSTRL 4MM 42MM NLEX TI FULTHD HUM TIB SLFTAP,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
04.005.432S,SUP,HCPCS C1713,,04.005.432S  -  SCREW BONE T25 FULTHD BLUNT 4MM 8MM 42MM 2 LEAD SELF TAP,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.434,SUP,HCPCS C1713,,04.005.434  -  SCREW BONE 4MM 44MM NLEX TI FULTHD HUM TIB SLFTAP LCK,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
04.005.434S,SUP,HCPCS C1713,,04.005.434S  -  SCREW BN T25 FT 4MM 3.3MM 44MM BLU STRL LCK ST BLNT TIP 2 LD,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.436,SUP,HCPCS C1713,,04.005.436  -  SCREW BONE NONSTRL 4MM 46MM NLEX TI FULTHD HUM TIB SLFTAP,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
04.005.436S,SUP,HCPCS C1713,,04.005.436S  -  SCREW BN T25 FT 4MM 3.3MM 46MM BLU STRL LCK ST BLNT TIP 2 LD,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.438,SUP,HCPCS C1713,,04.005.438  -  SCREW BONE NONSTRL 4MM 48MM NLEX TI FULTHD HUM TIB SLFTAP,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
04.005.438S,SUP,HCPCS C1713,,04.005.438S  -  SCREW BN T25 FT 4MM 3.3MM 48MM BLU STRL LCK ST BLNT TIP 2 LD,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.440,SUP,HCPCS C1713,,04.005.440  -  SCREW BONE NONSTRL 4MM 50MM NLEX TI FULTHD HUM TIB SLFTAP,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
04.005.440S,SUP,HCPCS C1713,,04.005.440S  -  SCREW BN T25 FT 4MM 3.3MM 50MM BLU STRL LCK ST BLNT TIP 2 LD,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.442,SUP,HCPCS C1713,,04.005.442  -  SCREW BONE NONSTRL 4MM 52MM NLEX TI FULTHD HUM TIB SLFTAP,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
04.005.442S,SUP,HCPCS C1713,,04.005.442S  -  SCREW BN T25 FT 4MM 3.3MM 52MM BLU STRL LCK ST BLNT TIP 2 LD,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.444,SUP,HCPCS C1713,,04.005.444  -  SCREW BONE NONSTRL 4MM 54MM NLEX TI FULTHD HUM TIB SLFTAP,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
04.005.444S,SUP,HCPCS C1713,,04.005.444S  -  SCREW BN T25 FT 4MM 3.3MM 54MM BLU STRL LCK ST BLNT TIP 2 LD,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.446,SUP,HCPCS C1713,,04.005.446  -  SCREW BONE NONSTRL 4MM 56MM NLEX TI FULTHD HUM TIB SLFTAP,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
04.005.446S,SUP,HCPCS C1713,,04.005.446S  -  SCREW BN T25 FT 4MM 3.3MM 56MM BLU STRL LCK ST BLNT TIP 2 LD,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.448,SUP,HCPCS C1713,,04.005.448  -  SCREW BONE NONSTRL 4MM 58MM NLEX TI FULTHD HUM TIB SLFTAP,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
04.005.448S,SUP,HCPCS C1713,,04.005.448S  -  SCREW BN T25 FT 4MM 3.3MM 58MM BLU STRL LCK ST BLNT TIP 2 LD,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.450,SUP,HCPCS C1713,,04.005.450  -  SCREW BONE NONSTRL 4MM 60MM NLEX TI FULTHD HUM TIB SLFTAP,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
04.005.450S,SUP,HCPCS C1713,,04.005.450S  -  SCREW BN T25 FT 4MM 3.3MM 60MM BLU STRL LCK ST BLNT TIP 2 LD,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.452,SUP,HCPCS C1713,,04.005.452  -  SCREW BONE NONSTRL 4MM 62MM NLEX TI FULTHD HUM TIB SLFTAP,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
04.005.452S,SUP,HCPCS C1713,,04.005.452S  -  SCREW BN T25 FT 4MM 3.3MM 62MM BLU STRL LCK ST BLNT TIP 2 LD,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.454,SUP,HCPCS C1713,,04.005.454  -  SCREW BONE NONSTRL 4MM 64MM NLEX TI FULTHD HUM TIB SLFTAP,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
04.005.454S,SUP,HCPCS C1713,,04.005.454S  -  SCREW BN T25 FT 4MM 3.3MM 64MM BLU STRL LCK ST BLNT TIP 2 LD,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.456,SUP,HCPCS C1713,,04.005.456  -  SCREW BONE NONSTRL 4MM 66MM NLEX TI FULTHD HUM TIB SLFTAP,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
04.005.456S,SUP,HCPCS C1713,,04.005.456S  -  SCREW BN T25 FT 4MM 3.3MM 66MM BLU STRL LCK ST BLNT TIP 2 LD,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.458,SUP,HCPCS C1713,,04.005.458  -  SCREW BONE NONSTRL 4MM 68MM NLEX TI FULTHD HUM TIB SLFTAP,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
04.005.458S,SUP,HCPCS C1713,,04.005.458S  -  SCREW BN T25 FT 4MM 3.3MM 68MM BLU STRL LCK ST BLNT TIP 2 LD,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.460,SUP,HCPCS C1713,,04.005.460  -  SCREW BONE NONSTRL 4MM 70MM NLEX TI FULTHD HUM TIB SLFTAP,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
04.005.460S,SUP,HCPCS C1713,,04.005.460S  -  SCREW BN T25 FT 4MM 3.3MM 70MM BLU STRL LCK ST BLNT TIP 2 LD,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.462,SUP,HCPCS C1713,,04.005.462  -  SCREW BONE NONSTRL 4MM 72MM NLEX TI FULTHD HUM TIB SLFTAP,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
04.005.462S,SUP,HCPCS C1713,,04.005.462S  -  SCREW BN T25 FT 4MM 3.3MM 72MM BLU STRL LCK ST BLNT TIP 2 LD,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.464,SUP,HCPCS C1713,,04.005.464  -  SCREW BONE NONSTRL 4MM 74MM NLEX TI FULTHD HUM TIB SLFTAP,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
04.005.464S,SUP,HCPCS C1713,,04.005.464S  -  SCREW BN T25 FT 4MM 3.3MM 74MM BLU STRL LCK ST BLNT TIP 2 LD,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.466,SUP,HCPCS C1713,,04.005.466  -  SCREW BONE NONSTRL 4MM 76MM NLEX TI FULTHD HUM TIB SLFTAP,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
04.005.466S,SUP,HCPCS C1713,,04.005.466S  -  SCREW BN T25 FT 4MM 3.3MM 76MM BLU STRL LCK ST BLNT TIP 2 LD,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.468,SUP,HCPCS C1713,,04.005.468  -  SCREW BONE NONSTRL 4MM 78MM NLEX TI FULTHD HUM TIB SLFTAP,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
04.005.468S,SUP,HCPCS C1713,,04.005.468S  -  SCREW BN T25 FT 4MM 3.3MM 78MM BLU STRL LCK ST BLNT TIP 2 LD,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.470,SUP,HCPCS C1713,,04.005.470  -  SCREW BONE NONSTRL 4MM 80MM NLEX TI FULTHD HUM TIB SLFTAP,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
04.005.470S,SUP,HCPCS C1713,,04.005.470S  -  SCREW BN T25 FT 4MM 3.3MM 80MM BLU STRL LCK ST BLNT TIP 2 LD,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.516,SUP,HCPCS C1713,,04.005.516  -  SCREW BONE 5MM 26MM NLEX TI FEM/TIB LCK STARDRIVE RECESS,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
04.005.516S,SUP,HCPCS C1713,,04.005.516S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 26MM 2 LEAD SELF TAP,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.518,SUP,HCPCS C1713,,04.005.518  -  SCREW BONE 5MM 4.3MM 28MM NLEX TI FULTHD FEM/TIB T25,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
04.005.518S,SUP,HCPCS C1713,,04.005.518S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 28MM 2 LEAD SELF TAP,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.520,SUP,HCPCS C1713,,04.005.520  -  SCREW BONE 5MM 30MM NLEX TI FULTHD FEM/TIB SLFTAP LCK,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
04.005.520S,SUP,HCPCS C1713,,04.005.520S  -  SCREW BONE FULTHD 5MM 4.3MM 30MM T25 STARDRIVE RECESS,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.522,SUP,HCPCS C1713,,04.005.522  -  SCREW BONE NONSTRL 5MM 32MM NLEX TI FULTHD FEM/TIB SLFTAP,$307.65,$0.00,$307.65,$138.44,$219.57,$0.00,$53.01,$0.00,$0.00,$53.87,$307.65,$0.00,$153.83,$243.66,$246.12,$0.00,$48.15,$0.00,$48.98,$0.00
04.005.522S,SUP,HCPCS C1713,,04.005.522S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 32MM 2 LEAD SELF TAP,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.524,SUP,HCPCS C1713,,04.005.524  -  SCREW BONE NONSTRL 5MM 34MM NLEX TI FULTHD FEM/TIB SLFTAP,$307.65,$0.00,$307.65,$138.44,$219.57,$0.00,$53.01,$0.00,$0.00,$53.87,$307.65,$0.00,$153.83,$243.66,$246.12,$0.00,$48.15,$0.00,$48.98,$0.00
04.005.524S,SUP,HCPCS C1713,,04.005.524S  -  SCREW BONE FULTHD 5MM 4.3MM 34MM T25 STARDRIVE RECESS,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.526,SUP,HCPCS C1713,,04.005.526  -  SCREW BONE NONSTRL 5MM 36MM NLEX TI FULTHD FEM/TIB SLFTAP,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
04.005.526S,SUP,HCPCS C1713,,04.005.526S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 36MM 2 LEAD SELF TAP,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.528,SUP,HCPCS C1713,,04.005.528  -  SCREW BONE NONSTRL 5MM 38MM NLEX TI FULTHD FEM/TIB SLFTAP,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
04.005.528S,SUP,HCPCS C1713,,04.005.528S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 38MM 2 LEAD SELF TAP,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.530,SUP,HCPCS C1713,,04.005.530  -  SCREW BONE NONSTRL 5MM 40MM NLEX TI FULTHD FEM/TIB SLFTAP,$307.65,$0.00,$307.65,$138.44,$219.57,$0.00,$53.01,$0.00,$0.00,$53.87,$307.65,$0.00,$153.83,$243.66,$246.12,$0.00,$48.15,$0.00,$48.98,$0.00
04.005.530S,SUP,HCPCS C1713,,04.005.530S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 40MM 2 LEAD SELF TAP,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.532,SUP,HCPCS C1713,,04.005.532  -  SCREW BONE NONSTRL 5MM 42MM NLEX TI FULTHD FEM/TIB SLFTAP,$307.65,$0.00,$307.65,$138.44,$219.57,$0.00,$53.01,$0.00,$0.00,$53.87,$307.65,$0.00,$153.83,$243.66,$246.12,$0.00,$48.15,$0.00,$48.98,$0.00
04.005.532S,SUP,HCPCS C1713,,04.005.532S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 42MM 2 LEAD SELF TAP,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.534,SUP,HCPCS C1713,,04.005.534  -  SCREW BONE NONSTRL 5MM 44MM NLEX TI FULTHD FEM/TIB SLFTAP,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
04.005.534S,SUP,HCPCS C1713,,04.005.534S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 44MM 2 LEAD SELF TAP,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.536,SUP,HCPCS C1713,,04.005.536  -  SCREW BONE NONSTRL 5MM 46MM NLEX TI FULTHD FEM/TIB SLFTAP,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
04.005.536S,SUP,HCPCS C1713,,04.005.536S  -  SCREW BN T25 FT 5MM 4.3MM 46MM LGHT GRN STRL LCK ST BLNT TIP,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.538,SUP,HCPCS C1713,,04.005.538  -  SCREW BONE NONSTRL 5MM 48MM NLEX TI FULTHD FEM/TIB SLFTAP,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
04.005.538S,SUP,HCPCS C1713,,04.005.538S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 48MM 2 LEAD SELF TAP,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.540,SUP,HCPCS C1713,,04.005.540  -  SCREW BONE NONSTRL 5MM 50MM NLEX TI FULTHD FEM/TIB SLFTAP,$307.65,$0.00,$307.65,$138.44,$219.57,$0.00,$53.01,$0.00,$0.00,$53.87,$307.65,$0.00,$153.83,$243.66,$246.12,$0.00,$48.15,$0.00,$48.98,$0.00
04.005.540S,SUP,HCPCS C1713,,04.005.540S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 50MM 2 LEAD SELF TAP,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.542,SUP,HCPCS C1713,,04.005.542  -  SCREW BONE NONSTRL 5MM 52MM NLEX TI FULTHD FEM/TIB SLFTAP,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
04.005.542S,SUP,HCPCS C1713,,04.005.542S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 52MM 2 LEAD SELF TAP,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.544,SUP,HCPCS C1713,,04.005.544  -  SCREW BONE NONSTRL 5MM 54MM NLEX TI FULTHD FEM/TIB SLFTAP,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
04.005.544S,SUP,HCPCS C1713,,04.005.544S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 54MM 2 LEAD SELF TAP,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.546,SUP,HCPCS C1713,,04.005.546  -  SCREW BONE NONSTRL 5MM 56MM NLEX TI FULTHD FEM/TIB SLFTAP,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
04.005.546S,SUP,HCPCS C1713,,04.005.546S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 56MM 2 LEAD SELF TAP,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.548,SUP,HCPCS C1713,,04.005.548  -  SCREW BONE NONSTRL 5MM 58MM NLEX TI FULTHD FEM/TIB SLFTAP,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
04.005.548S,SUP,HCPCS C1713,,04.005.548S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 58MM 2 LEAD SELF TAP,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.550,SUP,HCPCS C1713,,04.005.550  -  SCREW BONE NONSTRL 5MM 60MM NLEX TI FULTHD FEM/TIB SLFTAP,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
04.005.550S,SUP,HCPCS C1713,,04.005.550S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 60MM 2 LEAD SELF TAP,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.552,SUP,HCPCS C1713,,04.005.552  -  SCREW BONE 5MM 62MM NLEX TI FEM/TIB LCK STARDRIVE RECESS,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
04.005.552S,SUP,HCPCS C1713,,04.005.552S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 62MM 2 LEAD SELF TAP,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.554,SUP,HCPCS C1713,,04.005.554  -  SCREW BONE 5MM 64MM NLEX TI FEM/TIB LCK STARDRIVE RECESS,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
04.005.554S,SUP,HCPCS C1713,,04.005.554S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 64MM 2 LEAD SELF TAP,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.556,SUP,HCPCS C1713,,04.005.556  -  SCREW BONE 5MM 66MM NLEX TI FEM/TIB LCK STARDRIVE RECESS,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
04.005.556S,SUP,HCPCS C1713,,04.005.556S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 66MM 2 LEAD SELF TAP,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.558,SUP,HCPCS C1713,,04.005.558  -  SCREW BONE 5MM 68MM NLEX TI FEM/TIB LCK STARDRIVE RECESS,$307.65,$0.00,$307.65,$138.44,$219.57,$0.00,$53.01,$0.00,$0.00,$53.87,$307.65,$0.00,$153.83,$243.66,$246.12,$0.00,$48.15,$0.00,$48.98,$0.00
04.005.558S,SUP,HCPCS C1713,,04.005.558S  -  SCREW BONE FULTHD 5MM 8MM 68MM T25 STARDRIVE RECESS LOCKING,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.560,SUP,HCPCS C1713,,04.005.560  -  SCREW BONE 5MM 70MM NLEX TI FEM/TIB LCK STARDRIVE RECESS,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
04.005.560S,SUP,HCPCS C1713,,04.005.560S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 70MM 2 LEAD SELF TAP,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.562,SUP,HCPCS C1713,,04.005.562  -  SCREW BONE 5MM 72MM NLEX TI FEM/TIB LCK STARDRIVE RECESS,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
04.005.562S,SUP,HCPCS C1713,,04.005.562S  -  SCREW BN T25 FT 5MM 4.3MM 72MM LGHT GRN STRL LCK ST BLNT TIP,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.564,SUP,HCPCS C1713,,04.005.564  -  SCREW BONE 5MM 74MM NLEX TI FEM/TIB LCK STARDRIVE RECESS,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
04.005.564S,SUP,HCPCS C1713,,04.005.564S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 74MM 2 LEAD SELF TAP,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.566,SUP,HCPCS C1713,,04.005.566  -  SCREW BONE 5MM 76MM NLEX TI FEM/TIB LCK STARDRIVE RECESS,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
04.005.566S,SUP,HCPCS C1713,,04.005.566S  -  SCREW BONE FULTHD 5MM 8MM 76MM T25 STARDRIVE RECESS LOCKING,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.568,SUP,HCPCS C1713,,04.005.568  -  SCREW BONE 5MM 78MM NLEX TI FEM/TIB LCK STARDRIVE RECESS,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
04.005.568S,SUP,HCPCS C1713,,04.005.568S  -  SCREW BONE FULTHD 5MM 8MM 78MM LOCK CANN SELF TAP BLUNT TIP,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.570,SUP,HCPCS C1713,,04.005.570  -  SCREW BONE 5MM 80MM NLEX TI FEM/TIB LCK STARDRIVE RECESS,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
04.005.570S,SUP,HCPCS C1713,,04.005.570S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 80MM 2 LEAD SELF TAP,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.575,SUP,HCPCS C1713,,04.005.575  -  SCREW BONE NONSTRL 5MM 85MM NLEX TI FULTHD FEM/TIB SLFTAP,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
04.005.575S,SUP,HCPCS C1713,,04.005.575S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 85MM 2 LEAD SELF TAP,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.580,SUP,HCPCS C1713,,04.005.580  -  SCREW BONE NONSTRL 5MM 90MM NLEX TI FULTHD FEM/TIB SLFTAP,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
04.005.580S,SUP,HCPCS C1713,,04.005.580S  -  SCREW BONE FULTHD 5MM 8MM 90MM T25 STARDRIVE RECESS LOCKING,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.585,SUP,HCPCS C1713,,04.005.585  -  SCREW BONE NONSTRL 5MM 95MM NLEX TI FULTHD FEM/TIB SLFTAP,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
04.005.585S,SUP,HCPCS C1713,,04.005.585S  -  SCREW BN T25 FT 5MM 4.3MM 95MM LGHT GRN STRL LCK ST BLNT TIP,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.590,SUP,HCPCS C1713,,04.005.590  -  SCREW BONE NONSTRL 5MM 100MM NLEX TI FULTHD FEM/TIB SLFTAP,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
04.005.590S,SUP,HCPCS C1713,,04.005.590S  -  SCREW BONE FULTHD 5MM 8MM 100MM T25 STARDRIVE RECESS LOCKING,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.616,SUP,HCPCS C1713,,04.005.616  -  SCREW BONE NONSTRL 6MM 26MM NLEX TI FULTHD FEM/TIB SLFTAP,$413.95,$0.00,$413.95,$186.28,$295.44,$0.00,$71.32,$0.00,$0.00,$72.48,$413.95,$0.00,$206.98,$327.85,$331.16,$0.00,$64.78,$0.00,$65.90,$0.00
04.005.616S,SUP,HCPCS C1713,,04.005.616S  -  SCREW BN FT 6MM 8MM 26MM AQ STRL NLEX T25 STRDR RCS LCK CNN,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.618,SUP,HCPCS C1713,,04.005.618  -  SCREW BONE NONSTRL 6MM 28MM NLEX TI FULTHD FEM/TIB SLFTAP,$413.95,$0.00,$413.95,$186.28,$295.44,$0.00,$71.32,$0.00,$0.00,$72.48,$413.95,$0.00,$206.98,$327.85,$331.16,$0.00,$64.78,$0.00,$65.90,$0.00
04.005.618S,SUP,HCPCS C1713,,04.005.618S  -  SCREW BN FT 6MM 8MM 28MM AQ STRL NLEX T25 STRDR RCS LCK CNN,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.620,SUP,HCPCS C1713,,04.005.620  -  SCREW BONE NONSTRL 6MM 30MM NLEX TI FULTHD FEM/TIB SLFTAP,$413.95,$0.00,$413.95,$186.28,$295.44,$0.00,$71.32,$0.00,$0.00,$72.48,$413.95,$0.00,$206.98,$327.85,$331.16,$0.00,$64.78,$0.00,$65.90,$0.00
04.005.620S,SUP,HCPCS C1713,,04.005.620S  -  SCREW BN FT 6MM 8MM 30MM AQ STRL NLEX T25 STRDR RCS LCK CNN,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.622,SUP,HCPCS C1713,,04.005.622  -  SCREW BONE NONSTRL 6MM 32MM NLEX TI FULTHD FEM/TIB SLFTAP,$413.95,$0.00,$413.95,$186.28,$295.44,$0.00,$71.32,$0.00,$0.00,$72.48,$413.95,$0.00,$206.98,$327.85,$331.16,$0.00,$64.78,$0.00,$65.90,$0.00
04.005.622S,SUP,HCPCS C1713,,04.005.622S  -  SCREW BN T25 FT BLNT 6MM 8MM 32MM AQ STRL XPRT 2 LD ST LCK,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.624,SUP,HCPCS C1713,,04.005.624  -  SCREW BONE NONSTRL 6MM 34MM NLEX TI FULTHD FEM/TIB SLFTAP,$413.95,$0.00,$413.95,$186.28,$295.44,$0.00,$71.32,$0.00,$0.00,$72.48,$413.95,$0.00,$206.98,$327.85,$331.16,$0.00,$64.78,$0.00,$65.90,$0.00
04.005.624S,SUP,HCPCS C1713,,04.005.624S  -  SCREW BN FT 6MM 8MM 34MM AQ STRL NLEX T25 STRDR RCS LCK CNN,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.626,SUP,HCPCS C1713,,04.005.626  -  SCREW BONE NONSTRL 6MM 36MM NLEX TI FULTHD FEM/TIB SLFTAP,$413.95,$0.00,$413.95,$186.28,$295.44,$0.00,$71.32,$0.00,$0.00,$72.48,$413.95,$0.00,$206.98,$327.85,$331.16,$0.00,$64.78,$0.00,$65.90,$0.00
04.005.626S,SUP,HCPCS C1713,,04.005.626S  -  SCREW BN T25 FT BLNT 6MM 8MM 36MM AQ STRL XPRT 2 LD ST LCK,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.628,SUP,HCPCS C1713,,04.005.628  -  SCREW BONE NONSTRL 6MM 38MM NLEX TI FULTHD FEM/TIB SLFTAP,$413.95,$0.00,$413.95,$186.28,$295.44,$0.00,$71.32,$0.00,$0.00,$72.48,$413.95,$0.00,$206.98,$327.85,$331.16,$0.00,$64.78,$0.00,$65.90,$0.00
04.005.628S,SUP,HCPCS C1713,,04.005.628S  -  SCREW BN T25 FT 6MM 4.8MM 38MM AQ STRL LCK ST BLNT TIP 2 LD,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.630,SUP,HCPCS C1713,,04.005.630  -  SCREW BONE NONSTRL 6MM 40MM NLEX TI FULTHD FEM/TIB SLFTAP,$413.95,$0.00,$413.95,$186.28,$295.44,$0.00,$71.32,$0.00,$0.00,$72.48,$413.95,$0.00,$206.98,$327.85,$331.16,$0.00,$64.78,$0.00,$65.90,$0.00
04.005.630S,SUP,HCPCS C1713,,04.005.630S  -  SCREW BN FT 6MM 8MM 40MM AQ STRL NLEX T25 STRDR RCS LCK CNN,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.632,SUP,HCPCS C1713,,04.005.632  -  SCREW BONE NONSTRL 6MM 42MM NLEX TI FULTHD FEM/TIB SLFTAP,$413.95,$0.00,$413.95,$186.28,$295.44,$0.00,$71.32,$0.00,$0.00,$72.48,$413.95,$0.00,$206.98,$327.85,$331.16,$0.00,$64.78,$0.00,$65.90,$0.00
04.005.632S,SUP,HCPCS C1713,,04.005.632S  -  SCREW BN FT 6MM 8MM 42MM AQ STRL NLEX T25 STRDR RCS LCK CNN,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.634,SUP,HCPCS C1713,,04.005.634  -  SCREW BONE NONSTRL 6MM 44MM NLEX TI FULTHD FEM/TIB SLFTAP,$413.95,$0.00,$413.95,$186.28,$295.44,$0.00,$71.32,$0.00,$0.00,$72.48,$413.95,$0.00,$206.98,$327.85,$331.16,$0.00,$64.78,$0.00,$65.90,$0.00
04.005.634S,SUP,HCPCS C1713,,04.005.634S  -  SCREW BN T25 FT 6MM 4.8MM 44MM AQ STRL LCK ST BLNT TIP 2 LD,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.636,SUP,HCPCS C1713,,04.005.636  -  SCREW BONE NONSTRL 6MM 46MM NLEX TI FULTHD FEM/TIB SLFTAP,$413.95,$0.00,$413.95,$186.28,$295.44,$0.00,$71.32,$0.00,$0.00,$72.48,$413.95,$0.00,$206.98,$327.85,$331.16,$0.00,$64.78,$0.00,$65.90,$0.00
04.005.636S,SUP,HCPCS C1713,,04.005.636S  -  SCREW BN FT 6MM 8MM 46MM AQ STRL NLEX T25 STRDR RCS LCK CNN,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.638,SUP,HCPCS C1713,,04.005.638  -  SCREW BONE NONSTRL 6MM 48MM NLEX TI FULTHD FEM/TIB SLFTAP,$413.95,$0.00,$413.95,$186.28,$295.44,$0.00,$71.32,$0.00,$0.00,$72.48,$413.95,$0.00,$206.98,$327.85,$331.16,$0.00,$64.78,$0.00,$65.90,$0.00
04.005.638S,SUP,HCPCS C1713,,04.005.638S  -  SCREW BN FT 6MM 8MM 48MM AQ STRL NLEX T25 STRDR RCS LCK CNN,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.640,SUP,HCPCS C1713,,04.005.640  -  SCREW BONE NONSTRL 6MM 50MM NLEX TI FULTHD FEM/TIB SLFTAP,$413.95,$0.00,$413.95,$186.28,$295.44,$0.00,$71.32,$0.00,$0.00,$72.48,$413.95,$0.00,$206.98,$327.85,$331.16,$0.00,$64.78,$0.00,$65.90,$0.00
04.005.640S,SUP,HCPCS C1713,,04.005.640S  -  SCREW BN FT 6MM 8MM 50MM AQ STRL NLEX T25 STRDR RCS LCK CNN,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.642,SUP,HCPCS C1713,,04.005.642  -  SCREW BONE NONSTRL 6MM 52MM NLEX TI FULTHD FEM/TIB SLFTAP,$413.95,$0.00,$413.95,$186.28,$295.44,$0.00,$71.32,$0.00,$0.00,$72.48,$413.95,$0.00,$206.98,$327.85,$331.16,$0.00,$64.78,$0.00,$65.90,$0.00
04.005.642S,SUP,HCPCS C1713,,04.005.642S  -  SCREW BN T25 FT BLNT 6MM 8MM 52MM AQ STRL XPRT 2 LD ST LCK,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.644,SUP,HCPCS C1713,,04.005.644  -  SCREW BONE NONSTRL 6MM 54MM NLEX TI FULTHD FEM/TIB SLFTAP,$413.95,$0.00,$413.95,$186.28,$295.44,$0.00,$71.32,$0.00,$0.00,$72.48,$413.95,$0.00,$206.98,$327.85,$331.16,$0.00,$64.78,$0.00,$65.90,$0.00
04.005.644S,SUP,HCPCS C1713,,04.005.644S  -  SCREW BN T25 FT 6MM 8MM 54MM AQ STRL ST LCK BLNT TIP STRDR,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.646,SUP,HCPCS C1713,,04.005.646  -  SCREW BONE NONSTRL 6MM 56MM NLEX TI FULTHD FEM/TIB SLFTAP,$413.95,$0.00,$413.95,$186.28,$295.44,$0.00,$71.32,$0.00,$0.00,$72.48,$413.95,$0.00,$206.98,$327.85,$331.16,$0.00,$64.78,$0.00,$65.90,$0.00
04.005.646S,SUP,HCPCS C1713,,04.005.646S  -  SCREW BN T25 FT 6MM 8MM 56MM AQ STRL ST LCK 2 LD STRDR TI,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.648,SUP,HCPCS C1713,,04.005.648  -  SCREW BONE NONSTRL 6MM 58MM NLEX TI FULTHD FEM/TIB SLFTAP,$413.95,$0.00,$413.95,$186.28,$295.44,$0.00,$71.32,$0.00,$0.00,$72.48,$413.95,$0.00,$206.98,$327.85,$331.16,$0.00,$64.78,$0.00,$65.90,$0.00
04.005.648S,SUP,HCPCS C1713,,04.005.648S  -  SCREW BN T25 FT 6MM 4.8MM 58MM AQ STRL LCK ST BLNT TIP 2 LD,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.650,SUP,HCPCS C1713,,04.005.650  -  SCREW BONE NONSTRL 6MM 60MM NLEX TI FULTHD FEM/TIB SLFTAP,$413.95,$0.00,$413.95,$186.28,$295.44,$0.00,$71.32,$0.00,$0.00,$72.48,$413.95,$0.00,$206.98,$327.85,$331.16,$0.00,$64.78,$0.00,$65.90,$0.00
04.005.650S,SUP,HCPCS C1713,,04.005.650S  -  SCREW BN T25 FT 6MM 4.8MM 60MM AQ STRL LCK ST BLNT TIP 2 LD,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.654,SUP,HCPCS C1713,,04.005.654  -  SCREW BONE NONSTRL 6MM 64MM NLEX TI FULTHD FEM/TIB SLFTAP,$413.95,$0.00,$413.95,$186.28,$295.44,$0.00,$71.32,$0.00,$0.00,$72.48,$413.95,$0.00,$206.98,$327.85,$331.16,$0.00,$64.78,$0.00,$65.90,$0.00
04.005.654S,SUP,HCPCS C1713,,04.005.654S  -  SCREW BN T25 FT 6MM 4.8MM 64MM AQ STRL LCK CNN ST BLNT TIP,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.658,SUP,HCPCS C1713,,04.005.658  -  SCREW BONE 6MM 68MM NLEX TI FEM LCK STARDRIVE RECESS NONSTRL,$413.95,$0.00,$413.95,$186.28,$295.44,$0.00,$71.32,$0.00,$0.00,$72.48,$413.95,$0.00,$206.98,$327.85,$331.16,$0.00,$64.78,$0.00,$65.90,$0.00
04.005.658S,SUP,HCPCS C1713,,04.005.658S  -  SCREW BN T25 FT 6MM 4.8MM 68MM AQ STRL LCK ST BLNT TIP 2 LD,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.662,SUP,HCPCS C1713,,04.005.662  -  SCREW BONE NONSTRL 6MM 72MM NLEX TI FULTHD FEM/TIB SLFTAP,$413.95,$0.00,$413.95,$186.28,$295.44,$0.00,$71.32,$0.00,$0.00,$72.48,$413.95,$0.00,$206.98,$327.85,$331.16,$0.00,$64.78,$0.00,$65.90,$0.00
04.005.662S,SUP,HCPCS C1713,,04.005.662S  -  SCREW BN T25 FT 6MM 4.8MM 72MM AQ STRL LCK ST BLNT TIP 2 LD,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.666,SUP,HCPCS C1713,,04.005.666  -  SCREW BONE NONSTRL 6MM 76MM NLEX TI FULTHD FEM/TIB SLFTAP,$413.95,$0.00,$413.95,$186.28,$295.44,$0.00,$71.32,$0.00,$0.00,$72.48,$413.95,$0.00,$206.98,$327.85,$331.16,$0.00,$64.78,$0.00,$65.90,$0.00
04.005.666S,SUP,HCPCS C1713,,04.005.666S  -  SCREW BN T25 FT BLNT 6MM 8MM 76MM AQ STRL XPRT 2 LD ST LCK,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.670,SUP,HCPCS C1713,,04.005.670  -  SCREW BONE 6MM 80MM NLEX TI FEM LCK STARDRIVE RECESS NONSTRL,$413.95,$0.00,$413.95,$186.28,$295.44,$0.00,$71.32,$0.00,$0.00,$72.48,$413.95,$0.00,$206.98,$327.85,$331.16,$0.00,$64.78,$0.00,$65.90,$0.00
04.005.670S,SUP,HCPCS C1713,,04.005.670S  -  SCREW BN FT 6MM 8MM 80MM AQ STRL NLEX T25 STRDR RCS LCK CNN,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.675,SUP,HCPCS C1713,,04.005.675  -  SCREW BONE NONSTRL 6MM 85MM NLEX TI FULTHD FEM/TIB SLFTAP,$413.95,$0.00,$413.95,$186.28,$295.44,$0.00,$71.32,$0.00,$0.00,$72.48,$413.95,$0.00,$206.98,$327.85,$331.16,$0.00,$64.78,$0.00,$65.90,$0.00
04.005.675S,SUP,HCPCS C1713,,04.005.675S  -  SCREW BN T25 FT 6MM 4.8MM 85MM AQ STRL LCK ST BLNT TIP 2 LD,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.680,SUP,HCPCS C1713,,04.005.680  -  SCREW BONE NONSTRL 6MM 90MM NLEX TI FULTHD FEM/TIB SLFTAP,$413.95,$0.00,$413.95,$186.28,$295.44,$0.00,$71.32,$0.00,$0.00,$72.48,$413.95,$0.00,$206.98,$327.85,$331.16,$0.00,$64.78,$0.00,$65.90,$0.00
04.005.680S,SUP,HCPCS C1713,,04.005.680S  -  SCREW BN FT 6MM 8MM 90MM AQ STRL NLEX T25 STRDR RCS LCK CNN,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.685,SUP,HCPCS C1713,,04.005.685  -  SCREW BONE NONSTRL 6MM 95MM NLEX TI FULTHD FEM/TIB SLFTAP,$413.95,$0.00,$413.95,$186.28,$295.44,$0.00,$71.32,$0.00,$0.00,$72.48,$413.95,$0.00,$206.98,$327.85,$331.16,$0.00,$64.78,$0.00,$65.90,$0.00
04.005.685S,SUP,HCPCS C1713,,04.005.685S  -  SCREW BN FT 6MM 8MM 95MM AQ STRL NLEX T25 STRDR RCS LCK CNN,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.690,SUP,HCPCS C1713,,04.005.690  -  SCREW BONE 6MM 100MM NLEX TI FULTHD FEM/TIB SLFTAP CANN LCK,$413.95,$0.00,$413.95,$186.28,$295.44,$0.00,$71.32,$0.00,$0.00,$72.48,$413.95,$0.00,$206.98,$327.85,$331.16,$0.00,$64.78,$0.00,$65.90,$0.00
04.005.690S,SUP,HCPCS C1713,,04.005.690S  -  SCREW BN FT 6MM 8MM 100MM AQ STRL NLEX T25 STRDR RCS LCK CNN,$423.45,$0.00,$423.45,$190.55,$302.22,$0.00,$70.83,$0.00,$0.00,$74.14,$423.45,$0.00,$211.73,$335.37,$338.76,$0.00,$64.34,$0.00,$67.41,$0.00
04.005.691,SUP,HCPCS C1713,,04.005.691  -  SCREW BONE FULTHD 6MM 105MM SLFTAP CANN LOCKING STARDRIVE,$331.40,$0.00,$331.40,$149.13,$236.52,$0.00,$55.44,$0.00,$0.00,$58.03,$331.40,$0.00,$165.70,$262.47,$265.12,$0.00,$50.35,$0.00,$52.76,$0.00
04.005.692,SUP,HCPCS C1713,,04.005.692  -  SCREW BONE FULTHD 6MM 110MM SLFTAP CANN LOCKING STARDRIVE,$331.40,$0.00,$331.40,$149.13,$236.52,$0.00,$55.44,$0.00,$0.00,$58.03,$331.40,$0.00,$165.70,$262.47,$265.12,$0.00,$50.35,$0.00,$52.76,$0.00
04.005.693,SUP,HCPCS C1713,,04.005.693  -  SCREW BONE FULTHD 6MM 115MM SLFTAP CANN LOCKING STARDRIVE,$331.40,$0.00,$331.40,$149.13,$236.52,$0.00,$55.44,$0.00,$0.00,$58.03,$331.40,$0.00,$165.70,$262.47,$265.12,$0.00,$50.35,$0.00,$52.76,$0.00
04.005.694,SUP,HCPCS C1713,,04.005.694  -  SCREW BONE FULTHD 6MM 120MM SLFTAP CANN LOCKING STARDRIVE,$331.40,$0.00,$331.40,$149.13,$236.52,$0.00,$55.44,$0.00,$0.00,$58.03,$331.40,$0.00,$165.70,$262.47,$265.12,$0.00,$50.35,$0.00,$52.76,$0.00
04.005.695,SUP,HCPCS C1713,,04.005.695  -  SCREW BONE FULTHD 6MM 125MM SLFTAP CANN LOCKING STARDRIVE,$331.40,$0.00,$331.40,$149.13,$236.52,$0.00,$55.44,$0.00,$0.00,$58.03,$331.40,$0.00,$165.70,$262.47,$265.12,$0.00,$50.35,$0.00,$52.76,$0.00
04.008.000S,SUP,Custom 27803010,,04.008.000S  -  CAP END T25 STARDRIVE RECESS NAIL-EX GOLD TITANIUM HINDFOOT,$416.38,$0.00,$416.38,$0.00,$297.17,$0.00,$0.00,$0.00,$0.00,$0.00,$416.38,$0.00,$208.19,$329.77,$333.10,$0.00,$0.00,$0.00,$0.00,$0.00
04.008.001S,SUP,Custom 27803010,,04.008.001S  -  CAP END 0MM EXTENDED STARDRIVE RECESS NAIL-EX AQUA TITANIUM,$416.38,$0.00,$416.38,$0.00,$297.17,$0.00,$0.00,$0.00,$0.00,$0.00,$416.38,$0.00,$208.19,$329.77,$333.10,$0.00,$0.00,$0.00,$0.00,$0.00
04.008.010S,SUP,HCPCS C1713,,04.008.010S  -  NAIL INTRAMEDULLARY 10MM 150CM CANN EXPERT GREEN TITANIUM,"$2,918.90",$0.00,"$2,918.90","$1,313.51","$2,083.22",$0.00,$488.26,$0.00,$0.00,$511.08,"$2,918.90",$0.00,"$1,459.45","$2,311.77","$2,335.12",$0.00,$443.50,$0.00,$464.69,$0.00
04.008.016S,SUP,HCPCS C1713,,04.008.016S  -  NAIL INTRAMEDULLARY 12D 10MM 180MM CANN BALL TIPPED REAMING,"$2,918.90",$0.00,"$2,918.90","$1,313.51","$2,083.22",$0.00,$488.26,$0.00,$0.00,$511.08,"$2,918.90",$0.00,"$1,459.45","$2,311.77","$2,335.12",$0.00,$443.50,$0.00,$464.69,$0.00
04.008.028S,SUP,HCPCS C1713,,04.008.028S  -  NAIL INTRAMEDULLARY 12D 10MM 240MM CANN BALL TIPPED REAMING,"$2,918.90",$0.00,"$2,918.90","$1,313.51","$2,083.22",$0.00,$488.26,$0.00,$0.00,$511.08,"$2,918.90",$0.00,"$1,459.45","$2,311.77","$2,335.12",$0.00,$443.50,$0.00,$464.69,$0.00
04.008.060S,SUP,HCPCS C1713,,04.008.060S  -  NAIL INTRAMEDULLARY 10MM 15CM CANN NAIL-EX GREEN TITANIUM,"$2,918.90",$0.00,"$2,918.90","$1,313.51","$2,083.22",$0.00,$488.26,$0.00,$0.00,$511.08,"$2,918.90",$0.00,"$1,459.45","$2,311.77","$2,335.12",$0.00,$443.50,$0.00,$464.69,$0.00
04.008.066S,SUP,HCPCS C1713,,04.008.066S  -  NAIL INTRAMEDULLARY 10MM 180MM CANN NAIL-EX GREEN TITANIUM,"$2,918.90",$0.00,"$2,918.90","$1,313.51","$2,083.22",$0.00,$488.26,$0.00,$0.00,$511.08,"$2,918.90",$0.00,"$1,459.45","$2,311.77","$2,335.12",$0.00,$443.50,$0.00,$464.69,$0.00
04.008.078S,SUP,HCPCS C1713,,04.008.078S  -  NAIL INTRAMEDULLARY 10MM 24CM CANN NAIL-EX TITANIUM LEFT,"$2,918.90",$0.00,"$2,918.90","$1,313.51","$2,083.22",$0.00,$488.26,$0.00,$0.00,$511.08,"$2,918.90",$0.00,"$1,459.45","$2,311.77","$2,335.12",$0.00,$443.50,$0.00,$464.69,$0.00
04.008.210S,SUP,HCPCS C1713,,04.008.210S  -  NAIL INTRAMEDULLARY 12MM 15CM CANN NAIL-EX TITANIUM RIGHT,"$3,006.70",$0.00,"$3,006.70","$1,353.02","$2,145.88",$0.00,$502.95,$0.00,$0.00,$526.45,"$3,006.70",$0.00,"$1,503.35","$2,381.31","$2,405.36",$0.00,$456.84,$0.00,$478.67,$0.00
04.008.216S,SUP,HCPCS C1713,,04.008.216S  -  NAIL INTRAMEDULLARY 12MM 180MM CANN NAIL-EX TITANIUM RIGHT,"$2,918.90",$0.00,"$2,918.90","$1,313.51","$2,083.22",$0.00,$488.26,$0.00,$0.00,$511.08,"$2,918.90",$0.00,"$1,459.45","$2,311.77","$2,335.12",$0.00,$443.50,$0.00,$464.69,$0.00
04.008.228S,SUP,HCPCS C1713,,04.008.228S  -  NAIL INTRAMEDULLARY 12MM 24CM CANN NAIL-EX TITANIUM RIGHT,"$2,918.90",$0.00,"$2,918.90","$1,313.51","$2,083.22",$0.00,$488.26,$0.00,$0.00,$511.08,"$2,918.90",$0.00,"$1,459.45","$2,311.77","$2,335.12",$0.00,$443.50,$0.00,$464.69,$0.00
04.008.260S,SUP,HCPCS C1713,,04.008.260S  -  NAIL INTRAMEDULLARY 12MM 15CM CANN NAIL-EX TITANIUM LEFT,"$3,006.70",$0.00,"$3,006.70","$1,353.02","$2,145.88",$0.00,$502.95,$0.00,$0.00,$526.45,"$3,006.70",$0.00,"$1,503.35","$2,381.31","$2,405.36",$0.00,$456.84,$0.00,$478.67,$0.00
04.008.266S,SUP,HCPCS C1713,,04.008.266S  -  NAIL INTRAMEDULLARY 12MM 18CM CANN NAIL-EX TITANIUM LEFT,"$2,918.90",$0.00,"$2,918.90","$1,313.51","$2,083.22",$0.00,$488.26,$0.00,$0.00,$511.08,"$2,918.90",$0.00,"$1,459.45","$2,311.77","$2,335.12",$0.00,$443.50,$0.00,$464.69,$0.00
04.008.278S,SUP,HCPCS C1713,,04.008.278S  -  NAIL INTRAMEDULLARY 12MM 24CM CANN NAIL-EX TITANIUM LEFT,"$2,918.90",$0.00,"$2,918.90","$1,313.51","$2,083.22",$0.00,$488.26,$0.00,$0.00,$511.08,"$2,918.90",$0.00,"$1,459.45","$2,311.77","$2,335.12",$0.00,$443.50,$0.00,$464.69,$0.00
04.008.310S,SUP,HCPCS C1713,,04.008.310S  -  NAIL INTRAMEDULLARY 13MM 15CM CANN NAIL-EX TITANIUM RIGHT,"$3,006.70",$0.00,"$3,006.70","$1,353.02","$2,145.88",$0.00,$502.95,$0.00,$0.00,$526.45,"$3,006.70",$0.00,"$1,503.35","$2,381.31","$2,405.36",$0.00,$456.84,$0.00,$478.67,$0.00
04.008.316S,SUP,HCPCS C1713,,04.008.316S  -  NAIL INTRAMEDULLARY 13MM 18CM CANN NAIL-EX TITANIUM RIGHT,"$3,006.70",$0.00,"$3,006.70","$1,353.02","$2,145.88",$0.00,$502.95,$0.00,$0.00,$526.45,"$3,006.70",$0.00,"$1,503.35","$2,381.31","$2,405.36",$0.00,$456.84,$0.00,$478.67,$0.00
04.008.328S,SUP,HCPCS C1713,,04.008.328S  -  NAIL INTRAMEDULLARY 13MM 240MM FLUTED EXPERT LIGHT GREEN,"$2,918.90",$0.00,"$2,918.90","$1,313.51","$2,083.22",$0.00,$488.26,$0.00,$0.00,$511.08,"$2,918.90",$0.00,"$1,459.45","$2,311.77","$2,335.12",$0.00,$443.50,$0.00,$464.69,$0.00
04.008.360S,SUP,HCPCS C1713,,04.008.360S  -  NAIL INTRAMEDULLARY 13MM 15CM CANN NAIL-EX TITANIUM LEFT,"$3,006.70",$0.00,"$3,006.70","$1,353.02","$2,145.88",$0.00,$502.95,$0.00,$0.00,$526.45,"$3,006.70",$0.00,"$1,503.35","$2,381.31","$2,405.36",$0.00,$456.84,$0.00,$478.67,$0.00
04.008.366S,SUP,HCPCS C1713,,04.008.366S  -  NAIL INTRAMEDULLARY 13MM 18CM CANN NAIL-EX TITANIUM LEFT,"$3,006.70",$0.00,"$3,006.70","$1,353.02","$2,145.88",$0.00,$502.95,$0.00,$0.00,$526.45,"$3,006.70",$0.00,"$1,503.35","$2,381.31","$2,405.36",$0.00,$456.84,$0.00,$478.67,$0.00
04.008.378S,SUP,HCPCS C1713,,04.008.378S  -  NAIL INTRAMEDULLARY 13MM 24CM CANN NAIL-EX TITANIUM LEFT,"$2,918.90",$0.00,"$2,918.90","$1,313.51","$2,083.22",$0.00,$488.26,$0.00,$0.00,$511.08,"$2,918.90",$0.00,"$1,459.45","$2,311.77","$2,335.12",$0.00,$443.50,$0.00,$464.69,$0.00
04.013.000,SUP,HCPCS C1713,,04.013.000  -  CAP END 0MM FEM XTD STARDRIVE RECESS CANN IM NAIL TI NONSTRL,$357.38,$0.00,$357.38,$160.82,$255.06,$0.00,$61.57,$0.00,$0.00,$62.57,$357.38,$0.00,$178.69,$283.04,$285.90,$0.00,$55.93,$0.00,$56.89,$0.00
04.013.000S,SUP,Custom 27803010,,04.013.000S  -  CAP END 0MM T40 STARDRIVE NAIL-EX GOLD TITANIUM FEMUR,$402.23,$0.00,$402.23,$0.00,$287.07,$0.00,$0.00,$0.00,$0.00,$0.00,$402.23,$0.00,$201.11,$318.57,$321.78,$0.00,$0.00,$0.00,$0.00,$0.00
04.013.041S,SUP,Custom 27803010,,04.013.041S  -  BLADE INTRAMEDULLARY NAIL 45MM CANN SPIRAL RTRGRD NAIL-EX,"$1,127.33",$0.00,"$1,127.33",$0.00,$804.57,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,127.33",$0.00,$563.66,$892.85,$901.86,$0.00,$0.00,$0.00,$0.00,$0.00
04.013.042S,SUP,Custom 27803010,,04.013.042S  -  BLADE INTRAMEDULLARY NAIL 50MM CANN SPIRAL RTRGRD NAIL-EX,"$1,127.33",$0.00,"$1,127.33",$0.00,$804.57,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,127.33",$0.00,$563.66,$892.85,$901.86,$0.00,$0.00,$0.00,$0.00,$0.00
04.013.043S,SUP,Custom 27803010,,04.013.043S  -  BLADE INTRAMEDULLARY NAIL 55MM CANN SPIRAL RTRGRD NAIL-EX,"$1,127.33",$0.00,"$1,127.33",$0.00,$804.57,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,127.33",$0.00,$563.66,$892.85,$901.86,$0.00,$0.00,$0.00,$0.00,$0.00
04.013.044S,SUP,Custom 27803010,,04.013.044S  -  BLADE INTRAMEDULLARY NAIL 60MM CANN SPIRAL RTRGRD NAIL-EX,"$1,127.33",$0.00,"$1,127.33",$0.00,$804.57,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,127.33",$0.00,$563.66,$892.85,$901.86,$0.00,$0.00,$0.00,$0.00,$0.00
04.013.045S,SUP,Custom 27803010,,04.013.045S  -  BLADE INTRAMEDULLARY FIX SPIRAL 65MM RTRGRD EXPERT GOLD,"$1,127.33",$0.00,"$1,127.33",$0.00,$804.57,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,127.33",$0.00,$563.66,$892.85,$901.86,$0.00,$0.00,$0.00,$0.00,$0.00
04.013.046,SUP,HCPCS C1713,,04.013.046  -  BLADE IM NAIL 70MM NLEX FEM TI CANN SPRL RTRGRD NONSTRL,"$1,214.65",$0.00,"$1,214.65",$546.59,$866.90,$0.00,$209.28,$0.00,$0.00,$212.68,"$1,214.65",$0.00,$607.33,$962.00,$971.72,$0.00,$190.09,$0.00,$193.37,$0.00
04.013.046S,SUP,Custom 27803010,,04.013.046S  -  BLADE INTRAMEDULLARY NAIL 70MM SPIRAL RTRGRD NAIL-EX GOLD,"$1,127.33",$0.00,"$1,127.33",$0.00,$804.57,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,127.33",$0.00,$563.66,$892.85,$901.86,$0.00,$0.00,$0.00,$0.00,$0.00
04.013.047S,SUP,Custom 27803010,,04.013.047S  -  BLADE INTRAMEDULLARY FIX 12.5MM 75MM SPIRAL CANN NAIL-EX,"$1,127.33",$0.00,"$1,127.33",$0.00,$804.57,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,127.33",$0.00,$563.66,$892.85,$901.86,$0.00,$0.00,$0.00,$0.00,$0.00
04.013.048S,SUP,Custom 27803010,,04.013.048S  -  BLADE INTRAMEDULLARY FIX 80MM SPIRAL NAIL-EX TITANIUM FEMUR,"$1,127.33",$0.00,"$1,127.33",$0.00,$804.57,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,127.33",$0.00,$563.66,$892.85,$901.86,$0.00,$0.00,$0.00,$0.00,$0.00
04.013.049S,SUP,Custom 27803010,,04.013.049S  -  BLADE INTRAMEDULLARY NAIL SPIRAL 12.5MM 85MM RTRGRD CANN,"$1,127.33",$0.00,"$1,127.33",$0.00,$804.57,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,127.33",$0.00,$563.66,$892.85,$901.86,$0.00,$0.00,$0.00,$0.00,$0.00
04.013.050S,SUP,Custom 27803010,,04.013.050S  -  BLADE INTRAMEDULLARY FIX SPIRAL 90MM CANN RTRGRD EXPERT GOLD,"$1,127.33",$0.00,"$1,127.33",$0.00,$804.57,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,127.33",$0.00,$563.66,$892.85,$901.86,$0.00,$0.00,$0.00,$0.00,$0.00
04.013.051S,SUP,Custom 27803010,,04.013.051S  -  BLADE INTRAMEDULLARY NAIL 95MM CANN SPIRAL RTRGRD NAIL-EX,"$1,127.33",$0.00,"$1,127.33",$0.00,$804.57,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,127.33",$0.00,$563.66,$892.85,$901.86,$0.00,$0.00,$0.00,$0.00,$0.00
04.013.052S,SUP,Custom 27803010,,04.013.052S  -  BLADE INTRAMEDULLARY NAIL 100MM CANN SPIRAL RTRGRD NAIL-EX,"$1,127.33",$0.00,"$1,127.33",$0.00,$804.57,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,127.33",$0.00,$563.66,$892.85,$901.86,$0.00,$0.00,$0.00,$0.00,$0.00
04.013.312S,SUP,HCPCS C1713,,04.013.312S  -  NAIL INTRAMEDULLARY 9MM 16CM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,343.78",$0.00,"$3,343.78","$1,504.70","$2,386.45",$0.00,$559.33,$0.00,$0.00,$585.47,"$3,343.78",$0.00,"$1,671.89","$2,648.27","$2,675.02",$0.00,$508.06,$0.00,$532.33,$0.00
04.013.316S,SUP,HCPCS C1713,,04.013.316S  -  NAIL INTRAMEDULLARY 9MM 18CM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,343.78",$0.00,"$3,343.78","$1,504.70","$2,386.45",$0.00,$559.33,$0.00,$0.00,$585.47,"$3,343.78",$0.00,"$1,671.89","$2,648.27","$2,675.02",$0.00,$508.06,$0.00,$532.33,$0.00
04.013.320S,SUP,HCPCS C1713,,04.013.320S  -  NAIL INTRAMEDULLARY 9MM 20CM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,343.78",$0.00,"$3,343.78","$1,504.70","$2,386.45",$0.00,$559.33,$0.00,$0.00,$585.47,"$3,343.78",$0.00,"$1,671.89","$2,648.27","$2,675.02",$0.00,$508.06,$0.00,$532.33,$0.00
04.013.324S,SUP,HCPCS C1713,,04.013.324S  -  NAIL INTRAMEDULLARY 9MM 22CM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,343.78",$0.00,"$3,343.78","$1,504.70","$2,386.45",$0.00,$559.33,$0.00,$0.00,$585.47,"$3,343.78",$0.00,"$1,671.89","$2,648.27","$2,675.02",$0.00,$508.06,$0.00,$532.33,$0.00
04.013.328S,SUP,HCPCS C1713,,04.013.328S  -  NAIL INTRAMEDULLARY 9MM 24CM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,343.78",$0.00,"$3,343.78","$1,504.70","$2,386.45",$0.00,$559.33,$0.00,$0.00,$585.47,"$3,343.78",$0.00,"$1,671.89","$2,648.27","$2,675.02",$0.00,$508.06,$0.00,$532.33,$0.00
04.013.332S,SUP,HCPCS C1713,,04.013.332S  -  NAIL INTRAMEDULLARY 9MM 26CM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,343.78",$0.00,"$3,343.78","$1,504.70","$2,386.45",$0.00,$559.33,$0.00,$0.00,$585.47,"$3,343.78",$0.00,"$1,671.89","$2,648.27","$2,675.02",$0.00,$508.06,$0.00,$532.33,$0.00
04.013.336S,SUP,HCPCS C1713,,04.013.336S  -  NAIL INTRAMEDULLARY 9MM 28CM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,244.63",$0.00,"$3,244.63","$1,460.08","$2,315.69",$0.00,$542.75,$0.00,$0.00,$568.11,"$3,244.63",$0.00,"$1,622.31","$2,569.75","$2,595.70",$0.00,$492.99,$0.00,$516.54,$0.00
04.013.340S,SUP,HCPCS C1713,,04.013.340S  -  NAIL INTRAMEDULLARY 9MM 30CM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.344S,SUP,HCPCS C1713,,04.013.344S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 320MM CANN ROUND BARREL,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.348S,SUP,HCPCS C1713,,04.013.348S  -  NAIL INTRAMEDULLARY 9MM 34CM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.352S,SUP,HCPCS C1713,,04.013.352S  -  NAIL INTRAMEDULLARY 9MM 36CM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.356S,SUP,HCPCS C1713,,04.013.356S  -  NAIL INTRAMEDULLARY 9MM 38CM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.360S,SUP,HCPCS C1713,,04.013.360S  -  NAIL INTRAMEDULLARY 9MM 40CM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.364S,SUP,HCPCS C1713,,04.013.364S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 420MM CANN ROUND BARREL,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.368S,SUP,HCPCS C1713,,04.013.368S  -  NAIL INTRAMEDULLARY 9MM 44CM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.372S,SUP,HCPCS C1713,,04.013.372S  -  NAIL INTRAMEDULLARY 9MM 46CM CANN ANTEGRADE/RTRGRD NAIL-EX,"$3,343.78",$0.00,"$3,343.78","$1,504.70","$2,386.45",$0.00,$559.33,$0.00,$0.00,$585.47,"$3,343.78",$0.00,"$1,671.89","$2,648.27","$2,675.02",$0.00,$508.06,$0.00,$532.33,$0.00
04.013.376S,SUP,HCPCS C1713,,04.013.376S  -  NAIL INTRAMEDULLARY 9MM 48CM CANN ANTEGRADE/RTRGRD NAIL-EX,"$3,343.78",$0.00,"$3,343.78","$1,504.70","$2,386.45",$0.00,$559.33,$0.00,$0.00,$585.47,"$3,343.78",$0.00,"$1,671.89","$2,648.27","$2,675.02",$0.00,$508.06,$0.00,$532.33,$0.00
04.013.412S,SUP,HCPCS C1713,,04.013.412S  -  NAIL INTRAMEDULLARY 10MM 16CM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.416S,SUP,HCPCS C1713,,04.013.416S  -  NAIL INTRAMEDULLARY 10MM 18CM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.420S,SUP,HCPCS C1713,,04.013.420S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 200MM CANN ROUND BARREL,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.424S,SUP,HCPCS C1713,,04.013.424S  -  NAIL INTRAMEDULLARY 10MM 22CM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.428S,SUP,HCPCS C1713,,04.013.428S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 240MM CANN ROUND BARREL,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.432S,SUP,HCPCS C1713,,04.013.432S  -  NAIL INTRAMEDULLARY 10MM 26CM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.436S,SUP,HCPCS C1713,,04.013.436S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 280MM CANN ROUND BARREL,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.440S,SUP,HCPCS C1713,,04.013.440S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 300MM CANN ROUND BARREL,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.444S,SUP,HCPCS C1713,,04.013.444S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 320MM CANN ROUND BARREL,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.448S,SUP,HCPCS C1713,,04.013.448S  -  NAIL INTRAMEDULLARY 10MM 34CM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.452S,SUP,HCPCS C1713,,04.013.452S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 360MM CANN ROUND BARREL,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.456S,SUP,HCPCS C1713,,04.013.456S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 380MM CANN ROUND BARREL,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.460S,SUP,HCPCS C1713,,04.013.460S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 400MM CANN ROUND BARREL,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.464S,SUP,HCPCS C1713,,04.013.464S  -  NAIL INTRAMEDULLARY UNIVERSAL ROUND 10MM 420MM CANN RTRGRD,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.468S,SUP,HCPCS C1713,,04.013.468S  -  NAIL INTRAMEDULLARY 10MM 440MM CANN NAIL-EX GREEN TITANIUM,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.472S,SUP,HCPCS C1713,,04.013.472S  -  NAIL INTRAMEDULLARY 10MM 46CM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.476S,SUP,HCPCS C1713,,04.013.476S  -  NAIL INTRAMEDULLARY 10MM 48CM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,244.63",$0.00,"$3,244.63","$1,460.08","$2,315.69",$0.00,$542.75,$0.00,$0.00,$568.11,"$3,244.63",$0.00,"$1,622.31","$2,569.75","$2,595.70",$0.00,$492.99,$0.00,$516.54,$0.00
04.013.512S,SUP,HCPCS C1713,,04.013.512S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 160MM CANN ROUND BARREL,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.516S,SUP,HCPCS C1713,,04.013.516S  -  NAIL INTRAMEDULLARY 11MM 18CM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.520S,SUP,HCPCS C1713,,04.013.520S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 200MM CANN ROUND BARREL,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.524S,SUP,HCPCS C1713,,04.013.524S  -  NAIL INTRAMEDULLARY 11MM 22CM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.528S,SUP,HCPCS C1713,,04.013.528S  -  NAIL INTRAMEDULLARY 11MM 24CM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.532S,SUP,HCPCS C1713,,04.013.532S  -  NAIL INTRAMEDULLARY 11MM 26CM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.536S,SUP,HCPCS C1713,,04.013.536S  -  NAIL INTRAMEDULLARY 11MM 28CM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.540S,SUP,HCPCS C1713,,04.013.540S  -  NAIL INTRAMEDULLARY 11MM 30CM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.544S,SUP,HCPCS C1713,,04.013.544S  -  NAIL INTRAMEDULLARY UNIVERSAL FLUTED BARREL 11MM 320MM CANN,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.548S,SUP,HCPCS C1713,,04.013.548S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 340MM CANN ROUND BARREL,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.552S,SUP,HCPCS C1713,,04.013.552S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 360MM CANN ROUND BARREL,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.556S,SUP,HCPCS C1713,,04.013.556S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 380MM CANN ROUND BARREL,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.560S,SUP,HCPCS C1713,,04.013.560S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 400MM CANN ROUND BARREL,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.564S,SUP,HCPCS C1713,,04.013.564S  -  NAIL INTRAMEDULLARY 11MM 42CM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.568S,SUP,HCPCS C1713,,04.013.568S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 440MM CANN ROUND BARREL,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.572S,SUP,HCPCS C1713,,04.013.572S  -  NAIL INTRAMEDULLARY 11MM 46CM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.576S,SUP,HCPCS C1713,,04.013.576S  -  NAIL INTRAMEDULLARY 11MM 48CM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,244.63",$0.00,"$3,244.63","$1,460.08","$2,315.69",$0.00,$542.75,$0.00,$0.00,$568.11,"$3,244.63",$0.00,"$1,622.31","$2,569.75","$2,595.70",$0.00,$492.99,$0.00,$516.54,$0.00
04.013.612S,SUP,HCPCS C1713,,04.013.612S  -  NAIL INTRAMEDULLARY 12MM 16CM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.616S,SUP,HCPCS C1713,,04.013.616S  -  NAIL INTRAMEDULLARY 12MM 18CM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.620S,SUP,HCPCS C1713,,04.013.620S  -  NAIL INTRAMEDULLARY 12MM 20CM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.624S,SUP,HCPCS C1713,,04.013.624S  -  NAIL INTRAMEDULLARY 12MM 22CM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.628S,SUP,HCPCS C1713,,04.013.628S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 240MM CANN FLUTED BARREL,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.632S,SUP,HCPCS C1713,,04.013.632S  -  NAIL INTRAMEDULLARY 12MM 26CM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.636S,SUP,HCPCS C1713,,04.013.636S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 280MM CANN FLUTED BARREL,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.640S,SUP,HCPCS C1713,,04.013.640S  -  NAIL INTRAMEDULLARY UNIVERSAL FLUTED 12MM 300MM CANN RTRGRD,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.644S,SUP,HCPCS C1713,,04.013.644S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 320MM CANN FLUTED BARREL,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.648S,SUP,HCPCS C1713,,04.013.648S  -  NAIL INTRAMEDULLARY 12MM 340MM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.652S,SUP,HCPCS C1713,,04.013.652S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 36CM CANN RTRGRD,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.656S,SUP,HCPCS C1713,,04.013.656S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 380MM CANN ROUND BARREL,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.660S,SUP,HCPCS C1713,,04.013.660S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 400MM CANN ROUND BARREL,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.664S,SUP,HCPCS C1713,,04.013.664S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 420MM CANN ROUND BARREL,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.668S,SUP,HCPCS C1713,,04.013.668S  -  NAIL INTRAMEDULLARY 12MM 44CM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.672S,SUP,HCPCS C1713,,04.013.672S  -  NAIL INTRAMEDULLARY 12MM 46CM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,234.73",$0.00,"$3,234.73","$1,455.63","$2,308.62",$0.00,$541.09,$0.00,$0.00,$566.37,"$3,234.73",$0.00,"$1,617.36","$2,561.91","$2,587.78",$0.00,$491.49,$0.00,$514.97,$0.00
04.013.676S,SUP,HCPCS C1713,,04.013.676S  -  NAIL INTRAMEDULLARY 12MM 48CM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,343.78",$0.00,"$3,343.78","$1,504.70","$2,386.45",$0.00,$559.33,$0.00,$0.00,$585.47,"$3,343.78",$0.00,"$1,671.89","$2,648.27","$2,675.02",$0.00,$508.06,$0.00,$532.33,$0.00
04.013.712S,SUP,HCPCS C1713,,04.013.712S  -  NAIL INTRAMEDULLARY 13MM 16CM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,234.73",$0.00,"$3,234.73","$1,455.63","$2,308.62",$0.00,$541.09,$0.00,$0.00,$566.37,"$3,234.73",$0.00,"$1,617.36","$2,561.91","$2,587.78",$0.00,$491.49,$0.00,$514.97,$0.00
04.013.716S,SUP,HCPCS C1713,,04.013.716S  -  NAIL INTRAMEDULLARY 13MM 18CM CANN RTRGRD NAIL-EX TITANIUM,"$3,234.73",$0.00,"$3,234.73","$1,455.63","$2,308.62",$0.00,$541.09,$0.00,$0.00,$566.37,"$3,234.73",$0.00,"$1,617.36","$2,561.91","$2,587.78",$0.00,$491.49,$0.00,$514.97,$0.00
04.013.720S,SUP,HCPCS C1713,,04.013.720S  -  NAIL INTRAMEDULLARY 13MM 200CM CANN RTRGRD ANTEGRADE EXPERT,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.724S,SUP,HCPCS C1713,,04.013.724S  -  NAIL INTRAMEDULLARY 13MM 22CM CANN RTRGRD NAIL-EX TITANIUM,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.728S,SUP,HCPCS C1713,,04.013.728S  -  NAIL INTRAMEDULLARY 13MM 24CM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.732S,SUP,HCPCS C1713,,04.013.732S  -  NAIL INTRAMEDULLARY 13MM 26CM CANN RTRGRD NAIL-EX TITANIUM,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.736S,SUP,HCPCS C1713,,04.013.736S  -  NAIL INTRAMEDULLARY 13MM 28CM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.740S,SUP,HCPCS C1713,,04.013.740S  -  NAIL INTRAMEDULLARY 13MM 30CM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.744S,SUP,HCPCS C1713,,04.013.744S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 320MM CANN RTRGRD NAIL-EX,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.748S,SUP,HCPCS C1713,,04.013.748S  -  NAIL INTRAMEDULLARY 13MM 340MM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.752S,SUP,HCPCS C1713,,04.013.752S  -  NAIL INTRAMEDULLARY 13MM 360CM CANN RTRGRD ANTEGRADE EXPERT,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.756S,SUP,HCPCS C1713,,04.013.756S  -  NAIL INTRAMEDULLARY 13MM 380MM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.760S,SUP,HCPCS C1713,,04.013.760S  -  NAIL INTRAMEDULLARY 13MM 400CM CANN RTRGRD ANTEGRADE EXPERT,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.764S,SUP,HCPCS C1713,,04.013.764S  -  NAIL INTRAMEDULLARY 13MM 420MM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.768S,SUP,HCPCS C1713,,04.013.768S  -  NAIL INTRAMEDULLARY 13MM 44CM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.772S,SUP,HCPCS C1713,,04.013.772S  -  NAIL INTRAMEDULLARY 13MM 46CM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,234.73",$0.00,"$3,234.73","$1,455.63","$2,308.62",$0.00,$541.09,$0.00,$0.00,$566.37,"$3,234.73",$0.00,"$1,617.36","$2,561.91","$2,587.78",$0.00,$491.49,$0.00,$514.97,$0.00
04.013.776S,SUP,HCPCS C1713,,04.013.776S  -  NAIL INTRAMEDULLARY 13MM 48CM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,343.78",$0.00,"$3,343.78","$1,504.70","$2,386.45",$0.00,$559.33,$0.00,$0.00,$585.47,"$3,343.78",$0.00,"$1,671.89","$2,648.27","$2,675.02",$0.00,$508.06,$0.00,$532.33,$0.00
04.013.812S,SUP,HCPCS C1713,,04.013.812S  -  NAIL INTRAMEDULLARY 14MM 16CM CANN RTRGRD ANTEGRADE TITANIUM,"$3,343.78",$0.00,"$3,343.78","$1,504.70","$2,386.45",$0.00,$559.33,$0.00,$0.00,$585.47,"$3,343.78",$0.00,"$1,671.89","$2,648.27","$2,675.02",$0.00,$508.06,$0.00,$532.33,$0.00
04.013.816S,SUP,HCPCS C1713,,04.013.816S  -  NAIL INTRAMEDULLARY 14MM 18CM CANN RTRGRD NAIL-EX TITANIUM,"$3,343.78",$0.00,"$3,343.78","$1,504.70","$2,386.45",$0.00,$559.33,$0.00,$0.00,$585.47,"$3,343.78",$0.00,"$1,671.89","$2,648.27","$2,675.02",$0.00,$508.06,$0.00,$532.33,$0.00
04.013.820S,SUP,HCPCS C1713,,04.013.820S  -  NAIL INTRAMEDULLARY 14MM 20CM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,343.78",$0.00,"$3,343.78","$1,504.70","$2,386.45",$0.00,$559.33,$0.00,$0.00,$585.47,"$3,343.78",$0.00,"$1,671.89","$2,648.27","$2,675.02",$0.00,$508.06,$0.00,$532.33,$0.00
04.013.824S,SUP,HCPCS C1713,,04.013.824S  -  NAIL INTRAMEDULLARY 14MM 22CM CANN RTRGRD NAIL-EX TITANIUM,"$3,343.78",$0.00,"$3,343.78","$1,504.70","$2,386.45",$0.00,$559.33,$0.00,$0.00,$585.47,"$3,343.78",$0.00,"$1,671.89","$2,648.27","$2,675.02",$0.00,$508.06,$0.00,$532.33,$0.00
04.013.828S,SUP,HCPCS C1713,,04.013.828S  -  NAIL INTRAMEDULLARY 14MM 240MM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,343.78",$0.00,"$3,343.78","$1,504.70","$2,386.45",$0.00,$559.33,$0.00,$0.00,$585.47,"$3,343.78",$0.00,"$1,671.89","$2,648.27","$2,675.02",$0.00,$508.06,$0.00,$532.33,$0.00
04.013.832S,SUP,HCPCS C1713,,04.013.832S  -  NAIL INTRAMEDULLARY 14MM 26CM CANN RTRGRD NAIL-EX TITANIUM,"$3,343.78",$0.00,"$3,343.78","$1,504.70","$2,386.45",$0.00,$559.33,$0.00,$0.00,$585.47,"$3,343.78",$0.00,"$1,671.89","$2,648.27","$2,675.02",$0.00,$508.06,$0.00,$532.33,$0.00
04.013.836S,SUP,HCPCS C1713,,04.013.836S  -  NAIL INTRAMEDULLARY 14MM 280MM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,343.78",$0.00,"$3,343.78","$1,504.70","$2,386.45",$0.00,$559.33,$0.00,$0.00,$585.47,"$3,343.78",$0.00,"$1,671.89","$2,648.27","$2,675.02",$0.00,$508.06,$0.00,$532.33,$0.00
04.013.840S,SUP,HCPCS C1713,,04.013.840S  -  NAIL INTRAMEDULLARY 14MM 300MM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.844S,SUP,HCPCS C1713,,04.013.844S  -  NAIL INTRAMEDULLARY 14MM 320MM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.848S,SUP,HCPCS C1713,,04.013.848S  -  NAIL INTRAMEDULLARY 14MM 340MM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.852S,SUP,HCPCS C1713,,04.013.852S  -  NAIL INTRAMEDULLARY 14MM 360MM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.856S,SUP,HCPCS C1713,,04.013.856S  -  NAIL INTRAMEDULLARY 14MM 38CM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.860S,SUP,HCPCS C1713,,04.013.860S  -  NAIL INTRAMEDULLARY 14MM 40CM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.864S,SUP,HCPCS C1713,,04.013.864S  -  NAIL INTRAMEDULLARY 14MM 42CM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.868S,SUP,HCPCS C1713,,04.013.868S  -  NAIL INTRAMEDULLARY 14MM 44CM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.872S,SUP,HCPCS C1713,,04.013.872S  -  NAIL INTRAMEDULLARY 14MM 46CM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.876S,SUP,HCPCS C1713,,04.013.876S  -  NAIL INTRAMEDULLARY 14MM 480MM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,343.78",$0.00,"$3,343.78","$1,504.70","$2,386.45",$0.00,$559.33,$0.00,$0.00,$585.47,"$3,343.78",$0.00,"$1,671.89","$2,648.27","$2,675.02",$0.00,$508.06,$0.00,$532.33,$0.00
04.013.912S,SUP,HCPCS C1713,,04.013.912S  -  NAIL INTRAMEDULLARY 15MM 160MM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,343.78",$0.00,"$3,343.78","$1,504.70","$2,386.45",$0.00,$559.33,$0.00,$0.00,$585.47,"$3,343.78",$0.00,"$1,671.89","$2,648.27","$2,675.02",$0.00,$508.06,$0.00,$532.33,$0.00
04.013.916S,SUP,HCPCS C1713,,04.013.916S  -  NAIL INTRAMEDULLARY 15MM 18CM CANN RTRGRD NAIL-EX TITANIUM,"$3,343.78",$0.00,"$3,343.78","$1,504.70","$2,386.45",$0.00,$559.33,$0.00,$0.00,$585.47,"$3,343.78",$0.00,"$1,671.89","$2,648.27","$2,675.02",$0.00,$508.06,$0.00,$532.33,$0.00
04.013.920S,SUP,HCPCS C1713,,04.013.920S  -  NAIL INTRAMEDULLARY 15MM 200MM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,244.63",$0.00,"$3,244.63","$1,460.08","$2,315.69",$0.00,$542.75,$0.00,$0.00,$568.11,"$3,244.63",$0.00,"$1,622.31","$2,569.75","$2,595.70",$0.00,$492.99,$0.00,$516.54,$0.00
04.013.924S,SUP,HCPCS C1713,,04.013.924S  -  NAIL INTRAMEDULLARY 15MM 22CM CANN RTRGRD NAIL-EX TITANIUM,"$3,244.63",$0.00,"$3,244.63","$1,460.08","$2,315.69",$0.00,$542.75,$0.00,$0.00,$568.11,"$3,244.63",$0.00,"$1,622.31","$2,569.75","$2,595.70",$0.00,$492.99,$0.00,$516.54,$0.00
04.013.928S,SUP,HCPCS C1713,,04.013.928S  -  NAIL INTRAMEDULLARY 15MM 24CM CANN RTRGRD NAIL-EX TITANIUM,"$3,244.63",$0.00,"$3,244.63","$1,460.08","$2,315.69",$0.00,$542.75,$0.00,$0.00,$568.11,"$3,244.63",$0.00,"$1,622.31","$2,569.75","$2,595.70",$0.00,$492.99,$0.00,$516.54,$0.00
04.013.932S,SUP,HCPCS C1713,,04.013.932S  -  NAIL INTRAMEDULLARY 15MM 26CM CANN RTRGRD NAIL-EX TITANIUM,"$3,244.63",$0.00,"$3,244.63","$1,460.08","$2,315.69",$0.00,$542.75,$0.00,$0.00,$568.11,"$3,244.63",$0.00,"$1,622.31","$2,569.75","$2,595.70",$0.00,$492.99,$0.00,$516.54,$0.00
04.013.936S,SUP,HCPCS C1713,,04.013.936S  -  NAIL INTRAMEDULLARY 15MM 280MM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,244.63",$0.00,"$3,244.63","$1,460.08","$2,315.69",$0.00,$542.75,$0.00,$0.00,$568.11,"$3,244.63",$0.00,"$1,622.31","$2,569.75","$2,595.70",$0.00,$492.99,$0.00,$516.54,$0.00
04.013.940S,SUP,HCPCS C1713,,04.013.940S  -  NAIL INTRAMEDULLARY 15MM 300MM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.944S,SUP,HCPCS C1713,,04.013.944S  -  NAIL INTRAMEDULLARY 15MM 320MM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.948S,SUP,HCPCS C1713,,04.013.948S  -  NAIL INTRAMEDULLARY 15MM 340MM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.952S,SUP,HCPCS C1713,,04.013.952S  -  NAIL INTRAMEDULLARY 15MM 360MM CANN RTRGRD ANTEGRADE FLUTED,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.956S,SUP,HCPCS C1713,,04.013.956S  -  NAIL INTRAMEDULLARY 15MM 380MM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.960S,SUP,HCPCS C1713,,04.013.960S  -  NAIL INTRAMEDULLARY 15MM 40CM CANN RTRGRD/ANTEGRADE NAIL-EX,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.964S,SUP,HCPCS C1713,,04.013.964S  -  NAIL INTRAMEDULLARY 15MM 42CM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.968S,SUP,HCPCS C1713,,04.013.968S  -  NAIL INTRAMEDULLARY 15MM 44CM CANN RTRGRD/ANTEGRADE NAIL-EX,"$3,138.40",$0.00,"$3,138.40","$1,412.28","$2,239.88",$0.00,$524.98,$0.00,$0.00,$549.51,"$3,138.40",$0.00,"$1,569.20","$2,485.61","$2,510.72",$0.00,$476.86,$0.00,$499.63,$0.00
04.013.972S,SUP,HCPCS C1713,,04.013.972S  -  NAIL INTRAMEDULLARY 15MM 46CM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,244.63",$0.00,"$3,244.63","$1,460.08","$2,315.69",$0.00,$542.75,$0.00,$0.00,$568.11,"$3,244.63",$0.00,"$1,622.31","$2,569.75","$2,595.70",$0.00,$492.99,$0.00,$516.54,$0.00
04.013.976S,SUP,HCPCS C1713,,04.013.976S  -  NAIL INTRAMEDULLARY 15MM 48CM CANN RTRGRD ANTEGRADE NAIL-EX,"$3,343.78",$0.00,"$3,343.78","$1,504.70","$2,386.45",$0.00,$559.33,$0.00,$0.00,$585.47,"$3,343.78",$0.00,"$1,671.89","$2,648.27","$2,675.02",$0.00,$508.06,$0.00,$532.33,$0.00
04.015.518S,SUP,HCPCS C1713,,04.015.518S  -  SCREW BONE FULTHD 5MM 28MM 2 CORE LOCK GOLD TITANIUM KNEE,$463.13,$0.00,$463.13,$208.41,$330.53,$0.00,$77.47,$0.00,$0.00,$81.09,$463.13,$0.00,$231.56,$366.80,$370.50,$0.00,$70.37,$0.00,$73.73,$0.00
04.015.520,SUP,HCPCS C1713,,04.015.520  -  SCREW BONE T25 BLUNT 5MM 8MM 30MM 2 CORE SELF TAP LOCK,$376.73,$0.00,$376.73,$169.53,$268.87,$0.00,$63.02,$0.00,$0.00,$65.96,$376.73,$0.00,$188.36,$298.37,$301.38,$0.00,$57.24,$0.00,$59.97,$0.00
04.015.522S,SUP,HCPCS C1713,,04.015.522S  -  SCREW BONE FULTHD 5MM 32MM 2 CORE LOCK T25 STARDRIVE RECESS,$468.78,$0.00,$468.78,$210.95,$334.56,$0.00,$78.42,$0.00,$0.00,$82.08,$468.78,$0.00,$234.39,$371.27,$375.02,$0.00,$71.23,$0.00,$74.63,$0.00
04.015.525,SUP,HCPCS C1713,,04.015.525  -  SCREW BONE T25 BLUNT 5MM 8MM 35MM 2 CORE SELF TAP LOCK,$376.73,$0.00,$376.73,$169.53,$268.87,$0.00,$63.02,$0.00,$0.00,$65.96,$376.73,$0.00,$188.36,$298.37,$301.38,$0.00,$57.24,$0.00,$59.97,$0.00
04.015.527S,SUP,HCPCS C1713,,04.015.527S  -  SCREW BONE FULTHD 5MM 37MM 2 CORE LOCK T25 STARDRIVE RECESS,$468.78,$0.00,$468.78,$210.95,$334.56,$0.00,$78.42,$0.00,$0.00,$82.08,$468.78,$0.00,$234.39,$371.27,$375.02,$0.00,$71.23,$0.00,$74.63,$0.00
04.015.530,SUP,HCPCS C1713,,04.015.530  -  SCREW BONE T25 BLUNT 5MM 8MM 40MM 2 CORE SELF TAP LOCK,$376.73,$0.00,$376.73,$169.53,$268.87,$0.00,$63.02,$0.00,$0.00,$65.96,$376.73,$0.00,$188.36,$298.37,$301.38,$0.00,$57.24,$0.00,$59.97,$0.00
04.015.532S,SUP,HCPCS C1713,,04.015.532S  -  SCREW BONE FULTHD 5MM 42MM 2 CORE LOCK T25 STARDRIVE RECESS,$468.78,$0.00,$468.78,$210.95,$334.56,$0.00,$78.42,$0.00,$0.00,$82.08,$468.78,$0.00,$234.39,$371.27,$375.02,$0.00,$71.23,$0.00,$74.63,$0.00
04.015.535,SUP,HCPCS C1713,,04.015.535  -  SCREW BONE T25 BLUNT 5MM 8MM 45MM 2 CORE SELF TAP LOCK,$376.73,$0.00,$376.73,$169.53,$268.87,$0.00,$63.02,$0.00,$0.00,$65.96,$376.73,$0.00,$188.36,$298.37,$301.38,$0.00,$57.24,$0.00,$59.97,$0.00
04.015.537S,SUP,HCPCS C1713,,04.015.537S  -  SCREW BONE FULTHD 5MM 47MM 2 CORE LOCK T25 STARDRIVE RECESS,$468.78,$0.00,$468.78,$210.95,$334.56,$0.00,$78.42,$0.00,$0.00,$82.08,$468.78,$0.00,$234.39,$371.27,$375.02,$0.00,$71.23,$0.00,$74.63,$0.00
04.015.540,SUP,HCPCS C1713,,04.015.540  -  SCREW BONE T25 BLUNT 5MM 8MM 50MM 2 CORE SELF TAP LOCK,$376.73,$0.00,$376.73,$169.53,$268.87,$0.00,$63.02,$0.00,$0.00,$65.96,$376.73,$0.00,$188.36,$298.37,$301.38,$0.00,$57.24,$0.00,$59.97,$0.00
04.015.542S,SUP,HCPCS C1713,,04.015.542S  -  SCREW BONE FULTHD 5MM 52MM 2 CORE LOCK T25 STARDRIVE RECESS,$468.78,$0.00,$468.78,$210.95,$334.56,$0.00,$78.42,$0.00,$0.00,$82.08,$468.78,$0.00,$234.39,$371.27,$375.02,$0.00,$71.23,$0.00,$74.63,$0.00
04.015.545,SUP,HCPCS C1713,,04.015.545  -  SCREW BONE T25 FULTHD 5MM 55MM 2 CORE LOCK STARDRIVE RECESS,$376.73,$0.00,$376.73,$169.53,$268.87,$0.00,$63.02,$0.00,$0.00,$65.96,$376.73,$0.00,$188.36,$298.37,$301.38,$0.00,$57.24,$0.00,$59.97,$0.00
04.015.547S,SUP,HCPCS C1713,,04.015.547S  -  SCREW BONE FULTHD 5MM 57MM 2 CORE LOCK T25 STARDRIVE RECESS,$468.78,$0.00,$468.78,$210.95,$334.56,$0.00,$78.42,$0.00,$0.00,$82.08,$468.78,$0.00,$234.39,$371.27,$375.02,$0.00,$71.23,$0.00,$74.63,$0.00
04.015.550,SUP,HCPCS C1713,,04.015.550  -  SCREW BONE T25 BLUNT 5MM 8MM 60MM 2 CORE SELF TAP LOCK,$376.73,$0.00,$376.73,$169.53,$268.87,$0.00,$63.02,$0.00,$0.00,$65.96,$376.73,$0.00,$188.36,$298.37,$301.38,$0.00,$57.24,$0.00,$59.97,$0.00
04.015.552S,SUP,HCPCS C1713,,04.015.552S  -  SCREW BONE FULTHD 5MM 62MM 2 CORE LOCK SELF TAP T25,$468.78,$0.00,$468.78,$210.95,$334.56,$0.00,$78.42,$0.00,$0.00,$82.08,$468.78,$0.00,$234.39,$371.27,$375.02,$0.00,$71.23,$0.00,$74.63,$0.00
04.015.555,SUP,HCPCS C1713,,04.015.555  -  SCREW BONE T25 BLUNT 5MM 8MM 65MM 2 CORE SELF TAP LOCK,$376.73,$0.00,$376.73,$169.53,$268.87,$0.00,$63.02,$0.00,$0.00,$65.96,$376.73,$0.00,$188.36,$298.37,$301.38,$0.00,$57.24,$0.00,$59.97,$0.00
04.015.555S,SUP,HCPCS C1713,,04.015.555S  -  SCREW BONE 5MM 65MM NLEX TI FULTHD TIB SLFTAP LCK 2 CORE,$506.70,$0.00,$506.70,$228.02,$361.63,$0.00,$87.30,$0.00,$0.00,$88.72,$506.70,$0.00,$253.35,$401.31,$405.36,$0.00,$79.30,$0.00,$80.67,$0.00
04.015.557S,SUP,HCPCS C1713,,04.015.557S  -  SCREW BONE FULTHD 5MM 67MM 2 CORE LOCK T25 STARDRIVE RECESS,$468.78,$0.00,$468.78,$210.95,$334.56,$0.00,$78.42,$0.00,$0.00,$82.08,$468.78,$0.00,$234.39,$371.27,$375.02,$0.00,$71.23,$0.00,$74.63,$0.00
04.015.560,SUP,HCPCS C1713,,04.015.560  -  SCREW BONE T25 BLUNT 5MM 8MM 70MM 2 CORE SELF TAP LOCK,$376.73,$0.00,$376.73,$169.53,$268.87,$0.00,$63.02,$0.00,$0.00,$65.96,$376.73,$0.00,$188.36,$298.37,$301.38,$0.00,$57.24,$0.00,$59.97,$0.00
04.015.562S,SUP,HCPCS C1713,,04.015.562S  -  SCREW BONE FULTHD 5MM 72MM 2 CORE LOCK T25 STARDRIVE RECESS,$468.78,$0.00,$468.78,$210.95,$334.56,$0.00,$78.42,$0.00,$0.00,$82.08,$468.78,$0.00,$234.39,$371.27,$375.02,$0.00,$71.23,$0.00,$74.63,$0.00
04.015.565,SUP,HCPCS C1713,,04.015.565  -  SCREW BONE T25 BLUNT 5MM 8MM 75MM 2 CORE SELF TAP LOCK,$376.73,$0.00,$376.73,$169.53,$268.87,$0.00,$63.02,$0.00,$0.00,$65.96,$376.73,$0.00,$188.36,$298.37,$301.38,$0.00,$57.24,$0.00,$59.97,$0.00
04.015.567S,SUP,HCPCS C1713,,04.015.567S  -  SCREW BONE FULTHD 5MM 77MM 2 CORE LOCK T25 STARDRIVE RECESS,$468.78,$0.00,$468.78,$210.95,$334.56,$0.00,$78.42,$0.00,$0.00,$82.08,$468.78,$0.00,$234.39,$371.27,$375.02,$0.00,$71.23,$0.00,$74.63,$0.00
04.015.570,SUP,HCPCS C1713,,04.015.570  -  SCREW BONE T25 BLUNT 5MM 8MM 80MM 2 CORE SELF TAP LOCK,$376.73,$0.00,$376.73,$169.53,$268.87,$0.00,$63.02,$0.00,$0.00,$65.96,$376.73,$0.00,$188.36,$298.37,$301.38,$0.00,$57.24,$0.00,$59.97,$0.00
04.015.572S,SUP,HCPCS C1713,,04.015.572S  -  SCREW BONE FULTHD 5MM 82MM 2 CORE LOCK T25 STARDRIVE RECESS,$468.78,$0.00,$468.78,$210.95,$334.56,$0.00,$78.42,$0.00,$0.00,$82.08,$468.78,$0.00,$234.39,$371.27,$375.02,$0.00,$71.23,$0.00,$74.63,$0.00
04.015.575,SUP,HCPCS C1713,,04.015.575  -  SCREW BONE T25 BLUNT 5MM 8MM 85MM 2 CORE SELF TAP LOCK,$376.73,$0.00,$376.73,$169.53,$268.87,$0.00,$63.02,$0.00,$0.00,$65.96,$376.73,$0.00,$188.36,$298.37,$301.38,$0.00,$57.24,$0.00,$59.97,$0.00
04.015.577S,SUP,HCPCS C1713,,04.015.577S  -  SCREW BONE FULTHD 5MM 87MM 2 CORE LOCK T25 STARDRIVE RECESS,$468.78,$0.00,$468.78,$210.95,$334.56,$0.00,$78.42,$0.00,$0.00,$82.08,$468.78,$0.00,$234.39,$371.27,$375.02,$0.00,$71.23,$0.00,$74.63,$0.00
04.015.580,SUP,HCPCS C1713,,04.015.580  -  SCREW BONE T25 BLUNT 5MM 8MM 90MM 2 CORE SELF TAP LOCK,$376.73,$0.00,$376.73,$169.53,$268.87,$0.00,$63.02,$0.00,$0.00,$65.96,$376.73,$0.00,$188.36,$298.37,$301.38,$0.00,$57.24,$0.00,$59.97,$0.00
04.016.034S,SUP,HCPCS C1713,,04.016.034S  -  NAIL INTRAMEDULLARY SHORT STR 8MM 9.5MM 160MM CANN MULTILOC,"$3,560.45",$0.00,"$3,560.45","$1,602.20","$2,541.09",$0.00,$595.58,$0.00,$0.00,$623.41,"$3,560.45",$0.00,"$1,780.23","$2,819.88","$2,848.36",$0.00,$540.98,$0.00,$566.82,$0.00
04.016.255S,SUP,HCPCS C1713,,04.016.255S  -  NAIL INTRAMEDULLARY LONG STR 7MM 255MM CANN ROUND BARREL,"$3,710.58",$0.00,"$3,710.58","$1,669.76","$2,648.24",$0.00,$620.69,$0.00,$0.00,$649.69,"$3,710.58",$0.00,"$1,855.29","$2,938.78","$2,968.46",$0.00,$563.79,$0.00,$590.72,$0.00
04.017.240S,SUP,HCPCS C1713,,04.017.240S  -  NAIL INTRAMEDULLARY LONG STR 7MM 240MM CANN ROUND BARREL,"$3,710.58",$0.00,"$3,710.58","$1,669.76","$2,648.24",$0.00,$620.69,$0.00,$0.00,$649.69,"$3,710.58",$0.00,"$1,855.29","$2,938.78","$2,968.46",$0.00,$563.79,$0.00,$590.72,$0.00
04.018.225S,SUP,HCPCS C1713,,04.018.225S  -  NAIL IM LNG STRG 8.5MM 9.5MM 225MM BLU STRL MULTILOC CNN TI,"$3,710.58",$0.00,"$3,710.58","$1,669.76","$2,648.24",$0.00,$620.69,$0.00,$0.00,$649.69,"$3,710.58",$0.00,"$1,855.29","$2,938.78","$2,968.46",$0.00,$563.79,$0.00,$590.72,$0.00
04.018.255S,SUP,HCPCS C1713,,04.018.255S  -  NAIL IM LNG STRG 8.5MM 9.5MM 255MM BLU STRL MULTILOC CNN TI,"$3,710.58",$0.00,"$3,710.58","$1,669.76","$2,648.24",$0.00,$620.69,$0.00,$0.00,$649.69,"$3,710.58",$0.00,"$1,855.29","$2,938.78","$2,968.46",$0.00,$563.79,$0.00,$590.72,$0.00
04.018.270S,SUP,HCPCS C1713,,04.018.270S  -  NAIL INTRAMEDULLARY LONG STR 8.5MM 270MM CANN ROUND BARREL,"$3,710.58",$0.00,"$3,710.58","$1,669.76","$2,648.24",$0.00,$620.69,$0.00,$0.00,$649.69,"$3,710.58",$0.00,"$1,855.29","$2,938.78","$2,968.46",$0.00,$563.79,$0.00,$590.72,$0.00
04.019.030S,SUP,HCPCS C1713,,04.019.030S  -  SCREW BONE FULTHD 4.5MM 30MM BLUNT TIP SELF CUTTING,$562.25,$0.00,$562.25,$253.01,$401.28,$0.00,$94.05,$0.00,$0.00,$98.45,$562.25,$0.00,$281.13,$445.30,$449.80,$0.00,$85.43,$0.00,$89.51,$0.00
04.019.034S,SUP,HCPCS C1713,,04.019.034S  -  SCREW BONE 3.8MM FULTHD BLUNT 4.5MM 3.9MM 34MM SELF CUT,$562.25,$0.00,$562.25,$253.01,$401.28,$0.00,$94.05,$0.00,$0.00,$98.45,$562.25,$0.00,$281.13,$445.30,$449.80,$0.00,$85.43,$0.00,$89.51,$0.00
04.019.036S,SUP,HCPCS C1713,,04.019.036S  -  SCREW BONE 3.8MM FULTHD BLUNT 4.5MM 3.9MM 36MM SELF CUT,$562.25,$0.00,$562.25,$253.01,$401.28,$0.00,$94.05,$0.00,$0.00,$98.45,$562.25,$0.00,$281.13,$445.30,$449.80,$0.00,$85.43,$0.00,$89.51,$0.00
04.019.038S,SUP,HCPCS C1713,,04.019.038S  -  SCREW BONE FULTHD 4.5MM 38MM BLUNT TIP SELF CUTTING,$562.25,$0.00,$562.25,$253.01,$401.28,$0.00,$94.05,$0.00,$0.00,$98.45,$562.25,$0.00,$281.13,$445.30,$449.80,$0.00,$85.43,$0.00,$89.51,$0.00
04.019.040S,SUP,HCPCS C1713,,04.019.040S  -  SCREW BONE FULTHD 4.5MM 3.9MM 40MM BLUNT TIP SELF CUTTING,$562.25,$0.00,$562.25,$253.01,$401.28,$0.00,$94.05,$0.00,$0.00,$98.45,$562.25,$0.00,$281.13,$445.30,$449.80,$0.00,$85.43,$0.00,$89.51,$0.00
04.019.042S,SUP,HCPCS C1713,,04.019.042S  -  SCREW BONE 3.8MM FULTHD BLUNT 4.5MM 3.9MM 42MM SELF CUT,$562.25,$0.00,$562.25,$253.01,$401.28,$0.00,$94.05,$0.00,$0.00,$98.45,$562.25,$0.00,$281.13,$445.30,$449.80,$0.00,$85.43,$0.00,$89.51,$0.00
04.019.044S,SUP,HCPCS C1713,,04.019.044S  -  SCREW BONE 3.8MM FULTHD BLUNT 4.5MM 3.9MM 44MM SELF CUT,$562.25,$0.00,$562.25,$253.01,$401.28,$0.00,$94.05,$0.00,$0.00,$98.45,$562.25,$0.00,$281.13,$445.30,$449.80,$0.00,$85.43,$0.00,$89.51,$0.00
04.019.046S,SUP,HCPCS C1713,,04.019.046S  -  SCREW BONE FULTHD 4.5MM 46MM BLUNT TIP SELF CUTTING,$562.25,$0.00,$562.25,$253.01,$401.28,$0.00,$94.05,$0.00,$0.00,$98.45,$562.25,$0.00,$281.13,$445.30,$449.80,$0.00,$85.43,$0.00,$89.51,$0.00
04.019.050S,SUP,HCPCS C1713,,04.019.050S  -  SCREW BN FT 4.5MM 3.9MM 50MM AU STRL MULTILOC BLNT TIP SLF,$562.25,$0.00,$562.25,$253.01,$401.28,$0.00,$94.05,$0.00,$0.00,$98.45,$562.25,$0.00,$281.13,$445.30,$449.80,$0.00,$85.43,$0.00,$89.51,$0.00
04.019.225S,SUP,HCPCS C1713,,04.019.225S  -  NAIL IM LNG STRG 8.5MM 9.5MM 225MM BLU STRL MULTILOC CNN TI,"$3,710.58",$0.00,"$3,710.58","$1,669.76","$2,648.24",$0.00,$620.69,$0.00,$0.00,$649.69,"$3,710.58",$0.00,"$1,855.29","$2,938.78","$2,968.46",$0.00,$563.79,$0.00,$590.72,$0.00
04.019.240S,SUP,HCPCS C1713,,04.019.240S  -  NAIL INTRAMEDULLARY LONG STR 8.5MM 240MM CANN ROUND BARREL,"$3,710.58",$0.00,"$3,710.58","$1,669.76","$2,648.24",$0.00,$620.69,$0.00,$0.00,$649.69,"$3,710.58",$0.00,"$1,855.29","$2,938.78","$2,968.46",$0.00,$563.79,$0.00,$590.72,$0.00
04.019.255S,SUP,HCPCS C1713,,04.019.255S  -  NAIL INTRAMEDULLARY MULTILOC TITANIUM ALUMINUM NIOBIUM LONG,"$3,710.58",$0.00,"$3,710.58","$1,669.76","$2,648.24",$0.00,$620.69,$0.00,$0.00,$649.69,"$3,710.58",$0.00,"$1,855.29","$2,938.78","$2,968.46",$0.00,$563.79,$0.00,$590.72,$0.00
04.019.270S,SUP,HCPCS C1713,,04.019.270S  -  NAIL INTRAMEDULLARY LONG STR 8.5MM 270MM CANN ROUND BARREL,"$3,710.58",$0.00,"$3,710.58","$1,669.76","$2,648.24",$0.00,$620.69,$0.00,$0.00,$649.69,"$3,710.58",$0.00,"$1,855.29","$2,938.78","$2,968.46",$0.00,$563.79,$0.00,$590.72,$0.00
04.019.285S,SUP,HCPCS C1713,,04.019.285S  -  NAIL INTRAMEDULLARY LONG STR 8.5MM 285MM CANN ROUND BARREL,"$3,710.58",$0.00,"$3,710.58","$1,669.76","$2,648.24",$0.00,$620.69,$0.00,$0.00,$649.69,"$3,710.58",$0.00,"$1,855.29","$2,938.78","$2,968.46",$0.00,$563.79,$0.00,$590.72,$0.00
04.025.416S,SUP,HCPCS C1713,,04.025.416S  -  SCREW BONE T25 FULTHD BLUNT 4MM 8MM 26MM SELF TAP STARDRIVE,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.418S,SUP,HCPCS C1713,,04.025.418S  -  SCREW BONE T25 FULTHD BLUNT 4MM 8MM 28MM SELF TAP STARDRIVE,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.420S,SUP,HCPCS C1713,,04.025.420S  -  SCREW BONE FULTHD 4MM 30MM T25 STARDRIVE RECESS LOCKING,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.422S,SUP,HCPCS C1713,,04.025.422S  -  SCREW BONE T25 FULTHD BLUNT 4MM 8MM 32MM SELF TAP STARDRIVE,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.424S,SUP,HCPCS C1713,,04.025.424S  -  SCREW BONE T25 FULTHD BLUNT 4MM 8MM 34MM SELF TAP STARDRIVE,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.426S,SUP,HCPCS C1713,,04.025.426S  -  SCREW BONE T25 FULTHD BLUNT 4MM 8MM 36MM SELF TAP STARDRIVE,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.428S,SUP,HCPCS C1713,,04.025.428S  -  SCREW BONE T25 FULTHD BLUNT 4MM 8MM 38MM SELF TAP STARDRIVE,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.430S,SUP,HCPCS C1713,,04.025.430S  -  SCREW BONE T25 FULTHD BLUNT 4MM 8MM 40MM SELF TAP STARDRIVE,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.432S,SUP,HCPCS C1713,,04.025.432S  -  SCREW BONE 4MM 42MM T25 STARDRIVE RECESS ANGULAR STABLE,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.434S,SUP,HCPCS C1713,,04.025.434S  -  SCREW BONE T25 FULTHD BLUNT 4MM 8MM 44MM SELF TAP STARDRIVE,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.436S,SUP,HCPCS C1713,,04.025.436S  -  SCREW BONE T25 FULTHD BLUNT 4MM 8MM 46MM SELF TAP STARDRIVE,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.438S,SUP,HCPCS C1713,,04.025.438S  -  SCREW BONE FULTHD 4MM 48MM LOCKING STARDRIVE RECESS ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.440S,SUP,HCPCS C1713,,04.025.440S  -  SCREW BONE FULTHD 4MM 50MM LOCKING STARDRIVE RECESS ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.442S,SUP,HCPCS C1713,,04.025.442S  -  SCREW BONE FULTHD 4MM 52MM T25 STARDRIVE RECESS LOCKING,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.444S,SUP,HCPCS C1713,,04.025.444S  -  SCREW BONE FULTHD 4MM 54MM LOCKING STARDRIVE RECESS ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.446S,SUP,HCPCS C1713,,04.025.446S  -  SCREW BONE FULTHD 4MM 56MM LOCKING STARDRIVE RECESS ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.448S,SUP,HCPCS C1713,,04.025.448S  -  SCREW BONE FULTHD 4MM 58MM LOCKING STARDRIVE RECESS ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.450S,SUP,HCPCS C1713,,04.025.450S  -  SCREW BONE FULTHD 4MM 60MM LOCKING STARDRIVE RECESS ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.452S,SUP,HCPCS C1713,,04.025.452S  -  SCREW BONE FULTHD 4MM 62MM LOCKING STARDRIVE RECESS ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.454S,SUP,HCPCS C1713,,04.025.454S  -  SCREW BONE FULTHD 4MM 64MM LOCKING STARDRIVE RECESS ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.456S,SUP,HCPCS C1713,,04.025.456S  -  SCREW BONE FULTHD 4MM 66MM LOCKING STARDRIVE RECESS ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.458S,SUP,HCPCS C1713,,04.025.458S  -  SCREW BONE FULTHD 4MM 68MM LOCKING STARDRIVE RECESS ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.460S,SUP,HCPCS C1713,,04.025.460S  -  SCREW BONE FULTHD 4MM 70MM LOCKING STARDRIVE RECESS ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.462S,SUP,HCPCS C1713,,04.025.462S  -  SCREW BONE FULTHD 4MM 72MM LOCKING STARDRIVE RECESS ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.464S,SUP,HCPCS C1713,,04.025.464S  -  SCREW BONE FULTHD 4MM 74MM LOCKING STARDRIVE RECESS ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.466S,SUP,HCPCS C1713,,04.025.466S  -  SCREW BONE FULTHD 4MM 76MM LOCKING STARDRIVE RECESS ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.468S,SUP,HCPCS C1713,,04.025.468S  -  SCREW BONE FULTHD 4MM 78MM LOCKING STARDRIVE RECESS ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.470S,SUP,HCPCS C1713,,04.025.470S  -  SCREW BONE FULTHD 4MM 80MM LOCKING STARDRIVE RECESS ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.520S,SUP,HCPCS C1713,,04.025.520S  -  SCREW BONE FULTHD 5MM 8MM 30MM T25 STARDRIVE RECESS SLFTAP,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.522S,SUP,HCPCS C1713,,04.025.522S  -  SCREW BONE FULTHD 5MM 32MM LOCKING STARDRIVE RECESS ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.524S,SUP,HCPCS C1713,,04.025.524S  -  SCREW BONE FULTHD 5MM 34MM T25 STARDRIVE RECESS LOCKING ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.526S,SUP,HCPCS C1713,,04.025.526S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 36MM SELF TAP STARDRIVE,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.528S,SUP,HCPCS C1713,,04.025.528S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 38MM SELF TAP STARDRIVE,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.530S,SUP,HCPCS C1713,,04.025.530S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 40MM SELF TAP STARDRIVE,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.532S,SUP,HCPCS C1713,,04.025.532S  -  SCREW BONE FULTHD 5MM 8MM 42MM T25 STARDRIVE RECESS SLFTAP,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.534S,SUP,HCPCS C1713,,04.025.534S  -  SCREW BONE FULTHD 5MM 30MM LOCKING STARDRIVE RECESS ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.536S,SUP,HCPCS C1713,,04.025.536S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 46MM SELF TAP STARDRIVE,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.538S,SUP,HCPCS C1713,,04.025.538S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 48MM SELF TAP STARDRIVE,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.540S,SUP,HCPCS C1713,,04.025.540S  -  SCREW BONE FULTHD 5MM 50MM LOCKING STARDRIVE RECESS ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.542S,SUP,HCPCS C1713,,04.025.542S  -  SCREW BONE FULTHD 5MM 52MM LOCKING STARDRIVE RECESS ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.544S,SUP,HCPCS C1713,,04.025.544S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 54MM SELF TAP STARDRIVE,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.546S,SUP,HCPCS C1713,,04.025.546S  -  SCREW BONE FULTHD 5MM 56MM LOCKING STARDRIVE RECESS ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.548S,SUP,HCPCS C1713,,04.025.548S  -  SCREW BONE FULTHD 5MM 58MM T25 STARDRIVE RECESS LOCKING ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.550S,SUP,HCPCS C1713,,04.025.550S  -  SCREW BONE FULTHD 5MM 8MM 60MM T25 STARDRIVE RECESS SLFTAP,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.552S,SUP,HCPCS C1713,,04.025.552S  -  SCREW BONE FULTHD 5MM 8MM 62MM SLFTAP BLUNT TIP T25,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.554S,SUP,HCPCS C1713,,04.025.554S  -  SCREW BONE FULTHD 5MM 64MM LOCKING STARDRIVE RECESS ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.556S,SUP,HCPCS C1713,,04.025.556S  -  SCREW BONE FULTHD 5MM 66MM LOCKING STARDRIVE RECESS ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.558S,SUP,HCPCS C1713,,04.025.558S  -  SCREW BONE FULTHD 5MM 68MM LOCKING STARDRIVE RECESS ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.560S,SUP,HCPCS C1713,,04.025.560S  -  SCREW BONE FULTHD 5MM 70MM LOCKING STARDRIVE RECESS ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.562S,SUP,HCPCS C1713,,04.025.562S  -  SCREW BONE FULTHD 5MM 72MM LOCKING STARDRIVE RECESS ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.564S,SUP,HCPCS C1713,,04.025.564S  -  SCREW BONE FULTHD 5MM 8MM 74MM SLFTAP BLUNT TIP T25,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.566S,SUP,HCPCS C1713,,04.025.566S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 76MM SELF TAP STARDRIVE,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.568S,SUP,HCPCS C1713,,04.025.568S  -  SCREW BONE FULTHD 5MM 78MM LOCKING STARDRIVE RECESS ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.570S,SUP,HCPCS C1713,,04.025.570S  -  SCREW BONE FULTHD 5MM 80MM LOCKING STARDRIVE RECESS ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.575S,SUP,HCPCS C1713,,04.025.575S  -  SCREW BONE T25 FULTHD BLUNT 5MM 8MM 85MM SELF TAP STARDRIVE,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.580S,SUP,HCPCS C1713,,04.025.580S  -  SCREW BONE FULTHD 5MM 90MM LOCKING STARDRIVE RECESS ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.585S,SUP,HCPCS C1713,,04.025.585S  -  SCREW BONE FULTHD 5MM 95MM LOCKING STARDRIVE RECESS ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.590S,SUP,HCPCS C1713,,04.025.590S  -  SCREW BONE FULTHD 5MM 100MM LOCKING STARDRIVE RECESS ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.622S,SUP,HCPCS C1713,,04.025.622S  -  SCREW BONE FULTHD 6MM 32MM LOCKING STARDRIVE RECESS ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.624S,SUP,HCPCS C1713,,04.025.624S  -  SCREW BONE FULTHD 6MM 34MM LOCKING STARDRIVE RECESS ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.626S,SUP,HCPCS C1713,,04.025.626S  -  SCREW BONE FULTHD 6MM 36MM LOCKING STARDRIVE RECESS ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.628S,SUP,HCPCS C1713,,04.025.628S  -  SCREW BONE FULTHD 6MM 38MM LOCKING STARDRIVE RECESS ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.630S,SUP,HCPCS C1713,,04.025.630S  -  SCREW BONE FULTHD 6MM 40MM LOCKING STARDRIVE RECESS ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.632S,SUP,HCPCS C1713,,04.025.632S  -  SCREW BONE FULTHD 6MM 42MM LOCKING STARDRIVE RECESS ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.634S,SUP,HCPCS C1713,,04.025.634S  -  SCREW BONE FULTHD 6MM 44MM LOCKING STARDRIVE RECESS ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.636S,SUP,HCPCS C1713,,04.025.636S  -  SCREW BONE FULTHD 6MM 46MM LOCKING STARDRIVE RECESS ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.638S,SUP,HCPCS C1713,,04.025.638S  -  SCREW BONE FULTHD 6MM 48MM LOCKING STARDRIVE RECESS ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.640S,SUP,HCPCS C1713,,04.025.640S  -  SCREW BONE FULTHD 6MM 50MM LOCKING STARDRIVE RECESS ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.642S,SUP,HCPCS C1713,,04.025.642S  -  SCREW BONE FULTHD 6MM 52MM LOCKING STARDRIVE RECESS ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.644S,SUP,HCPCS C1713,,04.025.644S  -  SCREW BONE FULTHD 6MM 54MM LOCKING STARDRIVE RECESS ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.646S,SUP,HCPCS C1713,,04.025.646S  -  SCREW BONE FULTHD 6MM 56MM LOCKING STARDRIVE RECESS ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.648S,SUP,HCPCS C1713,,04.025.648S  -  SCREW BONE FULTHD 6MM 58MM LOCKING STARDRIVE RECESS ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.650S,SUP,HCPCS C1713,,04.025.650S  -  SCREW BONE FULTHD 6MM 60MM LOCKING STARDRIVE RECESS ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.652S,SUP,HCPCS C1713,,04.025.652S  -  SCREW BONE FULTHD 6MM 62MM LOCKING STARDRIVE RECESS ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.654S,SUP,HCPCS C1713,,04.025.654S  -  SCREW BONE FULTHD 6MM 64MM LOCKING STARDRIVE RECESS ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.656S,SUP,HCPCS C1713,,04.025.656S  -  SCREW BONE FULTHD 6MM 66MM LOCKING STARDRIVE RECESS ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.658S,SUP,HCPCS C1713,,04.025.658S  -  SCREW BONE FULTHD 6MM 68MM LOCKING STARDRIVE RECESS ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.660S,SUP,HCPCS C1713,,04.025.660S  -  SCREW BONE FULTHD 6MM 70MM LOCKING STARDRIVE RECESS ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.662S,SUP,HCPCS C1713,,04.025.662S  -  SCREW BONE FULTHD 6MM 72MM LOCKING STARDRIVE RECESS ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.664S,SUP,HCPCS C1713,,04.025.664S  -  SCREW BONE FULTHD 6MM 74MM LOCKING STARDRIVE RECESS ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.666S,SUP,HCPCS C1713,,04.025.666S  -  SCREW BONE FULTHD 6MM 78MM LOCKING STARDRIVE RECESS ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.668S,SUP,HCPCS C1713,,04.025.668S  -  SCREW BONE FULTHD 6MM 78MM LOCKING STARDRIVE RECESS ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.670S,SUP,HCPCS C1713,,04.025.670S  -  SCREW BONE FULTHD 6MM 80MM LOCKING STARDRIVE RECESS ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.675S,SUP,HCPCS C1713,,04.025.675S  -  SCREW BONE FULTHD 6MM 85MM LOCKING STARDRIVE RECESS ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.680S,SUP,HCPCS C1713,,04.025.680S  -  SCREW BONE FULTHD 6MM 90MM LOCKING STARDRIVE RECESS ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.685S,SUP,HCPCS C1713,,04.025.685S  -  SCREW BONE FULTHD 6MM 95MM LOCKING STARDRIVE RECESS ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.690S,SUP,HCPCS C1713,,04.025.690S  -  SCREW BONE FULTHD 6MM 100MM LOCKING STARDRIVE RECESS ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.695S,SUP,HCPCS C1713,,04.025.695S  -  SCREW BONE FULTHD 6MM 105MM LOCKING STARDRIVE RECESS ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.700S,SUP,HCPCS C1713,,04.025.700S  -  SCREW BONE FULTHD 6MM 110MM LOCKING STARDRIVE RECESS ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.705S,SUP,HCPCS C1713,,04.025.705S  -  SCREW BONE FULTHD 6MM 115MM LOCKING STARDRIVE RECESS ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.710S,SUP,HCPCS C1713,,04.025.710S  -  SCREW BONE FULTHD 6MM 120MM LOCKING STARDRIVE RECESS ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.025.715S,SUP,HCPCS C1713,,04.025.715S  -  SCREW BONE FULTHD 6MM 125MM LOCKING STARDRIVE RECESS ASLS,$406.48,$0.00,$406.48,$182.91,$290.10,$0.00,$67.99,$0.00,$0.00,$71.17,$406.48,$0.00,$203.24,$321.93,$325.18,$0.00,$61.76,$0.00,$64.71,$0.00
04.030.030S,SUP,HCPCS C1713,,04.030.030S  -  NAIL 10MM 30CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.031S,SUP,HCPCS C1713,,04.030.031S  -  NAIL 10MM 30CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.032S,SUP,HCPCS C1713,,04.030.032S  -  NAIL 10MM 32CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.033S,SUP,HCPCS C1713,,04.030.033S  -  NAIL 10MM 32CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.034S,SUP,HCPCS C1713,,04.030.034S  -  NAIL 10MM 34CM RIGHT FEM NLEX IM CANN TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.035S,SUP,HCPCS C1713,,04.030.035S  -  NAIL 10MM 34CM LEFT FEM NLEX IM CANN TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.036S,SUP,HCPCS C1713,,04.030.036S  -  NAIL 10MM 36CM RIGHT FEM NLEX IM CANN TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.037S,SUP,HCPCS C1713,,04.030.037S  -  NAIL 10MM 36CM LEFT FEM NLEX IM CANN TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.038S,SUP,HCPCS C1713,,04.030.038S  -  NAIL 10MM 38CM RIGHT FEM NLEX IM CANN TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.039S,SUP,HCPCS C1713,,04.030.039S  -  NAIL 10MM 38CM LEFT FEM NLEX IM CANN TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.040S,SUP,HCPCS C1713,,04.030.040S  -  NAIL 10MM 40CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.041S,SUP,HCPCS C1713,,04.030.041S  -  NAIL 10MM 40CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.042S,SUP,HCPCS C1713,,04.030.042S  -  NAIL 10MM 42CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.043S,SUP,HCPCS C1713,,04.030.043S  -  NAIL 10MM 42CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL GRN,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.044S,SUP,HCPCS C1713,,04.030.044S  -  NAIL 10MM 44CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.045S,SUP,HCPCS C1713,,04.030.045S  -  NAIL 10MM 44CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.046S,SUP,HCPCS C1713,,04.030.046S  -  NAIL 10MM 46CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.047S,SUP,HCPCS C1713,,04.030.047S  -  NAIL 10MM 46CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.048S,SUP,HCPCS C1713,,04.030.048S  -  NAIL 10MM 48CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.049S,SUP,HCPCS C1713,,04.030.049S  -  NAIL 10MM 48CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.130S,SUP,HCPCS C1713,,04.030.130S  -  NAIL 11MM 30CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.131S,SUP,HCPCS C1713,,04.030.131S  -  NAIL 11MM 30CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.132S,SUP,HCPCS C1713,,04.030.132S  -  NAIL 11MM 32CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.133S,SUP,HCPCS C1713,,04.030.133S  -  NAIL 11MM 32CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.134S,SUP,HCPCS C1713,,04.030.134S  -  NAIL IM 11MM 340MM LGHT GRN STRL NLEX CNN LAT ENTRY TI AL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.135S,SUP,HCPCS C1713,,04.030.135S  -  NAIL 11MM 34CM LEFT FEM NLEX IM CANN TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.136S,SUP,HCPCS C1713,,04.030.136S  -  NAIL 11MM 36CM RIGHT FEM NLEX IM CANN TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.137S,SUP,HCPCS C1713,,04.030.137S  -  NAIL 11MM 36CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.138S,SUP,HCPCS C1713,,04.030.138S  -  NAIL 11MM 38CM RIGHT FEM NLEX IM CANN TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.139S,SUP,HCPCS C1713,,04.030.139S  -  NAIL 11MM 38CM LEFT FEM NLEX IM CANN TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.140S,SUP,HCPCS C1713,,04.030.140S  -  NAIL 11MM 40CM RIGHT FEM NLEX IM CANN TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.141S,SUP,HCPCS C1713,,04.030.141S  -  NAIL 11MM 40CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.142S,SUP,HCPCS C1713,,04.030.142S  -  NAIL 11MM 42CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.143S,SUP,HCPCS C1713,,04.030.143S  -  NAIL 11MM 42CM LEFT FEM NLEX IM CANN TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.144S,SUP,HCPCS C1713,,04.030.144S  -  NAIL 11MM 44CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.145S,SUP,HCPCS C1713,,04.030.145S  -  NAIL 11MM 44CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.146S,SUP,HCPCS C1713,,04.030.146S  -  NAIL 11MM 46CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.147S,SUP,HCPCS C1713,,04.030.147S  -  NAIL 11MM 46CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.148S,SUP,HCPCS C1713,,04.030.148S  -  NAIL 11MM 48CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.149S,SUP,HCPCS C1713,,04.030.149S  -  NAIL 11MM 48CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.230S,SUP,HCPCS C1713,,04.030.230S  -  NAIL 12MM 30CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.231S,SUP,HCPCS C1713,,04.030.231S  -  NAIL 12MM 30CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.232S,SUP,HCPCS C1713,,04.030.232S  -  NAIL 12MM 32CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.233S,SUP,HCPCS C1713,,04.030.233S  -  NAIL 12MM 32CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.234S,SUP,HCPCS C1713,,04.030.234S  -  NAIL 12MM 34CM RIGHT FEM NLEX IM CANN TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.235S,SUP,HCPCS C1713,,04.030.235S  -  NAIL 12MM 34CM LEFT FEM NLEX IM CANN TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.236S,SUP,HCPCS C1713,,04.030.236S  -  NAIL 12MM 36CM RIGHT FEM NLEX IM CANN TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.237S,SUP,HCPCS C1713,,04.030.237S  -  NAIL 12MM 36CM LEFT FEM NLEX IM CANN TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.238S,SUP,HCPCS C1713,,04.030.238S  -  NAIL 12MM 38CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.239S,SUP,HCPCS C1713,,04.030.239S  -  NAIL 12MM 38CM LEFT FEM NLEX IM CANN TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.240S,SUP,HCPCS C1713,,04.030.240S  -  NAIL 12MM 40CM RIGHT FEM NLEX IM CANN TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.241S,SUP,HCPCS C1713,,04.030.241S  -  NAIL 12MM 40CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.242S,SUP,HCPCS C1713,,04.030.242S  -  NAIL 12MM 42CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.243S,SUP,HCPCS C1713,,04.030.243S  -  NAIL 12MM 42CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.244S,SUP,HCPCS C1713,,04.030.244S  -  NAIL 12MM 44CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.245S,SUP,HCPCS C1713,,04.030.245S  -  NAIL 12MM 44CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.246S,SUP,HCPCS C1713,,04.030.246S  -  NAIL 12MM 46CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.247S,SUP,HCPCS C1713,,04.030.247S  -  NAIL 12MM 46CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.248S,SUP,HCPCS C1713,,04.030.248S  -  NAIL 12MM 48CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.249S,SUP,HCPCS C1713,,04.030.249S  -  NAIL 12MM 48CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.330S,SUP,HCPCS C1713,,04.030.330S  -  NAIL 13MM 30CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.331S,SUP,HCPCS C1713,,04.030.331S  -  NAIL 13MM 30CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.332S,SUP,HCPCS C1713,,04.030.332S  -  NAIL 13MM 32CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.333S,SUP,HCPCS C1713,,04.030.333S  -  NAIL 13MM 32CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.334S,SUP,HCPCS C1713,,04.030.334S  -  NAIL 13MM 34CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.335S,SUP,HCPCS C1713,,04.030.335S  -  NAIL 13MM 34CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.336S,SUP,HCPCS C1713,,04.030.336S  -  NAIL 13MM 36CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.337S,SUP,HCPCS C1713,,04.030.337S  -  NAIL 13MM 36CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.338S,SUP,HCPCS C1713,,04.030.338S  -  NAIL 13MM 38CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.339S,SUP,HCPCS C1713,,04.030.339S  -  NAIL 13MM 38CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.340S,SUP,HCPCS C1713,,04.030.340S  -  NAIL 13MM 40CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.341S,SUP,HCPCS C1713,,04.030.341S  -  NAIL 13MM 40CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.342S,SUP,HCPCS C1713,,04.030.342S  -  NAIL 13MM 42CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.343S,SUP,HCPCS C1713,,04.030.343S  -  NAIL 13MM 42CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.344S,SUP,HCPCS C1713,,04.030.344S  -  NAIL 13MM 44CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.345S,SUP,HCPCS C1713,,04.030.345S  -  NAIL 13MM 44CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.346S,SUP,HCPCS C1713,,04.030.346S  -  NAIL 13MM 46CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.347S,SUP,HCPCS C1713,,04.030.347S  -  NAIL 13MM 46CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.348S,SUP,HCPCS C1713,,04.030.348S  -  NAIL 13MM 48CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.349S,SUP,HCPCS C1713,,04.030.349S  -  NAIL 13MM 48CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.430S,SUP,HCPCS C1713,,04.030.430S  -  NAIL 14MM 30CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.431S,SUP,HCPCS C1713,,04.030.431S  -  NAIL 14MM 30CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.432S,SUP,HCPCS C1713,,04.030.432S  -  NAIL 14MM 32CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.433S,SUP,HCPCS C1713,,04.030.433S  -  NAIL 14MM 32CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.434S,SUP,HCPCS C1713,,04.030.434S  -  NAIL 14MM 34CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.435S,SUP,HCPCS C1713,,04.030.435S  -  NAIL 14MM 34CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.436S,SUP,HCPCS C1713,,04.030.436S  -  NAIL 14MM 36CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.437S,SUP,HCPCS C1713,,04.030.437S  -  NAIL 14MM 36CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.438S,SUP,HCPCS C1713,,04.030.438S  -  NAIL 14MM 38CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.439S,SUP,HCPCS C1713,,04.030.439S  -  NAIL 14MM 38CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.440S,SUP,HCPCS C1713,,04.030.440S  -  NAIL 14MM 40CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.441S,SUP,HCPCS C1713,,04.030.441S  -  NAIL 14MM 40CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.442S,SUP,HCPCS C1713,,04.030.442S  -  NAIL 14MM 42CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.443S,SUP,HCPCS C1713,,04.030.443S  -  NAIL 14MM 42CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.444S,SUP,HCPCS C1713,,04.030.444S  -  NAIL 14MM 44CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.445S,SUP,HCPCS C1713,,04.030.445S  -  NAIL 14MM 44CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.446S,SUP,HCPCS C1713,,04.030.446S  -  NAIL 14MM 46CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.447S,SUP,HCPCS C1713,,04.030.447S  -  NAIL 14MM 46CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.448S,SUP,HCPCS C1713,,04.030.448S  -  NAIL 14MM 48CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.449S,SUP,HCPCS C1713,,04.030.449S  -  NAIL 14MM 48CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.530S,SUP,HCPCS C1713,,04.030.530S  -  NAIL 15MM 30CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.531S,SUP,HCPCS C1713,,04.030.531S  -  NAIL 15MM 30CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.532S,SUP,HCPCS C1713,,04.030.532S  -  NAIL 15MM 32CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.533S,SUP,HCPCS C1713,,04.030.533S  -  NAIL 15MM 32CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.534S,SUP,HCPCS C1713,,04.030.534S  -  NAIL 15MM 34CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.535S,SUP,HCPCS C1713,,04.030.535S  -  NAIL 15MM 34CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.536S,SUP,HCPCS C1713,,04.030.536S  -  NAIL 15MM 36CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.537S,SUP,HCPCS C1713,,04.030.537S  -  NAIL 15MM 36CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.538S,SUP,HCPCS C1713,,04.030.538S  -  NAIL 15MM 38CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.539S,SUP,HCPCS C1713,,04.030.539S  -  NAIL 15MM 38CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.540S,SUP,HCPCS C1713,,04.030.540S  -  NAIL 15MM 40CM FEM NLEX IM CANN PROX BND TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.541S,SUP,HCPCS C1713,,04.030.541S  -  NAIL 15MM 40CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.542S,SUP,HCPCS C1713,,04.030.542S  -  NAIL 15MM 42CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.543S,SUP,HCPCS C1713,,04.030.543S  -  NAIL 15MM 42CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.544S,SUP,HCPCS C1713,,04.030.544S  -  NAIL 15MM 44CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.545S,SUP,HCPCS C1713,,04.030.545S  -  NAIL 15MM 44CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.546S,SUP,HCPCS C1713,,04.030.546S  -  NAIL 15MM 46CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.547S,SUP,HCPCS C1713,,04.030.547S  -  NAIL 15MM 46CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.548S,SUP,HCPCS C1713,,04.030.548S  -  NAIL 15MM 48CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.549S,SUP,HCPCS C1713,,04.030.549S  -  NAIL 15MM 48CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.630S,SUP,HCPCS C1713,,04.030.630S  -  NAIL 16MM 30CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.631S,SUP,HCPCS C1713,,04.030.631S  -  NAIL 16MM 30CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.632S,SUP,HCPCS C1713,,04.030.632S  -  NAIL 16MM 32CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.633S,SUP,HCPCS C1713,,04.030.633S  -  NAIL 16MM 32CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.634S,SUP,HCPCS C1713,,04.030.634S  -  NAIL 16MM 34CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.635S,SUP,HCPCS C1713,,04.030.635S  -  NAIL 16MM 34CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.636S,SUP,HCPCS C1713,,04.030.636S  -  NAIL 16MM 36CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.637S,SUP,HCPCS C1713,,04.030.637S  -  NAIL 16MM 36CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.638S,SUP,HCPCS C1713,,04.030.638S  -  NAIL 16MM 38CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.639S,SUP,HCPCS C1713,,04.030.639S  -  NAIL 16MM 38CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.640S,SUP,HCPCS C1713,,04.030.640S  -  NAIL 16MM 40CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.641S,SUP,HCPCS C1713,,04.030.641S  -  NAIL 16MM 40CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.642S,SUP,HCPCS C1713,,04.030.642S  -  NAIL 16MM 42CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.643S,SUP,HCPCS C1713,,04.030.643S  -  NAIL 16MM 42CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.644S,SUP,HCPCS C1713,,04.030.644S  -  NAIL 16MM 44CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.645S,SUP,HCPCS C1713,,04.030.645S  -  NAIL 16MM 44CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.646S,SUP,HCPCS C1713,,04.030.646S  -  NAIL 16MM 46CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.647S,SUP,HCPCS C1713,,04.030.647S  -  NAIL 16MM 46CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.648S,SUP,HCPCS C1713,,04.030.648S  -  NAIL 16MM 48CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.649S,SUP,HCPCS C1713,,04.030.649S  -  NAIL 16MM 48CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.930S,SUP,HCPCS C1713,,04.030.930S  -  NAIL 9MM 30CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.931S,SUP,HCPCS C1713,,04.030.931S  -  NAIL 9MM 30CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.932S,SUP,HCPCS C1713,,04.030.932S  -  NAIL 9MM 320MM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.933S,SUP,HCPCS C1713,,04.030.933S  -  NAIL 9MM 320MM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.934S,SUP,HCPCS C1713,,04.030.934S  -  NAIL 9MM 340MM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.935S,SUP,HCPCS C1713,,04.030.935S  -  NAIL 9MM 340MM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.936S,SUP,HCPCS C1713,,04.030.936S  -  NAIL 9MM 360MM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.937S,SUP,HCPCS C1713,,04.030.937S  -  NAIL 9MM 36CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.938S,SUP,HCPCS C1713,,04.030.938S  -  NAIL 9MM 380MM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.939S,SUP,HCPCS C1713,,04.030.939S  -  NAIL 9MM 380MM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.940S,SUP,HCPCS C1713,,04.030.940S  -  NAIL 9MM 400MM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.941S,SUP,HCPCS C1713,,04.030.941S  -  NAIL 9MM 400MM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.942S,SUP,HCPCS C1713,,04.030.942S  -  NAIL 9MM 420MM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.943S,SUP,HCPCS C1713,,04.030.943S  -  NAIL 9MM 420MM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.944S,SUP,HCPCS C1713,,04.030.944S  -  NAIL 9MM 44CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.945S,SUP,HCPCS C1713,,04.030.945S  -  NAIL 9MM 44CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.946S,SUP,HCPCS C1713,,04.030.946S  -  NAIL 9MM 46CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.947S,SUP,HCPCS C1713,,04.030.947S  -  NAIL 9MM 46CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.948S,SUP,HCPCS C1713,,04.030.948S  -  NAIL 9MM 48CM RIGHT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.030.949S,SUP,HCPCS C1713,,04.030.949S  -  NAIL 9MM 48CM LEFT FEM NLEX IM CANN LAT ENTRY TI STRL,"$3,685.58",$0.00,"$3,685.58","$1,658.51","$2,630.39",$0.00,$635.01,$0.00,$0.00,$645.31,"$3,685.58",$0.00,"$1,842.79","$2,918.98","$2,948.46",$0.00,$576.79,$0.00,$586.74,$0.00
04.031.000S,SUP,HCPCS C1713,,04.031.000S  -  CAP END 0MM T40 STARDRIVE RECESS CANN LATERAL ENTRY NAIL-EX,$378.03,$0.00,$378.03,$170.11,$269.80,$0.00,$63.24,$0.00,$0.00,$66.19,$378.03,$0.00,$189.01,$299.40,$302.42,$0.00,$57.44,$0.00,$60.18,$0.00
04.031.001S,SUP,HCPCS C1713,,04.031.001S  -  CAP END 5MM T40 LATERAL ENTRY EXTN STARDRIVE RECESS NAIL-EX,$378.03,$0.00,$378.03,$170.11,$269.80,$0.00,$63.24,$0.00,$0.00,$66.19,$378.03,$0.00,$189.01,$299.40,$302.42,$0.00,$57.44,$0.00,$60.18,$0.00
04.031.002S,SUP,HCPCS C1713,,04.031.002S  -  CAP END 10MM T40 EXTENDED STARDRIVE RECESS NAIL-EX TITANIUM,$378.03,$0.00,$378.03,$170.11,$269.80,$0.00,$63.24,$0.00,$0.00,$66.19,$378.03,$0.00,$189.01,$299.40,$302.42,$0.00,$57.44,$0.00,$60.18,$0.00
04.031.003S,SUP,HCPCS C1713,,04.031.003S  -  CAP END 15MM T40 LATERAL ENTRY EXTN STARDRIVE RECESS NAIL-EX,$378.03,$0.00,$378.03,$170.11,$269.80,$0.00,$63.24,$0.00,$0.00,$66.19,$378.03,$0.00,$189.01,$299.40,$302.42,$0.00,$57.44,$0.00,$60.18,$0.00
04.031.021,SUP,HCPCS C1713,,04.031.021  -  SCREW BONE PTHRD 5MM 55MM T25 STARDRIVE RECESS SLFTAP BLUNT,$312.53,$0.00,$312.53,$140.64,$223.05,$0.00,$52.28,$0.00,$0.00,$54.72,$312.53,$0.00,$156.26,$247.52,$250.02,$0.00,$47.49,$0.00,$49.75,$0.00
04.031.022,SUP,HCPCS C1713,,04.031.022  -  SCREW BONE PTHRD 5MM 60MM T25 STARDRIVE RECESS SLFTAP BLUNT,$312.53,$0.00,$312.53,$140.64,$223.05,$0.00,$52.28,$0.00,$0.00,$54.72,$312.53,$0.00,$156.26,$247.52,$250.02,$0.00,$47.49,$0.00,$49.75,$0.00
04.031.023,SUP,HCPCS C1713,,04.031.023  -  SCREW BONE STANDARD PTHRD BLUNT 5MM 8.2MM 65MM SELF TAP SELF,$312.53,$0.00,$312.53,$140.64,$223.05,$0.00,$52.28,$0.00,$0.00,$54.72,$312.53,$0.00,$156.26,$247.52,$250.02,$0.00,$47.49,$0.00,$49.75,$0.00
04.031.024,SUP,HCPCS C1713,,04.031.024  -  SCREW BONE STANDARD PTHRD BLUNT 5MM 8.2MM 70MM SELF TAP SELF,$312.53,$0.00,$312.53,$140.64,$223.05,$0.00,$52.28,$0.00,$0.00,$54.72,$312.53,$0.00,$156.26,$247.52,$250.02,$0.00,$47.49,$0.00,$49.75,$0.00
04.031.025,SUP,HCPCS C1713,,04.031.025  -  SCREW BONE PTHRD 5MM 75MM RECONSTRUCTION STARDRIVE RECESS,$312.53,$0.00,$312.53,$140.64,$223.05,$0.00,$52.28,$0.00,$0.00,$54.72,$312.53,$0.00,$156.26,$247.52,$250.02,$0.00,$47.49,$0.00,$49.75,$0.00
04.031.026,SUP,HCPCS C1713,,04.031.026  -  SCREW BONE PTHRD 5MM 80MM RECONSTRUCTION STARDRIVE RECESS,$312.53,$0.00,$312.53,$140.64,$223.05,$0.00,$52.28,$0.00,$0.00,$54.72,$312.53,$0.00,$156.26,$247.52,$250.02,$0.00,$47.49,$0.00,$49.75,$0.00
04.031.027,SUP,HCPCS C1713,,04.031.027  -  SCREW BONE PTHRD 5MM 85MM RECONSTRUCTION STARDRIVE RECESS,$312.53,$0.00,$312.53,$140.64,$223.05,$0.00,$52.28,$0.00,$0.00,$54.72,$312.53,$0.00,$156.26,$247.52,$250.02,$0.00,$47.49,$0.00,$49.75,$0.00
04.031.028,SUP,HCPCS C1713,,04.031.028  -  SCREW BONE PTHRD 5MM 90MM RECONSTRUCTION STARDRIVE RECESS,$312.53,$0.00,$312.53,$140.64,$223.05,$0.00,$52.28,$0.00,$0.00,$54.72,$312.53,$0.00,$156.26,$247.52,$250.02,$0.00,$47.49,$0.00,$49.75,$0.00
04.031.029,SUP,HCPCS C1713,,04.031.029  -  SCREW BONE PTHRD 5MM 3.2MM 95MM T25 STARDRIVE RECESS,$312.53,$0.00,$312.53,$140.64,$223.05,$0.00,$52.28,$0.00,$0.00,$54.72,$312.53,$0.00,$156.26,$247.52,$250.02,$0.00,$47.49,$0.00,$49.75,$0.00
04.031.030,SUP,HCPCS C1713,,04.031.030  -  SCREW BONE PTHRD 5MM 100MM RECONSTRUCTION STARDRIVE RECESS,$312.53,$0.00,$312.53,$140.64,$223.05,$0.00,$52.28,$0.00,$0.00,$54.72,$312.53,$0.00,$156.26,$247.52,$250.02,$0.00,$47.49,$0.00,$49.75,$0.00
04.031.031,SUP,HCPCS C1713,,04.031.031  -  SCREW BONE PTHRD 5MM 105MM RECONSTRUCTION STARDRIVE RECESS,$312.53,$0.00,$312.53,$140.64,$223.05,$0.00,$52.28,$0.00,$0.00,$54.72,$312.53,$0.00,$156.26,$247.52,$250.02,$0.00,$47.49,$0.00,$49.75,$0.00
04.031.032,SUP,HCPCS C1713,,04.031.032  -  SCREW BONE PTHRD 5MM 110MM RECONSTRUCTION STARDRIVE RECESS,$312.53,$0.00,$312.53,$140.64,$223.05,$0.00,$52.28,$0.00,$0.00,$54.72,$312.53,$0.00,$156.26,$247.52,$250.02,$0.00,$47.49,$0.00,$49.75,$0.00
04.031.033,SUP,HCPCS C1713,,04.031.033  -  SCREW BONE PTHRD 5MM 115MM RECONSTRUCTION STARDRIVE RECESS,$312.53,$0.00,$312.53,$140.64,$223.05,$0.00,$52.28,$0.00,$0.00,$54.72,$312.53,$0.00,$156.26,$247.52,$250.02,$0.00,$47.49,$0.00,$49.75,$0.00
04.031.034,SUP,HCPCS C1713,,04.031.034  -  SCREW BONE PTHRD 5MM 120MM RECONSTRUCTION STARDRIVE RECESS,$312.53,$0.00,$312.53,$140.64,$223.05,$0.00,$52.28,$0.00,$0.00,$54.72,$312.53,$0.00,$156.26,$247.52,$250.02,$0.00,$47.49,$0.00,$49.75,$0.00
04.031.035,SUP,HCPCS C1713,,04.031.035  -  SCREW BONE PTHRD 5MM 125MM RECONSTRUCTION STARDRIVE RECESS,$312.53,$0.00,$312.53,$140.64,$223.05,$0.00,$52.28,$0.00,$0.00,$54.72,$312.53,$0.00,$156.26,$247.52,$250.02,$0.00,$47.49,$0.00,$49.75,$0.00
04.031.924S,SUP,HCPCS C1713,,04.031.924S  -  NAIL INTRAMEDULLARY 8.2MM 240MM LATERAL ENTRY EXPERT,"$2,725.40",$0.00,"$2,725.40","$1,226.43","$1,945.12",$0.00,$455.90,$0.00,$0.00,$477.20,"$2,725.40",$0.00,"$1,362.70","$2,158.52","$2,180.32",$0.00,$414.10,$0.00,$433.88,$0.00
04.031.925S,SUP,HCPCS C1713,,04.031.925S  -  NAIL INTRAMEDULLARY 8.2MM 240MM LATERAL ENTRY EXPERT,"$2,725.40",$0.00,"$2,725.40","$1,226.43","$1,945.12",$0.00,$455.90,$0.00,$0.00,$477.20,"$2,725.40",$0.00,"$1,362.70","$2,158.52","$2,180.32",$0.00,$414.10,$0.00,$433.88,$0.00
04.031.926S,SUP,HCPCS C1713,,04.031.926S  -  NAIL INTRAMEDULLARY 8.2MM 260MM LATERAL ENTRY EXPERT,"$2,725.40",$0.00,"$2,725.40","$1,226.43","$1,945.12",$0.00,$455.90,$0.00,$0.00,$477.20,"$2,725.40",$0.00,"$1,362.70","$2,158.52","$2,180.32",$0.00,$414.10,$0.00,$433.88,$0.00
04.031.927S,SUP,HCPCS C1713,,04.031.927S  -  NAIL INTRAMEDULLARY 8.2MM 260MM LATERAL ENTRY EXPERT,"$2,725.40",$0.00,"$2,725.40","$1,226.43","$1,945.12",$0.00,$455.90,$0.00,$0.00,$477.20,"$2,725.40",$0.00,"$1,362.70","$2,158.52","$2,180.32",$0.00,$414.10,$0.00,$433.88,$0.00
04.031.928S,SUP,HCPCS C1713,,04.031.928S  -  NAIL INTRAMEDULLARY 8.2MM 280MM LATERAL ENTRY EXPERT,"$2,725.40",$0.00,"$2,725.40","$1,226.43","$1,945.12",$0.00,$455.90,$0.00,$0.00,$477.20,"$2,725.40",$0.00,"$1,362.70","$2,158.52","$2,180.32",$0.00,$414.10,$0.00,$433.88,$0.00
04.031.929S,SUP,HCPCS C1713,,04.031.929S  -  NAIL INTRAMEDULLARY 8.2MM 280MM LATERAL ENTRY EXPERT,"$2,725.40",$0.00,"$2,725.40","$1,226.43","$1,945.12",$0.00,$455.90,$0.00,$0.00,$477.20,"$2,725.40",$0.00,"$1,362.70","$2,158.52","$2,180.32",$0.00,$414.10,$0.00,$433.88,$0.00
04.031.930S,SUP,HCPCS C1713,,04.031.930S  -  NAIL INTRAMEDULLARY 8.2MM 300MM LATERAL ENTRY EXPERT,"$2,725.40",$0.00,"$2,725.40","$1,226.43","$1,945.12",$0.00,$455.90,$0.00,$0.00,$477.20,"$2,725.40",$0.00,"$1,362.70","$2,158.52","$2,180.32",$0.00,$414.10,$0.00,$433.88,$0.00
04.031.931S,SUP,HCPCS C1713,,04.031.931S  -  NAIL INTRAMEDULLARY 8.2MM 300MM LATERAL ENTRY EXPERT,"$2,725.40",$0.00,"$2,725.40","$1,226.43","$1,945.12",$0.00,$455.90,$0.00,$0.00,$477.20,"$2,725.40",$0.00,"$1,362.70","$2,158.52","$2,180.32",$0.00,$414.10,$0.00,$433.88,$0.00
04.031.932S,SUP,HCPCS C1713,,04.031.932S  -  NAIL INTRAMEDULLARY 8.2MM 320MM LATERAL ENTRY TITANIUM,"$2,725.40",$0.00,"$2,725.40","$1,226.43","$1,945.12",$0.00,$455.90,$0.00,$0.00,$477.20,"$2,725.40",$0.00,"$1,362.70","$2,158.52","$2,180.32",$0.00,$414.10,$0.00,$433.88,$0.00
04.031.933S,SUP,HCPCS C1713,,04.031.933S  -  NAIL INTRAMEDULLARY 8.2MM LATERAL ENTRY TITANIUM PEDIATRIC,"$2,725.40",$0.00,"$2,725.40","$1,226.43","$1,945.12",$0.00,$455.90,$0.00,$0.00,$477.20,"$2,725.40",$0.00,"$1,362.70","$2,158.52","$2,180.32",$0.00,$414.10,$0.00,$433.88,$0.00
04.031.934S,SUP,HCPCS C1713,,04.031.934S  -  NAIL INTRAMEDULLARY 8.2MM LATERAL ENTRY TITANIUM PEDIATRIC,"$2,725.40",$0.00,"$2,725.40","$1,226.43","$1,945.12",$0.00,$455.90,$0.00,$0.00,$477.20,"$2,725.40",$0.00,"$1,362.70","$2,158.52","$2,180.32",$0.00,$414.10,$0.00,$433.88,$0.00
04.031.935S,SUP,HCPCS C1713,,04.031.935S  -  NAIL INTRAMEDULLARY 8.2MM 340MM LATERAL ENTRY NAIL-EX,"$2,725.40",$0.00,"$2,725.40","$1,226.43","$1,945.12",$0.00,$455.90,$0.00,$0.00,$477.20,"$2,725.40",$0.00,"$1,362.70","$2,158.52","$2,180.32",$0.00,$414.10,$0.00,$433.88,$0.00
04.031.936S,SUP,HCPCS C1713,,04.031.936S  -  NAIL INTRAMEDULLARY 8.2MM LATERAL ENTRY TITANIUM PEDIATRIC,"$2,725.40",$0.00,"$2,725.40","$1,226.43","$1,945.12",$0.00,$455.90,$0.00,$0.00,$477.20,"$2,725.40",$0.00,"$1,362.70","$2,158.52","$2,180.32",$0.00,$414.10,$0.00,$433.88,$0.00
04.031.937S,SUP,HCPCS C1713,,04.031.937S  -  NAIL INTRAMEDULLARY 8.2MM LATERAL ENTRY TITANIUM PEDIATRIC,"$2,725.40",$0.00,"$2,725.40","$1,226.43","$1,945.12",$0.00,$455.90,$0.00,$0.00,$477.20,"$2,725.40",$0.00,"$1,362.70","$2,158.52","$2,180.32",$0.00,$414.10,$0.00,$433.88,$0.00
04.031.938S,SUP,HCPCS C1713,,04.031.938S  -  NAIL INTRAMEDULLARY 380MM CANN LATERAL ENTRY NAIL-EX,"$2,725.40",$0.00,"$2,725.40","$1,226.43","$1,945.12",$0.00,$455.90,$0.00,$0.00,$477.20,"$2,725.40",$0.00,"$1,362.70","$2,158.52","$2,180.32",$0.00,$414.10,$0.00,$433.88,$0.00
04.031.939S,SUP,HCPCS C1713,,04.031.939S  -  NAIL INTRAMEDULLARY 380MM CANN LATERAL ENTRY NAIL-EX,"$2,725.40",$0.00,"$2,725.40","$1,226.43","$1,945.12",$0.00,$455.90,$0.00,$0.00,$477.20,"$2,725.40",$0.00,"$1,362.70","$2,158.52","$2,180.32",$0.00,$414.10,$0.00,$433.88,$0.00
04.031.940S,SUP,HCPCS C1713,,04.031.940S  -  NAIL INTRAMEDULLARY 8.2MM 400MM LATERAL ENTRY EXPERT,"$2,725.40",$0.00,"$2,725.40","$1,226.43","$1,945.12",$0.00,$455.90,$0.00,$0.00,$477.20,"$2,725.40",$0.00,"$1,362.70","$2,158.52","$2,180.32",$0.00,$414.10,$0.00,$433.88,$0.00
04.031.941S,SUP,HCPCS C1713,,04.031.941S  -  NAIL INTRAMEDULLARY 8.2MM 400MM LATERAL ENTRY EXPERT,"$2,725.40",$0.00,"$2,725.40","$1,226.43","$1,945.12",$0.00,$455.90,$0.00,$0.00,$477.20,"$2,725.40",$0.00,"$1,362.70","$2,158.52","$2,180.32",$0.00,$414.10,$0.00,$433.88,$0.00
04.031.944S,SUP,HCPCS C1713,,04.031.944S  -  NAIL INTRAMEDULLARY 9MM 240MM LATERAL ENTRY CANN EXPERT DARK,"$2,725.40",$0.00,"$2,725.40","$1,226.43","$1,945.12",$0.00,$455.90,$0.00,$0.00,$477.20,"$2,725.40",$0.00,"$1,362.70","$2,158.52","$2,180.32",$0.00,$414.10,$0.00,$433.88,$0.00
04.031.945S,SUP,HCPCS C1713,,04.031.945S  -  NAIL INTRAMEDULLARY 9MM 240MM LATERAL ENTRY CANN EXPERT DARK,"$2,725.40",$0.00,"$2,725.40","$1,226.43","$1,945.12",$0.00,$455.90,$0.00,$0.00,$477.20,"$2,725.40",$0.00,"$1,362.70","$2,158.52","$2,180.32",$0.00,$414.10,$0.00,$433.88,$0.00
04.031.946S,SUP,HCPCS C1713,,04.031.946S  -  NAIL INTRAMEDULLARY 9MM 260MM LATERAL ENTRY CANN EXPERT DARK,"$2,725.40",$0.00,"$2,725.40","$1,226.43","$1,945.12",$0.00,$455.90,$0.00,$0.00,$477.20,"$2,725.40",$0.00,"$1,362.70","$2,158.52","$2,180.32",$0.00,$414.10,$0.00,$433.88,$0.00
04.031.947S,SUP,HCPCS C1713,,04.031.947S  -  NAIL INTRAMEDULLARY 9MM 260MM LATERAL ENTRY IMPLANT NAIL-EX,"$2,725.40",$0.00,"$2,725.40","$1,226.43","$1,945.12",$0.00,$455.90,$0.00,$0.00,$477.20,"$2,725.40",$0.00,"$1,362.70","$2,158.52","$2,180.32",$0.00,$414.10,$0.00,$433.88,$0.00
04.031.948S,SUP,HCPCS C1713,,04.031.948S  -  NAIL INTRAMEDULLARY 9MM 280MM LATERAL ENTRY IMPLANT NAIL-EX,"$2,725.40",$0.00,"$2,725.40","$1,226.43","$1,945.12",$0.00,$455.90,$0.00,$0.00,$477.20,"$2,725.40",$0.00,"$1,362.70","$2,158.52","$2,180.32",$0.00,$414.10,$0.00,$433.88,$0.00
04.031.949S,SUP,HCPCS C1713,,04.031.949S  -  NAIL INTRAMEDULLARY 9MM 280MM LATERAL ENTRY IMPLANT NAIL-EX,"$2,725.40",$0.00,"$2,725.40","$1,226.43","$1,945.12",$0.00,$455.90,$0.00,$0.00,$477.20,"$2,725.40",$0.00,"$1,362.70","$2,158.52","$2,180.32",$0.00,$414.10,$0.00,$433.88,$0.00
04.031.950S,SUP,HCPCS C1713,,04.031.950S  -  NAIL INTRAMEDULLARY 9MM 300MM LATERAL ENTRY CANN HELICAL,"$2,725.40",$0.00,"$2,725.40","$1,226.43","$1,945.12",$0.00,$455.90,$0.00,$0.00,$477.20,"$2,725.40",$0.00,"$1,362.70","$2,158.52","$2,180.32",$0.00,$414.10,$0.00,$433.88,$0.00
04.031.951S,SUP,HCPCS C1713,,04.031.951S  -  NAIL INTRAMEDULLARY 9MM 300MM LATERAL ENTRY IMPLANT NAIL-EX,"$2,725.40",$0.00,"$2,725.40","$1,226.43","$1,945.12",$0.00,$455.90,$0.00,$0.00,$477.20,"$2,725.40",$0.00,"$1,362.70","$2,158.52","$2,180.32",$0.00,$414.10,$0.00,$433.88,$0.00
04.031.952S,SUP,HCPCS C1713,,04.031.952S  -  NAIL INTRAMEDULLARY 9MM 320MM LATERAL ENTRY IMPLANT NAIL-EX,"$2,725.40",$0.00,"$2,725.40","$1,226.43","$1,945.12",$0.00,$455.90,$0.00,$0.00,$477.20,"$2,725.40",$0.00,"$1,362.70","$2,158.52","$2,180.32",$0.00,$414.10,$0.00,$433.88,$0.00
04.031.953S,SUP,HCPCS C1713,,04.031.953S  -  NAIL INTRAMEDULLARY 9MM 320MM LATERAL ENTRY IMPLANT NAIL-EX,"$2,725.40",$0.00,"$2,725.40","$1,226.43","$1,945.12",$0.00,$455.90,$0.00,$0.00,$477.20,"$2,725.40",$0.00,"$1,362.70","$2,158.52","$2,180.32",$0.00,$414.10,$0.00,$433.88,$0.00
04.031.954S,SUP,HCPCS C1713,,04.031.954S  -  NAIL INTRAMEDULLARY 9MM 340MM LATERAL ENTRY TITANIUM,"$2,725.40",$0.00,"$2,725.40","$1,226.43","$1,945.12",$0.00,$455.90,$0.00,$0.00,$477.20,"$2,725.40",$0.00,"$1,362.70","$2,158.52","$2,180.32",$0.00,$414.10,$0.00,$433.88,$0.00
04.031.955S,SUP,HCPCS C1713,,04.031.955S  -  NAIL INTRAMEDULLARY 9MM 340MM LATERAL ENTRY IMPLANT NAIL-EX,"$2,725.40",$0.00,"$2,725.40","$1,226.43","$1,945.12",$0.00,$455.90,$0.00,$0.00,$477.20,"$2,725.40",$0.00,"$1,362.70","$2,158.52","$2,180.32",$0.00,$414.10,$0.00,$433.88,$0.00
04.031.956S,SUP,HCPCS C1713,,04.031.956S  -  NAIL INTRAMEDULLARY 9MM 360MM LATERAL ENTRY IMPLANT NAIL-EX,"$2,725.40",$0.00,"$2,725.40","$1,226.43","$1,945.12",$0.00,$455.90,$0.00,$0.00,$477.20,"$2,725.40",$0.00,"$1,362.70","$2,158.52","$2,180.32",$0.00,$414.10,$0.00,$433.88,$0.00
04.031.957S,SUP,HCPCS C1713,,04.031.957S  -  NAIL INTRAMEDULLARY 9MM 360MM LATERAL ENTRY NAIL-EX TITANIUM,"$2,725.40",$0.00,"$2,725.40","$1,226.43","$1,945.12",$0.00,$455.90,$0.00,$0.00,$477.20,"$2,725.40",$0.00,"$1,362.70","$2,158.52","$2,180.32",$0.00,$414.10,$0.00,$433.88,$0.00
04.031.958S,SUP,HCPCS C1713,,04.031.958S  -  NAIL INTRAMEDULLARY 9MM 380MM LATERAL ENTRY NAIL-EX TITANIUM,"$2,725.40",$0.00,"$2,725.40","$1,226.43","$1,945.12",$0.00,$455.90,$0.00,$0.00,$477.20,"$2,725.40",$0.00,"$1,362.70","$2,158.52","$2,180.32",$0.00,$414.10,$0.00,$433.88,$0.00
04.031.959S,SUP,HCPCS C1713,,04.031.959S  -  NAIL INTRAMEDULLARY 9MM 380MM LATERAL ENTRY IMPLANT NAIL-EX,"$2,725.40",$0.00,"$2,725.40","$1,226.43","$1,945.12",$0.00,$455.90,$0.00,$0.00,$477.20,"$2,725.40",$0.00,"$1,362.70","$2,158.52","$2,180.32",$0.00,$414.10,$0.00,$433.88,$0.00
04.031.960S,SUP,HCPCS C1713,,04.031.960S  -  NAIL INTRAMEDULLARY 9MM 400MM LATERAL ENTRY IMPLANT NAIL-EX,"$2,725.40",$0.00,"$2,725.40","$1,226.43","$1,945.12",$0.00,$455.90,$0.00,$0.00,$477.20,"$2,725.40",$0.00,"$1,362.70","$2,158.52","$2,180.32",$0.00,$414.10,$0.00,$433.88,$0.00
04.031.961S,SUP,HCPCS C1713,,04.031.961S  -  NAIL INTRAMEDULLARY 9MM 400MM LATERAL ENTRY IMPLANT NAIL-EX,"$2,725.40",$0.00,"$2,725.40","$1,226.43","$1,945.12",$0.00,$455.90,$0.00,$0.00,$477.20,"$2,725.40",$0.00,"$1,362.70","$2,158.52","$2,180.32",$0.00,$414.10,$0.00,$433.88,$0.00
04.031.964S,SUP,HCPCS C1713,,04.031.964S  -  NAIL INTRAMEDULLARY 10MM 240MM LATERAL ENTRY CANN EXPERT,"$2,808.65",$0.00,"$2,808.65","$1,263.89","$2,004.53",$0.00,$469.82,$0.00,$0.00,$491.77,"$2,808.65",$0.00,"$1,404.33","$2,224.45","$2,246.92",$0.00,$426.75,$0.00,$447.14,$0.00
04.031.965S,SUP,HCPCS C1713,,04.031.965S  -  NAIL INTRAMEDULLARY 10MM 240MM LATERAL ENTRY CANN EXPERT,"$2,808.65",$0.00,"$2,808.65","$1,263.89","$2,004.53",$0.00,$469.82,$0.00,$0.00,$491.77,"$2,808.65",$0.00,"$1,404.33","$2,224.45","$2,246.92",$0.00,$426.75,$0.00,$447.14,$0.00
04.031.966S,SUP,HCPCS C1713,,04.031.966S  -  NAIL INTRAMEDULLARY 10MM 260MM LATERAL ENTRY CANN EXPERT,"$2,808.65",$0.00,"$2,808.65","$1,263.89","$2,004.53",$0.00,$469.82,$0.00,$0.00,$491.77,"$2,808.65",$0.00,"$1,404.33","$2,224.45","$2,246.92",$0.00,$426.75,$0.00,$447.14,$0.00
04.031.967S,SUP,HCPCS C1713,,04.031.967S  -  NAIL INTRAMEDULLARY 10MM 260MM LATERAL ENTRY CANN EXPERT,"$2,808.65",$0.00,"$2,808.65","$1,263.89","$2,004.53",$0.00,$469.82,$0.00,$0.00,$491.77,"$2,808.65",$0.00,"$1,404.33","$2,224.45","$2,246.92",$0.00,$426.75,$0.00,$447.14,$0.00
04.031.968S,SUP,HCPCS C1713,,04.031.968S  -  NAIL INTRAMEDULLARY 10MM 280MM LATERAL ENTRY IMPLANT NAIL-EX,"$2,808.65",$0.00,"$2,808.65","$1,263.89","$2,004.53",$0.00,$469.82,$0.00,$0.00,$491.77,"$2,808.65",$0.00,"$1,404.33","$2,224.45","$2,246.92",$0.00,$426.75,$0.00,$447.14,$0.00
04.031.969S,SUP,HCPCS C1713,,04.031.969S  -  NAIL INTRAMEDULLARY 10MM 280MM LATERAL ENTRY IMPLANT NAIL-EX,"$2,808.65",$0.00,"$2,808.65","$1,263.89","$2,004.53",$0.00,$469.82,$0.00,$0.00,$491.77,"$2,808.65",$0.00,"$1,404.33","$2,224.45","$2,246.92",$0.00,$426.75,$0.00,$447.14,$0.00
04.031.970S,SUP,HCPCS C1713,,04.031.970S  -  NAIL INTRAMEDULLARY 10MM 300MM LATERAL ENTRY IMPLANT NAIL-EX,"$2,808.65",$0.00,"$2,808.65","$1,263.89","$2,004.53",$0.00,$469.82,$0.00,$0.00,$491.77,"$2,808.65",$0.00,"$1,404.33","$2,224.45","$2,246.92",$0.00,$426.75,$0.00,$447.14,$0.00
04.031.971S,SUP,HCPCS C1713,,04.031.971S  -  NAIL INTRAMEDULLARY 10MM 300MM LATERAL ENTRY IMPLANT NAIL-EX,"$2,808.65",$0.00,"$2,808.65","$1,263.89","$2,004.53",$0.00,$469.82,$0.00,$0.00,$491.77,"$2,808.65",$0.00,"$1,404.33","$2,224.45","$2,246.92",$0.00,$426.75,$0.00,$447.14,$0.00
04.031.972S,SUP,HCPCS C1713,,04.031.972S  -  NAIL INTRAMEDULLARY 10MM 320MM LATERAL ENTRY IMPLANT NAIL-EX,"$2,808.65",$0.00,"$2,808.65","$1,263.89","$2,004.53",$0.00,$469.82,$0.00,$0.00,$491.77,"$2,808.65",$0.00,"$1,404.33","$2,224.45","$2,246.92",$0.00,$426.75,$0.00,$447.14,$0.00
04.031.973S,SUP,HCPCS C1713,,04.031.973S  -  NAIL INTRAMEDULLARY 10MM 320MM LATERAL ENTRY IMPLANT NAIL-EX,"$2,808.65",$0.00,"$2,808.65","$1,263.89","$2,004.53",$0.00,$469.82,$0.00,$0.00,$491.77,"$2,808.65",$0.00,"$1,404.33","$2,224.45","$2,246.92",$0.00,$426.75,$0.00,$447.14,$0.00
04.031.974S,SUP,HCPCS C1713,,04.031.974S  -  NAIL INTRAMEDULLARY 10MM 340MM LATERAL ENTRY IMPLANT NAIL-EX,"$2,808.65",$0.00,"$2,808.65","$1,263.89","$2,004.53",$0.00,$469.82,$0.00,$0.00,$491.77,"$2,808.65",$0.00,"$1,404.33","$2,224.45","$2,246.92",$0.00,$426.75,$0.00,$447.14,$0.00
04.031.975S,SUP,HCPCS C1713,,04.031.975S  -  NAIL INTRAMEDULLARY 10MM 340MM LATERAL ENTRY IMPLANT NAIL-EX,"$2,808.65",$0.00,"$2,808.65","$1,263.89","$2,004.53",$0.00,$469.82,$0.00,$0.00,$491.77,"$2,808.65",$0.00,"$1,404.33","$2,224.45","$2,246.92",$0.00,$426.75,$0.00,$447.14,$0.00
04.031.976S,SUP,HCPCS C1713,,04.031.976S  -  NAIL INTRAMEDULLARY 10MM 360MM LATERAL ENTRY IMPLANT NAIL-EX,"$2,808.65",$0.00,"$2,808.65","$1,263.89","$2,004.53",$0.00,$469.82,$0.00,$0.00,$491.77,"$2,808.65",$0.00,"$1,404.33","$2,224.45","$2,246.92",$0.00,$426.75,$0.00,$447.14,$0.00
04.031.977S,SUP,HCPCS C1713,,04.031.977S  -  NAIL INTRAMEDULLARY 10MM 360MM LATERAL ENTRY IMPLANT NAIL-EX,"$2,808.65",$0.00,"$2,808.65","$1,263.89","$2,004.53",$0.00,$469.82,$0.00,$0.00,$491.77,"$2,808.65",$0.00,"$1,404.33","$2,224.45","$2,246.92",$0.00,$426.75,$0.00,$447.14,$0.00
04.031.978S,SUP,HCPCS C1713,,04.031.978S  -  NAIL INTRAMEDULLARY 10MM 380MM LATERAL ENTRY IMPLANT NAIL-EX,"$2,808.65",$0.00,"$2,808.65","$1,263.89","$2,004.53",$0.00,$469.82,$0.00,$0.00,$491.77,"$2,808.65",$0.00,"$1,404.33","$2,224.45","$2,246.92",$0.00,$426.75,$0.00,$447.14,$0.00
04.031.979S,SUP,HCPCS C1713,,04.031.979S  -  NAIL INTRAMEDULLARY 10MM 380MM LATERAL ENTRY IMPLANT NAIL-EX,"$2,808.65",$0.00,"$2,808.65","$1,263.89","$2,004.53",$0.00,$469.82,$0.00,$0.00,$491.77,"$2,808.65",$0.00,"$1,404.33","$2,224.45","$2,246.92",$0.00,$426.75,$0.00,$447.14,$0.00
04.031.980S,SUP,HCPCS C1713,,04.031.980S  -  NAIL INTRAMEDULLARY 10MM 400MM LATERAL ENTRY IMPLANT NAIL-EX,"$2,808.65",$0.00,"$2,808.65","$1,263.89","$2,004.53",$0.00,$469.82,$0.00,$0.00,$491.77,"$2,808.65",$0.00,"$1,404.33","$2,224.45","$2,246.92",$0.00,$426.75,$0.00,$447.14,$0.00
04.031.981S,SUP,HCPCS C1713,,04.031.981S  -  NAIL INTRAMEDULLARY 10MM 400MM LATERAL ENTRY IMPLANT NAIL-EX,"$2,808.65",$0.00,"$2,808.65","$1,263.89","$2,004.53",$0.00,$469.82,$0.00,$0.00,$491.77,"$2,808.65",$0.00,"$1,404.33","$2,224.45","$2,246.92",$0.00,$426.75,$0.00,$447.14,$0.00
04.032.001S,SUP,HCPCS C1713,,04.032.001S  -  SCREW SET 130D TITANIUM INTRAMEDULLARY STERILE TROC NAIL,$313.00,$0.00,$313.00,$140.85,$223.39,$0.00,$52.36,$0.00,$0.00,$54.80,$313.00,$0.00,$156.50,$247.90,$250.40,$0.00,$47.56,$0.00,$49.83,$0.00
04.032.070S,SUP,HCPCS C1713,,04.032.070S  -  SCREW BONE THREAD 11MM 70X130MM FIX SELFTAPPING INVERSE,"$1,070.68",$0.00,"$1,070.68",$481.80,$764.14,$0.00,$179.10,$0.00,$0.00,$187.47,"$1,070.68",$0.00,$535.34,$847.98,$856.54,$0.00,$162.68,$0.00,$170.45,$0.00
04.032.075S,SUP,HCPCS C1713,,04.032.075S  -  SCREW BONE 11MM 75MM FIX TITANIUM FEMUR TROCHANTER PROXIMAL,"$1,070.68",$0.00,"$1,070.68",$481.80,$764.14,$0.00,$179.10,$0.00,$0.00,$187.47,"$1,070.68",$0.00,$535.34,$847.98,$856.54,$0.00,$162.68,$0.00,$170.45,$0.00
04.032.080S,SUP,HCPCS C1713,,04.032.080S  -  SCREW BONE 11MM 80MM FIX TITANIUM FEMUR TROCHANTER PROXIMAL,"$1,070.68",$0.00,"$1,070.68",$481.80,$764.14,$0.00,$179.10,$0.00,$0.00,$187.47,"$1,070.68",$0.00,$535.34,$847.98,$856.54,$0.00,$162.68,$0.00,$170.45,$0.00
04.032.085S,SUP,HCPCS C1713,,04.032.085S  -  SCREW BONE 11MM 85MM FIX TITANIUM FEMUR TROCHANTER PROXIMAL,"$1,070.68",$0.00,"$1,070.68",$481.80,$764.14,$0.00,$179.10,$0.00,$0.00,$187.47,"$1,070.68",$0.00,$535.34,$847.98,$856.54,$0.00,$162.68,$0.00,$170.45,$0.00
04.032.090S,SUP,HCPCS C1713,,04.032.090S  -  SCREW BONE 11MM 90MM FIX TITANIUM FEMUR TROCHANTER PROXIMAL,"$1,070.68",$0.00,"$1,070.68",$481.80,$764.14,$0.00,$179.10,$0.00,$0.00,$187.47,"$1,070.68",$0.00,$535.34,$847.98,$856.54,$0.00,$162.68,$0.00,$170.45,$0.00
04.032.095S,SUP,HCPCS C1713,,04.032.095S  -  SCREW BONE 11MM 95MM FIX TITANIUM FEMUR TROCHANTER PROXIMAL,"$1,070.68",$0.00,"$1,070.68",$481.80,$764.14,$0.00,$179.10,$0.00,$0.00,$187.47,"$1,070.68",$0.00,$535.34,$847.98,$856.54,$0.00,$162.68,$0.00,$170.45,$0.00
04.032.100S,SUP,HCPCS C1713,,04.032.100S  -  SCREW BONE 11MM 100MM FIX TITANIUM FEMUR TROCHANTER PROXIMAL,"$1,070.68",$0.00,"$1,070.68",$481.80,$764.14,$0.00,$179.10,$0.00,$0.00,$187.47,"$1,070.68",$0.00,$535.34,$847.98,$856.54,$0.00,$162.68,$0.00,$170.45,$0.00
04.032.105S,SUP,HCPCS C1713,,04.032.105S  -  SCREW BONE 11MM 105MM FIX TITANIUM FEMUR TROCHANTER PROXIMAL,"$1,070.68",$0.00,"$1,070.68",$481.80,$764.14,$0.00,$179.10,$0.00,$0.00,$187.47,"$1,070.68",$0.00,$535.34,$847.98,$856.54,$0.00,$162.68,$0.00,$170.45,$0.00
04.032.110S,SUP,HCPCS C1713,,04.032.110S  -  SCREW BONE 11MM 110MM FIX TITANIUM FEMUR TROCHANTER PROXIMAL,"$1,070.68",$0.00,"$1,070.68",$481.80,$764.14,$0.00,$179.10,$0.00,$0.00,$187.47,"$1,070.68",$0.00,$535.34,$847.98,$856.54,$0.00,$162.68,$0.00,$170.45,$0.00
04.032.115S,SUP,HCPCS C1713,,04.032.115S  -  SCREW BONE 11MM 115MM FIX TITANIUM FEMUR TROCHANTER PROXIMAL,"$1,070.68",$0.00,"$1,070.68",$481.80,$764.14,$0.00,$179.10,$0.00,$0.00,$187.47,"$1,070.68",$0.00,$535.34,$847.98,$856.54,$0.00,$162.68,$0.00,$170.45,$0.00
04.032.120S,SUP,HCPCS C1713,,04.032.120S  -  SCREW BONE 11MM 120MM FIX TITANIUM FEMUR TROCHANTER PROXIMAL,"$1,070.68",$0.00,"$1,070.68",$481.80,$764.14,$0.00,$179.10,$0.00,$0.00,$187.47,"$1,070.68",$0.00,$535.34,$847.98,$856.54,$0.00,$162.68,$0.00,$170.45,$0.00
04.032.125S,SUP,HCPCS C1713,,04.032.125S  -  SCREW BONE 11MM 125MM TITANIUM FEMUR TROCHANTER PROXIMAL,"$1,070.68",$0.00,"$1,070.68",$481.80,$764.14,$0.00,$179.10,$0.00,$0.00,$187.47,"$1,070.68",$0.00,$535.34,$847.98,$856.54,$0.00,$162.68,$0.00,$170.45,$0.00
04.032.130S,SUP,HCPCS C1713,,04.032.130S  -  SCREW BN 11MM 130MM AU STRL CNN SELP TAP INVERSE ANG THRD TI,"$1,070.68",$0.00,"$1,070.68",$481.80,$764.14,$0.00,$179.10,$0.00,$0.00,$187.47,"$1,070.68",$0.00,$535.34,$847.98,$856.54,$0.00,$162.68,$0.00,$170.45,$0.00
04.034.231S,SUP,HCPCS C1713,,04.034.231S  -  NAIL INTRAMEDULLARY 8MM 255MM CANN PROXIMAL BEND NAIL-EX,"$2,842.43",$0.00,"$2,842.43","$1,279.09","$2,028.64",$0.00,$475.47,$0.00,$0.00,$497.69,"$2,842.43",$0.00,"$1,421.21","$2,251.20","$2,273.94",$0.00,$431.88,$0.00,$452.51,$0.00
04.034.234S,SUP,HCPCS C1713,,04.034.234S  -  NAIL INTRAMEDULLARY 8MM 27CM CANN PROXIMAL BEND NAIL-EX DARK,"$2,842.43",$0.00,"$2,842.43","$1,279.09","$2,028.64",$0.00,$475.47,$0.00,$0.00,$497.69,"$2,842.43",$0.00,"$1,421.21","$2,251.20","$2,273.94",$0.00,$431.88,$0.00,$452.51,$0.00
04.034.237S,SUP,HCPCS C1713,,04.034.237S  -  NAIL INTRAMEDULLARY UNIVERSAL 8MM 285MM CANN PROXIMAL BEND,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.034.240S,SUP,HCPCS C1713,,04.034.240S  -  NAIL INTRAMEDULLARY 8MM 30CM CANN PROXIMAL BEND NAIL-EX,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.034.243S,SUP,HCPCS C1713,,04.034.243S  -  NAIL INTRAMEDULLARY UNIVERSAL 8MM 315MM CANN PROXIMAL BEND,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.034.246S,SUP,HCPCS C1713,,04.034.246S  -  NAIL INTRAMEDULLARY 8MM 33CM CANN PROXIMAL BEND NAIL-EX,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.034.249S,SUP,HCPCS C1713,,04.034.249S  -  NAIL INTRAMEDULLARY 8MM 34.5CM CANN PROXIMAL BEND NAIL-EX,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.034.252S,SUP,HCPCS C1713,,04.034.252S  -  NAIL INTRAMEDULLARY UNIVERSAL ROUND BARREL 8MM 36CM CANN,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.034.255S,SUP,HCPCS C1713,,04.034.255S  -  NAIL INTRAMEDULLARY UNIVERSAL 8MM 375MM CANN PROXIMAL BEND,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.034.258S,SUP,HCPCS C1713,,04.034.258S  -  NAIL INTRAMEDULLARY UNIVERSAL 8MM 390MM CANN PROXIMAL BEND,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.034.261S,SUP,HCPCS C1713,,04.034.261S  -  NAIL INTRAMEDULLARY UNIVERSAL 8MM 405MM CANN PROXIMAL BEND,"$2,832.50",$0.00,"$2,832.50","$1,274.63","$2,021.56",$0.00,$473.81,$0.00,$0.00,$495.95,"$2,832.50",$0.00,"$1,416.25","$2,243.34","$2,266.00",$0.00,$430.38,$0.00,$450.93,$0.00
04.034.264S,SUP,HCPCS C1713,,04.034.264S  -  NAIL INTRAMEDULLARY UNIVERSAL 8MM 420MM CANN PROXIMAL BEND,"$2,928.80",$0.00,"$2,928.80","$1,317.96","$2,090.28",$0.00,$489.92,$0.00,$0.00,$512.81,"$2,928.80",$0.00,"$1,464.40","$2,319.61","$2,343.04",$0.00,$445.01,$0.00,$466.26,$0.00
04.034.267S,SUP,HCPCS C1713,,04.034.267S  -  NAIL INTRAMEDULLARY 8MM 43.5CM CANN PROXIMAL BEND NAIL-EX,"$2,928.80",$0.00,"$2,928.80","$1,317.96","$2,090.28",$0.00,$489.92,$0.00,$0.00,$512.81,"$2,928.80",$0.00,"$1,464.40","$2,319.61","$2,343.04",$0.00,$445.01,$0.00,$466.26,$0.00
04.034.331S,SUP,HCPCS C1713,,04.034.331S  -  NAIL INTRAMEDULLARY 9MM 25.5CM CANN PROXIMAL BEND NAIL-EX,"$2,928.80",$0.00,"$2,928.80","$1,317.96","$2,090.28",$0.00,$489.92,$0.00,$0.00,$512.81,"$2,928.80",$0.00,"$1,464.40","$2,319.61","$2,343.04",$0.00,$445.01,$0.00,$466.26,$0.00
04.034.334S,SUP,HCPCS C1713,,04.034.334S  -  NAIL INTRAMEDULLARY 9MM 27CM CANN PROXIMAL BEND NAIL-EX DARK,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.034.337S,SUP,HCPCS C1713,,04.034.337S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 285MM CANN PROXIMAL BEND,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.034.340S,SUP,HCPCS C1713,,04.034.340S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 300MM CANN PROXIMAL BEND,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.034.343S,SUP,HCPCS C1713,,04.034.343S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 315MM CANN PROXIMAL BEND,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.034.346S,SUP,HCPCS C1713,,04.034.346S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 330MM CANN PROXIMAL BEND,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.034.349S,SUP,HCPCS C1713,,04.034.349S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 345MM CANN PROXIMAL BEND,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.034.352S,SUP,HCPCS C1713,,04.034.352S  -  NAIL INTRAMEDULLARY UNIVERSAL ROUND 9MM 36CM CANN PROXIMAL,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.034.355S,SUP,HCPCS C1713,,04.034.355S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 375MM CANN PROXIMAL BEND,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.034.358S,SUP,HCPCS C1713,,04.034.358S  -  NAIL INTRAMEDULLARY 9MM 39CM PROXIMAL BEND CANN EXPERT,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.034.361S,SUP,HCPCS C1713,,04.034.361S  -  NAIL INTRAMEDULLARY 9MM 40.5CM CANN PROXIMAL BEND NAIL-EX,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.034.364S,SUP,HCPCS C1713,,04.034.364S  -  NAIL INTRAMEDULLARY 9MM 420MM CANN PROXIMAL BEND NAIL-EX,"$2,928.80",$0.00,"$2,928.80","$1,317.96","$2,090.28",$0.00,$489.92,$0.00,$0.00,$512.81,"$2,928.80",$0.00,"$1,464.40","$2,319.61","$2,343.04",$0.00,$445.01,$0.00,$466.26,$0.00
04.034.367S,SUP,HCPCS C1713,,04.034.367S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 435MM CANN PROXIMAL BEND,"$2,928.80",$0.00,"$2,928.80","$1,317.96","$2,090.28",$0.00,$489.92,$0.00,$0.00,$512.81,"$2,928.80",$0.00,"$1,464.40","$2,319.61","$2,343.04",$0.00,$445.01,$0.00,$466.26,$0.00
04.034.431S,SUP,HCPCS C1713,,04.034.431S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 255MM CANN PROXIMAL BEND,"$2,928.80",$0.00,"$2,928.80","$1,317.96","$2,090.28",$0.00,$489.92,$0.00,$0.00,$512.81,"$2,928.80",$0.00,"$1,464.40","$2,319.61","$2,343.04",$0.00,$445.01,$0.00,$466.26,$0.00
04.034.434S,SUP,HCPCS C1713,,04.034.434S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 270MM CANN PROXIMAL BEND,"$2,842.43",$0.00,"$2,842.43","$1,279.09","$2,028.64",$0.00,$475.47,$0.00,$0.00,$497.69,"$2,842.43",$0.00,"$1,421.21","$2,251.20","$2,273.94",$0.00,$431.88,$0.00,$452.51,$0.00
04.034.437S,SUP,HCPCS C1713,,04.034.437S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 285MM CANN PROXIMAL BEND,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.034.440S,SUP,HCPCS C1713,,04.034.440S  -  NAIL INTRAMEDULLARY 10MM 30CM CANN PROXIMAL BEND NAIL-EX,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.034.443S,SUP,HCPCS C1713,,04.034.443S  -  NAIL INTRAMEDULLARY 10MM 315MM CANN PROXIMAL BEND NAIL-EX,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.034.446S,SUP,HCPCS C1713,,04.034.446S  -  NAIL INTRAMEDULLARY 10MM 33CM CANN PROXIMAL BEND NAIL-EX,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.034.449S,SUP,HCPCS C1713,,04.034.449S  -  NAIL INTRAMEDULLARY 10MM 34.5CM CANN PROXIMAL BEND NAIL-EX,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.034.452S,SUP,HCPCS C1713,,04.034.452S  -  NAIL INTRAMEDULLARY 10MM 360MM CANN PROXIMAL BEND NAIL-EX,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.034.455S,SUP,HCPCS C1713,,04.034.455S  -  NAIL INTRAMEDULLARY 10MM 375MM CANN PROXIMAL BEND NAIL-EX,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.034.458S,SUP,HCPCS C1713,,04.034.458S  -  NAIL INTRAMEDULLARY 10MM 390MM CANN PROXIMAL BEND NAIL-EX,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.034.461S,SUP,HCPCS C1713,,04.034.461S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 405MM CANN PROXIMAL BEND,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.034.464S,SUP,HCPCS C1713,,04.034.464S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 420MM CANN PROXIMAL BEND,"$2,842.43",$0.00,"$2,842.43","$1,279.09","$2,028.64",$0.00,$475.47,$0.00,$0.00,$497.69,"$2,842.43",$0.00,"$1,421.21","$2,251.20","$2,273.94",$0.00,$431.88,$0.00,$452.51,$0.00
04.034.467S,SUP,HCPCS C1713,,04.034.467S  -  NAIL INTRAMEDULLARY 10MM 435MM CANN PROXIMAL BEND NAIL-EX,"$2,928.80",$0.00,"$2,928.80","$1,317.96","$2,090.28",$0.00,$489.92,$0.00,$0.00,$512.81,"$2,928.80",$0.00,"$1,464.40","$2,319.61","$2,343.04",$0.00,$445.01,$0.00,$466.26,$0.00
04.034.531S,SUP,HCPCS C1713,,04.034.531S  -  NAIL INTRAMEDULLARY 11MM 255MM CANN PROXIMAL BEND NAIL-EX,"$2,928.80",$0.00,"$2,928.80","$1,317.96","$2,090.28",$0.00,$489.92,$0.00,$0.00,$512.81,"$2,928.80",$0.00,"$1,464.40","$2,319.61","$2,343.04",$0.00,$445.01,$0.00,$466.26,$0.00
04.034.534S,SUP,HCPCS C1713,,04.034.534S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 270MM CANN PROXIMAL BEND,"$2,928.80",$0.00,"$2,928.80","$1,317.96","$2,090.28",$0.00,$489.92,$0.00,$0.00,$512.81,"$2,928.80",$0.00,"$1,464.40","$2,319.61","$2,343.04",$0.00,$445.01,$0.00,$466.26,$0.00
04.034.537S,SUP,HCPCS C1713,,04.034.537S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 285MM CANN PROXIMAL BEND,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.034.540S,SUP,HCPCS C1713,,04.034.540S  -  NAIL INTRAMEDULLARY UNIVERSAL FLUTE BARREL 11MM 300MM CANN,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.034.543S,SUP,HCPCS C1713,,04.034.543S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 315MM CANN PROXIMAL BEND,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.034.546S,SUP,HCPCS C1713,,04.034.546S  -  NAIL INTRAMEDULLARY 11MM 330MM CANN PROXIMAL BEND NAIL-EX,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.034.549S,SUP,HCPCS C1713,,04.034.549S  -  NAIL INTRAMEDULLARY 11MM 345MM CANN PROXIMAL BEND NAIL-EX,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.034.552S,SUP,HCPCS C1713,,04.034.552S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 360MM CANN PROXIMAL BEND,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.034.555S,SUP,HCPCS C1713,,04.034.555S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 375MM CANN PROXIMAL BEND,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.034.558S,SUP,HCPCS C1713,,04.034.558S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 390MM CANN PROXIMAL BEND,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.034.561S,SUP,HCPCS C1713,,04.034.561S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 405MM CANN PROXIMAL BEND,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.034.564S,SUP,HCPCS C1713,,04.034.564S  -  NAIL INTRAMEDULLARY 11MM 420MM CANN PROXIMAL BEND NAIL-EX,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.034.567S,SUP,HCPCS C1713,,04.034.567S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 235MM CANN PROXIMAL BEND,"$2,928.80",$0.00,"$2,928.80","$1,317.96","$2,090.28",$0.00,$489.92,$0.00,$0.00,$512.81,"$2,928.80",$0.00,"$1,464.40","$2,319.61","$2,343.04",$0.00,$445.01,$0.00,$466.26,$0.00
04.034.631S,SUP,HCPCS C1713,,04.034.631S  -  NAIL INTRAMEDULLARY 12MM 255MM CANN PROXIMAL BEND NAIL-EX,"$2,928.80",$0.00,"$2,928.80","$1,317.96","$2,090.28",$0.00,$489.92,$0.00,$0.00,$512.81,"$2,928.80",$0.00,"$1,464.40","$2,319.61","$2,343.04",$0.00,$445.01,$0.00,$466.26,$0.00
04.034.634S,SUP,HCPCS C1713,,04.034.634S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 270MM CANN PROXIMAL BEND,"$2,928.80",$0.00,"$2,928.80","$1,317.96","$2,090.28",$0.00,$489.92,$0.00,$0.00,$512.81,"$2,928.80",$0.00,"$1,464.40","$2,319.61","$2,343.04",$0.00,$445.01,$0.00,$466.26,$0.00
04.034.637S,SUP,HCPCS C1713,,04.034.637S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 285MM CANN PROXIMAL BEND,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.034.640S,SUP,HCPCS C1713,,04.034.640S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 300MM CANN PROXIMAL BEND,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.034.643S,SUP,HCPCS C1713,,04.034.643S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 315MM CANN PROXIMAL BEND,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.034.646S,SUP,HCPCS C1713,,04.034.646S  -  NAIL INTRAMEDULLARY 12MM 33CM CANN PROXIMAL BEND EXPERT,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.034.649S,SUP,HCPCS C1713,,04.034.649S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 345MM CANN PROXIMAL BEND,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.034.652S,SUP,HCPCS C1713,,04.034.652S  -  NAIL INTRAMEDULLARY 12MM 360MM CANN PROXIMAL BEND NAIL-EX,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.034.655S,SUP,HCPCS C1713,,04.034.655S  -  NAIL INTRAMEDULLARY 12MM 375MM CANN PROXIMAL BEND NAIL-EX,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.034.658S,SUP,HCPCS C1713,,04.034.658S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 390MM CANN PROXIMAL BEND,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.034.661S,SUP,HCPCS C1713,,04.034.661S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 405MM CANN PROXIMAL BEND,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.034.664S,SUP,HCPCS C1713,,04.034.664S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 420MM CANN PROXIMAL BEND,"$2,928.80",$0.00,"$2,928.80","$1,317.96","$2,090.28",$0.00,$489.92,$0.00,$0.00,$512.81,"$2,928.80",$0.00,"$1,464.40","$2,319.61","$2,343.04",$0.00,$445.01,$0.00,$466.26,$0.00
04.034.667S,SUP,HCPCS C1713,,04.034.667S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 435MM CANN PROXIMAL BEND,"$2,928.80",$0.00,"$2,928.80","$1,317.96","$2,090.28",$0.00,$489.92,$0.00,$0.00,$512.81,"$2,928.80",$0.00,"$1,464.40","$2,319.61","$2,343.04",$0.00,$445.01,$0.00,$466.26,$0.00
04.034.731S,SUP,HCPCS C1713,,04.034.731S  -  NAIL INTRAMEDULLARY 13MM 255MM CANN PROXIMAL BEND NAIL-EX,"$2,928.80",$0.00,"$2,928.80","$1,317.96","$2,090.28",$0.00,$489.92,$0.00,$0.00,$512.81,"$2,928.80",$0.00,"$1,464.40","$2,319.61","$2,343.04",$0.00,$445.01,$0.00,$466.26,$0.00
04.034.734S,SUP,HCPCS C1713,,04.034.734S  -  NAIL INTRAMEDULLARY 13MM 270MM CANN PROXIMAL BEND NAIL-EX,"$2,928.80",$0.00,"$2,928.80","$1,317.96","$2,090.28",$0.00,$489.92,$0.00,$0.00,$512.81,"$2,928.80",$0.00,"$1,464.40","$2,319.61","$2,343.04",$0.00,$445.01,$0.00,$466.26,$0.00
04.034.737S,SUP,HCPCS C1713,,04.034.737S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 285MM CANN PROXIMAL BEND,"$2,832.50",$0.00,"$2,832.50","$1,274.63","$2,021.56",$0.00,$473.81,$0.00,$0.00,$495.95,"$2,832.50",$0.00,"$1,416.25","$2,243.34","$2,266.00",$0.00,$430.38,$0.00,$450.93,$0.00
04.034.740S,SUP,HCPCS C1713,,04.034.740S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 300MM CANN PROXIMAL BEND,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.034.743S,SUP,HCPCS C1713,,04.034.743S  -  NAIL INTRAMEDULLARY 13MM 31.5CM CANN PROXIMAL BEND TITANIUM,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.034.746S,SUP,HCPCS C1713,,04.034.746S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 330MM CANN PROXIMAL BEND,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.034.749S,SUP,HCPCS C1713,,04.034.749S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 345MM CANN PROXIMAL BEND,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.034.752S,SUP,HCPCS C1713,,04.034.752S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 360MM CANN PROXIMAL BEND,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.034.755S,SUP,HCPCS C1713,,04.034.755S  -  NAIL INTRAMEDULLARY UNIVERSAL ROUND BARREL 13MM 37.5CM CANN,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.034.758S,SUP,HCPCS C1713,,04.034.758S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 390MM CANN PROXIMAL BEND,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.034.761S,SUP,HCPCS C1713,,04.034.761S  -  NAIL INTRAMEDULLARY 13MM 40.5CM CANN PROXIMAL BEND NAIL-EX,"$2,748.95",$0.00,"$2,748.95","$1,237.03","$1,961.93",$0.00,$459.83,$0.00,$0.00,$481.32,"$2,748.95",$0.00,"$1,374.48","$2,177.17","$2,199.16",$0.00,$417.68,$0.00,$437.63,$0.00
04.034.764S,SUP,HCPCS C1713,,04.034.764S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 420MM CANN PROXIMAL BEND,"$2,842.43",$0.00,"$2,842.43","$1,279.09","$2,028.64",$0.00,$475.47,$0.00,$0.00,$497.69,"$2,842.43",$0.00,"$1,421.21","$2,251.20","$2,273.94",$0.00,$431.88,$0.00,$452.51,$0.00
04.034.767S,SUP,HCPCS C1713,,04.034.767S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 435MM CANN PROXIMAL BEND,"$2,928.80",$0.00,"$2,928.80","$1,317.96","$2,090.28",$0.00,$489.92,$0.00,$0.00,$512.81,"$2,928.80",$0.00,"$1,464.40","$2,319.61","$2,343.04",$0.00,$445.01,$0.00,$466.26,$0.00
04.037.142S,SUP,HCPCS C1713,,04.037.142S  -  NAIL IM 130D SHRT 11MM 170MM GRN STRL TFN-ADV CNN,"$3,042.03",$0.00,"$3,042.03","$1,368.91","$2,171.09",$0.00,$508.86,$0.00,$0.00,$532.63,"$3,042.03",$0.00,"$1,521.01","$2,409.29","$2,433.62",$0.00,$462.21,$0.00,$484.29,$0.00
04.037.165S,SUP,HCPCS C1713,,04.037.165S  -  NAIL IM 130D LNG 11MM 440MM GRN STRL TFN-ADV CNN PREASSEMBLE,"$4,263.48",$0.00,"$4,263.48","$1,918.56","$3,042.84",$0.00,$713.18,$0.00,$0.00,$746.50,"$4,263.48",$0.00,"$2,131.74","$3,376.68","$3,410.78",$0.00,$647.80,$0.00,$678.75,$0.00
04.037.167S,SUP,HCPCS C1713,,04.037.167S  -  NAIL IM 130D LNG 11MM 460MM GRN STRL TFN-ADV LAT RLF CUT CNN,"$4,263.48",$0.00,"$4,263.48","$1,918.56","$3,042.84",$0.00,$713.18,$0.00,$0.00,$746.50,"$4,263.48",$0.00,"$2,131.74","$3,376.68","$3,410.78",$0.00,$647.80,$0.00,$678.75,$0.00
04.037.242S,SUP,HCPCS C1713,,04.037.242S  -  NAIL IM 130D SHRT 12MM 170MM GRN STRL TFN-ADV CNN,"$3,042.03",$0.00,"$3,042.03","$1,368.91","$2,171.09",$0.00,$508.86,$0.00,$0.00,$532.63,"$3,042.03",$0.00,"$1,521.01","$2,409.29","$2,433.62",$0.00,$462.21,$0.00,$484.29,$0.00
04.037.257S,SUP,HCPCS C1713,,04.037.257S  -  NAIL IM 130D LNG 12MM 360MM GRN STRL TFN-ADV LAT RLF CUT CNN,"$4,263.48",$0.00,"$4,263.48","$1,918.56","$3,042.84",$0.00,$713.18,$0.00,$0.00,$746.50,"$4,263.48",$0.00,"$2,131.74","$3,376.68","$3,410.78",$0.00,$647.80,$0.00,$678.75,$0.00
04.037.259S,SUP,HCPCS C1713,,04.037.259S  -  NAIL IM 130D LNG 12MM 380MM GRN STRL TFN-ADV LAT RLF CUT CNN,"$4,263.48",$0.00,"$4,263.48","$1,918.56","$3,042.84",$0.00,$713.18,$0.00,$0.00,$746.50,"$4,263.48",$0.00,"$2,131.74","$3,376.68","$3,410.78",$0.00,$647.80,$0.00,$678.75,$0.00
04.037.261S,SUP,HCPCS C1713,,04.037.261S  -  NAIL IM 130D LNG 12MM 400MM GRN STRL TFN-ADV LAT RLF CUT CNN,"$4,263.48",$0.00,"$4,263.48","$1,918.56","$3,042.84",$0.00,$713.18,$0.00,$0.00,$746.50,"$4,263.48",$0.00,"$2,131.74","$3,376.68","$3,410.78",$0.00,$647.80,$0.00,$678.75,$0.00
04.037.262S,SUP,HCPCS C1713,,04.037.262S  -  NAIL IM 130D LNG 12MM 420MM GRN STRL TFN-ADV LAT RLF CUT CNN,"$4,263.48",$0.00,"$4,263.48","$1,918.56","$3,042.84",$0.00,$713.18,$0.00,$0.00,$746.50,"$4,263.48",$0.00,"$2,131.74","$3,376.68","$3,410.78",$0.00,$647.80,$0.00,$678.75,$0.00
04.038.105S,SUP,HCPCS C1713,,04.038.105S  -  SCREW BN 10.35MM 105MM AU STRL LF TFN-ADV CNN TI,"$1,385.23",$0.00,"$1,385.23",$623.35,$988.64,$0.00,$231.72,$0.00,$0.00,$242.54,"$1,385.23",$0.00,$692.61,"$1,097.10","$1,108.18",$0.00,$210.47,$0.00,$220.53,$0.00
04.038.285S,SUP,Custom 27203010,,04.038.285S  -  BLADE IM NL HLCL 10.35MM 85MM AU STRL TFN-ADV CNN TI-6AL-7NB,"$1,453.45",$0.00,"$1,453.45",$0.00,"$1,037.33",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,453.45",$0.00,$726.73,"$1,151.13","$1,162.76",$0.00,$0.00,$0.00,$0.00,$0.00
04.038.290S,SUP,Custom 27203010,,04.038.290S  -  BLADE IM NL HLCL 90MM STRL TFN-ADV CNN TI FEM PROX,"$1,453.45",$0.00,"$1,453.45",$0.00,"$1,037.33",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,453.45",$0.00,$726.73,"$1,151.13","$1,162.76",$0.00,$0.00,$0.00,$0.00,$0.00
04.038.295S,SUP,Custom 27203010,,04.038.295S  -  BLADE IM NL HLCL 10.35MM 95MM AU STRL TFN-ADV CNN TI-6AL-7NB,"$1,453.45",$0.00,"$1,453.45",$0.00,"$1,037.33",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,453.45",$0.00,$726.73,"$1,151.13","$1,162.76",$0.00,$0.00,$0.00,$0.00,$0.00
04.038.305S,SUP,Custom 27203010,,04.038.305S  -  BLADE IM NL HLCL 10.35MM 105MM AU STRL TFN-ADV CNN TI-6AL-7,"$1,453.45",$0.00,"$1,453.45",$0.00,"$1,037.33",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,453.45",$0.00,$726.73,"$1,151.13","$1,162.76",$0.00,$0.00,$0.00,$0.00,$0.00
04.100.020,SUP,HCPCS C1713,,04.100.020  -  PLATE BONE LOCK TITANIUM FT NONSTRL 2.4-2.7 MM SCREWS,"$1,422.08",$0.00,"$1,422.08",$639.93,"$1,014.93",$0.00,$237.88,$0.00,$0.00,$248.99,"$1,422.08",$0.00,$711.04,"$1,126.29","$1,137.66",$0.00,$216.07,$0.00,$226.39,$0.00
04.100.021,SUP,HCPCS C1713,,04.100.021  -  PLATE BONE LOCK TITANIUM LEFT CUBOID FT NONSTRL 2.4-2.7 MM,"$1,383.85",$0.00,"$1,383.85",$622.73,$987.65,$0.00,$231.49,$0.00,$0.00,$242.30,"$1,383.85",$0.00,$691.93,"$1,096.01","$1,107.08",$0.00,$210.27,$0.00,$220.31,$0.00
04.100.022,SUP,HCPCS C1713,,04.100.022  -  PLATE BONE LOCK TITANIUM RIGHT CUBOID FT NONSTRL 2.4-2.7 MM,"$1,383.85",$0.00,"$1,383.85",$622.73,$987.65,$0.00,$231.49,$0.00,$0.00,$242.30,"$1,383.85",$0.00,$691.93,"$1,096.01","$1,107.08",$0.00,$210.27,$0.00,$220.31,$0.00
04.100.023,SUP,HCPCS C1713,,04.100.023  -  PLATE BONE LOCK TITANIUM TALUS FT NONSTRL 2.4-2.7 MM SCREW,"$1,367.48",$0.00,"$1,367.48",$615.36,$975.97,$0.00,$228.75,$0.00,$0.00,$239.43,"$1,367.48",$0.00,$683.74,"$1,083.04","$1,093.98",$0.00,$207.78,$0.00,$217.70,$0.00
04.100.032S,SUP,HCPCS C1713,,04.100.032S  -  PLATE 100MM TI 6 HOLE LCP BONE ANT ANKL FT STRL,"$2,315.60",$0.00,"$2,315.60","$1,042.02","$1,652.64",$0.00,$398.97,$0.00,$0.00,$405.44,"$2,315.60",$0.00,"$1,157.80","$1,833.96","$1,852.48",$0.00,$362.39,$0.00,$368.64,$0.00
04.100.033S,SUP,HCPCS C1713,,04.100.033S  -  PLATE 116MM TI 7 HOLE LCP BONE ANT ANKL FT STRL,"$2,380.43",$0.00,"$2,380.43","$1,071.19","$1,698.91",$0.00,$410.14,$0.00,$0.00,$416.79,"$2,380.43",$0.00,"$1,190.21","$1,885.30","$1,904.34",$0.00,$372.54,$0.00,$378.96,$0.00
04.104.004S,SUP,HCPCS C1713,,04.104.004S  -  PLATE BONE 122MM 4 HOLE LCP TITANIUM EXTART RIGHT HUMERUS,"$2,314.63",$0.00,"$2,314.63","$1,041.58","$1,651.95",$0.00,$387.18,$0.00,$0.00,$405.27,"$2,314.63",$0.00,"$1,157.31","$1,833.19","$1,851.70",$0.00,$351.69,$0.00,$368.49,$0.00
04.104.006S,SUP,HCPCS C1713,,04.104.006S  -  PLATE BONE 158MM 6 HOLE LCP TITANIUM EXTART RIGHT HUMERUS,"$2,635.33",$0.00,"$2,635.33","$1,185.90","$1,880.83",$0.00,$440.83,$0.00,$0.00,$461.42,"$2,635.33",$0.00,"$1,317.66","$2,087.18","$2,108.26",$0.00,$400.42,$0.00,$419.54,$0.00
04.104.008S,SUP,HCPCS C1713,,04.104.008S  -  PLATE BN 194MM STRL LCP CMBN 8 HL PRECONTOUR LMT CNTCT TI,"$2,790.93",$0.00,"$2,790.93","$1,255.92","$1,991.88",$0.00,$466.85,$0.00,$0.00,$488.67,"$2,790.93",$0.00,"$1,395.46","$2,210.42","$2,232.74",$0.00,$424.06,$0.00,$444.32,$0.00
04.104.010S,SUP,HCPCS C1713,,04.104.010S  -  PLATE BONE 230MM 10 HOLE LCP TITANIUM EXTART RIGHT HUMERUS,"$2,949.23",$0.00,"$2,949.23","$1,327.15","$2,104.86",$0.00,$493.34,$0.00,$0.00,$516.39,"$2,949.23",$0.00,"$1,474.61","$2,335.79","$2,359.38",$0.00,$448.11,$0.00,$469.52,$0.00
04.104.012S,SUP,HCPCS C1713,,04.104.012S  -  PLATE BONE 266MM 12 HOLE LCP TITANIUM EXTART RIGHT HUMERUS,"$3,357.28",$0.00,"$3,357.28","$1,510.77","$2,396.09",$0.00,$561.60,$0.00,$0.00,$587.83,"$3,357.28",$0.00,"$1,678.64","$2,658.97","$2,685.82",$0.00,$510.11,$0.00,$534.48,$0.00
04.104.014S,SUP,HCPCS C1713,,04.104.014S  -  PLATE BONE 302MM 14 HOLE LCP TITANIUM EXTART RIGHT HUMERUS,"$3,686.20",$0.00,"$3,686.20","$1,658.79","$2,630.84",$0.00,$616.61,$0.00,$0.00,$645.42,"$3,686.20",$0.00,"$1,843.10","$2,919.47","$2,948.96",$0.00,$560.09,$0.00,$586.84,$0.00
04.104.024S,SUP,HCPCS C1713,,04.104.024S  -  PLATE BONE 122MM 4 HOLE LCP TITANIUM LEFT DISTAL EXTART,"$2,314.63",$0.00,"$2,314.63","$1,041.58","$1,651.95",$0.00,$387.18,$0.00,$0.00,$405.27,"$2,314.63",$0.00,"$1,157.31","$1,833.19","$1,851.70",$0.00,$351.69,$0.00,$368.49,$0.00
04.104.026S,SUP,HCPCS C1713,,04.104.026S  -  PLATE BONE 158MM 6 HOLE LCP TITANIUM LEFT DISTAL EXTART,"$2,635.33",$0.00,"$2,635.33","$1,185.90","$1,880.83",$0.00,$440.83,$0.00,$0.00,$461.42,"$2,635.33",$0.00,"$1,317.66","$2,087.18","$2,108.26",$0.00,$400.42,$0.00,$419.54,$0.00
04.104.028S,SUP,HCPCS C1713,,04.104.028S  -  PLATE BONE 194MM 8 HOLE LCP TITANIUM LEFT DISTAL EXTART,"$2,790.93",$0.00,"$2,790.93","$1,255.92","$1,991.88",$0.00,$466.85,$0.00,$0.00,$488.67,"$2,790.93",$0.00,"$1,395.46","$2,210.42","$2,232.74",$0.00,$424.06,$0.00,$444.32,$0.00
04.104.030S,SUP,HCPCS C1713,,04.104.030S  -  PLATE BONE 230MM 10 HOLE LCP TITANIUM LEFT DISTAL EXTART,"$2,949.23",$0.00,"$2,949.23","$1,327.15","$2,104.86",$0.00,$493.34,$0.00,$0.00,$516.39,"$2,949.23",$0.00,"$1,474.61","$2,335.79","$2,359.38",$0.00,$448.11,$0.00,$469.52,$0.00
04.104.032S,SUP,HCPCS C1713,,04.104.032S  -  PLATE BONE 266MM 12 HOLE LCP TITANIUM LEFT DISTAL EXTART,"$3,357.28",$0.00,"$3,357.28","$1,510.77","$2,396.09",$0.00,$561.60,$0.00,$0.00,$587.83,"$3,357.28",$0.00,"$1,678.64","$2,658.97","$2,685.82",$0.00,$510.11,$0.00,$534.48,$0.00
04.104.034S,SUP,HCPCS C1713,,04.104.034S  -  PLATE BONE 302MM 14 HOLE LCP TITANIUM LEFT DISTAL EXTART,"$3,686.20",$0.00,"$3,686.20","$1,658.79","$2,630.84",$0.00,$616.61,$0.00,$0.00,$645.42,"$3,686.20",$0.00,"$1,843.10","$2,919.47","$2,948.96",$0.00,$560.09,$0.00,$586.84,$0.00
04.110.005,SUP,HCPCS C1713,,04.110.005  -  PLATE BONE 5 HOLE LCP TITANIUM RIGHT DISTAL DIAPHYSEAL,"$2,835.95",$0.00,"$2,835.95","$1,276.18","$2,024.02",$0.00,$474.39,$0.00,$0.00,$496.55,"$2,835.95",$0.00,"$1,417.98","$2,246.07","$2,268.76",$0.00,$430.90,$0.00,$451.48,$0.00
04.110.007,SUP,HCPCS C1713,,04.110.007  -  PLATE BONE 7 HOLE LCP TITANIUM RIGHT DISTAL DIAPHYSEAL,"$2,905.55",$0.00,"$2,905.55","$1,307.50","$2,073.69",$0.00,$486.03,$0.00,$0.00,$508.74,"$2,905.55",$0.00,"$1,452.78","$2,301.20","$2,324.44",$0.00,$441.47,$0.00,$462.56,$0.00
04.110.009,SUP,HCPCS C1713,,04.110.009  -  PLATE BONE 9 HOLE LCP TITANIUM RIGHT DISTAL DIAPHYSEAL,"$2,973.80",$0.00,"$2,973.80","$1,338.21","$2,122.40",$0.00,$497.45,$0.00,$0.00,$520.69,"$2,973.80",$0.00,"$1,486.90","$2,355.25","$2,379.04",$0.00,$451.84,$0.00,$473.43,$0.00
04.110.011,SUP,HCPCS C1713,,04.110.011  -  PLATE BONE 11 HOLE LCP TITANIUM RIGHT DISTAL DIAPHYSEAL,"$3,156.68",$0.00,"$3,156.68","$1,420.50","$2,252.92",$0.00,$528.04,$0.00,$0.00,$552.71,"$3,156.68",$0.00,"$1,578.34","$2,500.09","$2,525.34",$0.00,$479.63,$0.00,$502.54,$0.00
04.110.013S,SUP,HCPCS C1713,,04.110.013S  -  PLATE BONE 13 HOLE LCP TITANIUM RIGHT DISTAL DIAPHYSEAL,"$3,395.50",$0.00,"$3,395.50","$1,527.98","$2,423.37",$0.00,$567.99,$0.00,$0.00,$594.52,"$3,395.50",$0.00,"$1,697.75","$2,689.24","$2,716.40",$0.00,$515.92,$0.00,$540.56,$0.00
04.110.015S,SUP,HCPCS C1713,,04.110.015S  -  PLATE BONE 15 HOLE LCP TITANIUM RIGHT DISTAL DIAPHYSEAL,"$3,506.05",$0.00,"$3,506.05","$1,577.72","$2,502.27",$0.00,$586.48,$0.00,$0.00,$613.88,"$3,506.05",$0.00,"$1,753.03","$2,776.79","$2,804.84",$0.00,$532.71,$0.00,$558.16,$0.00
04.110.105,SUP,HCPCS C1713,,04.110.105  -  PLATE BONE 5 HOLE LCP TITANIUM LEFT DISTAL RADIAL NONSTRL,"$2,835.95",$0.00,"$2,835.95","$1,276.18","$2,024.02",$0.00,$474.39,$0.00,$0.00,$496.55,"$2,835.95",$0.00,"$1,417.98","$2,246.07","$2,268.76",$0.00,$430.90,$0.00,$451.48,$0.00
04.110.107,SUP,HCPCS C1713,,04.110.107  -  PLATE BONE 7 HOLE LCP TITANIUM LEFT DISTAL DIAPHYSEAL,"$2,905.55",$0.00,"$2,905.55","$1,307.50","$2,073.69",$0.00,$486.03,$0.00,$0.00,$508.74,"$2,905.55",$0.00,"$1,452.78","$2,301.20","$2,324.44",$0.00,$441.47,$0.00,$462.56,$0.00
04.110.109,SUP,HCPCS C1713,,04.110.109  -  PLATE BONE 9 HOLE LCP TITANIUM LEFT DISTAL DIAPHYSEAL,"$2,973.80",$0.00,"$2,973.80","$1,338.21","$2,122.40",$0.00,$497.45,$0.00,$0.00,$520.69,"$2,973.80",$0.00,"$1,486.90","$2,355.25","$2,379.04",$0.00,$451.84,$0.00,$473.43,$0.00
04.110.111,SUP,HCPCS C1713,,04.110.111  -  PLATE BONE 11 HOLE LCP TITANIUM LEFT DISTAL DIAPHYSEAL,"$3,156.68",$0.00,"$3,156.68","$1,420.50","$2,252.92",$0.00,$528.04,$0.00,$0.00,$552.71,"$3,156.68",$0.00,"$1,578.34","$2,500.09","$2,525.34",$0.00,$479.63,$0.00,$502.54,$0.00
04.110.113S,SUP,HCPCS C1713,,04.110.113S  -  PLATE BONE 13 HOLE LCP TITANIUM LEFT DISTAL DIAPHYSEAL,"$3,395.50",$0.00,"$3,395.50","$1,527.98","$2,423.37",$0.00,$567.99,$0.00,$0.00,$594.52,"$3,395.50",$0.00,"$1,697.75","$2,689.24","$2,716.40",$0.00,$515.92,$0.00,$540.56,$0.00
04.110.115S,SUP,HCPCS C1713,,04.110.115S  -  PLATE BONE 15 HOLE LCP TITANIUM LEFT DISTAL DIAPHYSEAL,"$3,506.05",$0.00,"$3,506.05","$1,577.72","$2,502.27",$0.00,$586.48,$0.00,$0.00,$613.88,"$3,506.05",$0.00,"$1,753.03","$2,776.79","$2,804.84",$0.00,$532.71,$0.00,$558.16,$0.00
04.110.150,SUP,HCPCS C1713,,04.110.150  -  PLATE BONE STANDARD BEND 118MM FUSION LCP TITANIUM WRIST,"$3,054.30",$0.00,"$3,054.30","$1,374.44","$2,179.85",$0.00,$510.91,$0.00,$0.00,$534.78,"$3,054.30",$0.00,"$1,527.15","$2,419.01","$2,443.44",$0.00,$464.08,$0.00,$486.24,$0.00
04.110.151,SUP,HCPCS C1713,,04.110.151  -  PLATE BN SHRT BND 118MM NS LCP FSN TI WRST,"$3,054.30",$0.00,"$3,054.30","$1,374.44","$2,179.85",$0.00,$510.91,$0.00,$0.00,$534.78,"$3,054.30",$0.00,"$1,527.15","$2,419.01","$2,443.44",$0.00,$464.08,$0.00,$486.24,$0.00
04.110.152,SUP,HCPCS C1713,,04.110.152  -  PLATE BONE 112MM STR FUSION LCP TITANIUM WRIST NONSTRL,"$3,054.30",$0.00,"$3,054.30","$1,374.44","$2,179.85",$0.00,$510.91,$0.00,$0.00,$534.78,"$3,054.30",$0.00,"$1,527.15","$2,419.01","$2,443.44",$0.00,$464.08,$0.00,$486.24,$0.00
04.110.201,SUP,HCPCS C1713,,04.110.201  -  PLATE BONE 5X3 HOLE VAR ANG LCP TITANIUM RIGHT VOLAR DISTAL,"$1,819.20",$0.00,"$1,819.20",$818.64,"$1,298.36",$0.00,$304.31,$0.00,$0.00,$318.53,"$1,819.20",$0.00,$909.60,"$1,440.81","$1,455.36",$0.00,$276.41,$0.00,$289.62,$0.00
04.110.202,SUP,HCPCS C1713,,04.110.202  -  PLATE BONE 5X5 HOLE VAR ANG LCP TITANIUM RIGHT VOLAR DISTAL,"$1,957.05",$0.00,"$1,957.05",$880.67,"$1,396.75",$0.00,$327.37,$0.00,$0.00,$342.66,"$1,957.05",$0.00,$978.53,"$1,549.98","$1,565.64",$0.00,$297.36,$0.00,$311.56,$0.00
04.110.203,SUP,HCPCS C1713,,04.110.203  -  PLATE BONE 4X3 HOLE VAR ANG LCP TITANIUM LEFT VOLAR DISTAL,"$1,819.20",$0.00,"$1,819.20",$818.64,"$1,298.36",$0.00,$304.31,$0.00,$0.00,$318.53,"$1,819.20",$0.00,$909.60,"$1,440.81","$1,455.36",$0.00,$276.41,$0.00,$289.62,$0.00
04.110.204,SUP,HCPCS C1713,,04.110.204  -  PLATE BONE 5X5 HOLE VAR ANG LCP TITANIUM LEFT VOLAR DISTAL,"$1,957.05",$0.00,"$1,957.05",$880.67,"$1,396.75",$0.00,$327.37,$0.00,$0.00,$342.66,"$1,957.05",$0.00,$978.53,"$1,549.98","$1,565.64",$0.00,$297.36,$0.00,$311.56,$0.00
04.110.205,SUP,HCPCS C1713,,04.110.205  -  PLATE BONE 4X3 HOLE VAR ANG LCP TITANIUM RIGHT VOLAR DISTAL,"$1,819.20",$0.00,"$1,819.20",$818.64,"$1,298.36",$0.00,$304.31,$0.00,$0.00,$318.53,"$1,819.20",$0.00,$909.60,"$1,440.81","$1,455.36",$0.00,$276.41,$0.00,$289.62,$0.00
04.110.206,SUP,HCPCS C1713,,04.110.206  -  PLATE BONE 4X5 HOLE VAR ANG LCP TITANIUM RIGHT VOLAR DISTAL,"$1,957.05",$0.00,"$1,957.05",$880.67,"$1,396.75",$0.00,$327.37,$0.00,$0.00,$342.66,"$1,957.05",$0.00,$978.53,"$1,549.98","$1,565.64",$0.00,$297.36,$0.00,$311.56,$0.00
04.110.207,SUP,HCPCS C1713,,04.110.207  -  PLATE BONE 4X3 HOLE VAR ANG LCP TITANIUM LEFT VOLAR DISTAL,"$1,819.20",$0.00,"$1,819.20",$818.64,"$1,298.36",$0.00,$304.31,$0.00,$0.00,$318.53,"$1,819.20",$0.00,$909.60,"$1,440.81","$1,455.36",$0.00,$276.41,$0.00,$289.62,$0.00
04.110.208,SUP,HCPCS C1713,,04.110.208  -  PLATE BONE 4X5 HOLE VAR ANG LCP TITANIUM LEFT VOLAR DISTAL,"$1,957.05",$0.00,"$1,957.05",$880.67,"$1,396.75",$0.00,$327.37,$0.00,$0.00,$342.66,"$1,957.05",$0.00,$978.53,"$1,549.98","$1,565.64",$0.00,$297.36,$0.00,$311.56,$0.00
04.110.300,SUP,Custom 27203010,,04.110.300  -  WIRE FIX 1.8MM 150MM TROCAR POINT DEPTH MARKING KWIRE,$19.52,$0.00,$19.52,$0.00,$13.93,$0.00,$0.00,$0.00,$0.00,$0.00,$19.52,$0.00,$9.76,$15.46,$15.61,$0.00,$0.00,$0.00,$0.00,$0.00
04.110.330,SUP,HCPCS C1713,,04.110.330  -  PLATE BONE 50.5MM 9X3 HOLE COLUMN LCP TITANIUM RIGHT DISTAL,"$1,524.43",$0.00,"$1,524.43",$685.99,"$1,087.98",$0.00,$255.00,$0.00,$0.00,$266.91,"$1,524.43",$0.00,$762.21,"$1,207.35","$1,219.54",$0.00,$231.62,$0.00,$242.69,$0.00
04.110.331,SUP,HCPCS C1713,,04.110.331  -  PLATE BONE 50.5MM 9X3 HOLE COLUMN LCP TITANIUM LEFT DISTAL,"$1,524.43",$0.00,"$1,524.43",$685.99,"$1,087.98",$0.00,$255.00,$0.00,$0.00,$266.91,"$1,524.43",$0.00,$762.21,"$1,207.35","$1,219.54",$0.00,$231.62,$0.00,$242.69,$0.00
04.110.340,SUP,HCPCS C1713,,04.110.340  -  PLATE BONE 59.5MM 9X4 HOLE COLUMN LCP TITANIUM RIGHT DISTAL,"$1,572.20",$0.00,"$1,572.20",$707.49,"$1,122.08",$0.00,$262.99,$0.00,$0.00,$275.28,"$1,572.20",$0.00,$786.10,"$1,245.18","$1,257.76",$0.00,$238.88,$0.00,$250.29,$0.00
04.110.341,SUP,HCPCS C1713,,04.110.341  -  PLATE BONE 59.5MM 9X4 HOLE COLUMN LCP TITANIUM LEFT DISTAL,"$1,572.20",$0.00,"$1,572.20",$707.49,"$1,122.08",$0.00,$262.99,$0.00,$0.00,$275.28,"$1,572.20",$0.00,$786.10,"$1,245.18","$1,257.76",$0.00,$238.88,$0.00,$250.29,$0.00
04.110.350,SUP,HCPCS C1713,,04.110.350  -  PLATE BONE 68.5MM 9X5 HOLE COLUMN LCP TITANIUM RIGHT DISTAL,"$1,618.60",$0.00,"$1,618.60",$728.37,"$1,155.19",$0.00,$270.75,$0.00,$0.00,$283.40,"$1,618.60",$0.00,$809.30,"$1,281.93","$1,294.88",$0.00,$245.93,$0.00,$257.68,$0.00
04.110.351,SUP,HCPCS C1713,,04.110.351  -  PLATE BONE 68.5MM 9X5 HOLE COLUMN LCP TITANIUM LEFT DISTAL,"$1,618.60",$0.00,"$1,618.60",$728.37,"$1,155.19",$0.00,$270.75,$0.00,$0.00,$283.40,"$1,618.60",$0.00,$809.30,"$1,281.93","$1,294.88",$0.00,$245.93,$0.00,$257.68,$0.00
04.110.430,SUP,HCPCS C1713,,04.110.430  -  PLATE BONE 50.5MM 8X3 HOLE COLUMN LCP TITANIUM RIGHT DISTAL,"$1,524.43",$0.00,"$1,524.43",$685.99,"$1,087.98",$0.00,$255.00,$0.00,$0.00,$266.91,"$1,524.43",$0.00,$762.21,"$1,207.35","$1,219.54",$0.00,$231.62,$0.00,$242.69,$0.00
04.110.431,SUP,HCPCS C1713,,04.110.431  -  PLATE BN 50.5MM NS LCP CMBN 8 HLE/HD 3 HL SHFT CLMN RND EDG,"$1,524.43",$0.00,"$1,524.43",$685.99,"$1,087.98",$0.00,$255.00,$0.00,$0.00,$266.91,"$1,524.43",$0.00,$762.21,"$1,207.35","$1,219.54",$0.00,$231.62,$0.00,$242.69,$0.00
04.110.440,SUP,HCPCS C1713,,04.110.440  -  PLATE BONE 59.5MM 8X4 HOLE COLUMN LCP TITANIUM RIGHT DISTAL,"$1,572.20",$0.00,"$1,572.20",$707.49,"$1,122.08",$0.00,$262.99,$0.00,$0.00,$275.28,"$1,572.20",$0.00,$786.10,"$1,245.18","$1,257.76",$0.00,$238.88,$0.00,$250.29,$0.00
04.110.441,SUP,HCPCS C1713,,04.110.441  -  PLATE BONE 59.5MM 8X4 HOLE COLUMN LCP TITANIUM LEFT DISTAL,"$1,572.20",$0.00,"$1,572.20",$707.49,"$1,122.08",$0.00,$262.99,$0.00,$0.00,$275.28,"$1,572.20",$0.00,$786.10,"$1,245.18","$1,257.76",$0.00,$238.88,$0.00,$250.29,$0.00
04.110.450,SUP,HCPCS C1713,,04.110.450  -  PLATE BONE 68.5MM 8X5 HOLE COLUMN LCP TITANIUM RIGHT DISTAL,"$1,618.60",$0.00,"$1,618.60",$728.37,"$1,155.19",$0.00,$270.75,$0.00,$0.00,$283.40,"$1,618.60",$0.00,$809.30,"$1,281.93","$1,294.88",$0.00,$245.93,$0.00,$257.68,$0.00
04.110.451,SUP,HCPCS C1713,,04.110.451  -  PLATE BONE 68.5MM 8X5 HOLE COLUMN LCP TITANIUM LEFT DISTAL,"$1,618.60",$0.00,"$1,618.60",$728.37,"$1,155.19",$0.00,$270.75,$0.00,$0.00,$283.40,"$1,618.60",$0.00,$809.30,"$1,281.93","$1,294.88",$0.00,$245.93,$0.00,$257.68,$0.00
04.110.730,SUP,HCPCS C1713,,04.110.730  -  PLATE BONE 45MM 6X3 HOLE COLUMN LCP TITANIUM RIGHT DISTAL,"$1,524.43",$0.00,"$1,524.43",$685.99,"$1,087.98",$0.00,$255.00,$0.00,$0.00,$266.91,"$1,524.43",$0.00,$762.21,"$1,207.35","$1,219.54",$0.00,$231.62,$0.00,$242.69,$0.00
04.110.731,SUP,HCPCS C1713,,04.110.731  -  PLATE BONE 45MM 6X3 HOLE COLUMN LCP TITANIUM LEFT DISTAL,"$1,524.43",$0.00,"$1,524.43",$685.99,"$1,087.98",$0.00,$255.00,$0.00,$0.00,$266.91,"$1,524.43",$0.00,$762.21,"$1,207.35","$1,219.54",$0.00,$231.62,$0.00,$242.69,$0.00
04.110.740,SUP,HCPCS C1713,,04.110.740  -  PLATE BONE 54MM 6X4 HOLE COLUMN LCP TITANIUM RIGHT DISTAL,"$1,572.20",$0.00,"$1,572.20",$707.49,"$1,122.08",$0.00,$262.99,$0.00,$0.00,$275.28,"$1,572.20",$0.00,$786.10,"$1,245.18","$1,257.76",$0.00,$238.88,$0.00,$250.29,$0.00
04.110.741,SUP,HCPCS C1713,,04.110.741  -  PLATE BONE 54MM 6X4 HOLE COLUMN LCP TITANIUM LEFT DISTAL,"$1,572.20",$0.00,"$1,572.20",$707.49,"$1,122.08",$0.00,$262.99,$0.00,$0.00,$275.28,"$1,572.20",$0.00,$786.10,"$1,245.18","$1,257.76",$0.00,$238.88,$0.00,$250.29,$0.00
04.110.750,SUP,HCPCS C1713,,04.110.750  -  PLATE BONE 63MM 6X5 HOLE COLUMN LCP TITANIUM RIGHT DISTAL,"$1,618.60",$0.00,"$1,618.60",$728.37,"$1,155.19",$0.00,$270.75,$0.00,$0.00,$283.40,"$1,618.60",$0.00,$809.30,"$1,281.93","$1,294.88",$0.00,$245.93,$0.00,$257.68,$0.00
04.110.751,SUP,HCPCS C1713,,04.110.751  -  PLATE BONE 63MM 6X5 HOLE COLUMN LCP TITANIUM LEFT DISTAL,"$1,618.60",$0.00,"$1,618.60",$728.37,"$1,155.19",$0.00,$270.75,$0.00,$0.00,$283.40,"$1,618.60",$0.00,$809.30,"$1,281.93","$1,294.88",$0.00,$245.93,$0.00,$257.68,$0.00
04.110.830,SUP,HCPCS C1713,,04.110.830  -  PLATE BONE 45MM 7X3 HOLE COLUMN LCP TITANIUM RIGHT DISTAL,"$1,524.43",$0.00,"$1,524.43",$685.99,"$1,087.98",$0.00,$255.00,$0.00,$0.00,$266.91,"$1,524.43",$0.00,$762.21,"$1,207.35","$1,219.54",$0.00,$231.62,$0.00,$242.69,$0.00
04.110.831,SUP,HCPCS C1713,,04.110.831  -  PLATE BONE 45MM 7X3 HOLE COLUMN LCP TITANIUM LEFT VOLAR,"$1,524.43",$0.00,"$1,524.43",$685.99,"$1,087.98",$0.00,$255.00,$0.00,$0.00,$266.91,"$1,524.43",$0.00,$762.21,"$1,207.35","$1,219.54",$0.00,$231.62,$0.00,$242.69,$0.00
04.110.840,SUP,HCPCS C1713,,04.110.840  -  PLATE BONE 54MM 7X4 HOLE COLUMN LCP TITANIUM RIGHT DISTAL,"$1,572.20",$0.00,"$1,572.20",$707.49,"$1,122.08",$0.00,$262.99,$0.00,$0.00,$275.28,"$1,572.20",$0.00,$786.10,"$1,245.18","$1,257.76",$0.00,$238.88,$0.00,$250.29,$0.00
04.110.841,SUP,HCPCS C1713,,04.110.841  -  PLATE BONE 54MM 7X4 HOLE COLUMN LCP TITANIUM LEFT DISTAL,"$1,572.20",$0.00,"$1,572.20",$707.49,"$1,122.08",$0.00,$262.99,$0.00,$0.00,$275.28,"$1,572.20",$0.00,$786.10,"$1,245.18","$1,257.76",$0.00,$238.88,$0.00,$250.29,$0.00
04.110.850,SUP,HCPCS C1713,,04.110.850  -  PLATE BONE 63MM 7X5 HOLE COLUMN LCP TITANIUM RIGHT DISTAL,"$1,618.60",$0.00,"$1,618.60",$728.37,"$1,155.19",$0.00,$270.75,$0.00,$0.00,$283.40,"$1,618.60",$0.00,$809.30,"$1,281.93","$1,294.88",$0.00,$245.93,$0.00,$257.68,$0.00
04.110.851,SUP,HCPCS C1713,,04.110.851  -  PLATE BONE 63MM 7X5 HOLE COLUMN LCP TITANIUM LEFT DISTAL,"$1,618.60",$0.00,"$1,618.60",$728.37,"$1,155.19",$0.00,$270.75,$0.00,$0.00,$283.40,"$1,618.60",$0.00,$809.30,"$1,281.93","$1,294.88",$0.00,$245.93,$0.00,$257.68,$0.00
04.111.520,SUP,HCPCS C1713,,04.111.520  -  PLATE BONE NARROW 42MM 6X2 HOLE 2 COLUMN VAR ANG LCP,"$1,749.60",$0.00,"$1,749.60",$787.32,"$1,248.69",$0.00,$292.67,$0.00,$0.00,$306.34,"$1,749.60",$0.00,$874.80,"$1,385.68","$1,399.68",$0.00,$265.84,$0.00,$278.54,$0.00
04.111.521,SUP,HCPCS C1713,,04.111.521  -  PLATE BONE NARROW 42MM 6X2 HOLE 2 COLUMN VAR ANG LCP,"$1,749.60",$0.00,"$1,749.60",$787.32,"$1,248.69",$0.00,$292.67,$0.00,$0.00,$306.34,"$1,749.60",$0.00,$874.80,"$1,385.68","$1,399.68",$0.00,$265.84,$0.00,$278.54,$0.00
04.111.530,SUP,HCPCS C1713,,04.111.530  -  PLATE BONE NARROW 51MM 6X3 HOLE 2 COLUMN VAR ANG LCP,"$1,819.20",$0.00,"$1,819.20",$818.64,"$1,298.36",$0.00,$304.31,$0.00,$0.00,$318.53,"$1,819.20",$0.00,$909.60,"$1,440.81","$1,455.36",$0.00,$276.41,$0.00,$289.62,$0.00
04.111.531,SUP,HCPCS C1713,,04.111.531  -  PLATE BONE NARROW 51MM 6X3 HOLE 2 COLUMN VAR ANG LCP,"$1,819.20",$0.00,"$1,819.20",$818.64,"$1,298.36",$0.00,$304.31,$0.00,$0.00,$318.53,"$1,819.20",$0.00,$909.60,"$1,440.81","$1,455.36",$0.00,$276.41,$0.00,$289.62,$0.00
04.111.540,SUP,HCPCS C1713,,04.111.540  -  PLATE BONE NARROW 63MM 6X4 HOLE 2 COLUMN VAR ANG LCP,"$1,887.45",$0.00,"$1,887.45",$849.35,"$1,347.07",$0.00,$315.73,$0.00,$0.00,$330.48,"$1,887.45",$0.00,$943.73,"$1,494.86","$1,509.96",$0.00,$286.78,$0.00,$300.48,$0.00
04.111.541,SUP,HCPCS C1713,,04.111.541  -  PLATE BONE NARROW 63MM 6X4 HOLE 2 COLUMN VAR ANG LCP,"$1,887.45",$0.00,"$1,887.45",$849.35,"$1,347.07",$0.00,$315.73,$0.00,$0.00,$330.48,"$1,887.45",$0.00,$943.73,"$1,494.86","$1,509.96",$0.00,$286.78,$0.00,$300.48,$0.00
04.111.550,SUP,HCPCS C1713,,04.111.550  -  PLATE BONE NARROW 72MM 6X5 HOLE 2 COLUMN VAR ANG LCP,"$1,957.05",$0.00,"$1,957.05",$880.67,"$1,396.75",$0.00,$327.37,$0.00,$0.00,$342.66,"$1,957.05",$0.00,$978.53,"$1,549.98","$1,565.64",$0.00,$297.36,$0.00,$311.56,$0.00
04.111.551,SUP,HCPCS C1713,,04.111.551  -  PLATE BONE NARROW 72MM 6X5 HOLE 2 COLUMN VAR ANG LCP,"$1,957.05",$0.00,"$1,957.05",$880.67,"$1,396.75",$0.00,$327.37,$0.00,$0.00,$342.66,"$1,957.05",$0.00,$978.53,"$1,549.98","$1,565.64",$0.00,$297.36,$0.00,$311.56,$0.00
04.111.620,SUP,HCPCS C1713,,04.111.620  -  PLATE BN STD 45MM NS LCP CMBN 6 HLE/HD 2 HL SHFT 2 CLMN VA,"$1,749.60",$0.00,"$1,749.60",$787.32,"$1,248.69",$0.00,$292.67,$0.00,$0.00,$306.34,"$1,749.60",$0.00,$874.80,"$1,385.68","$1,399.68",$0.00,$265.84,$0.00,$278.54,$0.00
04.111.621,SUP,HCPCS C1713,,04.111.621  -  PLATE BN STD 45MM NS LCP CMBN 6 HLE/HD 2 HL SHFT 2 CLMN VA,"$1,749.60",$0.00,"$1,749.60",$787.32,"$1,248.69",$0.00,$292.67,$0.00,$0.00,$306.34,"$1,749.60",$0.00,$874.80,"$1,385.68","$1,399.68",$0.00,$265.84,$0.00,$278.54,$0.00
04.111.630,SUP,HCPCS C1713,,04.111.630  -  PLATE BN STD 54MM NS LCP CMBN 6 HLE/HD 3 HL SHFT 2 CLMN VA,"$1,819.20",$0.00,"$1,819.20",$818.64,"$1,298.36",$0.00,$304.31,$0.00,$0.00,$318.53,"$1,819.20",$0.00,$909.60,"$1,440.81","$1,455.36",$0.00,$276.41,$0.00,$289.62,$0.00
04.111.631,SUP,HCPCS C1713,,04.111.631  -  PLATE BONE 54MM 6X3 HOLE 2 COLUMN VAR ANG LCP TITANIUM LEFT,"$1,819.20",$0.00,"$1,819.20",$818.64,"$1,298.36",$0.00,$304.31,$0.00,$0.00,$318.53,"$1,819.20",$0.00,$909.60,"$1,440.81","$1,455.36",$0.00,$276.41,$0.00,$289.62,$0.00
04.111.640,SUP,HCPCS C1713,,04.111.640  -  PLATE BONE 70MM 6X4 HOLE VAR ANG 2 COLUMN LCP TITANIUM LEFT,"$1,887.45",$0.00,"$1,887.45",$849.35,"$1,347.07",$0.00,$315.73,$0.00,$0.00,$330.48,"$1,887.45",$0.00,$943.73,"$1,494.86","$1,509.96",$0.00,$286.78,$0.00,$300.48,$0.00
04.111.641,SUP,HCPCS C1713,,04.111.641  -  PLATE BONE 70MM 6X4 HOLE VAR ANG 2 COLUMN LCP TITANIUM RIGHT,"$1,887.45",$0.00,"$1,887.45",$849.35,"$1,347.07",$0.00,$315.73,$0.00,$0.00,$330.48,"$1,887.45",$0.00,$943.73,"$1,494.86","$1,509.96",$0.00,$286.78,$0.00,$300.48,$0.00
04.111.650,SUP,HCPCS C1713,,04.111.650  -  PLATE BONE 75MM 6X5 HOLE 2 COLUMN VAR ANG LCP TITANIUM RIGHT,"$1,957.05",$0.00,"$1,957.05",$880.67,"$1,396.75",$0.00,$327.37,$0.00,$0.00,$342.66,"$1,957.05",$0.00,$978.53,"$1,549.98","$1,565.64",$0.00,$297.36,$0.00,$311.56,$0.00
04.111.651,SUP,HCPCS C1713,,04.111.651  -  PLATE BONE 75MM 6X5 HOLE 2 COLUMN VAR ANG LCP TITANIUM LEFT,"$1,957.05",$0.00,"$1,957.05",$880.67,"$1,396.75",$0.00,$327.37,$0.00,$0.00,$342.66,"$1,957.05",$0.00,$978.53,"$1,549.98","$1,565.64",$0.00,$297.36,$0.00,$311.56,$0.00
04.111.720,SUP,HCPCS C1713,,04.111.720  -  PLATE BN STD 47MM NS LCP CMBN 7 HLE/HD 2 HL SHFT 2 CLMN VA,"$1,749.60",$0.00,"$1,749.60",$787.32,"$1,248.69",$0.00,$292.67,$0.00,$0.00,$306.34,"$1,749.60",$0.00,$874.80,"$1,385.68","$1,399.68",$0.00,$265.84,$0.00,$278.54,$0.00
04.111.721,SUP,HCPCS C1713,,04.111.721  -  PLATE BONE 49MM 7X2 HOLE 2 COLUMN VAR ANG LCP TITANIUM LEFT,"$1,749.60",$0.00,"$1,749.60",$787.32,"$1,248.69",$0.00,$292.67,$0.00,$0.00,$306.34,"$1,749.60",$0.00,$874.80,"$1,385.68","$1,399.68",$0.00,$265.84,$0.00,$278.54,$0.00
04.111.730,SUP,HCPCS C1713,,04.111.730  -  PLATE BONE 55MM 7X3 HOLE 2 COLUMN VAR ANG LCP TITANIUM RIGHT,"$1,819.20",$0.00,"$1,819.20",$818.64,"$1,298.36",$0.00,$304.31,$0.00,$0.00,$318.53,"$1,819.20",$0.00,$909.60,"$1,440.81","$1,455.36",$0.00,$276.41,$0.00,$289.62,$0.00
04.111.731,SUP,HCPCS C1713,,04.111.731  -  PLATE BONE 55MM 7X3 HOLE 2 COLUMN VAR ANG LCP TITANIUM LEFT,"$1,819.20",$0.00,"$1,819.20",$818.64,"$1,298.36",$0.00,$304.31,$0.00,$0.00,$318.53,"$1,819.20",$0.00,$909.60,"$1,440.81","$1,455.36",$0.00,$276.41,$0.00,$289.62,$0.00
04.111.740,SUP,HCPCS C1713,,04.111.740  -  PLATE BONE 70MM 7X4 HOLE VAR ANG 2 COLUMN LCP TITANIUM RIGHT,"$1,887.45",$0.00,"$1,887.45",$849.35,"$1,347.07",$0.00,$315.73,$0.00,$0.00,$330.48,"$1,887.45",$0.00,$943.73,"$1,494.86","$1,509.96",$0.00,$286.78,$0.00,$300.48,$0.00
04.111.741,SUP,HCPCS C1713,,04.111.741  -  PLATE BONE 70MM 7X4 HOLE VAR ANG 2 COLUMN LCP TITANIUM LEFT,"$1,887.45",$0.00,"$1,887.45",$849.35,"$1,347.07",$0.00,$315.73,$0.00,$0.00,$330.48,"$1,887.45",$0.00,$943.73,"$1,494.86","$1,509.96",$0.00,$286.78,$0.00,$300.48,$0.00
04.111.750,SUP,HCPCS C1713,,04.111.750  -  PLATE BONE 77MM 7X5 HOLE 2 COLUMN VAR ANG LCP TITANIUM RIGHT,"$1,957.05",$0.00,"$1,957.05",$880.67,"$1,396.75",$0.00,$327.37,$0.00,$0.00,$342.66,"$1,957.05",$0.00,$978.53,"$1,549.98","$1,565.64",$0.00,$297.36,$0.00,$311.56,$0.00
04.111.751,SUP,HCPCS C1713,,04.111.751  -  PLATE BONE 77MM 7X5 HOLE 2 COLUMN VARIABLE LCP TITANIUM LEFT,"$1,957.05",$0.00,"$1,957.05",$880.67,"$1,396.75",$0.00,$327.37,$0.00,$0.00,$342.66,"$1,957.05",$0.00,$978.53,"$1,549.98","$1,565.64",$0.00,$297.36,$0.00,$311.56,$0.00
04.112.006,SUP,HCPCS C1713,,04.112.006  -  PLATE BONE 69MM 3 HOLE LATERAL EXTN LCP TITANIUM LEFT,"$1,576.28",$0.00,"$1,576.28",$709.32,"$1,124.99",$0.00,$263.68,$0.00,$0.00,$275.99,"$1,576.28",$0.00,$788.14,"$1,248.41","$1,261.02",$0.00,$239.50,$0.00,$250.94,$0.00
04.112.007,SUP,HCPCS C1713,,04.112.007  -  PLATE BONE 69MM 3 HOLE LATERAL EXTN LCP TITANIUM LEFT,"$1,576.28",$0.00,"$1,576.28",$709.32,"$1,124.99",$0.00,$263.68,$0.00,$0.00,$275.99,"$1,576.28",$0.00,$788.14,"$1,248.41","$1,261.02",$0.00,$239.50,$0.00,$250.94,$0.00
04.112.008,SUP,HCPCS C1713,,04.112.008  -  PLATE BONE 108MM 6 HOLE LATERAL EXTN LCP TITANIUM LEFT,"$1,645.90",$0.00,"$1,645.90",$740.66,"$1,174.68",$0.00,$275.32,$0.00,$0.00,$288.18,"$1,645.90",$0.00,$822.95,"$1,303.55","$1,316.72",$0.00,$250.08,$0.00,$262.03,$0.00
04.112.009,SUP,HCPCS C1713,,04.112.009  -  PLATE BONE 108MM 6 HOLE LATERAL EXTN LCP TITANIUM LEFT,"$1,645.90",$0.00,"$1,645.90",$740.66,"$1,174.68",$0.00,$275.32,$0.00,$0.00,$288.18,"$1,645.90",$0.00,$822.95,"$1,303.55","$1,316.72",$0.00,$250.08,$0.00,$262.03,$0.00
04.112.010,SUP,HCPCS C1713,,04.112.010  -  PLATE BONE 81MM 4 HOLE LATERAL EXTN LCP TITANIUM LEFT,"$1,600.85",$0.00,"$1,600.85",$720.38,"$1,142.53",$0.00,$267.79,$0.00,$0.00,$280.30,"$1,600.85",$0.00,$800.43,"$1,267.87","$1,280.68",$0.00,$243.24,$0.00,$254.86,$0.00
04.112.011,SUP,HCPCS C1713,,04.112.011  -  PLATE BONE 81MM 4 HOLE LATERAL EXTN LCP TITANIUM LEFT,"$1,600.85",$0.00,"$1,600.85",$720.38,"$1,142.53",$0.00,$267.79,$0.00,$0.00,$280.30,"$1,600.85",$0.00,$800.43,"$1,267.87","$1,280.68",$0.00,$243.24,$0.00,$254.86,$0.00
04.112.012,SUP,HCPCS C1713,,04.112.012  -  PLATE BONE 94MM 5 HOLE LATERAL EXTN LCP TITANIUM LEFT,"$1,628.15",$0.00,"$1,628.15",$732.67,"$1,162.01",$0.00,$272.35,$0.00,$0.00,$285.08,"$1,628.15",$0.00,$814.08,"$1,289.49","$1,302.52",$0.00,$247.38,$0.00,$259.20,$0.00
04.112.013,SUP,HCPCS C1713,,04.112.013  -  PLATE BONE 94MM 5 HOLE LATERAL EXTN LCP TITANIUM LEFT,"$1,628.15",$0.00,"$1,628.15",$732.67,"$1,162.01",$0.00,$272.35,$0.00,$0.00,$285.08,"$1,628.15",$0.00,$814.08,"$1,289.49","$1,302.52",$0.00,$247.38,$0.00,$259.20,$0.00
04.112.018,SUP,HCPCS C1713,,04.112.018  -  PLATE BONE 123MM 7 HOLE LATERAL EXTN LCP TITANIUM LEFT,"$1,689.55",$0.00,"$1,689.55",$760.30,"$1,205.83",$0.00,$282.62,$0.00,$0.00,$295.83,"$1,689.55",$0.00,$844.78,"$1,338.12","$1,351.64",$0.00,$256.71,$0.00,$268.98,$0.00
04.112.019,SUP,HCPCS C1713,,04.112.019  -  PLATE BONE 123MM 7 HOLE LATERAL EXTN LCP TITANIUM LEFT,"$1,689.55",$0.00,"$1,689.55",$760.30,"$1,205.83",$0.00,$282.62,$0.00,$0.00,$295.83,"$1,689.55",$0.00,$844.78,"$1,338.12","$1,351.64",$0.00,$256.71,$0.00,$268.98,$0.00
04.112.020,SUP,HCPCS C1713,,04.112.020  -  PLATE BONE 135MM 8 HOLE LATERAL EXTN LCP TITANIUM RIGHT,"$1,733.23",$0.00,"$1,733.23",$779.95,"$1,237.00",$0.00,$289.93,$0.00,$0.00,$303.47,"$1,733.23",$0.00,$866.61,"$1,372.72","$1,386.58",$0.00,$263.35,$0.00,$275.93,$0.00
04.112.021,SUP,HCPCS C1713,,04.112.021  -  PLATE BONE 135MM 8 HOLE LATERAL EXTN LCP TITANIUM LEFT,"$1,733.23",$0.00,"$1,733.23",$779.95,"$1,237.00",$0.00,$289.93,$0.00,$0.00,$303.47,"$1,733.23",$0.00,$866.61,"$1,372.72","$1,386.58",$0.00,$263.35,$0.00,$275.93,$0.00
04.112.026,SUP,HCPCS C1713,,04.112.026  -  PLATE BN 94MM NS LCP CMBN 6 HL PRECONTOUR LMT CNTCT TPR TIP,"$1,645.90",$0.00,"$1,645.90",$740.66,"$1,174.68",$0.00,$275.32,$0.00,$0.00,$288.18,"$1,645.90",$0.00,$822.95,"$1,303.55","$1,316.72",$0.00,$250.08,$0.00,$262.03,$0.00
04.112.027,SUP,HCPCS C1713,,04.112.027  -  PLATE BONE 94MM 6 HOLE LCP TITANIUM LEFT SUPERIOR ANTERIOR,"$1,645.90",$0.00,"$1,645.90",$740.66,"$1,174.68",$0.00,$275.32,$0.00,$0.00,$288.18,"$1,645.90",$0.00,$822.95,"$1,303.55","$1,316.72",$0.00,$250.08,$0.00,$262.03,$0.00
04.112.028,SUP,HCPCS C1713,,04.112.028  -  PLATE BONE 110MM 7 HOLE LCP TITANIUM RIGHT SUPERIOR ANTERIOR,"$1,689.55",$0.00,"$1,689.55",$760.30,"$1,205.83",$0.00,$282.62,$0.00,$0.00,$295.83,"$1,689.55",$0.00,$844.78,"$1,338.12","$1,351.64",$0.00,$256.71,$0.00,$268.98,$0.00
04.112.029,SUP,HCPCS C1713,,04.112.029  -  PLATE BONE 110MM 7 HOLE LCP TITANIUM LEFT SUPERIOR ANTERIOR,"$1,689.55",$0.00,"$1,689.55",$760.30,"$1,205.83",$0.00,$282.62,$0.00,$0.00,$295.83,"$1,689.55",$0.00,$844.78,"$1,338.12","$1,351.64",$0.00,$256.71,$0.00,$268.98,$0.00
04.112.030,SUP,HCPCS C1713,,04.112.030  -  PLATE BONE 120MM 8 HOLE LCP TITANIUM RIGHT SUPERIOR ANTERIOR,"$1,733.23",$0.00,"$1,733.23",$779.95,"$1,237.00",$0.00,$289.93,$0.00,$0.00,$303.47,"$1,733.23",$0.00,$866.61,"$1,372.72","$1,386.58",$0.00,$263.35,$0.00,$275.93,$0.00
04.112.031,SUP,HCPCS C1713,,04.112.031  -  PLATE BONE 120MM 8 HOLE LCP TITANIUM RIGHT SUPERIOR ANTERIOR,"$1,733.23",$0.00,"$1,733.23",$779.95,"$1,237.00",$0.00,$289.93,$0.00,$0.00,$303.47,"$1,733.23",$0.00,$866.61,"$1,372.72","$1,386.58",$0.00,$263.35,$0.00,$275.93,$0.00
04.112.040S,SUP,HCPCS C1713,,04.112.040S  -  PLATE BONE 79MM 6 HOLE LCP TITANIUM MEDIAL ANTERIOR CLAVICLE,"$1,821.95",$0.00,"$1,821.95",$819.88,"$1,300.33",$0.00,$304.77,$0.00,$0.00,$319.01,"$1,821.95",$0.00,$910.98,"$1,442.98","$1,457.56",$0.00,$276.83,$0.00,$290.05,$0.00
04.112.041,SUP,HCPCS C1713,,04.112.041  -  PLATE BONE 91MM 7 HOLE LCP TITANIUM MEDIAL ANTERIOR CLAVICLE,"$1,733.23",$0.00,"$1,733.23",$779.95,"$1,237.00",$0.00,$289.93,$0.00,$0.00,$303.47,"$1,733.23",$0.00,$866.61,"$1,372.72","$1,386.58",$0.00,$263.35,$0.00,$275.93,$0.00
04.112.042,SUP,HCPCS C1713,,04.112.042  -  PLATE BONE 102MM 8 HOLE LCP TITANIUM MEDIAL ANTERIOR,"$1,733.23",$0.00,"$1,733.23",$779.95,"$1,237.00",$0.00,$289.93,$0.00,$0.00,$303.47,"$1,733.23",$0.00,$866.61,"$1,372.72","$1,386.58",$0.00,$263.35,$0.00,$275.93,$0.00
04.112.045,SUP,HCPCS C1713,,04.112.045  -  PLATE BONE 77MM 7 HOLE VAR ANG LCP TITANIUM LATERAL ANTERIOR,"$1,733.23",$0.00,"$1,733.23",$779.95,"$1,237.00",$0.00,$289.93,$0.00,$0.00,$303.47,"$1,733.23",$0.00,$866.61,"$1,372.72","$1,386.58",$0.00,$263.35,$0.00,$275.93,$0.00
04.112.046,SUP,HCPCS C1713,,04.112.046  -  PLATE BONE 89MM 9 HOLE VAR ANG LCP TITANIUM LATERAL ANTERIOR,"$1,733.23",$0.00,"$1,733.23",$779.95,"$1,237.00",$0.00,$289.93,$0.00,$0.00,$303.47,"$1,733.23",$0.00,$866.61,"$1,372.72","$1,386.58",$0.00,$263.35,$0.00,$275.93,$0.00
04.112.047,SUP,HCPCS C1713,,04.112.047  -  PLATE BONE 101MM 10 HOLE VAR ANG LCP TITANIUM LATERAL,"$1,733.23",$0.00,"$1,733.23",$779.95,"$1,237.00",$0.00,$289.93,$0.00,$0.00,$303.47,"$1,733.23",$0.00,$866.61,"$1,372.72","$1,386.58",$0.00,$263.35,$0.00,$275.93,$0.00
04.112.048S,SUP,HCPCS C1713,,04.112.048S  -  PLATE BONE 113MM 11 HOLE VAR ANG LCP TITANIUM LATERAL,"$1,821.95",$0.00,"$1,821.95",$819.88,"$1,300.33",$0.00,$304.77,$0.00,$0.00,$319.01,"$1,821.95",$0.00,$910.98,"$1,442.98","$1,457.56",$0.00,$276.83,$0.00,$290.05,$0.00
04.112.049S,SUP,HCPCS C1713,,04.112.049S  -  PLATE BONE 124MM 12 HOLE VAR ANG LCP TITANIUM LATERAL,"$1,821.95",$0.00,"$1,821.95",$819.88,"$1,300.33",$0.00,$304.77,$0.00,$0.00,$319.01,"$1,821.95",$0.00,$910.98,"$1,442.98","$1,457.56",$0.00,$276.83,$0.00,$290.05,$0.00
04.112.080,SUP,HCPCS C1713,,04.112.080  -  PLATE BONE 85MM 6 HOLE LCP TITANIUM RIGHT SUPERIOR ANTERIOR,"$1,645.90",$0.00,"$1,645.90",$740.66,"$1,174.68",$0.00,$275.32,$0.00,$0.00,$288.18,"$1,645.90",$0.00,$822.95,"$1,303.55","$1,316.72",$0.00,$250.08,$0.00,$262.03,$0.00
04.112.081,SUP,HCPCS C1713,,04.112.081  -  PLATE BONE 85MM 6 HOLE LCP TITANIUM LEFT SUPERIOR ANTERIOR,"$1,645.90",$0.00,"$1,645.90",$740.66,"$1,174.68",$0.00,$275.32,$0.00,$0.00,$288.18,"$1,645.90",$0.00,$822.95,"$1,303.55","$1,316.72",$0.00,$250.08,$0.00,$262.03,$0.00
04.112.082,SUP,HCPCS C1713,,04.112.082  -  PLATE BONE 100MM 7 HOLE LCP TITANIUM RIGHT SUPERIOR ANTERIOR,"$1,689.55",$0.00,"$1,689.55",$760.30,"$1,205.83",$0.00,$282.62,$0.00,$0.00,$295.83,"$1,689.55",$0.00,$844.78,"$1,338.12","$1,351.64",$0.00,$256.71,$0.00,$268.98,$0.00
04.112.083,SUP,HCPCS C1713,,04.112.083  -  PLATE BONE 100MM 7 HOLE LCP TITANIUM LEFT SUPERIOR CLAVICLE,"$1,689.55",$0.00,"$1,689.55",$760.30,"$1,205.83",$0.00,$282.62,$0.00,$0.00,$295.83,"$1,689.55",$0.00,$844.78,"$1,338.12","$1,351.64",$0.00,$256.71,$0.00,$268.98,$0.00
04.112.084,SUP,HCPCS C1713,,04.112.084  -  PLATE BONE 115MM 8 HOLE LCP TITANIUM RIGHT SUPERIOR CLAVICLE,"$1,733.23",$0.00,"$1,733.23",$779.95,"$1,237.00",$0.00,$289.93,$0.00,$0.00,$303.47,"$1,733.23",$0.00,$866.61,"$1,372.72","$1,386.58",$0.00,$263.35,$0.00,$275.93,$0.00
04.112.085,SUP,HCPCS C1713,,04.112.085  -  PLATE BONE 115MM 8 HOLE LCP TITANIUM LEFT SUPERIOR CLAVICLE,"$1,733.23",$0.00,"$1,733.23",$779.95,"$1,237.00",$0.00,$289.93,$0.00,$0.00,$303.47,"$1,733.23",$0.00,$866.61,"$1,372.72","$1,386.58",$0.00,$263.35,$0.00,$275.93,$0.00
04.112.090,SUP,HCPCS C1713,,04.112.090  -  PLATE BONE 105MM 6 HOLE LATERAL EXTN LCP TITANIUM RIGHT,"$1,645.90",$0.00,"$1,645.90",$740.66,"$1,174.68",$0.00,$275.32,$0.00,$0.00,$288.18,"$1,645.90",$0.00,$822.95,"$1,303.55","$1,316.72",$0.00,$250.08,$0.00,$262.03,$0.00
04.112.091,SUP,HCPCS C1713,,04.112.091  -  PLATE BN 105MM NS LCP CMBN 6 HL LAT XTN PRECONTOUR LMT CNTCT,"$1,645.90",$0.00,"$1,645.90",$740.66,"$1,174.68",$0.00,$275.32,$0.00,$0.00,$288.18,"$1,645.90",$0.00,$822.95,"$1,303.55","$1,316.72",$0.00,$250.08,$0.00,$262.03,$0.00
04.112.092,SUP,HCPCS C1713,,04.112.092  -  PLATE BONE 120MM 7 HOLE LATERAL EXTN LCP TITANIUM RIGHT,"$1,689.55",$0.00,"$1,689.55",$760.30,"$1,205.83",$0.00,$282.62,$0.00,$0.00,$295.83,"$1,689.55",$0.00,$844.78,"$1,338.12","$1,351.64",$0.00,$256.71,$0.00,$268.98,$0.00
04.112.093,SUP,HCPCS C1713,,04.112.093  -  PLATE BONE 120MM 7 HOLE LATERAL EXTN LCP TITANIUM LEFT,"$1,689.55",$0.00,"$1,689.55",$760.30,"$1,205.83",$0.00,$282.62,$0.00,$0.00,$295.83,"$1,689.55",$0.00,$844.78,"$1,338.12","$1,351.64",$0.00,$256.71,$0.00,$268.98,$0.00
04.112.094,SUP,HCPCS C1713,,04.112.094  -  PLATE BONE 130MM 8 HOLE LATERAL EXTN LCP TITANIUM RIGHT,"$1,733.23",$0.00,"$1,733.23",$779.95,"$1,237.00",$0.00,$289.93,$0.00,$0.00,$303.47,"$1,733.23",$0.00,$866.61,"$1,372.72","$1,386.58",$0.00,$263.35,$0.00,$275.93,$0.00
04.112.095,SUP,HCPCS C1713,,04.112.095  -  PLATE BONE 130MM 8 HOLE LATERAL EXTN LCP TITANIUM LEFT,"$1,733.23",$0.00,"$1,733.23",$779.95,"$1,237.00",$0.00,$289.93,$0.00,$0.00,$303.47,"$1,733.23",$0.00,$866.61,"$1,372.72","$1,386.58",$0.00,$263.35,$0.00,$275.93,$0.00
04.112.106,SUP,HCPCS C1713,,04.112.106  -  PLATE BONE 73MM 3 HOLE LCP TITANIUM RIGHT DISTAL POSTLAT,"$1,151.85",$0.00,"$1,151.85",$518.33,$822.08,$0.00,$192.68,$0.00,$0.00,$201.68,"$1,151.85",$0.00,$575.93,$912.27,$921.48,$0.00,$175.01,$0.00,$183.37,$0.00
04.112.107,SUP,HCPCS C1713,,04.112.107  -  PLATE BONE 73MM 3 HOLE LCP TITANIUM LEFT DISTAL POSTLAT,"$1,151.85",$0.00,"$1,151.85",$518.33,$822.08,$0.00,$192.68,$0.00,$0.00,$201.68,"$1,151.85",$0.00,$575.93,$912.27,$921.48,$0.00,$175.01,$0.00,$183.37,$0.00
04.112.108,SUP,HCPCS C1713,,04.112.108  -  PLATE BONE 86MM 4 HOLE LCP TITANIUM RIGHT DISTAL POSTLAT,"$1,170.95",$0.00,"$1,170.95",$526.93,$835.71,$0.00,$195.87,$0.00,$0.00,$205.02,"$1,170.95",$0.00,$585.48,$927.39,$936.76,$0.00,$177.92,$0.00,$186.42,$0.00
04.112.109,SUP,HCPCS C1713,,04.112.109  -  PLATE BONE 86MM 4 HOLE LCP TITANIUM LEFT DISTAL POSTLAT,"$1,170.95",$0.00,"$1,170.95",$526.93,$835.71,$0.00,$195.87,$0.00,$0.00,$205.02,"$1,170.95",$0.00,$585.48,$927.39,$936.76,$0.00,$177.92,$0.00,$186.42,$0.00
04.112.110,SUP,HCPCS C1713,,04.112.110  -  PLATE BONE 99MM 5 HOLE LCP TITANIUM RIGHT DISTAL POSTLAT,"$1,185.98",$0.00,"$1,185.98",$533.69,$846.43,$0.00,$198.38,$0.00,$0.00,$207.65,"$1,185.98",$0.00,$592.99,$939.30,$948.78,$0.00,$180.20,$0.00,$188.81,$0.00
04.112.111,SUP,HCPCS C1713,,04.112.111  -  PLATE BONE 99MM 5 HOLE LCP TITANIUM LEFT DISTAL POSTLAT,"$1,185.98",$0.00,"$1,185.98",$533.69,$846.43,$0.00,$198.38,$0.00,$0.00,$207.65,"$1,185.98",$0.00,$592.99,$939.30,$948.78,$0.00,$180.20,$0.00,$188.81,$0.00
04.112.112,SUP,HCPCS C1713,,04.112.112  -  PLATE BONE 112MM 6 HOLE LCP TITANIUM RIGHT DISTAL POSTLAT,"$1,205.08",$0.00,"$1,205.08",$542.28,$860.06,$0.00,$201.58,$0.00,$0.00,$211.00,"$1,205.08",$0.00,$602.54,$954.42,$964.06,$0.00,$183.10,$0.00,$191.85,$0.00
04.112.113,SUP,HCPCS C1713,,04.112.113  -  PLATE BONE 112MM 6 HOLE LCP TITANIUM LEFT DISTAL POSTLAT,"$1,205.08",$0.00,"$1,205.08",$542.28,$860.06,$0.00,$201.58,$0.00,$0.00,$211.00,"$1,205.08",$0.00,$602.54,$954.42,$964.06,$0.00,$183.10,$0.00,$191.85,$0.00
04.112.114,SUP,HCPCS C1713,,04.112.114  -  PLATE BONE 125MM 7 HOLE LCP TITANIUM RIGHT DISTAL POSTLAT,"$1,221.45",$0.00,"$1,221.45",$549.65,$871.75,$0.00,$204.32,$0.00,$0.00,$213.87,"$1,221.45",$0.00,$610.73,$967.39,$977.16,$0.00,$185.59,$0.00,$194.45,$0.00
04.112.115,SUP,HCPCS C1713,,04.112.115  -  PLATE BONE 125MM 7 HOLE LCP TITANIUM LEFT DISTAL POSTLAT,"$1,221.45",$0.00,"$1,221.45",$549.65,$871.75,$0.00,$204.32,$0.00,$0.00,$213.87,"$1,221.45",$0.00,$610.73,$967.39,$977.16,$0.00,$185.59,$0.00,$194.45,$0.00
04.112.118,SUP,HCPCS C1713,,04.112.118  -  PLATE BONE 151MM 9 HOLE LCP TITANIUM RIGHT DISTAL POSTLAT,"$1,239.20",$0.00,"$1,239.20",$557.64,$884.42,$0.00,$207.29,$0.00,$0.00,$216.97,"$1,239.20",$0.00,$619.60,$981.45,$991.36,$0.00,$188.29,$0.00,$197.28,$0.00
04.112.119,SUP,HCPCS C1713,,04.112.119  -  PLATE BONE 151MM 9 HOLE LCP TITANIUM LEFT DISTAL POSTLAT,"$1,239.20",$0.00,"$1,239.20",$557.64,$884.42,$0.00,$207.29,$0.00,$0.00,$216.97,"$1,239.20",$0.00,$619.60,$981.45,$991.36,$0.00,$188.29,$0.00,$197.28,$0.00
04.112.122,SUP,HCPCS C1713,,04.112.122  -  PLATE BONE 177MM 11 HOLE LCP TITANIUM RIGHT DISTAL POSTLAT,"$1,258.30",$0.00,"$1,258.30",$566.24,$898.05,$0.00,$210.48,$0.00,$0.00,$220.32,"$1,258.30",$0.00,$629.15,$996.57,"$1,006.64",$0.00,$191.19,$0.00,$200.32,$0.00
04.112.123,SUP,HCPCS C1713,,04.112.123  -  PLATE BONE 177MM 11 HOLE LCP TITANIUM LEFT DISTAL POSTLAT,"$1,258.30",$0.00,"$1,258.30",$566.24,$898.05,$0.00,$210.48,$0.00,$0.00,$220.32,"$1,258.30",$0.00,$629.15,$996.57,"$1,006.64",$0.00,$191.19,$0.00,$200.32,$0.00
04.112.126,SUP,HCPCS C1713,,04.112.126  -  PLATE BONE 207MM 13 HOLE LCP TITANIUM RIGHT POSTLAT DISTAL,"$1,274.68",$0.00,"$1,274.68",$573.60,$909.74,$0.00,$213.22,$0.00,$0.00,$223.19,"$1,274.68",$0.00,$637.34,"$1,009.55","$1,019.74",$0.00,$193.68,$0.00,$202.93,$0.00
04.112.127,SUP,HCPCS C1713,,04.112.127  -  PLATE BONE 207MM 13 HOLE LCP TITANIUM LEFT POSTLAT DISTAL,"$1,274.68",$0.00,"$1,274.68",$573.60,$909.74,$0.00,$213.22,$0.00,$0.00,$223.19,"$1,274.68",$0.00,$637.34,"$1,009.55","$1,019.74",$0.00,$193.68,$0.00,$202.93,$0.00
04.112.130,SUP,HCPCS C1713,,04.112.130  -  PLATE BONE 233MM 15 HOLE LCP RIGHT POSTLAT DISTAL FIBULAR,"$1,291.05",$0.00,"$1,291.05",$580.97,$921.42,$0.00,$215.96,$0.00,$0.00,$226.05,"$1,291.05",$0.00,$645.53,"$1,022.51","$1,032.84",$0.00,$196.16,$0.00,$205.54,$0.00
04.112.131,SUP,HCPCS C1713,,04.112.131  -  PLATE BONE 233MM 15 HOLE LCP LEFT POSTLAT DISTAL FIBULAR,"$1,291.05",$0.00,"$1,291.05",$580.97,$921.42,$0.00,$215.96,$0.00,$0.00,$226.05,"$1,291.05",$0.00,$645.53,"$1,022.51","$1,032.84",$0.00,$196.16,$0.00,$205.54,$0.00
04.112.136,SUP,HCPCS C1713,,04.112.136  -  PLATE BONE 73MM 3 HOLE LCP TITANIUM RIGHT DISTAL FIBULAR,"$1,113.63",$0.00,"$1,113.63",$501.13,$794.79,$0.00,$186.29,$0.00,$0.00,$194.99,"$1,113.63",$0.00,$556.81,$881.99,$890.90,$0.00,$169.21,$0.00,$177.29,$0.00
04.112.137,SUP,HCPCS C1713,,04.112.137  -  PLATE BONE 73MM 3 HOLE LCP TITANIUM LEFT DISTAL FIBULA,"$1,113.63",$0.00,"$1,113.63",$501.13,$794.79,$0.00,$186.29,$0.00,$0.00,$194.99,"$1,113.63",$0.00,$556.81,$881.99,$890.90,$0.00,$169.21,$0.00,$177.29,$0.00
04.112.138,SUP,HCPCS C1713,,04.112.138  -  PLATE BONE 86MM LCP TITANIUM RIGHT LEFT DISTAL LATERAL,"$1,132.75",$0.00,"$1,132.75",$509.74,$808.44,$0.00,$189.48,$0.00,$0.00,$198.34,"$1,132.75",$0.00,$566.38,$897.14,$906.20,$0.00,$172.11,$0.00,$180.33,$0.00
04.112.139,SUP,HCPCS C1713,,04.112.139  -  PLATE BONE 86MM 4 HOLE LCP TITANIUM RIGHT DISTAL FIBULAR,"$1,132.75",$0.00,"$1,132.75",$509.74,$808.44,$0.00,$189.48,$0.00,$0.00,$198.34,"$1,132.75",$0.00,$566.38,$897.14,$906.20,$0.00,$172.11,$0.00,$180.33,$0.00
04.112.140,SUP,HCPCS C1713,,04.112.140  -  PLATE BONE 99MM 5 HOLE LCP TITANIUM RIGHT DISTAL FIBULAR,"$1,147.75",$0.00,"$1,147.75",$516.49,$819.15,$0.00,$191.99,$0.00,$0.00,$200.96,"$1,147.75",$0.00,$573.88,$909.02,$918.20,$0.00,$174.39,$0.00,$182.72,$0.00
04.112.141,SUP,HCPCS C1713,,04.112.141  -  PLATE BONE 99MM 5 HOLE LCP TITANIUM LEFT DISTAL FIBULAR,"$1,147.75",$0.00,"$1,147.75",$516.49,$819.15,$0.00,$191.99,$0.00,$0.00,$200.96,"$1,147.75",$0.00,$573.88,$909.02,$918.20,$0.00,$174.39,$0.00,$182.72,$0.00
04.112.142,SUP,HCPCS C1713,,04.112.142  -  PLATE BONE 112MM 6 HOLE LCP TITANIUM RIGHT DISTAL FIBULAR,"$1,165.50",$0.00,"$1,165.50",$524.48,$831.82,$0.00,$194.96,$0.00,$0.00,$204.07,"$1,165.50",$0.00,$582.75,$923.08,$932.40,$0.00,$177.09,$0.00,$185.55,$0.00
04.112.143,SUP,HCPCS C1713,,04.112.143  -  PLATE BONE 112MM 6 HOLE LCP TITANIUM LEFT LATERAL DISTAL,"$1,165.50",$0.00,"$1,165.50",$524.48,$831.82,$0.00,$194.96,$0.00,$0.00,$204.07,"$1,165.50",$0.00,$582.75,$923.08,$932.40,$0.00,$177.09,$0.00,$185.55,$0.00
04.112.144,SUP,HCPCS C1713,,04.112.144  -  PLATE BONE 125MM 7 HOLE LCP TITANIUM RIGHT LATERAL DISTAL,"$1,181.88",$0.00,"$1,181.88",$531.84,$843.50,$0.00,$197.70,$0.00,$0.00,$206.94,"$1,181.88",$0.00,$590.94,$936.05,$945.50,$0.00,$179.58,$0.00,$188.15,$0.00
04.112.145,SUP,HCPCS C1713,,04.112.145  -  PLATE BONE 125MM 7 HOLE LCP TITANIUM LEFT LATERAL DISTAL,"$1,181.88",$0.00,"$1,181.88",$531.84,$843.50,$0.00,$197.70,$0.00,$0.00,$206.94,"$1,181.88",$0.00,$590.94,$936.05,$945.50,$0.00,$179.58,$0.00,$188.15,$0.00
04.112.148,SUP,HCPCS C1713,,04.112.148  -  PLATE BONE 177MM 11 HOLE LCP TITANIUM RIGHT LATERAL DISTAL,"$1,239.20",$0.00,"$1,239.20",$557.64,$884.42,$0.00,$207.29,$0.00,$0.00,$216.97,"$1,239.20",$0.00,$619.60,$981.45,$991.36,$0.00,$188.29,$0.00,$197.28,$0.00
04.112.149,SUP,HCPCS C1713,,04.112.149  -  PLATE BONE 151MM 9 HOLE LCP TITANIUM LEFT LATERAL DISTAL,"$1,239.20",$0.00,"$1,239.20",$557.64,$884.42,$0.00,$207.29,$0.00,$0.00,$216.97,"$1,239.20",$0.00,$619.60,$981.45,$991.36,$0.00,$188.29,$0.00,$197.28,$0.00
04.112.152,SUP,HCPCS C1713,,04.112.152  -  PLATE BONE 177MM 11 HOLE LCP TITANIUM RIGHT LATERAL DISTAL,"$1,258.30",$0.00,"$1,258.30",$566.24,$898.05,$0.00,$210.48,$0.00,$0.00,$220.32,"$1,258.30",$0.00,$629.15,$996.57,"$1,006.64",$0.00,$191.19,$0.00,$200.32,$0.00
04.112.153,SUP,HCPCS C1713,,04.112.153  -  PLATE BONE 177MM 11 HOLE LCP TITANIUM LEFT LATERAL DISTAL,"$1,258.30",$0.00,"$1,258.30",$566.24,$898.05,$0.00,$210.48,$0.00,$0.00,$220.32,"$1,258.30",$0.00,$629.15,$996.57,"$1,006.64",$0.00,$191.19,$0.00,$200.32,$0.00
04.112.156,SUP,HCPCS C1713,,04.112.156  -  PLATE BONE 203MM 13 HOLE LCP RIGHT LATERAL DISTAL FIBULAR,"$1,311.53",$0.00,"$1,311.53",$590.19,$936.04,$0.00,$219.39,$0.00,$0.00,$229.64,"$1,311.53",$0.00,$655.76,"$1,038.73","$1,049.22",$0.00,$199.28,$0.00,$208.79,$0.00
04.112.157,SUP,HCPCS C1713,,04.112.157  -  PLATE BONE 203MM 13 HOLE LCP LEFT LATERAL DISTAL FIBULAR,"$1,311.53",$0.00,"$1,311.53",$590.19,$936.04,$0.00,$219.39,$0.00,$0.00,$229.64,"$1,311.53",$0.00,$655.76,"$1,038.73","$1,049.22",$0.00,$199.28,$0.00,$208.79,$0.00
04.112.160,SUP,HCPCS C1713,,04.112.160  -  PLATE BONE 229MM LCP LATERAL DISTAL FIBULAR NONSTRL 2.7/3.5,"$1,330.63",$0.00,"$1,330.63",$598.78,$949.67,$0.00,$222.58,$0.00,$0.00,$232.98,"$1,330.63",$0.00,$665.31,"$1,053.86","$1,064.50",$0.00,$202.18,$0.00,$211.84,$0.00
04.112.161,SUP,HCPCS C1713,,04.112.161  -  PLATE BONE 229MM 15 HOLE LCP LATERAL DISTAL FIBULAR NONSTRL,"$1,330.63",$0.00,"$1,330.63",$598.78,$949.67,$0.00,$222.58,$0.00,$0.00,$232.98,"$1,330.63",$0.00,$665.31,"$1,053.86","$1,064.50",$0.00,$202.18,$0.00,$211.84,$0.00
04.112.510,SUP,HCPCS C1713,,04.112.510  -  PLATE BONE 109MM 4 HOLE LOW BEND LCP TITANIUM RIGHT MEDIAL,"$2,606.68",$0.00,"$2,606.68","$1,173.00","$1,860.38",$0.00,$436.04,$0.00,$0.00,$456.41,"$2,606.68",$0.00,"$1,303.34","$2,064.49","$2,085.34",$0.00,$396.06,$0.00,$414.98,$0.00
04.112.511,SUP,HCPCS C1713,,04.112.511  -  PLATE BONE 109MM 4 HOLE LOW BEND LCP TITANIUM TIBIA LEFT,"$2,606.68",$0.00,"$2,606.68","$1,173.00","$1,860.38",$0.00,$436.04,$0.00,$0.00,$456.41,"$2,606.68",$0.00,"$1,303.34","$2,064.49","$2,085.34",$0.00,$396.06,$0.00,$414.98,$0.00
04.112.514,SUP,HCPCS C1713,,04.112.514  -  PLATE BONE 135MM 6 HOLE LOW BEND LCP TITANIUM TIBIA RIGHT,"$2,550.73",$0.00,"$2,550.73","$1,147.83","$1,820.45",$0.00,$426.68,$0.00,$0.00,$446.61,"$2,550.73",$0.00,"$1,275.36","$2,020.18","$2,040.58",$0.00,$387.56,$0.00,$406.08,$0.00
04.112.515,SUP,HCPCS C1713,,04.112.515  -  PLATE BONE 135MM 6 HOLE LOW BEND LCP TITANIUM LEFT MEDIAL,"$2,550.73",$0.00,"$2,550.73","$1,147.83","$1,820.45",$0.00,$426.68,$0.00,$0.00,$446.61,"$2,550.73",$0.00,"$1,275.36","$2,020.18","$2,040.58",$0.00,$387.56,$0.00,$406.08,$0.00
04.112.518,SUP,HCPCS C1713,,04.112.518  -  PLATE BONE 161MM 8 HOLE LOW BEND LCP TITANIUM TIBIA RIGHT,"$2,575.28",$0.00,"$2,575.28","$1,158.87","$1,837.97",$0.00,$430.78,$0.00,$0.00,$450.91,"$2,575.28",$0.00,"$1,287.64","$2,039.62","$2,060.22",$0.00,$391.29,$0.00,$409.98,$0.00
04.112.519,SUP,HCPCS C1713,,04.112.519  -  PLATE BONE 161MM 8 HOLE LOW BEND LCP TITANIUM TIBIA LEFT,"$2,575.28",$0.00,"$2,575.28","$1,158.87","$1,837.97",$0.00,$430.78,$0.00,$0.00,$450.91,"$2,575.28",$0.00,"$1,287.64","$2,039.62","$2,060.22",$0.00,$391.29,$0.00,$409.98,$0.00
04.112.522,SUP,HCPCS C1713,,04.112.522  -  PLATE BONE 187MM 10 HOLE LOW BEND LCP TITANIUM TIBIA RIGHT,"$2,602.58",$0.00,"$2,602.58","$1,171.16","$1,857.46",$0.00,$435.35,$0.00,$0.00,$455.69,"$2,602.58",$0.00,"$1,301.29","$2,061.24","$2,082.06",$0.00,$395.44,$0.00,$414.33,$0.00
04.112.523,SUP,HCPCS C1713,,04.112.523  -  PLATE BONE 187MM 10 HOLE LOW BEND LCP TITANIUM TIBIA LEFT,"$2,602.58",$0.00,"$2,602.58","$1,171.16","$1,857.46",$0.00,$435.35,$0.00,$0.00,$455.69,"$2,602.58",$0.00,"$1,301.29","$2,061.24","$2,082.06",$0.00,$395.44,$0.00,$414.33,$0.00
04.112.526,SUP,HCPCS C1713,,04.112.526  -  PLATE BONE 213MM 12 HOLE LOW BEND LCP TITANIUM TIBIA RIGHT,"$2,631.25",$0.00,"$2,631.25","$1,184.06","$1,877.92",$0.00,$440.14,$0.00,$0.00,$460.71,"$2,631.25",$0.00,"$1,315.63","$2,083.95","$2,105.00",$0.00,$399.79,$0.00,$418.90,$0.00
04.112.527,SUP,HCPCS C1713,,04.112.527  -  PLATE BONE 213MM 12 HOLE LOW BEND LCP TITANIUM TIBIA LEFT,"$2,631.25",$0.00,"$2,631.25","$1,184.06","$1,877.92",$0.00,$440.14,$0.00,$0.00,$460.71,"$2,631.25",$0.00,"$1,315.63","$2,083.95","$2,105.00",$0.00,$399.79,$0.00,$418.90,$0.00
04.112.530,SUP,HCPCS C1713,,04.112.530  -  PLATE BONE 239MM 14 HOLE LOW BEND LCP TITANIUM TIBIA RIGHT,"$2,755.43",$0.00,"$2,755.43","$1,239.94","$1,966.55",$0.00,$460.92,$0.00,$0.00,$482.45,"$2,755.43",$0.00,"$1,377.71","$2,182.30","$2,204.34",$0.00,$418.66,$0.00,$438.66,$0.00
04.112.531,SUP,HCPCS C1713,,04.112.531  -  PLATE BONE 239MM 14 HOLE LOW BEND LCP TITANIUM TIBIA LEFT,"$2,755.43",$0.00,"$2,755.43","$1,239.94","$1,966.55",$0.00,$460.92,$0.00,$0.00,$482.45,"$2,755.43",$0.00,"$1,377.71","$2,182.30","$2,204.34",$0.00,$418.66,$0.00,$438.66,$0.00
04.113.103,SUP,HCPCS C1713,,04.113.103  -  PLATE BONE 62MM 3 HOLE HOOK LCP TITANIUM NONSTRL 3.5MM,$989.45,$0.00,$989.45,$445.25,$706.17,$0.00,$165.51,$0.00,$0.00,$173.24,$989.45,$0.00,$494.73,$783.64,$791.56,$0.00,$150.34,$0.00,$157.52,$0.00
04.114.002,SUP,HCPCS C1713,,04.114.002  -  PLATE BONE 23MM 4 HOLE PURE STR LCP TITANIUM HAND WRIST,$398.50,$0.00,$398.50,$179.33,$284.41,$0.00,$66.66,$0.00,$0.00,$69.77,$398.50,$0.00,$199.25,$315.61,$318.80,$0.00,$60.55,$0.00,$63.44,$0.00
04.114.003,SUP,HCPCS C1713,,04.114.003  -  PLATE BONE 29MM 6 HOLE PURE STR LOCKING LCP TITANIUM HAND,$730.15,$0.00,$730.15,$328.57,$521.11,$0.00,$122.14,$0.00,$0.00,$127.84,$730.15,$0.00,$365.08,$578.28,$584.12,$0.00,$110.94,$0.00,$116.24,$0.00
04.114.004,SUP,HCPCS C1713,,04.114.004  -  PLATE BONE 36MM 6 HOLE PURE STR LCP TITANIUM HAND WRIST,$398.50,$0.00,$398.50,$179.33,$284.41,$0.00,$66.66,$0.00,$0.00,$69.77,$398.50,$0.00,$199.25,$315.61,$318.80,$0.00,$60.55,$0.00,$63.44,$0.00
04.114.005,SUP,HCPCS C1713,,04.114.005  -  PLATE BONE 59MM 12 HOLE PURE STR LOCKING ADAPTION LCP,$730.15,$0.00,$730.15,$328.57,$521.11,$0.00,$122.14,$0.00,$0.00,$127.84,$730.15,$0.00,$365.08,$578.28,$584.12,$0.00,$110.94,$0.00,$116.24,$0.00
04.114.006,SUP,HCPCS C1713,,04.114.006  -  PLATE BONE T 3X8 HOLE LCP TITANIUM SPN NONSTRL 1.5MM SCREW,$767.00,$0.00,$767.00,$345.15,$547.41,$0.00,$128.30,$0.00,$0.00,$134.30,$767.00,$0.00,$383.50,$607.46,$613.60,$0.00,$116.54,$0.00,$122.11,$0.00
04.114.007,SUP,HCPCS C1713,,04.114.007  -  PLATE BONE T 4X8 HOLE LCP TITANIUM SPN NONSTRL 1.5MM SCREW,$767.00,$0.00,$767.00,$345.15,$547.41,$0.00,$128.30,$0.00,$0.00,$134.30,$767.00,$0.00,$383.50,$607.46,$613.60,$0.00,$116.54,$0.00,$122.11,$0.00
04.114.009,SUP,HCPCS C1713,,04.114.009  -  PLATE BONE H LEFT EXTEND LCP TITANIUM SPN NONSTRL 1.5MM,$738.33,$0.00,$738.33,$332.25,$526.94,$0.00,$123.51,$0.00,$0.00,$129.27,$738.33,$0.00,$369.16,$584.76,$590.66,$0.00,$112.18,$0.00,$117.54,$0.00
04.114.010,SUP,HCPCS C1713,,04.114.010  -  PLATE BONE H RIGHT EXTEND LCP TITANIUM SPN NONSTRL 1.5MM,$738.33,$0.00,$738.33,$332.25,$526.94,$0.00,$123.51,$0.00,$0.00,$129.27,$738.33,$0.00,$369.16,$584.76,$590.66,$0.00,$112.18,$0.00,$117.54,$0.00
04.114.013,SUP,HCPCS C1713,,04.114.013  -  PLATE BONE Y 3X8 HOLE LCP TITANIUM SPN NONSTRL 1.5MM SCREW,$738.33,$0.00,$738.33,$332.25,$526.94,$0.00,$123.51,$0.00,$0.00,$129.27,$738.33,$0.00,$369.16,$584.76,$590.66,$0.00,$112.18,$0.00,$117.54,$0.00
04.114.014,SUP,HCPCS C1713,,04.114.014  -  PLATE BONE Y 3X8 HOLE LCP TITANIUM SPN NONSTRL 1.5MM SCREW,$858.43,$0.00,$858.43,$386.29,$612.66,$0.00,$143.59,$0.00,$0.00,$150.30,$858.43,$0.00,$429.21,$679.88,$686.74,$0.00,$130.43,$0.00,$136.66,$0.00
04.114.502,SUP,HCPCS C1713,,04.114.502  -  PLATE BONE SHORT THREAD 23MM 4 HOLE ASSEMBLE DRILL GUIDE LCP,$476.30,$0.00,$476.30,$214.34,$339.94,$0.00,$79.67,$0.00,$0.00,$83.40,$476.30,$0.00,$238.15,$377.23,$381.04,$0.00,$72.37,$0.00,$75.83,$0.00
04.114.503,SUP,HCPCS C1713,,04.114.503  -  PLATE BONE SHORT THREAD 29MM 6 HOLE ADAPTION LCP TITANIUM,$812.03,$0.00,$812.03,$365.41,$579.54,$0.00,$135.83,$0.00,$0.00,$142.18,$812.03,$0.00,$406.01,$643.13,$649.62,$0.00,$123.38,$0.00,$129.27,$0.00
04.114.504,SUP,HCPCS C1713,,04.114.504  -  PLATE BONE 36MM 6 HOLE PURE STR PREASSEMBLED DRILL SLEEVE,$476.30,$0.00,$476.30,$214.34,$339.94,$0.00,$79.67,$0.00,$0.00,$83.40,$476.30,$0.00,$238.15,$377.23,$381.04,$0.00,$72.37,$0.00,$75.83,$0.00
04.114.505,SUP,HCPCS C1713,,04.114.505  -  PLATE BONE 59MM 12 HOLE PURE STR PREASSEMBLED DRILL SLEEVE,$812.03,$0.00,$812.03,$365.41,$579.54,$0.00,$135.83,$0.00,$0.00,$142.18,$812.03,$0.00,$406.01,$643.13,$649.62,$0.00,$123.38,$0.00,$129.27,$0.00
04.114.506,SUP,HCPCS C1713,,04.114.506  -  PLATE BONE 3X8 HOLE T PREASSEMBLED DRILL SLEEVE LOCKING LCP,$859.80,$0.00,$859.80,$386.91,$613.64,$0.00,$143.82,$0.00,$0.00,$150.54,$859.80,$0.00,$429.90,$680.96,$687.84,$0.00,$130.64,$0.00,$136.88,$0.00
04.114.507,SUP,HCPCS C1713,,04.114.507  -  PLATE BONE 4X8 HOLE T PREASSEMBLED DRILL SLEEVE LOCKING LCP,$859.80,$0.00,$859.80,$386.91,$613.64,$0.00,$143.82,$0.00,$0.00,$150.54,$859.80,$0.00,$429.90,$680.96,$687.84,$0.00,$130.64,$0.00,$136.88,$0.00
04.114.509,SUP,HCPCS C1713,,04.114.509  -  PLATE BONE 8 HOLE STRUT PREASSEMBLED DRILL SLEEVE LOCKING,$821.58,$0.00,$821.58,$369.71,$586.36,$0.00,$137.43,$0.00,$0.00,$143.85,$821.58,$0.00,$410.79,$650.69,$657.26,$0.00,$124.83,$0.00,$130.79,$0.00
04.114.510,SUP,HCPCS C1713,,04.114.510  -  PLATE BONE H RIGHT EXTEND LCP TITANIUM SPN NONSTRL 1.5MM,$821.58,$0.00,$821.58,$369.71,$586.36,$0.00,$137.43,$0.00,$0.00,$143.85,$821.58,$0.00,$410.79,$650.69,$657.26,$0.00,$124.83,$0.00,$130.79,$0.00
04.114.513,SUP,HCPCS C1713,,04.114.513  -  PLATE BONE Y 3X8 HOLE LCP TITANIUM SPN NONSTRL 1.5MM SCREW,$821.58,$0.00,$821.58,$369.71,$586.36,$0.00,$137.43,$0.00,$0.00,$143.85,$821.58,$0.00,$410.79,$650.69,$657.26,$0.00,$124.83,$0.00,$130.79,$0.00
04.114.514,SUP,HCPCS C1713,,04.114.514  -  PLATE BONE 6 HOLE LCP TITANIUM CONDYLE NONSTRL 1.5 MM SCREWS,$940.33,$0.00,$940.33,$423.15,$671.11,$0.00,$157.29,$0.00,$0.00,$164.64,$940.33,$0.00,$470.16,$744.74,$752.26,$0.00,$142.87,$0.00,$149.70,$0.00
04.115.130,SUP,HCPCS C1713,,04.115.130  -  PLATE BONE +90D 37MM 2X3 HOLE L VAR ANG LOCKING LCP TITANIUM,$996.28,$0.00,$996.28,$448.32,$711.04,$0.00,$166.65,$0.00,$0.00,$174.44,$996.28,$0.00,$498.14,$789.05,$797.02,$0.00,$151.37,$0.00,$158.61,$0.00
04.115.131,SUP,HCPCS C1713,,04.115.131  -  PLATE BONE -90D 37MM 2X3 HOLE L VAR ANG LOCKING LCP TITANIUM,$996.28,$0.00,$996.28,$448.32,$711.04,$0.00,$166.65,$0.00,$0.00,$174.44,$996.28,$0.00,$498.14,$789.05,$797.02,$0.00,$151.37,$0.00,$158.61,$0.00
04.115.150,SUP,HCPCS C1713,,04.115.150  -  PLATE BONE +90D 51MM 2X5 HOLE L VAR ANG LOCKING LCP TITANIUM,"$1,046.78",$0.00,"$1,046.78",$471.05,$747.08,$0.00,$175.10,$0.00,$0.00,$183.28,"$1,046.78",$0.00,$523.39,$829.05,$837.42,$0.00,$159.05,$0.00,$166.65,$0.00
04.115.151,SUP,HCPCS C1713,,04.115.151  -  PLATE BONE -90D 51MM 2X5 HOLE L VAR ANG LOCKING LCP TITANIUM,"$1,046.78",$0.00,"$1,046.78",$471.05,$747.08,$0.00,$175.10,$0.00,$0.00,$183.28,"$1,046.78",$0.00,$523.39,$829.05,$837.42,$0.00,$159.05,$0.00,$166.65,$0.00
04.115.230,SUP,HCPCS C1713,,04.115.230  -  PLATE BONE +90D 37MM 3X3 HOLE L VAR ANG LOCKING LCP TITANIUM,$996.28,$0.00,$996.28,$448.32,$711.04,$0.00,$166.65,$0.00,$0.00,$174.44,$996.28,$0.00,$498.14,$789.05,$797.02,$0.00,$151.37,$0.00,$158.61,$0.00
04.115.231,SUP,HCPCS C1713,,04.115.231  -  PLATE BONE -90D 37MM 3X3 HOLE L VAR ANG LOCKING LCP TITANIUM,$996.28,$0.00,$996.28,$448.32,$711.04,$0.00,$166.65,$0.00,$0.00,$174.44,$996.28,$0.00,$498.14,$789.05,$797.02,$0.00,$151.37,$0.00,$158.61,$0.00
04.115.250,SUP,HCPCS C1713,,04.115.250  -  PLATE BONE +90D 51MM 3X5 HOLE L VAR ANG LOCKING LCP TITANIUM,"$1,046.78",$0.00,"$1,046.78",$471.05,$747.08,$0.00,$175.10,$0.00,$0.00,$183.28,"$1,046.78",$0.00,$523.39,$829.05,$837.42,$0.00,$159.05,$0.00,$166.65,$0.00
04.115.251,SUP,HCPCS C1713,,04.115.251  -  PLATE BONE -90D 51MM 3X5 HOLE L VAR ANG LOCKING LCP TITANIUM,"$1,046.78",$0.00,"$1,046.78",$471.05,$747.08,$0.00,$175.10,$0.00,$0.00,$183.28,"$1,046.78",$0.00,$523.39,$829.05,$837.42,$0.00,$159.05,$0.00,$166.65,$0.00
04.115.330,SUP,HCPCS C1713,,04.115.330  -  PLATE BONE 37MM 3X3 HOLE T VAR ANG LOCKING LCP TITANIUM,"$1,029.03",$0.00,"$1,029.03",$463.06,$734.42,$0.00,$172.13,$0.00,$0.00,$180.17,"$1,029.03",$0.00,$514.51,$814.99,$823.22,$0.00,$156.35,$0.00,$163.82,$0.00
04.115.350,SUP,HCPCS C1713,,04.115.350  -  PLATE BONE 51MM 3X5 HOLE T VAR ANG LOCKING LCP TITANIUM,"$1,074.05",$0.00,"$1,074.05",$483.32,$766.55,$0.00,$179.66,$0.00,$0.00,$188.06,"$1,074.05",$0.00,$537.03,$850.65,$859.24,$0.00,$163.19,$0.00,$170.99,$0.00
04.115.430,SUP,HCPCS C1713,,04.115.430  -  PLATE BONE +20D 41MM 3X3 HOLE L VAR ANG OPLIQUE LOCKING LCP,$996.28,$0.00,$996.28,$448.32,$711.04,$0.00,$166.65,$0.00,$0.00,$174.44,$996.28,$0.00,$498.14,$789.05,$797.02,$0.00,$151.37,$0.00,$158.61,$0.00
04.115.431,SUP,HCPCS C1713,,04.115.431  -  PLATE BONE -20D 41MM 3X3 HOLE L VAR ANG OBLIQUE LOCKING LCP,$996.28,$0.00,$996.28,$448.32,$711.04,$0.00,$166.65,$0.00,$0.00,$174.44,$996.28,$0.00,$498.14,$789.05,$797.02,$0.00,$151.37,$0.00,$158.61,$0.00
04.115.450,SUP,HCPCS C1713,,04.115.450  -  PLATE BONE +20D 55MM 3X5 HOLE L VAR ANG OBLIQUE LOCKING LCP,"$1,046.78",$0.00,"$1,046.78",$471.05,$747.08,$0.00,$175.10,$0.00,$0.00,$183.28,"$1,046.78",$0.00,$523.39,$829.05,$837.42,$0.00,$159.05,$0.00,$166.65,$0.00
04.115.451,SUP,HCPCS C1713,,04.115.451  -  PLATE BONE -20D 55MM 3X5 HOLE L VAR ANG OBLIQUE LOCKING LCP,"$1,046.78",$0.00,"$1,046.78",$471.05,$747.08,$0.00,$175.10,$0.00,$0.00,$183.28,"$1,046.78",$0.00,$523.39,$829.05,$837.42,$0.00,$159.05,$0.00,$166.65,$0.00
04.115.530,SUP,HCPCS C1713,,04.115.530  -  PLATE BONE 46MM 3X5 HOLE VAR ANG COLUMN LOCKING LCP TITANIUM,"$1,029.03",$0.00,"$1,029.03",$463.06,$734.42,$0.00,$172.13,$0.00,$0.00,$180.17,"$1,029.03",$0.00,$514.51,$814.99,$823.22,$0.00,$156.35,$0.00,$163.82,$0.00
04.115.540,SUP,HCPCS C1713,,04.115.540  -  PLATE BONE 57MM 6 HOLE L VAR ANG COLUMN LCP TITANIUM DISTAL,"$1,074.05",$0.00,"$1,074.05",$483.32,$766.55,$0.00,$179.66,$0.00,$0.00,$188.06,"$1,074.05",$0.00,$537.03,$850.65,$859.24,$0.00,$163.19,$0.00,$170.99,$0.00
04.115.630,SUP,HCPCS C1713,,04.115.630  -  PLATE BONE +90D 41MM 2X3 HOLE VARIABLE INTERMEDIATE COLUMN,"$1,074.05",$0.00,"$1,074.05",$483.32,$766.55,$0.00,$179.66,$0.00,$0.00,$188.06,"$1,074.05",$0.00,$537.03,$850.65,$859.24,$0.00,$163.19,$0.00,$170.99,$0.00
04.115.631,SUP,HCPCS C1713,,04.115.631  -  PLATE BONE -90D 41MM 2X3 HOLE VARIABLE INTERMEDIATE COLUMN,"$1,074.05",$0.00,"$1,074.05",$483.32,$766.55,$0.00,$179.66,$0.00,$0.00,$188.06,"$1,074.05",$0.00,$537.03,$850.65,$859.24,$0.00,$163.19,$0.00,$170.99,$0.00
04.115.640,SUP,HCPCS C1713,,04.115.640  -  PLATE BONE +90D 49MM 2X4 HOLE VARIABLE INTERMEDIATE COLUMN,"$1,113.63",$0.00,"$1,113.63",$501.13,$794.79,$0.00,$186.29,$0.00,$0.00,$194.99,"$1,113.63",$0.00,$556.81,$881.99,$890.90,$0.00,$169.21,$0.00,$177.29,$0.00
04.115.641,SUP,HCPCS C1713,,04.115.641  -  PLATE BONE -90D 49MM 2X4 HOLE VARIABLE INTERMEDIATE COLUMN,"$1,113.63",$0.00,"$1,113.63",$501.13,$794.79,$0.00,$186.29,$0.00,$0.00,$194.99,"$1,113.63",$0.00,$556.81,$881.99,$890.90,$0.00,$169.21,$0.00,$177.29,$0.00
04.120.601,SUP,HCPCS C1713,,04.120.601  -  PLATE BONE 4.5MM 4 HOLE LOCKING ATTCH LCP TITANIUM FEMUR,$913.03,$0.00,$913.03,$410.86,$651.63,$0.00,$152.73,$0.00,$0.00,$159.86,$913.03,$0.00,$456.51,$723.12,$730.42,$0.00,$138.73,$0.00,$145.35,$0.00
04.120.602,SUP,HCPCS C1713,,04.120.602  -  PLATE BONE 4.5MM 8 HOLE LOCKING ATTCH LCP TITANIUM FEMUR,"$1,000.35",$0.00,"$1,000.35",$450.16,$713.95,$0.00,$167.34,$0.00,$0.00,$175.15,"$1,000.35",$0.00,$500.18,$792.28,$800.28,$0.00,$152.00,$0.00,$159.26,$0.00
04.120.606,SUP,HCPCS C1713,,04.120.606  -  SCREW BONE 6MM CONNCTNG STARDRIVE RECESS TITANIUM NONSTRL,$294.78,$0.00,$294.78,$132.65,$210.38,$0.00,$49.31,$0.00,$0.00,$51.61,$294.78,$0.00,$147.39,$233.47,$235.82,$0.00,$44.79,$0.00,$46.93,$0.00
04.120.701,SUP,HCPCS C1713,,04.120.701  -  PLATE BONE 69MM 1 HOLE LCP TITANIUM TIBIA POSTEROMEDIAL,"$1,699.13",$0.00,"$1,699.13",$764.61,"$1,212.67",$0.00,$284.22,$0.00,$0.00,$297.50,"$1,699.13",$0.00,$849.56,"$1,345.71","$1,359.30",$0.00,$258.17,$0.00,$270.50,$0.00
04.120.702,SUP,HCPCS C1713,,04.120.702  -  PLATE BONE 79MM 2 HOLE LCP TITANIUM TIBIA POSTEROMEDIAL,"$1,718.23",$0.00,"$1,718.23",$773.20,"$1,226.30",$0.00,$287.42,$0.00,$0.00,$300.85,"$1,718.23",$0.00,$859.11,"$1,360.84","$1,374.58",$0.00,$261.07,$0.00,$273.54,$0.00
04.120.704,SUP,HCPCS C1713,,04.120.704  -  PLATE BONE 105MM 4 HOLE LCP TITANIUM TIBIA POSTEROMEDIAL,"$1,735.95",$0.00,"$1,735.95",$781.18,"$1,238.95",$0.00,$290.39,$0.00,$0.00,$303.95,"$1,735.95",$0.00,$867.98,"$1,374.87","$1,388.76",$0.00,$263.77,$0.00,$276.36,$0.00
04.120.706,SUP,HCPCS C1713,,04.120.706  -  PLATE BONE 131MM 6 HOLE LCP TITANIUM TIBIA POSTEROMEDIAL,"$1,752.35",$0.00,"$1,752.35",$788.56,"$1,250.65",$0.00,$293.13,$0.00,$0.00,$306.82,"$1,752.35",$0.00,$876.18,"$1,387.86","$1,401.88",$0.00,$266.25,$0.00,$278.97,$0.00
04.120.708,SUP,HCPCS C1713,,04.120.708  -  PLATE BONE 157MM 8 HOLE LCP TITANIUM TIBIA POSTEROMEDIAL,"$1,771.45",$0.00,"$1,771.45",$797.15,"$1,264.28",$0.00,$296.32,$0.00,$0.00,$310.17,"$1,771.45",$0.00,$885.73,"$1,402.99","$1,417.16",$0.00,$269.16,$0.00,$282.01,$0.00
04.120.710,SUP,HCPCS C1713,,04.120.710  -  PLATE BONE 183MM 10 HOLE LCP TITANIUM TIBIA POSTEROMEDIAL,"$1,790.55",$0.00,"$1,790.55",$805.75,"$1,277.92",$0.00,$299.52,$0.00,$0.00,$313.51,"$1,790.55",$0.00,$895.28,"$1,418.12","$1,432.44",$0.00,$272.06,$0.00,$285.06,$0.00
04.124.030S,SUP,HCPCS C1713,,04.124.030S  -  PLATE BONE 356MM 15 HOLE LCP TITANIUM FEMUR RIGHT DISTAL,"$3,222.18",$0.00,"$3,222.18","$1,449.98","$2,299.67",$0.00,$538.99,$0.00,$0.00,$564.18,"$3,222.18",$0.00,"$1,611.09","$2,551.97","$2,577.74",$0.00,$489.58,$0.00,$512.97,$0.00
04.124.031S,SUP,HCPCS C1713,,04.124.031S  -  PLATE BONE 356MM 15 HOLE LCP TITANIUM FEMUR LEFT DISTAL,"$3,222.18",$0.00,"$3,222.18","$1,449.98","$2,299.67",$0.00,$538.99,$0.00,$0.00,$564.18,"$3,222.18",$0.00,"$1,611.09","$2,551.97","$2,577.74",$0.00,$489.58,$0.00,$512.97,$0.00
04.124.034S,SUP,HCPCS C1713,,04.124.034S  -  PLATE BONE 396MM 17 HOLE LCP TITANIUM FEMUR RIGHT DISTAL,"$3,280.85",$0.00,"$3,280.85","$1,476.38","$2,341.54",$0.00,$548.81,$0.00,$0.00,$574.45,"$3,280.85",$0.00,"$1,640.43","$2,598.43","$2,624.68",$0.00,$498.50,$0.00,$522.31,$0.00
04.124.035S,SUP,HCPCS C1713,,04.124.035S  -  PLATE BONE 396MM 17 HOLE LCP TITANIUM FEMUR LEFT DISTAL,"$3,280.85",$0.00,"$3,280.85","$1,476.38","$2,341.54",$0.00,$548.81,$0.00,$0.00,$574.45,"$3,280.85",$0.00,"$1,640.43","$2,598.43","$2,624.68",$0.00,$498.50,$0.00,$522.31,$0.00
04.124.038S,SUP,HCPCS C1713,,04.124.038S  -  PLATE BONE 436MM 19 HOLE LCP TITANIUM FEMUR RIGHT DISTAL,"$3,340.90",$0.00,"$3,340.90","$1,503.41","$2,384.40",$0.00,$558.86,$0.00,$0.00,$584.96,"$3,340.90",$0.00,"$1,670.45","$2,645.99","$2,672.72",$0.00,$507.62,$0.00,$531.87,$0.00
04.124.039S,SUP,HCPCS C1713,,04.124.039S  -  PLATE BONE 436MM 19 HOLE LCP TITANIUM FEMUR LEFT DISTAL,"$3,340.90",$0.00,"$3,340.90","$1,503.41","$2,384.40",$0.00,$558.86,$0.00,$0.00,$584.96,"$3,340.90",$0.00,"$1,670.45","$2,645.99","$2,672.72",$0.00,$507.62,$0.00,$531.87,$0.00
04.124.200,SUP,HCPCS C1713,,04.124.200  -  PLATE BONE 76MM 4 HOLE LOW BEND LCP TITANIUM TIBIA RIGHT,"$2,586.20",$0.00,"$2,586.20","$1,163.79","$1,845.77",$0.00,$432.61,$0.00,$0.00,$452.82,"$2,586.20",$0.00,"$1,293.10","$2,048.27","$2,068.96",$0.00,$392.95,$0.00,$411.72,$0.00
04.124.201,SUP,HCPCS C1713,,04.124.201  -  PLATE BONE 76MM 6 HOLE LOW BEND LCP TITANIUM TIBIA LEFT,"$2,586.20",$0.00,"$2,586.20","$1,163.79","$1,845.77",$0.00,$432.61,$0.00,$0.00,$452.82,"$2,586.20",$0.00,"$1,293.10","$2,048.27","$2,068.96",$0.00,$392.95,$0.00,$411.72,$0.00
04.124.204,SUP,HCPCS C1713,,04.124.204  -  PLATE BONE 102MM 6 HOLE LOW BEND LCP TITANIUM TIBIA RIGHT,"$2,617.60",$0.00,"$2,617.60","$1,177.92","$1,868.18",$0.00,$437.86,$0.00,$0.00,$458.32,"$2,617.60",$0.00,"$1,308.80","$2,073.14","$2,094.08",$0.00,$397.72,$0.00,$416.72,$0.00
04.124.205,SUP,HCPCS C1713,,04.124.205  -  PLATE BONE 102MM 6 HOLE LOW BEND LCP TITANIUM TIBIA LEFT,"$2,617.60",$0.00,"$2,617.60","$1,177.92","$1,868.18",$0.00,$437.86,$0.00,$0.00,$458.32,"$2,617.60",$0.00,"$1,308.80","$2,073.14","$2,094.08",$0.00,$397.72,$0.00,$416.72,$0.00
04.124.208,SUP,HCPCS C1713,,04.124.208  -  PLATE BONE 128MM 8 HOLE LOW BEND LCP TITANIUM TIBIA RIGHT,"$2,647.63",$0.00,"$2,647.63","$1,191.43","$1,889.61",$0.00,$442.88,$0.00,$0.00,$463.58,"$2,647.63",$0.00,"$1,323.81","$2,096.92","$2,118.10",$0.00,$402.28,$0.00,$421.50,$0.00
04.124.209,SUP,HCPCS C1713,,04.124.209  -  PLATE BONE 128MM 8 HOLE LOW BEND LCP TITANIUM TIBIA LEFT,"$2,647.63",$0.00,"$2,647.63","$1,191.43","$1,889.61",$0.00,$442.88,$0.00,$0.00,$463.58,"$2,647.63",$0.00,"$1,323.81","$2,096.92","$2,118.10",$0.00,$402.28,$0.00,$421.50,$0.00
04.124.212,SUP,HCPCS C1713,,04.124.212  -  PLATE BONE 154MM 10 HOLE LOW BEND LCP TITANIUM TIBIA RIGHT,"$2,676.28",$0.00,"$2,676.28","$1,204.32","$1,910.06",$0.00,$447.68,$0.00,$0.00,$468.59,"$2,676.28",$0.00,"$1,338.14","$2,119.61","$2,141.02",$0.00,$406.64,$0.00,$426.06,$0.00
04.124.213,SUP,HCPCS C1713,,04.124.213  -  PLATE BONE 154MM 10 HOLE LOW BEND LCP TITANIUM TIBIA LEFT,"$2,676.28",$0.00,"$2,676.28","$1,204.32","$1,910.06",$0.00,$447.68,$0.00,$0.00,$468.59,"$2,676.28",$0.00,"$1,338.14","$2,119.61","$2,141.02",$0.00,$406.64,$0.00,$426.06,$0.00
04.124.216,SUP,HCPCS C1713,,04.124.216  -  PLATE BONE 180MM 12 HOLE LOW BEND LCP TITANIUM TIBIA RIGHT,"$2,803.20",$0.00,"$2,803.20","$1,261.44","$2,000.64",$0.00,$468.91,$0.00,$0.00,$490.82,"$2,803.20",$0.00,"$1,401.60","$2,220.13","$2,242.56",$0.00,$425.92,$0.00,$446.27,$0.00
04.124.217,SUP,HCPCS C1713,,04.124.217  -  PLATE BONE 180MM 12 HOLE LOW BEND LCP TITANIUM TIBIA LEFT,"$2,803.20",$0.00,"$2,803.20","$1,261.44","$2,000.64",$0.00,$468.91,$0.00,$0.00,$490.82,"$2,803.20",$0.00,"$1,401.60","$2,220.13","$2,242.56",$0.00,$425.92,$0.00,$446.27,$0.00
04.124.220,SUP,HCPCS C1713,,04.124.220  -  PLATE BONE 206MM 14 HOLE LOW BEND LCP TITANIUM TIBIA RIGHT,"$2,833.23",$0.00,"$2,833.23","$1,274.95","$2,022.07",$0.00,$473.93,$0.00,$0.00,$496.08,"$2,833.23",$0.00,"$1,416.61","$2,243.92","$2,266.58",$0.00,$430.48,$0.00,$451.05,$0.00
04.124.221,SUP,HCPCS C1713,,04.124.221  -  PLATE BONE 206MM 14 HOLE LOW BEND LCP TITANIUM TIBIA LEFT,"$2,833.23",$0.00,"$2,833.23","$1,274.95","$2,022.07",$0.00,$473.93,$0.00,$0.00,$496.08,"$2,833.23",$0.00,"$1,416.61","$2,243.92","$2,266.58",$0.00,$430.48,$0.00,$451.05,$0.00
04.124.224,SUP,HCPCS C1713,,04.124.224  -  PLATE BONE 232MM 16 HOLE LOW BEND LCP TITANIUM TIBIA RIGHT,"$2,932.85",$0.00,"$2,932.85","$1,319.78","$2,093.18",$0.00,$490.60,$0.00,$0.00,$513.52,"$2,932.85",$0.00,"$1,466.43","$2,322.82","$2,346.28",$0.00,$445.62,$0.00,$466.91,$0.00
04.124.225,SUP,HCPCS C1713,,04.124.225  -  PLATE BONE 232MM 16 HOLE LOW BEND LCP TITANIUM TIBIA LEFT,"$2,932.85",$0.00,"$2,932.85","$1,319.78","$2,093.18",$0.00,$490.60,$0.00,$0.00,$513.52,"$2,932.85",$0.00,"$1,466.43","$2,322.82","$2,346.28",$0.00,$445.62,$0.00,$466.91,$0.00
04.161.001,SUP,HCPCS C1713,,04.161.001  -  PLATE 50MM TI BONE OCCPTL NONSTRL,"$8,232.00",$0.00,"$8,232.00","$3,704.40","$5,158.80",$0.00,"$1,418.33",$0.00,$0.00,"$1,441.36","$8,232.00",$0.00,"$4,116.00","$6,519.74","$6,585.60",$0.00,"$1,288.31",$0.00,"$1,310.53",$0.00
04.161.032,SUP,HCPCS C1713,,04.161.032  -  ROD SPNL 240MM 3.5MM OCCPTL TI PREBNT,$892.50,$0.00,$892.50,$401.63,$636.98,$0.00,$153.77,$0.00,$0.00,$156.27,$892.50,$0.00,$446.25,$706.86,$714.00,$0.00,$139.68,$0.00,$142.09,$0.00
04.161.210S,SUP,HCPCS C1713,,04.161.210S  -  PLATE BONE NARROW 10 HOLE CVD LCP TITANIUM STERILE 3.5MM,$772.45,$0.00,$772.45,$347.60,$551.30,$0.00,$129.21,$0.00,$0.00,$135.25,$772.45,$0.00,$386.23,$611.78,$617.96,$0.00,$117.37,$0.00,$122.97,$0.00
04.161.212S,SUP,HCPCS C1713,,04.161.212S  -  PLATE BONE NARROW 12 HOLE CVD LCP TITANIUM PEDIATRIC STERILE,"$1,130.03",$0.00,"$1,130.03",$508.51,$806.50,$0.00,$189.02,$0.00,$0.00,$197.86,"$1,130.03",$0.00,$565.01,$894.98,$904.02,$0.00,$171.70,$0.00,$179.90,$0.00
04.161.214S,SUP,HCPCS C1713,,04.161.214S  -  PLATE BONE CURVE NARROW 14 HOLE LCP TITANIUM PEDIATRIC SPN,"$1,293.78",$0.00,"$1,293.78",$582.20,$923.37,$0.00,$216.42,$0.00,$0.00,$226.53,"$1,293.78",$0.00,$646.89,"$1,024.67","$1,035.02",$0.00,$196.58,$0.00,$205.97,$0.00
04.161.216S,SUP,HCPCS C1713,,04.161.216S  -  PLATE BONE CURVE NARROW 16 HOLE LCP TITANIUM PEDIATRIC SPN,"$1,390.68",$0.00,"$1,390.68",$625.80,$992.52,$0.00,$232.63,$0.00,$0.00,$243.50,"$1,390.68",$0.00,$695.34,"$1,101.42","$1,112.54",$0.00,$211.30,$0.00,$221.40,$0.00
04.161.218S,SUP,HCPCS C1713,,04.161.218S  -  PLATE BONE CURVE NARROW 18 HOLE LCP TITANIUM PEDIATRIC SPN,"$1,554.45",$0.00,"$1,554.45",$699.50,"$1,109.41",$0.00,$260.02,$0.00,$0.00,$272.17,"$1,554.45",$0.00,$777.23,"$1,231.12","$1,243.56",$0.00,$236.19,$0.00,$247.47,$0.00
04.161.220S,SUP,HCPCS C1713,,04.161.220S  -  PLATE BONE CURVE NARROW 20 HOLE LCP TITANIUM PEDIATRIC SPN,"$1,715.50",$0.00,"$1,715.50",$771.98,"$1,224.35",$0.00,$286.96,$0.00,$0.00,$300.37,"$1,715.50",$0.00,$857.75,"$1,358.68","$1,372.40",$0.00,$260.65,$0.00,$273.11,$0.00
04.161.222S,SUP,HCPCS C1713,,04.161.222S  -  PLATE BONE CURVE NARROW 22 HOLE LCP TITANIUM PEDIATRIC SPN,"$1,715.50",$0.00,"$1,715.50",$771.98,"$1,224.35",$0.00,$286.96,$0.00,$0.00,$300.37,"$1,715.50",$0.00,$857.75,"$1,358.68","$1,372.40",$0.00,$260.65,$0.00,$273.11,$0.00
04.161.240S,SUP,HCPCS C1713,,04.161.240S  -  PLATE BONE CURVE NARROW 10 HOLE LCP TITANIUM PEDIATRIC SPN,"$1,220.08",$0.00,"$1,220.08",$549.03,$870.77,$0.00,$204.09,$0.00,$0.00,$213.63,"$1,220.08",$0.00,$610.04,$966.30,$976.06,$0.00,$185.38,$0.00,$194.24,$0.00
04.161.242S,SUP,HCPCS C1713,,04.161.242S  -  PLATE BONE CURVE NARROW 12 HOLE LCP TITANIUM PEDIATRIC SPN,"$1,394.78",$0.00,"$1,394.78",$627.65,$995.45,$0.00,$233.31,$0.00,$0.00,$244.21,"$1,394.78",$0.00,$697.39,"$1,104.67","$1,115.82",$0.00,$211.92,$0.00,$222.05,$0.00
04.161.244S,SUP,HCPCS C1713,,04.161.244S  -  PLATE BONE CURVE NARROW 14 HOLE LCP TITANIUM PEDIATRIC SPN,"$1,482.13",$0.00,"$1,482.13",$666.96,"$1,057.79",$0.00,$247.92,$0.00,$0.00,$259.51,"$1,482.13",$0.00,$741.06,"$1,173.85","$1,185.70",$0.00,$225.20,$0.00,$235.95,$0.00
04.161.246S,SUP,HCPCS C1713,,04.161.246S  -  PLATE BONE CURVE NARROW 16 HOLE LCP TITANIUM PEDIATRIC SPN,"$1,655.45",$0.00,"$1,655.45",$744.95,"$1,181.49",$0.00,$276.92,$0.00,$0.00,$289.86,"$1,655.45",$0.00,$827.73,"$1,311.12","$1,324.36",$0.00,$251.53,$0.00,$263.55,$0.00
04.161.248S,SUP,HCPCS C1713,,04.161.248S  -  PLATE BONE CURVE NARROW 18 HOLE LCP TITANIUM PEDIATRIC SPN,"$2,000.73",$0.00,"$2,000.73",$900.33,"$1,427.92",$0.00,$334.67,$0.00,$0.00,$350.31,"$2,000.73",$0.00,"$1,000.36","$1,584.58","$1,600.58",$0.00,$303.99,$0.00,$318.52,$0.00
04.161.250S,SUP,HCPCS C1713,,04.161.250S  -  PLATE BONE CURVE NARROW 20 HOLE LCP TITANIUM PEDIATRIC SPN,"$2,350.10",$0.00,"$2,350.10","$1,057.55","$1,677.27",$0.00,$393.12,$0.00,$0.00,$411.48,"$2,350.10",$0.00,"$1,175.05","$1,861.28","$1,880.08",$0.00,$357.08,$0.00,$374.14,$0.00
04.161.252S,SUP,HCPCS C1713,,04.161.252S  -  PLATE BONE CURVE NARROW 22 HOLE LCP TITANIUM PEDIATRIC SPN,"$2,610.78",$0.00,"$2,610.78","$1,174.85","$1,863.31",$0.00,$436.72,$0.00,$0.00,$457.13,"$2,610.78",$0.00,"$1,305.39","$2,067.74","$2,088.62",$0.00,$396.68,$0.00,$415.64,$0.00
04.161.270S,SUP,HCPCS C1713,,04.161.270S  -  PLATE BONE CURVE BROAD 10 HOLE LCP TITANIUM PEDIATRIC SPN,$952.60,$0.00,$952.60,$428.67,$679.87,$0.00,$159.35,$0.00,$0.00,$166.79,$952.60,$0.00,$476.30,$754.46,$762.08,$0.00,$144.74,$0.00,$151.65,$0.00
04.161.272S,SUP,HCPCS C1713,,04.161.272S  -  PLATE BONE CURVE BROAD 12 HOLE LCP TITANIUM PEDIATRIC SPN,"$1,211.90",$0.00,"$1,211.90",$545.36,$864.93,$0.00,$202.72,$0.00,$0.00,$212.19,"$1,211.90",$0.00,$605.95,$959.82,$969.52,$0.00,$184.14,$0.00,$192.93,$0.00
04.161.274S,SUP,HCPCS C1713,,04.161.274S  -  PLATE BONE CURVE BROAD 14 HOLE LCP TITANIUM PEDIATRIC SPN,"$1,293.78",$0.00,"$1,293.78",$582.20,$923.37,$0.00,$216.42,$0.00,$0.00,$226.53,"$1,293.78",$0.00,$646.89,"$1,024.67","$1,035.02",$0.00,$196.58,$0.00,$205.97,$0.00
04.161.276S,SUP,HCPCS C1713,,04.161.276S  -  PLATE BONE CURVE BROAD 16 HOLE LCP TITANIUM PEDIATRIC SPN,"$1,390.68",$0.00,"$1,390.68",$625.80,$992.52,$0.00,$232.63,$0.00,$0.00,$243.50,"$1,390.68",$0.00,$695.34,"$1,101.42","$1,112.54",$0.00,$211.30,$0.00,$221.40,$0.00
04.161.278S,SUP,HCPCS C1713,,04.161.278S  -  PLATE BONE CURVE BROAD 18 HOLE LCP TITANIUM PEDIATRIC SPN,"$1,554.45",$0.00,"$1,554.45",$699.50,"$1,109.41",$0.00,$260.02,$0.00,$0.00,$272.17,"$1,554.45",$0.00,$777.23,"$1,231.12","$1,243.56",$0.00,$236.19,$0.00,$247.47,$0.00
04.161.280S,SUP,HCPCS C1713,,04.161.280S  -  PLATE BONE CURVE BROAD 20 HOLE LCP TITANIUM PEDIATRIC SPN,"$1,649.98",$0.00,"$1,649.98",$742.49,"$1,177.59",$0.00,$276.00,$0.00,$0.00,$288.90,"$1,649.98",$0.00,$824.99,"$1,306.78","$1,319.98",$0.00,$250.70,$0.00,$262.68,$0.00
04.161.282S,SUP,HCPCS C1713,,04.161.282S  -  PLATE BONE CURVE BROAD 22 HOLE LCP TITANIUM PEDIATRIC SPN,"$1,731.88",$0.00,"$1,731.88",$779.34,"$1,236.04",$0.00,$289.70,$0.00,$0.00,$303.24,"$1,731.88",$0.00,$865.94,"$1,371.65","$1,385.50",$0.00,$263.14,$0.00,$275.71,$0.00
04.161.284S,SUP,HCPCS C1713,,04.161.284S  -  PLATE BONE CURVE BROAD 24 HOLE LCP TITANIUM PEDIATRIC SPN,"$1,731.88",$0.00,"$1,731.88",$779.34,"$1,236.04",$0.00,$289.70,$0.00,$0.00,$303.24,"$1,731.88",$0.00,$865.94,"$1,371.65","$1,385.50",$0.00,$263.14,$0.00,$275.71,$0.00
04.161.286S,SUP,HCPCS C1713,,04.161.286S  -  PLATE BONE 26 HOLE CVD LCP TITANIUM PEDIATRIC STERILE 3.5 MM,"$1,831.50",$0.00,"$1,831.50",$824.18,"$1,307.14",$0.00,$306.37,$0.00,$0.00,$320.68,"$1,831.50",$0.00,$915.75,"$1,450.55","$1,465.20",$0.00,$278.28,$0.00,$291.57,$0.00
04.161.288S,SUP,HCPCS C1713,,04.161.288S  -  PLATE BONE 28 HOLE CVD LCP TITANIUM PEDIATRIC STERILE 3.5 MM,"$2,004.83",$0.00,"$2,004.83",$902.17,"$1,430.84",$0.00,$335.36,$0.00,$0.00,$351.03,"$2,004.83",$0.00,"$1,002.41","$1,587.83","$1,603.86",$0.00,$304.62,$0.00,$319.17,$0.00
04.161.290S,SUP,HCPCS C1713,,04.161.290S  -  PLATE BONE 30 HOLE CVD LCP TITANIUM PEDIATRIC STERILE 3.5 MM,"$2,179.50",$0.00,"$2,179.50",$980.78,"$1,555.51",$0.00,$364.58,$0.00,$0.00,$381.61,"$2,179.50",$0.00,"$1,089.75","$1,726.16","$1,743.60",$0.00,$331.16,$0.00,$346.98,$0.00
04.200.010,SUP,HCPCS C1713,,04.200.010  -  SCREW BONE FULTHD 3.5MM 10MM SLFTAP LOCKING STARDRIVE RECESS,$46.05,$0.00,$46.05,$20.72,$32.87,$0.00,$7.70,$0.00,$0.00,$8.06,$46.05,$0.00,$23.03,$36.47,$36.84,$0.00,$7.00,$0.00,$7.33,$0.00
04.200.012,SUP,HCPCS C1713,,04.200.012  -  SCREW BONE FULTHD 3.5MM 12MM SLFTAP LOCKING STARDRIVE RECESS,$46.05,$0.00,$46.05,$20.72,$32.87,$0.00,$7.70,$0.00,$0.00,$8.06,$46.05,$0.00,$23.03,$36.47,$36.84,$0.00,$7.00,$0.00,$7.33,$0.00
04.200.014,SUP,HCPCS C1713,,04.200.014  -  SCREW BONE FULTHD 3.5MM 14MM SLFTAP LOCKING STARDRIVE RECESS,$46.05,$0.00,$46.05,$20.72,$32.87,$0.00,$7.70,$0.00,$0.00,$8.06,$46.05,$0.00,$23.03,$36.47,$36.84,$0.00,$7.00,$0.00,$7.33,$0.00
04.200.016,SUP,HCPCS C1713,,04.200.016  -  SCREW BONE FULTHD 3.5MM 16MM SLFTAP LOCKING STARDRIVE RECESS,$46.05,$0.00,$46.05,$20.72,$32.87,$0.00,$7.70,$0.00,$0.00,$8.06,$46.05,$0.00,$23.03,$36.47,$36.84,$0.00,$7.00,$0.00,$7.33,$0.00
04.200.018,SUP,HCPCS C1713,,04.200.018  -  SCREW BONE FULTHD 3.5MM 18MM SLFTAP LOCKING STARDRIVE RECESS,$46.05,$0.00,$46.05,$20.72,$32.87,$0.00,$7.70,$0.00,$0.00,$8.06,$46.05,$0.00,$23.03,$36.47,$36.84,$0.00,$7.00,$0.00,$7.33,$0.00
04.200.020,SUP,HCPCS C1713,,04.200.020  -  SCREW BONE FULTHD 3.5MM 20MM SLFTAP LOCKING STARDRIVE RECESS,$46.05,$0.00,$46.05,$20.72,$32.87,$0.00,$7.70,$0.00,$0.00,$8.06,$46.05,$0.00,$23.03,$36.47,$36.84,$0.00,$7.00,$0.00,$7.33,$0.00
04.200.022,SUP,HCPCS C1713,,04.200.022  -  SCREW BONE FULTHD 3.5MM 22MM SLFTAP LOCKING STARDRIVE RECESS,$46.05,$0.00,$46.05,$20.72,$32.87,$0.00,$7.70,$0.00,$0.00,$8.06,$46.05,$0.00,$23.03,$36.47,$36.84,$0.00,$7.00,$0.00,$7.33,$0.00
04.200.024,SUP,HCPCS C1713,,04.200.024  -  SCREW BONE FULTHD 3.5MM 25MM SLFTAP LOCKING STARDRIVE RECESS,$46.05,$0.00,$46.05,$20.72,$32.87,$0.00,$7.70,$0.00,$0.00,$8.06,$46.05,$0.00,$23.03,$36.47,$36.84,$0.00,$7.00,$0.00,$7.33,$0.00
04.200.026,SUP,HCPCS C1713,,04.200.026  -  SCREW BONE FULTHD 3.5MM 26MM SLFTAP LOCKING STARDRIVE RECESS,$46.05,$0.00,$46.05,$20.72,$32.87,$0.00,$7.70,$0.00,$0.00,$8.06,$46.05,$0.00,$23.03,$36.47,$36.84,$0.00,$7.00,$0.00,$7.33,$0.00
04.200.028,SUP,HCPCS C1713,,04.200.028  -  SCREW BONE FULTHD 3.5MM 28MM SLFTAP LOCKING STARDRIVE RECESS,$46.05,$0.00,$46.05,$20.72,$32.87,$0.00,$7.70,$0.00,$0.00,$8.06,$46.05,$0.00,$23.03,$36.47,$36.84,$0.00,$7.00,$0.00,$7.33,$0.00
04.200.030,SUP,HCPCS C1713,,04.200.030  -  SCREW BONE FULTHD 3.5MM 30MM SLFTAP LOCKING STARDRIVE RECESS,$46.05,$0.00,$46.05,$20.72,$32.87,$0.00,$7.70,$0.00,$0.00,$8.06,$46.05,$0.00,$23.03,$36.47,$36.84,$0.00,$7.00,$0.00,$7.33,$0.00
04.200.032,SUP,HCPCS C1713,,04.200.032  -  SCREW BONE FULTHD 3.5MM 32MM SLFTAP LOCKING STARDRIVE RECESS,$46.05,$0.00,$46.05,$20.72,$32.87,$0.00,$7.70,$0.00,$0.00,$8.06,$46.05,$0.00,$23.03,$36.47,$36.84,$0.00,$7.00,$0.00,$7.33,$0.00
04.200.034,SUP,HCPCS C1713,,04.200.034  -  SCREW BONE FULTHD 3.5MM 34MM SLFTAP LOCKING STARDRIVE RECESS,$46.05,$0.00,$46.05,$20.72,$32.87,$0.00,$7.70,$0.00,$0.00,$8.06,$46.05,$0.00,$23.03,$36.47,$36.84,$0.00,$7.00,$0.00,$7.33,$0.00
04.200.036,SUP,HCPCS C1713,,04.200.036  -  SCREW BONE FULTHD 3.5MM 36MM SLFTAP LOCKING STARDRIVE RECESS,$46.05,$0.00,$46.05,$20.72,$32.87,$0.00,$7.70,$0.00,$0.00,$8.06,$46.05,$0.00,$23.03,$36.47,$36.84,$0.00,$7.00,$0.00,$7.33,$0.00
04.200.038,SUP,HCPCS C1713,,04.200.038  -  SCREW BONE FULTHD 3.5MM 38MM SLFTAP LOCKING STARDRIVE RECESS,$46.05,$0.00,$46.05,$20.72,$32.87,$0.00,$7.70,$0.00,$0.00,$8.06,$46.05,$0.00,$23.03,$36.47,$36.84,$0.00,$7.00,$0.00,$7.33,$0.00
04.200.040,SUP,HCPCS C1713,,04.200.040  -  SCREW BONE FULTHD 3.5MM 40MM SLFTAP LOCKING STARDRIVE RECESS,$46.05,$0.00,$46.05,$20.72,$32.87,$0.00,$7.70,$0.00,$0.00,$8.06,$46.05,$0.00,$23.03,$36.47,$36.84,$0.00,$7.00,$0.00,$7.33,$0.00
04.200.042,SUP,HCPCS C1713,,04.200.042  -  SCREW BONE FULTHD 3.5MM 42MM SLFTAP LOCKING STARDRIVE RECESS,$46.05,$0.00,$46.05,$20.72,$32.87,$0.00,$7.70,$0.00,$0.00,$8.06,$46.05,$0.00,$23.03,$36.47,$36.84,$0.00,$7.00,$0.00,$7.33,$0.00
04.200.044,SUP,HCPCS C1713,,04.200.044  -  SCREW BONE FULTHD 3.5MM 44MM SLFTAP LOCKING STARDRIVE RECESS,$46.05,$0.00,$46.05,$20.72,$32.87,$0.00,$7.70,$0.00,$0.00,$8.06,$46.05,$0.00,$23.03,$36.47,$36.84,$0.00,$7.00,$0.00,$7.33,$0.00
04.200.045,SUP,HCPCS C1713,,04.200.045  -  SCREW BONE FULTHD 3.5MM 45MM SLFTAP LOCKING STARDRIVE RECESS,$46.05,$0.00,$46.05,$20.72,$32.87,$0.00,$7.70,$0.00,$0.00,$8.06,$46.05,$0.00,$23.03,$36.47,$36.84,$0.00,$7.00,$0.00,$7.33,$0.00
04.200.046,SUP,HCPCS C1713,,04.200.046  -  SCREW BONE FULTHD 3.5MM 46MM SLFTAP LOCKING STARDRIVE RECESS,$46.05,$0.00,$46.05,$20.72,$32.87,$0.00,$7.70,$0.00,$0.00,$8.06,$46.05,$0.00,$23.03,$36.47,$36.84,$0.00,$7.00,$0.00,$7.33,$0.00
04.200.048,SUP,HCPCS C1713,,04.200.048  -  SCREW BONE FULTHD 3.5MM 48MM SLFTAP LOCKING STARDRIVE RECESS,$46.05,$0.00,$46.05,$20.72,$32.87,$0.00,$7.70,$0.00,$0.00,$8.06,$46.05,$0.00,$23.03,$36.47,$36.84,$0.00,$7.00,$0.00,$7.33,$0.00
04.200.050,SUP,HCPCS C1713,,04.200.050  -  SCREW BONE FULTHD 3.5MM 50MM SLFTAP LOCKING STARDRIVE RECESS,$46.05,$0.00,$46.05,$20.72,$32.87,$0.00,$7.70,$0.00,$0.00,$8.06,$46.05,$0.00,$23.03,$36.47,$36.84,$0.00,$7.00,$0.00,$7.33,$0.00
04.200.055,SUP,HCPCS C1713,,04.200.055  -  SCREW BONE FULTHD 3.5MM 55MM SLFTAP LOCKING STARDRIVE RECESS,$46.05,$0.00,$46.05,$20.72,$32.87,$0.00,$7.70,$0.00,$0.00,$8.06,$46.05,$0.00,$23.03,$36.47,$36.84,$0.00,$7.00,$0.00,$7.33,$0.00
04.200.060,SUP,HCPCS C1713,,04.200.060  -  SCREW BONE FULTHD 3.5MM 60MM SLFTAP LOCKING STARDRIVE RECESS,$46.05,$0.00,$46.05,$20.72,$32.87,$0.00,$7.70,$0.00,$0.00,$8.06,$46.05,$0.00,$23.03,$36.47,$36.84,$0.00,$7.00,$0.00,$7.33,$0.00
04.204.014,SUP,HCPCS C1713,,04.204.014  -  SCREW BONE 4MM 14MM SLFTAP LOCKING STARDRIVE RECESS LCP,$254.40,$0.00,$254.40,$114.48,$181.57,$0.00,$43.83,$0.00,$0.00,$44.54,$254.40,$0.00,$127.20,$201.48,$203.52,$0.00,$39.81,$0.00,$40.50,$0.00
04.204.016,SUP,HCPCS C1713,,04.204.016  -  SCREW BONE 4MM 16MM SLFTAP LOCKING STARDRIVE RECESS LCP,$254.40,$0.00,$254.40,$114.48,$181.57,$0.00,$43.83,$0.00,$0.00,$44.54,$254.40,$0.00,$127.20,$201.48,$203.52,$0.00,$39.81,$0.00,$40.50,$0.00
04.204.018,SUP,HCPCS C1713,,04.204.018  -  SCREW BONE 4MM 18MM SLFTAP LOCKING STARDRIVE RECESS LCP,$254.40,$0.00,$254.40,$114.48,$181.57,$0.00,$43.83,$0.00,$0.00,$44.54,$254.40,$0.00,$127.20,$201.48,$203.52,$0.00,$39.81,$0.00,$40.50,$0.00
04.204.020,SUP,HCPCS C1713,,04.204.020  -  SCREW BONE 4MM 20MM SLFTAP LOCKING STARDRIVE RECESS LCP,$254.40,$0.00,$254.40,$114.48,$181.57,$0.00,$43.83,$0.00,$0.00,$44.54,$254.40,$0.00,$127.20,$201.48,$203.52,$0.00,$39.81,$0.00,$40.50,$0.00
04.204.022,SUP,HCPCS C1713,,04.204.022  -  SCREW BONE 4MM 22MM SLFTAP LOCKING STARDRIVE RECESS LCP,$254.40,$0.00,$254.40,$114.48,$181.57,$0.00,$43.83,$0.00,$0.00,$44.54,$254.40,$0.00,$127.20,$201.48,$203.52,$0.00,$39.81,$0.00,$40.50,$0.00
04.204.024,SUP,HCPCS C1713,,04.204.024  -  SCREW BONE 4MM 24MM SLFTAP LOCKING STARDRIVE RECESS LCP,$254.40,$0.00,$254.40,$114.48,$181.57,$0.00,$43.83,$0.00,$0.00,$44.54,$254.40,$0.00,$127.20,$201.48,$203.52,$0.00,$39.81,$0.00,$40.50,$0.00
04.204.026,SUP,HCPCS C1713,,04.204.026  -  SCREW BONE 4MM 26MM SLFTAP LOCKING STARDRIVE RECESS LCP,$254.40,$0.00,$254.40,$114.48,$181.57,$0.00,$43.83,$0.00,$0.00,$44.54,$254.40,$0.00,$127.20,$201.48,$203.52,$0.00,$39.81,$0.00,$40.50,$0.00
04.204.028,SUP,HCPCS C1713,,04.204.028  -  SCREW BONE 4MM 28MM SLFTAP LOCKING STARDRIVE RECESS LCP,$254.40,$0.00,$254.40,$114.48,$181.57,$0.00,$43.83,$0.00,$0.00,$44.54,$254.40,$0.00,$127.20,$201.48,$203.52,$0.00,$39.81,$0.00,$40.50,$0.00
04.204.030,SUP,HCPCS C1713,,04.204.030  -  SCREW BONE 4MM 30MM SLFTAP LOCKING STARDRIVE RECESS LCP,$254.40,$0.00,$254.40,$114.48,$181.57,$0.00,$43.83,$0.00,$0.00,$44.54,$254.40,$0.00,$127.20,$201.48,$203.52,$0.00,$39.81,$0.00,$40.50,$0.00
04.204.032,SUP,HCPCS C1713,,04.204.032  -  SCREW BONE 4MM 32MM SLFTAP LOCKING STARDRIVE RECESS LCP,$254.40,$0.00,$254.40,$114.48,$181.57,$0.00,$43.83,$0.00,$0.00,$44.54,$254.40,$0.00,$127.20,$201.48,$203.52,$0.00,$39.81,$0.00,$40.50,$0.00
04.204.034,SUP,HCPCS C1713,,04.204.034  -  SCREW BONE 4MM 34MM SLFTAP LOCKING STARDRIVE RECESS LCP,$254.40,$0.00,$254.40,$114.48,$181.57,$0.00,$43.83,$0.00,$0.00,$44.54,$254.40,$0.00,$127.20,$201.48,$203.52,$0.00,$39.81,$0.00,$40.50,$0.00
04.204.036,SUP,HCPCS C1713,,04.204.036  -  SCREW BONE 4MM 36MM SLFTAP LOCKING STARDRIVE RECESS LCP,$254.40,$0.00,$254.40,$114.48,$181.57,$0.00,$43.83,$0.00,$0.00,$44.54,$254.40,$0.00,$127.20,$201.48,$203.52,$0.00,$39.81,$0.00,$40.50,$0.00
04.204.038,SUP,HCPCS C1713,,04.204.038  -  SCREW BONE 4MM 38MM SLFTAP LOCKING STARDRIVE RECESS LCP,$254.40,$0.00,$254.40,$114.48,$181.57,$0.00,$43.83,$0.00,$0.00,$44.54,$254.40,$0.00,$127.20,$201.48,$203.52,$0.00,$39.81,$0.00,$40.50,$0.00
04.204.040,SUP,HCPCS C1713,,04.204.040  -  SCREW BONE 4MM 40MM SLFTAP LOCKING STARDRIVE RECESS LCP,$254.40,$0.00,$254.40,$114.48,$181.57,$0.00,$43.83,$0.00,$0.00,$44.54,$254.40,$0.00,$127.20,$201.48,$203.52,$0.00,$39.81,$0.00,$40.50,$0.00
04.204.042,SUP,HCPCS C1713,,04.204.042  -  SCREW BONE 4MM 42MM SLFTAP LOCKING STARDRIVE RECESS LCP,$254.40,$0.00,$254.40,$114.48,$181.57,$0.00,$43.83,$0.00,$0.00,$44.54,$254.40,$0.00,$127.20,$201.48,$203.52,$0.00,$39.81,$0.00,$40.50,$0.00
04.204.044,SUP,HCPCS C1713,,04.204.044  -  SCREW BONE 4MM 44MM SLFTAP LOCKING STARDRIVE RECESS LCP,$254.40,$0.00,$254.40,$114.48,$181.57,$0.00,$43.83,$0.00,$0.00,$44.54,$254.40,$0.00,$127.20,$201.48,$203.52,$0.00,$39.81,$0.00,$40.50,$0.00
04.204.046,SUP,HCPCS C1713,,04.204.046  -  SCREW BONE 4MM 46MM SLFTAP LOCKING STARDRIVE RECESS LCP,$254.40,$0.00,$254.40,$114.48,$181.57,$0.00,$43.83,$0.00,$0.00,$44.54,$254.40,$0.00,$127.20,$201.48,$203.52,$0.00,$39.81,$0.00,$40.50,$0.00
04.204.048,SUP,HCPCS C1713,,04.204.048  -  SCREW BONE 4MM 48MM SLFTAP LOCKING STARDRIVE RECESS LCP,$254.40,$0.00,$254.40,$114.48,$181.57,$0.00,$43.83,$0.00,$0.00,$44.54,$254.40,$0.00,$127.20,$201.48,$203.52,$0.00,$39.81,$0.00,$40.50,$0.00
04.204.050,SUP,HCPCS C1713,,04.204.050  -  SCREW BONE 4MM 50MM SLFTAP LOCKING STARDRIVE RECESS LCP,$254.40,$0.00,$254.40,$114.48,$181.57,$0.00,$43.83,$0.00,$0.00,$44.54,$254.40,$0.00,$127.20,$201.48,$203.52,$0.00,$39.81,$0.00,$40.50,$0.00
04.204.052,SUP,HCPCS C1713,,04.204.052  -  SCREW BONE 4MM 52MM SLFTAP LOCKING STARDRIVE RECESS LCP,$254.40,$0.00,$254.40,$114.48,$181.57,$0.00,$43.83,$0.00,$0.00,$44.54,$254.40,$0.00,$127.20,$201.48,$203.52,$0.00,$39.81,$0.00,$40.50,$0.00
04.204.054,SUP,HCPCS C1713,,04.204.054  -  SCREW BONE 4MM 54MM SLFTAP LOCKING STARDRIVE RECESS LCP,$254.40,$0.00,$254.40,$114.48,$181.57,$0.00,$43.83,$0.00,$0.00,$44.54,$254.40,$0.00,$127.20,$201.48,$203.52,$0.00,$39.81,$0.00,$40.50,$0.00
04.204.056,SUP,HCPCS C1713,,04.204.056  -  SCREW BONE 4MM 56MM SLFTAP LOCKING STARDRIVE RECESS LCP,$254.40,$0.00,$254.40,$114.48,$181.57,$0.00,$43.83,$0.00,$0.00,$44.54,$254.40,$0.00,$127.20,$201.48,$203.52,$0.00,$39.81,$0.00,$40.50,$0.00
04.204.058,SUP,HCPCS C1713,,04.204.058  -  SCREW BONE 4MM 58MM SLFTAP LOCKING STARDRIVE RECESS LCP,$254.40,$0.00,$254.40,$114.48,$181.57,$0.00,$43.83,$0.00,$0.00,$44.54,$254.40,$0.00,$127.20,$201.48,$203.52,$0.00,$39.81,$0.00,$40.50,$0.00
04.204.060,SUP,HCPCS C1713,,04.204.060  -  SCREW BONE 4MM 60MM SLFTAP LOCKING STARDRIVE RECESS LCP,$254.40,$0.00,$254.40,$114.48,$181.57,$0.00,$43.83,$0.00,$0.00,$44.54,$254.40,$0.00,$127.20,$201.48,$203.52,$0.00,$39.81,$0.00,$40.50,$0.00
04.204.062,SUP,HCPCS C1713,,04.204.062  -  SCREW BONE 4MM 62MM SLFTAP LOCKING STARDRIVE RECESS LCP,$254.40,$0.00,$254.40,$114.48,$181.57,$0.00,$43.83,$0.00,$0.00,$44.54,$254.40,$0.00,$127.20,$201.48,$203.52,$0.00,$39.81,$0.00,$40.50,$0.00
04.205.025,SUP,HCPCS C1713,,04.205.025  -  SCREW BONE 5MM 25MM LOCK CANN LCP TITANIUM PERIARTICULAR,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
04.205.030,SUP,HCPCS C1713,,04.205.030  -  SCREW BONE 5MM 30MM LOCK CANN LCP TITANIUM PERIARTICULAR,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
04.205.035,SUP,HCPCS C1713,,04.205.035  -  SCREW BONE 5MM 35MM LOCK CANN LCP TITANIUM PERIARTICULAR,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
04.205.040,SUP,HCPCS C1713,,04.205.040  -  SCREW BONE 5MM 40MM LOCK CANN LCP TITANIUM PERIARTICULAR,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
04.205.045,SUP,HCPCS C1713,,04.205.045  -  SCREW BONE 5MM 45MM LOCK CANN LCP TITANIUM PERIARTICULAR,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
04.205.050,SUP,HCPCS C1713,,04.205.050  -  SCREW BONE 5MM 50MM LOCK CANN LCP TITANIUM PERIARTICULAR,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
04.205.055,SUP,HCPCS C1713,,04.205.055  -  SCREW BONE 5MM 55MM LOCK CANN LCP TITANIUM PERIARTICULAR,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
04.205.060,SUP,HCPCS C1713,,04.205.060  -  SCREW BONE 5MM 60MM LOCK CANN LCP TITANIUM PERIARTICULAR,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
04.205.065,SUP,HCPCS C1713,,04.205.065  -  SCREW BONE 5MM 65MM CANN SELF DRILL LOCK THREAD CONICAL HEAD,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
04.205.070,SUP,HCPCS C1713,,04.205.070  -  SCREW BONE 5MM 70MM LOCK CANN LCP TITANIUM PERIARTICULAR,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
04.205.075,SUP,HCPCS C1713,,04.205.075  -  SCREW BONE 5MM 75MM CANN SELF DRILL LOCK THREAD CONICAL HEAD,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
04.205.080,SUP,HCPCS C1713,,04.205.080  -  SCREW BONE 5MM 80MM CANN SELF DRILL LOCK THREAD CONICAL HEAD,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
04.205.085,SUP,HCPCS C1713,,04.205.085  -  SCREW BONE 5MM 85MM LOCK CANN LCP TITANIUM PERIARTICULAR,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
04.205.090,SUP,HCPCS C1713,,04.205.090  -  SCREW BONE 5MM 90MM LOCK CANN LCP TITANIUM PERIARTICULAR,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
04.205.095,SUP,HCPCS C1713,,04.205.095  -  SCREW BONE 5MM 95MM LOCK CANN LCP TITANIUM PERIARTICULAR,$357.58,$0.00,$357.58,$160.91,$255.20,$0.00,$59.81,$0.00,$0.00,$62.61,$357.58,$0.00,$178.79,$283.20,$286.06,$0.00,$54.33,$0.00,$56.93,$0.00
04.205.240,SUP,HCPCS C1713,,04.205.240  -  SCREW BONE CONE 5MM 40MM CANN LCP TITANIUM PERIARTICULAR,$316.63,$0.00,$316.63,$142.48,$225.98,$0.00,$52.96,$0.00,$0.00,$55.44,$316.63,$0.00,$158.31,$250.77,$253.30,$0.00,$48.11,$0.00,$50.41,$0.00
04.205.245,SUP,HCPCS C1713,,04.205.245  -  SCREW BONE CONE 5MM 45MM CANN LCP TITANIUM PERIARTICULAR,$316.63,$0.00,$316.63,$142.48,$225.98,$0.00,$52.96,$0.00,$0.00,$55.44,$316.63,$0.00,$158.31,$250.77,$253.30,$0.00,$48.11,$0.00,$50.41,$0.00
04.205.250,SUP,HCPCS C1713,,04.205.250  -  SCREW BONE CONE 5MM 50MM CANN LCP TITANIUM PERIARTICULAR,$316.63,$0.00,$316.63,$142.48,$225.98,$0.00,$52.96,$0.00,$0.00,$55.44,$316.63,$0.00,$158.31,$250.77,$253.30,$0.00,$48.11,$0.00,$50.41,$0.00
04.205.255,SUP,HCPCS C1713,,04.205.255  -  SCREW BONE CONE 5MM 55MM CANN LCP TITANIUM PERIARTICULAR,$316.63,$0.00,$316.63,$142.48,$225.98,$0.00,$52.96,$0.00,$0.00,$55.44,$316.63,$0.00,$158.31,$250.77,$253.30,$0.00,$48.11,$0.00,$50.41,$0.00
04.205.260,SUP,HCPCS C1713,,04.205.260  -  SCREW BONE CONE 5MM 60MM CANN LCP TITANIUM PERIARTICULAR,$316.63,$0.00,$316.63,$142.48,$225.98,$0.00,$52.96,$0.00,$0.00,$55.44,$316.63,$0.00,$158.31,$250.77,$253.30,$0.00,$48.11,$0.00,$50.41,$0.00
04.205.265,SUP,HCPCS C1713,,04.205.265  -  SCREW BONE CONE 5MM 65MM CANN LCP TITANIUM PERIARTICULAR,$316.63,$0.00,$316.63,$142.48,$225.98,$0.00,$52.96,$0.00,$0.00,$55.44,$316.63,$0.00,$158.31,$250.77,$253.30,$0.00,$48.11,$0.00,$50.41,$0.00
04.205.270,SUP,HCPCS C1713,,04.205.270  -  SCREW BONE CONE 5MM 70MM CANN LCP TITANIUM PERIARTICULAR,$316.63,$0.00,$316.63,$142.48,$225.98,$0.00,$52.96,$0.00,$0.00,$55.44,$316.63,$0.00,$158.31,$250.77,$253.30,$0.00,$48.11,$0.00,$50.41,$0.00
04.205.275,SUP,HCPCS C1713,,04.205.275  -  SCREW BONE CONE 5MM 75MM CANN LCP TITANIUM PERIARTICULAR,$316.63,$0.00,$316.63,$142.48,$225.98,$0.00,$52.96,$0.00,$0.00,$55.44,$316.63,$0.00,$158.31,$250.77,$253.30,$0.00,$48.11,$0.00,$50.41,$0.00
04.205.280,SUP,HCPCS C1713,,04.205.280  -  SCREW BONE CONE 5MM 80MM CANN LCP TITANIUM PERIARTICULAR,$316.63,$0.00,$316.63,$142.48,$225.98,$0.00,$52.96,$0.00,$0.00,$55.44,$316.63,$0.00,$158.31,$250.77,$253.30,$0.00,$48.11,$0.00,$50.41,$0.00
04.205.285,SUP,HCPCS C1713,,04.205.285  -  SCREW BONE CONE 5MM 85MM CANN LCP TITANIUM PERIARTICULAR,$316.63,$0.00,$316.63,$142.48,$225.98,$0.00,$52.96,$0.00,$0.00,$55.44,$316.63,$0.00,$158.31,$250.77,$253.30,$0.00,$48.11,$0.00,$50.41,$0.00
04.205.290,SUP,HCPCS C1713,,04.205.290  -  SCREW BONE CONE 5MM 90MM CANN LCP TITANIUM PERIARTICULAR,$316.63,$0.00,$316.63,$142.48,$225.98,$0.00,$52.96,$0.00,$0.00,$55.44,$316.63,$0.00,$158.31,$250.77,$253.30,$0.00,$48.11,$0.00,$50.41,$0.00
04.205.295,SUP,HCPCS C1713,,04.205.295  -  SCREW BONE CONE 5MM 95MM CANN LCP TITANIUM PERIARTICULAR,$316.63,$0.00,$316.63,$142.48,$225.98,$0.00,$52.96,$0.00,$0.00,$55.44,$316.63,$0.00,$158.31,$250.77,$253.30,$0.00,$48.11,$0.00,$50.41,$0.00
04.210.078,SUP,HCPCS C1713,,04.210.078  -  PIN FIX 1.8MM 8MM BUTTRESS VAR ANG LOCKING T8 STARDRIVE,$247.03,$0.00,$247.03,$111.16,$176.30,$0.00,$41.32,$0.00,$0.00,$43.25,$247.03,$0.00,$123.51,$195.65,$197.62,$0.00,$37.53,$0.00,$39.33,$0.00
04.210.080,SUP,HCPCS C1713,,04.210.080  -  PIN FIX 1.8MM 10MM BUTTRESS VAR ANG LOCKING T8 STARDRIVE,$242.93,$0.00,$242.93,$109.32,$173.38,$0.00,$40.64,$0.00,$0.00,$42.53,$242.93,$0.00,$121.46,$192.40,$194.34,$0.00,$36.91,$0.00,$38.67,$0.00
04.210.082,SUP,HCPCS C1713,,04.210.082  -  PIN FIX 1.8MM 12MM BUTTRESS VAR ANG LOCKING T8 STARDRIVE,$242.93,$0.00,$242.93,$109.32,$173.38,$0.00,$40.64,$0.00,$0.00,$42.53,$242.93,$0.00,$121.46,$192.40,$194.34,$0.00,$36.91,$0.00,$38.67,$0.00
04.210.084,SUP,HCPCS C1713,,04.210.084  -  PIN FIX 1.8MM 14MM BUTTRESS VAR ANG LOCKING T8 STARDRIVE,$242.93,$0.00,$242.93,$109.32,$173.38,$0.00,$40.64,$0.00,$0.00,$42.53,$242.93,$0.00,$121.46,$192.40,$194.34,$0.00,$36.91,$0.00,$38.67,$0.00
04.210.086,SUP,HCPCS C1713,,04.210.086  -  PIN FIX 1.8MM 16MM BUTTRESS VAR ANG LOCKING T8 STARDRIVE,$242.93,$0.00,$242.93,$109.32,$173.38,$0.00,$40.64,$0.00,$0.00,$42.53,$242.93,$0.00,$121.46,$192.40,$194.34,$0.00,$36.91,$0.00,$38.67,$0.00
04.210.088,SUP,HCPCS C1713,,04.210.088  -  PIN FIX 1.8MM 18MM BUTTRESS VAR ANG LOCKING T8 STARDRIVE,$242.93,$0.00,$242.93,$109.32,$173.38,$0.00,$40.64,$0.00,$0.00,$42.53,$242.93,$0.00,$121.46,$192.40,$194.34,$0.00,$36.91,$0.00,$38.67,$0.00
04.210.090,SUP,HCPCS C1713,,04.210.090  -  PIN FIX 1.8MM 20MM BUTTRESS VAR ANG LOCKING T8 STARDRIVE,$242.93,$0.00,$242.93,$109.32,$173.38,$0.00,$40.64,$0.00,$0.00,$42.53,$242.93,$0.00,$121.46,$192.40,$194.34,$0.00,$36.91,$0.00,$38.67,$0.00
04.210.092,SUP,HCPCS C1713,,04.210.092  -  PIN FIX 1.8MM 22MM BUTTRESS VAR ANG LOCKING T8 STARDRIVE,$242.93,$0.00,$242.93,$109.32,$173.38,$0.00,$40.64,$0.00,$0.00,$42.53,$242.93,$0.00,$121.46,$192.40,$194.34,$0.00,$36.91,$0.00,$38.67,$0.00
04.210.094,SUP,HCPCS C1713,,04.210.094  -  PIN FIX 1.8MM 24MM BUTTRESS VAR ANG LOCKING T8 STARDRIVE,$242.93,$0.00,$242.93,$109.32,$173.38,$0.00,$40.64,$0.00,$0.00,$42.53,$242.93,$0.00,$121.46,$192.40,$194.34,$0.00,$36.91,$0.00,$38.67,$0.00
04.210.096,SUP,HCPCS C1713,,04.210.096  -  PIN FIX 1.8MM 26MM BUTTRESS VAR ANG LOCKING T8 STARDRIVE,$242.93,$0.00,$242.93,$109.32,$173.38,$0.00,$40.64,$0.00,$0.00,$42.53,$242.93,$0.00,$121.46,$192.40,$194.34,$0.00,$36.91,$0.00,$38.67,$0.00
04.210.098,SUP,HCPCS C1713,,04.210.098  -  PIN FIX 1.8MM 28MM BUTTRESS VAR ANG LOCKING T8 STARDRIVE,$242.93,$0.00,$242.93,$109.32,$173.38,$0.00,$40.64,$0.00,$0.00,$42.53,$242.93,$0.00,$121.46,$192.40,$194.34,$0.00,$36.91,$0.00,$38.67,$0.00
04.210.100,SUP,HCPCS C1713,,04.210.100  -  PIN FIX 1.8MM 30MM BUTTRESS VAR ANG LOCKING T8 STARDRIVE,$242.93,$0.00,$242.93,$109.32,$173.38,$0.00,$40.64,$0.00,$0.00,$42.53,$242.93,$0.00,$121.46,$192.40,$194.34,$0.00,$36.91,$0.00,$38.67,$0.00
04.210.107,SUP,HCPCS C1713,,04.210.107  -  SCREW BONE 2.4MM 7MM STARDRIVE LOCKING VAR ANG SLFTAP LCP,$242.93,$0.00,$242.93,$109.32,$173.38,$0.00,$40.64,$0.00,$0.00,$42.53,$242.93,$0.00,$121.46,$192.40,$194.34,$0.00,$36.91,$0.00,$38.67,$0.00
04.210.108,SUP,HCPCS C1713,,04.210.108  -  SCREW BONE 2.4MM 8MM T8 STARDRIVE RECESS LOCKING VAR ANG LCP,$242.93,$0.00,$242.93,$109.32,$173.38,$0.00,$40.64,$0.00,$0.00,$42.53,$242.93,$0.00,$121.46,$192.40,$194.34,$0.00,$36.91,$0.00,$38.67,$0.00
04.210.109,SUP,HCPCS C1713,,04.210.109  -  SCREW BONE 2.4MM 9MM STARDRIVE LOCKING VAR ANG SLFTAP LCP,$242.93,$0.00,$242.93,$109.32,$173.38,$0.00,$40.64,$0.00,$0.00,$42.53,$242.93,$0.00,$121.46,$192.40,$194.34,$0.00,$36.91,$0.00,$38.67,$0.00
04.210.110,SUP,HCPCS C1713,,04.210.110  -  SCREW BONE 2.4MM 10MM LOCKING VAR ANG STARDRIVE RECESS LCP,$242.93,$0.00,$242.93,$109.32,$173.38,$0.00,$40.64,$0.00,$0.00,$42.53,$242.93,$0.00,$121.46,$192.40,$194.34,$0.00,$36.91,$0.00,$38.67,$0.00
04.210.111,SUP,HCPCS C1713,,04.210.111  -  SCREW BONE 2.4MM 11MM STARDRIVE LOCKING VAR ANG SLFTAP LCP,$242.93,$0.00,$242.93,$109.32,$173.38,$0.00,$40.64,$0.00,$0.00,$42.53,$242.93,$0.00,$121.46,$192.40,$194.34,$0.00,$36.91,$0.00,$38.67,$0.00
04.210.112,SUP,HCPCS C1713,,04.210.112  -  SCREW BONE 2.4MM 12MM LOCKING VAR ANG STARDRIVE RECESS LCP,$242.93,$0.00,$242.93,$109.32,$173.38,$0.00,$40.64,$0.00,$0.00,$42.53,$242.93,$0.00,$121.46,$192.40,$194.34,$0.00,$36.91,$0.00,$38.67,$0.00
04.210.113,SUP,HCPCS C1713,,04.210.113  -  SCREW BONE 2.4MM 13MM STARDRIVE LOCKING VAR ANG SLFTAP LCP,$242.93,$0.00,$242.93,$109.32,$173.38,$0.00,$40.64,$0.00,$0.00,$42.53,$242.93,$0.00,$121.46,$192.40,$194.34,$0.00,$36.91,$0.00,$38.67,$0.00
04.210.114,SUP,HCPCS C1713,,04.210.114  -  SCREW BONE T8 2.4MM 14MM VAR ANG LOCK STARDRIVE LCP TITANIUM,$242.93,$0.00,$242.93,$109.32,$173.38,$0.00,$40.64,$0.00,$0.00,$42.53,$242.93,$0.00,$121.46,$192.40,$194.34,$0.00,$36.91,$0.00,$38.67,$0.00
04.210.116,SUP,HCPCS C1713,,04.210.116  -  SCREW BONE T8 2.4MM 16MM VAR ANG LOCK STARDRIVE LCP TITANIUM,$242.93,$0.00,$242.93,$109.32,$173.38,$0.00,$40.64,$0.00,$0.00,$42.53,$242.93,$0.00,$121.46,$192.40,$194.34,$0.00,$36.91,$0.00,$38.67,$0.00
04.210.118,SUP,HCPCS C1713,,04.210.118  -  SCREW BONE T8 2.4MM 18MM VAR ANG LOCK STARDRIVE LCP TITANIUM,$242.93,$0.00,$242.93,$109.32,$173.38,$0.00,$40.64,$0.00,$0.00,$42.53,$242.93,$0.00,$121.46,$192.40,$194.34,$0.00,$36.91,$0.00,$38.67,$0.00
04.210.120,SUP,HCPCS C1713,,04.210.120  -  SCREW BONE T8 2.4MM 20MM VAR ANG LOCK STARDRIVE LCP TITANIUM,$242.93,$0.00,$242.93,$109.32,$173.38,$0.00,$40.64,$0.00,$0.00,$42.53,$242.93,$0.00,$121.46,$192.40,$194.34,$0.00,$36.91,$0.00,$38.67,$0.00
04.210.122,SUP,HCPCS C1713,,04.210.122  -  SCREW BONE T8 2.4MM 22MM VAR ANG LOCK STARDRIVE LCP TITANIUM,$242.93,$0.00,$242.93,$109.32,$173.38,$0.00,$40.64,$0.00,$0.00,$42.53,$242.93,$0.00,$121.46,$192.40,$194.34,$0.00,$36.91,$0.00,$38.67,$0.00
04.210.124,SUP,HCPCS C1713,,04.210.124  -  SCREW BONE T8 2.4MM 24MM VAR ANG LOCK STARDRIVE LCP TITANIUM,$242.93,$0.00,$242.93,$109.32,$173.38,$0.00,$40.64,$0.00,$0.00,$42.53,$242.93,$0.00,$121.46,$192.40,$194.34,$0.00,$36.91,$0.00,$38.67,$0.00
04.210.126,SUP,HCPCS C1713,,04.210.126  -  SCREW BONE 2.4MM 26MM LOCKING VAR ANG STARDRIVE RECESS LCP,$242.93,$0.00,$242.93,$109.32,$173.38,$0.00,$40.64,$0.00,$0.00,$42.53,$242.93,$0.00,$121.46,$192.40,$194.34,$0.00,$36.91,$0.00,$38.67,$0.00
04.210.128,SUP,HCPCS C1713,,04.210.128  -  SCREW BONE 2.4MM 28MM LOCKING STARDRIVE RECESS VAR ANG LCP,$242.93,$0.00,$242.93,$109.32,$173.38,$0.00,$40.64,$0.00,$0.00,$42.53,$242.93,$0.00,$121.46,$192.40,$194.34,$0.00,$36.91,$0.00,$38.67,$0.00
04.210.130,SUP,HCPCS C1713,,04.210.130  -  SCREW BONE 2.4MM 30MM LOCKING STARDRIVE RECESS VAR ANG LCP,$242.93,$0.00,$242.93,$109.32,$173.38,$0.00,$40.64,$0.00,$0.00,$42.53,$242.93,$0.00,$121.46,$192.40,$194.34,$0.00,$36.91,$0.00,$38.67,$0.00
04.210.132,SUP,HCPCS C1713,,04.210.132  -  SCREW BONE 2.4MM 32MM LOCKING VAR ANG STARDRIVE RECESS LCP,$242.93,$0.00,$242.93,$109.32,$173.38,$0.00,$40.64,$0.00,$0.00,$42.53,$242.93,$0.00,$121.46,$192.40,$194.34,$0.00,$36.91,$0.00,$38.67,$0.00
04.210.134,SUP,HCPCS C1713,,04.210.134  -  SCREW BONE 2.4MM 34MM STARDRIVE LOCKING VAR ANG SLFTAP LCP,$242.93,$0.00,$242.93,$109.32,$173.38,$0.00,$40.64,$0.00,$0.00,$42.53,$242.93,$0.00,$121.46,$192.40,$194.34,$0.00,$36.91,$0.00,$38.67,$0.00
04.210.136,SUP,HCPCS C1713,,04.210.136  -  SCREW BONE 2.4MM 36MM STARDRIVE LOCKING VAR ANG SLFTAP LCP,$242.93,$0.00,$242.93,$109.32,$173.38,$0.00,$40.64,$0.00,$0.00,$42.53,$242.93,$0.00,$121.46,$192.40,$194.34,$0.00,$36.91,$0.00,$38.67,$0.00
04.210.138,SUP,HCPCS C1713,,04.210.138  -  SCREW BONE 2.4MM 38MM STARDRIVE LOCKING VAR ANG SLFTAP LCP,$242.93,$0.00,$242.93,$109.32,$173.38,$0.00,$40.64,$0.00,$0.00,$42.53,$242.93,$0.00,$121.46,$192.40,$194.34,$0.00,$36.91,$0.00,$38.67,$0.00
04.210.140,SUP,HCPCS C1713,,04.210.140  -  SCREW BONE 2.4MM 40MM STARDRIVE LOCKING VAR ANG SLFTAP LCP,$242.93,$0.00,$242.93,$109.32,$173.38,$0.00,$40.64,$0.00,$0.00,$42.53,$242.93,$0.00,$121.46,$192.40,$194.34,$0.00,$36.91,$0.00,$38.67,$0.00
04.210.142,SUP,HCPCS C1713,,04.210.142  -  SCREW BONE 2.4MM 42MM LOCKING VAR ANG SLFTAP T8 STARDRIVE,$242.93,$0.00,$242.93,$109.32,$173.38,$0.00,$40.64,$0.00,$0.00,$42.53,$242.93,$0.00,$121.46,$192.40,$194.34,$0.00,$36.91,$0.00,$38.67,$0.00
04.210.144,SUP,HCPCS C1713,,04.210.144  -  SCREW BONE 2.4MM 44MM LOCKING VAR ANG SLFTAP T8 STARDRIVE,$242.93,$0.00,$242.93,$109.32,$173.38,$0.00,$40.64,$0.00,$0.00,$42.53,$242.93,$0.00,$121.46,$192.40,$194.34,$0.00,$36.91,$0.00,$38.67,$0.00
04.210.146,SUP,HCPCS C1713,,04.210.146  -  SCREW BONE 2.4MM 46MM LOCKING VAR ANG SLFTAP T8 STARDRIVE,$242.93,$0.00,$242.93,$109.32,$173.38,$0.00,$40.64,$0.00,$0.00,$42.53,$242.93,$0.00,$121.46,$192.40,$194.34,$0.00,$36.91,$0.00,$38.67,$0.00
04.210.148,SUP,HCPCS C1713,,04.210.148  -  SCREW BONE 2.4MM 48MM LOCKING VAR ANG SLFTAP T8 STARDRIVE,$242.93,$0.00,$242.93,$109.32,$173.38,$0.00,$40.64,$0.00,$0.00,$42.53,$242.93,$0.00,$121.46,$192.40,$194.34,$0.00,$36.91,$0.00,$38.67,$0.00
04.210.150,SUP,HCPCS C1713,,04.210.150  -  SCREW BONE 2.4MM 50MM LOCKING VAR ANG SLFTAP T8 STARDRIVE,$242.93,$0.00,$242.93,$109.32,$173.38,$0.00,$40.64,$0.00,$0.00,$42.53,$242.93,$0.00,$121.46,$192.40,$194.34,$0.00,$36.91,$0.00,$38.67,$0.00
04.210.152,SUP,HCPCS C1713,,04.210.152  -  SCREW BONE 2.4MM 52MM LOCKING VAR ANG SLFTAP T8 STARDRIVE,$242.93,$0.00,$242.93,$109.32,$173.38,$0.00,$40.64,$0.00,$0.00,$42.53,$242.93,$0.00,$121.46,$192.40,$194.34,$0.00,$36.91,$0.00,$38.67,$0.00
04.210.154,SUP,HCPCS C1713,,04.210.154  -  SCREW BONE 2.4MM 54MM LOCKING VAR ANG SLFTAP T8 STARDRIVE,$242.93,$0.00,$242.93,$109.32,$173.38,$0.00,$40.64,$0.00,$0.00,$42.53,$242.93,$0.00,$121.46,$192.40,$194.34,$0.00,$36.91,$0.00,$38.67,$0.00
04.210.156,SUP,HCPCS C1713,,04.210.156  -  SCREW BONE 2.4MM 56MM LOCKING VAR ANG SLFTAP T8 STARDRIVE,$242.93,$0.00,$242.93,$109.32,$173.38,$0.00,$40.64,$0.00,$0.00,$42.53,$242.93,$0.00,$121.46,$192.40,$194.34,$0.00,$36.91,$0.00,$38.67,$0.00
04.210.158,SUP,HCPCS C1713,,04.210.158  -  SCREW BONE 2.4MM 58MM LOCKING VAR ANG SLFTAP T8 STARDRIVE,$242.93,$0.00,$242.93,$109.32,$173.38,$0.00,$40.64,$0.00,$0.00,$42.53,$242.93,$0.00,$121.46,$192.40,$194.34,$0.00,$36.91,$0.00,$38.67,$0.00
04.210.160,SUP,HCPCS C1713,,04.210.160  -  SCREW BONE 2.4MM 60MM LOCKING VAR ANG SLFTAP T8 STARDRIVE,$242.93,$0.00,$242.93,$109.32,$173.38,$0.00,$40.64,$0.00,$0.00,$42.53,$242.93,$0.00,$121.46,$192.40,$194.34,$0.00,$36.91,$0.00,$38.67,$0.00
04.210.942,SUP,HCPCS C1713,,04.210.942  -  SCREW BONE 2.4MM 42MM T8 STARDRIVE RECESS VAR ANG SLFTAP LCP,$90.75,$0.00,$90.75,$40.84,$64.77,$0.00,$15.18,$0.00,$0.00,$15.89,$90.75,$0.00,$45.38,$71.87,$72.60,$0.00,$13.79,$0.00,$14.45,$0.00
04.210.944,SUP,HCPCS C1713,,04.210.944  -  SCREW BONE 2.4MM 44MM T8 STARDRIVE RECESS VAR ANG SLFTAP LCP,$90.75,$0.00,$90.75,$40.84,$64.77,$0.00,$15.18,$0.00,$0.00,$15.89,$90.75,$0.00,$45.38,$71.87,$72.60,$0.00,$13.79,$0.00,$14.45,$0.00
04.210.946,SUP,HCPCS C1713,,04.210.946  -  SCREW BONE 2.4MM 46MM T8 STARDRIVE RECESS VAR ANG SLFTAP LCP,$90.75,$0.00,$90.75,$40.84,$64.77,$0.00,$15.18,$0.00,$0.00,$15.89,$90.75,$0.00,$45.38,$71.87,$72.60,$0.00,$13.79,$0.00,$14.45,$0.00
04.210.948,SUP,HCPCS C1713,,04.210.948  -  SCREW BONE 2.4MM 48MM T8 STARDRIVE RECESS VAR ANG SLFTAP LCP,$90.75,$0.00,$90.75,$40.84,$64.77,$0.00,$15.18,$0.00,$0.00,$15.89,$90.75,$0.00,$45.38,$71.87,$72.60,$0.00,$13.79,$0.00,$14.45,$0.00
04.210.950,SUP,HCPCS C1713,,04.210.950  -  SCREW BONE 2.4MM 50MM T8 STARDRIVE RECESS VAR ANG SLFTAP LCP,$90.75,$0.00,$90.75,$40.84,$64.77,$0.00,$15.18,$0.00,$0.00,$15.89,$90.75,$0.00,$45.38,$71.87,$72.60,$0.00,$13.79,$0.00,$14.45,$0.00
04.210.952,SUP,HCPCS C1713,,04.210.952  -  SCREW BONE 2.4MM 52MM T8 STARDRIVE RECESS VAR ANG SLFTAP LCP,$90.75,$0.00,$90.75,$40.84,$64.77,$0.00,$15.18,$0.00,$0.00,$15.89,$90.75,$0.00,$45.38,$71.87,$72.60,$0.00,$13.79,$0.00,$14.45,$0.00
04.210.954,SUP,HCPCS C1713,,04.210.954  -  SCREW BONE 2.4MM 54MM T8 STARDRIVE RECESS VAR ANG SLFTAP LCP,$90.75,$0.00,$90.75,$40.84,$64.77,$0.00,$15.18,$0.00,$0.00,$15.89,$90.75,$0.00,$45.38,$71.87,$72.60,$0.00,$13.79,$0.00,$14.45,$0.00
04.210.956,SUP,HCPCS C1713,,04.210.956  -  SCREW BONE 2.4MM 56MM T8 STARDRIVE RECESS VAR ANG SLFTAP LCP,$90.75,$0.00,$90.75,$40.84,$64.77,$0.00,$15.18,$0.00,$0.00,$15.89,$90.75,$0.00,$45.38,$71.87,$72.60,$0.00,$13.79,$0.00,$14.45,$0.00
04.210.958,SUP,HCPCS C1713,,04.210.958  -  SCREW BONE 2.4MM 58MM T8 STARDRIVE RECESS VAR ANG SLFTAP LCP,$90.75,$0.00,$90.75,$40.84,$64.77,$0.00,$15.18,$0.00,$0.00,$15.89,$90.75,$0.00,$45.38,$71.87,$72.60,$0.00,$13.79,$0.00,$14.45,$0.00
04.210.960,SUP,HCPCS C1713,,04.210.960  -  SCREW BONE 2.4MM 60MM T8 STARDRIVE RECESS VAR ANG SLFTAP LCP,$90.75,$0.00,$90.75,$40.84,$64.77,$0.00,$15.18,$0.00,$0.00,$15.89,$90.75,$0.00,$45.38,$71.87,$72.60,$0.00,$13.79,$0.00,$14.45,$0.00
04.211.008,SUP,HCPCS C1713,,04.211.008  -  SCREW BONE 2.7MM 8MM T8 STARDRIVE RECESS VAR ANG SLFTAP,$245.65,$0.00,$245.65,$110.54,$175.32,$0.00,$41.09,$0.00,$0.00,$43.01,$245.65,$0.00,$122.83,$194.55,$196.52,$0.00,$37.33,$0.00,$39.11,$0.00
04.211.009,SUP,HCPCS C1713,,04.211.009  -  SCREW BONE 2.7MM 9MM T8 STARDRIVE RECESS VAR ANG SLFTAP,$245.65,$0.00,$245.65,$110.54,$175.32,$0.00,$41.09,$0.00,$0.00,$43.01,$245.65,$0.00,$122.83,$194.55,$196.52,$0.00,$37.33,$0.00,$39.11,$0.00
04.211.010,SUP,HCPCS C1713,,04.211.010  -  SCREW BONE 2.7MM 10MM LOCKING VAR ANG SLFTAP T8 STARDRIVE,$245.65,$0.00,$245.65,$110.54,$175.32,$0.00,$41.09,$0.00,$0.00,$43.01,$245.65,$0.00,$122.83,$194.55,$196.52,$0.00,$37.33,$0.00,$39.11,$0.00
04.211.011,SUP,HCPCS C1713,,04.211.011  -  SCREW BONE 2.7MM 11MM T8 STARDRIVE RECESS VAR ANG SLFTAP,$245.65,$0.00,$245.65,$110.54,$175.32,$0.00,$41.09,$0.00,$0.00,$43.01,$245.65,$0.00,$122.83,$194.55,$196.52,$0.00,$37.33,$0.00,$39.11,$0.00
04.211.012,SUP,HCPCS C1713,,04.211.012  -  SCREW BONE 2.7MM 12MM LOCKING VAR ANG SLFTAP T8 STARDRIVE,$245.65,$0.00,$245.65,$110.54,$175.32,$0.00,$41.09,$0.00,$0.00,$43.01,$245.65,$0.00,$122.83,$194.55,$196.52,$0.00,$37.33,$0.00,$39.11,$0.00
04.211.013,SUP,HCPCS C1713,,04.211.013  -  SCREW BONE 2.7MM 13MM T8 STARDRIVE RECESS VAR ANG SLFTAP,$245.65,$0.00,$245.65,$110.54,$175.32,$0.00,$41.09,$0.00,$0.00,$43.01,$245.65,$0.00,$122.83,$194.55,$196.52,$0.00,$37.33,$0.00,$39.11,$0.00
04.211.014,SUP,HCPCS C1713,,04.211.014  -  SCREW BONE 2.7MM 14MM T8 STARDRIVE RECESS SLFTAP LOCKING VAR,$245.65,$0.00,$245.65,$110.54,$175.32,$0.00,$41.09,$0.00,$0.00,$43.01,$245.65,$0.00,$122.83,$194.55,$196.52,$0.00,$37.33,$0.00,$39.11,$0.00
04.211.016,SUP,HCPCS C1713,,04.211.016  -  SCREW BONE 2.7MM 16MM LOCKING VAR ANG SLFTAP T8 STARDRIVE,$245.65,$0.00,$245.65,$110.54,$175.32,$0.00,$41.09,$0.00,$0.00,$43.01,$245.65,$0.00,$122.83,$194.55,$196.52,$0.00,$37.33,$0.00,$39.11,$0.00
04.211.018,SUP,HCPCS C1713,,04.211.018  -  SCREW BONE T8 2.7MM 18MM VAR ANG SELF TAP LOCK STARDRIVE LCP,$245.65,$0.00,$245.65,$110.54,$175.32,$0.00,$41.09,$0.00,$0.00,$43.01,$245.65,$0.00,$122.83,$194.55,$196.52,$0.00,$37.33,$0.00,$39.11,$0.00
04.211.020,SUP,HCPCS C1713,,04.211.020  -  SCREW BONE T8 2.7MM 20MM VAR ANG SELF TAP LOCK STARDRIVE LCP,$245.65,$0.00,$245.65,$110.54,$175.32,$0.00,$41.09,$0.00,$0.00,$43.01,$245.65,$0.00,$122.83,$194.55,$196.52,$0.00,$37.33,$0.00,$39.11,$0.00
04.211.022,SUP,HCPCS C1713,,04.211.022  -  SCREW BONE T8 2.7MM 22MM VAR ANG SELF TAP LOCK STARDRIVE LCP,$245.65,$0.00,$245.65,$110.54,$175.32,$0.00,$41.09,$0.00,$0.00,$43.01,$245.65,$0.00,$122.83,$194.55,$196.52,$0.00,$37.33,$0.00,$39.11,$0.00
04.211.024,SUP,HCPCS C1713,,04.211.024  -  SCREW BONE T8 2.7MM 24MM VAR ANG SELF TAP LOCK STARDRIVE LCP,$245.65,$0.00,$245.65,$110.54,$175.32,$0.00,$41.09,$0.00,$0.00,$43.01,$245.65,$0.00,$122.83,$194.55,$196.52,$0.00,$37.33,$0.00,$39.11,$0.00
04.211.026,SUP,HCPCS C1713,,04.211.026  -  SCREW BONE T8 2.7MM 26MM VAR ANG SELF TAP LOCK STARDRIVE LCP,$245.65,$0.00,$245.65,$110.54,$175.32,$0.00,$41.09,$0.00,$0.00,$43.01,$245.65,$0.00,$122.83,$194.55,$196.52,$0.00,$37.33,$0.00,$39.11,$0.00
04.211.028,SUP,HCPCS C1713,,04.211.028  -  SCREW BONE T8 2.7MM 28MM VAR ANG SELF TAP LOCK STARDRIVE LCP,$245.65,$0.00,$245.65,$110.54,$175.32,$0.00,$41.09,$0.00,$0.00,$43.01,$245.65,$0.00,$122.83,$194.55,$196.52,$0.00,$37.33,$0.00,$39.11,$0.00
04.211.030,SUP,HCPCS C1713,,04.211.030  -  SCREW BONE 2.7MM 30MM VAR ANG LOCKING SLFTAP T8 STARDRIVE,$245.65,$0.00,$245.65,$110.54,$175.32,$0.00,$41.09,$0.00,$0.00,$43.01,$245.65,$0.00,$122.83,$194.55,$196.52,$0.00,$37.33,$0.00,$39.11,$0.00
04.211.032,SUP,HCPCS C1713,,04.211.032  -  SCREW BONE 2.7MM 32MM VAR ANG LOCKING SLFTAP T8 STARDRIVE,$245.65,$0.00,$245.65,$110.54,$175.32,$0.00,$41.09,$0.00,$0.00,$43.01,$245.65,$0.00,$122.83,$194.55,$196.52,$0.00,$37.33,$0.00,$39.11,$0.00
04.211.034,SUP,HCPCS C1713,,04.211.034  -  SCREW BONE 2.7MM 34MM VAR ANG LOCKING SLFTAP T8 STARDRIVE,$245.65,$0.00,$245.65,$110.54,$175.32,$0.00,$41.09,$0.00,$0.00,$43.01,$245.65,$0.00,$122.83,$194.55,$196.52,$0.00,$37.33,$0.00,$39.11,$0.00
04.211.036,SUP,HCPCS C1713,,04.211.036  -  SCREW BONE 2.7MM 36MM VAR ANG LOCKING SLFTAP T8 STARDRIVE,$245.65,$0.00,$245.65,$110.54,$175.32,$0.00,$41.09,$0.00,$0.00,$43.01,$245.65,$0.00,$122.83,$194.55,$196.52,$0.00,$37.33,$0.00,$39.11,$0.00
04.211.038,SUP,HCPCS C1713,,04.211.038  -  SCREW BONE 2.7MM 38MM VAR ANG LOCKING SLFTAP T8 STARDRIVE,$245.65,$0.00,$245.65,$110.54,$175.32,$0.00,$41.09,$0.00,$0.00,$43.01,$245.65,$0.00,$122.83,$194.55,$196.52,$0.00,$37.33,$0.00,$39.11,$0.00
04.211.040,SUP,HCPCS C1713,,04.211.040  -  SCREW BONE 2.7MM 40MM VAR ANG LOCKING SLFTAP T8 STARDRIVE,$245.65,$0.00,$245.65,$110.54,$175.32,$0.00,$41.09,$0.00,$0.00,$43.01,$245.65,$0.00,$122.83,$194.55,$196.52,$0.00,$37.33,$0.00,$39.11,$0.00
04.211.042,SUP,HCPCS C1713,,04.211.042  -  SCREW BONE 2.7MM 42MM VAR ANG LOCKING SLFTAP T8 STARDRIVE,$245.65,$0.00,$245.65,$110.54,$175.32,$0.00,$41.09,$0.00,$0.00,$43.01,$245.65,$0.00,$122.83,$194.55,$196.52,$0.00,$37.33,$0.00,$39.11,$0.00
04.211.044,SUP,HCPCS C1713,,04.211.044  -  SCREW BONE 2.7MM 44MM VAR ANG LOCKING SLFTAP T8 STARDRIVE,$245.65,$0.00,$245.65,$110.54,$175.32,$0.00,$41.09,$0.00,$0.00,$43.01,$245.65,$0.00,$122.83,$194.55,$196.52,$0.00,$37.33,$0.00,$39.11,$0.00
04.211.046,SUP,HCPCS C1713,,04.211.046  -  SCREW BONE 2.7MM 46MM VAR ANG LOCKING SLFTAP T8 STARDRIVE,$245.65,$0.00,$245.65,$110.54,$175.32,$0.00,$41.09,$0.00,$0.00,$43.01,$245.65,$0.00,$122.83,$194.55,$196.52,$0.00,$37.33,$0.00,$39.11,$0.00
04.211.048,SUP,HCPCS C1713,,04.211.048  -  SCREW BONE 2.7MM 48MM VAR ANG LOCKING SLFTAP T8 STARDRIVE,$245.65,$0.00,$245.65,$110.54,$175.32,$0.00,$41.09,$0.00,$0.00,$43.01,$245.65,$0.00,$122.83,$194.55,$196.52,$0.00,$37.33,$0.00,$39.11,$0.00
04.211.050,SUP,HCPCS C1713,,04.211.050  -  SCREW BONE 2.7MM 50MM VAR ANG LOCKING SLFTAP T8 STARDRIVE,$245.65,$0.00,$245.65,$110.54,$175.32,$0.00,$41.09,$0.00,$0.00,$43.01,$245.65,$0.00,$122.83,$194.55,$196.52,$0.00,$37.33,$0.00,$39.11,$0.00
04.211.052,SUP,HCPCS C1713,,04.211.052  -  SCREW BONE 2.7MM 52MM VAR ANG LOCKING SLFTAP T8 STARDRIVE,$245.65,$0.00,$245.65,$110.54,$175.32,$0.00,$41.09,$0.00,$0.00,$43.01,$245.65,$0.00,$122.83,$194.55,$196.52,$0.00,$37.33,$0.00,$39.11,$0.00
04.211.054,SUP,HCPCS C1713,,04.211.054  -  SCREW BONE 2.7MM 54MM VAR ANG LOCKING SLFTAP T8 STARDRIVE,$245.65,$0.00,$245.65,$110.54,$175.32,$0.00,$41.09,$0.00,$0.00,$43.01,$245.65,$0.00,$122.83,$194.55,$196.52,$0.00,$37.33,$0.00,$39.11,$0.00
04.211.056,SUP,HCPCS C1713,,04.211.056  -  SCREW BONE 2.7MM 56MM VAR ANG LOCKING SLFTAP T8 STARDRIVE,$245.65,$0.00,$245.65,$110.54,$175.32,$0.00,$41.09,$0.00,$0.00,$43.01,$245.65,$0.00,$122.83,$194.55,$196.52,$0.00,$37.33,$0.00,$39.11,$0.00
04.211.058,SUP,HCPCS C1713,,04.211.058  -  SCREW BONE 2.4MM 58MM LOCKING T8 STARDRIVE RECESS VAR ANG,$245.65,$0.00,$245.65,$110.54,$175.32,$0.00,$41.09,$0.00,$0.00,$43.01,$245.65,$0.00,$122.83,$194.55,$196.52,$0.00,$37.33,$0.00,$39.11,$0.00
04.211.060,SUP,HCPCS C1713,,04.211.060  -  SCREW BONE 2.4MM 60MM LOCKING T8 STARDRIVE RECESS VAR ANG,$245.65,$0.00,$245.65,$110.54,$175.32,$0.00,$41.09,$0.00,$0.00,$43.01,$245.65,$0.00,$122.83,$194.55,$196.52,$0.00,$37.33,$0.00,$39.11,$0.00
04.211.201,SUP,HCPCS C1713,,04.211.201  -  PLATE BONE XS 24MM VAR ANG LOCKING X LCP TITANIUM FRFT MIDFT,"$1,768.73",$0.00,"$1,768.73",$795.93,"$1,262.34",$0.00,$295.86,$0.00,$0.00,$309.69,"$1,768.73",$0.00,$884.36,"$1,400.83","$1,414.98",$0.00,$268.74,$0.00,$281.58,$0.00
04.211.202,SUP,HCPCS C1713,,04.211.202  -  PLATE BONE SMALL 27MM VAR ANG LOCKING X LCP TITANIUM FRFT,"$1,768.73",$0.00,"$1,768.73",$795.93,"$1,262.34",$0.00,$295.86,$0.00,$0.00,$309.69,"$1,768.73",$0.00,$884.36,"$1,400.83","$1,414.98",$0.00,$268.74,$0.00,$281.58,$0.00
04.211.203,SUP,HCPCS C1713,,04.211.203  -  PLATE BONE MEDIUM 32MM VAR ANG LOCKING X LCP TITANIUM FRFT,"$1,768.73",$0.00,"$1,768.73",$795.93,"$1,262.34",$0.00,$295.86,$0.00,$0.00,$309.69,"$1,768.73",$0.00,$884.36,"$1,400.83","$1,414.98",$0.00,$268.74,$0.00,$281.58,$0.00
04.211.204,SUP,HCPCS C1713,,04.211.204  -  PLATE BN LG X 36MM NS LCP VA LCK LOPRFL CMPR WRE HL TI,"$1,768.73",$0.00,"$1,768.73",$795.93,"$1,262.34",$0.00,$295.86,$0.00,$0.00,$309.69,"$1,768.73",$0.00,$884.36,"$1,400.83","$1,414.98",$0.00,$268.74,$0.00,$281.58,$0.00
04.211.210,SUP,HCPCS C1713,,04.211.210  -  PLATE BONE 0MM SPACER VAR ANG LOCKING LCP TITANIUM FRFT,"$1,726.40",$0.00,"$1,726.40",$776.88,"$1,232.13",$0.00,$288.79,$0.00,$0.00,$302.28,"$1,726.40",$0.00,$863.20,"$1,367.31","$1,381.12",$0.00,$262.31,$0.00,$274.84,$0.00
04.211.211,SUP,HCPCS C1713,,04.211.211  -  PLATE BONE 3MM SPACER VAR ANG LOCKING LCP TITANIUM FRFT,"$1,726.40",$0.00,"$1,726.40",$776.88,"$1,232.13",$0.00,$288.79,$0.00,$0.00,$302.28,"$1,726.40",$0.00,$863.20,"$1,367.31","$1,381.12",$0.00,$262.31,$0.00,$274.84,$0.00
04.211.212,SUP,HCPCS C1713,,04.211.212  -  PLATE BONE 4MM SPACER VAR ANG LOCKING LCP TITANIUM FRFT,"$1,726.40",$0.00,"$1,726.40",$776.88,"$1,232.13",$0.00,$288.79,$0.00,$0.00,$302.28,"$1,726.40",$0.00,$863.20,"$1,367.31","$1,381.12",$0.00,$262.31,$0.00,$274.84,$0.00
04.211.213,SUP,HCPCS C1713,,04.211.213  -  PLATE BONE 5MM SPACER VAR ANG LOCKING LCP TITANIUM FRFT,"$1,680.00",$0.00,"$1,680.00",$756.00,"$1,199.02",$0.00,$281.03,$0.00,$0.00,$294.15,"$1,680.00",$0.00,$840.00,"$1,330.56","$1,344.00",$0.00,$255.26,$0.00,$267.46,$0.00
04.211.214,SUP,HCPCS C1713,,04.211.214  -  PLATE BONE 6MM SPACER VAR ANG LOCKING LCP TITANIUM FRFT,"$1,726.40",$0.00,"$1,726.40",$776.88,"$1,232.13",$0.00,$288.79,$0.00,$0.00,$302.28,"$1,726.40",$0.00,$863.20,"$1,367.31","$1,381.12",$0.00,$262.31,$0.00,$274.84,$0.00
04.211.215,SUP,HCPCS C1713,,04.211.215  -  PLATE BONE 7MM SPACER VAR ANG LOCKING LCP TITANIUM FRFT,"$1,726.40",$0.00,"$1,726.40",$776.88,"$1,232.13",$0.00,$288.79,$0.00,$0.00,$302.28,"$1,726.40",$0.00,$863.20,"$1,367.31","$1,381.12",$0.00,$262.31,$0.00,$274.84,$0.00
04.211.220,SUP,HCPCS C1713,,04.211.220  -  PLATE BONE VAR ANG LOCKING LCP TITANIUM NAVICULAR TARSAL,"$2,105.80",$0.00,"$2,105.80",$947.61,"$1,502.91",$0.00,$352.25,$0.00,$0.00,$368.71,"$2,105.80",$0.00,"$1,052.90","$1,667.79","$1,684.64",$0.00,$319.96,$0.00,$335.24,$0.00
04.211.221,SUP,HCPCS C1713,,04.211.221  -  PLATE BONE VAR ANG LOCKING LCP TITANIUM LEFT CUBOID TARSAL,"$2,105.80",$0.00,"$2,105.80",$947.61,"$1,502.91",$0.00,$352.25,$0.00,$0.00,$368.71,"$2,105.80",$0.00,"$1,052.90","$1,667.79","$1,684.64",$0.00,$319.96,$0.00,$335.24,$0.00
04.211.222,SUP,HCPCS C1713,,04.211.222  -  PLATE BONE VAR ANG LOCKING LCP TITANIUM RIGHT CUBOID TARSAL,"$2,105.80",$0.00,"$2,105.80",$947.61,"$1,502.91",$0.00,$352.25,$0.00,$0.00,$368.71,"$2,105.80",$0.00,"$1,052.90","$1,667.79","$1,684.64",$0.00,$319.96,$0.00,$335.24,$0.00
04.211.224,SUP,HCPCS C1713,,04.211.224  -  PLATE BONE 5X12 HOLE MESH VAR ANG LOCKING LCP TITANIUM,"$2,965.60",$0.00,"$2,965.60","$1,334.52","$2,116.55",$0.00,$496.08,$0.00,$0.00,$519.25,"$2,965.60",$0.00,"$1,482.80","$2,348.76","$2,372.48",$0.00,$450.60,$0.00,$472.12,$0.00
04.211.230,SUP,HCPCS C1713,,04.211.230  -  PLATE BN 0D SM 42MM NS LCP VA FSN LOPRFL CMPR WRE HL TI 1ST,"$1,801.48",$0.00,"$1,801.48",$810.66,"$1,285.71",$0.00,$301.34,$0.00,$0.00,$315.42,"$1,801.48",$0.00,$900.74,"$1,426.77","$1,441.18",$0.00,$273.72,$0.00,$286.79,$0.00
04.211.231,SUP,HCPCS C1713,,04.211.231  -  PLATE BONE 0D SMALL 42MM FUSION VAR ANG LCP TITANIUM LEFT,"$1,801.48",$0.00,"$1,801.48",$810.66,"$1,285.71",$0.00,$301.34,$0.00,$0.00,$315.42,"$1,801.48",$0.00,$900.74,"$1,426.77","$1,441.18",$0.00,$273.72,$0.00,$286.79,$0.00
04.211.232,SUP,HCPCS C1713,,04.211.232  -  PLATE BONE 5D SMALL 42MM FUSION VAR ANG LCP TITANIUM RIGHT,"$1,801.48",$0.00,"$1,801.48",$810.66,"$1,285.71",$0.00,$301.34,$0.00,$0.00,$315.42,"$1,801.48",$0.00,$900.74,"$1,426.77","$1,441.18",$0.00,$273.72,$0.00,$286.79,$0.00
04.211.233,SUP,HCPCS C1713,,04.211.233  -  PLATE BONE 5D SMALL 42MM FUSION VAR ANG LCP TITANIUM LEFT,"$1,801.48",$0.00,"$1,801.48",$810.66,"$1,285.71",$0.00,$301.34,$0.00,$0.00,$315.42,"$1,801.48",$0.00,$900.74,"$1,426.77","$1,441.18",$0.00,$273.72,$0.00,$286.79,$0.00
04.211.234,SUP,HCPCS C1713,,04.211.234  -  PLATE BONE 10D SMALL 42MM FUSION VAR ANG LCP TITANIUM RIGHT,"$1,851.98",$0.00,"$1,851.98",$833.39,"$1,321.75",$0.00,$309.79,$0.00,$0.00,$324.27,"$1,851.98",$0.00,$925.99,"$1,466.77","$1,481.58",$0.00,$281.39,$0.00,$294.83,$0.00
04.211.235,SUP,HCPCS C1713,,04.211.235  -  PLATE BONE 10D SMALL 42MM FUSION VAR ANG LCP TITANIUM LEFT,"$1,851.98",$0.00,"$1,851.98",$833.39,"$1,321.75",$0.00,$309.79,$0.00,$0.00,$324.27,"$1,851.98",$0.00,$925.99,"$1,466.77","$1,481.58",$0.00,$281.39,$0.00,$294.83,$0.00
04.211.236,SUP,HCPCS C1713,,04.211.236  -  PLATE BN 0D MED 52MM NS LCP VA FSN LOPRFL CMPR WRE HL TI 1ST,"$1,801.48",$0.00,"$1,801.48",$810.66,"$1,285.71",$0.00,$301.34,$0.00,$0.00,$315.42,"$1,801.48",$0.00,$900.74,"$1,426.77","$1,441.18",$0.00,$273.72,$0.00,$286.79,$0.00
04.211.237,SUP,HCPCS C1713,,04.211.237  -  PLATE BN 0D MED 52MM NS LCP VA FSN LOPRFL CMPR WRE HL TI 1ST,"$1,851.98",$0.00,"$1,851.98",$833.39,"$1,321.75",$0.00,$309.79,$0.00,$0.00,$324.27,"$1,851.98",$0.00,$925.99,"$1,466.77","$1,481.58",$0.00,$281.39,$0.00,$294.83,$0.00
04.211.238,SUP,HCPCS C1713,,04.211.238  -  PLATE BONE 5D MEDIUM 52MM FUSION VAR ANG LCP TITANIUM RIGHT,"$1,801.48",$0.00,"$1,801.48",$810.66,"$1,285.71",$0.00,$301.34,$0.00,$0.00,$315.42,"$1,801.48",$0.00,$900.74,"$1,426.77","$1,441.18",$0.00,$273.72,$0.00,$286.79,$0.00
04.211.239,SUP,HCPCS C1713,,04.211.239  -  PLATE BN 5D MED 52MM NS LCP VA FSN LOPRFL CMPR WRE HL TI 1ST,"$1,851.98",$0.00,"$1,851.98",$833.39,"$1,321.75",$0.00,$309.79,$0.00,$0.00,$324.27,"$1,851.98",$0.00,$925.99,"$1,466.77","$1,481.58",$0.00,$281.39,$0.00,$294.83,$0.00
04.211.240,SUP,HCPCS C1713,,04.211.240  -  PLATE BONE 10D MEDIUM 52MM FUSION VAR ANG LCP TITANIUM RIGHT,"$1,851.98",$0.00,"$1,851.98",$833.39,"$1,321.75",$0.00,$309.79,$0.00,$0.00,$324.27,"$1,851.98",$0.00,$925.99,"$1,466.77","$1,481.58",$0.00,$281.39,$0.00,$294.83,$0.00
04.211.241,SUP,HCPCS C1713,,04.211.241  -  PLATE BONE 10D MEDIUM 52MM FUSION VAR ANG LCP TITANIUM LEFT,"$1,851.98",$0.00,"$1,851.98",$833.39,"$1,321.75",$0.00,$309.79,$0.00,$0.00,$324.27,"$1,851.98",$0.00,$925.99,"$1,466.77","$1,481.58",$0.00,$281.39,$0.00,$294.83,$0.00
04.211.242,SUP,HCPCS C1713,,04.211.242  -  PLATE BONE 5D LARGE 57MM FUSION VAR ANG LCP TITANIUM RIGHT,"$2,105.80",$0.00,"$2,105.80",$947.61,"$1,502.91",$0.00,$352.25,$0.00,$0.00,$368.71,"$2,105.80",$0.00,"$1,052.90","$1,667.79","$1,684.64",$0.00,$319.96,$0.00,$335.24,$0.00
04.211.243,SUP,HCPCS C1713,,04.211.243  -  PLATE BONE 5D LARGE 57MM FUSION VAR ANG LCP TITANIUM LEFT,"$2,105.80",$0.00,"$2,105.80",$947.61,"$1,502.91",$0.00,$352.25,$0.00,$0.00,$368.71,"$2,105.80",$0.00,"$1,052.90","$1,667.79","$1,684.64",$0.00,$319.96,$0.00,$335.24,$0.00
04.211.244,SUP,HCPCS C1713,,04.211.244  -  PLATE BONE 0D 53MM REVISION FUSION VAR ANG LCP TITANIUM,"$2,273.68",$0.00,"$2,273.68","$1,023.15","$1,622.72",$0.00,$380.33,$0.00,$0.00,$398.10,"$2,273.68",$0.00,"$1,136.84","$1,800.75","$1,818.94",$0.00,$345.47,$0.00,$361.97,$0.00
04.211.245,SUP,HCPCS C1713,,04.211.245  -  PLATE BONE 0D 53MM REVISION FUSION VAR ANG LCP TITANIUM LEFT,"$2,273.68",$0.00,"$2,273.68","$1,023.15","$1,622.72",$0.00,$380.33,$0.00,$0.00,$398.10,"$2,273.68",$0.00,"$1,136.84","$1,800.75","$1,818.94",$0.00,$345.47,$0.00,$361.97,$0.00
04.211.246,SUP,HCPCS C1713,,04.211.246  -  PLATE BONE LONG 39MM FUSION VAR ANG LCP TITANIUM FIRST,"$1,801.48",$0.00,"$1,801.48",$810.66,"$1,285.71",$0.00,$301.34,$0.00,$0.00,$315.42,"$1,801.48",$0.00,$900.74,"$1,426.77","$1,441.18",$0.00,$273.72,$0.00,$286.79,$0.00
04.211.247,SUP,HCPCS C1713,,04.211.247  -  PLATE BONE LONG 48MM FUSION VAR ANG LCP TITANIUM FIRST,"$1,851.98",$0.00,"$1,851.98",$833.39,"$1,321.75",$0.00,$309.79,$0.00,$0.00,$324.27,"$1,851.98",$0.00,$925.99,"$1,466.77","$1,481.58",$0.00,$281.39,$0.00,$294.83,$0.00
04.211.250,SUP,HCPCS C1713,,04.211.250  -  PLATE BONE SHORT 38MM CLOVERLEAF FUSION VAR ANG LCP TITANIUM,"$1,643.15",$0.00,"$1,643.15",$739.42,"$1,172.72",$0.00,$274.86,$0.00,$0.00,$287.70,"$1,643.15",$0.00,$821.58,"$1,301.37","$1,314.52",$0.00,$249.66,$0.00,$261.59,$0.00
04.211.251,SUP,HCPCS C1713,,04.211.251  -  PLATE BONE STANDARD 45MM CLOVERLEAF FUSION VAR ANG LCP,"$1,643.15",$0.00,"$1,643.15",$739.42,"$1,172.72",$0.00,$274.86,$0.00,$0.00,$287.70,"$1,643.15",$0.00,$821.58,"$1,301.37","$1,314.52",$0.00,$249.66,$0.00,$261.59,$0.00
04.211.252,SUP,HCPCS C1713,,04.211.252  -  PLATE BONE LONG 64MM CLOVERLEAF FUSION VAR ANG LCP TITANIUM,"$1,684.10",$0.00,"$1,684.10",$757.85,"$1,201.94",$0.00,$281.71,$0.00,$0.00,$294.87,"$1,684.10",$0.00,$842.05,"$1,333.81","$1,347.28",$0.00,$255.89,$0.00,$268.11,$0.00
04.211.253,SUP,HCPCS C1713,,04.211.253  -  PLATE BONE SHORT 35MM T FUSION VAR ANG LCP TITANIUM FRFT,"$1,557.18",$0.00,"$1,557.18",$700.73,"$1,111.36",$0.00,$260.48,$0.00,$0.00,$272.65,"$1,557.18",$0.00,$778.59,"$1,233.29","$1,245.74",$0.00,$236.60,$0.00,$247.90,$0.00
04.211.254,SUP,HCPCS C1713,,04.211.254  -  PLATE BONE STANDARD 42MM T FUSION VAR ANG LCP TITANIUM FRFT,"$1,643.15",$0.00,"$1,643.15",$739.42,"$1,172.72",$0.00,$274.86,$0.00,$0.00,$287.70,"$1,643.15",$0.00,$821.58,"$1,301.37","$1,314.52",$0.00,$249.66,$0.00,$261.59,$0.00
04.211.255,SUP,HCPCS C1713,,04.211.255  -  PLATE BONE LONG 61MM T FUSION VAR ANG LCP TITANIUM FRFT,"$1,684.10",$0.00,"$1,684.10",$757.85,"$1,201.94",$0.00,$281.71,$0.00,$0.00,$294.87,"$1,684.10",$0.00,$842.05,"$1,333.81","$1,347.28",$0.00,$255.89,$0.00,$268.11,$0.00
04.211.256,SUP,HCPCS C1713,,04.211.256  -  PLATE BONE SHORT 37MM L FUSION VAR ANG LCP TITANIUM RIGHT,"$1,600.85",$0.00,"$1,600.85",$720.38,"$1,142.53",$0.00,$267.79,$0.00,$0.00,$280.30,"$1,600.85",$0.00,$800.43,"$1,267.87","$1,280.68",$0.00,$243.24,$0.00,$254.86,$0.00
04.211.257,SUP,HCPCS C1713,,04.211.257  -  PLATE BONE SHORT 37MM L FUSION VAR ANG LCP TITANIUM LEFT,"$1,600.85",$0.00,"$1,600.85",$720.38,"$1,142.53",$0.00,$267.79,$0.00,$0.00,$280.30,"$1,600.85",$0.00,$800.43,"$1,267.87","$1,280.68",$0.00,$243.24,$0.00,$254.86,$0.00
04.211.258,SUP,HCPCS C1713,,04.211.258  -  PLATE BONE STANDARD 37MM L FUSION VAR ANG LCP TITANIUM RIGHT,"$1,643.15",$0.00,"$1,643.15",$739.42,"$1,172.72",$0.00,$274.86,$0.00,$0.00,$287.70,"$1,643.15",$0.00,$821.58,"$1,301.37","$1,314.52",$0.00,$249.66,$0.00,$261.59,$0.00
04.211.259,SUP,HCPCS C1713,,04.211.259  -  PLATE BONE STANDARD 44MM L FUSION VAR ANG LCP TITANIUM LEFT,"$1,643.15",$0.00,"$1,643.15",$739.42,"$1,172.72",$0.00,$274.86,$0.00,$0.00,$287.70,"$1,643.15",$0.00,$821.58,"$1,301.37","$1,314.52",$0.00,$249.66,$0.00,$261.59,$0.00
04.211.260,SUP,HCPCS C1713,,04.211.260  -  PLATE BONE LONG 62MM L FUSION VAR ANG LCP TITANIUM RIGHT,"$1,684.10",$0.00,"$1,684.10",$757.85,"$1,201.94",$0.00,$281.71,$0.00,$0.00,$294.87,"$1,684.10",$0.00,$842.05,"$1,333.81","$1,347.28",$0.00,$255.89,$0.00,$268.11,$0.00
04.211.261,SUP,HCPCS C1713,,04.211.261  -  PLATE BN LNG L 62MM NS LCP VA FSN LOPRFL CMPR WRE HL TI,"$1,684.10",$0.00,"$1,684.10",$757.85,"$1,201.94",$0.00,$281.71,$0.00,$0.00,$294.87,"$1,684.10",$0.00,$842.05,"$1,333.81","$1,347.28",$0.00,$255.89,$0.00,$268.11,$0.00
04.211.262,SUP,HCPCS C1713,,04.211.262  -  PLATE BONE 27MM 2 HOLE STR FUSION LOCKING VAR ANG LCP,"$1,433.00",$0.00,"$1,433.00",$644.85,"$1,022.73",$0.00,$239.71,$0.00,$0.00,$250.91,"$1,433.00",$0.00,$716.50,"$1,134.94","$1,146.40",$0.00,$217.73,$0.00,$228.13,$0.00
04.211.263,SUP,HCPCS C1713,,04.211.263  -  PLATE BONE 40MM 4 HOLE STR FUSION LOCKING VAR ANG LCP,"$1,514.88",$0.00,"$1,514.88",$681.69,"$1,081.17",$0.00,$253.40,$0.00,$0.00,$265.24,"$1,514.88",$0.00,$757.44,"$1,199.78","$1,211.90",$0.00,$230.17,$0.00,$241.17,$0.00
04.211.265,SUP,HCPCS C1713,,04.211.265  -  PLATE BONE XLONG 92MM 3 HOLE T FUSION VAR ANG LCP TITANIUM,"$2,105.80",$0.00,"$2,105.80",$947.61,"$1,502.91",$0.00,$352.25,$0.00,$0.00,$368.71,"$2,105.80",$0.00,"$1,052.90","$1,667.79","$1,684.64",$0.00,$319.96,$0.00,$335.24,$0.00
04.211.266,SUP,HCPCS C1713,,04.211.266  -  PLATE BONE 43MM TMT FUSION VAR ANG LCP TITANIUM FRFT MIDFT,"$1,637.70",$0.00,"$1,637.70",$736.97,"$1,168.83",$0.00,$273.95,$0.00,$0.00,$286.75,"$1,637.70",$0.00,$818.85,"$1,297.06","$1,310.16",$0.00,$248.84,$0.00,$260.72,$0.00
04.212.054,SUP,HCPCS C1713,,04.212.054  -  SCREW BONE 3.5MM 54MM SELF TAP LOCK LCP TITANIUM FIBULA,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
04.212.056,SUP,HCPCS C1713,,04.212.056  -  SCREW BONE 3.5MM 56MM SELF TAP LOCK LCP TITANIUM FIBULA,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
04.212.058,SUP,HCPCS C1713,,04.212.058  -  SCREW BONE 3.5MM 58MM SELF TAP LOCK LCP TITANIUM FIBULA,$227.93,$0.00,$227.93,$102.57,$162.67,$0.00,$38.12,$0.00,$0.00,$39.91,$227.93,$0.00,$113.96,$180.52,$182.34,$0.00,$34.63,$0.00,$36.29,$0.00
04.214.006,SUP,HCPCS C1713,,04.214.006  -  SCREW BONE 1.5MM 6MM LOCKING SLFTAP T4 STARDRIVE RECESS,$201.98,$0.00,$201.98,$90.89,$144.15,$0.00,$33.79,$0.00,$0.00,$35.36,$201.98,$0.00,$100.99,$159.97,$161.58,$0.00,$30.69,$0.00,$32.15,$0.00
04.214.007,SUP,HCPCS C1713,,04.214.007  -  SCREW BONE 1.5MM 7MM LOCKING SLFTAP T4 STARDRIVE RECESS,$201.98,$0.00,$201.98,$90.89,$144.15,$0.00,$33.79,$0.00,$0.00,$35.36,$201.98,$0.00,$100.99,$159.97,$161.58,$0.00,$30.69,$0.00,$32.15,$0.00
04.214.008,SUP,HCPCS C1713,,04.214.008  -  SCREW BONE 1.5MM 8MM LOCKING SLFTAP T4 STARDRIVE RECESS,$201.98,$0.00,$201.98,$90.89,$144.15,$0.00,$33.79,$0.00,$0.00,$35.36,$201.98,$0.00,$100.99,$159.97,$161.58,$0.00,$30.69,$0.00,$32.15,$0.00
04.214.009,SUP,HCPCS C1713,,04.214.009  -  SCREW BONE 1.5MM 9MM LOCKING SLFTAP T4 STARDRIVE RECESS,$201.98,$0.00,$201.98,$90.89,$144.15,$0.00,$33.79,$0.00,$0.00,$35.36,$201.98,$0.00,$100.99,$159.97,$161.58,$0.00,$30.69,$0.00,$32.15,$0.00
04.214.010,SUP,HCPCS C1713,,04.214.010  -  SCREW BONE 1.5MM 10MM LOCKING SLFTAP T4 STARDRIVE RECESS,$201.98,$0.00,$201.98,$90.89,$144.15,$0.00,$33.79,$0.00,$0.00,$35.36,$201.98,$0.00,$100.99,$159.97,$161.58,$0.00,$30.69,$0.00,$32.15,$0.00
04.214.011,SUP,HCPCS C1713,,04.214.011  -  SCREW BONE 1.5MM 11MM LOCKING SLFTAP T4 STARDRIVE RECESS,$201.98,$0.00,$201.98,$90.89,$144.15,$0.00,$33.79,$0.00,$0.00,$35.36,$201.98,$0.00,$100.99,$159.97,$161.58,$0.00,$30.69,$0.00,$32.15,$0.00
04.214.012,SUP,HCPCS C1713,,04.214.012  -  SCREW BONE 1.5MM 12MM LOCKING SLFTAP T4 STARDRIVE RECESS,$201.98,$0.00,$201.98,$90.89,$144.15,$0.00,$33.79,$0.00,$0.00,$35.36,$201.98,$0.00,$100.99,$159.97,$161.58,$0.00,$30.69,$0.00,$32.15,$0.00
04.214.013,SUP,HCPCS C1713,,04.214.013  -  SCREW BONE 1.5MM 13MM SLFTAP STARDRIVE TITANIUM ALLOY,$201.98,$0.00,$201.98,$90.89,$144.15,$0.00,$33.79,$0.00,$0.00,$35.36,$201.98,$0.00,$100.99,$159.97,$161.58,$0.00,$30.69,$0.00,$32.15,$0.00
04.214.014,SUP,HCPCS C1713,,04.214.014  -  SCREW BONE 1.5MM 14MM SLFTAP STARDRIVE TITANIUM ALLOY,$201.98,$0.00,$201.98,$90.89,$144.15,$0.00,$33.79,$0.00,$0.00,$35.36,$201.98,$0.00,$100.99,$159.97,$161.58,$0.00,$30.69,$0.00,$32.15,$0.00
04.214.015,SUP,HCPCS C1713,,04.214.015  -  SCREW BONE 1.5MM 15MM SLFTAP STARDRIVE TITANIUM ALLOY,$201.98,$0.00,$201.98,$90.89,$144.15,$0.00,$33.79,$0.00,$0.00,$35.36,$201.98,$0.00,$100.99,$159.97,$161.58,$0.00,$30.69,$0.00,$32.15,$0.00
04.214.016,SUP,HCPCS C1713,,04.214.016  -  SCREW BONE 1.5MM 16MM SLFTAP STARDRIVE TITANIUM ALLOY,$201.98,$0.00,$201.98,$90.89,$144.15,$0.00,$33.79,$0.00,$0.00,$35.36,$201.98,$0.00,$100.99,$159.97,$161.58,$0.00,$30.69,$0.00,$32.15,$0.00
04.214.018,SUP,HCPCS C1713,,04.214.018  -  SCREW BONE 1.5MM 18MM SLFTAP STARDRIVE TITANIUM ALLOY,$201.98,$0.00,$201.98,$90.89,$144.15,$0.00,$33.79,$0.00,$0.00,$35.36,$201.98,$0.00,$100.99,$159.97,$161.58,$0.00,$30.69,$0.00,$32.15,$0.00
04.214.020,SUP,HCPCS C1713,,04.214.020  -  SCREW BONE 1.5MM 20MM SLFTAP STARDRIVE TITANIUM ALLOY,$201.98,$0.00,$201.98,$90.89,$144.15,$0.00,$33.79,$0.00,$0.00,$35.36,$201.98,$0.00,$100.99,$159.97,$161.58,$0.00,$30.69,$0.00,$32.15,$0.00
04.214.022,SUP,HCPCS C1713,,04.214.022  -  SCREW BONE 1.5MM 22MM LOCKING SLFTAP COMPACT STARDRIVE LCP,$201.98,$0.00,$201.98,$90.89,$144.15,$0.00,$33.79,$0.00,$0.00,$35.36,$201.98,$0.00,$100.99,$159.97,$161.58,$0.00,$30.69,$0.00,$32.15,$0.00
04.214.024,SUP,HCPCS C1713,,04.214.024  -  SCREW BONE 1.5MM 24MM LOCKING SLFTAP COMPACT STARDRIVE LCP,$201.98,$0.00,$201.98,$90.89,$144.15,$0.00,$33.79,$0.00,$0.00,$35.36,$201.98,$0.00,$100.99,$159.97,$161.58,$0.00,$30.69,$0.00,$32.15,$0.00
04.214.106,SUP,HCPCS C1713,,04.214.106  -  SCREW BONE 1.5MM 6MM SLFTAP COMPACT STARDRIVE LCP TITANIUM,$81.88,$0.00,$81.88,$36.84,$58.43,$0.00,$13.70,$0.00,$0.00,$14.34,$81.88,$0.00,$40.94,$64.85,$65.50,$0.00,$12.44,$0.00,$13.03,$0.00
04.214.107,SUP,HCPCS C1713,,04.214.107  -  SCREW BONE 1.5MM 7MM SLFTAP COMPACT STARDRIVE LCP TITANIUM,$81.88,$0.00,$81.88,$36.84,$58.43,$0.00,$13.70,$0.00,$0.00,$14.34,$81.88,$0.00,$40.94,$64.85,$65.50,$0.00,$12.44,$0.00,$13.03,$0.00
04.214.108,SUP,HCPCS C1713,,04.214.108  -  SCREW BONE 1.5MM 8MM SLFTAP COMPACT STARDRIVE LCP TITANIUM,$81.88,$0.00,$81.88,$36.84,$58.43,$0.00,$13.70,$0.00,$0.00,$14.34,$81.88,$0.00,$40.94,$64.85,$65.50,$0.00,$12.44,$0.00,$13.03,$0.00
04.214.109,SUP,HCPCS C1713,,04.214.109  -  SCREW BONE 1.5MM 9MM SLFTAP COMPACT STARDRIVE LCP TITANIUM,$81.88,$0.00,$81.88,$36.84,$58.43,$0.00,$13.70,$0.00,$0.00,$14.34,$81.88,$0.00,$40.94,$64.85,$65.50,$0.00,$12.44,$0.00,$13.03,$0.00
04.214.110,SUP,HCPCS C1713,,04.214.110  -  SCREW BONE 1.5MM 8MM SLFTAP COMPACT STARDRIVE LCP TITANIUM,$81.88,$0.00,$81.88,$36.84,$58.43,$0.00,$13.70,$0.00,$0.00,$14.34,$81.88,$0.00,$40.94,$64.85,$65.50,$0.00,$12.44,$0.00,$13.03,$0.00
04.214.111,SUP,HCPCS C1713,,04.214.111  -  SCREW BONE 1.5MM 11MM SLFTAP COMPACT STARDRIVE LCP TITANIUM,$81.88,$0.00,$81.88,$36.84,$58.43,$0.00,$13.70,$0.00,$0.00,$14.34,$81.88,$0.00,$40.94,$64.85,$65.50,$0.00,$12.44,$0.00,$13.03,$0.00
04.214.112,SUP,HCPCS C1713,,04.214.112  -  SCREW BONE 1.5MM 12MM SLFTAP COMPACT STARDRIVE LCP TITANIUM,$81.88,$0.00,$81.88,$36.84,$58.43,$0.00,$13.70,$0.00,$0.00,$14.34,$81.88,$0.00,$40.94,$64.85,$65.50,$0.00,$12.44,$0.00,$13.03,$0.00
04.214.113,SUP,HCPCS C1713,,04.214.113  -  SCREW BONE 1.5MM 13MM SLFTAP COMPACT STARDRIVE LCP TITANIUM,$81.88,$0.00,$81.88,$36.84,$58.43,$0.00,$13.70,$0.00,$0.00,$14.34,$81.88,$0.00,$40.94,$64.85,$65.50,$0.00,$12.44,$0.00,$13.03,$0.00
04.214.114,SUP,HCPCS C1713,,04.214.114  -  SCREW BONE 1.5MM 14MM SLFTAP LCP STARDRIVE TITANIUM ALLOY,$81.88,$0.00,$81.88,$36.84,$58.43,$0.00,$13.70,$0.00,$0.00,$14.34,$81.88,$0.00,$40.94,$64.85,$65.50,$0.00,$12.44,$0.00,$13.03,$0.00
04.214.115,SUP,HCPCS C1713,,04.214.115  -  SCREW BONE 1.5MM 15MM SLFTAP T4 STARDRIVE RECESS MODULAR LCP,$81.88,$0.00,$81.88,$36.84,$58.43,$0.00,$13.70,$0.00,$0.00,$14.34,$81.88,$0.00,$40.94,$64.85,$65.50,$0.00,$12.44,$0.00,$13.03,$0.00
04.214.116,SUP,HCPCS C1713,,04.214.116  -  SCREW BONE 1.5MM 16MM SLFTAP T4 STARDRIVE RECESS MODULAR LCP,$81.88,$0.00,$81.88,$36.84,$58.43,$0.00,$13.70,$0.00,$0.00,$14.34,$81.88,$0.00,$40.94,$64.85,$65.50,$0.00,$12.44,$0.00,$13.03,$0.00
04.214.118,SUP,HCPCS C1713,,04.214.118  -  SCREW BONE 1.5MM 18MM SLFTAP T4 STARDRIVE RECESS MODULAR LCP,$81.88,$0.00,$81.88,$36.84,$58.43,$0.00,$13.70,$0.00,$0.00,$14.34,$81.88,$0.00,$40.94,$64.85,$65.50,$0.00,$12.44,$0.00,$13.03,$0.00
04.214.120,SUP,HCPCS C1713,,04.214.120  -  SCREW BONE 1.5MM 20MM SLFTAP T4 STARDRIVE RECESS MODULAR LCP,$81.88,$0.00,$81.88,$36.84,$58.43,$0.00,$13.70,$0.00,$0.00,$14.34,$81.88,$0.00,$40.94,$64.85,$65.50,$0.00,$12.44,$0.00,$13.03,$0.00
04.214.122,SUP,HCPCS C1713,,04.214.122  -  SCREW BONE 1.5MM 22MM SLFTAP T4 STARDRIVE RECESS MODULAR LCP,$81.88,$0.00,$81.88,$36.84,$58.43,$0.00,$13.70,$0.00,$0.00,$14.34,$81.88,$0.00,$40.94,$64.85,$65.50,$0.00,$12.44,$0.00,$13.03,$0.00
04.214.124,SUP,HCPCS C1713,,04.214.124  -  SCREW BONE 1.5MM 24MM SLFTAP T4 STARDRIVE RECESS MODULAR LCP,$81.88,$0.00,$81.88,$36.84,$58.43,$0.00,$13.70,$0.00,$0.00,$14.34,$81.88,$0.00,$40.94,$64.85,$65.50,$0.00,$12.44,$0.00,$13.03,$0.00
04.221.002S,SUP,HCPCS C1713,,04.221.002S  -  BUTTON FIX 2.5MM CERCLAGE HEXAGONAL STARDRIVE RECESS,$331.63,$0.00,$331.63,$149.23,$236.68,$0.00,$55.47,$0.00,$0.00,$58.06,$331.63,$0.00,$165.81,$262.65,$265.30,$0.00,$50.39,$0.00,$52.79,$0.00
04.221.003S,SUP,HCPCS C1713,,04.221.003S  -  BUTTON FIX HEXAGON 3.5MM CERCLAGE T25 STARDRIVE TITANIUM,$331.63,$0.00,$331.63,$149.23,$236.68,$0.00,$55.47,$0.00,$0.00,$58.06,$331.63,$0.00,$165.81,$262.65,$265.30,$0.00,$50.39,$0.00,$52.79,$0.00
04.221.004S,SUP,HCPCS C1713,,04.221.004S  -  NAIL INTRAMEDULLARY 4MM CANN HEXAGONAL TITANIUM ORTHOPEDIC,$333.00,$0.00,$333.00,$149.85,$237.66,$0.00,$55.70,$0.00,$0.00,$58.31,$333.00,$0.00,$166.50,$263.74,$266.40,$0.00,$50.60,$0.00,$53.01,$0.00
04.221.005S,SUP,Custom 27803010,,04.221.005S  -  CABLE ORTHOPEDIC 5MM POSITIONING PIN CRIMP STAINLESS STEEL,$500.88,$0.00,$500.88,$0.00,$357.47,$0.00,$0.00,$0.00,$0.00,$0.00,$500.88,$0.00,$250.44,$396.70,$400.70,$0.00,$0.00,$0.00,$0.00,$0.00
04.221.508,SUP,HCPCS C1713,,04.221.508  -  SCREW BONE 5MM 8MM SLFTAP LOCKING STARDRIVE PERIPROSTHETIC,$386.23,$0.00,$386.23,$173.80,$275.65,$0.00,$64.61,$0.00,$0.00,$67.62,$386.23,$0.00,$193.11,$305.89,$308.98,$0.00,$58.68,$0.00,$61.49,$0.00
04.221.510,SUP,HCPCS C1713,,04.221.510  -  SCREW BONE 5MM 10MM SLFTAP LOCKING STARDRIVE RECESS,$386.23,$0.00,$386.23,$173.80,$275.65,$0.00,$64.61,$0.00,$0.00,$67.62,$386.23,$0.00,$193.11,$305.89,$308.98,$0.00,$58.68,$0.00,$61.49,$0.00
04.221.512,SUP,HCPCS C1713,,04.221.512  -  SCREW BONE 5MM 12MM SLFTAP LOCKING STARDRIVE RECESS TITANIUM,$386.23,$0.00,$386.23,$173.80,$275.65,$0.00,$64.61,$0.00,$0.00,$67.62,$386.23,$0.00,$193.11,$305.89,$308.98,$0.00,$58.68,$0.00,$61.49,$0.00
04.221.514,SUP,HCPCS C1713,,04.221.514  -  SCREW BONE 5MM 14MM SLFTAP LOCKING STARDRIVE RECESS TITANIUM,$386.23,$0.00,$386.23,$173.80,$275.65,$0.00,$64.61,$0.00,$0.00,$67.62,$386.23,$0.00,$193.11,$305.89,$308.98,$0.00,$58.68,$0.00,$61.49,$0.00
04.221.518,SUP,HCPCS C1713,,04.221.518  -  SCREW BONE 5MM 18MM SLFTAP LOCKING STARDRIVE RECESS TITANIUM,$386.23,$0.00,$386.23,$173.80,$275.65,$0.00,$64.61,$0.00,$0.00,$67.62,$386.23,$0.00,$193.11,$305.89,$308.98,$0.00,$58.68,$0.00,$61.49,$0.00
04.226.010,SUP,HCPCS C1713,,04.226.010  -  SCREW BONE SHORT THREAD 3MM 10MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.011,SUP,HCPCS C1713,,04.226.011  -  SCREW BONE SHORT THREAD 3MM 11MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.012,SUP,HCPCS C1713,,04.226.012  -  SCREW BONE SHORT THREAD 3MM 12MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.013,SUP,HCPCS C1713,,04.226.013  -  SCREW BONE SHORT THREAD 3MM 13MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.014,SUP,HCPCS C1713,,04.226.014  -  SCREW BONE SHORT THREAD 3MM 14MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.015,SUP,HCPCS C1713,,04.226.015  -  SCREW BONE SHORT THREAD 3MM 15MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.016,SUP,HCPCS C1713,,04.226.016  -  SCREW BONE SHORT THREAD 3MM 16MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.017,SUP,HCPCS C1713,,04.226.017  -  SCREW BONE SHORT THREAD 3MM 17MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.018,SUP,HCPCS C1713,,04.226.018  -  SCREW BONE SHORT THREAD 3MM 18MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.019,SUP,HCPCS C1713,,04.226.019  -  SCREW BONE SHORT THREAD 3MM 19MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.020,SUP,HCPCS C1713,,04.226.020  -  SCREW BONE SHORT THREAD 3MM 20MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.021,SUP,HCPCS C1713,,04.226.021  -  SCREW BONE SHORT THREAD 3MM 21MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.022,SUP,HCPCS C1713,,04.226.022  -  SCREW BONE SHORT THREAD 3MM 22MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.023,SUP,HCPCS C1713,,04.226.023  -  SCREW BONE SHORT THREAD 3MM 23MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.024,SUP,HCPCS C1713,,04.226.024  -  SCREW BONE SHORT THREAD 3MM 24MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.025,SUP,HCPCS C1713,,04.226.025  -  SCREW BONE SHORT THREAD 3MM 25MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.026,SUP,HCPCS C1713,,04.226.026  -  SCREW BONE SHORT THREAD 3MM 26MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.027,SUP,HCPCS C1713,,04.226.027  -  SCREW BONE SHORT THREAD 3MM 27MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.028,SUP,HCPCS C1713,,04.226.028  -  SCREW BONE SHORT THREAD 3MM 28MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.029,SUP,HCPCS C1713,,04.226.029  -  SCREW BONE SHORT THREAD 3MM 29MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.030,SUP,HCPCS C1713,,04.226.030  -  SCREW BONE SHORT THREAD 3MM 30MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.032,SUP,HCPCS C1713,,04.226.032  -  SCREW BONE SHORT THREAD 3MM 32MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.034,SUP,HCPCS C1713,,04.226.034  -  SCREW BONE SHORT THREAD 3MM 34MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.036,SUP,HCPCS C1713,,04.226.036  -  SCREW BONE SHORT THREAD 3MM 36MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.038,SUP,HCPCS C1713,,04.226.038  -  SCREW BONE SHORT THREAD 3MM 38MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.040,SUP,HCPCS C1713,,04.226.040  -  SCREW BONE SHORT THREAD 3MM 40MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.116,SUP,HCPCS C1713,,04.226.116  -  SCREW BONE LNGTHRD 3MM 16MM COMPRESSION HEADLESS TITANIUM,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.117,SUP,HCPCS C1713,,04.226.117  -  SCREW BONE 3MM 17MM 6MM COMPRESSION TITANIUM SMALL BONE,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.118,SUP,HCPCS C1713,,04.226.118  -  SCREW BONE LNGTHRD 3MM 18MM COMPRESSION HEADLESS TITANIUM,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.119,SUP,HCPCS C1713,,04.226.119  -  SCREW BONE LNGTHRD 3MM 19MM COMPRESSION HEADLESS TITANIUM,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.120,SUP,HCPCS C1713,,04.226.120  -  SCREW BONE 3MM 20MM 7MM COMPRESSION TITANIUM SMALL BONE,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.121,SUP,HCPCS C1713,,04.226.121  -  SCREW BONE LNGTHRD 3MM 21MM COMPRESSION HEADLESS TITANIUM,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.122,SUP,HCPCS C1713,,04.226.122  -  SCREW BONE LNGTHRD 3MM 22MM COMPRESSION HEADLESS TITANIUM,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.123,SUP,HCPCS C1713,,04.226.123  -  SCREW BONE LNGTHRD 3MM 23MM COMPRESSION HEADLESS TITANIUM,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.124,SUP,HCPCS C1713,,04.226.124  -  SCREW BONE LNGTHRD 3MM 24MM COMPRESSION HEADLESS TITANIUM,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.125,SUP,HCPCS C1713,,04.226.125  -  SCREW BONE LNGTHRD 3MM 25MM COMPRESSION HEADLESS TITANIUM,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.126,SUP,HCPCS C1713,,04.226.126  -  SCREW BONE LNGTHRD 3MM 26MM COMPRESSION HEADLESS TITANIUM,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.127,SUP,HCPCS C1713,,04.226.127  -  SCREW BONE LNGTHRD 3MM 27MM COMPRESSION HEADLESS TITANIUM,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.128,SUP,HCPCS C1713,,04.226.128  -  SCREW BONE LNGTHRD 3MM 28MM COMPRESSION HEADLESS TITANIUM,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.129,SUP,HCPCS C1713,,04.226.129  -  SCREW BONE LNGTHRD 3MM 29MM COMPRESSION HEADLESS TITANIUM,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.130,SUP,HCPCS C1713,,04.226.130  -  SCREW BONE LNGTHRD 3MM 30MM COMPRESSION HEADLESS TITANIUM,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.132,SUP,HCPCS C1713,,04.226.132  -  SCREW BONE LNGTHRD 3MM 32MM COMPRESSION HEADLESS TITANIUM,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.134,SUP,HCPCS C1713,,04.226.134  -  SCREW BONE LNGTHRD 3MM 34MM COMPRESSION HEADLESS TITANIUM,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.136,SUP,HCPCS C1713,,04.226.136  -  SCREW BONE LNGTHRD 3MM 36MM COMPRESSION HEADLESS TITANIUM,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.138,SUP,HCPCS C1713,,04.226.138  -  SCREW BONE LNGTHRD 3MM 38MM COMPRESSION HEADLESS TITANIUM,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.140,SUP,HCPCS C1713,,04.226.140  -  SCREW BONE LNGTHRD 3MM 40MM COMPRESSION HEADLESS TITANIUM,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.209,SUP,HCPCS C1713,,04.226.209  -  SCREW BONE SHORT THREAD 2.4MM 9MM 4MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.210,SUP,HCPCS C1713,,04.226.210  -  SCREW BONE SHORT THREAD 2.4MM 10MM 4MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.211,SUP,HCPCS C1713,,04.226.211  -  SCREW BONE SHORT THREAD 2.4MM 11MM 4MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.212,SUP,HCPCS C1713,,04.226.212  -  SCREW BONE SHORT THREAD 2.4MM 12MM 4MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.213,SUP,HCPCS C1713,,04.226.213  -  SCREW BONE SHORT THREAD 2.4MM 13MM 4MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.214,SUP,HCPCS C1713,,04.226.214  -  SCREW BONE SHORT THREAD 2.4MM 14MM 4MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.215,SUP,HCPCS C1713,,04.226.215  -  SCREW BONE SHORT THREAD 2.4MM 15MM 4MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.216,SUP,HCPCS C1713,,04.226.216  -  SCREW BONE SHORT THREAD 2.4MM 16MM 4MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.217,SUP,HCPCS C1713,,04.226.217  -  SCREW BONE SHORT THREAD 2.4MM 17MM 4MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.218,SUP,HCPCS C1713,,04.226.218  -  SCREW BONE 2.4MM 18MM 4MM COMPRESSION TITANIUM SMALL BONE,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.219,SUP,HCPCS C1713,,04.226.219  -  SCREW BONE SHORT THREAD 2.4MM 19MM 4MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.220,SUP,HCPCS C1713,,04.226.220  -  SCREW BONE 2.4MM 20MM 4MM COMPRESSION TITANIUM SMALL BONE,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.221,SUP,HCPCS C1713,,04.226.221  -  SCREW BONE SHORT THREAD 2.4MM 21MM 4MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.222,SUP,HCPCS C1713,,04.226.222  -  SCREW BONE SHORT THREAD 2.4MM 22MM 4MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.223,SUP,HCPCS C1713,,04.226.223  -  SCREW BONE SHORT THREAD 2.4MM 23MM 4MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.224,SUP,HCPCS C1713,,04.226.224  -  SCREW BONE SHORT THREAD 2.4MM 24MM 5MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.225,SUP,HCPCS C1713,,04.226.225  -  SCREW BONE SHORT THREAD 2.4MM 25MM 5MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.226,SUP,HCPCS C1713,,04.226.226  -  SCREW BONE SHORT THREAD 2.4MM 26MM 5MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.227,SUP,HCPCS C1713,,04.226.227  -  SCREW BONE SHORT THREAD 2.4MM 27MM 6MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.228,SUP,HCPCS C1713,,04.226.228  -  SCREW BONE SHORT THREAD 2.4MM 28MM 6MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.229,SUP,HCPCS C1713,,04.226.229  -  SCREW BONE SHORT THREAD 2.4MM 29MM 6MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.230,SUP,HCPCS C1713,,04.226.230  -  SCREW BONE 2.4MM 30MM 7MM COMPRESSION TITANIUM SMALL BONE,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.232,SUP,HCPCS C1713,,04.226.232  -  SCREW BONE SHORT THREAD 2.4MM 32MM 7MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.234,SUP,HCPCS C1713,,04.226.234  -  SCREW BONE SHORT THREAD 2.4MM 34MM 8MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.236,SUP,HCPCS C1713,,04.226.236  -  SCREW BONE SHORT THREAD 2.4MM 36MM 9MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.238,SUP,HCPCS C1713,,04.226.238  -  SCREW BONE SHORT THREAD 2.4MM 38MM 9MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.240,SUP,HCPCS C1713,,04.226.240  -  SCREW BONE 2.4MM 40MM 10MM COMPRESSION SHORT THREAD HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.317,SUP,HCPCS C1713,,04.226.317  -  SCREW BONE LNGTHRD 2.4MM 17MM 6MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.318,SUP,HCPCS C1713,,04.226.318  -  SCREW BONE LNGTHRD 2.4MM 18MM 6MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.319,SUP,HCPCS C1713,,04.226.319  -  SCREW BONE LNGTHRD 2.4MM 19MM 7MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.320,SUP,HCPCS C1713,,04.226.320  -  SCREW BONE LNGTHRD 2.4MM 20MM 7MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.321,SUP,HCPCS C1713,,04.226.321  -  SCREW BONE LNGTHRD 2.4MM 21MM 8MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.322,SUP,HCPCS C1713,,04.226.322  -  SCREW BONE LNGTHRD 2.4MM 22MM 8MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.323,SUP,HCPCS C1713,,04.226.323  -  SCREW BONE LNGTHRD 2.4MM 23MM 8MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.324,SUP,HCPCS C1713,,04.226.324  -  SCREW BONE LNGTHRD 2.4MM 24MM 8MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.325,SUP,HCPCS C1713,,04.226.325  -  SCREW BONE LNGTHRD 2.4MM 25MM 8MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.326,SUP,HCPCS C1713,,04.226.326  -  SCREW BONE LNGTHRD 2.4MM 26MM 10MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.327,SUP,HCPCS C1713,,04.226.327  -  SCREW BONE LNGTHRD 2.4MM 27MM 10MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.328,SUP,HCPCS C1713,,04.226.328  -  SCREW BONE LNGTHRD 2.4MM 28MM 10MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.329,SUP,HCPCS C1713,,04.226.329  -  SCREW BONE LNGTHRD 2.4MM 29MM 10MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.330,SUP,HCPCS C1713,,04.226.330  -  SCREW BONE LNGTHRD 2.4MM 30MM 12MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.332,SUP,HCPCS C1713,,04.226.332  -  SCREW BONE LNGTHRD 2.4MM 32MM 12MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.334,SUP,HCPCS C1713,,04.226.334  -  SCREW BONE LNGTHRD 2.4MM 34MM 14MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.336,SUP,HCPCS C1713,,04.226.336  -  SCREW BONE LNGTHRD 2.4MM 36MM 14MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.338,SUP,HCPCS C1713,,04.226.338  -  SCREW BONE LNGTHRD 2.4MM 38MM 16MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.340,SUP,HCPCS C1713,,04.226.340  -  SCREW BONE LNGTHRD 2.4MM 40MM 16MM COMPRESSION HEADLESS,$622.33,$0.00,$622.33,$280.05,$444.15,$0.00,$104.10,$0.00,$0.00,$108.96,$622.33,$0.00,$311.16,$492.89,$497.86,$0.00,$94.56,$0.00,$99.07,$0.00
04.226.620,SUP,HCPCS C1713,,04.226.620  -  SCREW BONE SHORT THREAD 4.5MM 20MM 7MM HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.226.622,SUP,HCPCS C1713,,04.226.622  -  SCREW BONE SHORT THREAD 4.5MM 22MM 7MM HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.226.624,SUP,HCPCS C1713,,04.226.624  -  SCREW BONE SHORT THREAD 4.5MM 24MM 7MM HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.226.626,SUP,HCPCS C1713,,04.226.626  -  SCREW BONE SHORT THREAD 4.5MM 26MM 7MM HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.226.628,SUP,HCPCS C1713,,04.226.628  -  SCREW BONE SHORT THREAD 4.5MM 28MM 7MM HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.226.630,SUP,HCPCS C1713,,04.226.630  -  SCREW BONE SHORT THREAD 4.5MM 30MM 7MM HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.226.632,SUP,HCPCS C1713,,04.226.632  -  SCREW BONE SHORT THREAD 4.5MM 32MM 7MM HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.226.634,SUP,HCPCS C1713,,04.226.634  -  SCREW BONE SHORT THREAD 4.5MM 34MM 7MM HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.226.636,SUP,HCPCS C1713,,04.226.636  -  SCREW BONE SHORT THREAD 4.5MM 36MM 7MM HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.226.638,SUP,HCPCS C1713,,04.226.638  -  SCREW BONE SHORT THREAD 4.5MM 38MM 7MM HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.226.640,SUP,HCPCS C1713,,04.226.640  -  SCREW BONE SHORT THREAD 4.5MM 40MM 8MM HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.226.642,SUP,HCPCS C1713,,04.226.642  -  SCREW BONE SHORT THREAD 4.5MM 42MM 8MM HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.226.644,SUP,HCPCS C1713,,04.226.644  -  SCREW BONE SHORT THREAD 4.5MM 44MM 9MM HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.226.646,SUP,HCPCS C1713,,04.226.646  -  SCREW BONE SHORT THREAD 4.5MM 46MM 9MM HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.226.648,SUP,HCPCS C1713,,04.226.648  -  SCREW BONE SHORT THREAD 4.5MM 48MM 9MM HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.226.650,SUP,HCPCS C1713,,04.226.650  -  SCREW BONE SHORT THREAD 4.5MM 50MM 10MM HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.226.652,SUP,HCPCS C1713,,04.226.652  -  SCREW BONE SHORT THREAD 4.5MM 52MM 10MM HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.226.654,SUP,HCPCS C1713,,04.226.654  -  SCREW BONE SHORT THREAD 6.5MM 54MM 16MM HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.226.656,SUP,HCPCS C1713,,04.226.656  -  SCREW BONE SHORT THREAD 4.5MM 56MM 11MM COMPRESSION HEADLESS,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.226.658,SUP,HCPCS C1713,,04.226.658  -  SCREW BONE SHORT THREAD 4.5MM 58MM 11MM HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.226.660,SUP,HCPCS C1713,,04.226.660  -  SCREW BONE SHORT THREAD 4.5MM 60MM 12MM HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.226.665,SUP,HCPCS C1713,,04.226.665  -  SCREW BONE SHORT THREAD 4.5MM 65MM 13MM HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.226.670,SUP,HCPCS C1713,,04.226.670  -  SCREW BONE SHORT THREAD 4.5MM 70MM 14MM HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.226.675,SUP,HCPCS C1713,,04.226.675  -  SCREW BONE SHORT THREAD 4.5MM 75MM 15MM HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.226.680,SUP,HCPCS C1713,,04.226.680  -  SCREW BONE SHORT THREAD 4.5MM 80MM HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.226.685,SUP,HCPCS C1713,,04.226.685  -  SCREW BONE SHORT THREAD 4.5MM 85MM HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.226.690,SUP,HCPCS C1713,,04.226.690  -  SCREW BONE SHORT THREAD 4.5MM 90MM HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.226.695,SUP,HCPCS C1713,,04.226.695  -  SCREW BONE SHORT THREAD 4.5MM 95MM HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.226.700,SUP,HCPCS C1713,,04.226.700  -  SCREW BONE SHORT THREAD 4.5MM 100MM HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.226.730,SUP,HCPCS C1713,,04.226.730  -  SCREW BONE LNGTHRD 4.5MM 32MM 12MM HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.226.732,SUP,HCPCS C1713,,04.226.732  -  SCREW BONE LNGTHRD 4.5MM 32MM 12MM HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.226.734,SUP,HCPCS C1713,,04.226.734  -  SCREW BONE LNGTHRD 4.5MM 34MM 12MM HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.226.736,SUP,HCPCS C1713,,04.226.736  -  SCREW BONE LNGTHRD 4.5MM 36MM 14MM HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.226.738,SUP,HCPCS C1713,,04.226.738  -  SCREW BONE LNGTHRD 4.5MM 38MM 14MM HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.226.740,SUP,HCPCS C1713,,04.226.740  -  SCREW BONE LNGTHRD 4.5MM 40MM 16MM HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.226.742,SUP,HCPCS C1713,,04.226.742  -  SCREW BONE LNGTHRD 4.5MM 42MM 16MM HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.226.744,SUP,HCPCS C1713,,04.226.744  -  SCREW BONE LNGTHRD 4.5MM 44MM 18MM HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.226.746,SUP,HCPCS C1713,,04.226.746  -  SCREW BONE LNGTHRD 4.5MM 46MM 18MM HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.226.748,SUP,HCPCS C1713,,04.226.748  -  SCREW BONE LNGTHRD 4.5MM 48MM 18MM HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.226.750,SUP,HCPCS C1713,,04.226.750  -  SCREW BONE LNGTHRD 4.5MM 50MM 20MM HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.226.752,SUP,HCPCS C1713,,04.226.752  -  SCREW BONE LNGTHRD 4.5MM 52MM 20MM HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.226.754,SUP,HCPCS C1713,,04.226.754  -  SCREW BONE LNGTHRD 4.5MM 54MM 22MM HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.226.756,SUP,HCPCS C1713,,04.226.756  -  SCREW BONE LNGTHRD 4.5MM 56MM 22MM COMPRESSION HEADLESS,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.226.758,SUP,HCPCS C1713,,04.226.758  -  SCREW BONE LNGTHRD 4.5MM 58MM 22MM HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.226.760,SUP,HCPCS C1713,,04.226.760  -  SCREW BONE LNGTHRD 4.5MM 60MM 24MM COMPRESSION HEADLESS,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.226.765,SUP,HCPCS C1713,,04.226.765  -  SCREW BONE LNGTHRD 4.5MM 65MM 26MM HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.226.770,SUP,HCPCS C1713,,04.226.770  -  SCREW BONE LNGTHRD 4.5MM 70MM 28MM HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.226.775,SUP,HCPCS C1713,,04.226.775  -  SCREW BONE LNGTHRD 4.5MM 75MM 30MM HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.226.780,SUP,HCPCS C1713,,04.226.780  -  SCREW BONE LNGTHRD 4.5MM 80MM 32MM HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.226.785,SUP,HCPCS C1713,,04.226.785  -  SCREW BONE LNGTHRD 4.5MM 85MM 34MM COMPRESSION HEADLESS,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.226.790,SUP,HCPCS C1713,,04.226.790  -  SCREW BONE LNGTHRD 4.5MM 90MM 36MM COMPRESSION HEADLESS,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.226.795,SUP,HCPCS C1713,,04.226.795  -  SCREW BONE LNGTHRD 4.5MM 95MM 38MM HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.226.800,SUP,HCPCS C1713,,04.226.800  -  SCREW BONE LNGTHRD 4.5MM 100MM 40MM HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.227.030,SUP,HCPCS C1713,,04.227.030  -  SCREW BONE 6.5MM 30MM 16MM HEADLESS COMPRESSION THREADED,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.227.035,SUP,HCPCS C1713,,04.227.035  -  SCREW BONE 6.5MM 35MM 16MM COMPRESSION HEADLESS TITANIUM,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.227.040,SUP,HCPCS C1713,,04.227.040  -  SCREW BONE 6.5MM 40MM 16MM COMPRESSION HEADLESS TITANIUM,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.227.045,SUP,HCPCS C1713,,04.227.045  -  SCREW BONE 6.5MM 45MM 16MM HEADLESS COMPRESSION THREADED,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.227.050,SUP,HCPCS C1713,,04.227.050  -  SCREW BONE 6.5MM 50MM 16MM HEADLESS COMPRESSION THREADED,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.227.055,SUP,HCPCS C1713,,04.227.055  -  SCREW BONE 6.5MM 55MM 16MM HEADLESS COMPRESSION THREADED,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.227.060,SUP,HCPCS C1713,,04.227.060  -  SCREW BONE 6.5MM 60MM 16MM HEADLESS COMPRESSION THREADED SET,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.227.065,SUP,HCPCS C1713,,04.227.065  -  SCREW BONE 6.5MM 65MM 16MM HEADLESS COMPRESSION THREADED SET,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.227.070,SUP,HCPCS C1713,,04.227.070  -  SCREW BONE 6.5MM 70MM 16MM COMPRESSION THREAD TITANIUM FEMUR,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.227.075,SUP,HCPCS C1713,,04.227.075  -  SCREW BONE 6.5MM 75MM 16MM HEADLESS COMPRESSION THREADED SET,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.227.080,SUP,HCPCS C1713,,04.227.080  -  SCREW BONE 6.5MM 80MM 16MM HEADLESS COMPRESSION THREADED SET,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.227.085,SUP,HCPCS C1713,,04.227.085  -  SCREW BONE 6.5MM 85MM 16MM COMPRESSION HEADLESS THREADED,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.227.090,SUP,HCPCS C1713,,04.227.090  -  SCREW BONE 6.5MM 90MM 16MM HEADLESS COMPRESSION THREADED,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.227.095,SUP,HCPCS C1713,,04.227.095  -  SCREW BONE 6.5MM 95MM 16MM HEADLESS COMPRESSION THREADED,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.227.100,SUP,HCPCS C1713,,04.227.100  -  SCREW BONE 6.5MM 100MM 16MM THREADED HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.227.105,SUP,HCPCS C1713,,04.227.105  -  SCREW BONE 6.5MM 105MM 16MM THREADED HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.227.110,SUP,HCPCS C1713,,04.227.110  -  SCREW BONE 6.5MM 105MM 16MM THREADED HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.227.115,SUP,HCPCS C1713,,04.227.115  -  SCREW BONE 6.5MM 115MM 16MM THREADED HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.227.120,SUP,HCPCS C1713,,04.227.120  -  SCREW BONE 6.5MM 120MM 16MM THREADED HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.227.125,SUP,HCPCS C1713,,04.227.125  -  SCREW BONE 6.5MM 125MM 16MM HEADLESS COMPRESSION THREADED,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.227.130,SUP,HCPCS C1713,,04.227.130  -  SCREW BONE 6.5MM 130MM 16MM HEADLESS COMPRESSION THREADED,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.227.135,SUP,HCPCS C1713,,04.227.135  -  SCREW BONE 6.5MM 135MM 16MM HEADLESS COMPRESSION THREADED,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.227.140,SUP,HCPCS C1713,,04.227.140  -  SCREW BONE 6.5MM 140MM 16MM HEADLESS COMPRESSION THREADED,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.227.145,SUP,HCPCS C1713,,04.227.145  -  SCREW BONE 6.5MM 145MM 16MM THREADED HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.227.150,SUP,HCPCS C1713,,04.227.150  -  SCREW BONE 6.5MM 150MM 16MM THREADED HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.227.245,SUP,HCPCS C1713,,04.227.245  -  SCREW BONE 6.5MM 45MM 32MM THREADED HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.227.250,SUP,HCPCS C1713,,04.227.250  -  SCREW BONE 6.5MM 50MM 32MM THREADED HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.227.255,SUP,HCPCS C1713,,04.227.255  -  SCREW BONE 6.5MM 55MM 32MM THREADED HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.227.260,SUP,HCPCS C1713,,04.227.260  -  SCREW BONE 6.5MM 60MM 32MM COMPRESSION HEADLESS TITANIUM,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.227.265,SUP,HCPCS C1713,,04.227.265  -  SCREW BONE 6.5MM 65MM 32MM THREADED HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.227.270,SUP,HCPCS C1713,,04.227.270  -  SCREW BONE 6.5MM 70MM 32MM THREADED HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.227.275,SUP,HCPCS C1713,,04.227.275  -  SCREW BONE 6.5MM 75MM 32MM COMPRESSION THREAD TITANIUM FEMUR,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.227.280,SUP,HCPCS C1713,,04.227.280  -  SCREW BONE 6.5MM 80MM 32MM THREADED HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.227.285,SUP,HCPCS C1713,,04.227.285  -  SCREW BONE 6.5MM 85MM 32MM THREADED HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.227.290,SUP,HCPCS C1713,,04.227.290  -  SCREW BONE 6.5MM 90MM 32MM THREADED HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.227.295,SUP,HCPCS C1713,,04.227.295  -  SCREW BONE 6.5MM 95MM 32MM THREADED HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.227.300,SUP,HCPCS C1713,,04.227.300  -  SCREW BONE 6.5MM 100MM 32MM THREADED HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.227.305,SUP,HCPCS C1713,,04.227.305  -  SCREW BONE 6.5MM 105MM 32MM THREADED HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.227.310,SUP,HCPCS C1713,,04.227.310  -  SCREW BONE 6.5MM 110MM 32MM THREADED HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.227.315,SUP,HCPCS C1713,,04.227.315  -  SCREW BONE 6.5MM 115MM 32MM THREADED HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.227.320,SUP,HCPCS C1713,,04.227.320  -  SCREW BONE 6.5MM 120MM 32MM THREADED HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.227.325,SUP,HCPCS C1713,,04.227.325  -  SCREW BONE 6.5MM 125MM 32MM THREADED HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.227.330,SUP,HCPCS C1713,,04.227.330  -  SCREW BONE 6.5MM 130MM 32MM THREADED HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.227.335,SUP,HCPCS C1713,,04.227.335  -  SCREW BONE 6.5MM 135MM 32MM THREADED HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.227.340,SUP,HCPCS C1713,,04.227.340  -  SCREW BONE 6.5MM 140MM 32MM THREADED HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.227.345,SUP,HCPCS C1713,,04.227.345  -  SCREW BONE 6.5MM 145MM 32MM THREADED HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.227.350,SUP,HCPCS C1713,,04.227.350  -  SCREW BONE 6.5MM 150MM 32MM THREADED HEADLESS COMPRESSION,$630.53,$0.00,$630.53,$283.74,$450.01,$0.00,$105.47,$0.00,$0.00,$110.40,$630.53,$0.00,$315.26,$499.38,$504.42,$0.00,$95.80,$0.00,$100.38,$0.00
04.230.109,SUP,HCPCS C1713,,04.230.109  -  SCREW BONE 1.5MM 9MM 4MM HEADLESS COMPRESSION THREAD,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
04.230.110,SUP,HCPCS C1713,,04.230.110  -  SCREW BONE 1.5MM 10MM 4MM HEADLESS COMPRESSION THREAD,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
04.230.111,SUP,HCPCS C1713,,04.230.111  -  SCREW BONE 1.5MM 11MM 4MM HEADLESS COMPRESSION THREAD,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
04.230.112,SUP,HCPCS C1713,,04.230.112  -  SCREW BONE 1.5MM 12MM 4MM HEADLESS COMPRESSION THREAD,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
04.230.113,SUP,HCPCS C1713,,04.230.113  -  SCREW BONE 1.5MM 13MM 4MM HEADLESS COMPRESSION THREAD,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
04.230.114,SUP,HCPCS C1713,,04.230.114  -  SCREW BONE 1.5MM 14MM 4MM HEADLESS COMPRESSION THREAD,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
04.230.115,SUP,HCPCS C1713,,04.230.115  -  SCREW BONE 1.5MM 15MM 4MM HEADLESS COMPRESSION THREAD,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
04.230.116,SUP,HCPCS C1713,,04.230.116  -  SCREW BONE 1.5MM 16MM 5MM HEADLESS COMPRESSION THREAD,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
04.230.117,SUP,HCPCS C1713,,04.230.117  -  SCREW BONE 1.5MM 17MM 5MM HEADLESS COMPRESSION THREAD,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
04.230.118,SUP,HCPCS C1713,,04.230.118  -  SCREW BONE 1.5MM 18MM 5MM HEADLESS COMPRESSION THREAD,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
04.230.119,SUP,HCPCS C1713,,04.230.119  -  SCREW BONE 1.5MM 19MM 5MM HEADLESS COMPRESSION THREAD,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
04.230.120,SUP,HCPCS C1713,,04.230.120  -  SCREW BONE 1.5MM 20MM 6MM HEADLESS COMPRESSION THREAD,$472.20,$0.00,$472.20,$212.49,$337.01,$0.00,$78.99,$0.00,$0.00,$82.68,$472.20,$0.00,$236.10,$373.98,$377.76,$0.00,$71.75,$0.00,$75.17,$0.00
04.305.003,SUP,HCPCS C1713,,04.305.003  -  SCREW BONE 2.5/4MM 50MM BLUNT TIP SCHANZ TITANIUM MANDIB,$900.00,$0.00,$900.00,$405.00,$642.33,$0.00,$155.07,$0.00,$0.00,$157.58,$900.00,$0.00,$450.00,$712.80,$720.00,$0.00,$140.85,$0.00,$143.28,$0.00
04.305.004,SUP,HCPCS C1713,,04.305.004  -  SCREW BONE 2.5/4MM 60MM BLUNT TIP SCHANZ TITANIUM MANDIB,$900.00,$0.00,$900.00,$405.00,$642.33,$0.00,$155.07,$0.00,$0.00,$157.58,$900.00,$0.00,$450.00,$712.80,$720.00,$0.00,$140.85,$0.00,$143.28,$0.00
04.305.005,SUP,HCPCS C1713,,04.305.005  -  SCREW BONE 2.5/4MM 70MM BLUNT TIP SCHANZ TITANIUM MANDIB,$900.00,$0.00,$900.00,$405.00,$642.33,$0.00,$155.07,$0.00,$0.00,$157.58,$900.00,$0.00,$450.00,$712.80,$720.00,$0.00,$140.85,$0.00,$143.28,$0.00
04.305.010,SUP,HCPCS C1713,,04.305.010  -  SCREW BONE 2.5/4MM 50MM SLFDRILL SCHANZ TITANIUM MANDIB,"$1,055.00",$0.00,"$1,055.00",$474.75,$752.95,$0.00,$181.77,$0.00,$0.00,$184.72,"$1,055.00",$0.00,$527.50,$835.56,$844.00,$0.00,$165.11,$0.00,$167.96,$0.00
04.305.011,SUP,HCPCS C1713,,04.305.011  -  SCREW BONE 2.5/4MM 60MM SLFDRILL SCHANZ TITANIUM MANDIB,"$1,055.00",$0.00,"$1,055.00",$474.75,$752.95,$0.00,$181.77,$0.00,$0.00,$184.72,"$1,055.00",$0.00,$527.50,$835.56,$844.00,$0.00,$165.11,$0.00,$167.96,$0.00
04.305.012,SUP,HCPCS C1713,,04.305.012  -  SCREW BONE 2.5/4MM 70MM SLFDRILL SCHANZ TITANIUM MANDIB,"$1,055.00",$0.00,"$1,055.00",$474.75,$752.95,$0.00,$181.77,$0.00,$0.00,$184.72,"$1,055.00",$0.00,$527.50,$835.56,$844.00,$0.00,$165.11,$0.00,$167.96,$0.00
04.305.100,SUP,Custom 27203010,,04.305.100  -  ROD EXFIX 4MM FULL PREBENT RAMUS TITANIUM MANDIB NONSTRL,"$2,167.50",$0.00,"$2,167.50",$0.00,"$1,546.94",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,167.50",$0.00,"$1,083.75","$1,716.66","$1,734.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.305.101,SUP,Custom 27203010,,04.305.101  -  ROD EXFIX 4MM FULL PREBENT TITANIUM MANDIB NONSTRL MANDIB,"$1,852.50",$0.00,"$1,852.50",$0.00,"$1,322.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,852.50",$0.00,$926.25,"$1,467.18","$1,482.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.305.102,SUP,Custom 27203010,,04.305.102  -  ROD EXFIX 4MM .75 PREBENT TITANIUM MANDIB NONSTRL MANDIB,"$1,702.50",$0.00,"$1,702.50",$0.00,"$1,215.07",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,702.50",$0.00,$851.25,"$1,348.38","$1,362.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.305.103,SUP,HCPCS C1713,,04.305.103  -  ROD FIX 4MM .5 PREBENT TITANIUM MANDIB NONSTRL EXFIX SYSTEM,"$1,552.50",$0.00,"$1,552.50",$698.63,"$1,108.02",$0.00,$267.49,$0.00,$0.00,$271.83,"$1,552.50",$0.00,$776.25,"$1,229.58","$1,242.00",$0.00,$242.97,$0.00,$247.16,$0.00
04.305.128,SUP,HCPCS C1713,,04.305.128  -  SCREW BONE 2.5MM 4MM 8MM SELF DRILL SCHANZ TITANIUM MANDIB,"$1,100.00",$0.00,"$1,100.00",$495.00,$785.07,$0.00,$189.52,$0.00,$0.00,$192.60,"$1,100.00",$0.00,$550.00,$871.20,$880.00,$0.00,$172.15,$0.00,$175.12,$0.00
04.305.130,SUP,HCPCS C1713,,04.305.130  -  SCREW XTRNFX 2.5MM 4MM 10MM SCHNZ SLF DRL TI MNDB RAMUS,"$1,100.00",$0.00,"$1,100.00",$495.00,$785.07,$0.00,$189.52,$0.00,$0.00,$192.60,"$1,100.00",$0.00,$550.00,$871.20,$880.00,$0.00,$172.15,$0.00,$175.12,$0.00
04.305.134,SUP,HCPCS C1713,,04.305.134  -  SCREW XTRNFX 2.5MM 4MM 14MM SCHNZ SLF DRL TI MNDB XTRNFXTR,"$1,100.00",$0.00,"$1,100.00",$495.00,$785.07,$0.00,$189.52,$0.00,$0.00,$192.60,"$1,100.00",$0.00,$550.00,$871.20,$880.00,$0.00,$172.15,$0.00,$175.12,$0.00
04.305.138,SUP,HCPCS C1713,,04.305.138  -  SCREW XTRNFX 2.5MM 4MM 18MM SCHNZ SLF DRL TI MNDB XTRNFXTR,"$1,100.00",$0.00,"$1,100.00",$495.00,$785.07,$0.00,$189.52,$0.00,$0.00,$192.60,"$1,100.00",$0.00,$550.00,$871.20,$880.00,$0.00,$172.15,$0.00,$175.12,$0.00
04.305.140,SUP,HCPCS C1713,,04.305.140  -  SCREW BONE 2.5/4MM 20MM SLFDRILL SCHANZ TITANIUM RAMUS,"$1,100.00",$0.00,"$1,100.00",$495.00,$785.07,$0.00,$189.52,$0.00,$0.00,$192.60,"$1,100.00",$0.00,$550.00,$871.20,$880.00,$0.00,$172.15,$0.00,$175.12,$0.00
04.305.142,SUP,HCPCS C1713,,04.305.142  -  SCREW BONE 2.5/4MM 22MM SLFDRILL SCHANZ TITANIUM MANDIB,"$1,100.00",$0.00,"$1,100.00",$495.00,$785.07,$0.00,$189.52,$0.00,$0.00,$192.60,"$1,100.00",$0.00,$550.00,$871.20,$880.00,$0.00,$172.15,$0.00,$175.12,$0.00
04.307.001,SUP,Custom 27803010,,04.307.001  -  FOOTPLATE BONE 40MM TITANIUM MAXL NONSTRL,"$1,277.50",$0.00,"$1,277.50",$0.00,$911.75,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,277.50",$0.00,$638.75,"$1,011.78","$1,022.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.307.008,SUP,HCPCS C1713,,04.307.008  -  ROD FIX 80MM TITANIUM MAXL NONSTRL,$767.50,$0.00,$767.50,$345.38,$547.76,$0.00,$132.24,$0.00,$0.00,$134.38,$767.50,$0.00,$383.75,$607.86,$614.00,$0.00,$120.11,$0.00,$122.19,$0.00
04.307.108,SUP,HCPCS C1713,,04.307.108  -  ROD FIX 80MM TALL OFFST TITANIUM MAXL NONSTRL,"$1,125.00",$0.00,"$1,125.00",$506.25,$802.91,$0.00,$193.83,$0.00,$0.00,$196.98,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$176.06,$0.00,$179.10,$0.00
04.307.111,SUP,HCPCS C1713,,04.307.111  -  ROD FIX 110MM TALL OFFST TITANIUM MAXL NONSTRL,"$1,125.00",$0.00,"$1,125.00",$506.25,$802.91,$0.00,$193.83,$0.00,$0.00,$196.98,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$176.06,$0.00,$179.10,$0.00
04.315.000,SUP,HCPCS C1713,,04.315.000  -  SCREW MACHINE 2.7MM TITANIUM CMF DISTRCT,$647.50,$0.00,$647.50,$291.38,$462.12,$0.00,$111.56,$0.00,$0.00,$113.37,$647.50,$0.00,$323.75,$512.82,$518.00,$0.00,$101.33,$0.00,$103.08,$0.00
04.315.001,SUP,Custom 27803010,,04.315.001  -  CAP END REMOVABLE CMF DISTRCT,"$1,070.00",$0.00,"$1,070.00",$0.00,$763.66,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,070.00",$0.00,$535.00,$847.44,$856.00,$0.00,$0.00,$0.00,$0.00,$0.00
04.315.003,SUP,Custom 27803010,,04.315.003  -  AB DISTRACTOR BODY END ACT 15MM FOR CMF DISTRACTOR,"$11,330.00",$0.00,"$11,330.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,330.00",$0.00,"$5,665.00","$8,973.36","$9,064.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.315.004,SUP,Custom 27803010,,04.315.004  -  AB DISTRACTOR BODY END ACT. 20MM FOR CMF DISTRACTOR,"$11,330.00",$0.00,"$11,330.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,330.00",$0.00,"$5,665.00","$8,973.36","$9,064.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.315.005,SUP,Custom 27803010,,04.315.005  -  AB DISTRACTOR BODY END ACT. 25MM FOR CMF DISTRACTOR,"$11,330.00",$0.00,"$11,330.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,330.00",$0.00,"$5,665.00","$8,973.36","$9,064.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.315.006,SUP,Custom 27803010,,04.315.006  -  AB DISTRACTOR BODY END ACT. 30MM FOR CMF DISTRACTOR,"$11,330.00",$0.00,"$11,330.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,330.00",$0.00,"$5,665.00","$8,973.36","$9,064.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.315.023,SUP,Custom 27803010,,04.315.023  -  BC DISTRACTOR BODY END ACT. 15MM FOR CMF DISTRACTOR,"$11,330.00",$0.00,"$11,330.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,330.00",$0.00,"$5,665.00","$8,973.36","$9,064.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.315.024,SUP,Custom 27803010,,04.315.024  -  BC DISTRACTOR BODY END ACT. 20MM FOR CMF DISTRACTOR,"$11,330.00",$0.00,"$11,330.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,330.00",$0.00,"$5,665.00","$8,973.36","$9,064.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.315.025,SUP,Custom 27803010,,04.315.025  -  DISTRCT 25MM BODY SURG,"$11,330.00",$0.00,"$11,330.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,330.00",$0.00,"$5,665.00","$8,973.36","$9,064.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.315.026,SUP,Custom 27803010,,04.315.026  -  BC DISTRACTOR BODY END ACT. 30MM FOR CMF DISTRACTOR,"$11,330.00",$0.00,"$11,330.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,330.00",$0.00,"$5,665.00","$8,973.36","$9,064.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.315.027,SUP,Custom 27803010,,04.315.027  -  BC DISTRACTOR BODY END ACT 35MM FOR CMF DISTRACTOR,"$11,330.00",$0.00,"$11,330.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,330.00",$0.00,"$5,665.00","$8,973.36","$9,064.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.315.028,SUP,Custom 27803010,,04.315.028  -  BC DISTRACTOR BODY END ACT 40MM FOR CMF DISTRACTOR,"$11,330.00",$0.00,"$11,330.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,330.00",$0.00,"$5,665.00","$8,973.36","$9,064.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.315.053,SUP,Custom 27803010,,04.315.053  -  AB DISTRACTOR BODY END ACT. W/U-JOINT 15MM FOR CMF DSTR,"$11,952.50",$0.00,"$11,952.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,952.50",$0.00,"$5,976.25","$9,466.38","$9,562.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.315.054,SUP,Custom 27803010,,04.315.054  -  DISTRCT 20MM CRNMXF U JNT BD END ACT SURG TI NONSTRL,"$11,952.50",$0.00,"$11,952.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,952.50",$0.00,"$5,976.25","$9,466.38","$9,562.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.315.055,SUP,Custom 27803010,,04.315.055  -  AB DISTRACTOR BODY END ACT. W/U-JOINT 25MM FOR CMF DSTR,"$11,952.50",$0.00,"$11,952.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,952.50",$0.00,"$5,976.25","$9,466.38","$9,562.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.315.056,SUP,Custom 27803010,,04.315.056  -  AB DISTRACTOR BODY END ACT. W/U-JOINT 30MM FOR CMF DSTR,"$11,952.50",$0.00,"$11,952.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,952.50",$0.00,"$5,976.25","$9,466.38","$9,562.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.315.063,SUP,Custom 27803010,,04.315.063  -  DISTRCT 15MM CRNMXF BD END ACT U JNT SURG TI BC NONSTRL,"$11,952.50",$0.00,"$11,952.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,952.50",$0.00,"$5,976.25","$9,466.38","$9,562.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.315.064,SUP,Custom 27803010,,04.315.064  -  DISTRCT 20MM BD END ACT U JNT SURG TI BC CMF NONSTRL,"$11,952.50",$0.00,"$11,952.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,952.50",$0.00,"$5,976.25","$9,466.38","$9,562.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.315.065,SUP,Custom 27803010,,04.315.065  -  DISTRCT U JNT BODY 25MM SURG,"$11,952.50",$0.00,"$11,952.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,952.50",$0.00,"$5,976.25","$9,466.38","$9,562.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.315.066,SUP,Custom 27803010,,04.315.066  -  DISTRCT 30MM SURG NONSTRL,"$11,952.50",$0.00,"$11,952.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,952.50",$0.00,"$5,976.25","$9,466.38","$9,562.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.315.067,SUP,Custom 27803010,,04.315.067  -  BC DISTRACTOR BODY END ACT W/U-JOINT 35MM FOR CMF DSTR,"$11,952.50",$0.00,"$11,952.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,952.50",$0.00,"$5,976.25","$9,466.38","$9,562.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.315.068,SUP,Custom 27803010,,04.315.068  -  BC DISTRACTOR BODY END ACT W/U-JOINT 40MM FOR CMF DSTR,"$11,952.50",$0.00,"$11,952.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,952.50",$0.00,"$5,976.25","$9,466.38","$9,562.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.315.104,SUP,Custom 27203010,,04.315.104  -  ARM DISTRCT 20MM EXTN RIGID,"$2,282.50",$0.00,"$2,282.50",$0.00,"$1,629.02",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,282.50",$0.00,"$1,141.25","$1,807.74","$1,826.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.315.108,SUP,Custom 27203010,,04.315.108  -  SET EXTN 40MM REMOVABLE RIGID ARM NONSTRL,"$2,282.50",$0.00,"$2,282.50",$0.00,"$1,629.02",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,282.50",$0.00,"$1,141.25","$1,807.74","$1,826.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.315.112,SUP,Custom 27803010,,04.315.112  -  ARM EXTN 60MM RIGID REMOVAL TITANIUM COCR SILICONE NONSTRL,"$2,282.50",$0.00,"$2,282.50",$0.00,"$1,629.02",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,282.50",$0.00,"$1,141.25","$1,807.74","$1,826.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.315.125,SUP,Custom 27203010,,04.315.125  -  SET EXTN 30MM FLEXIBLE REMOVABLE ARM,"$2,700.00",$0.00,"$2,700.00",$0.00,"$1,926.99",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,700.00",$0.00,"$1,350.00","$2,138.40","$2,160.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.315.127,SUP,Custom 27203010,,04.315.127  -  SET EXTN 40MM FLEXIBLE REMOVABLE ARM,"$2,700.00",$0.00,"$2,700.00",$0.00,"$1,926.99",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,700.00",$0.00,"$1,350.00","$2,138.40","$2,160.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.315.132,SUP,Custom 27203010,,04.315.132  -  ARM DISTRCT 60MM EXTN FLEXIBLE REMOVABLE TITANIUM NONSTRL,"$2,700.00",$0.00,"$2,700.00",$0.00,"$1,926.99",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,700.00",$0.00,"$1,350.00","$2,138.40","$2,160.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.315.201,SUP,Custom 27803010,,04.315.201  -  COMPONENT DISTRCT 1MM A TYPE MESH FEET TITANIUM MANDIB,"$2,130.00",$0.00,"$2,130.00",$0.00,"$1,520.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,130.00",$0.00,"$1,065.00","$1,686.96","$1,704.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.315.202,SUP,Custom 27803010,,04.315.202  -  COMPONENT DISTRCT 1MM MESH FT B TYPE INTERNAL MANDIB,"$2,130.00",$0.00,"$2,130.00",$0.00,"$1,520.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,130.00",$0.00,"$1,065.00","$1,686.96","$1,704.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.315.203,SUP,Custom 27803010,,04.315.203  -  COMPONENT DISTRCT 1MM MESH FT C TYPE INTERNAL MANDIB,"$2,130.00",$0.00,"$2,130.00",$0.00,"$1,520.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,130.00",$0.00,"$1,065.00","$1,686.96","$1,704.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.315.211,SUP,Custom 27803010,,04.315.211  -  FOOTPLATE BONE TYPE B CLOVERLEAF GREEN TITANIUM MANDIB,"$2,130.00",$0.00,"$2,130.00",$0.00,"$1,520.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,130.00",$0.00,"$1,065.00","$1,686.96","$1,704.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.315.212,SUP,Custom 27803010,,04.315.212  -  FOOTPLATE BONE CLOVERLEAF B TYPE INTERNAL MANDIB 1 MM SCREW,"$2,130.00",$0.00,"$2,130.00",$0.00,"$1,520.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,130.00",$0.00,"$1,065.00","$1,686.96","$1,704.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.315.213,SUP,Custom 27803010,,04.315.213  -  FOOTPLATE BONE MESH C TYPE INTERNAL MANDIB 1 MM SCREW,"$2,130.00",$0.00,"$2,130.00",$0.00,"$1,520.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,130.00",$0.00,"$1,065.00","$1,686.96","$1,704.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.315.301,SUP,Custom 27803010,,04.315.301  -  FOOTPLATE BONE TYPE A MESH PINK TITANIUM MANDIB NONSTRL 1.5,"$2,130.00",$0.00,"$2,130.00",$0.00,"$1,520.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,130.00",$0.00,"$1,065.00","$1,686.96","$1,704.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.315.302,SUP,HCPCS C1713,,04.315.302  -  FOOTPLATE BONE B TYPE MESH TITANIUM MANDIB NONSTRL CMF,"$2,130.00",$0.00,"$2,130.00",$958.50,"$1,520.18",$0.00,$366.99,$0.00,$0.00,$372.95,"$2,130.00",$0.00,"$1,065.00","$1,686.96","$1,704.00",$0.00,$333.35,$0.00,$339.10,$0.00
04.315.303,SUP,HCPCS C1713,,04.315.303  -  FOOTPLATE BONE C TYPE MESH TITANIUM MANDIB NONSTRL CMF,"$2,130.00",$0.00,"$2,130.00",$958.50,"$1,520.18",$0.00,$366.99,$0.00,$0.00,$372.95,"$2,130.00",$0.00,"$1,065.00","$1,686.96","$1,704.00",$0.00,$333.35,$0.00,$339.10,$0.00
04.315.311,SUP,Custom 27803010,,04.315.311  -  FOOTPLATE BONE TYPE A CLOVERLEAF PINK TITANIUM MANDIB,"$2,130.00",$0.00,"$2,130.00",$0.00,"$1,520.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,130.00",$0.00,"$1,065.00","$1,686.96","$1,704.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.315.312,SUP,Custom 27803010,,04.315.312  -  FOOTPLATE BONE TYPE B CLOVERLEAF PINK TITANIUM MANDIB,"$2,130.00",$0.00,"$2,130.00",$0.00,"$1,520.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,130.00",$0.00,"$1,065.00","$1,686.96","$1,704.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.315.313,SUP,Custom 27803010,,04.315.313  -  FOOTPLATE BONE TYPE C CLOVERLEAF PINK TITANIUM MANDIB,"$2,130.00",$0.00,"$2,130.00",$0.00,"$1,520.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,130.00",$0.00,"$1,065.00","$1,686.96","$1,704.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.315.321,SUP,Custom 27803010,,04.315.321  -  FOOTPLATE BONE 5.5MM TYPE B ELEVATED MESH OFFST PINK,"$2,130.00",$0.00,"$2,130.00",$0.00,"$1,520.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,130.00",$0.00,"$1,065.00","$1,686.96","$1,704.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.315.322,SUP,Custom 27803010,,04.315.322  -  FOOTPLATE BONE 7.5MM TYPE B ELEVATED MESH OFFST PINK,"$2,130.00",$0.00,"$2,130.00",$0.00,"$1,520.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,130.00",$0.00,"$1,065.00","$1,686.96","$1,704.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.315.323,SUP,Custom 27803010,,04.315.323  -  FOOTPLATE BONE TYPE C ELEVATED MESH OFFST PINK TITANIUM,"$2,130.00",$0.00,"$2,130.00",$0.00,"$1,520.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,130.00",$0.00,"$1,065.00","$1,686.96","$1,704.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.315.401,SUP,Custom 27803010,,04.315.401  -  FOOTPLATE BONE TYPE A MESH BLUE TITANIUM MANDIB NONSTRL 2MM,"$2,130.00",$0.00,"$2,130.00",$0.00,"$1,520.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,130.00",$0.00,"$1,065.00","$1,686.96","$1,704.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.315.402,SUP,Custom 27803010,,04.315.402  -  FOOTPLATE BONE TYPE B MESH BLUE TITANIUM MANDIB NONSTRL 2MM,"$2,130.00",$0.00,"$2,130.00",$0.00,"$1,520.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,130.00",$0.00,"$1,065.00","$1,686.96","$1,704.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.315.403,SUP,Custom 27803010,,04.315.403  -  FOOTPLATE BONE TYPE C MESH BLUE TITANIUM MANDIB NONSTRL 2MM,"$2,130.00",$0.00,"$2,130.00",$0.00,"$1,520.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,130.00",$0.00,"$1,065.00","$1,686.96","$1,704.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.315.411,SUP,Custom 27803010,,04.315.411  -  FOOTPLATE BONE TYPE A CLOVERLEAF BLUE TITANIUM MANDIB,"$2,130.00",$0.00,"$2,130.00",$0.00,"$1,520.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,130.00",$0.00,"$1,065.00","$1,686.96","$1,704.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.315.412,SUP,Custom 27803010,,04.315.412  -  FOOTPLATE BONE TYPE B CLOVERLEAF BLUE TITANIUM MANDIB,"$2,130.00",$0.00,"$2,130.00",$0.00,"$1,520.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,130.00",$0.00,"$1,065.00","$1,686.96","$1,704.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.315.413,SUP,Custom 27803010,,04.315.413  -  FOOTPLATE BONE TYPE C CLOVERLEAF BLUE TITANIUM MANDIB,"$2,130.00",$0.00,"$2,130.00",$0.00,"$1,520.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,130.00",$0.00,"$1,065.00","$1,686.96","$1,704.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.315.421,SUP,Custom 27803010,,04.315.421  -  FOOTPLATE BONE 5.5MM TYPE B MESH OFFST BLUE TITANIUM MANDIB,"$2,130.00",$0.00,"$2,130.00",$0.00,"$1,520.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,130.00",$0.00,"$1,065.00","$1,686.96","$1,704.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.315.422,SUP,Custom 27803010,,04.315.422  -  FOOTPLATE BONE 7.5MM TYPE C MESH OFFST BLUE TITANIUM MANDIB,"$2,130.00",$0.00,"$2,130.00",$0.00,"$1,520.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,130.00",$0.00,"$1,065.00","$1,686.96","$1,704.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.315.423,SUP,Custom 27803010,,04.315.423  -  FOOTPLATE BONE TYPE C MESH OFFST BLUE TITANIUM MANDIB,"$2,130.00",$0.00,"$2,130.00",$0.00,"$1,520.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,130.00",$0.00,"$1,065.00","$1,686.96","$1,704.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.315.501,SUP,Custom 27803010,,04.315.501  -  FOOTPLATE BONE TYPE A MESH YELLOW TITANIUM MANDIB NONSTRL,"$2,130.00",$0.00,"$2,130.00",$0.00,"$1,520.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,130.00",$0.00,"$1,065.00","$1,686.96","$1,704.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.315.502,SUP,Custom 27803010,,04.315.502  -  COMPONENT DISTRCT 1.3MM MESH FEET INTERNAL B TYPE MANDIB,"$2,130.00",$0.00,"$2,130.00",$0.00,"$1,520.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,130.00",$0.00,"$1,065.00","$1,686.96","$1,704.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.315.503,SUP,Custom 27803010,,04.315.503  -  COMPONENT DISTRCT 1.3MM MESH FEET C TYPE INTERNAL MANDIB,"$2,130.00",$0.00,"$2,130.00",$0.00,"$1,520.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,130.00",$0.00,"$1,065.00","$1,686.96","$1,704.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.315.511,SUP,Custom 27803010,,04.315.511  -  FOOTPLATE BONE TYPE A CLOVERLEAF YELLOW TITANIUM MANDIB,"$2,130.00",$0.00,"$2,130.00",$0.00,"$1,520.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,130.00",$0.00,"$1,065.00","$1,686.96","$1,704.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.315.512,SUP,HCPCS C1713,,04.315.512  -  PLATE BONE B MANDIB NONSTRL 1.3 MM SCREWS,"$2,130.00",$0.00,"$2,130.00",$958.50,"$1,520.18",$0.00,$366.99,$0.00,$0.00,$372.95,"$2,130.00",$0.00,"$1,065.00","$1,686.96","$1,704.00",$0.00,$333.35,$0.00,$339.10,$0.00
04.315.513,SUP,HCPCS C1713,,04.315.513  -  PLATE BONE C MANDIB NONSTRL 1.3 MM SCREWS,"$2,130.00",$0.00,"$2,130.00",$958.50,"$1,520.18",$0.00,$366.99,$0.00,$0.00,$372.95,"$2,130.00",$0.00,"$1,065.00","$1,686.96","$1,704.00",$0.00,$333.35,$0.00,$339.10,$0.00
04.402.007S,SUP,HCPCS C1713,,04.402.007S  -  STEM RADIAL STR 7MM 26MM TITANIUM STERILE,"$3,286.33",$0.00,"$3,286.33","$1,478.85","$2,345.45",$0.00,$549.72,$0.00,$0.00,$575.41,"$3,286.33",$0.00,"$1,643.16","$2,602.77","$2,629.06",$0.00,$499.33,$0.00,$523.18,$0.00
04.449.000,SUP,HCPCS C1713,,04.449.000  -  HEAD SCR CNDYLR TI NONSTRL,"$6,745.50",$0.00,"$6,745.50","$3,035.48","$4,814.26",$0.00,"$1,162.22",$0.00,$0.00,"$1,181.08","$6,745.50",$0.00,"$3,372.75","$5,342.44","$5,396.40",$0.00,"$1,055.67",$0.00,"$1,073.88",$0.00
04.449.010,SUP,HCPCS C1713,,04.449.010  -  PLATE BONE 0MM CRNMXF TI LCK CNDYLR HEAD RECON NONSTRL,$771.75,$0.00,$771.75,$347.29,$550.80,$0.00,$132.97,$0.00,$0.00,$135.13,$771.75,$0.00,$385.88,$611.23,$617.40,$0.00,$120.78,$0.00,$122.86,$0.00
04.449.020,SUP,HCPCS C1713,,04.449.020  -  PLATE 2MM CRNMXF LCK CNDYLR HEAD RECON BONE TI NONSTRL,$771.75,$0.00,$771.75,$347.29,$550.80,$0.00,$132.97,$0.00,$0.00,$135.13,$771.75,$0.00,$385.88,$611.23,$617.40,$0.00,$120.78,$0.00,$122.86,$0.00
04.449.030,SUP,HCPCS C1713,,04.449.030  -  PLATE 4MM CRNMXF LCK CNDYLR HEAD RECON BONE TI NONSTRL,$771.75,$0.00,$771.75,$347.29,$550.80,$0.00,$132.97,$0.00,$0.00,$135.13,$771.75,$0.00,$385.88,$611.23,$617.40,$0.00,$120.78,$0.00,$122.86,$0.00
04.449.040,SUP,HCPCS C1713,,04.449.040  -  PLATE 6MM CRNMXF LCK CNDYLR HEAD RECON BONE TI NONSTRL,$771.75,$0.00,$771.75,$347.29,$550.80,$0.00,$132.97,$0.00,$0.00,$135.13,$771.75,$0.00,$385.88,$611.23,$617.40,$0.00,$120.78,$0.00,$122.86,$0.00
04.497.000,SUP,HCPCS C1713,,04.497.000  -  SCREW TI CNDYLR HEAD BONE NONSTRL,$328.50,$0.00,$328.50,$147.83,$234.45,$0.00,$56.60,$0.00,$0.00,$57.52,$328.50,$0.00,$164.25,$260.17,$262.80,$0.00,$51.41,$0.00,$52.30,$0.00
04.497.001,SUP,HCPCS C1713,,04.497.001  -  SCREW TI CNDYLR SLT HEAD BONE MTRXMAND,$384.75,$0.00,$384.75,$173.14,$274.60,$0.00,$66.29,$0.00,$0.00,$67.37,$384.75,$0.00,$192.38,$304.72,$307.80,$0.00,$60.21,$0.00,$61.25,$0.00
04.500.000,SUP,HCPCS C1713,,04.500.000  -  ROD FIX 110MM TITANIUM MAXL NONSTRL,$767.50,$0.00,$767.50,$345.38,$547.76,$0.00,$132.24,$0.00,$0.00,$134.38,$767.50,$0.00,$383.75,$607.86,$614.00,$0.00,$120.11,$0.00,$122.19,$0.00
04.500.001,SUP,HCPCS C1713,,04.500.001  -  SCREW SURG DISTRCT EXTERNAL TITANIUM MAXILLOMANDIBULAR,$290.00,$0.00,$290.00,$130.50,$206.97,$0.00,$49.97,$0.00,$0.00,$50.78,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$45.39,$0.00,$46.17,$0.00
04.500.002,SUP,HCPCS C1713,,04.500.002  -  SCREW BONE 27MM SLFDRILL WIRE FIX TITANIUM MANDIB NONSTRL,$347.50,$0.00,$347.50,$156.38,$248.01,$0.00,$59.87,$0.00,$0.00,$60.84,$347.50,$0.00,$173.75,$275.22,$278.00,$0.00,$54.38,$0.00,$55.32,$0.00
04.500.006,SUP,HCPCS C1713,,04.500.006  -  ANCHOR SCR 6MM OTHDNTC BONE TI ANCHORAGE SLFDRILL,$274.50,$0.00,$274.50,$123.53,$195.91,$0.00,$47.29,$0.00,$0.00,$48.06,$274.50,$0.00,$137.25,$217.40,$219.60,$0.00,$42.96,$0.00,$43.70,$0.00
04.500.008,SUP,HCPCS C1713,,04.500.008  -  ANCHOR SCR 8MM OTHDNTC BONE TI SLFDRILL NONSTRL,$274.50,$0.00,$274.50,$123.53,$195.91,$0.00,$47.29,$0.00,$0.00,$48.06,$274.50,$0.00,$137.25,$217.40,$219.60,$0.00,$42.96,$0.00,$43.70,$0.00
04.500.010,SUP,HCPCS C1713,,04.500.010  -  SCREW ANCH 10MM TI ANCH SLFTAP OBA,$274.50,$0.00,$274.50,$123.53,$195.91,$0.00,$47.29,$0.00,$0.00,$48.06,$274.50,$0.00,$137.25,$217.40,$219.60,$0.00,$42.96,$0.00,$43.70,$0.00
04.500.012,SUP,HCPCS C1713,,04.500.012  -  TI OBA PLATE ANCHOR BRACKET DESIGN 4 HOLES,$483.75,$0.00,$483.75,$217.69,$345.25,$0.00,$83.35,$0.00,$0.00,$84.70,$483.75,$0.00,$241.88,$383.13,$387.00,$0.00,$75.71,$0.00,$77.01,$0.00
04.500.013,SUP,HCPCS C1713,,04.500.013  -  PLATE ANCH TI 4 HOLE DOMED DSGN,$483.75,$0.00,$483.75,$217.69,$345.25,$0.00,$83.35,$0.00,$0.00,$84.70,$483.75,$0.00,$241.88,$383.13,$387.00,$0.00,$75.71,$0.00,$77.01,$0.00
04.500.014,SUP,HCPCS C1713,,04.500.014  -  PLATE OTHDNTC 4 HOLE ANCH MESH PAD DSGN BONE TI NONSTRL,$483.75,$0.00,$483.75,$217.69,$345.25,$0.00,$83.35,$0.00,$0.00,$84.70,$483.75,$0.00,$241.88,$383.13,$387.00,$0.00,$75.71,$0.00,$77.01,$0.00
04.500.015,SUP,HCPCS C1713,,04.500.015  -  TI OBA PLATE ANCHOR BRACKET DESIGN 5 HOLES,$483.75,$0.00,$483.75,$217.69,$345.25,$0.00,$83.35,$0.00,$0.00,$84.70,$483.75,$0.00,$241.88,$383.13,$387.00,$0.00,$75.71,$0.00,$77.01,$0.00
04.500.016,SUP,HCPCS C1713,,04.500.016  -  PLATE ANCH TI 5 HOLE DOMED DSGN,$483.75,$0.00,$483.75,$217.69,$345.25,$0.00,$83.35,$0.00,$0.00,$84.70,$483.75,$0.00,$241.88,$383.13,$387.00,$0.00,$75.71,$0.00,$77.01,$0.00
04.500.017,SUP,HCPCS C1713,,04.500.017  -  PLATE OTHDNTC 5 HOLE ANCH MESH PAD DSGN BONE TI NONSTRL,$483.75,$0.00,$483.75,$217.69,$345.25,$0.00,$83.35,$0.00,$0.00,$84.70,$483.75,$0.00,$241.88,$383.13,$387.00,$0.00,$75.71,$0.00,$77.01,$0.00
04.500.018,SUP,Custom 27803010,,04.500.018  -  BODY DISTRCT 100MM RAD STR CURVILINEAR TITANIUM MANDIB,"$16,962.50",$0.00,"$16,962.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$16,962.50",$0.00,"$8,481.25","$13,434.30","$13,570.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.500.024.01,SUP,HCPCS C1713,,04.500.024.01  -  TI OBA PLATE ANCHOR SCREW SELF-DRILLING 4MM,$218.25,$0.00,$218.25,$98.21,$155.77,$0.00,$37.60,$0.00,$0.00,$38.21,$218.25,$0.00,$109.13,$172.85,$174.60,$0.00,$34.16,$0.00,$34.75,$0.00
04.500.026.01,SUP,HCPCS C1713,,04.500.026.01  -  TI OBA PLATE ANCHOR SCREW SELF-DRILLING 6MM,$218.25,$0.00,$218.25,$98.21,$155.77,$0.00,$37.60,$0.00,$0.00,$38.21,$218.25,$0.00,$109.13,$172.85,$174.60,$0.00,$34.16,$0.00,$34.75,$0.00
04.500.028.01,SUP,HCPCS C1713,,04.500.028.01  -  TI OBA PLATE ANCHOR SCREW SELF-DRILLING 8MM,$218.25,$0.00,$218.25,$98.21,$155.77,$0.00,$37.60,$0.00,$0.00,$38.21,$218.25,$0.00,$109.13,$172.85,$174.60,$0.00,$34.16,$0.00,$34.75,$0.00
04.500.034.01,SUP,HCPCS C1713,,04.500.034.01  -  SCREW TI 4MM MAXFACL OTHDNTC ER BONE NONSTRL,$214.88,$0.00,$214.88,$96.69,$153.36,$0.00,$37.02,$0.00,$0.00,$37.62,$214.88,$0.00,$107.44,$170.18,$171.90,$0.00,$33.63,$0.00,$34.21,$0.00
04.500.036.01,SUP,HCPCS C1713,,04.500.036.01  -  TI OBA EMERGENCY SCREW 6MM,$214.88,$0.00,$214.88,$96.69,$153.36,$0.00,$37.02,$0.00,$0.00,$37.62,$214.88,$0.00,$107.44,$170.18,$171.90,$0.00,$33.63,$0.00,$34.21,$0.00
04.500.038.01,SUP,HCPCS C1713,,04.500.038.01  -  SCREW TI 8MM MAXFACL ER BONE,$214.88,$0.00,$214.88,$96.69,$153.36,$0.00,$37.02,$0.00,$0.00,$37.62,$214.88,$0.00,$107.44,$170.18,$171.90,$0.00,$33.63,$0.00,$34.21,$0.00
04.500.100,SUP,Custom 27803010,,04.500.100  -  BODY DSTRCT 100MM RDS STRG NS CURVILINEAR TI MNDB RT 2MM LCK,"$16,962.50",$0.00,"$16,962.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$16,962.50",$0.00,"$8,481.25","$13,434.30","$13,570.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.500.101,SUP,Custom 27803010,,04.500.101  -  BODY DSTRCT 100MM RDS STRG NS CURVILINEAR TI MNDB LT 2MM LCK,"$16,962.50",$0.00,"$16,962.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$16,962.50",$0.00,"$8,481.25","$13,434.30","$13,570.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.500.130,SUP,Custom 27803010,,04.500.130  -  BODY DSTRCT 30MM RDS STRG NS CURVILINEAR TI MNDB RT 2MM LCK,"$16,962.50",$0.00,"$16,962.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$16,962.50",$0.00,"$8,481.25","$13,434.30","$13,570.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.500.131,SUP,Custom 27803010,,04.500.131  -  BODY DSTRCT 30MM RDS STRG NS CURVILINEAR TI MNDB LT 2MM LCK,"$16,962.50",$0.00,"$16,962.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$16,962.50",$0.00,"$8,481.25","$13,434.30","$13,570.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.500.140,SUP,Custom 27803010,,04.500.140  -  BODY DSTRCT 40MM RDS STRG NS CURVILINEAR TI MNDB RT 2MM LCK,"$16,962.50",$0.00,"$16,962.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$16,962.50",$0.00,"$8,481.25","$13,434.30","$13,570.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.500.141,SUP,Custom 27803010,,04.500.141  -  BODY DSTRCT 40MM RDS STRG NS CURVILINEAR TI MNDB LT 2MM LCK,"$16,962.50",$0.00,"$16,962.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$16,962.50",$0.00,"$8,481.25","$13,434.30","$13,570.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.500.150,SUP,Custom 27803010,,04.500.150  -  BODY DSTRCT 50MM RDS STRG NS CURVILINEAR TI MNDB RT 2MM LCK,"$16,962.50",$0.00,"$16,962.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$16,962.50",$0.00,"$8,481.25","$13,434.30","$13,570.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.500.151,SUP,Custom 27803010,,04.500.151  -  BODY DSTRCT 50MM RDS STRG NS CURVILINEAR TI MNDB LT 2MM LCK,"$16,962.50",$0.00,"$16,962.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$16,962.50",$0.00,"$8,481.25","$13,434.30","$13,570.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.500.170,SUP,Custom 27803010,,04.500.170  -  BODY DSTRCT 70MM RDS STRG NS CURVILINEAR TI MNDB RT 2MM LCK,"$16,962.50",$0.00,"$16,962.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$16,962.50",$0.00,"$8,481.25","$13,434.30","$13,570.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.500.171,SUP,Custom 27803010,,04.500.171  -  BODY DSTRCT 70MM RDS STRG NS CURVILINEAR TI MNDB LT 2MM LCK,"$16,962.50",$0.00,"$16,962.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$16,962.50",$0.00,"$8,481.25","$13,434.30","$13,570.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.501.001,SUP,HCPCS C1713,,04.501.001  -  PLATE BN 1.5MM NS MATRIXRIB 15 HL PRECONTOUR LCK LOPRFL TI 3,"$4,307.50",$0.00,"$4,307.50","$1,938.38","$3,074.26",$0.00,$742.16,$0.00,$0.00,$754.21,"$4,307.50",$0.00,"$2,153.75","$3,411.54","$3,446.00",$0.00,$674.12,$0.00,$685.75,$0.00
04.501.002,SUP,HCPCS C1713,,04.501.002  -  PLATE BN 1.5MM NS MATRIXRIB 15 HL PRECONTOUR LCK LOPRFL TI 3,"$4,307.50",$0.00,"$4,307.50","$1,938.38","$3,074.26",$0.00,$742.16,$0.00,$0.00,$754.21,"$4,307.50",$0.00,"$2,153.75","$3,411.54","$3,446.00",$0.00,$674.12,$0.00,$685.75,$0.00
04.501.003,SUP,HCPCS C1713,,04.501.003  -  PLATE BN 1.5MM NS MATRIXRIB 16 HL PRECONTOUR LCK LOPRFL TI 4,"$4,154.38",$0.00,"$4,154.38","$1,869.47","$2,964.98",$0.00,$715.78,$0.00,$0.00,$727.40,"$4,154.38",$0.00,"$2,077.19","$3,290.27","$3,323.50",$0.00,$650.16,$0.00,$661.38,$0.00
04.501.004,SUP,HCPCS C1713,,04.501.004  -  PLATE BN 1.5MM NS MATRIXRIB 16 HL PRECONTOUR LCK LOPRFL TI 4,"$4,154.38",$0.00,"$4,154.38","$1,869.47","$2,964.98",$0.00,$715.78,$0.00,$0.00,$727.40,"$4,154.38",$0.00,"$2,077.19","$3,290.27","$3,323.50",$0.00,$650.16,$0.00,$661.38,$0.00
04.501.005,SUP,HCPCS C1713,,04.501.005  -  PLATE BN 1.5MM NS MATRIXRIB 17 HL PRECONTOUR LCK LOPRFL TI 6,"$4,154.38",$0.00,"$4,154.38","$1,869.47","$2,964.98",$0.00,$715.78,$0.00,$0.00,$727.40,"$4,154.38",$0.00,"$2,077.19","$3,290.27","$3,323.50",$0.00,$650.16,$0.00,$661.38,$0.00
04.501.006,SUP,HCPCS C1713,,04.501.006  -  PLATE BN 1.5MM NS MATRIXRIB 17 HL PRECONTOUR LCK LOPRFL TI 6,"$4,154.38",$0.00,"$4,154.38","$1,869.47","$2,964.98",$0.00,$715.78,$0.00,$0.00,$727.40,"$4,154.38",$0.00,"$2,077.19","$3,290.27","$3,323.50",$0.00,$650.16,$0.00,$661.38,$0.00
04.501.007,SUP,HCPCS C1713,,04.501.007  -  PLATE BN 1.5MM NS MATRIXRIB 18 HL PRECONTOUR LCK LOPRFL TI,"$4,307.50",$0.00,"$4,307.50","$1,938.38","$3,074.26",$0.00,$742.16,$0.00,$0.00,$754.21,"$4,307.50",$0.00,"$2,153.75","$3,411.54","$3,446.00",$0.00,$674.12,$0.00,$685.75,$0.00
04.501.008,SUP,HCPCS C1713,,04.501.008  -  PLATE BN 1.5MM NS MATRIXRIB 18 HL PRECONTOUR LCK LOPRFL TI,"$4,307.50",$0.00,"$4,307.50","$1,938.38","$3,074.26",$0.00,$742.16,$0.00,$0.00,$754.21,"$4,307.50",$0.00,"$2,153.75","$3,411.54","$3,446.00",$0.00,$674.12,$0.00,$685.75,$0.00
04.501.009,SUP,HCPCS C1713,,04.501.009  -  PLATE BONE UNIVERSAL 8 HOLE MATRIXRIB TITANIUM RIB NONSTRL,"$2,935.00",$0.00,"$2,935.00","$1,320.75","$2,094.71",$0.00,$505.69,$0.00,$0.00,$513.90,"$2,935.00",$0.00,"$1,467.50","$2,324.52","$2,348.00",$0.00,$459.33,$0.00,$467.25,$0.00
04.501.010,SUP,HCPCS C1713,,04.501.010  -  IMPLANT FIX SMALL 3MM SPLINT MATRIXRIB TITANIUM,"$1,557.50",$0.00,"$1,557.50",$700.88,"$1,111.59",$0.00,$268.35,$0.00,$0.00,$272.71,"$1,557.50",$0.00,$778.75,"$1,233.54","$1,246.00",$0.00,$243.75,$0.00,$247.95,$0.00
04.501.011,SUP,HCPCS C1713,,04.501.011  -  IMPLANT FIX MEDIUM 4MM SPLINT MATRIXRIB TITANIUM,"$1,557.50",$0.00,"$1,557.50",$700.88,"$1,111.59",$0.00,$268.35,$0.00,$0.00,$272.71,"$1,557.50",$0.00,$778.75,"$1,233.54","$1,246.00",$0.00,$243.75,$0.00,$247.95,$0.00
04.501.012,SUP,Custom 27803010,,04.501.012  -  IMPLANT FIX LARGE 5MM SPLINT MATRIXRIB TITANIUM,"$1,557.50",$0.00,"$1,557.50",$0.00,"$1,111.59",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,557.50",$0.00,$778.75,"$1,233.54","$1,246.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.501.016.01,SUP,HCPCS C1713,,04.501.016.01  -  SCREW BONE 2.9MM 6MM SELF TAP LOCK MATRIXRIB TITANIUM RIB,$542.50,$0.00,$542.50,$244.13,$387.18,$0.00,$93.47,$0.00,$0.00,$94.99,$542.50,$0.00,$271.25,$429.66,$434.00,$0.00,$84.90,$0.00,$86.37,$0.00
04.501.018.01,SUP,HCPCS C1713,,04.501.018.01  -  SCREW BONE 2.9MM 8MM SELF TAP LOCK MATRIXRIB TITANIUM RIB,$542.50,$0.00,$542.50,$244.13,$387.18,$0.00,$93.47,$0.00,$0.00,$94.99,$542.50,$0.00,$271.25,$429.66,$434.00,$0.00,$84.90,$0.00,$86.37,$0.00
04.501.020.01,SUP,HCPCS C1713,,04.501.020.01  -  SCREW BONE 2.9MM 10MM SELF TAP LOCK MATRIXRIB TITANIUM RIB,$542.50,$0.00,$542.50,$244.13,$387.18,$0.00,$93.47,$0.00,$0.00,$94.99,$542.50,$0.00,$271.25,$429.66,$434.00,$0.00,$84.90,$0.00,$86.37,$0.00
04.501.022.01,SUP,HCPCS C1713,,04.501.022.01  -  SCREW BONE 2.9MM 12MM SELF TAP LOCK MATRIXRIB TITANIUM RIB,$524.88,$0.00,$524.88,$236.19,$374.60,$0.00,$90.43,$0.00,$0.00,$91.90,$524.88,$0.00,$262.44,$415.70,$419.90,$0.00,$82.14,$0.00,$83.56,$0.00
04.501.024.01,SUP,HCPCS C1713,,04.501.024.01  -  IMPLANT FIX 14MM SYSTEM SET MATRIXRIB,$542.50,$0.00,$542.50,$244.13,$387.18,$0.00,$93.47,$0.00,$0.00,$94.99,$542.50,$0.00,$271.25,$429.66,$434.00,$0.00,$84.90,$0.00,$86.37,$0.00
04.501.026.01,SUP,HCPCS C1713,,04.501.026.01  -  SCREW BONE 2.9MM 16MM ANGULAR STABLE SLFTAP LOCKING,$542.50,$0.00,$542.50,$244.13,$387.18,$0.00,$93.47,$0.00,$0.00,$94.99,$542.50,$0.00,$271.25,$429.66,$434.00,$0.00,$84.90,$0.00,$86.37,$0.00
04.501.028.01,SUP,HCPCS C1713,,04.501.028.01  -  SCREW BONE 2.9MM 18MM ANGULAR STABLE SLFTAP LOCKING,$542.50,$0.00,$542.50,$244.13,$387.18,$0.00,$93.47,$0.00,$0.00,$94.99,$542.50,$0.00,$271.25,$429.66,$434.00,$0.00,$84.90,$0.00,$86.37,$0.00
04.501.036.05,SUP,HCPCS C1713,,04.501.036.05  -  SCREW BONE 2.9MM 6MM MATRIXRIB TI RB SLFTAP NLCKG NONSTRL,$295.00,$0.00,$295.00,$132.75,$210.54,$0.00,$50.83,$0.00,$0.00,$51.65,$295.00,$0.00,$147.50,$233.64,$236.00,$0.00,$46.17,$0.00,$46.96,$0.00
04.501.094,SUP,HCPCS C1713,,04.501.094  -  PLATE BN I 2.8MM NS MATRIXRIB 9 HL TI RB,"$3,170.00",$0.00,"$3,170.00","$1,426.50","$2,262.43",$0.00,$546.18,$0.00,$0.00,$555.04,"$3,170.00",$0.00,"$1,585.00","$2,510.64","$2,536.00",$0.00,$496.11,$0.00,$504.66,$0.00
04.501.110.01,SUP,HCPCS C1713,,04.501.110.01  -  SCREW BONE 3MM 10MM LOCK SELF DRILL TITANIUM STERNAL NONSTRL,$510.00,$0.00,$510.00,$229.50,$363.99,$0.00,$87.87,$0.00,$0.00,$89.30,$510.00,$0.00,$255.00,$403.92,$408.00,$0.00,$79.82,$0.00,$81.19,$0.00
04.501.112.01,SUP,HCPCS C1713,,04.501.112.01  -  SCREW BONE 3MM 12MM SELF DRILL UNILOCK TITANIUM STERNUM,$490.88,$0.00,$490.88,$220.89,$350.34,$0.00,$84.58,$0.00,$0.00,$85.95,$490.88,$0.00,$245.44,$388.78,$392.70,$0.00,$76.82,$0.00,$78.15,$0.00
04.501.114.01,SUP,HCPCS C1713,,04.501.114.01  -  SCREW BONE 3MM 14MM SELF DRILL UNILOCK TITANIUM STERNUM,$577.50,$0.00,$577.50,$259.88,$412.16,$0.00,$99.50,$0.00,$0.00,$101.12,$577.50,$0.00,$288.75,$457.38,$462.00,$0.00,$90.38,$0.00,$91.94,$0.00
04.501.116.01,SUP,HCPCS C1713,,04.501.116.01  -  SCREW BONE 3MM 16MM SELF DRILL UNILOCK TITANIUM STERNUM,$577.50,$0.00,$577.50,$259.88,$412.16,$0.00,$99.50,$0.00,$0.00,$101.12,$577.50,$0.00,$288.75,$457.38,$462.00,$0.00,$90.38,$0.00,$91.94,$0.00
04.501.118.01,SUP,HCPCS C1713,,04.501.118.01  -  SCREW BONE 3MM 18MM SELF DRILL UNILOCK TITANIUM STERNUM,$510.00,$0.00,$510.00,$229.50,$363.99,$0.00,$87.87,$0.00,$0.00,$89.30,$510.00,$0.00,$255.00,$403.92,$408.00,$0.00,$79.82,$0.00,$81.19,$0.00
04.501.120.01,SUP,HCPCS C1713,,04.501.120.01  -  SCREW BONE 3MM 20MM SLFDRILL TITANIUM STERNUM NONSTRL,$510.00,$0.00,$510.00,$229.50,$363.99,$0.00,$87.87,$0.00,$0.00,$89.30,$510.00,$0.00,$255.00,$403.92,$408.00,$0.00,$79.82,$0.00,$81.19,$0.00
04.503.021,SUP,Custom 27803010,,04.503.021  -  COVER BUR HOLE BLUE 12MM MATRIXNEURO TI NONSTRL,$697.50,$0.00,$697.50,$0.00,$497.81,$0.00,$0.00,$0.00,$0.00,$0.00,$697.50,$0.00,$348.75,$552.42,$558.00,$0.00,$0.00,$0.00,$0.00,$0.00
04.503.022,SUP,Custom 27803010,,04.503.022  -  COVER BUR HOLE 15MM MATRIXNEURO TI NONSTRL,$697.50,$0.00,$697.50,$0.00,$497.81,$0.00,$0.00,$0.00,$0.00,$0.00,$697.50,$0.00,$348.75,$552.42,$558.00,$0.00,$0.00,$0.00,$0.00,$0.00
04.503.023,SUP,Custom 27803010,,04.503.023  -  COVER BUR HOLE 17MM MATRIXNEURO MIDFAC CRANFCL TI NONSTRL,$697.50,$0.00,$697.50,$0.00,$497.81,$0.00,$0.00,$0.00,$0.00,$0.00,$697.50,$0.00,$348.75,$552.42,$558.00,$0.00,$0.00,$0.00,$0.00,$0.00
04.503.024,SUP,Custom 27803010,,04.503.024  -  COVER BUR HOLE 24MM MATRIXNEURO CRANIAL TI NONSTRL,$697.50,$0.00,$697.50,$0.00,$497.81,$0.00,$0.00,$0.00,$0.00,$0.00,$697.50,$0.00,$348.75,$552.42,$558.00,$0.00,$0.00,$0.00,$0.00,$0.00
04.503.026,SUP,Custom 27803010,,04.503.026  -  COVER BUR HOLE 12MM MATRIXNEURO CRNMXF TI SHNT NONSTRL,$697.50,$0.00,$697.50,$0.00,$497.81,$0.00,$0.00,$0.00,$0.00,$0.00,$697.50,$0.00,$348.75,$552.42,$558.00,$0.00,$0.00,$0.00,$0.00,$0.00
04.503.027,SUP,Custom 27803010,,04.503.027  -  COVER BUR HOLE 15MM MATRIXNEURO CRNMXF TI SHNT NONSTRL,$697.50,$0.00,$697.50,$0.00,$497.81,$0.00,$0.00,$0.00,$0.00,$0.00,$697.50,$0.00,$348.75,$552.42,$558.00,$0.00,$0.00,$0.00,$0.00,$0.00
04.503.028,SUP,Custom 27803010,,04.503.028  -  COVER BUR HOLE 17MM MATRIXNEURO TI SHNT NONSTRL,$697.50,$0.00,$697.50,$0.00,$497.81,$0.00,$0.00,$0.00,$0.00,$0.00,$697.50,$0.00,$348.75,$552.42,$558.00,$0.00,$0.00,$0.00,$0.00,$0.00
04.503.029,SUP,Custom 27803010,,04.503.029  -  COVER BUR HOLE 24MM MATRIXNEURO CRNMXF TI NONSTRL,$697.50,$0.00,$697.50,$0.00,$497.81,$0.00,$0.00,$0.00,$0.00,$0.00,$697.50,$0.00,$348.75,$552.42,$558.00,$0.00,$0.00,$0.00,$0.00,$0.00
04.503.056,SUP,HCPCS C1713,,04.503.056  -  PLATE BONE MATRIXNEURO CRANIAL TI MESH STRUT MALBLE NONSTRL,"$1,665.00",$0.00,"$1,665.00",$749.25,"$1,188.31",$0.00,$286.87,$0.00,$0.00,$291.53,"$1,665.00",$0.00,$832.50,"$1,318.68","$1,332.00",$0.00,$260.57,$0.00,$265.07,$0.00
04.503.057,SUP,HCPCS C1713,,04.503.057  -  PLATE BONE MATRIXNEURO TMPR TI MESH MALBLE NONSTRL,"$2,202.75",$0.00,"$2,202.75",$991.24,"$1,572.10",$0.00,$379.52,$0.00,$0.00,$385.68,"$2,202.75",$0.00,"$1,101.38","$1,744.58","$1,762.20",$0.00,$344.73,$0.00,$350.68,$0.00
04.503.061,SUP,HCPCS C1713,,04.503.061  -  PLATE BONE 9MM MATRIXNEURO CRNMXF TI 2 HOLE STR NONSTRL,$176.63,$0.00,$176.63,$79.48,$126.06,$0.00,$30.43,$0.00,$0.00,$30.93,$176.63,$0.00,$88.31,$139.89,$141.30,$0.00,$27.64,$0.00,$28.12,$0.00
04.503.062,SUP,HCPCS C1713,,04.503.062  -  PLATE BN STRG 12MMX.4MM NS MATRIXNEURO 2 HL TI CRNL,$183.38,$0.00,$183.38,$82.52,$130.87,$0.00,$31.59,$0.00,$0.00,$32.11,$183.38,$0.00,$91.69,$145.24,$146.70,$0.00,$28.70,$0.00,$29.19,$0.00
04.503.063,SUP,HCPCS C1713,,04.503.063  -  PLATE BN STRG 24MMX.4MM NS MATRIXNEURO 4 HL TI CRNL,$209.25,$0.00,$209.25,$94.16,$149.34,$0.00,$36.05,$0.00,$0.00,$36.64,$209.25,$0.00,$104.63,$165.73,$167.40,$0.00,$32.75,$0.00,$33.31,$0.00
04.503.064,SUP,HCPCS C1713,,04.503.064  -  PLATE BN X .4MM NS MATRIXNEURO 4 HL TI CRNL,$675.00,$0.00,$675.00,$303.75,$481.75,$0.00,$116.30,$0.00,$0.00,$118.19,$675.00,$0.00,$337.50,$534.60,$540.00,$0.00,$105.64,$0.00,$107.46,$0.00
04.503.065,SUP,HCPCS C1713,,04.503.065  -  PLATE BN BX 14X14X.4MM NS MATRIXNEURO 4 HL TI CRNL,$675.00,$0.00,$675.00,$303.75,$481.75,$0.00,$116.30,$0.00,$0.00,$118.19,$675.00,$0.00,$337.50,$534.60,$540.00,$0.00,$105.64,$0.00,$107.46,$0.00
04.503.066,SUP,HCPCS C1713,,04.503.066  -  PLATE BONE 16X16MM MATRIXNEURO CRNMXF TI BOX NONSTRL,$675.00,$0.00,$675.00,$303.75,$481.75,$0.00,$116.30,$0.00,$0.00,$118.19,$675.00,$0.00,$337.50,$534.60,$540.00,$0.00,$105.64,$0.00,$107.46,$0.00
04.503.067,SUP,HCPCS C1713,,04.503.067  -  PLATE BN Y .4MM NS MATRIXNEURO 5 HL TI CRNL,$675.00,$0.00,$675.00,$303.75,$481.75,$0.00,$116.30,$0.00,$0.00,$118.19,$675.00,$0.00,$337.50,$534.60,$540.00,$0.00,$105.64,$0.00,$107.46,$0.00
04.503.068,SUP,HCPCS C1713,,04.503.068  -  PLATE BN 2Y 18MMX.4MM NS MATRIXNEURO 6 HL TI CRNL,$675.00,$0.00,$675.00,$303.75,$481.75,$0.00,$116.30,$0.00,$0.00,$118.19,$675.00,$0.00,$337.50,$534.60,$540.00,$0.00,$105.64,$0.00,$107.46,$0.00
04.503.069,SUP,HCPCS C1713,,04.503.069  -  PLATE BN 2Y 21MMX.4MM NS MATRIXNEURO 6 HL TI CRNL,$675.00,$0.00,$675.00,$303.75,$481.75,$0.00,$116.30,$0.00,$0.00,$118.19,$675.00,$0.00,$337.50,$534.60,$540.00,$0.00,$105.64,$0.00,$107.46,$0.00
04.503.070,SUP,HCPCS C1713,,04.503.070  -  PLATE BN .4MM NS MATRIXNEURO 5 HL ADP TI CRNL,$605.25,$0.00,$605.25,$272.36,$431.97,$0.00,$104.28,$0.00,$0.00,$105.97,$605.25,$0.00,$302.63,$479.36,$484.20,$0.00,$94.72,$0.00,$96.36,$0.00
04.503.071,SUP,HCPCS C1713,,04.503.071  -  PLATE BONE MATRIXNEURO CRNMXF TI 7 HOLE ADP NONSTRL,$751.50,$0.00,$751.50,$338.18,$536.35,$0.00,$129.48,$0.00,$0.00,$131.58,$751.50,$0.00,$375.75,$595.19,$601.20,$0.00,$117.61,$0.00,$119.64,$0.00
04.503.072,SUP,HCPCS C1713,,04.503.072  -  PLATE BONE MATRIXNEURO CRNMXF TI 20 HOLE ADP NONSTRL,"$1,498.50",$0.00,"$1,498.50",$674.33,"$1,069.48",$0.00,$258.18,$0.00,$0.00,$262.38,"$1,498.50",$0.00,$749.25,"$1,186.81","$1,198.80",$0.00,$234.52,$0.00,$238.56,$0.00
04.503.073,SUP,HCPCS C1713,,04.503.073  -  PLATE BN BX 16X10X.4MM NS MATRIXNEURO 4 HL TI CRNL,$643.50,$0.00,$643.50,$289.58,$459.27,$0.00,$110.87,$0.00,$0.00,$112.67,$643.50,$0.00,$321.75,$509.65,$514.80,$0.00,$100.71,$0.00,$102.45,$0.00
04.503.074,SUP,HCPCS C1713,,04.503.074  -  PLATE BONE 9MM MATRIXNEURO CRNMXF TI 2X3 HOLE STRUT NONSTRL,"$1,170.00",$0.00,"$1,170.00",$526.50,$835.03,$0.00,$201.59,$0.00,$0.00,$204.86,"$1,170.00",$0.00,$585.00,$926.64,$936.00,$0.00,$183.11,$0.00,$186.26,$0.00
04.503.075,SUP,HCPCS C1713,,04.503.075  -  PLATE BONE 34X14MM MATRIXNEURO CRNMXF TI 2X4 HOLE STRUT,"$1,665.00",$0.00,"$1,665.00",$749.25,"$1,188.31",$0.00,$286.87,$0.00,$0.00,$291.53,"$1,665.00",$0.00,$832.50,"$1,318.68","$1,332.00",$0.00,$260.57,$0.00,$265.07,$0.00
04.503.076,SUP,HCPCS C1713,,04.503.076  -  PLATE BONE MATRIXNEURO CRNMXF TI 2X3 HOLE STRUT CVD NONSTRL,"$1,091.25",$0.00,"$1,091.25",$491.06,$778.83,$0.00,$188.02,$0.00,$0.00,$191.07,"$1,091.25",$0.00,$545.63,$864.27,$873.00,$0.00,$170.78,$0.00,$173.73,$0.00
04.503.077,SUP,HCPCS C1713,,04.503.077  -  TI MATRIXNEURO CURVED STRUT PLATE/2 X 4 HOLE,"$1,554.75",$0.00,"$1,554.75",$699.64,"$1,109.63",$0.00,$267.88,$0.00,$0.00,$272.22,"$1,554.75",$0.00,$777.38,"$1,231.36","$1,243.80",$0.00,$243.32,$0.00,$247.52,$0.00
04.503.081,SUP,HCPCS C1713,,04.503.081  -  PLATE BONE 45X38X.4MM MATRIXNEURO TI CONTUR MESH MALBLE,"$3,831.75",$0.00,"$3,831.75","$1,724.29","$2,734.72",$0.00,$660.19,$0.00,$0.00,$670.91,"$3,831.75",$0.00,"$1,915.88","$3,034.75","$3,065.40",$0.00,$599.67,$0.00,$610.01,$0.00
04.503.082,SUP,HCPCS C1713,,04.503.082  -  PLATE BONE 45X38X.4MM MATRIXNEURO TI CONTUR MESH RGD NONSTRL,"$3,831.75",$0.00,"$3,831.75","$1,724.29","$2,734.72",$0.00,$660.19,$0.00,$0.00,$670.91,"$3,831.75",$0.00,"$1,915.88","$3,034.75","$3,065.40",$0.00,$599.67,$0.00,$610.01,$0.00
04.503.083,SUP,HCPCS C1713,,04.503.083  -  MESH CRNL CNTR 100X100X.4MM SLVR NS MATRIXNEURO RGD TI,"$5,964.75",$0.00,"$5,964.75","$2,684.14","$4,257.04",$0.00,"$1,027.70",$0.00,$0.00,"$1,044.38","$5,964.75",$0.00,"$2,982.38","$4,724.08","$4,771.80",$0.00,$933.48,$0.00,$949.59,$0.00
04.503.084,SUP,HCPCS C1713,,04.503.084  -  MESH CRNL CNTR 100X100X.4MM BLU NS MATRIXNEURO RGD TI,"$5,964.75",$0.00,"$5,964.75","$2,684.14","$4,257.04",$0.00,"$1,027.70",$0.00,$0.00,"$1,044.38","$5,964.75",$0.00,"$2,982.38","$4,724.08","$4,771.80",$0.00,$933.48,$0.00,$949.59,$0.00
04.503.085,SUP,HCPCS C1713,,04.503.085  -  PLATE BONE MATRIXNEURO CRNMXF TI CONTUR MESH RGD NONSTRL,"$22,842.00",$0.00,"$22,842.00","$10,278.90","$5,158.80",$0.00,"$3,935.56",$0.00,$0.00,"$3,999.45","$22,842.00",$0.00,"$11,421.00","$18,090.86","$18,273.60",$0.00,"$3,574.77",$0.00,"$3,636.45",$0.00
04.503.086,SUP,HCPCS C1713,,04.503.086  -  PLATE BONE MATRIXNEURO SM CRNMXF TI CONTUR MESH MALBLE ARC,"$2,202.75",$0.00,"$2,202.75",$991.24,"$1,572.10",$0.00,$379.52,$0.00,$0.00,$385.68,"$2,202.75",$0.00,"$1,101.38","$1,744.58","$1,762.20",$0.00,$344.73,$0.00,$350.68,$0.00
04.503.087,SUP,HCPCS C1713,,04.503.087  -  PLATE BONE MATRIXNEURO LG CRNMXF TI CONTUR MESH MALBLE ARC,"$3,433.50",$0.00,"$3,433.50","$1,545.08","$2,450.49",$0.00,$591.57,$0.00,$0.00,$601.18,"$3,433.50",$0.00,"$1,716.75","$2,719.33","$2,746.80",$0.00,$537.34,$0.00,$546.61,$0.00
04.503.088,SUP,HCPCS C1713,,04.503.088  -  PLATE BONE MATRIXNEURO SM CRNMXF TI CONTUR MESH RGD ARC,"$2,202.75",$0.00,"$2,202.75",$991.24,"$1,572.10",$0.00,$379.52,$0.00,$0.00,$385.68,"$2,202.75",$0.00,"$1,101.38","$1,744.58","$1,762.20",$0.00,$344.73,$0.00,$350.68,$0.00
04.503.089,SUP,HCPCS C1713,,04.503.089  -  PLATE LG MIDFAC RGD ARC BONE MATRIXNEURO TI NONSTRL BLUE,"$3,433.50",$0.00,"$3,433.50","$1,545.08","$2,450.49",$0.00,$591.57,$0.00,$0.00,$601.18,"$3,433.50",$0.00,"$1,716.75","$2,719.33","$2,746.80",$0.00,$537.34,$0.00,$546.61,$0.00
04.503.090,SUP,HCPCS C1713,,04.503.090  -  PLATE BONE 30MM MATRIXNEURO CRNMXF TI CONTUR MESH MALBLE,"$2,202.75",$0.00,"$2,202.75",$991.24,"$1,572.10",$0.00,$379.52,$0.00,$0.00,$385.68,"$2,202.75",$0.00,"$1,101.38","$1,744.58","$1,762.20",$0.00,$344.73,$0.00,$350.68,$0.00
04.503.091,SUP,HCPCS C1713,,04.503.091  -  PLATE BONE 70MM MATRIXNEURO CRNMXF TI CONTUR MESH MALBLE,"$4,560.75",$0.00,"$4,560.75","$2,052.34","$3,255.01",$0.00,$785.79,$0.00,$0.00,$798.55,"$4,560.75",$0.00,"$2,280.38","$3,612.11","$3,648.60",$0.00,$713.76,$0.00,$726.07,$0.00
04.503.092,SUP,HCPCS C1713,,04.503.092  -  PLATE BONE 100MM MATRIXNEURO CRNMXF TI MESH CONTUR MALBLE,"$5,688.00",$0.00,"$5,688.00","$2,559.60","$4,059.53",$0.00,$980.01,$0.00,$0.00,$995.92,"$5,688.00",$0.00,"$2,844.00","$4,504.90","$4,550.40",$0.00,$890.17,$0.00,$905.53,$0.00
04.503.093,SUP,HCPCS C1713,,04.503.093  -  PLATE BONE 30MM MATRIXNEURO CRNMXF TI CONTUR MESH RGD,"$2,202.75",$0.00,"$2,202.75",$991.24,"$1,572.10",$0.00,$379.52,$0.00,$0.00,$385.68,"$2,202.75",$0.00,"$1,101.38","$1,744.58","$1,762.20",$0.00,$344.73,$0.00,$350.68,$0.00
04.503.094,SUP,HCPCS C1713,,04.503.094  -  PLATE BONE 70MM MATRIXNEURO CRNMXF TI CONTUR MESH RGD,"$4,560.75",$0.00,"$4,560.75","$2,052.34","$3,255.01",$0.00,$785.79,$0.00,$0.00,$798.55,"$4,560.75",$0.00,"$2,280.38","$3,612.11","$3,648.60",$0.00,$713.76,$0.00,$726.07,$0.00
04.503.095,SUP,HCPCS C1713,,04.503.095  -  PLATE BONE 100MM MATRIXNEURO .4MM CRNMXF TI CONTUR MESH RGD,"$5,688.00",$0.00,"$5,688.00","$2,559.60","$4,059.53",$0.00,$980.01,$0.00,$0.00,$995.92,"$5,688.00",$0.00,"$2,844.00","$4,504.90","$4,550.40",$0.00,$890.17,$0.00,$905.53,$0.00
04.503.096,SUP,HCPCS C1713,,04.503.096  -  PLATE SM .4MM MSTD CONTUR MESH MALBLE BONE MATRIXNEURO TI,"$2,135.25",$0.00,"$2,135.25",$960.86,"$1,523.93",$0.00,$367.89,$0.00,$0.00,$373.87,"$2,135.25",$0.00,"$1,067.63","$1,691.12","$1,708.20",$0.00,$334.17,$0.00,$339.93,$0.00
04.503.097,SUP,HCPCS C1713,,04.503.097  -  PLATE MED .4MM MSTD CONTUR MESH MALBLE BONE MATRIXNEURO TI,"$2,416.50",$0.00,"$2,416.50","$1,087.43","$1,724.66",$0.00,$416.35,$0.00,$0.00,$423.11,"$2,416.50",$0.00,"$1,208.25","$1,913.87","$1,933.20",$0.00,$378.18,$0.00,$384.71,$0.00
04.503.098,SUP,HCPCS C1713,,04.503.098  -  PLATE LG .4MM MSTD CONTUR MESH MALBLE BONE MATRIXNEURO TI,"$2,664.00",$0.00,"$2,664.00","$1,198.80","$1,901.30",$0.00,$458.99,$0.00,$0.00,$466.45,"$2,664.00",$0.00,"$1,332.00","$2,109.89","$2,131.20",$0.00,$416.92,$0.00,$424.11,$0.00
04.503.103.01,SUP,HCPCS C1713,,04.503.103.01  -  SCREW BONE 3MM MATRIXNEURO CRNMXF TI SLFDRILL NONSTRL,$217.13,$0.00,$217.13,$97.71,$154.96,$0.00,$37.41,$0.00,$0.00,$38.02,$217.13,$0.00,$108.56,$171.97,$173.70,$0.00,$33.98,$0.00,$34.57,$0.00
04.503.104.01,SUP,HCPCS C1713,,04.503.104.01  -  SCREW BN 4MM NS MATRIXNEURO SLF DRL TI CRNMXF,$217.13,$0.00,$217.13,$97.71,$154.96,$0.00,$37.41,$0.00,$0.00,$38.02,$217.13,$0.00,$108.56,$171.97,$173.70,$0.00,$33.98,$0.00,$34.57,$0.00
04.503.105.01,SUP,HCPCS C1713,,04.503.105.01  -  SCREW BN 5MM NS MATRIXNEURO SLF DRL TI CRNMXF,$217.13,$0.00,$217.13,$97.71,$154.96,$0.00,$37.41,$0.00,$0.00,$38.02,$217.13,$0.00,$108.56,$171.97,$173.70,$0.00,$33.98,$0.00,$34.57,$0.00
04.503.113.01,SUP,HCPCS C1713,,04.503.113.01  -  SCREW BONE 3MM MATRIXNEURO CRNMXF TI ER NONSTRL,$217.13,$0.00,$217.13,$97.71,$154.96,$0.00,$37.41,$0.00,$0.00,$38.02,$217.13,$0.00,$108.56,$171.97,$173.70,$0.00,$33.98,$0.00,$34.57,$0.00
04.503.114.01,SUP,HCPCS C1713,,04.503.114.01  -  SCREW BN 4MM NS MATRIXNEURO ER TI CRNMXF,$217.13,$0.00,$217.13,$97.71,$154.96,$0.00,$37.41,$0.00,$0.00,$38.02,$217.13,$0.00,$108.56,$171.97,$173.70,$0.00,$33.98,$0.00,$34.57,$0.00
04.503.115.01,SUP,HCPCS C1713,,04.503.115.01  -  SCREW BONE 5MM MATRIXNEURO CRNMXF TI ER NONSTRL,$217.13,$0.00,$217.13,$97.71,$154.96,$0.00,$37.41,$0.00,$0.00,$38.02,$217.13,$0.00,$108.56,$171.97,$173.70,$0.00,$33.98,$0.00,$34.57,$0.00
04.503.120,SUP,HCPCS C1713,,04.503.120  -  PLATE BONE 45X38MM MATRIXNEURO .6MM CRNMXF TI CONTUR MESH,"$3,831.75",$0.00,"$3,831.75","$1,724.29","$2,734.72",$0.00,$660.19,$0.00,$0.00,$670.91,"$3,831.75",$0.00,"$1,915.88","$3,034.75","$3,065.40",$0.00,$599.67,$0.00,$610.01,$0.00
04.503.121,SUP,HCPCS C1713,,04.503.121  -  PLATE 100X100X.6MM TI CONTUR MESH RGD MATRIXNEURO BONE,"$5,964.75",$0.00,"$5,964.75","$2,684.14","$4,257.04",$0.00,"$1,027.70",$0.00,$0.00,"$1,044.38","$5,964.75",$0.00,"$2,982.38","$4,724.08","$4,771.80",$0.00,$933.48,$0.00,$949.59,$0.00
04.503.122,SUP,Custom 27803010,,04.503.122  -  TI MATRIXNEURO CONTOUR MESH 200MM X 200MM/0.6MM RIGID,"$22,842.00",$0.00,"$22,842.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$22,842.00",$0.00,"$11,421.00","$18,090.86","$18,273.60",$0.00,$0.00,$0.00,$0.00,$0.00
04.503.123,SUP,Custom 27803010,,04.503.123  -  TI MATRIXNEURO CONTOUR MESH SMALL ARC/0.6MM RIGID,"$2,202.75",$0.00,"$2,202.75",$0.00,"$1,572.10",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,202.75",$0.00,"$1,101.38","$1,744.58","$1,762.20",$0.00,$0.00,$0.00,$0.00,$0.00
04.503.124,SUP,Custom 27803010,,04.503.124  -  TI MATRIXNEURO CONTOUR MESH LARGE ARC/0.6MM RIGID,"$3,433.50",$0.00,"$3,433.50",$0.00,"$2,450.49",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,433.50",$0.00,"$1,716.75","$2,719.33","$2,746.80",$0.00,$0.00,$0.00,$0.00,$0.00
04.503.125,SUP,HCPCS C1713,,04.503.125  -  PLATE BONE PNK .6MM 30MM MATRIXNEURO TI CONTUR MESH RGD,"$2,202.75",$0.00,"$2,202.75",$991.24,"$1,572.10",$0.00,$379.52,$0.00,$0.00,$385.68,"$2,202.75",$0.00,"$1,101.38","$1,744.58","$1,762.20",$0.00,$344.73,$0.00,$350.68,$0.00
04.503.126,SUP,HCPCS C1713,,04.503.126  -  PLATE BONE PNK .6MM 70MM MATRIXNEURO TI CONTUR MESH RGD,"$4,560.75",$0.00,"$4,560.75","$2,052.34","$3,255.01",$0.00,$785.79,$0.00,$0.00,$798.55,"$4,560.75",$0.00,"$2,280.38","$3,612.11","$3,648.60",$0.00,$713.76,$0.00,$726.07,$0.00
04.503.127,SUP,Custom 27803010,,04.503.127  -  TI MATRIXNEURO CONTOUR MESH 100MM DIA/0.6MM RIGID,"$5,688.00",$0.00,"$5,688.00",$0.00,"$4,059.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,688.00",$0.00,"$2,844.00","$4,504.90","$4,550.40",$0.00,$0.00,$0.00,$0.00,$0.00
04.503.131S,SUP,Custom 27803010,,04.503.131S  -  KIT SCR MATRIXNEURO 4MM STD RTU LP RPD INS CRANIAL BONE FLP,"$1,842.75",$0.00,"$1,842.75",$0.00,"$1,315.17",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,842.75",$0.00,$921.38,"$1,459.46","$1,474.20",$0.00,$0.00,$0.00,$0.00,$0.00
04.503.134S,SUP,Custom 27803010,,04.503.134S  -  MATRIXNEURO STERILE KIT 17MM BURR HOLE COVER/4MM,"$2,781.00",$0.00,"$2,781.00",$0.00,"$1,984.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,781.00",$0.00,"$1,390.50","$2,202.55","$2,224.80",$0.00,$0.00,$0.00,$0.00,$0.00
04.503.203.01,SUP,HCPCS C1713,,04.503.203.01  -  SCREW TI 3MM SLFTAP BONE MTRXMDFACE NONSTRL BRNZ,$211.50,$0.00,$211.50,$95.18,$150.95,$0.00,$36.44,$0.00,$0.00,$37.03,$211.50,$0.00,$105.75,$167.51,$169.20,$0.00,$33.10,$0.00,$33.67,$0.00
04.503.204.01,SUP,HCPCS C1713,,04.503.204.01  -  SCREW TI 4MM SLFTAP ER BONE MTRXMDFACE BRNZ,$211.50,$0.00,$211.50,$95.18,$150.95,$0.00,$36.44,$0.00,$0.00,$37.03,$211.50,$0.00,$105.75,$167.51,$169.20,$0.00,$33.10,$0.00,$33.67,$0.00
04.503.205.01,SUP,HCPCS C1713,,04.503.205.01  -  SCREW TI 5MM SLFTAP BONE MTRXMDFACE NONSTRL BRNZ,$211.50,$0.00,$211.50,$95.18,$150.95,$0.00,$36.44,$0.00,$0.00,$37.03,$211.50,$0.00,$105.75,$167.51,$169.20,$0.00,$33.10,$0.00,$33.67,$0.00
04.503.206.01,SUP,HCPCS C1713,,04.503.206.01  -  SCREW TI 6MM SLFTAP BONE MTRXMDFACE NONSTRL BRNZ,$211.50,$0.00,$211.50,$95.18,$150.95,$0.00,$36.44,$0.00,$0.00,$37.03,$211.50,$0.00,$105.75,$167.51,$169.20,$0.00,$33.10,$0.00,$33.67,$0.00
04.503.208.01,SUP,HCPCS C1713,,04.503.208.01  -  SCREW TI BRNZ 8MM MIDFAC SLFTAP BONE MTRXMDFACE NONSTRL,$211.50,$0.00,$211.50,$95.18,$150.95,$0.00,$36.44,$0.00,$0.00,$37.03,$211.50,$0.00,$105.75,$167.51,$169.20,$0.00,$33.10,$0.00,$33.67,$0.00
04.503.210.01,SUP,HCPCS C1713,,04.503.210.01  -  SCREW TI 10MM CRNMXF SLFTAP BONE MTRXMDFACE NONSTRL BRNZ,$211.50,$0.00,$211.50,$95.18,$150.95,$0.00,$36.44,$0.00,$0.00,$37.03,$211.50,$0.00,$105.75,$167.51,$169.20,$0.00,$33.10,$0.00,$33.67,$0.00
04.503.212.01,SUP,HCPCS C1713,,04.503.212.01  -  SCREW TI 12MM CRNMXF SLFTAP BONE MTRXMDFACE NONSTRL BRNZ,$211.50,$0.00,$211.50,$95.18,$150.95,$0.00,$36.44,$0.00,$0.00,$37.03,$211.50,$0.00,$105.75,$167.51,$169.20,$0.00,$33.10,$0.00,$33.67,$0.00
04.503.214.01,SUP,HCPCS C1713,,04.503.214.01  -  SCREW TI 14MM CRNMXF SLFTAP BONE MTRXMDFACE NONSTRL BRNZ,$211.50,$0.00,$211.50,$95.18,$150.95,$0.00,$36.44,$0.00,$0.00,$37.03,$211.50,$0.00,$105.75,$167.51,$169.20,$0.00,$33.10,$0.00,$33.67,$0.00
04.503.216.01,SUP,HCPCS C1713,,04.503.216.01  -  SCREW TI 16MM MIDFAC SLFTAP BONE NONSTRL,$211.50,$0.00,$211.50,$95.18,$150.95,$0.00,$36.44,$0.00,$0.00,$37.03,$211.50,$0.00,$105.75,$167.51,$169.20,$0.00,$33.10,$0.00,$33.67,$0.00
04.503.218.01,SUP,HCPCS C1713,,04.503.218.01  -  TI MATRIXMIDFACE SCREW SELF-TAPPING 18MM,$211.50,$0.00,$211.50,$95.18,$150.95,$0.00,$36.44,$0.00,$0.00,$37.03,$211.50,$0.00,$105.75,$167.51,$169.20,$0.00,$33.10,$0.00,$33.67,$0.00
04.503.223.01,SUP,HCPCS C1713,,04.503.223.01  -  SCREW BONE SLVR 3MM MTRXMDFACE CRNMXF TI SLFDRILL NONSTRL,$218.25,$0.00,$218.25,$98.21,$155.77,$0.00,$37.60,$0.00,$0.00,$38.21,$218.25,$0.00,$109.13,$172.85,$174.60,$0.00,$34.16,$0.00,$34.75,$0.00
04.503.224,SUP,HCPCS C1713,,04.503.224  -  SCREW TI 4MM CRNMXF ORBTL FLR SLFDRILL BONE MTRX MIDFAC,$164.25,$0.00,$164.25,$73.91,$117.23,$0.00,$28.30,$0.00,$0.00,$28.76,$164.25,$0.00,$82.13,$130.09,$131.40,$0.00,$25.71,$0.00,$26.15,$0.00
04.503.224.01,SUP,HCPCS C1713,,04.503.224.01  -  SCREW TI 4MM 1.5MM MIDFAC SLFDRILL BONE MTRXMDFACE NONSTRL,$218.25,$0.00,$218.25,$98.21,$155.77,$0.00,$37.60,$0.00,$0.00,$38.21,$218.25,$0.00,$109.13,$172.85,$174.60,$0.00,$34.16,$0.00,$34.75,$0.00
04.503.225,SUP,HCPCS C1713,,04.503.225  -  SCREW TI 5MM MIDFAC BONE MTRXMDFACE NONSTRL,$164.25,$0.00,$164.25,$73.91,$117.23,$0.00,$28.30,$0.00,$0.00,$28.76,$164.25,$0.00,$82.13,$130.09,$131.40,$0.00,$25.71,$0.00,$26.15,$0.00
04.503.225.01,SUP,HCPCS C1713,,04.503.225.01  -  SCREW TI 5MM 1.5MM ORBTL FLR SLFDRILL BONE MTRXMDFACE,$218.25,$0.00,$218.25,$98.21,$155.77,$0.00,$37.60,$0.00,$0.00,$38.21,$218.25,$0.00,$109.13,$172.85,$174.60,$0.00,$34.16,$0.00,$34.75,$0.00
04.503.226,SUP,HCPCS C1713,,04.503.226  -  SCREW TI 6MM CRNMXF ORBTL FLR SLFDRILL BONE MTRXMDFACE,$164.25,$0.00,$164.25,$73.91,$117.23,$0.00,$28.30,$0.00,$0.00,$28.76,$164.25,$0.00,$82.13,$130.09,$131.40,$0.00,$25.71,$0.00,$26.15,$0.00
04.503.226.01,SUP,HCPCS C1713,,04.503.226.01  -  SCREW TI 6MM 1.5MM ORBTL FLR SLFDRILL BONE MTRXMDFACE,$218.25,$0.00,$218.25,$98.21,$155.77,$0.00,$37.60,$0.00,$0.00,$38.21,$218.25,$0.00,$109.13,$172.85,$174.60,$0.00,$34.16,$0.00,$34.75,$0.00
04.503.228.01,SUP,HCPCS C1713,,04.503.228.01  -  SCREW TI 8MM 1.5MM ORBTL FLR SLFDRILL BONE MTRXMDFACE,$218.25,$0.00,$218.25,$98.21,$155.77,$0.00,$37.60,$0.00,$0.00,$38.21,$218.25,$0.00,$109.13,$172.85,$174.60,$0.00,$34.16,$0.00,$34.75,$0.00
04.503.233.01,SUP,HCPCS C1713,,04.503.233.01  -  SCREW TI 3MM ER BONE MTRXMDFACE LBLU,$218.25,$0.00,$218.25,$98.21,$155.77,$0.00,$37.60,$0.00,$0.00,$38.21,$218.25,$0.00,$109.13,$172.85,$174.60,$0.00,$34.16,$0.00,$34.75,$0.00
04.503.234.01,SUP,HCPCS C1713,,04.503.234.01  -  SCREW_ TI MATRIXMIDFACE EMERGENCY  4MM,$218.25,$0.00,$218.25,$98.21,$155.77,$0.00,$37.60,$0.00,$0.00,$38.21,$218.25,$0.00,$109.13,$172.85,$174.60,$0.00,$34.16,$0.00,$34.75,$0.00
04.503.235.01,SUP,HCPCS C1713,,04.503.235.01  -  SCREW TI 5MM 1.5MM ORBTL FLR ER BONE MTRXMDFACE NONSTRL LBLU,$218.25,$0.00,$218.25,$98.21,$155.77,$0.00,$37.60,$0.00,$0.00,$38.21,$218.25,$0.00,$109.13,$172.85,$174.60,$0.00,$34.16,$0.00,$34.75,$0.00
04.503.236.01,SUP,HCPCS C1713,,04.503.236.01  -  SCREW TI 6MM 1.5MM ORBTL FLR ER BONE MTRXMDFACE NONSTRL,$218.25,$0.00,$218.25,$98.21,$155.77,$0.00,$37.60,$0.00,$0.00,$38.21,$218.25,$0.00,$109.13,$172.85,$174.60,$0.00,$34.16,$0.00,$34.75,$0.00
04.503.238.01,SUP,HCPCS C1713,,04.503.238.01  -  SCREW TI 8MM ER BONE MTRXMDFACE NONSTRL,$218.25,$0.00,$218.25,$98.21,$155.77,$0.00,$37.60,$0.00,$0.00,$38.21,$218.25,$0.00,$109.13,$172.85,$174.60,$0.00,$34.16,$0.00,$34.75,$0.00
04.503.240.01,SUP,HCPCS C1713,,04.503.240.01  -  SCREW TI 10MM ER BONE MTRXMDFACE,$218.25,$0.00,$218.25,$98.21,$155.77,$0.00,$37.60,$0.00,$0.00,$38.21,$218.25,$0.00,$109.13,$172.85,$174.60,$0.00,$34.16,$0.00,$34.75,$0.00
04.503.242.01,SUP,HCPCS C1713,,04.503.242.01  -  SCREW TI 12MM ER BONE MTRXMDFACE,$218.25,$0.00,$218.25,$98.21,$155.77,$0.00,$37.60,$0.00,$0.00,$38.21,$218.25,$0.00,$109.13,$172.85,$174.60,$0.00,$34.16,$0.00,$34.75,$0.00
04.503.244.01,SUP,HCPCS C1713,,04.503.244.01  -  SCREW TI 14MM ER BONE MTRXMDFACE,$218.25,$0.00,$218.25,$98.21,$155.77,$0.00,$37.60,$0.00,$0.00,$38.21,$218.25,$0.00,$109.13,$172.85,$174.60,$0.00,$34.16,$0.00,$34.75,$0.00
04.503.246.01,SUP,HCPCS C1713,,04.503.246.01  -  SCREW TI 16MM ER BONE MTRXMDFACE,$218.25,$0.00,$218.25,$98.21,$155.77,$0.00,$37.60,$0.00,$0.00,$38.21,$218.25,$0.00,$109.13,$172.85,$174.60,$0.00,$34.16,$0.00,$34.75,$0.00
04.503.248.01,SUP,HCPCS C1713,,04.503.248.01  -  SCREW TI 18MM ER BONE MTRXMDFACE,$218.25,$0.00,$218.25,$98.21,$155.77,$0.00,$37.60,$0.00,$0.00,$38.21,$218.25,$0.00,$109.13,$172.85,$174.60,$0.00,$34.16,$0.00,$34.75,$0.00
04.503.301,SUP,HCPCS C1713,,04.503.301  -  PLATE BN SM .3MM NS MATRIXMIDFACE TI ORBT FLR,"$3,201.75",$0.00,"$3,201.75","$1,440.79","$2,285.09",$0.00,$551.65,$0.00,$0.00,$560.60,"$3,201.75",$0.00,"$1,600.88","$2,535.79","$2,561.40",$0.00,$501.07,$0.00,$509.72,$0.00
04.503.302,SUP,HCPCS C1713,,04.503.302  -  PLATE BN MED .3MM NS MATRIXMIDFACE TI ORBT FLR,"$3,201.75",$0.00,"$3,201.75","$1,440.79","$2,285.09",$0.00,$551.65,$0.00,$0.00,$560.60,"$3,201.75",$0.00,"$1,600.88","$2,535.79","$2,561.40",$0.00,$501.07,$0.00,$509.72,$0.00
04.503.303,SUP,HCPCS C1713,,04.503.303  -  PLATE BN LG .3MM NS MATRIXMIDFACE TI ORBT FLR,"$3,201.75",$0.00,"$3,201.75","$1,440.79","$2,285.09",$0.00,$551.65,$0.00,$0.00,$560.60,"$3,201.75",$0.00,"$1,600.88","$2,535.79","$2,561.40",$0.00,$501.07,$0.00,$509.72,$0.00
04.503.304,SUP,HCPCS C1713,,04.503.304  -  PLATE BN UNV .4MM NS MATRIXMIDFACE TI ORBT FLR,"$3,201.75",$0.00,"$3,201.75","$1,440.79","$2,285.09",$0.00,$551.65,$0.00,$0.00,$560.60,"$3,201.75",$0.00,"$1,600.88","$2,535.79","$2,561.40",$0.00,$501.07,$0.00,$509.72,$0.00
04.503.305,SUP,HCPCS C1713,,04.503.305  -  PLATE BN UNV .5MM NS MATRIXMIDFACE TI ORBT FLR MDL WL,"$3,201.75",$0.00,"$3,201.75","$1,440.79","$2,285.09",$0.00,$551.65,$0.00,$0.00,$560.60,"$3,201.75",$0.00,"$1,600.88","$2,535.79","$2,561.40",$0.00,$501.07,$0.00,$509.72,$0.00
04.503.306,SUP,HCPCS C1713,,04.503.306  -  PLATE BN .2MM NS MATRIXMIDFACE MESH TI ORBT FLR,"$3,323.25",$0.00,"$3,323.25","$1,495.46","$2,371.80",$0.00,$572.58,$0.00,$0.00,$581.87,"$3,323.25",$0.00,"$1,661.63","$2,632.01","$2,658.60",$0.00,$520.09,$0.00,$529.06,$0.00
04.503.307,SUP,HCPCS C1713,,04.503.307  -  PLATE BN .3MM NS MATRIXMIDFACE MESH TI ORBT FLR,"$3,323.25",$0.00,"$3,323.25","$1,495.46","$2,371.80",$0.00,$572.58,$0.00,$0.00,$581.87,"$3,323.25",$0.00,"$1,661.63","$2,632.01","$2,658.60",$0.00,$520.09,$0.00,$529.06,$0.00
04.503.308,SUP,HCPCS C1713,,04.503.308  -  PLATE BN .4MM NS MATRIXMIDFACE MESH TI ORBT FLR,"$3,323.25",$0.00,"$3,323.25","$1,495.46","$2,371.80",$0.00,$572.58,$0.00,$0.00,$581.87,"$3,323.25",$0.00,"$1,661.63","$2,632.01","$2,658.60",$0.00,$520.09,$0.00,$529.06,$0.00
04.503.313,SUP,HCPCS C1713,,04.503.313  -  PLATE BN STD MIC .4MM NS MATRIXMIDFACE 12 HL TI ORBT RIM,$927.00,$0.00,$927.00,$417.15,$661.60,$0.00,$159.72,$0.00,$0.00,$162.31,$927.00,$0.00,$463.50,$734.18,$741.60,$0.00,$145.08,$0.00,$147.58,$0.00
04.503.314,SUP,HCPCS C1713,,04.503.314  -  PLATE BONE .4MM MTRXMDFACE CRNMXF TI 6 HOLE ADP NONSTRL,$679.50,$0.00,$679.50,$305.78,$484.96,$0.00,$117.07,$0.00,$0.00,$118.98,$679.50,$0.00,$339.75,$538.16,$543.60,$0.00,$106.34,$0.00,$108.18,$0.00
04.503.315,SUP,HCPCS C1713,,04.503.315  -  PLATE BN STD MIC .4MM SLVR NS MATRIXMIDFACE 8 HL ADP TI MDFC,$841.50,$0.00,$841.50,$378.68,$600.58,$0.00,$144.99,$0.00,$0.00,$147.34,$841.50,$0.00,$420.75,$666.47,$673.20,$0.00,$131.69,$0.00,$133.97,$0.00
04.503.316,SUP,HCPCS C1713,,04.503.316  -  PLATE BN STD MIC .4MM NS MATRIXMIDFACE 20 HL ADP TI MDFC,"$1,680.75",$0.00,"$1,680.75",$756.34,"$1,199.55",$0.00,$289.58,$0.00,$0.00,$294.29,"$1,680.75",$0.00,$840.38,"$1,331.15","$1,344.60",$0.00,$263.04,$0.00,$267.58,$0.00
04.503.317,SUP,HCPCS C1713,,04.503.317  -  PLATE BN STD MIC Y .4MM NS MATRIXMIDFACE 1X3 HL TI MDFC,$747.00,$0.00,$747.00,$336.15,$533.13,$0.00,$128.70,$0.00,$0.00,$130.79,$747.00,$0.00,$373.50,$591.62,$597.60,$0.00,$116.91,$0.00,$118.92,$0.00
04.503.318,SUP,HCPCS C1713,,04.503.318  -  PLATE BN STD MIC 2Y .4MM NS MATRIXMIDFACE 6 HL TI MDFC,$758.25,$0.00,$758.25,$341.21,$541.16,$0.00,$130.64,$0.00,$0.00,$132.76,$758.25,$0.00,$379.13,$600.53,$606.60,$0.00,$118.67,$0.00,$120.71,$0.00
04.503.322,SUP,HCPCS C1713,,04.503.322  -  PLATE BN STD MN H .5MM NS MATRIXMIDFACE 11 HL TI MDFC,$758.25,$0.00,$758.25,$341.21,$541.16,$0.00,$130.64,$0.00,$0.00,$132.76,$758.25,$0.00,$379.13,$600.53,$606.60,$0.00,$118.67,$0.00,$120.71,$0.00
04.503.323,SUP,HCPCS C1713,,04.503.323  -  PLATE BN STD MN OB L L .5MM NS MATRIXMIDFACE 2X3 HL TI MDFC,$758.25,$0.00,$758.25,$341.21,$541.16,$0.00,$130.64,$0.00,$0.00,$132.76,$758.25,$0.00,$379.13,$600.53,$606.60,$0.00,$118.67,$0.00,$120.71,$0.00
04.503.324,SUP,HCPCS C1713,,04.503.324  -  PLATE BN STD MN OB R L .5MM NS MATRIXMIDFACE 2X3 HL TI MDFC,$758.25,$0.00,$758.25,$341.21,$541.16,$0.00,$130.64,$0.00,$0.00,$132.76,$758.25,$0.00,$379.13,$600.53,$606.60,$0.00,$118.67,$0.00,$120.71,$0.00
04.503.325,SUP,HCPCS C1713,,04.503.325  -  PLATE BN STD MN OB L L .5MM NS MATRIXMIDFACE 3X4 HL TI MDFC,$776.25,$0.00,$776.25,$349.31,$554.01,$0.00,$133.74,$0.00,$0.00,$135.92,$776.25,$0.00,$388.13,$614.79,$621.00,$0.00,$121.48,$0.00,$123.58,$0.00
04.503.326,SUP,HCPCS C1713,,04.503.326  -  PLATE BN STD MN OB R L .5MM NS MATRIXMIDFACE 3X4 HL TI MDFC,$776.25,$0.00,$776.25,$349.31,$554.01,$0.00,$133.74,$0.00,$0.00,$135.92,$776.25,$0.00,$388.13,$614.79,$621.00,$0.00,$121.48,$0.00,$123.58,$0.00
04.503.327,SUP,HCPCS C1713,,04.503.327  -  PLATE BN STD MN T .5MM NS MATRIXMIDFACE 3X4 HL TI MDFC,$675.00,$0.00,$675.00,$303.75,$481.75,$0.00,$116.30,$0.00,$0.00,$118.19,$675.00,$0.00,$337.50,$534.60,$540.00,$0.00,$105.64,$0.00,$107.46,$0.00
04.503.330,SUP,HCPCS C1713,,04.503.330  -  PLATE BN STD MIC BX 10X5X.4MM NS MATRIXMIDFACE 4 HL TI MDFC,$747.00,$0.00,$747.00,$336.15,$533.13,$0.00,$128.70,$0.00,$0.00,$130.79,$747.00,$0.00,$373.50,$591.62,$597.60,$0.00,$116.91,$0.00,$118.92,$0.00
04.503.331,SUP,HCPCS C1713,,04.503.331  -  PLATE BN STD MN BX 10X10X.4MM NS MATRIXMIDFACE 4 HL TI MDFC,$758.25,$0.00,$758.25,$341.21,$541.16,$0.00,$130.64,$0.00,$0.00,$132.76,$758.25,$0.00,$379.13,$600.53,$606.60,$0.00,$118.67,$0.00,$120.71,$0.00
04.503.332,SUP,HCPCS C1713,,04.503.332  -  PLATE BN STD MIC X .4MM NS MATRIXMIDFACE 4 HL TI MDFC,$747.00,$0.00,$747.00,$336.15,$533.13,$0.00,$128.70,$0.00,$0.00,$130.79,$747.00,$0.00,$373.50,$591.62,$597.60,$0.00,$116.91,$0.00,$118.92,$0.00
04.503.333,SUP,HCPCS C1713,,04.503.333  -  PLATE BN STD MIC .4MM NS MATRIXMIDFACE 18 HL STRUT TI MDFC,"$1,599.75",$0.00,"$1,599.75",$719.89,"$1,141.74",$0.00,$275.63,$0.00,$0.00,$280.10,"$1,599.75",$0.00,$799.88,"$1,267.00","$1,279.80",$0.00,$250.36,$0.00,$254.68,$0.00
04.503.334,SUP,HCPCS C1713,,04.503.334  -  PLATE BN STD MN OB L L .5MM NS MATRIXMIDFACE 4X6 HL TI MDFC,$803.25,$0.00,$803.25,$361.46,$573.28,$0.00,$138.40,$0.00,$0.00,$140.64,$803.25,$0.00,$401.63,$636.17,$642.60,$0.00,$125.71,$0.00,$127.88,$0.00
04.503.335,SUP,HCPCS C1713,,04.503.335  -  PLATE BN STD MN OB R L .5MM NS MATRIXMIDFACE 4X6 HL TI MDFC,$803.25,$0.00,$803.25,$361.46,$573.28,$0.00,$138.40,$0.00,$0.00,$140.64,$803.25,$0.00,$401.63,$636.17,$642.60,$0.00,$125.71,$0.00,$127.88,$0.00
04.503.343,SUP,HCPCS C1713,,04.503.343  -  PLATE BN STD MN .5MM NS MATRIXMIDFACE 12 HL TI ORBT RIM,$927.00,$0.00,$927.00,$417.15,$661.60,$0.00,$159.72,$0.00,$0.00,$162.31,$927.00,$0.00,$463.50,$734.18,$741.60,$0.00,$145.08,$0.00,$147.58,$0.00
04.503.344,SUP,HCPCS C1713,,04.503.344  -  PLATE .5MM ORBTL RIM 6 HOLE ADP BONE MTRXMDFACE TI NONSTRL,$679.50,$0.00,$679.50,$305.78,$484.96,$0.00,$117.07,$0.00,$0.00,$118.98,$679.50,$0.00,$339.75,$538.16,$543.60,$0.00,$106.34,$0.00,$108.18,$0.00
04.503.345,SUP,HCPCS C1713,,04.503.345  -  PLATE BN STD MN .5MM NS MATRIXMIDFACE 8 HL ADP TI MDFC,$841.50,$0.00,$841.50,$378.68,$600.58,$0.00,$144.99,$0.00,$0.00,$147.34,$841.50,$0.00,$420.75,$666.47,$673.20,$0.00,$131.69,$0.00,$133.97,$0.00
04.503.346,SUP,HCPCS C1713,,04.503.346  -  PLATE BONE BLUE .5MM MTRXMDFACE CRNMXF TI 20 HOLE ADP,"$1,494.00",$0.00,"$1,494.00",$672.30,"$1,066.27",$0.00,$257.41,$0.00,$0.00,$261.59,"$1,494.00",$0.00,$747.00,"$1,183.25","$1,195.20",$0.00,$233.81,$0.00,$237.84,$0.00
04.503.347,SUP,HCPCS C1713,,04.503.347  -  PLATE BN STD MN Y .5MM NS MATRIXMIDFACE 1X3 HL TI MDFC,$747.00,$0.00,$747.00,$336.15,$533.13,$0.00,$128.70,$0.00,$0.00,$130.79,$747.00,$0.00,$373.50,$591.62,$597.60,$0.00,$116.91,$0.00,$118.92,$0.00
04.503.348,SUP,HCPCS C1713,,04.503.348  -  PLATE BN STD MN 2Y .5MM NS MATRIXMIDFACE 6 HL TI MDFC,$758.25,$0.00,$758.25,$341.21,$541.16,$0.00,$130.64,$0.00,$0.00,$132.76,$758.25,$0.00,$379.13,$600.53,$606.60,$0.00,$118.67,$0.00,$120.71,$0.00
04.503.352,SUP,HCPCS C1713,,04.503.352  -  PLATE BN STD MED H .7MM NS MATRIXMIDFACE 11 HL TI MDFC,$758.25,$0.00,$758.25,$341.21,$541.16,$0.00,$130.64,$0.00,$0.00,$132.76,$758.25,$0.00,$379.13,$600.53,$606.60,$0.00,$118.67,$0.00,$120.71,$0.00
04.503.353,SUP,HCPCS C1713,,04.503.353  -  PLATE BN STD MED OB L L .7MM NS MATRIXMIDFACE 2X3 HL TI MDFC,$758.25,$0.00,$758.25,$341.21,$541.16,$0.00,$130.64,$0.00,$0.00,$132.76,$758.25,$0.00,$379.13,$600.53,$606.60,$0.00,$118.67,$0.00,$120.71,$0.00
04.503.354,SUP,HCPCS C1713,,04.503.354  -  PLATE BN STD MED OB R L .7MM NS MATRIXMIDFACE 2X3 HL TI MDFC,$758.25,$0.00,$758.25,$341.21,$541.16,$0.00,$130.64,$0.00,$0.00,$132.76,$758.25,$0.00,$379.13,$600.53,$606.60,$0.00,$118.67,$0.00,$120.71,$0.00
04.503.355,SUP,HCPCS C1713,,04.503.355  -  PLATE BN STD MN OB L L .7MM NS MATRIXMIDFACE 3X4 HL TI MDFC,$776.25,$0.00,$776.25,$349.31,$554.01,$0.00,$133.74,$0.00,$0.00,$135.92,$776.25,$0.00,$388.13,$614.79,$621.00,$0.00,$121.48,$0.00,$123.58,$0.00
04.503.356,SUP,HCPCS C1713,,04.503.356  -  PLATE BN STD MN OB R L .7MM NS MATRIXMIDFACE 3X4 HL TI MDFC,$776.25,$0.00,$776.25,$349.31,$554.01,$0.00,$133.74,$0.00,$0.00,$135.92,$776.25,$0.00,$388.13,$614.79,$621.00,$0.00,$121.48,$0.00,$123.58,$0.00
04.503.357,SUP,HCPCS C1713,,04.503.357  -  PLATE BN STD MED T .7MM NS MATRIXMIDFACE 3X4 HL TI MDFC,$675.00,$0.00,$675.00,$303.75,$481.75,$0.00,$116.30,$0.00,$0.00,$118.19,$675.00,$0.00,$337.50,$534.60,$540.00,$0.00,$105.64,$0.00,$107.46,$0.00
04.503.360,SUP,HCPCS C1713,,04.503.360  -  PLATE BN STD MN BX 10X5X.5MM NS MATRIXMIDFACE 4 HL TI MDFC,$747.00,$0.00,$747.00,$336.15,$533.13,$0.00,$128.70,$0.00,$0.00,$130.79,$747.00,$0.00,$373.50,$591.62,$597.60,$0.00,$116.91,$0.00,$118.92,$0.00
04.503.361,SUP,HCPCS C1713,,04.503.361  -  PLATE BN STD MN BX 10X10X.5MM NS MATRIXMIDFACE 4 HL TI MDFC,$758.25,$0.00,$758.25,$341.21,$541.16,$0.00,$130.64,$0.00,$0.00,$132.76,$758.25,$0.00,$379.13,$600.53,$606.60,$0.00,$118.67,$0.00,$120.71,$0.00
04.503.362,SUP,HCPCS C1713,,04.503.362  -  PLATE BN STD MN X .5MM NS MATRIXMIDFACE 4 HL TI MDFC,$747.00,$0.00,$747.00,$336.15,$533.13,$0.00,$128.70,$0.00,$0.00,$130.79,$747.00,$0.00,$373.50,$591.62,$597.60,$0.00,$116.91,$0.00,$118.92,$0.00
04.503.363,SUP,HCPCS C1713,,04.503.363  -  PLATE BN STD MN .5MM NS MATRIXMIDFACE 18 HL STRUT TI MDFC,"$1,599.75",$0.00,"$1,599.75",$719.89,"$1,141.74",$0.00,$275.63,$0.00,$0.00,$280.10,"$1,599.75",$0.00,$799.88,"$1,267.00","$1,279.80",$0.00,$250.36,$0.00,$254.68,$0.00
04.503.364,SUP,HCPCS C1713,,04.503.364  -  PLATE BN STD MED OB L L .7MM NS MATRIXMIDFACE 4X6 HL TI MDFC,$803.25,$0.00,$803.25,$361.46,$573.28,$0.00,$138.40,$0.00,$0.00,$140.64,$803.25,$0.00,$401.63,$636.17,$642.60,$0.00,$125.71,$0.00,$127.88,$0.00
04.503.365,SUP,HCPCS C1713,,04.503.365  -  PLATE BN STD MED OB R L .7MM NS MATRIXMIDFACE 4X6 HL TI MDFC,$803.25,$0.00,$803.25,$361.46,$573.28,$0.00,$138.40,$0.00,$0.00,$140.64,$803.25,$0.00,$401.63,$636.17,$642.60,$0.00,$125.71,$0.00,$127.88,$0.00
04.503.373,SUP,HCPCS C1713,,04.503.373  -  PLATE BN STD MED .7MM NS MATRIXMIDFACE 12 HL TI ORBT RIM,$927.00,$0.00,$927.00,$417.15,$661.60,$0.00,$159.72,$0.00,$0.00,$162.31,$927.00,$0.00,$463.50,$734.18,$741.60,$0.00,$145.08,$0.00,$147.58,$0.00
04.503.374,SUP,HCPCS C1713,,04.503.374  -  PLATE .7MM CRANFCL 6 HOLE ADP BONE MTRXMDFACE TI NONSTRL,$679.50,$0.00,$679.50,$305.78,$484.96,$0.00,$117.07,$0.00,$0.00,$118.98,$679.50,$0.00,$339.75,$538.16,$543.60,$0.00,$106.34,$0.00,$108.18,$0.00
04.503.375,SUP,HCPCS C1713,,04.503.375  -  PLATE BN STD MED .7MM NS MATRIXMIDFACE 8 HL ADP TI MDFC,$841.50,$0.00,$841.50,$378.68,$600.58,$0.00,$144.99,$0.00,$0.00,$147.34,$841.50,$0.00,$420.75,$666.47,$673.20,$0.00,$131.69,$0.00,$133.97,$0.00
04.503.376,SUP,HCPCS C1713,,04.503.376  -  PLATE BN STD MED .7MM NS MATRIXMIDFACE 20 HL ADP TI MDFC,"$1,680.75",$0.00,"$1,680.75",$756.34,"$1,199.55",$0.00,$289.58,$0.00,$0.00,$294.29,"$1,680.75",$0.00,$840.38,"$1,331.15","$1,344.60",$0.00,$263.04,$0.00,$267.58,$0.00
04.503.377,SUP,HCPCS C1713,,04.503.377  -  PLATE BN STD MED Y .7MM NS MATRIXMIDFACE 1X3 HL TI MDFC,$747.00,$0.00,$747.00,$336.15,$533.13,$0.00,$128.70,$0.00,$0.00,$130.79,$747.00,$0.00,$373.50,$591.62,$597.60,$0.00,$116.91,$0.00,$118.92,$0.00
04.503.378,SUP,HCPCS C1713,,04.503.378  -  PLATE BN STD MED 2Y .7MM NS MATRIXMIDFACE 6 HL TI MDFC,$758.25,$0.00,$758.25,$341.21,$541.16,$0.00,$130.64,$0.00,$0.00,$132.76,$758.25,$0.00,$379.13,$600.53,$606.60,$0.00,$118.67,$0.00,$120.71,$0.00
04.503.382,SUP,HCPCS C1713,,04.503.382  -  PLATE BN STD LG H .8MM NS MATRIXMIDFACE 11 HL TI MDFC,$758.25,$0.00,$758.25,$341.21,$541.16,$0.00,$130.64,$0.00,$0.00,$132.76,$758.25,$0.00,$379.13,$600.53,$606.60,$0.00,$118.67,$0.00,$120.71,$0.00
04.503.383,SUP,HCPCS C1713,,04.503.383  -  PLATE BN STD LG OB L L .8MM NS MATRIXMIDFACE 2X3 HL TI MDFC,$758.25,$0.00,$758.25,$341.21,$541.16,$0.00,$130.64,$0.00,$0.00,$132.76,$758.25,$0.00,$379.13,$600.53,$606.60,$0.00,$118.67,$0.00,$120.71,$0.00
04.503.384,SUP,HCPCS C1713,,04.503.384  -  PLATE BN STD LG OB R L .8MM NS MATRIXMIDFACE 2X3 HL TI MDFC,$758.25,$0.00,$758.25,$341.21,$541.16,$0.00,$130.64,$0.00,$0.00,$132.76,$758.25,$0.00,$379.13,$600.53,$606.60,$0.00,$118.67,$0.00,$120.71,$0.00
04.503.385,SUP,HCPCS C1713,,04.503.385  -  PLATE BN STD LG OB L L .8MM NS MATRIXMIDFACE 3X4 HL TI MDFC,$776.25,$0.00,$776.25,$349.31,$554.01,$0.00,$133.74,$0.00,$0.00,$135.92,$776.25,$0.00,$388.13,$614.79,$621.00,$0.00,$121.48,$0.00,$123.58,$0.00
04.503.386,SUP,HCPCS C1713,,04.503.386  -  PLATE BN STD LG OB R L .8MM NS MATRIXMIDFACE 3X4 HL TI MDFC,$776.25,$0.00,$776.25,$349.31,$554.01,$0.00,$133.74,$0.00,$0.00,$135.92,$776.25,$0.00,$388.13,$614.79,$621.00,$0.00,$121.48,$0.00,$123.58,$0.00
04.503.387,SUP,HCPCS C1713,,04.503.387  -  PLATE BN STD LG T .8MM NS MATRIXMIDFACE 3X4 HL TI MDFC,$675.00,$0.00,$675.00,$303.75,$481.75,$0.00,$116.30,$0.00,$0.00,$118.19,$675.00,$0.00,$337.50,$534.60,$540.00,$0.00,$105.64,$0.00,$107.46,$0.00
04.503.390,SUP,HCPCS C1713,,04.503.390  -  PLATE BN STD MED BX 10X5X.7MM NS MATRIXMIDFACE 4 HL TI MDFC,$747.00,$0.00,$747.00,$336.15,$533.13,$0.00,$128.70,$0.00,$0.00,$130.79,$747.00,$0.00,$373.50,$591.62,$597.60,$0.00,$116.91,$0.00,$118.92,$0.00
04.503.391,SUP,HCPCS C1713,,04.503.391  -  PLATE BN STD MED BX 10X10X.7MM NS MATRIXMIDFACE 4 HL TI MDFC,$758.25,$0.00,$758.25,$341.21,$541.16,$0.00,$130.64,$0.00,$0.00,$132.76,$758.25,$0.00,$379.13,$600.53,$606.60,$0.00,$118.67,$0.00,$120.71,$0.00
04.503.392,SUP,HCPCS C1713,,04.503.392  -  PLATE BN STD MED X .7MM NS MATRIXMIDFACE 4 HL TI MDFC,$747.00,$0.00,$747.00,$336.15,$533.13,$0.00,$128.70,$0.00,$0.00,$130.79,$747.00,$0.00,$373.50,$591.62,$597.60,$0.00,$116.91,$0.00,$118.92,$0.00
04.503.393,SUP,HCPCS C1713,,04.503.393  -  PLATE BN STD MED .7MM NS MATRIXMIDFACE 18 HL STRUT TI MDFC,"$1,599.75",$0.00,"$1,599.75",$719.89,"$1,141.74",$0.00,$275.63,$0.00,$0.00,$280.10,"$1,599.75",$0.00,$799.88,"$1,267.00","$1,279.80",$0.00,$250.36,$0.00,$254.68,$0.00
04.503.394,SUP,HCPCS C1713,,04.503.394  -  PLATE BN L OB L .8MM NS MATRIXMIDFACE 4X6 HL TI MDFC,$803.25,$0.00,$803.25,$361.46,$573.28,$0.00,$138.40,$0.00,$0.00,$140.64,$803.25,$0.00,$401.63,$636.17,$642.60,$0.00,$125.71,$0.00,$127.88,$0.00
04.503.395,SUP,HCPCS C1713,,04.503.395  -  PLATE BN STD LG OB R L .8MM NS MATRIXMIDFACE 4X6 HL TI MDFC,$803.25,$0.00,$803.25,$361.46,$573.28,$0.00,$138.40,$0.00,$0.00,$140.64,$803.25,$0.00,$401.63,$636.17,$642.60,$0.00,$125.71,$0.00,$127.88,$0.00
04.503.396,SUP,HCPCS C1713,,04.503.396  -  PLATE BN LG .8MM NS MATRIXMIDFACE 20 HL ADP TI MDFC,"$1,680.75",$0.00,"$1,680.75",$756.34,"$1,199.55",$0.00,$289.58,$0.00,$0.00,$294.29,"$1,680.75",$0.00,$840.38,"$1,331.15","$1,344.60",$0.00,$263.04,$0.00,$267.58,$0.00
04.503.397,SUP,HCPCS C1713,,04.503.397  -  PLATE BONE .8MM MTRXMDFACE ORBTL RIM TI 12 HOLE NONSTRL,$927.00,$0.00,$927.00,$417.15,$661.60,$0.00,$159.72,$0.00,$0.00,$162.31,$927.00,$0.00,$463.50,$734.18,$741.60,$0.00,$145.08,$0.00,$147.58,$0.00
04.503.398,SUP,HCPCS C1713,,04.503.398  -  PLATE .8MM ORBTL RIM 6 HOLE ADP BONE MTRXMDFACE TI NONSTRL,$679.50,$0.00,$679.50,$305.78,$484.96,$0.00,$117.07,$0.00,$0.00,$118.98,$679.50,$0.00,$339.75,$538.16,$543.60,$0.00,$106.34,$0.00,$108.18,$0.00
04.503.399,SUP,HCPCS C1713,,04.503.399  -  PLATE .8MM ORBTL RIM 8 HOLE ADP BONE MTRXMDFACE TI NONSTRL,$841.50,$0.00,$841.50,$378.68,$600.58,$0.00,$144.99,$0.00,$0.00,$147.34,$841.50,$0.00,$420.75,$666.47,$673.20,$0.00,$131.69,$0.00,$133.97,$0.00
04.503.405.01,SUP,HCPCS C1713,,04.503.405.01  -  SCREW BONE 5MM 2MM MTRXMAND CRNMXF TI SLFTAP NONSTRL,$168.75,$0.00,$168.75,$75.94,$120.44,$0.00,$29.07,$0.00,$0.00,$29.55,$168.75,$0.00,$84.38,$133.65,$135.00,$0.00,$26.41,$0.00,$26.87,$0.00
04.503.406,SUP,HCPCS C1713,,04.503.406  -  SCREW TI 6MM 2MM MIDFAC SLFTAP BONE MTRXMDFACE NONSTRL,$135.00,$0.00,$135.00,$60.75,$96.35,$0.00,$23.26,$0.00,$0.00,$23.64,$135.00,$0.00,$67.50,$106.92,$108.00,$0.00,$21.13,$0.00,$21.49,$0.00
04.503.406.01,SUP,HCPCS C1713,,04.503.406.01  -  SCREW TI 6MM 2MM CRNMXF SLFTAP BONE MTRXMAND NONSTRL,$168.75,$0.00,$168.75,$75.94,$120.44,$0.00,$29.07,$0.00,$0.00,$29.55,$168.75,$0.00,$84.38,$133.65,$135.00,$0.00,$26.41,$0.00,$26.87,$0.00
04.503.408,SUP,HCPCS C1713,,04.503.408  -  SCREW TI 8MM 2MM CRNMXF SLFTAP BONE MTRXMAND NONSTRL,$135.00,$0.00,$135.00,$60.75,$96.35,$0.00,$23.26,$0.00,$0.00,$23.64,$135.00,$0.00,$67.50,$106.92,$108.00,$0.00,$21.13,$0.00,$21.49,$0.00
04.503.408.01,SUP,HCPCS C1713,,04.503.408.01  -  SCREW TI 8MM 2MM SLFTAP LCK BONE MTRXMAND NONSTRL,$168.75,$0.00,$168.75,$75.94,$120.44,$0.00,$29.07,$0.00,$0.00,$29.55,$168.75,$0.00,$84.38,$133.65,$135.00,$0.00,$26.41,$0.00,$26.87,$0.00
04.503.408.01E,SUP,HCPCS C1713,,04.503.408.01E  -  SCREW TI 8MM 2MM SLFTAP LCK BONE MTRXMAND NONSTRL,$135.00,$0.00,$135.00,$60.75,$96.35,$0.00,$23.26,$0.00,$0.00,$23.64,$135.00,$0.00,$67.50,$106.92,$108.00,$0.00,$21.13,$0.00,$21.49,$0.00
04.503.410.01,SUP,HCPCS C1713,,04.503.410.01  -  SCREW TI 10MM 2MM CRNMXF SLFTAP BONE MTRXMAND NONSTRL,$168.75,$0.00,$168.75,$75.94,$120.44,$0.00,$29.07,$0.00,$0.00,$29.55,$168.75,$0.00,$84.38,$133.65,$135.00,$0.00,$26.41,$0.00,$26.87,$0.00
04.503.412,SUP,HCPCS C1713,,04.503.412  -  SCREW TI 12MM 2MM CRNMXF SLFTAP BONE MTRXMAND NONSTRL,$135.00,$0.00,$135.00,$60.75,$96.35,$0.00,$23.26,$0.00,$0.00,$23.64,$135.00,$0.00,$67.50,$106.92,$108.00,$0.00,$21.13,$0.00,$21.49,$0.00
04.503.412.01,SUP,HCPCS C1713,,04.503.412.01  -  SCREW TI 12MM 2MM SLFTAP ER BONE MTRXMAND NONSTRL,$168.75,$0.00,$168.75,$75.94,$120.44,$0.00,$29.07,$0.00,$0.00,$29.55,$168.75,$0.00,$84.38,$133.65,$135.00,$0.00,$26.41,$0.00,$26.87,$0.00
04.503.414.01,SUP,HCPCS C1713,,04.503.414.01  -  SCREW TI 14MM 2MM MANDIB SLFTAP BONE MTRX,$168.75,$0.00,$168.75,$75.94,$120.44,$0.00,$29.07,$0.00,$0.00,$29.55,$168.75,$0.00,$84.38,$133.65,$135.00,$0.00,$26.41,$0.00,$26.87,$0.00
04.503.416.01,SUP,HCPCS C1713,,04.503.416.01  -  SCREW TI 16MM 2MM CRNMXF SLFTAP BONE MTRXMAND NONSTRL,$168.75,$0.00,$168.75,$75.94,$120.44,$0.00,$29.07,$0.00,$0.00,$29.55,$168.75,$0.00,$84.38,$133.65,$135.00,$0.00,$26.41,$0.00,$26.87,$0.00
04.503.418.01,SUP,HCPCS C1713,,04.503.418.01  -  SCREW TI 18MM 2.4MM SLFTAP BONE MTRXMAND NONSTRL,$168.75,$0.00,$168.75,$75.94,$120.44,$0.00,$29.07,$0.00,$0.00,$29.55,$168.75,$0.00,$84.38,$133.65,$135.00,$0.00,$26.41,$0.00,$26.87,$0.00
04.503.435.01,SUP,HCPCS C1713,,04.503.435.01  -  SCREW TI 5MM 2.4MM SLFTAP BONE MTRXMAND NONSTRL,$243.00,$0.00,$243.00,$109.35,$173.43,$0.00,$41.87,$0.00,$0.00,$42.55,$243.00,$0.00,$121.50,$192.46,$194.40,$0.00,$38.03,$0.00,$38.69,$0.00
04.503.436.01,SUP,HCPCS C1713,,04.503.436.01  -  SCREW TI 6MM 2.4MM SLFTAP BONE MTRXMAND NONSTRL,$243.00,$0.00,$243.00,$109.35,$173.43,$0.00,$41.87,$0.00,$0.00,$42.55,$243.00,$0.00,$121.50,$192.46,$194.40,$0.00,$38.03,$0.00,$38.69,$0.00
04.503.438.01,SUP,HCPCS C1713,,04.503.438.01  -  SCREW TI 8MM 2.4MM SLFTAP ER BONE MTRXMAND NONSTRL,$243.00,$0.00,$243.00,$109.35,$173.43,$0.00,$41.87,$0.00,$0.00,$42.55,$243.00,$0.00,$121.50,$192.46,$194.40,$0.00,$38.03,$0.00,$38.69,$0.00
04.503.440.01,SUP,HCPCS C1713,,04.503.440.01  -  SCREW TI 10MM 2.4MM MANDIB SLFTAP BONE MTRXMAND NONSTRL,$243.00,$0.00,$243.00,$109.35,$173.43,$0.00,$41.87,$0.00,$0.00,$42.55,$243.00,$0.00,$121.50,$192.46,$194.40,$0.00,$38.03,$0.00,$38.69,$0.00
04.503.442.01,SUP,HCPCS C1713,,04.503.442.01  -  SCREW TI 12MM 2.4MM SLFTAP ER BONE MTRXMAND NONSTRL,$243.00,$0.00,$243.00,$109.35,$173.43,$0.00,$41.87,$0.00,$0.00,$42.55,$243.00,$0.00,$121.50,$192.46,$194.40,$0.00,$38.03,$0.00,$38.69,$0.00
04.503.444,SUP,HCPCS C1713,,04.503.444  -  SCREW TI 14MM 2.4MM SLFTAP BONE MTRXMAND NONSTRL,$193.50,$0.00,$193.50,$87.08,$138.10,$0.00,$33.34,$0.00,$0.00,$33.88,$193.50,$0.00,$96.75,$153.25,$154.80,$0.00,$30.28,$0.00,$30.81,$0.00
04.503.444.01,SUP,HCPCS C1713,,04.503.444.01  -  SCREW BONE 14MM 2.4MM MTRXMAND CRNMXF TI SLFTAP NONSTRL,$243.00,$0.00,$243.00,$109.35,$173.43,$0.00,$41.87,$0.00,$0.00,$42.55,$243.00,$0.00,$121.50,$192.46,$194.40,$0.00,$38.03,$0.00,$38.69,$0.00
04.503.446,SUP,HCPCS C1713,,04.503.446  -  SCREW TI 16MM 2.4MM SLFTAP BONE MTRXMAND NONSTRL,$193.50,$0.00,$193.50,$87.08,$138.10,$0.00,$33.34,$0.00,$0.00,$33.88,$193.50,$0.00,$96.75,$153.25,$154.80,$0.00,$30.28,$0.00,$30.81,$0.00
04.503.446.01,SUP,HCPCS C1713,,04.503.446.01  -  SCREW TI 16MM 2.4MM SLFTAP BONE MTRXMAND NONSTRL,$243.00,$0.00,$243.00,$109.35,$173.43,$0.00,$41.87,$0.00,$0.00,$42.55,$243.00,$0.00,$121.50,$192.46,$194.40,$0.00,$38.03,$0.00,$38.69,$0.00
04.503.448.01,SUP,HCPCS C1713,,04.503.448.01  -  SCREW TI 18MM 2.4MM SLFTAP BONE MTRXMAND NONSTRL,$243.00,$0.00,$243.00,$109.35,$173.43,$0.00,$41.87,$0.00,$0.00,$42.55,$243.00,$0.00,$121.50,$192.46,$194.40,$0.00,$38.03,$0.00,$38.69,$0.00
04.503.465.01,SUP,HCPCS C1713,,04.503.465.01  -  SCREW TI 5MM 2.7MM SLFTAP BONE MTRXMAND NONSTRL ER,$265.50,$0.00,$265.50,$119.48,$189.49,$0.00,$45.74,$0.00,$0.00,$46.49,$265.50,$0.00,$132.75,$210.28,$212.40,$0.00,$41.55,$0.00,$42.27,$0.00
04.503.466.01,SUP,HCPCS C1713,,04.503.466.01  -  SCREW TI 6MM 2.7MM ER SLFTAP BONE MTRXMAND,$265.50,$0.00,$265.50,$119.48,$189.49,$0.00,$45.74,$0.00,$0.00,$46.49,$265.50,$0.00,$132.75,$210.28,$212.40,$0.00,$41.55,$0.00,$42.27,$0.00
04.503.468,SUP,HCPCS C1713,,04.503.468  -  SCREW TI 8MM 2.7MM SLFTAP ER BONE MTRXMAND NONSTRL,$211.50,$0.00,$211.50,$95.18,$150.95,$0.00,$36.44,$0.00,$0.00,$37.03,$211.50,$0.00,$105.75,$167.51,$169.20,$0.00,$33.10,$0.00,$33.67,$0.00
04.503.468.01,SUP,HCPCS C1713,,04.503.468.01  -  SCREW TI 8MM 2.7MM SLFTAP ER BONE MTRXMAND NONSTRL,$265.50,$0.00,$265.50,$119.48,$189.49,$0.00,$45.74,$0.00,$0.00,$46.49,$265.50,$0.00,$132.75,$210.28,$212.40,$0.00,$41.55,$0.00,$42.27,$0.00
04.503.470,SUP,HCPCS C1713,,04.503.470  -  SCREW TI 10MM 2.7MM SLFTAP ER BONE MTRXMAND NONSTRL,$211.50,$0.00,$211.50,$95.18,$150.95,$0.00,$36.44,$0.00,$0.00,$37.03,$211.50,$0.00,$105.75,$167.51,$169.20,$0.00,$33.10,$0.00,$33.67,$0.00
04.503.470.01,SUP,HCPCS C1713,,04.503.470.01  -  SCREW TI 10MM 2.7MM SLFTAP ER BONE MTRXMAND NONSTRL,$265.50,$0.00,$265.50,$119.48,$189.49,$0.00,$45.74,$0.00,$0.00,$46.49,$265.50,$0.00,$132.75,$210.28,$212.40,$0.00,$41.55,$0.00,$42.27,$0.00
04.503.472.01,SUP,HCPCS C1713,,04.503.472.01  -  SCREW TI 12MM 2.7MM SLFTAP ER BONE MTRXMAND NONSTRL,$265.50,$0.00,$265.50,$119.48,$189.49,$0.00,$45.74,$0.00,$0.00,$46.49,$265.50,$0.00,$132.75,$210.28,$212.40,$0.00,$41.55,$0.00,$42.27,$0.00
04.503.474.01,SUP,HCPCS C1713,,04.503.474.01  -  SCREW TI 14MM 2.7MM SLFTAP ER BONE MTRXMAND NONSTRL,$265.50,$0.00,$265.50,$119.48,$189.49,$0.00,$45.74,$0.00,$0.00,$46.49,$265.50,$0.00,$132.75,$210.28,$212.40,$0.00,$41.55,$0.00,$42.27,$0.00
04.503.476.01,SUP,HCPCS C1713,,04.503.476.01  -  SCREW TI 16MM 2.7MM SLFTAP ER BONE MTRXMAND NONSTRL,$265.50,$0.00,$265.50,$119.48,$189.49,$0.00,$45.74,$0.00,$0.00,$46.49,$265.50,$0.00,$132.75,$210.28,$212.40,$0.00,$41.55,$0.00,$42.27,$0.00
04.503.478.01,SUP,HCPCS C1713,,04.503.478.01  -  SCREW TI 18MM 2.7MM SLFTAP ER BONE MTRXMAND NONSTRL,$265.50,$0.00,$265.50,$119.48,$189.49,$0.00,$45.74,$0.00,$0.00,$46.49,$265.50,$0.00,$132.75,$210.28,$212.40,$0.00,$41.55,$0.00,$42.27,$0.00
04.503.506.01,SUP,HCPCS C1713,,04.503.506.01  -  SCREW TI 6MM 2MM MANDIB SLFDRILL MTRX BONE MTRXMAND NONSTRL,$187.88,$0.00,$187.88,$84.54,$134.09,$0.00,$32.37,$0.00,$0.00,$32.90,$187.88,$0.00,$93.94,$148.80,$150.30,$0.00,$29.40,$0.00,$29.91,$0.00
04.503.508.01,SUP,HCPCS C1713,,04.503.508.01  -  SCREW TI 8MM 2MM MANDIB SLFDRILL MTRX BONE MTRXMAND NONSTRL,$187.88,$0.00,$187.88,$84.54,$134.09,$0.00,$32.37,$0.00,$0.00,$32.90,$187.88,$0.00,$93.94,$148.80,$150.30,$0.00,$29.40,$0.00,$29.91,$0.00
04.503.546.01,SUP,HCPCS C1713,,04.503.546.01  -  SCREW BONE 6MM 2MM MTRXMAND CRNMXF TI LCK SLFDRILL NONSTRL,$324.00,$0.00,$324.00,$145.80,$231.24,$0.00,$55.82,$0.00,$0.00,$56.73,$324.00,$0.00,$162.00,$256.61,$259.20,$0.00,$50.71,$0.00,$51.58,$0.00
04.503.548.01,SUP,HCPCS C1713,,04.503.548.01  -  SCREW BONE 8MM 2MM MTRXMAND CRNMXF TI LCK SLFDRILL NONSTRL,$324.00,$0.00,$324.00,$145.80,$231.24,$0.00,$55.82,$0.00,$0.00,$56.73,$324.00,$0.00,$162.00,$256.61,$259.20,$0.00,$50.71,$0.00,$51.58,$0.00
04.503.605,SUP,HCPCS C1713,,04.503.605  -  SCREW TI 5MM 2MM LCK SLFTAP BONE MTRXMAND NONSTRL,$252.00,$0.00,$252.00,$113.40,$179.85,$0.00,$43.42,$0.00,$0.00,$44.12,$252.00,$0.00,$126.00,$199.58,$201.60,$0.00,$39.44,$0.00,$40.12,$0.00
04.503.605.01,SUP,HCPCS C1713,,04.503.605.01  -  SCREW TI 5MM 2MM SLFTAP LCK BONE MTRXMAND NONSTRL,$317.25,$0.00,$317.25,$142.76,$226.42,$0.00,$54.66,$0.00,$0.00,$55.55,$317.25,$0.00,$158.63,$251.26,$253.80,$0.00,$49.65,$0.00,$50.51,$0.00
04.503.606.01,SUP,HCPCS C1713,,04.503.606.01  -  SCREW TI 6MM 2MM MANDIB SLFTAP LCK BONE MTRXMAND NONSTRL,$317.25,$0.00,$317.25,$142.76,$226.42,$0.00,$54.66,$0.00,$0.00,$55.55,$317.25,$0.00,$158.63,$251.26,$253.80,$0.00,$49.65,$0.00,$50.51,$0.00
04.503.608,SUP,HCPCS C1713,,04.503.608  -  SCREW TI 8MM 2MM SLFTAP LCK BONE MTRXMAND NONSTRL,$252.00,$0.00,$252.00,$113.40,$179.85,$0.00,$43.42,$0.00,$0.00,$44.12,$252.00,$0.00,$126.00,$199.58,$201.60,$0.00,$39.44,$0.00,$40.12,$0.00
04.503.608.01,SUP,HCPCS C1713,,04.503.608.01  -  SCREW TI 8MM 2.4MM SLFTAP ER BONE MTRXMAND STRL,$317.25,$0.00,$317.25,$142.76,$226.42,$0.00,$54.66,$0.00,$0.00,$55.55,$317.25,$0.00,$158.63,$251.26,$253.80,$0.00,$49.65,$0.00,$50.51,$0.00
04.503.608.01E,SUP,HCPCS C1713,,04.503.608.01E  -  SCREW TI 8MM 2.4MM SLFTAP ER BONE MTRXMAND STRL,$252.00,$0.00,$252.00,$113.40,$179.85,$0.00,$43.42,$0.00,$0.00,$44.12,$252.00,$0.00,$126.00,$199.58,$201.60,$0.00,$39.44,$0.00,$40.12,$0.00
04.503.610,SUP,HCPCS C1713,,04.503.610  -  SCREW TI 10MM 2MM SLFTAP LCK BONE MTRXMAND NONSTRL,$252.00,$0.00,$252.00,$113.40,$179.85,$0.00,$43.42,$0.00,$0.00,$44.12,$252.00,$0.00,$126.00,$199.58,$201.60,$0.00,$39.44,$0.00,$40.12,$0.00
04.503.610.01,SUP,HCPCS C1713,,04.503.610.01  -  SCREW TI 10MM 2MM MANDIB SLFTAP LCK BONE MTRXMAND NONSTRL,$317.25,$0.00,$317.25,$142.76,$226.42,$0.00,$54.66,$0.00,$0.00,$55.55,$317.25,$0.00,$158.63,$251.26,$253.80,$0.00,$49.65,$0.00,$50.51,$0.00
04.503.612,SUP,HCPCS C1713,,04.503.612  -  SCREW TI 12MM 2MM SLFTAP LCK BONE MTRXMAND NONSTRL,$252.00,$0.00,$252.00,$113.40,$179.85,$0.00,$43.42,$0.00,$0.00,$44.12,$252.00,$0.00,$126.00,$199.58,$201.60,$0.00,$39.44,$0.00,$40.12,$0.00
04.503.612.01,SUP,HCPCS C1713,,04.503.612.01  -  SCREW BONE 2MM 12MM TI MAXFACL SLFTAP LCK NONSTRL,$317.25,$0.00,$317.25,$142.76,$226.42,$0.00,$54.66,$0.00,$0.00,$55.55,$317.25,$0.00,$158.63,$251.26,$253.80,$0.00,$49.65,$0.00,$50.51,$0.00
04.503.614,SUP,HCPCS C1713,,04.503.614  -  SCREW TI 14MM 2MM LCK SLFTAP BONE MTRXMAND NONSTRL,$252.00,$0.00,$252.00,$113.40,$179.85,$0.00,$43.42,$0.00,$0.00,$44.12,$252.00,$0.00,$126.00,$199.58,$201.60,$0.00,$39.44,$0.00,$40.12,$0.00
04.503.614.01,SUP,HCPCS C1713,,04.503.614.01  -  SCREW BONE 2MM 14MM TI MAXFACL SLFTAP LCK NONSTRL,$317.25,$0.00,$317.25,$142.76,$226.42,$0.00,$54.66,$0.00,$0.00,$55.55,$317.25,$0.00,$158.63,$251.26,$253.80,$0.00,$49.65,$0.00,$50.51,$0.00
04.503.616,SUP,HCPCS C1713,,04.503.616  -  SCREW TI 16MM 2MM LCK SLFTAP BONE MTRXMAND NONSTRL,$252.00,$0.00,$252.00,$113.40,$179.85,$0.00,$43.42,$0.00,$0.00,$44.12,$252.00,$0.00,$126.00,$199.58,$201.60,$0.00,$39.44,$0.00,$40.12,$0.00
04.503.616.01,SUP,HCPCS C1713,,04.503.616.01  -  SCREW TI 16MM 2MM MANDIB SLFTAP LCK BONE MTRXMAND NONSTRL,$317.25,$0.00,$317.25,$142.76,$226.42,$0.00,$54.66,$0.00,$0.00,$55.55,$317.25,$0.00,$158.63,$251.26,$253.80,$0.00,$49.65,$0.00,$50.51,$0.00
04.503.618.01,SUP,HCPCS C1713,,04.503.618.01  -  SCREW TI 18MM 2MM SLFTAP LCK BONE MTRXMAND NONSTRL,$317.25,$0.00,$317.25,$142.76,$226.42,$0.00,$54.66,$0.00,$0.00,$55.55,$317.25,$0.00,$158.63,$251.26,$253.80,$0.00,$49.65,$0.00,$50.51,$0.00
04.503.638.01,SUP,HCPCS C1713,,04.503.638.01  -  SCREW TI 8MM 2.4MM MIDFAC SLFTAP LCK BONE MTRXMAND NONSTRL,$389.25,$0.00,$389.25,$175.16,$277.81,$0.00,$67.07,$0.00,$0.00,$68.15,$389.25,$0.00,$194.63,$308.29,$311.40,$0.00,$60.92,$0.00,$61.97,$0.00
04.503.640,SUP,HCPCS C1713,,04.503.640  -  SCREW TI 10MM 2.4MM SLFTAP LCK BONE MTRXMAND NONSTRL,$310.50,$0.00,$310.50,$139.73,$221.60,$0.00,$53.50,$0.00,$0.00,$54.37,$310.50,$0.00,$155.25,$245.92,$248.40,$0.00,$48.59,$0.00,$49.43,$0.00
04.503.640.01,SUP,HCPCS C1713,,04.503.640.01  -  SCREW TI 10MM 2.4MM SLFTAP LCK BONE MTRXMAND NONSTRL,$389.25,$0.00,$389.25,$175.16,$277.81,$0.00,$67.07,$0.00,$0.00,$68.15,$389.25,$0.00,$194.63,$308.29,$311.40,$0.00,$60.92,$0.00,$61.97,$0.00
04.503.642.01,SUP,HCPCS C1713,,04.503.642.01  -  SCREW TI 12MM 2.4MM SLFTAP LCK BONE MTRXMAND NONSTRL,$389.25,$0.00,$389.25,$175.16,$277.81,$0.00,$67.07,$0.00,$0.00,$68.15,$389.25,$0.00,$194.63,$308.29,$311.40,$0.00,$60.92,$0.00,$61.97,$0.00
04.503.644,SUP,HCPCS C1713,,04.503.644  -  SCREW TI 14MM 2.4MM SLFTAP LCK BONE MTRXMAND NONSTRL,$310.50,$0.00,$310.50,$139.73,$221.60,$0.00,$53.50,$0.00,$0.00,$54.37,$310.50,$0.00,$155.25,$245.92,$248.40,$0.00,$48.59,$0.00,$49.43,$0.00
04.503.644.01,SUP,HCPCS C1713,,04.503.644.01  -  SCREW TI 14MM 2.4MM SLFTAP LCK BONE MTRXMAND NONSTRL,$389.25,$0.00,$389.25,$175.16,$277.81,$0.00,$67.07,$0.00,$0.00,$68.15,$389.25,$0.00,$194.63,$308.29,$311.40,$0.00,$60.92,$0.00,$61.97,$0.00
04.503.646,SUP,HCPCS C1713,,04.503.646  -  SCREW TI 16MM 2.4MM LCK SLFTAP BONE MTRXMAND NONSTRL,$310.50,$0.00,$310.50,$139.73,$221.60,$0.00,$53.50,$0.00,$0.00,$54.37,$310.50,$0.00,$155.25,$245.92,$248.40,$0.00,$48.59,$0.00,$49.43,$0.00
04.503.646.01,SUP,HCPCS C1713,,04.503.646.01  -  SCREW TI 16MM 2.4MM SLFTAP LCK BONE MTRXMAND NONSTRL,$389.25,$0.00,$389.25,$175.16,$277.81,$0.00,$67.07,$0.00,$0.00,$68.15,$389.25,$0.00,$194.63,$308.29,$311.40,$0.00,$60.92,$0.00,$61.97,$0.00
04.503.648.01,SUP,HCPCS C1713,,04.503.648.01  -  SCREW TI 18MM 2.4MM SLFTAP LCK BONE MTRXMAND NONSTRL,$389.25,$0.00,$389.25,$175.16,$277.81,$0.00,$67.07,$0.00,$0.00,$68.15,$389.25,$0.00,$194.63,$308.29,$311.40,$0.00,$60.92,$0.00,$61.97,$0.00
04.503.668.01,SUP,HCPCS C1713,,04.503.668.01  -  SCREW BONE 2.8MM 8MM TI LCK,$447.75,$0.00,$447.75,$201.49,$319.56,$0.00,$77.15,$0.00,$0.00,$78.40,$447.75,$0.00,$223.88,$354.62,$358.20,$0.00,$70.07,$0.00,$71.28,$0.00
04.503.670,SUP,HCPCS C1713,,04.503.670  -  SCREW TI 10MM 2.9MM LCK SLFTAP BONE MTRXMAND NONSTRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
04.503.670.01,SUP,HCPCS C1713,,04.503.670.01  -  SCREW BONE 2.8MM 10MM TI LCK,$447.75,$0.00,$447.75,$201.49,$319.56,$0.00,$77.15,$0.00,$0.00,$78.40,$447.75,$0.00,$223.88,$354.62,$358.20,$0.00,$70.07,$0.00,$71.28,$0.00
04.503.672,SUP,HCPCS C1713,,04.503.672  -  SCREW TI 12MM 2.9MM LCK SLFTAP BONE MTRXMAND NONSTRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
04.503.672.01,SUP,HCPCS C1713,,04.503.672.01  -  SCREW BONE 2.9MM 12MM TI LCK,$447.75,$0.00,$447.75,$201.49,$319.56,$0.00,$77.15,$0.00,$0.00,$78.40,$447.75,$0.00,$223.88,$354.62,$358.20,$0.00,$70.07,$0.00,$71.28,$0.00
04.503.674.01,SUP,HCPCS C1713,,04.503.674.01  -  SCREW BONE 2.9MM 14MM TI LCK,$447.75,$0.00,$447.75,$201.49,$319.56,$0.00,$77.15,$0.00,$0.00,$78.40,$447.75,$0.00,$223.88,$354.62,$358.20,$0.00,$70.07,$0.00,$71.28,$0.00
04.503.676.01,SUP,HCPCS C1713,,04.503.676.01  -  SCREW BONE 2.8MM 16MM TI LCK,$447.75,$0.00,$447.75,$201.49,$319.56,$0.00,$77.15,$0.00,$0.00,$78.40,$447.75,$0.00,$223.88,$354.62,$358.20,$0.00,$70.07,$0.00,$71.28,$0.00
04.503.678.01,SUP,HCPCS C1713,,04.503.678.01  -  SCREW TI 18MM 2.9MM SLFTAP LCK BONE MTRXMAND,$447.75,$0.00,$447.75,$201.49,$319.56,$0.00,$77.15,$0.00,$0.00,$78.40,$447.75,$0.00,$223.88,$354.62,$358.20,$0.00,$70.07,$0.00,$71.28,$0.00
04.503.701,SUP,HCPCS C1713,,04.503.701  -  PLATE BN MN NAR 1MM NS MATRIXMANDIBLE 2X2 HL TNSNBND MLBL TI,$922.50,$0.00,$922.50,$415.13,$658.39,$0.00,$158.94,$0.00,$0.00,$161.52,$922.50,$0.00,$461.25,$730.62,$738.00,$0.00,$144.37,$0.00,$146.86,$0.00
04.503.702,SUP,HCPCS C1713,,04.503.702  -  PLATE MINI NAR 1MM MANDIB 2X2 HOLE TNSNBND BONE MTRXMAND TI,$922.50,$0.00,$922.50,$415.13,$658.39,$0.00,$158.94,$0.00,$0.00,$161.52,$922.50,$0.00,$461.25,$730.62,$738.00,$0.00,$144.37,$0.00,$146.86,$0.00
04.503.703,SUP,HCPCS C1713,,04.503.703  -  PLATE BN MN NAR 1MM NS MATRIXMANDIBLE 3X3 HL TNSNBND MLBL TI,"$1,005.75",$0.00,"$1,005.75",$452.59,$717.80,$0.00,$173.29,$0.00,$0.00,$176.10,"$1,005.75",$0.00,$502.88,$796.55,$804.60,$0.00,$157.40,$0.00,$160.12,$0.00
04.503.704,SUP,HCPCS C1713,,04.503.704  -  PLATE MINI NAR NONSTRL 1MM 2X2 HOLE TNSNBND MALBLE BONE,"$1,005.75",$0.00,"$1,005.75",$452.59,$717.80,$0.00,$173.29,$0.00,$0.00,$176.10,"$1,005.75",$0.00,$502.88,$796.55,$804.60,$0.00,$157.40,$0.00,$160.12,$0.00
04.503.705,SUP,HCPCS C1713,,04.503.705  -  PLATE BN 1MM NS MATRIXMANDIBLE 12 HL ADP TI MNDB,"$1,651.50",$0.00,"$1,651.50",$743.18,"$1,178.68",$0.00,$284.55,$0.00,$0.00,$289.16,"$1,651.50",$0.00,$825.75,"$1,307.99","$1,321.20",$0.00,$258.46,$0.00,$262.92,$0.00
04.503.706,SUP,HCPCS C1713,,04.503.706  -  PLATE BN 1MM NS MATRIXMANDIBLE 20 HL ADP TI MNDB,"$1,809.00",$0.00,"$1,809.00",$814.05,"$1,291.08",$0.00,$311.68,$0.00,$0.00,$316.74,"$1,809.00",$0.00,$904.50,"$1,432.73","$1,447.20",$0.00,$283.11,$0.00,$287.99,$0.00
04.503.707,SUP,HCPCS C1713,,04.503.707  -  PLATE BN BX 1MM NS MATRIXMANDIBLE 4 HL MLBL TI MNDB,$722.25,$0.00,$722.25,$325.01,$515.47,$0.00,$124.44,$0.00,$0.00,$126.46,$722.25,$0.00,$361.13,$572.02,$577.80,$0.00,$113.03,$0.00,$114.98,$0.00
04.503.708,SUP,HCPCS C1713,,04.503.708  -  PLATE BN 1MM NS MATRIXMANDIBLE 8 HL MLBL STRUT TI MNDB,"$1,419.75",$0.00,"$1,419.75",$638.89,"$1,013.28",$0.00,$244.62,$0.00,$0.00,$248.59,"$1,419.75",$0.00,$709.88,"$1,124.44","$1,135.80",$0.00,$222.19,$0.00,$226.02,$0.00
04.503.709,SUP,HCPCS C1713,,04.503.709  -  PLATE BN MN CRV 1MM NS MATRIXMANDIBLE 8 HL MLBL STRUT TI,"$1,419.75",$0.00,"$1,419.75",$638.89,"$1,013.28",$0.00,$244.62,$0.00,$0.00,$248.59,"$1,419.75",$0.00,$709.88,"$1,124.44","$1,135.80",$0.00,$222.19,$0.00,$226.02,$0.00
04.503.710,SUP,HCPCS C1713,,04.503.710  -  PLATE BN STRG 1.25MM NS MATRIXMANDIBLE DCP 2X2 HL TI MNDB,$893.25,$0.00,$893.25,$401.96,$637.51,$0.00,$153.90,$0.00,$0.00,$156.40,$893.25,$0.00,$446.63,$707.45,$714.60,$0.00,$139.79,$0.00,$142.21,$0.00
04.503.711,SUP,HCPCS C1713,,04.503.711  -  PLATE BN CRSNT 1.25MM NS MATRIXMANDIBLE 2X2 HL TI MNDB,"$1,188.00",$0.00,"$1,188.00",$534.60,$847.88,$0.00,$204.69,$0.00,$0.00,$208.01,"$1,188.00",$0.00,$594.00,$940.90,$950.40,$0.00,$185.92,$0.00,$189.13,$0.00
04.503.712,SUP,HCPCS C1713,,04.503.712  -  PLATE BN STRG 1.25MM NS MATRIXMANDIBLE DCP 3X3 HL TI MNDB,"$1,050.75",$0.00,"$1,050.75",$472.84,$749.92,$0.00,$181.04,$0.00,$0.00,$183.98,"$1,050.75",$0.00,$525.38,$832.19,$840.60,$0.00,$164.44,$0.00,$167.28,$0.00
04.503.713,SUP,HCPCS C1713,,04.503.713  -  PLATE BN CRSNT 1.25MM NS MATRIXMANDIBLE DCP 3X3 HL TI MNDB,"$1,264.50",$0.00,"$1,264.50",$569.03,$902.47,$0.00,$217.87,$0.00,$0.00,$221.40,"$1,264.50",$0.00,$632.25,"$1,001.48","$1,011.60",$0.00,$197.89,$0.00,$201.31,$0.00
04.503.714,SUP,HCPCS C1713,,04.503.714  -  PLATE BN ANG 1.25MM NS MATRIXMANDIBLE DCP 3X3 HL TI MNDB,"$1,323.00",$0.00,"$1,323.00",$595.35,$944.23,$0.00,$227.95,$0.00,$0.00,$231.65,"$1,323.00",$0.00,$661.50,"$1,047.82","$1,058.40",$0.00,$207.05,$0.00,$210.62,$0.00
04.503.715,SUP,HCPCS C1713,,04.503.715  -  PLATE BN STRG 1.5MM NS MATRIXMANDIBLE 6 HL TI MNDB,"$1,784.25",$0.00,"$1,784.25",$802.91,"$1,273.42",$0.00,$307.42,$0.00,$0.00,$312.41,"$1,784.25",$0.00,$892.13,"$1,413.13","$1,427.40",$0.00,$279.24,$0.00,$284.05,$0.00
04.503.716,SUP,HCPCS C1713,,04.503.716  -  PLATE BN STRG 1.5MM NS MATRIXMANDIBLE 3X3 HL TI MNDB,"$1,784.25",$0.00,"$1,784.25",$802.91,"$1,273.42",$0.00,$307.42,$0.00,$0.00,$312.41,"$1,784.25",$0.00,$892.13,"$1,413.13","$1,427.40",$0.00,$279.24,$0.00,$284.05,$0.00
04.503.717,SUP,HCPCS C1713,,04.503.717  -  PLATE BN STRG 1.5MM NS MATRIXMANDIBLE 12 HL TI MNDB,"$2,043.00",$0.00,"$2,043.00",$919.35,"$1,458.09",$0.00,$352.00,$0.00,$0.00,$357.71,"$2,043.00",$0.00,"$1,021.50","$1,618.06","$1,634.40",$0.00,$319.73,$0.00,$325.25,$0.00
04.503.718,SUP,HCPCS C1713,,04.503.718  -  PLATE BN STRG 1.5MM NS MATRIXMANDIBLE 20 HL TI MNDB,"$2,819.25",$0.00,"$2,819.25","$1,268.66","$2,012.10",$0.00,$485.74,$0.00,$0.00,$493.63,"$2,819.25",$0.00,"$1,409.63","$2,232.85","$2,255.40",$0.00,$441.21,$0.00,$448.82,$0.00
04.503.721,SUP,HCPCS C1713,,04.503.721  -  PLATE BN ANG 1.5MM NS MATRIXMANDIBLE 3X3 HL TI MNDB,"$2,457.00",$0.00,"$2,457.00","$1,105.65","$1,753.56",$0.00,$423.33,$0.00,$0.00,$430.20,"$2,457.00",$0.00,"$1,228.50","$1,945.94","$1,965.60",$0.00,$384.52,$0.00,$391.15,$0.00
04.503.722,SUP,HCPCS C1713,,04.503.722  -  PLATE BN CRSNT 1.5MM NS MATRIXMANDIBLE 3X3 HL TI MNDB,"$2,457.00",$0.00,"$2,457.00","$1,105.65","$1,753.56",$0.00,$423.33,$0.00,$0.00,$430.20,"$2,457.00",$0.00,"$1,228.50","$1,945.94","$1,965.60",$0.00,$384.52,$0.00,$391.15,$0.00
04.503.723,SUP,HCPCS C1713,,04.503.723  -  PLATE BN STRG 1.5MM NS MATRIXMANDIBLE DCP 2X2 HL TI MNDB,"$1,590.75",$0.00,"$1,590.75",$715.84,"$1,135.32",$0.00,$274.08,$0.00,$0.00,$278.53,"$1,590.75",$0.00,$795.38,"$1,259.87","$1,272.60",$0.00,$248.95,$0.00,$253.25,$0.00
04.503.724,SUP,HCPCS C1713,,04.503.724  -  PLATE BN STRG 1.5MM NS MATRIXMANDIBLE DCP 3X3 HL TI MNDB,"$1,683.00",$0.00,"$1,683.00",$757.35,"$1,201.16",$0.00,$289.97,$0.00,$0.00,$294.68,"$1,683.00",$0.00,$841.50,"$1,332.94","$1,346.40",$0.00,$263.39,$0.00,$267.93,$0.00
04.503.726,SUP,HCPCS C1713,,04.503.726  -  PLATE BN BRD CRSNT 2MM NS MATRIXMANDIBLE 2X2 HL TI MNDB,"$1,732.50",$0.00,"$1,732.50",$779.63,"$1,236.49",$0.00,$298.50,$0.00,$0.00,$303.35,"$1,732.50",$0.00,$866.25,"$1,372.14","$1,386.00",$0.00,$271.14,$0.00,$275.81,$0.00
04.503.727,SUP,HCPCS C1713,,04.503.727  -  PLATE BN BRD CRSNT 2MM NS MATRIXMANDIBLE 3X3 HL TI MNDB,"$1,863.00",$0.00,"$1,863.00",$838.35,"$1,329.62",$0.00,$320.99,$0.00,$0.00,$326.20,"$1,863.00",$0.00,$931.50,"$1,475.50","$1,490.40",$0.00,$291.56,$0.00,$296.59,$0.00
04.503.728,SUP,HCPCS C1713,,04.503.728  -  PLATE BN STRG 2MM NS MATRIXMANDIBLE 6 HL TI MNDB,"$1,732.50",$0.00,"$1,732.50",$779.63,"$1,236.49",$0.00,$298.50,$0.00,$0.00,$303.35,"$1,732.50",$0.00,$866.25,"$1,372.14","$1,386.00",$0.00,$271.14,$0.00,$275.81,$0.00
04.503.729,SUP,HCPCS C1713,,04.503.729  -  PLATE BN STRG 2MM NS MATRIXMANDIBLE 12 HL TI MNDB,"$2,342.25",$0.00,"$2,342.25","$1,054.01","$1,671.66",$0.00,$403.56,$0.00,$0.00,$410.11,"$2,342.25",$0.00,"$1,171.13","$1,855.06","$1,873.80",$0.00,$366.56,$0.00,$372.89,$0.00
04.503.730,SUP,HCPCS C1713,,04.503.730  -  PLATE BN STRG 2MM NS MATRIXMANDIBLE 20 HL TI MNDB,"$2,954.25",$0.00,"$2,954.25","$1,329.41","$2,108.45",$0.00,$509.00,$0.00,$0.00,$517.27,"$2,954.25",$0.00,"$1,477.13","$2,339.77","$2,363.40",$0.00,$462.34,$0.00,$470.32,$0.00
04.503.731,SUP,HCPCS C1713,,04.503.731  -  PLATE BN BRD ANG 2MM NS MATRIXMANDIBLE 3X3 HL TI MNDB,"$2,556.00",$0.00,"$2,556.00","$1,150.20","$1,824.22",$0.00,$440.39,$0.00,$0.00,$447.54,"$2,556.00",$0.00,"$1,278.00","$2,024.35","$2,044.80",$0.00,$400.01,$0.00,$406.92,$0.00
04.503.732,SUP,HCPCS C1713,,04.503.732  -  PLATE BN LT ANG 2MM NS MATRIXMANDIBLE 7X23 HL RECON TI MNDB,"$4,887.00",$0.00,"$4,887.00","$2,199.15","$3,487.85",$0.00,$842.01,$0.00,$0.00,$855.67,"$4,887.00",$0.00,"$2,443.50","$3,870.50","$3,909.60",$0.00,$764.82,$0.00,$778.01,$0.00
04.503.733,SUP,HCPCS C1713,,04.503.733  -  PLATE BN RT ANG 2MM NS MATRIXMANDIBLE 7X23 HL RECON TI MNDB,"$4,887.00",$0.00,"$4,887.00","$2,199.15","$3,487.85",$0.00,$842.01,$0.00,$0.00,$855.67,"$4,887.00",$0.00,"$2,443.50","$3,870.50","$3,909.60",$0.00,$764.82,$0.00,$778.01,$0.00
04.503.734,SUP,HCPCS C1713,,04.503.734  -  PLATE BN 2 ANG SM 2MM NS MATRIXMANDIBLE 4X20X4 HL RECON TI,"$5,656.50",$0.00,"$5,656.50","$2,545.43","$4,037.04",$0.00,$974.59,$0.00,$0.00,$990.41,"$5,656.50",$0.00,"$2,828.25","$4,479.95","$4,525.20",$0.00,$885.24,$0.00,$900.51,$0.00
04.503.735,SUP,HCPCS C1713,,04.503.735  -  PLATE BN 2 ANG MED 2MM NS MATRIXMANDIBLE 5X22X5 HL RECON TI,"$5,973.75",$0.00,"$5,973.75","$2,688.19","$4,263.47",$0.00,"$1,029.25",$0.00,$0.00,"$1,045.96","$5,973.75",$0.00,"$2,986.88","$4,731.21","$4,779.00",$0.00,$934.89,$0.00,$951.02,$0.00
04.503.736,SUP,HCPCS C1713,,04.503.736  -  PLATE BN 2 ANG LG 2MM NS MATRIXMANDIBLE 6X24X6 HL RECON TI,"$6,293.25",$0.00,"$6,293.25","$2,831.96","$4,491.49",$0.00,"$1,084.30",$0.00,$0.00,"$1,101.90","$6,293.25",$0.00,"$3,146.63","$4,984.25","$5,034.60",$0.00,$984.89,$0.00,"$1,001.89",$0.00
04.503.737,SUP,HCPCS C1713,,04.503.737  -  PLATE BN STRG 2.5MM NS MATRIXMANDIBLE 12 HL RECON TI MNDB,"$2,520.00",$0.00,"$2,520.00","$1,134.00","$1,798.52",$0.00,$434.18,$0.00,$0.00,$441.23,"$2,520.00",$0.00,"$1,260.00","$1,995.84","$2,016.00",$0.00,$394.38,$0.00,$401.18,$0.00
04.503.738,SUP,HCPCS C1713,,04.503.738  -  PLATE BN STRG 2.5MM NS MATRIXMANDIBLE 20 HL RECON TI MNDB,"$3,492.00",$0.00,"$3,492.00","$1,571.40","$2,492.24",$0.00,$601.65,$0.00,$0.00,$611.42,"$3,492.00",$0.00,"$1,746.00","$2,765.66","$2,793.60",$0.00,$546.50,$0.00,$555.93,$0.00
04.503.739,SUP,HCPCS C1713,,04.503.739  -  PLATE BN LT ANG 2.5MM NS MATRIXMANDIBLE 7X23 HL RECON TI,"$5,260.50",$0.00,"$5,260.50","$2,367.23","$3,754.42",$0.00,$906.36,$0.00,$0.00,$921.07,"$5,260.50",$0.00,"$2,630.25","$4,166.32","$4,208.40",$0.00,$823.27,$0.00,$837.47,$0.00
04.503.740,SUP,HCPCS C1713,,04.503.740  -  PLATE BN RT ANG 2.5MM NS MATRIXMANDIBLE 7X23 HL RECON TI,"$5,260.50",$0.00,"$5,260.50","$2,367.23","$3,754.42",$0.00,$906.36,$0.00,$0.00,$921.07,"$5,260.50",$0.00,"$2,630.25","$4,166.32","$4,208.40",$0.00,$823.27,$0.00,$837.47,$0.00
04.503.741,SUP,HCPCS C1713,,04.503.741  -  PLATE BN 2 ANG SM 2.5MM NS MATRIXMANDIBLE 4X20X4 HL RECON TI,"$6,090.75",$0.00,"$6,090.75","$2,740.84","$4,346.97",$0.00,"$1,049.41",$0.00,$0.00,"$1,066.44","$6,090.75",$0.00,"$3,045.38","$4,823.87","$4,872.60",$0.00,$953.20,$0.00,$969.65,$0.00
04.503.742,SUP,HCPCS C1713,,04.503.742  -  PLATE BN 2 ANG MED 2.5MM NS MATRIXMANDIBLE 5X22X5 HL RECON,"$6,428.25",$0.00,"$6,428.25","$2,892.71","$4,587.84",$0.00,"$1,107.56",$0.00,$0.00,"$1,125.54","$6,428.25",$0.00,"$3,214.13","$5,091.17","$5,142.60",$0.00,"$1,006.02",$0.00,"$1,023.38",$0.00
04.503.743,SUP,HCPCS C1713,,04.503.743  -  PLATE BN 2 ANG LG 2.5MM NS MATRIXMANDIBLE 6X24X6 HL RECON TI,"$6,783.75",$0.00,"$6,783.75","$3,052.69","$4,841.56",$0.00,"$1,168.81",$0.00,$0.00,"$1,187.78","$6,783.75",$0.00,"$3,391.88","$5,372.73","$5,427.00",$0.00,"$1,061.66",$0.00,"$1,079.97",$0.00
04.503.750,SUP,HCPCS C1713,,04.503.750  -  PLATE BN BRD MN 1MM NS MATRIXMANDIBLE 2X2 HL MLBL TNSNBND TI,"$1,152.00",$0.00,"$1,152.00",$518.40,$822.18,$0.00,$198.48,$0.00,$0.00,$201.71,"$1,152.00",$0.00,$576.00,$912.38,$921.60,$0.00,$180.29,$0.00,$183.40,$0.00
04.503.751,SUP,HCPCS C1713,,04.503.751  -  PLATE BN BRD MN 1MM NS MATRIXMANDIBLE 2X3 HL MLBL TNSNBND TI,"$1,197.00",$0.00,"$1,197.00",$538.65,$854.30,$0.00,$206.24,$0.00,$0.00,$209.59,"$1,197.00",$0.00,$598.50,$948.02,$957.60,$0.00,$187.33,$0.00,$190.56,$0.00
04.503.752,SUP,HCPCS C1713,,04.503.752  -  PLATE BN BRD MN 1MM NS MATRIXMANDIBLE 3X3 HL MLBL TNSNBND TI,"$1,244.25",$0.00,"$1,244.25",$559.91,$888.02,$0.00,$214.38,$0.00,$0.00,$217.86,"$1,244.25",$0.00,$622.13,$985.45,$995.40,$0.00,$194.73,$0.00,$198.08,$0.00
04.503.756,SUP,HCPCS C1713,,04.503.756  -  PLATE BN 1.25MM NS MATRIXMANDIBLE 12 HL ADP TI MNDB,"$1,773.00",$0.00,"$1,773.00",$797.85,"$1,265.39",$0.00,$305.48,$0.00,$0.00,$310.44,"$1,773.00",$0.00,$886.50,"$1,404.22","$1,418.40",$0.00,$277.47,$0.00,$282.26,$0.00
04.503.761,SUP,HCPCS C1713,,04.503.761  -  PLATE BONE STR 1.25MM 2X2 HOLE MTRXMAND DCP SILVER TITANIUM,"$1,188.00",$0.00,"$1,188.00",$534.60,$847.88,$0.00,$204.69,$0.00,$0.00,$208.01,"$1,188.00",$0.00,$594.00,$940.90,$950.40,$0.00,$185.92,$0.00,$189.13,$0.00
04.503.770,SUP,HCPCS C1713,,04.503.770  -  PLATE BN STRG 2.8MM NS MATRIXMANDIBLE 12 HL RECON TI MNDB,"$2,965.50",$0.00,"$2,965.50","$1,334.48","$2,116.48",$0.00,$510.94,$0.00,$0.00,$519.24,"$2,965.50",$0.00,"$1,482.75","$2,348.68","$2,372.40",$0.00,$464.10,$0.00,$472.11,$0.00
04.503.771,SUP,HCPCS C1713,,04.503.771  -  PLATE BN STRG 2.8MM NS MATRIXMANDIBLE 20 HL RECON TI MNDB,"$4,338.00",$0.00,"$4,338.00","$1,952.10","$3,096.03",$0.00,$747.42,$0.00,$0.00,$759.55,"$4,338.00",$0.00,"$2,169.00","$3,435.70","$3,470.40",$0.00,$678.90,$0.00,$690.61,$0.00
04.503.772,SUP,HCPCS C1713,,04.503.772  -  PLATE BN LT ANG 2.8MM NS MATRIXMANDIBLE 7X23 HL RECON TI,"$6,444.00",$0.00,"$6,444.00","$2,899.80","$4,599.08",$0.00,"$1,110.27",$0.00,$0.00,"$1,128.29","$6,444.00",$0.00,"$3,222.00","$5,103.65","$5,155.20",$0.00,"$1,008.49",$0.00,"$1,025.88",$0.00
04.503.773,SUP,HCPCS C1713,,04.503.773  -  PLATE BN RT ANG 2.8MM NS MATRIXMANDIBLE 7X23 HL RECON TI,"$6,444.00",$0.00,"$6,444.00","$2,899.80","$4,599.08",$0.00,"$1,110.27",$0.00,$0.00,"$1,128.29","$6,444.00",$0.00,"$3,222.00","$5,103.65","$5,155.20",$0.00,"$1,008.49",$0.00,"$1,025.88",$0.00
04.503.780,SUP,HCPCS C1713,,04.503.780  -  PLATE 1MM RIGHT MANDIB 2 HOLE LCK TNSNBND PREBNT BONE,$987.75,$0.00,$987.75,$444.49,$704.96,$0.00,$170.18,$0.00,$0.00,$172.95,$987.75,$0.00,$493.88,$782.30,$790.20,$0.00,$154.58,$0.00,$157.25,$0.00
04.503.781,SUP,HCPCS C1713,,04.503.781  -  PLATE 1MM LEFT MANDIB 2 HOLE LCK TNSNBND PREBNT BONE,$987.75,$0.00,$987.75,$444.49,$704.96,$0.00,$170.18,$0.00,$0.00,$172.95,$987.75,$0.00,$493.88,$782.30,$790.20,$0.00,$154.58,$0.00,$157.25,$0.00
04.503.783,SUP,HCPCS C1713,,04.503.783  -  PLATE BONE 1MM 4 HOLE ADAPTION MTRXMAND SILVER TITANIUM,$927.00,$0.00,$927.00,$417.15,$661.60,$0.00,$159.72,$0.00,$0.00,$162.31,$927.00,$0.00,$463.50,$734.18,$741.60,$0.00,$145.08,$0.00,$147.58,$0.00
04.503.801,SUP,HCPCS C1713,,04.503.801  -  PLATE BN 3D SM .4MM NS MATRIXMIDFACE MATRIXORBITAL PREFORM,"$4,167.00",$0.00,"$4,167.00","$1,875.15","$2,973.99",$0.00,$717.95,$0.00,$0.00,$729.61,"$4,167.00",$0.00,"$2,083.50","$3,300.26","$3,333.60",$0.00,$652.14,$0.00,$663.39,$0.00
04.503.802,SUP,HCPCS C1713,,04.503.802  -  PLATE BN 3D LG .4MM NS MATRIXMIDFACE MATRIXORBITAL PREFORM,"$4,311.00",$0.00,"$4,311.00","$1,939.95","$3,076.76",$0.00,$742.76,$0.00,$0.00,$754.82,"$4,311.00",$0.00,"$2,155.50","$3,414.31","$3,448.80",$0.00,$674.67,$0.00,$686.31,$0.00
04.503.811,SUP,HCPCS C1713,,04.503.811  -  PLATE BN 3D SM .4MM NS MATRIXMIDFACE MATRIXORBITAL PREFORM,"$4,167.00",$0.00,"$4,167.00","$1,875.15","$2,973.99",$0.00,$717.95,$0.00,$0.00,$729.61,"$4,167.00",$0.00,"$2,083.50","$3,300.26","$3,333.60",$0.00,$652.14,$0.00,$663.39,$0.00
04.503.812,SUP,HCPCS C1713,,04.503.812  -  PLATE BN 3D LG .4MM NS MATRIXMIDFACE MATRIXORBITAL PREFORM,"$4,311.00",$0.00,"$4,311.00","$1,939.95","$3,076.76",$0.00,$742.76,$0.00,$0.00,$754.82,"$4,311.00",$0.00,"$2,155.50","$3,414.31","$3,448.80",$0.00,$674.67,$0.00,$686.31,$0.00
04.503.820,SUP,HCPCS C1713,,04.503.820  -  PLATE BN SHRT NS MATRIXWAVE 10 HL TI MXLMNDB,$776.25,$0.00,$776.25,$349.31,$554.01,$0.00,$133.74,$0.00,$0.00,$135.92,$776.25,$0.00,$388.13,$614.79,$621.00,$0.00,$121.48,$0.00,$123.58,$0.00
04.503.824.01,SUP,HCPCS C1713,,04.503.824.01  -  MATRIXWAVE MMF TI 1.85MM SCREW SELF-DRILLING/6MM LENGTH,$337.50,$0.00,$337.50,$151.88,$240.87,$0.00,$58.15,$0.00,$0.00,$59.09,$337.50,$0.00,$168.75,$267.30,$270.00,$0.00,$52.82,$0.00,$53.73,$0.00
04.503.825.01,SUP,HCPCS C1713,,04.503.825.01  -  SCREW BONE 8MM SELF DRILL MATRIXWAVE TITANIUM 1.85MM,$337.50,$0.00,$337.50,$151.88,$240.87,$0.00,$58.15,$0.00,$0.00,$59.09,$337.50,$0.00,$168.75,$267.30,$270.00,$0.00,$52.82,$0.00,$53.73,$0.00
04.503.830,SUP,HCPCS C1713,,04.503.830  -  PLATE RIGHT SUBCONDYLAR 7 HOLE MALBLE LMBD BONE MTRXMAND,"$2,099.25",$0.00,"$2,099.25",$944.66,"$1,498.23",$0.00,$361.69,$0.00,$0.00,$367.56,"$2,099.25",$0.00,"$1,049.63","$1,662.61","$1,679.40",$0.00,$328.53,$0.00,$334.20,$0.00
04.503.831,SUP,HCPCS C1713,,04.503.831  -  PLATE LEFT SUBCONDYLAR 7 HOLE MALBLE LMBD BONE MTRXMAND,"$2,099.25",$0.00,"$2,099.25",$944.66,"$1,498.23",$0.00,$361.69,$0.00,$0.00,$367.56,"$2,099.25",$0.00,"$1,049.63","$1,662.61","$1,679.40",$0.00,$328.53,$0.00,$334.20,$0.00
04.503.834,SUP,HCPCS C1713,,04.503.834  -  PLATE THK1MM SM SUBCONDYLAR 4 HOLE TRPZD MALBLE BONE,"$2,099.25",$0.00,"$2,099.25",$944.66,"$1,498.23",$0.00,$361.69,$0.00,$0.00,$367.56,"$2,099.25",$0.00,"$1,049.63","$1,662.61","$1,679.40",$0.00,$328.53,$0.00,$334.20,$0.00
04.503.900,SUP,HCPCS C1713,,04.503.900  -  PLATE BN SM 2.5MM NS MATRIXMANDIBLE PRFRM RECON TI MNDB RT,"$7,143.75",$0.00,"$7,143.75","$3,214.69","$5,098.49",$0.00,"$1,230.83",$0.00,$0.00,"$1,250.81","$7,143.75",$0.00,"$3,571.88","$5,657.85","$5,715.00",$0.00,"$1,118.00",$0.00,"$1,137.29",$0.00
04.503.901,SUP,HCPCS C1713,,04.503.901  -  PLATE BN SM 2.5MM NS MATRIXMANDIBLE PRFRM RECON TI MNDB LT,"$7,143.75",$0.00,"$7,143.75","$3,214.69","$5,098.49",$0.00,"$1,230.83",$0.00,$0.00,"$1,250.81","$7,143.75",$0.00,"$3,571.88","$5,657.85","$5,715.00",$0.00,"$1,118.00",$0.00,"$1,137.29",$0.00
04.503.902,SUP,HCPCS C1713,,04.503.902  -  PLATE BN MED 2.5MM NS MATRIXMANDIBLE PRFRM RECON TI MNDB RT,"$7,411.50",$0.00,"$7,411.50","$3,335.18","$5,158.80",$0.00,"$1,276.96",$0.00,$0.00,"$1,297.69","$7,411.50",$0.00,"$3,705.75","$5,869.91","$5,929.20",$0.00,"$1,159.90",$0.00,"$1,179.91",$0.00
04.503.903,SUP,HCPCS C1713,,04.503.903  -  PLATE BN MED 2.5MM NS MATRIXMANDIBLE PRFRM RECON TI MNDB LT,"$7,411.50",$0.00,"$7,411.50","$3,335.18","$5,158.80",$0.00,"$1,276.96",$0.00,$0.00,"$1,297.69","$7,411.50",$0.00,"$3,705.75","$5,869.91","$5,929.20",$0.00,"$1,159.90",$0.00,"$1,179.91",$0.00
04.503.904,SUP,HCPCS C1713,,04.503.904  -  PLATE BN LG 2.5MM NS MATRIXMANDIBLE PRFRM RECON TI MNDB RT,"$7,679.25",$0.00,"$7,679.25","$3,455.66","$5,158.80",$0.00,"$1,323.10",$0.00,$0.00,"$1,344.58","$7,679.25",$0.00,"$3,839.63","$6,081.97","$6,143.40",$0.00,"$1,201.80",$0.00,"$1,222.54",$0.00
04.503.905,SUP,HCPCS C1713,,04.503.905  -  PLATE BN LG 2.5MM NS MATRIXMANDIBLE PRFRM RECON TI MNDB LT,"$7,679.25",$0.00,"$7,679.25","$3,455.66","$5,158.80",$0.00,"$1,323.10",$0.00,$0.00,"$1,344.58","$7,679.25",$0.00,"$3,839.63","$6,081.97","$6,143.40",$0.00,"$1,201.80",$0.00,"$1,222.54",$0.00
04.511.204.01,SUP,HCPCS C1713,,04.511.204.01  -  SCREW TI 4MM 1.85MM MANDIB SLFTAP ORTHGNAT BONE MTRX NONSTRL,$211.50,$0.00,$211.50,$95.18,$150.95,$0.00,$36.44,$0.00,$0.00,$37.03,$211.50,$0.00,$105.75,$167.51,$169.20,$0.00,$33.10,$0.00,$33.67,$0.00
04.511.205.01,SUP,HCPCS C1713,,04.511.205.01  -  SCREW BONE 1.85MM 15MM MTRX TI LEFT SLFDRILL NONSTRL,$211.50,$0.00,$211.50,$95.18,$150.95,$0.00,$36.44,$0.00,$0.00,$37.03,$211.50,$0.00,$105.75,$167.51,$169.20,$0.00,$33.10,$0.00,$33.67,$0.00
04.511.206.01,SUP,HCPCS C1713,,04.511.206.01  -  SCREW TI 6MM 1.85MM MANDIB SLFTAP ORTHGNAT BONE MTRX NONSTRL,$211.50,$0.00,$211.50,$95.18,$150.95,$0.00,$36.44,$0.00,$0.00,$37.03,$211.50,$0.00,$105.75,$167.51,$169.20,$0.00,$33.10,$0.00,$33.67,$0.00
04.511.208.01,SUP,HCPCS C1713,,04.511.208.01  -  SCREW TI 8MM 1.85MM MANDIB SLFTAP ORTHGNAT BONE MTRX NONSTRL,$211.50,$0.00,$211.50,$95.18,$150.95,$0.00,$36.44,$0.00,$0.00,$37.03,$211.50,$0.00,$105.75,$167.51,$169.20,$0.00,$33.10,$0.00,$33.67,$0.00
04.511.210.01,SUP,HCPCS C1713,,04.511.210.01  -  SCREW TI 10MM 1.85MM MANDIB SLFTAP ORTHGNAT BONE MTRX,$211.50,$0.00,$211.50,$95.18,$150.95,$0.00,$36.44,$0.00,$0.00,$37.03,$211.50,$0.00,$105.75,$167.51,$169.20,$0.00,$33.10,$0.00,$33.67,$0.00
04.511.212.01,SUP,HCPCS C1713,,04.511.212.01  -  SCREW TI 12MM 1.85MM MANDIB SLFTAP ORTHGNAT BONE MTRX,$211.50,$0.00,$211.50,$95.18,$150.95,$0.00,$36.44,$0.00,$0.00,$37.03,$211.50,$0.00,$105.75,$167.51,$169.20,$0.00,$33.10,$0.00,$33.67,$0.00
04.511.214.01,SUP,HCPCS C1713,,04.511.214.01  -  SCREW TI 14MM 1.85MM MANDIB SLFTAP ORTHGNAT BONE MTRX,$211.50,$0.00,$211.50,$95.18,$150.95,$0.00,$36.44,$0.00,$0.00,$37.03,$211.50,$0.00,$105.75,$167.51,$169.20,$0.00,$33.10,$0.00,$33.67,$0.00
04.511.216.01,SUP,HCPCS C1713,,04.511.216.01  -  SCREW TI 16MM 1.85MM MANDIB SLFTAP ORTHGNAT BONE MTRX,$211.50,$0.00,$211.50,$95.18,$150.95,$0.00,$36.44,$0.00,$0.00,$37.03,$211.50,$0.00,$105.75,$167.51,$169.20,$0.00,$33.10,$0.00,$33.67,$0.00
04.511.218.01,SUP,HCPCS C1713,,04.511.218.01  -  SCREW TI 18MM 1.85MM MANDIB SLFTAP ORTHGNAT BONE MTRX,$211.50,$0.00,$211.50,$95.18,$150.95,$0.00,$36.44,$0.00,$0.00,$37.03,$211.50,$0.00,$105.75,$167.51,$169.20,$0.00,$33.10,$0.00,$33.67,$0.00
04.511.224.01,SUP,HCPCS C1713,,04.511.224.01  -  SCREW TI 4MM 1.85MM MANDIB SLFDRILL ORTHGNAT BONE MTRX,$222.75,$0.00,$222.75,$100.24,$158.98,$0.00,$38.38,$0.00,$0.00,$39.00,$222.75,$0.00,$111.38,$176.42,$178.20,$0.00,$34.86,$0.00,$35.46,$0.00
04.511.225.01,SUP,HCPCS C1713,,04.511.225.01  -  SCREW TI 5MM 1.85MM SLFDRILL BONE MATRIXORTHOGNATHIC NONSTRL,$222.75,$0.00,$222.75,$100.24,$158.98,$0.00,$38.38,$0.00,$0.00,$39.00,$222.75,$0.00,$111.38,$176.42,$178.20,$0.00,$34.86,$0.00,$35.46,$0.00
04.511.226.01,SUP,HCPCS C1713,,04.511.226.01  -  SCREW BONE 1.85MM 6MM MTRX TI CRNMXF SLFDRILL ORTHGNAT,$222.75,$0.00,$222.75,$100.24,$158.98,$0.00,$38.38,$0.00,$0.00,$39.00,$222.75,$0.00,$111.38,$176.42,$178.20,$0.00,$34.86,$0.00,$35.46,$0.00
04.511.228.01,SUP,HCPCS C1713,,04.511.228.01  -  SCREW TI 8MM 1.85MM MANDIB SLFDRILL ORTHGNAT BONE MTRX,$222.75,$0.00,$222.75,$100.24,$158.98,$0.00,$38.38,$0.00,$0.00,$39.00,$222.75,$0.00,$111.38,$176.42,$178.20,$0.00,$34.86,$0.00,$35.46,$0.00
04.511.234.01,SUP,HCPCS C1713,,04.511.234.01  -  SCREW TI 4MM 2.1MM MANDIB SLFTAP ORTHGNAT BONE MTRX NONSTRL,$222.75,$0.00,$222.75,$100.24,$158.98,$0.00,$38.38,$0.00,$0.00,$39.00,$222.75,$0.00,$111.38,$176.42,$178.20,$0.00,$34.86,$0.00,$35.46,$0.00
04.511.235.01,SUP,HCPCS C1713,,04.511.235.01  -  SCREW BONE 2.1MM 5MM MTRX TI LEFT STR NONSTRL,$222.75,$0.00,$222.75,$100.24,$158.98,$0.00,$38.38,$0.00,$0.00,$39.00,$222.75,$0.00,$111.38,$176.42,$178.20,$0.00,$34.86,$0.00,$35.46,$0.00
04.511.236.01,SUP,HCPCS C1713,,04.511.236.01  -  SCREW TI 6MM 2.1MM MANDIB SLFTAP ORTHGNAT BONE MTRX NONSTRL,$222.75,$0.00,$222.75,$100.24,$158.98,$0.00,$38.38,$0.00,$0.00,$39.00,$222.75,$0.00,$111.38,$176.42,$178.20,$0.00,$34.86,$0.00,$35.46,$0.00
04.511.238.01,SUP,HCPCS C1713,,04.511.238.01  -  SCREW TI 8MM 2.1MM MANDIB SLFDRILL ORTHGNAT BONE MTRX,$222.75,$0.00,$222.75,$100.24,$158.98,$0.00,$38.38,$0.00,$0.00,$39.00,$222.75,$0.00,$111.38,$176.42,$178.20,$0.00,$34.86,$0.00,$35.46,$0.00
04.511.240.01,SUP,HCPCS C1713,,04.511.240.01  -  SCREW TI 10MM 2.1MM COARSE PTCH SLFTAP ORTHGNAT BONE MTRX,$222.75,$0.00,$222.75,$100.24,$158.98,$0.00,$38.38,$0.00,$0.00,$39.00,$222.75,$0.00,$111.38,$176.42,$178.20,$0.00,$34.86,$0.00,$35.46,$0.00
04.511.242.01,SUP,HCPCS C1713,,04.511.242.01  -  SCREW TI 12MM 2.1MM SLFTAP COARSE PTCH BONE MTRX NONSTRL PNK,$222.75,$0.00,$222.75,$100.24,$158.98,$0.00,$38.38,$0.00,$0.00,$39.00,$222.75,$0.00,$111.38,$176.42,$178.20,$0.00,$34.86,$0.00,$35.46,$0.00
04.511.244.01,SUP,HCPCS C1713,,04.511.244.01  -  SCREW TI 14MM 2.1MM MANDIB SLFTAP ORTHGNAT BONE MTRX NONSTRL,$222.75,$0.00,$222.75,$100.24,$158.98,$0.00,$38.38,$0.00,$0.00,$39.00,$222.75,$0.00,$111.38,$176.42,$178.20,$0.00,$34.86,$0.00,$35.46,$0.00
04.511.246.01,SUP,HCPCS C1713,,04.511.246.01  -  SCREW BONE PNK 16MM 2.1MM MTRX CRNMXF TI SLFTAP COARSE PTCH,$222.75,$0.00,$222.75,$100.24,$158.98,$0.00,$38.38,$0.00,$0.00,$39.00,$222.75,$0.00,$111.38,$176.42,$178.20,$0.00,$34.86,$0.00,$35.46,$0.00
04.511.248.01,SUP,HCPCS C1713,,04.511.248.01  -  SCREW TI 18MM 2.1MM MANDIB SLFTAP ORTHGNAT BONE MTRX NONSTRL,$222.75,$0.00,$222.75,$100.24,$158.98,$0.00,$38.38,$0.00,$0.00,$39.00,$222.75,$0.00,$111.38,$176.42,$178.20,$0.00,$34.86,$0.00,$35.46,$0.00
04.511.301,SUP,HCPCS C1713,,04.511.301  -  PLATE BN 90D L 2MMX.5MM NS MATRIXORTHOGNATHIC 2X2 HL RVRS,$657.00,$0.00,$657.00,$295.65,$468.90,$0.00,$113.20,$0.00,$0.00,$115.04,$657.00,$0.00,$328.50,$520.34,$525.60,$0.00,$102.82,$0.00,$104.59,$0.00
04.511.302,SUP,HCPCS C1713,,04.511.302  -  PLATE BN 90D L 6MMX.5MM NS MATRIXORTHOGNATHIC 2X2 HL RVRS,$657.00,$0.00,$657.00,$295.65,$468.90,$0.00,$113.20,$0.00,$0.00,$115.04,$657.00,$0.00,$328.50,$520.34,$525.60,$0.00,$102.82,$0.00,$104.59,$0.00
04.511.303,SUP,HCPCS C1713,,04.511.303  -  PLATE BN 90D L 11MMX.5MM NS MATRIXORTHOGNATHIC 2X2 HL RVRS,$657.00,$0.00,$657.00,$295.65,$468.90,$0.00,$113.20,$0.00,$0.00,$115.04,$657.00,$0.00,$328.50,$520.34,$525.60,$0.00,$102.82,$0.00,$104.59,$0.00
04.511.304,SUP,HCPCS C1713,,04.511.304  -  PLATE BN 90D L 2MMX.7MM NS MATRIXORTHOGNATHIC 2X2 HL RVRS,$657.00,$0.00,$657.00,$295.65,$468.90,$0.00,$113.20,$0.00,$0.00,$115.04,$657.00,$0.00,$328.50,$520.34,$525.60,$0.00,$102.82,$0.00,$104.59,$0.00
04.511.305,SUP,HCPCS C1713,,04.511.305  -  PLATE BN 90D L 6MMX.7MM NS MATRIXORTHOGNATHIC 2X2 HL RVRS,$657.00,$0.00,$657.00,$295.65,$468.90,$0.00,$113.20,$0.00,$0.00,$115.04,$657.00,$0.00,$328.50,$520.34,$525.60,$0.00,$102.82,$0.00,$104.59,$0.00
04.511.306,SUP,HCPCS C1713,,04.511.306  -  PLATE BN 90D L 11MMX.7MM NS MATRIXORTHOGNATHIC 2X2 HL RVRS,$657.00,$0.00,$657.00,$295.65,$468.90,$0.00,$113.20,$0.00,$0.00,$115.04,$657.00,$0.00,$328.50,$520.34,$525.60,$0.00,$102.82,$0.00,$104.59,$0.00
04.511.307,SUP,HCPCS C1713,,04.511.307  -  PLATE 90D .8MM 2X2 HOLE L RVRS SHRT BAR BONE,$657.00,$0.00,$657.00,$295.65,$468.90,$0.00,$113.20,$0.00,$0.00,$115.04,$657.00,$0.00,$328.50,$520.34,$525.60,$0.00,$102.82,$0.00,$104.59,$0.00
04.511.308,SUP,HCPCS C1713,,04.511.308  -  PLATE 90D MED .8MM MAXL 2X2 HOLE L RVRS ORTHGNAT BONE MTRX,$657.00,$0.00,$657.00,$295.65,$468.90,$0.00,$113.20,$0.00,$0.00,$115.04,$657.00,$0.00,$328.50,$520.34,$525.60,$0.00,$102.82,$0.00,$104.59,$0.00
04.511.309,SUP,HCPCS C1713,,04.511.309  -  PLATE BN 90D L 11MMX.8MM NS MATRIXORTHOGNATHIC 2X2 HL RVRS,$657.00,$0.00,$657.00,$295.65,$468.90,$0.00,$113.20,$0.00,$0.00,$115.04,$657.00,$0.00,$328.50,$520.34,$525.60,$0.00,$102.82,$0.00,$104.59,$0.00
04.511.321,SUP,HCPCS C1713,,04.511.321  -  PLATE BN L OBLQ 4MMX.5MM NS MATRIXORTHOGNATHIC 3X3 HL RVRS,$686.25,$0.00,$686.25,$308.81,$489.78,$0.00,$118.24,$0.00,$0.00,$120.16,$686.25,$0.00,$343.13,$543.51,$549.00,$0.00,$107.40,$0.00,$109.25,$0.00
04.511.322,SUP,HCPCS C1713,,04.511.322  -  PLATE BN L OBLQ 8MMX.5MM NS MATRIXORTHOGNATHIC 3X3 HL RVRS,$686.25,$0.00,$686.25,$308.81,$489.78,$0.00,$118.24,$0.00,$0.00,$120.16,$686.25,$0.00,$343.13,$543.51,$549.00,$0.00,$107.40,$0.00,$109.25,$0.00
04.511.323,SUP,HCPCS C1713,,04.511.323  -  PLATE BN L OBLQ 13MMX.5MM NS MATRIXORTHOGNATHIC 3X3 HL RVRS,$686.25,$0.00,$686.25,$308.81,$489.78,$0.00,$118.24,$0.00,$0.00,$120.16,$686.25,$0.00,$343.13,$543.51,$549.00,$0.00,$107.40,$0.00,$109.25,$0.00
04.511.324,SUP,HCPCS C1713,,04.511.324  -  PLATE BN L OBLQ 4MMX.7MM NS MATRIXORTHOGNATHIC 3X3 HL RVRS,$686.25,$0.00,$686.25,$308.81,$489.78,$0.00,$118.24,$0.00,$0.00,$120.16,$686.25,$0.00,$343.13,$543.51,$549.00,$0.00,$107.40,$0.00,$109.25,$0.00
04.511.325,SUP,HCPCS C1713,,04.511.325  -  PLATE BN L OBLQ 8MMX.7MM NS MATRIXORTHOGNATHIC 3X3 HL RVRS,$686.25,$0.00,$686.25,$308.81,$489.78,$0.00,$118.24,$0.00,$0.00,$120.16,$686.25,$0.00,$343.13,$543.51,$549.00,$0.00,$107.40,$0.00,$109.25,$0.00
04.511.326,SUP,HCPCS C1713,,04.511.326  -  PLATE BN L OBLQ 13MMX.7MM NS MATRIXORTHOGNATHIC 3X3 HL RVRS,$686.25,$0.00,$686.25,$308.81,$489.78,$0.00,$118.24,$0.00,$0.00,$120.16,$686.25,$0.00,$343.13,$543.51,$549.00,$0.00,$107.40,$0.00,$109.25,$0.00
04.511.327,SUP,HCPCS C1713,,04.511.327  -  PLATE BN L OBLQ 4MMX.8MM NS MATRIXORTHOGNATHIC 3X3 HL RVRS,$686.25,$0.00,$686.25,$308.81,$489.78,$0.00,$118.24,$0.00,$0.00,$120.16,$686.25,$0.00,$343.13,$543.51,$549.00,$0.00,$107.40,$0.00,$109.25,$0.00
04.511.328,SUP,HCPCS C1713,,04.511.328  -  PLATE BN L OBLQ 8MMX.8MM NS MATRIXORTHOGNATHIC 3X3 HL RVRS,$686.25,$0.00,$686.25,$308.81,$489.78,$0.00,$118.24,$0.00,$0.00,$120.16,$686.25,$0.00,$343.13,$543.51,$549.00,$0.00,$107.40,$0.00,$109.25,$0.00
04.511.329,SUP,HCPCS C1713,,04.511.329  -  PLATE BN L OBLQ 13MMX.8MM NS MATRIXORTHOGNATHIC 3X3 HL RVRS,$686.25,$0.00,$686.25,$308.81,$489.78,$0.00,$118.24,$0.00,$0.00,$120.16,$686.25,$0.00,$343.13,$543.51,$549.00,$0.00,$107.40,$0.00,$109.25,$0.00
04.511.341,SUP,HCPCS C1713,,04.511.341  -  PLATE BN L 4MMX.5MM NS MATRIXORTHOGNATHIC 3X3 HL ANTM RVRS,$717.75,$0.00,$717.75,$322.99,$512.26,$0.00,$123.66,$0.00,$0.00,$125.67,$717.75,$0.00,$358.88,$568.46,$574.20,$0.00,$112.33,$0.00,$114.27,$0.00
04.511.342,SUP,HCPCS C1713,,04.511.342  -  PLATE BN L 8MMX.5MM NS MATRIXORTHOGNATHIC 3X3 HL ANTM RVRS,$717.75,$0.00,$717.75,$322.99,$512.26,$0.00,$123.66,$0.00,$0.00,$125.67,$717.75,$0.00,$358.88,$568.46,$574.20,$0.00,$112.33,$0.00,$114.27,$0.00
04.511.343,SUP,HCPCS C1713,,04.511.343  -  PLATE BN L 12MMX.5MM NS MATRIXORTHOGNATHIC 3X3 HL ANTM RVRS,$717.75,$0.00,$717.75,$322.99,$512.26,$0.00,$123.66,$0.00,$0.00,$125.67,$717.75,$0.00,$358.88,$568.46,$574.20,$0.00,$112.33,$0.00,$114.27,$0.00
04.511.344,SUP,HCPCS C1713,,04.511.344  -  PLATE BN L 4MMX.7MM NS MATRIXORTHOGNATHIC 3X3 HL ANTM RVRS,$717.75,$0.00,$717.75,$322.99,$512.26,$0.00,$123.66,$0.00,$0.00,$125.67,$717.75,$0.00,$358.88,$568.46,$574.20,$0.00,$112.33,$0.00,$114.27,$0.00
04.511.345,SUP,HCPCS C1713,,04.511.345  -  PLATE BN L 8MMX.7MM NS MATRIXORTHOGNATHIC 3X3 HL ANTM RVRS,$717.75,$0.00,$717.75,$322.99,$512.26,$0.00,$123.66,$0.00,$0.00,$125.67,$717.75,$0.00,$358.88,$568.46,$574.20,$0.00,$112.33,$0.00,$114.27,$0.00
04.511.346,SUP,HCPCS C1713,,04.511.346  -  PLATE BN L 12MMX.7MM NS MATRIXORTHOGNATHIC 3X3 HL ANTM RVRS,$717.75,$0.00,$717.75,$322.99,$512.26,$0.00,$123.66,$0.00,$0.00,$125.67,$717.75,$0.00,$358.88,$568.46,$574.20,$0.00,$112.33,$0.00,$114.27,$0.00
04.511.347,SUP,HCPCS C1713,,04.511.347  -  PLATE BN L 4MMX.8MM NS MATRIXORTHOGNATHIC 3X3 HL ANTM RVRS,$717.75,$0.00,$717.75,$322.99,$512.26,$0.00,$123.66,$0.00,$0.00,$125.67,$717.75,$0.00,$358.88,$568.46,$574.20,$0.00,$112.33,$0.00,$114.27,$0.00
04.511.348,SUP,HCPCS C1713,,04.511.348  -  PLATE BN L 8MMX.8MM NS MATRIXORTHOGNATHIC 3X3 HL ANTM RVRS,$717.75,$0.00,$717.75,$322.99,$512.26,$0.00,$123.66,$0.00,$0.00,$125.67,$717.75,$0.00,$358.88,$568.46,$574.20,$0.00,$112.33,$0.00,$114.27,$0.00
04.511.349,SUP,HCPCS C1713,,04.511.349  -  PLATE BN L 12MMX.8MM NS MATRIXORTHOGNATHIC 3X3 HL ANTM RVRS,$717.75,$0.00,$717.75,$322.99,$512.26,$0.00,$123.66,$0.00,$0.00,$125.67,$717.75,$0.00,$358.88,$568.46,$574.20,$0.00,$112.33,$0.00,$114.27,$0.00
04.511.381,SUP,HCPCS C1713,,04.511.381  -  PLATE BN 2MM LT OFST PREBNT .8MM NS MATRIXORTHOGNATHIC,"$1,100.25",$0.00,"$1,100.25",$495.11,$785.25,$0.00,$189.57,$0.00,$0.00,$192.64,"$1,100.25",$0.00,$550.13,$871.40,$880.20,$0.00,$172.19,$0.00,$175.16,$0.00
04.511.382,SUP,HCPCS C1713,,04.511.382  -  PLATE BN 2MM RT OFST PREBNT .8MM NS MATRIXORTHOGNATHIC,"$1,100.25",$0.00,"$1,100.25",$495.11,$785.25,$0.00,$189.57,$0.00,$0.00,$192.64,"$1,100.25",$0.00,$550.13,$871.40,$880.20,$0.00,$172.19,$0.00,$175.16,$0.00
04.511.383,SUP,HCPCS C1713,,04.511.383  -  PLATE BN 4MM LT OFST PREBNT .8MM NS MATRIXORTHOGNATHIC,"$1,100.25",$0.00,"$1,100.25",$495.11,$785.25,$0.00,$189.57,$0.00,$0.00,$192.64,"$1,100.25",$0.00,$550.13,$871.40,$880.20,$0.00,$172.19,$0.00,$175.16,$0.00
04.511.384,SUP,HCPCS C1713,,04.511.384  -  PLATE BN 4MM RT OFST PREBNT .8MM NS MATRIXORTHOGNATHIC,"$1,100.25",$0.00,"$1,100.25",$495.11,$785.25,$0.00,$189.57,$0.00,$0.00,$192.64,"$1,100.25",$0.00,$550.13,$871.40,$880.20,$0.00,$172.19,$0.00,$175.16,$0.00
04.511.385,SUP,HCPCS C1713,,04.511.385  -  PLATE BN 6MM LT OFST PREBNT .8MM NS MATRIXORTHOGNATHIC,"$1,100.25",$0.00,"$1,100.25",$495.11,$785.25,$0.00,$189.57,$0.00,$0.00,$192.64,"$1,100.25",$0.00,$550.13,$871.40,$880.20,$0.00,$172.19,$0.00,$175.16,$0.00
04.511.386,SUP,HCPCS C1713,,04.511.386  -  PLATE BN 6MM RT OFST PREBNT .8MM NS MATRIXORTHOGNATHIC,"$1,100.25",$0.00,"$1,100.25",$495.11,$785.25,$0.00,$189.57,$0.00,$0.00,$192.64,"$1,100.25",$0.00,$550.13,$871.40,$880.20,$0.00,$172.19,$0.00,$175.16,$0.00
04.511.387,SUP,HCPCS C1713,,04.511.387  -  PLATE BN 8MM LT OFST PREBNT .8MM NS MATRIXORTHOGNATHIC,"$1,100.25",$0.00,"$1,100.25",$495.11,$785.25,$0.00,$189.57,$0.00,$0.00,$192.64,"$1,100.25",$0.00,$550.13,$871.40,$880.20,$0.00,$172.19,$0.00,$175.16,$0.00
04.511.388,SUP,HCPCS C1713,,04.511.388  -  PLATE BN 8MM RT OFST PREBNT .8MM NS MATRIXORTHOGNATHIC,"$1,100.25",$0.00,"$1,100.25",$495.11,$785.25,$0.00,$189.57,$0.00,$0.00,$192.64,"$1,100.25",$0.00,$550.13,$871.40,$880.20,$0.00,$172.19,$0.00,$175.16,$0.00
04.511.389,SUP,HCPCS C1713,,04.511.389  -  PLATE BN 10MM LT OFST PREBNT .8MM NS MATRIXORTHOGNATHIC,"$1,100.25",$0.00,"$1,100.25",$495.11,$785.25,$0.00,$189.57,$0.00,$0.00,$192.64,"$1,100.25",$0.00,$550.13,$871.40,$880.20,$0.00,$172.19,$0.00,$175.16,$0.00
04.511.390,SUP,HCPCS C1713,,04.511.390  -  PLATE BN 10MM RT OFST PREBNT .8MM NS MATRIXORTHOGNATHIC,"$1,100.25",$0.00,"$1,100.25",$495.11,$785.25,$0.00,$189.57,$0.00,$0.00,$192.64,"$1,100.25",$0.00,$550.13,$871.40,$880.20,$0.00,$172.19,$0.00,$175.16,$0.00
04.511.401,SUP,HCPCS C1713,,04.511.401  -  PLATE BN CRV 6MMX1MM NS MATRIXORTHOGNATHIC 6 HL LOPRFL SGTL,$956.25,$0.00,$956.25,$430.31,$682.48,$0.00,$164.76,$0.00,$0.00,$167.43,$956.25,$0.00,$478.13,$757.35,$765.00,$0.00,$149.65,$0.00,$152.24,$0.00
04.511.402,SUP,HCPCS C1713,,04.511.402  -  PLATE BN CRV 8MMX1MM NS MATRIXORTHOGNATHIC 6 HL LOPRFL SGTL,$956.25,$0.00,$956.25,$430.31,$682.48,$0.00,$164.76,$0.00,$0.00,$167.43,$956.25,$0.00,$478.13,$757.35,$765.00,$0.00,$149.65,$0.00,$152.24,$0.00
04.511.403,SUP,HCPCS C1713,,04.511.403  -  PLATE BN CRV 10MMX1MM NS MATRIXORTHOGNATHIC 6 HL LOPRFL SGTL,$956.25,$0.00,$956.25,$430.31,$682.48,$0.00,$164.76,$0.00,$0.00,$167.43,$956.25,$0.00,$478.13,$757.35,$765.00,$0.00,$149.65,$0.00,$152.24,$0.00
04.511.404,SUP,HCPCS C1713,,04.511.404  -  PLATE BN CRV 12MMX1MM NS MATRIXORTHOGNATHIC 6 HL LOPRFL SGTL,$956.25,$0.00,$956.25,$430.31,$682.48,$0.00,$164.76,$0.00,$0.00,$167.43,$956.25,$0.00,$478.13,$757.35,$765.00,$0.00,$149.65,$0.00,$152.24,$0.00
04.511.421,SUP,HCPCS C1713,,04.511.421  -  PLATE BN STRG 6MMX1MM NS MATRIXORTHOGNATHIC 4 HL LOPRFL SGTL,$940.50,$0.00,$940.50,$423.23,$671.23,$0.00,$162.04,$0.00,$0.00,$164.67,$940.50,$0.00,$470.25,$744.88,$752.40,$0.00,$147.19,$0.00,$149.73,$0.00
04.511.422,SUP,HCPCS C1713,,04.511.422  -  PLATE BN STRG 8MMX1MM NS MATRIXORTHOGNATHIC 4 HL LOPRFL SGTL,$940.50,$0.00,$940.50,$423.23,$671.23,$0.00,$162.04,$0.00,$0.00,$164.67,$940.50,$0.00,$470.25,$744.88,$752.40,$0.00,$147.19,$0.00,$149.73,$0.00
04.511.423,SUP,HCPCS C1713,,04.511.423  -  PLATE BN STRG 10MMX1MM NS MATRIXORTHOGNATHIC 4 HL LOPRFL,$940.50,$0.00,$940.50,$423.23,$671.23,$0.00,$162.04,$0.00,$0.00,$164.67,$940.50,$0.00,$470.25,$744.88,$752.40,$0.00,$147.19,$0.00,$149.73,$0.00
04.511.424,SUP,HCPCS C1713,,04.511.424  -  PLATE BN STRG 12MMX1MM NS MATRIXORTHOGNATHIC 4 HL LOPRFL,$940.50,$0.00,$940.50,$423.23,$671.23,$0.00,$162.04,$0.00,$0.00,$164.67,$940.50,$0.00,$470.25,$744.88,$752.40,$0.00,$147.19,$0.00,$149.73,$0.00
04.511.444,SUP,HCPCS C1713,,04.511.444  -  PLATE BN 33MMX.7MM NS MATRIXORTHOGNATHIC 4 HL SGTL SPLT ADJ,"$1,282.50",$0.00,"$1,282.50",$577.13,$915.32,$0.00,$220.97,$0.00,$0.00,$224.56,"$1,282.50",$0.00,$641.25,"$1,015.74","$1,026.00",$0.00,$200.71,$0.00,$204.17,$0.00
04.511.445,SUP,Custom 27203010,,04.511.445  -  INSRTR SURG LINR CNSTRN TI MTRX 40MMX.7MM NONSTRL,"$1,282.50",$0.00,"$1,282.50",$0.00,$915.32,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,282.50",$0.00,$641.25,"$1,015.74","$1,026.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.511.461,SUP,HCPCS C1713,,04.511.461  -  PLATE BN 4MM OFST 2 CRV .7MM NS MATRIXORTHOGNATHIC 5 HL,$897.75,$0.00,$897.75,$403.99,$640.72,$0.00,$154.68,$0.00,$0.00,$157.19,$897.75,$0.00,$448.88,$711.02,$718.20,$0.00,$140.50,$0.00,$142.92,$0.00
04.511.462,SUP,HCPCS C1713,,04.511.462  -  PLATE BN 6MM OFST 2 CRV .7MM NS MATRIXORTHOGNATHIC 5 HL,$897.75,$0.00,$897.75,$403.99,$640.72,$0.00,$154.68,$0.00,$0.00,$157.19,$897.75,$0.00,$448.88,$711.02,$718.20,$0.00,$140.50,$0.00,$142.92,$0.00
04.511.463,SUP,HCPCS C1713,,04.511.463  -  PLATE BN 8MM OFST 2 CRV .7MM NS MATRIXORTHOGNATHIC 5 HL,$897.75,$0.00,$897.75,$403.99,$640.72,$0.00,$154.68,$0.00,$0.00,$157.19,$897.75,$0.00,$448.88,$711.02,$718.20,$0.00,$140.50,$0.00,$142.92,$0.00
04.511.464,SUP,HCPCS C1713,,04.511.464  -  PLATE BN 10MM OFST 2 CRV .7MM NS MATRIXORTHOGNATHIC 5 HL,$897.75,$0.00,$897.75,$403.99,$640.72,$0.00,$154.68,$0.00,$0.00,$157.19,$897.75,$0.00,$448.88,$711.02,$718.20,$0.00,$140.50,$0.00,$142.92,$0.00
04.600.022.02S,SUP,HCPCS C1713,,04.600.022.02S  -  PIN 12MM DSTRCT TI STRL,$896.00,$0.00,$896.00,$403.20,$639.48,$0.00,$154.38,$0.00,$0.00,$156.88,$896.00,$0.00,$448.00,$709.63,$716.80,$0.00,$140.22,$0.00,$142.64,$0.00
04.600.023.02S,SUP,HCPCS C1713,,04.600.023.02S  -  PIN 14MM DSTRCT TI STRL,$448.00,$0.00,$448.00,$201.60,$319.74,$0.00,$77.19,$0.00,$0.00,$78.44,$448.00,$0.00,$224.00,$354.82,$358.40,$0.00,$70.11,$0.00,$71.32,$0.00
04.600.029.02S,SUP,HCPCS C1713,,04.600.029.02S  -  PIN 16MM DSTRCT TI STRL,$448.00,$0.00,$448.00,$201.60,$319.74,$0.00,$77.19,$0.00,$0.00,$78.44,$448.00,$0.00,$224.00,$354.82,$358.40,$0.00,$70.11,$0.00,$71.32,$0.00
04.601.108,SUP,HCPCS C1713,,04.601.108  -  SCREW BN T15 4.5MM 3.2MM 8MM NS SLF RTN STRDR BLNT TIP TI,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
04.601.110,SUP,HCPCS C1713,,04.601.110  -  SCREW BONE 4.5MM 10MM TI OCCPTL NONSTRL,$392.00,$0.00,$392.00,$176.40,$279.77,$0.00,$67.54,$0.00,$0.00,$68.64,$392.00,$0.00,$196.00,$310.46,$313.60,$0.00,$61.35,$0.00,$62.41,$0.00
04.601.112,SUP,HCPCS C1713,,04.601.112  -  SCREW BONE 4.5MM 12MM TITANIUM OCCIPITOCERVICAL SPN NONSTRL,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
04.601.208,SUP,HCPCS C1713,,04.601.208  -  SCREW BN T15 5MM 3.2MM 8MM NS SLFRET STRDR BLNT TIP 7%,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
04.601.210,SUP,HCPCS C1713,,04.601.210  -  SCREW BN T15 5MM 3.2MM 10MM NS SLFRET STRDR BLNT TIP 7%,$399.00,$0.00,$399.00,$179.55,$284.77,$0.00,$68.75,$0.00,$0.00,$69.86,$399.00,$0.00,$199.50,$316.01,$319.20,$0.00,$62.44,$0.00,$63.52,$0.00
04.613.014,SUP,HCPCS C1713,,04.613.014  -  PLATE 23MM TI 1 LVL VCTR BONE 14MM ANT CERV SPN NONSTRL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
04.613.016,SUP,HCPCS C1713,,04.613.016  -  PLATE 25MM TI 1 LVL VCTR BONE 16MM ANT CERV SPN NONSTRL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
04.613.130,SUP,HCPCS C1713,,04.613.130  -  PLATE BN BNT GRV PREBNT 39X16.5X2.5MM NS 30MM VCTR 2 LVL 1,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
04.613.132,SUP,HCPCS C1713,,04.613.132  -  PLATE BN BNT GRV PREBNT 41X16.5X2.5MM NS 32MM VCTR 2 LVL 1,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
04.613.516,SUP,HCPCS C1713,,04.613.516  -  SCREW BONE 4MM 16MM VCT-T TI ANT CERV SPN SLFRET SLFDRILL,$498.10,$0.00,$498.10,$224.15,$355.49,$0.00,$85.82,$0.00,$0.00,$87.21,$498.10,$0.00,$249.05,$394.50,$398.48,$0.00,$77.95,$0.00,$79.30,$0.00
04.613.616,SUP,HCPCS C1713,,04.613.616  -  SCREW BONE 4MM 16MM VCT-T TI ANT CERV SPN SLFTAP SLFRET VAR,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
04.613.618,SUP,HCPCS C1713,,04.613.618  -  SCREW BONE 4MM 18MM VCT-T TI ANT CERV SPN SLFTAP SLFRET VAR,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
04.613.666,SUP,HCPCS C1713,,04.613.666  -  SCREW BONE 4.5MM 16MM VCT-T TI ANT CERV SPN SLFTAP SLFRET,$477.70,$0.00,$477.70,$214.97,$340.93,$0.00,$82.31,$0.00,$0.00,$83.64,$477.70,$0.00,$238.85,$378.34,$382.16,$0.00,$74.76,$0.00,$76.05,$0.00
04.614.010,SUP,HCPCS C1713,,04.614.010  -  SCREW BONE 3.5MM 10MM SYNAPSE TI CANC SPNL POLYAX NONSTRL,"$2,576.00",$0.00,"$2,576.00","$1,159.20","$1,838.49",$0.00,$443.83,$0.00,$0.00,$451.04,"$2,576.00",$0.00,"$1,288.00","$2,040.19","$2,060.80",$0.00,$403.14,$0.00,$410.10,$0.00
04.614.012,SUP,HCPCS C1713,,04.614.012  -  SCREW BONE 3.5MM 12MM SYNAPSE TI CANC SPNL POLYAX NONSTRL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
04.614.014,SUP,HCPCS C1713,,04.614.014  -  SCREW BONE 3.5MM 14MM SYNAPSE TI CANC SPNL POLYAX NONSTRL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
04.614.016,SUP,HCPCS C1713,,04.614.016  -  SCREW BONE 3.5MM 16MM SYNAPSE TI CANC SPNL POLYAX NONSTRL,"$2,576.00",$0.00,"$2,576.00","$1,159.20","$1,838.49",$0.00,$443.83,$0.00,$0.00,$451.04,"$2,576.00",$0.00,"$1,288.00","$2,040.19","$2,060.80",$0.00,$403.14,$0.00,$410.10,$0.00
04.614.020,SUP,HCPCS C1713,,04.614.020  -  SCREW BONE 3.5MM 20MM SYNAPSE TI CANC SPNL POLYAX NONSTRL,"$2,576.00",$0.00,"$2,576.00","$1,159.20","$1,838.49",$0.00,$443.83,$0.00,$0.00,$451.04,"$2,576.00",$0.00,"$1,288.00","$2,040.19","$2,060.80",$0.00,$403.14,$0.00,$410.10,$0.00
04.614.110,SUP,HCPCS C1713,,04.614.110  -  SCREW BONE 4MM 10MM SYNAPSE TI CANC SPNL POLYAX,"$2,576.00",$0.00,"$2,576.00","$1,159.20","$1,838.49",$0.00,$443.83,$0.00,$0.00,$451.04,"$2,576.00",$0.00,"$1,288.00","$2,040.19","$2,060.80",$0.00,$403.14,$0.00,$410.10,$0.00
04.614.112,SUP,HCPCS C1713,,04.614.112  -  SCREW BONE 0-50D 4MM 2.4MM 12MM T15 STARDRIVE POLYAX SLFTAP,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
04.614.114,SUP,HCPCS C1713,,04.614.114  -  SCREW BONE 4MM 2.4MM 14MM SYNAPSE TI 50- D T15 SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
04.614.118,SUP,HCPCS C1713,,04.614.118  -  SCREW BN 50- D T15 4MM 2.4MM 18MM GRN GRY NS SYNAPSE PA ST,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
04.614.124,SUP,HCPCS C1713,,04.614.124  -  SCREW BONE 4MM 24MM SYNAPSE TI CANC SPNL POLYAX,"$2,576.00",$0.00,"$2,576.00","$1,159.20","$1,838.49",$0.00,$443.83,$0.00,$0.00,$451.04,"$2,576.00",$0.00,"$1,288.00","$2,040.19","$2,060.80",$0.00,$403.14,$0.00,$410.10,$0.00
04.614.126,SUP,HCPCS C1713,,04.614.126  -  SCREW BONE 4MM 26MM SYNAPSE TI CANC SPNL POLYAX NONSTRL,"$2,576.00",$0.00,"$2,576.00","$1,159.20","$1,838.49",$0.00,$443.83,$0.00,$0.00,$451.04,"$2,576.00",$0.00,"$1,288.00","$2,040.19","$2,060.80",$0.00,$403.14,$0.00,$410.10,$0.00
04.614.226,SUP,HCPCS C1713,,04.614.226  -  SCREW BONE 40D LARGE DIAMETER T15 SQUARE 4.5MM 3.2MM 26MM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
04.614.508,SUP,HCPCS C1713,,04.614.508  -  SCREW BONE 5MM 8MM TI SPNL LCK NONSTRL,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
04.614.510,SUP,HCPCS C1713,,04.614.510  -  ROD SPNL 120-175MM 3.5-6MM TI HRD NONSTRL,"$1,748.25",$0.00,"$1,748.25",$786.71,"$1,247.73",$0.00,$301.21,$0.00,$0.00,$306.10,"$1,748.25",$0.00,$874.13,"$1,384.61","$1,398.60",$0.00,$273.60,$0.00,$278.32,$0.00
04.614.513,SUP,Custom 27803010,,04.614.513  -  TRNCON ROD 60MM SPNL TI NONSTRL,"$2,709.00",$0.00,"$2,709.00",$0.00,"$1,933.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,709.00",$0.00,"$1,354.50","$2,145.53","$2,167.20",$0.00,$0.00,$0.00,$0.00,$0.00
04.614.516,SUP,Custom 27803010,,04.614.516  -  TRNCON ROD MED TI TOP LD NONSTRL,"$3,150.00",$0.00,"$3,150.00",$0.00,"$2,248.16",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,150.00",$0.00,"$1,575.00","$2,494.80","$2,520.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.614.521,SUP,HCPCS C1713,,04.614.521  -  SCREW BONE 7.5MM SYNAPSE TI SPNL LCK TRNCON NONSTRL,$218.75,$0.00,$218.75,$98.44,$156.12,$0.00,$37.69,$0.00,$0.00,$38.30,$218.75,$0.00,$109.38,$173.25,$175.00,$0.00,$34.23,$0.00,$34.83,$0.00
04.614.522,SUP,HCPCS C1713,,04.614.522  -  SCREW BONE SYNAPSE TI SPNL LCK TRNCON NONSTRL,$393.75,$0.00,$393.75,$177.19,$281.02,$0.00,$67.84,$0.00,$0.00,$68.94,$393.75,$0.00,$196.88,$311.85,$315.00,$0.00,$61.62,$0.00,$62.69,$0.00
04.614.745,SUP,HCPCS C1713,,04.614.745  -  ROD SPNL 45MM 3.5MM CURVE TI NONSTRL,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
04.617.129S,SUP,Custom 27803010,,04.617.129S  -  SPACER SPNL STD LRDTC 9MM STRL ZERO-PPEEK-OPTM TI,"$10,500.00",$0.00,"$10,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$10,500.00",$0.00,"$5,250.00","$8,316.00","$8,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.617.814,SUP,HCPCS C1713,,04.617.814  -  SCREW BONE 3MM 14MM TI CERV SPN LCK NONSTRL,$722.50,$0.00,$722.50,$325.13,$515.65,$0.00,$124.48,$0.00,$0.00,$126.50,$722.50,$0.00,$361.25,$572.22,$578.00,$0.00,$113.07,$0.00,$115.02,$0.00
04.620.000,SUP,Custom 27803010,,04.620.000  -  CAP LCK PANGEA SPNL TI NONSTRL,$375.00,$0.00,$375.00,$0.00,$267.64,$0.00,$0.00,$0.00,$0.00,$0.00,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$0.00,$0.00,$0.00,$0.00
04.620.170,SUP,HCPCS C1713,,04.620.170  -  ROD SPNL 70MM 6MM PANGEA USS PDCL TI CVD SFT PRECONTOURED,$483.00,$0.00,$483.00,$217.35,$344.72,$0.00,$83.22,$0.00,$0.00,$84.57,$483.00,$0.00,$241.50,$382.54,$386.40,$0.00,$75.59,$0.00,$76.89,$0.00
04.620.203,SUP,Custom 27803010,,04.620.203  -  TRNCON ROD 33-36.5MM PANGEA PDCL TI LP 6MM ROD NONSTRL,"$2,432.50",$0.00,"$2,432.50",$0.00,"$1,736.08",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,432.50",$0.00,"$1,216.25","$1,926.54","$1,946.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.620.204,SUP,Custom 27803010,,04.620.204  -  TRNCON ROD 38.5-48MM 6MM PANGEA USS SPNL PDCL TI LP NONSTRL,"$2,432.50",$0.00,"$2,432.50",$0.00,"$1,736.08",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,432.50",$0.00,"$1,216.25","$1,926.54","$1,946.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.620.205,SUP,Custom 27803010,,04.620.205  -  TRNCON ROD 49-69MM 6MM PANGEA USS SPNL PDCL TI LP NONSTRL,"$2,432.50",$0.00,"$2,432.50",$0.00,"$1,736.08",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,432.50",$0.00,"$1,216.25","$1,926.54","$1,946.00",$0.00,$0.00,$0.00,$0.00,$0.00
04.620.425,SUP,HCPCS C1713,,04.620.425  -  SCREW BONE 4MM 25MM PANGEA TI PDCL POLYAX STARDRIVE RECESS 2,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
04.620.430,SUP,HCPCS C1713,,04.620.430  -  SCREW BONE 4MM 30MM PANGEA TI PDCL POLYAX STARDRIVE RECESS 2,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
04.620.530,SUP,HCPCS C1713,,04.620.530  -  SCREW BONE 5MM 30MM PANGEA TI PDCL POLYAX DUAL CORE THRD,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
04.620.535,SUP,HCPCS C1713,,04.620.535  -  SCREW BONE 5MM 35MM PANGEA TI PDCL 2 CORE POLYAX NONSTRL,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
04.620.540,SUP,HCPCS C1713,,04.620.540  -  SCREW BONE 5MM 40MM PANGEA TI PDCL 2 CORE POLYAX NONSTRL,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
04.620.630,SUP,HCPCS C1713,,04.620.630  -  SCREW BONE 6MM 30MM PANGEA TI PDCL 2 CORE POLYAX NONSTRL,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
04.620.635,SUP,HCPCS C1713,,04.620.635  -  SCREW BONE 6MM 35MM PANGEA TI PDCL 2 CORE POLYAX NONSTRL,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
04.620.640,SUP,HCPCS C1713,,04.620.640  -  SCREW BONE 6MM 40MM PANGEA TI PDCL 2 CORE POLYAX NONSTRL,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
04.620.645,SUP,HCPCS C1713,,04.620.645  -  SCREW BONE 6MM 45MM PANGEA TI PDCL 2 CORE POLYAX NONSTRL,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
04.620.650,SUP,HCPCS C1713,,04.620.650  -  SCREW BONE 6MM 50MM PANGEA TI PDCL 2 CORE POLYAX NONSTRL,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
04.620.740,SUP,HCPCS C1713,,04.620.740  -  SCREW BONE 7MM 40MM PANGEA TI PDCL 2 CORE POLYAX NONSTRL,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
04.620.745,SUP,HCPCS C1713,,04.620.745  -  SCREW BONE 7MM 45MM PANGEA TI PDCL POLYAX 2 CORE NONSTRL,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
04.620.750,SUP,HCPCS C1713,,04.620.750  -  SCREW BONE 7MM 50MM PANGEA TI PDCL 2 CORE POLYAX NONSTRL,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
04.808.003,SUP,HCPCS C1713,,04.808.003  -  CAGE SPNL 29X21MM SYNEX 2 TI ALIF NONSTRL,"$10,017.00",$0.00,"$10,017.00","$4,507.65","$5,158.80",$0.00,"$1,725.88",$0.00,$0.00,"$1,753.90","$10,017.00",$0.00,"$5,008.50","$7,933.46","$8,013.60",$0.00,"$1,567.66",$0.00,"$1,594.71",$0.00
04.808.004,SUP,HCPCS C1713,,04.808.004  -  CAGE SPNL 25-33MM SYNEX 2 TI LMBR INTRBD FS CENTRL BODY,"$11,408.25",$0.00,"$11,408.25","$5,133.71","$5,158.80",$0.00,"$1,965.58",$0.00,$0.00,"$1,997.49","$11,408.25",$0.00,"$5,704.13","$9,035.33","$9,126.60",$0.00,"$1,785.39",$0.00,"$1,816.19",$0.00
04.808.018,SUP,HCPCS C1713,,04.808.018  -  EPLT SPNL GOLD 20X19MM SYNEX 2 SM 0,"$2,040.50",$0.00,"$2,040.50",$918.23,"$1,456.30",$0.00,$351.57,$0.00,$0.00,$357.28,"$2,040.50",$0.00,"$1,020.25","$1,616.08","$1,632.40",$0.00,$319.34,$0.00,$324.85,$0.00
04.808.027,SUP,HCPCS C1713,,04.808.027  -  EPLT SPNL 25MM 22MM 0D TI NONSTRL,"$2,040.50",$0.00,"$2,040.50",$918.23,"$1,456.30",$0.00,$351.57,$0.00,$0.00,$357.28,"$2,040.50",$0.00,"$1,020.25","$1,616.08","$1,632.40",$0.00,$319.34,$0.00,$324.85,$0.00
04-503-228,SUP,HCPCS C1713,,04-503-228  -  SCREW TI 8MM SLFDRILL BONE MTRXMDFACE PLT SYS,$164.25,$0.00,$164.25,$73.91,$117.23,$0.00,$28.30,$0.00,$0.00,$28.76,$164.25,$0.00,$82.13,$130.09,$131.40,$0.00,$25.71,$0.00,$26.15,$0.00
04-503-346,SUP,HCPCS C1713,,04-503-346  -  PLATE .5MM 20 HOLE ADP BONE MATRIXMIDFACE TI NSTRL BLUE,"$1,206.00",$0.00,"$1,206.00",$542.70,$860.72,$0.00,$207.79,$0.00,$0.00,$211.16,"$1,206.00",$0.00,$603.00,$955.15,$964.80,$0.00,$188.74,$0.00,$192.00,$0.00
04-503-396,SUP,HCPCS C1713,,04-503-396  -  PLATE STD MINI .8MM 20 HOLE ADP BONE MATRIXMIDFACE TI NSTRL,"$1,206.00",$0.00,"$1,206.00",$542.70,$860.72,$0.00,$207.79,$0.00,$0.00,$211.16,"$1,206.00",$0.00,$603.00,$955.15,$964.80,$0.00,$188.74,$0.00,$192.00,$0.00
046-237,SUP,Custom 27803010,,046-237  -  WIRE SUTURE 6 CCS-1 14IN 2 MONOFILAMENT MYO/WIRE II,"$1,980.00",$0.00,"$1,980.00",$0.00,"$1,413.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,980.00",$0.00,$990.00,"$1,568.16","$1,584.00",$0.00,$0.00,$0.00,$0.00,$0.00
050-508-000,SUP,Custom 27203010,,CONNECTOR PRFSN STRG EQL .5IN X.5IN STRL,$19.90,$0.00,$19.90,$0.00,$14.20,$0.00,$0.00,$0.00,$0.00,$0.00,$19.90,$0.00,$9.95,$15.76,$15.92,$0.00,$0.00,$0.00,$0.00,$0.00
050-526-000,SUP,Custom 27011340,,050-526-000  -  CONNECTOR PERFUSION 3/8INX3/8INX3/8IN 3/8INX3/8INX3/8IN Y,$0.53,$0.00,$0.53,$0.00,$0.38,$0.00,$0.00,$0.00,$0.00,$0.00,$0.53,$0.00,$0.26,$0.42,$0.42,$0.00,$0.00,$0.00,$0.00,$0.00
050-604-000,SUP,Custom 27203010,,CONNECTOR PRFSN STRG LUER LOCK LOCK .25IN X.25IN,$315.00,$0.00,$315.00,$0.00,$224.82,$0.00,$0.00,$0.00,$0.00,$0.00,$315.00,$0.00,$157.50,$249.48,$252.00,$0.00,$0.00,$0.00,$0.00,$0.00
0523-48,SUP,Custom 27203010,,ADHESIVE LQ VL AMPULE MSTSL STRL 2/3ML SKN,$3.25,$0.00,$3.25,$0.00,$2.32,$0.00,$0.00,$0.00,$0.00,$0.00,$3.25,$0.00,$1.63,$2.57,$2.60,$0.00,$0.00,$0.00,$0.00,$0.00
05-538-51,SUP,Custom 27203010,,TUBE CNTRF 119MM 17MM 15ML POLYPRO GRAD SKRT BTM SCR CAP,$1.18,$0.00,$1.18,$0.00,$0.84,$0.00,$0.00,$0.00,$0.00,$0.00,$1.18,$0.00,$0.59,$0.93,$0.94,$0.00,$0.00,$0.00,$0.00,$0.00
0580-0-200,SUP,HCPCS C1776,,0580-0-200  -  STEM FEM 200MM OFFST EXTR 3 LNG,"$6,271.00",$0.00,"$6,271.00","$2,821.95","$4,475.61",$0.00,"$1,080.46",$0.00,$0.00,"$1,098.00","$6,271.00",$0.00,"$3,135.50","$4,966.63","$5,016.80",$0.00,$981.41,$0.00,$998.34,$0.00
0580-0-220,SUP,HCPCS C1776,,0580-0-220  -  STEM FEM 220MM OFFST EXTR 3 LNG,"$6,271.00",$0.00,"$6,271.00","$2,821.95","$4,475.61",$0.00,"$1,080.46",$0.00,$0.00,"$1,098.00","$6,271.00",$0.00,"$3,135.50","$4,966.63","$5,016.80",$0.00,$981.41,$0.00,$998.34,$0.00
0580-0-240,SUP,HCPCS C1776,,0580-0-240  -  STEM FEM 240MM OFFST EXTR 3 LNG,"$6,271.00",$0.00,"$6,271.00","$2,821.95","$4,475.61",$0.00,"$1,080.46",$0.00,$0.00,"$1,098.00","$6,271.00",$0.00,"$3,135.50","$4,966.63","$5,016.80",$0.00,$981.41,$0.00,$998.34,$0.00
0580-0-260,SUP,HCPCS C1776,,0580-0-260  -  STEM FEM 260MM OFFST EXTR 3 LNG,"$6,271.00",$0.00,"$6,271.00","$2,821.95","$4,475.61",$0.00,"$1,080.46",$0.00,$0.00,"$1,098.00","$6,271.00",$0.00,"$3,135.50","$4,966.63","$5,016.80",$0.00,$981.41,$0.00,$998.34,$0.00
0580-0-330,SUP,HCPCS C1776,,0580-0-330  -  STEM FEM 120MM EXTR 2 ANT POST,"$4,264.00",$0.00,"$4,264.00","$1,918.80","$3,043.22",$0.00,$734.67,$0.00,$0.00,$746.59,"$4,264.00",$0.00,"$2,132.00","$3,377.09","$3,411.20",$0.00,$667.32,$0.00,$678.83,$0.00
0580-0-351,SUP,HCPCS C1776,,0580-0-351  -  STEM FEM OFFST EXTR 1 35.5MM,"$4,264.00",$0.00,"$4,264.00","$1,918.80","$3,043.22",$0.00,$734.67,$0.00,$0.00,$746.59,"$4,264.00",$0.00,"$2,132.00","$3,377.09","$3,411.20",$0.00,$667.32,$0.00,$678.83,$0.00
0580-0-352,SUP,HCPCS C1776,,0580-0-352  -  STEM FEM OFFST SYS EXTR ORTHNX 37.5MM LG TOT HIP,"$4,264.00",$0.00,"$4,264.00","$1,918.80","$3,043.22",$0.00,$734.67,$0.00,$0.00,$746.59,"$4,264.00",$0.00,"$2,132.00","$3,377.09","$3,411.20",$0.00,$667.32,$0.00,$678.83,$0.00
0580-0-371,SUP,HCPCS C1776,,0580-0-371  -  STEM FEM OFFST EXTR ORTHNX 1 37.5MM HIP,"$4,264.00",$0.00,"$4,264.00","$1,918.80","$3,043.22",$0.00,$734.67,$0.00,$0.00,$746.59,"$4,264.00",$0.00,"$2,132.00","$3,377.09","$3,411.20",$0.00,$667.32,$0.00,$678.83,$0.00
0580-0-372,SUP,HCPCS C1776,,0580-0-372  -  STEM FEM OFFST EXTR 2 37.5MM,"$4,264.00",$0.00,"$4,264.00","$1,918.80","$3,043.22",$0.00,$734.67,$0.00,$0.00,$746.59,"$4,264.00",$0.00,"$2,132.00","$3,377.09","$3,411.20",$0.00,$667.32,$0.00,$678.83,$0.00
0580-0-373,SUP,HCPCS C1776,,0580-0-373  -  STEM FEM OFFST EXTR 3 37.5MM,"$4,264.00",$0.00,"$4,264.00","$1,918.80","$3,043.22",$0.00,$734.67,$0.00,$0.00,$746.59,"$4,264.00",$0.00,"$2,132.00","$3,377.09","$3,411.20",$0.00,$667.32,$0.00,$678.83,$0.00
0580-0-374,SUP,HCPCS C1776,,0580-0-374  -  STEM FEM OFFST EXTR 4 37.5MM,"$4,264.00",$0.00,"$4,264.00","$1,918.80","$3,043.22",$0.00,$734.67,$0.00,$0.00,$746.59,"$4,264.00",$0.00,"$2,132.00","$3,377.09","$3,411.20",$0.00,$667.32,$0.00,$678.83,$0.00
0580-0-441,SUP,HCPCS C1776,,0580-0-441  -  STEM FEM 44MM OFFST EXTR 1,"$4,264.00",$0.00,"$4,264.00","$1,918.80","$3,043.22",$0.00,$734.67,$0.00,$0.00,$746.59,"$4,264.00",$0.00,"$2,132.00","$3,377.09","$3,411.20",$0.00,$667.32,$0.00,$678.83,$0.00
0580-0-442,SUP,HCPCS C1776,,0580-0-442  -  STEM FEM OFFST EXTR 2 44MM,"$4,264.00",$0.00,"$4,264.00","$1,918.80","$3,043.22",$0.00,$734.67,$0.00,$0.00,$746.59,"$4,264.00",$0.00,"$2,132.00","$3,377.09","$3,411.20",$0.00,$667.32,$0.00,$678.83,$0.00
0580-0-443,SUP,HCPCS C1776,,0580-0-443  -  STEM FEM OFFST EXTR 3 44MM,"$4,264.00",$0.00,"$4,264.00","$1,918.80","$3,043.22",$0.00,$734.67,$0.00,$0.00,$746.59,"$4,264.00",$0.00,"$2,132.00","$3,377.09","$3,411.20",$0.00,$667.32,$0.00,$678.83,$0.00
0580-0-444,SUP,HCPCS C1776,,0580-0-444  -  STEM FEM OFFST EXTR 4 44MM,"$4,264.00",$0.00,"$4,264.00","$1,918.80","$3,043.22",$0.00,$734.67,$0.00,$0.00,$746.59,"$4,264.00",$0.00,"$2,132.00","$3,377.09","$3,411.20",$0.00,$667.32,$0.00,$678.83,$0.00
0580-0-445,SUP,HCPCS C1776,,0580-0-445  -  STEM FEM OFFST EXTR 5 44MM,"$4,264.00",$0.00,"$4,264.00","$1,918.80","$3,043.22",$0.00,$734.67,$0.00,$0.00,$746.59,"$4,264.00",$0.00,"$2,132.00","$3,377.09","$3,411.20",$0.00,$667.32,$0.00,$678.83,$0.00
0580-0-446,SUP,HCPCS C1776,,0580-0-446  -  STEM FEM OFFST EXTR 6 44MM,"$4,264.00",$0.00,"$4,264.00","$1,918.80","$3,043.22",$0.00,$734.67,$0.00,$0.00,$746.59,"$4,264.00",$0.00,"$2,132.00","$3,377.09","$3,411.20",$0.00,$667.32,$0.00,$678.83,$0.00
0580-0-503,SUP,HCPCS C1776,,0580-0-503  -  STEM FEM OFFST EXTR 3 50MM,"$4,264.00",$0.00,"$4,264.00","$1,918.80","$3,043.22",$0.00,$734.67,$0.00,$0.00,$746.59,"$4,264.00",$0.00,"$2,132.00","$3,377.09","$3,411.20",$0.00,$667.32,$0.00,$678.83,$0.00
0580-0-504,SUP,HCPCS C1776,,0580-0-504  -  STEM FEM 50MM OFFST EXTR 4,"$4,264.00",$0.00,"$4,264.00","$1,918.80","$3,043.22",$0.00,$734.67,$0.00,$0.00,$746.59,"$4,264.00",$0.00,"$2,132.00","$3,377.09","$3,411.20",$0.00,$667.32,$0.00,$678.83,$0.00
0580-0-505,SUP,HCPCS C1776,,0580-0-505  -  STEM FEM OFFST EXTR 5 50MM,"$4,264.00",$0.00,"$4,264.00","$1,918.80","$3,043.22",$0.00,$734.67,$0.00,$0.00,$746.59,"$4,264.00",$0.00,"$2,132.00","$3,377.09","$3,411.20",$0.00,$667.32,$0.00,$678.83,$0.00
0580-0-506,SUP,HCPCS C1776,,0580-0-506  -  STEM FEM OFFST EXTR 6 50MM,"$4,264.00",$0.00,"$4,264.00","$1,918.80","$3,043.22",$0.00,$734.67,$0.00,$0.00,$746.59,"$4,264.00",$0.00,"$2,132.00","$3,377.09","$3,411.20",$0.00,$667.32,$0.00,$678.83,$0.00
0580-1-044,SUP,HCPCS C1776,,0580-1-044  -  STEM FEMORAL 0 44MM OFFST LONG CEMENTED EXETER V40 HIP,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
0580-1-200,SUP,HCPCS C1776,,0580-1-200  -  STEM FEMORAL 3 44MM OFFST LONG 200MM CEMENTED EXETER V40 HIP,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
0580-1-220,SUP,HCPCS C1776,,0580-1-220  -  STEM FEMORAL 3 44MM OFFST LONG 220MM CEMENTED EXETER V40 HIP,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
0580-1-240,SUP,HCPCS C1776,,0580-1-240  -  STEM FEMORAL 3 44MM OFFST LONG 240MM CEMENTED EXETER V40 HIP,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
0580-1-260,SUP,HCPCS C1776,,0580-1-260  -  STEM FEMORAL 3 44MM OFFST LONG 260MM CEMENTED EXETER V40 HIP,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
0580-1-300,SUP,HCPCS C1776,,0580-1-300  -  STEM FEMORAL 30MM OFFST CEMENTED EXETER V40 HIP,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
0580-1-330,SUP,HCPCS C1776,,0580-1-330  -  STEM FEMORAL 33MM OFFST CEMENTED EXETER V40 HIP,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
0580-1-351,SUP,HCPCS C1776,,0580-1-351  -  STEM FEMORAL 35.5MM OFFST CEMENTED EXETER V40 HIP,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
0580-1-352,SUP,HCPCS C1776,,0580-1-352  -  STEM FEMORAL 0 35.5MM OFFST CEMENTED EXETER V40 HIP,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
0580-1-371,SUP,HCPCS C1776,,0580-1-371  -  STEM FEMORAL 1 37.5MM OFFST CEMENTED EXETER V40 HIP,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
0580-1-372,SUP,HCPCS C1776,,0580-1-372  -  STEM FEMORAL 2 37.5MM OFFST CEMENTED EXETER V40 HIP,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
0580-1-373,SUP,HCPCS C1776,,0580-1-373  -  STEM FEMORAL 3 37.5MM OFFST CEMENTED EXETER V40 HIP,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
0580-1-374,SUP,HCPCS C1776,,0580-1-374  -  STEM FEMORAL 4 37.5MM OFFST CEMENTED EXETER V40 HIP,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
0580-1-440,SUP,HCPCS C1776,,0580-1-440  -  STEM FEMORAL 0 44MM OFFST CEMENTED EXETER V40 HIP,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
0580-1-441,SUP,HCPCS C1776,,0580-1-441  -  STEM FEMORAL 1 44MM OFFST CEMENTED EXETER V40 HIP,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
0580-1-442,SUP,HCPCS C1776,,0580-1-442  -  STEM FEMORAL 2 44MM OFFST CEMENTED EXETER V40 HIP,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
0580-1-443,SUP,HCPCS C1776,,0580-1-443  -  STEM FEMORAL 3 44MM OFFST CEMENTED EXETER V40 HIP,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
0580-1-444,SUP,HCPCS C1776,,0580-1-444  -  STEM FEMORAL 4 44MM OFFST CEMENTED EXETER V40 HIP,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
0580-1-445,SUP,HCPCS C1776,,0580-1-445  -  STEM FEMORAL 5 45MM OFFST CEMENTED EXETER V40 HIP,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
0580-1-446,SUP,HCPCS C1776,,0580-1-446  -  STEM FEMORAL 6 45MM OFFST CEMENTED EXETER V40 HIP,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
0580-1-501,SUP,HCPCS C1776,,0580-1-501  -  STEM FEMORAL 1 50MM OFFST CEMENTED EXETER V40 HIP,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
0580-1-502,SUP,HCPCS C1776,,0580-1-502  -  STEM FEMORAL 2 50MM OFFST CEMENTED EXETER V40 HIP,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
0580-1-503,SUP,HCPCS C1776,,0580-1-503  -  STEM FEMORAL 3 50MM OFFST CEMENTED EXETER V40 HIP,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
0580-1-504,SUP,HCPCS C1776,,0580-1-504  -  STEM FEMORAL 4 50MM OFFST CEMENTED EXETER V40 HIP,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
0580-1-505,SUP,HCPCS C1776,,0580-1-505  -  STEM FEMORAL 5 50MM OFFST CEMENTED EXETER V40 HIP,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
0580-2-442,SUP,HCPCS C1776,,0580-2-442  -  STEM FEM 205MM TPR EXTR V40 2 LNG 44MM,"$6,271.00",$0.00,"$6,271.00","$2,821.95","$4,475.61",$0.00,"$1,080.46",$0.00,$0.00,"$1,098.00","$6,271.00",$0.00,"$3,135.50","$4,966.63","$5,016.80",$0.00,$981.41,$0.00,$998.34,$0.00
0580-3-371,SUP,HCPCS C1776,,0580-3-371  -  STEM FEM 1 37.5MM OFST 125MM STRL EXTR V40 HIP,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
0580-3-422,SUP,HCPCS C1776,,0580-3-422  -  STEM FEMORAL 2 44MM TAPER 44MM 205MM EXETER V40 HIP,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
0580-3-441,SUP,HCPCS C1776,,0580-3-441  -  STEM FEM 1 44MM OFST 125MM STRL EXTR V40 HIP,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
0580-3-501,SUP,HCPCS C1776,,0580-3-501  -  STEM FEM 1 50MM OFST 125MM STRL EXTR V40 HIP,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
0580-9-300,SUP,Custom 27803010,,0580-9-300  -  STEM SURG 30MM EXTR ANTEROPOSTERIOR ORTHNX AP1 TCHQ OFFST,$721.00,$0.00,$721.00,$0.00,$514.58,$0.00,$0.00,$0.00,$0.00,$0.00,$721.00,$0.00,$360.50,$571.03,$576.80,$0.00,$0.00,$0.00,$0.00,$0.00
0586-0-022,SUP,Custom 27803010,,0586-0-022  -  HEAD FEMORAL +0MM 22MM CEMENTED EXETER ORTHINOX HIP,"$1,155.00",$0.00,"$1,155.00",$0.00,$824.32,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,155.00",$0.00,$577.50,$914.76,$924.00,$0.00,$0.00,$0.00,$0.00,$0.00
0586-0-026,SUP,Custom 27803010,,0586-0-026  -  HEAD FEMORAL +0MM 26MM CEMENTED EXETER ORTHINOX HIP,"$1,155.00",$0.00,"$1,155.00",$0.00,$824.32,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,155.00",$0.00,$577.50,$914.76,$924.00,$0.00,$0.00,$0.00,$0.00,$0.00
0586-0-028,SUP,Custom 27803010,,0586-0-028  -  HEAD FEMORAL +0MM 28MM CEMENTED EXETER ORTHINOX HIP,"$1,155.00",$0.00,"$1,155.00",$0.00,$824.32,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,155.00",$0.00,$577.50,$914.76,$924.00,$0.00,$0.00,$0.00,$0.00,$0.00
0586-0-032,SUP,Custom 27803010,,0586-0-032  -  HEAD FEMORAL +0MM 32MM CEMENTED EXETER ORTHINOX HIP,"$1,155.00",$0.00,"$1,155.00",$0.00,$824.32,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,155.00",$0.00,$577.50,$914.76,$924.00,$0.00,$0.00,$0.00,$0.00,$0.00
0586-0-326,SUP,Custom 27803010,,0586-0-326  -  HEAD FEMORAL -3MM 26MM CEMENTED EXETER ORTHINOX HIP,"$1,155.00",$0.00,"$1,155.00",$0.00,$824.32,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,155.00",$0.00,$577.50,$914.76,$924.00,$0.00,$0.00,$0.00,$0.00,$0.00
0586-0-328,SUP,Custom 27803010,,0586-0-328  -  HEAD FEMORAL -3MM 28MM NECK EXETER ORTHINOX HIP,"$1,155.00",$0.00,"$1,155.00",$0.00,$824.32,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,155.00",$0.00,$577.50,$914.76,$924.00,$0.00,$0.00,$0.00,$0.00,$0.00
0586-0-332,SUP,Custom 27803010,,0586-0-332  -  HEAD FEMORAL -3MM 32MM NECK EXETER ORTHINOX HIP,"$1,155.00",$0.00,"$1,155.00",$0.00,$824.32,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,155.00",$0.00,$577.50,$914.76,$924.00,$0.00,$0.00,$0.00,$0.00,$0.00
0586-5-026,SUP,Custom 27803010,,0586-5-026  -  HEAD FEMORAL +5MM 26MM NECK EXETER ORTHINOX HIP,"$1,155.00",$0.00,"$1,155.00",$0.00,$824.32,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,155.00",$0.00,$577.50,$914.76,$924.00,$0.00,$0.00,$0.00,$0.00,$0.00
0586-5-028,SUP,Custom 27803010,,0586-5-028  -  HEAD FEMORAL +5MM 28MM NECK EXETER ORTHINOX HIP,"$1,155.00",$0.00,"$1,155.00",$0.00,$824.32,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,155.00",$0.00,$577.50,$914.76,$924.00,$0.00,$0.00,$0.00,$0.00,$0.00
0586-5-032,SUP,Custom 27803010,,0586-5-032  -  HEAD FEMORAL 5MM 35MM NECK EXETER ORTHINOX HIP,"$1,155.00",$0.00,"$1,155.00",$0.00,$824.32,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,155.00",$0.00,$577.50,$914.76,$924.00,$0.00,$0.00,$0.00,$0.00,$0.00
05CR000029,SUP,Custom 27203010,,REAGENT ANALY RNS SOL ALC BLND 3.6L,$135.00,$0.00,$135.00,$0.00,$96.35,$0.00,$0.00,$0.00,$0.00,$0.00,$135.00,$0.00,$67.50,$106.92,$108.00,$0.00,$0.00,$0.00,$0.00,$0.00
05CR000037,SUP,Custom 27203010,,REAGENT CYTO CYSTOLITH FLUID PRSV GYN 4L,$225.00,$0.00,$225.00,$0.00,$160.58,$0.00,$0.00,$0.00,$0.00,$0.00,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$0.00,$0.00,$0.00,$0.00
0650HYB0605A,SUP,HCPCS C1768,,0650HYB0605A  -  GRAFT CARDIO 50CM 6MM 6MM 5CM HBRD REINF GORE NTNL,"$6,125.00",$0.00,"$6,125.00","$2,756.25","$4,371.41",$0.00,"$1,055.31",$0.00,$0.00,"$1,072.44","$6,125.00",$0.00,"$3,062.50","$4,851.00","$4,900.00",$0.00,$958.56,$0.00,$975.10,$0.00
0650HYB0610A,SUP,HCPCS C1768,,0650HYB0610A  -  GRAFT VASCULAR 50CM HYBRID REINFORCED COATED NITINOL PTFE 10,"$7,125.00",$0.00,"$7,125.00","$3,206.25","$5,085.11",$0.00,"$1,227.60",$0.00,$0.00,"$1,247.53","$7,125.00",$0.00,"$3,562.50","$5,643.00","$5,700.00",$0.00,"$1,115.06",$0.00,"$1,134.30",$0.00
0650HYB0705A,SUP,HCPCS C1768,,0650HYB0705A  -  GRAFT VASC 50CM 7MM 6MM GORE NTNL HBRD REINF CNFIG 5CM,"$6,125.00",$0.00,"$6,125.00","$2,756.25","$4,371.41",$0.00,"$1,055.31",$0.00,$0.00,"$1,072.44","$6,125.00",$0.00,"$3,062.50","$4,851.00","$4,900.00",$0.00,$958.56,$0.00,$975.10,$0.00
0650HYB0805A,SUP,HCPCS C1768,,0650HYB0805A  -  GRAFT VASC 50CM 8MM 6MM GORE NTNL HBRD REINF CNFIG 5CM,"$6,125.00",$0.00,"$6,125.00","$2,756.25","$4,371.41",$0.00,"$1,055.31",$0.00,$0.00,"$1,072.44","$6,125.00",$0.00,"$3,062.50","$4,851.00","$4,900.00",$0.00,$958.56,$0.00,$975.10,$0.00
0684-00-0568-01,SUP,Custom 27803010,,0684-00-0568-01  -  CATHETER IAB 7.5FR 6IN 40ML SNS + 2 STLK DEV FO INS KT INTRO,"$2,725.00",$0.00,"$2,725.00",$0.00,"$1,944.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,725.00",$0.00,"$1,362.50","$2,158.20","$2,180.00",$0.00,$0.00,$0.00,$0.00,$0.00
0684-00-0576-01,SUP,Custom 27803010,,0684-00-0576-01  -  CATHETER IAB .025IN 8FR 17.4MM .027IN 6IN 50CC 258MM SNS +,"$2,613.63",$0.00,"$2,613.63",$0.00,"$1,865.34",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,613.63",$0.00,"$1,306.81","$2,069.99","$2,090.90",$0.00,$0.00,$0.00,$0.00,$0.00
07.704.105S,SUP,HCPCS C1713,,07.704.105S  -  FILLER BONE VOID DRILLABLE FAST SET PUTTY NORIAN 5ML STERILE,"$3,570.88",$0.00,"$3,570.88","$1,606.89","$2,548.53",$0.00,$597.33,$0.00,$0.00,$625.23,"$3,570.88",$0.00,"$1,785.44","$2,828.14","$2,856.70",$0.00,$542.57,$0.00,$568.48,$0.00
07.704.110S,SUP,HCPCS C1713,,07.704.110S  -  FILLER BONE VOID DRILLABLE FAST SET PUTTY NORIAN 10ML,"$7,018.18",$0.00,"$7,018.18","$3,158.18","$5,008.87",$0.00,"$1,173.98",$0.00,$0.00,"$1,228.83","$7,018.18",$0.00,"$3,509.09","$5,558.40","$5,614.54",$0.00,"$1,066.35",$0.00,"$1,117.29",$0.00
07.704-003S,SUP,HCPCS C1713,,07.704-003S  -  CEMENT BONE NRN SRS 3ML VOID FILR ROT MX STRL,"$2,018.60",$0.00,"$2,018.60",$908.37,"$1,440.67",$0.00,$347.79,$0.00,$0.00,$353.44,"$2,018.60",$0.00,"$1,009.30","$1,598.73","$1,614.88",$0.00,$315.91,$0.00,$321.36,$0.00
07.704-005S,SUP,HCPCS C1713,,07.704-005S  -  FILLER BONE VOID DRILLABLE INJECT REINFORCED BIORESORBABLE,"$3,570.88",$0.00,"$3,570.88","$1,606.89","$2,548.53",$0.00,$571.17,$0.00,$0.00,$625.23,"$3,570.88",$0.00,"$1,785.44","$2,828.14","$2,856.70",$0.00,$518.81,$0.00,$568.48,$0.00
07.704-010S,SUP,HCPCS C1713,,07.704-010S  -  FILLER BONE VOID DRILLABLE INJECT REINFORCED BIORESORBABLE,"$7,018.18",$0.00,"$7,018.18","$3,158.18","$5,008.87",$0.00,"$1,173.98",$0.00,$0.00,"$1,228.83","$7,018.18",$0.00,"$3,509.09","$5,558.40","$5,614.54",$0.00,"$1,066.35",$0.00,"$1,117.29",$0.00
07-036P,SUP,HCPCS C1713,,07-036P  -  7 MM WASHER,$28.50,$0.00,$28.50,$12.83,$20.34,$0.00,$4.91,$0.00,$0.00,$4.99,$28.50,$0.00,$14.25,$22.57,$22.80,$0.00,$4.46,$0.00,$4.54,$0.00
07-150-10,SUP,Custom 27203010,,07-150-10  -  PROBE DOPPLER 20MHZ 280MM BAYONETED STERILE,"$2,547.50",$0.00,"$2,547.50",$0.00,"$1,818.15",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,547.50",$0.00,"$1,273.75","$2,017.62","$2,038.00",$0.00,$0.00,$0.00,$0.00,$0.00
07-150-12,SUP,Custom 27203010,,07-150-12  -  PROBE DOPPLER MINI NEURO DISPOSABLE,"$3,897.50",$0.00,"$3,897.50",$0.00,"$2,781.65",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,897.50",$0.00,"$1,948.75","$3,086.82","$3,118.00",$0.00,$0.00,$0.00,$0.00,$0.00
073701-CD,SUP,Custom 27203010,,073701-CD  -  SET DILAT S-CURVE HYDPHI PLMR SDPRT LFRIC SLIP SRFC 37CM,$485.00,$0.00,$485.00,$0.00,$346.14,$0.00,$0.00,$0.00,$0.00,$0.00,$485.00,$0.00,$242.50,$384.12,$388.00,$0.00,$0.00,$0.00,$0.00,$0.00
07-40230,SUP,Custom 27803010,,07-40230  -  DRILL DRL 2.4MM CNN D STP,$489.50,$0.00,$489.50,$0.00,$349.36,$0.00,$0.00,$0.00,$0.00,$0.00,$489.50,$0.00,$244.75,$387.68,$391.60,$0.00,$0.00,$0.00,$0.00,$0.00
07-40232,SUP,Custom 27803010,,07-40232  -  TAP CANN DEPTH STOP SURG,$375.38,$0.00,$375.38,$0.00,$267.91,$0.00,$0.00,$0.00,$0.00,$0.00,$375.38,$0.00,$187.69,$297.30,$300.30,$0.00,$0.00,$0.00,$0.00,$0.00
07-40280,SUP,HCPCS C1713,,07-40280  -  WIRE FIX 1MM 160MM KWIRE SS ORTH LEIBINGER,$4.13,$0.00,$4.13,$1.86,$2.94,$0.00,$0.71,$0.00,$0.00,$0.72,$4.13,$0.00,$2.06,$3.27,$3.30,$0.00,$0.65,$0.00,$0.66,$0.00
07-40281,SUP,HCPCS C1713,,07-40281  -  WIRE FX 1.1MM 160MM NS KRSH LGTH MRK SS,$38.50,$0.00,$38.50,$17.33,$27.48,$0.00,$6.63,$0.00,$0.00,$6.74,$38.50,$0.00,$19.25,$30.49,$30.80,$0.00,$6.03,$0.00,$6.13,$0.00
07782G,SUP,Custom 27203010,,CORK GRAD LAB 4,$0.25,$0.00,$0.25,$0.00,$0.18,$0.00,$0.00,$0.00,$0.00,$0.00,$0.25,$0.00,$0.13,$0.20,$0.20,$0.00,$0.00,$0.00,$0.00,$0.00
08.510.543S,SUP,HCPCS C1713,,08.510.543S  -  PLATE BONE 24MMX1.5MM SYNPOR POLYETHYLENE POROUS ORBTL FLOOR,"$1,447.50",$0.00,"$1,447.50",$651.38,"$1,033.08",$0.00,$249.40,$0.00,$0.00,$253.45,"$1,447.50",$0.00,$723.75,"$1,146.42","$1,158.00",$0.00,$226.53,$0.00,$230.44,$0.00
08.520.221S,SUP,HCPCS C1713,,08.520.221S  -  PLATE BN FAN .8MM STRL SYNPOR SMTH EXPOSE FX HL RADGR VSB TI,"$4,292.50",$0.00,"$4,292.50","$1,931.63","$3,063.56",$0.00,$739.58,$0.00,$0.00,$751.58,"$4,292.50",$0.00,"$2,146.25","$3,399.66","$3,434.00",$0.00,$671.78,$0.00,$683.37,$0.00
08.803.209,SUP,HCPCS C1713,,08.803.209  -  SPACER SPNL BLT NOSE 32X10X9MM NS OPAL REVOLVE RADOPQ SLF,"$13,782.50",$0.00,"$13,782.50","$6,202.13","$5,158.80",$0.00,"$2,374.66",$0.00,$0.00,"$2,413.21","$13,782.50",$0.00,"$6,891.25","$10,915.74","$11,026.00",$0.00,"$2,156.96",$0.00,"$2,194.17",$0.00
08A020,SUP,Custom 27804086,,08A020  -  GRAFT BONE CANC 30ML 4-10MM FRZDR,"$1,190.70",$0.00,"$1,190.70",$0.00,$849.80,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,190.70",$0.00,$595.35,$943.03,$952.56,$0.00,$0.00,$0.00,$0.00,$0.00
08A022,SUP,Custom 27803010,,08A022  -  GRAFT BN 15ML CHP CANC,$740.00,$0.00,$740.00,$0.00,$528.14,$0.00,$0.00,$0.00,$0.00,$0.00,$740.00,$0.00,$370.00,$586.08,$592.00,$0.00,$0.00,$0.00,$0.00,$0.00
08A024,SUP,Custom 27804086,,08A024  -  GRAFT BN 4-10MM 5ML CHP CANC TBA 013470059 09,$462.50,$0.00,$462.50,$0.00,$330.09,$0.00,$0.00,$0.00,$0.00,$0.00,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$0.00,$0.00,$0.00,$0.00
09.402.022S,SUP,HCPCS C1713,,09.402.022S  -  HEAD RADIAL STANDARD 22MM 12MM COCR ELBOW STERILE,"$3,286.33",$0.00,"$3,286.33","$1,478.85","$2,345.45",$0.00,$549.72,$0.00,$0.00,$575.41,"$3,286.33",$0.00,"$1,643.16","$2,602.77","$2,629.06",$0.00,$499.33,$0.00,$523.18,$0.00
0900-05,SUP,Custom 27203010,,NUNC NULL STRIPS,$197.50,$0.00,$197.50,$0.00,$140.96,$0.00,$0.00,$0.00,$0.00,$0.00,$197.50,$0.00,$98.75,$156.42,$158.00,$0.00,$0.00,$0.00,$0.00,$0.00
0920-2-920,SUP,Custom 27803010,,0920-2-920  -  CENTRALIZER STEM EXETER PMMA,$112.50,$0.00,$112.50,$0.00,$80.29,$0.00,$0.00,$0.00,$0.00,$0.00,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$0.00,$0.00,$0.00,$0.00
0939-0-106,SUP,HCPCS C1713,,0939-0-106  -  PLUG BONE CEMENT 6MM EXETER PMMA INTRAMEDULLARY,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
0939-0-108,SUP,HCPCS C1713,,0939-0-108  -  PLUG BONE CEMENT 8MM EXETER PMMA INTRAMEDULLARY,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
0939-0-110,SUP,HCPCS C1713,,0939-0-110  -  PLUG BONE CEMENT 10MM EXETER PMMA INTRAMEDULLARY,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
0939-0-112,SUP,HCPCS C1713,,0939-0-112  -  PLUG BONE CEMENT 12MM EXETER PMMA INTRAMEDULLARY,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
0939-0-114,SUP,HCPCS C1713,,0939-0-114  -  PLUG BONE CEMENT 14MM EXETER PMMA INTRAMEDULLARY,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
0939-0-116,SUP,HCPCS C1713,,0939-0-116  -  PLUG BONE CEMENT 16MM EXETER PMMA INTRAMEDULLARY,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
0939-0-118,SUP,HCPCS C1713,,0939-0-118  -  PLUG BONE CEMENT 18MM EXETER PMMA INTRAMEDULLARY,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
0939-0-120,SUP,HCPCS C1713,,0939-0-120  -  PLUG BONE CEMENT 20MM EXETER PMMA INTRAMEDULLARY,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
0942-2-110,SUP,HCPCS C1713,,0942-2-110  -  PLUG BONE CEMENT 10MM EXETER X-CHANGE,$122.50,$0.00,$122.50,$55.13,$87.43,$0.00,$21.11,$0.00,$0.00,$21.45,$122.50,$0.00,$61.25,$97.02,$98.00,$0.00,$19.17,$0.00,$19.50,$0.00
0942-2-112,SUP,HCPCS C1713,,0942-2-112  -  PLUG BONE CEMENT 12MM EXETER X-CHANGE,$122.50,$0.00,$122.50,$55.13,$87.43,$0.00,$21.11,$0.00,$0.00,$21.45,$122.50,$0.00,$61.25,$97.02,$98.00,$0.00,$19.17,$0.00,$19.50,$0.00
0942-2-114,SUP,HCPCS C1713,,0942-2-114  -  SPACER CEMENT 14MM 14MM BONE PLUGS ACCESSORIES EXETER,$122.50,$0.00,$122.50,$55.13,$87.43,$0.00,$21.11,$0.00,$0.00,$21.45,$122.50,$0.00,$61.25,$97.02,$98.00,$0.00,$19.17,$0.00,$19.50,$0.00
0942-2-116,SUP,HCPCS C1713,,0942-2-116  -  PLUG BONE CEMENT 16MM EXETER X-CHANGE,$122.50,$0.00,$122.50,$55.13,$87.43,$0.00,$21.11,$0.00,$0.00,$21.45,$122.50,$0.00,$61.25,$97.02,$98.00,$0.00,$19.17,$0.00,$19.50,$0.00
0942-2-118,SUP,HCPCS C1713,,0942-2-118  -  SPACER CEMENT 18MM BONE PLUGS ACCESSORIES EXETER X-CHANGE,$122.50,$0.00,$122.50,$55.13,$87.43,$0.00,$21.11,$0.00,$0.00,$21.45,$122.50,$0.00,$61.25,$97.02,$98.00,$0.00,$19.17,$0.00,$19.50,$0.00
0942-2-120,SUP,HCPCS C1713,,0942-2-120  -  PLUG BONE CEMENT 20MM 20MM EXETER X-CHANGE HIP,$122.50,$0.00,$122.50,$55.13,$87.43,$0.00,$21.11,$0.00,$0.00,$21.45,$122.50,$0.00,$61.25,$97.02,$98.00,$0.00,$19.17,$0.00,$19.50,$0.00
0942-8-000,SUP,HCPCS C1713,,0942-8-000  -  SCREW BONE 3.5MM 10MM SELF TAP SELF DRILL X-CHANGE HIP,$122.50,$0.00,$122.50,$55.13,$87.43,$0.00,$21.11,$0.00,$0.00,$21.45,$122.50,$0.00,$61.25,$97.02,$98.00,$0.00,$19.17,$0.00,$19.50,$0.00
0942-8-001,SUP,HCPCS C1713,,0942-8-001  -  SCREW BONE 3.5MM 15MM SELF TAP SELF DRILL X-CHANGE HIP,$122.50,$0.00,$122.50,$55.13,$87.43,$0.00,$21.11,$0.00,$0.00,$21.45,$122.50,$0.00,$61.25,$97.02,$98.00,$0.00,$19.17,$0.00,$19.50,$0.00
0942-8-002,SUP,HCPCS C1713,,0942-8-002  -  SCREW BONE 3.5MM 20MM SELF TAP SELF DRILL X-CHANGE HIP,$122.50,$0.00,$122.50,$55.13,$87.43,$0.00,$21.11,$0.00,$0.00,$21.45,$122.50,$0.00,$61.25,$97.02,$98.00,$0.00,$19.17,$0.00,$19.50,$0.00
0942-8-003,SUP,HCPCS C1713,,0942-8-003  -  SCREW BONE 3.5MM 25MM SELF TAP SELF DRILL X-CHANGE HIP,$122.50,$0.00,$122.50,$55.13,$87.43,$0.00,$21.11,$0.00,$0.00,$21.45,$122.50,$0.00,$61.25,$97.02,$98.00,$0.00,$19.17,$0.00,$19.50,$0.00
0942-8-004,SUP,HCPCS C1713,,0942-8-004  -  SCREW BONE 3.5MM 30MM SELF TAP SELF DRILL X-CHANGE HIP,$122.50,$0.00,$122.50,$55.13,$87.43,$0.00,$21.11,$0.00,$0.00,$21.45,$122.50,$0.00,$61.25,$97.02,$98.00,$0.00,$19.17,$0.00,$19.50,$0.00
0942-8-005,SUP,HCPCS C1713,,0942-8-005  -  SCREW BONE 3.5MM 35MM SELF TAP SELF DRILL X-CHANGE HIP,$122.50,$0.00,$122.50,$55.13,$87.43,$0.00,$21.11,$0.00,$0.00,$21.45,$122.50,$0.00,$61.25,$97.02,$98.00,$0.00,$19.17,$0.00,$19.50,$0.00
0942-8-010,SUP,HCPCS C1781,,0942-8-010  -  MESH ACETAB CURVE X-CHANGE RSTOR HIP,"$1,285.00",$0.00,"$1,285.00",$578.25,$917.10,$0.00,$221.40,$0.00,$0.00,$224.99,"$1,285.00",$0.00,$642.50,"$1,017.72","$1,028.00",$0.00,$201.10,$0.00,$204.57,$0.00
0942-8-020,SUP,HCPCS C1781,,0942-8-020  -  MESH ACETAB LARGE X-CHANGE RSTOR HIP MEDIAL WALL,"$1,285.00",$0.00,"$1,285.00",$578.25,$917.10,$0.00,$221.40,$0.00,$0.00,$224.99,"$1,285.00",$0.00,$642.50,"$1,017.72","$1,028.00",$0.00,$201.10,$0.00,$204.57,$0.00
0942-8-025,SUP,HCPCS C1781,,0942-8-025  -  MESH ACETAB SMALL X-CHANGE RSTOR HIP MEDIAL WALL,"$1,285.00",$0.00,"$1,285.00",$578.25,$917.10,$0.00,$221.40,$0.00,$0.00,$224.99,"$1,285.00",$0.00,$642.50,"$1,017.72","$1,028.00",$0.00,$201.10,$0.00,$204.57,$0.00
0942-8-030,SUP,HCPCS C1781,,0942-8-030  -  MESH ACETAB FLAT X-CHANGE RSTOR HIP,"$1,285.00",$0.00,"$1,285.00",$578.25,$917.10,$0.00,$221.40,$0.00,$0.00,$224.99,"$1,285.00",$0.00,$642.50,"$1,017.72","$1,028.00",$0.00,$201.10,$0.00,$204.57,$0.00
0942-8-040,SUP,HCPCS C1781,,0942-8-040  -  MESH ACETAB SMALL X-CHANGE RSTOR HIP RIM,"$1,285.00",$0.00,"$1,285.00",$578.25,$917.10,$0.00,$221.40,$0.00,$0.00,$224.99,"$1,285.00",$0.00,$642.50,"$1,017.72","$1,028.00",$0.00,$201.10,$0.00,$204.57,$0.00
0942-8-050,SUP,HCPCS C1781,,0942-8-050  -  MESH ACETAB MEDIUM X-CHANGE RSTOR HIP RIM,"$1,285.00",$0.00,"$1,285.00",$578.25,$917.10,$0.00,$221.40,$0.00,$0.00,$224.99,"$1,285.00",$0.00,$642.50,"$1,017.72","$1,028.00",$0.00,$201.10,$0.00,$204.57,$0.00
0942-8-060,SUP,HCPCS C1781,,0942-8-060  -  MESH ACETAB LARGE X-CHANGE RSTOR HIP RIM,"$1,285.00",$0.00,"$1,285.00",$578.25,$917.10,$0.00,$221.40,$0.00,$0.00,$224.99,"$1,285.00",$0.00,$642.50,"$1,017.72","$1,028.00",$0.00,$201.10,$0.00,$204.57,$0.00
0942-8-070,SUP,HCPCS C1781,,0942-8-070  -  MESH ACETAB ANATOMIC X-CHANGE RSTOR HIP FEMURAL,"$1,285.00",$0.00,"$1,285.00",$578.25,$917.10,$0.00,$221.40,$0.00,$0.00,$224.99,"$1,285.00",$0.00,$642.50,"$1,017.72","$1,028.00",$0.00,$201.10,$0.00,$204.57,$0.00
0994-001,SUP,HCPCS C1887,,0994-001  -  CATHETER GD 6FR 140CM VNTR OTW RADOPQ STRBL ML LR COIL TRQ,"$1,625.00",$0.00,"$1,625.00",$882.38,"$1,159.76",$0.00,$279.98,$0.00,$0.00,$284.52,"$1,625.00",$0.00,$812.50,"$1,287.00","$1,300.00",$0.00,$254.31,$0.00,$258.70,$0.00
1000-00-0614,SUP,HCPCS C1713,,1000-00-0614  -  CAGE SPNL 7D LRDTC 14X12X6MM COHERE LOPRFL MATTE FNSH PEEK,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
1000-00-0616,SUP,HCPCS C1713,,1000-00-0616  -  CAGE SPNL 7D LRDTC 16X14X6MM COHERE LOPRFL MATTE FNSH PEEK,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
1000-00-0714,SUP,HCPCS C1713,,1000-00-0714  -  CAGE SPNL 7D LRDTC 14X12X7MM COHERE LOPRFL MATTE FNSH PEEK,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
1000-00-0716,SUP,HCPCS C1713,,1000-00-0716  -  CAGE SPNL 7D LRDTC 16X14X7MM COHERE LOPRFL MATTE FNSH PEEK,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
1000-00-0814,SUP,HCPCS C1713,,1000-00-0814  -  CAGE SPNL 7D LRDTC 14X12X8MM COHERE LOPRFL MATTE FNSH PEEK,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
1000-00-0816,SUP,HCPCS C1713,,1000-00-0816  -  CAGE SPNL 7D LRDTC 16X14X8MM COHERE LOPRFL MATTE FNSH PEEK,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
1000-00-0914,SUP,HCPCS C1713,,1000-00-0914  -  CAGE SPNL 7D LRDTC 14X12X9MM COHERE LOPRFL MATTE FNSH PEEK,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
1000-00-0916,SUP,HCPCS C1713,,1000-00-0916  -  CAGE SPNL 7D LRDTC 16X14X9MM COHERE LOPRFL MATTE FNSH PEEK,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
1000-00-1014,SUP,HCPCS C1713,,1000-00-1014  -  CAGE SPNL 7D LRDTC 14X12X10MM COHERE LOPRFL MATTE FNSH PEEK,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
1000-00-1016,SUP,HCPCS C1713,,1000-00-1016  -  CAGE SPNL 7D LRDTC 16X14X10MM COHERE LOPRFL MATTE FNSH PEEK,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
100-06,SUP,HCPCS C1713,,100-06  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$248.63,$0.00,$248.63,$111.88,$177.44,$0.00,$42.84,$0.00,$0.00,$43.53,$248.63,$0.00,$124.31,$196.91,$198.90,$0.00,$38.91,$0.00,$39.58,$0.00
1001-2200,SUP,Custom 27803010,,1001-2200  -  HEAD FEMORAL +00MM MORSE TAPER 32MM OMNIFIT COCR HIP,"$1,297.50",$0.00,"$1,297.50",$0.00,$926.03,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,297.50",$0.00,$648.75,"$1,027.62","$1,038.00",$0.00,$0.00,$0.00,$0.00,$0.00
1001-2205,SUP,Custom 27803010,,1001-2205  -  HEAD FEMORAL +05MM MORSE TAPER 22MM OMNIFIT COCR HIP,"$1,297.50",$0.00,"$1,297.50",$0.00,$926.03,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,297.50",$0.00,$648.75,"$1,027.62","$1,038.00",$0.00,$0.00,$0.00,$0.00,$0.00
1001-2600,SUP,Custom 27803010,,1001-2600  -  HEAD FEMORAL +00MM MORSE TAPER 26MM OMNIFIT COCR HIP,"$1,297.50",$0.00,"$1,297.50",$0.00,$926.03,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,297.50",$0.00,$648.75,"$1,027.62","$1,038.00",$0.00,$0.00,$0.00,$0.00,$0.00
1001-2605,SUP,Custom 27803010,,1001-2605  -  HEAD FEMORAL +05MM MORSE TAPER 26MM OMNIFIT COCR HIP,"$1,297.50",$0.00,"$1,297.50",$0.00,$926.03,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,297.50",$0.00,$648.75,"$1,027.62","$1,038.00",$0.00,$0.00,$0.00,$0.00,$0.00
1001-2610,SUP,Custom 27803010,,1001-2610  -  HEAD FEMORAL +10MM MORSE TAPER 26MM OMNIFIT COCR HIP,"$1,297.50",$0.00,"$1,297.50",$0.00,$926.03,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,297.50",$0.00,$648.75,"$1,027.62","$1,038.00",$0.00,$0.00,$0.00,$0.00,$0.00
1001-2800,SUP,Custom 27803010,,1001-2800  -  HEAD FEMORAL +00MM MORSE TAPER 28MM OMNIFIT COCR HIP,"$1,297.50",$0.00,"$1,297.50",$0.00,$926.03,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,297.50",$0.00,$648.75,"$1,027.62","$1,038.00",$0.00,$0.00,$0.00,$0.00,$0.00
1001-2805,SUP,Custom 27803010,,1001-2805  -  HEAD FEMORAL +5MM 28MM MORSE TAPERED LFIT COCR HIP,"$1,297.50",$0.00,"$1,297.50",$0.00,$926.03,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,297.50",$0.00,$648.75,"$1,027.62","$1,038.00",$0.00,$0.00,$0.00,$0.00,$0.00
1001-2810,SUP,Custom 27803010,,1001-2810  -  HEAD FEM +10 28MM HIP MRS TPR COCR LFIT,$814.00,$0.00,$814.00,$0.00,$580.95,$0.00,$0.00,$0.00,$0.00,$0.00,$814.00,$0.00,$407.00,$644.69,$651.20,$0.00,$0.00,$0.00,$0.00,$0.00
1001-3200,SUP,Custom 27803010,,1001-3200  -  HEAD FEMORAL +00MM MORSE TAPER 32MM OMNIFIT COCR HIP,"$1,297.50",$0.00,"$1,297.50",$0.00,$926.03,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,297.50",$0.00,$648.75,"$1,027.62","$1,038.00",$0.00,$0.00,$0.00,$0.00,$0.00
1001-3205,SUP,Custom 27803010,,1001-3205  -  HEAD FEMORAL +05MM MORSE TAPER 32MM OMNIFIT COCR HIP,"$1,297.50",$0.00,"$1,297.50",$0.00,$926.03,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,297.50",$0.00,$648.75,"$1,027.62","$1,038.00",$0.00,$0.00,$0.00,$0.00,$0.00
1001-3210,SUP,Custom 27803010,,1001-3210  -  HEAD FEMORAL +10MM MORSE TAPER 32MM OMNIFIT COCR HIP,"$1,297.50",$0.00,"$1,297.50",$0.00,$926.03,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,297.50",$0.00,$648.75,"$1,027.62","$1,038.00",$0.00,$0.00,$0.00,$0.00,$0.00
1001-3299,SUP,Custom 27803010,,1001-3299  -  HEAD FEMORAL +99MM MORSE TAPER 32MM OMNIFIT COCR HIP,"$1,297.50",$0.00,"$1,297.50",$0.00,$926.03,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,297.50",$0.00,$648.75,"$1,027.62","$1,038.00",$0.00,$0.00,$0.00,$0.00,$0.00
1001-532,SUP,Custom 27203010,,1001-532  -  CLAMP SURG 75-80GM CLAMPING PRESSURE MIDI STR BULLDOG,$209.50,$0.00,$209.50,$0.00,$149.52,$0.00,$0.00,$0.00,$0.00,$0.00,$209.50,$0.00,$104.75,$165.92,$167.60,$0.00,$0.00,$0.00,$0.00,$0.00
1003381-13,SUP,HCPCS C1874,,1003381-13  -  STENT CORON .014IN LP 4.5MM 13MM RAPEX SMOOTH SURFACE MARKER,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
1003381-18,SUP,HCPCS C1874,,1003381-18  -  SYSTEM COR STNT 4.5MM 18MM MTLNK UL RX LOPRFL RADOPQ SMTH,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
1003381-28,SUP,HCPCS C1874,,1003381-28  -  STENT CORON .014IN LP 4.5MM 28MM RAPEX SMOOTH SURFACE MARKER,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
100-36-01,SUP,Custom 27203010,,100-36-01  -  CHEST TUBE INSERTION DEVICE MINIMALLY INVASIVE,"$5,025.00",$0.00,"$5,025.00",$0.00,"$3,586.34",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,025.00",$0.00,"$2,512.50","$3,979.80","$4,020.00",$0.00,$0.00,$0.00,$0.00,$0.00
1005359H,SUP,HCPCS C1760,,1005359H  -  GUIDEWIRE VASCULAR STR .014IN 300CM 3CM HI-TORQUE WHISPER MS,$177.50,$0.00,$177.50,$79.88,$126.68,$0.00,$30.58,$0.00,$0.00,$31.08,$177.50,$0.00,$88.75,$140.58,$142.00,$0.00,$27.78,$0.00,$28.26,$0.00
1005359H NEW ITEM # 80322174,SUP,HCPCS C1760,,1005359H NEW ITEM # 80322174  -  GUIDEWIRE VASCULAR STR .014IN 300CM 3CM HI-TORQUE WHISPER MS,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
1007-00,SUP,Custom 27203010,,1007-00  -  VALVULOTOME ANGIOSCOPIC 98CM EXPANDABLE OTW 1.5MM,"$4,197.50",$0.00,"$4,197.50",$0.00,"$2,995.76",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,197.50",$0.00,"$2,098.75","$3,324.42","$3,358.00",$0.00,$0.00,$0.00,$0.00,$0.00
1007822-08,SUP,HCPCS C1874,,1007822-08  -  STENT CORON 2.25MM 8MM 2 RADIOPQ MARKER BALLOON EXPANDABLE,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
1007823-08,SUP,HCPCS C1874,,1007823-08  -  STENT CORON 2.5MM 8MM .014IN RAPEX FLXB LP MTLNK MVSN COCR,"$1,625.00",$0.00,"$1,625.00",$731.25,"$1,159.76",$0.00,$279.98,$0.00,$0.00,$284.52,"$1,625.00",$0.00,$812.50,"$1,287.00","$1,300.00",$0.00,$254.31,$0.00,$258.70,$0.00
1007823-15,SUP,HCPCS C1874,,1007823-15  -  STENT CORON LP 2.5MM 15MM 2 RADIOPQ MARKER BALLOON,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
1007823-28,SUP,HCPCS C1874,,1007823-28  -  STENT CORON LP 2.5MM 28MM 2 RADIOPQ MARKER BALLOON,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
1007848-08,SUP,HCPCS C1874,,1007848-08  -  SYSTEM CORON STENT 3MM 8MM RAPEX MULTI-LINK VISION BARE,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
1007848-12,SUP,HCPCS C1874,,1007848-12  -  SYSTEM CORON STENT 3MM 12MM RAPEX MULTI-LINK VISION BARE,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
1007848-23,SUP,HCPCS C1874,,1007848-23  -  STENT CORON LP 3MM 23MM 2 RADIOPQ MARKER BALLOON EXPANDABLE,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
1007848-28,SUP,HCPCS C1874,,1007848-28  -  SYSTEM CORON STENT 3MM 28MM RAPEX MULTI-LINK VISION BARE,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
1007849-12,SUP,HCPCS C1874,,1007849-12  -  SYSTEM COR STNT 3.5MM 12MM MTLNK VSN RX LOPRFL RADOPQ BLN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
1007849-18,SUP,HCPCS C1874,,1007849-18  -  STENT CORON LP 3.5MM 18MM 2 RADIOPQ MARKER BALLOON,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
1007849-23,SUP,HCPCS C1874,,1007849-23  -  STENT CORON LP 3.5MM 23MM 2 RADIOPQ MARKER BALLOON,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
1007849-28,SUP,HCPCS C1874,,1007849-28  -  SYSTEM COR STNT 3.5MM 28MM MTLNK VSN RX LOPRFL RADOPQ BLN,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
1007850-08,SUP,HCPCS C1874,,1007850-08  -  STENT CORON 4MM 8MM .014IN RAPEX FLXB LP MTLNK VSN COCR,"$1,625.00",$0.00,"$1,625.00",$731.25,"$1,159.76",$0.00,$279.98,$0.00,$0.00,$284.52,"$1,625.00",$0.00,$812.50,"$1,287.00","$1,300.00",$0.00,$254.31,$0.00,$258.70,$0.00
1007850-12,SUP,HCPCS C1874,,1007850-12  -  STENT CORON LP 4MM 12MM 2 RADIOPQ MARKER BALLOON EXPANDABLE,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
1007850-15,SUP,HCPCS C1874,,1007850-15  -  STENT CORON LP 4MM 15MM 2 RADIOPQ MARKER BALLOON EXPANDABLE,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
1008193-20,SUP,HCPCS C1725,,1008193-20  -  CATHETER BLNDIL 5MM 135CM 20MM VTRC14 + RX LOPRFL FLXB KINK,$450.00,$0.00,$450.00,$244.35,$321.17,$0.00,$77.53,$0.00,$0.00,$78.79,$450.00,$0.00,$225.00,$356.40,$360.00,$0.00,$70.43,$0.00,$71.64,$0.00
1009539-08,SUP,HCPCS C1874,,1009539-08  -  STENT COR 2.5MM 8MM 143CM XIENCE V DLV SYS RX RADOPQ TPR BLN,"$3,625.00",$0.00,"$3,625.00","$1,631.25","$2,587.16",$0.00,$624.57,$0.00,$0.00,$634.71,"$3,625.00",$0.00,"$1,812.50","$2,871.00","$2,900.00",$0.00,$567.31,$0.00,$577.10,$0.00
1009539-12,SUP,HCPCS C1874,,1009539-12  -  SYSTEM COR STNT 2.5MM 12MM 143CM XIENCE V RX DLV SYS RADOPQ,"$3,625.00",$0.00,"$3,625.00","$1,631.25","$2,587.16",$0.00,$624.57,$0.00,$0.00,$634.71,"$3,625.00",$0.00,"$1,812.50","$2,871.00","$2,900.00",$0.00,$567.31,$0.00,$577.10,$0.00
1009539-15,SUP,HCPCS C1874,,1009539-15  -  SYSTEM COR STNT 2.5MM 15MM 143CM XIENCE V RX DLV SYS RADOPQ,"$3,625.00",$0.00,"$3,625.00","$1,631.25","$2,587.16",$0.00,$624.57,$0.00,$0.00,$634.71,"$3,625.00",$0.00,"$1,812.50","$2,871.00","$2,900.00",$0.00,$567.31,$0.00,$577.10,$0.00
1009539-18,SUP,HCPCS C1874,,1009539-18  -  SYSTEM COR STNT 2.5MM 18MM 143CM XIENCE V RX DLV SYS RADOPQ,"$3,625.00",$0.00,"$3,625.00","$1,631.25","$2,587.16",$0.00,$624.57,$0.00,$0.00,$634.71,"$3,625.00",$0.00,"$1,812.50","$2,871.00","$2,900.00",$0.00,$567.31,$0.00,$577.10,$0.00
1009539-23,SUP,HCPCS C1874,,1009539-23  -  SYSTEM COR STNT 2.5MM 23MM 143CM XIENCE V RX DLV SYS RADOPQ,"$3,625.00",$0.00,"$3,625.00","$1,631.25","$2,587.16",$0.00,$624.57,$0.00,$0.00,$634.71,"$3,625.00",$0.00,"$1,812.50","$2,871.00","$2,900.00",$0.00,$567.31,$0.00,$577.10,$0.00
1009539-28,SUP,HCPCS C1874,,1009539-28  -  SYSTEM COR STNT 2.5MM 28MM 143CM XIENCE V RX DLV SYS RADOPQ,"$3,625.00",$0.00,"$3,625.00","$1,631.25","$2,587.16",$0.00,$624.57,$0.00,$0.00,$634.71,"$3,625.00",$0.00,"$1,812.50","$2,871.00","$2,900.00",$0.00,$567.31,$0.00,$577.10,$0.00
1009540-12,SUP,HCPCS C1874,,1009540-12  -  SYSTEM COR STNT 2.75MM 12MM 143CM XIENCE V RX DLV SYS RADOPQ,"$3,625.00",$0.00,"$3,625.00","$1,631.25","$2,587.16",$0.00,$624.57,$0.00,$0.00,$634.71,"$3,625.00",$0.00,"$1,812.50","$2,871.00","$2,900.00",$0.00,$567.31,$0.00,$577.10,$0.00
1009540-15,SUP,HCPCS C1874,,1009540-15  -  SYSTEM COR STNT 2.75MM 15MM 143CM XIENCE V RX DLV SYS RADOPQ,"$3,625.00",$0.00,"$3,625.00","$1,631.25","$2,587.16",$0.00,$624.57,$0.00,$0.00,$634.71,"$3,625.00",$0.00,"$1,812.50","$2,871.00","$2,900.00",$0.00,$567.31,$0.00,$577.10,$0.00
1009540-18,SUP,HCPCS C1874,,1009540-18  -  SYSTEM COR STNT 2.75MM 18MM 143CM XIENCE V RX DLV SYS RADOPQ,"$3,625.00",$0.00,"$3,625.00","$1,631.25","$2,587.16",$0.00,$624.57,$0.00,$0.00,$634.71,"$3,625.00",$0.00,"$1,812.50","$2,871.00","$2,900.00",$0.00,$567.31,$0.00,$577.10,$0.00
1009540-23,SUP,HCPCS C1874,,1009540-23  -  SYSTEM COR STNT 2.75MM 23MM 143CM XIENCE V RX DLV SYS RADOPQ,"$3,625.00",$0.00,"$3,625.00","$1,631.25","$2,587.16",$0.00,$624.57,$0.00,$0.00,$634.71,"$3,625.00",$0.00,"$1,812.50","$2,871.00","$2,900.00",$0.00,$567.31,$0.00,$577.10,$0.00
1009540-28,SUP,HCPCS C1874,,1009540-28  -  SYSTEM COR STNT 2.75MM 28MM 143CM XIENCE V RX DLV SYS RADOPQ,"$3,625.00",$0.00,"$3,625.00","$1,631.25","$2,587.16",$0.00,$624.57,$0.00,$0.00,$634.71,"$3,625.00",$0.00,"$1,812.50","$2,871.00","$2,900.00",$0.00,$567.31,$0.00,$577.10,$0.00
1009541-12,SUP,HCPCS C1874,,1009541-12  -  SYSTEM COR STNT 3MM 12MM 143CM XIENCE V RX DLV SYS RADOPQ,"$3,625.00",$0.00,"$3,625.00","$1,631.25","$2,587.16",$0.00,$624.57,$0.00,$0.00,$634.71,"$3,625.00",$0.00,"$1,812.50","$2,871.00","$2,900.00",$0.00,$567.31,$0.00,$577.10,$0.00
1009541-15,SUP,HCPCS C1874,,1009541-15  -  SYSTEM COR STNT 3MM 15MM 143CM XIENCE V RX DLV SYS RADOPQ,"$3,625.00",$0.00,"$3,625.00","$1,631.25","$2,587.16",$0.00,$624.57,$0.00,$0.00,$634.71,"$3,625.00",$0.00,"$1,812.50","$2,871.00","$2,900.00",$0.00,$567.31,$0.00,$577.10,$0.00
1009541-18,SUP,HCPCS C1874,,1009541-18  -  SYSTEM COR STNT 3MM 18MM 143CM XIENCE V RX DLV SYS RADOPQ,"$3,625.00",$0.00,"$3,625.00","$1,631.25","$2,587.16",$0.00,$624.57,$0.00,$0.00,$634.71,"$3,625.00",$0.00,"$1,812.50","$2,871.00","$2,900.00",$0.00,$567.31,$0.00,$577.10,$0.00
1009541-23,SUP,HCPCS C1874,,1009541-23  -  SYSTEM COR STNT 3MM 23MM 143CM XIENCE V RX DLV SYS RADOPQ,"$3,625.00",$0.00,"$3,625.00","$1,631.25","$2,587.16",$0.00,$624.57,$0.00,$0.00,$634.71,"$3,625.00",$0.00,"$1,812.50","$2,871.00","$2,900.00",$0.00,$567.31,$0.00,$577.10,$0.00
1009541-28,SUP,HCPCS C1874,,1009541-28  -  SYSTEM COR STNT 3MM 28MM 143CM XIENCE V RX DLV SYS RADOPQ,"$3,625.00",$0.00,"$3,625.00","$1,631.25","$2,587.16",$0.00,$624.57,$0.00,$0.00,$634.71,"$3,625.00",$0.00,"$1,812.50","$2,871.00","$2,900.00",$0.00,$567.31,$0.00,$577.10,$0.00
1009542-08,SUP,HCPCS C1874,,1009542-08  -  SYSTEM COR STNT 3.5MM 8MM 143CM XIENCE V RX DLV SYS RADOPQ,"$3,625.00",$0.00,"$3,625.00","$1,631.25","$2,587.16",$0.00,$624.57,$0.00,$0.00,$634.71,"$3,625.00",$0.00,"$1,812.50","$2,871.00","$2,900.00",$0.00,$567.31,$0.00,$577.10,$0.00
1009542-12,SUP,HCPCS C1874,,1009542-12  -  SYSTEM COR STNT 3.5MM 12MM 143CM XIENCE V RX DLV SYS RADOPQ,"$3,625.00",$0.00,"$3,625.00","$1,631.25","$2,587.16",$0.00,$624.57,$0.00,$0.00,$634.71,"$3,625.00",$0.00,"$1,812.50","$2,871.00","$2,900.00",$0.00,$567.31,$0.00,$577.10,$0.00
1009542-15,SUP,HCPCS C1874,,1009542-15  -  SYSTEM COR STNT 3.5MM 15MM 143CM XIENCE V RX DLV SYS RADOPQ,"$3,625.00",$0.00,"$3,625.00","$1,631.25","$2,587.16",$0.00,$624.57,$0.00,$0.00,$634.71,"$3,625.00",$0.00,"$1,812.50","$2,871.00","$2,900.00",$0.00,$567.31,$0.00,$577.10,$0.00
1009542-18,SUP,HCPCS C1874,,1009542-18  -  SYSTEM COR STNT 3.5MM 18MM 143CM XIENCE V RX DLV SYS RADOPQ,"$3,625.00",$0.00,"$3,625.00","$1,631.25","$2,587.16",$0.00,$624.57,$0.00,$0.00,$634.71,"$3,625.00",$0.00,"$1,812.50","$2,871.00","$2,900.00",$0.00,$567.31,$0.00,$577.10,$0.00
1009542-23,SUP,HCPCS C1874,,1009542-23  -  SYSTEM COR STNT 3.5MM 23MM 143CM XIENCE V RX DLV SYS RADOPQ,"$3,625.00",$0.00,"$3,625.00","$1,631.25","$2,587.16",$0.00,$624.57,$0.00,$0.00,$634.71,"$3,625.00",$0.00,"$1,812.50","$2,871.00","$2,900.00",$0.00,$567.31,$0.00,$577.10,$0.00
1009542-28,SUP,HCPCS C1874,,1009542-28  -  SYSTEM COR STNT 3.5MM 28MM 143CM XIENCE V RX DLV SYS RADOPQ,"$3,625.00",$0.00,"$3,625.00","$1,631.25","$2,587.16",$0.00,$624.57,$0.00,$0.00,$634.71,"$3,625.00",$0.00,"$1,812.50","$2,871.00","$2,900.00",$0.00,$567.31,$0.00,$577.10,$0.00
1009543-08,SUP,HCPCS C1874,,1009543-08  -  SYSTEM COR STNT 4MM 8MM 143CM XIENCE V RX DLV SYS RADOPQ TPR,"$3,625.00",$0.00,"$3,625.00","$1,631.25","$2,587.16",$0.00,$624.57,$0.00,$0.00,$634.71,"$3,625.00",$0.00,"$1,812.50","$2,871.00","$2,900.00",$0.00,$567.31,$0.00,$577.10,$0.00
1009543-12,SUP,HCPCS C1874,,1009543-12  -  SYSTEM COR STNT 4MM 12MM 143CM XIENCE V RX DLV SYS RADOPQ,"$3,625.00",$0.00,"$3,625.00","$1,631.25","$2,587.16",$0.00,$624.57,$0.00,$0.00,$634.71,"$3,625.00",$0.00,"$1,812.50","$2,871.00","$2,900.00",$0.00,$567.31,$0.00,$577.10,$0.00
1009543-15,SUP,HCPCS C1874,,1009543-15  -  SYSTEM COR STNT 4MM 15MM 143CM XIENCE V RX DLV SYS RADOPQ,"$3,625.00",$0.00,"$3,625.00","$1,631.25","$2,587.16",$0.00,$624.57,$0.00,$0.00,$634.71,"$3,625.00",$0.00,"$1,812.50","$2,871.00","$2,900.00",$0.00,$567.31,$0.00,$577.10,$0.00
1009543-18,SUP,HCPCS C1874,,1009543-18  -  SYSTEM COR STNT 4MM 18MM 143CM XIENCE V RX DLV SYS RADOPQ,"$3,625.00",$0.00,"$3,625.00","$1,631.25","$2,587.16",$0.00,$624.57,$0.00,$0.00,$634.71,"$3,625.00",$0.00,"$1,812.50","$2,871.00","$2,900.00",$0.00,$567.31,$0.00,$577.10,$0.00
1009543-23,SUP,HCPCS C1874,,1009543-23  -  SYSTEM COR STNT 4MM 23MM 143CM XIENCE V RX DLV SYS RADOPQ,"$3,625.00",$0.00,"$3,625.00","$1,631.25","$2,587.16",$0.00,$624.57,$0.00,$0.00,$634.71,"$3,625.00",$0.00,"$1,812.50","$2,871.00","$2,900.00",$0.00,$567.31,$0.00,$577.10,$0.00
1009543-28,SUP,HCPCS C1874,,1009543-28  -  SYSTEM COR STNT 4MM 28MM 143CM XIENCE V RX DLV SYS RADOPQ,"$3,625.00",$0.00,"$3,625.00","$1,631.25","$2,587.16",$0.00,$624.57,$0.00,$0.00,$634.71,"$3,625.00",$0.00,"$1,812.50","$2,871.00","$2,900.00",$0.00,$567.31,$0.00,$577.10,$0.00
1009544-08,SUP,HCPCS C1874,,1009544-08  -  SYSTEM COR STNT 2.25MM 8MM 143CM XIENCE V RX DLV SYS RADOPQ,"$3,625.00",$0.00,"$3,625.00","$1,631.25","$2,587.16",$0.00,$624.57,$0.00,$0.00,$634.71,"$3,625.00",$0.00,"$1,812.50","$2,871.00","$2,900.00",$0.00,$567.31,$0.00,$577.10,$0.00
1009544-15,SUP,HCPCS C1874,,1009544-15  -  SYSTEM COR STNT 2.25MM 15MM 143CM XIENCE V RX DLV SYS RADOPQ,"$3,625.00",$0.00,"$3,625.00","$1,631.25","$2,587.16",$0.00,$624.57,$0.00,$0.00,$634.71,"$3,625.00",$0.00,"$1,812.50","$2,871.00","$2,900.00",$0.00,$567.31,$0.00,$577.10,$0.00
1009544-18,SUP,HCPCS C1874,,1009544-18  -  SYSTEM COR STNT 2.25MM 18MM 143CM XIENCE V RX DLV SYS RADOPQ,"$3,625.00",$0.00,"$3,625.00","$1,631.25","$2,587.16",$0.00,$624.57,$0.00,$0.00,$634.71,"$3,625.00",$0.00,"$1,812.50","$2,871.00","$2,900.00",$0.00,$567.31,$0.00,$577.10,$0.00
1009544-28,SUP,HCPCS C1874,,1009544-28  -  SYSTEM COR STNT 2.25MM 28MM 143CM XIENCE V RX DLV SYS RADOPQ,"$3,625.00",$0.00,"$3,625.00","$1,631.25","$2,587.16",$0.00,$624.57,$0.00,$0.00,$634.71,"$3,625.00",$0.00,"$1,812.50","$2,871.00","$2,900.00",$0.00,$567.31,$0.00,$577.10,$0.00
1010-10-PAD,SUP,HCPCS A4565,,1010-10-PAD  -  SLING ORTH XL,$7.07,$0.00,$7.07,$0.00,$5.05,$0.00,$0.00,$0.00,$0.00,$0.00,$7.07,$0.00,$3.54,$5.60,$5.66,$0.00,$0.00,$0.00,$0.00,$0.00
1010-10-PAD-30,SUP,HCPCS A4565,,1010-10-PAD-30  -  SLING ORTH MED,$7.07,$0.00,$7.07,$0.00,$5.05,$0.00,$0.00,$0.00,$0.00,$0.00,$7.07,$0.00,$3.54,$5.60,$5.66,$0.00,$0.00,$0.00,$0.00,$0.00
1010-10-PAD-40,SUP,HCPCS A4565,,1010-10-PAD-40  -  SLING ORTH LG,$7.07,$0.00,$7.07,$0.00,$5.05,$0.00,$0.00,$0.00,$0.00,$0.00,$7.07,$0.00,$3.54,$5.60,$5.66,$0.00,$0.00,$0.00,$0.00,$0.00
1010480H,SUP,HCPCS C1769,,GUIDEWIRE VASC .014IN 190CM 3CM STRG HTORQ PILT 50 HDRCT,$187.50,$0.00,$187.50,$101.81,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
10-1073,SUP,Custom 27203010,,10-1073  -  SET BONE BIOP 16CM BONOPTY CORT CANNU STY EJTR PIN DEPTH GA,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
1011337-40,SUP,HCPCS C1876,,1011337-40  -  STENT VASCULAR STR LP 5MM 8FR 40MM 132CM SELF EXPANDABLE,"$4,125.00",$0.00,"$4,125.00","$1,856.25","$2,944.01",$0.00,$710.72,$0.00,$0.00,$722.25,"$4,125.00",$0.00,"$2,062.50","$3,267.00","$3,300.00",$0.00,$645.56,$0.00,$656.70,$0.00
1011338-40,SUP,HCPCS C1876,,1011338-40  -  STENT VASCULAR STR LP 6MM 8FR 40MM 132CM SELF EXPANDABLE,"$4,125.00",$0.00,"$4,125.00","$1,856.25","$2,944.01",$0.00,$710.72,$0.00,$0.00,$722.25,"$4,125.00",$0.00,"$2,062.50","$3,267.00","$3,300.00",$0.00,$645.56,$0.00,$656.70,$0.00
1011339-40,SUP,HCPCS C1876,,1011339-40  -  STENT VASCULAR STR LP 7MM 8FR 40MM 132CM SELF EXPANDABLE,"$4,125.00",$0.00,"$4,125.00","$1,856.25","$2,944.01",$0.00,$710.72,$0.00,$0.00,$722.25,"$4,125.00",$0.00,"$2,062.50","$3,267.00","$3,300.00",$0.00,$645.56,$0.00,$656.70,$0.00
1011340-40,SUP,HCPCS C1876,,1011340-40  -  STENT VASCULAR STR LP 8MM 8FR 40MM 132CM SELF EXPANDABLE,"$4,125.00",$0.00,"$4,125.00","$1,856.25","$2,944.01",$0.00,$710.72,$0.00,$0.00,$722.25,"$4,125.00",$0.00,"$2,062.50","$3,267.00","$3,300.00",$0.00,$645.56,$0.00,$656.70,$0.00
1011341-40,SUP,HCPCS C1876,,1011341-40  -  STENT VASCULAR STR LP 9MM 8FR 40MM 132CM SELF EXPANDABLE,"$4,125.00",$0.00,"$4,125.00","$1,856.25","$2,944.01",$0.00,$710.72,$0.00,$0.00,$722.25,"$4,125.00",$0.00,"$2,062.50","$3,267.00","$3,300.00",$0.00,$645.56,$0.00,$656.70,$0.00
1011342-40,SUP,HCPCS C1876,,1011342-40  -  STENT VASCULAR STR LP 10MM 8FR 40MM 132CM SELF EXPANDABLE,"$4,125.00",$0.00,"$4,125.00","$1,856.25","$2,944.01",$0.00,$710.72,$0.00,$0.00,$722.25,"$4,125.00",$0.00,"$2,062.50","$3,267.00","$3,300.00",$0.00,$645.56,$0.00,$656.70,$0.00
1011343-30,SUP,HCPCS C1876,,1011343-30  -  STENT VASCULAR LP TAPER 6-8MM 8FR 30MM 132CM SELF EXPANDABLE,"$4,125.00",$0.00,"$4,125.00","$1,856.25","$2,944.01",$0.00,$710.72,$0.00,$0.00,$722.25,"$4,125.00",$0.00,"$2,062.50","$3,267.00","$3,300.00",$0.00,$645.56,$0.00,$656.70,$0.00
1011343-40,SUP,HCPCS C1876,,1011343-40  -  STENT VASCULAR LP TAPER 6-8MM 8FR 40MM 132CM SELF EXPANDABLE,"$4,125.00",$0.00,"$4,125.00","$1,856.25","$2,944.01",$0.00,$710.72,$0.00,$0.00,$722.25,"$4,125.00",$0.00,"$2,062.50","$3,267.00","$3,300.00",$0.00,$645.56,$0.00,$656.70,$0.00
1011344-40,SUP,HCPCS C1876,,1011344-40  -  STENT VASCULAR LP TAPER 7-10MM 8FR 40MM 132CM SELF,"$4,125.00",$0.00,"$4,125.00","$1,856.25","$2,944.01",$0.00,$710.72,$0.00,$0.00,$722.25,"$4,125.00",$0.00,"$2,062.50","$3,267.00","$3,300.00",$0.00,$645.56,$0.00,$656.70,$0.00
1011650-55,SUP,HCPCS C1760,,1011650-55  -  SYSTEM EMBOLIC PROTECTION LP 4.5MM 6-8FR 300CM GWIRE,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
1012402-15A,SUP,HCPCS C1725,,1012402-15A  -  CATHETER BLNDIL 1.5MM 145CM 15MM MN TREK II OTW 2 LUM ULT,$212.50,$0.00,$212.50,$115.39,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
1012534-100,SUP,HCPCS C1876,,1012534-100  -  STENT BILIARY 6MM 100MM 135CM SELF EXPANDABLE RADIOPQ MARKER,$937.50,$0.00,$937.50,$421.88,$669.09,$0.00,$161.53,$0.00,$0.00,$164.15,$937.50,$0.00,$468.75,$742.50,$750.00,$0.00,$146.72,$0.00,$149.25,$0.00
1012535-100,SUP,HCPCS C1876,,1012535-100  -  STENT BILIARY 7MM 100MM 135CM SELF EXPANDABLE RADIOPQ MARKER,$937.50,$0.00,$937.50,$421.88,$669.09,$0.00,$161.53,$0.00,$0.00,$164.15,$937.50,$0.00,$468.75,$742.50,$750.00,$0.00,$146.72,$0.00,$149.25,$0.00
1016-17,SUP,HCPCS Q4116,,1016-17  -  GRAFT SKIN MEDIUM FROZEN CADAVER NONMESHED 232 SQ CM/ ¼ SQ F,"$1,120.00",$0.00,"$1,120.00",$504.00,$799.34,$0.00,$192.97,$0.00,$0.00,$196.10,"$1,120.00",$0.00,$560.00,$887.04,$896.00,$0.00,$175.28,$0.00,$178.30,$0.00
1017-17,SUP,HCPCS Q4116,,1017-17  -  GRAFT SKN 154SQ CM NONMESHED CRPRS,$645.00,$0.00,$645.00,$290.25,$460.34,$0.00,$111.13,$0.00,$0.00,$112.93,$645.00,$0.00,$322.50,$510.84,$516.00,$0.00,$100.94,$0.00,$102.68,$0.00
101-L05-C,SUP,HCPCS C1713,,101-L05-C  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$408.00,$0.00,$408.00,$183.60,$291.19,$0.00,$70.30,$0.00,$0.00,$71.44,$408.00,$0.00,$204.00,$323.14,$326.40,$0.00,$63.85,$0.00,$64.95,$0.00
101-L25,SUP,HCPCS C1713,,101-L25  -  PLATE 18MM TI BONE SPNL,$403.75,$0.00,$403.75,$181.69,$288.16,$0.00,$69.56,$0.00,$0.00,$70.69,$403.75,$0.00,$201.88,$319.77,$323.00,$0.00,$63.19,$0.00,$64.28,$0.00
101-R25,SUP,HCPCS C1713,,101-R25  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$408.00,$0.00,$408.00,$183.60,$291.19,$0.00,$70.30,$0.00,$0.00,$71.44,$408.00,$0.00,$204.00,$323.14,$326.40,$0.00,$63.85,$0.00,$64.95,$0.00
1022-0004,SUP,Custom 27803010,,1022-0004  -  STEM FEM COLLAR SMTH OMFLX 4,$610.00,$0.00,$610.00,$0.00,$435.36,$0.00,$0.00,$0.00,$0.00,$0.00,$610.00,$0.00,$305.00,$483.12,$488.00,$0.00,$0.00,$0.00,$0.00,$0.00
1022-0005,SUP,Custom 27803010,,1022-0005  -  STEM FEM COLLAR SMTH OMFLX 5,$610.00,$0.00,$610.00,$0.00,$435.36,$0.00,$0.00,$0.00,$0.00,$0.00,$610.00,$0.00,$305.00,$483.12,$488.00,$0.00,$0.00,$0.00,$0.00,$0.00
1022-0006,SUP,Custom 27803010,,1022-0006  -  STEM FEM COLLAR SMTH OMFLX 6,$610.00,$0.00,$610.00,$0.00,$435.36,$0.00,$0.00,$0.00,$0.00,$0.00,$610.00,$0.00,$305.00,$483.12,$488.00,$0.00,$0.00,$0.00,$0.00,$0.00
1022-0007,SUP,Custom 27803010,,1022-0007  -  STEM FEM COLLAR SMTH OMFLX 7,$610.00,$0.00,$610.00,$0.00,$435.36,$0.00,$0.00,$0.00,$0.00,$0.00,$610.00,$0.00,$305.00,$483.12,$488.00,$0.00,$0.00,$0.00,$0.00,$0.00
1022-0008,SUP,Custom 27803010,,1022-0008  -  STEM FEM COLLAR SMTH OMFLX 8,$610.00,$0.00,$610.00,$0.00,$435.36,$0.00,$0.00,$0.00,$0.00,$0.00,$610.00,$0.00,$305.00,$483.12,$488.00,$0.00,$0.00,$0.00,$0.00,$0.00
1022-0009,SUP,Custom 27803010,,1022-0009  -  STEM FEM COLLAR SMTH OMFLX 9,$610.00,$0.00,$610.00,$0.00,$435.36,$0.00,$0.00,$0.00,$0.00,$0.00,$610.00,$0.00,$305.00,$483.12,$488.00,$0.00,$0.00,$0.00,$0.00,$0.00
1022-0010,SUP,Custom 27803010,,1022-0010  -  STEM FEM COLLAR SMTH OMFLX 10,$610.00,$0.00,$610.00,$0.00,$435.36,$0.00,$0.00,$0.00,$0.00,$0.00,$610.00,$0.00,$305.00,$483.12,$488.00,$0.00,$0.00,$0.00,$0.00,$0.00
1022-0011,SUP,Custom 27803010,,1022-0011  -  STEM FEM COLLAR SMTH OMFLX 11,$610.00,$0.00,$610.00,$0.00,$435.36,$0.00,$0.00,$0.00,$0.00,$0.00,$610.00,$0.00,$305.00,$483.12,$488.00,$0.00,$0.00,$0.00,$0.00,$0.00
1022-0012,SUP,Custom 27803010,,1022-0012  -  STEM FEM COLLAR SMTH OMFLX 12,$610.00,$0.00,$610.00,$0.00,$435.36,$0.00,$0.00,$0.00,$0.00,$0.00,$610.00,$0.00,$305.00,$483.12,$488.00,$0.00,$0.00,$0.00,$0.00,$0.00
1022-0013,SUP,Custom 27803010,,1022-0013  -  STEM FEM COLLAR SMTH OMFLX 13,$610.00,$0.00,$610.00,$0.00,$435.36,$0.00,$0.00,$0.00,$0.00,$0.00,$610.00,$0.00,$305.00,$483.12,$488.00,$0.00,$0.00,$0.00,$0.00,$0.00
1022-0014,SUP,Custom 27803010,,1022-0014  -  STEM FEM COLLAR SMTH OMFLX 14,$610.00,$0.00,$610.00,$0.00,$435.36,$0.00,$0.00,$0.00,$0.00,$0.00,$610.00,$0.00,$305.00,$483.12,$488.00,$0.00,$0.00,$0.00,$0.00,$0.00
103.25.180,SUP,Custom 27203010,,103.25.180  -  BIT DRL 2 FLUT 2.5MM 180MM 154MM QC,$208.00,$0.00,$208.00,$0.00,$148.45,$0.00,$0.00,$0.00,$0.00,$0.00,$208.00,$0.00,$104.00,$164.74,$166.40,$0.00,$0.00,$0.00,$0.00,$0.00
103-0304,SUP,Custom 27203010,,103-0304  -  DEVICE CADENCE PRCS 1ML SYR INJECTOR INFLAT,$249.50,$0.00,$249.50,$0.00,$178.07,$0.00,$0.00,$0.00,$0.00,$0.00,$249.50,$0.00,$124.75,$197.60,$199.60,$0.00,$0.00,$0.00,$0.00,$0.00
103-0601-200,SUP,HCPCS C1769,,103-0601-200  -  GWIRE VASC .01IN 200CM 10CM SILVERSPEED HYDPHI,$575.00,$0.00,$575.00,$312.23,$410.38,$0.00,$99.07,$0.00,$0.00,$100.68,$575.00,$0.00,$287.50,$455.40,$460.00,$0.00,$89.99,$0.00,$91.54,$0.00
103-0602-300,SUP,HCPCS C1769,,103-0602-300  -  GWIRE VASC .014IN 300CM 20CM FLXB EXCH XCLRT HYDPHI,$867.50,$0.00,$867.50,$471.05,$619.13,$0.00,$149.47,$0.00,$0.00,$151.89,$867.50,$0.00,$433.75,$687.06,$694.00,$0.00,$135.76,$0.00,$138.11,$0.00
103-0603-200,SUP,HCPCS C1769,,103-0603-200  -  GWIRE VASC .016IN 200CM FLXB SILVERSPEED HYDPHI,$537.50,$0.00,$537.50,$291.86,$383.61,$0.00,$92.61,$0.00,$0.00,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
103-0605-200,SUP,HCPCS C1769,,103-0605-200  -  GWIRE VASC 175CM 20CM .014IN SFT COIL TIP HYDPHI XPDN,$657.50,$0.00,$657.50,$357.02,$469.26,$0.00,$113.28,$0.00,$0.00,$115.12,$657.50,$0.00,$328.75,$520.74,$526.00,$0.00,$102.90,$0.00,$104.67,$0.00
103-0608,SUP,HCPCS C1769,,103-0608  -  GWIRE VASC .008IN 200CM 10CM SFT COIL TIP TPR X SPRT MRG,"$1,090.00",$0.00,"$1,090.00",$591.87,$777.93,$0.00,$187.80,$0.00,$0.00,$190.85,"$1,090.00",$0.00,$545.00,$863.28,$872.00,$0.00,$170.59,$0.00,$173.53,$0.00
103-L05,SUP,HCPCS C1713,,103-L05  -  PLATE 18MM TI BONE SPNL,$403.75,$0.00,$403.75,$181.69,$288.16,$0.00,$69.56,$0.00,$0.00,$70.69,$403.75,$0.00,$201.88,$319.77,$323.00,$0.00,$63.19,$0.00,$64.28,$0.00
103-R05,SUP,HCPCS C1713,,103-R05  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$408.00,$0.00,$408.00,$183.60,$291.19,$0.00,$70.30,$0.00,$0.00,$71.44,$408.00,$0.00,$204.00,$323.14,$326.40,$0.00,$63.85,$0.00,$64.95,$0.00
10-403FC,SUP,Custom 27203010,,10-403FC -  DEVICE SPECIMEN RETRIEVAL TISSUE REMOVAL MYOSURE,"$3,890.00",$0.00,"$3,890.00",$0.00,"$2,776.29",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,890.00",$0.00,"$1,945.00","$3,080.88","$3,112.00",$0.00,$0.00,$0.00,$0.00,$0.00
104-4112,SUP,HCPCS C2628,,104-4112  -  CATH BLNOCC 2.8-2.2FR 4MM 150CM 15MM REINF SHFT HYDPHI,"$2,675.00",$0.00,"$2,675.00",$0.00,"$1,909.15",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,675.00",$0.00,"$1,337.50","$2,118.60","$2,140.00",$0.00,$0.00,$0.00,$0.00,$0.00
104-4127,SUP,HCPCS C2628,,104-4127  -  CATH BLNOCC 2.8-2.2FR 20MM 150CM 4MM REINF SHFT HYDPHI,"$2,562.50",$0.00,"$2,562.50",$0.00,"$1,828.86",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,562.50",$0.00,"$1,281.25","$2,029.50","$2,050.00",$0.00,$0.00,$0.00,$0.00,$0.00
104-4132,SUP,HCPCS C2628,,104-4132  -  CATH BLNOCC 2.3FR 4MM 150CM 30MM REINF SHFT HYDPHI,"$2,562.50",$0.00,"$2,562.50",$0.00,"$1,828.86",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,562.50",$0.00,"$1,281.25","$2,029.50","$2,050.00",$0.00,$0.00,$0.00,$0.00,$0.00
104-4310,SUP,HCPCS C1726,,104-4310  -  HYPERGLIDE 3.0 X 10MM,"$2,675.00",$0.00,"$2,675.00","$1,452.53","$1,909.15",$0.00,$460.89,$0.00,$0.00,$468.37,"$2,675.00",$0.00,"$1,337.50","$2,118.60","$2,140.00",$0.00,$418.64,$0.00,$425.86,$0.00
104-4315,SUP,HCPCS C2628,,104-4315  -  CATHETER BALLOON  HYPERGLIDE .010 IN L150 CM L15 MM,"$2,675.00",$0.00,"$2,675.00",$0.00,"$1,909.15",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,675.00",$0.00,"$1,337.50","$2,118.60","$2,140.00",$0.00,$0.00,$0.00,$0.00,$0.00
104-4470,SUP,HCPCS C1751,,104-4470  -  CATHETER BLNOCC .01IN 2MM 2.5-2.8FR 4MM 150CM 7MM HYPERFORM,"$3,312.50",$0.00,"$3,312.50","$1,798.69","$2,364.13",$0.00,$570.73,$0.00,$0.00,$579.99,"$3,312.50",$0.00,"$1,656.25","$2,623.50","$2,650.00",$0.00,$518.41,$0.00,$527.35,$0.00
104-44770,SUP,HCPCS C2628,,"104-44770  -  BALLOON, HYPERFORM 4MM X 7MM","$3,312.50",$0.00,"$3,312.50",$0.00,"$2,364.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,312.50",$0.00,"$1,656.25","$2,623.50","$2,650.00",$0.00,$0.00,$0.00,$0.00,$0.00
104-4515,SUP,HCPCS C1757,,104-4515  -  CATHETER BLNOCC .01IN 4MM 2.8-2.2FR 5MM 150CM 15MM,"$2,675.00",$0.00,"$2,675.00",$0.00,"$1,909.15",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,675.00",$0.00,"$1,337.50","$2,118.60","$2,140.00",$0.00,$0.00,$0.00,$0.00,$0.00
104-4520,SUP,HCPCS C1757,,104-4520  -  CATHETER BLNOCC 4MM 2.8-2.2FR 5MM 150CM 20MM HYPERGLIDE 1,"$2,562.50",$0.00,"$2,562.50",$0.00,"$1,828.86",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,562.50",$0.00,"$1,281.25","$2,029.50","$2,050.00",$0.00,$0.00,$0.00,$0.00,$0.00
104-4770,SUP,HCPCS C2628,,104-4770  -  CATH BLNOCC .01IN 7MM 150CM 7MM GWIRE SL ASYM VASCULATURE,"$3,312.50",$0.00,"$3,312.50",$0.00,"$2,364.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,312.50",$0.00,"$1,656.25","$2,623.50","$2,650.00",$0.00,$0.00,$0.00,$0.00,$0.00
104834-001,SUP,Custom 27203010,,104834-001  -  CATHETER THROMBECTOMY Y SPIKE 6FR LATEX FREE ANGIOJET POWER,$425.00,$0.00,$425.00,$0.00,$303.32,$0.00,$0.00,$0.00,$0.00,$0.00,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$0.00,$0.00,$0.00,$0.00
104834-002,SUP,HCPCS C1757,,104834-002  -  KIT THRMB 1.5MM 3-4FR 145CM LF 15MM ANGJT ULT ULT SYS OTW,$85.00,$0.00,$85.00,$0.00,$60.66,$0.00,$0.00,$0.00,$0.00,$0.00,$85.00,$0.00,$42.50,$67.32,$68.00,$0.00,$0.00,$0.00,$0.00,$0.00
1050-02,SUP,Custom 27203010,,1050-02  -  VLVLTM ANGIOSCOPIC ANTGRD 12.5CM LEMILLS,"$2,062.50",$0.00,"$2,062.50",$0.00,"$1,472.01",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,062.50",$0.00,"$1,031.25","$1,633.50","$1,650.00",$0.00,$0.00,$0.00,$0.00,$0.00
1050-0523,SUP,HCPCS C1776,,1050-0523  -  STEM FEM HDNK OMFT,"$5,486.00",$0.00,"$5,486.00","$2,468.70","$3,915.36",$0.00,$945.21,$0.00,$0.00,$960.55,"$5,486.00",$0.00,"$2,743.00","$4,344.91","$4,388.80",$0.00,$858.56,$0.00,$873.37,$0.00
1050-0531,SUP,HCPCS C1776,,1050-0531  -  STEM FEM HDNK OMFT,"$5,486.00",$0.00,"$5,486.00","$2,468.70","$3,915.36",$0.00,$945.21,$0.00,$0.00,$960.55,"$5,486.00",$0.00,"$2,743.00","$4,344.91","$4,388.80",$0.00,$858.56,$0.00,$873.37,$0.00
1050-0727,SUP,HCPCS C1776,,1050-0727  -  STEM FEM HDNK OMFT,"$5,486.00",$0.00,"$5,486.00","$2,468.70","$3,915.36",$0.00,$945.21,$0.00,$0.00,$960.55,"$5,486.00",$0.00,"$2,743.00","$4,344.91","$4,388.80",$0.00,$858.56,$0.00,$873.37,$0.00
1050-0737,SUP,HCPCS C1776,,1050-0737  -  STEM FEM 37MM OMFT 7 HIP,"$5,486.00",$0.00,"$5,486.00","$2,468.70","$3,915.36",$0.00,$945.21,$0.00,$0.00,$960.55,"$5,486.00",$0.00,"$2,743.00","$4,344.91","$4,388.80",$0.00,$858.56,$0.00,$873.37,$0.00
1050-0747,SUP,HCPCS C1776,,1050-0747  -  STEM FEM HDNK OMFT,"$5,486.00",$0.00,"$5,486.00","$2,468.70","$3,915.36",$0.00,$945.21,$0.00,$0.00,$960.55,"$5,486.00",$0.00,"$2,743.00","$4,344.91","$4,388.80",$0.00,$858.56,$0.00,$873.37,$0.00
1050-0932,SUP,HCPCS C1776,,1050-0932  -  STEM FEM 32MM OMFT 9 HIP,"$5,486.00",$0.00,"$5,486.00","$2,468.70","$3,915.36",$0.00,$945.21,$0.00,$0.00,$960.55,"$5,486.00",$0.00,"$2,743.00","$4,344.91","$4,388.80",$0.00,$858.56,$0.00,$873.37,$0.00
1050-0943,SUP,HCPCS C1776,,1050-0943  -  STEM FEM 43MM OMFT 9 HIP,"$5,486.00",$0.00,"$5,486.00","$2,468.70","$3,915.36",$0.00,$945.21,$0.00,$0.00,$960.55,"$5,486.00",$0.00,"$2,743.00","$4,344.91","$4,388.80",$0.00,$858.56,$0.00,$873.37,$0.00
1050-0955,SUP,HCPCS C1776,,1050-0955  -  STEM FEM HDNK OMFT,"$5,486.00",$0.00,"$5,486.00","$2,468.70","$3,915.36",$0.00,$945.21,$0.00,$0.00,$960.55,"$5,486.00",$0.00,"$2,743.00","$4,344.91","$4,388.80",$0.00,$858.56,$0.00,$873.37,$0.00
1050-1136,SUP,HCPCS C1776,,1050-1136  -  STEM FEM HDNK OMFT,"$5,486.00",$0.00,"$5,486.00","$2,468.70","$3,915.36",$0.00,$945.21,$0.00,$0.00,$960.55,"$5,486.00",$0.00,"$2,743.00","$4,344.91","$4,388.80",$0.00,$858.56,$0.00,$873.37,$0.00
1050-1149,SUP,HCPCS C1776,,1050-1149  -  STEM FEM 49MM OMFT 11 HIP,"$5,486.00",$0.00,"$5,486.00","$2,468.70","$3,915.36",$0.00,$945.21,$0.00,$0.00,$960.55,"$5,486.00",$0.00,"$2,743.00","$4,344.91","$4,388.80",$0.00,$858.56,$0.00,$873.37,$0.00
1050-1163,SUP,HCPCS C1776,,1050-1163  -  STEM FEM HDNK OMFT,"$5,486.00",$0.00,"$5,486.00","$2,468.70","$3,915.36",$0.00,$945.21,$0.00,$0.00,$960.55,"$5,486.00",$0.00,"$2,743.00","$4,344.91","$4,388.80",$0.00,$858.56,$0.00,$873.37,$0.00
105039-001,SUP,HCPCS C1757,,105039-001  -  KIT CATH 50CM 6FR AVX ANGJT ULT .035IN CMPT SYS SHFT VSL OTW,"$1,850.00",$0.00,"$1,850.00",$0.00,"$1,320.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,850.00",$0.00,$925.00,"$1,465.20","$1,480.00",$0.00,$0.00,$0.00,$0.00,$0.00
105040-001,SUP,HCPCS C1757,,105040-001  -  SET THRMB 6FR 3MM 120CM LF ANGJT ULT XPEEDIOR 1 LUM OTW CATH,"$3,287.50",$0.00,"$3,287.50",$0.00,"$2,346.29",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,287.50",$0.00,"$1,643.75","$2,603.70","$2,630.00",$0.00,$0.00,$0.00,$0.00,$0.00
105042-001,SUP,HCPCS C1757,,105042-001  -  SET THROMBECTOMY XVC,"$4,362.50",$0.00,"$4,362.50",$0.00,"$3,113.52",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,362.50",$0.00,"$2,181.25","$3,455.10","$3,490.00",$0.00,$0.00,$0.00,$0.00,$0.00
105-5055,SUP,HCPCS C1757,,105-5055  -  CATHETER INFUS .010IN MICRO 2.7-1.5FR .013IN 170CM 25CM COIL,"$1,575.00",$0.00,"$1,575.00",$0.00,"$1,124.08",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$0.00,$0.00,$0.00,$0.00
105-5056,SUP,HCPCS C1757,,105-5056  -  CATHETER INFS .010IN MIC 2.7-1.5FR .013IN 170CM 25CM MRTHN,"$1,500.00",$0.00,"$1,500.00",$0.00,"$1,070.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
105-5091-150,SUP,HCPCS C1751,,105-5091-150  -  CATH INFUS 250 PSI 5FR .014IN 155CM 150CM STR GWIRE NTNL,"$1,667.50",$0.00,"$1,667.50",$905.45,"$1,190.09",$0.00,$287.30,$0.00,$0.00,$291.97,"$1,667.50",$0.00,$833.75,"$1,320.66","$1,334.00",$0.00,$260.96,$0.00,$265.47,$0.00
105-5092-150,SUP,HCPCS C1751,,105-5092-150  -  CATH INFUS 45D MIC 2.4-1.9FR .014IN 150CM STR GWIRE BRAID,"$1,667.50",$0.00,"$1,667.50",$905.45,"$1,190.09",$0.00,$287.30,$0.00,$0.00,$291.97,"$1,667.50",$0.00,$833.75,"$1,320.66","$1,334.00",$0.00,$260.96,$0.00,$265.47,$0.00
105-5094-153,SUP,HCPCS C1757,,105-5094-153  -  MICROCATHETER GD 2.8-2.2FR 155CM NAUTICA 14XL OTW REINF ACPT,"$1,310.00",$0.00,"$1,310.00",$0.00,$934.95,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,310.00",$0.00,$655.00,"$1,037.52","$1,048.00",$0.00,$0.00,$0.00,$0.00,$0.00
1057-0018,SUP,HCPCS C1713,,1057-0018  -  SPACER CMNT 18MM KNEE CMNT,$75.00,$0.00,$75.00,$33.75,$53.53,$0.00,$12.92,$0.00,$0.00,$13.13,$75.00,$0.00,$37.50,$59.40,$60.00,$0.00,$11.74,$0.00,$11.94,$0.00
1057-0019,SUP,HCPCS C1713,,1057-0019  -  SPACER CMNT 19MM KNEE CMNT,$75.00,$0.00,$75.00,$33.75,$53.53,$0.00,$12.92,$0.00,$0.00,$13.13,$75.00,$0.00,$37.50,$59.40,$60.00,$0.00,$11.74,$0.00,$11.94,$0.00
1057-0020,SUP,HCPCS C1713,,1057-0020  -  SPACER CMNT 20MM KNEE CMNT,$75.00,$0.00,$75.00,$33.75,$53.53,$0.00,$12.92,$0.00,$0.00,$13.13,$75.00,$0.00,$37.50,$59.40,$60.00,$0.00,$11.74,$0.00,$11.94,$0.00
1057-0021,SUP,HCPCS C1713,,1057-0021  -  SPACER CMNT 21MM KNEE CMNT,$75.00,$0.00,$75.00,$33.75,$53.53,$0.00,$12.92,$0.00,$0.00,$13.13,$75.00,$0.00,$37.50,$59.40,$60.00,$0.00,$11.74,$0.00,$11.94,$0.00
1057-0022,SUP,HCPCS C1713,,1057-0022  -  SPACER CMNT 22MM KNEE CMNT,$75.00,$0.00,$75.00,$33.75,$53.53,$0.00,$12.92,$0.00,$0.00,$13.13,$75.00,$0.00,$37.50,$59.40,$60.00,$0.00,$11.74,$0.00,$11.94,$0.00
105-7100-060,SUP,Custom 27803010,,105-7100-060  -  SYSTEM EMBL 1.5ML 1ML ONX18 SYR DMTH SLFXD,"$5,625.00",$0.00,"$5,625.00",$0.00,"$4,014.56",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,625.00",$0.00,"$2,812.50","$4,455.00","$4,500.00",$0.00,$0.00,$0.00,$0.00,$0.00
105-7100-080,SUP,HCPCS C1760,,105-7100-080  -  PRTCL EMBL NADH LQ ONX34 8% EVOH,"$5,907.50",$0.00,"$5,907.50","$2,658.38","$4,216.18",$0.00,"$1,017.83",$0.00,$0.00,"$1,034.36","$5,907.50",$0.00,"$2,953.75","$4,678.74","$4,726.00",$0.00,$924.52,$0.00,$940.47,$0.00
1058-0005,SUP,Custom 27803010,,1058-0005  -  SPACER FEMORAL 5MM OMNIFIT BARIUM HIP PROXIMAL,$112.50,$0.00,$112.50,$0.00,$80.29,$0.00,$0.00,$0.00,$0.00,$0.00,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$0.00,$0.00,$0.00,$0.00
1058-0006,SUP,Custom 27803010,,1058-0006  -  SPACER FEMORAL 6MM OMNIFIT BARIUM HIP PROXIMAL,$112.50,$0.00,$112.50,$0.00,$80.29,$0.00,$0.00,$0.00,$0.00,$0.00,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$0.00,$0.00,$0.00,$0.00
1058-0007,SUP,Custom 27803010,,1058-0007  -  SPACER FEMORAL 7MM OMNIFIT BARIUM HIP PROXIMAL,$112.50,$0.00,$112.50,$0.00,$80.29,$0.00,$0.00,$0.00,$0.00,$0.00,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$0.00,$0.00,$0.00,$0.00
1058-0008,SUP,Custom 27803010,,1058-0008  -  SPACER FEMORAL 8MM OMNIFIT BARIUM HIP PROXIMAL,$112.50,$0.00,$112.50,$0.00,$80.29,$0.00,$0.00,$0.00,$0.00,$0.00,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$0.00,$0.00,$0.00,$0.00
1058-0009,SUP,Custom 27803010,,1058-0009  -  SPACER FEMORAL 9MM OMNIFIT BARIUM HIP PROXIMAL,$112.50,$0.00,$112.50,$0.00,$80.29,$0.00,$0.00,$0.00,$0.00,$0.00,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$0.00,$0.00,$0.00,$0.00
1058-0010,SUP,Custom 27803010,,1058-0010  -  SPACER FEMORAL 10MM OMNIFIT BARIUM HIP PROXIMAL,$112.50,$0.00,$112.50,$0.00,$80.29,$0.00,$0.00,$0.00,$0.00,$0.00,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$0.00,$0.00,$0.00,$0.00
1058-0011,SUP,Custom 27803010,,1058-0011  -  SPACER FEMORAL 11MM OMNIFIT BARIUM HIP PROXIMAL,$112.50,$0.00,$112.50,$0.00,$80.29,$0.00,$0.00,$0.00,$0.00,$0.00,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$0.00,$0.00,$0.00,$0.00
1059-2310,SUP,Custom 27803010,,1059-2310  -  SPACER FEMORAL SMALL 10MM RING STYLE CEMENTED ACCOLADE C HIP,$112.50,$0.00,$112.50,$0.00,$80.29,$0.00,$0.00,$0.00,$0.00,$0.00,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$0.00,$0.00,$0.00,$0.00
1059-2311,SUP,Custom 27803010,,1059-2311  -  SPACER FEMORAL SMALL 11MM RING STYLE CEMENTED ACCOLADE C HIP,$112.50,$0.00,$112.50,$0.00,$80.29,$0.00,$0.00,$0.00,$0.00,$0.00,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$0.00,$0.00,$0.00,$0.00
1059-2312,SUP,Custom 27803010,,1059-2312  -  SPACER FEMORAL SMALL 12MM RING STYLE CEMENTED ACCOLADE C HIP,$112.50,$0.00,$112.50,$0.00,$80.29,$0.00,$0.00,$0.00,$0.00,$0.00,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$0.00,$0.00,$0.00,$0.00
1059-2313,SUP,Custom 27803010,,1059-2313  -  SPACER FEMORAL SMALL 13MM RING STYLE CEMENTED ACCOLADE C HIP,$112.50,$0.00,$112.50,$0.00,$80.29,$0.00,$0.00,$0.00,$0.00,$0.00,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$0.00,$0.00,$0.00,$0.00
1059-2314,SUP,Custom 27803010,,1059-2314  -  SPACER FEMORAL SMALL 14MM RING STYLE CEMENTED ACCOLADE C HIP,$112.50,$0.00,$112.50,$0.00,$80.29,$0.00,$0.00,$0.00,$0.00,$0.00,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$0.00,$0.00,$0.00,$0.00
1059-2315,SUP,Custom 27803010,,1059-2315  -  SPACER FEMORAL SMALL 15MM RING STYLE CEMENTED ACCOLADE C HIP,$112.50,$0.00,$112.50,$0.00,$80.29,$0.00,$0.00,$0.00,$0.00,$0.00,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$0.00,$0.00,$0.00,$0.00
1059-4512,SUP,Custom 27803010,,1059-4512  -  SPACER FEMORAL MEDIUM 12MM RING STYLE CEMENTED ACCOLADE C,$112.50,$0.00,$112.50,$0.00,$80.29,$0.00,$0.00,$0.00,$0.00,$0.00,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$0.00,$0.00,$0.00,$0.00
1059-4513,SUP,Custom 27803010,,1059-4513  -  SPACER FEMORAL MEDIUM 13MM RING STYLE CEMENTED ACCOLADE C,$112.50,$0.00,$112.50,$0.00,$80.29,$0.00,$0.00,$0.00,$0.00,$0.00,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$0.00,$0.00,$0.00,$0.00
1059-4514,SUP,Custom 27803010,,1059-4514  -  SPACER FEMORAL MEDIUM 14MM RING STYLE CEMENTED ACCOLADE C,$112.50,$0.00,$112.50,$0.00,$80.29,$0.00,$0.00,$0.00,$0.00,$0.00,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$0.00,$0.00,$0.00,$0.00
1059-4515,SUP,Custom 27803010,,1059-4515  -  SPACER FEMORAL MEDIUM 15MM RING STYLE CEMENTED ACCOLADE C,$112.50,$0.00,$112.50,$0.00,$80.29,$0.00,$0.00,$0.00,$0.00,$0.00,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$0.00,$0.00,$0.00,$0.00
1059-4516,SUP,Custom 27803010,,1059-4516  -  SPACER FEMORAL MEDIUM 16MM RING STYLE CEMENTED ACCOLADE C,$112.50,$0.00,$112.50,$0.00,$80.29,$0.00,$0.00,$0.00,$0.00,$0.00,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$0.00,$0.00,$0.00,$0.00
1059-4517,SUP,Custom 27803010,,1059-4517  -  SPACER FEMORAL MEDIUM 17MM RING STYLE CEMENTED ACCOLADE C,$112.50,$0.00,$112.50,$0.00,$80.29,$0.00,$0.00,$0.00,$0.00,$0.00,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$0.00,$0.00,$0.00,$0.00
1059-6713,SUP,Custom 27803010,,1059-6713  -  SPACER FEMORAL LARGE 13MM RING STYLE CEMENTED ACCOLADE C HIP,$112.50,$0.00,$112.50,$0.00,$80.29,$0.00,$0.00,$0.00,$0.00,$0.00,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$0.00,$0.00,$0.00,$0.00
1059-6714,SUP,Custom 27803010,,1059-6714  -  SPACER FEMORAL LARGE 14MM RING STYLE CEMENTED ACCOLADE C HIP,$112.50,$0.00,$112.50,$0.00,$80.29,$0.00,$0.00,$0.00,$0.00,$0.00,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$0.00,$0.00,$0.00,$0.00
1059-6715,SUP,Custom 27803010,,1059-6715  -  SPACER FEMORAL LARGE 15MM RING STYLE CEMENTED ACCOLADE C HIP,$112.50,$0.00,$112.50,$0.00,$80.29,$0.00,$0.00,$0.00,$0.00,$0.00,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$0.00,$0.00,$0.00,$0.00
1059-6716,SUP,Custom 27803010,,1059-6716  -  SPACER FEMORAL LARGE 16MM RING STYLE CEMENTED ACCOLADE C HIP,$112.50,$0.00,$112.50,$0.00,$80.29,$0.00,$0.00,$0.00,$0.00,$0.00,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$0.00,$0.00,$0.00,$0.00
1059-6717,SUP,Custom 27803010,,1059-6717  -  SPACER FEMORAL LARGE 17MM RING STYLE CEMENTED ACCOLADE C HIP,$112.50,$0.00,$112.50,$0.00,$80.29,$0.00,$0.00,$0.00,$0.00,$0.00,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$0.00,$0.00,$0.00,$0.00
1059-6718,SUP,Custom 27803010,,1059-6718  -  SPACER FEMORAL LARGE 18MM RING STYLE CEMENTED ACCOLADE C HIP,$112.50,$0.00,$112.50,$0.00,$80.29,$0.00,$0.00,$0.00,$0.00,$0.00,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$0.00,$0.00,$0.00,$0.00
1064-0425,SUP,HCPCS C1776,,1064-0425  -  STEM FEM CMNT OMFT EON HIP,"$5,062.00",$0.00,"$5,062.00","$2,277.90","$3,612.75",$0.00,$872.16,$0.00,$0.00,$886.32,"$5,062.00",$0.00,"$2,531.00","$4,009.10","$4,049.60",$0.00,$792.20,$0.00,$805.87,$0.00
1064-0525,SUP,HCPCS C1776,,1064-0525  -  OMNIFIT CEMENTED STEM (MT),"$5,062.00",$0.00,"$5,062.00","$2,277.90","$3,612.75",$0.00,$872.16,$0.00,$0.00,$886.32,"$5,062.00",$0.00,"$2,531.00","$4,009.10","$4,049.60",$0.00,$792.20,$0.00,$805.87,$0.00
1064-0625,SUP,HCPCS C1776,,1064-0625  -  STEM FEM CMNT OMFT EON HIP,"$3,657.00",$0.00,"$3,657.00","$1,645.65","$2,610.00",$0.00,$630.08,$0.00,$0.00,$640.31,"$3,657.00",$0.00,"$1,828.50","$2,896.34","$2,925.60",$0.00,$572.32,$0.00,$582.19,$0.00
1064-0730,SUP,HCPCS C1776,,1064-0730  -  STEM FEM CMNT OMFT EON HIP,"$5,062.00",$0.00,"$5,062.00","$2,277.90","$3,612.75",$0.00,$872.16,$0.00,$0.00,$886.32,"$5,062.00",$0.00,"$2,531.00","$4,009.10","$4,049.60",$0.00,$792.20,$0.00,$805.87,$0.00
1064-0830,SUP,HCPCS C1776,,1064-0830  -  STEM FEM CMNT OMFT EON HIP,"$5,062.00",$0.00,"$5,062.00","$2,277.90","$3,612.75",$0.00,$872.16,$0.00,$0.00,$886.32,"$5,062.00",$0.00,"$2,531.00","$4,009.10","$4,049.60",$0.00,$792.20,$0.00,$805.87,$0.00
106552-001,SUP,HCPCS C1757,,106552-001  -  CATH THRMB 90CM 6FR ANGJT DVX ULT .035IN OTW LP TIP RADIOPQ,"$3,787.50",$0.00,"$3,787.50",$0.00,"$2,703.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,787.50",$0.00,"$1,893.75","$2,999.70","$3,030.00",$0.00,$0.00,$0.00,$0.00,$0.00
106553-001,SUP,HCPCS C1757,,106553-001  -  SET THROMBECTOMY LONG TAPER 4FR 2MM 135CM OTW RAPEX CATHETER,"$4,487.50",$0.00,"$4,487.50",$0.00,"$3,202.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,487.50",$0.00,"$2,243.75","$3,554.10","$3,590.00",$0.00,$0.00,$0.00,$0.00,$0.00
106608-001,SUP,HCPCS C1757,,106608-001  -  SET CATH 135CM 5FR 3MM SPIROFLEX VG ANGJT .014IN THRMB GWIRE,"$5,375.00",$0.00,"$5,375.00",$0.00,"$3,836.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,375.00",$0.00,"$2,687.50","$4,257.00","$4,300.00",$0.00,$0.00,$0.00,$0.00,$0.00
1067-0002,SUP,HCPCS C1713,,1067-0002  -  SPACER FEMORAL UNIVERSAL HOLE PLUG CEMENTED OMNIFIT,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
1067-0008,SUP,HCPCS C1713,,1067-0008  -  SPACER FEMORAL UNIVERSAL 8MM CEMENTED ACCOLADE HIP,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
1067-0009,SUP,HCPCS C1713,,1067-0009  -  SPACER FEMORAL UNIVERSAL 9MM CEMENTED ACCOLADE HIP,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
1067-0010,SUP,Custom 27803010,,1067-0010  -  SPACER CMNT UNV 10MM HIP DIST,$112.50,$0.00,$112.50,$0.00,$80.29,$0.00,$0.00,$0.00,$0.00,$0.00,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$0.00,$0.00,$0.00,$0.00
1067-0011,SUP,HCPCS C1713,,1067-0011  -  SPACER FEMORAL UNIVERSAL 11MM CEMENTED ACCOLADE HIP,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
1067-0012,SUP,Custom 27803010,,1067-0012  -  SPACER FEMORAL UNIVERSAL 12MM CEMENTED ACCOLADE HIP,$112.50,$0.00,$112.50,$0.00,$80.29,$0.00,$0.00,$0.00,$0.00,$0.00,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$0.00,$0.00,$0.00,$0.00
1067-0013,SUP,HCPCS C1713,,1067-0013  -  SPACER FEMORAL UNIVERSAL 13MM CEMENTED ACCOLADE HIP,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
1067-0014,SUP,HCPCS C1713,,1067-0014  -  SPACER CMNT UNV 14MM ACLD HIP DIST,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
1067-0015,SUP,HCPCS C1713,,1067-0015  -  SPACER FEMORAL UNIVERSAL 15MM CEMENTED ACCOLADE HIP,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
1067-0016,SUP,HCPCS C1713,,1067-0016  -  SPACER CMNT UNV 16MM ACLD HIP DIST,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
1067-0017,SUP,HCPCS C1713,,1067-0017  -  SPACER CMNT UNV 17MM ACLD HIP DIST,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
1067-0018,SUP,HCPCS C1713,,1067-0018  -  SPACER FEMORAL UNIVERSAL 18MM CEMENTED ACCOLADE HIP,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
1067-0019,SUP,HCPCS C1713,,1067-0019  -  SPACER CMNT UNV 19MM ACLD HIP DIST,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
1067-0020,SUP,HCPCS C1713,,1067-0020  -  SPACER FEMORAL UNIVERSAL 20MM PRIM C-STEM HIP DISTAL,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
1067-0021,SUP,HCPCS C1713,,1067-0021  -  SPACER CMNT UNV 21MM ACLD HIP DIST,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
1067-0022,SUP,HCPCS C1713,,1067-0022  -  SPACER CMNT UNV 22MM ACLD HIP DIST,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
1067-0023,SUP,HCPCS C1713,,1067-0023  -  SPACER CMNT UNV 23MM ACLD HIP DIST,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
1067-0024,SUP,HCPCS C1713,,1067-0024  -  SPACER CMNT UNV 24MM ACLD HIP DIST,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
1067-0025,SUP,HCPCS C1713,,1067-0025  -  SPACER FEM UNV 25MM ACLD POLYMETHYLMETHACRYLATE DIST HIP,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
1074225-08,SUP,HCPCS C1874,,1074225-08  -  STENT CORON .014IN TAPER 2.25MM 8MM 145CM 2 RADIOPQ MARKER 1,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
1074225-12,SUP,HCPCS C1874,,1074225-12  -  STENT CORON .014IN TAPER 2.25MM 12MM 145CM 2 RADIOPQ MARKER,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
1074225-15,SUP,HCPCS C1874,,1074225-15  -  STENT CORON .014IN TAPER 2.25MM 15MM 145CM 2 RADIOPQ MARKER,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
1074225-18,SUP,HCPCS C1874,,1074225-18  -  STENT CORON .014IN TAPER 2.25MM 18MM 145CM 2 RADIOPQ MARKER,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
1074225-23,SUP,HCPCS C1874,,1074225-23  -  STENT CORON .014IN TAPER 2.25MM 23MM 145CM 2 RADIOPQ MARKER,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
1074225-28,SUP,HCPCS C1874,,1074225-28  -  STENT CORON .014IN TAPER 2.25MM 28MM 145CM 2 RADIOPQ MARKER,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
1074250-08,SUP,HCPCS C1874,,1074250-08  -  STENT CORON .014IN TAPER 2.5MM 8MM 145CM 2 RADIOPQ MARKER 1,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
1074250-12,SUP,HCPCS C1874,,1074250-12  -  STENT CORON .014IN TAPER 2.5MM 12MM 145CM 2 RADIOPQ MARKER 1,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
1074250-15,SUP,HCPCS C1874,,1074250-15  -  STENT CORON .014IN TAPER 2.5MM 15MM 145CM 2 RADIOPQ MARKER 1,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
1074250-18,SUP,HCPCS C1874,,1074250-18  -  STENT CORON .014IN TAPER 2.5MM 18MM 145CM 2 RADIOPQ MARKER 1,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
1074250-23,SUP,HCPCS C1874,,1074250-23  -  STENT CORON .014IN TAPER 2.5MM 23MM 145CM 2 RADIOPQ MARKER 1,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
1074250-28,SUP,HCPCS C1874,,1074250-28  -  STENT CORON .014IN TAPER 2.5MM 28MM 145CM 2 RADIOPQ MARKER 1,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
1074250-33,SUP,HCPCS C1874,,1074250-33  -  STENT CORON .014IN TAPER 2.5MM 33MM 145CM 2 RADIOPQ MARKER 1,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
1074250-38,SUP,HCPCS C1874,,1074250-38  -  STENT CORON .014IN TAPER 2.5MM 38MM 145CM 2 RADIOPQ MARKER 1,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
1074275-08,SUP,HCPCS C1874,,1074275-08  -  STENT CORON .014IN TAPER 2.75MM 8MM 145CM 2 RADIOPQ MARKER 1,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
1074275-12,SUP,HCPCS C1874,,1074275-12  -  STENT CORON .014IN TAPER 2.75MM 12MM 145CM 2 RADIOPQ MARKER,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
1074275-15,SUP,HCPCS C1874,,1074275-15  -  STENT CORON .014IN TAPER 2.75MM 15MM 145CM 2 RADIOPQ MARKER,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
1074275-18,SUP,HCPCS C1874,,1074275-18  -  STENT CORON .014IN TAPER 2.75MM 18MM 145CM 2 RADIOPQ MARKER,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
1074275-23,SUP,HCPCS C1874,,1074275-23  -  STENT CORON .014IN TAPER 2.75MM 23MM 145CM 2 RADIOPQ MARKER,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
1074275-28,SUP,HCPCS C1874,,1074275-28  -  STENT CORON .014IN TAPER 2.75MM 28MM 145CM 2 RADIOPQ MARKER,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
1074275-33,SUP,HCPCS C1874,,1074275-33  -  STENT CORON .014IN TAPER 2.75MM 33MM 145CM 2 RADIOPQ MARKER,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
1074275-38,SUP,HCPCS C1874,,1074275-38  -  STENT CORON .014IN TAPER 2.75MM 38MM 145CM 2 RADIOPQ MARKER,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
1074300-08,SUP,HCPCS C1874,,1074300-08  -  STENT CORON .014IN TAPER 3MM 8MM 145CM 2 RADIOPQ MARKER 1,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
1074300-12,SUP,HCPCS C1874,,1074300-12  -  STENT CORON .014IN TAPER 3MM 12MM 145CM 2 RADIOPQ MARKER 1,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
1074300-15,SUP,HCPCS C1874,,1074300-15  -  STENT CORON .014IN TAPER 3MM 15MM 145CM 2 RADIOPQ MARKER 1,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
1074300-18,SUP,HCPCS C1874,,1074300-18  -  STENT CORON .014IN TAPER 3MM 18MM 145CM 2 RADIOPQ MARKER 1,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
1074300-23,SUP,HCPCS C1874,,1074300-23  -  STENT CORON .014IN TAPER 3MM 23MM 145CM 2 RADIOPQ MARKER 1,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
1074300-28,SUP,HCPCS C1874,,1074300-28  -  STENT CORON .014IN TAPER 3MM 28MM 145CM 2 RADIOPQ MARKER 1,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
1074300-33,SUP,HCPCS C1874,,1074300-33  -  STENT CORON .014IN TAPER 3MM 33MM 145CM 2 RADIOPQ MARKER 1,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
1074300-38,SUP,HCPCS C1874,,1074300-38  -  STENT CORON .014IN TAPER 3MM 38MM 145CM 2 RADIOPQ MARKER 1,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
1074325-08,SUP,HCPCS C1874,,1074325-08  -  STENT CORON .014IN TAPER 3.25MM .028IN 5FR 8MM 145CM 2,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
1074325-12,SUP,HCPCS C1874,,1074325-12  -  STENT CORON .014IN TAPER 3.25MM .028IN 5FR 12MM 145CM 2,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
1074325-18,SUP,HCPCS C1874,,1074325-18  -  STENT CORON .014IN TAPER 3.25MM 18MM 145CM 2 RADIOPQ MARKER,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
1074325-23,SUP,HCPCS C1874,,1074325-23  -  STENT CORON .014IN TAPER 3.25MM 23MM 145CM 2 RADIOPQ MARKER,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
1074325-28,SUP,HCPCS C1874,,1074325-28  -  STENT CORON .014IN TAPER 3.25MM 28MM 145CM 2 RADIOPQ MARKER,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
1074325-33,SUP,HCPCS C1874,,1074325-33  -  STENT CORON .014IN TAPER 3.25MM 33MM 145CM 2 RADIOPQ MARKER,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
1074325-38,SUP,HCPCS C1874,,1074325-38  -  STENT CORON .014IN TAPER 3.25MM 38MM 145CM 2 RADIOPQ MARKER,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
1074350-08,SUP,HCPCS C1874,,1074350-08  -  STENT CORON .014IN TAPER 3.5MM 8MM 145CM 2 RADIOPQ MARKER 1,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
1074350-12,SUP,HCPCS C1874,,1074350-12  -  STENT CORON .014IN TAPER 3.5MM 12MM 145CM 2 RADIOPQ MARKER 1,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
1074350-15,SUP,HCPCS C1874,,1074350-15  -  STENT CORON .014IN TAPER 3.5MM 15MM 145CM 2 RADIOPQ MARKER 1,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
1074350-18,SUP,HCPCS C1874,,1074350-18  -  STENT CORON .014IN TAPER 3.5MM 18MM 145CM 2 RADIOPQ MARKER 1,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
1074350-23,SUP,HCPCS C1874,,1074350-23  -  STENT CORON .014IN TAPER 3.5MM 23MM 145CM 2 RADIOPQ 1 ACCES,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
1074350-28,SUP,HCPCS C1874,,1074350-28  -  STENT CORON .014IN TAPER 3.5MM 28MM 145CM 2 RADIOPQ MARKER 1,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
1074350-33,SUP,HCPCS C1874,,1074350-33  -  STENT CORON .014IN TAPER 3.5MM 33MM 145CM 2 RADIOPQ MARKER 1,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
1074350-38,SUP,HCPCS C1874,,1074350-38  -  STENT CORON .014IN TAPER 3.5MM 38MM 145CM 2 RADIOPQ MARKER 1,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
1074400-08,SUP,HCPCS C1874,,1074400-08  -  STENT CORON .014IN TAPER 4MM 8MM 145CM 2 RADIOPQ MARKER 1,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
1074400-12,SUP,HCPCS C1874,,1074400-12  -  STENT CORON .014IN TAPER 4MM 12MM 145CM 2 RADIOPQ MARKER 1,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
1074400-15,SUP,HCPCS C1874,,1074400-15  -  STENT CORON .014IN TAPER 4MM 15MM 145CM 2 RADIOPQ MARKER 1,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
1074400-18,SUP,HCPCS C1874,,1074400-18  -  STENT CORON .014IN TAPER 4MM 18MM 145CM 2 RADIOPQ MARKER 1,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
1074400-23,SUP,HCPCS C1874,,1074400-23  -  STENT CORON .014IN TAPER 4MM 23MM 145CM 2 RADIOPQ MARKER 1,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
1074400-28,SUP,HCPCS C1874,,1074400-28  -  STENT CORON .014IN TAPER 4MM 28MM 145CM 2 RADIOPQ MARKER 1,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
1074400-33,SUP,HCPCS C1874,,1074400-33  -  STENT CORON .014IN TAPER 4MM 33MM 145CM 2 RADIOPQ MARKER 1,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
1074400-38,SUP,HCPCS C1874,,1074400-38  -  STENT CORON .014IN TAPER 4MM 38MM 145CM 2 RADIOPQ MARKER 1,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
1082-MED,SUP,HCPCS L3702,,1082-MED  -  SPRT ORTH MED 10IN LS CRST ELAST VLCR CLSR WHT,$44.75,$0.00,$208.54,$20.14,$31.94,$7.97,$208.54,$0.00,$0.00,$7.84,$44.75,$0.00,$22.38,$35.44,$35.80,$26.85,$198.56,$0.00,$202.65,$0.00
109681-001,SUP,HCPCS C1757,,109681-001  -  SET THROMBECTOMY 6FR 3MM 120CM 15MM OTW CONTRAST INJEC PORT,"$4,225.00",$0.00,"$4,225.00",$0.00,"$3,015.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,225.00",$0.00,"$2,112.50","$3,346.20","$3,380.00",$0.00,$0.00,$0.00,$0.00,$0.00
10A001,SUP,Custom 27804086,,10A001  -  GRAFT BONE 1-4MM CANCELLOUS CORTICAL 30ML,"$1,042.50",$0.00,"$1,042.50",$0.00,$744.03,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,042.50",$0.00,$521.25,$825.66,$834.00,$0.00,$0.00,$0.00,$0.00,$0.00
10A002,SUP,Custom 27804086,,10A002  -  GRAFT BONE 1-4MM CANCELLOUS CORTICAL 15ML,$595.00,$0.00,$595.00,$0.00,$424.65,$0.00,$0.00,$0.00,$0.00,$0.00,$595.00,$0.00,$297.50,$471.24,$476.00,$0.00,$0.00,$0.00,$0.00,$0.00
10AC50,SUP,Custom 27203010,,10AC50  -  PLATE 18MM TI BONE SPNL,$314.50,$0.00,$314.50,$0.00,$224.46,$0.00,$0.00,$0.00,$0.00,$0.00,$314.50,$0.00,$157.25,$249.08,$251.60,$0.00,$0.00,$0.00,$0.00,$0.00
10AC60,SUP,Custom 27203010,,10AC60  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$314.50,$0.00,$314.50,$0.00,$224.46,$0.00,$0.00,$0.00,$0.00,$0.00,$314.50,$0.00,$157.25,$249.08,$251.60,$0.00,$0.00,$0.00,$0.00,$0.00
10BA10,SUP,Custom 27203010,,10BA10  -  PLATE 18MM TI BONE SPNL,$306.00,$0.00,$306.00,$0.00,$218.39,$0.00,$0.00,$0.00,$0.00,$0.00,$306.00,$0.00,$153.00,$242.35,$244.80,$0.00,$0.00,$0.00,$0.00,$0.00
10BA10D,SUP,Custom 27203010,,10BA10D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$327.25,$0.00,$327.25,$0.00,$233.56,$0.00,$0.00,$0.00,$0.00,$0.00,$327.25,$0.00,$163.63,$259.18,$261.80,$0.00,$0.00,$0.00,$0.00,$0.00
10BA10D-MN,SUP,Custom 27203010,,10BA10D-MN  -  PLATE 18MM TI BONE SPNL,$327.25,$0.00,$327.25,$0.00,$233.56,$0.00,$0.00,$0.00,$0.00,$0.00,$327.25,$0.00,$163.63,$259.18,$261.80,$0.00,$0.00,$0.00,$0.00,$0.00
10BA10-MN,SUP,Custom 27203010,,10BA10-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$306.00,$0.00,$306.00,$0.00,$218.39,$0.00,$0.00,$0.00,$0.00,$0.00,$306.00,$0.00,$153.00,$242.35,$244.80,$0.00,$0.00,$0.00,$0.00,$0.00
10BA20,SUP,Custom 27203010,,10BA20  -  PLATE 18MM TI BONE SPNL,$306.00,$0.00,$306.00,$0.00,$218.39,$0.00,$0.00,$0.00,$0.00,$0.00,$306.00,$0.00,$153.00,$242.35,$244.80,$0.00,$0.00,$0.00,$0.00,$0.00
10BA20D,SUP,Custom 27203010,,10BA20D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$327.25,$0.00,$327.25,$0.00,$233.56,$0.00,$0.00,$0.00,$0.00,$0.00,$327.25,$0.00,$163.63,$259.18,$261.80,$0.00,$0.00,$0.00,$0.00,$0.00
10BA20D-MN,SUP,Custom 27203010,,10BA20D-MN  -  PLATE 18MM TI BONE SPNL,$327.25,$0.00,$327.25,$0.00,$233.56,$0.00,$0.00,$0.00,$0.00,$0.00,$327.25,$0.00,$163.63,$259.18,$261.80,$0.00,$0.00,$0.00,$0.00,$0.00
10BA20-MN,SUP,Custom 27203010,,10BA20-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$306.00,$0.00,$306.00,$0.00,$218.39,$0.00,$0.00,$0.00,$0.00,$0.00,$306.00,$0.00,$153.00,$242.35,$244.80,$0.00,$0.00,$0.00,$0.00,$0.00
10BA30,SUP,Custom 27203010,,10BA30  -  PLATE 18MM TI BONE SPNL,$306.00,$0.00,$306.00,$0.00,$218.39,$0.00,$0.00,$0.00,$0.00,$0.00,$306.00,$0.00,$153.00,$242.35,$244.80,$0.00,$0.00,$0.00,$0.00,$0.00
10BA30D,SUP,Custom 27203010,,10BA30D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$327.25,$0.00,$327.25,$0.00,$233.56,$0.00,$0.00,$0.00,$0.00,$0.00,$327.25,$0.00,$163.63,$259.18,$261.80,$0.00,$0.00,$0.00,$0.00,$0.00
10BA30DC,SUP,Custom 27203010,,10BA30DC  -  PLATE 18MM TI BONE SPNL,$329.38,$0.00,$329.38,$0.00,$235.07,$0.00,$0.00,$0.00,$0.00,$0.00,$329.38,$0.00,$164.69,$260.87,$263.50,$0.00,$0.00,$0.00,$0.00,$0.00
10BA30D-MN,SUP,Custom 27203010,,10BA30D-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$327.25,$0.00,$327.25,$0.00,$233.56,$0.00,$0.00,$0.00,$0.00,$0.00,$327.25,$0.00,$163.63,$259.18,$261.80,$0.00,$0.00,$0.00,$0.00,$0.00
10BA30-MN,SUP,Custom 27203010,,10BA30-MN  -  PLATE 18MM TI BONE SPNL,$306.00,$0.00,$306.00,$0.00,$218.39,$0.00,$0.00,$0.00,$0.00,$0.00,$306.00,$0.00,$153.00,$242.35,$244.80,$0.00,$0.00,$0.00,$0.00,$0.00
10BA40,SUP,Custom 27203010,,10BA40  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$333.63,$0.00,$333.63,$0.00,$238.11,$0.00,$0.00,$0.00,$0.00,$0.00,$333.63,$0.00,$166.81,$264.23,$266.90,$0.00,$0.00,$0.00,$0.00,$0.00
10BA40D,SUP,Custom 27203010,,10BA40D  -  PLATE 18MM TI BONE SPNL,$333.63,$0.00,$333.63,$0.00,$238.11,$0.00,$0.00,$0.00,$0.00,$0.00,$333.63,$0.00,$166.81,$264.23,$266.90,$0.00,$0.00,$0.00,$0.00,$0.00
10BA40DC,SUP,Custom 27203010,,10BA40DC  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$335.75,$0.00,$335.75,$0.00,$239.62,$0.00,$0.00,$0.00,$0.00,$0.00,$335.75,$0.00,$167.88,$265.91,$268.60,$0.00,$0.00,$0.00,$0.00,$0.00
10BA40D-MN,SUP,Custom 27203010,,10BA40D-MN  -  PLATE 18MM TI BONE SPNL,$327.25,$0.00,$327.25,$0.00,$233.56,$0.00,$0.00,$0.00,$0.00,$0.00,$327.25,$0.00,$163.63,$259.18,$261.80,$0.00,$0.00,$0.00,$0.00,$0.00
10BA40DX,SUP,Custom 27203010,,10BA40DX  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$346.38,$0.00,$346.38,$0.00,$247.21,$0.00,$0.00,$0.00,$0.00,$0.00,$346.38,$0.00,$173.19,$274.33,$277.10,$0.00,$0.00,$0.00,$0.00,$0.00
10BA40-MN,SUP,Custom 27203010,,10BA40-MN  -  PLATE 18MM TI BONE SPNL,$314.50,$0.00,$314.50,$0.00,$224.46,$0.00,$0.00,$0.00,$0.00,$0.00,$314.50,$0.00,$157.25,$249.08,$251.60,$0.00,$0.00,$0.00,$0.00,$0.00
10BA50,SUP,Custom 27203010,,10BA50  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$320.88,$0.00,$320.88,$0.00,$229.01,$0.00,$0.00,$0.00,$0.00,$0.00,$320.88,$0.00,$160.44,$254.14,$256.70,$0.00,$0.00,$0.00,$0.00,$0.00
10BA50D,SUP,Custom 27203010,,10BA50D  -  PLATE 18MM TI BONE SPNL,$329.38,$0.00,$329.38,$0.00,$235.07,$0.00,$0.00,$0.00,$0.00,$0.00,$329.38,$0.00,$164.69,$260.87,$263.50,$0.00,$0.00,$0.00,$0.00,$0.00
10BA50DC,SUP,Custom 27203010,,10BA50DC  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$329.38,$0.00,$329.38,$0.00,$235.07,$0.00,$0.00,$0.00,$0.00,$0.00,$329.38,$0.00,$164.69,$260.87,$263.50,$0.00,$0.00,$0.00,$0.00,$0.00
10BA50D-MN,SUP,Custom 27203010,,10BA50D-MN  -  PLATE 18MM TI BONE SPNL,$327.25,$0.00,$327.25,$0.00,$233.56,$0.00,$0.00,$0.00,$0.00,$0.00,$327.25,$0.00,$163.63,$259.18,$261.80,$0.00,$0.00,$0.00,$0.00,$0.00
10BA50DX,SUP,Custom 27203010,,10BA50DX  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$335.75,$0.00,$335.75,$0.00,$239.62,$0.00,$0.00,$0.00,$0.00,$0.00,$335.75,$0.00,$167.88,$265.91,$268.60,$0.00,$0.00,$0.00,$0.00,$0.00
10BA50-MN,SUP,Custom 27203010,,10BA50-MN  -  PLATE 18MM TI BONE SPNL,$308.13,$0.00,$308.13,$0.00,$219.91,$0.00,$0.00,$0.00,$0.00,$0.00,$308.13,$0.00,$154.06,$244.04,$246.50,$0.00,$0.00,$0.00,$0.00,$0.00
10BA60,SUP,Custom 27203010,,10BA60  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$327.25,$0.00,$327.25,$0.00,$233.56,$0.00,$0.00,$0.00,$0.00,$0.00,$327.25,$0.00,$163.63,$259.18,$261.80,$0.00,$0.00,$0.00,$0.00,$0.00
10BA60D,SUP,Custom 27203010,,10BA60D  -  PLATE 18MM TI BONE SPNL,$327.25,$0.00,$327.25,$0.00,$233.56,$0.00,$0.00,$0.00,$0.00,$0.00,$327.25,$0.00,$163.63,$259.18,$261.80,$0.00,$0.00,$0.00,$0.00,$0.00
10BA60D-MN,SUP,Custom 27203010,,10BA60D-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$327.25,$0.00,$327.25,$0.00,$233.56,$0.00,$0.00,$0.00,$0.00,$0.00,$327.25,$0.00,$163.63,$259.18,$261.80,$0.00,$0.00,$0.00,$0.00,$0.00
10BA60DX,SUP,Custom 27203010,,10BA60DX  -  PLATE 18MM TI BONE SPNL,$333.63,$0.00,$333.63,$0.00,$238.11,$0.00,$0.00,$0.00,$0.00,$0.00,$333.63,$0.00,$166.81,$264.23,$266.90,$0.00,$0.00,$0.00,$0.00,$0.00
10BA60-MN,SUP,Custom 27203010,,10BA60-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$308.13,$0.00,$308.13,$0.00,$219.91,$0.00,$0.00,$0.00,$0.00,$0.00,$308.13,$0.00,$154.06,$244.04,$246.50,$0.00,$0.00,$0.00,$0.00,$0.00
10CY40,SUP,Custom 27203010,,10CY40  -  PLATE 18MM TI BONE SPNL,$306.00,$0.00,$306.00,$0.00,$218.39,$0.00,$0.00,$0.00,$0.00,$0.00,$306.00,$0.00,$153.00,$242.35,$244.80,$0.00,$0.00,$0.00,$0.00,$0.00
10CY40BR,SUP,Custom 27203010,,10CY40BR  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$354.88,$0.00,$354.88,$0.00,$253.27,$0.00,$0.00,$0.00,$0.00,$0.00,$354.88,$0.00,$177.44,$281.06,$283.90,$0.00,$0.00,$0.00,$0.00,$0.00
10CY50,SUP,Custom 27203010,,10CY50  -  PLATE 18MM TI BONE SPNL,$306.00,$0.00,$306.00,$0.00,$218.39,$0.00,$0.00,$0.00,$0.00,$0.00,$306.00,$0.00,$153.00,$242.35,$244.80,$0.00,$0.00,$0.00,$0.00,$0.00
10CY50BR,SUP,Custom 27203010,,10CY50BR  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$354.88,$0.00,$354.88,$0.00,$253.27,$0.00,$0.00,$0.00,$0.00,$0.00,$354.88,$0.00,$177.44,$281.06,$283.90,$0.00,$0.00,$0.00,$0.00,$0.00
10CY50L,SUP,Custom 27203010,,10CY50L  -  PLATE 18MM TI BONE SPNL,$312.38,$0.00,$312.38,$0.00,$222.94,$0.00,$0.00,$0.00,$0.00,$0.00,$312.38,$0.00,$156.19,$247.40,$249.90,$0.00,$0.00,$0.00,$0.00,$0.00
10CY60,SUP,Custom 27203010,,10CY60  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$306.00,$0.00,$306.00,$0.00,$218.39,$0.00,$0.00,$0.00,$0.00,$0.00,$306.00,$0.00,$153.00,$242.35,$244.80,$0.00,$0.00,$0.00,$0.00,$0.00
10CY60BR,SUP,Custom 27203010,,10CY60BR  -  PLATE 18MM TI BONE SPNL,$354.88,$0.00,$354.88,$0.00,$253.27,$0.00,$0.00,$0.00,$0.00,$0.00,$354.88,$0.00,$177.44,$281.06,$283.90,$0.00,$0.00,$0.00,$0.00,$0.00
10CY65DX,SUP,Custom 27203010,,10CY65DX  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$340.00,$0.00,$340.00,$0.00,$242.66,$0.00,$0.00,$0.00,$0.00,$0.00,$340.00,$0.00,$170.00,$269.28,$272.00,$0.00,$0.00,$0.00,$0.00,$0.00
10DCT,SUP,Custom 27203010,,10DCT  -  TUBE TRCH 10 13.8MM 8.9MM 79MM STRL LF SHLY CUF DISP INR CNN,$95.08,$0.00,$95.08,$0.00,$67.86,$0.00,$0.00,$0.00,$0.00,$0.00,$95.08,$0.00,$47.54,$75.30,$76.06,$0.00,$0.00,$0.00,$0.00,$0.00
10DFEN,SUP,Custom 27203010,,10DFEN  -  TUBE TRACHEOSTOMY 10 13MM 8.9MM 79MM CUFF DISPOSABLE INNER,$91.35,$0.00,$91.35,$0.00,$65.20,$0.00,$0.00,$0.00,$0.00,$0.00,$91.35,$0.00,$45.68,$72.35,$73.08,$0.00,$0.00,$0.00,$0.00,$0.00
10LGT,SUP,Custom 27203010,,10LGT  -  TUBE TRACHEOSTOMY 10 13.7MM 8.9MM 50MM SMOOTH INNER CANNU,$116.45,$0.00,$116.45,$0.00,$83.11,$0.00,$0.00,$0.00,$0.00,$0.00,$116.45,$0.00,$58.22,$92.23,$93.16,$0.00,$0.00,$0.00,$0.00,$0.00
10LGT,SUP,Custom 27203010,,TUBE 8.9MM UNCUF LRNTMY INR CANNU SHLY TRCH 10 DISP,$119.98,$0.00,$116.45,$0.00,$83.11,$0.00,$0.00,$0.00,$0.00,$0.00,$116.45,$0.00,$58.22,$95.02,$93.16,$0.00,$0.00,$0.00,$0.00,$0.00
10MH17,SUP,Custom 27203010,,10MH17  -  PLATE 18MM TI BONE SPNL,$284.75,$0.00,$284.75,$0.00,$203.23,$0.00,$0.00,$0.00,$0.00,$0.00,$284.75,$0.00,$142.38,$225.52,$227.80,$0.00,$0.00,$0.00,$0.00,$0.00
10MH17D,SUP,Custom 27203010,,10MH17D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$306.00,$0.00,$306.00,$0.00,$218.39,$0.00,$0.00,$0.00,$0.00,$0.00,$306.00,$0.00,$153.00,$242.35,$244.80,$0.00,$0.00,$0.00,$0.00,$0.00
10MH22,SUP,Custom 27203010,,10MH22  -  PLATE 18MM TI BONE SPNL,$278.38,$0.00,$278.38,$0.00,$198.68,$0.00,$0.00,$0.00,$0.00,$0.00,$278.38,$0.00,$139.19,$220.48,$222.70,$0.00,$0.00,$0.00,$0.00,$0.00
10MH22D,SUP,Custom 27203010,,10MH22D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$306.00,$0.00,$306.00,$0.00,$218.39,$0.00,$0.00,$0.00,$0.00,$0.00,$306.00,$0.00,$153.00,$242.35,$244.80,$0.00,$0.00,$0.00,$0.00,$0.00
10MH30,SUP,Custom 27203010,,10MH30  -  PLATE 18MM TI BONE SPNL,$286.88,$0.00,$286.88,$0.00,$204.74,$0.00,$0.00,$0.00,$0.00,$0.00,$286.88,$0.00,$143.44,$227.21,$229.50,$0.00,$0.00,$0.00,$0.00,$0.00
10MH30DC,SUP,Custom 27203010,,10MH30DC  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$310.25,$0.00,$310.25,$0.00,$221.43,$0.00,$0.00,$0.00,$0.00,$0.00,$310.25,$0.00,$155.13,$245.72,$248.20,$0.00,$0.00,$0.00,$0.00,$0.00
10MH30D-MN,SUP,Custom 27203010,,10MH30D-MN  -  PLATE 18MM TI BONE SPNL,$327.25,$0.00,$327.25,$0.00,$233.56,$0.00,$0.00,$0.00,$0.00,$0.00,$327.25,$0.00,$163.63,$259.18,$261.80,$0.00,$0.00,$0.00,$0.00,$0.00
10MH30L,SUP,Custom 27203010,,10MH30L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$354.88,$0.00,$354.88,$0.00,$253.27,$0.00,$0.00,$0.00,$0.00,$0.00,$354.88,$0.00,$177.44,$281.06,$283.90,$0.00,$0.00,$0.00,$0.00,$0.00
10MH30-MN,SUP,Custom 27203010,,10MH30-MN  -  PLATE 18MM TI BONE SPNL,$308.13,$0.00,$308.13,$0.00,$219.91,$0.00,$0.00,$0.00,$0.00,$0.00,$308.13,$0.00,$154.06,$244.04,$246.50,$0.00,$0.00,$0.00,$0.00,$0.00
10OV40,SUP,Custom 27203010,,10OV40  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$323.00,$0.00,$323.00,$0.00,$230.53,$0.00,$0.00,$0.00,$0.00,$0.00,$323.00,$0.00,$161.50,$255.82,$258.40,$0.00,$0.00,$0.00,$0.00,$0.00
10OV40L,SUP,Custom 27203010,,10OV40L  -  PLATE 18MM TI BONE SPNL,$342.13,$0.00,$342.13,$0.00,$244.17,$0.00,$0.00,$0.00,$0.00,$0.00,$342.13,$0.00,$171.06,$270.97,$273.70,$0.00,$0.00,$0.00,$0.00,$0.00
10SCT,SUP,Custom 27203010,,10SCT  -  TUBE TRACHEOSTOMY 10 13.3MM 10MM 105MM CANNU CUFF LOW,$72.45,$0.00,$72.45,$0.00,$51.70,$0.00,$0.00,$0.00,$0.00,$0.00,$72.45,$0.00,$36.22,$57.38,$57.96,$0.00,$0.00,$0.00,$0.00,$0.00
10TA23,SUP,Custom 27203010,,10TA23  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$295.38,$0.00,$295.38,$0.00,$210.81,$0.00,$0.00,$0.00,$0.00,$0.00,$295.38,$0.00,$147.69,$233.94,$236.30,$0.00,$0.00,$0.00,$0.00,$0.00
10X52,SUP,Custom 27203010,,10X52  -  SUTURE NONABSORBABLE 2-0 V-5 30IN 2 ARM BRAID 10 STRAND,$139.88,$0.00,$139.88,$0.00,$99.84,$0.00,$0.00,$0.00,$0.00,$0.00,$139.88,$0.00,$69.94,$110.78,$111.91,$0.00,$0.00,$0.00,$0.00,$0.00
10X72,SUP,Custom 27203010,,10X72  -  SUTURE NONABSORBABLE 2-0 V-7 30IN 2 ARM BRAID 10 STRAND,$139.98,$0.00,$139.98,$0.00,$99.90,$0.00,$0.00,$0.00,$0.00,$0.00,$139.98,$0.00,$69.99,$110.86,$111.98,$0.00,$0.00,$0.00,$0.00,$0.00
110-08,SUP,HCPCS C1713,,110-08  -  PLATE 18MM TI BONE SPNL,$248.63,$0.00,$248.63,$111.88,$177.44,$0.00,$42.84,$0.00,$0.00,$43.53,$248.63,$0.00,$124.31,$196.91,$198.90,$0.00,$38.91,$0.00,$39.58,$0.00
11-0401-CA,SUP,Custom 27203010,,11-0401-CA  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$3,600.00",$0.00,"$3,600.00",$0.00,"$2,569.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,600.00",$0.00,"$1,800.00","$2,851.20","$2,880.00",$0.00,$0.00,$0.00,$0.00,$0.00
11-0401-CAL,SUP,Custom 27203010,,11-0401-CAL  -  KIT CRANIOTOMY SEPS SLIDOCAINE EPINEPHRINE STERILE,"$4,221.00",$0.00,"$4,221.00",$0.00,"$3,012.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,221.00",$0.00,"$2,110.50","$3,343.03","$3,376.80",$0.00,$0.00,$0.00,$0.00,$0.00
11-0401-CE,SUP,Custom 27203010,,11-0401-CE  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$3,712.50",$0.00,"$3,712.50",$0.00,"$2,649.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,712.50",$0.00,"$1,856.25","$2,940.30","$2,970.00",$0.00,$0.00,$0.00,$0.00,$0.00
1104B,SUP,Custom 27803010,,1104B  -  KIT PRESSURE MONITR TRANSDUCER TIPPED CATHETER DRILL BIT,"$2,402.50",$0.00,"$2,402.50",$0.00,"$1,714.66",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,402.50",$0.00,"$1,201.25","$1,902.78","$1,922.00",$0.00,$0.00,$0.00,$0.00,$0.00
110-4HMC,SUP,Custom 27203010,,110-4HMC  -  KIT PRSS MNTR MIC 4FR 12FR STRL CMN TRNDCR TIP CATH DRN STY,"$5,034.00",$0.00,"$5,034.00",$0.00,"$3,592.77",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,034.00",$0.00,"$2,517.00","$3,986.93","$4,027.20",$0.00,$0.00,$0.00,$0.00,$0.00
110-4L,SUP,Custom 27803010,,110-4L  -  KIT PRESSURE MONITR 4FR TRANSDUCER TIPPED CATHETER BOLT,"$2,007.50",$0.00,"$2,007.50",$0.00,"$1,432.75",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,007.50",$0.00,"$1,003.75","$1,589.94","$1,606.00",$0.00,$0.00,$0.00,$0.00,$0.00
1111-1-501,SUP,HCPCS C1713,,1111-1-501  -  TRAY STRL ML NUT GRS-K LCK NAIL SYS,$368.50,$0.00,$368.50,$165.83,$263.00,$0.00,$63.49,$0.00,$0.00,$64.52,$368.50,$0.00,$184.25,$291.85,$294.80,$0.00,$57.67,$0.00,$58.67,$0.00
111303-001,SUP,Custom 27203010,,111303-001  -  SET THROMBECTOMY .014IN 3FR 1.5MM 145CM OTW DISTAL SHAFT,"$5,000.00",$0.00,"$5,000.00",$0.00,"$3,568.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
1120-1810,SUP,Custom 27203010,,TIP PIP 1-20UL TIPONE BVL RK STRL NTR,$132.50,$0.00,$132.50,$0.00,$94.57,$0.00,$0.00,$0.00,$0.00,$0.00,$132.50,$0.00,$66.25,$104.94,$106.00,$0.00,$0.00,$0.00,$0.00,$0.00
1156T/75,SUP,HCPCS C1900,,1156T/75  -  LEAD PCNG S LOPRFL 5-5.6FR 7FR 75CM 8MM QUICKFLEX IS-1 BP,"$4,000.00",$0.00,"$4,000.00",$0.00,"$2,854.80",$0.00,$689.18,$0.00,$0.00,$0.00,"$4,000.00",$0.00,"$2,000.00","$3,168.00","$3,200.00",$0.00,$626.00,$0.00,$0.00,$0.00
1156T/86,SUP,HCPCS C1900,,1156T/86  -  QUICKFLEX+++PMM#:89271,"$4,000.00",$0.00,"$4,000.00",$0.00,"$2,854.80",$0.00,$689.18,$0.00,$0.00,$0.00,"$4,000.00",$0.00,"$2,000.00","$3,168.00","$3,200.00",$0.00,$626.00,$0.00,$0.00,$0.00
1158T/75,SUP,HCPCS C1900,,1158T/75  -  QUICKFLEX+++PMM#:89272,"$4,000.00",$0.00,"$4,000.00",$0.00,"$2,854.80",$0.00,$689.18,$0.00,$0.00,$0.00,"$4,000.00",$0.00,"$2,000.00","$3,168.00","$3,200.00",$0.00,$626.00,$0.00,$0.00,$0.00
1158T/86,SUP,HCPCS C1900,,1158T/86  -  LEAD PCNG 16MM S 7FR 86CM QUICKFLEX IS 1 BP CNCT STRBL TIP,"$4,000.00",$0.00,"$4,000.00",$0.00,"$2,854.80",$0.00,$689.18,$0.00,$0.00,$0.00,"$4,000.00",$0.00,"$2,000.00","$3,168.00","$3,200.00",$0.00,$626.00,$0.00,$0.00,$0.00
1174108D,SUP,HCPCS C1751,,1174108D  -  CATHETER CV 4FR P PICC SHRLK 3CG LUM MAXIMAL BRR TPS STY PP,$521.50,$0.00,$521.50,$283.17,$372.19,$0.00,$89.85,$0.00,$0.00,$91.31,$521.50,$0.00,$260.75,$413.03,$417.20,$0.00,$81.61,$0.00,$83.02,$0.00
11-996-16,SUP,Custom 27203010,,SCISSORS 6.25IN SMTH SRR NTCH SURG TC,$367.50,$0.00,$367.50,$0.00,$262.28,$0.00,$0.00,$0.00,$0.00,$0.00,$367.50,$0.00,$183.75,$291.06,$294.00,$0.00,$0.00,$0.00,$0.00,$0.00
1200-01-1022,SUP,HCPCS C1713,,"1200-01-1022  -  DYNANAIL, 10 MM X 22 CM","$11,000.00",$0.00,"$11,000.00","$4,950.00","$5,158.80",$0.00,"$1,895.25",$0.00,$0.00,"$1,926.01","$11,000.00",$0.00,"$5,500.00","$8,712.00","$8,800.00",$0.00,"$1,721.50",$0.00,"$1,751.20",$0.00
1200-01-1222,SUP,HCPCS C1713,,"1200-01-1222  -  DYNANAIL, 12 MM X 22 CM","$11,000.00",$0.00,"$11,000.00","$4,950.00","$5,158.80",$0.00,"$1,895.25",$0.00,$0.00,"$1,926.01","$11,000.00",$0.00,"$5,500.00","$8,712.00","$8,800.00",$0.00,"$1,721.50",$0.00,"$1,751.20",$0.00
1200-02-5020,SUP,HCPCS C1713,,1200-02-5020  -  SCREW BONE 5MM 20MM CORT,$312.50,$0.00,$312.50,$140.63,$223.03,$0.00,$53.84,$0.00,$0.00,$54.72,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$48.91,$0.00,$49.75,$0.00
1200-02-5025,SUP,HCPCS C1713,,"1200-02-5025  -  HEADED CORTICAL SCREW, 5.0 MM X 25 MM",$312.50,$0.00,$312.50,$140.63,$223.03,$0.00,$53.84,$0.00,$0.00,$54.72,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$48.91,$0.00,$49.75,$0.00
1200-02-5030,SUP,HCPCS C1713,,1200-02-5030  -  SCREW BONE 5MM 30MM HEADED SECURE FIX DYNANAIL HINDFOOT,$312.50,$0.00,$312.50,$140.63,$223.03,$0.00,$53.84,$0.00,$0.00,$54.72,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$48.91,$0.00,$49.75,$0.00
1200-02-5035,SUP,HCPCS C1713,,"1200-02-5035  -  HEADED CORTICAL SCREW, 5.0 MM X 35 MM",$312.50,$0.00,$312.50,$140.63,$223.03,$0.00,$53.84,$0.00,$0.00,$54.72,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$48.91,$0.00,$49.75,$0.00
1200-02-5040,SUP,HCPCS C1713,,"1200-02-5040  -  HEADED CORTICAL SCREW, 5.0 MM X 40 MM",$312.50,$0.00,$312.50,$140.63,$223.03,$0.00,$53.84,$0.00,$0.00,$54.72,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$48.91,$0.00,$49.75,$0.00
1200-02-5045,SUP,HCPCS C1713,,"1200-02-5045  -  HEADED CORTICAL SCREW, 5.0 MM X 45 MM",$312.50,$0.00,$312.50,$140.63,$223.03,$0.00,$53.84,$0.00,$0.00,$54.72,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$48.91,$0.00,$49.75,$0.00
1200-02-5050,SUP,HCPCS C1713,,"1200-02-5050  -  HEADED CORTICAL SCREW, 5.0 MM X 50 MM",$312.50,$0.00,$312.50,$140.63,$223.03,$0.00,$53.84,$0.00,$0.00,$54.72,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$48.91,$0.00,$49.75,$0.00
1200-02-5055,SUP,HCPCS C1713,,"1200-02-5055  -  HEADED CORTICAL SCREW, 5.0 MM X 55 MM",$312.50,$0.00,$312.50,$140.63,$223.03,$0.00,$53.84,$0.00,$0.00,$54.72,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$48.91,$0.00,$49.75,$0.00
1200-02-5060,SUP,HCPCS C1713,,"1200-02-5060  -  HEADED CORTICAL SCREW, 5.0 MM X 60 MM",$312.50,$0.00,$312.50,$140.63,$223.03,$0.00,$53.84,$0.00,$0.00,$54.72,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$48.91,$0.00,$49.75,$0.00
1200-03-5065,SUP,HCPCS C1713,,1200-03-5065  -  SCREW BONE 5MM 65MM CORT,$428.13,$0.00,$428.13,$192.66,$305.55,$0.00,$73.76,$0.00,$0.00,$74.96,$428.13,$0.00,$214.06,$339.08,$342.50,$0.00,$67.00,$0.00,$68.16,$0.00
1200-03-5070,SUP,HCPCS C1713,,"1200-03-5070  -  HEADLESS PA SCREW, 5.0 MM X 70 MM",$428.13,$0.00,$428.13,$192.66,$305.55,$0.00,$73.76,$0.00,$0.00,$74.96,$428.13,$0.00,$214.06,$339.08,$342.50,$0.00,$67.00,$0.00,$68.16,$0.00
1200-03-5075,SUP,HCPCS C1713,,"1200-03-5075  -  HEADLESS PA SCREW, 5.0 MM X 75 MM",$428.13,$0.00,$428.13,$192.66,$305.55,$0.00,$73.76,$0.00,$0.00,$74.96,$428.13,$0.00,$214.06,$339.08,$342.50,$0.00,$67.00,$0.00,$68.16,$0.00
1200-03-5080,SUP,HCPCS C1713,,"1200-03-5080  -  HEADLESS PA SCREW, 5.0 MM X 80 MM",$428.13,$0.00,$428.13,$192.66,$305.55,$0.00,$73.76,$0.00,$0.00,$74.96,$428.13,$0.00,$214.06,$339.08,$342.50,$0.00,$67.00,$0.00,$68.16,$0.00
1200-03-5085,SUP,HCPCS C1713,,"1200-03-5085  -  HEADLESS PA SCREW, 5.0 MM X 85 MM",$428.13,$0.00,$428.13,$192.66,$305.55,$0.00,$73.76,$0.00,$0.00,$74.96,$428.13,$0.00,$214.06,$339.08,$342.50,$0.00,$67.00,$0.00,$68.16,$0.00
1200-03-5090,SUP,HCPCS C1713,,"1200-03-5090  -  HEADLESS PA SCREW, 5.0 MM X 90 MM",$428.13,$0.00,$428.13,$192.66,$305.55,$0.00,$73.76,$0.00,$0.00,$74.96,$428.13,$0.00,$214.06,$339.08,$342.50,$0.00,$67.00,$0.00,$68.16,$0.00
1200-03-5095,SUP,HCPCS C1713,,"1200-03-5095  -  HEADLESS PA SCREW, 5.0 MM X 95 MM",$428.13,$0.00,$428.13,$192.66,$305.55,$0.00,$73.76,$0.00,$0.00,$74.96,$428.13,$0.00,$214.06,$339.08,$342.50,$0.00,$67.00,$0.00,$68.16,$0.00
1200-03-5100,SUP,HCPCS C1713,,"1200-03-5100  -  HEADLESS PA SCREW, 5.0 MM X 100 MM",$428.13,$0.00,$428.13,$192.66,$305.55,$0.00,$73.76,$0.00,$0.00,$74.96,$428.13,$0.00,$214.06,$339.08,$342.50,$0.00,$67.00,$0.00,$68.16,$0.00
1200-03-5105,SUP,HCPCS C1713,,"1200-03-5105  -  HEADLESS PA SCREW, 5.0 MM X 105 MM",$428.13,$0.00,$428.13,$192.66,$305.55,$0.00,$73.76,$0.00,$0.00,$74.96,$428.13,$0.00,$214.06,$339.08,$342.50,$0.00,$67.00,$0.00,$68.16,$0.00
1200-03-5110,SUP,HCPCS C1713,,"1200-03-5110  -  HEADLESS PA SCREW, 5.0 MM X 110 MM",$428.13,$0.00,$428.13,$192.66,$305.55,$0.00,$73.76,$0.00,$0.00,$74.96,$428.13,$0.00,$214.06,$339.08,$342.50,$0.00,$67.00,$0.00,$68.16,$0.00
120602F,SUP,HCPCS C1884,,120602F  -  CATHETER EMBL RND 2FR 4MM 60CM STRL LTX FGRTY BLN REINF SMTH,$220.00,$0.00,$174.24,$0.00,$0.00,$0.00,$37.90,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$174.24,$0.00,$0.00,$34.43,$0.00,$0.00,$0.00
120803F,SUP,HCPCS C1757,,120803F  -  CATHETER EMBL RND 3FR 5MM 80CM .1ML STRL LTX FGRTY BLN REINF,$125.00,$0.00,$99.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$99.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
120804F,SUP,Custom 27203010,,120804F  -  CATHETER EMBL RND 4FR 9MM 80CM .5ML STRL LTX FGRTY BLN REINF,$125.00,$0.00,$99.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$99.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
120805F,SUP,HCPCS C1757,,120805F  -  CATHETER EMBL RND 5FR 11MM 80CM STRL LTX FGRTY BLN REINF,$125.00,$0.00,$99.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$99.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
120806F,SUP,HCPCS C1757,,120806F  -  CATHETER EMBL RND 6FR 13MM 80CM STRL LTX FGRTY BLN REINF,$125.00,$0.00,$99.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$99.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
120807F,SUP,HCPCS C1757,,120807F  -  CATHETER EMBL RND 7FR 14MM 80CM 2ML STRL LTX FGRTY BLN REINF,$129.95,$0.00,$102.92,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$102.92,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
1210-3,SUP,HCPCS C1713,,"1210-3  -  ""MRI PRESSURE PIN SET FOR TRACTION TONGS, 3""""""","$1,362.50",$0.00,"$1,362.50",$613.13,$972.42,$0.00,$234.75,$0.00,$0.00,$238.56,"$1,362.50",$0.00,$681.25,"$1,079.10","$1,090.00",$0.00,$213.23,$0.00,$216.91,$0.00
1210-5-250,SUP,HCPCS C1769,,1210-5-250  -  GWIRE ORTH KWIRE GAMA,$495.00,$0.00,$495.00,$268.79,$353.28,$0.00,$85.29,$0.00,$0.00,$86.67,$495.00,$0.00,$247.50,$392.04,$396.00,$0.00,$77.47,$0.00,$78.80,$0.00
1210-6450,SUP,HCPCS C1713,,1210-6450  -  WIRE FIX 3.2MM 450MM KWIRE SS ORTH GAMA,$127.88,$0.00,$127.88,$57.54,$91.26,$0.00,$22.03,$0.00,$0.00,$22.39,$127.88,$0.00,$63.94,$101.28,$102.30,$0.00,$20.01,$0.00,$20.36,$0.00
1210-6450S,SUP,Custom 27203010,,1210-6450S  -  WIRE FX 3.2MM 450MM STRL KRSH,$192.50,$0.00,$192.50,$0.00,$137.39,$0.00,$0.00,$0.00,$0.00,$0.00,$192.50,$0.00,$96.25,$152.46,$154.00,$0.00,$0.00,$0.00,$0.00,$0.00
12-1113,SUP,HCPCS C1713,,12-1113  -  SCREW BN STD .5IN 9MM 120MM 21MM AMBI CLS IMHS LG,"$1,134.00",$0.00,"$1,134.00",$510.30,$809.34,$0.00,$195.38,$0.00,$0.00,$198.55,"$1,134.00",$0.00,$567.00,$898.13,$907.20,$0.00,$177.47,$0.00,$180.53,$0.00
12-1114,SUP,HCPCS C1713,,12-1114  -  SCREW BN STD .5IN 9MM 125MM 21MM AMBI CLS IMHS LG,"$1,134.00",$0.00,"$1,134.00",$510.30,$809.34,$0.00,$195.38,$0.00,$0.00,$198.55,"$1,134.00",$0.00,$567.00,$898.13,$907.20,$0.00,$177.47,$0.00,$180.53,$0.00
1211-3055,SUP,Custom 27203010,,1211-3055  -  DRILL SRG 5.5MM GMA NL DIST,$203.50,$0.00,$203.50,$0.00,$145.24,$0.00,$0.00,$0.00,$0.00,$0.00,$203.50,$0.00,$101.75,$161.17,$162.80,$0.00,$0.00,$0.00,$0.00,$0.00
12-1180,SUP,HCPCS C1713,,12-1180  -  SCREW BN 9/16IN 9MM 55MM 21MM AMBI CLS SPLG,"$1,210.00",$0.00,"$1,210.00",$544.50,$863.58,$0.00,$208.48,$0.00,$0.00,$211.86,"$1,210.00",$0.00,$605.00,$958.32,$968.00,$0.00,$189.37,$0.00,$192.63,$0.00
12-1182,SUP,HCPCS C1713,,12-1182  -  SCREW BN 9/16IN 9MM 65MM 21MM AMBI CLS SPLG,"$1,210.00",$0.00,"$1,210.00",$544.50,$863.58,$0.00,$208.48,$0.00,$0.00,$211.86,"$1,210.00",$0.00,$605.00,$958.32,$968.00,$0.00,$189.37,$0.00,$192.63,$0.00
12-1183,SUP,HCPCS C1713,,12-1183  -  SCREW BN 9/16IN 9MM 70MM 21MM AMBI CLS SPLG,"$1,210.00",$0.00,"$1,210.00",$544.50,$863.58,$0.00,$208.48,$0.00,$0.00,$211.86,"$1,210.00",$0.00,$605.00,$958.32,$968.00,$0.00,$189.37,$0.00,$192.63,$0.00
12-1184,SUP,HCPCS C1713,,12-1184  -  SCREW BN 9/16IN 9MM 75MM 21MM AMBI CLS SPLG,"$1,210.00",$0.00,"$1,210.00",$544.50,$863.58,$0.00,$208.48,$0.00,$0.00,$211.86,"$1,210.00",$0.00,$605.00,$958.32,$968.00,$0.00,$189.37,$0.00,$192.63,$0.00
12-1185,SUP,HCPCS C1713,,12-1185  -  SCREW BN 9/16IN 9MM 80MM 21MM AMBI CLS SPLG,"$1,210.00",$0.00,"$1,210.00",$544.50,$863.58,$0.00,$208.48,$0.00,$0.00,$211.86,"$1,210.00",$0.00,$605.00,$958.32,$968.00,$0.00,$189.37,$0.00,$192.63,$0.00
12-1186,SUP,HCPCS C1713,,12-1186  -  SCREW BN 9/16IN 9MM 85MM 21MM AMBI CLS SPLG,"$1,210.00",$0.00,"$1,210.00",$544.50,$863.58,$0.00,$208.48,$0.00,$0.00,$211.86,"$1,210.00",$0.00,$605.00,$958.32,$968.00,$0.00,$189.37,$0.00,$192.63,$0.00
12-1187,SUP,HCPCS C1713,,12-1187  -  SCREW BN 9/16IN 9MM 90MM 21MM AMBI CLS SPLG,"$1,210.00",$0.00,"$1,210.00",$544.50,$863.58,$0.00,$208.48,$0.00,$0.00,$211.86,"$1,210.00",$0.00,$605.00,$958.32,$968.00,$0.00,$189.37,$0.00,$192.63,$0.00
12-1188,SUP,HCPCS C1713,,12-1188  -  SCREW BN 9/16IN 9MM 95MM 21MM AMBI CLS SPLG,"$1,210.00",$0.00,"$1,210.00",$544.50,$863.58,$0.00,$208.48,$0.00,$0.00,$211.86,"$1,210.00",$0.00,$605.00,$958.32,$968.00,$0.00,$189.37,$0.00,$192.63,$0.00
12-1189,SUP,HCPCS C1713,,12-1189  -  SCREW BN 9/16IN 9MM 100MM 21MM AMBI CLS SPLG,"$1,210.00",$0.00,"$1,210.00",$544.50,$863.58,$0.00,$208.48,$0.00,$0.00,$211.86,"$1,210.00",$0.00,$605.00,$958.32,$968.00,$0.00,$189.37,$0.00,$192.63,$0.00
12-1190,SUP,HCPCS C1713,,12-1190  -  SCREW BN 9/16IN 9MM 105MM 21MM AMBI CLS SPLG,"$1,210.00",$0.00,"$1,210.00",$544.50,$863.58,$0.00,$208.48,$0.00,$0.00,$211.86,"$1,210.00",$0.00,$605.00,$958.32,$968.00,$0.00,$189.37,$0.00,$192.63,$0.00
1212-5160S,SUP,Custom 27203010,,1212-5160S  -  DRILL SURG 160MM AO HIP GAMA 5.5MM STRL,$295.63,$0.00,$295.63,$0.00,$210.99,$0.00,$0.00,$0.00,$0.00,$0.00,$295.63,$0.00,$147.81,$234.14,$236.50,$0.00,$0.00,$0.00,$0.00,$0.00
1212-5300S,SUP,Custom 27203010,,1212-5300S  -  DRILL SURG 300MM AO CLBRT GAMA 5.5MM STRL,$295.63,$0.00,$295.63,$0.00,$210.99,$0.00,$0.00,$0.00,$0.00,$0.00,$295.63,$0.00,$147.81,$234.14,$236.50,$0.00,$0.00,$0.00,$0.00,$0.00
1213-9091S,SUP,HCPCS C1713,,1213-9091S  -  GDPN ORTH 400MM 4MM GAMMA3 HIP CANN CANN CTR STRL,$192.50,$0.00,$192.50,$86.63,$137.39,$0.00,$33.17,$0.00,$0.00,$33.71,$192.50,$0.00,$96.25,$152.46,$154.00,$0.00,$30.13,$0.00,$30.65,$0.00
1214-5055,SUP,Custom 27203010,,1214-5055  -  BIT DRILL 300MM 5.2MM GAMA SS STRL,$213.13,$0.00,$213.13,$0.00,$152.11,$0.00,$0.00,$0.00,$0.00,$0.00,$213.13,$0.00,$106.56,$168.80,$170.50,$0.00,$0.00,$0.00,$0.00,$0.00
1214-5160S,SUP,Custom 27203010,,1214-5160S  -  BIT DRILL 165MM 5.5MM GAMA SS STRL,$295.63,$0.00,$295.63,$0.00,$210.99,$0.00,$0.00,$0.00,$0.00,$0.00,$295.63,$0.00,$147.81,$234.14,$236.50,$0.00,$0.00,$0.00,$0.00,$0.00
1214-5-180,SUP,Custom 27203010,,1214-5-180  -  BIT DRILL 220MM 5.5MM GAMA SS STRL,$203.50,$0.00,$203.50,$0.00,$145.24,$0.00,$0.00,$0.00,$0.00,$0.00,$203.50,$0.00,$101.75,$161.17,$162.80,$0.00,$0.00,$0.00,$0.00,$0.00
1214-5300S,SUP,Custom 27203010,,1214-5300S  -  BIT DRILL 300MM 5.5MM GAMA SS STRL,$295.63,$0.00,$295.63,$0.00,$210.99,$0.00,$0.00,$0.00,$0.00,$0.00,$295.63,$0.00,$147.81,$234.14,$236.50,$0.00,$0.00,$0.00,$0.00,$0.00
1235-2-461,SUP,Custom 27803010,,1235-2-461  -  CUP ACETAB 46MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP,"$2,877.50",$0.00,"$2,877.50",$0.00,"$2,053.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,877.50",$0.00,"$1,438.75","$2,278.98","$2,302.00",$0.00,$0.00,$0.00,$0.00,$0.00
1235-2-462,SUP,Custom 27803010,,1235-2-462  -  CUP ACETAB 46MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP,"$2,877.50",$0.00,"$2,877.50",$0.00,"$2,053.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,877.50",$0.00,"$1,438.75","$2,278.98","$2,302.00",$0.00,$0.00,$0.00,$0.00,$0.00
1235-2-481,SUP,Custom 27803010,,1235-2-481  -  CUP ACETAB 48MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP,"$2,877.50",$0.00,"$2,877.50",$0.00,"$2,053.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,877.50",$0.00,"$1,438.75","$2,278.98","$2,302.00",$0.00,$0.00,$0.00,$0.00,$0.00
1235-2-482,SUP,Custom 27803010,,1235-2-482  -  CUP ACTB 48MM RSTR ADM MBL BR HIP PERI SLF LCK X3 HA HIP LT,"$2,877.50",$0.00,"$2,877.50",$0.00,"$2,053.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,877.50",$0.00,"$1,438.75","$2,278.98","$2,302.00",$0.00,$0.00,$0.00,$0.00,$0.00
1235-2-501,SUP,Custom 27803010,,1235-2-501  -  CUP ACETAB 50MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP,"$2,877.50",$0.00,"$2,877.50",$0.00,"$2,053.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,877.50",$0.00,"$1,438.75","$2,278.98","$2,302.00",$0.00,$0.00,$0.00,$0.00,$0.00
1235-2-502,SUP,Custom 27803010,,1235-2-502  -  CUP ACTB 50MM RSTR ADM MBL BR HIP PERI SLF LCK X3 HA HIP LT,"$2,877.50",$0.00,"$2,877.50",$0.00,"$2,053.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,877.50",$0.00,"$1,438.75","$2,278.98","$2,302.00",$0.00,$0.00,$0.00,$0.00,$0.00
1235-2-521,SUP,Custom 27803010,,1235-2-521  -  CUP ACETAB 52MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP,"$2,877.50",$0.00,"$2,877.50",$0.00,"$2,053.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,877.50",$0.00,"$1,438.75","$2,278.98","$2,302.00",$0.00,$0.00,$0.00,$0.00,$0.00
1235-2-522,SUP,Custom 27803010,,1235-2-522  -  SHELL ACETAB 52MM ANATOMIC DUAL MOBILITY MOBILE BEARING HIP,"$2,877.50",$0.00,"$2,877.50",$0.00,"$2,053.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,877.50",$0.00,"$1,438.75","$2,278.98","$2,302.00",$0.00,$0.00,$0.00,$0.00,$0.00
1235-2-541,SUP,Custom 27803010,,1235-2-541  -  CUP ACETAB 54MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP,"$2,877.50",$0.00,"$2,877.50",$0.00,"$2,053.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,877.50",$0.00,"$1,438.75","$2,278.98","$2,302.00",$0.00,$0.00,$0.00,$0.00,$0.00
1235-2-542,SUP,Custom 27803010,,1235-2-542  -  CUP ACETAB 54MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP,"$2,877.50",$0.00,"$2,877.50",$0.00,"$2,053.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,877.50",$0.00,"$1,438.75","$2,278.98","$2,302.00",$0.00,$0.00,$0.00,$0.00,$0.00
1235-2-561,SUP,Custom 27803010,,1235-2-561  -  CUP ACETAB 56MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP,"$2,877.50",$0.00,"$2,877.50",$0.00,"$2,053.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,877.50",$0.00,"$1,438.75","$2,278.98","$2,302.00",$0.00,$0.00,$0.00,$0.00,$0.00
1235-2-562,SUP,Custom 27803010,,1235-2-562  -  CUP ACETAB 56MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP,"$2,877.50",$0.00,"$2,877.50",$0.00,"$2,053.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,877.50",$0.00,"$1,438.75","$2,278.98","$2,302.00",$0.00,$0.00,$0.00,$0.00,$0.00
1235-2-581,SUP,Custom 27803010,,1235-2-581  -  CUP ACETAB 58MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP,"$2,877.50",$0.00,"$2,877.50",$0.00,"$2,053.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,877.50",$0.00,"$1,438.75","$2,278.98","$2,302.00",$0.00,$0.00,$0.00,$0.00,$0.00
1235-2-582,SUP,Custom 27803010,,1235-2-582  -  CUP ACETAB 58MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP,"$2,877.50",$0.00,"$2,877.50",$0.00,"$2,053.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,877.50",$0.00,"$1,438.75","$2,278.98","$2,302.00",$0.00,$0.00,$0.00,$0.00,$0.00
1235-2-601,SUP,Custom 27803010,,1235-2-601  -  CUP ACETAB 60MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP,"$2,877.50",$0.00,"$2,877.50",$0.00,"$2,053.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,877.50",$0.00,"$1,438.75","$2,278.98","$2,302.00",$0.00,$0.00,$0.00,$0.00,$0.00
1235-2-602,SUP,Custom 27803010,,1235-2-602  -  CUP ACETAB 60MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP,"$2,877.50",$0.00,"$2,877.50",$0.00,"$2,053.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,877.50",$0.00,"$1,438.75","$2,278.98","$2,302.00",$0.00,$0.00,$0.00,$0.00,$0.00
1235-2-621,SUP,Custom 27803010,,1235-2-621  -  CUP ACETAB 62MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP,"$2,877.50",$0.00,"$2,877.50",$0.00,"$2,053.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,877.50",$0.00,"$1,438.75","$2,278.98","$2,302.00",$0.00,$0.00,$0.00,$0.00,$0.00
1235-2-622,SUP,Custom 27803010,,1235-2-622  -  CUP ACETAB 62MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP,"$2,877.50",$0.00,"$2,877.50",$0.00,"$2,053.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,877.50",$0.00,"$1,438.75","$2,278.98","$2,302.00",$0.00,$0.00,$0.00,$0.00,$0.00
1235-2-641,SUP,Custom 27803010,,1235-2-641  -  CUP ACETAB 64MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP,"$2,877.50",$0.00,"$2,877.50",$0.00,"$2,053.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,877.50",$0.00,"$1,438.75","$2,278.98","$2,302.00",$0.00,$0.00,$0.00,$0.00,$0.00
1235-2-642,SUP,Custom 27803010,,1235-2-642  -  CUP ACETAB 64MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP,"$2,877.50",$0.00,"$2,877.50",$0.00,"$2,053.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,877.50",$0.00,"$1,438.75","$2,278.98","$2,302.00",$0.00,$0.00,$0.00,$0.00,$0.00
1235-2-848,SUP,Custom 27803010,,1235-2-848  -  INSERT ACETAB 0D 48MM 28MM 6.9MM ADM MOBILE BEARING HIP,"$2,015.00",$0.00,"$2,015.00",$0.00,"$1,438.11",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,015.00",$0.00,"$1,007.50","$1,595.88","$1,612.00",$0.00,$0.00,$0.00,$0.00,$0.00
1235-2-850,SUP,Custom 27803010,,1235-2-850  -  INSERT ACTB 0D 50MM 28MM 7.9MM ADM MBL BR HIP RSTR DRTN,"$2,015.00",$0.00,"$2,015.00",$0.00,"$1,438.11",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,015.00",$0.00,"$1,007.50","$1,595.88","$1,612.00",$0.00,$0.00,$0.00,$0.00,$0.00
1235-2-852,SUP,Custom 27803010,,1235-2-852  -  INSERT ACETAB 0D 52MM 28MM 8.9MM ADM MOBILE BEARING HIP,"$2,015.00",$0.00,"$2,015.00",$0.00,"$1,438.11",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,015.00",$0.00,"$1,007.50","$1,595.88","$1,612.00",$0.00,$0.00,$0.00,$0.00,$0.00
1235-2-854,SUP,Custom 27803010,,1235-2-854  -  INSERT ACETAB 0D 54MM 28MM 9.9MM ADM MOBILE BEARING HIP,"$2,015.00",$0.00,"$2,015.00",$0.00,"$1,438.11",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,015.00",$0.00,"$1,007.50","$1,595.88","$1,612.00",$0.00,$0.00,$0.00,$0.00,$0.00
1235-2-856,SUP,Custom 27803010,,1235-2-856  -  INSERT ACETAB 0D 56MM 28MM 10.9MM ADM MOBILE BEARING HIP,"$2,015.00",$0.00,"$2,015.00",$0.00,"$1,438.11",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,015.00",$0.00,"$1,007.50","$1,595.88","$1,612.00",$0.00,$0.00,$0.00,$0.00,$0.00
1235-2-858,SUP,Custom 27803010,,1235-2-858  -  INSERT ACETAB 0D 58MM 28MM 11.9MM ADM MOBILE BEARING HIP,"$2,015.00",$0.00,"$2,015.00",$0.00,"$1,438.11",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,015.00",$0.00,"$1,007.50","$1,595.88","$1,612.00",$0.00,$0.00,$0.00,$0.00,$0.00
1235-2-860,SUP,Custom 27803010,,1235-2-860  -  INSERT ACETAB 0D 60MM 28MM 12.9MM ADM MOBILE BEARING HIP,"$2,015.00",$0.00,"$2,015.00",$0.00,"$1,438.11",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,015.00",$0.00,"$1,007.50","$1,595.88","$1,612.00",$0.00,$0.00,$0.00,$0.00,$0.00
1235-2-862,SUP,Custom 27803010,,1235-2-862  -  INSERT ACETAB 0D 62MM 28MM 13.9MM ADM MOBILE BEARING HIP,"$2,015.00",$0.00,"$2,015.00",$0.00,"$1,438.11",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,015.00",$0.00,"$1,007.50","$1,595.88","$1,612.00",$0.00,$0.00,$0.00,$0.00,$0.00
1235-2-864,SUP,Custom 27803010,,1235-2-864  -  INSERT ACETAB 0D 64MM 28MM 14.9MM ADM MOBILE BEARING HIP,"$2,015.00",$0.00,"$2,015.00",$0.00,"$1,438.11",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,015.00",$0.00,"$1,007.50","$1,595.88","$1,612.00",$0.00,$0.00,$0.00,$0.00,$0.00
1236-2-242,SUP,HCPCS C1776,,1236-2-242  -  INSERT ACTB MBL BR HIP ANTM DL MBL MDLR X3 HIP 22.2 MM FEM,"$2,015.00",$0.00,"$2,015.00",$906.75,"$1,438.11",$0.00,$347.17,$0.00,$0.00,$352.81,"$2,015.00",$0.00,"$1,007.50","$1,595.88","$1,612.00",$0.00,$315.35,$0.00,$320.79,$0.00
1236-2-244,SUP,HCPCS C1776,,1236-2-244  -  INSERT ACTB 38MM ADM MDM MBL BR HIP RSTR X3 HIP 22.2MM FEM,"$2,015.00",$0.00,"$2,015.00",$906.75,"$1,438.11",$0.00,$347.17,$0.00,$0.00,$352.81,"$2,015.00",$0.00,"$1,007.50","$1,595.88","$1,612.00",$0.00,$315.35,$0.00,$320.79,$0.00
1236-2-846,SUP,HCPCS C1776,,1236-2-846  -  INSERT ACTB 0D 46MM 28MM 5.9MM ADM MBL BR HIP RSTR X3,"$2,015.00",$0.00,"$2,015.00",$906.75,"$1,438.11",$0.00,$347.17,$0.00,$0.00,$352.81,"$2,015.00",$0.00,"$1,007.50","$1,595.88","$1,612.00",$0.00,$315.35,$0.00,$320.79,$0.00
1236-2-848,SUP,Custom 27803010,,"1236-2-848  -  INSERT, X3 FOR ADM/ MDM, RESTORATION","$2,015.00",$0.00,"$2,015.00",$0.00,"$1,438.11",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,015.00",$0.00,"$1,007.50","$1,595.88","$1,612.00",$0.00,$0.00,$0.00,$0.00,$0.00
1236-2-850,SUP,HCPCS C1776,,1236-2-850  -  INSERT ACTB 0D 50MM 28MM 7.9MM ADM MBL BR HIP RSTR X3,"$2,015.00",$0.00,"$2,015.00",$906.75,"$1,438.11",$0.00,$347.17,$0.00,$0.00,$352.81,"$2,015.00",$0.00,"$1,007.50","$1,595.88","$1,612.00",$0.00,$315.35,$0.00,$320.79,$0.00
1236-2-856,SUP,HCPCS C1776,,1236-2-856  -  INSERT ACTB 0D 56MM 28MM 10.9MM ADM MBL BR HIP RSTR X3,"$2,015.00",$0.00,"$2,015.00",$906.75,"$1,438.11",$0.00,$347.17,$0.00,$0.00,$352.81,"$2,015.00",$0.00,"$1,007.50","$1,595.88","$1,612.00",$0.00,$315.35,$0.00,$320.79,$0.00
1236-2-858,SUP,HCPCS C1776,,1236-2-858  -  INSERT ACTB 58MM 14.9MM ADM MDM MBL BR HIP RSTR X3 HIP 28MM,"$2,015.00",$0.00,"$2,015.00",$906.75,"$1,438.11",$0.00,$347.17,$0.00,$0.00,$352.81,"$2,015.00",$0.00,"$1,007.50","$1,595.88","$1,612.00",$0.00,$315.35,$0.00,$320.79,$0.00
1236-2-860,SUP,HCPCS C1776,,1236-2-860  -  INSERT ACTB 0D 60MM 28MM 12.9MM DRTN ADM X3,"$2,015.00",$0.00,"$2,015.00",$906.75,"$1,438.11",$0.00,$347.17,$0.00,$0.00,$352.81,"$2,015.00",$0.00,"$1,007.50","$1,595.88","$1,612.00",$0.00,$315.35,$0.00,$320.79,$0.00
1236-2-862,SUP,HCPCS C1776,,1236-2-862  -  INSERT ACTB 62MM 13.9MM ADM MDM MBL BR HIP RSTR X3 HIP 28MM,"$2,015.00",$0.00,"$2,015.00",$906.75,"$1,438.11",$0.00,$347.17,$0.00,$0.00,$352.81,"$2,015.00",$0.00,"$1,007.50","$1,595.88","$1,612.00",$0.00,$315.35,$0.00,$320.79,$0.00
1236-2-864,SUP,HCPCS C1776,,1236-2-864  -  INSERT ACTB 0D 64MM 28MM 14.9MM ADM MBL BR HIP RSTR X3,"$2,015.00",$0.00,"$2,015.00",$906.75,"$1,438.11",$0.00,$347.17,$0.00,$0.00,$352.81,"$2,015.00",$0.00,"$1,007.50","$1,595.88","$1,612.00",$0.00,$315.35,$0.00,$320.79,$0.00
125-150P,SUP,Custom 27203010,,125-150P  -  GUIDEPIN1.25 MM,$75.00,$0.00,$75.00,$0.00,$53.53,$0.00,$0.00,$0.00,$0.00,$0.00,$75.00,$0.00,$37.50,$59.40,$60.00,$0.00,$0.00,$0.00,$0.00,$0.00
1258T/75,SUP,HCPCS C1900,,1258T/75  -  LEAD PACING MICRO S CURVE 4.3FR 75CM BIPOL STEERABLE TIP,"$4,275.00",$0.00,"$4,275.00",$0.00,"$3,051.07",$0.00,$736.56,$0.00,$0.00,$0.00,"$4,275.00",$0.00,"$2,137.50","$3,385.80","$3,420.00",$0.00,$669.04,$0.00,$0.00,$0.00
1258T/86,SUP,HCPCS C1900,,1258T/86  -  LEAD PCNG MIC S 4.3FR 86CM QUICKFLEX BP STRBL TIP OPTIM INSL,"$4,275.00",$0.00,"$4,275.00",$0.00,"$3,051.07",$0.00,$736.56,$0.00,$0.00,$0.00,"$4,275.00",$0.00,"$2,137.50","$3,385.80","$3,420.00",$0.00,$669.04,$0.00,$0.00,$0.00
1258T/92,SUP,HCPCS C1900,,1258T/92  -  LEAD PACING MICRO S CURVE 4.3FR 92CM BIPOL STEERABLE TIP,"$4,275.00",$0.00,"$4,275.00",$0.00,"$3,051.07",$0.00,$736.56,$0.00,$0.00,$0.00,"$4,275.00",$0.00,"$2,137.50","$3,385.80","$3,420.00",$0.00,$669.04,$0.00,$0.00,$0.00
1259BOP16,SUP,Custom 27203010,,1259BOP16  -  IMMOBILIZER ORTH THK3/8IN 16IN KNEE EZ WRP FOAM,$85.90,$0.00,$85.90,$0.00,$61.31,$0.00,$0.00,$0.00,$0.00,$0.00,$85.90,$0.00,$42.95,$68.03,$68.72,$0.00,$0.00,$0.00,$0.00,$0.00
1259BOP18,SUP,Custom 27203010,,1259BOP18  -  IMMOBILIZER ORTH THK3/8IN 18IN KNEE EZ WRP FOAM,$89.63,$0.00,$89.63,$0.00,$63.97,$0.00,$0.00,$0.00,$0.00,$0.00,$89.63,$0.00,$44.82,$70.99,$71.71,$0.00,$0.00,$0.00,$0.00,$0.00
12673-03,SUP,HCPCS C1760,,12673-03  -  DEVICE CLOSURE 6FR SUTURE MEDIATE KNOT PUSHER LATEX FREE,$650.00,$0.00,$650.00,$292.50,$463.91,$0.00,$111.99,$0.00,$0.00,$113.81,$650.00,$0.00,$325.00,$514.80,$520.00,$0.00,$101.73,$0.00,$103.48,$0.00
12744-16,SUP,HCPCS C1875,,12744-16  -  STENT COR 3MM 16MM JSTNT GFTMSTR OTW BLN EXPANDABLE SS PTFE,"$5,987.50",$0.00,"$5,987.50",$0.00,"$4,273.28",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,987.50",$0.00,"$2,993.75","$4,742.10","$4,790.00",$0.00,$0.00,$0.00,$0.00,$0.00
12745-16,SUP,HCPCS C1875,,12745-16  -  STENT COR 3.5MM 16MM JSTNT GFTMSTR OTW BLN EXPANDABLE SS,"$5,987.50",$0.00,"$5,987.50",$0.00,"$4,273.28",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,987.50",$0.00,"$2,993.75","$4,742.10","$4,790.00",$0.00,$0.00,$0.00,$0.00,$0.00
12746-19,SUP,HCPCS C1874,,12746-19  -  STENT COR 4MM 19MM JSTNT GFTMSTR OTW BLN EXPANDABLE SS PTFE,"$5,987.50",$0.00,"$5,987.50","$2,694.38","$4,273.28",$0.00,"$1,031.62",$0.00,$0.00,"$1,048.36","$5,987.50",$0.00,"$2,993.75","$4,742.10","$4,790.00",$0.00,$937.04,$0.00,$953.21,$0.00
1275108D,SUP,HCPCS C1751,,1275108D  -  CATHETER CV 5FR LF P PICC SHRLK 3CG 2 LUM MAXIMAL BRR TRY,$538.50,$0.00,$538.50,$292.41,$384.33,$0.00,$92.78,$0.00,$0.00,$94.29,$538.50,$0.00,$269.25,$426.49,$430.80,$0.00,$84.28,$0.00,$85.73,$0.00
12A0806F,SUP,HCPCS C1757,,12A0806F  -  CATH EMBL 80CM 6FR FGRTY ART BLN INFLAT PORT TUBE PK STRL,$134.50,$0.00,$106.52,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$106.52,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
12BA30,SUP,Custom 27203010,,12BA30  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$329.38,$0.00,$329.38,$0.00,$235.07,$0.00,$0.00,$0.00,$0.00,$0.00,$329.38,$0.00,$164.69,$260.87,$263.50,$0.00,$0.00,$0.00,$0.00,$0.00
12BA30D,SUP,Custom 27203010,,12BA30D  -  PLATE 18MM TI BONE SPNL,$348.50,$0.00,$348.50,$0.00,$248.72,$0.00,$0.00,$0.00,$0.00,$0.00,$348.50,$0.00,$174.25,$276.01,$278.80,$0.00,$0.00,$0.00,$0.00,$0.00
12BA40,SUP,Custom 27203010,,12BA40  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$329.38,$0.00,$329.38,$0.00,$235.07,$0.00,$0.00,$0.00,$0.00,$0.00,$329.38,$0.00,$164.69,$260.87,$263.50,$0.00,$0.00,$0.00,$0.00,$0.00
12BA40D,SUP,Custom 27203010,,12BA40D  -  PLATE 18MM TI BONE SPNL,$348.50,$0.00,$348.50,$0.00,$248.72,$0.00,$0.00,$0.00,$0.00,$0.00,$348.50,$0.00,$174.25,$276.01,$278.80,$0.00,$0.00,$0.00,$0.00,$0.00
12BA40DX,SUP,Custom 27203010,,12BA40DX  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$395.25,$0.00,$395.25,$0.00,$282.09,$0.00,$0.00,$0.00,$0.00,$0.00,$395.25,$0.00,$197.63,$313.04,$316.20,$0.00,$0.00,$0.00,$0.00,$0.00
12BA50,SUP,Custom 27203010,,12BA50  -  PLATE 18MM TI BONE SPNL,$329.38,$0.00,$329.38,$0.00,$235.07,$0.00,$0.00,$0.00,$0.00,$0.00,$329.38,$0.00,$164.69,$260.87,$263.50,$0.00,$0.00,$0.00,$0.00,$0.00
12BA50D,SUP,Custom 27203010,,12BA50D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$348.50,$0.00,$348.50,$0.00,$248.72,$0.00,$0.00,$0.00,$0.00,$0.00,$348.50,$0.00,$174.25,$276.01,$278.80,$0.00,$0.00,$0.00,$0.00,$0.00
12BA60,SUP,Custom 27203010,,12BA60  -  PLATE 18MM TI BONE SPNL,$329.38,$0.00,$329.38,$0.00,$235.07,$0.00,$0.00,$0.00,$0.00,$0.00,$329.38,$0.00,$164.69,$260.87,$263.50,$0.00,$0.00,$0.00,$0.00,$0.00
12BA60D,SUP,Custom 27203010,,12BA60D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$329.38,$0.00,$329.38,$0.00,$235.07,$0.00,$0.00,$0.00,$0.00,$0.00,$329.38,$0.00,$164.69,$260.87,$263.50,$0.00,$0.00,$0.00,$0.00,$0.00
12BA60DX,SUP,Custom 27203010,,12BA60DX  -  PLATE 18MM TI BONE SPNL,$401.63,$0.00,$401.63,$0.00,$286.64,$0.00,$0.00,$0.00,$0.00,$0.00,$401.63,$0.00,$200.81,$318.09,$321.30,$0.00,$0.00,$0.00,$0.00,$0.00
12MH22,SUP,Custom 27203010,,12MH22  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$295.38,$0.00,$295.38,$0.00,$210.81,$0.00,$0.00,$0.00,$0.00,$0.00,$295.38,$0.00,$147.69,$233.94,$236.30,$0.00,$0.00,$0.00,$0.00,$0.00
12MH30,SUP,Custom 27203010,,12MH30  -  PLATE 18MM TI BONE SPNL,$299.63,$0.00,$299.63,$0.00,$213.84,$0.00,$0.00,$0.00,$0.00,$0.00,$299.63,$0.00,$149.81,$237.31,$239.70,$0.00,$0.00,$0.00,$0.00,$0.00
12MH30D,SUP,Custom 27203010,,12MH30D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$340.00,$0.00,$340.00,$0.00,$242.66,$0.00,$0.00,$0.00,$0.00,$0.00,$340.00,$0.00,$170.00,$269.28,$272.00,$0.00,$0.00,$0.00,$0.00,$0.00
12TLW805F35,SUP,HCPCS C1757,,12TLW805F35  -  CATHETER EMBOLECTOMY 5.5FR 11MM 80CM OTW RADIOPACITY LATEX,$225.00,$0.00,$225.00,$0.00,$160.58,$0.00,$0.00,$0.00,$0.00,$0.00,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$0.00,$0.00,$0.00,$0.00
13016540P3,SUP,HCPCS C1713,,13016540P3  -  SCREW BN 6.5MM 40MM NS RELINE PA SPNL 2S,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
13016545P3,SUP,HCPCS C1713,,13016545P3  -  SCREW BN 6.5MM 45MM NS RELINE PA SPNL 2S,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
13016550P3,SUP,HCPCS C1713,,13016550P3  -  SCREW BN 6.5MM 50MM NS RELINE PA SPNL 2S,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
13-066P,SUP,HCPCS C1713,,13-066P  -  WASHERS 13MM,$28.50,$0.00,$28.50,$12.83,$20.34,$0.00,$4.91,$0.00,$0.00,$4.99,$28.50,$0.00,$14.25,$22.57,$22.80,$0.00,$4.46,$0.00,$4.54,$0.00
1314-3042,SUP,Custom 27203010,,1314-3042  -  BIT DRL 4.2MM 300MM TRFLT,$220.00,$0.00,$220.00,$0.00,$157.01,$0.00,$0.00,$0.00,$0.00,$0.00,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$0.00,$0.00,$0.00,$0.00
131712-01,SUP,HCPCS Q4130,,131712-01  -  DRESSING BIO 12X3IN EZ DERM MSH,$215.74,$0.00,$215.74,$0.00,$153.97,$0.00,$0.00,$0.00,$0.00,$0.00,$215.74,$0.00,$107.87,$170.87,$172.59,$0.00,$0.00,$0.00,$0.00,$0.00
1320-0125S,SUP,Custom 27203010,,1320-0125S  -  CLIP SURG CLOSE TUBE STRL GAMMA3,$226.88,$0.00,$226.88,$0.00,$161.92,$0.00,$0.00,$0.00,$0.00,$0.00,$226.88,$0.00,$113.44,$179.69,$181.50,$0.00,$0.00,$0.00,$0.00,$0.00
1320-0190,SUP,Custom 27203010,,1320-0190  -  BIT DRILL 3 LAG STP STRL,"$2,695.00",$0.00,"$2,695.00",$0.00,"$1,923.42",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,695.00",$0.00,"$1,347.50","$2,134.44","$2,156.00",$0.00,$0.00,$0.00,$0.00,$0.00
1320-3030S,SUP,Custom 27203010,,1320-3030S  -  BIT DRILL 300MM 3MM GAMA SS STRL,$275.00,$0.00,$275.00,$0.00,$196.27,$0.00,$0.00,$0.00,$0.00,$0.00,$275.00,$0.00,$137.50,$217.80,$220.00,$0.00,$0.00,$0.00,$0.00,$0.00
1320-3042S,SUP,Custom 27203010,,1320-3042S  -  BIT DRL 4.2MM 300MM STRL QC DISP,$281.88,$0.00,$281.88,$0.00,$201.17,$0.00,$0.00,$0.00,$0.00,$0.00,$281.88,$0.00,$140.94,$223.25,$225.50,$0.00,$0.00,$0.00,$0.00,$0.00
132-40-53,SUP,HCPCS C1776,,132-40-53  -  LINER ACETAB LIPPED NOVATION CROWN CUP CONNEXION GXL GRAY 40,"$4,118.13",$0.00,"$4,118.13","$1,853.16","$2,939.11",$0.00,$709.53,$0.00,$0.00,$721.05,"$4,118.13",$0.00,"$2,059.06","$3,261.56","$3,294.50",$0.00,$644.49,$0.00,$655.61,$0.00
134046J,SUP,Custom 27203010,,134046J  -  APPLIER IN CLP SM 9IN LF PRM SGCLP SUP INTLK 20 ATO CLIP LGT,$20.79,$0.00,$20.79,$0.00,$14.84,$0.00,$0.00,$0.00,$0.00,$0.00,$20.79,$0.00,$10.40,$16.47,$16.63,$0.00,$0.00,$0.00,$0.00,$0.00
1365-24-000,SUP,HCPCS C1776,,1365-24-000  -  HEAD FEM +13MM 12/14 STD 32MM STRL LF ART/EZE SKRT COCR HIP,"$2,897.50",$0.00,"$2,897.50","$1,303.88","$2,067.95",$0.00,$499.22,$0.00,$0.00,$507.33,"$2,897.50",$0.00,"$1,448.75","$2,294.82","$2,318.00",$0.00,$453.46,$0.00,$461.28,$0.00
13-678-31F,SUP,Custom 27203010,,PIPETTE SERO BOROSIL GLS 1ML GRAD NONPLUGGED REG TIP NSTRL,$0.35,$0.00,$0.35,$0.00,$0.25,$0.00,$0.00,$0.00,$0.00,$0.00,$0.35,$0.00,$0.18,$0.28,$0.28,$0.00,$0.00,$0.00,$0.00,$0.00
13-678-31J,SUP,Custom 27203010,,PIPETTE SERO BOROSIL GLS 10ML GRAD NONPLUGGED REG TIP NSTRL,$0.55,$0.00,$0.55,$0.00,$0.39,$0.00,$0.00,$0.00,$0.00,$0.00,$0.55,$0.00,$0.28,$0.44,$0.44,$0.00,$0.00,$0.00,$0.00,$0.00
138-36-53,SUP,HCPCS C1776,,138-36-53  -  LINER ACETAB FACE NOVATION CONNEXION GXL 10D 53MM 36MM HIP,"$4,118.13",$0.00,"$4,118.13","$1,853.16","$2,939.11",$0.00,$709.53,$0.00,$0.00,$721.05,"$4,118.13",$0.00,"$2,059.06","$3,261.56","$3,294.50",$0.00,$644.49,$0.00,$655.61,$0.00
1385108QD,SUP,HCPCS C1751,,1385108QD  -  CATHETER CV 5FR LF P PICC SHRLK 3CG 3 LUM MAXIMAL BRR TRY,$624.25,$0.00,$624.25,$338.97,$445.53,$0.00,$107.56,$0.00,$0.00,$109.30,$624.25,$0.00,$312.13,$494.41,$499.40,$0.00,$97.70,$0.00,$99.38,$0.00
14 377 259,SUP,Custom 27203010,,SLIDE DECISLIDE URISYS ACRL INTGR CVRSLP UA 10 TST,$247.90,$0.00,$247.90,$0.00,$176.93,$0.00,$0.00,$0.00,$0.00,$0.00,$247.90,$0.00,$123.95,$196.34,$198.32,$0.00,$0.00,$0.00,$0.00,$0.00
14-375-560,SUP,Custom 27203010,,PIPETTE KOVA DECANTING BLB SED SYS UA,$133.18,$0.00,$133.18,$0.00,$95.05,$0.00,$0.00,$0.00,$0.00,$0.00,$133.18,$0.00,$66.59,$105.48,$106.54,$0.00,$0.00,$0.00,$0.00,$0.00
14-521014,SUP,Custom 27203010,,14-521014  -  BIT DRL 4MM 14MM MAXAN SPNE ANT CRV PLT SYS,$752.00,$0.00,$752.00,$0.00,$536.70,$0.00,$0.00,$0.00,$0.00,$0.00,$752.00,$0.00,$376.00,$595.58,$601.60,$0.00,$0.00,$0.00,$0.00,$0.00
14-521614,SUP,HCPCS C1713,,14-521614  -  SCREW BN 4MM 14MM MAXAN VA SLF DRL SPNE,"$1,064.00",$0.00,"$1,064.00",$478.80,$759.38,$0.00,$183.32,$0.00,$0.00,$186.30,"$1,064.00",$0.00,$532.00,$842.69,$851.20,$0.00,$166.52,$0.00,$169.39,$0.00
14-521616,SUP,HCPCS C1713,,14-521616  -  SCREW BONE 4MM 16MM MAXAN SPN VAR ANG,"$1,064.00",$0.00,"$1,064.00",$478.80,$759.38,$0.00,$183.32,$0.00,$0.00,$186.30,"$1,064.00",$0.00,$532.00,$842.69,$851.20,$0.00,$166.52,$0.00,$169.39,$0.00
14-524004,SUP,HCPCS C1713,,14-524004  -  ROD SPINAL 40MM PRECUT LINEUM UNIVERSAL BLUE TITANIUM 3.5MM,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
14-524008,SUP,HCPCS C1713,,14-524008  -  ROD SPNL UNV 3.5MM 80MM BLU NS LINEUM PCUT TI OCT,"$1,100.00",$0.00,"$1,100.00",$495.00,$785.07,$0.00,$189.52,$0.00,$0.00,$192.60,"$1,100.00",$0.00,$550.00,$871.20,$880.00,$0.00,$172.15,$0.00,$175.12,$0.00
14-524018,SUP,HCPCS C1713,,14-524018  -  ROD SPINAL UNIVERSAL 3.5MM 180MM PRECUT LINEUM BLUE TITANIUM,"$1,100.00",$0.00,"$1,100.00",$495.00,$785.07,$0.00,$189.52,$0.00,$0.00,$192.60,"$1,100.00",$0.00,$550.00,$871.20,$880.00,$0.00,$172.15,$0.00,$175.12,$0.00
14-524024,SUP,HCPCS C1713,,14-524024  -  ROD SPNL UNV 3.5MM 240MM BLU NS LINEUM PCUT TI OCT,"$1,050.00",$0.00,"$1,050.00",$472.50,$749.39,$0.00,$180.91,$0.00,$0.00,$183.85,"$1,050.00",$0.00,$525.00,$831.60,$840.00,$0.00,$164.33,$0.00,$167.16,$0.00
14-524038,SUP,HCPCS C1713,,14-524038  -  SCREW SET PLUG LINEUM HELICAL FLANGE TITANIUM SPN CERV UPPER,$430.00,$0.00,$430.00,$193.50,$306.89,$0.00,$74.09,$0.00,$0.00,$75.29,$430.00,$0.00,$215.00,$340.56,$344.00,$0.00,$67.30,$0.00,$68.46,$0.00
14-524212,SUP,HCPCS C1713,,14-524212  -  SCREW BN 3.5MM 12MM AU NS LINEUM TRNSL HLCL FLNG ST TOP LD,"$4,694.00",$0.00,"$4,694.00","$2,112.30","$3,350.11",$0.00,$808.75,$0.00,$0.00,$821.88,"$4,694.00",$0.00,"$2,347.00","$3,717.65","$3,755.20",$0.00,$734.61,$0.00,$747.28,$0.00
14-524214,SUP,HCPCS C1713,,14-524214  -  SCREW BONE 14MM SELF TAP TOP LOAD FRICTION FIT SMOOTH SHANK,"$4,694.00",$0.00,"$4,694.00","$2,112.30","$3,350.11",$0.00,$808.75,$0.00,$0.00,$821.88,"$4,694.00",$0.00,"$2,347.00","$3,717.65","$3,755.20",$0.00,$734.61,$0.00,$747.28,$0.00
14-524218,SUP,HCPCS C1713,,14-524218  -  SCREW BONE STANDARD 3.5MM 18MM SLFTAP TOP LOADING FRICTION,"$4,694.00",$0.00,"$4,694.00","$2,112.30","$3,350.11",$0.00,$808.75,$0.00,$0.00,$821.88,"$4,694.00",$0.00,"$2,347.00","$3,717.65","$3,755.20",$0.00,$734.61,$0.00,$747.28,$0.00
14-524378,SUP,HCPCS C1713,,14-524378  -  SCREW BONE LINEUM TITANIUM L28 MM OD3.5 MM OCCIPITOCERVICOTH,"$4,694.00",$0.00,"$4,694.00","$2,112.30","$3,350.11",$0.00,$808.75,$0.00,$0.00,$821.88,"$4,694.00",$0.00,"$2,347.00","$3,717.65","$3,755.20",$0.00,$734.61,$0.00,$747.28,$0.00
14-524380,SUP,HCPCS C1713,,14-524380  -  SCREW BONE 3.5MM 30MM SMOOTH SHANK TRANSLATION TECHNOLOGY,"$4,694.00",$0.00,"$4,694.00","$2,112.30","$3,350.11",$0.00,$808.75,$0.00,$0.00,$821.88,"$4,694.00",$0.00,"$2,347.00","$3,717.65","$3,755.20",$0.00,$734.61,$0.00,$747.28,$0.00
14-524512,SUP,HCPCS C1713,,14-524512  -  SCREW BONE 12MM TRANSLATION TECHNOLOGY GREEN HEAD LINEUM,"$5,867.50",$0.00,"$5,867.50","$2,640.38","$4,187.63",$0.00,"$1,010.94",$0.00,$0.00,"$1,027.35","$5,867.50",$0.00,"$2,933.75","$4,647.06","$4,694.00",$0.00,$918.26,$0.00,$934.11,$0.00
14-524514,SUP,HCPCS C1713,,14-524514  -  SCREW BN 4MM 14MM LINEUM TRNSL TCH GRN HD TI OCT SPNE,"$5,867.50",$0.00,"$5,867.50","$2,640.38","$4,187.63",$0.00,"$1,010.94",$0.00,$0.00,"$1,027.35","$5,867.50",$0.00,"$2,933.75","$4,647.06","$4,694.00",$0.00,$918.26,$0.00,$934.11,$0.00
14-524530,SUP,HCPCS C1713,,14-524530  -  SCREW BONE 30MM TRANSLATION TECHNOLOGY GREEN HEAD LINEUM,"$4,694.00",$0.00,"$4,694.00","$2,112.30","$3,350.11",$0.00,$808.75,$0.00,$0.00,$821.88,"$4,694.00",$0.00,"$2,347.00","$3,717.65","$3,755.20",$0.00,$734.61,$0.00,$747.28,$0.00
14-524728,SUP,HCPCS C1713,,14-524728  -  SCREW BONE 4.35MM 28MM TRANSLATION TECHNOLOGY BLUE HEAD,"$4,694.00",$0.00,"$4,694.00","$2,112.30","$3,350.11",$0.00,$808.75,$0.00,$0.00,$821.88,"$4,694.00",$0.00,"$2,347.00","$3,717.65","$3,755.20",$0.00,$734.61,$0.00,$747.28,$0.00
14-525000,SUP,HCPCS C1713,,14-525000  -  DRILL SURG SLEEVE LINEUM STANDARD GOLD TITANIUM 3.5MM,$892.50,$0.00,$892.50,$401.63,$636.98,$0.00,$153.77,$0.00,$0.00,$156.27,$892.50,$0.00,$446.25,$706.86,$714.00,$0.00,$139.68,$0.00,$142.09,$0.00
14-525055,SUP,HCPCS C1713,,14-525055  -  TAP SURGICAL LINEUM STANDARD OD3 MM OCCIPITOCERVICOTHORACIC,"$1,050.00",$0.00,"$1,050.00",$472.50,$749.39,$0.00,$180.91,$0.00,$0.00,$183.85,"$1,050.00",$0.00,$525.00,$831.60,$840.00,$0.00,$164.33,$0.00,$167.16,$0.00
145-351,SUP,HCPCS C1768,,145-351  -  STENT URET 4.8FR 24CM W/O GWIRE PRCFLX HDR+,$315.53,$0.00,$315.53,$141.99,$225.19,$0.00,$54.36,$0.00,$0.00,$55.25,$315.53,$0.00,$157.76,$249.90,$252.42,$0.00,$49.38,$0.00,$50.23,$0.00
145-5091-150,SUP,HCPCS C1751,,145-5091-150  -  CATH INFUS 45D .014IN 2.1FR 1.7FR 150CM 3MM GWIRE TIP MCTH,"$1,772.50",$0.00,"$1,772.50",$962.47,"$1,265.03",$0.00,$305.39,$0.00,$0.00,$310.35,"$1,772.50",$0.00,$886.25,"$1,403.82","$1,418.00",$0.00,$277.40,$0.00,$282.18,$0.00
145-5092-150,SUP,HCPCS C1751,,145-5092-150  -  CATH INFUS .014IN 45D 250 PSI 2.4-1.9FR .017IN 150CM 3MM,"$1,772.50",$0.00,"$1,772.50",$962.47,"$1,265.03",$0.00,$305.39,$0.00,$0.00,$310.35,"$1,772.50",$0.00,$886.25,"$1,403.82","$1,418.00",$0.00,$277.40,$0.00,$282.18,$0.00
14574-01,SUP,HCPCS C2617,,14574-01  -  STENT BIL 5MM 30MM 120CM .018IN SLF XPD FLXB TRNSHEP XPERT,"$4,312.50",$0.00,"$4,312.50","$1,940.63","$3,077.83",$0.00,$743.02,$0.00,$0.00,$755.08,"$4,312.50",$0.00,"$2,156.25","$3,415.50","$3,450.00",$0.00,$674.91,$0.00,$686.55,$0.00
14575-01,SUP,HCPCS C2617,,14575-01  -  STENT BIL 5MM 40MM 120CM .018IN SLF XPD FLXB TRNSHEP XPERT,"$4,312.50",$0.00,"$4,312.50","$1,940.63","$3,077.83",$0.00,$743.02,$0.00,$0.00,$755.08,"$4,312.50",$0.00,"$2,156.25","$3,415.50","$3,450.00",$0.00,$674.91,$0.00,$686.55,$0.00
14577-01,SUP,HCPCS C2617,,14577-01  -  STENT BIL 6MM 30MM 120CM .018IN SLF XPD FLXB TRNSHEP XPERT,"$4,312.50",$0.00,"$4,312.50","$1,940.63","$3,077.83",$0.00,$743.02,$0.00,$0.00,$755.08,"$4,312.50",$0.00,"$2,156.25","$3,415.50","$3,450.00",$0.00,$674.91,$0.00,$686.55,$0.00
14578-01,SUP,HCPCS C2617,,14578-01  -  STENT BIL 6MM 40MM 120CM .018IN SLF XPD FLXB TRNSHEP XPERT,"$4,312.50",$0.00,"$4,312.50","$1,940.63","$3,077.83",$0.00,$743.02,$0.00,$0.00,$755.08,"$4,312.50",$0.00,"$2,156.25","$3,415.50","$3,450.00",$0.00,$674.91,$0.00,$686.55,$0.00
145FS38,SUP,HCPCS C1769,,145FS38  -  GWIRE ENDSCP .038IN 145CM STR TIP HDRGLD HYDPHI STRL DISP,$157.50,$0.00,$157.50,$85.52,$112.41,$0.00,$27.14,$0.00,$0.00,$27.58,$157.50,$0.00,$78.75,$124.74,$126.00,$0.00,$24.65,$0.00,$25.07,$0.00
14679-01,SUP,HCPCS C1760,,14679-01  -  DEVICE CLOSURE 6FR CLIP LATEX FREE STARCLOSE SE NITINOL,$787.50,$0.00,$787.50,$354.38,$562.04,$0.00,$135.68,$0.00,$0.00,$137.88,$787.50,$0.00,$393.75,$623.70,$630.00,$0.00,$123.24,$0.00,$125.37,$0.00
14937-01,SUP,HCPCS C1769,,14937-01  -  GUIDEWIRE VASC .014IN 300CM STRL 11CM ASAHI MRCLBRS 3 RADOPQ,$60.00,$0.00,$60.00,$32.58,$42.82,$0.00,$10.34,$0.00,$0.00,$10.51,$60.00,$0.00,$30.00,$47.52,$48.00,$0.00,$9.39,$0.00,$9.55,$0.00
149R,SUP,Custom 27203010,,149R  -  BRUSH CYTOLOGY RING HANDLE 3MM LATEX FREE PULMONARY STERILE,$24.33,$0.00,$24.33,$0.00,$17.36,$0.00,$0.00,$0.00,$0.00,$0.00,$24.33,$0.00,$12.16,$19.27,$19.46,$0.00,$0.00,$0.00,$0.00,$0.00
14AC50,SUP,Custom 27203010,,14AC50  -  PLATE 18MM TI BONE SPNL,$327.25,$0.00,$327.25,$0.00,$233.56,$0.00,$0.00,$0.00,$0.00,$0.00,$327.25,$0.00,$163.63,$259.18,$261.80,$0.00,$0.00,$0.00,$0.00,$0.00
14AC60,SUP,Custom 27203010,,14AC60  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$327.25,$0.00,$327.25,$0.00,$233.56,$0.00,$0.00,$0.00,$0.00,$0.00,$327.25,$0.00,$163.63,$259.18,$261.80,$0.00,$0.00,$0.00,$0.00,$0.00
14AC90,SUP,Custom 27203010,,14AC90  -  PLATE 18MM TI BONE SPNL,$327.25,$0.00,$327.25,$0.00,$233.56,$0.00,$0.00,$0.00,$0.00,$0.00,$327.25,$0.00,$163.63,$259.18,$261.80,$0.00,$0.00,$0.00,$0.00,$0.00
14BA20,SUP,Custom 27203010,,14BA20  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$348.50,$0.00,$348.50,$0.00,$248.72,$0.00,$0.00,$0.00,$0.00,$0.00,$348.50,$0.00,$174.25,$276.01,$278.80,$0.00,$0.00,$0.00,$0.00,$0.00
14BA25,SUP,Custom 27203010,,14BA25  -  PLATE 18MM TI BONE SPNL,$348.50,$0.00,$348.50,$0.00,$248.72,$0.00,$0.00,$0.00,$0.00,$0.00,$348.50,$0.00,$174.25,$276.01,$278.80,$0.00,$0.00,$0.00,$0.00,$0.00
14BA25D,SUP,Custom 27203010,,14BA25D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$371.88,$0.00,$371.88,$0.00,$265.41,$0.00,$0.00,$0.00,$0.00,$0.00,$371.88,$0.00,$185.94,$294.53,$297.50,$0.00,$0.00,$0.00,$0.00,$0.00
14BA30,SUP,Custom 27203010,,14BA30  -  PLATE 18MM TI BONE SPNL,$354.88,$0.00,$354.88,$0.00,$253.27,$0.00,$0.00,$0.00,$0.00,$0.00,$354.88,$0.00,$177.44,$281.06,$283.90,$0.00,$0.00,$0.00,$0.00,$0.00
14BA30D,SUP,Custom 27203010,,14BA30D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$371.88,$0.00,$371.88,$0.00,$265.41,$0.00,$0.00,$0.00,$0.00,$0.00,$371.88,$0.00,$185.94,$294.53,$297.50,$0.00,$0.00,$0.00,$0.00,$0.00
14BA30DC,SUP,Custom 27203010,,14BA30DC  -  PLATE 18MM TI BONE SPNL,$376.13,$0.00,$376.13,$0.00,$268.44,$0.00,$0.00,$0.00,$0.00,$0.00,$376.13,$0.00,$188.06,$297.89,$300.90,$0.00,$0.00,$0.00,$0.00,$0.00
14BA40D,SUP,Custom 27203010,,14BA40D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$378.25,$0.00,$378.25,$0.00,$269.96,$0.00,$0.00,$0.00,$0.00,$0.00,$378.25,$0.00,$189.13,$299.57,$302.60,$0.00,$0.00,$0.00,$0.00,$0.00
14BA40DC,SUP,Custom 27203010,,14BA40DC  -  PLATE 18MM TI BONE SPNL,$376.13,$0.00,$376.13,$0.00,$268.44,$0.00,$0.00,$0.00,$0.00,$0.00,$376.13,$0.00,$188.06,$297.89,$300.90,$0.00,$0.00,$0.00,$0.00,$0.00
14BA40DX,SUP,Custom 27203010,,14BA40DX  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$382.50,$0.00,$382.50,$0.00,$272.99,$0.00,$0.00,$0.00,$0.00,$0.00,$382.50,$0.00,$191.25,$302.94,$306.00,$0.00,$0.00,$0.00,$0.00,$0.00
14BA50,SUP,Custom 27203010,,14BA50  -  PLATE 18MM TI BONE SPNL,$363.38,$0.00,$363.38,$0.00,$259.34,$0.00,$0.00,$0.00,$0.00,$0.00,$363.38,$0.00,$181.69,$287.80,$290.70,$0.00,$0.00,$0.00,$0.00,$0.00
14BA50D,SUP,Custom 27203010,,14BA50D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$378.25,$0.00,$378.25,$0.00,$269.96,$0.00,$0.00,$0.00,$0.00,$0.00,$378.25,$0.00,$189.13,$299.57,$302.60,$0.00,$0.00,$0.00,$0.00,$0.00
14BA50DC,SUP,Custom 27203010,,14BA50DC  -  PLATE 18MM TI BONE SPNL,$378.25,$0.00,$378.25,$0.00,$269.96,$0.00,$0.00,$0.00,$0.00,$0.00,$378.25,$0.00,$189.13,$299.57,$302.60,$0.00,$0.00,$0.00,$0.00,$0.00
14BA50DX,SUP,Custom 27203010,,14BA50DX  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$382.50,$0.00,$382.50,$0.00,$272.99,$0.00,$0.00,$0.00,$0.00,$0.00,$382.50,$0.00,$191.25,$302.94,$306.00,$0.00,$0.00,$0.00,$0.00,$0.00
14BA60,SUP,Custom 27203010,,14BA60  -  PLATE 18MM TI BONE SPNL,$354.88,$0.00,$354.88,$0.00,$253.27,$0.00,$0.00,$0.00,$0.00,$0.00,$354.88,$0.00,$177.44,$281.06,$283.90,$0.00,$0.00,$0.00,$0.00,$0.00
14BA60D,SUP,Custom 27203010,,14BA60D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$371.88,$0.00,$371.88,$0.00,$265.41,$0.00,$0.00,$0.00,$0.00,$0.00,$371.88,$0.00,$185.94,$294.53,$297.50,$0.00,$0.00,$0.00,$0.00,$0.00
14BA60DC,SUP,Custom 27203010,,14BA60DC  -  PLATE 18MM TI BONE SPNL,$376.13,$0.00,$376.13,$0.00,$268.44,$0.00,$0.00,$0.00,$0.00,$0.00,$376.13,$0.00,$188.06,$297.89,$300.90,$0.00,$0.00,$0.00,$0.00,$0.00
14BA60DX,SUP,Custom 27203010,,14BA60DX  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$382.50,$0.00,$382.50,$0.00,$272.99,$0.00,$0.00,$0.00,$0.00,$0.00,$382.50,$0.00,$191.25,$302.94,$306.00,$0.00,$0.00,$0.00,$0.00,$0.00
14BA70DX,SUP,Custom 27203010,,14BA70DX  -  PLATE 18MM TI BONE SPNL,$382.50,$0.00,$382.50,$0.00,$272.99,$0.00,$0.00,$0.00,$0.00,$0.00,$382.50,$0.00,$191.25,$302.94,$306.00,$0.00,$0.00,$0.00,$0.00,$0.00
14BA75,SUP,Custom 27203010,,14BA75  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$354.88,$0.00,$354.88,$0.00,$253.27,$0.00,$0.00,$0.00,$0.00,$0.00,$354.88,$0.00,$177.44,$281.06,$283.90,$0.00,$0.00,$0.00,$0.00,$0.00
14BA75D,SUP,Custom 27203010,,14BA75D  -  PLATE 18MM TI BONE SPNL,$371.88,$0.00,$371.88,$0.00,$265.41,$0.00,$0.00,$0.00,$0.00,$0.00,$371.88,$0.00,$185.94,$294.53,$297.50,$0.00,$0.00,$0.00,$0.00,$0.00
14BA80DX,SUP,Custom 27203010,,14BA80DX  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$382.50,$0.00,$382.50,$0.00,$272.99,$0.00,$0.00,$0.00,$0.00,$0.00,$382.50,$0.00,$191.25,$302.94,$306.00,$0.00,$0.00,$0.00,$0.00,$0.00
14BA90,SUP,Custom 27203010,,14BA90  -  PLATE 18MM TI BONE SPNL,$354.88,$0.00,$354.88,$0.00,$253.27,$0.00,$0.00,$0.00,$0.00,$0.00,$354.88,$0.00,$177.44,$281.06,$283.90,$0.00,$0.00,$0.00,$0.00,$0.00
14CY50,SUP,Custom 27203010,,14CY50  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$333.63,$0.00,$333.63,$0.00,$238.11,$0.00,$0.00,$0.00,$0.00,$0.00,$333.63,$0.00,$166.81,$264.23,$266.90,$0.00,$0.00,$0.00,$0.00,$0.00
14CY50B,SUP,Custom 27203010,,14CY50B  -  PLATE 18MM TI BONE SPNL,$333.63,$0.00,$333.63,$0.00,$238.11,$0.00,$0.00,$0.00,$0.00,$0.00,$333.63,$0.00,$166.81,$264.23,$266.90,$0.00,$0.00,$0.00,$0.00,$0.00
14CY50DCSH,SUP,Custom 27203010,,14CY50DCSH  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$412.25,$0.00,$412.25,$0.00,$294.22,$0.00,$0.00,$0.00,$0.00,$0.00,$412.25,$0.00,$206.13,$326.50,$329.80,$0.00,$0.00,$0.00,$0.00,$0.00
14CY60DCSH,SUP,Custom 27203010,,14CY60DCSH  -  PLATE 18MM TI BONE SPNL,$412.25,$0.00,$412.25,$0.00,$294.22,$0.00,$0.00,$0.00,$0.00,$0.00,$412.25,$0.00,$206.13,$326.50,$329.80,$0.00,$0.00,$0.00,$0.00,$0.00
14CY65DX,SUP,Custom 27203010,,14CY65DX  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$378.25,$0.00,$378.25,$0.00,$269.96,$0.00,$0.00,$0.00,$0.00,$0.00,$378.25,$0.00,$189.13,$299.57,$302.60,$0.00,$0.00,$0.00,$0.00,$0.00
14CY70DCSH,SUP,Custom 27203010,,14CY70DCSH  -  PLATE 18MM TI BONE SPNL,$412.25,$0.00,$412.25,$0.00,$294.22,$0.00,$0.00,$0.00,$0.00,$0.00,$412.25,$0.00,$206.13,$326.50,$329.80,$0.00,$0.00,$0.00,$0.00,$0.00
14CY75,SUP,Custom 27203010,,14CY75  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$333.63,$0.00,$333.63,$0.00,$238.11,$0.00,$0.00,$0.00,$0.00,$0.00,$333.63,$0.00,$166.81,$264.23,$266.90,$0.00,$0.00,$0.00,$0.00,$0.00
14CY76L,SUP,Custom 27203010,,14CY76L  -  PLATE 18MM TI BONE SPNL,$388.88,$0.00,$388.88,$0.00,$277.54,$0.00,$0.00,$0.00,$0.00,$0.00,$388.88,$0.00,$194.44,$307.99,$311.10,$0.00,$0.00,$0.00,$0.00,$0.00
14CY90,SUP,Custom 27203010,,14CY90  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$333.63,$0.00,$333.63,$0.00,$238.11,$0.00,$0.00,$0.00,$0.00,$0.00,$333.63,$0.00,$166.81,$264.23,$266.90,$0.00,$0.00,$0.00,$0.00,$0.00
14HM126,SUP,Custom 27203010,,14HM126  -  PLATE 18MM TI BONE SPNL,$425.00,$0.00,$425.00,$0.00,$303.32,$0.00,$0.00,$0.00,$0.00,$0.00,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$0.00,$0.00,$0.00,$0.00
14HM95,SUP,Custom 27203010,,14HM95  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$425.00,$0.00,$425.00,$0.00,$303.32,$0.00,$0.00,$0.00,$0.00,$0.00,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$0.00,$0.00,$0.00,$0.00
14MH30DC,SUP,Custom 27203010,,14MH30DC  -  PLATE 18MM TI BONE SPNL,$376.13,$0.00,$376.13,$0.00,$268.44,$0.00,$0.00,$0.00,$0.00,$0.00,$376.13,$0.00,$188.06,$297.89,$300.90,$0.00,$0.00,$0.00,$0.00,$0.00
14OV55,SUP,Custom 27203010,,14OV55  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$323.00,$0.00,$323.00,$0.00,$230.53,$0.00,$0.00,$0.00,$0.00,$0.00,$323.00,$0.00,$161.50,$255.82,$258.40,$0.00,$0.00,$0.00,$0.00,$0.00
14TA30,SUP,Custom 27203010,,14TA30  -  PLATE 18MM TI BONE SPNL,$350.63,$0.00,$350.63,$0.00,$250.24,$0.00,$0.00,$0.00,$0.00,$0.00,$350.63,$0.00,$175.31,$277.70,$280.50,$0.00,$0.00,$0.00,$0.00,$0.00
14TA31,SUP,Custom 27203010,,14TA31  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$350.63,$0.00,$350.63,$0.00,$250.24,$0.00,$0.00,$0.00,$0.00,$0.00,$350.63,$0.00,$175.31,$277.70,$280.50,$0.00,$0.00,$0.00,$0.00,$0.00
1501652SP,SUP,HCPCS C9250,,1501652SP  -  KIT TISS CLSR FRZN SLNT ARTISS 4ML,$741.80,$0.00,$741.80,$333.81,$529.42,$164.85,$127.81,$0.00,$0.00,$129.88,$741.80,$173.09,$370.90,$587.51,$593.44,$239.03,$116.09,$0.00,$118.09,$164.85
1501653SP,SUP,Custom 27203010,,1501653SP  -  KIT TISS CLSR 10ML ARTISS DUO PREFL SYR HMN FBRN SLNT SPRY,"$1,868.63",$0.00,"$1,868.63",$0.00,"$1,333.64",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,868.63",$0.00,$934.31,"$1,479.95","$1,494.90",$0.00,$0.00,$0.00,$0.00,$0.00
151F7,SUP,Custom 27203010,,151F7  -  CATHETER ART LN STD 7FR 110CM SG 4 LUM S TIP TD FEM VN,$145.00,$0.00,$145.00,$0.00,$103.49,$0.00,$0.00,$0.00,$0.00,$0.00,$145.00,$0.00,$72.50,$114.84,$116.00,$0.00,$0.00,$0.00,$0.00,$0.00
15-28126,SUP,Custom 27203010,,15-28126  -  SPLINT NSL MED FOAM RBR LTWT AL LNNG WTR RS ADH XTRN SKNPRP,$20.50,$0.00,$20.50,$0.00,$14.63,$0.00,$0.00,$0.00,$0.00,$0.00,$20.50,$0.00,$10.25,$16.24,$16.40,$0.00,$0.00,$0.00,$0.00,$0.00
1541-01-000,SUP,HCPCS C1776,,1541-01-000  -  STEM FEM 1 STD OFST 105MM LF PROSTALAC CMNT XTN HIP,"$13,132.50",$0.00,"$13,132.50","$5,909.63","$5,158.80",$0.00,"$2,262.66",$0.00,$0.00,"$2,299.40","$13,132.50",$0.00,"$6,566.25","$10,400.94","$10,506.00",$0.00,"$2,055.24",$0.00,"$2,090.69",$0.00
1541-28-000,SUP,HCPCS C1776,,1541-28-000  -  STEM FEM 3 RT HIP,"$10,425.00",$0.00,"$10,425.00","$4,691.25","$5,158.80",$0.00,"$1,796.18",$0.00,$0.00,"$1,825.33","$10,425.00",$0.00,"$5,212.50","$8,256.60","$8,340.00",$0.00,"$1,631.51",$0.00,"$1,659.66",$0.00
1541-42-320,SUP,HCPCS C1776,,1541-42-320  -  CUP ACETAB 42MM 32MM CEMENTED PROSTALAC ALL POLY HIP,"$2,615.00",$0.00,"$2,615.00","$1,176.75","$1,866.33",$0.00,$450.55,$0.00,$0.00,$457.87,"$2,615.00",$0.00,"$1,307.50","$2,071.08","$2,092.00",$0.00,$409.25,$0.00,$416.31,$0.00
15-711,SUP,HCPCS C1894,,INTRODUCER SHTH 5FR 2.5CM 10CM MINI GUIDEWIRE DILAT PNCL,$24.38,$0.00,$24.38,$13.24,$17.40,$0.00,$4.20,$0.00,$0.00,$4.27,$24.38,$0.00,$12.19,$19.31,$19.50,$0.00,$3.81,$0.00,$3.88,$0.00
1584S,SUP,Custom 27203010,,1584S  -  WRAP COMPRESSION 5YDX4IN ELAST SELF ADHERENT FULL STRETCH,$70.39,$0.00,$70.39,$0.00,$50.24,$0.00,$0.00,$0.00,$0.00,$0.00,$70.39,$0.00,$35.20,$55.75,$56.31,$0.00,$0.00,$0.00,$0.00,$0.00
15AC50,SUP,Custom 27203010,,15AC50  -  PLATE 18MM TI BONE SPNL,$327.25,$0.00,$327.25,$0.00,$233.56,$0.00,$0.00,$0.00,$0.00,$0.00,$327.25,$0.00,$163.63,$259.18,$261.80,$0.00,$0.00,$0.00,$0.00,$0.00
15AC60,SUP,Custom 27203010,,15AC60  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$327.25,$0.00,$327.25,$0.00,$233.56,$0.00,$0.00,$0.00,$0.00,$0.00,$327.25,$0.00,$163.63,$259.18,$261.80,$0.00,$0.00,$0.00,$0.00,$0.00
15BA40D,SUP,Custom 27203010,,15BA40D  -  PLATE 18MM TI BONE SPNL,$382.50,$0.00,$382.50,$0.00,$272.99,$0.00,$0.00,$0.00,$0.00,$0.00,$382.50,$0.00,$191.25,$302.94,$306.00,$0.00,$0.00,$0.00,$0.00,$0.00
15BA40DX,SUP,Custom 27203010,,15BA40DX  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$386.75,$0.00,$386.75,$0.00,$276.02,$0.00,$0.00,$0.00,$0.00,$0.00,$386.75,$0.00,$193.38,$306.31,$309.40,$0.00,$0.00,$0.00,$0.00,$0.00
15BA50,SUP,Custom 27203010,,15BA50  -  PLATE 18MM TI BONE SPNL,$354.88,$0.00,$354.88,$0.00,$253.27,$0.00,$0.00,$0.00,$0.00,$0.00,$354.88,$0.00,$177.44,$281.06,$283.90,$0.00,$0.00,$0.00,$0.00,$0.00
15BA50D,SUP,Custom 27203010,,15BA50D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$382.50,$0.00,$382.50,$0.00,$272.99,$0.00,$0.00,$0.00,$0.00,$0.00,$382.50,$0.00,$191.25,$302.94,$306.00,$0.00,$0.00,$0.00,$0.00,$0.00
15BA60,SUP,Custom 27203010,,15BA60  -  PLATE 18MM TI BONE SPNL,$354.88,$0.00,$354.88,$0.00,$253.27,$0.00,$0.00,$0.00,$0.00,$0.00,$354.88,$0.00,$177.44,$281.06,$283.90,$0.00,$0.00,$0.00,$0.00,$0.00
15BA60D,SUP,Custom 27203010,,15BA60D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$382.50,$0.00,$382.50,$0.00,$272.99,$0.00,$0.00,$0.00,$0.00,$0.00,$382.50,$0.00,$191.25,$302.94,$306.00,$0.00,$0.00,$0.00,$0.00,$0.00
15CY50,SUP,Custom 27203010,,15CY50  -  PLATE 18MM TI BONE SPNL,$325.13,$0.00,$325.13,$0.00,$232.04,$0.00,$0.00,$0.00,$0.00,$0.00,$325.13,$0.00,$162.56,$257.50,$260.10,$0.00,$0.00,$0.00,$0.00,$0.00
15CY50L,SUP,Custom 27203010,,15CY50L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$333.63,$0.00,$333.63,$0.00,$238.11,$0.00,$0.00,$0.00,$0.00,$0.00,$333.63,$0.00,$166.81,$264.23,$266.90,$0.00,$0.00,$0.00,$0.00,$0.00
15CY60,SUP,Custom 27203010,,15CY60  -  PLATE 18MM TI BONE SPNL,$325.13,$0.00,$325.13,$0.00,$232.04,$0.00,$0.00,$0.00,$0.00,$0.00,$325.13,$0.00,$162.56,$257.50,$260.10,$0.00,$0.00,$0.00,$0.00,$0.00
15CY65DX,SUP,Custom 27203010,,15CY65DX  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$376.13,$0.00,$376.13,$0.00,$268.44,$0.00,$0.00,$0.00,$0.00,$0.00,$376.13,$0.00,$188.06,$297.89,$300.90,$0.00,$0.00,$0.00,$0.00,$0.00
15MH17,SUP,Custom 27203010,,15MH17  -  PLATE 18MM TI BONE SPNL,$325.13,$0.00,$325.13,$0.00,$232.04,$0.00,$0.00,$0.00,$0.00,$0.00,$325.13,$0.00,$162.56,$257.50,$260.10,$0.00,$0.00,$0.00,$0.00,$0.00
15MH17D,SUP,Custom 27203010,,15MH17D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$327.25,$0.00,$327.25,$0.00,$233.56,$0.00,$0.00,$0.00,$0.00,$0.00,$327.25,$0.00,$163.63,$259.18,$261.80,$0.00,$0.00,$0.00,$0.00,$0.00
15MH22,SUP,Custom 27203010,,15MH22  -  PLATE 18MM TI BONE SPNL,$325.13,$0.00,$325.13,$0.00,$232.04,$0.00,$0.00,$0.00,$0.00,$0.00,$325.13,$0.00,$162.56,$257.50,$260.10,$0.00,$0.00,$0.00,$0.00,$0.00
15MH30D,SUP,Custom 27203010,,15MH30D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$363.38,$0.00,$363.38,$0.00,$259.34,$0.00,$0.00,$0.00,$0.00,$0.00,$363.38,$0.00,$181.69,$287.80,$290.70,$0.00,$0.00,$0.00,$0.00,$0.00
15TA23,SUP,Custom 27203010,,15TA23  -  PLATE 18MM TI BONE SPNL,$342.13,$0.00,$342.13,$0.00,$244.17,$0.00,$0.00,$0.00,$0.00,$0.00,$342.13,$0.00,$171.06,$270.97,$273.70,$0.00,$0.00,$0.00,$0.00,$0.00
15TA23L,SUP,Custom 27203010,,15TA23L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$342.13,$0.00,$342.13,$0.00,$244.17,$0.00,$0.00,$0.00,$0.00,$0.00,$342.13,$0.00,$171.06,$270.97,$273.70,$0.00,$0.00,$0.00,$0.00,$0.00
1601-04132,SUP,HCPCS C1776,,1601-04132  -  STEM FEM 132D 4 31.5MM OFST 5.1MM 110MM STRL SCRFT ADV PRFT,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
1601-05132,SUP,HCPCS C1776,,1601-05132  -  STEM FEM 132D 5 32.5MM OFST 6MM 115MM STRL SCRFT ADV PRFT,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
1601-06127,SUP,HCPCS C1776,,1601-06127  -  STEM FEM 127D 6 37.2MM OFST 6.9MM 120MM STRL SCRFT ADV PRFT,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
1601-06132,SUP,HCPCS C1776,,1601-06132  -  STEM FEM 132D 6 33.6MM OFST 6.9MM 120MM STRL SCRFT ADV PRFT,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
1601-07127,SUP,HCPCS C1776,,1601-07127  -  STEM FEM 127D 7 41.5MM OFST 7.4MM 130MM STRL SCRFT ADV PRFT,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
1601-07132,SUP,HCPCS C1776,,1601-07132  -  STEM FEM 132D 7 37.5MM OFST 7.4MM 130MM STRL SCRFT ADV PRFT,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
1601-08127,SUP,HCPCS C1776,,1601-08127  -  STEM FEM 127D 8 42.4MM OFST 8.1MM 136MM STRL SCRFT ADV PRFT,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
1601-08132,SUP,HCPCS C1776,,1601-08132  -  STEM FEM 132D 8 38.4MM OFST 8.1MM 136MM STRL SCRFT ADV PRFT,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
1601-09127,SUP,HCPCS C1776,,1601-09127  -  STEM FEM 127D 9 46.9MM OFST 8.9MM 142MM STRL SCRFT ADV PRFT,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
1601-09132,SUP,HCPCS C1776,,1601-09132  -  STEM FEM 132D 9 42.6MM OFST 8.9MM 142MM STRL SCRFT ADV PRFT,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
1601-10127,SUP,HCPCS C1776,,1601-10127  -  STEM FEM 127D 10 48.1MM OFST 9.7MM 148MM STRL SCRFT ADV PRFT,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
1601-10132,SUP,HCPCS C1776,,1601-10132  -  STEM FEM 132D 10 43.8MM OFST 9.7MM 148MM STRL SCRFT ADV PRFT,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
1601-11127,SUP,HCPCS C1776,,1601-11127  -  STEM FEM 127D 11 52.6MM OFST 9.7MM 155MM STRL SCRFT ADV PRFT,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
1601-11132,SUP,HCPCS C1776,,1601-11132  -  STEM FEM 132D 11 47.9MM OFST 9.7MM 155MM STRL SCRFT ADV PRFT,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
1601-12127,SUP,HCPCS C1776,,1601-12127  -  STEM FEM 127D 12 53.7MM OFST 10.7MM 160MM STRL SCRFT ADV,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
1601-12132,SUP,HCPCS C1776,,1601-12132  -  STEM FEM 132D 12 49MM OFST 10.7MM 160MM STRL SCRFT ADV PRFT,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
16-3663,SUP,HCPCS C1776,,16-3663  -  HEAD FEMORAL +3MM 28MM MODULAR TYPE 1 COCR HIP,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
1663H,SUP,Custom 27203010,,1663H  -  SUTURE NABSB 3-0 PS1 18IN BLK ETH MTPS MFL,$29.35,$0.00,$29.35,$0.00,$20.95,$0.00,$0.00,$0.00,$0.00,$0.00,$29.35,$0.00,$14.68,$23.25,$23.48,$0.00,$0.00,$0.00,$0.00,$0.00
1698G,SUP,Custom 27203010,,1698G  -  SUTURE NABSB 6-0 P-3 18IN BLK ETH MTPS MFL,$9.92,$0.00,$9.92,$0.00,$7.08,$0.00,$0.00,$0.00,$0.00,$0.00,$9.92,$0.00,$4.96,$7.86,$7.94,$0.00,$0.00,$0.00,$0.00,$0.00
1699T/40,SUP,HCPCS C1898,,1699T/40  -  OPTISENSE,"$1,125.00",$0.00,"$1,125.00",$506.25,$802.91,$0.00,$193.83,$0.00,$0.00,$196.98,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$176.06,$0.00,$179.10,$0.00
1699T/58,SUP,HCPCS C1898,,1699T/58  -  OPTISENSE,"$1,125.00",$0.00,"$1,125.00",$506.25,$802.91,$0.00,$193.83,$0.00,$0.00,$196.98,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$176.06,$0.00,$179.10,$0.00
1699TC/40,SUP,HCPCS C1898,,1699TC/40  -  LEAD PCNG 6.2FR 40CM LF TNDRL FSR STRD ELUT ATR,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
1699TC/46,SUP,HCPCS C1898,,1699TC/46  -  OPTISENSE,"$1,125.00",$0.00,"$1,125.00",$506.25,$802.91,$0.00,$193.83,$0.00,$0.00,$196.98,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$176.06,$0.00,$179.10,$0.00
1699TC/52,SUP,HCPCS C1898,,1699TC/52  -  LEAD PCNG 1.1MM SPC 6.2FR 52CM LF OPTISENSE 1 PASS VDD BP,"$1,125.00",$0.00,"$1,125.00",$506.25,$802.91,$0.00,$193.83,$0.00,$0.00,$196.98,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$176.06,$0.00,$179.10,$0.00
16MH18,SUP,Custom 27203010,,16MH18  -  PLATE 18MM TI BONE SPNL,$269.88,$0.00,$269.88,$0.00,$192.61,$0.00,$0.00,$0.00,$0.00,$0.00,$269.88,$0.00,$134.94,$213.74,$215.90,$0.00,$0.00,$0.00,$0.00,$0.00
16MH18L,SUP,Custom 27203010,,16MH18L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$269.88,$0.00,$269.88,$0.00,$192.61,$0.00,$0.00,$0.00,$0.00,$0.00,$269.88,$0.00,$134.94,$213.74,$215.90,$0.00,$0.00,$0.00,$0.00,$0.00
16MH22,SUP,Custom 27203010,,16MH22  -  PLATE 18MM TI BONE SPNL,$269.88,$0.00,$269.88,$0.00,$192.61,$0.00,$0.00,$0.00,$0.00,$0.00,$269.88,$0.00,$134.94,$213.74,$215.90,$0.00,$0.00,$0.00,$0.00,$0.00
16TA11,SUP,Custom 27203010,,16TA11  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$269.88,$0.00,$269.88,$0.00,$192.61,$0.00,$0.00,$0.00,$0.00,$0.00,$269.88,$0.00,$134.94,$213.74,$215.90,$0.00,$0.00,$0.00,$0.00,$0.00
16TA13,SUP,Custom 27203010,,16TA13  -  PLATE 18MM TI BONE SPNL,$269.88,$0.00,$269.88,$0.00,$192.61,$0.00,$0.00,$0.00,$0.00,$0.00,$269.88,$0.00,$134.94,$213.74,$215.90,$0.00,$0.00,$0.00,$0.00,$0.00
16TA15,SUP,Custom 27203010,,16TA15  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$269.88,$0.00,$269.88,$0.00,$192.61,$0.00,$0.00,$0.00,$0.00,$0.00,$269.88,$0.00,$134.94,$213.74,$215.90,$0.00,$0.00,$0.00,$0.00,$0.00
16TA17,SUP,Custom 27203010,,16TA17  -  PLATE 18MM TI BONE SPNL,$269.88,$0.00,$269.88,$0.00,$192.61,$0.00,$0.00,$0.00,$0.00,$0.00,$269.88,$0.00,$134.94,$213.74,$215.90,$0.00,$0.00,$0.00,$0.00,$0.00
16TA23,SUP,Custom 27203010,,16TA23  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$269.88,$0.00,$269.88,$0.00,$192.61,$0.00,$0.00,$0.00,$0.00,$0.00,$269.88,$0.00,$134.94,$213.74,$215.90,$0.00,$0.00,$0.00,$0.00,$0.00
16TA24,SUP,Custom 27203010,,16TA24  -  PLATE 18MM TI BONE SPNL,$269.88,$0.00,$269.88,$0.00,$192.61,$0.00,$0.00,$0.00,$0.00,$0.00,$269.88,$0.00,$134.94,$213.74,$215.90,$0.00,$0.00,$0.00,$0.00,$0.00
17-0000E,SUP,Custom 27803010,,17-0000E  -  SLEEVE ADAPTER V40 TITANIUM ALUM CERAMIC NONSTRL,$112.50,$0.00,$112.50,$0.00,$80.29,$0.00,$0.00,$0.00,$0.00,$0.00,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$0.00,$0.00,$0.00,$0.00
17-001-01,SUP,HCPCS C1713,,17-001-01  -  CLIP ANEURYSM 1 8.5MM OPENING STANDARD 7MM STR SUGITA,"$1,217.50",$0.00,"$1,217.50",$547.88,$868.93,$0.00,$209.77,$0.00,$0.00,$213.17,"$1,217.50",$0.00,$608.75,$964.26,$974.00,$0.00,$190.54,$0.00,$193.83,$0.00
17-001-02,SUP,HCPCS C1713,,17-001-02  -  CLIP ANEURYSM 10.5MM STANDARD 10MM STR SUGITA TITANIUM 2,"$1,217.50",$0.00,"$1,217.50",$547.88,$868.93,$0.00,$209.77,$0.00,$0.00,$213.17,"$1,217.50",$0.00,$608.75,$964.26,$974.00,$0.00,$190.54,$0.00,$193.83,$0.00
17-001-03,SUP,HCPCS C1713,,17-001-03  -  CLIP ANEURYSM 11MM STANDARD 7MM BAYONET SUGITA TITANIUM 2,$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
17-001-04,SUP,HCPCS C1713,,17-001-04  -  CLIP ANEURYSM 9.5MM STANDARD 8MM BENT SUGITA TITANIUM 2,$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
17-001-05,SUP,HCPCS C1713,,17-001-05  -  CLIP ANRSM 8MM SGTA 11MM STD TI 2 SDWRD BNT,$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
17-001-06,SUP,HCPCS C1713,,17-001-06  -  CLIP ANEURYSM 6 10MM OPENING STANDARD 9MM SIDEWARD CVD,$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
17-001-07,SUP,HCPCS C1713,,17-001-07  -  CLIP ANEURYSM 12MM STANDARD 8.5MM SLIGHTLY CVD BAYONET,$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
17-001-08,SUP,HCPCS C1713,,17-001-08  -  CLIP ANRSM 9MM SGTA 9.5MM STD TI 2 CVD NONSTRL,$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
17-001-09,SUP,HCPCS C1713,,17-001-09  -  CLIP ANEURYSM 10MM STANDARD 9MM SLIGHTLY CVD SUGITA TITANIUM,$937.50,$0.00,$937.50,$421.88,$669.09,$0.00,$161.53,$0.00,$0.00,$164.15,$937.50,$0.00,$468.75,$742.50,$750.00,$0.00,$146.72,$0.00,$149.25,$0.00
17-001-10,SUP,HCPCS C1713,,17-001-10  -  CLIP ANEURYSM 11.5MM STANDARD 12MM STR SUGITA TITANIUM 2,$937.50,$0.00,"$1,217.50",$547.88,$868.93,$0.00,$161.53,$0.00,$0.00,$213.17,"$1,217.50",$0.00,$608.75,$742.50,$974.00,$0.00,$146.72,$0.00,$193.83,$0.00
17-001-11,SUP,HCPCS C1713,,17-001-11  -  CLIP ANRSM 12MM SGTA 13.5MM STD TI 2 SDWRD BNT,$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
17-001-13,SUP,HCPCS C1713,,17-001-13  -  CLIP ANEURYSM 13MM STANDARD 10MM BAYONET SUGITA TITANIUM 2,$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
17-001-15,SUP,HCPCS C1713,,17-001-15  -  CLIP ANRSM 15MM SGTA 13.5MM STD TI 2 STR NONSTRL,$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
17-001-18,SUP,HCPCS C1713,,17-001-18  -  CLIP ANRSM 18MM SGTA 15.5MM STD TI 2 STR,$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
17-001-20,SUP,HCPCS C1713,,17-001-20  -  CLIP ANEURYSM 8MM STANDARD 5MM L SUGITA TITANIUM 2 NONSTRL,$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
17-001-23,SUP,HCPCS C1713,,17-001-23  -  CLIP ANRSM 6MM SGTA 9MM STD TI 2 J,$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
17-001-26,SUP,HCPCS C1713,,17-001-26  -  CLIP ANEURYSM 26 11MM OPENING STANDARD STR FENST SUGITA,$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
17-001-27,SUP,HCPCS C1713,,17-001-27  -  CLIP ANRSM 9MM 3.5MM SGTA 13MM STD TI 2 STR FENST,$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
17-001-29,SUP,HCPCS C1713,,17-001-29  -  CLIP ANEURYSM 29 12MM OPENING STANDARD 5MM 6MM STR FENST,$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
17-001-30,SUP,HCPCS C1713,,17-001-30  -  CLIP ANEURYSM 14MM STANDARD 5MM 9MM STR FENST SUGITA,"$1,182.50",$0.00,"$1,182.50",$532.13,$843.95,$0.00,$203.74,$0.00,$0.00,$207.05,"$1,182.50",$0.00,$591.25,$936.54,$946.00,$0.00,$185.06,$0.00,$188.25,$0.00
17-001-31,SUP,HCPCS C1713,,17-001-31  -  CLIP ANEURYSM 15.5MM STANDARD 5MM 12MM STR FENST SUGITA,$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
17-001-35,SUP,HCPCS C1713,,17-001-35  -  CLIP ANRSM 5MM 5MM SGTA 9.5MM STD TI 2 BNT FENST,$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
17-001-36,SUP,HCPCS C1713,,17-001-36  -  CLIP ANRSM 7.5MM 5MM SGTA 10MM STD TI 2 BNT FENST,$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
17-001-37,SUP,HCPCS C1713,,17-001-37  -  CLIP ANRSM 10MM 5MM SGTA 11MM STD TI 2 BNT FENST,$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
17-001-38,SUP,HCPCS C1713,,17-001-38  -  CLIP ANRSM 5MM 3.5MM SGTA 7.5MM STD TI 2 L FENST,$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
17-001-41,SUP,HCPCS C1713,,17-001-41  -  CLIP ANRSM 5MM 5MM SGTA 8.5MM STD TI 2 L FENST,$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
17-001-48,SUP,HCPCS C1713,,17-001-48  -  CLIP ANRSM 7.5MM SGTA 45D 11.5MM STD TI 2 ANG,$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
17-001-50,SUP,HCPCS C1713,,17-001-50  -  CLIP ANEURYSM 13MM STANDARD 14MM CVD SUGITA TITANIUM 2,$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
17-001-51,SUP,HCPCS C1713,,17-001-51  -  CLIP ANEURYSM 9MM STANDARD 7MM STR TEMPORARY SUGITA TITANIUM,"$1,217.50",$0.00,"$1,217.50",$547.88,$868.93,$0.00,$209.77,$0.00,$0.00,$213.17,"$1,217.50",$0.00,$608.75,$964.26,$974.00,$0.00,$190.54,$0.00,$193.83,$0.00
17-001-52,SUP,HCPCS C1713,,17-001-52  -  CLIP ANEURYSM 10.5MM STANDARD 10MM STR TEMPORARY SUGITA,$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
17-001-53,SUP,HCPCS C1713,,17-001-53  -  CLIP ANEURYSM 11.5MM STANDARD 7MM BAYONET TEMPORARY SUGITA,$937.50,$0.00,$937.50,$421.88,$669.09,$0.00,$161.53,$0.00,$0.00,$164.15,$937.50,$0.00,$468.75,$742.50,$750.00,$0.00,$146.72,$0.00,$149.25,$0.00
17-001-54,SUP,HCPCS C1713,,17-001-54  -  CLIP ANRSM 8MM SGTA 9.5MM STD TI 2 BNT TEMP,$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
17-001-55,SUP,HCPCS C1713,,17-001-55  -  CLIP ANRSM 11MM SGTA 11MM STD TI 2 SLT CVD TEMP,$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
17-001-56,SUP,HCPCS C1713,,17-001-56  -  CLIP ANEURYSM 56 7MM MINI STR 6MM TEMPORARY WIDE OPENING,"$1,217.50",$0.00,"$1,217.50",$547.88,$868.93,$0.00,$209.77,$0.00,$0.00,$213.17,"$1,217.50",$0.00,$608.75,$964.26,$974.00,$0.00,$190.54,$0.00,$193.83,$0.00
17-001-57,SUP,HCPCS C1713,,17-001-57  -  CLIP ANEURYSM 7MM MINI 5MM BENT TEMPORARY SUGITA TITANIUM 2,$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
17-001-58,SUP,HCPCS C1713,,17-001-58  -  CLIP ANEURYSM 7MM MINI 6MM STR TEMPORARY SLIM TIP SUGITA,"$1,217.50",$0.00,"$1,217.50",$547.88,$868.93,$0.00,$209.77,$0.00,$0.00,$213.17,"$1,217.50",$0.00,$608.75,$964.26,$974.00,$0.00,$190.54,$0.00,$193.83,$0.00
17-001-64,SUP,HCPCS C1713,,17-001-64  -  CLIP ANRSM 8MM SGTA 10.5MM STD TI 2 SLT BNT,"$1,182.50",$0.00,"$1,182.50",$532.13,$843.95,$0.00,$203.74,$0.00,$0.00,$207.05,"$1,182.50",$0.00,$591.25,$936.54,$946.00,$0.00,$185.06,$0.00,$188.25,$0.00
17-001-65,SUP,HCPCS C1713,,17-001-65  -  CLIP ANEURYSM 11MM STANDARD 11MM SLIGHTLY CVD SUGITA,$937.50,$0.00,$937.50,$421.88,$669.09,$0.00,$161.53,$0.00,$0.00,$164.15,$937.50,$0.00,$468.75,$742.50,$750.00,$0.00,$146.72,$0.00,$149.25,$0.00
17-001-66,SUP,HCPCS C1713,,17-001-66  -  CLIP ANRSM 11MM SGTA 11MM STD TI 2 CVD NONSTRL,$937.50,$0.00,$937.50,$421.88,$669.09,$0.00,$161.53,$0.00,$0.00,$164.15,$937.50,$0.00,$468.75,$742.50,$750.00,$0.00,$146.72,$0.00,$149.25,$0.00
17-001-68,SUP,HCPCS C1713,,17-001-68  -  CLIP ANEURYSM 10MM STANDARD 9MM SLIGHTLY CVD SUGITA TITANIUM,$937.50,$0.00,$937.50,$421.88,$669.09,$0.00,$161.53,$0.00,$0.00,$164.15,$937.50,$0.00,$468.75,$742.50,$750.00,$0.00,$146.72,$0.00,$149.25,$0.00
17-001-69,SUP,HCPCS C1713,,17-001-69  -  CLIP ANRSM 9MM SGTA 69 9.5MM OPN STD TI 2 CVD,"$1,217.50",$0.00,"$1,217.50",$547.88,$868.93,$0.00,$209.77,$0.00,$0.00,$213.17,"$1,217.50",$0.00,$608.75,$964.26,$974.00,$0.00,$190.54,$0.00,$193.83,$0.00
17-001-72,SUP,HCPCS C1713,,17-001-72  -  TII 18.0 STRAIGHT 25MM,$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
17-001-76,SUP,HCPCS C1713,,17-001-76  -  CLIP ANRSM 10MM 5MM 8.5MM STD LEFT TI 2 L FENST,$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
17-001-79,SUP,HCPCS C1713,,17-001-79  -  CLIP ANRSM 10MM 5MM 8.5MM STD RIGHT TI 2 L FENST,$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
17-001-80,SUP,HCPCS C1713,,17-001-80  -  CLIP ANEURYSM 5.5MM MINI 4MM STR SUGITA TITANIUM 2 NONSTRL,"$1,217.50",$0.00,"$1,217.50",$547.88,$868.93,$0.00,$209.77,$0.00,$0.00,$213.17,"$1,217.50",$0.00,$608.75,$964.26,$974.00,$0.00,$190.54,$0.00,$193.83,$0.00
17-001-81,SUP,HCPCS C1713,,17-001-81  -  CLIP ANEURYSM 7MM MINI 6MM STR SUGITA TITANIUM 2 NONSTRL,"$1,217.50",$0.00,"$1,217.50",$547.88,$868.93,$0.00,$209.77,$0.00,$0.00,$213.17,"$1,217.50",$0.00,$608.75,$964.26,$974.00,$0.00,$190.54,$0.00,$193.83,$0.00
17-001-83,SUP,HCPCS C1713,,17-001-83  -  CLIP ANRSM 5MM SGTA 6.5MM MINI TI 2 CVD NONSTRL,$937.50,$0.00,$937.50,$421.88,$669.09,$0.00,$161.53,$0.00,$0.00,$164.15,$937.50,$0.00,$468.75,$742.50,$750.00,$0.00,$146.72,$0.00,$149.25,$0.00
17-001-84,SUP,HCPCS C1713,,17-001-84  -  CLIP ANEURYSM 7MM MINI 5MM BENT SUGITA TITANIUM 2 NONSTRL,$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
17-001-85,SUP,HCPCS C1713,,17-001-85  -  CLIP ANRSM 4MM SGTA 5.5MM MINI TI 2 CVD NONSTRL,$937.50,$0.00,$937.50,$421.88,$669.09,$0.00,$161.53,$0.00,$0.00,$164.15,$937.50,$0.00,$468.75,$742.50,$750.00,$0.00,$146.72,$0.00,$149.25,$0.00
17-001-86,SUP,HCPCS C1713,,17-001-86  -  CLIP ANRSM 7MM SGTA 7.5MM MINI TI 2 SDWRD CVD,$937.50,$0.00,$937.50,$421.88,$669.09,$0.00,$161.53,$0.00,$0.00,$164.15,$937.50,$0.00,$468.75,$742.50,$750.00,$0.00,$146.72,$0.00,$149.25,$0.00
17-001-88,SUP,HCPCS C1713,,17-001-88  -  CLIP ANEURYSM 7.5MM MINI 7MM CVD SUGITA TITANIUM 2 NONSTRL,$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
17-001-89,SUP,HCPCS C1713,,17-001-89  -  CLIP ANRSM 5MM SGTA 89 8.5MM OPN MINI TI 2 BYNT,$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
17-001-90,SUP,HCPCS C1713,,17-001-90  -  T2 20.5 STRAIGHT 30MM,"$1,740.05",$0.00,"$1,740.05",$783.02,"$1,241.87",$0.00,$299.80,$0.00,$0.00,$304.67,"$1,740.05",$0.00,$870.03,"$1,378.12","$1,392.04",$0.00,$272.32,$0.00,$277.02,$0.00
17-001-91,SUP,HCPCS C1713,,17-001-91  -  T2 23.5 STRAIGHT 35MM,"$1,740.05",$0.00,"$1,740.05",$783.02,"$1,241.87",$0.00,$299.80,$0.00,$0.00,$304.67,"$1,740.05",$0.00,$870.03,"$1,378.12","$1,392.04",$0.00,$272.32,$0.00,$277.02,$0.00
17-001-92,SUP,HCPCS C1713,,17-001-92  -  CLIP ANRSM 92 26MM OPN LNG STRG 40MM TI 2,"$1,740.05",$0.00,"$1,740.05",$783.02,"$1,241.87",$0.00,$299.80,$0.00,$0.00,$304.67,"$1,740.05",$0.00,$870.03,"$1,378.12","$1,392.04",$0.00,$272.32,$0.00,$277.02,$0.00
17-001-95,SUP,HCPCS C1713,,17-001-95  -  CLIP ANEURYSM 5.5MM MINI 4MM STR SLIM TIP SUGITA TITANIUM 2,"$1,182.50",$0.00,"$1,182.50",$532.13,$843.95,$0.00,$203.74,$0.00,$0.00,$207.05,"$1,182.50",$0.00,$591.25,$936.54,$946.00,$0.00,$185.06,$0.00,$188.25,$0.00
17-001-96,SUP,HCPCS C1713,,17-001-96  -  CLIP ANEURYSM 7MM MINI 6MM STR SLIM TIP SUGITA TITANIUM 2,"$1,217.50",$0.00,"$1,217.50",$547.88,$868.93,$0.00,$209.77,$0.00,$0.00,$213.17,"$1,217.50",$0.00,$608.75,$964.26,$974.00,$0.00,$190.54,$0.00,$193.83,$0.00
17-001-97,SUP,HCPCS C1713,,17-001-97  -  CLIP ANRSM 6.7MM SGTA 7MM MINI TI 2 CVD SLIM TIP,$937.50,$0.00,$937.50,$421.88,$669.09,$0.00,$161.53,$0.00,$0.00,$164.15,$937.50,$0.00,$468.75,$742.50,$750.00,$0.00,$146.72,$0.00,$149.25,$0.00
17-001-99,SUP,HCPCS C1713,,17-001-99  -  CLIP ANRSM 5.2MM SGTA 6.5MM MINI TI 2 CVD SLIM TIP,$937.50,$0.00,$937.50,$421.88,$669.09,$0.00,$161.53,$0.00,$0.00,$164.15,$937.50,$0.00,$468.75,$742.50,$750.00,$0.00,$146.72,$0.00,$149.25,$0.00
17-002-03,SUP,HCPCS C1713,,17-002-03  -  CLIP ANRSM 10 T2 STD TLL 4MM SGTA CRANK SHFT TI,$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
17-002-05,SUP,HCPCS C1713,,17-002-05  -  CLIP ANRSM 12MM 5MM HEAD STRNG 7.5MM STD TI 2,$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
17-002-15,SUP,HCPCS C1713,,17-002-15  -  CLIP ANEURYSM 8MM MINI 8MM STR SUGITA TITANIUM 2,$937.50,$0.00,"$1,217.50",$547.88,$868.93,$0.00,$161.53,$0.00,$0.00,$213.17,"$1,217.50",$0.00,$608.75,$742.50,$974.00,$0.00,$146.72,$0.00,$193.83,$0.00
17-002-16,SUP,HCPCS C1713,,17-002-16  -  CLIP ANRSM 6.5MM SGTA 7MM MINI TI 2 CVD,$937.50,$0.00,$937.50,$421.88,$669.09,$0.00,$161.53,$0.00,$0.00,$164.15,$937.50,$0.00,$468.75,$742.50,$750.00,$0.00,$146.72,$0.00,$149.25,$0.00
17-002-17,SUP,HCPCS C1713,,17-002-17  -  CLIP ANRSM 5.5MM SGTA 6.5MM MINI TI 2 SLT CVD,$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
17-002-19,SUP,Custom 27011340,,17-002-19  -  CLIP ANRSM 6MM SGTA 8.5MM MINI TI 2 SDWRD BNT,"$1,182.50",$0.00,"$1,182.50",$0.00,$843.95,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,182.50",$0.00,$591.25,$936.54,$946.00,$0.00,$0.00,$0.00,$0.00,$0.00
17-002-20,SUP,HCPCS C1713,,17-002-20  -  CLIP ANRSM 7MM SGTA 10MM MINI TI 2 BYNT,$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
17-002-21,SUP,HCPCS C1713,,17-002-21  -  CLIP ANRSM 5.5MM SGTA 6.5MM MINI TI 2 CVD SLIM TIP,$937.50,$0.00,$937.50,$421.88,$669.09,$0.00,$161.53,$0.00,$0.00,$164.15,$937.50,$0.00,$468.75,$742.50,$750.00,$0.00,$146.72,$0.00,$149.25,$0.00
170-03-25008,SUP,HCPCS C1874,,170-03-25008  -  SYSTEM COR STNT 2.5MM 8MM CBR PZF RX DLV SYS POLYZENE-F COCR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
170-03-25012,SUP,HCPCS C1874,,170-03-25012  -  SYSTEM COR STNT 2.5MM 12MM CBR PZF RX DLV SYS POLYZENE-F,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
170-03-25015,SUP,HCPCS C1874,,170-03-25015  -  SYSTEM COR STNT 2.5MM 15MM CBR PZF RX DLV SYS POLYZENE-F,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
170-03-25018,SUP,HCPCS C1874,,170-03-25018  -  SYSTEM COR STNT 2.5MM 18MM CBR PZF RX DLV SYS POLYZENE-F,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
170-03-25024,SUP,HCPCS C1874,,170-03-25024  -  SYSTEM COR STNT 2.5MM 24MM CBR PZF RX DLV SYS POLYZENE-F,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
170-03-25030,SUP,HCPCS C1874,,170-03-25030  -  SYSTEM COR STNT 2.5MM 30MM CBR PZF RX DLV SYS POLYZENE-F,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
170-03-27508,SUP,HCPCS C1874,,170-03-27508  -  SYSTEM COR STNT 2.75MM 8MM CBR PZF RX DLV SYS POLYZENE-F,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
170-03-27512,SUP,HCPCS C1874,,170-03-27512  -  SYSTEM COR STNT 2.75MM 12MM CBR PZF RX DLV SYS POLYZENE-F,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
170-03-27515,SUP,HCPCS C1874,,170-03-27515  -  SYSTEM COR STNT 2.75MM 15MM CBR PZF RX DLV SYS POLYZENE-F,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
170-03-27518,SUP,HCPCS C1874,,170-03-27518  -  SYSTEM COR STNT 2.75MM 18MM CBR PZF RX DLV SYS POLYZENE-F,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
170-03-27524,SUP,HCPCS C1874,,170-03-27524  -  SYSTEM COR STNT 2.75MM 24MM CBR PZF RX DLV SYS POLYZENE-F,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
170-03-27530,SUP,HCPCS C1874,,170-03-27530  -  SYSTEM COR STNT 2.75MM 30MM CBR PZF RX DLV SYS POLYZENE-F,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
170-03-30008,SUP,HCPCS C1874,,170-03-30008  -  SYSTEM COR STNT 3MM 8MM CBR PZF RX DLV SYS POLYZENE-F COCR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
170-03-30012,SUP,HCPCS C1874,,170-03-30012  -  SYSTEM COR STNT 3MM 12MM CBR PZF RX DLV SYS POLYZENE-F COCR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
170-03-30015,SUP,HCPCS C1874,,170-03-30015  -  SYSTEM COR STNT 3MM 15MM CBR PZF RX DLV SYS POLYZENE-F COCR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
170-03-30018,SUP,HCPCS C1874,,170-03-30018  -  SYSTEM COR STNT 3MM 18MM CBR PZF RX DLV SYS POLYZENE-F COCR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
170-03-30024,SUP,HCPCS C1874,,170-03-30024  -  SYSTEM COR STNT 3MM 24MM CBR PZF RX DLV SYS POLYZENE-F COCR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
170-03-30030,SUP,HCPCS C1874,,170-03-30030  -  SYSTEM COR STNT 3MM 30MM CBR PZF RX DLV SYS POLYZENE-F COCR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
170-03-35008,SUP,HCPCS C1874,,170-03-35008  -  SYSTEM COR STNT 3.5MM 8MM CBR PZF RX DLV SYS POLYZENE-F COCR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
170-03-35012,SUP,HCPCS C1874,,170-03-35012  -  SYSTEM COR STNT 3.5MM 12MM CBR PZF RX DLV SYS POLYZENE-F,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
170-03-35015,SUP,HCPCS C1876,,170-03-35015  -  SYSTEM COR STNT 3.5MM 15MM CBR PZF RX DLV SYS POLYZENE-F,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
170-03-35018,SUP,HCPCS C1876,,170-03-35018  -  SYSTEM COR STNT 3.5MM 18MM CBR PZF RX DLV SYS POLYZENE-F,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
170-03-35024,SUP,HCPCS C1874,,170-03-35024  -  SYSTEM COR STNT 3.5MM 24MM CBR PZF RX DLV SYS POLYZENE-F,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
170-03-35030,SUP,HCPCS C1874,,170-03-35030  -  SYSTEM COR STNT 3.5MM 30MM CBR PZF RX DLV SYS POLYZENE-F,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
170-03-40008,SUP,HCPCS C1874,,170-03-40008  -  SYSTEM COR STNT 4MM 8MM CBR PZF RX DLV SYS POLYZENE-F COCR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
170-03-40012,SUP,HCPCS C1874,,170-03-40012  -  SYSTEM COR STNT 4MM 12MM CBR PZF RX DLV SYS POLYZENE-F COCR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
170-03-40015,SUP,HCPCS C1874,,170-03-40015  -  SYSTEM COR STNT 4MM 15MM CBR PZF RX DLV SYS POLYZENE-F COCR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
170-03-40018,SUP,HCPCS C1874,,170-03-40018  -  SYSTEM COR STNT 4MM 18MM CBR PZF RX DLV SYS POLYZENE-F COCR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
170-03-40024,SUP,HCPCS C1874,,170-03-40024  -  SYSTEM COR STNT 4MM 24MM CBR PZF RX DLV SYS POLYZENE-F COCR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
170-03-40030,SUP,HCPCS C1874,,170-03-40030  -  SYSTEM COR STNT 4MM 30MM CBR PZF RX DLV SYS POLYZENE-F COCR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
17-006-03,SUP,HCPCS C1713,,17-006-03  -  CLIP ANRSM 11 T2 STD L 5MM SGTA WDW TI,"$1,302.30",$0.00,"$1,302.30",$586.04,$929.45,$0.00,$224.38,$0.00,$0.00,$228.02,"$1,302.30",$0.00,$651.15,"$1,031.42","$1,041.84",$0.00,$203.81,$0.00,$207.33,$0.00
17-006-36,SUP,HCPCS C1713,,17-006-36  -  CLIP ANRSM 142 006-36 STD BNT 5MM 3MM FENESTRATE TI,$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
17-006-39,SUP,HCPCS C1713,,17-006-39  -  CLIP ANRSM STRG 3.5MM 4MM SGTA T2 FENESTRATE TI,"$1,217.50",$0.00,"$1,217.50",$547.88,$868.93,$0.00,$209.77,$0.00,$0.00,$213.17,"$1,217.50",$0.00,$608.75,$964.26,$974.00,$0.00,$190.54,$0.00,$193.83,$0.00
17-006-40,SUP,HCPCS C1713,,17-006-40  -  CLIP ANRSM STRG 5MM 4MM SGTA T2 FENESTRATE TI,$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
1714G,SUP,Custom 27203010,,1714G  -  SUTURE NONABSORBABLE 8-0 TG100-8 12IN 2 ARM MONOFILAMENT,$33.98,$0.00,$33.98,$0.00,$24.25,$0.00,$0.00,$0.00,$0.00,$0.00,$33.98,$0.00,$16.99,$26.91,$27.18,$0.00,$0.00,$0.00,$0.00,$0.00
1716G,SUP,Custom 27203010,,1716G  -  SUTURE NONABSORBABLE 8-0 TG175-8 12IN 2 ARM MONOFILAMENT,$34.11,$0.00,$34.11,$0.00,$24.35,$0.00,$0.00,$0.00,$0.00,$0.00,$34.11,$0.00,$17.06,$27.02,$27.29,$0.00,$0.00,$0.00,$0.00,$0.00
17200D600,SUP,Custom 27203010,,17200D600  -  PUNCH SURG 6MM CORNEUM 2 PC VAC UL SHRP BLADE SPRG,$187.50,$0.00,$187.50,$0.00,$133.82,$0.00,$0.00,$0.00,$0.00,$0.00,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$0.00,$0.00,$0.00,$0.00
17200D650,SUP,Custom 27203010,,17200D650  -  PUNCH SURG 6.5MM CORNEUM 2 PC VAC UL SHRP BLADE,$187.50,$0.00,$187.50,$0.00,$133.82,$0.00,$0.00,$0.00,$0.00,$0.00,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$0.00,$0.00,$0.00,$0.00
17200D700,SUP,Custom 27203010,,17200D700  -  PUNCH SURG 7MM CORNEUM 2 PC VAC UL SHRP BLADE SPRG,$187.50,$0.00,$187.50,$0.00,$133.82,$0.00,$0.00,$0.00,$0.00,$0.00,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$0.00,$0.00,$0.00,$0.00
17200D725,SUP,Custom 27203010,,17200D725  -  PUNCH SURG 7.25MM CORNEUM 2 PC VAC UL SHRP BLADE,$187.50,$0.00,$187.50,$0.00,$133.82,$0.00,$0.00,$0.00,$0.00,$0.00,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$0.00,$0.00,$0.00,$0.00
17200D750,SUP,Custom 27203010,,17200D750  -  PUNCH SURG 7.5MM CORNEUM 2 PC VAC UL SHRP BLADE,$187.50,$0.00,$187.50,$0.00,$133.82,$0.00,$0.00,$0.00,$0.00,$0.00,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$0.00,$0.00,$0.00,$0.00
17200D775,SUP,Custom 27203010,,17200D775  -  PUNCH SURG 7.75MM CORNEUM 2 PC VAC UL SHRP BLADE,$187.50,$0.00,$187.50,$0.00,$133.82,$0.00,$0.00,$0.00,$0.00,$0.00,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$0.00,$0.00,$0.00,$0.00
17200D800,SUP,Custom 27203010,,17200D800  -  PUNCH SURG 8MM CORNEUM 2 PC VAC UL SHRP BLADE SPRG,$187.50,$0.00,$187.50,$0.00,$133.82,$0.00,$0.00,$0.00,$0.00,$0.00,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$0.00,$0.00,$0.00,$0.00
17200D825,SUP,Custom 27203010,,17200D825  -  PUNCH SURG 8.25MM CORNEUM 2 PC VAC UL SHRP BLADE,$187.50,$0.00,$187.50,$0.00,$133.82,$0.00,$0.00,$0.00,$0.00,$0.00,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$0.00,$0.00,$0.00,$0.00
17200D850,SUP,Custom 27203010,,17200D850  -  PUNCH SURG 8.5MM CORNEUM 2 PC VAC UL SHRP BLADE,$187.50,$0.00,$187.50,$0.00,$133.82,$0.00,$0.00,$0.00,$0.00,$0.00,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$0.00,$0.00,$0.00,$0.00
17200D875,SUP,Custom 27203010,,17200D875  -  PUNCH SURG 8.75MM CORNEUM 2 PC VAC UL SHRP BLADE,$187.50,$0.00,$187.50,$0.00,$133.82,$0.00,$0.00,$0.00,$0.00,$0.00,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$0.00,$0.00,$0.00,$0.00
17200D900,SUP,Custom 27203010,,17200D900  -  PUNCH SURG 9MM CORNEUM 2 PC VAC UL SHRP BLADE SPRG,$187.50,$0.00,$187.50,$0.00,$133.82,$0.00,$0.00,$0.00,$0.00,$0.00,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$0.00,$0.00,$0.00,$0.00
17200D950,SUP,Custom 27203010,,17200D950  -  PUNCH SURG 9.5MM CORNEUM 2 PC VAC UL SHRP BLADE,$187.50,$0.00,$187.50,$0.00,$133.82,$0.00,$0.00,$0.00,$0.00,$0.00,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$0.00,$0.00,$0.00,$0.00
1722G,SUP,Custom 27203010,,1722G  -  SUTURE MERS 6-0 S-14 18IN WVN TPE BRAID DBL ARM WHT NABSB,$33.57,$0.00,$33.57,$0.00,$23.96,$0.00,$0.00,$0.00,$0.00,$0.00,$33.57,$0.00,$16.78,$26.59,$26.85,$0.00,$0.00,$0.00,$0.00,$0.00
17-2800E,SUP,Custom 27803010,,17-2800E  -  HEAD FEMORAL C TAPER ALUM HIP,"$1,725.00",$0.00,"$1,725.00",$0.00,"$1,231.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$0.00,$0.00,$0.00,$0.00
17-2805E,SUP,Custom 27803010,,17-2805E  -  HEAD FEMORAL +5MM 28MM C TAPER ALUM HIP,"$1,725.00",$0.00,"$1,725.00",$0.00,"$1,231.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$0.00,$0.00,$0.00,$0.00
17-28-3E,SUP,Custom 27803010,,17-28-3E  -  HEAD FEMORAL +3MM 28MM C TAPER ALUM HIP,"$1,725.00",$0.00,"$1,725.00",$0.00,"$1,231.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$0.00,$0.00,$0.00,$0.00
173050G,SUP,Custom 27203010,,173050G  -  POUCH SPECIMEN RETRIEVAL 10MM 34.5CM MINIMIZE SPILLAGE,$150.17,$0.00,$150.17,$0.00,$107.18,$0.00,$0.00,$0.00,$0.00,$0.00,$150.17,$0.00,$75.08,$118.93,$120.14,$0.00,$0.00,$0.00,$0.00,$0.00
17-3200E,SUP,Custom 27803010,,17-3200E  -  HEAD FEM +0MM OFST CTPR 32MM STRL AL CERM HIP,"$1,725.00",$0.00,"$1,725.00",$0.00,"$1,231.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$0.00,$0.00,$0.00,$0.00
17-3205E,SUP,Custom 27803010,,17-3205E  -  HEAD FEMORAL +5MM 32MM C TAPER ALUM HIP,"$1,725.00",$0.00,"$1,725.00",$0.00,"$1,231.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$0.00,$0.00,$0.00,$0.00
17-32-3E,SUP,Custom 27803010,,17-32-3E  -  HEAD FEM -2.5MM CTPR 32MM STRL AL CERM HIP,"$1,725.00",$0.00,"$1,725.00",$0.00,"$1,231.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$0.00,$0.00,$0.00,$0.00
1735G,SUP,Custom 27203010,,1735G  -  SUTURE ABSORBABLE 6-0 TG140-8 18IN 2 ARM MONOFILAMENT,$56.56,$0.00,$56.56,$0.00,$40.37,$0.00,$0.00,$0.00,$0.00,$0.00,$56.56,$0.00,$28.28,$44.80,$45.25,$0.00,$0.00,$0.00,$0.00,$0.00
17-3600E,SUP,Custom 27803010,,17-3600E  -  HEAD FEM +0MM OFST CTPR 36MM STRL AL CERM HIP,"$1,725.00",$0.00,"$1,725.00",$0.00,"$1,231.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$0.00,$0.00,$0.00,$0.00
17-3605E,SUP,Custom 27803010,,17-3605E  -  HEAD FEMORAL +5MM 36MM C TAPER ALUM HIP,"$1,725.00",$0.00,"$1,725.00",$0.00,"$1,231.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$0.00,$0.00,$0.00,$0.00
17-36-5E,SUP,HCPCS C1713,,17-36-5E  -  HEAD FEMORAL -5MM C-TAPER 36MM OFFST ALUM HIP,"$1,725.00",$0.00,"$1,725.00",$776.25,"$1,231.13",$0.00,$297.21,$0.00,$0.00,$302.03,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$269.96,$0.00,$274.62,$0.00
174105-2,SUP,Custom 27203010,,174105-2  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
175031EN,SUP,Custom 27203010,,175031EN  -  PLATE 18MM TI BONE SPNL,$24.00,$0.00,$24.00,$0.00,$17.13,$0.00,$0.00,$0.00,$0.00,$0.00,$24.00,$0.00,$12.00,$19.01,$19.20,$0.00,$0.00,$0.00,$0.00,$0.00
1754G,SUP,Custom 27203010,,1754G  -  SUTURE NONABSORBABLE 9-0 TG140-8 6IN 2 ARM MONOFILAMENT,$42.02,$0.00,$42.02,$0.00,$29.99,$0.00,$0.00,$0.00,$0.00,$0.00,$42.02,$0.00,$21.01,$33.28,$33.62,$0.00,$0.00,$0.00,$0.00,$0.00
1758SI16,SUP,Custom 27203010,,1758SI16  -  CATHETER URTH 16FR 5CC STRL LF BARD LBRSL IC 2W FL BLN,$1.00,$0.00,$1.00,$0.00,$0.71,$0.00,$0.00,$0.00,$0.00,$0.00,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.00,$0.00,$0.00,$0.00
1762G,SUP,Custom 27203010,,1762G  -  SUTURE NONABSORBABLE 4-0 S-24 18IN MONOFILAMENT PLIABILIZE,$37.83,$0.00,$37.83,$0.00,$27.00,$0.00,$0.00,$0.00,$0.00,$0.00,$37.83,$0.00,$18.91,$29.96,$30.26,$0.00,$0.00,$0.00,$0.00,$0.00
1764G,SUP,Custom 27203010,,1764G  -  SUTURE NABSB 5-0 S-24 18IN WHT MERS SABRELOC 2 ARM BRD,$37.45,$0.00,$37.45,$0.00,$26.73,$0.00,$0.00,$0.00,$0.00,$0.00,$37.45,$0.00,$18.73,$29.66,$29.96,$0.00,$0.00,$0.00,$0.00,$0.00
1773.00.126,SUP,HCPCS C1713,,1773.00.126  -  CAGE SPNL 12MM STD PRLL 14X26MM NS LF BENGAL STKBL RDLCNT,"$8,790.00",$0.00,"$8,790.00","$3,955.50","$5,158.80",$0.00,"$1,514.47",$0.00,$0.00,"$1,539.06","$8,790.00",$0.00,"$4,395.00","$6,961.68","$7,032.00",$0.00,"$1,375.64",$0.00,"$1,399.37",$0.00
1779G,SUP,Custom 27203010,,1779G  -  SUTURE NONABSORBABLE 4-0 S-2 18IN MONOFILAMENT PLIABILIZE,$33.94,$0.00,$33.94,$0.00,$24.22,$0.00,$0.00,$0.00,$0.00,$0.00,$33.94,$0.00,$16.97,$26.88,$27.15,$0.00,$0.00,$0.00,$0.00,$0.00
179071P,SUP,Custom 27203010,,179071P  -  TROCAR LAPSCOP 100MM 5-12MM VPRT+ RPF BLADED CNVTRLS RDLCNT,$128.52,$0.00,$128.52,$0.00,$91.72,$0.00,$0.00,$0.00,$0.00,$0.00,$128.52,$0.00,$64.26,$101.79,$102.81,$0.00,$0.00,$0.00,$0.00,$0.00
179075P,SUP,Custom 27203010,,179075P  -  TROCAR LAPSCOP 5-12MM BLNTPRT PLUS VRSPRT SLV CNVTRLS STAB,$35.84,$0.00,$35.84,$0.00,$25.58,$0.00,$0.00,$0.00,$0.00,$0.00,$35.84,$0.00,$17.92,$28.39,$28.67,$0.00,$0.00,$0.00,$0.00,$0.00
179078P,SUP,Custom 27203010,,179078P  -  TROCAR LAPSCOP PYRAMID 10-15MM 100MM 5MM SAFETY SHIELD SELF,$120.15,$0.00,$120.15,$0.00,$85.75,$0.00,$0.00,$0.00,$0.00,$0.00,$120.15,$0.00,$60.08,$95.16,$96.12,$0.00,$0.00,$0.00,$0.00,$0.00
179094F,SUP,Custom 27203010,,179094F  -  TROCAR LAPSCP 5MM LVN VPRT+ V2 VERSASEAL + FX CNN CNVTRLS,$73.95,$0.00,$73.95,$0.00,$52.78,$0.00,$0.00,$0.00,$0.00,$0.00,$73.95,$0.00,$36.98,$58.57,$59.16,$0.00,$0.00,$0.00,$0.00,$0.00
179096PF,SUP,Custom 27203010,,179096PF  -  TROCAR LAPSCOP 12MM VPRT+ V2 BLADED FIX CANNU STRL DISP,$123.01,$0.00,$123.01,$0.00,$87.79,$0.00,$0.00,$0.00,$0.00,$0.00,$123.01,$0.00,$61.51,$97.42,$98.41,$0.00,$0.00,$0.00,$0.00,$0.00
179097P,SUP,Custom 27203010,,179097P  -  TROCAR LAPSCOP LONG 5-12MM 150MM SHARP LINEAR BLADE SPRING,$85.00,$0.00,$85.00,$0.00,$60.66,$0.00,$0.00,$0.00,$0.00,$0.00,$85.00,$0.00,$42.50,$67.32,$68.00,$0.00,$0.00,$0.00,$0.00,$0.00
1797.12.765,SUP,HCPCS C1713,,1797.12.765  -  SCREW BONE 7MM 65MM 1 INNIE POLYAX EXPEDIUM TITANIUM SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
1797.71.150,SUP,HCPCS C1713,,1797.71.150  -  ROD SPNL PREBNT 5.5MM 150MM NS XPDM LN TI,$937.50,$0.00,$937.50,$421.88,$669.09,$0.00,$161.53,$0.00,$0.00,$164.15,$937.50,$0.00,$468.75,$742.50,$750.00,$0.00,$146.72,$0.00,$149.25,$0.00
1797.71.555,SUP,HCPCS C1713,,1797.71.555  -  CONNECTOR ROD 5.5MM TOP NOTCH OUTER TO OUTER SIDE SPN,"$2,752.50",$0.00,"$2,752.50","$1,238.63","$1,964.46",$0.00,$474.24,$0.00,$0.00,$481.94,"$2,752.50",$0.00,"$1,376.25","$2,179.98","$2,202.00",$0.00,$430.77,$0.00,$438.20,$0.00
1797G,SUP,Custom 27203010,,1797G  -  SUTURE ABSORBABLE 7-0 TG140-8 18IN 2 ARM MONOFILAMENT,$68.03,$0.00,$68.03,$0.00,$48.55,$0.00,$0.00,$0.00,$0.00,$0.00,$68.03,$0.00,$34.01,$53.88,$54.42,$0.00,$0.00,$0.00,$0.00,$0.00
180204HC-S-V,SUP,HCPCS C1884,,COIL MICROPLEX 18SOFT 2MM X 4CM,$12.50,$0.00,$12.50,$5.63,$8.92,$0.00,$2.15,$0.00,$0.00,$2.19,$12.50,$0.00,$6.25,$9.90,$10.00,$0.00,$1.96,$0.00,$1.99,$0.00
180208HC-S-V,SUP,HCPCS C1884,,COIL MICROPLEX 18SOFT 2MM X 8CM,$12.50,$0.00,$12.50,$5.63,$8.92,$0.00,$2.15,$0.00,$0.00,$2.19,$12.50,$0.00,$6.25,$9.90,$10.00,$0.00,$1.96,$0.00,$1.99,$0.00
180308HC-S-V,SUP,HCPCS C1884,,COIL MICROPLEX 18SOFT 3MM X 8CM,$12.50,$0.00,$12.50,$5.63,$8.92,$0.00,$2.15,$0.00,$0.00,$2.19,$12.50,$0.00,$6.25,$9.90,$10.00,$0.00,$1.96,$0.00,$1.99,$0.00
180320-1,SUP,HCPCS C1776,,180320-1  -  COMPONENT PTLR RND 26MM RSRFC KN MCK SYS,"$2,192.50",$0.00,"$2,192.50",$986.63,"$1,564.79",$0.00,$377.76,$0.00,$0.00,$383.89,"$2,192.50",$0.00,"$1,096.25","$1,736.46","$1,754.00",$0.00,$343.13,$0.00,$349.05,$0.00
180320-2,SUP,HCPCS C1776,,180320-2  -  COMPONENT PTLR RND 29MM RSRFC KN MCK SYS,"$2,192.50",$0.00,"$2,192.50",$986.63,"$1,564.79",$0.00,$377.76,$0.00,$0.00,$383.89,"$2,192.50",$0.00,"$1,096.25","$1,736.46","$1,754.00",$0.00,$343.13,$0.00,$349.05,$0.00
180320-3,SUP,HCPCS C1776,,180320-3  -  COMPONENT PTLR RND 32MM RSRFC KN MCK SYS,"$2,192.50",$0.00,"$2,192.50",$986.63,"$1,564.79",$0.00,$377.76,$0.00,$0.00,$383.89,"$2,192.50",$0.00,"$1,096.25","$1,736.46","$1,754.00",$0.00,$343.13,$0.00,$349.05,$0.00
180320-4,SUP,HCPCS C1776,,180320-4  -  DOME PTLR RND 35MM RSRFC KN MCK SYS,"$2,192.50",$0.00,"$2,192.50",$986.63,"$1,564.79",$0.00,$377.76,$0.00,$0.00,$383.89,"$2,192.50",$0.00,"$1,096.25","$1,736.46","$1,754.00",$0.00,$343.13,$0.00,$349.05,$0.00
180320-6,SUP,HCPCS C1776,,180320-6  -  DOME PTLR RND 41MM RSRFC KN MCK SYS,"$2,192.50",$0.00,"$2,192.50",$986.63,"$1,564.79",$0.00,$377.76,$0.00,$0.00,$383.89,"$2,192.50",$0.00,"$1,096.25","$1,736.46","$1,754.00",$0.00,$343.13,$0.00,$349.05,$0.00
180406HC-S-V,SUP,HCPCS C1884,,COIL MICROPLEX 18SOFT 4MM X 6CM,$12.50,$0.00,$12.50,$5.63,$8.92,$0.00,$2.15,$0.00,$0.00,$2.19,$12.50,$0.00,$6.25,$9.90,$10.00,$0.00,$1.96,$0.00,$1.99,$0.00
180512HC-S-V,SUP,HCPCS C1884,,COIL MICROPLEX 18SOFT 5MM X 12CM,$12.50,$0.00,$12.50,$5.63,$8.92,$0.00,$2.15,$0.00,$0.00,$2.19,$12.50,$0.00,$6.25,$9.90,$10.00,$0.00,$1.96,$0.00,$1.99,$0.00
180520HC-R-V,SUP,HCPCS C1884,,COIL MICROPLEX 18REG 5MM X 20CM,"$1,536.65",$0.00,"$1,536.65",$691.49,"$1,096.71",$0.00,$264.76,$0.00,$0.00,$269.06,"$1,536.65",$0.00,$768.33,"$1,217.03","$1,229.32",$0.00,$240.49,$0.00,$244.63,$0.00
1806-0004,SUP,HCPCS C1713,,1806-0004  -  SCREW BONE T2 LCK INS,$460.63,$0.00,$460.63,$207.28,$328.75,$0.00,$79.36,$0.00,$0.00,$80.65,$460.63,$0.00,$230.31,$364.82,$368.50,$0.00,$72.09,$0.00,$73.33,$0.00
1806-0007,SUP,HCPCS C1713,,1806-0007  -  SCREW BONE T2 CNDYLR INS,$426.25,$0.00,$426.25,$191.81,$304.21,$0.00,$73.44,$0.00,$0.00,$74.63,$426.25,$0.00,$213.13,$337.59,$341.00,$0.00,$66.71,$0.00,$67.86,$0.00
1806-0009,SUP,HCPCS C1713,,1806-0009  -  SCREW BONE T2 FEM/TIB INS CMPR,$526.63,$0.00,$526.63,$236.98,$375.85,$0.00,$90.73,$0.00,$0.00,$92.21,$526.63,$0.00,$263.31,$417.09,$421.30,$0.00,$82.42,$0.00,$83.84,$0.00
1806-0050S,SUP,HCPCS C1713,,1806-0050S  -  WIRE FX 3MM 285MM STRL KRSH T2 SS,$200.75,$0.00,$200.75,$90.34,$143.28,$0.00,$34.59,$0.00,$0.00,$35.15,$200.75,$0.00,$100.38,$158.99,$160.60,$0.00,$31.42,$0.00,$31.96,$0.00
1806-0073S,SUP,Custom 27203010,,1806-0073S  -  TUBE ORTH TFLN T2 HUM NL SYS,$387.75,$0.00,$387.75,$0.00,$276.74,$0.00,$0.00,$0.00,$0.00,$0.00,$387.75,$0.00,$193.88,$307.10,$310.20,$0.00,$0.00,$0.00,$0.00,$0.00
1806-0080S,SUP,HCPCS C1769,,1806-0080S  -  GWIRE ORTH 800MM 3MM T2 TI BALL TIP FEM NAIL SYS STRL,$295.63,$0.00,$295.63,$160.52,$210.99,$0.00,$50.93,$0.00,$0.00,$51.76,$295.63,$0.00,$147.81,$234.14,$236.50,$0.00,$46.27,$0.00,$47.06,$0.00
1806-0083S,SUP,HCPCS C1769,,1806-0083S  -  GWIRE ORTH 800MM 2.5MM T2 TI BALL TIP FEM NAIL SYS STRL,$294.25,$0.00,$294.25,$159.78,$210.01,$0.00,$50.70,$0.00,$0.00,$51.52,$294.25,$0.00,$147.13,$233.05,$235.40,$0.00,$46.05,$0.00,$46.84,$0.00
1806-0085S,SUP,HCPCS C1769,,1806-0085S  -  GWIRE ORTH 1000MM 3MM T2 TI BALL TIP FEM NAIL SYS STRL,$336.88,$0.00,$336.88,$182.92,$240.43,$0.00,$58.04,$0.00,$0.00,$58.98,$336.88,$0.00,$168.44,$266.81,$269.50,$0.00,$52.72,$0.00,$53.63,$0.00
1806-0090S,SUP,HCPCS C1769,,1806-0090S  -  GWIRE ORTH 800MM 3MM T2 TI SMTH TIP FEM NAIL SYS STRL,$302.50,$0.00,$302.50,$164.26,$215.89,$0.00,$52.12,$0.00,$0.00,$52.97,$302.50,$0.00,$151.25,$239.58,$242.00,$0.00,$47.34,$0.00,$48.16,$0.00
1806-0093S,SUP,HCPCS C1769,,1806-0093S  -  GWIRE ORTH 800MM 2.2MM T2 TI SMTH TIP FEM NAIL SYS STRL,$294.25,$0.00,$294.25,$159.78,$210.01,$0.00,$50.70,$0.00,$0.00,$51.52,$294.25,$0.00,$147.13,$233.05,$235.40,$0.00,$46.05,$0.00,$46.84,$0.00
1806-0225,SUP,Custom 27203010,,1806-0225  -  BIT DRILL 3.5MM T2 LNG DRVR AO,$716.38,$0.00,$716.38,$0.00,$511.28,$0.00,$0.00,$0.00,$0.00,$0.00,$716.38,$0.00,$358.19,$567.37,$573.10,$0.00,$0.00,$0.00,$0.00,$0.00
1806-1005,SUP,Custom 27203010,,1806-1005  -  SET ORTH FEM TRGT DEV,"$6,639.88",$0.00,"$6,639.88",$0.00,"$4,738.88",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,639.88",$0.00,"$3,319.94","$5,258.78","$5,311.90",$0.00,$0.00,$0.00,$0.00,$0.00
1806-1250S,SUP,HCPCS C1769,,1806-1250S  -  GWIRE ORTH 1250MM 3MM T2 BALL TIP STRL,$302.50,$0.00,$302.50,$164.26,$215.89,$0.00,$52.12,$0.00,$0.00,$52.97,$302.50,$0.00,$151.25,$239.58,$242.00,$0.00,$47.34,$0.00,$48.16,$0.00
180615HC-S-V,SUP,HCPCS C1884,,COIL MICROPLEX 18SOFT 6MM X 15CM,$12.50,$0.00,$12.50,$5.63,$8.92,$0.00,$2.15,$0.00,$0.00,$2.19,$12.50,$0.00,$6.25,$9.90,$10.00,$0.00,$1.96,$0.00,$1.99,$0.00
1806-2020,SUP,Custom 27203010,,1806-2020  -  DRILL SURG CRWN T2 NONSTRL,$598.13,$0.00,$598.13,$0.00,$426.88,$0.00,$0.00,$0.00,$0.00,$0.00,$598.13,$0.00,$299.06,$473.72,$478.50,$0.00,$0.00,$0.00,$0.00,$0.00
180620HC-R-V,SUP,HCPCS C1884,,COIL MICROPLEX 18REG 6MM X 20CM,$12.50,$0.00,$12.50,$5.63,$8.92,$0.00,$2.15,$0.00,$0.00,$2.19,$12.50,$0.00,$6.25,$9.90,$10.00,$0.00,$1.96,$0.00,$1.99,$0.00
1806-3025,SUP,Custom 27203010,,1806-3025  -  BIT DRILL T2 CANN STP,"$2,151.88",$0.00,"$2,151.88",$0.00,"$1,535.79",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,151.88",$0.00,"$1,075.94","$1,704.29","$1,721.50",$0.00,$0.00,$0.00,$0.00,$0.00
1806-3030,SUP,HCPCS C1713,,1806-3030  -  WIRE FX 3.2MM 400MM NS KRSH T2 RECON SS NL SYS,$288.75,$0.00,$288.75,$129.94,$206.08,$0.00,$49.75,$0.00,$0.00,$50.56,$288.75,$0.00,$144.38,$228.69,$231.00,$0.00,$45.19,$0.00,$45.97,$0.00
1806-3030S,SUP,HCPCS C1713,,1806-3030S  -  WIRE 400MM 3.2MM KWIRE T2 SS RECON NL SYS STRL,$391.88,$0.00,$391.88,$176.34,$279.68,$0.00,$67.52,$0.00,$0.00,$68.61,$391.88,$0.00,$195.94,$310.37,$313.50,$0.00,$61.33,$0.00,$62.39,$0.00
1806-3031S,SUP,HCPCS C1713,,1806-3031S  -  WIRE FX 3.2MM 400MM STRL KRSH T2 RECON COCR NL SYS,$247.50,$0.00,$247.50,$111.38,$176.64,$0.00,$42.64,$0.00,$0.00,$43.34,$247.50,$0.00,$123.75,$196.02,$198.00,$0.00,$38.73,$0.00,$39.40,$0.00
1806-3500S,SUP,Custom 27203010,,1806-3500S  -  BIT DRILL 130MM 3.5MM T2 AO STRL,$295.63,$0.00,$295.63,$0.00,$210.99,$0.00,$0.00,$0.00,$0.00,$0.00,$295.63,$0.00,$147.81,$234.14,$236.50,$0.00,$0.00,$0.00,$0.00,$0.00
1806-3505,SUP,Custom 27203010,,1806-3505  -  BIT DRILL 130MM 3.5MM T2 TRFLT,$226.88,$0.00,$226.88,$0.00,$161.92,$0.00,$0.00,$0.00,$0.00,$0.00,$226.88,$0.00,$113.44,$179.69,$181.50,$0.00,$0.00,$0.00,$0.00,$0.00
1806-3510S,SUP,Custom 27203010,,1806-3510S  -  BIT DRILL 230MM 3.5MM T2 AO STRL,$207.63,$0.00,$207.63,$0.00,$148.18,$0.00,$0.00,$0.00,$0.00,$0.00,$207.63,$0.00,$103.81,$164.44,$166.10,$0.00,$0.00,$0.00,$0.00,$0.00
1806-3515,SUP,Custom 27203010,,1806-3515  -  BIT DRILL 230MM 3.5MM T2 TRFLT,$178.75,$0.00,$178.75,$0.00,$127.57,$0.00,$0.00,$0.00,$0.00,$0.00,$178.75,$0.00,$89.38,$141.57,$143.00,$0.00,$0.00,$0.00,$0.00,$0.00
1806-3520S,SUP,Custom 27203010,,1806-3520S  -  BIT DRILL 130MM 3.5MM T2 AO STRL,$295.63,$0.00,$295.63,$0.00,$210.99,$0.00,$0.00,$0.00,$0.00,$0.00,$295.63,$0.00,$147.81,$234.14,$236.50,$0.00,$0.00,$0.00,$0.00,$0.00
1806-3525S,SUP,Custom 27203010,,1806-3525S  -  BIT DRILL 130MM 3.5MM T2 TRFLT STRL,$294.25,$0.00,$294.25,$0.00,$210.01,$0.00,$0.00,$0.00,$0.00,$0.00,$294.25,$0.00,$147.13,$233.05,$235.40,$0.00,$0.00,$0.00,$0.00,$0.00
1806-3540S,SUP,Custom 27203010,,1806-3540S  -  BIT DRILL 230MM 3.5MM T2 AO STRL,$294.25,$0.00,$294.25,$0.00,$210.01,$0.00,$0.00,$0.00,$0.00,$0.00,$294.25,$0.00,$147.13,$233.05,$235.40,$0.00,$0.00,$0.00,$0.00,$0.00
1806-3545S,SUP,Custom 27203010,,1806-3545S  -  BIT DRILL 230MM 3.5MM T2 TRFLT STRL,$226.88,$0.00,$226.88,$0.00,$161.92,$0.00,$0.00,$0.00,$0.00,$0.00,$226.88,$0.00,$113.44,$179.69,$181.50,$0.00,$0.00,$0.00,$0.00,$0.00
1806-3550S,SUP,Custom 27203010,,1806-3550S  -  BIT DRL 3.5MM 130MM STRL AO CPLNG,$294.25,$0.00,$294.25,$0.00,$210.01,$0.00,$0.00,$0.00,$0.00,$0.00,$294.25,$0.00,$147.13,$233.05,$235.40,$0.00,$0.00,$0.00,$0.00,$0.00
1806-3555S,SUP,Custom 27203010,,1806-3555S  -  BIT DRILL 130MM 3.5MM T2 AO STRL,$226.88,$0.00,$226.88,$0.00,$161.92,$0.00,$0.00,$0.00,$0.00,$0.00,$226.88,$0.00,$113.44,$179.69,$181.50,$0.00,$0.00,$0.00,$0.00,$0.00
1806-4000S,SUP,Custom 27203010,,1806-4000S  -  BIT DRL 4MM 180MM STRL AO CPLNG,$294.25,$0.00,$294.25,$0.00,$210.01,$0.00,$0.00,$0.00,$0.00,$0.00,$294.25,$0.00,$147.13,$233.05,$235.40,$0.00,$0.00,$0.00,$0.00,$0.00
1806-4005S,SUP,Custom 27203010,,1806-4005S  -  BIT DRILL 180MM 4MM T2 TRFLT HUM NL SYS STRL,$294.25,$0.00,$294.25,$0.00,$210.01,$0.00,$0.00,$0.00,$0.00,$0.00,$294.25,$0.00,$147.13,$233.05,$235.40,$0.00,$0.00,$0.00,$0.00,$0.00
1806-4200S,SUP,Custom 27203010,,1806-4200S  -  BIT DRILL 260MM 4.2MM T2 AO STRL,$200.75,$0.00,$200.75,$0.00,$143.28,$0.00,$0.00,$0.00,$0.00,$0.00,$200.75,$0.00,$100.38,$158.99,$160.60,$0.00,$0.00,$0.00,$0.00,$0.00
1806-4205,SUP,Custom 27203010,,1806-4205  -  BIT DRILL 260MM 4.2MM T2 TRFLT,$191.13,$0.00,$191.13,$0.00,$136.41,$0.00,$0.00,$0.00,$0.00,$0.00,$191.13,$0.00,$95.56,$151.37,$152.90,$0.00,$0.00,$0.00,$0.00,$0.00
1806-4210,SUP,Custom 27203010,,1806-4210  -  BIT DRILL 340MM 4.2MM T2 AO,$210.38,$0.00,$210.38,$0.00,$150.14,$0.00,$0.00,$0.00,$0.00,$0.00,$210.38,$0.00,$105.19,$166.62,$168.30,$0.00,$0.00,$0.00,$0.00,$0.00
1806-4220,SUP,Custom 27203010,,1806-4220  -  BIT DRILL 180MM 4.2MM T2 AO,$210.38,$0.00,$210.38,$0.00,$150.14,$0.00,$0.00,$0.00,$0.00,$0.00,$210.38,$0.00,$105.19,$166.62,$168.30,$0.00,$0.00,$0.00,$0.00,$0.00
1806-4230S,SUP,Custom 27203010,,1806-4230S  -  BIT DRILL 130MM 4.2MM T2 AO STRL,$200.75,$0.00,$200.75,$0.00,$143.28,$0.00,$0.00,$0.00,$0.00,$0.00,$200.75,$0.00,$100.38,$158.99,$160.60,$0.00,$0.00,$0.00,$0.00,$0.00
1806-4235,SUP,Custom 27203010,,1806-4235  -  BIT DRILL 130MM 4.2MM T2 TRFLT,$191.13,$0.00,$191.13,$0.00,$136.41,$0.00,$0.00,$0.00,$0.00,$0.00,$191.13,$0.00,$95.56,$151.37,$152.90,$0.00,$0.00,$0.00,$0.00,$0.00
1806-4240,SUP,Custom 27203010,,1806-4240  -  BIT DRILL 30MM 4.2MM T2 AO,$210.38,$0.00,$210.38,$0.00,$150.14,$0.00,$0.00,$0.00,$0.00,$0.00,$210.38,$0.00,$105.19,$166.62,$168.30,$0.00,$0.00,$0.00,$0.00,$0.00
1806-4245,SUP,Custom 27203010,,1806-4245  -  BIT DRILL 230MM 4.2MM T2 TRFLT,$191.13,$0.00,$191.13,$0.00,$136.41,$0.00,$0.00,$0.00,$0.00,$0.00,$191.13,$0.00,$95.56,$151.37,$152.90,$0.00,$0.00,$0.00,$0.00,$0.00
1806-4250S,SUP,Custom 27203010,,1806-4250S  -  BIT DRL 4.2MM 260MM STRL AO,$302.50,$0.00,$302.50,$0.00,$215.89,$0.00,$0.00,$0.00,$0.00,$0.00,$302.50,$0.00,$151.25,$239.58,$242.00,$0.00,$0.00,$0.00,$0.00,$0.00
1806-4255S,SUP,Custom 27203010,,1806-4255S  -  BIT DRILL 260MM 4.2MM T2 TRFLT STRL,$302.50,$0.00,$302.50,$0.00,$215.89,$0.00,$0.00,$0.00,$0.00,$0.00,$302.50,$0.00,$151.25,$239.58,$242.00,$0.00,$0.00,$0.00,$0.00,$0.00
1806-4260S,SUP,Custom 27203010,,1806-4260S  -  BIT DRL 4.2MM 340MM STRL AO CPLNG,$302.50,$0.00,$302.50,$0.00,$215.89,$0.00,$0.00,$0.00,$0.00,$0.00,$302.50,$0.00,$151.25,$239.58,$242.00,$0.00,$0.00,$0.00,$0.00,$0.00
1806-4265S,SUP,Custom 27203010,,1806-4265S  -  BIT DRILL 340MM 4.2MM T2 TRFLT STRL,$191.13,$0.00,$191.13,$0.00,$136.41,$0.00,$0.00,$0.00,$0.00,$0.00,$191.13,$0.00,$95.56,$151.37,$152.90,$0.00,$0.00,$0.00,$0.00,$0.00
1806-4270S,SUP,Custom 27203010,,1806-4270S  -  DRILL SRG 4.2MM 180MM STRL AO CPLNG,$323.13,$0.00,$323.13,$0.00,$230.61,$0.00,$0.00,$0.00,$0.00,$0.00,$323.13,$0.00,$161.56,$255.92,$258.50,$0.00,$0.00,$0.00,$0.00,$0.00
1806-4275S,SUP,Custom 27203010,,1806-4275S  -  BIT DRILL 180MM 4.2MM T2 TRFLT STRL,$210.38,$0.00,$210.38,$0.00,$150.14,$0.00,$0.00,$0.00,$0.00,$0.00,$210.38,$0.00,$105.19,$166.62,$168.30,$0.00,$0.00,$0.00,$0.00,$0.00
1806-4280S,SUP,Custom 27203010,,1806-4280S  -  BIT DRL 4.2MM 130MM STRL AO CPLNG,$302.50,$0.00,$302.50,$0.00,$215.89,$0.00,$0.00,$0.00,$0.00,$0.00,$302.50,$0.00,$151.25,$239.58,$242.00,$0.00,$0.00,$0.00,$0.00,$0.00
1806-4285S,SUP,Custom 27203010,,1806-4285S  -  BIT DRILL 130MM 4.2MM T2 TRFLT STRL,$297.00,$0.00,$297.00,$0.00,$211.97,$0.00,$0.00,$0.00,$0.00,$0.00,$297.00,$0.00,$148.50,$235.22,$237.60,$0.00,$0.00,$0.00,$0.00,$0.00
1806-4290S,SUP,Custom 27203010,,1806-4290S  -  BIT DRILL 230MM 4.2MM T2 AO STRL,$325.88,$0.00,$325.88,$0.00,$232.58,$0.00,$0.00,$0.00,$0.00,$0.00,$325.88,$0.00,$162.94,$258.10,$260.70,$0.00,$0.00,$0.00,$0.00,$0.00
1806-4295S,SUP,Custom 27203010,,1806-4295S  -  BIT DRILL GRN 230MM 4.2MM T2 AO CPLNG TRFLT STRL,$297.00,$0.00,$297.00,$0.00,$211.97,$0.00,$0.00,$0.00,$0.00,$0.00,$297.00,$0.00,$148.50,$235.22,$237.60,$0.00,$0.00,$0.00,$0.00,$0.00
1806-5000S,SUP,Custom 27203010,,1806-5000S  -  BIT DRL 5MM 230MM STRL AO CPLNG,$302.50,$0.00,$302.50,$0.00,$215.89,$0.00,$0.00,$0.00,$0.00,$0.00,$302.50,$0.00,$151.25,$239.58,$242.00,$0.00,$0.00,$0.00,$0.00,$0.00
1806-5005S,SUP,Custom 27203010,,1806-5005S  -  BIT DRILL 230MM 5MM T2 TRFLT STRL DISP,$302.50,$0.00,$302.50,$0.00,$215.89,$0.00,$0.00,$0.00,$0.00,$0.00,$302.50,$0.00,$151.25,$239.58,$242.00,$0.00,$0.00,$0.00,$0.00,$0.00
1806-5010S,SUP,Custom 27203010,,1806-5010S  -  BIT DRILL 180MM 5MM T2 STD AO FIT STRL,$302.50,$0.00,$302.50,$0.00,$215.89,$0.00,$0.00,$0.00,$0.00,$0.00,$302.50,$0.00,$151.25,$239.58,$242.00,$0.00,$0.00,$0.00,$0.00,$0.00
1806-5015S,SUP,Custom 27203010,,1806-5015S  -  BIT DRILL 180MM 5MM T2 TRFLT OPTN STRL,$297.00,$0.00,$297.00,$0.00,$211.97,$0.00,$0.00,$0.00,$0.00,$0.00,$297.00,$0.00,$148.50,$235.22,$237.60,$0.00,$0.00,$0.00,$0.00,$0.00
1806-5020S,SUP,Custom 27203010,,1806-5020S  -  BIT DRILL 340MM 5MM T2 AO STRL,$325.88,$0.00,$325.88,$0.00,$232.58,$0.00,$0.00,$0.00,$0.00,$0.00,$325.88,$0.00,$162.94,$258.10,$260.70,$0.00,$0.00,$0.00,$0.00,$0.00
1806-5025S,SUP,Custom 27203010,,1806-5025S  -  BIT DRILL 340MM 5MM T2 TRFLT STRL,$297.00,$0.00,$297.00,$0.00,$211.97,$0.00,$0.00,$0.00,$0.00,$0.00,$297.00,$0.00,$148.50,$235.22,$237.60,$0.00,$0.00,$0.00,$0.00,$0.00
1806-5032S,SUP,HCPCS C1713,,1806-5032S  -  SCREW BONE 5MM 32.5MM T2 TI FULTHD PROX FEM LCK STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1806-5045S,SUP,HCPCS C1713,,1806-5045S  -  SCREW BONE 45MM ORTH LCK,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1806-8018S,SUP,Custom 27203010,,1806-8018S  -  BIT DRILL 250MM 4.2MM S2 AO OBLQ STRL,$297.00,$0.00,$297.00,$0.00,$211.97,$0.00,$0.00,$0.00,$0.00,$0.00,$297.00,$0.00,$148.50,$235.22,$237.60,$0.00,$0.00,$0.00,$0.00,$0.00
180701-2,SUP,HCPCS C1776,,180701-2  -  INSERT TIB 1 9MM STRL RESTORIS ONLAY MULTICOMPARTMENTAL KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
180702-1,SUP,HCPCS C1776,,180702-1  -  INSERT TIB 2 8MM ONLAY KN MCK SYS,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
180702-2,SUP,HCPCS C1776,,180702-2  -  INSERT TIB 2 9MM ONLAY KN MCK SYS,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
180702-3,SUP,HCPCS C1776,,180702-3  -  INSERT TIB 2 10MM STRL RESTORIS ONLAY MULTICOMPARTMENTAL KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
180702-5,SUP,HCPCS C1776,,180702-5  -  INSERT TIB 2 12MM STRL RESTORIS ONLAY MULTICOMPARTMENTAL KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
180703-1,SUP,HCPCS C1776,,180703-1  -  INSERT TIB 3 8MM ONLAY KN MCK SYS,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
180703-2,SUP,HCPCS C1776,,180703-2  -  INSERT TIB 3 9MM ONLAY KN MCK SYS,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
180703-3,SUP,HCPCS C1776,,180703-3  -  INSERT TIB 3 10MM ONLAY KN MCK SYS,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
180704-1,SUP,HCPCS C1776,,180704-1  -  INSERT TIB 4 8MM ONLAY KN MCK SYS,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
180704-2,SUP,HCPCS C1776,,180704-2  -  INSERT TIB 4 9MM ONLAY KN MCK SYS,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
180704-3,SUP,HCPCS C1776,,180704-3  -  INSERT TIB 4 10MM ONLAY KN MCK SYS,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
180704-5,SUP,HCPCS C1776,,180704-5  -  INSERT TIB 4 12MM STRL RESTORIS ONLAY MULTICOMPARTMENTAL KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
180705-1,SUP,HCPCS C1776,,180705-1  -  INSERT TIB 5 8MM ONLAY KN MCK SYS,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
180705-3,SUP,HCPCS C1776,,180705-3  -  INSERT TIB 5 10MM ONLAY KN MCK SYS,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
180705-4,SUP,HCPCS C1776,,180705-4  -  INSERT TIB 5 10MM ONLAY KN MCK SYS,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
180705-6,SUP,HCPCS C1776,,180705-6  -  INSERT TIB 5 13MM ONLAY KN MCK SYS,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
180705-7,SUP,HCPCS C1776,,180705-7  -  INSERT TIB 5 14MM ONLAY MULTICOMPARTMENTAL KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
180705-8,SUP,HCPCS C1776,,180705-8  -  INSERT TIB 5 15MM ONLAY MULTICOMPARTMENTAL KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
180705-9,SUP,HCPCS C1776,,180705-9  -  INSERT TIB 5 16MM ONLAY MULTICOMPARTMENTAL KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
180706-1,SUP,HCPCS C1776,,180706-1  -  INSERT TIB 6 8MM ONLAY KN MCK SYS,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
180706-2,SUP,HCPCS C1776,,180706-2  -  INSERT TIB 6 9MM ONLAY KN MCK SYS,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
180706-3,SUP,HCPCS C1776,,180706-3  -  INSERT TIB 6 10MM ONLAY,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
180706-4,SUP,HCPCS C1776,,180706-4  -  INSERT TIB 6 11MM ONLAY MULTICOMPARTMENTAL KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
180706-6,SUP,HCPCS C1776,,180706-6  -  INSERT TIB 6 13MM ONLAY MULTICOMPARTMENTAL KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
180706-7,SUP,HCPCS C1776,,180706-7  -  INSERT TIB 6 14MM ONLAY MULTICOMPARTMENTAL KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
180706-8,SUP,HCPCS C1776,,180706-8  -  INSERT TIB 6 15MM ONLAY MULTICOMPARTMENTAL KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
180706-9,SUP,HCPCS C1776,,180706-9  -  INSERT TIB 6 16MM ONLAY MULTICOMPARTMENTAL KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
180707-1,SUP,HCPCS C1776,,180707-1  -  INSERT TIB 7 8MM ONLAY KN MCK SYS,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
180707-2,SUP,HCPCS C1776,,180707-2  -  INSERT TIB 7 9MM ONLAY KN MCK SYS,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
180707-3,SUP,HCPCS C1776,,180707-3  -  INSERT TIB 7 10MM ONLAY KN MCK SYS,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
180707-4,SUP,HCPCS C1776,,180707-4  -  INSERT TIB 7 11MM ONLAY KN MULTICOMPARTMENTAL SYS,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
180707-6,SUP,HCPCS C1776,,180707-6  -  INSERT TIB 7 13MM ONLAY KN MULTICOMPARTMENTAL SYS,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
180707-7,SUP,HCPCS C1776,,180707-7  -  INSERT TIB 7 14MM ONLAY KN MULTICOMPARTMENTAL SYS,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
180707-8,SUP,HCPCS C1776,,180707-8  -  INSERT TIB 7 15MM ONLAY KN MULTICOMPARTMENTAL SYS,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
180707-9,SUP,HCPCS C1776,,180707-9  -  INSERT TIB 7 16MM ONLAY KN MULTICOMPARTMENTAL SYS,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
180708-4,SUP,HCPCS C1776,,180708-4  -  INSERT TIB 8 11MM ONLAY KN MULTICOMPARTMENTAL SYS,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
180708-6,SUP,HCPCS C1776,,180708-6  -  INSERT TIB 8 13MM ONLAY KN MULTICOMPARTMENTAL SYS,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
180708-7,SUP,HCPCS C1776,,180708-7  -  INSERT TIB 8 14MM ONLAY KN MULTICOMPARTMENTAL SYS,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
180708-8,SUP,HCPCS C1776,,180708-8  -  INSERT TIB 8 15MM ONLAY KN MULTICOMPARTMENTAL SYS,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
180708-9,SUP,HCPCS C1776,,180708-9  -  INSERT TIB 8 16MM ONLAY KN MULTICOMPARTMENTAL SYS,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
180731-1,SUP,HCPCS C1776,,180731-1  -  INSERT TIB 1 8MM MAKO X3 UNCMP ONLAY KN,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
180731-1-E,SUP,HCPCS C1776,,180731-1-E  -  INSERT TIB 1 8MM STRL MAKO UNCMP ONLAY X3 KN,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
180731-2,SUP,HCPCS C1776,,180731-2  -  INSERT TIB 1 9MM MAKO X3 UNCMP ONLAY KN,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
180731-2-E,SUP,HCPCS C1776,,180731-2-E  -  INSERT TIB 1 9MM STRL MAKO UNCMP ONLAY X3 KN,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
180731-3,SUP,HCPCS C1776,,180731-3  -  INSERT TIB 1 10MM MAKO X3 UNCMP ONLAY KN,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
180731-3-E,SUP,HCPCS C1776,,180731-3-E  -  INSERT TIB 1 10MM STRL MAKO UNCMP ONLAY X3 KN,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
180731-5,SUP,HCPCS C1776,,180731-5  -  INSERT TIB 1 12MM MAKO X3 UNCMP ONLAY KN,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
180731-5-E,SUP,HCPCS C1776,,180731-5-E  -  INSERT TIB 1 12MM STRL MAKO UNCMP ONLAY X3 KN,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
180732-1,SUP,HCPCS C1776,,180732-1  -  INSERT TIB 2 8MM MAKO X3 UNCMP ONLAY KN,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
180732-1-E,SUP,HCPCS C1776,,180732-1-E  -  INSERT TIB 2 8MM STRL MAKO UNCMP ONLAY X3 KN,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
180732-2,SUP,HCPCS C1776,,180732-2  -  INSERT TIB 2 9MM MAKO X3 UNCMP ONLAY KN,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
180732-2-E,SUP,HCPCS C1776,,180732-2-E  -  INSERT TIB 2 9MM STRL MAKO UNCMP ONLAY X3 KN,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
180732-3,SUP,HCPCS C1776,,180732-3  -  INSERT TIB 2 10MM MAKO X3 UNCMP ONLAY KN,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
180732-3-E,SUP,HCPCS C1776,,180732-3-E  -  INSERT TIB 2 10MM STRL MAKO UNCMP ONLAY X3 KN,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
180732-5,SUP,HCPCS C1776,,180732-5  -  INSERT TIB,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
180732-5-E,SUP,HCPCS C1776,,180732-5-E  -  INSERT TIB 2 12MM STRL MAKO UNCMP ONLAY X3 KN,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
180733-1,SUP,HCPCS C1776,,180733-1  -  INSERT TIB 3 8MM MAKO UNCMP ONLAY X3 KN,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
180733-1-E,SUP,HCPCS C1776,,180733-1-E  -  INSERT TIB 3 8MM STRL MAKO UNCMP ONLAY X3 KN,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
180733-2,SUP,HCPCS C1776,,180733-2  -  INSERT TIB 3 9MM MAKO UNCMP ONLAY X3 KN,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
180733-2-E,SUP,HCPCS C1776,,180733-2-E  -  INSERT TIB 3 9MM STRL MAKO UNCMP ONLAY X3 KN,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
180733-3,SUP,HCPCS C1776,,180733-3  -  INSERT TIB 10MM STRL MAKO BRNG ONLAY X3 KN,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
180733-3-E,SUP,HCPCS C1776,,180733-3-E  -  INSERT TIB 3 10MM STRL MAKO UNCMP ONLAY X3 KN,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
180733-5,SUP,HCPCS C1776,,180733-5  -  INSERT TIB 3 12MM MAKO X3 UNCMP ONLAY KN,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
180733-5-E,SUP,HCPCS C1776,,180733-5-E  -  INSERT TIB 3 12MM STRL MAKO UNCMP ONLAY X3 KN,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
180734-1,SUP,HCPCS C1776,,180734-1  -  INSERT TIB 4 8MM MAKO UNCMP ONLAY X3 KN,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
180734-1-E,SUP,HCPCS C1776,,180734-1-E  -  INSERT TIB 4 8MM STRL MAKO UNCMP ONLAY X3 KN,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
180734-2,SUP,HCPCS C1776,,180734-2  -  INSERT TIB 4 9MM MAKO X3 UNCMP ONLAY KN,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
180734-2-E,SUP,HCPCS C1776,,180734-2-E  -  INSERT TIB 4 9MM STRL MAKO UNCMP ONLAY X3 KN,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
180734-3,SUP,HCPCS C1776,,180734-3  -  INSERT TIB 10MM STRL MAKO BRNG ONLAY X3 KN,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
180734-3-E,SUP,HCPCS C1776,,180734-3-E  -  INSERT TIB 4 10MM STRL MAKO UNCMP ONLAY X3 KN,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
180734-5,SUP,HCPCS C1776,,180734-5  -  INSERT TIB,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
180735-1,SUP,HCPCS C1776,,180735-1  -  INSERT TIB 5 8MM MAKO UNCMP ONLAY X3 KN,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
180735-1-E,SUP,HCPCS C1776,,180735-1-E  -  INSERT TIB 5 8MM STRL MAKO UNCMP ONLAY X3 KN,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
180735-2,SUP,HCPCS C1776,,180735-2  -  INSERT TIB 5 9MM MAKO UNCMP ONLAY X3 KN,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
180735-2-E,SUP,HCPCS C1776,,180735-2-E  -  INSERT TIB 5 9MM STRL MAKO UNCMP ONLAY X3 KN,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
180735-3,SUP,HCPCS C1776,,180735-3  -  INSERT TIB,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
180735-5,SUP,HCPCS C1776,,180735-5  -  INSERT TIB 5 12MM MAKO X3 UNCMP ONLAY KN,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
180735-5-E,SUP,HCPCS C1776,,180735-5-E  -  INSERT TIB 5 12MM STRL MAKO UNCMP ONLAY X3 KN,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
180736-1,SUP,HCPCS C1776,,180736-1  -  INSERT TIB 6 8MM MAKO UNCMP ONLAY X3 KN,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
180736-1-E,SUP,HCPCS C1776,,180736-1-E  -  INSERT TIB 6 8MM STRL MAKO UNCMP ONLAY X3 KN,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
180736-2,SUP,HCPCS C1776,,180736-2  -  INSERT TIB 6 9MM MAKO UNCMP ONLAY X3 KN,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
180736-2-E,SUP,HCPCS C1776,,180736-2-E  -  INSERT TIB 6 9MM STRL MAKO UNCMP ONLAY X3 KN,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
180736-3,SUP,HCPCS C1776,,180736-3  -  INSERT TIB 6 10MM MAKO X3 UNCMP ONLAY KN,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
180736-3-E,SUP,HCPCS C1776,,180736-3-E  -  INSERT TIB 6 10MM STRL MAKO UNCMP ONLAY X3 KN,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
180736-5,SUP,HCPCS C1776,,180736-5  -  INSERT TIB,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
180736-5-E,SUP,HCPCS C1776,,180736-5-E  -  INSERT TIB 6 12MM STRL MAKO UNCMP ONLAY X3 KN,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
180737-1,SUP,HCPCS C1776,,180737-1  -  INSERT TIB 8MM STRL MAKO BRNG ONLAY X3 KN,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
180737-1-E,SUP,HCPCS C1776,,180737-1-E  -  INSERT TIB 7 8MM STRL MAKO UNCMP ONLAY X3 KN,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
180737-2,SUP,HCPCS C1776,,180737-2  -  INSERT TIB 7 9MM MAKO X3 UNCMP ONLAY KN,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
180737-2-E,SUP,HCPCS C1776,,180737-2-E  -  INSERT TIB 7 9MM STRL MAKO UNCMP ONLAY X3 KN,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
180737-3,SUP,HCPCS C1776,,180737-3  -  INSERT TIB 7 10MM MAKO X3 UNCMP ONLAY KN,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
180737-3-E,SUP,HCPCS C1776,,180737-3-E  -  INSERT TIB 7 10MM STRL MAKO UNCMP ONLAY X3 KN,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
180737-5,SUP,HCPCS C1776,,180737-5  -  INSERT TIB,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
180737-5-E,SUP,HCPCS C1776,,180737-5-E  -  INSERT TIB 7 12MM STRL MAKO UNCMP ONLAY X3 KN,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
180738-1,SUP,HCPCS C1776,,180738-1  -  INSERT TIB 8 8MM MAKO X3 UNCMP ONLAY KN,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
180738-1-E,SUP,HCPCS C1776,,180738-1-E  -  INSERT TIB 8 8MM STRL MAKO UNCMP ONLAY X3 KN,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
180738-2,SUP,HCPCS C1776,,180738-2  -  INSERT TIB,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
180738-2-E,SUP,HCPCS C1776,,180738-2-E  -  INSERT TIB 8 9MM STRL MAKO UNCMP ONLAY X3 KN,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
180738-3,SUP,HCPCS C1776,,180738-3  -  INSERT TIB,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
180738-3-E,SUP,HCPCS C1776,,180738-3-E  -  INSERT TIB 8 10MM STRL MAKO UNCMP ONLAY X3 KN,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
180738-5,SUP,HCPCS C1776,,180738-5  -  INSERT TIB,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
180738-5-E,SUP,HCPCS C1776,,180738-5-E  -  INSERT TIB 8 12MM STRL MAKO UNCMP ONLAY X3 KN,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
18-131,SUP,HCPCS C1887,,18-131  -  CATH GUID 130CM 20CM MCTH STR HYDPHI RNGD STC-18,"$1,225.00",$0.00,"$1,225.00",$665.18,$874.28,$0.00,$211.06,$0.00,$0.00,$214.49,"$1,225.00",$0.00,$612.50,$970.20,$980.00,$0.00,$191.71,$0.00,$195.02,$0.00
1818-0001S,SUP,HCPCS C1713,,1818-0001S  -  SCREW BONE 8MM 14.5MM T2 TI ANKL CMPR CANN PRELD ARTHDES,$276.38,$0.00,$276.38,$124.37,$197.25,$0.00,$47.62,$0.00,$0.00,$48.39,$276.38,$0.00,$138.19,$218.89,$221.10,$0.00,$43.25,$0.00,$44.00,$0.00
1818-1015S,SUP,HCPCS C1713,,1818-1015S  -  NAIL 10MM 15CM LEFT ANKL T2 IM ARTHDES LCK TI STRL,"$3,485.63",$0.00,"$3,485.63","$1,568.53","$2,487.69",$0.00,$600.56,$0.00,$0.00,$610.31,"$3,485.63",$0.00,"$1,742.81","$2,760.62","$2,788.50",$0.00,$545.50,$0.00,$554.91,$0.00
1818-1020S,SUP,HCPCS C1713,,1818-1020S  -  NAIL 10MM 20CM LEFT ANKL T2 IM ARTHDES LCK TI STRL,"$3,485.63",$0.00,"$3,485.63","$1,568.53","$2,487.69",$0.00,$600.56,$0.00,$0.00,$610.31,"$3,485.63",$0.00,"$1,742.81","$2,760.62","$2,788.50",$0.00,$545.50,$0.00,$554.91,$0.00
1818-1030S,SUP,HCPCS C1713,,1818-1030S  -  NAIL 10MM 30CM LEFT ANKL T2 IM ARTHDES LCK TI STRL,"$3,485.63",$0.00,"$3,485.63","$1,568.53","$2,487.69",$0.00,$600.56,$0.00,$0.00,$610.31,"$3,485.63",$0.00,"$1,742.81","$2,760.62","$2,788.50",$0.00,$545.50,$0.00,$554.91,$0.00
1818-1115S,SUP,HCPCS C1713,,1818-1115S  -  NAIL 11MM 15CM LEFT ANKL T2 IM ARTHDES LCK TI STRL,"$3,485.63",$0.00,"$3,485.63","$1,568.53","$2,487.69",$0.00,$600.56,$0.00,$0.00,$610.31,"$3,485.63",$0.00,"$1,742.81","$2,760.62","$2,788.50",$0.00,$545.50,$0.00,$554.91,$0.00
1818-1120S,SUP,HCPCS C1713,,1818-1120S  -  NAIL 11MM 20CM LEFT ANKL T2 IM ARTHDES LCK TI STRL,"$3,485.63",$0.00,"$3,485.63","$1,568.53","$2,487.69",$0.00,$600.56,$0.00,$0.00,$610.31,"$3,485.63",$0.00,"$1,742.81","$2,760.62","$2,788.50",$0.00,$545.50,$0.00,$554.91,$0.00
1818-1130S,SUP,HCPCS C1713,,1818-1130S  -  NAIL 11MM 30CM LEFT ANKL T2 IM ARTHDES LCK TI STRL,"$3,485.63",$0.00,"$3,485.63","$1,568.53","$2,487.69",$0.00,$600.56,$0.00,$0.00,$610.31,"$3,485.63",$0.00,"$1,742.81","$2,760.62","$2,788.50",$0.00,$545.50,$0.00,$554.91,$0.00
1818-1215S,SUP,HCPCS C1713,,1818-1215S  -  NAIL 12MM 15CM LEFT ANKL T2 IM ARTHDES LCK TI STRL,"$3,485.63",$0.00,"$3,485.63","$1,568.53","$2,487.69",$0.00,$600.56,$0.00,$0.00,$610.31,"$3,485.63",$0.00,"$1,742.81","$2,760.62","$2,788.50",$0.00,$545.50,$0.00,$554.91,$0.00
1818-1220S,SUP,HCPCS C1713,,1818-1220S  -  NAIL 12MM 20CM LEFT ANKL T2 IM ARTHDES LCK TI STRL,"$3,485.63",$0.00,"$3,485.63","$1,568.53","$2,487.69",$0.00,$600.56,$0.00,$0.00,$610.31,"$3,485.63",$0.00,"$1,742.81","$2,760.62","$2,788.50",$0.00,$545.50,$0.00,$554.91,$0.00
1818-1230S,SUP,HCPCS C1713,,1818-1230S  -  T2 ANKLE ARTHRODESIS NAIL LEFT 12MM X 300MM,"$3,485.63",$0.00,"$3,485.63","$1,568.53","$2,487.69",$0.00,$600.56,$0.00,$0.00,$610.31,"$3,485.63",$0.00,"$1,742.81","$2,760.62","$2,788.50",$0.00,$545.50,$0.00,$554.91,$0.00
1819-1015S,SUP,HCPCS C1713,,1819-1015S  -  NAIL 10MM 15CM RIGHT ANKL T2 IM ARTHDES LCK TI STRL,"$3,485.63",$0.00,"$3,485.63","$1,568.53","$2,487.69",$0.00,$600.56,$0.00,$0.00,$610.31,"$3,485.63",$0.00,"$1,742.81","$2,760.62","$2,788.50",$0.00,$545.50,$0.00,$554.91,$0.00
1819-1020S,SUP,HCPCS C1713,,1819-1020S  -  NAIL 10MM 20CM RIGHT ANKL T2 IM ARTHDES LCK TI STRL,"$3,485.63",$0.00,"$3,485.63","$1,568.53","$2,487.69",$0.00,$600.56,$0.00,$0.00,$610.31,"$3,485.63",$0.00,"$1,742.81","$2,760.62","$2,788.50",$0.00,$545.50,$0.00,$554.91,$0.00
1819-1030S,SUP,HCPCS C1713,,1819-1030S  -  NAIL 10MM 30CM RIGHT ANKL T2 IM ARTHDES LCK TI STRL,"$3,485.63",$0.00,"$3,485.63","$1,568.53","$2,487.69",$0.00,$600.56,$0.00,$0.00,$610.31,"$3,485.63",$0.00,"$1,742.81","$2,760.62","$2,788.50",$0.00,$545.50,$0.00,$554.91,$0.00
1819-1115S,SUP,HCPCS C1713,,1819-1115S  -  NAIL 11MM 15CM RIGHT ANKL T2 IM ARTHDES LCK TI STRL,"$3,485.63",$0.00,"$3,485.63","$1,568.53","$2,487.69",$0.00,$600.56,$0.00,$0.00,$610.31,"$3,485.63",$0.00,"$1,742.81","$2,760.62","$2,788.50",$0.00,$545.50,$0.00,$554.91,$0.00
1819-1120S,SUP,HCPCS C1713,,1819-1120S  -  NAIL 11MM 20CM RIGHT ANKL T2 IM ARTHDES LCK TI STRL,"$3,485.63",$0.00,"$3,485.63","$1,568.53","$2,487.69",$0.00,$600.56,$0.00,$0.00,$610.31,"$3,485.63",$0.00,"$1,742.81","$2,760.62","$2,788.50",$0.00,$545.50,$0.00,$554.91,$0.00
1819-1130S,SUP,HCPCS C1713,,1819-1130S  -  NAIL 11MM 30CM RIGHT ANKL T2 IM ARTHDES LCK TI STRL,"$3,485.63",$0.00,"$3,485.63","$1,568.53","$2,487.69",$0.00,$600.56,$0.00,$0.00,$610.31,"$3,485.63",$0.00,"$1,742.81","$2,760.62","$2,788.50",$0.00,$545.50,$0.00,$554.91,$0.00
1819-1215S,SUP,HCPCS C1713,,1819-1215S  -  NAIL 12MM 15CM RIGHT ANKL T2 IM ARTHDES LCK TI STRL,"$3,485.63",$0.00,"$3,485.63","$1,568.53","$2,487.69",$0.00,$600.56,$0.00,$0.00,$610.31,"$3,485.63",$0.00,"$1,742.81","$2,760.62","$2,788.50",$0.00,$545.50,$0.00,$554.91,$0.00
1819-1220S,SUP,HCPCS C1713,,1819-1220S  -  NAIL 12MM 20CM RIGHT ANKL T2 IM ARTHDES LCK TI STRL,"$3,485.63",$0.00,"$3,485.63","$1,568.53","$2,487.69",$0.00,$600.56,$0.00,$0.00,$610.31,"$3,485.63",$0.00,"$1,742.81","$2,760.62","$2,788.50",$0.00,$545.50,$0.00,$554.91,$0.00
1819-1230S,SUP,HCPCS C1713,,1819-1230S  -  NAIL 12MM 30CM RIGHT ANKL T2 IM ARTHDES LCK TI STRL,"$3,485.63",$0.00,"$3,485.63","$1,568.53","$2,487.69",$0.00,$600.56,$0.00,$0.00,$610.31,"$3,485.63",$0.00,"$1,742.81","$2,760.62","$2,788.50",$0.00,$545.50,$0.00,$554.91,$0.00
1822-0001S,SUP,HCPCS C1713,,1822-0001S  -  SCREW BONE 8MM T2 TI TIB CMPR STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1822-0003S,SUP,HCPCS C1713,,1822-0003S  -  CAP END STD STRL T2 8MM,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1822-0004S,SUP,HCPCS C1713,,1822-0004S  -  CAP END FULTHRD T2,$239.25,$0.00,$239.25,$107.66,$170.75,$0.00,$41.22,$0.00,$0.00,$41.89,$239.25,$0.00,$119.63,$189.49,$191.40,$0.00,$37.44,$0.00,$38.09,$0.00
1822-0005S,SUP,HCPCS C1713,,1822-0005S  -  CAP END +5MM STRL T2 11.5MM,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1822-0010S,SUP,HCPCS C1713,,1822-0010S  -  CAP END 10MM 10+ MM HUM IM NAIL STRL T2 11.5MM,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1822-0015S,SUP,HCPCS C1713,,1822-0015S  -  CAP END 15MM FEM IM NAIL TI STRL T2,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1822-0824S,SUP,HCPCS C1713,,1822-0824S  -  NAIL 8MM 24CM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-0825S,SUP,HCPCS C1713,,1822-0825S  -  NAIL 8MM 25.5CM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-0827S,SUP,HCPCS C1713,,1822-0827S  -  NAIL 8MM 27CM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-0828S,SUP,HCPCS C1713,,1822-0828S  -  NAIL 8MM 28.5CM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-0830S,SUP,HCPCS C1713,,1822-0830S  -  NAIL 8MM 30CM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-0831S,SUP,HCPCS C1713,,1822-0831S  -  NAIL 8MM 31.5CM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-0833S,SUP,HCPCS C1713,,1822-0833S  -  NAIL 8MM 330MM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-0834S,SUP,HCPCS C1713,,1822-0834S  -  NAIL 8MM 345MM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-0836S,SUP,HCPCS C1713,,1822-0836S  -  NAIL 8MM 36CM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-0837S,SUP,HCPCS C1713,,1822-0837S  -  NAIL 8MM 37.5CM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-0839S,SUP,HCPCS C1713,,1822-0839S  -  NAIL 8MM 39CM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-0840S,SUP,HCPCS C1713,,1822-0840S  -  NAIL 8MM 40.5CM TIB T2 IM STD TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-0842S,SUP,HCPCS C1713,,1822-0842S  -  NAIL 8MM 42CM TIB T2 IM STD TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-0924S,SUP,HCPCS C1713,,1822-0924S  -  NAIL 9MM 24CM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-0925S,SUP,HCPCS C1713,,1822-0925S  -  NAIL 9MM 25.5CM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-0927S,SUP,HCPCS C1713,,1822-0927S  -  NAIL 9MM 27CM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-0928S,SUP,HCPCS C1713,,1822-0928S  -  NAIL 0D9MM 28.5CM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-0930S,SUP,HCPCS C1713,,1822-0930S  -  NAIL 9MM 30CM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-0931S,SUP,HCPCS C1713,,1822-0931S  -  NAIL 9MM 31.5CM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-0933S,SUP,HCPCS C1713,,1822-0933S  -  NAIL 9MM 33CM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-0934S,SUP,HCPCS C1713,,1822-0934S  -  NAIL 9MM 345MM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-0936S,SUP,HCPCS C1713,,1822-0936S  -  NAIL 9MM 360MM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-0937S,SUP,HCPCS C1713,,1822-0937S  -  NAIL 9MM 37.5CM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-0939S,SUP,HCPCS C1713,,1822-0939S  -  NAIL 9MM 39CM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-0940S,SUP,HCPCS C1713,,1822-0940S  -  NAIL 9MM 40.5CM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-0942S,SUP,HCPCS C1713,,1822-0942S  -  NAIL 9MM 42CM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-0945S,SUP,HCPCS C1713,,1822-0945S  -  NAIL 9MM 450MM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1024S,SUP,HCPCS C1713,,1822-1024S  -  NAIL 10MM 24CM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1025S,SUP,HCPCS C1713,,1822-1025S  -  NAIL 10MM 25.5CM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1027S,SUP,HCPCS C1713,,1822-1027S  -  NAIL 10MM 27CM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1028S,SUP,HCPCS C1713,,1822-1028S  -  NAIL 10MM 28.5CM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1030S,SUP,HCPCS C1713,,1822-1030S  -  NAIL 10MM 300MM TIB T2 IM STD TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1031S,SUP,HCPCS C1713,,1822-1031S  -  NAIL 10MM 31.5CM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1033S,SUP,HCPCS C1713,,1822-1033S  -  NAIL 10MM 33CM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1034S,SUP,HCPCS C1713,,1822-1034S  -  NAIL 10MM 34.5CM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1036S,SUP,HCPCS C1713,,1822-1036S  -  NAIL 10MM 36CM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1037S,SUP,HCPCS C1713,,1822-1037S  -  NAIL 10MM 37.5CM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1039S,SUP,HCPCS C1713,,1822-1039S  -  NAIL 11MM 390MM TIB T2 IM STD STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1040S,SUP,HCPCS C1713,,1822-1040S  -  NAIL 10MM 40.5CM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1042S,SUP,HCPCS C1713,,1822-1042S  -  NAIL 10MM 420MM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1043S,SUP,HCPCS C1713,,1822-1043S  -  NAIL 10MM 435MM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1045S,SUP,HCPCS C1713,,1822-1045S  -  NAIL 10MM 450MM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1046S,SUP,HCPCS C1713,,1822-1046S  -  NAIL 10MM 465MM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1048S,SUP,HCPCS C1713,,1822-1048S  -  NAIL 10MM 480MM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1124S,SUP,HCPCS C1713,,1822-1124S  -  NAIL 11MM 240MM TIB T2 IM STD IMPL TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1125S,SUP,HCPCS C1713,,1822-1125S  -  NAIL 11MM 25.5CM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1127S,SUP,HCPCS C1713,,1822-1127S  -  NAIL 11MM 27CM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1128S,SUP,HCPCS C1713,,1822-1128S  -  NAIL 11MM 28CM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1130S,SUP,HCPCS C1713,,1822-1130S  -  NAIL 11MM 300MM TIB T2 IM STD,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1131S,SUP,HCPCS C1713,,1822-1131S  -  NAIL 11MM 315MM TIB T2 IM STD TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1133S,SUP,HCPCS C1713,,1822-1133S  -  NAIL 11MM 330MM TIB T2 IM STD,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1134S,SUP,HCPCS C1713,,1822-1134S  -  NAIL 11MM 345MM TIB T2 IM STD TI ALLOY STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1136S,SUP,HCPCS C1713,,1822-1136S  -  NAIL 11MM 36CM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1137S,SUP,HCPCS C1713,,1822-1137S  -  NAIL 11MM 375MM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1139S,SUP,HCPCS C1713,,1822-1139S  -  NAIL 11MM 390MM TIB T2 IM STD TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1140S,SUP,HCPCS C1713,,1822-1140S  -  NAIL 11MM 40.5CM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1142S,SUP,HCPCS C1713,,1822-1142S  -  NAIL 11MM 42CM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1143S,SUP,HCPCS C1713,,1822-1143S  -  NAIL 11MM 435MM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1145S,SUP,HCPCS C1713,,1822-1145S  -  NAIL 11MM 450MM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1146S,SUP,HCPCS C1713,,1822-1146S  -  NAIL 11MM 465MM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1148S,SUP,HCPCS C1713,,1822-1148S  -  NAIL 11MM 480MM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1224S,SUP,HCPCS C1713,,1822-1224S  -  NAIL 12MM 24CM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1225S,SUP,HCPCS C1713,,1822-1225S  -  NAIL 12MM 25.5CM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1227S,SUP,HCPCS C1713,,1822-1227S  -  NAIL 12MM 27CM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1228S,SUP,HCPCS C1713,,1822-1228S  -  NAIL 12MM 28.5CM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1230S,SUP,HCPCS C1713,,1822-1230S  -  NAIL 12MM 300MM TIB T2 IM STD TI,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1231S,SUP,HCPCS C1713,,1822-1231S  -  NAIL 12MM 31.5CM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1233S,SUP,HCPCS C1713,,1822-1233S  -  NAIL 12MM 33CM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1234S,SUP,HCPCS C1713,,1822-1234S  -  NAIL 12MM 345MM TIB T2 IM STD TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1236S,SUP,HCPCS C1713,,1822-1236S  -  NAIL 12MM 360MM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1237S,SUP,HCPCS C1713,,1822-1237S  -  NAIL 12MM 370MM TIB T2 IM STD TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1239S,SUP,HCPCS C1713,,1822-1239S  -  NAIL 12MM 390MM TIB T2 IM STD TI,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1240S,SUP,HCPCS C1713,,1822-1240S  -  NAIL 12MM 405MM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1242S,SUP,HCPCS C1713,,1822-1242S  -  NAIL 12MM 420MM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1245S,SUP,HCPCS C1713,,1822-1245S  -  NAIL 12MM 450MM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1324S,SUP,HCPCS C1713,,1822-1324S  -  NAIL 13MM 240MM TIB T2 IM STD,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1325S,SUP,HCPCS C1713,,1822-1325S  -  NAIL 13MM 255MM TIB T2 IM STD,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1327S,SUP,HCPCS C1713,,1822-1327S  -  NAIL 13MM 270MM TIB T2 IM STD,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1328S,SUP,HCPCS C1713,,1822-1328S  -  NAIL 13MM 285MM TIB T2 IM STD,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1330S,SUP,HCPCS C1713,,1822-1330S  -  NAIL 13MM 30CM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1331S,SUP,HCPCS C1713,,1822-1331S  -  NAIL 13MM 31.5CM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1333S,SUP,HCPCS C1713,,1822-1333S  -  NAIL 13MM 33CM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1334S,SUP,HCPCS C1713,,1822-1334S  -  NAIL 13MM 34.5CM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1336S,SUP,HCPCS C1713,,1822-1336S  -  NAIL 13MM 36CM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1337S,SUP,HCPCS C1713,,1822-1337S  -  NAIL 13MM 37.5CM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1339S,SUP,HCPCS C1713,,1822-1339S  -  NAIL 13MM 39CM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1340S,SUP,HCPCS C1713,,1822-1340S  -  NAIL 13MM 40.5CM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1342S,SUP,HCPCS C1713,,1822-1342S  -  NAIL 13MM 42CM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1424S,SUP,HCPCS C1713,,1822-1424S  -  NAIL 14MM 240MM TIB T2 IM STD,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1425S,SUP,HCPCS C1713,,1822-1425S  -  NAIL 14MM 255MM TIB T2 IM STD IMPL STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1427S,SUP,Custom 27803010,,1822-1427S  -  CMPNT PATLR 15MM CONC SGL T2 MDL LAT STRL,"$2,322.38",$0.00,"$2,322.38",$0.00,"$1,657.48",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$0.00,$0.00,$0.00,$0.00
1822-1428S,SUP,HCPCS C1713,,1822-1428S  -  NAIL 14MM 285MM TIB T2 IM STD IMPL STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1430S,SUP,HCPCS C1713,,1822-1430S  -  NAIL 14MM 300MM TIB T2 IM STD IMPL STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1431S,SUP,HCPCS C1713,,1822-1431S  -  NAIL 14MM 315MM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1433S,SUP,HCPCS C1713,,1822-1433S  -  NAIL 14MM 330MM TIB T2 IM STD TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1434S,SUP,HCPCS C1713,,1822-1434S  -  NAIL 14MM 34.5CM TIB T2 IM STD STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1436S,SUP,HCPCS C1713,,1822-1436S  -  NAIL 14MM 360MM TIB T2 IM STD TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1437S,SUP,HCPCS C1713,,1822-1437S  -  NAIL 14MM 375MM TIB T2 IM STD LCK TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1439S,SUP,HCPCS C1713,,1822-1439S  -  NAIL 14MM 390MM TIB T2 IM STD TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1440S,SUP,HCPCS C1713,,1822-1440S  -  NAIL 14MM 405MM TIB T2 IM STD TI STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1442S,SUP,HCPCS C1713,,1822-1442S  -  NAIL 14MM 420MM TIB T2 IM STD IMPL STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1524S,SUP,HCPCS C1713,,1822-1524S  -  NAIL 15MM 240MM TIB T2 IM STD IMPL STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1525S,SUP,HCPCS C1713,,1822-1525S  -  NAIL 15MM 255MM TIB T2 IM STD IMPL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1527S,SUP,HCPCS C1713,,1822-1527S  -  NAIL 15MM 270MM TIB T2 IM STD IMPL STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1528S,SUP,HCPCS C1713,,1822-1528S  -  NAIL 15MM 285MM TIB T2 IM STD IMPL STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1530S,SUP,HCPCS C1713,,1822-1530S  -  NAIL 15MM 300MM TIB T2 IM STD IMPL STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1531S,SUP,HCPCS C1713,,1822-1531S  -  NAIL 15MM 315MM TIB T2 IM STD IMPL STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1533S,SUP,HCPCS C1713,,1822-1533S  -  NAIL 15MM 330MM TIB T2 IM STD IMPL STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1534S,SUP,HCPCS C1713,,1822-1534S  -  NAIL 15MM 345MM TIB T2 IM STD IMPL STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1536S,SUP,HCPCS C1713,,1822-1536S  -  NAIL 15MM 360MM TIB T2 IM STD IMPL STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1537S,SUP,HCPCS C1713,,1822-1537S  -  NAIL 15MM 375MM TIB T2 IM STD IMPL STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1539S,SUP,HCPCS C1713,,1822-1539S  -  NAIL 15MM 390MM TIB T2 IM STD IMPL STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1540S,SUP,HCPCS C1713,,1822-1540S  -  NAIL 15MM 330MM TIB T2 IM STD IMPL STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1822-1542S,SUP,HCPCS C1713,,1822-1542S  -  NAIL 15MM 420MM TIB T2 IM STD IMPL STRL,"$2,322.38",$0.00,"$2,322.38","$1,045.07","$1,657.48",$0.00,$400.13,$0.00,$0.00,$406.63,"$2,322.38",$0.00,"$1,161.19","$1,839.32","$1,857.90",$0.00,$363.45,$0.00,$369.72,$0.00
1825-0000S,SUP,HCPCS C1713,,1825-0000S  -  SCREW BONE 8MM T2 TI STD FEM CMPR STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1825-0001S,SUP,HCPCS C1713,,1825-0001S  -  SCREW BONE 8MM T2 TI +0MM FEM CMPR STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1825-0005S,SUP,HCPCS C1713,,1825-0005S  -  SCREW BONE 8MM T2 TI +5MM FEM CMPR STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1825-0010S,SUP,HCPCS C1713,,1825-0010S  -  SCREW BONE 8MM T2 TI +10MM FEM CMPR STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1825-0015S,SUP,HCPCS C1713,,1825-0015S  -  SCREW BONE 8MM T2 TI +15MM FEM CMPR STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1825-0814S,SUP,HCPCS C1713,,1825-0814S  -  NAIL 8MM 14CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-0816S,SUP,HCPCS C1713,,1825-0816S  -  NAIL 8MM 16CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-0818S,SUP,HCPCS C1713,,1825-0818S  -  NAIL 8MM 18CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-0820S,SUP,HCPCS C1713,,1825-0820S  -  NAIL 8MM 20CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-0822S,SUP,HCPCS C1713,,1825-0822S  -  NAIL 8MM 22CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-0824S,SUP,HCPCS C1713,,1825-0824S  -  NAIL 8MM 24CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-0826S,SUP,HCPCS C1713,,1825-0826S  -  NAIL 8MM 26CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-0828S,SUP,HCPCS C1713,,1825-0828S  -  NAIL 8MM 28CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-0830S,SUP,HCPCS C1713,,1825-0830S  -  NAIL 8MM 30CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-0832S,SUP,HCPCS C1713,,1825-0832S  -  NAIL 8MM 32CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-0834S,SUP,HCPCS C1713,,1825-0834S  -  NAIL 8MM 34CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-0836S,SUP,HCPCS C1713,,1825-0836S  -  NAIL 8MM 36CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-0838S,SUP,HCPCS C1713,,1825-0838S  -  NAIL 8MM 38CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-0840S,SUP,HCPCS C1713,,1825-0840S  -  NAIL 8MM 40CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-0842S,SUP,HCPCS C1713,,1825-0842S  -  NAIL 8MM 42CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-0844S,SUP,HCPCS C1713,,1825-0844S  -  NAIL 8MM 44CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-0846S,SUP,HCPCS C1713,,1825-0846S  -  NAIL 8MM 46CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-0848S,SUP,HCPCS C1713,,1825-0848S  -  NAIL 8MM 48CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-0914S,SUP,HCPCS C1713,,1825-0914S  -  NAIL 9MM 140MM FEM T2 IM,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-0916S,SUP,HCPCS C1713,,1825-0916S  -  NAIL 9MM 160MM FEM T2 IM,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-0918S,SUP,HCPCS C1713,,1825-0918S  -  NAIL 9MM 18CM FEM T2 IM STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-0920S,SUP,HCPCS C1713,,1825-0920S  -  NAIL 9MM 20CM FEM T2 IM STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-0922S,SUP,HCPCS C1713,,1825-0922S  -  NAIL 9MM 22CM FEM T2 IM STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-0924S,SUP,HCPCS C1713,,1825-0924S  -  NAIL 9MM 24CM FEM T2 IM LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-0926S,SUP,HCPCS C1713,,1825-0926S  -  NAIL 9MM 26CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-0928S,SUP,HCPCS C1713,,1825-0928S  -  NAIL 9MM 28CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-0930S,SUP,HCPCS C1713,,1825-0930S  -  NAIL 9MM 30CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-0932S,SUP,HCPCS C1713,,1825-0932S  -  NAIL 9MM 32CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-0934S,SUP,HCPCS C1713,,1825-0934S  -  NAIL 9MM 34CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-0936S,SUP,HCPCS C1713,,1825-0936S  -  NAIL 9MM 360MM FEM T2 IM TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-0938S,SUP,HCPCS C1713,,1825-0938S  -  NAIL 9MM 380MM FEM T2 IM TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-0940S,SUP,HCPCS C1713,,1825-0940S  -  NAIL 9MM 40CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-0942S,SUP,HCPCS C1713,,1825-0942S  -  NAIL 9MM 42CM FEM T2 IM ANTGRD RTRGRD LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-0944S,SUP,HCPCS C1713,,1825-0944S  -  NAIL 9MM 44CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-0946S,SUP,HCPCS C1713,,1825-0946S  -  NAIL 9MM 46CM FEM T2 IM LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-0948S,SUP,HCPCS C1713,,1825-0948S  -  NAIL 9MM 48CM FEM T2 IM LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1014S,SUP,HCPCS C1713,,1825-1014S  -  NAIL 10MM 140MM FEM T2 IM,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1016S,SUP,HCPCS C1713,,1825-1016S  -  NAIL 10MM 160MM FEM T2 IM,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1018S,SUP,HCPCS C1713,,1825-1018S  -  NAIL 10MM 18CM FEM T2 IM STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1020S,SUP,HCPCS C1713,,1825-1020S  -  NAIL 10MM 20CM FEM T2 IM STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1022S,SUP,HCPCS C1713,,1825-1022S  -  NAIL 10MM 22CM FEM T2 IM STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1024S,SUP,HCPCS C1713,,1825-1024S  -  NAIL 10MM 24CM FEM T2 IM LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1026S,SUP,HCPCS C1713,,1825-1026S  -  NAIL 10MM 26CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1028S,SUP,HCPCS C1713,,1825-1028S  -  NAIL 10MM 60MM FEM T2 IM TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1030S,SUP,HCPCS C1713,,1825-1030S  -  NAIL 10MM 30CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1032S,SUP,HCPCS C1713,,1825-1032S  -  NAIL 10MM 320MM FEM T2 IM LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1034S,SUP,HCPCS C1713,,1825-1034S  -  NAIL 10MM 340MM FEM T2 IM LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1036S,SUP,HCPCS C1713,,1825-1036S  -  NAIL 10MM 36CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1038S,SUP,HCPCS C1713,,1825-1038S  -  NAIL 10MM 38CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1040S,SUP,HCPCS C1713,,1825-1040S  -  NAIL 10MM 400MM FEM T2 IM LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1042S,SUP,HCPCS C1713,,1825-1042S  -  NAIL 10MM 42CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1044S,SUP,HCPCS C1713,,1825-1044S  -  NAIL 10MM 44CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1046S,SUP,HCPCS C1713,,1825-1046S  -  NAIL 10MM 46CM FEM T2 IM LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1048S,SUP,HCPCS C1713,,1825-1048S  -  NAIL 10MM 48CM FEM T2 IM LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1114S,SUP,HCPCS C1713,,1825-1114S  -  NAIL 11MM 140MM FEM T2 IM,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1116S,SUP,HCPCS C1713,,1825-1116S  -  NAIL 11MM 160MM FEM T2 IM,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1118S,SUP,HCPCS C1713,,1825-1118S  -  NAIL 11MM 18CM FEM T2 IM STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1120S,SUP,HCPCS C1713,,1825-1120S  -  NAIL 11MM 20CM FEM T2 IM STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1122S,SUP,HCPCS C1713,,1825-1122S  -  NAIL 11MM 22CM FEM T2 IM STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1124S,SUP,HCPCS C1713,,1825-1124S  -  NAIL 11MM 24CM FEM T2 IM LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1126S,SUP,HCPCS C1713,,1825-1126S  -  NAIL 11MM 26CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1128S,SUP,HCPCS C1713,,1825-1128S  -  NAIL 11MM 280MM FEM T2 IM TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1130S,SUP,HCPCS C1713,,1825-1130S  -  NAIL 11MM 30CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1132S,SUP,HCPCS C1713,,1825-1132S  -  NAIL 11MM 320MM FEM T2 IM,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1134S,SUP,HCPCS C1713,,1825-1134S  -  NAIL 11MM 340MM FEM T2 IM,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1136S,SUP,HCPCS C1713,,1825-1136S  -  NAIL 11MM 36CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1138S,SUP,HCPCS C1713,,1825-1138S  -  NAIL 11MM 38CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1140S,SUP,HCPCS C1713,,1825-1140S  -  NAIL 11MM 40CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1142S,SUP,HCPCS C1713,,1825-1142S  -  NAIL 11MM 42CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1144S,SUP,HCPCS C1713,,1825-1144S  -  NAIL 11MM 44CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1146S,SUP,HCPCS C1713,,1825-1146S  -  NAIL 11MM 46CM FEM T2 IM LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1148S,SUP,HCPCS C1713,,1825-1148S  -  NAIL 11MM 48CM FEM T2 IM LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1214S,SUP,HCPCS C1713,,1825-1214S  -  NAIL 12MM 14CM FEM T2 IM LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1216S,SUP,HCPCS C1713,,1825-1216S  -  NAIL 12MM 160MM FEM T2 IM ANTGRD RTRGRD STR LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1218S,SUP,HCPCS C1713,,1825-1218S  -  NAIL 12MM 18CM FEM T2 IM STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1220S,SUP,HCPCS C1713,,1825-1220S  -  NAIL 12MM 20CM FEM T2 IM STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1222S,SUP,HCPCS C1713,,1825-1222S  -  NAIL 12MM 22CM FEM T2 IM STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1224S,SUP,HCPCS C1713,,1825-1224S  -  NAIL 12MM 24CM FEM T2 IM LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1226S,SUP,HCPCS C1713,,1825-1226S  -  NAIL 12MM 26CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1228S,SUP,HCPCS C1713,,1825-1228S  -  NAIL 12MM 28CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1230S,SUP,HCPCS C1713,,1825-1230S  -  NAIL 12MM 30CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1232S,SUP,HCPCS C1713,,1825-1232S  -  NAIL 12MM 320MM FEM T2 IM TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1234S,SUP,HCPCS C1713,,1825-1234S  -  NAIL 12MM 340MM FEM T2 IM,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1236S,SUP,HCPCS C1713,,1825-1236S  -  NAIL 12MM 36CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1238S,SUP,HCPCS C1713,,1825-1238S  -  NAIL 12MM 38CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1240S,SUP,HCPCS C1713,,1825-1240S  -  NAIL 12MM 400MM FEM T2 IM STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1242S,SUP,HCPCS C1713,,1825-1242S  -  NAIL 12MM 42CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1244S,SUP,HCPCS C1713,,1825-1244S  -  NAIL 12MM 440MM FEM T2 IM,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1246S,SUP,HCPCS C1713,,1825-1246S  -  NAIL 12MM 46CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1248S,SUP,HCPCS C1713,,1825-1248S  -  NAIL 12MM 48CM FEM T2 IM LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1314S,SUP,HCPCS C1713,,1825-1314S  -  NAIL 13MM 140MM FEM T2 IM,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1316S,SUP,HCPCS C1713,,1825-1316S  -  NAIL 13MM 160MM FEM T2 IM,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1318S,SUP,HCPCS C1713,,1825-1318S  -  NAIL 13MM 18CM FEM T2 IM LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1320S,SUP,HCPCS C1713,,1825-1320S  -  NAIL 13MM 20CM FEM T2 IM LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1322S,SUP,HCPCS C1713,,1825-1322S  -  NAIL 13MM 22CM FEM T2 IM LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1324S,SUP,HCPCS C1713,,1825-1324S  -  NAIL 13MM 24CM FEM T2 IM LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1326S,SUP,HCPCS C1713,,1825-1326S  -  NAIL 13MM 26CM FEM T2 IM LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1328S,SUP,HCPCS C1713,,1825-1328S  -  NAIL 13MM 28CM FEM T2 IM LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1330S,SUP,HCPCS C1713,,1825-1330S  -  NAIL 13MM 30CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1332S,SUP,HCPCS C1713,,1825-1332S  -  NAIL 13MM 32CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1334S,SUP,HCPCS C1713,,1825-1334S  -  NAIL 13MM 34CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1336S,SUP,HCPCS C1713,,1825-1336S  -  NAIL 13MM 36CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1338S,SUP,HCPCS C1713,,1825-1338S  -  NAIL 13MM 380MM FEM T2 IM,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1340S,SUP,HCPCS C1713,,1825-1340S  -  NAIL 13MM 40CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1342S,SUP,HCPCS C1713,,1825-1342S  -  NAIL 13MM 42CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1344S,SUP,HCPCS C1713,,1825-1344S  -  NAIL 13MM 440MM FEM T2 IM STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1346S,SUP,HCPCS C1713,,1825-1346S  -  NAIL 13MM 46CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1348S,SUP,HCPCS C1713,,1825-1348S  -  NAIL 13MM 48CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1414S,SUP,HCPCS C1713,,1825-1414S  -  NAIL 14MM 160MM FEM T2 IM,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1416S,SUP,HCPCS C1713,,1825-1416S  -  NAIL 14MM 160MM FEM T2 IM,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1418S,SUP,HCPCS C1713,,1825-1418S  -  NAIL 14MM 18CM FEM T2 IM STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1420S,SUP,HCPCS C1713,,1825-1420S  -  NAIL 14MM 20CM FEM T2 IM STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1422S,SUP,HCPCS C1713,,1825-1422S  -  NAIL 14MM 22CM FEM T2 IM STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1424S,SUP,HCPCS C1713,,1825-1424S  -  NAIL 14MM 24CM FEM T2 IM LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1426S,SUP,HCPCS C1713,,1825-1426S  -  NAIL 14MM 26CM FEM T2 IM LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1428S,SUP,HCPCS C1713,,1825-1428S  -  NAIL 14MM 28CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1430S,SUP,HCPCS C1713,,1825-1430S  -  NAIL 14MM 30CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1432S,SUP,HCPCS C1713,,1825-1432S  -  NAIL 14MM 32CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1434S,SUP,HCPCS C1713,,1825-1434S  -  NAIL 14MM 34CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1436S,SUP,HCPCS C1713,,1825-1436S  -  NAIL 14MM 36CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1438S,SUP,HCPCS C1713,,1825-1438S  -  NAIL 14MM 38CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1440S,SUP,HCPCS C1713,,1825-1440S  -  NAIL 14MM 40CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1442S,SUP,HCPCS C1713,,1825-1442S  -  NAIL 14MM 42CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1444S,SUP,HCPCS C1713,,1825-1444S  -  NAIL 14MM 44CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1446S,SUP,HCPCS C1713,,1825-1446S  -  NAIL 14MM 46CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1448S,SUP,HCPCS C1713,,1825-1448S  -  NAIL 14MM 48CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1514S,SUP,HCPCS C1713,,1825-1514S  -  NAIL 15MM 140MM FEM T2 IM LCK STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1516S,SUP,HCPCS C1713,,1825-1516S  -  NAIL 15MM 160MM FEM T2 IM LCK STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1518S,SUP,HCPCS C1713,,1825-1518S  -  NAIL 15MM 18CM FEM T2 IM STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1520S,SUP,HCPCS C1713,,1825-1520S  -  NAIL 15MM 20CM FEM T2 IM STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1522S,SUP,HCPCS C1713,,1825-1522S  -  NAIL 15MM 22CM FEM T2 IM STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1524S,SUP,HCPCS C1713,,1825-1524S  -  NAIL 15MM 24CM FEM T2 IM STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1526S,SUP,HCPCS C1713,,1825-1526S  -  NAIL 15MM 26CM FEM T2 IM STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1528S,SUP,HCPCS C1713,,1825-1528S  -  NAIL 15MM 28CM FEM T2 IM STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1530S,SUP,HCPCS C1713,,1825-1530S  -  NAIL 15MM 30CM FEM T2 IM STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1532S,SUP,HCPCS C1713,,1825-1532S  -  NAIL 15MM 32CM FEM T2 IM STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1534S,SUP,HCPCS C1713,,1825-1534S  -  NAIL 15MM 34CM FEM T2 IM LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1536S,SUP,HCPCS C1713,,1825-1536S  -  NAIL 15MM 36CM FEM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1538S,SUP,HCPCS C1713,,1825-1538S  -  NAIL 15MM 38CM FEM T2 IM LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1540S,SUP,HCPCS C1713,,1825-1540S  -  NAIL 15MM 400MM FEM T2 IM LCK TI STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1542S,SUP,HCPCS C1713,,1825-1542S  -  NAIL 15MM 420MM FEM T2 IM LCK TI ALLOY STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1544S,SUP,HCPCS C1713,,1825-1544S  -  NAIL 15MM 44CM FEM T2 IM STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1546S,SUP,HCPCS C1713,,1825-1546S  -  NAIL 15MM 46CM FEM T2 IM STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1825-1548S,SUP,HCPCS C1713,,1825-1548S  -  NAIL 15MM 48CM FEM T2 IM STRL,"$2,442.00",$0.00,"$2,442.00","$1,098.90","$1,742.86",$0.00,$420.74,$0.00,$0.00,$427.57,"$2,442.00",$0.00,"$1,221.00","$1,934.06","$1,953.60",$0.00,$382.17,$0.00,$388.77,$0.00
1826-0003S,SUP,HCPCS C1713,,1826-0003S  -  CAP END 4MM ANKL INS ARTHDES NAIL STRL T2 8MM,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1826-0917S,SUP,HCPCS C1713,,1826-0917S  -  NAIL 9MM 17CM SPCNDYL T2 IM SHRT LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-0920S,SUP,HCPCS C1713,,1826-0920S  -  NAIL 9MM 20CM SPCNDYL T2 IM SHRT LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-0924S,SUP,HCPCS C1713,,1826-0924S  -  NAIL 9MM 24CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-0926S,SUP,HCPCS C1713,,1826-0926S  -  NAIL 9MM 26CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-0928S,SUP,HCPCS C1713,,1826-0928S  -  NAIL 9MM 28CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-0930S,SUP,HCPCS C1713,,1826-0930S  -  NAIL 9MM 30CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-0932S,SUP,HCPCS C1713,,1826-0932S  -  NAIL 9MM 32CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-0934S,SUP,HCPCS C1713,,1826-0934S  -  NAIL 9MM 34CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-0936S,SUP,HCPCS C1713,,1826-0936S  -  NAIL 9MM 36CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-0938S,SUP,HCPCS C1713,,1826-0938S  -  NAIL 9MM 38CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-0940S,SUP,HCPCS C1713,,1826-0940S  -  NAIL 9MM 40CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-0942S,SUP,HCPCS C1713,,1826-0942S  -  NAIL 9MM 42CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-0944S,SUP,HCPCS C1713,,1826-0944S  -  NAIL 9MM 440MM SPCNDYL T2 IM,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-1017S,SUP,HCPCS C1713,,1826-1017S  -  NAIL 10MM 17CM SPCNDYL T2 IM SHRT LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-1020S,SUP,HCPCS C1713,,1826-1020S  -  NAIL 10MM 20CM SPCNDYL T2 IM SHRT LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-1024S,SUP,HCPCS C1713,,1826-1024S  -  NAIL 10MM 24CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-1026S,SUP,HCPCS C1713,,1826-1026S  -  NAIL 10MM 26CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-1028S,SUP,HCPCS C1713,,1826-1028S  -  NAIL 10MM 28CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-1030S,SUP,HCPCS C1713,,1826-1030S  -  NAIL 10MM 30CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-1032S,SUP,HCPCS C1713,,1826-1032S  -  NAIL 10MM 32CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-1034S,SUP,HCPCS C1713,,1826-1034S  -  NAIL 10MM 34CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-1036S,SUP,HCPCS C1713,,1826-1036S  -  NAIL 10MM 36CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-1038S,SUP,HCPCS C1713,,1826-1038S  -  NAIL 10MM 38CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-1040S,SUP,HCPCS C1713,,1826-1040S  -  NAIL 10MM 40CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-1042S,SUP,HCPCS C1713,,1826-1042S  -  NAIL 10MM 42CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-1044S,SUP,HCPCS C1713,,1826-1044S  -  NAIL 10MM 44CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-1117S,SUP,HCPCS C1713,,1826-1117S  -  NAIL 11MM 17CM SPCNDYL T2 IM SHRT LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-1120S,SUP,HCPCS C1713,,1826-1120S  -  NAIL 11MM 20CM SPCNDYL T2 IM SHRT LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-1124S,SUP,HCPCS C1713,,1826-1124S  -  NAIL 11MM 24CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-1126S,SUP,HCPCS C1713,,1826-1126S  -  NAIL 11MM 26CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-1128S,SUP,HCPCS C1713,,1826-1128S  -  NAIL 11MM 28CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-1130S,SUP,HCPCS C1713,,1826-1130S  -  NAIL 11MM 30CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-1132S,SUP,HCPCS C1713,,1826-1132S  -  NAIL 11MM 32CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-1134S,SUP,HCPCS C1713,,1826-1134S  -  NAIL 11MM 34CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-1136S,SUP,HCPCS C1713,,1826-1136S  -  NAIL 11MM 36CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-1138S,SUP,HCPCS C1713,,1826-1138S  -  NAIL 11MM 38CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-1140S,SUP,HCPCS C1713,,1826-1140S  -  NAIL 11MM 40CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-1142S,SUP,HCPCS C1713,,1826-1142S  -  NAIL 11MM 42CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-1144S,SUP,HCPCS C1713,,1826-1144S  -  NAIL 11MM 44CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-1217S,SUP,HCPCS C1713,,1826-1217S  -  NAIL 12MM 17CM SPCNDYL T2 IM SHRT LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-1220S,SUP,HCPCS C1713,,1826-1220S  -  NAIL 12MM 20CM SPCNDYL T2 IM SHRT LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-1224S,SUP,HCPCS C1713,,1826-1224S  -  NAIL 12MM 24CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-1226S,SUP,HCPCS C1713,,1826-1226S  -  NAIL 12MM 26CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-1228S,SUP,HCPCS C1713,,1826-1228S  -  NAIL 12MM 28CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-1230S,SUP,HCPCS C1713,,1826-1230S  -  NAIL 12MM 30CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-1232S,SUP,HCPCS C1713,,1826-1232S  -  NAIL 12MM 32CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-1234S,SUP,HCPCS C1713,,1826-1234S  -  NAIL 12MM 34CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-1236S,SUP,HCPCS C1713,,1826-1236S  -  NAIL 12MM 360MM SPCNDYL T2 IM,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-1238S,SUP,HCPCS C1713,,1826-1238S  -  NAIL 12MM 38CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-1240S,SUP,HCPCS C1713,,1826-1240S  -  NAIL 12MM 40CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-1242S,SUP,HCPCS C1713,,1826-1242S  -  NAIL 12MM 42CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-1244S,SUP,HCPCS C1713,,1826-1244S  -  NAIL 12MM 44CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-1317S,SUP,HCPCS C1713,,1826-1317S  -  NAIL 13MM 17CM SPCNDYL T2 IM SHRT LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-1320S,SUP,HCPCS C1713,,1826-1320S  -  NAIL 13MM 200MM SPCNDYL T2 IM SHRT TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-1324S,SUP,HCPCS C1713,,1826-1324S  -  NAIL 13MM 24CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-1326S,SUP,HCPCS C1713,,1826-1326S  -  NAIL 13MM 26CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-1328S,SUP,HCPCS C1713,,1826-1328S  -  NAIL 13MM 28CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-1330S,SUP,HCPCS C1713,,1826-1330S  -  NAIL 13MM 30CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-1332S,SUP,HCPCS C1713,,1826-1332S  -  NAIL 13MM 32CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-1334S,SUP,HCPCS C1713,,1826-1334S  -  NAIL 13MM 34CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-1336S,SUP,HCPCS C1713,,1826-1336S  -  NAIL 13MM 360MM SPCNDYL T2 IM LNG TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-1338S,SUP,HCPCS C1713,,1826-1338S  -  NAIL 13MM 38CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-1340S,SUP,HCPCS C1713,,1826-1340S  -  NAIL 13MM 40CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-1342S,SUP,HCPCS C1713,,1826-1342S  -  NAIL 13MM 42CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-1344S,SUP,HCPCS C1713,,1826-1344S  -  NAIL 13MM 44CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-1417S,SUP,HCPCS C1713,,1826-1417S  -  NAIL 14MM 17CM SPCNDYL T2 IM SHRT LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-1420S,SUP,HCPCS C1713,,1826-1420S  -  NAIL 14MM 20CM SPCNDYL T2 IM SHRT LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-1424S,SUP,HCPCS C1713,,1826-1424S  -  NAIL 14MM 24CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-1426S,SUP,HCPCS C1713,,1826-1426S  -  NAIL 14MM 26CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-1428S,SUP,HCPCS C1713,,1826-1428S  -  NAIL 14MM 28CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-1430S,SUP,HCPCS C1713,,1826-1430S  -  NAIL 14MM 30CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-1432S,SUP,HCPCS C1713,,1826-1432S  -  NAIL 14MM 32CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-1434S,SUP,HCPCS C1713,,1826-1434S  -  NAIL 14MM 34CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-1436S,SUP,HCPCS C1713,,1826-1436S  -  NAIL 14MM 36CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-1438S,SUP,HCPCS C1713,,1826-1438S  -  NAIL 14MM 38CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-1440S,SUP,HCPCS C1713,,1826-1440S  -  NAIL 14MM 40CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-1442S,SUP,HCPCS C1713,,1826-1442S  -  NAIL 14MM 42CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
1826-1444S,SUP,HCPCS C1713,,1826-1444S  -  NAIL 14MM 44CM SPCNDYL T2 IM LNG LCK RTRGRD TI STRL,"$3,022.25",$0.00,"$3,022.25","$1,360.01","$2,156.98",$0.00,$520.72,$0.00,$0.00,$529.17,"$3,022.25",$0.00,"$1,511.13","$2,393.62","$2,417.80",$0.00,$472.98,$0.00,$481.14,$0.00
18-2800,SUP,Custom 27803010,,18-2800  -  HEAD FEMORAL +0MM OFFST C TAPER 28MM HIGH PERFORMANCE BIOLOX,"$1,725.00",$0.00,"$1,725.00",$0.00,"$1,231.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$0.00,$0.00,$0.00,$0.00
18-2805,SUP,Custom 27803010,,18-2805  -  HEAD FEMORAL +5MM OFFST C TAPER 28MM HIGH PERFORMANCE BIOLOX,"$1,725.00",$0.00,"$1,725.00",$0.00,"$1,231.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$0.00,$0.00,$0.00,$0.00
1828-0824S,SUP,HCPCS C1713,,1828-0824S  -  NAIL 8MM 24CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-0826S,SUP,HCPCS C1713,,1828-0826S  -  NAIL 8MM 26CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-0828S,SUP,HCPCS C1713,,1828-0828S  -  NAIL 8MM 28CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-0830S,SUP,HCPCS C1713,,1828-0830S  -  NAIL 8MM 30CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-0832S,SUP,HCPCS C1713,,1828-0832S  -  NAIL 8MM 32CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-0834S,SUP,HCPCS C1713,,1828-0834S  -  NAIL 8MM 34CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-0836S,SUP,HCPCS C1713,,1828-0836S  -  NAIL 8MM 36CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-0838S,SUP,HCPCS C1713,,1828-0838S  -  NAIL 8MM 38CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-0840S,SUP,HCPCS C1713,,1828-0840S  -  NAIL 8MM 40CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-0842S,SUP,HCPCS C1713,,1828-0842S  -  NAIL 8MM 42CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-0844S,SUP,HCPCS C1713,,1828-0844S  -  NAIL 8MM 44CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-0846S,SUP,HCPCS C1713,,1828-0846S  -  NAIL 8MM 46CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-0848S,SUP,HCPCS C1713,,1828-0848S  -  NAIL 8MM 48CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-0924S,SUP,HCPCS C1713,,1828-0924S  -  NAIL 9MM 24CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-0926S,SUP,HCPCS C1713,,1828-0926S  -  NAIL 9MM 26CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-0928S,SUP,HCPCS C1713,,1828-0928S  -  NAIL 9MM 28CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-0930S,SUP,HCPCS C1713,,1828-0930S  -  NAIL 9MM 30CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-0932S,SUP,HCPCS C1713,,1828-0932S  -  NAIL 9MM 32CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-0934S,SUP,HCPCS C1713,,1828-0934S  -  NAIL 9MM 34CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-0936S,SUP,HCPCS C1713,,1828-0936S  -  NAIL 9MM 36CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-0938S,SUP,HCPCS C1713,,1828-0938S  -  NAIL 9MM 38CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-0940S,SUP,HCPCS C1713,,1828-0940S  -  NAIL 9MM 40CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-0942S,SUP,HCPCS C1713,,1828-0942S  -  NAIL 9MM 42CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-0944S,SUP,HCPCS C1713,,1828-0944S  -  NAIL 9MM 44CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-0946S,SUP,HCPCS C1713,,1828-0946S  -  NAIL 9MM 46CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-0948S,SUP,HCPCS C1713,,1828-0948S  -  NAIL 9MM 48CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1024S,SUP,HCPCS C1713,,1828-1024S  -  NAIL 10MM 24CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1026S,SUP,HCPCS C1713,,1828-1026S  -  NAIL 10MM 26CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1028S,SUP,HCPCS C1713,,1828-1028S  -  NAIL 10MM 28CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1030S,SUP,HCPCS C1713,,1828-1030S  -  NAIL 10MM 30CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1032S,SUP,HCPCS C1713,,1828-1032S  -  NAIL 10MM 32CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1034S,SUP,HCPCS C1713,,1828-1034S  -  NAIL 10MM 38CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1036S,SUP,HCPCS C1713,,1828-1036S  -  NAIL 10MM 36CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1038S,SUP,HCPCS C1713,,1828-1038S  -  NAIL 10MM 38CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1040S,SUP,HCPCS C1713,,1828-1040S  -  NAIL 10MM 40CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1042S,SUP,HCPCS C1713,,1828-1042S  -  NAIL 10MM 42CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1044S,SUP,HCPCS C1713,,1828-1044S  -  NAIL 10MM 44CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1046S,SUP,HCPCS C1713,,1828-1046S  -  NAIL 10MM 46CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1048S,SUP,HCPCS C1713,,1828-1048S  -  NAIL 10MM 48CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1124S,SUP,HCPCS C1713,,1828-1124S  -  NAIL 11MM 24CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1126S,SUP,HCPCS C1713,,1828-1126S  -  NAIL 11MM 26CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1128S,SUP,HCPCS C1713,,1828-1128S  -  NAIL 11MM 28CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1130S,SUP,HCPCS C1713,,1828-1130S  -  NAIL 11MM 30CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1132S,SUP,HCPCS C1713,,1828-1132S  -  T2 FEMORAL NAIL R1500 11MMX320MM,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1134S,SUP,HCPCS C1713,,1828-1134S  -  NAIL 11MM 34CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1136S,SUP,HCPCS C1713,,1828-1136S  -  NAIL 11MM 36CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1138S,SUP,HCPCS C1713,,1828-1138S  -  NAIL 11MM 38CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1140S,SUP,HCPCS C1713,,1828-1140S  -  NAIL 11MM 40CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1142S,SUP,HCPCS C1713,,1828-1142S  -  NAIL 11MM 42CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1144S,SUP,HCPCS C1713,,1828-1144S  -  NAIL 11MM 44CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1146S,SUP,HCPCS C1713,,1828-1146S  -  NAIL 11MM 46CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1148S,SUP,HCPCS C1713,,1828-1148S  -  NAIL 11MM 48CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1224S,SUP,HCPCS C1713,,1828-1224S  -  NAIL 12MM 24CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1226S,SUP,HCPCS C1713,,1828-1226S  -  NAIL 12MM 26CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1228S,SUP,HCPCS C1713,,1828-1228S  -  NAIL 12MM 28CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1230S,SUP,HCPCS C1713,,1828-1230S  -  NAIL 12MM 20CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1232S,SUP,HCPCS C1713,,1828-1232S  -  NAIL 12MM 32CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1234S,SUP,HCPCS C1713,,1828-1234S  -  NAIL 12MM 34CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1236S,SUP,HCPCS C1713,,1828-1236S  -  NAIL 12MM 36CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1238S,SUP,HCPCS C1713,,1828-1238S  -  NAIL 12MM 38CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1240S,SUP,HCPCS C1713,,1828-1240S  -  NAIL 12MM 40CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1242S,SUP,HCPCS C1713,,1828-1242S  -  NAIL 12MM 42CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1244S,SUP,HCPCS C1713,,1828-1244S  -  NAIL 12MM 44CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1246S,SUP,HCPCS C1713,,1828-1246S  -  NAIL 12MM 46CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1248S,SUP,HCPCS C1713,,1828-1248S  -  NAIL 12MM 48CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1324S,SUP,HCPCS C1713,,1828-1324S  -  NAIL 13MM 24CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1326S,SUP,HCPCS C1713,,1828-1326S  -  NAIL 13MM 26CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1328S,SUP,HCPCS C1713,,1828-1328S  -  NAIL 13MM 28CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1330S,SUP,HCPCS C1713,,1828-1330S  -  NAIL 13MM 30CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1332S,SUP,HCPCS C1713,,1828-1332S  -  NAIL 13MM 32CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1334S,SUP,HCPCS C1713,,1828-1334S  -  NAIL 13MM 34CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1336S,SUP,HCPCS C1713,,1828-1336S  -  NAIL 13MM 36CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1338S,SUP,HCPCS C1713,,1828-1338S  -  NAIL 13MM 38CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1340S,SUP,HCPCS C1713,,1828-1340S  -  NAIL 13MM 40CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1342S,SUP,HCPCS C1713,,1828-1342S  -  NAIL 13MM 42CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1344S,SUP,HCPCS C1713,,1828-1344S  -  NAIL 13MM 44CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1346S,SUP,HCPCS C1713,,1828-1346S  -  NAIL 13MM 46CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1348S,SUP,HCPCS C1713,,1828-1348S  -  NAIL 13MM 48CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1424S,SUP,HCPCS C1713,,1828-1424S  -  NAIL 14MM 24CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1426S,SUP,HCPCS C1713,,1828-1426S  -  NAIL 14MM 26CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1428S,SUP,HCPCS C1713,,1828-1428S  -  NAIL 14MM 28CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1430S,SUP,HCPCS C1713,,1828-1430S  -  NAIL 14MM 30CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1432S,SUP,HCPCS C1713,,1828-1432S  -  NAIL 14MM 32CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1434S,SUP,HCPCS C1713,,1828-1434S  -  NAIL 14MM 34CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1436S,SUP,HCPCS C1713,,1828-1436S  -  NAIL 14MM 36CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1438S,SUP,HCPCS C1713,,1828-1438S  -  NAIL 14MM 38CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1440S,SUP,HCPCS C1713,,1828-1440S  -  NAIL 14MM 40CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1442S,SUP,HCPCS C1713,,1828-1442S  -  NAIL 14MM 42CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1444S,SUP,HCPCS C1713,,1828-1444S  -  NAIL 14MM 44CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1446S,SUP,HCPCS C1713,,1828-1446S  -  NAIL 14MM 46CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1448S,SUP,HCPCS C1713,,1828-1448S  -  NAIL 14MM 48CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1524S,SUP,HCPCS C1713,,1828-1524S  -  NAIL 15MM 24CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1526S,SUP,HCPCS C1713,,1828-1526S  -  NAIL 15MM 26CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1528S,SUP,HCPCS C1713,,1828-1528S  -  NAIL 15MM 28CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1530S,SUP,HCPCS C1713,,1828-1530S  -  NAIL 15MM 30CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1532S,SUP,HCPCS C1713,,1828-1532S  -  NAIL 15MM 32CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1534S,SUP,HCPCS C1713,,1828-1534S  -  NAIL 15MM 34CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1536S,SUP,HCPCS C1713,,1828-1536S  -  NAIL 15MM 36CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1538S,SUP,HCPCS C1713,,1828-1538S  -  NAIL 15MM 38CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1540S,SUP,HCPCS C1713,,1828-1540S  -  NAIL 15MM 40CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1542S,SUP,HCPCS C1713,,1828-1542S  -  NAIL 15MM 42CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1544S,SUP,HCPCS C1713,,1828-1544S  -  NAIL 15MM 44CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1546S,SUP,HCPCS C1713,,1828-1546S  -  NAIL 15MM 46CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
1828-1548S,SUP,HCPCS C1713,,1828-1548S  -  NAIL 15MM 48CM FEM T2 IM LCK TI STRL R1.5,"$2,601.50",$0.00,"$2,601.50","$1,170.68","$1,856.69",$0.00,$448.23,$0.00,$0.00,$455.50,"$2,601.50",$0.00,"$1,300.75","$2,060.39","$2,081.20",$0.00,$407.13,$0.00,$414.16,$0.00
18-2825,SUP,Custom 27803010,,18-2825  -  HEAD FEMORAL +2.5MM OFFST C TAPER 28MM HIGH PERFORMANCE,"$1,725.00",$0.00,"$1,725.00",$0.00,"$1,231.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$0.00,$0.00,$0.00,$0.00
18-28-3,SUP,Custom 27803010,,18-28-3  -  HEAD FEM -2.5MM OFST CTPR 28MM HPRFR BLX D HIP,"$1,725.00",$0.00,"$1,725.00",$0.00,"$1,231.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$0.00,$0.00,$0.00,$0.00
1829-1104S,SUP,HCPCS C1713,,1829-1104S  -  NAIL 11.5MM 54CM LEFT T2 IM ARTHDES TI STRL,"$8,658.38",$0.00,"$8,658.38","$3,896.27","$5,158.80",$0.00,"$1,491.79",$0.00,$0.00,"$1,516.01","$8,658.38",$0.00,"$4,329.19","$6,857.44","$6,926.70",$0.00,"$1,355.04",$0.00,"$1,378.41",$0.00
1829-1108S,SUP,HCPCS C1713,,1829-1108S  -  NAIL 11.5MM 58CM LEFT T2 IM ARTHDES TI STRL,"$8,658.38",$0.00,"$8,658.38","$3,896.27","$5,158.80",$0.00,"$1,491.79",$0.00,$0.00,"$1,516.01","$8,658.38",$0.00,"$4,329.19","$6,857.44","$6,926.70",$0.00,"$1,355.04",$0.00,"$1,378.41",$0.00
1829-1112S,SUP,HCPCS C1713,,1829-1112S  -  NAIL 11.5MM 62CM LEFT T2 IM ARTHDES TI STRL,"$8,658.38",$0.00,"$8,658.38","$3,896.27","$5,158.80",$0.00,"$1,491.79",$0.00,$0.00,"$1,516.01","$8,658.38",$0.00,"$4,329.19","$6,857.44","$6,926.70",$0.00,"$1,355.04",$0.00,"$1,378.41",$0.00
1829-1116S,SUP,HCPCS C1713,,1829-1116S  -  NAIL 11.5MM 66CM LEFT T2 IM ARTHDES TI STRL,"$8,658.38",$0.00,"$8,658.38","$3,896.27","$5,158.80",$0.00,"$1,491.79",$0.00,$0.00,"$1,516.01","$8,658.38",$0.00,"$4,329.19","$6,857.44","$6,926.70",$0.00,"$1,355.04",$0.00,"$1,378.41",$0.00
1829-1120S,SUP,HCPCS C1713,,1829-1120S  -  NAIL 11.5MM 70CM LEFT T2 IM ARTHDES TI STRL,"$8,658.38",$0.00,"$8,658.38","$3,896.27","$5,158.80",$0.00,"$1,491.79",$0.00,$0.00,"$1,516.01","$8,658.38",$0.00,"$4,329.19","$6,857.44","$6,926.70",$0.00,"$1,355.04",$0.00,"$1,378.41",$0.00
1829-1124S,SUP,HCPCS C1713,,1829-1124S  -  NAIL 11.5MM 74CM LEFT T2 IM ARTHDES TI STRL,"$8,658.38",$0.00,"$8,658.38","$3,896.27","$5,158.80",$0.00,"$1,491.79",$0.00,$0.00,"$1,516.01","$8,658.38",$0.00,"$4,329.19","$6,857.44","$6,926.70",$0.00,"$1,355.04",$0.00,"$1,378.41",$0.00
1829-1128S,SUP,HCPCS C1713,,1829-1128S  -  NAIL 11.5MM 78CM LEFT T2 IM ARTHDES TI STRL,"$8,658.38",$0.00,"$8,658.38","$3,896.27","$5,158.80",$0.00,"$1,491.79",$0.00,$0.00,"$1,516.01","$8,658.38",$0.00,"$4,329.19","$6,857.44","$6,926.70",$0.00,"$1,355.04",$0.00,"$1,378.41",$0.00
1829-1154S,SUP,HCPCS C1713,,1829-1154S  -  NAIL 11.5MM 54CM RIGHT T2 IM ARTHDES TI STRL,"$8,658.38",$0.00,"$8,658.38","$3,896.27","$5,158.80",$0.00,"$1,491.79",$0.00,$0.00,"$1,516.01","$8,658.38",$0.00,"$4,329.19","$6,857.44","$6,926.70",$0.00,"$1,355.04",$0.00,"$1,378.41",$0.00
1829-1158S,SUP,HCPCS C1713,,1829-1158S  -  NAIL 11.5MM 58CM RIGHT T2 IM ARTHDES TI STRL,"$8,658.38",$0.00,"$8,658.38","$3,896.27","$5,158.80",$0.00,"$1,491.79",$0.00,$0.00,"$1,516.01","$8,658.38",$0.00,"$4,329.19","$6,857.44","$6,926.70",$0.00,"$1,355.04",$0.00,"$1,378.41",$0.00
1829-1162S,SUP,HCPCS C1713,,1829-1162S  -  NAIL 11.5MM 62CM RIGHT T2 IM ARTHDES TI STRL,"$8,658.38",$0.00,"$8,658.38","$3,896.27","$5,158.80",$0.00,"$1,491.79",$0.00,$0.00,"$1,516.01","$8,658.38",$0.00,"$4,329.19","$6,857.44","$6,926.70",$0.00,"$1,355.04",$0.00,"$1,378.41",$0.00
1829-1166S,SUP,HCPCS C1713,,1829-1166S  -  NAIL 11.5MM 66CM RIGHT T2 IM ARTHDES TI STRL,"$8,658.38",$0.00,"$8,658.38","$3,896.27","$5,158.80",$0.00,"$1,491.79",$0.00,$0.00,"$1,516.01","$8,658.38",$0.00,"$4,329.19","$6,857.44","$6,926.70",$0.00,"$1,355.04",$0.00,"$1,378.41",$0.00
1829-1170S,SUP,HCPCS C1713,,1829-1170S  -  NAIL 11.5MM 70CM RIGHT T2 IM ARTHDES TI STRL,"$8,658.38",$0.00,"$8,658.38","$3,896.27","$5,158.80",$0.00,"$1,491.79",$0.00,$0.00,"$1,516.01","$8,658.38",$0.00,"$4,329.19","$6,857.44","$6,926.70",$0.00,"$1,355.04",$0.00,"$1,378.41",$0.00
1829-1174S,SUP,HCPCS C1713,,1829-1174S  -  NAIL 11.5MM 75CM RIGHT T2 IM ARTHDES TI STRL,"$8,658.38",$0.00,"$8,658.38","$3,896.27","$5,158.80",$0.00,"$1,491.79",$0.00,$0.00,"$1,516.01","$8,658.38",$0.00,"$4,329.19","$6,857.44","$6,926.70",$0.00,"$1,355.04",$0.00,"$1,378.41",$0.00
1829-1178S,SUP,HCPCS C1713,,1829-1178S  -  NAIL 11.5MM 78CM RIGHT T2 IM ARTHDES TI STRL,"$8,658.38",$0.00,"$8,658.38","$3,896.27","$5,158.80",$0.00,"$1,491.79",$0.00,$0.00,"$1,516.01","$8,658.38",$0.00,"$4,329.19","$6,857.44","$6,926.70",$0.00,"$1,355.04",$0.00,"$1,378.41",$0.00
1829-1304S,SUP,HCPCS C1713,,1829-1304S  -  NAIL 13MM 54CM LEFT T2 IM ARTHDES TI STRL,"$8,658.38",$0.00,"$8,658.38","$3,896.27","$5,158.80",$0.00,"$1,491.79",$0.00,$0.00,"$1,516.01","$8,658.38",$0.00,"$4,329.19","$6,857.44","$6,926.70",$0.00,"$1,355.04",$0.00,"$1,378.41",$0.00
1829-1308S,SUP,HCPCS C1713,,1829-1308S  -  NAIL 13MM 58CM LEFT T2 IM ARTHDES TI STRL,"$8,658.38",$0.00,"$8,658.38","$3,896.27","$5,158.80",$0.00,"$1,491.79",$0.00,$0.00,"$1,516.01","$8,658.38",$0.00,"$4,329.19","$6,857.44","$6,926.70",$0.00,"$1,355.04",$0.00,"$1,378.41",$0.00
1829-1312S,SUP,HCPCS C1713,,1829-1312S  -  NAIL 13MM 62CM LEFT T2 IM ARTHDES TI STRL,"$8,658.38",$0.00,"$8,658.38","$3,896.27","$5,158.80",$0.00,"$1,491.79",$0.00,$0.00,"$1,516.01","$8,658.38",$0.00,"$4,329.19","$6,857.44","$6,926.70",$0.00,"$1,355.04",$0.00,"$1,378.41",$0.00
1829-1316S,SUP,HCPCS C1713,,1829-1316S  -  NAIL 13MM 66CM LEFT T2 IM ARTHDES TI STRL,"$8,658.38",$0.00,"$8,658.38","$3,896.27","$5,158.80",$0.00,"$1,491.79",$0.00,$0.00,"$1,516.01","$8,658.38",$0.00,"$4,329.19","$6,857.44","$6,926.70",$0.00,"$1,355.04",$0.00,"$1,378.41",$0.00
1829-1320S,SUP,HCPCS C1713,,1829-1320S  -  NAIL 13MM 70CM LEFT T2 IM ARTHDES TI STRL,"$8,658.38",$0.00,"$8,658.38","$3,896.27","$5,158.80",$0.00,"$1,491.79",$0.00,$0.00,"$1,516.01","$8,658.38",$0.00,"$4,329.19","$6,857.44","$6,926.70",$0.00,"$1,355.04",$0.00,"$1,378.41",$0.00
1829-1324S,SUP,HCPCS C1713,,1829-1324S  -  NAIL 13MM 74CM LEFT T2 IM ARTHDES TI STRL,"$8,658.38",$0.00,"$8,658.38","$3,896.27","$5,158.80",$0.00,"$1,491.79",$0.00,$0.00,"$1,516.01","$8,658.38",$0.00,"$4,329.19","$6,857.44","$6,926.70",$0.00,"$1,355.04",$0.00,"$1,378.41",$0.00
1829-1328S,SUP,HCPCS C1713,,1829-1328S  -  NAIL 13MM 78CM LEFT T2 IM ARTHDES TI STRL,"$8,658.38",$0.00,"$8,658.38","$3,896.27","$5,158.80",$0.00,"$1,491.79",$0.00,$0.00,"$1,516.01","$8,658.38",$0.00,"$4,329.19","$6,857.44","$6,926.70",$0.00,"$1,355.04",$0.00,"$1,378.41",$0.00
1829-1354S,SUP,HCPCS C1713,,1829-1354S  -  NAIL 13MM 54CM RIGHT T2 IM ARTHDES TI STRL,"$8,658.38",$0.00,"$8,658.38","$3,896.27","$5,158.80",$0.00,"$1,491.79",$0.00,$0.00,"$1,516.01","$8,658.38",$0.00,"$4,329.19","$6,857.44","$6,926.70",$0.00,"$1,355.04",$0.00,"$1,378.41",$0.00
1829-1358S,SUP,HCPCS C1713,,1829-1358S  -  NAIL 13MM 58CM RIGHT T2 IM ARTHDES TI STRL,"$8,658.38",$0.00,"$8,658.38","$3,896.27","$5,158.80",$0.00,"$1,491.79",$0.00,$0.00,"$1,516.01","$8,658.38",$0.00,"$4,329.19","$6,857.44","$6,926.70",$0.00,"$1,355.04",$0.00,"$1,378.41",$0.00
1829-1362S,SUP,HCPCS C1713,,1829-1362S  -  NAIL 13MM 62CM RIGHT T2 IM ARTHDES TI STRL,"$8,658.38",$0.00,"$8,658.38","$3,896.27","$5,158.80",$0.00,"$1,491.79",$0.00,$0.00,"$1,516.01","$8,658.38",$0.00,"$4,329.19","$6,857.44","$6,926.70",$0.00,"$1,355.04",$0.00,"$1,378.41",$0.00
1829-1366S,SUP,HCPCS C1713,,1829-1366S  -  NAIL 13MM 66CM RIGHT T2 IM ARTHDES TI STRL,"$8,658.38",$0.00,"$8,658.38","$3,896.27","$5,158.80",$0.00,"$1,491.79",$0.00,$0.00,"$1,516.01","$8,658.38",$0.00,"$4,329.19","$6,857.44","$6,926.70",$0.00,"$1,355.04",$0.00,"$1,378.41",$0.00
1829-1370S,SUP,HCPCS C1713,,1829-1370S  -  NAIL 13MM 70CM RIGHT T2 IM ARTHDES TI STRL,"$8,658.38",$0.00,"$8,658.38","$3,896.27","$5,158.80",$0.00,"$1,491.79",$0.00,$0.00,"$1,516.01","$8,658.38",$0.00,"$4,329.19","$6,857.44","$6,926.70",$0.00,"$1,355.04",$0.00,"$1,378.41",$0.00
1829-1374S,SUP,HCPCS C1713,,1829-1374S  -  NAIL 13MM 74CM RIGHT T2 IM ARTHDES TI STRL,"$8,658.38",$0.00,"$8,658.38","$3,896.27","$5,158.80",$0.00,"$1,491.79",$0.00,$0.00,"$1,516.01","$8,658.38",$0.00,"$4,329.19","$6,857.44","$6,926.70",$0.00,"$1,355.04",$0.00,"$1,378.41",$0.00
1829-1378S,SUP,HCPCS C1713,,1829-1378S  -  NAIL 13MM 78CM RIGHT T2 IM ARTHDES TI STRL,"$8,658.38",$0.00,"$8,658.38","$3,896.27","$5,158.80",$0.00,"$1,491.79",$0.00,$0.00,"$1,516.01","$8,658.38",$0.00,"$4,329.19","$6,857.44","$6,926.70",$0.00,"$1,355.04",$0.00,"$1,378.41",$0.00
1829-2004S,SUP,HCPCS C1713,,1829-2004S  -  NAIL 10MM 54CM LEFT T2 IM ARTHDES TI STRL,"$8,658.38",$0.00,"$8,658.38","$3,896.27","$5,158.80",$0.00,"$1,491.79",$0.00,$0.00,"$1,516.01","$8,658.38",$0.00,"$4,329.19","$6,857.44","$6,926.70",$0.00,"$1,355.04",$0.00,"$1,378.41",$0.00
1829-2008S,SUP,HCPCS C1713,,1829-2008S  -  NAIL 10MM 58CM LEFT T2 IM ARTHDES TI STRL,"$8,658.38",$0.00,"$8,658.38","$3,896.27","$5,158.80",$0.00,"$1,491.79",$0.00,$0.00,"$1,516.01","$8,658.38",$0.00,"$4,329.19","$6,857.44","$6,926.70",$0.00,"$1,355.04",$0.00,"$1,378.41",$0.00
1829-2012S,SUP,HCPCS C1713,,1829-2012S  -  NAIL 10MM 62CM LEFT T2 IM ARTHDES TI STRL,"$8,658.38",$0.00,"$8,658.38","$3,896.27","$5,158.80",$0.00,"$1,491.79",$0.00,$0.00,"$1,516.01","$8,658.38",$0.00,"$4,329.19","$6,857.44","$6,926.70",$0.00,"$1,355.04",$0.00,"$1,378.41",$0.00
1829-2016S,SUP,HCPCS C1713,,1829-2016S  -  NAIL 10MM 66CM LEFT T2 IM ARTHDES TI STRL,"$8,658.38",$0.00,"$8,658.38","$3,896.27","$5,158.80",$0.00,"$1,491.79",$0.00,$0.00,"$1,516.01","$8,658.38",$0.00,"$4,329.19","$6,857.44","$6,926.70",$0.00,"$1,355.04",$0.00,"$1,378.41",$0.00
1829-2020S,SUP,HCPCS C1713,,1829-2020S  -  NAIL 10MM 70CM LEFT T2 IM ARTHDES TI STRL,"$8,658.38",$0.00,"$8,658.38","$3,896.27","$5,158.80",$0.00,"$1,491.79",$0.00,$0.00,"$1,516.01","$8,658.38",$0.00,"$4,329.19","$6,857.44","$6,926.70",$0.00,"$1,355.04",$0.00,"$1,378.41",$0.00
1829-2024S,SUP,HCPCS C1713,,1829-2024S  -  NAIL 10MM 74CM LEFT T2 IM ARTHDES TI STRL,"$8,658.38",$0.00,"$8,658.38","$3,896.27","$5,158.80",$0.00,"$1,491.79",$0.00,$0.00,"$1,516.01","$8,658.38",$0.00,"$4,329.19","$6,857.44","$6,926.70",$0.00,"$1,355.04",$0.00,"$1,378.41",$0.00
1829-2028S,SUP,HCPCS C1713,,1829-2028S  -  NAIL 10MM 78CM LEFT T2 IM ARTHDES TI STRL,"$8,658.38",$0.00,"$8,658.38","$3,896.27","$5,158.80",$0.00,"$1,491.79",$0.00,$0.00,"$1,516.01","$8,658.38",$0.00,"$4,329.19","$6,857.44","$6,926.70",$0.00,"$1,355.04",$0.00,"$1,378.41",$0.00
1829-2054S,SUP,HCPCS C1713,,1829-2054S  -  NAIL 10MM 54CM RIGHT T2 IM ARTHDES TI STRL,"$8,658.38",$0.00,"$8,658.38","$3,896.27","$5,158.80",$0.00,"$1,491.79",$0.00,$0.00,"$1,516.01","$8,658.38",$0.00,"$4,329.19","$6,857.44","$6,926.70",$0.00,"$1,355.04",$0.00,"$1,378.41",$0.00
1829-2058S,SUP,HCPCS C1713,,1829-2058S  -  NAIL 10MM 58CM RIGHT T2 IM ARTHDES TI STRL,"$8,658.38",$0.00,"$8,658.38","$3,896.27","$5,158.80",$0.00,"$1,491.79",$0.00,$0.00,"$1,516.01","$8,658.38",$0.00,"$4,329.19","$6,857.44","$6,926.70",$0.00,"$1,355.04",$0.00,"$1,378.41",$0.00
1829-2062S,SUP,HCPCS C1713,,1829-2062S  -  NAIL 10MM 62CM RIGHT T2 IM ARTHDES TI STRL,"$8,658.38",$0.00,"$8,658.38","$3,896.27","$5,158.80",$0.00,"$1,491.79",$0.00,$0.00,"$1,516.01","$8,658.38",$0.00,"$4,329.19","$6,857.44","$6,926.70",$0.00,"$1,355.04",$0.00,"$1,378.41",$0.00
1829-2066S,SUP,HCPCS C1713,,1829-2066S  -  NAIL 10MM 66CM RIGHT T2 IM ARTHDES TI STRL,"$8,658.38",$0.00,"$8,658.38","$3,896.27","$5,158.80",$0.00,"$1,491.79",$0.00,$0.00,"$1,516.01","$8,658.38",$0.00,"$4,329.19","$6,857.44","$6,926.70",$0.00,"$1,355.04",$0.00,"$1,378.41",$0.00
1829-2070S,SUP,HCPCS C1713,,1829-2070S  -  NAIL 10MM 70CM RIGHT T2 IM ARTHDES TI STRL,"$8,658.38",$0.00,"$8,658.38","$3,896.27","$5,158.80",$0.00,"$1,491.79",$0.00,$0.00,"$1,516.01","$8,658.38",$0.00,"$4,329.19","$6,857.44","$6,926.70",$0.00,"$1,355.04",$0.00,"$1,378.41",$0.00
1829-2074S,SUP,HCPCS C1713,,1829-2074S  -  NAIL 10MM 74CM RIGHT T2 IM ARTHDES TI STRL,"$8,658.38",$0.00,"$8,658.38","$3,896.27","$5,158.80",$0.00,"$1,491.79",$0.00,$0.00,"$1,516.01","$8,658.38",$0.00,"$4,329.19","$6,857.44","$6,926.70",$0.00,"$1,355.04",$0.00,"$1,378.41",$0.00
1829-2078S,SUP,HCPCS C1713,,1829-2078S  -  NAIL 10MM 78CM RIGHT T2 IM ARTHDES TI STRL,"$8,658.38",$0.00,"$8,658.38","$3,896.27","$5,158.80",$0.00,"$1,491.79",$0.00,$0.00,"$1,516.01","$8,658.38",$0.00,"$4,329.19","$6,857.44","$6,926.70",$0.00,"$1,355.04",$0.00,"$1,378.41",$0.00
1830-0001S,SUP,HCPCS C1713,,1830-0001S  -  SCREW BONE T2 TI CMPR ADV STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1830-0003S,SUP,HCPCS C1713,,1830-0003S  -  CAP END 6MM HUM IM NAIL TI STRL T2 9MM,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1830-0005S,SUP,HCPCS C1713,,1830-0005S  -  CAP END +5MM HUM IM NAIL TI STRL T2 9MM,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1830-0008S,SUP,HCPCS C1713,,1830-0008S  -  WASHER HUM RND T2 ORTH TI IM NAIL STRL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1830-0009S,SUP,HCPCS C1713,,1830-0009S  -  WASHER HUM SQ T2 ORTH TI IM NAIL STRL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1830-0010S,SUP,HCPCS C1713,,1830-0010S  -  CAP END +10MM HUM IM NAIL TI STRL T2,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1830-0015S,SUP,HCPCS C1713,,1830-0015S  -  CAP END +15MM HUM IM NAIL TI STRL T2,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1830-0020S,SUP,HCPCS C1713,,1830-0020S  -  CAP END +20MM HUM IM NAIL TI STRL T2,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1830-0025S,SUP,HCPCS C1713,,1830-0025S  -  CAP END +25MM HUM IM NAIL TI STRL T2,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1830-0714S,SUP,HCPCS C1713,,1830-0714S  -  NAIL 7MM 14CM HUM T2 IM LCK TI STRL,"$2,406.25",$0.00,"$2,406.25","$1,082.81","$1,717.34",$0.00,$414.58,$0.00,$0.00,$421.32,"$2,406.25",$0.00,"$1,203.13","$1,905.75","$1,925.00",$0.00,$376.58,$0.00,$383.08,$0.00
1830-0716S,SUP,HCPCS C1713,,1830-0716S  -  NAIL 7MM 16CM HUM T2 IM LCK TI STRL,"$2,406.25",$0.00,"$2,406.25","$1,082.81","$1,717.34",$0.00,$414.58,$0.00,$0.00,$421.32,"$2,406.25",$0.00,"$1,203.13","$1,905.75","$1,925.00",$0.00,$376.58,$0.00,$383.08,$0.00
1830-0718S,SUP,HCPCS C1713,,1830-0718S  -  NAIL 7MM 18CM HUM T2 IM LCK TI STRL,"$2,406.25",$0.00,"$2,406.25","$1,082.81","$1,717.34",$0.00,$414.58,$0.00,$0.00,$421.32,"$2,406.25",$0.00,"$1,203.13","$1,905.75","$1,925.00",$0.00,$376.58,$0.00,$383.08,$0.00
1830-0719S,SUP,HCPCS C1713,,1830-0719S  -  NAIL 7MM 19CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,406.25",$0.00,"$2,406.25","$1,082.81","$1,717.34",$0.00,$414.58,$0.00,$0.00,$421.32,"$2,406.25",$0.00,"$1,203.13","$1,905.75","$1,925.00",$0.00,$376.58,$0.00,$383.08,$0.00
1830-0720S,SUP,HCPCS C1713,,1830-0720S  -  NAIL 7MM 20CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,406.25",$0.00,"$2,406.25","$1,082.81","$1,717.34",$0.00,$414.58,$0.00,$0.00,$421.32,"$2,406.25",$0.00,"$1,203.13","$1,905.75","$1,925.00",$0.00,$376.58,$0.00,$383.08,$0.00
1830-0721S,SUP,HCPCS C1713,,1830-0721S  -  NAIL 7MM 21CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,406.25",$0.00,"$2,406.25","$1,082.81","$1,717.34",$0.00,$414.58,$0.00,$0.00,$421.32,"$2,406.25",$0.00,"$1,203.13","$1,905.75","$1,925.00",$0.00,$376.58,$0.00,$383.08,$0.00
1830-0722S,SUP,HCPCS C1713,,1830-0722S  -  NAIL 7MM 22CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,406.25",$0.00,"$2,406.25","$1,082.81","$1,717.34",$0.00,$414.58,$0.00,$0.00,$421.32,"$2,406.25",$0.00,"$1,203.13","$1,905.75","$1,925.00",$0.00,$376.58,$0.00,$383.08,$0.00
1830-0723S,SUP,HCPCS C1713,,1830-0723S  -  NAIL 7MM 23CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,406.25",$0.00,"$2,406.25","$1,082.81","$1,717.34",$0.00,$414.58,$0.00,$0.00,$421.32,"$2,406.25",$0.00,"$1,203.13","$1,905.75","$1,925.00",$0.00,$376.58,$0.00,$383.08,$0.00
1830-0724S,SUP,HCPCS C1713,,1830-0724S  -  NAIL 7MM 24CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,406.25",$0.00,"$2,406.25","$1,082.81","$1,717.34",$0.00,$414.58,$0.00,$0.00,$421.32,"$2,406.25",$0.00,"$1,203.13","$1,905.75","$1,925.00",$0.00,$376.58,$0.00,$383.08,$0.00
1830-0725S,SUP,HCPCS C1713,,1830-0725S  -  NAIL 7MM 25CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,406.25",$0.00,"$2,406.25","$1,082.81","$1,717.34",$0.00,$414.58,$0.00,$0.00,$421.32,"$2,406.25",$0.00,"$1,203.13","$1,905.75","$1,925.00",$0.00,$376.58,$0.00,$383.08,$0.00
1830-0726S,SUP,HCPCS C1713,,1830-0726S  -  NAIL 7MM 26CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,406.25",$0.00,"$2,406.25","$1,082.81","$1,717.34",$0.00,$414.58,$0.00,$0.00,$421.32,"$2,406.25",$0.00,"$1,203.13","$1,905.75","$1,925.00",$0.00,$376.58,$0.00,$383.08,$0.00
1830-0727S,SUP,HCPCS C1713,,1830-0727S  -  NAIL 7MM 27CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,406.25",$0.00,"$2,406.25","$1,082.81","$1,717.34",$0.00,$414.58,$0.00,$0.00,$421.32,"$2,406.25",$0.00,"$1,203.13","$1,905.75","$1,925.00",$0.00,$376.58,$0.00,$383.08,$0.00
1830-0728S,SUP,HCPCS C1713,,1830-0728S  -  NAIL 7MM 28CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,406.25",$0.00,"$2,406.25","$1,082.81","$1,717.34",$0.00,$414.58,$0.00,$0.00,$421.32,"$2,406.25",$0.00,"$1,203.13","$1,905.75","$1,925.00",$0.00,$376.58,$0.00,$383.08,$0.00
1830-0729S,SUP,HCPCS C1713,,1830-0729S  -  NAIL 7MM 29CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,406.25",$0.00,"$2,406.25","$1,082.81","$1,717.34",$0.00,$414.58,$0.00,$0.00,$421.32,"$2,406.25",$0.00,"$1,203.13","$1,905.75","$1,925.00",$0.00,$376.58,$0.00,$383.08,$0.00
1830-0730S,SUP,HCPCS C1713,,1830-0730S  -  NAIL 7MM 30CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,406.25",$0.00,"$2,406.25","$1,082.81","$1,717.34",$0.00,$414.58,$0.00,$0.00,$421.32,"$2,406.25",$0.00,"$1,203.13","$1,905.75","$1,925.00",$0.00,$376.58,$0.00,$383.08,$0.00
1830-0731S,SUP,HCPCS C1713,,1830-0731S  -  NAIL 7MM 31CM HUM T2 IM ANTGRD/RTRGRD LCK TI STRL,"$2,406.25",$0.00,"$2,406.25","$1,082.81","$1,717.34",$0.00,$414.58,$0.00,$0.00,$421.32,"$2,406.25",$0.00,"$1,203.13","$1,905.75","$1,925.00",$0.00,$376.58,$0.00,$383.08,$0.00
1830-0732S,SUP,HCPCS C1713,,1830-0732S  -  NAIL 7MM 32CM HUM T2 IM ANTGRD/RTRGRD LCK TI STRL,"$2,406.25",$0.00,"$2,406.25","$1,082.81","$1,717.34",$0.00,$414.58,$0.00,$0.00,$421.32,"$2,406.25",$0.00,"$1,203.13","$1,905.75","$1,925.00",$0.00,$376.58,$0.00,$383.08,$0.00
1830-0814S,SUP,HCPCS C1713,,1830-0814S  -  NAIL 8MM 14CM HUM T2 IM ANTGRD/RTRGRD LCK TI STRL,"$2,406.25",$0.00,"$2,406.25","$1,082.81","$1,717.34",$0.00,$414.58,$0.00,$0.00,$421.32,"$2,406.25",$0.00,"$1,203.13","$1,905.75","$1,925.00",$0.00,$376.58,$0.00,$383.08,$0.00
1830-0816S,SUP,HCPCS C1713,,1830-0816S  -  NAIL 8MM 16CM HUM T2 IM ANTGRD/RTRGRD LCK TI STRL,"$2,406.25",$0.00,"$2,406.25","$1,082.81","$1,717.34",$0.00,$414.58,$0.00,$0.00,$421.32,"$2,406.25",$0.00,"$1,203.13","$1,905.75","$1,925.00",$0.00,$376.58,$0.00,$383.08,$0.00
1830-0818S,SUP,HCPCS C1713,,1830-0818S  -  NAIL 8MM 18CM HUM T2 IM ANTGRD/RTRGRD LCK TI STRL,"$2,406.25",$0.00,"$2,406.25","$1,082.81","$1,717.34",$0.00,$414.58,$0.00,$0.00,$421.32,"$2,406.25",$0.00,"$1,203.13","$1,905.75","$1,925.00",$0.00,$376.58,$0.00,$383.08,$0.00
1830-0819S,SUP,HCPCS C1713,,1830-0819S  -  NAIL 8MM 19CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,406.25",$0.00,"$2,406.25","$1,082.81","$1,717.34",$0.00,$414.58,$0.00,$0.00,$421.32,"$2,406.25",$0.00,"$1,203.13","$1,905.75","$1,925.00",$0.00,$376.58,$0.00,$383.08,$0.00
1830-0820S,SUP,HCPCS C1713,,1830-0820S  -  NAIL 8MM 20CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,406.25",$0.00,"$2,406.25","$1,082.81","$1,717.34",$0.00,$414.58,$0.00,$0.00,$421.32,"$2,406.25",$0.00,"$1,203.13","$1,905.75","$1,925.00",$0.00,$376.58,$0.00,$383.08,$0.00
1830-0821S,SUP,HCPCS C1713,,1830-0821S  -  NAIL 8MM 21CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,406.25",$0.00,"$2,406.25","$1,082.81","$1,717.34",$0.00,$414.58,$0.00,$0.00,$421.32,"$2,406.25",$0.00,"$1,203.13","$1,905.75","$1,925.00",$0.00,$376.58,$0.00,$383.08,$0.00
1830-0822S,SUP,HCPCS C1713,,1830-0822S  -  NAIL 8MM 22CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,406.25",$0.00,"$2,406.25","$1,082.81","$1,717.34",$0.00,$414.58,$0.00,$0.00,$421.32,"$2,406.25",$0.00,"$1,203.13","$1,905.75","$1,925.00",$0.00,$376.58,$0.00,$383.08,$0.00
1830-0823S,SUP,HCPCS C1713,,1830-0823S  -  NAIL 8MM 23CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,406.25",$0.00,"$2,406.25","$1,082.81","$1,717.34",$0.00,$414.58,$0.00,$0.00,$421.32,"$2,406.25",$0.00,"$1,203.13","$1,905.75","$1,925.00",$0.00,$376.58,$0.00,$383.08,$0.00
1830-0824S,SUP,HCPCS C1713,,1830-0824S  -  NAIL 8MM 24CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,406.25",$0.00,"$2,406.25","$1,082.81","$1,717.34",$0.00,$414.58,$0.00,$0.00,$421.32,"$2,406.25",$0.00,"$1,203.13","$1,905.75","$1,925.00",$0.00,$376.58,$0.00,$383.08,$0.00
1830-0825S,SUP,HCPCS C1713,,1830-0825S  -  NAIL 8MM 25CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,406.25",$0.00,"$2,406.25","$1,082.81","$1,717.34",$0.00,$414.58,$0.00,$0.00,$421.32,"$2,406.25",$0.00,"$1,203.13","$1,905.75","$1,925.00",$0.00,$376.58,$0.00,$383.08,$0.00
1830-0826S,SUP,HCPCS C1713,,1830-0826S  -  NAIL 8MM 26CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,406.25",$0.00,"$2,406.25","$1,082.81","$1,717.34",$0.00,$414.58,$0.00,$0.00,$421.32,"$2,406.25",$0.00,"$1,203.13","$1,905.75","$1,925.00",$0.00,$376.58,$0.00,$383.08,$0.00
1830-0827S,SUP,HCPCS C1713,,1830-0827S  -  NAIL 8MM 27CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,406.25",$0.00,"$2,406.25","$1,082.81","$1,717.34",$0.00,$414.58,$0.00,$0.00,$421.32,"$2,406.25",$0.00,"$1,203.13","$1,905.75","$1,925.00",$0.00,$376.58,$0.00,$383.08,$0.00
1830-0828S,SUP,HCPCS C1713,,1830-0828S  -  NAIL 8MM 28CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,406.25",$0.00,"$2,406.25","$1,082.81","$1,717.34",$0.00,$414.58,$0.00,$0.00,$421.32,"$2,406.25",$0.00,"$1,203.13","$1,905.75","$1,925.00",$0.00,$376.58,$0.00,$383.08,$0.00
1830-0829S,SUP,HCPCS C1713,,1830-0829S  -  NAIL 8MM 29CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,406.25",$0.00,"$2,406.25","$1,082.81","$1,717.34",$0.00,$414.58,$0.00,$0.00,$421.32,"$2,406.25",$0.00,"$1,203.13","$1,905.75","$1,925.00",$0.00,$376.58,$0.00,$383.08,$0.00
1830-0830S,SUP,HCPCS C1713,,1830-0830S  -  NAIL 8MM 30CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,406.25",$0.00,"$2,406.25","$1,082.81","$1,717.34",$0.00,$414.58,$0.00,$0.00,$421.32,"$2,406.25",$0.00,"$1,203.13","$1,905.75","$1,925.00",$0.00,$376.58,$0.00,$383.08,$0.00
1830-0831S,SUP,HCPCS C1713,,1830-0831S  -  NAIL 8MM 31CM HUM T2 IM ANTGRD/RTRGRD LCK TI STRL,"$2,406.25",$0.00,"$2,406.25","$1,082.81","$1,717.34",$0.00,$414.58,$0.00,$0.00,$421.32,"$2,406.25",$0.00,"$1,203.13","$1,905.75","$1,925.00",$0.00,$376.58,$0.00,$383.08,$0.00
1830-0832S,SUP,HCPCS C1713,,1830-0832S  -  NAIL 8MM 32CM HUM T2 IM ANTGRD/RTRGRD LCK TI STRL,"$2,406.25",$0.00,"$2,406.25","$1,082.81","$1,717.34",$0.00,$414.58,$0.00,$0.00,$421.32,"$2,406.25",$0.00,"$1,203.13","$1,905.75","$1,925.00",$0.00,$376.58,$0.00,$383.08,$0.00
1830-0914S,SUP,HCPCS C1713,,1830-0914S  -  NAIL 9MM 14CM HUM T2 IM ANTGRD/RTRGRD LCK TI STRL,"$2,406.25",$0.00,"$2,406.25","$1,082.81","$1,717.34",$0.00,$414.58,$0.00,$0.00,$421.32,"$2,406.25",$0.00,"$1,203.13","$1,905.75","$1,925.00",$0.00,$376.58,$0.00,$383.08,$0.00
1830-0916S,SUP,HCPCS C1713,,1830-0916S  -  NAIL 9MM 16CM HUM T2 IM ANTGRD/RTRGRD LCK TI STRL,"$2,406.25",$0.00,"$2,406.25","$1,082.81","$1,717.34",$0.00,$414.58,$0.00,$0.00,$421.32,"$2,406.25",$0.00,"$1,203.13","$1,905.75","$1,925.00",$0.00,$376.58,$0.00,$383.08,$0.00
1830-0918S,SUP,HCPCS C1713,,1830-0918S  -  NAIL 9MM 18CM HUM T2 IM ANTGRD/RTRGRD LCK TI STRL,"$2,406.25",$0.00,"$2,406.25","$1,082.81","$1,717.34",$0.00,$414.58,$0.00,$0.00,$421.32,"$2,406.25",$0.00,"$1,203.13","$1,905.75","$1,925.00",$0.00,$376.58,$0.00,$383.08,$0.00
1830-0919S,SUP,HCPCS C1713,,1830-0919S  -  NAIL 9MM 19CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,406.25",$0.00,"$2,406.25","$1,082.81","$1,717.34",$0.00,$414.58,$0.00,$0.00,$421.32,"$2,406.25",$0.00,"$1,203.13","$1,905.75","$1,925.00",$0.00,$376.58,$0.00,$383.08,$0.00
1830-0920S,SUP,HCPCS C1713,,1830-0920S  -  NAIL 9MM 20CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,406.25",$0.00,"$2,406.25","$1,082.81","$1,717.34",$0.00,$414.58,$0.00,$0.00,$421.32,"$2,406.25",$0.00,"$1,203.13","$1,905.75","$1,925.00",$0.00,$376.58,$0.00,$383.08,$0.00
1830-0921S,SUP,HCPCS C1713,,1830-0921S  -  NAIL 9MM 21CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,406.25",$0.00,"$2,406.25","$1,082.81","$1,717.34",$0.00,$414.58,$0.00,$0.00,$421.32,"$2,406.25",$0.00,"$1,203.13","$1,905.75","$1,925.00",$0.00,$376.58,$0.00,$383.08,$0.00
1830-0922S,SUP,HCPCS C1713,,1830-0922S  -  NAIL 9MM 22CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,406.25",$0.00,"$2,406.25","$1,082.81","$1,717.34",$0.00,$414.58,$0.00,$0.00,$421.32,"$2,406.25",$0.00,"$1,203.13","$1,905.75","$1,925.00",$0.00,$376.58,$0.00,$383.08,$0.00
1830-0923S,SUP,HCPCS C1713,,1830-0923S  -  NAIL 9MM 23CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,406.25",$0.00,"$2,406.25","$1,082.81","$1,717.34",$0.00,$414.58,$0.00,$0.00,$421.32,"$2,406.25",$0.00,"$1,203.13","$1,905.75","$1,925.00",$0.00,$376.58,$0.00,$383.08,$0.00
1830-0924S,SUP,HCPCS C1713,,1830-0924S  -  NAIL 9MM 24CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,406.25",$0.00,"$2,406.25","$1,082.81","$1,717.34",$0.00,$414.58,$0.00,$0.00,$421.32,"$2,406.25",$0.00,"$1,203.13","$1,905.75","$1,925.00",$0.00,$376.58,$0.00,$383.08,$0.00
1830-0925S,SUP,HCPCS C1713,,1830-0925S  -  NAIL 9MM 25CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,406.25",$0.00,"$2,406.25","$1,082.81","$1,717.34",$0.00,$414.58,$0.00,$0.00,$421.32,"$2,406.25",$0.00,"$1,203.13","$1,905.75","$1,925.00",$0.00,$376.58,$0.00,$383.08,$0.00
1830-0926S,SUP,HCPCS C1713,,1830-0926S  -  NAIL 9MM 26CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,406.25",$0.00,"$2,406.25","$1,082.81","$1,717.34",$0.00,$414.58,$0.00,$0.00,$421.32,"$2,406.25",$0.00,"$1,203.13","$1,905.75","$1,925.00",$0.00,$376.58,$0.00,$383.08,$0.00
1830-0927S,SUP,HCPCS C1713,,1830-0927S  -  NAIL 9MM 27CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,406.25",$0.00,"$2,406.25","$1,082.81","$1,717.34",$0.00,$414.58,$0.00,$0.00,$421.32,"$2,406.25",$0.00,"$1,203.13","$1,905.75","$1,925.00",$0.00,$376.58,$0.00,$383.08,$0.00
1830-0928S,SUP,HCPCS C1713,,1830-0928S  -  NAIL 9MM 28CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,406.25",$0.00,"$2,406.25","$1,082.81","$1,717.34",$0.00,$414.58,$0.00,$0.00,$421.32,"$2,406.25",$0.00,"$1,203.13","$1,905.75","$1,925.00",$0.00,$376.58,$0.00,$383.08,$0.00
1830-0929S,SUP,HCPCS C1713,,1830-0929S  -  NAIL 9MM 29CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,406.25",$0.00,"$2,406.25","$1,082.81","$1,717.34",$0.00,$414.58,$0.00,$0.00,$421.32,"$2,406.25",$0.00,"$1,203.13","$1,905.75","$1,925.00",$0.00,$376.58,$0.00,$383.08,$0.00
1830-0930S,SUP,HCPCS C1713,,1830-0930S  -  NAIL 9MM 30CM HUM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,406.25",$0.00,"$2,406.25","$1,082.81","$1,717.34",$0.00,$414.58,$0.00,$0.00,$421.32,"$2,406.25",$0.00,"$1,203.13","$1,905.75","$1,925.00",$0.00,$376.58,$0.00,$383.08,$0.00
1830-0931S,SUP,HCPCS C1713,,1830-0931S  -  NAIL 9MM 31CM HUM T2 IM ANTGRD/RTRGRD LCK TI STRL,"$2,406.25",$0.00,"$2,406.25","$1,082.81","$1,717.34",$0.00,$414.58,$0.00,$0.00,$421.32,"$2,406.25",$0.00,"$1,203.13","$1,905.75","$1,925.00",$0.00,$376.58,$0.00,$383.08,$0.00
1830-0932S,SUP,HCPCS C1713,,1830-0932S  -  NAIL 9MM 32CM HUM T2 IM ANTGRD/RTRGRD LCK TI STRL,"$2,406.25",$0.00,"$2,406.25","$1,082.81","$1,717.34",$0.00,$414.58,$0.00,$0.00,$421.32,"$2,406.25",$0.00,"$1,203.13","$1,905.75","$1,925.00",$0.00,$376.58,$0.00,$383.08,$0.00
18-3200,SUP,Custom 27803010,,18-3200  -  HEAD FEMORAL +0MM OFFST C TAPER 32MM HIGH PERFORMANCE BIOLOX,"$1,725.00",$0.00,"$1,725.00",$0.00,"$1,231.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$0.00,$0.00,$0.00,$0.00
1832-0002S,SUP,HCPCS C1713,,1832-0002S  -  CAP END +2MM PROX HUM IM NAIL TI STRL T2,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1832-0003S,SUP,HCPCS C1713,,1832-0003S  -  CAP END +3MM PROX HUM IM NAIL TI STRL T2,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1832-0004S,SUP,HCPCS C1713,,1832-0004S  -  CAP END +4MM PROX HUM IM NAIL TI STRL T2,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
18-3205,SUP,Custom 27803010,,18-3205  -  HEAD FEMORAL +5MM OFFST C TAPER 32MM HIGH PERFORMANCE BIOLOX,"$1,725.00",$0.00,"$1,725.00",$0.00,"$1,231.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$0.00,$0.00,$0.00,$0.00
18-3225,SUP,Custom 27803010,,18-3225  -  HEAD FEMORAL +2.5MM OFFST C TAPER 32MM HIGH PERFORMANCE,"$1,725.00",$0.00,"$1,725.00",$0.00,"$1,231.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$0.00,$0.00,$0.00,$0.00
1832-2822S,SUP,HCPCS C1713,,1832-2822S  -  NAIL 8MM 22CM LEFT PROX HUM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,928.75",$0.00,"$2,928.75","$1,317.94","$2,090.25",$0.00,$504.61,$0.00,$0.00,$512.80,"$2,928.75",$0.00,"$1,464.38","$2,319.57","$2,343.00",$0.00,$458.35,$0.00,$466.26,$0.00
1832-2824S,SUP,HCPCS C1713,,1832-2824S  -  NAIL 8MM 240MM LEFT PROX HUM T2 IM LG,"$2,928.75",$0.00,"$2,928.75","$1,317.94","$2,090.25",$0.00,$504.61,$0.00,$0.00,$512.80,"$2,928.75",$0.00,"$1,464.38","$2,319.57","$2,343.00",$0.00,$458.35,$0.00,$466.26,$0.00
1832-2826S,SUP,HCPCS C1713,,1832-2826S  -  NAIL 8MM 26CM LEFT PROX HUM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,928.75",$0.00,"$2,928.75","$1,317.94","$2,090.25",$0.00,$504.61,$0.00,$0.00,$512.80,"$2,928.75",$0.00,"$1,464.38","$2,319.57","$2,343.00",$0.00,$458.35,$0.00,$466.26,$0.00
1832-2828S,SUP,HCPCS C1713,,1832-2828S  -  NAIL 8MM 28CM LEFT PROX HUM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,928.75",$0.00,"$2,928.75","$1,317.94","$2,090.25",$0.00,$504.61,$0.00,$0.00,$512.80,"$2,928.75",$0.00,"$1,464.38","$2,319.57","$2,343.00",$0.00,$458.35,$0.00,$466.26,$0.00
1832-2830S,SUP,HCPCS C1713,,1832-2830S  -  NAIL 8MM 30CM LEFT PROX HUM T2 IM RTRGRD ANTGRD LCK TI STRL,"$2,928.75",$0.00,"$2,928.75","$1,317.94","$2,090.25",$0.00,$504.61,$0.00,$0.00,$512.80,"$2,928.75",$0.00,"$1,464.38","$2,319.57","$2,343.00",$0.00,$458.35,$0.00,$466.26,$0.00
18-32-3,SUP,Custom 27803010,,18-32-3  -  HEAD FEMORAL -2.5MM OFFST C TAPER 32MM HIGH PERFORMANCE,"$1,725.00",$0.00,"$1,725.00",$0.00,"$1,231.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$0.00,$0.00,$0.00,$0.00
1832-3822S,SUP,HCPCS C1713,,1832-3822S  -  NAIL 8MM 22CM RIGHT PROX HUM T2 IM LNG RTRGRD ANTGRD LCK TI,"$2,928.75",$0.00,"$2,928.75","$1,317.94","$2,090.25",$0.00,$504.61,$0.00,$0.00,$512.80,"$2,928.75",$0.00,"$1,464.38","$2,319.57","$2,343.00",$0.00,$458.35,$0.00,$466.26,$0.00
1832-3824S,SUP,HCPCS C1713,,1832-3824S  -  NAIL 8MM 24CM RIGHT PROX HUM T2 IM LNG RTRGRD ANTGRD LCK TI,"$2,928.75",$0.00,"$2,928.75","$1,317.94","$2,090.25",$0.00,$504.61,$0.00,$0.00,$512.80,"$2,928.75",$0.00,"$1,464.38","$2,319.57","$2,343.00",$0.00,$458.35,$0.00,$466.26,$0.00
1832-3826S,SUP,HCPCS C1713,,1832-3826S  -  NAIL 8MM 26CM RIGHT PROX HUM T2 IM LNG RTRGRD ANTGRD LCK TI,"$2,928.75",$0.00,"$2,928.75","$1,317.94","$2,090.25",$0.00,$504.61,$0.00,$0.00,$512.80,"$2,928.75",$0.00,"$1,464.38","$2,319.57","$2,343.00",$0.00,$458.35,$0.00,$466.26,$0.00
1832-3828S,SUP,HCPCS C1713,,1832-3828S  -  NAIL 8MM 28CM RIGHT PROX HUM T2 IM LNG RTRGRD ANTGRD LCK TI,"$2,928.75",$0.00,"$2,928.75","$1,317.94","$2,090.25",$0.00,$504.61,$0.00,$0.00,$512.80,"$2,928.75",$0.00,"$1,464.38","$2,319.57","$2,343.00",$0.00,$458.35,$0.00,$466.26,$0.00
1832-3830S,SUP,HCPCS C1713,,1832-3830S  -  NAIL 8MM 30CM RIGHT PROX HUM T2 IM LNG RTRGRD ANTGRD LCK TI,"$2,928.75",$0.00,"$2,928.75","$1,317.94","$2,090.25",$0.00,$504.61,$0.00,$0.00,$512.80,"$2,928.75",$0.00,"$1,464.38","$2,319.57","$2,343.00",$0.00,$458.35,$0.00,$466.26,$0.00
18-3600,SUP,Custom 27803010,,18-3600  -  HEAD FEMORAL 0MM OFFST C TAPER 36MM HIGH PERFORMANCE BIOLOX,"$1,725.00",$0.00,"$1,725.00",$0.00,"$1,231.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$0.00,$0.00,$0.00,$0.00
18-3605,SUP,Custom 27803010,,18-3605  -  HEAD FEMORAL +5MM OFFST C TAPER 36MM HIGH PERFORMANCE BIOLOX,"$1,725.00",$0.00,"$1,725.00",$0.00,"$1,231.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$0.00,$0.00,$0.00,$0.00
18-3625,SUP,Custom 27803010,,18-3625  -  HEAD FEMORAL +2.5MM OFFST C TAPER 36MM HIGH PERFORMANCE,"$1,725.00",$0.00,"$1,725.00",$0.00,"$1,231.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$0.00,$0.00,$0.00,$0.00
18-36-3,SUP,Custom 27803010,,18-36-3  -  HEAD FEMORAL -2.5MM OFFST C TAPER 36MM HIGH PERFORMANCE,"$1,725.00",$0.00,"$1,725.00",$0.00,"$1,231.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$0.00,$0.00,$0.00,$0.00
18-36-5,SUP,Custom 27803010,,18-36-5  -  HEAD FEMORAL -5MM OFFST C TAPER 36MM HIGH PERFORMANCE,"$1,725.00",$0.00,"$1,725.00",$0.00,"$1,231.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$0.00,$0.00,$0.00,$0.00
18-3675,SUP,Custom 27803010,,18-3675  -  HEAD FEMORAL +7.5MM 36MM C TAPER BIOLOX DELTA HIP,"$1,725.00",$0.00,"$1,725.00",$0.00,"$1,231.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$0.00,$0.00,$0.00,$0.00
1846-0928S,SUP,HCPCS C1713,,1846-0928S  -  NAIL 9MM 28CM LEFT T2 IM RECON TI STRL,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1846-0930S,SUP,HCPCS C1713,,1846-0930S  -  NAIL 9MM 30CM LEFT T2 IM RECON TI STRL,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1846-0932S,SUP,HCPCS C1713,,1846-0932S  -  NAIL 9MM 32CM LEFT T2 IM RECON TI STRL,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1846-0934S,SUP,HCPCS C1713,,1846-0934S  -  NAIL 9MM 34CM LEFT T2 IM RECON TI STRL,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1846-0936S,SUP,HCPCS C1713,,1846-0936S  -  NAIL 9MM 36CM LEFT T2 IM RECON TI STRL,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1846-0938S,SUP,HCPCS C1713,,1846-0938S  -  NAIL 9MM 38CM LEFT T2 IM RECON TI STRL,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1846-0940S,SUP,HCPCS C1713,,1846-0940S  -  NAIL 9MM 40CM LEFT T2 IM RECON TI STRL,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1846-0942S,SUP,HCPCS C1713,,1846-0942S  -  NAIL 9MM 42CM LEFT T2 IM RECON TI STRL,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1846-0944S,SUP,HCPCS C1713,,1846-0944S  -  NAIL 9MM 44CM LEFT T2 IM RECON TI STRL,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1846-0946S,SUP,HCPCS C1713,,1846-0946S  -  NAIL 9MM 460MM LEFT T2 IM RECON STRL,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1846-0948S,SUP,HCPCS C1713,,1846-0948S  -  NAIL 9MM 480MM LEFT T2 IM RECON STRL,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1846-1128S,SUP,HCPCS C1713,,1846-1128S  -  NAIL 11MM 28CM LEFT T2 IM RECON TI STRL,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1846-1130S,SUP,HCPCS C1713,,1846-1130S  -  NAIL 11MM 30CM LEFT T2 IM RECON TI STRL,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1846-1132S,SUP,HCPCS C1713,,1846-1132S  -  NAIL 11MM 32CM LEFT T2 IM RECON TI STRL,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1846-1134S,SUP,HCPCS C1713,,1846-1134S  -  NAIL 11MM 34CM LEFT T2 IM RECON TI STRL,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1846-1136S,SUP,HCPCS C1713,,1846-1136S  -  NAIL 11MM 36CM LEFT T2 IM RECON TI STRL,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1846-1138S,SUP,HCPCS C1713,,1846-1138S  -  NAIL 11MM 38CM LEFT T2 IM RECON TI STRL,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1846-1140S,SUP,HCPCS C1713,,1846-1140S  -  NAIL 11MM 40CM LEFT T2 IM RECON TI STRL,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1846-1142S,SUP,HCPCS C1713,,1846-1142S  -  NAIL 11MM 42CM LEFT T2 IM RECON TI STRL,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1846-1144S,SUP,HCPCS C1713,,1846-1144S  -  NAIL 11MM 44CM LEFT T2 IM RECON TI STRL,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1846-1146S,SUP,HCPCS C1713,,1846-1146S  -  NAIL 11MM 460MM LEFT T2 IM RECON STRL,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1846-1148S,SUP,HCPCS C1713,,1846-1148S  -  NAIL 11MM 480MM LEFT T2 IM RECON STRL,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1846-1334S,SUP,HCPCS C1713,,1846-1334S  -  NAIL 13MM 34CM LEFT T2 IM RECON TI STRL,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1846-1336S,SUP,HCPCS C1713,,1846-1336S  -  NAIL 13MM 36CM LEFT T2 IM RECON TI STRL,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1846-1338S,SUP,HCPCS C1713,,1846-1338S  -  NAIL 13MM 38CM LEFT T2 IM RECON TI STRL,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1846-1340S,SUP,HCPCS C1713,,1846-1340S  -  NAIL 13MM 40CM LEFT T2 IM RECON TI STRL,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1846-1342S,SUP,HCPCS C1713,,1846-1342S  -  NAIL 13MM 42CM LEFT T2 IM RECON TI STRL,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1846-1344S,SUP,HCPCS C1713,,1846-1344S  -  NAIL 13MM 44CM LEFT T2 IM RECON TI STRL,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1846-1346S,SUP,HCPCS C1713,,1846-1346S  -  NAIL 13MM 46CM LEFT T2 IM RECON TI STRL,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1846-1348S,SUP,HCPCS C1713,,1846-1348S  -  NAIL 13MM 48CM LEFT T2 IM RECON TI STRL,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1846-1534S,SUP,HCPCS C1713,,1846-1534S  -  NAIL 15MM 340MM LEFT T2 IM RECON,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1846-1536S,SUP,HCPCS C1713,,1846-1536S  -  NAIL 360MM LEFT IM LCK ANTEGADE,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1846-1538S,SUP,HCPCS C1713,,1846-1538S  -  NAIL 15MM 380MM LEFT ORTH T2 IM ANTGRD RECON TI 5MM STRL,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1846-1540S,SUP,HCPCS C1713,,1846-1540S  -  NAIL 400MM LEFT IM LCK ANTEGADE,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1846-1542S,SUP,HCPCS C1713,,1846-1542S  -  NAIL 420MM LEFT IM LCK ANTEGADE,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1846-1544S,SUP,HCPCS C1713,,1846-1544S  -  NAIL 440MM LEFT IM LCK ANTEGADE,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1846-1546S,SUP,HCPCS C1713,,1846-1546S  -  NAIL 460MM LEFT IM LCK RECON TI,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1846-1548S,SUP,HCPCS C1713,,1846-1548S  -  NAIL 15MM 480MM LEFT T2 IM RECON,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1847-0001S,SUP,HCPCS C1713,,1847-0001S  -  SCREW SET T2 8MM STRL LCK RECON ANGL STAB TI PROX IM NL,$288.75,$0.00,$288.75,$129.94,$206.08,$0.00,$49.75,$0.00,$0.00,$50.56,$288.75,$0.00,$144.38,$228.69,$231.00,$0.00,$45.19,$0.00,$45.97,$0.00
1847-0002S,SUP,HCPCS C1713,,1847-0002S  -  SCREW SET TI 8MM PROX RECON MODE T2 STRL IM NAIL,$288.75,$0.00,$288.75,$129.94,$206.08,$0.00,$49.75,$0.00,$0.00,$50.56,$288.75,$0.00,$144.38,$228.69,$231.00,$0.00,$45.19,$0.00,$45.97,$0.00
1847-0003S,SUP,HCPCS C1713,,1847-0003S  -  SCREW SET TI 8MM PROX ANTGRD T2 STRL IM NAIL,$295.63,$0.00,$295.63,$133.03,$210.99,$0.00,$50.93,$0.00,$0.00,$51.76,$295.63,$0.00,$147.81,$234.14,$236.50,$0.00,$46.27,$0.00,$47.06,$0.00
1847-0005S,SUP,HCPCS C1713,,1847-0005S  -  CAP END +5MM RECON IM NAIL TI STRL T2,$295.63,$0.00,$295.63,$133.03,$210.99,$0.00,$50.93,$0.00,$0.00,$51.76,$295.63,$0.00,$147.81,$234.14,$236.50,$0.00,$46.27,$0.00,$47.06,$0.00
1847-0010S,SUP,HCPCS C1713,,1847-0010S  -  CAP END +10MM RECON IM NAIL TI STRL T2,$295.63,$0.00,$295.63,$133.03,$210.99,$0.00,$50.93,$0.00,$0.00,$51.76,$295.63,$0.00,$147.81,$234.14,$236.50,$0.00,$46.27,$0.00,$47.06,$0.00
1847-0015S,SUP,HCPCS C1713,,1847-0015S  -  CAP END +15MM RECON IM NAIL TI STRL T2,$295.63,$0.00,$295.63,$133.03,$210.99,$0.00,$50.93,$0.00,$0.00,$51.76,$295.63,$0.00,$147.81,$234.14,$236.50,$0.00,$46.27,$0.00,$47.06,$0.00
1847-0928S,SUP,HCPCS C1713,,1847-0928S  -  NAIL 9MM 28CM RIGHT T2 IM RECON TI STRL,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1847-0930S,SUP,HCPCS C1713,,1847-0930S  -  NAIL 9MM 30CM RIGHT T2 IM RECON TI STRL,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1847-0932S,SUP,HCPCS C1713,,1847-0932S  -  NAIL 9MM 32CM RIGHT T2 IM RECON TI STRL,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1847-0934S,SUP,HCPCS C1713,,1847-0934S  -  NAIL 9MM 34CM RIGHT T2 IM RECON TI STRL,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1847-0936S,SUP,HCPCS C1713,,1847-0936S  -  NAIL 9MM 36CM RIGHT T2 IM RECON TI STRL,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1847-0938S,SUP,HCPCS C1713,,1847-0938S  -  NAIL 9MM 38CM RIGHT T2 IM RECON TI STRL,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1847-0940S,SUP,HCPCS C1713,,1847-0940S  -  NAIL 9MM 40CM RIGHT T2 IM RECON TI STRL,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1847-0942S,SUP,HCPCS C1713,,1847-0942S  -  NAIL 9MM 42CM RIGHT T2 IM RECON TI STRL,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1847-0944S,SUP,HCPCS C1713,,1847-0944S  -  NAIL 9MM 44CM RIGHT T2 IM RECON TI STRL,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1847-0946S,SUP,HCPCS C1713,,1847-0946S  -  NAIL 9MM 460MM RIGHT T2 IM RECON STRL,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1847-0948S,SUP,HCPCS C1713,,1847-0948S  -  NAIL 9MM 480MM RIGHT T2 IM RECON STRL,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1847-1128S,SUP,HCPCS C1713,,1847-1128S  -  NAIL 11MM 28CM RIGHT T2 IM RECON TI STRL,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1847-1130S,SUP,HCPCS C1713,,1847-1130S  -  NAIL 11MM 30CM RIGHT T2 IM RECON TI STRL,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1847-1132S,SUP,HCPCS C1713,,1847-1132S  -  NAIL 11MM 32CM RIGHT T2 IM RECON TI STRL,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1847-1134S,SUP,HCPCS C1713,,1847-1134S  -  NAIL 11MM 34CM RIGHT T2 IM RECON TI STRL,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1847-1136S,SUP,HCPCS C1713,,1847-1136S  -  NAIL 11MM 36CM RIGHT T2 IM RECON TI STRL,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1847-1138S,SUP,HCPCS C1713,,1847-1138S  -  NAIL 11MM 38CM RIGHT T2 IM RECON TI STRL,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1847-1140S,SUP,HCPCS C1713,,1847-1140S  -  NAIL 11MM 40CM RIGHT T2 IM RECON TI STRL,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1847-1142S,SUP,HCPCS C1713,,1847-1142S  -  NAIL 11MM 42CM RIGHT T2 IM RECON TI STRL,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1847-1144S,SUP,HCPCS C1713,,1847-1144S  -  NAIL 11MM 44CM RIGHT T2 IM RECON TI STRL,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1847-1146S,SUP,HCPCS C1713,,1847-1146S  -  NAIL 11MM 460MM RIGHT T2 IM RECON STRL,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1847-1148S,SUP,HCPCS C1713,,1847-1148S  -  NAIL 11MM 480MM RIGHT T2 IM RECON STRL,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1847-1334S,SUP,HCPCS C1713,,1847-1334S  -  NAIL 13MM 34CM RIGHT T2 IM RECON TI STRL,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1847-1336S,SUP,HCPCS C1713,,1847-1336S  -  NAIL 13MM 36CM RIGHT T2 IM RECON TI STRL,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1847-1338S,SUP,HCPCS C1713,,1847-1338S  -  NAIL 13MM 38CM RIGHT T2 IM RECON TI STRL,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1847-1340S,SUP,HCPCS C1713,,1847-1340S  -  NAIL 13MM 40CM RIGHT T2 IM RECON TI STRL,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1847-1342S,SUP,HCPCS C1713,,1847-1342S  -  NAIL 13MM 42CM RIGHT T2 IM RECON TI STRL,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1847-1344S,SUP,HCPCS C1713,,1847-1344S  -  NAIL 13MM 44CM RIGHT T2 IM RECON TI STRL,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1847-1346S,SUP,HCPCS C1713,,1847-1346S  -  NAIL 13MM 46CM RIGHT T2 IM RECON TI STRL,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1847-1348S,SUP,HCPCS C1713,,1847-1348S  -  NAIL 13MM 48CM RIGHT T2 IM RECON TI STRL,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1847-1534S,SUP,HCPCS C1713,,1847-1534S  -  NAIL 15MM 340MM RIGHT T2 IM RECON ANTEGADE TI,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1847-1536S,SUP,HCPCS C1713,,1847-1536S  -  NAIL 15MM 36CM RIGHT ORTH T2 IM RECON TI STRL,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1847-1538S,SUP,HCPCS C1713,,1847-1538S  -  NAIL 15MM 38CM RIGHT T2 IM RECON TI STRL,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1847-1540S,SUP,HCPCS C1713,,1847-1540S  -  NAIL 15MM 400MM RIGHT T2 IM ANTGRD RECON TI,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1847-1542S,SUP,HCPCS C1713,,1847-1542S  -  NAIL 15MM 420MM RIGHT T2 IM LCK ANTEGADE RECON TI 5MM,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1847-1544S,SUP,HCPCS C1713,,1847-1544S  -  NAIL 15MM 440MM RIGHT T2 IM ANTGRD RECON TI,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1847-1546S,SUP,HCPCS C1713,,1847-1546S  -  NAIL 15MM 460MM RIGHT T2 IM RECON IMPL TI,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1847-1548S,SUP,HCPCS C1713,,1847-1548S  -  NAIL 480MM IM LCK,"$3,196.88",$0.00,"$3,196.88","$1,438.59","$2,281.61",$0.00,$550.81,$0.00,$0.00,$559.75,"$3,196.88",$0.00,"$1,598.44","$2,531.93","$2,557.50",$0.00,$500.31,$0.00,$508.94,$0.00
1850-0002S,SUP,HCPCS C1713,,1850-0002S  -  END CAP PLUS 0 MM,$309.38,$0.00,$309.38,$139.22,$220.80,$0.00,$53.30,$0.00,$0.00,$54.17,$309.38,$0.00,$154.69,$245.03,$247.50,$0.00,$48.42,$0.00,$49.25,$0.00
1850-0003S,SUP,HCPCS C1713,,1850-0003S  -  T2 CANNULATED COMP. SCREW,$330.00,$0.00,$330.00,$148.50,$235.52,$0.00,$56.86,$0.00,$0.00,$57.78,$330.00,$0.00,$165.00,$261.36,$264.00,$0.00,$51.65,$0.00,$52.54,$0.00
1850-0005S,SUP,HCPCS C1713,,1850-0005S  -  END CAP PLUS 5 MM,$309.38,$0.00,$309.38,$139.22,$220.80,$0.00,$53.30,$0.00,$0.00,$54.17,$309.38,$0.00,$154.69,$245.03,$247.50,$0.00,$48.42,$0.00,$49.25,$0.00
1850-0010S,SUP,HCPCS C1713,,1850-0010S  -  END CAP PLUS 10  MM,$309.38,$0.00,$309.38,$139.22,$220.80,$0.00,$53.30,$0.00,$0.00,$54.17,$309.38,$0.00,$154.69,$245.03,$247.50,$0.00,$48.42,$0.00,$49.25,$0.00
1850-0015S,SUP,HCPCS C1713,,1850-0015S  -  END CAP PLUS 15 MM,$309.38,$0.00,$309.38,$139.22,$220.80,$0.00,$53.30,$0.00,$0.00,$54.17,$309.38,$0.00,$154.69,$245.03,$247.50,$0.00,$48.42,$0.00,$49.25,$0.00
186002-44,SUP,HCPCS C1776,,186002-44  -  SHELL ACTB 44MM CH POR HIP,"$2,302.50",$0.00,"$2,302.50","$1,036.13","$1,643.29",$0.00,$396.71,$0.00,$0.00,$403.15,"$2,302.50",$0.00,"$1,151.25","$1,823.58","$1,842.00",$0.00,$360.34,$0.00,$366.56,$0.00
186002-46,SUP,HCPCS C1776,,186002-46  -  SHELL ACTB HMSPHR 46MM 3.1MM PST RESTORIS CH CUP TI HIP,"$2,302.50",$0.00,"$2,302.50","$1,036.13","$1,643.29",$0.00,$396.71,$0.00,$0.00,$403.15,"$2,302.50",$0.00,"$1,151.25","$1,823.58","$1,842.00",$0.00,$360.34,$0.00,$366.56,$0.00
186002-48,SUP,HCPCS C1776,,186002-48  -  SHELL ACTB HMSPHR 48MM 3.2MM PST RESTORIS CH CUP TI HIP,"$2,302.50",$0.00,"$2,302.50","$1,036.13","$1,643.29",$0.00,$396.71,$0.00,$0.00,$403.15,"$2,302.50",$0.00,"$1,151.25","$1,823.58","$1,842.00",$0.00,$360.34,$0.00,$366.56,$0.00
186002-50,SUP,HCPCS C1776,,186002-50  -  SHELL ACTB HMSPHR 50MM 3.1MM STRL PST RESTORIS CH TI HIP,"$2,302.50",$0.00,"$2,302.50","$1,036.13","$1,643.29",$0.00,$396.71,$0.00,$0.00,$403.15,"$2,302.50",$0.00,"$1,151.25","$1,823.58","$1,842.00",$0.00,$360.34,$0.00,$366.56,$0.00
186002-52,SUP,HCPCS C1776,,186002-52  -  SHELL ACTB HMSPHR 52MM 3.1MM STRL PST RESTORIS CH TI HIP,"$2,302.50",$0.00,"$2,302.50","$1,036.13","$1,643.29",$0.00,$396.71,$0.00,$0.00,$403.15,"$2,302.50",$0.00,"$1,151.25","$1,823.58","$1,842.00",$0.00,$360.34,$0.00,$366.56,$0.00
186002-54,SUP,HCPCS C1776,,186002-54  -  SHELL ACTB HMSPHR 54MM 3.5MM STRL PST RESTORIS TI HIP,"$2,302.50",$0.00,"$2,302.50","$1,036.13","$1,643.29",$0.00,$396.71,$0.00,$0.00,$403.15,"$2,302.50",$0.00,"$1,151.25","$1,823.58","$1,842.00",$0.00,$360.34,$0.00,$366.56,$0.00
186002-56,SUP,HCPCS C1776,,186002-56  -  SHELL ACTB HMSPHR 56MM 3.7MM STRL PST RESTORIS TI HIP,"$2,302.50",$0.00,"$2,302.50","$1,036.13","$1,643.29",$0.00,$396.71,$0.00,$0.00,$403.15,"$2,302.50",$0.00,"$1,151.25","$1,823.58","$1,842.00",$0.00,$360.34,$0.00,$366.56,$0.00
186002-58,SUP,HCPCS C1776,,186002-58  -  SHELL ACTB 58MM CH POR HIP,"$2,302.50",$0.00,"$2,302.50","$1,036.13","$1,643.29",$0.00,$396.71,$0.00,$0.00,$403.15,"$2,302.50",$0.00,"$1,151.25","$1,823.58","$1,842.00",$0.00,$360.34,$0.00,$366.56,$0.00
186002-60,SUP,HCPCS C1776,,186002-60  -  SHELL ACTB HMSPHR 60MM 4.8MM PST RESTORIS CH CUP TI HIP,"$2,302.50",$0.00,"$2,302.50","$1,036.13","$1,643.29",$0.00,$396.71,$0.00,$0.00,$403.15,"$2,302.50",$0.00,"$1,151.25","$1,823.58","$1,842.00",$0.00,$360.34,$0.00,$366.56,$0.00
186002-62,SUP,HCPCS C1776,,186002-62  -  SHELL ACTB HMSPHR 62MM 4MM STRL PST RESTORIS CH CUP TI HIP,"$2,302.50",$0.00,"$2,302.50","$1,036.13","$1,643.29",$0.00,$396.71,$0.00,$0.00,$403.15,"$2,302.50",$0.00,"$1,151.25","$1,823.58","$1,842.00",$0.00,$360.34,$0.00,$366.56,$0.00
186002-64,SUP,HCPCS C1776,,186002-64  -  SHELL ACTB HMSPHR 64MM 5MM PST RESTORIS CH CUP TI HIP,"$2,302.50",$0.00,"$2,302.50","$1,036.13","$1,643.29",$0.00,$396.71,$0.00,$0.00,$403.15,"$2,302.50",$0.00,"$1,151.25","$1,823.58","$1,842.00",$0.00,$360.34,$0.00,$366.56,$0.00
186002-66,SUP,HCPCS C1776,,186002-66  -  SHELL ACTB HMSPHR 66MM 4.6MM PST RESTORIS CH CUP TI HIP,"$2,302.50",$0.00,"$2,302.50","$1,036.13","$1,643.29",$0.00,$396.71,$0.00,$0.00,$403.15,"$2,302.50",$0.00,"$1,151.25","$1,823.58","$1,842.00",$0.00,$360.34,$0.00,$366.56,$0.00
186002-68,SUP,HCPCS C1776,,186002-68  -  SHELL ACTB HMSPHR 68MM 5.6MM PST RESTORIS CH CUP TI HIP,"$2,302.50",$0.00,"$2,302.50","$1,036.13","$1,643.29",$0.00,$396.71,$0.00,$0.00,$403.15,"$2,302.50",$0.00,"$1,151.25","$1,823.58","$1,842.00",$0.00,$360.34,$0.00,$366.56,$0.00
186003-02,SUP,HCPCS C1776,,186003-02  -  STEM FEM,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
186003-03,SUP,HCPCS C1776,,186003-03  -  STEM FEM 3 12/14 TPR STRL RESTORIS STD NK HIP,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
186003-04,SUP,HCPCS C1776,,186003-04  -  STEM FEM,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
186003-05,SUP,HCPCS C1776,,186003-05  -  STEM FEM 5 12/14 TPR STRL RESTORIS STD NK HIP,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
186003-06,SUP,HCPCS C1776,,186003-06  -  STEM FEM,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
186003-07,SUP,HCPCS C1776,,186003-07  -  STEM FEM,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
186003-08,SUP,HCPCS C1776,,186003-08  -  STEM FEM,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
186003-09,SUP,HCPCS C1776,,186003-09  -  STEM FEM,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
186003-10,SUP,HCPCS C1776,,186003-10  -  STEM FEM,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
186003-11,SUP,HCPCS C1776,,186003-11  -  STEM FEM,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
186003-12,SUP,HCPCS C1776,,186003-12  -  STEM FEM,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
186004-02,SUP,HCPCS C1776,,186004-02  -  STEM FEM 2 12/14 TPR STRL RESTORIS HI OFST NK HIP,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
186004-03,SUP,HCPCS C1776,,186004-03  -  STEM FEM,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
186004-04,SUP,HCPCS C1776,,186004-04  -  STEM FEM 4 12/14 TPR STRL RESTORIS HI OFST NK HIP,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
186004-05,SUP,HCPCS C1776,,186004-05  -  STEM FEM,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
186004-06,SUP,HCPCS C1776,,186004-06  -  STEM FEM,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
186004-07,SUP,HCPCS C1776,,186004-07  -  STEM FEM 7 12/14 TPR STRL RESTORIS XTD OFST NK HIP,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
186004-08,SUP,HCPCS C1776,,186004-08  -  STEM FEM,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
186004-09,SUP,HCPCS C1776,,186004-09  -  STEM FEM 9 12/14 TPR STRL RESTORIS HI OFST NK HIP,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
186004-10,SUP,HCPCS C1776,,186004-10  -  STEM FEM,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
186004-11,SUP,HCPCS C1776,,186004-11  -  STEM FEM,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
186004-12,SUP,HCPCS C1776,,186004-12  -  STEM FEM,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
186005-15,SUP,HCPCS C1713,,186005-15  -  SCREW ACTB 6.5MM 15MM ACTB,$70.00,$0.00,$70.00,$31.50,$49.96,$0.00,$12.06,$0.00,$0.00,$12.26,$70.00,$0.00,$35.00,$55.44,$56.00,$0.00,$10.96,$0.00,$11.14,$0.00
186005-20,SUP,HCPCS C1713,,186005-20  -  SCREW ACTB 6.5MM 20MM ACTB,$70.00,$0.00,$70.00,$31.50,$49.96,$0.00,$12.06,$0.00,$0.00,$12.26,$70.00,$0.00,$35.00,$55.44,$56.00,$0.00,$10.96,$0.00,$11.14,$0.00
186005-25,SUP,HCPCS C1713,,186005-25  -  SCREW ACTB 6.5MM 25MM ACTB,$70.00,$0.00,$70.00,$31.50,$49.96,$0.00,$12.06,$0.00,$0.00,$12.26,$70.00,$0.00,$35.00,$55.44,$56.00,$0.00,$10.96,$0.00,$11.14,$0.00
186005-30,SUP,HCPCS C1713,,186005-30  -  SCREW ACTB 6.5MM 30MM ACTB,$70.00,$0.00,$70.00,$31.50,$49.96,$0.00,$12.06,$0.00,$0.00,$12.26,$70.00,$0.00,$35.00,$55.44,$56.00,$0.00,$10.96,$0.00,$11.14,$0.00
186005-35,SUP,HCPCS C1713,,186005-35  -  SCREW ACTB 6.5MM 35MM ACTB,$70.00,$0.00,$70.00,$31.50,$49.96,$0.00,$12.06,$0.00,$0.00,$12.26,$70.00,$0.00,$35.00,$55.44,$56.00,$0.00,$10.96,$0.00,$11.14,$0.00
186005-40,SUP,HCPCS C1713,,186005-40  -  SCREW ACTB 6.5MM 40MM STRL RESTORIS,$70.00,$0.00,$70.00,$31.50,$49.96,$0.00,$12.06,$0.00,$0.00,$12.26,$70.00,$0.00,$35.00,$55.44,$56.00,$0.00,$10.96,$0.00,$11.14,$0.00
186128-44,SUP,HCPCS C1776,,186128-44  -  LINER ACTB 44MM 28MM 7.1MM RESTORIS WR RST OXDT STAB XLVE,"$1,440.00",$0.00,"$1,440.00",$648.00,"$1,027.73",$0.00,$248.10,$0.00,$0.00,$252.13,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$225.36,$0.00,$229.25,$0.00
186128-46,SUP,HCPCS C1776,,186128-46  -  LINER ACTB 46MM 28MM 7.1MM RESTORIS WR RST OXDT STAB XLVE,"$1,440.00",$0.00,"$1,440.00",$648.00,"$1,027.73",$0.00,$248.10,$0.00,$0.00,$252.13,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$225.36,$0.00,$229.25,$0.00
186128-48,SUP,HCPCS C1776,,186128-48  -  LINER ACTB 48MM 28MM 7.6MM RESTORIS WR RST OXDT STAB XLVE,"$1,440.00",$0.00,"$1,440.00",$648.00,"$1,027.73",$0.00,$248.10,$0.00,$0.00,$252.13,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$225.36,$0.00,$229.25,$0.00
186128-50,SUP,HCPCS C1776,,186128-50  -  LINER ACTB 50MM 28MM 8.6MM RESTORIS WR RST OXDT STAB XLVE,"$1,440.00",$0.00,"$1,440.00",$648.00,"$1,027.73",$0.00,$248.10,$0.00,$0.00,$252.13,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$225.36,$0.00,$229.25,$0.00
186132-48,SUP,HCPCS C1776,,186132-48  -  LINER ACTB NTRL 48MM 32MM E-POLY HIP,"$1,440.00",$0.00,"$1,440.00",$648.00,"$1,027.73",$0.00,$248.10,$0.00,$0.00,$252.13,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$225.36,$0.00,$229.25,$0.00
186132-50,SUP,HCPCS C1776,,186132-50  -  LINER ACTB HMSPHR 50MM 32MM 6.9MM STRL 4.5MM RESTORIS XLVE,"$1,440.00",$0.00,"$1,440.00",$648.00,"$1,027.73",$0.00,$248.10,$0.00,$0.00,$252.13,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$225.36,$0.00,$229.25,$0.00
186132-52,SUP,HCPCS C1776,,186132-52  -  LINER ACTB NTRL 52MM 32MM E-POLY HIP,"$1,440.00",$0.00,"$1,440.00",$648.00,"$1,027.73",$0.00,$248.10,$0.00,$0.00,$252.13,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$225.36,$0.00,$229.25,$0.00
186132-54,SUP,HCPCS C1776,,186132-54  -  LINER ACTB 54MM 32MM 7.8MM RESTORIS WR RST OXDT STAB XLVE,"$1,440.00",$0.00,"$1,440.00",$648.00,"$1,027.73",$0.00,$248.10,$0.00,$0.00,$252.13,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$225.36,$0.00,$229.25,$0.00
186136-52,SUP,HCPCS C1776,,186136-52  -  LINER ACTB HMSPHR 52MM 36MM 6.6MM STRL 3.7MM RESTORIS XLVE,"$1,440.00",$0.00,"$1,440.00",$648.00,"$1,027.73",$0.00,$248.10,$0.00,$0.00,$252.13,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$225.36,$0.00,$229.25,$0.00
186136-54,SUP,HCPCS C1776,,186136-54  -  LINER ACTB HMSPHR 36MM 54MM 6.7MM STRL RESTORIS XLVE HIP,"$1,440.00",$0.00,"$1,440.00",$648.00,"$1,027.73",$0.00,$248.10,$0.00,$0.00,$252.13,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$225.36,$0.00,$229.25,$0.00
186136-56,SUP,HCPCS C1776,,186136-56  -  LINER ACTB HMSPHR 36MM 56MM 7.1MM STRL RESTORIS XLVE HIP,"$1,440.00",$0.00,"$1,440.00",$648.00,"$1,027.73",$0.00,$248.10,$0.00,$0.00,$252.13,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$225.36,$0.00,$229.25,$0.00
186136-58,SUP,HCPCS C1776,,186136-58  -  LINER ACTB NTRL DOME TPR 58-60MM 36MM 7.7MM LD BRNG XLVE HIP,"$1,440.00",$0.00,"$1,440.00",$648.00,"$1,027.73",$0.00,$248.10,$0.00,$0.00,$252.13,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$225.36,$0.00,$229.25,$0.00
186136-62,SUP,HCPCS C1776,,186136-62  -  LINER ACTB 62-64MM 36MM 9.3MM RESTORIS WR RST OXDT STAB XLVE,"$1,440.00",$0.00,"$1,440.00",$648.00,"$1,027.73",$0.00,$248.10,$0.00,$0.00,$252.13,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$225.36,$0.00,$229.25,$0.00
186136-66,SUP,HCPCS C1776,,186136-66  -  LINER ACTB 66-68MM 36MM 10.9MM RESTORIS WR RST OXDT STAB,"$1,440.00",$0.00,"$1,440.00",$648.00,"$1,027.73",$0.00,$248.10,$0.00,$0.00,$252.13,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$225.36,$0.00,$229.25,$0.00
186140-56,SUP,HCPCS C1776,,186140-56  -  LINER ACTB 7.5MM,"$1,440.00",$0.00,"$1,440.00",$648.00,"$1,027.73",$0.00,$248.10,$0.00,$0.00,$252.13,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$225.36,$0.00,$229.25,$0.00
186140-58,SUP,HCPCS C1776,,186140-58  -  LINER ACTB 8.4MM,"$1,440.00",$0.00,"$1,440.00",$648.00,"$1,027.73",$0.00,$248.10,$0.00,$0.00,$252.13,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$225.36,$0.00,$229.25,$0.00
186140-62,SUP,HCPCS C1776,,186140-62  -  LINER ACTB 10.3MM,"$1,440.00",$0.00,"$1,440.00",$648.00,"$1,027.73",$0.00,$248.10,$0.00,$0.00,$252.13,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$225.36,$0.00,$229.25,$0.00
186140-66,SUP,HCPCS C1776,,186140-66  -  LINER ACTB 11.9MM,"$1,440.00",$0.00,"$1,440.00",$648.00,"$1,027.73",$0.00,$248.10,$0.00,$0.00,$252.13,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$225.36,$0.00,$229.25,$0.00
186228-44,SUP,HCPCS C1776,,186228-44  -  LINER ACTB 44MM 28MM HW E-POLY HIP,"$1,440.00",$0.00,"$1,440.00",$648.00,"$1,027.73",$0.00,$248.10,$0.00,$0.00,$252.13,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$225.36,$0.00,$229.25,$0.00
186228-46,SUP,HCPCS C1776,,186228-46  -  LINER ACTB 46MM 28MM HW E-POLY HIP,"$1,440.00",$0.00,"$1,440.00",$648.00,"$1,027.73",$0.00,$248.10,$0.00,$0.00,$252.13,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$225.36,$0.00,$229.25,$0.00
186228-48,SUP,HCPCS C1776,,186228-48  -  LINER ACTB,"$1,440.00",$0.00,"$1,440.00",$648.00,"$1,027.73",$0.00,$248.10,$0.00,$0.00,$252.13,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$225.36,$0.00,$229.25,$0.00
186228-50,SUP,HCPCS C1776,,186228-50  -  LINER ACTB,"$1,440.00",$0.00,"$1,440.00",$648.00,"$1,027.73",$0.00,$248.10,$0.00,$0.00,$252.13,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$225.36,$0.00,$229.25,$0.00
186232-48,SUP,HCPCS C1776,,186232-48  -  LINER ACTB 48MM 32MM HW E-POLY HIP,"$1,440.00",$0.00,"$1,440.00",$648.00,"$1,027.73",$0.00,$248.10,$0.00,$0.00,$252.13,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$225.36,$0.00,$229.25,$0.00
186232-50,SUP,HCPCS C1776,,186232-50  -  LINER ACTB 50MM PST RESTORIS HIP,"$1,440.00",$0.00,"$1,440.00",$648.00,"$1,027.73",$0.00,$248.10,$0.00,$0.00,$252.13,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$225.36,$0.00,$229.25,$0.00
186232-52,SUP,HCPCS C1776,,186232-52  -  LINER ACTB 52MM 32MM HW E-POLY HIP,"$1,440.00",$0.00,"$1,440.00",$648.00,"$1,027.73",$0.00,$248.10,$0.00,$0.00,$252.13,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$225.36,$0.00,$229.25,$0.00
186232-54,SUP,HCPCS C1776,,186232-54  -  LINER ACTB,"$1,440.00",$0.00,"$1,440.00",$648.00,"$1,027.73",$0.00,$248.10,$0.00,$0.00,$252.13,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$225.36,$0.00,$229.25,$0.00
186236-52,SUP,HCPCS C1776,,186236-52  -  LINER ACTB 52MM 36MM HW E-POLY HIP,"$1,440.00",$0.00,"$1,440.00",$648.00,"$1,027.73",$0.00,$248.10,$0.00,$0.00,$252.13,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$225.36,$0.00,$229.25,$0.00
186236-54,SUP,HCPCS C1776,,186236-54  -  LINER ACTB 54MM 36MM HW E-POLY HIP,"$1,440.00",$0.00,"$1,440.00",$648.00,"$1,027.73",$0.00,$248.10,$0.00,$0.00,$252.13,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$225.36,$0.00,$229.25,$0.00
186236-56,SUP,HCPCS C1776,,186236-56  -  LINER ACTB 56MM 36MM HW E-POLY HIP,"$1,440.00",$0.00,"$1,440.00",$648.00,"$1,027.73",$0.00,$248.10,$0.00,$0.00,$252.13,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$225.36,$0.00,$229.25,$0.00
186236-58,SUP,HCPCS C1776,,186236-58  -  LINER ACTB 58-60MM 36MM HW E-POLY HIP,"$1,440.00",$0.00,"$1,440.00",$648.00,"$1,027.73",$0.00,$248.10,$0.00,$0.00,$252.13,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$225.36,$0.00,$229.25,$0.00
186236-62,SUP,HCPCS C1776,,186236-62  -  LINER ACTB 62/63/64MM 36MM STRL RESTORIS HW XLVE HIP,"$1,440.00",$0.00,"$1,440.00",$648.00,"$1,027.73",$0.00,$248.10,$0.00,$0.00,$252.13,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$225.36,$0.00,$229.25,$0.00
186236-66,SUP,HCPCS C1776,,186236-66  -  LINER ACTB,"$1,440.00",$0.00,"$1,440.00",$648.00,"$1,027.73",$0.00,$248.10,$0.00,$0.00,$252.13,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$225.36,$0.00,$229.25,$0.00
186628-00,SUP,HCPCS C1776,,186628-00  -  HEAD FEM,"$1,725.00",$0.00,"$1,725.00",$776.25,"$1,231.13",$0.00,$297.21,$0.00,$0.00,$302.03,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$269.96,$0.00,$274.62,$0.00
186628-01,SUP,HCPCS C1776,,186628-01  -  HEAD FEM,"$1,725.00",$0.00,"$1,725.00",$776.25,"$1,231.13",$0.00,$297.21,$0.00,$0.00,$302.03,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$269.96,$0.00,$274.62,$0.00
186628-02,SUP,HCPCS C1776,,186628-02  -  HEAD FEM,"$1,725.00",$0.00,"$1,725.00",$776.25,"$1,231.13",$0.00,$297.21,$0.00,$0.00,$302.03,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$269.96,$0.00,$274.62,$0.00
186632-00,SUP,HCPCS C1776,,186632-00  -  HEAD FEM SM 32MM RESTORIS CERM HIP,"$1,725.00",$0.00,"$1,725.00",$776.25,"$1,231.13",$0.00,$297.21,$0.00,$0.00,$302.03,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$269.96,$0.00,$274.62,$0.00
186632-01,SUP,HCPCS C1776,,186632-01  -  SHELL ACTB HMSPHR 50MM 3.1MM STRL PST RESTORIS CH TI HIP,"$1,725.00",$0.00,"$1,725.00",$776.25,"$1,231.13",$0.00,$297.21,$0.00,$0.00,$302.03,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$269.96,$0.00,$274.62,$0.00
186632-02,SUP,HCPCS C1776,,186632-02  -  HEAD FEM,"$1,725.00",$0.00,"$1,725.00",$776.25,"$1,231.13",$0.00,$297.21,$0.00,$0.00,$302.03,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$269.96,$0.00,$274.62,$0.00
186632-03,SUP,HCPCS C1776,,186632-03  -  HEAD FEM,"$1,725.00",$0.00,"$1,725.00",$776.25,"$1,231.13",$0.00,$297.21,$0.00,$0.00,$302.03,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$269.96,$0.00,$274.62,$0.00
186636-00,SUP,HCPCS C1776,,186636-00  -  HEAD FEM,"$1,725.00",$0.00,"$1,725.00",$776.25,"$1,231.13",$0.00,$297.21,$0.00,$0.00,$302.03,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$269.96,$0.00,$274.62,$0.00
186636-01,SUP,HCPCS C1776,,186636-01  -  HEAD FEM +0MM 12/14 TPR MED 36MM STRL RESTORIS CERM HIP,"$1,725.00",$0.00,"$1,725.00",$776.25,"$1,231.13",$0.00,$297.21,$0.00,$0.00,$302.03,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$269.96,$0.00,$274.62,$0.00
186636-02,SUP,HCPCS C1776,,186636-02  -  HEAD FEM LG 36MM RESTORIS CERM HIP,"$1,725.00",$0.00,"$1,725.00",$776.25,"$1,231.13",$0.00,$297.21,$0.00,$0.00,$302.03,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$269.96,$0.00,$274.62,$0.00
186636-03,SUP,HCPCS C1776,,186636-03  -  HEAD FEM XL 36MM RESTORIS CERM HIP,"$1,725.00",$0.00,"$1,725.00",$776.25,"$1,231.13",$0.00,$297.21,$0.00,$0.00,$302.03,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$269.96,$0.00,$274.62,$0.00
186640-00,SUP,HCPCS C1776,,186640-00  -  HEAD FEM SM 40MM RESTORIS CERM HIP,"$1,725.00",$0.00,"$1,725.00",$776.25,"$1,231.13",$0.00,$297.21,$0.00,$0.00,$302.03,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$269.96,$0.00,$274.62,$0.00
186640-01,SUP,HCPCS C1776,,186640-01  -  HEAD FEM MED 40MM RESTORIS CERM HIP,"$1,725.00",$0.00,"$1,725.00",$776.25,"$1,231.13",$0.00,$297.21,$0.00,$0.00,$302.03,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$269.96,$0.00,$274.62,$0.00
186640-02,SUP,HCPCS C1776,,186640-02  -  HEAD FEM LG 40MM RESTORIS CERM HIP,"$1,725.00",$0.00,"$1,725.00",$776.25,"$1,231.13",$0.00,$297.21,$0.00,$0.00,$302.03,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$269.96,$0.00,$274.62,$0.00
186640-03,SUP,HCPCS C1776,,186640-03  -  HEAD FEM XL 40MM RESTORIS CERM HIP,"$1,725.00",$0.00,"$1,725.00",$776.25,"$1,231.13",$0.00,$297.21,$0.00,$0.00,$302.03,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$269.96,$0.00,$274.62,$0.00
1867.31.430,SUP,HCPCS C1713,,1867.31.430  -  SCREW BN 4.35MM 30MM NS VPR FX PA TI SPNE CORT 5.5MM ROD,"$4,215.00",$0.00,"$4,215.00","$1,896.75","$3,008.25",$0.00,$726.22,$0.00,$0.00,$738.01,"$4,215.00",$0.00,"$2,107.50","$3,338.28","$3,372.00",$0.00,$659.65,$0.00,$671.03,$0.00
1867.31.435,SUP,HCPCS C1713,,1867.31.435  -  SCREW BN 4.35MM 35MM NS VPR FX PA TI SPNE CORT 5.5MM ROD,"$4,215.00",$0.00,"$4,215.00","$1,896.75","$3,008.25",$0.00,$726.22,$0.00,$0.00,$738.01,"$4,215.00",$0.00,"$2,107.50","$3,338.28","$3,372.00",$0.00,$659.65,$0.00,$671.03,$0.00
1867.31.525,SUP,HCPCS C1713,,1867.31.525  -  SCREW BN 5MM 25MM NS VPR XPDM FX PA TI SPNE CORT 5.5MM ROD,"$4,215.00",$0.00,"$4,215.00","$1,896.75","$3,008.25",$0.00,$726.22,$0.00,$0.00,$738.01,"$4,215.00",$0.00,"$2,107.50","$3,338.28","$3,372.00",$0.00,$659.65,$0.00,$671.03,$0.00
1867.31.645,SUP,HCPCS C1713,,1867.31.645  -  SCREW BONE 6MM 45MM FIX EXPEDIUM TITANIUM SPN CORTICAL 5.5MM,"$4,215.00",$0.00,"$4,215.00","$1,896.75","$3,008.25",$0.00,$726.22,$0.00,$0.00,$738.01,"$4,215.00",$0.00,"$2,107.50","$3,338.28","$3,372.00",$0.00,$659.65,$0.00,$671.03,$0.00
1867.31.675,SUP,HCPCS C1713,,1867.31.675  -  SCREW BONE 7MM 50MM XPDM TI SPN CORT FIX 5.5MM ROD,"$4,215.00",$0.00,"$4,215.00","$1,896.75","$3,008.25",$0.00,$726.22,$0.00,$0.00,$738.01,"$4,215.00",$0.00,"$2,107.50","$3,338.28","$3,372.00",$0.00,$659.65,$0.00,$671.03,$0.00
1867.31.845,SUP,HCPCS C1713,,1867.31.845  -  SCREW BONE 8MM 45MM FIX EXPEDIUM TITANIUM SPN CORTICAL 5.5MM,"$4,215.00",$0.00,"$4,215.00","$1,896.75","$3,008.25",$0.00,$726.22,$0.00,$0.00,$738.01,"$4,215.00",$0.00,"$2,107.50","$3,338.28","$3,372.00",$0.00,$659.65,$0.00,$671.03,$0.00
1867.31.850,SUP,HCPCS C1713,,1867.31.850  -  SCREW BONE 8MM 50MM FIX EXPEDIUM TITANIUM SPN CORTICAL 5.5MM,"$4,215.00",$0.00,"$4,215.00","$1,896.75","$3,008.25",$0.00,$726.22,$0.00,$0.00,$738.01,"$4,215.00",$0.00,"$2,107.50","$3,338.28","$3,372.00",$0.00,$659.65,$0.00,$671.03,$0.00
1867-15-780,SUP,HCPCS C1713,,1867-15-780  -  SCREW BN 7MM 80MM VPR 2 PA CNN TI SPNE MIS,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
1882TC/46,SUP,HCPCS C1898,,1882TC/46  -  TENDRIL ST OPTIM,"$1,125.00",$0.00,"$1,125.00",$506.25,$802.91,$0.00,$193.83,$0.00,$0.00,$196.98,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$176.06,$0.00,$179.10,$0.00
1882TC/52,SUP,HCPCS C1898,,1882TC/52  -  TENDRIL ST OPTIM,"$1,125.00",$0.00,"$1,125.00",$506.25,$802.91,$0.00,$193.83,$0.00,$0.00,$196.98,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$176.06,$0.00,$179.10,$0.00
18-83525,SUP,Custom 27203010,,18-83525  -  BLADE SHVR 18CM 3.5MM SKMR 15D LRYNG 2 CVD ANG TIP LP IRR,"$2,137.50",$0.00,"$2,137.50",$0.00,"$1,525.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,137.50",$0.00,"$1,068.75","$1,692.90","$1,710.00",$0.00,$0.00,$0.00,$0.00,$0.00
1888TC/46,SUP,HCPCS C1898,,1888TC/46  -  LEAD PCNG 46CM VNTRC LUBRICITY FLXB DRBLTY BIOSTABILITY,"$1,125.00",$0.00,"$1,125.00",$506.25,$802.91,$0.00,$193.83,$0.00,$0.00,$196.98,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$176.06,$0.00,$179.10,$0.00
1888TC/52,SUP,HCPCS C1898,,1888TC/52  -  LEAD PCNG 52CM VNTRC LUBRICITY FLXB DRBLTY BIOSTABILITY,"$1,125.00",$0.00,"$1,125.00",$506.25,$802.91,$0.00,$193.83,$0.00,$0.00,$196.98,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$176.06,$0.00,$179.10,$0.00
1888TC/58,SUP,HCPCS C1898,,1888TC/58  -  LEAD PCNG STRG THN 6FR 58CM TNDRL ST IS-1 BP CNCT XTD-RETRAC,"$1,125.00",$0.00,"$1,125.00",$506.25,$802.91,$0.00,$193.83,$0.00,$0.00,$196.98,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$176.06,$0.00,$179.10,$0.00
1888TC/65,SUP,HCPCS C1898,,1888TC/65  -  LEAD PCNG THN STRG 6FR 65CM TNDRL ST IS-1 BP CNCT XTD-RETRAC,"$1,125.00",$0.00,"$1,125.00",$506.25,$802.91,$0.00,$193.83,$0.00,$0.00,$196.98,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$176.06,$0.00,$179.10,$0.00
1891-4020S,SUP,HCPCS C1713,,1891-4020S  -  SCREW BONE 4MM 20MM T2 TI PTHRD HUM SHFT STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1891-4022S,SUP,HCPCS C1713,,1891-4022S  -  SCREW BONE 4MM 22MM T2 TI PTHRD HUM SHFT STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1891-4024S,SUP,HCPCS C1713,,1891-4024S  -  SCREW BONE 4MM 24MM T2 TI PTHRD HUM SHFT STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1891-4025S,SUP,HCPCS C1713,,1891-4025S  -  SCREW BONE 4MM 25MM T2 TI ORTH SHFT PTHRD STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1891-4026S,SUP,HCPCS C1713,,1891-4026S  -  SCREW BONE 4MM 26MM T2 TI PTHRD HUM SHFT STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1891-4028S,SUP,HCPCS C1713,,1891-4028S  -  SCREW BONE 4MM 28MM T2 TI PTHRD HUM SHFT STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1891-4030S,SUP,HCPCS C1713,,1891-4030S  -  SCREW BONE 4MM 30MM T2 TI PTHRD HUM SHFT STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1891-4032S,SUP,HCPCS C1713,,1891-4032S  -  SCREW BONE 4MM 32MM T2 TI PTHRD HUM SHFT STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1891-4034S,SUP,HCPCS C1713,,1891-4034S  -  SCREW BONE 4MM 34MM T2 TI PTHRD HUM SHFT STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1891-4035S,SUP,HCPCS C1713,,1891-4035S  -  SCREW BONE 4MM 35MM T2 TI ORTH SHFT PTHRD STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1891-4036S,SUP,HCPCS C1713,,1891-4036S  -  SCREW BONE 4MM 36MM T2 TI PTHRD HUM SHFT STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1891-4038S,SUP,HCPCS C1713,,1891-4038S  -  SCREW BONE 4MM 38MM T2 TI PTHRD HUM SHFT STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1891-4040S,SUP,HCPCS C1713,,1891-4040S  -  SCREW BONE 4MM 40MM T2 TI PTHRD HUM SHFT STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1891-4045S,SUP,HCPCS C1713,,1891-4045S  -  SCREW BONE 4MM 45MM T2 TI PTHRD HUM SHFT STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1891-4050S,SUP,HCPCS C1713,,1891-4050S  -  SCREW BONE 4MM 50MM T2 TI PTHRD HUM SHFT STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1891-4055S,SUP,HCPCS C1713,,1891-4055S  -  SCREW BONE 4MM 55MM T2 TI PTHRD HUM SHFT STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1891-4060S,SUP,HCPCS C1713,,1891-4060S  -  SCREW BONE 4MM 60MM T2 TI PTHRD HUM SHFT STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1891-5025S,SUP,HCPCS C1713,,1891-5025S  -  SCREW BONE 5MM 25MM T2 TI PTHRD FEM/TIB SHFT STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1891-5030S,SUP,HCPCS C1713,,1891-5030S  -  SCREW BONE 5MM 30MM T2 TI PTHRD FEM/TIB SHFT STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1891-5035S,SUP,HCPCS C1713,,1891-5035S  -  SCREW BONE 5MM 35MM T2 TI PTHRD FEM/TIB SHFT STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1891-5040S,SUP,HCPCS C1713,,1891-5040S  -  SCREW BONE 5MM 40MM T2 TI PTHRD FEM/TIB SHFT STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1891-5045S,SUP,HCPCS C1713,,1891-5045S  -  SCREW BONE 5MM 45MM T2 TI PTHRD FEM/TIB SHFT STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1891-5050S,SUP,HCPCS C1713,,1891-5050S  -  SCREW BONE 5MM 50MM T2 TI PTHRD FEM/TIB SHFT STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1891-5055S,SUP,HCPCS C1713,,1891-5055S  -  SCREW BONE 5MM 55MM T2 TI PTHRD FEM/TIB SHFT STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1891-5060S,SUP,HCPCS C1713,,1891-5060S  -  SCREW BONE 5MM 60MM T2 TI PTHRD FEM/TIB SHFT STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1891-5065S,SUP,HCPCS C1713,,1891-5065S  -  SCREW BONE 5MM 65MM T2 TI PTHRD FEM/TIB SHFT STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1891-5070S,SUP,HCPCS C1713,,1891-5070S  -  SCREW BONE 5MM 70MM T2 TI PTHRD FEM/TIB SHFT STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1891-5075S,SUP,HCPCS C1713,,1891-5075S  -  SCREW BONE 5MM 75MM T2 TI PTHRD FEM/TIB SHFT STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1891-5080S,SUP,HCPCS C1713,,1891-5080S  -  SCREW BONE 5MM 80MM T2 TI PTHRD FEM/TIB SHFT STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1891-5085S,SUP,HCPCS C1713,,1891-5085S  -  SCREW BONE 5MM 85MM T2 TI PTHRD FEM/TIB SHFT STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1891-5090S,SUP,HCPCS C1713,,1891-5090S  -  SCREW BONE 5MM 90MM T2 TI PTHRD FEM/TIB SHFT STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1891-5095S,SUP,HCPCS C1713,,1891-5095S  -  SCREW BONE 5MM 95MM T2 TI PTHRD FEM/TIB SHFT STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1891-5100S,SUP,HCPCS C1713,,1891-5100S  -  SCREW BONE 5MM 100MM T2 TI PTHRD FEM/TIB SHFT STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1891-5105S,SUP,HCPCS C1713,,1891-5105S  -  SCREW BONE 5MM 105MM T2 TI PTHRD FEM/TIB SHFT STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1891-5110S,SUP,HCPCS C1713,,1891-5110S  -  SCREW BONE 5MM 110MM T2 TI PTHRD FEM/TIB SHFT STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1891-5115S,SUP,HCPCS C1713,,1891-5115S  -  SCREW BONE 5MM 115MM T2 TI PTHRD FEM/TIB SHFT STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1891-5120S,SUP,HCPCS C1713,,1891-5120S  -  SCREW BONE 5MM 120MM T2 TI PTHRD FEM/TIB SHFT STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1895-5001S,SUP,HCPCS C1713,,1895-5001S  -  NUT ORTH 5MM T2 CNDYLR TI CNDYLR SCR STRL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1895-5040S,SUP,HCPCS C1713,,1895-5040S  -  SCREW BONE 5MM 40MM T2 TI PTHRD CNDYLR LCK STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1895-5045S,SUP,HCPCS C1713,,1895-5045S  -  SCREW BONE 5MM 45MM T2 TI PTHRD CNDYLR LCK STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1895-5050S,SUP,HCPCS C1713,,1895-5050S  -  SCREW BONE 5MM 50MM T2 TI PTHRD CNDYLR LCK STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1895-5055S,SUP,HCPCS C1713,,1895-5055S  -  SCREW BONE 5MM 55MM T2 TI PTHRD CNDYLR LCK STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1895-5060S,SUP,HCPCS C1713,,1895-5060S  -  SCREW BONE 5MM 60MM T2 TI PTHRD CNDYLR LCK STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1895-5065S,SUP,HCPCS C1713,,1895-5065S  -  SCREW BONE 5MM 65MM T2 TI PTHRD CNDYLR LCK STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1895-5070S,SUP,HCPCS C1713,,1895-5070S  -  SCREW BONE 5MM 70MM T2 TI PTHRD CNDYLR LCK STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1895-5075S,SUP,HCPCS C1713,,1895-5075S  -  SCREW BONE 5MM 75MM T2 TI PTHRD CNDYLR LCK STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1895-5080S,SUP,HCPCS C1713,,1895-5080S  -  SCREW BONE 5MM 80MM T2 TI PTHRD CNDYLR LCK STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1895-5085S,SUP,HCPCS C1713,,1895-5085S  -  SCREW BONE 5MM 85MM T2 TI PTHRD CNDYLR LCK STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1895-5090S,SUP,HCPCS C1713,,1895-5090S  -  SCREW BONE 5MM 90MM T2 TI PTHRD CNDYLR LCK STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1895-5095S,SUP,HCPCS C1713,,1895-5095S  -  SCREW BONE 5MM 95MM T2 TI PTHRD CNDYLR LCK STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1895-5100S,SUP,HCPCS C1713,,1895-5100S  -  SCREW BONE 5MM 100MM T2 TI PTHRD CNDYLR LCK STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1895-5105S,SUP,HCPCS C1713,,1895-5105S  -  SCREW BONE 5MM 105MM T2 TI PTHRD CNDYLR LCK STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1895-5110S,SUP,HCPCS C1713,,1895-5110S  -  SCREW BONE 5MM 110MM T2 TI PTHRD CNDYLR LCK STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1895-5115S,SUP,HCPCS C1713,,1895-5115S  -  SCREW BONE 5MM 115MM T2 TI PTHRD CNDYLR LCK STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1895-5120S,SUP,HCPCS C1713,,1895-5120S  -  SCREW BONE 5MM 120MM T2 TI PTHRD CNDYLR LCK STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1896-4020S,SUP,HCPCS C1713,,1896-4020S  -  SCREW BONE 4MM 20MM T2 TI FULTHD HUM TIB LCK STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1896-4022S,SUP,HCPCS C1713,,1896-4022S  -  SCREW BONE 4MM 22MM T2 TI FULTHD HUM TIB LCK STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1896-4024S,SUP,HCPCS C1713,,1896-4024S  -  SCREW BONE 4MM 24MM T2 TI FULTHD HUM TIB LCK STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1896-4025S,SUP,HCPCS C1713,,1896-4025S  -  SCREW BN FT 4MM 25MM STRL LCK TI T2 NL SYS UNV SYS,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1896-4026S,SUP,HCPCS C1713,,1896-4026S  -  SCREW BONE 4MM 26MM T2 TI FULTHD HUM TIB LCK STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1896-4028S,SUP,HCPCS C1713,,1896-4028S  -  SCREW BONE 4MM 28MM T2 TI DISTAL LCK FULTHRD STRL IM NL SYS,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1896-4030S,SUP,HCPCS C1713,,1896-4030S  -  SCREW BONE 4MM 30MM T2 TI FULTHD HUM TIB LCK STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1896-4032S,SUP,HCPCS C1713,,1896-4032S  -  SCREW BONE 4MM 32MM T2 TI FULTHD HUM TIB LCK STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1896-4034S,SUP,HCPCS C1713,,1896-4034S  -  SCREW BONE 4MM 34MM T2 TI FULTHD HUM TIB LCK STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1896-4035S,SUP,HCPCS C1713,,1896-4035S  -  SCREW BONE 4MM 35MM T2 TI FULTHD HUM TIB LCK STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1896-4036S,SUP,HCPCS C1713,,1896-4036S  -  SCREW BONE 4MM 36MM T2 TI FULTHD HUM TIB LCK STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1896-4038S,SUP,HCPCS C1713,,1896-4038S  -  SCREW BONE 4MM 38MM T2 TI FULTHD LCK,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1896-4040S,SUP,HCPCS C1713,,1896-4040S  -  SCREW BONE 4MM 40MM T2 TI FULTHD HUM TIB LCK STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1896-4045S,SUP,HCPCS C1713,,1896-4045S  -  SCREW BONE 4MM 45MM T2 TI FULTHD HUM TIB LCK STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1896-4050S,SUP,HCPCS C1713,,1896-4050S  -  SCREW BONE 4MM 50MM T2 TI FULTHD HUM TIB LCK STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1896-4055S,SUP,HCPCS C1713,,1896-4055S  -  SCREW BONE 4MM 55MM T2 TI FULTHD HUM TIB LCK STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1896-4060S,SUP,HCPCS C1713,,1896-4060S  -  SCREW BONE 4MM 60MM T2 TI FULTHD HUM TIB LCK STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1896-5025S,SUP,HCPCS C1713,,1896-5025S  -  SCREW BONE 5MM 25MM T2 TI6AL4V PROX LCK FULTHRD STRL IM NL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1896-5027S,SUP,HCPCS C1713,,1896-5027S  -  SCREW BN FT 5MM 27.5MM STRL LCK TI T2 NL SYS UNV SYS,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1896-5030S,SUP,HCPCS C1713,,1896-5030S  -  SCREW BONE 5MM 30MM T2 TI FULTHD PROX FEM LCK STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1896-5032S,SUP,HCPCS C1713,,1896-5032S  -  SCREW BN FT 5MM 32.5MM STRL LCK TI T2 NL SYS UNV SYS,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1896-5035S,SUP,HCPCS C1713,,1896-5035S  -  SCREW BONE 5MM 35MM T2 TI FULTHD PROX FEM LCK STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1896-5037S,SUP,HCPCS C1713,,1896-5037S  -  SCREW BN FT 5MM 37.5MM STRL LCK TI T2 NL SYS UNV SYS,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1896-5040S,SUP,HCPCS C1713,,1896-5040S  -  SCREW BONE 5MM 40MM T2 TI FULTHD PROX FEM LCK STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1896-5042S,SUP,HCPCS C1713,,1896-5042S  -  SCREW BN FT 5MM 42.5MM STRL LCK TI T2 NL SYS UNV SYS,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1896-5045S,SUP,HCPCS C1713,,1896-5045S  -  SCREW BONE 5MM 45MM T2 TI FULTHD PROX FEM LCK STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1896-5047S,SUP,HCPCS C1713,,1896-5047S  -  SCREW BN FT 5MM 47.5MM STRL LCK TI T2 NL SYS UNV SYS,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1896-5050S,SUP,HCPCS C1713,,1896-5050S  -  SCREW BONE 5MM 50MM T2 TI FULTHD PROX FEM LCK STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1896-5052S,SUP,HCPCS C1713,,1896-5052S  -  SCREW BN FT 5MM 52.5MM STRL LCK TI T2 NL SYS UNV SYS,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1896-5055S,SUP,HCPCS C1713,,1896-5055S  -  SCREW BONE 5MM 55MM T2 TI FULTHD PROX FEM LCK STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1896-5057S,SUP,HCPCS C1713,,1896-5057S  -  SCREW BN FT 5MM 57.5MM STRL LCK TI T2 NL SYS UNV SYS,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1896-5060S,SUP,HCPCS C1713,,1896-5060S  -  SCREW BONE 5MM 60MM T2 TI FULTHD PROX FEM LCK STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1896-5065S,SUP,HCPCS C1713,,1896-5065S  -  SCREW BN FT 5MM 65MM STRL LCK TI T2 NL SYS UNV SYS,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1896-5070S,SUP,HCPCS C1713,,1896-5070S  -  SCREW BONE 5MM 70MM T2 TI FULTHD PROX FEM LCK STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1896-5075S,SUP,HCPCS C1713,,1896-5075S  -  SCREW BONE 5MM 75MM T2 TI FULTHD PROX FEM LCK STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1896-5080S,SUP,HCPCS C1713,,1896-5080S  -  SCREW BONE 5MM 80MM T2 TI FULTHD PROX FEM LCK STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1896-5085S,SUP,HCPCS C1713,,1896-5085S  -  SCREW BONE 5MM 85MM T2 TI FULTHD PROX FEM LCK STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1896-5090S,SUP,HCPCS C1713,,1896-5090S  -  SCREW BONE 5MM 90MM T2 TI FULTHD PROX FEM LCK STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1896-5095S,SUP,HCPCS C1713,,1896-5095S  -  SCREW BONE 5MM 95MM T2 TI FULTHD LCK STRL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1896-5100S,SUP,HCPCS C1713,,1896-5100S  -  SCREW BONE 5MM 100MM T2 FULTHD FEM HIP LCK STRL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1896-5105S,SUP,HCPCS C1713,,1896-5105S  -  SCREW BONE 5MM 105MM T2 TI FULTHD PROX FEM LCK STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1896-5110S,SUP,HCPCS C1713,,1896-5110S  -  SCREW BONE 5MM 110MM T2 TI FULTHD PROX FEM LCK STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1896-5115S,SUP,HCPCS C1713,,1896-5115S  -  SCREW BONE 5MM 115MM T2 TI FULTHD PROX FEM LCK STRL IM NAIL,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1896-5120S,SUP,HCPCS C1713,,1896-5120S  -  SCREW BN FT 5MM 120MM STRL LCK TI T2 NL SYS UNV SYS,$291.50,$0.00,$291.50,$131.18,$208.04,$0.00,$50.22,$0.00,$0.00,$51.04,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$45.62,$0.00,$46.41,$0.00
1897-6065S,SUP,HCPCS C1713,,1897-6065S  -  SCREW BONE 6.5MM 65MM T2 TI FEM LAG RECON STRL IM NAIL,$398.75,$0.00,$398.75,$179.44,$284.59,$0.00,$68.70,$0.00,$0.00,$69.82,$398.75,$0.00,$199.38,$315.81,$319.00,$0.00,$62.40,$0.00,$63.48,$0.00
1897-6070S,SUP,HCPCS C1713,,1897-6070S  -  SCREW BONE 6.5MM 70MM T2 TI FEM LAG RECON STRL IM NAIL,$398.75,$0.00,$398.75,$179.44,$284.59,$0.00,$68.70,$0.00,$0.00,$69.82,$398.75,$0.00,$199.38,$315.81,$319.00,$0.00,$62.40,$0.00,$63.48,$0.00
1897-6075S,SUP,HCPCS C1713,,1897-6075S  -  SCREW BN 6.5MM 75MM BRNZ STRL LG CNN TI FEM T2 RECON NL SYS,$398.75,$0.00,$398.75,$179.44,$284.59,$0.00,$68.70,$0.00,$0.00,$69.82,$398.75,$0.00,$199.38,$315.81,$319.00,$0.00,$62.40,$0.00,$63.48,$0.00
1897-6080S,SUP,HCPCS C1713,,1897-6080S  -  SCREW BN 6.5MM 80MM BRNZ STRL LG CNN TI FEM T2 RECON NL SYS,$398.75,$0.00,$398.75,$179.44,$284.59,$0.00,$68.70,$0.00,$0.00,$69.82,$398.75,$0.00,$199.38,$315.81,$319.00,$0.00,$62.40,$0.00,$63.48,$0.00
1897-6085S,SUP,HCPCS C1713,,1897-6085S  -  SCREW BN 6.5MM 85MM BRNZ STRL LG CNN TI FEM T2 RECON NL SYS,$398.75,$0.00,$398.75,$179.44,$284.59,$0.00,$68.70,$0.00,$0.00,$69.82,$398.75,$0.00,$199.38,$315.81,$319.00,$0.00,$62.40,$0.00,$63.48,$0.00
1897-6090S,SUP,HCPCS C1713,,1897-6090S  -  SCREW BN 6.5MM 90MM BRNZ STRL LG CNN TI FEM T2 RECON NL SYS,$398.75,$0.00,$398.75,$179.44,$284.59,$0.00,$68.70,$0.00,$0.00,$69.82,$398.75,$0.00,$199.38,$315.81,$319.00,$0.00,$62.40,$0.00,$63.48,$0.00
1897-6095S,SUP,HCPCS C1713,,1897-6095S  -  SCREW BN 6.5MM 95MM BRNZ STRL LG CNN TI FEM T2 RECON NL SYS,$398.75,$0.00,$398.75,$179.44,$284.59,$0.00,$68.70,$0.00,$0.00,$69.82,$398.75,$0.00,$199.38,$315.81,$319.00,$0.00,$62.40,$0.00,$63.48,$0.00
1897-6100S,SUP,HCPCS C1713,,1897-6100S  -  SCREW BN 6.5MM 100MM BRNZ STRL LG CNN TI FEM T2 RECON NL SYS,$398.75,$0.00,$398.75,$179.44,$284.59,$0.00,$68.70,$0.00,$0.00,$69.82,$398.75,$0.00,$199.38,$315.81,$319.00,$0.00,$62.40,$0.00,$63.48,$0.00
1897-6105S,SUP,HCPCS C1713,,1897-6105S  -  SCREW BN 6.5MM 105MM BRNZ STRL LG CNN TI FEM T2 RECON NL SYS,$398.75,$0.00,$398.75,$179.44,$284.59,$0.00,$68.70,$0.00,$0.00,$69.82,$398.75,$0.00,$199.38,$315.81,$319.00,$0.00,$62.40,$0.00,$63.48,$0.00
1897-6110S,SUP,HCPCS C1713,,1897-6110S  -  SCREW BONE 6.5MM 110MM T2 TI FEM LAG RECON STRL IM NAIL,$398.75,$0.00,$398.75,$179.44,$284.59,$0.00,$68.70,$0.00,$0.00,$69.82,$398.75,$0.00,$199.38,$315.81,$319.00,$0.00,$62.40,$0.00,$63.48,$0.00
1897-6115S,SUP,HCPCS C1713,,1897-6115S  -  SCREW BONE 6.5MM 115MM T2 TI FEM LAG RECON STRL IM NAIL,$398.75,$0.00,$398.75,$179.44,$284.59,$0.00,$68.70,$0.00,$0.00,$69.82,$398.75,$0.00,$199.38,$315.81,$319.00,$0.00,$62.40,$0.00,$63.48,$0.00
1897-6120S,SUP,HCPCS C1713,,1897-6120S  -  SCREW BONE 6.5MM 120MM T2 TI FEM LAG RECON STRL IM NAIL,$398.75,$0.00,$398.75,$179.44,$284.59,$0.00,$68.70,$0.00,$0.00,$69.82,$398.75,$0.00,$199.38,$315.81,$319.00,$0.00,$62.40,$0.00,$63.48,$0.00
1897-6125S,SUP,HCPCS C1713,,1897-6125S  -  SCREW BONE 6.5MM 125MM T2 TI FEM LAG RECON STRL IM NAIL,$398.75,$0.00,$398.75,$179.44,$284.59,$0.00,$68.70,$0.00,$0.00,$69.82,$398.75,$0.00,$199.38,$315.81,$319.00,$0.00,$62.40,$0.00,$63.48,$0.00
1897-6130S,SUP,HCPCS C1713,,1897-6130S  -  SCREW BONE 6.5MM 130MM T2 TI FEM LAG RECON STRL IM NAIL,$398.75,$0.00,$398.75,$179.44,$284.59,$0.00,$68.70,$0.00,$0.00,$69.82,$398.75,$0.00,$199.38,$315.81,$319.00,$0.00,$62.40,$0.00,$63.48,$0.00
19-0000T,SUP,Custom 27203010,,19-0000T  -  SLEEVE ADPR +0MM OFST UNV CTPR TI,$112.50,$0.00,$112.50,$0.00,$80.29,$0.00,$0.00,$0.00,$0.00,$0.00,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$0.00,$0.00,$0.00,$0.00
19-0005T,SUP,Custom 27203010,,19-0005T  -  SLEEVE ADPR 5MM OFST UNV CTPR STRL LF HIP,$112.50,$0.00,$112.50,$0.00,$80.29,$0.00,$0.00,$0.00,$0.00,$0.00,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$0.00,$0.00,$0.00,$0.00
19-0025T,SUP,Custom 27203010,,19-0025T  -  SLEEVE ADAPTER +2.5MM OFFST UNIVERSAL C TAPER TITANIUM,$112.50,$0.00,$112.50,$0.00,$80.29,$0.00,$0.00,$0.00,$0.00,$0.00,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$0.00,$0.00,$0.00,$0.00
190-151,SUP,HCPCS C2617,,190-151  -  STENT URET 8FR 22CM W/O GWIRE DUAL DRMTR PLRS HDR+,$306.25,$0.00,$306.25,$137.81,$218.57,$0.00,$52.77,$0.00,$0.00,$53.62,$306.25,$0.00,$153.13,$242.55,$245.00,$0.00,$47.93,$0.00,$48.76,$0.00
19-0325T,SUP,Custom 27203010,,19-0325T  -  UNIVERSAL C-TAPER -2.5mm ADAPTER SLEEVE (Ti),$112.50,$0.00,$112.50,$0.00,$80.29,$0.00,$0.00,$0.00,$0.00,$0.00,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$0.00,$0.00,$0.00,$0.00
190-5091-150,SUP,HCPCS C1751,,190-5091-150  -  CATH INFUS 90D .014IN ANG 2.1-1.7FR .017IN 150CM 5MM MCTH,"$1,772.50",$0.00,"$1,772.50",$962.47,"$1,265.03",$0.00,$305.39,$0.00,$0.00,$310.35,"$1,772.50",$0.00,$886.25,"$1,403.82","$1,418.00",$0.00,$277.40,$0.00,$282.18,$0.00
190-5092-150,SUP,HCPCS C1751,,190-5092-150  -  CATH INFUS 90D 2.4-1.9FR .017IN 150CM 5MM MCTH ANG PSHP NTNL,"$1,772.50",$0.00,"$1,772.50",$962.47,"$1,265.03",$0.00,$305.39,$0.00,$0.00,$310.35,"$1,772.50",$0.00,$886.25,"$1,403.82","$1,418.00",$0.00,$277.40,$0.00,$282.18,$0.00
19-1005,SUP,HCPCS C1713,,19-1005  -  PLATE BN STRG 15MM THINFLAP 2 HL TI CRNMXF,$197.50,$0.00,$197.50,$88.88,$140.96,$0.00,$34.03,$0.00,$0.00,$34.58,$197.50,$0.00,$98.75,$156.42,$158.00,$0.00,$30.91,$0.00,$31.44,$0.00
19-1010,SUP,HCPCS C1713,,19-1010  -  PLATE BONE WIDE 2 HOLE THINFLAP TITANIUM CRANIOMAXILLOFACIAL,$295.00,$0.00,$295.00,$132.75,$210.54,$0.00,$50.83,$0.00,$0.00,$51.65,$295.00,$0.00,$147.50,$233.64,$236.00,$0.00,$46.17,$0.00,$46.96,$0.00
19-1015,SUP,HCPCS C1713,,19-1015  -  PLATE BN SQ 13MM THINFLAP 4 HL TI CRNMXF,$780.00,$0.00,$780.00,$351.00,$556.69,$0.00,$134.39,$0.00,$0.00,$136.57,$780.00,$0.00,$390.00,$617.76,$624.00,$0.00,$122.07,$0.00,$124.18,$0.00
19-1019,SUP,HCPCS C1713,,19-1019  -  COVER BURR HOLE 13.5MM BENT SPN,$847.50,$0.00,$847.50,$381.38,$604.86,$0.00,$146.02,$0.00,$0.00,$148.39,$847.50,$0.00,$423.75,$671.22,$678.00,$0.00,$132.63,$0.00,$134.92,$0.00
19-1020,SUP,HCPCS C1713,,19-1020  -  PLATE BONE 18.5MM BURR HOLE THINFLAP TITANIUM,$847.50,$0.00,$847.50,$381.38,$604.86,$0.00,$146.02,$0.00,$0.00,$148.39,$847.50,$0.00,$423.75,$671.22,$678.00,$0.00,$132.63,$0.00,$134.92,$0.00
19-1021,SUP,HCPCS C1713,,19-1021  -  COVER BURR HOLE BENT LP 24MM THINFLAP CRANIOMAXILLOFACIAL,$847.50,$0.00,$847.50,$381.38,$604.86,$0.00,$146.02,$0.00,$0.00,$148.39,$847.50,$0.00,$423.75,$671.22,$678.00,$0.00,$132.63,$0.00,$134.92,$0.00
19-1030,SUP,HCPCS C1713,,19-1030  -  PLATE BONE 85X53X.5MM GRID PANEL THINFLAP TITANIUM,"$4,047.50",$0.00,"$4,047.50","$1,821.38","$2,888.70",$0.00,$697.36,$0.00,$0.00,$708.68,"$4,047.50",$0.00,"$2,023.75","$3,205.62","$3,238.00",$0.00,$633.43,$0.00,$644.36,$0.00
19-1040,SUP,HCPCS C1713,,19-1040  -  PLATE BONE LONG 6 HOLE STR THINFLAP TITANIUM,$820.00,$0.00,$820.00,$369.00,$585.23,$0.00,$141.28,$0.00,$0.00,$143.58,$820.00,$0.00,$410.00,$649.44,$656.00,$0.00,$128.33,$0.00,$130.54,$0.00
19-1045,SUP,HCPCS C1713,,19-1045  -  PLATE BONE LONG 4 HOLE STR THINFLAP TITANIUM,$405.00,$0.00,$405.00,$182.25,$289.05,$0.00,$69.78,$0.00,$0.00,$70.91,$405.00,$0.00,$202.50,$320.76,$324.00,$0.00,$63.38,$0.00,$64.48,$0.00
19-1050,SUP,HCPCS C1713,,19-1050  -  PLATE BONE STANDARD 6 HOLE CVD THINFLAP TITANIUM CRANFCL,$820.00,$0.00,$820.00,$369.00,$585.23,$0.00,$141.28,$0.00,$0.00,$143.58,$820.00,$0.00,$410.00,$649.44,$656.00,$0.00,$128.33,$0.00,$130.54,$0.00
19-1060,SUP,HCPCS C1713,,19-1060  -  PLATE BN 2Y 16MM THINFLAP 6 HL TI CRNMXF,$820.00,$0.00,$820.00,$369.00,$585.23,$0.00,$141.28,$0.00,$0.00,$143.58,$820.00,$0.00,$410.00,$649.44,$656.00,$0.00,$128.33,$0.00,$130.54,$0.00
19-1065,SUP,HCPCS C1713,,19-1065  -  PLATE BONE STANDARD 6 HOLE Y THINFLAP TITANIUM,$880.00,$0.00,$880.00,$396.00,$628.06,$0.00,$151.62,$0.00,$0.00,$154.08,$880.00,$0.00,$440.00,$696.96,$704.00,$0.00,$137.72,$0.00,$140.10,$0.00
19-1200AU,SUP,Custom 27203010,,19-1200AU  -  FORCEP BIPOL 8-.7MM HARDY BAYONETTE DISP,$372.50,$0.00,$372.50,$0.00,$265.85,$0.00,$0.00,$0.00,$0.00,$0.00,$372.50,$0.00,$186.25,$295.02,$298.00,$0.00,$0.00,$0.00,$0.00,$0.00
1924-508,SUP,Custom 27203010,,1924-508  -  CIRCUIT BRTHG CSTM RESP HMD LN UNHT 1.5FT INF 10MM,$6.22,$0.00,$6.22,$0.00,$4.44,$0.00,$0.00,$0.00,$0.00,$0.00,$6.22,$0.00,$3.11,$4.93,$4.98,$0.00,$0.00,$0.00,$0.00,$0.00
1944/46,SUP,HCPCS C1898,,1944/46  -  LEAD PCNG 10MM SPC S J 7FR 46CM ISFLX ATCPT IS-1 BP CNCT PSV,"$1,125.00",$0.00,"$1,125.00",$506.25,$802.91,$0.00,$193.83,$0.00,$0.00,$196.98,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$176.06,$0.00,$179.10,$0.00
1944/52,SUP,HCPCS C1898,,1944/52  -  LEAD PCNG J 7FR 52CM ISFLX IS-1 BP CNCT TINE FX OPTIM STRD,"$1,125.00",$0.00,"$1,125.00",$506.25,$802.91,$0.00,$193.83,$0.00,$0.00,$196.98,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$176.06,$0.00,$179.10,$0.00
1948/46,SUP,HCPCS C1898,,1948/46  -  LEAD PCNG STRG 46CM STRL LF ISFLX ATCPT TINE FX IS-1 BP CNCT,"$1,125.00",$0.00,"$1,125.00",$506.25,$802.91,$0.00,$193.83,$0.00,$0.00,$196.98,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$176.06,$0.00,$179.10,$0.00
1948/52,SUP,HCPCS C1898,,1948/52  -  LEAD PCNG 7FR 52CM ISFLX BP PSV FX TINE IS 1 OPTIM STRD,"$1,125.00",$0.00,"$1,125.00",$506.25,$802.91,$0.00,$193.83,$0.00,$0.00,$196.98,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$176.06,$0.00,$179.10,$0.00
1948/58,SUP,HCPCS C1898,,1948/58  -  LEAD PCNG STRG 7FR 58CM ISFLX ABRSN RST IS-1 BP CNCT TINE FX,"$1,125.00",$0.00,"$1,125.00",$506.25,$802.91,$0.00,$193.83,$0.00,$0.00,$196.98,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$176.06,$0.00,$179.10,$0.00
195-7112-6,SUP,Custom 27203010,,REAGENT DPS EXCH BUFF RMD HS ANALY,"$2,335.00",$0.00,"$2,335.00",$0.00,"$1,666.49",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,335.00",$0.00,"$1,167.50","$1,849.32","$1,868.00",$0.00,$0.00,$0.00,$0.00,$0.00
195-7115,SUP,Custom 27203010,,REAGENT WSH SOL CHM,$840.00,$0.00,$840.00,$0.00,$599.51,$0.00,$0.00,$0.00,$0.00,$0.00,$840.00,$0.00,$420.00,$665.28,$672.00,$0.00,$0.00,$0.00,$0.00,$0.00
195-7119HS,SUP,Custom 27203010,,REAGENT CHK MX ANALY,$36.88,$0.00,$36.88,$0.00,$26.32,$0.00,$0.00,$0.00,$0.00,$0.00,$36.88,$0.00,$18.44,$29.21,$29.50,$0.00,$0.00,$0.00,$0.00,$0.00
195-7137,SUP,Custom 27203010,,REAGENT DILU ANALY,$133.00,$0.00,$133.00,$0.00,$94.92,$0.00,$0.00,$0.00,$0.00,$0.00,$133.00,$0.00,$66.50,$105.34,$106.40,$0.00,$0.00,$0.00,$0.00,$0.00
195-7150,SUP,Custom 27203010,,CARTRIDGE ANALY PURF,$777.50,$0.00,$777.50,$0.00,$554.90,$0.00,$0.00,$0.00,$0.00,$0.00,$777.50,$0.00,$388.75,$615.78,$622.00,$0.00,$0.00,$0.00,$0.00,$0.00
1967.89.300,SUP,HCPCS C1713,,1967.89.300  -  ROD SPINAL STR 300MM HEXAGON VIPER 2 COCR,"$1,957.50",$0.00,"$1,957.50",$880.88,"$1,397.07",$0.00,$337.27,$0.00,$0.00,$342.74,"$1,957.50",$0.00,$978.75,"$1,550.34","$1,566.00",$0.00,$306.35,$0.00,$311.63,$0.00
1967.89.480,SUP,HCPCS C1713,,1967.89.480  -  ROD SPINAL STR 480MM VIPER 2 COCR,"$2,130.00",$0.00,"$2,130.00",$958.50,"$1,520.18",$0.00,$366.99,$0.00,$0.00,$372.95,"$2,130.00",$0.00,"$1,065.00","$1,686.96","$1,704.00",$0.00,$333.35,$0.00,$339.10,$0.00
197230FLA,SUP,HCPCS C1894,,197230FLA  -  SHEATH IRRIGATION ENDO-SCRUB 2 45D 4MM LEFT STERILE,$687.50,$0.00,$687.50,$373.31,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
199.933S,SUP,Custom 27203010,,199.933S  -  KIT SCRL BAR THRD 6MM 200MM STRL,"$2,240.93",$0.00,"$2,240.93",$0.00,"$1,599.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,240.93",$0.00,"$1,120.46","$1,774.82","$1,792.74",$0.00,$0.00,$0.00,$0.00,$0.00
199.936S,SUP,HCPCS C1713,,199.936S  -  BAR SACRAL 6MM 260MM THREAD SPN STERILE,"$2,240.93",$0.00,"$2,240.93","$1,008.42","$1,599.35",$0.00,$374.85,$0.00,$0.00,$392.37,"$2,240.93",$0.00,"$1,120.46","$1,774.82","$1,792.74",$0.00,$340.49,$0.00,$356.76,$0.00
19A001,SUP,Custom 27804086,,19A001  -  GRAFT BONE 4-10MM FREEZE DRIED CANCELLOUS CORTICAL 30ML,"$1,022.50",$0.00,"$1,022.50",$0.00,$729.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,022.50",$0.00,$511.25,$809.82,$818.00,$0.00,$0.00,$0.00,$0.00,$0.00
19A002,SUP,Custom 27804086,,19A002  -  GRAFT BONE 4-10MM FREEZE DRIED CANCELLOUS CORTICAL 15ML,$582.50,$0.00,$582.50,$0.00,$415.73,$0.00,$0.00,$0.00,$0.00,$0.00,$582.50,$0.00,$291.25,$461.34,$466.00,$0.00,$0.00,$0.00,$0.00,$0.00
19AGFN-756,SUP,Custom 27803010,,19AGFN-756  -  VALVE AORTIC 85D 19MM 17.8MM 1 DIGIT GRADIENT MECHANICAL,"$11,750.00",$0.00,"$11,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,750.00",$0.00,"$5,875.00","$9,306.00","$9,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
1DLMC03,SUP,HCPCS C1781,,1DLMC03  -  MESH SURG THK1MM 15X10CM BIOMATERIAL DUALMESH GORE-TEX SOFT,$982.50,$0.00,$982.50,$442.13,$701.21,$0.00,$169.28,$0.00,$0.00,$172.03,$982.50,$0.00,$491.25,$778.14,$786.00,$0.00,$153.76,$0.00,$156.41,$0.00
1MTD202,SUP,Custom 27203010,,1MTD202  -  DEVICE THYRPL 20CMX.4CMX.6MM VOCAL CORD SFT INERT NALRG,$875.00,$0.00,$875.00,$0.00,$624.49,$0.00,$0.00,$0.00,$0.00,$0.00,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$0.00,$0.00,$0.00,$0.00
2000-49,SUP,HCPCS C1877,,2000-49  -  SHUNT CARDIO 9FR P-I CRTD OUTLYING T PORT 31CM STRL,$422.50,$0.00,$422.50,$190.13,$301.54,$0.00,$72.79,$0.00,$0.00,$73.98,$422.50,$0.00,$211.25,$334.62,$338.00,$0.00,$66.12,$0.00,$67.26,$0.00
200-120,SUP,Custom 27203010,,200-120  -  KIT DIL .035IN 18GA 180CM GW INS NDL SCPL PCTV SHTH FLSH,$421.68,$0.00,$421.68,$0.00,$300.95,$0.00,$0.00,$0.00,$0.00,$0.00,$421.68,$0.00,$210.84,$333.97,$337.34,$0.00,$0.00,$0.00,$0.00,$0.00
2001-2240,SUP,Custom 27803010,,2001-2240  -  INSERT ACETAB 10D 40MM 22MM OMNIFIT HIP SERIES I,"$2,002.50",$0.00,"$2,002.50",$0.00,"$1,429.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,002.50",$0.00,"$1,001.25","$1,585.98","$1,602.00",$0.00,$0.00,$0.00,$0.00,$0.00
2001-2242,SUP,Custom 27803010,,2001-2242  -  INSERT ACETAB 10D 42MM 22MM OMNIFIT HIP SERIES I,"$2,002.50",$0.00,"$2,002.50",$0.00,"$1,429.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,002.50",$0.00,"$1,001.25","$1,585.98","$1,602.00",$0.00,$0.00,$0.00,$0.00,$0.00
2001-2244,SUP,Custom 27803010,,2001-2244  -  INSERT ACETAB 10D 44MM 22MM OMNIFIT HIP SERIES I,"$2,002.50",$0.00,"$2,002.50",$0.00,"$1,429.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,002.50",$0.00,"$1,001.25","$1,585.98","$1,602.00",$0.00,$0.00,$0.00,$0.00,$0.00
2001-2246,SUP,Custom 27803010,,2001-2246  -  INSERT ACETAB 10D 46MM 22MM OMNIFIT HIP SERIES I,"$2,002.50",$0.00,"$2,002.50",$0.00,"$1,429.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,002.50",$0.00,"$1,001.25","$1,585.98","$1,602.00",$0.00,$0.00,$0.00,$0.00,$0.00
2001-2248,SUP,Custom 27803010,,2001-2248  -  INSERT ACETAB 10D 48MM 22MM OMNIFIT HIP SERIES I,"$2,002.50",$0.00,"$2,002.50",$0.00,"$1,429.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,002.50",$0.00,"$1,001.25","$1,585.98","$1,602.00",$0.00,$0.00,$0.00,$0.00,$0.00
2001-2250,SUP,Custom 27803010,,2001-2250  -  INSERT ACETAB 10D 50MM 22MM OMNIFIT HIP SERIES I,"$2,002.50",$0.00,"$2,002.50",$0.00,"$1,429.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,002.50",$0.00,"$1,001.25","$1,585.98","$1,602.00",$0.00,$0.00,$0.00,$0.00,$0.00
2001-2252,SUP,Custom 27803010,,2001-2252  -  INSERT ACETAB 10D 52MM 22MM OMNIFIT HIP SERIES I,"$2,002.50",$0.00,"$2,002.50",$0.00,"$1,429.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,002.50",$0.00,"$1,001.25","$1,585.98","$1,602.00",$0.00,$0.00,$0.00,$0.00,$0.00
2001-2254,SUP,Custom 27803010,,2001-2254  -  INSERT ACETAB 10D 54MM 22MM OMNIFIT HIP SERIES I,"$2,002.50",$0.00,"$2,002.50",$0.00,"$1,429.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,002.50",$0.00,"$1,001.25","$1,585.98","$1,602.00",$0.00,$0.00,$0.00,$0.00,$0.00
2001-2256,SUP,Custom 27803010,,2001-2256  -  INSERT ACETAB 10D 56MM 22MM OMNIFIT HIP SERIES I,"$2,002.50",$0.00,"$2,002.50",$0.00,"$1,429.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,002.50",$0.00,"$1,001.25","$1,585.98","$1,602.00",$0.00,$0.00,$0.00,$0.00,$0.00
2001-2258,SUP,Custom 27803010,,2001-2258  -  INSERT ACETAB 10D 58MM 22MM OMNIFIT HIP SERIES I,"$2,002.50",$0.00,"$2,002.50",$0.00,"$1,429.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,002.50",$0.00,"$1,001.25","$1,585.98","$1,602.00",$0.00,$0.00,$0.00,$0.00,$0.00
2001-2261,SUP,Custom 27803010,,2001-2261  -  INSERT ACETAB 10D 61MM 22MM OMNIFIT HIP SERIES I,"$2,002.50",$0.00,"$2,002.50",$0.00,"$1,429.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,002.50",$0.00,"$1,001.25","$1,585.98","$1,602.00",$0.00,$0.00,$0.00,$0.00,$0.00
2001-2644,SUP,Custom 27803010,,2001-2644  -  INSERT ACETAB 10D 44MM 26MM OMNIFIT HIP SERIES I,"$2,002.50",$0.00,"$2,002.50",$0.00,"$1,429.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,002.50",$0.00,"$1,001.25","$1,585.98","$1,602.00",$0.00,$0.00,$0.00,$0.00,$0.00
2001-2646,SUP,Custom 27803010,,2001-2646  -  INSERT ACETAB 10D 46MM 26MM OMNIFIT HIP SERIES I,"$2,002.50",$0.00,"$2,002.50",$0.00,"$1,429.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,002.50",$0.00,"$1,001.25","$1,585.98","$1,602.00",$0.00,$0.00,$0.00,$0.00,$0.00
2001-2648,SUP,Custom 27803010,,2001-2648  -  INSERT ACETAB 10D 48MM 26MM OMNIFIT HIP SERIES I,"$2,002.50",$0.00,"$2,002.50",$0.00,"$1,429.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,002.50",$0.00,"$1,001.25","$1,585.98","$1,602.00",$0.00,$0.00,$0.00,$0.00,$0.00
2001-2650,SUP,Custom 27803010,,2001-2650  -  INSERT ACETAB 10D 50MM 26MM OMNIFIT HIP SERIES I,"$2,002.50",$0.00,"$2,002.50",$0.00,"$1,429.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,002.50",$0.00,"$1,001.25","$1,585.98","$1,602.00",$0.00,$0.00,$0.00,$0.00,$0.00
2001-2652,SUP,Custom 27803010,,2001-2652  -  INSERT ACETAB 10D 52MM 26MM OMNIFIT HIP SERIES I,"$2,002.50",$0.00,"$2,002.50",$0.00,"$1,429.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,002.50",$0.00,"$1,001.25","$1,585.98","$1,602.00",$0.00,$0.00,$0.00,$0.00,$0.00
2001-2654,SUP,Custom 27803010,,2001-2654  -  INSERT ACETAB 10D 54MM 26MM OMNIFIT HIP SERIES I,"$2,002.50",$0.00,"$2,002.50",$0.00,"$1,429.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,002.50",$0.00,"$1,001.25","$1,585.98","$1,602.00",$0.00,$0.00,$0.00,$0.00,$0.00
2001-2656,SUP,Custom 27803010,,2001-2656  -  INSERT ACETAB 10D 56MM 26MM OMNIFIT HIP SERIES I,"$2,002.50",$0.00,"$2,002.50",$0.00,"$1,429.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,002.50",$0.00,"$1,001.25","$1,585.98","$1,602.00",$0.00,$0.00,$0.00,$0.00,$0.00
2001-2658,SUP,Custom 27803010,,2001-2658  -  INSERT ACETAB 10D 58MM 26MM OMNIFIT HIP SERIES I,"$2,002.50",$0.00,"$2,002.50",$0.00,"$1,429.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,002.50",$0.00,"$1,001.25","$1,585.98","$1,602.00",$0.00,$0.00,$0.00,$0.00,$0.00
2001-2661,SUP,Custom 27803010,,2001-2661  -  INSERT ACETAB 10D 61MM 26MM OMNIFIT HIP SERIES I,"$2,002.50",$0.00,"$2,002.50",$0.00,"$1,429.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,002.50",$0.00,"$1,001.25","$1,585.98","$1,602.00",$0.00,$0.00,$0.00,$0.00,$0.00
2001-2844,SUP,Custom 27803010,,2001-2844  -  INSERT ACETAB 10D 44MM 28MM OMNIFIT HIP SERIES I,"$2,002.50",$0.00,"$2,002.50",$0.00,"$1,429.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,002.50",$0.00,"$1,001.25","$1,585.98","$1,602.00",$0.00,$0.00,$0.00,$0.00,$0.00
2001-2846,SUP,Custom 27803010,,2001-2846  -  INSERT ACETAB 10D 46MM 28MM OMNIFIT HIP SERIES I,"$2,002.50",$0.00,"$2,002.50",$0.00,"$1,429.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,002.50",$0.00,"$1,001.25","$1,585.98","$1,602.00",$0.00,$0.00,$0.00,$0.00,$0.00
2001-2848,SUP,Custom 27803010,,2001-2848  -  INSERT ACETAB 10D 48MM 28MM OMNIFIT HIP SERIES I,"$2,002.50",$0.00,"$2,002.50",$0.00,"$1,429.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,002.50",$0.00,"$1,001.25","$1,585.98","$1,602.00",$0.00,$0.00,$0.00,$0.00,$0.00
2001-2850,SUP,Custom 27803010,,2001-2850  -  INSERT ACETAB 10D 50MM 28MM OMNIFIT HIP SERIES I,"$2,002.50",$0.00,"$2,002.50",$0.00,"$1,429.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,002.50",$0.00,"$1,001.25","$1,585.98","$1,602.00",$0.00,$0.00,$0.00,$0.00,$0.00
2001-2852,SUP,Custom 27803010,,2001-2852  -  INSERT ACETAB 10D 52MM 28MM OMNIFIT HIP SERIES I,"$2,002.50",$0.00,"$2,002.50",$0.00,"$1,429.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,002.50",$0.00,"$1,001.25","$1,585.98","$1,602.00",$0.00,$0.00,$0.00,$0.00,$0.00
2001-2854,SUP,Custom 27803010,,2001-2854  -  INSERT ACETAB 10D 54MM 28MM OMNIFIT HIP SERIES I,"$2,002.50",$0.00,"$2,002.50",$0.00,"$1,429.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,002.50",$0.00,"$1,001.25","$1,585.98","$1,602.00",$0.00,$0.00,$0.00,$0.00,$0.00
2001-2856,SUP,Custom 27803010,,2001-2856  -  INSERT ACETAB 10D 56MM 28MM OMNIFIT HIP SERIES I,"$2,002.50",$0.00,"$2,002.50",$0.00,"$1,429.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,002.50",$0.00,"$1,001.25","$1,585.98","$1,602.00",$0.00,$0.00,$0.00,$0.00,$0.00
2001-2858,SUP,Custom 27803010,,2001-2858  -  INSERT ACETAB 10D 58MM 28MM OMNIFIT HIP SERIES I,"$2,002.50",$0.00,"$2,002.50",$0.00,"$1,429.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,002.50",$0.00,"$1,001.25","$1,585.98","$1,602.00",$0.00,$0.00,$0.00,$0.00,$0.00
2001-2861,SUP,Custom 27803010,,2001-2861  -  INSERT ACETAB 10D 61MM 28MM OMNIFIT HIP SERIES I,"$2,002.50",$0.00,"$2,002.50",$0.00,"$1,429.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,002.50",$0.00,"$1,001.25","$1,585.98","$1,602.00",$0.00,$0.00,$0.00,$0.00,$0.00
2001-3250,SUP,Custom 27803010,,2001-3250  -  INSERT ACETAB 10D 50MM 32MM OMNIFIT HIP SERIES I,"$2,002.50",$0.00,"$2,002.50",$0.00,"$1,429.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,002.50",$0.00,"$1,001.25","$1,585.98","$1,602.00",$0.00,$0.00,$0.00,$0.00,$0.00
2001-3252,SUP,Custom 27803010,,2001-3252  -  INSERT ACETAB 10D 52MM 32MM OMNIFIT HIP SERIES I,"$2,002.50",$0.00,"$2,002.50",$0.00,"$1,429.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,002.50",$0.00,"$1,001.25","$1,585.98","$1,602.00",$0.00,$0.00,$0.00,$0.00,$0.00
2001-3254,SUP,Custom 27803010,,2001-3254  -  INSERT ACETAB 10D 54MM 32MM OMNIFIT HIP SERIES I,"$2,002.50",$0.00,"$2,002.50",$0.00,"$1,429.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,002.50",$0.00,"$1,001.25","$1,585.98","$1,602.00",$0.00,$0.00,$0.00,$0.00,$0.00
2001-3256,SUP,Custom 27803010,,2001-3256  -  INSERT ACETAB 10D 56MM 32MM OMNIFIT HIP SERIES I,"$2,002.50",$0.00,"$2,002.50",$0.00,"$1,429.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,002.50",$0.00,"$1,001.25","$1,585.98","$1,602.00",$0.00,$0.00,$0.00,$0.00,$0.00
2001-3258,SUP,Custom 27803010,,2001-3258  -  INSERT ACETAB 10D 58MM 32MM OMNIFIT HIP SERIES I,"$2,002.50",$0.00,"$2,002.50",$0.00,"$1,429.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,002.50",$0.00,"$1,001.25","$1,585.98","$1,602.00",$0.00,$0.00,$0.00,$0.00,$0.00
2001-3261,SUP,Custom 27803010,,2001-3261  -  INSERT ACETAB 10D 61MM 32MM OMNIFIT HIP SERIES I,"$2,002.50",$0.00,"$2,002.50",$0.00,"$1,429.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,002.50",$0.00,"$1,001.25","$1,585.98","$1,602.00",$0.00,$0.00,$0.00,$0.00,$0.00
2002-000,SUP,HCPCS C1729,,2002-000  -  DRAIN INCISION SMALL STATURE 1 CHAMBER SUCTION CONTROL,$53.29,$0.00,$53.29,$28.94,$38.03,$0.00,$9.18,$0.00,$0.00,$9.33,$53.29,$0.00,$26.64,$42.21,$42.63,$0.00,$8.34,$0.00,$8.48,$0.00
20022 B-M,SUP,Custom 27803010,,20022 B-M  -  PLATE 18MM TI BONE SPNL,"$7,326.88",$0.00,"$7,326.88",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,326.88",$0.00,"$3,663.44","$5,802.89","$5,861.50",$0.00,$0.00,$0.00,$0.00,$0.00
20026 A-H,SUP,Custom 27803010,,20026 A-H  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,543.75",$0.00,"$1,543.75",$0.00,"$1,101.77",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,543.75",$0.00,$771.88,"$1,222.65","$1,235.00",$0.00,$0.00,$0.00,$0.00,$0.00
20026 A-M,SUP,Custom 27803010,,20026 A-M  -  PLATE 18MM TI BONE SPNL,"$1,700.50",$0.00,"$1,700.50",$0.00,"$1,213.65",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,700.50",$0.00,$850.25,"$1,346.80","$1,360.40",$0.00,$0.00,$0.00,$0.00,$0.00
2003-01,SUP,Custom 27203010,,2003-01  -  STABILIT FIRST FRACTURE KIT WITH POWERCURVE,"$7,000.00",$0.00,"$7,000.00",$0.00,"$4,995.90",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,000.00",$0.00,"$3,500.00","$5,544.00","$5,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
20038 B,SUP,Custom 27803010,,20038 B  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,047.38",$0.00,"$1,047.38",$0.00,$747.51,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,047.38",$0.00,$523.69,$829.52,$837.90,$0.00,$0.00,$0.00,$0.00,$0.00
20038 C,SUP,Custom 27803010,,20038 C  -  PLATE 18MM TI BONE SPNL,"$1,047.38",$0.00,"$1,047.38",$0.00,$747.51,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,047.38",$0.00,$523.69,$829.52,$837.90,$0.00,$0.00,$0.00,$0.00,$0.00
20038 D,SUP,Custom 27803010,,20038 D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,282.50",$0.00,"$1,282.50",$0.00,$915.32,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,282.50",$0.00,$641.25,"$1,015.74","$1,026.00",$0.00,$0.00,$0.00,$0.00,$0.00
20040 L,SUP,Custom 27203010,,20040 L  -  PLATE 18MM TI BONE SPNL,"$3,374.88",$0.00,"$3,374.88",$0.00,"$2,408.65",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,374.88",$0.00,"$1,687.44","$2,672.90","$2,699.90",$0.00,$0.00,$0.00,$0.00,$0.00
20040 M,SUP,Custom 27203010,,20040 M  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$3,374.88",$0.00,"$3,374.88",$0.00,"$2,408.65",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,374.88",$0.00,"$1,687.44","$2,672.90","$2,699.90",$0.00,$0.00,$0.00,$0.00,$0.00
20049 A-H,SUP,Custom 27803010,,20049 A-H  -  PLATE 18MM TI BONE SPNL,"$1,615.00",$0.00,"$1,615.00",$0.00,"$1,152.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,615.00",$0.00,$807.50,"$1,279.08","$1,292.00",$0.00,$0.00,$0.00,$0.00,$0.00
20049 C-H,SUP,Custom 27803010,,20049 C-H  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,615.00",$0.00,"$1,615.00",$0.00,"$1,152.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,615.00",$0.00,$807.50,"$1,279.08","$1,292.00",$0.00,$0.00,$0.00,$0.00,$0.00
2006-2240,SUP,Custom 27803010,,2006-2240  -  INSERT ACETAB 40MM 22MM 20D HIP OMFT,"$1,925.63",$0.00,"$1,925.63",$0.00,"$1,374.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,925.63",$0.00,$962.81,"$1,525.10","$1,540.50",$0.00,$0.00,$0.00,$0.00,$0.00
2006-2242,SUP,Custom 27803010,,2006-2242  -  INSERT ACETAB 42MM 22MM 20D HIP OMFT,"$1,925.63",$0.00,"$1,925.63",$0.00,"$1,374.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,925.63",$0.00,$962.81,"$1,525.10","$1,540.50",$0.00,$0.00,$0.00,$0.00,$0.00
2006-2244,SUP,Custom 27803010,,2006-2244  -  INSERT ACETAB 20D 44MM 22MM OMNIFIT HIP SERIES II,"$2,002.50",$0.00,"$2,002.50",$0.00,"$1,429.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,002.50",$0.00,"$1,001.25","$1,585.98","$1,602.00",$0.00,$0.00,$0.00,$0.00,$0.00
2006-2246,SUP,Custom 27803010,,2006-2246  -  INSERT ACETAB 46MM 22MM 20D HIP OMFT,"$1,925.63",$0.00,"$1,925.63",$0.00,"$1,374.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,925.63",$0.00,$962.81,"$1,525.10","$1,540.50",$0.00,$0.00,$0.00,$0.00,$0.00
2006-2248,SUP,Custom 27803010,,2006-2248  -  INSERT ACETAB 20D 48MM 22MM OMNIFIT HIP SERIES II,"$2,002.50",$0.00,"$2,002.50",$0.00,"$1,429.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,002.50",$0.00,"$1,001.25","$1,585.98","$1,602.00",$0.00,$0.00,$0.00,$0.00,$0.00
2006-2250,SUP,Custom 27803010,,2006-2250  -  INSERT ACETAB 50MM 22MM 20D HIP OMFT,"$1,925.63",$0.00,"$1,925.63",$0.00,"$1,374.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,925.63",$0.00,$962.81,"$1,525.10","$1,540.50",$0.00,$0.00,$0.00,$0.00,$0.00
2006-2252,SUP,Custom 27803010,,2006-2252  -  INSERT ACETAB 20D 52MM 22MM OMNIFIT HIP SERIES II,"$2,002.50",$0.00,"$2,002.50",$0.00,"$1,429.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,002.50",$0.00,"$1,001.25","$1,585.98","$1,602.00",$0.00,$0.00,$0.00,$0.00,$0.00
2006-2254,SUP,Custom 27803010,,2006-2254  -  INSERT ACETAB 54MM 22MM 20D HIP OMFT,"$1,925.63",$0.00,"$1,925.63",$0.00,"$1,374.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,925.63",$0.00,$962.81,"$1,525.10","$1,540.50",$0.00,$0.00,$0.00,$0.00,$0.00
2006-2256,SUP,Custom 27803010,,2006-2256  -  INSERT ACETAB 20D 56MM 22MM OMNIFIT HIP SERIES II,"$2,002.50",$0.00,"$2,002.50",$0.00,"$1,429.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,002.50",$0.00,"$1,001.25","$1,585.98","$1,602.00",$0.00,$0.00,$0.00,$0.00,$0.00
2006-2258,SUP,Custom 27803010,,2006-2258  -  INSERT ACETAB 58MM 22MM 20D HIP OMFT,"$1,925.63",$0.00,"$1,925.63",$0.00,"$1,374.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,925.63",$0.00,$962.81,"$1,525.10","$1,540.50",$0.00,$0.00,$0.00,$0.00,$0.00
2006-2261,SUP,Custom 27803010,,2006-2261  -  INSERT ACETAB 20D 61MM 22MM OMNIFIT HIP SERIES II,"$2,002.50",$0.00,"$2,002.50",$0.00,"$1,429.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,002.50",$0.00,"$1,001.25","$1,585.98","$1,602.00",$0.00,$0.00,$0.00,$0.00,$0.00
2006-2644,SUP,Custom 27803010,,2006-2644  -  INSERT ACETAB 20D 44MM 26MM OMNIFIT HIP SERIES II,"$2,002.50",$0.00,"$2,002.50",$0.00,"$1,429.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,002.50",$0.00,"$1,001.25","$1,585.98","$1,602.00",$0.00,$0.00,$0.00,$0.00,$0.00
2006-2646,SUP,Custom 27803010,,2006-2646  -  INSERT ACETAB 46MM 26MM 20D HIP OMFT,"$1,925.63",$0.00,"$1,925.63",$0.00,"$1,374.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,925.63",$0.00,$962.81,"$1,525.10","$1,540.50",$0.00,$0.00,$0.00,$0.00,$0.00
2006-2648,SUP,Custom 27803010,,2006-2648  -  INSERT ACETAB 20D 48MM 26MM OMNIFIT HIP SERIES II,"$2,002.50",$0.00,"$2,002.50",$0.00,"$1,429.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,002.50",$0.00,"$1,001.25","$1,585.98","$1,602.00",$0.00,$0.00,$0.00,$0.00,$0.00
2006-2650,SUP,Custom 27803010,,2006-2650  -  INSERT ACETAB 50MM 26MM 20D HIP OMFT,"$1,925.63",$0.00,"$1,925.63",$0.00,"$1,374.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,925.63",$0.00,$962.81,"$1,525.10","$1,540.50",$0.00,$0.00,$0.00,$0.00,$0.00
2006-2652,SUP,Custom 27803010,,2006-2652  -  INSERT ACETAB 20D 52MM 26MM OMNIFIT HIP SERIES II,"$2,002.50",$0.00,"$2,002.50",$0.00,"$1,429.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,002.50",$0.00,"$1,001.25","$1,585.98","$1,602.00",$0.00,$0.00,$0.00,$0.00,$0.00
2006-2654,SUP,Custom 27803010,,2006-2654  -  INSERT ACETAB 54MM 26MM 20D HIP OMFT,"$1,925.63",$0.00,"$1,925.63",$0.00,"$1,374.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,925.63",$0.00,$962.81,"$1,525.10","$1,540.50",$0.00,$0.00,$0.00,$0.00,$0.00
2006-2656,SUP,Custom 27803010,,2006-2656  -  INSERT ACETAB 20D 56MM 26MM OMNIFIT HIP SERIES II,"$2,002.50",$0.00,"$2,002.50",$0.00,"$1,429.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,002.50",$0.00,"$1,001.25","$1,585.98","$1,602.00",$0.00,$0.00,$0.00,$0.00,$0.00
2006-2658,SUP,Custom 27803010,,2006-2658  -  INSERT ACETAB 58MM 26MM 20D HIP OMFT,"$1,925.63",$0.00,"$1,925.63",$0.00,"$1,374.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,925.63",$0.00,$962.81,"$1,525.10","$1,540.50",$0.00,$0.00,$0.00,$0.00,$0.00
2006-2661,SUP,Custom 27803010,,2006-2661  -  INSERT ACETAB 20D 61MM 26MM OMNIFIT HIP SERIES II,"$2,002.50",$0.00,"$2,002.50",$0.00,"$1,429.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,002.50",$0.00,"$1,001.25","$1,585.98","$1,602.00",$0.00,$0.00,$0.00,$0.00,$0.00
2006-2846,SUP,Custom 27803010,,2006-2846  -  INSERT ACETAB 46MM 28MM 20D HIP OMFT,"$1,925.63",$0.00,"$1,925.63",$0.00,"$1,374.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,925.63",$0.00,$962.81,"$1,525.10","$1,540.50",$0.00,$0.00,$0.00,$0.00,$0.00
2006-2848,SUP,Custom 27803010,,2006-2848  -  INSERT ACETAB 20D 48MM 28MM OMNIFIT HIP SERIES II,"$2,002.50",$0.00,"$2,002.50",$0.00,"$1,429.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,002.50",$0.00,"$1,001.25","$1,585.98","$1,602.00",$0.00,$0.00,$0.00,$0.00,$0.00
2006-2850,SUP,Custom 27803010,,2006-2850  -  INSERT ACETAB 50MM 28MM 20D HIP OMFT,"$1,925.63",$0.00,"$1,925.63",$0.00,"$1,374.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,925.63",$0.00,$962.81,"$1,525.10","$1,540.50",$0.00,$0.00,$0.00,$0.00,$0.00
2006-2852,SUP,Custom 27803010,,2006-2852  -  INSERT ACETAB 20D 52MM 28MM OMNIFIT HIP SERIES II,"$2,002.50",$0.00,"$2,002.50",$0.00,"$1,429.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,002.50",$0.00,"$1,001.25","$1,585.98","$1,602.00",$0.00,$0.00,$0.00,$0.00,$0.00
2006-2854,SUP,Custom 27803010,,2006-2854  -  INSERT ACETAB 54MM 28MM 20D HIP OMFT,"$1,925.63",$0.00,"$1,925.63",$0.00,"$1,374.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,925.63",$0.00,$962.81,"$1,525.10","$1,540.50",$0.00,$0.00,$0.00,$0.00,$0.00
2006-2856,SUP,Custom 27803010,,2006-2856  -  INSERT ACETAB 20D 54MM 28MM OMNIFIT HIP SERIES II,"$2,002.50",$0.00,"$2,002.50",$0.00,"$1,429.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,002.50",$0.00,"$1,001.25","$1,585.98","$1,602.00",$0.00,$0.00,$0.00,$0.00,$0.00
2006-2858,SUP,Custom 27803010,,2006-2858  -  INSERT ACETAB 58MM 28MM 20D HIP OMFT,"$1,925.63",$0.00,"$1,925.63",$0.00,"$1,374.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,925.63",$0.00,$962.81,"$1,525.10","$1,540.50",$0.00,$0.00,$0.00,$0.00,$0.00
2006-2861,SUP,Custom 27803010,,2006-2861  -  INSERT ACETAB 20D 61MM 28MM OMNIFIT HIP SERIES II,"$2,002.50",$0.00,"$2,002.50",$0.00,"$1,429.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,002.50",$0.00,"$1,001.25","$1,585.98","$1,602.00",$0.00,$0.00,$0.00,$0.00,$0.00
2006-3250,SUP,Custom 27803010,,2006-3250  -  INSERT ACETAB 50MM 32MM 20D HIP OMFT,"$1,925.63",$0.00,"$1,925.63",$0.00,"$1,374.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,925.63",$0.00,$962.81,"$1,525.10","$1,540.50",$0.00,$0.00,$0.00,$0.00,$0.00
2006-3252,SUP,Custom 27803010,,2006-3252  -  INSERT ACETAB 20D 61MM 28MM OMNIFIT HIP SERIES II,"$2,002.50",$0.00,"$2,002.50",$0.00,"$1,429.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,002.50",$0.00,"$1,001.25","$1,585.98","$1,602.00",$0.00,$0.00,$0.00,$0.00,$0.00
2006-3254,SUP,Custom 27803010,,2006-3254  -  INSERT ACETAB 54MM 32MM 20D HIP OMFT,"$1,925.63",$0.00,"$1,925.63",$0.00,"$1,374.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,925.63",$0.00,$962.81,"$1,525.10","$1,540.50",$0.00,$0.00,$0.00,$0.00,$0.00
2006-3256,SUP,Custom 27803010,,2006-3256  -  INSERT ACETAB 20D 61MM 28MM OMNIFIT HIP SERIES II,"$2,002.50",$0.00,"$2,002.50",$0.00,"$1,429.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,002.50",$0.00,"$1,001.25","$1,585.98","$1,602.00",$0.00,$0.00,$0.00,$0.00,$0.00
2006-3258,SUP,Custom 27803010,,2006-3258  -  INSERT ACETAB 58MM 32MM 20D HIP OMFT,"$1,925.63",$0.00,"$1,925.63",$0.00,"$1,374.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,925.63",$0.00,$962.81,"$1,525.10","$1,540.50",$0.00,$0.00,$0.00,$0.00,$0.00
2006-3261,SUP,Custom 27803010,,2006-3261  -  INSERT ACETAB 20D 61MM 28MM OMNIFIT HIP SERIES II,"$2,002.50",$0.00,"$2,002.50",$0.00,"$1,429.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,002.50",$0.00,"$1,001.25","$1,585.98","$1,602.00",$0.00,$0.00,$0.00,$0.00,$0.00
2007-4-211,SUP,Custom 27203010,,2007-4-211  -  VITALLIUM ALLERGY DISC,$60.13,$0.00,$60.13,$0.00,$42.91,$0.00,$0.00,$0.00,$0.00,$0.00,$60.13,$0.00,$30.06,$47.62,$48.10,$0.00,$0.00,$0.00,$0.00,$0.00
2007-4-212,SUP,Custom 27203010,,2007-4-212  -  TITANIUM ALLERGY DISC,$60.13,$0.00,$60.13,$0.00,$42.91,$0.00,$0.00,$0.00,$0.00,$0.00,$60.13,$0.00,$30.06,$47.62,$48.10,$0.00,$0.00,$0.00,$0.00,$0.00
2008774-001,SUP,Custom 27203010,,PROBE ORAL TEMP CLR CD TRB TMP THRMTR LF REUSE,$298.08,$0.00,$298.08,$0.00,$212.74,$0.00,$0.00,$0.00,$0.00,$0.00,$298.08,$0.00,$149.04,$236.08,$238.46,$0.00,$0.00,$0.00,$0.00,$0.00
201.356.97,SUP,HCPCS C1713,,201.356.97  -  SCREW BONE T6 LP 2MM 6MM SELF TAP MODULAR STARDRIVE LCP,$64.48,$0.00,$64.48,$29.01,$46.02,$0.00,$10.79,$0.00,$0.00,$11.29,$64.48,$0.00,$32.24,$51.07,$51.58,$0.00,$9.80,$0.00,$10.26,$0.00
201.357.97,SUP,HCPCS C1713,,201.357.97  -  SCREW BONE T6 LP 2MM 7MM SELF TAP MODULAR STARDRIVE LCP,$64.48,$0.00,$64.48,$29.01,$46.02,$0.00,$10.79,$0.00,$0.00,$11.29,$64.48,$0.00,$32.24,$51.07,$51.58,$0.00,$9.80,$0.00,$10.26,$0.00
201.358.97,SUP,HCPCS C1713,,201.358.97  -  SCREW BONE T6 LP 2MM 8MM SELF TAP MODULAR STARDRIVE LCP,$64.48,$0.00,$64.48,$29.01,$46.02,$0.00,$10.79,$0.00,$0.00,$11.29,$64.48,$0.00,$32.24,$51.07,$51.58,$0.00,$9.80,$0.00,$10.26,$0.00
201.359.97,SUP,HCPCS C1713,,201.359.97  -  SCREW BONE T6 LP 2MM 9MM SELF TAP MODULAR STARDRIVE LCP,$64.48,$0.00,$64.48,$29.01,$46.02,$0.00,$10.79,$0.00,$0.00,$11.29,$64.48,$0.00,$32.24,$51.07,$51.58,$0.00,$9.80,$0.00,$10.26,$0.00
201.360.97,SUP,HCPCS C1713,,201.360.97  -  SCREW BONE T6 LP 2MM 10MM SELF TAP MODULAR STARDRIVE LCP,$64.48,$0.00,$64.48,$29.01,$46.02,$0.00,$10.79,$0.00,$0.00,$11.29,$64.48,$0.00,$32.24,$51.07,$51.58,$0.00,$9.80,$0.00,$10.26,$0.00
201.361.97,SUP,HCPCS C1713,,201.361.97  -  SCREW BONE T6 LP 2MM 11MM SELF TAP MODULAR STARDRIVE LCP,$64.48,$0.00,$64.48,$29.01,$46.02,$0.00,$10.79,$0.00,$0.00,$11.29,$64.48,$0.00,$32.24,$51.07,$51.58,$0.00,$9.80,$0.00,$10.26,$0.00
201.362.97,SUP,HCPCS C1713,,201.362.97  -  SCREW BONE T6 LP 2MM 12MM SELF TAP MODULAR STARDRIVE LCP,$64.48,$0.00,$64.48,$29.01,$46.02,$0.00,$10.79,$0.00,$0.00,$11.29,$64.48,$0.00,$32.24,$51.07,$51.58,$0.00,$9.80,$0.00,$10.26,$0.00
201.363.97,SUP,HCPCS C1713,,201.363.97  -  SCREW BONE T6 LP 2MM 13MM SELF TAP MODULAR STARDRIVE LCP,$64.48,$0.00,$64.48,$29.01,$46.02,$0.00,$10.79,$0.00,$0.00,$11.29,$64.48,$0.00,$32.24,$51.07,$51.58,$0.00,$9.80,$0.00,$10.26,$0.00
201.364.97,SUP,HCPCS C1713,,201.364.97  -  SCREW BONE T6 LP 2MM 14MM SELF TAP MODULAR STARDRIVE LCP,$64.48,$0.00,$64.48,$29.01,$46.02,$0.00,$10.79,$0.00,$0.00,$11.29,$64.48,$0.00,$32.24,$51.07,$51.58,$0.00,$9.80,$0.00,$10.26,$0.00
201.365.97,SUP,HCPCS C1713,,201.365.97  -  SCREW BN T6 2MM 15MM ST SLF RTN STRDR SS CORT,$66.50,$0.00,$66.50,$29.93,$47.46,$0.00,$11.13,$0.00,$0.00,$11.64,$66.50,$0.00,$33.25,$52.67,$53.20,$0.00,$10.11,$0.00,$10.59,$0.00
201.366.97,SUP,HCPCS C1713,,201.366.97  -  SCREW BONE T6 LP 2MM 16MM SELF TAP MODULAR STARDRIVE LCP,$64.48,$0.00,$64.48,$29.01,$46.02,$0.00,$10.79,$0.00,$0.00,$11.29,$64.48,$0.00,$32.24,$51.07,$51.58,$0.00,$9.80,$0.00,$10.26,$0.00
201.368.97,SUP,HCPCS C1713,,201.368.97  -  SCREW BONE T6 LP 2MM 18MM SELF TAP MODULAR STARDRIVE LCP,$64.48,$0.00,$64.48,$29.01,$46.02,$0.00,$10.79,$0.00,$0.00,$11.29,$64.48,$0.00,$32.24,$51.07,$51.58,$0.00,$9.80,$0.00,$10.26,$0.00
201.370.97,SUP,HCPCS C1713,,201.370.97  -  SCREW BONE T6 LP 2MM 20MM SELF TAP MODULAR STARDRIVE LCP,$64.48,$0.00,$64.48,$29.01,$46.02,$0.00,$10.79,$0.00,$0.00,$11.29,$64.48,$0.00,$32.24,$51.07,$51.58,$0.00,$9.80,$0.00,$10.26,$0.00
201.372.97,SUP,HCPCS C1713,,201.372.97  -  SCREW BONE T6 LP 2MM 22MM SELF TAP MODULAR STARDRIVE LCP,$64.48,$0.00,$64.48,$29.01,$46.02,$0.00,$10.79,$0.00,$0.00,$11.29,$64.48,$0.00,$32.24,$51.07,$51.58,$0.00,$9.80,$0.00,$10.26,$0.00
201.374.97,SUP,HCPCS C1713,,201.374.97  -  SCREW BONE T6 LP 2MM 24MM SELF TAP MODULAR STARDRIVE LCP,$64.48,$0.00,$64.48,$29.01,$46.02,$0.00,$10.79,$0.00,$0.00,$11.29,$64.48,$0.00,$32.24,$51.07,$51.58,$0.00,$9.80,$0.00,$10.26,$0.00
201.375.97,SUP,HCPCS C1713,,201.375.97  -  SCREW BONE T6 LP 2MM 26MM SELF TAP MODULAR STARDRIVE LCP,$64.48,$0.00,$64.48,$29.01,$46.02,$0.00,$10.79,$0.00,$0.00,$11.29,$64.48,$0.00,$32.24,$51.07,$51.58,$0.00,$9.80,$0.00,$10.26,$0.00
201.376.97,SUP,HCPCS C1713,,201.376.97  -  SCREW BONE T6 LP 2MM 28MM SELF TAP MODULAR STARDRIVE LCP,$64.48,$0.00,$64.48,$29.01,$46.02,$0.00,$10.79,$0.00,$0.00,$11.29,$64.48,$0.00,$32.24,$51.07,$51.58,$0.00,$9.80,$0.00,$10.26,$0.00
201.377.97,SUP,HCPCS C1713,,201.377.97  -  SCREW BONE T6 LP 2MM 30MM SELF TAP MODULAR STARDRIVE LCP,$64.48,$0.00,$64.48,$29.01,$46.02,$0.00,$10.79,$0.00,$0.00,$11.29,$64.48,$0.00,$32.24,$51.07,$51.58,$0.00,$9.80,$0.00,$10.26,$0.00
201.378.97,SUP,HCPCS C1713,,201.378.97  -  SCREW BONE T6 LP 2MM 32MM SELF TAP MODULAR STARDRIVE LCP,$64.48,$0.00,$64.48,$29.01,$46.02,$0.00,$10.79,$0.00,$0.00,$11.29,$64.48,$0.00,$32.24,$51.07,$51.58,$0.00,$9.80,$0.00,$10.26,$0.00
201.379.97,SUP,HCPCS C1713,,201.379.97  -  SCREW BONE T6 LP 2MM 34MM SELF TAP MODULAR STARDRIVE LCP,$64.48,$0.00,$64.48,$29.01,$46.02,$0.00,$10.79,$0.00,$0.00,$11.29,$64.48,$0.00,$32.24,$51.07,$51.58,$0.00,$9.80,$0.00,$10.26,$0.00
201.380.97,SUP,HCPCS C1713,,201.380.97  -  SCREW BONE T6 LP 2MM 36MM SELF TAP MODULAR STARDRIVE LCP,$64.48,$0.00,$64.48,$29.01,$46.02,$0.00,$10.79,$0.00,$0.00,$11.29,$64.48,$0.00,$32.24,$51.07,$51.58,$0.00,$9.80,$0.00,$10.26,$0.00
201.381.97,SUP,HCPCS C1713,,201.381.97  -  SCREW BONE T6 LP 2MM 38MM SELF TAP MODULAR STARDRIVE LCP,$64.48,$0.00,$64.48,$29.01,$46.02,$0.00,$10.79,$0.00,$0.00,$11.29,$64.48,$0.00,$32.24,$51.07,$51.58,$0.00,$9.80,$0.00,$10.26,$0.00
201.382.97,SUP,HCPCS C1713,,201.382.97  -  SCREW BONE T6 LP 2MM 40MM SELF TAP MODULAR STARDRIVE LCP,$64.48,$0.00,$64.48,$29.01,$46.02,$0.00,$10.79,$0.00,$0.00,$11.29,$64.48,$0.00,$32.24,$51.07,$51.58,$0.00,$9.80,$0.00,$10.26,$0.00
201.804.98,SUP,HCPCS C1713,,201.804.98  -  SCREW BONE 2MM 3.5MM 4MM SLFTAP CRCIFRM RECESS STAINLESS,$119.38,$0.00,$119.38,$53.72,$85.20,$0.00,$20.57,$0.00,$0.00,$20.90,$119.38,$0.00,$59.69,$94.55,$95.50,$0.00,$18.68,$0.00,$19.00,$0.00
201.806.98,SUP,HCPCS C1713,,201.806.98  -  SCREW BONE 2MM 3.5MM 6MM SLFTAP CRCIFRM RECESS STAINLESS,$119.38,$0.00,$119.38,$53.72,$85.20,$0.00,$20.57,$0.00,$0.00,$20.90,$119.38,$0.00,$59.69,$94.55,$95.50,$0.00,$18.68,$0.00,$19.00,$0.00
201.808.98,SUP,HCPCS C1713,,201.808.98  -  SCREW BONE 2MM 3.5MM 8MM SLFTAP CRCIFRM RECESS STAINLESS,$119.38,$0.00,$119.38,$53.72,$85.20,$0.00,$20.57,$0.00,$0.00,$20.90,$119.38,$0.00,$59.69,$94.55,$95.50,$0.00,$18.68,$0.00,$19.00,$0.00
201.810.98,SUP,HCPCS C1713,,201.810.98  -  SCREW BONE 2MM 3.5MM 10MM SLFTAP CRCIFRM RECESS STAINLESS,$119.38,$0.00,$119.38,$53.72,$85.20,$0.00,$20.57,$0.00,$0.00,$20.90,$119.38,$0.00,$59.69,$94.55,$95.50,$0.00,$18.68,$0.00,$19.00,$0.00
201.812.98,SUP,HCPCS C1713,,201.812.98  -  SCREW BONE 2MM 3.5MM 12MM SLFTAP CRCIFRM RECESS STAINLESS,$119.38,$0.00,$119.38,$53.72,$85.20,$0.00,$20.57,$0.00,$0.00,$20.90,$119.38,$0.00,$59.69,$94.55,$95.50,$0.00,$18.68,$0.00,$19.00,$0.00
201.814.98,SUP,HCPCS C1713,,201.814.98  -  SCREW BONE 2MM 3.5MM 14MM SLFTAP CRCIFRM RECESS STAINLESS,$119.38,$0.00,$119.38,$53.72,$85.20,$0.00,$20.57,$0.00,$0.00,$20.90,$119.38,$0.00,$59.69,$94.55,$95.50,$0.00,$18.68,$0.00,$19.00,$0.00
201.932E,SUP,HCPCS C1713,,201.932E  -  SCREW BONE 12MM 2MM MAXFACL SS SLF DRILING IMF NONSTRL,$288.00,$0.00,$288.00,$129.60,$205.55,$0.00,$49.62,$0.00,$0.00,$50.43,$288.00,$0.00,$144.00,$228.10,$230.40,$0.00,$45.07,$0.00,$45.85,$0.00
2010-01,SUP,Custom 27203010,,2010-01  -  LARYNGECTOMY PULMONARY KIT 9/36,$970.00,$0.00,$970.00,$0.00,$692.29,$0.00,$0.00,$0.00,$0.00,$0.00,$970.00,$0.00,$485.00,$768.24,$776.00,$0.00,$0.00,$0.00,$0.00,$0.00
20100-190,SUP,HCPCS C1884,,20100-190  -  SYSTEM EMBL PRTC .014IN 110UM 3.2FR 6FR 3.5-5.5MM 190CM F EZ,"$4,187.50",$0.00,"$4,187.50","$1,884.38","$2,988.62",$0.00,$721.49,$0.00,$0.00,$733.20,"$4,187.50",$0.00,"$2,093.75","$3,316.50","$3,350.00",$0.00,$655.34,$0.00,$666.65,$0.00
20-1226,SUP,Custom 27203010,,20-1226  -  TUBE NASOGASTRIC 6FR 22IN 2 LUMEN Y PORT RADIOPQ STRIPE,$20.61,$0.00,$20.61,$0.00,$14.71,$0.00,$0.00,$0.00,$0.00,$0.00,$20.61,$0.00,$10.31,$16.32,$16.49,$0.00,$0.00,$0.00,$0.00,$0.00
2012-320,SUP,HCPCS C1729,,2012-320  -  DRAIN INCISION C220ML .25IN 1 COLLECT SUCTION CONTROL,$77.27,$0.00,$77.27,$41.96,$55.15,$0.00,$13.31,$0.00,$0.00,$13.53,$77.27,$0.00,$38.63,$61.20,$61.81,$0.00,$12.09,$0.00,$12.30,$0.00
20132-214,SUP,Custom 27203010,,20132-214  -  PROBE ELECTROSURGICAL 2.3MM 220CM FLEXIBLE STR FIRE FIAPC,$547.38,$0.00,$547.38,$0.00,$390.66,$0.00,$0.00,$0.00,$0.00,$0.00,$547.38,$0.00,$273.69,$433.52,$437.90,$0.00,$0.00,$0.00,$0.00,$0.00
20-1384KI,SUP,Custom 27203010,,20-1384KI  -  KIT ESURG .75MM BYNT STRG 7.75IN STRL 3IN OLSN BP FCP SMTH,$118.41,$0.00,$118.41,$0.00,$84.51,$0.00,$0.00,$0.00,$0.00,$0.00,$118.41,$0.00,$59.20,$93.78,$94.72,$0.00,$0.00,$0.00,$0.00,$0.00
20-2050,SUP,Custom 27203010,,20-2050  -  SEALANT DURA 5ML DURASEAL PG TRILYSINE AMINE,"$8,626.25",$0.00,"$8,626.25",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,626.25",$0.00,"$4,313.13","$6,831.99","$6,901.00",$0.00,$0.00,$0.00,$0.00,$0.00
2020-6520-1,SUP,HCPCS C1713,,2020-6520-1  -  SCREW BONE 6.5MM 20MM CANCELLOUS,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
2020-6525-1,SUP,HCPCS C1713,,2020-6525-1  -  SCREW ACETAB 6.5MM 25MM PRIM HIP CANCELLOUS,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
2020-6530-1,SUP,HCPCS C1713,,2020-6530-1  -  SCREW BONE 6.5MM 30MM CANCELLOUS,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
2020-6535-1,SUP,HCPCS C1713,,2020-6535-1  -  SCREW ACETAB 6.5MM 35MM PRIM HIP CANCELLOUS,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
2020-6540-1,SUP,HCPCS C1713,,2020-6540-1  -  SCREW ACETAB 6.5MM 40MM PRIM HIP CANCELLOUS,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
2020-6545-1,SUP,HCPCS C1713,,2020-6545-1  -  SCREW ACETAB 6.5MM 45MM PRIM HIP CANCELLOUS,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
2020-6550-1,SUP,HCPCS C1713,,2020-6550-1  -  SCREW ACETAB 6.5MM 50MM PRIM HIP CANCELLOUS,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
2020-6555-1,SUP,HCPCS C1713,,2020-6555-1  -  SCREW ACETAB 6.5MM 55MM PRIM HIP CANCELLOUS,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
2020-6560-1,SUP,HCPCS C1713,,2020-6560-1  -  SCREW ACETAB 6.5MM 60MM PRIM HIP CANCELLOUS,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
2028-4520-1,SUP,HCPCS C1713,,2028-4520-1  -  SCREW BONE 4.5MM 20MM SECFIT X CANC,$152.00,$0.00,$152.00,$68.40,$108.48,$0.00,$26.19,$0.00,$0.00,$26.61,$152.00,$0.00,$76.00,$120.38,$121.60,$0.00,$23.79,$0.00,$24.20,$0.00
2028-4525-1,SUP,HCPCS C1713,,2028-4525-1  -  SCREW BONE 4.5MM 25MM SECFIT X CANC,$152.00,$0.00,$152.00,$68.40,$108.48,$0.00,$26.19,$0.00,$0.00,$26.61,$152.00,$0.00,$76.00,$120.38,$121.60,$0.00,$23.79,$0.00,$24.20,$0.00
2028-4530-1,SUP,HCPCS C1713,,2028-4530-1  -  SCREW BONE 4.5MM 30MM SECFIT X CANC,$152.00,$0.00,$152.00,$68.40,$108.48,$0.00,$26.19,$0.00,$0.00,$26.61,$152.00,$0.00,$76.00,$120.38,$121.60,$0.00,$23.79,$0.00,$24.20,$0.00
2028-4535,SUP,HCPCS C1713,,2028-4535  -  S-FIT X-TRA BN SCRW 4.5 MM,$127.00,$0.00,$127.00,$57.15,$90.64,$0.00,$21.88,$0.00,$0.00,$22.24,$127.00,$0.00,$63.50,$100.58,$101.60,$0.00,$19.88,$0.00,$20.22,$0.00
2028-4535-1,SUP,HCPCS C1713,,2028-4535-1  -  SCREW BONE 4.5MM 35MM SECFIT X CANC,$152.00,$0.00,$152.00,$68.40,$108.48,$0.00,$26.19,$0.00,$0.00,$26.61,$152.00,$0.00,$76.00,$120.38,$121.60,$0.00,$23.79,$0.00,$24.20,$0.00
2028-4540-1,SUP,HCPCS C1713,,2028-4540-1  -  SCREW BONE 4.5MM 40MM SECFIT X CANC,$152.00,$0.00,$152.00,$68.40,$108.48,$0.00,$26.19,$0.00,$0.00,$26.61,$152.00,$0.00,$76.00,$120.38,$121.60,$0.00,$23.79,$0.00,$24.20,$0.00
2028-4545-1,SUP,HCPCS C1713,,2028-4545-1  -  SCREW BONE 4.5MM 45MM SECFIT X CANC,$152.00,$0.00,$152.00,$68.40,$108.48,$0.00,$26.19,$0.00,$0.00,$26.61,$152.00,$0.00,$76.00,$120.38,$121.60,$0.00,$23.79,$0.00,$24.20,$0.00
2028-4550-1,SUP,HCPCS C1713,,2028-4550-1  -  SCREW BONE 4.5MM 50MM SECFIT X CANC,$152.00,$0.00,$152.00,$68.40,$108.48,$0.00,$26.19,$0.00,$0.00,$26.61,$152.00,$0.00,$76.00,$120.38,$121.60,$0.00,$23.79,$0.00,$24.20,$0.00
2028-4555-1,SUP,HCPCS C1713,,2028-4555-1  -  SCREW BONE 4.5MM 55MM SECFIT X CANC,$152.00,$0.00,$152.00,$68.40,$108.48,$0.00,$26.19,$0.00,$0.00,$26.61,$152.00,$0.00,$76.00,$120.38,$121.60,$0.00,$23.79,$0.00,$24.20,$0.00
2028-4560-1,SUP,HCPCS C1713,,2028-4560-1  -  SCREW BONE 4.5MM 60MM SECFIT X CANC,$152.00,$0.00,$152.00,$68.40,$108.48,$0.00,$26.19,$0.00,$0.00,$26.61,$152.00,$0.00,$76.00,$120.38,$121.60,$0.00,$23.79,$0.00,$24.20,$0.00
2029-5515-1,SUP,HCPCS C1713,,2029-5515-1  -  SCREW BONE 5.5MM 15MM CANCELLOUS,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
2029-5520-1,SUP,HCPCS C1713,,2029-5520-1  -  SCREW ACETAB 5.5MM 20MM SECFIT TRIDENT TITANIUM HIP,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
2029-5525-1,SUP,HCPCS C1713,,2029-5525-1  -  SCREW ACETAB 5.5MM 25MM SECFIT TRIDENT TITANIUM HIP,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
2029-5530-1,SUP,HCPCS C1713,,2029-5530-1  -  SCREW ACETAB 5.5MM 30MM SECFIT TRIDENT TITANIUM HIP,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
2029-5535-1,SUP,HCPCS C1713,,2029-5535-1  -  SCREW ACETAB 5.5MM 35MM SECFIT TRIDENT TITANIUM HIP,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
2029-5540-1,SUP,HCPCS C1713,,2029-5540-1  -  SCREW ACETAB 5.5MM 40MM SECFIT TRIDENT TITANIUM HIP,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
2029-5545-1,SUP,HCPCS C1713,,2029-5545-1  -  SCREW ACETAB 5.5MM 45MM SECFIT TRIDENT TITANIUM HIP,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
2029-5550-1,SUP,HCPCS C1713,,2029-5550-1  -  SCREW ACETAB 5.5MM 50MM SECFIT TRIDENT TITANIUM HIP,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
2029-5555-1,SUP,HCPCS C1713,,2029-5555-1  -  SCREW ACETAB 5.5MM 55MM SECFIT TRIDENT TITANIUM HIP,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
2029-5560-1,SUP,HCPCS C1713,,2029-5560-1  -  SCREW ACETAB 5.5MM 60MM SECFIT TRIDENT TITANIUM HIP,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
2030-1125S,SUP,HCPCS C1713,,2030-1125S  -  NAIL 300MM HIP GAMMA3 IM R2 LNG STRL STSCR,"$2,908.13",$0.00,"$2,908.13","$1,308.66","$2,075.53",$0.00,$501.06,$0.00,$0.00,$509.19,"$2,908.13",$0.00,"$1,454.06","$2,303.24","$2,326.50",$0.00,$455.12,$0.00,$462.97,$0.00
2030-1130S,SUP,HCPCS C1713,,2030-1130S  -  NAIL 11MM 30CM RIGHT FEM GAMA IM 130D LNG LCK TI STRL,"$2,908.13",$0.00,"$2,908.13","$1,308.66","$2,075.53",$0.00,$501.06,$0.00,$0.00,$509.19,"$2,908.13",$0.00,"$1,454.06","$2,303.24","$2,326.50",$0.00,$455.12,$0.00,$462.97,$0.00
2030-1135S,SUP,HCPCS C1713,,2030-1135S  -  NAIL 11MM 300MM RIGHT GAMA IM 135D R2 LNG LCK STRL,"$2,908.13",$0.00,"$2,908.13","$1,308.66","$2,075.53",$0.00,$501.06,$0.00,$0.00,$509.19,"$2,908.13",$0.00,"$1,454.06","$2,303.24","$2,326.50",$0.00,$455.12,$0.00,$462.97,$0.00
2030-1330S,SUP,HCPCS C1713,,2030-1330S  -  NAIL 300MM HIP RIGHT GAMMA3 IM R2 LNG ORTHNX,"$2,908.13",$0.00,"$2,908.13","$1,308.66","$2,075.53",$0.00,$501.06,$0.00,$0.00,$509.19,"$2,908.13",$0.00,"$1,454.06","$2,303.24","$2,326.50",$0.00,$455.12,$0.00,$462.97,$0.00
203-060-200,SUP,HCPCS C1769,,203-060-200  -  GUILDWIRE X PEION -142,$657.50,$0.00,$657.50,$357.02,$469.26,$0.00,$113.28,$0.00,$0.00,$115.12,$657.50,$0.00,$328.75,$520.74,$526.00,$0.00,$102.90,$0.00,$104.67,$0.00
2030-6516-1,SUP,HCPCS C1713,,2030-6516-1  -  SCREW BN 6.5MM 16MM NS TX TI ACTB CANC,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
2030-6520-1,SUP,HCPCS C1713,,2030-6520-1  -  SCREW BN 6.5MM 20MM NS TX TI ACTB CANC,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
2030-6525-1,SUP,HCPCS C1713,,2030-6525-1  -  SCREW ACETAB 6.5MM 25MM SECFIT TRIDENT TITANIUM CANCELLOUS,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
2030-6530-1,SUP,HCPCS C1713,,2030-6530-1  -  SCREW BONE 6.5MM 30MM TRIDENT SECFIT TORX TITANIUM ACETAB,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
2030-6535-1,SUP,HCPCS C1713,,2030-6535-1  -  SCREW BN 6.5MM 35MM NS TX TI ACTB CANC,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
2030-6540-1,SUP,HCPCS C1713,,2030-6540-1  -  SCREW BN 6.5MM 40MM NS TX TI ACTB CANC,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
2030-6545-1,SUP,HCPCS C1713,,2030-6545-1  -  SCREW BN 6.5MM 45MM NS TX TI ACTB CANC,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
2030-6550-1,SUP,HCPCS C1713,,2030-6550-1  -  SCREW BONE HEMISPHERE 6.5MM 50MM TRIDENT TITANIUM ACETAB,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
2030-6555-1,SUP,HCPCS C1713,,2030-6555-1  -  SCREW BONE HEMISPHERE 6.5MM 55MM TRIDENT TITANIUM ACETAB,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
2030-6560-1,SUP,HCPCS C1713,,2030-6560-1  -  SCREW BONE HEMISPHERE 6.5MM 60MM TRIDENT TITANIUM ACETAB,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
2032-1125S,SUP,HCPCS C1713,,2032-1125S  -  NAIL 320MM HIP RIGHT GAMMA3 IM R2 LNG,"$2,908.13",$0.00,"$2,908.13","$1,308.66","$2,075.53",$0.00,$501.06,$0.00,$0.00,$509.19,"$2,908.13",$0.00,"$1,454.06","$2,303.24","$2,326.50",$0.00,$455.12,$0.00,$462.97,$0.00
2032-1130S,SUP,HCPCS C1713,,2032-1130S  -  NAIL 11MM 32CM RIGHT FEM GAMA IM 130D LNG KIT STRL,"$2,908.13",$0.00,"$2,908.13","$1,308.66","$2,075.53",$0.00,$501.06,$0.00,$0.00,$509.19,"$2,908.13",$0.00,"$1,454.06","$2,303.24","$2,326.50",$0.00,$455.12,$0.00,$462.97,$0.00
2032-1135S,SUP,HCPCS C1713,,2032-1135S  -  NAIL 11MM 320MM HIP RIGHT GAMMA3 IM 135D LNG,"$2,908.13",$0.00,"$2,908.13","$1,308.66","$2,075.53",$0.00,$501.06,$0.00,$0.00,$509.19,"$2,908.13",$0.00,"$1,454.06","$2,303.24","$2,326.50",$0.00,$455.12,$0.00,$462.97,$0.00
2032-1330S,SUP,HCPCS C1713,,2032-1330S  -  NAIL 13MM 32CM RIGHT FEM GAMA IM 130D LNG LCK TI STRL,"$2,908.13",$0.00,"$2,908.13","$1,308.66","$2,075.53",$0.00,$501.06,$0.00,$0.00,$509.19,"$2,908.13",$0.00,"$1,454.06","$2,303.24","$2,326.50",$0.00,$455.12,$0.00,$462.97,$0.00
2034-1125S,SUP,HCPCS C1713,,2034-1125S  -  NAIL 11MM 340MM HIP RIGHT GAMMA3 IM 125D LNG,"$2,908.13",$0.00,"$2,908.13","$1,308.66","$2,075.53",$0.00,$501.06,$0.00,$0.00,$509.19,"$2,908.13",$0.00,"$1,454.06","$2,303.24","$2,326.50",$0.00,$455.12,$0.00,$462.97,$0.00
2034-1130S,SUP,HCPCS C1713,,2034-1130S  -  NAIL 11MM 34CM RIGHT FEM GAMA IM 130D LNG KIT TI STRL,"$2,908.13",$0.00,"$2,908.13","$1,308.66","$2,075.53",$0.00,$501.06,$0.00,$0.00,$509.19,"$2,908.13",$0.00,"$1,454.06","$2,303.24","$2,326.50",$0.00,$455.12,$0.00,$462.97,$0.00
2034-1135S,SUP,HCPCS C1713,,2034-1135S  -  NAIL 11MM 340MM RIGHT GAMA IM 135D LNG,"$2,908.13",$0.00,"$2,908.13","$1,308.66","$2,075.53",$0.00,$501.06,$0.00,$0.00,$509.19,"$2,908.13",$0.00,"$1,454.06","$2,303.24","$2,326.50",$0.00,$455.12,$0.00,$462.97,$0.00
2034-1330S,SUP,HCPCS C1713,,2034-1330S  -  NAIL 13MM 34CM RIGHT FEM GAMA IM 130D LNG LCK TI STRL,"$2,908.13",$0.00,"$2,908.13","$1,308.66","$2,075.53",$0.00,$501.06,$0.00,$0.00,$509.19,"$2,908.13",$0.00,"$1,454.06","$2,303.24","$2,326.50",$0.00,$455.12,$0.00,$462.97,$0.00
2036-1125S,SUP,HCPCS C1713,,2036-1125S  -  NAIL 11MM 36CM RIGHT FEM GAMA IM 125D LNG LCK TI STRL,"$2,908.13",$0.00,"$2,908.13","$1,308.66","$2,075.53",$0.00,$501.06,$0.00,$0.00,$509.19,"$2,908.13",$0.00,"$1,454.06","$2,303.24","$2,326.50",$0.00,$455.12,$0.00,$462.97,$0.00
2036-1130S,SUP,HCPCS C1713,,2036-1130S  -  NAIL 11MM 36CM RIGHT FEM GAMA IM 130D LNG LCK TI STRL,"$2,908.13",$0.00,"$2,908.13","$1,308.66","$2,075.53",$0.00,$501.06,$0.00,$0.00,$509.19,"$2,908.13",$0.00,"$1,454.06","$2,303.24","$2,326.50",$0.00,$455.12,$0.00,$462.97,$0.00
2036-1135S,SUP,HCPCS C1713,,2036-1135S  -  NAIL 11MM 36CM RIGHT FEM GAMA IM 135D LNG LCK TI STRL,"$2,908.13",$0.00,"$2,908.13","$1,308.66","$2,075.53",$0.00,$501.06,$0.00,$0.00,$509.19,"$2,908.13",$0.00,"$1,454.06","$2,303.24","$2,326.50",$0.00,$455.12,$0.00,$462.97,$0.00
2036-1330S,SUP,HCPCS C1713,,2036-1330S  -  NAIL 13MM 36CM RIGHT FEM GAMA IM 130D LNG LCK TI STRL,"$2,908.13",$0.00,"$2,908.13","$1,308.66","$2,075.53",$0.00,$501.06,$0.00,$0.00,$509.19,"$2,908.13",$0.00,"$1,454.06","$2,303.24","$2,326.50",$0.00,$455.12,$0.00,$462.97,$0.00
2038-1125S,SUP,HCPCS C1713,,2038-1125S  -  NAIL 11MM 38CM RIGHT FEM GAMA IM 130D LNG LCK TI STRL,"$2,908.13",$0.00,"$2,908.13","$1,308.66","$2,075.53",$0.00,$501.06,$0.00,$0.00,$509.19,"$2,908.13",$0.00,"$1,454.06","$2,303.24","$2,326.50",$0.00,$455.12,$0.00,$462.97,$0.00
2038-1130S,SUP,HCPCS C1713,,2038-1130S  -  NAIL 11MM 38CM RIGHT FEM GAMA IM 130D LNG LCK TI STRL,"$2,908.13",$0.00,"$2,908.13","$1,308.66","$2,075.53",$0.00,$501.06,$0.00,$0.00,$509.19,"$2,908.13",$0.00,"$1,454.06","$2,303.24","$2,326.50",$0.00,$455.12,$0.00,$462.97,$0.00
2038-1135S,SUP,HCPCS C1713,,2038-1135S  -  NAIL 11MM 38CM RIGHT FEM GAMA IM 135D LNG LCK TI STRL,"$2,908.13",$0.00,"$2,908.13","$1,308.66","$2,075.53",$0.00,$501.06,$0.00,$0.00,$509.19,"$2,908.13",$0.00,"$1,454.06","$2,303.24","$2,326.50",$0.00,$455.12,$0.00,$462.97,$0.00
2038-1330S,SUP,HCPCS C1713,,2038-1330S  -  NAIL 13MM 38CM RIGHT FEM GAMA IM 130D LNG LCK TI STRL,"$2,908.13",$0.00,"$2,908.13","$1,308.66","$2,075.53",$0.00,$501.06,$0.00,$0.00,$509.19,"$2,908.13",$0.00,"$1,454.06","$2,303.24","$2,326.50",$0.00,$455.12,$0.00,$462.97,$0.00
2040-1125S,SUP,HCPCS C1713,,2040-1125S  -  NAIL 400MM HIP LEFT GAMMA3 IM R2 LNG STRL STSCR,"$2,908.13",$0.00,"$2,908.13","$1,308.66","$2,075.53",$0.00,$501.06,$0.00,$0.00,$509.19,"$2,908.13",$0.00,"$1,454.06","$2,303.24","$2,326.50",$0.00,$455.12,$0.00,$462.97,$0.00
2040-1130S,SUP,HCPCS C1713,,2040-1130S  -  NAIL 11MM 40CM RIGHT FEM GAMA IM 130D LNG LCK TI STRL,"$2,908.13",$0.00,"$2,908.13","$1,308.66","$2,075.53",$0.00,$501.06,$0.00,$0.00,$509.19,"$2,908.13",$0.00,"$1,454.06","$2,303.24","$2,326.50",$0.00,$455.12,$0.00,$462.97,$0.00
2040-1135S,SUP,HCPCS C1713,,2040-1135S  -  NAIL 11MM 40CM RIGHT FEM GAMA IM 135D LNG LCK TI STRL,"$2,908.13",$0.00,"$2,908.13","$1,308.66","$2,075.53",$0.00,$501.06,$0.00,$0.00,$509.19,"$2,908.13",$0.00,"$1,454.06","$2,303.24","$2,326.50",$0.00,$455.12,$0.00,$462.97,$0.00
2040-1330S,SUP,HCPCS C1713,,2040-1330S  -  NAIL 400MM HIP RIGHT GAMMA3 IM R2 LNG ORTHNX,"$2,908.13",$0.00,"$2,908.13","$1,308.66","$2,075.53",$0.00,$501.06,$0.00,$0.00,$509.19,"$2,908.13",$0.00,"$1,454.06","$2,303.24","$2,326.50",$0.00,$455.12,$0.00,$462.97,$0.00
2041-2240,SUP,Custom 27803010,,2041-2240  -  INSERT ACETAB 40MM 22MM 10D HIP S2 OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2041-2242,SUP,Custom 27803010,,2041-2242  -  INSERT ACETAB 42MM 22MM 10D HIP OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2041-2246,SUP,Custom 27803010,,2041-2246  -  INSERT ACETAB 46MM 22MM 10D HIP OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2041-2250,SUP,Custom 27803010,,2041-2250  -  INSERT ACETAB 50MM 22MM 10D HIP OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2041-2254,SUP,Custom 27803010,,2041-2254  -  INSERT ACETAB 54MM 22MM 10D HIP OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2041-2258,SUP,Custom 27803010,,2041-2258  -  INSERT ACETAB 58MM 22MM 10D HIP OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2041-2262,SUP,Custom 27803010,,2041-2262  -  INSERT ACETAB 62MM 22MM 10D HIP OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2041-2266,SUP,Custom 27803010,,2041-2266  -  INSERT ACETAB 66MM 22MM 10D HIP OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2041-2270,SUP,Custom 27803010,,2041-2270  -  INSERT ACETAB 70MM 22MM 10D HIP OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2041-2274,SUP,Custom 27803010,,2041-2274  -  INSERT ACETAB 74MM 22MM 10D HIP OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2041-2642,SUP,Custom 27803010,,2041-2642  -  INSERT ACETAB 42MM 26MM 10D HIP OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2041-2646,SUP,Custom 27803010,,2041-2646  -  INSERT ACETAB 46MM 26MM 10D HIP OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2041-2650,SUP,Custom 27803010,,2041-2650  -  INSERT ACETAB 50-52MM 26MM 10D HIP S2 UHMWPE OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2041-2654,SUP,Custom 27803010,,2041-2654  -  INSERT ACETAB 54-56MM 26MM 10D HIP S2 UHMWPE OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2041-2658,SUP,Custom 27803010,,2041-2658  -  INSERT ACETAB 58MM 26MM 10D HIP OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2041-2662,SUP,Custom 27803010,,2041-2662  -  INSERT ACETAB 62MM 26MM 10D HIP OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2041-2666,SUP,Custom 27803010,,2041-2666  -  INSERT ACETAB 66MM 26MM -10D HIP OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2041-2670,SUP,Custom 27803010,,2041-2670  -  INSERT ACETAB 70MM 26MM 10D HIP OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2041-2674,SUP,Custom 27803010,,2041-2674  -  INSERT ACETAB 74MM 26MM 10D HIP OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2041-2846,SUP,Custom 27803010,,2041-2846  -  INSERT ACETAB 46MM 28MM 10D HIP OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2041-2850,SUP,Custom 27803010,,2041-2850  -  INSERT ACETAB 50MM 28MM 10D HIP OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2041-2854,SUP,Custom 27803010,,2041-2854  -  INSERT ACETAB 55-56MM 28MM 10D HIP S2 UHMWPE OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2041-2858,SUP,Custom 27803010,,2041-2858  -  INSERT ACETAB 58MM 28MM 10D HIP S2 OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2041-2862,SUP,Custom 27803010,,2041-2862  -  INSERT ACETAB 62MM 28MM 10D HIP S2 OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2041-2866,SUP,Custom 27803010,,2041-2866  -  INSERT ACETAB 66MM 28MM -10D HIP OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2041-2870,SUP,Custom 27803010,,2041-2870  -  INSERT ACETAB 70MM 28MM -10D HIP OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2041-2874,SUP,Custom 27803010,,2041-2874  -  INSERT ACETAB 74MM 28MM 10D HIP OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2041-3250,SUP,Custom 27803010,,2041-3250  -  INSERT ACETAB 10D 50-52MM 32MM OMNIFIT HIP SERIES II,"$1,767.50",$0.00,"$1,767.50",$0.00,"$1,261.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,767.50",$0.00,$883.75,"$1,399.86","$1,414.00",$0.00,$0.00,$0.00,$0.00,$0.00
2041-3254,SUP,Custom 27803010,,2041-3254  -  INSERT ACETAB 10D 54MM 32MM OMNIFIT HIP SERIES II,"$1,767.50",$0.00,"$1,767.50",$0.00,"$1,261.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,767.50",$0.00,$883.75,"$1,399.86","$1,414.00",$0.00,$0.00,$0.00,$0.00,$0.00
2041-3258,SUP,Custom 27803010,,2041-3258  -  INSERT ACETAB 58MM 32MM 10D HIP OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2041-3262,SUP,Custom 27803010,,2041-3262  -  INSERT ACETAB 62MM 32MM 10D HIP S2 OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2041-3266,SUP,Custom 27803010,,2041-3266  -  INSERT ACETAB 66MM 32MM -10D HIP OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2041-3270,SUP,Custom 27803010,,2041-3270  -  INSERT ACETAB 70MM 32MM -10D HIP OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2041-3274,SUP,Custom 27803010,,2041-3274  -  INSERT ACETAB 74MM 32MM 10D HIP OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2041C-2244,SUP,Custom 27803010,,2041C-2244  -  INSERT ACETAB 10D 44MM 22MM XFIRE HIP SERIES II,"$2,720.00",$0.00,"$2,720.00",$0.00,"$1,941.26",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,720.00",$0.00,"$1,360.00","$2,154.24","$2,176.00",$0.00,$0.00,$0.00,$0.00,$0.00
2041C-2248,SUP,Custom 27803010,,2041C-2248  -  INSERT ACETAB 10D 48MM 22MM XFIRE HIP SERIES II,"$2,720.00",$0.00,"$2,720.00",$0.00,"$1,941.26",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,720.00",$0.00,"$1,360.00","$2,154.24","$2,176.00",$0.00,$0.00,$0.00,$0.00,$0.00
2041C-2252,SUP,Custom 27803010,,2041C-2252  -  INSERT ACETAB 10D 52MM 22MM XFIRE HIP SERIES II,"$2,720.00",$0.00,"$2,720.00",$0.00,"$1,941.26",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,720.00",$0.00,"$1,360.00","$2,154.24","$2,176.00",$0.00,$0.00,$0.00,$0.00,$0.00
2041C-2256,SUP,Custom 27803010,,2041C-2256  -  INSERT ACETAB 10D 56MM 22MM XFIRE HIP SERIES II,"$2,720.00",$0.00,"$2,720.00",$0.00,"$1,941.26",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,720.00",$0.00,"$1,360.00","$2,154.24","$2,176.00",$0.00,$0.00,$0.00,$0.00,$0.00
2041C-2642,SUP,Custom 27803010,,2041C-2642  -  INSERT ACETAB 26MM 10D HIP S2 XFIRE,"$1,610.00",$0.00,"$1,610.00",$0.00,"$1,149.06",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,610.00",$0.00,$805.00,"$1,275.12","$1,288.00",$0.00,$0.00,$0.00,$0.00,$0.00
2041C-2646,SUP,Custom 27803010,,2041C-2646  -  INSERT ACETAB 10D 46MM 26MM XFIRE HIP SERIES II,"$2,720.00",$0.00,"$2,720.00",$0.00,"$1,941.26",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,720.00",$0.00,"$1,360.00","$2,154.24","$2,176.00",$0.00,$0.00,$0.00,$0.00,$0.00
2041C-2648,SUP,Custom 27803010,,2041C-2648  -  INSERT ACETAB 10D 48MM 26MM XFIRE HIP SERIES II,"$2,720.00",$0.00,"$2,720.00",$0.00,"$1,941.26",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,720.00",$0.00,"$1,360.00","$2,154.24","$2,176.00",$0.00,$0.00,$0.00,$0.00,$0.00
2041C-2650,SUP,Custom 27803010,,2041C-2650  -  INSERT ACETAB 10D 50MM 26MM XFIRE HIP SERIES II,"$2,720.00",$0.00,"$2,720.00",$0.00,"$1,941.26",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,720.00",$0.00,"$1,360.00","$2,154.24","$2,176.00",$0.00,$0.00,$0.00,$0.00,$0.00
2041C-2652,SUP,Custom 27803010,,2041C-2652  -  INSERT ACETAB 10D 52MM 26MM XFIRE HIP SERIES II,"$2,720.00",$0.00,"$2,720.00",$0.00,"$1,941.26",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,720.00",$0.00,"$1,360.00","$2,154.24","$2,176.00",$0.00,$0.00,$0.00,$0.00,$0.00
2041C-2654,SUP,Custom 27803010,,2041C-2654  -  INSERT ACETAB 10D 54MM 26MM XFIRE HIP SERIES II,"$2,720.00",$0.00,"$2,720.00",$0.00,"$1,941.26",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,720.00",$0.00,"$1,360.00","$2,154.24","$2,176.00",$0.00,$0.00,$0.00,$0.00,$0.00
2041C-2656,SUP,Custom 27803010,,2041C-2656  -  INSERT ACETAB 10D 56MM 26MM XFIRE HIP SERIES II,"$2,720.00",$0.00,"$2,720.00",$0.00,"$1,941.26",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,720.00",$0.00,"$1,360.00","$2,154.24","$2,176.00",$0.00,$0.00,$0.00,$0.00,$0.00
2041C-2658,SUP,Custom 27803010,,2041C-2658  -  INSERT ACETAB 10D 58MM 26MM XFIRE HIP SERIES II,"$2,720.00",$0.00,"$2,720.00",$0.00,"$1,941.26",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,720.00",$0.00,"$1,360.00","$2,154.24","$2,176.00",$0.00,$0.00,$0.00,$0.00,$0.00
2041C-2662,SUP,Custom 27803010,,2041C-2662  -  INSERT ACETAB 10D 62MM 26MM XFIRE HIP SERIES II,"$2,720.00",$0.00,"$2,720.00",$0.00,"$1,941.26",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,720.00",$0.00,"$1,360.00","$2,154.24","$2,176.00",$0.00,$0.00,$0.00,$0.00,$0.00
2041C-2846,SUP,Custom 27803010,,2041C-2846  -  INSERT ACETAB 10D 46MM 28MM XFIRE HIP SERIES II,"$2,397.50",$0.00,"$2,397.50",$0.00,"$1,711.10",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,397.50",$0.00,"$1,198.75","$1,898.82","$1,918.00",$0.00,$0.00,$0.00,$0.00,$0.00
2041C-2848,SUP,Custom 27803010,,2041C-2848  -  INSERT ACETAB 10D 48MM 28MM XFIRE HIP SERIES II,"$2,720.00",$0.00,"$2,720.00",$0.00,"$1,941.26",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,720.00",$0.00,"$1,360.00","$2,154.24","$2,176.00",$0.00,$0.00,$0.00,$0.00,$0.00
2041C-2850,SUP,Custom 27803010,,2041C-2850  -  INSERT ACETAB 10D 50MM 28MM XFIRE HIP SERIES II,"$2,397.50",$0.00,"$2,397.50",$0.00,"$1,711.10",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,397.50",$0.00,"$1,198.75","$1,898.82","$1,918.00",$0.00,$0.00,$0.00,$0.00,$0.00
2041C-2852,SUP,Custom 27803010,,2041C-2852  -  INSERT ACETAB 10D 52MM 28MM XFIRE HIP SERIES II,"$2,720.00",$0.00,"$2,720.00",$0.00,"$1,941.26",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,720.00",$0.00,"$1,360.00","$2,154.24","$2,176.00",$0.00,$0.00,$0.00,$0.00,$0.00
2041C-2854,SUP,Custom 27803010,,2041C-2854  -  INSERT ACETAB 10D 54-56MM 28MM XFIRE HIP SERIES II,"$2,397.50",$0.00,"$2,397.50",$0.00,"$1,711.10",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,397.50",$0.00,"$1,198.75","$1,898.82","$1,918.00",$0.00,$0.00,$0.00,$0.00,$0.00
2041C-2856,SUP,Custom 27803010,,2041C-2856  -  INSERT ACETAB 10D 56MM 28MM XFIRE HIP SERIES II,"$2,720.00",$0.00,"$2,720.00",$0.00,"$1,941.26",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,720.00",$0.00,"$1,360.00","$2,154.24","$2,176.00",$0.00,$0.00,$0.00,$0.00,$0.00
2041C-2858,SUP,Custom 27803010,,2041C-2858  -  INSERT ACETAB 10D 58MM 28MM XFIRE HIP SERIES II,"$2,397.50",$0.00,"$2,397.50",$0.00,"$1,711.10",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,397.50",$0.00,"$1,198.75","$1,898.82","$1,918.00",$0.00,$0.00,$0.00,$0.00,$0.00
2041C-2862,SUP,Custom 27803010,,2041C-2862  -  INSERT ACETAB 10D 62-72MM 28MM XFIRE HIP SERIES II,"$2,397.50",$0.00,"$2,397.50",$0.00,"$1,711.10",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,397.50",$0.00,"$1,198.75","$1,898.82","$1,918.00",$0.00,$0.00,$0.00,$0.00,$0.00
2041C-3250,SUP,Custom 27803010,,2041C-3250  -  INSERT ACETAB 10D 50-52MM 32MM XFIRE HIP SERIES II,"$2,397.50",$0.00,"$2,397.50",$0.00,"$1,711.10",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,397.50",$0.00,"$1,198.75","$1,898.82","$1,918.00",$0.00,$0.00,$0.00,$0.00,$0.00
2041C-3254,SUP,Custom 27803010,,2041C-3254  -  INSERT ACETAB 10D 54MM 32MM XFIRE HIP SERIES II,"$2,397.50",$0.00,"$2,397.50",$0.00,"$1,711.10",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,397.50",$0.00,"$1,198.75","$1,898.82","$1,918.00",$0.00,$0.00,$0.00,$0.00,$0.00
2041C-3256,SUP,Custom 27803010,,2041C-3256  -  INSERT ACETAB 10D 56MM 32MM XFIRE HIP SERIES II,"$2,720.00",$0.00,"$2,720.00",$0.00,"$1,941.26",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,720.00",$0.00,"$1,360.00","$2,154.24","$2,176.00",$0.00,$0.00,$0.00,$0.00,$0.00
2041C-3258,SUP,Custom 27803010,,2041C-3258  -  INSERT ACETAB 10D 58-60MM 32MM XFIRE HIP SERIES II,"$2,397.50",$0.00,"$2,397.50",$0.00,"$1,711.10",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,397.50",$0.00,"$1,198.75","$1,898.82","$1,918.00",$0.00,$0.00,$0.00,$0.00,$0.00
2041C-3262,SUP,Custom 27803010,,2041C-3262  -  INSERT ACETAB 10D 62MM 32MM XFIRE HIP SERIES II,"$2,397.50",$0.00,"$2,397.50",$0.00,"$1,711.10",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,397.50",$0.00,"$1,198.75","$1,898.82","$1,918.00",$0.00,$0.00,$0.00,$0.00,$0.00
2041C-3266,SUP,Custom 27803010,,2041C-3266  -  INSERT ACETAB 10D 66MM 32MM XFIRE HIP SERIES II,"$2,397.50",$0.00,"$2,397.50",$0.00,"$1,711.10",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,397.50",$0.00,"$1,198.75","$1,898.82","$1,918.00",$0.00,$0.00,$0.00,$0.00,$0.00
2041C-3270,SUP,Custom 27803010,,2041C-3270  -  INSERT ACETAB 10D 70MM 32MM XFIRE HIP SERIES II,"$2,397.50",$0.00,"$2,397.50",$0.00,"$1,711.10",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,397.50",$0.00,"$1,198.75","$1,898.82","$1,918.00",$0.00,$0.00,$0.00,$0.00,$0.00
2041C-3274,SUP,Custom 27803010,,2041C-3274  -  INSERT ACETAB 10D 74MM 32MM XFIRE HIP SERIES II,"$2,397.50",$0.00,"$2,397.50",$0.00,"$1,711.10",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,397.50",$0.00,"$1,198.75","$1,898.82","$1,918.00",$0.00,$0.00,$0.00,$0.00,$0.00
2041-H-228,SUP,Custom 27803010,,2041-H-228  -  LINER ACETAB 46-48MM 28MM HIP S2 CNSTRN,"$2,950.00",$0.00,"$2,950.00",$0.00,"$2,105.42",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,950.00",$0.00,"$1,475.00","$2,336.40","$2,360.00",$0.00,$0.00,$0.00,$0.00,$0.00
2041J-2246,SUP,Custom 27803010,,2041J-2246  -  INSERT ACETAB 10D S2 OMFT,"$1,195.00",$0.00,"$1,195.00",$0.00,$852.87,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,195.00",$0.00,$597.50,$946.44,$956.00,$0.00,$0.00,$0.00,$0.00,$0.00
2041-N-228,SUP,Custom 27803010,,2041-N-228  -  LINER ACETAB 46-48MM 28MM HIP S2 CNSTRN,"$2,950.00",$0.00,"$2,950.00",$0.00,"$2,105.42",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,950.00",$0.00,"$1,475.00","$2,336.40","$2,360.00",$0.00,$0.00,$0.00,$0.00,$0.00
2041-N-532,SUP,Custom 27803010,,2041-N-532  -  LINER ACETAB 58-60MM 32MM HIP S2 CNSTRN,"$2,950.00",$0.00,"$2,950.00",$0.00,"$2,105.42",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,950.00",$0.00,"$1,475.00","$2,336.40","$2,360.00",$0.00,$0.00,$0.00,$0.00,$0.00
2042-1125S,SUP,HCPCS C1713,,2042-1125S  -  NAIL 11MM 42CM HIP RIGHT FEM GAMMA3 IM 125D LNG TI STRL,"$2,908.13",$0.00,"$2,908.13","$1,308.66","$2,075.53",$0.00,$501.06,$0.00,$0.00,$509.19,"$2,908.13",$0.00,"$1,454.06","$2,303.24","$2,326.50",$0.00,$455.12,$0.00,$462.97,$0.00
2042-1130S,SUP,HCPCS C1713,,2042-1130S  -  NAIL 11MM 420MM RIGHT FEM GAMA IM 130D R2 LNG LCK TI STRL,"$2,908.13",$0.00,"$2,908.13","$1,308.66","$2,075.53",$0.00,$501.06,$0.00,$0.00,$509.19,"$2,908.13",$0.00,"$1,454.06","$2,303.24","$2,326.50",$0.00,$455.12,$0.00,$462.97,$0.00
2042-1135S,SUP,HCPCS C1713,,2042-1135S  -  NAIL 11MM 420MM HIP RIGHT GAMMA3 IM 135D LNG,"$2,908.13",$0.00,"$2,908.13","$1,308.66","$2,075.53",$0.00,$501.06,$0.00,$0.00,$509.19,"$2,908.13",$0.00,"$1,454.06","$2,303.24","$2,326.50",$0.00,$455.12,$0.00,$462.97,$0.00
2042-1330S,SUP,HCPCS C1713,,2042-1330S  -  NAIL 13MM 42CM RIGHT FEM GAMA IM 130D LNG LCK TI STRL,"$2,908.13",$0.00,"$2,908.13","$1,308.66","$2,075.53",$0.00,$501.06,$0.00,$0.00,$509.19,"$2,908.13",$0.00,"$1,454.06","$2,303.24","$2,326.50",$0.00,$455.12,$0.00,$462.97,$0.00
2042-2240,SUP,Custom 27803010,,2042-2240  -  INSERT ACETAB 20D 40MM 22MM OMNIFIT HIP SERIES II,"$1,767.50",$0.00,"$1,767.50",$0.00,"$1,261.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,767.50",$0.00,$883.75,"$1,399.86","$1,414.00",$0.00,$0.00,$0.00,$0.00,$0.00
2042-2242,SUP,Custom 27803010,,2042-2242  -  INSERT ACETAB 42MM 22MM 20D HIP OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2042-2246,SUP,Custom 27803010,,2042-2246  -  INSERT ACETAB 46MM 22MM 20D HIP OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2042-2250,SUP,Custom 27803010,,2042-2250  -  INSERT ACETAB 20D 50MM 22MM OMNIFIT HIP SERIES II,"$1,767.50",$0.00,"$1,767.50",$0.00,"$1,261.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,767.50",$0.00,$883.75,"$1,399.86","$1,414.00",$0.00,$0.00,$0.00,$0.00,$0.00
2042-2254,SUP,Custom 27803010,,2042-2254  -  INSERT ACETAB 54MM 22MM 20D HIP OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2042-2258,SUP,Custom 27803010,,2042-2258  -  INSERT ACETAB 58MM 22MM 20D HIP OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2042-2262,SUP,Custom 27803010,,2042-2262  -  INSERT ACETAB 62MM 22MM 20D HIP OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2042-2266,SUP,Custom 27803010,,2042-2266  -  INSERT ACETAB 66MM 22MM 20D HIP OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2042-2270,SUP,Custom 27803010,,2042-2270  -  INSERT ACETAB 70MM 22MM 20D HIP OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2042-2274,SUP,Custom 27803010,,2042-2274  -  INSERT ACETAB 20D 74MM 22MM OMNIFIT HIP SERIES II,"$1,767.50",$0.00,"$1,767.50",$0.00,"$1,261.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,767.50",$0.00,$883.75,"$1,399.86","$1,414.00",$0.00,$0.00,$0.00,$0.00,$0.00
2042-2642,SUP,Custom 27803010,,2042-2642  -  INSERT ACETAB 20D 42MM 26MM OMNIFIT HIP SERIES II,"$1,767.50",$0.00,"$1,767.50",$0.00,"$1,261.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,767.50",$0.00,$883.75,"$1,399.86","$1,414.00",$0.00,$0.00,$0.00,$0.00,$0.00
2042-2646,SUP,Custom 27803010,,2042-2646  -  INSERT ACETAB 46MM 26MM 20D HIP OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2042-2650,SUP,Custom 27803010,,2042-2650  -  INSERT ACETAB 20D 50MM 26MM OMNIFIT HIP SERIES II,"$1,767.50",$0.00,"$1,767.50",$0.00,"$1,261.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,767.50",$0.00,$883.75,"$1,399.86","$1,414.00",$0.00,$0.00,$0.00,$0.00,$0.00
2042-2654,SUP,Custom 27803010,,2042-2654  -  INSERT ACETAB 20D 54MM 26MM OMNIFIT HIP SERIES II,"$1,767.50",$0.00,"$1,767.50",$0.00,"$1,261.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,767.50",$0.00,$883.75,"$1,399.86","$1,414.00",$0.00,$0.00,$0.00,$0.00,$0.00
2042-2658,SUP,Custom 27803010,,2042-2658  -  INSERT ACETAB 58MM 26MM 20D HIP OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2042-2662,SUP,Custom 27803010,,2042-2662  -  INSERT ACETAB 62MM 26MM 20D HIP OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2042-2666,SUP,Custom 27803010,,2042-2666  -  INSERT ACETAB 66MM 26MM 20D HIP OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2042-2670,SUP,Custom 27803010,,2042-2670  -  INSERT ACETAB 70MM 26MM 20D HIP OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2042-2674,SUP,Custom 27803010,,2042-2674  -  INSERT ACETAB 74MM 26MM 20D HIP OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2042-2846,SUP,Custom 27803010,,2042-2846  -  INSERT ACETAB 20D 46MM 28MM OMNIFIT HIP SERIES II,"$1,767.50",$0.00,"$1,767.50",$0.00,"$1,261.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,767.50",$0.00,$883.75,"$1,399.86","$1,414.00",$0.00,$0.00,$0.00,$0.00,$0.00
2042-2850,SUP,Custom 27803010,,2042-2850  -  INSERT ACETAB 20D 50MM 28MM OMNIFIT HIP SERIES II,"$1,767.50",$0.00,"$1,767.50",$0.00,"$1,261.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,767.50",$0.00,$883.75,"$1,399.86","$1,414.00",$0.00,$0.00,$0.00,$0.00,$0.00
2042-2854,SUP,Custom 27803010,,2042-2854  -  INSERT ACETAB 20D 54MM 28MM OMNIFIT HIP SERIES II,"$1,767.50",$0.00,"$1,767.50",$0.00,"$1,261.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,767.50",$0.00,$883.75,"$1,399.86","$1,414.00",$0.00,$0.00,$0.00,$0.00,$0.00
2042-2858,SUP,Custom 27803010,,2042-2858  -  INSERT ACETAB 20D 58MM 28MM OMNIFIT HIP SERIES II,"$1,767.50",$0.00,"$1,767.50",$0.00,"$1,261.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,767.50",$0.00,$883.75,"$1,399.86","$1,414.00",$0.00,$0.00,$0.00,$0.00,$0.00
2042-2862,SUP,Custom 27803010,,2042-2862  -  INSERT ACETAB 20D 62-72MM 28MM OMNIFIT HIP SERIES II,"$1,767.50",$0.00,"$1,767.50",$0.00,"$1,261.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,767.50",$0.00,$883.75,"$1,399.86","$1,414.00",$0.00,$0.00,$0.00,$0.00,$0.00
2042-2866,SUP,Custom 27803010,,2042-2866  -  INSERT ACETAB 20D 66MM 28MM OMNIFIT HIP SERIES II,"$1,767.50",$0.00,"$1,767.50",$0.00,"$1,261.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,767.50",$0.00,$883.75,"$1,399.86","$1,414.00",$0.00,$0.00,$0.00,$0.00,$0.00
2042-2870,SUP,Custom 27803010,,2042-2870  -  INSERT ACETAB 70MM 28MM 20D HIP OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2042-2874,SUP,Custom 27803010,,2042-2874  -  INSERT ACETAB 74MM 28MM 20D HIP OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2042-3250,SUP,Custom 27803010,,2042-3250  -  INSERT ACETAB 20D 50MM 32MM OMNIFIT HIP SERIES II,"$1,767.50",$0.00,"$1,767.50",$0.00,"$1,261.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,767.50",$0.00,$883.75,"$1,399.86","$1,414.00",$0.00,$0.00,$0.00,$0.00,$0.00
2042-3254,SUP,Custom 27803010,,2042-3254  -  INSERT ACETAB 20D 54MM 32MM OMNIFIT HIP SERIES II,"$1,767.50",$0.00,"$1,767.50",$0.00,"$1,261.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,767.50",$0.00,$883.75,"$1,399.86","$1,414.00",$0.00,$0.00,$0.00,$0.00,$0.00
2042-3258,SUP,Custom 27803010,,2042-3258  -  INSERT ACETAB 20D 58-60MM 32MM OMNIFIT HIP,"$1,767.50",$0.00,"$1,767.50",$0.00,"$1,261.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,767.50",$0.00,$883.75,"$1,399.86","$1,414.00",$0.00,$0.00,$0.00,$0.00,$0.00
2042-3262,SUP,Custom 27803010,,2042-3262  -  INSERT ACETAB 20D 62MM 32MM OMNIFIT HIP SERIES II,"$1,767.50",$0.00,"$1,767.50",$0.00,"$1,261.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,767.50",$0.00,$883.75,"$1,399.86","$1,414.00",$0.00,$0.00,$0.00,$0.00,$0.00
2042-3266,SUP,Custom 27803010,,2042-3266  -  INSERT ACETAB 20D 66MM 32MM OMNIFIT HIP SERIES II,"$1,767.50",$0.00,"$1,767.50",$0.00,"$1,261.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,767.50",$0.00,$883.75,"$1,399.86","$1,414.00",$0.00,$0.00,$0.00,$0.00,$0.00
2042-3270,SUP,Custom 27803010,,2042-3270  -  INSERT ACETAB 20D 70MM 32MM OMNIFIT HIP SERIES II,"$1,767.50",$0.00,"$1,767.50",$0.00,"$1,261.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,767.50",$0.00,$883.75,"$1,399.86","$1,414.00",$0.00,$0.00,$0.00,$0.00,$0.00
2042-3274,SUP,Custom 27803010,,2042-3274  -  INSERT ACETAB 74MM 32MM 20D HIP OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2042C-2244,SUP,Custom 27803010,,2042C-2244  -  INSERT ACETAB 22MM 20D HIP XFIRE,"$1,610.00",$0.00,"$1,610.00",$0.00,"$1,149.06",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,610.00",$0.00,$805.00,"$1,275.12","$1,288.00",$0.00,$0.00,$0.00,$0.00,$0.00
2042C-2248,SUP,Custom 27803010,,2042C-2248  -  INSERT ACETAB 22MM 20D HIP XFIRE,"$1,610.00",$0.00,"$1,610.00",$0.00,"$1,149.06",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,610.00",$0.00,$805.00,"$1,275.12","$1,288.00",$0.00,$0.00,$0.00,$0.00,$0.00
2042C-2252,SUP,Custom 27803010,,2042C-2252  -  INSERT ACETAB 22MM 20D HIP XFIRE,"$1,610.00",$0.00,"$1,610.00",$0.00,"$1,149.06",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,610.00",$0.00,$805.00,"$1,275.12","$1,288.00",$0.00,$0.00,$0.00,$0.00,$0.00
2042C-2256,SUP,Custom 27803010,,2042C-2256  -  INSERT ACETAB 22MM 20D HIP XFIRE,"$1,610.00",$0.00,"$1,610.00",$0.00,"$1,149.06",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,610.00",$0.00,$805.00,"$1,275.12","$1,288.00",$0.00,$0.00,$0.00,$0.00,$0.00
2042C-2648,SUP,Custom 27803010,,2042C-2648  -  INSERT ACETAB 26MM 20D HIP XFIRE,"$1,610.00",$0.00,"$1,610.00",$0.00,"$1,149.06",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,610.00",$0.00,$805.00,"$1,275.12","$1,288.00",$0.00,$0.00,$0.00,$0.00,$0.00
2042C-2652,SUP,Custom 27803010,,2042C-2652  -  INSERT ACETAB 26MM 20D HIP XFIRE,"$1,610.00",$0.00,"$1,610.00",$0.00,"$1,149.06",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,610.00",$0.00,$805.00,"$1,275.12","$1,288.00",$0.00,$0.00,$0.00,$0.00,$0.00
2042C-2656,SUP,Custom 27803010,,2042C-2656  -  INSERT ACETAB 26MM 20D HIP XFIRE,"$1,610.00",$0.00,"$1,610.00",$0.00,"$1,149.06",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,610.00",$0.00,$805.00,"$1,275.12","$1,288.00",$0.00,$0.00,$0.00,$0.00,$0.00
2042C-2848,SUP,Custom 27803010,,2042C-2848  -  INSERT ACETAB 28MM 20D HIP XFIRE,"$1,610.00",$0.00,"$1,610.00",$0.00,"$1,149.06",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,610.00",$0.00,$805.00,"$1,275.12","$1,288.00",$0.00,$0.00,$0.00,$0.00,$0.00
2042C-2852,SUP,Custom 27803010,,2042C-2852  -  INSERT ACETAB 28MM 20D HIP XFIRE,"$1,610.00",$0.00,"$1,610.00",$0.00,"$1,149.06",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,610.00",$0.00,$805.00,"$1,275.12","$1,288.00",$0.00,$0.00,$0.00,$0.00,$0.00
2042C-2856,SUP,Custom 27803010,,2042C-2856  -  INSERT ACETAB 56MM 28MM 20D HIP XFIRE,"$1,610.00",$0.00,"$1,610.00",$0.00,"$1,149.06",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,610.00",$0.00,$805.00,"$1,275.12","$1,288.00",$0.00,$0.00,$0.00,$0.00,$0.00
2042C-3256,SUP,Custom 27803010,,2042C-3256  -  INSERT ACETAB 56MM 32MM 20D HIP XFIRE,"$1,610.00",$0.00,"$1,610.00",$0.00,"$1,149.06",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,610.00",$0.00,$805.00,"$1,275.12","$1,288.00",$0.00,$0.00,$0.00,$0.00,$0.00
2043-2240,SUP,Custom 27803010,,2043-2240  -  INSERT ACETAB 40MM 22MM 0D HIP OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2043-2242,SUP,Custom 27803010,,2043-2242  -  INSERT ACETAB 42MM 22MM 0D HIP OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2043-2246,SUP,Custom 27803010,,2043-2246  -  INSERT ACETAB 46-48MM 22MM 0D HIP OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2043-2250,SUP,Custom 27803010,,2043-2250  -  INSERT ACETAB 50-52MM 22MM 0D HIP OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2043-2254,SUP,Custom 27803010,,2043-2254  -  INSERT ACETAB 54-56MM 22MM 0D HIP OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2043-2258,SUP,Custom 27803010,,2043-2258  -  INSERT ACETAB 58-60MM 22MM 0D HIP OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2043-2262,SUP,Custom 27803010,,2043-2262  -  INSERT ACETAB 62-72MM 22MM 0D HIP OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2043-2266,SUP,Custom 27803010,,2043-2266  -  INSERT ACETAB 66MM 22MM 0D HIP OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2043-2270,SUP,Custom 27803010,,2043-2270  -  INSERT ACETAB 70MM 22MM 0D HIP OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2043-2274,SUP,Custom 27803010,,2043-2274  -  INSERT ACETAB 74MM 22MM 0D HIP OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2043-2642,SUP,Custom 27803010,,2043-2642  -  INSERT ACETAB 42MM 26MM 0D HIP OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2043-2646,SUP,Custom 27803010,,2043-2646  -  INSERT ACETAB 46-48MM 26MM 0D HIP OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2043-2650,SUP,Custom 27803010,,2043-2650  -  INSERT ACETAB 50-52MM 26MM 0D HIP S2 UHMWPE OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2043-2654,SUP,Custom 27803010,,2043-2654  -  INSERT ACETAB 54-56MM 26MM 0D HIP S2 UHMWPE OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2043-2658,SUP,Custom 27803010,,2043-2658  -  INSERT ACETAB 58MM ID 26MM 0D HIP OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2043-2662,SUP,Custom 27803010,,2043-2662  -  INSERT ACETAB 62-72MM 26MM 0D HIP OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2043-2666,SUP,Custom 27803010,,2043-2666  -  INSERT ACETAB 66MM 26MM 0D HIP OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2043-2670,SUP,Custom 27803010,,2043-2670  -  INSERT ACETAB 70MM 26MM 0D HIP OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2043-2674,SUP,Custom 27803010,,2043-2674  -  INSERT ACETAB 74MM 26MM 0D HIP OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2043-2846,SUP,Custom 27803010,,2043-2846  -  INSERT ACETAB 46-48MM 28MM 0D HIP S2 UHMWPE OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2043-2850,SUP,Custom 27803010,,2043-2850  -  INSERT ACETAB 50-52MM 28MM 0D HIP S2 UHMWPE OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2043-2854,SUP,Custom 27803010,,2043-2854  -  INSERT ACETAB 54-56MM 28MM 0D HIP S2 UHMWPE OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2043-2858,SUP,Custom 27803010,,2043-2858  -  INSERT ACETAB 58-60MM 28MM 0D HIP S2 UHMWPE OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2043-2862,SUP,Custom 27803010,,2043-2862  -  INSERT ACETAB 62-72MM 28MM 0D HIP OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2043-2866,SUP,Custom 27803010,,2043-2866  -  INSERT ACETAB 66MM 28MM 0D HIP OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2043-2870,SUP,Custom 27803010,,2043-2870  -  INSERT ACETAB 70MM 28MM 0D HIP OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2043-2874,SUP,Custom 27803010,,2043-2874  -  INSERT ACETAB 74MM 28MM 0D HIP OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2043-3246,SUP,Custom 27803010,,2043-3246  -  INSERT ACETAB 46-48MM 32MM 0D HIP OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2043-3250,SUP,Custom 27803010,,2043-3250  -  INSERT ACETAB 50-52MM 32MM 0D HIP S2 UHMWPE OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2043-3254,SUP,Custom 27803010,,2043-3254  -  INSERT ACETAB 54-56MM 32MM 0D HIP S2 UHMWPE OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2043-3258,SUP,Custom 27803010,,2043-3258  -  INSERT ACETAB 58-60MM 32MM 0D HIP S2 UHMWPE OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2043-3262,SUP,Custom 27803010,,2043-3262  -  INSERT ACETAB 62-70MM 32MM 0D HIP S2 UHMWPE OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2043-3266,SUP,Custom 27803010,,2043-3266  -  INSERT ACETAB 66MM 32MM 0D HIP OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2043-3270,SUP,Custom 27803010,,2043-3270  -  INSERT ACETAB 70MM 32MM 0D HIP OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2043-3274,SUP,Custom 27803010,,2043-3274  -  INSERT ACETAB 74MM 32MM 0D HIP OMFT,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
2043C-2642,SUP,Custom 27803010,,2043C-2642  -  INSERT ACETAB 42MM 26MM 0D HIP S2 XFIRE,"$1,610.00",$0.00,"$1,610.00",$0.00,"$1,149.06",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,610.00",$0.00,$805.00,"$1,275.12","$1,288.00",$0.00,$0.00,$0.00,$0.00,$0.00
2043C-2646,SUP,Custom 27803010,,2043C-2646  -  INSERT ACETAB 46MM 26MM 0D HIP S2 XFIRE,"$1,610.00",$0.00,"$1,610.00",$0.00,"$1,149.06",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,610.00",$0.00,$805.00,"$1,275.12","$1,288.00",$0.00,$0.00,$0.00,$0.00,$0.00
2043C-2650,SUP,Custom 27803010,,2043C-2650  -  INSERT ACETAB 26MM 0D HIP S2 XFIRE,"$1,610.00",$0.00,"$1,610.00",$0.00,"$1,149.06",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,610.00",$0.00,$805.00,"$1,275.12","$1,288.00",$0.00,$0.00,$0.00,$0.00,$0.00
2043C-2654,SUP,Custom 27803010,,2043C-2654  -  INSERT ACETAB 26MM 0D HIP S2 XFIRE,"$1,610.00",$0.00,"$1,610.00",$0.00,"$1,149.06",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,610.00",$0.00,$805.00,"$1,275.12","$1,288.00",$0.00,$0.00,$0.00,$0.00,$0.00
2043C-2846,SUP,Custom 27803010,,2043C-2846  -  INSERT ACETAB 0D 46MM 28MM XFIRE HIP,"$2,397.50",$0.00,"$2,397.50",$0.00,"$1,711.10",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,397.50",$0.00,"$1,198.75","$1,898.82","$1,918.00",$0.00,$0.00,$0.00,$0.00,$0.00
2043C-2850,SUP,Custom 27803010,,2043C-2850  -  INSERT ACETAB 0D 50-52MM 28MM SERIES II XFIRE HIP,"$2,397.50",$0.00,"$2,397.50",$0.00,"$1,711.10",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,397.50",$0.00,"$1,198.75","$1,898.82","$1,918.00",$0.00,$0.00,$0.00,$0.00,$0.00
2043C-2854,SUP,Custom 27803010,,2043C-2854  -  INSERT ACETAB 0D 54-56MM 28MM 11.4MM SERIES II OMNIFIT XFIRE,"$2,397.50",$0.00,"$2,397.50",$0.00,"$1,711.10",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,397.50",$0.00,"$1,198.75","$1,898.82","$1,918.00",$0.00,$0.00,$0.00,$0.00,$0.00
2043C-2858,SUP,Custom 27803010,,2043C-2858  -  INSERT ACETAB 0D 58-60MM 28MM SERIES II XFIRE HIP,"$2,397.50",$0.00,"$2,397.50",$0.00,"$1,711.10",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,397.50",$0.00,"$1,198.75","$1,898.82","$1,918.00",$0.00,$0.00,$0.00,$0.00,$0.00
2043C-2862,SUP,Custom 27803010,,2043C-2862  -  INSERT ACETAB 0D 62-72MM 28MM SERIES II XFIRE HIP,"$2,397.50",$0.00,"$2,397.50",$0.00,"$1,711.10",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,397.50",$0.00,"$1,198.75","$1,898.82","$1,918.00",$0.00,$0.00,$0.00,$0.00,$0.00
2043C-2866,SUP,Custom 27803010,,2043C-2866  -  INSERT ACETAB 0D 66MM 28MM XFIRE HIP,"$2,397.50",$0.00,"$2,397.50",$0.00,"$1,711.10",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,397.50",$0.00,"$1,198.75","$1,898.82","$1,918.00",$0.00,$0.00,$0.00,$0.00,$0.00
2043C-3250,SUP,Custom 27803010,,2043C-3250  -  INSERT ACETAB 0D 50MM 32MM XFIRE HIP,"$2,397.50",$0.00,"$2,397.50",$0.00,"$1,711.10",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,397.50",$0.00,"$1,198.75","$1,898.82","$1,918.00",$0.00,$0.00,$0.00,$0.00,$0.00
2043C-3254,SUP,Custom 27803010,,2043C-3254  -  INSERT ACETAB 0D 32MM LINER XFIRE HIP,"$2,397.50",$0.00,"$2,397.50",$0.00,"$1,711.10",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,397.50",$0.00,"$1,198.75","$1,898.82","$1,918.00",$0.00,$0.00,$0.00,$0.00,$0.00
2043C-3258,SUP,Custom 27803010,,2043C-3258  -  INSERT ACETAB 0D 58-60MM 32MM SERIES II XFIRE HIP,"$2,397.50",$0.00,"$2,397.50",$0.00,"$1,711.10",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,397.50",$0.00,"$1,198.75","$1,898.82","$1,918.00",$0.00,$0.00,$0.00,$0.00,$0.00
2043C-3262,SUP,Custom 27803010,,2043C-3262  -  INSERT ACETAB 10D 62MM 32MM XFIRE HIP,"$2,397.50",$0.00,"$2,397.50",$0.00,"$1,711.10",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,397.50",$0.00,"$1,198.75","$1,898.82","$1,918.00",$0.00,$0.00,$0.00,$0.00,$0.00
2043C-3266,SUP,Custom 27803010,,2043C-3266  -  INSERT ACETAB 0D 66MM 32MM XFIRE HIP,"$2,397.50",$0.00,"$2,397.50",$0.00,"$1,711.10",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,397.50",$0.00,"$1,198.75","$1,898.82","$1,918.00",$0.00,$0.00,$0.00,$0.00,$0.00
2043C-3270,SUP,Custom 27803010,,2043C-3270  -  INSERT ACETAB 0D 70MM 32MM XFIRE HIP,"$2,720.00",$0.00,"$2,720.00",$0.00,"$1,941.26",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,720.00",$0.00,"$1,360.00","$2,154.24","$2,176.00",$0.00,$0.00,$0.00,$0.00,$0.00
2043C-3274,SUP,Custom 27803010,,2043C-3274  -  INSERT ACETAB 0D 74MM 32MM XFIRE HIP,"$2,720.00",$0.00,"$2,720.00",$0.00,"$1,941.26",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,720.00",$0.00,"$1,360.00","$2,154.24","$2,176.00",$0.00,$0.00,$0.00,$0.00,$0.00
2044-1125S,SUP,HCPCS C1713,,2044-1125S  -  NAIL 440MM HIP RIGHT GAMMA3 IM R2 LNG,"$2,908.13",$0.00,"$2,908.13","$1,308.66","$2,075.53",$0.00,$501.06,$0.00,$0.00,$509.19,"$2,908.13",$0.00,"$1,454.06","$2,303.24","$2,326.50",$0.00,$455.12,$0.00,$462.97,$0.00
2044-1130S,SUP,HCPCS C1713,,2044-1130S  -  NAIL 11MM 44CM RIGHT FEM GAMA IM 130D LNG TI STRL,"$2,908.13",$0.00,"$2,908.13","$1,308.66","$2,075.53",$0.00,$501.06,$0.00,$0.00,$509.19,"$2,908.13",$0.00,"$1,454.06","$2,303.24","$2,326.50",$0.00,$455.12,$0.00,$462.97,$0.00
2044-1135S,SUP,HCPCS C1713,,2044-1135S  -  NAIL 11MM 44CM RIGHT FEM GAMA IM 130D LNG LCK TI STRL,"$2,908.13",$0.00,"$2,908.13","$1,308.66","$2,075.53",$0.00,$501.06,$0.00,$0.00,$509.19,"$2,908.13",$0.00,"$1,454.06","$2,303.24","$2,326.50",$0.00,$455.12,$0.00,$462.97,$0.00
2044-1330S,SUP,HCPCS C1713,,2044-1330S  -  NAIL 440MM HIP RIGHT GAMMA3 IM R2 LNG ORTHNX,"$2,908.13",$0.00,"$2,908.13","$1,308.66","$2,075.53",$0.00,$501.06,$0.00,$0.00,$509.19,"$2,908.13",$0.00,"$1,454.06","$2,303.24","$2,326.50",$0.00,$455.12,$0.00,$462.97,$0.00
2050-2040,SUP,Custom 27803010,,2050-2040  -  SHELL ACETAB 40MM HIP CLSHOLE SECFIT PSL,"$2,409.00",$0.00,"$2,409.00",$0.00,"$1,719.30",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,409.00",$0.00,"$1,204.50","$1,907.93","$1,927.20",$0.00,$0.00,$0.00,$0.00,$0.00
2050-2040CS,SUP,Custom 27803010,,2050-2040CS  -  SHELL ACETAB 40MM HIP SECFIT PSL,"$2,409.00",$0.00,"$2,409.00",$0.00,"$1,719.30",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,409.00",$0.00,"$1,204.50","$1,907.93","$1,927.20",$0.00,$0.00,$0.00,$0.00,$0.00
2050-2042,SUP,Custom 27803010,,2050-2042  -  SHELL ACETAB 42MM HIP CLSHOLE SECFIT PSL,"$2,409.00",$0.00,"$2,409.00",$0.00,"$1,719.30",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,409.00",$0.00,"$1,204.50","$1,907.93","$1,927.20",$0.00,$0.00,$0.00,$0.00,$0.00
2050-2042CS,SUP,Custom 27803010,,2050-2042CS  -  SHELL ACETAB 42MM HIP SECFIT PSL,"$2,409.00",$0.00,"$2,409.00",$0.00,"$1,719.30",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,409.00",$0.00,"$1,204.50","$1,907.93","$1,927.20",$0.00,$0.00,$0.00,$0.00,$0.00
2050-2044,SUP,Custom 27803010,,2050-2044  -  SHELL ACETAB 44MM HIP CLSHOLE SECFIT PSL,"$2,409.00",$0.00,"$2,409.00",$0.00,"$1,719.30",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,409.00",$0.00,"$1,204.50","$1,907.93","$1,927.20",$0.00,$0.00,$0.00,$0.00,$0.00
2050-2044CS,SUP,Custom 27803010,,2050-2044CS  -  SHELL ACETAB 44MM HIP SECFIT PSL,"$2,409.00",$0.00,"$2,409.00",$0.00,"$1,719.30",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,409.00",$0.00,"$1,204.50","$1,907.93","$1,927.20",$0.00,$0.00,$0.00,$0.00,$0.00
2050-2046,SUP,Custom 27803010,,2050-2046  -  SHELL ACETAB 46MM HIP CLSHOLE SECFIT PSL,"$2,377.00",$0.00,"$2,377.00",$0.00,"$1,696.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,377.00",$0.00,"$1,188.50","$1,882.58","$1,901.60",$0.00,$0.00,$0.00,$0.00,$0.00
2050-2048,SUP,Custom 27803010,,2050-2048  -  SHELL ACETAB 48MM HIP CLSHOLE SECFIT PSL,"$2,377.00",$0.00,"$2,377.00",$0.00,"$1,696.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,377.00",$0.00,"$1,188.50","$1,882.58","$1,901.60",$0.00,$0.00,$0.00,$0.00,$0.00
2050-2050,SUP,Custom 27803010,,2050-2050  -  SHELL ACETAB 50MM HIP CLSHOLE SECFIT PSL,"$2,377.00",$0.00,"$2,377.00",$0.00,"$1,696.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,377.00",$0.00,"$1,188.50","$1,882.58","$1,901.60",$0.00,$0.00,$0.00,$0.00,$0.00
2050-2052,SUP,Custom 27803010,,2050-2052  -  SHELL ACETAB 52MM HIP CLSHOLE SECFIT PSL,"$2,377.00",$0.00,"$2,377.00",$0.00,"$1,696.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,377.00",$0.00,"$1,188.50","$1,882.58","$1,901.60",$0.00,$0.00,$0.00,$0.00,$0.00
2050-2054,SUP,Custom 27803010,,2050-2054  -  SHELL ACETAB 54MM HIP CLSHOLE SECFIT PSL,"$2,377.00",$0.00,"$2,377.00",$0.00,"$1,696.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,377.00",$0.00,"$1,188.50","$1,882.58","$1,901.60",$0.00,$0.00,$0.00,$0.00,$0.00
2050-2056,SUP,Custom 27803010,,2050-2056  -  SHELL ACETAB 56MM HIP CLSHOLE SECFIT PSL,"$2,377.00",$0.00,"$2,377.00",$0.00,"$1,696.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,377.00",$0.00,"$1,188.50","$1,882.58","$1,901.60",$0.00,$0.00,$0.00,$0.00,$0.00
2050-2058,SUP,Custom 27803010,,2050-2058  -  SHELL ACETAB 58MM HIP CLSHOLE SECFIT PSL,"$2,377.00",$0.00,"$2,377.00",$0.00,"$1,696.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,377.00",$0.00,"$1,188.50","$1,882.58","$1,901.60",$0.00,$0.00,$0.00,$0.00,$0.00
2050-2060,SUP,Custom 27803010,,2050-2060  -  SHELL ACETAB 60MM HIP CLSHOLE SECFIT PSL,"$2,377.00",$0.00,"$2,377.00",$0.00,"$1,696.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,377.00",$0.00,"$1,188.50","$1,882.58","$1,901.60",$0.00,$0.00,$0.00,$0.00,$0.00
2050-2062,SUP,Custom 27803010,,2050-2062  -  SHELL ACETAB 62MM HIP CLSHOLE SECFIT PSL,"$2,377.00",$0.00,"$2,377.00",$0.00,"$1,696.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,377.00",$0.00,"$1,188.50","$1,882.58","$1,901.60",$0.00,$0.00,$0.00,$0.00,$0.00
2050-2064,SUP,Custom 27803010,,2050-2064  -  SHELL ACETAB HIP CLSHOLE SECFIT PSL,"$2,377.00",$0.00,"$2,377.00",$0.00,"$1,696.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,377.00",$0.00,"$1,188.50","$1,882.58","$1,901.60",$0.00,$0.00,$0.00,$0.00,$0.00
2050-2066,SUP,Custom 27803010,,2050-2066  -  SHELL ACETAB 66MM HIP CLSHOLE SECFIT PSL,"$2,409.00",$0.00,"$2,409.00",$0.00,"$1,719.30",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,409.00",$0.00,"$1,204.50","$1,907.93","$1,927.20",$0.00,$0.00,$0.00,$0.00,$0.00
2050-2068,SUP,Custom 27803010,,2050-2068  -  SHELL ACETAB 68MM HIP CLSHOLE SECFIT PSL,"$2,409.00",$0.00,"$2,409.00",$0.00,"$1,719.30",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,409.00",$0.00,"$1,204.50","$1,907.93","$1,927.20",$0.00,$0.00,$0.00,$0.00,$0.00
2050-2070,SUP,Custom 27803010,,2050-2070  -  SHELL ACETAB 70MM HIP CLSHOLE SECFIT PSL,"$2,409.00",$0.00,"$2,409.00",$0.00,"$1,719.30",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,409.00",$0.00,"$1,204.50","$1,907.93","$1,927.20",$0.00,$0.00,$0.00,$0.00,$0.00
2050-2072,SUP,Custom 27803010,,2050-2072  -  SHELL ACETAB 72MM HIP CLSHOLE SECFIT PSL,"$2,409.00",$0.00,"$2,409.00",$0.00,"$1,719.30",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,409.00",$0.00,"$1,204.50","$1,907.93","$1,927.20",$0.00,$0.00,$0.00,$0.00,$0.00
2050-3040,SUP,Custom 27803010,,2050-3040  -  SHELL ACETAB 40MM HIP SCRLES SECFIT PSL,"$2,505.00",$0.00,"$2,505.00",$0.00,"$1,787.82",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,505.00",$0.00,"$1,252.50","$1,983.96","$2,004.00",$0.00,$0.00,$0.00,$0.00,$0.00
2050-3042,SUP,Custom 27803010,,2050-3042  -  SHELL ACETAB 42MM HIP SCRLES SECFIT PSL,"$2,505.00",$0.00,"$2,505.00",$0.00,"$1,787.82",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,505.00",$0.00,"$1,252.50","$1,983.96","$2,004.00",$0.00,$0.00,$0.00,$0.00,$0.00
2050-3044,SUP,Custom 27803010,,2050-3044  -  SHELL ACETAB 44MM HIP SCRLES SECFIT PSL,"$2,505.00",$0.00,"$2,505.00",$0.00,"$1,787.82",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,505.00",$0.00,"$1,252.50","$1,983.96","$2,004.00",$0.00,$0.00,$0.00,$0.00,$0.00
2050-3046,SUP,Custom 27803010,,2050-3046  -  SHELL ACETAB 46MM HIP SCRLES SECFIT PSL,"$2,505.00",$0.00,"$2,505.00",$0.00,"$1,787.82",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,505.00",$0.00,"$1,252.50","$1,983.96","$2,004.00",$0.00,$0.00,$0.00,$0.00,$0.00
2050-3048,SUP,Custom 27803010,,2050-3048  -  SHELL ACETAB 48MM HIP SCRLES SECFIT PSL,"$2,505.00",$0.00,"$2,505.00",$0.00,"$1,787.82",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,505.00",$0.00,"$1,252.50","$1,983.96","$2,004.00",$0.00,$0.00,$0.00,$0.00,$0.00
2050-3050,SUP,Custom 27803010,,2050-3050  -  SHELL ACETAB 50MM HIP SCRLES SECFIT PSL,"$2,505.00",$0.00,"$2,505.00",$0.00,"$1,787.82",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,505.00",$0.00,"$1,252.50","$1,983.96","$2,004.00",$0.00,$0.00,$0.00,$0.00,$0.00
2050-3052,SUP,Custom 27803010,,2050-3052  -  SHELL ACETAB 52MM HIP SCRLES SECFIT PSL,"$2,505.00",$0.00,"$2,505.00",$0.00,"$1,787.82",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,505.00",$0.00,"$1,252.50","$1,983.96","$2,004.00",$0.00,$0.00,$0.00,$0.00,$0.00
2050-3054,SUP,Custom 27803010,,2050-3054  -  SHELL ACETAB 54MM HIP SCRLES SECFIT PSL,"$2,505.00",$0.00,"$2,505.00",$0.00,"$1,787.82",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,505.00",$0.00,"$1,252.50","$1,983.96","$2,004.00",$0.00,$0.00,$0.00,$0.00,$0.00
2050-3056,SUP,Custom 27803010,,2050-3056  -  SHELL ACETAB 56MM HIP SCRLES SECFIT PSL,"$2,505.00",$0.00,"$2,505.00",$0.00,"$1,787.82",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,505.00",$0.00,"$1,252.50","$1,983.96","$2,004.00",$0.00,$0.00,$0.00,$0.00,$0.00
2050-3058,SUP,Custom 27803010,,2050-3058  -  SHELL ACETAB 58MM HIP SCRLES SECFIT PSL,"$2,505.00",$0.00,"$2,505.00",$0.00,"$1,787.82",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,505.00",$0.00,"$1,252.50","$1,983.96","$2,004.00",$0.00,$0.00,$0.00,$0.00,$0.00
2050-3060,SUP,Custom 27803010,,2050-3060  -  SHELL ACETAB 60MM HIP SCRLES SECFIT PSL,"$2,505.00",$0.00,"$2,505.00",$0.00,"$1,787.82",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,505.00",$0.00,"$1,252.50","$1,983.96","$2,004.00",$0.00,$0.00,$0.00,$0.00,$0.00
2050-3062,SUP,Custom 27803010,,2050-3062  -  SHELL ACETAB 62MM HIP SCRLES SECFIT PSL,"$2,505.00",$0.00,"$2,505.00",$0.00,"$1,787.82",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,505.00",$0.00,"$1,252.50","$1,983.96","$2,004.00",$0.00,$0.00,$0.00,$0.00,$0.00
2050-3064,SUP,Custom 27803010,,2050-3064  -  SHELL ACETAB 64MM HIP SCRLES SECFIT PSL,"$2,505.00",$0.00,"$2,505.00",$0.00,"$1,787.82",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,505.00",$0.00,"$1,252.50","$1,983.96","$2,004.00",$0.00,$0.00,$0.00,$0.00,$0.00
2050-3066,SUP,Custom 27803010,,2050-3066  -  SHELL ACETAB 66MM HIP SCRLES SECFIT PSL,"$2,505.00",$0.00,"$2,505.00",$0.00,"$1,787.82",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,505.00",$0.00,"$1,252.50","$1,983.96","$2,004.00",$0.00,$0.00,$0.00,$0.00,$0.00
2050-3068,SUP,Custom 27803010,,2050-3068  -  SHELL ACETAB 68MM HIP SCRLES SECFIT PSL,"$2,505.00",$0.00,"$2,505.00",$0.00,"$1,787.82",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,505.00",$0.00,"$1,252.50","$1,983.96","$2,004.00",$0.00,$0.00,$0.00,$0.00,$0.00
2050-3070,SUP,Custom 27803010,,2050-3070  -  SHELL ACETAB 70MM HIP SCRLES SECFIT PSL,"$2,505.00",$0.00,"$2,505.00",$0.00,"$1,787.82",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,505.00",$0.00,"$1,252.50","$1,983.96","$2,004.00",$0.00,$0.00,$0.00,$0.00,$0.00
2050-3072,SUP,Custom 27803010,,2050-3072  -  SHELL ACETAB 72MM HIP SCRLES SECFIT PSL,"$2,505.00",$0.00,"$2,505.00",$0.00,"$1,787.82",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,505.00",$0.00,"$1,252.50","$1,983.96","$2,004.00",$0.00,$0.00,$0.00,$0.00,$0.00
2050-5060P,SUP,Custom 27803010,,2050-5060P  -  SHELL ACETAB ARC DEPOSITED OPTN SECFIT,"$2,228.00",$0.00,"$2,228.00",$0.00,"$1,590.12",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,228.00",$0.00,"$1,114.00","$1,764.58","$1,782.40",$0.00,$0.00,$0.00,$0.00,$0.00
2051-2040,SUP,Custom 27803010,,2051-2040  -  SHELL ACETAB 40MM HIP CLSHOLE HYDRXAPT SECFIT PSL,"$2,135.00",$0.00,"$2,135.00",$0.00,"$1,523.75",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,135.00",$0.00,"$1,067.50","$1,690.92","$1,708.00",$0.00,$0.00,$0.00,$0.00,$0.00
2051-2040P,SUP,Custom 27803010,,2051-2040P  -  CUP ACETAB 40MM CLSHOLE SECFIT PSL HA HIP,"$2,228.00",$0.00,"$2,228.00",$0.00,"$1,590.12",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,228.00",$0.00,"$1,114.00","$1,764.58","$1,782.40",$0.00,$0.00,$0.00,$0.00,$0.00
2051-2042,SUP,Custom 27803010,,2051-2042  -  SHELL ACETAB 42MM HIP CLSHOLE HYDRXAPT SECFIT PSL,"$2,135.00",$0.00,"$2,135.00",$0.00,"$1,523.75",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,135.00",$0.00,"$1,067.50","$1,690.92","$1,708.00",$0.00,$0.00,$0.00,$0.00,$0.00
2051-2042P,SUP,Custom 27803010,,2051-2042P  -  SHELL ACETAB 42MM HIP CLSHOLE HYDRXAPT SECFIT PSL,"$2,228.00",$0.00,"$2,228.00",$0.00,"$1,590.12",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,228.00",$0.00,"$1,114.00","$1,764.58","$1,782.40",$0.00,$0.00,$0.00,$0.00,$0.00
2051-2044,SUP,Custom 27803010,,2051-2044  -  SHELL ACETAB 44MM HIP CLSHOLE HYDRXAPT SECFIT PSL,"$2,135.00",$0.00,"$2,135.00",$0.00,"$1,523.75",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,135.00",$0.00,"$1,067.50","$1,690.92","$1,708.00",$0.00,$0.00,$0.00,$0.00,$0.00
2051-2044P,SUP,Custom 27803010,,2051-2044P  -  SHELL ACETAB 44MM HIP CLSHOLE HYDRXAPT SECFIT PSL,"$2,228.00",$0.00,"$2,228.00",$0.00,"$1,590.12",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,228.00",$0.00,"$1,114.00","$1,764.58","$1,782.40",$0.00,$0.00,$0.00,$0.00,$0.00
2051-2046,SUP,Custom 27803010,,2051-2046  -  SHELL ACETAB 46MM HIP CLSHOLE HYDRXAPT SECFIT,"$2,102.00",$0.00,"$2,102.00",$0.00,"$1,500.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,102.00",$0.00,"$1,051.00","$1,664.78","$1,681.60",$0.00,$0.00,$0.00,$0.00,$0.00
2051-2046P,SUP,Custom 27803010,,2051-2046P  -  CUP ACETAB 46MM CLSHOLE SECFIT PSL HA HIP,"$2,228.00",$0.00,"$2,228.00",$0.00,"$1,590.12",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,228.00",$0.00,"$1,114.00","$1,764.58","$1,782.40",$0.00,$0.00,$0.00,$0.00,$0.00
2051-2048,SUP,Custom 27803010,,2051-2048  -  SHELL ACETAB 48MM CLSTR SH HYDRXAPT SECFIT PSL,"$2,102.00",$0.00,"$2,102.00",$0.00,"$1,500.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,102.00",$0.00,"$1,051.00","$1,664.78","$1,681.60",$0.00,$0.00,$0.00,$0.00,$0.00
2051-2048P,SUP,Custom 27803010,,2051-2048P  -  SHELL ACETAB 48MM HIP CLSHOLE HYDRXAPT SECFIT PSL,"$2,228.00",$0.00,"$2,228.00",$0.00,"$1,590.12",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,228.00",$0.00,"$1,114.00","$1,764.58","$1,782.40",$0.00,$0.00,$0.00,$0.00,$0.00
2051-2050,SUP,Custom 27803010,,2051-2050  -  SHELL ACETAB 50MM CLSTR SH HYDRXAPT SECFIT PSL,"$2,102.00",$0.00,"$2,102.00",$0.00,"$1,500.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,102.00",$0.00,"$1,051.00","$1,664.78","$1,681.60",$0.00,$0.00,$0.00,$0.00,$0.00
2051-2050P,SUP,Custom 27803010,,2051-2050P  -  SHELL ACETAB 50MM HIP CLSHOLE HYDRXAPT PSL SECFIT,"$2,228.00",$0.00,"$2,228.00",$0.00,"$1,590.12",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,228.00",$0.00,"$1,114.00","$1,764.58","$1,782.40",$0.00,$0.00,$0.00,$0.00,$0.00
2051-2052,SUP,Custom 27803010,,2051-2052  -  SHELL ACETAB 52MM CLSTR SH HYDRXAPT SECFIT PSL,"$2,102.00",$0.00,"$2,102.00",$0.00,"$1,500.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,102.00",$0.00,"$1,051.00","$1,664.78","$1,681.60",$0.00,$0.00,$0.00,$0.00,$0.00
2051-2052P,SUP,Custom 27803010,,2051-2052P  -  SHELL ACETAB 52MM HIP CLSHOLE HYDRXAPT SECFIT PSL,"$2,228.00",$0.00,"$2,228.00",$0.00,"$1,590.12",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,228.00",$0.00,"$1,114.00","$1,764.58","$1,782.40",$0.00,$0.00,$0.00,$0.00,$0.00
2051-2054,SUP,Custom 27803010,,2051-2054  -  SHELL ACETAB 54MM CLSTR SH HYDRXAPT SECFIT PSL,"$2,102.00",$0.00,"$2,102.00",$0.00,"$1,500.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,102.00",$0.00,"$1,051.00","$1,664.78","$1,681.60",$0.00,$0.00,$0.00,$0.00,$0.00
2051-2054P,SUP,Custom 27803010,,2051-2054P  -  CUP ACETAB 54MM SECFIT PSL CLSTR HIP HYDRXAPT,"$2,228.00",$0.00,"$2,228.00",$0.00,"$1,590.12",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,228.00",$0.00,"$1,114.00","$1,764.58","$1,782.40",$0.00,$0.00,$0.00,$0.00,$0.00
2051-2056,SUP,Custom 27803010,,2051-2056  -  SHELL ACETAB 56MM CLSTR CUP SH HYDRXAPT SECFIT PSL,"$2,102.00",$0.00,"$2,102.00",$0.00,"$1,500.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,102.00",$0.00,"$1,051.00","$1,664.78","$1,681.60",$0.00,$0.00,$0.00,$0.00,$0.00
2051-2056P,SUP,Custom 27803010,,2051-2056P  -  CUP ACETAB 56MM SECFIT PSL CLSTR HIP HYDRXAPT,"$2,228.00",$0.00,"$2,228.00",$0.00,"$1,590.12",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,228.00",$0.00,"$1,114.00","$1,764.58","$1,782.40",$0.00,$0.00,$0.00,$0.00,$0.00
2051-2058,SUP,Custom 27803010,,2051-2058  -  CUP ACETAB 58MM SECFIT CLSTR SCR HOLE HIP HYDRXAPT,"$2,102.00",$0.00,"$2,102.00",$0.00,"$1,500.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,102.00",$0.00,"$1,051.00","$1,664.78","$1,681.60",$0.00,$0.00,$0.00,$0.00,$0.00
2051-2058P,SUP,Custom 27803010,,2051-2058P  -  CUP ACETAB 58MM SECFIT PSL CLSTR HIP HYDRXAPT,"$2,228.00",$0.00,"$2,228.00",$0.00,"$1,590.12",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,228.00",$0.00,"$1,114.00","$1,764.58","$1,782.40",$0.00,$0.00,$0.00,$0.00,$0.00
2051-2060,SUP,Custom 27803010,,2051-2060  -  SHELL ACETAB 60MM CLSTR CUP SH HYDRXAPT SECFIT PSL,"$2,102.00",$0.00,"$2,102.00",$0.00,"$1,500.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,102.00",$0.00,"$1,051.00","$1,664.78","$1,681.60",$0.00,$0.00,$0.00,$0.00,$0.00
2051-2060P,SUP,Custom 27803010,,2051-2060P  -  CUP ACETAB 60MM SECFIT PSL CLSTR HIP HYDRXAPT,"$2,228.00",$0.00,"$2,228.00",$0.00,"$1,590.12",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,228.00",$0.00,"$1,114.00","$1,764.58","$1,782.40",$0.00,$0.00,$0.00,$0.00,$0.00
2051-2062,SUP,Custom 27803010,,2051-2062  -  SHELL ACETAB CLSHOLE HYDRXAPT SECFIT PSL,"$2,102.00",$0.00,"$2,102.00",$0.00,"$1,500.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,102.00",$0.00,"$1,051.00","$1,664.78","$1,681.60",$0.00,$0.00,$0.00,$0.00,$0.00
2051-2062P,SUP,Custom 27803010,,2051-2062P  -  CUP ACETAB 62MM SECFIT PSL CLSTR HIP HYDRXAPT,"$2,228.00",$0.00,"$2,228.00",$0.00,"$1,590.12",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,228.00",$0.00,"$1,114.00","$1,764.58","$1,782.40",$0.00,$0.00,$0.00,$0.00,$0.00
2051-2064,SUP,Custom 27803010,,2051-2064  -  SHELL ACETAB 64MM HIP CLSHOLE PUREFIX HYDRXAPT SECFIT,"$2,102.00",$0.00,"$2,102.00",$0.00,"$1,500.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,102.00",$0.00,"$1,051.00","$1,664.78","$1,681.60",$0.00,$0.00,$0.00,$0.00,$0.00
2051-2064P,SUP,Custom 27803010,,2051-2064P  -  CUP ACETAB 64MM SECFIT PSL CLSTR HIP HYDRXAPT,"$2,228.00",$0.00,"$2,228.00",$0.00,"$1,590.12",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,228.00",$0.00,"$1,114.00","$1,764.58","$1,782.40",$0.00,$0.00,$0.00,$0.00,$0.00
2051-2066,SUP,Custom 27803010,,2051-2066  -  SHELL ACETAB 66MM HIP CLSHOLE HYDRXAPT SECFIT,"$2,135.00",$0.00,"$2,135.00",$0.00,"$1,523.75",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,135.00",$0.00,"$1,067.50","$1,690.92","$1,708.00",$0.00,$0.00,$0.00,$0.00,$0.00
2051-2066P,SUP,Custom 27803010,,2051-2066P  -  SHELL ACETAB 66MM HIP CLSHOLE HYDRXAPT SECFIT PSL,"$2,228.00",$0.00,"$2,228.00",$0.00,"$1,590.12",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,228.00",$0.00,"$1,114.00","$1,764.58","$1,782.40",$0.00,$0.00,$0.00,$0.00,$0.00
2051-2068,SUP,Custom 27803010,,2051-2068  -  SHELL ACETAB 68MM HIP CLSHOLE HYDRXAPT SECFIT PSL,"$2,135.00",$0.00,"$2,135.00",$0.00,"$1,523.75",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,135.00",$0.00,"$1,067.50","$1,690.92","$1,708.00",$0.00,$0.00,$0.00,$0.00,$0.00
2051-2068P,SUP,Custom 27803010,,2051-2068P  -  SHELL ACETAB 68MM HIP CLSHOLE HYDRXAPT SECFIT PSL,"$2,228.00",$0.00,"$2,228.00",$0.00,"$1,590.12",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,228.00",$0.00,"$1,114.00","$1,764.58","$1,782.40",$0.00,$0.00,$0.00,$0.00,$0.00
2051-2070,SUP,Custom 27803010,,2051-2070  -  SHELL ACETAB 70MM HIP CLSHOLE HYDRXAPT SECFIT,"$2,135.00",$0.00,"$2,135.00",$0.00,"$1,523.75",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,135.00",$0.00,"$1,067.50","$1,690.92","$1,708.00",$0.00,$0.00,$0.00,$0.00,$0.00
2051-2070P,SUP,Custom 27803010,,2051-2070P  -  SHELL ACETAB 70MM HIP CLSHOLE HYDRXAPT SECFIT PSL,"$2,228.00",$0.00,"$2,228.00",$0.00,"$1,590.12",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,228.00",$0.00,"$1,114.00","$1,764.58","$1,782.40",$0.00,$0.00,$0.00,$0.00,$0.00
2051-2072,SUP,Custom 27803010,,2051-2072  -  SHELL ACETAB 72MM HIP CLSHOLE HYDRXAPT SECFIT PSL,"$2,135.00",$0.00,"$2,135.00",$0.00,"$1,523.75",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,135.00",$0.00,"$1,067.50","$1,690.92","$1,708.00",$0.00,$0.00,$0.00,$0.00,$0.00
2051-2072P,SUP,Custom 27803010,,2051-2072P  -  SHELL ACETAB 72MM HIP CLSHOLE HYDRXAPT SECFIT PSL,"$2,228.00",$0.00,"$2,228.00",$0.00,"$1,590.12",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,228.00",$0.00,"$1,114.00","$1,764.58","$1,782.40",$0.00,$0.00,$0.00,$0.00,$0.00
2051-3040,SUP,Custom 27803010,,2051-3040  -  SHELL ACETAB 40MM HIP SCRLES HYDRXAPT SECFIT,"$2,260.00",$0.00,"$2,260.00",$0.00,"$1,612.96",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,260.00",$0.00,"$1,130.00","$1,789.92","$1,808.00",$0.00,$0.00,$0.00,$0.00,$0.00
2051-3042,SUP,Custom 27803010,,2051-3042  -  SHELL ACETAB 42MM HIP SCRLES HYDRXAPT SECFIT,"$2,260.00",$0.00,"$2,260.00",$0.00,"$1,612.96",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,260.00",$0.00,"$1,130.00","$1,789.92","$1,808.00",$0.00,$0.00,$0.00,$0.00,$0.00
2051-3044,SUP,Custom 27803010,,2051-3044  -  CUP ACETAB 44MM SECFIT PSL SCRLES HIP HYDRXAPT,"$2,260.00",$0.00,"$2,260.00",$0.00,"$1,612.96",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,260.00",$0.00,"$1,130.00","$1,789.92","$1,808.00",$0.00,$0.00,$0.00,$0.00,$0.00
2051-3046,SUP,Custom 27803010,,2051-3046  -  CUP ACETAB 46MM SECFIT PSL SCRLES HIP HYDRXAPT,"$2,227.00",$0.00,"$2,227.00",$0.00,"$1,589.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,227.00",$0.00,"$1,113.50","$1,763.78","$1,781.60",$0.00,$0.00,$0.00,$0.00,$0.00
2051-3048,SUP,Custom 27803010,,2051-3048  -  CUP ACETAB 48MM SECFIT PSL SCRLES HIP HYDRXAPT,"$2,227.00",$0.00,"$2,227.00",$0.00,"$1,589.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,227.00",$0.00,"$1,113.50","$1,763.78","$1,781.60",$0.00,$0.00,$0.00,$0.00,$0.00
2051-3050,SUP,Custom 27803010,,2051-3050  -  CUP ACETAB 50MM SECFIT PSL SCRLES HIP HYDRXAPT,"$2,227.00",$0.00,"$2,227.00",$0.00,"$1,589.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,227.00",$0.00,"$1,113.50","$1,763.78","$1,781.60",$0.00,$0.00,$0.00,$0.00,$0.00
2051-3052,SUP,Custom 27803010,,2051-3052  -  CUP ACETAB 52MM SECFIT PSL SCRLES HIP HYDRXAPT,"$2,227.00",$0.00,"$2,227.00",$0.00,"$1,589.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,227.00",$0.00,"$1,113.50","$1,763.78","$1,781.60",$0.00,$0.00,$0.00,$0.00,$0.00
2051-3054,SUP,Custom 27803010,,2051-3054  -  SHELL ACETAB 54MM HIP NO HOLE SLD PUREFIX HYDRXAPT SECFIT,"$2,227.00",$0.00,"$2,227.00",$0.00,"$1,589.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,227.00",$0.00,"$1,113.50","$1,763.78","$1,781.60",$0.00,$0.00,$0.00,$0.00,$0.00
2051-3056,SUP,Custom 27803010,,2051-3056  -  CUP ACETAB 56MM SECFIT NO HOLE SLD HIP HYDRXAPT,"$2,227.00",$0.00,"$2,227.00",$0.00,"$1,589.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,227.00",$0.00,"$1,113.50","$1,763.78","$1,781.60",$0.00,$0.00,$0.00,$0.00,$0.00
2051-3058,SUP,Custom 27803010,,2051-3058  -  CUP ACETAB 58MM SECFIT NO HOLE SLD HIP HYDRXAPT,"$2,227.00",$0.00,"$2,227.00",$0.00,"$1,589.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,227.00",$0.00,"$1,113.50","$1,763.78","$1,781.60",$0.00,$0.00,$0.00,$0.00,$0.00
2051-3060,SUP,Custom 27803010,,2051-3060  -  CUP ACETAB 60MM SECFIT NO HOLE SLD HIP HYDRXAPT,"$2,227.00",$0.00,"$2,227.00",$0.00,"$1,589.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,227.00",$0.00,"$1,113.50","$1,763.78","$1,781.60",$0.00,$0.00,$0.00,$0.00,$0.00
2051-3062,SUP,Custom 27803010,,2051-3062  -  SHELL ACETAB 62MM HIP SCRLES HYDRXAPT SECFIT PSL,"$2,227.00",$0.00,"$2,227.00",$0.00,"$1,589.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,227.00",$0.00,"$1,113.50","$1,763.78","$1,781.60",$0.00,$0.00,$0.00,$0.00,$0.00
2051-3064,SUP,Custom 27803010,,2051-3064  -  CUP ACETAB 64MM SECFIT PSL SCRLES HIP HYDRXAPT,"$2,227.00",$0.00,"$2,227.00",$0.00,"$1,589.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,227.00",$0.00,"$1,113.50","$1,763.78","$1,781.60",$0.00,$0.00,$0.00,$0.00,$0.00
2051-3066,SUP,Custom 27803010,,2051-3066  -  SHELL ACETAB 66MM HIP SCRLES HYDRXAPT SECFIT PSL,"$2,260.00",$0.00,"$2,260.00",$0.00,"$1,612.96",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,260.00",$0.00,"$1,130.00","$1,789.92","$1,808.00",$0.00,$0.00,$0.00,$0.00,$0.00
2051-3068,SUP,Custom 27803010,,2051-3068  -  SHELL ACETAB 68MM HIP SCRLES HYDRXAPT SECFIT PSL,"$2,260.00",$0.00,"$2,260.00",$0.00,"$1,612.96",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,260.00",$0.00,"$1,130.00","$1,789.92","$1,808.00",$0.00,$0.00,$0.00,$0.00,$0.00
2051-3070,SUP,Custom 27803010,,2051-3070  -  SHELL ACETAB 70MM HIP SCRLES HYDRXAPT SECFIT,"$2,260.00",$0.00,"$2,260.00",$0.00,"$1,612.96",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,260.00",$0.00,"$1,130.00","$1,789.92","$1,808.00",$0.00,$0.00,$0.00,$0.00,$0.00
2051-3072,SUP,Custom 27803010,,2051-3072  -  SHELL ACETAB 72MM HIP SCRLES HYDRXAPT SECFIT,"$2,260.00",$0.00,"$2,260.00",$0.00,"$1,612.96",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,260.00",$0.00,"$1,130.00","$1,789.92","$1,808.00",$0.00,$0.00,$0.00,$0.00,$0.00
2053-2048,SUP,Custom 27803010,,2053-2048  -  SHELL ACETAB 48MM HIP CLSHOLE HYDRXAPT SECFIT X,"$4,190.88",$0.00,"$4,190.88",$0.00,"$2,991.03",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,190.88",$0.00,"$2,095.44","$3,319.18","$3,352.70",$0.00,$0.00,$0.00,$0.00,$0.00
2053-2050,SUP,Custom 27803010,,2053-2050  -  SHELL ACETAB 50MM HIP CLSHOLE HYDRXAPT SECFIT X,"$4,190.88",$0.00,"$4,190.88",$0.00,"$2,991.03",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,190.88",$0.00,"$2,095.44","$3,319.18","$3,352.70",$0.00,$0.00,$0.00,$0.00,$0.00
2053-2052,SUP,Custom 27803010,,2053-2052  -  SHELL ACETAB 52MM HIP CLSHOLE HYDRXAPT SECFIT X,"$4,190.88",$0.00,"$4,190.88",$0.00,"$2,991.03",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,190.88",$0.00,"$2,095.44","$3,319.18","$3,352.70",$0.00,$0.00,$0.00,$0.00,$0.00
2053-2054,SUP,Custom 27803010,,2053-2054  -  SHELL ACETAB 54MM HIP CLSHOLE HYDRXAPT SECFIT X,"$4,190.88",$0.00,"$4,190.88",$0.00,"$2,991.03",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,190.88",$0.00,"$2,095.44","$3,319.18","$3,352.70",$0.00,$0.00,$0.00,$0.00,$0.00
2053-2056,SUP,Custom 27803010,,2053-2056  -  SHELL ACETAB 56MM HIP CLSHOLE HYDRXAPT SECFIT X,"$4,190.88",$0.00,"$4,190.88",$0.00,"$2,991.03",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,190.88",$0.00,"$2,095.44","$3,319.18","$3,352.70",$0.00,$0.00,$0.00,$0.00,$0.00
2053-2058,SUP,Custom 27803010,,2053-2058  -  SHELL ACETAB 58MM CLSHOLE HYDRXAPT SECFIT PSL,"$4,190.88",$0.00,"$4,190.88",$0.00,"$2,991.03",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,190.88",$0.00,"$2,095.44","$3,319.18","$3,352.70",$0.00,$0.00,$0.00,$0.00,$0.00
2053-2060,SUP,Custom 27803010,,2053-2060  -  SHELL ACETAB 60MM HIP CLSHOLE HYDRXAPT SECFIT X,"$4,190.88",$0.00,"$4,190.88",$0.00,"$2,991.03",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,190.88",$0.00,"$2,095.44","$3,319.18","$3,352.70",$0.00,$0.00,$0.00,$0.00,$0.00
2053-2062,SUP,Custom 27803010,,2053-2062  -  SHELL ACETAB 62MM HIP CLSHOLE HYDRXAPT SECFIT X,"$4,190.88",$0.00,"$4,190.88",$0.00,"$2,991.03",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,190.88",$0.00,"$2,095.44","$3,319.18","$3,352.70",$0.00,$0.00,$0.00,$0.00,$0.00
2053-2064,SUP,Custom 27803010,,2053-2064  -  SHELL ACETAB 64MM HIP CLSHOLE HYDRXAPT SECFIT X,"$4,190.88",$0.00,"$4,190.88",$0.00,"$2,991.03",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,190.88",$0.00,"$2,095.44","$3,319.18","$3,352.70",$0.00,$0.00,$0.00,$0.00,$0.00
2053-2066,SUP,Custom 27803010,,2053-2066  -  SHELL ACETAB 66MM HIP CLSHOLE HYDRXAPT SECFIT X,"$4,190.88",$0.00,"$4,190.88",$0.00,"$2,991.03",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,190.88",$0.00,"$2,095.44","$3,319.18","$3,352.70",$0.00,$0.00,$0.00,$0.00,$0.00
2053-2068,SUP,Custom 27803010,,2053-2068  -  SHELL ACETAB 68MM HIP CLSHOLE HYDRXAPT SECFIT X,"$4,190.88",$0.00,"$4,190.88",$0.00,"$2,991.03",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,190.88",$0.00,"$2,095.44","$3,319.18","$3,352.70",$0.00,$0.00,$0.00,$0.00,$0.00
2053-2070,SUP,Custom 27803010,,2053-2070  -  SHELL ACETAB 70MM HIP CLSHOLE HYDRXAPT SECFIT X,"$4,190.88",$0.00,"$4,190.88",$0.00,"$2,991.03",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,190.88",$0.00,"$2,095.44","$3,319.18","$3,352.70",$0.00,$0.00,$0.00,$0.00,$0.00
2053-2072,SUP,Custom 27803010,,2053-2072  -  SHELL ACETAB 72MM HIP CLSHOLE HYDRXAPT SECFIT X,"$4,190.88",$0.00,"$4,190.88",$0.00,"$2,991.03",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,190.88",$0.00,"$2,095.44","$3,319.18","$3,352.70",$0.00,$0.00,$0.00,$0.00,$0.00
2053-2074,SUP,Custom 27803010,,2053-2074  -  SHELL ACETAB 74MM HIP CLSHOLE HYDRXAPT SECFIT X,"$4,190.88",$0.00,"$4,190.88",$0.00,"$2,991.03",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,190.88",$0.00,"$2,095.44","$3,319.18","$3,352.70",$0.00,$0.00,$0.00,$0.00,$0.00
2053-2076,SUP,Custom 27803010,,2053-2076  -  SHELL ACETAB 76MM HIP CLSHOLE HYDRXAPT SECFIT X,"$4,190.88",$0.00,"$4,190.88",$0.00,"$2,991.03",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,190.88",$0.00,"$2,095.44","$3,319.18","$3,352.70",$0.00,$0.00,$0.00,$0.00,$0.00
2053-2078,SUP,Custom 27803010,,2053-2078  -  SHELL ACETAB CLSHOLE HYDRXAPT SECFIT X,"$4,190.88",$0.00,"$4,190.88",$0.00,"$2,991.03",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,190.88",$0.00,"$2,095.44","$3,319.18","$3,352.70",$0.00,$0.00,$0.00,$0.00,$0.00
2053-2080,SUP,Custom 27803010,,2053-2080  -  SHELL ACETAB CLSHOLE HYDRXAPT SECFIT X,"$4,190.88",$0.00,"$4,190.88",$0.00,"$2,991.03",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,190.88",$0.00,"$2,095.44","$3,319.18","$3,352.70",$0.00,$0.00,$0.00,$0.00,$0.00
2053-3048,SUP,Custom 27803010,,2053-3048  -  SHELL ACETAB 48MM HIP NO DOME HOLE HYDRXAPT SECFIT X,"$4,423.25",$0.00,"$4,423.25",$0.00,"$3,156.87",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,423.25",$0.00,"$2,211.63","$3,503.21","$3,538.60",$0.00,$0.00,$0.00,$0.00,$0.00
2053-3050,SUP,Custom 27803010,,2053-3050  -  SHELL ACETAB 50MM HIP NO DOME HOLE HYDRXAPT SECFIT X,"$4,423.25",$0.00,"$4,423.25",$0.00,"$3,156.87",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,423.25",$0.00,"$2,211.63","$3,503.21","$3,538.60",$0.00,$0.00,$0.00,$0.00,$0.00
2053-3052,SUP,Custom 27803010,,2053-3052  -  SHELL ACETAB 52MM HIP NO DOME HOLE HYDRXAPT SECFIT X,"$4,423.25",$0.00,"$4,423.25",$0.00,"$3,156.87",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,423.25",$0.00,"$2,211.63","$3,503.21","$3,538.60",$0.00,$0.00,$0.00,$0.00,$0.00
2053-3054,SUP,Custom 27803010,,2053-3054  -  SHELL ACETAB 54MM HIP NO DOME HOLE HYDRXAPT SECFIT X,"$4,423.25",$0.00,"$4,423.25",$0.00,"$3,156.87",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,423.25",$0.00,"$2,211.63","$3,503.21","$3,538.60",$0.00,$0.00,$0.00,$0.00,$0.00
2053-3056,SUP,Custom 27803010,,2053-3056  -  SHELL ACETAB 56MM HIP NO DOME HOLE HYDRXAPT SECFIT X,"$4,423.25",$0.00,"$4,423.25",$0.00,"$3,156.87",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,423.25",$0.00,"$2,211.63","$3,503.21","$3,538.60",$0.00,$0.00,$0.00,$0.00,$0.00
2053-3058,SUP,Custom 27803010,,2053-3058  -  SHELL ACETAB 58MM HIP NO DOME HOLE HYDRXAPT SECFIT X,"$4,423.25",$0.00,"$4,423.25",$0.00,"$3,156.87",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,423.25",$0.00,"$2,211.63","$3,503.21","$3,538.60",$0.00,$0.00,$0.00,$0.00,$0.00
2053-3060,SUP,Custom 27803010,,2053-3060  -  SHELL ACETAB 60MM HIP NO DOME HOLE HYDRXAPT SECFIT X,"$4,423.25",$0.00,"$4,423.25",$0.00,"$3,156.87",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,423.25",$0.00,"$2,211.63","$3,503.21","$3,538.60",$0.00,$0.00,$0.00,$0.00,$0.00
2053-3062,SUP,Custom 27803010,,2053-3062  -  SHELL ACETAB 62MM HIP NO DOME HOLE HYDRXAPT SECFIT X,"$4,423.25",$0.00,"$4,423.25",$0.00,"$3,156.87",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,423.25",$0.00,"$2,211.63","$3,503.21","$3,538.60",$0.00,$0.00,$0.00,$0.00,$0.00
2053-3064,SUP,Custom 27803010,,2053-3064  -  SHELL ACETAB 64MM HIP NO DOME HOLE HYDRXAPT SECFIT X,"$4,423.25",$0.00,"$4,423.25",$0.00,"$3,156.87",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,423.25",$0.00,"$2,211.63","$3,503.21","$3,538.60",$0.00,$0.00,$0.00,$0.00,$0.00
2053-3066,SUP,Custom 27803010,,2053-3066  -  SHELL ACETAB 66MM HIP NO DOME HOLE HYDRXAPT SECFIT X,"$4,423.25",$0.00,"$4,423.25",$0.00,"$3,156.87",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,423.25",$0.00,"$2,211.63","$3,503.21","$3,538.60",$0.00,$0.00,$0.00,$0.00,$0.00
2053-3068,SUP,Custom 27803010,,2053-3068  -  SHELL ACETAB 68MM HIP NO DOME HOLE HYDRXAPT SECFIT X,"$4,423.25",$0.00,"$4,423.25",$0.00,"$3,156.87",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,423.25",$0.00,"$2,211.63","$3,503.21","$3,538.60",$0.00,$0.00,$0.00,$0.00,$0.00
2053-3070,SUP,Custom 27803010,,2053-3070  -  SHELL ACETAB 70MM HIP NO DOME HOLE HYDRXAPT SECFIT X,"$4,423.25",$0.00,"$4,423.25",$0.00,"$3,156.87",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,423.25",$0.00,"$2,211.63","$3,503.21","$3,538.60",$0.00,$0.00,$0.00,$0.00,$0.00
2053-3072,SUP,Custom 27803010,,2053-3072  -  SHELL ACETAB 72MM HIP NO DOME HOLE HYDRXAPT SECFIT X,"$4,423.25",$0.00,"$4,423.25",$0.00,"$3,156.87",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,423.25",$0.00,"$2,211.63","$3,503.21","$3,538.60",$0.00,$0.00,$0.00,$0.00,$0.00
2053-3074,SUP,Custom 27803010,,2053-3074  -  SHELL ACETAB 74MM HIP NO DOME HOLE HYDRXAPT SECFIT X,"$4,423.25",$0.00,"$4,423.25",$0.00,"$3,156.87",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,423.25",$0.00,"$2,211.63","$3,503.21","$3,538.60",$0.00,$0.00,$0.00,$0.00,$0.00
2053-3076,SUP,Custom 27803010,,2053-3076  -  SHELL ACETAB 76MM HIP NO DOME HOLE HYDRXAPT SECFIT X,"$4,423.25",$0.00,"$4,423.25",$0.00,"$3,156.87",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,423.25",$0.00,"$2,211.63","$3,503.21","$3,538.60",$0.00,$0.00,$0.00,$0.00,$0.00
2053-3078,SUP,Custom 27803010,,2053-3078  -  SHELL ACETAB 78MM HIP NO DOME HOLE HYDRXAPT SECFIT X,"$4,423.25",$0.00,"$4,423.25",$0.00,"$3,156.87",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,423.25",$0.00,"$2,211.63","$3,503.21","$3,538.60",$0.00,$0.00,$0.00,$0.00,$0.00
2053-3080,SUP,Custom 27803010,,2053-3080  -  SHELL ACETAB 80MM HIP NO DOME HOLE HYDRXAPT SECFIT X,"$4,423.25",$0.00,"$4,423.25",$0.00,"$3,156.87",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,423.25",$0.00,"$2,211.63","$3,503.21","$3,538.60",$0.00,$0.00,$0.00,$0.00,$0.00
2060-0000,SUP,Custom 27803010,,2060-0000  -  PLUG DOME HOLE ACETAB DOME,$127.00,$0.00,$127.00,$0.00,$90.64,$0.00,$0.00,$0.00,$0.00,$0.00,$127.00,$0.00,$63.50,$100.58,$101.60,$0.00,$0.00,$0.00,$0.00,$0.00
2060-0000-1,SUP,Custom 27803010,,2060-0000-1  -  PLUG DOME HL ACTB,$112.50,$0.00,$112.50,$0.00,$80.29,$0.00,$0.00,$0.00,$0.00,$0.00,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$0.00,$0.00,$0.00,$0.00
2078-1330S,SUP,HCPCS C1713,,2078-1330S  -  NAIL 280MM HIP RIGHT GAMMA3 IM R2 LNG ORTHNX,"$2,090.00",$0.00,"$2,090.00",$940.50,"$1,491.63",$0.00,$360.10,$0.00,$0.00,$365.94,"$2,090.00",$0.00,"$1,045.00","$1,655.28","$1,672.00",$0.00,$327.09,$0.00,$332.73,$0.00
2078-1530S,SUP,HCPCS C1713,,2078-1530S  -  NAIL 280MM HIP LEFT GAMMA3 IM R2 LNG STRL STSCR,"$2,090.00",$0.00,"$2,090.00",$940.50,"$1,491.63",$0.00,$360.10,$0.00,$0.00,$365.94,"$2,090.00",$0.00,"$1,045.00","$1,655.28","$1,672.00",$0.00,$327.09,$0.00,$332.73,$0.00
207-G,SUP,Custom 27203010,,REMOVER STAIN ERANDO-SOL 1 GAL,$194.18,$0.00,$194.18,$0.00,$138.58,$0.00,$0.00,$0.00,$0.00,$0.00,$194.18,$0.00,$97.09,$153.79,$155.34,$0.00,$0.00,$0.00,$0.00,$0.00
2080-0015,SUP,HCPCS C1713,,2080-0015  -  SCREW BN 6.5MM 15MM TX ACTB CANC TRITANIUM MLHL SHL,$285.00,$0.00,$285.00,$128.25,$203.40,$0.00,$49.10,$0.00,$0.00,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
2080-0020,SUP,HCPCS C1713,,2080-0020  -  SCREW BN 6.5MM 20MM TX ACTB CANC TRITANIUM MLHL SHL,$285.00,$0.00,$285.00,$128.25,$203.40,$0.00,$49.10,$0.00,$0.00,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
2080-0025,SUP,HCPCS C1713,,2080-0025  -  SCREW BN 6.5MM 25MM TX ACTB CANC TRITANIUM MLHL SHL,$285.00,$0.00,$285.00,$128.25,$203.40,$0.00,$49.10,$0.00,$0.00,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
2080-0030,SUP,HCPCS C1713,,2080-0030  -  SCREW BN 6.5MM 30MM TX ACTB CANC TRITANIUM MLHL SHL,$285.00,$0.00,$285.00,$128.25,$203.40,$0.00,$49.10,$0.00,$0.00,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
2080-0035,SUP,HCPCS C1713,,2080-0035  -  SCREW BN 6.5MM 35MM TX ACTB CANC TRITANIUM MLHL SHL,$285.00,$0.00,$285.00,$128.25,$203.40,$0.00,$49.10,$0.00,$0.00,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
2080-0040,SUP,HCPCS C1713,,2080-0040  -  SCREW BN 6.5MM 40MM TX ACTB CANC TRITANIUM MLHL SHL,$285.00,$0.00,$285.00,$128.25,$203.40,$0.00,$49.10,$0.00,$0.00,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
2080-0045,SUP,HCPCS C1713,,2080-0045  -  SCREW BN 6.5MM 45MM TX ACTB CANC TRITANIUM MLHL SHL,$285.00,$0.00,$285.00,$128.25,$203.40,$0.00,$49.10,$0.00,$0.00,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
2080-0050,SUP,HCPCS C1713,,2080-0050  -  SCREW ACETAB 6.5MM 50MM GAP HIP CANCELLOUS,$285.00,$0.00,$285.00,$128.25,$203.40,$0.00,$49.10,$0.00,$0.00,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
2080-0055,SUP,HCPCS C1713,,2080-0055  -  SCREW ACETAB 6.5MM 55MM PLATE TORX GAP II CANCELLOUS,$285.00,$0.00,$285.00,$128.25,$203.40,$0.00,$49.10,$0.00,$0.00,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
2080-0060,SUP,HCPCS C1713,,2080-0060  -  SCREW ACETAB 6.5MM 60MM GAP II HIP STERILE,$285.00,$0.00,$285.00,$128.25,$203.40,$0.00,$49.10,$0.00,$0.00,$49.90,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$44.60,$0.00,$45.37,$0.00
2080-1125S,SUP,HCPCS C1713,,2080-1125S  -  NAIL 300MM HIP RIGHT GAMMA3 IM R2 LNG ORTHNX,"$2,908.13",$0.00,"$2,908.13","$1,308.66","$2,075.53",$0.00,$501.06,$0.00,$0.00,$509.19,"$2,908.13",$0.00,"$1,454.06","$2,303.24","$2,326.50",$0.00,$455.12,$0.00,$462.97,$0.00
2080-1130S,SUP,HCPCS C1713,,2080-1130S  -  NAIL 11MM 30CM LEFT FEM GAMA IM 130D LNG TI STRL,"$2,908.13",$0.00,"$2,908.13","$1,308.66","$2,075.53",$0.00,$501.06,$0.00,$0.00,$509.19,"$2,908.13",$0.00,"$1,454.06","$2,303.24","$2,326.50",$0.00,$455.12,$0.00,$462.97,$0.00
2080-1135S,SUP,HCPCS C1713,,2080-1135S  -  NAIL 11MM 300MM HIP LEFT GAMMA3 IM 135D LNG,"$2,908.13",$0.00,"$2,908.13","$1,308.66","$2,075.53",$0.00,$501.06,$0.00,$0.00,$509.19,"$2,908.13",$0.00,"$1,454.06","$2,303.24","$2,326.50",$0.00,$455.12,$0.00,$462.97,$0.00
2080-1330S,SUP,HCPCS C1713,,2080-1330S  -  NAIL 300MM HIP GAMMA3 IM R2 LNG ORTHNX,"$2,908.13",$0.00,"$2,908.13","$1,308.66","$2,075.53",$0.00,$501.06,$0.00,$0.00,$509.19,"$2,908.13",$0.00,"$1,454.06","$2,303.24","$2,326.50",$0.00,$455.12,$0.00,$462.97,$0.00
2082-0048L,SUP,Custom 27803010,,2082-0048L  -  SHELL ACETAB 48MM 45MM RSTOR GAP II TITANIUM HIP LEFT,"$6,930.00",$0.00,"$6,930.00",$0.00,"$4,945.94",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,930.00",$0.00,"$3,465.00","$5,488.56","$5,544.00",$0.00,$0.00,$0.00,$0.00,$0.00
2082-0048R,SUP,Custom 27803010,,2082-0048R  -  SHELL ACETAB 48MM RSTOR GAP II TITANIUM RIGHT HIP,"$6,930.00",$0.00,"$6,930.00",$0.00,"$4,945.94",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,930.00",$0.00,"$3,465.00","$5,488.56","$5,544.00",$0.00,$0.00,$0.00,$0.00,$0.00
2082-0052L,SUP,Custom 27803010,,2082-0052L  -  SHELL ACETAB 52MM RSTOR GAP II TITANIUM LEFT HIP,"$6,930.00",$0.00,"$6,930.00",$0.00,"$4,945.94",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,930.00",$0.00,"$3,465.00","$5,488.56","$5,544.00",$0.00,$0.00,$0.00,$0.00,$0.00
2082-0052R,SUP,Custom 27803010,,2082-0052R  -  SHELL ACETAB 52MM RSTOR GAP II TITANIUM RIGHT HIP,"$6,930.00",$0.00,"$6,930.00",$0.00,"$4,945.94",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,930.00",$0.00,"$3,465.00","$5,488.56","$5,544.00",$0.00,$0.00,$0.00,$0.00,$0.00
2082-0056L,SUP,Custom 27803010,,2082-0056L  -  SHELL ACETAB 56MM 53MM RSTOR GAP II TITANIUM HIP LEFT,"$6,930.00",$0.00,"$6,930.00",$0.00,"$4,945.94",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,930.00",$0.00,"$3,465.00","$5,488.56","$5,544.00",$0.00,$0.00,$0.00,$0.00,$0.00
2082-0056R,SUP,Custom 27803010,,2082-0056R  -  SHELL ACETAB 56MM RSTOR GAP II TITANIUM RIGHT HIP,"$6,930.00",$0.00,"$6,930.00",$0.00,"$4,945.94",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,930.00",$0.00,"$3,465.00","$5,488.56","$5,544.00",$0.00,$0.00,$0.00,$0.00,$0.00
2082-0060L,SUP,Custom 27803010,,2082-0060L  -  SHELL ACETAB 60MM 56MM RSTOR GAP II TITANIUM HIP LEFT,"$6,930.00",$0.00,"$6,930.00",$0.00,"$4,945.94",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,930.00",$0.00,"$3,465.00","$5,488.56","$5,544.00",$0.00,$0.00,$0.00,$0.00,$0.00
2082-0060R,SUP,Custom 27803010,,2082-0060R  -  SHELL ACETAB 60MM RSTOR GAP II TITANIUM RIGHT HIP,"$6,930.00",$0.00,"$6,930.00",$0.00,"$4,945.94",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,930.00",$0.00,"$3,465.00","$5,488.56","$5,544.00",$0.00,$0.00,$0.00,$0.00,$0.00
2082-0064L,SUP,Custom 27803010,,2082-0064L  -  SHELL ACETAB 64MM 61MM RSTOR GAP II TITANIUM HIP LEFT,"$6,930.00",$0.00,"$6,930.00",$0.00,"$4,945.94",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,930.00",$0.00,"$3,465.00","$5,488.56","$5,544.00",$0.00,$0.00,$0.00,$0.00,$0.00
2082-0064R,SUP,Custom 27803010,,2082-0064R  -  SHELL ACETAB 64MM RSTOR GAP II TITANIUM RIGHT HIP,"$6,930.00",$0.00,"$6,930.00",$0.00,"$4,945.94",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,930.00",$0.00,"$3,465.00","$5,488.56","$5,544.00",$0.00,$0.00,$0.00,$0.00,$0.00
2082-0068L,SUP,Custom 27803010,,2082-0068L  -  SHELL ACETAB 68MM 64MM RSTOR GAP II TITANIUM HIP LEFT,"$6,930.00",$0.00,"$6,930.00",$0.00,"$4,945.94",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,930.00",$0.00,"$3,465.00","$5,488.56","$5,544.00",$0.00,$0.00,$0.00,$0.00,$0.00
2082-0068R,SUP,Custom 27803010,,2082-0068R  -  SHELL ACETAB 68MM RSTOR GAP II TITANIUM RIGHT HIP,"$6,930.00",$0.00,"$6,930.00",$0.00,"$4,945.94",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,930.00",$0.00,"$3,465.00","$5,488.56","$5,544.00",$0.00,$0.00,$0.00,$0.00,$0.00
2082-0072L,SUP,Custom 27803010,,2082-0072L  -  SHELL ACETAB 72MM 69MM RSTOR GAP II TITANIUM HIP LEFT,"$6,930.00",$0.00,"$6,930.00",$0.00,"$4,945.94",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,930.00",$0.00,"$3,465.00","$5,488.56","$5,544.00",$0.00,$0.00,$0.00,$0.00,$0.00
2082-0072R,SUP,Custom 27803010,,2082-0072R  -  SHELL ACETAB 72MM RSTOR GAP II TITANIUM RIGHT HIP,"$6,930.00",$0.00,"$6,930.00",$0.00,"$4,945.94",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,930.00",$0.00,"$3,465.00","$5,488.56","$5,544.00",$0.00,$0.00,$0.00,$0.00,$0.00
2082-1125S,SUP,HCPCS C1713,,2082-1125S  -  NAIL 11MM 320MM LEFT GAMA IM LNG 125D LCK SCR STRL,"$2,908.13",$0.00,"$2,908.13","$1,308.66","$2,075.53",$0.00,$501.06,$0.00,$0.00,$509.19,"$2,908.13",$0.00,"$1,454.06","$2,303.24","$2,326.50",$0.00,$455.12,$0.00,$462.97,$0.00
2082-1130S,SUP,HCPCS C1713,,2082-1130S  -  NAIL 11MM 32CM LEFT FEM GAMA IM 130D LNG TI STRL,"$2,908.13",$0.00,"$2,908.13","$1,308.66","$2,075.53",$0.00,$501.06,$0.00,$0.00,$509.19,"$2,908.13",$0.00,"$1,454.06","$2,303.24","$2,326.50",$0.00,$455.12,$0.00,$462.97,$0.00
2082-1135S,SUP,HCPCS C1713,,2082-1135S  -  NAIL 11MM 32CM LEFT HIP GAMA IM 135D LNG LCK ORTHNX STRL,"$2,908.13",$0.00,"$2,908.13","$1,308.66","$2,075.53",$0.00,$501.06,$0.00,$0.00,$509.19,"$2,908.13",$0.00,"$1,454.06","$2,303.24","$2,326.50",$0.00,$455.12,$0.00,$462.97,$0.00
2082-1330S,SUP,HCPCS C1713,,2082-1330S  -  NAIL 13MM 320MM LEFT GAMA IM LNG 130D LCK SCR STRL,"$2,908.13",$0.00,"$2,908.13","$1,308.66","$2,075.53",$0.00,$501.06,$0.00,$0.00,$509.19,"$2,908.13",$0.00,"$1,454.06","$2,303.24","$2,326.50",$0.00,$455.12,$0.00,$462.97,$0.00
2083-0048,SUP,Custom 27803010,,2083-0048  -  SHELL ACETAB 48MM RING GAP OMNIFIT OSTEOLOCK RSTOR SECFIT,"$5,675.00",$0.00,"$5,675.00",$0.00,"$4,050.25",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,675.00",$0.00,"$2,837.50","$4,494.60","$4,540.00",$0.00,$0.00,$0.00,$0.00,$0.00
2083-0052,SUP,Custom 27803010,,2083-0052  -  RING ACETAB 52MM RSTOR GAP TITANIUM HIP,"$5,675.00",$0.00,"$5,675.00",$0.00,"$4,050.25",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,675.00",$0.00,"$2,837.50","$4,494.60","$4,540.00",$0.00,$0.00,$0.00,$0.00,$0.00
2083-0056,SUP,Custom 27803010,,2083-0056  -  RING ACETAB 56MM RSTOR GAP II TITANIUM HIP,"$5,675.00",$0.00,"$5,675.00",$0.00,"$4,050.25",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,675.00",$0.00,"$2,837.50","$4,494.60","$4,540.00",$0.00,$0.00,$0.00,$0.00,$0.00
2083-0060,SUP,Custom 27803010,,2083-0060  -  RING ACETAB 60MM RSTOR GAP II TITANIUM HIP,"$5,675.00",$0.00,"$5,675.00",$0.00,"$4,050.25",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,675.00",$0.00,"$2,837.50","$4,494.60","$4,540.00",$0.00,$0.00,$0.00,$0.00,$0.00
2083-0064,SUP,Custom 27803010,,2083-0064  -  RING ACETAB 64MM RSTOR GAP II TITANIUM HIP,"$5,675.00",$0.00,"$5,675.00",$0.00,"$4,050.25",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,675.00",$0.00,"$2,837.50","$4,494.60","$4,540.00",$0.00,$0.00,$0.00,$0.00,$0.00
2083-0068,SUP,Custom 27803010,,2083-0068  -  SHELL ACETAB 68MM RING GAP OMNIFIT OSTEOLOCK RSTOR SECFIT,"$5,675.00",$0.00,"$5,675.00",$0.00,"$4,050.25",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,675.00",$0.00,"$2,837.50","$4,494.60","$4,540.00",$0.00,$0.00,$0.00,$0.00,$0.00
2083-0072,SUP,Custom 27803010,,2083-0072  -  RING ACETAB 72MM RSTOR GAP II TITANIUM HIP,"$5,675.00",$0.00,"$5,675.00",$0.00,"$4,050.25",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,675.00",$0.00,"$2,837.50","$4,494.60","$4,540.00",$0.00,$0.00,$0.00,$0.00,$0.00
2084-1125S,SUP,HCPCS C1713,,2084-1125S  -  NAIL 11MM 34CM LEFT HIP GAMA IM 125D LNG LCK ORTHNX STRL,"$2,908.13",$0.00,"$2,908.13","$1,308.66","$2,075.53",$0.00,$501.06,$0.00,$0.00,$509.19,"$2,908.13",$0.00,"$1,454.06","$2,303.24","$2,326.50",$0.00,$455.12,$0.00,$462.97,$0.00
2084-1130S,SUP,HCPCS C1713,,2084-1130S  -  NAIL 11MM 34CM LEFT FEM GAMA IM 130D LNG LCK TI STRL,"$2,908.13",$0.00,"$2,908.13","$1,308.66","$2,075.53",$0.00,$501.06,$0.00,$0.00,$509.19,"$2,908.13",$0.00,"$1,454.06","$2,303.24","$2,326.50",$0.00,$455.12,$0.00,$462.97,$0.00
2084-1135S,SUP,HCPCS C1713,,2084-1135S  -  NAIL 11MM 34CM LEFT ORTH GAMA IM 135D LNG STRL,"$2,908.13",$0.00,"$2,908.13","$1,308.66","$2,075.53",$0.00,$501.06,$0.00,$0.00,$509.19,"$2,908.13",$0.00,"$1,454.06","$2,303.24","$2,326.50",$0.00,$455.12,$0.00,$462.97,$0.00
2084-1330S,SUP,HCPCS C1713,,2084-1330S  -  NAIL 13MM 340MM HIP LEFT GAMMA3 IM 130D LNG,"$2,908.13",$0.00,"$2,908.13","$1,308.66","$2,075.53",$0.00,$501.06,$0.00,$0.00,$509.19,"$2,908.13",$0.00,"$1,454.06","$2,303.24","$2,326.50",$0.00,$455.12,$0.00,$462.97,$0.00
2086-1125S,SUP,HCPCS C1713,,2086-1125S  -  NAIL 11MM 36CM HIP LEFT FEM GAMMA3 IM 125D LNG TI STRL,"$2,908.13",$0.00,"$2,908.13","$1,308.66","$2,075.53",$0.00,$501.06,$0.00,$0.00,$509.19,"$2,908.13",$0.00,"$1,454.06","$2,303.24","$2,326.50",$0.00,$455.12,$0.00,$462.97,$0.00
2086-1130S,SUP,HCPCS C1713,,2086-1130S  -  NAIL 11MM 36CM LEFT FEM GAMA IM 130D LNG LCK TI STRL,"$2,908.13",$0.00,"$2,908.13","$1,308.66","$2,075.53",$0.00,$501.06,$0.00,$0.00,$509.19,"$2,908.13",$0.00,"$1,454.06","$2,303.24","$2,326.50",$0.00,$455.12,$0.00,$462.97,$0.00
2086-1135S,SUP,HCPCS C1713,,2086-1135S  -  NAIL 11MM 36CM LEFT ORTH GAMA IM 135D LNG STRL,"$2,908.13",$0.00,"$2,908.13","$1,308.66","$2,075.53",$0.00,$501.06,$0.00,$0.00,$509.19,"$2,908.13",$0.00,"$1,454.06","$2,303.24","$2,326.50",$0.00,$455.12,$0.00,$462.97,$0.00
2086-1330S,SUP,HCPCS C1713,,2086-1330S  -  NAIL 13MM 360MM LEFT GAMA IM LNG 130D LCK SCR STRL,"$2,908.13",$0.00,"$2,908.13","$1,308.66","$2,075.53",$0.00,$501.06,$0.00,$0.00,$509.19,"$2,908.13",$0.00,"$1,454.06","$2,303.24","$2,326.50",$0.00,$455.12,$0.00,$462.97,$0.00
2088-1125S,SUP,HCPCS C1713,,2088-1125S  -  NAIL 11MM 380MM HIP LEFT GAMMA3 IM 125D LNG,"$2,908.13",$0.00,"$2,908.13","$1,308.66","$2,075.53",$0.00,$501.06,$0.00,$0.00,$509.19,"$2,908.13",$0.00,"$1,454.06","$2,303.24","$2,326.50",$0.00,$455.12,$0.00,$462.97,$0.00
2088-1130S,SUP,HCPCS C1713,,2088-1130S  -  NAIL 11MM 38CM LEFT FEM GAMA IM 130D LNG LCK TI STRL,"$2,908.13",$0.00,"$2,908.13","$1,308.66","$2,075.53",$0.00,$501.06,$0.00,$0.00,$509.19,"$2,908.13",$0.00,"$1,454.06","$2,303.24","$2,326.50",$0.00,$455.12,$0.00,$462.97,$0.00
2088-1135S,SUP,HCPCS C1713,,2088-1135S  -  NAIL 11MM 38CM LEFT HIP GAMA IM 135D LNG LCK ORTHNX STRL,"$2,908.13",$0.00,"$2,908.13","$1,308.66","$2,075.53",$0.00,$501.06,$0.00,$0.00,$509.19,"$2,908.13",$0.00,"$1,454.06","$2,303.24","$2,326.50",$0.00,$455.12,$0.00,$462.97,$0.00
2088-1330S,SUP,HCPCS C1713,,2088-1330S  -  NAIL 13MM 380MM HIP LEFT GAMMA3 IM 130D LNG,"$2,908.13",$0.00,"$2,908.13","$1,308.66","$2,075.53",$0.00,$501.06,$0.00,$0.00,$509.19,"$2,908.13",$0.00,"$1,454.06","$2,303.24","$2,326.50",$0.00,$455.12,$0.00,$462.97,$0.00
2088TC/100,SUP,HCPCS C1898,,2088TC/100  -  LEAD PCNG HLX 6FR 100CM TNDRL STS IS 1 BP CNCT RING ELTRD,"$1,125.00",$0.00,"$1,125.00",$506.25,$802.91,$0.00,$193.83,$0.00,$0.00,$196.98,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$176.06,$0.00,$179.10,$0.00
2088TC/46,SUP,HCPCS C1898,,2088TC/46  -  LEAD PCNG HLX 6FR 46CM TNDRL STS IS-1 CNCT BP ACTFX XTD STRD,"$1,125.00",$0.00,"$1,125.00",$506.25,$802.91,$0.00,$193.83,$0.00,$0.00,$196.98,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$176.06,$0.00,$179.10,$0.00
2088TC/52,SUP,HCPCS C1898,,2088TC/52  -  LEAD PCNG 6FR 52CM TNDRL STS IS-1 BP CNCT ACT RTRCT XTD HLX,"$1,125.00",$0.00,"$1,125.00",$506.25,$802.91,$0.00,$193.83,$0.00,$0.00,$196.98,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$176.06,$0.00,$179.10,$0.00
2088TC/58,SUP,HCPCS C1898,,2088TC/58  -  LEAD PCNG HLX 6FR 58CM TNDRL STS IS 1 CNCT ACTFX BP SFT STRD,"$1,125.00",$0.00,"$1,125.00",$506.25,$802.91,$0.00,$193.83,$0.00,$0.00,$196.98,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$176.06,$0.00,$179.10,$0.00
2088TC/65,SUP,HCPCS C1898,,2088TC/65  -  TENDRIL STS 2088TC/65,"$1,125.00",$0.00,"$1,125.00",$506.25,$802.91,$0.00,$193.83,$0.00,$0.00,$196.98,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$176.06,$0.00,$179.10,$0.00
209.740S,SUP,HCPCS C1713,,209.740S  -  SCREW BN FT 7.3MM 140MM STRL CNN SS,$562.28,$0.00,$562.28,$253.02,$401.30,$0.00,$94.06,$0.00,$0.00,$98.45,$562.28,$0.00,$281.14,$445.33,$449.82,$0.00,$85.43,$0.00,$89.51,$0.00
2090-1125S,SUP,HCPCS C1713,,2090-1125S  -  NAIL 400MM HIP RIGHT GAMMA3 IM R2 LNG ORTHNX,"$2,908.13",$0.00,"$2,908.13","$1,308.66","$2,075.53",$0.00,$501.06,$0.00,$0.00,$509.19,"$2,908.13",$0.00,"$1,454.06","$2,303.24","$2,326.50",$0.00,$455.12,$0.00,$462.97,$0.00
2090-1130S,SUP,HCPCS C1713,,2090-1130S  -  NAIL 11MM 40CM LEFT FEM GAMA IM 130D LNG LCK TI STRL,"$2,908.13",$0.00,"$2,908.13","$1,308.66","$2,075.53",$0.00,$501.06,$0.00,$0.00,$509.19,"$2,908.13",$0.00,"$1,454.06","$2,303.24","$2,326.50",$0.00,$455.12,$0.00,$462.97,$0.00
2090-1135S,SUP,HCPCS C1713,,2090-1135S  -  NAIL 11MM 40CM LEFT HIP GAMA IM 135D LNG LCK ORTHNX STRL,"$2,908.13",$0.00,"$2,908.13","$1,308.66","$2,075.53",$0.00,$501.06,$0.00,$0.00,$509.19,"$2,908.13",$0.00,"$1,454.06","$2,303.24","$2,326.50",$0.00,$455.12,$0.00,$462.97,$0.00
2090-1330S,SUP,HCPCS C1713,,2090-1330S  -  NAIL 13MM 400MM HIP LEFT GAMMA3 IM 130D LNG,"$2,908.13",$0.00,"$2,908.13","$1,308.66","$2,075.53",$0.00,$501.06,$0.00,$0.00,$509.19,"$2,908.13",$0.00,"$1,454.06","$2,303.24","$2,326.50",$0.00,$455.12,$0.00,$462.97,$0.00
2092-1125S,SUP,HCPCS C1713,,2092-1125S  -  NAIL 11MM 420MM HIP LEFT GAMMA3 IM LNG 125D,"$2,908.13",$0.00,"$2,908.13","$1,308.66","$2,075.53",$0.00,$501.06,$0.00,$0.00,$509.19,"$2,908.13",$0.00,"$1,454.06","$2,303.24","$2,326.50",$0.00,$455.12,$0.00,$462.97,$0.00
2092-1130S,SUP,HCPCS C1713,,2092-1130S  -  NAIL 11MM 42CM LEFT FEM GAMA IM 130D LNG LCK TI STRL,"$2,908.13",$0.00,"$2,908.13","$1,308.66","$2,075.53",$0.00,$501.06,$0.00,$0.00,$509.19,"$2,908.13",$0.00,"$1,454.06","$2,303.24","$2,326.50",$0.00,$455.12,$0.00,$462.97,$0.00
2092-1135S,SUP,HCPCS C1713,,2092-1135S  -  NAIL 11MM 42CM LEFT HIP GAMA IM 135D LNG LCK ORTHNX STRL,"$2,908.13",$0.00,"$2,908.13","$1,308.66","$2,075.53",$0.00,$501.06,$0.00,$0.00,$509.19,"$2,908.13",$0.00,"$1,454.06","$2,303.24","$2,326.50",$0.00,$455.12,$0.00,$462.97,$0.00
2092-1330S,SUP,HCPCS C1713,,2092-1330S  -  NAIL 13MM 42CM LEFT HIP GAMA IM 130D LNG LCK ORTHNX STRL,"$2,908.13",$0.00,"$2,908.13","$1,308.66","$2,075.53",$0.00,$501.06,$0.00,$0.00,$509.19,"$2,908.13",$0.00,"$1,454.06","$2,303.24","$2,326.50",$0.00,$455.12,$0.00,$462.97,$0.00
2092-1530S,SUP,HCPCS C1713,,2092-1530S  -  NAIL 15MM 420MM HIP LEFT GAMMA3 IM 130D LNG,"$2,908.13",$0.00,"$2,908.13","$1,308.66","$2,075.53",$0.00,$501.06,$0.00,$0.00,$509.19,"$2,908.13",$0.00,"$1,454.06","$2,303.24","$2,326.50",$0.00,$455.12,$0.00,$462.97,$0.00
2092-3-963,SUP,HCPCS C1713,,2092-3-963  -  PIN HALF 240MM 5MM APEX SLFDRILL 50MM,$122.38,$0.00,$122.38,$55.07,$87.34,$0.00,$21.08,$0.00,$0.00,$21.43,$122.38,$0.00,$61.19,$96.92,$97.90,$0.00,$19.15,$0.00,$19.48,$0.00
2094-1125S,SUP,HCPCS C1713,,2094-1125S  -  NAIL 11MM 44CM LEFT HIP GAMA IM 125D LNG LCK ORTHNX STRL,"$2,908.13",$0.00,"$2,908.13","$1,308.66","$2,075.53",$0.00,$501.06,$0.00,$0.00,$509.19,"$2,908.13",$0.00,"$1,454.06","$2,303.24","$2,326.50",$0.00,$455.12,$0.00,$462.97,$0.00
2094-1130S,SUP,HCPCS C1713,,2094-1130S  -  NAIL 11MM 44CM LEFT FEM GAMA IM 130D LNG LCK TI STRL,"$2,908.13",$0.00,"$2,908.13","$1,308.66","$2,075.53",$0.00,$501.06,$0.00,$0.00,$509.19,"$2,908.13",$0.00,"$1,454.06","$2,303.24","$2,326.50",$0.00,$455.12,$0.00,$462.97,$0.00
2094-1135S,SUP,HCPCS C1713,,2094-1135S  -  NAIL 11MM 44CM LEFT HIP GAMA IM 135D LNG LCK ORTHNX STRL,"$2,908.13",$0.00,"$2,908.13","$1,308.66","$2,075.53",$0.00,$501.06,$0.00,$0.00,$509.19,"$2,908.13",$0.00,"$1,454.06","$2,303.24","$2,326.50",$0.00,$455.12,$0.00,$462.97,$0.00
2094-1330S,SUP,HCPCS C1713,,2094-1330S  -  NAIL 13MM 440MM HIP LEFT GAMMA3 IM 130D LNG,"$2,908.13",$0.00,"$2,908.13","$1,308.66","$2,075.53",$0.00,$501.06,$0.00,$0.00,$509.19,"$2,908.13",$0.00,"$1,454.06","$2,303.24","$2,326.50",$0.00,$455.12,$0.00,$462.97,$0.00
2099-2250,SUP,Custom 27803010,,2099-2250  -  INSERT ACETAB 50MM 22MM CONSTRAIN HIP,"$6,550.00",$0.00,"$6,550.00",$0.00,"$4,674.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,550.00",$0.00,"$3,275.00","$5,187.60","$5,240.00",$0.00,$0.00,$0.00,$0.00,$0.00
2099-2252,SUP,Custom 27803010,,2099-2252  -  INSERT ACETAB 52MM 22MM CONSTRAIN HIP,"$6,550.00",$0.00,"$6,550.00",$0.00,"$4,674.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,550.00",$0.00,"$3,275.00","$5,187.60","$5,240.00",$0.00,$0.00,$0.00,$0.00,$0.00
2099-2254,SUP,Custom 27803010,,2099-2254  -  INSERT ACETAB 54MM 22MM CONSTRAIN HIP,"$6,550.00",$0.00,"$6,550.00",$0.00,"$4,674.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,550.00",$0.00,"$3,275.00","$5,187.60","$5,240.00",$0.00,$0.00,$0.00,$0.00,$0.00
2099-2256,SUP,Custom 27803010,,2099-2256  -  INSERT ACETAB 56MM 22MM CONSTRAIN HIP,"$6,550.00",$0.00,"$6,550.00",$0.00,"$4,674.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,550.00",$0.00,"$3,275.00","$5,187.60","$5,240.00",$0.00,$0.00,$0.00,$0.00,$0.00
2099-2258,SUP,Custom 27803010,,2099-2258  -  INSERT ACETAB 58MM 22MM CONSTRAIN HIP,"$6,550.00",$0.00,"$6,550.00",$0.00,"$4,674.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,550.00",$0.00,"$3,275.00","$5,187.60","$5,240.00",$0.00,$0.00,$0.00,$0.00,$0.00
2099-2261,SUP,Custom 27803010,,2099-2261  -  INSERT ACETAB 61MM 22MM CONSTRAIN HIP,"$6,550.00",$0.00,"$6,550.00",$0.00,"$4,674.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,550.00",$0.00,"$3,275.00","$5,187.60","$5,240.00",$0.00,$0.00,$0.00,$0.00,$0.00
2099-2266,SUP,Custom 27803010,,2099-2266  -  INSERT ACETAB 66MM 22MM CONSTRAIN HIP,"$6,550.00",$0.00,"$6,550.00",$0.00,"$4,674.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,550.00",$0.00,"$3,275.00","$5,187.60","$5,240.00",$0.00,$0.00,$0.00,$0.00,$0.00
2099-2270,SUP,Custom 27803010,,2099-2270  -  INSERT ACETAB 70MM 22MM CONSTRAIN HIP,"$6,550.00",$0.00,"$6,550.00",$0.00,"$4,674.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,550.00",$0.00,"$3,275.00","$5,187.60","$5,240.00",$0.00,$0.00,$0.00,$0.00,$0.00
2099-2274,SUP,Custom 27803010,,2099-2274  -  INSERT ACETAB 74MM 22MM CONSTRAIN HIP,"$6,550.00",$0.00,"$6,550.00",$0.00,"$4,674.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,550.00",$0.00,"$3,275.00","$5,187.60","$5,240.00",$0.00,$0.00,$0.00,$0.00,$0.00
2099-2656,SUP,Custom 27803010,,2099-2656  -  INSERT ACETAB 56MM 26MM CONSTRAIN HIP,"$6,550.00",$0.00,"$6,550.00",$0.00,"$4,674.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,550.00",$0.00,"$3,275.00","$5,187.60","$5,240.00",$0.00,$0.00,$0.00,$0.00,$0.00
2099-2658,SUP,Custom 27803010,,2099-2658  -  INSERT ACETAB 58MM 26MM CONSTRAIN HIP,"$6,550.00",$0.00,"$6,550.00",$0.00,"$4,674.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,550.00",$0.00,"$3,275.00","$5,187.60","$5,240.00",$0.00,$0.00,$0.00,$0.00,$0.00
2099-2661,SUP,Custom 27803010,,2099-2661  -  INSERT ACETAB 61MM 26MM CONSTRAIN HIP,"$6,550.00",$0.00,"$6,550.00",$0.00,"$4,674.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,550.00",$0.00,"$3,275.00","$5,187.60","$5,240.00",$0.00,$0.00,$0.00,$0.00,$0.00
2099-2666,SUP,Custom 27803010,,2099-2666  -  INSERT ACETAB 66MM 26MM CONSTRAIN HIP,"$6,550.00",$0.00,"$6,550.00",$0.00,"$4,674.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,550.00",$0.00,"$3,275.00","$5,187.60","$5,240.00",$0.00,$0.00,$0.00,$0.00,$0.00
2099-2670,SUP,Custom 27803010,,2099-2670  -  INSERT ACETAB 70MM 26MM CONSTRAIN HIP,"$6,550.00",$0.00,"$6,550.00",$0.00,"$4,674.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,550.00",$0.00,"$3,275.00","$5,187.60","$5,240.00",$0.00,$0.00,$0.00,$0.00,$0.00
2099-2674,SUP,Custom 27803010,,2099-2674  -  INSERT ACETAB 74MM 26MM CONSTRAIN HIP,"$6,550.00",$0.00,"$6,550.00",$0.00,"$4,674.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,550.00",$0.00,"$3,275.00","$5,187.60","$5,240.00",$0.00,$0.00,$0.00,$0.00,$0.00
2099-2858,SUP,Custom 27803010,,2099-2858  -  INSERT ACETAB 58MM 28MM CONSTRAIN HIP,"$6,550.00",$0.00,"$6,550.00",$0.00,"$4,674.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,550.00",$0.00,"$3,275.00","$5,187.60","$5,240.00",$0.00,$0.00,$0.00,$0.00,$0.00
2099-2861,SUP,Custom 27803010,,2099-2861  -  INSERT ACETAB 61MM 28MM CONSTRAIN HIP,"$6,550.00",$0.00,"$6,550.00",$0.00,"$4,674.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,550.00",$0.00,"$3,275.00","$5,187.60","$5,240.00",$0.00,$0.00,$0.00,$0.00,$0.00
2099-2866,SUP,Custom 27803010,,2099-2866  -  INSERT ACETAB 66MM 28MM CONSTRAIN HIP,"$6,550.00",$0.00,"$6,550.00",$0.00,"$4,674.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,550.00",$0.00,"$3,275.00","$5,187.60","$5,240.00",$0.00,$0.00,$0.00,$0.00,$0.00
2099-2870,SUP,Custom 27803010,,2099-2870  -  INSERT ACETAB 70MM 28MM CONSTRAIN HIP,"$6,550.00",$0.00,"$6,550.00",$0.00,"$4,674.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,550.00",$0.00,"$3,275.00","$5,187.60","$5,240.00",$0.00,$0.00,$0.00,$0.00,$0.00
2099-2874,SUP,Custom 27803010,,2099-2874  -  INSERT ACETAB 74MM 28MM CONSTRAIN HIP,"$6,550.00",$0.00,"$6,550.00",$0.00,"$4,674.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,550.00",$0.00,"$3,275.00","$5,187.60","$5,240.00",$0.00,$0.00,$0.00,$0.00,$0.00
21000 A,SUP,Custom 27803010,,21000 A  -  PLATE 18MM TI BONE SPNL,$888.25,$0.00,$888.25,$0.00,$633.94,$0.00,$0.00,$0.00,$0.00,$0.00,$888.25,$0.00,$444.13,$703.49,$710.60,$0.00,$0.00,$0.00,$0.00,$0.00
21000 B,SUP,Custom 27803010,,21000 B  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$997.50,$0.00,$997.50,$0.00,$711.92,$0.00,$0.00,$0.00,$0.00,$0.00,$997.50,$0.00,$498.75,$790.02,$798.00,$0.00,$0.00,$0.00,$0.00,$0.00
21020 A-M,SUP,Custom 27803010,,21020 A-M  -  PLATE 18MM TI BONE SPNL,"$1,037.88",$0.00,"$1,037.88",$0.00,$740.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,037.88",$0.00,$518.94,$822.00,$830.30,$0.00,$0.00,$0.00,$0.00,$0.00
21020 B-M,SUP,Custom 27803010,,21020 B-M  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,037.88",$0.00,"$1,037.88",$0.00,$740.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,037.88",$0.00,$518.94,$822.00,$830.30,$0.00,$0.00,$0.00,$0.00,$0.00
2102-1500,SUP,HCPCS C9359,,2102-1500  -  SUBSTITUTE BNGFT 100X25X4MM VOID FILR FOAM STRIP BIOACTIVE,"$3,857.50",$0.00,"$3,857.50",$0.00,"$2,753.10",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,857.50",$0.00,"$1,928.75","$3,055.14","$3,086.00",$0.00,$0.00,$0.00,$0.00,$0.00
2102-1505,SUP,HCPCS C9359,,2102-1505  -  SUBSTITUTE BNGFT 240X25X4MM VOID FILR FOAM STRIP BIOACTIVE,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2102-1510,SUP,HCPCS C9359,,2102-1510  -  SUBSTITUTE BNGFT 50X25X8MM VOID FILR FOAM STRIP COMPRESSION,"$3,997.00",$0.00,"$3,997.00",$0.00,"$2,852.66",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,997.00",$0.00,"$1,998.50","$3,165.62","$3,197.60",$0.00,$0.00,$0.00,$0.00,$0.00
2102-1520,SUP,HCPCS C9359,,2102-1520  -  SUBSTITUTE BNGFT 25MMX100MMX8MM 100X25X8MM VOID FILR FOAM,"$5,000.00",$0.00,"$5,000.00",$0.00,"$3,568.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2102-1601,SUP,HCPCS C9359,,2102-1601  -  SUBSTITUTE BNGFT FOAM PACK BIOACTIVE VITOSS BTCP COLLAGEN,$300.00,$0.00,$300.00,$0.00,$214.11,$0.00,$0.00,$0.00,$0.00,$0.00,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$0.00,$0.00,$0.00,$0.00
2102-1602,SUP,HCPCS C9359,,2102-1602  -  SUBSTITUTE BNGFT VOID FILR FOAM PACK BIOACTIVE VITOSS BTCP,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
2102-1605,SUP,HCPCS C9359,,2102-1605  -  SUBSTITUTE BNGFT VOID FILR FOAM PACK BIOACTIVE VITOSS BTCP,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2102-1610,SUP,HCPCS C9359,,2102-1610  -  SUBSTITUTE BNGFT VOID FILR FOAM PACK BIOACTIVE VITOSS BTCP,"$2,500.00",$0.00,"$2,500.00",$0.00,"$1,784.25",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2102-1901,SUP,HCPCS C1713,,2102-1901  -  SUBSTITUTE BNGFT BIOMODAL FOAM PACK VITOSS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
2102-1902,SUP,HCPCS C1713,,2102-1902  -  SUBSTITUTE BNGFT BIOMODAL FOAM PACK VITOSS,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
2102-1905,SUP,HCPCS C1713,,2102-1905  -  SUBSTITUTE BNGFT BIMODAL FOAM PACK VITOSS,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
2102-1910,SUP,HCPCS C1713,,2102-1910  -  SUBSTITUTE BNGFT BIOMODAL FOAM PACK VITOSS,"$5,000.00",$0.00,"$5,000.00","$2,250.00","$3,568.50",$0.00,$861.48,$0.00,$0.00,$875.46,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$782.50,$0.00,$796.00,$0.00
2102-2110,SUP,HCPCS C1713,,2102-2110  -  SUBSTITUTE BNGFT VOID FILR PACK BIOACTIVE COMPRESSION,"$6,300.00",$0.00,"$6,300.00","$2,835.00","$4,496.31",$0.00,"$1,085.46",$0.00,$0.00,"$1,103.08","$6,300.00",$0.00,"$3,150.00","$4,989.60","$5,040.00",$0.00,$985.95,$0.00,"$1,002.96",$0.00
2108-110,SUP,Custom 27203010,,BLADE SW W THK SGTL,$174.00,$0.00,$174.00,$0.00,$124.18,$0.00,$0.00,$0.00,$0.00,$0.00,$174.00,$0.00,$87.00,$137.81,$139.20,$0.00,$0.00,$0.00,$0.00,$0.00
2108-110-000,SUP,Custom 27203010,,2108-110-000  -  BLADE SAW THK1.3MM 73MM WIDE 25MM 2 CUT SAGITTAL STAINLESS,$77.25,$0.00,$77.25,$0.00,$55.13,$0.00,$0.00,$0.00,$0.00,$0.00,$77.25,$0.00,$38.63,$61.18,$61.80,$0.00,$0.00,$0.00,$0.00,$0.00
2108-120,SUP,Custom 27203010,,BLADE SW SHRT SGTL THN,$191.40,$0.00,$191.40,$0.00,$136.60,$0.00,$0.00,$0.00,$0.00,$0.00,$191.40,$0.00,$95.70,$151.59,$153.12,$0.00,$0.00,$0.00,$0.00,$0.00
2108-120-000,SUP,Custom 27203010,,2108-120-000  -  BLADE SAW SHORT NARROW THIN 60.5X18.5X.64MM SAGITTAL,$77.25,$0.00,$77.25,$0.00,$55.13,$0.00,$0.00,$0.00,$0.00,$0.00,$77.25,$0.00,$38.63,$61.18,$61.80,$0.00,$0.00,$0.00,$0.00,$0.00
2108-120-006,SUP,Custom 27203010,,2108-120-006  -  BLADE SAW THK.64MM 63X18.5MM SAGITTAL HEAVY DUTY STAINLESS,$77.25,$0.00,$77.25,$0.00,$55.13,$0.00,$0.00,$0.00,$0.00,$0.00,$77.25,$0.00,$38.63,$61.18,$61.80,$0.00,$0.00,$0.00,$0.00,$0.00
2108-131-000,SUP,Custom 27203010,,2108-131-000  -  BLADE SAW THK.6MM 46X17MM SAGITTAL CUT EDGE SAFEDGE,$77.25,$0.00,$77.25,$0.00,$55.13,$0.00,$0.00,$0.00,$0.00,$0.00,$77.25,$0.00,$38.63,$61.18,$61.80,$0.00,$0.00,$0.00,$0.00,$0.00
2108-148,SUP,Custom 27203010,,BLADE SW 34.5X9X.64MM SHRT NAR THN SGTL STRL,$191.40,$0.00,$191.40,$0.00,$136.60,$0.00,$0.00,$0.00,$0.00,$0.00,$191.40,$0.00,$95.70,$151.59,$153.12,$0.00,$0.00,$0.00,$0.00,$0.00
2108-148-000,SUP,Custom 27203010,,2108-148-000  -  BLADE SAW THK.64MM SHORT NARROW THIN 34.5X9MM SAGITTAL,$77.25,$0.00,$77.25,$0.00,$55.13,$0.00,$0.00,$0.00,$0.00,$0.00,$77.25,$0.00,$38.63,$61.18,$61.80,$0.00,$0.00,$0.00,$0.00,$0.00
2108-151,SUP,Custom 27203010,,BLADE SW 85X25.4X1.19MM W THK STANILESS STL SGTL WO OFST,$191.40,$0.00,$191.40,$0.00,$136.60,$0.00,$0.00,$0.00,$0.00,$0.00,$191.40,$0.00,$95.70,$151.59,$153.12,$0.00,$0.00,$0.00,$0.00,$0.00
2108-151-000,SUP,Custom 27203010,,2108-151-000  -  BLADE SAW THK1.19MM WIDE THICK 85X25MM SAGITTAL STAINLESS,$77.25,$0.00,$77.25,$0.00,$55.13,$0.00,$0.00,$0.00,$0.00,$0.00,$77.25,$0.00,$38.63,$61.18,$61.80,$0.00,$0.00,$0.00,$0.00,$0.00
2108-175-000,SUP,Custom 27203010,,2108-175-000  -  BLADE SAW THK1.5MM SHORT NARROW THIN 79.5X25MM SAGITTAL,$77.25,$0.00,$77.25,$0.00,$55.13,$0.00,$0.00,$0.00,$0.00,$0.00,$77.25,$0.00,$38.63,$61.18,$61.80,$0.00,$0.00,$0.00,$0.00,$0.00
2108-182-000,SUP,Custom 27203010,,2108-182-000  -  BLADE SAW LONG THICK 18MM SAGITTAL NO OFFST STAINLESS STEEL,$72.89,$0.00,$72.89,$0.00,$52.02,$0.00,$0.00,$0.00,$0.00,$0.00,$72.89,$0.00,$36.44,$57.73,$58.31,$0.00,$0.00,$0.00,$0.00,$0.00
2108-193-000,SUP,Custom 27203010,,2108-193-000  -  BLADE SAW THK.96MM MEDIUM WIDE 81.5X25MM SAGITTAL STAINLESS,$77.25,$0.00,$77.25,$0.00,$55.13,$0.00,$0.00,$0.00,$0.00,$0.00,$77.25,$0.00,$38.63,$61.18,$61.80,$0.00,$0.00,$0.00,$0.00,$0.00
21-2000-24,SUP,HCPCS C1752,,21-2000-24  -  CATHETER DLYS STRG BLNT 14.7FR 4.9MM 2.6MM 48CM DELTEC,$657.50,$0.00,$657.50,$0.00,$469.26,$0.00,$0.00,$0.00,$0.00,$0.00,$657.50,$0.00,$328.75,$520.74,$526.00,$0.00,$0.00,$0.00,$0.00,$0.00
2120F,SUP,HCPCS C1880,,2120F  -  FILTER CARDIO 7FR 48CM SIM VC SNF/SL FEM DLV KIT NTNL,"$1,937.50",$0.00,"$1,937.50",$871.88,"$1,382.79",$0.00,$333.82,$0.00,$0.00,$339.24,"$1,937.50",$0.00,$968.75,"$1,534.50","$1,550.00",$0.00,$303.22,$0.00,$308.45,$0.00
21-2369,SUP,HCPCS C1751,,21-2369  -  TRAY CATH 9FR 72.5CM 72.5L VENTRA 2 LUM SIL PERC,$387.50,$0.00,$387.50,$174.38,$276.56,$0.00,$66.76,$0.00,$0.00,$67.85,$387.50,$0.00,$193.75,$306.90,$310.00,$0.00,$60.64,$0.00,$61.69,$0.00
21-343,SUP,Custom 27203010,,TIP PIP 1ML MLA 3 TRY AUTOCLAV,$146.65,$0.00,$146.65,$0.00,$104.66,$0.00,$0.00,$0.00,$0.00,$0.00,$146.65,$0.00,$73.33,$116.15,$117.32,$0.00,$0.00,$0.00,$0.00,$0.00
21-4055,SUP,HCPCS C1788,,21-4055  -  TRAY INFS PORT 7.8FR 11.4MM 1MM 76CM 30.5MMX14.7MM PRTACTH,$550.00,$0.00,$550.00,$247.50,$392.54,$0.00,$94.76,$0.00,$0.00,$96.30,$550.00,$0.00,$275.00,$435.60,$440.00,$0.00,$86.08,$0.00,$87.56,$0.00
21-4065-24,SUP,HCPCS C1788,,21-4065-24  -  TRAY INFS PORT 8.5FR STRL PRTACTH II 1 LUM CATHETHER PRTL,$800.00,$0.00,$800.00,$360.00,$570.96,$0.00,$137.84,$0.00,$0.00,$140.07,$800.00,$0.00,$400.00,$633.60,$640.00,$0.00,$125.20,$0.00,$127.36,$0.00
21-4082,SUP,HCPCS C1788,,21-4082  -  PORT-A-CATHETER II,$12.50,$0.00,$12.50,$5.63,$8.92,$0.00,$2.15,$0.00,$0.00,$2.19,$12.50,$0.00,$6.25,$9.90,$10.00,$0.00,$1.96,$0.00,$1.99,$0.00
21-4165-24,SUP,HCPCS C1788,,21-4165-24  -  PROPORT PLASTIC,$12.50,$0.00,$12.50,$5.63,$8.92,$0.00,$2.15,$0.00,$0.00,$2.19,$12.50,$0.00,$6.25,$9.90,$10.00,$0.00,$1.96,$0.00,$1.99,$0.00
21-4483-24,SUP,Custom 27203010,,21-4483-24  -  TRAY INFUS PORT LP 6FR 1.9MM 1MM 76CM 1 LUMEN INTROD NEEDLE,"$1,612.65",$0.00,"$1,612.65",$0.00,"$1,150.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,612.65",$0.00,$806.33,"$1,277.22","$1,290.12",$0.00,$0.00,$0.00,$0.00,$0.00
21-4572,SUP,HCPCS C1788,,DEVICE  PAST-PORT,$12.50,$0.00,$12.50,$5.63,$8.92,$0.00,$2.15,$0.00,$0.00,$2.19,$12.50,$0.00,$6.25,$9.90,$10.00,$0.00,$1.96,$0.00,$1.99,$0.00
21-4572-24,SUP,HCPCS C1788,,21-4572-24  -  KIT INFS PORT 5.8FR PSPRT T2 1 LUM PLFLW CATH INTRO UNAS,$562.50,$0.00,$562.50,$253.13,$401.46,$0.00,$96.92,$0.00,$0.00,$98.49,$562.50,$0.00,$281.25,$445.50,$450.00,$0.00,$88.03,$0.00,$89.55,$0.00
21-4590,SUP,HCPCS C1788,,PASPORT ELITE KIT,$12.50,$0.00,$12.50,$5.63,$8.92,$0.00,$2.15,$0.00,$0.00,$2.19,$12.50,$0.00,$6.25,$9.90,$10.00,$0.00,$1.96,$0.00,$1.99,$0.00
21-8067,SUP,HCPCS C1751,,21-8067  -  KIT INFS PORT LOPRFL 10FR 3.2MM 1.4MM 760MM PCTH2 PLFL 2 LUM,"$1,070.00",$0.00,"$1,070.00",$481.50,$763.66,$0.00,$184.36,$0.00,$0.00,$187.35,"$1,070.00",$0.00,$535.00,$847.44,$856.00,$0.00,$167.46,$0.00,$170.34,$0.00
219.952S,SUP,Custom 27803010,,219.952S  -  WASHER ORTHOPEDIC SMALL OVAL STAINLESS STEEL STERILE 6.5/7.3,$363.03,$0.00,$363.03,$0.00,$259.09,$0.00,$0.00,$0.00,$0.00,$0.00,$363.03,$0.00,$181.51,$287.52,$290.42,$0.00,$0.00,$0.00,$0.00,$0.00
219.953S,SUP,Custom 27803010,,219.953S  -  WASHER ORTHOPEDIC LARGE ROUND STAINLESS STEEL STERILE,$363.03,$0.00,$363.03,$0.00,$259.09,$0.00,$0.00,$0.00,$0.00,$0.00,$363.03,$0.00,$181.51,$287.52,$290.42,$0.00,$0.00,$0.00,$0.00,$0.00
21AC60,SUP,Custom 27203010,,21AC60  -  PLATE 18MM TI BONE SPNL,$337.88,$0.00,$337.88,$0.00,$241.14,$0.00,$0.00,$0.00,$0.00,$0.00,$337.88,$0.00,$168.94,$267.60,$270.30,$0.00,$0.00,$0.00,$0.00,$0.00
21AC75,SUP,Custom 27203010,,21AC75  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$337.88,$0.00,$337.88,$0.00,$241.14,$0.00,$0.00,$0.00,$0.00,$0.00,$337.88,$0.00,$168.94,$267.60,$270.30,$0.00,$0.00,$0.00,$0.00,$0.00
21AC90,SUP,Custom 27203010,,21AC90  -  PLATE 18MM TI BONE SPNL,$337.88,$0.00,$337.88,$0.00,$241.14,$0.00,$0.00,$0.00,$0.00,$0.00,$337.88,$0.00,$168.94,$267.60,$270.30,$0.00,$0.00,$0.00,$0.00,$0.00
21AGFN-756,SUP,Custom 27803010,,21AGFN-756  -  VALVE AORTIC 85D 21MM 19.6MM 1 DIGIT GRADIENT MECHANICAL,"$11,750.00",$0.00,"$11,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,750.00",$0.00,"$5,875.00","$9,306.00","$9,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
21AJ-501,SUP,Custom 27803010,,21AJ-501  -  VALVE AOR 85D 2.06SQ CM 1.51SQ CM 21MM 16.7MM MSTR SER MECH,"$10,000.00",$0.00,"$10,000.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
21BA50,SUP,Custom 27203010,,21BA50  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$484.50,$0.00,$484.50,$0.00,$345.79,$0.00,$0.00,$0.00,$0.00,$0.00,$484.50,$0.00,$242.25,$383.72,$387.60,$0.00,$0.00,$0.00,$0.00,$0.00
21BA50DX,SUP,Custom 27203010,,21BA50DX  -  PLATE 18MM TI BONE SPNL,$401.63,$0.00,$401.63,$0.00,$286.64,$0.00,$0.00,$0.00,$0.00,$0.00,$401.63,$0.00,$200.81,$318.09,$321.30,$0.00,$0.00,$0.00,$0.00,$0.00
21BA60,SUP,Custom 27203010,,21BA60  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$401.63,$0.00,$401.63,$0.00,$286.64,$0.00,$0.00,$0.00,$0.00,$0.00,$401.63,$0.00,$200.81,$318.09,$321.30,$0.00,$0.00,$0.00,$0.00,$0.00
21BA70DX,SUP,Custom 27203010,,21BA70DX  -  PLATE 18MM TI BONE SPNL,$401.63,$0.00,$401.63,$0.00,$286.64,$0.00,$0.00,$0.00,$0.00,$0.00,$401.63,$0.00,$200.81,$318.09,$321.30,$0.00,$0.00,$0.00,$0.00,$0.00
21BA75,SUP,Custom 27203010,,21BA75  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$391.00,$0.00,$391.00,$0.00,$279.06,$0.00,$0.00,$0.00,$0.00,$0.00,$391.00,$0.00,$195.50,$309.67,$312.80,$0.00,$0.00,$0.00,$0.00,$0.00
21BA90,SUP,Custom 27203010,,21BA90  -  PLATE 18MM TI BONE SPNL,$384.63,$0.00,$384.63,$0.00,$274.51,$0.00,$0.00,$0.00,$0.00,$0.00,$384.63,$0.00,$192.31,$304.63,$307.70,$0.00,$0.00,$0.00,$0.00,$0.00
21CY64BC,SUP,Custom 27203010,,21CY64BC  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$374.00,$0.00,$374.00,$0.00,$266.92,$0.00,$0.00,$0.00,$0.00,$0.00,$374.00,$0.00,$187.00,$296.21,$299.20,$0.00,$0.00,$0.00,$0.00,$0.00
21CY65DX,SUP,Custom 27203010,,21CY65DX  -  PLATE 18MM TI BONE SPNL,$386.75,$0.00,$386.75,$0.00,$276.02,$0.00,$0.00,$0.00,$0.00,$0.00,$386.75,$0.00,$193.38,$306.31,$309.40,$0.00,$0.00,$0.00,$0.00,$0.00
21CY90,SUP,Custom 27203010,,21CY90  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$335.75,$0.00,$335.75,$0.00,$239.62,$0.00,$0.00,$0.00,$0.00,$0.00,$335.75,$0.00,$167.88,$265.91,$268.60,$0.00,$0.00,$0.00,$0.00,$0.00
21MH30,SUP,Custom 27203010,,21MH30  -  PLATE 18MM TI BONE SPNL,$337.88,$0.00,$337.88,$0.00,$241.14,$0.00,$0.00,$0.00,$0.00,$0.00,$337.88,$0.00,$168.94,$267.60,$270.30,$0.00,$0.00,$0.00,$0.00,$0.00
21MJ-501,SUP,Custom 27803010,,21MJ-501  -  VALVE MTRL 85D STD RING 21MM 16.7MM MSTR MECH LFLT ORFC,"$10,000.00",$0.00,"$10,000.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
21TA30,SUP,Custom 27203010,,21TA30  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$371.88,$0.00,$371.88,$0.00,$265.41,$0.00,$0.00,$0.00,$0.00,$0.00,$371.88,$0.00,$185.94,$294.53,$297.50,$0.00,$0.00,$0.00,$0.00,$0.00
2200-09-0040,SUP,Custom 27203010,,2200-09-0040  -  DRILL SURG DYNANAIL 4MM DISP TIBIOTALOCALCANEAL,$112.50,$0.00,$112.50,$0.00,$80.29,$0.00,$0.00,$0.00,$0.00,$0.00,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$0.00,$0.00,$0.00,$0.00
2200-09-0050,SUP,Custom 27203010,,2200-09-0050  -  DRILL SURG STP DYNANAIL 5MM DISP,$112.50,$0.00,$112.50,$0.00,$80.29,$0.00,$0.00,$0.00,$0.00,$0.00,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$0.00,$0.00,$0.00,$0.00
2200-18-4031,SUP,Custom 27203010,,2200-18-4031  -  GUIDEWIRE ORTH 400MM 3.1MM DYNANAIL TROCAR TIP,$212.50,$0.00,$212.50,$0.00,$151.66,$0.00,$0.00,$0.00,$0.00,$0.00,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$0.00,$0.00,$0.00,$0.00
2200-18-5031,SUP,Custom 27203010,,2200-18-5031  -  GUIDEWIRE ORTH 500MM 3.1MM DYNANAIL BEAD TIP,$212.50,$0.00,$212.50,$0.00,$151.66,$0.00,$0.00,$0.00,$0.00,$0.00,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$0.00,$0.00,$0.00,$0.00
2200-19-0031,SUP,Custom 27203010,,2200-19-0031  -  PIN FIX 3.1MM DYNANAIL STNM DISP,$212.50,$0.00,$212.50,$0.00,$151.66,$0.00,$0.00,$0.00,$0.00,$0.00,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$0.00,$0.00,$0.00,$0.00
22002 H,SUP,Custom 27803010,,22002 H  -  PLATE 18MM TI BONE SPNL,$748.13,$0.00,$748.13,$0.00,$533.94,$0.00,$0.00,$0.00,$0.00,$0.00,$748.13,$0.00,$374.06,$592.52,$598.50,$0.00,$0.00,$0.00,$0.00,$0.00
22002 L,SUP,Custom 27803010,,22002 L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$748.13,$0.00,$748.13,$0.00,$533.94,$0.00,$0.00,$0.00,$0.00,$0.00,$748.13,$0.00,$374.06,$592.52,$598.50,$0.00,$0.00,$0.00,$0.00,$0.00
22002 M,SUP,Custom 27803010,,22002 M  -  PLATE 18MM TI BONE SPNL,$748.13,$0.00,$748.13,$0.00,$533.94,$0.00,$0.00,$0.00,$0.00,$0.00,$748.13,$0.00,$374.06,$592.52,$598.50,$0.00,$0.00,$0.00,$0.00,$0.00
22-004-186,SUP,Custom 27203010,,KIT SYR LUER LOCK SLIP NDL PRDVC SPRT FLTRPRO 23.5IU/ML 5/8,$313.60,$0.00,$313.60,$0.00,$223.82,$0.00,$0.00,$0.00,$0.00,$0.00,$313.60,$0.00,$156.80,$248.37,$250.88,$0.00,$0.00,$0.00,$0.00,$0.00
22017 A-L,SUP,Custom 27803010,,22017 A-L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,750.25",$0.00,"$2,750.25",$0.00,"$1,962.85",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.25",$0.00,"$1,375.13","$2,178.20","$2,200.20",$0.00,$0.00,$0.00,$0.00,$0.00
22017 A-M,SUP,Custom 27803010,,22017 A-M  -  PLATE 18MM TI BONE SPNL,"$2,750.25",$0.00,"$2,750.25",$0.00,"$1,962.85",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.25",$0.00,"$1,375.13","$2,178.20","$2,200.20",$0.00,$0.00,$0.00,$0.00,$0.00
22017 B-L,SUP,Custom 27803010,,22017 B-L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,498.50",$0.00,"$2,498.50",$0.00,"$1,783.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,498.50",$0.00,"$1,249.25","$1,978.81","$1,998.80",$0.00,$0.00,$0.00,$0.00,$0.00
22017 B-M,SUP,Custom 27803010,,22017 B-M  -  PLATE 18MM TI BONE SPNL,"$2,498.50",$0.00,"$2,498.50",$0.00,"$1,783.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,498.50",$0.00,"$1,249.25","$1,978.81","$1,998.80",$0.00,$0.00,$0.00,$0.00,$0.00
22017A-LL,SUP,HCPCS C1713,,22017A-LL  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,327.50",$0.00,"$2,327.50","$1,047.38","$1,661.14",$0.00,$401.02,$0.00,$0.00,$407.53,"$2,327.50",$0.00,"$1,163.75","$1,843.38","$1,862.00",$0.00,$364.25,$0.00,$370.54,$0.00
22017B-LL,SUP,Custom 27803010,,22017B-LL  -  PLATE 18MM TI BONE SPNL,"$2,498.50",$0.00,"$2,498.50",$0.00,"$1,783.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,498.50",$0.00,"$1,249.25","$1,978.81","$1,998.80",$0.00,$0.00,$0.00,$0.00,$0.00
22-046-221,SUP,Custom 27203010,,RENOL OSMOLALITY CONTROL,$385.63,$0.00,$385.63,$0.00,$275.22,$0.00,$0.00,$0.00,$0.00,$0.00,$385.63,$0.00,$192.81,$305.42,$308.50,$0.00,$0.00,$0.00,$0.00,$0.00
22-046346,SUP,Custom 27203010,,REAGENT METHNL ISOPRPNL FLX 95 1GL DEHYDRANT BTL HISTOLGY,$95.25,$0.00,$95.25,$0.00,$67.98,$0.00,$0.00,$0.00,$0.00,$0.00,$95.25,$0.00,$47.63,$75.44,$76.20,$0.00,$0.00,$0.00,$0.00,$0.00
22-046-781,SUP,Custom 27203010,,CONTROL PROTINOL 280 OSMOLALITY 3X3ML,$412.65,$0.00,$412.65,$0.00,$294.51,$0.00,$0.00,$0.00,$0.00,$0.00,$412.65,$0.00,$206.33,$326.82,$330.12,$0.00,$0.00,$0.00,$0.00,$0.00
22050 B,SUP,Custom 27803010,,22050 B  -  KIT VNCLSTM STD DOME 6MM STRL CSF SNP,$629.38,$0.00,$629.38,$0.00,$449.18,$0.00,$0.00,$0.00,$0.00,$0.00,$629.38,$0.00,$314.69,$498.47,$503.50,$0.00,$0.00,$0.00,$0.00,$0.00
22082 F,SUP,Custom 27803010,,22082 F  -  PLATE 18MM TI BONE SPNL,$501.13,$0.00,$501.13,$0.00,$357.65,$0.00,$0.00,$0.00,$0.00,$0.00,$501.13,$0.00,$250.56,$396.89,$400.90,$0.00,$0.00,$0.00,$0.00,$0.00
22082 G,SUP,Custom 27803010,,22082 G  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$501.13,$0.00,$501.13,$0.00,$357.65,$0.00,$0.00,$0.00,$0.00,$0.00,$501.13,$0.00,$250.56,$396.89,$400.90,$0.00,$0.00,$0.00,$0.00,$0.00
22082 H,SUP,Custom 27803010,,22082 H  -  PLATE 18MM TI BONE SPNL,$501.13,$0.00,$501.13,$0.00,$357.65,$0.00,$0.00,$0.00,$0.00,$0.00,$501.13,$0.00,$250.56,$396.89,$400.90,$0.00,$0.00,$0.00,$0.00,$0.00
22082 I,SUP,Custom 27803010,,22082 I  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$501.13,$0.00,$501.13,$0.00,$357.65,$0.00,$0.00,$0.00,$0.00,$0.00,$501.13,$0.00,$250.56,$396.89,$400.90,$0.00,$0.00,$0.00,$0.00,$0.00
22082 K,SUP,Custom 27803010,,22082 K  -  PLATE 18MM TI BONE SPNL,$513.00,$0.00,$513.00,$0.00,$366.13,$0.00,$0.00,$0.00,$0.00,$0.00,$513.00,$0.00,$256.50,$406.30,$410.40,$0.00,$0.00,$0.00,$0.00,$0.00
22097 A-L,SUP,Custom 27803010,,22097 A-L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$3,028.13",$0.00,"$3,028.13",$0.00,"$2,161.17",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,028.13",$0.00,"$1,514.06","$2,398.28","$2,422.50",$0.00,$0.00,$0.00,$0.00,$0.00
22097 A-M,SUP,Custom 27803010,,22097 A-M  -  PLATE 18MM TI BONE SPNL,"$3,028.13",$0.00,"$3,028.13",$0.00,"$2,161.17",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,028.13",$0.00,"$1,514.06","$2,398.28","$2,422.50",$0.00,$0.00,$0.00,$0.00,$0.00
22097 B-L,SUP,Custom 27803010,,22097 B-L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$3,028.13",$0.00,"$3,028.13",$0.00,"$2,161.17",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,028.13",$0.00,"$1,514.06","$2,398.28","$2,422.50",$0.00,$0.00,$0.00,$0.00,$0.00
22097 B-M,SUP,Custom 27803010,,22097 B-M  -  PLATE 18MM TI BONE SPNL,"$3,028.13",$0.00,"$3,028.13",$0.00,"$2,161.17",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,028.13",$0.00,"$1,514.06","$2,398.28","$2,422.50",$0.00,$0.00,$0.00,$0.00,$0.00
22098 B-L,SUP,Custom 27803010,,22098 B-L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$3,028.13",$0.00,"$3,028.13",$0.00,"$2,161.17",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,028.13",$0.00,"$1,514.06","$2,398.28","$2,422.50",$0.00,$0.00,$0.00,$0.00,$0.00
22098 B-M,SUP,Custom 27803010,,22098 B-M  -  PLATE 18MM TI BONE SPNL,"$3,028.13",$0.00,"$3,028.13",$0.00,"$2,161.17",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,028.13",$0.00,"$1,514.06","$2,398.28","$2,422.50",$0.00,$0.00,$0.00,$0.00,$0.00
22098 C-L,SUP,Custom 27803010,,22098 C-L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$3,415.25",$0.00,"$3,415.25",$0.00,"$2,437.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,415.25",$0.00,"$1,707.63","$2,704.88","$2,732.20",$0.00,$0.00,$0.00,$0.00,$0.00
22098 C-M,SUP,Custom 27803010,,22098 C-M  -  PLATE 18MM TI BONE SPNL,"$3,028.13",$0.00,"$3,028.13",$0.00,"$2,161.17",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,028.13",$0.00,"$1,514.06","$2,398.28","$2,422.50",$0.00,$0.00,$0.00,$0.00,$0.00
22101 A,SUP,Custom 27803010,,22101 A  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,047.38",$0.00,"$1,047.38",$0.00,$747.51,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,047.38",$0.00,$523.69,$829.52,$837.90,$0.00,$0.00,$0.00,$0.00,$0.00
22101 B,SUP,Custom 27803010,,22101 B  -  PLATE 18MM TI BONE SPNL,"$1,047.38",$0.00,"$1,047.38",$0.00,$747.51,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,047.38",$0.00,$523.69,$829.52,$837.90,$0.00,$0.00,$0.00,$0.00,$0.00
22101 C,SUP,Custom 27803010,,22101 C  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,047.38",$0.00,"$1,047.38",$0.00,$747.51,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,047.38",$0.00,$523.69,$829.52,$837.90,$0.00,$0.00,$0.00,$0.00,$0.00
22101 D,SUP,Custom 27803010,,22101 D  -  PLATE 18MM TI BONE SPNL,"$1,047.38",$0.00,"$1,047.38",$0.00,$747.51,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,047.38",$0.00,$523.69,$829.52,$837.90,$0.00,$0.00,$0.00,$0.00,$0.00
22-1266,SUP,Custom 27203010,,22-1266  -  PROBE ESURG STR BIPOL TPR BLNT PNT WTFLD STRL 20-23GA,$425.00,$0.00,$425.00,$0.00,$303.32,$0.00,$0.00,$0.00,$0.00,$0.00,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$0.00,$0.00,$0.00,$0.00
22-143-975,SUP,Custom 27203010,,REAGENT XYLN CTRSLV 1GL CLR AGNT HISTOLGY,$481.98,$0.00,$481.98,$0.00,$343.99,$0.00,$0.00,$0.00,$0.00,$0.00,$481.98,$0.00,$240.99,$381.73,$385.58,$0.00,$0.00,$0.00,$0.00,$0.00
2220J,SUP,HCPCS C1880,,2220J  -  FILTER CV 7FR 83CM SIM SBCLV DLV KT NTNL JUG VN VC,"$2,544.16",$0.00,"$2,544.16","$1,144.87","$1,815.77",$0.00,$438.35,$0.00,$0.00,$445.46,"$2,544.16",$0.00,"$1,272.08","$2,014.97","$2,035.33",$0.00,$398.16,$0.00,$405.03,$0.00
22-267-013,SUP,Custom 27203010,,SLIDE 3X2IN MSCP X THK FRST END PRECLN PLN THK1.2MM,$245.15,$0.00,$245.15,$0.00,$174.96,$0.00,$0.00,$0.00,$0.00,$0.00,$245.15,$0.00,$122.58,$194.16,$196.12,$0.00,$0.00,$0.00,$0.00,$0.00
224.510.,SUP,Custom 27803010,,224.510.  -  ROD SPNL 100MM 5.5MM REVERE SS STR,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
22438-19,SUP,HCPCS C1884,,22438-19  -  SYSTEM EMBOLIC PROTECTION .014IN LARGE 4-7MM 5-6FR 190CM,"$3,425.00",$0.00,"$3,425.00","$1,541.25","$2,444.42",$0.00,$590.11,$0.00,$0.00,$599.69,"$3,425.00",$0.00,"$1,712.50","$2,712.60","$2,740.00",$0.00,$536.01,$0.00,$545.26,$0.00
22-553,SUP,HCPCS C2617,,22-553  -  STENT URET 8FR 28CM REG DRMTR LG DRAIN HOLE LCK PGTL 22-553,$270.75,$0.00,$270.75,$121.84,$193.23,$0.00,$46.65,$0.00,$0.00,$47.41,$270.75,$0.00,$135.38,$214.43,$216.60,$0.00,$42.37,$0.00,$43.10,$0.00
226.662S,SUP,HCPCS C1713,,226.662S  -  PLATE BRD 300MM SS 4.5MM SCR 16 HOLE CVD LCP BONE ORTH STRL,"$2,151.03",$0.00,"$2,151.03",$967.96,"$1,535.19",$0.00,$370.61,$0.00,$0.00,$376.63,"$2,151.03",$0.00,"$1,075.51","$1,703.62","$1,720.82",$0.00,$336.64,$0.00,$342.44,$0.00
226.702S,SUP,HCPCS C1713,,226.702S  -  PLATE BONE BROAD 372MM 20 HOLE CVD LCP STAINLESS STEEL,"$2,371.93",$0.00,"$2,371.93","$1,067.37","$1,692.84",$0.00,$396.77,$0.00,$0.00,$415.31,"$2,371.93",$0.00,"$1,185.96","$1,878.57","$1,897.54",$0.00,$360.40,$0.00,$377.61,$0.00
226.722S,SUP,HCPCS C1713,,226.722S  -  PLATE BONE BROAD 408MM 22 HOLE CVD LCP STAINLESS STEEL,"$2,679.00",$0.00,"$2,679.00","$1,205.55","$1,912.00",$0.00,$448.13,$0.00,$0.00,$469.07,"$2,679.00",$0.00,"$1,339.50","$2,121.77","$2,143.20",$0.00,$407.05,$0.00,$426.50,$0.00
226.742S,SUP,HCPCS C1713,,226.742S  -  PLATE BONE BROAD 443MM 24 HOLE CVD LCP STAINLESS STEEL,"$2,908.28",$0.00,"$2,908.28","$1,308.72","$2,075.64",$0.00,$486.49,$0.00,$0.00,$509.22,"$2,908.28",$0.00,"$1,454.14","$2,303.36","$2,326.62",$0.00,$441.89,$0.00,$463.00,$0.00
226.762S,SUP,HCPCS C1713,,226.762S  -  PLATE BONE BROAD 479MM 26 HOLE CVD LCP STAINLESS STEEL,"$3,140.30",$0.00,"$3,140.30","$1,413.14","$2,241.23",$0.00,$525.30,$0.00,$0.00,$549.84,"$3,140.30",$0.00,"$1,570.15","$2,487.12","$2,512.24",$0.00,$477.14,$0.00,$499.94,$0.00
2284-0-426,SUP,Custom 27803010,,2284-0-426  -  HEAD FEMORAL 15MM OFFST 26MM PCA HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
2284-0-428,SUP,Custom 27803010,,2284-0-428  -  HEAD FEM +15MM OFST 28MM STRL PCA HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
2284-0-432,SUP,Custom 27803010,,2284-0-432  -  HEAD FEMORAL +15MM OFFST 32MM PCA HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
2296003109S2,SUP,Custom 27203010,,2296003109S2  -  BLADE SW LF CMND II MODIFICATION HVDTY SGTL MNT RT,$206.00,$0.00,$206.00,$0.00,$147.02,$0.00,$0.00,$0.00,$0.00,$0.00,$206.00,$0.00,$103.00,$163.15,$164.80,$0.00,$0.00,$0.00,$0.00,$0.00
2296-003-115,SUP,Custom 27203010,,2296-003-115  -  BLADE SW 29.5X7X.38MM PRCS LNG MIC NAR THN SS OSC/SAG STRL,$85.00,$0.00,$85.00,$0.00,$60.66,$0.00,$0.00,$0.00,$0.00,$0.00,$85.00,$0.00,$42.50,$67.32,$68.00,$0.00,$0.00,$0.00,$0.00,$0.00
2296-003-414,SUP,Custom 27203010,,2296-003-414  -  BLADE SW MIC THN 25X5.5X.38MM STRL PRCS OSC/SAG SS,$85.00,$0.00,$85.00,$0.00,$60.66,$0.00,$0.00,$0.00,$0.00,$0.00,$85.00,$0.00,$42.50,$67.32,$68.00,$0.00,$0.00,$0.00,$0.00,$0.00
2296-033-102,SUP,Custom 27203010,,2296-033-102  -  BLADE SW MED W AGRS,$85.00,$0.00,$85.00,$0.00,$60.66,$0.00,$0.00,$0.00,$0.00,$0.00,$85.00,$0.00,$42.50,$67.32,$68.00,$0.00,$0.00,$0.00,$0.00,$0.00
2296-033-103,SUP,Custom 27203010,,2296-033-103  -  BLADE SW 25X7X.51MM CORE SS OSC/SAG AGRS STRL,$85.00,$0.00,$85.00,$0.00,$60.66,$0.00,$0.00,$0.00,$0.00,$0.00,$85.00,$0.00,$42.50,$67.32,$68.00,$0.00,$0.00,$0.00,$0.00,$0.00
2296-033-104,SUP,Custom 27203010,,2296-033-104  -  BLADE SW 16.5MM CORE TPS 34.5MM THK.51MM MIC OSC/SAG,$85.00,$0.00,$85.00,$0.00,$60.66,$0.00,$0.00,$0.00,$0.00,$0.00,$85.00,$0.00,$42.50,$67.32,$68.00,$0.00,$0.00,$0.00,$0.00,$0.00
2296-033-105,SUP,Custom 27203010,,2296-033-105  -  BLADE SAW THK.4MM MEDIUM 18.5X9MM OSCILLATING SAGITTAL,$90.10,$0.00,$90.10,$0.00,$64.30,$0.00,$0.00,$0.00,$0.00,$0.00,$90.10,$0.00,$45.05,$71.36,$72.08,$0.00,$0.00,$0.00,$0.00,$0.00
2296-033-111,SUP,Custom 27203010,,2296-033-111  -  BLADE SAW MEDIUM LONG 25X9MM SAGITTAL LATEX FREE STAINLESS,$90.10,$0.00,$90.10,$0.00,$64.30,$0.00,$0.00,$0.00,$0.00,$0.00,$90.10,$0.00,$45.05,$71.36,$72.08,$0.00,$0.00,$0.00,$0.00,$0.00
2296-033-114,SUP,Custom 27203010,,2296-033-114  -  BLADE SAW MEDIUM 18.5X7X.51MM SAGITTAL OSCILLATE AGGRESSIVE,$90.10,$0.00,$90.10,$0.00,$64.30,$0.00,$0.00,$0.00,$0.00,$0.00,$90.10,$0.00,$45.05,$71.36,$72.08,$0.00,$0.00,$0.00,$0.00,$0.00
2296-033-125,SUP,Custom 27203010,,2296-033-125  -  BLADE SW 31X9X.51MM LNG MED SS OSC/SAG AGRS,$85.00,$0.00,$85.00,$0.00,$60.66,$0.00,$0.00,$0.00,$0.00,$0.00,$85.00,$0.00,$42.50,$67.32,$68.00,$0.00,$0.00,$0.00,$0.00,$0.00
2296-033-212,SUP,Custom 27203010,,2296-033-212  -  BLADE SAW MEDIUM NARROW 18.5X5.5X.51MM AGGRESSIVE CORE TPS,$90.10,$0.00,$90.10,$0.00,$64.30,$0.00,$0.00,$0.00,$0.00,$0.00,$90.10,$0.00,$45.05,$71.36,$72.08,$0.00,$0.00,$0.00,$0.00,$0.00
2296-033-411,SUP,Custom 27203010,,2296-033-411  -  BLADE SW 9MM CORE TPS 11.5MM THK.51MM MIC OSC/SAG,$85.00,$0.00,$85.00,$0.00,$60.66,$0.00,$0.00,$0.00,$0.00,$0.00,$85.00,$0.00,$42.50,$67.32,$68.00,$0.00,$0.00,$0.00,$0.00,$0.00
2296-100-191,SUP,Custom 27203010,,2296-100-191  -  BURR SURG 39MM 3MM RND DMD STRL,$138.00,$0.00,$138.00,$0.00,$98.49,$0.00,$0.00,$0.00,$0.00,$0.00,$138.00,$0.00,$69.00,$109.30,$110.40,$0.00,$0.00,$0.00,$0.00,$0.00
2296-100-193,SUP,Custom 27203010,,2296-100-193  -  BURR SURG 3MM 3.5MM RND DMD STRL,$138.00,$0.00,$138.00,$0.00,$98.49,$0.00,$0.00,$0.00,$0.00,$0.00,$138.00,$0.00,$69.00,$109.30,$110.40,$0.00,$0.00,$0.00,$0.00,$0.00
2296-100-195,SUP,Custom 27203010,,2296-100-195  -  BURR SURG 39MM 4MM RND DMD STRL,$138.00,$0.00,$138.00,$0.00,$98.49,$0.00,$0.00,$0.00,$0.00,$0.00,$138.00,$0.00,$69.00,$109.30,$110.40,$0.00,$0.00,$0.00,$0.00,$0.00
2296-100-210,SUP,Custom 27203010,,2296-100-210  -  BURR SURG 44.5MM 1MM CRB XCUT FSSR STRL,$18.02,$0.00,$18.02,$0.00,$12.86,$0.00,$0.00,$0.00,$0.00,$0.00,$18.02,$0.00,$9.01,$14.27,$14.42,$0.00,$0.00,$0.00,$0.00,$0.00
2296-100-212,SUP,Custom 27203010,,2296-100-212  -  BURR SURG 1.2MM 44.5MM CROSS CUT FISSURE CARBIDE STERILE,$15.90,$0.00,$15.90,$0.00,$11.35,$0.00,$0.00,$0.00,$0.00,$0.00,$15.90,$0.00,$7.95,$12.59,$12.72,$0.00,$0.00,$0.00,$0.00,$0.00
2296-100-216,SUP,Custom 27203010,,2296-100-216  -  BURR SURG 1.6MM 44.5MM CROSS CUT FISSURE CARBIDE STERILE,$15.90,$0.00,$15.90,$0.00,$11.35,$0.00,$0.00,$0.00,$0.00,$0.00,$15.90,$0.00,$7.95,$12.59,$12.72,$0.00,$0.00,$0.00,$0.00,$0.00
2296-100-221,SUP,Custom 27203010,,2296-100-221  -  BURR SURG 2.1MM 44.5MM CROSS CUT FISSURE CARBIDE STERILE,$15.90,$0.00,$15.90,$0.00,$11.35,$0.00,$0.00,$0.00,$0.00,$0.00,$15.90,$0.00,$7.95,$12.59,$12.72,$0.00,$0.00,$0.00,$0.00,$0.00
2296-100-240,SUP,Custom 27203010,,2296-100-240  -  BURR SURG 39MM 4MM CRB RND 6 FLUT STRL,$138.00,$0.00,$138.00,$0.00,$98.49,$0.00,$0.00,$0.00,$0.00,$0.00,$138.00,$0.00,$69.00,$109.30,$110.40,$0.00,$0.00,$0.00,$0.00,$0.00
2296-100-245,SUP,Custom 27203010,,2296-100-245  -  BURR SURG 39MM 4.5MM CRB RND STRL,$138.00,$0.00,$138.00,$0.00,$98.49,$0.00,$0.00,$0.00,$0.00,$0.00,$138.00,$0.00,$69.00,$109.30,$110.40,$0.00,$0.00,$0.00,$0.00,$0.00
2296-100-418,SUP,Custom 27203010,,2296-100-418  -  BURR SURG 1.8MM ROUND HEAD CARBIDE STERILE,$15.90,$0.00,$15.90,$0.00,$11.35,$0.00,$0.00,$0.00,$0.00,$0.00,$15.90,$0.00,$7.95,$12.59,$12.72,$0.00,$0.00,$0.00,$0.00,$0.00
2296-100-423,SUP,Custom 27203010,,2296-100-423  -  BURR SURG 2.3MM 45MM 8 FLUTED ROUND HEAD CARBIDE STERILE,$15.90,$0.00,$15.90,$0.00,$11.35,$0.00,$0.00,$0.00,$0.00,$0.00,$15.90,$0.00,$7.95,$12.59,$12.72,$0.00,$0.00,$0.00,$0.00,$0.00
2296-101-230,SUP,Custom 27203010,,2296-101-230  -  BURR SURG 3MM 55MM 6 FLUTED ROUND HEAD CARBIDE STERILE,$84.80,$0.00,$84.80,$0.00,$60.52,$0.00,$0.00,$0.00,$0.00,$0.00,$84.80,$0.00,$42.40,$67.16,$67.84,$0.00,$0.00,$0.00,$0.00,$0.00
2296-101-418,SUP,Custom 27203010,,2296-101-418  -  BURR SURG 1.8MM ROUND CARBIDE STERILE,$16.38,$0.00,$16.38,$0.00,$11.69,$0.00,$0.00,$0.00,$0.00,$0.00,$16.38,$0.00,$8.19,$12.97,$13.10,$0.00,$0.00,$0.00,$0.00,$0.00
2296-101-421,SUP,Custom 27203010,,2296-101-421  -  BURR SURG 2.1MM 58.5MM ROUND HEAD CROSS CUT FISSURE CARBIDE,$16.38,$0.00,$16.38,$0.00,$11.69,$0.00,$0.00,$0.00,$0.00,$0.00,$16.38,$0.00,$8.19,$12.97,$13.10,$0.00,$0.00,$0.00,$0.00,$0.00
23011 L,SUP,Custom 27803010,,23011 L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$3,562.50",$0.00,"$3,562.50",$0.00,"$2,542.56",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,562.50",$0.00,"$1,781.25","$2,821.50","$2,850.00",$0.00,$0.00,$0.00,$0.00,$0.00
23011 M,SUP,Custom 27803010,,23011 M  -  PLATE 18MM TI BONE SPNL,"$3,738.25",$0.00,"$3,738.25",$0.00,"$2,667.99",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,738.25",$0.00,"$1,869.13","$2,960.69","$2,990.60",$0.00,$0.00,$0.00,$0.00,$0.00
23038 A,SUP,Custom 27803010,,23038 A  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,047.38",$0.00,"$1,047.38",$0.00,$747.51,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,047.38",$0.00,$523.69,$829.52,$837.90,$0.00,$0.00,$0.00,$0.00,$0.00
23038 B,SUP,Custom 27803010,,23038 B  -  PLATE 18MM TI BONE SPNL,"$1,047.38",$0.00,"$1,047.38",$0.00,$747.51,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,047.38",$0.00,$523.69,$829.52,$837.90,$0.00,$0.00,$0.00,$0.00,$0.00
23038 C,SUP,Custom 27803010,,23038 C  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,047.38",$0.00,"$1,047.38",$0.00,$747.51,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,047.38",$0.00,$523.69,$829.52,$837.90,$0.00,$0.00,$0.00,$0.00,$0.00
23038 D,SUP,Custom 27803010,,23038 D  -  PLATE 18MM TI BONE SPNL,"$1,047.38",$0.00,"$1,047.38",$0.00,$747.51,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,047.38",$0.00,$523.69,$829.52,$837.90,$0.00,$0.00,$0.00,$0.00,$0.00
23038 E,SUP,Custom 27803010,,23038 E  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,047.38",$0.00,"$1,047.38",$0.00,$747.51,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,047.38",$0.00,$523.69,$829.52,$837.90,$0.00,$0.00,$0.00,$0.00,$0.00
23-038-386,SUP,Custom 27203010,,MAS CSF TRK LIQCNTL 2X3.3.5ML,$196.88,$0.00,$196.88,$0.00,$140.51,$0.00,$0.00,$0.00,$0.00,$0.00,$196.88,$0.00,$98.44,$155.93,$157.50,$0.00,$0.00,$0.00,$0.00,$0.00
23059 L,SUP,Custom 27803010,,23059 L  -  PLATE 18MM TI BONE SPNL,"$3,051.88",$0.00,"$3,051.88",$0.00,"$2,178.12",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,051.88",$0.00,"$1,525.94","$2,417.09","$2,441.50",$0.00,$0.00,$0.00,$0.00,$0.00
23059 M,SUP,Custom 27803010,,23059 M  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$3,051.88",$0.00,"$3,051.88",$0.00,"$2,178.12",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,051.88",$0.00,"$1,525.94","$2,417.09","$2,441.50",$0.00,$0.00,$0.00,$0.00,$0.00
23064 B,SUP,Custom 27803010,,23064 B  -  PLATE 18MM TI BONE SPNL,$427.50,$0.00,$427.50,$0.00,$305.11,$0.00,$0.00,$0.00,$0.00,$0.00,$427.50,$0.00,$213.75,$338.58,$342.00,$0.00,$0.00,$0.00,$0.00,$0.00
23066 B,SUP,Custom 27803010,,23066 B  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,401.25",$0.00,"$1,401.25",$0.00,"$1,000.07",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,401.25",$0.00,$700.63,"$1,109.79","$1,121.00",$0.00,$0.00,$0.00,$0.00,$0.00
23066 C,SUP,Custom 27803010,,23066 C  -  PLATE 18MM TI BONE SPNL,"$1,258.75",$0.00,"$1,258.75",$0.00,$898.37,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,258.75",$0.00,$629.38,$996.93,"$1,007.00",$0.00,$0.00,$0.00,$0.00,$0.00
231120M5,SUP,HCPCS C1713,,231120M5  -  SCREW INTERFERENCE 20MM PROVEN BONE INGROWTH UNIFORMLY,$653.63,$0.00,$653.63,$294.13,$466.49,$0.00,$112.62,$0.00,$0.00,$114.44,$653.63,$0.00,$326.81,$517.67,$522.90,$0.00,$102.29,$0.00,$104.06,$0.00
23-112-1,SUP,Custom 27011340,,23-112-1  -  SEALER BIPOL 5.1IN .226IN 2 ELTRD HMST DISP,"$1,450.78",$0.00,"$1,450.78",$0.00,"$1,035.42",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,450.78",$0.00,$725.39,"$1,149.02","$1,160.62",$0.00,$0.00,$0.00,$0.00,$0.00
23-139109,SUP,Custom 27203010,,CONTROL MLANLT MAS URCHMTK LVL 1 15ML UA,$325.00,$0.00,$325.00,$0.00,$231.95,$0.00,$0.00,$0.00,$0.00,$0.00,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$0.00,$0.00,$0.00,$0.00
23-139110,SUP,Custom 27203010,,CONTROL MLANLT MAS URCHMTK LVL 2 15ML UA,$325.00,$0.00,$325.00,$0.00,$231.95,$0.00,$0.00,$0.00,$0.00,$0.00,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$0.00,$0.00,$0.00,$0.00
2320A,SUP,HCPCS C1884,,2320A  -  SYSTEM EMBL PRTC 103CM VC FEM AC APRCH INTROD GWIRE 7FR NTNL,"$2,544.16",$0.00,"$2,544.16","$1,144.87","$1,815.77",$0.00,$438.35,$0.00,$0.00,$445.46,"$2,544.16",$0.00,"$1,272.08","$2,014.97","$2,035.33",$0.00,$398.16,$0.00,$405.03,$0.00
23-247056,SUP,Custom 27203010,,STAIN WRTS PRC HMTK 1GL REG HMTL,$360.70,$0.00,$360.70,$0.00,$257.43,$0.00,$0.00,$0.00,$0.00,$0.00,$360.70,$0.00,$180.35,$285.67,$288.56,$0.00,$0.00,$0.00,$0.00,$0.00
23-309178,SUP,Custom 27203010,,REAGENT .85% NA CHLOR 20L PH 7.2 BUFF BLOOD BANK,$71.13,$0.00,$71.13,$0.00,$50.76,$0.00,$0.00,$0.00,$0.00,$0.00,$71.13,$0.00,$35.56,$56.33,$56.90,$0.00,$0.00,$0.00,$0.00,$0.00
23-453-18,SUP,Custom 27203010,,ELEVATOR SURG 9 KNURL HNDL PROST,$131.25,$0.00,$131.25,$0.00,$93.67,$0.00,$0.00,$0.00,$0.00,$0.00,$131.25,$0.00,$65.63,$103.95,$105.00,$0.00,$0.00,$0.00,$0.00,$0.00
2347-15-02,SUP,HCPCS C1713,,2347-15-02  -  PLATE 51MM SS 2 HOLE BONE PERIART RIGHT FIB DISTAL,$846.40,$0.00,$846.40,$380.88,$604.08,$0.00,$145.83,$0.00,$0.00,$148.20,$846.40,$0.00,$423.20,$670.35,$677.12,$0.00,$132.46,$0.00,$134.75,$0.00
2347-15-04,SUP,HCPCS C1713,,2347-15-04  -  PLATE 74MM SS 4 HOLE BONE PERIART RIGHT FIB DISTAL,$852.15,$0.00,$852.15,$383.47,$608.18,$0.00,$146.82,$0.00,$0.00,$149.20,$852.15,$0.00,$426.08,$674.90,$681.72,$0.00,$133.36,$0.00,$135.66,$0.00
2347-15-06,SUP,HCPCS C1713,,2347-15-06  -  PLATE 95MM SS 6 HOLE BONE PERIART RIGHT FIB DISTAL,$863.65,$0.00,$863.65,$388.64,$616.39,$0.00,$148.80,$0.00,$0.00,$151.22,$863.65,$0.00,$431.83,$684.01,$690.92,$0.00,$135.16,$0.00,$137.49,$0.00
2347-15-08,SUP,HCPCS C1713,,2347-15-08  -  PLATE 116MM SS 8 HOLE BONE PERIART RIGHT FIB DISTAL,$876.20,$0.00,$876.20,$394.29,$625.34,$0.00,$150.96,$0.00,$0.00,$153.42,$876.20,$0.00,$438.10,$693.95,$700.96,$0.00,$137.13,$0.00,$139.49,$0.00
2347-15-10,SUP,HCPCS C1713,,2347-15-10  -  PLATE 136MM SS 10 HOLE BONE FIB RIGHT DISTAL LAT,$891.00,$0.00,$891.00,$400.95,$635.91,$0.00,$153.51,$0.00,$0.00,$156.01,$891.00,$0.00,$445.50,$705.67,$712.80,$0.00,$139.44,$0.00,$141.85,$0.00
2347-15-12,SUP,HCPCS C1713,,2347-15-12  -  PLATE 157MM SS 12 HOLE BONE FIB RIGHT DISTAL LAT,"$1,054.55",$0.00,"$1,054.55",$474.55,$752.63,$0.00,$181.69,$0.00,$0.00,$184.64,"$1,054.55",$0.00,$527.28,$835.20,$843.64,$0.00,$165.04,$0.00,$167.88,$0.00
2347-15-14,SUP,HCPCS C1713,,2347-15-14  -  PLATE 178MM SS 14 HOLE BONE FIB RIGHT DISTAL LAT,"$1,125.85",$0.00,"$1,125.85",$506.63,$803.52,$0.00,$193.98,$0.00,$0.00,$197.13,"$1,125.85",$0.00,$562.93,$891.67,$900.68,$0.00,$176.20,$0.00,$179.24,$0.00
2347-15-16,SUP,HCPCS C1713,,2347-15-16  -  PLATE 199MM SS 16 HOLE BONE FIB RIGHT DISTAL LAT,"$1,220.15",$0.00,"$1,220.15",$549.07,$870.82,$0.00,$210.23,$0.00,$0.00,$213.64,"$1,220.15",$0.00,$610.08,$966.36,$976.12,$0.00,$190.95,$0.00,$194.25,$0.00
2347-15-18,SUP,HCPCS C1713,,2347-15-18  -  PLATE 220MM SS 18 HOLE BONE FIB RIGHT DISTAL LAT,"$1,315.60",$0.00,"$1,315.60",$592.02,$938.94,$0.00,$226.67,$0.00,$0.00,$230.35,"$1,315.60",$0.00,$657.80,"$1,041.96","$1,052.48",$0.00,$205.89,$0.00,$209.44,$0.00
2347-15-20,SUP,HCPCS C1713,,2347-15-20  -  PLATE 241MM SS 20 HOLE BONE FIB RIGHT DISTAL LAT,"$1,434.05",$0.00,"$1,434.05",$645.32,"$1,023.48",$0.00,$247.08,$0.00,$0.00,$251.09,"$1,434.05",$0.00,$717.03,"$1,135.77","$1,147.24",$0.00,$224.43,$0.00,$228.30,$0.00
2347-16-02,SUP,HCPCS C1713,,2347-16-02  -  PLATE 51MM SS 2 HOLE BONE FIB LEFT DISTAL LAT,$846.40,$0.00,$846.40,$380.88,$604.08,$0.00,$145.83,$0.00,$0.00,$148.20,$846.40,$0.00,$423.20,$670.35,$677.12,$0.00,$132.46,$0.00,$134.75,$0.00
2347-16-04,SUP,HCPCS C1713,,2347-16-04  -  PLATE 74MM SS 2.7MM 3.5MM CORT PERIART 2.7MM CANC,$852.15,$0.00,$852.15,$383.47,$608.18,$0.00,$146.82,$0.00,$0.00,$149.20,$852.15,$0.00,$426.08,$674.90,$681.72,$0.00,$133.36,$0.00,$135.66,$0.00
2347-16-06,SUP,HCPCS C1713,,2347-16-06  -  PLATE 95MM 6 HOLE BONE FIB L/L,$863.90,$0.00,$863.90,$388.76,$616.57,$0.00,$148.85,$0.00,$0.00,$151.26,$863.90,$0.00,$431.95,$684.21,$691.12,$0.00,$135.20,$0.00,$137.53,$0.00
2347-16-08,SUP,HCPCS C1713,,2347-16-08  -  PLATE 116MM 8 HOLE BONE FIB L/L,$876.20,$0.00,$876.20,$394.29,$625.34,$0.00,$150.96,$0.00,$0.00,$153.42,$876.20,$0.00,$438.10,$693.95,$700.96,$0.00,$137.13,$0.00,$139.49,$0.00
2347-16-10,SUP,HCPCS C1713,,2347-16-10  -  PLATE 135MM 10 HOLE BONE FIB L/L,$966.00,$0.00,$966.00,$434.70,$689.43,$0.00,$166.44,$0.00,$0.00,$169.14,$966.00,$0.00,$483.00,$765.07,$772.80,$0.00,$151.18,$0.00,$153.79,$0.00
2347-16-12,SUP,HCPCS C1713,,2347-16-12  -  PLATE 157MM 12 HOLE BONE FIB L/L,"$1,054.55",$0.00,"$1,054.55",$474.55,$752.63,$0.00,$181.69,$0.00,$0.00,$184.64,"$1,054.55",$0.00,$527.28,$835.20,$843.64,$0.00,$165.04,$0.00,$167.88,$0.00
2347-16-14,SUP,HCPCS C1713,,2347-16-14  -  PLATE 178MM 14 HOLE BONE FIB L/L,"$1,125.85",$0.00,"$1,125.85",$506.63,$803.52,$0.00,$193.98,$0.00,$0.00,$197.13,"$1,125.85",$0.00,$562.93,$891.67,$900.68,$0.00,$176.20,$0.00,$179.24,$0.00
2347-16-16,SUP,HCPCS C1713,,2347-16-16  -  PLATE 199MM 16 HOLE BONE FIB L/L,"$1,220.15",$0.00,"$1,220.15",$549.07,$870.82,$0.00,$210.23,$0.00,$0.00,$213.64,"$1,220.15",$0.00,$610.08,$966.36,$976.12,$0.00,$190.95,$0.00,$194.25,$0.00
2347-16-18,SUP,HCPCS C1713,,2347-16-18  -  PLATE 220MM 18 HOLE BONE FIB L/L,"$1,315.60",$0.00,"$1,315.60",$592.02,$938.94,$0.00,$226.67,$0.00,$0.00,$230.35,"$1,315.60",$0.00,$657.80,"$1,041.96","$1,052.48",$0.00,$205.89,$0.00,$209.44,$0.00
2347-16-20,SUP,HCPCS C1713,,2347-16-20  -  PLATE 241MM 20 HOLE BONE FIB L/L,"$1,434.05",$0.00,"$1,434.05",$645.32,"$1,023.48",$0.00,$247.08,$0.00,$0.00,$251.09,"$1,434.05",$0.00,$717.03,"$1,135.77","$1,147.24",$0.00,$224.43,$0.00,$228.30,$0.00
2347-17-02,SUP,HCPCS C1713,,2347-17-02  -  PLATE 51MM 2 HOLE BONE FIB RIGHT,$846.40,$0.00,$846.40,$380.88,$604.08,$0.00,$145.83,$0.00,$0.00,$148.20,$846.40,$0.00,$423.20,$670.35,$677.12,$0.00,$132.46,$0.00,$134.75,$0.00
2347-17-04,SUP,HCPCS C1713,,2347-17-04  -  PLATE 73MM SS 4 HOLE BONE FIB RIGHT DISTAL LAT,$852.15,$0.00,$852.15,$383.47,$608.18,$0.00,$146.82,$0.00,$0.00,$149.20,$852.15,$0.00,$426.08,$674.90,$681.72,$0.00,$133.36,$0.00,$135.66,$0.00
2347-17-06,SUP,HCPCS C1713,,2347-17-06  -  PLATE 94MM SS 6 HOLE BONE FIB RIGHT DISTAL LAT,$863.65,$0.00,$863.65,$388.64,$616.39,$0.00,$148.80,$0.00,$0.00,$151.22,$863.65,$0.00,$431.83,$684.01,$690.92,$0.00,$135.16,$0.00,$137.49,$0.00
2347-17-08,SUP,HCPCS C1713,,2347-17-08  -  PLATE 115MM SS 8 HOLE BONE FIB RIGHT DISTAL LAT,$876.20,$0.00,$876.20,$394.29,$625.34,$0.00,$150.96,$0.00,$0.00,$153.42,$876.20,$0.00,$438.10,$693.95,$700.96,$0.00,$137.13,$0.00,$139.49,$0.00
2347-17-10,SUP,HCPCS C1713,,2347-17-10  -  PLATE 135MM SS 10 HOLE BONE FIB RIGHT DISTAL LAT,$966.00,$0.00,$966.00,$434.70,$689.43,$0.00,$166.44,$0.00,$0.00,$169.14,$966.00,$0.00,$483.00,$765.07,$772.80,$0.00,$151.18,$0.00,$153.79,$0.00
2347-17-12,SUP,HCPCS C1713,,2347-17-12  -  PLATE 156MM SS 12 HOLE BONE PERIART RIGHT FIB,"$1,054.55",$0.00,"$1,054.55",$474.55,$752.63,$0.00,$181.69,$0.00,$0.00,$184.64,"$1,054.55",$0.00,$527.28,$835.20,$843.64,$0.00,$165.04,$0.00,$167.88,$0.00
2347-17-14,SUP,HCPCS C1713,,2347-17-14  -  PLATE 177MM SS 14 HOLE BONE PERIART RIGHT FIB,"$1,125.85",$0.00,"$1,125.85",$506.63,$803.52,$0.00,$193.98,$0.00,$0.00,$197.13,"$1,125.85",$0.00,$562.93,$891.67,$900.68,$0.00,$176.20,$0.00,$179.24,$0.00
2347-17-16,SUP,HCPCS C1713,,2347-17-16  -  PLATE 198MM SS 16 HOLE BONE PERIART RIGHT FIB,"$1,220.15",$0.00,"$1,220.15",$549.07,$870.82,$0.00,$210.23,$0.00,$0.00,$213.64,"$1,220.15",$0.00,$610.08,$966.36,$976.12,$0.00,$190.95,$0.00,$194.25,$0.00
2347-17-18,SUP,HCPCS C1713,,2347-17-18  -  PLATE 219MM SS 18 HOLE BONE PERIART RIGHT FIB,"$1,315.60",$0.00,"$1,315.60",$592.02,$938.94,$0.00,$226.67,$0.00,$0.00,$230.35,"$1,315.60",$0.00,$657.80,"$1,041.96","$1,052.48",$0.00,$205.89,$0.00,$209.44,$0.00
2347-17-20,SUP,HCPCS C1713,,2347-17-20  -  PLATE 239MM SS 20 HOLE BONE PERIART RIGHT FIB,"$1,284.05",$0.00,"$1,284.05",$577.82,$916.43,$0.00,$221.24,$0.00,$0.00,$224.83,"$1,284.05",$0.00,$642.03,"$1,016.97","$1,027.24",$0.00,$200.95,$0.00,$204.42,$0.00
2347-18-02,SUP,HCPCS C1713,,2347-18-02  -  PLATE 51MM SS 2 HOLE BONE PERIART LEFT FIB,$846.40,$0.00,$846.40,$380.88,$604.08,$0.00,$145.83,$0.00,$0.00,$148.20,$846.40,$0.00,$423.20,$670.35,$677.12,$0.00,$132.46,$0.00,$134.75,$0.00
2347-18-04,SUP,HCPCS C1713,,2347-18-04  -  PLATE BN 73MM STRL 4 HL SS FIB LT DIST LAT PERIART,$852.15,$0.00,$852.15,$383.47,$608.18,$0.00,$146.82,$0.00,$0.00,$149.20,$852.15,$0.00,$426.08,$674.90,$681.72,$0.00,$133.36,$0.00,$135.66,$0.00
2347-18-06,SUP,HCPCS C1713,,2347-18-06  -  PLATE 94MM 6 HOLE BONE LEFT DISTAL LAT FIB,$863.65,$0.00,$863.65,$388.64,$616.39,$0.00,$148.80,$0.00,$0.00,$151.22,$863.65,$0.00,$431.83,$684.01,$690.92,$0.00,$135.16,$0.00,$137.49,$0.00
2347-18-08,SUP,HCPCS C1713,,2347-18-08  -  PLATE 115MM SS 8 HOLE BONE FIB LEFT DISTAL LAT,$876.20,$0.00,$876.20,$394.29,$625.34,$0.00,$150.96,$0.00,$0.00,$153.42,$876.20,$0.00,$438.10,$693.95,$700.96,$0.00,$137.13,$0.00,$139.49,$0.00
2347-18-10,SUP,HCPCS C1713,,2347-18-10  -  PLATE 135MM SS 10 HOLE BONE FIB LEFT DISTAL LAT,$966.00,$0.00,$966.00,$434.70,$689.43,$0.00,$166.44,$0.00,$0.00,$169.14,$966.00,$0.00,$483.00,$765.07,$772.80,$0.00,$151.18,$0.00,$153.79,$0.00
2347-18-12,SUP,HCPCS C1713,,2347-18-12  -  PLATE 156MM SS 12 HOLE BONE FIB LEFT DISTAL LAT,"$1,054.55",$0.00,"$1,054.55",$474.55,$752.63,$0.00,$181.69,$0.00,$0.00,$184.64,"$1,054.55",$0.00,$527.28,$835.20,$843.64,$0.00,$165.04,$0.00,$167.88,$0.00
2347-18-14,SUP,HCPCS C1713,,2347-18-14  -  PLATE 177MM SS 14 HOLE BONE FIB LEFT DISTAL LAT,"$1,125.85",$0.00,"$1,125.85",$506.63,$803.52,$0.00,$193.98,$0.00,$0.00,$197.13,"$1,125.85",$0.00,$562.93,$891.67,$900.68,$0.00,$176.20,$0.00,$179.24,$0.00
2347-18-16,SUP,HCPCS C1713,,2347-18-16  -  PLATE 198MM SS 16 HOLE BONE FIB LEFT DISTAL LAT,"$1,220.15",$0.00,"$1,220.15",$549.07,$870.82,$0.00,$210.23,$0.00,$0.00,$213.64,"$1,220.15",$0.00,$610.08,$966.36,$976.12,$0.00,$190.95,$0.00,$194.25,$0.00
2347-18-18,SUP,HCPCS C1713,,2347-18-18  -  PLATE 219MM SS 18 HOLE BONE FIB LEFT DISTAL LAT,"$1,300.60",$0.00,"$1,300.60",$585.27,$928.24,$0.00,$224.09,$0.00,$0.00,$227.72,"$1,300.60",$0.00,$650.30,"$1,030.08","$1,040.48",$0.00,$203.54,$0.00,$207.06,$0.00
2347-18-20,SUP,HCPCS C1713,,2347-18-20  -  PLATE 239MM SS 20 HOLE BONE FIB LEFT DISTAL LAT,"$1,434.05",$0.00,"$1,434.05",$645.32,"$1,023.48",$0.00,$247.08,$0.00,$0.00,$251.09,"$1,434.05",$0.00,$717.03,"$1,135.77","$1,147.24",$0.00,$224.43,$0.00,$228.30,$0.00
2348-12-35,SUP,HCPCS C1713,,2348-12-35  -  SCREW BN 3.5MM 2.7MM 12MM NS ST SS ELB CORT PERIART,$62.10,$0.00,$62.10,$27.95,$44.32,$0.00,$10.70,$0.00,$0.00,$10.87,$62.10,$0.00,$31.05,$49.18,$49.68,$0.00,$9.72,$0.00,$9.89,$0.00
2348-14-35,SUP,HCPCS C1713,,2348-14-35  -  SCREW BN 3.5MM 2.7MM 14MM NS ST SS ELB CORT PERIART,$62.10,$0.00,$62.10,$27.95,$44.32,$0.00,$10.70,$0.00,$0.00,$10.87,$62.10,$0.00,$31.05,$49.18,$49.68,$0.00,$9.72,$0.00,$9.89,$0.00
2348-16-35,SUP,HCPCS C1713,,2348-16-35  -  SCREW BN 3.5MM 2.7MM 16MM NS ST SS ELB CORT PERIART,$62.10,$0.00,$62.10,$27.95,$44.32,$0.00,$10.70,$0.00,$0.00,$10.87,$62.10,$0.00,$31.05,$49.18,$49.68,$0.00,$9.72,$0.00,$9.89,$0.00
2348-18-35,SUP,HCPCS C1713,,2348-18-35  -  SCREW BONE 3.5MM 2.7MM 18MM SELF TAP STAINLESS STEEL,$74.75,$0.00,$74.75,$33.64,$53.35,$0.00,$12.88,$0.00,$0.00,$13.09,$74.75,$0.00,$37.38,$59.20,$59.80,$0.00,$11.70,$0.00,$11.90,$0.00
2348-20-35,SUP,HCPCS C1713,,2348-20-35  -  SCREW BN 2.7MM 3.5MM 20MM ST CORT,$62.10,$0.00,$62.10,$27.95,$44.32,$0.00,$10.70,$0.00,$0.00,$10.87,$62.10,$0.00,$31.05,$49.18,$49.68,$0.00,$9.72,$0.00,$9.89,$0.00
2348-22-35,SUP,HCPCS C1713,,2348-22-35  -  SCREW BN 3.5MM 2.7MM 22MM NS ST SS ELB CORT PERIART,$62.10,$0.00,$62.10,$27.95,$44.32,$0.00,$10.70,$0.00,$0.00,$10.87,$62.10,$0.00,$31.05,$49.18,$49.68,$0.00,$9.72,$0.00,$9.89,$0.00
2348-24-35,SUP,HCPCS C1713,,2348-24-35  -  SCREW BN 3.5MM 2.7MM 24MM NS ST SS ELB CORT PERIART,$62.10,$0.00,$62.10,$27.95,$44.32,$0.00,$10.70,$0.00,$0.00,$10.87,$62.10,$0.00,$31.05,$49.18,$49.68,$0.00,$9.72,$0.00,$9.89,$0.00
2348-26-35,SUP,HCPCS C1713,,2348-26-35  -  SCREW BN 3.5MM 2.7MM 26MM NS ST SS ELB CORT PERIART,$62.10,$0.00,$62.10,$27.95,$44.32,$0.00,$10.70,$0.00,$0.00,$10.87,$62.10,$0.00,$31.05,$49.18,$49.68,$0.00,$9.72,$0.00,$9.89,$0.00
2348-28-35,SUP,HCPCS C1713,,2348-28-35  -  SCREW BN 3.5MM 2.7MM 28MM NS ST SS ELB CORT PERIART,$62.10,$0.00,$62.10,$27.95,$44.32,$0.00,$10.70,$0.00,$0.00,$10.87,$62.10,$0.00,$31.05,$49.18,$49.68,$0.00,$9.72,$0.00,$9.89,$0.00
2348-30-35,SUP,HCPCS C1713,,2348-30-35  -  SCREW BN 3.5MM 2.7MM 30MM NS ST SS ELB CORT PERIART,$62.10,$0.00,$62.10,$27.95,$44.32,$0.00,$10.70,$0.00,$0.00,$10.87,$62.10,$0.00,$31.05,$49.18,$49.68,$0.00,$9.72,$0.00,$9.89,$0.00
2348-32-35,SUP,HCPCS C1713,,2348-32-35  -  SCREW BN 3.5MM 2.7MM 32MM NS ST SS ELB CORT PERIART,$62.10,$0.00,$62.10,$27.95,$44.32,$0.00,$10.70,$0.00,$0.00,$10.87,$62.10,$0.00,$31.05,$49.18,$49.68,$0.00,$9.72,$0.00,$9.89,$0.00
2348-34-35,SUP,HCPCS C1713,,2348-34-35  -  SCREW BN 3.5MM 2.7MM 34MM NS ST SS ELB CORT PERIART,$62.10,$0.00,$62.10,$27.95,$44.32,$0.00,$10.70,$0.00,$0.00,$10.87,$62.10,$0.00,$31.05,$49.18,$49.68,$0.00,$9.72,$0.00,$9.89,$0.00
2348-36-35,SUP,HCPCS C1713,,2348-36-35  -  SCREW BN 3.5MM 2.7MM 36MM NS ST SS ELB CORT PERIART,$62.10,$0.00,$62.10,$27.95,$44.32,$0.00,$10.70,$0.00,$0.00,$10.87,$62.10,$0.00,$31.05,$49.18,$49.68,$0.00,$9.72,$0.00,$9.89,$0.00
2348-38-35,SUP,HCPCS C1713,,2348-38-35  -  SCREW BN 3.5MM 2.7MM 38MM NS ST SS ELB CORT PERIART,$62.10,$0.00,$62.10,$27.95,$44.32,$0.00,$10.70,$0.00,$0.00,$10.87,$62.10,$0.00,$31.05,$49.18,$49.68,$0.00,$9.72,$0.00,$9.89,$0.00
2348-40-35,SUP,HCPCS C1713,,2348-40-35  -  SCREW BN 3.5MM 2.7MM 40MM NS ST SS ELB CORT PERIART,$62.10,$0.00,$62.10,$27.95,$44.32,$0.00,$10.70,$0.00,$0.00,$10.87,$62.10,$0.00,$31.05,$49.18,$49.68,$0.00,$9.72,$0.00,$9.89,$0.00
2348-42-35,SUP,HCPCS C1713,,2348-42-35  -  SCREW BN 3.5MM 2.7MM 42MM NS ST SS ELB CORT PERIART,$62.10,$0.00,$62.10,$27.95,$44.32,$0.00,$10.70,$0.00,$0.00,$10.87,$62.10,$0.00,$31.05,$49.18,$49.68,$0.00,$9.72,$0.00,$9.89,$0.00
2348-44-35,SUP,HCPCS C1713,,2348-44-35  -  SCREW BN 3.5MM 2.7MM 44MM NS ST SS ELB CORT PERIART,$62.10,$0.00,$62.10,$27.95,$44.32,$0.00,$10.70,$0.00,$0.00,$10.87,$62.10,$0.00,$31.05,$49.18,$49.68,$0.00,$9.72,$0.00,$9.89,$0.00
2348-46-35,SUP,HCPCS C1713,,2348-46-35  -  SCREW BN 3.5MM 2.7MM 46MM NS ST SS ELB CORT PERIART,$60.85,$0.00,$60.85,$27.38,$43.43,$0.00,$10.48,$0.00,$0.00,$10.65,$60.85,$0.00,$30.43,$48.19,$48.68,$0.00,$9.52,$0.00,$9.69,$0.00
2348-48-35,SUP,HCPCS C1713,,2348-48-35  -  SCREW BN 3.5MM 2.7MM 48MM NS ST SS ELB CORT PERIART,$60.85,$0.00,$60.85,$27.38,$43.43,$0.00,$10.48,$0.00,$0.00,$10.65,$60.85,$0.00,$30.43,$48.19,$48.68,$0.00,$9.52,$0.00,$9.69,$0.00
2348-50-35,SUP,HCPCS C1713,,2348-50-35  -  SCREW BN 3.5MM 2.7MM 50MM NS ST SS ELB CORT PERIART,$60.85,$0.00,$60.85,$27.38,$43.43,$0.00,$10.48,$0.00,$0.00,$10.65,$60.85,$0.00,$30.43,$48.19,$48.68,$0.00,$9.52,$0.00,$9.69,$0.00
2348-52-35,SUP,HCPCS C1713,,2348-52-35  -  SCREW BN 3.5MM 2.7MM 52MM NS ST SS ELB CORT PERIART,$60.85,$0.00,$60.85,$27.38,$43.43,$0.00,$10.48,$0.00,$0.00,$10.65,$60.85,$0.00,$30.43,$48.19,$48.68,$0.00,$9.52,$0.00,$9.69,$0.00
2348-54-35,SUP,HCPCS C1713,,2348-54-35  -  SCREW BN 3.5MM 2.7MM 54MM NS ST SS ELB CORT PERIART,$60.85,$0.00,$60.85,$27.38,$43.43,$0.00,$10.48,$0.00,$0.00,$10.65,$60.85,$0.00,$30.43,$48.19,$48.68,$0.00,$9.52,$0.00,$9.69,$0.00
2348-56-35,SUP,HCPCS C1713,,2348-56-35  -  SCREW BN 3.5MM 2.7MM 56MM NS ST SS ELB CORT PERIART,$60.85,$0.00,$60.85,$27.38,$43.43,$0.00,$10.48,$0.00,$0.00,$10.65,$60.85,$0.00,$30.43,$48.19,$48.68,$0.00,$9.52,$0.00,$9.69,$0.00
2348-58-35,SUP,HCPCS C1713,,2348-58-35  -  SCREW BN 3.5MM 58MM PERIART,$60.85,$0.00,$60.85,$27.38,$43.43,$0.00,$10.48,$0.00,$0.00,$10.65,$60.85,$0.00,$30.43,$48.19,$48.68,$0.00,$9.52,$0.00,$9.69,$0.00
2348-60-35,SUP,HCPCS C1713,,2348-60-35  -  SCREW BN 3.5MM 2.7MM 60MM NS ST SS ELB CORT PERIART,$60.85,$0.00,$60.85,$27.38,$43.43,$0.00,$10.48,$0.00,$0.00,$10.65,$60.85,$0.00,$30.43,$48.19,$48.68,$0.00,$9.52,$0.00,$9.69,$0.00
2348-65-35,SUP,HCPCS C1713,,2348-65-35  -  SCREW BN 3.5MM 2.7MM 65MM NS ST SS ELB CORT PERIART,$60.85,$0.00,$60.85,$27.38,$43.43,$0.00,$10.48,$0.00,$0.00,$10.65,$60.85,$0.00,$30.43,$48.19,$48.68,$0.00,$9.52,$0.00,$9.69,$0.00
2348-70-35,SUP,HCPCS C1713,,2348-70-35  -  SCREW BN 3.5MM 2.7MM 70MM NS ST SS ELB CORT PERIART,$60.85,$0.00,$60.85,$27.38,$43.43,$0.00,$10.48,$0.00,$0.00,$10.65,$60.85,$0.00,$30.43,$48.19,$48.68,$0.00,$9.52,$0.00,$9.69,$0.00
2348-75-35,SUP,HCPCS C1713,,2348-75-35  -  SCREW BN 3.5MM 2.7MM 75MM NS ST SS ELB CORT PERIART,$60.85,$0.00,$60.85,$27.38,$43.43,$0.00,$10.48,$0.00,$0.00,$10.65,$60.85,$0.00,$30.43,$48.19,$48.68,$0.00,$9.52,$0.00,$9.69,$0.00
2348-80-35,SUP,HCPCS C1713,,2348-80-35  -  SCREW BN 3.5MM 2.7MM 80MM NS ST SS ELB CORT PERIART,$60.85,$0.00,$60.85,$27.38,$43.43,$0.00,$10.48,$0.00,$0.00,$10.65,$60.85,$0.00,$30.43,$48.19,$48.68,$0.00,$9.52,$0.00,$9.69,$0.00
2348-85-35,SUP,HCPCS C1713,,2348-85-35  -  SCREW BN 3.5MM 2.7MM 85MM NS ST SS ELB CORT PERIART,$60.85,$0.00,$60.85,$27.38,$43.43,$0.00,$10.48,$0.00,$0.00,$10.65,$60.85,$0.00,$30.43,$48.19,$48.68,$0.00,$9.52,$0.00,$9.69,$0.00
2348-90-35,SUP,HCPCS C1713,,2348-90-35  -  SCREW BN 3.5MM 2.7MM 90MM NS ST SS ELB CORT PERIART,$60.85,$0.00,$60.85,$27.38,$43.43,$0.00,$10.48,$0.00,$0.00,$10.65,$60.85,$0.00,$30.43,$48.19,$48.68,$0.00,$9.52,$0.00,$9.69,$0.00
2348-95-35,SUP,HCPCS C1713,,2348-95-35  -  SCREW BN 3.5MM 2.7MM 95MM NS ST SS ELB CORT PERIART,$60.85,$0.00,$60.85,$27.38,$43.43,$0.00,$10.48,$0.00,$0.00,$10.65,$60.85,$0.00,$30.43,$48.19,$48.68,$0.00,$9.52,$0.00,$9.69,$0.00
235-F,SUP,Custom 27803010,,235-F  -  PLATE 18MM TI BONE SPNL,"$1,623.50",$0.00,"$1,623.50",$0.00,"$1,158.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,623.50",$0.00,$811.75,"$1,285.81","$1,298.80",$0.00,$0.00,$0.00,$0.00,$0.00
236.504S,SUP,HCPCS C1713,,236.504S  -  PLATE BN CNTR 112MM STRL LCP CMBN 4 HL ELONGATE HL PROX TAB,"$1,755.08",$0.00,"$1,755.08",$789.78,"$1,252.60",$0.00,$293.58,$0.00,$0.00,$307.30,"$1,755.08",$0.00,$877.54,"$1,390.02","$1,404.06",$0.00,$266.67,$0.00,$279.41,$0.00
236-01,SUP,HCPCS C1713,,236-01  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$490.88,$0.00,$490.88,$220.89,$350.34,$0.00,$84.58,$0.00,$0.00,$85.95,$490.88,$0.00,$245.44,$388.78,$392.70,$0.00,$76.82,$0.00,$78.15,$0.00
236-02,SUP,HCPCS C1713,,236-02  -  PLATE 18MM TI BONE SPNL,$575.88,$0.00,$575.88,$259.14,$411.00,$0.00,$99.22,$0.00,$0.00,$100.83,$575.88,$0.00,$287.94,$456.10,$460.70,$0.00,$90.12,$0.00,$91.68,$0.00
236-04,SUP,HCPCS C1713,,236-04  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$735.25,$0.00,$735.25,$330.86,$524.75,$0.00,$126.68,$0.00,$0.00,$128.74,$735.25,$0.00,$367.63,$582.32,$588.20,$0.00,$115.07,$0.00,$117.05,$0.00
23-640-000,SUP,Custom 27203010,,MAS CARDIOIMMUNE XL LVL 1 3ML 6/PK,$315.00,$0.00,$315.00,$0.00,$224.82,$0.00,$0.00,$0.00,$0.00,$0.00,$315.00,$0.00,$157.50,$249.48,$252.00,$0.00,$0.00,$0.00,$0.00,$0.00
23-640-001,SUP,Custom 27203010,,MAS CARDIOIMMUNE XL LVL 2 3ML 6/PK,$315.00,$0.00,$315.00,$0.00,$224.82,$0.00,$0.00,$0.00,$0.00,$0.00,$315.00,$0.00,$157.50,$249.48,$252.00,$0.00,$0.00,$0.00,$0.00,$0.00
23-640-002,SUP,Custom 27203010,,MAS CARDIOIMMUNE XL LVL 3 3ML 6/PK,$315.00,$0.00,$315.00,$0.00,$224.82,$0.00,$0.00,$0.00,$0.00,$0.00,$315.00,$0.00,$157.50,$249.48,$252.00,$0.00,$0.00,$0.00,$0.00,$0.00
23-640-003,SUP,Custom 27203010,,MAS CARDIOIMMUNE XL LVL L 3ML 6/PK,$315.00,$0.00,$315.00,$0.00,$224.82,$0.00,$0.00,$0.00,$0.00,$0.00,$315.00,$0.00,$157.50,$249.48,$252.00,$0.00,$0.00,$0.00,$0.00,$0.00
23-666471,SUP,Custom 27203010,,REAGENT B-OHB R1 R2 50ML ANALY,$854.13,$0.00,$854.13,$0.00,$609.59,$0.00,$0.00,$0.00,$0.00,$0.00,$854.13,$0.00,$427.06,$676.47,$683.30,$0.00,$0.00,$0.00,$0.00,$0.00
23-666472,SUP,Custom 27203010,,CONTROL CHM 5ML SET B-OHB,$723.00,$0.00,$723.00,$0.00,$516.01,$0.00,$0.00,$0.00,$0.00,$0.00,$723.00,$0.00,$361.50,$572.62,$578.40,$0.00,$0.00,$0.00,$0.00,$0.00
237.043S,SUP,HCPCS C1713,,237.043S  -  PLATE BONE 90D 30MM 4 HOLE LIMITED CONTACT ANGLED BLADE CANN,"$1,629.75",$0.00,"$1,629.75",$733.39,"$1,163.15",$0.00,$280.80,$0.00,$0.00,$285.36,"$1,629.75",$0.00,$814.88,"$1,290.76","$1,303.80",$0.00,$255.06,$0.00,$259.46,$0.00
237.044S,SUP,HCPCS C1713,,237.044S  -  PLATE BONE 90D 40MM 4 HOLE LIMITED CONTACT ANGLED BLADE CANN,"$1,629.75",$0.00,"$1,629.75",$733.39,"$1,163.15",$0.00,$280.80,$0.00,$0.00,$285.36,"$1,629.75",$0.00,$814.88,"$1,290.76","$1,303.80",$0.00,$255.06,$0.00,$259.46,$0.00
237.053S,SUP,HCPCS C1713,,237.053S  -  PLATE BN 90D 30X11.7MM STRL 5 HL LMT CNTCT CNN SS 4.5MM SCR,"$1,629.75",$0.00,"$1,629.75",$733.39,"$1,163.15",$0.00,$280.80,$0.00,$0.00,$285.36,"$1,629.75",$0.00,$814.88,"$1,290.76","$1,303.80",$0.00,$255.06,$0.00,$259.46,$0.00
237.054S,SUP,HCPCS C1713,,237.054S  -  PLATE BONE 90D 40MM 5 HOLE LIMITED CONTACT ANGLED BLADE CANN,"$1,629.75",$0.00,"$1,629.75",$733.39,"$1,163.15",$0.00,$280.80,$0.00,$0.00,$285.36,"$1,629.75",$0.00,$814.88,"$1,290.76","$1,303.80",$0.00,$255.06,$0.00,$259.46,$0.00
237.063S,SUP,HCPCS C1713,,237.063S  -  PLATE BONE 90D 30MM 6 HOLE LIMITED CONTACT ANGLED BLADE CANN,"$1,629.75",$0.00,"$1,629.75",$733.39,"$1,163.15",$0.00,$280.80,$0.00,$0.00,$285.36,"$1,629.75",$0.00,$814.88,"$1,290.76","$1,303.80",$0.00,$255.06,$0.00,$259.46,$0.00
237.064S,SUP,HCPCS C1713,,237.064S  -  PLATE BONE 90D 40MM 6 HOLE LIMITED CONTACT ANGLED BLADE CANN,"$1,629.75",$0.00,"$1,629.75",$733.39,"$1,163.15",$0.00,$280.80,$0.00,$0.00,$285.36,"$1,629.75",$0.00,$814.88,"$1,290.76","$1,303.80",$0.00,$255.06,$0.00,$259.46,$0.00
237.083S,SUP,HCPCS C1713,,237.083S  -  PLATE BONE 90D 30MM 8 HOLE LIMITED CONTACT ANGLED BLADE CANN,"$1,629.75",$0.00,"$1,629.75",$733.39,"$1,163.15",$0.00,$280.80,$0.00,$0.00,$285.36,"$1,629.75",$0.00,$814.88,"$1,290.76","$1,303.80",$0.00,$255.06,$0.00,$259.46,$0.00
237.084S,SUP,HCPCS C1713,,237.084S  -  PLATE BONE 90D 40MM 8 HOLE LIMITED CONTACT ANGLED BLADE CANN,"$1,629.75",$0.00,"$1,629.75",$733.39,"$1,163.15",$0.00,$280.80,$0.00,$0.00,$285.36,"$1,629.75",$0.00,$814.88,"$1,290.76","$1,303.80",$0.00,$255.06,$0.00,$259.46,$0.00
237.085S,SUP,HCPCS C1713,,237.085S  -  PLATE BONE 90D 50MM 8 HOLE LIMITED CONTACT ANGLED BLADE CANN,"$1,629.75",$0.00,"$1,629.75",$733.39,"$1,163.15",$0.00,$280.80,$0.00,$0.00,$285.36,"$1,629.75",$0.00,$814.88,"$1,290.76","$1,303.80",$0.00,$255.06,$0.00,$259.46,$0.00
237.086S,SUP,HCPCS C1713,,237.086S  -  PLATE BN 90D 60X11.7MM STRL 8 HL LMT CNTCT CNN SS 4.5MM SCR,"$1,629.75",$0.00,"$1,629.75",$733.39,"$1,163.15",$0.00,$280.80,$0.00,$0.00,$285.36,"$1,629.75",$0.00,$814.88,"$1,290.76","$1,303.80",$0.00,$255.06,$0.00,$259.46,$0.00
237.103S,SUP,HCPCS C1713,,237.103S  -  PLATE BONE 90D 30MM 10 HOLE LIMITED CONTACT ANGLED BLADE,"$2,134.58",$0.00,"$2,134.58",$960.56,"$1,523.45",$0.00,$367.78,$0.00,$0.00,$373.75,"$2,134.58",$0.00,"$1,067.29","$1,690.59","$1,707.66",$0.00,$334.06,$0.00,$339.82,$0.00
237.104S,SUP,HCPCS C1713,,237.104S  -  PLATE BONE 90D 40MM 10 HOLE LIMITED CONTACT ANGLED BLADE,"$2,134.58",$0.00,"$2,134.58",$960.56,"$1,523.45",$0.00,$367.78,$0.00,$0.00,$373.75,"$2,134.58",$0.00,"$1,067.29","$1,690.59","$1,707.66",$0.00,$334.06,$0.00,$339.82,$0.00
237.105S,SUP,HCPCS C1713,,237.105S  -  PLATE BONE 90D 50MM 10 HOLE LIMITED CONTACT ANGLED BLADE,"$2,134.58",$0.00,"$2,134.58",$960.56,"$1,523.45",$0.00,$367.78,$0.00,$0.00,$373.75,"$2,134.58",$0.00,"$1,067.29","$1,690.59","$1,707.66",$0.00,$334.06,$0.00,$339.82,$0.00
237.106S,SUP,HCPCS C1713,,237.106S  -  PLATE BONE 90D 60MM 10 HOLE LIMITED CONTACT ANGLED BLADE,"$2,134.58",$0.00,"$2,134.58",$960.56,"$1,523.45",$0.00,$367.78,$0.00,$0.00,$373.75,"$2,134.58",$0.00,"$1,067.29","$1,690.59","$1,707.66",$0.00,$334.06,$0.00,$339.82,$0.00
237.123S,SUP,HCPCS C1713,,237.123S  -  PLATE BONE 90D 30MM 12 HOLE LIMITED CONTACT ANGLED BLADE,"$2,134.58",$0.00,"$2,134.58",$960.56,"$1,523.45",$0.00,$367.78,$0.00,$0.00,$373.75,"$2,134.58",$0.00,"$1,067.29","$1,690.59","$1,707.66",$0.00,$334.06,$0.00,$339.82,$0.00
237.124S,SUP,HCPCS C1713,,237.124S  -  PLATE BONE 90D 40MM 220MM 12 HOLE SHAFT LCP STAINLESS STEEL,"$2,134.58",$0.00,"$2,134.58",$960.56,"$1,523.45",$0.00,$367.78,$0.00,$0.00,$373.75,"$2,134.58",$0.00,"$1,067.29","$1,690.59","$1,707.66",$0.00,$334.06,$0.00,$339.82,$0.00
237.125S,SUP,HCPCS C1713,,237.125S  -  PLATE BONE 90D 50MM 12 HOLE LIMITED CONTACT ANGLED BLADE,"$2,134.58",$0.00,"$2,134.58",$960.56,"$1,523.45",$0.00,$367.78,$0.00,$0.00,$373.75,"$2,134.58",$0.00,"$1,067.29","$1,690.59","$1,707.66",$0.00,$334.06,$0.00,$339.82,$0.00
237.126S,SUP,HCPCS C1713,,237.126S  -  PLATE BONE 90D 60MM 12 HOLE LIMITED CONTACT ANGLED BLADE,"$2,134.58",$0.00,"$2,134.58",$960.56,"$1,523.45",$0.00,$367.78,$0.00,$0.00,$373.75,"$2,134.58",$0.00,"$1,067.29","$1,690.59","$1,707.66",$0.00,$334.06,$0.00,$339.82,$0.00
237.143S,SUP,HCPCS C1713,,237.143S  -  PLATE BONE 90D 30MM 14 HOLE LIMITED CONTACT ANGLED BLADE,"$2,709.63",$0.00,"$2,709.63","$1,219.33","$1,933.86",$0.00,$466.85,$0.00,$0.00,$474.43,"$2,709.63",$0.00,"$1,354.81","$2,146.03","$2,167.70",$0.00,$424.06,$0.00,$431.37,$0.00
237.144S,SUP,HCPCS C1713,,237.144S  -  PLATE BONE 90D 40MM 14 HOLE LIMITED CONTACT ANGLED BLADE,"$2,709.63",$0.00,"$2,709.63","$1,219.33","$1,933.86",$0.00,$466.85,$0.00,$0.00,$474.43,"$2,709.63",$0.00,"$1,354.81","$2,146.03","$2,167.70",$0.00,$424.06,$0.00,$431.37,$0.00
237.145S,SUP,HCPCS C1713,,237.145S  -  PLATE BONE 90D 50MM 14 HOLE LIMITED CONTACT ANGLED BLADE,"$2,709.63",$0.00,"$2,709.63","$1,219.33","$1,933.86",$0.00,$466.85,$0.00,$0.00,$474.43,"$2,709.63",$0.00,"$1,354.81","$2,146.03","$2,167.70",$0.00,$424.06,$0.00,$431.37,$0.00
237.146S,SUP,HCPCS C1713,,237.146S  -  PLATE BONE 90D 60MM 14 HOLE LIMITED CONTACT ANGLED BLADE,"$2,709.63",$0.00,"$2,709.63","$1,219.33","$1,933.86",$0.00,$466.85,$0.00,$0.00,$474.43,"$2,709.63",$0.00,"$1,354.81","$2,146.03","$2,167.70",$0.00,$424.06,$0.00,$431.37,$0.00
237020T5,SUP,HCPCS C1713,,237020T5  -  SCREW INTFR PLA 20MM 7.3MM ACL BABSR SLF REINF MATRYX STRL,$725.00,$0.00,$725.00,$326.25,$517.43,$0.00,$124.91,$0.00,$0.00,$126.94,$725.00,$0.00,$362.50,$574.20,$580.00,$0.00,$113.46,$0.00,$115.42,$0.00
238020T5,SUP,HCPCS C1713,,238020T5  -  SCREW BABSR 20MM 8MM MATRYX,$725.00,$0.00,$725.00,$326.25,$517.43,$0.00,$124.91,$0.00,$0.00,$126.94,$725.00,$0.00,$362.50,$574.20,$580.00,$0.00,$113.46,$0.00,$115.42,$0.00
23-875-595,SUP,Custom 27203010,,KIT BIOSTAR ACV HCG CNTRL POS NEG MCBLTST,$187.50,$0.00,$187.50,$0.00,$133.82,$0.00,$0.00,$0.00,$0.00,$0.00,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$0.00,$0.00,$0.00,$0.00
239.955S,SUP,HCPCS C1713,,239.955S  -  PLATE 93MM SS 3.5MM SCR 4 HOLE SM FRAG LCP BONE OD LEFT MDL,"$3,143.98",$0.00,"$3,143.98","$1,414.79","$2,243.85",$0.00,$541.69,$0.00,$0.00,$550.48,"$3,143.98",$0.00,"$1,571.99","$2,490.03","$2,515.18",$0.00,$492.03,$0.00,$500.52,$0.00
239.986S,SUP,HCPCS C1713,,239.986S  -  PLATE BN CNTR 142MM STRL LCP CMBN 6 HL LMT CNTCT SS TIB RT,"$2,707.68",$0.00,"$2,707.68","$1,218.45","$1,932.47",$0.00,$452.93,$0.00,$0.00,$474.09,"$2,707.68",$0.00,"$1,353.84","$2,144.48","$2,166.14",$0.00,$411.41,$0.00,$431.06,$0.00
23AGFN-756,SUP,Custom 27803010,,23AGFN-756  -  VALVE AOR 85D 23MM 21.4MM REGENT FLEXCUFF 1 DGT GRDNT LFLT,"$11,750.00",$0.00,"$11,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,750.00",$0.00,"$5,875.00","$9,306.00","$9,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
23AJ-501,SUP,Custom 27803010,,23AJ-501  -  VALVE AOR 85D STD 23MM 18.6MM MSTR-SER CUF LFLT OPN CNTRL,"$10,000.00",$0.00,"$10,000.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
240.048S,SUP,HCPCS C1713,,240.048S  -  PLATE BN CNTR 298MM STRL LCP CMBN 4 HL LMT CNTCT TPR END SS,"$2,935.58",$0.00,"$2,935.58","$1,321.01","$2,095.12",$0.00,$491.05,$0.00,$0.00,$514.00,"$2,935.58",$0.00,"$1,467.79","$2,324.98","$2,348.46",$0.00,$446.04,$0.00,$467.34,$0.00
240.049S,SUP,HCPCS C1713,,240.049S  -  PLATE BONE 298MM 16 HOLE LCP STAINLESS STEEL TIBIA LEFT,"$2,935.58",$0.00,"$2,935.58","$1,321.01","$2,095.12",$0.00,$491.05,$0.00,$0.00,$514.00,"$2,935.58",$0.00,"$1,467.79","$2,324.98","$2,348.46",$0.00,$446.04,$0.00,$467.34,$0.00
240.052S,SUP,HCPCS C1713,,240.052S  -  PLATE BONE 334MM 18 HOLE LOCKING LCP STAINLESS STEEL,"$2,991.53",$0.00,"$2,991.53","$1,346.19","$2,135.05",$0.00,$500.41,$0.00,$0.00,$523.79,"$2,991.53",$0.00,"$1,495.76","$2,369.29","$2,393.22",$0.00,$454.54,$0.00,$476.25,$0.00
240.053S,SUP,HCPCS C1713,,240.053S  -  PLATE BONE 334MM 18 HOLE LCP STAINLESS STEEL TIBIA LEFT,"$2,991.53",$0.00,"$2,991.53","$1,346.19","$2,135.05",$0.00,$500.41,$0.00,$0.00,$523.79,"$2,991.53",$0.00,"$1,495.76","$2,369.29","$2,393.22",$0.00,$454.54,$0.00,$476.25,$0.00
240.054S,SUP,HCPCS C1713,,240.054S  -  PLATE BONE 370MM 20 HOLE LOCKING LCP STAINLESS STEEL,"$3,048.85",$0.00,"$3,048.85","$1,371.98","$2,175.96",$0.00,$510.00,$0.00,$0.00,$533.83,"$3,048.85",$0.00,"$1,524.43","$2,414.69","$2,439.08",$0.00,$463.25,$0.00,$485.38,$0.00
240.055S,SUP,HCPCS C1713,,240.055S  -  PLATE BONE 370MM 20 HOLE LOCKING LCP STAINLESS STEEL,"$3,048.85",$0.00,"$3,048.85","$1,371.98","$2,175.96",$0.00,$510.00,$0.00,$0.00,$533.83,"$3,048.85",$0.00,"$1,524.43","$2,414.69","$2,439.08",$0.00,$463.25,$0.00,$485.38,$0.00
24003 L,SUP,Custom 27803010,,24003 L  -  PLATE 18MM TI BONE SPNL,"$2,147.00",$0.00,"$2,147.00",$0.00,"$1,532.31",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,147.00",$0.00,"$1,073.50","$1,700.42","$1,717.60",$0.00,$0.00,$0.00,$0.00,$0.00
24003 LL,SUP,Custom 27803010,,24003 LL  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,147.00",$0.00,"$2,147.00",$0.00,"$1,532.31",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,147.00",$0.00,"$1,073.50","$1,700.42","$1,717.60",$0.00,$0.00,$0.00,$0.00,$0.00
24003 M,SUP,Custom 27803010,,24003 M  -  PLATE 18MM TI BONE SPNL,"$2,147.00",$0.00,"$2,147.00",$0.00,"$1,532.31",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,147.00",$0.00,"$1,073.50","$1,700.42","$1,717.60",$0.00,$0.00,$0.00,$0.00,$0.00
24004 B,SUP,Custom 27803010,,24004 B  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$501.13,$0.00,$501.13,$0.00,$357.65,$0.00,$0.00,$0.00,$0.00,$0.00,$501.13,$0.00,$250.56,$396.89,$400.90,$0.00,$0.00,$0.00,$0.00,$0.00
2400-58,SUP,Custom 27203010,,2400-58  -  CATHETER CHOLANGIOGRAM 50CM REDDICK CYSTIC DUCT STERILE,"$1,499.38",$0.00,"$1,499.38",$0.00,"$1,070.10",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,499.38",$0.00,$749.69,"$1,187.51","$1,199.50",$0.00,$0.00,$0.00,$0.00,$0.00
24013-1,SUP,Custom 27803010,,24013-1  -  PLATE 18MM TI BONE SPNL,"$4,723.88",$0.00,"$4,723.88",$0.00,"$3,371.43",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,723.88",$0.00,"$2,361.94","$3,741.31","$3,779.10",$0.00,$0.00,$0.00,$0.00,$0.00
24013-2,SUP,Custom 27803010,,24013-2  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$4,723.88",$0.00,"$4,723.88",$0.00,"$3,371.43",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,723.88",$0.00,"$2,361.94","$3,741.31","$3,779.10",$0.00,$0.00,$0.00,$0.00,$0.00
24013-5,SUP,Custom 27803010,,24013-5  -  PLATE 18MM TI BONE SPNL,"$4,723.88",$0.00,"$4,723.88",$0.00,"$3,371.43",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,723.88",$0.00,"$2,361.94","$3,741.31","$3,779.10",$0.00,$0.00,$0.00,$0.00,$0.00
24-025-01-09,SUP,HCPCS C1713,,24-025-01-09  -  STERNAL LCK PLATE 6 HOLE XIPHOID PLATE 2.0MM THICK,$718.25,$0.00,$718.25,$323.21,$512.62,$0.00,$123.75,$0.00,$0.00,$125.76,$718.25,$0.00,$359.13,$568.85,$574.60,$0.00,$112.41,$0.00,$114.35,$0.00
24-025-03-09,SUP,HCPCS C1713,,24-025-03-09  -  STERNAL LOCK PLATE 10 HOLE BODY PLATE 2.0MM THICK,$967.20,$0.00,$967.20,$435.24,$690.29,$0.00,$166.64,$0.00,$0.00,$169.35,$967.20,$0.00,$483.60,$766.02,$773.76,$0.00,$151.37,$0.00,$153.98,$0.00
24-025-04-09,SUP,HCPCS C1713,,24-025-04-09  -  STERNAL LOCK PLATE 14 HOLE MANUBRIUM PLATE 2.0MM THICK,"$1,212.53",$0.00,"$1,212.53",$545.64,$865.38,$0.00,$208.91,$0.00,$0.00,$212.30,"$1,212.53",$0.00,$606.26,$960.32,$970.02,$0.00,$189.76,$0.00,$193.03,$0.00
24027-1,SUP,Custom 27803010,,24027-1  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$4,754.75",$0.00,"$4,754.75",$0.00,"$3,393.47",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,754.75",$0.00,"$2,377.38","$3,765.76","$3,803.80",$0.00,$0.00,$0.00,$0.00,$0.00
24027-2,SUP,Custom 27803010,,24027-2  -  PLATE 18MM TI BONE SPNL,"$4,754.75",$0.00,"$4,754.75",$0.00,"$3,393.47",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,754.75",$0.00,"$2,377.38","$3,765.76","$3,803.80",$0.00,$0.00,$0.00,$0.00,$0.00
24027-4,SUP,Custom 27803010,,24027-4  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$4,657.38",$0.00,"$4,657.38",$0.00,"$3,323.97",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,657.38",$0.00,"$2,328.69","$3,688.64","$3,725.90",$0.00,$0.00,$0.00,$0.00,$0.00
24027-5,SUP,Custom 27803010,,24027-5  -  PLATE 18MM TI BONE SPNL,"$4,754.75",$0.00,"$4,754.75",$0.00,"$3,393.47",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,754.75",$0.00,"$2,377.38","$3,765.76","$3,803.80",$0.00,$0.00,$0.00,$0.00,$0.00
24028-1,SUP,Custom 27803010,,24028-1  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$4,754.75",$0.00,"$4,754.75",$0.00,"$3,393.47",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,754.75",$0.00,"$2,377.38","$3,765.76","$3,803.80",$0.00,$0.00,$0.00,$0.00,$0.00
24028-2,SUP,Custom 27803010,,24028-2  -  PLATE 18MM TI BONE SPNL,"$4,754.75",$0.00,"$4,754.75",$0.00,"$3,393.47",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,754.75",$0.00,"$2,377.38","$3,765.76","$3,803.80",$0.00,$0.00,$0.00,$0.00,$0.00
24028-5,SUP,Custom 27803010,,24028-5  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$4,754.75",$0.00,"$4,754.75",$0.00,"$3,393.47",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,754.75",$0.00,"$2,377.38","$3,765.76","$3,803.80",$0.00,$0.00,$0.00,$0.00,$0.00
24039-1,SUP,Custom 27803010,,24039-1  -  PLATE 18MM TI BONE SPNL,"$4,094.50",$0.00,"$4,094.50",$0.00,"$2,922.24",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,094.50",$0.00,"$2,047.25","$3,242.84","$3,275.60",$0.00,$0.00,$0.00,$0.00,$0.00
24039-2,SUP,Custom 27803010,,24039-2  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$4,094.50",$0.00,"$4,094.50",$0.00,"$2,922.24",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,094.50",$0.00,"$2,047.25","$3,242.84","$3,275.60",$0.00,$0.00,$0.00,$0.00,$0.00
24039-5,SUP,Custom 27203010,,24039-5  -  PLATE 18MM TI BONE SPNL,"$4,094.50",$0.00,"$4,094.50",$0.00,"$2,922.24",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,094.50",$0.00,"$2,047.25","$3,242.84","$3,275.60",$0.00,$0.00,$0.00,$0.00,$0.00
24079-1,SUP,Custom 27803010,,24079-1  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$4,723.88",$0.00,"$4,723.88",$0.00,"$3,371.43",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,723.88",$0.00,"$2,361.94","$3,741.31","$3,779.10",$0.00,$0.00,$0.00,$0.00,$0.00
24079-2,SUP,Custom 27803010,,24079-2  -  PLATE 18MM TI BONE SPNL,"$5,526.63",$0.00,"$5,526.63",$0.00,"$3,944.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,526.63",$0.00,"$2,763.31","$4,377.09","$4,421.30",$0.00,$0.00,$0.00,$0.00,$0.00
24079-5,SUP,Custom 27803010,,24079-5  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$4,723.88",$0.00,"$4,723.88",$0.00,"$3,371.43",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,723.88",$0.00,"$2,361.94","$3,741.31","$3,779.10",$0.00,$0.00,$0.00,$0.00,$0.00
24088 C,SUP,Custom 27803010,,24088 C  -  PLATE 18MM TI BONE SPNL,$501.13,$0.00,$501.13,$0.00,$357.65,$0.00,$0.00,$0.00,$0.00,$0.00,$501.13,$0.00,$250.56,$396.89,$400.90,$0.00,$0.00,$0.00,$0.00,$0.00
24088 D,SUP,Custom 27803010,,24088 D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$501.13,$0.00,$501.13,$0.00,$357.65,$0.00,$0.00,$0.00,$0.00,$0.00,$501.13,$0.00,$250.56,$396.89,$400.90,$0.00,$0.00,$0.00,$0.00,$0.00
241.072S,SUP,HCPCS C1713,,241.072S  -  PLATE BN 12MM 70MM STRL LCP CMBN 4 HL HK PRECONTOUR RND SHFT,"$1,430.25",$0.00,"$1,430.25",$643.61,"$1,020.77",$0.00,$239.25,$0.00,$0.00,$250.43,"$1,430.25",$0.00,$715.13,"$1,132.76","$1,144.20",$0.00,$217.32,$0.00,$227.70,$0.00
241.073S,SUP,HCPCS C1713,,241.073S  -  PLATE BONE 12MM 4 HOLE HOOK LCP STAINLESS STEEL LEFT,"$1,430.25",$0.00,"$1,430.25",$643.61,"$1,020.77",$0.00,$239.25,$0.00,$0.00,$250.43,"$1,430.25",$0.00,$715.13,"$1,132.76","$1,144.20",$0.00,$217.32,$0.00,$227.70,$0.00
241.074S,SUP,HCPCS C1713,,241.074S  -  PLATE BN 15MM 70MM STRL LCP CMBN 4 HL HK PRECONTOUR RND SHFT,"$1,430.25",$0.00,"$1,430.25",$643.61,"$1,020.77",$0.00,$239.25,$0.00,$0.00,$250.43,"$1,430.25",$0.00,$715.13,"$1,132.76","$1,144.20",$0.00,$217.32,$0.00,$227.70,$0.00
241.075S,SUP,HCPCS C1713,,241.075S  -  PLATE BN 15MM 70MM STRL LCP CMBN 4 HL HK PRECONTOUR RND SHFT,"$1,430.25",$0.00,"$1,430.25",$643.61,"$1,020.77",$0.00,$239.25,$0.00,$0.00,$250.43,"$1,430.25",$0.00,$715.13,"$1,132.76","$1,144.20",$0.00,$217.32,$0.00,$227.70,$0.00
241.076S,SUP,HCPCS C1713,,241.076S  -  PLATE BN 18MM 70MM STRL LCP CMBN 4 HL HK PRECONTOUR RND SHFT,"$1,430.25",$0.00,"$1,430.25",$643.61,"$1,020.77",$0.00,$239.25,$0.00,$0.00,$250.43,"$1,430.25",$0.00,$715.13,"$1,132.76","$1,144.20",$0.00,$217.32,$0.00,$227.70,$0.00
241.077S,SUP,HCPCS C1713,,241.077S  -  PLATE BONE 18MM 4 HOLE HOOK PRECONTOUR LCP STAINLESS STEEL,"$1,430.25",$0.00,"$1,430.25",$643.61,"$1,020.77",$0.00,$239.25,$0.00,$0.00,$250.43,"$1,430.25",$0.00,$715.13,"$1,132.76","$1,144.20",$0.00,$217.32,$0.00,$227.70,$0.00
241.082S,SUP,HCPCS C1713,,241.082S  -  PLATE BONE 12MM 5 HOLE HOOK LCP STAINLESS STEEL RIGHT,"$1,495.78",$0.00,"$1,495.78",$673.10,"$1,067.53",$0.00,$250.21,$0.00,$0.00,$261.90,"$1,495.78",$0.00,$747.89,"$1,184.66","$1,196.62",$0.00,$227.27,$0.00,$238.13,$0.00
241.083S,SUP,HCPCS C1713,,241.083S  -  PLATE BONE 12MM 5 HOLE HOOK LCP STAINLESS STEEL LEFT,"$1,495.78",$0.00,"$1,495.78",$673.10,"$1,067.53",$0.00,$250.21,$0.00,$0.00,$261.90,"$1,495.78",$0.00,$747.89,"$1,184.66","$1,196.62",$0.00,$227.27,$0.00,$238.13,$0.00
241.084S,SUP,HCPCS C1713,,241.084S  -  PLATE BN 15MM 85MM STRL LCP CMBN 5 HL HK PRECONTOUR RND SHFT,"$1,495.78",$0.00,"$1,495.78",$673.10,"$1,067.53",$0.00,$250.21,$0.00,$0.00,$261.90,"$1,495.78",$0.00,$747.89,"$1,184.66","$1,196.62",$0.00,$227.27,$0.00,$238.13,$0.00
241.085S,SUP,HCPCS C1713,,241.085S  -  PLATE BONE 15MM 5 HOLE HOOK LCP STAINLESS STEEL LEFT,"$1,495.78",$0.00,"$1,495.78",$673.10,"$1,067.53",$0.00,$250.21,$0.00,$0.00,$261.90,"$1,495.78",$0.00,$747.89,"$1,184.66","$1,196.62",$0.00,$227.27,$0.00,$238.13,$0.00
241.086S,SUP,HCPCS C1713,,241.086S  -  PLATE BN 18MM 85MM STRL LCP CMBN 5 HL HK PRECONTOUR RND SHFT,"$1,495.78",$0.00,"$1,495.78",$673.10,"$1,067.53",$0.00,$250.21,$0.00,$0.00,$261.90,"$1,495.78",$0.00,$747.89,"$1,184.66","$1,196.62",$0.00,$227.27,$0.00,$238.13,$0.00
241.087S,SUP,HCPCS C1713,,241.087S  -  PLATE BN 18MM 85MM STRL LCP CMBN 5 HL HK PRECONTOUR RND SHFT,"$1,495.78",$0.00,"$1,495.78",$673.10,"$1,067.53",$0.00,$250.21,$0.00,$0.00,$261.90,"$1,495.78",$0.00,$747.89,"$1,184.66","$1,196.62",$0.00,$227.27,$0.00,$238.13,$0.00
241.094S,SUP,HCPCS C1713,,241.094S  -  PLATE BN 15MM 99MM STRL LCP CMBN 6 HL HK PRECONTOUR RND SHFT,"$1,538.08",$0.00,"$1,538.08",$692.13,"$1,097.72",$0.00,$257.28,$0.00,$0.00,$269.30,"$1,538.08",$0.00,$769.04,"$1,218.16","$1,230.46",$0.00,$233.70,$0.00,$244.86,$0.00
241.095S,SUP,HCPCS C1713,,241.095S  -  PLATE BN 15MM 99MM STRL LCP CMBN 6 HL HK PRECONTOUR RND SHFT,"$1,538.08",$0.00,"$1,538.08",$692.13,"$1,097.72",$0.00,$257.28,$0.00,$0.00,$269.30,"$1,538.08",$0.00,$769.04,"$1,218.16","$1,230.46",$0.00,$233.70,$0.00,$244.86,$0.00
241.096S,SUP,HCPCS C1713,,241.096S  -  PLATE BN 18MM 99MM STRL LCP CMBN 6 HL HK PRECONTOUR RND SHFT,"$1,538.08",$0.00,"$1,538.08",$692.13,"$1,097.72",$0.00,$257.28,$0.00,$0.00,$269.30,"$1,538.08",$0.00,$769.04,"$1,218.16","$1,230.46",$0.00,$233.70,$0.00,$244.86,$0.00
241.097S,SUP,HCPCS C1713,,241.097S  -  PLATE BONE 18MM 6 HOLE HOOK LCP STAINLESS STEEL LEFT,"$1,538.08",$0.00,"$1,538.08",$692.13,"$1,097.72",$0.00,$257.28,$0.00,$0.00,$269.30,"$1,538.08",$0.00,$769.04,"$1,218.16","$1,230.46",$0.00,$233.70,$0.00,$244.86,$0.00
241.104S,SUP,HCPCS C1713,,241.104S  -  PLATE BONE 15MM 7 HOLE HOOK LCP STAINLESS STEEL RIGHT,"$1,603.58",$0.00,"$1,603.58",$721.61,"$1,144.47",$0.00,$268.24,$0.00,$0.00,$280.77,"$1,603.58",$0.00,$801.79,"$1,270.04","$1,282.86",$0.00,$243.65,$0.00,$255.29,$0.00
241.105S,SUP,HCPCS C1713,,241.105S  -  PLATE BONE 15MM 7 HOLE HOOK LCP STAINLESS STEEL LEFT,"$1,603.58",$0.00,"$1,603.58",$721.61,"$1,144.47",$0.00,$268.24,$0.00,$0.00,$280.77,"$1,603.58",$0.00,$801.79,"$1,270.04","$1,282.86",$0.00,$243.65,$0.00,$255.29,$0.00
241.106S,SUP,HCPCS C1713,,241.106S  -  PLATE BONE 18MM 7 HOLE HOOK LCP STAINLESS STEEL RIGHT,"$1,603.58",$0.00,"$1,603.58",$721.61,"$1,144.47",$0.00,$268.24,$0.00,$0.00,$280.77,"$1,603.58",$0.00,$801.79,"$1,270.04","$1,282.86",$0.00,$243.65,$0.00,$255.29,$0.00
241.107S,SUP,HCPCS C1713,,241.107S  -  PLATE BONE 18MM 7 HOLE HOOK LCP STAINLESS STEEL LEFT,"$1,603.58",$0.00,"$1,603.58",$721.61,"$1,144.47",$0.00,$268.24,$0.00,$0.00,$280.77,"$1,603.58",$0.00,$801.79,"$1,270.04","$1,282.86",$0.00,$243.65,$0.00,$255.29,$0.00
241.266S,SUP,HCPCS C1713,,241.266S  -  PLATE BN 116X11X2.5MM STRL LCP CMBN 7 HL PRECONTOUR LMT,"$2,139.93",$0.00,"$2,139.93",$962.97,"$1,527.26",$0.00,$357.96,$0.00,$0.00,$374.68,"$2,139.93",$0.00,"$1,069.96","$1,694.82","$1,711.94",$0.00,$325.14,$0.00,$340.68,$0.00
241.919S,SUP,HCPCS C1713,,241.919S  -  PLATE BONE LONG 160X12X3.7MM 6 HOLE PRECONTOUR LCP STAINLESS,"$3,092.53",$0.00,"$3,092.53","$1,391.64","$2,207.14",$0.00,$517.31,$0.00,$0.00,$541.48,"$3,092.53",$0.00,"$1,546.26","$2,449.28","$2,474.02",$0.00,$469.88,$0.00,$492.33,$0.00
241.921S,SUP,HCPCS C1713,,241.921S  -  PLATE LNG 196MM SS 3.5MM SCR SM FRAG SET 8 HOLE LCP BONE,"$3,788.60",$0.00,"$3,788.60","$1,704.87","$2,703.92",$0.00,$652.76,$0.00,$0.00,$663.35,"$3,788.60",$0.00,"$1,894.30","$3,000.57","$3,030.88",$0.00,$592.92,$0.00,$603.15,$0.00
241-01,SUP,HCPCS C1781,,241-01  -  PLATE 18MM TI BONE SPNL,$465.38,$0.00,$465.38,$209.42,$332.14,$0.00,$80.18,$0.00,$0.00,$81.48,$465.38,$0.00,$232.69,$368.58,$372.30,$0.00,$72.83,$0.00,$74.09,$0.00
241-02,SUP,HCPCS C1781,,241-02  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$571.63,$0.00,$571.63,$257.23,$407.97,$0.00,$98.49,$0.00,$0.00,$100.09,$571.63,$0.00,$285.81,$452.73,$457.30,$0.00,$89.46,$0.00,$91.00,$0.00
241-02-C,SUP,HCPCS C1781,,241-02-C  -  PLATE BN 121MM FLEXMESH 2 HL STRP SKL,$575.88,$0.00,$575.88,$259.14,$411.00,$0.00,$99.22,$0.00,$0.00,$100.83,$575.88,$0.00,$287.94,$456.10,$460.70,$0.00,$90.12,$0.00,$91.68,$0.00
241-03,SUP,HCPCS C1781,,241-03  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$652.38,$0.00,$652.38,$293.57,$465.60,$0.00,$112.40,$0.00,$0.00,$114.23,$652.38,$0.00,$326.19,$516.68,$521.90,$0.00,$102.10,$0.00,$103.86,$0.00
241-04,SUP,HCPCS C1713,,241-04  -  PLATE 18MM TI BONE SPNL,$735.25,$0.00,$735.25,$330.86,$524.75,$0.00,$126.68,$0.00,$0.00,$128.74,$735.25,$0.00,$367.63,$582.32,$588.20,$0.00,$115.07,$0.00,$117.05,$0.00
24106 A,SUP,Custom 27803010,,24106 A  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,047.38",$0.00,"$1,047.38",$0.00,$747.51,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,047.38",$0.00,$523.69,$829.52,$837.90,$0.00,$0.00,$0.00,$0.00,$0.00
24106 B,SUP,Custom 27803010,,24106 B  -  PLATE 18MM TI BONE SPNL,"$1,047.38",$0.00,"$1,047.38",$0.00,$747.51,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,047.38",$0.00,$523.69,$829.52,$837.90,$0.00,$0.00,$0.00,$0.00,$0.00
24106 C,SUP,Custom 27803010,,24106 C  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,047.38",$0.00,"$1,047.38",$0.00,$747.51,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,047.38",$0.00,$523.69,$829.52,$837.90,$0.00,$0.00,$0.00,$0.00,$0.00
24106 D,SUP,Custom 27803010,,24106 D  -  PLATE 18MM TI BONE SPNL,"$1,047.38",$0.00,"$1,047.38",$0.00,$747.51,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,047.38",$0.00,$523.69,$829.52,$837.90,$0.00,$0.00,$0.00,$0.00,$0.00
24106 E,SUP,Custom 27803010,,24106 E  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,047.38",$0.00,"$1,047.38",$0.00,$747.51,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,047.38",$0.00,$523.69,$829.52,$837.90,$0.00,$0.00,$0.00,$0.00,$0.00
24106 H,SUP,HCPCS C1725,,24106 H  -  PLATE 18MM TI BONE SPNL,"$1,220.75",$0.00,"$1,220.75",$662.87,$871.25,$0.00,$210.33,$0.00,$0.00,$213.74,"$1,220.75",$0.00,$610.38,$966.83,$976.60,$0.00,$191.05,$0.00,$194.34,$0.00
24133-1,SUP,Custom 27803010,,24133-1  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$5,241.63",$0.00,"$5,241.63",$0.00,"$3,740.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,241.63",$0.00,"$2,620.81","$4,151.37","$4,193.30",$0.00,$0.00,$0.00,$0.00,$0.00
242.531S,SUP,HCPCS C1713,,242.531S  -  PLATE BONE 46MM 7 HOLE LCP STAINLESS STEEL DISTAL ULNA,"$1,516.23",$0.00,"$1,516.23",$682.30,"$1,082.13",$0.00,$253.63,$0.00,$0.00,$265.48,"$1,516.23",$0.00,$758.11,"$1,200.85","$1,212.98",$0.00,$230.38,$0.00,$241.38,$0.00
24-2050,SUP,Custom 27203010,,24-2050  -  DRILL SURG 1.8MM 50MM 26MM STOP BLADE LORENZ MANDIB,$432.50,$0.00,$432.50,$0.00,$308.68,$0.00,$0.00,$0.00,$0.00,$0.00,$432.50,$0.00,$216.25,$342.54,$346.00,$0.00,$0.00,$0.00,$0.00,$0.00
246.354S,SUP,HCPCS C1713,,246.354S  -  PLATE BONE 27MM 2X5 HOLE ROTATION CORRECTION LCP STAINLESS,"$1,516.23",$0.00,"$1,516.23",$682.30,"$1,082.13",$0.00,$253.63,$0.00,$0.00,$265.48,"$1,516.23",$0.00,$758.11,"$1,200.85","$1,212.98",$0.00,$230.38,$0.00,$241.38,$0.00
246.355S,SUP,HCPCS C1713,,246.355S  -  PLATE BONE 32MM 2X5 HOLE ROTATION CORRECTION LCP STAINLESS,"$1,516.23",$0.00,"$1,516.23",$682.30,"$1,082.13",$0.00,$253.63,$0.00,$0.00,$265.48,"$1,516.23",$0.00,$758.11,"$1,200.85","$1,212.98",$0.00,$230.38,$0.00,$241.38,$0.00
247.354S,SUP,HCPCS C1713,,247.354S  -  PLATE BONE 34MM 2X5 HOLE ROTATION CORRECTION LCP STAINLESS,"$1,516.23",$0.00,"$1,516.23",$682.30,"$1,082.13",$0.00,$253.63,$0.00,$0.00,$265.48,"$1,516.23",$0.00,$758.11,"$1,200.85","$1,212.98",$0.00,$230.38,$0.00,$241.38,$0.00
247.355S,SUP,HCPCS C1713,,247.355S  -  PLATE BONE 40MM 2X5 HOLE ROTATION CORRECTION LCP STAINLESS,"$1,516.23",$0.00,"$1,516.23",$682.30,"$1,082.13",$0.00,$253.63,$0.00,$0.00,$265.48,"$1,516.23",$0.00,$758.11,"$1,200.85","$1,212.98",$0.00,$230.38,$0.00,$241.38,$0.00
2480-10-41,SUP,HCPCS C1713,,2480-10-41  -  SCREW BN FT 4MM 10MM NS FORTE SS CANC PERIART,$111.55,$0.00,$111.55,$50.20,$79.61,$0.00,$19.22,$0.00,$0.00,$19.53,$111.55,$0.00,$55.78,$88.35,$89.24,$0.00,$17.46,$0.00,$17.76,$0.00
2480-12-41,SUP,HCPCS C1713,,2480-12-41  -  SCREW BN FT 4MM 12MM NS FORTE SS CANC PERIART,$111.55,$0.00,$111.55,$50.20,$79.61,$0.00,$19.22,$0.00,$0.00,$19.53,$111.55,$0.00,$55.78,$88.35,$89.24,$0.00,$17.46,$0.00,$17.76,$0.00
2480-14-41,SUP,HCPCS C1713,,2480-14-41  -  SCREW BN FT 4MM 14MM NS FORTE SS CANC PERIART,$111.55,$0.00,$111.55,$50.20,$79.61,$0.00,$19.22,$0.00,$0.00,$19.53,$111.55,$0.00,$55.78,$88.35,$89.24,$0.00,$17.46,$0.00,$17.76,$0.00
2480-16-41,SUP,HCPCS C1713,,2480-16-41  -  SCREW BN FT 4MM 16MM NS FORTE SS CANC PERIART,$111.55,$0.00,$111.55,$50.20,$79.61,$0.00,$19.22,$0.00,$0.00,$19.53,$111.55,$0.00,$55.78,$88.35,$89.24,$0.00,$17.46,$0.00,$17.76,$0.00
2480-18-41,SUP,HCPCS C1713,,2480-18-41  -  SCREW BN FT 4MM 18MM NS FORTE SS CANC PERIART,$111.55,$0.00,$111.55,$50.20,$79.61,$0.00,$19.22,$0.00,$0.00,$19.53,$111.55,$0.00,$55.78,$88.35,$89.24,$0.00,$17.46,$0.00,$17.76,$0.00
2480-20-41,SUP,HCPCS C1713,,2480-20-41  -  SCREW BN FT 4MM 20MM NS FORTE SS PERIART CANC,$111.55,$0.00,$111.55,$50.20,$79.61,$0.00,$19.22,$0.00,$0.00,$19.53,$111.55,$0.00,$55.78,$88.35,$89.24,$0.00,$17.46,$0.00,$17.76,$0.00
2480-22-41,SUP,HCPCS C1713,,2480-22-41  -  SCREW BN FT 4MM 22MM NS FORTE SS CANC PERIART,$111.55,$0.00,$111.55,$50.20,$79.61,$0.00,$19.22,$0.00,$0.00,$19.53,$111.55,$0.00,$55.78,$88.35,$89.24,$0.00,$17.46,$0.00,$17.76,$0.00
2480-24-41,SUP,HCPCS C1713,,2480-24-41  -  SCREW BN FT 4MM 24MM NS FORTE SS CANC PERIART,$111.55,$0.00,$111.55,$50.20,$79.61,$0.00,$19.22,$0.00,$0.00,$19.53,$111.55,$0.00,$55.78,$88.35,$89.24,$0.00,$17.46,$0.00,$17.76,$0.00
2480-26-41,SUP,HCPCS C1713,,2480-26-41  -  SCREW BN FT 4MM 26MM NS FORTE SS CANC PERIART,$111.55,$0.00,$111.55,$50.20,$79.61,$0.00,$19.22,$0.00,$0.00,$19.53,$111.55,$0.00,$55.78,$88.35,$89.24,$0.00,$17.46,$0.00,$17.76,$0.00
2480-28-41,SUP,HCPCS C1713,,2480-28-41  -  SCREW BN FT 4MM 28MM NS FORTE SS CANC PERIART,$111.55,$0.00,$111.55,$50.20,$79.61,$0.00,$19.22,$0.00,$0.00,$19.53,$111.55,$0.00,$55.78,$88.35,$89.24,$0.00,$17.46,$0.00,$17.76,$0.00
2480-30-41,SUP,HCPCS C1713,,2480-30-41  -  SCREW BN FT 4MM 30MM NS FORTE SS CANC PERIART,$111.55,$0.00,$111.55,$50.20,$79.61,$0.00,$19.22,$0.00,$0.00,$19.53,$111.55,$0.00,$55.78,$88.35,$89.24,$0.00,$17.46,$0.00,$17.76,$0.00
2480-32-41,SUP,HCPCS C1713,,2480-32-41  -  SCREW BN FT 4MM 32MM NS FORTE SS CANC PERIART,$111.55,$0.00,$111.55,$50.20,$79.61,$0.00,$19.22,$0.00,$0.00,$19.53,$111.55,$0.00,$55.78,$88.35,$89.24,$0.00,$17.46,$0.00,$17.76,$0.00
2480-34-41,SUP,HCPCS C1713,,2480-34-41  -  SCREW BN FT 4MM 34MM NS FORTE SS CANC PERIART,$111.55,$0.00,$111.55,$50.20,$79.61,$0.00,$19.22,$0.00,$0.00,$19.53,$111.55,$0.00,$55.78,$88.35,$89.24,$0.00,$17.46,$0.00,$17.76,$0.00
2480-36-41,SUP,HCPCS C1713,,2480-36-41  -  SCREW BN FT 4MM 36MM NS FORTE SS CANC PERIART,$111.55,$0.00,$111.55,$50.20,$79.61,$0.00,$19.22,$0.00,$0.00,$19.53,$111.55,$0.00,$55.78,$88.35,$89.24,$0.00,$17.46,$0.00,$17.76,$0.00
2480-38-41,SUP,HCPCS C1713,,2480-38-41  -  SCREW BN FT 4MM 38MM NS FORTE SS CANC PERIART,$111.55,$0.00,$111.55,$50.20,$79.61,$0.00,$19.22,$0.00,$0.00,$19.53,$111.55,$0.00,$55.78,$88.35,$89.24,$0.00,$17.46,$0.00,$17.76,$0.00
2480-40-41,SUP,HCPCS C1713,,2480-40-41  -  SCREW BN FT 4MM 40MM NS FORTE SS CANC PERIART,$111.55,$0.00,$111.55,$50.20,$79.61,$0.00,$19.22,$0.00,$0.00,$19.53,$111.55,$0.00,$55.78,$88.35,$89.24,$0.00,$17.46,$0.00,$17.76,$0.00
24B002,SUP,HCPCS C9359,,24B002  -  GRAFT BONE PROX FEM HD FRZN ALLOWASH TCH GAMA IRR,"$3,260.00",$0.00,"$3,260.00",$0.00,"$2,326.66",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,260.00",$0.00,"$1,630.00","$2,581.92","$2,608.00",$0.00,$0.00,$0.00,$0.00,$0.00
250.25S,SUP,HCPCS C1713,,250.25S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 255MM STAINLESS STEEL,"$2,131.25",$0.00,"$2,131.25",$959.06,"$1,521.07",$0.00,$367.20,$0.00,$0.00,$373.16,"$2,131.25",$0.00,"$1,065.63","$1,687.95","$1,705.00",$0.00,$333.54,$0.00,$339.30,$0.00
250.27S,SUP,HCPCS C1713,,250.27S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 270MM STAINLESS STEEL,"$2,131.25",$0.00,"$2,131.25",$959.06,"$1,521.07",$0.00,$367.20,$0.00,$0.00,$373.16,"$2,131.25",$0.00,"$1,065.63","$1,687.95","$1,705.00",$0.00,$333.54,$0.00,$339.30,$0.00
250.28S,SUP,HCPCS C1713,,250.28S  -  NAIL 10MM 285MM TIB IM UNV SS STRL,"$2,533.98",$0.00,"$2,533.98","$1,140.29","$1,808.50",$0.00,$436.59,$0.00,$0.00,$443.68,"$2,533.98",$0.00,"$1,266.99","$2,006.91","$2,027.18",$0.00,$396.57,$0.00,$403.41,$0.00
250.30S,SUP,HCPCS C1713,,250.30S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 300MM TITANIUM TIBIA,"$2,131.25",$0.00,"$2,131.25",$959.06,"$1,521.07",$0.00,$367.20,$0.00,$0.00,$373.16,"$2,131.25",$0.00,"$1,065.63","$1,687.95","$1,705.00",$0.00,$333.54,$0.00,$339.30,$0.00
250.31S,SUP,HCPCS C1713,,250.31S  -  NAIL 10MM 315MM TIB IM UNV SS STRL,"$2,533.98",$0.00,"$2,533.98","$1,140.29","$1,808.50",$0.00,$436.59,$0.00,$0.00,$443.68,"$2,533.98",$0.00,"$1,266.99","$2,006.91","$2,027.18",$0.00,$396.57,$0.00,$403.41,$0.00
250.33S,SUP,HCPCS C1713,,250.33S  -  NAIL 10MM 330MM TIB IM UNV SS STRL,"$2,533.98",$0.00,"$2,533.98","$1,140.29","$1,808.50",$0.00,$436.59,$0.00,$0.00,$443.68,"$2,533.98",$0.00,"$1,266.99","$2,006.91","$2,027.18",$0.00,$396.57,$0.00,$403.41,$0.00
250.34S,SUP,HCPCS C1713,,250.34S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 345MM STAINLESS STEEL,"$2,131.25",$0.00,"$2,131.25",$959.06,"$1,521.07",$0.00,$367.20,$0.00,$0.00,$373.16,"$2,131.25",$0.00,"$1,065.63","$1,687.95","$1,705.00",$0.00,$333.54,$0.00,$339.30,$0.00
250.36S,SUP,HCPCS C1713,,250.36S  -  NAIL 10MM 360MM TIB IM UNV SS STRL,"$2,533.98",$0.00,"$2,533.98","$1,140.29","$1,808.50",$0.00,$436.59,$0.00,$0.00,$443.68,"$2,533.98",$0.00,"$1,266.99","$2,006.91","$2,027.18",$0.00,$396.57,$0.00,$403.41,$0.00
250.38S,SUP,HCPCS C1713,,250.38S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 380MM STAINLESS STEEL,"$2,131.25",$0.00,"$2,131.25",$959.06,"$1,521.07",$0.00,$367.20,$0.00,$0.00,$373.16,"$2,131.25",$0.00,"$1,065.63","$1,687.95","$1,705.00",$0.00,$333.54,$0.00,$339.30,$0.00
250.40S,SUP,HCPCS C1713,,250.40S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 400MM STAINLESS STEEL,"$2,131.25",$0.00,"$2,131.25",$959.06,"$1,521.07",$0.00,$367.20,$0.00,$0.00,$373.16,"$2,131.25",$0.00,"$1,065.63","$1,687.95","$1,705.00",$0.00,$333.54,$0.00,$339.30,$0.00
250.42S,SUP,HCPCS C1713,,250.42S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 420MM STAINLESS STEEL,"$2,131.25",$0.00,"$2,131.25",$959.06,"$1,521.07",$0.00,$367.20,$0.00,$0.00,$373.16,"$2,131.25",$0.00,"$1,065.63","$1,687.95","$1,705.00",$0.00,$333.54,$0.00,$339.30,$0.00
25000C+10.00,SUP,HCPCS V2632,,25000C+10.00  -  LENS IOL +10 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25000C+10.50,SUP,HCPCS V2632,,25000C+10.50  -  LENS IOL +10.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25000C+11.00,SUP,HCPCS V2632,,25000C+11.00  -  LENS IOL +11 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25000C+11.50,SUP,HCPCS V2632,,25000C+11.50  -  LENS IOL +11.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25000C+12.00,SUP,HCPCS V2632,,25000C+12.00  -  LENS IOL +12 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25000C+12.50,SUP,HCPCS V2632,,25000C+12.50  -  LENS IOL +12.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25000C+13.00,SUP,HCPCS V2632,,25000C+13.00  -  LENS IOL +13 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25000C+13.50,SUP,HCPCS V2632,,25000C+13.50  -  LENS IOL +13.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25000C+14.00,SUP,HCPCS V2632,,25000C+14.00  -  LENS IOL +14 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25000C+14.50,SUP,HCPCS V2632,,25000C+14.50  -  LENS IOL +14.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25000C+15.00,SUP,HCPCS V2632,,25000C+15.00  -  LENS IOL +15 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25000C+15.50,SUP,HCPCS V2632,,25000C+15.50  -  LENS IOL +15.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25000C+16.00,SUP,HCPCS V2632,,25000C+16.00  -  LENS IOL +16 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25000C+16.50,SUP,HCPCS V2632,,25000C+16.50  -  LENS IOL +16.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25000C+17.00,SUP,HCPCS V2632,,25000C+17.00  -  LENS IOL +17 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25000C+17.50,SUP,HCPCS V2632,,25000C+17.50  -  LENS IOL +17.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25000C+18.00,SUP,HCPCS V2632,,25000C+18.00  -  LENS IOL +18 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25000C+18.50,SUP,HCPCS V2632,,25000C+18.50  -  LENS IOL +18.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25000C+19.00,SUP,HCPCS V2632,,25000C+19.00  -  LENS IOL +19 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25000C+19.50,SUP,HCPCS V2632,,25000C+19.50  -  LENS IOL +19.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25000C+20.00,SUP,HCPCS V2632,,25000C+20.00  -  LENS IOL +20 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25000C+20.50,SUP,HCPCS V2632,,25000C+20.50  -  LENS IOL +20.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25000C+21.00,SUP,HCPCS V2632,,25000C+21.00  -  LENS IOL +21 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25000C+21.50,SUP,HCPCS V2632,,25000C+21.50  -  LENS IOL +21.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25000C+22.00,SUP,HCPCS V2632,,25000C+22.00  -  LENS IOL +22 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25000C+22.50,SUP,HCPCS V2632,,25000C+22.50  -  LENS IOL +22.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25000C+23.00,SUP,HCPCS V2632,,25000C+23.00  -  LENS IOL +23 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25000C+23.50,SUP,HCPCS V2632,,25000C+23.50  -  LENS IOL +23.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25000C+24.00,SUP,HCPCS V2632,,25000C+24.00  -  LENS IOL +24 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25000C+24.50,SUP,HCPCS V2632,,25000C+24.50  -  LENS IOL +24.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25000C+25.00,SUP,HCPCS V2632,,25000C+25.00  -  LENS IOL +25 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25000C+25.50,SUP,HCPCS V2632,,25000C+25.50  -  LENS IOL +25.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25000C+26.00,SUP,HCPCS V2632,,25000C+26.00  -  LENS IOL +26 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25000C+26.50,SUP,HCPCS V2632,,25000C+26.50  -  LENS IOL +26.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25000C+27.00,SUP,HCPCS V2632,,25000C+27.00  -  LENS IOL +27 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25000C+27.50,SUP,HCPCS V2632,,25000C+27.50  -  LENS IOL +27.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25000C+28.00,SUP,HCPCS V2632,,25000C+28.00  -  LENS IOL +28 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25000C+28.50,SUP,HCPCS V2632,,25000C+28.50  -  LENS IOL +28.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25000C+29.00,SUP,HCPCS V2632,,25000C+29.00  -  LENS IOL +29 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25000C+29.50,SUP,HCPCS V2632,,25000C+29.50  -  LENS IOL +29.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25000C+30.00,SUP,HCPCS V2632,,25000C+30.00  -  LENS IOL +30 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25000C+6.00,SUP,HCPCS V2632,,25000C+6.00  -  LENS IOL +6 DIOP MOD C 6MM 12.5MM CLR HOYA ISERT ASPH BAL,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25000C+6.50,SUP,HCPCS V2632,,25000C+6.50  -  LENS IOL +6.5 DIOP MOD C 6MM 12.5MM CLR HOYA ISERT ASPH BAL,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25000C+7.00,SUP,HCPCS V2632,,25000C+7.00  -  LENS IOL +7 DIOP MOD C 6MM 12.5MM CLR HOYA ISERT ASPH BAL,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25000C+7.50,SUP,HCPCS V2632,,25000C+7.50  -  LENS IOL +7.5 DIOP MOD C 6MM 12.5MM CLR HOYA ISERT ASPH BAL,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25000C+8.00,SUP,HCPCS V2632,,25000C+8.00  -  LENS IOL +8 DIOP MOD C 6MM 12.5MM CLR HOYA ISERT ASPH BAL,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25000C+8.50,SUP,HCPCS V2632,,25000C+8.50  -  LENS IOL +8.5 DIOP MOD C 6MM 12.5MM CLR HOYA ISERT ASPH BAL,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25000C+9.00,SUP,HCPCS V2632,,25000C+9.00  -  LENS IOL +9 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25000C+9.50,SUP,HCPCS V2632,,25000C+9.50  -  LENS IOL +9.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25-003-10-09,SUP,HCPCS C1713,,25-003-10-09  -  MESH CRNL 85X50X.3MM SM GRID PNL TI 1.5MM SCR,"$1,823.00",$0.00,"$1,823.00",$820.35,"$1,301.08",$0.00,$314.09,$0.00,$0.00,$319.19,"$1,823.00",$0.00,$911.50,"$1,443.82","$1,458.40",$0.00,$285.30,$0.00,$290.22,$0.00
25-003-14-09,SUP,HCPCS C1713,,25-003-14-09  -  NEURO PLATE  ULTRA LOW PROFILE BOX STYLE  2X2-HOLE  W/TAB,$701.53,$0.00,$701.53,$315.69,$500.68,$0.00,$120.87,$0.00,$0.00,$122.83,$701.53,$0.00,$350.76,$555.61,$561.22,$0.00,$109.79,$0.00,$111.68,$0.00
25-003-21-09,SUP,Custom 27803010,,25-003-21-09  -  COVER BURR HOLE MEDIUM 15MM .3MM HOLE ULTRA LP SMOOTH,$789.55,$0.00,$789.55,$0.00,$563.50,$0.00,$0.00,$0.00,$0.00,$0.00,$789.55,$0.00,$394.78,$625.32,$631.64,$0.00,$0.00,$0.00,$0.00,$0.00
25-003-25-09,SUP,Custom 27803010,,25-003-25-09  -  COVER BURR HOLE LARGE 25MM .3MM HOLE ULTRA LP SMOOTH ROUNDED,$789.55,$0.00,$789.55,$0.00,$563.50,$0.00,$0.00,$0.00,$0.00,$0.00,$789.55,$0.00,$394.78,$625.32,$631.64,$0.00,$0.00,$0.00,$0.00,$0.00
25-004-70-09,SUP,HCPCS C1781,,25-004-70-09  -  PLATE BONE ROUND MICRO MESH 73MM .6MM PANEL CNTOUR TITANIUM,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
25-007-80-09,SUP,HCPCS C1713,,25-007-80-09  -  MESH CRNL 3D 80X80X.3MM TI 1.5MM SCR,"$4,042.10",$0.00,"$4,042.10","$1,818.95","$2,884.85",$0.00,$696.43,$0.00,$0.00,$707.74,"$4,042.10",$0.00,"$2,021.05","$3,201.34","$3,233.68",$0.00,$632.59,$0.00,$643.50,$0.00
25-008-12-09,SUP,HCPCS C1781,,25-008-12-09  -  PLATE BONE 3D MICRO MESH 120X120X.6MM TITANIUM FRONTAL MAXL,"$5,736.28",$0.00,"$5,736.28","$2,581.32","$4,093.98",$0.00,$988.33,$0.00,$0.00,"$1,004.38","$5,736.28",$0.00,"$2,868.14","$4,543.13","$4,589.02",$0.00,$897.73,$0.00,$913.21,$0.00
25-008-80-09,SUP,HCPCS C1713,,25-008-80-09  -  PLATE BONE 3D MESH 80X80X.6MM TITANIUM MANDIB 1.5MM SCREW,"$3,664.13",$0.00,"$3,664.13","$1,648.86","$2,615.09",$0.00,$631.31,$0.00,$0.00,$641.56,"$3,664.13",$0.00,"$1,832.06","$2,901.99","$2,931.30",$0.00,$573.44,$0.00,$583.33,$0.00
25014-1,SUP,Custom 27803010,,25014-1  -  PLATE 18MM TI BONE SPNL,"$4,723.88",$0.00,"$4,723.88",$0.00,"$3,371.43",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,723.88",$0.00,"$2,361.94","$3,741.31","$3,779.10",$0.00,$0.00,$0.00,$0.00,$0.00
25014-2,SUP,Custom 27803010,,25014-2  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$4,723.88",$0.00,"$4,723.88",$0.00,"$3,371.43",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,723.88",$0.00,"$2,361.94","$3,741.31","$3,779.10",$0.00,$0.00,$0.00,$0.00,$0.00
25014-5,SUP,Custom 27803010,,25014-5  -  PLATE 18MM TI BONE SPNL,"$4,723.88",$0.00,"$4,723.88",$0.00,"$3,371.43",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,723.88",$0.00,"$2,361.94","$3,741.31","$3,779.10",$0.00,$0.00,$0.00,$0.00,$0.00
25-015-04-09,SUP,HCPCS C1713,,25-015-04-09  -  PLATE BONE MICRO SQUARE .6MM 2X2 HOLE TITANIUM FRONTAL MAXL,$377.18,$0.00,$377.18,$169.73,$269.19,$0.00,$64.99,$0.00,$0.00,$66.04,$377.18,$0.00,$188.59,$298.73,$301.74,$0.00,$59.03,$0.00,$60.05,$0.00
25-015-06-09,SUP,HCPCS C1713,,25-015-06-09  -  PLATE BONE MICRO SQUARE .6MM 3X2 HOLE TITANIUM MAXFACL 1.5MM,$452.60,$0.00,$452.60,$203.67,$323.02,$0.00,$77.98,$0.00,$0.00,$79.25,$452.60,$0.00,$226.30,$358.46,$362.08,$0.00,$70.83,$0.00,$72.05,$0.00
250-202,SUP,HCPCS C1892,,SHEATH ACCES 35CM 12FR URETERAL FLEXOR,$296.10,$0.00,$296.10,$160.78,$211.33,$0.00,$51.02,$0.00,$0.00,$51.84,$296.10,$0.00,$148.05,$234.51,$236.88,$0.00,$46.34,$0.00,$47.14,$0.00
250-208,SUP,HCPCS C1892,,SHEATH ACCES 36CM 13/15FR NVGTR URET DUAL TPR TIP HYDPHI,$286.00,$0.00,$286.00,$155.30,$204.12,$0.00,$49.28,$0.00,$0.00,$50.08,$286.00,$0.00,$143.00,$226.51,$228.80,$0.00,$44.76,$0.00,$45.53,$0.00
25-022-28-09,SUP,HCPCS C1713,,25-022-28-09  -  PLATE BONE 2MMX1MM 2 STRIP MESH BLUE TITANIUM MAXFACL 2MM,$608.65,$0.00,$608.65,$273.89,$434.39,$0.00,$104.87,$0.00,$0.00,$106.57,$608.65,$0.00,$304.33,$482.05,$486.92,$0.00,$95.25,$0.00,$96.90,$0.00
25-040-25-09,SUP,HCPCS C1713,,25-040-25-09  -  MESH CRNL 85X54X.2MM SCRN PNL TI 1MM SCR,"$1,191.80",$0.00,"$1,191.80",$536.31,$850.59,$0.00,$205.34,$0.00,$0.00,$208.67,"$1,191.80",$0.00,$595.90,$943.91,$953.44,$0.00,$186.52,$0.00,$189.73,$0.00
25-043-01-09,SUP,HCPCS C1713,,25-043-01-09  -  MESH CRNL .3MM TI ORBT FLR 1.5MM SCR,"$1,010.08",$0.00,"$1,010.08",$454.53,$720.89,$0.00,$174.03,$0.00,$0.00,$176.86,"$1,010.08",$0.00,$505.04,$799.98,$808.06,$0.00,$158.08,$0.00,$160.80,$0.00
25-043-02-09,SUP,HCPCS C1713,,25-043-02-09  -  MESH CRNL .5MM AU TI ORBT FLR 1.5MM SCR,"$1,010.08",$0.00,"$1,010.08",$454.53,$720.89,$0.00,$174.03,$0.00,$0.00,$176.86,"$1,010.08",$0.00,$505.04,$799.98,$808.06,$0.00,$158.08,$0.00,$160.80,$0.00
25-044-02-09,SUP,HCPCS C1713,,25-044-02-09  -  PLATE BN 3D PSHP .4MM TI LT ORBT FLR,"$2,758.28",$0.00,"$2,758.28","$1,241.22","$1,968.58",$0.00,$475.24,$0.00,$0.00,$482.95,"$2,758.28",$0.00,"$1,379.14","$2,184.56","$2,206.62",$0.00,$431.67,$0.00,$439.12,$0.00
25-045-40-09,SUP,HCPCS C1713,,25-045-40-09  -  PLATE BN NS LF LVL 1 CRNMXF ORBT FLR,"$3,512.30",$0.00,"$3,512.30","$1,580.54","$2,506.73",$0.00,$605.15,$0.00,$0.00,$614.98,"$3,512.30",$0.00,"$1,756.15","$2,781.74","$2,809.84",$0.00,$549.67,$0.00,$559.16,$0.00
25-092-38-91,SUP,HCPCS C1713,,25-092-38-91  -  DRILL FREE MAXDRIVE MMF SCREW  2.0MM X 12MM  8MM THD LNGTH,$264.55,$0.00,$264.55,$119.05,$188.81,$0.00,$45.58,$0.00,$0.00,$46.32,$264.55,$0.00,$132.28,$209.52,$211.64,$0.00,$41.40,$0.00,$42.12,$0.00
25-092-42-91,SUP,HCPCS C1713,,25-092-42-91  -  DRILL FREE MAXDRIVE MMF SCREW  2.0MM X 16MM  12MM THD LNGTH,$264.55,$0.00,$264.55,$119.05,$188.81,$0.00,$45.58,$0.00,$0.00,$46.32,$264.55,$0.00,$132.28,$209.52,$211.64,$0.00,$41.40,$0.00,$42.12,$0.00
251.25S,SUP,HCPCS C1713,,251.25S  -  NAIL INTRAMEDULLARY 11D UNIVERSAL TAPER TUBULAR 11MM,"$2,131.25",$0.00,"$2,131.25",$959.06,"$1,521.07",$0.00,$367.20,$0.00,$0.00,$373.16,"$2,131.25",$0.00,"$1,065.63","$1,687.95","$1,705.00",$0.00,$333.54,$0.00,$339.30,$0.00
251.28S,SUP,HCPCS C1713,,251.28S  -  NAIL INTRAMEDULLARY 11D UNIVERSAL TAPER 11MM 285MMX1.2MM 1,"$2,131.25",$0.00,"$2,131.25",$959.06,"$1,521.07",$0.00,$367.20,$0.00,$0.00,$373.16,"$2,131.25",$0.00,"$1,065.63","$1,687.95","$1,705.00",$0.00,$333.54,$0.00,$339.30,$0.00
251.30S,SUP,HCPCS C1713,,251.30S  -  NAIL INTRAMEDULLARY 11D UNIVERSAL TUBULAR BARREL 11MM,"$2,131.25",$0.00,"$2,131.25",$959.06,"$1,521.07",$0.00,$367.20,$0.00,$0.00,$373.16,"$2,131.25",$0.00,"$1,065.63","$1,687.95","$1,705.00",$0.00,$333.54,$0.00,$339.30,$0.00
251.31S,SUP,HCPCS C1713,,251.31S  -  NAIL 11MM 315MM TIB IM UNV SS STRL,"$2,533.98",$0.00,"$2,533.98","$1,140.29","$1,808.50",$0.00,$436.59,$0.00,$0.00,$443.68,"$2,533.98",$0.00,"$1,266.99","$2,006.91","$2,027.18",$0.00,$396.57,$0.00,$403.41,$0.00
251.33S,SUP,HCPCS C1713,,251.33S  -  NAIL 11MM 330MM TIB IM UNV SS STRL,"$2,533.98",$0.00,"$2,533.98","$1,140.29","$1,808.50",$0.00,$436.59,$0.00,$0.00,$443.68,"$2,533.98",$0.00,"$1,266.99","$2,006.91","$2,027.18",$0.00,$396.57,$0.00,$403.41,$0.00
251.34S,SUP,HCPCS C1713,,251.34S  -  NAIL 11MM 345MM TIB IM UNV SS STRL,"$2,533.98",$0.00,"$2,533.98","$1,140.29","$1,808.50",$0.00,$436.59,$0.00,$0.00,$443.68,"$2,533.98",$0.00,"$1,266.99","$2,006.91","$2,027.18",$0.00,$396.57,$0.00,$403.41,$0.00
251.36S,SUP,HCPCS C1713,,251.36S  -  NAIL 11MM 360MM TIB IM UNV SS STRL,"$2,533.98",$0.00,"$2,533.98","$1,140.29","$1,808.50",$0.00,$436.59,$0.00,$0.00,$443.68,"$2,533.98",$0.00,"$1,266.99","$2,006.91","$2,027.18",$0.00,$396.57,$0.00,$403.41,$0.00
251.38S,SUP,HCPCS C1713,,251.38S  -  NAIL INTRAMEDULLARY 11D UNIVERSAL TUBULAR BARREL 11MM,"$2,131.25",$0.00,"$2,131.25",$959.06,"$1,521.07",$0.00,$367.20,$0.00,$0.00,$373.16,"$2,131.25",$0.00,"$1,065.63","$1,687.95","$1,705.00",$0.00,$333.54,$0.00,$339.30,$0.00
251.40S,SUP,HCPCS C1713,,251.40S  -  NAIL INTRAMEDULLARY 11D UNIVERSAL TAPER 11MM 400MMX1.2MM 1,"$2,135.38",$0.00,"$2,135.38",$960.92,"$1,524.02",$0.00,$367.91,$0.00,$0.00,$373.89,"$2,135.38",$0.00,"$1,067.69","$1,691.22","$1,708.30",$0.00,$334.19,$0.00,$339.95,$0.00
251.42S,SUP,HCPCS C1713,,251.42S  -  NAIL INTRAMEDULLARY 11D UNIVERSAL TAPER 11MM 420MMX1.2MM 1,"$2,135.38",$0.00,"$2,135.38",$960.92,"$1,524.02",$0.00,$367.91,$0.00,$0.00,$373.89,"$2,135.38",$0.00,"$1,067.69","$1,691.22","$1,708.30",$0.00,$334.19,$0.00,$339.95,$0.00
25100C+10.00,SUP,HCPCS V2632,,25100C+10.00  -  LENS IOL +10 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25100C+10.50,SUP,HCPCS V2632,,25100C+10.50  -  LENS IOL +10.5 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25100C+11.00,SUP,HCPCS V2632,,25100C+11.00  -  LENS IOL +11 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25100C+11.50,SUP,HCPCS V2632,,25100C+11.50  -  LENS IOL +11.5 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25100C+12.00,SUP,HCPCS V2632,,25100C+12.00  -  LENS IOL +12 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25100C+12.50,SUP,HCPCS V2632,,25100C+12.50  -  LENS IOL +12.5 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25100C+13.00,SUP,HCPCS V2632,,25100C+13.00  -  LENS IOL +13 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25100C+13.50,SUP,HCPCS V2632,,25100C+13.50  -  LENS IOL +13.5 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25100C+14.00,SUP,HCPCS V2632,,25100C+14.00  -  LENS IOL +14 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25100C+14.50,SUP,HCPCS V2632,,25100C+14.50  -  LENS IOL +14.5 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25100C+15.00,SUP,HCPCS V2632,,25100C+15.00  -  LENS IOL +15 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25100C+15.50,SUP,HCPCS V2632,,25100C+15.50  -  LENS IOL +15.5 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25100C+16.00,SUP,HCPCS V2632,,25100C+16.00  -  LENS IOL +16 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25100C+16.50,SUP,HCPCS V2632,,25100C+16.50  -  LENS IOL +16.5 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25100C+17.00,SUP,HCPCS V2632,,25100C+17.00  -  LENS IOL +17 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25100C+17.50,SUP,HCPCS V2632,,25100C+17.50  -  LENS IOL +17.5 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25100C+18.00,SUP,HCPCS V2632,,25100C+18.00  -  LENS IOL +18 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25100C+18.50,SUP,HCPCS V2632,,25100C+18.50  -  LENS IOL +18.5 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25100C+19.00,SUP,HCPCS V2632,,25100C+19.00  -  LENS IOL +19 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25100C+19.50,SUP,HCPCS V2632,,25100C+19.50  -  LENS IOL +19.5 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25100C+20.00,SUP,HCPCS V2632,,25100C+20.00  -  LENS IOL +20 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25100C+20.50,SUP,HCPCS V2632,,25100C+20.50  -  LENS IOL +20.5 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25100C+21.00,SUP,HCPCS V2632,,25100C+21.00  -  LENS IOL +21 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25100C+21.50,SUP,HCPCS V2632,,25100C+21.50  -  LENS IOL +21.5 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25100C+22.00,SUP,HCPCS V2632,,25100C+22.00  -  LENS IOL +22 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25100C+22.50,SUP,HCPCS V2632,,25100C+22.50  -  LENS IOL +22.5 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25100C+23.00,SUP,HCPCS V2632,,25100C+23.00  -  LENS IOL +23 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25100C+23.50,SUP,HCPCS V2632,,25100C+23.50  -  LENS IOL +23.5 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25100C+24.00,SUP,HCPCS V2632,,25100C+24.00  -  LENS IOL +24 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25100C+24.50,SUP,HCPCS V2632,,25100C+24.50  -  LENS IOL +24.5 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25100C+25.00,SUP,HCPCS V2632,,25100C+25.00  -  LENS IOL +25 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25100C+25.50,SUP,HCPCS V2632,,25100C+25.50  -  LENS IOL +25.5 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25100C+26.00,SUP,HCPCS V2632,,25100C+26.00  -  LENS IOL +26 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25100C+26.50,SUP,HCPCS V2632,,25100C+26.50  -  LENS IOL +26.5 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25100C+27.00,SUP,HCPCS V2632,,25100C+27.00  -  LENS IOL +27 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25100C+27.50,SUP,HCPCS V2632,,25100C+27.50  -  LENS IOL +27.5 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25100C+28.00,SUP,HCPCS V2632,,25100C+28.00  -  LENS IOL +28 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25100C+28.50,SUP,HCPCS V2632,,25100C+28.50  -  LENS IOL +28.5 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25100C+29.00,SUP,HCPCS V2632,,25100C+29.00  -  LENS IOL +29 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25100C+29.50,SUP,HCPCS V2632,,25100C+29.50  -  LENS IOL +29.5 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25100C+30.00,SUP,HCPCS V2632,,25100C+30.00  -  LENS IOL +30 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25100C+6.00,SUP,HCPCS V2632,,25100C+6.00  -  LENS IOL +6 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25100C+6.50,SUP,HCPCS V2632,,25100C+6.50  -  LENS IOL +6.5 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25100C+7.00,SUP,HCPCS V2632,,25100C+7.00  -  LENS IOL +7 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25100C+7.50,SUP,HCPCS V2632,,25100C+7.50  -  LENS IOL +7.5 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25100C+8.50,SUP,HCPCS V2632,,25100C+8.50  -  LENS IOL +8.5 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25100C+9.00,SUP,HCPCS V2632,,25100C+9.00  -  LENS IOL +9 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25100C+9.50,SUP,HCPCS V2632,,25100C+9.50  -  LENS IOL +9.5 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25100C-8.00,SUP,HCPCS V2632,,25100C-8.00  -  LENS IOL +8 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
25121-1,SUP,Custom 27203010,,25121-1  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$4,754.75",$0.00,"$4,754.75",$0.00,"$3,393.47",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,754.75",$0.00,"$2,377.38","$3,765.76","$3,803.80",$0.00,$0.00,$0.00,$0.00,$0.00
25121-2,SUP,Custom 27803010,,25121-2  -  PLATE 18MM TI BONE SPNL,"$4,754.75",$0.00,"$4,754.75",$0.00,"$3,393.47",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,754.75",$0.00,"$2,377.38","$3,765.76","$3,803.80",$0.00,$0.00,$0.00,$0.00,$0.00
25121-5,SUP,Custom 27203010,,25121-5  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$4,754.75",$0.00,"$4,754.75",$0.00,"$3,393.47",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,754.75",$0.00,"$2,377.38","$3,765.76","$3,803.80",$0.00,$0.00,$0.00,$0.00,$0.00
25-197-07-71,SUP,HCPCS C1713,,25-197-07-71  -  PLATE BN STRL LVL 1 HBRD CRNMXF,$828.00,$0.00,$828.00,$372.60,$590.94,$0.00,$142.66,$0.00,$0.00,$144.98,$828.00,$0.00,$414.00,$655.78,$662.40,$0.00,$129.58,$0.00,$131.82,$0.00
25-198-06-71,SUP,HCPCS C1713,,25-198-06-71  -  SCREW BN STRL LVL 1 MAXDRIVE CRNMXF,$358.00,$0.00,$358.00,$161.10,$255.50,$0.00,$61.68,$0.00,$0.00,$62.68,$358.00,$0.00,$179.00,$283.54,$286.40,$0.00,$56.03,$0.00,$56.99,$0.00
25-198-06-75,SUP,HCPCS C1713,,25-198-06-75  -  SCREW BN STRL LVL 1 MAXDRIVE CRNMXF,"$1,790.00",$0.00,"$1,790.00",$805.50,"$1,277.52",$0.00,$308.41,$0.00,$0.00,$313.41,"$1,790.00",$0.00,$895.00,"$1,417.68","$1,432.00",$0.00,$280.14,$0.00,$284.97,$0.00
25221B,SUP,Custom 27203010,,SARSTEDT TUBES,$137.50,$0.00,$137.50,$0.00,$98.13,$0.00,$0.00,$0.00,$0.00,$0.00,$137.50,$0.00,$68.75,$108.90,$110.00,$0.00,$0.00,$0.00,$0.00,$0.00
25222B,SUP,Custom 27203010,,CAP TUBE 2ML,$157.50,$0.00,$157.50,$0.00,$112.41,$0.00,$0.00,$0.00,$0.00,$0.00,$157.50,$0.00,$78.75,$124.74,$126.00,$0.00,$0.00,$0.00,$0.00,$0.00
252-952,SUP,Custom 27203010,,MASK INFANT BMV AMBU,$176.50,$0.00,$176.50,$0.00,$125.97,$0.00,$0.00,$0.00,$0.00,$0.00,$176.50,$0.00,$88.25,$139.79,$141.20,$0.00,$0.00,$0.00,$0.00,$0.00
253.27S,SUP,HCPCS C1713,,253.27S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 270MM STAINLESS STEEL,"$2,135.38",$0.00,"$2,135.38",$960.92,"$1,524.02",$0.00,$367.91,$0.00,$0.00,$373.89,"$2,135.38",$0.00,"$1,067.69","$1,691.22","$1,708.30",$0.00,$334.19,$0.00,$339.95,$0.00
25-302-70-91,SUP,HCPCS C1713,,25-302-70-91  -  PLATE BONE MICRO STR MEDIUM .6MM 2 HOLE TITANIUM FRONTAL,$113.18,$0.00,$113.18,$50.93,$80.77,$0.00,$19.50,$0.00,$0.00,$19.82,$113.18,$0.00,$56.59,$89.64,$90.54,$0.00,$17.71,$0.00,$18.02,$0.00
25-304-00-91,SUP,HCPCS C1713,,25-304-00-91  -  PLATE BONE MICRO REGULAR STR .6MM 4 HOLE TITANIUM MAXFACL,$171.00,$0.00,$171.00,$76.95,$122.04,$0.00,$29.46,$0.00,$0.00,$29.94,$171.00,$0.00,$85.50,$135.43,$136.80,$0.00,$26.76,$0.00,$27.22,$0.00
25-304-55-91,SUP,HCPCS C1713,,25-304-55-91  -  PLATE BONE MICRO MEDIUM STR .6MM 4 HOLE TITANIUM MAXFACL 1.5,$176.13,$0.00,$176.13,$79.26,$125.70,$0.00,$30.35,$0.00,$0.00,$30.84,$176.13,$0.00,$88.06,$139.49,$140.90,$0.00,$27.56,$0.00,$28.04,$0.00
25-306-00-91,SUP,HCPCS C1713,,25-306-00-91  -  PLATE BN MIC STRG .6MM THREADLOCK TS 6 HL TI MXLFCL 1.5MM,$230.50,$0.00,$230.50,$103.73,$164.51,$0.00,$39.71,$0.00,$0.00,$40.36,$230.50,$0.00,$115.25,$182.56,$184.40,$0.00,$36.07,$0.00,$36.70,$0.00
25-306-55-91,SUP,HCPCS C1713,,25-306-55-91  -  PLATE BONE MICRO STR MEDIUM .6MM 6 HOLE TITANIUM MIDFAC 1.5,$230.50,$0.00,$230.50,$103.73,$164.51,$0.00,$39.71,$0.00,$0.00,$40.36,$230.50,$0.00,$115.25,$182.56,$184.40,$0.00,$36.07,$0.00,$36.70,$0.00
25-308-00-91,SUP,HCPCS C1713,,25-308-00-91  -  PLATE BONE MICRO STR REGULAR .6MM 8 HOLE TITANIUM RIGHT,$253.80,$0.00,$253.80,$114.21,$181.14,$0.00,$43.73,$0.00,$0.00,$44.44,$253.80,$0.00,$126.90,$201.01,$203.04,$0.00,$39.72,$0.00,$40.40,$0.00
25-308-16-09,SUP,HCPCS C1713,,25-308-16-09  -  MIDFACE PLATE  MEDIUM  6 HOLE  DOUBLE Y  0.8MM THICK,$660.40,$0.00,$660.40,$297.18,$471.33,$0.00,$113.78,$0.00,$0.00,$115.63,$660.40,$0.00,$330.20,$523.04,$528.32,$0.00,$103.35,$0.00,$105.14,$0.00
25-310-09-09,SUP,HCPCS C1713,,25-310-09-09  -  PLATE LARGE L-SHAPE W/ TAB 10 HOLE 5X4 1MM,$608.65,$0.00,$608.65,$273.89,$434.39,$0.00,$104.87,$0.00,$0.00,$106.57,$608.65,$0.00,$304.33,$482.05,$486.92,$0.00,$95.25,$0.00,$96.90,$0.00
25-310-70-91,SUP,HCPCS C1713,,25-310-70-91  -  PLATE BONE L MICRO .6MM TITANIUM MIDFAC 1.5MM SCREW,$388.50,$0.00,$388.50,$174.83,$277.27,$0.00,$66.94,$0.00,$0.00,$68.02,$388.50,$0.00,$194.25,$307.69,$310.80,$0.00,$60.80,$0.00,$61.85,$0.00
25-311-70-91,SUP,HCPCS C1713,,25-311-70-91  -  PLATE BONE L MICRO MEDIUM .6MM TITANIUM RIGHT MIDFAC STERILE,$388.50,$0.00,$388.50,$174.83,$277.27,$0.00,$66.94,$0.00,$0.00,$68.02,$388.50,$0.00,$194.25,$307.69,$310.80,$0.00,$60.80,$0.00,$61.85,$0.00
25-311-85-91,SUP,HCPCS C1713,,25-311-85-91  -  PLATE BONE L MICRO LONG .6MM TITANIUM RIGHT MIDFAC STERILE,$388.50,$0.00,$388.50,$174.83,$277.27,$0.00,$66.94,$0.00,$0.00,$68.02,$388.50,$0.00,$194.25,$307.69,$310.80,$0.00,$60.80,$0.00,$61.85,$0.00
25-314-85-91,SUP,HCPCS C1713,,25-314-85-91  -  PLATE BN 100D LNG MIC L .6MM THREADLOCK TS 3X2 HL TI MXLFCL,$388.50,$0.00,$388.50,$174.83,$277.27,$0.00,$66.94,$0.00,$0.00,$68.02,$388.50,$0.00,$194.25,$307.69,$310.80,$0.00,$60.80,$0.00,$61.85,$0.00
25-315-06-91,SUP,HCPCS C1713,,25-315-06-91  -  PLATE BONE T MICRO REGULAR .6MM TITANIUM MIDFAC STERILE 1.5,$388.50,$0.00,$388.50,$174.83,$277.27,$0.00,$66.94,$0.00,$0.00,$68.02,$388.50,$0.00,$194.25,$307.69,$310.80,$0.00,$60.80,$0.00,$61.85,$0.00
25-315-85-91,SUP,HCPCS C1713,,25-315-85-91  -  PLATE BONE 100D L MICRO .6MM TITANIUM RIGHT MIDFAC STERILE,$388.50,$0.00,$388.50,$174.83,$277.27,$0.00,$66.94,$0.00,$0.00,$68.02,$388.50,$0.00,$194.25,$307.69,$310.80,$0.00,$60.80,$0.00,$61.85,$0.00
25-316-00-91,SUP,HCPCS C1713,,25-316-00-91  -  PLATE BONE MICRO .6MM 16 HOLE TITANIUM MIDFAC STERILE 1.5MM,$414.88,$0.00,$414.88,$186.69,$296.10,$0.00,$71.48,$0.00,$0.00,$72.64,$414.88,$0.00,$207.44,$328.58,$331.90,$0.00,$64.93,$0.00,$66.05,$0.00
25-320-70-91,SUP,HCPCS C1713,,25-320-70-91  -  PLATE BONE Y MICRO LONG .6MM TITANIUM MIDFAC STERILE 1.5MM,$389.73,$0.00,$389.73,$175.38,$278.15,$0.00,$67.15,$0.00,$0.00,$68.24,$389.73,$0.00,$194.86,$308.67,$311.78,$0.00,$60.99,$0.00,$62.04,$0.00
25-322-55-91,SUP,HCPCS C1713,,25-322-55-91  -  PLATE BN MIC SHRT 2Y .6MM THREADLOCK TS 6 HL TI MXLFCL 1.5MM,$453.23,$0.00,$453.23,$203.95,$323.47,$0.00,$78.09,$0.00,$0.00,$79.36,$453.23,$0.00,$226.61,$358.96,$362.58,$0.00,$70.93,$0.00,$72.15,$0.00
25-322-70-91,SUP,HCPCS C1713,,25-322-70-91  -  PLATE BONE 2Y MICRO MEDIUM .6MM TITANIUM RIGHT FRONTAL MAXL,$440.03,$0.00,$440.03,$198.01,$314.05,$0.00,$75.81,$0.00,$0.00,$77.04,$440.03,$0.00,$220.01,$348.50,$352.02,$0.00,$68.86,$0.00,$70.05,$0.00
25-325-10-91,SUP,HCPCS C1713,,25-325-10-91  -  PLATE BN MIC CRV .6MM THREADLOCK TS 10 HL TI MXLFCL 1.5MM,$427.33,$0.00,$427.33,$192.30,$304.98,$0.00,$73.63,$0.00,$0.00,$74.82,$427.33,$0.00,$213.66,$338.45,$341.86,$0.00,$66.88,$0.00,$68.03,$0.00
25-326-55-91,SUP,HCPCS C1713,,25-326-55-91  -  PLATE BONE X MICRO REGULAR .6MM TITANIUM MIDFAC STERILE 1.5,$427.33,$0.00,$427.33,$192.30,$304.98,$0.00,$73.63,$0.00,$0.00,$74.82,$427.33,$0.00,$213.66,$338.45,$341.86,$0.00,$66.88,$0.00,$68.03,$0.00
25-329-05-09,SUP,HCPCS C1713,,25-329-05-09  -  PLATE BONE Y MICRO .6MM 6 HOLE TITANIUM MIDFAC 1.5MM SCREW,$414.38,$0.00,$414.38,$186.47,$295.74,$0.00,$71.39,$0.00,$0.00,$72.55,$414.38,$0.00,$207.19,$328.19,$331.50,$0.00,$64.85,$0.00,$65.97,$0.00
25-330-05-09,SUP,HCPCS C1713,,25-330-05-09  -  PLATE BONE 100D L MICRO LEFT ANGLE .6MM 7 HOLE TITANIUM,$414.38,$0.00,$414.38,$186.47,$295.74,$0.00,$71.39,$0.00,$0.00,$72.55,$414.38,$0.00,$207.19,$328.19,$331.50,$0.00,$64.85,$0.00,$65.97,$0.00
25-330-07-09,SUP,HCPCS C1713,,25-330-07-09  -  PLATE BONE T MICRO .6MM 6 HOLE TITANIUM MIDFAC 1.5MM SCREW,$388.50,$0.00,$388.50,$174.83,$277.27,$0.00,$66.94,$0.00,$0.00,$68.02,$388.50,$0.00,$194.25,$307.69,$310.80,$0.00,$60.80,$0.00,$61.85,$0.00
25-330-24-09,SUP,HCPCS C1713,,25-330-24-09  -  PLATE BN MIC STRG .6MM THREADLOCK TS 24 HL TI MXLFCL 1.5MM,$582.75,$0.00,$582.75,$262.24,$415.91,$0.00,$100.40,$0.00,$0.00,$102.03,$582.75,$0.00,$291.38,$461.54,$466.20,$0.00,$91.20,$0.00,$92.77,$0.00
25-331-05-09,SUP,HCPCS C1713,,25-331-05-09  -  PLATE BONE 100D L MICRO RIGHT ANG .6MM 7 HOLE TITANIUM,$414.38,$0.00,$414.38,$186.47,$295.74,$0.00,$71.39,$0.00,$0.00,$72.55,$414.38,$0.00,$207.19,$328.19,$331.50,$0.00,$64.85,$0.00,$65.97,$0.00
25-331-85-91,SUP,HCPCS C1713,,25-331-85-91  -  PLATE BONE L MICRO .6MM TITANIUM MIDFAC 1.5MM SCREW,$414.38,$0.00,$414.38,$186.47,$295.74,$0.00,$71.39,$0.00,$0.00,$72.55,$414.38,$0.00,$207.19,$328.19,$331.50,$0.00,$64.85,$0.00,$65.97,$0.00
25-332-08-09,SUP,HCPCS C1713,,25-332-08-09  -  PLATE BONE MICRO .6MM 8 HOLE INSERT TITANIUM ORBTL FLOOR,$401.43,$0.00,$401.43,$180.64,$286.50,$0.00,$69.16,$0.00,$0.00,$70.29,$401.43,$0.00,$200.71,$317.93,$321.14,$0.00,$62.82,$0.00,$63.91,$0.00
25-377-04,SUP,HCPCS C1713,,25-377-04  -  PLATE MED LEFT MAXFACL L BONE .6MM,$325.50,$0.00,$325.50,$146.48,$232.31,$0.00,$56.08,$0.00,$0.00,$56.99,$325.50,$0.00,$162.75,$257.80,$260.40,$0.00,$50.94,$0.00,$51.82,$0.00
254.27S,SUP,HCPCS C1713,,254.27S  -  NAIL INTRAMEDULLARY UNIVERSAL 14MM 270MM STAINLESS STEEL,"$2,220.63",$0.00,"$2,220.63",$999.28,"$1,584.86",$0.00,$382.60,$0.00,$0.00,$388.81,"$2,220.63",$0.00,"$1,110.31","$1,758.74","$1,776.50",$0.00,$347.53,$0.00,$353.52,$0.00
254.28S,SUP,HCPCS C1713,,254.28S  -  NAIL INTRAMEDULLARY UNIVERSAL 14MM 285MM STAINLESS STEEL,"$2,220.63",$0.00,"$2,220.63",$999.28,"$1,584.86",$0.00,$382.60,$0.00,$0.00,$388.81,"$2,220.63",$0.00,"$1,110.31","$1,758.74","$1,776.50",$0.00,$347.53,$0.00,$353.52,$0.00
25-438-35-07,SUP,HCPCS C1713,,25-438-35-07  -  SCREW BYRD MIDFACE LARGE,$640.00,$0.00,$640.00,$288.00,$456.77,$0.00,$110.27,$0.00,$0.00,$112.06,$640.00,$0.00,$320.00,$506.88,$512.00,$0.00,$100.16,$0.00,$101.89,$0.00
25-449-07-91,SUP,Custom 27203010,,25-449-07-91  -  DRILL TWIST 1.5MM 50MM 7MM STOP,$290.05,$0.00,$290.05,$0.00,$207.01,$0.00,$0.00,$0.00,$0.00,$0.00,$290.05,$0.00,$145.03,$229.72,$232.04,$0.00,$0.00,$0.00,$0.00,$0.00
25-449-16-91,SUP,Custom 27100030,,25-449-16-91  -  DRILL TWIST 1.5MM 50MM 20MM NOTCH STOP STAINLESS STEEL,$290.05,$0.00,$290.05,$0.00,$207.01,$0.00,$0.00,$0.00,$0.00,$0.00,$290.05,$0.00,$145.03,$229.72,$232.04,$0.00,$0.00,$0.00,$0.00,$0.00
25-452-00-91,SUP,Custom 27100030,,25-452-00-91  -  DRILL TWIST 1.1MM 50MM NOTCH STAINLESS STEEL,$290.05,$0.00,$290.05,$0.00,$207.01,$0.00,$0.00,$0.00,$0.00,$0.00,$290.05,$0.00,$145.03,$229.72,$232.04,$0.00,$0.00,$0.00,$0.00,$0.00
25-452-05-91,SUP,Custom 27100030,,25-452-05-91  -  DRILL TWST 5MM 1.1MM 50MM J NTCH STP DISP,$290.05,$0.00,$290.05,$0.00,$207.01,$0.00,$0.00,$0.00,$0.00,$0.00,$290.05,$0.00,$145.03,$229.72,$232.04,$0.00,$0.00,$0.00,$0.00,$0.00
25-452-07-91,SUP,Custom 27100030,,25-452-07-91  -  BIT DRILL 1.1MM 50MM 7MM J NOTCH STOP TWIST STAINLESS STEEL,$290.05,$0.00,$290.05,$0.00,$207.01,$0.00,$0.00,$0.00,$0.00,$0.00,$290.05,$0.00,$145.03,$229.72,$232.04,$0.00,$0.00,$0.00,$0.00,$0.00
25452-525,SUP,Custom 27203010,,25452-525  -  LEAD CONNCTNG WIRE SNP,$10.94,$0.00,$10.94,$0.00,$7.81,$0.00,$0.00,$0.00,$0.00,$0.00,$10.94,$0.00,$5.47,$8.66,$8.75,$0.00,$0.00,$0.00,$0.00,$0.00
25-458-19-07,SUP,Custom 27100030,,25-458-19-07  -  DRILL TWIST J 1.9MM 50MM NOTCH DISPOSABLE 2.3MM FRAC SYSTEM,$290.05,$0.00,$290.05,$0.00,$207.01,$0.00,$0.00,$0.00,$0.00,$0.00,$290.05,$0.00,$145.03,$229.72,$232.04,$0.00,$0.00,$0.00,$0.00,$0.00
25-460-19-07,SUP,Custom 27100030,,25-460-19-07  -  DRILL TWIST 1.9MM 70MM STAINLESS STEEL,$290.05,$0.00,$290.05,$0.00,$207.01,$0.00,$0.00,$0.00,$0.00,$0.00,$290.05,$0.00,$145.03,$229.72,$232.04,$0.00,$0.00,$0.00,$0.00,$0.00
25-469-11-07,SUP,Custom 27100030,,25-469-11-07  -  BIT DRILL TWIST 1.5MM 115MM J NOTCH 2MM SCREW,$290.05,$0.00,$290.05,$0.00,$207.01,$0.00,$0.00,$0.00,$0.00,$0.00,$290.05,$0.00,$145.03,$229.72,$232.04,$0.00,$0.00,$0.00,$0.00,$0.00
255-000-001,SUP,Custom 27203010,,255-000-001  -  GRSPR LAPSCOP ALGTR 250MM 2.3MM AL MINI STRL LATEX FREE,$534.86,$0.00,$534.86,$0.00,$381.73,$0.00,$0.00,$0.00,$0.00,$0.00,$534.86,$0.00,$267.43,$423.61,$427.89,$0.00,$0.00,$0.00,$0.00,$0.00
2552-06-L,SUP,HCPCS L3935,,2552-06-L  -  TRIGGER FINGER SPLINTS LARGE,$0.42,$0.00,$159.57,$0.19,$0.30,$0.07,$159.57,$0.00,$0.00,$0.07,$0.42,$0.00,$0.21,$0.33,$0.33,$0.25,$151.93,$0.00,$155.06,$0.00
2552-06-M,SUP,HCPCS L3935,,2552-06-M  -  TRIGGER FINGER SPLINTS ME,$0.42,$0.00,$159.57,$0.19,$0.30,$0.07,$159.57,$0.00,$0.00,$0.07,$0.42,$0.00,$0.21,$0.33,$0.33,$0.25,$151.93,$0.00,$155.06,$0.00
2552-06-S,SUP,HCPCS L3935,,2552-06-S  -  TRIGGER FINGER SPLINTS SMALL,$0.42,$0.00,$159.57,$0.19,$0.30,$0.07,$159.57,$0.00,$0.00,$0.07,$0.42,$0.00,$0.21,$0.33,$0.33,$0.25,$151.93,$0.00,$155.06,$0.00
25-550-04-91,SUP,HCPCS C1713,,25-550-04-91  -  PLATE BONE MINI REGULAR 1MM 4 HOLE TITANIUM MANDIB 2MM SCREW,$178.73,$0.00,$178.73,$80.43,$127.56,$0.00,$30.79,$0.00,$0.00,$31.29,$178.73,$0.00,$89.36,$141.55,$142.98,$0.00,$27.97,$0.00,$28.45,$0.00
25-550-08-91,SUP,HCPCS C1713,,25-550-08-91  -  PLATE BONE MINI REGULAR 1MM 8 HOLE TITANIUM MANDIB 2MM SCREW,$220.13,$0.00,$220.13,$99.06,$157.10,$0.00,$37.93,$0.00,$0.00,$38.54,$220.13,$0.00,$110.06,$174.34,$176.10,$0.00,$34.45,$0.00,$35.04,$0.00
25-551-04-91,SUP,HCPCS C1713,,25-551-04-91  -  PLATE BONE MINI MEDIUM STANDARD 1MM 4 HOLE TITANIUM MAXFACL,$173.53,$0.00,$173.53,$78.09,$123.84,$0.00,$29.90,$0.00,$0.00,$30.38,$173.53,$0.00,$86.76,$137.44,$138.82,$0.00,$27.16,$0.00,$27.63,$0.00
25-552-04-91,SUP,HCPCS C1713,,25-552-04-91  -  PLATE BONE MINI LONG STANDARD 1MM 4 HOLE TITANIUM MANDIB 2MM,$176.13,$0.00,$176.13,$79.26,$125.70,$0.00,$30.35,$0.00,$0.00,$30.84,$176.13,$0.00,$88.06,$139.49,$140.90,$0.00,$27.56,$0.00,$28.04,$0.00
25-552-06-91,SUP,HCPCS C1713,,25-552-06-91  -  PLATE BONE MINI LONG STANDARD 1MM 6 HOLE TITANIUM MAXFACL 2,$204.58,$0.00,$204.58,$92.06,$146.01,$0.00,$35.25,$0.00,$0.00,$35.82,$204.58,$0.00,$102.29,$162.03,$163.66,$0.00,$32.02,$0.00,$32.57,$0.00
25-592-04-1,SUP,HCPCS C1713,,25-592-04-1  -  LOCKING PLATE  4 HOLE,$158.10,$0.00,$158.10,$71.15,$112.84,$0.00,$27.24,$0.00,$0.00,$27.68,$158.10,$0.00,$79.05,$125.22,$126.48,$0.00,$24.74,$0.00,$25.17,$0.00
25-672-15-1,SUP,HCPCS C1713,,25-672-15-1  -  SCREW TI 15MM 2MM MAXFACL XDR BONE,$99.98,$0.00,$99.98,$44.99,$71.35,$0.00,$17.23,$0.00,$0.00,$17.50,$99.98,$0.00,$49.99,$79.18,$79.98,$0.00,$15.65,$0.00,$15.92,$0.00
25-673-49-1,SUP,HCPCS C1713,,25-673-49-1  -  SCREW TI 9MM 2.3MM MAXFACL XDR ER BONE,$592.88,$0.00,$592.88,$266.79,$423.13,$0.00,$102.15,$0.00,$0.00,$103.81,$592.88,$0.00,$296.44,$469.56,$474.30,$0.00,$92.78,$0.00,$94.39,$0.00
25-677-12,SUP,HCPCS C1713,,25-677-12  -  SCREW TI 12MM 2.7MM MAXFACL XDR ER BONE,$238.00,$0.00,$238.00,$107.10,$169.86,$0.00,$41.01,$0.00,$0.00,$41.67,$238.00,$0.00,$119.00,$188.50,$190.40,$0.00,$37.25,$0.00,$37.89,$0.00
25-677-12-91,SUP,HCPCS C1713,,25-677-12-91  -  SCREW BONE 2.7MM 12MM EMERGENCY CROSS DRIVE TITANIUM MANDIB,$270.15,$0.00,$270.15,$121.57,$192.81,$0.00,$46.55,$0.00,$0.00,$47.30,$270.15,$0.00,$135.08,$213.96,$216.12,$0.00,$42.28,$0.00,$43.01,$0.00
25-677-14,SUP,HCPCS C1713,,25-677-14  -  SCREW TI 14MM 2.7MM MAXFACL XDR ER BONE,$238.00,$0.00,$238.00,$107.10,$169.86,$0.00,$41.01,$0.00,$0.00,$41.67,$238.00,$0.00,$119.00,$188.50,$190.40,$0.00,$37.25,$0.00,$37.89,$0.00
25-677-14-91,SUP,HCPCS C1713,,25-677-14-91  -  SCREW BONE 2.7MM 14MM NONLOCKING CROSS DRIVE THREADLOCK TS,$270.15,$0.00,$270.15,$121.57,$192.81,$0.00,$46.55,$0.00,$0.00,$47.30,$270.15,$0.00,$135.08,$213.96,$216.12,$0.00,$42.28,$0.00,$43.01,$0.00
25-677-16-91,SUP,HCPCS C1713,,25-677-16-91  -  SCREW BONE 2.7MM 16MM NONLOCKING CROSS DRIVE THREADLOCK TS,$270.15,$0.00,$270.15,$121.57,$192.81,$0.00,$46.55,$0.00,$0.00,$47.30,$270.15,$0.00,$135.08,$213.96,$216.12,$0.00,$42.28,$0.00,$43.01,$0.00
25-677-52-91,SUP,HCPCS C1713,,25-677-52-91  -  SCREW BONE 3.2MM 12MM EMERGENCY CROSS DRIVE TITANIUM MANDIB,$321.15,$0.00,$321.15,$144.52,$229.20,$0.00,$55.33,$0.00,$0.00,$56.23,$321.15,$0.00,$160.58,$254.35,$256.92,$0.00,$50.26,$0.00,$51.13,$0.00
25-677-56-1,SUP,HCPCS C1713,,25-677-56-1  -  SCREW TI 16MM 3.2MM MAXFACL XDR ER BONE,$230.50,$0.00,$230.50,$103.73,$164.51,$0.00,$39.71,$0.00,$0.00,$40.36,$230.50,$0.00,$115.25,$182.56,$184.40,$0.00,$36.07,$0.00,$36.70,$0.00
25-750-04-09,SUP,HCPCS C1713,,25-750-04-09  -  PLATE BONE 3D 1MM 4 HOLE THREADLOCK TITANIUM MANDIB,$668.38,$0.00,$668.38,$300.77,$477.02,$0.00,$115.16,$0.00,$0.00,$117.03,$668.38,$0.00,$334.19,$529.36,$534.70,$0.00,$104.60,$0.00,$106.41,$0.00
25-750-14-09,SUP,HCPCS C1713,,25-750-14-09  -  PLATE BONE 3D REGULAR 1MM 14 HOLE THREADLOCK TITANIUM MANDIB,"$1,308.90",$0.00,"$1,308.90",$589.01,$934.16,$0.00,$225.52,$0.00,$0.00,$229.18,"$1,308.90",$0.00,$654.45,"$1,036.65","$1,047.12",$0.00,$204.84,$0.00,$208.38,$0.00
25-752-04-09,SUP,HCPCS C1713,,25-752-04-09  -  PLATE BN LNG MN 1MM THREADLOCK TS 4 HL LCK TI MNDB,$710.13,$0.00,$710.13,$319.56,$506.82,$0.00,$122.35,$0.00,$0.00,$124.34,$710.13,$0.00,$355.06,$562.42,$568.10,$0.00,$111.13,$0.00,$113.05,$0.00
25-752-06-09,SUP,HCPCS C1713,,25-752-06-09  -  PLATE BONE MINI LONG 1MM 6 HOLE THREADLOCK GREEN TITANIUM,$779.75,$0.00,$779.75,$350.89,$556.51,$0.00,$134.35,$0.00,$0.00,$136.53,$779.75,$0.00,$389.88,$617.56,$623.80,$0.00,$122.03,$0.00,$124.14,$0.00
25-774-07-91,SUP,HCPCS C1713,,25-774-07-91  -  SCREW BONE 2.7MM 7MM LOCKING CROSS DRIVE TITANIUM MANDIB,$328.63,$0.00,$328.63,$147.88,$234.54,$0.00,$56.62,$0.00,$0.00,$57.54,$328.63,$0.00,$164.31,$260.27,$262.90,$0.00,$51.43,$0.00,$52.32,$0.00
25-774-09-91,SUP,HCPCS C1713,,25-774-09-91  -  SCREW BONE 2.7MM 9MM LOCKING CROSS DRIVE TITANIUM MANDIB,$328.63,$0.00,$328.63,$147.88,$234.54,$0.00,$56.62,$0.00,$0.00,$57.54,$328.63,$0.00,$164.31,$260.27,$262.90,$0.00,$51.43,$0.00,$52.32,$0.00
25-774-11-91,SUP,HCPCS C1713,,25-774-11-91  -  SCREW BONE 2.7MM 11MM LOCKING CROSS DRIVE TITANIUM MANDIB,$328.63,$0.00,$328.63,$147.88,$234.54,$0.00,$56.62,$0.00,$0.00,$57.54,$328.63,$0.00,$164.31,$260.27,$262.90,$0.00,$51.43,$0.00,$52.32,$0.00
25-774-13-91,SUP,HCPCS C1713,,25-774-13-91  -  SCREW BONE 2.7MM 13MM LOCKING CROSS DRIVE TITANIUM MANDIB,$328.63,$0.00,$328.63,$147.88,$234.54,$0.00,$56.62,$0.00,$0.00,$57.54,$328.63,$0.00,$164.31,$260.27,$262.90,$0.00,$51.43,$0.00,$52.32,$0.00
25-774-15-91,SUP,HCPCS C1713,,25-774-15-91  -  SCREW BONE 2.7MM 15MM LOCKING CROSS DRIVE TITANIUM MANDIB,$328.63,$0.00,$328.63,$147.88,$234.54,$0.00,$56.62,$0.00,$0.00,$57.54,$328.63,$0.00,$164.31,$260.27,$262.90,$0.00,$51.43,$0.00,$52.32,$0.00
25-780-04-91,SUP,HCPCS C1713,,25-780-04-91  -  NEURO SCREW  ULTRA LOW PROFILE 1.5 X 4.0MM,$201.15,$0.00,$201.15,$90.52,$143.56,$0.00,$34.66,$0.00,$0.00,$35.22,$201.15,$0.00,$100.58,$159.31,$160.92,$0.00,$31.48,$0.00,$32.02,$0.00
25-872-05-91,SUP,HCPCS C1713,,25-872-05-91  -  SCREW BN 2MM 5MM NS THREADLOCK TS LVL 1 MAXDRIVE CNCV TI,$124.33,$0.00,$124.33,$55.95,$88.73,$0.00,$21.42,$0.00,$0.00,$21.77,$124.33,$0.00,$62.16,$98.47,$99.46,$0.00,$19.46,$0.00,$19.79,$0.00
25-872-07-91,SUP,HCPCS C1713,,25-872-07-91  -  SCREW BN 2MM 7MM NS THREADLOCK TS LVL 1 MAXDRIVE CNCV TI,$124.33,$0.00,$124.33,$55.95,$88.73,$0.00,$21.42,$0.00,$0.00,$21.77,$124.33,$0.00,$62.16,$98.47,$99.46,$0.00,$19.46,$0.00,$19.79,$0.00
25-872-09-91,SUP,HCPCS C1713,,25-872-09-91  -  SCREW BN 2MM 9MM NS THREADLOCK TS LVL 1 MAXDRIVE CNCV TI,$124.33,$0.00,$124.33,$55.95,$88.73,$0.00,$21.42,$0.00,$0.00,$21.77,$124.33,$0.00,$62.16,$98.47,$99.46,$0.00,$19.46,$0.00,$19.79,$0.00
25-872-11-91,SUP,HCPCS C1713,,25-872-11-91  -  SCREW BN 2MM 11MM NS THREADLOCK TS LVL 1 MAXDRIVE CNCV TI,$124.33,$0.00,$124.33,$55.95,$88.73,$0.00,$21.42,$0.00,$0.00,$21.77,$124.33,$0.00,$62.16,$98.47,$99.46,$0.00,$19.46,$0.00,$19.79,$0.00
25-872-13-91,SUP,HCPCS C1713,,25-872-13-91  -  SCREW BN 2MM 13MM NS THREADLOCK TS LVL 1 MAXDRIVE CNCV TI,$124.33,$0.00,$124.33,$55.95,$88.73,$0.00,$21.42,$0.00,$0.00,$21.77,$124.33,$0.00,$62.16,$98.47,$99.46,$0.00,$19.46,$0.00,$19.79,$0.00
25-873-05-91,SUP,HCPCS C1713,,25-873-05-91  -  SCREW BONE 2.3MM 5MM MAXDRIVE TITANIUM ORAL MAXFACL,$160.58,$0.00,$160.58,$72.26,$114.60,$0.00,$27.67,$0.00,$0.00,$28.12,$160.58,$0.00,$80.29,$127.18,$128.46,$0.00,$25.13,$0.00,$25.56,$0.00
25-873-07-91,SUP,HCPCS C1713,,25-873-07-91  -  SCREW BONE 2.3MM 7MM MAXDRIVE TITANIUM ORAL MAXFACL,$160.58,$0.00,$160.58,$72.26,$114.60,$0.00,$27.67,$0.00,$0.00,$28.12,$160.58,$0.00,$80.29,$127.18,$128.46,$0.00,$25.13,$0.00,$25.56,$0.00
25-873-09-91,SUP,HCPCS C1713,,25-873-09-91  -  SCREW BONE 2.3MM 9MM MAXDRIVE TITANIUM ORAL MAXFACL,$160.58,$0.00,$160.58,$72.26,$114.60,$0.00,$27.67,$0.00,$0.00,$28.12,$160.58,$0.00,$80.29,$127.18,$128.46,$0.00,$25.13,$0.00,$25.56,$0.00
25-873-13-91,SUP,HCPCS C1713,,25-873-13-91  -  SCREW BONE 2.3MM 13MM MAXDRIVE TITANIUM ORAL MAXFACL,$160.58,$0.00,$160.58,$72.26,$114.60,$0.00,$27.67,$0.00,$0.00,$28.12,$160.58,$0.00,$80.29,$127.18,$128.46,$0.00,$25.13,$0.00,$25.56,$0.00
25-873-45-91,SUP,HCPCS C1713,,25-873-45-91  -  SCREW BN 2.3MM 5MM NS THREADLOCK TS LVL 1 MAXDRIVE SLFRET ER,$160.58,$0.00,$160.58,$72.26,$114.60,$0.00,$27.67,$0.00,$0.00,$28.12,$160.58,$0.00,$80.29,$127.18,$128.46,$0.00,$25.13,$0.00,$25.56,$0.00
25-873-47-91,SUP,HCPCS C1713,,25-873-47-91  -  SCREW BN 2.3MM 7MM NS THREADLOCK TS LVL 1 MAXDRIVE SLFRET ER,$160.58,$0.00,$160.58,$72.26,$114.60,$0.00,$27.67,$0.00,$0.00,$28.12,$160.58,$0.00,$80.29,$127.18,$128.46,$0.00,$25.13,$0.00,$25.56,$0.00
25-874-13-91,SUP,HCPCS C1713,,25-874-13-91  -  SCREW BN 2.5MM 13MM NS THREADLOCK TS LVL 1 MAXDRIVE SLFRET,$163.18,$0.00,$163.18,$73.43,$116.46,$0.00,$28.11,$0.00,$0.00,$28.57,$163.18,$0.00,$81.59,$129.24,$130.54,$0.00,$25.54,$0.00,$25.98,$0.00
25-875-09-91,SUP,HCPCS C1713,,25-875-09-91  -  SCREW BONE MICRO 1.5MM 9MM MAXDRIVE TITANIUM ORAL MAXFACL,$124.33,$0.00,$124.33,$55.95,$88.73,$0.00,$21.42,$0.00,$0.00,$21.77,$124.33,$0.00,$62.16,$98.47,$99.46,$0.00,$19.46,$0.00,$19.79,$0.00
25-876-05-91,SUP,HCPCS C1713,,25-876-05-91  -  SCREW BN MIC 1.8MM 5MM NS LVL 1 MAXDRIVE DRLFR ER TI-6AL-4V,$142.43,$0.00,$142.43,$64.09,$101.65,$0.00,$24.54,$0.00,$0.00,$24.94,$142.43,$0.00,$71.21,$112.80,$113.94,$0.00,$22.29,$0.00,$22.67,$0.00
25-876-07-91,SUP,HCPCS C1713,,25-876-07-91  -  SCREW BONE MICRO 1.8MM 5MM EMERGENCY DRILL FREE MAXDRIVE,$142.43,$0.00,$142.43,$64.09,$101.65,$0.00,$24.54,$0.00,$0.00,$24.94,$142.43,$0.00,$71.21,$112.80,$113.94,$0.00,$22.29,$0.00,$22.67,$0.00
25-878-04-91,SUP,HCPCS C1713,,25-878-04-91  -  SCREW BN MIC 1.5MM 4MM NS LVL 1 MAXDRIVE DRLFR TI-6AL-4V,$142.43,$0.00,$142.43,$64.09,$101.65,$0.00,$24.54,$0.00,$0.00,$24.94,$142.43,$0.00,$71.21,$112.80,$113.94,$0.00,$22.29,$0.00,$22.67,$0.00
25-878-05-91,SUP,HCPCS C1713,,25-878-05-91  -  SCREW BN MIC 1.5MM 5MM NS LVL 1 MAXDRIVE DRLFR TI-6AL-4V,$142.43,$0.00,$142.43,$64.09,$101.65,$0.00,$24.54,$0.00,$0.00,$24.94,$142.43,$0.00,$71.21,$112.80,$113.94,$0.00,$22.29,$0.00,$22.67,$0.00
25-878-07-91,SUP,HCPCS C1713,,25-878-07-91  -  SCREW BONE MICRO 1.5MM 7MM DRILL FREE MAXDRIVE TITANIUM ORAL,$142.43,$0.00,$142.43,$64.09,$101.65,$0.00,$24.54,$0.00,$0.00,$24.94,$142.43,$0.00,$71.21,$112.80,$113.94,$0.00,$22.29,$0.00,$22.67,$0.00
25-879-05-91,SUP,HCPCS C1713,,25-879-05-91  -  SCREW BN MN 2MM 5MM NS LVL 1 MAXDRIVE DRLFR TI-6AL-4V CRNMXF,$134.68,$0.00,$134.68,$60.60,$96.12,$0.00,$23.20,$0.00,$0.00,$23.58,$134.68,$0.00,$67.34,$106.67,$107.74,$0.00,$21.08,$0.00,$21.44,$0.00
25-879-07-91,SUP,HCPCS C1713,,25-879-07-91  -  SCREW BN MN 2MM 7MM NS LVL 1 MAXDRIVE DRLFR TI-6AL-4V CRNMXF,$134.68,$0.00,$134.68,$60.60,$96.12,$0.00,$23.20,$0.00,$0.00,$23.58,$134.68,$0.00,$67.34,$106.67,$107.74,$0.00,$21.08,$0.00,$21.44,$0.00
25-882-07-91,SUP,HCPCS C1713,,25-882-07-91  -  SCREW BN 2MM 7MM GRN NS THREADLOCK TS LVL 1 MAXDRIVE SLFRET,$270.15,$0.00,$270.15,$121.57,$192.81,$0.00,$46.55,$0.00,$0.00,$47.30,$270.15,$0.00,$135.08,$213.96,$216.12,$0.00,$42.28,$0.00,$43.01,$0.00
25-882-09-91,SUP,HCPCS C1713,,25-882-09-91  -  SCREW BN 2MM 9MM GRN NS THREADLOCK TS LVL 1 MAXDRIVE SLFRET,$270.15,$0.00,$270.15,$121.57,$192.81,$0.00,$46.55,$0.00,$0.00,$47.30,$270.15,$0.00,$135.08,$213.96,$216.12,$0.00,$42.28,$0.00,$43.01,$0.00
25-882-11-91,SUP,HCPCS C1713,,25-882-11-91  -  SCREW BN 2MM 11MM NS LVL 1 MAXDRIVE LCK TI CRNMXF,$270.15,$0.00,$270.15,$121.57,$192.81,$0.00,$46.55,$0.00,$0.00,$47.30,$270.15,$0.00,$135.08,$213.96,$216.12,$0.00,$42.28,$0.00,$43.01,$0.00
25-882-13-91,SUP,HCPCS C1713,,25-882-13-91  -  SCREW BONE 2MM 13MM LOCKING MAXDRIVE TITANIUM ORAL MAXFACL,$270.15,$0.00,$270.15,$121.57,$192.81,$0.00,$46.55,$0.00,$0.00,$47.30,$270.15,$0.00,$135.08,$213.96,$216.12,$0.00,$42.28,$0.00,$43.01,$0.00
25-882-15-91,SUP,HCPCS C1713,,25-882-15-91  -  SCREW BN 2MM 15MM GRN NS THREADLOCK TS LVL 1 MAXDRIVE SLFRET,$270.15,$0.00,$270.15,$121.57,$192.81,$0.00,$46.55,$0.00,$0.00,$47.30,$270.15,$0.00,$135.08,$213.96,$216.12,$0.00,$42.28,$0.00,$43.01,$0.00
25-883-11-91,SUP,HCPCS C1713,,25-883-11-91  -  SCREW BN 2.3MM 11MM GRN NS THREADLOCK TS LVL 1 MAXDRIVE,$300.75,$0.00,$300.75,$135.34,$214.65,$0.00,$51.82,$0.00,$0.00,$52.66,$300.75,$0.00,$150.38,$238.19,$240.60,$0.00,$47.07,$0.00,$47.88,$0.00
25AGFN-756,SUP,Custom 27803010,,25AGFN-756  -  VALVE AORTIC 85D 25MM 23MM 1 DIGIT GRADIENT MECHANICAL,"$11,750.00",$0.00,"$11,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,750.00",$0.00,"$5,875.00","$9,306.00","$9,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
25AJ-501,SUP,Custom 27803010,,25AJ-501  -  VALVE AOR 25MM MSTR MECH STD CUF ROT,"$10,000.00",$0.00,"$10,000.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
25MJ-501,SUP,Custom 27803010,,25MJ-501  -  VALVE AORTIC 25MM MSTR HRT MECH,"$10,000.00",$0.00,"$10,000.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
260-120,SUP,Custom 27203010,,260-120  -  DILAT SURG AMPTZ PTFE COAX STY SF WIRE INTROD 8-10FR,$100.00,$0.00,$100.00,$0.00,$71.37,$0.00,$0.00,$0.00,$0.00,$0.00,$100.00,$0.00,$50.00,$79.20,$80.00,$0.00,$0.00,$0.00,$0.00,$0.00
260-250-,SUP,Custom 27203010,,DILATOR SURG AMPTZ SET RNL STRL DISP,$566.60,$0.00,$566.60,$0.00,$404.38,$0.00,$0.00,$0.00,$0.00,$0.00,$566.60,$0.00,$283.30,$448.75,$453.28,$0.00,$0.00,$0.00,$0.00,$0.00
26026-2,SUP,Custom 27803010,,26026-2  -  PLATE 18MM TI BONE SPNL,"$3,997.13",$0.00,"$3,997.13",$0.00,"$2,852.75",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,997.13",$0.00,"$1,998.56","$3,165.73","$3,197.70",$0.00,$0.00,$0.00,$0.00,$0.00
26026-5,SUP,Custom 27803010,,26026-5  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$4,134.88",$0.00,"$4,134.88",$0.00,"$2,951.06",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,134.88",$0.00,"$2,067.44","$3,274.82","$3,307.90",$0.00,$0.00,$0.00,$0.00,$0.00
2627-2-905,SUP,Custom 27803010,,2627-2-905  -  INSERT TIB STD 5MM KNEE CRUC RET HI,"$3,536.00",$0.00,"$3,536.00",$0.00,"$2,523.64",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,536.00",$0.00,"$1,768.00","$2,800.51","$2,828.80",$0.00,$0.00,$0.00,$0.00,$0.00
2627-2-915,SUP,Custom 27803010,,2627-2-915  -  INSERT TIB STD 15MM KNEE CRUC RET HI,"$3,536.00",$0.00,"$3,536.00",$0.00,"$2,523.64",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,536.00",$0.00,"$1,768.00","$2,800.51","$2,828.80",$0.00,$0.00,$0.00,$0.00,$0.00
2627-6-901,SUP,HCPCS C1713,,2627-6-901  -  PIN FIX VAK LCK ASMBLY ORTH SM,$342.88,$0.00,$342.88,$154.29,$244.71,$0.00,$59.08,$0.00,$0.00,$60.03,$342.88,$0.00,$171.44,$271.56,$274.30,$0.00,$53.66,$0.00,$54.59,$0.00
2642-1-109,SUP,Custom 27803010,,2642-1-109  -  INSERT TIBIAL SMALL 9MM PRIM PCA KNEE,"$2,152.50",$0.00,"$2,152.50",$0.00,"$1,536.24",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,152.50",$0.00,"$1,076.25","$1,704.78","$1,722.00",$0.00,$0.00,$0.00,$0.00,$0.00
2642-1-111,SUP,Custom 27803010,,2642-1-111  -  INSERT TIBIAL MEDIUM 11MM PRIM PCA KNEE,"$2,152.50",$0.00,"$2,152.50",$0.00,"$1,536.24",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,152.50",$0.00,"$1,076.25","$1,704.78","$1,722.00",$0.00,$0.00,$0.00,$0.00,$0.00
2642-1-113,SUP,Custom 27803010,,2642-1-113  -  INSERT TIBIAL SMALL 13MM PRIM PCA KNEE,"$2,152.50",$0.00,"$2,152.50",$0.00,"$1,536.24",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,152.50",$0.00,"$1,076.25","$1,704.78","$1,722.00",$0.00,$0.00,$0.00,$0.00,$0.00
2642-1-116,SUP,Custom 27803010,,2642-1-116  -  INSERT TIBIAL SMALL 16MM PRIM PCA KNEE,"$2,152.50",$0.00,"$2,152.50",$0.00,"$1,536.24",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,152.50",$0.00,"$1,076.25","$1,704.78","$1,722.00",$0.00,$0.00,$0.00,$0.00,$0.00
2642-1-119,SUP,Custom 27803010,,2642-1-119  -  INSERT TIBIAL SMALL 19MM PRIM PCA KNEE,"$2,152.50",$0.00,"$2,152.50",$0.00,"$1,536.24",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,152.50",$0.00,"$1,076.25","$1,704.78","$1,722.00",$0.00,$0.00,$0.00,$0.00,$0.00
2642-1-122,SUP,Custom 27803010,,2642-1-122  -  INSERT TIBIAL SMALL 22MM PRIM PCA KNEE,"$2,152.50",$0.00,"$2,152.50",$0.00,"$1,536.24",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,152.50",$0.00,"$1,076.25","$1,704.78","$1,722.00",$0.00,$0.00,$0.00,$0.00,$0.00
2642-1-125,SUP,Custom 27803010,,2642-1-125  -  INSERT TIBIAL PCA KNEE,"$2,152.50",$0.00,"$2,152.50",$0.00,"$1,536.24",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,152.50",$0.00,"$1,076.25","$1,704.78","$1,722.00",$0.00,$0.00,$0.00,$0.00,$0.00
2642-1-128,SUP,Custom 27803010,,2642-1-128  -  INSERT TIBIAL SMALL 28MM PRIM PCA KNEE,"$2,152.50",$0.00,"$2,152.50",$0.00,"$1,536.24",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,152.50",$0.00,"$1,076.25","$1,704.78","$1,722.00",$0.00,$0.00,$0.00,$0.00,$0.00
2642-1-131,SUP,Custom 27803010,,2642-1-131  -  INSERT TIBIAL SMALL 31MM PRIM PCA KNEE,"$2,152.50",$0.00,"$2,152.50",$0.00,"$1,536.24",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,152.50",$0.00,"$1,076.25","$1,704.78","$1,722.00",$0.00,$0.00,$0.00,$0.00,$0.00
2642-3-111,SUP,Custom 27803010,,2642-3-111  -  INSERT TIBIAL MEDIUM 11MM PRIM PCA KNEE,"$2,152.50",$0.00,"$2,152.50",$0.00,"$1,536.24",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,152.50",$0.00,"$1,076.25","$1,704.78","$1,722.00",$0.00,$0.00,$0.00,$0.00,$0.00
2642-3-113,SUP,Custom 27803010,,2642-3-113  -  INSERT TIBIAL MEDIUM 13MM PRIM PCA KNEE,"$2,152.50",$0.00,"$2,152.50",$0.00,"$1,536.24",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,152.50",$0.00,"$1,076.25","$1,704.78","$1,722.00",$0.00,$0.00,$0.00,$0.00,$0.00
2642-3-116,SUP,Custom 27803010,,2642-3-116  -  INSERT TIBIAL MEDIUM 16MM PRIM PCA KNEE,"$2,152.50",$0.00,"$2,152.50",$0.00,"$1,536.24",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,152.50",$0.00,"$1,076.25","$1,704.78","$1,722.00",$0.00,$0.00,$0.00,$0.00,$0.00
2642-3-119,SUP,Custom 27803010,,2642-3-119  -  INSERT TIBIAL MEDIUM 19MM PRIM PCA KNEE,"$2,152.50",$0.00,"$2,152.50",$0.00,"$1,536.24",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,152.50",$0.00,"$1,076.25","$1,704.78","$1,722.00",$0.00,$0.00,$0.00,$0.00,$0.00
2642-3-122,SUP,Custom 27803010,,2642-3-122  -  INSERT TIBIAL MEDIUM 22MM PRIM PCA KNEE,"$2,152.50",$0.00,"$2,152.50",$0.00,"$1,536.24",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,152.50",$0.00,"$1,076.25","$1,704.78","$1,722.00",$0.00,$0.00,$0.00,$0.00,$0.00
2642-3-125,SUP,Custom 27803010,,2642-3-125  -  INSERT TIBIAL MEDIUM 25MM PRIM PCA KNEE,"$2,152.50",$0.00,"$2,152.50",$0.00,"$1,536.24",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,152.50",$0.00,"$1,076.25","$1,704.78","$1,722.00",$0.00,$0.00,$0.00,$0.00,$0.00
2642-3-128,SUP,Custom 27803010,,2642-3-128  -  INSERT TIBIAL MEDIUM 28MM PRIM PCA KNEE,"$2,152.50",$0.00,"$2,152.50",$0.00,"$1,536.24",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,152.50",$0.00,"$1,076.25","$1,704.78","$1,722.00",$0.00,$0.00,$0.00,$0.00,$0.00
2642-3-131,SUP,Custom 27803010,,2642-3-131  -  INSERT TIBIAL MEDIUM 31MM PRIM PCA KNEE,"$2,152.50",$0.00,"$2,152.50",$0.00,"$1,536.24",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,152.50",$0.00,"$1,076.25","$1,704.78","$1,722.00",$0.00,$0.00,$0.00,$0.00,$0.00
2642-5-109,SUP,Custom 27803010,,2642-5-109  -  INSERT TIBIAL LARGE 19MM PRIM PCA KNEE,"$2,152.50",$0.00,"$2,152.50",$0.00,"$1,536.24",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,152.50",$0.00,"$1,076.25","$1,704.78","$1,722.00",$0.00,$0.00,$0.00,$0.00,$0.00
2642-5-111,SUP,Custom 27803010,,2642-5-111  -  INSERT TIBIAL LARGE 11MM PRIM PCA KNEE,"$2,152.50",$0.00,"$2,152.50",$0.00,"$1,536.24",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,152.50",$0.00,"$1,076.25","$1,704.78","$1,722.00",$0.00,$0.00,$0.00,$0.00,$0.00
2642-5-113,SUP,Custom 27803010,,2642-5-113  -  INSERT TIBIAL LARGE 13MM PRIM PCA KNEE,"$2,152.50",$0.00,"$2,152.50",$0.00,"$1,536.24",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,152.50",$0.00,"$1,076.25","$1,704.78","$1,722.00",$0.00,$0.00,$0.00,$0.00,$0.00
2642-5-116,SUP,Custom 27803010,,2642-5-116  -  INSERT TIBIAL LARGE 16MM PCA KNEE,"$2,152.50",$0.00,"$2,152.50",$0.00,"$1,536.24",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,152.50",$0.00,"$1,076.25","$1,704.78","$1,722.00",$0.00,$0.00,$0.00,$0.00,$0.00
2642-5-119,SUP,Custom 27803010,,2642-5-119  -  INSERT TIBIAL LARGE 19MM PRIM PCA KNEE,"$2,152.50",$0.00,"$2,152.50",$0.00,"$1,536.24",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,152.50",$0.00,"$1,076.25","$1,704.78","$1,722.00",$0.00,$0.00,$0.00,$0.00,$0.00
2642-5-122,SUP,Custom 27803010,,2642-5-122  -  INSERT TIBIAL LARGE 22MM PRIM PCA KNEE,"$2,152.50",$0.00,"$2,152.50",$0.00,"$1,536.24",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,152.50",$0.00,"$1,076.25","$1,704.78","$1,722.00",$0.00,$0.00,$0.00,$0.00,$0.00
2642-5-125,SUP,Custom 27803010,,2642-5-125  -  INSERT TIBIAL LARGE 25MM PRIM PCA KNEE,"$2,152.50",$0.00,"$2,152.50",$0.00,"$1,536.24",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,152.50",$0.00,"$1,076.25","$1,704.78","$1,722.00",$0.00,$0.00,$0.00,$0.00,$0.00
2642-5-128,SUP,Custom 27803010,,2642-5-128  -  INSERT TIBIAL LARGE 28MM PRIM PCA KNEE,"$2,152.50",$0.00,"$2,152.50",$0.00,"$1,536.24",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,152.50",$0.00,"$1,076.25","$1,704.78","$1,722.00",$0.00,$0.00,$0.00,$0.00,$0.00
2642-5-131,SUP,Custom 27803010,,2642-5-131  -  INSERT TIBIAL LARGE 31MM PRIM PCA KNEE,"$2,152.50",$0.00,"$2,152.50",$0.00,"$1,536.24",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,152.50",$0.00,"$1,076.25","$1,704.78","$1,722.00",$0.00,$0.00,$0.00,$0.00,$0.00
2642-6-109,SUP,Custom 27803010,,2642-6-109  -  INSERT TIBIAL XL 9MM PRIM PCA KNEE,"$2,152.50",$0.00,"$2,152.50",$0.00,"$1,536.24",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,152.50",$0.00,"$1,076.25","$1,704.78","$1,722.00",$0.00,$0.00,$0.00,$0.00,$0.00
2642-6-111,SUP,Custom 27803010,,2642-6-111  -  INSERT TIBIAL PCA KNEE,"$2,152.50",$0.00,"$2,152.50",$0.00,"$1,536.24",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,152.50",$0.00,"$1,076.25","$1,704.78","$1,722.00",$0.00,$0.00,$0.00,$0.00,$0.00
2642-6-113,SUP,Custom 27803010,,2642-6-113  -  INSERT TIBIAL PCA KNEE,"$2,152.50",$0.00,"$2,152.50",$0.00,"$1,536.24",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,152.50",$0.00,"$1,076.25","$1,704.78","$1,722.00",$0.00,$0.00,$0.00,$0.00,$0.00
2642-6-116,SUP,Custom 27803010,,2642-6-116  -  INSERT TIBIAL XL 16MM PRIM PCA KNEE,"$2,152.50",$0.00,"$2,152.50",$0.00,"$1,536.24",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,152.50",$0.00,"$1,076.25","$1,704.78","$1,722.00",$0.00,$0.00,$0.00,$0.00,$0.00
2642-6-119,SUP,Custom 27803010,,2642-6-119  -  INSERT TIBIAL XL 19MM PRIM PCA KNEE,"$2,152.50",$0.00,"$2,152.50",$0.00,"$1,536.24",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,152.50",$0.00,"$1,076.25","$1,704.78","$1,722.00",$0.00,$0.00,$0.00,$0.00,$0.00
2642-6-122,SUP,Custom 27803010,,2642-6-122  -  INSERT TIBIAL XL 22MM PRIM PCA KNEE,"$2,152.50",$0.00,"$2,152.50",$0.00,"$1,536.24",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,152.50",$0.00,"$1,076.25","$1,704.78","$1,722.00",$0.00,$0.00,$0.00,$0.00,$0.00
2642-6-125,SUP,Custom 27803010,,2642-6-125  -  INSERT TIBIAL XL 25MM PRIM PCA KNEE,"$2,065.00",$0.00,"$2,065.00",$0.00,"$1,473.79",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,065.00",$0.00,"$1,032.50","$1,635.48","$1,652.00",$0.00,$0.00,$0.00,$0.00,$0.00
2642-6-128,SUP,Custom 27803010,,2642-6-128  -  INSERT TIBIAL XL 28MM PRIM PCA KNEE,"$2,065.00",$0.00,"$2,065.00",$0.00,"$1,473.79",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,065.00",$0.00,"$1,032.50","$1,635.48","$1,652.00",$0.00,$0.00,$0.00,$0.00,$0.00
2642-6-131,SUP,Custom 27803010,,2642-6-131  -  INSERT TIBIAL XL 31MM PRIM PCA KNEE,"$2,065.00",$0.00,"$2,065.00",$0.00,"$1,473.79",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,065.00",$0.00,"$1,032.50","$1,635.48","$1,652.00",$0.00,$0.00,$0.00,$0.00,$0.00
26AC60,SUP,Custom 27203010,,26AC60  -  PLATE 18MM TI BONE SPNL,$350.63,$0.00,$350.63,$0.00,$250.24,$0.00,$0.00,$0.00,$0.00,$0.00,$350.63,$0.00,$175.31,$277.70,$280.50,$0.00,$0.00,$0.00,$0.00,$0.00
26AC75,SUP,Custom 27203010,,26AC75  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$350.63,$0.00,$350.63,$0.00,$250.24,$0.00,$0.00,$0.00,$0.00,$0.00,$350.63,$0.00,$175.31,$277.70,$280.50,$0.00,$0.00,$0.00,$0.00,$0.00
26AC90,SUP,Custom 27203010,,26AC90  -  PLATE 18MM TI BONE SPNL,$350.63,$0.00,$350.63,$0.00,$250.24,$0.00,$0.00,$0.00,$0.00,$0.00,$350.63,$0.00,$175.31,$277.70,$280.50,$0.00,$0.00,$0.00,$0.00,$0.00
26BA50DX,SUP,Custom 27203010,,26BA50DX  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$412.25,$0.00,$412.25,$0.00,$294.22,$0.00,$0.00,$0.00,$0.00,$0.00,$412.25,$0.00,$206.13,$326.50,$329.80,$0.00,$0.00,$0.00,$0.00,$0.00
26BA60,SUP,Custom 27203010,,26BA60  -  PLATE 18MM TI BONE SPNL,$384.63,$0.00,$384.63,$0.00,$274.51,$0.00,$0.00,$0.00,$0.00,$0.00,$384.63,$0.00,$192.31,$304.63,$307.70,$0.00,$0.00,$0.00,$0.00,$0.00
26BA70DX,SUP,Custom 27203010,,26BA70DX  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$412.25,$0.00,$412.25,$0.00,$294.22,$0.00,$0.00,$0.00,$0.00,$0.00,$412.25,$0.00,$206.13,$326.50,$329.80,$0.00,$0.00,$0.00,$0.00,$0.00
26BA75,SUP,Custom 27203010,,26BA75  -  PLATE 18MM TI BONE SPNL,$376.13,$0.00,$376.13,$0.00,$268.44,$0.00,$0.00,$0.00,$0.00,$0.00,$376.13,$0.00,$188.06,$297.89,$300.90,$0.00,$0.00,$0.00,$0.00,$0.00
26BA90,SUP,Custom 27203010,,26BA90  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$376.13,$0.00,$376.13,$0.00,$268.44,$0.00,$0.00,$0.00,$0.00,$0.00,$376.13,$0.00,$188.06,$297.89,$300.90,$0.00,$0.00,$0.00,$0.00,$0.00
26CY75,SUP,Custom 27203010,,26CY75  -  PLATE 18MM TI BONE SPNL,$348.50,$0.00,$348.50,$0.00,$248.72,$0.00,$0.00,$0.00,$0.00,$0.00,$348.50,$0.00,$174.25,$276.01,$278.80,$0.00,$0.00,$0.00,$0.00,$0.00
26CY90,SUP,Custom 27203010,,26CY90  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$348.50,$0.00,$348.50,$0.00,$248.72,$0.00,$0.00,$0.00,$0.00,$0.00,$348.50,$0.00,$174.25,$276.01,$278.80,$0.00,$0.00,$0.00,$0.00,$0.00
26L2,SUP,Custom 27203010,,KIT MNLTX MONO LTX AGGL SERTST 50 TST,$355.10,$0.00,$355.10,$0.00,$253.43,$0.00,$0.00,$0.00,$0.00,$0.00,$355.10,$0.00,$177.55,$281.24,$284.08,$0.00,$0.00,$0.00,$0.00,$0.00
26MH30,SUP,Custom 27203010,,26MH30  -  PLATE 18MM TI BONE SPNL,$346.38,$0.00,$346.38,$0.00,$247.21,$0.00,$0.00,$0.00,$0.00,$0.00,$346.38,$0.00,$173.19,$274.33,$277.10,$0.00,$0.00,$0.00,$0.00,$0.00
26TA30,SUP,Custom 27203010,,26TA30  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$380.38,$0.00,$380.38,$0.00,$271.47,$0.00,$0.00,$0.00,$0.00,$0.00,$380.38,$0.00,$190.19,$301.26,$304.30,$0.00,$0.00,$0.00,$0.00,$0.00
27-0120,SUP,HCPCS C1713,,27-0120  -  SCREW BN 2.7MM 12MM CNN XTRMT,$445.00,$0.00,$445.00,$200.25,$317.60,$0.00,$76.67,$0.00,$0.00,$77.92,$445.00,$0.00,$222.50,$352.44,$356.00,$0.00,$69.64,$0.00,$70.84,$0.00
27-0140,SUP,HCPCS C1713,,27-0140  -  SCREW BN 2.7MM 14MM CNN XTRMT,$445.00,$0.00,$445.00,$200.25,$317.60,$0.00,$76.67,$0.00,$0.00,$77.92,$445.00,$0.00,$222.50,$352.44,$356.00,$0.00,$69.64,$0.00,$70.84,$0.00
27-0160,SUP,HCPCS C1713,,27-0160  -  SCREW BN 2.7MM 16MM CNN XTRMT,$445.00,$0.00,$445.00,$200.25,$317.60,$0.00,$76.67,$0.00,$0.00,$77.92,$445.00,$0.00,$222.50,$352.44,$356.00,$0.00,$69.64,$0.00,$70.84,$0.00
27-0180,SUP,HCPCS C1713,,27-0180  -  SCREW BN 2.7MM 18MM CNN XTRMT,$445.00,$0.00,$445.00,$200.25,$317.60,$0.00,$76.67,$0.00,$0.00,$77.92,$445.00,$0.00,$222.50,$352.44,$356.00,$0.00,$69.64,$0.00,$70.84,$0.00
27020 M,SUP,Custom 27803010,,27020 M  -  PLATE 18MM TI BONE SPNL,"$3,080.38",$0.00,"$3,080.38",$0.00,"$2,198.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,080.38",$0.00,"$1,540.19","$2,439.66","$2,464.30",$0.00,$0.00,$0.00,$0.00,$0.00
27-0200,SUP,HCPCS C1713,,27-0200  -  SCREW BN 2.7MM 20MM CNN XTRMT,$445.00,$0.00,$445.00,$200.25,$317.60,$0.00,$76.67,$0.00,$0.00,$77.92,$445.00,$0.00,$222.50,$352.44,$356.00,$0.00,$69.64,$0.00,$70.84,$0.00
270-2149,SUP,Custom 27203010,,VIAL VAR 2 SMPL PRC CAP ANALY,$78.75,$0.00,$78.75,$0.00,$56.20,$0.00,$0.00,$0.00,$0.00,$0.00,$78.75,$0.00,$39.38,$62.37,$63.00,$0.00,$0.00,$0.00,$0.00,$0.00
270-2154,SUP,Custom 27203010,,REAGENT B THAL VAR 2 RCDR PK 500 TST ANALY,"$4,392.50",$0.00,"$4,392.50",$0.00,"$3,134.93",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,392.50",$0.00,"$2,196.25","$3,478.86","$3,514.00",$0.00,$0.00,$0.00,$0.00,$0.00
27-0220,SUP,HCPCS C1713,,27-0220  -  SCREW BN 2.7MM 22MM CNN XTRMT,$445.00,$0.00,$445.00,$200.25,$317.60,$0.00,$76.67,$0.00,$0.00,$77.92,$445.00,$0.00,$222.50,$352.44,$356.00,$0.00,$69.64,$0.00,$70.84,$0.00
27-0240,SUP,HCPCS C1713,,27-0240  -  SCREW BN 2.7MM 24MM CNN XTRMT,$445.00,$0.00,$445.00,$200.25,$317.60,$0.00,$76.67,$0.00,$0.00,$77.92,$445.00,$0.00,$222.50,$352.44,$356.00,$0.00,$69.64,$0.00,$70.84,$0.00
2703-3-626,SUP,Custom 27203010,,2703-3-626  -  WIRE FX .015IN 72IN VIT,$284.38,$0.00,$284.38,$0.00,$202.96,$0.00,$0.00,$0.00,$0.00,$0.00,$284.38,$0.00,$142.19,$225.23,$227.50,$0.00,$0.00,$0.00,$0.00,$0.00
2704-1-024,SUP,Custom 27203010,,2704-1-024  -  WIRE FX .04IN 24MM VIT,$11.38,$0.00,$11.38,$0.00,$8.12,$0.00,$0.00,$0.00,$0.00,$0.00,$11.38,$0.00,$5.69,$9.01,$9.10,$0.00,$0.00,$0.00,$0.00,$0.00
2704-3-018,SUP,Custom 27203010,,2704-3-018  -  WIRE FX .046IN 18IN DLMLS VIT 6 PER TUBE,$58.50,$0.00,$58.50,$0.00,$41.75,$0.00,$0.00,$0.00,$0.00,$0.00,$58.50,$0.00,$29.25,$46.33,$46.80,$0.00,$0.00,$0.00,$0.00,$0.00
27050K/6,SUP,Custom 27203010,,27050K/6  -  ELTRD ESURG 27FR 1 PR PNT,$285.80,$0.00,$285.80,$0.00,$203.98,$0.00,$0.00,$0.00,$0.00,$0.00,$285.80,$0.00,$142.90,$226.35,$228.64,$0.00,$0.00,$0.00,$0.00,$0.00
27050KG/6,SUP,Custom 27203010,,27050KG/6  -  ELTRD ESURG YLW 24-26FR URO RLLR CUT STRL DISP,$392.93,$0.00,$392.93,$0.00,$280.43,$0.00,$0.00,$0.00,$0.00,$0.00,$392.93,$0.00,$196.46,$311.20,$314.34,$0.00,$0.00,$0.00,$0.00,$0.00
27065 A,SUP,Custom 27803010,,27065 A  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$665.00,$0.00,$665.00,$0.00,$474.61,$0.00,$0.00,$0.00,$0.00,$0.00,$665.00,$0.00,$332.50,$526.68,$532.00,$0.00,$0.00,$0.00,$0.00,$0.00
27065 B,SUP,Custom 27803010,,27065 B  -  PLATE 18MM TI BONE SPNL,$665.00,$0.00,$665.00,$0.00,$474.61,$0.00,$0.00,$0.00,$0.00,$0.00,$665.00,$0.00,$332.50,$526.68,$532.00,$0.00,$0.00,$0.00,$0.00,$0.00
27065 C,SUP,Custom 27803010,,27065 C  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$665.00,$0.00,$665.00,$0.00,$474.61,$0.00,$0.00,$0.00,$0.00,$0.00,$665.00,$0.00,$332.50,$526.68,$532.00,$0.00,$0.00,$0.00,$0.00,$0.00
27065 D,SUP,Custom 27803010,,27065 D  -  PLATE 18MM TI BONE SPNL,$665.00,$0.00,$665.00,$0.00,$474.61,$0.00,$0.00,$0.00,$0.00,$0.00,$665.00,$0.00,$332.50,$526.68,$532.00,$0.00,$0.00,$0.00,$0.00,$0.00
27065 E,SUP,Custom 27803010,,27065 E  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$665.00,$0.00,$665.00,$0.00,$474.61,$0.00,$0.00,$0.00,$0.00,$0.00,$665.00,$0.00,$332.50,$526.68,$532.00,$0.00,$0.00,$0.00,$0.00,$0.00
27065 F,SUP,Custom 27803010,,27065 F  -  PLATE 18MM TI BONE SPNL,$665.00,$0.00,$665.00,$0.00,$474.61,$0.00,$0.00,$0.00,$0.00,$0.00,$665.00,$0.00,$332.50,$526.68,$532.00,$0.00,$0.00,$0.00,$0.00,$0.00
27065 G,SUP,Custom 27803010,,27065 G  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$665.00,$0.00,$665.00,$0.00,$474.61,$0.00,$0.00,$0.00,$0.00,$0.00,$665.00,$0.00,$332.50,$526.68,$532.00,$0.00,$0.00,$0.00,$0.00,$0.00
27065 H,SUP,Custom 27803010,,27065 H  -  PLATE 18MM TI BONE SPNL,$665.00,$0.00,$665.00,$0.00,$474.61,$0.00,$0.00,$0.00,$0.00,$0.00,$665.00,$0.00,$332.50,$526.68,$532.00,$0.00,$0.00,$0.00,$0.00,$0.00
27065 J,SUP,Custom 27803010,,27065 J  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$826.50,$0.00,$826.50,$0.00,$589.87,$0.00,$0.00,$0.00,$0.00,$0.00,$826.50,$0.00,$413.25,$654.59,$661.20,$0.00,$0.00,$0.00,$0.00,$0.00
27065 K,SUP,Custom 27803010,,27065 K  -  PLATE 18MM TI BONE SPNL,$665.00,$0.00,$665.00,$0.00,$474.61,$0.00,$0.00,$0.00,$0.00,$0.00,$665.00,$0.00,$332.50,$526.68,$532.00,$0.00,$0.00,$0.00,$0.00,$0.00
27065 L,SUP,Custom 27803010,,27065 L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$665.00,$0.00,$665.00,$0.00,$474.61,$0.00,$0.00,$0.00,$0.00,$0.00,$665.00,$0.00,$332.50,$526.68,$532.00,$0.00,$0.00,$0.00,$0.00,$0.00
27065 M,SUP,Custom 27803010,,27065 M  -  PLATE 18MM TI BONE SPNL,$826.50,$0.00,$826.50,$0.00,$589.87,$0.00,$0.00,$0.00,$0.00,$0.00,$826.50,$0.00,$413.25,$654.59,$661.20,$0.00,$0.00,$0.00,$0.00,$0.00
27065 N,SUP,Custom 27803010,,27065 N  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$603.25,$0.00,$603.25,$0.00,$430.54,$0.00,$0.00,$0.00,$0.00,$0.00,$603.25,$0.00,$301.63,$477.77,$482.60,$0.00,$0.00,$0.00,$0.00,$0.00
27065 R,SUP,Custom 27803010,,27065 R  -  PLATE 18MM TI BONE SPNL,$826.50,$0.00,$826.50,$0.00,$589.87,$0.00,$0.00,$0.00,$0.00,$0.00,$826.50,$0.00,$413.25,$654.59,$661.20,$0.00,$0.00,$0.00,$0.00,$0.00
27065 T,SUP,Custom 27803010,,27065 T  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$826.50,$0.00,$826.50,$0.00,$589.87,$0.00,$0.00,$0.00,$0.00,$0.00,$826.50,$0.00,$413.25,$654.59,$661.20,$0.00,$0.00,$0.00,$0.00,$0.00
27097-1,SUP,Custom 27803010,,27097-1  -  PLATE 18MM TI BONE SPNL,"$3,009.13",$0.00,"$3,009.13",$0.00,"$2,147.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,009.13",$0.00,"$1,504.56","$2,383.23","$2,407.30",$0.00,$0.00,$0.00,$0.00,$0.00
27167 L,SUP,Custom 27803010,,27167 L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$3,051.88",$0.00,"$3,051.88",$0.00,"$2,178.12",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,051.88",$0.00,"$1,525.94","$2,417.09","$2,441.50",$0.00,$0.00,$0.00,$0.00,$0.00
27167 M,SUP,Custom 27803010,,27167 M  -  PLATE 18MM TI BONE SPNL,"$3,051.88",$0.00,"$3,051.88",$0.00,"$2,178.12",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,051.88",$0.00,"$1,525.94","$2,417.09","$2,441.50",$0.00,$0.00,$0.00,$0.00,$0.00
27183-1,SUP,Custom 27803010,,27183-1  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$5,080.13",$0.00,"$5,080.13",$0.00,"$3,625.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,080.13",$0.00,"$2,540.06","$4,023.46","$4,064.10",$0.00,$0.00,$0.00,$0.00,$0.00
27183-2,SUP,Custom 27803010,,27183-2  -  PLATE 18MM TI BONE SPNL,"$5,080.13",$0.00,"$5,080.13",$0.00,"$3,625.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,080.13",$0.00,"$2,540.06","$4,023.46","$4,064.10",$0.00,$0.00,$0.00,$0.00,$0.00
27183-4,SUP,Custom 27803010,,27183-4  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$5,080.13",$0.00,"$5,080.13",$0.00,"$3,625.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,080.13",$0.00,"$2,540.06","$4,023.46","$4,064.10",$0.00,$0.00,$0.00,$0.00,$0.00
27183-5,SUP,Custom 27803010,,27183-5  -  PLATE 18MM TI BONE SPNL,"$5,080.13",$0.00,"$5,080.13",$0.00,"$3,625.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,080.13",$0.00,"$2,540.06","$4,023.46","$4,064.10",$0.00,$0.00,$0.00,$0.00,$0.00
27202-01,SUP,HCPCS C1765,,27202-01  -  BRR ADH PLLC ACD BIORESBL SHT SURGIWRAP 130X100X.02MM,$560.00,$0.00,$560.00,$0.00,$399.67,$0.00,$96.49,$0.00,$0.00,$98.05,$560.00,$0.00,$280.00,$443.52,$448.00,$0.00,$87.64,$0.00,$0.00,$0.00
27202-05,SUP,HCPCS C1765,,27202-05  -  BARRIER ADHESION 130X100X.02MM BIORESORBABLE SHEET SURGIWRAP,$560.00,$0.00,$560.00,$0.00,$399.67,$0.00,$96.49,$0.00,$0.00,$98.05,$560.00,$0.00,$280.00,$443.52,$448.00,$0.00,$87.64,$0.00,$0.00,$0.00
27203-5,SUP,Custom 27203010,,27203-5  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$5,472.00",$0.00,"$5,472.00",$0.00,"$3,905.37",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,472.00",$0.00,"$2,736.00","$4,333.82","$4,377.60",$0.00,$0.00,$0.00,$0.00,$0.00
27204-05,SUP,HCPCS C1765,,27204-05  -  BARRIER ADHESION 130X100X.02MM BIORESORBABLE SHEET SURGIWRAP,$642.50,$0.00,$642.50,$0.00,$458.55,$0.00,$110.70,$0.00,$0.00,$112.50,$642.50,$0.00,$321.25,$508.86,$514.00,$0.00,$100.55,$0.00,$0.00,$0.00
27219-1,SUP,Custom 27803010,,27219-1  -  PLATE 18MM TI BONE SPNL,"$3,617.13",$0.00,"$3,617.13",$0.00,"$2,581.54",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,617.13",$0.00,"$1,808.56","$2,864.77","$2,893.70",$0.00,$0.00,$0.00,$0.00,$0.00
27219-2,SUP,Custom 27803010,,27219-2  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$3,617.13",$0.00,"$3,617.13",$0.00,"$2,581.54",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,617.13",$0.00,"$1,808.56","$2,864.77","$2,893.70",$0.00,$0.00,$0.00,$0.00,$0.00
27219-5,SUP,Custom 27803010,,27219-5  -  PLATE 18MM TI BONE SPNL,"$3,617.13",$0.00,"$3,617.13",$0.00,"$2,581.54",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,617.13",$0.00,"$1,808.56","$2,864.77","$2,893.70",$0.00,$0.00,$0.00,$0.00,$0.00
27224-1,SUP,Custom 27203010,,27224-1  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$4,754.75",$0.00,"$4,754.75",$0.00,"$3,393.47",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,754.75",$0.00,"$2,377.38","$3,765.76","$3,803.80",$0.00,$0.00,$0.00,$0.00,$0.00
27224-2,SUP,Custom 27203010,,27224-2  -  PLATE 18MM TI BONE SPNL,"$4,754.75",$0.00,"$4,754.75",$0.00,"$3,393.47",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,754.75",$0.00,"$2,377.38","$3,765.76","$3,803.80",$0.00,$0.00,$0.00,$0.00,$0.00
27224-4,SUP,Custom 27203010,,27224-4  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$4,754.75",$0.00,"$4,754.75",$0.00,"$3,393.47",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,754.75",$0.00,"$2,377.38","$3,765.76","$3,803.80",$0.00,$0.00,$0.00,$0.00,$0.00
27224-5,SUP,Custom 27203010,,27224-5  -  PLATE 18MM TI BONE SPNL,"$4,754.75",$0.00,"$4,754.75",$0.00,"$3,393.47",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,754.75",$0.00,"$2,377.38","$3,765.76","$3,803.80",$0.00,$0.00,$0.00,$0.00,$0.00
27241 L,SUP,Custom 27803010,,27241 L  -  SHUNT NS 10MM 50MM PRTNL CATH NEO,"$1,211.25",$0.00,"$1,211.25",$0.00,$864.47,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,211.25",$0.00,$605.63,$959.31,$969.00,$0.00,$0.00,$0.00,$0.00,$0.00
27242 L,SUP,Custom 27803010,,27242 L  -  PLATE 18MM TI BONE SPNL,"$2,562.63",$0.00,"$2,562.63",$0.00,"$1,828.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,562.63",$0.00,"$1,281.31","$2,029.60","$2,050.10",$0.00,$0.00,$0.00,$0.00,$0.00
27242 LL,SUP,Custom 27803010,,27242 LL  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,562.63",$0.00,"$2,562.63",$0.00,"$1,828.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,562.63",$0.00,"$1,281.31","$2,029.60","$2,050.10",$0.00,$0.00,$0.00,$0.00,$0.00
274.00S,SUP,HCPCS C1713,,274.00S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 340MM STAINLESS STEEL,"$2,101.73",$0.00,"$2,101.73",$945.78,"$1,500.00",$0.00,$364.83,$0.00,$0.00,$368.00,"$2,101.73",$0.00,"$1,050.86","$1,664.57","$1,681.38",$0.00,$331.39,$0.00,$334.59,$0.00
274.01S,SUP,HCPCS C1713,,274.01S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 36CM STAINLESS STEEL,"$2,101.73",$0.00,"$2,101.73",$945.78,"$1,500.00",$0.00,$364.83,$0.00,$0.00,$368.00,"$2,101.73",$0.00,"$1,050.86","$1,664.57","$1,681.38",$0.00,$331.39,$0.00,$334.59,$0.00
274.02S,SUP,HCPCS C1713,,274.02S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 380MM STAINLESS STEEL,"$2,101.73",$0.00,"$2,101.73",$945.78,"$1,500.00",$0.00,$364.83,$0.00,$0.00,$368.00,"$2,101.73",$0.00,"$1,050.86","$1,664.57","$1,681.38",$0.00,$331.39,$0.00,$334.59,$0.00
274.03S,SUP,HCPCS C1713,,274.03S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 400MM STAINLESS STEEL,"$2,101.73",$0.00,"$2,101.73",$945.78,"$1,500.00",$0.00,$364.83,$0.00,$0.00,$368.00,"$2,101.73",$0.00,"$1,050.86","$1,664.57","$1,681.38",$0.00,$331.39,$0.00,$334.59,$0.00
274.04S,SUP,HCPCS C1713,,274.04S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 420MM STAINLESS STEEL,"$2,101.73",$0.00,"$2,101.73",$945.78,"$1,500.00",$0.00,$364.83,$0.00,$0.00,$368.00,"$2,101.73",$0.00,"$1,050.86","$1,664.57","$1,681.38",$0.00,$331.39,$0.00,$334.59,$0.00
274.05S,SUP,HCPCS C1713,,274.05S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 440MM STAINLESS STEEL,"$2,101.73",$0.00,"$2,101.73",$945.78,"$1,500.00",$0.00,$364.83,$0.00,$0.00,$368.00,"$2,101.73",$0.00,"$1,050.86","$1,664.57","$1,681.38",$0.00,$331.39,$0.00,$334.59,$0.00
274.06S,SUP,HCPCS C1713,,274.06S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 460MM STAINLESS STEEL,"$2,101.73",$0.00,"$2,101.73",$945.78,"$1,500.00",$0.00,$364.83,$0.00,$0.00,$368.00,"$2,101.73",$0.00,"$1,050.86","$1,664.57","$1,681.38",$0.00,$331.39,$0.00,$334.59,$0.00
274.07S,SUP,HCPCS C1713,,274.07S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 480MM STAINLESS STEEL,"$2,101.73",$0.00,"$2,101.73",$945.78,"$1,500.00",$0.00,$364.83,$0.00,$0.00,$368.00,"$2,101.73",$0.00,"$1,050.86","$1,664.57","$1,681.38",$0.00,$331.39,$0.00,$334.59,$0.00
274.08S,SUP,HCPCS C1713,,274.08S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 300MM STAINLESS STEEL,"$2,101.73",$0.00,"$2,101.73",$945.78,"$1,500.00",$0.00,$364.83,$0.00,$0.00,$368.00,"$2,101.73",$0.00,"$1,050.86","$1,664.57","$1,681.38",$0.00,$331.39,$0.00,$334.59,$0.00
274.09S,SUP,HCPCS C1713,,274.09S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 320MM STAINLESS STEEL,"$2,101.73",$0.00,"$2,101.73",$945.78,"$1,500.00",$0.00,$364.83,$0.00,$0.00,$368.00,"$2,101.73",$0.00,"$1,050.86","$1,664.57","$1,681.38",$0.00,$331.39,$0.00,$334.59,$0.00
274.10S,SUP,HCPCS C1713,,274.10S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 340MM STAINLESS STEEL,"$2,117.50",$0.00,"$2,117.50",$952.88,"$1,511.26",$0.00,$364.83,$0.00,$0.00,$370.76,"$2,117.50",$0.00,"$1,058.75","$1,677.06","$1,694.00",$0.00,$331.39,$0.00,$337.11,$0.00
274.11S,SUP,HCPCS C1713,,274.11S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 360MM STAINLESS STEEL,"$2,117.50",$0.00,"$2,117.50",$952.88,"$1,511.26",$0.00,$364.83,$0.00,$0.00,$370.76,"$2,117.50",$0.00,"$1,058.75","$1,677.06","$1,694.00",$0.00,$331.39,$0.00,$337.11,$0.00
274.12S,SUP,HCPCS C1713,,274.12S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 380MM STAINLESS STEEL,"$2,117.50",$0.00,"$2,117.50",$952.88,"$1,511.26",$0.00,$364.83,$0.00,$0.00,$370.76,"$2,117.50",$0.00,"$1,058.75","$1,677.06","$1,694.00",$0.00,$331.39,$0.00,$337.11,$0.00
274.13S,SUP,HCPCS C1713,,274.13S  -  NAIL INTRAMEDULLARY 400MM 11MM 40CM STAINLEES STEEL FEMUR,"$2,117.50",$0.00,"$2,117.50",$952.88,"$1,511.26",$0.00,$364.83,$0.00,$0.00,$370.76,"$2,117.50",$0.00,"$1,058.75","$1,677.06","$1,694.00",$0.00,$331.39,$0.00,$337.11,$0.00
274.14S,SUP,HCPCS C1713,,274.14S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 420MM STAINLESS STEEL,"$2,117.50",$0.00,"$2,117.50",$952.88,"$1,511.26",$0.00,$364.83,$0.00,$0.00,$370.76,"$2,117.50",$0.00,"$1,058.75","$1,677.06","$1,694.00",$0.00,$331.39,$0.00,$337.11,$0.00
274.15S,SUP,HCPCS C1713,,274.15S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 440MM STAINLESS STEEL,"$2,117.50",$0.00,"$2,117.50",$952.88,"$1,511.26",$0.00,$364.83,$0.00,$0.00,$370.76,"$2,117.50",$0.00,"$1,058.75","$1,677.06","$1,694.00",$0.00,$331.39,$0.00,$337.11,$0.00
274.16S,SUP,HCPCS C1713,,274.16S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 460MM STAINLESS STEEL,"$2,101.73",$0.00,"$2,101.73",$945.78,"$1,500.00",$0.00,$364.83,$0.00,$0.00,$368.00,"$2,101.73",$0.00,"$1,050.86","$1,664.57","$1,681.38",$0.00,$331.39,$0.00,$334.59,$0.00
274.17S,SUP,HCPCS C1713,,274.17S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 480MM STAINLESS STEEL,"$2,101.73",$0.00,"$2,101.73",$945.78,"$1,500.00",$0.00,$364.83,$0.00,$0.00,$368.00,"$2,101.73",$0.00,"$1,050.86","$1,664.57","$1,681.38",$0.00,$331.39,$0.00,$334.59,$0.00
274.18S,SUP,HCPCS C1713,,274.18S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 300MM STAINLESS STEEL,"$2,101.73",$0.00,"$2,101.73",$945.78,"$1,500.00",$0.00,$364.83,$0.00,$0.00,$368.00,"$2,101.73",$0.00,"$1,050.86","$1,664.57","$1,681.38",$0.00,$331.39,$0.00,$334.59,$0.00
274.19S,SUP,HCPCS C1713,,274.19S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 320MM STAINLESS STEEL,"$2,117.50",$0.00,"$2,117.50",$952.88,"$1,511.26",$0.00,$364.83,$0.00,$0.00,$370.76,"$2,117.50",$0.00,"$1,058.75","$1,677.06","$1,694.00",$0.00,$331.39,$0.00,$337.11,$0.00
274.20S,SUP,HCPCS C1713,,274.20S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 12MM 34CMX.12CM,"$2,101.73",$0.00,"$2,101.73",$945.78,"$1,500.00",$0.00,$364.83,$0.00,$0.00,$368.00,"$2,101.73",$0.00,"$1,050.86","$1,664.57","$1,681.38",$0.00,$331.39,$0.00,$334.59,$0.00
274.21S,SUP,HCPCS C1713,,274.21S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 360MM STAINLESS STEEL,"$2,101.73",$0.00,"$2,101.73",$945.78,"$1,500.00",$0.00,$364.83,$0.00,$0.00,$368.00,"$2,101.73",$0.00,"$1,050.86","$1,664.57","$1,681.38",$0.00,$331.39,$0.00,$334.59,$0.00
274.22S,SUP,HCPCS C1713,,274.22S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 380MM STAINLESS STEEL,"$2,101.73",$0.00,"$2,101.73",$945.78,"$1,500.00",$0.00,$364.83,$0.00,$0.00,$368.00,"$2,101.73",$0.00,"$1,050.86","$1,664.57","$1,681.38",$0.00,$331.39,$0.00,$334.59,$0.00
274.23S,SUP,HCPCS C1713,,274.23S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 4000CM STAINLESS STEEL,"$2,101.73",$0.00,"$2,101.73",$945.78,"$1,500.00",$0.00,$364.83,$0.00,$0.00,$368.00,"$2,101.73",$0.00,"$1,050.86","$1,664.57","$1,681.38",$0.00,$331.39,$0.00,$334.59,$0.00
274.24S,SUP,HCPCS C1713,,274.24S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 420MM STAINLESS STEEL,"$2,101.73",$0.00,"$2,101.73",$945.78,"$1,500.00",$0.00,$364.83,$0.00,$0.00,$368.00,"$2,101.73",$0.00,"$1,050.86","$1,664.57","$1,681.38",$0.00,$331.39,$0.00,$334.59,$0.00
274.25S,SUP,HCPCS C1713,,274.25S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 12MM 44CMX.12CM,"$2,117.50",$0.00,"$2,117.50",$952.88,"$1,511.26",$0.00,$364.83,$0.00,$0.00,$370.76,"$2,117.50",$0.00,"$1,058.75","$1,677.06","$1,694.00",$0.00,$331.39,$0.00,$337.11,$0.00
274.26S,SUP,HCPCS C1713,,274.26S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 12MM 46CMX.12CM,"$2,117.50",$0.00,"$2,117.50",$952.88,"$1,511.26",$0.00,$364.83,$0.00,$0.00,$370.76,"$2,117.50",$0.00,"$1,058.75","$1,677.06","$1,694.00",$0.00,$331.39,$0.00,$337.11,$0.00
274.27S,SUP,HCPCS C1713,,274.27S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 480MM STAINLESS STEEL,"$2,117.50",$0.00,"$2,117.50",$952.88,"$1,511.26",$0.00,$364.83,$0.00,$0.00,$370.76,"$2,117.50",$0.00,"$1,058.75","$1,677.06","$1,694.00",$0.00,$331.39,$0.00,$337.11,$0.00
274.28S,SUP,HCPCS C1713,,274.28S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 300MM STAINLESS STEEL,"$2,117.50",$0.00,"$2,117.50",$952.88,"$1,511.26",$0.00,$364.83,$0.00,$0.00,$370.76,"$2,117.50",$0.00,"$1,058.75","$1,677.06","$1,694.00",$0.00,$331.39,$0.00,$337.11,$0.00
274.29S,SUP,HCPCS C1713,,274.29S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 320MM STAINLESS STEEL,"$2,117.50",$0.00,"$2,117.50",$952.88,"$1,511.26",$0.00,$364.83,$0.00,$0.00,$370.76,"$2,117.50",$0.00,"$1,058.75","$1,677.06","$1,694.00",$0.00,$331.39,$0.00,$337.11,$0.00
274.30S,SUP,HCPCS C1713,,274.30S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 13MM 34CMX.12CM,"$2,117.50",$0.00,"$2,117.50",$952.88,"$1,511.26",$0.00,$364.83,$0.00,$0.00,$370.76,"$2,117.50",$0.00,"$1,058.75","$1,677.06","$1,694.00",$0.00,$331.39,$0.00,$337.11,$0.00
274.31S,SUP,HCPCS C1713,,274.31S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 360MM STAINLESS STEEL,"$2,117.50",$0.00,"$2,117.50",$952.88,"$1,511.26",$0.00,$364.83,$0.00,$0.00,$370.76,"$2,117.50",$0.00,"$1,058.75","$1,677.06","$1,694.00",$0.00,$331.39,$0.00,$337.11,$0.00
274.32S,SUP,HCPCS C1713,,274.32S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 13MM 38CMX.12CM,"$2,117.50",$0.00,"$2,117.50",$952.88,"$1,511.26",$0.00,$364.83,$0.00,$0.00,$370.76,"$2,117.50",$0.00,"$1,058.75","$1,677.06","$1,694.00",$0.00,$331.39,$0.00,$337.11,$0.00
274.33S,SUP,HCPCS C1713,,274.33S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 13MM 40CMX.12CM,"$2,117.50",$0.00,"$2,117.50",$952.88,"$1,511.26",$0.00,$364.83,$0.00,$0.00,$370.76,"$2,117.50",$0.00,"$1,058.75","$1,677.06","$1,694.00",$0.00,$331.39,$0.00,$337.11,$0.00
274.34S,SUP,HCPCS C1713,,274.34S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 13MM 42CMX.12CM,"$2,117.50",$0.00,"$2,117.50",$952.88,"$1,511.26",$0.00,$364.83,$0.00,$0.00,$370.76,"$2,117.50",$0.00,"$1,058.75","$1,677.06","$1,694.00",$0.00,$331.39,$0.00,$337.11,$0.00
274.35S,SUP,HCPCS C1713,,274.35S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 13MM 44CMX.12CM,"$2,117.50",$0.00,"$2,117.50",$952.88,"$1,511.26",$0.00,$364.83,$0.00,$0.00,$370.76,"$2,117.50",$0.00,"$1,058.75","$1,677.06","$1,694.00",$0.00,$331.39,$0.00,$337.11,$0.00
274.36S,SUP,HCPCS C1713,,274.36S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 13MM 46CMX.12CM,"$2,117.50",$0.00,"$2,117.50",$952.88,"$1,511.26",$0.00,$364.83,$0.00,$0.00,$370.76,"$2,117.50",$0.00,"$1,058.75","$1,677.06","$1,694.00",$0.00,$331.39,$0.00,$337.11,$0.00
274.37S,SUP,HCPCS C1713,,274.37S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 480CM STAINLESS STEEL,"$2,117.50",$0.00,"$2,117.50",$952.88,"$1,511.26",$0.00,$364.83,$0.00,$0.00,$370.76,"$2,117.50",$0.00,"$1,058.75","$1,677.06","$1,694.00",$0.00,$331.39,$0.00,$337.11,$0.00
274.38S,SUP,HCPCS C1713,,274.38S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 300MM STAINLESS STEEL,"$2,117.50",$0.00,"$2,117.50",$952.88,"$1,511.26",$0.00,$364.83,$0.00,$0.00,$370.76,"$2,117.50",$0.00,"$1,058.75","$1,677.06","$1,694.00",$0.00,$331.39,$0.00,$337.11,$0.00
274.39S,SUP,HCPCS C1713,,274.39S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 320MM FEMUR STERILE,"$2,117.50",$0.00,"$2,117.50",$952.88,"$1,511.26",$0.00,$364.83,$0.00,$0.00,$370.76,"$2,117.50",$0.00,"$1,058.75","$1,677.06","$1,694.00",$0.00,$331.39,$0.00,$337.11,$0.00
274.40S,SUP,HCPCS C1713,,274.40S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 14MM 34CMX.12CM,"$2,117.50",$0.00,"$2,117.50",$952.88,"$1,511.26",$0.00,$364.83,$0.00,$0.00,$370.76,"$2,117.50",$0.00,"$1,058.75","$1,677.06","$1,694.00",$0.00,$331.39,$0.00,$337.11,$0.00
274.41S,SUP,HCPCS C1713,,274.41S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 14MM 36CMX.12CM,"$2,117.50",$0.00,"$2,117.50",$952.88,"$1,511.26",$0.00,$364.83,$0.00,$0.00,$370.76,"$2,117.50",$0.00,"$1,058.75","$1,677.06","$1,694.00",$0.00,$331.39,$0.00,$337.11,$0.00
274.42S,SUP,HCPCS C1713,,274.42S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 14MM 38CMX.12CM,"$2,117.50",$0.00,"$2,117.50",$952.88,"$1,511.26",$0.00,$364.83,$0.00,$0.00,$370.76,"$2,117.50",$0.00,"$1,058.75","$1,677.06","$1,694.00",$0.00,$331.39,$0.00,$337.11,$0.00
274.43S,SUP,HCPCS C1713,,274.43S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 14MM 40CMX.12CM,"$2,117.50",$0.00,"$2,117.50",$952.88,"$1,511.26",$0.00,$364.83,$0.00,$0.00,$370.76,"$2,117.50",$0.00,"$1,058.75","$1,677.06","$1,694.00",$0.00,$331.39,$0.00,$337.11,$0.00
274.44S,SUP,HCPCS C1713,,274.44S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 14MM 42CMX.12CM,"$2,117.50",$0.00,"$2,117.50",$952.88,"$1,511.26",$0.00,$364.83,$0.00,$0.00,$370.76,"$2,117.50",$0.00,"$1,058.75","$1,677.06","$1,694.00",$0.00,$331.39,$0.00,$337.11,$0.00
274.45S,SUP,HCPCS C1713,,274.45S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 14MM 44CMX.12CM,"$2,117.50",$0.00,"$2,117.50",$952.88,"$1,511.26",$0.00,$364.83,$0.00,$0.00,$370.76,"$2,117.50",$0.00,"$1,058.75","$1,677.06","$1,694.00",$0.00,$331.39,$0.00,$337.11,$0.00
274.46S,SUP,HCPCS C1713,,274.46S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 14MM 46CMX.12CM,"$2,117.50",$0.00,"$2,117.50",$952.88,"$1,511.26",$0.00,$364.83,$0.00,$0.00,$370.76,"$2,117.50",$0.00,"$1,058.75","$1,677.06","$1,694.00",$0.00,$331.39,$0.00,$337.11,$0.00
274.47S,SUP,HCPCS C1713,,274.47S  -  NAIL INTRAMEDULLARY UNIVERSAL 14MM 480MM STAINLESS STEEL,"$2,117.50",$0.00,"$2,117.50",$952.88,"$1,511.26",$0.00,$364.83,$0.00,$0.00,$370.76,"$2,117.50",$0.00,"$1,058.75","$1,677.06","$1,694.00",$0.00,$331.39,$0.00,$337.11,$0.00
274.48S,SUP,HCPCS C1713,,274.48S  -  NAIL INTRAMEDULLARY UNIVERSAL 14MM 300MM STAINLESS STEEL,"$2,117.50",$0.00,"$2,117.50",$952.88,"$1,511.26",$0.00,$364.83,$0.00,$0.00,$370.76,"$2,117.50",$0.00,"$1,058.75","$1,677.06","$1,694.00",$0.00,$331.39,$0.00,$337.11,$0.00
274.49S,SUP,HCPCS C1713,,274.49S  -  NAIL INTRAMEDULLARY UNIVERSAL 14MM 320MM STAINLESS STEEL,"$2,117.50",$0.00,"$2,117.50",$952.88,"$1,511.26",$0.00,$364.83,$0.00,$0.00,$370.76,"$2,117.50",$0.00,"$1,058.75","$1,677.06","$1,694.00",$0.00,$331.39,$0.00,$337.11,$0.00
274.50S,SUP,HCPCS C1713,,274.50S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 15MM 34CMX.12CM,"$2,277.00",$0.00,"$2,277.00","$1,024.65","$1,625.09",$0.00,$392.32,$0.00,$0.00,$398.68,"$2,277.00",$0.00,"$1,138.50","$1,803.38","$1,821.60",$0.00,$356.35,$0.00,$362.50,$0.00
274.51S,SUP,HCPCS C1713,,274.51S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 15MM 36CMX.12CM,"$2,277.00",$0.00,"$2,277.00","$1,024.65","$1,625.09",$0.00,$392.32,$0.00,$0.00,$398.68,"$2,277.00",$0.00,"$1,138.50","$1,803.38","$1,821.60",$0.00,$356.35,$0.00,$362.50,$0.00
274.52S,SUP,HCPCS C1713,,274.52S  -  NAIL INTRAMEDULLARY UNIVERSAL 15MM 380MM STAINLESS STEEL,"$2,277.00",$0.00,"$2,277.00","$1,024.65","$1,625.09",$0.00,$392.32,$0.00,$0.00,$398.68,"$2,277.00",$0.00,"$1,138.50","$1,803.38","$1,821.60",$0.00,$356.35,$0.00,$362.50,$0.00
274.53S,SUP,HCPCS C1713,,274.53S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 15MM 40CMX.12CM,"$2,277.00",$0.00,"$2,277.00","$1,024.65","$1,625.09",$0.00,$392.32,$0.00,$0.00,$398.68,"$2,277.00",$0.00,"$1,138.50","$1,803.38","$1,821.60",$0.00,$356.35,$0.00,$362.50,$0.00
274.54S,SUP,HCPCS C1713,,274.54S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 15MM 42CMX.12CM,"$2,277.00",$0.00,"$2,277.00","$1,024.65","$1,625.09",$0.00,$392.32,$0.00,$0.00,$398.68,"$2,277.00",$0.00,"$1,138.50","$1,803.38","$1,821.60",$0.00,$356.35,$0.00,$362.50,$0.00
274.55S,SUP,HCPCS C1713,,274.55S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 15MM 44CMX.12CM,"$2,277.00",$0.00,"$2,277.00","$1,024.65","$1,625.09",$0.00,$392.32,$0.00,$0.00,$398.68,"$2,277.00",$0.00,"$1,138.50","$1,803.38","$1,821.60",$0.00,$356.35,$0.00,$362.50,$0.00
274.56S,SUP,HCPCS C1713,,274.56S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 15MM 46CMX.12CM,"$2,277.00",$0.00,"$2,277.00","$1,024.65","$1,625.09",$0.00,$392.32,$0.00,$0.00,$398.68,"$2,277.00",$0.00,"$1,138.50","$1,803.38","$1,821.60",$0.00,$356.35,$0.00,$362.50,$0.00
274.57S,SUP,HCPCS C1713,,274.57S  -  NAIL INTRAMEDULLARY UNIVERSAL 15MM 480MM STAINLESS STEEL,"$2,277.00",$0.00,"$2,277.00","$1,024.65","$1,625.09",$0.00,$392.32,$0.00,$0.00,$398.68,"$2,277.00",$0.00,"$1,138.50","$1,803.38","$1,821.60",$0.00,$356.35,$0.00,$362.50,$0.00
274.58S,SUP,HCPCS C1713,,274.58S  -  NAIL INTRAMEDULLARY UNIVERSAL 15MM 300MM STAINLESS STEEL,"$2,277.00",$0.00,"$2,277.00","$1,024.65","$1,625.09",$0.00,$392.32,$0.00,$0.00,$398.68,"$2,277.00",$0.00,"$1,138.50","$1,803.38","$1,821.60",$0.00,$356.35,$0.00,$362.50,$0.00
274.59S,SUP,HCPCS C1713,,274.59S  -  NAIL INTRAMEDULLARY UNIVERSAL 15MM 320MM STAINLESS STEEL,"$2,277.00",$0.00,"$2,277.00","$1,024.65","$1,625.09",$0.00,$392.32,$0.00,$0.00,$398.68,"$2,277.00",$0.00,"$1,138.50","$1,803.38","$1,821.60",$0.00,$356.35,$0.00,$362.50,$0.00
274.60S,SUP,HCPCS C1713,,274.60S  -  NAIL INTRAMEDULLARY UNIVERSAL CONE THREAD TUBE BARREL 16MM,"$2,277.00",$0.00,"$2,277.00","$1,024.65","$1,625.09",$0.00,$392.32,$0.00,$0.00,$398.68,"$2,277.00",$0.00,"$1,138.50","$1,803.38","$1,821.60",$0.00,$356.35,$0.00,$362.50,$0.00
274.61S,SUP,HCPCS C1713,,274.61S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 16MM 36CMX.12CM,"$2,277.00",$0.00,"$2,277.00","$1,024.65","$1,625.09",$0.00,$392.32,$0.00,$0.00,$398.68,"$2,277.00",$0.00,"$1,138.50","$1,803.38","$1,821.60",$0.00,$356.35,$0.00,$362.50,$0.00
274.62S,SUP,HCPCS C1713,,274.62S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 16MM 38CMX.12CM,"$2,277.00",$0.00,"$2,277.00","$1,024.65","$1,625.09",$0.00,$392.32,$0.00,$0.00,$398.68,"$2,277.00",$0.00,"$1,138.50","$1,803.38","$1,821.60",$0.00,$356.35,$0.00,$362.50,$0.00
274.63S,SUP,HCPCS C1713,,274.63S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 16MM 40CMX.12CM,"$2,277.00",$0.00,"$2,277.00","$1,024.65","$1,625.09",$0.00,$392.32,$0.00,$0.00,$398.68,"$2,277.00",$0.00,"$1,138.50","$1,803.38","$1,821.60",$0.00,$356.35,$0.00,$362.50,$0.00
274.64S,SUP,HCPCS C1713,,274.64S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 16MM 42CMX.12CM,"$2,277.00",$0.00,"$2,277.00","$1,024.65","$1,625.09",$0.00,$392.32,$0.00,$0.00,$398.68,"$2,277.00",$0.00,"$1,138.50","$1,803.38","$1,821.60",$0.00,$356.35,$0.00,$362.50,$0.00
274.65S,SUP,HCPCS C1713,,274.65S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 16MM 44CMX.12CM,"$2,277.00",$0.00,"$2,277.00","$1,024.65","$1,625.09",$0.00,$392.32,$0.00,$0.00,$398.68,"$2,277.00",$0.00,"$1,138.50","$1,803.38","$1,821.60",$0.00,$356.35,$0.00,$362.50,$0.00
274.66S,SUP,HCPCS C1713,,274.66S  -  NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 16MM 46CMX.12CM,"$2,277.00",$0.00,"$2,277.00","$1,024.65","$1,625.09",$0.00,$392.32,$0.00,$0.00,$398.68,"$2,277.00",$0.00,"$1,138.50","$1,803.38","$1,821.60",$0.00,$356.35,$0.00,$362.50,$0.00
274.67S,SUP,HCPCS C1713,,274.67S  -  NAIL INTRAMEDULLARY UNIVERSAL 16MM 480MM STAINLESS STEEL,"$2,277.00",$0.00,"$2,277.00","$1,024.65","$1,625.09",$0.00,$392.32,$0.00,$0.00,$398.68,"$2,277.00",$0.00,"$1,138.50","$1,803.38","$1,821.60",$0.00,$356.35,$0.00,$362.50,$0.00
274.68S,SUP,HCPCS C1713,,274.68S  -  NAIL INTRAMEDULLARY UNIVERSAL 16MM 300MM STAINLESS STEEL,"$2,277.00",$0.00,"$2,277.00","$1,024.65","$1,625.09",$0.00,$392.32,$0.00,$0.00,$398.68,"$2,277.00",$0.00,"$1,138.50","$1,803.38","$1,821.60",$0.00,$356.35,$0.00,$362.50,$0.00
274.69S,SUP,HCPCS C1713,,274.69S  -  NAIL INTRAMEDULLARY UNIVERSAL 16MM 320MM STAINLESS STEEL,"$2,277.00",$0.00,"$2,277.00","$1,024.65","$1,625.09",$0.00,$392.32,$0.00,$0.00,$398.68,"$2,277.00",$0.00,"$1,138.50","$1,803.38","$1,821.60",$0.00,$356.35,$0.00,$362.50,$0.00
274.70S,SUP,HCPCS C1713,,274.70S  -  NAIL INTRAMEDULLARY UNIVERSAL 17MM 34CM STAINLESS STEEL,"$2,277.00",$0.00,"$2,277.00","$1,024.65","$1,625.09",$0.00,$392.32,$0.00,$0.00,$398.68,"$2,277.00",$0.00,"$1,138.50","$1,803.38","$1,821.60",$0.00,$356.35,$0.00,$362.50,$0.00
274.71S,SUP,HCPCS C1713,,274.71S  -  NAIL INTRAMEDULLARY UNIVERSAL 17MM 360MM STAINLESS STEEL,"$2,277.00",$0.00,"$2,277.00","$1,024.65","$1,625.09",$0.00,$392.32,$0.00,$0.00,$398.68,"$2,277.00",$0.00,"$1,138.50","$1,803.38","$1,821.60",$0.00,$356.35,$0.00,$362.50,$0.00
274.72S,SUP,HCPCS C1713,,274.72S  -  NAIL INTRAMEDULLARY UNIVERSAL 17MM 380MM STAINLESS STEEL,"$2,277.00",$0.00,"$2,277.00","$1,024.65","$1,625.09",$0.00,$392.32,$0.00,$0.00,$398.68,"$2,277.00",$0.00,"$1,138.50","$1,803.38","$1,821.60",$0.00,$356.35,$0.00,$362.50,$0.00
274.73S,SUP,HCPCS C1713,,274.73S  -  NAIL INTRAMEDULLARY UNIVERSAL 17MM 400MM STAINLESS STEEL,"$2,277.00",$0.00,"$2,277.00","$1,024.65","$1,625.09",$0.00,$392.32,$0.00,$0.00,$398.68,"$2,277.00",$0.00,"$1,138.50","$1,803.38","$1,821.60",$0.00,$356.35,$0.00,$362.50,$0.00
274.74S,SUP,HCPCS C1713,,274.74S  -  NAIL INTRAMEDULLARY UNIVERSAL 14MM 420MM STAINLESS STEEL,"$2,277.00",$0.00,"$2,277.00","$1,024.65","$1,625.09",$0.00,$392.32,$0.00,$0.00,$398.68,"$2,277.00",$0.00,"$1,138.50","$1,803.38","$1,821.60",$0.00,$356.35,$0.00,$362.50,$0.00
274.75S,SUP,HCPCS C1713,,274.75S  -  NAIL INTRAMEDULLARY UNIVERSAL 17MM 440MM STAINLESS STEEL,"$2,277.00",$0.00,"$2,277.00","$1,024.65","$1,625.09",$0.00,$392.32,$0.00,$0.00,$398.68,"$2,277.00",$0.00,"$1,138.50","$1,803.38","$1,821.60",$0.00,$356.35,$0.00,$362.50,$0.00
274.76S,SUP,HCPCS C1713,,274.76S  -  NAIL INTRAMEDULLARY UNIVERSAL 17MM 460MM STAINLESS STEEL,"$2,277.00",$0.00,"$2,277.00","$1,024.65","$1,625.09",$0.00,$392.32,$0.00,$0.00,$398.68,"$2,277.00",$0.00,"$1,138.50","$1,803.38","$1,821.60",$0.00,$356.35,$0.00,$362.50,$0.00
274.77S,SUP,HCPCS C1713,,274.77S  -  NAIL INTRAMEDULLARY UNIVERSAL 17MM 480MM STAINLESS STEEL,"$2,277.00",$0.00,"$2,277.00","$1,024.65","$1,625.09",$0.00,$392.32,$0.00,$0.00,$398.68,"$2,277.00",$0.00,"$1,138.50","$1,803.38","$1,821.60",$0.00,$356.35,$0.00,$362.50,$0.00
274.78S,SUP,HCPCS C1713,,274.78S  -  NAIL INTRAMEDULLARY 300MM 17MM 30CM STAINLEES STEEL FEMUR,"$2,277.00",$0.00,"$2,277.00","$1,024.65","$1,625.09",$0.00,$392.32,$0.00,$0.00,$398.68,"$2,277.00",$0.00,"$1,138.50","$1,803.38","$1,821.60",$0.00,$356.35,$0.00,$362.50,$0.00
274.79S,SUP,HCPCS C1713,,274.79S  -  NAIL INTRAMEDULLARY UNIVERSAL 17MM 320MM STAINLESS STEEL,"$2,277.00",$0.00,"$2,277.00","$1,024.65","$1,625.09",$0.00,$392.32,$0.00,$0.00,$398.68,"$2,277.00",$0.00,"$1,138.50","$1,803.38","$1,821.60",$0.00,$356.35,$0.00,$362.50,$0.00
274.80S,SUP,HCPCS C1713,,274.80S  -  NAIL INTRAMEDULLARY UNIVERSAL 18MM 340MM STAINLESS STEEL,"$2,277.00",$0.00,"$2,277.00","$1,024.65","$1,625.09",$0.00,$392.32,$0.00,$0.00,$398.68,"$2,277.00",$0.00,"$1,138.50","$1,803.38","$1,821.60",$0.00,$356.35,$0.00,$362.50,$0.00
274.81S,SUP,HCPCS C1713,,274.81S  -  NAIL INTRAMEDULLARY UNIVERSAL 18MM 360MM STAINLESS STEEL,"$2,277.00",$0.00,"$2,277.00","$1,024.65","$1,625.09",$0.00,$392.32,$0.00,$0.00,$398.68,"$2,277.00",$0.00,"$1,138.50","$1,803.38","$1,821.60",$0.00,$356.35,$0.00,$362.50,$0.00
274.82S,SUP,HCPCS C1713,,274.82S  -  NAIL INTRAMEDULLARY UNIVERSAL 18MM 380MM STAINLESS STEEL,"$2,277.00",$0.00,"$2,277.00","$1,024.65","$1,625.09",$0.00,$392.32,$0.00,$0.00,$398.68,"$2,277.00",$0.00,"$1,138.50","$1,803.38","$1,821.60",$0.00,$356.35,$0.00,$362.50,$0.00
274.83S,SUP,HCPCS C1713,,274.83S  -  NAIL INTRAMEDULLARY UNIVERSAL 18MM 400MM STAINLESS STEEL,"$2,277.00",$0.00,"$2,277.00","$1,024.65","$1,625.09",$0.00,$392.32,$0.00,$0.00,$398.68,"$2,277.00",$0.00,"$1,138.50","$1,803.38","$1,821.60",$0.00,$356.35,$0.00,$362.50,$0.00
274.84S,SUP,HCPCS C1713,,274.84S  -  NAIL INTRAMEDULLARY UNIVERSAL 18MM 420MM STAINLESS STEEL,"$2,277.00",$0.00,"$2,277.00","$1,024.65","$1,625.09",$0.00,$392.32,$0.00,$0.00,$398.68,"$2,277.00",$0.00,"$1,138.50","$1,803.38","$1,821.60",$0.00,$356.35,$0.00,$362.50,$0.00
274.85S,SUP,HCPCS C1713,,274.85S  -  NAIL INTRAMEDULLARY UNIVERSAL 18MM 18MM 440MM STAINLESS,"$2,277.00",$0.00,"$2,277.00","$1,024.65","$1,625.09",$0.00,$392.32,$0.00,$0.00,$398.68,"$2,277.00",$0.00,"$1,138.50","$1,803.38","$1,821.60",$0.00,$356.35,$0.00,$362.50,$0.00
274.86S,SUP,HCPCS C1713,,274.86S  -  NAIL INTRAMEDULLARY UNIVERSAL 18MM 460MM STAINLESS STEEL,"$2,277.00",$0.00,"$2,277.00","$1,024.65","$1,625.09",$0.00,$392.32,$0.00,$0.00,$398.68,"$2,277.00",$0.00,"$1,138.50","$1,803.38","$1,821.60",$0.00,$356.35,$0.00,$362.50,$0.00
274.87S,SUP,HCPCS C1713,,274.87S  -  NAIL INTRAMEDULLARY UNIVERSAL 18MM 480MM STAINLESS STEEL,"$2,277.00",$0.00,"$2,277.00","$1,024.65","$1,625.09",$0.00,$392.32,$0.00,$0.00,$398.68,"$2,277.00",$0.00,"$1,138.50","$1,803.38","$1,821.60",$0.00,$356.35,$0.00,$362.50,$0.00
274.88S,SUP,HCPCS C1713,,274.88S  -  NAIL INTRAMEDULLARY UNIVERSAL 18MM 300MM STAINLESS STEEL,"$2,277.00",$0.00,"$2,277.00","$1,024.65","$1,625.09",$0.00,$392.32,$0.00,$0.00,$398.68,"$2,277.00",$0.00,"$1,138.50","$1,803.38","$1,821.60",$0.00,$356.35,$0.00,$362.50,$0.00
274.89S,SUP,HCPCS C1713,,274.89S  -  NAIL INTRAMEDULLARY UNIVERSAL 18MM 320MM STAINLESS STEEL,"$2,277.00",$0.00,"$2,277.00","$1,024.65","$1,625.09",$0.00,$392.32,$0.00,$0.00,$398.68,"$2,277.00",$0.00,"$1,138.50","$1,803.38","$1,821.60",$0.00,$356.35,$0.00,$362.50,$0.00
274.92S,SUP,HCPCS C1713,,274.92S  -  NAIL INTRAMEDULLARY UNIVERSAL 19MM 380MM STAINLESS STEEL,"$2,277.00",$0.00,"$2,277.00","$1,024.65","$1,625.09",$0.00,$392.32,$0.00,$0.00,$398.68,"$2,277.00",$0.00,"$1,138.50","$1,803.38","$1,821.60",$0.00,$356.35,$0.00,$362.50,$0.00
274.93S,SUP,HCPCS C1713,,274.93S  -  NAIL INTRAMEDULLARY UNIVERSAL 19MM 400MM STAINLESS STEEL,"$2,277.00",$0.00,"$2,277.00","$1,024.65","$1,625.09",$0.00,$392.32,$0.00,$0.00,$398.68,"$2,277.00",$0.00,"$1,138.50","$1,803.38","$1,821.60",$0.00,$356.35,$0.00,$362.50,$0.00
274.94S,SUP,HCPCS C1713,,274.94S  -  NAIL INTRAMEDULLARY UNIVERSAL 19MM 420MM STAINLESS STEEL,"$2,277.00",$0.00,"$2,277.00","$1,024.65","$1,625.09",$0.00,$392.32,$0.00,$0.00,$398.68,"$2,277.00",$0.00,"$1,138.50","$1,803.38","$1,821.60",$0.00,$356.35,$0.00,$362.50,$0.00
274.95S,SUP,HCPCS C1713,,274.95S  -  NAIL INTRAMEDULLARY UNIVERSAL 19MM 440MM STAINLESS STEEL,"$2,277.00",$0.00,"$2,277.00","$1,024.65","$1,625.09",$0.00,$392.32,$0.00,$0.00,$398.68,"$2,277.00",$0.00,"$1,138.50","$1,803.38","$1,821.60",$0.00,$356.35,$0.00,$362.50,$0.00
274.96S,SUP,HCPCS C1713,,274.96S  -  NAIL INTRAMEDULLARY UNIVERSAL 19MM 460MM STAINLESS STEEL,"$2,277.00",$0.00,"$2,277.00","$1,024.65","$1,625.09",$0.00,$392.32,$0.00,$0.00,$398.68,"$2,277.00",$0.00,"$1,138.50","$1,803.38","$1,821.60",$0.00,$356.35,$0.00,$362.50,$0.00
274.97S,SUP,HCPCS C1713,,274.97S  -  NAIL INTRAMEDULLARY UNIVERSAL 19MM 480MM DCP LC-DCP,"$2,277.00",$0.00,"$2,277.00","$1,024.65","$1,625.09",$0.00,$392.32,$0.00,$0.00,$398.68,"$2,277.00",$0.00,"$1,138.50","$1,803.38","$1,821.60",$0.00,$356.35,$0.00,$362.50,$0.00
27448 B,SUP,Custom 27803010,,27448 B  -  PLATE 18MM TI BONE SPNL,$418.00,$0.00,$418.00,$0.00,$298.33,$0.00,$0.00,$0.00,$0.00,$0.00,$418.00,$0.00,$209.00,$331.06,$334.40,$0.00,$0.00,$0.00,$0.00,$0.00
27451-5,SUP,Custom 27803010,,27451-5  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$4,662.13",$0.00,"$4,662.13",$0.00,"$3,327.36",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,662.13",$0.00,"$2,331.06","$3,692.41","$3,729.70",$0.00,$0.00,$0.00,$0.00,$0.00
27490 L,SUP,Custom 27803010,,27490 L  -  PLATE 18MM TI BONE SPNL,"$2,614.88",$0.00,"$2,614.88",$0.00,"$1,866.24",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,614.88",$0.00,"$1,307.44","$2,070.98","$2,091.90",$0.00,$0.00,$0.00,$0.00,$0.00
27496 L,SUP,Custom 27803010,,27496 L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$3,051.88",$0.00,"$3,051.88",$0.00,"$2,178.12",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,051.88",$0.00,"$1,525.94","$2,417.09","$2,441.50",$0.00,$0.00,$0.00,$0.00,$0.00
27496 M,SUP,Custom 27803010,,27496 M  -  PLATE 18MM TI BONE SPNL,"$3,051.88",$0.00,"$3,051.88",$0.00,"$2,178.12",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,051.88",$0.00,"$1,525.94","$2,417.09","$2,441.50",$0.00,$0.00,$0.00,$0.00,$0.00
27499-1,SUP,Custom 27803010,,27499-1  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$4,754.75",$0.00,"$4,754.75",$0.00,"$3,393.47",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,754.75",$0.00,"$2,377.38","$3,765.76","$3,803.80",$0.00,$0.00,$0.00,$0.00,$0.00
27499-5,SUP,Custom 27803010,,27499-5  -  PLATE 18MM TI BONE SPNL,"$4,754.75",$0.00,"$4,754.75",$0.00,"$3,393.47",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,754.75",$0.00,"$2,377.38","$3,765.76","$3,803.80",$0.00,$0.00,$0.00,$0.00,$0.00
27505-1,SUP,Custom 27803010,,27505-1  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$3,944.88",$0.00,"$3,944.88",$0.00,"$2,815.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,944.88",$0.00,"$1,972.44","$3,124.34","$3,155.90",$0.00,$0.00,$0.00,$0.00,$0.00
27553 H,SUP,Custom 27803010,,27553 H  -  PLATE 18MM TI BONE SPNL,"$3,415.25",$0.00,"$3,415.25",$0.00,"$2,437.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,415.25",$0.00,"$1,707.63","$2,704.88","$2,732.20",$0.00,$0.00,$0.00,$0.00,$0.00
27553 L,SUP,Custom 27803010,,27553 L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$3,415.25",$0.00,"$3,415.25",$0.00,"$2,437.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,415.25",$0.00,"$1,707.63","$2,704.88","$2,732.20",$0.00,$0.00,$0.00,$0.00,$0.00
27553 M,SUP,Custom 27803010,,27553 M  -  PLATE 18MM TI BONE SPNL,"$3,415.25",$0.00,"$3,415.25",$0.00,"$2,437.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,415.25",$0.00,"$1,707.63","$2,704.88","$2,732.20",$0.00,$0.00,$0.00,$0.00,$0.00
27554-1,SUP,Custom 27803010,,27554-1  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$5,170.38",$0.00,"$5,170.38",$0.00,"$3,690.10",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,170.38",$0.00,"$2,585.19","$4,094.94","$4,136.30",$0.00,$0.00,$0.00,$0.00,$0.00
27554-2,SUP,Custom 27803010,,27554-2  -  PLATE 18MM TI BONE SPNL,"$5,170.38",$0.00,"$5,170.38",$0.00,"$3,690.10",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,170.38",$0.00,"$2,585.19","$4,094.94","$4,136.30",$0.00,$0.00,$0.00,$0.00,$0.00
27554-5,SUP,Custom 27803010,,27554-5  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$5,170.38",$0.00,"$5,170.38",$0.00,"$3,690.10",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,170.38",$0.00,"$2,585.19","$4,094.94","$4,136.30",$0.00,$0.00,$0.00,$0.00,$0.00
275-637-000,SUP,Custom 27203010,,275-637-000  -  BLADE SHVR 3.5MM FULL RAD ARTHRO STRL,$136.70,$0.00,$136.70,$0.00,$97.56,$0.00,$0.00,$0.00,$0.00,$0.00,$136.70,$0.00,$68.35,$108.27,$109.36,$0.00,$0.00,$0.00,$0.00,$0.00
275-641-000,SUP,Custom 27203010,,275-641-000  -  BURR SURG 2MM TMJ RND ARTHRO STRL,$144.78,$0.00,$144.78,$0.00,$103.33,$0.00,$0.00,$0.00,$0.00,$0.00,$144.78,$0.00,$72.39,$114.67,$115.82,$0.00,$0.00,$0.00,$0.00,$0.00
27573A,SUP,Custom 27803010,,27573A  -  PLATE 18MM TI BONE SPNL,$653.13,$0.00,$653.13,$0.00,$466.14,$0.00,$0.00,$0.00,$0.00,$0.00,$653.13,$0.00,$326.56,$517.28,$522.50,$0.00,$0.00,$0.00,$0.00,$0.00
27589A,SUP,Custom 27803010,,27589A  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$938.13,$0.00,$938.13,$0.00,$669.54,$0.00,$0.00,$0.00,$0.00,$0.00,$938.13,$0.00,$469.06,$743.00,$750.50,$0.00,$0.00,$0.00,$0.00,$0.00
27589B,SUP,Custom 27803010,,27589B  -  PLATE 18MM TI BONE SPNL,"$1,047.38",$0.00,"$1,047.38",$0.00,$747.51,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,047.38",$0.00,$523.69,$829.52,$837.90,$0.00,$0.00,$0.00,$0.00,$0.00
27589C,SUP,Custom 27803010,,27589C  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,047.38",$0.00,"$1,047.38",$0.00,$747.51,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,047.38",$0.00,$523.69,$829.52,$837.90,$0.00,$0.00,$0.00,$0.00,$0.00
27589D,SUP,Custom 27803010,,27589D  -  PLATE 18MM TI BONE SPNL,$938.13,$0.00,$938.13,$0.00,$669.54,$0.00,$0.00,$0.00,$0.00,$0.00,$938.13,$0.00,$469.06,$743.00,$750.50,$0.00,$0.00,$0.00,$0.00,$0.00
27589E,SUP,Custom 27803010,,27589E  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$938.13,$0.00,$938.13,$0.00,$669.54,$0.00,$0.00,$0.00,$0.00,$0.00,$938.13,$0.00,$469.06,$743.00,$750.50,$0.00,$0.00,$0.00,$0.00,$0.00
27589F,SUP,Custom 27803010,,27589F  -  PLATE 18MM TI BONE SPNL,$938.13,$0.00,$938.13,$0.00,$669.54,$0.00,$0.00,$0.00,$0.00,$0.00,$938.13,$0.00,$469.06,$743.00,$750.50,$0.00,$0.00,$0.00,$0.00,$0.00
27589H,SUP,Custom 27803010,,27589H  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$938.13,$0.00,$938.13,$0.00,$669.54,$0.00,$0.00,$0.00,$0.00,$0.00,$938.13,$0.00,$469.06,$743.00,$750.50,$0.00,$0.00,$0.00,$0.00,$0.00
27607 A,SUP,Custom 27803010,,27607 A  -  PLATE 18MM TI BONE SPNL,$427.50,$0.00,$427.50,$0.00,$305.11,$0.00,$0.00,$0.00,$0.00,$0.00,$427.50,$0.00,$213.75,$338.58,$342.00,$0.00,$0.00,$0.00,$0.00,$0.00
27607 B,SUP,Custom 27803010,,27607 B  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$427.50,$0.00,$427.50,$0.00,$305.11,$0.00,$0.00,$0.00,$0.00,$0.00,$427.50,$0.00,$213.75,$338.58,$342.00,$0.00,$0.00,$0.00,$0.00,$0.00
27607 C,SUP,Custom 27803010,,27607 C  -  PLATE 18MM TI BONE SPNL,$427.50,$0.00,$427.50,$0.00,$305.11,$0.00,$0.00,$0.00,$0.00,$0.00,$427.50,$0.00,$213.75,$338.58,$342.00,$0.00,$0.00,$0.00,$0.00,$0.00
27607 D,SUP,Custom 27803010,,27607 D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$427.50,$0.00,$427.50,$0.00,$305.11,$0.00,$0.00,$0.00,$0.00,$0.00,$427.50,$0.00,$213.75,$338.58,$342.00,$0.00,$0.00,$0.00,$0.00,$0.00
27643L,SUP,Custom 27803010,,27643L  -  PLATE 18MM TI BONE SPNL,"$2,498.50",$0.00,"$2,498.50",$0.00,"$1,783.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,498.50",$0.00,"$1,249.25","$1,978.81","$1,998.80",$0.00,$0.00,$0.00,$0.00,$0.00
27643M,SUP,Custom 27803010,,27643M  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,498.50",$0.00,"$2,498.50",$0.00,"$1,783.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,498.50",$0.00,"$1,249.25","$1,978.81","$1,998.80",$0.00,$0.00,$0.00,$0.00,$0.00
27644DL,SUP,Custom 27803010,,27644DL  -  PLATE 18MM TI BONE SPNL,"$3,237.13",$0.00,"$3,237.13",$0.00,"$2,310.34",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,237.13",$0.00,"$1,618.56","$2,563.81","$2,589.70",$0.00,$0.00,$0.00,$0.00,$0.00
27644DM,SUP,Custom 27803010,,27644DM  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$3,237.13",$0.00,"$3,237.13",$0.00,"$2,310.34",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,237.13",$0.00,"$1,618.56","$2,563.81","$2,589.70",$0.00,$0.00,$0.00,$0.00,$0.00
27644HM,SUP,Custom 27803010,,27644HM  -  PLATE 18MM TI BONE SPNL,"$3,237.13",$0.00,"$3,237.13",$0.00,"$2,310.34",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,237.13",$0.00,"$1,618.56","$2,563.81","$2,589.70",$0.00,$0.00,$0.00,$0.00,$0.00
27645L,SUP,Custom 27803010,,27645L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,498.50",$0.00,"$2,498.50",$0.00,"$1,783.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,498.50",$0.00,"$1,249.25","$1,978.81","$1,998.80",$0.00,$0.00,$0.00,$0.00,$0.00
27645M,SUP,Custom 27803010,,27645M  -  PLATE 18MM TI BONE SPNL,"$2,498.50",$0.00,"$2,498.50",$0.00,"$1,783.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,498.50",$0.00,"$1,249.25","$1,978.81","$1,998.80",$0.00,$0.00,$0.00,$0.00,$0.00
27683H,SUP,Custom 27803010,,27683H  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$3,051.88",$0.00,"$3,051.88",$0.00,"$2,178.12",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,051.88",$0.00,"$1,525.94","$2,417.09","$2,441.50",$0.00,$0.00,$0.00,$0.00,$0.00
27683L,SUP,Custom 27803010,,27683L  -  PLATE 18MM TI BONE SPNL,"$3,051.88",$0.00,"$3,051.88",$0.00,"$2,178.12",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,051.88",$0.00,"$1,525.94","$2,417.09","$2,441.50",$0.00,$0.00,$0.00,$0.00,$0.00
27683M,SUP,Custom 27803010,,27683M  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$3,051.88",$0.00,"$3,051.88",$0.00,"$2,178.12",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,051.88",$0.00,"$1,525.94","$2,417.09","$2,441.50",$0.00,$0.00,$0.00,$0.00,$0.00
27862M,SUP,Custom 27803010,,27862M  -  PLATE 18MM TI BONE SPNL,"$2,498.50",$0.00,"$2,498.50",$0.00,"$1,783.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,498.50",$0.00,"$1,249.25","$1,978.81","$1,998.80",$0.00,$0.00,$0.00,$0.00,$0.00
27-9020,SUP,HCPCS C1713,,27-9020  -  CNTRSNK DRILL 2.7MM XTRMT 2.7MM SCR,$300.00,$0.00,$300.00,$135.00,$214.11,$0.00,$51.69,$0.00,$0.00,$52.53,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$46.95,$0.00,$47.76,$0.00
279-251-101,SUP,Custom 27203010,,279-251-101  -  ELTRD ESURG 2.5MM SERFAS ENRG PRB AARDVARK,$413.09,$0.00,$413.09,$0.00,$294.82,$0.00,$0.00,$0.00,$0.00,$0.00,$413.09,$0.00,$206.54,$327.17,$330.47,$0.00,$0.00,$0.00,$0.00,$0.00
279-351-100,SUP,Custom 27203010,,279-351-100  -  ELTRD ESURG 90MM 3.5MM SERFAS ENRG 90D PRB SCT ARTHRO LATEX,$433.02,$0.00,$433.02,$0.00,$309.04,$0.00,$0.00,$0.00,$0.00,$0.00,$433.02,$0.00,$216.51,$342.95,$346.41,$0.00,$0.00,$0.00,$0.00,$0.00
279-351-300,SUP,Custom 27203010,,279-351-300  -  PROBE SCT 90MM LF 3.5MM SERFAS ENRG,$433.02,$0.00,$433.02,$0.00,$309.04,$0.00,$0.00,$0.00,$0.00,$0.00,$433.02,$0.00,$216.51,$342.95,$346.41,$0.00,$0.00,$0.00,$0.00,$0.00
2793G,SUP,Custom 27203010,,2793G  -  SUTURE NABSB 9-0 BV100-4 5IN BLU PRLN MFL,$58.24,$0.00,$58.24,$0.00,$41.57,$0.00,$0.00,$0.00,$0.00,$0.00,$58.24,$0.00,$29.12,$46.13,$46.59,$0.00,$0.00,$0.00,$0.00,$0.00
279-401-100,SUP,Custom 27203010,,279-401-100  -  PROBE SUCTION 90D 4MM ARTHRO SERFAS ENERGY MAXL STERILE,$393.03,$0.00,$393.03,$0.00,$280.50,$0.00,$0.00,$0.00,$0.00,$0.00,$393.03,$0.00,$196.51,$311.28,$314.42,$0.00,$0.00,$0.00,$0.00,$0.00
279-401-200,SUP,Custom 27203010,,279-401-200  -  SURGICAL ARTHROSCOPIC SERFAS 90-S 4.0MM CRUISE ENERG PROBE,$375.00,$0.00,$375.00,$0.00,$267.64,$0.00,$0.00,$0.00,$0.00,$0.00,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$0.00,$0.00,$0.00,$0.00
2794G,SUP,Custom 27203010,,2794G  -  SUTURE NONABSORBABLE 10-0 BV100-3 5CM MONOFILAMENT PROLENE,$63.69,$0.00,$63.69,$0.00,$45.45,$0.00,$0.00,$0.00,$0.00,$0.00,$63.69,$0.00,$31.84,$50.44,$50.95,$0.00,$0.00,$0.00,$0.00,$0.00
27AGFN-756,SUP,Custom 27803010,,27AGFN-756  -  VALVE AORTIC 85D 27MM 24.9MM 1 DIGIT GRADIENT MECHANICAL,"$11,750.00",$0.00,"$11,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,750.00",$0.00,"$5,875.00","$9,306.00","$9,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
27AJ-501,SUP,Custom 27803010,,27AJ-501  -  VALVE AOR 85D 3.67SQ CM 3.08SQ CM 27MM 22.5MM MSTR SER MECH,"$10,000.00",$0.00,"$10,000.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
27B006,SUP,Custom 27804086,,27B006  -  GRAFT BONE FEMORAL SHAFT,"$2,847.50",$0.00,"$2,847.50",$0.00,"$2,032.26",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,847.50",$0.00,"$1,423.75","$2,255.22","$2,278.00",$0.00,$0.00,$0.00,$0.00,$0.00
27MJ-501,SUP,Custom 27803010,,27MJ-501  -  VALVE MTRL 85D 3.67SQ CM STD RING 27MM 22.5MM MSTR SER LFLT,"$10,000.00",$0.00,"$10,000.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
280.651S,SUP,HCPCS C1713,,280.651S  -  SCREW BONE 14MM 50MM LAG DHS/DCS STAINLESS STEEL HIP CONDYLE,$790.20,$0.00,$790.20,$355.59,$563.97,$0.00,$132.18,$0.00,$0.00,$138.36,$790.20,$0.00,$395.10,$625.84,$632.16,$0.00,$120.06,$0.00,$125.80,$0.00
280.655S,SUP,HCPCS C1713,,280.655S  -  SCREW BONE 14MM 55MM LAG CANN DHS/DCS STAINLESS STEEL HIP,$790.20,$0.00,$790.20,$355.59,$563.97,$0.00,$132.18,$0.00,$0.00,$138.36,$790.20,$0.00,$395.10,$625.84,$632.16,$0.00,$120.06,$0.00,$125.80,$0.00
280.665S,SUP,HCPCS C1713,,280.665S  -  SCREW BONE 14MM 65MM LAG CANN DHS/DCS STAINLESS STEEL HIP,$790.20,$0.00,$790.20,$355.59,$563.97,$0.00,$132.18,$0.00,$0.00,$138.36,$790.20,$0.00,$395.10,$625.84,$632.16,$0.00,$120.06,$0.00,$125.80,$0.00
280.675S,SUP,HCPCS C1713,,280.675S  -  SCREW BONE 14MM 75MM LAG CANN DHS/DCS STAINLESS STEEL HIP,$790.20,$0.00,$790.20,$355.59,$563.97,$0.00,$132.18,$0.00,$0.00,$138.36,$790.20,$0.00,$395.10,$625.84,$632.16,$0.00,$120.06,$0.00,$125.80,$0.00
280.685S,SUP,HCPCS C1713,,280.685S  -  SCREW BONE 14MM 85MM LAG CANN DHS/DCS STAINLESS STEEL HIP,$790.20,$0.00,$790.20,$355.59,$563.97,$0.00,$132.18,$0.00,$0.00,$138.36,$790.20,$0.00,$395.10,$625.84,$632.16,$0.00,$120.06,$0.00,$125.80,$0.00
280.695S,SUP,HCPCS C1713,,280.695S  -  SCREW BONE 14MM 95MM LAG CANN DHS/DCS STAINLESS STEEL HIP,$790.20,$0.00,$790.20,$355.59,$563.97,$0.00,$132.18,$0.00,$0.00,$138.36,$790.20,$0.00,$395.10,$625.84,$632.16,$0.00,$120.06,$0.00,$125.80,$0.00
280.701S,SUP,HCPCS C1713,,280.701S  -  SCREW BONE 14MM 100MM LAG DHS/DCS STAINLESS STEEL HIP,$790.20,$0.00,$790.20,$355.59,$563.97,$0.00,$132.18,$0.00,$0.00,$138.36,$790.20,$0.00,$395.10,$625.84,$632.16,$0.00,$120.06,$0.00,$125.80,$0.00
280.705S,SUP,HCPCS C1713,,280.705S  -  SCREW BONE 14MM 105MM LAG DHS/DCS STAINLESS STEEL HIP,$790.20,$0.00,$790.20,$355.59,$563.97,$0.00,$132.18,$0.00,$0.00,$138.36,$790.20,$0.00,$395.10,$625.84,$632.16,$0.00,$120.06,$0.00,$125.80,$0.00
280.715S,SUP,HCPCS C1713,,280.715S  -  SCREW BONE 14MM 115MM LAG DHS/DCS STAINLESS STEEL HIP,$790.20,$0.00,$790.20,$355.59,$563.97,$0.00,$132.18,$0.00,$0.00,$138.36,$790.20,$0.00,$395.10,$625.84,$632.16,$0.00,$120.06,$0.00,$125.80,$0.00
280.725S,SUP,HCPCS C1713,,280.725S  -  SCREW BONE 14MM 8.2MM 125MM 22MM 1 STEP LAG CANN DHS/DCS,$790.20,$0.00,$790.20,$355.59,$563.97,$0.00,$132.18,$0.00,$0.00,$138.36,$790.20,$0.00,$395.10,$625.84,$632.16,$0.00,$120.06,$0.00,$125.80,$0.00
280.735S,SUP,HCPCS C1713,,280.735S  -  SCREW BONE 14MM 135MM 22MM LAG CANN DHS/DCS STAINLESS STEEL,$790.20,$0.00,$790.20,$355.59,$563.97,$0.00,$132.18,$0.00,$0.00,$138.36,$790.20,$0.00,$395.10,$625.84,$632.16,$0.00,$120.06,$0.00,$125.80,$0.00
280.745S,SUP,HCPCS C1713,,280.745S  -  SCREW BONE 14MM 145MM LAG DHS/DCS STAINLESS STEEL HIP,$790.20,$0.00,$790.20,$355.59,$563.97,$0.00,$132.18,$0.00,$0.00,$138.36,$790.20,$0.00,$395.10,$625.84,$632.16,$0.00,$120.06,$0.00,$125.80,$0.00
2808G,SUP,Custom 27203010,,2808G  -  SUTURE NABSB 8-0 BV130-5 5IN BLK ETH MTPS MFL,$41.14,$0.00,$41.14,$0.00,$29.36,$0.00,$0.00,$0.00,$0.00,$0.00,$41.14,$0.00,$20.57,$32.58,$32.91,$0.00,$0.00,$0.00,$0.00,$0.00
281.502S,SUP,HCPCS C1713,,281.502S  -  PLATE 130D SHRT BRL 46MM SS 2 HOLE DHS/DCP BONE 25MM CNDYLR,"$1,162.60",$0.00,"$1,162.60",$523.17,$829.75,$0.00,$200.31,$0.00,$0.00,$203.56,"$1,162.60",$0.00,$581.30,$920.78,$930.08,$0.00,$181.95,$0.00,$185.09,$0.00
2813G,SUP,Custom 27203010,,2813G  -  SUTURE NABSB 9-0 BV130-4 5IN BLK ETH MFL,$41.47,$0.00,$41.47,$0.00,$29.60,$0.00,$0.00,$0.00,$0.00,$0.00,$41.47,$0.00,$20.74,$32.84,$33.18,$0.00,$0.00,$0.00,$0.00,$0.00
28164FGM,SUP,Custom 27203010,,28164FGM  -  FORCEPS BIPOLAR 45 D L20 CM L1 MM OD3 MM INSERT ANGLED DISTA,"$2,490.00",$0.00,"$2,490.00",$0.00,"$1,777.11",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,490.00",$0.00,"$1,245.00","$1,972.08","$1,992.00",$0.00,$0.00,$0.00,$0.00,$0.00
282.234S,SUP,Custom 27803010,,282.234S  -  BLADE INTRAMEDULLARY NAIL HELIX 75MM LCP DHHS STERILE,$711.03,$0.00,$711.03,$0.00,$507.46,$0.00,$0.00,$0.00,$0.00,$0.00,$711.03,$0.00,$355.51,$563.14,$568.82,$0.00,$0.00,$0.00,$0.00,$0.00
282.235S,SUP,Custom 27803010,,282.235S  -  BLADE INTRAMEDULLARY NAIL 80MM LCP DHHS STAINLESS STEEL HIP,$711.03,$0.00,$711.03,$0.00,$507.46,$0.00,$0.00,$0.00,$0.00,$0.00,$711.03,$0.00,$355.51,$563.14,$568.82,$0.00,$0.00,$0.00,$0.00,$0.00
282.236S,SUP,Custom 27803010,,282.236S  -  BLADE SURG 85MM HELICAL STERILE,$711.03,$0.00,$711.03,$0.00,$507.46,$0.00,$0.00,$0.00,$0.00,$0.00,$711.03,$0.00,$355.51,$563.14,$568.82,$0.00,$0.00,$0.00,$0.00,$0.00
282.237S,SUP,Custom 27803010,,282.237S  -  BLADE FIX 90MM HELICAL LCP DHHS STAINLESS STEEL ORTHOPEDIC,$711.03,$0.00,$711.03,$0.00,$507.46,$0.00,$0.00,$0.00,$0.00,$0.00,$711.03,$0.00,$355.51,$563.14,$568.82,$0.00,$0.00,$0.00,$0.00,$0.00
282.238S,SUP,Custom 27803010,,282.238S  -  BLADE FIX 95MM HELICAL LCP DHHS STAINLESS STEEL STERILE,$711.03,$0.00,$711.03,$0.00,$507.46,$0.00,$0.00,$0.00,$0.00,$0.00,$711.03,$0.00,$355.51,$563.14,$568.82,$0.00,$0.00,$0.00,$0.00,$0.00
282.239S,SUP,Custom 27803010,,282.239S  -  BLADE FIX 100MM HELICAL LCP DHHS STAINLESS STEEL ORTHOPEDIC,$719.23,$0.00,$719.23,$0.00,$513.31,$0.00,$0.00,$0.00,$0.00,$0.00,$719.23,$0.00,$359.61,$569.63,$575.38,$0.00,$0.00,$0.00,$0.00,$0.00
282.240S,SUP,Custom 27803010,,282.240S  -  BLADE FIX 105MM LCP DHHS STAINLESS STEEL HIP STERILE,$719.23,$0.00,$719.23,$0.00,$513.31,$0.00,$0.00,$0.00,$0.00,$0.00,$719.23,$0.00,$359.61,$569.63,$575.38,$0.00,$0.00,$0.00,$0.00,$0.00
282.241S,SUP,Custom 27803010,,282.241S  -  BLADE INTRAMEDULLARY NAIL HELIX 110MM LCP DHHS STERILE,$719.23,$0.00,$719.23,$0.00,$513.31,$0.00,$0.00,$0.00,$0.00,$0.00,$719.23,$0.00,$359.61,$569.63,$575.38,$0.00,$0.00,$0.00,$0.00,$0.00
282.242S,SUP,Custom 27803010,,282.242S  -  BLADE INTRAMEDULLARY NAIL HELIX 115MM LCP DHHS STERILE,$719.23,$0.00,$719.23,$0.00,$513.31,$0.00,$0.00,$0.00,$0.00,$0.00,$719.23,$0.00,$359.61,$569.63,$575.38,$0.00,$0.00,$0.00,$0.00,$0.00
282.243S,SUP,Custom 27803010,,282.243S  -  BLADE FIX 120MM LCP DHHS STAINLESS STEEL HIP STERILE,$719.23,$0.00,$719.23,$0.00,$513.31,$0.00,$0.00,$0.00,$0.00,$0.00,$719.23,$0.00,$359.61,$569.63,$575.38,$0.00,$0.00,$0.00,$0.00,$0.00
282.244S,SUP,Custom 27803010,,282.244S  -  BLADE FIX 125MM LCP DHHS STAINLESS STEEL HIP STERILE,$719.23,$0.00,$719.23,$0.00,$513.31,$0.00,$0.00,$0.00,$0.00,$0.00,$719.23,$0.00,$359.61,$569.63,$575.38,$0.00,$0.00,$0.00,$0.00,$0.00
282.245S,SUP,Custom 27803010,,282.245S  -  BLADE FIX 130MM LCP DHHS STAINLESS STEEL HIP STERILE,$727.40,$0.00,$727.40,$0.00,$519.15,$0.00,$0.00,$0.00,$0.00,$0.00,$727.40,$0.00,$363.70,$576.10,$581.92,$0.00,$0.00,$0.00,$0.00,$0.00
282.246S,SUP,Custom 27803010,,282.246S  -  BLADE FIX 135MM LCP DHHS STAINLESS STEEL HIP STERILE,$727.40,$0.00,$727.40,$0.00,$519.15,$0.00,$0.00,$0.00,$0.00,$0.00,$727.40,$0.00,$363.70,$576.10,$581.92,$0.00,$0.00,$0.00,$0.00,$0.00
282.247S,SUP,Custom 27803010,,282.247S  -  BLADE FIX 140MM LCP DHHS STAINLESS STEEL HIP STERILE,$727.40,$0.00,$727.40,$0.00,$519.15,$0.00,$0.00,$0.00,$0.00,$0.00,$727.40,$0.00,$363.70,$576.10,$581.92,$0.00,$0.00,$0.00,$0.00,$0.00
282.248S,SUP,Custom 27803010,,282.248S  -  BLADE FIX 145MM LCP DHHS STAINLESS STEEL HIP STERILE,$727.40,$0.00,$727.40,$0.00,$519.15,$0.00,$0.00,$0.00,$0.00,$0.00,$727.40,$0.00,$363.70,$576.10,$581.92,$0.00,$0.00,$0.00,$0.00,$0.00
282.249S,SUP,Custom 27803010,,282.249S  -  BLADE FIX 150MM LCP DHHS STAINLESS STEEL HIP STERILE,$727.40,$0.00,$727.40,$0.00,$519.15,$0.00,$0.00,$0.00,$0.00,$0.00,$727.40,$0.00,$363.70,$576.10,$581.92,$0.00,$0.00,$0.00,$0.00,$0.00
282.605S,SUP,HCPCS C1713,,282.605S  -  SIDEPLATE BONE 130D STANDARD BARREL 162MM 38MM 8 HOLE LCP,"$1,411.15",$0.00,"$1,411.15",$635.02,"$1,007.14",$0.00,$236.05,$0.00,$0.00,$247.08,"$1,411.15",$0.00,$705.58,"$1,117.63","$1,128.92",$0.00,$214.41,$0.00,$224.66,$0.00
282.606S,SUP,HCPCS C1713,,282.606S  -  SIDEPLATE BONE 130D STANDARD BARREL 198MM 38MM 10 HOLE LCP,"$1,411.15",$0.00,"$1,411.15",$635.02,"$1,007.14",$0.00,$236.05,$0.00,$0.00,$247.08,"$1,411.15",$0.00,$705.58,"$1,117.63","$1,128.92",$0.00,$214.41,$0.00,$224.66,$0.00
282.607S,SUP,HCPCS C1713,,282.607S  -  SIDEPLATE BONE 130D STANDARD BARREL 234MM 38MM 12 HOLE LCP,"$1,411.15",$0.00,"$1,411.15",$635.02,"$1,007.14",$0.00,$236.05,$0.00,$0.00,$247.08,"$1,411.15",$0.00,$705.58,"$1,117.63","$1,128.92",$0.00,$214.41,$0.00,$224.66,$0.00
282.608S,SUP,HCPCS C1713,,282.608S  -  SIDEPLATE BONE 130D STANDARD BARREL 270MM 38MM 14 HOLE LCP,"$1,808.30",$0.00,"$1,808.30",$813.74,"$1,290.58",$0.00,$302.49,$0.00,$0.00,$316.62,"$1,808.30",$0.00,$904.15,"$1,432.17","$1,446.64",$0.00,$274.76,$0.00,$287.88,$0.00
282.615S,SUP,HCPCS C1713,,282.615S  -  SIDEPLATE BONE 135D STANDARD BARREL 162MM 38MM 8 HOLE LCP,"$1,411.15",$0.00,"$1,411.15",$635.02,"$1,007.14",$0.00,$236.05,$0.00,$0.00,$247.08,"$1,411.15",$0.00,$705.58,"$1,117.63","$1,128.92",$0.00,$214.41,$0.00,$224.66,$0.00
282.616S,SUP,HCPCS C1713,,282.616S  -  SIDEPLATE BONE 135D STANDARD BARREL 198MM 38MM 10 HOLE LCP,"$1,411.15",$0.00,"$1,411.15",$635.02,"$1,007.14",$0.00,$236.05,$0.00,$0.00,$247.08,"$1,411.15",$0.00,$705.58,"$1,117.63","$1,128.92",$0.00,$214.41,$0.00,$224.66,$0.00
282.617S,SUP,HCPCS C1713,,282.617S  -  SIDEPLATE BONE 135D STANDARD BARREL 234MM 38MM 12 HOLE LCP,"$1,411.15",$0.00,"$1,411.15",$635.02,"$1,007.14",$0.00,$236.05,$0.00,$0.00,$247.08,"$1,411.15",$0.00,$705.58,"$1,117.63","$1,128.92",$0.00,$214.41,$0.00,$224.66,$0.00
282.618S,SUP,HCPCS C1713,,282.618S  -  SIDEPLATE BONE 135D STANDARD BARREL 270MM 38MM 14 HOLE LCP,"$1,808.30",$0.00,"$1,808.30",$813.74,"$1,290.58",$0.00,$302.49,$0.00,$0.00,$316.62,"$1,808.30",$0.00,$904.15,"$1,432.17","$1,446.64",$0.00,$274.76,$0.00,$287.88,$0.00
282.619S,SUP,HCPCS C1713,,282.619S  -  SIDEPLATE BONE 135D STANDARD BARREL 306MM 38MM 16 HOLE LCP,"$1,808.30",$0.00,"$1,808.30",$813.74,"$1,290.58",$0.00,$302.49,$0.00,$0.00,$316.62,"$1,808.30",$0.00,$904.15,"$1,432.17","$1,446.64",$0.00,$274.76,$0.00,$287.88,$0.00
282.620S,SUP,HCPCS C1713,,282.620S  -  SIDEPLATE BONE 135D STANDARD BARREL 342MM 38MM 18 HOLE LCP,"$1,860.15",$0.00,"$1,860.15",$837.07,"$1,327.59",$0.00,$311.16,$0.00,$0.00,$325.70,"$1,860.15",$0.00,$930.08,"$1,473.24","$1,488.12",$0.00,$282.64,$0.00,$296.14,$0.00
282.621S,SUP,HCPCS C1713,,282.621S  -  SIDEPLATE BONE 135D STANDARD BARREL 378MM 38MM 20 HOLE LCP,"$1,860.15",$0.00,"$1,860.15",$837.07,"$1,327.59",$0.00,$311.16,$0.00,$0.00,$325.70,"$1,860.15",$0.00,$930.08,"$1,473.24","$1,488.12",$0.00,$282.64,$0.00,$296.14,$0.00
282.635S,SUP,HCPCS C1713,,282.635S  -  SIDEPLATE BONE 140D STANDARD BARREL 162MM 38MM 8 HOLE LCP,"$1,411.15",$0.00,"$1,411.15",$635.02,"$1,007.14",$0.00,$236.05,$0.00,$0.00,$247.08,"$1,411.15",$0.00,$705.58,"$1,117.63","$1,128.92",$0.00,$214.41,$0.00,$224.66,$0.00
282.636S,SUP,HCPCS C1713,,282.636S  -  SIDEPLATE BONE 140D STANDARD BARREL 198MM 38MM 10 HOLE LCP,"$1,411.15",$0.00,"$1,411.15",$635.02,"$1,007.14",$0.00,$236.05,$0.00,$0.00,$247.08,"$1,411.15",$0.00,$705.58,"$1,117.63","$1,128.92",$0.00,$214.41,$0.00,$224.66,$0.00
282.637S,SUP,HCPCS C1713,,282.637S  -  SIDEPLATE BONE 140D STANDARD BARREL 234MM 38MM 12 HOLE LCP,"$1,411.15",$0.00,"$1,411.15",$635.02,"$1,007.14",$0.00,$236.05,$0.00,$0.00,$247.08,"$1,411.15",$0.00,$705.58,"$1,117.63","$1,128.92",$0.00,$214.41,$0.00,$224.66,$0.00
282.638S,SUP,HCPCS C1713,,282.638S  -  SIDEPLATE BONE 140D STANDARD BARREL 270MM 38MM 14 HOLE LCP,"$1,808.30",$0.00,"$1,808.30",$813.74,"$1,290.58",$0.00,$302.49,$0.00,$0.00,$316.62,"$1,808.30",$0.00,$904.15,"$1,432.17","$1,446.64",$0.00,$274.76,$0.00,$287.88,$0.00
282.639S,SUP,HCPCS C1713,,282.639S  -  SIDEPLATE BONE 140D STANDARD BARREL 306MM 38MM 16 HOLE LCP,"$1,808.30",$0.00,"$1,808.30",$813.74,"$1,290.58",$0.00,$302.49,$0.00,$0.00,$316.62,"$1,808.30",$0.00,$904.15,"$1,432.17","$1,446.64",$0.00,$274.76,$0.00,$287.88,$0.00
282.645S,SUP,HCPCS C1713,,282.645S  -  SIDEPLATE BONE 145D STANDARD BARREL 162MM 38MM 8 HOLE LCP,"$1,411.15",$0.00,"$1,411.15",$635.02,"$1,007.14",$0.00,$236.05,$0.00,$0.00,$247.08,"$1,411.15",$0.00,$705.58,"$1,117.63","$1,128.92",$0.00,$214.41,$0.00,$224.66,$0.00
282.646S,SUP,HCPCS C1713,,282.646S  -  SIDEPLATE BONE 145D STANDARD BARREL 198MM 38MM 10 HOLE LCP,"$1,411.15",$0.00,"$1,411.15",$635.02,"$1,007.14",$0.00,$236.05,$0.00,$0.00,$247.08,"$1,411.15",$0.00,$705.58,"$1,117.63","$1,128.92",$0.00,$214.41,$0.00,$224.66,$0.00
282.647S,SUP,HCPCS C1713,,282.647S  -  SIDEPLATE BONE 145D STANDARD BARREL 234MM 38MM 12 HOLE LCP,"$1,411.15",$0.00,"$1,411.15",$635.02,"$1,007.14",$0.00,$236.05,$0.00,$0.00,$247.08,"$1,411.15",$0.00,$705.58,"$1,117.63","$1,128.92",$0.00,$214.41,$0.00,$224.66,$0.00
282.648S,SUP,HCPCS C1713,,282.648S  -  SIDEPLATE BONE 145D STANDARD BARREL 270MM 38MM 14 HOLE LCP,"$1,808.30",$0.00,"$1,808.30",$813.74,"$1,290.58",$0.00,$302.49,$0.00,$0.00,$316.62,"$1,808.30",$0.00,$904.15,"$1,432.17","$1,446.64",$0.00,$274.76,$0.00,$287.88,$0.00
282.649S,SUP,HCPCS C1713,,282.649S  -  SIDEPLATE BONE 145D STANDARD BARREL 306MM 38MM 16 HOLE LCP,"$1,808.30",$0.00,"$1,808.30",$813.74,"$1,290.58",$0.00,$302.49,$0.00,$0.00,$316.62,"$1,808.30",$0.00,$904.15,"$1,432.17","$1,446.64",$0.00,$274.76,$0.00,$287.88,$0.00
282.655S,SUP,HCPCS C1713,,282.655S  -  SIDEPLATE BONE 150D STANDARD BARREL 162MM 38MM 8 HOLE LCP,"$1,411.15",$0.00,"$1,411.15",$635.02,"$1,007.14",$0.00,$236.05,$0.00,$0.00,$247.08,"$1,411.15",$0.00,$705.58,"$1,117.63","$1,128.92",$0.00,$214.41,$0.00,$224.66,$0.00
282.656S,SUP,HCPCS C1713,,282.656S  -  SIDEPLATE BONE 150D STANDARD BARREL 198MM 38MM 10 HOLE LCP,"$1,411.15",$0.00,"$1,411.15",$635.02,"$1,007.14",$0.00,$236.05,$0.00,$0.00,$247.08,"$1,411.15",$0.00,$705.58,"$1,117.63","$1,128.92",$0.00,$214.41,$0.00,$224.66,$0.00
282.657S,SUP,HCPCS C1713,,282.657S  -  SIDEPLATE BONE 150D STANDARD BARREL 234MM 38MM 12 HOLE LCP,"$1,411.15",$0.00,"$1,411.15",$635.02,"$1,007.14",$0.00,$236.05,$0.00,$0.00,$247.08,"$1,411.15",$0.00,$705.58,"$1,117.63","$1,128.92",$0.00,$214.41,$0.00,$224.66,$0.00
282.658S,SUP,HCPCS C1713,,282.658S  -  SIDEPLATE BONE 150D STANDARD BARREL 270MM 38MM 14 HOLE LCP,"$1,808.30",$0.00,"$1,808.30",$813.74,"$1,290.58",$0.00,$302.49,$0.00,$0.00,$316.62,"$1,808.30",$0.00,$904.15,"$1,432.17","$1,446.64",$0.00,$274.76,$0.00,$287.88,$0.00
282.659S,SUP,HCPCS C1713,,282.659S  -  SIDEPLATE BONE 150D STANDARD BARREL 306MM 38MM 16 HOLE LCP,"$1,808.30",$0.00,"$1,808.30",$813.74,"$1,290.58",$0.00,$302.49,$0.00,$0.00,$316.62,"$1,808.30",$0.00,$904.15,"$1,432.17","$1,446.64",$0.00,$274.76,$0.00,$287.88,$0.00
282.660S,SUP,HCPCS C1713,,282.660S  -  SIDEPLATE BONE 150D STANDARD BARREL 342MM 38MM 18 HOLE LCP,"$1,860.15",$0.00,"$1,860.15",$837.07,"$1,327.59",$0.00,$311.16,$0.00,$0.00,$325.70,"$1,860.15",$0.00,$930.08,"$1,473.24","$1,488.12",$0.00,$282.64,$0.00,$296.14,$0.00
282.661S,SUP,HCPCS C1713,,282.661S  -  SIDEPLATE BONE 150D STANDARD BARREL 378MM 38MM 20 HOLE LCP,"$1,860.15",$0.00,"$1,860.15",$837.07,"$1,327.59",$0.00,$311.16,$0.00,$0.00,$325.70,"$1,860.15",$0.00,$930.08,"$1,473.24","$1,488.12",$0.00,$282.64,$0.00,$296.14,$0.00
282.671S,SUP,HCPCS C1713,,282.671S  -  SIDEPLATE BONE 130D SHORT BARREL 72MM 25MM 3 HOLE LCP DHHS,"$1,145.03",$0.00,"$1,145.03",$515.26,$817.20,$0.00,$191.54,$0.00,$0.00,$200.48,"$1,145.03",$0.00,$572.51,$906.86,$916.02,$0.00,$173.98,$0.00,$182.29,$0.00
282.673S,SUP,HCPCS C1713,,282.673S  -  SIDEPLATE BONE 130D SHORT BARREL 5 HOLE LCP DHHS STAINLESS,"$1,145.03",$0.00,"$1,145.03",$515.26,$817.20,$0.00,$191.54,$0.00,$0.00,$200.48,"$1,145.03",$0.00,$572.51,$906.86,$916.02,$0.00,$173.98,$0.00,$182.29,$0.00
282.674S,SUP,HCPCS C1713,,282.674S  -  SIDEPLATE BONE 130D SHORT BARREL 108MM 25MM 5 HOLE LCP DHHS,"$1,145.03",$0.00,"$1,145.03",$515.26,$817.20,$0.00,$191.54,$0.00,$0.00,$200.48,"$1,145.03",$0.00,$572.51,$906.86,$916.02,$0.00,$173.98,$0.00,$182.29,$0.00
282.677S,SUP,HCPCS C1713,,282.677S  -  SIDEPLATE BONE 135D SHORT BARREL 72MM 25MM 3 HOLE LCP DHHS,"$1,145.03",$0.00,"$1,145.03",$515.26,$817.20,$0.00,$191.54,$0.00,$0.00,$200.48,"$1,145.03",$0.00,$572.51,$906.86,$916.02,$0.00,$173.98,$0.00,$182.29,$0.00
282.679S,SUP,HCPCS C1713,,282.679S  -  SIDEPLATE BONE 135D SHORT BARREL 108MM 25MM 5 HOLE LCP DHHS,"$1,145.03",$0.00,"$1,145.03",$515.26,$817.20,$0.00,$191.54,$0.00,$0.00,$200.48,"$1,145.03",$0.00,$572.51,$906.86,$916.02,$0.00,$173.98,$0.00,$182.29,$0.00
282.680S,SUP,HCPCS C1713,,282.680S  -  SIDEPLATE BONE 135D SHORT BARREL 126MM 25MM 6 HOLE LCP DHHS,"$1,145.03",$0.00,"$1,145.03",$515.26,$817.20,$0.00,$191.54,$0.00,$0.00,$200.48,"$1,145.03",$0.00,$572.51,$906.86,$916.02,$0.00,$173.98,$0.00,$182.29,$0.00
282.681S,SUP,HCPCS C1713,,282.681S  -  SIDEPLATE BONE 140D SHORT BARREL 54MM 25MM 2 HOLE LCP DHHS,"$1,145.03",$0.00,"$1,145.03",$515.26,$817.20,$0.00,$191.54,$0.00,$0.00,$200.48,"$1,145.03",$0.00,$572.51,$906.86,$916.02,$0.00,$173.98,$0.00,$182.29,$0.00
282.682S,SUP,HCPCS C1713,,282.682S  -  SIDEPLATE BONE 140D SHORT BARREL 72MM 25MM 3 HOLE LCP DHHS,"$1,145.03",$0.00,"$1,145.03",$515.26,$817.20,$0.00,$191.54,$0.00,$0.00,$200.48,"$1,145.03",$0.00,$572.51,$906.86,$916.02,$0.00,$173.98,$0.00,$182.29,$0.00
282.684S,SUP,HCPCS C1713,,282.684S  -  SIDEPLATE BONE 140D SHORT BARREL 108MM 25MM 5 HOLE LCP DHHS,"$1,145.03",$0.00,"$1,145.03",$515.26,$817.20,$0.00,$191.54,$0.00,$0.00,$200.48,"$1,145.03",$0.00,$572.51,$906.86,$916.02,$0.00,$173.98,$0.00,$182.29,$0.00
282.685S,SUP,HCPCS C1713,,282.685S  -  SIDEPLATE BONE 140D SHORT BARREL 126MM 25MM 6 HOLE LCP DHHS,"$1,145.03",$0.00,"$1,145.03",$515.26,$817.20,$0.00,$191.54,$0.00,$0.00,$200.48,"$1,145.03",$0.00,$572.51,$906.86,$916.02,$0.00,$173.98,$0.00,$182.29,$0.00
282.686S,SUP,HCPCS C1713,,282.686S  -  SIDEPLATE BONE 145D SHORT BARREL 54MM 25MM 2 HOLE LCP DHHS,"$1,145.03",$0.00,"$1,145.03",$515.26,$817.20,$0.00,$191.54,$0.00,$0.00,$200.48,"$1,145.03",$0.00,$572.51,$906.86,$916.02,$0.00,$173.98,$0.00,$182.29,$0.00
282.687S,SUP,HCPCS C1713,,282.687S  -  SIDEPLATE BONE 145D SHORT BARREL 72MM 25MM 3 HOLE LCP DHHS,"$1,145.03",$0.00,"$1,145.03",$515.26,$817.20,$0.00,$191.54,$0.00,$0.00,$200.48,"$1,145.03",$0.00,$572.51,$906.86,$916.02,$0.00,$173.98,$0.00,$182.29,$0.00
282.689S,SUP,HCPCS C1713,,282.689S  -  SIDEPLATE BONE 145D SHORT BARREL 108MM 25MM 5 HOLE LCP DHHS,"$1,145.03",$0.00,"$1,145.03",$515.26,$817.20,$0.00,$191.54,$0.00,$0.00,$200.48,"$1,145.03",$0.00,$572.51,$906.86,$916.02,$0.00,$173.98,$0.00,$182.29,$0.00
282.690S,SUP,HCPCS C1713,,282.690S  -  SIDEPLATE BONE 145D SHORT BARREL 126MM 25MM 6 HOLE LCP DHHS,"$1,145.03",$0.00,"$1,145.03",$515.26,$817.20,$0.00,$191.54,$0.00,$0.00,$200.48,"$1,145.03",$0.00,$572.51,$906.86,$916.02,$0.00,$173.98,$0.00,$182.29,$0.00
282.692S,SUP,HCPCS C1713,,282.692S  -  SIDEPLATE BONE 150D SHORT BARREL 72MM 25MM 3 HOLE LCP DHHS,"$1,145.03",$0.00,"$1,145.03",$515.26,$817.20,$0.00,$191.54,$0.00,$0.00,$200.48,"$1,145.03",$0.00,$572.51,$906.86,$916.02,$0.00,$173.98,$0.00,$182.29,$0.00
282.694S,SUP,HCPCS C1713,,282.694S  -  SIDEPLATE BONE 150D SHORT BARREL 108MM 25MM 5 HOLE LCP DHHS,"$1,145.03",$0.00,"$1,145.03",$515.26,$817.20,$0.00,$191.54,$0.00,$0.00,$200.48,"$1,145.03",$0.00,$572.51,$906.86,$916.02,$0.00,$173.98,$0.00,$182.29,$0.00
282.695S,SUP,HCPCS C1713,,282.695S  -  SIDEPLATE BONE 150D SHORT BARREL 126MM 25MM 6 HOLE LCP DHHS,"$1,145.03",$0.00,"$1,145.03",$515.26,$817.20,$0.00,$191.54,$0.00,$0.00,$200.48,"$1,145.03",$0.00,$572.51,$906.86,$916.02,$0.00,$173.98,$0.00,$182.29,$0.00
28-300,SUP,Custom 27203010,,28-300  -  GUIDEPIN THREAD-TIPPED 2.8MM X 300MM,$75.00,$0.00,$75.00,$0.00,$53.53,$0.00,$0.00,$0.00,$0.00,$0.00,$75.00,$0.00,$37.50,$59.40,$60.00,$0.00,$0.00,$0.00,$0.00,$0.00
2836-47,SUP,Custom 27203010,,REAGENT MCBL ANSR SHIG BYD2 GRP C 1-7 LYPH 3ML,$262.83,$0.00,$262.83,$0.00,$187.58,$0.00,$0.00,$0.00,$0.00,$0.00,$262.83,$0.00,$131.41,$208.16,$210.26,$0.00,$0.00,$0.00,$0.00,$0.00
2837-47,SUP,Custom 27203010,,REAGENT MCBL ANSR SHIG BYD2 GRP D LYPH DFC 3ML,$279.20,$0.00,$279.20,$0.00,$199.27,$0.00,$0.00,$0.00,$0.00,$0.00,$279.20,$0.00,$139.60,$221.13,$223.36,$0.00,$0.00,$0.00,$0.00,$0.00
2850G,SUP,Custom 27203010,,2850G  -  SUTURE NONABSORBABLE 10-0 BV75-4 5IN MONOFILAMENT ETHILON,$70.52,$0.00,$70.52,$0.00,$50.33,$0.00,$0.00,$0.00,$0.00,$0.00,$70.52,$0.00,$35.26,$55.85,$56.42,$0.00,$0.00,$0.00,$0.00,$0.00
2867-05-230,SUP,HCPCS C1769,,2867-05-230  -  GUIDEWIRE ORTH 1.37MM VPR 2 SHRP,$575.00,$0.00,$575.00,$312.23,$410.38,$0.00,$99.07,$0.00,$0.00,$100.68,$575.00,$0.00,$287.50,$455.40,$460.00,$0.00,$89.99,$0.00,$91.54,$0.00
2887B,SUP,Custom 27203010,,PROBE ORAL LNG CORD THRMTR BLUE TRB TMP,$200.00,$0.00,$200.00,$0.00,$142.74,$0.00,$0.00,$0.00,$0.00,$0.00,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$0.00,$0.00,$0.00,$0.00
2894G,SUP,Custom 27203010,,2894G  -  SUTURE NONABSORBABLE 9-0 V100-3 5IN MONOFILAMENT ETHILON,$56.81,$0.00,$56.81,$0.00,$40.54,$0.00,$0.00,$0.00,$0.00,$0.00,$56.81,$0.00,$28.40,$44.99,$45.45,$0.00,$0.00,$0.00,$0.00,$0.00
28-M322090222290U,SUP,HCPCS C2625,,28-M322090222290U  -  GRAFT EVAS 22MMX100MM RESR MAIN,"$25,000.00",$0.00,"$25,000.00","$11,250.00","$5,158.80",$0.00,"$4,307.38",$0.00,$0.00,"$4,377.30","$25,000.00",$0.00,"$12,500.00","$19,800.00","$20,000.00",$0.00,"$3,912.50",$0.00,"$3,980.00",$0.00
28-M322150222290U,SUP,HCPCS C2625,,28-M322150222290U  -  GRAFT EVAS 22MMX150MM RESR MAIN,"$30,000.00",$0.00,"$30,000.00","$13,500.00","$5,158.80",$0.00,"$5,168.85",$0.00,$0.00,"$5,252.76","$30,000.00",$0.00,"$15,000.00","$23,760.00","$24,000.00",$0.00,"$4,695.00",$0.00,"$4,776.00",$0.00
28-M322190222290U,SUP,HCPCS C2625,,28-M322190222290U  -  GRAFT EVAS 22MMX200MM RESR MAIN,"$35,000.00",$0.00,"$35,000.00","$15,750.00","$5,158.80",$0.00,"$6,030.33",$0.00,$0.00,"$6,128.22","$35,000.00",$0.00,"$17,500.00","$27,720.00","$28,000.00",$0.00,"$5,477.50",$0.00,"$5,572.00",$0.00
28-M322250222390U,SUP,HCPCS C2625,,28-M322250222390U  -  GRAFT EVAS 22MMX250MM RESR MAIN,"$40,000.00",$0.00,"$40,000.00","$18,000.00","$5,158.80",$0.00,"$6,891.80",$0.00,$0.00,"$7,003.68","$40,000.00",$0.00,"$20,000.00","$31,680.00","$32,000.00",$0.00,"$6,260.00",$0.00,"$6,368.00",$0.00
28-M324090242290U,SUP,HCPCS C2625,,28-M324090242290U  -  GRAFT EVAS 24MMX100MM RESR MAIN,"$25,000.00",$0.00,"$25,000.00","$11,250.00","$5,158.80",$0.00,"$4,307.38",$0.00,$0.00,"$4,377.30","$25,000.00",$0.00,"$12,500.00","$19,800.00","$20,000.00",$0.00,"$3,912.50",$0.00,"$3,980.00",$0.00
28-M324150242290U,SUP,HCPCS C2625,,28-M324150242290U  -  GRAFT EVAS 24MMX150MM RESR MAIN,"$30,000.00",$0.00,"$30,000.00","$13,500.00","$5,158.80",$0.00,"$5,168.85",$0.00,$0.00,"$5,252.76","$30,000.00",$0.00,"$15,000.00","$23,760.00","$24,000.00",$0.00,"$4,695.00",$0.00,"$4,776.00",$0.00
28-M324190242290U,SUP,HCPCS C2625,,28-M324190242290U  -  GRAFT EVAS 24MMX200MM RESR MAIN,"$35,000.00",$0.00,"$35,000.00","$15,750.00","$5,158.80",$0.00,"$6,030.33",$0.00,$0.00,"$6,128.22","$35,000.00",$0.00,"$17,500.00","$27,720.00","$28,000.00",$0.00,"$5,477.50",$0.00,"$5,572.00",$0.00
28-M324250222390U,SUP,HCPCS C2625,,28-M324250222390U  -  GRAFT EVAS 24MMX250MM RESR MAIN,"$40,000.00",$0.00,"$40,000.00","$18,000.00","$5,158.80",$0.00,"$6,891.80",$0.00,$0.00,"$7,003.68","$40,000.00",$0.00,"$20,000.00","$31,680.00","$32,000.00",$0.00,"$6,260.00",$0.00,"$6,368.00",$0.00
28-M326095262290U,SUP,HCPCS C2625,,28-M326095262290U  -  GRAFT EVAS 26MMX100MM RESR MAIN,"$25,000.00",$0.00,"$25,000.00","$11,250.00","$5,158.80",$0.00,"$4,307.38",$0.00,$0.00,"$4,377.30","$25,000.00",$0.00,"$12,500.00","$19,800.00","$20,000.00",$0.00,"$3,912.50",$0.00,"$3,980.00",$0.00
28-M326155262290U,SUP,HCPCS C2625,,28-M326155262290U  -  GRAFT EVAS 26MMX150MM RESR MAIN,"$30,000.00",$0.00,"$30,000.00","$13,500.00","$5,158.80",$0.00,"$5,168.85",$0.00,$0.00,"$5,252.76","$30,000.00",$0.00,"$15,000.00","$23,760.00","$24,000.00",$0.00,"$4,695.00",$0.00,"$4,776.00",$0.00
28-M326195262290U,SUP,HCPCS C2625,,28-M326195262290U  -  GRAFT EVAS 26MMX200MM RESR MAIN,"$35,000.00",$0.00,"$35,000.00","$15,750.00","$5,158.80",$0.00,"$6,030.33",$0.00,$0.00,"$6,128.22","$35,000.00",$0.00,"$17,500.00","$27,720.00","$28,000.00",$0.00,"$5,477.50",$0.00,"$5,572.00",$0.00
28-M326250262390U,SUP,HCPCS C2625,,28-M326250262390U  -  GRAFT EVAS 26MMX250MM RESR MAIN,"$40,000.00",$0.00,"$40,000.00","$18,000.00","$5,158.80",$0.00,"$6,891.80",$0.00,$0.00,"$7,003.68","$40,000.00",$0.00,"$20,000.00","$31,680.00","$32,000.00",$0.00,"$6,260.00",$0.00,"$6,368.00",$0.00
28-M328095282290U,SUP,HCPCS C2625,,28-M328095282290U  -  GRAFT EVAS 28MMX100MM RESR MAIN,"$25,000.00",$0.00,"$25,000.00","$11,250.00","$5,158.80",$0.00,"$4,307.38",$0.00,$0.00,"$4,377.30","$25,000.00",$0.00,"$12,500.00","$19,800.00","$20,000.00",$0.00,"$3,912.50",$0.00,"$3,980.00",$0.00
28-M328155242290U,SUP,HCPCS C2625,,28-M328155242290U  -  GRAFT EVAS 28/24X150 TAPERED,"$30,000.00",$0.00,"$30,000.00","$13,500.00","$5,158.80",$0.00,"$5,168.85",$0.00,$0.00,"$5,252.76","$30,000.00",$0.00,"$15,000.00","$23,760.00","$24,000.00",$0.00,"$4,695.00",$0.00,"$4,776.00",$0.00
28-M328155282290U,SUP,HCPCS C2625,,28-M328155282290U  -  GRAFT EVAS 28MMX150MM RESR MAIN,"$30,000.00",$0.00,"$30,000.00","$13,500.00","$5,158.80",$0.00,"$5,168.85",$0.00,$0.00,"$5,252.76","$30,000.00",$0.00,"$15,000.00","$23,760.00","$24,000.00",$0.00,"$4,695.00",$0.00,"$4,776.00",$0.00
28-M328195242290U,SUP,HCPCS C2625,,28-M328195242290U  -  GRAFT EVAS 28/24X200 TAPERED,"$35,000.00",$0.00,"$35,000.00","$15,750.00","$5,158.80",$0.00,"$6,030.33",$0.00,$0.00,"$6,128.22","$35,000.00",$0.00,"$17,500.00","$27,720.00","$28,000.00",$0.00,"$5,477.50",$0.00,"$5,572.00",$0.00
28-M328195282290U,SUP,HCPCS C2625,,28-M328195282290U  -  GRAFT EVAS 28MMX200MM RESR MAIN,"$35,000.00",$0.00,"$35,000.00","$15,750.00","$5,158.80",$0.00,"$6,030.33",$0.00,$0.00,"$6,128.22","$35,000.00",$0.00,"$17,500.00","$27,720.00","$28,000.00",$0.00,"$5,477.50",$0.00,"$5,572.00",$0.00
28-M328250242390U,SUP,HCPCS C2625,,28-M328250242390U  -  GRAFT EVAS 28/24X250 TAPERED,"$40,000.00",$0.00,"$40,000.00","$18,000.00","$5,158.80",$0.00,"$6,891.80",$0.00,$0.00,"$7,003.68","$40,000.00",$0.00,"$20,000.00","$31,680.00","$32,000.00",$0.00,"$6,260.00",$0.00,"$6,368.00",$0.00
28-M328250282390U,SUP,HCPCS C2625,,28-M328250282390U  -  GRAFT EVAS 28MMX250MM RESR MAIN,"$40,000.00",$0.00,"$40,000.00","$18,000.00","$5,158.80",$0.00,"$6,891.80",$0.00,$0.00,"$7,003.68","$40,000.00",$0.00,"$20,000.00","$31,680.00","$32,000.00",$0.00,"$6,260.00",$0.00,"$6,368.00",$0.00
28-M330095302290U,SUP,HCPCS C2625,,28-M330095302290U  -  GRAFT EVAS 30MMX100MM RESR MAIN,"$25,000.00",$0.00,"$25,000.00","$11,250.00","$5,158.80",$0.00,"$4,307.38",$0.00,$0.00,"$4,377.30","$25,000.00",$0.00,"$12,500.00","$19,800.00","$20,000.00",$0.00,"$3,912.50",$0.00,"$3,980.00",$0.00
28-M330155262290U,SUP,HCPCS C2625,,28-M330155262290U  -  GRAFT EVAS 30/26X150 TAPERED,"$30,000.00",$0.00,"$30,000.00","$13,500.00","$5,158.80",$0.00,"$5,168.85",$0.00,$0.00,"$5,252.76","$30,000.00",$0.00,"$15,000.00","$23,760.00","$24,000.00",$0.00,"$4,695.00",$0.00,"$4,776.00",$0.00
28-M330155302290U,SUP,HCPCS C2625,,28-M330155302290U  -  GRAFT EVAS 30MMX150MM RESR MAIN,"$30,000.00",$0.00,"$30,000.00","$13,500.00","$5,158.80",$0.00,"$5,168.85",$0.00,$0.00,"$5,252.76","$30,000.00",$0.00,"$15,000.00","$23,760.00","$24,000.00",$0.00,"$4,695.00",$0.00,"$4,776.00",$0.00
28-M330200262390U,SUP,HCPCS C2625,,28-M330200262390U  -  GRAFT EVAS 30/26X200 TAPERED,"$35,000.00",$0.00,"$35,000.00","$15,750.00","$5,158.80",$0.00,"$6,030.33",$0.00,$0.00,"$6,128.22","$35,000.00",$0.00,"$17,500.00","$27,720.00","$28,000.00",$0.00,"$5,477.50",$0.00,"$5,572.00",$0.00
28-M330200302390U,SUP,HCPCS C2625,,28-M330200302390U  -  GRAFT EVAS 30MMX200MM RESR MAIN,"$35,000.00",$0.00,"$35,000.00","$15,750.00","$5,158.80",$0.00,"$6,030.33",$0.00,$0.00,"$6,128.22","$35,000.00",$0.00,"$17,500.00","$27,720.00","$28,000.00",$0.00,"$5,477.50",$0.00,"$5,572.00",$0.00
28-M330250262390U,SUP,HCPCS C2625,,28-M330250262390U  -  GRAFT EVAS 30/26X250 TAPERED,"$40,000.00",$0.00,"$40,000.00","$18,000.00","$5,158.80",$0.00,"$6,891.80",$0.00,$0.00,"$7,003.68","$40,000.00",$0.00,"$20,000.00","$31,680.00","$32,000.00",$0.00,"$6,260.00",$0.00,"$6,368.00",$0.00
28-M330250302390U,SUP,HCPCS C2625,,28-M330250302390U  -  GRAFT EVAS 30MMX250MM RESR MAIN,"$40,000.00",$0.00,"$40,000.00","$18,000.00","$5,158.80",$0.00,"$6,891.80",$0.00,$0.00,"$7,003.68","$40,000.00",$0.00,"$20,000.00","$31,680.00","$32,000.00",$0.00,"$6,260.00",$0.00,"$6,368.00",$0.00
28-M332095322290U,SUP,HCPCS C2625,,28-M332095322290U  -  GRAFT EVAS 32MMX100MM RESR MAIN,"$25,000.00",$0.00,"$25,000.00","$11,250.00","$5,158.80",$0.00,"$4,307.38",$0.00,$0.00,"$4,377.30","$25,000.00",$0.00,"$12,500.00","$19,800.00","$20,000.00",$0.00,"$3,912.50",$0.00,"$3,980.00",$0.00
28-M332155282290U,SUP,HCPCS C2625,,28-M332155282290U  -  GRAFT EVAS 32/28X150 TAPERED,"$30,000.00",$0.00,"$30,000.00","$13,500.00","$5,158.80",$0.00,"$5,168.85",$0.00,$0.00,"$5,252.76","$30,000.00",$0.00,"$15,000.00","$23,760.00","$24,000.00",$0.00,"$4,695.00",$0.00,"$4,776.00",$0.00
28-M332155322290U,SUP,HCPCS C2625,,28-M332155322290U  -  GRAFT EVAS 32MMX150MM RESR MAIN,"$30,000.00",$0.00,"$30,000.00","$13,500.00","$5,158.80",$0.00,"$5,168.85",$0.00,$0.00,"$5,252.76","$30,000.00",$0.00,"$15,000.00","$23,760.00","$24,000.00",$0.00,"$4,695.00",$0.00,"$4,776.00",$0.00
28-M332200282390U,SUP,HCPCS C2625,,28-M332200282390U  -  GRAFT EVAS 32/28X200 TAPERED,"$35,000.00",$0.00,"$35,000.00","$15,750.00","$5,158.80",$0.00,"$6,030.33",$0.00,$0.00,"$6,128.22","$35,000.00",$0.00,"$17,500.00","$27,720.00","$28,000.00",$0.00,"$5,477.50",$0.00,"$5,572.00",$0.00
28-M332200322390U,SUP,HCPCS C2625,,28-M332200322390U  -  GRAFT EVAS 32MMX200MM RESR MAIN,"$35,000.00",$0.00,"$35,000.00","$15,750.00","$5,158.80",$0.00,"$6,030.33",$0.00,$0.00,"$6,128.22","$35,000.00",$0.00,"$17,500.00","$27,720.00","$28,000.00",$0.00,"$5,477.50",$0.00,"$5,572.00",$0.00
28-M332250282490U,SUP,HCPCS C2625,,28-M332250282490U  -  GRAFT EVAS 32/28X250 TAPERED,"$40,000.00",$0.00,"$40,000.00","$18,000.00","$5,158.80",$0.00,"$6,891.80",$0.00,$0.00,"$7,003.68","$40,000.00",$0.00,"$20,000.00","$31,680.00","$32,000.00",$0.00,"$6,260.00",$0.00,"$6,368.00",$0.00
28-M332250322490U,SUP,HCPCS C2625,,28-M332250322490U  -  GRAFT EVAS 32MMX250MM RESR MAIN,"$40,000.00",$0.00,"$40,000.00","$18,000.00","$5,158.80",$0.00,"$6,891.80",$0.00,$0.00,"$7,003.68","$40,000.00",$0.00,"$20,000.00","$31,680.00","$32,000.00",$0.00,"$6,260.00",$0.00,"$6,368.00",$0.00
28-M334100342390U,SUP,HCPCS C2625,,28-M334100342390U  -  GRAFT EVAS 34MMX100MM RESR MAIN,"$25,000.00",$0.00,"$25,000.00","$11,250.00","$5,158.80",$0.00,"$4,307.38",$0.00,$0.00,"$4,377.30","$25,000.00",$0.00,"$12,500.00","$19,800.00","$20,000.00",$0.00,"$3,912.50",$0.00,"$3,980.00",$0.00
28-M334145302390U,SUP,HCPCS C2625,,28-M334145302390U  -  GRAFT EVAS 34/30X150 TAPERED,"$30,000.00",$0.00,"$30,000.00","$13,500.00","$5,158.80",$0.00,"$5,168.85",$0.00,$0.00,"$5,252.76","$30,000.00",$0.00,"$15,000.00","$23,760.00","$24,000.00",$0.00,"$4,695.00",$0.00,"$4,776.00",$0.00
28-M334145342390U,SUP,HCPCS C2625,,28-M334145342390U  -  GRAFT EVAS 34MMX150MM RESR MAIN,"$30,000.00",$0.00,"$30,000.00","$13,500.00","$5,158.80",$0.00,"$5,168.85",$0.00,$0.00,"$5,252.76","$30,000.00",$0.00,"$15,000.00","$23,760.00","$24,000.00",$0.00,"$4,695.00",$0.00,"$4,776.00",$0.00
28-M334200302490U,SUP,HCPCS C2625,,28-M334200302490U  -  GRAFT EVAS 34/30X200 TAPERED,"$35,000.00",$0.00,"$35,000.00","$15,750.00","$5,158.80",$0.00,"$6,030.33",$0.00,$0.00,"$6,128.22","$35,000.00",$0.00,"$17,500.00","$27,720.00","$28,000.00",$0.00,"$5,477.50",$0.00,"$5,572.00",$0.00
28-M334200342490U,SUP,HCPCS C2625,,28-M334200342490U  -  GRAFT EVAS 34MMX200MM RESR MAIN,"$35,000.00",$0.00,"$35,000.00","$15,750.00","$5,158.80",$0.00,"$6,030.33",$0.00,$0.00,"$6,128.22","$35,000.00",$0.00,"$17,500.00","$27,720.00","$28,000.00",$0.00,"$5,477.50",$0.00,"$5,572.00",$0.00
28-M334250302490U,SUP,HCPCS C2625,,28-M334250302490U  -  GRAFT EVAS 34/30X250 TAPERED,"$40,000.00",$0.00,"$40,000.00","$18,000.00","$5,158.80",$0.00,"$6,891.80",$0.00,$0.00,"$7,003.68","$40,000.00",$0.00,"$20,000.00","$31,680.00","$32,000.00",$0.00,"$6,260.00",$0.00,"$6,368.00",$0.00
28-M334250342490U,SUP,HCPCS C2625,,28-M334250342490U  -  GRAFT EVAS 34MMX250MM RESR MAIN,"$40,000.00",$0.00,"$40,000.00","$18,000.00","$5,158.80",$0.00,"$6,891.80",$0.00,$0.00,"$7,003.68","$40,000.00",$0.00,"$20,000.00","$31,680.00","$32,000.00",$0.00,"$6,260.00",$0.00,"$6,368.00",$0.00
28-M336100362390U,SUP,HCPCS C2625,,28-M336100362390U  -  GRAFT EVAS 36MMX100MM RESR MAIN,"$25,000.00",$0.00,"$25,000.00","$11,250.00","$5,158.80",$0.00,"$4,307.38",$0.00,$0.00,"$4,377.30","$25,000.00",$0.00,"$12,500.00","$19,800.00","$20,000.00",$0.00,"$3,912.50",$0.00,"$3,980.00",$0.00
28-M336145322490U,SUP,HCPCS C2625,,28-M336145322490U  -  GRAFT EVAS 36/32X150 TAPERED,"$30,000.00",$0.00,"$30,000.00","$13,500.00","$5,158.80",$0.00,"$5,168.85",$0.00,$0.00,"$5,252.76","$30,000.00",$0.00,"$15,000.00","$23,760.00","$24,000.00",$0.00,"$4,695.00",$0.00,"$4,776.00",$0.00
28-M336145362490U,SUP,HCPCS C2625,,28-M336145362490U  -  GRAFT EVAS 36MMX150MM RESR MAIN,"$30,000.00",$0.00,"$30,000.00","$13,500.00","$5,158.80",$0.00,"$5,168.85",$0.00,$0.00,"$5,252.76","$30,000.00",$0.00,"$15,000.00","$23,760.00","$24,000.00",$0.00,"$4,695.00",$0.00,"$4,776.00",$0.00
28-M336190322490U,SUP,HCPCS C2625,,28-M336190322490U  -  GRAFT EVAS 36/32X200 TAPERED,"$35,000.00",$0.00,"$35,000.00","$15,750.00","$5,158.80",$0.00,"$6,030.33",$0.00,$0.00,"$6,128.22","$35,000.00",$0.00,"$17,500.00","$27,720.00","$28,000.00",$0.00,"$5,477.50",$0.00,"$5,572.00",$0.00
28-M336190362490U,SUP,HCPCS C2625,,28-M336190362490U  -  GRAFT EVAS 36MMX200MM RESR MAIN,"$35,000.00",$0.00,"$35,000.00","$15,750.00","$5,158.80",$0.00,"$6,030.33",$0.00,$0.00,"$6,128.22","$35,000.00",$0.00,"$17,500.00","$27,720.00","$28,000.00",$0.00,"$5,477.50",$0.00,"$5,572.00",$0.00
28-M336250322490U,SUP,HCPCS C2625,,28-M336250322490U  -  GRAFT EVAS 36/32X250 TAPERED,"$40,000.00",$0.00,"$40,000.00","$18,000.00","$5,158.80",$0.00,"$6,891.80",$0.00,$0.00,"$7,003.68","$40,000.00",$0.00,"$20,000.00","$31,680.00","$32,000.00",$0.00,"$6,260.00",$0.00,"$6,368.00",$0.00
28-M336250362490U,SUP,HCPCS C2625,,28-M336250362490U  -  GRAFT EVAS 36MMX250MM RESR MAIN,"$40,000.00",$0.00,"$40,000.00","$18,000.00","$5,158.80",$0.00,"$6,891.80",$0.00,$0.00,"$7,003.68","$40,000.00",$0.00,"$20,000.00","$31,680.00","$32,000.00",$0.00,"$6,260.00",$0.00,"$6,368.00",$0.00
28-M338100382490U,SUP,HCPCS C2625,,28-M338100382490U  -  GRAFT EVAS 38MMX100MM RESR MAIN,"$25,000.00",$0.00,"$25,000.00","$11,250.00","$5,158.80",$0.00,"$4,307.38",$0.00,$0.00,"$4,377.30","$25,000.00",$0.00,"$12,500.00","$19,800.00","$20,000.00",$0.00,"$3,912.50",$0.00,"$3,980.00",$0.00
28-M338145342490U,SUP,HCPCS C2625,,28-M338145342490U  -  GRAFT EVAS 38/34X150 TAPERED,"$30,000.00",$0.00,"$30,000.00","$13,500.00","$5,158.80",$0.00,"$5,168.85",$0.00,$0.00,"$5,252.76","$30,000.00",$0.00,"$15,000.00","$23,760.00","$24,000.00",$0.00,"$4,695.00",$0.00,"$4,776.00",$0.00
28-M338145382490U,SUP,HCPCS C2625,,28-M338145382490U  -  GRAFT EVAS 38MMX150MM RESR MAIN,"$30,000.00",$0.00,"$30,000.00","$13,500.00","$5,158.80",$0.00,"$5,168.85",$0.00,$0.00,"$5,252.76","$30,000.00",$0.00,"$15,000.00","$23,760.00","$24,000.00",$0.00,"$4,695.00",$0.00,"$4,776.00",$0.00
28-M338190342590U,SUP,HCPCS C2625,,28-M338190342590U  -  GRAFT EVAS 38/34X200 TAPERED,"$35,000.00",$0.00,"$35,000.00","$15,750.00","$5,158.80",$0.00,"$6,030.33",$0.00,$0.00,"$6,128.22","$35,000.00",$0.00,"$17,500.00","$27,720.00","$28,000.00",$0.00,"$5,477.50",$0.00,"$5,572.00",$0.00
28-M338190382590U,SUP,HCPCS C2625,,28-M338190382590U  -  GRAFT EVAS 38MMX200MM RESR MAIN,"$35,000.00",$0.00,"$35,000.00","$15,750.00","$5,158.80",$0.00,"$6,030.33",$0.00,$0.00,"$6,128.22","$35,000.00",$0.00,"$17,500.00","$27,720.00","$28,000.00",$0.00,"$5,477.50",$0.00,"$5,572.00",$0.00
28-M338250342590U,SUP,HCPCS C2625,,28-M338250342590U  -  GRAFT EVAS 38/34X250 TAPERED,"$40,000.00",$0.00,"$40,000.00","$18,000.00","$5,158.80",$0.00,"$6,891.80",$0.00,$0.00,"$7,003.68","$40,000.00",$0.00,"$20,000.00","$31,680.00","$32,000.00",$0.00,"$6,260.00",$0.00,"$6,368.00",$0.00
28-M338250382590U,SUP,HCPCS C2625,,28-M338250382590U  -  GRAFT EVAS 38MMX250MM RESR MAIN,"$40,000.00",$0.00,"$40,000.00","$18,000.00","$5,158.80",$0.00,"$6,891.80",$0.00,$0.00,"$7,003.68","$40,000.00",$0.00,"$20,000.00","$31,680.00","$32,000.00",$0.00,"$6,260.00",$0.00,"$6,368.00",$0.00
28-M340105402490U,SUP,HCPCS C2625,,28-M340105402490U  -  GRAFT EVAS 40MMX100MM RESR MAIN,"$25,000.00",$0.00,"$25,000.00","$11,250.00","$5,158.80",$0.00,"$4,307.38",$0.00,$0.00,"$4,377.30","$25,000.00",$0.00,"$12,500.00","$19,800.00","$20,000.00",$0.00,"$3,912.50",$0.00,"$3,980.00",$0.00
28-M340145362590U,SUP,HCPCS C2625,,28-M340145362590U  -  GRAFT EVAS 40/36X150 TAPERED,"$30,000.00",$0.00,"$30,000.00","$13,500.00","$5,158.80",$0.00,"$5,168.85",$0.00,$0.00,"$5,252.76","$30,000.00",$0.00,"$15,000.00","$23,760.00","$24,000.00",$0.00,"$4,695.00",$0.00,"$4,776.00",$0.00
28-M340145402590U,SUP,HCPCS C2625,,28-M340145402590U  -  GRAFT EVAS 40MMX150MM RESR MAIN,"$30,000.00",$0.00,"$30,000.00","$13,500.00","$5,158.80",$0.00,"$5,168.85",$0.00,$0.00,"$5,252.76","$30,000.00",$0.00,"$15,000.00","$23,760.00","$24,000.00",$0.00,"$4,695.00",$0.00,"$4,776.00",$0.00
28-M340195362590U,SUP,HCPCS C2625,,28-M340195362590U  -  GRAFT EVAS 40/36X200 TAPERED,"$35,000.00",$0.00,"$35,000.00","$15,750.00","$5,158.80",$0.00,"$6,030.33",$0.00,$0.00,"$6,128.22","$35,000.00",$0.00,"$17,500.00","$27,720.00","$28,000.00",$0.00,"$5,477.50",$0.00,"$5,572.00",$0.00
28-M340195402590U,SUP,HCPCS C2625,,28-M340195402590U  -  GRAFT EVAS 40MMX200MM RESR MAIN,"$35,000.00",$0.00,"$35,000.00","$15,750.00","$5,158.80",$0.00,"$6,030.33",$0.00,$0.00,"$6,128.22","$35,000.00",$0.00,"$17,500.00","$27,720.00","$28,000.00",$0.00,"$5,477.50",$0.00,"$5,572.00",$0.00
28-M340250362590U,SUP,HCPCS C2625,,28-M340250362590U  -  GRAFT EVAS 40/36X250 TAPERED,"$40,000.00",$0.00,"$40,000.00","$18,000.00","$5,158.80",$0.00,"$6,891.80",$0.00,$0.00,"$7,003.68","$40,000.00",$0.00,"$20,000.00","$31,680.00","$32,000.00",$0.00,"$6,260.00",$0.00,"$6,368.00",$0.00
28-M340250402590U,SUP,HCPCS C2625,,28-M340250402590U  -  GRAFT EVAS 40MMX250MM RESR MAIN,"$40,000.00",$0.00,"$40,000.00","$18,000.00","$5,158.80",$0.00,"$6,891.80",$0.00,$0.00,"$7,003.68","$40,000.00",$0.00,"$20,000.00","$31,680.00","$32,000.00",$0.00,"$6,260.00",$0.00,"$6,368.00",$0.00
28-M342105422590U,SUP,HCPCS C2625,,28-M342105422590U  -  GRAFT EVAS 42MMX100MM RESR MAIN,"$25,000.00",$0.00,"$25,000.00","$11,250.00","$5,158.80",$0.00,"$4,307.38",$0.00,$0.00,"$4,377.30","$25,000.00",$0.00,"$12,500.00","$19,800.00","$20,000.00",$0.00,"$3,912.50",$0.00,"$3,980.00",$0.00
28-M342150382590U,SUP,HCPCS C2625,,28-M342150382590U  -  GRAFT EVAS 42/38X150 TAPERED,"$30,000.00",$0.00,"$30,000.00","$13,500.00","$5,158.80",$0.00,"$5,168.85",$0.00,$0.00,"$5,252.76","$30,000.00",$0.00,"$15,000.00","$23,760.00","$24,000.00",$0.00,"$4,695.00",$0.00,"$4,776.00",$0.00
28-M342150422590U,SUP,HCPCS C2625,,28-M342150422590U  -  GRAFT EVAS 42MMX150MM RESR MAIN,"$30,000.00",$0.00,"$30,000.00","$13,500.00","$5,158.80",$0.00,"$5,168.85",$0.00,$0.00,"$5,252.76","$30,000.00",$0.00,"$15,000.00","$23,760.00","$24,000.00",$0.00,"$4,695.00",$0.00,"$4,776.00",$0.00
28-M342195382590U,SUP,HCPCS C2625,,28-M342195382590U  -  GRAFT EVAS 42/38X200 TAPERED,"$35,000.00",$0.00,"$35,000.00","$15,750.00","$5,158.80",$0.00,"$6,030.33",$0.00,$0.00,"$6,128.22","$35,000.00",$0.00,"$17,500.00","$27,720.00","$28,000.00",$0.00,"$5,477.50",$0.00,"$5,572.00",$0.00
28-M342195422590U,SUP,HCPCS C2625,,28-M342195422590U  -  GRAFT EVAS 42MMX200MM RESR MAIN,"$35,000.00",$0.00,"$35,000.00","$15,750.00","$5,158.80",$0.00,"$6,030.33",$0.00,$0.00,"$6,128.22","$35,000.00",$0.00,"$17,500.00","$27,720.00","$28,000.00",$0.00,"$5,477.50",$0.00,"$5,572.00",$0.00
28-M342250382590U,SUP,HCPCS C2625,,28-M342250382590U  -  GRAFT EVAS 42/38X250 TAPERED,"$40,000.00",$0.00,"$40,000.00","$18,000.00","$5,158.80",$0.00,"$6,891.80",$0.00,$0.00,"$7,003.68","$40,000.00",$0.00,"$20,000.00","$31,680.00","$32,000.00",$0.00,"$6,260.00",$0.00,"$6,368.00",$0.00
28-M342250422590U,SUP,HCPCS C2625,,28-M342250422590U  -  GRAFT EVAS 42MMX250MM RESR MAIN,"$40,000.00",$0.00,"$40,000.00","$18,000.00","$5,158.80",$0.00,"$6,891.80",$0.00,$0.00,"$7,003.68","$40,000.00",$0.00,"$20,000.00","$31,680.00","$32,000.00",$0.00,"$6,260.00",$0.00,"$6,368.00",$0.00
28-M344105442590U,SUP,HCPCS C2625,,28-M344105442590U  -  GRAFT EVAS 44MMX100MM RESR MAIN,"$25,000.00",$0.00,"$25,000.00","$11,250.00","$5,158.80",$0.00,"$4,307.38",$0.00,$0.00,"$4,377.30","$25,000.00",$0.00,"$12,500.00","$19,800.00","$20,000.00",$0.00,"$3,912.50",$0.00,"$3,980.00",$0.00
28-M344155402590U,SUP,HCPCS C2625,,28-M344155402590U  -  GRAFT EVAS 44/40X150 TAPERED,"$30,000.00",$0.00,"$30,000.00","$13,500.00","$5,158.80",$0.00,"$5,168.85",$0.00,$0.00,"$5,252.76","$30,000.00",$0.00,"$15,000.00","$23,760.00","$24,000.00",$0.00,"$4,695.00",$0.00,"$4,776.00",$0.00
28-M344155442590U,SUP,HCPCS C2625,,28-M344155442590U  -  GRAFT EVAS 44MMX150MM RESR MAIN,"$30,000.00",$0.00,"$30,000.00","$13,500.00","$5,158.80",$0.00,"$5,168.85",$0.00,$0.00,"$5,252.76","$30,000.00",$0.00,"$15,000.00","$23,760.00","$24,000.00",$0.00,"$4,695.00",$0.00,"$4,776.00",$0.00
28-M344200402590U,SUP,HCPCS C2625,,28-M344200402590U  -  GRAFT EVAS 44/40X200 TAPERED,"$35,000.00",$0.00,"$35,000.00","$15,750.00","$5,158.80",$0.00,"$6,030.33",$0.00,$0.00,"$6,128.22","$35,000.00",$0.00,"$17,500.00","$27,720.00","$28,000.00",$0.00,"$5,477.50",$0.00,"$5,572.00",$0.00
28-M344200442590U,SUP,HCPCS C2625,,28-M344200442590U  -  GRAFT EVAS 44MMX200MM RESR MAIN,"$35,000.00",$0.00,"$35,000.00","$15,750.00","$5,158.80",$0.00,"$6,030.33",$0.00,$0.00,"$6,128.22","$35,000.00",$0.00,"$17,500.00","$27,720.00","$28,000.00",$0.00,"$5,477.50",$0.00,"$5,572.00",$0.00
28-M344250402690U,SUP,HCPCS C2625,,28-M344250402690U  -  GRAFT EVAS 44/40X250 TAPERED,"$40,000.00",$0.00,"$40,000.00","$18,000.00","$5,158.80",$0.00,"$6,891.80",$0.00,$0.00,"$7,003.68","$40,000.00",$0.00,"$20,000.00","$31,680.00","$32,000.00",$0.00,"$6,260.00",$0.00,"$6,368.00",$0.00
28-M344250442690U,SUP,HCPCS C2625,,28-M344250442690U  -  GRAFT EVAS 44MMX250MM RESR MAIN,"$40,000.00",$0.00,"$40,000.00","$18,000.00","$5,158.80",$0.00,"$6,891.80",$0.00,$0.00,"$7,003.68","$40,000.00",$0.00,"$20,000.00","$31,680.00","$32,000.00",$0.00,"$6,260.00",$0.00,"$6,368.00",$0.00
28-M346105462690U,SUP,HCPCS C2625,,28-M346105462690U  -  GRAFT EVAS 46MMX100MM RESR MAIN,"$25,000.00",$0.00,"$25,000.00","$11,250.00","$5,158.80",$0.00,"$4,307.38",$0.00,$0.00,"$4,377.30","$25,000.00",$0.00,"$12,500.00","$19,800.00","$20,000.00",$0.00,"$3,912.50",$0.00,"$3,980.00",$0.00
28-M346155422690U,SUP,HCPCS C2625,,28-M346155422690U  -  GRAFT EVAS 46/42X150 TAPERED,"$30,000.00",$0.00,"$30,000.00","$13,500.00","$5,158.80",$0.00,"$5,168.85",$0.00,$0.00,"$5,252.76","$30,000.00",$0.00,"$15,000.00","$23,760.00","$24,000.00",$0.00,"$4,695.00",$0.00,"$4,776.00",$0.00
28-M346155462690U,SUP,HCPCS C2625,,28-M346155462690U  -  GRAFT EVAS 46MMX150MM RESR MAIN,"$30,000.00",$0.00,"$30,000.00","$13,500.00","$5,158.80",$0.00,"$5,168.85",$0.00,$0.00,"$5,252.76","$30,000.00",$0.00,"$15,000.00","$23,760.00","$24,000.00",$0.00,"$4,695.00",$0.00,"$4,776.00",$0.00
28-M346200422690U,SUP,HCPCS C2625,,28-M346200422690U  -  GRAFT EVAS 46/42X200 TAPERED,"$35,000.00",$0.00,"$35,000.00","$15,750.00","$5,158.80",$0.00,"$6,030.33",$0.00,$0.00,"$6,128.22","$35,000.00",$0.00,"$17,500.00","$27,720.00","$28,000.00",$0.00,"$5,477.50",$0.00,"$5,572.00",$0.00
28-M346200462690U,SUP,HCPCS C2625,,28-M346200462690U  -  GRAFT EVAS 46MMX200MM RESR MAIN,"$35,000.00",$0.00,"$35,000.00","$15,750.00","$5,158.80",$0.00,"$6,030.33",$0.00,$0.00,"$6,128.22","$35,000.00",$0.00,"$17,500.00","$27,720.00","$28,000.00",$0.00,"$5,477.50",$0.00,"$5,572.00",$0.00
28-M346250422690U,SUP,HCPCS C2625,,28-M346250422690U  -  GRAFT EVAS 46/42X250 TAPERED,"$40,000.00",$0.00,"$40,000.00","$18,000.00","$5,158.80",$0.00,"$6,891.80",$0.00,$0.00,"$7,003.68","$40,000.00",$0.00,"$20,000.00","$31,680.00","$32,000.00",$0.00,"$6,260.00",$0.00,"$6,368.00",$0.00
28-M346250462690U,SUP,HCPCS C2625,,28-M346250462690U  -  GRAFT EVAS 46MMX250MM RESR MAIN,"$40,000.00",$0.00,"$40,000.00","$18,000.00","$5,158.80",$0.00,"$6,891.80",$0.00,$0.00,"$7,003.68","$40,000.00",$0.00,"$20,000.00","$31,680.00","$32,000.00",$0.00,"$6,260.00",$0.00,"$6,368.00",$0.00
290.20.280,SUP,Custom 27203010,,290.20.280  -  WIRE FX STD 2MM 280MM NS KRSH SS,$48.75,$0.00,$48.75,$0.00,$34.79,$0.00,$0.00,$0.00,$0.00,$0.00,$48.75,$0.00,$24.38,$38.61,$39.00,$0.00,$0.00,$0.00,$0.00,$0.00
291.230.98,SUP,Custom 27203010,,291.230.98  -  WIRE CERCLAGE .5MM 175MM PRECUT STAINLESS STEEL MANDIB,$31.50,$0.00,$31.50,$0.00,$22.48,$0.00,$0.00,$0.00,$0.00,$0.00,$31.50,$0.00,$15.75,$24.95,$25.20,$0.00,$0.00,$0.00,$0.00,$0.00
291.240.98,SUP,Custom 27203010,,291.240.98  -  WIRE FIX 175MM .6MM MANDIB SS CRLGE PCUT NONSTRL,$27.00,$0.00,$27.00,$0.00,$19.27,$0.00,$0.00,$0.00,$0.00,$0.00,$27.00,$0.00,$13.50,$21.38,$21.60,$0.00,$0.00,$0.00,$0.00,$0.00
291.911.01S,SUP,Custom 27803010,,291.911.01S  -  CABLE ORTH SS 1MM 750MM STRNL W/O NDL CRIMPING FRL PRLL END,$223.75,$0.00,$223.75,$0.00,$159.69,$0.00,$0.00,$0.00,$0.00,$0.00,$223.75,$0.00,$111.88,$177.21,$179.00,$0.00,$0.00,$0.00,$0.00,$0.00
291.916.01S,SUP,Custom 27803010,,291.916.01S  -  CABLE ORTH SS 1MM 750MM STRNL NDL CRIMPING FRL PRLL END FIT,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
291.916.03S,SUP,Custom 27803010,,291.916.03S  -  CABLE ORTH SS 1MM 750MM STRNL NDL CRIMPING FRL PRLL END FIT,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
29-15044,SUP,HCPCS C1713,,29-15044  -  DISK IMPL 4MM SLFTAP PRELD NONSTRL 1.5MM SCR,"$18,936.55",$0.00,"$18,936.55","$8,521.45","$5,158.80",$0.00,"$3,262.67",$0.00,$0.00,"$3,315.64","$18,936.55",$0.00,"$9,468.28","$14,997.75","$15,149.24",$0.00,"$2,963.57",$0.00,"$3,014.70",$0.00
293.48L,SUP,Custom 27203010,,293.48L  -  PIN FIX 4.5MM 275MM 3 FLAT ROUND TROCAR POINT SMOOTH SHAFT,$122.20,$0.00,$122.20,$0.00,$87.21,$0.00,$0.00,$0.00,$0.00,$0.00,$122.20,$0.00,$61.10,$96.78,$97.76,$0.00,$0.00,$0.00,$0.00,$0.00
293.48X,SUP,Custom 27203010,,293.48X  -  PIN FIX 4.5MM 300MM 3 FLAT ROUND TROCAR POINT SMOOTH SHAFT,$122.20,$0.00,$122.20,$0.00,$87.21,$0.00,$0.00,$0.00,$0.00,$0.00,$122.20,$0.00,$61.10,$96.78,$97.76,$0.00,$0.00,$0.00,$0.00,$0.00
294.30SHA,SUP,HCPCS C1713,,294.30SHA  -  SCREW XTRNFX 4MM 3MM 80MM STRL 20MM SCHNZ SPD PNT SS HA SEF,$204.40,$0.00,$204.40,$91.98,$145.88,$0.00,$34.19,$0.00,$0.00,$35.79,$204.40,$0.00,$102.20,$161.88,$163.52,$0.00,$31.06,$0.00,$32.54,$0.00
294.43SHA,SUP,HCPCS C1713,,294.43SHA  -  SCREW XTRNFX 4MM 60MM STRL 25MM SCHNZ SPD PNT SS HA PLVC LG,$204.40,$0.00,$204.40,$91.98,$145.88,$0.00,$34.19,$0.00,$0.00,$35.79,$204.40,$0.00,$102.20,$161.88,$163.52,$0.00,$31.06,$0.00,$32.54,$0.00
294.44SHA,SUP,HCPCS C1713,,294.44SHA  -  SCREW XTRNFX 4MM 80MM STRL 25MM SCHNZ SPD PNT SS HA PLVC LG,$204.40,$0.00,$204.40,$91.98,$145.88,$0.00,$34.19,$0.00,$0.00,$35.79,$204.40,$0.00,$102.20,$161.88,$163.52,$0.00,$31.06,$0.00,$32.54,$0.00
294.45SHA,SUP,HCPCS C1713,,294.45SHA  -  SCREW XTRNFX 4MM 100MM STRL 25MM SCHNZ SPD PNT SS HA PLVC LG,$204.40,$0.00,$204.40,$91.98,$145.88,$0.00,$34.19,$0.00,$0.00,$35.79,$204.40,$0.00,$102.20,$161.88,$163.52,$0.00,$31.06,$0.00,$32.54,$0.00
294.46SHA,SUP,HCPCS C1713,,294.46SHA  -  SCREW XTRNFX 4MM 120MM STRL 25MM SCHNZ SPD PNT SS HA PLVC LG,$204.40,$0.00,$204.40,$91.98,$145.88,$0.00,$34.19,$0.00,$0.00,$35.79,$204.40,$0.00,$102.20,$161.88,$163.52,$0.00,$31.06,$0.00,$32.54,$0.00
294.52SHA,SUP,HCPCS C1713,,294.52SHA  -  SCREW XTRNFX XLNG 5MM 100MM STRL 50MM SCHNZ BLNT TROC PNT SS,$204.40,$0.00,$204.40,$91.98,$145.88,$0.00,$34.19,$0.00,$0.00,$35.79,$204.40,$0.00,$102.20,$161.88,$163.52,$0.00,$31.06,$0.00,$32.54,$0.00
294.53SHA,SUP,HCPCS C1713,,294.53SHA  -  SCREW XTRNFX XLNG 5MM 125MM STRL 50MM SCHNZ BLNT TROC PNT SS,$204.40,$0.00,$204.40,$91.98,$145.88,$0.00,$34.19,$0.00,$0.00,$35.79,$204.40,$0.00,$102.20,$161.88,$163.52,$0.00,$31.06,$0.00,$32.54,$0.00
294.54SHA,SUP,HCPCS C1713,,294.54SHA  -  SCREW XTRNFX XLNG 5MM 150MM STRL 50MM SCHNZ BLNT TROC PNT SS,$204.40,$0.00,$204.40,$91.98,$145.88,$0.00,$34.19,$0.00,$0.00,$35.79,$204.40,$0.00,$102.20,$161.88,$163.52,$0.00,$31.06,$0.00,$32.54,$0.00
294.55SHA,SUP,HCPCS C1713,,294.55SHA  -  PIN HALF 5MM 170MM TROCAR BLUNT SCHANZ STAINLESS STEEL,$219.55,$0.00,$219.55,$98.80,$156.69,$0.00,$36.72,$0.00,$0.00,$38.44,$219.55,$0.00,$109.78,$173.88,$175.64,$0.00,$33.36,$0.00,$34.95,$0.00
294.56SHA,SUP,HCPCS C1713,,294.56SHA  -  SCREW XTRNFX XLNG 5MM 200MM STRL 50MM SCHNZ BLNT TROC PNT SS,$219.55,$0.00,$219.55,$98.80,$156.69,$0.00,$36.72,$0.00,$0.00,$38.44,$219.55,$0.00,$109.78,$173.88,$175.64,$0.00,$33.36,$0.00,$34.95,$0.00
294.57SHA,SUP,HCPCS C1713,,294.57SHA  -  SCREW XTRNFX XLNG 5MM 250MM STRL 50MM SCHNZ BLNT TROC PNT SS,$219.55,$0.00,$219.55,$98.80,$156.69,$0.00,$36.72,$0.00,$0.00,$38.44,$219.55,$0.00,$109.78,$173.88,$175.64,$0.00,$33.36,$0.00,$34.95,$0.00
294.67SHA,SUP,HCPCS C1713,,294.67SHA  -  SCREW XTRNFX 6MM 160MM STRL 50MM SCHNZ SPD PNT SS HA LG,$204.40,$0.00,$204.40,$91.98,$145.88,$0.00,$34.19,$0.00,$0.00,$35.79,$204.40,$0.00,$102.20,$161.88,$163.52,$0.00,$31.06,$0.00,$32.54,$0.00
294.68SHA,SUP,HCPCS C1713,,294.68SHA  -  SCREW XTRNFX 6MM 190MM STRL 50MM SCHNZ SPD PNT SS HA LG,$204.40,$0.00,$204.40,$91.98,$145.88,$0.00,$34.19,$0.00,$0.00,$35.79,$204.40,$0.00,$102.20,$161.88,$163.52,$0.00,$31.06,$0.00,$32.54,$0.00
294.73SHA,SUP,HCPCS C1713,,294.73SHA  -  SCREW XTRNFX ST 4.5MM 125MM STRL 18MM SCHNZ BLNT TROC PNT SS,$204.40,$0.00,$204.40,$91.98,$145.88,$0.00,$34.19,$0.00,$0.00,$35.79,$204.40,$0.00,$102.20,$161.88,$163.52,$0.00,$31.06,$0.00,$32.54,$0.00
294.74SHA,SUP,HCPCS C1713,,294.74SHA  -  SCREW XTRNFX ST 4.5MM 150MM STRL 18MM SCHNZ BLNT TROC PNT SS,$204.40,$0.00,$204.40,$91.98,$145.88,$0.00,$34.19,$0.00,$0.00,$35.79,$204.40,$0.00,$102.20,$161.88,$163.52,$0.00,$31.06,$0.00,$32.54,$0.00
294.75SHA,SUP,HCPCS C1713,,294.75SHA  -  SCREW XTRNFX ST 4.5MM 175MM STRL 18MM SCHNZ BLNT TROC PNT SS,$211.98,$0.00,$211.98,$95.39,$151.29,$0.00,$35.46,$0.00,$0.00,$37.12,$211.98,$0.00,$105.99,$167.89,$169.58,$0.00,$32.21,$0.00,$33.75,$0.00
294.76SHA,SUP,HCPCS C1713,,294.76SHA  -  SCREW XTRNFX ST 4.5MM 200MM STRL 18MM SCHNZ BLNT TROC PNT SS,$211.98,$0.00,$211.98,$95.39,$151.29,$0.00,$35.46,$0.00,$0.00,$37.12,$211.98,$0.00,$105.99,$167.89,$169.58,$0.00,$32.21,$0.00,$33.75,$0.00
294.771SHA,SUP,HCPCS C1713,,294.771SHA  -  SCREW BONE 4/3MM 80MM SLFDRILL SCHANZ STAINLESS STEEL DISTAL,$299.58,$0.00,$299.58,$134.81,$213.81,$0.00,$50.11,$0.00,$0.00,$52.45,$299.58,$0.00,$149.79,$237.27,$239.66,$0.00,$45.52,$0.00,$47.69,$0.00
294.775SHA,SUP,HCPCS C1713,,294.775SHA  -  SCREW XTRNFX 4MM 80MM STRL 20MM SCHNZ SLF DRL SS HA HIP,$299.58,$0.00,$299.58,$134.81,$213.81,$0.00,$50.11,$0.00,$0.00,$52.45,$299.58,$0.00,$149.79,$237.27,$239.66,$0.00,$45.52,$0.00,$47.69,$0.00
294.776SHA,SUP,HCPCS C1713,,294.776SHA  -  SCREW XTRNFX 4MM 100MM STRL 30MM SCHNZ SLF DRL SS HA HIP,$299.58,$0.00,$299.58,$134.81,$213.81,$0.00,$50.11,$0.00,$0.00,$52.45,$299.58,$0.00,$149.79,$237.27,$239.66,$0.00,$45.52,$0.00,$47.69,$0.00
294.777SHA,SUP,HCPCS C1713,,294.777SHA  -  SCREW XTRNFX 4MM 125MM STRL 40MM SCHNZ SLF DRL SS HA HIP,$299.58,$0.00,$299.58,$134.81,$213.81,$0.00,$50.11,$0.00,$0.00,$52.45,$299.58,$0.00,$149.79,$237.27,$239.66,$0.00,$45.52,$0.00,$47.69,$0.00
294.778SHA,SUP,HCPCS C1713,,294.778SHA  -  SCREW XTRNFX 4MM 150MM STRL 40MM SCHNZ SLF DRL SS HA HIP,$299.58,$0.00,$299.58,$134.81,$213.81,$0.00,$50.11,$0.00,$0.00,$52.45,$299.58,$0.00,$149.79,$237.27,$239.66,$0.00,$45.52,$0.00,$47.69,$0.00
294.779SHA,SUP,HCPCS C1713,,294.779SHA  -  SCREW BONE 4MM 175MM SLFDRILL SCHANZ STAINLESS STEEL HA,$299.58,$0.00,$299.58,$134.81,$213.81,$0.00,$50.11,$0.00,$0.00,$52.45,$299.58,$0.00,$149.79,$237.27,$239.66,$0.00,$45.52,$0.00,$47.69,$0.00
294.782SHA,SUP,HCPCS C1713,,294.782SHA  -  SCREW XTRNFX 5MM 100MM STRL 30MM SCHNZ SLF DRL SS HA HIP,$330.95,$0.00,$330.95,$148.93,$236.20,$0.00,$55.36,$0.00,$0.00,$57.95,$330.95,$0.00,$165.48,$262.11,$264.76,$0.00,$50.28,$0.00,$52.69,$0.00
294.783SHA,SUP,HCPCS C1713,,294.783SHA  -  SCREW XTRNFX 5MM 125MM STRL 40MM SCHNZ SLF DRL SS HA HIP,$330.95,$0.00,$330.95,$148.93,$236.20,$0.00,$55.36,$0.00,$0.00,$57.95,$330.95,$0.00,$165.48,$262.11,$264.76,$0.00,$50.28,$0.00,$52.69,$0.00
294.784SHA,SUP,HCPCS C1713,,294.784SHA  -  SCREW BONE 5MM 150MM 60MM SLFDRILL SCHANZ STAINLESS STEEL HA,$330.95,$0.00,$330.95,$148.93,$236.20,$0.00,$55.36,$0.00,$0.00,$57.95,$330.95,$0.00,$165.48,$262.11,$264.76,$0.00,$50.28,$0.00,$52.69,$0.00
294.785SHA,SUP,HCPCS C1713,,294.785SHA  -  SCREW BONE 5MM 175MM 60MM SLFDRILL SCHANZ STAINLESS STEEL HA,$330.95,$0.00,$330.95,$148.93,$236.20,$0.00,$55.36,$0.00,$0.00,$57.95,$330.95,$0.00,$165.48,$262.11,$264.76,$0.00,$50.28,$0.00,$52.69,$0.00
294.786SHA,SUP,HCPCS C1713,,294.786SHA  -  SCREW BONE 5MM 200MM 80MM SLFDRILL SCHANZ STAINLESS STEEL HA,$330.95,$0.00,$330.95,$148.93,$236.20,$0.00,$55.36,$0.00,$0.00,$57.95,$330.95,$0.00,$165.48,$262.11,$264.76,$0.00,$50.28,$0.00,$52.69,$0.00
294.788SHA,SUP,HCPCS C1713,,294.788SHA  -  SCREW XTRNFX 5MM 250MM STRL 80MM SCHNZ SLF DRL SS HA HIP,$330.95,$0.00,$330.95,$148.93,$236.20,$0.00,$55.36,$0.00,$0.00,$57.95,$330.95,$0.00,$165.48,$262.11,$264.76,$0.00,$50.28,$0.00,$52.69,$0.00
294.796SHA,SUP,HCPCS C1713,,294.796SHA  -  SCREW XTRNFX 6MM 200MM STRL 80MM SCHNZ SLF DRL SS HA HIP,$350.40,$0.00,$350.40,$157.68,$250.08,$0.00,$58.61,$0.00,$0.00,$61.35,$350.40,$0.00,$175.20,$277.52,$280.32,$0.00,$53.24,$0.00,$55.78,$0.00
2940511S,SUP,HCPCS C1713,,2940511S  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
2940512S,SUP,HCPCS C1713,,2940512S  -  PLATE 18MM TI BONE SPNL,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
2940513S,SUP,HCPCS C1713,,2940513S  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
2940514S,SUP,HCPCS C1713,,2940514S  -  PLATE 18MM TI BONE SPNL,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
2940515S,SUP,HCPCS C1713,,2940515S  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
2940516S,SUP,HCPCS C1713,,2940516S  -  PLATE 18MM TI BONE SPNL,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
2940517S,SUP,HCPCS C1713,,2940517S  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
2940521M,SUP,HCPCS C1713,,2940521M  -  PLATE 18MM TI BONE SPNL,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
2940522M,SUP,HCPCS C1713,,2940522M  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
2940523M,SUP,HCPCS C1713,,2940523M  -  PLATE 18MM TI BONE SPNL,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
2940524M,SUP,HCPCS C1713,,2940524M  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
2940525M,SUP,HCPCS C1713,,2940525M  -  PLATE 18MM TI BONE SPNL,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
2940526M,SUP,HCPCS C1713,,2940526M  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
2940527M,SUP,HCPCS C1713,,2940527M  -  PLATE 18MM TI BONE SPNL,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
2940528M,SUP,HCPCS C1713,,2940528M  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
2940531L,SUP,HCPCS C1713,,2940531L  -  PLATE 18MM TI BONE SPNL,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
2940532L,SUP,HCPCS C1713,,2940532L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
2940533L,SUP,HCPCS C1713,,2940533L  -  PLATE 18MM TI BONE SPNL,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
2940534L,SUP,HCPCS C1713,,2940534L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
2940535L,SUP,HCPCS C1713,,2940535L  -  PLATE 18MM TI BONE SPNL,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
2940536L,SUP,HCPCS C1713,,2940536L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
2940537L,SUP,HCPCS C1713,,2940537L  -  PLATE 18MM TI BONE SPNL,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
2940538L,SUP,HCPCS C1713,,2940538L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
298.801.01S,SUP,Custom 27803010,,298.801.01S  -  CABLE ORTHOPEDIC 1.7MM 750MM CRIMP CERCLAGE LCP STAINLESS,$892.55,$0.00,$892.55,$0.00,$637.01,$0.00,$0.00,$0.00,$0.00,$0.00,$892.55,$0.00,$446.28,$706.90,$714.04,$0.00,$0.00,$0.00,$0.00,$0.00
298.803S,SUP,Custom 27203010,,298.803S  -  PIN POSITIONING 4.5MM CERCLAGE THREADED LCP STAINLESS STEEL,$333.00,$0.00,$333.00,$0.00,$237.66,$0.00,$0.00,$0.00,$0.00,$0.00,$333.00,$0.00,$166.50,$263.74,$266.40,$0.00,$0.00,$0.00,$0.00,$0.00
29AJ-501,SUP,Custom 27803010,,29AJ-501  -  VALVE AOR 85D 29MM 24.2MM MSTR SER MECH STD CUF LFLT OPN,"$11,250.00",$0.00,"$11,250.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,250.00",$0.00,"$5,625.00","$8,910.00","$9,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
29MJ-501,SUP,Custom 27803010,,29MJ-501  -  VALVE MTRL 85D 4.41SQ CM STD RING 29MM 24.2MM MSTR SER LFLT,"$11,250.00",$0.00,"$11,250.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,250.00",$0.00,"$5,625.00","$8,910.00","$9,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
2B0061,SUP,Custom 25803010,,SOLUTION IV 5% DEX 150ML VFLX LF,$2.23,$0.00,$2.23,$0.00,$1.59,$0.00,$0.00,$0.00,$0.00,$0.00,$2.23,$0.00,$1.11,$1.77,$1.78,$0.00,$0.00,$0.00,$0.00,$0.00
2B0062Q,SUP,Custom 25803010,,SOLUTION IV 5% DEX 250ML VFLX LF,$2.13,$0.00,$2.13,$0.00,$1.52,$0.00,$0.00,$0.00,$0.00,$0.00,$2.13,$0.00,$1.06,$1.69,$1.70,$0.00,$0.00,$0.00,$0.00,$0.00
2B0063Q,SUP,Custom 25803010,,SOLUTION IV 5% DEX 500ML VFLX LF,$2.15,$0.00,$2.15,$0.00,$1.53,$0.00,$0.00,$0.00,$0.00,$0.00,$2.15,$0.00,$1.08,$1.70,$1.72,$0.00,$0.00,$0.00,$0.00,$0.00
2B0064X,SUP,Custom 25803010,,SOLUTION IV 5% DEX 1L VFLX LF,$2.65,$0.00,$2.65,$0.00,$1.89,$0.00,$0.00,$0.00,$0.00,$0.00,$2.65,$0.00,$1.33,$2.10,$2.12,$0.00,$0.00,$0.00,$0.00,$0.00
2B0089,SUP,Custom 25803010,,SOLUTION IV 5% DEX 100ML MPK VFLX LF,$2.60,$0.00,$2.60,$0.00,$1.86,$0.00,$0.00,$0.00,$0.00,$0.00,$2.60,$0.00,$1.30,$2.06,$2.08,$0.00,$0.00,$0.00,$0.00,$0.00
2B0163Q,SUP,Custom 25803010,,SOLUTION IV 10% DEX 500ML VFLX LF,$2.73,$0.00,$2.73,$0.00,$1.94,$0.00,$0.00,$0.00,$0.00,$0.00,$2.73,$0.00,$1.36,$2.16,$2.18,$0.00,$0.00,$0.00,$0.00,$0.00
2B0164X,SUP,Custom 25803010,,SOLUTION IV 10% DEX 1L VFLX LF,$3.75,$0.00,$3.75,$0.00,$2.68,$0.00,$0.00,$0.00,$0.00,$0.00,$3.75,$0.00,$1.88,$2.97,$3.00,$0.00,$0.00,$0.00,$0.00,$0.00
2B1063Q,SUP,Custom 25803010,,SOLUTION IV 5% DEX 0.9% NA CHLOR 500ML VFLX LF,$1.63,$0.00,$1.63,$0.00,$1.16,$0.00,$0.00,$0.00,$0.00,$0.00,$1.63,$0.00,$0.81,$1.29,$1.30,$0.00,$0.00,$0.00,$0.00,$0.00
2B1064X,SUP,Custom 25803010,,SOLUTION IV 5% DEX 0.9% NA CHLOR 1L VFLX LF,$2.68,$0.00,$2.68,$0.00,$1.91,$0.00,$0.00,$0.00,$0.00,$0.00,$2.68,$0.00,$1.34,$2.12,$2.14,$0.00,$0.00,$0.00,$0.00,$0.00
2B1073Q,SUP,Custom 25803010,,SOLUTION IV 5% DEX 0.45% NA CHLOR 500ML VFLX LF,$2.23,$0.00,$2.23,$0.00,$1.59,$0.00,$0.00,$0.00,$0.00,$0.00,$2.23,$0.00,$1.11,$1.77,$1.78,$0.00,$0.00,$0.00,$0.00,$0.00
2B1074X,SUP,Custom 25803010,,SOLUTION IV 5% DEX 0.45% NA CHLOR 1L VFLX LF,$2.70,$0.00,$2.70,$0.00,$1.93,$0.00,$0.00,$0.00,$0.00,$0.00,$2.70,$0.00,$1.35,$2.14,$2.16,$0.00,$0.00,$0.00,$0.00,$0.00
2B1309,SUP,Custom 25803010,,SOLUTION IV 0.9% NA CHLOR 100ML MPK VFLX LF,$41.25,$0.00,$41.25,$0.00,$29.44,$0.00,$0.00,$0.00,$0.00,$0.00,$41.25,$0.00,$20.63,$32.67,$33.00,$0.00,$0.00,$0.00,$0.00,$0.00
2B1313Q,SUP,Custom 25803010,,SOLUTION IV 0.45% NA CHLOR 500ML VFLX LF,$2.23,$0.00,$2.23,$0.00,$1.59,$0.00,$0.00,$0.00,$0.00,$0.00,$2.23,$0.00,$1.11,$1.77,$1.78,$0.00,$0.00,$0.00,$0.00,$0.00
2B1314X,SUP,Custom 25803010,,SOLUTION IV 0.45% NA CHLOR 1L VFLX LF,$2.83,$0.00,$2.83,$0.00,$2.02,$0.00,$0.00,$0.00,$0.00,$0.00,$2.83,$0.00,$1.41,$2.24,$2.26,$0.00,$0.00,$0.00,$0.00,$0.00
2B1321,SUP,Custom 25803010,,SOLUTION IV 0.9% NA CHLOR 150ML VFLX LF,$2.23,$0.00,$2.23,$0.00,$1.59,$0.00,$0.00,$0.00,$0.00,$0.00,$2.23,$0.00,$1.11,$1.77,$1.78,$0.00,$0.00,$0.00,$0.00,$0.00
2B1654X,SUP,Custom 25803010,,SOLUTION IV 20 MEQ K CHLOR 5% DEX 0.45% NA CHLOR VFLX 1L LF,$3.45,$0.00,$3.45,$0.00,$2.46,$0.00,$0.00,$0.00,$0.00,$0.00,$3.45,$0.00,$1.73,$2.73,$2.76,$0.00,$0.00,$0.00,$0.00,$0.00
2B2074X,SUP,Custom 25803010,,SOLUTION IV 5% DEX LR 1L VFLX LF,$2.68,$0.00,$2.68,$0.00,$1.91,$0.00,$0.00,$0.00,$0.00,$0.00,$2.68,$0.00,$1.34,$2.12,$2.14,$0.00,$0.00,$0.00,$0.00,$0.00
2B2324X,SUP,Custom 25803010,,SOLUTION IV LR 1L VFLX LF,$2.83,$0.00,$2.83,$0.00,$2.02,$0.00,$0.00,$0.00,$0.00,$0.00,$2.83,$0.00,$1.41,$2.24,$2.26,$0.00,$0.00,$0.00,$0.00,$0.00
2B2544X,SUP,Custom 25803010,,SOLUTION IV PLSMLT A VFLX MLT ELCLY VFLX 1L LF,$5.10,$0.00,$5.10,$0.00,$3.64,$0.00,$0.00,$0.00,$0.00,$0.00,$5.10,$0.00,$2.55,$4.04,$4.08,$0.00,$0.00,$0.00,$0.00,$0.00
2B7231,SUP,Custom 25803010,,2B7231  -  SOLUTION IRRIGATION BAG USP CONTAINER 0.9% SODIUM CHLORIDE 1,$188.28,$0.00,$188.28,$0.00,$134.38,$0.00,$0.00,$0.00,$0.00,$0.00,$188.28,$0.00,$94.14,$149.12,$150.63,$0.00,$0.00,$0.00,$0.00,$0.00
2C2164,SUP,Custom 27203010,,2C2164  -  TUBINGIRRIGATION-LAPAROS,$36.89,$0.00,$36.89,$0.00,$26.32,$0.00,$0.00,$0.00,$0.00,$0.00,$36.89,$0.00,$18.44,$29.22,$29.51,$0.00,$0.00,$0.00,$0.00,$0.00
2N03A,SUP,Custom 27803010,,2N03A  -  SUTURE NABSB CV-2 THX-22 36IN WHT MFL GRTX,$66.46,$0.00,$66.46,$0.00,$47.43,$0.00,$0.00,$0.00,$0.00,$0.00,$66.46,$0.00,$33.23,$52.64,$53.17,$0.00,$0.00,$0.00,$0.00,$0.00
2N05A,SUP,Custom 27803010,,2N05A  -  SUTURE NABSB CV-2 THX-26 36IN WHT MFL GRTX,$66.46,$0.00,$66.46,$0.00,$47.43,$0.00,$0.00,$0.00,$0.00,$0.00,$66.46,$0.00,$33.23,$52.64,$53.17,$0.00,$0.00,$0.00,$0.00,$0.00
2N1116,SUP,HCPCS C1753,,CATHETER INTRAVASCULAR QUIK CATH 22G X 1IN LUER PLUG,$1.83,$0.00,$1.83,$0.99,$1.30,$0.00,$0.31,$0.00,$0.00,$0.32,$1.83,$0.00,$0.91,$1.45,$1.46,$0.00,$0.29,$0.00,$0.29,$0.00
2P9,SUP,Custom 27803010,,2P9  -  PATCH VASCULAR 9X2CM XENOSURE THK.45MM BOVINE PERICARDIUM,$662.50,$0.00,$662.50,$0.00,$472.83,$0.00,$0.00,$0.00,$0.00,$0.00,$662.50,$0.00,$331.25,$524.70,$530.00,$0.00,$0.00,$0.00,$0.00,$0.00
3.0 NEO,SUP,Custom 27203010,,3.0 NEO  -  TUBE 30MM 4.5MM 3MM UNCUF OBT TRCH PLVN CHLOR NEO,$94.29,$0.00,$94.29,$0.00,$67.29,$0.00,$0.00,$0.00,$0.00,$0.00,$94.29,$0.00,$47.14,$74.68,$75.43,$0.00,$0.00,$0.00,$0.00,$0.00
30-0001,SUP,Custom 27203010,,30-0001  -  GUIDE TRGT SCPHD ASMBLY NONSTRL,"$4,370.00",$0.00,"$4,370.00",$0.00,"$3,118.87",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,370.00",$0.00,"$2,185.00","$3,461.04","$3,496.00",$0.00,$0.00,$0.00,$0.00,$0.00
30-0017-S,SUP,Custom 27203010,,30-0017-S  -  GUIDE TRGT 1 .035IN SCPHD DISK STRL DISP,$652.50,$0.00,$652.50,$0.00,$465.69,$0.00,$0.00,$0.00,$0.00,$0.00,$652.50,$0.00,$326.25,$516.78,$522.00,$0.00,$0.00,$0.00,$0.00,$0.00
30-0018-S,SUP,Custom 27203010,,30-0018-S  -  GUIDE MINI TRGT SURG SCPHD,$652.50,$0.00,$652.50,$0.00,$465.69,$0.00,$0.00,$0.00,$0.00,$0.00,$652.50,$0.00,$326.25,$516.78,$522.00,$0.00,$0.00,$0.00,$0.00,$0.00
30-0019-S,SUP,Custom 27203010,,30-0019-S  -  GUIDE TRGT 3 .054IN SCPHD DISK STRL,$652.50,$0.00,$652.50,$0.00,$465.69,$0.00,$0.00,$0.00,$0.00,$0.00,$652.50,$0.00,$326.25,$516.78,$522.00,$0.00,$0.00,$0.00,$0.00,$0.00
30-0021-S,SUP,HCPCS C1713,,30-0021-S  -  SCREW BN 5.5MM 25MM ACTRK2 MTP MIDFOOT,"$1,160.00",$0.00,"$1,160.00",$522.00,$827.89,$0.00,$199.86,$0.00,$0.00,$203.11,"$1,160.00",$0.00,$580.00,$918.72,$928.00,$0.00,$181.54,$0.00,$184.67,$0.00
30-0023-S,SUP,HCPCS C1713,,30-0023-S  -  SCREW BN 5.5MM 30MM ACTRK2 MTP MIDFOOT,"$1,160.00",$0.00,"$1,160.00",$522.00,$827.89,$0.00,$199.86,$0.00,$0.00,$203.11,"$1,160.00",$0.00,$580.00,$918.72,$928.00,$0.00,$181.54,$0.00,$184.67,$0.00
30-0025-S,SUP,HCPCS C1713,,30-0025-S  -  SCREW BN 5.5MM 35MM ACUTRACK II,"$1,160.00",$0.00,"$1,160.00",$522.00,$827.89,$0.00,$199.86,$0.00,$0.00,$203.11,"$1,160.00",$0.00,$580.00,$918.72,$928.00,$0.00,$181.54,$0.00,$184.67,$0.00
30-0027-S,SUP,HCPCS C1713,,30-0027-S  -  SCREW BN 5.5MM 40MM ACUTRACK II,"$1,160.00",$0.00,"$1,160.00",$522.00,$827.89,$0.00,$199.86,$0.00,$0.00,$203.11,"$1,160.00",$0.00,$580.00,$918.72,$928.00,$0.00,$181.54,$0.00,$184.67,$0.00
30-0029-S,SUP,HCPCS C1713,,30-0029-S  -  SCREW BN 5.5MM 45MM ACTRK2 MTP MIDFOOT,"$1,160.00",$0.00,"$1,160.00",$522.00,$827.89,$0.00,$199.86,$0.00,$0.00,$203.11,"$1,160.00",$0.00,$580.00,$918.72,$928.00,$0.00,$181.54,$0.00,$184.67,$0.00
30-0031-S,SUP,HCPCS C1713,,30-0031-S  -  SCREW BN 50MM ACTRK2,"$1,160.00",$0.00,"$1,160.00",$522.00,$827.89,$0.00,$199.86,$0.00,$0.00,$203.11,"$1,160.00",$0.00,$580.00,$918.72,$928.00,$0.00,$181.54,$0.00,$184.67,$0.00
30-0033-S,SUP,HCPCS C1713,,30-0033-S  -  SCREW BONE 6MM 30MM ACTRK FSN DEV HMRTOE SYS,$895.00,$0.00,$895.00,$402.75,$638.76,$0.00,$154.20,$0.00,$0.00,$156.71,$895.00,$0.00,$447.50,$708.84,$716.00,$0.00,$140.07,$0.00,$142.48,$0.00
300-070,SUP,Custom 27203010,,"300-070  -  BONE GRAFT HARVESTER, COREX 7MM","$2,237.50",$0.00,"$2,237.50",$0.00,"$1,596.90",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$0.00,$0.00,$0.00,$0.00
30-0084-S,SUP,HCPCS C1713,,30-0084-S  -  SCREW BN 5.5MM 55MM ACTRK,"$1,160.00",$0.00,"$1,160.00",$522.00,$827.89,$0.00,$199.86,$0.00,$0.00,$203.11,"$1,160.00",$0.00,$580.00,$918.72,$928.00,$0.00,$181.54,$0.00,$184.67,$0.00
30-0085-S,SUP,HCPCS C1713,,30-0085-S  -  SCREW BN 5.5MM 60MM ACTRK,"$1,160.00",$0.00,"$1,160.00",$522.00,$827.89,$0.00,$199.86,$0.00,$0.00,$203.11,"$1,160.00",$0.00,$580.00,$918.72,$928.00,$0.00,$181.54,$0.00,$184.67,$0.00
300-090,SUP,Custom 27203010,,300-090  -  HARVESTER BN 9MM STRL LF COREX CANC BN DISP,"$2,237.50",$0.00,"$2,237.50",$0.00,"$1,596.90",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$0.00,$0.00,$0.00,$0.00
30-0093,SUP,HCPCS C1713,,30-0093  -  PLATE SCR ACLC 2 BONE DISTAL VOLR RADL,$590.00,$0.00,$590.00,$265.50,$421.08,$0.00,$101.65,$0.00,$0.00,$103.30,$590.00,$0.00,$295.00,$467.28,$472.00,$0.00,$92.34,$0.00,$93.93,$0.00
30-0098,SUP,HCPCS C1713,,30-0098  -  PIN FX 70MM NS TNSNBND,$137.50,$0.00,$137.50,$61.88,$98.13,$0.00,$23.69,$0.00,$0.00,$24.08,$137.50,$0.00,$68.75,$108.90,$110.00,$0.00,$21.52,$0.00,$21.89,$0.00
30-0099,SUP,HCPCS C1713,,30-0099  -  PIN FX 90MM NS TNSNBND,$137.50,$0.00,$137.50,$61.88,$98.13,$0.00,$23.69,$0.00,$0.00,$24.08,$137.50,$0.00,$68.75,$108.90,$110.00,$0.00,$21.52,$0.00,$21.89,$0.00
30-0232,SUP,HCPCS C1713,,30-0232  -  SCREW BONE 3.5MM 8MM ELB LCK HEXALOBE,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0233,SUP,HCPCS C1713,,30-0233  -  SCREW BONE 3.5MM 10MM ELB LCK HEXALOBE NONSTRL,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0234,SUP,HCPCS C1713,,30-0234  -  SCREW BONE 3.5MM 12MM ELB LCK HEXALOBE NONSTRL,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0235,SUP,HCPCS C1713,,30-0235  -  SCREW BONE 3.5MM 14MM ELB LCK HEXALOBE,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0236,SUP,HCPCS C1713,,30-0236  -  SCREW BONE 3.5MM 16MM DISTAL HUM ELB LCK HEXALOBE NONSTRL,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0237,SUP,HCPCS C1713,,30-0237  -  SCREW BONE 3.5MM 18MM DISTAL HUM ELB LCK HEXALOBE NONSTRL,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0238,SUP,HCPCS C1713,,30-0238  -  SCREW BONE 3.5MM 20MM LCK HEXALOBE,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0239,SUP,HCPCS C1713,,30-0239  -  SCREW BONE 3.5MM 22MM ELB LCK HEXALOBE,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0240,SUP,HCPCS C1713,,30-0240  -  SCREW BONE 3.5MM 24MM ELB LCK HEXALOBE,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0241,SUP,HCPCS C1713,,30-0241  -  SCREW BONE 3.5MM 26MM DISTAL HUM ELB LCK HEXALOBE NONSTRL,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0242,SUP,HCPCS C1713,,30-0242  -  SCREW BONE 3.5MM 28MM ELB LCK HEXALOBE,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0243,SUP,HCPCS C1713,,30-0243  -  SCREW BONE 3.5MM 30MM ELB LCK HEXALOBE,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0244,SUP,HCPCS C1713,,30-0244  -  SCREW BONE 3.5MM 32MM DISTAL HUM ELB LCK HEXALOBE NONSTRL,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0245,SUP,HCPCS C1713,,30-0245  -  SCREW BONE 3.5MM 34MM ELB LCK HEXALOBE,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0246,SUP,HCPCS C1713,,30-0246  -  SCREW BONE 3.5MM 36MM ELB LCK HEXALOBE,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0247,SUP,HCPCS C1713,,30-0247  -  SCREW BONE 3.5MM 38MM ELB LCK HEXALOBE,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0248,SUP,HCPCS C1713,,30-0248  -  SCREW BONE 3.5MM 40MM ELB LCK HEXALOBE NONSTRL,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0249,SUP,HCPCS C1713,,30-0249  -  SCREW BONE 3.5MM 45MM DISTAL HUM ELB LCK HEXALOBE NONSTRL,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0250,SUP,HCPCS C1713,,30-0250  -  SCREW BONE 3.5MM 50MM DISTAL HUM ELB LCK HEXALOBE NONSTRL,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0251,SUP,HCPCS C1713,,30-0251  -  SCREW BONE 3.5MM 55MM DISTAL HUM ELB LCK HEXALOBE NONSTRL,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0252,SUP,HCPCS C1713,,30-0252  -  SCREW BONE 3.5MM 60MM ELB LCK HEXALOBE NONSTRL,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0255,SUP,HCPCS C1713,,30-0255  -  SCREW BONE 3.5MM 8MM CORT ELB NLCKG HEXALOBE HEAD,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0256,SUP,HCPCS C1713,,30-0256  -  SCREW BN 3.5MM 10MM NS HEXALOBE TI SM FRAG BS SET,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0257,SUP,HCPCS C1713,,30-0257  -  SCREW BN 3.5MM 12MM NS HEXALOBE TI SM FRAG BS SET,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0258,SUP,HCPCS C1713,,30-0258  -  SCREW BN 3.5MM 14MM NS HEXALOBE TI SM FRAG BS SET,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0259,SUP,HCPCS C1713,,30-0259  -  SCREW BONE 3.5MM 16MM ELB NLCKG TRAUMA,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0260,SUP,HCPCS C1713,,30-0260  -  SCREW BONE 3.5MM 18MM NLCKG HEXALOBE,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0261,SUP,HCPCS C1713,,30-0261  -  SCREW BONE 3.5MM 20MM ELB NLCKG HEXALOBE NONSTRL,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0262,SUP,HCPCS C1713,,30-0262  -  SCREW BONE 3.5MM 22MM NLCKG HEXALOBE,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0263,SUP,HCPCS C1713,,30-0263  -  SCREW BONE 3.5MM 24MM ELB NLCKG HEXALOBE NONSTRL,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0264,SUP,HCPCS C1713,,30-0264  -  SCREW BONE 3.5MM 26MM DISTAL HUM ELB NLCKG HEXALOBE NONSTRL,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0265,SUP,HCPCS C1713,,30-0265  -  SCREW BONE 3.5MM 28MM ELB NLCKG HEXALOBE,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0266,SUP,HCPCS C1713,,30-0266  -  SCREW BN 3.5MM 30MM NS HEXALOBE TI SM FRAG BS SET,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0267,SUP,HCPCS C1713,,30-0267  -  SCREW BONE 3.5MM 32MM DISTAL HUM ELB NLCKG HEXALOBE NONSTRL,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0268,SUP,HCPCS C1713,,30-0268  -  SCREW BONE 3.5MM 34MM ELB NLCKG HEXALOBE NONSTRL,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0269,SUP,HCPCS C1713,,30-0269  -  SCREW BONE 3.5MM 36MM CORT ELB NLCKG HEXALOBE,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0270,SUP,HCPCS C1713,,30-0270  -  SCREW BONE 3.5MM 38MM DISTAL HUM ELB NLCKG HEXALOBE NONSTRL,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0271,SUP,HCPCS C1713,,30-0271  -  SCREW BONE 3.5MM 40MM ELB NLCKG HEXALOBE NONSTRL,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0272,SUP,HCPCS C1713,,30-0272  -  SCREW BONE 3.5MM 45MM DISTAL HUM ELB NLCKG HEXALOBE NONSTRL,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0273,SUP,HCPCS C1713,,30-0273  -  SCREW BONE 3.5MM 50MM DISTAL HUM ELB NLCKG HEXALOBE,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0274,SUP,HCPCS C1713,,30-0274  -  SCREW BONE 3.5MM 55MM CORT ELB NLCKG HEXALOBE HEAD,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0275,SUP,HCPCS C1713,,30-0275  -  SCREW BONE 3.5MM 60MM DISTAL HUM ELB NLCKG HEXALOBE NONSTRL,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0276,SUP,HCPCS C1713,,30-0276  -  SCREW BONE 3.5MM 65MM ELB NLCKG HEXALOBE,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0278,SUP,HCPCS C1713,,30-0278  -  SCREW BONE 3MM 8MM ELB LCK HEXALOBE NONSTRL,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0279,SUP,HCPCS C1713,,30-0279  -  SCREW BONE 2.7MM 10MM ELB LCK,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0280,SUP,HCPCS C1713,,30-0280  -  SCREW BONE 3MM 12MM ELB LCK,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0281,SUP,HCPCS C1713,,30-0281  -  SCREW BONE 3MM 14MM CORT LCK,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0282,SUP,HCPCS C1713,,30-0282  -  SCREW BONE 3MM 16MM ELB LCK HEXALOBE NONSTRL,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0283,SUP,HCPCS C1713,,30-0283  -  SCREW BONE 3MM 18MM LCK HEXALOBE,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0284,SUP,HCPCS C1713,,30-0284  -  SCREW BONE 3MM 20MM ELB LCK HEXALOBE,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0285,SUP,HCPCS C1713,,30-0285  -  SCREW BONE 3MM 22MM CORT ELB LCK HEXALOBE,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0286,SUP,HCPCS C1713,,30-0286  -  SCREW BONE 3MM 24MM CORT ELB LCK HEXALOBE,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0287,SUP,HCPCS C1713,,30-0287  -  SCREW BONE 3MM 26MM CORT ELB LCK HEXALOBE,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0288,SUP,HCPCS C1713,,30-0288  -  SCREW BONE 3MM 28MM ELB LCK HEXALOBE,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0289,SUP,HCPCS C1713,,30-0289  -  SCREW BONE 3MM 30MM ELB LCK HEXALOBE NONSTRL,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0290,SUP,HCPCS C1713,,30-0290  -  SCREW BONE 3MM 32MM ELB LCK HEXALOBE,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0291,SUP,HCPCS C1713,,30-0291  -  SCREW BONE 3.5MM 34MM ELB LCK HEXALOBE,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0292,SUP,HCPCS C1713,,30-0292  -  SCREW BONE 3MM 36MM ELB LCK HEXALOBE,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0293,SUP,HCPCS C1713,,30-0293  -  SCREW BONE 3MM 38MM CORT ELB LCK HEXALOBE,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0294,SUP,HCPCS C1713,,30-0294  -  SCREW BONE 3MM 40MM ELB LCK HEXALOBE,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0295,SUP,HCPCS C1713,,30-0295  -  SCREW BONE 3MM 45MM ELB LCK HEXALOBE,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0296,SUP,HCPCS C1713,,30-0296  -  SCREW BONE 3MM 50MM ELB LCK HEXALOBE,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0297,SUP,HCPCS C1713,,30-0297  -  SCREW BN 3MM 55MM LCK HEXALOBE ELB,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0298,SUP,HCPCS C1713,,30-0298  -  SCREW BONE 3MM 60MM ELB LCK HEXALOBE,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0301,SUP,HCPCS C1713,,30-0301  -  SCREW BONE 3MM 8MM ELB NLCKG HEXALOBE,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0302,SUP,HCPCS C1713,,30-0302  -  SCREW BONE 3MM 10MM ELB NLCKG HEXALOBE NONSTRL,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0303,SUP,HCPCS C1713,,30-0303  -  SCREW BONE 3MM 12MM ELB NLCKG HEXALOBE,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0304,SUP,HCPCS C1713,,30-0304  -  SCREW BONE 3MM 14MM DISTAL HUM ELB NLCKG HEXALOBE,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0305,SUP,HCPCS C1713,,30-0305  -  SCREW BONE 3MM 16MM CORT ELB NLCKG HEXALOBE,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0306,SUP,HCPCS C1713,,30-0306  -  SCREW BN 3MM 18MM NONLOCK HEXALOBE HD,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0307,SUP,HCPCS C1713,,30-0307  -  SCREW BONE 3MM 20MM CORT ELB NLCKG HEXALOBE,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0308,SUP,HCPCS C1713,,30-0308  -  SCREW BN 3MM 22MM NS HEXALOBE TI SM FRAG BS SET,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
3003-0822S,SUP,HCPCS C1713,,3003-0822S  -  SCREW SET TI 17.5MM 8MM TROC HIP GAMMA3 STRL LNG NAIL,$288.75,$0.00,$288.75,$129.94,$206.08,$0.00,$49.75,$0.00,$0.00,$50.56,$288.75,$0.00,$144.38,$228.69,$231.00,$0.00,$45.19,$0.00,$45.97,$0.00
30-0309,SUP,HCPCS C1713,,30-0309  -  SCREW BONE 3MM 24MM CORT ELB NLCKG HEXALOBE,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0310,SUP,HCPCS C1713,,30-0310  -  SCREW BONE 3MM 26MM ELB NLCKG HEXALOBE NONSTRL,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0311,SUP,HCPCS C1713,,30-0311  -  SCREW BONE 3.5MM 28MM ELB NLCKG,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0312,SUP,HCPCS C1713,,30-0312  -  SCREW BONE 3.5MM 30MM ELB NLCKG HEXALOBE,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0313,SUP,HCPCS C1713,,30-0313  -  SCREW BONE 3MM 32MM ELB NLCKG HEXALOBE,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0314,SUP,HCPCS C1713,,30-0314  -  SCREW BONE 3MM 34MM DISTAL HUM ELB NLCKG HEXALOBE,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0315,SUP,HCPCS C1713,,30-0315  -  SCREW BONE 3MM 36MM CORT ELB NLCKG HEXALOBE,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0316,SUP,HCPCS C1713,,30-0316  -  SCREW BONE 3MM 38MM ELB NLCKG HEXALOBE,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0317,SUP,HCPCS C1713,,30-0317  -  SCREW BONE 3MM 40MM DISTAL HUM ELB NLCKG HEXALOBE,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0318,SUP,HCPCS C1713,,30-0318  -  SCREW BONE 3MM 45MM CORT ELB NLCKG HEXALOBE,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0319,SUP,HCPCS C1713,,30-0319  -  SCREW BN 3MM 50MM NS HEXALOBE TI SM FRAG BS SET,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0320,SUP,HCPCS C1713,,30-0320  -  SCREW BONE 3MM 55MM DISTAL HUM ELB NLCKG HEXALOBE,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0321,SUP,HCPCS C1713,,30-0321  -  SCREW BONE 3MM 60MM DISTAL VOLR RADL NLCKG HEXALOBE,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0322,SUP,HCPCS C1713,,30-0322  -  SCREW BONE 3MM 65MM ELB NLCKG HEXALOBE,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0324,SUP,HCPCS C1713,,30-0324  -  SCREW BONE 2.7MM 8MM DISTAL HUM ELB LCK HEXALOBE NONSTRL,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0325,SUP,HCPCS C1713,,30-0325  -  SCREW BONE 2.7MM 10MM ELB LCK,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0326,SUP,HCPCS C1713,,30-0326  -  SCREW BONE 2.7MM 12MM TRAUMA LCK,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0327,SUP,HCPCS C1713,,30-0327  -  SCREW BONE 2.7MM 14MM DISTAL HUM ELB LCK HEXALOBE NONSTRL,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0328,SUP,HCPCS C1713,,30-0328  -  SCREW BN 2.7MM 16MM NS LCK HEXALOBE TI SM FRAG BS SET,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0329,SUP,HCPCS C1713,,30-0329  -  SCREW BONE 2.7MM 18MM DISTAL HUM ELB LCK HEXALOBE NONSTRL,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0330,SUP,HCPCS C1713,,30-0330  -  SCREW BONE 2.7MM 20MM DISTAL HUM ELB LCK HEXALOBE NONSTRL,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0331,SUP,HCPCS C1713,,30-0331  -  SCREW BN 2.7MM 22MM NS LCK HEXALOBE TI SM FRAG BS SET,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0332,SUP,HCPCS C1713,,30-0332  -  SCREW BONE 2.7MM 24MM ELB LCK HEXALOBE NONSTRL,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0333,SUP,HCPCS C1713,,30-0333  -  SCREW BONE 2.7MM 26MM ELB LCK HEXALOBE,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0334,SUP,HCPCS C1713,,30-0334  -  SCREW BONE 2.7MM 28MM DISTAL HUM ELB LCK HEXALOBE,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0335,SUP,HCPCS C1713,,30-0335  -  SCREW BONE 2.7MM 30MM ELB LCK HEXALOBE,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0336,SUP,HCPCS C1713,,30-0336  -  SCREW BONE 2.7MM 32MM ELB LCK HEXALOBE,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0343,SUP,HCPCS C1713,,30-0343  -  SCREW BONE 2.7MM 8MM ELB NLCKG HEXALOBE,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0344,SUP,HCPCS C1713,,30-0344  -  SCREW BONE 2.7MM 10MM ELB NLCKG HEXALOBE,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0345,SUP,HCPCS C1713,,30-0345  -  SCREW BONE 2.7MM 12MM ELB NLCKG HEXALOBE,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0346,SUP,HCPCS C1713,,30-0346  -  SCREW BONE 2.7MM 14MM NLCKG TRAUMA,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0347,SUP,HCPCS C1713,,30-0347  -  SCREW BONE 2.7MM 16MM TI NLCKG,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0348,SUP,HCPCS C1713,,30-0348  -  SCREW BONE 2.7MM 18MM DISTAL HUM ELB NLCKG HEXALOBE NONSTRL,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0349,SUP,HCPCS C1713,,30-0349  -  SCREW BONE 2.7MM 20MM ELB NLCKG HEXALOBE,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0350,SUP,HCPCS C1713,,30-0350  -  SCREW BN 2.7MM 22MM NS HEXALOBE TI SM FRAG BS SET,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0351,SUP,HCPCS C1713,,30-0351  -  SCREW BN 2.7MM 24MM NS HEXALOBE TI SM FRAG BS SET,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0352,SUP,HCPCS C1713,,30-0352  -  SCREW BONE 2.7MM 26MM ELB NLCKG HEXALOBE,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0353,SUP,HCPCS C1713,,30-0353  -  SCREW BONE 2.7MM 28MM ELB NLCKG HEXALOBE,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0354,SUP,HCPCS C1713,,30-0354  -  SCREW BN 2.7MM 30MM NS HEXALOBE TI SM FRAG BS SET,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0355,SUP,HCPCS C1713,,30-0355  -  SCREW BONE 2.7MM 32MM ELB NLCKG HEXALOBE,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0370,SUP,Custom 27203010,,30-0370  -  SLEEVE CMPR NS FRAG-LOC BN SCR,$650.00,$0.00,$650.00,$0.00,$463.91,$0.00,$0.00,$0.00,$0.00,$0.00,$650.00,$0.00,$325.00,$514.80,$520.00,$0.00,$0.00,$0.00,$0.00,$0.00
30-0371,SUP,HCPCS C1713,,30-0371  -  SCREW BN STRL FRAG-LOC CMPR,$395.00,$0.00,$395.00,$177.75,$281.91,$0.00,$68.06,$0.00,$0.00,$69.16,$395.00,$0.00,$197.50,$312.84,$316.00,$0.00,$61.82,$0.00,$62.88,$0.00
3004-15010,SUP,HCPCS C1713,,3004-15010  -  SCREW BONE 10MM HEXALOBE MULTI TITANIUM 1.5MM HAND,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
3004-15011,SUP,HCPCS C1713,,3004-15011  -  SCREW BONE 1.5MM 11MM HEXALOBE MULTI TITANIUM HAND,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
3004-23009,SUP,HCPCS C1713,,3004-23009  -  SCREW BONE 9MM MULTI HEXALOBE 2.3MM ELBOW NONSTRL,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
3004-23010,SUP,HCPCS C1713,,3004-23010  -  SCREW BONE 10MM MULTI HEXALOBE TITANIUM 2.3MM HAND NONSTRL,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
3004-23011,SUP,HCPCS C1713,,3004-23011  -  SCREW BONE 11MM HEXALOBE DRIVER 2.3MM ELBOW,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
3004-23012,SUP,HCPCS C1713,,3004-23012  -  SCREW BONE 12MM MULTI HEXALOBE 2.3MM WRIST,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
3004-23013,SUP,HCPCS C1713,,3004-23013  -  SCREW BN 2.3MM 13MM MLLK VA HEXALOBE TI HND FX SYS,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
3004-23014,SUP,HCPCS C1713,,3004-23014  -  SCREW BONE 14MM HEXALOBE DRIVER 2.3MM ELBOW,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
3004-23016,SUP,HCPCS C1713,,3004-23016  -  SCREW BONE 2.3MM 16MM ELB HEXALOBE DRVR,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
30-0426,SUP,HCPCS C1713,,30-0426  -  SCREW BONE 5.7MM 26MM PLRS TI PROX CANC HUM LCK,$422.50,$0.00,$422.50,$190.13,$301.54,$0.00,$72.79,$0.00,$0.00,$73.98,$422.50,$0.00,$211.25,$334.62,$338.00,$0.00,$66.12,$0.00,$67.26,$0.00
30-0428,SUP,HCPCS C1713,,30-0428  -  SCREW BONE 5.7MM 28MM PLRS TI PROX CANC HUM LCK,$422.50,$0.00,$422.50,$190.13,$301.54,$0.00,$72.79,$0.00,$0.00,$73.98,$422.50,$0.00,$211.25,$334.62,$338.00,$0.00,$66.12,$0.00,$67.26,$0.00
30-0430,SUP,HCPCS C1713,,30-0430  -  SCREW BONE 5.7MM 30MM PLRS TI PROX CANC HUM LCK,$422.50,$0.00,$422.50,$190.13,$301.54,$0.00,$72.79,$0.00,$0.00,$73.98,$422.50,$0.00,$211.25,$334.62,$338.00,$0.00,$66.12,$0.00,$67.26,$0.00
30-0432,SUP,HCPCS C1713,,30-0432  -  SCREW BONE 5.7MM 32MM PLRS TI PROX CANC HUM LCK,$422.50,$0.00,$422.50,$190.13,$301.54,$0.00,$72.79,$0.00,$0.00,$73.98,$422.50,$0.00,$211.25,$334.62,$338.00,$0.00,$66.12,$0.00,$67.26,$0.00
30-0434,SUP,HCPCS C1713,,30-0434  -  SCREW BONE 5.7MM 34MM PLRS TI PROX CANC HUM LCK,$422.50,$0.00,$422.50,$190.13,$301.54,$0.00,$72.79,$0.00,$0.00,$73.98,$422.50,$0.00,$211.25,$334.62,$338.00,$0.00,$66.12,$0.00,$67.26,$0.00
30-0436,SUP,HCPCS C1713,,30-0436  -  SCREW BONE 5.7MM 36MM PLRS TI PROX CANC HUM LCK,$422.50,$0.00,$422.50,$190.13,$301.54,$0.00,$72.79,$0.00,$0.00,$73.98,$422.50,$0.00,$211.25,$334.62,$338.00,$0.00,$66.12,$0.00,$67.26,$0.00
30-0438,SUP,HCPCS C1713,,30-0438  -  SCREW BONE 5.7MM 38MM PLRS TI PROX CANC HUM LCK,$422.50,$0.00,$422.50,$190.13,$301.54,$0.00,$72.79,$0.00,$0.00,$73.98,$422.50,$0.00,$211.25,$334.62,$338.00,$0.00,$66.12,$0.00,$67.26,$0.00
30-0440,SUP,HCPCS C1713,,30-0440  -  SCREW BONE 5.7MM 40MM PLRS TI PROX CANC HUM LCK,$422.50,$0.00,$422.50,$190.13,$301.54,$0.00,$72.79,$0.00,$0.00,$73.98,$422.50,$0.00,$211.25,$334.62,$338.00,$0.00,$66.12,$0.00,$67.26,$0.00
30-0442,SUP,HCPCS C1713,,30-0442  -  SCREW BONE 5.7MM 42MM PLRS TI PROX CANC HUM LCK,$422.50,$0.00,$422.50,$190.13,$301.54,$0.00,$72.79,$0.00,$0.00,$73.98,$422.50,$0.00,$211.25,$334.62,$338.00,$0.00,$66.12,$0.00,$67.26,$0.00
30-0444,SUP,HCPCS C1713,,30-0444  -  SCREW BONE 5.7MM 44MM PLRS TI PROX CANC HUM LCK,$422.50,$0.00,$422.50,$190.13,$301.54,$0.00,$72.79,$0.00,$0.00,$73.98,$422.50,$0.00,$211.25,$334.62,$338.00,$0.00,$66.12,$0.00,$67.26,$0.00
30-0446,SUP,HCPCS C1713,,30-0446  -  SCREW BONE 5.7MM 46MM PLRS TI PROX CANC HUM LCK,$422.50,$0.00,$422.50,$190.13,$301.54,$0.00,$72.79,$0.00,$0.00,$73.98,$422.50,$0.00,$211.25,$334.62,$338.00,$0.00,$66.12,$0.00,$67.26,$0.00
30-0448,SUP,HCPCS C1713,,30-0448  -  SCREW BONE 5.7MM 48MM PLRS TI PROX CANC HUM LCK,$422.50,$0.00,$422.50,$190.13,$301.54,$0.00,$72.79,$0.00,$0.00,$73.98,$422.50,$0.00,$211.25,$334.62,$338.00,$0.00,$66.12,$0.00,$67.26,$0.00
30-0450,SUP,HCPCS C1713,,30-0450  -  SCREW BONE 5.7MM 50MM PLRS TI PROX CANC HUM LCK,$422.50,$0.00,$422.50,$190.13,$301.54,$0.00,$72.79,$0.00,$0.00,$73.98,$422.50,$0.00,$211.25,$334.62,$338.00,$0.00,$66.12,$0.00,$67.26,$0.00
30-0452,SUP,HCPCS C1713,,30-0452  -  SCREW BONE 5.7MM 52MM PLRS TI PROX CANC HUM LCK,$422.50,$0.00,$422.50,$190.13,$301.54,$0.00,$72.79,$0.00,$0.00,$73.98,$422.50,$0.00,$211.25,$334.62,$338.00,$0.00,$66.12,$0.00,$67.26,$0.00
30-0454,SUP,HCPCS C1713,,30-0454  -  SCREW BONE 5.7MM 54MM PLRS TI PROX CANC HUM LCK,$422.50,$0.00,$422.50,$190.13,$301.54,$0.00,$72.79,$0.00,$0.00,$73.98,$422.50,$0.00,$211.25,$334.62,$338.00,$0.00,$66.12,$0.00,$67.26,$0.00
3005-1100S,SUP,HCPCS C1713,,3005-1100S  -  CAP END STD 15.3MM HIP FEM IM NAIL TI STRL GAMMA3 11MM,$288.75,$0.00,$288.75,$129.94,$206.08,$0.00,$49.75,$0.00,$0.00,$50.56,$288.75,$0.00,$144.38,$228.69,$231.00,$0.00,$45.19,$0.00,$45.97,$0.00
3005-1105S,SUP,HCPCS C1713,,3005-1105S  -  CAP END +5MM HIP FEM IM NAIL TI STRL GAMMA3,$288.75,$0.00,$288.75,$129.94,$206.08,$0.00,$49.75,$0.00,$0.00,$50.56,$288.75,$0.00,$144.38,$228.69,$231.00,$0.00,$45.19,$0.00,$45.97,$0.00
3005-1110S,SUP,HCPCS C1713,,3005-1110S  -  CAP END +10MM HIP FEM IM NAIL TI STRL GAMMA3,$288.75,$0.00,$288.75,$129.94,$206.08,$0.00,$49.75,$0.00,$0.00,$50.56,$288.75,$0.00,$144.38,$228.69,$231.00,$0.00,$45.19,$0.00,$45.97,$0.00
3006-00,SUP,Custom 27203010,,3006-00  -  PIN SKL BLU STRL DORO ADLT,$49.67,$0.00,$49.67,$0.00,$35.45,$0.00,$0.00,$0.00,$0.00,$0.00,$49.67,$0.00,$24.83,$39.34,$39.73,$0.00,$0.00,$0.00,$0.00,$0.00
3006-20,SUP,Custom 27203010,,3006-20  -  PIN SKL TI ADLT CRNL DISP,$67.59,$0.00,$67.59,$0.00,$48.24,$0.00,$0.00,$0.00,$0.00,$0.00,$67.59,$0.00,$33.80,$53.53,$54.08,$0.00,$0.00,$0.00,$0.00,$0.00
30-0650,SUP,HCPCS C1713,,30-0650  -  SCREW BONE 50MM CANN COMPRESSION SELF CUTTING HELICAL RELIEF,"$1,160.00",$0.00,"$1,160.00",$522.00,$827.89,$0.00,$199.86,$0.00,$0.00,$203.11,"$1,160.00",$0.00,$580.00,$918.72,$928.00,$0.00,$181.54,$0.00,$184.67,$0.00
3006570-06,SUP,Custom 27203010,,CABLE QUIK-COMBO THERAPY,$648.13,$0.00,$648.13,$0.00,$462.57,$0.00,$0.00,$0.00,$0.00,$0.00,$648.13,$0.00,$324.06,$513.32,$518.50,$0.00,$0.00,$0.00,$0.00,$0.00
3008 A,SUP,HCPCS C1713,,3008 A  -  PLATE 18MM TI BONE SPNL,$152.00,$0.00,$152.00,$68.40,$108.48,$0.00,$26.19,$0.00,$0.00,$26.61,$152.00,$0.00,$76.00,$120.38,$121.60,$0.00,$23.79,$0.00,$24.20,$0.00
3008 B,SUP,HCPCS C1713,,3008 B  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$152.00,$0.00,$152.00,$68.40,$108.48,$0.00,$26.19,$0.00,$0.00,$26.61,$152.00,$0.00,$76.00,$120.38,$121.60,$0.00,$23.79,$0.00,$24.20,$0.00
301130B,SUP,Custom 27203010,,REAGENT MCBL KT AP CMB 2 250 TST,"$19,000.00",$0.00,"$19,000.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$19,000.00",$0.00,"$9,500.00","$15,048.00","$15,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
3012-15008,SUP,HCPCS C1713,,3012-15008  -  SCREW BONE HEXALOBE PTHRD 1.5MM 8MM LAG HAND NONSTRL,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
3012-15009,SUP,HCPCS C1713,,3012-15009  -  SCREW BONE 9MM LAG HEXALOBE PTHRD 1.5MM HAND NONSTRL,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
3012-15010,SUP,HCPCS C1713,,3012-15010  -  SCREW BONE 10MM LAG HEXALOBE PTHRD 1.5MM HAND NONSTRL,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
3012-15011,SUP,HCPCS C1713,,3012-15011  -  SCREW BONE 11MM HEXALOBE DRIVER LAG 1.5MM ELBOW,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
3012-15013,SUP,HCPCS C1713,,3012-15013  -  SCREW BONE 13MM HEXALOBE DRIVER LAG 1.5MM ELBOW,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
3012-15014,SUP,HCPCS C1713,,3012-15014  -  SCREW BONE 14MM HEXALOBE DRIVER LAG 1.5MM ELBOW,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
3012-23008,SUP,HCPCS C1713,,3012-23008  -  SCREW BONE 8MM LAG HEXALOBE PTHRD 2.3MM HAND NONSTRL,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
3012-23009,SUP,HCPCS C1713,,3012-23009  -  SCREW BONE 9MM LAG HEXALOBE 2.3MM HAND,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
3012-23010,SUP,HCPCS C1713,,3012-23010  -  SCREW BONE 10MM HEXALOBE LAG TITANIUM 2.3MM HAND METACARPAL,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
3012-23012,SUP,HCPCS C1713,,3012-23012  -  SCREW BONE 12MM LAG HEXALOBE PTHRD 2.3MM HAND NONSTRL,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
3012-23013,SUP,HCPCS C1713,,3012-23013  -  SCREW BONE 2.3MM 13MM ACUMED TI HEXALOBE MTCRPL,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
3012-23016,SUP,HCPCS C1713,,3012-23016  -  SCREW BN HEXALOBE 2.3MM 16MM YLW NS ACUMED LG LOPRFL TI,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
3012-23018,SUP,HCPCS C1713,,3012-23018  -  SCREW BONE 18MM LAG HEXALOBE PTHRD 2.3MM HAND NONSTRL,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
3013SP,SUP,Custom 27203010,,3013SP  -  HEMOSTAT ABS SRGCL OXD REGENERATED CLU PWDR,$394.57,$0.00,$394.57,$0.00,$281.60,$0.00,$0.00,$0.00,$0.00,$0.00,$394.57,$0.00,$197.28,$312.50,$315.65,$0.00,$0.00,$0.00,$0.00,$0.00
3016-16,SUP,Custom 27203010,,CHEMICAL MTHY ALC ANHY 4L ACS LAB,$431.58,$0.00,$431.58,$0.00,$308.02,$0.00,$0.00,$0.00,$0.00,$0.00,$431.58,$0.00,$215.79,$341.81,$345.26,$0.00,$0.00,$0.00,$0.00,$0.00
30170007-S,SUP,HCPCS C1713,,30170007-S  -  SCREW BONE 3.6/4.3MM 16MM BIOTRAK .045IN STD KNEE RESORB,"$1,617.50",$0.00,"$1,617.50",$727.88,"$1,154.41",$0.00,$278.69,$0.00,$0.00,$283.21,"$1,617.50",$0.00,$808.75,"$1,281.06","$1,294.00",$0.00,$253.14,$0.00,$257.51,$0.00
30170008-S,SUP,HCPCS C1713,,30170008-S  -  SCREW BN 18MM BIOTRAK,"$1,617.50",$0.00,"$1,617.50",$727.88,"$1,154.41",$0.00,$278.69,$0.00,$0.00,$283.21,"$1,617.50",$0.00,$808.75,"$1,281.06","$1,294.00",$0.00,$253.14,$0.00,$257.51,$0.00
30170009-S,SUP,HCPCS C1713,,30170009-S  -  SCREW BONE 20MM BIOTRAK CALC,"$1,617.50",$0.00,"$1,617.50",$727.88,"$1,154.41",$0.00,$278.69,$0.00,$0.00,$283.21,"$1,617.50",$0.00,$808.75,"$1,281.06","$1,294.00",$0.00,$253.14,$0.00,$257.51,$0.00
30170010-S,SUP,HCPCS C1713,,30170010-S  -  SCREW BN 22MM BIOTRAK,"$1,617.50",$0.00,"$1,617.50",$727.88,"$1,154.41",$0.00,$278.69,$0.00,$0.00,$283.21,"$1,617.50",$0.00,$808.75,"$1,281.06","$1,294.00",$0.00,$253.14,$0.00,$257.51,$0.00
30170011-S,SUP,HCPCS C1713,,30170011-S  -  SCREW BN 24MM BIOTRAK,"$1,617.50",$0.00,"$1,617.50",$727.88,"$1,154.41",$0.00,$278.69,$0.00,$0.00,$283.21,"$1,617.50",$0.00,$808.75,"$1,281.06","$1,294.00",$0.00,$253.14,$0.00,$257.51,$0.00
30170057-S,SUP,HCPCS C1713,,30170057-S  -  SCREW BN MN 16MM BIOTRAK,"$1,617.50",$0.00,"$1,617.50",$727.88,"$1,154.41",$0.00,$278.69,$0.00,$0.00,$283.21,"$1,617.50",$0.00,$808.75,"$1,281.06","$1,294.00",$0.00,$253.14,$0.00,$257.51,$0.00
30170058-S,SUP,HCPCS C1713,,30170058-S  -  SCREW BN MN 18MM BIOTRAK,"$1,617.50",$0.00,"$1,617.50",$727.88,"$1,154.41",$0.00,$278.69,$0.00,$0.00,$283.21,"$1,617.50",$0.00,$808.75,"$1,281.06","$1,294.00",$0.00,$253.14,$0.00,$257.51,$0.00
30170059-S,SUP,HCPCS C1713,,30170059-S  -  SCREW BN MN FT TPR 3.2-3.6MM 20MM STRL BIOTRAK RSRB RDLCNT,"$1,617.50",$0.00,"$1,617.50",$727.88,"$1,154.41",$0.00,$278.69,$0.00,$0.00,$283.21,"$1,617.50",$0.00,$808.75,"$1,281.06","$1,294.00",$0.00,$253.14,$0.00,$257.51,$0.00
30170060-S,SUP,HCPCS C1713,,30170060-S  -  SCREW BN MN FT TPR 3.2-3.7MM 22MM STRL BIOTRAK RSRB RDLCNT,"$1,617.50",$0.00,"$1,617.50",$727.88,"$1,154.41",$0.00,$278.69,$0.00,$0.00,$283.21,"$1,617.50",$0.00,$808.75,"$1,281.06","$1,294.00",$0.00,$253.14,$0.00,$257.51,$0.00
30170061-S,SUP,HCPCS C1713,,30170061-S  -  SCREW BONE 3.2/3.5MM 24MM BIOTRAK .035IN MINI WRST ANKL HAND,"$1,617.50",$0.00,"$1,617.50",$727.88,"$1,154.41",$0.00,$278.69,$0.00,$0.00,$283.21,"$1,617.50",$0.00,$808.75,"$1,281.06","$1,294.00",$0.00,$253.14,$0.00,$257.51,$0.00
30170320-S,SUP,Custom 27203010,,30170320-S  -  PIN FX 20MM BIOTRAK,$605.00,$0.00,$605.00,$0.00,$431.79,$0.00,$0.00,$0.00,$0.00,$0.00,$605.00,$0.00,$302.50,$479.16,$484.00,$0.00,$0.00,$0.00,$0.00,$0.00
30170330-S,SUP,Custom 27203010,,30170330-S  -  PIN FX 30MM BIOTRAK,$605.00,$0.00,$605.00,$0.00,$431.79,$0.00,$0.00,$0.00,$0.00,$0.00,$605.00,$0.00,$302.50,$479.16,$484.00,$0.00,$0.00,$0.00,$0.00,$0.00
30170340-S,SUP,Custom 27203010,,30170340-S  -  PIN FX 40MM BIOTRAK,$605.00,$0.00,$605.00,$0.00,$431.79,$0.00,$0.00,$0.00,$0.00,$0.00,$605.00,$0.00,$302.50,$479.16,$484.00,$0.00,$0.00,$0.00,$0.00,$0.00
3044-0026,SUP,Custom 27803010,,3044-0026  -  COMPONENT PATLR 26MM RECESSED UHMWPE,$600.00,$0.00,$600.00,$0.00,$428.22,$0.00,$0.00,$0.00,$0.00,$0.00,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$0.00,$0.00,$0.00,$0.00
3044-0028,SUP,Custom 27803010,,3044-0028  -  COMPONENT PATLR 28MM RECESSED UHMWPE,$600.00,$0.00,$600.00,$0.00,$428.22,$0.00,$0.00,$0.00,$0.00,$0.00,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$0.00,$0.00,$0.00,$0.00
3044-0030,SUP,Custom 27803010,,3044-0030  -  COMPONENT PATLR 30MM RECESSED UHMWPE,$600.00,$0.00,$600.00,$0.00,$428.22,$0.00,$0.00,$0.00,$0.00,$0.00,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$0.00,$0.00,$0.00,$0.00
3044-0032,SUP,Custom 27803010,,3044-0032  -  COMPONENT PATLR 32MM RECESSED UHMWPE,$600.00,$0.00,$600.00,$0.00,$428.22,$0.00,$0.00,$0.00,$0.00,$0.00,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$0.00,$0.00,$0.00,$0.00
3045-0026,SUP,Custom 27803010,,3045-0026  -  CMPNT PATLR MTLBLK RCSS,"$1,211.00",$0.00,"$1,211.00",$0.00,$864.29,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,211.00",$0.00,$605.50,$959.11,$968.80,$0.00,$0.00,$0.00,$0.00,$0.00
3045-0028,SUP,Custom 27803010,,3045-0028  -  CMPNT PATLR MTLBLK RCSS,"$1,211.00",$0.00,"$1,211.00",$0.00,$864.29,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,211.00",$0.00,$605.50,$959.11,$968.80,$0.00,$0.00,$0.00,$0.00,$0.00
3045-0030,SUP,Custom 27803010,,3045-0030  -  CMPNT PATLR MTLBLK RCSS,"$1,211.00",$0.00,"$1,211.00",$0.00,$864.29,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,211.00",$0.00,$605.50,$959.11,$968.80,$0.00,$0.00,$0.00,$0.00,$0.00
3045-0032,SUP,Custom 27803010,,3045-0032  -  CMPNT PATLR MTLBLK RCSS,"$1,211.00",$0.00,"$1,211.00",$0.00,$864.29,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,211.00",$0.00,$605.50,$959.11,$968.80,$0.00,$0.00,$0.00,$0.00,$0.00
30-5052122,SUP,Custom 27203010,,MILTEX HANK DILATOR SZ. 21-22,$174.38,$0.00,$174.38,$0.00,$124.45,$0.00,$0.00,$0.00,$0.00,$0.00,$174.38,$0.00,$87.19,$138.11,$139.50,$0.00,$0.00,$0.00,$0.00,$0.00
30-5052324,SUP,Custom 27203010,,MILTEX HANK DILATOR SZ. 23-24,$174.38,$0.00,$174.38,$0.00,$124.45,$0.00,$0.00,$0.00,$0.00,$0.00,$174.38,$0.00,$87.19,$138.11,$139.50,$0.00,$0.00,$0.00,$0.00,$0.00
30-505-2526,SUP,Custom 27203010,,MILTEX HANK DILATOR SZ. 25-26,$181.85,$0.00,$181.85,$0.00,$129.79,$0.00,$0.00,$0.00,$0.00,$0.00,$181.85,$0.00,$90.93,$144.03,$145.48,$0.00,$0.00,$0.00,$0.00,$0.00
3051-0308,SUP,Custom 27803010,,3051-0308  -  INSERT TIB LG KNEE SER 1 BRNG,$985.00,$0.00,$985.00,$0.00,$702.99,$0.00,$0.00,$0.00,$0.00,$0.00,$985.00,$0.00,$492.50,$780.12,$788.00,$0.00,$0.00,$0.00,$0.00,$0.00
3052-0308,SUP,Custom 27803010,,3052-0308  -  INSERT TIBIAL 3 8MM BEARING KNEE SERIES II,"$2,060.00",$0.00,"$2,060.00",$0.00,"$1,470.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,060.00",$0.00,"$1,030.00","$1,631.52","$1,648.00",$0.00,$0.00,$0.00,$0.00,$0.00
3052-0310,SUP,Custom 27803010,,3052-0310  -  INSERT TIBIAL 3 10MM BEARING KNEE SERIES II,"$2,060.00",$0.00,"$2,060.00",$0.00,"$1,470.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,060.00",$0.00,"$1,030.00","$1,631.52","$1,648.00",$0.00,$0.00,$0.00,$0.00,$0.00
3052-0312,SUP,Custom 27803010,,3052-0312  -  INSERT TIBIAL 3 12MM BEARING KNEE SERIES II,"$2,060.00",$0.00,"$2,060.00",$0.00,"$1,470.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,060.00",$0.00,"$1,030.00","$1,631.52","$1,648.00",$0.00,$0.00,$0.00,$0.00,$0.00
3052-0315,SUP,Custom 27803010,,3052-0315  -  INSERT TIBIAL 3 15MM BEARING KNEE SERIES II,"$2,060.00",$0.00,"$2,060.00",$0.00,"$1,470.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,060.00",$0.00,"$1,030.00","$1,631.52","$1,648.00",$0.00,$0.00,$0.00,$0.00,$0.00
3052-0318,SUP,Custom 27803010,,3052-0318  -  INSERT TIBIAL 3 18MM BEARING KNEE SERIES II,"$2,060.00",$0.00,"$2,060.00",$0.00,"$1,470.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,060.00",$0.00,"$1,030.00","$1,631.52","$1,648.00",$0.00,$0.00,$0.00,$0.00,$0.00
3052-0321,SUP,Custom 27803010,,3052-0321  -  INSERT TIBIAL 3 21MM BEARING KNEE SERIES II,"$2,060.00",$0.00,"$2,060.00",$0.00,"$1,470.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,060.00",$0.00,"$1,030.00","$1,631.52","$1,648.00",$0.00,$0.00,$0.00,$0.00,$0.00
3052-0324,SUP,Custom 27803010,,3052-0324  -  INSERT TIBIAL 3 24MM BEARING KNEE SERIES II,"$2,060.00",$0.00,"$2,060.00",$0.00,"$1,470.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,060.00",$0.00,"$1,030.00","$1,631.52","$1,648.00",$0.00,$0.00,$0.00,$0.00,$0.00
3052-0508,SUP,Custom 27803010,,3052-0508  -  INSERT TIBIAL 5 8MM BEARING KNEE SERIES II,"$2,060.00",$0.00,"$2,060.00",$0.00,"$1,470.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,060.00",$0.00,"$1,030.00","$1,631.52","$1,648.00",$0.00,$0.00,$0.00,$0.00,$0.00
3052-0510,SUP,Custom 27803010,,3052-0510  -  INSERT TIBIAL 5 10MM BEARING KNEE SERIES II,"$2,060.00",$0.00,"$2,060.00",$0.00,"$1,470.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,060.00",$0.00,"$1,030.00","$1,631.52","$1,648.00",$0.00,$0.00,$0.00,$0.00,$0.00
3052-0512,SUP,Custom 27803010,,3052-0512  -  INSERT TIBIAL 5 12MM BEARING KNEE SERIES II,"$2,060.00",$0.00,"$2,060.00",$0.00,"$1,470.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,060.00",$0.00,"$1,030.00","$1,631.52","$1,648.00",$0.00,$0.00,$0.00,$0.00,$0.00
3052-0515,SUP,Custom 27803010,,3052-0515  -  INSERT TIBIAL 5 15MM BEARING KNEE SERIES II,"$2,060.00",$0.00,"$2,060.00",$0.00,"$1,470.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,060.00",$0.00,"$1,030.00","$1,631.52","$1,648.00",$0.00,$0.00,$0.00,$0.00,$0.00
3052-0518,SUP,Custom 27803010,,3052-0518  -  INSERT TIBIAL 5 18MM BEARING KNEE SERIES II,"$2,060.00",$0.00,"$2,060.00",$0.00,"$1,470.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,060.00",$0.00,"$1,030.00","$1,631.52","$1,648.00",$0.00,$0.00,$0.00,$0.00,$0.00
3052-0521,SUP,Custom 27803010,,3052-0521  -  INSERT TIBIAL 5 21MM BEARING KNEE SERIES II,"$2,060.00",$0.00,"$2,060.00",$0.00,"$1,470.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,060.00",$0.00,"$1,030.00","$1,631.52","$1,648.00",$0.00,$0.00,$0.00,$0.00,$0.00
3052-0524,SUP,Custom 27803010,,3052-0524  -  INSERT TIBIAL 5 24MM BEARING KNEE SERIES II,"$2,060.00",$0.00,"$2,060.00",$0.00,"$1,470.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,060.00",$0.00,"$1,030.00","$1,631.52","$1,648.00",$0.00,$0.00,$0.00,$0.00,$0.00
3052-0708,SUP,Custom 27803010,,3052-0708  -  INSERT TIBIAL 7 8MM BEARING KNEE SERIES II,"$2,060.00",$0.00,"$2,060.00",$0.00,"$1,470.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,060.00",$0.00,"$1,030.00","$1,631.52","$1,648.00",$0.00,$0.00,$0.00,$0.00,$0.00
3052-0710,SUP,Custom 27803010,,3052-0710  -  INSERT TIBIAL 7 10MM BEARING KNEE SERIES II,"$2,060.00",$0.00,"$2,060.00",$0.00,"$1,470.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,060.00",$0.00,"$1,030.00","$1,631.52","$1,648.00",$0.00,$0.00,$0.00,$0.00,$0.00
3052-0712,SUP,Custom 27803010,,3052-0712  -  INSERT TIBIAL 7 12MM BEARING KNEE SERIES II,"$2,060.00",$0.00,"$2,060.00",$0.00,"$1,470.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,060.00",$0.00,"$1,030.00","$1,631.52","$1,648.00",$0.00,$0.00,$0.00,$0.00,$0.00
3052-0715,SUP,Custom 27803010,,3052-0715  -  INSERT TIBIAL 7 15MM BEARING KNEE SERIES II,"$2,060.00",$0.00,"$2,060.00",$0.00,"$1,470.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,060.00",$0.00,"$1,030.00","$1,631.52","$1,648.00",$0.00,$0.00,$0.00,$0.00,$0.00
3052-0718,SUP,Custom 27803010,,3052-0718  -  INSERT TIBIAL 7 18MM BEARING KNEE SERIES II,"$2,060.00",$0.00,"$2,060.00",$0.00,"$1,470.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,060.00",$0.00,"$1,030.00","$1,631.52","$1,648.00",$0.00,$0.00,$0.00,$0.00,$0.00
3052-0721,SUP,Custom 27803010,,3052-0721  -  INSERT TIBIAL 7 21MM BEARING KNEE SERIES II,"$2,060.00",$0.00,"$2,060.00",$0.00,"$1,470.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,060.00",$0.00,"$1,030.00","$1,631.52","$1,648.00",$0.00,$0.00,$0.00,$0.00,$0.00
3052-0724,SUP,Custom 27803010,,3052-0724  -  INSERT TIBIAL 7 24MM BEARING KNEE SERIES II,"$2,060.00",$0.00,"$2,060.00",$0.00,"$1,470.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,060.00",$0.00,"$1,030.00","$1,631.52","$1,648.00",$0.00,$0.00,$0.00,$0.00,$0.00
3052-0908,SUP,Custom 27803010,,3052-0908  -  INSERT TIBIAL 9 8MM BEARING KNEE SERIES II,"$2,060.00",$0.00,"$2,060.00",$0.00,"$1,470.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,060.00",$0.00,"$1,030.00","$1,631.52","$1,648.00",$0.00,$0.00,$0.00,$0.00,$0.00
3052-0910,SUP,Custom 27803010,,3052-0910  -  INSERT TIBIAL 9 10MM BEARING KNEE SERIES II,"$2,060.00",$0.00,"$2,060.00",$0.00,"$1,470.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,060.00",$0.00,"$1,030.00","$1,631.52","$1,648.00",$0.00,$0.00,$0.00,$0.00,$0.00
3052-0912,SUP,Custom 27803010,,3052-0912  -  INSERT TIBIAL 9 12MM BEARING KNEE SERIES II,"$2,060.00",$0.00,"$2,060.00",$0.00,"$1,470.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,060.00",$0.00,"$1,030.00","$1,631.52","$1,648.00",$0.00,$0.00,$0.00,$0.00,$0.00
3052-0915,SUP,Custom 27803010,,3052-0915  -  INSERT TIBIAL 9 15MM BEARING KNEE SERIES II,"$2,060.00",$0.00,"$2,060.00",$0.00,"$1,470.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,060.00",$0.00,"$1,030.00","$1,631.52","$1,648.00",$0.00,$0.00,$0.00,$0.00,$0.00
3052-0918,SUP,Custom 27803010,,3052-0918  -  INSERT TIBIAL 9 18MM BEARING KNEE SERIES II,"$2,060.00",$0.00,"$2,060.00",$0.00,"$1,470.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,060.00",$0.00,"$1,030.00","$1,631.52","$1,648.00",$0.00,$0.00,$0.00,$0.00,$0.00
3052-0921,SUP,Custom 27803010,,3052-0921  -  INSERT TIBIAL 9 21MM BEARING KNEE SERIES II,"$2,060.00",$0.00,"$2,060.00",$0.00,"$1,470.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,060.00",$0.00,"$1,030.00","$1,631.52","$1,648.00",$0.00,$0.00,$0.00,$0.00,$0.00
3052-0924,SUP,Custom 27803010,,3052-0924  -  INSERT TIBIAL 9 24MM BEARING KNEE SERIES II,"$2,060.00",$0.00,"$2,060.00",$0.00,"$1,470.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,060.00",$0.00,"$1,030.00","$1,631.52","$1,648.00",$0.00,$0.00,$0.00,$0.00,$0.00
3052-1108,SUP,Custom 27803010,,3052-1108  -  INSERT TIBIAL 11 8MM BEARING KNEE SERIES II,"$2,060.00",$0.00,"$2,060.00",$0.00,"$1,470.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,060.00",$0.00,"$1,030.00","$1,631.52","$1,648.00",$0.00,$0.00,$0.00,$0.00,$0.00
3052-1110,SUP,Custom 27803010,,3052-1110  -  INSERT TIBIAL 11 10MM BEARING KNEE SERIES II,"$2,060.00",$0.00,"$2,060.00",$0.00,"$1,470.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,060.00",$0.00,"$1,030.00","$1,631.52","$1,648.00",$0.00,$0.00,$0.00,$0.00,$0.00
3052-1112,SUP,Custom 27803010,,3052-1112  -  INSERT TIBIAL 11 12MM BEARING KNEE SERIES II,"$2,060.00",$0.00,"$2,060.00",$0.00,"$1,470.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,060.00",$0.00,"$1,030.00","$1,631.52","$1,648.00",$0.00,$0.00,$0.00,$0.00,$0.00
3052-1115,SUP,Custom 27803010,,3052-1115  -  INSERT TIBIAL 11 15MM BEARING KNEE SERIES II,"$2,060.00",$0.00,"$2,060.00",$0.00,"$1,470.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,060.00",$0.00,"$1,030.00","$1,631.52","$1,648.00",$0.00,$0.00,$0.00,$0.00,$0.00
3052-1118,SUP,Custom 27803010,,3052-1118  -  INSERT TIBIAL 11 18MM BEARING KNEE SERIES II,"$2,060.00",$0.00,"$2,060.00",$0.00,"$1,470.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,060.00",$0.00,"$1,030.00","$1,631.52","$1,648.00",$0.00,$0.00,$0.00,$0.00,$0.00
3052-1121,SUP,Custom 27803010,,3052-1121  -  INSERT TIBIAL 11 21MM BEARING KNEE SERIES II,"$2,060.00",$0.00,"$2,060.00",$0.00,"$1,470.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,060.00",$0.00,"$1,030.00","$1,631.52","$1,648.00",$0.00,$0.00,$0.00,$0.00,$0.00
3052-1124,SUP,Custom 27803010,,3052-1124  -  INSERT TIBIAL 11 24MM BEARING KNEE SERIES II,"$2,060.00",$0.00,"$2,060.00",$0.00,"$1,470.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,060.00",$0.00,"$1,030.00","$1,631.52","$1,648.00",$0.00,$0.00,$0.00,$0.00,$0.00
305C2101,SUP,Custom 27803010,,305C2101  -  VALVE AORTIC 21MM MSC BPRTH CNCH HLDR MODL 305 STRL,"$19,000.00",$0.00,"$19,000.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$19,000.00",$0.00,"$9,500.00","$15,048.00","$15,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
305C219,SUP,Custom 27803010,,305C219  -  VALVE AORTIC 19MM MSC BPRTH CNCH HLDR MODL 305 STRL,"$2,022.50",$0.00,"$2,022.50",$0.00,"$1,443.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,022.50",$0.00,"$1,011.25","$1,601.82","$1,618.00",$0.00,$0.00,$0.00,$0.00,$0.00
305C221,SUP,Custom 27803010,,305C221  -  VALVE AORTIC 21MM MSC BPRTH CNCH HLDR MODL 305 STRL,"$19,500.00",$0.00,"$19,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$19,500.00",$0.00,"$9,750.00","$15,444.00","$15,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
305C223,SUP,Custom 27803010,,305C223  -  VALVE AORTIC 23MM MSC CNCH BPRTH CNCH HLDR MODL 305,"$19,500.00",$0.00,"$19,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$19,500.00",$0.00,"$9,750.00","$15,444.00","$15,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
305C227,SUP,Custom 27803010,,305C227  -  VALVE AORTIC 27MM MSC BPRTH CNCH HLDR MODL 305,"$19,500.00",$0.00,"$19,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$19,500.00",$0.00,"$9,750.00","$15,444.00","$15,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
305C229,SUP,Custom 27803010,,305C229  -  VALVE AORTIC 29MM MSC BPRTH CNCH HLDR MODL 305 STRL,"$19,500.00",$0.00,"$19,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$19,500.00",$0.00,"$9,750.00","$15,444.00","$15,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
3060-0070S,SUP,HCPCS C1713,,3060-0070S  -  SCREW BONE 10.5MM 70MM GAMMA3 TI TROC HIP LAG STRL LNG NAIL,$694.38,$0.00,$694.38,$312.47,$495.58,$0.00,$119.64,$0.00,$0.00,$121.58,$694.38,$0.00,$347.19,$549.95,$555.50,$0.00,$108.67,$0.00,$110.54,$0.00
3060-0075S,SUP,HCPCS C1713,,3060-0075S  -  SCREW BN 10.5MM 75MM STRL GAMMA3 LG TI HIP TROCH NL 180,$804.38,$0.00,$804.38,$361.97,$574.08,$0.00,$138.59,$0.00,$0.00,$140.84,$804.38,$0.00,$402.19,$637.07,$643.50,$0.00,$125.88,$0.00,$128.06,$0.00
3060-0080S,SUP,HCPCS C1713,,3060-0080S  -  SCREW BONE 10.5MM 80MM GAMMA3 TI TROC HIP LAG STRL LNG NAIL,$804.38,$0.00,$804.38,$361.97,$574.08,$0.00,$138.59,$0.00,$0.00,$140.84,$804.38,$0.00,$402.19,$637.07,$643.50,$0.00,$125.88,$0.00,$128.06,$0.00
3060-0085S,SUP,HCPCS C1713,,3060-0085S  -  SCREW BN 10.5MM 85MM STRL GAMMA3 LG TI HIP TROCH NL 180,$804.38,$0.00,$804.38,$361.97,$574.08,$0.00,$138.59,$0.00,$0.00,$140.84,$804.38,$0.00,$402.19,$637.07,$643.50,$0.00,$125.88,$0.00,$128.06,$0.00
3060-0090S,SUP,HCPCS C1713,,3060-0090S  -  SCREW BN 10.5MM 90MM STRL GAMMA3 LG TI HIP TROCH NL 180,$804.38,$0.00,$804.38,$361.97,$574.08,$0.00,$138.59,$0.00,$0.00,$140.84,$804.38,$0.00,$402.19,$637.07,$643.50,$0.00,$125.88,$0.00,$128.06,$0.00
3060-0095S,SUP,HCPCS C1713,,3060-0095S  -  SCREW BN 10.5MM 95MM STRL GAMMA3 LG TI HIP TROCH NL 180,$804.38,$0.00,$804.38,$361.97,$574.08,$0.00,$138.59,$0.00,$0.00,$140.84,$804.38,$0.00,$402.19,$637.07,$643.50,$0.00,$125.88,$0.00,$128.06,$0.00
3060-0100S,SUP,HCPCS C1713,,3060-0100S  -  SCREW BN 10.5MM 100MM STRL GAMMA3 LG TI HIP TROCH NL 180,$804.38,$0.00,$804.38,$361.97,$574.08,$0.00,$138.59,$0.00,$0.00,$140.84,$804.38,$0.00,$402.19,$637.07,$643.50,$0.00,$125.88,$0.00,$128.06,$0.00
3060-0105S,SUP,HCPCS C1713,,3060-0105S  -  SCREW BN 10.5MM 105MM STRL GAMMA3 LG TI HIP TROCH NL 180,$804.38,$0.00,$804.38,$361.97,$574.08,$0.00,$138.59,$0.00,$0.00,$140.84,$804.38,$0.00,$402.19,$637.07,$643.50,$0.00,$125.88,$0.00,$128.06,$0.00
3060-0110S,SUP,HCPCS C1713,,3060-0110S  -  SCREW BN 10.5MM 110MM STRL GAMMA3 LG TI HIP TROCH NL 180,$804.38,$0.00,$804.38,$361.97,$574.08,$0.00,$138.59,$0.00,$0.00,$140.84,$804.38,$0.00,$402.19,$637.07,$643.50,$0.00,$125.88,$0.00,$128.06,$0.00
3060-0115S,SUP,HCPCS C1713,,3060-0115S  -  SCREW BN 10.5MM 115MM STRL GAMMA3 LG TI HIP TROCH NL 180,$804.38,$0.00,$804.38,$361.97,$574.08,$0.00,$138.59,$0.00,$0.00,$140.84,$804.38,$0.00,$402.19,$637.07,$643.50,$0.00,$125.88,$0.00,$128.06,$0.00
3060-0120S,SUP,HCPCS C1713,,3060-0120S  -  SCREW BN 10.5MM 120MM STRL GAMMA3 LG TI HIP TROCH NL 180,$804.38,$0.00,$804.38,$361.97,$574.08,$0.00,$138.59,$0.00,$0.00,$140.84,$804.38,$0.00,$402.19,$637.07,$643.50,$0.00,$125.88,$0.00,$128.06,$0.00
3060-0125S,SUP,HCPCS C1713,,3060-0125S  -  SCREW BN 10.5MM 125MM STRL GAMMA3 LG TI HIP TROCH NL 180,$756.25,$0.00,$756.25,$340.31,$539.74,$0.00,$130.30,$0.00,$0.00,$132.41,$756.25,$0.00,$378.13,$598.95,$605.00,$0.00,$118.35,$0.00,$120.40,$0.00
3060-0130S,SUP,HCPCS C1713,,3060-0130S  -  SCREW BN 10.5MM 130MM STRL GAMMA3 LG TI HIP TROCH NL 180,$756.25,$0.00,$756.25,$340.31,$539.74,$0.00,$130.30,$0.00,$0.00,$132.41,$756.25,$0.00,$378.13,$598.95,$605.00,$0.00,$118.35,$0.00,$120.40,$0.00
3060L,SUP,Custom 27203010,,RESTRAINT VST 65IN MED QRLSE TIE BACK CLSR STRAP,$42.03,$0.00,$42.03,$0.00,$29.99,$0.00,$0.00,$0.00,$0.00,$0.00,$42.03,$0.00,$21.01,$33.29,$33.62,$0.00,$0.00,$0.00,$0.00,$0.00
3060M,SUP,Custom 27203010,,RESTRAINT VST 65IN MED CTTN QRLSE TIE BACK CLSR STRAP,$42.03,$0.00,$42.03,$0.00,$29.99,$0.00,$0.00,$0.00,$0.00,$0.00,$42.03,$0.00,$21.01,$33.29,$33.62,$0.00,$0.00,$0.00,$0.00,$0.00
3060S,SUP,Custom 27203010,,RESTRAINT VST 65IN SM QRLSE TIE BACK CLSR STRAP,$42.03,$0.00,$42.03,$0.00,$29.99,$0.00,$0.00,$0.00,$0.00,$0.00,$42.03,$0.00,$21.01,$33.29,$33.62,$0.00,$0.00,$0.00,$0.00,$0.00
3060XL,SUP,Custom 27203010,,RESTRAINT VST 75IN XL QRLSE TIE BACK CLSR STRAP,$42.03,$0.00,$42.03,$0.00,$29.99,$0.00,$0.00,$0.00,$0.00,$0.00,$42.03,$0.00,$21.01,$33.29,$33.62,$0.00,$0.00,$0.00,$0.00,$0.00
3060XXXL,SUP,Custom 27203010,,RESTRAINT VST 3XL ZP QRLSE STRAP MESH,$61.23,$0.00,$61.23,$0.00,$43.70,$0.00,$0.00,$0.00,$0.00,$0.00,$61.23,$0.00,$30.61,$48.49,$48.98,$0.00,$0.00,$0.00,$0.00,$0.00
309.004S,SUP,Custom 27203010,,309.004S  -  BIT DRL 4MM STRL CRB 3.5MM SCR,$509.05,$0.00,$509.05,$0.00,$363.31,$0.00,$0.00,$0.00,$0.00,$0.00,$509.05,$0.00,$254.53,$403.17,$407.24,$0.00,$0.00,$0.00,$0.00,$0.00
309.006S,SUP,Custom 27203010,,309.006S  -  BIT DRL 6MM STRL CRB,$580.03,$0.00,$580.03,$0.00,$413.96,$0.00,$0.00,$0.00,$0.00,$0.00,$580.03,$0.00,$290.01,$459.38,$464.02,$0.00,$0.00,$0.00,$0.00,$0.00
3092-040,SUP,HCPCS C1713,,CEMENT BONE ENDRN SST 40GM HVISC STRL,$365.00,$0.00,$365.00,$164.25,$260.50,$0.00,$62.89,$0.00,$0.00,$63.91,$365.00,$0.00,$182.50,$289.08,$292.00,$0.00,$57.12,$0.00,$58.11,$0.00
310.11.98,SUP,Custom 27203010,,310.11.98  -  BIT DRILL 60MM 1.1MM QC NONSTRL,$209.25,$0.00,$209.25,$0.00,$149.34,$0.00,$0.00,$0.00,$0.00,$0.00,$209.25,$0.00,$104.63,$165.73,$167.40,$0.00,$0.00,$0.00,$0.00,$0.00
310.15.98,SUP,Custom 27203010,,310.15.98  -  BIT DRILL 85MM 1.5MM QC W/O STOP NONSTRL,$209.25,$0.00,$209.25,$0.00,$149.34,$0.00,$0.00,$0.00,$0.00,$0.00,$209.25,$0.00,$104.63,$165.73,$167.40,$0.00,$0.00,$0.00,$0.00,$0.00
310.16.98,SUP,Custom 27203010,,310.16.98  -  BIT DRILL 110MM 1.5MM QC W/O STOP NONSTRL,$209.25,$0.00,$209.25,$0.00,$149.34,$0.00,$0.00,$0.00,$0.00,$0.00,$209.25,$0.00,$104.63,$165.73,$167.40,$0.00,$0.00,$0.00,$0.00,$0.00
310.16J,SUP,Custom 27203010,,310.16J  -  BIT DRILL 1.5MM 95MM JACOBS CHUCK NONSTRL,$131.68,$0.00,$131.68,$0.00,$93.98,$0.00,$0.00,$0.00,$0.00,$0.00,$131.68,$0.00,$65.84,$104.29,$105.34,$0.00,$0.00,$0.00,$0.00,$0.00
310.21.98,SUP,Custom 27203010,,310.21.98  -  BIT DRILL 125MM 2MM QC W/O STOP NONSTRL,$234.00,$0.00,$234.00,$0.00,$167.01,$0.00,$0.00,$0.00,$0.00,$0.00,$234.00,$0.00,$117.00,$185.33,$187.20,$0.00,$0.00,$0.00,$0.00,$0.00
310.21J,SUP,Custom 27203010,,310.21J  -  BIT DRILL LONG 2MM 110MM JACOBS CHUCK DCP STAINLESS STEEL,$131.68,$0.00,$131.68,$0.00,$93.98,$0.00,$0.00,$0.00,$0.00,$0.00,$131.68,$0.00,$65.84,$104.29,$105.34,$0.00,$0.00,$0.00,$0.00,$0.00
310.-288,SUP,Custom 27203010,,BIT DRILL 165MM 2.8MM QC NSTRL,$238.60,$0.00,$238.60,$0.00,$170.29,$0.00,$0.00,$0.00,$0.00,$0.00,$238.60,$0.00,$119.30,$188.97,$190.88,$0.00,$0.00,$0.00,$0.00,$0.00
310.28J,SUP,Custom 27203010,,310.28J  -  BIT DRILL 2.7MM 110MM JACOBS CHUCK STERILE,$139.20,$0.00,$139.20,$0.00,$99.35,$0.00,$0.00,$0.00,$0.00,$0.00,$139.20,$0.00,$69.60,$110.25,$111.36,$0.00,$0.00,$0.00,$0.00,$0.00
310.31.,SUP,Custom 27203010,,310.31.  -  DRILL BIT  3.2MM X 145MM QUICK COUPLING,$91.79,$0.00,$91.79,$0.00,$65.51,$0.00,$0.00,$0.00,$0.00,$0.00,$91.79,$0.00,$45.90,$72.70,$73.43,$0.00,$0.00,$0.00,$0.00,$0.00
310.60J,SUP,Custom 27203010,,310.60J  -  BIT DRILL 6MM 195MM JACOBS CHUCK NONSTRL,$274.33,$0.00,$274.33,$0.00,$195.79,$0.00,$0.00,$0.00,$0.00,$0.00,$274.33,$0.00,$137.16,$217.27,$219.46,$0.00,$0.00,$0.00,$0.00,$0.00
3100-25,SUP,Custom 27203010,,KIT SYR ART LN 25 UN 1ML BAL HEP,$1.35,$0.00,$1.35,$0.00,$0.96,$0.00,$0.00,$0.00,$0.00,$0.00,$1.35,$0.00,$0.68,$1.07,$1.08,$0.00,$0.00,$0.00,$0.00,$0.00
31004U,SUP,Custom 27203010,,KIT IMMUN TST ELISA SPHL IGG 96 TST,$343.20,$0.00,$343.20,$0.00,$244.94,$0.00,$0.00,$0.00,$0.00,$0.00,$343.20,$0.00,$171.60,$271.81,$274.56,$0.00,$0.00,$0.00,$0.00,$0.00
310-25M,SUP,Custom 27803010,,310-25M  -  VALVE MTRL 25MM MSC CNCH PIG,"$19,500.00",$0.00,"$19,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$19,500.00",$0.00,"$9,750.00","$15,444.00","$15,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
310-31M,SUP,Custom 27803010,,310-31M  -  VALVE MTRL 31MM MSC CNCH PIG,"$19,500.00",$0.00,"$19,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$19,500.00",$0.00,"$9,750.00","$15,444.00","$15,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
310-33M,SUP,Custom 27803010,,310-33M  -  VALVE MTRL 33MM MSC CNCH PIG,"$19,500.00",$0.00,"$19,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$19,500.00",$0.00,"$9,750.00","$15,444.00","$15,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
310C29,SUP,Custom 27803010,,310C29  -  VALVE MTRL 29MM MSC HRT PIG CNCH HLDR 310,"$19,500.00",$0.00,"$19,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$19,500.00",$0.00,"$9,750.00","$15,444.00","$15,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
311.031.01S,SUP,HCPCS C1713,,311.031.01S  -  TAP 4MM SLFDRILL MNQK CPLNG STOP SURG 1.5MM RESORB CORTEX,$751.50,$0.00,$751.50,$338.18,$536.35,$0.00,$129.48,$0.00,$0.00,$131.58,$751.50,$0.00,$375.75,$595.19,$601.20,$0.00,$117.61,$0.00,$119.64,$0.00
311.032.01S,SUP,HCPCS C1713,,311.032.01S  -  TAP 6MM SLFDRILL MNQK CPLNG STOP SURG 1.5MM RESORB CORTEX,$751.50,$0.00,$751.50,$338.18,$536.35,$0.00,$129.48,$0.00,$0.00,$131.58,$751.50,$0.00,$375.75,$595.19,$601.20,$0.00,$117.61,$0.00,$119.64,$0.00
311.033.01S,SUP,HCPCS C1713,,311.033.01S  -  TAP 3MM SLFDRILL MNQK CPLNG STOP SURG 1.5MM RESORB CORTEX,$751.50,$0.00,$751.50,$338.18,$536.35,$0.00,$129.48,$0.00,$0.00,$131.58,$751.50,$0.00,$375.75,$595.19,$601.20,$0.00,$117.61,$0.00,$119.64,$0.00
311.034.01S,SUP,HCPCS C1713,,311.034.01S  -  TAP 2MM RESORB CORTEX SCR 4MM SLFDRILL MNQK CPLNG STOP SURG,$751.50,$0.00,$751.50,$338.18,$536.35,$0.00,$129.48,$0.00,$0.00,$131.58,$751.50,$0.00,$375.75,$595.19,$601.20,$0.00,$117.61,$0.00,$119.64,$0.00
311.035.01S,SUP,HCPCS C1713,,311.035.01S  -  TAP 5MM SLFDRILL MNQK CPLNG STOP SURG 1.5MM RESORB CORTEX,$751.50,$0.00,$751.50,$338.18,$536.35,$0.00,$129.48,$0.00,$0.00,$131.58,$751.50,$0.00,$375.75,$595.19,$601.20,$0.00,$117.61,$0.00,$119.64,$0.00
311.035.97S,SUP,HCPCS C1713,,311.035.97S  -  TAP SURG 1.5MM 5MM RESORB STOP STERILE CORTICAL SCREW,$679.80,$0.00,$679.80,$305.91,$485.17,$0.00,$113.71,$0.00,$0.00,$119.03,$679.80,$0.00,$339.90,$538.40,$543.84,$0.00,$103.29,$0.00,$108.22,$0.00
311.036.01S,SUP,HCPCS C1713,,311.036.01S  -  TAP 2MM RESORB CORTEX SCR 6MM SLFDRILL MNQK CPLNG STOP SURG,$751.50,$0.00,$751.50,$338.18,$536.35,$0.00,$129.48,$0.00,$0.00,$131.58,$751.50,$0.00,$375.75,$595.19,$601.20,$0.00,$117.61,$0.00,$119.64,$0.00
311.037.01S,SUP,HCPCS C1713,,311.037.01S  -  TAP 8MM SLFDRILL MNQK CPLNG STOP SURG 1.5MM RESORB CORTEX,$751.50,$0.00,$751.50,$338.18,$536.35,$0.00,$129.48,$0.00,$0.00,$131.58,$751.50,$0.00,$375.75,$595.19,$601.20,$0.00,$117.61,$0.00,$119.64,$0.00
311.038.01S,SUP,HCPCS C1713,,311.038.01S  -  TAP 2MM RESORB CORTEX SCR 8MM SLFDRILL MNQK CPLNG STOP SURG,$751.50,$0.00,$751.50,$338.18,$536.35,$0.00,$129.48,$0.00,$0.00,$131.58,$751.50,$0.00,$375.75,$595.19,$601.20,$0.00,$117.61,$0.00,$119.64,$0.00
311.044.01S,SUP,HCPCS C1713,,311.044.01S  -  TAP 4MM SLFDRILL MNQK CPLNG STOP SURG 2.5MM RESORB ER SCR,$751.50,$0.00,$751.50,$338.18,$536.35,$0.00,$129.48,$0.00,$0.00,$131.58,$751.50,$0.00,$375.75,$595.19,$601.20,$0.00,$117.61,$0.00,$119.64,$0.00
311.046.01S,SUP,HCPCS C1713,,311.046.01S  -  TAP 6MM SLFDRILL MNQK CPLNG STOP SURG 2.5MM RESORB ER SCR,$751.50,$0.00,$751.50,$338.18,$536.35,$0.00,$129.48,$0.00,$0.00,$131.58,$751.50,$0.00,$375.75,$595.19,$601.20,$0.00,$117.61,$0.00,$119.64,$0.00
311.048.01S,SUP,HCPCS C1713,,311.048.01S  -  TAP 8MM SLFDRILL MNQK CPLNG STOP SURG 2.5MM RESORB ER SCR,$751.50,$0.00,$751.50,$338.18,$536.35,$0.00,$129.48,$0.00,$0.00,$131.58,$751.50,$0.00,$375.75,$595.19,$601.20,$0.00,$117.61,$0.00,$119.64,$0.00
311.054.01S,SUP,HCPCS C1713,,311.054.01S  -  TAP 2MM RESORB CORTEX SCR 1.5MM PLT 4MM SLFDRILL MNQK CPLNG,$751.50,$0.00,$751.50,$338.18,$536.35,$0.00,$129.48,$0.00,$0.00,$131.58,$751.50,$0.00,$375.75,$595.19,$601.20,$0.00,$117.61,$0.00,$119.64,$0.00
311.056.01S,SUP,HCPCS C1713,,311.056.01S  -  TAP 2MM RESORB CORTEX SCR 1.5MM PLT 6MM SLFDRILL MNQK CPLNG,$751.50,$0.00,$751.50,$338.18,$536.35,$0.00,$129.48,$0.00,$0.00,$131.58,$751.50,$0.00,$375.75,$595.19,$601.20,$0.00,$117.61,$0.00,$119.64,$0.00
311.056.97S,SUP,HCPCS C1713,,311.056.97S  -  TAP SURG 6MM STERILE 2MM RESORB CORTICAL SCREW,$679.80,$0.00,$679.80,$305.91,$485.17,$0.00,$113.71,$0.00,$0.00,$119.03,$679.80,$0.00,$339.90,$538.40,$543.84,$0.00,$103.29,$0.00,$108.22,$0.00
311.058.01S,SUP,HCPCS C1713,,311.058.01S  -  TAP 2MM RESORB CORTEX SCR 1.5MM PLT 8MM SLFDRILL MNQK CPLNG,$751.50,$0.00,$751.50,$338.18,$536.35,$0.00,$129.48,$0.00,$0.00,$131.58,$751.50,$0.00,$375.75,$595.19,$601.20,$0.00,$117.61,$0.00,$119.64,$0.00
311.060.01S,SUP,HCPCS C1713,,311.060.01S  -  TAP 4MM STOP SLFDRILL HEX CPLNG SURG 1.5MM RESORB CORTEX SCR,$751.50,$0.00,$751.50,$338.18,$536.35,$0.00,$129.48,$0.00,$0.00,$131.58,$751.50,$0.00,$375.75,$595.19,$601.20,$0.00,$117.61,$0.00,$119.64,$0.00
311.061.01S,SUP,HCPCS C1713,,311.061.01S  -  TAP 6MM STOP SLFDRILL HEX CPLNG SURG 1.5MM RESORB CORTEX SCR,$751.50,$0.00,$751.50,$338.18,$536.35,$0.00,$129.48,$0.00,$0.00,$131.58,$751.50,$0.00,$375.75,$595.19,$601.20,$0.00,$117.61,$0.00,$119.64,$0.00
311.062.01S,SUP,HCPCS C1713,,311.062.01S  -  TAP 3MM SLFDRILL HEX CPLNG STOP SURG 1.5MM RESORB CORTEX SCR,$751.50,$0.00,$751.50,$338.18,$536.35,$0.00,$129.48,$0.00,$0.00,$131.58,$751.50,$0.00,$375.75,$595.19,$601.20,$0.00,$117.61,$0.00,$119.64,$0.00
311.063.01S,SUP,HCPCS C1713,,311.063.01S  -  TAP 4MM STOP SLFDRILL HEX CPLNG SURG 2MM RESORB CORTEX SCR,$751.50,$0.00,$751.50,$338.18,$536.35,$0.00,$129.48,$0.00,$0.00,$131.58,$751.50,$0.00,$375.75,$595.19,$601.20,$0.00,$117.61,$0.00,$119.64,$0.00
311.064.01S,SUP,HCPCS C1713,,311.064.01S  -  TAP 6MM STOP SLFDRILL HEX CPLNG SURG 2MM RESORB CORTEX SCR,$751.50,$0.00,$751.50,$338.18,$536.35,$0.00,$129.48,$0.00,$0.00,$131.58,$751.50,$0.00,$375.75,$595.19,$601.20,$0.00,$117.61,$0.00,$119.64,$0.00
311.065.01S,SUP,HCPCS C1713,,311.065.01S  -  TAP 2MM RESORB CORTEX SCR 8MM SLFDRILL HEX CPLNG STOP SURG,$751.50,$0.00,$751.50,$338.18,$536.35,$0.00,$129.48,$0.00,$0.00,$131.58,$751.50,$0.00,$375.75,$595.19,$601.20,$0.00,$117.61,$0.00,$119.64,$0.00
311.067.01S,SUP,HCPCS C1713,,311.067.01S  -  TAP 4MM SLFDRILL HEX CPLNG STOP SURG 2MM RESORB CORTEX SCR,$751.50,$0.00,$751.50,$338.18,$536.35,$0.00,$129.48,$0.00,$0.00,$131.58,$751.50,$0.00,$375.75,$595.19,$601.20,$0.00,$117.61,$0.00,$119.64,$0.00
311.068.01S,SUP,HCPCS C1713,,311.068.01S  -  TAP 6MM SLFDRILL HEX CPLNG STOP SURG 2MM RESORB CORTEX SCR,$751.50,$0.00,$751.50,$338.18,$536.35,$0.00,$129.48,$0.00,$0.00,$131.58,$751.50,$0.00,$375.75,$595.19,$601.20,$0.00,$117.61,$0.00,$119.64,$0.00
311.069.01S,SUP,HCPCS C1713,,311.069.01S  -  TAP 2MM RESORB CORTEX SCR 1.5MM PLT 8MM SLFDRILL HEX CPLNG,$751.50,$0.00,$751.50,$338.18,$536.35,$0.00,$129.48,$0.00,$0.00,$131.58,$751.50,$0.00,$375.75,$595.19,$601.20,$0.00,$117.61,$0.00,$119.64,$0.00
311.071.01S,SUP,HCPCS C1713,,311.071.01S  -  TAP 4MM SLFDRILL HEX CPLNG STOP SURG 2.5MM RESORB ER SCR,$751.50,$0.00,$751.50,$338.18,$536.35,$0.00,$129.48,$0.00,$0.00,$131.58,$751.50,$0.00,$375.75,$595.19,$601.20,$0.00,$117.61,$0.00,$119.64,$0.00
311.072.01S,SUP,HCPCS C1713,,311.072.01S  -  TAP 6MM SLFDRILL HEX CPLNG STOP SURG 2.5MM RESORB ER SCR,$751.50,$0.00,$751.50,$338.18,$536.35,$0.00,$129.48,$0.00,$0.00,$131.58,$751.50,$0.00,$375.75,$595.19,$601.20,$0.00,$117.61,$0.00,$119.64,$0.00
311.073.01S,SUP,HCPCS C1713,,311.073.01S  -  TAP 8MM SLFDRILL HEX CPLNG STOP SURG 2.5MM RESORB ER SCR,$751.50,$0.00,$751.50,$338.18,$536.35,$0.00,$129.48,$0.00,$0.00,$131.58,$751.50,$0.00,$375.75,$595.19,$601.20,$0.00,$117.61,$0.00,$119.64,$0.00
311.093.01S,SUP,HCPCS C1713,,311.093.01S  -  TAP 5MM SLFDRILL HEX CPLNG STOP SURG 1.5MM RESORB CORTEX SCR,$751.50,$0.00,$751.50,$338.18,$536.35,$0.00,$129.48,$0.00,$0.00,$131.58,$751.50,$0.00,$375.75,$595.19,$601.20,$0.00,$117.61,$0.00,$119.64,$0.00
311.094.01S,SUP,HCPCS C1713,,311.094.01S  -  TAP 8MM SLFDRILL HEX CPLNG STOP SURG 1.5MM RESORB CORTEX SCR,$751.50,$0.00,$751.50,$338.18,$536.35,$0.00,$129.48,$0.00,$0.00,$131.58,$751.50,$0.00,$375.75,$595.19,$601.20,$0.00,$117.61,$0.00,$119.64,$0.00
311.100.01S,SUP,HCPCS C1713,,311.100.01S  -  TAP SLFDRILL ADJ LGTH SURG 1.5 MM SCR STRL,"$1,021.50",$0.00,"$1,021.50",$459.68,$729.04,$0.00,$176.00,$0.00,$0.00,$178.86,"$1,021.50",$0.00,$510.75,$809.03,$817.20,$0.00,$159.86,$0.00,$162.62,$0.00
311.101.01S,SUP,HCPCS C1713,,311.101.01S  -  TAP SLFDRILL ADJ LGTH SURG 2 MM SCR STRL,"$1,021.50",$0.00,"$1,021.50",$459.68,$729.04,$0.00,$176.00,$0.00,$0.00,$178.86,"$1,021.50",$0.00,$510.75,$809.03,$817.20,$0.00,$159.86,$0.00,$162.62,$0.00
311.102.01S,SUP,HCPCS C1713,,311.102.01S  -  TAP SLFDRILL ADJ LGTH SURG 2.5 MM SCR STRL,"$1,021.50",$0.00,"$1,021.50",$459.68,$729.04,$0.00,$176.00,$0.00,$0.00,$178.86,"$1,021.50",$0.00,$510.75,$809.03,$817.20,$0.00,$159.86,$0.00,$162.62,$0.00
311.110.01S,SUP,HCPCS C1713,,311.110.01S  -  TAP SLFDRILL HEX CPLNG ADJ SURG 1.5 MM RESORB CORTEX SCR,"$1,021.50",$0.00,"$1,021.50",$459.68,$729.04,$0.00,$176.00,$0.00,$0.00,$178.86,"$1,021.50",$0.00,$510.75,$809.03,$817.20,$0.00,$159.86,$0.00,$162.62,$0.00
311.111.01S,SUP,HCPCS C1713,,311.111.01S  -  TAP SLFDRILL HEX CPLNG ADJ SURG 2 MM RESORB CORTEX SCR STRL,"$1,021.50",$0.00,"$1,021.50",$459.68,$729.04,$0.00,$176.00,$0.00,$0.00,$178.86,"$1,021.50",$0.00,$510.75,$809.03,$817.20,$0.00,$159.86,$0.00,$162.62,$0.00
311.112.01S,SUP,HCPCS C1713,,311.112.01S  -  TAP SLFDRILL ADJ LGTH HEX CPLNG SURG 2.5 MM SCR STRL,"$1,021.50",$0.00,"$1,021.50",$459.68,$729.04,$0.00,$176.00,$0.00,$0.00,$178.86,"$1,021.50",$0.00,$510.75,$809.03,$817.20,$0.00,$159.86,$0.00,$162.62,$0.00
311.21.98,SUP,HCPCS C1713,,311.21.98  -  TAP LNG MNQK CPLNG SURG 2MM CORTEX SCR,$283.50,$0.00,$283.50,$127.58,$202.33,$0.00,$48.85,$0.00,$0.00,$49.64,$283.50,$0.00,$141.75,$224.53,$226.80,$0.00,$44.37,$0.00,$45.13,$0.00
3120-0170S,SUP,HCPCS C1713,,3120-0170S  -  NAIL 10MM 170MM TROC HIP GAMMA3 IM 120D TI STRL,"$2,798.13",$0.00,"$2,798.13","$1,259.16","$1,997.02",$0.00,$482.10,$0.00,$0.00,$489.93,"$2,798.13",$0.00,"$1,399.06","$2,216.12","$2,238.50",$0.00,$437.91,$0.00,$445.46,$0.00
3120-1180S,SUP,HCPCS C1713,,3120-1180S  -  NAIL 11MM 180MM TROC HIP GAMMA3 IM 120D TI STRL,"$2,124.38",$0.00,"$2,124.38",$955.97,"$1,516.17",$0.00,$366.02,$0.00,$0.00,$371.96,"$2,124.38",$0.00,"$1,062.19","$1,682.51","$1,699.50",$0.00,$332.46,$0.00,$338.20,$0.00
3125-0170S,SUP,HCPCS C1713,,3125-0170S  -  NAIL 10MM 170MM TROC HIP GAMMA3 IM 125D TI STRL,"$2,798.13",$0.00,"$2,798.13","$1,259.16","$1,997.02",$0.00,$482.10,$0.00,$0.00,$489.93,"$2,798.13",$0.00,"$1,399.06","$2,216.12","$2,238.50",$0.00,$437.91,$0.00,$445.46,$0.00
3125-1180S,SUP,HCPCS C1713,,3125-1180S  -  NAIL 11MM 180MM TROC HIP GAMMA3 IM 125D TI STRL,"$2,124.38",$0.00,"$2,124.38",$955.97,"$1,516.17",$0.00,$366.02,$0.00,$0.00,$371.96,"$2,124.38",$0.00,"$1,062.19","$1,682.51","$1,699.50",$0.00,$332.46,$0.00,$338.20,$0.00
31287751A,SUP,Custom 27203010,,CABLE EKG 5 LEAD 12 PNDN PT MONITR D-1585,$327.50,$0.00,$327.50,$0.00,$233.74,$0.00,$0.00,$0.00,$0.00,$0.00,$327.50,$0.00,$163.75,$259.38,$262.00,$0.00,$0.00,$0.00,$0.00,$0.00
3130-0170S,SUP,HCPCS C1713,,3130-0170S  -  NAIL 10MM 170MM HIP TROC GAMMA3 IM 130D KIT TI STRL,"$2,798.13",$0.00,"$2,798.13","$1,259.16","$1,997.02",$0.00,$482.10,$0.00,$0.00,$489.93,"$2,798.13",$0.00,"$1,399.06","$2,216.12","$2,238.50",$0.00,$437.91,$0.00,$445.46,$0.00
3130-1180S,SUP,HCPCS C1713,,3130-1180S  -  NAIL 11MM 180MM TROC HIP GAMMA3 IM 130D TI STRL,"$2,124.38",$0.00,"$2,124.38",$955.97,"$1,516.17",$0.00,$366.02,$0.00,$0.00,$371.96,"$2,124.38",$0.00,"$1,062.19","$1,682.51","$1,699.50",$0.00,$332.46,$0.00,$338.20,$0.00
313-7034EA,SUP,Custom 27203010,,313-7034EA  -  MASK CPAP 02 RESQ BITRAC ED WITH 7.5 CM VALVE & FLOW GENERAT,$100.00,$0.00,$100.00,$0.00,$71.37,$0.00,$0.00,$0.00,$0.00,$0.00,$100.00,$0.00,$50.00,$79.20,$80.00,$0.00,$0.00,$0.00,$0.00,$0.00
314.746S,SUP,Custom 27203010,,314.746S  -  ASSEMBLY TUBE 520MM REAMER IRRIGATOR ASPIRAT STERILE,$800.18,$0.00,$800.18,$0.00,$571.08,$0.00,$0.00,$0.00,$0.00,$0.00,$800.18,$0.00,$400.09,$633.74,$640.14,$0.00,$0.00,$0.00,$0.00,$0.00
31-462,SUP,HCPCS C1887,,31-462  -  CATHETER 5FR 65CM COBRA 1,$30.00,$0.00,$30.00,$16.29,$21.41,$0.00,$5.17,$0.00,$0.00,$5.25,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$4.70,$0.00,$4.78,$0.00
31-466,SUP,HCPCS C1887,,31-466  -  CATHETER 5FR 65CM COBRA 2,$30.00,$0.00,$30.00,$16.29,$21.41,$0.00,$5.17,$0.00,$0.00,$5.25,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$4.70,$0.00,$4.78,$0.00
315.40S,SUP,Custom 27203010,,315.40S  -  BIT DRILL 195MM 4MM QC 3 FLT STRL,$369.65,$0.00,$369.65,$0.00,$263.82,$0.00,$0.00,$0.00,$0.00,$0.00,$369.65,$0.00,$184.83,$292.76,$295.72,$0.00,$0.00,$0.00,$0.00,$0.00
31560-950,SUP,Custom 27203010,,BULB SCP 3.5V FBROP LGHT HEAD ANOSCP SGSCP KLNSPC DISP,"$1,092.50",$0.00,"$1,092.50",$0.00,$779.72,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,092.50",$0.00,$546.25,$865.26,$874.00,$0.00,$0.00,$0.00,$0.00,$0.00
315-92,SUP,Custom 27203010,,BIT DRILL 230MM 2.5MM 200MM CLBRT QC 3 FLT NSTRL,$456.10,$0.00,$456.10,$0.00,$325.52,$0.00,$0.00,$0.00,$0.00,$0.00,$456.10,$0.00,$228.05,$361.23,$364.88,$0.00,$0.00,$0.00,$0.00,$0.00
316.114.96,SUP,Custom 27203010,,316.114.96  -  BIT DRILL 14MM STOP .76MM 44.5MM J LATCH NONSTRL,$238.83,$0.00,$238.83,$0.00,$170.45,$0.00,$0.00,$0.00,$0.00,$0.00,$238.83,$0.00,$119.41,$189.15,$191.06,$0.00,$0.00,$0.00,$0.00,$0.00
316.235.96,SUP,Custom 27203010,,316.235.96  -  BIT DRILL 35MM STOP 1MM 60MM J LATCH NONSTRL,$238.83,$0.00,$238.83,$0.00,$170.45,$0.00,$0.00,$0.00,$0.00,$0.00,$238.83,$0.00,$119.41,$189.15,$191.06,$0.00,$0.00,$0.00,$0.00,$0.00
316.335.96,SUP,Custom 27203010,,316.335.96  -  BIT DRILL 40MM STOP 1.3MM 65MM J LATCH NONSTRL,$238.83,$0.00,$238.83,$0.00,$170.45,$0.00,$0.00,$0.00,$0.00,$0.00,$238.83,$0.00,$119.41,$189.15,$191.06,$0.00,$0.00,$0.00,$0.00,$0.00
317.235.96,SUP,Custom 27203010,,317.235.96  -  BIT DRILL 40MM STOP 1.1MM 65MM J LATCH TITANIUM NONSTRL,$238.83,$0.00,$238.83,$0.00,$170.45,$0.00,$0.00,$0.00,$0.00,$0.00,$238.83,$0.00,$119.41,$189.15,$191.06,$0.00,$0.00,$0.00,$0.00,$0.00
317.435.96,SUP,Custom 27203010,,317.435.96  -  BIT DRILL 60MM STOP 1.5MM 85MM J LATCH NONSTRL,$238.83,$0.00,$238.83,$0.00,$170.45,$0.00,$0.00,$0.00,$0.00,$0.00,$238.83,$0.00,$119.41,$189.15,$191.06,$0.00,$0.00,$0.00,$0.00,$0.00
319416AM,SUP,Custom 27203010,,319416AM  -  TRAY CATHETERIZATION 16FR 2 CONCTR TEMPERATURE SENSE,$68.56,$0.00,$68.56,$0.00,$48.93,$0.00,$0.00,$0.00,$0.00,$0.00,$68.56,$0.00,$34.28,$54.30,$54.85,$0.00,$0.00,$0.00,$0.00,$0.00
31AJ-501,SUP,Custom 27803010,,31AJ-501  -  VALVE AORTIC 85D 5.18SQ CM 31MM 26.1MM MECHANICAL HEART,"$11,250.00",$0.00,"$11,250.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,250.00",$0.00,"$5,625.00","$8,910.00","$9,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
31MJ-501,SUP,Custom 27803010,,31MJ-501  -  VALVE MTRL 85D 5.18SQ CM STD 31MM 26.1MM MSTR-SER CUF LFLT,"$17,425.00",$0.00,"$17,425.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$17,425.00",$0.00,"$8,712.50","$13,800.60","$13,940.00",$0.00,$0.00,$0.00,$0.00,$0.00
3220-0240S,SUP,HCPCS C1713,,3220-0240S  -  NAIL 11MM 240MM RIGHT FEM HIP GAMMA3 IM 120D LNG STRL,"$2,447.50",$0.00,"$2,447.50","$1,101.38","$1,746.78",$0.00,$421.69,$0.00,$0.00,$428.54,"$2,447.50",$0.00,"$1,223.75","$1,938.42","$1,958.00",$0.00,$383.03,$0.00,$389.64,$0.00
3220-0260S,SUP,HCPCS C1713,,3220-0260S  -  NAIL 11MM 260MM RIGHT FEM HIP GAMMA3 IM 120D LNG STRL,"$2,447.50",$0.00,"$2,447.50","$1,101.38","$1,746.78",$0.00,$421.69,$0.00,$0.00,$428.54,"$2,447.50",$0.00,"$1,223.75","$1,938.42","$1,958.00",$0.00,$383.03,$0.00,$389.64,$0.00
3220-0280S,SUP,HCPCS C1713,,3220-0280S  -  NAIL 11MM 28CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL,"$2,798.13",$0.00,"$2,798.13","$1,259.16","$1,997.02",$0.00,$482.10,$0.00,$0.00,$489.93,"$2,798.13",$0.00,"$1,399.06","$2,216.12","$2,238.50",$0.00,$437.91,$0.00,$445.46,$0.00
3220-0300S,SUP,HCPCS C1713,,3220-0300S  -  NAIL 11MM 30CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL,"$3,093.75",$0.00,"$3,093.75","$1,392.19","$2,208.01",$0.00,$533.04,$0.00,$0.00,$541.69,"$3,093.75",$0.00,"$1,546.88","$2,450.25","$2,475.00",$0.00,$484.17,$0.00,$492.53,$0.00
3220-0320S,SUP,HCPCS C1713,,3220-0320S  -  NAIL 11MM 32CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL,"$3,093.75",$0.00,"$3,093.75","$1,392.19","$2,208.01",$0.00,$533.04,$0.00,$0.00,$541.69,"$3,093.75",$0.00,"$1,546.88","$2,450.25","$2,475.00",$0.00,$484.17,$0.00,$492.53,$0.00
3220-0340S,SUP,HCPCS C1713,,3220-0340S  -  NAIL 11MM 34CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL,"$3,093.75",$0.00,"$3,093.75","$1,392.19","$2,208.01",$0.00,$533.04,$0.00,$0.00,$541.69,"$3,093.75",$0.00,"$1,546.88","$2,450.25","$2,475.00",$0.00,$484.17,$0.00,$492.53,$0.00
3220-0360S,SUP,HCPCS C1713,,3220-0360S  -  NAIL 11MM 36CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL,"$3,093.75",$0.00,"$3,093.75","$1,392.19","$2,208.01",$0.00,$533.04,$0.00,$0.00,$541.69,"$3,093.75",$0.00,"$1,546.88","$2,450.25","$2,475.00",$0.00,$484.17,$0.00,$492.53,$0.00
3220-0380S,SUP,HCPCS C1713,,3220-0380S  -  NAIL 11MM 38CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL,"$3,093.75",$0.00,"$3,093.75","$1,392.19","$2,208.01",$0.00,$533.04,$0.00,$0.00,$541.69,"$3,093.75",$0.00,"$1,546.88","$2,450.25","$2,475.00",$0.00,$484.17,$0.00,$492.53,$0.00
3220-0400S,SUP,HCPCS C1713,,3220-0400S  -  NAIL 11MM 40CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL,"$3,093.75",$0.00,"$3,093.75","$1,392.19","$2,208.01",$0.00,$533.04,$0.00,$0.00,$541.69,"$3,093.75",$0.00,"$1,546.88","$2,450.25","$2,475.00",$0.00,$484.17,$0.00,$492.53,$0.00
3220-0420S,SUP,HCPCS C1713,,3220-0420S  -  NAIL 11MM 42CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL,"$3,093.75",$0.00,"$3,093.75","$1,392.19","$2,208.01",$0.00,$533.04,$0.00,$0.00,$541.69,"$3,093.75",$0.00,"$1,546.88","$2,450.25","$2,475.00",$0.00,$484.17,$0.00,$492.53,$0.00
3220-0440S,SUP,HCPCS C1713,,3220-0440S  -  NAIL 11MM 44CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL,"$3,093.75",$0.00,"$3,093.75","$1,392.19","$2,208.01",$0.00,$533.04,$0.00,$0.00,$541.69,"$3,093.75",$0.00,"$1,546.88","$2,450.25","$2,475.00",$0.00,$484.17,$0.00,$492.53,$0.00
3220-0460S,SUP,HCPCS C1713,,3220-0460S  -  NAIL 11MM 46CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL,"$2,798.13",$0.00,"$2,798.13","$1,259.16","$1,997.02",$0.00,$482.10,$0.00,$0.00,$489.93,"$2,798.13",$0.00,"$1,399.06","$2,216.12","$2,238.50",$0.00,$437.91,$0.00,$445.46,$0.00
3220-3340S,SUP,HCPCS C1713,,3220-3340S  -  NAIL 13MM 34CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3220-3360S,SUP,HCPCS C1713,,3220-3360S  -  NAIL 13MM 36CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3220-3380S,SUP,HCPCS C1713,,3220-3380S  -  NAIL 13MM 38CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3220-3400S,SUP,HCPCS C1713,,3220-3400S  -  NAIL 13MM 40CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3220-3420S,SUP,HCPCS C1713,,3220-3420S  -  NAIL 13MM 42CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3220-3440S,SUP,HCPCS C1713,,3220-3440S  -  NAIL 13MM 44CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3220-3460S,SUP,HCPCS C1713,,3220-3460S  -  NAIL 13MM 46CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3220-5340S,SUP,HCPCS C1713,,3220-5340S  -  NAIL 15MM 34CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3220-5360S,SUP,HCPCS C1713,,3220-5360S  -  NAIL 15MM 36CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3220-5380S,SUP,HCPCS C1713,,3220-5380S  -  NAIL 15MM 38CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3220-5400S,SUP,HCPCS C1713,,3220-5400S  -  NAIL 15MM 40CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3220-5420S,SUP,HCPCS C1713,,3220-5420S  -  NAIL 15MM 42CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3220-5440S,SUP,HCPCS C1713,,3220-5440S  -  NAIL 15MM 44CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3220-5460S,SUP,HCPCS C1713,,3220-5460S  -  NAIL 15MM 46CM RIGHT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
32-250,SUP,HCPCS C1713,,32-250  -  HOLDER NDL CRV 9IN STRATTE INS SHNK TC,$373.33,$0.00,$373.33,$168.00,$266.44,$0.00,$64.32,$0.00,$0.00,$65.37,$373.33,$0.00,$186.66,$295.68,$298.66,$0.00,$58.43,$0.00,$59.43,$0.00
3225-0240S,SUP,HCPCS C1713,,3225-0240S  -  NAIL 11MM 240MM HIP RIGHT GAMMA3 IM 125D LNG,"$2,798.13",$0.00,"$2,798.13","$1,259.16","$1,997.02",$0.00,$482.10,$0.00,$0.00,$489.93,"$2,798.13",$0.00,"$1,399.06","$2,216.12","$2,238.50",$0.00,$437.91,$0.00,$445.46,$0.00
3225-0260S,SUP,HCPCS C1713,,3225-0260S  -  NAIL 11MM 260MM RIGHT FEM HIP GAMMA3 IM 125D LNG STRL,"$2,688.13",$0.00,"$2,688.13","$1,209.66","$1,918.51",$0.00,$463.15,$0.00,$0.00,$470.67,"$2,688.13",$0.00,"$1,344.06","$2,129.00","$2,150.50",$0.00,$420.69,$0.00,$427.95,$0.00
3225-0280S,SUP,HCPCS C1713,,3225-0280S  -  NAIL 11MM 28CM RIGHT FEM HIP GAMMA3 IM 125D LNG KIT TI STRL,"$2,798.13",$0.00,"$2,798.13","$1,259.16","$1,997.02",$0.00,$482.10,$0.00,$0.00,$489.93,"$2,798.13",$0.00,"$1,399.06","$2,216.12","$2,238.50",$0.00,$437.91,$0.00,$445.46,$0.00
3225-0300S,SUP,HCPCS C1713,,3225-0300S  -  NAIL 11MM 30CM RIGHT FEM HIP GAMMA3 IM 125D LNG KIT TI STRL,"$3,093.75",$0.00,"$3,093.75","$1,392.19","$2,208.01",$0.00,$533.04,$0.00,$0.00,$541.69,"$3,093.75",$0.00,"$1,546.88","$2,450.25","$2,475.00",$0.00,$484.17,$0.00,$492.53,$0.00
3225-0320S,SUP,HCPCS C1713,,3225-0320S  -  NAIL 11MM 32CM RIGHT FEM HIP GAMMA3 IM 125D LNG KIT TI STRL,"$3,093.75",$0.00,"$3,093.75","$1,392.19","$2,208.01",$0.00,$533.04,$0.00,$0.00,$541.69,"$3,093.75",$0.00,"$1,546.88","$2,450.25","$2,475.00",$0.00,$484.17,$0.00,$492.53,$0.00
3225-0340S,SUP,HCPCS C1713,,3225-0340S  -  NAIL 11MM 34CM RIGHT FEM HIP GAMMA3 IM 125D LNG KIT TI STRL,"$3,093.75",$0.00,"$3,093.75","$1,392.19","$2,208.01",$0.00,$533.04,$0.00,$0.00,$541.69,"$3,093.75",$0.00,"$1,546.88","$2,450.25","$2,475.00",$0.00,$484.17,$0.00,$492.53,$0.00
3225-0360S,SUP,HCPCS C1713,,3225-0360S  -  NAIL 11MM 36CM RIGHT FEM HIP GAMMA3 IM 125D LNG KIT TI STRL,"$3,093.75",$0.00,"$3,093.75","$1,392.19","$2,208.01",$0.00,$533.04,$0.00,$0.00,$541.69,"$3,093.75",$0.00,"$1,546.88","$2,450.25","$2,475.00",$0.00,$484.17,$0.00,$492.53,$0.00
3225-0380S,SUP,HCPCS C1713,,3225-0380S  -  NAIL 11MM 38CM RIGHT FEM HIP GAMMA3 IM 125D LNG KIT TI STRL,"$3,093.75",$0.00,"$3,093.75","$1,392.19","$2,208.01",$0.00,$533.04,$0.00,$0.00,$541.69,"$3,093.75",$0.00,"$1,546.88","$2,450.25","$2,475.00",$0.00,$484.17,$0.00,$492.53,$0.00
3225-0400S,SUP,HCPCS C1713,,3225-0400S  -  NAIL 11MM 40CM RIGHT FEM HIP GAMMA3 IM 125D LNG KIT TI STRL,"$3,093.75",$0.00,"$3,093.75","$1,392.19","$2,208.01",$0.00,$533.04,$0.00,$0.00,$541.69,"$3,093.75",$0.00,"$1,546.88","$2,450.25","$2,475.00",$0.00,$484.17,$0.00,$492.53,$0.00
3225-0420S,SUP,HCPCS C1713,,3225-0420S  -  NAIL 11MM 42CM RIGHT FEM HIP GAMMA3 IM 125D LNG KIT TI STRL,"$3,093.75",$0.00,"$3,093.75","$1,392.19","$2,208.01",$0.00,$533.04,$0.00,$0.00,$541.69,"$3,093.75",$0.00,"$1,546.88","$2,450.25","$2,475.00",$0.00,$484.17,$0.00,$492.53,$0.00
3225-0440S,SUP,HCPCS C1713,,3225-0440S  -  NAIL 11MM 44CM RIGHT FEM HIP GAMMA3 IM 125D LNG KIT TI STRL,"$3,093.75",$0.00,"$3,093.75","$1,392.19","$2,208.01",$0.00,$533.04,$0.00,$0.00,$541.69,"$3,093.75",$0.00,"$1,546.88","$2,450.25","$2,475.00",$0.00,$484.17,$0.00,$492.53,$0.00
3225-0460S,SUP,HCPCS C1713,,3225-0460S  -  NAIL 11MM 46CM RIGHT FEM HIP GAMMA3 IM 125D LNG KIT TI STRL,"$2,798.13",$0.00,"$2,798.13","$1,259.16","$1,997.02",$0.00,$482.10,$0.00,$0.00,$489.93,"$2,798.13",$0.00,"$1,399.06","$2,216.12","$2,238.50",$0.00,$437.91,$0.00,$445.46,$0.00
3225-3300S,SUP,HCPCS C1713,,3225-3300S  -  NAIL 13MM 300MM RIGHT FEM HIP GAMMA3 IM 125D LNG STRL,"$2,688.13",$0.00,"$2,688.13","$1,209.66","$1,918.51",$0.00,$463.15,$0.00,$0.00,$470.67,"$2,688.13",$0.00,"$1,344.06","$2,129.00","$2,150.50",$0.00,$420.69,$0.00,$427.95,$0.00
3225-3320S,SUP,HCPCS C1713,,3225-3320S  -  NAIL 13MM 32CM HIP RIGHT FEM GAMMA3 IM 125D LNG TI STRL,"$2,688.13",$0.00,"$2,688.13","$1,209.66","$1,918.51",$0.00,$463.15,$0.00,$0.00,$470.67,"$2,688.13",$0.00,"$1,344.06","$2,129.00","$2,150.50",$0.00,$420.69,$0.00,$427.95,$0.00
3225-3340S,SUP,HCPCS C1713,,3225-3340S  -  NAIL 13MM 34CM RIGHT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3225-3360S,SUP,HCPCS C1713,,3225-3360S  -  NAIL 13MM 36CM RIGHT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3225-3380S,SUP,HCPCS C1713,,3225-3380S  -  NAIL 13MM 38CM RIGHT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3225-3400S,SUP,HCPCS C1713,,3225-3400S  -  NAIL 13MM 40CM RIGHT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3225-3420S,SUP,HCPCS C1713,,3225-3420S  -  NAIL 13MM 42CM RIGHT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3225-3440S,SUP,HCPCS C1713,,3225-3440S  -  NAIL 13MM 44CM RIGHT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3225-3460S,SUP,HCPCS C1713,,3225-3460S  -  NAIL 13MM 46CM RIGHT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3225-5300S,SUP,HCPCS C1713,,3225-5300S  -  NAIL 15MM 300MM RIGHT FEM HIP GAMMA3 IM 125D LNG STRL,"$2,447.50",$0.00,"$2,447.50","$1,101.38","$1,746.78",$0.00,$421.69,$0.00,$0.00,$428.54,"$2,447.50",$0.00,"$1,223.75","$1,938.42","$1,958.00",$0.00,$383.03,$0.00,$389.64,$0.00
3225-5320S,SUP,HCPCS C1713,,3225-5320S  -  NAIL 15MM 320MM RIGHT FEM HIP GAMMA3 IM 125D LNG STRL,"$2,447.50",$0.00,"$2,447.50","$1,101.38","$1,746.78",$0.00,$421.69,$0.00,$0.00,$428.54,"$2,447.50",$0.00,"$1,223.75","$1,938.42","$1,958.00",$0.00,$383.03,$0.00,$389.64,$0.00
3225-5340S,SUP,HCPCS C1713,,3225-5340S  -  NAIL 15MM 34CM RIGHT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3225-5360S,SUP,HCPCS C1713,,3225-5360S  -  NAIL 15MM 36CM RIGHT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3225-5380S,SUP,HCPCS C1713,,3225-5380S  -  NAIL 15MM 38CM RIGHT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3225-5400S,SUP,HCPCS C1713,,3225-5400S  -  NAIL 15MM 40CM RIGHT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3225-5420S,SUP,HCPCS C1713,,3225-5420S  -  NAIL 15MM 42CM RIGHT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3225-5440S,SUP,HCPCS C1713,,3225-5440S  -  NAIL 15MM 44CM RIGHT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3225-5460S,SUP,HCPCS C1713,,3225-5460S  -  NAIL 15MM 46CM RIGHT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3230-0240S,SUP,HCPCS C1713,,3230-0240S  -  NAIL 11MM 240MM RIGHT FEM HIP GAMMA3 IM LNG 130D STRL,"$2,447.50",$0.00,"$2,447.50","$1,101.38","$1,746.78",$0.00,$421.69,$0.00,$0.00,$428.54,"$2,447.50",$0.00,"$1,223.75","$1,938.42","$1,958.00",$0.00,$383.03,$0.00,$389.64,$0.00
3230-0260S,SUP,HCPCS C1713,,3230-0260S  -  NAIL 11MM 260MM RIGHT FEM HIP GAMMA3 IM 130D LNG STRL,"$2,447.50",$0.00,"$2,447.50","$1,101.38","$1,746.78",$0.00,$421.69,$0.00,$0.00,$428.54,"$2,447.50",$0.00,"$1,223.75","$1,938.42","$1,958.00",$0.00,$383.03,$0.00,$389.64,$0.00
3230-0280S,SUP,HCPCS C1713,,3230-0280S  -  NAIL 11MM 28CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL,"$2,798.13",$0.00,"$2,798.13","$1,259.16","$1,997.02",$0.00,$482.10,$0.00,$0.00,$489.93,"$2,798.13",$0.00,"$1,399.06","$2,216.12","$2,238.50",$0.00,$437.91,$0.00,$445.46,$0.00
3230-0300S,SUP,HCPCS C1713,,3230-0300S  -  NAIL 11MM 30CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL,"$3,093.75",$0.00,"$3,093.75","$1,392.19","$2,208.01",$0.00,$533.04,$0.00,$0.00,$541.69,"$3,093.75",$0.00,"$1,546.88","$2,450.25","$2,475.00",$0.00,$484.17,$0.00,$492.53,$0.00
3230-0320S,SUP,HCPCS C1713,,3230-0320S  -  NAIL 11MM 32CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL,"$3,093.75",$0.00,"$3,093.75","$1,392.19","$2,208.01",$0.00,$533.04,$0.00,$0.00,$541.69,"$3,093.75",$0.00,"$1,546.88","$2,450.25","$2,475.00",$0.00,$484.17,$0.00,$492.53,$0.00
3230-0340S,SUP,HCPCS C1713,,3230-0340S  -  NAIL 11MM 34CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL,"$3,093.75",$0.00,"$3,093.75","$1,392.19","$2,208.01",$0.00,$533.04,$0.00,$0.00,$541.69,"$3,093.75",$0.00,"$1,546.88","$2,450.25","$2,475.00",$0.00,$484.17,$0.00,$492.53,$0.00
3230-0360S,SUP,HCPCS C1713,,3230-0360S  -  NAIL 11MM 36CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL,"$3,093.75",$0.00,"$3,093.75","$1,392.19","$2,208.01",$0.00,$533.04,$0.00,$0.00,$541.69,"$3,093.75",$0.00,"$1,546.88","$2,450.25","$2,475.00",$0.00,$484.17,$0.00,$492.53,$0.00
3230-0380S,SUP,HCPCS C1713,,3230-0380S  -  NAIL 11MM 38CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL,"$3,093.75",$0.00,"$3,093.75","$1,392.19","$2,208.01",$0.00,$533.04,$0.00,$0.00,$541.69,"$3,093.75",$0.00,"$1,546.88","$2,450.25","$2,475.00",$0.00,$484.17,$0.00,$492.53,$0.00
3230-0400S,SUP,HCPCS C1713,,3230-0400S  -  NAIL 11MM 40CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL,"$3,093.75",$0.00,"$3,093.75","$1,392.19","$2,208.01",$0.00,$533.04,$0.00,$0.00,$541.69,"$3,093.75",$0.00,"$1,546.88","$2,450.25","$2,475.00",$0.00,$484.17,$0.00,$492.53,$0.00
3230-0420S,SUP,HCPCS C1713,,3230-0420S  -  NAIL 11MM 42CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL,"$3,093.75",$0.00,"$3,093.75","$1,392.19","$2,208.01",$0.00,$533.04,$0.00,$0.00,$541.69,"$3,093.75",$0.00,"$1,546.88","$2,450.25","$2,475.00",$0.00,$484.17,$0.00,$492.53,$0.00
3230-0440S,SUP,HCPCS C1713,,3230-0440S  -  NAIL 11MM 44CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL,"$3,093.75",$0.00,"$3,093.75","$1,392.19","$2,208.01",$0.00,$533.04,$0.00,$0.00,$541.69,"$3,093.75",$0.00,"$1,546.88","$2,450.25","$2,475.00",$0.00,$484.17,$0.00,$492.53,$0.00
3230-0460S,SUP,HCPCS C1713,,3230-0460S  -  NAIL 11MM 46CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL,"$2,798.13",$0.00,"$2,798.13","$1,259.16","$1,997.02",$0.00,$482.10,$0.00,$0.00,$489.93,"$2,798.13",$0.00,"$1,399.06","$2,216.12","$2,238.50",$0.00,$437.91,$0.00,$445.46,$0.00
3230-3300S,SUP,HCPCS C1713,,3230-3300S  -  NAIL 13MM 300MM RIGHT FEM HIP GAMMA3 IM 130D LNG STRL,"$2,447.50",$0.00,"$2,447.50","$1,101.38","$1,746.78",$0.00,$421.69,$0.00,$0.00,$428.54,"$2,447.50",$0.00,"$1,223.75","$1,938.42","$1,958.00",$0.00,$383.03,$0.00,$389.64,$0.00
3230-3320S,SUP,HCPCS C1713,,3230-3320S  -  NAIL 13MM 32CM HIP RIGHT GAMMA3 IM LNG 130D,"$3,093.75",$0.00,"$3,093.75","$1,392.19","$2,208.01",$0.00,$533.04,$0.00,$0.00,$541.69,"$3,093.75",$0.00,"$1,546.88","$2,450.25","$2,475.00",$0.00,$484.17,$0.00,$492.53,$0.00
3230-3340S,SUP,HCPCS C1713,,3230-3340S  -  NAIL 13MM 34CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3230-3360S,SUP,HCPCS C1713,,3230-3360S  -  NAIL 13MM 36CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3230-3380S,SUP,HCPCS C1713,,3230-3380S  -  NAIL 13MM 38CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3230-3400S,SUP,HCPCS C1713,,3230-3400S  -  NAIL 13MM 40CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3230-3420S,SUP,HCPCS C1713,,3230-3420S  -  NAIL 13MM 42CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3230-3440S,SUP,HCPCS C1713,,3230-3440S  -  NAIL 13MM 44CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3230-3460S,SUP,HCPCS C1713,,3230-3460S  -  NAIL 13MM 46CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
323040R,SUP,Custom 27803010,,323040R  -  KEEL LARYNGEAL 12MM UMBRELLA SHAPE RADIOPQ MONTGOMERY,$235.00,$0.00,$235.00,$0.00,$167.72,$0.00,$0.00,$0.00,$0.00,$0.00,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$0.00,$0.00,$0.00,$0.00
323050R,SUP,Custom 27803010,,323050R  -  KEEL LARYNGEAL 14MM UMBRELLA SHAPE RADIOPQ MONTGOMERY,$235.00,$0.00,$235.00,$0.00,$167.72,$0.00,$0.00,$0.00,$0.00,$0.00,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$0.00,$0.00,$0.00,$0.00
3230-5340S,SUP,HCPCS C1713,,3230-5340S  -  NAIL 15MM 34CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3230-5360S,SUP,HCPCS C1713,,3230-5360S  -  NAIL 15MM 36CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3230-5380S,SUP,HCPCS C1713,,3230-5380S  -  NAIL 15MM 38CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3230-5400S,SUP,HCPCS C1713,,3230-5400S  -  NAIL 15MM 40CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3230-5420S,SUP,HCPCS C1713,,3230-5420S  -  NAIL 15MM 42CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3230-5440S,SUP,HCPCS C1713,,3230-5440S  -  NAIL 15MM 44CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3230-5460S,SUP,HCPCS C1713,,3230-5460S  -  NAIL 15MM 46CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
325014S,SUP,HCPCS C1713,,325014S  -  SCREW BN P/T LOPRFL RVRS CUT FLUT FLT HEX 4MM 5MM 14MM STRL,$266.75,$0.00,$266.75,$120.04,$190.38,$0.00,$45.96,$0.00,$0.00,$46.71,$266.75,$0.00,$133.38,$211.27,$213.40,$0.00,$41.75,$0.00,$42.47,$0.00
325016S,SUP,HCPCS C1713,,325016S  -  SCREW BONE 4MM 16MM 8MM ASNS 3 SS ORTH SLFTAP SLFDRILL CANN,$266.75,$0.00,$266.75,$120.04,$190.38,$0.00,$45.96,$0.00,$0.00,$46.71,$266.75,$0.00,$133.38,$211.27,$213.40,$0.00,$41.75,$0.00,$42.47,$0.00
325018S,SUP,HCPCS C1713,,325018S  -  SCREW BN 4MM 18MM STRL ASNS III P/T IMPL SS,$266.75,$0.00,$266.75,$120.04,$190.38,$0.00,$45.96,$0.00,$0.00,$46.71,$266.75,$0.00,$133.38,$211.27,$213.40,$0.00,$41.75,$0.00,$42.47,$0.00
325020S,SUP,HCPCS C1713,,325020S  -  SCREW BONE 4MM 20MM ASNS 3 SS ORTH CANN STRL,$266.75,$0.00,$266.75,$120.04,$190.38,$0.00,$45.96,$0.00,$0.00,$46.71,$266.75,$0.00,$133.38,$211.27,$213.40,$0.00,$41.75,$0.00,$42.47,$0.00
325022S,SUP,HCPCS C1713,,325022S  -  SCREW BONE 4MM 22MM 8MM ASNS 3 SS ORTH SLFTAP SLFDRILL CANN,$266.75,$0.00,$266.75,$120.04,$190.38,$0.00,$45.96,$0.00,$0.00,$46.71,$266.75,$0.00,$133.38,$211.27,$213.40,$0.00,$41.75,$0.00,$42.47,$0.00
325024S,SUP,HCPCS C1713,,325024S  -  SCREW BONE 4MM 24MM 8MM ASNS 3 SS ORTH SLFTAP SLFDRILL CANN,$266.75,$0.00,$266.75,$120.04,$190.38,$0.00,$45.96,$0.00,$0.00,$46.71,$266.75,$0.00,$133.38,$211.27,$213.40,$0.00,$41.75,$0.00,$42.47,$0.00
325026S,SUP,HCPCS C1713,,325026S  -  SCREW BN P/T 4MM 26MM STRL 9MM ASNS III ST SLF DRL CNN SS,$266.75,$0.00,$266.75,$120.04,$190.38,$0.00,$45.96,$0.00,$0.00,$46.71,$266.75,$0.00,$133.38,$211.27,$213.40,$0.00,$41.75,$0.00,$42.47,$0.00
325028S,SUP,HCPCS C1713,,325028S  -  SCREW BN 4MM 28MM STRL 9.5MM ASNS III SLF DRL ST CNN SS HIP,$266.75,$0.00,$266.75,$120.04,$190.38,$0.00,$45.96,$0.00,$0.00,$46.71,$266.75,$0.00,$133.38,$211.27,$213.40,$0.00,$41.75,$0.00,$42.47,$0.00
325030S,SUP,HCPCS C1713,,325030S  -  SCREW BN P/T 4MM 30MM STRL ASNS III ST SLF DRL CNN SS HIP,$266.75,$0.00,$266.75,$120.04,$190.38,$0.00,$45.96,$0.00,$0.00,$46.71,$266.75,$0.00,$133.38,$211.27,$213.40,$0.00,$41.75,$0.00,$42.47,$0.00
325210S,SUP,HCPCS C1713,,325210S  -  SCREW BONE 4MM 10MM ASNS 3 SS FULTHD ORTH SLFTAP SLFDRILL,$273.63,$0.00,$273.63,$123.13,$195.29,$0.00,$47.14,$0.00,$0.00,$47.91,$273.63,$0.00,$136.81,$216.71,$218.90,$0.00,$42.82,$0.00,$43.56,$0.00
325212S,SUP,HCPCS C1713,,325212S  -  SCREW BONE 4MM 12MM ASNS 3 SS FULTHD ORTH SLFTAP SLFDRILL,$273.63,$0.00,$273.63,$123.13,$195.29,$0.00,$47.14,$0.00,$0.00,$47.91,$273.63,$0.00,$136.81,$216.71,$218.90,$0.00,$42.82,$0.00,$43.56,$0.00
325214S,SUP,HCPCS C1713,,325214S  -  SCREW BONE 4MM 14MM ASNS 3 SS FULTHRD CANN IMPL STRL,$273.63,$0.00,$273.63,$123.13,$195.29,$0.00,$47.14,$0.00,$0.00,$47.91,$273.63,$0.00,$136.81,$216.71,$218.90,$0.00,$42.82,$0.00,$43.56,$0.00
325216S,SUP,HCPCS C1713,,325216S  -  SCREW BONE 4MM 16MM ASNS 3 SS FULTHD ORTH SLFTAP SLFDRILL,$273.63,$0.00,$273.63,$123.13,$195.29,$0.00,$47.14,$0.00,$0.00,$47.91,$273.63,$0.00,$136.81,$216.71,$218.90,$0.00,$42.82,$0.00,$43.56,$0.00
325218S,SUP,HCPCS C1713,,325218S  -  SCREW BONE 4MM 18MM ASNS 3 SS FULTHD ORTH SLFTAP SLFDRILL,$273.63,$0.00,$273.63,$123.13,$195.29,$0.00,$47.14,$0.00,$0.00,$47.91,$273.63,$0.00,$136.81,$216.71,$218.90,$0.00,$42.82,$0.00,$43.56,$0.00
325220S,SUP,HCPCS C1713,,325220S  -  SCREW BONE 4MM 20MM ASNS 3 SS FULTHD ORTH SLFTAP SLFDRILL,$273.63,$0.00,$273.63,$123.13,$195.29,$0.00,$47.14,$0.00,$0.00,$47.91,$273.63,$0.00,$136.81,$216.71,$218.90,$0.00,$42.82,$0.00,$43.56,$0.00
325222S,SUP,HCPCS C1713,,325222S  -  SCREW BONE 4MM 22MM ASNS 3 SS FULTHRD CANN IMPL STRL,$273.63,$0.00,$273.63,$123.13,$195.29,$0.00,$47.14,$0.00,$0.00,$47.91,$273.63,$0.00,$136.81,$216.71,$218.90,$0.00,$42.82,$0.00,$43.56,$0.00
325224S,SUP,HCPCS C1713,,325224S  -  SCREW BONE 4MM 24MM ASNS 3 SS FULTHD ORTH SLFTAP SLFDRILL,$273.63,$0.00,$273.63,$123.13,$195.29,$0.00,$47.14,$0.00,$0.00,$47.91,$273.63,$0.00,$136.81,$216.71,$218.90,$0.00,$42.82,$0.00,$43.56,$0.00
325226S,SUP,HCPCS C1713,,325226S  -  SCREW BONE 4MM 26MM ASNS 3 SS FULTHD FEM HIP SLFTAP SLFDRILL,$273.63,$0.00,$273.63,$123.13,$195.29,$0.00,$47.14,$0.00,$0.00,$47.91,$273.63,$0.00,$136.81,$216.71,$218.90,$0.00,$42.82,$0.00,$43.56,$0.00
325228S,SUP,HCPCS C1713,,325228S  -  SCREW BONE 4MM 28MM ASNS 3 SS FULTHD ORTH SLFTAP SLFDRILL,$273.63,$0.00,$273.63,$123.13,$195.29,$0.00,$47.14,$0.00,$0.00,$47.91,$273.63,$0.00,$136.81,$216.71,$218.90,$0.00,$42.82,$0.00,$43.56,$0.00
325230S,SUP,HCPCS C1713,,325230S  -  SCREW BONE 4MM 30MM ASNS 3 SS FULTHD FEM HIP SLFTAP SLFDRILL,$273.63,$0.00,$273.63,$123.13,$195.29,$0.00,$47.14,$0.00,$0.00,$47.91,$273.63,$0.00,$136.81,$216.71,$218.90,$0.00,$42.82,$0.00,$43.56,$0.00
325232S,SUP,HCPCS C1713,,325232S  -  SCREW BONE 4MM 32MM ASNS 3 SS CANN,$273.63,$0.00,$273.63,$123.13,$195.29,$0.00,$47.14,$0.00,$0.00,$47.91,$273.63,$0.00,$136.81,$216.71,$218.90,$0.00,$42.82,$0.00,$43.56,$0.00
325234S,SUP,HCPCS C1713,,325234S  -  SCREW BONE 4MM 34MM ASNS 3 SS FULTHD FEM HIP SLFTAP SLFDRILL,$273.63,$0.00,$273.63,$123.13,$195.29,$0.00,$47.14,$0.00,$0.00,$47.91,$273.63,$0.00,$136.81,$216.71,$218.90,$0.00,$42.82,$0.00,$43.56,$0.00
325236S,SUP,HCPCS C1713,,325236S  -  SCREW BONE 4MM 36MM ASNS 3 SS FULTHD ORTH SLFTAP SLFDRILL,$273.63,$0.00,$273.63,$123.13,$195.29,$0.00,$47.14,$0.00,$0.00,$47.91,$273.63,$0.00,$136.81,$216.71,$218.90,$0.00,$42.82,$0.00,$43.56,$0.00
325238S,SUP,HCPCS C1713,,325238S  -  SCREW BONE 4MM 38MM ASNS 3 SS FULTHD FEM HIP SLFTAP SLFDRILL,$273.63,$0.00,$273.63,$123.13,$195.29,$0.00,$47.14,$0.00,$0.00,$47.91,$273.63,$0.00,$136.81,$216.71,$218.90,$0.00,$42.82,$0.00,$43.56,$0.00
325240S,SUP,HCPCS C1713,,325240S  -  SCREW BONE 4MM 40MM ASNS 3 SS FULTHD HIP CANN SLFTAP,$273.63,$0.00,$273.63,$123.13,$195.29,$0.00,$47.14,$0.00,$0.00,$47.91,$273.63,$0.00,$136.81,$216.71,$218.90,$0.00,$42.82,$0.00,$43.56,$0.00
325242S,SUP,HCPCS C1713,,325242S  -  SCREW BONE 4MM 42MM ASNS 3 SS CANN,$273.63,$0.00,$273.63,$123.13,$195.29,$0.00,$47.14,$0.00,$0.00,$47.91,$273.63,$0.00,$136.81,$216.71,$218.90,$0.00,$42.82,$0.00,$43.56,$0.00
325244S,SUP,HCPCS C1713,,325244S  -  SCREW BONE 4MM 44MM ASNS 3 SS FULTHD HIP CANN SLFTAP,$273.63,$0.00,$273.63,$123.13,$195.29,$0.00,$47.14,$0.00,$0.00,$47.91,$273.63,$0.00,$136.81,$216.71,$218.90,$0.00,$42.82,$0.00,$43.56,$0.00
325246S,SUP,HCPCS C1713,,325246S  -  SCREW BONE 4MM 46MM ASNS 3 SS FULTHD ORTH SLFTAP SLFDRILL,$273.63,$0.00,$273.63,$123.13,$195.29,$0.00,$47.14,$0.00,$0.00,$47.91,$273.63,$0.00,$136.81,$216.71,$218.90,$0.00,$42.82,$0.00,$43.56,$0.00
325248S,SUP,HCPCS C1713,,325248S  -  SCREW BONE 4MM 48MM ASNS 3 SS FULTHD ORTH SLFTAP SLFDRILL,$273.63,$0.00,$273.63,$123.13,$195.29,$0.00,$47.14,$0.00,$0.00,$47.91,$273.63,$0.00,$136.81,$216.71,$218.90,$0.00,$42.82,$0.00,$43.56,$0.00
325250S,SUP,HCPCS C1713,,325250S  -  SCREW BONE 4MM 50MM ASNS 3 SS PTHRD HIP CANN STRL,$273.63,$0.00,$273.63,$123.13,$195.29,$0.00,$47.14,$0.00,$0.00,$47.91,$273.63,$0.00,$136.81,$216.71,$218.90,$0.00,$42.82,$0.00,$43.56,$0.00
325260S,SUP,HCPCS C1713,,325260S  -  SCREW BONE 6.5MM 60MM ASNS 3 SS HIP CANN STRL,$206.25,$0.00,$206.25,$92.81,$147.20,$0.00,$35.54,$0.00,$0.00,$36.11,$206.25,$0.00,$103.13,$163.35,$165.00,$0.00,$32.28,$0.00,$32.84,$0.00
325265S,SUP,HCPCS C1713,,325265S  -  SCREW BONE 6.5MM 65MM ASNS 3 SS HIP CANN STRL,$206.25,$0.00,$206.25,$92.81,$147.20,$0.00,$35.54,$0.00,$0.00,$36.11,$206.25,$0.00,$103.13,$163.35,$165.00,$0.00,$32.28,$0.00,$32.84,$0.00
325270S,SUP,HCPCS C1713,,325270S  -  SCREW BONE 6.5MM 70MM ASNS 3 SS HIP CANN STRL,$206.25,$0.00,$206.25,$92.81,$147.20,$0.00,$35.54,$0.00,$0.00,$36.11,$206.25,$0.00,$103.13,$163.35,$165.00,$0.00,$32.28,$0.00,$32.84,$0.00
325422S,SUP,HCPCS C1713,,325422S  -  SCREW BONE 5MM 22MM ASNS 3 SS ORTH CANN PTHRD STRL,$299.75,$0.00,$299.75,$134.89,$213.93,$0.00,$51.65,$0.00,$0.00,$52.48,$299.75,$0.00,$149.88,$237.40,$239.80,$0.00,$46.91,$0.00,$47.72,$0.00
325424S,SUP,HCPCS C1713,,325424S  -  SCREW BONE 5MM 24MM ASNS 3 SS ORTH CANN PTHRD STRL,$299.75,$0.00,$299.75,$134.89,$213.93,$0.00,$51.65,$0.00,$0.00,$52.48,$299.75,$0.00,$149.88,$237.40,$239.80,$0.00,$46.91,$0.00,$47.72,$0.00
325426S,SUP,HCPCS C1713,,325426S  -  SCREW BONE 5MM 26MM ASNS 3 SS ORTH CANN PTHRD STRL,$299.75,$0.00,$299.75,$134.89,$213.93,$0.00,$51.65,$0.00,$0.00,$52.48,$299.75,$0.00,$149.88,$237.40,$239.80,$0.00,$46.91,$0.00,$47.72,$0.00
325428S,SUP,HCPCS C1713,,325428S  -  SCREW BONE 5MM 28MM ASNS 3 SS ORTH CANN PTHRD STRL,$299.75,$0.00,$299.75,$134.89,$213.93,$0.00,$51.65,$0.00,$0.00,$52.48,$299.75,$0.00,$149.88,$237.40,$239.80,$0.00,$46.91,$0.00,$47.72,$0.00
325430S,SUP,HCPCS C1713,,325430S  -  SCREW BONE 5MM 30MM ASNS 3 SS ORTH CANN PTHRD STRL,$299.75,$0.00,$299.75,$134.89,$213.93,$0.00,$51.65,$0.00,$0.00,$52.48,$299.75,$0.00,$149.88,$237.40,$239.80,$0.00,$46.91,$0.00,$47.72,$0.00
325432S,SUP,HCPCS C1713,,325432S  -  SCREW BONE 5MM 32MM ASNS 3 SS ORTH CANN PTHRD STRL,$299.75,$0.00,$299.75,$134.89,$213.93,$0.00,$51.65,$0.00,$0.00,$52.48,$299.75,$0.00,$149.88,$237.40,$239.80,$0.00,$46.91,$0.00,$47.72,$0.00
325434S,SUP,HCPCS C1713,,325434S  -  SCREW BONE 5MM 34MM ASNS 3 SS ORTH CANN PTHRD STRL,$299.75,$0.00,$299.75,$134.89,$213.93,$0.00,$51.65,$0.00,$0.00,$52.48,$299.75,$0.00,$149.88,$237.40,$239.80,$0.00,$46.91,$0.00,$47.72,$0.00
325436S,SUP,HCPCS C1713,,325436S  -  SCREW BONE 5MM 36MM ASNS 3 SS ORTH CANN PTHRD STRL,$299.75,$0.00,$299.75,$134.89,$213.93,$0.00,$51.65,$0.00,$0.00,$52.48,$299.75,$0.00,$149.88,$237.40,$239.80,$0.00,$46.91,$0.00,$47.72,$0.00
325438S,SUP,HCPCS C1713,,325438S  -  SCREW BONE 5MM 38MM ASNS 3 SS ORTH CANN PTHRD STRL,$299.75,$0.00,$299.75,$134.89,$213.93,$0.00,$51.65,$0.00,$0.00,$52.48,$299.75,$0.00,$149.88,$237.40,$239.80,$0.00,$46.91,$0.00,$47.72,$0.00
325440S,SUP,HCPCS C1713,,325440S  -  SCREW BONE 5MM 40MM ASNS 3 SS ORTH CANN PTHRD STRL,$299.75,$0.00,$299.75,$134.89,$213.93,$0.00,$51.65,$0.00,$0.00,$52.48,$299.75,$0.00,$149.88,$237.40,$239.80,$0.00,$46.91,$0.00,$47.72,$0.00
325442S,SUP,HCPCS C1713,,325442S  -  SCREW BONE 5MM 42MM ASNS 3 SS ORTH CANN PTHRD STRL,$299.75,$0.00,$299.75,$134.89,$213.93,$0.00,$51.65,$0.00,$0.00,$52.48,$299.75,$0.00,$149.88,$237.40,$239.80,$0.00,$46.91,$0.00,$47.72,$0.00
325444S,SUP,HCPCS C1713,,325444S  -  SCREW BONE 5MM 44MM ASNS 3 SS CANN,$299.75,$0.00,$299.75,$134.89,$213.93,$0.00,$51.65,$0.00,$0.00,$52.48,$299.75,$0.00,$149.88,$237.40,$239.80,$0.00,$46.91,$0.00,$47.72,$0.00
325446S,SUP,HCPCS C1713,,325446S  -  SCREW BONE 5MM 46MM ASNS 3 SS ORTH SLFTAP SLFDRILL CANN,$299.75,$0.00,$299.75,$134.89,$213.93,$0.00,$51.65,$0.00,$0.00,$52.48,$299.75,$0.00,$149.88,$237.40,$239.80,$0.00,$46.91,$0.00,$47.72,$0.00
325448S,SUP,HCPCS C1713,,325448S  -  SCREW BONE 5MM 48MM ASNS 3 SS ORTH CANN PTHRD STRL,$299.75,$0.00,$299.75,$134.89,$213.93,$0.00,$51.65,$0.00,$0.00,$52.48,$299.75,$0.00,$149.88,$237.40,$239.80,$0.00,$46.91,$0.00,$47.72,$0.00
325450S,SUP,HCPCS C1713,,325450S  -  SCREW BONE 5MM 50MM 17MM ASNS 3 SS CANN PTHRD SLFDRILL,$299.75,$0.00,$299.75,$134.89,$213.93,$0.00,$51.65,$0.00,$0.00,$52.48,$299.75,$0.00,$149.88,$237.40,$239.80,$0.00,$46.91,$0.00,$47.72,$0.00
325455S,SUP,HCPCS C1713,,325455S  -  SCREW BONE 5MM 55MM ASNS 3 SS HIP SLFTAP SLFDRILL CANN PTHRD,$299.75,$0.00,$299.75,$134.89,$213.93,$0.00,$51.65,$0.00,$0.00,$52.48,$299.75,$0.00,$149.88,$237.40,$239.80,$0.00,$46.91,$0.00,$47.72,$0.00
325460S,SUP,HCPCS C1713,,325460S  -  SCREW BONE 5MM 60MM ASNS 3 SS PTHRD HIP CANN STRL,$299.75,$0.00,$299.75,$134.89,$213.93,$0.00,$51.65,$0.00,$0.00,$52.48,$299.75,$0.00,$149.88,$237.40,$239.80,$0.00,$46.91,$0.00,$47.72,$0.00
325465S,SUP,HCPCS C1713,,325465S  -  SCREW BONE 5MM 65MM ASNS 3 SS HIP SLFTAP SLFDRILL CANN PTHRD,$299.75,$0.00,$299.75,$134.89,$213.93,$0.00,$51.65,$0.00,$0.00,$52.48,$299.75,$0.00,$149.88,$237.40,$239.80,$0.00,$46.91,$0.00,$47.72,$0.00
325470S,SUP,HCPCS C1713,,325470S  -  SCREW BONE 5MM 70MM ASNS 3 SS ORTH CANN PTHRD STRL,$299.75,$0.00,$299.75,$134.89,$213.93,$0.00,$51.65,$0.00,$0.00,$52.48,$299.75,$0.00,$149.88,$237.40,$239.80,$0.00,$46.91,$0.00,$47.72,$0.00
325475S,SUP,HCPCS C1713,,325475S  -  SCREW BONE 5MM 75MM ASNS 3 SS ORTH SLFTAP SLFDRILL CANN STRL,$299.75,$0.00,$299.75,$134.89,$213.93,$0.00,$51.65,$0.00,$0.00,$52.48,$299.75,$0.00,$149.88,$237.40,$239.80,$0.00,$46.91,$0.00,$47.72,$0.00
325480S,SUP,HCPCS C1713,,325480S  -  SCREW BONE 5MM 80MM ASNS 3 SS HIP SLFTAP SLFDRILL CANN PTHRD,$299.75,$0.00,$299.75,$134.89,$213.93,$0.00,$51.65,$0.00,$0.00,$52.48,$299.75,$0.00,$149.88,$237.40,$239.80,$0.00,$46.91,$0.00,$47.72,$0.00
325620S,SUP,HCPCS C1713,,325620S  -  SCREW BONE 5MM 20MM ASNS 3 SS CANN,$299.75,$0.00,$299.75,$134.89,$213.93,$0.00,$51.65,$0.00,$0.00,$52.48,$299.75,$0.00,$149.88,$237.40,$239.80,$0.00,$46.91,$0.00,$47.72,$0.00
325622S,SUP,HCPCS C1713,,325622S  -  SCREW BONE 5MM 22MM ASNS 3 SS FULTHRD CANN SLFDRILL SLFTAP,$299.75,$0.00,$299.75,$134.89,$213.93,$0.00,$51.65,$0.00,$0.00,$52.48,$299.75,$0.00,$149.88,$237.40,$239.80,$0.00,$46.91,$0.00,$47.72,$0.00
325624S,SUP,HCPCS C1713,,325624S  -  SCREW BONE 5MM 24MM ASNS 3 SS FULTHD CANN SLFDRILL TAP,$299.75,$0.00,$299.75,$134.89,$213.93,$0.00,$51.65,$0.00,$0.00,$52.48,$299.75,$0.00,$149.88,$237.40,$239.80,$0.00,$46.91,$0.00,$47.72,$0.00
325626S,SUP,HCPCS C1713,,325626S  -  SCREW BONE 5MM 26MM ASNS 3 SS FULTHD ORTH CANN STRL,$299.75,$0.00,$299.75,$134.89,$213.93,$0.00,$51.65,$0.00,$0.00,$52.48,$299.75,$0.00,$149.88,$237.40,$239.80,$0.00,$46.91,$0.00,$47.72,$0.00
325628S,SUP,HCPCS C1713,,325628S  -  SCREW BONE 5MM 28MM ASNS 3 SS FULTHD ORTH SLFTAP SLFDRILL,$299.75,$0.00,$299.75,$134.89,$213.93,$0.00,$51.65,$0.00,$0.00,$52.48,$299.75,$0.00,$149.88,$237.40,$239.80,$0.00,$46.91,$0.00,$47.72,$0.00
325630S,SUP,HCPCS C1713,,325630S  -  SCREW BONE 5MM 30MM ASNS 3 SS FULTHD ORTH SLFTAP SLFDRILL,$299.75,$0.00,$299.75,$134.89,$213.93,$0.00,$51.65,$0.00,$0.00,$52.48,$299.75,$0.00,$149.88,$237.40,$239.80,$0.00,$46.91,$0.00,$47.72,$0.00
325632S,SUP,HCPCS C1713,,325632S  -  SCREW BONE 5MM 32MM ASNS 3 SS FULTHD ORTH CANN STRL,$299.75,$0.00,$299.75,$134.89,$213.93,$0.00,$51.65,$0.00,$0.00,$52.48,$299.75,$0.00,$149.88,$237.40,$239.80,$0.00,$46.91,$0.00,$47.72,$0.00
325634S,SUP,HCPCS C1713,,325634S  -  SCREW BONE 5MM 34MM ASNS 3 SS FULTHD ORTH CANN STRL,$299.75,$0.00,$299.75,$134.89,$213.93,$0.00,$51.65,$0.00,$0.00,$52.48,$299.75,$0.00,$149.88,$237.40,$239.80,$0.00,$46.91,$0.00,$47.72,$0.00
325636S,SUP,HCPCS C1713,,325636S  -  SCREW BONE 5MM 36MM SS FULTHRD IMPL STRL,$299.75,$0.00,$299.75,$134.89,$213.93,$0.00,$51.65,$0.00,$0.00,$52.48,$299.75,$0.00,$149.88,$237.40,$239.80,$0.00,$46.91,$0.00,$47.72,$0.00
325638S,SUP,HCPCS C1713,,325638S  -  SCREW BONE 5MM 38MM ASNS 3 SS ORTH SLFTAP SLFDRILL CANN,$299.75,$0.00,$299.75,$134.89,$213.93,$0.00,$51.65,$0.00,$0.00,$52.48,$299.75,$0.00,$149.88,$237.40,$239.80,$0.00,$46.91,$0.00,$47.72,$0.00
325640S,SUP,HCPCS C1713,,325640S  -  SCREW BONE 5MM 40MM ASNS 3 SS FULTHD ORTH CANN STRL,$299.75,$0.00,$299.75,$134.89,$213.93,$0.00,$51.65,$0.00,$0.00,$52.48,$299.75,$0.00,$149.88,$237.40,$239.80,$0.00,$46.91,$0.00,$47.72,$0.00
325642S,SUP,HCPCS C1713,,325642S  -  SCREW BONE 5MM 42MM ASNS 3 SS FULTHD ORTH CANN STRL,$299.75,$0.00,$299.75,$134.89,$213.93,$0.00,$51.65,$0.00,$0.00,$52.48,$299.75,$0.00,$149.88,$237.40,$239.80,$0.00,$46.91,$0.00,$47.72,$0.00
325644S,SUP,HCPCS C1713,,325644S  -  SCREW BONE 5MM 44MM ASNS 3 SS FULTHD ORTH CANN STRL,$299.75,$0.00,$299.75,$134.89,$213.93,$0.00,$51.65,$0.00,$0.00,$52.48,$299.75,$0.00,$149.88,$237.40,$239.80,$0.00,$46.91,$0.00,$47.72,$0.00
325646S,SUP,HCPCS C1713,,325646S  -  SCREW BONE 5MM 46MM ASNS 3 SS FULTHD ORTH CANN STRL,$299.75,$0.00,$299.75,$134.89,$213.93,$0.00,$51.65,$0.00,$0.00,$52.48,$299.75,$0.00,$149.88,$237.40,$239.80,$0.00,$46.91,$0.00,$47.72,$0.00
325650S,SUP,HCPCS C1713,,325650S  -  SCREW BONE 5MM 50MM ASNS 3 SS FULTHD ORTH CANN STRL,$299.75,$0.00,$299.75,$134.89,$213.93,$0.00,$51.65,$0.00,$0.00,$52.48,$299.75,$0.00,$149.88,$237.40,$239.80,$0.00,$46.91,$0.00,$47.72,$0.00
325655S,SUP,HCPCS C1713,,325655S  -  SCREW BONE 5MM 55MM ASNS 3 SS FULTHD HIP CANN STRL,$299.75,$0.00,$299.75,$134.89,$213.93,$0.00,$51.65,$0.00,$0.00,$52.48,$299.75,$0.00,$149.88,$237.40,$239.80,$0.00,$46.91,$0.00,$47.72,$0.00
325660S,SUP,HCPCS C1713,,325660S  -  SCREW BONE 5MM 60MM ASNS 3 SS FULTHD ORTH CANN STRL,$299.75,$0.00,$299.75,$134.89,$213.93,$0.00,$51.65,$0.00,$0.00,$52.48,$299.75,$0.00,$149.88,$237.40,$239.80,$0.00,$46.91,$0.00,$47.72,$0.00
325665S,SUP,HCPCS C1713,,325665S  -  SCREW BONE 5MM 65MM ASNS 3 SS FULTHD ORTH CANN STRL,$299.75,$0.00,$299.75,$134.89,$213.93,$0.00,$51.65,$0.00,$0.00,$52.48,$299.75,$0.00,$149.88,$237.40,$239.80,$0.00,$46.91,$0.00,$47.72,$0.00
325670S,SUP,HCPCS C1713,,325670S  -  SCREW BONE 5MM 70MM ASNS 3 SS ORTH CANN FULTHD STRL,$299.75,$0.00,$299.75,$134.89,$213.93,$0.00,$51.65,$0.00,$0.00,$52.48,$299.75,$0.00,$149.88,$237.40,$239.80,$0.00,$46.91,$0.00,$47.72,$0.00
326040S,SUP,HCPCS C1713,,326040S  -  SCREW BONE 6.5MM 40MM 20MM ASNS 3 SS ORTH SLFTAP SLFDRILL,$391.88,$0.00,$391.88,$176.34,$279.68,$0.00,$67.52,$0.00,$0.00,$68.61,$391.88,$0.00,$195.94,$310.37,$313.50,$0.00,$61.33,$0.00,$62.39,$0.00
326045S,SUP,HCPCS C1713,,326045S  -  SCREW BONE 6.5MM 45MM ASNS 3 SS ORTH CANN THRD STRL,$391.88,$0.00,$391.88,$176.34,$279.68,$0.00,$67.52,$0.00,$0.00,$68.61,$391.88,$0.00,$195.94,$310.37,$313.50,$0.00,$61.33,$0.00,$62.39,$0.00
326050S,SUP,HCPCS C1713,,326050S  -  SCREW BONE 6.5MM 50MM ASNS 3 SS ORTH CANN THRD STRL,$391.88,$0.00,$391.88,$176.34,$279.68,$0.00,$67.52,$0.00,$0.00,$68.61,$391.88,$0.00,$195.94,$310.37,$313.50,$0.00,$61.33,$0.00,$62.39,$0.00
326055S,SUP,HCPCS C1713,,326055S  -  SCREW BONE 6.5MM 55MM ASNS 3 SS ORTH CANN THRD STRL,$391.88,$0.00,$391.88,$176.34,$279.68,$0.00,$67.52,$0.00,$0.00,$68.61,$391.88,$0.00,$195.94,$310.37,$313.50,$0.00,$61.33,$0.00,$62.39,$0.00
326060S,SUP,HCPCS C1713,,326060S  -  SCREW BONE 6.5MM 60MM 20MM ASNS 3 SS HIP CANN STRL,$391.88,$0.00,$391.88,$176.34,$279.68,$0.00,$67.52,$0.00,$0.00,$68.61,$391.88,$0.00,$195.94,$310.37,$313.50,$0.00,$61.33,$0.00,$62.39,$0.00
326065S,SUP,HCPCS C1713,,326065S  -  SCREW BONE 6.5MM 65MM ASNS 3 SS ORTH CANN THRD STRL,$391.88,$0.00,$391.88,$176.34,$279.68,$0.00,$67.52,$0.00,$0.00,$68.61,$391.88,$0.00,$195.94,$310.37,$313.50,$0.00,$61.33,$0.00,$62.39,$0.00
326070S,SUP,HCPCS C1713,,326070S  -  SCREW BONE 6.5MM 70MM 20MM ASNS SS HIP CANN STRL,$391.88,$0.00,$391.88,$176.34,$279.68,$0.00,$67.52,$0.00,$0.00,$68.61,$391.88,$0.00,$195.94,$310.37,$313.50,$0.00,$61.33,$0.00,$62.39,$0.00
326075S,SUP,HCPCS C1713,,326075S  -  SCREW BONE 6.5MM 75MM 20MM ASNS SS HIP CANN STRL,$391.88,$0.00,$391.88,$176.34,$279.68,$0.00,$67.52,$0.00,$0.00,$68.61,$391.88,$0.00,$195.94,$310.37,$313.50,$0.00,$61.33,$0.00,$62.39,$0.00
326080S,SUP,HCPCS C1713,,326080S  -  SCREW BONE 6.5MM 80MM 20MM ASNS 3 SS HIP CANN STRL,$391.88,$0.00,$391.88,$176.34,$279.68,$0.00,$67.52,$0.00,$0.00,$68.61,$391.88,$0.00,$195.94,$310.37,$313.50,$0.00,$61.33,$0.00,$62.39,$0.00
326085S,SUP,HCPCS C1713,,326085S  -  SCREW BONE 6.5MM 85MM 20MM ASNS 3 SS ORTH CANN STRL,$391.88,$0.00,$391.88,$176.34,$279.68,$0.00,$67.52,$0.00,$0.00,$68.61,$391.88,$0.00,$195.94,$310.37,$313.50,$0.00,$61.33,$0.00,$62.39,$0.00
326090S,SUP,HCPCS C1713,,326090S  -  SCREW BONE 6.5MM 90MM 20MM ASNS 3 SS ORTH CANN STRL,$391.88,$0.00,$391.88,$176.34,$279.68,$0.00,$67.52,$0.00,$0.00,$68.61,$391.88,$0.00,$195.94,$310.37,$313.50,$0.00,$61.33,$0.00,$62.39,$0.00
326095S,SUP,HCPCS C1713,,326095S  -  SCREW BONE 6.5MM 95MM 20MM ASNS 3 SS ORTH CANN STRL,$391.88,$0.00,$391.88,$176.34,$279.68,$0.00,$67.52,$0.00,$0.00,$68.61,$391.88,$0.00,$195.94,$310.37,$313.50,$0.00,$61.33,$0.00,$62.39,$0.00
326100S,SUP,HCPCS C1713,,326100S  -  SCREW BONE 6.5MM 100MM 20MM ASNS 3 SS HIP CANN STRL,$391.88,$0.00,$391.88,$176.34,$279.68,$0.00,$67.52,$0.00,$0.00,$68.61,$391.88,$0.00,$195.94,$310.37,$313.50,$0.00,$61.33,$0.00,$62.39,$0.00
326105S,SUP,HCPCS C1713,,326105S  -  SCREW BONE 6.5MM 105MM 20MM ASNS 3 SS ORTH CANN STRL,$391.88,$0.00,$391.88,$176.34,$279.68,$0.00,$67.52,$0.00,$0.00,$68.61,$391.88,$0.00,$195.94,$310.37,$313.50,$0.00,$61.33,$0.00,$62.39,$0.00
326110S,SUP,HCPCS C1713,,326110S  -  SCREW BONE 6.5MM 110MM 20MM ASNS SS FEM HIP CANN STRL,$391.88,$0.00,$391.88,$176.34,$279.68,$0.00,$67.52,$0.00,$0.00,$68.61,$391.88,$0.00,$195.94,$310.37,$313.50,$0.00,$61.33,$0.00,$62.39,$0.00
326115S,SUP,HCPCS C1713,,326115S  -  SCREW BONE 6.5MM 115MM 20MM ASNS 3 SS HIP CANN STRL,$391.88,$0.00,$391.88,$176.34,$279.68,$0.00,$67.52,$0.00,$0.00,$68.61,$391.88,$0.00,$195.94,$310.37,$313.50,$0.00,$61.33,$0.00,$62.39,$0.00
326120S,SUP,HCPCS C1713,,326120S  -  SCREW BONE 6.5MM 120MM 20MM ASNS 3 SS ORTH SLFTAP SLFDRILL,$391.88,$0.00,$391.88,$176.34,$279.68,$0.00,$67.52,$0.00,$0.00,$68.61,$391.88,$0.00,$195.94,$310.37,$313.50,$0.00,$61.33,$0.00,$62.39,$0.00
326255S,SUP,HCPCS C1713,,326255S  -  SCREW BONE 6.5MM 55MM 40MM ASNS 3 SS ORTH CANN STRL,$391.88,$0.00,$391.88,$176.34,$279.68,$0.00,$67.52,$0.00,$0.00,$68.61,$391.88,$0.00,$195.94,$310.37,$313.50,$0.00,$61.33,$0.00,$62.39,$0.00
326260S,SUP,HCPCS C1713,,326260S  -  SCREW BONE 6.5MM 60MM 40MM ASNS 3 SS ORTH CANN STRL,$391.88,$0.00,$391.88,$176.34,$279.68,$0.00,$67.52,$0.00,$0.00,$68.61,$391.88,$0.00,$195.94,$310.37,$313.50,$0.00,$61.33,$0.00,$62.39,$0.00
326265S,SUP,HCPCS C1713,,326265S  -  SCREW BONE 6.5MM 65MM 40MM ASNS SS HIP CANN STRL,$391.88,$0.00,$391.88,$176.34,$279.68,$0.00,$67.52,$0.00,$0.00,$68.61,$391.88,$0.00,$195.94,$310.37,$313.50,$0.00,$61.33,$0.00,$62.39,$0.00
326270S,SUP,HCPCS C1713,,326270S  -  SCREW BONE 6.5MM 70MM 40MM ASNS SS PTHRD ORTH CANN STRL,$391.88,$0.00,$391.88,$176.34,$279.68,$0.00,$67.52,$0.00,$0.00,$68.61,$391.88,$0.00,$195.94,$310.37,$313.50,$0.00,$61.33,$0.00,$62.39,$0.00
326275S,SUP,HCPCS C1713,,326275S  -  SCREW BONE 6.5MM 75MM 40MM ASNS 3 SS ORTH SLFTAP SLFDRILL,$391.88,$0.00,$391.88,$176.34,$279.68,$0.00,$67.52,$0.00,$0.00,$68.61,$391.88,$0.00,$195.94,$310.37,$313.50,$0.00,$61.33,$0.00,$62.39,$0.00
326280S,SUP,HCPCS C1713,,326280S  -  SCREW BONE 6.5MM 80MM 40MM ASNS 3 SS PTHRD HIP CANN STRL,$391.88,$0.00,$391.88,$176.34,$279.68,$0.00,$67.52,$0.00,$0.00,$68.61,$391.88,$0.00,$195.94,$310.37,$313.50,$0.00,$61.33,$0.00,$62.39,$0.00
326285S,SUP,HCPCS C1713,,326285S  -  SCREW BONE 6.5MM 85MM 40MM ASNS 3 SS HIP CANN STRL,$391.88,$0.00,$391.88,$176.34,$279.68,$0.00,$67.52,$0.00,$0.00,$68.61,$391.88,$0.00,$195.94,$310.37,$313.50,$0.00,$61.33,$0.00,$62.39,$0.00
326290S,SUP,HCPCS C1713,,326290S  -  SCREW BONE 6.5MM 90MM 40MM ASNS 3 SS HIP CANN STRL,$391.88,$0.00,$391.88,$176.34,$279.68,$0.00,$67.52,$0.00,$0.00,$68.61,$391.88,$0.00,$195.94,$310.37,$313.50,$0.00,$61.33,$0.00,$62.39,$0.00
326295S,SUP,HCPCS C1713,,326295S  -  SCREW BONE 6.5MM 95MM 20MM ASNS 3 SS HIP CANN THRD IMPL STRL,$391.88,$0.00,$391.88,$176.34,$279.68,$0.00,$67.52,$0.00,$0.00,$68.61,$391.88,$0.00,$195.94,$310.37,$313.50,$0.00,$61.33,$0.00,$62.39,$0.00
326300S,SUP,HCPCS C1713,,326300S  -  SCREW BONE 6.5MM 100MM 40MM ASNS 3 SS HIP CANN STRL,$391.88,$0.00,$391.88,$176.34,$279.68,$0.00,$67.52,$0.00,$0.00,$68.61,$391.88,$0.00,$195.94,$310.37,$313.50,$0.00,$61.33,$0.00,$62.39,$0.00
326305S,SUP,HCPCS C1713,,326305S  -  SCREW BONE 6.5MM 105MM 40MM ASNS SS FEM HIP CANN STRL,$391.88,$0.00,$391.88,$176.34,$279.68,$0.00,$67.52,$0.00,$0.00,$68.61,$391.88,$0.00,$195.94,$310.37,$313.50,$0.00,$61.33,$0.00,$62.39,$0.00
326310S,SUP,HCPCS C1713,,326310S  -  SCREW BONE 6.5MM 110MM 40MM ASNS SS CANN STRL,$391.88,$0.00,$391.88,$176.34,$279.68,$0.00,$67.52,$0.00,$0.00,$68.61,$391.88,$0.00,$195.94,$310.37,$313.50,$0.00,$61.33,$0.00,$62.39,$0.00
326315S,SUP,HCPCS C1713,,326315S  -  SCREW BONE 6.5MM 115MM 40MM ASNS SS CANN STRL,$391.88,$0.00,$391.88,$176.34,$279.68,$0.00,$67.52,$0.00,$0.00,$68.61,$391.88,$0.00,$195.94,$310.37,$313.50,$0.00,$61.33,$0.00,$62.39,$0.00
326320S,SUP,HCPCS C1713,,326320S  -  SCREW BONE 6.5MM 120MM 40MM ASNS SS CANN STRL,$391.88,$0.00,$391.88,$176.34,$279.68,$0.00,$67.52,$0.00,$0.00,$68.61,$391.88,$0.00,$195.94,$310.37,$313.50,$0.00,$61.33,$0.00,$62.39,$0.00
326325S,SUP,HCPCS C1713,,326325S  -  ASNIS III SS CANN SCR6.5X125MM,$440.00,$0.00,$440.00,$198.00,$314.03,$0.00,$75.81,$0.00,$0.00,$77.04,$440.00,$0.00,$220.00,$348.48,$352.00,$0.00,$68.86,$0.00,$70.05,$0.00
326330S,SUP,HCPCS C1713,,326330S  -  ASNIS III SS CANN SCR6.5X130MM,$440.00,$0.00,$440.00,$198.00,$314.03,$0.00,$75.81,$0.00,$0.00,$77.04,$440.00,$0.00,$220.00,$348.48,$352.00,$0.00,$68.86,$0.00,$70.05,$0.00
326430S,SUP,HCPCS C1713,,326430S  -  SCREW BONE 6.5MM 30MM ASNS 3 SS FULTHRD CANN SLFDRILL SLFTAP,$391.88,$0.00,$391.88,$176.34,$279.68,$0.00,$67.52,$0.00,$0.00,$68.61,$391.88,$0.00,$195.94,$310.37,$313.50,$0.00,$61.33,$0.00,$62.39,$0.00
326435S,SUP,HCPCS C1713,,326435S  -  SCREW BONE 6.5MM 35MM ASNS 3 TI FULTHRD CANN SLFDRILL SLFTAP,$391.88,$0.00,$391.88,$176.34,$279.68,$0.00,$67.52,$0.00,$0.00,$68.61,$391.88,$0.00,$195.94,$310.37,$313.50,$0.00,$61.33,$0.00,$62.39,$0.00
326440S,SUP,HCPCS C1713,,326440S  -  SCREW BONE 6.5MM 40MM ASNS 3 SS FULTHRD CANN SLFDRILL SLFTAP,$391.88,$0.00,$391.88,$176.34,$279.68,$0.00,$67.52,$0.00,$0.00,$68.61,$391.88,$0.00,$195.94,$310.37,$313.50,$0.00,$61.33,$0.00,$62.39,$0.00
326445S,SUP,HCPCS C1713,,326445S  -  SCREW BONE 6.5MM 45MM ASNS 3 SS CANN FULTHD SLFDRILL SLFTAP,$391.88,$0.00,$391.88,$176.34,$279.68,$0.00,$67.52,$0.00,$0.00,$68.61,$391.88,$0.00,$195.94,$310.37,$313.50,$0.00,$61.33,$0.00,$62.39,$0.00
326450S,SUP,HCPCS C1713,,326450S  -  SCREW BONE 6.5MM 50MM ASNS 3 SS ORTH CANN FULTHD STRL,$391.88,$0.00,$391.88,$176.34,$279.68,$0.00,$67.52,$0.00,$0.00,$68.61,$391.88,$0.00,$195.94,$310.37,$313.50,$0.00,$61.33,$0.00,$62.39,$0.00
326455S,SUP,HCPCS C1713,,326455S  -  SCREW BONE 6.5MM 55MM ASNS 3 SS CANN,$391.88,$0.00,$391.88,$176.34,$279.68,$0.00,$67.52,$0.00,$0.00,$68.61,$391.88,$0.00,$195.94,$310.37,$313.50,$0.00,$61.33,$0.00,$62.39,$0.00
326460S,SUP,HCPCS C1713,,326460S  -  SCREW BONE 6.5MM 60MM ASNS 3 SS CANN,$391.88,$0.00,$391.88,$176.34,$279.68,$0.00,$67.52,$0.00,$0.00,$68.61,$391.88,$0.00,$195.94,$310.37,$313.50,$0.00,$61.33,$0.00,$62.39,$0.00
326465S,SUP,HCPCS C1713,,326465S  -  SCREW BONE 6.5MM 65MM ASNS 3 SS CANN FULTHD SLFDRILL SLFTAP,$391.88,$0.00,$391.88,$176.34,$279.68,$0.00,$67.52,$0.00,$0.00,$68.61,$391.88,$0.00,$195.94,$310.37,$313.50,$0.00,$61.33,$0.00,$62.39,$0.00
326470S,SUP,HCPCS C1713,,326470S  -  SCREW BONE 6.5MM 70MM ASNS 3 SS FULTHD CANN SLFDRILL SLFTAP,$391.88,$0.00,$391.88,$176.34,$279.68,$0.00,$67.52,$0.00,$0.00,$68.61,$391.88,$0.00,$195.94,$310.37,$313.50,$0.00,$61.33,$0.00,$62.39,$0.00
326475S,SUP,HCPCS C1713,,326475S  -  SCREW BONE 6.5MM 75MM ASNS 3 SS FULTHD HIP CANN STRL,$391.88,$0.00,$391.88,$176.34,$279.68,$0.00,$67.52,$0.00,$0.00,$68.61,$391.88,$0.00,$195.94,$310.37,$313.50,$0.00,$61.33,$0.00,$62.39,$0.00
326480S,SUP,HCPCS C1713,,326480S  -  SCREW BONE 6.5MM 80MM ASNS 3 SS FULTHD ORTH CANN STRL,$391.88,$0.00,$391.88,$176.34,$279.68,$0.00,$67.52,$0.00,$0.00,$68.61,$391.88,$0.00,$195.94,$310.37,$313.50,$0.00,$61.33,$0.00,$62.39,$0.00
326485S,SUP,HCPCS C1713,,326485S  -  SCREW BONE 6.5MM 85MM ASNS 3 SS FULTHD HIP CANN STRL,$391.88,$0.00,$391.88,$176.34,$279.68,$0.00,$67.52,$0.00,$0.00,$68.61,$391.88,$0.00,$195.94,$310.37,$313.50,$0.00,$61.33,$0.00,$62.39,$0.00
326490S,SUP,HCPCS C1713,,326490S  -  SCREW BONE 6.5MM 90MM ASNS 3 SS FULTHD HIP CANN STRL,$391.88,$0.00,$391.88,$176.34,$279.68,$0.00,$67.52,$0.00,$0.00,$68.61,$391.88,$0.00,$195.94,$310.37,$313.50,$0.00,$61.33,$0.00,$62.39,$0.00
326495S,SUP,HCPCS C1713,,326495S  -  SCREW BONE 6.5MM 95MM ASNS 3 SS FULTHD ORTH CANN STRL,$391.88,$0.00,$391.88,$176.34,$279.68,$0.00,$67.52,$0.00,$0.00,$68.61,$391.88,$0.00,$195.94,$310.37,$313.50,$0.00,$61.33,$0.00,$62.39,$0.00
326500S,SUP,HCPCS C1713,,326500S  -  SCREW BONE 6.5MM 100MM ASNS 3 SS FULTHD HIP CANN STRL,$391.88,$0.00,$391.88,$176.34,$279.68,$0.00,$67.52,$0.00,$0.00,$68.61,$391.88,$0.00,$195.94,$310.37,$313.50,$0.00,$61.33,$0.00,$62.39,$0.00
326505S,SUP,HCPCS C1713,,326505S  -  SCREW BONE 6.5MM 105MM ASNS 3 SS FULTHD SLFTAP SLFDRILL CANN,$391.88,$0.00,$391.88,$176.34,$279.68,$0.00,$67.52,$0.00,$0.00,$68.61,$391.88,$0.00,$195.94,$310.37,$313.50,$0.00,$61.33,$0.00,$62.39,$0.00
326510S,SUP,HCPCS C1713,,326510S  -  SCREW BONE 6.5MM 110MM ASNS 3 SS FULTHD HIP CANN STRL,$391.88,$0.00,$391.88,$176.34,$279.68,$0.00,$67.52,$0.00,$0.00,$68.61,$391.88,$0.00,$195.94,$310.37,$313.50,$0.00,$61.33,$0.00,$62.39,$0.00
326515S,SUP,HCPCS C1713,,326515S  -  SCREW BONE 6.5MM 115MM ASNS 3 SS FULTHD SLFTAP SLFDRILL CANN,$391.88,$0.00,$391.88,$176.34,$279.68,$0.00,$67.52,$0.00,$0.00,$68.61,$391.88,$0.00,$195.94,$310.37,$313.50,$0.00,$61.33,$0.00,$62.39,$0.00
326520S,SUP,HCPCS C1713,,326520S  -  SCREW BONE 6.5MM 120MM ASNS 3 SS FULTHD HIP CANN STRL,$391.88,$0.00,$391.88,$176.34,$279.68,$0.00,$67.52,$0.00,$0.00,$68.61,$391.88,$0.00,$195.94,$310.37,$313.50,$0.00,$61.33,$0.00,$62.39,$0.00
326525S,SUP,HCPCS C1713,,326525S  -  SCREW BONE 6.5MM 125MM ASNS 3 SS FULTHRD CANN STRL,$371.25,$0.00,$371.25,$167.06,$264.96,$0.00,$63.96,$0.00,$0.00,$65.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$58.10,$0.00,$59.10,$0.00
326530S,SUP,HCPCS C1713,,326530S  -  SCREW BONE 6.5MM 130MM ASNS 3 SS FULTHRD STRL,$371.25,$0.00,$371.25,$167.06,$264.96,$0.00,$63.96,$0.00,$0.00,$65.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$58.10,$0.00,$59.10,$0.00
326640S,SUP,HCPCS C1713,,326640S  -  SCREW BONE 8MM 40MM 25MM ASNS 3 SS SLFTAP SLFDRILL CANN STRL,$385.00,$0.00,$385.00,$173.25,$274.77,$0.00,$66.33,$0.00,$0.00,$67.41,$385.00,$0.00,$192.50,$304.92,$308.00,$0.00,$60.25,$0.00,$61.29,$0.00
326645S,SUP,HCPCS C1713,,326645S  -  SCREW BONE 8MM 45MM 25MM ASNS SS CANN STRL,$385.00,$0.00,$385.00,$173.25,$274.77,$0.00,$66.33,$0.00,$0.00,$67.41,$385.00,$0.00,$192.50,$304.92,$308.00,$0.00,$60.25,$0.00,$61.29,$0.00
326650S,SUP,HCPCS C1713,,326650S  -  SCREW BONE 8MM 50MM 25MM ASNS SS CANN STRL,$385.00,$0.00,$385.00,$173.25,$274.77,$0.00,$66.33,$0.00,$0.00,$67.41,$385.00,$0.00,$192.50,$304.92,$308.00,$0.00,$60.25,$0.00,$61.29,$0.00
326655S,SUP,HCPCS C1713,,326655S  -  SCREW BONE 8MM 55MM 25MM ASNS 3 SS ORTH CANN STRL,$385.00,$0.00,$385.00,$173.25,$274.77,$0.00,$66.33,$0.00,$0.00,$67.41,$385.00,$0.00,$192.50,$304.92,$308.00,$0.00,$60.25,$0.00,$61.29,$0.00
326660S,SUP,HCPCS C1713,,326660S  -  SCREW BONE 8MM 60MM 25MM ASNS SS CANN STRL,$385.00,$0.00,$385.00,$173.25,$274.77,$0.00,$66.33,$0.00,$0.00,$67.41,$385.00,$0.00,$192.50,$304.92,$308.00,$0.00,$60.25,$0.00,$61.29,$0.00
326665S,SUP,HCPCS C1713,,326665S  -  SCREW BONE 8MM 65MM 25MM ASNS 3 SS ORTH SLFTAP SLFDRILL CANN,$385.00,$0.00,$385.00,$173.25,$274.77,$0.00,$66.33,$0.00,$0.00,$67.41,$385.00,$0.00,$192.50,$304.92,$308.00,$0.00,$60.25,$0.00,$61.29,$0.00
326670S,SUP,HCPCS C1713,,326670S  -  SCREW BONE 8MM 70MM 25MM ASNS 3 SS CANN STRL,$385.00,$0.00,$385.00,$173.25,$274.77,$0.00,$66.33,$0.00,$0.00,$67.41,$385.00,$0.00,$192.50,$304.92,$308.00,$0.00,$60.25,$0.00,$61.29,$0.00
326675S,SUP,HCPCS C1713,,326675S  -  SCREW BONE 8MM 75MM 25MM ASNS SS CANN STRL,$385.00,$0.00,$385.00,$173.25,$274.77,$0.00,$66.33,$0.00,$0.00,$67.41,$385.00,$0.00,$192.50,$304.92,$308.00,$0.00,$60.25,$0.00,$61.29,$0.00
326680S,SUP,HCPCS C1713,,326680S  -  SCREW BONE 8MM 80MM 25MM ASNS 3 SS CANN STRL,$385.00,$0.00,$385.00,$173.25,$274.77,$0.00,$66.33,$0.00,$0.00,$67.41,$385.00,$0.00,$192.50,$304.92,$308.00,$0.00,$60.25,$0.00,$61.29,$0.00
326685S,SUP,HCPCS C1713,,326685S  -  SCREW BONE 8MM 85MM 25MM ASNS 3 SS SLFTAP SLFDRILL CANN STRL,$385.00,$0.00,$385.00,$173.25,$274.77,$0.00,$66.33,$0.00,$0.00,$67.41,$385.00,$0.00,$192.50,$304.92,$308.00,$0.00,$60.25,$0.00,$61.29,$0.00
326690S,SUP,HCPCS C1713,,326690S  -  SCREW BONE 8MM 90MM 25MM ASNS 3 SS SLFTAP SLFDRILL CANN STRL,$385.00,$0.00,$385.00,$173.25,$274.77,$0.00,$66.33,$0.00,$0.00,$67.41,$385.00,$0.00,$192.50,$304.92,$308.00,$0.00,$60.25,$0.00,$61.29,$0.00
326695S,SUP,HCPCS C1713,,326695S  -  SCREW BONE 8MM 95MM 25MM ASNS 3 SS SLFTAP SLFDRILL CANN STRL,$385.00,$0.00,$385.00,$173.25,$274.77,$0.00,$66.33,$0.00,$0.00,$67.41,$385.00,$0.00,$192.50,$304.92,$308.00,$0.00,$60.25,$0.00,$61.29,$0.00
326700S,SUP,HCPCS C1713,,326700S  -  SCREW BONE 8MM 100MM 25MM ASNS SS THRD CANN STRL,$385.00,$0.00,$385.00,$173.25,$274.77,$0.00,$66.33,$0.00,$0.00,$67.41,$385.00,$0.00,$192.50,$304.92,$308.00,$0.00,$60.25,$0.00,$61.29,$0.00
326705S,SUP,HCPCS C1713,,326705S  -  SCREW BONE 8MM 105MM 25MM ASNS 3 SS SLFTAP SLFDRILL CANN,$385.00,$0.00,$385.00,$173.25,$274.77,$0.00,$66.33,$0.00,$0.00,$67.41,$385.00,$0.00,$192.50,$304.92,$308.00,$0.00,$60.25,$0.00,$61.29,$0.00
326710S,SUP,HCPCS C1713,,326710S  -  SCREW BONE 8MM 110MM 25MM ASNS 3 SS SLFTAP SLFDRILL CANN,$385.00,$0.00,$385.00,$173.25,$274.77,$0.00,$66.33,$0.00,$0.00,$67.41,$385.00,$0.00,$192.50,$304.92,$308.00,$0.00,$60.25,$0.00,$61.29,$0.00
326715S,SUP,HCPCS C1713,,326715S  -  SCREW BONE 8MM 115MM 25MM ASNS 3 SS SLFTAP SLFDRILL CANN,$385.00,$0.00,$385.00,$173.25,$274.77,$0.00,$66.33,$0.00,$0.00,$67.41,$385.00,$0.00,$192.50,$304.92,$308.00,$0.00,$60.25,$0.00,$61.29,$0.00
326720S,SUP,HCPCS C1713,,326720S  -  SCREW BONE 8MM 120MM 25MM ASNS 3 SS SLFTAP SLFDRILL CANN,$385.00,$0.00,$385.00,$173.25,$274.77,$0.00,$66.33,$0.00,$0.00,$67.41,$385.00,$0.00,$192.50,$304.92,$308.00,$0.00,$60.25,$0.00,$61.29,$0.00
326725S,SUP,HCPCS C1713,,326725S  -  SCREW BONE 8MM 125MM 25MM ASNS 3 SS HIP STRL,$728.75,$0.00,$728.75,$327.94,$520.11,$0.00,$125.56,$0.00,$0.00,$127.60,$728.75,$0.00,$364.38,$577.17,$583.00,$0.00,$114.05,$0.00,$116.02,$0.00
326730S,SUP,HCPCS C1713,,326730S  -  SCREW BONE 8MM 135MM 25MM ASNS 3 SS THRD STRL,$728.75,$0.00,$728.75,$327.94,$520.11,$0.00,$125.56,$0.00,$0.00,$127.60,$728.75,$0.00,$364.38,$577.17,$583.00,$0.00,$114.05,$0.00,$116.02,$0.00
326840S,SUP,HCPCS C1713,,326840S  -  SCREW BONE 8MM 40MM ASNS 3 SS FULTHD SLFTAP SLFDRILL CANN,$385.00,$0.00,$385.00,$173.25,$274.77,$0.00,$66.33,$0.00,$0.00,$67.41,$385.00,$0.00,$192.50,$304.92,$308.00,$0.00,$60.25,$0.00,$61.29,$0.00
326845S,SUP,HCPCS C1713,,326845S  -  SCREW BONE 8MM 45MM ASNS 3 SS FULTHD CANN SLFDRILL SLFTAP,$385.00,$0.00,$385.00,$173.25,$274.77,$0.00,$66.33,$0.00,$0.00,$67.41,$385.00,$0.00,$192.50,$304.92,$308.00,$0.00,$60.25,$0.00,$61.29,$0.00
326850S,SUP,HCPCS C1713,,326850S  -  SCREW BONE 8MM 50MM ASNS 3 SS CANN,$385.00,$0.00,$385.00,$173.25,$274.77,$0.00,$66.33,$0.00,$0.00,$67.41,$385.00,$0.00,$192.50,$304.92,$308.00,$0.00,$60.25,$0.00,$61.29,$0.00
326855S,SUP,HCPCS C1713,,326855S  -  SCREW BONE 8MM 55MM ASNS 3 SS FULTHD CANN SLFDRILL SLFTAP,$385.00,$0.00,$385.00,$173.25,$274.77,$0.00,$66.33,$0.00,$0.00,$67.41,$385.00,$0.00,$192.50,$304.92,$308.00,$0.00,$60.25,$0.00,$61.29,$0.00
326860S,SUP,HCPCS C1713,,326860S  -  SCREW BONE 8MM 60MM ASNS 3 SS FULTHD SLFTAP SLFDRILL CANN,$385.00,$0.00,$385.00,$173.25,$274.77,$0.00,$66.33,$0.00,$0.00,$67.41,$385.00,$0.00,$192.50,$304.92,$308.00,$0.00,$60.25,$0.00,$61.29,$0.00
326865S,SUP,HCPCS C1713,,326865S  -  SCREW BONE 8MM 65MM ASNS 3 SS CANN,$385.00,$0.00,$385.00,$173.25,$274.77,$0.00,$66.33,$0.00,$0.00,$67.41,$385.00,$0.00,$192.50,$304.92,$308.00,$0.00,$60.25,$0.00,$61.29,$0.00
326870S,SUP,HCPCS C1713,,326870S  -  SCREW BONE 8MM 70MM ASNS 3 SS FULTHD HIP CANN STRL,$385.00,$0.00,$385.00,$173.25,$274.77,$0.00,$66.33,$0.00,$0.00,$67.41,$385.00,$0.00,$192.50,$304.92,$308.00,$0.00,$60.25,$0.00,$61.29,$0.00
326875S,SUP,HCPCS C1713,,326875S  -  SCREW BONE 8MM 75MM ASNS 3 SS FULTHD SLFTAP SLFDRILL CANN,$385.00,$0.00,$385.00,$173.25,$274.77,$0.00,$66.33,$0.00,$0.00,$67.41,$385.00,$0.00,$192.50,$304.92,$308.00,$0.00,$60.25,$0.00,$61.29,$0.00
326880S,SUP,HCPCS C1713,,326880S  -  SCREW BONE 8MM 80MM ASNS 3 SS FULTHD CANN SLFDRILL SLFTAP,$385.00,$0.00,$385.00,$173.25,$274.77,$0.00,$66.33,$0.00,$0.00,$67.41,$385.00,$0.00,$192.50,$304.92,$308.00,$0.00,$60.25,$0.00,$61.29,$0.00
326885S,SUP,HCPCS C1713,,326885S  -  SCREW BONE 8MM 85MM ASNS 3 TI ORTH CANN PTHRD STRL,$385.00,$0.00,$385.00,$173.25,$274.77,$0.00,$66.33,$0.00,$0.00,$67.41,$385.00,$0.00,$192.50,$304.92,$308.00,$0.00,$60.25,$0.00,$61.29,$0.00
326890S,SUP,HCPCS C1713,,326890S  -  SCREW BONE 8MM 90MM ASNS 3 SS FULTHD HIP CANN STRL,$385.00,$0.00,$385.00,$173.25,$274.77,$0.00,$66.33,$0.00,$0.00,$67.41,$385.00,$0.00,$192.50,$304.92,$308.00,$0.00,$60.25,$0.00,$61.29,$0.00
326895S,SUP,HCPCS C1713,,326895S  -  SCREW BONE 8MM 95MM ASNS 3 SS FULTHD HIP CANN STRL,$385.00,$0.00,$385.00,$173.25,$274.77,$0.00,$66.33,$0.00,$0.00,$67.41,$385.00,$0.00,$192.50,$304.92,$308.00,$0.00,$60.25,$0.00,$61.29,$0.00
326900S,SUP,HCPCS C1713,,326900S  -  SCREW BONE 8MM 100MM ASNS 3 SS FULTHD HIP CANN STRL,$385.00,$0.00,$385.00,$173.25,$274.77,$0.00,$66.33,$0.00,$0.00,$67.41,$385.00,$0.00,$192.50,$304.92,$308.00,$0.00,$60.25,$0.00,$61.29,$0.00
326905S,SUP,HCPCS C1713,,326905S  -  SCREW BONE 8MM 105MM ASNS 3 SS FULTHD HIP CANN STRL,$385.00,$0.00,$385.00,$173.25,$274.77,$0.00,$66.33,$0.00,$0.00,$67.41,$385.00,$0.00,$192.50,$304.92,$308.00,$0.00,$60.25,$0.00,$61.29,$0.00
326910S,SUP,HCPCS C1713,,326910S  -  SCREW BONE 8MM 110MM ASNS 3 SS FULTHD HIP CANN STRL,$385.00,$0.00,$385.00,$173.25,$274.77,$0.00,$66.33,$0.00,$0.00,$67.41,$385.00,$0.00,$192.50,$304.92,$308.00,$0.00,$60.25,$0.00,$61.29,$0.00
326915S,SUP,HCPCS C1713,,326915S  -  SCREW BONE 8MM 115MM ASNS 3 SS FEM HIP CANN STRL,$385.00,$0.00,$385.00,$173.25,$274.77,$0.00,$66.33,$0.00,$0.00,$67.41,$385.00,$0.00,$192.50,$304.92,$308.00,$0.00,$60.25,$0.00,$61.29,$0.00
326920S,SUP,HCPCS C1713,,326920S  -  SCREW BONE 8MM 120MM ASNS 3 TI ORTH CANN PTHRD STRL,$385.00,$0.00,$385.00,$173.25,$274.77,$0.00,$66.33,$0.00,$0.00,$67.41,$385.00,$0.00,$192.50,$304.92,$308.00,$0.00,$60.25,$0.00,$61.29,$0.00
326925S,SUP,HCPCS C1713,,326925S  -  SCREW BONE 8MM 125MM ASNS 3 SS FULTHRD STRL,$378.13,$0.00,$378.13,$170.16,$269.87,$0.00,$65.15,$0.00,$0.00,$66.21,$378.13,$0.00,$189.06,$299.48,$302.50,$0.00,$59.18,$0.00,$60.20,$0.00
326930S,SUP,HCPCS C1713,,326930S  -  SCREW BONE 8MM 130MM ASNS 3 SS FULTHRD CANN STRL,$378.13,$0.00,$378.13,$170.16,$269.87,$0.00,$65.15,$0.00,$0.00,$66.21,$378.13,$0.00,$189.06,$299.48,$302.50,$0.00,$59.18,$0.00,$60.20,$0.00
327-1010,SUP,HCPCS C1713,,327-1010  -  SCREW BN 2.7MM 10MM ST CORT,$167.50,$0.00,$167.50,$75.38,$119.54,$0.00,$28.86,$0.00,$0.00,$29.33,$167.50,$0.00,$83.75,$132.66,$134.00,$0.00,$26.21,$0.00,$26.67,$0.00
327-1012,SUP,HCPCS C1713,,327-1012  -  SCREW BN 2.7MM 12MM ST CORT,$167.50,$0.00,$167.50,$75.38,$119.54,$0.00,$28.86,$0.00,$0.00,$29.33,$167.50,$0.00,$83.75,$132.66,$134.00,$0.00,$26.21,$0.00,$26.67,$0.00
327-1014,SUP,HCPCS C1713,,327-1014  -  SCREW BN 2.7MM 14MM ST CORT,$167.50,$0.00,$167.50,$75.38,$119.54,$0.00,$28.86,$0.00,$0.00,$29.33,$167.50,$0.00,$83.75,$132.66,$134.00,$0.00,$26.21,$0.00,$26.67,$0.00
327-1016,SUP,HCPCS C1713,,327-1016  -  SCREW BN 2.7MM 16MM ST CORT,$167.50,$0.00,$167.50,$75.38,$119.54,$0.00,$28.86,$0.00,$0.00,$29.33,$167.50,$0.00,$83.75,$132.66,$134.00,$0.00,$26.21,$0.00,$26.67,$0.00
327-1018,SUP,HCPCS C1713,,327-1018  -  SCREW BN 2.7MM 18MM ST CORT,$167.50,$0.00,$167.50,$75.38,$119.54,$0.00,$28.86,$0.00,$0.00,$29.33,$167.50,$0.00,$83.75,$132.66,$134.00,$0.00,$26.21,$0.00,$26.67,$0.00
327-1020,SUP,HCPCS C1713,,327-1020  -  SCREW BN 2.7MM 20MM ST CORT,$167.50,$0.00,$167.50,$75.38,$119.54,$0.00,$28.86,$0.00,$0.00,$29.33,$167.50,$0.00,$83.75,$132.66,$134.00,$0.00,$26.21,$0.00,$26.67,$0.00
327-1022,SUP,HCPCS C1713,,327-1022  -  SCREW BN 2.7MM 22MM ST CORT,$167.50,$0.00,$167.50,$75.38,$119.54,$0.00,$28.86,$0.00,$0.00,$29.33,$167.50,$0.00,$83.75,$132.66,$134.00,$0.00,$26.21,$0.00,$26.67,$0.00
327-1024,SUP,HCPCS C1713,,327-1024  -  SCREW BN 2.7MM 24MM ST CORT,$167.50,$0.00,$167.50,$75.38,$119.54,$0.00,$28.86,$0.00,$0.00,$29.33,$167.50,$0.00,$83.75,$132.66,$134.00,$0.00,$26.21,$0.00,$26.67,$0.00
327-1026,SUP,HCPCS C1713,,327-1026  -  SCREW BN 2.7MM 26MM ST CORT,$167.50,$0.00,$167.50,$75.38,$119.54,$0.00,$28.86,$0.00,$0.00,$29.33,$167.50,$0.00,$83.75,$132.66,$134.00,$0.00,$26.21,$0.00,$26.67,$0.00
327-1028,SUP,HCPCS C1713,,327-1028  -  SCREW BN 2.7MM 28MM ST CORT,$167.50,$0.00,$167.50,$75.38,$119.54,$0.00,$28.86,$0.00,$0.00,$29.33,$167.50,$0.00,$83.75,$132.66,$134.00,$0.00,$26.21,$0.00,$26.67,$0.00
327-1030,SUP,HCPCS C1713,,327-1030  -  SCREW BN 2.7MM 30MM ST CORT,$167.50,$0.00,$167.50,$75.38,$119.54,$0.00,$28.86,$0.00,$0.00,$29.33,$167.50,$0.00,$83.75,$132.66,$134.00,$0.00,$26.21,$0.00,$26.67,$0.00
327-1032,SUP,HCPCS C1713,,327-1032  -  SCREW BN 2.7MM 32MM ST CORT,$167.50,$0.00,$167.50,$75.38,$119.54,$0.00,$28.86,$0.00,$0.00,$29.33,$167.50,$0.00,$83.75,$132.66,$134.00,$0.00,$26.21,$0.00,$26.67,$0.00
3300TFX19MM,SUP,Custom 27803010,,3300TFX19MM  -  VALVE AOR LOPRFL 19MM CRP-ED PRIMNT MG EASE BPRTH THERMAFIX,"$22,275.00",$0.00,"$22,275.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$22,275.00",$0.00,"$11,137.50","$17,641.80","$17,820.00",$0.00,$0.00,$0.00,$0.00,$0.00
3300TFX21MM,SUP,Custom 27803010,,3300TFX21MM  -  VALVE AOR 21MM CRP-ED PRIMNT MG EASE THERMAFIX BPRTH SUP,"$22,275.00",$0.00,"$22,275.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$22,275.00",$0.00,"$11,137.50","$17,641.80","$17,820.00",$0.00,$0.00,$0.00,$0.00,$0.00
3300TFX23MM,SUP,Custom 27803010,,3300TFX23MM  -  VALVE AOR 23MM CRP-ED PRIMNT MG EASE THERMAFIX BPRTH STNT BS,"$22,275.00",$0.00,"$22,275.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$22,275.00",$0.00,"$11,137.50","$17,641.80","$17,820.00",$0.00,$0.00,$0.00,$0.00,$0.00
3300TFX25MM,SUP,Custom 27803010,,3300TFX25MM  -  VALVE AORTIC LP 25MM BIOPROSTHESIS THERMAFIX PROCESS STENT,"$22,275.00",$0.00,"$22,275.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$22,275.00",$0.00,"$11,137.50","$17,641.80","$17,820.00",$0.00,$0.00,$0.00,$0.00,$0.00
3300TFX27MM,SUP,Custom 27803010,,3300TFX27MM  -  VALVE AORTIC LP 27MM BIOPROSTHESIS THERMAFIX PROCESS STENT,"$22,275.00",$0.00,"$22,275.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$22,275.00",$0.00,"$11,137.50","$17,641.80","$17,820.00",$0.00,$0.00,$0.00,$0.00,$0.00
3300TFX29MM,SUP,Custom 27803010,,3300TFX29MM  -  VALVE AOR LOPRFL 29MM CRP-ED PRIMNT MG EASE BPRTH THERMAFIX,"$22,275.00",$0.00,"$22,275.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$22,275.00",$0.00,"$11,137.50","$17,641.80","$17,820.00",$0.00,$0.00,$0.00,$0.00,$0.00
3304-G,SUP,Custom 27203010,,3304-G  -  RING RTRCTR LNSTR NORYL RSN PLST CATH CLIP DISP STRL LATEX,$110.00,$0.00,$110.00,$0.00,$78.51,$0.00,$0.00,$0.00,$0.00,$0.00,$110.00,$0.00,$55.00,$87.12,$88.00,$0.00,$0.00,$0.00,$0.00,$0.00
3307-G,SUP,Custom 27203010,,3307-G  -  RING RTRCTR SM G2 NORYL RSN W/O STAY KIT RCTL BLUE DISP STRL,$121.28,$0.00,$121.28,$0.00,$86.55,$0.00,$0.00,$0.00,$0.00,$0.00,$121.28,$0.00,$60.64,$96.05,$97.02,$0.00,$0.00,$0.00,$0.00,$0.00
331 443,SUP,HCPCS C1900,,331 443  -  PHILOS DR,"$7,250.00",$0.00,"$7,250.00",$0.00,"$5,158.80",$0.00,"$1,249.14",$0.00,$0.00,$0.00,"$7,250.00",$0.00,"$3,625.00","$5,742.00","$5,800.00",$0.00,"$1,134.63",$0.00,$0.00,$0.00
331 446,SUP,HCPCS C1900,,331 446  -  PHILOS SR,"$7,000.00",$0.00,"$7,000.00",$0.00,"$4,995.90",$0.00,"$1,206.07",$0.00,$0.00,$0.00,"$7,000.00",$0.00,"$3,500.00","$5,544.00","$5,600.00",$0.00,"$1,095.50",$0.00,$0.00,$0.00
3320-0240S,SUP,HCPCS C1713,,3320-0240S  -  NAIL 11MM 240MM LEFT FEM HIP GAMMA3 IM 120D LNG STRL,"$2,447.50",$0.00,"$2,447.50","$1,101.38","$1,746.78",$0.00,$421.69,$0.00,$0.00,$428.54,"$2,447.50",$0.00,"$1,223.75","$1,938.42","$1,958.00",$0.00,$383.03,$0.00,$389.64,$0.00
3320-0260S,SUP,HCPCS C1713,,3320-0260S  -  NAIL 11MM 260MM LEFT FEM HIP GAMMA3 IM 120D LNG STRL,"$2,447.50",$0.00,"$2,447.50","$1,101.38","$1,746.78",$0.00,$421.69,$0.00,$0.00,$428.54,"$2,447.50",$0.00,"$1,223.75","$1,938.42","$1,958.00",$0.00,$383.03,$0.00,$389.64,$0.00
3320-0280S,SUP,HCPCS C1713,,3320-0280S  -  NAIL 11MM 28CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL,"$2,798.13",$0.00,"$2,798.13","$1,259.16","$1,997.02",$0.00,$482.10,$0.00,$0.00,$489.93,"$2,798.13",$0.00,"$1,399.06","$2,216.12","$2,238.50",$0.00,$437.91,$0.00,$445.46,$0.00
3320-0300S,SUP,HCPCS C1713,,3320-0300S  -  NAIL 11MM 30CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL,"$3,093.75",$0.00,"$3,093.75","$1,392.19","$2,208.01",$0.00,$533.04,$0.00,$0.00,$541.69,"$3,093.75",$0.00,"$1,546.88","$2,450.25","$2,475.00",$0.00,$484.17,$0.00,$492.53,$0.00
3320-0320S,SUP,HCPCS C1713,,3320-0320S  -  NAIL 11MM 32CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL,"$3,093.75",$0.00,"$3,093.75","$1,392.19","$2,208.01",$0.00,$533.04,$0.00,$0.00,$541.69,"$3,093.75",$0.00,"$1,546.88","$2,450.25","$2,475.00",$0.00,$484.17,$0.00,$492.53,$0.00
3320-0340S,SUP,HCPCS C1713,,3320-0340S  -  NAIL 11MM 34CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL,"$3,093.75",$0.00,"$3,093.75","$1,392.19","$2,208.01",$0.00,$533.04,$0.00,$0.00,$541.69,"$3,093.75",$0.00,"$1,546.88","$2,450.25","$2,475.00",$0.00,$484.17,$0.00,$492.53,$0.00
3320-0360S,SUP,HCPCS C1713,,3320-0360S  -  NAIL 11MM 36CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL,"$3,093.75",$0.00,"$3,093.75","$1,392.19","$2,208.01",$0.00,$533.04,$0.00,$0.00,$541.69,"$3,093.75",$0.00,"$1,546.88","$2,450.25","$2,475.00",$0.00,$484.17,$0.00,$492.53,$0.00
3320-0380S,SUP,HCPCS C1713,,3320-0380S  -  NAIL 11MM 38CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL,"$3,093.75",$0.00,"$3,093.75","$1,392.19","$2,208.01",$0.00,$533.04,$0.00,$0.00,$541.69,"$3,093.75",$0.00,"$1,546.88","$2,450.25","$2,475.00",$0.00,$484.17,$0.00,$492.53,$0.00
3320-0400S,SUP,HCPCS C1713,,3320-0400S  -  NAIL 11MM 40CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL,"$3,093.75",$0.00,"$3,093.75","$1,392.19","$2,208.01",$0.00,$533.04,$0.00,$0.00,$541.69,"$3,093.75",$0.00,"$1,546.88","$2,450.25","$2,475.00",$0.00,$484.17,$0.00,$492.53,$0.00
3320-0420S,SUP,HCPCS C1713,,3320-0420S  -  NAIL 11MM 42CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL,"$3,093.75",$0.00,"$3,093.75","$1,392.19","$2,208.01",$0.00,$533.04,$0.00,$0.00,$541.69,"$3,093.75",$0.00,"$1,546.88","$2,450.25","$2,475.00",$0.00,$484.17,$0.00,$492.53,$0.00
3320-0440S,SUP,HCPCS C1713,,3320-0440S  -  NAIL 11MM 44CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL,"$3,093.75",$0.00,"$3,093.75","$1,392.19","$2,208.01",$0.00,$533.04,$0.00,$0.00,$541.69,"$3,093.75",$0.00,"$1,546.88","$2,450.25","$2,475.00",$0.00,$484.17,$0.00,$492.53,$0.00
3320-0460S,SUP,HCPCS C1713,,3320-0460S  -  NAIL 11MM 46CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL,"$2,798.13",$0.00,"$2,798.13","$1,259.16","$1,997.02",$0.00,$482.10,$0.00,$0.00,$489.93,"$2,798.13",$0.00,"$1,399.06","$2,216.12","$2,238.50",$0.00,$437.91,$0.00,$445.46,$0.00
3320-3340S,SUP,HCPCS C1713,,3320-3340S  -  NAIL 13MM 34CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3320-3360S,SUP,HCPCS C1713,,3320-3360S  -  NAIL 13MM 36CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3320-3380S,SUP,HCPCS C1713,,3320-3380S  -  NAIL 13MM 38CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3320-3400S,SUP,HCPCS C1713,,3320-3400S  -  NAIL 13MM 40CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3320-3420S,SUP,HCPCS C1713,,3320-3420S  -  NAIL 13MM 42CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3320-3440S,SUP,HCPCS C1713,,3320-3440S  -  NAIL 13MM 46CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3320-3460S,SUP,HCPCS C1713,,3320-3460S  -  NAIL 13MM 44CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3320-5340S,SUP,HCPCS C1713,,3320-5340S  -  NAIL 15MM 34CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3320-5360S,SUP,HCPCS C1713,,3320-5360S  -  NAIL 15MM 36CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3320-5380S,SUP,HCPCS C1713,,3320-5380S  -  NAIL 15MM 38CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3320-5400S,SUP,HCPCS C1713,,3320-5400S  -  NAIL 15MM 40CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3320-5420S,SUP,HCPCS C1713,,3320-5420S  -  NAIL 15MM 42CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3320-5440S,SUP,HCPCS C1713,,3320-5440S  -  NAIL 15MM 44CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3320-5460S,SUP,HCPCS C1713,,3320-5460S  -  NAIL 15MM 46CM LEFT FEM HIP GAMMA3 IM 120D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3325-0240S,SUP,HCPCS C1713,,3325-0240S  -  NAIL 11MM 240MM LEFT FEM HIP GAMMA3 IM 125D LNG STRL,"$2,798.13",$0.00,"$2,798.13","$1,259.16","$1,997.02",$0.00,$482.10,$0.00,$0.00,$489.93,"$2,798.13",$0.00,"$1,399.06","$2,216.12","$2,238.50",$0.00,$437.91,$0.00,$445.46,$0.00
3325-0260S,SUP,HCPCS C1713,,3325-0260S  -  NAIL 11MM 260MM LEFT FEM HIP GAMMA3 IM 125D LNG STRL,"$2,688.13",$0.00,"$2,688.13","$1,209.66","$1,918.51",$0.00,$463.15,$0.00,$0.00,$470.67,"$2,688.13",$0.00,"$1,344.06","$2,129.00","$2,150.50",$0.00,$420.69,$0.00,$427.95,$0.00
3325-0280S,SUP,HCPCS C1713,,3325-0280S  -  NAIL 11MM 28CM LEFT FEM HIP GAMMA3 IM 125D LNG KIT TI STRL,"$2,798.13",$0.00,"$2,798.13","$1,259.16","$1,997.02",$0.00,$482.10,$0.00,$0.00,$489.93,"$2,798.13",$0.00,"$1,399.06","$2,216.12","$2,238.50",$0.00,$437.91,$0.00,$445.46,$0.00
3325-0300S,SUP,HCPCS C1713,,3325-0300S  -  NAIL 11MM 30CM LEFT FEM HIP GAMMA3 IM 125D LNG KIT TI STRL,"$3,093.75",$0.00,"$3,093.75","$1,392.19","$2,208.01",$0.00,$533.04,$0.00,$0.00,$541.69,"$3,093.75",$0.00,"$1,546.88","$2,450.25","$2,475.00",$0.00,$484.17,$0.00,$492.53,$0.00
3325-0320S,SUP,HCPCS C1713,,3325-0320S  -  NAIL 11MM 32CM LEFT FEM HIP GAMMA3 IM 125D LNG KIT TI STRL,"$3,093.75",$0.00,"$3,093.75","$1,392.19","$2,208.01",$0.00,$533.04,$0.00,$0.00,$541.69,"$3,093.75",$0.00,"$1,546.88","$2,450.25","$2,475.00",$0.00,$484.17,$0.00,$492.53,$0.00
3325-0340S,SUP,HCPCS C1713,,3325-0340S  -  NAIL 11MM 34CM LEFT FEM HIP GAMMA3 IM 125D LNG KIT TI STRL,"$3,093.75",$0.00,"$3,093.75","$1,392.19","$2,208.01",$0.00,$533.04,$0.00,$0.00,$541.69,"$3,093.75",$0.00,"$1,546.88","$2,450.25","$2,475.00",$0.00,$484.17,$0.00,$492.53,$0.00
3325-0360S,SUP,HCPCS C1713,,3325-0360S  -  NAIL 11MM 36CM LEFT FEM HIP GAMMA3 IM 125D LNG KIT TI STRL,"$3,093.75",$0.00,"$3,093.75","$1,392.19","$2,208.01",$0.00,$533.04,$0.00,$0.00,$541.69,"$3,093.75",$0.00,"$1,546.88","$2,450.25","$2,475.00",$0.00,$484.17,$0.00,$492.53,$0.00
3325-0380S,SUP,HCPCS C1713,,3325-0380S  -  NAIL 11MM 38CM LEFT FEM HIP GAMMA3 IM 125D LNG KIT TI STRL,"$3,093.75",$0.00,"$3,093.75","$1,392.19","$2,208.01",$0.00,$533.04,$0.00,$0.00,$541.69,"$3,093.75",$0.00,"$1,546.88","$2,450.25","$2,475.00",$0.00,$484.17,$0.00,$492.53,$0.00
3325-0400S,SUP,HCPCS C1713,,3325-0400S  -  NAIL 11MM 40CM LEFT FEM HIP GAMMA3 IM 125D LNG KIT TI STRL,"$3,093.75",$0.00,"$3,093.75","$1,392.19","$2,208.01",$0.00,$533.04,$0.00,$0.00,$541.69,"$3,093.75",$0.00,"$1,546.88","$2,450.25","$2,475.00",$0.00,$484.17,$0.00,$492.53,$0.00
3325-0420S,SUP,HCPCS C1713,,3325-0420S  -  NAIL 11MM 42CM LEFT FEM HIP GAMMA3 IM 125D LNG KIT TI STRL,"$3,093.75",$0.00,"$3,093.75","$1,392.19","$2,208.01",$0.00,$533.04,$0.00,$0.00,$541.69,"$3,093.75",$0.00,"$1,546.88","$2,450.25","$2,475.00",$0.00,$484.17,$0.00,$492.53,$0.00
3325-0440S,SUP,HCPCS C1713,,3325-0440S  -  NAIL 11MM 44CM LEFT FEM HIP GAMMA3 IM 125D LNG KIT TI STRL,"$3,093.75",$0.00,"$3,093.75","$1,392.19","$2,208.01",$0.00,$533.04,$0.00,$0.00,$541.69,"$3,093.75",$0.00,"$1,546.88","$2,450.25","$2,475.00",$0.00,$484.17,$0.00,$492.53,$0.00
3325-0460S,SUP,HCPCS C1713,,3325-0460S  -  NAIL 11MM 46CM LEFT FEM HIP GAMMA3 IM 125D LNG KIT TI STRL,"$2,798.13",$0.00,"$2,798.13","$1,259.16","$1,997.02",$0.00,$482.10,$0.00,$0.00,$489.93,"$2,798.13",$0.00,"$1,399.06","$2,216.12","$2,238.50",$0.00,$437.91,$0.00,$445.46,$0.00
3325-3280S,SUP,HCPCS C1713,,3325-3280S  -  NAIL 13MM 280MM LEFT FEM HIP GAMMA3 IM 125D LNG STRL,"$2,447.50",$0.00,"$2,447.50","$1,101.38","$1,746.78",$0.00,$421.69,$0.00,$0.00,$428.54,"$2,447.50",$0.00,"$1,223.75","$1,938.42","$1,958.00",$0.00,$383.03,$0.00,$389.64,$0.00
3325-3300S,SUP,HCPCS C1713,,3325-3300S  -  NAIL 13MM 30CM HIP LEFT GAMMA3 IM 125D LNG TI STRL,"$2,688.13",$0.00,"$2,688.13","$1,209.66","$1,918.51",$0.00,$463.15,$0.00,$0.00,$470.67,"$2,688.13",$0.00,"$1,344.06","$2,129.00","$2,150.50",$0.00,$420.69,$0.00,$427.95,$0.00
3325-3320S,SUP,HCPCS C1713,,3325-3320S  -  NAIL 13MM 32CM LEFT FEM HIP GAMMA3 IM 125D LNG STRL,"$2,688.13",$0.00,"$2,688.13","$1,209.66","$1,918.51",$0.00,$463.15,$0.00,$0.00,$470.67,"$2,688.13",$0.00,"$1,344.06","$2,129.00","$2,150.50",$0.00,$420.69,$0.00,$427.95,$0.00
3325-3340S,SUP,HCPCS C1713,,3325-3340S  -  NAIL 13MM 34CM LEFT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3325-3360S,SUP,HCPCS C1713,,3325-3360S  -  NAIL 13MM 36CM LEFT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3325-3380S,SUP,HCPCS C1713,,3325-3380S  -  NAIL 13MM 38CM LEFT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3325-3400S,SUP,HCPCS C1713,,3325-3400S  -  NAIL 13MM 40CM LEFT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3325-3420S,SUP,HCPCS C1713,,3325-3420S  -  NAIL 13MM 42CM LEFT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3325-3440S,SUP,HCPCS C1713,,3325-3440S  -  NAIL 13MM 44CM LEFT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3325-3460S,SUP,HCPCS C1713,,3325-3460S  -  NAIL 13MM 46CM LEFT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3325-5280S,SUP,HCPCS C1713,,3325-5280S  -  NAIL 15MM 280MM LEFT FEM HIP GAMMA3 IM 125D LNG STRL,"$2,447.50",$0.00,"$2,447.50","$1,101.38","$1,746.78",$0.00,$421.69,$0.00,$0.00,$428.54,"$2,447.50",$0.00,"$1,223.75","$1,938.42","$1,958.00",$0.00,$383.03,$0.00,$389.64,$0.00
3325-5300S,SUP,HCPCS C1713,,3325-5300S  -  NAIL 15MM 300MM LEFT FEM HIP GAMMA3 IM 125D LNG STRL,"$2,447.50",$0.00,"$2,447.50","$1,101.38","$1,746.78",$0.00,$421.69,$0.00,$0.00,$428.54,"$2,447.50",$0.00,"$1,223.75","$1,938.42","$1,958.00",$0.00,$383.03,$0.00,$389.64,$0.00
3325-5320S,SUP,HCPCS C1713,,3325-5320S  -  NAIL 15MM 320MM LEFT FEM HIP GAMMA3 IM 125D LNG STRL,"$2,447.50",$0.00,"$2,447.50","$1,101.38","$1,746.78",$0.00,$421.69,$0.00,$0.00,$428.54,"$2,447.50",$0.00,"$1,223.75","$1,938.42","$1,958.00",$0.00,$383.03,$0.00,$389.64,$0.00
3325-5340S,SUP,HCPCS C1713,,3325-5340S  -  NAIL 15MM 34CM LEFT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3325-5360S,SUP,HCPCS C1713,,3325-5360S  -  NAIL 15MM 36CM LEFT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3325-5380S,SUP,HCPCS C1713,,3325-5380S  -  NAIL 15MM 38CM LEFT FEM HIP GAMMA3 IM 125D LNG KIT TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3325-5400S,SUP,HCPCS C1713,,3325-5400S  -  NAIL 15MM 40CM LEFT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3325-5420S,SUP,HCPCS C1713,,3325-5420S  -  NAIL 15MM 42CM LEFT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3325-5440S,SUP,HCPCS C1713,,3325-5440S  -  NAIL 15MM 44CM LEFT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3325-5460S,SUP,HCPCS C1713,,3325-5460S  -  NAIL 15MM 46CM LEFT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3330-0240S,SUP,HCPCS C1713,,3330-0240S  -  NAIL 11MM 240MM LEFT FEM HIP GAMMA3 IM 130D LNG STRL,"$2,447.50",$0.00,"$2,447.50","$1,101.38","$1,746.78",$0.00,$421.69,$0.00,$0.00,$428.54,"$2,447.50",$0.00,"$1,223.75","$1,938.42","$1,958.00",$0.00,$383.03,$0.00,$389.64,$0.00
3330-0260S,SUP,HCPCS C1713,,3330-0260S  -  NAIL 11MM 260MM LEFT FEM HIP GAMMA3 IM 130D LNG STRL,"$2,447.50",$0.00,"$2,447.50","$1,101.38","$1,746.78",$0.00,$421.69,$0.00,$0.00,$428.54,"$2,447.50",$0.00,"$1,223.75","$1,938.42","$1,958.00",$0.00,$383.03,$0.00,$389.64,$0.00
3330-0280S,SUP,HCPCS C1713,,3330-0280S  -  NAIL 11MM 28CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL,"$2,798.13",$0.00,"$2,798.13","$1,259.16","$1,997.02",$0.00,$482.10,$0.00,$0.00,$489.93,"$2,798.13",$0.00,"$1,399.06","$2,216.12","$2,238.50",$0.00,$437.91,$0.00,$445.46,$0.00
3330-0300S,SUP,HCPCS C1713,,3330-0300S  -  NAIL 11MM 30CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL,"$3,093.75",$0.00,"$3,093.75","$1,392.19","$2,208.01",$0.00,$533.04,$0.00,$0.00,$541.69,"$3,093.75",$0.00,"$1,546.88","$2,450.25","$2,475.00",$0.00,$484.17,$0.00,$492.53,$0.00
3330-0320S,SUP,HCPCS C1713,,3330-0320S  -  NAIL 11MM 32CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL,"$3,093.75",$0.00,"$3,093.75","$1,392.19","$2,208.01",$0.00,$533.04,$0.00,$0.00,$541.69,"$3,093.75",$0.00,"$1,546.88","$2,450.25","$2,475.00",$0.00,$484.17,$0.00,$492.53,$0.00
3330-0340S,SUP,HCPCS C1713,,3330-0340S  -  NAIL 11MM 34CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL,"$3,093.75",$0.00,"$3,093.75","$1,392.19","$2,208.01",$0.00,$533.04,$0.00,$0.00,$541.69,"$3,093.75",$0.00,"$1,546.88","$2,450.25","$2,475.00",$0.00,$484.17,$0.00,$492.53,$0.00
3330-0360S,SUP,HCPCS C1713,,3330-0360S  -  NAIL 11MM 36CM LEFT FEM HIP GAMMA3 IM 130D LNG KIT TI STRL,"$3,093.75",$0.00,"$3,093.75","$1,392.19","$2,208.01",$0.00,$533.04,$0.00,$0.00,$541.69,"$3,093.75",$0.00,"$1,546.88","$2,450.25","$2,475.00",$0.00,$484.17,$0.00,$492.53,$0.00
3330-0380S,SUP,HCPCS C1713,,3330-0380S  -  NAIL 11MM 38CM LEFT FEM HIP GAMMA3 IM 130D LNG KIT TI STRL,"$3,093.75",$0.00,"$3,093.75","$1,392.19","$2,208.01",$0.00,$533.04,$0.00,$0.00,$541.69,"$3,093.75",$0.00,"$1,546.88","$2,450.25","$2,475.00",$0.00,$484.17,$0.00,$492.53,$0.00
3330-0400S,SUP,HCPCS C1713,,3330-0400S  -  NAIL 11MM 40CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL,"$3,093.75",$0.00,"$3,093.75","$1,392.19","$2,208.01",$0.00,$533.04,$0.00,$0.00,$541.69,"$3,093.75",$0.00,"$1,546.88","$2,450.25","$2,475.00",$0.00,$484.17,$0.00,$492.53,$0.00
3330-0420S,SUP,HCPCS C1713,,3330-0420S  -  NAIL 11MM 42CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL,"$3,093.75",$0.00,"$3,093.75","$1,392.19","$2,208.01",$0.00,$533.04,$0.00,$0.00,$541.69,"$3,093.75",$0.00,"$1,546.88","$2,450.25","$2,475.00",$0.00,$484.17,$0.00,$492.53,$0.00
3330-0440S,SUP,HCPCS C1713,,3330-0440S  -  NAIL 11MM 44CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL,"$3,093.75",$0.00,"$3,093.75","$1,392.19","$2,208.01",$0.00,$533.04,$0.00,$0.00,$541.69,"$3,093.75",$0.00,"$1,546.88","$2,450.25","$2,475.00",$0.00,$484.17,$0.00,$492.53,$0.00
3330-0460S,SUP,HCPCS C1713,,3330-0460S  -  NAIL 11MM 46CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL,"$2,798.13",$0.00,"$2,798.13","$1,259.16","$1,997.02",$0.00,$482.10,$0.00,$0.00,$489.93,"$2,798.13",$0.00,"$1,399.06","$2,216.12","$2,238.50",$0.00,$437.91,$0.00,$445.46,$0.00
3330-3300S,SUP,HCPCS C1713,,3330-3300S  -  NAIL 13MM 300MM LEFT FEM HIP GAMMA3 IM 130D LNG STRL,"$2,447.50",$0.00,"$2,447.50","$1,101.38","$1,746.78",$0.00,$421.69,$0.00,$0.00,$428.54,"$2,447.50",$0.00,"$1,223.75","$1,938.42","$1,958.00",$0.00,$383.03,$0.00,$389.64,$0.00
3330-3320S,SUP,HCPCS C1713,,3330-3320S  -  NAIL 13MM 280MM LEFT FEM HIP GAMMA3 IM 125D LNG STRL,"$2,447.50",$0.00,"$2,447.50","$1,101.38","$1,746.78",$0.00,$421.69,$0.00,$0.00,$428.54,"$2,447.50",$0.00,"$1,223.75","$1,938.42","$1,958.00",$0.00,$383.03,$0.00,$389.64,$0.00
3330-3340S,SUP,HCPCS C1713,,3330-3340S  -  NAIL 13MM 34CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3330-3360S,SUP,HCPCS C1713,,3330-3360S  -  NAIL 13MM 36CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3330-3380S,SUP,HCPCS C1713,,3330-3380S  -  NAIL 13MM 38CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3330-3400S,SUP,HCPCS C1713,,3330-3400S  -  NAIL 13MM 40CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3330-3420S,SUP,HCPCS C1713,,3330-3420S  -  NAIL 13MM 42CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3330-3440S,SUP,HCPCS C1713,,3330-3440S  -  NAIL 13MM 44CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3330-3460S,SUP,HCPCS C1713,,3330-3460S  -  NAIL 13MM 46CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3330-5340S,SUP,HCPCS C1713,,3330-5340S  -  NAIL 15MM 34CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3330-5360S,SUP,HCPCS C1713,,3330-5360S  -  NAIL 15MM 36CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3330-5380S,SUP,HCPCS C1713,,3330-5380S  -  NAIL 15MM 38CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3330-5400S,SUP,HCPCS C1713,,3330-5400S  -  NAIL 15MM 40CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3330-5420S,SUP,HCPCS C1713,,3330-5420S  -  NAIL 15MM 42CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3330-5440S,SUP,HCPCS C1713,,3330-5440S  -  NAIL 15MM 44CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
3330-5460S,SUP,HCPCS C1713,,3330-5460S  -  NAIL 15MM 46CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL,"$3,293.13",$0.00,"$3,293.13","$1,481.91","$2,350.30",$0.00,$567.39,$0.00,$0.00,$576.60,"$3,293.13",$0.00,"$1,646.56","$2,608.16","$2,634.50",$0.00,$515.37,$0.00,$524.27,$0.00
333-070-003,SUP,Custom 27203010,,333-070-003  -  OBT ENDSCP 70MM DRAIN CANNU,$203.06,$0.00,$203.06,$0.00,$144.93,$0.00,$0.00,$0.00,$0.00,$0.00,$203.06,$0.00,$101.53,$160.82,$162.45,$0.00,$0.00,$0.00,$0.00,$0.00
334 051,SUP,HCPCS C1900,,334 051  -  PHILOS SR SYSTEM,"$8,000.00",$0.00,"$8,000.00",$0.00,"$5,158.80",$0.00,"$1,378.36",$0.00,$0.00,$0.00,"$8,000.00",$0.00,"$4,000.00","$6,336.00","$6,400.00",$0.00,"$1,252.00",$0.00,$0.00,$0.00
335-1012,SUP,HCPCS C1713,,335-1012  -  SCREW BN 3.5MM 12MM NS ST SS CORT,$167.50,$0.00,$167.50,$75.38,$119.54,$0.00,$28.86,$0.00,$0.00,$29.33,$167.50,$0.00,$83.75,$132.66,$134.00,$0.00,$26.21,$0.00,$26.67,$0.00
335-1014,SUP,HCPCS C1713,,335-1014  -  SCREW BN 3.5MM 14MM NS ST SS CORT,$167.50,$0.00,$167.50,$75.38,$119.54,$0.00,$28.86,$0.00,$0.00,$29.33,$167.50,$0.00,$83.75,$132.66,$134.00,$0.00,$26.21,$0.00,$26.67,$0.00
335-1016,SUP,HCPCS C1713,,335-1016  -  SCREW BN 3.5MM 16MM NS ST SS CORT,$167.50,$0.00,$167.50,$75.38,$119.54,$0.00,$28.86,$0.00,$0.00,$29.33,$167.50,$0.00,$83.75,$132.66,$134.00,$0.00,$26.21,$0.00,$26.67,$0.00
335-1018,SUP,HCPCS C1713,,335-1018  -  SCREW BN 3.5MM 18MM NS ST SS CORT,$167.50,$0.00,$167.50,$75.38,$119.54,$0.00,$28.86,$0.00,$0.00,$29.33,$167.50,$0.00,$83.75,$132.66,$134.00,$0.00,$26.21,$0.00,$26.67,$0.00
335-1020,SUP,HCPCS C1713,,335-1020  -  SCREW BN 3.5MM 20MM NS ST SS CORT,$167.50,$0.00,$167.50,$75.38,$119.54,$0.00,$28.86,$0.00,$0.00,$29.33,$167.50,$0.00,$83.75,$132.66,$134.00,$0.00,$26.21,$0.00,$26.67,$0.00
335-1022,SUP,HCPCS C1713,,335-1022  -  SCREW BN 3.5MM 22MM NS ST SS CORT,$167.50,$0.00,$167.50,$75.38,$119.54,$0.00,$28.86,$0.00,$0.00,$29.33,$167.50,$0.00,$83.75,$132.66,$134.00,$0.00,$26.21,$0.00,$26.67,$0.00
335-1024,SUP,HCPCS C1713,,335-1024  -  SCREW BN 3.5MM 24MM NS ST SS CORT,$167.50,$0.00,$167.50,$75.38,$119.54,$0.00,$28.86,$0.00,$0.00,$29.33,$167.50,$0.00,$83.75,$132.66,$134.00,$0.00,$26.21,$0.00,$26.67,$0.00
335-1026,SUP,HCPCS C1713,,335-1026  -  SCREW BN 3.5MM 26MM NS ST SS CORT,$167.50,$0.00,$167.50,$75.38,$119.54,$0.00,$28.86,$0.00,$0.00,$29.33,$167.50,$0.00,$83.75,$132.66,$134.00,$0.00,$26.21,$0.00,$26.67,$0.00
335-1028,SUP,HCPCS C1713,,335-1028  -  SCREW BN 3.5MM 28MM NS ST SS CORT,$167.50,$0.00,$167.50,$75.38,$119.54,$0.00,$28.86,$0.00,$0.00,$29.33,$167.50,$0.00,$83.75,$132.66,$134.00,$0.00,$26.21,$0.00,$26.67,$0.00
335-1030,SUP,HCPCS C1713,,335-1030  -  SCREW BN 3.5MM 30MM NS ST SS CORT,$167.50,$0.00,$167.50,$75.38,$119.54,$0.00,$28.86,$0.00,$0.00,$29.33,$167.50,$0.00,$83.75,$132.66,$134.00,$0.00,$26.21,$0.00,$26.67,$0.00
335-1032,SUP,HCPCS C1713,,335-1032  -  SCREW BN 3.5MM 32MM NS ST SS CORT,$167.50,$0.00,$167.50,$75.38,$119.54,$0.00,$28.86,$0.00,$0.00,$29.33,$167.50,$0.00,$83.75,$132.66,$134.00,$0.00,$26.21,$0.00,$26.67,$0.00
335-1034,SUP,HCPCS C1713,,335-1034  -  SCREW BN 3.5MM 34MM NS ST SS CORT,$167.50,$0.00,$167.50,$75.38,$119.54,$0.00,$28.86,$0.00,$0.00,$29.33,$167.50,$0.00,$83.75,$132.66,$134.00,$0.00,$26.21,$0.00,$26.67,$0.00
335-1036,SUP,HCPCS C1713,,335-1036  -  SCREW BN 3.5MM 36MM NS ST SS CORT,$167.50,$0.00,$167.50,$75.38,$119.54,$0.00,$28.86,$0.00,$0.00,$29.33,$167.50,$0.00,$83.75,$132.66,$134.00,$0.00,$26.21,$0.00,$26.67,$0.00
335-1038,SUP,HCPCS C1713,,335-1038  -  SCREW BN 3.5MM 38MM NS ST SS CORT,$167.50,$0.00,$167.50,$75.38,$119.54,$0.00,$28.86,$0.00,$0.00,$29.33,$167.50,$0.00,$83.75,$132.66,$134.00,$0.00,$26.21,$0.00,$26.67,$0.00
335-1040,SUP,HCPCS C1713,,335-1040  -  SCREW BN 3.5MM 40MM NS ST SS CORT,$167.50,$0.00,$167.50,$75.38,$119.54,$0.00,$28.86,$0.00,$0.00,$29.33,$167.50,$0.00,$83.75,$132.66,$134.00,$0.00,$26.21,$0.00,$26.67,$0.00
335-1042,SUP,HCPCS C1713,,335-1042  -  SCREW BN 3.5MM 42MM NS ST SS CORT,$167.50,$0.00,$167.50,$75.38,$119.54,$0.00,$28.86,$0.00,$0.00,$29.33,$167.50,$0.00,$83.75,$132.66,$134.00,$0.00,$26.21,$0.00,$26.67,$0.00
335-1044,SUP,HCPCS C1713,,335-1044  -  SCREW BN 3.5MM 44MM NS ST SS CORT,$167.50,$0.00,$167.50,$75.38,$119.54,$0.00,$28.86,$0.00,$0.00,$29.33,$167.50,$0.00,$83.75,$132.66,$134.00,$0.00,$26.21,$0.00,$26.67,$0.00
335-1046,SUP,HCPCS C1713,,335-1046  -  SCREW BN 3.5MM 46MM NS ST SS CORT,$167.50,$0.00,$167.50,$75.38,$119.54,$0.00,$28.86,$0.00,$0.00,$29.33,$167.50,$0.00,$83.75,$132.66,$134.00,$0.00,$26.21,$0.00,$26.67,$0.00
335-1048,SUP,HCPCS C1713,,335-1048  -  SCREW BN 3.5MM 48MM NS ST SS CORT,$167.50,$0.00,$167.50,$75.38,$119.54,$0.00,$28.86,$0.00,$0.00,$29.33,$167.50,$0.00,$83.75,$132.66,$134.00,$0.00,$26.21,$0.00,$26.67,$0.00
335-1050,SUP,HCPCS C1713,,335-1050  -  SCREW BN 3.5MM 50MM NS ST SS CORT,$167.50,$0.00,$167.50,$75.38,$119.54,$0.00,$28.86,$0.00,$0.00,$29.33,$167.50,$0.00,$83.75,$132.66,$134.00,$0.00,$26.21,$0.00,$26.67,$0.00
335-1055,SUP,HCPCS C1713,,335-1055  -  SCREW BN 3.5MM 55MM NS ST SS CORT,$167.50,$0.00,$167.50,$75.38,$119.54,$0.00,$28.86,$0.00,$0.00,$29.33,$167.50,$0.00,$83.75,$132.66,$134.00,$0.00,$26.21,$0.00,$26.67,$0.00
335-1060,SUP,HCPCS C1713,,335-1060  -  SCREW BN 3.5MM 60MM NS ST SS CORT,$167.50,$0.00,$167.50,$75.38,$119.54,$0.00,$28.86,$0.00,$0.00,$29.33,$167.50,$0.00,$83.75,$132.66,$134.00,$0.00,$26.21,$0.00,$26.67,$0.00
3362-0-304,SUP,HCPCS C1713,,3362-0-304  -  SDPLT BONE OMEGA+ 130D SHRT BRL HIP SS 4 HOLE CMPR,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-0-305,SUP,HCPCS C1713,,3362-0-305  -  SDPLT BONE OMEGA+ 130D SHRT BRL HIP SS 5 HOLE CMPR,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-0-354,SUP,HCPCS C1713,,3362-0-354  -  SDPLT BONE OMEGA+ 135D SHRT BRL HIP SS 4 HOLE CMPR,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-0-355,SUP,HCPCS C1713,,3362-0-355  -  SDPLT BONE OMEGA+ 135D SHRT BRL HIP SS 5 HOLE CMPR,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-0-404,SUP,HCPCS C1713,,3362-0-404  -  SDPLT BONE OMEGA+ 140D SHRT BRL HIP SS 4 HOLE CMPR,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-0-405,SUP,HCPCS C1713,,3362-0-405  -  SDPLT BONE OMEGA+ 140D SHRT BRL HIP SS 5 HOLE CMPR,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-0-454,SUP,HCPCS C1713,,3362-0-454  -  SDPLT BONE OMEGA+ 145D SHRT BRL HIP SS 4 HOLE CMPR,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-0-455,SUP,HCPCS C1713,,3362-0-455  -  SDPLT BONE OMEGA+ 145D SHRT BRL HIP SS 5 HOLE CMPR,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-0-504,SUP,HCPCS C1713,,3362-0-504  -  SDPLT BONE OMEGA+ 150D SHRT BRL HIP SS 4 HOLE CMPR,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-0-505,SUP,HCPCS C1713,,3362-0-505  -  SDPLT BONE OMEGA+ 150D SHRT BRL HIP SS 5 HOLE CMPR,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-1-002,SUP,HCPCS C1713,,3362-1-002  -  SDPLT BONE OMEGA+ 130D STD BRL HIP SS 2 HOLE CMPR,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-1-003,SUP,HCPCS C1713,,3362-1-003  -  SDPLT BONE OMEGA+ 130D STD BRL HIP SS 3 HOLE CMPR,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-1-004,SUP,HCPCS C1713,,3362-1-004  -  SDPLT BONE OMEGA+ 130D STD BRL HIP SS 4 HOLE CMPR,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-1-005,SUP,HCPCS C1713,,3362-1-005  -  SDPLT BONE OMEGA+ 130D STD BRL HIP SS 5 HOLE CMPR,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-1-006,SUP,HCPCS C1713,,3362-1-006  -  SDPLT BONE OMEGA+ 130D STD BRL HIP SS 6 HOLE CMPR,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-1-008,SUP,HCPCS C1713,,3362-1-008  -  SDPLT BONE OMEGA+ 130D STD BRL HIP SS 8 HOLE CMPR,"$1,058.75",$0.00,"$1,058.75",$476.44,$755.63,$0.00,$182.42,$0.00,$0.00,$185.38,"$1,058.75",$0.00,$529.38,$838.53,$847.00,$0.00,$165.69,$0.00,$168.55,$0.00
3362-1-010,SUP,HCPCS C1713,,3362-1-010  -  SDPLT BONE OMEGA+ 130D STD BRL HIP SS 10 HOLE CMPR,"$1,054.63",$0.00,"$1,054.63",$474.58,$752.69,$0.00,$181.71,$0.00,$0.00,$184.66,"$1,054.63",$0.00,$527.31,$835.27,$843.70,$0.00,$165.05,$0.00,$167.90,$0.00
3362-1-012,SUP,HCPCS C1713,,3362-1-012  -  SDPLT BONE OMEGA+ 130D STD BRL HIP SS 12 HOLE CMPR,"$1,054.63",$0.00,"$1,054.63",$474.58,$752.69,$0.00,$181.71,$0.00,$0.00,$184.66,"$1,054.63",$0.00,$527.31,$835.27,$843.70,$0.00,$165.05,$0.00,$167.90,$0.00
3362-1-102,SUP,HCPCS C1713,,3362-1-102  -  SDPLT BONE OMEGA+ 135D HIP 2 HOLE,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-1-103,SUP,HCPCS C1713,,3362-1-103  -  SDPLT BONE OMEGA+ 135D STD BRL HIP SS 3 HOLE CMPR,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-1-104,SUP,HCPCS C1713,,3362-1-104  -  SDPLT BONE OMEGA+ 135D STD BRL HIP SS 4 HOLE CMPR,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-1-105,SUP,HCPCS C1713,,3362-1-105  -  SDPLT BONE OMEGA+ 135D STD BRL HIP SS 5 HOLE CMPR,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-1-106,SUP,HCPCS C1713,,3362-1-106  -  SDPLT BONE OMEGA+ 135D STD BRL HIP SS 6 HOLE CMPR,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-1-108,SUP,HCPCS C1713,,3362-1-108  -  SDPLT BONE OMEGA+ 135D STD BRL HIP SS 8 HOLE CMPR,"$1,058.75",$0.00,"$1,058.75",$476.44,$755.63,$0.00,$182.42,$0.00,$0.00,$185.38,"$1,058.75",$0.00,$529.38,$838.53,$847.00,$0.00,$165.69,$0.00,$168.55,$0.00
3362-1-110,SUP,HCPCS C1713,,3362-1-110  -  SDPLT BONE OMEGA+ 135D STD BRL HIP SS 10 HOLE CMPR,"$1,058.75",$0.00,"$1,058.75",$476.44,$755.63,$0.00,$182.42,$0.00,$0.00,$185.38,"$1,058.75",$0.00,$529.38,$838.53,$847.00,$0.00,$165.69,$0.00,$168.55,$0.00
3362-1-112,SUP,HCPCS C1713,,3362-1-112  -  SDPLT BONE OMEGA+ 135D STD BRL HIP SS 12 HOLE CMPR,"$1,058.75",$0.00,"$1,058.75",$476.44,$755.63,$0.00,$182.42,$0.00,$0.00,$185.38,"$1,058.75",$0.00,$529.38,$838.53,$847.00,$0.00,$165.69,$0.00,$168.55,$0.00
3362-1-202,SUP,HCPCS C1713,,3362-1-202  -  SDPLT BONE OMEGA+ 140D STD BRL HIP SS 2 HOLE CMPR,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-1-203,SUP,HCPCS C1713,,3362-1-203  -  SDPLT BONE OMEGA+ 140D STD BRL HIP SS 3 HOLE CMPR,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-1-204,SUP,HCPCS C1713,,3362-1-204  -  SDPLT BONE OMEGA+ 140D STD BRL HIP SS 4 HOLE CMPR,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-1-205,SUP,HCPCS C1713,,3362-1-205  -  SDPLT BONE OMEGA+ 140D STD BRL HIP SS 5 HOLE CMPR,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-1-206,SUP,HCPCS C1713,,3362-1-206  -  SDPLT BONE OMEGA+ 140D STD BRL HIP SS 6 HOLE CMPR,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-1-208,SUP,HCPCS C1713,,3362-1-208  -  SDPLT BONE OMEGA+ 140D STD BRL HIP SS 8 HOLE CMPR,"$1,058.75",$0.00,"$1,058.75",$476.44,$755.63,$0.00,$182.42,$0.00,$0.00,$185.38,"$1,058.75",$0.00,$529.38,$838.53,$847.00,$0.00,$165.69,$0.00,$168.55,$0.00
3362-1-210,SUP,HCPCS C1713,,3362-1-210  -  SDPLT BONE OMEGA+ 140D STD BRL HIP SS 10 HOLE CMPR,"$1,058.75",$0.00,"$1,058.75",$476.44,$755.63,$0.00,$182.42,$0.00,$0.00,$185.38,"$1,058.75",$0.00,$529.38,$838.53,$847.00,$0.00,$165.69,$0.00,$168.55,$0.00
3362-1-212,SUP,HCPCS C1713,,3362-1-212  -  SDPLT BONE OMEGA+ 140D STD BRL HIP SS 12 HOLE CMPR,"$1,058.75",$0.00,"$1,058.75",$476.44,$755.63,$0.00,$182.42,$0.00,$0.00,$185.38,"$1,058.75",$0.00,$529.38,$838.53,$847.00,$0.00,$165.69,$0.00,$168.55,$0.00
3362-1-302,SUP,HCPCS C1713,,3362-1-302  -  SDPLT BONE OMEGA+ 145D STD BRL HIP SS 2 HOLE CMPR,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-1-303,SUP,HCPCS C1713,,3362-1-303  -  SDPLT BONE OMEGA+ 145D STD BRL HIP SS 3 HOLE CMPR,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-1-304,SUP,HCPCS C1713,,3362-1-304  -  SDPLT BONE OMEGA+ 145D STD BRL HIP SS 4 HOLE CMPR,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-1-305,SUP,HCPCS C1713,,3362-1-305  -  SDPLT BONE OMEGA+ 145D STD BRL HIP SS 5 HOLE CMPR,$856.63,$0.00,$856.63,$385.48,$611.37,$0.00,$147.59,$0.00,$0.00,$149.99,$856.63,$0.00,$428.31,$678.45,$685.30,$0.00,$134.06,$0.00,$136.37,$0.00
3362-1-306,SUP,HCPCS C1713,,3362-1-306  -  SDPLT BONE OMEGA+ 145D STD BRL HIP SS 6 HOLE CMPR,$856.63,$0.00,$856.63,$385.48,$611.37,$0.00,$147.59,$0.00,$0.00,$149.99,$856.63,$0.00,$428.31,$678.45,$685.30,$0.00,$134.06,$0.00,$136.37,$0.00
3362-1-308,SUP,HCPCS C1713,,3362-1-308  -  SDPLT BONE OMEGA+ 145D STD BRL HIP SS 8 HOLE CMPR,"$1,058.75",$0.00,"$1,058.75",$476.44,$755.63,$0.00,$182.42,$0.00,$0.00,$185.38,"$1,058.75",$0.00,$529.38,$838.53,$847.00,$0.00,$165.69,$0.00,$168.55,$0.00
3362-1-310,SUP,HCPCS C1713,,3362-1-310  -  SDPLT BONE OMEGA+ 145D STD BRL HIP SS 10 HOLE CMPR,"$1,058.75",$0.00,"$1,058.75",$476.44,$755.63,$0.00,$182.42,$0.00,$0.00,$185.38,"$1,058.75",$0.00,$529.38,$838.53,$847.00,$0.00,$165.69,$0.00,$168.55,$0.00
3362-1-312,SUP,HCPCS C1713,,3362-1-312  -  SDPLT BONE OMEGA+ 145D STD BRL HIP SS 12 HOLE CMPR,"$1,058.75",$0.00,"$1,058.75",$476.44,$755.63,$0.00,$182.42,$0.00,$0.00,$185.38,"$1,058.75",$0.00,$529.38,$838.53,$847.00,$0.00,$165.69,$0.00,$168.55,$0.00
3362-1-402,SUP,HCPCS C1713,,3362-1-402  -  SDPLT BONE OMEGA+ 150D STD BRL HIP SS 2 HOLE CMPR,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-1-403,SUP,HCPCS C1713,,3362-1-403  -  SDPLT BONE OMEGA+ 150D STD BRL HIP SS 3 HOLE CMPR,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-1-404,SUP,HCPCS C1713,,3362-1-404  -  SDPLT BONE OMEGA+ 150D STD BRL HIP SS 4 HOLE CMPR,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-1-405,SUP,HCPCS C1713,,3362-1-405  -  SDPLT BONE OMEGA+ 150D STD BRL HIP SS 5 HOLE CMPR,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-1-406,SUP,HCPCS C1713,,3362-1-406  -  SDPLT BONE OMEGA+ 150D STD BRL HIP SS 6 HOLE CMPR,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-1-408,SUP,HCPCS C1713,,3362-1-408  -  SDPLT BONE OMEGA+ 150D STD BRL HIP SS 8 HOLE CMPR,"$1,058.75",$0.00,"$1,058.75",$476.44,$755.63,$0.00,$182.42,$0.00,$0.00,$185.38,"$1,058.75",$0.00,$529.38,$838.53,$847.00,$0.00,$165.69,$0.00,$168.55,$0.00
3362-1-410,SUP,HCPCS C1713,,3362-1-410  -  SDPLT BONE OMEGA+ 150D STD BRL HIP SS 10 HOLE CMPR,"$1,054.63",$0.00,"$1,054.63",$474.58,$752.69,$0.00,$181.71,$0.00,$0.00,$184.66,"$1,054.63",$0.00,$527.31,$835.27,$843.70,$0.00,$165.05,$0.00,$167.90,$0.00
3362-1-412,SUP,HCPCS C1713,,3362-1-412  -  SDPLT BONE OMEGA+ 150D STD BRL HIP SS 12 HOLE CMPR,"$1,058.75",$0.00,"$1,058.75",$476.44,$755.63,$0.00,$182.42,$0.00,$0.00,$185.38,"$1,058.75",$0.00,$529.38,$838.53,$847.00,$0.00,$165.69,$0.00,$168.55,$0.00
3362-3-002,SUP,HCPCS C1713,,3362-3-002  -  PLATE 130D STD BRL SS 2 HOLE KYLS OMEGA+ BONE SPCNDYL HIP,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-3-003,SUP,HCPCS C1713,,3362-3-003  -  PLATE 130D STD BRL SS 3 HOLE KYLS OMEGA+ BONE SPCNDYL HIP,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-3-004,SUP,HCPCS C1713,,3362-3-004  -  PLATE 130D STD BRL SS 4 HOLE KYLS OMEGA+ BONE SPCNDYL HIP,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-3-005,SUP,HCPCS C1713,,3362-3-005  -  PLATE 130D STD BRL SS 5 HOLE KYLS OMEGA+ BONE SPCNDYL HIP,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-3-006,SUP,HCPCS C1713,,3362-3-006  -  PLATE 130D STD BRL SS 6 HOLE KYLS OMEGA+ BONE SPCNDYL HIP,$856.63,$0.00,$856.63,$385.48,$611.37,$0.00,$147.59,$0.00,$0.00,$149.99,$856.63,$0.00,$428.31,$678.45,$685.30,$0.00,$134.06,$0.00,$136.37,$0.00
3362-3-008,SUP,HCPCS C1713,,3362-3-008  -  PLATE 130D STD BRL SS 8 HOLE KYLS OMEGA+ BONE SPCNDYL HIP,"$1,058.75",$0.00,"$1,058.75",$476.44,$755.63,$0.00,$182.42,$0.00,$0.00,$185.38,"$1,058.75",$0.00,$529.38,$838.53,$847.00,$0.00,$165.69,$0.00,$168.55,$0.00
3362-3-010,SUP,HCPCS C1713,,3362-3-010  -  PLATE 130D STD BRL SS 10 HOLE KYLS OMEGA+ BONE SPCNDYL HIP,"$1,058.75",$0.00,"$1,058.75",$476.44,$755.63,$0.00,$182.42,$0.00,$0.00,$185.38,"$1,058.75",$0.00,$529.38,$838.53,$847.00,$0.00,$165.69,$0.00,$168.55,$0.00
3362-3-012,SUP,HCPCS C1713,,3362-3-012  -  PLATE 130D STD BRL SS 12 HOLE KYLS OMEGA+ BONE SPCNDYL HIP,"$1,058.75",$0.00,"$1,058.75",$476.44,$755.63,$0.00,$182.42,$0.00,$0.00,$185.38,"$1,058.75",$0.00,$529.38,$838.53,$847.00,$0.00,$165.69,$0.00,$168.55,$0.00
3362-3-102,SUP,HCPCS C1713,,3362-3-102  -  PLATE 135D STD BRL SS 2 HOLE KYLS OMEGA+ BONE SPCNDYL HIP,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-3-103,SUP,HCPCS C1713,,3362-3-103  -  PLATE 135D STD BRL SS 3 HOLE KYLS OMEGA+ BONE SPCNDYL HIP,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-3-104,SUP,HCPCS C1713,,3362-3-104  -  PLATE 135D STD BRL SS 4 HOLE KYLS OMEGA+ BONE SPCNDYL HIP,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-3-105,SUP,HCPCS C1713,,3362-3-105  -  PLATE 135D STD BRL SS 5 HOLE KYLS OMEGA+ BONE SPCNDYL HIP,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-3-106,SUP,HCPCS C1713,,3362-3-106  -  PLATE 135D STD BRL SS 6 HOLE KYLS OMEGA+ BONE SPCNDYL HIP,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-3-108,SUP,HCPCS C1713,,3362-3-108  -  PLATE 135D STD BRL SS 8 HOLE KYLS OMEGA+ BONE SPCNDYL HIP,"$1,058.75",$0.00,"$1,058.75",$476.44,$755.63,$0.00,$182.42,$0.00,$0.00,$185.38,"$1,058.75",$0.00,$529.38,$838.53,$847.00,$0.00,$165.69,$0.00,$168.55,$0.00
3362-3-110,SUP,HCPCS C1713,,3362-3-110  -  PLATE 135D STD BRL SS 10 HOLE KYLS OMEGA+ BONE SPCNDYL HIP,"$1,058.75",$0.00,"$1,058.75",$476.44,$755.63,$0.00,$182.42,$0.00,$0.00,$185.38,"$1,058.75",$0.00,$529.38,$838.53,$847.00,$0.00,$165.69,$0.00,$168.55,$0.00
3362-3-112,SUP,HCPCS C1713,,3362-3-112  -  PLATE 135D STD BRL SS 12 HOLE KYLS OMEGA+ BONE SPCNDYL HIP,"$1,058.75",$0.00,"$1,058.75",$476.44,$755.63,$0.00,$182.42,$0.00,$0.00,$185.38,"$1,058.75",$0.00,$529.38,$838.53,$847.00,$0.00,$165.69,$0.00,$168.55,$0.00
3362-3-202,SUP,HCPCS C1713,,3362-3-202  -  PLATE 140D STD BRL SS 2 HOLE KYLS OMEGA+ BONE SPCNDYL HIP,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-3-203,SUP,HCPCS C1713,,3362-3-203  -  PLATE 140D STD BRL SS 3 HOLE KYLS OMEGA+ BONE SPCNDYL HIP,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-3-204,SUP,HCPCS C1713,,3362-3-204  -  PLATE 140D STD BRL SS 4 HOLE KYLS OMEGA+ BONE SPCNDYL HIP,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-3-205,SUP,HCPCS C1713,,3362-3-205  -  PLATE 140D STD BRL SS 5 HOLE KYLS OMEGA+ BONE SPCNDYL HIP,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-3-206,SUP,HCPCS C1713,,3362-3-206  -  PLATE 140D STD BRL SS 6 HOLE KYLS OMEGA+ BONE SPCNDYL HIP,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-3-208,SUP,HCPCS C1713,,3362-3-208  -  PLATE 140D STD BRL SS 8 HOLE KYLS OMEGA+ BONE SPCNDYL HIP,"$1,058.75",$0.00,"$1,058.75",$476.44,$755.63,$0.00,$182.42,$0.00,$0.00,$185.38,"$1,058.75",$0.00,$529.38,$838.53,$847.00,$0.00,$165.69,$0.00,$168.55,$0.00
3362-3-210,SUP,HCPCS C1713,,3362-3-210  -  PLATE 140D STD BRL SS 10 HOLE KYLS OMEGA+ BONE SPCNDYL HIP,"$1,054.63",$0.00,"$1,054.63",$474.58,$752.69,$0.00,$181.71,$0.00,$0.00,$184.66,"$1,054.63",$0.00,$527.31,$835.27,$843.70,$0.00,$165.05,$0.00,$167.90,$0.00
3362-3-212,SUP,HCPCS C1713,,3362-3-212  -  PLATE 140D STD BRL SS 12 HOLE KYLS OMEGA+ BONE SPCNDYL HIP,"$1,058.75",$0.00,"$1,058.75",$476.44,$755.63,$0.00,$182.42,$0.00,$0.00,$185.38,"$1,058.75",$0.00,$529.38,$838.53,$847.00,$0.00,$165.69,$0.00,$168.55,$0.00
3362-3-302,SUP,HCPCS C1713,,3362-3-302  -  PLATE 145D STD BRL SS 3 HOLE KYLS OMEGA+ BONE SPCNDYL HIP,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-3-303,SUP,HCPCS C1713,,3362-3-303  -  PLATE 145D STD BRL SS 3 HOLE KYLS OMEGA+ BONE SPCNDYL HIP,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-3-304,SUP,HCPCS C1713,,3362-3-304  -  PLATE 145D STD BRL SS 4 HOLE KYLS OMEGA+ BONE SPCNDYL HIP,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-3-305,SUP,HCPCS C1713,,3362-3-305  -  PLATE 145D STD BRL SS 5 HOLE KYLS OMEGA+ BONE SPCNDYL HIP,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-3-306,SUP,HCPCS C1713,,3362-3-306  -  PLATE 145D STD BRL SS 6 HOLE KYLS OMEGA+ BONE SPCNDYL HIP,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-3-308,SUP,HCPCS C1713,,3362-3-308  -  PLATE 145D STD BRL SS 8 HOLE KYLS OMEGA+ BONE SPCNDYL HIP,"$1,058.75",$0.00,"$1,058.75",$476.44,$755.63,$0.00,$182.42,$0.00,$0.00,$185.38,"$1,058.75",$0.00,$529.38,$838.53,$847.00,$0.00,$165.69,$0.00,$168.55,$0.00
3362-3-310,SUP,HCPCS C1713,,3362-3-310  -  PLATE 145D STD BRL SS 10 HOLE KYLS OMEGA+ BONE SPCNDYL HIP,"$1,058.75",$0.00,"$1,058.75",$476.44,$755.63,$0.00,$182.42,$0.00,$0.00,$185.38,"$1,058.75",$0.00,$529.38,$838.53,$847.00,$0.00,$165.69,$0.00,$168.55,$0.00
3362-3-312,SUP,HCPCS C1713,,3362-3-312  -  PLATE 145D STD BRL SS 12 HOLE KYLS OMEGA+ BONE SPCNDYL HIP,"$1,058.75",$0.00,"$1,058.75",$476.44,$755.63,$0.00,$182.42,$0.00,$0.00,$185.38,"$1,058.75",$0.00,$529.38,$838.53,$847.00,$0.00,$165.69,$0.00,$168.55,$0.00
3362-3-402,SUP,HCPCS C1713,,3362-3-402  -  PLATE 150D STD BRL SS 2 HOLE KYLS OMEGA+ BONE SPCNDYL HIP,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-3-403,SUP,HCPCS C1713,,3362-3-403  -  PLATE 150D STD BRL SS 3 HOLE KYLS OMEGA+ BONE SPCNDYL HIP,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-3-404,SUP,HCPCS C1713,,3362-3-404  -  PLATE 150D STD BRL SS 4 HOLE KYLS OMEGA+ BONE SPCNDYL HIP,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-3-405,SUP,HCPCS C1713,,3362-3-405  -  PLATE 150D STD BRL SS 5 HOLE KYLS OMEGA+ BONE SPCNDYL HIP,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-3-406,SUP,HCPCS C1713,,3362-3-406  -  PLATE 150D STD BRL SS 6 HOLE KYLS OMEGA+ BONE SPCNDYL HIP,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-3-408,SUP,HCPCS C1713,,3362-3-408  -  PLATE 150D STD BRL SS 8 HOLE KYLS OMEGA+ BONE SPCNDYL HIP,"$1,058.75",$0.00,"$1,058.75",$476.44,$755.63,$0.00,$182.42,$0.00,$0.00,$185.38,"$1,058.75",$0.00,$529.38,$838.53,$847.00,$0.00,$165.69,$0.00,$168.55,$0.00
3362-3-410,SUP,HCPCS C1713,,3362-3-410  -  PLATE 150D STD BRL SS 10 HOLE KYLS OMEGA+ BONE SPCNDYL HIP,"$1,058.75",$0.00,"$1,058.75",$476.44,$755.63,$0.00,$182.42,$0.00,$0.00,$185.38,"$1,058.75",$0.00,$529.38,$838.53,$847.00,$0.00,$165.69,$0.00,$168.55,$0.00
3362-3-412,SUP,HCPCS C1713,,3362-3-412  -  PLATE 150D STD BRL SS 12 HOLE KYLS OMEGA+ BONE SPCNDYL HIP,"$1,058.75",$0.00,"$1,058.75",$476.44,$755.63,$0.00,$182.42,$0.00,$0.00,$185.38,"$1,058.75",$0.00,$529.38,$838.53,$847.00,$0.00,$165.69,$0.00,$168.55,$0.00
3362-4-304,SUP,HCPCS C1713,,3362-4-304  -  PLATE 130D STD BRL SS 4 HOLE KYLS OMEGA+ BONE SPCNDYL HIP,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-4-305,SUP,HCPCS C1713,,3362-4-305  -  PLATE 130D STD BRL SS 5 HOLE KYLS OMEGA+ BONE SPCNDYL HIP,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-4-354,SUP,HCPCS C1713,,3362-4-354  -  PLATE 135D STD BRL SS 4 HOLE KYLS OMEGA+ BONE SPCNDYL HIP,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-4-355,SUP,HCPCS C1713,,3362-4-355  -  PLATE 135D STD BRL SS 5 HOLE KYLS OMEGA+ BONE SPCNDYL HIP,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-4-404,SUP,HCPCS C1713,,3362-4-404  -  PLATE 140D STD BRL SS 4 HOLE KYLS OMEGA+ BONE SPCNDYL HIP,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-4-405,SUP,HCPCS C1713,,3362-4-405  -  PLATE 140D STD BRL SS 5 HOLE KYLS OMEGA+ BONE SPCNDYL HIP,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-4-454,SUP,HCPCS C1713,,3362-4-454  -  PLATE 145D STD BRL SS 4 HOLE KYLS OMEGA+ BONE SPCNDYL HIP,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-4-455,SUP,HCPCS C1713,,3362-4-455  -  PLATE 145D STD BRL SS 5 HOLE KYLS OMEGA+ BONE SPCNDYL HIP,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-4-504,SUP,HCPCS C1713,,3362-4-504  -  PLATE 150D STD BRL SS 4 HOLE KYLS OMEGA+ BONE SPCNDYL HIP,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-4-505,SUP,HCPCS C1713,,3362-4-505  -  PLATE 150D STD BRL SS 5 HOLE KYLS OMEGA+ BONE SPCNDYL HIP,$859.38,$0.00,$859.38,$386.72,$613.34,$0.00,$148.07,$0.00,$0.00,$150.47,$859.38,$0.00,$429.69,$680.63,$687.50,$0.00,$134.49,$0.00,$136.81,$0.00
3362-5-050,SUP,HCPCS C1713,,3362-5-050  -  SCREW BONE 13MM 50MM OMEGA+ SS STD FEM HIP LAG STRL,$501.88,$0.00,$501.88,$225.84,$358.19,$0.00,$86.47,$0.00,$0.00,$87.87,$501.88,$0.00,$250.94,$397.49,$401.50,$0.00,$78.54,$0.00,$79.90,$0.00
3362-5-055,SUP,HCPCS C1713,,3362-5-055  -  SCREW BONE 13MM 55MM OMEGA+ SS STD FEM HIP LAG STRL,$501.88,$0.00,$501.88,$225.84,$358.19,$0.00,$86.47,$0.00,$0.00,$87.87,$501.88,$0.00,$250.94,$397.49,$401.50,$0.00,$78.54,$0.00,$79.90,$0.00
3362-5-060,SUP,HCPCS C1713,,3362-5-060  -  SCREW BONE 13MM 60MM OMEGA+ SS STD FEM HIP LAG STRL,$501.88,$0.00,$501.88,$225.84,$358.19,$0.00,$86.47,$0.00,$0.00,$87.87,$501.88,$0.00,$250.94,$397.49,$401.50,$0.00,$78.54,$0.00,$79.90,$0.00
3362-5-065,SUP,HCPCS C1713,,3362-5-065  -  SCREW BONE 13MM 65MM OMEGA+ SS STD FEM HIP LAG STRL,$501.88,$0.00,$501.88,$225.84,$358.19,$0.00,$86.47,$0.00,$0.00,$87.87,$501.88,$0.00,$250.94,$397.49,$401.50,$0.00,$78.54,$0.00,$79.90,$0.00
3362-5-070,SUP,HCPCS C1713,,3362-5-070  -  SCREW BONE 13MM 70MM OMEGA+ SS STD FEM HIP LAG STRL,$501.88,$0.00,$501.88,$225.84,$358.19,$0.00,$86.47,$0.00,$0.00,$87.87,$501.88,$0.00,$250.94,$397.49,$401.50,$0.00,$78.54,$0.00,$79.90,$0.00
3362-5-075,SUP,HCPCS C1713,,3362-5-075  -  SCREW BONE 75MM OMEGA+ HIP LAG,$501.88,$0.00,$501.88,$225.84,$358.19,$0.00,$86.47,$0.00,$0.00,$87.87,$501.88,$0.00,$250.94,$397.49,$401.50,$0.00,$78.54,$0.00,$79.90,$0.00
3362-5-080,SUP,HCPCS C1713,,3362-5-080  -  SCREW BONE 13MM 80MM OMEGA+ SS STD FEM HIP LAG STRL,$501.88,$0.00,$501.88,$225.84,$358.19,$0.00,$86.47,$0.00,$0.00,$87.87,$501.88,$0.00,$250.94,$397.49,$401.50,$0.00,$78.54,$0.00,$79.90,$0.00
3362-5-085,SUP,HCPCS C1713,,3362-5-085  -  SCREW BONE 13MM 85MM OMEGA+ SS STD FEM HIP LAG STRL,$501.88,$0.00,$501.88,$225.84,$358.19,$0.00,$86.47,$0.00,$0.00,$87.87,$501.88,$0.00,$250.94,$397.49,$401.50,$0.00,$78.54,$0.00,$79.90,$0.00
3362-5-090,SUP,HCPCS C1713,,3362-5-090  -  SCREW BONE 13MM 90MM OMEGA+ SS STD FEM HIP LAG STRL,$501.88,$0.00,$501.88,$225.84,$358.19,$0.00,$86.47,$0.00,$0.00,$87.87,$501.88,$0.00,$250.94,$397.49,$401.50,$0.00,$78.54,$0.00,$79.90,$0.00
3362-5-095,SUP,HCPCS C1713,,3362-5-095  -  SCREW BONE 13MM 95MM OMEGA+ SS STD FEM HIP LAG STRL,$501.88,$0.00,$501.88,$225.84,$358.19,$0.00,$86.47,$0.00,$0.00,$87.87,$501.88,$0.00,$250.94,$397.49,$401.50,$0.00,$78.54,$0.00,$79.90,$0.00
3362-5-100,SUP,HCPCS C1713,,3362-5-100  -  SCREW BONE 13MM 100MM OMEGA+ SS STD FEM HIP LAG STRL,$501.88,$0.00,$501.88,$225.84,$358.19,$0.00,$86.47,$0.00,$0.00,$87.87,$501.88,$0.00,$250.94,$397.49,$401.50,$0.00,$78.54,$0.00,$79.90,$0.00
3362-5-105,SUP,HCPCS C1713,,3362-5-105  -  SCREW BONE 13MM 105MM OMEGA+ SS STD FEM HIP LAG STRL,$501.88,$0.00,$501.88,$225.84,$358.19,$0.00,$86.47,$0.00,$0.00,$87.87,$501.88,$0.00,$250.94,$397.49,$401.50,$0.00,$78.54,$0.00,$79.90,$0.00
3362-5-110,SUP,HCPCS C1713,,3362-5-110  -  SCREW BONE 13MM 110MM OMEGA+ SS STD FEM HIP LAG STRL,$501.88,$0.00,$501.88,$225.84,$358.19,$0.00,$86.47,$0.00,$0.00,$87.87,$501.88,$0.00,$250.94,$397.49,$401.50,$0.00,$78.54,$0.00,$79.90,$0.00
3362-5-115,SUP,HCPCS C1713,,3362-5-115  -  SCREW BONE 13MM 115MM OMEGA+ SS STD FEM HIP LAG STRL,$501.88,$0.00,$501.88,$225.84,$358.19,$0.00,$86.47,$0.00,$0.00,$87.87,$501.88,$0.00,$250.94,$397.49,$401.50,$0.00,$78.54,$0.00,$79.90,$0.00
3362-5-120,SUP,HCPCS C1713,,3362-5-120  -  SCREW BONE 13MM 120MM OMEGA+ SS STD FEM HIP LAG STRL,$501.88,$0.00,$501.88,$225.84,$358.19,$0.00,$86.47,$0.00,$0.00,$87.87,$501.88,$0.00,$250.94,$397.49,$401.50,$0.00,$78.54,$0.00,$79.90,$0.00
3362-5-125,SUP,HCPCS C1713,,3362-5-125  -  SCREW BONE 13MM 125MM OMEGA+ SS STD FEM HIP LAG STRL,$501.88,$0.00,$501.88,$225.84,$358.19,$0.00,$86.47,$0.00,$0.00,$87.87,$501.88,$0.00,$250.94,$397.49,$401.50,$0.00,$78.54,$0.00,$79.90,$0.00
3362-5-130,SUP,HCPCS C1713,,3362-5-130  -  SCREW BONE 13MM 130MM OMEGA+ SS STD FEM HIP LAG STRL,$501.88,$0.00,$501.88,$225.84,$358.19,$0.00,$86.47,$0.00,$0.00,$87.87,$501.88,$0.00,$250.94,$397.49,$401.50,$0.00,$78.54,$0.00,$79.90,$0.00
3362-6-055,SUP,HCPCS C1713,,3362-6-055  -  SCREW BONE 55MM OMEGA+ SS HIP SUPLAG,$313.50,$0.00,$313.50,$141.08,$223.74,$0.00,$54.01,$0.00,$0.00,$54.89,$313.50,$0.00,$156.75,$248.29,$250.80,$0.00,$49.06,$0.00,$49.91,$0.00
3362-6-060,SUP,HCPCS C1713,,3362-6-060  -  SCREW BONE 60MM OMEGA+ SS HIP SUPLAG,$229.63,$0.00,$229.63,$103.33,$163.88,$0.00,$39.56,$0.00,$0.00,$40.21,$229.63,$0.00,$114.81,$181.87,$183.70,$0.00,$35.94,$0.00,$36.56,$0.00
3362-6-070,SUP,HCPCS C1713,,3362-6-070  -  SCREW BONE 70MM OMEGA+ SS HIP SUPLAG,$313.50,$0.00,$313.50,$141.08,$223.74,$0.00,$54.01,$0.00,$0.00,$54.89,$313.50,$0.00,$156.75,$248.29,$250.80,$0.00,$49.06,$0.00,$49.91,$0.00
3362-6-080,SUP,HCPCS C1713,,3362-6-080  -  SCREW BONE 80MM OMEGA+ SS HIP SUPLAG,$280.50,$0.00,$280.50,$126.23,$200.19,$0.00,$48.33,$0.00,$0.00,$49.11,$280.50,$0.00,$140.25,$222.16,$224.40,$0.00,$43.90,$0.00,$44.66,$0.00
3362-6-090,SUP,HCPCS C1713,,3362-6-090  -  SCREW BONE 90MM OMEGA+ SS HIP SUPLAG,$209.00,$0.00,$209.00,$94.05,$149.16,$0.00,$36.01,$0.00,$0.00,$36.59,$209.00,$0.00,$104.50,$165.53,$167.20,$0.00,$32.71,$0.00,$33.27,$0.00
3362-6-100,SUP,HCPCS C1713,,3362-6-100  -  SCREW BONE 100MM OMEGA+ SS HIP SUPLAG,$345.13,$0.00,$345.13,$155.31,$246.32,$0.00,$59.46,$0.00,$0.00,$60.43,$345.13,$0.00,$172.56,$273.34,$276.10,$0.00,$54.01,$0.00,$54.94,$0.00
3362-6-105,SUP,HCPCS C1713,,3362-6-105  -  SCREW BONE 105MM OMEGA+ SS HIP SUPLAG,$302.50,$0.00,$302.50,$136.13,$215.89,$0.00,$52.12,$0.00,$0.00,$52.97,$302.50,$0.00,$151.25,$239.58,$242.00,$0.00,$47.34,$0.00,$48.16,$0.00
3362-6-110,SUP,HCPCS C1713,,3362-6-110  -  SCREW BONE 110MM OMEGA+ SS HIP SUPLAG,$378.13,$0.00,$378.13,$170.16,$269.87,$0.00,$65.15,$0.00,$0.00,$66.21,$378.13,$0.00,$189.06,$299.48,$302.50,$0.00,$59.18,$0.00,$60.20,$0.00
3362-6-115,SUP,HCPCS C1713,,3362-6-115  -  SCREW BONE 115MM OMEGA+ SS HIP SUPLAG,$345.13,$0.00,$345.13,$155.31,$246.32,$0.00,$59.46,$0.00,$0.00,$60.43,$345.13,$0.00,$172.56,$273.34,$276.10,$0.00,$54.01,$0.00,$54.94,$0.00
3362-6-120,SUP,HCPCS C1713,,3362-6-120  -  SCREW BONE 120MM OMEGA+ SS HIP SUPLAG,$313.50,$0.00,$313.50,$141.08,$223.74,$0.00,$54.01,$0.00,$0.00,$54.89,$313.50,$0.00,$156.75,$248.29,$250.80,$0.00,$49.06,$0.00,$49.91,$0.00
3362-6-130,SUP,HCPCS C1713,,3362-6-130  -  SCREW BONE 130MM OMEGA+ SS HIP SUPLAG,$313.50,$0.00,$313.50,$141.08,$223.74,$0.00,$54.01,$0.00,$0.00,$54.89,$313.50,$0.00,$156.75,$248.29,$250.80,$0.00,$49.06,$0.00,$49.91,$0.00
3363-0-354,SUP,HCPCS C1713,,3363-0-354  -  PLATE 135D 25MM SS 4 HOLE CMPR OMEGA+ BONE HIP NONSTRL,$563.75,$0.00,$563.75,$253.69,$402.35,$0.00,$97.13,$0.00,$0.00,$98.71,$563.75,$0.00,$281.88,$446.49,$451.00,$0.00,$88.23,$0.00,$89.75,$0.00
3363-1-203,SUP,HCPCS C1713,,3363-1-203  -  PLATE 140D SS 3 HOLE CMPR OMEGA+ BONE HIP NONSTRL,$501.88,$0.00,$501.88,$225.84,$358.19,$0.00,$86.47,$0.00,$0.00,$87.87,$501.88,$0.00,$250.94,$397.49,$401.50,$0.00,$78.54,$0.00,$79.90,$0.00
3363-1-303,SUP,HCPCS C1713,,3363-1-303  -  PLATE 145D SS 3 HOLE CMPR OMEGA+ BONE HIP NONSTRL,$529.38,$0.00,$529.38,$238.22,$377.81,$0.00,$91.21,$0.00,$0.00,$92.69,$529.38,$0.00,$264.69,$419.27,$423.50,$0.00,$82.85,$0.00,$84.28,$0.00
3363-1-403,SUP,HCPCS C1713,,3363-1-403  -  PLATE 150D SS 3 HOLE CMPR OMEGA+ BONE HIP NONSTRL,$501.88,$0.00,$501.88,$225.84,$358.19,$0.00,$86.47,$0.00,$0.00,$87.87,$501.88,$0.00,$250.94,$397.49,$401.50,$0.00,$78.54,$0.00,$79.90,$0.00
3363-5-085,SUP,HCPCS C1713,,3363-5-085  -  SCREW BONE 85MM OMEGA+ HIP LAG NONSTRL,$488.13,$0.00,$488.13,$219.66,$348.37,$0.00,$84.10,$0.00,$0.00,$85.47,$488.13,$0.00,$244.06,$386.60,$390.50,$0.00,$76.39,$0.00,$77.71,$0.00
3363-7-000,SUP,HCPCS C1713,,3363-7-000  -  SCREW BONE OMEGA+ SS HIP CMPR NONSTRL,$52.25,$0.00,$52.25,$23.51,$37.29,$0.00,$9.00,$0.00,$0.00,$9.15,$52.25,$0.00,$26.13,$41.38,$41.80,$0.00,$8.18,$0.00,$8.32,$0.00
33661200MR,SUP,HCPCS C1713,,33661200MR  -  CAP LOCKING LARGE ROUND 12MM SPN,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
33661200SR,SUP,HCPCS C1713,,33661200SR  -  CAP LOCKING SMALL ROUND 12MM SPN,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
33661205MR,SUP,HCPCS C1713,,33661205MR  -  ENDCAP SPINAL 5D LARGE ROUND 12MM MODULAR VBOSS,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
33661205SR,SUP,Custom 27803010,,33661205SR  -  ENDCAP SPINAL 5D SMALL ROUND 12MM MODULAR VBOSS,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
33661400MR,SUP,Custom 27803010,,33661400MR  -  ENDCAP SPINAL 0D LARGE ROUND 14MM MODULAR VBOSS,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
33661400SR,SUP,Custom 27803010,,33661400SR  -  ENDCAP SPINAL 0D SMALL ROUND 14MM MODULAR VBOSS TITANIUM,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
33661405MR,SUP,Custom 27803010,,33661405MR  -  ENDCAP SPINAL 5D LARGE ROUND 14MM MODULAR VBOSS,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
33661405SR,SUP,Custom 27803010,,33661405SR  -  ENDCAP SPINAL 5D SMALL ROUND 14MM MODULAR VBOSS,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
33661600MR,SUP,Custom 27803010,,33661600MR  -  ENDCAP SPINAL LARGE 16MM ROUND VBOSS TITANIUM,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
33661600SR,SUP,Custom 27803010,,33661600SR  -  ENDCAP SPINAL SMALL 16MM ROUND VBOSS TITANIUM,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
33661605MR,SUP,Custom 27803010,,33661605MR  -  ENDCAP SPINAL 5D LARGE 16MM ROUND VBOSS TITANIUM,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
33661605SR,SUP,Custom 27803010,,33661605SR  -  ENDCAP SPINAL 5D SMALL 16MM ROUND VBOSS TITANIUM,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
33662000MO,SUP,Custom 27803010,,33662000MO  -  ENDCAP SPINAL LARGE 20MM OVAL VBOSS TITANIUM,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
33662000MR,SUP,Custom 27803010,,33662000MR  -  ENDCAP SPINAL LARGE 20MM ROUND VBOSS TITANIUM,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
33662000SO,SUP,Custom 27803010,,33662000SO  -  ENDCAP SPINAL SMALL 20MM OVAL VBOSS TITANIUM,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
33662000SR,SUP,Custom 27803010,,33662000SR  -  ENDCAP SPINAL SMALL 20MM ROUND VBOSS TITANIUM,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
33662005MO,SUP,Custom 27803010,,33662005MO  -  ENDCAP SPINAL 5D LARGE 20MM OVAL VBOSS TITANIUM,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
33662005MR,SUP,Custom 27803010,,33662005MR  -  ENDCAP SPINAL 5D LARGE 20MM ROUND VBOSS TITANIUM,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
33662005SO,SUP,Custom 27803010,,33662005SO  -  ENDCAP SPINAL 5D SMALL 20MM OVAL VBOSS TITANIUM,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
33662005SR,SUP,Custom 27803010,,33662005SR  -  ENDCAP SPINAL 5D SMALL 20MM ROUND VBOSS TITANIUM,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
33662010MO,SUP,Custom 27803010,,33662010MO  -  ENDCAP SPINAL 10D LARGE 20MM OVAL VBOSS TITANIUM,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
33662010SO,SUP,Custom 27803010,,33662010SO  -  ENDCAP SPINAL 10D SMALL 20MM OVAL VBOSS TITANIUM,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
33662500MO,SUP,Custom 27803010,,33662500MO  -  ENDCAP SPINAL LARGE 25MM OVAL VBOSS TITANIUM,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
33662500MR,SUP,Custom 27803010,,33662500MR  -  ENDCAP SPINAL LARGE 25MM ROUND VBOSS TITANIUM,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
33662500SO,SUP,Custom 27803010,,33662500SO  -  ENDCAP SPINAL SMALL 25MM OVAL VBOSS TITANIUM,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
33662500SR,SUP,Custom 27803010,,33662500SR  -  ENDCAP SPINAL SMALL 25MM ROUND VBOSS TITANIUM,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
33662505MO,SUP,Custom 27803010,,33662505MO  -  ENDCAP SPINAL 5D LARGE 25MM OVAL VBOSS TITANIUM,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
33662505MR,SUP,Custom 27803010,,33662505MR  -  ENDCAP SPINAL 5D LARGE 25MM ROUND VBOSS TITANIUM,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
33662505SO,SUP,Custom 27803010,,33662505SO  -  ENDCAP SPINAL 5D SMALL 25MM OVAL VBOSS TITANIUM,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
33662505SR,SUP,Custom 27803010,,33662505SR  -  ENDCAP SPINAL 5D SMALL 25MM ROUND VBOSS TITANIUM,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
33662510MO,SUP,Custom 27803010,,33662510MO  -  ENDCAP SPINAL 10D LARGE 25MM OVAL VBOSS TITANIUM,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
33662510SO,SUP,Custom 27803010,,33662510SO  -  ENDCAP SPINAL 10D SMALL 25MM OVAL VBOSS TITANIUM,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
3370-0-230,SUP,HCPCS C1713,,3370-0-230  -  NAIL 12MM 21CM HIP GAMA IM 130D STD GAMA SYS STYKER ORTH,"$1,498.75",$0.00,"$1,498.75",$674.44,"$1,069.66",$0.00,$258.23,$0.00,$0.00,$262.42,"$1,498.75",$0.00,$749.38,"$1,187.01","$1,199.00",$0.00,$234.55,$0.00,$238.60,$0.00
3370-0-235,SUP,HCPCS C1713,,3370-0-235  -  NAIL 12MM 21MM HIP GAMA IM 135D STD GAMA SYS,"$1,155.00",$0.00,"$1,155.00",$519.75,$824.32,$0.00,$199.00,$0.00,$0.00,$202.23,"$1,155.00",$0.00,$577.50,$914.76,$924.00,$0.00,$180.76,$0.00,$183.88,$0.00
3370-0-430,SUP,HCPCS C1713,,3370-0-430  -  NAIL 14MM 21CM HIP GAMA IM 130D STD GAMA SYS STRYK ORTH,"$1,051.88",$0.00,"$1,051.88",$473.34,$750.72,$0.00,$181.23,$0.00,$0.00,$184.17,"$1,051.88",$0.00,$525.94,$833.09,$841.50,$0.00,$164.62,$0.00,$167.46,$0.00
3370-0-435,SUP,HCPCS C1713,,3370-0-435  -  NAIL 14MM 21CM HIP GAMA IM 135D STD SS GAMA SYS,"$1,361.25",$0.00,"$1,361.25",$612.56,$971.52,$0.00,$234.54,$0.00,$0.00,$238.34,"$1,361.25",$0.00,$680.63,"$1,078.11","$1,089.00",$0.00,$213.04,$0.00,$216.71,$0.00
3370-1-000,SUP,HCPCS C1713,,3370-1-000  -  SCREW SET 8MM 27MM GMA HIP IM NL,$295.63,$0.00,$295.63,$133.03,$210.99,$0.00,$50.93,$0.00,$0.00,$51.76,$295.63,$0.00,$147.81,$234.14,$236.50,$0.00,$46.27,$0.00,$47.06,$0.00
3370-1-050,SUP,HCPCS C1713,,3370-1-050  -  SCREW BONE GAMA CAP NAIL,$195.25,$0.00,$195.25,$87.86,$139.35,$0.00,$33.64,$0.00,$0.00,$34.19,$195.25,$0.00,$97.63,$154.64,$156.20,$0.00,$30.56,$0.00,$31.08,$0.00
3370-1-060,SUP,HCPCS C1713,,3370-1-060  -  SCREW BONE 12MM 60MM GAMA SS FEM LAG IM NAIL,$295.63,$0.00,$295.63,$133.03,$210.99,$0.00,$50.93,$0.00,$0.00,$51.76,$295.63,$0.00,$147.81,$234.14,$236.50,$0.00,$46.27,$0.00,$47.06,$0.00
3370-2-080,SUP,HCPCS C1713,,3370-2-080  -  SCREW BONE 12MM 80MM GAMA LAG IM NAIL,$653.13,$0.00,$653.13,$293.91,$466.14,$0.00,$112.53,$0.00,$0.00,$114.36,$653.13,$0.00,$326.56,$517.28,$522.50,$0.00,$102.21,$0.00,$103.98,$0.00
3370-2-085,SUP,HCPCS C1713,,3370-2-085  -  NAIL 12MM 85MM GAMA IM NAIL LAG,$653.13,$0.00,$653.13,$293.91,$466.14,$0.00,$112.53,$0.00,$0.00,$114.36,$653.13,$0.00,$326.56,$517.28,$522.50,$0.00,$102.21,$0.00,$103.98,$0.00
3370-2-090,SUP,HCPCS C1713,,3370-2-090  -  NAIL 12MM 90MM GAMA IM NAIL LAG,$653.13,$0.00,$653.13,$293.91,$466.14,$0.00,$112.53,$0.00,$0.00,$114.36,$653.13,$0.00,$326.56,$517.28,$522.50,$0.00,$102.21,$0.00,$103.98,$0.00
3370-2-095,SUP,HCPCS C1713,,3370-2-095  -  NAIL 12MM 95MM HIP GAMA IM NAIL LAG TI,$653.13,$0.00,$653.13,$293.91,$466.14,$0.00,$112.53,$0.00,$0.00,$114.36,$653.13,$0.00,$326.56,$517.28,$522.50,$0.00,$102.21,$0.00,$103.98,$0.00
3370-2-100,SUP,HCPCS C1713,,3370-2-100  -  SCREW BONE 12MM 100MM GAMA FEM LAG IM NAIL,$653.13,$0.00,$653.13,$293.91,$466.14,$0.00,$112.53,$0.00,$0.00,$114.36,$653.13,$0.00,$326.56,$517.28,$522.50,$0.00,$102.21,$0.00,$103.98,$0.00
3370-2-105,SUP,HCPCS C1713,,3370-2-105  -  SCREW BONE 105MM 12MM GAMA FEM LAG SCR IM NAIL,$653.13,$0.00,$653.13,$293.91,$466.14,$0.00,$112.53,$0.00,$0.00,$114.36,$653.13,$0.00,$326.56,$517.28,$522.50,$0.00,$102.21,$0.00,$103.98,$0.00
3370-2-110,SUP,HCPCS C1713,,3370-2-110  -  SCREW BONE 12MM 110MM GAMA FEM LAG IM NAIL,$653.13,$0.00,$653.13,$293.91,$466.14,$0.00,$112.53,$0.00,$0.00,$114.36,$653.13,$0.00,$326.56,$517.28,$522.50,$0.00,$102.21,$0.00,$103.98,$0.00
3370-2-120,SUP,HCPCS C1713,,3370-2-120  -  SCREW BONE 12MM 120MM GAMA SS FEM LAG IM NAIL,$653.13,$0.00,$653.13,$293.91,$466.14,$0.00,$112.53,$0.00,$0.00,$114.36,$653.13,$0.00,$326.56,$517.28,$522.50,$0.00,$102.21,$0.00,$103.98,$0.00
3370-2-130,SUP,HCPCS C1713,,3370-2-130  -  SCREW BONE 12MM 130MM GAMMA3 SS HIP FEM LAG IM NAIL,$653.13,$0.00,$653.13,$293.91,$466.14,$0.00,$112.53,$0.00,$0.00,$114.36,$653.13,$0.00,$326.56,$517.28,$522.50,$0.00,$102.21,$0.00,$103.98,$0.00
3370-3-035,SUP,HCPCS C1713,,3370-3-035  -  SCREW BONE 6.28MM 35MM GAMMA3 HIP DISTAL NAIL,$178.75,$0.00,$178.75,$80.44,$127.57,$0.00,$30.80,$0.00,$0.00,$31.30,$178.75,$0.00,$89.38,$141.57,$143.00,$0.00,$27.97,$0.00,$28.46,$0.00
3370-3-040,SUP,HCPCS C1713,,3370-3-040  -  SCREW BONE 6.28MM 40MM GAMA DISTAL IM NAIL,$178.75,$0.00,$178.75,$80.44,$127.57,$0.00,$30.80,$0.00,$0.00,$31.30,$178.75,$0.00,$89.38,$141.57,$143.00,$0.00,$27.97,$0.00,$28.46,$0.00
3370-6-025,SUP,HCPCS C1713,,3370-6-025  -  NAIL 11MM 34CM HIP LEFT FEM GAMMA3 IM 125D LNG LCK TI,"$2,293.50",$0.00,"$2,293.50","$1,032.08","$1,636.87",$0.00,$395.16,$0.00,$0.00,$401.57,"$2,293.50",$0.00,"$1,146.75","$1,816.45","$1,834.80",$0.00,$358.93,$0.00,$365.13,$0.00
3370-6-030,SUP,HCPCS C1713,,3370-6-030  -  NAIL 11MM 34CM HIP LEFT FEM GAMMA3 IM 130D LNG LCK TI,"$2,293.50",$0.00,"$2,293.50","$1,032.08","$1,636.87",$0.00,$395.16,$0.00,$0.00,$401.57,"$2,293.50",$0.00,"$1,146.75","$1,816.45","$1,834.80",$0.00,$358.93,$0.00,$365.13,$0.00
3370-6-035,SUP,HCPCS C1713,,3370-6-035  -  NAIL 11MM 34CM LEFT FEM GAMA IM 135D LNG LCK SS STRL,"$2,293.50",$0.00,"$2,293.50","$1,032.08","$1,636.87",$0.00,$395.16,$0.00,$0.00,$401.57,"$2,293.50",$0.00,"$1,146.75","$1,816.45","$1,834.80",$0.00,$358.93,$0.00,$365.13,$0.00
3370-6-125,SUP,HCPCS C1713,,3370-6-125  -  NAIL 11MM 36CM LEFT FEM GAMA IM 125D LNG LCK SS STRL,"$2,293.50",$0.00,"$2,293.50","$1,032.08","$1,636.87",$0.00,$395.16,$0.00,$0.00,$401.57,"$2,293.50",$0.00,"$1,146.75","$1,816.45","$1,834.80",$0.00,$358.93,$0.00,$365.13,$0.00
3370-6-130,SUP,HCPCS C1713,,3370-6-130  -  NAIL 11MM 360MM LEFT GAMA IM 130D LNG,"$2,293.50",$0.00,"$2,293.50","$1,032.08","$1,636.87",$0.00,$395.16,$0.00,$0.00,$401.57,"$2,293.50",$0.00,"$1,146.75","$1,816.45","$1,834.80",$0.00,$358.93,$0.00,$365.13,$0.00
3370-6-135,SUP,HCPCS C1713,,3370-6-135  -  NAIL 11MM 36CM LEFT FEM GAMA IM 135D LNG LCK SS STRL,"$2,293.50",$0.00,"$2,293.50","$1,032.08","$1,636.87",$0.00,$395.16,$0.00,$0.00,$401.57,"$2,293.50",$0.00,"$1,146.75","$1,816.45","$1,834.80",$0.00,$358.93,$0.00,$365.13,$0.00
3370-6-225,SUP,HCPCS C1713,,3370-6-225  -  NAIL 11MM 38CM LEFT FEM GAMA IM 125D LNG LCK SS STRL,"$2,293.50",$0.00,"$2,293.50","$1,032.08","$1,636.87",$0.00,$395.16,$0.00,$0.00,$401.57,"$2,293.50",$0.00,"$1,146.75","$1,816.45","$1,834.80",$0.00,$358.93,$0.00,$365.13,$0.00
3370-6-230,SUP,HCPCS C1713,,3370-6-230  -  NAIL 11MM 38CM LEFT FEM GAMA IM 130D LNG LCK SS STRL,"$2,293.50",$0.00,"$2,293.50","$1,032.08","$1,636.87",$0.00,$395.16,$0.00,$0.00,$401.57,"$2,293.50",$0.00,"$1,146.75","$1,816.45","$1,834.80",$0.00,$358.93,$0.00,$365.13,$0.00
3370-6-235,SUP,HCPCS C1713,,3370-6-235  -  NAIL 11MM 38CM LEFT FEM GAMA IM 135D LNG LCK SS STRL,"$2,293.50",$0.00,"$2,293.50","$1,032.08","$1,636.87",$0.00,$395.16,$0.00,$0.00,$401.57,"$2,293.50",$0.00,"$1,146.75","$1,816.45","$1,834.80",$0.00,$358.93,$0.00,$365.13,$0.00
3370-6-325,SUP,HCPCS C1713,,3370-6-325  -  NAIL 11MM 40CM LEFT FEM GAMA IM 125D LNG LCK SS STRL,"$2,293.50",$0.00,"$2,293.50","$1,032.08","$1,636.87",$0.00,$395.16,$0.00,$0.00,$401.57,"$2,293.50",$0.00,"$1,146.75","$1,816.45","$1,834.80",$0.00,$358.93,$0.00,$365.13,$0.00
3370-6-330,SUP,HCPCS C1713,,3370-6-330  -  NAIL 11MM 400MM LEFT GAMA IM 130D LNG,"$2,293.50",$0.00,"$2,293.50","$1,032.08","$1,636.87",$0.00,$395.16,$0.00,$0.00,$401.57,"$2,293.50",$0.00,"$1,146.75","$1,816.45","$1,834.80",$0.00,$358.93,$0.00,$365.13,$0.00
3370-6-335,SUP,HCPCS C1713,,3370-6-335  -  NAIL 11MM 40CM LEFT FEM GAMA IM 135D LNG LCK SS STRL,"$2,293.50",$0.00,"$2,293.50","$1,032.08","$1,636.87",$0.00,$395.16,$0.00,$0.00,$401.57,"$2,293.50",$0.00,"$1,146.75","$1,816.45","$1,834.80",$0.00,$358.93,$0.00,$365.13,$0.00
3370-6-425,SUP,HCPCS C1713,,3370-6-425  -  NAIL 11MM 42CM LEFT FEM GAMA IM 125D LNG LCK SS STRL,"$2,293.50",$0.00,"$2,293.50","$1,032.08","$1,636.87",$0.00,$395.16,$0.00,$0.00,$401.57,"$2,293.50",$0.00,"$1,146.75","$1,816.45","$1,834.80",$0.00,$358.93,$0.00,$365.13,$0.00
3370-6-430,SUP,HCPCS C1713,,3370-6-430  -  NAIL 11MM 42CM LEFT FEM GAMA IM 130D LNG LCK SS STRL,"$2,293.50",$0.00,"$2,293.50","$1,032.08","$1,636.87",$0.00,$395.16,$0.00,$0.00,$401.57,"$2,293.50",$0.00,"$1,146.75","$1,816.45","$1,834.80",$0.00,$358.93,$0.00,$365.13,$0.00
3370-6-435,SUP,HCPCS C1713,,3370-6-435  -  NAIL 11MM 42CM LEFT FEM GAMA IM 135D LNG LCK SS STRL,"$2,293.50",$0.00,"$2,293.50","$1,032.08","$1,636.87",$0.00,$395.16,$0.00,$0.00,$401.57,"$2,293.50",$0.00,"$1,146.75","$1,816.45","$1,834.80",$0.00,$358.93,$0.00,$365.13,$0.00
3370-6-525,SUP,HCPCS C1713,,3370-6-525  -  NAIL 11MM 44CM LEFT FEM GAMA IM 125D LNG LCK SS STRL,"$2,293.50",$0.00,"$2,293.50","$1,032.08","$1,636.87",$0.00,$395.16,$0.00,$0.00,$401.57,"$2,293.50",$0.00,"$1,146.75","$1,816.45","$1,834.80",$0.00,$358.93,$0.00,$365.13,$0.00
3370-6-530,SUP,HCPCS C1713,,3370-6-530  -  NAIL 11MM 44CM LEFT FEM GAMA IM 130D LNG LCK SS STRL,"$2,293.50",$0.00,"$2,293.50","$1,032.08","$1,636.87",$0.00,$395.16,$0.00,$0.00,$401.57,"$2,293.50",$0.00,"$1,146.75","$1,816.45","$1,834.80",$0.00,$358.93,$0.00,$365.13,$0.00
3370-6-535,SUP,HCPCS C1713,,3370-6-535  -  NAIL 11MM 44CM LEFT FEM GAMA IM 135D LNG LCK SS STRL,"$2,413.13",$0.00,"$2,413.13","$1,085.91","$1,722.25",$0.00,$415.77,$0.00,$0.00,$422.52,"$2,413.13",$0.00,"$1,206.56","$1,911.20","$1,930.50",$0.00,$377.65,$0.00,$384.17,$0.00
3370-7-025,SUP,HCPCS C1713,,3370-7-025  -  NAIL 11MM 34CM RIGHT FEM GAMA IM 125D LNG LCK SS STRL,"$2,293.50",$0.00,"$2,293.50","$1,032.08","$1,636.87",$0.00,$395.16,$0.00,$0.00,$401.57,"$2,293.50",$0.00,"$1,146.75","$1,816.45","$1,834.80",$0.00,$358.93,$0.00,$365.13,$0.00
3370-7-030,SUP,HCPCS C1713,,3370-7-030  -  NAIL 11MM 34CM RIGHT HIP GAMMA3 IM 130D LNG LCK TI,"$2,293.50",$0.00,"$2,293.50","$1,032.08","$1,636.87",$0.00,$395.16,$0.00,$0.00,$401.57,"$2,293.50",$0.00,"$1,146.75","$1,816.45","$1,834.80",$0.00,$358.93,$0.00,$365.13,$0.00
3370-7-035,SUP,HCPCS C1713,,3370-7-035  -  NAIL 11MM 34CM RIGHT FEM GAMA IM 135D LNG LCK SS STRL,"$2,293.50",$0.00,"$2,293.50","$1,032.08","$1,636.87",$0.00,$395.16,$0.00,$0.00,$401.57,"$2,293.50",$0.00,"$1,146.75","$1,816.45","$1,834.80",$0.00,$358.93,$0.00,$365.13,$0.00
3370-7-125,SUP,HCPCS C1713,,3370-7-125  -  NAIL 11MM 36CM RIGHT FEM GAMA IM 125D LNG LCK SS STRL,"$2,293.50",$0.00,"$2,293.50","$1,032.08","$1,636.87",$0.00,$395.16,$0.00,$0.00,$401.57,"$2,293.50",$0.00,"$1,146.75","$1,816.45","$1,834.80",$0.00,$358.93,$0.00,$365.13,$0.00
3370-7-130,SUP,HCPCS C1713,,3370-7-130  -  NAIL 11MM 360MM RIGHT TROC GAMA IM 130D LNG LCK SS STRL,"$2,293.50",$0.00,"$2,293.50","$1,032.08","$1,636.87",$0.00,$395.16,$0.00,$0.00,$401.57,"$2,293.50",$0.00,"$1,146.75","$1,816.45","$1,834.80",$0.00,$358.93,$0.00,$365.13,$0.00
3370-7-135,SUP,HCPCS C1713,,3370-7-135  -  NAIL 11MM 36CM RIGHT FEM GAMA IM 135D LNG LCK SS STRL,"$2,293.50",$0.00,"$2,293.50","$1,032.08","$1,636.87",$0.00,$395.16,$0.00,$0.00,$401.57,"$2,293.50",$0.00,"$1,146.75","$1,816.45","$1,834.80",$0.00,$358.93,$0.00,$365.13,$0.00
3370-7-225,SUP,HCPCS C1713,,3370-7-225  -  NAIL 11MM 38CM RIGHT FEM GAMA IM 125D LNG LCK SS STRL,"$2,293.50",$0.00,"$2,293.50","$1,032.08","$1,636.87",$0.00,$395.16,$0.00,$0.00,$401.57,"$2,293.50",$0.00,"$1,146.75","$1,816.45","$1,834.80",$0.00,$358.93,$0.00,$365.13,$0.00
3370-7-230,SUP,HCPCS C1713,,3370-7-230  -  NAIL 11MM 38CM RIGHT FEM GAMA IM 130D LNG LCK SS STRL,"$2,293.50",$0.00,"$2,293.50","$1,032.08","$1,636.87",$0.00,$395.16,$0.00,$0.00,$401.57,"$2,293.50",$0.00,"$1,146.75","$1,816.45","$1,834.80",$0.00,$358.93,$0.00,$365.13,$0.00
3370-7-235,SUP,HCPCS C1713,,3370-7-235  -  NAIL 11MM 38CM RIGHT FEM GAMA IM 135D LNG LCK SS STRL,"$2,293.50",$0.00,"$2,293.50","$1,032.08","$1,636.87",$0.00,$395.16,$0.00,$0.00,$401.57,"$2,293.50",$0.00,"$1,146.75","$1,816.45","$1,834.80",$0.00,$358.93,$0.00,$365.13,$0.00
3370-7-325,SUP,HCPCS C1713,,3370-7-325  -  NAIL 11MM 40CM RIGHT FEM GAMA IM 125D LNG LCK SS STRL,"$2,293.50",$0.00,"$2,293.50","$1,032.08","$1,636.87",$0.00,$395.16,$0.00,$0.00,$401.57,"$2,293.50",$0.00,"$1,146.75","$1,816.45","$1,834.80",$0.00,$358.93,$0.00,$365.13,$0.00
3370-7-330,SUP,HCPCS C1713,,3370-7-330  -  NAIL 11MM 40CM RIGHT FEM GAMA IM 130D LNG LCK STRL,"$2,293.50",$0.00,"$2,293.50","$1,032.08","$1,636.87",$0.00,$395.16,$0.00,$0.00,$401.57,"$2,293.50",$0.00,"$1,146.75","$1,816.45","$1,834.80",$0.00,$358.93,$0.00,$365.13,$0.00
3370-7-335,SUP,HCPCS C1713,,3370-7-335  -  NAIL 11MM 40CM RIGHT FEM GAMA IM 135D LNG LCK SS STRL,"$2,293.50",$0.00,"$2,293.50","$1,032.08","$1,636.87",$0.00,$395.16,$0.00,$0.00,$401.57,"$2,293.50",$0.00,"$1,146.75","$1,816.45","$1,834.80",$0.00,$358.93,$0.00,$365.13,$0.00
3370-7-425,SUP,HCPCS C1713,,3370-7-425  -  NAIL 11MM 42CM RIGHT FEM GAMA IM 125D LNG LCK SS STRL,"$2,293.50",$0.00,"$2,293.50","$1,032.08","$1,636.87",$0.00,$395.16,$0.00,$0.00,$401.57,"$2,293.50",$0.00,"$1,146.75","$1,816.45","$1,834.80",$0.00,$358.93,$0.00,$365.13,$0.00
3370-7-430,SUP,HCPCS C1713,,3370-7-430  -  NAIL 11MM 42CM RIGHT FEM GAMA IM 130D LNG LCK SS STRL,"$2,293.50",$0.00,"$2,293.50","$1,032.08","$1,636.87",$0.00,$395.16,$0.00,$0.00,$401.57,"$2,293.50",$0.00,"$1,146.75","$1,816.45","$1,834.80",$0.00,$358.93,$0.00,$365.13,$0.00
3370-7-435,SUP,HCPCS C1713,,3370-7-435  -  NAIL 11MM 42CM RIGHT FEM GAMA IM 135D LNG LCK SS STRL,"$2,293.50",$0.00,"$2,293.50","$1,032.08","$1,636.87",$0.00,$395.16,$0.00,$0.00,$401.57,"$2,293.50",$0.00,"$1,146.75","$1,816.45","$1,834.80",$0.00,$358.93,$0.00,$365.13,$0.00
3370-7-525,SUP,HCPCS C1713,,3370-7-525  -  NAIL 11MM 44CM RIGHT FEM GAMA IM 125D LNG LCK SS STRL,"$2,293.50",$0.00,"$2,293.50","$1,032.08","$1,636.87",$0.00,$395.16,$0.00,$0.00,$401.57,"$2,293.50",$0.00,"$1,146.75","$1,816.45","$1,834.80",$0.00,$358.93,$0.00,$365.13,$0.00
3370-7-530,SUP,HCPCS C1713,,3370-7-530  -  NAIL 11MM 44CM RIGHT FEM GAMA IM 130D LNG LCK SS STRL,"$2,293.50",$0.00,"$2,293.50","$1,032.08","$1,636.87",$0.00,$395.16,$0.00,$0.00,$401.57,"$2,293.50",$0.00,"$1,146.75","$1,816.45","$1,834.80",$0.00,$358.93,$0.00,$365.13,$0.00
3370-7-535,SUP,HCPCS C1713,,3370-7-535  -  NAIL 11MM 44CM RIGHT FEM GAMA IM 135D LNG LCK SS STRL,"$2,293.50",$0.00,"$2,293.50","$1,032.08","$1,636.87",$0.00,$395.16,$0.00,$0.00,$401.57,"$2,293.50",$0.00,"$1,146.75","$1,816.45","$1,834.80",$0.00,$358.93,$0.00,$365.13,$0.00
3370-8-125,SUP,HCPCS C1713,,3370-8-125  -  NAIL 11MM 18CM TROC GAMA IM 125D LCK SS STRL,"$1,863.13",$0.00,"$1,863.13",$838.41,"$1,329.71",$0.00,$321.01,$0.00,$0.00,$326.22,"$1,863.13",$0.00,$931.56,"$1,475.60","$1,490.50",$0.00,$291.58,$0.00,$296.61,$0.00
3370-8-130,SUP,HCPCS C1713,,3370-8-130  -  NAIL TROC IM 130D,"$1,863.13",$0.00,"$1,863.13",$838.41,"$1,329.71",$0.00,$321.01,$0.00,$0.00,$326.22,"$1,863.13",$0.00,$931.56,"$1,475.60","$1,490.50",$0.00,$291.58,$0.00,$296.61,$0.00
3370-8-135,SUP,HCPCS C1713,,3370-8-135  -  NAIL 11MM 18CM TROC GAMA IM 135D LCK SS,"$1,863.13",$0.00,"$1,863.13",$838.41,"$1,329.71",$0.00,$321.01,$0.00,$0.00,$326.22,"$1,863.13",$0.00,$931.56,"$1,475.60","$1,490.50",$0.00,$291.58,$0.00,$296.61,$0.00
3371-1-015,SUP,HCPCS C1769,,3371-1-015  -  GUIDEWIRE ORTH 3MM STRL BLNT TIP PACKAGED,$233.75,$0.00,$233.75,$126.93,$166.83,$0.00,$40.27,$0.00,$0.00,$40.93,$233.75,$0.00,$116.88,$185.13,$187.00,$0.00,$36.58,$0.00,$37.21,$0.00
3371-1-060,SUP,HCPCS C1713,,3371-1-060  -  WIRE FX 3.2MM 450MM KRSH SS GMA NL SYS,$192.50,$0.00,$192.50,$86.63,$137.39,$0.00,$33.17,$0.00,$0.00,$33.71,$192.50,$0.00,$96.25,$152.46,$154.00,$0.00,$30.13,$0.00,$30.65,$0.00
3371-1-078,SUP,Custom 27203010,,3371-1-078  -  HEAD FEM +5MM OFST 36MM V40 LFIT COCR HIP,"$1,684.38",$0.00,"$1,684.38",$0.00,"$1,202.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,684.38",$0.00,$842.19,"$1,334.03","$1,347.50",$0.00,$0.00,$0.00,$0.00,$0.00
3371-1-085,SUP,Custom 27803010,,3371-1-085  -  TAP LAG SCR SURG,"$1,313.13",$0.00,"$1,313.13",$0.00,$937.18,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,313.13",$0.00,$656.56,"$1,040.00","$1,050.50",$0.00,$0.00,$0.00,$0.00,$0.00
3371-1-180,SUP,Custom 27203010,,3371-1-180  -  BIT DRILL 5.5MM,$203.50,$0.00,$203.50,$0.00,$145.24,$0.00,$0.00,$0.00,$0.00,$0.00,$203.50,$0.00,$101.75,$161.17,$162.80,$0.00,$0.00,$0.00,$0.00,$0.00
3371-1-185,SUP,Custom 27203010,,3371-1-185  -  SLEEVE DRILL 5.5MM GAMA GUIDE NAIL,$467.50,$0.00,$467.50,$0.00,$333.65,$0.00,$0.00,$0.00,$0.00,$0.00,$467.50,$0.00,$233.75,$370.26,$374.00,$0.00,$0.00,$0.00,$0.00,$0.00
338 021,SUP,HCPCS C1900,,338 021  -  AROX 60 BP LEAD,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$0.00,$0.00
338 022,SUP,HCPCS C1900,,338 022  -  AROX 45 JBP LEAD,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$0.00,$0.00
338 023,SUP,HCPCS C1900,,338 023  -  AROX 53 BP LEAD,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$0.00,$0.00
33MJ-501,SUP,Custom 27803010,,33MJ-501  -  VALVE MTRL 85D 5.18SQ CM 33MM 26.1MM MSTR SER MECH STD CUF,"$11,250.00",$0.00,"$11,250.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,250.00",$0.00,"$5,625.00","$8,910.00","$9,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
3420-0260S,SUP,HCPCS C1713,,3420-0260S  -  NAIL 10MM 26CM RIGHT FEM HIP GAMMA3 IM 120D LNG TI STRL R1.5,"$3,698.75",$0.00,"$3,698.75","$1,664.44","$2,639.80",$0.00,$637.28,$0.00,$0.00,$647.62,"$3,698.75",$0.00,"$1,849.38","$2,929.41","$2,959.00",$0.00,$578.85,$0.00,$588.84,$0.00
3420-0280S,SUP,HCPCS C1713,,3420-0280S  -  NAIL 10MM 28CM RIGHT FEM HIP GAMMA3 IM 120D LNG TI STRL R1.5,"$3,698.75",$0.00,"$3,698.75","$1,664.44","$2,639.80",$0.00,$637.28,$0.00,$0.00,$647.62,"$3,698.75",$0.00,"$1,849.38","$2,929.41","$2,959.00",$0.00,$578.85,$0.00,$588.84,$0.00
3420-0300S,SUP,HCPCS C1713,,3420-0300S  -  NAIL 10MM 30CM RIGHT FEM HIP GAMMA3 IM 120D LNG TI STRL R1.5,"$3,698.75",$0.00,"$3,698.75","$1,664.44","$2,639.80",$0.00,$637.28,$0.00,$0.00,$647.62,"$3,698.75",$0.00,"$1,849.38","$2,929.41","$2,959.00",$0.00,$578.85,$0.00,$588.84,$0.00
3420-0320S,SUP,HCPCS C1713,,3420-0320S  -  NAIL 10MM 32CM RIGHT FEM HIP GAMMA3 IM 120D LNG TI STRL R1.5,"$3,698.75",$0.00,"$3,698.75","$1,664.44","$2,639.80",$0.00,$637.28,$0.00,$0.00,$647.62,"$3,698.75",$0.00,"$1,849.38","$2,929.41","$2,959.00",$0.00,$578.85,$0.00,$588.84,$0.00
3420-0340S,SUP,HCPCS C1713,,3420-0340S  -  NAIL 10MM 34CM RIGHT FEM HIP GAMMA3 IM 120D LNG TI STRL R1.5,"$3,698.75",$0.00,"$3,698.75","$1,664.44","$2,639.80",$0.00,$637.28,$0.00,$0.00,$647.62,"$3,698.75",$0.00,"$1,849.38","$2,929.41","$2,959.00",$0.00,$578.85,$0.00,$588.84,$0.00
3420-0360S,SUP,HCPCS C1713,,3420-0360S  -  NAIL 10MM 36CM RIGHT FEM HIP GAMMA3 IM 120D LNG TI STRL R1.5,"$3,698.75",$0.00,"$3,698.75","$1,664.44","$2,639.80",$0.00,$637.28,$0.00,$0.00,$647.62,"$3,698.75",$0.00,"$1,849.38","$2,929.41","$2,959.00",$0.00,$578.85,$0.00,$588.84,$0.00
3420-0380S,SUP,HCPCS C1713,,3420-0380S  -  NAIL 10MM 38CM RIGHT FEM HIP GAMMA3 IM 120D LNG TI STRL R1.5,"$3,698.75",$0.00,"$3,698.75","$1,664.44","$2,639.80",$0.00,$637.28,$0.00,$0.00,$647.62,"$3,698.75",$0.00,"$1,849.38","$2,929.41","$2,959.00",$0.00,$578.85,$0.00,$588.84,$0.00
3420-0400S,SUP,HCPCS C1713,,3420-0400S  -  NAIL 10MM 40CM RIGHT FEM HIP GAMMA3 IM 120D LNG TI STRL R1.5,"$3,698.75",$0.00,"$3,698.75","$1,664.44","$2,639.80",$0.00,$637.28,$0.00,$0.00,$647.62,"$3,698.75",$0.00,"$1,849.38","$2,929.41","$2,959.00",$0.00,$578.85,$0.00,$588.84,$0.00
3420-0420S,SUP,HCPCS C1713,,3420-0420S  -  GAMMA 3 S NAIL RIGHT 10X420MM X 120,"$3,698.75",$0.00,"$3,698.75","$1,664.44","$2,639.80",$0.00,$637.28,$0.00,$0.00,$647.62,"$3,698.75",$0.00,"$1,849.38","$2,929.41","$2,959.00",$0.00,$578.85,$0.00,$588.84,$0.00
3420-0440S,SUP,HCPCS C1713,,3420-0440S  -  NAIL IM 120D 10MM 440MM STRL GAMMA3 RT,"$3,698.75",$0.00,"$3,698.75","$1,664.44","$2,639.80",$0.00,$637.28,$0.00,$0.00,$647.62,"$3,698.75",$0.00,"$1,849.38","$2,929.41","$2,959.00",$0.00,$578.85,$0.00,$588.84,$0.00
3420-0460S,SUP,HCPCS C1713,,3420-0460S  -  NAIL IM 120D 10MM 460MM STRL GAMMA3 RT,"$3,698.75",$0.00,"$3,698.75","$1,664.44","$2,639.80",$0.00,$637.28,$0.00,$0.00,$647.62,"$3,698.75",$0.00,"$1,849.38","$2,929.41","$2,959.00",$0.00,$578.85,$0.00,$588.84,$0.00
3425-0260S,SUP,HCPCS C1713,,3425-0260S  -  NAIL 10MM 26CM RIGHT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL,"$3,698.75",$0.00,"$3,698.75","$1,664.44","$2,639.80",$0.00,$637.28,$0.00,$0.00,$647.62,"$3,698.75",$0.00,"$1,849.38","$2,929.41","$2,959.00",$0.00,$578.85,$0.00,$588.84,$0.00
3425-0280S,SUP,HCPCS C1713,,3425-0280S  -  NAIL 10MM 28CM RIGHT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL,"$3,698.75",$0.00,"$3,698.75","$1,664.44","$2,639.80",$0.00,$637.28,$0.00,$0.00,$647.62,"$3,698.75",$0.00,"$1,849.38","$2,929.41","$2,959.00",$0.00,$578.85,$0.00,$588.84,$0.00
3425-0300S,SUP,HCPCS C1713,,3425-0300S  -  NAIL 10MM 30CM RIGHT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL,"$3,698.75",$0.00,"$3,698.75","$1,664.44","$2,639.80",$0.00,$637.28,$0.00,$0.00,$647.62,"$3,698.75",$0.00,"$1,849.38","$2,929.41","$2,959.00",$0.00,$578.85,$0.00,$588.84,$0.00
3425-0320S,SUP,HCPCS C1713,,3425-0320S  -  NAIL 10MM 32CM RIGHT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL,"$3,698.75",$0.00,"$3,698.75","$1,664.44","$2,639.80",$0.00,$637.28,$0.00,$0.00,$647.62,"$3,698.75",$0.00,"$1,849.38","$2,929.41","$2,959.00",$0.00,$578.85,$0.00,$588.84,$0.00
3425-0340S,SUP,HCPCS C1713,,3425-0340S  -  NAIL 10MM 34CM RIGHT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL,"$3,698.75",$0.00,"$3,698.75","$1,664.44","$2,639.80",$0.00,$637.28,$0.00,$0.00,$647.62,"$3,698.75",$0.00,"$1,849.38","$2,929.41","$2,959.00",$0.00,$578.85,$0.00,$588.84,$0.00
3425-0360S,SUP,HCPCS C1713,,3425-0360S  -  NAIL 10MM 36CM RIGHT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL,"$3,698.75",$0.00,"$3,698.75","$1,664.44","$2,639.80",$0.00,$637.28,$0.00,$0.00,$647.62,"$3,698.75",$0.00,"$1,849.38","$2,929.41","$2,959.00",$0.00,$578.85,$0.00,$588.84,$0.00
3425-0380S,SUP,HCPCS C1713,,3425-0380S  -  NAIL 10MM 38CM RIGHT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL,"$3,698.75",$0.00,"$3,698.75","$1,664.44","$2,639.80",$0.00,$637.28,$0.00,$0.00,$647.62,"$3,698.75",$0.00,"$1,849.38","$2,929.41","$2,959.00",$0.00,$578.85,$0.00,$588.84,$0.00
3425-0400S,SUP,HCPCS C1713,,3425-0400S  -  NAIL 10MM 40CM RIGHT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL,"$3,698.75",$0.00,"$3,698.75","$1,664.44","$2,639.80",$0.00,$637.28,$0.00,$0.00,$647.62,"$3,698.75",$0.00,"$1,849.38","$2,929.41","$2,959.00",$0.00,$578.85,$0.00,$588.84,$0.00
3425-0420S,SUP,HCPCS C1713,,3425-0420S  -  GAMMA 3 S NAIL RIGHT 10X420MM X 125,"$3,698.75",$0.00,"$3,698.75","$1,664.44","$2,639.80",$0.00,$637.28,$0.00,$0.00,$647.62,"$3,698.75",$0.00,"$1,849.38","$2,929.41","$2,959.00",$0.00,$578.85,$0.00,$588.84,$0.00
3425-0440S,SUP,HCPCS C1713,,3425-0440S  -  GAMMA 3 S NAIL RIGHT 10X440MM X 125,"$3,698.75",$0.00,"$3,698.75","$1,664.44","$2,639.80",$0.00,$637.28,$0.00,$0.00,$647.62,"$3,698.75",$0.00,"$1,849.38","$2,929.41","$2,959.00",$0.00,$578.85,$0.00,$588.84,$0.00
3425-0460S,SUP,HCPCS C1713,,3425-0460S  -  NAIL IM 125D 10MM 460MM STRL GAMMA3 RT,"$3,698.75",$0.00,"$3,698.75","$1,664.44","$2,639.80",$0.00,$637.28,$0.00,$0.00,$647.62,"$3,698.75",$0.00,"$1,849.38","$2,929.41","$2,959.00",$0.00,$578.85,$0.00,$588.84,$0.00
3425-0480S,SUP,HCPCS C1713,,3425-0480S  -  NAIL IM 10MM 480MM STRL 125MM GAMMA3 RT,"$4,703.88",$0.00,"$4,703.88","$2,116.74","$3,357.16",$0.00,$810.45,$0.00,$0.00,$823.61,"$4,703.88",$0.00,"$2,351.94","$3,725.47","$3,763.10",$0.00,$736.16,$0.00,$748.86,$0.00
3430-0260S,SUP,HCPCS C1713,,3430-0260S  -  NAIL 10MM 26CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL,"$3,698.75",$0.00,"$3,698.75","$1,664.44","$2,639.80",$0.00,$637.28,$0.00,$0.00,$647.62,"$3,698.75",$0.00,"$1,849.38","$2,929.41","$2,959.00",$0.00,$578.85,$0.00,$588.84,$0.00
3430-0280S,SUP,HCPCS C1713,,3430-0280S  -  NAIL 10MM 28CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL,"$3,698.75",$0.00,"$3,698.75","$1,664.44","$2,639.80",$0.00,$637.28,$0.00,$0.00,$647.62,"$3,698.75",$0.00,"$1,849.38","$2,929.41","$2,959.00",$0.00,$578.85,$0.00,$588.84,$0.00
3430-0300S,SUP,HCPCS C1713,,3430-0300S  -  NAIL 10MM 30CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL,"$3,698.75",$0.00,"$3,698.75","$1,664.44","$2,639.80",$0.00,$637.28,$0.00,$0.00,$647.62,"$3,698.75",$0.00,"$1,849.38","$2,929.41","$2,959.00",$0.00,$578.85,$0.00,$588.84,$0.00
3430-0320S,SUP,HCPCS C1713,,3430-0320S  -  NAIL 10MM 32CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL,"$3,698.75",$0.00,"$3,698.75","$1,664.44","$2,639.80",$0.00,$637.28,$0.00,$0.00,$647.62,"$3,698.75",$0.00,"$1,849.38","$2,929.41","$2,959.00",$0.00,$578.85,$0.00,$588.84,$0.00
3430-0340S,SUP,HCPCS C1713,,3430-0340S  -  NAIL 10MM 34CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL,"$3,698.75",$0.00,"$3,698.75","$1,664.44","$2,639.80",$0.00,$637.28,$0.00,$0.00,$647.62,"$3,698.75",$0.00,"$1,849.38","$2,929.41","$2,959.00",$0.00,$578.85,$0.00,$588.84,$0.00
3430-0360S,SUP,HCPCS C1713,,3430-0360S  -  NAIL 10MM 36CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL,"$3,698.75",$0.00,"$3,698.75","$1,664.44","$2,639.80",$0.00,$637.28,$0.00,$0.00,$647.62,"$3,698.75",$0.00,"$1,849.38","$2,929.41","$2,959.00",$0.00,$578.85,$0.00,$588.84,$0.00
3430-0380S,SUP,HCPCS C1713,,3430-0380S  -  NAIL 10MM 38CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL,"$3,698.75",$0.00,"$3,698.75","$1,664.44","$2,639.80",$0.00,$637.28,$0.00,$0.00,$647.62,"$3,698.75",$0.00,"$1,849.38","$2,929.41","$2,959.00",$0.00,$578.85,$0.00,$588.84,$0.00
3430-0400S,SUP,HCPCS C1713,,3430-0400S  -  NAIL 10MM 40CM RIGHT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL,"$3,698.75",$0.00,"$3,698.75","$1,664.44","$2,639.80",$0.00,$637.28,$0.00,$0.00,$647.62,"$3,698.75",$0.00,"$1,849.38","$2,929.41","$2,959.00",$0.00,$578.85,$0.00,$588.84,$0.00
3430-0420S,SUP,HCPCS C1713,,3430-0420S  -  GAMMA 3 S NAIL RIGHT 10X420MM X 130,"$3,698.75",$0.00,"$3,698.75","$1,664.44","$2,639.80",$0.00,$637.28,$0.00,$0.00,$647.62,"$3,698.75",$0.00,"$1,849.38","$2,929.41","$2,959.00",$0.00,$578.85,$0.00,$588.84,$0.00
3430-0440S,SUP,HCPCS C1713,,3430-0440S  -  GAMMA 3 S NAIL RIGHT 10X440MM X 130,"$3,698.75",$0.00,"$3,698.75","$1,664.44","$2,639.80",$0.00,$637.28,$0.00,$0.00,$647.62,"$3,698.75",$0.00,"$1,849.38","$2,929.41","$2,959.00",$0.00,$578.85,$0.00,$588.84,$0.00
3430-0460S,SUP,HCPCS C1713,,3430-0460S  -  NAIL IM 130D 10MM 460MM STRL GAMMA3 RT,"$3,698.75",$0.00,"$3,698.75","$1,664.44","$2,639.80",$0.00,$637.28,$0.00,$0.00,$647.62,"$3,698.75",$0.00,"$1,849.38","$2,929.41","$2,959.00",$0.00,$578.85,$0.00,$588.84,$0.00
346 366,SUP,HCPCS C1898,,346 366  -  SELOX ST 53 LEAD,"$1,125.00",$0.00,"$1,125.00",$506.25,$802.91,$0.00,$193.83,$0.00,$0.00,$196.98,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$176.06,$0.00,$179.10,$0.00
346 367,SUP,HCPCS C1898,,346 367  -  SELOX ST 60 LEAD,"$1,125.00",$0.00,"$1,125.00",$506.25,$802.91,$0.00,$193.83,$0.00,$0.00,$196.98,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$176.06,$0.00,$179.10,$0.00
346 368,SUP,HCPCS C1898,,346 368  -  SELOX JT 53 LEAD,"$1,125.00",$0.00,"$1,125.00",$506.25,$802.91,$0.00,$193.83,$0.00,$0.00,$196.98,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$176.06,$0.00,$179.10,$0.00
346 369,SUP,HCPCS C1898,,346 369  -  SELOX JT 45 LEAD,"$1,125.00",$0.00,"$1,125.00",$506.25,$802.91,$0.00,$193.83,$0.00,$0.00,$196.98,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$176.06,$0.00,$179.10,$0.00
3460-7-006,SUP,HCPCS C1713,,3460-7-006  -  SCREW BONE 8MM 19MM PED HIP OSTMY,$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
3460-7-007,SUP,HCPCS C1713,,3460-7-007  -  SCREW BONE 8MM 22MM PED ORTH OSTMY PEDI HIP SYS,$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
3460-7-030,SUP,HCPCS C1713,,3460-7-030  -  SCREW BONE 8MM 76MM PED PDCL HIP OSTMY,$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
349 799,SUP,HCPCS C1900,,349 799  -  CYLOS DR WITH CLS AUTONOMIC RESPONSE,"$8,500.00",$0.00,"$8,500.00",$0.00,"$5,158.80",$0.00,"$1,464.51",$0.00,$0.00,$0.00,"$8,500.00",$0.00,"$4,250.00","$6,732.00","$6,800.00",$0.00,"$1,330.25",$0.00,$0.00,$0.00
349 811,SUP,HCPCS C1900,,349 811  -  CYLOS VR WITH CLS AUTONOMIC RESPONSE,"$8,500.00",$0.00,"$8,500.00",$0.00,"$5,158.80",$0.00,"$1,464.51",$0.00,$0.00,$0.00,"$8,500.00",$0.00,"$4,250.00","$6,732.00","$6,800.00",$0.00,"$1,330.25",$0.00,$0.00,$0.00
350 053,SUP,HCPCS C1895,,350 053  -  LINOX SD STEROID 65/16,"$11,250.00",$0.00,"$11,250.00","$5,062.50","$5,158.80",$0.00,"$1,938.32",$0.00,$0.00,"$1,969.79","$11,250.00",$0.00,"$5,625.00","$8,910.00","$9,000.00",$0.00,"$1,760.63",$0.00,"$1,791.00",$0.00
350 056,SUP,HCPCS C1895,,350 056  -  LINOX SD STEROID 75/18,"$11,250.00",$0.00,"$11,250.00","$5,062.50","$5,158.80",$0.00,"$1,938.32",$0.00,$0.00,"$1,969.79","$11,250.00",$0.00,"$5,625.00","$8,910.00","$9,000.00",$0.00,"$1,760.63",$0.00,"$1,791.00",$0.00
350 975,SUP,HCPCS C1895,,350 975  -  SETROX S 60 LEAD,"$1,125.00",$0.00,"$1,125.00",$506.25,$802.91,$0.00,$193.83,$0.00,$0.00,$196.98,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$176.06,$0.00,$179.10,$0.00
35-0002,SUP,Custom 27203010,,35-0002  -  PIN FIX 4MM LCK CALCANEUS STNM SS,$142.50,$0.00,$142.50,$0.00,$101.70,$0.00,$0.00,$0.00,$0.00,$0.00,$142.50,$0.00,$71.25,$112.86,$114.00,$0.00,$0.00,$0.00,$0.00,$0.00
35-0003,SUP,Custom 27203010,,35-0003  -  PIN FIX 5MM ORTH STNM SS,$142.50,$0.00,$142.50,$0.00,$101.70,$0.00,$0.00,$0.00,$0.00,$0.00,$142.50,$0.00,$71.25,$112.86,$114.00,$0.00,$0.00,$0.00,$0.00,$0.00
35-0011,SUP,HCPCS C1769,,35-0011  -  GUIDEWIRE ORTHOPEDIC STR .045IN 5.75IN THREAD TITANIUM,$17.50,$0.00,$17.50,$9.50,$12.49,$0.00,$3.02,$0.00,$0.00,$3.06,$17.50,$0.00,$8.75,$13.86,$14.00,$0.00,$2.74,$0.00,$2.79,$0.00
350-2001 BC,SUP,HCPCS C1789,,350-2001 BC  -  IMPL BRST 200ML GEL SMTH SIL P3.2CM MODEARTE PRFL RND 10.5CM,"$2,187.50",$0.00,"$2,187.50",$984.38,"$1,561.22",$0.00,$376.90,$0.00,$0.00,$383.01,"$2,187.50",$0.00,"$1,093.75","$1,732.50","$1,750.00",$0.00,$342.34,$0.00,$348.25,$0.00
350-2500,SUP,HCPCS C1789,,350-2500  -  IMPL BRST 500-600ML STY 2000 SMTH RND SAL P5.9CM MDRT PLUS,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
350-2501BC,SUP,HCPCS C1789,,350-2501BC  -  IMPLANT BRST P3.4CM MDRT + HI PRFL RND 11.3CM 250ML STRL,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
350-3001BC,SUP,HCPCS C1789,,350-3001BC  -  IMPLANT BRST P3.6CM RND MDRT + PRFL 12CM 300ML STRL,"$2,187.50",$0.00,"$2,187.50",$984.38,"$1,561.22",$0.00,$376.90,$0.00,$0.00,$383.01,"$2,187.50",$0.00,"$1,093.75","$1,732.50","$1,750.00",$0.00,$342.34,$0.00,$348.25,$0.00
350-3004BC,SUP,HCPCS C1789,,350-3004BC  -  IMPLANT BRST P4.5CM HI PRFL RND NAR BS 11.1CM 300CC,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
350-3501 BC,SUP,HCPCS C1789,,350-3501 BC  -  IMPL BRST 350ML GEL SMTH SIL P3.9CM MDRT PLUS PRFL RND 12.5,"$2,187.50",$0.00,"$2,187.50",$984.38,"$1,561.22",$0.00,$376.90,$0.00,$0.00,$383.01,"$2,187.50",$0.00,"$1,093.75","$1,732.50","$1,750.00",$0.00,$342.34,$0.00,$348.25,$0.00
350-3504BC,SUP,HCPCS C1789,,350-3504BC  -  IMPL BRST 350ML GEL SMTH MEMORYGEL SIL P4.8CM HI PRFL RND,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
350-4001 BC,SUP,HCPCS C1789,,350-4001 BC  -  IMPLANT BRST P4CM MDRT + PRFL RND 13.1CM 400CC MEMORYGEL,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
350-4004 BC,SUP,HCPCS C1789,,350-4004 BC  -  IMPLANT BRST P5CM HI PRFL RND NAR BS 12.2CM 400CC MEMORYGEL,"$2,325.00",$0.00,"$2,325.00","$1,046.25","$1,659.35",$0.00,$400.59,$0.00,$0.00,$407.09,"$2,325.00",$0.00,"$1,162.50","$1,841.40","$1,860.00",$0.00,$363.86,$0.00,$370.14,$0.00
350-4501BC,SUP,HCPCS C1789,,350-4501BC  -  IMPLANT BRST P4.2CM MDRT + PRFL 13.6CM 450ML CHSV I GEL RND,"$2,187.50",$0.00,"$2,187.50",$984.38,"$1,561.22",$0.00,$376.90,$0.00,$0.00,$383.01,"$2,187.50",$0.00,"$1,093.75","$1,732.50","$1,750.00",$0.00,$342.34,$0.00,$348.25,$0.00
350-4504BC,SUP,HCPCS C1789,,350-4504BC  -  IMPLANT BRST P5.1CM RND 12.8CM 450ML STRL MEMORYGEL SMTH HI,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
350-5001 BC,SUP,HCPCS C1789,,350-5001 BC  -  IMPLANT BREAST P4.3CM MODERATE PLUS PROFILE ROUND MODERATE,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
350-5004BC,SUP,HCPCS C1789,,350-5004BC  -  IMPL BRST 500ML GEL SMTH MEMORYGEL SIL P5.3CM HI PRFL RND,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
350-5501 BC,SUP,HCPCS C1789,,350-5501 BC  -  IMPL BRST 550ML GEL SMTH SIL P4.5CM MDRT PRFL RND 14.6CM,"$2,187.50",$0.00,"$2,187.50",$984.38,"$1,561.22",$0.00,$376.90,$0.00,$0.00,$383.01,"$2,187.50",$0.00,"$1,093.75","$1,732.50","$1,750.00",$0.00,$342.34,$0.00,$348.25,$0.00
350-5504 BC,SUP,HCPCS C1789,,350-5504 BC  -  IMPL BRST 550ML GEL SMTH MEMORYGEL SIL P5.5CM HI PRFL RND,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
350-800 1BC,SUP,HCPCS C1789,,350-800 1BC  -  IMPLANT BRST P5.1CM MDRT + PRFL RND 16.5CM 800ML STRL CHSV I,"$2,262.50",$0.00,"$2,262.50","$1,018.13","$1,614.75",$0.00,$389.82,$0.00,$0.00,$396.15,"$2,262.50",$0.00,"$1,131.25","$1,791.90","$1,810.00",$0.00,$354.08,$0.00,$360.19,$0.00
351 337,SUP,HCPCS C1895,,351 337  -  LINOX TD STEROID 65/16 CM,"$11,250.00",$0.00,"$11,250.00","$5,062.50","$5,158.80",$0.00,"$1,938.32",$0.00,$0.00,"$1,969.79","$11,250.00",$0.00,"$5,625.00","$8,910.00","$9,000.00",$0.00,"$1,760.63",$0.00,"$1,791.00",$0.00
351.16J,SUP,Custom 27203010,,351.16J  -  CHUCK DRILL CONCTR CANN QUICK COUPLING JACOBS,$766.20,$0.00,$766.20,$0.00,$546.84,$0.00,$0.00,$0.00,$0.00,$0.00,$766.20,$0.00,$383.10,$606.83,$612.96,$0.00,$0.00,$0.00,$0.00,$0.00
351.27S,SUP,Custom 27203010,,351.27S  -  BIT DRL 13MM 300MM STRL CNN,"$1,176.90",$0.00,"$1,176.90",$0.00,$839.95,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,176.90",$0.00,$588.45,$932.10,$941.52,$0.00,$0.00,$0.00,$0.00,$0.00
351.704S,SUP,Custom 27203010,,351.704S  -  ROD REAMER 2.5MM 1150MM BALL TIP EXTN STERILE,$234.73,$0.00,$234.73,$0.00,$167.52,$0.00,$0.00,$0.00,$0.00,$0.00,$234.73,$0.00,$117.36,$185.91,$187.78,$0.00,$0.00,$0.00,$0.00,$0.00
351.706S,SUP,Custom 27203010,,351.706S  -  ROD REAMING 2.5MM 950MM BALL TIP GWIRE STERILE DISPOSABLE,$216.68,$0.00,$216.68,$0.00,$154.64,$0.00,$0.00,$0.00,$0.00,$0.00,$216.68,$0.00,$108.34,$171.61,$173.34,$0.00,$0.00,$0.00,$0.00,$0.00
351.707S,SUP,Custom 27203010,,351.707S  -  ROD REAMING 2.5MM 950MM BALL TIP EXTN STERILE DISPOSABLE,$216.68,$0.00,$216.68,$0.00,$154.64,$0.00,$0.00,$0.00,$0.00,$0.00,$216.68,$0.00,$108.34,$171.61,$173.34,$0.00,$0.00,$0.00,$0.00,$0.00
351.708S,SUP,Custom 27203010,,351.708S  -  ROD REAMING BALL 2.5MM 1150MM STERILE INTRAMEDULLARY NAIL,$262.00,$0.00,$262.00,$0.00,$186.99,$0.00,$0.00,$0.00,$0.00,$0.00,$262.00,$0.00,$131.00,$207.50,$209.60,$0.00,$0.00,$0.00,$0.00,$0.00
351.709S,SUP,Custom 27203010,,351.709S  -  ROD REAMER 2.5MM 650MM BALL TIP STERILE,$230.85,$0.00,$230.85,$0.00,$164.76,$0.00,$0.00,$0.00,$0.00,$0.00,$230.85,$0.00,$115.43,$182.83,$184.68,$0.00,$0.00,$0.00,$0.00,$0.00
351.718S,SUP,Custom 27203010,,351.718S  -  SEAL DRIVE SHAFT ELASTOMERIC STERILE DISPOSABLE RIA,$19.76,$0.00,$19.76,$0.00,$14.10,$0.00,$0.00,$0.00,$0.00,$0.00,$19.76,$0.00,$9.88,$15.65,$15.81,$0.00,$0.00,$0.00,$0.00,$0.00
3515-9-100,SUP,HCPCS C1713,,3515-9-100  -  NAIL ORTH IM,$213.13,$0.00,$213.13,$95.91,$152.11,$0.00,$36.72,$0.00,$0.00,$37.32,$213.13,$0.00,$106.56,$168.80,$170.50,$0.00,$33.35,$0.00,$33.93,$0.00
352.229S,SUP,Custom 27203010,,352.229S  -  FILTER GRAFT PLUNGER GRADUATED 100ML STERILE DISPOSABLE RIA,$599.08,$0.00,$599.08,$0.00,$427.56,$0.00,$0.00,$0.00,$0.00,$0.00,$599.08,$0.00,$299.54,$474.47,$479.26,$0.00,$0.00,$0.00,$0.00,$0.00
352.250S,SUP,Custom 27203010,,352.250S  -  REAMER SURG 12MM HEAD STERILE DISPOSABLE RIA,$664.23,$0.00,$664.23,$0.00,$474.06,$0.00,$0.00,$0.00,$0.00,$0.00,$664.23,$0.00,$332.11,$526.07,$531.38,$0.00,$0.00,$0.00,$0.00,$0.00
352.251S,SUP,Custom 27203010,,352.251S  -  REAMER SURG 12.5MM HEAD STERILE DISPOSABLE RIA,$664.23,$0.00,$664.23,$0.00,$474.06,$0.00,$0.00,$0.00,$0.00,$0.00,$664.23,$0.00,$332.11,$526.07,$531.38,$0.00,$0.00,$0.00,$0.00,$0.00
352.252S,SUP,Custom 27203010,,352.252S  -  HEAD RMR DP FLUT 13MM STRL CNCL TIP SHRP EDG SS DISP IRR ASP,$664.23,$0.00,$664.23,$0.00,$474.06,$0.00,$0.00,$0.00,$0.00,$0.00,$664.23,$0.00,$332.11,$526.07,$531.38,$0.00,$0.00,$0.00,$0.00,$0.00
352.253S,SUP,Custom 27203010,,352.253S  -  REAMER SURG 13.5MM HEAD STERILE DISPOSABLE RIA,$664.23,$0.00,$664.23,$0.00,$474.06,$0.00,$0.00,$0.00,$0.00,$0.00,$664.23,$0.00,$332.11,$526.07,$531.38,$0.00,$0.00,$0.00,$0.00,$0.00
352.254S,SUP,Custom 27203010,,352.254S  -  REAMER SURG 14MM HEAD STERILE DISPOSABLE RIA,$664.23,$0.00,$664.23,$0.00,$474.06,$0.00,$0.00,$0.00,$0.00,$0.00,$664.23,$0.00,$332.11,$526.07,$531.38,$0.00,$0.00,$0.00,$0.00,$0.00
352.255S,SUP,Custom 27203010,,352.255S  -  REAMER SURG 14.5MM CONICAL TIP DEEP FLUTE SHARP EDGE,$664.23,$0.00,$664.23,$0.00,$474.06,$0.00,$0.00,$0.00,$0.00,$0.00,$664.23,$0.00,$332.11,$526.07,$531.38,$0.00,$0.00,$0.00,$0.00,$0.00
352.256S,SUP,Custom 27203010,,352.256S  -  HEAD RMR DP FLUT 15MM STRL CNCL TIP SHRP EDG SS DISP IRR ASP,$664.23,$0.00,$664.23,$0.00,$474.06,$0.00,$0.00,$0.00,$0.00,$0.00,$664.23,$0.00,$332.11,$526.07,$531.38,$0.00,$0.00,$0.00,$0.00,$0.00
352.257S,SUP,HCPCS C1713,,352.257S  -  HEAD REAMER 15.5MM STERILE IRRIGATOR ASPIRAT,$664.23,$0.00,$664.23,$298.90,$474.06,$0.00,$111.11,$0.00,$0.00,$116.30,$664.23,$0.00,$332.11,$526.07,$531.38,$0.00,$100.92,$0.00,$105.74,$0.00
352.258S,SUP,Custom 27203010,,352.258S  -  REAMER SURG 16MM HEAD STERILE DISPOSABLE RIA,$664.23,$0.00,$664.23,$0.00,$474.06,$0.00,$0.00,$0.00,$0.00,$0.00,$664.23,$0.00,$332.11,$526.07,$531.38,$0.00,$0.00,$0.00,$0.00,$0.00
352.259S,SUP,Custom 27203010,,352.259S  -  REAMER SURG 16.5MM HEAD STERILE DISPOSABLE RIA,$664.23,$0.00,$664.23,$0.00,$474.06,$0.00,$0.00,$0.00,$0.00,$0.00,$664.23,$0.00,$332.11,$526.07,$531.38,$0.00,$0.00,$0.00,$0.00,$0.00
352.260S,SUP,Custom 27203010,,352.260S  -  CLIP LOCKING SECURE ATTCH DRIVE SHAFT TUBE ASMBLY STERILE,$133.13,$0.00,$133.13,$0.00,$95.01,$0.00,$0.00,$0.00,$0.00,$0.00,$133.13,$0.00,$66.56,$105.44,$106.50,$0.00,$0.00,$0.00,$0.00,$0.00
3520-0240S,SUP,HCPCS C1713,,3520-0240S  -  NAIL IM 120D 10MM 240MM STRL GAMMA3 LT,"$3,698.75",$0.00,"$3,698.75","$1,664.44","$2,639.80",$0.00,$637.28,$0.00,$0.00,$647.62,"$3,698.75",$0.00,"$1,849.38","$2,929.41","$2,959.00",$0.00,$578.85,$0.00,$588.84,$0.00
3520-0260S,SUP,HCPCS C1713,,3520-0260S  -  NAIL 10MM 260MM LEFT FEM HIP GAMMA3 IM 120D TI STRL R1.5,"$4,296.88",$0.00,"$4,296.88","$1,933.59","$3,066.68",$0.00,$740.33,$0.00,$0.00,$752.35,"$4,296.88",$0.00,"$2,148.44","$3,403.13","$3,437.50",$0.00,$672.46,$0.00,$684.06,$0.00
3520-0280S,SUP,HCPCS C1713,,3520-0280S  -  NAIL 10MM 280MM LEFT FEM HIP GAMMA3 IM 120D TI STRL R1.5,"$3,698.75",$0.00,"$3,698.75","$1,664.44","$2,639.80",$0.00,$637.28,$0.00,$0.00,$647.62,"$3,698.75",$0.00,"$1,849.38","$2,929.41","$2,959.00",$0.00,$578.85,$0.00,$588.84,$0.00
3520-0300S,SUP,HCPCS C1713,,3520-0300S  -  NAIL 10MM 300MM LEFT FEM HIP GAMMA3 IM 120D TI STRL R1.5,"$3,698.75",$0.00,"$3,698.75","$1,664.44","$2,639.80",$0.00,$637.28,$0.00,$0.00,$647.62,"$3,698.75",$0.00,"$1,849.38","$2,929.41","$2,959.00",$0.00,$578.85,$0.00,$588.84,$0.00
3520-0320S,SUP,HCPCS C1713,,3520-0320S  -  NAIL 10MM 320MM LEFT FEM HIP GAMMA3 IM 120D TI STRL R1.5,"$3,698.75",$0.00,"$3,698.75","$1,664.44","$2,639.80",$0.00,$637.28,$0.00,$0.00,$647.62,"$3,698.75",$0.00,"$1,849.38","$2,929.41","$2,959.00",$0.00,$578.85,$0.00,$588.84,$0.00
3520-0340S,SUP,HCPCS C1713,,3520-0340S  -  NAIL 10MM 340MM LEFT FEM HIP GAMMA3 IM 120D TI STRL R1.5,"$3,698.75",$0.00,"$3,698.75","$1,664.44","$2,639.80",$0.00,$637.28,$0.00,$0.00,$647.62,"$3,698.75",$0.00,"$1,849.38","$2,929.41","$2,959.00",$0.00,$578.85,$0.00,$588.84,$0.00
3520-0360S,SUP,HCPCS C1713,,3520-0360S  -  NAIL 10MM 360MM LEFT FEM HIP GAMMA3 IM 120D TI STRL R1.5,"$3,698.75",$0.00,"$3,698.75","$1,664.44","$2,639.80",$0.00,$637.28,$0.00,$0.00,$647.62,"$3,698.75",$0.00,"$1,849.38","$2,929.41","$2,959.00",$0.00,$578.85,$0.00,$588.84,$0.00
3520-0380S,SUP,HCPCS C1713,,3520-0380S  -  NAIL 10MM 380MM LEFT FEM HIP GAMMA3 IM 120D TI STRL R1.5,"$3,698.75",$0.00,"$3,698.75","$1,664.44","$2,639.80",$0.00,$637.28,$0.00,$0.00,$647.62,"$3,698.75",$0.00,"$1,849.38","$2,929.41","$2,959.00",$0.00,$578.85,$0.00,$588.84,$0.00
3520-0400S,SUP,HCPCS C1713,,3520-0400S  -  NAIL 10MM 400MM LEFT FEM HIP GAMMA3 IM 120D TI STRL R1.5,"$3,698.75",$0.00,"$3,698.75","$1,664.44","$2,639.80",$0.00,$637.28,$0.00,$0.00,$647.62,"$3,698.75",$0.00,"$1,849.38","$2,929.41","$2,959.00",$0.00,$578.85,$0.00,$588.84,$0.00
3520-0420S,SUP,HCPCS C1713,,3520-0420S  -  NAIL IM 120D 10MM 420MM STRL GAMMA3 LT,"$3,698.75",$0.00,"$3,698.75","$1,664.44","$2,639.80",$0.00,$637.28,$0.00,$0.00,$647.62,"$3,698.75",$0.00,"$1,849.38","$2,929.41","$2,959.00",$0.00,$578.85,$0.00,$588.84,$0.00
3520-0440S,SUP,HCPCS C1713,,3520-0440S  -  NAIL IM 120D 10MM 440MM STRL GAMMA3 LT,"$3,698.75",$0.00,"$3,698.75","$1,664.44","$2,639.80",$0.00,$637.28,$0.00,$0.00,$647.62,"$3,698.75",$0.00,"$1,849.38","$2,929.41","$2,959.00",$0.00,$578.85,$0.00,$588.84,$0.00
3520-0460S,SUP,HCPCS C1713,,3520-0460S  -  NAIL IM 120D 10MM 460MM STRL GAMMA3 LT,"$3,698.75",$0.00,"$3,698.75","$1,664.44","$2,639.80",$0.00,$637.28,$0.00,$0.00,$647.62,"$3,698.75",$0.00,"$1,849.38","$2,929.41","$2,959.00",$0.00,$578.85,$0.00,$588.84,$0.00
3520-9-180,SUP,HCPCS C1713,,3520-9-180  -  NAIL 9MM 180MM HUM L/R IM RECON SDL SYS,"$2,942.50",$0.00,"$2,942.50","$1,324.13","$2,100.06",$0.00,$506.98,$0.00,$0.00,$515.21,"$2,942.50",$0.00,"$1,471.25","$2,330.46","$2,354.00",$0.00,$460.50,$0.00,$468.45,$0.00
3520-9-200,SUP,HCPCS C1713,,3520-9-200  -  NAIL 16MM 48CM HUM IM HUM R/L RECON GRS-K SYS,"$2,942.50",$0.00,"$2,942.50","$1,324.13","$2,100.06",$0.00,$506.98,$0.00,$0.00,$515.21,"$2,942.50",$0.00,"$1,471.25","$2,330.46","$2,354.00",$0.00,$460.50,$0.00,$468.45,$0.00
3520-9-220,SUP,HCPCS C1713,,3520-9-220  -  NAIL 9MM 220CM IM RECON,"$2,942.50",$0.00,"$2,942.50","$1,324.13","$2,100.06",$0.00,$506.98,$0.00,$0.00,$515.21,"$2,942.50",$0.00,"$1,471.25","$2,330.46","$2,354.00",$0.00,$460.50,$0.00,$468.45,$0.00
3520-9-240,SUP,HCPCS C1713,,3520-9-240  -  NAIL 9MM 240MM L/R HUM IM RECON SDL SYS STR,"$2,942.50",$0.00,"$2,942.50","$1,324.13","$2,100.06",$0.00,$506.98,$0.00,$0.00,$515.21,"$2,942.50",$0.00,"$1,471.25","$2,330.46","$2,354.00",$0.00,$460.50,$0.00,$468.45,$0.00
3520-9-250,SUP,HCPCS C1713,,3520-9-250  -  NAIL HUM 250MM 9MM LCK,"$2,942.50",$0.00,"$2,942.50","$1,324.13","$2,100.06",$0.00,$506.98,$0.00,$0.00,$515.21,"$2,942.50",$0.00,"$1,471.25","$2,330.46","$2,354.00",$0.00,$460.50,$0.00,$468.45,$0.00
3520-9-260,SUP,HCPCS C1713,,3520-9-260  -  NAIL 9MM 260CM HUM IM R/L RECON,"$2,942.50",$0.00,"$2,942.50","$1,324.13","$2,100.06",$0.00,$506.98,$0.00,$0.00,$515.21,"$2,942.50",$0.00,"$1,471.25","$2,330.46","$2,354.00",$0.00,$460.50,$0.00,$468.45,$0.00
3520-9-270,SUP,HCPCS C1713,,3520-9-270  -  NAIL 9MM 270MM LEFT HUM IM RIGHT RECON SDL SYS,"$2,942.50",$0.00,"$2,942.50","$1,324.13","$2,100.06",$0.00,$506.98,$0.00,$0.00,$515.21,"$2,942.50",$0.00,"$1,471.25","$2,330.46","$2,354.00",$0.00,$460.50,$0.00,$468.45,$0.00
3520-9-280,SUP,HCPCS C1713,,3520-9-280  -  NAIL 9MM 280MM HUM LEFT IM RIGHT RECON SDL SYS,"$2,942.50",$0.00,"$2,942.50","$1,324.13","$2,100.06",$0.00,$506.98,$0.00,$0.00,$515.21,"$2,942.50",$0.00,"$1,471.25","$2,330.46","$2,354.00",$0.00,$460.50,$0.00,$468.45,$0.00
3520-9-300,SUP,HCPCS C1713,,3520-9-300  -  NAIL 9MM 300MM HUM IM RECON STRL,"$2,942.50",$0.00,"$2,942.50","$1,324.13","$2,100.06",$0.00,$506.98,$0.00,$0.00,$515.21,"$2,942.50",$0.00,"$1,471.25","$2,330.46","$2,354.00",$0.00,$460.50,$0.00,$468.45,$0.00
3520-9-945,SUP,HCPCS C1713,,3520-9-945  -  NAIL 5MM 45CM HUM IM LCK SPRD SCR,$818.13,$0.00,$818.13,$368.16,$583.90,$0.00,$140.96,$0.00,$0.00,$143.25,$818.13,$0.00,$409.06,$647.96,$654.50,$0.00,$128.04,$0.00,$130.25,$0.00
3525-0260S,SUP,HCPCS C1713,,3525-0260S  -  NAIL 10MM 26CM LEFT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL,"$3,698.75",$0.00,"$3,698.75","$1,664.44","$2,639.80",$0.00,$637.28,$0.00,$0.00,$647.62,"$3,698.75",$0.00,"$1,849.38","$2,929.41","$2,959.00",$0.00,$578.85,$0.00,$588.84,$0.00
3525-0280S,SUP,HCPCS C1713,,3525-0280S  -  NAIL 10MM 28CM LEFT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL,"$3,698.75",$0.00,"$3,698.75","$1,664.44","$2,639.80",$0.00,$637.28,$0.00,$0.00,$647.62,"$3,698.75",$0.00,"$1,849.38","$2,929.41","$2,959.00",$0.00,$578.85,$0.00,$588.84,$0.00
3525-0300S,SUP,HCPCS C1713,,3525-0300S  -  NAIL 10MM 30CM LEFT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL,"$3,698.75",$0.00,"$3,698.75","$1,664.44","$2,639.80",$0.00,$637.28,$0.00,$0.00,$647.62,"$3,698.75",$0.00,"$1,849.38","$2,929.41","$2,959.00",$0.00,$578.85,$0.00,$588.84,$0.00
3525-0320S,SUP,HCPCS C1713,,3525-0320S  -  NAIL 10MM 32CM LEFT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL,"$3,698.75",$0.00,"$3,698.75","$1,664.44","$2,639.80",$0.00,$637.28,$0.00,$0.00,$647.62,"$3,698.75",$0.00,"$1,849.38","$2,929.41","$2,959.00",$0.00,$578.85,$0.00,$588.84,$0.00
3525-0340S,SUP,HCPCS C1713,,3525-0340S  -  NAIL 10MM 34CM LEFT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL,"$3,698.75",$0.00,"$3,698.75","$1,664.44","$2,639.80",$0.00,$637.28,$0.00,$0.00,$647.62,"$3,698.75",$0.00,"$1,849.38","$2,929.41","$2,959.00",$0.00,$578.85,$0.00,$588.84,$0.00
3525-0360S,SUP,HCPCS C1713,,3525-0360S  -  NAIL 10MM 36CM LEFT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL,"$3,698.75",$0.00,"$3,698.75","$1,664.44","$2,639.80",$0.00,$637.28,$0.00,$0.00,$647.62,"$3,698.75",$0.00,"$1,849.38","$2,929.41","$2,959.00",$0.00,$578.85,$0.00,$588.84,$0.00
3525-0380S,SUP,HCPCS C1713,,3525-0380S  -  NAIL 10MM 38CM LEFT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL,"$3,698.75",$0.00,"$3,698.75","$1,664.44","$2,639.80",$0.00,$637.28,$0.00,$0.00,$647.62,"$3,698.75",$0.00,"$1,849.38","$2,929.41","$2,959.00",$0.00,$578.85,$0.00,$588.84,$0.00
3525-0400S,SUP,HCPCS C1713,,3525-0400S  -  NAIL 10MM 40CM LEFT FEM HIP GAMMA3 IM 125D LNG LCK TI STRL,"$3,698.75",$0.00,"$3,698.75","$1,664.44","$2,639.80",$0.00,$637.28,$0.00,$0.00,$647.62,"$3,698.75",$0.00,"$1,849.38","$2,929.41","$2,959.00",$0.00,$578.85,$0.00,$588.84,$0.00
3525-0420S,SUP,HCPCS C1713,,3525-0420S  -  GAMMA 3 S NAIL LEFT 10X420MM X 125,"$3,698.75",$0.00,"$3,698.75","$1,664.44","$2,639.80",$0.00,$637.28,$0.00,$0.00,$647.62,"$3,698.75",$0.00,"$1,849.38","$2,929.41","$2,959.00",$0.00,$578.85,$0.00,$588.84,$0.00
3525-0440S,SUP,HCPCS C1713,,3525-0440S  -  GAMMA 3 S NAIL LEFT 10X440MM X 125,"$3,698.75",$0.00,"$3,698.75","$1,664.44","$2,639.80",$0.00,$637.28,$0.00,$0.00,$647.62,"$3,698.75",$0.00,"$1,849.38","$2,929.41","$2,959.00",$0.00,$578.85,$0.00,$588.84,$0.00
3525-0460S,SUP,HCPCS C1713,,3525-0460S  -  NAIL IM 125D 10MM 460MM STRL GAMMA3 LT,"$3,698.75",$0.00,"$3,698.75","$1,664.44","$2,639.80",$0.00,$637.28,$0.00,$0.00,$647.62,"$3,698.75",$0.00,"$1,849.38","$2,929.41","$2,959.00",$0.00,$578.85,$0.00,$588.84,$0.00
352506070E,SUP,HCPCS C1880,,352506070E  -  SYSTEM EMBOLIC PROTECTION 6.5FR 0-32MM 5FR 70CM FILTER KIT,"$1,812.50",$0.00,"$1,812.50",$815.63,"$1,293.58",$0.00,$312.28,$0.00,$0.00,$317.35,"$1,812.50",$0.00,$906.25,"$1,435.50","$1,450.00",$0.00,$283.66,$0.00,$288.55,$0.00
352506100E,SUP,HCPCS C1880,,352506100E  -  FILTER EMBL 30- MM 5FR 100CM STRL LF OPTIONELITE INTRO SHTH,"$2,062.50",$0.00,"$2,062.50",$928.13,"$1,472.01",$0.00,$355.36,$0.00,$0.00,$361.13,"$2,062.50",$0.00,"$1,031.25","$1,633.50","$1,650.00",$0.00,$322.78,$0.00,$328.35,$0.00
3530-0260S,SUP,HCPCS C1713,,3530-0260S  -  NAIL 10MM 26CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL,"$3,698.75",$0.00,"$3,698.75","$1,664.44","$2,639.80",$0.00,$637.28,$0.00,$0.00,$647.62,"$3,698.75",$0.00,"$1,849.38","$2,929.41","$2,959.00",$0.00,$578.85,$0.00,$588.84,$0.00
3530-0280S,SUP,HCPCS C1713,,3530-0280S  -  NAIL 10MM 28CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL,"$3,698.75",$0.00,"$3,698.75","$1,664.44","$2,639.80",$0.00,$637.28,$0.00,$0.00,$647.62,"$3,698.75",$0.00,"$1,849.38","$2,929.41","$2,959.00",$0.00,$578.85,$0.00,$588.84,$0.00
3530-0300S,SUP,HCPCS C1713,,3530-0300S  -  NAIL 10MM 30CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL,"$3,698.75",$0.00,"$3,698.75","$1,664.44","$2,639.80",$0.00,$637.28,$0.00,$0.00,$647.62,"$3,698.75",$0.00,"$1,849.38","$2,929.41","$2,959.00",$0.00,$578.85,$0.00,$588.84,$0.00
3530-0320S,SUP,HCPCS C1713,,3530-0320S  -  NAIL 10MM 32CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL,"$3,698.75",$0.00,"$3,698.75","$1,664.44","$2,639.80",$0.00,$637.28,$0.00,$0.00,$647.62,"$3,698.75",$0.00,"$1,849.38","$2,929.41","$2,959.00",$0.00,$578.85,$0.00,$588.84,$0.00
3530-0340S,SUP,HCPCS C1713,,3530-0340S  -  NAIL 10MM 34CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL,"$3,698.75",$0.00,"$3,698.75","$1,664.44","$2,639.80",$0.00,$637.28,$0.00,$0.00,$647.62,"$3,698.75",$0.00,"$1,849.38","$2,929.41","$2,959.00",$0.00,$578.85,$0.00,$588.84,$0.00
3530-0360S,SUP,HCPCS C1713,,3530-0360S  -  NAIL 10MM 36CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL,"$3,698.75",$0.00,"$3,698.75","$1,664.44","$2,639.80",$0.00,$637.28,$0.00,$0.00,$647.62,"$3,698.75",$0.00,"$1,849.38","$2,929.41","$2,959.00",$0.00,$578.85,$0.00,$588.84,$0.00
3530-0380S,SUP,HCPCS C1713,,3530-0380S  -  NAIL 10MM 38CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL,"$3,698.75",$0.00,"$3,698.75","$1,664.44","$2,639.80",$0.00,$637.28,$0.00,$0.00,$647.62,"$3,698.75",$0.00,"$1,849.38","$2,929.41","$2,959.00",$0.00,$578.85,$0.00,$588.84,$0.00
3530-0400S,SUP,HCPCS C1713,,3530-0400S  -  NAIL 10MM 40CM LEFT FEM HIP GAMMA3 IM 130D LNG LCK TI STRL,"$3,698.75",$0.00,"$3,698.75","$1,664.44","$2,639.80",$0.00,$637.28,$0.00,$0.00,$647.62,"$3,698.75",$0.00,"$1,849.38","$2,929.41","$2,959.00",$0.00,$578.85,$0.00,$588.84,$0.00
3530-0420S,SUP,HCPCS C1713,,3530-0420S  -  GAMMA 3 S NAIL LEFT 10X420MM X 130,"$3,698.75",$0.00,"$3,698.75","$1,664.44","$2,639.80",$0.00,$637.28,$0.00,$0.00,$647.62,"$3,698.75",$0.00,"$1,849.38","$2,929.41","$2,959.00",$0.00,$578.85,$0.00,$588.84,$0.00
3530-0440S,SUP,HCPCS C1713,,3530-0440S  -  GAMMA 3 S NAIL LEFT 10X440MM X 130,"$3,698.75",$0.00,"$3,698.75","$1,664.44","$2,639.80",$0.00,$637.28,$0.00,$0.00,$647.62,"$3,698.75",$0.00,"$1,849.38","$2,929.41","$2,959.00",$0.00,$578.85,$0.00,$588.84,$0.00
3530-0460S,SUP,HCPCS C1713,,3530-0460S  -  NAIL IM 130D 10MM 460MM STRL GAMMA3 LT,"$3,698.75",$0.00,"$3,698.75","$1,664.44","$2,639.80",$0.00,$637.28,$0.00,$0.00,$647.62,"$3,698.75",$0.00,"$1,849.38","$2,929.41","$2,959.00",$0.00,$578.85,$0.00,$588.84,$0.00
354 805,SUP,HCPCS C1900,,354 805  -  COROX OTW 75 BP LEAD,"$5,000.00",$0.00,"$5,000.00",$0.00,"$3,568.50",$0.00,$861.48,$0.00,$0.00,$0.00,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$782.50,$0.00,$0.00,$0.00
354 807,SUP,HCPCS C1900,,354 807  -  COROX OTW 85 BP LEAD,"$5,000.00",$0.00,"$5,000.00",$0.00,"$3,568.50",$0.00,$861.48,$0.00,$0.00,$0.00,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$782.50,$0.00,$0.00,$0.00
354-7212,SUP,HCPCS C1789,,354-7212  -  EXPANDER TISS P6.6CM CNTR PRFL 11.7X10CM 350ML SLTX CPX3 STY,"$3,412.50",$0.00,"$3,412.50","$1,535.63","$2,435.50",$0.00,$587.96,$0.00,$0.00,$597.50,"$3,412.50",$0.00,"$1,706.25","$2,702.70","$2,730.00",$0.00,$534.06,$0.00,$543.27,$0.00
354-7213,SUP,HCPCS C1789,,354-7213  -  EXPANDER TISS P7CM MED HT 12.7X10.8CM 450CC STRL SLTX CNTR,"$3,312.50",$0.00,"$3,312.50","$1,490.63","$2,364.13",$0.00,$570.73,$0.00,$0.00,$579.99,"$3,312.50",$0.00,"$1,656.25","$2,623.50","$2,650.00",$0.00,$518.41,$0.00,$527.35,$0.00
354-7214,SUP,HCPCS C1789,,354-7214  -  EXPANDER TISS P7.4CM CNTR PRFL 13.5X11.7CM 550ML SLTX CPX3,"$3,412.50",$0.00,"$3,412.50","$1,535.63","$2,435.50",$0.00,$587.96,$0.00,$0.00,$597.50,"$3,412.50",$0.00,"$1,706.25","$2,702.70","$2,730.00",$0.00,$534.06,$0.00,$543.27,$0.00
354-7215,SUP,HCPCS C1789,,354-7215  -  EXPANDER TISS P7.6CM CNTR PRFL 14.6X12.6CM 650ML SLTX CPX3,"$3,412.50",$0.00,"$3,412.50","$1,535.63","$2,435.50",$0.00,$587.96,$0.00,$0.00,$597.50,"$3,412.50",$0.00,"$1,706.25","$2,702.70","$2,730.00",$0.00,$534.06,$0.00,$543.27,$0.00
354-9212,SUP,HCPCS C1789,,354-9212  -  EXPANDER TISS P6.6CM CNTR PRFL MED HT 11.7X10CM 350ML CPX4,"$2,937.50",$0.00,"$2,937.50","$1,321.88","$2,096.49",$0.00,$506.12,$0.00,$0.00,$514.33,"$2,937.50",$0.00,"$1,468.75","$2,326.50","$2,350.00",$0.00,$459.72,$0.00,$467.65,$0.00
355 148,SUP,HCPCS C1900,,355 148  -  COROX OTW 75 BP-S LEAD,"$5,000.00",$0.00,"$5,000.00",$0.00,"$3,568.50",$0.00,$861.48,$0.00,$0.00,$0.00,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$782.50,$0.00,$0.00,$0.00
355.399S,SUP,Custom 27203010,,355.399S  -  HOOK EXTRACTION 650MM STERILE CANN INTRAMEDULLARY NAIL,$631.65,$0.00,$631.65,$0.00,$450.81,$0.00,$0.00,$0.00,$0.00,$0.00,$631.65,$0.00,$315.83,$500.27,$505.32,$0.00,$0.00,$0.00,$0.00,$0.00
3550-0-035,SUP,HCPCS C1713,,3550-0-035  -  SCREW BONE 6.5MM 35MM ASNS 2 CORT GD,$365.75,$0.00,$365.75,$164.59,$261.04,$0.00,$63.02,$0.00,$0.00,$64.04,$365.75,$0.00,$182.88,$289.67,$292.60,$0.00,$57.24,$0.00,$58.23,$0.00
3550-0-040,SUP,HCPCS C1713,,3550-0-040  -  SCREW BONE 6.5MM 40MM ASNS 2 CORT GD,$365.75,$0.00,$365.75,$164.59,$261.04,$0.00,$63.02,$0.00,$0.00,$64.04,$365.75,$0.00,$182.88,$289.67,$292.60,$0.00,$57.24,$0.00,$58.23,$0.00
3550-0-045,SUP,HCPCS C1713,,3550-0-045  -  SCREW BONE 6.5MM 45MM ASNS 2 CORT GD,$365.75,$0.00,$365.75,$164.59,$261.04,$0.00,$63.02,$0.00,$0.00,$64.04,$365.75,$0.00,$182.88,$289.67,$292.60,$0.00,$57.24,$0.00,$58.23,$0.00
3550-0-050,SUP,HCPCS C1713,,3550-0-050  -  SCREW BONE 6.5MM 50MM ASNS 2 CORT GD,$365.75,$0.00,$365.75,$164.59,$261.04,$0.00,$63.02,$0.00,$0.00,$64.04,$365.75,$0.00,$182.88,$289.67,$292.60,$0.00,$57.24,$0.00,$58.23,$0.00
3550-0-055,SUP,HCPCS C1713,,3550-0-055  -  SCREW BONE 6.5MM 55MM ASNS 2 CORT GD,$365.75,$0.00,$365.75,$164.59,$261.04,$0.00,$63.02,$0.00,$0.00,$64.04,$365.75,$0.00,$182.88,$289.67,$292.60,$0.00,$57.24,$0.00,$58.23,$0.00
3550-0-060,SUP,HCPCS C1713,,3550-0-060  -  SCREW BONE 6.5MM 60MM ASNS 2 CORT GD,$365.75,$0.00,$365.75,$164.59,$261.04,$0.00,$63.02,$0.00,$0.00,$64.04,$365.75,$0.00,$182.88,$289.67,$292.60,$0.00,$57.24,$0.00,$58.23,$0.00
3550-0-065,SUP,HCPCS C1713,,3550-0-065  -  SCREW BONE 6.5MM 65MM ASNS 2 CORT GD,$365.75,$0.00,$365.75,$164.59,$261.04,$0.00,$63.02,$0.00,$0.00,$64.04,$365.75,$0.00,$182.88,$289.67,$292.60,$0.00,$57.24,$0.00,$58.23,$0.00
3550-0-070,SUP,HCPCS C1713,,3550-0-070  -  SCREW BONE 6.5MM 70MM ASNS 2 CORT GD,$365.75,$0.00,$365.75,$164.59,$261.04,$0.00,$63.02,$0.00,$0.00,$64.04,$365.75,$0.00,$182.88,$289.67,$292.60,$0.00,$57.24,$0.00,$58.23,$0.00
3550-0-075,SUP,HCPCS C1713,,3550-0-075  -  SCREW BONE 6.5MM 75MM ASNS 2 CORT GD,$402.88,$0.00,$402.88,$181.29,$287.53,$0.00,$69.41,$0.00,$0.00,$70.54,$402.88,$0.00,$201.44,$319.08,$322.30,$0.00,$63.05,$0.00,$64.14,$0.00
3550-0-080,SUP,HCPCS C1713,,3550-0-080  -  SCREW BONE 6.5MM 80MM ASNS 2 CORT GD,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
3550-0-085,SUP,HCPCS C1713,,3550-0-085  -  SCREW BONE 6.5MM 85MM ASNS 2 CORT GD,$402.88,$0.00,$402.88,$181.29,$287.53,$0.00,$69.41,$0.00,$0.00,$70.54,$402.88,$0.00,$201.44,$319.08,$322.30,$0.00,$63.05,$0.00,$64.14,$0.00
3550-0-090,SUP,HCPCS C1713,,3550-0-090  -  SCREW BONE 6.5MM 90MM ASNS 2 CORT GD,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
3550-0-095,SUP,HCPCS C1713,,3550-0-095  -  SCREW BONE 6.5MM 95MM ASNS 2 CORT GD,$402.88,$0.00,$402.88,$181.29,$287.53,$0.00,$69.41,$0.00,$0.00,$70.54,$402.88,$0.00,$201.44,$319.08,$322.30,$0.00,$63.05,$0.00,$64.14,$0.00
3550-0-100,SUP,HCPCS C1713,,3550-0-100  -  SCREW BONE 6.5MM 100MM ASNS 2 CORT GD,$402.88,$0.00,$402.88,$181.29,$287.53,$0.00,$69.41,$0.00,$0.00,$70.54,$402.88,$0.00,$201.44,$319.08,$322.30,$0.00,$63.05,$0.00,$64.14,$0.00
3550-0-105,SUP,HCPCS C1713,,3550-0-105  -  SCREW BONE 6.5MM 105MM ASNS 2 CORT GD,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
3550-0-110,SUP,HCPCS C1713,,3550-0-110  -  SCREW BONE 6.5MM 110MM ASNS 2 CORT GD,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
3550-0-115,SUP,HCPCS C1713,,3550-0-115  -  SCREW BONE 6.5MM 115MM ASNS 2 CORT GD,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
3550-0-120,SUP,HCPCS C1713,,3550-0-120  -  SCREW BONE 6.5MM 120MM ASNS 2 CORT GD,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
3550-0-125,SUP,HCPCS C1713,,3550-0-125  -  SCREW BONE 6.5MM 125MM ASNS 2 CORT GD,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
3550-0-130,SUP,HCPCS C1713,,3550-0-130  -  SCREW BONE 6.5MM 130MM ASNS 2 CORT GD,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
3550-4-024,SUP,HCPCS C1713,,3550-4-024  -  ASNIS2 GUIDED SCREW 5.0CANC 24,$273.63,$0.00,$273.63,$123.13,$195.29,$0.00,$47.14,$0.00,$0.00,$47.91,$273.63,$0.00,$136.81,$216.71,$218.90,$0.00,$42.82,$0.00,$43.56,$0.00
3550-4-026,SUP,HCPCS C1713,,3550-4-026  -  SCREW BONE 5MM 2MM ASNS 2 CANC GD,$257.13,$0.00,$257.13,$115.71,$183.51,$0.00,$44.30,$0.00,$0.00,$45.02,$257.13,$0.00,$128.56,$203.65,$205.70,$0.00,$40.24,$0.00,$40.93,$0.00
3550-4-028,SUP,HCPCS C1713,,3550-4-028  -  ASNIS2 GUIDED SCREW 5.0CANC 28,$273.63,$0.00,$273.63,$123.13,$195.29,$0.00,$47.14,$0.00,$0.00,$47.91,$273.63,$0.00,$136.81,$216.71,$218.90,$0.00,$42.82,$0.00,$43.56,$0.00
3550-4-030,SUP,HCPCS C1713,,3550-4-030  -  ASNIS2 GUIDED SCREW 5.0CANC 30,$273.63,$0.00,$273.63,$123.13,$195.29,$0.00,$47.14,$0.00,$0.00,$47.91,$273.63,$0.00,$136.81,$216.71,$218.90,$0.00,$42.82,$0.00,$43.56,$0.00
3550-4-032,SUP,HCPCS C1713,,3550-4-032  -  ASNIS2 GUIDED SCREW 5.0CANC 32,$273.63,$0.00,$273.63,$123.13,$195.29,$0.00,$47.14,$0.00,$0.00,$47.91,$273.63,$0.00,$136.81,$216.71,$218.90,$0.00,$42.82,$0.00,$43.56,$0.00
3550-4-034,SUP,HCPCS C1713,,3550-4-034  -  SCREW BONE 5MM 34MM ASNS 2 SS PTTHRD GD CANC STRL,$273.63,$0.00,$273.63,$123.13,$195.29,$0.00,$47.14,$0.00,$0.00,$47.91,$273.63,$0.00,$136.81,$216.71,$218.90,$0.00,$42.82,$0.00,$43.56,$0.00
3550-4-036,SUP,HCPCS C1713,,3550-4-036  -  SCREW BONE 5MM 3MM ASNS 2 CANC GD,$273.63,$0.00,$273.63,$123.13,$195.29,$0.00,$47.14,$0.00,$0.00,$47.91,$273.63,$0.00,$136.81,$216.71,$218.90,$0.00,$42.82,$0.00,$43.56,$0.00
3550-4-038,SUP,HCPCS C1713,,3550-4-038  -  ASNIS2 GUIDED SCREW 5.0CANC 38,$273.63,$0.00,$273.63,$123.13,$195.29,$0.00,$47.14,$0.00,$0.00,$47.91,$273.63,$0.00,$136.81,$216.71,$218.90,$0.00,$42.82,$0.00,$43.56,$0.00
3550-4-040,SUP,HCPCS C1713,,3550-4-040  -  ASNIS2 GUIDED SCREW 5.0CANC 40,$273.63,$0.00,$273.63,$123.13,$195.29,$0.00,$47.14,$0.00,$0.00,$47.91,$273.63,$0.00,$136.81,$216.71,$218.90,$0.00,$42.82,$0.00,$43.56,$0.00
3550-4-042,SUP,HCPCS C1713,,3550-4-042  -  SCREW BONE 5MM 4MM ASNS 2 CANC GD,$273.63,$0.00,$273.63,$123.13,$195.29,$0.00,$47.14,$0.00,$0.00,$47.91,$273.63,$0.00,$136.81,$216.71,$218.90,$0.00,$42.82,$0.00,$43.56,$0.00
3550-4-045,SUP,HCPCS C1713,,3550-4-045  -  SCREW BONE 5MM 4MM ASNS 2 CANC GD,$273.63,$0.00,$273.63,$123.13,$195.29,$0.00,$47.14,$0.00,$0.00,$47.91,$273.63,$0.00,$136.81,$216.71,$218.90,$0.00,$42.82,$0.00,$43.56,$0.00
3550-4-055,SUP,HCPCS C1713,,3550-4-055  -  SCREW BONE 5MM 55MM ASNS 2 CANC GD,$273.63,$0.00,$273.63,$123.13,$195.29,$0.00,$47.14,$0.00,$0.00,$47.91,$273.63,$0.00,$136.81,$216.71,$218.90,$0.00,$42.82,$0.00,$43.56,$0.00
3550-4-060,SUP,HCPCS C1713,,3550-4-060  -  SCREW BONE 5MM 60MM ASNS 2 CANC GD,$273.63,$0.00,$273.63,$123.13,$195.29,$0.00,$47.14,$0.00,$0.00,$47.91,$273.63,$0.00,$136.81,$216.71,$218.90,$0.00,$42.82,$0.00,$43.56,$0.00
3550-4-065,SUP,HCPCS C1713,,3550-4-065  -  SCREW BONE 5MM 6MM ASNS 2 CANC GD,$273.63,$0.00,$273.63,$123.13,$195.29,$0.00,$47.14,$0.00,$0.00,$47.91,$273.63,$0.00,$136.81,$216.71,$218.90,$0.00,$42.82,$0.00,$43.56,$0.00
3550-4-070,SUP,HCPCS C1713,,3550-4-070  -  ASNIS2 GUIDED SCREW 5.0CANC 70,$273.63,$0.00,$273.63,$123.13,$195.29,$0.00,$47.14,$0.00,$0.00,$47.91,$273.63,$0.00,$136.81,$216.71,$218.90,$0.00,$42.82,$0.00,$43.56,$0.00
3550-5-000,SUP,Custom 27803010,,3550-5-000  -  SMALL WASHER,$64.63,$0.00,$64.63,$0.00,$46.12,$0.00,$0.00,$0.00,$0.00,$0.00,$64.63,$0.00,$32.31,$51.19,$51.70,$0.00,$0.00,$0.00,$0.00,$0.00
3600-100,SUP,HCPCS C1729,,3600-100  -  DRAIN INCISION 1 COLLECT 1 CHAMBER 1 PATIENT TUBE DRY,$71.94,$0.00,$71.94,$39.06,$51.34,$0.00,$12.39,$0.00,$0.00,$12.60,$71.94,$0.00,$35.97,$56.98,$57.55,$0.00,$11.26,$0.00,$11.45,$0.00
3611ED,SUP,Custom 27203010,,MATTRESS COMPLETE UNIT /F,"$2,006.95",$0.00,"$2,006.95",$0.00,"$1,432.36",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,006.95",$0.00,"$1,003.48","$1,589.50","$1,605.56",$0.00,$0.00,$0.00,$0.00,$0.00
3634LF,SUP,Custom 27203010,,STOCKING CMPR THG HI LG SHRT ANEMB INSP TOE TED NYL,$707.48,$0.00,$707.48,$0.00,$504.92,$0.00,$0.00,$0.00,$0.00,$0.00,$707.48,$0.00,$353.74,$560.32,$565.98,$0.00,$0.00,$0.00,$0.00,$0.00
3704-0-040,SUP,Custom 27803010,,3704-0-040  -  CABLE/SLEEVE ORTHOPEDIC 1.6MM BEAD SET DALL-MILES STAINLESS,$757.50,$0.00,$757.50,$0.00,$540.63,$0.00,$0.00,$0.00,$0.00,$0.00,$757.50,$0.00,$378.75,$599.94,$606.00,$0.00,$0.00,$0.00,$0.00,$0.00
3704-0-050,SUP,Custom 27803010,,3704-0-050  -  CABLE/SLEEVE ORTHOPEDIC LP 2MM BEAD SET DALL-MILES STAINLESS,$757.50,$0.00,$757.50,$0.00,$540.63,$0.00,$0.00,$0.00,$0.00,$0.00,$757.50,$0.00,$378.75,$599.94,$606.00,$0.00,$0.00,$0.00,$0.00,$0.00
3704-0-410,SUP,Custom 27803010,,3704-0-410  -  CABLE/SLEEVE ORTHOPEDIC FLAT 1.6MM SET LP DALL-MILES,$757.50,$0.00,$757.50,$0.00,$540.63,$0.00,$0.00,$0.00,$0.00,$0.00,$757.50,$0.00,$378.75,$599.94,$606.00,$0.00,$0.00,$0.00,$0.00,$0.00
3704-0-510,SUP,Custom 27803010,,3704-0-510  -  CABLE/SLEEVE ORTHOPEDIC 2MM BEAD SET DALL-MILES STAINLESS,$757.50,$0.00,$757.50,$0.00,$540.63,$0.00,$0.00,$0.00,$0.00,$0.00,$757.50,$0.00,$378.75,$599.94,$606.00,$0.00,$0.00,$0.00,$0.00,$0.00
3704-1-100,SUP,Custom 27803010,,3704-1-100  -  SLEEVE CABLE SMALL DALL-MILES STAINLESS STEEL HIP,$757.50,$0.00,$757.50,$0.00,$540.63,$0.00,$0.00,$0.00,$0.00,$0.00,$757.50,$0.00,$378.75,$599.94,$606.00,$0.00,$0.00,$0.00,$0.00,$0.00
3704-1-110,SUP,Custom 27803010,,3704-1-110  -  SLEEVE CABLE MEDIUM DALL-MILES STAINLESS STEEL HIP,$757.50,$0.00,$757.50,$0.00,$540.63,$0.00,$0.00,$0.00,$0.00,$0.00,$757.50,$0.00,$378.75,$599.94,$606.00,$0.00,$0.00,$0.00,$0.00,$0.00
3704-2-070,SUP,Custom 27803010,,3704-2-070  -  GRIP CABLE SMALL 43MM DALL-MILES STAINLESS STEEL HIP TROC,"$2,117.50",$0.00,"$2,117.50",$0.00,"$1,511.26",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,117.50",$0.00,"$1,058.75","$1,677.06","$1,694.00",$0.00,$0.00,$0.00,$0.00,$0.00
3704-2-080,SUP,Custom 27803010,,3704-2-080  -  GRIP CABLE MEDIUM 48MM DALL-MILES STAINLESS STEEL HIP TROC,"$2,117.50",$0.00,"$2,117.50",$0.00,"$1,511.26",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,117.50",$0.00,"$1,058.75","$1,677.06","$1,694.00",$0.00,$0.00,$0.00,$0.00,$0.00
3704-2-081,SUP,HCPCS C1713,,3704-2-081  -  PLATE BONE MEDIUM 100MM GRIP DALL-MILES STAINLESS STEEL HIP,"$2,610.00",$0.00,"$2,610.00","$1,174.50","$1,862.76",$0.00,$449.69,$0.00,$0.00,$456.99,"$2,610.00",$0.00,"$1,305.00","$2,067.12","$2,088.00",$0.00,$408.47,$0.00,$415.51,$0.00
3704-2-082,SUP,Custom 27803010,,3704-2-082  -  PLATE BONE MEDIUM 150MM GRIP DALL-MILES STAINLESS STEEL HIP,"$3,422.50",$0.00,"$3,422.50",$0.00,"$2,442.64",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,422.50",$0.00,"$1,711.25","$2,710.62","$2,738.00",$0.00,$0.00,$0.00,$0.00,$0.00
3704-2-083,SUP,Custom 27803010,,3704-2-083  -  PLATE BONE MEDIUM 200MM GRIP DALL-MILES STAINLESS STEEL HIP,"$4,240.00",$0.00,"$4,240.00",$0.00,"$3,026.09",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,240.00",$0.00,"$2,120.00","$3,358.08","$3,392.00",$0.00,$0.00,$0.00,$0.00,$0.00
3704-2-090,SUP,Custom 27803010,,3704-2-090  -  GRIP CABLE LARGE 200MM DALL-MILES STAINLESS STEEL HIP TROC,"$1,800.00",$0.00,"$1,800.00",$0.00,"$1,284.66",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,800.00",$0.00,$900.00,"$1,425.60","$1,440.00",$0.00,$0.00,$0.00,$0.00,$0.00
3704-2-091,SUP,Custom 27803010,,3704-2-091  -  PLATE BONE LARGE 110MM GRIP DALL-MILES STAINLESS STEEL HIP,"$2,217.50",$0.00,"$2,217.50",$0.00,"$1,582.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,217.50",$0.00,"$1,108.75","$1,756.26","$1,774.00",$0.00,$0.00,$0.00,$0.00,$0.00
3704-2-092,SUP,Custom 27803010,,3704-2-092  -  PLATE BONE LARGE 160MM GRIP DALL-MILES STAINLESS STEEL HIP,"$3,422.50",$0.00,"$3,422.50",$0.00,"$2,442.64",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,422.50",$0.00,"$1,711.25","$2,710.62","$2,738.00",$0.00,$0.00,$0.00,$0.00,$0.00
3704-2-093,SUP,Custom 27803010,,3704-2-093  -  PLATE BONE LARGE 210MM GRIP DALL-MILES STAINLESS STEEL HIP,"$4,240.00",$0.00,"$4,240.00",$0.00,"$3,026.09",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,240.00",$0.00,"$2,120.00","$3,358.08","$3,392.00",$0.00,$0.00,$0.00,$0.00,$0.00
3704-3-100,SUP,HCPCS C1713,,3704-3-100  -  PLATE BONE BROAD 6.5IN 5 HOLE 6 GROOVE COMPRESSION ROUND END,"$1,190.00",$0.00,"$1,190.00",$535.50,$849.30,$0.00,$205.03,$0.00,$0.00,$208.36,"$1,190.00",$0.00,$595.00,$942.48,$952.00,$0.00,$186.24,$0.00,$189.45,$0.00
3704-3-110,SUP,HCPCS C1713,,3704-3-110  -  PLATE BONE BROAD 8IN 7 HOLE 8 GROOVE COMPRESSION ROUND END,"$1,190.00",$0.00,"$1,190.00",$535.50,$849.30,$0.00,$205.03,$0.00,$0.00,$208.36,"$1,190.00",$0.00,$595.00,$942.48,$952.00,$0.00,$186.24,$0.00,$189.45,$0.00
3704-3-120,SUP,HCPCS C1713,,3704-3-120  -  PLATE BONE BROAD 10IN 9 HOLE 10 GROOVE COMPRESSION ROUND END,"$1,190.00",$0.00,"$1,190.00",$535.50,$849.30,$0.00,$205.03,$0.00,$0.00,$208.36,"$1,190.00",$0.00,$595.00,$942.48,$952.00,$0.00,$186.24,$0.00,$189.45,$0.00
3704-3-130,SUP,HCPCS C1713,,3704-3-130  -  PLATE BONE BROAD 12IN 11 HOLE 12 GROOVE COMPRESSION ROUND,"$1,190.00",$0.00,"$1,190.00",$535.50,$849.30,$0.00,$205.03,$0.00,$0.00,$208.36,"$1,190.00",$0.00,$595.00,$942.48,$952.00,$0.00,$186.24,$0.00,$189.45,$0.00
3704-8-236,SUP,Custom 27803010,,3704-8-236  -  CABLE ORTHOPEDIC 1.6MM SLEEVE RECONSTRUCTION TRAUMA,$757.50,$0.00,$757.50,$0.00,$540.63,$0.00,$0.00,$0.00,$0.00,$0.00,$757.50,$0.00,$378.75,$599.94,$606.00,$0.00,$0.00,$0.00,$0.00,$0.00
3704-8-240,SUP,Custom 27803010,,3704-8-240  -  CABLE ORTHOPEDIC 2MM 650MM DALL-MILES STAINLESS STEEL HIP,$757.50,$0.00,$757.50,$0.00,$540.63,$0.00,$0.00,$0.00,$0.00,$0.00,$757.50,$0.00,$378.75,$599.94,$606.00,$0.00,$0.00,$0.00,$0.00,$0.00
370605.S,SUP,HCPCS A6209,,370605.S  -  DRESSING WND THK10MM 6IN 665X802MM STRL LF ABTHERA VSCR PCTV,$875.00,$0.00,$875.00,$475.13,$624.49,$0.00,$7.03,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
370642.S,SUP,HCPCS A6209,,370642.S  -  SET TBG ABTHERA QCK ACC STABLIZED,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$7.03,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
37-11068,SUP,Custom 27203010,,FORCEPS SURG 45D 5.2IN ANG UP PEAR SHP CUP HRZN,"$1,722.50",$0.00,"$1,722.50",$0.00,"$1,229.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,722.50",$0.00,$861.25,"$1,364.22","$1,378.00",$0.00,$0.00,$0.00,$0.00,$0.00
375-535-000,SUP,Custom 27203010,,375-535-000  -  BLADE SHVR 3.5MM FRML ARTHRO TOMCAT STRL,$186.55,$0.00,$186.55,$0.00,$133.14,$0.00,$0.00,$0.00,$0.00,$0.00,$186.55,$0.00,$93.28,$147.75,$149.24,$0.00,$0.00,$0.00,$0.00,$0.00
375-542-000,SUP,Custom 27203010,,375-542-000  -  BLADE SHVR 4MM FRML RESCT F LATEX FREE,$143.43,$0.00,$143.43,$0.00,$102.37,$0.00,$0.00,$0.00,$0.00,$0.00,$143.43,$0.00,$71.72,$113.60,$114.74,$0.00,$0.00,$0.00,$0.00,$0.00
375-544-000,SUP,Custom 27203010,,375-544-000  -  BLADE SHVR 4MM FRML STR CTR AGRS+ ARTHRO F STRL LATEX FREE,$143.43,$0.00,$143.43,$0.00,$102.37,$0.00,$0.00,$0.00,$0.00,$0.00,$143.43,$0.00,$71.72,$113.60,$114.74,$0.00,$0.00,$0.00,$0.00,$0.00
375-545-000,SUP,Custom 27203010,,375-545-000  -  BLADE SHAVER 4MM ARTHRO TOMCAT STERILE,$138.58,$0.00,$138.58,$0.00,$98.90,$0.00,$0.00,$0.00,$0.00,$0.00,$138.58,$0.00,$69.29,$109.76,$110.86,$0.00,$0.00,$0.00,$0.00,$0.00
375-554-000,SUP,Custom 27203010,,375-554-000  -  BLADE SHVR 5MM FRML AGRS+ ARTHRO STRL,$186.55,$0.00,$186.55,$0.00,$133.14,$0.00,$0.00,$0.00,$0.00,$0.00,$186.55,$0.00,$93.28,$147.75,$149.24,$0.00,$0.00,$0.00,$0.00,$0.00
375-555-000,SUP,Custom 27203010,,375-555-000  -  CUTTER ENDSCP 5MM TOMCAT FORMULA STERILE,$134.94,$0.00,$134.94,$0.00,$96.31,$0.00,$0.00,$0.00,$0.00,$0.00,$134.94,$0.00,$67.47,$106.87,$107.95,$0.00,$0.00,$0.00,$0.00,$0.00
375-562-000,SUP,Custom 27203010,,375-562-000  -  CUTTER ENDSCP 5.5MM RESECTOR LATEX FREE FORMULA STERILE,$138.58,$0.00,$138.58,$0.00,$98.90,$0.00,$0.00,$0.00,$0.00,$0.00,$138.58,$0.00,$69.29,$109.76,$110.86,$0.00,$0.00,$0.00,$0.00,$0.00
375-564-000,SUP,Custom 27203010,,375-564-000  -  BLADE SURG 5.5MM AGRS+ AGRS+ F SER STRL,$186.55,$0.00,$186.55,$0.00,$133.14,$0.00,$0.00,$0.00,$0.00,$0.00,$186.55,$0.00,$93.28,$147.75,$149.24,$0.00,$0.00,$0.00,$0.00,$0.00
375-565-000,SUP,Custom 27203010,,375-565-000  -  CUTTER ENDSCP ARTHRO FRML STRL 5.5MM,$186.55,$0.00,$186.55,$0.00,$133.14,$0.00,$0.00,$0.00,$0.00,$0.00,$186.55,$0.00,$93.28,$147.75,$149.24,$0.00,$0.00,$0.00,$0.00,$0.00
375-628-000,SUP,Custom 27203010,,375-628-000  -  BLADE SHVR 2.5MM FRML S JNT AGRS STRL,$143.43,$0.00,$143.43,$0.00,$102.37,$0.00,$0.00,$0.00,$0.00,$0.00,$143.43,$0.00,$71.72,$113.60,$114.74,$0.00,$0.00,$0.00,$0.00,$0.00
375-636-000,SUP,Custom 27203010,,375-636-000  -  BLADE SHVR 3.5MM FRML S JNT FULL RAD STRL,$186.55,$0.00,$186.55,$0.00,$133.14,$0.00,$0.00,$0.00,$0.00,$0.00,$186.55,$0.00,$93.28,$147.75,$149.24,$0.00,$0.00,$0.00,$0.00,$0.00
375-638-000,SUP,Custom 27203010,,375-638-000  -  BLADE SHVR 3.5MM FRML S JNT AGRS STRL,$186.55,$0.00,$186.55,$0.00,$133.14,$0.00,$0.00,$0.00,$0.00,$0.00,$186.55,$0.00,$93.28,$147.75,$149.24,$0.00,$0.00,$0.00,$0.00,$0.00
375-641-000,SUP,Custom 27203010,,375-641-000  -  BLADE SHVR 2MM FRML ABRSN HOOD ARTHRO STRL,$197.05,$0.00,$197.05,$0.00,$140.63,$0.00,$0.00,$0.00,$0.00,$0.00,$197.05,$0.00,$98.53,$156.06,$157.64,$0.00,$0.00,$0.00,$0.00,$0.00
375-647-000,SUP,Custom 27203010,,375-647-000  -  BURR SHVR 3MM FRML S JNT ABRSN HOOD ARTHRO STRL,$197.05,$0.00,$197.05,$0.00,$140.63,$0.00,$0.00,$0.00,$0.00,$0.00,$197.05,$0.00,$98.53,$156.06,$157.64,$0.00,$0.00,$0.00,$0.00,$0.00
375-930-000,SUP,Custom 27203010,,375-930-000  -  BURR SHVR 3.5MM FRML RND 6 FLUT ABRSN RPD STRL,$151.50,$0.00,$151.50,$0.00,$108.13,$0.00,$0.00,$0.00,$0.00,$0.00,$151.50,$0.00,$75.75,$119.99,$121.20,$0.00,$0.00,$0.00,$0.00,$0.00
375-940-000,SUP,Custom 27203010,,375-940-000  -  BURR SURG 4MM ROUND 6 FLUTED ARTHRO FORMULA STERILE,$146.38,$0.00,$146.38,$0.00,$104.47,$0.00,$0.00,$0.00,$0.00,$0.00,$146.38,$0.00,$73.19,$115.93,$117.10,$0.00,$0.00,$0.00,$0.00,$0.00
375-940-012,SUP,Custom 27203010,,375-940-012  -  BURR SHVR 4MM FRML RND HLW 12 FLUT ARTHRO STRL,$151.50,$0.00,$151.50,$0.00,$108.13,$0.00,$0.00,$0.00,$0.00,$0.00,$151.50,$0.00,$75.75,$119.99,$121.20,$0.00,$0.00,$0.00,$0.00,$0.00
375-941-000,SUP,Custom 27203010,,375-941-000  -  BURR SRG 6 FLUT BRL 4MM STRL FRML F SER,$151.50,$0.00,$151.50,$0.00,$108.13,$0.00,$0.00,$0.00,$0.00,$0.00,$151.50,$0.00,$75.75,$119.99,$121.20,$0.00,$0.00,$0.00,$0.00,$0.00
375-941-012,SUP,Custom 27203010,,375-941-012  -  BURR SHVR 4MM FRML BRL 12 FLUT ARTHRO STRL,$197.05,$0.00,$197.05,$0.00,$140.63,$0.00,$0.00,$0.00,$0.00,$0.00,$197.05,$0.00,$98.53,$156.06,$157.64,$0.00,$0.00,$0.00,$0.00,$0.00
375-950-012,SUP,Custom 27203010,,375-950-012  -  BURR SHVR 5.5MM FRML 12 FLUT RND ARTHRO STRL,$197.05,$0.00,$197.05,$0.00,$140.63,$0.00,$0.00,$0.00,$0.00,$0.00,$197.05,$0.00,$98.53,$156.06,$157.64,$0.00,$0.00,$0.00,$0.00,$0.00
375-950-100,SUP,Custom 27203010,,375-950-100  -  BURR SHVR 5MM FRML 6 FLUT RND ARTHRO STRL,$151.50,$0.00,$151.50,$0.00,$108.13,$0.00,$0.00,$0.00,$0.00,$0.00,$151.50,$0.00,$75.75,$119.99,$121.20,$0.00,$0.00,$0.00,$0.00,$0.00
375-950-112,SUP,Custom 27203010,,375-950-112  -  BURR SHVR 5MM FRML 12 FLUT RND ARTHRO STRL,$197.05,$0.00,$197.05,$0.00,$140.63,$0.00,$0.00,$0.00,$0.00,$0.00,$197.05,$0.00,$98.53,$156.06,$157.64,$0.00,$0.00,$0.00,$0.00,$0.00
375-951-000,SUP,Custom 27203010,,375-951-000  -  BURR SHAVER 6 FLUTE ROUND BARREL 5.5MM ARTHRO FORMULA,$146.38,$0.00,$146.38,$0.00,$104.47,$0.00,$0.00,$0.00,$0.00,$0.00,$146.38,$0.00,$73.19,$115.93,$117.10,$0.00,$0.00,$0.00,$0.00,$0.00
375-951-012,SUP,Custom 27203010,,375-951-012  -  BURR SHVR 5.5MM FRML BRL 12 FLUT ARTHRO STRL,$197.05,$0.00,$197.05,$0.00,$140.63,$0.00,$0.00,$0.00,$0.00,$0.00,$197.05,$0.00,$98.53,$156.06,$157.64,$0.00,$0.00,$0.00,$0.00,$0.00
375-951-100,SUP,Custom 27203010,,375-951-100  -  BURR SHVR 5MM FRML 6 FLUT BRL ARTHRO STRL,$197.05,$0.00,$197.05,$0.00,$140.63,$0.00,$0.00,$0.00,$0.00,$0.00,$197.05,$0.00,$98.53,$156.06,$157.64,$0.00,$0.00,$0.00,$0.00,$0.00
375-951-112,SUP,Custom 27203010,,375-951-112  -  BURR SHVR 5MM FRML 12 FLUT BRL ARTHRO STRL,$197.05,$0.00,$197.05,$0.00,$140.63,$0.00,$0.00,$0.00,$0.00,$0.00,$197.05,$0.00,$98.53,$156.06,$157.64,$0.00,$0.00,$0.00,$0.00,$0.00
38-051-65,SUP,Custom 27203010,,38-051-65  -  BURR SURG 70MM 2.2MM LNDMN MED NTCH STRL,$142.50,$0.00,$142.50,$0.00,$101.70,$0.00,$0.00,$0.00,$0.00,$0.00,$142.50,$0.00,$71.25,$112.86,$114.00,$0.00,$0.00,$0.00,$0.00,$0.00
380-544-100,SUP,Custom 27203010,,380-544-100  -  BLADE SHVR 4MM FRML ANG AGRS+ ARTHRO STRL,$201.95,$0.00,$201.95,$0.00,$144.13,$0.00,$0.00,$0.00,$0.00,$0.00,$201.95,$0.00,$100.98,$159.94,$161.56,$0.00,$0.00,$0.00,$0.00,$0.00
380-545-100,SUP,Custom 27203010,,380-545-100  -  BLADE SHVR 4MM TOMCAT ANG TOMCAT STRL,$201.95,$0.00,$201.95,$0.00,$144.13,$0.00,$0.00,$0.00,$0.00,$0.00,$201.95,$0.00,$100.98,$159.94,$161.56,$0.00,$0.00,$0.00,$0.00,$0.00
380-545-150,SUP,Custom 27203010,,380-545-150  -  BLADE SHVR 4.5MM TOMCAT ANG TOMCAT STRL LATEX FREE,$201.95,$0.00,$201.95,$0.00,$144.13,$0.00,$0.00,$0.00,$0.00,$0.00,$201.95,$0.00,$100.98,$159.94,$161.56,$0.00,$0.00,$0.00,$0.00,$0.00
380-554-100,SUP,Custom 27203010,,380-554-100  -  CUTTER ENDSCP ANG AGRS+ FRML STRL 5MM,$201.95,$0.00,$201.95,$0.00,$144.13,$0.00,$0.00,$0.00,$0.00,$0.00,$201.95,$0.00,$100.98,$159.94,$161.56,$0.00,$0.00,$0.00,$0.00,$0.00
380-555-100,SUP,Custom 27203010,,380-555-100  -  CUTTER ENDSCP TOMCAT FRML ANG STRL 5MM,$201.95,$0.00,$201.95,$0.00,$144.13,$0.00,$0.00,$0.00,$0.00,$0.00,$201.95,$0.00,$100.98,$159.94,$161.56,$0.00,$0.00,$0.00,$0.00,$0.00
38-130-56,SUP,Custom 27203010,,38-130-56  -  PROP MTH PED DNTL SET BLK,$35.63,$0.00,$35.63,$0.00,$25.43,$0.00,$0.00,$0.00,$0.00,$0.00,$35.63,$0.00,$17.81,$28.22,$28.50,$0.00,$0.00,$0.00,$0.00,$0.00
3815-8-920,SUP,HCPCS C1713,,3815-8-920  -  PIN FIX 4MM STNM,$68.75,$0.00,$68.75,$30.94,$49.07,$0.00,$11.85,$0.00,$0.00,$12.04,$68.75,$0.00,$34.38,$54.45,$55.00,$0.00,$10.76,$0.00,$10.95,$0.00
3855-4-000,SUP,Custom 27203010,,3855-4-000  -  DRILL SURG STP CORT,$474.38,$0.00,$474.38,$0.00,$338.56,$0.00,$0.00,$0.00,$0.00,$0.00,$474.38,$0.00,$237.19,$375.71,$379.50,$0.00,$0.00,$0.00,$0.00,$0.00
38-709-03-07,SUP,HCPCS C1713,,38-709-03-07  -  INSTRUMENT RDC LG 5IN BYRD ZYG RDC SCR SS OSTSYN,$374.38,$0.00,$374.38,$168.47,$267.19,$0.00,$64.50,$0.00,$0.00,$65.55,$374.38,$0.00,$187.19,$296.51,$299.50,$0.00,$58.59,$0.00,$59.60,$0.00
390-110,SUP,Custom 27803010,,390-110  -  STONE CONE COIL,$506.00,$0.00,$506.00,$0.00,$361.13,$0.00,$0.00,$0.00,$0.00,$0.00,$506.00,$0.00,$253.00,$400.75,$404.80,$0.00,$0.00,$0.00,$0.00,$0.00
3910-900-020,SUP,HCPCS C1713,,3910-900-020  -  ANCHOR SUTURE 2 FRC FBR NDL STRN 38IN,$69.38,$0.00,$69.38,$31.22,$49.51,$0.00,$11.95,$0.00,$0.00,$12.15,$69.38,$0.00,$34.69,$54.95,$55.50,$0.00,$10.86,$0.00,$11.04,$0.00
3910-900-050,SUP,HCPCS C1713,,3910-900-050  -  SUTURE NABSB 5 3/8 CRC 38IN WHT BLU STRL FRC FBR NDL CO BRD,$80.00,$0.00,$80.00,$36.00,$57.10,$0.00,$13.78,$0.00,$0.00,$14.01,$80.00,$0.00,$40.00,$63.36,$64.00,$0.00,$12.52,$0.00,$12.74,$0.00
394500S,SUP,Custom 27203010,,394500S  -  HOOK BONE 25MM OMEGA 3 HANSSON HIP SS CMPR SCR TWN STRL,$178.75,$0.00,$178.75,$0.00,$127.57,$0.00,$0.00,$0.00,$0.00,$0.00,$178.75,$0.00,$89.38,$141.57,$143.00,$0.00,$0.00,$0.00,$0.00,$0.00
3A1505,SUP,Custom 27203010,,LEADWIRE EKG 5 LEAD SET SNP 40IN,$26.25,$0.00,$26.25,$0.00,$18.73,$0.00,$0.00,$0.00,$0.00,$0.00,$26.25,$0.00,$13.13,$20.79,$21.00,$0.00,$0.00,$0.00,$0.00,$0.00
3HSK-3038,SUP,Custom 27203010,,3HSK-3038  -  HEARTSTRING III PROXIMAL SEAL SYSTEM 3.8 MM,"$1,650.00",$0.00,"$1,650.00",$0.00,"$1,177.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,650.00",$0.00,$825.00,"$1,306.80","$1,320.00",$0.00,$0.00,$0.00,$0.00,$0.00
3MA005,SUP,Custom 27203010,,STANDARD ADV OSMTR CLBRT AMPULE 2ML 3300 SER CHM 50 MOSM/KG,$11.98,$0.00,$11.98,$0.00,$8.55,$0.00,$0.00,$0.00,$0.00,$0.00,$11.98,$0.00,$5.99,$9.49,$9.58,$0.00,$0.00,$0.00,$0.00,$0.00
3MA029,SUP,Custom 27203010,,CONTROL OSMTR CLNTRL 290 MOSM REF SOL OSM 2ML,$158.00,$0.00,$158.00,$0.00,$112.76,$0.00,$0.00,$0.00,$0.00,$0.00,$158.00,$0.00,$79.00,$125.14,$126.40,$0.00,$0.00,$0.00,$0.00,$0.00
3MA800,SUP,Custom 27203010,,SAMPLER ADV CHMBR CLNR SMPL TIP MODL 3300/3320 ANALY,$767.28,$0.00,$767.28,$0.00,$547.60,$0.00,$0.00,$0.00,$0.00,$0.00,$767.28,$0.00,$383.64,$607.69,$613.82,$0.00,$0.00,$0.00,$0.00,$0.00
3MAXC,SUP,HCPCS C1757,,3MAXC  -  CATHETER REPERFUSION 3MAX,"$3,225.00",$0.00,"$3,225.00",$0.00,"$2,301.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,225.00",$0.00,"$1,612.50","$2,554.20","$2,580.00",$0.00,$0.00,$0.00,$0.00,$0.00
3MAXCKIT,SUP,HCPCS C1757,,3MAXCKIT  -  CATHETER THROMBECTOMY .014IN 4.7-3.8FR .035IN 153CM 157CM,"$4,375.00",$0.00,"$4,375.00",$0.00,"$3,122.44",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,375.00",$0.00,"$2,187.50","$3,465.00","$3,500.00",$0.00,$0.00,$0.00,$0.00,$0.00
3N02A,SUP,Custom 27203010,,3N02A  -  SUTURE NONABSORBABLE CV-3 TT-17 36IN 2 ARM MONOFILAMENT,$677.50,$0.00,$677.50,$0.00,$483.53,$0.00,$0.00,$0.00,$0.00,$0.00,$677.50,$0.00,$338.75,$536.58,$542.00,$0.00,$0.00,$0.00,$0.00,$0.00
3X611,SUP,Custom 27203010,,BELT 5 56X21/32X7/16IN B53 TYPE,$48.33,$0.00,$48.33,$0.00,$34.49,$0.00,$0.00,$0.00,$0.00,$0.00,$48.33,$0.00,$24.16,$38.28,$38.66,$0.00,$0.00,$0.00,$0.00,$0.00
4.0PED,SUP,Custom 27203010,,4.0PED  -  TUBE 41MM 5.9MM 4MM UNCUF OBT TRCH PLVN CHLOR PED,$94.29,$0.00,$94.29,$0.00,$67.29,$0.00,$0.00,$0.00,$0.00,$0.00,$94.29,$0.00,$47.14,$74.68,$75.43,$0.00,$0.00,$0.00,$0.00,$0.00
4.5PED,SUP,Custom 27203010,,4.5PED  -  TUBE 42MM 6.5MM 4.5MM UNCUF OBT TRCH PLVN CHLOR PED,$94.29,$0.00,$94.29,$0.00,$67.29,$0.00,$0.00,$0.00,$0.00,$0.00,$94.29,$0.00,$47.14,$74.68,$75.43,$0.00,$0.00,$0.00,$0.00,$0.00
400.040E,SUP,HCPCS C1713,,400.040E  -  SCREW BONE 10MM 1.5MM CORT CRANFCL TI SLFTAP +DR RECESS,$144.00,$0.00,$144.00,$64.80,$102.77,$0.00,$24.81,$0.00,$0.00,$25.21,$144.00,$0.00,$72.00,$114.05,$115.20,$0.00,$22.54,$0.00,$22.92,$0.00
400.046E,SUP,HCPCS C1713,,400.046E  -  1.5MM TI CORTEX SCR SLF-TPNG WITH PLUSDRIVE(TM) RECESS 16MM,$144.00,$0.00,$144.00,$64.80,$102.77,$0.00,$24.81,$0.00,$0.00,$25.21,$144.00,$0.00,$72.00,$114.05,$115.20,$0.00,$22.54,$0.00,$22.92,$0.00
400.048E,SUP,HCPCS C1713,,400.048E  -  1.5MM TI CORTEX SCR SLF-TPNG WITH PLUSDRIVE(TM) RECESS 18MM,$144.00,$0.00,$144.00,$64.80,$102.77,$0.00,$24.81,$0.00,$0.00,$25.21,$144.00,$0.00,$72.00,$114.05,$115.20,$0.00,$22.54,$0.00,$22.92,$0.00
400.054E,SUP,HCPCS C1713,,400.054E  -  SCREW BONE 4MM 1.5MM CORT CRANIOMAXILOFACIAL TI +DR RECESS,$173.25,$0.00,$173.25,$77.96,$123.65,$0.00,$29.85,$0.00,$0.00,$30.33,$173.25,$0.00,$86.63,$137.21,$138.60,$0.00,$27.11,$0.00,$27.58,$0.00
400.055E,SUP,HCPCS C1713,,400.055E  -  SCREW BONE 5MM 1.5MM CRANFCL TI SLFDRILL +DR RECESS STRL,$173.25,$0.00,$173.25,$77.96,$123.65,$0.00,$29.85,$0.00,$0.00,$30.33,$173.25,$0.00,$86.63,$137.21,$138.60,$0.00,$27.11,$0.00,$27.58,$0.00
400.056E,SUP,HCPCS C1713,,400.056E  -  SCREW BONE 6MM 1.5MM CRANFCL TI SLFDRILL +DR RECESS STRL,$173.25,$0.00,$173.25,$77.96,$123.65,$0.00,$29.85,$0.00,$0.00,$30.33,$173.25,$0.00,$86.63,$137.21,$138.60,$0.00,$27.11,$0.00,$27.58,$0.00
400.280E,SUP,HCPCS C1713,,400.280E  -  SCREW BONE 2MM 10MM TI CRNMXF ER +DR RECESS STRL,$151.88,$0.00,$151.88,$68.34,$108.39,$0.00,$26.17,$0.00,$0.00,$26.59,$151.88,$0.00,$75.94,$120.29,$121.50,$0.00,$23.77,$0.00,$24.18,$0.00
400.282E,SUP,HCPCS C1713,,400.282E  -  SCREW BONE 2MM 12MM TI CRNMXF ER +DR RECESS STRL,$151.88,$0.00,$151.88,$68.34,$108.39,$0.00,$26.17,$0.00,$0.00,$26.59,$151.88,$0.00,$75.94,$120.29,$121.50,$0.00,$23.77,$0.00,$24.18,$0.00
400.284E,SUP,HCPCS C1713,,400.284E  -  2.0MM TI EMERGENCY SCREW WITH PLUSDRIVE(TM) RECESS 14MM,$151.88,$0.00,$151.88,$68.34,$108.39,$0.00,$26.17,$0.00,$0.00,$26.59,$151.88,$0.00,$75.94,$120.29,$121.50,$0.00,$23.77,$0.00,$24.18,$0.00
400.286E,SUP,HCPCS C1713,,400.286E  -  2.0MM TI EMERGENCY SCREW WITH PLUSDRIVE(TM) RECESS 16MM,$151.88,$0.00,$151.88,$68.34,$108.39,$0.00,$26.17,$0.00,$0.00,$26.59,$151.88,$0.00,$75.94,$120.29,$121.50,$0.00,$23.77,$0.00,$24.18,$0.00
400.288E,SUP,HCPCS C1713,,400.288E  -  2.0MM TI EMERGENCY SCREW WITH PLUSDRIVE(TM) RECESS 18MM,$151.88,$0.00,$151.88,$68.34,$108.39,$0.00,$26.17,$0.00,$0.00,$26.59,$151.88,$0.00,$75.94,$120.29,$121.50,$0.00,$23.77,$0.00,$24.18,$0.00
400.404E,SUP,HCPCS C1713,,400.404E  -  SCREW BONE STRL GOLD 4MM 1MM CORT CRANFCL TI SLFTAP +DR,$213.75,$0.00,$213.75,$96.19,$152.55,$0.00,$36.83,$0.00,$0.00,$37.43,$213.75,$0.00,$106.88,$169.29,$171.00,$0.00,$33.45,$0.00,$34.03,$0.00
400.405E,SUP,HCPCS C1713,,400.405E  -  SCREW BONE STRL GOLD 5MM 1MM CORT CRANFCL TI SLFTAP +DR,$213.75,$0.00,$213.75,$96.19,$152.55,$0.00,$36.83,$0.00,$0.00,$37.43,$213.75,$0.00,$106.88,$169.29,$171.00,$0.00,$33.45,$0.00,$34.03,$0.00
400.407E,SUP,HCPCS C1713,,400.407E  -  1.0MM TI CRTX SCREW SLF-TPNG W/PLUSDRIVE(TM) RECESS 7MM,$191.25,$0.00,$191.25,$86.06,$136.50,$0.00,$32.95,$0.00,$0.00,$33.49,$191.25,$0.00,$95.63,$151.47,$153.00,$0.00,$29.93,$0.00,$30.45,$0.00
400.408E,SUP,HCPCS C1713,,400.408E  -  SCREW BONE 1MM 8MM TI CORT SLFTAP NONSTRL,$213.75,$0.00,$213.75,$96.19,$152.55,$0.00,$36.83,$0.00,$0.00,$37.43,$213.75,$0.00,$106.88,$169.29,$171.00,$0.00,$33.45,$0.00,$34.03,$0.00
400.409E,SUP,HCPCS C1713,,400.409E  -  1.0MM TI CRTX SCREW SLF-TPNG W/PLUSDRIVE(TM) RECESS 9MM,$191.25,$0.00,$191.25,$86.06,$136.50,$0.00,$32.95,$0.00,$0.00,$33.49,$191.25,$0.00,$95.63,$151.47,$153.00,$0.00,$29.93,$0.00,$30.45,$0.00
400.410E,SUP,HCPCS C1713,,400.410E  -  1.0MM TI CRTX SCREW SLF-TPNG W/PLUSDRIVE(TM) RECESS 10MM,$213.75,$0.00,$213.75,$96.19,$152.55,$0.00,$36.83,$0.00,$0.00,$37.43,$213.75,$0.00,$106.88,$169.29,$171.00,$0.00,$33.45,$0.00,$34.03,$0.00
400.411E,SUP,HCPCS C1713,,400.411E  -  1.0MM TI CRTX SCREW SLF-TPNG W/PLUSDRIVE(TM) RECESS 11MM,$191.25,$0.00,$191.25,$86.06,$136.50,$0.00,$32.95,$0.00,$0.00,$33.49,$191.25,$0.00,$95.63,$151.47,$153.00,$0.00,$29.93,$0.00,$30.45,$0.00
400.412E,SUP,HCPCS C1713,,400.412E  -  1.0MM TI CRTX SCREW SLF-TPNG W/PLUSDRIVE(TM) RECESS 12MM,$213.75,$0.00,$213.75,$96.19,$152.55,$0.00,$36.83,$0.00,$0.00,$37.43,$213.75,$0.00,$106.88,$169.29,$171.00,$0.00,$33.45,$0.00,$34.03,$0.00
400.414E,SUP,HCPCS C1713,,400.414E  -  1.0MM TI CRTX SCREW SLF-TPNG W/PLUSDRIVE(TM) RECESS 14MM,$213.75,$0.00,$213.75,$96.19,$152.55,$0.00,$36.83,$0.00,$0.00,$37.43,$213.75,$0.00,$106.88,$169.29,$171.00,$0.00,$33.45,$0.00,$34.03,$0.00
400.437E,SUP,HCPCS C1713,,400.437E  -  SCREW BONE 7MM 1.3MM CORTEX TI SLFTAP DRV RECESS 3MM,$178.88,$0.00,$178.88,$80.49,$127.66,$0.00,$30.82,$0.00,$0.00,$31.32,$178.88,$0.00,$89.44,$141.67,$143.10,$0.00,$27.99,$0.00,$28.48,$0.00
400.439E,SUP,HCPCS C1713,,400.439E  -  1.3MM TI CRTX SCREW SLF-TPNG W/PLUSDRIVE(TM) RECESS 9MM,$178.88,$0.00,$178.88,$80.49,$127.66,$0.00,$30.82,$0.00,$0.00,$31.32,$178.88,$0.00,$89.44,$141.67,$143.10,$0.00,$27.99,$0.00,$28.48,$0.00
400.440E,SUP,HCPCS C1713,,400.440E  -  1.3MM TI CRTX SCREW SLF-TPNG W/PLUSDRIVE(TM) RECESS 10MM,$199.13,$0.00,$199.13,$89.61,$142.12,$0.00,$34.31,$0.00,$0.00,$34.87,$199.13,$0.00,$99.56,$157.71,$159.30,$0.00,$31.16,$0.00,$31.70,$0.00
400.442E,SUP,HCPCS C1713,,400.442E  -  1.3MM TI CRTX SCREW SLF-TPNG W/PLUSDRIVE(TM) RECESS 12MM,$199.13,$0.00,$199.13,$89.61,$142.12,$0.00,$34.31,$0.00,$0.00,$34.87,$199.13,$0.00,$99.56,$157.71,$159.30,$0.00,$31.16,$0.00,$31.70,$0.00
400.444E,SUP,HCPCS C1713,,400.444E  -  1.3MM TI CRTX SCREW SLF-TPNG W/PLUSDRIVE(TM) RECESS 14MM,$199.13,$0.00,$199.13,$89.61,$142.12,$0.00,$34.31,$0.00,$0.00,$34.87,$199.13,$0.00,$99.56,$157.71,$159.30,$0.00,$31.16,$0.00,$31.70,$0.00
400.446E,SUP,HCPCS C1713,,400.446E  -  1.3MM TI CRTX SCREW SLF-TPNG W/PLUSDRIVE(TM) RECESS 16MM,$199.13,$0.00,$199.13,$89.61,$142.12,$0.00,$34.31,$0.00,$0.00,$34.87,$199.13,$0.00,$99.56,$157.71,$159.30,$0.00,$31.16,$0.00,$31.70,$0.00
400.448E,SUP,HCPCS C1713,,400.448E  -  1.3MM TI CRTX SCREW SLF-TPNG W/PLUSDRIVE(TM) RECESS 18MM,$199.13,$0.00,$199.13,$89.61,$142.12,$0.00,$34.31,$0.00,$0.00,$34.87,$199.13,$0.00,$99.56,$157.71,$159.30,$0.00,$31.16,$0.00,$31.70,$0.00
400.454E,SUP,HCPCS C1713,,400.454E  -  SCREW BONE STRL SLVR 4MM 1.3MM CORT CRANFCL TI SLFDRILL +DR,$204.75,$0.00,$204.75,$92.14,$146.13,$0.00,$35.28,$0.00,$0.00,$35.85,$204.75,$0.00,$102.38,$162.16,$163.80,$0.00,$32.04,$0.00,$32.60,$0.00
400.455E,SUP,HCPCS C1713,,400.455E  -  SCREW BONE SLVR 5MM 1.3MM CRANFCL TI SLFDRILL +DR RECESS,$204.75,$0.00,$204.75,$92.14,$146.13,$0.00,$35.28,$0.00,$0.00,$35.85,$204.75,$0.00,$102.38,$162.16,$163.80,$0.00,$32.04,$0.00,$32.60,$0.00
400.456E,SUP,HCPCS C1713,,400.456E  -  SCREW BONE SLVR 6MM 1.3MM CRANFCL TI SLFDRILL +DR RECESS,$204.75,$0.00,$204.75,$92.14,$146.13,$0.00,$35.28,$0.00,$0.00,$35.85,$204.75,$0.00,$102.38,$162.16,$163.80,$0.00,$32.04,$0.00,$32.60,$0.00
400.465E,SUP,HCPCS C1713,,400.465E  -  SCREW BONE TEAL 5MM 1.2MM CRANFCL TI SLFDRILL +DR RECESS,$220.50,$0.00,$220.50,$99.23,$157.37,$0.00,$37.99,$0.00,$0.00,$38.61,$220.50,$0.00,$110.25,$174.64,$176.40,$0.00,$34.51,$0.00,$35.10,$0.00
400.467E,SUP,HCPCS C1713,,400.467E  -  SCREW BONE 7MM 1.2MM CRNMXF TI NONSTRL,$195.75,$0.00,$195.75,$88.09,$139.71,$0.00,$33.73,$0.00,$0.00,$34.27,$195.75,$0.00,$97.88,$155.03,$156.60,$0.00,$30.63,$0.00,$31.16,$0.00
400.469E,SUP,HCPCS C1713,,400.469E  -  1.2MM TI EMERGENCY SCREW WITH PLUSDRIVE(TM) RECESS 9MM,$195.75,$0.00,$195.75,$88.09,$139.71,$0.00,$33.73,$0.00,$0.00,$34.27,$195.75,$0.00,$97.88,$155.03,$156.60,$0.00,$30.63,$0.00,$31.16,$0.00
400.470E,SUP,HCPCS C1713,,400.470E  -  1.2MM TI EMERGENCY SCREW WITH PLUSDRIVE(TM) RECESS 10MM,$220.50,$0.00,$220.50,$99.23,$157.37,$0.00,$37.99,$0.00,$0.00,$38.61,$220.50,$0.00,$110.25,$174.64,$176.40,$0.00,$34.51,$0.00,$35.10,$0.00
400.471E,SUP,HCPCS C1713,,400.471E  -  1.2MM TI EMERGENCY SCREW WITH PLUSDRIVE(TM) RECESS 11MM,$195.75,$0.00,$195.75,$88.09,$139.71,$0.00,$33.73,$0.00,$0.00,$34.27,$195.75,$0.00,$97.88,$155.03,$156.60,$0.00,$30.63,$0.00,$31.16,$0.00
400.472E,SUP,HCPCS C1713,,400.472E  -  1.2MM TI EMERGENCY SCREW WITH PLUSDRIVE(TM) RECESS 12MM,$220.50,$0.00,$220.50,$99.23,$157.37,$0.00,$37.99,$0.00,$0.00,$38.61,$220.50,$0.00,$110.25,$174.64,$176.40,$0.00,$34.51,$0.00,$35.10,$0.00
400.474E,SUP,HCPCS C1713,,400.474E  -  1.2MM TI EMERGENCY SCREW WITH PLUSDRIVE(TM) RECESS 14MM,$220.50,$0.00,$220.50,$99.23,$157.37,$0.00,$37.99,$0.00,$0.00,$38.61,$220.50,$0.00,$110.25,$174.64,$176.40,$0.00,$34.51,$0.00,$35.10,$0.00
400.483E,SUP,HCPCS C1713,,400.483E  -  SCREW BONE 3MM 1.7MM CRANFCL TI ER +DR RECESS STRL,$207.00,$0.00,$207.00,$93.15,$147.74,$0.00,$35.67,$0.00,$0.00,$36.24,$207.00,$0.00,$103.50,$163.94,$165.60,$0.00,$32.40,$0.00,$32.95,$0.00
400.487E,SUP,HCPCS C1713,,400.487E  -  1.7MM TI EMERGENCY SCREW WITH PLUSDRIVE(TM) RECESS 7MM,$186.75,$0.00,$186.75,$84.04,$133.28,$0.00,$32.18,$0.00,$0.00,$32.70,$186.75,$0.00,$93.38,$147.91,$149.40,$0.00,$29.23,$0.00,$29.73,$0.00
400.488E,SUP,HCPCS C1713,,400.488E  -  SCREW BN 1.5MM 8MM NS TI CORT,$207.00,$0.00,$207.00,$93.15,$147.74,$0.00,$35.67,$0.00,$0.00,$36.24,$207.00,$0.00,$103.50,$163.94,$165.60,$0.00,$32.40,$0.00,$32.95,$0.00
400.489E,SUP,HCPCS C1713,,400.489E  -  1.7MM TI EMERGENCY SCREW WITH PLUSDRIVE(TM) RECESS 9MM,$186.75,$0.00,$186.75,$84.04,$133.28,$0.00,$32.18,$0.00,$0.00,$32.70,$186.75,$0.00,$93.38,$147.91,$149.40,$0.00,$29.23,$0.00,$29.73,$0.00
400.490E,SUP,HCPCS C1713,,400.490E  -  SCREW TI 10IN 1.7MM CRANFCL ER +DR RECESS BONE,$207.00,$0.00,$207.00,$93.15,$147.74,$0.00,$35.67,$0.00,$0.00,$36.24,$207.00,$0.00,$103.50,$163.94,$165.60,$0.00,$32.40,$0.00,$32.95,$0.00
400.492E,SUP,HCPCS C1713,,400.492E  -  1.7MM TI EMERGENCY SCREW WITH PLUSDRIVE(TM) RECESS 12MM,$207.00,$0.00,$207.00,$93.15,$147.74,$0.00,$35.67,$0.00,$0.00,$36.24,$207.00,$0.00,$103.50,$163.94,$165.60,$0.00,$32.40,$0.00,$32.95,$0.00
400.494E,SUP,HCPCS C1713,,400.494E  -  1.7MM TI EMERGENCY SCREW WITH PLUSDRIVE(TM) RECESS 14MM,$207.00,$0.00,$207.00,$93.15,$147.74,$0.00,$35.67,$0.00,$0.00,$36.24,$207.00,$0.00,$103.50,$163.94,$165.60,$0.00,$32.40,$0.00,$32.95,$0.00
400.496E,SUP,HCPCS C1713,,400.496E  -  1.7MM TI EMERGENCY SCREW WITH PLUSDRIVE(TM) RECESS 16MM,$207.00,$0.00,$207.00,$93.15,$147.74,$0.00,$35.67,$0.00,$0.00,$36.24,$207.00,$0.00,$103.50,$163.94,$165.60,$0.00,$32.40,$0.00,$32.95,$0.00
400.498E,SUP,HCPCS C1713,,400.498E  -  1.7MM TI EMERGENCY SCREW WITH PLUSDRIVE(TM) RECESS 18MM,$207.00,$0.00,$207.00,$93.15,$147.74,$0.00,$35.67,$0.00,$0.00,$36.24,$207.00,$0.00,$103.50,$163.94,$165.60,$0.00,$32.40,$0.00,$32.95,$0.00
400.806.96,SUP,HCPCS C1713,,400.806.96  -  SCREW BONE LP 1.5MM 3MM 6MM SELF TAP THREAD TITANIUM HAND,$63.45,$0.00,$63.45,$28.55,$45.28,$0.00,$16.28,$0.00,$0.00,$11.11,$63.45,$0.00,$31.73,$50.25,$50.76,$0.00,$14.79,$0.00,$10.10,$0.00
400.807.96,SUP,HCPCS C1713,,400.807.96  -  SCREW BONE LP 1.5MM 3MM 7MM SELF TAP THREAD TITANIUM HAND,$63.45,$0.00,$63.45,$28.55,$45.28,$0.00,$10.61,$0.00,$0.00,$11.11,$63.45,$0.00,$31.73,$50.25,$50.76,$0.00,$9.64,$0.00,$10.10,$0.00
400.808.96,SUP,HCPCS C1713,,400.808.96  -  SCREW BONE 1.5MM 3MM 8MM SLFTAP TITANIUM HAND CORTICAL,$63.45,$0.00,$63.45,$28.55,$45.28,$0.00,$10.61,$0.00,$0.00,$11.11,$63.45,$0.00,$31.73,$50.25,$50.76,$0.00,$9.64,$0.00,$10.10,$0.00
400.809.96,SUP,HCPCS C1713,,400.809.96  -  SCREW BONE 1.5MM 9MM SLFTAP TITANIUM CORTICAL HAND NONSTRL,$63.45,$0.00,$63.45,$28.55,$45.28,$0.00,$10.61,$0.00,$0.00,$11.11,$63.45,$0.00,$31.73,$50.25,$50.76,$0.00,$9.64,$0.00,$10.10,$0.00
400.810.96,SUP,HCPCS C1713,,400.810.96  -  SCREW BONE LP 1.5MM 3MM 10MM SELF TAP THREAD TITANIUM HAND,$63.45,$0.00,$63.45,$28.55,$45.28,$0.00,$10.61,$0.00,$0.00,$11.11,$63.45,$0.00,$31.73,$50.25,$50.76,$0.00,$9.64,$0.00,$10.10,$0.00
400.811.96,SUP,HCPCS C1713,,400.811.96  -  SCREW BONE LP 1.5MM 3MM 11MM SELF TAP THREAD TITANIUM HAND,$63.45,$0.00,$63.45,$28.55,$45.28,$0.00,$10.61,$0.00,$0.00,$11.11,$63.45,$0.00,$31.73,$50.25,$50.76,$0.00,$9.64,$0.00,$10.10,$0.00
400.812.96,SUP,HCPCS C1713,,400.812.96  -  SCREW BONE 1.5MM 3MM 12MM SLFTAP TITANIUM HAND CORTICAL,$63.45,$0.00,$63.45,$28.55,$45.28,$0.00,$10.61,$0.00,$0.00,$11.11,$63.45,$0.00,$31.73,$50.25,$50.76,$0.00,$9.64,$0.00,$10.10,$0.00
400.813.96,SUP,HCPCS C1713,,400.813.96  -  SCREW BONE 1.5MM 3MM 13MM SLFTAP LP HEAD THREADED TITANIUM,$63.45,$0.00,$63.45,$28.55,$45.28,$0.00,$10.61,$0.00,$0.00,$11.11,$63.45,$0.00,$31.73,$50.25,$50.76,$0.00,$9.64,$0.00,$10.10,$0.00
400.814.96,SUP,HCPCS C1713,,400.814.96  -  SCREW BONE LP 1.5MM 3MM 14MM SELF TAP THREAD TITANIUM HAND,$63.45,$0.00,$63.45,$28.55,$45.28,$0.00,$10.61,$0.00,$0.00,$11.11,$63.45,$0.00,$31.73,$50.25,$50.76,$0.00,$9.64,$0.00,$10.10,$0.00
400.816.96,SUP,HCPCS C1713,,400.816.96  -  SCREW BONE 1.5MM 16MM SLFTAP TITANIUM CORTICAL HAND NONSTRL,$63.45,$0.00,$63.45,$28.55,$45.28,$0.00,$10.61,$0.00,$0.00,$11.11,$63.45,$0.00,$31.73,$50.25,$50.76,$0.00,$9.64,$0.00,$10.10,$0.00
400.818.96,SUP,HCPCS C1713,,400.818.96  -  SCREW BONE LP 1.5MM 3MM 18MM SELF TAP THREAD TITANIUM HAND,$63.45,$0.00,$63.45,$28.55,$45.28,$0.00,$10.61,$0.00,$0.00,$11.11,$63.45,$0.00,$31.73,$50.25,$50.76,$0.00,$9.64,$0.00,$10.10,$0.00
400.820.96,SUP,HCPCS C1713,,400.820.96  -  SCREW BONE LP 1.5MM 3MM 20MM SELF TAP THREAD TITANIUM HAND,$63.45,$0.00,$63.45,$28.55,$45.28,$0.00,$10.61,$0.00,$0.00,$11.11,$63.45,$0.00,$31.73,$50.25,$50.76,$0.00,$9.64,$0.00,$10.10,$0.00
400.822.96,SUP,HCPCS C1713,,400.822.96  -  SCREW BONE LP 1.5MM 3MM 22MM SELF TAP THREAD TITANIUM HAND,$63.45,$0.00,$63.45,$28.55,$45.28,$0.00,$10.61,$0.00,$0.00,$11.11,$63.45,$0.00,$31.73,$50.25,$50.76,$0.00,$9.64,$0.00,$10.10,$0.00
400.824.96,SUP,HCPCS C1713,,400.824.96  -  SCREW BONE LP 1.5MM 3MM 24MM SELF TAP THREAD TITANIUM HAND,$63.45,$0.00,$63.45,$28.55,$45.28,$0.00,$10.61,$0.00,$0.00,$11.11,$63.45,$0.00,$31.73,$50.25,$50.76,$0.00,$9.64,$0.00,$10.10,$0.00
400.843E,SUP,HCPCS C1713,,400.843E  -  SCREW BONE 3MM 1.6MM CRNMXF TI ALLOY SLFTAP LP STRL,$196.88,$0.00,$196.88,$88.59,$140.51,$0.00,$33.92,$0.00,$0.00,$34.47,$196.88,$0.00,$98.44,$155.93,$157.50,$0.00,$30.81,$0.00,$31.34,$0.00
400.846E,SUP,HCPCS C1713,,400.846E  -  TI LOW PROFILE NEURO SCREW SELF-TAPPING 6MM,$196.88,$0.00,$196.88,$88.59,$140.51,$0.00,$33.92,$0.00,$0.00,$34.47,$196.88,$0.00,$98.44,$155.93,$157.50,$0.00,$30.81,$0.00,$31.34,$0.00
400.855E,SUP,HCPCS C1713,,400.855E  -  SCREW BONE 5MM 2MM CRANFCL TI SLFTAP LP ER STRL,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
400.856E,SUP,HCPCS C1713,,400.856E  -  SCREW BONE 6MM 2MM CRANFCL TI SLFTAP LP ER STRL,$196.88,$0.00,$196.88,$88.59,$140.51,$0.00,$33.92,$0.00,$0.00,$34.47,$196.88,$0.00,$98.44,$155.93,$157.50,$0.00,$30.81,$0.00,$31.34,$0.00
40-0001-S,SUP,HCPCS C1713,,40-0001-S  -  ROD XTRNFX CMPR OLCRN,"$2,480.00",$0.00,"$2,480.00","$1,116.00","$1,769.98",$0.00,$427.29,$0.00,$0.00,$434.23,"$2,480.00",$0.00,"$1,240.00","$1,964.16","$1,984.00",$0.00,$388.12,$0.00,$394.82,$0.00
40-0003,SUP,Custom 27203010,,40-0003  -  NUT EXFIX OLCRN GUIDE ASMBLY NONSTRL,"$1,140.00",$0.00,"$1,140.00",$0.00,$813.62,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,140.00",$0.00,$570.00,$902.88,$912.00,$0.00,$0.00,$0.00,$0.00,$0.00
40-0006,SUP,HCPCS C1713,,40-0006  -  BOLT LCK OLCRN NONSTRL,$657.50,$0.00,$657.50,$295.88,$469.26,$0.00,$113.28,$0.00,$0.00,$115.12,$657.50,$0.00,$328.75,$520.74,$526.00,$0.00,$102.90,$0.00,$104.67,$0.00
40-0007,SUP,HCPCS C1713,,40-0007  -  CANNU ORTH TRGT ROD NONSTRL OLCRN,"$1,005.00",$0.00,"$1,005.00",$452.25,$717.27,$0.00,$173.16,$0.00,$0.00,$175.97,"$1,005.00",$0.00,$502.50,$795.96,$804.00,$0.00,$157.28,$0.00,$160.00,$0.00
40-0008,SUP,Custom 27203010,,40-0008  -  GUIDE TRGT ASMBLY CMPR NUT SURG OLCRN NONSTRL,"$1,992.50",$0.00,"$1,992.50",$0.00,"$1,422.05",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,992.50",$0.00,$996.25,"$1,578.06","$1,594.00",$0.00,$0.00,$0.00,$0.00,$0.00
40-0012,SUP,Custom 27203010,,40-0012  -  DRILL SRG NUT CMPR OLCRN,$827.50,$0.00,$827.50,$0.00,$590.59,$0.00,$0.00,$0.00,$0.00,$0.00,$827.50,$0.00,$413.75,$655.38,$662.00,$0.00,$0.00,$0.00,$0.00,$0.00
40-0013-S,SUP,Custom 27203010,,40-0013-S  -  NUT XTRNFX 6MM CMPR OLCRN,$675.00,$0.00,$675.00,$0.00,$481.75,$0.00,$0.00,$0.00,$0.00,$0.00,$675.00,$0.00,$337.50,$534.60,$540.00,$0.00,$0.00,$0.00,$0.00,$0.00
40-0014-S,SUP,Custom 27203010,,40-0014-S  -  NUT XTRNFX 8MM CMPR OLCRN,$675.00,$0.00,$675.00,$0.00,$481.75,$0.00,$0.00,$0.00,$0.00,$0.00,$675.00,$0.00,$337.50,$534.60,$540.00,$0.00,$0.00,$0.00,$0.00,$0.00
40-0015-S,SUP,Custom 27203010,,40-0015-S  -  NUT XTRNFX 10MM CMPR OLCRN,$675.00,$0.00,$675.00,$0.00,$481.75,$0.00,$0.00,$0.00,$0.00,$0.00,$675.00,$0.00,$337.50,$534.60,$540.00,$0.00,$0.00,$0.00,$0.00,$0.00
40-0016-S,SUP,Custom 27803010,,40-0016-S  -  WASHER ORTH SMTH OLCRN,$537.50,$0.00,$537.50,$0.00,$383.61,$0.00,$0.00,$0.00,$0.00,$0.00,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$0.00,$0.00,$0.00,$0.00
40-0021-S,SUP,HCPCS C1713,,40-0021-S  -  WASHER ORTH THRD OLCRN,$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
40-0026-S,SUP,HCPCS C1713,,40-0026-S  -  ROD ORTH 110MM 3MM FIB IM IMPL,"$2,705.00",$0.00,"$2,705.00","$1,217.25","$1,930.56",$0.00,$466.06,$0.00,$0.00,$473.62,"$2,705.00",$0.00,"$1,352.50","$2,142.36","$2,164.00",$0.00,$423.33,$0.00,$430.64,$0.00
40-0027-S,SUP,HCPCS C1713,,40-0027-S  -  ROD ORTH 145MM 3MM FIB ANKL FIB IM IMPL STRL,"$2,705.00",$0.00,"$2,705.00","$1,217.25","$1,930.56",$0.00,$466.06,$0.00,$0.00,$473.62,"$2,705.00",$0.00,"$1,352.50","$2,142.36","$2,164.00",$0.00,$423.33,$0.00,$430.64,$0.00
40-0028-S,SUP,HCPCS C1713,,40-0028-S  -  ROD ORTH 180MM 3MM FIB FIB IM IMPL STRL,"$2,705.00",$0.00,"$2,705.00","$1,217.25","$1,930.56",$0.00,$466.06,$0.00,$0.00,$473.62,"$2,705.00",$0.00,"$1,352.50","$2,142.36","$2,164.00",$0.00,$423.33,$0.00,$430.64,$0.00
40-0029-S,SUP,HCPCS C1713,,40-0029-S  -  ROD ORTH 110MM 3.6MM FIB FIB IM IMPL STRL,"$2,705.00",$0.00,"$2,705.00","$1,217.25","$1,930.56",$0.00,$466.06,$0.00,$0.00,$473.62,"$2,705.00",$0.00,"$1,352.50","$2,142.36","$2,164.00",$0.00,$423.33,$0.00,$430.64,$0.00
40-0030-S,SUP,HCPCS C1713,,40-0030-S  -  ROD XTRNFX 3.6MM 145MM FIB,"$2,705.00",$0.00,"$2,705.00","$1,217.25","$1,930.56",$0.00,$466.06,$0.00,$0.00,$473.62,"$2,705.00",$0.00,"$1,352.50","$2,142.36","$2,164.00",$0.00,$423.33,$0.00,$430.64,$0.00
40-0031-S,SUP,Custom 27203010,,40-0031-S  -  ROD EXFIX 180MM 3.6MM FIB,"$2,705.00",$0.00,"$2,705.00",$0.00,"$1,930.56",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,705.00",$0.00,"$1,352.50","$2,142.36","$2,164.00",$0.00,$0.00,$0.00,$0.00,$0.00
40-0034,SUP,HCPCS C1713,,40-0034  -  BASEPLATE ROD FIB,"$1,980.00",$0.00,"$1,980.00",$891.00,"$1,413.13",$0.00,$341.14,$0.00,$0.00,$346.68,"$1,980.00",$0.00,$990.00,"$1,568.16","$1,584.00",$0.00,$309.87,$0.00,$315.22,$0.00
40-0136,SUP,HCPCS C1713,,40-0136  -  SCREW BONE 3MM 80MM DL TRK TI CLVCL DIFF PTCH CUT FLUT TAIL,"$2,987.50",$0.00,"$2,987.50","$1,344.38","$2,132.18",$0.00,$514.73,$0.00,$0.00,$523.09,"$2,987.50",$0.00,"$1,493.75","$2,366.10","$2,390.00",$0.00,$467.54,$0.00,$475.61,$0.00
40-0137,SUP,HCPCS C1713,,40-0137  -  SCREW BONE 3MM 90MM DL TRK TI CLVCL DIFF PTCH CUT FLUT TAIL,"$2,987.50",$0.00,"$2,987.50","$1,344.38","$2,132.18",$0.00,$514.73,$0.00,$0.00,$523.09,"$2,987.50",$0.00,"$1,493.75","$2,366.10","$2,390.00",$0.00,$467.54,$0.00,$475.61,$0.00
40-0138,SUP,HCPCS C1713,,40-0138  -  SCREW BONE 3MM 100MM DL TRK TI CLVCL DIFF PTCH CUT FLUT TAIL,"$2,987.50",$0.00,"$2,987.50","$1,344.38","$2,132.18",$0.00,$514.73,$0.00,$0.00,$523.09,"$2,987.50",$0.00,"$1,493.75","$2,366.10","$2,390.00",$0.00,$467.54,$0.00,$475.61,$0.00
40-0139,SUP,HCPCS C1713,,40-0139  -  SCREW BONE 3MM 110MM DL TRK TI CLVCL DIFF PTCH CUT FLUT TAIL,"$2,987.50",$0.00,"$2,987.50","$1,344.38","$2,132.18",$0.00,$514.73,$0.00,$0.00,$523.09,"$2,987.50",$0.00,"$1,493.75","$2,366.10","$2,390.00",$0.00,$467.54,$0.00,$475.61,$0.00
400-14,SUP,Custom 27203010,,400-14  -  BANDAGE ADH MRDH,"$2,470.00",$0.00,"$2,470.00",$0.00,"$1,762.84",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,470.00",$0.00,"$1,235.00","$1,956.24","$1,976.00",$0.00,$0.00,$0.00,$0.00,$0.00
40-0140,SUP,HCPCS C1713,,40-0140  -  SCREW BONE 3MM 120MM DL TRK TI CLVCL DIFF PTCH CUT FLUT TAIL,"$2,987.50",$0.00,"$2,987.50","$1,344.38","$2,132.18",$0.00,$514.73,$0.00,$0.00,$523.09,"$2,987.50",$0.00,"$1,493.75","$2,366.10","$2,390.00",$0.00,$467.54,$0.00,$475.61,$0.00
40-0143,SUP,HCPCS C1713,,40-0143  -  SCREW BONE 3.8MM 80MM DL TRK TI CLVCL DIFF PTCH CUT FLUT,"$2,987.50",$0.00,"$2,987.50","$1,344.38","$2,132.18",$0.00,$514.73,$0.00,$0.00,$523.09,"$2,987.50",$0.00,"$1,493.75","$2,366.10","$2,390.00",$0.00,$467.54,$0.00,$475.61,$0.00
40-0144,SUP,HCPCS C1713,,40-0144  -  SCREW BONE 3.8MM 90MM CLVCL DL TRK,"$2,987.50",$0.00,"$2,987.50","$1,344.38","$2,132.18",$0.00,$514.73,$0.00,$0.00,$523.09,"$2,987.50",$0.00,"$1,493.75","$2,366.10","$2,390.00",$0.00,$467.54,$0.00,$475.61,$0.00
40-0145,SUP,HCPCS C1713,,40-0145  -  SCREW BONE 3.8MM 100MM DL TRK TI CLVCL DIFF PTCH CUT FLUT,"$2,987.50",$0.00,"$2,987.50","$1,344.38","$2,132.18",$0.00,$514.73,$0.00,$0.00,$523.09,"$2,987.50",$0.00,"$1,493.75","$2,366.10","$2,390.00",$0.00,$467.54,$0.00,$475.61,$0.00
40-0146,SUP,HCPCS C1713,,40-0146  -  SCREW BONE 3.8MM 110MM DL TRK TI CLVCL DIFF PTCH CUT FLUT,"$2,987.50",$0.00,"$2,987.50","$1,344.38","$2,132.18",$0.00,$514.73,$0.00,$0.00,$523.09,"$2,987.50",$0.00,"$1,493.75","$2,366.10","$2,390.00",$0.00,$467.54,$0.00,$475.61,$0.00
40-0147,SUP,HCPCS C1713,,40-0147  -  SCREW BONE 3.8MM 120MM DL TRK TI CLVCL DIFF PTCH CUT FLUT,"$2,987.50",$0.00,"$2,987.50","$1,344.38","$2,132.18",$0.00,$514.73,$0.00,$0.00,$523.09,"$2,987.50",$0.00,"$1,493.75","$2,366.10","$2,390.00",$0.00,$467.54,$0.00,$475.61,$0.00
4002C0306,SUP,Custom 27803010,,4002C0306  -  COIL EMBL .02IN STD CMPLX 3MM 6CM THE PENUMBRA COIL 400,"$5,525.00",$0.00,"$5,525.00",$0.00,"$3,943.19",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,525.00",$0.00,"$2,762.50","$4,375.80","$4,420.00",$0.00,$0.00,$0.00,$0.00,$0.00
4002C0310,SUP,Custom 27803010,,"4002C0310  -  COIL 400 COMPLEX STANDARD, 3 MM X 10 CM","$5,625.00",$0.00,"$5,625.00",$0.00,"$4,014.56",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,625.00",$0.00,"$2,812.50","$4,455.00","$4,500.00",$0.00,$0.00,$0.00,$0.00,$0.00
4002C0408,SUP,Custom 27803010,,4002C0408  -  COIL EMBL .02IN STD CMPLX 4MM 8CM THE PENUMBRA COIL 400,"$5,017.50",$0.00,"$5,017.50",$0.00,"$3,580.99",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,017.50",$0.00,"$2,508.75","$3,973.86","$4,014.00",$0.00,$0.00,$0.00,$0.00,$0.00
4002C0412,SUP,Custom 27803010,,"4002C0412  -  COIL 400 COMPLEX STANDARD, 4 MM X 12 CM","$5,675.00",$0.00,"$5,675.00",$0.00,"$4,050.25",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,675.00",$0.00,"$2,837.50","$4,494.60","$4,540.00",$0.00,$0.00,$0.00,$0.00,$0.00
4002C0506,SUP,Custom 27803010,,4002C0506  -  COIL EMBOLIZATION .02IN STANDARD COMPLEX 5MM 6CM COMPLEX THE,"$4,972.50",$0.00,"$4,972.50",$0.00,"$3,548.87",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,972.50",$0.00,"$2,486.25","$3,938.22","$3,978.00",$0.00,$0.00,$0.00,$0.00,$0.00
4002C0510,SUP,Custom 27803010,,4002C0510  -  COIL EMBL STD 5MM 10CM PENUMBRA COIL 400 CMPLX,"$5,062.50",$0.00,"$5,062.50",$0.00,"$3,613.11",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,062.50",$0.00,"$2,531.25","$4,009.50","$4,050.00",$0.00,$0.00,$0.00,$0.00,$0.00
4002C0610,SUP,Custom 27803010,,4002C0610  -  COIL EMBOLIZATION .02IN STANDARD COMPLEX 6MM 10CM COMPLEX,"$5,062.50",$0.00,"$5,062.50",$0.00,"$3,613.11",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,062.50",$0.00,"$2,531.25","$4,009.50","$4,050.00",$0.00,$0.00,$0.00,$0.00,$0.00
4002C0615,SUP,Custom 27803010,,4002C0615  -  COIL EMBL STD 6MM 15CM PENUMBRA COIL 400 CMPLX,"$5,175.00",$0.00,"$5,175.00",$0.00,"$3,693.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,175.00",$0.00,"$2,587.50","$4,098.60","$4,140.00",$0.00,$0.00,$0.00,$0.00,$0.00
4002C0710,SUP,Custom 27803010,,4002C0710  -  COIL EMBOLIZATION .02IN STANDARD COMPLEX 7MM 10CM COMPLEX,"$5,062.50",$0.00,"$5,062.50",$0.00,"$3,613.11",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,062.50",$0.00,"$2,531.25","$4,009.50","$4,050.00",$0.00,$0.00,$0.00,$0.00,$0.00
4002C0715,SUP,Custom 27803010,,4002C0715  -  COIL EMBOLIZATION .02IN STANDARD COMPLEX 7MM 15CM COMPLEX,"$5,175.00",$0.00,"$5,175.00",$0.00,"$3,693.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,175.00",$0.00,"$2,587.50","$4,098.60","$4,140.00",$0.00,$0.00,$0.00,$0.00,$0.00
4002C0720,SUP,Custom 27803010,,4002C0720  -  COIL EMBL STD 7MM 20CM PENUMBRA COIL 400 CMPLX,"$5,287.50",$0.00,"$5,287.50",$0.00,"$3,773.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,287.50",$0.00,"$2,643.75","$4,187.70","$4,230.00",$0.00,$0.00,$0.00,$0.00,$0.00
4002C0815,SUP,Custom 27803010,,"4002C0815  -  COIL 400 COMPLEX STANDARD, 8 MM X 15 CM","$5,750.00",$0.00,"$5,750.00",$0.00,"$4,103.78",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,750.00",$0.00,"$2,875.00","$4,554.00","$4,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
4002C0820,SUP,Custom 27803010,,4002C0820  -  COIL EMBL .02IN STD CMPLX 8MM 20CM THE PENUMBRA COIL 400,"$5,287.50",$0.00,"$5,287.50",$0.00,"$3,773.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,287.50",$0.00,"$2,643.75","$4,187.70","$4,230.00",$0.00,$0.00,$0.00,$0.00,$0.00
4002C0830,SUP,Custom 27803010,,4002C0830  -  COIL EMBOLIZATION .02IN STANDARD COMPLEX 8MM 30CM COMPLEX,"$5,512.50",$0.00,"$5,512.50",$0.00,"$3,934.27",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,512.50",$0.00,"$2,756.25","$4,365.90","$4,410.00",$0.00,$0.00,$0.00,$0.00,$0.00
4002C0915,SUP,Custom 27803010,,4002C0915  -  COIL EMBL .02IN STD CMPLX 9MM 15CM THE PENUMBRA COIL 400,"$5,750.00",$0.00,"$5,750.00",$0.00,"$4,103.78",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,750.00",$0.00,"$2,875.00","$4,554.00","$4,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
4002C0925,SUP,Custom 27803010,,4002C0925  -  COIL EMBOLIZATION .02IN STANDARD COMPLEX 9MM 25CM COMPLEX,"$5,400.00",$0.00,"$5,400.00",$0.00,"$3,853.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,400.00",$0.00,"$2,700.00","$4,276.80","$4,320.00",$0.00,$0.00,$0.00,$0.00,$0.00
4002C0935,SUP,Custom 27803010,,4002C0935  -  COIL EMBL .02IN STD CMPLX 9MM 35CM THE PENUMBRA COIL 400,"$5,570.00",$0.00,"$5,570.00",$0.00,"$3,975.31",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,570.00",$0.00,"$2,785.00","$4,411.44","$4,456.00",$0.00,$0.00,$0.00,$0.00,$0.00
4002C1020,SUP,Custom 27803010,,4002C1020  -  COIL EMBOLIZATION .02IN STANDARD COMPLEX 10MM 20CM COMPLEX,"$5,287.50",$0.00,"$5,287.50",$0.00,"$3,773.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,287.50",$0.00,"$2,643.75","$4,187.70","$4,230.00",$0.00,$0.00,$0.00,$0.00,$0.00
4002C1030,SUP,Custom 27803010,,4002C1030  -  COIL EMBOLIZATION .02IN STANDARD COMPLEX 10MM 30CM COMPLEX,"$5,512.50",$0.00,"$5,512.50",$0.00,"$3,934.27",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,512.50",$0.00,"$2,756.25","$4,365.90","$4,410.00",$0.00,$0.00,$0.00,$0.00,$0.00
4002C1040,SUP,Custom 27803010,,4002C1040  -  COIL EMBL .02IN STD CMPLX 10MM 40CM THE PENUMBRA COIL 400,"$5,625.00",$0.00,"$5,625.00",$0.00,"$4,014.56",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,625.00",$0.00,"$2,812.50","$4,455.00","$4,500.00",$0.00,$0.00,$0.00,$0.00,$0.00
4002C1135,SUP,Custom 27803010,,4002C1135  -  COIL EMBOLIZATION .02IN STANDARD COMPLEX 11MM 35CM COMPLEX,"$5,570.00",$0.00,"$5,570.00",$0.00,"$3,975.31",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,570.00",$0.00,"$2,785.00","$4,411.44","$4,456.00",$0.00,$0.00,$0.00,$0.00,$0.00
4002C1145,SUP,Custom 27803010,,4002C1145  -  COIL EMBOLIZATION .02IN STANDARD COMPLEX 11MM 45CM COMPLEX,"$5,682.50",$0.00,"$5,682.50",$0.00,"$4,055.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,682.50",$0.00,"$2,841.25","$4,500.54","$4,546.00",$0.00,$0.00,$0.00,$0.00,$0.00
4002C1235,SUP,Custom 27803010,,4002C1235  -  COIL EMBOLIZATION .02IN STANDARD COMPLEX 12MM 35CM COMPLEX,"$5,570.00",$0.00,"$5,570.00",$0.00,"$3,975.31",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,570.00",$0.00,"$2,785.00","$4,411.44","$4,456.00",$0.00,$0.00,$0.00,$0.00,$0.00
4002C1245,SUP,Custom 27803010,,4002C1245  -  COIL EMBOLIZATION .02IN STANDARD COMPLEX 12MM 45CM COMPLEX,"$5,682.50",$0.00,"$5,682.50",$0.00,"$4,055.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,682.50",$0.00,"$2,841.25","$4,500.54","$4,546.00",$0.00,$0.00,$0.00,$0.00,$0.00
4002C1335,SUP,Custom 27803010,,"4002C1335  -  COIL 400 COMPLEX STANDARD, 13MM X 35CM","$6,187.50",$0.00,"$6,187.50",$0.00,"$4,416.02",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,187.50",$0.00,"$3,093.75","$4,900.50","$4,950.00",$0.00,$0.00,$0.00,$0.00,$0.00
4002C1348,SUP,Custom 27803010,,4002C1348  -  COIL EMBL STD .02IN 13MM 48CM DTCH CMPLX STRCH RS PLTN,"$5,715.00",$0.00,"$5,715.00",$0.00,"$4,078.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,715.00",$0.00,"$2,857.50","$4,526.28","$4,572.00",$0.00,$0.00,$0.00,$0.00,$0.00
4002C1450,SUP,Custom 27803010,,4002C1450  -  COIL EMBOLIZATION .02IN STANDARD COMPLEX 14MM 50CM COMPLEX,"$5,737.50",$0.00,"$5,737.50",$0.00,"$4,094.85",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,737.50",$0.00,"$2,868.75","$4,544.10","$4,590.00",$0.00,$0.00,$0.00,$0.00,$0.00
4002C1557,SUP,Custom 27803010,,4002C1557  -  COIL EMBOLIZATION .02IN STANDARD COMPLEX 15MM 57CM COMPLEX,"$5,817.50",$0.00,"$5,817.50",$0.00,"$4,151.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,817.50",$0.00,"$2,908.75","$4,607.46","$4,654.00",$0.00,$0.00,$0.00,$0.00,$0.00
4002C1660,SUP,Custom 27803010,,4002C1660  -  COIL EMBL .02IN STD CMPLX 16MM 60CM THE PENUMBRA COIL 400,"$5,850.00",$0.00,"$5,850.00",$0.00,"$4,175.15",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,850.00",$0.00,"$2,925.00","$4,633.20","$4,680.00",$0.00,$0.00,$0.00,$0.00,$0.00
4002C1857,SUP,Custom 27803010,,4002C1857  -  COIL EMBOLIZATION .02IN STANDARD COMPLEX 18MM 57CM COMPLEX,"$5,817.50",$0.00,"$5,817.50",$0.00,"$4,151.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,817.50",$0.00,"$2,908.75","$4,607.46","$4,654.00",$0.00,$0.00,$0.00,$0.00,$0.00
4002C2060,SUP,Custom 27803010,,4002C2060  -  COIL EMBL .02IN STD CMPLX 20MM 60CM THE PENUMBRA COIL 400,"$5,850.00",$0.00,"$5,850.00",$0.00,"$4,175.15",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,850.00",$0.00,"$2,925.00","$4,633.20","$4,680.00",$0.00,$0.00,$0.00,$0.00,$0.00
4002C2260,SUP,Custom 27803010,,4002C2260  -  COIL EMBOLIZATION .02IN STANDARD COMPLEX 22MM 60CM COMPLEX,"$5,850.00",$0.00,"$5,850.00",$0.00,"$4,175.15",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,850.00",$0.00,"$2,925.00","$4,633.20","$4,680.00",$0.00,$0.00,$0.00,$0.00,$0.00
4002C2457,SUP,Custom 27803010,,4002C2457  -  COIL EMBL .02IN STD CMPLX 24MM 57CM THE PENUMBRA COIL 400,"$5,817.50",$0.00,"$5,817.50",$0.00,"$4,151.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,817.50",$0.00,"$2,908.75","$4,607.46","$4,654.00",$0.00,$0.00,$0.00,$0.00,$0.00
4002C2860,SUP,Custom 27803010,,4002C2860  -  COIL EMBOLIZATION .02IN STANDARD COMPLEX 28MM 60CM COMPLEX,"$6,525.00",$0.00,"$6,525.00",$0.00,"$4,656.89",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,525.00",$0.00,"$3,262.50","$5,167.80","$5,220.00",$0.00,$0.00,$0.00,$0.00,$0.00
4002C3260,SUP,Custom 27803010,,4002C3260  -  COIL EMBL .02IN STD CMPLX 32MM 60CM THE PENUMBRA COIL 400,"$6,525.00",$0.00,"$6,525.00",$0.00,"$4,656.89",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,525.00",$0.00,"$3,262.50","$5,167.80","$5,220.00",$0.00,$0.00,$0.00,$0.00,$0.00
4004C0303,SUP,Custom 27803010,,"4004C0303  -  COIL 400 COMPLEX SOFT, 3 MM X 3 CM","$5,950.00",$0.00,"$5,950.00",$0.00,"$4,246.52",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,950.00",$0.00,"$2,975.00","$4,712.40","$4,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
4004C0304,SUP,Custom 27803010,,"4004C0304  -  COIL 400 COMPLEX SOFT, 3 MM X 4 CM","$5,975.00",$0.00,"$5,975.00",$0.00,"$4,264.36",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,975.00",$0.00,"$2,987.50","$4,732.20","$4,780.00",$0.00,$0.00,$0.00,$0.00,$0.00
4004C0306,SUP,Custom 27803010,,4004C0306  -  COIL EMBL .02IN CMPLX 3MM 6CM THE PENUMBRA COIL 400 SFT,"$5,422.50",$0.00,"$5,422.50",$0.00,"$3,870.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,422.50",$0.00,"$2,711.25","$4,294.62","$4,338.00",$0.00,$0.00,$0.00,$0.00,$0.00
4004C0310,SUP,Custom 27803010,,4004C0310  -  COIL EMBOLIZATION .02IN COMPLEX 3MM 10CM SOFT THE PENUMBRA,"$5,512.50",$0.00,"$5,512.50",$0.00,"$3,934.27",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,512.50",$0.00,"$2,756.25","$4,365.90","$4,410.00",$0.00,$0.00,$0.00,$0.00,$0.00
4004C0404,SUP,Custom 27803010,,4004C0404  -  COIL EMBOLIZATION .02IN COMPLEX 4MM 4CM SOFT THE PENUMBRA,"$5,377.50",$0.00,"$5,377.50",$0.00,"$3,837.92",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,377.50",$0.00,"$2,688.75","$4,258.98","$4,302.00",$0.00,$0.00,$0.00,$0.00,$0.00
4004C0406,SUP,Custom 27803010,,4004C0406  -  COIL EMBOLIZATION .02IN COMPLEX 4MM 6CM SOFT THE PENUMBRA,"$5,422.50",$0.00,"$5,422.50",$0.00,"$3,870.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,422.50",$0.00,"$2,711.25","$4,294.62","$4,338.00",$0.00,$0.00,$0.00,$0.00,$0.00
4004C0408,SUP,Custom 27803010,,4004C0408  -  COIL EMBL .02IN CMPLX 4MM 8CM THE PENUMBRA COIL 400 SFT,"$5,467.50",$0.00,"$5,467.50",$0.00,"$3,902.15",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,467.50",$0.00,"$2,733.75","$4,330.26","$4,374.00",$0.00,$0.00,$0.00,$0.00,$0.00
4004C0412,SUP,Custom 27803010,,4004C0412  -  COIL EMBOLIZATION .02IN COMPLEX 4MM 12CM SOFT THE PENUMBRA,"$5,557.50",$0.00,"$5,557.50",$0.00,"$3,966.39",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,557.50",$0.00,"$2,778.75","$4,401.54","$4,446.00",$0.00,$0.00,$0.00,$0.00,$0.00
4004C0509,SUP,Custom 27803010,,4004C0509  -  COIL EMBL .02IN CMPLX 5MM 9CM THE PENUMBRA COIL 400 SFT,"$5,490.00",$0.00,"$5,490.00",$0.00,"$3,918.21",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,490.00",$0.00,"$2,745.00","$4,348.08","$4,392.00",$0.00,$0.00,$0.00,$0.00,$0.00
4004C0513,SUP,Custom 27803010,,4004C0513  -  COIL EMBOLIZATION .02IN COMPLEX 5MM 13CM SOFT THE PENUMBRA,"$5,580.00",$0.00,"$5,580.00",$0.00,"$3,982.45",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,580.00",$0.00,"$2,790.00","$4,419.36","$4,464.00",$0.00,$0.00,$0.00,$0.00,$0.00
4004C0610,SUP,Custom 27803010,,4004C0610  -  COIL EMBL .02IN CMPLX 6MM 10CM THE PENUMBRA COIL 400 SFT,"$5,512.50",$0.00,"$5,512.50",$0.00,"$3,934.27",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,512.50",$0.00,"$2,756.25","$4,365.90","$4,410.00",$0.00,$0.00,$0.00,$0.00,$0.00
4004C0615,SUP,Custom 27803010,,4004C0615  -  COIL EMBOLIZATION .02IN COMPLEX 6MM 15CM SOFT THE PENUMBRA,"$5,625.00",$0.00,"$5,625.00",$0.00,"$4,014.56",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,625.00",$0.00,"$2,812.50","$4,455.00","$4,500.00",$0.00,$0.00,$0.00,$0.00,$0.00
4004C0620,SUP,Custom 27803010,,4004C0620  -  COIL EMBL .02IN CMPLX 6MM 20CM THE PENUMBRA COIL 400 SFT,"$6,375.00",$0.00,"$6,375.00",$0.00,"$4,549.84",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,375.00",$0.00,"$3,187.50","$5,049.00","$5,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
4004C0710,SUP,Custom 27803010,,4004C0710  -  COIL EMBL .02IN CMPLX 7MM 10CM THE PENUMBRA COIL 400 SFT,"$5,512.50",$0.00,"$5,512.50",$0.00,"$3,934.27",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,512.50",$0.00,"$2,756.25","$4,365.90","$4,410.00",$0.00,$0.00,$0.00,$0.00,$0.00
4004C0715,SUP,Custom 27803010,,4004C0715  -  COIL EMBL .02IN CMPLX 7MM 15CM THE PENUMBRA COIL 400 SFT,"$5,625.00",$0.00,"$5,625.00",$0.00,"$4,014.56",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,625.00",$0.00,"$2,812.50","$4,455.00","$4,500.00",$0.00,$0.00,$0.00,$0.00,$0.00
4004C0720,SUP,Custom 27803010,,4004C0720  -  COIL EMBOLIZATION .02IN COMPLEX 7MM 20CM SOFT THE PENUMBRA,"$5,737.50",$0.00,"$5,737.50",$0.00,"$4,094.85",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,737.50",$0.00,"$2,868.75","$4,544.10","$4,590.00",$0.00,$0.00,$0.00,$0.00,$0.00
4004C0815,SUP,Custom 27803010,,4004C0815  -  COIL EMBL .02IN CMPLX 8MM 15CM THE PENUMBRA COIL 400 SFT,"$5,625.00",$0.00,"$5,625.00",$0.00,"$4,014.56",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,625.00",$0.00,"$2,812.50","$4,455.00","$4,500.00",$0.00,$0.00,$0.00,$0.00,$0.00
4004C0820,SUP,Custom 27803010,,4004C0820  -  COIL EMBL .02IN CMPLX 8MM 20CM THE PENUMBRA COIL 400 SFT,"$5,737.50",$0.00,"$5,737.50",$0.00,"$4,094.85",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,737.50",$0.00,"$2,868.75","$4,544.10","$4,590.00",$0.00,$0.00,$0.00,$0.00,$0.00
4004C0830,SUP,Custom 27803010,,"4004C0830  -  COIL 400 COMPLEX SOFT, 8MM X 30CM","$6,625.00",$0.00,"$6,625.00",$0.00,"$4,728.26",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,625.00",$0.00,"$3,312.50","$5,247.00","$5,300.00",$0.00,$0.00,$0.00,$0.00,$0.00
4004C0925,SUP,Custom 27803010,,4004C0925  -  COIL EMBL .02IN CMPLX 9MM 25CM THE PENUMBRA COIL 400 SFT,"$5,850.00",$0.00,"$5,850.00",$0.00,"$4,175.15",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,850.00",$0.00,"$2,925.00","$4,633.20","$4,680.00",$0.00,$0.00,$0.00,$0.00,$0.00
4004C0935,SUP,Custom 27803010,,"4004C0935  -  COIL 400 COMPLEX SOFT, 9MM X 35CM","$6,750.00",$0.00,"$6,750.00",$0.00,"$4,817.48",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,750.00",$0.00,"$3,375.00","$5,346.00","$5,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
4004C1020,SUP,Custom 27803010,,4004C1020  -  COIL EMBL .02IN CMPLX 10MM 20CM THE PENUMBRA COIL 400 SFT,"$5,737.50",$0.00,"$5,737.50",$0.00,"$4,094.85",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,737.50",$0.00,"$2,868.75","$4,544.10","$4,590.00",$0.00,$0.00,$0.00,$0.00,$0.00
4004C1030,SUP,Custom 27803010,,4004C1030  -  COIL EMBOLIZATION .02IN COMPLEX 10MM 30CM SOFT THE PENUMBRA,"$5,962.50",$0.00,"$5,962.50",$0.00,"$4,255.44",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,962.50",$0.00,"$2,981.25","$4,722.30","$4,770.00",$0.00,$0.00,$0.00,$0.00,$0.00
4004C1040,SUP,Custom 27803010,,4004C1040  -  COIL EMBL .02IN CMPLX 10MM 40CM THE PENUMBRA COIL 400 SFT,"$6,875.00",$0.00,"$6,875.00",$0.00,"$4,906.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,875.00",$0.00,"$3,437.50","$5,445.00","$5,500.00",$0.00,$0.00,$0.00,$0.00,$0.00
4004C1135,SUP,Custom 27803010,,4004C1135  -  COIL EMBOLIZATION .02IN COMPLEX 11MM 35CM SOFT THE PENUMBRA,"$6,075.00",$0.00,"$6,075.00",$0.00,"$4,335.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,075.00",$0.00,"$3,037.50","$4,811.40","$4,860.00",$0.00,$0.00,$0.00,$0.00,$0.00
4004C1145,SUP,Custom 27803010,,4004C1145  -  COIL EMBL .02IN CMPLX 11MM 45CM THE PENUMBRA COIL 400 SFT,"$7,000.00",$0.00,"$7,000.00",$0.00,"$4,995.90",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,000.00",$0.00,"$3,500.00","$5,544.00","$5,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
4004C1235,SUP,Custom 27803010,,4004C1235  -  COIL EMBL .02IN CMPLX 12MM 35CM THE PENUMBRA COIL 400 SFT,"$6,075.00",$0.00,"$6,075.00",$0.00,"$4,335.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,075.00",$0.00,"$3,037.50","$4,811.40","$4,860.00",$0.00,$0.00,$0.00,$0.00,$0.00
4004C1245,SUP,Custom 27803010,,"4004C1245  -  COIL 400 COMPLEX SOFT, 12MM X 45CM","$7,000.00",$0.00,"$7,000.00",$0.00,"$4,995.90",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,000.00",$0.00,"$3,500.00","$5,544.00","$5,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
4004C1335,SUP,Custom 27803010,,4004C1335  -  COIL EMBOLIZATION .02IN COMPLEX 13MM 35CM SOFT THE PENUMBRA,"$6,075.00",$0.00,"$6,075.00",$0.00,"$4,335.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,075.00",$0.00,"$3,037.50","$4,811.40","$4,860.00",$0.00,$0.00,$0.00,$0.00,$0.00
4004C1348,SUP,Custom 27803010,,4004C1348  -  COIL EMBL .02IN CMPLX 13MM 48CM THE PENUMBRA COIL 400 SFT,"$7,075.00",$0.00,"$7,075.00",$0.00,"$5,049.43",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,075.00",$0.00,"$3,537.50","$5,603.40","$5,660.00",$0.00,$0.00,$0.00,$0.00,$0.00
4004C1440,SUP,Custom 27803010,,4004C1440  -  COIL EMBOLIZATION .02IN COMPLEX 14MM 40CM SOFT THE PENUMBRA,"$6,187.50",$0.00,"$6,187.50",$0.00,"$4,416.02",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,187.50",$0.00,"$3,093.75","$4,900.50","$4,950.00",$0.00,$0.00,$0.00,$0.00,$0.00
4004C1450,SUP,Custom 27803010,,4004C1450  -  COIL EMBL .02IN CMPLX 14MM 50CM THE PENUMBRA COIL 400 SFT,"$7,125.00",$0.00,"$7,125.00",$0.00,"$5,085.11",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,125.00",$0.00,"$3,562.50","$5,643.00","$5,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
4004C1645,SUP,Custom 27803010,,4004C1645  -  COIL EMBOLIZATION 16MM 45CM COMPLEX SOFT,"$6,300.00",$0.00,"$6,300.00",$0.00,"$4,496.31",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,300.00",$0.00,"$3,150.00","$4,989.60","$5,040.00",$0.00,$0.00,$0.00,$0.00,$0.00
4004J10,SUP,Custom 27803010,,4004J10  -  COIL EMBOLIZATION 10CM J SOFT FILL COIL 400 NITINOL,"$5,670.00",$0.00,"$5,670.00",$0.00,"$4,046.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,670.00",$0.00,"$2,835.00","$4,490.64","$4,536.00",$0.00,$0.00,$0.00,$0.00,$0.00
4004J15,SUP,Custom 27803010,,4004J15  -  COIL EMBOLIZATION 15CM J COIL 400,"$5,895.00",$0.00,"$5,895.00",$0.00,"$4,207.26",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,895.00",$0.00,"$2,947.50","$4,668.84","$4,716.00",$0.00,$0.00,$0.00,$0.00,$0.00
4004J25,SUP,Custom 27803010,,4004J25  -  COIL EMBL 25CM THE PENUMBRA COIL 400 J SFT FIL NTNL,"$6,345.00",$0.00,"$6,345.00",$0.00,"$4,528.43",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,345.00",$0.00,"$3,172.50","$5,025.24","$5,076.00",$0.00,$0.00,$0.00,$0.00,$0.00
4004J7,SUP,Custom 27803010,,4004J7  -  COIL EMBL 7CM PENUMBRA COIL 400 J SFT FIL NTNL,"$5,085.00",$0.00,"$5,085.00",$0.00,"$3,629.16",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$0.00,$0.00,$0.00,$0.00
4006C0202,SUP,Custom 27803010,,4006C0202  -  COIL EMBOLIZATION .02IN COMPLEX 2MM 2CM EXTRA SOFT THE,"$4,320.00",$0.00,"$4,320.00",$0.00,"$3,083.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,320.00",$0.00,"$2,160.00","$3,421.44","$3,456.00",$0.00,$0.00,$0.00,$0.00,$0.00
4006C0203,SUP,Custom 27803010,,4006C0203  -  COIL EMBOLIZATION .02IN COMPLEX .02IN 2MM 3CM EXTRA SOFT,"$4,557.50",$0.00,"$4,557.50",$0.00,"$3,252.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,557.50",$0.00,"$2,278.75","$3,609.54","$3,646.00",$0.00,$0.00,$0.00,$0.00,$0.00
4006C0204,SUP,Custom 27803010,,4006C0204  -  COIL EMBOLIZATION .02IN COMPLEX 2MM 4CM XSOFT THE PENUMBRA,"$4,792.50",$0.00,"$4,792.50",$0.00,"$3,420.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,792.50",$0.00,"$2,396.25","$3,795.66","$3,834.00",$0.00,$0.00,$0.00,$0.00,$0.00
4006C0303,SUP,Custom 27803010,,4006C0303  -  COIL EMBL .02IN CMPLX 3MM 3CM THE PENUMBRA COIL 400 XSFT,"$4,557.50",$0.00,"$4,557.50",$0.00,"$3,252.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,557.50",$0.00,"$2,278.75","$3,609.54","$3,646.00",$0.00,$0.00,$0.00,$0.00,$0.00
4006C0304,SUP,Custom 27803010,,4006C0304  -  COIL EMBOLIZATION .02IN COMPLEX 3MM 4CM XSOFT THE PENUMBRA,"$4,792.50",$0.00,"$4,792.50",$0.00,"$3,420.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,792.50",$0.00,"$2,396.25","$3,795.66","$3,834.00",$0.00,$0.00,$0.00,$0.00,$0.00
4006C0305,SUP,Custom 27803010,,4006C0305  -  COIL EMBL .02IN CMPLX 3MM 5CM THE PENUMBRA COIL 400 XSFT,"$5,030.00",$0.00,"$5,030.00",$0.00,"$3,589.91",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,030.00",$0.00,"$2,515.00","$3,983.76","$4,024.00",$0.00,$0.00,$0.00,$0.00,$0.00
4006C0306,SUP,Custom 27803010,,4006C0306  -  COIL EMBOLIZATION .02IN COMPLEX .02IN 3MM 6CM EXTRA SOFT,"$5,265.00",$0.00,"$5,265.00",$0.00,"$3,757.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,265.00",$0.00,"$2,632.50","$4,169.88","$4,212.00",$0.00,$0.00,$0.00,$0.00,$0.00
4006C0308,SUP,Custom 27803010,,4006C0308  -  COIL EMBL .02IN CMPLX 3MM 8CM THE PENUMBRA COIL 400 XSFT,"$5,737.50",$0.00,"$5,737.50",$0.00,"$4,094.85",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,737.50",$0.00,"$2,868.75","$4,544.10","$4,590.00",$0.00,$0.00,$0.00,$0.00,$0.00
4006C0310,SUP,Custom 27803010,,"4006C0310  -  COIL 400 COMPLEX EXTRA SOFT, 3MM X 10CM","$6,900.00",$0.00,"$6,900.00",$0.00,"$4,924.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,900.00",$0.00,"$3,450.00","$5,464.80","$5,520.00",$0.00,$0.00,$0.00,$0.00,$0.00
4006C0404,SUP,Custom 27803010,,4006C0404  -  COIL EMBL .02IN CMPLX 4MM 4CM THE PENUMBRA COIL 400 XSFT,"$4,792.50",$0.00,"$4,792.50",$0.00,"$3,420.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,792.50",$0.00,"$2,396.25","$3,795.66","$3,834.00",$0.00,$0.00,$0.00,$0.00,$0.00
4006C0406,SUP,Custom 27803010,,4006C0406  -  COIL EMBOLIZATION .02IN COMPLEX 4MM 6CM XSOFT THE PENUMBRA,"$5,265.00",$0.00,"$5,265.00",$0.00,"$3,757.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,265.00",$0.00,"$2,632.50","$4,169.88","$4,212.00",$0.00,$0.00,$0.00,$0.00,$0.00
4006C0408,SUP,Custom 27803010,,4006C0408  -  COIL EMBL .02IN CMPLX 4MM 8CM THE PENUMBRA COIL 400 XSFT,"$5,737.50",$0.00,"$5,737.50",$0.00,"$4,094.85",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,737.50",$0.00,"$2,868.75","$4,544.10","$4,590.00",$0.00,$0.00,$0.00,$0.00,$0.00
4006C0410,SUP,Custom 27803010,,4006C0410  -  COIL EMBL .02IN CMPLX 4MM 10CM THE PENUMBRA COIL 400 XSFT,"$6,210.00",$0.00,"$6,210.00",$0.00,"$4,432.08",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,210.00",$0.00,"$3,105.00","$4,918.32","$4,968.00",$0.00,$0.00,$0.00,$0.00,$0.00
4006U0201,SUP,Custom 27803010,,4006U0201  -  COIL EMBOLIZATION CURVE 2MM 1CM XSOFT THE PENUMBRA COIL 400,"$3,860.00",$0.00,"$3,860.00",$0.00,"$2,754.88",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,860.00",$0.00,"$1,930.00","$3,057.12","$3,088.00",$0.00,$0.00,$0.00,$0.00,$0.00
4006U0202,SUP,Custom 27803010,,4006U0202  -  COIL EMBL CRV 2MM 2CM THE PENUMBRA COIL 400 XSFT,"$4,095.00",$0.00,"$4,095.00",$0.00,"$2,922.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,095.00",$0.00,"$2,047.50","$3,243.24","$3,276.00",$0.00,$0.00,$0.00,$0.00,$0.00
4006U0203,SUP,Custom 27803010,,4006U0203  -  COIL EMBOLIZATION CURVE 2MM 3CM XSOFT THE PENUMBRA COIL 400,"$4,332.50",$0.00,"$4,332.50",$0.00,"$3,092.11",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,332.50",$0.00,"$2,166.25","$3,431.34","$3,466.00",$0.00,$0.00,$0.00,$0.00,$0.00
4006U0204,SUP,Custom 27803010,,4006U0204  -  COIL EMBL CRV 2MM 4CM THE PENUMBRA COIL 400 XSFT,"$4,567.50",$0.00,"$4,567.50",$0.00,"$3,259.82",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,567.50",$0.00,"$2,283.75","$3,617.46","$3,654.00",$0.00,$0.00,$0.00,$0.00,$0.00
4006U0302,SUP,Custom 27803010,,4006U0302  -  COIL EMBOLIZATION CURVE 3MM 2CM XSOFT THE PENUMBRA COIL 400,"$4,095.00",$0.00,"$4,095.00",$0.00,"$2,922.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,095.00",$0.00,"$2,047.50","$3,243.24","$3,276.00",$0.00,$0.00,$0.00,$0.00,$0.00
4006U0303,SUP,Custom 27803010,,4006U0303  -  COIL EMBL CRV 3MM 3CM THE PENUMBRA COIL 400 XSFT,"$4,332.50",$0.00,"$4,332.50",$0.00,"$3,092.11",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,332.50",$0.00,"$2,166.25","$3,431.34","$3,466.00",$0.00,$0.00,$0.00,$0.00,$0.00
4006U0304,SUP,Custom 27803010,,4006U0304  -  COIL EMBOLIZATION CURVE 3MM 4CM XSOFT THE PENUMBRA COIL 400,"$4,567.50",$0.00,"$4,567.50",$0.00,"$3,259.82",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,567.50",$0.00,"$2,283.75","$3,617.46","$3,654.00",$0.00,$0.00,$0.00,$0.00,$0.00
4006U0305,SUP,Custom 27803010,,4006U0305  -  COIL EMBL CRV 3MM 5CM THE PENUMBRA COIL 400 XSFT,"$4,805.00",$0.00,"$4,805.00",$0.00,"$3,429.33",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,805.00",$0.00,"$2,402.50","$3,805.56","$3,844.00",$0.00,$0.00,$0.00,$0.00,$0.00
4006U0306,SUP,Custom 27803010,,4006U0306  -  COIL EMBOLIZATION CURVE 3MM 6CM XSOFT THE PENUMBRA COIL 400,"$5,040.00",$0.00,"$5,040.00",$0.00,"$3,597.05",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,040.00",$0.00,"$2,520.00","$3,991.68","$4,032.00",$0.00,$0.00,$0.00,$0.00,$0.00
4006U0308,SUP,Custom 27803010,,4006U0308  -  COIL EMBOLIZATION CURVE 3MM 8CM XSOFT THE PENUMBRA COIL 400,"$5,512.50",$0.00,"$5,512.50",$0.00,"$3,934.27",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,512.50",$0.00,"$2,756.25","$4,365.90","$4,410.00",$0.00,$0.00,$0.00,$0.00,$0.00
4006U0310,SUP,Custom 27803010,,4006U0310  -  COIL EMBL CRV 3MM 10CM THE PENUMBRA COIL 400 XSFT,"$6,512.50",$0.00,"$6,512.50",$0.00,"$4,647.97",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,512.50",$0.00,"$3,256.25","$5,157.90","$5,210.00",$0.00,$0.00,$0.00,$0.00,$0.00
4006U0404,SUP,Custom 27803010,,4006U0404  -  COIL EMBOLIZATION CURVE 4MM 4CM XSOFT THE PENUMBRA COIL 400,"$4,567.50",$0.00,"$4,567.50",$0.00,"$3,259.82",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,567.50",$0.00,"$2,283.75","$3,617.46","$3,654.00",$0.00,$0.00,$0.00,$0.00,$0.00
4006U0406,SUP,Custom 27803010,,4006U0406  -  COIL EMBL CRV 4MM 6CM THE PENUMBRA COIL 400 XSFT,"$5,040.00",$0.00,"$5,040.00",$0.00,"$3,597.05",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,040.00",$0.00,"$2,520.00","$3,991.68","$4,032.00",$0.00,$0.00,$0.00,$0.00,$0.00
4006U0408,SUP,Custom 27803010,,4006U0408  -  COIL EMBOLIZATION CURVE 4MM 8CM XSOFT THE PENUMBRA COIL 400,"$5,512.50",$0.00,"$5,512.50",$0.00,"$3,934.27",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,512.50",$0.00,"$2,756.25","$4,365.90","$4,410.00",$0.00,$0.00,$0.00,$0.00,$0.00
4006U0410,SUP,Custom 27803010,,4006U0410  -  COIL EMBL CRV 4MM 10CM THE PENUMBRA COIL 400 XSFT,"$5,862.50",$0.00,"$5,862.50",$0.00,"$4,184.07",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,862.50",$0.00,"$2,931.25","$4,643.10","$4,690.00",$0.00,$0.00,$0.00,$0.00,$0.00
401.042E,SUP,HCPCS C1713,,401.042E  -  SCREW BONE SLFTAP +DR RECESS GOLD 5MM 2MM CORT CRANFCL TI,$158.63,$0.00,$158.63,$71.38,$113.21,$0.00,$27.33,$0.00,$0.00,$27.77,$158.63,$0.00,$79.31,$125.63,$126.90,$0.00,$24.82,$0.00,$25.25,$0.00
401.050E,SUP,HCPCS C1713,,401.050E  -  2.0MM TI CRTX SCR COARSE PITCH SLF-TPNG W/PLUSDRIVE(TM) 20MM,$158.63,$0.00,$158.63,$71.38,$113.21,$0.00,$27.33,$0.00,$0.00,$27.77,$158.63,$0.00,$79.31,$125.63,$126.90,$0.00,$24.82,$0.00,$25.25,$0.00
401.051E,SUP,HCPCS C1713,,401.051E  -  2.0MM TI CRTX SCR COARSE PITCH SLF-TPNG W/PLUSDRIVE(TM) 22MM,$158.63,$0.00,$158.63,$71.38,$113.21,$0.00,$27.33,$0.00,$0.00,$27.77,$158.63,$0.00,$79.31,$125.63,$126.90,$0.00,$24.82,$0.00,$25.25,$0.00
401.052E,SUP,HCPCS C1713,,401.052E  -  2.0MM TI CRTX SCR COARSE PITCH SLF-TPNG W/PLUSDRIVE(TM) 24MM,$158.63,$0.00,$158.63,$71.38,$113.21,$0.00,$27.33,$0.00,$0.00,$27.77,$158.63,$0.00,$79.31,$125.63,$126.90,$0.00,$24.82,$0.00,$25.25,$0.00
401.061E,SUP,HCPCS C1713,,401.061E  -  SCREW BONE SLVR 4MM 2MM CRANFCL TI SLFDRILL +DR RECESS STRL,$169.88,$0.00,$169.88,$76.44,$121.24,$0.00,$29.27,$0.00,$0.00,$29.74,$169.88,$0.00,$84.94,$134.54,$135.90,$0.00,$26.59,$0.00,$27.04,$0.00
401.062E,SUP,HCPCS C1713,,401.062E  -  SCREW BONE SLVR 5MM 2MM CRANFCL TI SLFDRILL +DR RECESS STRL,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
401.063E,SUP,HCPCS C1713,,401.063E  -  SCREW BONE SLVR 6MM 2MM CRANFCL TI SLFDRILL +DR RECESS STRL,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
401.064E,SUP,HCPCS C1713,,401.064E  -  SCREW BONE SLVR 7MM 2MM CRANFCL TI SLFDRILL +DR RECESS STRL,$169.88,$0.00,$169.88,$76.44,$121.24,$0.00,$29.27,$0.00,$0.00,$29.74,$169.88,$0.00,$84.94,$134.54,$135.90,$0.00,$26.59,$0.00,$27.04,$0.00
401.065E,SUP,HCPCS C1713,,401.065E  -  SCREW BONE SLVR 8MM 2MM CRANFCL TI SLFDRILL +DR RECESS STRL,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
401.134.99,SUP,HCPCS C1713,,401.134.99  -  SCREW BONE 2MM 4MM ARCH TI CORT SPNL SLFDRILL STARDRIVE,$101.50,$0.00,$101.50,$45.68,$72.44,$0.00,$17.49,$0.00,$0.00,$17.77,$101.50,$0.00,$50.75,$80.39,$81.20,$0.00,$15.88,$0.00,$16.16,$0.00
401.136.99,SUP,HCPCS C1713,,401.136.99  -  SCREW BONE 2MM 6MM ARCH TI CORT SPNL SLFDRILL STARDRIVE,$101.50,$0.00,$101.50,$45.68,$72.44,$0.00,$17.49,$0.00,$0.00,$17.77,$101.50,$0.00,$50.75,$80.39,$81.20,$0.00,$15.88,$0.00,$16.16,$0.00
401.138.99,SUP,HCPCS C1713,,401.138.99  -  SCREW BONE 2MM 8MM ARCH TI CORT SPNL SLFDRILL STARDRIVE,$101.50,$0.00,$101.50,$45.68,$72.44,$0.00,$17.49,$0.00,$0.00,$17.77,$101.50,$0.00,$50.75,$80.39,$81.20,$0.00,$15.88,$0.00,$16.16,$0.00
401.306E,SUP,HCPCS C1713,,401.306E  -  SCREW TI 6MM 2.4MM CRANFCL ER CRCIFRM RECESS BONE STRL TEAL,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
401.307E,SUP,HCPCS C1713,,401.307E  -  SCREW BONE TEAL 7MM 2.4MM 2MM CORT CRANFCL TI SLFTAP ER STRP,$148.50,$0.00,$148.50,$66.83,$105.98,$0.00,$25.59,$0.00,$0.00,$26.00,$148.50,$0.00,$74.25,$117.61,$118.80,$0.00,$23.24,$0.00,$23.64,$0.00
401.308E,SUP,HCPCS C1713,,401.308E  -  SCREW TI 8MM 2.4MM CRANFCL ER CRCIFRM RECESS BONE NONSTRL,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
401.309E,SUP,HCPCS C1713,,401.309E  -  SCREW BONE TEAL 9MM 2.4MM 2MM CORT CRANFCL TI SLFTAP ER STRP,$148.50,$0.00,$148.50,$66.83,$105.98,$0.00,$25.59,$0.00,$0.00,$26.00,$148.50,$0.00,$74.25,$117.61,$118.80,$0.00,$23.24,$0.00,$23.64,$0.00
401.311E,SUP,HCPCS C1713,,401.311E  -  SCREW BONE 2.4MM 11MM TI ER STRL,$148.50,$0.00,$148.50,$66.83,$105.98,$0.00,$25.59,$0.00,$0.00,$26.00,$148.50,$0.00,$74.25,$117.61,$118.80,$0.00,$23.24,$0.00,$23.64,$0.00
401.314E,SUP,HCPCS C1713,,401.314E  -  SCREW TI 14MM 2.4MM MANDIB ER CRCIFRM RECESS BONE STRL TEAL,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
401.316E,SUP,HCPCS C1713,,401.316E  -  SCREW BONE 16MM 2.4MM CRANFCL TI ER CRCIFRM RECESS NONSTRL,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
401.318E,SUP,HCPCS C1713,,401.318E  -  SCREW BONE 2.4MM 18MM TI ER CRCIFRM RECESS,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
401.356.97,SUP,HCPCS C1713,,401.356.97  -  SCREW BONE 2MM 6MM T6 STARDRIVE RECESS SLFTAP LCP TITANIUM,$64.48,$0.00,$64.48,$29.01,$46.02,$0.00,$10.79,$0.00,$0.00,$11.29,$64.48,$0.00,$32.24,$51.07,$51.58,$0.00,$9.80,$0.00,$10.26,$0.00
401.357.97,SUP,HCPCS C1713,,401.357.97  -  SCREW BONE 2MM 7MM SLFTAP STARDRIVE RECESS LCP TITANIUM,$64.48,$0.00,$64.48,$29.01,$46.02,$0.00,$10.79,$0.00,$0.00,$11.29,$64.48,$0.00,$32.24,$51.07,$51.58,$0.00,$9.80,$0.00,$10.26,$0.00
401.358.97,SUP,HCPCS C1713,,401.358.97  -  SCREW BONE T6 STARDRIVE 2MM 8MM SELF TAP TITANIUM CORTICAL,$64.48,$0.00,$64.48,$29.01,$46.02,$0.00,$10.79,$0.00,$0.00,$11.29,$64.48,$0.00,$32.24,$51.07,$51.58,$0.00,$9.80,$0.00,$10.26,$0.00
401.359.97,SUP,HCPCS C1713,,401.359.97  -  SCREW BONE 2MM 9MM SLFTAP STARDRIVE RECESS LCP TITANIUM,$64.48,$0.00,$64.48,$29.01,$46.02,$0.00,$10.79,$0.00,$0.00,$11.29,$64.48,$0.00,$32.24,$51.07,$51.58,$0.00,$9.80,$0.00,$10.26,$0.00
401.360.97,SUP,HCPCS C1713,,401.360.97  -  SCREW BONE T6 2MM 10MM SELF TAP STARDRIVE LCP TITANIUM RAD,$64.48,$0.00,$64.48,$29.01,$46.02,$0.00,$10.79,$0.00,$0.00,$11.29,$64.48,$0.00,$32.24,$51.07,$51.58,$0.00,$9.80,$0.00,$10.26,$0.00
401.361.97,SUP,HCPCS C1713,,401.361.97  -  SCREW BONE 2MM 11MM SLFTAP SELF RETAINING T6 STARDRIVE,$64.48,$0.00,$64.48,$29.01,$46.02,$0.00,$10.79,$0.00,$0.00,$11.29,$64.48,$0.00,$32.24,$51.07,$51.58,$0.00,$9.80,$0.00,$10.26,$0.00
401.362.97,SUP,HCPCS C1713,,401.362.97  -  SCREW BONE T6 2MM 12MM SELF TAP STARDRIVE LCP TITANIUM RAD,$64.48,$0.00,$64.48,$29.01,$46.02,$0.00,$10.79,$0.00,$0.00,$11.29,$64.48,$0.00,$32.24,$51.07,$51.58,$0.00,$9.80,$0.00,$10.26,$0.00
401.363.97,SUP,HCPCS C1713,,401.363.97  -  SCREW BONE T6 2MM 13MM SELF TAP STARDRIVE LCP TITANIUM RAD,$64.48,$0.00,$64.48,$29.01,$46.02,$0.00,$10.79,$0.00,$0.00,$11.29,$64.48,$0.00,$32.24,$51.07,$51.58,$0.00,$9.80,$0.00,$10.26,$0.00
401.364.97,SUP,HCPCS C1713,,401.364.97  -  SCREW BONE 2MM 14MM T6 STARDRIVE RECESS SLFTAP LCP TITANIUM,$64.48,$0.00,$64.48,$29.01,$46.02,$0.00,$10.79,$0.00,$0.00,$11.29,$64.48,$0.00,$32.24,$51.07,$51.58,$0.00,$9.80,$0.00,$10.26,$0.00
401.366.97,SUP,HCPCS C1713,,401.366.97  -  SCREW BONE 2MM 16MM SLFTAP STARDRIVE RECESS LCP TITANIUM,$64.48,$0.00,$64.48,$29.01,$46.02,$0.00,$10.79,$0.00,$0.00,$11.29,$64.48,$0.00,$32.24,$51.07,$51.58,$0.00,$9.80,$0.00,$10.26,$0.00
401.368.97,SUP,HCPCS C1713,,401.368.97  -  SCREW BONE 2MM 18MM T6 STARDRIVE RECESS SLFTAP LCP TITANIUM,$64.48,$0.00,$64.48,$29.01,$46.02,$0.00,$10.79,$0.00,$0.00,$11.29,$64.48,$0.00,$32.24,$51.07,$51.58,$0.00,$9.80,$0.00,$10.26,$0.00
401.370.97,SUP,HCPCS C1713,,401.370.97  -  SCREW BONE 2MM 20MM SLFTAP STARDRIVE RECESS LCP TITANIUM,$64.48,$0.00,$64.48,$29.01,$46.02,$0.00,$10.79,$0.00,$0.00,$11.29,$64.48,$0.00,$32.24,$51.07,$51.58,$0.00,$9.80,$0.00,$10.26,$0.00
401.372.97,SUP,HCPCS C1713,,401.372.97  -  SCREW BONE 2MM 22MM SLFTAP STARDRIVE RECESS LCP TITANIUM,$64.48,$0.00,$64.48,$29.01,$46.02,$0.00,$10.79,$0.00,$0.00,$11.29,$64.48,$0.00,$32.24,$51.07,$51.58,$0.00,$9.80,$0.00,$10.26,$0.00
401.374.97,SUP,HCPCS C1713,,401.374.97  -  SCREW BONE 2MM 24MM SLFTAP STARDRIVE RECESS LCP TITANIUM,$64.48,$0.00,$64.48,$29.01,$46.02,$0.00,$10.79,$0.00,$0.00,$11.29,$64.48,$0.00,$32.24,$51.07,$51.58,$0.00,$9.80,$0.00,$10.26,$0.00
401.375.97,SUP,HCPCS C1713,,401.375.97  -  SCREW BONE 2MM 26MM SLFTAP STARDRIVE RECESS LCP TITANIUM,$64.48,$0.00,$64.48,$29.01,$46.02,$0.00,$10.79,$0.00,$0.00,$11.29,$64.48,$0.00,$32.24,$51.07,$51.58,$0.00,$9.80,$0.00,$10.26,$0.00
401.376.97,SUP,HCPCS C1713,,401.376.97  -  SCREW BONE 2MM 28MM SLFTAP STARDRIVE RECESS LCP TITANIUM,$64.48,$0.00,$64.48,$29.01,$46.02,$0.00,$10.79,$0.00,$0.00,$11.29,$64.48,$0.00,$32.24,$51.07,$51.58,$0.00,$9.80,$0.00,$10.26,$0.00
401.377.97,SUP,HCPCS C1713,,401.377.97  -  SCREW BONE 2MM 30MM SLFTAP STARDRIVE RECESS LCP TITANIUM,$64.48,$0.00,$64.48,$29.01,$46.02,$0.00,$10.79,$0.00,$0.00,$11.29,$64.48,$0.00,$32.24,$51.07,$51.58,$0.00,$9.80,$0.00,$10.26,$0.00
401.378.97,SUP,HCPCS C1713,,401.378.97  -  SCREW BONE 2MM 32MM SLFTAP STARDRIVE RECESS LCP TITANIUM,$64.48,$0.00,$64.48,$29.01,$46.02,$0.00,$10.79,$0.00,$0.00,$11.29,$64.48,$0.00,$32.24,$51.07,$51.58,$0.00,$9.80,$0.00,$10.26,$0.00
401.379.97,SUP,HCPCS C1713,,401.379.97  -  SCREW BONE 2MM 34MM SLFTAP STARDRIVE RECESS LCP TITANIUM,$64.48,$0.00,$64.48,$29.01,$46.02,$0.00,$10.79,$0.00,$0.00,$11.29,$64.48,$0.00,$32.24,$51.07,$51.58,$0.00,$9.80,$0.00,$10.26,$0.00
401.380.97,SUP,HCPCS C1713,,401.380.97  -  SCREW BONE 2MM 36MM SLFTAP STARDRIVE RECESS LCP TITANIUM,$64.48,$0.00,$64.48,$29.01,$46.02,$0.00,$10.79,$0.00,$0.00,$11.29,$64.48,$0.00,$32.24,$51.07,$51.58,$0.00,$9.80,$0.00,$10.26,$0.00
401.381.97,SUP,HCPCS C1713,,401.381.97  -  SCREW BONE 2MM 38MM SLFTAP STARDRIVE RECESS LCP TITANIUM,$64.48,$0.00,$64.48,$29.01,$46.02,$0.00,$10.79,$0.00,$0.00,$11.29,$64.48,$0.00,$32.24,$51.07,$51.58,$0.00,$9.80,$0.00,$10.26,$0.00
401.382.97,SUP,HCPCS C1713,,401.382.97  -  SCREW BONE 2MM 40MM SLFTAP STARDRIVE RECESS LCP TITANIUM,$64.48,$0.00,$64.48,$29.01,$46.02,$0.00,$10.79,$0.00,$0.00,$11.29,$64.48,$0.00,$32.24,$51.07,$51.58,$0.00,$9.80,$0.00,$10.26,$0.00
401.506.96,SUP,HCPCS C1713,,401.506.96  -  SCREW BONE 2.4MM 4MM 6MM SELF TAP CRCIFRM RECESS TITANIUM,$146.03,$0.00,$146.03,$65.71,$104.22,$0.00,$24.43,$0.00,$0.00,$25.57,$146.03,$0.00,$73.01,$115.66,$116.82,$0.00,$22.19,$0.00,$23.25,$0.00
401.507.96,SUP,HCPCS C1713,,401.507.96  -  SCREW BONE 2.4MM 4MM 7MM SELF TAP CRCIFRM RECESS TITANIUM,$146.03,$0.00,$146.03,$65.71,$104.22,$0.00,$24.43,$0.00,$0.00,$25.57,$146.03,$0.00,$73.01,$115.66,$116.82,$0.00,$22.19,$0.00,$23.25,$0.00
401.508.96,SUP,HCPCS C1713,,401.508.96  -  SCREW BONE 2.4MM 4.5MM 8MM SLFTAP CRCIFRM RECESS TITANIUM,$146.03,$0.00,$146.03,$65.71,$104.22,$0.00,$24.43,$0.00,$0.00,$25.57,$146.03,$0.00,$73.01,$115.66,$116.82,$0.00,$22.19,$0.00,$23.25,$0.00
401.509.96,SUP,HCPCS C1713,,401.509.96  -  SCREW BONE 2.4MM 4MM 9MM SELF TAP CRCIFRM RECESS TITANIUM,$146.03,$0.00,$146.03,$65.71,$104.22,$0.00,$24.43,$0.00,$0.00,$25.57,$146.03,$0.00,$73.01,$115.66,$116.82,$0.00,$22.19,$0.00,$23.25,$0.00
401.510.96,SUP,HCPCS C1713,,401.510.96  -  SCREW BONE 2.4MM 4.5MM 10MM SELF TAP CRCIFRM RECESS TITANIUM,$146.03,$0.00,$146.03,$65.71,$104.22,$0.00,$24.43,$0.00,$0.00,$25.57,$146.03,$0.00,$73.01,$115.66,$116.82,$0.00,$22.19,$0.00,$23.25,$0.00
401.511.96,SUP,HCPCS C1713,,401.511.96  -  SCREW BONE 2.4MM 4.5MM 11MM SELF TAP CRCIFRM TITANIUM HAND,$146.03,$0.00,$146.03,$65.71,$104.22,$0.00,$24.43,$0.00,$0.00,$25.57,$146.03,$0.00,$73.01,$115.66,$116.82,$0.00,$22.19,$0.00,$23.25,$0.00
401.512.96,SUP,HCPCS C1713,,401.512.96  -  SCREW BONE 2.4MM 4.5MM 12MM SELF TAP CRCIFRM RECESS TITANIUM,$146.03,$0.00,$146.03,$65.71,$104.22,$0.00,$24.43,$0.00,$0.00,$25.57,$146.03,$0.00,$73.01,$115.66,$116.82,$0.00,$22.19,$0.00,$23.25,$0.00
401.513.96,SUP,HCPCS C1713,,401.513.96  -  SCREW BONE 2.4MM 4.5MM 13MM SLFTAP CRCIFRM RECESS TITANIUM,$146.03,$0.00,$146.03,$65.71,$104.22,$0.00,$24.43,$0.00,$0.00,$25.57,$146.03,$0.00,$73.01,$115.66,$116.82,$0.00,$22.19,$0.00,$23.25,$0.00
401.514.96,SUP,HCPCS C1713,,401.514.96  -  SCREW BONE 2.4MM 4.5MM 14MM SELF TAP CRCIFRM TITANIUM HAND,$146.03,$0.00,$146.03,$65.71,$104.22,$0.00,$24.43,$0.00,$0.00,$25.57,$146.03,$0.00,$73.01,$115.66,$116.82,$0.00,$22.19,$0.00,$23.25,$0.00
401.516.96,SUP,HCPCS C1713,,401.516.96  -  SCREW BONE 2.4MM 4.5MM 16MM SLFTAP CRCIFRM RECESS TITANIUM,$146.03,$0.00,$146.03,$65.71,$104.22,$0.00,$24.43,$0.00,$0.00,$25.57,$146.03,$0.00,$73.01,$115.66,$116.82,$0.00,$22.19,$0.00,$23.25,$0.00
401.518.96,SUP,HCPCS C1713,,401.518.96  -  SCREW BONE 2.4MM 4.5MM 18MM SLFTAP CRCIFRM RECESS TITANIUM,$146.03,$0.00,$146.03,$65.71,$104.22,$0.00,$24.43,$0.00,$0.00,$25.57,$146.03,$0.00,$73.01,$115.66,$116.82,$0.00,$22.19,$0.00,$23.25,$0.00
401.520.96,SUP,HCPCS C1713,,401.520.96  -  SCREW BONE 2.4MM 4.5MM 20MM SELF TAP CRCIFRM TITANIUM HAND,$146.03,$0.00,$146.03,$65.71,$104.22,$0.00,$24.43,$0.00,$0.00,$25.57,$146.03,$0.00,$73.01,$115.66,$116.82,$0.00,$22.19,$0.00,$23.25,$0.00
401.520E,SUP,HCPCS C1713,,401.520E  -  SCREW BONE 20MM SLFTAP CRCIFRM RECESS TITANIUM 2.4MM 4MM,$231.75,$0.00,$231.75,$104.29,$165.40,$0.00,$39.93,$0.00,$0.00,$40.58,$231.75,$0.00,$115.88,$183.55,$185.40,$0.00,$36.27,$0.00,$36.89,$0.00
401.522.96,SUP,HCPCS C1713,,401.522.96  -  SCREW BONE 2.4MM 4.5MM 22MM SELF TAP CRCIFRM TITANIUM HAND,$146.03,$0.00,$146.03,$65.71,$104.22,$0.00,$24.43,$0.00,$0.00,$25.57,$146.03,$0.00,$73.01,$115.66,$116.82,$0.00,$22.19,$0.00,$23.25,$0.00
401.524.96,SUP,HCPCS C1713,,401.524.96  -  SCREW BONE 2.4MM 4.5MM 24MM SELF TAP CRCIFRM TITANIUM HAND,$146.03,$0.00,$146.03,$65.71,$104.22,$0.00,$24.43,$0.00,$0.00,$25.57,$146.03,$0.00,$73.01,$115.66,$116.82,$0.00,$22.19,$0.00,$23.25,$0.00
401.524E,SUP,HCPCS C1713,,401.524E  -  SCREW BONE 2.4MM 24MM TI CORT HAND SLFTAP NONSTRL,$231.75,$0.00,$231.75,$104.29,$165.40,$0.00,$39.93,$0.00,$0.00,$40.58,$231.75,$0.00,$115.88,$183.55,$185.40,$0.00,$36.27,$0.00,$36.89,$0.00
401.526.96,SUP,HCPCS C1713,,401.526.96  -  SCREW BONE 2.4MM 4.5MM 26MM SELF TAP CRCIFRM TITANIUM HAND,$146.03,$0.00,$146.03,$65.71,$104.22,$0.00,$24.43,$0.00,$0.00,$25.57,$146.03,$0.00,$73.01,$115.66,$116.82,$0.00,$22.19,$0.00,$23.25,$0.00
401.526E,SUP,HCPCS C1713,,401.526E  -  SCREW BONE 2.4MM 26MM TI CORT HAND SLFTAP NONSTRL,$231.75,$0.00,$231.75,$104.29,$165.40,$0.00,$39.93,$0.00,$0.00,$40.58,$231.75,$0.00,$115.88,$183.55,$185.40,$0.00,$36.27,$0.00,$36.89,$0.00
401.528.96,SUP,HCPCS C1713,,401.528.96  -  SCREW BONE 2.4MM 4.5MM 28MM SELF TAP CRCIFRM TITANIUM HAND,$146.03,$0.00,$146.03,$65.71,$104.22,$0.00,$24.43,$0.00,$0.00,$25.57,$146.03,$0.00,$73.01,$115.66,$116.82,$0.00,$22.19,$0.00,$23.25,$0.00
401.528E,SUP,HCPCS C1713,,401.528E  -  SCREW BONE 2.4MM 28MM TI CORT HAND SLFTAP NONSTRL,$231.75,$0.00,$231.75,$104.29,$165.40,$0.00,$39.93,$0.00,$0.00,$40.58,$231.75,$0.00,$115.88,$183.55,$185.40,$0.00,$36.27,$0.00,$36.89,$0.00
401.530.96,SUP,HCPCS C1713,,401.530.96  -  SCREW BONE 2.4MM 4.5MM 30MM SELF TAP CRCIFRM TITANIUM HAND,$146.03,$0.00,$146.03,$65.71,$104.22,$0.00,$24.43,$0.00,$0.00,$25.57,$146.03,$0.00,$73.01,$115.66,$116.82,$0.00,$22.19,$0.00,$23.25,$0.00
401.530E,SUP,HCPCS C1713,,401.530E  -  SCREW BONE GOLD 30MM 2.4MM CRNMXF TI SLFTAP MDLR STRL,$231.75,$0.00,$231.75,$104.29,$165.40,$0.00,$39.93,$0.00,$0.00,$40.58,$231.75,$0.00,$115.88,$183.55,$185.40,$0.00,$36.27,$0.00,$36.89,$0.00
401.532.96,SUP,HCPCS C1713,,401.532.96  -  SCREW BONE 2.4MM 4.5MM 32MM SELF TAP CRCIFRM TITANIUM HAND,$146.03,$0.00,$146.03,$65.71,$104.22,$0.00,$24.43,$0.00,$0.00,$25.57,$146.03,$0.00,$73.01,$115.66,$116.82,$0.00,$22.19,$0.00,$23.25,$0.00
401.534.96,SUP,HCPCS C1713,,401.534.96  -  SCREW BONE 2.4MM 4.5MM 34MM SELF TAP CRCIFRM TITANIUM HAND,$146.03,$0.00,$146.03,$65.71,$104.22,$0.00,$24.43,$0.00,$0.00,$25.57,$146.03,$0.00,$73.01,$115.66,$116.82,$0.00,$22.19,$0.00,$23.25,$0.00
401.534E,SUP,HCPCS C1713,,401.534E  -  SCREW BONE GOLD 34MM 2.4MM CRNMXF TI SLFTAP MDLR STRL,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
401.536.96,SUP,HCPCS C1713,,401.536.96  -  SCREW BONE 2.4MM 4.5MM 36MM SELF TAP CRCIFRM TITANIUM HAND,$146.03,$0.00,$146.03,$65.71,$104.22,$0.00,$24.43,$0.00,$0.00,$25.57,$146.03,$0.00,$73.01,$115.66,$116.82,$0.00,$22.19,$0.00,$23.25,$0.00
401.538.96,SUP,HCPCS C1713,,401.538.96  -  SCREW BONE 2.4MM 4.5MM 38MM SELF TAP CRCIFRM TITANIUM HAND,$146.03,$0.00,$146.03,$65.71,$104.22,$0.00,$24.43,$0.00,$0.00,$25.57,$146.03,$0.00,$73.01,$115.66,$116.82,$0.00,$22.19,$0.00,$23.25,$0.00
401.540.96,SUP,HCPCS C1713,,401.540.96  -  SCREW BONE 2.4MM 4.5MM 40MM SELF TAP CRCIFRM TITANIUM HAND,$146.03,$0.00,$146.03,$65.71,$104.22,$0.00,$24.43,$0.00,$0.00,$25.57,$146.03,$0.00,$73.01,$115.66,$116.82,$0.00,$22.19,$0.00,$23.25,$0.00
401.542E,SUP,HCPCS C1713,,401.542E  -  SCREW BONE 2.4MM 42MM CORT MANDIB SLFTAP MDLR FIX SYS,$231.75,$0.00,$231.75,$104.29,$165.40,$0.00,$39.93,$0.00,$0.00,$40.58,$231.75,$0.00,$115.88,$183.55,$185.40,$0.00,$36.27,$0.00,$36.89,$0.00
401.544E,SUP,HCPCS C1713,,401.544E  -  SCREW TI 44MM 2.4MM CORT MANDIB SLFTAP BONE NONSTRL,$231.75,$0.00,$231.75,$104.29,$165.40,$0.00,$39.93,$0.00,$0.00,$40.58,$231.75,$0.00,$115.88,$183.55,$185.40,$0.00,$36.27,$0.00,$36.89,$0.00
401.546E,SUP,HCPCS C1713,,401.546E  -  SCREW TI 46MM 2.4MM CORT MANDIB SLFTAP LCK RECON BONE STRL,$231.75,$0.00,$231.75,$104.29,$165.40,$0.00,$39.93,$0.00,$0.00,$40.58,$231.75,$0.00,$115.88,$183.55,$185.40,$0.00,$36.27,$0.00,$36.89,$0.00
401.548E,SUP,HCPCS C1713,,401.548E  -  SCREW TI 48MM 2.4MM CORT MANDIB SLFTAP LCK RECON BONE STRL,$231.75,$0.00,$231.75,$104.29,$165.40,$0.00,$39.93,$0.00,$0.00,$40.58,$231.75,$0.00,$115.88,$183.55,$185.40,$0.00,$36.27,$0.00,$36.89,$0.00
401.558E,SUP,HCPCS C1713,,401.558E  -  SCREW TI 8MM 2.7MM MANDIB ER LCK BONE STRL,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
401.560E,SUP,HCPCS C1713,,401.560E  -  SCREW TI 10MM 2.7MM MANDIB ER LCK BONE STRL,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
401.566E,SUP,HCPCS C1713,,401.566E  -  SCREW TI 16MM 2.7MM MANDIB ER LCK BONE STRL,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
401.568E,SUP,HCPCS C1713,,401.568E  -  SCREW TI 18MM 2.7MM MANDIB ER LCK BONE STRL,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
401.594E,SUP,HCPCS C1713,,401.594E  -  2.0MM TI TENSION BAND SCREW SELF-TAPPING 4MM,$191.25,$0.00,$191.25,$86.06,$136.50,$0.00,$32.95,$0.00,$0.00,$33.49,$191.25,$0.00,$95.63,$151.47,$153.00,$0.00,$29.93,$0.00,$30.45,$0.00
401.596E,SUP,HCPCS C1713,,401.596E  -  2.0MM TI TENSION BAND SCREW SELF-TAPPING 6MM,$191.25,$0.00,$191.25,$86.06,$136.50,$0.00,$32.95,$0.00,$0.00,$33.49,$191.25,$0.00,$95.63,$151.47,$153.00,$0.00,$29.93,$0.00,$30.45,$0.00
401.797E,SUP,HCPCS C1713,,401.797E  -  SCREW BONE TEAL 14MM 2.4MM CRANFCL TI ER +DR RECESS NONSTRL,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
401.806.96,SUP,HCPCS C1713,,401.806.96  -  SCREW BONE 2MM 3.5MM 6MM SLFTAP CRCIFRM RECESS TITANIUM HAND,$63.13,$0.00,$63.13,$28.41,$45.05,$0.00,$10.56,$0.00,$0.00,$11.05,$63.13,$0.00,$31.56,$50.00,$50.50,$0.00,$9.59,$0.00,$10.05,$0.00
401.807.96,SUP,HCPCS C1713,,401.807.96  -  SCREW BONE 2MM 3.5MM 7MM SELF TAP CRCIFRM TITANIUM HAND,$63.13,$0.00,$63.13,$28.41,$45.05,$0.00,$10.56,$0.00,$0.00,$11.05,$63.13,$0.00,$31.56,$50.00,$50.50,$0.00,$9.59,$0.00,$10.05,$0.00
401.808.96,SUP,HCPCS C1713,,401.808.96  -  SCREW BONE 2MM 3.5MM 8MM SELF TAP CRCIFRM RECESS TITANIUM,$63.13,$0.00,$63.13,$28.41,$45.05,$0.00,$10.56,$0.00,$0.00,$11.05,$63.13,$0.00,$31.56,$50.00,$50.50,$0.00,$9.59,$0.00,$10.05,$0.00
401.809.96,SUP,HCPCS C1713,,401.809.96  -  SCREW BONE 2MM 3.5MM 9MM SELF TAP CRCIFRM TITANIUM HAND,$63.13,$0.00,$63.13,$28.41,$45.05,$0.00,$16.19,$0.00,$0.00,$11.05,$63.13,$0.00,$31.56,$50.00,$50.50,$0.00,$14.70,$0.00,$10.05,$0.00
401.810.96,SUP,HCPCS C1713,,401.810.96  -  SCREW BONE 2MM 10MM SLFTAP TITANIUM CORTICAL NONSTRL,$63.13,$0.00,$63.13,$28.41,$45.05,$0.00,$16.19,$0.00,$0.00,$11.05,$63.13,$0.00,$31.56,$50.00,$50.50,$0.00,$14.70,$0.00,$10.05,$0.00
401.811.96,SUP,HCPCS C1713,,401.811.96  -  SCREW BONE 2MM 3.5MM 11MM SELF TAP CRCIFRM TITANIUM HAND,$63.13,$0.00,$63.13,$28.41,$45.05,$0.00,$10.56,$0.00,$0.00,$11.05,$63.13,$0.00,$31.56,$50.00,$50.50,$0.00,$9.59,$0.00,$10.05,$0.00
401.812.96,SUP,HCPCS C1713,,401.812.96  -  SCREW BONE 2MM 3.5MM 12MM SELF TAP CRCIFRM RECESS TITANIUM,$63.13,$0.00,$63.13,$28.41,$45.05,$0.00,$10.56,$0.00,$0.00,$11.05,$63.13,$0.00,$31.56,$50.00,$50.50,$0.00,$9.59,$0.00,$10.05,$0.00
401.813.96,SUP,HCPCS C1713,,401.813.96  -  SCREW BONE 2MM 3.5MM 13MM SELF TAP CRCIFRM TITANIUM HAND,$63.13,$0.00,$63.13,$28.41,$45.05,$0.00,$10.56,$0.00,$0.00,$11.05,$63.13,$0.00,$31.56,$50.00,$50.50,$0.00,$9.59,$0.00,$10.05,$0.00
401.814.96,SUP,HCPCS C1713,,401.814.96  -  SCREW BONE 2MM 3.5MM 14MM SELF TAP CRCIFRM TITANIUM HAND,$63.13,$0.00,$63.13,$28.41,$45.05,$0.00,$16.19,$0.00,$0.00,$11.05,$63.13,$0.00,$31.56,$50.00,$50.50,$0.00,$14.70,$0.00,$10.05,$0.00
401.816.96,SUP,HCPCS C1713,,401.816.96  -  SCREW BONE 2MM 3.5MM 16MM SLFTAP CRCIFRM RECESS TITANIUM,$63.13,$0.00,$63.13,$28.41,$45.05,$0.00,$16.19,$0.00,$0.00,$11.05,$63.13,$0.00,$31.56,$50.00,$50.50,$0.00,$14.70,$0.00,$10.05,$0.00
401.818.96,SUP,HCPCS C1713,,401.818.96  -  SCREW BONE 2MM 3.5MM 18MM SELF TAP CRCIFRM TITANIUM HAND,$63.13,$0.00,$63.13,$28.41,$45.05,$0.00,$16.19,$0.00,$0.00,$11.05,$63.13,$0.00,$31.56,$50.00,$50.50,$0.00,$14.70,$0.00,$10.05,$0.00
401.820.96,SUP,HCPCS C1713,,401.820.96  -  SCREW BONE 2MM 3.5MM 20MM SELF TAP CRCIFRM TITANIUM HAND,$63.13,$0.00,$63.13,$28.41,$45.05,$0.00,$10.56,$0.00,$0.00,$11.05,$63.13,$0.00,$31.56,$50.00,$50.50,$0.00,$9.59,$0.00,$10.05,$0.00
401.822.96,SUP,HCPCS C1713,,401.822.96  -  SCREW BONE 2MM 3.5MM 22MM SLFTAP CRCIFRM RECESS TITANIUM,$63.13,$0.00,$63.13,$28.41,$45.05,$0.00,$10.56,$0.00,$0.00,$11.05,$63.13,$0.00,$31.56,$50.00,$50.50,$0.00,$9.59,$0.00,$10.05,$0.00
401.824.96,SUP,HCPCS C1713,,401.824.96  -  SCREW BONE 2MM 3.5MM 24MM SELF TAP CRCIFRM TITANIUM HAND,$63.13,$0.00,$63.13,$28.41,$45.05,$0.00,$10.56,$0.00,$0.00,$11.05,$63.13,$0.00,$31.56,$50.00,$50.50,$0.00,$9.59,$0.00,$10.05,$0.00
401.826.96,SUP,HCPCS C1713,,401.826.96  -  SCREW BONE 2MM 3.5MM 26MM SELF TAP CRCIFRM TITANIUM HAND,$63.13,$0.00,$63.13,$28.41,$45.05,$0.00,$10.56,$0.00,$0.00,$11.05,$63.13,$0.00,$31.56,$50.00,$50.50,$0.00,$9.59,$0.00,$10.05,$0.00
401.828.96,SUP,HCPCS C1713,,401.828.96  -  SCREW BONE 2MM 3.5MM 28MM SELF TAP CRCIFRM TITANIUM HAND,$63.13,$0.00,$63.13,$28.41,$45.05,$0.00,$10.56,$0.00,$0.00,$11.05,$63.13,$0.00,$31.56,$50.00,$50.50,$0.00,$9.59,$0.00,$10.05,$0.00
401.830.96,SUP,HCPCS C1713,,401.830.96  -  SCREW BONE 2MM 3.5MM 30MM SELF TAP CRCIFRM TITANIUM HAND,$63.13,$0.00,$63.13,$28.41,$45.05,$0.00,$10.56,$0.00,$0.00,$11.05,$63.13,$0.00,$31.56,$50.00,$50.50,$0.00,$9.59,$0.00,$10.05,$0.00
401.832.96,SUP,HCPCS C1713,,401.832.96  -  SCREW BONE 2MM 3.5MM 32MM SELF TAP CRCIFRM TITANIUM HAND,$63.13,$0.00,$63.13,$28.41,$45.05,$0.00,$10.56,$0.00,$0.00,$11.05,$63.13,$0.00,$31.56,$50.00,$50.50,$0.00,$9.59,$0.00,$10.05,$0.00
401.834.96,SUP,HCPCS C1713,,401.834.96  -  SCREW BONE 2MM 3.5MM 34MM SELF TAP CRCIFRM TITANIUM HAND,$63.13,$0.00,$63.13,$28.41,$45.05,$0.00,$10.56,$0.00,$0.00,$11.05,$63.13,$0.00,$31.56,$50.00,$50.50,$0.00,$9.59,$0.00,$10.05,$0.00
401.836.96,SUP,HCPCS C1713,,401.836.96  -  SCREW BONE 2MM 3.5MM 36MM SELF TAP CRCIFRM TITANIUM HAND,$63.13,$0.00,$63.13,$28.41,$45.05,$0.00,$10.56,$0.00,$0.00,$11.05,$63.13,$0.00,$31.56,$50.00,$50.50,$0.00,$9.59,$0.00,$10.05,$0.00
401.838.96,SUP,HCPCS C1713,,401.838.96  -  SCREW BONE 2MM 3.5MM 38MM SELF TAP CRCIFRM TITANIUM HAND,$63.13,$0.00,$63.13,$28.41,$45.05,$0.00,$10.56,$0.00,$0.00,$11.05,$63.13,$0.00,$31.56,$50.00,$50.50,$0.00,$9.59,$0.00,$10.05,$0.00
401.968.96,SUP,Custom 27203010,,401.968.96  -  PIN FIX 1.8MM 18MM BUTTRESS TITANIUM HAND NONSTRL,$111.23,$0.00,$111.23,$0.00,$79.38,$0.00,$0.00,$0.00,$0.00,$0.00,$111.23,$0.00,$55.61,$88.09,$88.98,$0.00,$0.00,$0.00,$0.00,$0.00
40-10102,SUP,HCPCS C1713,,40-10102  -  PLATE BN SM NS VARIAX MESH PA LCK LOPRFL TI FT CALCANEUS,$972.13,$0.00,$972.13,$437.46,$693.81,$0.00,$167.49,$0.00,$0.00,$170.21,$972.13,$0.00,$486.06,$769.93,$777.70,$0.00,$152.14,$0.00,$154.76,$0.00
40-10104,SUP,HCPCS C1713,,40-10104  -  PLATE BN MED 69MM NS VARIAX MESH PA LCK LOPRFL TI FT,$972.13,$0.00,$972.13,$437.46,$693.81,$0.00,$167.49,$0.00,$0.00,$170.21,$972.13,$0.00,$486.06,$769.93,$777.70,$0.00,$152.14,$0.00,$154.76,$0.00
40-10106,SUP,HCPCS C1713,,40-10106  -  PLATE BN LG NS VARIAX MESH PA LCK LOPRFL TI FT CALCANEUS,$972.13,$0.00,$972.13,$437.46,$693.81,$0.00,$167.49,$0.00,$0.00,$170.21,$972.13,$0.00,$486.06,$769.93,$777.70,$0.00,$152.14,$0.00,$154.76,$0.00
40-10112,SUP,HCPCS C1713,,40-10112  -  PLATE BN SM STD 1.5MM NS VARIAX PA LCK LOPRFL TI FT,$972.13,$0.00,$972.13,$437.46,$693.81,$0.00,$167.49,$0.00,$0.00,$170.21,$972.13,$0.00,$486.06,$769.93,$777.70,$0.00,$152.14,$0.00,$154.76,$0.00
40-10114,SUP,HCPCS C1713,,40-10114  -  PLATE BN MED STD 64MM NS VARIAX PA LCK LOPRFL TI FT,$972.13,$0.00,$972.13,$437.46,$693.81,$0.00,$167.49,$0.00,$0.00,$170.21,$972.13,$0.00,$486.06,$769.93,$777.70,$0.00,$152.14,$0.00,$154.76,$0.00
40-10116,SUP,HCPCS C1713,,40-10116  -  PLATE BN LG STD NS VARIAX PA LCK LOPRFL TI FT CALCANEUS,$972.13,$0.00,$972.13,$437.46,$693.81,$0.00,$167.49,$0.00,$0.00,$170.21,$972.13,$0.00,$486.06,$769.93,$777.70,$0.00,$152.14,$0.00,$154.76,$0.00
40-12016S,SUP,HCPCS C1713,,40-12016S  -  16MM LONG THREAD,$195.00,$0.00,$195.00,$87.75,$139.17,$0.00,$33.60,$0.00,$0.00,$34.14,$195.00,$0.00,$97.50,$154.44,$156.00,$0.00,$30.52,$0.00,$31.04,$0.00
40-12018S,SUP,HCPCS C1713,,40-12018S  -  18 MM LONG THREAD,$195.00,$0.00,$195.00,$87.75,$139.17,$0.00,$33.60,$0.00,$0.00,$34.14,$195.00,$0.00,$97.50,$154.44,$156.00,$0.00,$30.52,$0.00,$31.04,$0.00
40-12020S,SUP,HCPCS C1713,,40-12020S  -  20 MM LONG THREAD,$195.00,$0.00,$195.00,$87.75,$139.17,$0.00,$33.60,$0.00,$0.00,$34.14,$195.00,$0.00,$97.50,$154.44,$156.00,$0.00,$30.52,$0.00,$31.04,$0.00
40-12022S,SUP,HCPCS C1713,,40-12022S  -  22 MM LONG THREAD,$195.00,$0.00,$195.00,$87.75,$139.17,$0.00,$33.60,$0.00,$0.00,$34.14,$195.00,$0.00,$97.50,$154.44,$156.00,$0.00,$30.52,$0.00,$31.04,$0.00
40-12024S,SUP,HCPCS C1713,,40-12024S  -  24 MM LONG THREAD,$195.00,$0.00,$195.00,$87.75,$139.17,$0.00,$33.60,$0.00,$0.00,$34.14,$195.00,$0.00,$97.50,$154.44,$156.00,$0.00,$30.52,$0.00,$31.04,$0.00
40-12026S,SUP,HCPCS C1713,,40-12026S  -  26 MM LONG THREAD,$195.00,$0.00,$195.00,$87.75,$139.17,$0.00,$33.60,$0.00,$0.00,$34.14,$195.00,$0.00,$97.50,$154.44,$156.00,$0.00,$30.52,$0.00,$31.04,$0.00
40-12028S,SUP,HCPCS C1713,,40-12028S  -  28 MM LONG THREAD,$195.00,$0.00,$195.00,$87.75,$139.17,$0.00,$33.60,$0.00,$0.00,$34.14,$195.00,$0.00,$97.50,$154.44,$156.00,$0.00,$30.52,$0.00,$31.04,$0.00
40-12030S,SUP,HCPCS C1713,,40-12030S  -  30 MM LONG THREAD,$195.00,$0.00,$195.00,$87.75,$139.17,$0.00,$33.60,$0.00,$0.00,$34.14,$195.00,$0.00,$97.50,$154.44,$156.00,$0.00,$30.52,$0.00,$31.04,$0.00
40-12032S,SUP,HCPCS C1713,,40-12032S  -  32 MM LONG THREAD,$195.00,$0.00,$195.00,$87.75,$139.17,$0.00,$33.60,$0.00,$0.00,$34.14,$195.00,$0.00,$97.50,$154.44,$156.00,$0.00,$30.52,$0.00,$31.04,$0.00
40-12034S,SUP,HCPCS C1713,,40-12034S  -  34 MM LONG THREAD,$195.00,$0.00,$195.00,$87.75,$139.17,$0.00,$33.60,$0.00,$0.00,$34.14,$195.00,$0.00,$97.50,$154.44,$156.00,$0.00,$30.52,$0.00,$31.04,$0.00
40-12036S,SUP,HCPCS C1713,,40-12036S  -  36 MM LONG THREAD,$195.00,$0.00,$195.00,$87.75,$139.17,$0.00,$33.60,$0.00,$0.00,$34.14,$195.00,$0.00,$97.50,$154.44,$156.00,$0.00,$30.52,$0.00,$31.04,$0.00
40-12038S,SUP,HCPCS C1713,,40-12038S  -  38MM LONG THREAD,$195.00,$0.00,$195.00,$87.75,$139.17,$0.00,$33.60,$0.00,$0.00,$34.14,$195.00,$0.00,$97.50,$154.44,$156.00,$0.00,$30.52,$0.00,$31.04,$0.00
40-12040S,SUP,HCPCS C1713,,40-12040S  -  40MM LONG THREAD,$195.00,$0.00,$195.00,$87.75,$139.17,$0.00,$33.60,$0.00,$0.00,$34.14,$195.00,$0.00,$97.50,$154.44,$156.00,$0.00,$30.52,$0.00,$31.04,$0.00
40-12042S,SUP,HCPCS C1713,,40-12042S  -  42 MM LONG THREAD,$195.00,$0.00,$195.00,$87.75,$139.17,$0.00,$33.60,$0.00,$0.00,$34.14,$195.00,$0.00,$97.50,$154.44,$156.00,$0.00,$30.52,$0.00,$31.04,$0.00
40-12044S,SUP,HCPCS C1713,,40-12044S  -  44 MM LONG THREAD,$195.00,$0.00,$195.00,$87.75,$139.17,$0.00,$33.60,$0.00,$0.00,$34.14,$195.00,$0.00,$97.50,$154.44,$156.00,$0.00,$30.52,$0.00,$31.04,$0.00
40-12046S,SUP,HCPCS C1713,,40-12046S  -  46 MM LONG THREAD,$195.00,$0.00,$195.00,$87.75,$139.17,$0.00,$33.60,$0.00,$0.00,$34.14,$195.00,$0.00,$97.50,$154.44,$156.00,$0.00,$30.52,$0.00,$31.04,$0.00
40-12048S,SUP,HCPCS C1713,,40-12048S  -  48 MM LONG THREAD,$195.00,$0.00,$195.00,$87.75,$139.17,$0.00,$33.60,$0.00,$0.00,$34.14,$195.00,$0.00,$97.50,$154.44,$156.00,$0.00,$30.52,$0.00,$31.04,$0.00
40-12050S,SUP,HCPCS C1713,,40-12050S  -  50 MM LONG THREAD,$195.00,$0.00,$195.00,$87.75,$139.17,$0.00,$33.60,$0.00,$0.00,$34.14,$195.00,$0.00,$97.50,$154.44,$156.00,$0.00,$30.52,$0.00,$31.04,$0.00
40-13010S,SUP,HCPCS C1713,,40-13010S  -  10 MM  SHORT THREAD,$195.00,$0.00,$195.00,$87.75,$139.17,$0.00,$33.60,$0.00,$0.00,$34.14,$195.00,$0.00,$97.50,$154.44,$156.00,$0.00,$30.52,$0.00,$31.04,$0.00
40-13012S,SUP,HCPCS C1713,,40-13012S  -  CANNULATED SCREW PARTIALLY THRD SHORT 4.0 MM X 12 MM,$185.00,$0.00,$185.00,$83.25,$132.03,$0.00,$31.87,$0.00,$0.00,$32.39,$185.00,$0.00,$92.50,$146.52,$148.00,$0.00,$28.95,$0.00,$29.45,$0.00
40-13014S,SUP,HCPCS C1713,,40-13014S  -  14MM SHORT THREAD,$195.00,$0.00,$195.00,$87.75,$139.17,$0.00,$33.60,$0.00,$0.00,$34.14,$195.00,$0.00,$97.50,$154.44,$156.00,$0.00,$30.52,$0.00,$31.04,$0.00
40-13016S,SUP,HCPCS C1713,,40-13016S  -  16MM SHORT THREAD,$195.00,$0.00,$195.00,$87.75,$139.17,$0.00,$33.60,$0.00,$0.00,$34.14,$195.00,$0.00,$97.50,$154.44,$156.00,$0.00,$30.52,$0.00,$31.04,$0.00
40-13018S,SUP,HCPCS C1713,,40-13018S  -  18 MM SHORT THREAD,$195.00,$0.00,$195.00,$87.75,$139.17,$0.00,$33.60,$0.00,$0.00,$34.14,$195.00,$0.00,$97.50,$154.44,$156.00,$0.00,$30.52,$0.00,$31.04,$0.00
40-13020S,SUP,HCPCS C1713,,40-13020S  -  20 MM SHORT THREAD,$195.00,$0.00,$195.00,$87.75,$139.17,$0.00,$33.60,$0.00,$0.00,$34.14,$195.00,$0.00,$97.50,$154.44,$156.00,$0.00,$30.52,$0.00,$31.04,$0.00
40-13022S,SUP,HCPCS C1713,,40-13022S  -  22 MM SHORT THREAD,$195.00,$0.00,$195.00,$87.75,$139.17,$0.00,$33.60,$0.00,$0.00,$34.14,$195.00,$0.00,$97.50,$154.44,$156.00,$0.00,$30.52,$0.00,$31.04,$0.00
40-13024S,SUP,HCPCS C1713,,40-13024S  -  24 MM SHORT THREAD,$195.00,$0.00,$195.00,$87.75,$139.17,$0.00,$33.60,$0.00,$0.00,$34.14,$195.00,$0.00,$97.50,$154.44,$156.00,$0.00,$30.52,$0.00,$31.04,$0.00
40-13026S,SUP,HCPCS C1713,,40-13026S  -  26 MM SHORT THREAD,$195.00,$0.00,$195.00,$87.75,$139.17,$0.00,$33.60,$0.00,$0.00,$34.14,$195.00,$0.00,$97.50,$154.44,$156.00,$0.00,$30.52,$0.00,$31.04,$0.00
40-13028S,SUP,HCPCS C1713,,40-13028S  -  28 MM SHORT THREAD,$195.00,$0.00,$195.00,$87.75,$139.17,$0.00,$33.60,$0.00,$0.00,$34.14,$195.00,$0.00,$97.50,$154.44,$156.00,$0.00,$30.52,$0.00,$31.04,$0.00
40-13030S,SUP,HCPCS C1713,,40-13030S  -  30 MM SHORT THREAD,$195.00,$0.00,$195.00,$87.75,$139.17,$0.00,$33.60,$0.00,$0.00,$34.14,$195.00,$0.00,$97.50,$154.44,$156.00,$0.00,$30.52,$0.00,$31.04,$0.00
40-13032S,SUP,HCPCS C1713,,40-13032S  -  32 MM SHORT THREAD,$195.00,$0.00,$195.00,$87.75,$139.17,$0.00,$33.60,$0.00,$0.00,$34.14,$195.00,$0.00,$97.50,$154.44,$156.00,$0.00,$30.52,$0.00,$31.04,$0.00
40-13034S,SUP,HCPCS C1713,,40-13034S  -  34 MM SHORT THREAD,$195.00,$0.00,$195.00,$87.75,$139.17,$0.00,$33.60,$0.00,$0.00,$34.14,$195.00,$0.00,$97.50,$154.44,$156.00,$0.00,$30.52,$0.00,$31.04,$0.00
40-13036S,SUP,HCPCS C1713,,40-13036S  -  36 MM SHORT THREAD,$195.00,$0.00,$195.00,$87.75,$139.17,$0.00,$33.60,$0.00,$0.00,$34.14,$195.00,$0.00,$97.50,$154.44,$156.00,$0.00,$30.52,$0.00,$31.04,$0.00
40-13038S,SUP,HCPCS C1713,,40-13038S  -  38MM SHORT THREAD,$195.00,$0.00,$195.00,$87.75,$139.17,$0.00,$33.60,$0.00,$0.00,$34.14,$195.00,$0.00,$97.50,$154.44,$156.00,$0.00,$30.52,$0.00,$31.04,$0.00
40-13040S,SUP,HCPCS C1713,,40-13040S  -  40MM SHORT THREAD,$195.00,$0.00,$195.00,$87.75,$139.17,$0.00,$33.60,$0.00,$0.00,$34.14,$195.00,$0.00,$97.50,$154.44,$156.00,$0.00,$30.52,$0.00,$31.04,$0.00
40-13042S,SUP,HCPCS C1713,,40-13042S  -  42 MM SHORT THREAD,$195.00,$0.00,$195.00,$87.75,$139.17,$0.00,$33.60,$0.00,$0.00,$34.14,$195.00,$0.00,$97.50,$154.44,$156.00,$0.00,$30.52,$0.00,$31.04,$0.00
40-13044S,SUP,HCPCS C1713,,40-13044S  -  44 MM SHORT THREAD,$195.00,$0.00,$195.00,$87.75,$139.17,$0.00,$33.60,$0.00,$0.00,$34.14,$195.00,$0.00,$97.50,$154.44,$156.00,$0.00,$30.52,$0.00,$31.04,$0.00
40-13046S,SUP,HCPCS C1713,,40-13046S  -  46 MM SHORT THREAD,$195.00,$0.00,$195.00,$87.75,$139.17,$0.00,$33.60,$0.00,$0.00,$34.14,$195.00,$0.00,$97.50,$154.44,$156.00,$0.00,$30.52,$0.00,$31.04,$0.00
40-13048S,SUP,HCPCS C1713,,40-13048S  -  48 MM SHORT THREAD,$195.00,$0.00,$195.00,$87.75,$139.17,$0.00,$33.60,$0.00,$0.00,$34.14,$195.00,$0.00,$97.50,$154.44,$156.00,$0.00,$30.52,$0.00,$31.04,$0.00
40-13050S,SUP,HCPCS C1713,,40-13050S  -  CANNULATED SCREW PARTIALLY THRD SHORT 4.0 MM X 50 MM,$245.00,$0.00,$245.00,$110.25,$174.86,$0.00,$42.21,$0.00,$0.00,$42.90,$245.00,$0.00,$122.50,$194.04,$196.00,$0.00,$38.34,$0.00,$39.00,$0.00
40-15011,SUP,HCPCS C1713,,40-15011  -  PLATE BN CRV NS VARIAX 4 HL PA LCK LOPRFL TI FT,$598.13,$0.00,$598.13,$269.16,$426.88,$0.00,$103.05,$0.00,$0.00,$104.73,$598.13,$0.00,$299.06,$473.72,$478.50,$0.00,$93.61,$0.00,$95.22,$0.00
40-15012,SUP,HCPCS C1713,,40-15012  -  PLATE BN CRV NS VARIAX 5 HL PA LCK LOPRFL TI FT RT,$650.38,$0.00,$650.38,$292.67,$464.17,$0.00,$112.06,$0.00,$0.00,$113.88,$650.38,$0.00,$325.19,$515.10,$520.30,$0.00,$101.78,$0.00,$103.54,$0.00
40-15013,SUP,HCPCS C1713,,40-15013  -  PLATE BN CRV NS VARIAX 5 HL PA LCK LOPRFL TI FT LT,$650.38,$0.00,$650.38,$292.67,$464.17,$0.00,$112.06,$0.00,$0.00,$113.88,$650.38,$0.00,$325.19,$515.10,$520.30,$0.00,$101.78,$0.00,$103.54,$0.00
40-15014,SUP,HCPCS C1713,,40-15014  -  PLATE BN CRV NS VARIAX 6 HL PA LCK LOPRFL TI FT,$731.50,$0.00,$731.50,$329.18,$522.07,$0.00,$126.03,$0.00,$0.00,$128.08,$731.50,$0.00,$365.75,$579.35,$585.20,$0.00,$114.48,$0.00,$116.45,$0.00
40-15021,SUP,HCPCS C1713,,40-15021  -  PLATE BN SM H NS VARIAX PA LCK LOPRFL TI FT,$515.63,$0.00,$515.63,$232.03,$368.00,$0.00,$88.84,$0.00,$0.00,$90.28,$515.63,$0.00,$257.81,$408.38,$412.50,$0.00,$80.70,$0.00,$82.09,$0.00
40-15022,SUP,HCPCS C1713,,40-15022  -  PLATE BN MED H NS VARIAX PA LCK LOPRFL TI FT,$731.50,$0.00,$731.50,$329.18,$522.07,$0.00,$126.03,$0.00,$0.00,$128.08,$731.50,$0.00,$365.75,$579.35,$585.20,$0.00,$114.48,$0.00,$116.45,$0.00
40-15023,SUP,HCPCS C1713,,40-15023  -  PLATE BN LG H NS VARIAX PA LCK LOPRFL TI FT,$618.75,$0.00,$618.75,$278.44,$441.60,$0.00,$106.61,$0.00,$0.00,$108.34,$618.75,$0.00,$309.38,$490.05,$495.00,$0.00,$96.83,$0.00,$98.51,$0.00
40-15031,SUP,HCPCS C1713,,40-15031  -  PLATE TI RECT CMPR VARIAX BONE FT,$609.13,$0.00,$609.13,$274.11,$434.73,$0.00,$104.95,$0.00,$0.00,$106.65,$609.13,$0.00,$304.56,$482.43,$487.30,$0.00,$95.33,$0.00,$96.97,$0.00
40-15032,SUP,HCPCS C1713,,40-15032  -  PLATE BN 2 RECT NS VARIAX PA LCK LOPRFL TI FT,$618.75,$0.00,$618.75,$278.44,$441.60,$0.00,$106.61,$0.00,$0.00,$108.34,$618.75,$0.00,$309.38,$490.05,$495.00,$0.00,$96.83,$0.00,$98.51,$0.00
40-15033,SUP,HCPCS C1713,,40-15033  -  PLATE BN 2 RECT NS VARIAX PA LCK CMPR LOPRFL TI FT,$671.00,$0.00,$671.00,$301.95,$478.89,$0.00,$115.61,$0.00,$0.00,$117.49,$671.00,$0.00,$335.50,$531.43,$536.80,$0.00,$105.01,$0.00,$106.82,$0.00
40-15041,SUP,HCPCS C1713,,40-15041  -  PLATE BN SHRT BRD STRG NS VARIAX PA LCK LOPRFL TI FT,$577.50,$0.00,$577.50,$259.88,$412.16,$0.00,$99.50,$0.00,$0.00,$101.12,$577.50,$0.00,$288.75,$457.38,$462.00,$0.00,$90.38,$0.00,$91.94,$0.00
40-15042,SUP,HCPCS C1713,,40-15042  -  PLATE BN MED BRD STRG NS VARIAX PA LCK LOPRFL TI FT,$602.25,$0.00,$602.25,$271.01,$429.83,$0.00,$103.76,$0.00,$0.00,$105.45,$602.25,$0.00,$301.13,$476.98,$481.80,$0.00,$94.25,$0.00,$95.88,$0.00
40-15043,SUP,HCPCS C1713,,40-15043  -  PLATE BN LNG BRD STRG NS VARIAX PA LCK LOPRFL TI FT,$662.75,$0.00,$662.75,$298.24,$473.00,$0.00,$114.19,$0.00,$0.00,$116.04,$662.75,$0.00,$331.38,$524.90,$530.20,$0.00,$103.72,$0.00,$105.51,$0.00
40-15061,SUP,HCPCS C1713,,40-15061  -  PLATE BN 3D NS VARIAX PA LCK LOPRFL TI FT LT,$731.50,$0.00,$731.50,$329.18,$522.07,$0.00,$126.03,$0.00,$0.00,$128.08,$731.50,$0.00,$365.75,$579.35,$585.20,$0.00,$114.48,$0.00,$116.45,$0.00
40-15062,SUP,HCPCS C1713,,40-15062  -  PLATE BN 3D NS VARIAX PA LCK LOPRFL TI FT RT,$731.50,$0.00,$731.50,$329.18,$522.07,$0.00,$126.03,$0.00,$0.00,$128.08,$731.50,$0.00,$365.75,$579.35,$585.20,$0.00,$114.48,$0.00,$116.45,$0.00
40-15071,SUP,HCPCS C1713,,40-15071  -  PLATE BN T OBLQ NS VARIAX PA LCK LOPRFL TI FT LT,$609.13,$0.00,$609.13,$274.11,$434.73,$0.00,$104.95,$0.00,$0.00,$106.65,$609.13,$0.00,$304.56,$482.43,$487.30,$0.00,$95.33,$0.00,$96.97,$0.00
40-15072,SUP,HCPCS C1713,,40-15072  -  PLATE BN T OBLQ NS VARIAX PA LCK LOPRFL TI FT RT,$609.13,$0.00,$609.13,$274.11,$434.73,$0.00,$104.95,$0.00,$0.00,$106.65,$609.13,$0.00,$304.56,$482.43,$487.30,$0.00,$95.33,$0.00,$96.97,$0.00
40-15081,SUP,HCPCS C1713,,40-15081  -  PLATE BN T NS VARIAX PA LCK LOPRFL TI FT,$430.38,$0.00,$430.38,$193.67,$307.16,$0.00,$74.15,$0.00,$0.00,$75.36,$430.38,$0.00,$215.19,$340.86,$344.30,$0.00,$67.35,$0.00,$68.52,$0.00
40-15091,SUP,HCPCS C1713,,40-15091  -  PLATE BN L NS VARIAX PA LCK LOPRFL TI FT LT,$430.38,$0.00,$430.38,$193.67,$307.16,$0.00,$74.15,$0.00,$0.00,$75.36,$430.38,$0.00,$215.19,$340.86,$344.30,$0.00,$67.35,$0.00,$68.52,$0.00
40-15092,SUP,HCPCS C1713,,40-15092  -  PLATE BN L NS VARIAX PA LCK LOPRFL TI FT RT,$430.38,$0.00,$430.38,$193.67,$307.16,$0.00,$74.15,$0.00,$0.00,$75.36,$430.38,$0.00,$215.19,$340.86,$344.30,$0.00,$67.35,$0.00,$68.52,$0.00
402.110E,SUP,HCPCS C1713,,402.110E  -  SCREW TI 10MM 2.7MM CORT MAXFACL HEX SCKT BONE THORP NONSTRL,$130.50,$0.00,$130.50,$58.73,$93.14,$0.00,$22.48,$0.00,$0.00,$22.85,$130.50,$0.00,$65.25,$103.36,$104.40,$0.00,$20.42,$0.00,$20.78,$0.00
402.112E,SUP,HCPCS C1713,,402.112E  -  SCREW TI 12MM 2.7MM CORT MAXFACL HEX SCKT BONE THORP NONSTRL,$130.50,$0.00,$130.50,$58.73,$93.14,$0.00,$22.48,$0.00,$0.00,$22.85,$130.50,$0.00,$65.25,$103.36,$104.40,$0.00,$20.42,$0.00,$20.78,$0.00
402.114E,SUP,HCPCS C1713,,402.114E  -  SCREW TI 14MM 2.7MM CORT MAXFACL HEX SCKT BONE THORP NONSTRL,$130.50,$0.00,$130.50,$58.73,$93.14,$0.00,$22.48,$0.00,$0.00,$22.85,$130.50,$0.00,$65.25,$103.36,$104.40,$0.00,$20.42,$0.00,$20.78,$0.00
402.116E,SUP,HCPCS C1713,,402.116E  -  SCREW TI 16MM 2.7MM CORT MAXFACL BONE THORP NONSTRL,$130.50,$0.00,$130.50,$58.73,$93.14,$0.00,$22.48,$0.00,$0.00,$22.85,$130.50,$0.00,$65.25,$103.36,$104.40,$0.00,$20.42,$0.00,$20.78,$0.00
402.118E,SUP,HCPCS C1713,,402.118E  -  SCREW TI 18MM 2.7MM CORT MAXFACL HEX SCKT BONE THORP NONSTRL,$130.50,$0.00,$130.50,$58.73,$93.14,$0.00,$22.48,$0.00,$0.00,$22.85,$130.50,$0.00,$65.25,$103.36,$104.40,$0.00,$20.42,$0.00,$20.78,$0.00
4020-005R,SUP,HCPCS C1713,,4020-005R  -  CMPNT TIBTRY 5 KNEE RIGHT,"$1,213.00",$0.00,"$1,213.00",$545.85,$865.72,$0.00,$208.99,$0.00,$0.00,$212.39,"$1,213.00",$0.00,$606.50,$960.70,$970.40,$0.00,$189.83,$0.00,$193.11,$0.00
40-20108,SUP,HCPCS C1713,,40-20108  -  SCREW BONE 2MM 8MM 4MM ASNS TI MIC FT HAND CANN THRD NONSTRL,$297.00,$0.00,$297.00,$133.65,$211.97,$0.00,$51.17,$0.00,$0.00,$52.00,$297.00,$0.00,$148.50,$235.22,$237.60,$0.00,$46.48,$0.00,$47.28,$0.00
40-20109,SUP,HCPCS C1713,,40-20109  -  SCREW BONE 2MM 9MM 4MM ASNS TI MIC FT HAND CANN THRD NONSTRL,$297.00,$0.00,$297.00,$133.65,$211.97,$0.00,$51.17,$0.00,$0.00,$52.00,$297.00,$0.00,$148.50,$235.22,$237.60,$0.00,$46.48,$0.00,$47.28,$0.00
40-20110,SUP,HCPCS C1713,,40-20110  -  SCREW BONE 2MM 10MM 4MM ASNS TI MIC FT HAND CANN THRD,$297.00,$0.00,$297.00,$133.65,$211.97,$0.00,$51.17,$0.00,$0.00,$52.00,$297.00,$0.00,$148.50,$235.22,$237.60,$0.00,$46.48,$0.00,$47.28,$0.00
40-20111,SUP,HCPCS C1713,,40-20111  -  SCREW BONE 2MM 11MM 5MM ASNS TI MIC FT HAND CANN THRD,$297.00,$0.00,$297.00,$133.65,$211.97,$0.00,$51.17,$0.00,$0.00,$52.00,$297.00,$0.00,$148.50,$235.22,$237.60,$0.00,$46.48,$0.00,$47.28,$0.00
40-20112,SUP,HCPCS C1713,,40-20112  -  SCREW BONE 2MM 12MM 5MM ASNS TI MIC FT HAND CANN THRD,$297.00,$0.00,$297.00,$133.65,$211.97,$0.00,$51.17,$0.00,$0.00,$52.00,$297.00,$0.00,$148.50,$235.22,$237.60,$0.00,$46.48,$0.00,$47.28,$0.00
40-20113,SUP,HCPCS C1713,,40-20113  -  SCREW BONE 2MM 13MM 6MM ASNS TI MIC FT HAND CANN THRD,$297.00,$0.00,$297.00,$133.65,$211.97,$0.00,$51.17,$0.00,$0.00,$52.00,$297.00,$0.00,$148.50,$235.22,$237.60,$0.00,$46.48,$0.00,$47.28,$0.00
40-20114,SUP,HCPCS C1713,,40-20114  -  SCREW BONE 2MM 14MM 6MM ASNS TI MIC FT HAND CANN THRD,$297.00,$0.00,$297.00,$133.65,$211.97,$0.00,$51.17,$0.00,$0.00,$52.00,$297.00,$0.00,$148.50,$235.22,$237.60,$0.00,$46.48,$0.00,$47.28,$0.00
40-20115,SUP,HCPCS C1713,,40-20115  -  SCREW BONE 2MM 15MM 6MM ASNS TI MIC FT HAND CANN THRD,$297.00,$0.00,$297.00,$133.65,$211.97,$0.00,$51.17,$0.00,$0.00,$52.00,$297.00,$0.00,$148.50,$235.22,$237.60,$0.00,$46.48,$0.00,$47.28,$0.00
40-20116,SUP,HCPCS C1713,,40-20116  -  SCREW BONE 2MM 16MM 7MM ASNS TI MIC FT HAND CANN THRD,$297.00,$0.00,$297.00,$133.65,$211.97,$0.00,$51.17,$0.00,$0.00,$52.00,$297.00,$0.00,$148.50,$235.22,$237.60,$0.00,$46.48,$0.00,$47.28,$0.00
40-20117,SUP,HCPCS C1713,,40-20117  -  SCREW BONE 2MM 17MM 5MM ASNS TI MIC FT HAND CANN THRD STRL,$297.00,$0.00,$297.00,$133.65,$211.97,$0.00,$51.17,$0.00,$0.00,$52.00,$297.00,$0.00,$148.50,$235.22,$237.60,$0.00,$46.48,$0.00,$47.28,$0.00
40-20118,SUP,HCPCS C1713,,40-20118  -  SCREW BONE 2MM 18MM 5MM ASNS TI MIC FT HAND CANN THRD,$297.00,$0.00,$297.00,$133.65,$211.97,$0.00,$51.17,$0.00,$0.00,$52.00,$297.00,$0.00,$148.50,$235.22,$237.60,$0.00,$46.48,$0.00,$47.28,$0.00
40-20119,SUP,HCPCS C1713,,40-20119  -  SCREW BONE 2MM 19MM 5MM ASNS TI MIC FT HAND CANN THRD STRL,$297.00,$0.00,$297.00,$133.65,$211.97,$0.00,$51.17,$0.00,$0.00,$52.00,$297.00,$0.00,$148.50,$235.22,$237.60,$0.00,$46.48,$0.00,$47.28,$0.00
40-20120,SUP,HCPCS C1713,,40-20120  -  SCREW BN MIC RVRS CUT FLUT 2MM 20MM NS 5MM ASNS SLF CUT CNN,$297.00,$0.00,$297.00,$133.65,$211.97,$0.00,$51.17,$0.00,$0.00,$52.00,$297.00,$0.00,$148.50,$235.22,$237.60,$0.00,$46.48,$0.00,$47.28,$0.00
40-20122,SUP,HCPCS C1713,,40-20122  -  SCREW BONE 2MM 22MM 5MM ASNS TI MIC FT HAND CANN THRD,$297.00,$0.00,$297.00,$133.65,$211.97,$0.00,$51.17,$0.00,$0.00,$52.00,$297.00,$0.00,$148.50,$235.22,$237.60,$0.00,$46.48,$0.00,$47.28,$0.00
40-20124,SUP,HCPCS C1713,,40-20124  -  SCREW BONE 2MM 24MM 6MM ASNS TI MIC FT HAND CANN THRD STRL,$297.00,$0.00,$297.00,$133.65,$211.97,$0.00,$51.17,$0.00,$0.00,$52.00,$297.00,$0.00,$148.50,$235.22,$237.60,$0.00,$46.48,$0.00,$47.28,$0.00
40-20126,SUP,HCPCS C1713,,40-20126  -  SCREW BONE 2MM 26MM 6MM ASNS TI MIC FT HAND CANN THRD,$297.00,$0.00,$297.00,$133.65,$211.97,$0.00,$51.17,$0.00,$0.00,$52.00,$297.00,$0.00,$148.50,$235.22,$237.60,$0.00,$46.48,$0.00,$47.28,$0.00
40-20128,SUP,HCPCS C1713,,40-20128  -  SCREW BONE 2MM 28MM 6MM ASNS TI MIC FT HAND CANN THRD,$297.00,$0.00,$297.00,$133.65,$211.97,$0.00,$51.17,$0.00,$0.00,$52.00,$297.00,$0.00,$148.50,$235.22,$237.60,$0.00,$46.48,$0.00,$47.28,$0.00
40-20130,SUP,HCPCS C1713,,40-20130  -  SCREW BONE 2MM 32MM 6MM ASNS TI MIC FT HAND CANN THRD STRL,$297.00,$0.00,$297.00,$133.65,$211.97,$0.00,$51.17,$0.00,$0.00,$52.00,$297.00,$0.00,$148.50,$235.22,$237.60,$0.00,$46.48,$0.00,$47.28,$0.00
40-20217,SUP,HCPCS C1713,,40-20217  -  SCREW BONE 2MM 17MM 8MM ASNS TI MIC FT HAND CANN THRD STRL,$297.00,$0.00,$297.00,$133.65,$211.97,$0.00,$51.17,$0.00,$0.00,$52.00,$297.00,$0.00,$148.50,$235.22,$237.60,$0.00,$46.48,$0.00,$47.28,$0.00
40-20218,SUP,HCPCS C1713,,40-20218  -  SCREW BONE 2MM 18MM 8MM ASNS TI MIC FT HAND CANN THRD STRL,$297.00,$0.00,$297.00,$133.65,$211.97,$0.00,$51.17,$0.00,$0.00,$52.00,$297.00,$0.00,$148.50,$235.22,$237.60,$0.00,$46.48,$0.00,$47.28,$0.00
40-20219,SUP,HCPCS C1713,,40-20219  -  SCREW BONE 2MM 19MM 9MM ASNS TI MIC FT HAND CANN THRD STRL,$297.00,$0.00,$297.00,$133.65,$211.97,$0.00,$51.17,$0.00,$0.00,$52.00,$297.00,$0.00,$148.50,$235.22,$237.60,$0.00,$46.48,$0.00,$47.28,$0.00
40-20220,SUP,HCPCS C1713,,40-20220  -  SCREW BONE 2MM 20MM 9MM ASNS TI MIC FT HAND CANN THRD,$297.00,$0.00,$297.00,$133.65,$211.97,$0.00,$51.17,$0.00,$0.00,$52.00,$297.00,$0.00,$148.50,$235.22,$237.60,$0.00,$46.48,$0.00,$47.28,$0.00
40-20222,SUP,HCPCS C1713,,40-20222  -  SCREW BONE 2MM 22MM 10MM ASNS TI MIC FT HAND CANN THRD,$297.00,$0.00,$297.00,$133.65,$211.97,$0.00,$51.17,$0.00,$0.00,$52.00,$297.00,$0.00,$148.50,$235.22,$237.60,$0.00,$46.48,$0.00,$47.28,$0.00
40-20224,SUP,HCPCS C1713,,40-20224  -  SCREW BONE 2MM 24MM 9MM ASNS TI MIC FT HAND CANN THRD,$297.00,$0.00,$297.00,$133.65,$211.97,$0.00,$51.17,$0.00,$0.00,$52.00,$297.00,$0.00,$148.50,$235.22,$237.60,$0.00,$46.48,$0.00,$47.28,$0.00
40-20226,SUP,HCPCS C1713,,40-20226  -  SCREW BONE 2MM 26MM 12MM ASNS TI MIC FT HAND CANN THRD,$297.00,$0.00,$297.00,$133.65,$211.97,$0.00,$51.17,$0.00,$0.00,$52.00,$297.00,$0.00,$148.50,$235.22,$237.60,$0.00,$46.48,$0.00,$47.28,$0.00
40-20228,SUP,HCPCS C1713,,40-20228  -  SCREW BONE 2MM 28MM 12MM ASNS TI MIC FT HAND CANN THRD,$297.00,$0.00,$297.00,$133.65,$211.97,$0.00,$51.17,$0.00,$0.00,$52.00,$297.00,$0.00,$148.50,$235.22,$237.60,$0.00,$46.48,$0.00,$47.28,$0.00
40-20230,SUP,HCPCS C1713,,40-20230  -  SCREW BONE 2MM 30MM 14MM ASNS TI MIC FT HAND CANN THRD,$297.00,$0.00,$297.00,$133.65,$211.97,$0.00,$51.17,$0.00,$0.00,$52.00,$297.00,$0.00,$148.50,$235.22,$237.60,$0.00,$46.48,$0.00,$47.28,$0.00
40-20805,SUP,HCPCS C1713,,40-20805  -  PLATE BN STRG 72MMX2MM NS VARIAX 5 HL LCK LOPRFL TI FIB,"$1,210.00",$0.00,"$1,210.00",$544.50,$863.58,$0.00,$208.48,$0.00,$0.00,$211.86,"$1,210.00",$0.00,$605.00,$958.32,$968.00,$0.00,$189.37,$0.00,$192.63,$0.00
40-20900,SUP,HCPCS C1713,,40-20900  -  WASHER 2MM MIC ASNS ORTH NONSTRL,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
40-20903,SUP,HCPCS C1713,,40-20903  -  PLATE BN 77X10X2MM NS 16X1.3MM VARIAX 3 HL LCK LOPRFL TI FIB,$874.50,$0.00,$874.50,$393.53,$624.13,$0.00,$150.67,$0.00,$0.00,$153.12,$874.50,$0.00,$437.25,$692.60,$699.60,$0.00,$136.86,$0.00,$139.22,$0.00
40-20904,SUP,HCPCS C1713,,40-20904  -  PLATE BN 89X10X2MM NS 16X1.3MM VARIAX 4 HL LCK LOPRFL TI FIB,$874.50,$0.00,$874.50,$393.53,$624.13,$0.00,$150.67,$0.00,$0.00,$153.12,$874.50,$0.00,$437.25,$692.60,$699.60,$0.00,$136.86,$0.00,$139.22,$0.00
40-20905,SUP,HCPCS C1713,,40-20905  -  PLATE BN 101X10X2MM NS 16X1.3MM VARIAX 5 HL LCK LOPRFL TI,$874.50,$0.00,$874.50,$393.53,$624.13,$0.00,$150.67,$0.00,$0.00,$153.12,$874.50,$0.00,$437.25,$692.60,$699.60,$0.00,$136.86,$0.00,$139.22,$0.00
40-20906,SUP,HCPCS C1713,,40-20906  -  PLATE BN 113X10X2MM NS 16X1.3MM VARIAX 6 HL LCK LOPRFL TI,$874.50,$0.00,$874.50,$393.53,$624.13,$0.00,$150.67,$0.00,$0.00,$153.12,$874.50,$0.00,$437.25,$692.60,$699.60,$0.00,$136.86,$0.00,$139.22,$0.00
40-20907,SUP,HCPCS C1713,,40-20907  -  PLATE BN 125X10X2MM NS 16X1.3MM VARIAX 7 HL LCK LOPRFL TI,$951.50,$0.00,$951.50,$428.18,$679.09,$0.00,$163.94,$0.00,$0.00,$166.60,$951.50,$0.00,$475.75,$753.59,$761.20,$0.00,$148.91,$0.00,$151.48,$0.00
40-20908,SUP,HCPCS C1713,,40-20908  -  PLATE BN 137X10X2MM NS 16X1.3MM VARIAX 8 HL LCK LOPRFL TI,$951.50,$0.00,$951.50,$428.18,$679.09,$0.00,$163.94,$0.00,$0.00,$166.60,$951.50,$0.00,$475.75,$753.59,$761.20,$0.00,$148.91,$0.00,$151.48,$0.00
40-20909,SUP,HCPCS C1713,,40-20909  -  PLATE BN 149X10X2MM NS 16X1.3MM VARIAX 9 HL LCK LOPRFL TI,$951.50,$0.00,$951.50,$428.18,$679.09,$0.00,$163.94,$0.00,$0.00,$166.60,$951.50,$0.00,$475.75,$753.59,$761.20,$0.00,$148.91,$0.00,$151.48,$0.00
40-20910S,SUP,HCPCS C1713,,40-20910S  -  PLATE 161MM 10 HOLE VARIAX BONE LAT FIB STRL,"$1,075.25",$0.00,"$1,075.25",$483.86,$767.41,$0.00,$185.26,$0.00,$0.00,$188.27,"$1,075.25",$0.00,$537.63,$851.60,$860.20,$0.00,$168.28,$0.00,$171.18,$0.00
40-20912S,SUP,HCPCS C1713,,40-20912S  -  PLATE 185MM 12 HOLE VARIAX BONE LAT FIB STRL,"$1,075.25",$0.00,"$1,075.25",$483.86,$767.41,$0.00,$185.26,$0.00,$0.00,$188.27,"$1,075.25",$0.00,$537.63,$851.60,$860.20,$0.00,$168.28,$0.00,$171.18,$0.00
40-22800,SUP,Custom 27203010,,RULER SURG 15MM SIL MCGRD MTRC SCL BKGRND RADIOPQ STRL 30MM,$202.50,$0.00,$202.50,$0.00,$144.52,$0.00,$0.00,$0.00,$0.00,$0.00,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$0.00,$0.00,$0.00,$0.00
402609T,SUP,HCPCS C1894,,INTRODUCER SHTH 9FR 23CM WO GUIDEWIRE AVNT++ .035IN BLK,$112.50,$0.00,$112.50,$61.09,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
40-27008,SUP,HCPCS C1713,,40-27008  -  SCREW BN T7 2.7MM 8MM YLW NS VARIAX ST TI FT LCK PLT SYS,$89.38,$0.00,$89.38,$40.22,$63.79,$0.00,$15.40,$0.00,$0.00,$15.65,$89.38,$0.00,$44.69,$70.79,$71.50,$0.00,$13.99,$0.00,$14.23,$0.00
40-27010,SUP,HCPCS C1713,,40-27010  -  SCREW BN T7 2.7MM 10MM YLW NS VARIAX ST TI FT LCK PLT SYS,$89.38,$0.00,$89.38,$40.22,$63.79,$0.00,$15.40,$0.00,$0.00,$15.65,$89.38,$0.00,$44.69,$70.79,$71.50,$0.00,$13.99,$0.00,$14.23,$0.00
40-27012,SUP,HCPCS C1713,,40-27012  -  SCREW BN T7 2.7MM 12MM YLW NS VARIAX ST TI FT LCK PLT SYS,$89.38,$0.00,$89.38,$40.22,$63.79,$0.00,$15.40,$0.00,$0.00,$15.65,$89.38,$0.00,$44.69,$70.79,$71.50,$0.00,$13.99,$0.00,$14.23,$0.00
40-27014,SUP,HCPCS C1713,,40-27014  -  SCREW BN T7 2.7MM 14MM YLW NS VARIAX ST TI FT LCK PLT SYS,$89.38,$0.00,$89.38,$40.22,$63.79,$0.00,$15.40,$0.00,$0.00,$15.65,$89.38,$0.00,$44.69,$70.79,$71.50,$0.00,$13.99,$0.00,$14.23,$0.00
40-27016,SUP,HCPCS C1713,,40-27016  -  SCREW BN T7 2.7MM 16MM YLW NS VARIAX ST TI FT LCK PLT SYS,$89.38,$0.00,$89.38,$40.22,$63.79,$0.00,$15.40,$0.00,$0.00,$15.65,$89.38,$0.00,$44.69,$70.79,$71.50,$0.00,$13.99,$0.00,$14.23,$0.00
40-27018,SUP,HCPCS C1713,,40-27018  -  SCREW BN T7 2.7MM 18MM YLW NS VARIAX ST TI FT LCK PLT SYS,$89.38,$0.00,$89.38,$40.22,$63.79,$0.00,$15.40,$0.00,$0.00,$15.65,$89.38,$0.00,$44.69,$70.79,$71.50,$0.00,$13.99,$0.00,$14.23,$0.00
40-27020,SUP,HCPCS C1713,,40-27020  -  SCREW BN T7 2.7MM 20MM YLW NS VARIAX ST TI FT LCK PLT SYS,$89.38,$0.00,$89.38,$40.22,$63.79,$0.00,$15.40,$0.00,$0.00,$15.65,$89.38,$0.00,$44.69,$70.79,$71.50,$0.00,$13.99,$0.00,$14.23,$0.00
40-27022,SUP,HCPCS C1713,,40-27022  -  SCREW BN T7 2.7MM 22MM YLW NS VARIAX ST TI FT LCK PLT SYS,$89.38,$0.00,$89.38,$40.22,$63.79,$0.00,$15.40,$0.00,$0.00,$15.65,$89.38,$0.00,$44.69,$70.79,$71.50,$0.00,$13.99,$0.00,$14.23,$0.00
40-27024,SUP,HCPCS C1713,,40-27024  -  SCREW BN T7 2.7MM 24MM YLW NS VARIAX ST TI FT LCK PLT SYS,$89.38,$0.00,$89.38,$40.22,$63.79,$0.00,$15.40,$0.00,$0.00,$15.65,$89.38,$0.00,$44.69,$70.79,$71.50,$0.00,$13.99,$0.00,$14.23,$0.00
40-27026,SUP,HCPCS C1713,,40-27026  -  SCREW BN T7 2.7MM 26MM YLW NS VARIAX ST TI FT LCK PLT SYS,$89.38,$0.00,$89.38,$40.22,$63.79,$0.00,$15.40,$0.00,$0.00,$15.65,$89.38,$0.00,$44.69,$70.79,$71.50,$0.00,$13.99,$0.00,$14.23,$0.00
40-27028,SUP,HCPCS C1713,,40-27028  -  SCREW BN T7 2.7MM 28MM YLW NS VARIAX ST TI FT LCK PLT SYS,$89.38,$0.00,$89.38,$40.22,$63.79,$0.00,$15.40,$0.00,$0.00,$15.65,$89.38,$0.00,$44.69,$70.79,$71.50,$0.00,$13.99,$0.00,$14.23,$0.00
40-27030,SUP,HCPCS C1713,,40-27030  -  SCREW BN T7 2.7MM 30MM YLW NS VARIAX ST TI FT LCK PLT SYS,$89.38,$0.00,$89.38,$40.22,$63.79,$0.00,$15.40,$0.00,$0.00,$15.65,$89.38,$0.00,$44.69,$70.79,$71.50,$0.00,$13.99,$0.00,$14.23,$0.00
40-27032,SUP,HCPCS C1713,,40-27032  -  SCREW BN T7 2.7MM 32MM YLW NS VARIAX ST TI FT LCK PLT SYS,$89.38,$0.00,$89.38,$40.22,$63.79,$0.00,$15.40,$0.00,$0.00,$15.65,$89.38,$0.00,$44.69,$70.79,$71.50,$0.00,$13.99,$0.00,$14.23,$0.00
40-27034,SUP,HCPCS C1713,,40-27034  -  SCREW BN T7 2.7MM 34MM YLW NS VARIAX ST TI FT LCK PLT SYS,$89.38,$0.00,$89.38,$40.22,$63.79,$0.00,$15.40,$0.00,$0.00,$15.65,$89.38,$0.00,$44.69,$70.79,$71.50,$0.00,$13.99,$0.00,$14.23,$0.00
40-27036,SUP,HCPCS C1713,,40-27036  -  SCREW BN T7 2.7MM 36MM YLW NS VARIAX ST TI FT LCK PLT SYS,$89.38,$0.00,$89.38,$40.22,$63.79,$0.00,$15.40,$0.00,$0.00,$15.65,$89.38,$0.00,$44.69,$70.79,$71.50,$0.00,$13.99,$0.00,$14.23,$0.00
40-27038,SUP,HCPCS C1713,,40-27038  -  SCREW BN T7 2.7MM 38MM YLW NS VARIAX ST TI FT LCK PLT SYS,$89.38,$0.00,$89.38,$40.22,$63.79,$0.00,$15.40,$0.00,$0.00,$15.65,$89.38,$0.00,$44.69,$70.79,$71.50,$0.00,$13.99,$0.00,$14.23,$0.00
40-27040,SUP,HCPCS C1713,,40-27040  -  SCREW BN T7 2.7MM 40MM YLW NS VARIAX ST TI FT LCK PLT SYS,$89.38,$0.00,$89.38,$40.22,$63.79,$0.00,$15.40,$0.00,$0.00,$15.65,$89.38,$0.00,$44.69,$70.79,$71.50,$0.00,$13.99,$0.00,$14.23,$0.00
40-27045,SUP,HCPCS C1713,,40-27045  -  SCREW BN T7 2.7MM 45MM YLW NS VARIAX ST TI FT LCK PLT SYS,$89.38,$0.00,$89.38,$40.22,$63.79,$0.00,$15.40,$0.00,$0.00,$15.65,$89.38,$0.00,$44.69,$70.79,$71.50,$0.00,$13.99,$0.00,$14.23,$0.00
40-27050,SUP,HCPCS C1713,,40-27050  -  SCREW BN T7 2.7MM 50MM YLW NS VARIAX ST TI FT LCK PLT SYS,$89.38,$0.00,$89.38,$40.22,$63.79,$0.00,$15.40,$0.00,$0.00,$15.65,$89.38,$0.00,$44.69,$70.79,$71.50,$0.00,$13.99,$0.00,$14.23,$0.00
40-27608,SUP,HCPCS C1713,,40-27608  -  SCREW BN T7 2.7MM 8MM BLU NS VARIAX LCK ST TI FT LCK PLT SYS,$206.25,$0.00,$206.25,$92.81,$147.20,$0.00,$35.54,$0.00,$0.00,$36.11,$206.25,$0.00,$103.13,$163.35,$165.00,$0.00,$32.28,$0.00,$32.84,$0.00
40-27610,SUP,HCPCS C1713,,40-27610  -  SCREW BONE 2.7MM 10MM VARIAX FT LCK T7 NONSTRL,$206.25,$0.00,$206.25,$92.81,$147.20,$0.00,$35.54,$0.00,$0.00,$36.11,$206.25,$0.00,$103.13,$163.35,$165.00,$0.00,$32.28,$0.00,$32.84,$0.00
40-27612,SUP,HCPCS C1713,,40-27612  -  SCREW BN T7 2.7MM 12MM BLU NS VARIAX LCK ST TI FT LCK PLT,$206.25,$0.00,$206.25,$92.81,$147.20,$0.00,$35.54,$0.00,$0.00,$36.11,$206.25,$0.00,$103.13,$163.35,$165.00,$0.00,$32.28,$0.00,$32.84,$0.00
40-27614,SUP,HCPCS C1713,,40-27614  -  SCREW BN T7 2.7MM 14MM BLU NS VARIAX LCK ST TI FT LCK PLT,$206.25,$0.00,$206.25,$92.81,$147.20,$0.00,$35.54,$0.00,$0.00,$36.11,$206.25,$0.00,$103.13,$163.35,$165.00,$0.00,$32.28,$0.00,$32.84,$0.00
40-27616,SUP,HCPCS C1713,,40-27616  -  SCREW BN T7 2.7MM 16MM BLU NS VARIAX LCK ST TI FT LCK PLT,$206.25,$0.00,$206.25,$92.81,$147.20,$0.00,$35.54,$0.00,$0.00,$36.11,$206.25,$0.00,$103.13,$163.35,$165.00,$0.00,$32.28,$0.00,$32.84,$0.00
40-27618,SUP,HCPCS C1713,,40-27618  -  SCREW BN T7 2.7MM 18MM BLU NS VARIAX LCK ST TI FT LCK PLT,$206.25,$0.00,$206.25,$92.81,$147.20,$0.00,$35.54,$0.00,$0.00,$36.11,$206.25,$0.00,$103.13,$163.35,$165.00,$0.00,$32.28,$0.00,$32.84,$0.00
40-27620,SUP,HCPCS C1713,,40-27620  -  SCREW BN T7 2.7MM 20MM BLU NS VARIAX LCK ST TI FT LCK PLT,$206.25,$0.00,$206.25,$92.81,$147.20,$0.00,$35.54,$0.00,$0.00,$36.11,$206.25,$0.00,$103.13,$163.35,$165.00,$0.00,$32.28,$0.00,$32.84,$0.00
40-27622,SUP,HCPCS C1713,,40-27622  -  SCREW BN T7 2.7MM 22MM BLU NS VARIAX LCK ST TI FT LCK PLT,$206.25,$0.00,$206.25,$92.81,$147.20,$0.00,$35.54,$0.00,$0.00,$36.11,$206.25,$0.00,$103.13,$163.35,$165.00,$0.00,$32.28,$0.00,$32.84,$0.00
40-27624,SUP,HCPCS C1713,,40-27624  -  SCREW BN T7 2.7MM 24MM BLU NS VARIAX LCK ST TI FT LCK PLT,$206.25,$0.00,$206.25,$92.81,$147.20,$0.00,$35.54,$0.00,$0.00,$36.11,$206.25,$0.00,$103.13,$163.35,$165.00,$0.00,$32.28,$0.00,$32.84,$0.00
40-27626,SUP,HCPCS C1713,,40-27626  -  SCREW BN T7 2.7MM 26MM BLU NS VARIAX LCK ST TI FT LCK PLT,$206.25,$0.00,$206.25,$92.81,$147.20,$0.00,$35.54,$0.00,$0.00,$36.11,$206.25,$0.00,$103.13,$163.35,$165.00,$0.00,$32.28,$0.00,$32.84,$0.00
40-27628,SUP,HCPCS C1713,,40-27628  -  SCREW BN T7 2.7MM 28MM BLU NS VARIAX LCK ST TI FT LCK PLT,$206.25,$0.00,$206.25,$92.81,$147.20,$0.00,$35.54,$0.00,$0.00,$36.11,$206.25,$0.00,$103.13,$163.35,$165.00,$0.00,$32.28,$0.00,$32.84,$0.00
40-27630,SUP,HCPCS C1713,,40-27630  -  SCREW BN T7 2.7MM 30MM BLU NS VARIAX LCK ST TI FT LCK PLT,$206.25,$0.00,$206.25,$92.81,$147.20,$0.00,$35.54,$0.00,$0.00,$36.11,$206.25,$0.00,$103.13,$163.35,$165.00,$0.00,$32.28,$0.00,$32.84,$0.00
40-27632,SUP,HCPCS C1713,,40-27632  -  SCREW BN T7 2.7MM 32MM BLU NS VARIAX LCK ST TI FT LCK PLT,$206.25,$0.00,$206.25,$92.81,$147.20,$0.00,$35.54,$0.00,$0.00,$36.11,$206.25,$0.00,$103.13,$163.35,$165.00,$0.00,$32.28,$0.00,$32.84,$0.00
40-27634,SUP,HCPCS C1713,,40-27634  -  SCREW BN T7 2.7MM 34MM BLU NS VARIAX LCK ST TI FT LCK PLT,$206.25,$0.00,$206.25,$92.81,$147.20,$0.00,$35.54,$0.00,$0.00,$36.11,$206.25,$0.00,$103.13,$163.35,$165.00,$0.00,$32.28,$0.00,$32.84,$0.00
40-27636,SUP,HCPCS C1713,,40-27636  -  SCREW BN T7 2.7MM 36MM BLU NS VARIAX LCK ST TI FT LCK PLT,$206.25,$0.00,$206.25,$92.81,$147.20,$0.00,$35.54,$0.00,$0.00,$36.11,$206.25,$0.00,$103.13,$163.35,$165.00,$0.00,$32.28,$0.00,$32.84,$0.00
40-27638,SUP,HCPCS C1713,,40-27638  -  SCREW BN T7 2.7MM 38MM BLU NS VARIAX LCK ST TI FT LCK PLT,$206.25,$0.00,$206.25,$92.81,$147.20,$0.00,$35.54,$0.00,$0.00,$36.11,$206.25,$0.00,$103.13,$163.35,$165.00,$0.00,$32.28,$0.00,$32.84,$0.00
40-27640,SUP,HCPCS C1713,,40-27640  -  SCREW BN T7 2.7MM 40MM BLU NS VARIAX LCK ST TI FT LCK PLT,$206.25,$0.00,$206.25,$92.81,$147.20,$0.00,$35.54,$0.00,$0.00,$36.11,$206.25,$0.00,$103.13,$163.35,$165.00,$0.00,$32.28,$0.00,$32.84,$0.00
40-27645,SUP,HCPCS C1713,,40-27645  -  SCREW BN T7 2.7MM 45MM BLU NS VARIAX LCK ST TI FT LCK PLT,$206.25,$0.00,$206.25,$92.81,$147.20,$0.00,$35.54,$0.00,$0.00,$36.11,$206.25,$0.00,$103.13,$163.35,$165.00,$0.00,$32.28,$0.00,$32.84,$0.00
40-27650,SUP,HCPCS C1713,,40-27650  -  SCREW BN T7 2.7MM 50MM BLU NS VARIAX LCK ST TI FT LCK PLT,$206.25,$0.00,$206.25,$92.81,$147.20,$0.00,$35.54,$0.00,$0.00,$36.11,$206.25,$0.00,$103.13,$163.35,$165.00,$0.00,$32.28,$0.00,$32.84,$0.00
40-27900,SUP,HCPCS C1713,,40-27900  -  WASHER ORTH 2.7 MM SCR,$125.13,$0.00,$125.13,$56.31,$89.30,$0.00,$21.56,$0.00,$0.00,$21.91,$125.13,$0.00,$62.56,$99.10,$100.10,$0.00,$19.58,$0.00,$19.92,$0.00
403.318E,SUP,HCPCS C1713,,403.318E  -  3.2MM TI EMERGENCY SCREW 18MM,$200.25,$0.00,$200.25,$90.11,$142.92,$0.00,$34.50,$0.00,$0.00,$35.06,$200.25,$0.00,$100.13,$158.60,$160.20,$0.00,$31.34,$0.00,$31.88,$0.00
40-30108,SUP,HCPCS C1713,,40-30108  -  SCREW BONE 3MM 8MM 4MM ASNS TI MIC FT HAND CANN THRD NONSTRL,$295.63,$0.00,$295.63,$133.03,$210.99,$0.00,$50.93,$0.00,$0.00,$51.76,$295.63,$0.00,$147.81,$234.14,$236.50,$0.00,$46.27,$0.00,$47.06,$0.00
40-30109,SUP,HCPCS C1713,,40-30109  -  SCREW BONE 3MM ASNS MIC CANN,$295.63,$0.00,$295.63,$133.03,$210.99,$0.00,$50.93,$0.00,$0.00,$51.76,$295.63,$0.00,$147.81,$234.14,$236.50,$0.00,$46.27,$0.00,$47.06,$0.00
40-30110,SUP,HCPCS C1713,,40-30110  -  SCREW BONE 3MM 10MM 4MM ASNS TI MIC FT HAND CANN THRD,$295.63,$0.00,$295.63,$133.03,$210.99,$0.00,$50.93,$0.00,$0.00,$51.76,$295.63,$0.00,$147.81,$234.14,$236.50,$0.00,$46.27,$0.00,$47.06,$0.00
40-30111,SUP,HCPCS C1713,,40-30111  -  SCREW BONE 3MM 11MM 4MM ASNS TI MIC FT HAND CANN THRD,$295.63,$0.00,$295.63,$133.03,$210.99,$0.00,$50.93,$0.00,$0.00,$51.76,$295.63,$0.00,$147.81,$234.14,$236.50,$0.00,$46.27,$0.00,$47.06,$0.00
40-30112,SUP,HCPCS C1713,,40-30112  -  SCREW BONE 3MM 12MM 4MM ASNS TI MIC HAND FT CANN THRD,$295.63,$0.00,$295.63,$133.03,$210.99,$0.00,$50.93,$0.00,$0.00,$51.76,$295.63,$0.00,$147.81,$234.14,$236.50,$0.00,$46.27,$0.00,$47.06,$0.00
40-30113,SUP,HCPCS C1713,,40-30113  -  SCREW BONE 3MM 13MM 4MM ASNS TI MIC HAND FT CANN THRD,$295.63,$0.00,$295.63,$133.03,$210.99,$0.00,$50.93,$0.00,$0.00,$51.76,$295.63,$0.00,$147.81,$234.14,$236.50,$0.00,$46.27,$0.00,$47.06,$0.00
40-30114,SUP,HCPCS C1713,,40-30114  -  SCREW BONE 3MM 14MM 4MM ASNS TI MIC FT HAND CANN THRD,$295.63,$0.00,$295.63,$133.03,$210.99,$0.00,$50.93,$0.00,$0.00,$51.76,$295.63,$0.00,$147.81,$234.14,$236.50,$0.00,$46.27,$0.00,$47.06,$0.00
40-30115,SUP,HCPCS C1713,,40-30115  -  SCREW BONE 3MM 15MM 4MM ASNS TI MIC HAND FT CANN THRD,$295.63,$0.00,$295.63,$133.03,$210.99,$0.00,$50.93,$0.00,$0.00,$51.76,$295.63,$0.00,$147.81,$234.14,$236.50,$0.00,$46.27,$0.00,$47.06,$0.00
40-30116,SUP,HCPCS C1713,,40-30116  -  SCREW BONE 3MM 16MM 4MM ASNS TI MIC HAND FT CANN THRD,$295.63,$0.00,$295.63,$133.03,$210.99,$0.00,$50.93,$0.00,$0.00,$51.76,$295.63,$0.00,$147.81,$234.14,$236.50,$0.00,$46.27,$0.00,$47.06,$0.00
40-30117,SUP,HCPCS C1713,,40-30117  -  SCREW BONE 3MM 17MM 4MM ASNS TI MIC HAND FT CANN THRD,$295.63,$0.00,$295.63,$133.03,$210.99,$0.00,$50.93,$0.00,$0.00,$51.76,$295.63,$0.00,$147.81,$234.14,$236.50,$0.00,$46.27,$0.00,$47.06,$0.00
40-30118,SUP,HCPCS C1713,,40-30118  -  SCREW BONE 3MM 18MM 5MM ASNS TI MIC HAND FT CANN THRD,$295.63,$0.00,$295.63,$133.03,$210.99,$0.00,$50.93,$0.00,$0.00,$51.76,$295.63,$0.00,$147.81,$234.14,$236.50,$0.00,$46.27,$0.00,$47.06,$0.00
40-30119,SUP,HCPCS C1713,,40-30119  -  SCREW BONE 3MM 19MM 5MM ASNS TI MIC FT HAND CANN THRD,$295.63,$0.00,$295.63,$133.03,$210.99,$0.00,$50.93,$0.00,$0.00,$51.76,$295.63,$0.00,$147.81,$234.14,$236.50,$0.00,$46.27,$0.00,$47.06,$0.00
40-30120,SUP,HCPCS C1713,,40-30120  -  SCREW BONE 3MM 20MM 5MM ASNS TI MIC FT HAND CANN THRD,$295.63,$0.00,$295.63,$133.03,$210.99,$0.00,$50.93,$0.00,$0.00,$51.76,$295.63,$0.00,$147.81,$234.14,$236.50,$0.00,$46.27,$0.00,$47.06,$0.00
40-30121,SUP,HCPCS C1713,,40-30121  -  SCREW BONE 3MM 21MM 5MM ASNS TI MIC FT HAND CANN THRD STRL,$295.63,$0.00,$295.63,$133.03,$210.99,$0.00,$50.93,$0.00,$0.00,$51.76,$295.63,$0.00,$147.81,$234.14,$236.50,$0.00,$46.27,$0.00,$47.06,$0.00
40-30122,SUP,HCPCS C1713,,40-30122  -  SCREW BONE 3MM 22MM 5MM ASNS TI MIC FT HAND CANN THRD,$295.63,$0.00,$295.63,$133.03,$210.99,$0.00,$50.93,$0.00,$0.00,$51.76,$295.63,$0.00,$147.81,$234.14,$236.50,$0.00,$46.27,$0.00,$47.06,$0.00
40-30123,SUP,HCPCS C1713,,40-30123  -  SCREW BONE 3MM 23MM 5MM ASNS TI MIC FT HAND CANN THRD,$295.63,$0.00,$295.63,$133.03,$210.99,$0.00,$50.93,$0.00,$0.00,$51.76,$295.63,$0.00,$147.81,$234.14,$236.50,$0.00,$46.27,$0.00,$47.06,$0.00
40-30124,SUP,HCPCS C1713,,40-30124  -  SCREW BONE 3MM 24MM 6MM ASNS TI MIC FT HAND CANN THRD,$295.63,$0.00,$295.63,$133.03,$210.99,$0.00,$50.93,$0.00,$0.00,$51.76,$295.63,$0.00,$147.81,$234.14,$236.50,$0.00,$46.27,$0.00,$47.06,$0.00
40-30125,SUP,HCPCS C1713,,40-30125  -  SCREW BONE 3MM 25MM 6MM ASNS TI MIC FT HAND CANN THRD,$295.63,$0.00,$295.63,$133.03,$210.99,$0.00,$50.93,$0.00,$0.00,$51.76,$295.63,$0.00,$147.81,$234.14,$236.50,$0.00,$46.27,$0.00,$47.06,$0.00
40-30126,SUP,HCPCS C1713,,40-30126  -  SCREW BONE 3MM 26MM 6MM ASNS MIC CANN NONSTRL,$295.63,$0.00,$295.63,$133.03,$210.99,$0.00,$50.93,$0.00,$0.00,$51.76,$295.63,$0.00,$147.81,$234.14,$236.50,$0.00,$46.27,$0.00,$47.06,$0.00
40-30127,SUP,HCPCS C1713,,40-30127  -  SCREW BONE 3MM 27MM 6MM ASNS TI MIC FT HAND CANN THRD,$295.63,$0.00,$295.63,$133.03,$210.99,$0.00,$50.93,$0.00,$0.00,$51.76,$295.63,$0.00,$147.81,$234.14,$236.50,$0.00,$46.27,$0.00,$47.06,$0.00
40-30128,SUP,HCPCS C1713,,40-30128  -  SCREW BONE 3MM 28MM 6MM ASNS TI MIC FT HAND CANN NONSTRL,$295.63,$0.00,$295.63,$133.03,$210.99,$0.00,$50.93,$0.00,$0.00,$51.76,$295.63,$0.00,$147.81,$234.14,$236.50,$0.00,$46.27,$0.00,$47.06,$0.00
40-30129,SUP,HCPCS C1713,,40-30129  -  SCREW BONE 3MM 29MM 6MM ASNS TI MIC FT HAND CANN THRD,$295.63,$0.00,$295.63,$133.03,$210.99,$0.00,$50.93,$0.00,$0.00,$51.76,$295.63,$0.00,$147.81,$234.14,$236.50,$0.00,$46.27,$0.00,$47.06,$0.00
40-30130,SUP,HCPCS C1713,,40-30130  -  SCREW BONE 3MM 30MM 6MM ASNS TI MIC FT HAND CANN THRD,$295.63,$0.00,$295.63,$133.03,$210.99,$0.00,$50.93,$0.00,$0.00,$51.76,$295.63,$0.00,$147.81,$234.14,$236.50,$0.00,$46.27,$0.00,$47.06,$0.00
40-30132,SUP,HCPCS C1713,,40-30132  -  SCREW BONE 3MM 32MM 6MM ASNS TI MIC FT HAND CANN THRD STRL,$295.63,$0.00,$295.63,$133.03,$210.99,$0.00,$50.93,$0.00,$0.00,$51.76,$295.63,$0.00,$147.81,$234.14,$236.50,$0.00,$46.27,$0.00,$47.06,$0.00
40-30134,SUP,HCPCS C1713,,40-30134  -  SCREW BONE 3MM 34MM 7MM ASNS TI MIC FT HAND CANN THRD STRL,$295.63,$0.00,$295.63,$133.03,$210.99,$0.00,$50.93,$0.00,$0.00,$51.76,$295.63,$0.00,$147.81,$234.14,$236.50,$0.00,$46.27,$0.00,$47.06,$0.00
40-30136,SUP,HCPCS C1713,,40-30136  -  SCREW BONE 3MM 36MM 7MM ASNS TI MIC FT HAND CANN THRD STRL,$295.63,$0.00,$295.63,$133.03,$210.99,$0.00,$50.93,$0.00,$0.00,$51.76,$295.63,$0.00,$147.81,$234.14,$236.50,$0.00,$46.27,$0.00,$47.06,$0.00
40-30138,SUP,HCPCS C1713,,40-30138  -  SCREW BONE 3MM 38MM 8MM ASNS TI MIC FT HAND CANN THRD STRL,$295.63,$0.00,$295.63,$133.03,$210.99,$0.00,$50.93,$0.00,$0.00,$51.76,$295.63,$0.00,$147.81,$234.14,$236.50,$0.00,$46.27,$0.00,$47.06,$0.00
40-30140,SUP,HCPCS C1713,,40-30140  -  SCREW BN MIC RVRS CUT FLUT 3MM 40MM NS 8MM ASNS SLF CUT CNN,$295.63,$0.00,$295.63,$133.03,$210.99,$0.00,$50.93,$0.00,$0.00,$51.76,$295.63,$0.00,$147.81,$234.14,$236.50,$0.00,$46.27,$0.00,$47.06,$0.00
40-30214,SUP,HCPCS C1713,,40-30214  -  SCREW BONE 3MM 14MM 6MM ASNS TI MIC FT HAND CANN THRD,$295.63,$0.00,$295.63,$133.03,$210.99,$0.00,$50.93,$0.00,$0.00,$51.76,$295.63,$0.00,$147.81,$234.14,$236.50,$0.00,$46.27,$0.00,$47.06,$0.00
40-30215,SUP,HCPCS C1713,,40-30215  -  SCREW BONE 3MM 15MM 7MM ASNS TI MIC FT HAND CANN THRD,$295.63,$0.00,$295.63,$133.03,$210.99,$0.00,$50.93,$0.00,$0.00,$51.76,$295.63,$0.00,$147.81,$234.14,$236.50,$0.00,$46.27,$0.00,$47.06,$0.00
40-30216,SUP,HCPCS C1713,,40-30216  -  SCREW BONE 3MM 16MM 7MM ASNS TI MIC FT HAND CANN THRD STRL,$295.63,$0.00,$295.63,$133.03,$210.99,$0.00,$50.93,$0.00,$0.00,$51.76,$295.63,$0.00,$147.81,$234.14,$236.50,$0.00,$46.27,$0.00,$47.06,$0.00
40-30217,SUP,HCPCS C1713,,40-30217  -  SCREW BONE 3MM 17MM 8MM ASNS TI MIC FT HAND CANN THRD STRL,$295.63,$0.00,$295.63,$133.03,$210.99,$0.00,$50.93,$0.00,$0.00,$51.76,$295.63,$0.00,$147.81,$234.14,$236.50,$0.00,$46.27,$0.00,$47.06,$0.00
40-30218,SUP,HCPCS C1713,,40-30218  -  SCREW BONE 3MM 18MM 8MM ASNS TI MIC FT HAND CANN THRD,$295.63,$0.00,$295.63,$133.03,$210.99,$0.00,$50.93,$0.00,$0.00,$51.76,$295.63,$0.00,$147.81,$234.14,$236.50,$0.00,$46.27,$0.00,$47.06,$0.00
40-30219,SUP,HCPCS C1713,,40-30219  -  SCREW BONE 3MM 21MM 5MM ASNS TI MIC FT HAND CANN THRD STRL,$295.63,$0.00,$295.63,$133.03,$210.99,$0.00,$50.93,$0.00,$0.00,$51.76,$295.63,$0.00,$147.81,$234.14,$236.50,$0.00,$46.27,$0.00,$47.06,$0.00
40-30220,SUP,HCPCS C1713,,40-30220  -  SCREW BONE 3MM 20MM 9MM ASNS TI MIC FT HAND CANN THRD STRL,$295.63,$0.00,$295.63,$133.03,$210.99,$0.00,$50.93,$0.00,$0.00,$51.76,$295.63,$0.00,$147.81,$234.14,$236.50,$0.00,$46.27,$0.00,$47.06,$0.00
40-30221,SUP,HCPCS C1713,,40-30221  -  SCREW BONE 3MM 21MM 9MM ASNS TI MIC FT HAND CANN THRD,$295.63,$0.00,$295.63,$133.03,$210.99,$0.00,$50.93,$0.00,$0.00,$51.76,$295.63,$0.00,$147.81,$234.14,$236.50,$0.00,$46.27,$0.00,$47.06,$0.00
40-30222,SUP,HCPCS C1713,,40-30222  -  SCREW BN MIC RVRS CUT FLUT 3MM 22MM NS 10MM ASNS SLF CUT CNN,$295.63,$0.00,$295.63,$133.03,$210.99,$0.00,$50.93,$0.00,$0.00,$51.76,$295.63,$0.00,$147.81,$234.14,$236.50,$0.00,$46.27,$0.00,$47.06,$0.00
40-30223,SUP,HCPCS C1713,,40-30223  -  SCREW BONE 3MM 23MM 10MM ASNS TI MIC FT HAND CANN THRD,$295.63,$0.00,$295.63,$133.03,$210.99,$0.00,$50.93,$0.00,$0.00,$51.76,$295.63,$0.00,$147.81,$234.14,$236.50,$0.00,$46.27,$0.00,$47.06,$0.00
40-30224,SUP,HCPCS C1713,,40-30224  -  SCREW BONE 3MM 24MM 10MM ASNS TI MIC FT HAND CANN THRD,$295.63,$0.00,$295.63,$133.03,$210.99,$0.00,$50.93,$0.00,$0.00,$51.76,$295.63,$0.00,$147.81,$234.14,$236.50,$0.00,$46.27,$0.00,$47.06,$0.00
40-30225,SUP,HCPCS C1713,,40-30225  -  SCREW BONE 3MM 25MM 10MM ASNS TI MIC FT HAND CANN THRD,$295.63,$0.00,$295.63,$133.03,$210.99,$0.00,$50.93,$0.00,$0.00,$51.76,$295.63,$0.00,$147.81,$234.14,$236.50,$0.00,$46.27,$0.00,$47.06,$0.00
40-30226,SUP,HCPCS C1713,,40-30226  -  SCREW BONE 3MM 26MM 12MM ASNS TI MIC FT HAND CANN THRD,$295.63,$0.00,$295.63,$133.03,$210.99,$0.00,$50.93,$0.00,$0.00,$51.76,$295.63,$0.00,$147.81,$234.14,$236.50,$0.00,$46.27,$0.00,$47.06,$0.00
40-30227,SUP,HCPCS C1713,,40-30227  -  SCREW BONE 3MM 27MM 12MM ASNS TI MIC FT HAND CANN THRD,$295.63,$0.00,$295.63,$133.03,$210.99,$0.00,$50.93,$0.00,$0.00,$51.76,$295.63,$0.00,$147.81,$234.14,$236.50,$0.00,$46.27,$0.00,$47.06,$0.00
40-30228,SUP,HCPCS C1713,,40-30228  -  SCREW BONE 3MM 28MM 12MM ASNS TI MIC FT HAND CANN THRD,$295.63,$0.00,$295.63,$133.03,$210.99,$0.00,$50.93,$0.00,$0.00,$51.76,$295.63,$0.00,$147.81,$234.14,$236.50,$0.00,$46.27,$0.00,$47.06,$0.00
40-30229,SUP,HCPCS C1713,,40-30229  -  SCREW BONE 3MM 29MM 12MM ASNS TI MIC FT HAND CANN THRD,$295.63,$0.00,$295.63,$133.03,$210.99,$0.00,$50.93,$0.00,$0.00,$51.76,$295.63,$0.00,$147.81,$234.14,$236.50,$0.00,$46.27,$0.00,$47.06,$0.00
40-30230,SUP,HCPCS C1713,,40-30230  -  SCREW BONE 3MM 30MM 14MM ASNS TI MIC FT HAND CANN THRD,$295.63,$0.00,$295.63,$133.03,$210.99,$0.00,$50.93,$0.00,$0.00,$51.76,$295.63,$0.00,$147.81,$234.14,$236.50,$0.00,$46.27,$0.00,$47.06,$0.00
40-30232,SUP,HCPCS C1713,,40-30232  -  SCREW BONE 32MM 14MM TI MIC CANC,$295.63,$0.00,$295.63,$133.03,$210.99,$0.00,$50.93,$0.00,$0.00,$51.76,$295.63,$0.00,$147.81,$234.14,$236.50,$0.00,$46.27,$0.00,$47.06,$0.00
40-30234,SUP,HCPCS C1713,,40-30234  -  SCREW BONE 3MM 34MM 16MM ASNS TI MIC FT HAND CANN THRD,$295.63,$0.00,$295.63,$133.03,$210.99,$0.00,$50.93,$0.00,$0.00,$51.76,$295.63,$0.00,$147.81,$234.14,$236.50,$0.00,$46.27,$0.00,$47.06,$0.00
40-30236,SUP,HCPCS C1713,,40-30236  -  SCREW BONE 3MM 36MM 16MM ASNS TI MIC FT HAND CANN THRD STRL,$295.63,$0.00,$295.63,$133.03,$210.99,$0.00,$50.93,$0.00,$0.00,$51.76,$295.63,$0.00,$147.81,$234.14,$236.50,$0.00,$46.27,$0.00,$47.06,$0.00
40-30238,SUP,HCPCS C1713,,40-30238  -  SCREW BONE 2MM 38MM 16MM ASNS TI MIC FT HAND CANN THRD,$295.63,$0.00,$295.63,$133.03,$210.99,$0.00,$50.93,$0.00,$0.00,$51.76,$295.63,$0.00,$147.81,$234.14,$236.50,$0.00,$46.27,$0.00,$47.06,$0.00
40-30240,SUP,HCPCS C1713,,40-30240  -  SCREW BONE 3MM 40MM 18MM ASNS TI MIC FT HAND CANN THRD,$295.63,$0.00,$295.63,$133.03,$210.99,$0.00,$50.93,$0.00,$0.00,$51.76,$295.63,$0.00,$147.81,$234.14,$236.50,$0.00,$46.27,$0.00,$47.06,$0.00
40-30900,SUP,Custom 27803010,,40-30900  -  WASHER ORTH MIC 3MM ASNS,$127.88,$0.00,$127.88,$0.00,$91.26,$0.00,$0.00,$0.00,$0.00,$0.00,$127.88,$0.00,$63.94,$101.28,$102.30,$0.00,$0.00,$0.00,$0.00,$0.00
40-35010,SUP,HCPCS C1713,,40-35010  -  SCREW BN T10 FT 3.5MM 10MM YLW NS VARIAX ST TI FT/ANKL LCK,$103.13,$0.00,$103.13,$46.41,$73.60,$0.00,$17.77,$0.00,$0.00,$18.06,$103.13,$0.00,$51.56,$81.68,$82.50,$0.00,$16.14,$0.00,$16.42,$0.00
40-35012,SUP,HCPCS C1713,,40-35012  -  SCREW BN T10 FT 3.5MM 12MM YLW NS VARIAX ST TI FT/ANKL LCK,$103.13,$0.00,$103.13,$46.41,$73.60,$0.00,$17.77,$0.00,$0.00,$18.06,$103.13,$0.00,$51.56,$81.68,$82.50,$0.00,$16.14,$0.00,$16.42,$0.00
40-35014,SUP,HCPCS C1713,,40-35014  -  SCREW BN T10 FT 3.5MM 14MM YLW NS VARIAX ST TI FT/ANKL LCK,$103.13,$0.00,$103.13,$46.41,$73.60,$0.00,$17.77,$0.00,$0.00,$18.06,$103.13,$0.00,$51.56,$81.68,$82.50,$0.00,$16.14,$0.00,$16.42,$0.00
40-35016,SUP,HCPCS C1713,,40-35016  -  SCREW BN T10 FT 3.5MM 16MM YLW NS VARIAX ST TI FT/ANKL LCK,$103.13,$0.00,$103.13,$46.41,$73.60,$0.00,$17.77,$0.00,$0.00,$18.06,$103.13,$0.00,$51.56,$81.68,$82.50,$0.00,$16.14,$0.00,$16.42,$0.00
40-35018,SUP,HCPCS C1713,,40-35018  -  SCREW BN T10 FT 3.5MM 18MM YLW NS VARIAX ST TI FT/ANKL LCK,$103.13,$0.00,$103.13,$46.41,$73.60,$0.00,$17.77,$0.00,$0.00,$18.06,$103.13,$0.00,$51.56,$81.68,$82.50,$0.00,$16.14,$0.00,$16.42,$0.00
40-35020,SUP,HCPCS C1713,,40-35020  -  SCREW BN T10 FT 3.5MM 20MM YLW NS VARIAX ST TI FT/ANKL LCK,$103.13,$0.00,$103.13,$46.41,$73.60,$0.00,$17.77,$0.00,$0.00,$18.06,$103.13,$0.00,$51.56,$81.68,$82.50,$0.00,$16.14,$0.00,$16.42,$0.00
40-35022,SUP,HCPCS C1713,,40-35022  -  SCREW BN T10 FT 3.5MM 22MM YLW NS VARIAX ST TI FT/ANKL LCK,$103.13,$0.00,$103.13,$46.41,$73.60,$0.00,$17.77,$0.00,$0.00,$18.06,$103.13,$0.00,$51.56,$81.68,$82.50,$0.00,$16.14,$0.00,$16.42,$0.00
40-35024,SUP,HCPCS C1713,,40-35024  -  SCREW BN T10 FT 3.5MM 24MM YLW NS VARIAX ST TI FT/ANKL LCK,$103.13,$0.00,$103.13,$46.41,$73.60,$0.00,$17.77,$0.00,$0.00,$18.06,$103.13,$0.00,$51.56,$81.68,$82.50,$0.00,$16.14,$0.00,$16.42,$0.00
40-35026,SUP,HCPCS C1713,,40-35026  -  SCREW BN T10 FT 3.5MM 26MM YLW NS VARIAX ST TI FT/ANKL LCK,$103.13,$0.00,$103.13,$46.41,$73.60,$0.00,$17.77,$0.00,$0.00,$18.06,$103.13,$0.00,$51.56,$81.68,$82.50,$0.00,$16.14,$0.00,$16.42,$0.00
40-35028,SUP,HCPCS C1713,,40-35028  -  SCREW BN T10 FT 3.5MM 28MM YLW NS VARIAX ST TI FT/ANKL LCK,$103.13,$0.00,$103.13,$46.41,$73.60,$0.00,$17.77,$0.00,$0.00,$18.06,$103.13,$0.00,$51.56,$81.68,$82.50,$0.00,$16.14,$0.00,$16.42,$0.00
40-35030,SUP,HCPCS C1713,,40-35030  -  SCREW BN T10 FT 3.5MM 30MM YLW NS VARIAX ST TI FT/ANKL LCK,$103.13,$0.00,$103.13,$46.41,$73.60,$0.00,$17.77,$0.00,$0.00,$18.06,$103.13,$0.00,$51.56,$81.68,$82.50,$0.00,$16.14,$0.00,$16.42,$0.00
40-35032,SUP,HCPCS C1713,,40-35032  -  SCREW BN T10 FT 3.5MM 32MM YLW NS VARIAX ST TI FT/ANKL LCK,$103.13,$0.00,$103.13,$46.41,$73.60,$0.00,$17.77,$0.00,$0.00,$18.06,$103.13,$0.00,$51.56,$81.68,$82.50,$0.00,$16.14,$0.00,$16.42,$0.00
40-35034,SUP,HCPCS C1713,,40-35034  -  SCREW BN T10 FT 3.5MM 34MM YLW NS VARIAX ST TI FT/ANKL LCK,$103.13,$0.00,$103.13,$46.41,$73.60,$0.00,$17.77,$0.00,$0.00,$18.06,$103.13,$0.00,$51.56,$81.68,$82.50,$0.00,$16.14,$0.00,$16.42,$0.00
40-35036,SUP,HCPCS C1713,,40-35036  -  SCREW BN T10 FT 3.5MM 36MM YLW NS VARIAX ST TI FT/ANKL LCK,$103.13,$0.00,$103.13,$46.41,$73.60,$0.00,$17.77,$0.00,$0.00,$18.06,$103.13,$0.00,$51.56,$81.68,$82.50,$0.00,$16.14,$0.00,$16.42,$0.00
40-35038,SUP,HCPCS C1713,,40-35038  -  SCREW BN T10 FT 3.5MM 38MM YLW NS VARIAX ST TI FT/ANKL LCK,$103.13,$0.00,$103.13,$46.41,$73.60,$0.00,$17.77,$0.00,$0.00,$18.06,$103.13,$0.00,$51.56,$81.68,$82.50,$0.00,$16.14,$0.00,$16.42,$0.00
40-35040,SUP,HCPCS C1713,,40-35040  -  SCREW BN T10 FT 3.5MM 40MM YLW NS VARIAX ST TI FT/ANKL LCK,$103.13,$0.00,$103.13,$46.41,$73.60,$0.00,$17.77,$0.00,$0.00,$18.06,$103.13,$0.00,$51.56,$81.68,$82.50,$0.00,$16.14,$0.00,$16.42,$0.00
40-35042,SUP,HCPCS C1713,,40-35042  -  SCREW BN T10 FT 3.5MM 42MM YLW NS VARIAX ST TI FT/ANKL LCK,$103.13,$0.00,$103.13,$46.41,$73.60,$0.00,$17.77,$0.00,$0.00,$18.06,$103.13,$0.00,$51.56,$81.68,$82.50,$0.00,$16.14,$0.00,$16.42,$0.00
40-35044,SUP,HCPCS C1713,,40-35044  -  SCREW BN T10 FT 3.5MM 44MM YLW NS VARIAX ST TI FT/ANKL LCK,$103.13,$0.00,$103.13,$46.41,$73.60,$0.00,$17.77,$0.00,$0.00,$18.06,$103.13,$0.00,$51.56,$81.68,$82.50,$0.00,$16.14,$0.00,$16.42,$0.00
40-35046,SUP,HCPCS C1713,,40-35046  -  SCREW BN T10 FT 3.5MM 46MM YLW NS VARIAX ST TI FT/ANKL LCK,$103.13,$0.00,$103.13,$46.41,$73.60,$0.00,$17.77,$0.00,$0.00,$18.06,$103.13,$0.00,$51.56,$81.68,$82.50,$0.00,$16.14,$0.00,$16.42,$0.00
40-35048,SUP,HCPCS C1713,,40-35048  -  SCREW BN T10 FT 3.5MM 48MM YLW NS VARIAX ST TI FT/ANKL LCK,$103.13,$0.00,$103.13,$46.41,$73.60,$0.00,$17.77,$0.00,$0.00,$18.06,$103.13,$0.00,$51.56,$81.68,$82.50,$0.00,$16.14,$0.00,$16.42,$0.00
40-35050,SUP,HCPCS C1713,,40-35050  -  SCREW BN T10 FT 3.5MM 50MM YLW NS VARIAX ST TI FT/ANKL LCK,$103.13,$0.00,$103.13,$46.41,$73.60,$0.00,$17.77,$0.00,$0.00,$18.06,$103.13,$0.00,$51.56,$81.68,$82.50,$0.00,$16.14,$0.00,$16.42,$0.00
40-35055,SUP,HCPCS C1713,,40-35055  -  SCREW BN T10 FT 3.5MM 55MM YLW NS VARIAX ST TI FT/ANKL LCK,$103.13,$0.00,$103.13,$46.41,$73.60,$0.00,$17.77,$0.00,$0.00,$18.06,$103.13,$0.00,$51.56,$81.68,$82.50,$0.00,$16.14,$0.00,$16.42,$0.00
40-35060,SUP,HCPCS C1713,,40-35060  -  SCREW BN T10 FT 3.5MM 60MM YLW NS VARIAX ST TI FT/ANKL LCK,$103.13,$0.00,$103.13,$46.41,$73.60,$0.00,$17.77,$0.00,$0.00,$18.06,$103.13,$0.00,$51.56,$81.68,$82.50,$0.00,$16.14,$0.00,$16.42,$0.00
40-35065,SUP,HCPCS C1713,,40-35065  -  SCREW BN T10 FT 3.5MM 65MM YLW NS VARIAX ST TI FT/ANKL LCK,$103.13,$0.00,$103.13,$46.41,$73.60,$0.00,$17.77,$0.00,$0.00,$18.06,$103.13,$0.00,$51.56,$81.68,$82.50,$0.00,$16.14,$0.00,$16.42,$0.00
40-35070,SUP,HCPCS C1713,,40-35070  -  SCREW BN T10 FT 3.5MM 70MM YLW NS VARIAX ST TI FT/ANKL LCK,$103.13,$0.00,$103.13,$46.41,$73.60,$0.00,$17.77,$0.00,$0.00,$18.06,$103.13,$0.00,$51.56,$81.68,$82.50,$0.00,$16.14,$0.00,$16.42,$0.00
40-35610,SUP,HCPCS C1713,,40-35610  -  SCREW BN T10 FT 3.5MM 10MM BLU NS VARIAX LCK ST TI FT/ANKL,$209.00,$0.00,$209.00,$94.05,$149.16,$0.00,$36.01,$0.00,$0.00,$36.59,$209.00,$0.00,$104.50,$165.53,$167.20,$0.00,$32.71,$0.00,$33.27,$0.00
40-35612,SUP,HCPCS C1713,,40-35612  -  SCREW BN T10 FT 3.5MM 12MM BLU NS VARIAX LCK ST TI FT/ANKL,$209.00,$0.00,$209.00,$94.05,$149.16,$0.00,$36.01,$0.00,$0.00,$36.59,$209.00,$0.00,$104.50,$165.53,$167.20,$0.00,$32.71,$0.00,$33.27,$0.00
40-35614,SUP,HCPCS C1713,,40-35614  -  SCREW BN T10 FT 3.5MM 14MM BLU NS VARIAX LCK ST TI FT/ANKL,$209.00,$0.00,$209.00,$94.05,$149.16,$0.00,$36.01,$0.00,$0.00,$36.59,$209.00,$0.00,$104.50,$165.53,$167.20,$0.00,$32.71,$0.00,$33.27,$0.00
40-35616,SUP,HCPCS C1713,,40-35616  -  SCREW BN T10 FT 3.5MM 16MM BLU NS VARIAX LCK ST TI FT/ANKL,$209.00,$0.00,$209.00,$94.05,$149.16,$0.00,$36.01,$0.00,$0.00,$36.59,$209.00,$0.00,$104.50,$165.53,$167.20,$0.00,$32.71,$0.00,$33.27,$0.00
40-35618,SUP,HCPCS C1713,,40-35618  -  SCREW BN T10 FT 3.5MM 18MM BLU NS VARIAX LCK ST TI FT/ANKL,$209.00,$0.00,$209.00,$94.05,$149.16,$0.00,$36.01,$0.00,$0.00,$36.59,$209.00,$0.00,$104.50,$165.53,$167.20,$0.00,$32.71,$0.00,$33.27,$0.00
40-35620,SUP,HCPCS C1713,,40-35620  -  SCREW BN T10 FT 3.5MM 20MM BLU NS VARIAX LCK ST TI FT/ANKL,$209.00,$0.00,$209.00,$94.05,$149.16,$0.00,$36.01,$0.00,$0.00,$36.59,$209.00,$0.00,$104.50,$165.53,$167.20,$0.00,$32.71,$0.00,$33.27,$0.00
40-35622,SUP,HCPCS C1713,,40-35622  -  SCREW BN T10 FT 3.5MM 22MM BLU NS VARIAX LCK ST TI FT/ANKL,$209.00,$0.00,$209.00,$94.05,$149.16,$0.00,$36.01,$0.00,$0.00,$36.59,$209.00,$0.00,$104.50,$165.53,$167.20,$0.00,$32.71,$0.00,$33.27,$0.00
40-35624,SUP,HCPCS C1713,,40-35624  -  SCREW BN T10 FT 3.5MM 24MM BLU NS VARIAX LCK ST TI FT/ANKL,$209.00,$0.00,$209.00,$94.05,$149.16,$0.00,$36.01,$0.00,$0.00,$36.59,$209.00,$0.00,$104.50,$165.53,$167.20,$0.00,$32.71,$0.00,$33.27,$0.00
40-35626,SUP,HCPCS C1713,,40-35626  -  SCREW BN T10 FT 3.5MM 26MM BLU NS VARIAX LCK ST TI FT/ANKL,$209.00,$0.00,$209.00,$94.05,$149.16,$0.00,$36.01,$0.00,$0.00,$36.59,$209.00,$0.00,$104.50,$165.53,$167.20,$0.00,$32.71,$0.00,$33.27,$0.00
40-35628,SUP,HCPCS C1713,,40-35628  -  SCREW BN T10 FT 3.5MM 28MM BLU NS VARIAX LCK ST TI FT/ANKL,$209.00,$0.00,$209.00,$94.05,$149.16,$0.00,$36.01,$0.00,$0.00,$36.59,$209.00,$0.00,$104.50,$165.53,$167.20,$0.00,$32.71,$0.00,$33.27,$0.00
40-35630,SUP,HCPCS C1713,,40-35630  -  SCREW BN T10 FT 3.5MM 30MM BLU NS VARIAX LCK ST TI FT/ANKL,$209.00,$0.00,$209.00,$94.05,$149.16,$0.00,$36.01,$0.00,$0.00,$36.59,$209.00,$0.00,$104.50,$165.53,$167.20,$0.00,$32.71,$0.00,$33.27,$0.00
40-35632,SUP,HCPCS C1713,,40-35632  -  SCREW BN T10 FT 3.5MM 32MM BLU NS VARIAX LCK ST TI FT/ANKL,$209.00,$0.00,$209.00,$94.05,$149.16,$0.00,$36.01,$0.00,$0.00,$36.59,$209.00,$0.00,$104.50,$165.53,$167.20,$0.00,$32.71,$0.00,$33.27,$0.00
40-35634,SUP,HCPCS C1713,,40-35634  -  SCREW BONE 3.5MM 34MM VARIAX TI FT T10 LCK NONSTRL,$209.00,$0.00,$209.00,$94.05,$149.16,$0.00,$36.01,$0.00,$0.00,$36.59,$209.00,$0.00,$104.50,$165.53,$167.20,$0.00,$32.71,$0.00,$33.27,$0.00
40-35636,SUP,HCPCS C1713,,40-35636  -  SCREW BN T10 FT 3.5MM 36MM BLU NS VARIAX LCK ST TI FT/ANKL,$209.00,$0.00,$209.00,$94.05,$149.16,$0.00,$36.01,$0.00,$0.00,$36.59,$209.00,$0.00,$104.50,$165.53,$167.20,$0.00,$32.71,$0.00,$33.27,$0.00
40-35638,SUP,HCPCS C1713,,40-35638  -  SCREW BN T10 FT 3.5MM 38MM BLU NS VARIAX LCK ST TI FT/ANKL,$209.00,$0.00,$209.00,$94.05,$149.16,$0.00,$36.01,$0.00,$0.00,$36.59,$209.00,$0.00,$104.50,$165.53,$167.20,$0.00,$32.71,$0.00,$33.27,$0.00
40-35640,SUP,HCPCS C1713,,40-35640  -  SCREW BN T10 FT 3.5MM 40MM BLU NS VARIAX LCK ST TI FT/ANKL,$209.00,$0.00,$209.00,$94.05,$149.16,$0.00,$36.01,$0.00,$0.00,$36.59,$209.00,$0.00,$104.50,$165.53,$167.20,$0.00,$32.71,$0.00,$33.27,$0.00
40-35642,SUP,HCPCS C1713,,40-35642  -  SCREW BN T10 FT 3.5MM 42MM BLU NS VARIAX LCK ST TI FT/ANKL,$209.00,$0.00,$209.00,$94.05,$149.16,$0.00,$36.01,$0.00,$0.00,$36.59,$209.00,$0.00,$104.50,$165.53,$167.20,$0.00,$32.71,$0.00,$33.27,$0.00
40-35644,SUP,HCPCS C1713,,40-35644  -  SCREW BN T10 FT 3.5MM 44MM BLU NS VARIAX LCK ST TI FT/ANKL,$209.00,$0.00,$209.00,$94.05,$149.16,$0.00,$36.01,$0.00,$0.00,$36.59,$209.00,$0.00,$104.50,$165.53,$167.20,$0.00,$32.71,$0.00,$33.27,$0.00
40-35646,SUP,HCPCS C1713,,40-35646  -  SCREW BN T10 FT 3.5MM 46MM BLU NS VARIAX LCK ST TI FT/ANKL,$209.00,$0.00,$209.00,$94.05,$149.16,$0.00,$36.01,$0.00,$0.00,$36.59,$209.00,$0.00,$104.50,$165.53,$167.20,$0.00,$32.71,$0.00,$33.27,$0.00
40-35648,SUP,HCPCS C1713,,40-35648  -  SCREW BN T10 FT 3.5MM 48MM BLU NS VARIAX LCK ST TI FT/ANKL,$209.00,$0.00,$209.00,$94.05,$149.16,$0.00,$36.01,$0.00,$0.00,$36.59,$209.00,$0.00,$104.50,$165.53,$167.20,$0.00,$32.71,$0.00,$33.27,$0.00
40-35650,SUP,HCPCS C1713,,40-35650  -  SCREW BN T10 FT 3.5MM 50MM BLU NS VARIAX LCK ST TI FT/ANKL,$209.00,$0.00,$209.00,$94.05,$149.16,$0.00,$36.01,$0.00,$0.00,$36.59,$209.00,$0.00,$104.50,$165.53,$167.20,$0.00,$32.71,$0.00,$33.27,$0.00
40-35655,SUP,HCPCS C1713,,40-35655  -  SCREW BN T10 FT 3.5MM 55MM BLU NS VARIAX LCK ST TI FT/ANKL,$209.00,$0.00,$209.00,$94.05,$149.16,$0.00,$36.01,$0.00,$0.00,$36.59,$209.00,$0.00,$104.50,$165.53,$167.20,$0.00,$32.71,$0.00,$33.27,$0.00
40-35660,SUP,HCPCS C1713,,40-35660  -  SCREW BN T10 FT 3.5MM 60MM BLU NS VARIAX LCK ST TI FT/ANKL,$209.00,$0.00,$209.00,$94.05,$149.16,$0.00,$36.01,$0.00,$0.00,$36.59,$209.00,$0.00,$104.50,$165.53,$167.20,$0.00,$32.71,$0.00,$33.27,$0.00
40-35665,SUP,HCPCS C1713,,40-35665  -  SCREW BN T10 FT 3.5MM 65MM BLU NS VARIAX LCK ST TI FT/ANKL,$209.00,$0.00,$209.00,$94.05,$149.16,$0.00,$36.01,$0.00,$0.00,$36.59,$209.00,$0.00,$104.50,$165.53,$167.20,$0.00,$32.71,$0.00,$33.27,$0.00
40-35670,SUP,HCPCS C1713,,40-35670  -  SCREW BN T10 FT 3.5MM 70MM BLU NS VARIAX LCK ST TI FT/ANKL,$209.00,$0.00,$209.00,$94.05,$149.16,$0.00,$36.01,$0.00,$0.00,$36.59,$209.00,$0.00,$104.50,$165.53,$167.20,$0.00,$32.71,$0.00,$33.27,$0.00
40-35900,SUP,HCPCS C1713,,40-35900  -  WASHER ORTH 3.5 MM SCR,$143.00,$0.00,$143.00,$64.35,$102.06,$0.00,$24.64,$0.00,$0.00,$25.04,$143.00,$0.00,$71.50,$113.26,$114.40,$0.00,$22.38,$0.00,$22.77,$0.00
4040-0510R,SUP,Custom 27803010,,4040-0510R  -  INSERT TIB 5 10MM RIGHT KNEE,$858.00,$0.00,$858.00,$0.00,$612.35,$0.00,$0.00,$0.00,$0.00,$0.00,$858.00,$0.00,$429.00,$679.54,$686.40,$0.00,$0.00,$0.00,$0.00,$0.00
4040-0908R,SUP,Custom 27803010,,4040-0908R  -  INSERT TIB 9 RIGHT KNEE MDLR UNICOMP 8MM,$894.00,$0.00,$894.00,$0.00,$638.05,$0.00,$0.00,$0.00,$0.00,$0.00,$894.00,$0.00,$447.00,$708.05,$715.20,$0.00,$0.00,$0.00,$0.00,$0.00
40-5011,SUP,HCPCS C1725,,40-5011  -  CATH ANGIO RADIALTIGER CURVE 5FR 4MM 100CM CORON 1 SH DX,$87.50,$0.00,$87.50,$47.51,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
40-5012,SUP,HCPCS C1725,,40-5012  -  CATH ANGIO RADIALTIGER CURVE 5FR 4.5MM 100CM CORON 1 SH DX,$87.50,$0.00,$87.50,$47.51,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
4076-STDJ-185,SUP,HCPCS C1769,,4076-STDJ-185  -  4076-STDJ-185,$183.75,$0.00,$183.75,$99.78,$131.14,$0.00,$31.66,$0.00,$0.00,$32.17,$183.75,$0.00,$91.88,$145.53,$147.00,$0.00,$28.76,$0.00,$29.25,$0.00
4076-STDJ-300,SUP,HCPCS C1769,,4076-STDJ-300  -  4076-STDJ-300,$183.75,$0.00,$183.75,$99.78,$131.14,$0.00,$31.66,$0.00,$0.00,$32.17,$183.75,$0.00,$91.88,$145.53,$147.00,$0.00,$28.76,$0.00,$29.25,$0.00
40A002,SUP,HCPCS C1762,,40A002  -  GRAFT BONE SMALL 25X9X14MM WEDGE ILIAC CREST,"$2,005.00",$0.00,"$2,005.00",$0.00,"$1,430.97",$0.00,$345.45,$0.00,$0.00,$0.00,"$2,005.00",$0.00,"$1,002.50","$1,587.96","$1,604.00",$0.00,$313.78,$0.00,$0.00,$0.00
40A74,SUP,HCPCS C1768,,40A74  -  GRAFT VASC 40CM 7-4MM IMPR CBFL PTFE HMDIAL ACCES SHRT TPR,"$1,317.85",$0.00,"$1,317.85",$593.03,$940.55,$0.00,$227.06,$0.00,$0.00,$230.74,"$1,317.85",$0.00,$658.93,"$1,043.74","$1,054.28",$0.00,$206.24,$0.00,$209.80,$0.00
40S08,SUP,HCPCS C1768,,40S08  -  GRAFT VASC 8MM 40CM IMPRA CARBOFLO PTFE,$955.50,$0.00,$955.50,$429.98,$681.94,$0.00,$164.63,$0.00,$0.00,$167.30,$955.50,$0.00,$477.75,$756.76,$764.40,$0.00,$149.54,$0.00,$152.12,$0.00
4100M24,SUP,Custom 27803010,,4100M24  -  RING ANLPLS 24MM MTRL C-M-A IMR E TI,"$9,112.50",$0.00,"$9,112.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$9,112.50",$0.00,"$4,556.25","$7,217.10","$7,290.00",$0.00,$0.00,$0.00,$0.00,$0.00
4100M34,SUP,Custom 27803010,,4100M34  -  RING ANLPLS 34MM MTRL C-M-A IMR E TI SIL PLSTR,"$9,112.50",$0.00,"$9,112.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$9,112.50",$0.00,"$4,556.25","$7,217.10","$7,290.00",$0.00,$0.00,$0.00,$0.00,$0.00
41045-01,SUP,HCPCS C1887,,41045-01  -  CATH INFUS 5FR 40CM 20CM VLV DRG DLV CRGG-MCNAM,$202.50,$0.00,$202.50,$109.96,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
41046-01,SUP,HCPCS C1887,,41046-01  -  CATH INFUS .038IN 5FR 100CM 20CM PERI VLV CRGG-MCNAM,$202.50,$0.00,$202.50,$109.96,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
41050-01,SUP,HCPCS C1769,,41050-01  -  CATHETER INFS 5FR 100CM 10CM CRGG-MCNAM CRGG MICROVALVE 1,$262.50,$0.00,$262.50,$142.54,$187.35,$0.00,$45.23,$0.00,$0.00,$45.96,$262.50,$0.00,$131.25,$207.90,$210.00,$0.00,$41.08,$0.00,$41.79,$0.00
41053-01,SUP,HCPCS C1769,,41053-01  -  CATHETER INFS .038IN 5FR 100CM 40CM CRGG-MCNAM CRGG,$295.00,$0.00,$295.00,$160.19,$210.54,$0.00,$50.83,$0.00,$0.00,$51.65,$295.00,$0.00,$147.50,$233.64,$236.00,$0.00,$46.17,$0.00,$46.96,$0.00
41055-01,SUP,HCPCS C1887,,41055-01  -  CATHETER INFS 5FR 135CM 5CM CRGG-MCNAM CRGG-MICROVALVE 1 LUM,$262.50,$0.00,$262.50,$142.54,$187.35,$0.00,$45.23,$0.00,$0.00,$45.96,$262.50,$0.00,$131.25,$207.90,$210.00,$0.00,$41.08,$0.00,$41.79,$0.00
4105535XL,SUP,HCPCS C1713,,4105535XL  -  SCREW BONE 5.5MM 35MM XL SPNL,"$1,520.88",$0.00,"$1,520.88",$684.39,"$1,085.45",$0.00,$262.04,$0.00,$0.00,$266.29,"$1,520.88",$0.00,$760.44,"$1,204.54","$1,216.70",$0.00,$238.02,$0.00,$242.12,$0.00
4105540XL,SUP,HCPCS C1713,,4105540XL  -  SCREW BONE 5.5MM 40MM XL SPNL,"$1,520.88",$0.00,"$1,520.88",$684.39,"$1,085.45",$0.00,$262.04,$0.00,$0.00,$266.29,"$1,520.88",$0.00,$760.44,"$1,204.54","$1,216.70",$0.00,$238.02,$0.00,$242.12,$0.00
4105545XL,SUP,HCPCS C1713,,4105545XL  -  SCREW BONE 5.5MM 45MM XL SPNL,"$1,520.88",$0.00,"$1,520.88",$684.39,"$1,085.45",$0.00,$262.04,$0.00,$0.00,$266.29,"$1,520.88",$0.00,$760.44,"$1,204.54","$1,216.70",$0.00,$238.02,$0.00,$242.12,$0.00
41057-01,SUP,HCPCS C1769,,41057-01  -  CATHETER IV .038IN 5FR 135CM 20CM CRGG-MCNAM CRGG MICROVALVE,$202.50,$0.00,$202.50,$109.96,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
41059-01,SUP,HCPCS C1887,,41059-01  -  CATH INFUS .038IN 5FR 135CM 40CM VLV CRGG-MCNAM,$295.00,$0.00,$295.00,$160.19,$210.54,$0.00,$50.83,$0.00,$0.00,$51.65,$295.00,$0.00,$147.50,$233.64,$236.00,$0.00,$46.17,$0.00,$46.96,$0.00
4106545XL,SUP,HCPCS C1713,,4106545XL  -  SCREW BONE 6.5IN 45IN XL SPNL,"$1,734.30",$0.00,"$1,734.30",$780.44,"$1,237.77",$0.00,$298.81,$0.00,$0.00,$303.66,"$1,734.30",$0.00,$867.15,"$1,373.57","$1,387.44",$0.00,$271.42,$0.00,$276.10,$0.00
4106550XL,SUP,HCPCS C1713,,4106550XL  -  SCREW BONE 6.5MM 50MM XL SPNL,"$1,651.18",$0.00,"$1,651.18",$743.03,"$1,178.44",$0.00,$284.49,$0.00,$0.00,$289.11,"$1,651.18",$0.00,$825.59,"$1,307.73","$1,320.94",$0.00,$258.41,$0.00,$262.87,$0.00
4107540XL,SUP,HCPCS C1713,,4107540XL  -  SCREW BONE 7.5MM 40MM XL SPNL,"$1,651.18",$0.00,"$1,651.18",$743.03,"$1,178.44",$0.00,$284.49,$0.00,$0.00,$289.11,"$1,651.18",$0.00,$825.59,"$1,307.73","$1,320.94",$0.00,$258.41,$0.00,$262.87,$0.00
4107545XL,SUP,HCPCS C1713,,4107545XL  -  SCREW BONE 7.5MM 45MM XL SPNL,"$1,734.30",$0.00,"$1,734.30",$780.44,"$1,237.77",$0.00,$298.81,$0.00,$0.00,$303.66,"$1,734.30",$0.00,$867.15,"$1,373.57","$1,387.44",$0.00,$271.42,$0.00,$276.10,$0.00
4108540XL,SUP,HCPCS C1713,,4108540XL  -  SCREW BONE 8.5MM 40MM XL SPNL,"$1,651.18",$0.00,"$1,651.18",$743.03,"$1,178.44",$0.00,$284.49,$0.00,$0.00,$289.11,"$1,651.18",$0.00,$825.59,"$1,307.73","$1,320.94",$0.00,$258.41,$0.00,$262.87,$0.00
4108545XL,SUP,HCPCS C1713,,4108545XL  -  SCREW BONE 8.5MM 45MM XL SPNL,"$1,651.18",$0.00,"$1,651.18",$743.03,"$1,178.44",$0.00,$284.49,$0.00,$0.00,$289.11,"$1,651.18",$0.00,$825.59,"$1,307.73","$1,320.94",$0.00,$258.41,$0.00,$262.87,$0.00
412.113S,SUP,HCPCS C1713,,412.113S  -  SCREW BN SD15 FT 3.5MM 2.9MM 34MM GRN STRL MULTILOC LCK,$316.63,$0.00,$316.63,$142.48,$225.98,$0.00,$52.96,$0.00,$0.00,$55.44,$316.63,$0.00,$158.31,$250.77,$253.30,$0.00,$48.11,$0.00,$50.41,$0.00
41-2005,SUP,HCPCS C1713,,41-2005  -  SCREW 5MM 2MM MANDIB XDR NLCKG BONE LORENZ SLVR,$160.00,$0.00,$160.00,$72.00,$114.19,$0.00,$27.57,$0.00,$0.00,$28.01,$160.00,$0.00,$80.00,$126.72,$128.00,$0.00,$25.04,$0.00,$25.47,$0.00
41-2006,SUP,HCPCS C1713,,41-2006  -  SCREW BN 2MM 6MM BLU SLVR X-DRV NONLOCK XDR MNDB LORENZ,$222.50,$0.00,$222.50,$100.13,$158.80,$0.00,$38.34,$0.00,$0.00,$38.96,$222.50,$0.00,$111.25,$176.22,$178.00,$0.00,$34.82,$0.00,$35.42,$0.00
41-2008,SUP,HCPCS C1713,,41-2008  -  SCREW BONE 2MM 8MM X DRIVE TRAUMAONE SILVER MANDIB,$222.50,$0.00,$222.50,$100.13,$158.80,$0.00,$38.34,$0.00,$0.00,$38.96,$222.50,$0.00,$111.25,$176.22,$178.00,$0.00,$34.82,$0.00,$35.42,$0.00
41-2010,SUP,HCPCS C1713,,41-2010  -  SCREW BONE 2MM 10MM NONLOCKING XDRIVE LORENZ SILVER MANDIB,$222.50,$0.00,$222.50,$100.13,$158.80,$0.00,$38.34,$0.00,$0.00,$38.96,$222.50,$0.00,$111.25,$176.22,$178.00,$0.00,$34.82,$0.00,$35.42,$0.00
41-2012,SUP,HCPCS C1713,,41-2012  -  SCREW BONE 2MM 12MM X DRIVE TRAUMAONE SILVER MANDIB,$222.50,$0.00,$222.50,$100.13,$158.80,$0.00,$38.34,$0.00,$0.00,$38.96,$222.50,$0.00,$111.25,$176.22,$178.00,$0.00,$34.82,$0.00,$35.42,$0.00
41-2014,SUP,HCPCS C1713,,41-2014  -  SCREW BONE 2MM 14MM CROSS DRIVE NONLOCKING TRAUMAONE SILVER,$222.50,$0.00,$222.50,$100.13,$158.80,$0.00,$38.34,$0.00,$0.00,$38.96,$222.50,$0.00,$111.25,$176.22,$178.00,$0.00,$34.82,$0.00,$35.42,$0.00
41-2016,SUP,HCPCS C1713,,41-2016  -  SCREW BONE 2MM 16MM NONLOCKING CROSS DRIVE TRAUMAONE SILVER,$222.50,$0.00,$222.50,$100.13,$158.80,$0.00,$38.34,$0.00,$0.00,$38.96,$222.50,$0.00,$111.25,$176.22,$178.00,$0.00,$34.82,$0.00,$35.42,$0.00
41-2018,SUP,HCPCS C1713,,41-2018  -  SCREW BONE 2MM 18MM NONLOCKING CROSS DRIVE TRAUMAONE SILVER,$222.50,$0.00,$222.50,$100.13,$158.80,$0.00,$38.34,$0.00,$0.00,$38.96,$222.50,$0.00,$111.25,$176.22,$178.00,$0.00,$34.82,$0.00,$35.42,$0.00
41-2106,SUP,HCPCS C1713,,41-2106  -  SCREW BN 2.3MM 6MM SLVR X-DRV LCK,$390.00,$0.00,$390.00,$175.50,$278.34,$0.00,$67.20,$0.00,$0.00,$68.29,$390.00,$0.00,$195.00,$308.88,$312.00,$0.00,$61.04,$0.00,$62.09,$0.00
41-2108,SUP,HCPCS C1713,,41-2108  -  SCREW BONE 2MM 8MM CROSS DRIVE LOCKING TRAUMAONE SILVER,$390.00,$0.00,$390.00,$175.50,$278.34,$0.00,$67.20,$0.00,$0.00,$68.29,$390.00,$0.00,$195.00,$308.88,$312.00,$0.00,$61.04,$0.00,$62.09,$0.00
41-2110,SUP,HCPCS C1713,,41-2110  -  SCREW BONE 2MM 10MM LOCKING CROSS DRIVE TRAUMAONE LORENZ,$390.00,$0.00,$390.00,$175.50,$278.34,$0.00,$67.20,$0.00,$0.00,$68.29,$390.00,$0.00,$195.00,$308.88,$312.00,$0.00,$61.04,$0.00,$62.09,$0.00
41-2112,SUP,HCPCS C1713,,41-2112  -  SCREW BONE 2MM 12MM CROSS DRIVE LOCKING TRAUMAONE SILVER,$390.00,$0.00,$390.00,$175.50,$278.34,$0.00,$67.20,$0.00,$0.00,$68.29,$390.00,$0.00,$195.00,$308.88,$312.00,$0.00,$61.04,$0.00,$62.09,$0.00
41-2114,SUP,HCPCS C1713,,41-2114  -  SCREW BONE 2MM 14MM CROSS DRIVE LOCKING TRAUMAONE SILVER,$390.00,$0.00,$390.00,$175.50,$278.34,$0.00,$67.20,$0.00,$0.00,$68.29,$390.00,$0.00,$195.00,$308.88,$312.00,$0.00,$61.04,$0.00,$62.09,$0.00
41-2116,SUP,HCPCS C1713,,41-2116  -  SCREW BONE 2MM 16MM X-DRIVE LOCKING TRAUMAONE SILVER MANDIB,$390.00,$0.00,$390.00,$175.50,$278.34,$0.00,$67.20,$0.00,$0.00,$68.29,$390.00,$0.00,$195.00,$308.88,$312.00,$0.00,$61.04,$0.00,$62.09,$0.00
41-2118,SUP,HCPCS C1713,,41-2118  -  SCREW BONE 2MM 18MM LOCKING CROSS DRIVE MANDUBULAR,$390.00,$0.00,$390.00,$175.50,$278.34,$0.00,$67.20,$0.00,$0.00,$68.29,$390.00,$0.00,$195.00,$308.88,$312.00,$0.00,$61.04,$0.00,$62.09,$0.00
41-2205,SUP,HCPCS C1713,,41-2205  -  SCREW 5MM 2MM MANDIB SLFDRILL XDR NLCKG BONE TRAUMAONE BLUE,$200.00,$0.00,$200.00,$90.00,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
41-2305,SUP,HCPCS C1713,,41-2305  -  SCREW BONE 2.3MM 5MM CROSS DRIVE NONLOCKING TRAUMAONE GOLD,$295.00,$0.00,$295.00,$132.75,$210.54,$0.00,$50.83,$0.00,$0.00,$51.65,$295.00,$0.00,$147.50,$233.64,$236.00,$0.00,$46.17,$0.00,$46.96,$0.00
41-2306,SUP,HCPCS C1713,,41-2306  -  SCREW BN 2.3MM 6MM AU X-DRV NONLOCK,$295.00,$0.00,$295.00,$132.75,$210.54,$0.00,$50.83,$0.00,$0.00,$51.65,$295.00,$0.00,$147.50,$233.64,$236.00,$0.00,$46.17,$0.00,$46.96,$0.00
41-2308,SUP,HCPCS C1713,,41-2308  -  SCREW BONE 2.3MM 8MM NONLOCKING CROSS DRIVE TRAUMAONE GOLD,$295.00,$0.00,$295.00,$132.75,$210.54,$0.00,$50.83,$0.00,$0.00,$51.65,$295.00,$0.00,$147.50,$233.64,$236.00,$0.00,$46.17,$0.00,$46.96,$0.00
41-2310,SUP,HCPCS C1713,,41-2310  -  SCREW BONE 2.3MM 10MM NONLOCKING CROSS DRIVE TRAUMAONE GOLD,$295.00,$0.00,$295.00,$132.75,$210.54,$0.00,$50.83,$0.00,$0.00,$51.65,$295.00,$0.00,$147.50,$233.64,$236.00,$0.00,$46.17,$0.00,$46.96,$0.00
41-2312,SUP,HCPCS C1713,,41-2312  -  SCREW BONE 2.3MM 12MM NONLOCKING CROSS DRIVE TRAUMAONE GOLD,$295.00,$0.00,$295.00,$132.75,$210.54,$0.00,$50.83,$0.00,$0.00,$51.65,$295.00,$0.00,$147.50,$233.64,$236.00,$0.00,$46.17,$0.00,$46.96,$0.00
41-2314,SUP,HCPCS C1713,,41-2314  -  SCREW BONE 2.3MM 14MM NONLOCKING CROSS DRIVE TRAUMAONE GOLD,$295.00,$0.00,$295.00,$132.75,$210.54,$0.00,$50.83,$0.00,$0.00,$51.65,$295.00,$0.00,$147.50,$233.64,$236.00,$0.00,$46.17,$0.00,$46.96,$0.00
41-2316,SUP,HCPCS C1713,,41-2316  -  SCREW BONE 2.3MM 16MM NONLOCKING CROSS DRIVE TRAUMAONE GOLD,$295.00,$0.00,$295.00,$132.75,$210.54,$0.00,$50.83,$0.00,$0.00,$51.65,$295.00,$0.00,$147.50,$233.64,$236.00,$0.00,$46.17,$0.00,$46.96,$0.00
41-2318,SUP,HCPCS C1713,,41-2318  -  SCREW BONE 2.3MM 18MM NONLOCKING CROSS DRIVE TRAUMAONE GOLD,$295.00,$0.00,$295.00,$132.75,$210.54,$0.00,$50.83,$0.00,$0.00,$51.65,$295.00,$0.00,$147.50,$233.64,$236.00,$0.00,$46.17,$0.00,$46.96,$0.00
41-2406,SUP,HCPCS C1713,,41-2406  -  SCREW BONE 2.3MM 6MM LOCK CROSS DRIVE TRAUMAONE LORENZ GOLD,$340.00,$0.00,$340.00,$153.00,$242.66,$0.00,$58.58,$0.00,$0.00,$59.53,$340.00,$0.00,$170.00,$269.28,$272.00,$0.00,$53.21,$0.00,$54.13,$0.00
41-2408,SUP,HCPCS C1713,,41-2408  -  SCREW BONE 2.3MM 8MM CROSS DRIVE LOCK TRAUMAONE LORENZ GOLD,$467.50,$0.00,$467.50,$210.38,$333.65,$0.00,$80.55,$0.00,$0.00,$81.86,$467.50,$0.00,$233.75,$370.26,$374.00,$0.00,$73.16,$0.00,$74.43,$0.00
41-2410,SUP,HCPCS C1713,,41-2410  -  SCREW BONE 2.3MM 10MM CROSS DRIVE LOCK TRAUMAONE LORENZ GOLD,$467.50,$0.00,$467.50,$210.38,$333.65,$0.00,$80.55,$0.00,$0.00,$81.86,$467.50,$0.00,$233.75,$370.26,$374.00,$0.00,$73.16,$0.00,$74.43,$0.00
41-2412,SUP,HCPCS C1713,,41-2412  -  SCREW BONE 2.3MM 12MM CROSS DRIVE LOCK TRAUMAONE LORENZ GOLD,$467.50,$0.00,$467.50,$210.38,$333.65,$0.00,$80.55,$0.00,$0.00,$81.86,$467.50,$0.00,$233.75,$370.26,$374.00,$0.00,$73.16,$0.00,$74.43,$0.00
41-2414,SUP,HCPCS C1713,,41-2414  -  SCREW BONE 2.3MM 14MM CROSS DRIVE LOCK TRAUMAONE LORENZ GOLD,$467.50,$0.00,$467.50,$210.38,$333.65,$0.00,$80.55,$0.00,$0.00,$81.86,$467.50,$0.00,$233.75,$370.26,$374.00,$0.00,$73.16,$0.00,$74.43,$0.00
41-2416,SUP,HCPCS C1713,,41-2416  -  SCREW BONE 2.3MM 16MM CROSS DRIVE LOCK TRAUMAONE LORENZ GOLD,$467.50,$0.00,$467.50,$210.38,$333.65,$0.00,$80.55,$0.00,$0.00,$81.86,$467.50,$0.00,$233.75,$370.26,$374.00,$0.00,$73.16,$0.00,$74.43,$0.00
41-2418,SUP,HCPCS C1713,,41-2418  -  SCREW BN 2.3MM 18MM AU X-DRV LCK,$467.50,$0.00,$467.50,$210.38,$333.65,$0.00,$80.55,$0.00,$0.00,$81.86,$467.50,$0.00,$233.75,$370.26,$374.00,$0.00,$73.16,$0.00,$74.43,$0.00
4125-127-100,SUP,Custom 27203010,,4125-127-100  -  BLADE SAW THK.05IN MEDIUM 3.937X.984IN 2 CUT SAGITTAL,$116.85,$0.00,$116.85,$0.00,$83.40,$0.00,$0.00,$0.00,$0.00,$0.00,$116.85,$0.00,$58.43,$92.55,$93.48,$0.00,$0.00,$0.00,$0.00,$0.00
41-2708,SUP,HCPCS C1713,,41-2708  -  SCREW BONE 2.7MM 8MM EMERGENCY CROSS DRIVE TRAUMAONE MAGENTA,$297.50,$0.00,$297.50,$133.88,$212.33,$0.00,$51.26,$0.00,$0.00,$52.09,$297.50,$0.00,$148.75,$235.62,$238.00,$0.00,$46.56,$0.00,$47.36,$0.00
41-2710,SUP,HCPCS C1713,,41-2710  -  SCREW BN 2.7MM 10MM MAG NLCKG X DRV,$297.50,$0.00,$297.50,$133.88,$212.33,$0.00,$51.26,$0.00,$0.00,$52.09,$297.50,$0.00,$148.75,$235.62,$238.00,$0.00,$46.56,$0.00,$47.36,$0.00
41-2712,SUP,HCPCS C1713,,41-2712  -  SCREW BONE 2.7MM 12MM NONLOCKING X DRIVE LORENZ MAGENTA,$297.50,$0.00,$297.50,$133.88,$212.33,$0.00,$51.26,$0.00,$0.00,$52.09,$297.50,$0.00,$148.75,$235.62,$238.00,$0.00,$46.56,$0.00,$47.36,$0.00
41-2714,SUP,HCPCS C1713,,41-2714  -  SCREW BONE 2.7MM 14MM NONLOCKING X DRIVE LORENZ MAGENTA,$297.50,$0.00,$297.50,$133.88,$212.33,$0.00,$51.26,$0.00,$0.00,$52.09,$297.50,$0.00,$148.75,$235.62,$238.00,$0.00,$46.56,$0.00,$47.36,$0.00
41-2716,SUP,HCPCS C1713,,41-2716  -  SCREW BN 2.7MM 17MM LCK XDR ER,$297.50,$0.00,$297.50,$133.88,$212.33,$0.00,$51.26,$0.00,$0.00,$52.09,$297.50,$0.00,$148.75,$235.62,$238.00,$0.00,$46.56,$0.00,$47.36,$0.00
41-2718,SUP,HCPCS C1713,,41-2718  -  SCREW BONE 2.7MM 18MM NONLOCKING X DRIVE LORENZ MAGENTA,$297.50,$0.00,$297.50,$133.88,$212.33,$0.00,$51.26,$0.00,$0.00,$52.09,$297.50,$0.00,$148.75,$235.62,$238.00,$0.00,$46.56,$0.00,$47.36,$0.00
413.590E,SUP,HCPCS C1713,,413.590E  -  SCREW BONE 3MM 20MM LOCK TITANIUM STERNUM NONSTRL,$505.00,$0.00,$505.00,$227.25,$360.42,$0.00,$87.01,$0.00,$0.00,$88.42,$505.00,$0.00,$252.50,$399.96,$404.00,$0.00,$79.03,$0.00,$80.40,$0.00
413.592E,SUP,HCPCS C1713,,413.592E  -  SCREW BONE 3MM 22MM LOCK TITANIUM STERNUM NONSTRL,$505.00,$0.00,$505.00,$227.25,$360.42,$0.00,$87.01,$0.00,$0.00,$88.42,$505.00,$0.00,$252.50,$399.96,$404.00,$0.00,$79.03,$0.00,$80.40,$0.00
413.594E,SUP,HCPCS C1713,,413.594E  -  SCREW BONE 3MM 24MM LOCK TITANIUM STERNUM STERILE,$505.00,$0.00,$505.00,$227.25,$360.42,$0.00,$87.01,$0.00,$0.00,$88.42,$505.00,$0.00,$252.50,$399.96,$404.00,$0.00,$79.03,$0.00,$80.40,$0.00
416-022A,SUP,Custom 27203010,,KIT BINAXNOW FLU A B CLIA WVD NASO SWB CNTRL VIR TST 22 TST,$660.75,$0.00,$660.75,$0.00,$471.58,$0.00,$0.00,$0.00,$0.00,$0.00,$660.75,$0.00,$330.38,$523.31,$528.60,$0.00,$0.00,$0.00,$0.00,$0.00
41645B,SUP,Custom 27803010,,41645B  -  RELOAD STPLR 3.5MM 45MM BLU STRL LF DVNC SI EWRST REG TISS,$450.00,$0.00,$450.00,$0.00,$321.17,$0.00,$0.00,$0.00,$0.00,$0.00,$450.00,$0.00,$225.00,$356.40,$360.00,$0.00,$0.00,$0.00,$0.00,$0.00
4170-223,SUP,Custom 27203010,,4170-223  -  TUBING SUCT/IRR FLD MNG INFL STRL DISP,$72.94,$0.00,$72.94,$0.00,$52.06,$0.00,$0.00,$0.00,$0.00,$0.00,$72.94,$0.00,$36.47,$57.77,$58.35,$0.00,$0.00,$0.00,$0.00,$0.00
419.952S,SUP,Custom 27803010,,419.952S  -  WASHER OVL SM ORTH TI 6.5/7.3MM CANN SCR STRL,$328.50,$0.00,$328.50,$0.00,$234.45,$0.00,$0.00,$0.00,$0.00,$0.00,$328.50,$0.00,$164.25,$260.17,$262.80,$0.00,$0.00,$0.00,$0.00,$0.00
419.953S,SUP,Custom 27803010,,419.953S  -  WASHER ORTHOPEDIC LARGE ROUND TITANIUM STERILE 6.5/7.3MM,$358.93,$0.00,$358.93,$0.00,$256.16,$0.00,$0.00,$0.00,$0.00,$0.00,$358.93,$0.00,$179.46,$284.27,$287.14,$0.00,$0.00,$0.00,$0.00,$0.00
4195-78,SUP,HCPCS C1898,,4195-78  -  LEAD PACING 5FR 78CM IS-1 UNIPOLAR DEPLOYABLE LOBE FIX,"$5,000.00",$0.00,"$5,000.00","$2,250.00","$3,568.50",$0.00,$861.48,$0.00,$0.00,$875.46,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$782.50,$0.00,$796.00,$0.00
4200-10,SUP,Custom 27203010,,4200-10  -  DISSECTOR SURG MODELING CATHETER MARTIN UNBALLOON,"$3,987.50",$0.00,"$3,987.50",$0.00,"$2,845.88",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,987.50",$0.00,"$1,993.75","$3,158.10","$3,190.00",$0.00,$0.00,$0.00,$0.00,$0.00
4200-20,SUP,HCPCS C1773,,4200-20  -  DEVICE RETRIEVAL REMOVAL ENDSCP HELIX,"$5,237.50",$0.00,"$5,237.50","$2,843.96","$3,738.00",$0.00,$902.40,$0.00,$0.00,$917.04,"$5,237.50",$0.00,"$2,618.75","$4,148.10","$4,190.00",$0.00,$819.67,$0.00,$833.81,$0.00
4200927F,SUP,Custom 27803010,,4200927F  -  CAGE SPNL 0D 9MM 27MM WHL BD STNDALN,"$4,245.88",$0.00,"$4,245.88",$0.00,"$3,030.28",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,245.88",$0.00,"$2,122.94","$3,362.74","$3,396.70",$0.00,$0.00,$0.00,$0.00,$0.00
4201127F,SUP,Custom 27803010,,4201127F  -  CAGE SPNL 0D 11MM 27MM WHL BD STNDALN,"$4,245.88",$0.00,"$4,245.88",$0.00,"$3,030.28",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,245.88",$0.00,"$2,122.94","$3,362.74","$3,396.70",$0.00,$0.00,$0.00,$0.00,$0.00
4201327F,SUP,Custom 27803010,,4201327F  -  CAGE SPNL 0D 13MM 27MM WHL BD STNDALN,"$4,245.88",$0.00,"$4,245.88",$0.00,"$3,030.28",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,245.88",$0.00,"$2,122.94","$3,362.74","$3,396.70",$0.00,$0.00,$0.00,$0.00,$0.00
4201527F,SUP,Custom 27803010,,4201527F  -  CAGE SPNL 0D 15MM 27MM WHL BD STNDALN,"$4,245.88",$0.00,"$4,245.88",$0.00,"$3,030.28",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,245.88",$0.00,"$2,122.94","$3,362.74","$3,396.70",$0.00,$0.00,$0.00,$0.00,$0.00
4201727F,SUP,Custom 27803010,,4201727F  -  CAGE SPNL 0D 17MM 27MM WHL BD STNDALN,"$4,245.88",$0.00,"$4,245.88",$0.00,"$3,030.28",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,245.88",$0.00,"$2,122.94","$3,362.74","$3,396.70",$0.00,$0.00,$0.00,$0.00,$0.00
420404F,SUP,Custom 27203010,,420404F  -  CATHETER CHLGM 4FR 40CM STRL 3W LL BVL BIL,$67.65,$0.00,$67.65,$0.00,$48.28,$0.00,$0.00,$0.00,$0.00,$0.00,$67.65,$0.00,$33.83,$53.58,$54.12,$0.00,$0.00,$0.00,$0.00,$0.00
420406F,SUP,Custom 27203010,,420406F  -  CATHETER CHLGM 6FR 40CM BIL,$67.65,$0.00,$67.65,$0.00,$48.28,$0.00,$0.00,$0.00,$0.00,$0.00,$67.65,$0.00,$33.83,$53.58,$54.12,$0.00,$0.00,$0.00,$0.00,$0.00
42-1002,SUP,HCPCS C1713,,42-1002  -  PLATE LNG 1MM MANDIB 6 HOLE Y 2MM/2.3MM SCR BONE TRAUMAONE,"$1,402.50",$0.00,"$1,402.50",$631.13,"$1,000.96",$0.00,$241.64,$0.00,$0.00,$245.57,"$1,402.50",$0.00,$701.25,"$1,110.78","$1,122.00",$0.00,$219.49,$0.00,$223.28,$0.00
42-1003,SUP,HCPCS C1713,,42-1003  -  PLATE 1MM MANDIB 7 HOLE CVD 2MM/2.3MM SCR BONE TRAUMAONE TI,"$1,402.50",$0.00,"$1,402.50",$631.13,"$1,000.96",$0.00,$241.64,$0.00,$0.00,$245.57,"$1,402.50",$0.00,$701.25,"$1,110.78","$1,122.00",$0.00,$219.49,$0.00,$223.28,$0.00
42-1004,SUP,HCPCS C1713,,42-1004  -  PLATE BONE STR 1MM 4 HOLE GAP TRAUMAONE SILVER TITANIUM,"$1,930.00",$0.00,"$1,930.00",$868.50,"$1,377.44",$0.00,$332.53,$0.00,$0.00,$337.93,"$1,930.00",$0.00,$965.00,"$1,528.56","$1,544.00",$0.00,$302.05,$0.00,$307.26,$0.00
42-1005,SUP,HCPCS C1713,,42-1005  -  PLATE 1MM MANDIB 2X7 HOLE MTRX STR BONE TRAUMAONE SLVR,"$1,402.50",$0.00,"$1,402.50",$631.13,"$1,000.96",$0.00,$241.64,$0.00,$0.00,$245.57,"$1,402.50",$0.00,$701.25,"$1,110.78","$1,122.00",$0.00,$219.49,$0.00,$223.28,$0.00
42-1006,SUP,HCPCS C1713,,42-1006  -  PLATE  2X7 CRVD MATRIX  1.0MM,"$1,402.50",$0.00,"$1,402.50",$631.13,"$1,000.96",$0.00,$241.64,$0.00,$0.00,$245.57,"$1,402.50",$0.00,$701.25,"$1,110.78","$1,122.00",$0.00,$219.49,$0.00,$223.28,$0.00
42-1007,SUP,HCPCS C1713,,42-1007  -  PLATE BONE STR 1MM 7 HOLE TRAUMAONE LORENZ TITANIUM MANDIB,"$1,930.00",$0.00,"$1,930.00",$868.50,"$1,377.44",$0.00,$332.53,$0.00,$0.00,$337.93,"$1,930.00",$0.00,$965.00,"$1,528.56","$1,544.00",$0.00,$302.05,$0.00,$307.26,$0.00
42-1016,SUP,HCPCS C1713,,42-1016  -  PLATE  16 HOLE STR  1.0MM,"$2,295.00",$0.00,"$2,295.00","$1,032.75","$1,637.94",$0.00,$395.42,$0.00,$0.00,$401.84,"$2,295.00",$0.00,"$1,147.50","$1,817.64","$1,836.00",$0.00,$359.17,$0.00,$365.36,$0.00
4241327F,SUP,Custom 27803010,,4241327F  -  CAGE SPNL 4D 13MM 27MM WHL BD STNDALN,"$4,245.88",$0.00,"$4,245.88",$0.00,"$3,030.28",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,245.88",$0.00,"$2,122.94","$3,362.74","$3,396.70",$0.00,$0.00,$0.00,$0.00,$0.00
4241521F,SUP,Custom 27803010,,4241521F  -  CAGE SPNL 4D 15MM 21MM FRNTL STNDALN,"$2,021.88",$0.00,"$2,021.88",$0.00,"$1,443.01",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,021.88",$0.00,"$1,010.94","$1,601.33","$1,617.50",$0.00,$0.00,$0.00,$0.00,$0.00
4241527B,SUP,Custom 27803010,,4241527B  -  CAGE SPNL 4D 15MM 27MM WHL BD STNDALN,"$4,245.88",$0.00,"$4,245.88",$0.00,"$3,030.28",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,245.88",$0.00,"$2,122.94","$3,362.74","$3,396.70",$0.00,$0.00,$0.00,$0.00,$0.00
4241527F,SUP,Custom 27803010,,4241527F  -  CAGE SPNL 4D 15MM 27MM WHL BD STNDALN,"$4,245.88",$0.00,"$4,245.88",$0.00,"$3,030.28",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,245.88",$0.00,"$2,122.94","$3,362.74","$3,396.70",$0.00,$0.00,$0.00,$0.00,$0.00
4241727B,SUP,Custom 27803010,,4241727B  -  CAGE SPNL 4D 17MM 27MM WHL BD STNDALN,"$4,245.88",$0.00,"$4,245.88",$0.00,"$3,030.28",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,245.88",$0.00,"$2,122.94","$3,362.74","$3,396.70",$0.00,$0.00,$0.00,$0.00,$0.00
4241727F,SUP,Custom 27803010,,4241727F  -  CAGE SPNL 4D 17MM 27MM WHL BD STNDALN,"$4,245.88",$0.00,"$4,245.88",$0.00,"$3,030.28",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,245.88",$0.00,"$2,122.94","$3,362.74","$3,396.70",$0.00,$0.00,$0.00,$0.00,$0.00
426.702S,SUP,HCPCS C1713,,426.702S  -  PLATE BONE BROAD 372MM 20 HOLE CVD LCP TITANIUM ORTHOPEDIC,"$2,371.93",$0.00,"$2,371.93","$1,067.37","$1,692.84",$0.00,$396.77,$0.00,$0.00,$415.31,"$2,371.93",$0.00,"$1,185.96","$1,878.57","$1,897.54",$0.00,$360.40,$0.00,$377.61,$0.00
426.722S,SUP,HCPCS C1713,,426.722S  -  PLATE BONE BROAD 408MM 22 HOLE CVD LCP TITANIUM ORTHOPEDIC,"$2,591.65",$0.00,"$2,591.65","$1,166.24","$1,849.66",$0.00,$433.52,$0.00,$0.00,$453.78,"$2,591.65",$0.00,"$1,295.83","$2,052.59","$2,073.32",$0.00,$393.78,$0.00,$412.59,$0.00
426.742S,SUP,HCPCS C1713,,426.742S  -  PLATE BONE BROAD 443MM 24 HOLE CVD LCP TITANIUM ORTHOPEDIC,"$2,812.75",$0.00,"$2,812.75","$1,265.74","$2,007.46",$0.00,$470.51,$0.00,$0.00,$492.49,"$2,812.75",$0.00,"$1,406.38","$2,227.70","$2,250.20",$0.00,$427.37,$0.00,$447.79,$0.00
426.762S,SUP,HCPCS C1713,,426.762S  -  PLATE BONE BROAD 479MM 26 HOLE CVD LCP TITANIUM ORTHOPEDIC,"$3,037.93",$0.00,"$3,037.93","$1,367.07","$2,168.17",$0.00,$508.18,$0.00,$0.00,$531.92,"$3,037.93",$0.00,"$1,518.96","$2,406.04","$2,430.34",$0.00,$461.59,$0.00,$483.64,$0.00
42615-05,SUP,Custom 27203010,,42615-05  -  KIT PRESSURE MONITR 3ML/HR 48IN 2 LINE TRANSDUCER MALE TO,$36.36,$0.00,$36.36,$0.00,$25.95,$0.00,$0.00,$0.00,$0.00,$0.00,$36.36,$0.00,$18.18,$28.80,$29.09,$0.00,$0.00,$0.00,$0.00,$0.00
42650-06,SUP,Custom 27203010,,42650-06  -  KIT PRESSURE MONITR 84IN TRANSDUCER FLUSH DEVICE TUBE,$73.16,$0.00,$73.16,$0.00,$52.21,$0.00,$0.00,$0.00,$0.00,$0.00,$73.16,$0.00,$36.58,$57.94,$58.53,$0.00,$0.00,$0.00,$0.00,$0.00
427022S,SUP,HCPCS C1713,,427022S  -  PLATE BN 292MM STRL 22 HL CMPR LCK,$391.88,$0.00,$391.88,$176.34,$279.68,$0.00,$67.52,$0.00,$0.00,$68.61,$391.88,$0.00,$195.94,$310.37,$313.50,$0.00,$61.33,$0.00,$62.39,$0.00
427069S,SUP,HCPCS C1713,,427069S  -  PLATE 3MM 115MM SS 9 HOLE 1/3 TBLR SM FRAG IMPL AXSOS BONE,$236.50,$0.00,$236.50,$106.43,$168.79,$0.00,$40.75,$0.00,$0.00,$41.41,$236.50,$0.00,$118.25,$187.31,$189.20,$0.00,$37.01,$0.00,$37.65,$0.00
4281127B,SUP,Custom 27803010,,4281127B  -  CAGE SPNL 8D 11MM 27MM WHL BD STNDALN,"$4,245.88",$0.00,"$4,245.88",$0.00,"$3,030.28",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,245.88",$0.00,"$2,122.94","$3,362.74","$3,396.70",$0.00,$0.00,$0.00,$0.00,$0.00
4281127F,SUP,Custom 27803010,,4281127F  -  CAGE SPNL 8D 11MM 27MM WHL BD STNDALN,"$4,245.88",$0.00,"$4,245.88",$0.00,"$3,030.28",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,245.88",$0.00,"$2,122.94","$3,362.74","$3,396.70",$0.00,$0.00,$0.00,$0.00,$0.00
4281327B,SUP,Custom 27803010,,4281327B  -  CAGE SPNL 8D 13MM 27MM WHL BD STNDALN,"$4,245.88",$0.00,"$4,245.88",$0.00,"$3,030.28",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,245.88",$0.00,"$2,122.94","$3,362.74","$3,396.70",$0.00,$0.00,$0.00,$0.00,$0.00
4281327F,SUP,Custom 27803010,,4281327F  -  CAGE SPNL 8D 13MM 27MM WHL BD STNDALN,"$4,245.88",$0.00,"$4,245.88",$0.00,"$3,030.28",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,245.88",$0.00,"$2,122.94","$3,362.74","$3,396.70",$0.00,$0.00,$0.00,$0.00,$0.00
4296-78,SUP,HCPCS C1900,,4296-78  -  LEAD PACING 2 CURVE 5.3FR 78CM BIPOL 2 ELECTRODE 2 FIX IS-1,"$3,562.50",$0.00,"$3,562.50",$0.00,"$2,542.56",$0.00,$613.80,$0.00,$0.00,$0.00,"$3,562.50",$0.00,"$1,781.25","$2,821.50","$2,850.00",$0.00,$557.53,$0.00,$0.00,$0.00
43-1001,SUP,HCPCS C1713,,43-1001  -  PLATE BONE SMALL 1MM ANGLED TRAUMAONE GOLD TITANIUM MANDIB 2,"$3,127.50",$0.00,"$3,127.50","$1,407.38","$2,232.10",$0.00,$538.85,$0.00,$0.00,$547.60,"$3,127.50",$0.00,"$1,563.75","$2,476.98","$2,502.00",$0.00,$489.45,$0.00,$497.90,$0.00
43-1004,SUP,HCPCS C1713,,43-1004  -  PLATE BONE STR 4 HOLE GAP CRANIOMAXILLOFACIAL,"$1,930.00",$0.00,"$1,930.00",$868.50,"$1,377.44",$0.00,$332.53,$0.00,$0.00,$337.93,"$1,930.00",$0.00,$965.00,"$1,528.56","$1,544.00",$0.00,$302.05,$0.00,$307.26,$0.00
43-1005,SUP,HCPCS C1713,,43-1005  -  PLATE BONE 1MM 4 HOLE STR TRAUMAONE GOLD TITANIUM MANDIB,"$1,930.00",$0.00,"$1,930.00",$868.50,"$1,377.44",$0.00,$332.53,$0.00,$0.00,$337.93,"$1,930.00",$0.00,$965.00,"$1,528.56","$1,544.00",$0.00,$302.05,$0.00,$307.26,$0.00
43-1007,SUP,HCPCS C1713,,43-1007  -  PLATE BONE 1.6MM 7 HOLE STR,"$2,295.00",$0.00,"$2,295.00","$1,032.75","$1,637.94",$0.00,$395.42,$0.00,$0.00,$401.84,"$2,295.00",$0.00,"$1,147.50","$1,817.64","$1,836.00",$0.00,$359.17,$0.00,$365.36,$0.00
43-1008,SUP,HCPCS C1713,,43-1008  -  PLATE BONE THK1.6MM CVD 7 HOLE LORENZ GOLD MANDIB,"$3,127.50",$0.00,"$3,127.50","$1,407.38","$2,232.10",$0.00,$538.85,$0.00,$0.00,$547.60,"$3,127.50",$0.00,"$1,563.75","$2,476.98","$2,502.00",$0.00,$489.45,$0.00,$497.90,$0.00
43-1016,SUP,HCPCS C1713,,43-1016  -  PLATE BONE 1.6MM 16 HOLE STR TRAUMAONE GOLD MANDIB,"$3,552.50",$0.00,"$3,552.50","$1,598.63","$2,535.42",$0.00,$612.08,$0.00,$0.00,$622.01,"$3,552.50",$0.00,"$1,776.25","$2,813.58","$2,842.00",$0.00,$555.97,$0.00,$565.56,$0.00
43-1280,SUP,Custom 27203010,,43-1280  -  KIT RSN REPR 75 PPM CRNPLST CMPLT SET TY 2 PWDR CRNL,"$4,296.40",$0.00,"$4,296.40",$0.00,"$3,066.34",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,296.40",$0.00,"$2,148.20","$3,402.75","$3,437.12",$0.00,$0.00,$0.00,$0.00,$0.00
43154-060,SUP,Custom 27203010,,43154-060  -  TUBE ENDOTRAC 6MM NSL/ORL TRK REINF CUF MRPH SIL SS,$312.93,$0.00,$312.93,$0.00,$223.34,$0.00,$0.00,$0.00,$0.00,$0.00,$312.93,$0.00,$156.47,$247.84,$250.35,$0.00,$0.00,$0.00,$0.00,$0.00
4324A,SUP,Custom 27203010,,4324A  -  TRAY PROCEDURE 20GA 3.5IN MYELOGRAM PH WATER SOLUBLE CLEAR,$25.07,$0.00,$25.07,$0.00,$17.89,$0.00,$0.00,$0.00,$0.00,$0.00,$25.07,$0.00,$12.54,$19.86,$20.06,$0.00,$0.00,$0.00,$0.00,$0.00
433-01,SUP,Custom 27203010,,433-01  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,064.63",$0.00,"$1,064.63",$0.00,$759.82,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,064.63",$0.00,$532.31,$843.19,$851.70,$0.00,$0.00,$0.00,$0.00,$0.00
435002S,SUP,HCPCS C1713,,435002S  -  PLATE 34MM SS 3.5/4MM SCR 2 HOLE BONE LEFT PERIART TIB STRL,"$1,113.75",$0.00,"$1,113.75",$501.19,$794.88,$0.00,$191.89,$0.00,$0.00,$195.01,"$1,113.75",$0.00,$556.88,$882.09,$891.00,$0.00,$174.30,$0.00,$177.31,$0.00
435004S,SUP,HCPCS C1713,,435004S  -  PLATE 60MM SS 3.5/4MM SCR 4 HOLE BONE LEFT PERIART TIB STRL,"$1,113.75",$0.00,"$1,113.75",$501.19,$794.88,$0.00,$191.89,$0.00,$0.00,$195.01,"$1,113.75",$0.00,$556.88,$882.09,$891.00,$0.00,$174.30,$0.00,$177.31,$0.00
435006S,SUP,HCPCS C1713,,435006S  -  PLATE 86MM SS 3.5/4MM SCR 6 HOLE BONE LEFT PERIART TIB STRL,"$1,113.75",$0.00,"$1,113.75",$501.19,$794.88,$0.00,$191.89,$0.00,$0.00,$195.01,"$1,113.75",$0.00,$556.88,$882.09,$891.00,$0.00,$174.30,$0.00,$177.31,$0.00
435008S,SUP,HCPCS C1713,,435008S  -  PLATE 112MM SS 3.5/4MM SCR 8 HOLE BONE LEFT PERIART TIB STRL,"$1,113.75",$0.00,"$1,113.75",$501.19,$794.88,$0.00,$191.89,$0.00,$0.00,$195.01,"$1,113.75",$0.00,$556.88,$882.09,$891.00,$0.00,$174.30,$0.00,$177.31,$0.00
435010S,SUP,HCPCS C1713,,435010S  -  PLATE 138MM SS 3.5/4MM SCR 10 HOLE BONE LEFT PERIART TIB,"$1,149.50",$0.00,"$1,149.50",$517.28,$820.40,$0.00,$198.05,$0.00,$0.00,$201.27,"$1,149.50",$0.00,$574.75,$910.40,$919.60,$0.00,$179.90,$0.00,$183.00,$0.00
435012S,SUP,HCPCS C1713,,435012S  -  PLATE 164MM SS 3.5/4MM SCR 12 HOLE BONE LEFT PERIART TIB,"$1,149.50",$0.00,"$1,149.50",$517.28,$820.40,$0.00,$198.05,$0.00,$0.00,$201.27,"$1,149.50",$0.00,$574.75,$910.40,$919.60,$0.00,$179.90,$0.00,$183.00,$0.00
435014S,SUP,HCPCS C1713,,435014S  -  PLATE 190MM SS 3.5/4MM SCR 14 HOLE BONE LEFT PERIART TIB,"$1,193.50",$0.00,"$1,193.50",$537.08,$851.80,$0.00,$205.63,$0.00,$0.00,$208.97,"$1,193.50",$0.00,$596.75,$945.25,$954.80,$0.00,$186.78,$0.00,$190.01,$0.00
435022S,SUP,HCPCS C1713,,435022S  -  PLATE 34MM SS 3.5/4MM SCR 2 HOLE BONE RIGHT PERIART TIB STRL,"$1,113.75",$0.00,"$1,113.75",$501.19,$794.88,$0.00,$191.89,$0.00,$0.00,$195.01,"$1,113.75",$0.00,$556.88,$882.09,$891.00,$0.00,$174.30,$0.00,$177.31,$0.00
435024S,SUP,HCPCS C1713,,435024S  -  PLATE 60MM SS 3.5/4MM SCR 4 HOLE BONE RIGHT PERIART TIB STRL,"$1,113.75",$0.00,"$1,113.75",$501.19,$794.88,$0.00,$191.89,$0.00,$0.00,$195.01,"$1,113.75",$0.00,$556.88,$882.09,$891.00,$0.00,$174.30,$0.00,$177.31,$0.00
435026S,SUP,HCPCS C1713,,435026S  -  PLATE 86MM SS 3.5/4MM SCR 6 HOLE BONE RIGHT PERIART TIB STRL,"$1,113.75",$0.00,"$1,113.75",$501.19,$794.88,$0.00,$191.89,$0.00,$0.00,$195.01,"$1,113.75",$0.00,$556.88,$882.09,$891.00,$0.00,$174.30,$0.00,$177.31,$0.00
435028S,SUP,HCPCS C1713,,435028S  -  PLATE 112MM SS 3.5/4MM SCR 8 HOLE BONE RIGHT PERIART TIB,"$1,113.75",$0.00,"$1,113.75",$501.19,$794.88,$0.00,$191.89,$0.00,$0.00,$195.01,"$1,113.75",$0.00,$556.88,$882.09,$891.00,$0.00,$174.30,$0.00,$177.31,$0.00
435030S,SUP,HCPCS C1713,,435030S  -  PLATE 138MM SS 3.5/4MM SCR 10 HOLE BONE RIGHT PERIART TIB,"$1,149.50",$0.00,"$1,149.50",$517.28,$820.40,$0.00,$198.05,$0.00,$0.00,$201.27,"$1,149.50",$0.00,$574.75,$910.40,$919.60,$0.00,$179.90,$0.00,$183.00,$0.00
435032S,SUP,HCPCS C1713,,435032S  -  PLATE 164MM SS 3.5/4MM SCR 12 HOLE BONE RIGHT PERIART TIB,"$1,149.50",$0.00,"$1,149.50",$517.28,$820.40,$0.00,$198.05,$0.00,$0.00,$201.27,"$1,149.50",$0.00,$574.75,$910.40,$919.60,$0.00,$179.90,$0.00,$183.00,$0.00
435034S,SUP,HCPCS C1713,,435034S  -  PLATE 190MM SS 3.5/4MM SCR 14 HOLE BONE RIGHT PERIART TIB,"$1,193.50",$0.00,"$1,193.50",$537.08,$851.80,$0.00,$205.63,$0.00,$0.00,$208.97,"$1,193.50",$0.00,$596.75,$945.25,$954.80,$0.00,$186.78,$0.00,$190.01,$0.00
435506S,SUP,HCPCS C1713,,435506S  -  PLATE SS 6 HL SHFT BONE LEFT PERIART FEM STRL,"$1,080.75",$0.00,"$1,080.75",$486.34,$771.33,$0.00,$186.21,$0.00,$0.00,$189.23,"$1,080.75",$0.00,$540.38,$855.95,$864.60,$0.00,$169.14,$0.00,$172.06,$0.00
435508S,SUP,HCPCS C1713,,435508S  -  PLATE 193MM SS 4.5/6.5MM SCR 8 HOLE BONE LEFT PERIART FEM,"$1,080.75",$0.00,"$1,080.75",$486.34,$771.33,$0.00,$186.21,$0.00,$0.00,$189.23,"$1,080.75",$0.00,$540.38,$855.95,$864.60,$0.00,$169.14,$0.00,$172.06,$0.00
435526S,SUP,HCPCS C1713,,435526S  -  PLATE 157MM SS 4.5/6.5MM SCR 6 HOLE BONE RIGHT PERIART FEM,"$1,080.75",$0.00,"$1,080.75",$486.34,$771.33,$0.00,$186.21,$0.00,$0.00,$189.23,"$1,080.75",$0.00,$540.38,$855.95,$864.60,$0.00,$169.14,$0.00,$172.06,$0.00
435528S,SUP,HCPCS C1713,,435528S  -  PLATE 193MM SS 4.5/6.5MM SCR 8 HOLE BONE RIGHT PERIART FEM,"$1,080.75",$0.00,"$1,080.75",$486.34,$771.33,$0.00,$186.21,$0.00,$0.00,$189.23,"$1,080.75",$0.00,$540.38,$855.95,$864.60,$0.00,$169.14,$0.00,$172.06,$0.00
435604S,SUP,HCPCS C1713,,435604S  -  PLATE 78MM SS 4.5/6.5MM SCR 4 HOLE BONE LEFT PERIART TIB,"$1,127.50",$0.00,"$1,127.50",$507.38,$804.70,$0.00,$194.26,$0.00,$0.00,$197.42,"$1,127.50",$0.00,$563.75,$892.98,$902.00,$0.00,$176.45,$0.00,$179.50,$0.00
435606S,SUP,HCPCS C1713,,435606S  -  PLATE 114MM SS 4.5/6.5MM SCR 6 HOLE BONE LEFT PERIART TIB,"$1,127.50",$0.00,"$1,127.50",$507.38,$804.70,$0.00,$194.26,$0.00,$0.00,$197.42,"$1,127.50",$0.00,$563.75,$892.98,$902.00,$0.00,$176.45,$0.00,$179.50,$0.00
435608S,SUP,HCPCS C1713,,435608S  -  PLATE 150MM SS 4.5/6.5MM SCR 8 HOLE BONE LEFT PERIART TIB,"$1,171.50",$0.00,"$1,171.50",$527.18,$836.10,$0.00,$201.84,$0.00,$0.00,$205.12,"$1,171.50",$0.00,$585.75,$927.83,$937.20,$0.00,$183.34,$0.00,$186.50,$0.00
435624S,SUP,HCPCS C1713,,435624S  -  PLATE 78MM SS 4.5/6.5MM SCR 4 HOLE BONE RIGHT PERIART TIB,"$1,127.50",$0.00,"$1,127.50",$507.38,$804.70,$0.00,$194.26,$0.00,$0.00,$197.42,"$1,127.50",$0.00,$563.75,$892.98,$902.00,$0.00,$176.45,$0.00,$179.50,$0.00
435626S,SUP,HCPCS C1713,,435626S  -  PLATE 114MM SS 4.5/6.5MM SCR 6 HOLE BONE RIGHT PERIART TIB,"$1,127.50",$0.00,"$1,127.50",$507.38,$804.70,$0.00,$194.26,$0.00,$0.00,$197.42,"$1,127.50",$0.00,$563.75,$892.98,$902.00,$0.00,$176.45,$0.00,$179.50,$0.00
435628S,SUP,HCPCS C1713,,435628S  -  PLATE 150MM SS 4.5/6.5MM SCR 8 HOLE BONE RIGHT PERIART TIB,"$1,171.50",$0.00,"$1,171.50",$527.18,$836.10,$0.00,$201.84,$0.00,$0.00,$205.12,"$1,171.50",$0.00,$585.75,$927.83,$937.20,$0.00,$183.34,$0.00,$186.50,$0.00
436.504S,SUP,HCPCS C1713,,436.504S  -  PLATE BONE 4 LCP TITANIUM OLECRANON STERILE 3.5MM SCREWS,"$1,811.03",$0.00,"$1,811.03",$814.96,"$1,292.53",$0.00,$302.94,$0.00,$0.00,$317.10,"$1,811.03",$0.00,$905.51,"$1,434.34","$1,448.82",$0.00,$275.17,$0.00,$288.32,$0.00
436.505S,SUP,HCPCS C1713,,436.505S  -  PLATE BONE 112MM 4 HOLE LCP TITANIUM LEFT OLECRANON STERILE,"$1,811.03",$0.00,"$1,811.03",$814.96,"$1,292.53",$0.00,$302.94,$0.00,$0.00,$317.10,"$1,811.03",$0.00,$905.51,"$1,434.34","$1,448.82",$0.00,$275.17,$0.00,$288.32,$0.00
436.508S,SUP,HCPCS C1713,,436.508S  -  PLATE BONE 164MM 8 HOLE LCP TITANIUM RIGHT OLECRANON STERILE,"$1,957.05",$0.00,"$1,957.05",$880.67,"$1,396.75",$0.00,$327.37,$0.00,$0.00,$342.66,"$1,957.05",$0.00,$978.53,"$1,549.98","$1,565.64",$0.00,$297.36,$0.00,$311.56,$0.00
436.509S,SUP,HCPCS C1713,,436.509S  -  PLATE BONE 164MM 8 HOLE LCP TITANIUM LEFT OLECRANON STERILE,"$1,957.05",$0.00,"$1,957.05",$880.67,"$1,396.75",$0.00,$327.37,$0.00,$0.00,$342.66,"$1,957.05",$0.00,$978.53,"$1,549.98","$1,565.64",$0.00,$297.36,$0.00,$311.56,$0.00
436013B,SUP,HCPCS C1713,,436013B  -  CENTERPIECE 436013B 13MM B-SIZE,"$11,500.00",$0.00,"$11,500.00","$5,175.00","$5,158.80",$0.00,"$1,981.39",$0.00,$0.00,"$2,013.56","$11,500.00",$0.00,"$5,750.00","$9,108.00","$9,200.00",$0.00,"$1,799.75",$0.00,"$1,830.80",$0.00
436013C,SUP,HCPCS C1713,,436013C  -  CENTERPIECE 436013C 13MM C-SIZE,"$11,500.00",$0.00,"$11,500.00","$5,175.00","$5,158.80",$0.00,"$1,981.39",$0.00,$0.00,"$2,013.56","$11,500.00",$0.00,"$5,750.00","$9,108.00","$9,200.00",$0.00,"$1,799.75",$0.00,"$1,830.80",$0.00
436013D,SUP,HCPCS C1713,,436013D  -  CENTERPIECE 436013D 13MM D-SIZE,"$11,500.00",$0.00,"$11,500.00","$5,175.00","$5,158.80",$0.00,"$1,981.39",$0.00,$0.00,"$2,013.56","$11,500.00",$0.00,"$5,750.00","$9,108.00","$9,200.00",$0.00,"$1,799.75",$0.00,"$1,830.80",$0.00
436013E,SUP,HCPCS C1713,,436013E  -  CENTERPIECE 436013E 13MM E-SIZE,"$11,500.00",$0.00,"$11,500.00","$5,175.00","$5,158.80",$0.00,"$1,981.39",$0.00,$0.00,"$2,013.56","$11,500.00",$0.00,"$5,750.00","$9,108.00","$9,200.00",$0.00,"$1,799.75",$0.00,"$1,830.80",$0.00
436020A,SUP,HCPCS C1713,,436020A  -  CENTERPIECE 436020A 20MM A-SIZE,"$13,750.00",$0.00,"$13,750.00","$6,187.50","$5,158.80",$0.00,"$2,369.06",$0.00,$0.00,"$2,407.52","$13,750.00",$0.00,"$6,875.00","$10,890.00","$11,000.00",$0.00,"$2,151.88",$0.00,"$2,189.00",$0.00
436020B,SUP,HCPCS C1713,,436020B  -  CENTERPIECE 436020B 20MM B-SIZE,"$13,750.00",$0.00,"$13,750.00","$6,187.50","$5,158.80",$0.00,"$2,369.06",$0.00,$0.00,"$2,407.52","$13,750.00",$0.00,"$6,875.00","$10,890.00","$11,000.00",$0.00,"$2,151.88",$0.00,"$2,189.00",$0.00
436020C,SUP,HCPCS C1713,,436020C  -  CENTERPIECE 436020C 20MM C-SIZE,"$13,750.00",$0.00,"$13,750.00","$6,187.50","$5,158.80",$0.00,"$2,369.06",$0.00,$0.00,"$2,407.52","$13,750.00",$0.00,"$6,875.00","$10,890.00","$11,000.00",$0.00,"$2,151.88",$0.00,"$2,189.00",$0.00
436020D,SUP,HCPCS C1713,,436020D  -  CENTERPIECE 436020D 20MM D-SIZE,"$13,750.00",$0.00,"$13,750.00","$6,187.50","$5,158.80",$0.00,"$2,369.06",$0.00,$0.00,"$2,407.52","$13,750.00",$0.00,"$6,875.00","$10,890.00","$11,000.00",$0.00,"$2,151.88",$0.00,"$2,189.00",$0.00
436020E,SUP,HCPCS C1713,,436020E  -  CENTERPIECE 436020E 20MM E-SIZE,"$13,750.00",$0.00,"$13,750.00","$6,187.50","$5,158.80",$0.00,"$2,369.06",$0.00,$0.00,"$2,407.52","$13,750.00",$0.00,"$6,875.00","$10,890.00","$11,000.00",$0.00,"$2,151.88",$0.00,"$2,189.00",$0.00
436025A,SUP,HCPCS C1713,,436025A  -  CENTERPIECE 436025A 25MM A-SIZE,"$14,500.00",$0.00,"$14,500.00","$6,525.00","$5,158.80",$0.00,"$2,498.28",$0.00,$0.00,"$2,538.83","$14,500.00",$0.00,"$7,250.00","$11,484.00","$11,600.00",$0.00,"$2,269.25",$0.00,"$2,308.40",$0.00
436025B,SUP,HCPCS C1713,,436025B  -  CENTERPIECE 436025B 25MM B-SIZE,"$14,500.00",$0.00,"$14,500.00","$6,525.00","$5,158.80",$0.00,"$2,498.28",$0.00,$0.00,"$2,538.83","$14,500.00",$0.00,"$7,250.00","$11,484.00","$11,600.00",$0.00,"$2,269.25",$0.00,"$2,308.40",$0.00
436025C,SUP,HCPCS C1713,,436025C  -  CENTERPIECE 436025C 25MM C-SIZE,"$14,500.00",$0.00,"$14,500.00","$6,525.00","$5,158.80",$0.00,"$2,498.28",$0.00,$0.00,"$2,538.83","$14,500.00",$0.00,"$7,250.00","$11,484.00","$11,600.00",$0.00,"$2,269.25",$0.00,"$2,308.40",$0.00
436025D,SUP,HCPCS C1713,,436025D  -  CENTERPIECE 436025D 25MM D-SIZE,"$14,500.00",$0.00,"$14,500.00","$6,525.00","$5,158.80",$0.00,"$2,498.28",$0.00,$0.00,"$2,538.83","$14,500.00",$0.00,"$7,250.00","$11,484.00","$11,600.00",$0.00,"$2,269.25",$0.00,"$2,308.40",$0.00
436025E,SUP,HCPCS C1713,,436025E  -  CENTERPIECE 436025E 25MM E-SIZE,"$14,500.00",$0.00,"$14,500.00","$6,525.00","$5,158.80",$0.00,"$2,498.28",$0.00,$0.00,"$2,538.83","$14,500.00",$0.00,"$7,250.00","$11,484.00","$11,600.00",$0.00,"$2,269.25",$0.00,"$2,308.40",$0.00
436113A,SUP,HCPCS C1713,,436113A  -  CAGE 436113A 13MM A-SIZE STERILE,"$11,500.00",$0.00,"$11,500.00","$5,175.00","$5,158.80",$0.00,"$1,981.39",$0.00,$0.00,"$2,013.56","$11,500.00",$0.00,"$5,750.00","$9,108.00","$9,200.00",$0.00,"$1,799.75",$0.00,"$1,830.80",$0.00
436113B,SUP,HCPCS C1713,,436113B  -  CAGE 436113B 13MM B-SIZE STERILE,"$11,500.00",$0.00,"$11,500.00","$5,175.00","$5,158.80",$0.00,"$1,981.39",$0.00,$0.00,"$2,013.56","$11,500.00",$0.00,"$5,750.00","$9,108.00","$9,200.00",$0.00,"$1,799.75",$0.00,"$1,830.80",$0.00
436113C,SUP,HCPCS C1713,,436113C  -  CAGE 436113C 13MM C-SIZE STERILE,"$11,500.00",$0.00,"$11,500.00","$5,175.00","$5,158.80",$0.00,"$1,981.39",$0.00,$0.00,"$2,013.56","$11,500.00",$0.00,"$5,750.00","$9,108.00","$9,200.00",$0.00,"$1,799.75",$0.00,"$1,830.80",$0.00
436113D,SUP,HCPCS C1713,,436113D  -  CAGE 436113D 13MM D-SIZE STERILE,"$11,500.00",$0.00,"$11,500.00","$5,175.00","$5,158.80",$0.00,"$1,981.39",$0.00,$0.00,"$2,013.56","$11,500.00",$0.00,"$5,750.00","$9,108.00","$9,200.00",$0.00,"$1,799.75",$0.00,"$1,830.80",$0.00
436113E,SUP,HCPCS C1713,,436113E  -  CAGE 436113E 13MM E-SIZE STERILE,"$11,500.00",$0.00,"$11,500.00","$5,175.00","$5,158.80",$0.00,"$1,981.39",$0.00,$0.00,"$2,013.56","$11,500.00",$0.00,"$5,750.00","$9,108.00","$9,200.00",$0.00,"$1,799.75",$0.00,"$1,830.80",$0.00
436120A,SUP,HCPCS C1713,,436120A  -  CAGE 436120A 20MM A-SIZE STERILE,"$13,750.00",$0.00,"$13,750.00","$6,187.50","$5,158.80",$0.00,"$2,369.06",$0.00,$0.00,"$2,407.52","$13,750.00",$0.00,"$6,875.00","$10,890.00","$11,000.00",$0.00,"$2,151.88",$0.00,"$2,189.00",$0.00
436120B,SUP,HCPCS C1713,,436120B  -  CAGE 436120B 20MM B-SIZE STERILE,"$13,750.00",$0.00,"$13,750.00","$6,187.50","$5,158.80",$0.00,"$2,369.06",$0.00,$0.00,"$2,407.52","$13,750.00",$0.00,"$6,875.00","$10,890.00","$11,000.00",$0.00,"$2,151.88",$0.00,"$2,189.00",$0.00
436120C,SUP,HCPCS C1713,,436120C  -  CAGE 436120C 20MM C-SIZE STERILE,"$13,750.00",$0.00,"$13,750.00","$6,187.50","$5,158.80",$0.00,"$2,369.06",$0.00,$0.00,"$2,407.52","$13,750.00",$0.00,"$6,875.00","$10,890.00","$11,000.00",$0.00,"$2,151.88",$0.00,"$2,189.00",$0.00
436120D,SUP,HCPCS C1713,,436120D  -  CAGE 436120D 20MM D-SIZE STERILE,"$13,750.00",$0.00,"$13,750.00","$6,187.50","$5,158.80",$0.00,"$2,369.06",$0.00,$0.00,"$2,407.52","$13,750.00",$0.00,"$6,875.00","$10,890.00","$11,000.00",$0.00,"$2,151.88",$0.00,"$2,189.00",$0.00
436120E,SUP,HCPCS C1713,,436120E  -  CAGE 436120E 20MM E-SIZE STERILE,"$13,750.00",$0.00,"$13,750.00","$6,187.50","$5,158.80",$0.00,"$2,369.06",$0.00,$0.00,"$2,407.52","$13,750.00",$0.00,"$6,875.00","$10,890.00","$11,000.00",$0.00,"$2,151.88",$0.00,"$2,189.00",$0.00
436125A,SUP,HCPCS C1713,,436125A  -  CAGE 436125A 25MM A-SIZE STERILE,"$14,500.00",$0.00,"$14,500.00","$6,525.00","$5,158.80",$0.00,"$2,498.28",$0.00,$0.00,"$2,538.83","$14,500.00",$0.00,"$7,250.00","$11,484.00","$11,600.00",$0.00,"$2,269.25",$0.00,"$2,308.40",$0.00
436125B,SUP,HCPCS C1713,,436125B  -  CAGE 436125B 25MM B-SIZE STERILE,"$14,500.00",$0.00,"$14,500.00","$6,525.00","$5,158.80",$0.00,"$2,498.28",$0.00,$0.00,"$2,538.83","$14,500.00",$0.00,"$7,250.00","$11,484.00","$11,600.00",$0.00,"$2,269.25",$0.00,"$2,308.40",$0.00
436125C,SUP,HCPCS C1713,,436125C  -  CAGE 436125C 25MM C-SIZE STERILE,"$14,500.00",$0.00,"$14,500.00","$6,525.00","$5,158.80",$0.00,"$2,498.28",$0.00,$0.00,"$2,538.83","$14,500.00",$0.00,"$7,250.00","$11,484.00","$11,600.00",$0.00,"$2,269.25",$0.00,"$2,308.40",$0.00
436125D,SUP,HCPCS C1713,,436125D  -  CAGE 436125D 25MM D-SIZE STERILE,"$14,500.00",$0.00,"$14,500.00","$6,525.00","$5,158.80",$0.00,"$2,498.28",$0.00,$0.00,"$2,538.83","$14,500.00",$0.00,"$7,250.00","$11,484.00","$11,600.00",$0.00,"$2,269.25",$0.00,"$2,308.40",$0.00
436125E,SUP,HCPCS C1713,,436125E  -  CAGE 436125E 25MM E-SIZE STERILE,"$14,500.00",$0.00,"$14,500.00","$6,525.00","$5,158.80",$0.00,"$2,498.28",$0.00,$0.00,"$2,538.83","$14,500.00",$0.00,"$7,250.00","$11,484.00","$11,600.00",$0.00,"$2,269.25",$0.00,"$2,308.40",$0.00
436213A,SUP,HCPCS C1713,,436213A  -  CENTERPIECE 436213A 13MM A-SIZE CERVICAL,"$11,500.00",$0.00,"$11,500.00","$5,175.00","$5,158.80",$0.00,"$1,981.39",$0.00,$0.00,"$2,013.56","$11,500.00",$0.00,"$5,750.00","$9,108.00","$9,200.00",$0.00,"$1,799.75",$0.00,"$1,830.80",$0.00
436213B,SUP,HCPCS C1713,,436213B  -  CENTERPIECE 436213B 13MM B-SIZE CERVICAL,"$11,500.00",$0.00,"$11,500.00","$5,175.00","$5,158.80",$0.00,"$1,981.39",$0.00,$0.00,"$2,013.56","$11,500.00",$0.00,"$5,750.00","$9,108.00","$9,200.00",$0.00,"$1,799.75",$0.00,"$1,830.80",$0.00
436213C,SUP,HCPCS C1713,,436213C  -  CENTERPIECE 436213C 13MM C-SIZE CERVICAL,"$11,500.00",$0.00,"$11,500.00","$5,175.00","$5,158.80",$0.00,"$1,981.39",$0.00,$0.00,"$2,013.56","$11,500.00",$0.00,"$5,750.00","$9,108.00","$9,200.00",$0.00,"$1,799.75",$0.00,"$1,830.80",$0.00
436213D,SUP,HCPCS C1713,,436213D  -  CENTERPIECE 436213D 13MM D-SIZE CERVICAL,"$11,500.00",$0.00,"$11,500.00","$5,175.00","$5,158.80",$0.00,"$1,981.39",$0.00,$0.00,"$2,013.56","$11,500.00",$0.00,"$5,750.00","$9,108.00","$9,200.00",$0.00,"$1,799.75",$0.00,"$1,830.80",$0.00
436213E,SUP,HCPCS C1713,,436213E  -  CENTERPIECE 436213E 13MM E-SIZE CERVICAL,"$11,500.00",$0.00,"$11,500.00","$5,175.00","$5,158.80",$0.00,"$1,981.39",$0.00,$0.00,"$2,013.56","$11,500.00",$0.00,"$5,750.00","$9,108.00","$9,200.00",$0.00,"$1,799.75",$0.00,"$1,830.80",$0.00
436313A,SUP,HCPCS C1713,,436313A  -  CENTERPIECE 436313A 13MM A-SIZE CRV STER,"$11,500.00",$0.00,"$11,500.00","$5,175.00","$5,158.80",$0.00,"$1,981.39",$0.00,$0.00,"$2,013.56","$11,500.00",$0.00,"$5,750.00","$9,108.00","$9,200.00",$0.00,"$1,799.75",$0.00,"$1,830.80",$0.00
436313B,SUP,HCPCS C1713,,436313B  -  CENTERPIECE 436313B 13MM B-SIZE CRV STER,"$11,500.00",$0.00,"$11,500.00","$5,175.00","$5,158.80",$0.00,"$1,981.39",$0.00,$0.00,"$2,013.56","$11,500.00",$0.00,"$5,750.00","$9,108.00","$9,200.00",$0.00,"$1,799.75",$0.00,"$1,830.80",$0.00
436313C,SUP,HCPCS C1713,,436313C  -  CENTERPIECE 436313C 13MM C-SIZE CRV STER,"$11,500.00",$0.00,"$11,500.00","$5,175.00","$5,158.80",$0.00,"$1,981.39",$0.00,$0.00,"$2,013.56","$11,500.00",$0.00,"$5,750.00","$9,108.00","$9,200.00",$0.00,"$1,799.75",$0.00,"$1,830.80",$0.00
436313D,SUP,HCPCS C1713,,436313D  -  CENTERPIECE 436313D 13MM D-SIZE CRV STER,"$11,500.00",$0.00,"$11,500.00","$5,175.00","$5,158.80",$0.00,"$1,981.39",$0.00,$0.00,"$2,013.56","$11,500.00",$0.00,"$5,750.00","$9,108.00","$9,200.00",$0.00,"$1,799.75",$0.00,"$1,830.80",$0.00
436313E,SUP,HCPCS C1713,,436313E  -  CENTERPIECE 436313E 13MM E-SIZE CRV STER,"$11,500.00",$0.00,"$11,500.00","$5,175.00","$5,158.80",$0.00,"$1,981.39",$0.00,$0.00,"$2,013.56","$11,500.00",$0.00,"$5,750.00","$9,108.00","$9,200.00",$0.00,"$1,799.75",$0.00,"$1,830.80",$0.00
437.043S,SUP,HCPCS C1713,,437.043S  -  PLATE BONE 90D 30MM 4 HOLE CANN LC ANGLED TITANIUM,"$1,629.75",$0.00,"$1,629.75",$733.39,"$1,163.15",$0.00,$280.80,$0.00,$0.00,$285.36,"$1,629.75",$0.00,$814.88,"$1,290.76","$1,303.80",$0.00,$255.06,$0.00,$259.46,$0.00
437.044S,SUP,HCPCS C1713,,437.044S  -  PLATE BONE 90D 40MM 4 HOLE CANN LC ANGLED TITANIUM,"$1,629.75",$0.00,"$1,629.75",$733.39,"$1,163.15",$0.00,$280.80,$0.00,$0.00,$285.36,"$1,629.75",$0.00,$814.88,"$1,290.76","$1,303.80",$0.00,$255.06,$0.00,$259.46,$0.00
437.053S,SUP,HCPCS C1713,,437.053S  -  PLATE BONE 90D 30MM 5 HOLE CANN LC ANGLED TITANIUM,"$1,629.75",$0.00,"$1,629.75",$733.39,"$1,163.15",$0.00,$280.80,$0.00,$0.00,$285.36,"$1,629.75",$0.00,$814.88,"$1,290.76","$1,303.80",$0.00,$255.06,$0.00,$259.46,$0.00
437.054S,SUP,HCPCS C1713,,437.054S  -  PLATE BONE 90D 40MM 5 HOLE CANN LC ANGLED TITANIUM,"$1,629.75",$0.00,"$1,629.75",$733.39,"$1,163.15",$0.00,$280.80,$0.00,$0.00,$285.36,"$1,629.75",$0.00,$814.88,"$1,290.76","$1,303.80",$0.00,$255.06,$0.00,$259.46,$0.00
437.063S,SUP,HCPCS C1713,,437.063S  -  PLATE BONE 90D 30MM 6 HOLE CANN LC ANGLED TITANIUM,"$1,629.75",$0.00,"$1,629.75",$733.39,"$1,163.15",$0.00,$280.80,$0.00,$0.00,$285.36,"$1,629.75",$0.00,$814.88,"$1,290.76","$1,303.80",$0.00,$255.06,$0.00,$259.46,$0.00
437.064S,SUP,HCPCS C1713,,437.064S  -  PLATE BONE 90D 40MM 6 HOLE CANN LC ANGLED TITANIUM,"$1,629.75",$0.00,"$1,629.75",$733.39,"$1,163.15",$0.00,$280.80,$0.00,$0.00,$285.36,"$1,629.75",$0.00,$814.88,"$1,290.76","$1,303.80",$0.00,$255.06,$0.00,$259.46,$0.00
437.083S,SUP,HCPCS C1713,,437.083S  -  PLATE BONE 90D 30MM 8 HOLE CANN LC ANGLED TITANIUM,"$1,629.75",$0.00,"$1,629.75",$733.39,"$1,163.15",$0.00,$280.80,$0.00,$0.00,$285.36,"$1,629.75",$0.00,$814.88,"$1,290.76","$1,303.80",$0.00,$255.06,$0.00,$259.46,$0.00
437.084S,SUP,HCPCS C1713,,437.084S  -  PLATE BONE 90D 40MM 8 HOLE CANN LC ANGLED TITANIUM,"$1,629.75",$0.00,"$1,629.75",$733.39,"$1,163.15",$0.00,$280.80,$0.00,$0.00,$285.36,"$1,629.75",$0.00,$814.88,"$1,290.76","$1,303.80",$0.00,$255.06,$0.00,$259.46,$0.00
437.085S,SUP,HCPCS C1713,,437.085S  -  PLATE BONE 90D 50MM 8 HOLE CANN LC ANGLED TITANIUM,"$1,629.75",$0.00,"$1,629.75",$733.39,"$1,163.15",$0.00,$280.80,$0.00,$0.00,$285.36,"$1,629.75",$0.00,$814.88,"$1,290.76","$1,303.80",$0.00,$255.06,$0.00,$259.46,$0.00
437.086S,SUP,HCPCS C1713,,437.086S  -  PLATE BONE 90D 60MM 8 HOLE CANN LC ANGLED TITANIUM,"$1,629.75",$0.00,"$1,629.75",$733.39,"$1,163.15",$0.00,$280.80,$0.00,$0.00,$285.36,"$1,629.75",$0.00,$814.88,"$1,290.76","$1,303.80",$0.00,$255.06,$0.00,$259.46,$0.00
437.103S,SUP,HCPCS C1713,,437.103S  -  PLATE BONE 90D 30MM 10 HOLE CANN LC ANGLED TITANIUM,"$2,126.63",$0.00,"$2,126.63",$956.98,"$1,517.77",$0.00,$366.41,$0.00,$0.00,$372.36,"$2,126.63",$0.00,"$1,063.31","$1,684.29","$1,701.30",$0.00,$332.82,$0.00,$338.56,$0.00
437.104S,SUP,HCPCS C1713,,437.104S  -  PLATE BONE 90D 40MM 10 HOLE CANN LC ANGLED TITANIUM,"$2,126.63",$0.00,"$2,126.63",$956.98,"$1,517.77",$0.00,$366.41,$0.00,$0.00,$372.36,"$2,126.63",$0.00,"$1,063.31","$1,684.29","$1,701.30",$0.00,$332.82,$0.00,$338.56,$0.00
437.105S,SUP,HCPCS C1713,,437.105S  -  PLATE BONE 90D 50MM 10 HOLE CANN LC ANGLED TITANIUM,"$2,126.63",$0.00,"$2,126.63",$956.98,"$1,517.77",$0.00,$366.41,$0.00,$0.00,$372.36,"$2,126.63",$0.00,"$1,063.31","$1,684.29","$1,701.30",$0.00,$332.82,$0.00,$338.56,$0.00
437.106S,SUP,HCPCS C1713,,437.106S  -  PLATE BONE 90D 60MM 10 HOLE CANN LC ANGLED TITANIUM,"$2,126.63",$0.00,"$2,126.63",$956.98,"$1,517.77",$0.00,$366.41,$0.00,$0.00,$372.36,"$2,126.63",$0.00,"$1,063.31","$1,684.29","$1,701.30",$0.00,$332.82,$0.00,$338.56,$0.00
437.123S,SUP,HCPCS C1713,,437.123S  -  PLATE BONE 90D 30MM 12 HOLE CANN LC ANGLED TITANIUM,"$2,126.63",$0.00,"$2,126.63",$956.98,"$1,517.77",$0.00,$366.41,$0.00,$0.00,$372.36,"$2,126.63",$0.00,"$1,063.31","$1,684.29","$1,701.30",$0.00,$332.82,$0.00,$338.56,$0.00
437.124S,SUP,HCPCS C1713,,437.124S  -  PLATE BONE 90D 40MM 12 HOLE CANN LC ANGLED TITANIUM,"$2,126.63",$0.00,"$2,126.63",$956.98,"$1,517.77",$0.00,$366.41,$0.00,$0.00,$372.36,"$2,126.63",$0.00,"$1,063.31","$1,684.29","$1,701.30",$0.00,$332.82,$0.00,$338.56,$0.00
437.125S,SUP,HCPCS C1713,,437.125S  -  PLATE BONE 90D 50MM 12 HOLE CANN LC ANGLED TITANIUM,"$2,126.63",$0.00,"$2,126.63",$956.98,"$1,517.77",$0.00,$366.41,$0.00,$0.00,$372.36,"$2,126.63",$0.00,"$1,063.31","$1,684.29","$1,701.30",$0.00,$332.82,$0.00,$338.56,$0.00
437.126S,SUP,HCPCS C1713,,437.126S  -  PLATE BONE 90D 60MM 12 HOLE CANN LC ANGLED TITANIUM,"$2,126.63",$0.00,"$2,126.63",$956.98,"$1,517.77",$0.00,$366.41,$0.00,$0.00,$372.36,"$2,126.63",$0.00,"$1,063.31","$1,684.29","$1,701.30",$0.00,$332.82,$0.00,$338.56,$0.00
437.143S,SUP,HCPCS C1713,,437.143S  -  PLATE BONE 90D 30MM 14 HOLE CANN LC ANGLED TITANIUM,"$2,705.65",$0.00,"$2,705.65","$1,217.54","$1,931.02",$0.00,$466.17,$0.00,$0.00,$473.74,"$2,705.65",$0.00,"$1,352.83","$2,142.87","$2,164.52",$0.00,$423.43,$0.00,$430.74,$0.00
437.144S,SUP,HCPCS C1713,,437.144S  -  PLATE BONE 90D 40MM 14 HOLE CANN LC ANGLED TITANIUM,"$2,705.65",$0.00,"$2,705.65","$1,217.54","$1,931.02",$0.00,$466.17,$0.00,$0.00,$473.74,"$2,705.65",$0.00,"$1,352.83","$2,142.87","$2,164.52",$0.00,$423.43,$0.00,$430.74,$0.00
437.146S,SUP,HCPCS C1713,,437.146S  -  PLATE BONE 90D 256MM 60X11.7MM 14 HOLE CANN LC ANGLED BLADE,"$2,705.65",$0.00,"$2,705.65","$1,217.54","$1,931.02",$0.00,$466.17,$0.00,$0.00,$473.74,"$2,705.65",$0.00,"$1,352.83","$2,142.87","$2,164.52",$0.00,$423.43,$0.00,$430.74,$0.00
4396-78,SUP,HCPCS C1900,,4396-78  -  LEAD PACING STR 4FR 78CM 2 ELECTRODE TINES IS-1 ATTAIN,"$3,562.50",$0.00,"$3,562.50",$0.00,"$2,542.56",$0.00,$613.80,$0.00,$0.00,$0.00,"$3,562.50",$0.00,"$1,781.25","$2,821.50","$2,850.00",$0.00,$557.53,$0.00,$0.00,$0.00
4396-88,SUP,HCPCS C1900,,4396-88  -  LEAD PACING STR 4FR 88CM 2 ELECTRODE TINES IS-1 ATTAIN,"$3,562.50",$0.00,"$3,562.50",$0.00,"$2,542.56",$0.00,$613.80,$0.00,$0.00,$0.00,"$3,562.50",$0.00,"$1,781.25","$2,821.50","$2,850.00",$0.00,$557.53,$0.00,$0.00,$0.00
441.072S,SUP,HCPCS C1713,,441.072S  -  PLATE BONE 12MM 4 HOLE HOOK LCP TITANIUM RIGHT CLAVICLE,"$1,469.83",$0.00,"$1,469.83",$661.42,"$1,049.01",$0.00,$245.87,$0.00,$0.00,$257.35,"$1,469.83",$0.00,$734.91,"$1,164.11","$1,175.86",$0.00,$223.33,$0.00,$234.00,$0.00
441.073S,SUP,HCPCS C1713,,441.073S  -  PLATE BONE 12MM 4 HOLE HOOK LCP TITANIUM LEFT CLAVICLE,"$1,469.83",$0.00,"$1,469.83",$661.42,"$1,049.01",$0.00,$245.87,$0.00,$0.00,$257.35,"$1,469.83",$0.00,$734.91,"$1,164.11","$1,175.86",$0.00,$223.33,$0.00,$234.00,$0.00
441.074S,SUP,HCPCS C1713,,441.074S  -  PLATE BN 15MM 70MM STRL LCP CMBN 4 HL HK PRECONTOUR RND SHFT,"$1,469.83",$0.00,"$1,469.83",$661.42,"$1,049.01",$0.00,$245.87,$0.00,$0.00,$257.35,"$1,469.83",$0.00,$734.91,"$1,164.11","$1,175.86",$0.00,$223.33,$0.00,$234.00,$0.00
441.075S,SUP,HCPCS C1713,,441.075S  -  PLATE BONE 15MM 4 HOLE HOOK LCP TITANIUM LEFT CLAVICLE,"$1,469.83",$0.00,"$1,469.83",$661.42,"$1,049.01",$0.00,$245.87,$0.00,$0.00,$257.35,"$1,469.83",$0.00,$734.91,"$1,164.11","$1,175.86",$0.00,$223.33,$0.00,$234.00,$0.00
441.076S,SUP,HCPCS C1713,,441.076S  -  PLATE BONE 18MM 4 HOLE HOOK LCP TITANIUM RIGHT CLAVICLE,"$1,469.83",$0.00,"$1,469.83",$661.42,"$1,049.01",$0.00,$245.87,$0.00,$0.00,$257.35,"$1,469.83",$0.00,$734.91,"$1,164.11","$1,175.86",$0.00,$223.33,$0.00,$234.00,$0.00
441.077S,SUP,HCPCS C1713,,441.077S  -  PLATE BONE 18MM 4 HOLE HOOK LCP TITANIUM LEFT CLAVICLE,"$1,469.83",$0.00,"$1,469.83",$661.42,"$1,049.01",$0.00,$245.87,$0.00,$0.00,$257.35,"$1,469.83",$0.00,$734.91,"$1,164.11","$1,175.86",$0.00,$223.33,$0.00,$234.00,$0.00
441.082S,SUP,HCPCS C1713,,441.082S  -  PLATE BONE 12MM 5 HOLE HOOK LCP TITANIUM RIGHT CLAVICLE,"$1,538.08",$0.00,"$1,538.08",$692.13,"$1,097.72",$0.00,$257.28,$0.00,$0.00,$269.30,"$1,538.08",$0.00,$769.04,"$1,218.16","$1,230.46",$0.00,$233.70,$0.00,$244.86,$0.00
441.083S,SUP,HCPCS C1713,,441.083S  -  PLATE BONE 12MM 5 HOLE HOOK LCP TITANIUM LEFT CLAVICLE,"$1,538.08",$0.00,"$1,538.08",$692.13,"$1,097.72",$0.00,$257.28,$0.00,$0.00,$269.30,"$1,538.08",$0.00,$769.04,"$1,218.16","$1,230.46",$0.00,$233.70,$0.00,$244.86,$0.00
441.084S,SUP,HCPCS C1713,,441.084S  -  PLATE BONE 15MM 5 HOLE HOOK LCP TITANIUM RIGHT CLAVICLE,"$1,538.08",$0.00,"$1,538.08",$692.13,"$1,097.72",$0.00,$257.28,$0.00,$0.00,$269.30,"$1,538.08",$0.00,$769.04,"$1,218.16","$1,230.46",$0.00,$233.70,$0.00,$244.86,$0.00
441.085S,SUP,HCPCS C1713,,441.085S  -  PLATE BONE 15MM 5 HOLE HOOK LCP TITANIUM LEFT CLAVICLE,"$1,538.08",$0.00,"$1,538.08",$692.13,"$1,097.72",$0.00,$257.28,$0.00,$0.00,$269.30,"$1,538.08",$0.00,$769.04,"$1,218.16","$1,230.46",$0.00,$233.70,$0.00,$244.86,$0.00
441.086S,SUP,HCPCS C1713,,441.086S  -  PLATE BONE 18MM 5 HOLE HOOK LCP TITANIUM RIGHT CLAVICLE,"$1,538.08",$0.00,"$1,538.08",$692.13,"$1,097.72",$0.00,$257.28,$0.00,$0.00,$269.30,"$1,538.08",$0.00,$769.04,"$1,218.16","$1,230.46",$0.00,$233.70,$0.00,$244.86,$0.00
441.087S,SUP,HCPCS C1713,,441.087S  -  PLATE BONE 18MM 5 HOLE HOOK LCP TITANIUM LEFT CLAVICLE,"$1,538.08",$0.00,"$1,538.08",$692.13,"$1,097.72",$0.00,$257.28,$0.00,$0.00,$269.30,"$1,538.08",$0.00,$769.04,"$1,218.16","$1,230.46",$0.00,$233.70,$0.00,$244.86,$0.00
441.094S,SUP,HCPCS C1713,,441.094S  -  PLATE BONE 15MM 6 HOLE HOOK LCP TITANIUM RIGHT CLAVICLE,"$1,581.75",$0.00,"$1,581.75",$711.79,"$1,128.89",$0.00,$264.59,$0.00,$0.00,$276.95,"$1,581.75",$0.00,$790.88,"$1,252.75","$1,265.40",$0.00,$240.33,$0.00,$251.81,$0.00
441.095S,SUP,HCPCS C1713,,441.095S  -  PLATE BONE 15MM 6 HOLE HOOK LCP TITANIUM LEFT CLAVICLE,"$1,581.75",$0.00,"$1,581.75",$711.79,"$1,128.89",$0.00,$264.59,$0.00,$0.00,$276.95,"$1,581.75",$0.00,$790.88,"$1,252.75","$1,265.40",$0.00,$240.33,$0.00,$251.81,$0.00
441.096S,SUP,HCPCS C1713,,441.096S  -  PLATE BONE 18MM 6 HOLE HOOK LCP TITANIUM RIGHT CLAVICLE,"$1,581.75",$0.00,"$1,581.75",$711.79,"$1,128.89",$0.00,$264.59,$0.00,$0.00,$276.95,"$1,581.75",$0.00,$790.88,"$1,252.75","$1,265.40",$0.00,$240.33,$0.00,$251.81,$0.00
441.097S,SUP,HCPCS C1713,,441.097S  -  PLATE BONE 18MM 6 HOLE HOOK LCP TITANIUM LEFT CLAVICLE,"$1,581.75",$0.00,"$1,581.75",$711.79,"$1,128.89",$0.00,$264.59,$0.00,$0.00,$276.95,"$1,581.75",$0.00,$790.88,"$1,252.75","$1,265.40",$0.00,$240.33,$0.00,$251.81,$0.00
441.104S,SUP,HCPCS C1713,,441.104S  -  PLATE BONE 15MM 7 HOLE HOOK LCP TITANIUM RIGHT CLAVICLE,"$1,648.63",$0.00,"$1,648.63",$741.88,"$1,176.62",$0.00,$275.78,$0.00,$0.00,$288.66,"$1,648.63",$0.00,$824.31,"$1,305.71","$1,318.90",$0.00,$250.49,$0.00,$262.46,$0.00
441.105S,SUP,HCPCS C1713,,441.105S  -  PLATE BONE 15MM 7 HOLE HOOK LCP TITANIUM LEFT CLAVICLE,"$1,648.63",$0.00,"$1,648.63",$741.88,"$1,176.62",$0.00,$275.78,$0.00,$0.00,$288.66,"$1,648.63",$0.00,$824.31,"$1,305.71","$1,318.90",$0.00,$250.49,$0.00,$262.46,$0.00
441.106S,SUP,HCPCS C1713,,441.106S  -  PLATE BONE 18MM 7 HOLE HOOK LCP TITANIUM RIGHT CLAVICLE,"$1,648.63",$0.00,"$1,648.63",$741.88,"$1,176.62",$0.00,$275.78,$0.00,$0.00,$288.66,"$1,648.63",$0.00,$824.31,"$1,305.71","$1,318.90",$0.00,$250.49,$0.00,$262.46,$0.00
441.107S,SUP,HCPCS C1713,,441.107S  -  PLATE BONE 18MM 7 HOLE HOOK LCP TITANIUM LEFT CLAVICLE,"$1,648.63",$0.00,"$1,648.63",$741.88,"$1,176.62",$0.00,$275.78,$0.00,$0.00,$288.66,"$1,648.63",$0.00,$824.31,"$1,305.71","$1,318.90",$0.00,$250.49,$0.00,$262.46,$0.00
44-1001,SUP,HCPCS C1713,,44-1001  -  PLATE BONE LARGE 2MM ANGLED TRAUMAONE BLUE TITANIUM MANDIB 2,"$6,255.00",$0.00,"$6,255.00","$2,814.75","$4,464.19",$0.00,"$1,077.71",$0.00,$0.00,"$1,095.20","$6,255.00",$0.00,"$3,127.50","$4,953.96","$5,004.00",$0.00,$978.91,$0.00,$995.80,$0.00
44-1002,SUP,HCPCS C1713,,44-1002  -  PLATE BONE SMALL 2MM 2 ANGLED TRAUMAONE BLUE TITANIUM MANDIB,"$7,630.00",$0.00,"$7,630.00","$3,433.50","$5,158.80",$0.00,"$1,314.61",$0.00,$0.00,"$1,335.95","$7,630.00",$0.00,"$3,815.00","$6,042.96","$6,104.00",$0.00,"$1,194.10",$0.00,"$1,214.70",$0.00
44-1003,SUP,HCPCS C1713,,44-1003  -  PLATE BONE THK2MM MEDIUM 2 ANGLED LORENZ BLUE MANDIB,"$8,075.00",$0.00,"$8,075.00","$3,633.75","$5,158.80",$0.00,"$1,391.28",$0.00,$0.00,"$1,413.87","$8,075.00",$0.00,"$4,037.50","$6,395.40","$6,460.00",$0.00,"$1,263.74",$0.00,"$1,285.54",$0.00
44-1005,SUP,HCPCS C1713,,44-1005  -  PLATE BONE LARGE 2.6MM ANGLED TRAUMAONE MAGENTA TITANIUM,"$6,727.50",$0.00,"$6,727.50","$3,027.38","$4,801.42",$0.00,"$1,159.11",$0.00,$0.00,"$1,177.93","$6,727.50",$0.00,"$3,363.75","$5,328.18","$5,382.00",$0.00,"$1,052.85",$0.00,"$1,071.02",$0.00
44-1012,SUP,HCPCS C1713,,44-1012  -  PLATE BONE 2MM 12 HOLE STR TRAUMAONE BLUE TITANIUM MANDIB 2,"$2,765.00",$0.00,"$2,765.00","$1,244.25","$1,973.38",$0.00,$476.40,$0.00,$0.00,$484.13,"$2,765.00",$0.00,"$1,382.50","$2,189.88","$2,212.00",$0.00,$432.72,$0.00,$440.19,$0.00
44-1022,SUP,HCPCS C1713,,44-1022  -  PLATE BN MED 2 ANG 2MM BLU TRAUMAONE STRG TI MNDB 2MM/2.3MM,"$5,865.00",$0.00,"$5,865.00","$2,639.25","$4,185.85",$0.00,"$1,010.51",$0.00,$0.00,"$1,026.91","$5,865.00",$0.00,"$2,932.50","$4,645.08","$4,692.00",$0.00,$917.87,$0.00,$933.71,$0.00
44-1023,SUP,HCPCS C1713,,44-1023  -  PLATE BN LG ANG 2.6MM MAG TRAUMAONE STRG TI MNDB 2MM/2.3MM,"$6,727.50",$0.00,"$6,727.50","$3,027.38","$4,801.42",$0.00,"$1,159.11",$0.00,$0.00,"$1,177.93","$6,727.50",$0.00,"$3,363.75","$5,328.18","$5,382.00",$0.00,"$1,052.85",$0.00,"$1,071.02",$0.00
44-1024,SUP,HCPCS C1713,,44-1024  -  PLATE BONE 2MM 24 HOLE STR TRAUMAONE BLUE TITANIUM MANDIB 2,"$3,805.00",$0.00,"$3,805.00","$1,712.25","$2,715.63",$0.00,$655.58,$0.00,$0.00,$666.23,"$3,805.00",$0.00,"$1,902.50","$3,013.56","$3,044.00",$0.00,$595.48,$0.00,$605.76,$0.00
442.458TM,SUP,HCPCS C1713,,442.458TM  -  PLATE 48MM TI 2.4MM SCR 5 HLE/HD 3 HL SHFT LCP BONE RIGHT,"$1,819.53",$0.00,"$1,819.53",$818.79,"$1,298.59",$0.00,$313.50,$0.00,$0.00,$318.58,"$1,819.53",$0.00,$909.76,"$1,441.07","$1,455.62",$0.00,$284.76,$0.00,$289.67,$0.00
442.459TM,SUP,HCPCS C1713,,442.459TM  -  PLATE 66MM TI 2.4MM SCR 5 HLE/HD 5 HL SHFT LCP BONE RIGHT,"$1,928.98",$0.00,"$1,928.98",$868.04,"$1,376.71",$0.00,$332.35,$0.00,$0.00,$337.75,"$1,928.98",$0.00,$964.49,"$1,527.75","$1,543.18",$0.00,$301.88,$0.00,$307.09,$0.00
442.461TM,SUP,HCPCS C1713,,442.461TM  -  PLATE 48MM TI 2.4MM SCR 5X3 HOLE LCP BONE LEFT DISTAL VOLR,"$1,819.53",$0.00,"$1,819.53",$818.79,"$1,298.59",$0.00,$313.50,$0.00,$0.00,$318.58,"$1,819.53",$0.00,$909.76,"$1,441.07","$1,455.62",$0.00,$284.76,$0.00,$289.67,$0.00
442.462TM,SUP,HCPCS C1713,,442.462TM  -  PLATE 66MM TI 2.4MM SCR 5 HLE/HD 5 HL SHFT LCP BONE LEFT,"$1,928.98",$0.00,"$1,928.98",$868.04,"$1,376.71",$0.00,$332.35,$0.00,$0.00,$337.75,"$1,928.98",$0.00,$964.49,"$1,527.75","$1,543.18",$0.00,$301.88,$0.00,$307.09,$0.00
442.464TM,SUP,HCPCS C1713,,442.464TM  -  PLATE BN 47X6.3X1.6MM LCP 4 HLE/HD 3 HL SHFT TI RDS RT DIST,"$1,819.53",$0.00,"$1,819.53",$818.79,"$1,298.59",$0.00,$313.50,$0.00,$0.00,$318.58,"$1,819.53",$0.00,$909.76,"$1,441.07","$1,455.62",$0.00,$284.76,$0.00,$289.67,$0.00
442.465TM,SUP,HCPCS C1713,,442.465TM  -  PLATE 65MM TI 2.4MM SCR 4 HLE/HD 5 HL SHFT LCP BONE RIGHT,"$1,928.98",$0.00,"$1,928.98",$868.04,"$1,376.71",$0.00,$332.35,$0.00,$0.00,$337.75,"$1,928.98",$0.00,$964.49,"$1,527.75","$1,543.18",$0.00,$301.88,$0.00,$307.09,$0.00
442.467TM,SUP,HCPCS C1713,,442.467TM  -  PLATE 47MM TI 2.4MM SCR 3X4 HOLE LCP BONE LEFT DISTAL EXTART,"$1,819.53",$0.00,"$1,819.53",$818.79,"$1,298.59",$0.00,$313.50,$0.00,$0.00,$318.58,"$1,819.53",$0.00,$909.76,"$1,441.07","$1,455.62",$0.00,$284.76,$0.00,$289.67,$0.00
442.468TM,SUP,HCPCS C1713,,442.468TM  -  PLATE 65MM TI 4 HOLE LCK LCP BONE LEFT DISTAL VOLR RADL,"$1,928.98",$0.00,"$1,928.98",$868.04,"$1,376.71",$0.00,$332.35,$0.00,$0.00,$337.75,"$1,928.98",$0.00,$964.49,"$1,527.75","$1,543.18",$0.00,$301.88,$0.00,$307.09,$0.00
442.531S,SUP,HCPCS C1713,,442.531S  -  PLATE BONE 46MM 7 HOLE LCP TITANIUM DISTAL ULNAR STERILE 2MM,"$1,544.90",$0.00,"$1,544.90",$695.21,"$1,102.60",$0.00,$258.43,$0.00,$0.00,$270.50,"$1,544.90",$0.00,$772.45,"$1,223.56","$1,235.92",$0.00,$234.73,$0.00,$245.95,$0.00
443.61.96,SUP,HCPCS C1713,,443.61.96  -  PLATE BN 39X5X1.2MM NS LCP 7 HL LOPRFL PRECONTOUR TI CNDYL,$551.35,$0.00,$551.35,$248.11,$393.50,$0.00,$118.25,$0.00,$0.00,$96.54,$551.35,$0.00,$275.68,$436.67,$441.08,$0.00,$107.41,$0.00,$87.77,$0.00
443.62.96,SUP,HCPCS C1713,,443.62.96  -  PLATE BN 39X5X1.2MM NS LCP 7 HL LOPRFL PRECONTOUR TI CNDRL,$551.35,$0.00,$551.35,$248.11,$393.50,$0.00,$118.25,$0.00,$0.00,$96.54,$551.35,$0.00,$275.68,$436.67,$441.08,$0.00,$107.41,$0.00,$87.77,$0.00
4450M26,SUP,Custom 27803010,,4450M26  -  RING ANNULOPLASTY KIDNEY 26MM 30.7MM 24.9MM FLEXIBLE HOLDER,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
4450M28,SUP,Custom 27803010,,4450M28  -  RING ANLPLS 28MM C-E PH,"$8,295.00",$0.00,"$8,295.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,295.00",$0.00,"$4,147.50","$6,569.64","$6,636.00",$0.00,$0.00,$0.00,$0.00,$0.00
4450M30,SUP,Custom 27803010,,4450M30  -  RING ANLPLS 30MM C-E PH,"$8,295.00",$0.00,"$8,295.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,295.00",$0.00,"$4,147.50","$6,569.64","$6,636.00",$0.00,$0.00,$0.00,$0.00,$0.00
4450M32,SUP,Custom 27803010,,4450M32  -  RING ANLPLS 32MM C-E PH,"$8,295.00",$0.00,"$8,295.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,295.00",$0.00,"$4,147.50","$6,569.64","$6,636.00",$0.00,$0.00,$0.00,$0.00,$0.00
4450M34,SUP,Custom 27803010,,4450M34  -  RING ANLPLS 34MM C-E PH,"$8,295.00",$0.00,"$8,295.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,295.00",$0.00,"$4,147.50","$6,569.64","$6,636.00",$0.00,$0.00,$0.00,$0.00,$0.00
4450M36,SUP,Custom 27803010,,4450M36  -  RING ANLPLS KNDY 36MM 41.2MM 34.8MM STRL C-E PH FLXB HLDR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
446.354S,SUP,HCPCS C1713,,446.354S  -  PLATE BONE 27MM 2 HOLE HEAD 4 HOLE SHAFT ROTATION CORRECTION,"$1,544.90",$0.00,"$1,544.90",$695.21,"$1,102.60",$0.00,$258.43,$0.00,$0.00,$270.50,"$1,544.90",$0.00,$772.45,"$1,223.56","$1,235.92",$0.00,$234.73,$0.00,$245.95,$0.00
446.355S,SUP,HCPCS C1713,,446.355S  -  PLATE BONE 32MM 2 HOLE HEAD 5 HOLE SHAFT ROTATION CORRECTION,"$1,544.90",$0.00,"$1,544.90",$695.21,"$1,102.60",$0.00,$258.43,$0.00,$0.00,$270.50,"$1,544.90",$0.00,$772.45,"$1,223.56","$1,235.92",$0.00,$234.73,$0.00,$245.95,$0.00
446.63.96,SUP,HCPCS C1713,,446.63.96  -  PLATE BN 36X3.5X.9MM NS LCP 7 HL LOPRFL PRECONTOUR TI CNDYL,$524.08,$0.00,$524.08,$235.83,$374.03,$0.00,$87.66,$0.00,$0.00,$91.76,$524.08,$0.00,$262.04,$415.07,$419.26,$0.00,$79.63,$0.00,$83.43,$0.00
446.64.96,SUP,HCPCS C1713,,446.64.96  -  PLATE BN 36X3.5X.9MM NS LCP 7 HL LOPRFL PRECONTOUR TI CNDYL,$524.08,$0.00,$524.08,$235.83,$374.03,$0.00,$87.66,$0.00,$0.00,$91.76,$524.08,$0.00,$262.04,$415.07,$419.26,$0.00,$79.63,$0.00,$83.43,$0.00
447.354S,SUP,HCPCS C1713,,447.354S  -  PLATE BONE 34MM 2 HOLE HEAD 4 HOLE SHAFT ROTATION CORRECTION,"$1,544.90",$0.00,"$1,544.90",$695.21,"$1,102.60",$0.00,$258.43,$0.00,$0.00,$270.50,"$1,544.90",$0.00,$772.45,"$1,223.56","$1,235.92",$0.00,$234.73,$0.00,$245.95,$0.00
447.355S,SUP,HCPCS C1713,,447.355S  -  PLATE BONE 40MM 2 HOLE HEAD 2 HOLE SHAFT ROTATION CORRECTION,"$1,544.90",$0.00,"$1,544.90",$695.21,"$1,102.60",$0.00,$258.43,$0.00,$0.00,$270.50,"$1,544.90",$0.00,$772.45,"$1,223.56","$1,235.92",$0.00,$234.73,$0.00,$245.95,$0.00
450.701S,SUP,HCPCS C1713,,450.701S  -  NAIL INTRAMEDULLARY 9MM 16CM SOLID AQUA TITANIUM FEMUR,"$3,324.75",$0.00,"$3,324.75","$1,496.14","$2,372.87",$0.00,$572.84,$0.00,$0.00,$582.14,"$3,324.75",$0.00,"$1,662.38","$2,633.20","$2,659.80",$0.00,$520.32,$0.00,$529.30,$0.00
450.702S,SUP,HCPCS C1713,,450.702S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 20CM SOLID EXPERT AQUA,"$3,324.75",$0.00,"$3,324.75","$1,496.14","$2,372.87",$0.00,$572.84,$0.00,$0.00,$582.14,"$3,324.75",$0.00,"$1,662.38","$2,633.20","$2,659.80",$0.00,$520.32,$0.00,$529.30,$0.00
450.703S,SUP,HCPCS C1713,,450.703S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 24CM SOLID EXPERT AQUA,"$3,299.98",$0.00,"$3,299.98","$1,484.99","$2,355.19",$0.00,$659.85,$0.00,$0.00,$577.80,"$3,299.98",$0.00,"$1,649.99","$2,613.58","$2,639.98",$0.00,$599.36,$0.00,$525.36,$0.00
450.704S,SUP,HCPCS C1713,,450.704S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 28CM SOLID EXPERT AQUA,"$3,324.75",$0.00,"$3,324.75","$1,496.14","$2,372.87",$0.00,$572.84,$0.00,$0.00,$582.14,"$3,324.75",$0.00,"$1,662.38","$2,633.20","$2,659.80",$0.00,$520.32,$0.00,$529.30,$0.00
450.705S,SUP,HCPCS C1713,,450.705S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 30CM SOLID EXPERT AQUA,"$3,299.98",$0.00,"$3,299.98","$1,484.99","$2,355.19",$0.00,$659.85,$0.00,$0.00,$577.80,"$3,299.98",$0.00,"$1,649.99","$2,613.58","$2,639.98",$0.00,$599.36,$0.00,$525.36,$0.00
450.706S,SUP,HCPCS C1713,,450.706S  -  NAIL 9MM 32CM DISTAL FEM IM SLD TI STRL,"$3,829.78",$0.00,"$3,829.78","$1,723.40","$2,733.31",$0.00,$659.85,$0.00,$0.00,$670.56,"$3,829.78",$0.00,"$1,914.89","$3,033.19","$3,063.82",$0.00,$599.36,$0.00,$609.70,$0.00
450.707S,SUP,HCPCS C1713,,450.707S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 34CM SOLID EXPERT AQUA,"$3,234.00",$0.00,"$3,234.00","$1,455.30","$2,308.11",$0.00,$557.20,$0.00,$0.00,$566.25,"$3,234.00",$0.00,"$1,617.00","$2,561.33","$2,587.20",$0.00,$506.12,$0.00,$514.85,$0.00
450.708S,SUP,HCPCS C1713,,450.708S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 360MM SOLID ROUND BARREL,"$3,209.90",$0.00,"$3,209.90","$1,444.46","$2,290.91",$0.00,$557.20,$0.00,$0.00,$562.03,"$3,209.90",$0.00,"$1,604.95","$2,542.24","$2,567.92",$0.00,$506.12,$0.00,$511.02,$0.00
450.709S,SUP,HCPCS C1713,,450.709S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 380MM SOLID ROUND BARREL,"$3,234.00",$0.00,"$3,234.00","$1,455.30","$2,308.11",$0.00,$557.20,$0.00,$0.00,$566.25,"$3,234.00",$0.00,"$1,617.00","$2,561.33","$2,587.20",$0.00,$506.12,$0.00,$514.85,$0.00
450.710S,SUP,HCPCS C1713,,450.710S  -  NAIL 9MM 40CM DISTAL FEM IM SLD TI STRL AQ,"$3,829.78",$0.00,"$3,829.78","$1,723.40","$2,733.31",$0.00,$659.85,$0.00,$0.00,$670.56,"$3,829.78",$0.00,"$1,914.89","$3,033.19","$3,063.82",$0.00,$599.36,$0.00,$609.70,$0.00
450.711S,SUP,HCPCS C1713,,450.711S  -  NAIL INTRAMEDULLARY 9MM 42CM SOLID AQUA TITANIUM FEMUR,"$3,324.75",$0.00,"$3,324.75","$1,496.14","$2,372.87",$0.00,$572.84,$0.00,$0.00,$582.14,"$3,324.75",$0.00,"$1,662.38","$2,633.20","$2,659.80",$0.00,$520.32,$0.00,$529.30,$0.00
450.712S,SUP,HCPCS C1713,,450.712S  -  NAIL INTRAMEDULLARY 9MM 44CM SOLID AQUA TITANIUM FEMUR,"$3,299.98",$0.00,"$3,299.98","$1,484.99","$2,355.19",$0.00,$659.85,$0.00,$0.00,$577.80,"$3,299.98",$0.00,"$1,649.99","$2,613.58","$2,639.98",$0.00,$599.36,$0.00,$525.36,$0.00
450.713S,SUP,HCPCS C1713,,450.713S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 460MM SOLID ROUND BARREL,"$3,324.75",$0.00,"$3,324.75","$1,496.14","$2,372.87",$0.00,$572.84,$0.00,$0.00,$582.14,"$3,324.75",$0.00,"$1,662.38","$2,633.20","$2,659.80",$0.00,$520.32,$0.00,$529.30,$0.00
450.714S,SUP,HCPCS C1713,,450.714S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 180MM SOLID ROUND BARREL,"$3,324.75",$0.00,"$3,324.75","$1,496.14","$2,372.87",$0.00,$572.84,$0.00,$0.00,$582.14,"$3,324.75",$0.00,"$1,662.38","$2,633.20","$2,659.80",$0.00,$520.32,$0.00,$529.30,$0.00
450.715S,SUP,HCPCS C1713,,450.715S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 220MM SOLID ROUND BARREL,"$3,324.75",$0.00,"$3,324.75","$1,496.14","$2,372.87",$0.00,$572.84,$0.00,$0.00,$582.14,"$3,324.75",$0.00,"$1,662.38","$2,633.20","$2,659.80",$0.00,$520.32,$0.00,$529.30,$0.00
450.716S,SUP,HCPCS C1713,,450.716S  -  NAIL INTRAMEDULLARY UNIVERSAL 9MM 260MM SOLID ROUND BARREL,"$3,324.75",$0.00,"$3,324.75","$1,496.14","$2,372.87",$0.00,$572.84,$0.00,$0.00,$582.14,"$3,324.75",$0.00,"$1,662.38","$2,633.20","$2,659.80",$0.00,$520.32,$0.00,$529.30,$0.00
450.781S,SUP,HCPCS C1713,,450.781S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 160MM CANN ROUND BARREL,"$3,234.00",$0.00,"$3,234.00","$1,455.30","$2,308.11",$0.00,$557.20,$0.00,$0.00,$566.25,"$3,234.00",$0.00,"$1,617.00","$2,561.33","$2,587.20",$0.00,$506.12,$0.00,$514.85,$0.00
450.782S,SUP,HCPCS C1713,,450.782S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 200MM CANN ROUND BARREL,"$3,209.90",$0.00,"$3,209.90","$1,444.46","$2,290.91",$0.00,$659.85,$0.00,$0.00,$562.03,"$3,209.90",$0.00,"$1,604.95","$2,542.24","$2,567.92",$0.00,$599.36,$0.00,$511.02,$0.00
450.783S,SUP,HCPCS C1713,,450.783S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 240MM CANN ROUND BARREL,"$3,209.90",$0.00,"$3,209.90","$1,444.46","$2,290.91",$0.00,$659.85,$0.00,$0.00,$562.03,"$3,209.90",$0.00,"$1,604.95","$2,542.24","$2,567.92",$0.00,$599.36,$0.00,$511.02,$0.00
450.784S,SUP,HCPCS C1713,,450.784S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 280MM CANN ROUND BARREL,"$3,209.90",$0.00,"$3,209.90","$1,444.46","$2,290.91",$0.00,$659.85,$0.00,$0.00,$562.03,"$3,209.90",$0.00,"$1,604.95","$2,542.24","$2,567.92",$0.00,$599.36,$0.00,$511.02,$0.00
450.785S,SUP,HCPCS C1713,,450.785S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 300MM CANN ROUND BARREL,"$3,209.90",$0.00,"$3,209.90","$1,444.46","$2,290.91",$0.00,$659.85,$0.00,$0.00,$562.03,"$3,209.90",$0.00,"$1,604.95","$2,542.24","$2,567.92",$0.00,$599.36,$0.00,$511.02,$0.00
450.786S,SUP,HCPCS C1713,,450.786S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 320MM CANN ROUND BARREL,"$3,209.90",$0.00,"$3,209.90","$1,444.46","$2,290.91",$0.00,$659.85,$0.00,$0.00,$562.03,"$3,209.90",$0.00,"$1,604.95","$2,542.24","$2,567.92",$0.00,$599.36,$0.00,$511.02,$0.00
450.787S,SUP,HCPCS C1713,,450.787S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 340MM CANN ROUND BARREL,"$3,209.90",$0.00,"$3,209.90","$1,444.46","$2,290.91",$0.00,$659.85,$0.00,$0.00,$562.03,"$3,209.90",$0.00,"$1,604.95","$2,542.24","$2,567.92",$0.00,$599.36,$0.00,$511.02,$0.00
450.788S,SUP,HCPCS C1713,,450.788S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 360MM CANN ROUND BARREL,"$3,209.90",$0.00,"$3,209.90","$1,444.46","$2,290.91",$0.00,$659.85,$0.00,$0.00,$562.03,"$3,209.90",$0.00,"$1,604.95","$2,542.24","$2,567.92",$0.00,$599.36,$0.00,$511.02,$0.00
450.789S,SUP,HCPCS C1713,,450.789S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 380MM CANN ROUND BARREL,"$3,209.90",$0.00,"$3,209.90","$1,444.46","$2,290.91",$0.00,$659.85,$0.00,$0.00,$562.03,"$3,209.90",$0.00,"$1,604.95","$2,542.24","$2,567.92",$0.00,$599.36,$0.00,$511.02,$0.00
450.790S,SUP,HCPCS C1713,,450.790S  -  NAIL 10MM 40CM DISTAL FEM IM CANN TI STRL AQ,"$3,829.78",$0.00,"$3,829.78","$1,723.40","$2,733.31",$0.00,$659.85,$0.00,$0.00,$670.56,"$3,829.78",$0.00,"$1,914.89","$3,033.19","$3,063.82",$0.00,$599.36,$0.00,$609.70,$0.00
450.791S,SUP,HCPCS C1713,,450.791S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 420MM CANN ROUND BARREL,"$3,209.90",$0.00,"$3,209.90","$1,444.46","$2,290.91",$0.00,$659.85,$0.00,$0.00,$562.03,"$3,209.90",$0.00,"$1,604.95","$2,542.24","$2,567.92",$0.00,$599.36,$0.00,$511.02,$0.00
450.792S,SUP,HCPCS C1713,,450.792S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 440MM CANN ROUND BARREL,"$3,234.00",$0.00,"$3,234.00","$1,455.30","$2,308.11",$0.00,$557.20,$0.00,$0.00,$566.25,"$3,234.00",$0.00,"$1,617.00","$2,561.33","$2,587.20",$0.00,$506.12,$0.00,$514.85,$0.00
450.793S,SUP,HCPCS C1713,,450.793S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 460MM CANN ROUND BARREL,"$3,324.75",$0.00,"$3,324.75","$1,496.14","$2,372.87",$0.00,$572.84,$0.00,$0.00,$582.14,"$3,324.75",$0.00,"$1,662.38","$2,633.20","$2,659.80",$0.00,$520.32,$0.00,$529.30,$0.00
450.794S,SUP,HCPCS C1713,,450.794S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 180MM CANN ROUND BARREL,"$3,234.00",$0.00,"$3,234.00","$1,455.30","$2,308.11",$0.00,$557.20,$0.00,$0.00,$566.25,"$3,234.00",$0.00,"$1,617.00","$2,561.33","$2,587.20",$0.00,$506.12,$0.00,$514.85,$0.00
450.795S,SUP,HCPCS C1713,,450.795S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 220MM CANN ROUND BARREL,"$3,234.00",$0.00,"$3,234.00","$1,455.30","$2,308.11",$0.00,$557.20,$0.00,$0.00,$566.25,"$3,234.00",$0.00,"$1,617.00","$2,561.33","$2,587.20",$0.00,$506.12,$0.00,$514.85,$0.00
450.796S,SUP,HCPCS C1713,,450.796S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 260MM CANN ROUND BARREL,"$3,234.00",$0.00,"$3,234.00","$1,455.30","$2,308.11",$0.00,$557.20,$0.00,$0.00,$566.25,"$3,234.00",$0.00,"$1,617.00","$2,561.33","$2,587.20",$0.00,$506.12,$0.00,$514.85,$0.00
450.801S,SUP,HCPCS C1713,,450.801S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 160MM CANN FLUTED BARREL,"$3,234.00",$0.00,"$3,234.00","$1,455.30","$2,308.11",$0.00,$557.20,$0.00,$0.00,$566.25,"$3,234.00",$0.00,"$1,617.00","$2,561.33","$2,587.20",$0.00,$506.12,$0.00,$514.85,$0.00
450.802S,SUP,HCPCS C1713,,450.802S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 200MM CANN FLUTED BARREL,"$3,234.00",$0.00,"$3,234.00","$1,455.30","$2,308.11",$0.00,$557.20,$0.00,$0.00,$566.25,"$3,234.00",$0.00,"$1,617.00","$2,561.33","$2,587.20",$0.00,$506.12,$0.00,$514.85,$0.00
450.803S,SUP,HCPCS C1713,,450.803S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 240MM CANN FLUTED BARREL,"$3,234.00",$0.00,"$3,234.00","$1,455.30","$2,308.11",$0.00,$557.20,$0.00,$0.00,$566.25,"$3,234.00",$0.00,"$1,617.00","$2,561.33","$2,587.20",$0.00,$506.12,$0.00,$514.85,$0.00
450.804S,SUP,HCPCS C1713,,450.804S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 280MM CANN FLUTED BARREL,"$3,209.90",$0.00,"$3,209.90","$1,444.46","$2,290.91",$0.00,$659.85,$0.00,$0.00,$562.03,"$3,209.90",$0.00,"$1,604.95","$2,542.24","$2,567.92",$0.00,$599.36,$0.00,$511.02,$0.00
450.805S,SUP,HCPCS C1713,,450.805S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 300MM CANN FLUTED BARREL,"$3,234.00",$0.00,"$3,234.00","$1,455.30","$2,308.11",$0.00,$557.20,$0.00,$0.00,$566.25,"$3,234.00",$0.00,"$1,617.00","$2,561.33","$2,587.20",$0.00,$506.12,$0.00,$514.85,$0.00
450.806S,SUP,HCPCS C1713,,450.806S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 320MM CANN FLUTED BARREL,"$3,234.00",$0.00,"$3,234.00","$1,455.30","$2,308.11",$0.00,$557.20,$0.00,$0.00,$566.25,"$3,234.00",$0.00,"$1,617.00","$2,561.33","$2,587.20",$0.00,$506.12,$0.00,$514.85,$0.00
450.807S,SUP,HCPCS C1713,,450.807S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 340MM CANN FLUTED BARREL,"$3,234.00",$0.00,"$3,234.00","$1,455.30","$2,308.11",$0.00,$557.20,$0.00,$0.00,$566.25,"$3,234.00",$0.00,"$1,617.00","$2,561.33","$2,587.20",$0.00,$506.12,$0.00,$514.85,$0.00
450.808S,SUP,HCPCS C1713,,450.808S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 360MM CANN FLUTED BARREL,"$3,209.90",$0.00,"$3,209.90","$1,444.46","$2,290.91",$0.00,$659.85,$0.00,$0.00,$562.03,"$3,209.90",$0.00,"$1,604.95","$2,542.24","$2,567.92",$0.00,$599.36,$0.00,$511.02,$0.00
450.809S,SUP,HCPCS C1713,,450.809S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 380MM CANN FLUTED BARREL,"$3,209.90",$0.00,"$3,209.90","$1,444.46","$2,290.91",$0.00,$659.85,$0.00,$0.00,$562.03,"$3,209.90",$0.00,"$1,604.95","$2,542.24","$2,567.92",$0.00,$599.36,$0.00,$511.02,$0.00
450.810S,SUP,HCPCS C1713,,450.810S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 400MM CANN FLUTED BARREL,"$3,234.00",$0.00,"$3,234.00","$1,455.30","$2,308.11",$0.00,$557.20,$0.00,$0.00,$566.25,"$3,234.00",$0.00,"$1,617.00","$2,561.33","$2,587.20",$0.00,$506.12,$0.00,$514.85,$0.00
450.811S,SUP,HCPCS C1713,,450.811S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 420MM CANN FLUTED BARREL,"$3,234.00",$0.00,"$3,234.00","$1,455.30","$2,308.11",$0.00,$557.20,$0.00,$0.00,$566.25,"$3,234.00",$0.00,"$1,617.00","$2,561.33","$2,587.20",$0.00,$506.12,$0.00,$514.85,$0.00
450.812S,SUP,HCPCS C1713,,450.812S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 440MM CANN FLUTED BARREL,"$3,234.00",$0.00,"$3,234.00","$1,455.30","$2,308.11",$0.00,$557.20,$0.00,$0.00,$566.25,"$3,234.00",$0.00,"$1,617.00","$2,561.33","$2,587.20",$0.00,$506.12,$0.00,$514.85,$0.00
450.813S,SUP,HCPCS C1713,,450.813S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 460MM CANN FLUTED BARREL,"$3,324.75",$0.00,"$3,324.75","$1,496.14","$2,372.87",$0.00,$572.84,$0.00,$0.00,$582.14,"$3,324.75",$0.00,"$1,662.38","$2,633.20","$2,659.80",$0.00,$520.32,$0.00,$529.30,$0.00
450.814S,SUP,HCPCS C1713,,450.814S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 180MM CANN FLUTED BARREL,"$3,209.90",$0.00,"$3,209.90","$1,444.46","$2,290.91",$0.00,$659.85,$0.00,$0.00,$562.03,"$3,209.90",$0.00,"$1,604.95","$2,542.24","$2,567.92",$0.00,$599.36,$0.00,$511.02,$0.00
450.815S,SUP,HCPCS C1713,,450.815S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 220MM CANN FLUTED BARREL,"$3,234.00",$0.00,"$3,234.00","$1,455.30","$2,308.11",$0.00,$557.20,$0.00,$0.00,$566.25,"$3,234.00",$0.00,"$1,617.00","$2,561.33","$2,587.20",$0.00,$506.12,$0.00,$514.85,$0.00
450.816S,SUP,HCPCS C1713,,450.816S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 260MM CANN FLUTED BARREL,"$3,234.00",$0.00,"$3,234.00","$1,455.30","$2,308.11",$0.00,$557.20,$0.00,$0.00,$566.25,"$3,234.00",$0.00,"$1,617.00","$2,561.33","$2,587.20",$0.00,$506.12,$0.00,$514.85,$0.00
450.821S,SUP,HCPCS C1713,,450.821S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 160MM CANN FLUTED BARREL,"$3,234.00",$0.00,"$3,234.00","$1,455.30","$2,308.11",$0.00,$557.20,$0.00,$0.00,$566.25,"$3,234.00",$0.00,"$1,617.00","$2,561.33","$2,587.20",$0.00,$506.12,$0.00,$514.85,$0.00
450.822S,SUP,HCPCS C1713,,450.822S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 200MM CANN FLUTED BARREL,"$3,234.00",$0.00,"$3,234.00","$1,455.30","$2,308.11",$0.00,$557.20,$0.00,$0.00,$566.25,"$3,234.00",$0.00,"$1,617.00","$2,561.33","$2,587.20",$0.00,$506.12,$0.00,$514.85,$0.00
450.823S,SUP,HCPCS C1713,,450.823S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 240MM CANN FLUTED BARREL,"$3,234.00",$0.00,"$3,234.00","$1,455.30","$2,308.11",$0.00,$557.20,$0.00,$0.00,$566.25,"$3,234.00",$0.00,"$1,617.00","$2,561.33","$2,587.20",$0.00,$506.12,$0.00,$514.85,$0.00
450.824S,SUP,HCPCS C1713,,450.824S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 280MM CANN FLUTED BARREL,"$3,209.90",$0.00,"$3,209.90","$1,444.46","$2,290.91",$0.00,$659.85,$0.00,$0.00,$562.03,"$3,209.90",$0.00,"$1,604.95","$2,542.24","$2,567.92",$0.00,$599.36,$0.00,$511.02,$0.00
450.825S,SUP,HCPCS C1713,,450.825S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 30CM CANN EXPERT AQUA,"$3,234.00",$0.00,"$3,234.00","$1,455.30","$2,308.11",$0.00,$557.20,$0.00,$0.00,$566.25,"$3,234.00",$0.00,"$1,617.00","$2,561.33","$2,587.20",$0.00,$506.12,$0.00,$514.85,$0.00
450.826S,SUP,HCPCS C1713,,450.826S  -  NAIL 12MM 32CM DISTAL FEM IM CANN TI STRL AQ,"$3,829.78",$0.00,"$3,829.78","$1,723.40","$2,733.31",$0.00,$659.85,$0.00,$0.00,$670.56,"$3,829.78",$0.00,"$1,914.89","$3,033.19","$3,063.82",$0.00,$599.36,$0.00,$609.70,$0.00
450.827S,SUP,HCPCS C1713,,450.827S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 340MM CANN FLUTED BARREL,"$3,209.90",$0.00,"$3,209.90","$1,444.46","$2,290.91",$0.00,$659.85,$0.00,$0.00,$562.03,"$3,209.90",$0.00,"$1,604.95","$2,542.24","$2,567.92",$0.00,$599.36,$0.00,$511.02,$0.00
450.828S,SUP,HCPCS C1713,,450.828S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 360MM CANN FLUTED BARREL,"$3,209.90",$0.00,"$3,209.90","$1,444.46","$2,290.91",$0.00,$659.85,$0.00,$0.00,$562.03,"$3,209.90",$0.00,"$1,604.95","$2,542.24","$2,567.92",$0.00,$599.36,$0.00,$511.02,$0.00
450.829S,SUP,HCPCS C1713,,450.829S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 380MM CANN FLUTED BARREL,"$3,209.90",$0.00,"$3,209.90","$1,444.46","$2,290.91",$0.00,$659.85,$0.00,$0.00,$562.03,"$3,209.90",$0.00,"$1,604.95","$2,542.24","$2,567.92",$0.00,$599.36,$0.00,$511.02,$0.00
450.830S,SUP,HCPCS C1713,,450.830S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 400MM CANN FLUTED BARREL,"$3,209.90",$0.00,"$3,209.90","$1,444.46","$2,290.91",$0.00,$659.85,$0.00,$0.00,$562.03,"$3,209.90",$0.00,"$1,604.95","$2,542.24","$2,567.92",$0.00,$599.36,$0.00,$511.02,$0.00
450.831S,SUP,HCPCS C1713,,450.831S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 420MM CANN FLUTED BARREL,"$3,209.90",$0.00,"$3,209.90","$1,444.46","$2,290.91",$0.00,$659.85,$0.00,$0.00,$562.03,"$3,209.90",$0.00,"$1,604.95","$2,542.24","$2,567.92",$0.00,$599.36,$0.00,$511.02,$0.00
450.832S,SUP,HCPCS C1713,,450.832S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 440MM CANN FLUTED BARREL,"$3,234.00",$0.00,"$3,234.00","$1,455.30","$2,308.11",$0.00,$557.20,$0.00,$0.00,$566.25,"$3,234.00",$0.00,"$1,617.00","$2,561.33","$2,587.20",$0.00,$506.12,$0.00,$514.85,$0.00
450.833S,SUP,HCPCS C1713,,450.833S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 460MM CANN FLUTED BARREL,"$3,324.75",$0.00,"$3,324.75","$1,496.14","$2,372.87",$0.00,$572.84,$0.00,$0.00,$582.14,"$3,324.75",$0.00,"$1,662.38","$2,633.20","$2,659.80",$0.00,$520.32,$0.00,$529.30,$0.00
450.834S,SUP,HCPCS C1713,,450.834S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 180MM CANN FLUTED BARREL,"$3,234.00",$0.00,"$3,234.00","$1,455.30","$2,308.11",$0.00,$557.20,$0.00,$0.00,$566.25,"$3,234.00",$0.00,"$1,617.00","$2,561.33","$2,587.20",$0.00,$506.12,$0.00,$514.85,$0.00
450.835S,SUP,HCPCS C1713,,450.835S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 220MM CANN FLUTED BARREL,"$3,234.00",$0.00,"$3,234.00","$1,455.30","$2,308.11",$0.00,$557.20,$0.00,$0.00,$566.25,"$3,234.00",$0.00,"$1,617.00","$2,561.33","$2,587.20",$0.00,$506.12,$0.00,$514.85,$0.00
450.836S,SUP,HCPCS C1713,,450.836S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 260MM CANN FLUTED BARREL,"$3,234.00",$0.00,"$3,234.00","$1,455.30","$2,308.11",$0.00,$557.20,$0.00,$0.00,$566.25,"$3,234.00",$0.00,"$1,617.00","$2,561.33","$2,587.20",$0.00,$506.12,$0.00,$514.85,$0.00
450.841S,SUP,HCPCS C1713,,450.841S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 160MM CANN FLUTED BARREL,"$3,234.00",$0.00,"$3,234.00","$1,455.30","$2,308.11",$0.00,$557.20,$0.00,$0.00,$566.25,"$3,234.00",$0.00,"$1,617.00","$2,561.33","$2,587.20",$0.00,$506.12,$0.00,$514.85,$0.00
450.842S,SUP,HCPCS C1713,,450.842S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 200MM CANN FLUTED BARREL,"$3,234.00",$0.00,"$3,234.00","$1,455.30","$2,308.11",$0.00,$557.20,$0.00,$0.00,$566.25,"$3,234.00",$0.00,"$1,617.00","$2,561.33","$2,587.20",$0.00,$506.12,$0.00,$514.85,$0.00
450.843S,SUP,HCPCS C1713,,450.843S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 240MM CANN FLUTED BARREL,"$3,234.00",$0.00,"$3,234.00","$1,455.30","$2,308.11",$0.00,$557.20,$0.00,$0.00,$566.25,"$3,234.00",$0.00,"$1,617.00","$2,561.33","$2,587.20",$0.00,$506.12,$0.00,$514.85,$0.00
450.844S,SUP,HCPCS C1713,,450.844S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 280MM CANN FLUTED BARREL,"$3,209.90",$0.00,"$3,209.90","$1,444.46","$2,290.91",$0.00,$659.85,$0.00,$0.00,$562.03,"$3,209.90",$0.00,"$1,604.95","$2,542.24","$2,567.92",$0.00,$599.36,$0.00,$511.02,$0.00
450.845S,SUP,HCPCS C1713,,450.845S  -  NAIL 13MM 30CM DISTAL FEM IM CANN TI STRL AQ,"$3,829.78",$0.00,"$3,829.78","$1,723.40","$2,733.31",$0.00,$659.85,$0.00,$0.00,$670.56,"$3,829.78",$0.00,"$1,914.89","$3,033.19","$3,063.82",$0.00,$599.36,$0.00,$609.70,$0.00
450.846S,SUP,HCPCS C1713,,450.846S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 320MM CANN FLUTED BARREL,"$3,209.90",$0.00,"$3,209.90","$1,444.46","$2,290.91",$0.00,$659.85,$0.00,$0.00,$562.03,"$3,209.90",$0.00,"$1,604.95","$2,542.24","$2,567.92",$0.00,$599.36,$0.00,$511.02,$0.00
450.847S,SUP,HCPCS C1713,,450.847S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 340MM CANN FLUTED BARREL,"$3,234.00",$0.00,"$3,234.00","$1,455.30","$2,308.11",$0.00,$557.20,$0.00,$0.00,$566.25,"$3,234.00",$0.00,"$1,617.00","$2,561.33","$2,587.20",$0.00,$506.12,$0.00,$514.85,$0.00
450.848S,SUP,HCPCS C1713,,450.848S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 360MM CANN FLUTED BARREL,"$3,209.90",$0.00,"$3,209.90","$1,444.46","$2,290.91",$0.00,$659.85,$0.00,$0.00,$562.03,"$3,209.90",$0.00,"$1,604.95","$2,542.24","$2,567.92",$0.00,$599.36,$0.00,$511.02,$0.00
450.849S,SUP,HCPCS C1713,,450.849S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 380MM CANN FLUTED BARREL,"$3,234.00",$0.00,"$3,234.00","$1,455.30","$2,308.11",$0.00,$557.20,$0.00,$0.00,$566.25,"$3,234.00",$0.00,"$1,617.00","$2,561.33","$2,587.20",$0.00,$506.12,$0.00,$514.85,$0.00
450.850S,SUP,HCPCS C1713,,450.850S  -  NAIL 13MM 40CM DISTAL FEM IM CANN TI STRL AQ,"$3,829.78",$0.00,"$3,829.78","$1,723.40","$2,733.31",$0.00,$659.85,$0.00,$0.00,$670.56,"$3,829.78",$0.00,"$1,914.89","$3,033.19","$3,063.82",$0.00,$599.36,$0.00,$609.70,$0.00
450.851S,SUP,HCPCS C1713,,450.851S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 420MM CANN FLUTED BARREL,"$3,209.90",$0.00,"$3,209.90","$1,444.46","$2,290.91",$0.00,$659.85,$0.00,$0.00,$562.03,"$3,209.90",$0.00,"$1,604.95","$2,542.24","$2,567.92",$0.00,$599.36,$0.00,$511.02,$0.00
450.852S,SUP,HCPCS C1713,,450.852S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 440MM CANN FLUTED BARREL,"$3,234.00",$0.00,"$3,234.00","$1,455.30","$2,308.11",$0.00,$557.20,$0.00,$0.00,$566.25,"$3,234.00",$0.00,"$1,617.00","$2,561.33","$2,587.20",$0.00,$506.12,$0.00,$514.85,$0.00
450.853S,SUP,HCPCS C1713,,450.853S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 460MM CANN FLUTED BARREL,"$3,324.75",$0.00,"$3,324.75","$1,496.14","$2,372.87",$0.00,$572.84,$0.00,$0.00,$582.14,"$3,324.75",$0.00,"$1,662.38","$2,633.20","$2,659.80",$0.00,$520.32,$0.00,$529.30,$0.00
450.854S,SUP,HCPCS C1713,,450.854S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 180MM CANN FLUTED BARREL,"$3,234.00",$0.00,"$3,234.00","$1,455.30","$2,308.11",$0.00,$557.20,$0.00,$0.00,$566.25,"$3,234.00",$0.00,"$1,617.00","$2,561.33","$2,587.20",$0.00,$506.12,$0.00,$514.85,$0.00
450.855S,SUP,HCPCS C1713,,450.855S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 220MM CANN FLUTED BARREL,"$3,209.90",$0.00,"$3,209.90","$1,444.46","$2,290.91",$0.00,$557.20,$0.00,$0.00,$562.03,"$3,209.90",$0.00,"$1,604.95","$2,542.24","$2,567.92",$0.00,$506.12,$0.00,$511.02,$0.00
450.856S,SUP,HCPCS C1713,,450.856S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 260MM CANN FLUTED BARREL,"$3,234.00",$0.00,"$3,234.00","$1,455.30","$2,308.11",$0.00,$557.20,$0.00,$0.00,$566.25,"$3,234.00",$0.00,"$1,617.00","$2,561.33","$2,587.20",$0.00,$506.12,$0.00,$514.85,$0.00
450.896S,SUP,Custom 27803010,,450.896S  -  CAP END DISTAL FEM IM NAIL TI STRL AQ,$518.33,$0.00,$518.33,$0.00,$369.93,$0.00,$0.00,$0.00,$0.00,$0.00,$518.33,$0.00,$259.16,$410.52,$414.66,$0.00,$0.00,$0.00,$0.00,$0.00
45-0010,SUP,Custom 27203010,,REAGENT BLOOD LEAD METEXCHANGE KT ANALY,$380.00,$0.00,$380.00,$0.00,$271.21,$0.00,$0.00,$0.00,$0.00,$0.00,$380.00,$0.00,$190.00,$300.96,$304.00,$0.00,$0.00,$0.00,$0.00,$0.00
45-0032,SUP,Custom 27203010,,REAGENT NA CHLOR SOL CHM,$125.00,$0.00,$125.00,$0.00,$89.21,$0.00,$0.00,$0.00,$0.00,$0.00,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$0.00,$0.00,$0.00,$0.00
45-0058,SUP,Custom 27203010,,REAGENT PLT SOL LEAD POISONING ANALY,$125.00,$0.00,$125.00,$0.00,$89.21,$0.00,$0.00,$0.00,$0.00,$0.00,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$0.00,$0.00,$0.00,$0.00
450120-20,SUP,Custom 27203010,,CONTROL PRTN IMG VGL LVL 1 5ML IMMUN,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
450125-20,SUP,Custom 27203010,,CONTROL PRTN IMG VGL LVL 2 5ML IMMUN,"$1,000.00",$0.00,"$1,000.00",$0.00,$713.70,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,000.00",$0.00,$500.00,$792.00,$800.00,$0.00,$0.00,$0.00,$0.00,$0.00
450-1329,SUP,HCPCS L8699,,450-1329  -  PROSTHESIS TESTICULAR 4.9X2.9CM INFUS LINE NEEDLE LARGE,"$4,622.50",$0.00,"$4,622.50",$0.00,"$3,299.08",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,622.50",$0.00,"$2,311.25","$3,661.02","$3,698.00",$0.00,$0.00,$0.00,$0.00,$0.00
450162-20,SUP,Custom 27203010,,CONTROL ASO CRP RF VIGIL LVL 1 5ML SERO,$825.00,$0.00,$825.00,$0.00,$588.80,$0.00,$0.00,$0.00,$0.00,$0.00,$825.00,$0.00,$412.50,$653.40,$660.00,$0.00,$0.00,$0.00,$0.00,$0.00
450163-20,SUP,Custom 27203010,,CONTROL ASO CRP RF VIGIL LVL 2 5ML SERO,$825.00,$0.00,$825.00,$0.00,$588.80,$0.00,$0.00,$0.00,$0.00,$0.00,$825.00,$0.00,$412.50,$653.40,$660.00,$0.00,$0.00,$0.00,$0.00,$0.00
450164-20,SUP,Custom 27203010,,VIGIL SEROLOGY ASO/CRP/RHF CNTRL LEVEL 3,$825.00,$0.00,$825.00,$0.00,$588.80,$0.00,$0.00,$0.00,$0.00,$0.00,$825.00,$0.00,$412.50,$653.40,$660.00,$0.00,$0.00,$0.00,$0.00,$0.00
45-018-E2S,SUP,Custom 27203010,,45-018-E2S  -  CATHETER INFS 2 2/3FR 45CM CLARIVEIN,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
45-0225,SUP,Custom 27203010,,CALIBRATOR CHM 68 TST LOW BLOOD METEXCHANGE SA,$717.50,$0.00,$717.50,$0.00,$512.08,$0.00,$0.00,$0.00,$0.00,$0.00,$717.50,$0.00,$358.75,$568.26,$574.00,$0.00,$0.00,$0.00,$0.00,$0.00
45-0230,SUP,Custom 27203010,,CALIBRATOR CHM 68 TST HI BLOOD METEXCHANGE SA,$717.50,$0.00,$717.50,$0.00,$512.08,$0.00,$0.00,$0.00,$0.00,$0.00,$717.50,$0.00,$358.75,$568.26,$574.00,$0.00,$0.00,$0.00,$0.00,$0.00
45-0250A,SUP,Custom 27203010,,CONTROL LINEAR VRF KT TOX,$420.00,$0.00,$420.00,$0.00,$299.75,$0.00,$0.00,$0.00,$0.00,$0.00,$420.00,$0.00,$210.00,$332.64,$336.00,$0.00,$0.00,$0.00,$0.00,$0.00
450-4251-1,SUP,Custom 27803010,,450-4251-1  -  CLAMP SURG HALIFAX SPNL THRD C1,$483.00,$0.00,$483.00,$0.00,$344.72,$0.00,$0.00,$0.00,$0.00,$0.00,$483.00,$0.00,$241.50,$382.54,$386.40,$0.00,$0.00,$0.00,$0.00,$0.00
450-4253-1,SUP,Custom 27803010,,450-4253-1  -  CLAMP SURG HALIFAX 7MM SPNL THRD,$483.00,$0.00,$483.00,$0.00,$344.72,$0.00,$0.00,$0.00,$0.00,$0.00,$483.00,$0.00,$241.50,$382.54,$386.40,$0.00,$0.00,$0.00,$0.00,$0.00
451514H0,SUP,HCPCS C1725,,451514H0  -  CATHETER ANGIO VERT CRV 5FR .042IN 100CM CRDS TMP RADOPQ BRD,$44.85,$0.00,$44.85,$24.35,$32.01,$0.00,$7.73,$0.00,$0.00,$7.85,$44.85,$0.00,$22.43,$35.52,$35.88,$0.00,$7.02,$0.00,$7.14,$0.00
45-20005,SUP,Custom 27203010,,45-20005  -  BIT DRILL 1.7MM ASNS MIC AO CPLNG CANN STRL DISP,$302.50,$0.00,$302.50,$0.00,$215.89,$0.00,$0.00,$0.00,$0.00,$0.00,$302.50,$0.00,$151.25,$239.58,$242.00,$0.00,$0.00,$0.00,$0.00,$0.00
45-20006,SUP,Custom 27803010,,45-20006  -  TAP 2MM MIC CANN AO CPLNG SURG ASNS DISP,$154.00,$0.00,$154.00,$0.00,$109.91,$0.00,$0.00,$0.00,$0.00,$0.00,$154.00,$0.00,$77.00,$121.97,$123.20,$0.00,$0.00,$0.00,$0.00,$0.00
45-20007,SUP,Custom 27203010,,45-20007  -  CNTRSNK DRILL 2MM ASNS MIC CANN AO CPLNG DISP,$438.63,$0.00,$438.63,$0.00,$313.05,$0.00,$0.00,$0.00,$0.00,$0.00,$438.63,$0.00,$219.31,$347.39,$350.90,$0.00,$0.00,$0.00,$0.00,$0.00
45-20008,SUP,Custom 27203010,,45-20008  -  SLEEVE DRILL ASNS MIC HLD 2MM SCR,$273.63,$0.00,$273.63,$0.00,$195.29,$0.00,$0.00,$0.00,$0.00,$0.00,$273.63,$0.00,$136.81,$216.71,$218.90,$0.00,$0.00,$0.00,$0.00,$0.00
45-20009,SUP,Custom 27203010,,45-20009  -  GUIDE DRILL .8MM 1.7MM ASNS MIC DBL,$672.38,$0.00,$672.38,$0.00,$479.87,$0.00,$0.00,$0.00,$0.00,$0.00,$672.38,$0.00,$336.19,$532.52,$537.90,$0.00,$0.00,$0.00,$0.00,$0.00
45-20011,SUP,Custom 27203010,,45-20011  -  BIT DRILL 1.7MM ASNS 2MM AO CPLNG SLD NONSTRL,$125.13,$0.00,$125.13,$0.00,$89.30,$0.00,$0.00,$0.00,$0.00,$0.00,$125.13,$0.00,$62.56,$99.10,$100.10,$0.00,$0.00,$0.00,$0.00,$0.00
45-20014,SUP,Custom 27203010,,45-20014  -  STYLET SURG INSTR .8MM ASNS CLEAN,$34.38,$0.00,$34.38,$0.00,$24.53,$0.00,$0.00,$0.00,$0.00,$0.00,$34.38,$0.00,$17.19,$27.23,$27.50,$0.00,$0.00,$0.00,$0.00,$0.00
45-20015,SUP,HCPCS C1713,,45-20015  -  WIRE FX .8MM 100MM NS KRSH DISP 2MM ASNS MIC SCR,$35.75,$0.00,$35.75,$16.09,$25.51,$0.00,$6.16,$0.00,$0.00,$6.26,$35.75,$0.00,$17.88,$28.31,$28.60,$0.00,$5.59,$0.00,$5.69,$0.00
45-27005,SUP,Custom 27803010,,45-27005  -  TAP 50MM SURG 2.7MM SCR,$156.75,$0.00,$156.75,$0.00,$111.87,$0.00,$0.00,$0.00,$0.00,$0.00,$156.75,$0.00,$78.38,$124.15,$125.40,$0.00,$0.00,$0.00,$0.00,$0.00
45-27010,SUP,Custom 27203010,,45-27010  -  DRILL TWST 102MM 2MM VARIAX AO SHFT END 50MM NONSTRL,$156.75,$0.00,$156.75,$0.00,$111.87,$0.00,$0.00,$0.00,$0.00,$0.00,$156.75,$0.00,$78.38,$124.15,$125.40,$0.00,$0.00,$0.00,$0.00,$0.00
45-30005,SUP,Custom 27203010,,45-30005  -  DRILL SRG MIC 2.1MM STRL AO CPLNG CNN HND FT DISP 3MM ASNS,$434.50,$0.00,$434.50,$0.00,$310.10,$0.00,$0.00,$0.00,$0.00,$0.00,$434.50,$0.00,$217.25,$344.12,$347.60,$0.00,$0.00,$0.00,$0.00,$0.00
45-30006,SUP,Custom 27803010,,45-30006  -  TAP 3MM MIC CANN AO CPLNG SURG ASNS DISP,$160.88,$0.00,$160.88,$0.00,$114.82,$0.00,$0.00,$0.00,$0.00,$0.00,$160.88,$0.00,$80.44,$127.42,$128.70,$0.00,$0.00,$0.00,$0.00,$0.00
45-30007,SUP,Custom 27203010,,45-30007  -  CNTRSNK DRILL 3MM AO CPLNG CANN DISP,$405.63,$0.00,$405.63,$0.00,$289.49,$0.00,$0.00,$0.00,$0.00,$0.00,$405.63,$0.00,$202.81,$321.26,$324.50,$0.00,$0.00,$0.00,$0.00,$0.00
45-30008,SUP,Custom 27203010,,45-30008  -  SLEEVE DRILL ASNS MIC HLD 3MM SCR,$270.88,$0.00,$270.88,$0.00,$193.32,$0.00,$0.00,$0.00,$0.00,$0.00,$270.88,$0.00,$135.44,$214.54,$216.70,$0.00,$0.00,$0.00,$0.00,$0.00
45-30009,SUP,Custom 27203010,,45-30009  -  GUIDE DRILL 1.2MM 2.1MM ASNS DBL,$334.13,$0.00,$334.13,$0.00,$238.47,$0.00,$0.00,$0.00,$0.00,$0.00,$334.13,$0.00,$167.06,$264.63,$267.30,$0.00,$0.00,$0.00,$0.00,$0.00
45-30011,SUP,Custom 27203010,,45-30011  -  BIT DRILL 2.1MM ASNS MIC SLD AO CPLNG NONSTRL,$127.88,$0.00,$127.88,$0.00,$91.26,$0.00,$0.00,$0.00,$0.00,$0.00,$127.88,$0.00,$63.94,$101.28,$102.30,$0.00,$0.00,$0.00,$0.00,$0.00
45-30014,SUP,Custom 27203010,,45-30014  -  STYLET SURG INSTR 1.2MM ASNS CLEAN,$34.38,$0.00,$34.38,$0.00,$24.53,$0.00,$0.00,$0.00,$0.00,$0.00,$34.38,$0.00,$17.19,$27.23,$27.50,$0.00,$0.00,$0.00,$0.00,$0.00
45-30015,SUP,HCPCS C1713,,45-30015  -  WIRE FX 1.2MM 100MM NS KRSH 3MM ASNS MIC SCR,$39.88,$0.00,$39.88,$17.94,$28.46,$0.00,$6.87,$0.00,$0.00,$6.98,$39.88,$0.00,$19.94,$31.58,$31.90,$0.00,$6.24,$0.00,$6.35,$0.00
45-35001,SUP,Custom 27203010,,45-35001  -  GAUGE DEPTH MSR 3.5 MM SCR,$760.38,$0.00,$760.38,$0.00,$542.68,$0.00,$0.00,$0.00,$0.00,$0.00,$760.38,$0.00,$380.19,$602.22,$608.30,$0.00,$0.00,$0.00,$0.00,$0.00
45-35005,SUP,Custom 27803010,,45-35005  -  TAP 70MM SURG 3.5MM SCR,$185.63,$0.00,$185.63,$0.00,$132.48,$0.00,$0.00,$0.00,$0.00,$0.00,$185.63,$0.00,$92.81,$147.02,$148.50,$0.00,$0.00,$0.00,$0.00,$0.00
45-35010,SUP,Custom 27203010,,45-35010  -  DRILL TWST 122MM 2.6MM VARIAX AO SHFT END 70MM NONSTRL,$185.63,$0.00,$185.63,$0.00,$132.48,$0.00,$0.00,$0.00,$0.00,$0.00,$185.63,$0.00,$92.81,$147.02,$148.50,$0.00,$0.00,$0.00,$0.00,$0.00
45-35015,SUP,Custom 27203010,,45-35015  -  BLADE AO FIT ASNS SCRDRVR T10,$297.00,$0.00,$297.00,$0.00,$211.97,$0.00,$0.00,$0.00,$0.00,$0.00,$297.00,$0.00,$148.50,$235.22,$237.60,$0.00,$0.00,$0.00,$0.00,$0.00
45-35030,SUP,Custom 27203010,,45-35030  -  SLEEVE DRILL ASNS MIC HLD INSTR 3.5MM SCR,$664.13,$0.00,$664.13,$0.00,$473.99,$0.00,$0.00,$0.00,$0.00,$0.00,$664.13,$0.00,$332.06,$525.99,$531.30,$0.00,$0.00,$0.00,$0.00,$0.00
456.010S,SUP,HCPCS C1713,,456.010S  -  SLEEVE LCK 100D 15MM LGHT BLU STRL TI FEM 9-12MM IM NL SPRL,$756.25,$0.00,$756.25,$340.31,$539.74,$0.00,$130.30,$0.00,$0.00,$132.41,$756.25,$0.00,$378.13,$598.95,$605.00,$0.00,$118.35,$0.00,$120.40,$0.00
456.011S,SUP,HCPCS C1713,,456.011S  -  SLEEVE LOCKING 110D 15MM LIGHT BLUE TITANIUM FEMUR STERILE,$756.25,$0.00,$756.25,$340.31,$539.74,$0.00,$130.30,$0.00,$0.00,$132.41,$756.25,$0.00,$378.13,$598.95,$605.00,$0.00,$118.35,$0.00,$120.40,$0.00
456.012S,SUP,HCPCS C1713,,456.012S  -  SLEEVE LCK 120D 15MM LGHT BLU STRL TI FEM 9-12MM IM NL SPRL,$756.25,$0.00,$756.25,$340.31,$539.74,$0.00,$130.30,$0.00,$0.00,$132.41,$756.25,$0.00,$378.13,$598.95,$605.00,$0.00,$118.35,$0.00,$120.40,$0.00
456.013S,SUP,HCPCS C1713,,456.013S  -  SLEEVE LOCKING 130D 15MM PINK TITANIUM FEMUR STERILE SPIRAL,$756.25,$0.00,$756.25,$340.31,$539.74,$0.00,$130.30,$0.00,$0.00,$132.41,$756.25,$0.00,$378.13,$598.95,$605.00,$0.00,$118.35,$0.00,$120.40,$0.00
456.100S,SUP,Custom 27803010,,456.100S  -  BLADE FIX 100MM SPIRAL TITANIUM FEMUR STERILE INTRAMEDULLARY,"$1,326.88",$0.00,"$1,326.88",$0.00,$946.99,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,326.88",$0.00,$663.44,"$1,050.89","$1,061.50",$0.00,$0.00,$0.00,$0.00,$0.00
456.105S,SUP,Custom 27803010,,456.105S  -  BLADE FIX 105MM SPIRAL TITANIUM FEMUR STERILE INTRAMEDULLARY,"$1,326.88",$0.00,"$1,326.88",$0.00,$946.99,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,326.88",$0.00,$663.44,"$1,050.89","$1,061.50",$0.00,$0.00,$0.00,$0.00,$0.00
456.110S,SUP,Custom 27803010,,456.110S  -  BLADE FIX 110MM SPIRAL TITANIUM FEMUR STERILE INTRAMEDULLARY,"$1,326.88",$0.00,"$1,326.88",$0.00,$946.99,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,326.88",$0.00,$663.44,"$1,050.89","$1,061.50",$0.00,$0.00,$0.00,$0.00,$0.00
456.115S,SUP,Custom 27803010,,456.115S  -  BLADE FIX 115MM SPIRAL TITANIUM FEMUR STERILE INTRAMEDULLARY,"$1,326.88",$0.00,"$1,326.88",$0.00,$946.99,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,326.88",$0.00,$663.44,"$1,050.89","$1,061.50",$0.00,$0.00,$0.00,$0.00,$0.00
456.120S,SUP,Custom 27803010,,456.120S  -  BLADE FIX 120MM SPIRAL TITANIUM FEMUR STERILE INTRAMEDULLARY,"$1,326.88",$0.00,"$1,326.88",$0.00,$946.99,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,326.88",$0.00,$663.44,"$1,050.89","$1,061.50",$0.00,$0.00,$0.00,$0.00,$0.00
456.300S,SUP,Custom 27803010,,456.300S  -  BLADE INTRAMEDULLARY FIX HELIX 11MM 75MM HELICAL GOLD,"$1,220.80",$0.00,"$1,220.80",$0.00,$871.28,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,220.80",$0.00,$610.40,$966.87,$976.64,$0.00,$0.00,$0.00,$0.00,$0.00
456.301S,SUP,Custom 27803010,,456.301S  -  BLADE INTRAMEDULLARY FIX HELIX 11MM 80MM GOLD TITANIUM,"$1,220.80",$0.00,"$1,220.80",$0.00,$871.28,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,220.80",$0.00,$610.40,$966.87,$976.64,$0.00,$0.00,$0.00,$0.00,$0.00
456.302S,SUP,Custom 27803010,,456.302S  -  BLADE INTRAMEDULLARY FIX HELIX 11MM 85MM CANN GOLD TITANIUM,"$1,220.80",$0.00,"$1,220.80",$0.00,$871.28,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,220.80",$0.00,$610.40,$966.87,$976.64,$0.00,$0.00,$0.00,$0.00,$0.00
456.303S,SUP,Custom 27803010,,456.303S  -  BLADE INTRAMEDULLARY FIX HELIX 11MM 90MM GOLD TITANIUM,"$1,220.80",$0.00,"$1,220.80",$0.00,$871.28,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,220.80",$0.00,$610.40,$966.87,$976.64,$0.00,$0.00,$0.00,$0.00,$0.00
456.304S,SUP,Custom 27803010,,456.304S  -  BLADE INTRAMEDULLARY FIX HELIX 11MM 95MM GOLD TITANIUM,"$1,220.80",$0.00,"$1,220.80",$0.00,$871.28,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,220.80",$0.00,$610.40,$966.87,$976.64,$0.00,$0.00,$0.00,$0.00,$0.00
456.305S,SUP,Custom 27803010,,456.305S  -  BLADE INTRAMEDULLARY FIX HELIX 11MM 100MM GOLD TITANIUM,"$1,220.80",$0.00,"$1,220.80",$0.00,$871.28,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,220.80",$0.00,$610.40,$966.87,$976.64,$0.00,$0.00,$0.00,$0.00,$0.00
456.306S,SUP,HCPCS C1713,,456.306S  -  BLADE INTRAMEDULLARY FIX HELIX 11MM 105MM CANN GOLD TITANIUM,"$1,220.80",$0.00,"$1,220.80",$549.36,$871.28,$0.00,$204.21,$0.00,$0.00,$213.75,"$1,220.80",$0.00,$610.40,$966.87,$976.64,$0.00,$185.49,$0.00,$194.35,$0.00
456.307S,SUP,Custom 27803010,,456.307S  -  BLADE INTRAMEDULLARY FIX HELIX 11MM 110MM CANN GOLD TITANIUM,"$1,220.80",$0.00,"$1,220.80",$0.00,$871.28,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,220.80",$0.00,$610.40,$966.87,$976.64,$0.00,$0.00,$0.00,$0.00,$0.00
456.308S,SUP,Custom 27803010,,456.308S  -  BLADE INTRAMEDULLARY FIX HELIX 11MM 115MM GOLD TITANIUM,"$1,220.80",$0.00,"$1,220.80",$0.00,$871.28,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,220.80",$0.00,$610.40,$966.87,$976.64,$0.00,$0.00,$0.00,$0.00,$0.00
456.309S,SUP,Custom 27803010,,456.309S  -  BLADE INTRAMEDULLARY FIX HELIX 11MM 120MM GOLD TITANIUM,"$1,220.80",$0.00,"$1,220.80",$0.00,$871.28,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,220.80",$0.00,$610.40,$966.87,$976.64,$0.00,$0.00,$0.00,$0.00,$0.00
456.310S,SUP,Custom 27803010,,456.310S  -  BLADE INTRAMEDULLARY FIX HELIX 11MM 125MM HELICAL GOLD,"$1,220.80",$0.00,"$1,220.80",$0.00,$871.28,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,220.80",$0.00,$610.40,$966.87,$976.64,$0.00,$0.00,$0.00,$0.00,$0.00
456.311S,SUP,Custom 27803010,,456.311S  -  CAP END 0MM GREEN TITANIUM STERILE,$392.30,$0.00,$392.30,$0.00,$279.98,$0.00,$0.00,$0.00,$0.00,$0.00,$392.30,$0.00,$196.15,$310.70,$313.84,$0.00,$0.00,$0.00,$0.00,$0.00
456.312S,SUP,Custom 27803010,,456.312S  -  CAP END 5MM EXTEND GREEN TITANIUM TROC STERILE,$392.30,$0.00,$392.30,$0.00,$279.98,$0.00,$0.00,$0.00,$0.00,$0.00,$392.30,$0.00,$196.15,$310.70,$313.84,$0.00,$0.00,$0.00,$0.00,$0.00
456.313S,SUP,Custom 27803010,,456.313S  -  CAP END 10MM EXTEND GREEN TITANIUM TROC STERILE CANN,$392.30,$0.00,$392.30,$0.00,$279.98,$0.00,$0.00,$0.00,$0.00,$0.00,$392.30,$0.00,$196.15,$310.70,$313.84,$0.00,$0.00,$0.00,$0.00,$0.00
456.314S,SUP,HCPCS C1713,,456.314S  -  NAIL INTRAMEDULLARY 125D SHORT UNIVERSAL 10MM 170MM CANN,"$2,553.50",$0.00,"$2,553.50","$1,149.08","$1,822.43",$0.00,$427.14,$0.00,$0.00,$447.10,"$2,553.50",$0.00,"$1,276.75","$2,022.37","$2,042.80",$0.00,$387.98,$0.00,$406.52,$0.00
456.315S,SUP,HCPCS C1713,,456.315S  -  NAIL INTRAMEDULLARY 130D SHORT UNIVERSAL 10MM 170MM CANN,"$2,553.50",$0.00,"$2,553.50","$1,149.08","$1,822.43",$0.00,$548.22,$0.00,$0.00,$447.10,"$2,553.50",$0.00,"$1,276.75","$2,022.37","$2,042.80",$0.00,$497.96,$0.00,$406.52,$0.00
456.316S,SUP,HCPCS C1713,,456.316S  -  NAIL FIX 135D 10MM 17CM CANN GREEN TITANIUM TROCHANTER,"$2,553.50",$0.00,"$2,553.50","$1,149.08","$1,822.43",$0.00,$427.14,$0.00,$0.00,$447.10,"$2,553.50",$0.00,"$1,276.75","$2,022.37","$2,042.80",$0.00,$387.98,$0.00,$406.52,$0.00
456.317S,SUP,HCPCS C1713,,456.317S  -  NAIL INTRAMEDULLARY 125D SHORT UNIVERSAL 11MM 170MM CANN,"$2,553.50",$0.00,"$2,553.50","$1,149.08","$1,822.43",$0.00,$427.14,$0.00,$0.00,$447.10,"$2,553.50",$0.00,"$1,276.75","$2,022.37","$2,042.80",$0.00,$387.98,$0.00,$406.52,$0.00
456.318S,SUP,HCPCS C1713,,456.318S  -  NAIL INTRAMEDULLARY 130D SHORT UNIVERSAL 11MM 170MM CANN,"$2,553.50",$0.00,"$2,553.50","$1,149.08","$1,822.43",$0.00,$427.14,$0.00,$0.00,$447.10,"$2,553.50",$0.00,"$1,276.75","$2,022.37","$2,042.80",$0.00,$387.98,$0.00,$406.52,$0.00
456.319S,SUP,HCPCS C1713,,456.319S  -  NAIL INTRAMEDULLARY 135D SHORT UNIVERSAL 11MM 170MM CANN,"$2,553.50",$0.00,"$2,553.50","$1,149.08","$1,822.43",$0.00,$427.14,$0.00,$0.00,$447.10,"$2,553.50",$0.00,"$1,276.75","$2,022.37","$2,042.80",$0.00,$387.98,$0.00,$406.52,$0.00
456.321S,SUP,HCPCS C1713,,456.321S  -  NAIL INTRAMEDULLARY 125D SHORT UNIVERSAL 12MM 170MM CANN,"$2,553.50",$0.00,"$2,553.50","$1,149.08","$1,822.43",$0.00,$427.14,$0.00,$0.00,$447.10,"$2,553.50",$0.00,"$1,276.75","$2,022.37","$2,042.80",$0.00,$387.98,$0.00,$406.52,$0.00
456.322S,SUP,HCPCS C1713,,456.322S  -  NAIL INTRAMEDULLARY 130D SHORT 12MM 170MM CANN STATIC INTLCK,"$2,553.50",$0.00,"$2,553.50","$1,149.08","$1,822.43",$0.00,$427.14,$0.00,$0.00,$447.10,"$2,553.50",$0.00,"$1,276.75","$2,022.37","$2,042.80",$0.00,$387.98,$0.00,$406.52,$0.00
456.323S,SUP,HCPCS C1713,,456.323S  -  NAIL FIX 135D SHORT 12MM 170MM CANN STATIC INTLCK GREEN,"$2,553.50",$0.00,"$2,553.50","$1,149.08","$1,822.43",$0.00,$427.14,$0.00,$0.00,$447.10,"$2,553.50",$0.00,"$1,276.75","$2,022.37","$2,042.80",$0.00,$387.98,$0.00,$406.52,$0.00
456.324S,SUP,HCPCS C1713,,456.324S  -  NAIL INTRAMEDULLARY 125D SHORT UNIVERSAL 10MM 235MM CANN,"$2,639.90",$0.00,"$2,639.90","$1,187.96","$1,884.10",$0.00,$441.59,$0.00,$0.00,$462.23,"$2,639.90",$0.00,"$1,319.95","$2,090.80","$2,111.92",$0.00,$401.11,$0.00,$420.27,$0.00
456.325S,SUP,HCPCS C1713,,456.325S  -  NAIL INTRAMEDULLARY 130D SHORT UNIVERSAL 10MM 235MM CANN,"$2,639.90",$0.00,"$2,639.90","$1,187.96","$1,884.10",$0.00,$441.59,$0.00,$0.00,$462.23,"$2,639.90",$0.00,"$1,319.95","$2,090.80","$2,111.92",$0.00,$401.11,$0.00,$420.27,$0.00
456.326S,SUP,HCPCS C1713,,456.326S  -  NAIL FIX 135D SHORT 10MM 23.5CM CANN GREEN TITANIUM TROC,"$2,553.50",$0.00,"$2,553.50","$1,149.08","$1,822.43",$0.00,$427.14,$0.00,$0.00,$447.10,"$2,553.50",$0.00,"$1,276.75","$2,022.37","$2,042.80",$0.00,$387.98,$0.00,$406.52,$0.00
456.327S,SUP,HCPCS C1713,,456.327S  -  NAIL FIX 125D SHORT 11MM 23.5CM CANN GREEN TITANIUM,"$2,553.50",$0.00,"$2,553.50","$1,149.08","$1,822.43",$0.00,$427.14,$0.00,$0.00,$447.10,"$2,553.50",$0.00,"$1,276.75","$2,022.37","$2,042.80",$0.00,$387.98,$0.00,$406.52,$0.00
456.328S,SUP,HCPCS C1713,,456.328S  -  NAIL INTRAMEDULLARY 130D SHORT UNIVERSAL 11MM 235MM CANN,"$2,553.50",$0.00,"$2,553.50","$1,149.08","$1,822.43",$0.00,$427.14,$0.00,$0.00,$447.10,"$2,553.50",$0.00,"$1,276.75","$2,022.37","$2,042.80",$0.00,$387.98,$0.00,$406.52,$0.00
456.329S,SUP,HCPCS C1713,,456.329S  -  NAIL FIX 135D SHORT 11MM 23.5CM CANN GREEN TITANIUM,"$2,553.50",$0.00,"$2,553.50","$1,149.08","$1,822.43",$0.00,$427.14,$0.00,$0.00,$447.10,"$2,553.50",$0.00,"$1,276.75","$2,022.37","$2,042.80",$0.00,$387.98,$0.00,$406.52,$0.00
456.330S,SUP,HCPCS C1713,,456.330S  -  NAIL INTRAMEDULLARY 125D LONG 17-10MM 30CM CANN INTLCK GREEN,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.331S,SUP,HCPCS C1713,,456.331S  -  NAIL INTRAMEDULLARY 125D LONG 10MM 30CM CANN GREEN TITANIUM,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.332S,SUP,HCPCS C1713,,456.332S  -  NAIL INTRAMEDULLARY 125D LONG 17-10MM 32CM CANN INTLCK GREEN,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.333S,SUP,HCPCS C1713,,456.333S  -  NAIL INTRAMEDULLARY 125D LONG 10MM 32CM CANN GREEN TITANIUM,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.334S,SUP,HCPCS C1713,,456.334S  -  NAIL INTRAMEDULLARY 125D LONG 17-10MM 34CM CANN INTLCK GREEN,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.335S,SUP,HCPCS C1713,,456.335S  -  NAIL INTRAMEDULLARY 125D LONG 10MM 34CM CANN GREEN TITANIUM,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.336S,SUP,HCPCS C1713,,456.336S  -  NAIL INTRAMEDULLARY 125D LONG 17-10MM 36CM CANN INTLCK GREEN,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.337S,SUP,HCPCS C1713,,456.337S  -  NAIL INTRAMEDULLARY 125D LONG 10MM 36CM CANN GREEN TITANIUM,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.338S,SUP,HCPCS C1713,,456.338S  -  NAIL INTRAMEDULLARY 125D LONG 17-10MM 38CM CANN INTLCK GREEN,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.339S,SUP,HCPCS C1713,,456.339S  -  NAIL INTRAMEDULLARY 125D LONG 10MM 38CM CANN GREEN TITANIUM,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.340S,SUP,HCPCS C1713,,456.340S  -  NAIL INTRAMEDULLARY 125D LONG 17-10MM 40CM CANN INTLCK GREEN,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.341S,SUP,HCPCS C1713,,456.341S  -  NAIL INTRAMEDULLARY 125D LONG 10MM 40CM CANN GREEN TITANIUM,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.342S,SUP,HCPCS C1713,,456.342S  -  NAIL INTRAMEDULLARY 125D LONG 17-10MM 42CM CANN INTLCK GREEN,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.343S,SUP,HCPCS C1713,,456.343S  -  NAIL INTRAMEDULLARY 125D LONG 10MM 42CM CANN GREEN TITANIUM,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.344S,SUP,HCPCS C1713,,456.344S  -  NAIL INTRAMEDULLARY 125D LONG 17-10MM 44CM CANN INTLCK GREEN,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.345S,SUP,HCPCS C1713,,456.345S  -  NAIL INTRAMEDULLARY 125D LONG 10MM 44CM CANN GREEN TITANIUM,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.346S,SUP,HCPCS C1713,,456.346S  -  NAIL INTRAMEDULLARY 125D LONG 17-10MM 46CM CANN INTLCK GREEN,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.347S,SUP,HCPCS C1713,,456.347S  -  NAIL INTRAMEDULLARY 125D LONG 10MM 46CM CANN GREEN TITANIUM,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.350S,SUP,HCPCS C1713,,456.350S  -  NAIL INTRAMEDULLARY 130D LONG 17-10MM 30CM CANN INTLCK GREEN,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.351S,SUP,HCPCS C1713,,456.351S  -  NAIL INTRAMEDULLARY 130D LONG 10MM 30CM CANN GREEN TITANIUM,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.352S,SUP,HCPCS C1713,,456.352S  -  NAIL INTRAMEDULLARY 130D LONG 17-10MM 32CM CANN INTLCK GREEN,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.353S,SUP,HCPCS C1713,,456.353S  -  NAIL INTRAMEDULLARY 130D LONG 10MM 320MM CANN PREASSEMBLED,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.354S,SUP,HCPCS C1713,,456.354S  -  NAIL INTRAMEDULLARY 130D LONG 17-10MM 34CM CANN INTLCK GREEN,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.355S,SUP,HCPCS C1713,,456.355S  -  NAIL INTRAMEDULLARY 130D 10MM 34CM CANN GREEN TITANIUM LEFT,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.356S,SUP,HCPCS C1713,,456.356S  -  NAIL INTRAMEDULLARY 130D LONG 17-10MM 36CM CANN INTLCK GREEN,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.357S,SUP,HCPCS C1713,,456.357S  -  NAIL FIX 130D 10MM 360MM CANN STATIC INTLCK GREEN TITANIUM,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.358S,SUP,HCPCS C1713,,456.358S  -  NAIL INTRAMEDULLARY 130D LONG 10MM 38CM CANN INTERLOCK GREEN,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.359S,SUP,HCPCS C1713,,456.359S  -  NAIL INTRAMEDULLARY 130D 10MM 380MM CANN STATIC INTLCK GREEN,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.360S,SUP,HCPCS C1713,,456.360S  -  NAIL INTRAMEDULLARY 130D LONG 17-10MM 40CM CANN INTLCK GREEN,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.361S,SUP,HCPCS C1713,,456.361S  -  NAIL INTRAMEDULLARY 130D LONG 10MM 400MM CANN PREASSEMBLED,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.362S,SUP,HCPCS C1713,,456.362S  -  NAIL INTRAMEDULLARY 130D LONG 17-10MM 42CM CANN INTLCK GREEN,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.363S,SUP,HCPCS C1713,,456.363S  -  NAIL INTRAMEDULLARY 130D LONG 10MM 42CM CANN GREEN TITANIUM,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.364S,SUP,HCPCS C1713,,456.364S  -  NAIL INTRAMEDULLARY 130D LONG 17-10MM 44CM CANN INTLCK GREEN,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.365S,SUP,HCPCS C1713,,456.365S  -  NAIL INTRAMEDULLARY 130D LONG 10MM 44CM CANN GREEN TITANIUM,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.366S,SUP,HCPCS C1713,,456.366S  -  NAIL INTRAMEDULLARY 130D LONG 17-10MM 46CM CANN INTLCK GREEN,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.367S,SUP,HCPCS C1713,,456.367S  -  NAIL INTRAMEDULLARY 130D LONG 10MM 46CM CANN GREEN TITANIUM,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.370S,SUP,HCPCS C1713,,456.370S  -  NAIL INTRAMEDULLARY 135D LONG 10MM 33CM CANN GREEN TITANIUM,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.371S,SUP,HCPCS C1713,,456.371S  -  NAIL INTRAMEDULLARY 135D LONG 10MM 33CM CANN GREEN TITANIUM,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.372S,SUP,HCPCS C1713,,456.372S  -  NAIL INTRAMEDULLARY 135D LONG 10MM 320MM CANN GREEN TITANIUM,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.373S,SUP,HCPCS C1713,,456.373S  -  NAIL INTRAMEDULLARY 135D LONG 10MM 32CM CANN GREEN TITANIUM,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.374S,SUP,HCPCS C1713,,456.374S  -  NAIL INTRAMEDULLARY 135D LONG 10MM 34CM CANN GREEN TITANIUM,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.375S,SUP,HCPCS C1713,,456.375S  -  NAIL INTRAMEDULLARY 135D LONG 10MM 34CM CANN GREEN TITANIUM,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.376S,SUP,HCPCS C1713,,456.376S  -  NAIL INTRAMEDULLARY 135D LONG 10MM 36CM CANN GREEN TITANIUM,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.377S,SUP,HCPCS C1713,,456.377S  -  NAIL INTRAMEDULLARY 135D LONG 10MM 36CM CANN GREEN TITANIUM,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.378S,SUP,HCPCS C1713,,456.378S  -  NAIL INTRAMEDULLARY 135D LONG 10MM 38CM CANN GREEN TITANIUM,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.379S,SUP,HCPCS C1713,,456.379S  -  NAIL INTRAMEDULLARY 135D LONG 10MM 38CM CANN GREEN TITANIUM,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.380S,SUP,HCPCS C1713,,456.380S  -  NAIL INTRAMEDULLARY 135D LONG 10MM 40CM CANN GREEN TITANIUM,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.381S,SUP,HCPCS C1713,,456.381S  -  NAIL INTRAMEDULLARY 135D LONG 10MM 40CM CANN GREEN TITANIUM,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.382S,SUP,HCPCS C1713,,456.382S  -  NAIL INTRAMEDULLARY 135D LONG 10MM 42CM CANN GREEN TITANIUM,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.383S,SUP,HCPCS C1713,,456.383S  -  NAIL INTRAMEDULLARY 135D LONG 10MM 42CM CANN GREEN TITANIUM,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.384S,SUP,HCPCS C1713,,456.384S  -  NAIL INTRAMEDULLARY 135D LONG 10MM 44CM CANN GREEN TITANIUM,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.385S,SUP,HCPCS C1713,,456.385S  -  NAIL INTRAMEDULLARY 135D LONG 10MM 44CM CANN GREEN TITANIUM,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.386S,SUP,HCPCS C1713,,456.386S  -  NAIL INTRAMEDULLARY 135D LONG 10MM 46CM CANN GREEN TITANIUM,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.387S,SUP,HCPCS C1713,,456.387S  -  NAIL INTRAMEDULLARY 135D LONG 10MM 46CM CANN GREEN TITANIUM,"$3,474.05",$0.00,"$3,474.05","$1,563.32","$2,479.43",$0.00,$581.13,$0.00,$0.00,$608.28,"$3,474.05",$0.00,"$1,737.03","$2,751.45","$2,779.24",$0.00,$527.85,$0.00,$553.07,$0.00
456.390S,SUP,HCPCS C1713,,456.390S  -  NAIL INTRAMEDULLARY 125D LONG 17-11MM 33CM CANN INTLCK GREEN,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.391S,SUP,HCPCS C1713,,456.391S  -  NAIL INTRAMEDULLARY 125D LONG 11MM 33CM CANN GREEN TITANIUM,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.392S,SUP,HCPCS C1713,,456.392S  -  NAIL INTRAMEDULLARY 125D LONG 17-11MM 32CM CANN INTLCK GREEN,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.393S,SUP,HCPCS C1713,,456.393S  -  NAIL INTRAMEDULLARY 125D LONG 11MM 32CM CANN GREEN TITANIUM,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.394S,SUP,HCPCS C1713,,456.394S  -  NAIL INTRAMEDULLARY 125D LONG 17-11MM 34CM CANN INTLCK GREEN,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.395S,SUP,HCPCS C1713,,456.395S  -  NAIL INTRAMEDULLARY 125D LONG 11MM 34CM CANN GREEN TITANIUM,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.396S,SUP,HCPCS C1713,,456.396S  -  NAIL INTRAMEDULLARY 125D LONG 17-11MM 36CM CANN INTLCK GREEN,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.397S,SUP,HCPCS C1713,,456.397S  -  NAIL INTRAMEDULLARY 125D 11MM 36CM CANN GREEN TITANIUM LEFT,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.398S,SUP,HCPCS C1713,,456.398S  -  NAIL INTRAMEDULLARY 125D LONG 17-11MM 38CM CANN INTLCK GREEN,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.399S,SUP,HCPCS C1713,,456.399S  -  NAIL INTRAMEDULLARY 125D 11MM 38CM CANN GREEN TITANIUM LEFT,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.400S,SUP,HCPCS C1713,,456.400S  -  NAIL INTRAMEDULLARY 125D LONG 17-11MM 40CM CANN INTLCK GREEN,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.401S,SUP,HCPCS C1713,,456.401S  -  NAIL INTRAMEDULLARY 125D 11MM 40CM CANN GREEN TITANIUM LEFT,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.402S,SUP,HCPCS C1713,,456.402S  -  NAIL INTRAMEDULLARY 125D LONG 17-11MM 42CM CANN INTLCK GREEN,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.403S,SUP,HCPCS C1713,,456.403S  -  NAIL INTRAMEDULLARY 125D LONG 11MM 42CM CANN GREEN TITANIUM,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.404S,SUP,HCPCS C1713,,456.404S  -  NAIL INTRAMEDULLARY 125D LONG 17-11MM 44CM CANN INTLCK GREEN,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.405S,SUP,HCPCS C1713,,456.405S  -  NAIL INTRAMEDULLARY 125D LONG 11MM 44CM CANN GREEN TITANIUM,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.406S,SUP,HCPCS C1713,,456.406S  -  NAIL INTRAMEDULLARY 125D LONG 17-11MM 46CM CANN INTLCK GREEN,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.407S,SUP,HCPCS C1713,,456.407S  -  NAIL INTRAMEDULLARY 125D LONG 11MM 46CM CANN GREEN TITANIUM,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.410S,SUP,HCPCS C1713,,456.410S  -  NAIL INTRAMEDULLARY 130D LONG 11MM 30CM CANN PREASSEMBLE,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.411S,SUP,HCPCS C1713,,456.411S  -  NAIL FIX 130D SHORT 11MM 300MM CANN PREASSEMBLED LOCKING,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.412S,SUP,HCPCS C1713,,456.412S  -  NAIL FIX 130D SHORT 11MM 320MM CANN PREASSEMBLED LOCKING,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.413S,SUP,HCPCS C1713,,456.413S  -  NAIL FIX 130D SHORT 11MM 320MM CANN PREASSEMBLED LOCKING,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.414S,SUP,HCPCS C1713,,456.414S  -  NAIL FIX 130D 11MM 340MM CANN TITANIUM RIGHT TROCHANTER,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.415S,SUP,HCPCS C1713,,456.415S  -  NAIL FIX 130D SHORT 11MM 340MM CANN PREASSEMBLED LOCKING,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.416S,SUP,HCPCS C1713,,456.416S  -  NAIL FIX 130D SHORT 11MM 360MM CANN PREASSEMBLED LOCKING,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.417S,SUP,HCPCS C1713,,456.417S  -  NAIL FIX 130D SHORT 11MM 360MM CANN PREASSEMBLED LOCKING,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.418S,SUP,HCPCS C1713,,456.418S  -  NAIL FIX 130D SHORT 11MM 380MM CANN PREASSEMBLED LOCKING,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.419S,SUP,HCPCS C1713,,456.419S  -  NAIL FIX 130D SHORT 11MM 380MM CANN PREASSEMBLED LOCKING,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.420S,SUP,HCPCS C1713,,456.420S  -  NAIL FIX 130D SHORT 11MM 400MM CANN PREASSEMBLED LOCKING,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.421S,SUP,HCPCS C1713,,456.421S  -  NAIL FIX 130D SHORT 11MM 400MM CANN PREASSEMBLED LOCKING,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.422S,SUP,HCPCS C1713,,456.422S  -  NAIL FIX 130D SHORT 11MM 420MM CANN PREASSEMBLED LOCKING,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.423S,SUP,HCPCS C1713,,456.423S  -  NAIL FIX 130D SHORT 11MM 420MM CANN PREASSEMBLED LOCKING,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.424S,SUP,HCPCS C1713,,456.424S  -  NAIL FIX 130D SHORT 11MM 440MM CANN PREASSEMBLED LOCKING,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.425S,SUP,HCPCS C1713,,456.425S  -  NAIL INTRAMEDULLARY 130D LONG 11MM 440MM CANN PREASSEMBLED,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.426S,SUP,HCPCS C1713,,456.426S  -  NAIL FIX 130D LONG 11MM 460MM CANN PREASSEMBLED LOCKING,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.427S,SUP,HCPCS C1713,,456.427S  -  NAIL FIX 130D LONG 11MM 460MM CANN PREASSEMBLED LOCKING,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.430S,SUP,HCPCS C1713,,456.430S  -  NAIL INTRAMEDULLARY 135D LONG 17-11MM 33CM CANN INTLCK GREEN,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.431S,SUP,HCPCS C1713,,456.431S  -  NAIL INTRAMEDULLARY 135D LONG 11MM 33CM CANN GREEN TITANIUM,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.432S,SUP,HCPCS C1713,,456.432S  -  NAIL INTRAMEDULLARY 135D LONG 17-11MM 32CM CANN INTLCK GREEN,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.433S,SUP,HCPCS C1713,,456.433S  -  NAIL INTRAMEDULLARY 135D LONG 11MM 32CM CANN GREEN TITANIUM,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.434S,SUP,HCPCS C1713,,456.434S  -  NAIL INTRAMEDULLARY 135D LONG 17-11MM 34CM CANN INTLCK GREEN,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.435S,SUP,HCPCS C1713,,456.435S  -  NAIL INTRAMEDULLARY 135D 11MM 34CM CANN GREEN TITANIUM LEFT,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.436S,SUP,HCPCS C1713,,456.436S  -  NAIL INTRAMEDULLARY 135D LONG 17-11MM 36CM CANN INTLCK GREEN,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.437S,SUP,HCPCS C1713,,456.437S  -  NAIL INTRAMEDULLARY 135D 11MM 36CM CANN GREEN TITANIUM LEFT,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.438S,SUP,HCPCS C1713,,456.438S  -  NAIL INTRAMEDULLARY 135D LONG 17-11MM 38CM CANN INTLCK GREEN,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.439S,SUP,HCPCS C1713,,456.439S  -  NAIL INTRAMEDULLARY 135D 11MM 38CM CANN GREEN TITANIUM LEFT,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.440S,SUP,HCPCS C1713,,456.440S  -  NAIL INTRAMEDULLARY 135D LONG 17-11MM 40CM CANN INTLCK GREEN,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.441S,SUP,HCPCS C1713,,456.441S  -  NAIL INTRAMEDULLARY 135D 11MM 40CM CANN GREEN TITANIUM LEFT,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.442S,SUP,HCPCS C1713,,456.442S  -  NAIL INTRAMEDULLARY 135D LONG 17-11MM 42CM CANN INTLCK GREEN,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.443S,SUP,HCPCS C1713,,456.443S  -  NAIL INTRAMEDULLARY 135D 11MM 42CM CANN GREEN TITANIUM LEFT,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.444S,SUP,HCPCS C1713,,456.444S  -  NAIL INTRAMEDULLARY 135D LONG 17-11MM 44CM CANN INTLCK GREEN,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.445S,SUP,HCPCS C1713,,456.445S  -  NAIL INTRAMEDULLARY 135D LONG 11MM 44CM CANN GREEN TITANIUM,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.446S,SUP,HCPCS C1713,,456.446S  -  NAIL INTRAMEDULLARY 135D LONG 17-11MM 46CM CANN INTLCK GREEN,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.447S,SUP,HCPCS C1713,,456.447S  -  NAIL INTRAMEDULLARY 135D LONG 11MM 46CM CANN GREEN TITANIUM,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.450S,SUP,HCPCS C1713,,456.450S  -  NAIL INTRAMEDULLARY 125D LONG 17-12MM 30CM CANN INTLCK GREEN,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.451S,SUP,HCPCS C1713,,456.451S  -  NAIL INTRAMEDULLARY 125D 12MM 30CM CANN TITANIUM LEFT TROC,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.452S,SUP,HCPCS C1713,,456.452S  -  NAIL INTRAMEDULLARY 125D LONG 17-12MM 32CM CANN INTLCK GREEN,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.453S,SUP,HCPCS C1713,,456.453S  -  NAIL INTRAMEDULLARY 125D LONG 12MM 32CM CANN GREEN TITANIUM,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.454S,SUP,HCPCS C1713,,456.454S  -  NAIL INTRAMEDULLARY 125D LONG 17-12MM 34CM CANN INTLCK GREEN,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.455S,SUP,HCPCS C1713,,456.455S  -  NAIL INTRAMEDULLARY 125D 12MM 34CM CANN TITANIUM LEFT TROC,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.456S,SUP,HCPCS C1713,,456.456S  -  NAIL INTRAMEDULLARY 125D LONG 17-12MM 36CM CANN INTLCK GREEN,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.457S,SUP,HCPCS C1713,,456.457S  -  NAIL INTRAMEDULLARY 125D LONG 12MM 36CM CANN GREEN TITANIUM,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.458S,SUP,HCPCS C1713,,456.458S  -  NAIL INTRAMEDULLARY 125D LONG 17-12MM 38CM CANN INTLCK GREEN,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.459S,SUP,HCPCS C1713,,456.459S  -  NAIL INTRAMEDULLARY 125D LONG 12MM 38CM CANN GREEN TITANIUM,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.460S,SUP,HCPCS C1713,,456.460S  -  NAIL INTRAMEDULLARY 125D LONG 17-12MM 40CM CANN INTLCK GREEN,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.461S,SUP,HCPCS C1713,,456.461S  -  NAIL INTRAMEDULLARY 125D 12MM 40CM CANN TITANIUM LEFT TROC,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.462S,SUP,HCPCS C1713,,456.462S  -  NAIL INTRAMEDULLARY 125D LONG 17-12MM 42CM CANN INTLCK GREEN,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.463S,SUP,HCPCS C1713,,456.463S  -  NAIL INTRAMEDULLARY 125D LONG 12MM 42CM CANN GREEN TITANIUM,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.464S,SUP,HCPCS C1713,,456.464S  -  NAIL INTRAMEDULLARY 125D LONG 17-12MM 44CM CANN INTLCK GREEN,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.465S,SUP,HCPCS C1713,,456.465S  -  NAIL INTRAMEDULLARY 125D LONG 12MM 44CM CANN GREEN TITANIUM,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.466S,SUP,HCPCS C1713,,456.466S  -  NAIL INTRAMEDULLARY 125D LONG 17-12MM 46CM CANN INTLCK GREEN,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.467S,SUP,HCPCS C1713,,456.467S  -  NAIL INTRAMEDULLARY 125D LONG 12MM 46CM CANN GREEN TITANIUM,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.470S,SUP,HCPCS C1713,,456.470S  -  NAIL INTRAMEDULLARY 130D LONG 17-12MM 30CM CANN INTLCK GREEN,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.471S,SUP,HCPCS C1713,,456.471S  -  NAIL INTRAMEDULLARY 130D 12MM 30CM CANN TITANIUM LEFT TROC,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.472S,SUP,HCPCS C1713,,456.472S  -  NAIL INTRAMEDULLARY 130D LONG 17-12MM 32CM CANN INTLCK GREEN,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.473S,SUP,HCPCS C1713,,456.473S  -  NAIL INTRAMEDULLARY 130D LONG 12MM 32CM CANN GREEN TITANIUM,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.474S,SUP,HCPCS C1713,,456.474S  -  NAIL INTRAMEDULLARY 130D LONG 12MM 34CM CANN PREASSEMBLE,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.475S,SUP,HCPCS C1713,,456.475S  -  NAIL INTRAMEDULLARY 130D LONG 12MM 34CM CANN PREASSEMBLE,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.476S,SUP,HCPCS C1713,,456.476S  -  NAIL INTRAMEDULLARY 130D LONG 12MM 36CM CANN PREASSEMBLE,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.477S,SUP,HCPCS C1713,,456.477S  -  NAIL INTRAMEDULLARY 130D LONG 12MM 36CM CANN PREASSEMBLE,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.478S,SUP,HCPCS C1713,,456.478S  -  NAIL INTRAMEDULLARY 130D LONG 12MM 380MM CANN PREASSEMBLE,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.479S,SUP,HCPCS C1713,,456.479S  -  NAIL INTRAMEDULLARY 130D LONG 12MM 380MM CANN PREASSEMBLED,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.480S,SUP,HCPCS C1713,,456.480S  -  NAIL INTRAMEDULLARY 130D LONG 12MM 400MM CANN PREASSEMBLE,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.481S,SUP,HCPCS C1713,,456.481S  -  NAIL INTRAMEDULLARY 130D LONG 12MM 40CM CANN GREEN TITANIUM,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.482S,SUP,HCPCS C1713,,456.482S  -  NAIL INTRAMEDULLARY 130D LONG 12MM 420MM CANN PREASSEMBLE,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.483S,SUP,HCPCS C1713,,456.483S  -  NAIL INTRAMEDULLARY 130D LONG 12MM 420MM CANN PREASSEMBLE,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.484S,SUP,HCPCS C1713,,456.484S  -  NAIL INTRAMEDULLARY 130D LONG 12MM 440MM CANN PREASSEMBLE,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.485S,SUP,HCPCS C1713,,456.485S  -  NAIL INTRAMEDULLARY 130D 12MM 44CM CANN TITANIUM LEFT TROC,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.486S,SUP,HCPCS C1713,,456.486S  -  NAIL INTRAMEDULLARY 130D LONG 12MM 460MM CANN PREASSEMBLE,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.487S,SUP,HCPCS C1713,,456.487S  -  NAIL INTRAMEDULLARY 130D LONG 12MM 46CM CANN GREEN TITANIUM,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.490S,SUP,HCPCS C1713,,456.490S  -  NAIL INTRAMEDULLARY 135D LONG 17-12MM 30CM CANN INTLCK GREEN,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.491S,SUP,HCPCS C1713,,456.491S  -  NAIL INTRAMEDULLARY 135D LONG 12MM 33CM CANN GREEN TITANIUM,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.492S,SUP,HCPCS C1713,,456.492S  -  NAIL INTRAMEDULLARY 135D LONG 17-12MM 32CM CANN INTLCK GREEN,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.493S,SUP,HCPCS C1713,,456.493S  -  NAIL INTRAMEDULLARY 135D LONG 12MM 32CM CANN GREEN TITANIUM,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.494S,SUP,HCPCS C1713,,456.494S  -  NAIL INTRAMEDULLARY 135D LONG 17-12MM 34CM CANN INTLCK GREEN,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.495S,SUP,HCPCS C1713,,456.495S  -  NAIL INTRAMEDULLARY 135D 12MM 34CM CANN TITANIUM LEFT TROC,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.496S,SUP,HCPCS C1713,,456.496S  -  NAIL INTRAMEDULLARY 135D LONG 17-12MM 36CM CANN INTLCK GREEN,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.497S,SUP,HCPCS C1713,,456.497S  -  NAIL INTRAMEDULLARY 135D 12MM 36CM CANN TITANIUM LEFT TROC,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.498S,SUP,HCPCS C1713,,456.498S  -  NAIL INTRAMEDULLARY 135D LONG 17-12MM 38CM CANN INTLCK GREEN,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.499S,SUP,HCPCS C1713,,456.499S  -  NAIL INTRAMEDULLARY 135D 12MM 38CM CANN TITANIUM LEFT TROC,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.500S,SUP,HCPCS C1713,,456.500S  -  NAIL INTRAMEDULLARY 135D LONG 17-12MM 40CM CANN INTLCK GREEN,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.501S,SUP,HCPCS C1713,,456.501S  -  NAIL INTRAMEDULLARY 135D LONG 12MM 40CM CANN GREEN TITANIUM,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.502S,SUP,HCPCS C1713,,456.502S  -  NAIL INTRAMEDULLARY 135D LONG 17-12MM 42CM CANN INTLCK GREEN,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.503S,SUP,HCPCS C1713,,456.503S  -  NAIL INTRAMEDULLARY 135D 12MM 42CM CANN TITANIUM LEFT TROC,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.504S,SUP,HCPCS C1713,,456.504S  -  NAIL INTRAMEDULLARY 135D LONG 17-12MM 44CM CANN INTLCK GREEN,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.505S,SUP,HCPCS C1713,,456.505S  -  NAIL INTRAMEDULLARY 135D LONG 12MM 44CM CANN GREEN TITANIUM,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.506S,SUP,HCPCS C1713,,456.506S  -  NAIL INTRAMEDULLARY 135D LONG 17-12MM 46CM CANN INTLCK GREEN,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.507S,SUP,HCPCS C1713,,456.507S  -  NAIL INTRAMEDULLARY 135D LONG 12MM 46CM CANN GREEN TITANIUM,"$3,360.75",$0.00,"$3,360.75","$1,512.34","$2,398.57",$0.00,$562.18,$0.00,$0.00,$588.44,"$3,360.75",$0.00,"$1,680.38","$2,661.71","$2,688.60",$0.00,$510.64,$0.00,$535.03,$0.00
456.510S,SUP,HCPCS C1713,,456.510S  -  NAIL FIX 125D SHORT 12MM 23.5CM CANN PREASSEMBLED LOCKING,"$2,553.50",$0.00,"$2,553.50","$1,149.08","$1,822.43",$0.00,$427.14,$0.00,$0.00,$447.10,"$2,553.50",$0.00,"$1,276.75","$2,022.37","$2,042.80",$0.00,$387.98,$0.00,$406.52,$0.00
456.511S,SUP,HCPCS C1713,,456.511S  -  NAIL FIX 130D SHORT 12MM 23.5CM CANN PREASSEMBLED LOCKING,"$2,553.50",$0.00,"$2,553.50","$1,149.08","$1,822.43",$0.00,$427.14,$0.00,$0.00,$447.10,"$2,553.50",$0.00,"$1,276.75","$2,022.37","$2,042.80",$0.00,$387.98,$0.00,$406.52,$0.00
456.512S,SUP,HCPCS C1713,,456.512S  -  NAIL FIX 135D SHORT 12MM 23.5CM CANN GREEN TITANIUM TROC,"$2,553.50",$0.00,"$2,553.50","$1,149.08","$1,822.43",$0.00,$427.14,$0.00,$0.00,$447.10,"$2,553.50",$0.00,"$1,276.75","$2,022.37","$2,042.80",$0.00,$387.98,$0.00,$406.52,$0.00
456.630S,SUP,HCPCS C1713,,456.630S  -  NAIL INTRAMEDULLARY 130D LONG 14MM 30CM CANN GREEN TITANIUM,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.631S,SUP,HCPCS C1713,,456.631S  -  NAIL INTRAMEDULLARY 130D LONG 14MM 30CM CANN GREEN TITANIUM,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.632S,SUP,HCPCS C1713,,456.632S  -  NAIL INTRAMEDULLARY 130D 14MM 32CM CANN GREEN TITANIUM RIGHT,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.633S,SUP,HCPCS C1713,,456.633S  -  NAIL INTRAMEDULLARY 130D 14MM 32CM CANN GREEN TITANIUM LEFT,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.634S,SUP,HCPCS C1713,,456.634S  -  NAIL INTRAMEDULLARY 130D 14MM 130MM CANN GREEN TITANIUM,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.635S,SUP,HCPCS C1713,,456.635S  -  NAIL INTRAMEDULLARY 130D LONG 14MM 34CM CANN GREEN TITANIUM,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.636S,SUP,HCPCS C1713,,456.636S  -  NAIL INTRAMEDULLARY 130D LONG 14MM 36CM CANN GREEN TITANIUM,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.637S,SUP,HCPCS C1713,,456.637S  -  NAIL INTRAMEDULLARY 130D 14MM 360MM CANN GREEN TITANIUM LEFT,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.638S,SUP,HCPCS C1713,,456.638S  -  NAIL INTRAMEDULLARY 130D LONG 14MM 38CM CANN GREEN TITANIUM,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.639S,SUP,HCPCS C1713,,456.639S  -  NAIL INTRAMEDULLARY 130D 14MM 380MM CANN GREEN TITANIUM LEFT,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.640S,SUP,HCPCS C1713,,456.640S  -  NAIL INTRAMEDULLARY 130D 14MM 40CM CANN GREEN TITANIUM RIGHT,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.641S,SUP,HCPCS C1713,,456.641S  -  NAIL INTRAMEDULLARY 130D 14MM 40CM CANN GREEN TITANIUM LEFT,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.642S,SUP,HCPCS C1713,,456.642S  -  NAIL INTRAMEDULLARY 130D 14MM 42CM CANN GREEN TITANIUM RIGHT,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.643S,SUP,HCPCS C1713,,456.643S  -  NAIL INTRAMEDULLARY 130D 14MM 42CM CANN GREEN TITANIUM LEFT,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.644S,SUP,HCPCS C1713,,456.644S  -  NAIL INTRAMEDULLARY 130D LONG 14MM 44CM CANN GREEN TITANIUM,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.645S,SUP,HCPCS C1713,,456.645S  -  NAIL INTRAMEDULLARY 130D 14MM 44CM CANN GREEN TITANIUM LEFT,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.646S,SUP,HCPCS C1713,,456.646S  -  NAIL INTRAMEDULLARY 130D LONG 14MM 46CM CANN GREEN TITANIUM,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.647S,SUP,HCPCS C1713,,456.647S  -  NAIL INTRAMEDULLARY 130D LONG 14MM 46CM CANN GREEN TITANIUM,"$3,580.28",$0.00,"$3,580.28","$1,611.12","$2,555.24",$0.00,$598.90,$0.00,$0.00,$626.88,"$3,580.28",$0.00,"$1,790.14","$2,835.58","$2,864.22",$0.00,$543.99,$0.00,$569.98,$0.00
456.650S,SUP,Custom 27803010,,456.650S  -  BLADE FIX 11MM 130MM HELICAL TITANIUM TROC STERILE,"$1,217.98",$0.00,"$1,217.98",$0.00,$869.27,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,217.98",$0.00,$608.99,$964.64,$974.38,$0.00,$0.00,$0.00,$0.00,$0.00
456.70S,SUP,Custom 27803010,,456.70S  -  BLADE FIX 70MM SPIRAL TITANIUM TROC STERILE INTRAMEDULLARY,"$1,326.88",$0.00,"$1,326.88",$0.00,$946.99,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,326.88",$0.00,$663.44,"$1,050.89","$1,061.50",$0.00,$0.00,$0.00,$0.00,$0.00
456.75S,SUP,Custom 27803010,,456.75S  -  BLADE INTRAMEDULLARY FIX 75MM SPIRAL TITANIUM FEMUR STERILE,"$1,326.88",$0.00,"$1,326.88",$0.00,$946.99,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,326.88",$0.00,$663.44,"$1,050.89","$1,061.50",$0.00,$0.00,$0.00,$0.00,$0.00
456.80S,SUP,Custom 27803010,,456.80S  -  BLADE INTRAMEDULLARY FIX 80MM SPIRAL TITANIUM FEMUR STERILE,"$1,326.88",$0.00,"$1,326.88",$0.00,$946.99,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,326.88",$0.00,$663.44,"$1,050.89","$1,061.50",$0.00,$0.00,$0.00,$0.00,$0.00
456.85S,SUP,Custom 27803010,,456.85S  -  BLADE INTRAMEDULLARY FIX 85MM SPIRAL TITANIUM FEMUR STERILE,"$1,326.88",$0.00,"$1,326.88",$0.00,$946.99,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,326.88",$0.00,$663.44,"$1,050.89","$1,061.50",$0.00,$0.00,$0.00,$0.00,$0.00
456.90S,SUP,Custom 27803010,,456.90S  -  BLADE INTRAMEDULLARY FIX 90MM SPIRAL TITANIUM FEMUR STERILE,"$1,326.88",$0.00,"$1,326.88",$0.00,$946.99,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,326.88",$0.00,$663.44,"$1,050.89","$1,061.50",$0.00,$0.00,$0.00,$0.00,$0.00
456.95S,SUP,Custom 27803010,,456.95S  -  BLADE INTRAMEDULLARY FIX 95MM SPIRAL TITANIUM FEMUR STERILE,"$1,326.88",$0.00,"$1,326.88",$0.00,$946.99,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,326.88",$0.00,$663.44,"$1,050.89","$1,061.50",$0.00,$0.00,$0.00,$0.00,$0.00
45-600,SUP,HCPCS C1769,,45-600  -  CATH CEN VEN 5FR 50CM 1 LUM GWIRE VXCL PU .035IN,$507.50,$0.00,$507.50,$275.57,$362.20,$0.00,$87.44,$0.00,$0.00,$88.86,$507.50,$0.00,$253.75,$401.94,$406.00,$0.00,$79.42,$0.00,$80.79,$0.00
457.010S,SUP,Custom 27803010,,457.010S  -  CAP END 0MM 15MM FEM XTD IM NAIL SPRL BLDE TI STRL LBLU,$542.30,$0.00,$542.30,$0.00,$387.04,$0.00,$0.00,$0.00,$0.00,$0.00,$542.30,$0.00,$271.15,$429.50,$433.84,$0.00,$0.00,$0.00,$0.00,$0.00
457.011S,SUP,Custom 27803010,,457.011S  -  CAP END 10MM EXTEND LIGHT BLUE TITANIUM FEMUR STERILE SPIRAL,$470.25,$0.00,$470.25,$0.00,$335.62,$0.00,$0.00,$0.00,$0.00,$0.00,$470.25,$0.00,$235.13,$372.44,$376.20,$0.00,$0.00,$0.00,$0.00,$0.00
457.012S,SUP,Custom 27803010,,457.012S  -  CAP END 20MM 15MM EXTEND LIGHT BLUE TITANIUM FEMUR STERILE,$470.25,$0.00,$470.25,$0.00,$335.62,$0.00,$0.00,$0.00,$0.00,$0.00,$470.25,$0.00,$235.13,$372.44,$376.20,$0.00,$0.00,$0.00,$0.00,$0.00
457.210S,SUP,Custom 27803010,,457.210S  -  CAP END 0MM FEM XTD LCK IM NAIL TI STRL PNK 15MM,$513.53,$0.00,$513.53,$0.00,$366.50,$0.00,$0.00,$0.00,$0.00,$0.00,$513.53,$0.00,$256.76,$406.72,$410.82,$0.00,$0.00,$0.00,$0.00,$0.00
457.211S,SUP,Custom 27803010,,457.211S  -  CAP END 130D 10MM 15MM LOCK PINK TITANIUM FEMUR STERILE,$446.88,$0.00,$446.88,$0.00,$318.93,$0.00,$0.00,$0.00,$0.00,$0.00,$446.88,$0.00,$223.44,$353.93,$357.50,$0.00,$0.00,$0.00,$0.00,$0.00
457.212S,SUP,Custom 27803010,,457.212S  -  CAP END 130D 20MM 15MM LOCK PINK TITANIUM FEMUR STERILE,$446.88,$0.00,$446.88,$0.00,$318.93,$0.00,$0.00,$0.00,$0.00,$0.00,$446.88,$0.00,$223.44,$353.93,$357.50,$0.00,$0.00,$0.00,$0.00,$0.00
458.10S,SUP,Custom 27803010,,458.10S  -  CAP END 6MM 15MM EXTEND BLUE TITANIUM TIBIA STERILE SOLID,$331.38,$0.00,$331.38,$0.00,$236.50,$0.00,$0.00,$0.00,$0.00,$0.00,$331.38,$0.00,$165.69,$262.45,$265.10,$0.00,$0.00,$0.00,$0.00,$0.00
458.110S,SUP,Custom 27803010,,458.110S  -  CAP END 15MM 15MM EXTN BLUE TITANIUM TIBIA STERILE SOLID,$541.75,$0.00,$541.75,$0.00,$386.65,$0.00,$0.00,$0.00,$0.00,$0.00,$541.75,$0.00,$270.88,$429.07,$433.40,$0.00,$0.00,$0.00,$0.00,$0.00
458.120S,SUP,Custom 27803010,,458.120S  -  CAP END 8MM 15MM TIB XTD HEX DRV CANN IM NAIL TI STRL GRN 8,$307.65,$0.00,$307.65,$0.00,$219.57,$0.00,$0.00,$0.00,$0.00,$0.00,$307.65,$0.00,$153.83,$243.66,$246.12,$0.00,$0.00,$0.00,$0.00,$0.00
458.926S,SUP,HCPCS C1713,,458.926S  -  SCREW BN 3.5MM FT 5MM 8MM 26MM GRN STRL ST LCK 2 LD HEX TI,$431.95,$0.00,$431.95,$194.38,$308.28,$0.00,$72.26,$0.00,$0.00,$75.63,$431.95,$0.00,$215.98,$342.10,$345.56,$0.00,$65.63,$0.00,$68.77,$0.00
458.928S,SUP,HCPCS C1713,,458.928S  -  SCREW BN 3.5MM FT 5MM 8MM 28MM GRN STRL ST LCK 2 LD HEX TI,$431.95,$0.00,$431.95,$194.38,$308.28,$0.00,$72.26,$0.00,$0.00,$75.63,$431.95,$0.00,$215.98,$342.10,$345.56,$0.00,$65.63,$0.00,$68.77,$0.00
458.930S,SUP,HCPCS C1713,,458.930S  -  SCREW BN 3.5MM FT 5MM 8MM 30MM GRN STRL ST LCK 2 LD HEX TI,$431.95,$0.00,$431.95,$194.38,$308.28,$0.00,$72.26,$0.00,$0.00,$75.63,$431.95,$0.00,$215.98,$342.10,$345.56,$0.00,$65.63,$0.00,$68.77,$0.00
458.932S,SUP,HCPCS C1713,,458.932S  -  SCREW BN 3.5MM FT 5MM 8MM 32MM GRN STRL ST LCK 2 LD HEX TI,$431.95,$0.00,$431.95,$194.38,$308.28,$0.00,$72.26,$0.00,$0.00,$75.63,$431.95,$0.00,$215.98,$342.10,$345.56,$0.00,$65.63,$0.00,$68.77,$0.00
458.934S,SUP,HCPCS C1713,,458.934S  -  SCREW BN 3.5MM FT 5MM 8MM 34MM GRN STRL ST LCK 2 LD HEX TI,$431.95,$0.00,$431.95,$194.38,$308.28,$0.00,$72.26,$0.00,$0.00,$75.63,$431.95,$0.00,$215.98,$342.10,$345.56,$0.00,$65.63,$0.00,$68.77,$0.00
458.936S,SUP,HCPCS C1713,,458.936S  -  SCREW BN 3.5MM FT 5MM 8MM 36MM GRN STRL ST LCK 2 LD HEX TI,$431.95,$0.00,$431.95,$194.38,$308.28,$0.00,$72.26,$0.00,$0.00,$75.63,$431.95,$0.00,$215.98,$342.10,$345.56,$0.00,$65.63,$0.00,$68.77,$0.00
458.938S,SUP,HCPCS C1713,,458.938S  -  SCREW BN 3.5MM FT 5MM 8MM 38MM GRN STRL ST LCK 2 LD HEX TI,$431.95,$0.00,$431.95,$194.38,$308.28,$0.00,$72.26,$0.00,$0.00,$75.63,$431.95,$0.00,$215.98,$342.10,$345.56,$0.00,$65.63,$0.00,$68.77,$0.00
458.940S,SUP,HCPCS C1713,,458.940S  -  SCREW BN 3.5MM FT 5MM 8MM 40MM GRN STRL ST LCK 2 LD HEX TI,$431.95,$0.00,$431.95,$194.38,$308.28,$0.00,$72.26,$0.00,$0.00,$75.63,$431.95,$0.00,$215.98,$342.10,$345.56,$0.00,$65.63,$0.00,$68.77,$0.00
458.942S,SUP,HCPCS C1713,,458.942S  -  SCREW BN 3.5MM FT 5MM 8MM 42MM GRN STRL ST LCK 2 LD HEX TI,$431.95,$0.00,$431.95,$194.38,$308.28,$0.00,$72.26,$0.00,$0.00,$75.63,$431.95,$0.00,$215.98,$342.10,$345.56,$0.00,$65.63,$0.00,$68.77,$0.00
458.944S,SUP,HCPCS C1713,,458.944S  -  SCREW BN 3.5MM FT 5MM 8MM 44MM GRN STRL ST LCK 2 LD HEX TI,$431.95,$0.00,$431.95,$194.38,$308.28,$0.00,$72.26,$0.00,$0.00,$75.63,$431.95,$0.00,$215.98,$342.10,$345.56,$0.00,$65.63,$0.00,$68.77,$0.00
458.946S,SUP,HCPCS C1713,,458.946S  -  SCREW BN 3.5MM FT 5MM 8MM 46MM GRN STRL ST LCK 2 LD HEX TI,$431.95,$0.00,$431.95,$194.38,$308.28,$0.00,$72.26,$0.00,$0.00,$75.63,$431.95,$0.00,$215.98,$342.10,$345.56,$0.00,$65.63,$0.00,$68.77,$0.00
458.948S,SUP,HCPCS C1713,,458.948S  -  SCREW BN 3.5MM FT 5MM 8MM 48MM GRN STRL ST LCK 2 LD HEX TI,$431.95,$0.00,$431.95,$194.38,$308.28,$0.00,$72.26,$0.00,$0.00,$75.63,$431.95,$0.00,$215.98,$342.10,$345.56,$0.00,$65.63,$0.00,$68.77,$0.00
458.950S,SUP,HCPCS C1713,,458.950S  -  SCREW BN 3.5MM FT 5MM 8MM 50MM GRN STRL ST LCK 2 LD HEX TI,$431.95,$0.00,$431.95,$194.38,$308.28,$0.00,$72.26,$0.00,$0.00,$75.63,$431.95,$0.00,$215.98,$342.10,$345.56,$0.00,$65.63,$0.00,$68.77,$0.00
458.952S,SUP,HCPCS C1713,,458.952S  -  SCREW BN 3.5MM FT 5MM 8MM 52MM GRN STRL ST LCK 2 LD HEX TI,$431.95,$0.00,$431.95,$194.38,$308.28,$0.00,$72.26,$0.00,$0.00,$75.63,$431.95,$0.00,$215.98,$342.10,$345.56,$0.00,$65.63,$0.00,$68.77,$0.00
458.954S,SUP,HCPCS C1713,,458.954S  -  SCREW BN 3.5MM FT 5MM 8MM 54MM GRN STRL ST LCK 2 LD HEX TI,$431.95,$0.00,$431.95,$194.38,$308.28,$0.00,$72.26,$0.00,$0.00,$75.63,$431.95,$0.00,$215.98,$342.10,$345.56,$0.00,$65.63,$0.00,$68.77,$0.00
458.956S,SUP,HCPCS C1713,,458.956S  -  SCREW BN 3.5MM FT 5MM 8MM 56MM GRN STRL ST LCK 2 LD HEX TI,$431.95,$0.00,$431.95,$194.38,$308.28,$0.00,$72.26,$0.00,$0.00,$75.63,$431.95,$0.00,$215.98,$342.10,$345.56,$0.00,$65.63,$0.00,$68.77,$0.00
458.958S,SUP,HCPCS C1713,,458.958S  -  SCREW BN 3.5MM FT 5MM 8MM 58MM GRN STRL ST LCK 2 LD HEX TI,$431.95,$0.00,$431.95,$194.38,$308.28,$0.00,$72.26,$0.00,$0.00,$75.63,$431.95,$0.00,$215.98,$342.10,$345.56,$0.00,$65.63,$0.00,$68.77,$0.00
458.960S,SUP,HCPCS C1713,,458.960S  -  SCREW BN 3.5MM FT 5MM 8MM 60MM GRN STRL ST LCK 2 LD HEX TI,$431.95,$0.00,$431.95,$194.38,$308.28,$0.00,$72.26,$0.00,$0.00,$75.63,$431.95,$0.00,$215.98,$342.10,$345.56,$0.00,$65.63,$0.00,$68.77,$0.00
458.964S,SUP,HCPCS C1713,,458.964S  -  SCREW BN 3.5MM FT 5MM 8MM 64MM GRN STRL ST LCK 2 LD HEX TI,$431.95,$0.00,$431.95,$194.38,$308.28,$0.00,$72.26,$0.00,$0.00,$75.63,$431.95,$0.00,$215.98,$342.10,$345.56,$0.00,$65.63,$0.00,$68.77,$0.00
458.968S,SUP,HCPCS C1713,,458.968S  -  SCREW BN 3.5MM FT 5MM 8MM 68MM GRN STRL ST LCK 2 LD HEX TI,$431.95,$0.00,$431.95,$194.38,$308.28,$0.00,$72.26,$0.00,$0.00,$75.63,$431.95,$0.00,$215.98,$342.10,$345.56,$0.00,$65.63,$0.00,$68.77,$0.00
458.972S,SUP,HCPCS C1713,,458.972S  -  SCREW BN 3.5MM FT 5MM 8MM 72MM GRN STRL ST LCK 2 LD HEX TI,$431.95,$0.00,$431.95,$194.38,$308.28,$0.00,$72.26,$0.00,$0.00,$75.63,$431.95,$0.00,$215.98,$342.10,$345.56,$0.00,$65.63,$0.00,$68.77,$0.00
458.976S,SUP,HCPCS C1713,,458.976S  -  SCREW BN 3.5MM FT 5MM 8MM 76MM GRN STRL ST LCK 2 LD HEX TI,$431.95,$0.00,$431.95,$194.38,$308.28,$0.00,$72.26,$0.00,$0.00,$75.63,$431.95,$0.00,$215.98,$342.10,$345.56,$0.00,$65.63,$0.00,$68.77,$0.00
458.980S,SUP,HCPCS C1713,,458.980S  -  SCREW BN 3.5MM FT 5MM 8MM 80MM GRN STRL ST LCK 2 LD HEX TI,$431.95,$0.00,$431.95,$194.38,$308.28,$0.00,$72.26,$0.00,$0.00,$75.63,$431.95,$0.00,$215.98,$342.10,$345.56,$0.00,$65.63,$0.00,$68.77,$0.00
458.985S,SUP,HCPCS C1713,,458.985S  -  SCREW BN 3.5MM FT 5MM 8MM 85MM GRN STRL ST LCK 2 LD HEX TI,$431.95,$0.00,$431.95,$194.38,$308.28,$0.00,$72.26,$0.00,$0.00,$75.63,$431.95,$0.00,$215.98,$342.10,$345.56,$0.00,$65.63,$0.00,$68.77,$0.00
458.990S,SUP,HCPCS C1713,,458.990S  -  SCREW BN 3.5MM FT 5MM 8MM 90MM GRN STRL ST LCK 2 LD HEX TI,$431.95,$0.00,$431.95,$194.38,$308.28,$0.00,$72.26,$0.00,$0.00,$75.63,$431.95,$0.00,$215.98,$342.10,$345.56,$0.00,$65.63,$0.00,$68.77,$0.00
458.995S,SUP,HCPCS C1713,,458.995S  -  SCREW BN 3.5MM FT 5MM 8MM 95MM GRN STRL ST LCK 2 LD HEX TI,$431.95,$0.00,$431.95,$194.38,$308.28,$0.00,$72.26,$0.00,$0.00,$75.63,$431.95,$0.00,$215.98,$342.10,$345.56,$0.00,$65.63,$0.00,$68.77,$0.00
458.999S,SUP,HCPCS C1713,,458.999S  -  SCREW BN 5MM 100MM GRN STRL NLEX LCK HEX RCS TI FEM TIB,$431.95,$0.00,$431.95,$194.38,$308.28,$0.00,$72.26,$0.00,$0.00,$75.63,$431.95,$0.00,$215.98,$342.10,$345.56,$0.00,$65.63,$0.00,$68.77,$0.00
45-80001,SUP,Custom 27203010,,45-80001  -  GUIDE DRILL CIRC LCK HOLE,$851.13,$0.00,$851.13,$0.00,$607.45,$0.00,$0.00,$0.00,$0.00,$0.00,$851.13,$0.00,$425.56,$674.09,$680.90,$0.00,$0.00,$0.00,$0.00,$0.00
45-80005,SUP,Custom 27203010,,45-80005  -  GUIDE DRILL OVL CMPR HOLE,$955.63,$0.00,$955.63,$0.00,$682.03,$0.00,$0.00,$0.00,$0.00,$0.00,$955.63,$0.00,$477.81,$756.86,$764.50,$0.00,$0.00,$0.00,$0.00,$0.00
45-80010,SUP,HCPCS C1713,,45-80010  -  PLATE BNDRG PLR BONE,$907.50,$0.00,$907.50,$408.38,$647.68,$0.00,$156.36,$0.00,$0.00,$158.90,$907.50,$0.00,$453.75,$718.74,$726.00,$0.00,$142.02,$0.00,$144.47,$0.00
45-80100,SUP,HCPCS C1713,,45-80100  -  WIRE FX FT 1.6MM 200MM NS KRSH VARIAX FT LCK PLT SYS,$42.63,$0.00,$42.63,$19.18,$30.42,$0.00,$7.34,$0.00,$0.00,$7.46,$42.63,$0.00,$21.31,$33.76,$34.10,$0.00,$6.67,$0.00,$6.79,$0.00
45-80200,SUP,HCPCS C1713,,45-80200  -  WIRE FX 1.4MM 100MM NS KRSH SMTH VARIAX FT LCK PLT SYS,$27.50,$0.00,$27.50,$12.38,$19.63,$0.00,$4.74,$0.00,$0.00,$4.82,$27.50,$0.00,$13.75,$21.78,$22.00,$0.00,$4.30,$0.00,$4.38,$0.00
45-80300,SUP,Custom 27203010,,45-80300  -  PIN FIX 100MM 2.5MM STNM SS SMTH NONSTRL,$52.25,$0.00,$52.25,$0.00,$37.29,$0.00,$0.00,$0.00,$0.00,$0.00,$52.25,$0.00,$26.13,$41.38,$41.80,$0.00,$0.00,$0.00,$0.00,$0.00
459.012S,SUP,Custom 27803010,,459.012S  -  CAP END 0MM XTD 9-12MM IM NAIL STD LCK TI STRL GRN 12MM,$494.33,$0.00,$494.33,$0.00,$352.80,$0.00,$0.00,$0.00,$0.00,$0.00,$494.33,$0.00,$247.16,$391.51,$395.46,$0.00,$0.00,$0.00,$0.00,$0.00
459.013S,SUP,Custom 27803010,,459.013S  -  CAP END 10MM 12MM 12MM EXTENDED STANDARD LOCKING GREEN,$433.13,$0.00,$433.13,$0.00,$309.12,$0.00,$0.00,$0.00,$0.00,$0.00,$433.13,$0.00,$216.56,$343.04,$346.50,$0.00,$0.00,$0.00,$0.00,$0.00
459.014S,SUP,Custom 27803010,,459.014S  -  CAP END 20MM 12MM 12MM EXTENDED STANDARD LOCKING GREEN,$433.13,$0.00,$433.13,$0.00,$309.12,$0.00,$0.00,$0.00,$0.00,$0.00,$433.13,$0.00,$216.56,$343.04,$346.50,$0.00,$0.00,$0.00,$0.00,$0.00
460.001.01S,SUP,Custom 27803010,,460.001.01S  -  CLAMP TUBE 13MM CRANIAL FLP TI STRL,$940.50,$0.00,$940.50,$0.00,$671.23,$0.00,$0.00,$0.00,$0.00,$0.00,$940.50,$0.00,$470.25,$744.88,$752.40,$0.00,$0.00,$0.00,$0.00,$0.00
460.002.01S,SUP,Custom 27803010,,460.002.01S  -  CLAMP TUBE 18MM CRANIAL FLP TI STRL,$974.25,$0.00,$974.25,$0.00,$695.32,$0.00,$0.00,$0.00,$0.00,$0.00,$974.25,$0.00,$487.13,$771.61,$779.40,$0.00,$0.00,$0.00,$0.00,$0.00
460.003.01S,SUP,Custom 27803010,,460.003.01S  -  CLAMP TUBE 22MM CRANIAL FLP TI STRL,"$1,010.25",$0.00,"$1,010.25",$0.00,$721.02,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,010.25",$0.00,$505.13,$800.12,$808.20,$0.00,$0.00,$0.00,$0.00,$0.00
460.008.01S,SUP,Custom 27803010,,460.008.01S  -  CLAMP TUBE 13MM CRANIAL FLP TI TXTR STRL,$974.25,$0.00,$974.25,$0.00,$695.32,$0.00,$0.00,$0.00,$0.00,$0.00,$974.25,$0.00,$487.13,$771.61,$779.40,$0.00,$0.00,$0.00,$0.00,$0.00
460.009.01S,SUP,Custom 27803010,,460.009.01S  -  CLAMP TUBE 18MM CRANIAL FLP TI TXTR STRL,"$1,010.25",$0.00,"$1,010.25",$0.00,$721.02,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,010.25",$0.00,$505.13,$800.12,$808.20,$0.00,$0.00,$0.00,$0.00,$0.00
460.010.01S,SUP,Custom 27803010,,460.010.01S  -  CLAMP TUBE 22MM CRANIAL FLP TI TXTR STRL,"$1,050.75",$0.00,"$1,050.75",$0.00,$749.92,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,050.75",$0.00,$525.38,$832.19,$840.60,$0.00,$0.00,$0.00,$0.00,$0.00
460.022.05S,SUP,HCPCS C1713,,460.022.05S  -  PIN ER RELS STRNL TI STRL,$218.00,$0.00,$218.00,$98.10,$155.59,$0.00,$37.56,$0.00,$0.00,$38.17,$218.00,$0.00,$109.00,$172.66,$174.40,$0.00,$34.12,$0.00,$34.71,$0.00
460.100.01S,SUP,Custom 27803010,,460.100.01S  -  TI CRANIAL FLAP TUBE CLAMP 11MM DIA-STERILE,$893.25,$0.00,$893.25,$0.00,$637.51,$0.00,$0.00,$0.00,$0.00,$0.00,$893.25,$0.00,$446.63,$707.45,$714.60,$0.00,$0.00,$0.00,$0.00,$0.00
460.107.01S,SUP,Custom 27803010,,460.107.01S  -  TI CRANIAL FLAP TUBE CLAMP TEXTURED 11MM DIA-STERILE,$924.75,$0.00,$924.75,$0.00,$659.99,$0.00,$0.00,$0.00,$0.00,$0.00,$924.75,$0.00,$462.38,$732.40,$739.80,$0.00,$0.00,$0.00,$0.00,$0.00
46-1001T,SUP,Custom 27203010,,46-1001T  -  TEMPLATE SZ LG ANG PLT,$232.50,$0.00,$232.50,$0.00,$165.94,$0.00,$0.00,$0.00,$0.00,$0.00,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$0.00,$0.00,$0.00,$0.00
46-1002T,SUP,Custom 27203010,,46-1002T  -  TEMPLATE SZ 2 ANG LCK PLT,$232.50,$0.00,$232.50,$0.00,$165.94,$0.00,$0.00,$0.00,$0.00,$0.00,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$0.00,$0.00,$0.00,$0.00
46-1003T,SUP,Custom 27203010,,46-1003T  -  TEMPLATE SZ ANG LCK PLT,$232.50,$0.00,$232.50,$0.00,$165.94,$0.00,$0.00,$0.00,$0.00,$0.00,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$0.00,$0.00,$0.00,$0.00
46-1004,SUP,Custom 27203010,,46-1004  -  DRILL TWIST 1.8MM MICRO 26MM 115MM STOP,$632.50,$0.00,$632.50,$0.00,$451.42,$0.00,$0.00,$0.00,$0.00,$0.00,$632.50,$0.00,$316.25,$500.94,$506.00,$0.00,$0.00,$0.00,$0.00,$0.00
46-1006,SUP,Custom 27203010,,46-1006  -  BIT DRL 1.6MM 50MM 22MM TWST STP LORENZ TRAUMAONE,$632.50,$0.00,$632.50,$0.00,$451.42,$0.00,$0.00,$0.00,$0.00,$0.00,$632.50,$0.00,$316.25,$500.94,$506.00,$0.00,$0.00,$0.00,$0.00,$0.00
46-1007,SUP,Custom 27203010,,46-1007  -  DRILL SURG 1.6MM 115MM 26MM STOP TRAUMAONE MANDIB,$632.50,$0.00,$632.50,$0.00,$451.42,$0.00,$0.00,$0.00,$0.00,$0.00,$632.50,$0.00,$316.25,$500.94,$506.00,$0.00,$0.00,$0.00,$0.00,$0.00
46-1024T,SUP,Custom 27203010,,46-1024T  -  TEMPLATE SZ STRG 24 HL PLT,$232.50,$0.00,$232.50,$0.00,$165.94,$0.00,$0.00,$0.00,$0.00,$0.00,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$0.00,$0.00,$0.00,$0.00
46-123,SUP,Custom 27203010,,46-123  -  DRESSING WOUND LARGE ABSORBENT VEST NONADHERENT MULTILAYER,$26.60,$0.00,$26.60,$0.00,$18.98,$0.00,$0.00,$0.00,$0.00,$0.00,$26.60,$0.00,$13.30,$21.07,$21.28,$0.00,$0.00,$0.00,$0.00,$0.00
46-130,SUP,Custom 27203010,,46-130  -  DRESSING HYDROCOLLOID XL ABSORBENT LATEX FREE SOFSORB,$50.24,$0.00,$50.24,$0.00,$35.86,$0.00,$0.00,$0.00,$0.00,$0.00,$50.24,$0.00,$25.12,$39.79,$40.20,$0.00,$0.00,$0.00,$0.00,$0.00
46-133,SUP,Custom 27203010,,46-133  -  DRESSING BURN ABSORBENT HIP LEG,$63.89,$0.00,$63.89,$0.00,$45.60,$0.00,$0.00,$0.00,$0.00,$0.00,$63.89,$0.00,$31.94,$50.60,$51.11,$0.00,$0.00,$0.00,$0.00,$0.00
46-138,SUP,Custom 27203010,,DRESSING BURN 17 PLY GZE 36X36IN,$56.63,$0.00,$56.63,$0.00,$40.41,$0.00,$0.00,$0.00,$0.00,$0.00,$56.63,$0.00,$28.31,$44.85,$45.30,$0.00,$0.00,$0.00,$0.00,$0.00
46-152,SUP,Custom 27203010,,46-152  -  DRESSING WOUND XL ABSORBENT VEST HIGH PERFORMANCE,$28.44,$0.00,$28.44,$0.00,$20.30,$0.00,$0.00,$0.00,$0.00,$0.00,$28.44,$0.00,$14.22,$22.52,$22.75,$0.00,$0.00,$0.00,$0.00,$0.00
46-155,SUP,Custom 27203010,,46-155  -  DRESSING WND STRL LF SFSRB ABS STDR LINR ADLT HIP LG,$31.02,$0.00,$31.02,$0.00,$22.14,$0.00,$0.00,$0.00,$0.00,$0.00,$31.02,$0.00,$15.51,$24.57,$24.81,$0.00,$0.00,$0.00,$0.00,$0.00
462.634S,SUP,Custom 27803010,,462.634S  -  BLADE FIX 34MM SPIRAL SOLID TITANIUM HUMERUS STERILE,"$1,191.08",$0.00,"$1,191.08",$0.00,$850.07,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,191.08",$0.00,$595.54,$943.34,$952.86,$0.00,$0.00,$0.00,$0.00,$0.00
462.636S,SUP,Custom 27803010,,462.636S  -  BLADE INTRAMEDULLARY FIX 13MM 36MMX3.9MM SPIRAL CUTTING,"$1,191.08",$0.00,"$1,191.08",$0.00,$850.07,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,191.08",$0.00,$595.54,$943.34,$952.86,$0.00,$0.00,$0.00,$0.00,$0.00
462.638S,SUP,Custom 27803010,,462.638S  -  BLADE FIX 38MM SPIRAL SOLID TITANIUM HUMERUS STERILE,"$1,191.08",$0.00,"$1,191.08",$0.00,$850.07,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,191.08",$0.00,$595.54,$943.34,$952.86,$0.00,$0.00,$0.00,$0.00,$0.00
462.640S,SUP,HCPCS C1713,,462.640S  -  NAIL INTRAMEDULLARY 40MM SPIRAL BLADE TITANIUM STERILE,"$1,191.08",$0.00,"$1,191.08",$535.98,$850.07,$0.00,$199.24,$0.00,$0.00,$208.55,"$1,191.08",$0.00,$595.54,$943.34,$952.86,$0.00,$180.97,$0.00,$189.62,$0.00
462.642S,SUP,HCPCS C1713,,462.642S  -  BLADE INTRAMEDULLARY FIX 13MM 42MMX3.9MM SPIRAL CUTTING,"$1,191.08",$0.00,"$1,191.08",$535.98,$850.07,$0.00,$199.24,$0.00,$0.00,$208.55,"$1,191.08",$0.00,$595.54,$943.34,$952.86,$0.00,$180.97,$0.00,$189.62,$0.00
462.644S,SUP,HCPCS C1713,,462.644S  -  BLADE INTRAMEDULLARY FIX 44MM SPIRAL GOLD TITANIUM ALUMINUM,"$1,191.08",$0.00,"$1,191.08",$535.98,$850.07,$0.00,$199.24,$0.00,$0.00,$208.55,"$1,191.08",$0.00,$595.54,$943.34,$952.86,$0.00,$180.97,$0.00,$189.62,$0.00
462.646S,SUP,HCPCS C1713,,462.646S  -  BLADE INTRAMEDULLARY FIX 13MM 46MMX3.9MM SPIRAL CUTTING,"$1,191.08",$0.00,"$1,191.08",$535.98,$850.07,$0.00,$199.24,$0.00,$0.00,$208.55,"$1,191.08",$0.00,$595.54,$943.34,$952.86,$0.00,$180.97,$0.00,$189.62,$0.00
462.648S,SUP,HCPCS C1713,,462.648S  -  BLADE INTRAMEDULLARY FIX 48MM SPIRAL NAIL-EX TITANIUM,"$1,191.08",$0.00,"$1,191.08",$535.98,$850.07,$0.00,$199.24,$0.00,$0.00,$208.55,"$1,191.08",$0.00,$595.54,$943.34,$952.86,$0.00,$180.97,$0.00,$189.62,$0.00
462.650S,SUP,HCPCS C1713,,462.650S  -  BLADE INTRAMEDULLARY FIX 50MM SPIRAL GOLD TITANIUM ALUMINUM,"$1,191.08",$0.00,"$1,191.08",$535.98,$850.07,$0.00,$199.24,$0.00,$0.00,$208.55,"$1,191.08",$0.00,$595.54,$943.34,$952.86,$0.00,$180.97,$0.00,$189.62,$0.00
462.652S,SUP,HCPCS C1713,,462.652S  -  BLADE FIX 52MM CANN SPIRAL SOLID GOLD TITANIUM HUMERUS,"$1,191.08",$0.00,"$1,191.08",$535.98,$850.07,$0.00,$199.24,$0.00,$0.00,$208.55,"$1,191.08",$0.00,$595.54,$943.34,$952.86,$0.00,$180.97,$0.00,$189.62,$0.00
462.654S,SUP,HCPCS C1713,,462.654S  -  BLADE FIX 54MM CANN SPIRAL NAIL-EX TITANIUM HUMERUS STERILE,"$1,191.08",$0.00,"$1,191.08",$535.98,$850.07,$0.00,$199.24,$0.00,$0.00,$208.55,"$1,191.08",$0.00,$595.54,$943.34,$952.86,$0.00,$180.97,$0.00,$189.62,$0.00
462.660S,SUP,HCPCS C1713,,462.660S  -  CAP END 0MM T25 STARDRIVE RECESS GOLD TITANIUM HUMERUS,$433.13,$0.00,$433.13,$194.91,$309.12,$0.00,$74.63,$0.00,$0.00,$75.84,$433.13,$0.00,$216.56,$343.04,$346.50,$0.00,$67.78,$0.00,$68.95,$0.00
462.665S,SUP,HCPCS C1713,,462.665S  -  CAP END 5MM HUM XTD IM NAIL SPRL BLDE TI STRL,$494.33,$0.00,$494.33,$222.45,$352.80,$0.00,$85.17,$0.00,$0.00,$86.55,$494.33,$0.00,$247.16,$391.51,$395.46,$0.00,$77.36,$0.00,$78.70,$0.00
462.666S,SUP,HCPCS C1713,,462.666S  -  CAP END 10MM 3.5MM HEXAGONAL RECESS GOLD TITANIUM HUMERUS,$433.13,$0.00,$433.13,$194.91,$309.12,$0.00,$74.63,$0.00,$0.00,$75.84,$433.13,$0.00,$216.56,$343.04,$346.50,$0.00,$67.78,$0.00,$68.95,$0.00
462.667S,SUP,HCPCS C1713,,462.667S  -  CAP END 15MM 3.5MM HEXAGONAL RECESS GOLD TITANIUM HUMERUS,$433.13,$0.00,$433.13,$194.91,$309.12,$0.00,$74.63,$0.00,$0.00,$75.84,$433.13,$0.00,$216.56,$343.04,$346.50,$0.00,$67.78,$0.00,$68.95,$0.00
462.719S,SUP,HCPCS C1713,,462.719S  -  NAIL INTRAMEDULLARY UNIVERSAL 7.5MM 19CM SOLID ROUND CROSS,"$3,261.50",$0.00,"$3,261.50","$1,467.68","$2,327.73",$0.00,$561.94,$0.00,$0.00,$571.06,"$3,261.50",$0.00,"$1,630.75","$2,583.11","$2,609.20",$0.00,$510.42,$0.00,$519.23,$0.00
462.723S,SUP,HCPCS C1713,,462.723S  -  NAIL 7.5MM 23CM HUM IM SLD TI STRL,"$3,802.15",$0.00,"$3,802.15","$1,710.97","$2,713.59",$0.00,$655.09,$0.00,$0.00,$665.73,"$3,802.15",$0.00,"$1,901.08","$3,011.30","$3,041.72",$0.00,$595.04,$0.00,$605.30,$0.00
462.728S,SUP,HCPCS C1713,,462.728S  -  NAIL INTRAMEDULLARY 7.5MM 280MM SOLID ROUND CROSS SECTION,"$3,261.50",$0.00,"$3,261.50","$1,467.68","$2,327.73",$0.00,$561.94,$0.00,$0.00,$571.06,"$3,261.50",$0.00,"$1,630.75","$2,583.11","$2,609.20",$0.00,$510.42,$0.00,$519.23,$0.00
462.729S,SUP,HCPCS C1713,,462.729S  -  NAIL INTRAMEDULLARY 7.5MM 29.5CM SOLID BLUE TITANIUM HUMERUS,"$3,261.50",$0.00,"$3,261.50","$1,467.68","$2,327.73",$0.00,$561.94,$0.00,$0.00,$571.06,"$3,261.50",$0.00,"$1,630.75","$2,583.11","$2,609.20",$0.00,$510.42,$0.00,$519.23,$0.00
462.731S,SUP,HCPCS C1713,,462.731S  -  NAIL INTRAMEDULLARY 7.5MM 31CM SOLID TITANIUM HUMERUS,"$3,261.50",$0.00,"$3,261.50","$1,467.68","$2,327.73",$0.00,$561.94,$0.00,$0.00,$571.06,"$3,261.50",$0.00,"$1,630.75","$2,583.11","$2,609.20",$0.00,$510.42,$0.00,$519.23,$0.00
462.732S,SUP,HCPCS C1713,,462.732S  -  NAIL INTRAMEDULLARY 7.5MM 32.5CM SOLID TITANIUM HUMERUS,"$3,261.50",$0.00,"$3,261.50","$1,467.68","$2,327.73",$0.00,$561.94,$0.00,$0.00,$571.06,"$3,261.50",$0.00,"$1,630.75","$2,583.11","$2,609.20",$0.00,$510.42,$0.00,$519.23,$0.00
462.919S,SUP,HCPCS C1713,,462.919S  -  NAIL INTRAMEDULLARY UNIVERSAL 9.5MM 19CM SOLID FLUTED CROSS,"$3,261.50",$0.00,"$3,261.50","$1,467.68","$2,327.73",$0.00,$561.94,$0.00,$0.00,$571.06,"$3,261.50",$0.00,"$1,630.75","$2,583.11","$2,609.20",$0.00,$510.42,$0.00,$519.23,$0.00
462.920S,SUP,HCPCS C1713,,462.920S  -  NAIL INTRAMEDULLARY UNIVERSAL 9.5MM 20.5CM SOLID FLUTED,"$3,261.50",$0.00,"$3,261.50","$1,467.68","$2,327.73",$0.00,$561.94,$0.00,$0.00,$571.06,"$3,261.50",$0.00,"$1,630.75","$2,583.11","$2,609.20",$0.00,$510.42,$0.00,$519.23,$0.00
462.922S,SUP,HCPCS C1713,,462.922S  -  NAIL INTRAMEDULLARY UNIVERSAL 9.5MM 22CM SOLID FLUTED CROSS,"$3,261.50",$0.00,"$3,261.50","$1,467.68","$2,327.73",$0.00,$561.94,$0.00,$0.00,$571.06,"$3,261.50",$0.00,"$1,630.75","$2,583.11","$2,609.20",$0.00,$510.42,$0.00,$519.23,$0.00
462.923S,SUP,HCPCS C1713,,462.923S  -  NAIL INTRAMEDULLARY UNIVERSAL 9.5MM 23CM SOLID FLUTED CROSS,"$3,261.50",$0.00,"$3,261.50","$1,467.68","$2,327.73",$0.00,$561.94,$0.00,$0.00,$571.06,"$3,261.50",$0.00,"$1,630.75","$2,583.11","$2,609.20",$0.00,$510.42,$0.00,$519.23,$0.00
462.924S,SUP,HCPCS C1713,,462.924S  -  NAIL INTRAMEDULLARY 9.5MM 240MM SOLID FLUTED CROSS SECTION,"$3,261.50",$0.00,"$3,261.50","$1,467.68","$2,327.73",$0.00,$561.94,$0.00,$0.00,$571.06,"$3,261.50",$0.00,"$1,630.75","$2,583.11","$2,609.20",$0.00,$510.42,$0.00,$519.23,$0.00
462.925S,SUP,HCPCS C1713,,462.925S  -  NAIL 9.5MM 25CM HUM IM SLD TI STRL,"$3,802.15",$0.00,"$3,802.15","$1,710.97","$2,713.59",$0.00,$655.09,$0.00,$0.00,$665.73,"$3,802.15",$0.00,"$1,901.08","$3,011.30","$3,041.72",$0.00,$595.04,$0.00,$605.30,$0.00
462.927S,SUP,HCPCS C1713,,462.927S  -  NAIL INTRAMEDULLARY UNIVERSAL 9.5MM 27CM SOLID FLUTED CROSS,"$3,261.50",$0.00,"$3,261.50","$1,467.68","$2,327.73",$0.00,$561.94,$0.00,$0.00,$571.06,"$3,261.50",$0.00,"$1,630.75","$2,583.11","$2,609.20",$0.00,$510.42,$0.00,$519.23,$0.00
462.928S,SUP,HCPCS C1713,,462.928S  -  NAIL INTRAMEDULLARY UNIVERSAL 9.5MM 28CM SOLID FLUTED CROSS,"$3,261.50",$0.00,"$3,261.50","$1,467.68","$2,327.73",$0.00,$561.94,$0.00,$0.00,$571.06,"$3,261.50",$0.00,"$1,630.75","$2,583.11","$2,609.20",$0.00,$510.42,$0.00,$519.23,$0.00
462.929S,SUP,HCPCS C1713,,462.929S  -  NAIL INTRAMEDULLARY UNIVERSAL 9.5MM 29.5CM SOLID FLUTED,"$3,261.50",$0.00,"$3,261.50","$1,467.68","$2,327.73",$0.00,$561.94,$0.00,$0.00,$571.06,"$3,261.50",$0.00,"$1,630.75","$2,583.11","$2,609.20",$0.00,$510.42,$0.00,$519.23,$0.00
462.931S,SUP,HCPCS C1713,,462.931S  -  NAIL INTRAMEDULLARY 9.5MM 31CM SOLID TITANIUM HUMERUS,"$3,261.50",$0.00,"$3,261.50","$1,467.68","$2,327.73",$0.00,$561.94,$0.00,$0.00,$571.06,"$3,261.50",$0.00,"$1,630.75","$2,583.11","$2,609.20",$0.00,$510.42,$0.00,$519.23,$0.00
462.932S,SUP,HCPCS C1713,,462.932S  -  NAIL INTRAMEDULLARY 9.5MM 32.5CM SOLID TITANIUM HUMERUS,"$3,261.50",$0.00,"$3,261.50","$1,467.68","$2,327.73",$0.00,$561.94,$0.00,$0.00,$571.06,"$3,261.50",$0.00,"$1,630.75","$2,583.11","$2,609.20",$0.00,$510.42,$0.00,$519.23,$0.00
462.950S,SUP,Custom 27803010,,462.950S  -  CAP END 5MM 2.5MM HEXAGONAL RECESS BLUE TITANIUM HUMERUS,$484.00,$0.00,$484.00,$0.00,$345.43,$0.00,$0.00,$0.00,$0.00,$0.00,$484.00,$0.00,$242.00,$383.33,$387.20,$0.00,$0.00,$0.00,$0.00,$0.00
462.955S,SUP,Custom 27803010,,462.955S  -  CAP END 5MM HUM XTD IM NAIL TI STRL,$559.10,$0.00,$559.10,$0.00,$399.03,$0.00,$0.00,$0.00,$0.00,$0.00,$559.10,$0.00,$279.55,$442.81,$447.28,$0.00,$0.00,$0.00,$0.00,$0.00
462.960S,SUP,Custom 27803010,,462.960S  -  CAP END HUM SLD IM NAIL TI STRL 10MM,$559.10,$0.00,$559.10,$0.00,$399.03,$0.00,$0.00,$0.00,$0.00,$0.00,$559.10,$0.00,$279.55,$442.81,$447.28,$0.00,$0.00,$0.00,$0.00,$0.00
462.965S,SUP,Custom 27803010,,462.965S  -  CAP END 15MM 3.5MM HEXAGONAL RECESS BLUE TITANIUM HUMERUS,$484.00,$0.00,$484.00,$0.00,$345.43,$0.00,$0.00,$0.00,$0.00,$0.00,$484.00,$0.00,$242.00,$383.33,$387.20,$0.00,$0.00,$0.00,$0.00,$0.00
46-305,SUP,HCPCS C1769,,46-305  -  GWIRE VASC STD .035IN 150CM 3CM ANG TIP STF SHFT GLDWR,$118.75,$0.00,$118.75,$64.48,$84.75,$0.00,$20.46,$0.00,$0.00,$20.79,$118.75,$0.00,$59.38,$94.05,$95.00,$0.00,$18.58,$0.00,$18.91,$0.00
464.30S,SUP,HCPCS C1713,,464.30S  -  NAIL INTRAMEDULLARY 9MM 30CM SOLID GREEN TITANIUM FEMUR,"$2,054.25",$0.00,"$2,054.25",$924.41,"$1,466.12",$0.00,$353.94,$0.00,$0.00,$359.68,"$2,054.25",$0.00,"$1,027.13","$1,626.97","$1,643.40",$0.00,$321.49,$0.00,$327.04,$0.00
464.32S,SUP,HCPCS C1713,,464.32S  -  NAIL INTRAMEDULLARY 9MM 32CM SOLID GREEN TITANIUM FEMUR,"$2,054.25",$0.00,"$2,054.25",$924.41,"$1,466.12",$0.00,$353.94,$0.00,$0.00,$359.68,"$2,054.25",$0.00,"$1,027.13","$1,626.97","$1,643.40",$0.00,$321.49,$0.00,$327.04,$0.00
464.34S,SUP,HCPCS C1713,,464.34S  -  NAIL INTRAMEDULLARY 9MM 34CM SOLID TITANIUM FEMUR STERILE,"$2,054.25",$0.00,"$2,054.25",$924.41,"$1,466.12",$0.00,$353.94,$0.00,$0.00,$359.68,"$2,054.25",$0.00,"$1,027.13","$1,626.97","$1,643.40",$0.00,$321.49,$0.00,$327.04,$0.00
464.36S,SUP,HCPCS C1713,,464.36S  -  NAIL INTRAMEDULLARY 9MM 36CM SOLID GREEN TITANIUM FEMUR,"$2,054.25",$0.00,"$2,054.25",$924.41,"$1,466.12",$0.00,$353.94,$0.00,$0.00,$359.68,"$2,054.25",$0.00,"$1,027.13","$1,626.97","$1,643.40",$0.00,$321.49,$0.00,$327.04,$0.00
464.38S,SUP,HCPCS C1713,,464.38S  -  NAIL INTRAMEDULLARY 9MM 38CM SOLID GREEN TITANIUM FEMUR,"$2,054.25",$0.00,"$2,054.25",$924.41,"$1,466.12",$0.00,$353.94,$0.00,$0.00,$359.68,"$2,054.25",$0.00,"$1,027.13","$1,626.97","$1,643.40",$0.00,$321.49,$0.00,$327.04,$0.00
464.40S,SUP,HCPCS C1713,,464.40S  -  NAIL 9MM 40CM FEM IM SLD TI STRL GRN,"$2,344.43",$0.00,"$2,344.43","$1,054.99","$1,673.22",$0.00,$403.93,$0.00,$0.00,$410.49,"$2,344.43",$0.00,"$1,172.21","$1,856.79","$1,875.54",$0.00,$366.90,$0.00,$373.23,$0.00
464.42S,SUP,HCPCS C1713,,464.42S  -  NAIL INTRAMEDULLARY 9MM 420MM CANN SOLID TITANIUM FEMUR,"$2,054.25",$0.00,"$2,054.25",$924.41,"$1,466.12",$0.00,$353.94,$0.00,$0.00,$359.68,"$2,054.25",$0.00,"$1,027.13","$1,626.97","$1,643.40",$0.00,$321.49,$0.00,$327.04,$0.00
464.44S,SUP,HCPCS C1713,,464.44S  -  NAIL 9MM 44CM FEM IM SLD TI STRL,"$2,344.43",$0.00,"$2,344.43","$1,054.99","$1,673.22",$0.00,$403.93,$0.00,$0.00,$410.49,"$2,344.43",$0.00,"$1,172.21","$1,856.79","$1,875.54",$0.00,$366.90,$0.00,$373.23,$0.00
464.46S,SUP,HCPCS C1713,,464.46S  -  NAIL INTRAMEDULLARY 9MM 46CM SOLID TITANIUM FEMUR STERILE,"$2,054.25",$0.00,"$2,054.25",$924.41,"$1,466.12",$0.00,$353.94,$0.00,$0.00,$359.68,"$2,054.25",$0.00,"$1,027.13","$1,626.97","$1,643.40",$0.00,$321.49,$0.00,$327.04,$0.00
464.48S,SUP,HCPCS C1713,,464.48S  -  NAIL INTRAMEDULLARY 9MM 48CM SOLID GREEN TITANIUM FEMUR,"$2,054.25",$0.00,"$2,054.25",$924.41,"$1,466.12",$0.00,$353.94,$0.00,$0.00,$359.68,"$2,054.25",$0.00,"$1,027.13","$1,626.97","$1,643.40",$0.00,$321.49,$0.00,$327.04,$0.00
465.30S,SUP,HCPCS C1713,,465.30S  -  NAIL 10MM 30CM FEM IM SLD TI STRL GRN,"$2,344.43",$0.00,"$2,344.43","$1,054.99","$1,673.22",$0.00,$403.93,$0.00,$0.00,$410.49,"$2,344.43",$0.00,"$1,172.21","$1,856.79","$1,875.54",$0.00,$366.90,$0.00,$373.23,$0.00
465.32S,SUP,HCPCS C1713,,465.32S  -  NAIL INTRAMEDULLARY 10MM 32CM SOLID GREEN TITANIUM FEMUR,"$2,054.25",$0.00,"$2,054.25",$924.41,"$1,466.12",$0.00,$353.94,$0.00,$0.00,$359.68,"$2,054.25",$0.00,"$1,027.13","$1,626.97","$1,643.40",$0.00,$321.49,$0.00,$327.04,$0.00
465.34S,SUP,HCPCS C1713,,465.34S  -  NAIL INTRAMEDULLARY 10MM 34CM SOLID GREEN TITANIUM FEMUR,"$2,054.25",$0.00,"$2,054.25",$924.41,"$1,466.12",$0.00,$353.94,$0.00,$0.00,$359.68,"$2,054.25",$0.00,"$1,027.13","$1,626.97","$1,643.40",$0.00,$321.49,$0.00,$327.04,$0.00
465.36S,SUP,HCPCS C1713,,465.36S  -  NAIL INTRAMEDULLARY 10MM 36CM SOLID GREEN TITANIUM FEMUR,"$2,054.25",$0.00,"$2,054.25",$924.41,"$1,466.12",$0.00,$353.94,$0.00,$0.00,$359.68,"$2,054.25",$0.00,"$1,027.13","$1,626.97","$1,643.40",$0.00,$321.49,$0.00,$327.04,$0.00
465.38S,SUP,HCPCS C1713,,465.38S  -  NAIL 10MM 380MM FEM IM SLD TI STRL GRN,"$2,344.43",$0.00,"$2,344.43","$1,054.99","$1,673.22",$0.00,$403.93,$0.00,$0.00,$410.49,"$2,344.43",$0.00,"$1,172.21","$1,856.79","$1,875.54",$0.00,$366.90,$0.00,$373.23,$0.00
465.40S,SUP,HCPCS C1713,,465.40S  -  NAIL INTRAMEDULLARY 10MM 40CM SOLID GREEN TITANIUM FEMUR,"$2,054.25",$0.00,"$2,054.25",$924.41,"$1,466.12",$0.00,$353.94,$0.00,$0.00,$359.68,"$2,054.25",$0.00,"$1,027.13","$1,626.97","$1,643.40",$0.00,$321.49,$0.00,$327.04,$0.00
465.42S,SUP,HCPCS C1713,,465.42S  -  NAIL INTRAMEDULLARY 10MM 42CM SOLID GREEN TITANIUM FEMUR,"$2,054.25",$0.00,"$2,054.25",$924.41,"$1,466.12",$0.00,$353.94,$0.00,$0.00,$359.68,"$2,054.25",$0.00,"$1,027.13","$1,626.97","$1,643.40",$0.00,$321.49,$0.00,$327.04,$0.00
465.44S,SUP,HCPCS C1713,,465.44S  -  NAIL INTRAMEDULLARY 10MM 44CM SOLID GREEN TITANIUM FEMUR,"$2,054.25",$0.00,"$2,054.25",$924.41,"$1,466.12",$0.00,$353.94,$0.00,$0.00,$359.68,"$2,054.25",$0.00,"$1,027.13","$1,626.97","$1,643.40",$0.00,$321.49,$0.00,$327.04,$0.00
465.46S,SUP,HCPCS C1713,,465.46S  -  NAIL 10MM 46CM FEM IM SLD TI STRL GRN,"$2,344.43",$0.00,"$2,344.43","$1,054.99","$1,673.22",$0.00,$403.93,$0.00,$0.00,$410.49,"$2,344.43",$0.00,"$1,172.21","$1,856.79","$1,875.54",$0.00,$366.90,$0.00,$373.23,$0.00
465.48S,SUP,HCPCS C1713,,465.48S  -  NAIL INTRAMEDULLARY 10MM 48CM SOLID GREEN TITANIUM FEMUR,"$2,054.25",$0.00,"$2,054.25",$924.41,"$1,466.12",$0.00,$353.94,$0.00,$0.00,$359.68,"$2,054.25",$0.00,"$1,027.13","$1,626.97","$1,643.40",$0.00,$321.49,$0.00,$327.04,$0.00
465440-20,SUP,Custom 27203010,,CONTROL CRP SYN VIGIL HI SNS LVL C LOW MDLR DATA RDC 5ML LX,$366.68,$0.00,$366.68,$0.00,$261.70,$0.00,$0.00,$0.00,$0.00,$0.00,$366.68,$0.00,$183.34,$290.41,$293.34,$0.00,$0.00,$0.00,$0.00,$0.00
4655-03,SUP,HCPCS C1776,,4655-03  -  HEAD FEM +5 UNV 32MM,"$2,607.50",$0.00,"$2,607.50","$1,173.38","$1,860.97",$0.00,$449.26,$0.00,$0.00,$456.55,"$2,607.50",$0.00,"$1,303.75","$2,065.14","$2,086.00",$0.00,$408.07,$0.00,$415.11,$0.00
466.30S,SUP,HCPCS C1713,,466.30S  -  NAIL INTRAMEDULLARY 11MM 30CM SOLID GREEN TITANIUM FEMUR,"$2,054.25",$0.00,"$2,054.25",$924.41,"$1,466.12",$0.00,$353.94,$0.00,$0.00,$359.68,"$2,054.25",$0.00,"$1,027.13","$1,626.97","$1,643.40",$0.00,$321.49,$0.00,$327.04,$0.00
466.32S,SUP,HCPCS C1713,,466.32S  -  NAIL INTRAMEDULLARY 11MM 32CM SOLID GREEN TITANIUM FEMUR,"$2,054.25",$0.00,"$2,054.25",$924.41,"$1,466.12",$0.00,$353.94,$0.00,$0.00,$359.68,"$2,054.25",$0.00,"$1,027.13","$1,626.97","$1,643.40",$0.00,$321.49,$0.00,$327.04,$0.00
466.34S,SUP,HCPCS C1713,,466.34S  -  NAIL INTRAMEDULLARY 11MM 34CM SOLID GREEN TITANIUM FEMUR,"$2,054.25",$0.00,"$2,054.25",$924.41,"$1,466.12",$0.00,$353.94,$0.00,$0.00,$359.68,"$2,054.25",$0.00,"$1,027.13","$1,626.97","$1,643.40",$0.00,$321.49,$0.00,$327.04,$0.00
466.36S,SUP,HCPCS C1713,,466.36S  -  NAIL 11MM 36CM FEM IM SLD TI STRL GRN,"$2,344.43",$0.00,"$2,344.43","$1,054.99","$1,673.22",$0.00,$403.93,$0.00,$0.00,$410.49,"$2,344.43",$0.00,"$1,172.21","$1,856.79","$1,875.54",$0.00,$366.90,$0.00,$373.23,$0.00
466.38S,SUP,HCPCS C1713,,466.38S  -  NAIL INTRAMEDULLARY 11MM 38CM SOLID GREEN TITANIUM FEMUR,"$2,054.25",$0.00,"$2,054.25",$924.41,"$1,466.12",$0.00,$353.94,$0.00,$0.00,$359.68,"$2,054.25",$0.00,"$1,027.13","$1,626.97","$1,643.40",$0.00,$321.49,$0.00,$327.04,$0.00
466.40S,SUP,HCPCS C1713,,466.40S  -  NAIL 11MM 40CM FEM IM SLD TI STRL GRN,"$2,344.43",$0.00,"$2,344.43","$1,054.99","$1,673.22",$0.00,$403.93,$0.00,$0.00,$410.49,"$2,344.43",$0.00,"$1,172.21","$1,856.79","$1,875.54",$0.00,$366.90,$0.00,$373.23,$0.00
466.42S,SUP,HCPCS C1713,,466.42S  -  NAIL INTRAMEDULLARY 11MM 42CM SOLID GREEN TITANIUM FEMUR,"$2,054.25",$0.00,"$2,054.25",$924.41,"$1,466.12",$0.00,$353.94,$0.00,$0.00,$359.68,"$2,054.25",$0.00,"$1,027.13","$1,626.97","$1,643.40",$0.00,$321.49,$0.00,$327.04,$0.00
466.44S,SUP,HCPCS C1713,,466.44S  -  NAIL INTRAMEDULLARY 11MM 44CM SOLID GREEN TITANIUM FEMUR,"$2,054.25",$0.00,"$2,054.25",$924.41,"$1,466.12",$0.00,$353.94,$0.00,$0.00,$359.68,"$2,054.25",$0.00,"$1,027.13","$1,626.97","$1,643.40",$0.00,$321.49,$0.00,$327.04,$0.00
466.46S,SUP,HCPCS C1713,,466.46S  -  NAIL INTRAMEDULLARY 11MM 46CM SOLID GREEN TITANIUM FEMUR,"$2,054.25",$0.00,"$2,054.25",$924.41,"$1,466.12",$0.00,$353.94,$0.00,$0.00,$359.68,"$2,054.25",$0.00,"$1,027.13","$1,626.97","$1,643.40",$0.00,$321.49,$0.00,$327.04,$0.00
466.48S,SUP,HCPCS C1713,,466.48S  -  NAIL INTRAMEDULLARY 11MM 48CM SOLID GREEN TITANIUM FEMUR,"$2,054.25",$0.00,"$2,054.25",$924.41,"$1,466.12",$0.00,$353.94,$0.00,$0.00,$359.68,"$2,054.25",$0.00,"$1,027.13","$1,626.97","$1,643.40",$0.00,$321.49,$0.00,$327.04,$0.00
46-605,SUP,HCPCS C1769,,46-605  -  GWIRE VASC .018IN 260CM 3CM TIP SHRT TPR SPCL PLTN PLUS GLDX,$45.18,$0.00,$45.18,$24.53,$32.24,$0.00,$7.78,$0.00,$0.00,$7.91,$45.18,$0.00,$22.59,$35.78,$36.14,$0.00,$7.07,$0.00,$7.19,$0.00
466P306A,SUP,HCPCS C1884,,466P306A  -  FILTER EMBL 55CM LF TRPS CATH SHTH INTRO KT,"$3,112.50",$0.00,"$3,112.50","$1,400.63","$2,221.39",$0.00,$536.27,$0.00,$0.00,$544.97,"$3,112.50",$0.00,"$1,556.25","$2,465.10","$2,490.00",$0.00,$487.11,$0.00,$495.51,$0.00
467.30S,SUP,HCPCS C1713,,467.30S  -  NAIL 12MM 30CM FEM IM SLD TI STRL GRN,"$2,344.43",$0.00,"$2,344.43","$1,054.99","$1,673.22",$0.00,$403.93,$0.00,$0.00,$410.49,"$2,344.43",$0.00,"$1,172.21","$1,856.79","$1,875.54",$0.00,$366.90,$0.00,$373.23,$0.00
467.32S,SUP,HCPCS C1713,,467.32S  -  NAIL INTRAMEDULLARY 12MM 32CM SOLID GREEN TITANIUM FEMUR,"$2,054.25",$0.00,"$2,054.25",$924.41,"$1,466.12",$0.00,$353.94,$0.00,$0.00,$359.68,"$2,054.25",$0.00,"$1,027.13","$1,626.97","$1,643.40",$0.00,$321.49,$0.00,$327.04,$0.00
467.34S,SUP,HCPCS C1713,,467.34S  -  NAIL INTRAMEDULLARY 12MM 34CM SOLID GREEN TITANIUM FEMUR,"$2,054.25",$0.00,"$2,054.25",$924.41,"$1,466.12",$0.00,$353.94,$0.00,$0.00,$359.68,"$2,054.25",$0.00,"$1,027.13","$1,626.97","$1,643.40",$0.00,$321.49,$0.00,$327.04,$0.00
467.36S,SUP,HCPCS C1713,,467.36S  -  NAIL INTRAMEDULLARY 12MM 36CM SOLID GREEN TITANIUM FEMUR,"$2,054.25",$0.00,"$2,054.25",$924.41,"$1,466.12",$0.00,$353.94,$0.00,$0.00,$359.68,"$2,054.25",$0.00,"$1,027.13","$1,626.97","$1,643.40",$0.00,$321.49,$0.00,$327.04,$0.00
467.38S,SUP,HCPCS C1713,,467.38S  -  NAIL INTRAMEDULLARY 12MM 38CM SOLID GREEN TITANIUM FEMUR,"$2,054.25",$0.00,"$2,054.25",$924.41,"$1,466.12",$0.00,$353.94,$0.00,$0.00,$359.68,"$2,054.25",$0.00,"$1,027.13","$1,626.97","$1,643.40",$0.00,$321.49,$0.00,$327.04,$0.00
467.40S,SUP,HCPCS C1713,,467.40S  -  NAIL 12MM 40CM FEM IM SLD TI STRL GRN,"$2,344.43",$0.00,"$2,344.43","$1,054.99","$1,673.22",$0.00,$403.93,$0.00,$0.00,$410.49,"$2,344.43",$0.00,"$1,172.21","$1,856.79","$1,875.54",$0.00,$366.90,$0.00,$373.23,$0.00
467.42S,SUP,HCPCS C1713,,467.42S  -  NAIL INTRAMEDULLARY 12MM 420MM SOLID GREEN TITANIUM FEMORAL,"$2,054.25",$0.00,"$2,054.25",$924.41,"$1,466.12",$0.00,$353.94,$0.00,$0.00,$359.68,"$2,054.25",$0.00,"$1,027.13","$1,626.97","$1,643.40",$0.00,$321.49,$0.00,$327.04,$0.00
467.44S,SUP,HCPCS C1713,,467.44S  -  NAIL INTRAMEDULLARY 12MM 44CM SOLID GREEN TITANIUM FEMUR,"$2,054.25",$0.00,"$2,054.25",$924.41,"$1,466.12",$0.00,$353.94,$0.00,$0.00,$359.68,"$2,054.25",$0.00,"$1,027.13","$1,626.97","$1,643.40",$0.00,$321.49,$0.00,$327.04,$0.00
467.46S,SUP,HCPCS C1713,,467.46S  -  NAIL 12MM 46CM FEM IM SLD TI STRL GRN,"$2,344.43",$0.00,"$2,344.43","$1,054.99","$1,673.22",$0.00,$403.93,$0.00,$0.00,$410.49,"$2,344.43",$0.00,"$1,172.21","$1,856.79","$1,875.54",$0.00,$366.90,$0.00,$373.23,$0.00
467.48S,SUP,HCPCS C1713,,467.48S  -  NAIL 12MM 48CM FEM IM SLD TI STRL GRN,"$2,344.43",$0.00,"$2,344.43","$1,054.99","$1,673.22",$0.00,$403.93,$0.00,$0.00,$410.49,"$2,344.43",$0.00,"$1,172.21","$1,856.79","$1,875.54",$0.00,$366.90,$0.00,$373.23,$0.00
46-804,SUP,HCPCS C1769,,46-804  -  GUIDEWIRE TRANSEND EX .014,$937.50,$0.00,$937.50,$509.06,$669.09,$0.00,$161.53,$0.00,$0.00,$164.15,$937.50,$0.00,$468.75,$742.50,$750.00,$0.00,$146.72,$0.00,$149.25,$0.00
46-806,SUP,HCPCS C1769,,GUIDEWIRE VASC .014IN 205CM 2CM SHP TIP SFTP TRNSD EX HYDPHI,$20.30,$0.00,$20.30,$11.02,$14.49,$0.00,$3.50,$0.00,$0.00,$3.55,$20.30,$0.00,$10.15,$16.08,$16.24,$0.00,$3.18,$0.00,$3.23,$0.00
46B005,SUP,HCPCS V2790,,46B005  -  GRAFT SFT TIS 25X15X15MM PATLR TNDN TIB STRUT WHL,"$8,265.00",$0.00,"$8,265.00","$3,719.25","$5,158.80",$0.00,"$1,424.02",$0.00,$0.00,"$1,447.14","$8,265.00",$0.00,"$4,132.50","$6,545.88","$6,612.00",$0.00,"$1,293.47",$0.00,"$1,315.79",$0.00
47-2255-008-01,SUP,Custom 27203010,,47-2255-008-01  -  GWIRE ORTH 100CM 3MM SS ANTGRD IM FIX SYS STRL,$251.25,$0.00,$251.25,$0.00,$179.32,$0.00,$0.00,$0.00,$0.00,$0.00,$251.25,$0.00,$125.63,$198.99,$201.00,$0.00,$0.00,$0.00,$0.00,$0.00
47-2483-060-50,SUP,HCPCS C1713,,47-2483-060-50  -  SCREW BONE 3.5MM 5MM 60MM NTR NAIL TI6AL4V ALLOY CORT PTTHRD,$381.35,$0.00,$381.35,$171.61,$272.17,$0.00,$65.70,$0.00,$0.00,$66.77,$381.35,$0.00,$190.68,$302.03,$305.08,$0.00,$59.68,$0.00,$60.71,$0.00
47-2483-095-60,SUP,HCPCS C1713,,47-2483-095-60  -  SCREW BONE 6MM 3.5MM 95MM NTR NAIL TI6AL4V ALLOY CANC PTTHRD,$426.30,$0.00,$426.30,$191.84,$304.25,$0.00,$73.45,$0.00,$0.00,$74.64,$426.30,$0.00,$213.15,$337.63,$341.04,$0.00,$66.72,$0.00,$67.87,$0.00
47-2484-042-50,SUP,HCPCS C1713,,47-2484-042-50  -  SCREW BONE 5MM 42.5MM NTR NAIL TI6AL4V ALLOY FULTHD CORT,$381.35,$0.00,$381.35,$171.61,$272.17,$0.00,$65.70,$0.00,$0.00,$66.77,$381.35,$0.00,$190.68,$302.03,$305.08,$0.00,$59.68,$0.00,$60.71,$0.00
47-2484-045-50,SUP,HCPCS C1713,,47-2484-045-50  -  SCREW BONE 5MM 45MM TI 3.5MM CORT FIXANG HX HD,$381.35,$0.00,$381.35,$171.61,$272.17,$0.00,$65.70,$0.00,$0.00,$66.77,$381.35,$0.00,$190.68,$302.03,$305.08,$0.00,$59.68,$0.00,$60.71,$0.00
47-2484-070-60,SUP,HCPCS C1713,,47-2484-070-60  -  SCREW BONE 6MM 3.5MM 70MM NTR NAIL TI6AL4V ALLOY CANC FIXANG,$395.85,$0.00,$395.85,$178.13,$282.52,$0.00,$68.20,$0.00,$0.00,$69.31,$395.85,$0.00,$197.93,$313.51,$316.68,$0.00,$61.95,$0.00,$63.02,$0.00
47-2484-075-50,SUP,HCPCS C1713,,47-2484-075-50  -  SCREW BONE 5MM 3.5MM 75MM NTR NAIL TI6AL4V ALLOY CORT FIXANG,$381.35,$0.00,$381.35,$171.61,$272.17,$0.00,$65.70,$0.00,$0.00,$66.77,$381.35,$0.00,$190.68,$302.03,$305.08,$0.00,$59.68,$0.00,$60.71,$0.00
47-2484-075-60,SUP,HCPCS C1713,,47-2484-075-60  -  SCREW BONE 6MM 3.5MM 75MM NTR NAIL TI CANC FIXANG HEX HEAD,$395.85,$0.00,$395.85,$178.13,$282.52,$0.00,$68.20,$0.00,$0.00,$69.31,$395.85,$0.00,$197.93,$313.51,$316.68,$0.00,$61.95,$0.00,$63.02,$0.00
47-2484-095-60,SUP,HCPCS C1713,,47-2484-095-60  -  SCREW BONE 6MM 3.5MM 95MM NTR NAIL TI CANC FIXANG HEX HEAD,$395.85,$0.00,$395.85,$178.13,$282.52,$0.00,$68.20,$0.00,$0.00,$69.31,$395.85,$0.00,$197.93,$313.51,$316.68,$0.00,$61.95,$0.00,$63.02,$0.00
47-2485-095-10,SUP,HCPCS C1713,,47-2485-095-10  -  SCREW BONE 10.5MM 95MM NTR NAIL TI6AL4V ALLOY LAG,"$1,074.45",$0.00,"$1,074.45",$483.50,$766.83,$0.00,$185.12,$0.00,$0.00,$188.13,"$1,074.45",$0.00,$537.23,$850.96,$859.56,$0.00,$168.15,$0.00,$171.05,$0.00
47-2487-001-00,SUP,HCPCS C1713,,47-2487-001-00  -  NAIL FEM IM 0MM ANTGRD CAP,$411.80,$0.00,$411.80,$185.31,$293.90,$0.00,$70.95,$0.00,$0.00,$72.10,$411.80,$0.00,$205.90,$326.15,$329.44,$0.00,$64.45,$0.00,$65.56,$0.00
47-2487-002-00,SUP,HCPCS C1713,,47-2487-002-00  -  CAP END 0MM CEPHALOMEDULLARY NAIL TI6AL4V ALLOY NTR NAIL,$395.85,$0.00,$395.85,$178.13,$282.52,$0.00,$68.20,$0.00,$0.00,$69.31,$395.85,$0.00,$197.93,$313.51,$316.68,$0.00,$61.95,$0.00,$63.02,$0.00
47-2487-005-00,SUP,HCPCS C1713,,47-2487-005-00  -  CAP END 0MM TIB Z NTR NAIL,$411.80,$0.00,$411.80,$185.31,$293.90,$0.00,$70.95,$0.00,$0.00,$72.10,$411.80,$0.00,$205.90,$326.15,$329.44,$0.00,$64.45,$0.00,$65.56,$0.00
47-2487-008-00,SUP,HCPCS C1713,,47-2487-008-00  -  CAP END 0MM FEM RTRGRD TI ALLOY NTR NAIL,$411.80,$0.00,$411.80,$185.31,$293.90,$0.00,$70.95,$0.00,$0.00,$72.10,$411.80,$0.00,$205.90,$326.15,$329.44,$0.00,$64.45,$0.00,$65.56,$0.00
47-2488-000-01,SUP,HCPCS C1713,,47-2488-000-01  -  NUT ORTH CORT FEM KNEE TI RTRGRD 6 MM CANC SCR NTR NAIL SYS,$208.00,$0.00,$208.00,$93.60,$148.45,$0.00,$35.84,$0.00,$0.00,$36.42,$208.00,$0.00,$104.00,$164.74,$166.40,$0.00,$32.55,$0.00,$33.11,$0.00
47-2488-000-02,SUP,HCPCS C1713,,47-2488-000-02  -  WASHER CORT NTR NAIL ORTH TI ALLOY STRL,$175.50,$0.00,$175.50,$78.98,$125.25,$0.00,$30.24,$0.00,$0.00,$30.73,$175.50,$0.00,$87.75,$139.00,$140.40,$0.00,$27.47,$0.00,$27.94,$0.00
47-2491-360-12,SUP,HCPCS C1713,,47-2491-360-12  -  NAIL 12MM 36CM PIRIFORMIS FOSSA FEM NTR NAIL IM UNV ANTGRD,"$3,408.95",$0.00,"$3,408.95","$1,534.03","$2,432.97",$0.00,$587.35,$0.00,$0.00,$596.88,"$3,408.95",$0.00,"$1,704.48","$2,699.89","$2,727.16",$0.00,$533.50,$0.00,$542.70,$0.00
47-2492-360-12,SUP,HCPCS C1713,,47-2492-360-12  -  NAIL 12MM 36CM RIGHT GT IM,"$3,408.95",$0.00,"$3,408.95","$1,534.03","$2,432.97",$0.00,$587.35,$0.00,$0.00,$596.88,"$3,408.95",$0.00,"$1,704.48","$2,699.89","$2,727.16",$0.00,$533.50,$0.00,$542.70,$0.00
47-2493-210-11,SUP,HCPCS C1713,,47-2493-210-11  -  NAIL 11.5MM 21.5CM RIGHT DPHSL CEPHALOMEDULLARY NTR NAIL IM,"$2,965.25",$0.00,"$2,965.25","$1,334.36","$2,116.30",$0.00,$510.90,$0.00,$0.00,$519.19,"$2,965.25",$0.00,"$1,482.63","$2,348.48","$2,372.20",$0.00,$464.06,$0.00,$472.07,$0.00
47-2493-360-11,SUP,HCPCS C1713,,47-2493-360-11  -  NAIL 11.5MM 36CM RIGHT DPHSL CEPHALOMEDULLARY NTR NAIL IM,"$4,463.10",$0.00,"$4,463.10","$2,008.40","$3,185.31",$0.00,$768.97,$0.00,$0.00,$781.45,"$4,463.10",$0.00,"$2,231.55","$3,534.78","$3,570.48",$0.00,$698.48,$0.00,$710.53,$0.00
47-2494-200-11,SUP,HCPCS C1713,,47-2494-200-11  -  NAIL 11.5MM 20CM FEM NTR NAIL IM UNV SHRT RTRGRD TI ALLOY,"$4,218.05",$0.00,"$4,218.05","$1,898.12","$3,010.42",$0.00,$726.75,$0.00,$0.00,$738.55,"$4,218.05",$0.00,"$2,109.03","$3,340.70","$3,374.44",$0.00,$660.12,$0.00,$671.51,$0.00
47-2494-360-11,SUP,HCPCS C1713,,47-2494-360-11  -  NAIL 11.5MM 36CM FEM NTR NAIL IM UNV LNG RTRGRD TI,"$4,218.05",$0.00,"$4,218.05","$1,898.12","$3,010.42",$0.00,$726.75,$0.00,$0.00,$738.55,"$4,218.05",$0.00,"$2,109.03","$3,340.70","$3,374.44",$0.00,$660.12,$0.00,$671.51,$0.00
47-2495-320-12,SUP,HCPCS C1713,,47-2495-320-12  -  NAIL 12MM 32CM TIB NTR NAIL IM UNV TI6AL4V,"$3,240.75",$0.00,"$3,240.75","$1,458.34","$2,312.92",$0.00,$558.37,$0.00,$0.00,$567.43,"$3,240.75",$0.00,"$1,620.38","$2,566.67","$2,592.60",$0.00,$507.18,$0.00,$515.93,$0.00
474.031S,SUP,HCPCS C1713,,474.031S  -  NAIL 10MM 30CM FEM IM CANN TI STRL GRN,"$2,956.30",$0.00,"$2,956.30","$1,330.34","$2,109.91",$0.00,$509.36,$0.00,$0.00,$517.62,"$2,956.30",$0.00,"$1,478.15","$2,341.39","$2,365.04",$0.00,$462.66,$0.00,$470.64,$0.00
474.032S,SUP,HCPCS C1713,,474.032S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 320MM CANN ROUND BARREL,"$2,492.88",$0.00,"$2,492.88","$1,121.79","$1,779.16",$0.00,$429.51,$0.00,$0.00,$436.48,"$2,492.88",$0.00,"$1,246.44","$1,974.36","$1,994.30",$0.00,$390.13,$0.00,$396.87,$0.00
474.034S,SUP,HCPCS C1713,,474.034S  -  NAIL INTRAMEDULLARY 10MM 34CM CANN GREEN TITANIUM FEMUR,"$2,492.88",$0.00,"$2,492.88","$1,121.79","$1,779.16",$0.00,$429.51,$0.00,$0.00,$436.48,"$2,492.88",$0.00,"$1,246.44","$1,974.36","$1,994.30",$0.00,$390.13,$0.00,$396.87,$0.00
474.036S,SUP,HCPCS C1713,,474.036S  -  NAIL 10MM 36CM FEM IM CANN TI STRL,"$2,956.30",$0.00,"$2,956.30","$1,330.34","$2,109.91",$0.00,$509.36,$0.00,$0.00,$517.62,"$2,956.30",$0.00,"$1,478.15","$2,341.39","$2,365.04",$0.00,$462.66,$0.00,$470.64,$0.00
474.038S,SUP,HCPCS C1713,,474.038S  -  NAIL 10MM 38CM FEM IM CANN TI STRL,"$2,956.30",$0.00,"$2,956.30","$1,330.34","$2,109.91",$0.00,$509.36,$0.00,$0.00,$517.62,"$2,956.30",$0.00,"$1,478.15","$2,341.39","$2,365.04",$0.00,$462.66,$0.00,$470.64,$0.00
474.041S,SUP,HCPCS C1713,,474.041S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 400MM CANN ROUND BARREL,"$2,492.88",$0.00,"$2,492.88","$1,121.79","$1,779.16",$0.00,$429.51,$0.00,$0.00,$436.48,"$2,492.88",$0.00,"$1,246.44","$1,974.36","$1,994.30",$0.00,$390.13,$0.00,$396.87,$0.00
474.042S,SUP,HCPCS C1713,,474.042S  -  NAIL 10MM 42CM FEM IM CANN TI STRL,"$2,956.30",$0.00,"$2,956.30","$1,330.34","$2,109.91",$0.00,$509.36,$0.00,$0.00,$517.62,"$2,956.30",$0.00,"$1,478.15","$2,341.39","$2,365.04",$0.00,$462.66,$0.00,$470.64,$0.00
474.044S,SUP,HCPCS C1713,,474.044S  -  NAIL 10MM 44CM FEM IM CANN TI STRL,"$2,956.30",$0.00,"$2,956.30","$1,330.34","$2,109.91",$0.00,$509.36,$0.00,$0.00,$517.62,"$2,956.30",$0.00,"$1,478.15","$2,341.39","$2,365.04",$0.00,$462.66,$0.00,$470.64,$0.00
474.046S,SUP,HCPCS C1713,,474.046S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 460MM CANN ROUND BARREL,"$2,492.88",$0.00,"$2,492.88","$1,121.79","$1,779.16",$0.00,$429.51,$0.00,$0.00,$436.48,"$2,492.88",$0.00,"$1,246.44","$1,974.36","$1,994.30",$0.00,$390.13,$0.00,$396.87,$0.00
474.048S,SUP,HCPCS C1713,,474.048S  -  NAIL INTRAMEDULLARY UNIVERSAL 10MM 480MM CANN ROUND BARREL,"$2,492.88",$0.00,"$2,492.88","$1,121.79","$1,779.16",$0.00,$429.51,$0.00,$0.00,$436.48,"$2,492.88",$0.00,"$1,246.44","$1,974.36","$1,994.30",$0.00,$390.13,$0.00,$396.87,$0.00
474.131S,SUP,HCPCS C1713,,474.131S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 300MM CANN FLUTED BARREL,"$2,492.88",$0.00,"$2,492.88","$1,121.79","$1,779.16",$0.00,$429.51,$0.00,$0.00,$436.48,"$2,492.88",$0.00,"$1,246.44","$1,974.36","$1,994.30",$0.00,$390.13,$0.00,$396.87,$0.00
474.132S,SUP,HCPCS C1713,,474.132S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 320MM CANN FLUTED BARREL,"$2,492.88",$0.00,"$2,492.88","$1,121.79","$1,779.16",$0.00,$429.51,$0.00,$0.00,$436.48,"$2,492.88",$0.00,"$1,246.44","$1,974.36","$1,994.30",$0.00,$390.13,$0.00,$396.87,$0.00
474.134S,SUP,HCPCS C1713,,474.134S  -  NAIL 11MM 34CM FEM IM CANN TI STRL,"$2,956.30",$0.00,"$2,956.30","$1,330.34","$2,109.91",$0.00,$509.36,$0.00,$0.00,$517.62,"$2,956.30",$0.00,"$1,478.15","$2,341.39","$2,365.04",$0.00,$462.66,$0.00,$470.64,$0.00
474.136S,SUP,HCPCS C1713,,474.136S  -  NAIL 11MM 36CM FEM IM CANN TI STRL,"$2,956.30",$0.00,"$2,956.30","$1,330.34","$2,109.91",$0.00,$509.36,$0.00,$0.00,$517.62,"$2,956.30",$0.00,"$1,478.15","$2,341.39","$2,365.04",$0.00,$462.66,$0.00,$470.64,$0.00
474.138S,SUP,HCPCS C1713,,474.138S  -  NAIL 11MM 38CM FEM IM CANN TI STRL,"$2,956.30",$0.00,"$2,956.30","$1,330.34","$2,109.91",$0.00,$509.36,$0.00,$0.00,$517.62,"$2,956.30",$0.00,"$1,478.15","$2,341.39","$2,365.04",$0.00,$462.66,$0.00,$470.64,$0.00
474.141S,SUP,HCPCS C1713,,474.141S  -  NAIL 11MM 41CM FEM IM CANN TI STRL,"$2,956.30",$0.00,"$2,956.30","$1,330.34","$2,109.91",$0.00,$509.36,$0.00,$0.00,$517.62,"$2,956.30",$0.00,"$1,478.15","$2,341.39","$2,365.04",$0.00,$462.66,$0.00,$470.64,$0.00
474.142S,SUP,HCPCS C1713,,474.142S  -  NAIL 11MM 42CM FEM IM CANN TI STRL,"$2,956.30",$0.00,"$2,956.30","$1,330.34","$2,109.91",$0.00,$509.36,$0.00,$0.00,$517.62,"$2,956.30",$0.00,"$1,478.15","$2,341.39","$2,365.04",$0.00,$462.66,$0.00,$470.64,$0.00
474.144S,SUP,HCPCS C1713,,474.144S  -  NAIL 11MM 44CM FEM IM CANN TI STRL,"$2,956.30",$0.00,"$2,956.30","$1,330.34","$2,109.91",$0.00,$509.36,$0.00,$0.00,$517.62,"$2,956.30",$0.00,"$1,478.15","$2,341.39","$2,365.04",$0.00,$462.66,$0.00,$470.64,$0.00
474.146S,SUP,HCPCS C1713,,474.146S  -  NAIL 11MM 46CM FEM IM CANN TI STRL,"$2,956.30",$0.00,"$2,956.30","$1,330.34","$2,109.91",$0.00,$509.36,$0.00,$0.00,$517.62,"$2,956.30",$0.00,"$1,478.15","$2,341.39","$2,365.04",$0.00,$462.66,$0.00,$470.64,$0.00
474.148S,SUP,HCPCS C1713,,474.148S  -  NAIL INTRAMEDULLARY UNIVERSAL 11MM 480MM CANN FLUTED BARREL,"$2,492.88",$0.00,"$2,492.88","$1,121.79","$1,779.16",$0.00,$429.51,$0.00,$0.00,$436.48,"$2,492.88",$0.00,"$1,246.44","$1,974.36","$1,994.30",$0.00,$390.13,$0.00,$396.87,$0.00
474.231S,SUP,HCPCS C1713,,474.231S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 300MM CANN FLUTED BARREL,"$2,492.88",$0.00,"$2,492.88","$1,121.79","$1,779.16",$0.00,$429.51,$0.00,$0.00,$436.48,"$2,492.88",$0.00,"$1,246.44","$1,974.36","$1,994.30",$0.00,$390.13,$0.00,$396.87,$0.00
474.232S,SUP,HCPCS C1713,,474.232S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 320MM CANN FLUTED BARREL,"$2,492.88",$0.00,"$2,492.88","$1,121.79","$1,779.16",$0.00,$429.51,$0.00,$0.00,$436.48,"$2,492.88",$0.00,"$1,246.44","$1,974.36","$1,994.30",$0.00,$390.13,$0.00,$396.87,$0.00
474.234S,SUP,HCPCS C1713,,474.234S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 340MM CANN FLUTED BARREL,"$2,492.88",$0.00,"$2,492.88","$1,121.79","$1,779.16",$0.00,$429.51,$0.00,$0.00,$436.48,"$2,492.88",$0.00,"$1,246.44","$1,974.36","$1,994.30",$0.00,$390.13,$0.00,$396.87,$0.00
474.236S,SUP,HCPCS C1713,,474.236S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 360MM CANN FLUTED BARREL,"$2,492.88",$0.00,"$2,492.88","$1,121.79","$1,779.16",$0.00,$429.51,$0.00,$0.00,$436.48,"$2,492.88",$0.00,"$1,246.44","$1,974.36","$1,994.30",$0.00,$390.13,$0.00,$396.87,$0.00
474.238S,SUP,HCPCS C1713,,474.238S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 380MM CANN FLUTED BARREL,"$2,492.88",$0.00,"$2,492.88","$1,121.79","$1,779.16",$0.00,$429.51,$0.00,$0.00,$436.48,"$2,492.88",$0.00,"$1,246.44","$1,974.36","$1,994.30",$0.00,$390.13,$0.00,$396.87,$0.00
474.241S,SUP,HCPCS C1713,,474.241S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 400MM CANN FLUTED BARREL,"$2,492.88",$0.00,"$2,492.88","$1,121.79","$1,779.16",$0.00,$429.51,$0.00,$0.00,$436.48,"$2,492.88",$0.00,"$1,246.44","$1,974.36","$1,994.30",$0.00,$390.13,$0.00,$396.87,$0.00
474.242S,SUP,HCPCS C1713,,474.242S  -  NAIL 12MM 42CM FEM IM CANN TI STRL,"$2,956.30",$0.00,"$2,956.30","$1,330.34","$2,109.91",$0.00,$509.36,$0.00,$0.00,$517.62,"$2,956.30",$0.00,"$1,478.15","$2,341.39","$2,365.04",$0.00,$462.66,$0.00,$470.64,$0.00
474.244S,SUP,HCPCS C1713,,474.244S  -  NAIL 12MM 44CM FEM IM CANN TI STRL,"$2,956.30",$0.00,"$2,956.30","$1,330.34","$2,109.91",$0.00,$509.36,$0.00,$0.00,$517.62,"$2,956.30",$0.00,"$1,478.15","$2,341.39","$2,365.04",$0.00,$462.66,$0.00,$470.64,$0.00
474.246S,SUP,HCPCS C1713,,474.246S  -  NAIL INTRAMEDULLARY 12MM 460MM CANN GREEN TITANIUM FEMUR,"$2,492.88",$0.00,"$2,492.88","$1,121.79","$1,779.16",$0.00,$429.51,$0.00,$0.00,$436.48,"$2,492.88",$0.00,"$1,246.44","$1,974.36","$1,994.30",$0.00,$390.13,$0.00,$396.87,$0.00
474.248S,SUP,HCPCS C1713,,474.248S  -  NAIL INTRAMEDULLARY UNIVERSAL 12MM 480MM CANN FLUTED BARREL,"$2,492.88",$0.00,"$2,492.88","$1,121.79","$1,779.16",$0.00,$429.51,$0.00,$0.00,$436.48,"$2,492.88",$0.00,"$1,246.44","$1,974.36","$1,994.30",$0.00,$390.13,$0.00,$396.87,$0.00
474.331S,SUP,HCPCS C1713,,474.331S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 300MM CANN FLUTED BARREL,"$2,492.88",$0.00,"$2,492.88","$1,121.79","$1,779.16",$0.00,$429.51,$0.00,$0.00,$436.48,"$2,492.88",$0.00,"$1,246.44","$1,974.36","$1,994.30",$0.00,$390.13,$0.00,$396.87,$0.00
474.332S,SUP,HCPCS C1713,,474.332S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 320MM CANN FLUTED BARREL,"$2,492.88",$0.00,"$2,492.88","$1,121.79","$1,779.16",$0.00,$429.51,$0.00,$0.00,$436.48,"$2,492.88",$0.00,"$1,246.44","$1,974.36","$1,994.30",$0.00,$390.13,$0.00,$396.87,$0.00
474.334S,SUP,HCPCS C1713,,474.334S  -  NAIL 13MM 34CM FEM IM CANN TI STRL,"$2,956.30",$0.00,"$2,956.30","$1,330.34","$2,109.91",$0.00,$509.36,$0.00,$0.00,$517.62,"$2,956.30",$0.00,"$1,478.15","$2,341.39","$2,365.04",$0.00,$462.66,$0.00,$470.64,$0.00
474.336S,SUP,HCPCS C1713,,474.336S  -  NAIL 13MM 36CM FEM IM CANN TI STRL,"$2,956.30",$0.00,"$2,956.30","$1,330.34","$2,109.91",$0.00,$509.36,$0.00,$0.00,$517.62,"$2,956.30",$0.00,"$1,478.15","$2,341.39","$2,365.04",$0.00,$462.66,$0.00,$470.64,$0.00
474.338S,SUP,HCPCS C1713,,474.338S  -  NAIL 13MM 38CM FEM IM CANN TI STRL,"$2,956.30",$0.00,"$2,956.30","$1,330.34","$2,109.91",$0.00,$509.36,$0.00,$0.00,$517.62,"$2,956.30",$0.00,"$1,478.15","$2,341.39","$2,365.04",$0.00,$462.66,$0.00,$470.64,$0.00
474.341S,SUP,HCPCS C1713,,474.341S  -  NAIL 13MM 40CM FEM IM CANN TI STRL,"$2,956.30",$0.00,"$2,956.30","$1,330.34","$2,109.91",$0.00,$509.36,$0.00,$0.00,$517.62,"$2,956.30",$0.00,"$1,478.15","$2,341.39","$2,365.04",$0.00,$462.66,$0.00,$470.64,$0.00
474.342S,SUP,HCPCS C1713,,474.342S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 420MM CANN FLUTED BARREL,"$2,492.88",$0.00,"$2,492.88","$1,121.79","$1,779.16",$0.00,$429.51,$0.00,$0.00,$436.48,"$2,492.88",$0.00,"$1,246.44","$1,974.36","$1,994.30",$0.00,$390.13,$0.00,$396.87,$0.00
474.344S,SUP,HCPCS C1713,,474.344S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 440MM CANN FLUTED BARREL,"$2,492.88",$0.00,"$2,492.88","$1,121.79","$1,779.16",$0.00,$429.51,$0.00,$0.00,$436.48,"$2,492.88",$0.00,"$1,246.44","$1,974.36","$1,994.30",$0.00,$390.13,$0.00,$396.87,$0.00
474.346S,SUP,HCPCS C1713,,474.346S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 460MM CANN FLUTED BARREL,"$2,492.88",$0.00,"$2,492.88","$1,121.79","$1,779.16",$0.00,$429.51,$0.00,$0.00,$436.48,"$2,492.88",$0.00,"$1,246.44","$1,974.36","$1,994.30",$0.00,$390.13,$0.00,$396.87,$0.00
474.348S,SUP,HCPCS C1713,,474.348S  -  NAIL INTRAMEDULLARY UNIVERSAL 13MM 480MM CANN FLUTED BARREL,"$2,492.88",$0.00,"$2,492.88","$1,121.79","$1,779.16",$0.00,$429.51,$0.00,$0.00,$436.48,"$2,492.88",$0.00,"$1,246.44","$1,974.36","$1,994.30",$0.00,$390.13,$0.00,$396.87,$0.00
474.431S,SUP,HCPCS C1713,,474.431S  -  NAIL 14MM 30CM FEM IM CANN TI STRL GRN,"$2,956.30",$0.00,"$2,956.30","$1,330.34","$2,109.91",$0.00,$509.36,$0.00,$0.00,$517.62,"$2,956.30",$0.00,"$1,478.15","$2,341.39","$2,365.04",$0.00,$462.66,$0.00,$470.64,$0.00
474.432S,SUP,HCPCS C1713,,474.432S  -  NAIL INTRAMEDULLARY UNIVERSAL 14MM 320MM CANN FLUTED BARREL,"$2,492.88",$0.00,"$2,492.88","$1,121.79","$1,779.16",$0.00,$429.51,$0.00,$0.00,$436.48,"$2,492.88",$0.00,"$1,246.44","$1,974.36","$1,994.30",$0.00,$390.13,$0.00,$396.87,$0.00
474.434S,SUP,HCPCS C1713,,474.434S  -  NAIL INTRAMEDULLARY UNIVERSAL 14MM 340MM CANN FLUTED BARREL,"$2,492.88",$0.00,"$2,492.88","$1,121.79","$1,779.16",$0.00,$429.51,$0.00,$0.00,$436.48,"$2,492.88",$0.00,"$1,246.44","$1,974.36","$1,994.30",$0.00,$390.13,$0.00,$396.87,$0.00
474.436S,SUP,HCPCS C1713,,474.436S  -  NAIL INTRAMEDULLARY UNIVERSAL 14MM 360MM CANN FLUTED BARREL,"$2,492.88",$0.00,"$2,492.88","$1,121.79","$1,779.16",$0.00,$429.51,$0.00,$0.00,$436.48,"$2,492.88",$0.00,"$1,246.44","$1,974.36","$1,994.30",$0.00,$390.13,$0.00,$396.87,$0.00
474.438S,SUP,HCPCS C1713,,474.438S  -  NAIL INTRAMEDULLARY UNIVERSAL 14MM 380MM CANN FLUTED BARREL,"$2,492.88",$0.00,"$2,492.88","$1,121.79","$1,779.16",$0.00,$429.51,$0.00,$0.00,$436.48,"$2,492.88",$0.00,"$1,246.44","$1,974.36","$1,994.30",$0.00,$390.13,$0.00,$396.87,$0.00
474.441S,SUP,HCPCS C1713,,474.441S  -  NAIL INTRAMEDULLARY UNIVERSAL 14MM 400MM CANN FLUTED BARREL,"$2,492.88",$0.00,"$2,492.88","$1,121.79","$1,779.16",$0.00,$429.51,$0.00,$0.00,$436.48,"$2,492.88",$0.00,"$1,246.44","$1,974.36","$1,994.30",$0.00,$390.13,$0.00,$396.87,$0.00
474.442S,SUP,HCPCS C1713,,474.442S  -  NAIL INTRAMEDULLARY UNIVERSAL 14MM 420MM CANN FLUTED BARREL,"$2,492.88",$0.00,"$2,492.88","$1,121.79","$1,779.16",$0.00,$429.51,$0.00,$0.00,$436.48,"$2,492.88",$0.00,"$1,246.44","$1,974.36","$1,994.30",$0.00,$390.13,$0.00,$396.87,$0.00
474.444S,SUP,HCPCS C1713,,474.444S  -  NAIL INTRAMEDULLARY UNIVERSAL 14MM 440MM CANN FLUTED BARREL,"$2,492.88",$0.00,"$2,492.88","$1,121.79","$1,779.16",$0.00,$429.51,$0.00,$0.00,$436.48,"$2,492.88",$0.00,"$1,246.44","$1,974.36","$1,994.30",$0.00,$390.13,$0.00,$396.87,$0.00
474.446S,SUP,HCPCS C1713,,474.446S  -  NAIL INTRAMEDULLARY UNIVERSAL 14MM 460MM CANN FLUTED BARREL,"$2,492.88",$0.00,"$2,492.88","$1,121.79","$1,779.16",$0.00,$429.51,$0.00,$0.00,$436.48,"$2,492.88",$0.00,"$1,246.44","$1,974.36","$1,994.30",$0.00,$390.13,$0.00,$396.87,$0.00
474.448S,SUP,HCPCS C1713,,474.448S  -  NAIL INTRAMEDULLARY UNIVERSAL 14MM 480MM CANN FLUTED BARREL,"$2,492.88",$0.00,"$2,492.88","$1,121.79","$1,779.16",$0.00,$429.51,$0.00,$0.00,$436.48,"$2,492.88",$0.00,"$1,246.44","$1,974.36","$1,994.30",$0.00,$390.13,$0.00,$396.87,$0.00
474.531S,SUP,HCPCS C1713,,474.531S  -  NAIL INTRAMEDULLARY UNIVERSAL 15MM 300MM CANN FLUTED BARREL,"$2,574.00",$0.00,"$2,574.00","$1,158.30","$1,837.06",$0.00,$443.49,$0.00,$0.00,$450.69,"$2,574.00",$0.00,"$1,287.00","$2,038.61","$2,059.20",$0.00,$402.83,$0.00,$409.78,$0.00
474.532S,SUP,HCPCS C1713,,474.532S  -  NAIL 15MM 32CM FEM IM CANN TI STRL GRN,"$2,956.30",$0.00,"$2,956.30","$1,330.34","$2,109.91",$0.00,$509.36,$0.00,$0.00,$517.62,"$2,956.30",$0.00,"$1,478.15","$2,341.39","$2,365.04",$0.00,$462.66,$0.00,$470.64,$0.00
474.534S,SUP,HCPCS C1713,,474.534S  -  NAIL INTRAMEDULLARY UNIVERSAL 15MM 340MM CANN FLUTED BARREL,"$2,574.00",$0.00,"$2,574.00","$1,158.30","$1,837.06",$0.00,$443.49,$0.00,$0.00,$450.69,"$2,574.00",$0.00,"$1,287.00","$2,038.61","$2,059.20",$0.00,$402.83,$0.00,$409.78,$0.00
474.536S,SUP,HCPCS C1713,,474.536S  -  NAIL 15MM 36CM FEM IM CANN TI STRL GRN,"$2,956.30",$0.00,"$2,956.30","$1,330.34","$2,109.91",$0.00,$509.36,$0.00,$0.00,$517.62,"$2,956.30",$0.00,"$1,478.15","$2,341.39","$2,365.04",$0.00,$462.66,$0.00,$470.64,$0.00
474.538S,SUP,HCPCS C1713,,474.538S  -  NAIL INTRAMEDULLARY UNIVERSAL 15MM 380MM CANN FLUTED BARREL,"$2,574.00",$0.00,"$2,574.00","$1,158.30","$1,837.06",$0.00,$443.49,$0.00,$0.00,$450.69,"$2,574.00",$0.00,"$1,287.00","$2,038.61","$2,059.20",$0.00,$402.83,$0.00,$409.78,$0.00
474.541S,SUP,HCPCS C1713,,474.541S  -  NAIL 15MM 40CM FEM IM CANN TI STRL,"$2,956.30",$0.00,"$2,956.30","$1,330.34","$2,109.91",$0.00,$509.36,$0.00,$0.00,$517.62,"$2,956.30",$0.00,"$1,478.15","$2,341.39","$2,365.04",$0.00,$462.66,$0.00,$470.64,$0.00
474.542S,SUP,HCPCS C1713,,474.542S  -  NAIL INTRAMEDULLARY UNIVERSAL 15MM 420MM CANN FLUTED BARREL,"$2,574.00",$0.00,"$2,574.00","$1,158.30","$1,837.06",$0.00,$443.49,$0.00,$0.00,$450.69,"$2,574.00",$0.00,"$1,287.00","$2,038.61","$2,059.20",$0.00,$402.83,$0.00,$409.78,$0.00
474.544S,SUP,HCPCS C1713,,474.544S  -  NAIL 15MM 44CM FEM IM CANN TI STRL GRN,"$2,956.30",$0.00,"$2,956.30","$1,330.34","$2,109.91",$0.00,$509.36,$0.00,$0.00,$517.62,"$2,956.30",$0.00,"$1,478.15","$2,341.39","$2,365.04",$0.00,$462.66,$0.00,$470.64,$0.00
474.546S,SUP,HCPCS C1713,,474.546S  -  NAIL INTRAMEDULLARY UNIVERSAL 15MM 460MM CANN FLUTED BARREL,"$2,574.00",$0.00,"$2,574.00","$1,158.30","$1,837.06",$0.00,$443.49,$0.00,$0.00,$450.69,"$2,574.00",$0.00,"$1,287.00","$2,038.61","$2,059.20",$0.00,$402.83,$0.00,$409.78,$0.00
474.548S,SUP,HCPCS C1713,,474.548S  -  NAIL INTRAMEDULLARY UNIVERSAL 15MM 480MM CANN FLUTED BARREL,"$2,574.00",$0.00,"$2,574.00","$1,158.30","$1,837.06",$0.00,$443.49,$0.00,$0.00,$450.69,"$2,574.00",$0.00,"$1,287.00","$2,038.61","$2,059.20",$0.00,$402.83,$0.00,$409.78,$0.00
474.900S,SUP,HCPCS C1713,,474.900S  -  SLEEVE LCK STD GRN STRL TI FEM 13-15MM NL,$669.63,$0.00,$669.63,$301.33,$477.91,$0.00,$115.37,$0.00,$0.00,$117.25,$669.63,$0.00,$334.81,$530.35,$535.70,$0.00,$104.80,$0.00,$106.60,$0.00
474.910S,SUP,HCPCS C1713,,474.910S  -  SLEEVE LOCKING 100D BLUE TITANIUM FEMUR STERILE 13-15MM CANN,$756.25,$0.00,$756.25,$340.31,$539.74,$0.00,$130.30,$0.00,$0.00,$132.41,$756.25,$0.00,$378.13,$598.95,$605.00,$0.00,$118.35,$0.00,$120.40,$0.00
474.911S,SUP,HCPCS C1713,,474.911S  -  SLEEVE LOCKING 110D BLUE TITANIUM FEMUR STERILE 13-15MM CANN,$756.25,$0.00,$756.25,$340.31,$539.74,$0.00,$130.30,$0.00,$0.00,$132.41,$756.25,$0.00,$378.13,$598.95,$605.00,$0.00,$118.35,$0.00,$120.40,$0.00
474.912S,SUP,HCPCS C1713,,474.912S  -  SLEEVE LOCKING 120D BLUE TITANIUM FEMUR STERILE 13-15MM CANN,$756.25,$0.00,$756.25,$340.31,$539.74,$0.00,$130.30,$0.00,$0.00,$132.41,$756.25,$0.00,$378.13,$598.95,$605.00,$0.00,$118.35,$0.00,$120.40,$0.00
474.913S,SUP,HCPCS C1713,,474.913S  -  SLEEVE LOCKING 130D ANTEGRADE PINK TITANIUM FEMUR STERILE,$756.25,$0.00,$756.25,$340.31,$539.74,$0.00,$130.30,$0.00,$0.00,$132.41,$756.25,$0.00,$378.13,$598.95,$605.00,$0.00,$118.35,$0.00,$120.40,$0.00
474.920S,SUP,Custom 27803010,,474.920S  -  CAP END 0MM 15MM EXTEND GREEN TITANIUM FEMUR STERILE 13-15MM,$446.88,$0.00,$446.88,$0.00,$318.93,$0.00,$0.00,$0.00,$0.00,$0.00,$446.88,$0.00,$223.44,$353.93,$357.50,$0.00,$0.00,$0.00,$0.00,$0.00
474.921S,SUP,Custom 27803010,,474.921S  -  CAP END 10MM 15MM EXTEND GREEN TITANIUM FEMUR STERILE 13-15,$446.88,$0.00,$446.88,$0.00,$318.93,$0.00,$0.00,$0.00,$0.00,$0.00,$446.88,$0.00,$223.44,$353.93,$357.50,$0.00,$0.00,$0.00,$0.00,$0.00
474.922S,SUP,Custom 27803010,,474.922S  -  CAP END 20MM 15MM EXTEND GREEN TITANIUM FEMUR STERILE 13-15,$446.88,$0.00,$446.88,$0.00,$318.93,$0.00,$0.00,$0.00,$0.00,$0.00,$446.88,$0.00,$223.44,$353.93,$357.50,$0.00,$0.00,$0.00,$0.00,$0.00
475.900S,SUP,Custom 27803010,,475.900S  -  CAP END GREEN TITANIUM STERILE 3-4MM ELAST INTRAMEDULLARY,$240.20,$0.00,$240.20,$0.00,$171.43,$0.00,$0.00,$0.00,$0.00,$0.00,$240.20,$0.00,$120.10,$190.24,$192.16,$0.00,$0.00,$0.00,$0.00,$0.00
475.905S,SUP,Custom 27803010,,475.905S  -  CAP END ROSE RED TAN STERILE TEN SYSTEM,$240.20,$0.00,$240.20,$0.00,$171.43,$0.00,$0.00,$0.00,$0.00,$0.00,$240.20,$0.00,$120.10,$190.24,$192.16,$0.00,$0.00,$0.00,$0.00,$0.00
475.915S,SUP,HCPCS C1713,,475.915S  -  NAIL INTRAMEDULLARY 1.5MM 300MM ELAST PURPLE TITANIUM,$555.45,$0.00,$555.45,$249.95,$396.42,$0.00,$92.91,$0.00,$0.00,$97.25,$555.45,$0.00,$277.73,$439.92,$444.36,$0.00,$84.40,$0.00,$88.43,$0.00
475.920S,SUP,HCPCS C1713,,475.920S  -  NAIL INTRAMEDULLARY 2MM 440MM ELAST GREEN TITANIUM OLECRANON,$586.85,$0.00,$586.85,$264.08,$418.83,$0.00,$98.17,$0.00,$0.00,$102.75,$586.85,$0.00,$293.43,$464.79,$469.48,$0.00,$89.17,$0.00,$93.43,$0.00
475.925S,SUP,HCPCS C1713,,475.925S  -  NAIL INTRAMEDULLARY 2.5MM 440MM ELAST PINK TITANIUM,$623.70,$0.00,$623.70,$280.67,$445.13,$0.00,$104.33,$0.00,$0.00,$109.20,$623.70,$0.00,$311.85,$493.97,$498.96,$0.00,$94.76,$0.00,$99.29,$0.00
475.930S,SUP,HCPCS C1713,,475.930S  -  NAIL INTRAMEDULLARY 3MM 440MM ELAST GOLD TITANIUM OLECRANON,$655.08,$0.00,$655.08,$294.78,$467.53,$0.00,$109.58,$0.00,$0.00,$114.70,$655.08,$0.00,$327.54,$518.82,$524.06,$0.00,$99.53,$0.00,$104.29,$0.00
475.935S,SUP,HCPCS C1713,,475.935S  -  NAIL INTRAMEDULLARY 3.5MM 440MM ELAST BLUE TITANIUM,$686.48,$0.00,$686.48,$308.91,$489.94,$0.00,$114.83,$0.00,$0.00,$120.20,$686.48,$0.00,$343.24,$543.69,$549.18,$0.00,$104.30,$0.00,$109.29,$0.00
475.940S,SUP,HCPCS C1713,,475.940S  -  NAIL INTRAMEDULLARY 4MM 440MM ELAST PURPLE TITANIUM,$730.15,$0.00,$730.15,$328.57,$521.11,$0.00,$122.14,$0.00,$0.00,$127.84,$730.15,$0.00,$365.08,$578.28,$584.12,$0.00,$110.94,$0.00,$116.24,$0.00
47525P,SUP,HCPCS C1713,,47525P  -  SCREW BN 4.75MM 25MM SPRL R90D MULTIANGLE LCK TI SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
47525S,SUP,HCPCS C1713,,47525S  -  SCREW BN STD 4.75MM 25MM SPRL R90D LCK TI SPNE THORLMBR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
47530P,SUP,HCPCS C1713,,47530P  -  SCREW BN 4.75MM 30MM SPRL R90D MULTIANGLE LCK TI SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
47530S,SUP,HCPCS C1713,,47530S  -  SCREW BN STD 4.75MM 30MM SPRL R90D LCK TI SPNE THORLMBR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
47535P,SUP,HCPCS C1713,,47535P  -  SCREW BN 4.75MM 35MM SPRL R90D MULTIANGLE LCK TI SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
47535S,SUP,HCPCS C1713,,47535S  -  SCREW BN STD 4.75MM 35MM SPRL R90D LCK TI SPNE THORLMBR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
47540P,SUP,HCPCS C1713,,47540P  -  SCREW BN 4.75MM 40MM SPRL R90D MULTIANGLE LCK TI SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
47540S,SUP,HCPCS C1713,,47540S  -  SCREW BN STD 4.75MM 40MM SPRL R90D LCK TI SPNE THORLMBR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
47545P,SUP,HCPCS C1713,,47545P  -  SCREW BN 4.75MM 45MM SPRL R90D MULTIANGLE LCK TI SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
47545S,SUP,HCPCS C1713,,47545S  -  SCREW BN STD 4.75MM 45MM SPRL R90D LCK TI SPNE THORLMBR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
47550P,SUP,HCPCS C1713,,47550P  -  SCREW BN 4.75MM 50MM SPRL R90D MULTIANGLE LCK TI SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
47550S,SUP,HCPCS C1713,,47550S  -  SCREW BN STD 4.75MM 50MM SPRL R90D LCK TI SPNE THORLMBR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
47555P,SUP,HCPCS C1713,,47555P  -  SCREW BN 4.75MM 55MM SPRL R90D MULTIANGLE LCK TI SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
47555S,SUP,HCPCS C1713,,47555S  -  SCREW BN STD 4.75MM 55MM SPRL R90D LCK TI SPNE THORLMBR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
476.25S,SUP,HCPCS C1713,,476.25S  -  NAIL INTRAMEDULLARY 10MM 25.5CM SOLID TITANIUM TIBIA STERILE,"$2,517.63",$0.00,"$2,517.63","$1,132.93","$1,796.83",$0.00,$433.77,$0.00,$0.00,$440.82,"$2,517.63",$0.00,"$1,258.81","$1,993.96","$2,014.10",$0.00,$394.01,$0.00,$400.81,$0.00
476.27S,SUP,HCPCS C1713,,476.27S  -  NAIL INTRAMEDULLARY 10MM 27CM SOLID TITANIUM TIBIA STERILE,"$2,517.63",$0.00,"$2,517.63","$1,132.93","$1,796.83",$0.00,$433.77,$0.00,$0.00,$440.82,"$2,517.63",$0.00,"$1,258.81","$1,993.96","$2,014.10",$0.00,$394.01,$0.00,$400.81,$0.00
476.28S,SUP,HCPCS C1713,,476.28S  -  NAIL INTRAMEDULLARY 10MM 28.5CM SOLID TITANIUM TIBIA STERILE,"$2,517.63",$0.00,"$2,517.63","$1,132.93","$1,796.83",$0.00,$433.77,$0.00,$0.00,$440.82,"$2,517.63",$0.00,"$1,258.81","$1,993.96","$2,014.10",$0.00,$394.01,$0.00,$400.81,$0.00
476.30S,SUP,HCPCS C1713,,476.30S  -  NAIL INTRAMEDULLARY 10MM 30CM SOLID TITANIUM TIBIA STERILE,"$2,517.63",$0.00,"$2,517.63","$1,132.93","$1,796.83",$0.00,$433.77,$0.00,$0.00,$440.82,"$2,517.63",$0.00,"$1,258.81","$1,993.96","$2,014.10",$0.00,$394.01,$0.00,$400.81,$0.00
476.31S,SUP,HCPCS C1713,,476.31S  -  NAIL INTRAMEDULLARY 10MM 31.5CM SOLID TITANIUM TIBIA STERILE,"$2,517.63",$0.00,"$2,517.63","$1,132.93","$1,796.83",$0.00,$433.77,$0.00,$0.00,$440.82,"$2,517.63",$0.00,"$1,258.81","$1,993.96","$2,014.10",$0.00,$394.01,$0.00,$400.81,$0.00
476.33S,SUP,HCPCS C1713,,476.33S  -  NAIL INTRAMEDULLARY 10MM 33CM SOLID TITANIUM TIBIA STERILE,"$2,517.63",$0.00,"$2,517.63","$1,132.93","$1,796.83",$0.00,$433.77,$0.00,$0.00,$440.82,"$2,517.63",$0.00,"$1,258.81","$1,993.96","$2,014.10",$0.00,$394.01,$0.00,$400.81,$0.00
476.34S,SUP,HCPCS C1713,,476.34S  -  NAIL INTRAMEDULLARY 10MM 34.5CM SOLID TITANIUM TIBIA STERILE,"$2,517.63",$0.00,"$2,517.63","$1,132.93","$1,796.83",$0.00,$433.77,$0.00,$0.00,$440.82,"$2,517.63",$0.00,"$1,258.81","$1,993.96","$2,014.10",$0.00,$394.01,$0.00,$400.81,$0.00
476.36S,SUP,HCPCS C1713,,476.36S  -  NAIL INTRAMEDULLARY 10MM 36CM SOLID BLUE TITANIUM TIBIA,"$2,517.63",$0.00,"$2,517.63","$1,132.93","$1,796.83",$0.00,$433.77,$0.00,$0.00,$440.82,"$2,517.63",$0.00,"$1,258.81","$1,993.96","$2,014.10",$0.00,$394.01,$0.00,$400.81,$0.00
476.38S,SUP,HCPCS C1713,,476.38S  -  NAIL INTRAMEDULLARY 10MM 38CM SOLID TITANIUM TIBIA STERILE,"$2,517.63",$0.00,"$2,517.63","$1,132.93","$1,796.83",$0.00,$433.77,$0.00,$0.00,$440.82,"$2,517.63",$0.00,"$1,258.81","$1,993.96","$2,014.10",$0.00,$394.01,$0.00,$400.81,$0.00
476.40S,SUP,HCPCS C1713,,476.40S  -  NAIL INTRAMEDULLARY 10MM 40CM SOLID TITANIUM TIBIA STERILE,"$2,517.63",$0.00,"$2,517.63","$1,132.93","$1,796.83",$0.00,$433.77,$0.00,$0.00,$440.82,"$2,517.63",$0.00,"$1,258.81","$1,993.96","$2,014.10",$0.00,$394.01,$0.00,$400.81,$0.00
476.42S,SUP,HCPCS C1713,,476.42S  -  NAIL INTRAMEDULLARY 10MM 42CM SOLID TITANIUM TIBIA STERILE,"$2,517.63",$0.00,"$2,517.63","$1,132.93","$1,796.83",$0.00,$433.77,$0.00,$0.00,$440.82,"$2,517.63",$0.00,"$1,258.81","$1,993.96","$2,014.10",$0.00,$394.01,$0.00,$400.81,$0.00
478.25S,SUP,HCPCS C1713,,478.25S  -  NAIL INTRAMEDULLARY 8MM 25.5CM SOLID BLUE TITANIUM TIBIA,"$2,517.63",$0.00,"$2,517.63","$1,132.93","$1,796.83",$0.00,$433.77,$0.00,$0.00,$440.82,"$2,517.63",$0.00,"$1,258.81","$1,993.96","$2,014.10",$0.00,$394.01,$0.00,$400.81,$0.00
478.27S,SUP,HCPCS C1713,,478.27S  -  NAIL 8MM 27CM TIB IM SLD TI STRL,"$2,814.73",$0.00,"$2,814.73","$1,266.63","$2,008.87",$0.00,$484.96,$0.00,$0.00,$492.84,"$2,814.73",$0.00,"$1,407.36","$2,229.27","$2,251.78",$0.00,$440.50,$0.00,$448.10,$0.00
478.28S,SUP,HCPCS C1713,,478.28S  -  NAIL INTRAMEDULLARY 8MM 28.5CM SOLID TITANIUM TIBIA STERILE,"$2,450.25",$0.00,"$2,450.25","$1,102.61","$1,748.74",$0.00,$422.17,$0.00,$0.00,$429.02,"$2,450.25",$0.00,"$1,225.13","$1,940.60","$1,960.20",$0.00,$383.46,$0.00,$390.08,$0.00
478.30S,SUP,HCPCS C1713,,478.30S  -  NAIL INTRAMEDULLARY 8MM 30CM SOLID TITANIUM TIBIA STERILE,"$2,450.25",$0.00,"$2,450.25","$1,102.61","$1,748.74",$0.00,$422.17,$0.00,$0.00,$429.02,"$2,450.25",$0.00,"$1,225.13","$1,940.60","$1,960.20",$0.00,$383.46,$0.00,$390.08,$0.00
478.31S,SUP,HCPCS C1713,,478.31S  -  NAIL 8MM 31.5CM TIB IM SLD TI STRL,"$2,814.73",$0.00,"$2,814.73","$1,266.63","$2,008.87",$0.00,$484.96,$0.00,$0.00,$492.84,"$2,814.73",$0.00,"$1,407.36","$2,229.27","$2,251.78",$0.00,$440.50,$0.00,$448.10,$0.00
478.33S,SUP,HCPCS C1713,,478.33S  -  NAIL 8MM 33CM TIB IM SLD TI STRL,"$2,814.73",$0.00,"$2,814.73","$1,266.63","$2,008.87",$0.00,$484.96,$0.00,$0.00,$492.84,"$2,814.73",$0.00,"$1,407.36","$2,229.27","$2,251.78",$0.00,$440.50,$0.00,$448.10,$0.00
478.34S,SUP,HCPCS C1713,,478.34S  -  NAIL 8MM 34.5CM TIB IM SLD TI STRL,"$2,814.73",$0.00,"$2,814.73","$1,266.63","$2,008.87",$0.00,$484.96,$0.00,$0.00,$492.84,"$2,814.73",$0.00,"$1,407.36","$2,229.27","$2,251.78",$0.00,$440.50,$0.00,$448.10,$0.00
478.36S,SUP,HCPCS C1713,,478.36S  -  NAIL 8MM 36CM TIB IM SLD TI STRL,"$2,814.73",$0.00,"$2,814.73","$1,266.63","$2,008.87",$0.00,$484.96,$0.00,$0.00,$492.84,"$2,814.73",$0.00,"$1,407.36","$2,229.27","$2,251.78",$0.00,$440.50,$0.00,$448.10,$0.00
478.38S,SUP,HCPCS C1713,,478.38S  -  NAIL INTRAMEDULLARY 8MM 38CM SOLID TITANIUM TIBIA STERILE,"$2,450.25",$0.00,"$2,450.25","$1,102.61","$1,748.74",$0.00,$422.17,$0.00,$0.00,$429.02,"$2,450.25",$0.00,"$1,225.13","$1,940.60","$1,960.20",$0.00,$383.46,$0.00,$390.08,$0.00
478.40S,SUP,HCPCS C1713,,478.40S  -  NAIL 8MM 40CM TIB IM SLD TI STRL,"$2,814.73",$0.00,"$2,814.73","$1,266.63","$2,008.87",$0.00,$484.96,$0.00,$0.00,$492.84,"$2,814.73",$0.00,"$1,407.36","$2,229.27","$2,251.78",$0.00,$440.50,$0.00,$448.10,$0.00
478.42S,SUP,HCPCS C1713,,478.42S  -  NAIL INTRAMEDULLARY 8MM 42CM SOLID BLUE TITANIUM TIBIA,"$2,517.63",$0.00,"$2,517.63","$1,132.93","$1,796.83",$0.00,$433.77,$0.00,$0.00,$440.82,"$2,517.63",$0.00,"$1,258.81","$1,993.96","$2,014.10",$0.00,$394.01,$0.00,$400.81,$0.00
479.25S,SUP,HCPCS C1713,,479.25S  -  NAIL INTRAMEDULLARY 9MM 25.5CM SOLID BLUE TITANIUM TIBIA,"$2,517.63",$0.00,"$2,517.63","$1,132.93","$1,796.83",$0.00,$433.77,$0.00,$0.00,$440.82,"$2,517.63",$0.00,"$1,258.81","$1,993.96","$2,014.10",$0.00,$394.01,$0.00,$400.81,$0.00
479.27S,SUP,HCPCS C1713,,479.27S  -  NAIL INTRAMEDULLARY 9MM 27CM SOLID BLUE TITANIUM TIBIA,"$2,517.63",$0.00,"$2,517.63","$1,132.93","$1,796.83",$0.00,$433.77,$0.00,$0.00,$440.82,"$2,517.63",$0.00,"$1,258.81","$1,993.96","$2,014.10",$0.00,$394.01,$0.00,$400.81,$0.00
479.28S,SUP,HCPCS C1713,,479.28S  -  NAIL INTRAMEDULLARY 9MM 28.5CM SOLID TITANIUM TIBIA STERILE,"$2,517.63",$0.00,"$2,517.63","$1,132.93","$1,796.83",$0.00,$433.77,$0.00,$0.00,$440.82,"$2,517.63",$0.00,"$1,258.81","$1,993.96","$2,014.10",$0.00,$394.01,$0.00,$400.81,$0.00
479.30S,SUP,HCPCS C1713,,479.30S  -  NAIL INTRAMEDULLARY 9MM 30CM SOLID BLUE TITANIUM TIBIA,"$2,450.25",$0.00,"$2,450.25","$1,102.61","$1,748.74",$0.00,$422.17,$0.00,$0.00,$429.02,"$2,450.25",$0.00,"$1,225.13","$1,940.60","$1,960.20",$0.00,$383.46,$0.00,$390.08,$0.00
479.31S,SUP,HCPCS C1713,,479.31S  -  NAIL INTRAMEDULLARY 9MM 315MM SOLID BLUE TITANIUM TIBIAL,"$2,450.25",$0.00,"$2,450.25","$1,102.61","$1,748.74",$0.00,$422.17,$0.00,$0.00,$429.02,"$2,450.25",$0.00,"$1,225.13","$1,940.60","$1,960.20",$0.00,$383.46,$0.00,$390.08,$0.00
479.33S,SUP,HCPCS C1713,,479.33S  -  NAIL INTRAMEDULLARY 9MM 330MM SOLID BLUE TITANIUM TIBIAL,"$2,450.25",$0.00,"$2,450.25","$1,102.61","$1,748.74",$0.00,$422.17,$0.00,$0.00,$429.02,"$2,450.25",$0.00,"$1,225.13","$1,940.60","$1,960.20",$0.00,$383.46,$0.00,$390.08,$0.00
479.34S,SUP,HCPCS C1713,,479.34S  -  NAIL INTRAMEDULLARY 9MM 34.5CM SOLID BLUE TITANIUM TIBIA,"$2,450.25",$0.00,"$2,450.25","$1,102.61","$1,748.74",$0.00,$422.17,$0.00,$0.00,$429.02,"$2,450.25",$0.00,"$1,225.13","$1,940.60","$1,960.20",$0.00,$383.46,$0.00,$390.08,$0.00
479.36S,SUP,HCPCS C1713,,479.36S  -  NAIL INTRAMEDULLARY 9MM 36CM SOLID BLUE TITANIUM TIBIA,"$2,450.25",$0.00,"$2,450.25","$1,102.61","$1,748.74",$0.00,$422.17,$0.00,$0.00,$429.02,"$2,450.25",$0.00,"$1,225.13","$1,940.60","$1,960.20",$0.00,$383.46,$0.00,$390.08,$0.00
479.38S,SUP,HCPCS C1713,,479.38S  -  NAIL INTRAMEDULLARY 9MM 38CM SOLID TITANIUM TIBIA STERILE,"$2,450.25",$0.00,"$2,450.25","$1,102.61","$1,748.74",$0.00,$422.17,$0.00,$0.00,$429.02,"$2,450.25",$0.00,"$1,225.13","$1,940.60","$1,960.20",$0.00,$383.46,$0.00,$390.08,$0.00
479.40S,SUP,HCPCS C1713,,479.40S  -  NAIL INTRAMEDULLARY 9MM 40CM SOLID BLUE TITANIUM TIBIA,"$2,517.63",$0.00,"$2,517.63","$1,132.93","$1,796.83",$0.00,$433.77,$0.00,$0.00,$440.82,"$2,517.63",$0.00,"$1,258.81","$1,993.96","$2,014.10",$0.00,$394.01,$0.00,$400.81,$0.00
479.42S,SUP,HCPCS C1713,,479.42S  -  NAIL INTRAMEDULLARY 9MM 42CM SOLID BLUE TITANIUM TIBIA,"$2,517.63",$0.00,"$2,517.63","$1,132.93","$1,796.83",$0.00,$433.77,$0.00,$0.00,$440.82,"$2,517.63",$0.00,"$1,258.81","$1,993.96","$2,014.10",$0.00,$394.01,$0.00,$400.81,$0.00
4806-100-20,SUP,Custom 27203010,,4806-100-20  -  BIT DRL 2MM 100MM QCK CNCT,$136.85,$0.00,$136.85,$0.00,$97.67,$0.00,$0.00,$0.00,$0.00,$0.00,$136.85,$0.00,$68.43,$108.39,$109.48,$0.00,$0.00,$0.00,$0.00,$0.00
4806-100-27,SUP,Custom 27203010,,4806-100-27  -  BIT DRL 2.7MM,$136.85,$0.00,$136.85,$0.00,$97.67,$0.00,$0.00,$0.00,$0.00,$0.00,$136.85,$0.00,$68.43,$108.39,$109.48,$0.00,$0.00,$0.00,$0.00,$0.00
4806-110-25,SUP,Custom 27203010,,4806-110-25  -  BIT DRL 2.5MM 110MM QCK CNCT,$136.85,$0.00,$136.85,$0.00,$97.67,$0.00,$0.00,$0.00,$0.00,$0.00,$136.85,$0.00,$68.43,$108.39,$109.48,$0.00,$0.00,$0.00,$0.00,$0.00
4806-110-35,SUP,Custom 27203010,,4806-110-35  -  BIT DRL 3.5MM,$136.85,$0.00,$136.85,$0.00,$97.67,$0.00,$0.00,$0.00,$0.00,$0.00,$136.85,$0.00,$68.43,$108.39,$109.48,$0.00,$0.00,$0.00,$0.00,$0.00
4807-180-25,SUP,Custom 27203010,,4807-180-25  -  BIT DRILL 180MM 2.5MM SS QC NONSTRL,$136.85,$0.00,$136.85,$0.00,$97.67,$0.00,$0.00,$0.00,$0.00,$0.00,$136.85,$0.00,$68.43,$108.39,$109.48,$0.00,$0.00,$0.00,$0.00,$0.00
4809-27,SUP,Custom 27203010,,"4809-27  -  COUNTERSINK, Q-C, FOR 2.7MM SCREWS",$211.60,$0.00,$211.60,$0.00,$151.02,$0.00,$0.00,$0.00,$0.00,$0.00,$211.60,$0.00,$105.80,$167.59,$169.28,$0.00,$0.00,$0.00,$0.00,$0.00
4811-100-27,SUP,Custom 27203010,,4811-100-27  -  TAP 100MM QC SURG SS PERIART 2.7MM SCR NONSTRL,$163.30,$0.00,$163.30,$0.00,$116.55,$0.00,$0.00,$0.00,$0.00,$0.00,$163.30,$0.00,$81.65,$129.33,$130.64,$0.00,$0.00,$0.00,$0.00,$0.00
4811-110-35,SUP,Custom 27203010,,4811-110-35  -  TAP 110MM QC SURG SS PERIART 3.5MM SCR NONSTRL,$163.30,$0.00,$163.30,$0.00,$116.55,$0.00,$0.00,$0.00,$0.00,$0.00,$163.30,$0.00,$81.65,$129.33,$130.64,$0.00,$0.00,$0.00,$0.00,$0.00
4811-110-40,SUP,Custom 27203010,,4811-110-40  -  TAP 110MM QC SURG SS PERIART 4MM SCR NONSTRL,$163.30,$0.00,$163.30,$0.00,$116.55,$0.00,$0.00,$0.00,$0.00,$0.00,$163.30,$0.00,$81.65,$129.33,$130.64,$0.00,$0.00,$0.00,$0.00,$0.00
48210-025,SUP,Custom 27203010,,48210-025  -  TAPE DRSG 72YDX.5IN TWL BLCH CTTN WHT,$156.02,$0.00,$156.02,$0.00,$111.35,$0.00,$0.00,$0.00,$0.00,$0.00,$156.02,$0.00,$78.01,$123.57,$124.81,$0.00,$0.00,$0.00,$0.00,$0.00
48230260R,SUP,Custom 27803010,,48230260R  -  HOOK SPNL XIA 3 TI AL VNDM SCRL RT,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
4845-0101,SUP,HCPCS C1776,,4845-0101  -  STEM FEM 1 8.5MM 100MM ABG II V40 TMZF HA HIP RT,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
4845-0102,SUP,HCPCS C1776,,4845-0102  -  STEM FEM 2 8.5MM 100MM ABG II V40 TMZF HA HIP RT,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
4845-0103,SUP,HCPCS C1776,,4845-0103  -  STEM FEM 3 9MM 110MM ABG II V40 TMZF HA HIP RT,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
4845-0104,SUP,HCPCS C1776,,4845-0104  -  STEM FEM 4 10MM 115MM ABG II V40 TMZF HA HIP RT,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
4845-0105,SUP,HCPCS C1776,,4845-0105  -  STEM FEM 5 11MM 120MM ABG II V40 TMZF HA HIP RT,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
4845-0106,SUP,HCPCS C1776,,4845-0106  -  STEM FEM 6 12MM 125MM ABG II V40 TMZF HA HIP RT,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
4845-0107,SUP,HCPCS C1776,,4845-0107  -  STEM FEM 7 13MM 135MM ABG II V40 TMZF HA HIP RT,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
4845-0108,SUP,HCPCS C1776,,4845-0108  -  STEM FEM 8 14MM 145MM ABG II V40 TMZF HA HIP RT,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
4845-0201,SUP,HCPCS C1776,,4845-0201  -  STEM FEM 1 8.5MM 100MM ABG II V40 TMZF HA HIP LT,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
4845-0202,SUP,HCPCS C1776,,4845-0202  -  STEM FEM 2 8.5MM 100MM ABG II V40 TMZF HA HIP LT,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
4845-0203,SUP,HCPCS C1776,,4845-0203  -  STEM FEM 3 9MM 110MM ABG II V40 TMZF HA HIP LT,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
4845-0204,SUP,HCPCS C1776,,4845-0204  -  STEM FEM 4 10MM 115MM ABG II V40 TMZF HA HIP LT,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
4845-0205,SUP,HCPCS C1776,,4845-0205  -  STEM FEM 5 11MM 120MM ABG II V40 TMZF HA HIP LT,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
4845-0206,SUP,HCPCS C1776,,4845-0206  -  STEM FEM 6 12MM 125MM ABG II V40 TMZF HA HIP LT,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
4845-0207,SUP,HCPCS C1776,,4845-0207  -  STEM FEM 7 13MM 135MM ABG II V40 TMZF HA HIP LT,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
4845-0208,SUP,HCPCS C1776,,4845-0208  -  STEM FEM 8 14MM 145MM ABG II V40 TMZF HA HIP LT,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
4845-7-101,SUP,HCPCS C1776,,4845-7-101  -  STEM FEM 130D 1 37MM OFST 99MM STRL ANATO ANTEVERT HIP RT,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
4845-7-102,SUP,HCPCS C1776,,4845-7-102  -  STEM FEM 130D 2 39MM OFST 99MM STRL ANATO ANTEVERT HIP RT,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
4845-7-103,SUP,HCPCS C1776,,4845-7-103  -  STEM FEM 130D 3 42MM OFST 110MM STRL ANATO ANTEVERT HIP RT,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
4845-7-104,SUP,HCPCS C1776,,4845-7-104  -  STEM FEM 130D 4 44MM OFST 115MM STRL ANATO ANTEVERT HIP RT,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
4845-7-105,SUP,HCPCS C1776,,4845-7-105  -  STEM FEM 130D 5 44MM OFST 120MM STRL ANATO ANTEVERT HIP RT,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
4845-7-106,SUP,HCPCS C1776,,4845-7-106  -  STEM FEM 130D 6 47MM OFST 120MM STRL ANATO ANTEVERT HIP RT,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
4845-7-107,SUP,HCPCS C1776,,4845-7-107  -  STEM FEM 130D 7 50MM OFST 120MM STRL ANATO ANTEVERT HIP RT,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
4845-7-108,SUP,HCPCS C1776,,4845-7-108  -  STEM FEM 130D 8 53MM OFST 120MM STRL ANATO ANTEVERT HIP RT,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
4845-7-111,SUP,HCPCS C1776,,4845-7-111  -  STEM FEM 130D 1 37MM OFST 99MM STRL ANATO HIP RT,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
4845-7-112,SUP,HCPCS C1776,,4845-7-112  -  STEM FEM 130D 2 39MM OFST 99MM STRL ANATO HIP RT,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
4845-7-114,SUP,HCPCS C1776,,4845-7-114  -  STEM FEM 130D 4 44MM OFST 115MM STRL ANATO HIP RT,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
4845-7-115,SUP,HCPCS C1776,,4845-7-115  -  STEM FEM 130D 5 44MM OFST 120MM STRL ANATO HIP RT,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
4845-7-116,SUP,HCPCS C1776,,4845-7-116  -  STEM FEM 130D 6 47MM OFST 120MM STRL ANATO HIP RT,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
4845-7-117,SUP,HCPCS C1776,,4845-7-117  -  STEM FEM 130D 7 50MM OFST 120MM STRL ANATO HIP RT,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
4845-7-118,SUP,HCPCS C1776,,4845-7-118  -  STEM FEM 130D 8 53MM OFST 120MM STRL ANATO HIP RT,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
4845-7-201,SUP,HCPCS C1776,,4845-7-201  -  STEM FEM 130D 1 37MM OFST 99MM STRL ANATO ANTEVERT HIP LT,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
4845-7-202,SUP,HCPCS C1776,,4845-7-202  -  STEM FEM 130D 2 39MM OFST 99MM STRL ANATO ANTEVERT HIP LT,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
4845-7-203,SUP,HCPCS C1776,,4845-7-203  -  STEM FEM 130D 3 42MM OFST 110MM STRL ANATO ANTEVERT HIP LT,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
4845-7-204,SUP,HCPCS C1776,,4845-7-204  -  STEM FEM 130D 4 44MM OFST 115MM STRL ANATO ANTEVERT HIP LT,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
4845-7-205,SUP,HCPCS C1776,,4845-7-205  -  STEM FEM 130D 5 44MM OFST 120MM STRL ANATO ANTEVERT HIP LT,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
4845-7-206,SUP,HCPCS C1776,,4845-7-206  -  STEM FEM 130D 6 47MM OFST 120MM STRL ANATO ANTEVERT HIP LT,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
4845-7-207,SUP,HCPCS C1776,,4845-7-207  -  STEM FEM 130D 7 50MM OFST 120MM STRL ANATO ANTEVERT HIP LT,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
4845-7-208,SUP,HCPCS C1776,,4845-7-208  -  STEM FEM 130D 8 53MM OFST 120MM STRL ANATO ANTEVERT HIP LT,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
4845-7-211,SUP,HCPCS C1776,,4845-7-211  -  STEM FEM 130D 1 37MM OFST 99MM STRL ANATO HIP LT,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
4845-7-212,SUP,HCPCS C1776,,4845-7-212  -  STEM FEM 130D 2 39MM OFST 99MM STRL ANATO HIP LT,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
4845-7-213,SUP,HCPCS C1776,,4845-7-213  -  STEM FEM 130D 3 42MM OFST 110MM STRL ANATO HIP LT,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
4845-7-214,SUP,HCPCS C1776,,4845-7-214  -  STEM FEM 130D 4 44MM OFST 115MM STRL ANATO HIP LT,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
4845-7-215,SUP,HCPCS C1776,,4845-7-215  -  STEM FEM 130D 5 44MM OFST 120MM STRL ANATO HIP LT,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
4845-7-216,SUP,HCPCS C1776,,4845-7-216  -  STEM FEM 130D 6 47MM OFST 120MM STRL ANATO HIP LT,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
4845-7-217,SUP,HCPCS C1776,,4845-7-217  -  STEM FEM 130D 7 50MM OFST 120MM STRL ANATO HIP LT,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
4845-7-218,SUP,HCPCS C1776,,4845-7-218  -  STEM FEM 130D 8 53MM OFST 120MM STRL ANATO HIP LT,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
48485540XL,SUP,HCPCS C1713,,48485540XL  -  SCREW BONE 5.5MM 40MM DIAPASON OSS THOR SPN LNG ARM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
48485545XL,SUP,HCPCS C1713,,48485545XL  -  SCREW BONE 5.5MM 45MM DIAPASON OSS THOR SPN LNG ARM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
48486735XL,SUP,HCPCS C1713,,48486735XL  -  SCREW BONE 6.7MM 35MM DIAPASON OSS LMBR SPN LNG ARM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
48486740XL,SUP,HCPCS C1713,,48486740XL  -  SCREW BONE 6.7MM 40MM DIAPASON OSS LMBR SPN LNG ARM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
48486745XL,SUP,HCPCS C1713,,48486745XL  -  SCREW BONE 6.7MM 45MM DIAPASON OSS LMBR SPN LNG ARM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
48486750XL,SUP,HCPCS C1713,,48486750XL  -  SCREW BONE 6.7MM 50MM DIAPASON OSS LMBR SPN LNG ARM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
48486755XL,SUP,HCPCS C1713,,48486755XL  -  SCREW BONE 6.7MM 55MM DIAPASON OSS LMBR SPN LNG ARM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
48486760XL,SUP,HCPCS C1713,,48486760XL  -  SCREW BONE 6.7MM 60MM DIAPASON OSS LMBR SPN LNG ARM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
48487740XL,SUP,HCPCS C1713,,48487740XL  -  SCREW BONE 7.7MM 40MM DIAPASON OSS LMBR SPN LNG ARM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
48487745XL,SUP,HCPCS C1713,,48487745XL  -  SCREW BONE 7.7MM 45MM DIAPASON OSS LMBR SPN LNG ARM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
48487750XL,SUP,HCPCS C1713,,48487750XL  -  SCREW BONE 7.7MM 50MM DIAPASON OSS LMBR SPN LNG ARM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
48487755XL,SUP,HCPCS C1713,,48487755XL  -  SCREW BONE 7.7MM 55MM DIAPASON OSS LMBR SPN LNG ARM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
48487760XL,SUP,HCPCS C1713,,48487760XL  -  SCREW BONE 7.7MM 60MM DIAPASON OSS LMBR SPN LNG ARM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
48488050XL,SUP,HCPCS C1713,,48488050XL  -  SCREW BONE 8MM 50MM DIAPASON OSS LMBR SPN LNG ARM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
48488055XL,SUP,HCPCS C1713,,48488055XL  -  SCREW BONE 8MM 55MM DIAPASON OSS LMBR SPN LNG ARM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
48488060XL,SUP,HCPCS C1713,,48488060XL  -  SCREW BONE 8MM 60MM DIAPASON OSS LMBR SPN LNG ARM,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
485.025S,SUP,HCPCS C1713,,485.025S  -  NAIL INTRAMEDULLARY 10MM 25.5CM CANN GREEN TITANIUM TIBIA,"$2,484.63",$0.00,"$2,484.63","$1,118.08","$1,773.28",$0.00,$428.09,$0.00,$0.00,$435.04,"$2,484.63",$0.00,"$1,242.31","$1,967.83","$1,987.70",$0.00,$388.84,$0.00,$395.55,$0.00
485.027S,SUP,HCPCS C1713,,485.027S  -  NAIL INTRAMEDULLARY 10MM 27CM CANN GREEN TITANIUM TIBIA,"$2,484.63",$0.00,"$2,484.63","$1,118.08","$1,773.28",$0.00,$428.09,$0.00,$0.00,$435.04,"$2,484.63",$0.00,"$1,242.31","$1,967.83","$1,987.70",$0.00,$388.84,$0.00,$395.55,$0.00
485.028S,SUP,HCPCS C1713,,485.028S  -  NAIL INTRAMEDULLARY 10MM 28.5CM CANN GREEN TITANIUM TIBIA,"$2,484.63",$0.00,"$2,484.63","$1,118.08","$1,773.28",$0.00,$428.09,$0.00,$0.00,$435.04,"$2,484.63",$0.00,"$1,242.31","$1,967.83","$1,987.70",$0.00,$388.84,$0.00,$395.55,$0.00
485.030S,SUP,HCPCS C1713,,485.030S  -  NAIL INTRAMEDULLARY 10MM 30CM CANN GREEN TITANIUM TIBIA,"$2,484.63",$0.00,"$2,484.63","$1,118.08","$1,773.28",$0.00,$428.09,$0.00,$0.00,$435.04,"$2,484.63",$0.00,"$1,242.31","$1,967.83","$1,987.70",$0.00,$388.84,$0.00,$395.55,$0.00
485.031S,SUP,HCPCS C1713,,485.031S  -  NAIL INTRAMEDULLARY 10MM 31.5CM CANN GREEN TITANIUM TIBIA,"$2,484.63",$0.00,"$2,484.63","$1,118.08","$1,773.28",$0.00,$428.09,$0.00,$0.00,$435.04,"$2,484.63",$0.00,"$1,242.31","$1,967.83","$1,987.70",$0.00,$388.84,$0.00,$395.55,$0.00
485.033S,SUP,HCPCS C1713,,485.033S  -  NAIL INTRAMEDULLARY 10MM 33CM CANN GREEN TITANIUM TIBIA,"$2,484.63",$0.00,"$2,484.63","$1,118.08","$1,773.28",$0.00,$428.09,$0.00,$0.00,$435.04,"$2,484.63",$0.00,"$1,242.31","$1,967.83","$1,987.70",$0.00,$388.84,$0.00,$395.55,$0.00
485.034S,SUP,HCPCS C1713,,485.034S  -  NAIL INTRAMEDULLARY 10MM 34.5CM CANN GREEN TITANIUM TIBIA,"$2,484.63",$0.00,"$2,484.63","$1,118.08","$1,773.28",$0.00,$428.09,$0.00,$0.00,$435.04,"$2,484.63",$0.00,"$1,242.31","$1,967.83","$1,987.70",$0.00,$388.84,$0.00,$395.55,$0.00
485.036S,SUP,HCPCS C1713,,485.036S  -  NAIL 10MM 36CM TIB IM CANN TI STRL,"$2,853.10",$0.00,"$2,853.10","$1,283.90","$2,036.26",$0.00,$491.57,$0.00,$0.00,$499.55,"$2,853.10",$0.00,"$1,426.55","$2,259.66","$2,282.48",$0.00,$446.51,$0.00,$454.21,$0.00
485.038S,SUP,HCPCS C1713,,485.038S  -  NAIL INTRAMEDULLARY 10MM 380MM CANN TITANIUM TIBIA STERILE,"$2,484.63",$0.00,"$2,484.63","$1,118.08","$1,773.28",$0.00,$428.09,$0.00,$0.00,$435.04,"$2,484.63",$0.00,"$1,242.31","$1,967.83","$1,987.70",$0.00,$388.84,$0.00,$395.55,$0.00
485.040S,SUP,HCPCS C1713,,485.040S  -  NAIL INTRAMEDULLARY 10MM 40CM CANN GREEN TITANIUM TIBIA,"$2,484.63",$0.00,"$2,484.63","$1,118.08","$1,773.28",$0.00,$428.09,$0.00,$0.00,$435.04,"$2,484.63",$0.00,"$1,242.31","$1,967.83","$1,987.70",$0.00,$388.84,$0.00,$395.55,$0.00
485.042S,SUP,HCPCS C1713,,485.042S  -  NAIL INTRAMEDULLARY 10MM 42CM CANN GREEN TITANIUM TIBIA,"$2,553.38",$0.00,"$2,553.38","$1,149.02","$1,822.34",$0.00,$439.93,$0.00,$0.00,$447.08,"$2,553.38",$0.00,"$1,276.69","$2,022.28","$2,042.70",$0.00,$399.60,$0.00,$406.50,$0.00
485.125S,SUP,HCPCS C1713,,485.125S  -  NAIL INTRAMEDULLARY 11MM 25.5CM CANN GREEN TITANIUM TIBIA,"$2,484.63",$0.00,"$2,484.63","$1,118.08","$1,773.28",$0.00,$428.09,$0.00,$0.00,$435.04,"$2,484.63",$0.00,"$1,242.31","$1,967.83","$1,987.70",$0.00,$388.84,$0.00,$395.55,$0.00
485.127S,SUP,HCPCS C1713,,485.127S  -  NAIL INTRAMEDULLARY 11MM 27CM CANN GREEN TITANIUM TIBIA,"$2,484.63",$0.00,"$2,484.63","$1,118.08","$1,773.28",$0.00,$428.09,$0.00,$0.00,$435.04,"$2,484.63",$0.00,"$1,242.31","$1,967.83","$1,987.70",$0.00,$388.84,$0.00,$395.55,$0.00
485.128S,SUP,HCPCS C1713,,485.128S  -  NAIL INTRAMEDULLARY 11MM 28.5CM CANN GREEN TITANIUM TIBIA,"$2,484.63",$0.00,"$2,484.63","$1,118.08","$1,773.28",$0.00,$428.09,$0.00,$0.00,$435.04,"$2,484.63",$0.00,"$1,242.31","$1,967.83","$1,987.70",$0.00,$388.84,$0.00,$395.55,$0.00
485.130S,SUP,HCPCS C1713,,485.130S  -  NAIL INTRAMEDULLARY 11MM 30CM CANN GREEN TITANIUM TIBIA,"$2,484.63",$0.00,"$2,484.63","$1,118.08","$1,773.28",$0.00,$428.09,$0.00,$0.00,$435.04,"$2,484.63",$0.00,"$1,242.31","$1,967.83","$1,987.70",$0.00,$388.84,$0.00,$395.55,$0.00
485.131S,SUP,HCPCS C1713,,485.131S  -  NAIL INTRAMEDULLARY 11MM 315MM CANN GREEN TITANIUM TIBIA,"$2,484.63",$0.00,"$2,484.63","$1,118.08","$1,773.28",$0.00,$428.09,$0.00,$0.00,$435.04,"$2,484.63",$0.00,"$1,242.31","$1,967.83","$1,987.70",$0.00,$388.84,$0.00,$395.55,$0.00
485.133S,SUP,HCPCS C1713,,485.133S  -  NAIL INTRAMEDULLARY 11MM 330MM CANN GREEN TITANIUM TIBIA,"$2,484.63",$0.00,"$2,484.63","$1,118.08","$1,773.28",$0.00,$428.09,$0.00,$0.00,$435.04,"$2,484.63",$0.00,"$1,242.31","$1,967.83","$1,987.70",$0.00,$388.84,$0.00,$395.55,$0.00
485.134S,SUP,HCPCS C1713,,485.134S  -  NAIL INTRAMEDULLARY 11MM 34.5CM CANN GREEN TITANIUM TIBIA,"$2,484.63",$0.00,"$2,484.63","$1,118.08","$1,773.28",$0.00,$428.09,$0.00,$0.00,$435.04,"$2,484.63",$0.00,"$1,242.31","$1,967.83","$1,987.70",$0.00,$388.84,$0.00,$395.55,$0.00
485.136S,SUP,HCPCS C1713,,485.136S  -  NAIL INTRAMEDULLARY 11MM 360MM CANN GREEN TITANIUM TIBIA,"$2,484.63",$0.00,"$2,484.63","$1,118.08","$1,773.28",$0.00,$428.09,$0.00,$0.00,$435.04,"$2,484.63",$0.00,"$1,242.31","$1,967.83","$1,987.70",$0.00,$388.84,$0.00,$395.55,$0.00
485.138S,SUP,HCPCS C1713,,485.138S  -  NAIL INTRAMEDULLARY 11MM 38CM CANN GREEN TITANIUM TIBIA,"$2,484.63",$0.00,"$2,484.63","$1,118.08","$1,773.28",$0.00,$428.09,$0.00,$0.00,$435.04,"$2,484.63",$0.00,"$1,242.31","$1,967.83","$1,987.70",$0.00,$388.84,$0.00,$395.55,$0.00
485.140S,SUP,HCPCS C1713,,485.140S  -  NAIL INTRAMEDULLARY 11MM 400MM CANN GREEN TITANIUM TIBIAL,"$2,484.63",$0.00,"$2,484.63","$1,118.08","$1,773.28",$0.00,$428.09,$0.00,$0.00,$435.04,"$2,484.63",$0.00,"$1,242.31","$1,967.83","$1,987.70",$0.00,$388.84,$0.00,$395.55,$0.00
485.142S,SUP,HCPCS C1713,,485.142S  -  NAIL INTRAMEDULLARY 11MM 42CM CANN GREEN TITANIUM TIBIA,"$2,553.38",$0.00,"$2,553.38","$1,149.02","$1,822.34",$0.00,$439.93,$0.00,$0.00,$447.08,"$2,553.38",$0.00,"$1,276.69","$2,022.28","$2,042.70",$0.00,$399.60,$0.00,$406.50,$0.00
485.225S,SUP,HCPCS C1713,,485.225S  -  NAIL INTRAMEDULLARY 12MM 25.5CM CANN GREEN TITANIUM TIBIA,"$2,553.38",$0.00,"$2,553.38","$1,149.02","$1,822.34",$0.00,$439.93,$0.00,$0.00,$447.08,"$2,553.38",$0.00,"$1,276.69","$2,022.28","$2,042.70",$0.00,$399.60,$0.00,$406.50,$0.00
485.227S,SUP,HCPCS C1713,,485.227S  -  NAIL INTRAMEDULLARY 12MM 27CM CANN GREEN TITANIUM TIBIA,"$2,553.38",$0.00,"$2,553.38","$1,149.02","$1,822.34",$0.00,$439.93,$0.00,$0.00,$447.08,"$2,553.38",$0.00,"$1,276.69","$2,022.28","$2,042.70",$0.00,$399.60,$0.00,$406.50,$0.00
485.228S,SUP,HCPCS C1713,,485.228S  -  NAIL INTRAMEDULLARY 12MM 285MM CANN GREEN TITANIUM TIBIA,"$2,553.38",$0.00,"$2,553.38","$1,149.02","$1,822.34",$0.00,$439.93,$0.00,$0.00,$447.08,"$2,553.38",$0.00,"$1,276.69","$2,022.28","$2,042.70",$0.00,$399.60,$0.00,$406.50,$0.00
485.230S,SUP,HCPCS C1713,,485.230S  -  NAIL INTRAMEDULLARY 12MM 30CM CANN GREEN TITANIUM TIBIA,"$2,484.63",$0.00,"$2,484.63","$1,118.08","$1,773.28",$0.00,$428.09,$0.00,$0.00,$435.04,"$2,484.63",$0.00,"$1,242.31","$1,967.83","$1,987.70",$0.00,$388.84,$0.00,$395.55,$0.00
485.231S,SUP,HCPCS C1713,,485.231S  -  NAIL INTRAMEDULLARY 12MM 31.5CM CANN GREEN TITANIUM TIBIA,"$2,484.63",$0.00,"$2,484.63","$1,118.08","$1,773.28",$0.00,$428.09,$0.00,$0.00,$435.04,"$2,484.63",$0.00,"$1,242.31","$1,967.83","$1,987.70",$0.00,$388.84,$0.00,$395.55,$0.00
485.233S,SUP,HCPCS C1713,,485.233S  -  NAIL INTRAMEDULLARY 12MM 33CM CANN GREEN TITANIUM TIBIA,"$2,484.63",$0.00,"$2,484.63","$1,118.08","$1,773.28",$0.00,$428.09,$0.00,$0.00,$435.04,"$2,484.63",$0.00,"$1,242.31","$1,967.83","$1,987.70",$0.00,$388.84,$0.00,$395.55,$0.00
485.234S,SUP,HCPCS C1713,,485.234S  -  NAIL INTRAMEDULLARY 12MM 34.5CM CANN GREEN TITANIUM TIBIA,"$2,484.63",$0.00,"$2,484.63","$1,118.08","$1,773.28",$0.00,$428.09,$0.00,$0.00,$435.04,"$2,484.63",$0.00,"$1,242.31","$1,967.83","$1,987.70",$0.00,$388.84,$0.00,$395.55,$0.00
485.236S,SUP,HCPCS C1713,,485.236S  -  NAIL INTRAMEDULLARY 12MM 36CM CANN GREEN TITANIUM TIBIA,"$2,484.63",$0.00,"$2,484.63","$1,118.08","$1,773.28",$0.00,$428.09,$0.00,$0.00,$435.04,"$2,484.63",$0.00,"$1,242.31","$1,967.83","$1,987.70",$0.00,$388.84,$0.00,$395.55,$0.00
485.238S,SUP,HCPCS C1713,,485.238S  -  NAIL INTRAMEDULLARY 12MM 38CM CANN GREEN TITANIUM TIBIA,"$2,484.63",$0.00,"$2,484.63","$1,118.08","$1,773.28",$0.00,$428.09,$0.00,$0.00,$435.04,"$2,484.63",$0.00,"$1,242.31","$1,967.83","$1,987.70",$0.00,$388.84,$0.00,$395.55,$0.00
485.240S,SUP,HCPCS C1713,,485.240S  -  NAIL INTRAMEDULLARY 12MM 40CM CANN GREEN TITANIUM TIBIA,"$2,484.63",$0.00,"$2,484.63","$1,118.08","$1,773.28",$0.00,$428.09,$0.00,$0.00,$435.04,"$2,484.63",$0.00,"$1,242.31","$1,967.83","$1,987.70",$0.00,$388.84,$0.00,$395.55,$0.00
485.242S,SUP,HCPCS C1713,,485.242S  -  NAIL INTRAMEDULLARY 12MM 42CM CANN GREEN TITANIUM TIBIA,"$2,553.38",$0.00,"$2,553.38","$1,149.02","$1,822.34",$0.00,$439.93,$0.00,$0.00,$447.08,"$2,553.38",$0.00,"$1,276.69","$2,022.28","$2,042.70",$0.00,$399.60,$0.00,$406.50,$0.00
485.325S,SUP,HCPCS C1713,,485.325S  -  NAIL INTRAMEDULLARY 13MM 25.5CM CANN GREEN TITANIUM TIBIA,"$2,553.38",$0.00,"$2,553.38","$1,149.02","$1,822.34",$0.00,$439.93,$0.00,$0.00,$447.08,"$2,553.38",$0.00,"$1,276.69","$2,022.28","$2,042.70",$0.00,$399.60,$0.00,$406.50,$0.00
485.327S,SUP,HCPCS C1713,,485.327S  -  NAIL 13MM 27CM TIB IM CANN TI STRL BLUE,"$2,853.10",$0.00,"$2,853.10","$1,283.90","$2,036.26",$0.00,$491.57,$0.00,$0.00,$499.55,"$2,853.10",$0.00,"$1,426.55","$2,259.66","$2,282.48",$0.00,$446.51,$0.00,$454.21,$0.00
485.328S,SUP,HCPCS C1713,,485.328S  -  NAIL INTRAMEDULLARY 13MM 285MM CANN GREEN TITANIUM TIBIA,"$2,553.38",$0.00,"$2,553.38","$1,149.02","$1,822.34",$0.00,$439.93,$0.00,$0.00,$447.08,"$2,553.38",$0.00,"$1,276.69","$2,022.28","$2,042.70",$0.00,$399.60,$0.00,$406.50,$0.00
485.330S,SUP,HCPCS C1713,,485.330S  -  NAIL INTRAMEDULLARY 13MM 300MM CANN GREEN TITANIUM TIBIA,"$2,484.63",$0.00,"$2,484.63","$1,118.08","$1,773.28",$0.00,$428.09,$0.00,$0.00,$435.04,"$2,484.63",$0.00,"$1,242.31","$1,967.83","$1,987.70",$0.00,$388.84,$0.00,$395.55,$0.00
485.331S,SUP,HCPCS C1713,,485.331S  -  NAIL INTRAMEDULLARY 13MM 315MM CANN GREEN TITANIUM TIBIA,"$2,484.63",$0.00,"$2,484.63","$1,118.08","$1,773.28",$0.00,$428.09,$0.00,$0.00,$435.04,"$2,484.63",$0.00,"$1,242.31","$1,967.83","$1,987.70",$0.00,$388.84,$0.00,$395.55,$0.00
485.333S,SUP,HCPCS C1713,,485.333S  -  NAIL INTRAMEDULLARY 13MM 330MM CANN GREEN TITANIUM TIBIA,"$2,484.63",$0.00,"$2,484.63","$1,118.08","$1,773.28",$0.00,$428.09,$0.00,$0.00,$435.04,"$2,484.63",$0.00,"$1,242.31","$1,967.83","$1,987.70",$0.00,$388.84,$0.00,$395.55,$0.00
485.334S,SUP,HCPCS C1713,,485.334S  -  NAIL INTRAMEDULLARY 13MM 345MM CANN GREEN TITANIUM TIBIA,"$2,484.63",$0.00,"$2,484.63","$1,118.08","$1,773.28",$0.00,$428.09,$0.00,$0.00,$435.04,"$2,484.63",$0.00,"$1,242.31","$1,967.83","$1,987.70",$0.00,$388.84,$0.00,$395.55,$0.00
485.336S,SUP,HCPCS C1713,,485.336S  -  NAIL 13MM 36CM TIB IM CANN TI STRL,"$2,853.10",$0.00,"$2,853.10","$1,283.90","$2,036.26",$0.00,$491.57,$0.00,$0.00,$499.55,"$2,853.10",$0.00,"$1,426.55","$2,259.66","$2,282.48",$0.00,$446.51,$0.00,$454.21,$0.00
485.338S,SUP,HCPCS C1713,,485.338S  -  NAIL INTRAMEDULLARY 13MM 380MM CANN GREEN TITANIUM TIBIA,"$2,484.63",$0.00,"$2,484.63","$1,118.08","$1,773.28",$0.00,$428.09,$0.00,$0.00,$435.04,"$2,484.63",$0.00,"$1,242.31","$1,967.83","$1,987.70",$0.00,$388.84,$0.00,$395.55,$0.00
485.340S,SUP,HCPCS C1713,,485.340S  -  NAIL 13MM 40CM TIB IM CANN TI STRL BLUE,"$2,853.10",$0.00,"$2,853.10","$1,283.90","$2,036.26",$0.00,$491.57,$0.00,$0.00,$499.55,"$2,853.10",$0.00,"$1,426.55","$2,259.66","$2,282.48",$0.00,$446.51,$0.00,$454.21,$0.00
485.342S,SUP,HCPCS C1713,,485.342S  -  NAIL INTRAMEDULLARY 13MM 420MM CANN GREEN TITANIUM TIBIA,"$2,553.38",$0.00,"$2,553.38","$1,149.02","$1,822.34",$0.00,$439.93,$0.00,$0.00,$447.08,"$2,553.38",$0.00,"$1,276.69","$2,022.28","$2,042.70",$0.00,$399.60,$0.00,$406.50,$0.00
48551041L,SUP,HCPCS C1713,,48551041L  -  PLATE BONE 130D PRECONTOUR OASYS TITANIUM SPN LEFT THORACIC,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
48551041R,SUP,HCPCS C1713,,48551041R  -  PLATE BONE 130D PRECONTOUR OASYS TITANIUM SPN RIGHT THORACIC,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
48551043L,SUP,HCPCS C1713,,48551043L  -  PLATE BONE 100D PRECONTOUR OASYS TITANIUM SPN LEFT THORACIC,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
48551043R,SUP,HCPCS C1713,,48551043R  -  PLATE BONE 100D PRECONTOUR OASYS TITANIUM SPN RIGHT THORACIC,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
4900-40-51,SUP,HCPCS C1713,,4900-40-51  -  WASHER 7MM SM ORTH 2.7-4MM SCR NONSTRL,$71.30,$0.00,$71.30,$32.09,$50.89,$0.00,$12.28,$0.00,$0.00,$12.48,$71.30,$0.00,$35.65,$56.47,$57.04,$0.00,$11.16,$0.00,$11.35,$0.00
4900T26,SUP,Custom 27803010,,4900T26  -  RING ANLPLS 26MM STRL ED MC3 SEAM 2 WRP TI PLSTR SIL RBR,"$7,995.00",$0.00,"$7,995.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,995.00",$0.00,"$3,997.50","$6,332.04","$6,396.00",$0.00,$0.00,$0.00,$0.00,$0.00
4900T28,SUP,Custom 27803010,,4900T28  -  RING ANLPLS 28MM STRL ED MC3 SEAM 2 WRP TI PLSTR SIL RBR,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
4900T30,SUP,Custom 27803010,,4900T30  -  RING ANLPLS 30MM STRL ED MC3 1 SEAM 2 WRP ANTM TI SIL RBR,"$7,995.00",$0.00,"$7,995.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,995.00",$0.00,"$3,997.50","$6,332.04","$6,396.00",$0.00,$0.00,$0.00,$0.00,$0.00
4900T32,SUP,Custom 27803010,,4900T32  -  RING ANLPLS 3D ANG DNWRD 32MM ED MC3 RGD TRCSD,"$7,995.00",$0.00,"$7,995.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,995.00",$0.00,"$3,997.50","$6,332.04","$6,396.00",$0.00,$0.00,$0.00,$0.00,$0.00
4900T34,SUP,Custom 27803010,,4900T34  -  RING ANLPLS 34MM TRCSD ED MC3,"$7,995.00",$0.00,"$7,995.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,995.00",$0.00,"$3,997.50","$6,332.04","$6,396.00",$0.00,$0.00,$0.00,$0.00,$0.00
4900T36,SUP,HCPCS C1713,,4900T36  -  RING ANLPLS 36MM STRL ED MC3 1 SEAM 2 WRP ANTM TI SIL RBR,"$8,750.00",$0.00,"$8,750.00","$3,937.50","$5,158.80",$0.00,"$1,507.58",$0.00,$0.00,"$1,532.06","$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,"$1,369.38",$0.00,"$1,393.00",$0.00
491B,SUP,Custom 27203010,,491B  -  PROBE THRMTR SM STAT STRL STRPRB TEMP ESPH RCTM DISP,$12.74,$0.00,$12.74,$0.00,$9.09,$0.00,$0.00,$0.00,$0.00,$0.00,$12.74,$0.00,$6.37,$10.09,$10.19,$0.00,$0.00,$0.00,$0.00,$0.00
4920-0-000,SUP,Custom 27203010,,4920-0-000  -  ROD EXFIX HFMN2 DYN,"$3,734.50",$0.00,"$3,734.50",$0.00,"$2,665.31",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,734.50",$0.00,"$1,867.25","$2,957.72","$2,987.60",$0.00,$0.00,$0.00,$0.00,$0.00
4920-0-015,SUP,Custom 27203010,,4920-0-015  -  TUBE XTRNFX STD 40MM HFMN2 CMPR DSTRCT,$965.25,$0.00,$965.25,$0.00,$688.90,$0.00,$0.00,$0.00,$0.00,$0.00,$965.25,$0.00,$482.63,$764.48,$772.20,$0.00,$0.00,$0.00,$0.00,$0.00
4920-1-010,SUP,Custom 27203010,,4920-1-010  -  CLAMP EXFIX HFMN2 STD CARFBR NONMRI SAFE,$853.88,$0.00,$853.88,$0.00,$609.41,$0.00,$0.00,$0.00,$0.00,$0.00,$853.88,$0.00,$426.94,$676.27,$683.10,$0.00,$0.00,$0.00,$0.00,$0.00
4920-1-010R,SUP,Custom 27203010,,4920-1-010R  -  HOFF2 COUPLING 8/8MM RECERT,$853.88,$0.00,$853.88,$0.00,$609.41,$0.00,$0.00,$0.00,$0.00,$0.00,$853.88,$0.00,$426.94,$676.27,$683.10,$0.00,$0.00,$0.00,$0.00,$0.00
4920-1-020,SUP,Custom 27203010,,4920-1-020  -  CPLNG EXFIX HFMN2 4-5MM 8MM ARTC,$853.88,$0.00,$853.88,$0.00,$609.41,$0.00,$0.00,$0.00,$0.00,$0.00,$853.88,$0.00,$426.94,$676.27,$683.10,$0.00,$0.00,$0.00,$0.00,$0.00
4920-1-020R,SUP,Custom 27203010,,4920-1-020R  -  HOFF2 ARTIC COUPLING 8/4+5MM,$853.88,$0.00,$853.88,$0.00,$609.41,$0.00,$0.00,$0.00,$0.00,$0.00,$853.88,$0.00,$426.94,$676.27,$683.10,$0.00,$0.00,$0.00,$0.00,$0.00
4920-1-030,SUP,Custom 27203010,,4920-1-030  -  COUPLING XTRNFX 4 5/8MM HFMN2 INVERT PIN TO ROD,$853.88,$0.00,$853.88,$0.00,$609.41,$0.00,$0.00,$0.00,$0.00,$0.00,$853.88,$0.00,$426.94,$676.27,$683.10,$0.00,$0.00,$0.00,$0.00,$0.00
4920-1-030R,SUP,Custom 27203010,,4920-1-030R  -  HOFF2 INVERT COUPLING 8/4+5MM,$853.88,$0.00,$853.88,$0.00,$609.41,$0.00,$0.00,$0.00,$0.00,$0.00,$853.88,$0.00,$426.94,$676.27,$683.10,$0.00,$0.00,$0.00,$0.00,$0.00
4920-1-100,SUP,Custom 27203010,,4920-1-100  -  COUPLING XTRNFX STD 20MM 8MM HFMN2 TUBE TO ROD DYN,$948.75,$0.00,$948.75,$0.00,$677.12,$0.00,$0.00,$0.00,$0.00,$0.00,$948.75,$0.00,$474.38,$751.41,$759.00,$0.00,$0.00,$0.00,$0.00,$0.00
4920-2-020,SUP,Custom 27203010,,4920-2-020  -  CLAMP EXFIX HFMN2 8MM 4-5MM CARFBR PIN ASMBLY 5 HOLE W/O,$900.63,$0.00,$900.63,$0.00,$642.78,$0.00,$0.00,$0.00,$0.00,$0.00,$900.63,$0.00,$450.31,$713.30,$720.50,$0.00,$0.00,$0.00,$0.00,$0.00
4920-2-060,SUP,Custom 27203010,,4920-2-060  -  CLAMP EXFIX HFMN2 10 HOLE,"$1,516.63",$0.00,"$1,516.63",$0.00,"$1,082.42",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,516.63",$0.00,$758.31,"$1,201.17","$1,213.30",$0.00,$0.00,$0.00,$0.00,$0.00
4920-2-060R,SUP,Custom 27203010,,4920-2-060R  -  HOFF2 10 HOLE CLAMP,"$1,516.63",$0.00,"$1,516.63",$0.00,"$1,082.42",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,516.63",$0.00,$758.31,"$1,201.17","$1,213.30",$0.00,$0.00,$0.00,$0.00,$0.00
4920-2-080,SUP,Custom 27203010,,4920-2-080  -  CLAMP EXFIX HFMN2 PLVC CMPNT 4 MM 5 MM 6 MM PIN,"$1,328.25",$0.00,"$1,328.25",$0.00,$947.97,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,328.25",$0.00,$664.13,"$1,051.97","$1,062.60",$0.00,$0.00,$0.00,$0.00,$0.00
4920-2-120,SUP,Custom 27203010,,4920-2-120  -  POST XTRNFX STRG 8MM NS LF HFMN2 CMPNT SS DISP,$171.88,$0.00,$171.88,$0.00,$122.67,$0.00,$0.00,$0.00,$0.00,$0.00,$171.88,$0.00,$85.94,$136.13,$137.50,$0.00,$0.00,$0.00,$0.00,$0.00
4920-2-120R,SUP,Custom 27203010,,4920-2-120R  -  POST XTRNFX STRG 8MM NS LF HFMN2 CMPNT SS DISP REPRO,$171.88,$0.00,$171.88,$0.00,$122.67,$0.00,$0.00,$0.00,$0.00,$0.00,$171.88,$0.00,$85.94,$136.13,$137.50,$0.00,$0.00,$0.00,$0.00,$0.00
4920-2-140,SUP,Custom 27203010,,4920-2-140  -  POST XTRNFX 30D HFMN2 AL SS CFBR,$171.88,$0.00,$171.88,$0.00,$122.67,$0.00,$0.00,$0.00,$0.00,$0.00,$171.88,$0.00,$85.94,$136.13,$137.50,$0.00,$0.00,$0.00,$0.00,$0.00
4920-2-140R,SUP,Custom 27203010,,4920-2-140R  -  POST XTRNFX 30D 8MM NS LF HFMN2 CMPNT SS DISP REPRO,$171.88,$0.00,$171.88,$0.00,$122.67,$0.00,$0.00,$0.00,$0.00,$0.00,$171.88,$0.00,$85.94,$136.13,$137.50,$0.00,$0.00,$0.00,$0.00,$0.00
4920-2-160,SUP,Custom 27203010,,4920-2-160  -  POST EXFIX HFMN2 90D 8MM SS ANG CMPNT,$199.38,$0.00,$199.38,$0.00,$142.29,$0.00,$0.00,$0.00,$0.00,$0.00,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$0.00,$0.00,$0.00,$0.00
4920-2-160R,SUP,Custom 27203010,,4920-2-160R  -  POST XTRNFX 90D NS LF HFMN2 CMPNT SS DISP REPRO,$199.38,$0.00,$199.38,$0.00,$142.29,$0.00,$0.00,$0.00,$0.00,$0.00,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$0.00,$0.00,$0.00,$0.00
4920-2-180,SUP,Custom 27203010,,4920-2-180  -  POST EXFIX HFMN2 MI,$199.38,$0.00,$199.38,$0.00,$142.29,$0.00,$0.00,$0.00,$0.00,$0.00,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$0.00,$0.00,$0.00,$0.00
4920-3-010,SUP,Custom 27203010,,4920-3-010  -  COUPLING XTRNFX ROD TO WRE,$936.38,$0.00,$936.38,$0.00,$668.29,$0.00,$0.00,$0.00,$0.00,$0.00,$936.38,$0.00,$468.19,$741.61,$749.10,$0.00,$0.00,$0.00,$0.00,$0.00
4920-9-810,SUP,Custom 27203010,,4920-9-810  -  SET EXFIX HFMN2 ANKL KIT ROD TO ROD CPLNG MLPN CLMP SFT TIS,"$6,227.38",$0.00,"$6,227.38",$0.00,"$4,444.48",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,227.38",$0.00,"$3,113.69","$4,932.08","$4,981.90",$0.00,$0.00,$0.00,$0.00,$0.00
4920-9-830,SUP,Custom 27203010,,4920-9-830  -  SET EXFIX HFMN2 430MMX307MMX65MM TIB KIT ROD TO ROD CPLNG,"$6,539.50",$0.00,"$6,539.50",$0.00,"$4,667.24",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,539.50",$0.00,"$3,269.75","$5,179.28","$5,231.60",$0.00,$0.00,$0.00,$0.00,$0.00
4920-9-900,SUP,Custom 27203010,,4920-9-900  -  KIT EXFIX HFMN2 STRL,"$4,116.75",$0.00,"$4,116.75",$0.00,"$2,938.12",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,116.75",$0.00,"$2,058.38","$3,260.47","$3,293.40",$0.00,$0.00,$0.00,$0.00,$0.00
4920-9-920,SUP,Custom 27203010,,4920-9-920  -  KIT EXFIX HFMN2 STRL,"$3,430.63",$0.00,"$3,430.63",$0.00,"$2,448.44",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,430.63",$0.00,"$1,715.31","$2,717.06","$2,744.50",$0.00,$0.00,$0.00,$0.00,$0.00
4920-9-930,SUP,Custom 27203010,,4920-9-930  -  SET EXFIX HFMN2 PLVC KIT ROD TO ROD CPLNG MLPN CLMP SFT TIS,"$8,417.75",$0.00,"$8,417.75",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,417.75",$0.00,"$4,208.88","$6,666.86","$6,734.20",$0.00,$0.00,$0.00,$0.00,$0.00
4920-9-952,SUP,Custom 27203010,,4920-9-952  -  SET EXFIX HFMN2 KIT MLTR MUL PIN CLMP SLFDRILL APEX PIN ANG,"$4,138.75",$0.00,"$4,138.75",$0.00,"$2,953.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,138.75",$0.00,"$2,069.38","$3,277.89","$3,311.00",$0.00,$0.00,$0.00,$0.00,$0.00
4921-0-000,SUP,Custom 27203010,,4921-0-000  -  TUBE XTRNFX HFMN 3 DYN MRI SAFE,"$4,233.63",$0.00,"$4,233.63",$0.00,"$3,021.54",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,233.63",$0.00,"$2,116.81","$3,353.03","$3,386.90",$0.00,$0.00,$0.00,$0.00,$0.00
4921-0-015,SUP,Custom 27203010,,4921-0-015  -  TUBE XTRNFX 20MM HFMN2 CMPR DSTRCT MRI SAFE,$946.00,$0.00,$946.00,$0.00,$675.16,$0.00,$0.00,$0.00,$0.00,$0.00,$946.00,$0.00,$473.00,$749.23,$756.80,$0.00,$0.00,$0.00,$0.00,$0.00
4921-1-010,SUP,Custom 27203010,,4921-1-010  -  CPLNG EXFIX HFMN2 ROD TO ROD,"$1,586.00",$0.00,"$1,586.00",$0.00,"$1,131.93",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,586.00",$0.00,$793.00,"$1,256.11","$1,268.80",$0.00,$0.00,$0.00,$0.00,$0.00
4921-1-020,SUP,Custom 27203010,,4921-1-020  -  CLAMP EXFIX HFMN2 CLR CD REASSEMBLE GOLD HEAD BOLT,"$1,478.00",$0.00,"$1,478.00",$0.00,"$1,054.85",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,478.00",$0.00,$739.00,"$1,170.58","$1,182.40",$0.00,$0.00,$0.00,$0.00,$0.00
4921-1-030,SUP,Custom 27203010,,4921-1-030  -  COUPLING XTRNFX HFMN2 INVERT PIN TO ROD MRI CLR CD 4-5 MM,$875.88,$0.00,$875.88,$0.00,$625.11,$0.00,$0.00,$0.00,$0.00,$0.00,$875.88,$0.00,$437.94,$693.70,$700.70,$0.00,$0.00,$0.00,$0.00,$0.00
4921-1-100,SUP,Custom 27203010,,4921-1-100  -  DEVICE EXFIX YLW HFMN2 MRI FRM 6 PIN,$875.88,$0.00,$875.88,$0.00,$625.11,$0.00,$0.00,$0.00,$0.00,$0.00,$875.88,$0.00,$437.94,$693.70,$700.70,$0.00,$0.00,$0.00,$0.00,$0.00
4921-1-140,SUP,Custom 27203010,,4921-1-140  -  POST EXFIX 8MM HFMN2 30D MRI SAFE CMPNT GOLD TIP,$166.38,$0.00,$166.38,$0.00,$118.74,$0.00,$0.00,$0.00,$0.00,$0.00,$166.38,$0.00,$83.19,$131.77,$133.10,$0.00,$0.00,$0.00,$0.00,$0.00
4921-2-020,SUP,Custom 27203010,,4921-2-020  -  CLAMP EXFIX 6MM HFMN2 5 HOLE PIN MRI SAFE,"$1,684.00",$0.00,"$1,684.00",$0.00,"$1,201.87",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,684.00",$0.00,$842.00,"$1,333.73","$1,347.20",$0.00,$0.00,$0.00,$0.00,$0.00
4921-2-060,SUP,Custom 27203010,,4921-2-060  -  CLAMP EXFIX HFMN2 C 10 HOLE PIN,"$2,246.00",$0.00,"$2,246.00",$0.00,"$1,602.97",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,246.00",$0.00,"$1,123.00","$1,778.83","$1,796.80",$0.00,$0.00,$0.00,$0.00,$0.00
4921-2-080,SUP,Custom 27203010,,4921-2-080  -  CLAMP EXFIX HFMN2 MRI PLVC,"$1,130.25",$0.00,"$1,130.25",$0.00,$806.66,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,130.25",$0.00,$565.13,$895.16,$904.20,$0.00,$0.00,$0.00,$0.00,$0.00
4921-2-120,SUP,Custom 27203010,,4921-2-120  -  POST XTRNFX STRG 8MM HFMN 3 CLR CD MRI SAFE,$366.00,$0.00,$366.00,$0.00,$261.21,$0.00,$0.00,$0.00,$0.00,$0.00,$366.00,$0.00,$183.00,$289.87,$292.80,$0.00,$0.00,$0.00,$0.00,$0.00
4921-2-140,SUP,Custom 27203010,,4921-2-140  -  POST XTRNFX 30D 8MM HFMN2 CLR CD MRI SAFE,$280.00,$0.00,$280.00,$0.00,$199.84,$0.00,$0.00,$0.00,$0.00,$0.00,$280.00,$0.00,$140.00,$221.76,$224.00,$0.00,$0.00,$0.00,$0.00,$0.00
4921-2-160,SUP,Custom 27203010,,4921-2-160  -  POST XTRNFX 90D 8MM HFMN2 MRI SAFE H,$434.00,$0.00,$434.00,$0.00,$309.75,$0.00,$0.00,$0.00,$0.00,$0.00,$434.00,$0.00,$217.00,$343.73,$347.20,$0.00,$0.00,$0.00,$0.00,$0.00
4921-9-985,SUP,Custom 27203010,,4921-9-985  -  BAR XTRNFX 30D HFMN2 STOR LWR,$779.63,$0.00,$779.63,$0.00,$556.42,$0.00,$0.00,$0.00,$0.00,$0.00,$779.63,$0.00,$389.81,$617.47,$623.70,$0.00,$0.00,$0.00,$0.00,$0.00
4922-1-010,SUP,Custom 27203010,,4922-1-010  -  COUPLING EXFIX 5MM 8MM ROD TO ROD,"$1,686.95",$0.00,"$1,686.95",$0.00,"$1,203.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,686.95",$0.00,$843.48,"$1,336.06","$1,349.56",$0.00,$0.00,$0.00,$0.00,$0.00
4922-1-020,SUP,Custom 27203010,,4922-1-020  -  COUPLING EXFIX 5/8IN 4IN 5 HOLE PIN TO ROD APEX PIN CLMP,"$1,686.95",$0.00,"$1,686.95",$0.00,"$1,203.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,686.95",$0.00,$843.48,"$1,336.06","$1,349.56",$0.00,$0.00,$0.00,$0.00,$0.00
4922-1-030,SUP,Custom 27203010,,4922-1-030  -  COUPLING EXFIX 5MM 8MM PIN TO ROD,"$1,686.95",$0.00,"$1,686.95",$0.00,"$1,203.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,686.95",$0.00,$843.48,"$1,336.06","$1,349.56",$0.00,$0.00,$0.00,$0.00,$0.00
4922-2-020,SUP,Custom 27203010,,4922-2-020  -  CLAMP EXFIX 4/5/6MM 5 HOLE MULTIPIN MODULAR HOFFMANN III,"$1,770.13",$0.00,"$1,770.13",$0.00,"$1,263.34",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,770.13",$0.00,$885.06,"$1,401.94","$1,416.10",$0.00,$0.00,$0.00,$0.00,$0.00
4922-2-140,SUP,Custom 27203010,,4922-2-140  -  POST XTRNFX 30D 11MM HFMN 3,$308.88,$0.00,$308.88,$0.00,$220.44,$0.00,$0.00,$0.00,$0.00,$0.00,$308.88,$0.00,$154.44,$244.63,$247.10,$0.00,$0.00,$0.00,$0.00,$0.00
4922-2-240,SUP,Custom 27203010,,4922-2-240  -  CLAMP EXFIX 30D 11MM 5 HOLE PIN POST MODULAR HOFFMANN III,"$1,958.23",$0.00,"$1,958.23",$0.00,"$1,397.59",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,958.23",$0.00,$979.11,"$1,550.92","$1,566.58",$0.00,$0.00,$0.00,$0.00,$0.00
4922-8-150,SUP,Custom 27203010,,4922-8-150  -  ROD EXFIX 11MM 150MM CONNCTNG,$892.98,$0.00,$892.98,$0.00,$637.32,$0.00,$0.00,$0.00,$0.00,$0.00,$892.98,$0.00,$446.49,$707.24,$714.38,$0.00,$0.00,$0.00,$0.00,$0.00
4922-8-200,SUP,Custom 27203010,,4922-8-200  -  ROD EXFIX 11MM 200MM CONNCTNG MRI HOFFMANN 3 CARB,$918.73,$0.00,$918.73,$0.00,$655.69,$0.00,$0.00,$0.00,$0.00,$0.00,$918.73,$0.00,$459.36,$727.63,$734.98,$0.00,$0.00,$0.00,$0.00,$0.00
4922-8-250,SUP,Custom 27203010,,4922-8-250  -  ROD EXFIX 11MM 250MM CONNCTNG,$918.73,$0.00,$918.73,$0.00,$655.69,$0.00,$0.00,$0.00,$0.00,$0.00,$918.73,$0.00,$459.36,$727.63,$734.98,$0.00,$0.00,$0.00,$0.00,$0.00
4922-8-300,SUP,Custom 27203010,,4922-8-300  -  ROD EXFIX 11MM 300MM CONNCTNG MRI SAFE HOFFMANN III CARB,$940.50,$0.00,$940.50,$0.00,$671.23,$0.00,$0.00,$0.00,$0.00,$0.00,$940.50,$0.00,$470.25,$744.88,$752.40,$0.00,$0.00,$0.00,$0.00,$0.00
4922-8-350,SUP,Custom 27203010,,4922-8-350  -  ROD EXFIX 11MM 350MM CONNCTNG MRI HOFFMANN 3 CARB,$940.50,$0.00,$940.50,$0.00,$671.23,$0.00,$0.00,$0.00,$0.00,$0.00,$940.50,$0.00,$470.25,$744.88,$752.40,$0.00,$0.00,$0.00,$0.00,$0.00
4922-8-400,SUP,Custom 27203010,,4922-8-400  -  ROD EXFIX 11MM 400MM CONNCTNG MRI HOFFMANN 3 CARB,"$1,025.65",$0.00,"$1,025.65",$0.00,$732.01,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,025.65",$0.00,$512.83,$812.31,$820.52,$0.00,$0.00,$0.00,$0.00,$0.00
4922-8-500,SUP,HCPCS C1713,,4922-8-500  -  ROD EXFIX 11MM 500MM CONNECT MRI SAFE MODULAR HOFFMANN III,"$1,128.60",$0.00,"$1,128.60",$507.87,$805.48,$0.00,$194.45,$0.00,$0.00,$197.61,"$1,128.60",$0.00,$564.30,$893.85,$902.88,$0.00,$176.63,$0.00,$179.67,$0.00
493.100.01S,SUP,Custom 27803010,,493.100.01S  -  WIRE FX 26GA 500MM STRL NDL TI,$277.50,$0.00,$277.50,$0.00,$198.05,$0.00,$0.00,$0.00,$0.00,$0.00,$277.50,$0.00,$138.75,$219.78,$222.00,$0.00,$0.00,$0.00,$0.00,$0.00
493.101.01S,SUP,Custom 27803010,,493.101.01S  -  WIRE FX 28GA 500MM STRL NDL TI,$229.50,$0.00,$229.50,$0.00,$163.79,$0.00,$0.00,$0.00,$0.00,$0.00,$229.50,$0.00,$114.75,$181.76,$183.60,$0.00,$0.00,$0.00,$0.00,$0.00
493.102.01S,SUP,Custom 27803010,,493.102.01S  -  WIRE SPINAL .25MM 500MM NEEDLE TITANIUM STERILE,$277.50,$0.00,$277.50,$0.00,$198.05,$0.00,$0.00,$0.00,$0.00,$0.00,$277.50,$0.00,$138.75,$219.78,$222.00,$0.00,$0.00,$0.00,$0.00,$0.00
493.103.01S,SUP,Custom 27803010,,493.103.01S  -  WIRE SPINAL .2MM 500MM NEEDLE TITANIUM STERILE,$277.50,$0.00,$277.50,$0.00,$198.05,$0.00,$0.00,$0.00,$0.00,$0.00,$277.50,$0.00,$138.75,$219.78,$222.00,$0.00,$0.00,$0.00,$0.00,$0.00
493.104.01S,SUP,Custom 27803010,,493.104.01S  -  WIRE FX 28GA 500MM STRL BRB NDL TI,$900.00,$0.00,$900.00,$0.00,$642.33,$0.00,$0.00,$0.00,$0.00,$0.00,$900.00,$0.00,$450.00,$712.80,$720.00,$0.00,$0.00,$0.00,$0.00,$0.00
49-36-1550,SUP,Custom 27203010,,PAD FLRMCHN FOAM THK2IN 8IN CMPD MILWAUKEE,$42.58,$0.00,$42.58,$0.00,$30.39,$0.00,$0.00,$0.00,$0.00,$0.00,$42.58,$0.00,$21.29,$33.72,$34.06,$0.00,$0.00,$0.00,$0.00,$0.00
494.771SHA,SUP,HCPCS C1713,,494.771SHA  -  SCREW BONE 4/3MM 80MM SLFDRILL SCHANZ HYDRXAPT ORTHOPEDIC,$327.70,$0.00,$327.70,$147.47,$233.88,$0.00,$54.82,$0.00,$0.00,$57.38,$327.70,$0.00,$163.85,$259.54,$262.16,$0.00,$49.79,$0.00,$52.17,$0.00
494.784SHA,SUP,HCPCS C1713,,494.784SHA  -  SCREW BONE 5MM 150MM SLFDRILL SCHANZ HYDRXAPT ORTHOPEDIC,$370.95,$0.00,$370.95,$166.93,$264.75,$0.00,$62.05,$0.00,$0.00,$64.95,$370.95,$0.00,$185.48,$293.79,$296.76,$0.00,$56.36,$0.00,$59.06,$0.00
494.785SHA,SUP,HCPCS C1713,,494.785SHA  -  SCREW BONE 5MM 175MM SLFDRILL SCHANZ HYDRXAPT ORTHOPEDIC,$370.95,$0.00,$370.95,$166.93,$264.75,$0.00,$62.05,$0.00,$0.00,$64.95,$370.95,$0.00,$185.48,$293.79,$296.76,$0.00,$56.36,$0.00,$59.06,$0.00
494.786SHA,SUP,HCPCS C1713,,494.786SHA  -  SCREW BONE 5MM 200MM SLFDRILL SCHANZ HYDRXAPT ORTHOPEDIC,$370.95,$0.00,$370.95,$166.93,$264.75,$0.00,$62.05,$0.00,$0.00,$64.95,$370.95,$0.00,$185.48,$293.79,$296.76,$0.00,$56.36,$0.00,$59.06,$0.00
4940-0-015,SUP,Custom 27203010,,4940-0-015  -  TUBE XTRNFX SM 15MM 5MM HFMN2 C CMPR DSTRCT C,$844.25,$0.00,$844.25,$0.00,$602.54,$0.00,$0.00,$0.00,$0.00,$0.00,$844.25,$0.00,$422.13,$668.65,$675.40,$0.00,$0.00,$0.00,$0.00,$0.00
4940-1-010,SUP,Custom 27203010,,4940-1-010  -  COUPLING XTRNFX NS HFMN2 C ROD TO ROD 5 MM ROD/POST,$522.50,$0.00,$522.50,$0.00,$372.91,$0.00,$0.00,$0.00,$0.00,$0.00,$522.50,$0.00,$261.25,$413.82,$418.00,$0.00,$0.00,$0.00,$0.00,$0.00
4940-1-015,SUP,Custom 27203010,,4940-1-015  -  CLAMP EXFIX HFMN2 C KNEE CPLNG,$584.38,$0.00,$584.38,$0.00,$417.07,$0.00,$0.00,$0.00,$0.00,$0.00,$584.38,$0.00,$292.19,$462.83,$467.50,$0.00,$0.00,$0.00,$0.00,$0.00
4940-1-020,SUP,Custom 27203010,,4940-1-020  -  CPLNG EXFIX 5MM HFMN2 C 5MM 3-4MM PIN TO ROD,$522.50,$0.00,$522.50,$0.00,$372.91,$0.00,$0.00,$0.00,$0.00,$0.00,$522.50,$0.00,$261.25,$413.82,$418.00,$0.00,$0.00,$0.00,$0.00,$0.00
4940-1-058,SUP,Custom 27203010,,4940-1-058  -  CPLNG EXFIX 5MM HFMN2 C 5MM 8-8MM PIN TO ROD,$807.13,$0.00,$807.13,$0.00,$576.05,$0.00,$0.00,$0.00,$0.00,$0.00,$807.13,$0.00,$403.56,$639.25,$645.70,$0.00,$0.00,$0.00,$0.00,$0.00
4940-1-100,SUP,Custom 27203010,,4940-1-100  -  DEVICE EXFIX HFMN2 C CMPR DSTRCT ROD TO TUBE CPLNG,$522.50,$0.00,$522.50,$0.00,$372.91,$0.00,$0.00,$0.00,$0.00,$0.00,$522.50,$0.00,$261.25,$413.82,$418.00,$0.00,$0.00,$0.00,$0.00,$0.00
4940-2-020,SUP,Custom 27203010,,4940-2-020  -  CLAMP EXFIX HFMN2 4 HOLE MLPN,$617.38,$0.00,$617.38,$0.00,$440.62,$0.00,$0.00,$0.00,$0.00,$0.00,$617.38,$0.00,$308.69,$488.96,$493.90,$0.00,$0.00,$0.00,$0.00,$0.00
4940-2-120,SUP,Custom 27203010,,4940-2-120  -  POST XTRNFX STRG 5MM HFMN2 C SS,$115.50,$0.00,$115.50,$0.00,$82.43,$0.00,$0.00,$0.00,$0.00,$0.00,$115.50,$0.00,$57.75,$91.48,$92.40,$0.00,$0.00,$0.00,$0.00,$0.00
4940-2-140,SUP,Custom 27203010,,4940-2-140  -  POST XTRNFX 30D 5MM HFMN2 C SS,$115.50,$0.00,$115.50,$0.00,$82.43,$0.00,$0.00,$0.00,$0.00,$0.00,$115.50,$0.00,$57.75,$91.48,$92.40,$0.00,$0.00,$0.00,$0.00,$0.00
4941-0-015,SUP,Custom 27203010,,4941-0-015  -  TUBE XTRNFX 15MM 350MM YLW HFMN2 C CMPR DSTRCT MRI SAFE C,$737.00,$0.00,$737.00,$0.00,$526.00,$0.00,$0.00,$0.00,$0.00,$0.00,$737.00,$0.00,$368.50,$583.70,$589.60,$0.00,$0.00,$0.00,$0.00,$0.00
4941-1-010,SUP,Custom 27203010,,4941-1-010  -  CPLNG EXFIX HFMN2 ROD TO ROD CMPCT 5 MM ROD OR POST,$514.25,$0.00,$514.25,$0.00,$367.02,$0.00,$0.00,$0.00,$0.00,$0.00,$514.25,$0.00,$257.13,$407.29,$411.40,$0.00,$0.00,$0.00,$0.00,$0.00
4941-1-020,SUP,Custom 27203010,,4941-1-020  -  CLAMP EXFIX HFMN2 MRI PIN TO ROD CPLNG MRI 5 MM ROD OR POST,$514.25,$0.00,$514.25,$0.00,$367.02,$0.00,$0.00,$0.00,$0.00,$0.00,$514.25,$0.00,$257.13,$407.29,$411.40,$0.00,$0.00,$0.00,$0.00,$0.00
4941-1-058,SUP,Custom 27203010,,4941-1-058  -  COUPLING XTRNFX HFMN2 C MR SF 5 MM 8 MM ROD,$746.63,$0.00,$746.63,$0.00,$532.87,$0.00,$0.00,$0.00,$0.00,$0.00,$746.63,$0.00,$373.31,$591.33,$597.30,$0.00,$0.00,$0.00,$0.00,$0.00
4941-1-100,SUP,Custom 27203010,,4941-1-100  -  SYSTEM EXFIX 15MM 5MM DSTRCT TUBE ROD CPLNG POSTS,$456.50,$0.00,$456.50,$0.00,$325.80,$0.00,$0.00,$0.00,$0.00,$0.00,$456.50,$0.00,$228.25,$361.55,$365.20,$0.00,$0.00,$0.00,$0.00,$0.00
4941-2-020,SUP,Custom 27203010,,4941-2-020  -  CLAMP EXFIX HFMN2 C 4 HOLE PIN 3-4 MM PIN,$621.50,$0.00,$621.50,$0.00,$443.56,$0.00,$0.00,$0.00,$0.00,$0.00,$621.50,$0.00,$310.75,$492.23,$497.20,$0.00,$0.00,$0.00,$0.00,$0.00
4941-2-120,SUP,Custom 27203010,,4941-2-120  -  POST XTRNFX 30D STRG AU HFMN2 C MDLR MRI SAFE AL TI,$116.88,$0.00,$116.88,$0.00,$83.41,$0.00,$0.00,$0.00,$0.00,$0.00,$116.88,$0.00,$58.44,$92.57,$93.50,$0.00,$0.00,$0.00,$0.00,$0.00
4941-2-140,SUP,Custom 27203010,,4941-2-140  -  POST XTRNFX 30D HFMN2 C MRI SAFE,$116.88,$0.00,$116.88,$0.00,$83.41,$0.00,$0.00,$0.00,$0.00,$0.00,$116.88,$0.00,$58.44,$92.57,$93.50,$0.00,$0.00,$0.00,$0.00,$0.00
4941-2-200,SUP,Custom 27203010,,4941-2-200  -  CLAMP EXFIX HFMN2 MRI PERIART PIN CMPCT,$621.50,$0.00,$621.50,$0.00,$443.56,$0.00,$0.00,$0.00,$0.00,$0.00,$621.50,$0.00,$310.75,$492.23,$497.20,$0.00,$0.00,$0.00,$0.00,$0.00
4960-1-010,SUP,Custom 27203010,,4960-1-010  -  CPLNG EXFIX 3MM 3MM HFMN2 ROD TO ROD,$734.25,$0.00,$734.25,$0.00,$524.03,$0.00,$0.00,$0.00,$0.00,$0.00,$734.25,$0.00,$367.13,$581.53,$587.40,$0.00,$0.00,$0.00,$0.00,$0.00
4960-1-020,SUP,Custom 27203010,,4960-1-020  -  CPLNG EXFIX 1.65-2MM 3MM HFMN2 MIC HAND PIN TO ROD,$734.25,$0.00,$734.25,$0.00,$524.03,$0.00,$0.00,$0.00,$0.00,$0.00,$734.25,$0.00,$367.13,$581.53,$587.40,$0.00,$0.00,$0.00,$0.00,$0.00
4960-1-060,SUP,Custom 27203010,,4960-1-060  -  CPLNG EXFIX 5MM 3MM HFMN2 ROD TO ROD,$746.63,$0.00,$746.63,$0.00,$532.87,$0.00,$0.00,$0.00,$0.00,$0.00,$746.63,$0.00,$373.31,$591.33,$597.30,$0.00,$0.00,$0.00,$0.00,$0.00
4960-2-020,SUP,Custom 27203010,,4960-2-020  -  CLAMP EXFIX HFMN2 STR MLPN,$746.63,$0.00,$746.63,$0.00,$532.87,$0.00,$0.00,$0.00,$0.00,$0.00,$746.63,$0.00,$373.31,$591.33,$597.30,$0.00,$0.00,$0.00,$0.00,$0.00
4960-3-000,SUP,Custom 27203010,,4960-3-000  -  DEVICE EXFIX HFMN2 MIC LNTHNR,"$4,449.50",$0.00,"$4,449.50",$0.00,"$3,175.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,449.50",$0.00,"$2,224.75","$3,524.00","$3,559.60",$0.00,$0.00,$0.00,$0.00,$0.00
4960-3-015,SUP,Custom 27203010,,4960-3-015  -  CLAMP EXFIX HFMN2 MIC MLPN LNTHNR CMPNT,$59.13,$0.00,$59.13,$0.00,$42.20,$0.00,$0.00,$0.00,$0.00,$0.00,$59.13,$0.00,$29.56,$46.83,$47.30,$0.00,$0.00,$0.00,$0.00,$0.00
4960-3-020,SUP,Custom 27203010,,4960-3-020  -  CLAMP EXFIX HFMN2 MIC MLPN LNTHNR CMPNT,$651.75,$0.00,$651.75,$0.00,$465.15,$0.00,$0.00,$0.00,$0.00,$0.00,$651.75,$0.00,$325.88,$516.19,$521.40,$0.00,$0.00,$0.00,$0.00,$0.00
4960-3-025,SUP,Custom 27203010,,4960-3-025  -  CLAMP EXFIX HFMN2 PERIART MLPN LNTHNR,$651.75,$0.00,$651.75,$0.00,$465.15,$0.00,$0.00,$0.00,$0.00,$0.00,$651.75,$0.00,$325.88,$516.19,$521.40,$0.00,$0.00,$0.00,$0.00,$0.00
4960-3-030,SUP,Custom 27203010,,4960-3-030  -  HII MICRO LENGTHENER THUMBWHEEL,$174.63,$0.00,$174.63,$0.00,$124.63,$0.00,$0.00,$0.00,$0.00,$0.00,$174.63,$0.00,$87.31,$138.31,$139.70,$0.00,$0.00,$0.00,$0.00,$0.00
497.668E,SUP,HCPCS C1713,,497.668E  -  SCREW TI 8MM 2.4MM MANDIB SLFTAP LCK BONE STRL RECON PLT,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
497.670E,SUP,HCPCS C1713,,497.670E  -  SCREW TI 10MM 2.4MM MANDIB SLFTAP LCK BONE STRL RECON PLT,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
497.672E,SUP,HCPCS C1713,,497.672E  -  SCREW TI 12MM 2.4MM MANDIB SLFTAP LCK BONE STRL RECON PLT,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
497.674E,SUP,HCPCS C1713,,497.674E  -  SCREW TI 14MM 2.4MM MANDIB SLFTAP LCK BONE STRL RECON PLT,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
497.676E,SUP,HCPCS C1713,,497.676E  -  SCREW TI 16MM 2.4MM MANDIB SLFTAP LCK BONE STRL RECON PLT,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
497.678E,SUP,HCPCS C1713,,497.678E  -  SCREW TI 18MM 2.4MM MANDIB SLFTAP LCK BONE STRL RECON PLT,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
497.680E,SUP,HCPCS C1713,,497.680E  -  2.4MM TI LOCKING SCREW 20MM F/LOCKING RECONSTRUCTION PLATE,$389.25,$0.00,$389.25,$175.16,$277.81,$0.00,$67.07,$0.00,$0.00,$68.15,$389.25,$0.00,$194.63,$308.29,$311.40,$0.00,$60.92,$0.00,$61.97,$0.00
497.682E,SUP,HCPCS C1713,,497.682E  -  2.4MM TI LOCKING SCREW 22MM F/LOCKING RECONSTRUCTION PLATE,$389.25,$0.00,$389.25,$175.16,$277.81,$0.00,$67.07,$0.00,$0.00,$68.15,$389.25,$0.00,$194.63,$308.29,$311.40,$0.00,$60.92,$0.00,$61.97,$0.00
497.684E,SUP,HCPCS C1713,,497.684E  -  2.4MM TI LOCKING SCREW 24MM F/LOCKING RECONSTRUCTION PLATE,$389.25,$0.00,$389.25,$175.16,$277.81,$0.00,$67.07,$0.00,$0.00,$68.15,$389.25,$0.00,$194.63,$308.29,$311.40,$0.00,$60.92,$0.00,$61.97,$0.00
497.689E,SUP,HCPCS C1713,,497.689E  -  TI BENDING INSERT SCREW F/LOCKING RECONSTRUCTION PLATE,$113.63,$0.00,$113.63,$51.13,$81.09,$0.00,$19.58,$0.00,$0.00,$19.89,$113.63,$0.00,$56.81,$89.99,$90.90,$0.00,$17.78,$0.00,$18.09,$0.00
497.690E,SUP,HCPCS C1713,,497.690E  -  SCREW TI 8MM 3MM MANDIB SLFTAP LCK BONE STRL RECON PLT,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
497.691E,SUP,HCPCS C1713,,497.691E  -  SCREW TI 10MM 3MM MANDIB SLFTAP LCK BONE NONSTRL RECON PLT,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
497.692E,SUP,HCPCS C1713,,497.692E  -  SCREW TI 12MM 3MM MANDIB SLFTAP LCK BONE NONSTRL RECON PLT,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
497.693E,SUP,HCPCS C1713,,497.693E  -  SCREW TI 14MM 3MM MANDIB SLFTAP LCK BONE STRL RECON PLT,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
497.694E,SUP,HCPCS C1713,,497.694E  -  SCREW BONE 16MM 3MM CRNMXF TI SLFTAP LCK RECON PLT STRL,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
497.695E,SUP,HCPCS C1713,,497.695E  -  SCREW BONE 18MM 3MM CRNMXF TI SLFTAP LCK RECON PLT STRL,$1.00,$0.00,$1.00,$0.45,$0.71,$0.00,$0.17,$0.00,$0.00,$0.18,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.16,$0.00,$0.16,$0.00
497.696E,SUP,HCPCS C1713,,497.696E  -  SCREW TI 20MM 3MM MANDIB SLFTAP LCK BONE NONSTRL RECON PLT,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
497.697E,SUP,HCPCS C1713,,497.697E  -  SCREW BONE 3MM 22MM TI ORTH LCK NONSTRL,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
497.698E,SUP,HCPCS C1713,,497.698E  -  3.0MM TI LOCKING SCREW 24MM F/LOCKING RECONSTRUCTION PLATE,$452.25,$0.00,$452.25,$203.51,$322.77,$0.00,$77.92,$0.00,$0.00,$79.19,$452.25,$0.00,$226.13,$358.18,$361.80,$0.00,$70.78,$0.00,$72.00,$0.00
497.78.98,SUP,HCPCS C1713,,497.78.98  -  SCREW TI 5MM 1.8MM MAXFACL LCK BONE THORP NONSTRL,$85.50,$0.00,$85.50,$38.48,$61.02,$0.00,$14.73,$0.00,$0.00,$14.97,$85.50,$0.00,$42.75,$67.72,$68.40,$0.00,$13.38,$0.00,$13.61,$0.00
497-670,SUP,HCPCS C1713,,497-670  -  SCREW TI 10MM 2.4MM MANDIB SLFTAP LCK RECON BONE NONSTRL,$272.25,$0.00,$272.25,$122.51,$194.30,$0.00,$46.91,$0.00,$0.00,$47.67,$272.25,$0.00,$136.13,$215.62,$217.80,$0.00,$42.61,$0.00,$43.34,$0.00
498.800.01S,SUP,Custom 27803010,,498.800.01S  -  CABLE ORTHOPEDIC 1MM 750MM CRIMP TITANIUM STERILE,$892.55,$0.00,$892.55,$0.00,$637.01,$0.00,$0.00,$0.00,$0.00,$0.00,$892.55,$0.00,$446.28,$706.90,$714.04,$0.00,$0.00,$0.00,$0.00,$0.00
498.803S,SUP,Custom 27203010,,498.803S  -  POSITIONER IMPLANT 4.5MM THREAD CERCLAGE TITANIUM STERILE,$333.00,$0.00,$333.00,$0.00,$237.66,$0.00,$0.00,$0.00,$0.00,$0.00,$333.00,$0.00,$166.50,$263.74,$266.40,$0.00,$0.00,$0.00,$0.00,$0.00
498.806S,SUP,Custom 27803010,,498.806S  -  SYSTEM CABLE STANDARD REATTACHMENT DEVICE TITANIUM COCR,"$3,538.80",$0.00,"$3,538.80",$0.00,"$2,525.64",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,538.80",$0.00,"$1,769.40","$2,802.73","$2,831.04",$0.00,$0.00,$0.00,$0.00,$0.00
498.807S,SUP,Custom 27803010,,498.807S  -  SYSTEM CABLE LONG TITANIUM COCR TROC STERILE REATTACHMENT,"$5,098.70",$0.00,"$5,098.70",$0.00,"$3,638.94",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,098.70",$0.00,"$2,549.35","$4,038.17","$4,078.96",$0.00,$0.00,$0.00,$0.00,$0.00
498.821S,SUP,Custom 27803010,,498.821S  -  CABLE ORTHOPEDIC 1MM 750MM NEEDLE CRIMP TITANIUM STERILE,"$1,001.73",$0.00,"$1,001.73",$0.00,$714.93,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,001.73",$0.00,$500.86,$793.37,$801.38,$0.00,$0.00,$0.00,$0.00,$0.00
498.822S,SUP,Custom 27803010,,498.822S  -  CABLE ORTHOPEDIC CRIMP TITANIUM STERILE,$65.85,$0.00,$65.85,$0.00,$47.00,$0.00,$0.00,$0.00,$0.00,$0.00,$65.85,$0.00,$32.93,$52.15,$52.68,$0.00,$0.00,$0.00,$0.00,$0.00
498.837S,SUP,Custom 27203010,,498.837S  -  PIN FIX 3.5MM CERCLAGE POSITION STR TITANIUM ORTHOPEDIC,$333.00,$0.00,$333.00,$0.00,$237.66,$0.00,$0.00,$0.00,$0.00,$0.00,$333.00,$0.00,$166.50,$263.74,$266.40,$0.00,$0.00,$0.00,$0.00,$0.00
498.838S,SUP,HCPCS C1713,,498.838S  -  PIN FIX 3.5MM THREADED CERCLAGE POSITIONING TITANIUM,$333.00,$0.00,$333.00,$149.85,$237.66,$0.00,$55.70,$0.00,$0.00,$58.31,$333.00,$0.00,$166.50,$263.74,$266.40,$0.00,$50.60,$0.00,$53.01,$0.00
498.839S,SUP,Custom 27203010,,498.839S  -  POSITIONER SURG 4.5MM CERCLAGE NONTHREADED PIN TITANIUM,$333.00,$0.00,$333.00,$0.00,$237.66,$0.00,$0.00,$0.00,$0.00,$0.00,$333.00,$0.00,$166.50,$263.74,$266.40,$0.00,$0.00,$0.00,$0.00,$0.00
4981-1-010S,SUP,Custom 27203010,,4981-1-010S  -  CPLNG EXFIX 15/15MM 4 5/15MM HFMN XPRESS UNV STRL,$790.63,$0.00,$790.63,$0.00,$564.27,$0.00,$0.00,$0.00,$0.00,$0.00,$790.63,$0.00,$395.31,$626.18,$632.50,$0.00,$0.00,$0.00,$0.00,$0.00
4981-1-020S,SUP,Custom 27203010,,4981-1-020S  -  COUPLING XTRNFX UNV 5MM 6MM,$845.63,$0.00,$845.63,$0.00,$603.52,$0.00,$0.00,$0.00,$0.00,$0.00,$845.63,$0.00,$422.81,$669.74,$676.50,$0.00,$0.00,$0.00,$0.00,$0.00
4A0002,SUP,HCPCS C1725,,4A0002  -  CATHETER ANGIO JR4 CRV 4FR 100CM STSR,$21.88,$0.00,$21.88,$11.88,$15.61,$0.00,$3.77,$0.00,$0.00,$3.83,$21.88,$0.00,$10.94,$17.33,$17.50,$0.00,$3.42,$0.00,$3.48,$0.00
4A0004,SUP,HCPCS C1887,,4A0004  -  CATHETER ANGIOGRAPHIC JR5 CURVE 4FR 100CM SITESEER,$21.88,$0.00,$21.88,$11.88,$15.61,$0.00,$3.77,$0.00,$0.00,$3.83,$21.88,$0.00,$10.94,$17.33,$17.50,$0.00,$3.42,$0.00,$3.48,$0.00
4A001,SUP,HCPCS C1725,,CATHETER 4FR JR 3.5,$0.80,$0.00,$0.80,$0.43,$0.57,$0.00,$0.14,$0.00,$0.00,$0.14,$0.80,$0.00,$0.40,$0.63,$0.64,$0.00,$0.13,$0.00,$0.13,$0.00
4A0010,SUP,HCPCS C1725,,4A0010  -  CATHETER ANGIOGRAPHIC JL3.5 CURVE 4FR 100CM SITESEER,$21.88,$0.00,$21.88,$11.88,$15.61,$0.00,$3.77,$0.00,$0.00,$3.83,$21.88,$0.00,$10.94,$17.33,$17.50,$0.00,$3.42,$0.00,$3.48,$0.00
4A0011,SUP,HCPCS C1725,,4A0011  -  CATHETER ANGIO JL4 CRV 4FR 100CM STSR,$21.88,$0.00,$21.88,$11.88,$15.61,$0.00,$3.77,$0.00,$0.00,$3.83,$21.88,$0.00,$10.94,$17.33,$17.50,$0.00,$3.42,$0.00,$3.48,$0.00
4A0012,SUP,HCPCS C1725,,4A0012  -  CATHETER ANGIOGRAPHIC JL5 CURVE 4FR 100CM SITESEER,$21.88,$0.00,$21.88,$11.88,$15.61,$0.00,$3.77,$0.00,$0.00,$3.83,$21.88,$0.00,$10.94,$17.33,$17.50,$0.00,$3.42,$0.00,$3.48,$0.00
4A002,SUP,HCPCS C1887,,4A002  -  CATHETER GD JR CRV 4FR,$17.50,$0.00,$17.50,$9.50,$12.49,$0.00,$3.02,$0.00,$0.00,$3.06,$17.50,$0.00,$8.75,$13.86,$14.00,$0.00,$2.74,$0.00,$2.79,$0.00
4A0022,SUP,HCPCS C1725,,4A0022  -  CATHETER ANGIOGRAPHIC MPA2 CURVE 4FR 100CM 2 SIDEHOLE,$21.88,$0.00,$21.88,$11.88,$15.61,$0.00,$3.77,$0.00,$0.00,$3.83,$21.88,$0.00,$10.94,$17.33,$17.50,$0.00,$3.42,$0.00,$3.48,$0.00
4A101,SUP,Custom 27203010,,HAMMER TL 12.25IN 1.25IN NUPLA FBGLS PLMR DEAD BLOW 4IN 16OZ,$62.90,$0.00,$62.90,$0.00,$44.89,$0.00,$0.00,$0.00,$0.00,$0.00,$62.90,$0.00,$31.45,$49.82,$50.32,$0.00,$0.00,$0.00,$0.00,$0.00
4DCFN,SUP,Custom 27203010,,4DCFN  -  TUBE TRCH 4 9.4MM 5MM 62MM STRL LF SHLY CUFLS DISP INR CNN,$83.74,$0.00,$83.74,$0.00,$59.76,$0.00,$0.00,$0.00,$0.00,$0.00,$83.74,$0.00,$41.87,$66.32,$66.99,$0.00,$0.00,$0.00,$0.00,$0.00
4DCFS,SUP,Custom 27203010,,4DCFS  -  TUBE TRCH 4 9.4MM 5MM 62MM STRL LF SHLY CUFLS DISP INR CNN,$89.90,$0.00,$89.90,$0.00,$64.16,$0.00,$0.00,$0.00,$0.00,$0.00,$89.90,$0.00,$44.95,$71.20,$71.92,$0.00,$0.00,$0.00,$0.00,$0.00
4DFEN,SUP,Custom 27203010,,4DFEN  -  TUBE TRCH 4 9.4MM 5MM 62MM STRL LF SHLY CUF DISP INR CNN RND,$100.92,$0.00,$100.92,$0.00,$72.02,$0.00,$0.00,$0.00,$0.00,$0.00,$100.92,$0.00,$50.46,$79.93,$80.73,$0.00,$0.00,$0.00,$0.00,$0.00
4MAXC,SUP,HCPCS C1757,,4MAXC  -  CATHETER REPERFUSION 4MAX,"$3,225.00",$0.00,"$3,225.00",$0.00,"$2,301.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,225.00",$0.00,"$1,612.50","$2,554.20","$2,580.00",$0.00,$0.00,$0.00,$0.00,$0.00
4MAXCKIT,SUP,HCPCS C1757,,4MAXCKIT  -  CATHETER REPERFUSION 4MAX,"$4,375.00",$0.00,"$4,375.00",$0.00,"$3,122.44",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,375.00",$0.00,"$2,187.50","$3,465.00","$3,500.00",$0.00,$0.00,$0.00,$0.00,$0.00
4N06A,SUP,Custom 27803010,,4N06A  -  SUTURE NABSB CV-4 TH-26 36IN WHT 2 ARM MFL GRTX,$66.46,$0.00,$66.46,$0.00,$47.43,$0.00,$0.00,$0.00,$0.00,$0.00,$66.46,$0.00,$33.23,$52.64,$53.17,$0.00,$0.00,$0.00,$0.00,$0.00
4R5126,SUP,Custom 27203010,,DEVICE HMTP SEG NDL PRTC BLOOD BANK STRL,$900.00,$0.00,$900.00,$0.00,$642.33,$0.00,$0.00,$0.00,$0.00,$0.00,$900.00,$0.00,$450.00,$712.80,$720.00,$0.00,$0.00,$0.00,$0.00,$0.00
50000LTS,SUP,HCPCS C1713,,50000LTS  -  CAP LCK SPRL R90D TI SPNE WDG LCK CLSR MECH,$696.43,$0.00,$696.43,$313.39,$497.04,$0.00,$119.99,$0.00,$0.00,$121.94,$696.43,$0.00,$348.21,$551.57,$557.14,$0.00,$108.99,$0.00,$110.87,$0.00
500-01-42A,SUP,Custom 27803010,,500-01-42A  -  SHELL ACETAB A HEMISPHERICAL 42MM SOLID BACK TRIDENT HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
500-01-44B,SUP,Custom 27803010,,500-01-44B  -  SHELL ACETAB B HEMISPHERICAL 44MM SOLID BACK TRIDENT HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
500-01-46C,SUP,Custom 27803010,,500-01-46C  -  SHELL ACETAB C HEMISPHERICAL 46MM SOLID BACK TRIDENT HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
500-01-48D,SUP,Custom 27803010,,500-01-48D  -  SHELL ACETAB D HEMISPHERICAL 48MM SOLID BACK TRIDENT HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
500-01-50D,SUP,Custom 27803010,,500-01-50D  -  SHELL ACETAB D HEMISPHERICAL 50MM SOLID BACK TRIDENT HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
500-01-52E,SUP,Custom 27803010,,500-01-52E  -  SHELL ACETAB E HEMISPHERICAL 52MM SOLID BACK TRIDENT HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
500-01-54E,SUP,Custom 27803010,,500-01-54E  -  SHELL ACETAB E HEMISPHERICAL 54MM SOLID BACK TRIDENT HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
500-01-56F,SUP,Custom 27803010,,500-01-56F  -  SHELL ACETAB F HEMISPHERICAL 56MM SOLID BACK TRIDENT HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
500-01-58F,SUP,Custom 27803010,,500-01-58F  -  SHELL ACETAB F HEMISPHERICAL 58MM SOLID BACK TRIDENT HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
500-01-60G,SUP,Custom 27803010,,500-01-60G  -  SHELL ACETAB G HEMISPHERICAL 60MM SOLID BACK TRIDENT HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
500-01-62G,SUP,Custom 27803010,,500-01-62G  -  SHELL ACETAB G HEMISPHERICAL 62MM SOLID BACK TRIDENT HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
500-01-64H,SUP,Custom 27803010,,500-01-64H  -  SHELL ACETAB H HEMISPHERICAL 64MM SOLID BACK TRIDENT HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
500-01-66H,SUP,Custom 27803010,,500-01-66H  -  SHELL ACETAB H HEMISPHERICAL 66MM SOLID BACK TRIDENT HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
500-01-68I,SUP,Custom 27803010,,500-01-68I  -  SHELL ACETAB I HEMISPHERICAL 68MM SOLID BACK TRIDENT HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
500-01-70I,SUP,Custom 27803010,,500-01-70I  -  SHELL ACETAB I HEMISPHERICAL 70MM SOLID BACK TRIDENT HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
500-01-72J,SUP,Custom 27803010,,500-01-72J  -  SHELL ACETAB J HEMISPHERICAL 72MM SOLID BACK TRIDENT HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
500-01-74J,SUP,Custom 27803010,,500-01-74J  -  SHELL ACETAB J HEMISPHERICAL 74MM SOLID BACK TRIDENT HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
500-03-44A,SUP,Custom 27803010,,500-03-44A  -  SHELL ACETAB A HEMISPHERICAL 44MM SOLID BACK TRITANIUM HIP,"$2,302.50",$0.00,"$2,302.50",$0.00,"$1,643.29",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,302.50",$0.00,"$1,151.25","$1,823.58","$1,842.00",$0.00,$0.00,$0.00,$0.00,$0.00
500-03-46B,SUP,Custom 27803010,,500-03-46B  -  SHELL ACETAB B HEMISPHERICAL 46MM SOLID BACK TRITANIUM HIP,"$2,302.50",$0.00,"$2,302.50",$0.00,"$1,643.29",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,302.50",$0.00,"$1,151.25","$1,823.58","$1,842.00",$0.00,$0.00,$0.00,$0.00,$0.00
500-03-48C,SUP,Custom 27803010,,500-03-48C  -  SHELL ACETAB C HEMISPHERICAL 48MM SOLID BACK TRITANIUM HIP,"$2,302.50",$0.00,"$2,302.50",$0.00,"$1,643.29",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,302.50",$0.00,"$1,151.25","$1,823.58","$1,842.00",$0.00,$0.00,$0.00,$0.00,$0.00
500-03-50D,SUP,Custom 27803010,,500-03-50D  -  SHELL ACETAB D HEMISPHERICAL 50MM SOLID BACK TRITANIUM HIP,"$2,302.50",$0.00,"$2,302.50",$0.00,"$1,643.29",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,302.50",$0.00,"$1,151.25","$1,823.58","$1,842.00",$0.00,$0.00,$0.00,$0.00,$0.00
500-03-52D,SUP,Custom 27803010,,500-03-52D  -  SHELL ACETAB D HEMISPHERICAL 52MM SOLID BACK TRITANIUM HIP,"$2,302.50",$0.00,"$2,302.50",$0.00,"$1,643.29",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,302.50",$0.00,"$1,151.25","$1,823.58","$1,842.00",$0.00,$0.00,$0.00,$0.00,$0.00
500-03-54E,SUP,Custom 27803010,,500-03-54E  -  SHELL ACETAB E HEMISPHERICAL 54MM SOLID BACK PRIM TRITANIUM,"$2,302.50",$0.00,"$2,302.50",$0.00,"$1,643.29",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,302.50",$0.00,"$1,151.25","$1,823.58","$1,842.00",$0.00,$0.00,$0.00,$0.00,$0.00
500-03-56E,SUP,Custom 27803010,,500-03-56E  -  SHELL ACETAB E HEMISPHERICAL 56MM SOLID BACK PRIM TRITANIUM,"$2,302.50",$0.00,"$2,302.50",$0.00,"$1,643.29",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,302.50",$0.00,"$1,151.25","$1,823.58","$1,842.00",$0.00,$0.00,$0.00,$0.00,$0.00
500-03-58F,SUP,Custom 27803010,,500-03-58F  -  SHELL ACETAB F HEMISPHERICAL 58MM SOLID BACK PRIM TRITANIUM,"$2,302.50",$0.00,"$2,302.50",$0.00,"$1,643.29",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,302.50",$0.00,"$1,151.25","$1,823.58","$1,842.00",$0.00,$0.00,$0.00,$0.00,$0.00
500-03-60F,SUP,Custom 27803010,,500-03-60F  -  SHELL ACETAB F HEMISPHERICAL 60MM SOLID BACK PRIM TRITANIUM,"$2,302.50",$0.00,"$2,302.50",$0.00,"$1,643.29",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,302.50",$0.00,"$1,151.25","$1,823.58","$1,842.00",$0.00,$0.00,$0.00,$0.00,$0.00
500-03-62G,SUP,Custom 27803010,,500-03-62G  -  SHELL ACETAB F HEMISPHERICAL 60MM SOLID BACK PRIM TRITANIUM,"$2,302.50",$0.00,"$2,302.50",$0.00,"$1,643.29",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,302.50",$0.00,"$1,151.25","$1,823.58","$1,842.00",$0.00,$0.00,$0.00,$0.00,$0.00
500-03-64G,SUP,Custom 27803010,,500-03-64G  -  SHELL ACETAB G HEMISPHERICAL 64MM SOLID BACK PRIM TRITANIUM,"$2,302.50",$0.00,"$2,302.50",$0.00,"$1,643.29",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,302.50",$0.00,"$1,151.25","$1,823.58","$1,842.00",$0.00,$0.00,$0.00,$0.00,$0.00
500-03-66H,SUP,Custom 27803010,,500-03-66H  -  SHELL ACETAB H HEMISPHERICAL 66MM SOLID BACK PRIM TRITANIUM,"$2,302.50",$0.00,"$2,302.50",$0.00,"$1,643.29",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,302.50",$0.00,"$1,151.25","$1,823.58","$1,842.00",$0.00,$0.00,$0.00,$0.00,$0.00
5000L,SUP,Custom 27803010,,5000L  -  CONNECTOR ROD LNG SPRL R90D VAR CX TI SPNE,"$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
5000M,SUP,Custom 27803010,,5000M  -  CONNECTOR ROD MED SPRL R90D VAR CX TI THORLMBR SPNE,"$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
5000S,SUP,Custom 27803010,,5000S  -  CONNECTOR ROD SM SPRL R90D VAR CX TI THORLMBR SPNE,"$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
50010X,SUP,Custom 27803010,,50010X  -  CONNECTOR ROD 10MM SPRL R90D FX CX TI THORLMBR SPNE,"$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
500-11-42A,SUP,Custom 27803010,,500-11-42A  -  SHELL ACETAB A HEMISPHERICAL 42MM SOLID BACK TRIDENT METAL,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
500-11-44B,SUP,Custom 27803010,,500-11-44B  -  SHELL ACETAB B HEMISPHERICAL 44MM SOLID BACK TRIDENT METAL,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
500-11-46C,SUP,Custom 27803010,,500-11-46C  -  SHELL ACETAB C HEMISPHERICAL 46MM SOLID BACK TRIDENT METAL,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
500-11-48D,SUP,Custom 27803010,,500-11-48D  -  SHELL ACETAB D HEMISPHERICAL 48MM SOLID BACK TRIDENT METAL,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
500-11-50D,SUP,Custom 27803010,,500-11-50D  -  SHELL ACETAB D HEMISPHERICAL 50MM SOLID BACK TRIDENT METAL,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
500-11-52E,SUP,Custom 27803010,,500-11-52E  -  SHELL ACETAB E HEMISPHERICAL 52MM SOLID BACK TRIDENT METAL,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
500-11-54E,SUP,Custom 27803010,,500-11-54E  -  SHELL ACETAB E HEMISPHERICAL 54MM SOLID BACK TRIDENT METAL,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
500-11-56F,SUP,Custom 27803010,,500-11-56F  -  SHELL ACETAB F HEMISPHERICAL 56MM SOLID BACK TRIDENT METAL,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
500-11-58F,SUP,Custom 27803010,,500-11-58F  -  SHELL ACETAB F HEMISPHERICAL 58MM SOLID BACK TRIDENT METAL,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
500-11-60G,SUP,Custom 27803010,,500-11-60G  -  SHELL ACETAB G HEMISPHERICAL 60MM SOLID BACK TRIDENT METAL,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
500-11-62G,SUP,Custom 27803010,,500-11-62G  -  SHELL ACETAB G HEMISPHERICAL 62MM SOLID BACK TRIDENT METAL,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
500-11-64H,SUP,Custom 27803010,,500-11-64H  -  SHELL ACETAB H HEMISPHERICAL 64MM SOLID BACK TRIDENT METAL,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
500-11-66H,SUP,Custom 27803010,,500-11-66H  -  SHELL ACETAB H HEMISPHERICAL 66MM SOLID BACK TRIDENT METAL,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
500-11-68I,SUP,Custom 27803010,,500-11-68I  -  SHELL ACETAB I HEMISPHERICAL 68MM SOLID BACK TRIDENT METAL,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
500-11-70I,SUP,Custom 27803010,,500-11-70I  -  SHELL ACETAB I HEMISPHERICAL 70MM SOLID BACK TRIDENT METAL,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
500-11-72J,SUP,Custom 27803010,,500-11-72J  -  SHELL ACETAB J HEMISPHERICAL 72MM SOLID BACK TRIDENT METAL,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
500-11-74J,SUP,Custom 27803010,,500-11-74J  -  SHELL ACETAB J HEMISPHERICAL 74MM SOLID BACK TRIDENT METAL,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
50012X,SUP,Custom 27803010,,50012X  -  CONNECTOR ROD 12MM SPRL R90D FX CX TI THORLMBR SPNE,"$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
50014X,SUP,Custom 27803010,,50014X  -  CONNECTOR ROD 14MM SPRL R90D FX CX TI THORLMBR SPNE,"$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
50016X,SUP,Custom 27803010,,50016X  -  CONNECTOR ROD 16MM SPRL R90D FX CX TI THORLMBR SPNE,"$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
50018X,SUP,Custom 27803010,,50018X  -  CONNECTOR ROD 18MM SPRL R90D FX CX TI THORLMBR SPNE,"$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
50020X,SUP,Custom 27803010,,50020X  -  CONNECTOR ROD 20MM SPRL R90D VAR CX TI THORLMBR SPNE,"$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
50-022-01-07,SUP,Custom 27100030,,50-022-01-07  -  DRILL TWIST 2.7MM 2.2MM 70MM J NOTCH GLIDING 2.7MM SCREW 2.1,$290.05,$0.00,$290.05,$0.00,$207.01,$0.00,$0.00,$0.00,$0.00,$0.00,$290.05,$0.00,$145.03,$229.72,$232.04,$0.00,$0.00,$0.00,$0.00,$0.00
50-022-15-07,SUP,Custom 27100030,,50-022-15-07  -  DRILL TWIST 2.2MM 115MM STERILE,$290.05,$0.00,$290.05,$0.00,$207.01,$0.00,$0.00,$0.00,$0.00,$0.00,$290.05,$0.00,$145.03,$229.72,$232.04,$0.00,$0.00,$0.00,$0.00,$0.00
50022X,SUP,Custom 27803010,,50022X  -  CONNECTOR ROD 22MM SPRL R90D VAR CX TI THORLMBR SPNE,"$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
50024X,SUP,Custom 27803010,,50024X  -  CONNECTOR ROD 24MM SPRL R90D VAR CX TI THORLMBR SPNE,"$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
50026X,SUP,Custom 27803010,,50026X  -  CONNECTOR ROD 26MM SPRL R90D CX TI THORLMBR SPNE,"$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
50028X,SUP,Custom 27803010,,50028X  -  CONNECTOR ROD 28MM SPRL R90D CX TI THORLMBR SPNE,"$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
50030X,SUP,Custom 27803010,,50030X  -  CONNECTOR ROD 30MM SPRL R90D CX TI THORLMBR SPNE,"$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
5005 A,SUP,Custom 27803010,,5005 A  -  PLATE 18MM TI BONE SPNL,$427.50,$0.00,$427.50,$0.00,$305.11,$0.00,$0.00,$0.00,$0.00,$0.00,$427.50,$0.00,$213.75,$338.58,$342.00,$0.00,$0.00,$0.00,$0.00,$0.00
5005 B,SUP,Custom 27803010,,5005 B  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$427.50,$0.00,$427.50,$0.00,$305.11,$0.00,$0.00,$0.00,$0.00,$0.00,$427.50,$0.00,$213.75,$338.58,$342.00,$0.00,$0.00,$0.00,$0.00,$0.00
5005 C,SUP,Custom 27803010,,5005 C  -  PLATE 18MM TI BONE SPNL,$427.50,$0.00,$427.50,$0.00,$305.11,$0.00,$0.00,$0.00,$0.00,$0.00,$427.50,$0.00,$213.75,$338.58,$342.00,$0.00,$0.00,$0.00,$0.00,$0.00
5005 E,SUP,Custom 27803010,,5005 E  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$427.50,$0.00,$427.50,$0.00,$305.11,$0.00,$0.00,$0.00,$0.00,$0.00,$427.50,$0.00,$213.75,$338.58,$342.00,$0.00,$0.00,$0.00,$0.00,$0.00
5005 F,SUP,Custom 27803010,,5005 F  -  PLATE 18MM TI BONE SPNL,$427.50,$0.00,$427.50,$0.00,$305.11,$0.00,$0.00,$0.00,$0.00,$0.00,$427.50,$0.00,$213.75,$338.58,$342.00,$0.00,$0.00,$0.00,$0.00,$0.00
5005 G,SUP,Custom 27803010,,5005 G  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$427.50,$0.00,$427.50,$0.00,$305.11,$0.00,$0.00,$0.00,$0.00,$0.00,$427.50,$0.00,$213.75,$338.58,$342.00,$0.00,$0.00,$0.00,$0.00,$0.00
5005 H,SUP,Custom 27803010,,5005 H  -  PLATE 18MM TI BONE SPNL,$427.50,$0.00,$427.50,$0.00,$305.11,$0.00,$0.00,$0.00,$0.00,$0.00,$427.50,$0.00,$213.75,$338.58,$342.00,$0.00,$0.00,$0.00,$0.00,$0.00
5005 I,SUP,Custom 27803010,,5005 I  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$427.50,$0.00,$427.50,$0.00,$305.11,$0.00,$0.00,$0.00,$0.00,$0.00,$427.50,$0.00,$213.75,$338.58,$342.00,$0.00,$0.00,$0.00,$0.00,$0.00
500-580C-10U,SUP,Custom 27803010,,500-580C-10U  -  CLIP HMSTS 5FR BMRNG CTLST 2 SYS ART VASC CATH ACCES ST,$375.00,$0.00,$375.00,$0.00,$267.64,$0.00,$0.00,$0.00,$0.00,$0.00,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$0.00,$0.00,$0.00,$0.00
50100-1500,SUP,HCPCS C1884,,50100-1500  -  SHEATH RTRVL 4FR F EZ .014IN BNTP,$200.00,$0.00,$200.00,$90.00,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
50-12003,SUP,HCPCS C1713,,50-12003  -  SCREW BONE 1.2MM 3MM SELF TAP XPIN HEAD LEIBINGER UNIVERSAL,$27.75,$0.00,$27.75,$12.49,$19.81,$0.00,$4.78,$0.00,$0.00,$4.86,$27.75,$0.00,$13.88,$21.98,$22.20,$0.00,$4.34,$0.00,$4.42,$0.00
50-12004,SUP,HCPCS C1713,,50-12004  -  SCREW BONE 1.2MM 4MM SELF TAP XPIN HEAD LEIBINGER UNIVERSAL,$277.50,$0.00,$277.50,$124.88,$198.05,$0.00,$47.81,$0.00,$0.00,$48.59,$277.50,$0.00,$138.75,$219.78,$222.00,$0.00,$43.43,$0.00,$44.18,$0.00
50-12005,SUP,HCPCS C1713,,50-12005  -  SCREW BONE 1.2MM 5MM SLFTAP XPIN GOLD TITANIUM UPPERFACIAL,$277.50,$0.00,$277.50,$124.88,$198.05,$0.00,$47.81,$0.00,$0.00,$48.59,$277.50,$0.00,$138.75,$219.78,$222.00,$0.00,$43.43,$0.00,$44.18,$0.00
50-12006,SUP,HCPCS C1713,,50-12006  -  SCREW BONE 1.2MM 6MM SLFTAP XPIN GOLD TITANIUM UPPERFACIAL,$277.50,$0.00,$277.50,$124.88,$198.05,$0.00,$47.81,$0.00,$0.00,$48.59,$277.50,$0.00,$138.75,$219.78,$222.00,$0.00,$43.43,$0.00,$44.18,$0.00
50-12007,SUP,HCPCS C1713,,50-12007  -  SCREW BONE 1.2MM 7MM SLFTAP TITANIUM UPPERFACIAL,$277.50,$0.00,$277.50,$124.88,$198.05,$0.00,$47.81,$0.00,$0.00,$48.59,$277.50,$0.00,$138.75,$219.78,$222.00,$0.00,$43.43,$0.00,$44.18,$0.00
50-12008,SUP,HCPCS C1713,,50-12008  -  SCREW BONE 1.2MM 8MM SLFTAP XPIN GOLD TITANIUM UPPERFACIAL,$277.50,$0.00,$277.50,$124.88,$198.05,$0.00,$47.81,$0.00,$0.00,$48.59,$277.50,$0.00,$138.75,$219.78,$222.00,$0.00,$43.43,$0.00,$44.18,$0.00
50-12010,SUP,HCPCS C1713,,50-12010  -  SCREW BONE 1.2MM 10MM SLFTAP XPIN GOLD TITANIUM UPPERFACIAL,$277.50,$0.00,$277.50,$124.88,$198.05,$0.00,$47.81,$0.00,$0.00,$48.59,$277.50,$0.00,$138.75,$219.78,$222.00,$0.00,$43.43,$0.00,$44.18,$0.00
50-12012,SUP,HCPCS C1713,,50-12012  -  SCREW BONE 1.2MM 12MM SLFTAP XPIN GOLD TITANIUM UPPERFACIAL,$277.50,$0.00,$277.50,$124.88,$198.05,$0.00,$47.81,$0.00,$0.00,$48.59,$277.50,$0.00,$138.75,$219.78,$222.00,$0.00,$43.43,$0.00,$44.18,$0.00
50-12903,SUP,HCPCS C1713,,50-12903  -  SCREW BONE 1.2MM 3MM SLFDRILL XPIN HEAD LEIBINGER UNIVERSAL,$312.50,$0.00,$312.50,$140.63,$223.03,$0.00,$53.84,$0.00,$0.00,$54.72,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$48.91,$0.00,$49.75,$0.00
50-12904,SUP,HCPCS C1713,,50-12904  -  SCREW BONE 1.2MM 4MM SELF DRILL XPIN TITANIUM UPPERFACIAL,$62.50,$0.00,$62.50,$28.13,$44.61,$0.00,$10.77,$0.00,$0.00,$10.94,$62.50,$0.00,$31.25,$49.50,$50.00,$0.00,$9.78,$0.00,$9.95,$0.00
5013-2-120S,SUP,HCPCS C1713,,5013-2-120S  -  PIN 120MM 4MM APEX HA SS SLFTAP DRL THRD SHFT 20MM STRL,$247.50,$0.00,$247.50,$111.38,$176.64,$0.00,$42.64,$0.00,$0.00,$43.34,$247.50,$0.00,$123.75,$196.02,$198.00,$0.00,$38.73,$0.00,$39.40,$0.00
5013-3-090S,SUP,HCPCS C1713,,5013-3-090S  -  PIN 90MM 4MM APEX HA SS SLFTAP DRL THRD SHFT 30MM STRL,$247.50,$0.00,$247.50,$111.38,$176.64,$0.00,$42.64,$0.00,$0.00,$43.34,$247.50,$0.00,$123.75,$196.02,$198.00,$0.00,$38.73,$0.00,$39.40,$0.00
50-14003,SUP,HCPCS C1713,,50-14003  -  SCREW BONE 1.4MM 3MM SELF TAP XPIN EMERGENCY TITANIUM,$282.50,$0.00,$282.50,$127.13,$201.62,$0.00,$48.67,$0.00,$0.00,$49.46,$282.50,$0.00,$141.25,$223.74,$226.00,$0.00,$44.21,$0.00,$44.97,$0.00
50-14005,SUP,HCPCS C1713,,50-14005  -  SCREW BONE 1.4MM 5MM SELF TAP XPIN HEAD EMERGENCY LEIBINGER,$282.50,$0.00,$282.50,$127.13,$201.62,$0.00,$48.67,$0.00,$0.00,$49.46,$282.50,$0.00,$141.25,$223.74,$226.00,$0.00,$44.21,$0.00,$44.97,$0.00
50-14007,SUP,HCPCS C1713,,50-14007  -  SCREW BONE 1.4MM 7MM SLFTAP XPIN EMERGENCY TITANIUM,$282.50,$0.00,$282.50,$127.13,$201.62,$0.00,$48.67,$0.00,$0.00,$49.46,$282.50,$0.00,$141.25,$223.74,$226.00,$0.00,$44.21,$0.00,$44.97,$0.00
50-14009,SUP,HCPCS C1713,,50-14009  -  SCREW BONE 1.4MM 9MM SLFTAP XPIN EMERGENCY TITANIUM,$282.50,$0.00,$282.50,$127.13,$201.62,$0.00,$48.67,$0.00,$0.00,$49.46,$282.50,$0.00,$141.25,$223.74,$226.00,$0.00,$44.21,$0.00,$44.97,$0.00
5014-2-120S,SUP,HCPCS C1713,,5014-2-120S  -  PIN 6MM SLFTAP/DRL THRD SHFT 120MM APEX HA SS 30MM STRL,$259.88,$0.00,$259.88,$116.94,$185.47,$0.00,$44.78,$0.00,$0.00,$45.50,$259.88,$0.00,$129.94,$205.82,$207.90,$0.00,$40.67,$0.00,$41.37,$0.00
5014-3-150S,SUP,HCPCS C1713,,5014-3-150S  -  PIN 6MM SLFTAP/DRL THRD SHFT 150MM APEX HA SS 30MM STRL,$259.88,$0.00,$259.88,$116.94,$185.47,$0.00,$44.78,$0.00,$0.00,$45.50,$259.88,$0.00,$129.94,$205.82,$207.90,$0.00,$40.67,$0.00,$41.37,$0.00
5014-3-180S,SUP,HCPCS C1713,,5014-3-180S  -  PIN HALF 180MM 6MM APEX HA SS SLFDRILL SLFTAP THRD SHFT 30MM,$259.88,$0.00,$259.88,$116.94,$185.47,$0.00,$44.78,$0.00,$0.00,$45.50,$259.88,$0.00,$129.94,$205.82,$207.90,$0.00,$40.67,$0.00,$41.37,$0.00
5014-3-200S,SUP,HCPCS C1713,,5014-3-200S  -  PIN 6MM SLFTAP/DRL THRD SHFT 200MM APEX HA SS 30MM STRL,$268.13,$0.00,$268.13,$120.66,$191.36,$0.00,$46.20,$0.00,$0.00,$46.95,$268.13,$0.00,$134.06,$212.36,$214.50,$0.00,$41.96,$0.00,$42.69,$0.00
5014-4-150S,SUP,HCPCS C1713,,5014-4-150S  -  PIN 6MM SLFTAP/DRL THRD SHFT 150MM APEX HA SS 40MM STRL,$259.88,$0.00,$259.88,$116.94,$185.47,$0.00,$44.78,$0.00,$0.00,$45.50,$259.88,$0.00,$129.94,$205.82,$207.90,$0.00,$40.67,$0.00,$41.37,$0.00
5014-4-180S,SUP,HCPCS C1713,,5014-4-180S  -  PIN 6MM SLFTAP/DRL THRD SHFT 180MM APEX HA SS 40MM STRL,$259.88,$0.00,$259.88,$116.94,$185.47,$0.00,$44.78,$0.00,$0.00,$45.50,$259.88,$0.00,$129.94,$205.82,$207.90,$0.00,$40.67,$0.00,$41.37,$0.00
5014-4-200S,SUP,HCPCS C1713,,5014-4-200S  -  PIN 6MM SLFTAP/DRL THRD SHFT 200MM APEX HA SS 40MM STRL,$268.13,$0.00,$268.13,$120.66,$191.36,$0.00,$46.20,$0.00,$0.00,$46.95,$268.13,$0.00,$134.06,$212.36,$214.50,$0.00,$41.96,$0.00,$42.69,$0.00
5014-5-150S,SUP,HCPCS C1713,,5014-5-150S  -  PIN HALF 150MM 6MM APEX HA SS SLFDRILL SLFTAP 50MM FIX SYS,$259.88,$0.00,$259.88,$116.94,$185.47,$0.00,$44.78,$0.00,$0.00,$45.50,$259.88,$0.00,$129.94,$205.82,$207.90,$0.00,$40.67,$0.00,$41.37,$0.00
5014-5-180S,SUP,HCPCS C1713,,5014-5-180S  -  PIN HALF 180MM 6MM APEX HA SS SLFDRILL SLFTAP THRD SHFT 50MM,$259.88,$0.00,$259.88,$116.94,$185.47,$0.00,$44.78,$0.00,$0.00,$45.50,$259.88,$0.00,$129.94,$205.82,$207.90,$0.00,$40.67,$0.00,$41.37,$0.00
5014-5-200S,SUP,HCPCS C1713,,5014-5-200S  -  PIN 6MM SLFTAP/DRL THRD SHFT 200MM APEX HA SS 50MM STRL,$268.13,$0.00,$268.13,$120.66,$191.36,$0.00,$46.20,$0.00,$0.00,$46.95,$268.13,$0.00,$134.06,$212.36,$214.50,$0.00,$41.96,$0.00,$42.69,$0.00
5014-6-150S,SUP,HCPCS C1713,,5014-6-150S  -  PIN 6MM SLFTAP/DRL THRD SHFT 150MM APEX HA SS 60MM STRL,$259.88,$0.00,$259.88,$116.94,$185.47,$0.00,$44.78,$0.00,$0.00,$45.50,$259.88,$0.00,$129.94,$205.82,$207.90,$0.00,$40.67,$0.00,$41.37,$0.00
5014-6-180S,SUP,HCPCS C1713,,5014-6-180S  -  PIN 6MM SLFTAP/DRL THRD SHFT 180MM APEX HA SS 60MM STRL,$259.88,$0.00,$259.88,$116.94,$185.47,$0.00,$44.78,$0.00,$0.00,$45.50,$259.88,$0.00,$129.94,$205.82,$207.90,$0.00,$40.67,$0.00,$41.37,$0.00
5014-6-200S,SUP,HCPCS C1713,,5014-6-200S  -  PIN 6MM SLFTAP/DRL THRD SHFT 200MM APEX HA SS 60MM STRL,$268.13,$0.00,$268.13,$120.66,$191.36,$0.00,$46.20,$0.00,$0.00,$46.95,$268.13,$0.00,$134.06,$212.36,$214.50,$0.00,$41.96,$0.00,$42.69,$0.00
5014-7-250S,SUP,HCPCS C1713,,5014-7-250S  -  PIN HALF 250MM 6MM APEX SS HA SLFDRILL SLFTAP THRD 70MM STRL,$275.00,$0.00,$275.00,$123.75,$196.27,$0.00,$47.38,$0.00,$0.00,$48.15,$275.00,$0.00,$137.50,$217.80,$220.00,$0.00,$43.04,$0.00,$43.78,$0.00
5014-8-150S,SUP,HCPCS C1713,,5014-8-150S  -  PIN 6MM SLFDRILL SLFTAP THRD SHFT 150MM APEX HA SS 25MM STRL,$259.88,$0.00,$259.88,$116.94,$185.47,$0.00,$44.78,$0.00,$0.00,$45.50,$259.88,$0.00,$129.94,$205.82,$207.90,$0.00,$40.67,$0.00,$41.37,$0.00
5014-8-250S,SUP,HCPCS C1713,,5014-8-250S  -  PIN 6MM SLFDRILL SLFTAP THRD SHFT 150MM APEX HA SS 80MM STRL,$275.00,$0.00,$275.00,$123.75,$196.27,$0.00,$47.38,$0.00,$0.00,$48.15,$275.00,$0.00,$137.50,$217.80,$220.00,$0.00,$43.04,$0.00,$43.78,$0.00
5014-9-250S,SUP,HCPCS C1713,,5014-9-250S  -  PIN 6MM SLFDRILL SLFTAP THRD SHFT 250MM APEX HA SS 90MM STRL,$275.00,$0.00,$275.00,$123.75,$196.27,$0.00,$47.38,$0.00,$0.00,$48.15,$275.00,$0.00,$137.50,$217.80,$220.00,$0.00,$43.04,$0.00,$43.78,$0.00
50-15006,SUP,HCPCS C1713,,50-15006  -  SCREW BN 1.5MM 6MM ST CROSSPIN TI CRNMXF,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
5015-3-120,SUP,HCPCS C1713,,5015-3-120  -  SCREW BONE 5MM 120MM 35MM APEX THRD CANC,$220.00,$0.00,$220.00,$99.00,$157.01,$0.00,$37.90,$0.00,$0.00,$38.52,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$34.43,$0.00,$35.02,$0.00
5015-4-150,SUP,HCPCS C1713,,5015-4-150  -  PIN 5MM 150MM CANC APEX TI 40MM,$220.00,$0.00,$220.00,$99.00,$157.01,$0.00,$37.90,$0.00,$0.00,$38.52,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$34.43,$0.00,$35.02,$0.00
5015-5-150,SUP,HCPCS C1713,,5015-5-150  -  SCREW BONE 5MM 150MM 50MM APEX THRD CANC,$220.00,$0.00,$220.00,$99.00,$157.01,$0.00,$37.90,$0.00,$0.00,$38.52,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$34.43,$0.00,$35.02,$0.00
5015-6-180,SUP,HCPCS C1713,,5015-6-180  -  SCREW BONE 5MM 180MM 60MM APEX SS CANC,$220.00,$0.00,$220.00,$99.00,$157.01,$0.00,$37.90,$0.00,$0.00,$38.52,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$34.43,$0.00,$35.02,$0.00
5015-7-250,SUP,HCPCS C1713,,5015-7-250  -  PIN HALF 250MM 5MM APEX HFMN2 CANC SS THRD 70MM,$220.00,$0.00,$220.00,$99.00,$157.01,$0.00,$37.90,$0.00,$0.00,$38.52,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$34.43,$0.00,$35.02,$0.00
50-15904,SUP,HCPCS C1713,,50-15904  -  SCREW BONE 1.5MM 4MM SELF DRILL XPIN HEAD TITANIUM,$247.50,$0.00,$247.50,$111.38,$176.64,$0.00,$42.64,$0.00,$0.00,$43.34,$247.50,$0.00,$123.75,$196.02,$198.00,$0.00,$38.73,$0.00,$39.40,$0.00
50-15905,SUP,HCPCS C1713,,50-15905  -  SCREW BONE 1.5MM 5MM SELF DRILL XPIN HEAD TITANIUM,$247.50,$0.00,$247.50,$111.38,$176.64,$0.00,$42.64,$0.00,$0.00,$43.34,$247.50,$0.00,$123.75,$196.02,$198.00,$0.00,$38.73,$0.00,$39.40,$0.00
5016-5-111,SUP,HCPCS C1713,,5016-5-111  -  PIN HALF HFMN 5MMX120MM 35MM THRD TI SLFDRL ST F/EXFIX,$213.13,$0.00,$213.13,$95.91,$152.11,$0.00,$36.72,$0.00,$0.00,$37.32,$213.13,$0.00,$106.56,$168.80,$170.50,$0.00,$33.35,$0.00,$33.93,$0.00
5016-5-117,SUP,HCPCS C1713,,5016-5-117  -  PIN 5MM SLFDRILL SLFTAP 150MM APEX TI 40MM,$213.13,$0.00,$213.13,$95.91,$152.11,$0.00,$36.72,$0.00,$0.00,$37.32,$213.13,$0.00,$106.56,$168.80,$170.50,$0.00,$33.35,$0.00,$33.93,$0.00
5016-5-118,SUP,HCPCS C1713,,5016-5-118  -  PIN HALF HFMN 50MM 5MMX150MM TI SLFDRL ST F/EXFIX,$213.13,$0.00,$213.13,$95.91,$152.11,$0.00,$36.72,$0.00,$0.00,$37.32,$213.13,$0.00,$106.56,$168.80,$170.50,$0.00,$33.35,$0.00,$33.93,$0.00
5016-5-122,SUP,HCPCS C1713,,5016-5-122  -  PIN HALF HFMN 50MM 5MMX180MM TI SLFDRL ST F/EXFIX,$213.13,$0.00,$213.13,$95.91,$152.11,$0.00,$36.72,$0.00,$0.00,$37.32,$213.13,$0.00,$106.56,$168.80,$170.50,$0.00,$33.35,$0.00,$33.93,$0.00
50-17003,SUP,HCPCS C1713,,50-17003  -  SCREW BONE 1.7MM 3MM SLFTAP XPIN TITANIUM MIDFAC,$49.50,$0.00,$49.50,$22.28,$35.33,$0.00,$8.53,$0.00,$0.00,$8.67,$49.50,$0.00,$24.75,$39.20,$39.60,$0.00,$7.75,$0.00,$7.88,$0.00
50-17004,SUP,HCPCS C1713,,50-17004  -  SCREW BONE 1.7MM 4MM SLFTAP XPIN TITANIUM MIDFAC,$247.50,$0.00,$247.50,$111.38,$176.64,$0.00,$42.64,$0.00,$0.00,$43.34,$247.50,$0.00,$123.75,$196.02,$198.00,$0.00,$38.73,$0.00,$39.40,$0.00
50-17006,SUP,HCPCS C1713,,50-17006  -  SCREW BONE 1.7MM 6MM SLFTAP XPIN TITANIUM MIDFAC,$247.50,$0.00,$247.50,$111.38,$176.64,$0.00,$42.64,$0.00,$0.00,$43.34,$247.50,$0.00,$123.75,$196.02,$198.00,$0.00,$38.73,$0.00,$39.40,$0.00
50-17007,SUP,HCPCS C1713,,50-17007  -  SCREW BONE 1.7MM 7MM SLFTAP XPIN TITANIUM MIDFAC,$247.50,$0.00,$247.50,$111.38,$176.64,$0.00,$42.64,$0.00,$0.00,$43.34,$247.50,$0.00,$123.75,$196.02,$198.00,$0.00,$38.73,$0.00,$39.40,$0.00
50-17008,SUP,HCPCS C1713,,50-17008  -  SCREW BONE 1.7MM 8MM SELF TAP XPIN TITANIUM MIDFAC,$247.50,$0.00,$247.50,$111.38,$176.64,$0.00,$42.64,$0.00,$0.00,$43.34,$247.50,$0.00,$123.75,$196.02,$198.00,$0.00,$38.73,$0.00,$39.40,$0.00
50-17010,SUP,HCPCS C1713,,50-17010  -  SCREW BONE 1.7MM 10MM SELF TAP XPIN TITANIUM MIDFAC,$247.50,$0.00,$247.50,$111.38,$176.64,$0.00,$42.64,$0.00,$0.00,$43.34,$247.50,$0.00,$123.75,$196.02,$198.00,$0.00,$38.73,$0.00,$39.40,$0.00
50-17012,SUP,HCPCS C1713,,50-17012  -  SCREW BONE 1.7MM 12MM SLFTAP XPIN TITANIUM MIDFAC,$247.50,$0.00,$247.50,$111.38,$176.64,$0.00,$42.64,$0.00,$0.00,$43.34,$247.50,$0.00,$123.75,$196.02,$198.00,$0.00,$38.73,$0.00,$39.40,$0.00
5017-2-150S,SUP,HCPCS C1713,,5017-2-150S  -  PIN 5MM SLFDRILL SLFTAP THRD SHFT 150MM APEX HA SS 20MM STRL,$253.00,$0.00,$253.00,$113.85,$180.57,$0.00,$43.59,$0.00,$0.00,$44.30,$253.00,$0.00,$126.50,$200.38,$202.40,$0.00,$39.59,$0.00,$40.28,$0.00
50-17304,SUP,HCPCS C1713,,50-17304  -  SCREW BN 1.7MM 4MM NS UNV NEURO 2 ST XPN ER CRNMXF,$247.50,$0.00,$247.50,$111.38,$176.64,$0.00,$42.64,$0.00,$0.00,$43.34,$247.50,$0.00,$123.75,$196.02,$198.00,$0.00,$38.73,$0.00,$39.40,$0.00
5017-3-150S,SUP,Custom 27203010,,5017-3-150S  -  PIN XTRNFX 5MM 150MM STRL 30MM APX SLF DRL ST SS HA,$253.00,$0.00,$253.00,$0.00,$180.57,$0.00,$0.00,$0.00,$0.00,$0.00,$253.00,$0.00,$126.50,$200.38,$202.40,$0.00,$0.00,$0.00,$0.00,$0.00
5017-3-180S,SUP,HCPCS C1713,,5017-3-180S  -  PIN HALF 180MM 5MM APEX HA SS SLFDRILL SLFTAP THRD SHFT 30MM,$253.00,$0.00,$253.00,$113.85,$180.57,$0.00,$43.59,$0.00,$0.00,$44.30,$253.00,$0.00,$126.50,$200.38,$202.40,$0.00,$39.59,$0.00,$40.28,$0.00
50-174-01-09,SUP,HCPCS C1713,,50-174-01-09  -  IMPLANT PRT JNT TI RT CNDYL 3 MM RECON PLT,"$3,141.33",$0.00,"$3,141.33","$1,413.60","$2,241.96",$0.00,$541.23,$0.00,$0.00,$550.02,"$3,141.33",$0.00,"$1,570.66","$2,487.93","$2,513.06",$0.00,$491.62,$0.00,$500.10,$0.00
50-174-03-09,SUP,HCPCS C1713,,50-174-03-09  -  SCREW BN FX XDR TI CNDYL 3 MM RECON PLT,"$1,008.13",$0.00,"$1,008.13",$453.66,$719.50,$0.00,$173.69,$0.00,$0.00,$176.51,"$1,008.13",$0.00,$504.06,$798.44,$806.50,$0.00,$157.77,$0.00,$160.49,$0.00
5017-4-150S,SUP,HCPCS C1713,,5017-4-150S  -  PIN HALF STRL 150MM 5MM APEX SS SLFTAP SLFDRILL 40MM EXFIX,$253.00,$0.00,$253.00,$113.85,$180.57,$0.00,$43.59,$0.00,$0.00,$44.30,$253.00,$0.00,$126.50,$200.38,$202.40,$0.00,$39.59,$0.00,$40.28,$0.00
5017-4-180S,SUP,HCPCS C1713,,5017-4-180S  -  PIN HALF 180MM 5MM APEX HYDRXAPT EXFIX,$253.00,$0.00,$253.00,$113.85,$180.57,$0.00,$43.59,$0.00,$0.00,$44.30,$253.00,$0.00,$126.50,$200.38,$202.40,$0.00,$39.59,$0.00,$40.28,$0.00
50-17504,SUP,HCPCS C1713,,50-17504  -  SCREW BONE 1.7MM 4MM LOCK GRAY TITANIUM MIDFAC,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
50-17505,SUP,HCPCS C1713,,50-17505  -  SCREW BONE 1.7MM 5MM LOCKING XPIN GRAY TITANIUM MIDFAC,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
50-17506,SUP,HCPCS C1713,,50-17506  -  SCREW BONE 1.7MM 6MM SLFDRILL SLFTAP LOCKING XPIN TITANIUM,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
5017-5-150S,SUP,HCPCS C1713,,5017-5-150S  -  PIN HLF SLFDRL ORTH,$253.00,$0.00,$253.00,$113.85,$180.57,$0.00,$43.59,$0.00,$0.00,$44.30,$253.00,$0.00,$126.50,$200.38,$202.40,$0.00,$39.59,$0.00,$40.28,$0.00
5017-5-180S,SUP,HCPCS C1713,,5017-5-180S  -  PIN HALF 180MM 5MM APEX SS HA SLFDRILL SLFTAP THRD 50MM STRL,$253.00,$0.00,$253.00,$113.85,$180.57,$0.00,$43.59,$0.00,$0.00,$44.30,$253.00,$0.00,$126.50,$200.38,$202.40,$0.00,$39.59,$0.00,$40.28,$0.00
5017-6-150S,SUP,HCPCS C1713,,5017-6-150S  -  PIN 5MM SLFTAP/DRL THRD SHFT 150MM APEX HA SS 60MM STRL,$253.00,$0.00,$253.00,$113.85,$180.57,$0.00,$43.59,$0.00,$0.00,$44.30,$253.00,$0.00,$126.50,$200.38,$202.40,$0.00,$39.59,$0.00,$40.28,$0.00
5017-6-200S,SUP,HCPCS C1713,,5017-6-200S  -  PIN HALF 200MM 5MM APEX ORTH SS SLFTAP SLFDRILL 60MM EXFIX,$259.88,$0.00,$259.88,$116.94,$185.47,$0.00,$44.78,$0.00,$0.00,$45.50,$259.88,$0.00,$129.94,$205.82,$207.90,$0.00,$40.67,$0.00,$41.37,$0.00
5017-7-200S,SUP,HCPCS C1713,,5017-7-200S  -  PIN HALF 200MM 5MM APEX ORTH SS SLFTAP SLFDRILL 70MM EXFIX,$259.88,$0.00,$259.88,$116.94,$185.47,$0.00,$44.78,$0.00,$0.00,$45.50,$259.88,$0.00,$129.94,$205.82,$207.90,$0.00,$40.67,$0.00,$41.37,$0.00
5017-8-150S,SUP,HCPCS C1713,,5017-8-150S  -  PIN HALF 150MM 5MM APEX HA SS SLFDRILL SLFTAP THRD SHFT 25MM,$253.00,$0.00,$253.00,$113.85,$180.57,$0.00,$43.59,$0.00,$0.00,$44.30,$253.00,$0.00,$126.50,$200.38,$202.40,$0.00,$39.59,$0.00,$40.28,$0.00
50-17903,SUP,HCPCS C1713,,50-17903  -  SCREW BONE 1.7MM 3MM SELF DRILL XPIN TITANIUM MIDFAC,"$1,400.00",$0.00,"$1,400.00",$630.00,$999.18,$0.00,$241.21,$0.00,$0.00,$245.13,"$1,400.00",$0.00,$700.00,"$1,108.80","$1,120.00",$0.00,$219.10,$0.00,$222.88,$0.00
50-17904,SUP,HCPCS C1713,,50-17904  -  SCREW BONE 1.7MM 4MM SELF DRILL XPIN TITANIUM MIDFAC,$280.00,$0.00,$280.00,$126.00,$199.84,$0.00,$48.24,$0.00,$0.00,$49.03,$280.00,$0.00,$140.00,$221.76,$224.00,$0.00,$43.82,$0.00,$44.58,$0.00
50-17905,SUP,HCPCS C1713,,50-17905  -  SCREW BONE 1.7MM 5MM SLFDRILL XPIN TITANIUM MIDFAC,"$1,400.00",$0.00,"$1,400.00",$630.00,$999.18,$0.00,$241.21,$0.00,$0.00,$245.13,"$1,400.00",$0.00,$700.00,"$1,108.80","$1,120.00",$0.00,$219.10,$0.00,$222.88,$0.00
50-17906,SUP,HCPCS C1713,,50-17906  -  SCREW BONE 1.7MM 6MM SLFDRILL XPIN TITANIUM MIDFAC,$280.00,$0.00,$280.00,$126.00,$199.84,$0.00,$48.24,$0.00,$0.00,$49.03,$280.00,$0.00,$140.00,$221.76,$224.00,$0.00,$43.82,$0.00,$44.58,$0.00
5017-9-120S,SUP,HCPCS C1713,,5017-9-120S  -  PIN 5MM SLFDRILL SLFTAP THRD SHFT 120MM APEX HA SS 35MM STRL,$253.00,$0.00,$253.00,$113.85,$180.57,$0.00,$43.59,$0.00,$0.00,$44.30,$253.00,$0.00,$126.50,$200.38,$202.40,$0.00,$39.59,$0.00,$40.28,$0.00
5017-9-150S,SUP,HCPCS C1713,,5017-9-150S  -  PIN HALF 150MM 5MM APEX HYDRXAPT SLFDRILL EXFIX,$253.00,$0.00,$253.00,$113.85,$180.57,$0.00,$43.59,$0.00,$0.00,$44.30,$253.00,$0.00,$126.50,$200.38,$202.40,$0.00,$39.59,$0.00,$40.28,$0.00
5018-3-120,SUP,Custom 27203010,,5018-3-120  -  PIN HLF 5MM 120MM 30MM APX ST SLFDRL THRD SS FT/ANKL,$206.25,$0.00,$206.25,$0.00,$147.20,$0.00,$0.00,$0.00,$0.00,$0.00,$206.25,$0.00,$103.13,$163.35,$165.00,$0.00,$0.00,$0.00,$0.00,$0.00
5018-3-180,SUP,HCPCS C1713,,5018-3-180  -  PIN HALF 180MM 5MM APEX ORTH SS SLFDRILL,$206.25,$0.00,$206.25,$92.81,$147.20,$0.00,$35.54,$0.00,$0.00,$36.11,$206.25,$0.00,$103.13,$163.35,$165.00,$0.00,$32.28,$0.00,$32.84,$0.00
5018-5-120,SUP,Custom 27203010,,5018-5-120  -  PIN HALF 120MM 5MM APEX SS SLFTAP SLFDRILL 35MM EXFIX SYS,$206.25,$0.00,$206.25,$0.00,$147.20,$0.00,$0.00,$0.00,$0.00,$0.00,$206.25,$0.00,$103.13,$163.35,$165.00,$0.00,$0.00,$0.00,$0.00,$0.00
5018-5-150,SUP,Custom 27203010,,5018-5-150  -  PIN HALF 150MM 5MM APEX SS SLFTAP SLFDRILL 40MM EXFIX SYS,$206.25,$0.00,$206.25,$0.00,$147.20,$0.00,$0.00,$0.00,$0.00,$0.00,$206.25,$0.00,$103.13,$163.35,$165.00,$0.00,$0.00,$0.00,$0.00,$0.00
5018-5-200,SUP,Custom 27203010,,5018-5-200  -  PIN HALF 200MM 5MM APEX SS SLFTAP SLFDRILL 50MM EXFIX SYS,$206.25,$0.00,$206.25,$0.00,$147.20,$0.00,$0.00,$0.00,$0.00,$0.00,$206.25,$0.00,$103.13,$163.35,$165.00,$0.00,$0.00,$0.00,$0.00,$0.00
5018-5-250,SUP,Custom 27203010,,5018-5-250  -  PIN HALF 250MM 5MM APEX SS SLFTAP SLFDRILL 50MM EXFIX SYS,$206.25,$0.00,$206.25,$0.00,$147.20,$0.00,$0.00,$0.00,$0.00,$0.00,$206.25,$0.00,$103.13,$163.35,$165.00,$0.00,$0.00,$0.00,$0.00,$0.00
5018-6-150,SUP,Custom 27203010,,5018-6-150  -  PIN HALF 150MM 5MM APEX SS SLFTAP SLFDRILL 50MM EXFIX SYS,$206.25,$0.00,$206.25,$0.00,$147.20,$0.00,$0.00,$0.00,$0.00,$0.00,$206.25,$0.00,$103.13,$163.35,$165.00,$0.00,$0.00,$0.00,$0.00,$0.00
5018-6-180S,SUP,HCPCS C1713,,5018-6-180S  -  PIN HALF 180MM 5MM APEX ORTH SS SLFTAP SLFDRILL 50MM STRL,$218.63,$0.00,$218.63,$98.38,$156.03,$0.00,$37.67,$0.00,$0.00,$38.28,$218.63,$0.00,$109.31,$173.15,$174.90,$0.00,$34.21,$0.00,$34.81,$0.00
5018-6-200,SUP,Custom 27203010,,5018-6-200  -  PIN HALF 200MM 5MM APEX SS SLFTAP SLFDRILL 60MM EXFIX SYS,$206.25,$0.00,$206.25,$0.00,$147.20,$0.00,$0.00,$0.00,$0.00,$0.00,$206.25,$0.00,$103.13,$163.35,$165.00,$0.00,$0.00,$0.00,$0.00,$0.00
5018-7-250,SUP,Custom 27203010,,5018-7-250  -  PIN HALF 250MM 5MM APEX SS SLFTAP SLFDRILL 70MM EXFIX SYS,$206.25,$0.00,$206.25,$0.00,$147.20,$0.00,$0.00,$0.00,$0.00,$0.00,$206.25,$0.00,$103.13,$163.35,$165.00,$0.00,$0.00,$0.00,$0.00,$0.00
5018-8-180,SUP,Custom 27203010,,5018-8-180  -  PIN HALF 180MM 5MM APEX SS SLFTAP SLFDRILL 60MM EXFIX SYS,$206.25,$0.00,$206.25,$0.00,$147.20,$0.00,$0.00,$0.00,$0.00,$0.00,$206.25,$0.00,$103.13,$163.35,$165.00,$0.00,$0.00,$0.00,$0.00,$0.00
50-19003,SUP,HCPCS C1713,,50-19003  -  SCREW BONE 1.9MM 3MM EMERGENCY TITANIUM MIDFAC,"$1,362.50",$0.00,"$1,362.50",$613.13,$972.42,$0.00,$234.75,$0.00,$0.00,$238.56,"$1,362.50",$0.00,$681.25,"$1,079.10","$1,090.00",$0.00,$213.23,$0.00,$216.91,$0.00
50-19005,SUP,HCPCS C1713,,50-19005  -  SCREW BONE 1.9MM 5MM EMERGENCY TITANIUM MIDFAC,$54.50,$0.00,$54.50,$24.53,$38.90,$0.00,$9.39,$0.00,$0.00,$9.54,$54.50,$0.00,$27.25,$43.16,$43.60,$0.00,$8.53,$0.00,$8.68,$0.00
50-19007,SUP,HCPCS C1713,,50-19007  -  SCREW BONE 1.9MM 7MM SLFTAP XPIN EMERGENCY TITANIUM MAXFACL,$272.50,$0.00,$272.50,$122.63,$194.48,$0.00,$46.95,$0.00,$0.00,$47.71,$272.50,$0.00,$136.25,$215.82,$218.00,$0.00,$42.65,$0.00,$43.38,$0.00
50-19009,SUP,HCPCS C1713,,50-19009  -  SCREW BONE 1.9MM 9MM SLFTAP XPIN EMERGENCY TITANIUM MAXFACL,$272.50,$0.00,$272.50,$122.63,$194.48,$0.00,$46.95,$0.00,$0.00,$47.71,$272.50,$0.00,$136.25,$215.82,$218.00,$0.00,$42.65,$0.00,$43.38,$0.00
5019-1-180,SUP,HCPCS C1713,,5019-1-180  -  PIN HALF 120MM 5MM APEX SS SLFTAP CONTIN THRD 50MM,$195.25,$0.00,$195.25,$87.86,$139.35,$0.00,$33.64,$0.00,$0.00,$34.19,$195.25,$0.00,$97.63,$154.64,$156.20,$0.00,$30.56,$0.00,$31.08,$0.00
5019-7-120,SUP,HCPCS C1713,,5019-7-120  -  PIN HALF 120MM 6MM APEX SS SLFTAP CONTIN THRD 50MM,$258.50,$0.00,$258.50,$116.33,$184.49,$0.00,$44.54,$0.00,$0.00,$45.26,$258.50,$0.00,$129.25,$204.73,$206.80,$0.00,$40.46,$0.00,$41.15,$0.00
5019-7-150,SUP,HCPCS C1713,,5019-7-150  -  PIN HALF 150MM 6MM APEX SS CONTIN THRD BLNT TIP 50MM EXFIX,$206.25,$0.00,$206.25,$92.81,$147.20,$0.00,$35.54,$0.00,$0.00,$36.11,$206.25,$0.00,$103.13,$163.35,$165.00,$0.00,$32.28,$0.00,$32.84,$0.00
502-01-42A,SUP,Custom 27803010,,502-01-42A  -  SHELL ACETAB A HEMISPHERICAL 42MM 5 SCREW HOLE CLUSTER,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
502-01-44B,SUP,Custom 27803010,,502-01-44B  -  SHELL ACETAB B HEMISPHERICAL 44MM 3 SCREW HOLE CLUSTER,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
502-01-46C,SUP,Custom 27803010,,502-01-46C  -  SHELL ACETAB C HEMISPHERICAL 46MM 3 SCREW HOLE CLUSTER,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
502-01-48D,SUP,Custom 27803010,,502-01-48D  -  SHELL ACETAB 48MM HIP HMSPHR CLSTR TRDNT D,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
502-01-50D,SUP,Custom 27803010,,502-01-50D  -  SHELL ACETAB 50MM HIP HMSPHR CLSTR TRDNT D,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
502-01-52E,SUP,Custom 27803010,,502-01-52E  -  SHELL ACETAB 52MM HIP HMSPHR CLSTR TRDNT E,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
502-01-54E,SUP,Custom 27803010,,502-01-54E  -  SHELL ACETAB 54MM HIP HMSPHR CLSTR TRDNT E,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
502-01-56F,SUP,Custom 27803010,,502-01-56F  -  SHELL ACETAB F HEMISPHERICAL 56MM 5 SCREW HOLE CLUSTER,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
502-01-58F,SUP,Custom 27803010,,502-01-58F  -  SHELL ACETAB 58MM HIP HMSPHR CLSTR TRDNT F,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
502-01-60G,SUP,Custom 27803010,,502-01-60G  -  SHELL ACETAB G HEMISPHERICAL 60MM 5 SCREW HOLE CLUSTER,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
502-01-62G,SUP,Custom 27803010,,502-01-62G  -  SHELL ACETAB G HEMISPHERICAL 62MM 5 SCREW HOLE CLUSTER,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
502-01-64H,SUP,Custom 27803010,,502-01-64H  -  SHELL ACETAB H HEMISPHERICAL 64MM 5 SCREW HOLE CLUSTER,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
502-01-66H,SUP,Custom 27803010,,502-01-66H  -  SHELL ACETAB H HEMISPHERICAL 66MM 5 SCREW HOLE CLUSTER,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
502-01-68I,SUP,Custom 27803010,,502-01-68I  -  SHELL ACTB I HMSPHR 68MM TRDNT 5 SCR HL CLSTR MTL HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
502-01-70I,SUP,Custom 27803010,,502-01-70I  -  SHELL ACETAB I HEMISPHERICAL 70MM 5 SCREW HOLE CLUSTER,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
502-01-72J,SUP,Custom 27803010,,502-01-72J  -  SHELL ACETAB J HEMISPHERICAL 72MM 5 SCREW HOLE CLUSTER,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
502-01-74J,SUP,Custom 27803010,,502-01-74J  -  SHELL ACETAB J HEMISPHERICAL 74MM 5 SCREW HOLE CLUSTER,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
5020-2-150,SUP,Custom 27203010,,5020-2-150  -  PIN HLF 5MM 150MM 20MM APX BLNT,$259.88,$0.00,$259.88,$0.00,$185.47,$0.00,$0.00,$0.00,$0.00,$0.00,$259.88,$0.00,$129.94,$205.82,$207.90,$0.00,$0.00,$0.00,$0.00,$0.00
5020-2-180,SUP,Custom 27203010,,5020-2-180  -  PIN HLF 5MM 180MM 20MM APX BLNT,$259.88,$0.00,$259.88,$0.00,$185.47,$0.00,$0.00,$0.00,$0.00,$0.00,$259.88,$0.00,$129.94,$205.82,$207.90,$0.00,$0.00,$0.00,$0.00,$0.00
5020-2-200,SUP,Custom 27203010,,5020-2-200  -  PIN HLF 5MM 200MM 20MM APX BLNT,$259.88,$0.00,$259.88,$0.00,$185.47,$0.00,$0.00,$0.00,$0.00,$0.00,$259.88,$0.00,$129.94,$205.82,$207.90,$0.00,$0.00,$0.00,$0.00,$0.00
5020-2-250,SUP,Custom 27203010,,5020-2-250  -  PIN HLF 5MM 250MM 20MM APX BLNT,$259.88,$0.00,$259.88,$0.00,$185.47,$0.00,$0.00,$0.00,$0.00,$0.00,$259.88,$0.00,$129.94,$205.82,$207.90,$0.00,$0.00,$0.00,$0.00,$0.00
5020-3-120,SUP,Custom 27203010,,5020-3-120  -  PIN HALF 120MM 5MM APEX SS CONTIN THRD BLNT TIP 30MM EXFIX,$206.25,$0.00,$206.25,$0.00,$147.20,$0.00,$0.00,$0.00,$0.00,$0.00,$206.25,$0.00,$103.13,$163.35,$165.00,$0.00,$0.00,$0.00,$0.00,$0.00
5020-3-150,SUP,Custom 27203010,,5020-3-150  -  PIN HALF 150MM 5MM APEX SS CONTIN THRD BLNT TIP 40MM EXFIX,$206.25,$0.00,$206.25,$0.00,$147.20,$0.00,$0.00,$0.00,$0.00,$0.00,$206.25,$0.00,$103.13,$163.35,$165.00,$0.00,$0.00,$0.00,$0.00,$0.00
502-03-44A,SUP,Custom 27803010,,502-03-44A  -  SHELL ACETAB A HEMISPHERICAL 44MM PRIM RIM CLSHOLE TRITANIUM,"$2,302.50",$0.00,"$2,302.50",$0.00,"$1,643.29",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,302.50",$0.00,"$1,151.25","$1,823.58","$1,842.00",$0.00,$0.00,$0.00,$0.00,$0.00
502-03-46B,SUP,Custom 27803010,,502-03-46B  -  SHELL ACETAB B HEMISPHERICAL 46MM PRIM RIM CLSHOLE TRITANIUM,"$2,302.50",$0.00,"$2,302.50",$0.00,"$1,643.29",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,302.50",$0.00,"$1,151.25","$1,823.58","$1,842.00",$0.00,$0.00,$0.00,$0.00,$0.00
502-03-48C,SUP,Custom 27803010,,502-03-48C  -  SHELL ACETAB C HEMISPHERICAL 48MM PRIM RIM CLSHOLE TRITANIUM,"$2,302.50",$0.00,"$2,302.50",$0.00,"$1,643.29",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,302.50",$0.00,"$1,151.25","$1,823.58","$1,842.00",$0.00,$0.00,$0.00,$0.00,$0.00
502-03-50D,SUP,Custom 27803010,,502-03-50D  -  SHELL ACETAB D HEMISPHERICAL 50MM PRIM RIM CLSHOLE TRITANIUM,"$2,302.50",$0.00,"$2,302.50",$0.00,"$1,643.29",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,302.50",$0.00,"$1,151.25","$1,823.58","$1,842.00",$0.00,$0.00,$0.00,$0.00,$0.00
502-03-52D,SUP,Custom 27803010,,502-03-52D  -  SHELL ACETAB D 52MM PRIM HEMISPHERICAL CLSHOLE TRITANIUM,"$2,302.50",$0.00,"$2,302.50",$0.00,"$1,643.29",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,302.50",$0.00,"$1,151.25","$1,823.58","$1,842.00",$0.00,$0.00,$0.00,$0.00,$0.00
502-03-54E,SUP,Custom 27803010,,502-03-54E  -  SHELL ACETAB E HEMISPHERICAL 54MM PRIM RIM CLSHOLE TRITANIUM,"$2,302.50",$0.00,"$2,302.50",$0.00,"$1,643.29",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,302.50",$0.00,"$1,151.25","$1,823.58","$1,842.00",$0.00,$0.00,$0.00,$0.00,$0.00
502-03-56E,SUP,Custom 27803010,,502-03-56E  -  SHELL ACETAB E HEMISPHERICAL 56MM PRIM RIM CLSHOLE TRITANIUM,"$2,302.50",$0.00,"$2,302.50",$0.00,"$1,643.29",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,302.50",$0.00,"$1,151.25","$1,823.58","$1,842.00",$0.00,$0.00,$0.00,$0.00,$0.00
50-20358,SUP,HCPCS C1713,,50-20358  -  SCREW BN 2MM 8MM NS LEIBINGER UNV 2 MMF SLF DRL XPN LGT WRE,$560.00,$0.00,$560.00,$252.00,$399.67,$0.00,$96.49,$0.00,$0.00,$98.05,$560.00,$0.00,$280.00,$443.52,$448.00,$0.00,$87.64,$0.00,$89.15,$0.00
502-03-58F,SUP,Custom 27803010,,502-03-58F  -  SHELL ACETAB F HEMISPHERICAL 58MM PRIM RIM CLSHOLE TRITANIUM,"$2,302.50",$0.00,"$2,302.50",$0.00,"$1,643.29",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,302.50",$0.00,"$1,151.25","$1,823.58","$1,842.00",$0.00,$0.00,$0.00,$0.00,$0.00
502-03-60F,SUP,Custom 27803010,,502-03-60F  -  SHELL ACETAB F HEMISPHERICAL 60MM PRIM RIM CLSHOLE TRITANIUM,"$2,302.50",$0.00,"$2,302.50",$0.00,"$1,643.29",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,302.50",$0.00,"$1,151.25","$1,823.58","$1,842.00",$0.00,$0.00,$0.00,$0.00,$0.00
50-20362,SUP,HCPCS C1713,,50-20362  -  SCREW BONE 2MM 12MM SELF DRILL TITANIUM MANDIB,$560.00,$0.00,$560.00,$252.00,$399.67,$0.00,$96.49,$0.00,$0.00,$98.05,$560.00,$0.00,$280.00,$443.52,$448.00,$0.00,$87.64,$0.00,$89.15,$0.00
502-03-62G,SUP,Custom 27803010,,502-03-62G  -  SHELL ACETAB G 62MM PRIM HEMISPHERICAL CLSHOLE TRITANIUM,"$2,302.50",$0.00,"$2,302.50",$0.00,"$1,643.29",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,302.50",$0.00,"$1,151.25","$1,823.58","$1,842.00",$0.00,$0.00,$0.00,$0.00,$0.00
502-03-64G,SUP,Custom 27803010,,502-03-64G  -  SHELL ACETAB G HEMISPHERICAL 64MM PRIM RIM CLSHOLE TRITANIUM,"$2,302.50",$0.00,"$2,302.50",$0.00,"$1,643.29",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,302.50",$0.00,"$1,151.25","$1,823.58","$1,842.00",$0.00,$0.00,$0.00,$0.00,$0.00
502-03-66H,SUP,Custom 27803010,,502-03-66H  -  SHELL ACETAB H HEMISPHERICAL 66MM PRIM RIM CLSHOLE TRITANIUM,"$2,302.50",$0.00,"$2,302.50",$0.00,"$1,643.29",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,302.50",$0.00,"$1,151.25","$1,823.58","$1,842.00",$0.00,$0.00,$0.00,$0.00,$0.00
50-20404,SUP,HCPCS C1713,,50-20404  -  SCREW BONE 2MM 4MM XPIN TITANIUM MAXFACL,$125.93,$0.00,$125.93,$56.67,$89.87,$0.00,$21.70,$0.00,$0.00,$22.05,$125.93,$0.00,$62.96,$99.74,$100.74,$0.00,$19.71,$0.00,$20.05,$0.00
50-20405,SUP,HCPCS C1713,,50-20405  -  SCREW BONE 2MM 5MM XPIN TITANIUM MAXFACL,$240.00,$0.00,$240.00,$108.00,$171.29,$0.00,$41.35,$0.00,$0.00,$42.02,$240.00,$0.00,$120.00,$190.08,$192.00,$0.00,$37.56,$0.00,$38.21,$0.00
50-20407,SUP,HCPCS C1713,,50-20407  -  SCREW BONE 2MM 7MM XPIN TITANIUM MAXFACL,$240.00,$0.00,$240.00,$108.00,$171.29,$0.00,$41.35,$0.00,$0.00,$42.02,$240.00,$0.00,$120.00,$190.08,$192.00,$0.00,$37.56,$0.00,$38.21,$0.00
50-20408,SUP,HCPCS C1713,,50-20408  -  SCREW BONE 2MM 8MM XPIN TITANIUM MAXFACL,$240.00,$0.00,$240.00,$108.00,$171.29,$0.00,$41.35,$0.00,$0.00,$42.02,$240.00,$0.00,$120.00,$190.08,$192.00,$0.00,$37.56,$0.00,$38.21,$0.00
50-20410,SUP,HCPCS C1713,,50-20410  -  SCREW BN 2MM 10MM AU NS LEIBINGER UNV 2 ST XPN TI MXLFCL,$240.00,$0.00,$240.00,$108.00,$171.29,$0.00,$41.35,$0.00,$0.00,$42.02,$240.00,$0.00,$120.00,$190.08,$192.00,$0.00,$37.56,$0.00,$38.21,$0.00
50-20412,SUP,HCPCS C1713,,50-20412  -  SCREW BONE 2MM 12MM XPIN TITANIUM MAXFACL,$240.00,$0.00,$240.00,$108.00,$171.29,$0.00,$41.35,$0.00,$0.00,$42.02,$240.00,$0.00,$120.00,$190.08,$192.00,$0.00,$37.56,$0.00,$38.21,$0.00
50-20414,SUP,HCPCS C1713,,50-20414  -  SCREW BONE 2MM 14MM XPIN TITANIUM MANDIB,$240.00,$0.00,$240.00,$108.00,$171.29,$0.00,$41.35,$0.00,$0.00,$42.02,$240.00,$0.00,$120.00,$190.08,$192.00,$0.00,$37.56,$0.00,$38.21,$0.00
50-20416,SUP,HCPCS C1713,,50-20416  -  SCREW BONE 2MM 16MM XPIN TITANIUM MANDIB,$240.00,$0.00,$240.00,$108.00,$171.29,$0.00,$41.35,$0.00,$0.00,$42.02,$240.00,$0.00,$120.00,$190.08,$192.00,$0.00,$37.56,$0.00,$38.21,$0.00
50-20418,SUP,HCPCS C1713,,50-20418  -  SCREW BONE 2MM 18MM XPIN TITANIUM MANDIB,$267.50,$0.00,$267.50,$120.38,$190.91,$0.00,$46.09,$0.00,$0.00,$46.84,$267.50,$0.00,$133.75,$211.86,$214.00,$0.00,$41.86,$0.00,$42.59,$0.00
50-20420,SUP,HCPCS C1713,,50-20420  -  SCREW BONE 2MM 20MM SLFTAP XPIN TITANIUM MANDIB,$267.50,$0.00,$267.50,$120.38,$190.91,$0.00,$46.09,$0.00,$0.00,$46.84,$267.50,$0.00,$133.75,$211.86,$214.00,$0.00,$41.86,$0.00,$42.59,$0.00
50-20504,SUP,HCPCS C1713,,50-20504  -  SCREW BONE 2MM 4MM LOCKING XPIN TITANIUM MAXFACL,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
50-20505,SUP,HCPCS C1713,,50-20505  -  SCREW BN 2MM 5MM GRY NS LEIBINGER UNV 2 LCK XPN TI MXLFCL,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
50-20506,SUP,HCPCS C1713,,50-20506  -  SCREW BONE 2MM 6MM LOCK XPIN HEAD LEIBINGER UNIVERSAL 2,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
50-20507,SUP,HCPCS C1713,,50-20507  -  SCREW BONE 2MM 7MM LOCKING XPIN TITANIUM MAXFACL,$427.50,$0.00,$427.50,$192.38,$305.11,$0.00,$73.66,$0.00,$0.00,$74.85,$427.50,$0.00,$213.75,$338.58,$342.00,$0.00,$66.90,$0.00,$68.06,$0.00
50-20508,SUP,HCPCS C1713,,50-20508  -  SCREW BN 2MM 8MM GRY NS LEIBINGER UNV 2 LCK XPN TI MNDB,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
50-20510,SUP,HCPCS C1713,,50-20510  -  SCREW BONE 2MM 10MM LOCK XPIN HEAD LEIBINGER UNIVERSAL 2,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
50-20512,SUP,HCPCS C1713,,50-20512  -  SCREW BONE 2MM 12MM LOCK XPIN HEAD LEIBINGER UNIVERSAL 2,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
50-20514,SUP,HCPCS C1713,,50-20514  -  SCREW BONE 2MM 14MM LOCKING XPIN TITANIUM MAXFACL,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
5020-5-150,SUP,Custom 27203010,,5020-5-150  -  PIN HALF 150MM 5MM APEX ORTH BLNT TIP 25MM,$206.25,$0.00,$206.25,$0.00,$147.20,$0.00,$0.00,$0.00,$0.00,$0.00,$206.25,$0.00,$103.13,$163.35,$165.00,$0.00,$0.00,$0.00,$0.00,$0.00
50-20516,SUP,HCPCS C1713,,50-20516  -  SCREW BONE 2MM 16MM LOCKING XPIN LEIBINGER UNIVERSAL 2,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
50-205-16,SUP,Custom 27203010,,50-205-16  -  FORCEPS SURG UNV PLT HLD 2 BALLS,$712.50,$0.00,$712.50,$0.00,$508.51,$0.00,$0.00,$0.00,$0.00,$0.00,$712.50,$0.00,$356.25,$564.30,$570.00,$0.00,$0.00,$0.00,$0.00,$0.00
50-20518,SUP,HCPCS C1713,,50-20518  -  SCREW BONE 2MM 18MM LOCKING XPIN TITANIUM MANDIB,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
50-20520,SUP,HCPCS C1713,,50-20520  -  SCREW BONE 2MM 20MM LOCKING XPIN TITANIUM MAXFACL,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
50-20596,SUP,HCPCS C1713,,50-20596  -  SCREW BN 2MM 6MM NS LEIBINGER UNV 2 SMARTLOCK SLF DRL LCK TI,$380.00,$0.00,$380.00,$171.00,$271.21,$0.00,$65.47,$0.00,$0.00,$66.53,$380.00,$0.00,$190.00,$300.96,$304.00,$0.00,$59.47,$0.00,$60.50,$0.00
50-20598,SUP,HCPCS C1713,,50-20598  -  SCREW BN 2MM 8MM NS LEIBINGER UNV 2 SMARTLOCK SLF DRL LCK TI,$380.00,$0.00,$380.00,$171.00,$271.21,$0.00,$65.47,$0.00,$0.00,$66.53,$380.00,$0.00,$190.00,$300.96,$304.00,$0.00,$59.47,$0.00,$60.50,$0.00
5020-6-120,SUP,Custom 27203010,,5020-6-120  -  PIN HALF 120MM 5MM APEX SS THRD SHFT BLNT PREDRILLING 35MM,$206.25,$0.00,$206.25,$0.00,$147.20,$0.00,$0.00,$0.00,$0.00,$0.00,$206.25,$0.00,$103.13,$163.35,$165.00,$0.00,$0.00,$0.00,$0.00,$0.00
5020-6-200,SUP,Custom 27203010,,5020-6-200  -  PIN HALF 200MM 5MM APEX SS THRD SHFT BLNT PREDRILLING 60MM,$206.25,$0.00,$206.25,$0.00,$147.20,$0.00,$0.00,$0.00,$0.00,$0.00,$206.25,$0.00,$103.13,$163.35,$165.00,$0.00,$0.00,$0.00,$0.00,$0.00
50-20704,SUP,HCPCS C1713,,50-20704  -  SCREW BONE 2MM 4MM SLFTAP XPIN TITANIUM MAXFACL,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
50-20705,SUP,HCPCS C1713,,50-20705  -  SCREW BONE 2MM 5MM SLFTAP XPIN TITANIUM MAXFACL,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
50-20706,SUP,HCPCS C1713,,50-20706  -  SCREW BONE 2MM 6MM SLFTAP XPIN TITANIUM MAXFACL,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
50-20708,SUP,HCPCS C1713,,50-20708  -  SCREW BONE 2MM 8MM SLFTAP XPIN TITANIUM MAXFACL,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
50-20710,SUP,HCPCS C1713,,50-20710  -  SCREW BONE 2MM 10MM SLFTAP XPIN TITANIUM MAXFACL,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
50-20712,SUP,HCPCS C1713,,50-20712  -  SCREW BONE 2MM 12MM SLFTAP XPIN TITANIUM MAXFACL,$57.50,$0.00,$57.50,$25.88,$41.04,$0.00,$9.91,$0.00,$0.00,$10.07,$57.50,$0.00,$28.75,$45.54,$46.00,$0.00,$9.00,$0.00,$9.15,$0.00
50-20714,SUP,HCPCS C1713,,50-20714  -  SCREW BONE 2MM 14MM SLFTAP XPIN TITANIUM MAXFACL,$149.92,$0.00,$149.92,$67.46,$107.00,$0.00,$25.83,$0.00,$0.00,$26.25,$149.92,$0.00,$74.96,$118.74,$119.93,$0.00,$23.46,$0.00,$23.87,$0.00
5020-7-150,SUP,Custom 27203010,,5020-7-150  -  PIN HALF 150MM 5MM APEX SS CONTIN THRD 50MM EXFIX SYS,$206.25,$0.00,$206.25,$0.00,$147.20,$0.00,$0.00,$0.00,$0.00,$0.00,$206.25,$0.00,$103.13,$163.35,$165.00,$0.00,$0.00,$0.00,$0.00,$0.00
50-20716,SUP,HCPCS C1713,,50-20716  -  SCREW BONE 2MM 16MM SLFTAP XPIN TITANIUM MAXFACL,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
50-20718,SUP,HCPCS C1713,,50-20718  -  SCREW BONE 2MM 18MM SLFTAP XPIN TITANIUM MAXFACL,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
5020-7-180,SUP,Custom 27203010,,5020-7-180  -  PIN HALF 180MM 5MM APEX SS CONTIN THRD 50MM EXFIX SYS,$206.25,$0.00,$206.25,$0.00,$147.20,$0.00,$0.00,$0.00,$0.00,$0.00,$206.25,$0.00,$103.13,$163.35,$165.00,$0.00,$0.00,$0.00,$0.00,$0.00
50-20720,SUP,HCPCS C1713,,50-20720  -  SCREW BONE 2MM 20MM SLFTAP XPIN TITANIUM MAXFACL,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
5020-7-200,SUP,Custom 27203010,,5020-7-200  -  PIN HALF 200MM 5MM APEX SS CONTIN THRD 50MM EXFIX SYS,$206.25,$0.00,$206.25,$0.00,$147.20,$0.00,$0.00,$0.00,$0.00,$0.00,$206.25,$0.00,$103.13,$163.35,$165.00,$0.00,$0.00,$0.00,$0.00,$0.00
5020-7-250,SUP,Custom 27203010,,5020-7-250  -  PIN HALF 250MM 5MM APEX SS CONTIN THRD 50MM EXFIX SYS,$206.25,$0.00,$206.25,$0.00,$147.20,$0.00,$0.00,$0.00,$0.00,$0.00,$206.25,$0.00,$103.13,$163.35,$165.00,$0.00,$0.00,$0.00,$0.00,$0.00
5020-8-180,SUP,Custom 27203010,,5020-8-180  -  PIN HALF 180MM 5MM APEX SS BLNT TIP 60MM EXFIX SYS,$206.25,$0.00,$206.25,$0.00,$147.20,$0.00,$0.00,$0.00,$0.00,$0.00,$206.25,$0.00,$103.13,$163.35,$165.00,$0.00,$0.00,$0.00,$0.00,$0.00
5020-8-250,SUP,Custom 27203010,,5020-8-250  -  PIN HALF 250MM 5MM APEX SS BLNT TIP 70MM EXFIX SYS,$206.25,$0.00,$206.25,$0.00,$147.20,$0.00,$0.00,$0.00,$0.00,$0.00,$206.25,$0.00,$103.13,$163.35,$165.00,$0.00,$0.00,$0.00,$0.00,$0.00
50-20904,SUP,HCPCS C1713,,50-20904  -  SCREW BONE 2MM 4MM SLFDRILL XPIN TITANIUM MAXFACL,$342.50,$0.00,$342.50,$154.13,$244.44,$0.00,$59.01,$0.00,$0.00,$59.97,$342.50,$0.00,$171.25,$271.26,$274.00,$0.00,$53.60,$0.00,$54.53,$0.00
50-20905,SUP,HCPCS C1713,,50-20905  -  SCREW BONE 2MM 5MM SLFDRILL XPIN TITANIUM MAXFACL,$342.50,$0.00,$342.50,$154.13,$244.44,$0.00,$59.01,$0.00,$0.00,$59.97,$342.50,$0.00,$171.25,$271.26,$274.00,$0.00,$53.60,$0.00,$54.53,$0.00
50-20906,SUP,HCPCS C1713,,50-20906  -  SCREW BONE 2MM 6MM SLFDRILL XPIN TITANIUM MAXFACL,$342.50,$0.00,$342.50,$154.13,$244.44,$0.00,$59.01,$0.00,$0.00,$59.97,$342.50,$0.00,$171.25,$271.26,$274.00,$0.00,$53.60,$0.00,$54.53,$0.00
502-11-42A,SUP,Custom 27803010,,502-11-42A  -  SHELL ACETAB A HEMISPHERICAL 42MM 3 SCREW HOLE CLUSTER,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
502-11-44B,SUP,Custom 27803010,,502-11-44B  -  SHELL ACETAB B HEMISPHERICAL 44MM 3 SCREW HOLE CLUSTER,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
502-11-46C,SUP,Custom 27803010,,502-11-46C  -  SHELL ACETAB C HEMISPHERICAL 46MM 3 SCREW HOLE CLUSTER,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
502-11-48D,SUP,Custom 27803010,,502-11-48D  -  SHELL ACETAB D HEMISPHERICAL 48MM 3 SCREW HOLE CLUSTER,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
502-11-50D,SUP,Custom 27803010,,502-11-50D  -  SHELL ACETAB D HEMISPHERICAL 50MM 3 SCREW HOLE CLUSTER,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
502-11-52E,SUP,Custom 27803010,,502-11-52E  -  SHELL ACETAB E HEMISPHERICAL 52MM 5 SCREW HOLE CLUSTER,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
502-11-54E,SUP,Custom 27803010,,502-11-54E  -  SHELL ACETAB E HEMISPHERICAL 54MM 5 SCREW HOLE CLUSTER,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
502-11-56F,SUP,Custom 27803010,,502-11-56F  -  SHELL ACTB F HMSPHR 56MM TRDNT CH HA HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
502-11-58F,SUP,Custom 27803010,,502-11-58F  -  SHELL ACETAB F HEMISPHERICAL 58MM 5 SCREW HOLE CLUSTER,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
502-11-60G,SUP,Custom 27803010,,502-11-60G  -  SHELL ACETAB G HEMISPHERICAL 60MM 5 SCREW HOLE CLUSTER,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
502-11-62G,SUP,Custom 27803010,,502-11-62G  -  SHELL ACETAB G HEMISPHERICAL 62MM 5 SCREW HOLE CLUSTER,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
502-11-64H,SUP,Custom 27803010,,502-11-64H  -  SHELL ACETAB H HEMISPHERICAL 64MM 5 SCREW HOLE CLUSTER,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
502-11-66H,SUP,Custom 27803010,,502-11-66H  -  SHELL ACETAB H HEMISPHERICAL 66MM 5 SCREW HOLE CLUSTER,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
502-11-68I,SUP,Custom 27803010,,502-11-68I  -  SHELL ACETAB I HEMISPHERICAL 68MM 5 SCREW HOLE CLUSTER,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
502-11-70I,SUP,Custom 27803010,,502-11-70I  -  SHELL ACETAB I HEMISPHERICAL 70MM 5 SCREW HOLE CLUSTER,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
502-11-72J,SUP,Custom 27803010,,502-11-72J  -  SHELL ACETAB D HEMISPHERICAL 72MM 5 SCREW HOLE CLUSTER,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
502-11-74J,SUP,Custom 27803010,,502-11-74J  -  SHELL ACETAB J HEMISPHERICAL 74MM 5 SCREW HOLE CLUSTER,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
502-11-80L,SUP,Custom 27803010,,502-11-80L  -  SHELL ACETAB 80MM HIP CLSHOLE HMSPHR TRDNT L,"$2,506.00",$0.00,"$2,506.00",$0.00,"$1,788.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,506.00",$0.00,"$1,253.00","$1,984.75","$2,004.80",$0.00,$0.00,$0.00,$0.00,$0.00
502-11-82L,SUP,Custom 27803010,,502-11-82L  -  SHELL ACETAB 82MM HIP CLSHOLE HMSPHR TRDNT L,"$2,506.00",$0.00,"$2,506.00",$0.00,"$1,788.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,506.00",$0.00,"$1,253.00","$1,984.75","$2,004.80",$0.00,$0.00,$0.00,$0.00,$0.00
5021-7-150,SUP,Custom 27203010,,5021-7-150  -  PIN HALF 150MM 6MM APEX SS SLFDRILL THRD SHFT SLFTAP 50MM,$213.13,$0.00,$213.13,$0.00,$152.11,$0.00,$0.00,$0.00,$0.00,$0.00,$213.13,$0.00,$106.56,$168.80,$170.50,$0.00,$0.00,$0.00,$0.00,$0.00
5021-7-200,SUP,Custom 27203010,,5021-7-200  -  PIN HALF 200MM 6MM APEX SS SLFDRILL THRD 60MM,$206.25,$0.00,$206.25,$0.00,$147.20,$0.00,$0.00,$0.00,$0.00,$0.00,$206.25,$0.00,$103.13,$163.35,$165.00,$0.00,$0.00,$0.00,$0.00,$0.00
5023-1-090,SUP,Custom 27203010,,5023-1-090  -  PIN HALF 90MM 4MM APEX SS SLFTAP SLFDRILL THRD 10MM EXFIX,$169.13,$0.00,$169.13,$0.00,$120.70,$0.00,$0.00,$0.00,$0.00,$0.00,$169.13,$0.00,$84.56,$133.95,$135.30,$0.00,$0.00,$0.00,$0.00,$0.00
5023-2-090,SUP,Custom 27203010,,5023-2-090  -  PIN HALF 90MM 4MM APEX SS SLFTAP SLFDRILL THRD 20MM EXFIX,$169.13,$0.00,$169.13,$0.00,$120.70,$0.00,$0.00,$0.00,$0.00,$0.00,$169.13,$0.00,$84.56,$133.95,$135.30,$0.00,$0.00,$0.00,$0.00,$0.00
5023-3-090,SUP,Custom 27203010,,5023-3-090  -  PIN HALF 90MM 4MM APEX SS SLFTAP SLFDRILL THRD 30MM EXFIX,$169.13,$0.00,$169.13,$0.00,$120.70,$0.00,$0.00,$0.00,$0.00,$0.00,$169.13,$0.00,$84.56,$133.95,$135.30,$0.00,$0.00,$0.00,$0.00,$0.00
5023-3-120,SUP,Custom 27203010,,5023-3-120  -  PIN HALF 120MM 4MM APEX SS SLFDRILL SLFTAP THRD 30MM EXFIX,$169.13,$0.00,$169.13,$0.00,$120.70,$0.00,$0.00,$0.00,$0.00,$0.00,$169.13,$0.00,$84.56,$133.95,$135.30,$0.00,$0.00,$0.00,$0.00,$0.00
50-23404,SUP,HCPCS C1713,,50-23404  -  SCREW BONE 2.3MM 4MM SLFTAP XPIN TITANIUM MAXFACL,$280.00,$0.00,$280.00,$126.00,$199.84,$0.00,$48.24,$0.00,$0.00,$49.03,$280.00,$0.00,$140.00,$221.76,$224.00,$0.00,$43.82,$0.00,$44.58,$0.00
50-23406,SUP,HCPCS C1713,,50-23406  -  SCREW BONE 2.3MM 6MM SELF TAP XPIN TITANIUM MAXFACL NONSTRL,$280.00,$0.00,$280.00,$126.00,$199.84,$0.00,$48.24,$0.00,$0.00,$49.03,$280.00,$0.00,$140.00,$221.76,$224.00,$0.00,$43.82,$0.00,$44.58,$0.00
50-23408,SUP,HCPCS C1713,,50-23408  -  SCREW BONE 2.3MM 8MM SELF TAP XPIN TITANIUM MANDIB,$280.00,$0.00,$280.00,$126.00,$199.84,$0.00,$48.24,$0.00,$0.00,$49.03,$280.00,$0.00,$140.00,$221.76,$224.00,$0.00,$43.82,$0.00,$44.58,$0.00
50-23410,SUP,HCPCS C1713,,50-23410  -  SCREW BONE 2.3MM 10MM SELF TAP XPIN HEAD LEIBINGER UNIVERSAL,$280.00,$0.00,$280.00,$126.00,$199.84,$0.00,$48.24,$0.00,$0.00,$49.03,$280.00,$0.00,$140.00,$221.76,$224.00,$0.00,$43.82,$0.00,$44.58,$0.00
50-23412,SUP,HCPCS C1713,,50-23412  -  SCREW BONE 2.3MM 12MM SELF TAP XPIN HEAD LEIBINGER UNIVERSAL,$280.00,$0.00,$280.00,$126.00,$199.84,$0.00,$48.24,$0.00,$0.00,$49.03,$280.00,$0.00,$140.00,$221.76,$224.00,$0.00,$43.82,$0.00,$44.58,$0.00
5023-4-120,SUP,Custom 27203010,,5023-4-120  -  PIN HALF 120MM 4MM APEX ORTH SS 45MM,$160.88,$0.00,$160.88,$0.00,$114.82,$0.00,$0.00,$0.00,$0.00,$0.00,$160.88,$0.00,$80.44,$127.42,$128.70,$0.00,$0.00,$0.00,$0.00,$0.00
50-23414,SUP,HCPCS C1713,,50-23414  -  SCREW TI 14MM 2.3MM MANDIB SLFTAP XPIN BONE,$151.93,$0.00,$151.93,$68.37,$108.43,$0.00,$26.18,$0.00,$0.00,$26.60,$151.93,$0.00,$75.96,$120.33,$121.54,$0.00,$23.78,$0.00,$24.19,$0.00
50-23416,SUP,HCPCS C1713,,50-23416  -  SCREW BONE 2.3MM 16MM SELF TAP XPIN TITANIUM MANDIB,$280.00,$0.00,$280.00,$126.00,$199.84,$0.00,$48.24,$0.00,$0.00,$49.03,$280.00,$0.00,$140.00,$221.76,$224.00,$0.00,$43.82,$0.00,$44.58,$0.00
50-23418,SUP,HCPCS C1713,,50-23418  -  SCREW BONE 2.3MM 18MM SLFTAP XPIN TITANIUM MAXFACL,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
5023-4-180,SUP,Custom 27203010,,5023-4-180  -  PIN HLF 4MM 180MM 40MM HFMN2 APX SLF DRL ST THRD SS FT/ANKL,$169.13,$0.00,$169.13,$0.00,$120.70,$0.00,$0.00,$0.00,$0.00,$0.00,$169.13,$0.00,$84.56,$133.95,$135.30,$0.00,$0.00,$0.00,$0.00,$0.00
50-23420,SUP,HCPCS C1713,,50-23420  -  SCREW BONE 2.3MM 20MM SLFTAP XPIN TITANIUM MANDIB,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
50-23504,SUP,HCPCS C1713,,50-23504  -  SCREW BONE 2.3MM 4MM LOCKING XPIN TITANIUM MAXFACL,"$1,299.22",$0.00,"$1,299.22",$584.65,$927.25,$0.00,$223.85,$0.00,$0.00,$227.48,"$1,299.22",$0.00,$649.61,"$1,028.98","$1,039.37",$0.00,$203.33,$0.00,$206.84,$0.00
50-23506,SUP,HCPCS C1713,,50-23506  -  SCREW BONE 2.3MM 6MM LOCKING XPIN LEIBINGER UNIVERSAL 2,"$2,375.00",$0.00,"$2,375.00","$1,068.75","$1,695.04",$0.00,$409.20,$0.00,$0.00,$415.84,"$2,375.00",$0.00,"$1,187.50","$1,881.00","$1,900.00",$0.00,$371.69,$0.00,$378.10,$0.00
50-23508,SUP,HCPCS C1713,,50-23508  -  SCREW BONE 2.3MM 8MM LOCK XPIN HEAD LEIBINGER UNIVERSAL 2,$475.00,$0.00,$475.00,$213.75,$339.01,$0.00,$81.84,$0.00,$0.00,$83.17,$475.00,$0.00,$237.50,$376.20,$380.00,$0.00,$74.34,$0.00,$75.62,$0.00
5023-5-090,SUP,Custom 27203010,,5023-5-090  -  PIN HALF 90MM 4MM ORTH MDLR 40MM,$199.38,$0.00,$199.38,$0.00,$142.29,$0.00,$0.00,$0.00,$0.00,$0.00,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$0.00,$0.00,$0.00,$0.00
50-23510,SUP,HCPCS C1713,,50-23510  -  SCREW BONE 2.3MM 10MM LOCK XPIN HEAD LEIBINGER UNIVERSAL 2,$475.00,$0.00,$475.00,$213.75,$339.01,$0.00,$81.84,$0.00,$0.00,$83.17,$475.00,$0.00,$237.50,$376.20,$380.00,$0.00,$74.34,$0.00,$75.62,$0.00
50-23512,SUP,HCPCS C1713,,50-23512  -  SCREW BONE 2.3MM 12MM LOCK XPIN HEAD LEIBINGER UNIVERSAL 2,$475.00,$0.00,$475.00,$213.75,$339.01,$0.00,$81.84,$0.00,$0.00,$83.17,$475.00,$0.00,$237.50,$376.20,$380.00,$0.00,$74.34,$0.00,$75.62,$0.00
5023-5-120,SUP,Custom 27203010,,5023-5-120  -  PIN HALF 120MM 4MM APEX SS SLFTAP SLFDRILL THRD 35MM EXFIX,$169.13,$0.00,$169.13,$0.00,$120.70,$0.00,$0.00,$0.00,$0.00,$0.00,$169.13,$0.00,$84.56,$133.95,$135.30,$0.00,$0.00,$0.00,$0.00,$0.00
50-23514,SUP,HCPCS C1713,,50-23514  -  SCREW BONE 2.3MM 14MM LOCKING XPIN LEIBINGER UNIVERSAL 2,$475.00,$0.00,$475.00,$213.75,$339.01,$0.00,$81.84,$0.00,$0.00,$83.17,$475.00,$0.00,$237.50,$376.20,$380.00,$0.00,$74.34,$0.00,$75.62,$0.00
5023-5-150,SUP,Custom 27203010,,5023-5-150  -  PIN HALF 150MM 4MM APEX SS SLFTAP SLFDRILL THRD 40MM EXFIX,$169.13,$0.00,$169.13,$0.00,$120.70,$0.00,$0.00,$0.00,$0.00,$0.00,$169.13,$0.00,$84.56,$133.95,$135.30,$0.00,$0.00,$0.00,$0.00,$0.00
50-23516,SUP,HCPCS C1713,,50-23516  -  SCREW BONE 2.3MM 16MM LOCK XPIN HEAD LEIBINGER UNIVERSAL 2,$475.00,$0.00,$475.00,$213.75,$339.01,$0.00,$81.84,$0.00,$0.00,$83.17,$475.00,$0.00,$237.50,$376.20,$380.00,$0.00,$74.34,$0.00,$75.62,$0.00
50-23518,SUP,HCPCS C1713,,50-23518  -  SCREW BONE 2.3MM 18MM LOCK XPIN HEAD LEIBINGER UNIVERSAL 2,$475.00,$0.00,$475.00,$213.75,$339.01,$0.00,$81.84,$0.00,$0.00,$83.17,$475.00,$0.00,$237.50,$376.20,$380.00,$0.00,$74.34,$0.00,$75.62,$0.00
50-23520,SUP,HCPCS C1713,,50-23520  -  SCREW BONE 2.3MM 20MM LOCKING XPIN TITANIUM MAXFACL,$475.00,$0.00,$475.00,$213.75,$339.01,$0.00,$81.84,$0.00,$0.00,$83.17,$475.00,$0.00,$237.50,$376.20,$380.00,$0.00,$74.34,$0.00,$75.62,$0.00
5023-6-150,SUP,Custom 27203010,,5023-6-150  -  PIN HALF 150MM 4MM APEX SS SLFTAP SLFDRILL THRD 50MM EXFIX,$169.13,$0.00,$169.13,$0.00,$120.70,$0.00,$0.00,$0.00,$0.00,$0.00,$169.13,$0.00,$84.56,$133.95,$135.30,$0.00,$0.00,$0.00,$0.00,$0.00
5023-6-180,SUP,Custom 27203010,,5023-6-180  -  PIN 4MM TROCAR PNT 1 END THRD 180X50MM APEX SS 50MM XTRN,$169.13,$0.00,$169.13,$0.00,$120.70,$0.00,$0.00,$0.00,$0.00,$0.00,$169.13,$0.00,$84.56,$133.95,$135.30,$0.00,$0.00,$0.00,$0.00,$0.00
5023-6-200,SUP,Custom 27203010,,5023-6-200  -  PIN HALF 200MM 4MM APEX HFMN2 ORTH SS MDLR CNT THRD 40MM,$220.00,$0.00,$220.00,$0.00,$157.01,$0.00,$0.00,$0.00,$0.00,$0.00,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$0.00,$0.00,$0.00,$0.00
5023-6-250,SUP,Custom 27203010,,5023-6-250  -  PIN HALF 250MM 4MM APEX HFMN2 ORTH SS MDLR CNT THRD 50MM,$199.38,$0.00,$199.38,$0.00,$142.29,$0.00,$0.00,$0.00,$0.00,$0.00,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$0.00,$0.00,$0.00,$0.00
50-23706,SUP,HCPCS C1713,,50-23706  -  SCREW BONE 2.3MM 6MM SLFTAP XFIT TITANIUM MAXFACL,$307.50,$0.00,$307.50,$138.38,$219.46,$0.00,$52.98,$0.00,$0.00,$53.84,$307.50,$0.00,$153.75,$243.54,$246.00,$0.00,$48.12,$0.00,$48.95,$0.00
50-23708,SUP,HCPCS C1713,,50-23708  -  SCREW BONE 2.3MM 8MM SLFTAP XPIN EMERGENCY TITANIUM MAXFACL,$307.50,$0.00,$307.50,$138.38,$219.46,$0.00,$52.98,$0.00,$0.00,$53.84,$307.50,$0.00,$153.75,$243.54,$246.00,$0.00,$48.12,$0.00,$48.95,$0.00
50-23710,SUP,HCPCS C1713,,50-23710  -  SCREW BONE 2.3MM 10MM SLFTAP EMERGENCY XPIN TITANIUM MAXFACL,$307.50,$0.00,$307.50,$138.38,$219.46,$0.00,$52.98,$0.00,$0.00,$53.84,$307.50,$0.00,$153.75,$243.54,$246.00,$0.00,$48.12,$0.00,$48.95,$0.00
50-23712,SUP,HCPCS C1713,,50-23712  -  SCREW BONE 2.3MM 12MM SLFTAP EMERGENCY XPIN TITANIUM MAXFACL,$307.50,$0.00,$307.50,$138.38,$219.46,$0.00,$52.98,$0.00,$0.00,$53.84,$307.50,$0.00,$153.75,$243.54,$246.00,$0.00,$48.12,$0.00,$48.95,$0.00
50-23714,SUP,HCPCS C1713,,50-23714  -  SCREW BONE 2.3MM 14MM SLFTAP EMERGENCY XPIN TITANIUM MAXFACL,$307.50,$0.00,$307.50,$138.38,$219.46,$0.00,$52.98,$0.00,$0.00,$53.84,$307.50,$0.00,$153.75,$243.54,$246.00,$0.00,$48.12,$0.00,$48.95,$0.00
50-23716,SUP,HCPCS C1713,,50-23716  -  SCREW BONE 2.3MM 16MM EMERGENCY XPIN TITANIUM MAXFACL,$307.50,$0.00,$307.50,$138.38,$219.46,$0.00,$52.98,$0.00,$0.00,$53.84,$307.50,$0.00,$153.75,$243.54,$246.00,$0.00,$48.12,$0.00,$48.95,$0.00
5023-7-250,SUP,Custom 27203010,,5023-7-250  -  PIN HALF 250MM 4MM APEX HFMN2 ORTH SS MDLR CNT THRD 70MM,$96.25,$0.00,$96.25,$0.00,$68.69,$0.00,$0.00,$0.00,$0.00,$0.00,$96.25,$0.00,$48.13,$76.23,$77.00,$0.00,$0.00,$0.00,$0.00,$0.00
5027-1-040,SUP,Custom 27803010,,5027-1-040  -  CAP PCTV HFMN XPRESS NONSTRL TIP WHT 4MM 4MM 4MM DISP,$72.88,$0.00,$72.88,$0.00,$52.01,$0.00,$0.00,$0.00,$0.00,$0.00,$72.88,$0.00,$36.44,$57.72,$58.30,$0.00,$0.00,$0.00,$0.00,$0.00
5027-1-050,SUP,Custom 27803010,,5027-1-050  -  CAP PCTV TIP BLUE 5MM,$74.25,$0.00,$74.25,$0.00,$52.99,$0.00,$0.00,$0.00,$0.00,$0.00,$74.25,$0.00,$37.13,$58.81,$59.40,$0.00,$0.00,$0.00,$0.00,$0.00
5027-1-090,SUP,Custom 27203010,,5027-1-090  -  PIN HALF 90MM 4MM APEX SS BLNT TIP 10MM EXFIX SYS,$123.75,$0.00,$123.75,$0.00,$88.32,$0.00,$0.00,$0.00,$0.00,$0.00,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$0.00,$0.00,$0.00,$0.00
5027-2-090,SUP,Custom 27203010,,5027-2-090  -  PIN HALF 90MM 4MM APEX SS BLNT TIP 20MM EXFIX SYS,$123.75,$0.00,$123.75,$0.00,$88.32,$0.00,$0.00,$0.00,$0.00,$0.00,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$0.00,$0.00,$0.00,$0.00
5027-3-090,SUP,Custom 27203010,,5027-3-090  -  PIN HALF 90MM 4MM APEX SS BLNT TIP 30MM EXFIX SYS,$123.75,$0.00,$123.75,$0.00,$88.32,$0.00,$0.00,$0.00,$0.00,$0.00,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$0.00,$0.00,$0.00,$0.00
5027-3-120,SUP,Custom 27203010,,5027-3-120  -  PIN HALF 120MM 4MM APEX SS BLNT TIP 30MM EXFIX SYS,$123.75,$0.00,$123.75,$0.00,$88.32,$0.00,$0.00,$0.00,$0.00,$0.00,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$0.00,$0.00,$0.00,$0.00
50-27405,SUP,HCPCS C1713,,50-27405  -  SCREW BONE 2.7MM 5MM SLFTAP XPIN TITANIUM MAXFACL,$327.50,$0.00,$327.50,$147.38,$233.74,$0.00,$56.43,$0.00,$0.00,$57.34,$327.50,$0.00,$163.75,$259.38,$262.00,$0.00,$51.25,$0.00,$52.14,$0.00
50-27408,SUP,HCPCS C1713,,50-27408  -  SCREW BONE 2.7MM 8MM SLFTAP XPIN TITANIUM MAXFACL,$65.50,$0.00,$65.50,$29.48,$46.75,$0.00,$11.29,$0.00,$0.00,$11.47,$65.50,$0.00,$32.75,$51.88,$52.40,$0.00,$10.25,$0.00,$10.43,$0.00
50-27410,SUP,HCPCS C1713,,50-27410  -  SCREW BONE 2.7MM 10MM SELF TAP XPIN EMERGENCY TITANIUM,$327.50,$0.00,$327.50,$147.38,$233.74,$0.00,$56.43,$0.00,$0.00,$57.34,$327.50,$0.00,$163.75,$259.38,$262.00,$0.00,$51.25,$0.00,$52.14,$0.00
50-27412,SUP,HCPCS C1713,,50-27412  -  SCREW BONE 2 UNIVERSAL 2.7MM 12MM SELF TAP XPIN EMERGENCY,$327.50,$0.00,$327.50,$147.38,$233.74,$0.00,$56.43,$0.00,$0.00,$57.34,$327.50,$0.00,$163.75,$259.38,$262.00,$0.00,$51.25,$0.00,$52.14,$0.00
5027-4-120,SUP,Custom 27203010,,5027-4-120  -  PIN HALF 120MM 4MM APEX SS BLNT TIP 35MM EXFIX SYS,$123.75,$0.00,$123.75,$0.00,$88.32,$0.00,$0.00,$0.00,$0.00,$0.00,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$0.00,$0.00,$0.00,$0.00
50-27414,SUP,HCPCS C1713,,50-27414  -  SCREW BONE 2.7MM 14MM SLFTAP XPIN TITANIUM MAXFACL,$327.50,$0.00,$327.50,$147.38,$233.74,$0.00,$56.43,$0.00,$0.00,$57.34,$327.50,$0.00,$163.75,$259.38,$262.00,$0.00,$51.25,$0.00,$52.14,$0.00
5027-4-150,SUP,Custom 27203010,,5027-4-150  -  PIN HALF 150MM 4MM APEX SS BLNT TIP 40MM EXFIX SYS,$123.75,$0.00,$123.75,$0.00,$88.32,$0.00,$0.00,$0.00,$0.00,$0.00,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$0.00,$0.00,$0.00,$0.00
50-27416,SUP,HCPCS C1713,,50-27416  -  SCREW BONE 2.7MM 16MM SLFTAP XPIN TITANIUM MAXFACL,$327.50,$0.00,$327.50,$147.38,$233.74,$0.00,$56.43,$0.00,$0.00,$57.34,$327.50,$0.00,$163.75,$259.38,$262.00,$0.00,$51.25,$0.00,$52.14,$0.00
50-27418,SUP,HCPCS C1713,,50-27418  -  SCREW BONE 2.7MM 18MM SLFTAP XPIN TITANIUM MAXFACL,$65.50,$0.00,$65.50,$29.48,$46.75,$0.00,$11.29,$0.00,$0.00,$11.47,$65.50,$0.00,$32.75,$51.88,$52.40,$0.00,$10.25,$0.00,$10.43,$0.00
5027-4-180,SUP,Custom 27203010,,5027-4-180  -  PIN HALF 180MM 4MM APEX SS BLNT TIP 40MM EXFIX SYS,$123.75,$0.00,$123.75,$0.00,$88.32,$0.00,$0.00,$0.00,$0.00,$0.00,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$0.00,$0.00,$0.00,$0.00
50-27420,SUP,HCPCS C1713,,50-27420  -  SCREW BONE 2.7MM 20MM XPIN EMERGENCY TITANIUM MAXFACL,$327.50,$0.00,$327.50,$147.38,$233.74,$0.00,$56.43,$0.00,$0.00,$57.34,$327.50,$0.00,$163.75,$259.38,$262.00,$0.00,$51.25,$0.00,$52.14,$0.00
50-27505,SUP,HCPCS C1713,,50-27505  -  SCREW BONE 2.7MM 5MM LOCKING XPIN EMERGENCY TITANIUM MAXFACL,$525.00,$0.00,$525.00,$236.25,$374.69,$0.00,$90.45,$0.00,$0.00,$91.92,$525.00,$0.00,$262.50,$415.80,$420.00,$0.00,$82.16,$0.00,$83.58,$0.00
50-27508,SUP,HCPCS C1713,,50-27508  -  SCREW BONE 2.7MM 8MM LOCKING XPIN EMERGENCY TITANIUM MAXFACL,$105.00,$0.00,$105.00,$47.25,$74.94,$0.00,$18.09,$0.00,$0.00,$18.38,$105.00,$0.00,$52.50,$83.16,$84.00,$0.00,$16.43,$0.00,$16.72,$0.00
50-27510,SUP,HCPCS C1713,,50-27510  -  SCREW BONE 2.7MM 10MM LOCK XPIN HEAD LEIBINGER UNIVERSAL 2,$525.00,$0.00,$525.00,$236.25,$374.69,$0.00,$90.45,$0.00,$0.00,$91.92,$525.00,$0.00,$262.50,$415.80,$420.00,$0.00,$82.16,$0.00,$83.58,$0.00
50-27512,SUP,HCPCS C1713,,50-27512  -  SCREW BONE 2.7MM 12MM LOCK XPIN HEAD LEIBINGER UNIVERSAL 2,$525.00,$0.00,$525.00,$236.25,$374.69,$0.00,$90.45,$0.00,$0.00,$91.92,$525.00,$0.00,$262.50,$415.80,$420.00,$0.00,$82.16,$0.00,$83.58,$0.00
50-27514,SUP,HCPCS C1713,,50-27514  -  SCREW BONE 2.7MM 14MM LOCKING XPIN EMERGENCY TITANIUM,$525.00,$0.00,$525.00,$236.25,$374.69,$0.00,$90.45,$0.00,$0.00,$91.92,$525.00,$0.00,$262.50,$415.80,$420.00,$0.00,$82.16,$0.00,$83.58,$0.00
5027-5-150,SUP,Custom 27203010,,5027-5-150  -  PIN HALF 150MM 4MM APEX SS BLNT TIP 50MM EXFIX SYS,$123.75,$0.00,$123.75,$0.00,$88.32,$0.00,$0.00,$0.00,$0.00,$0.00,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$0.00,$0.00,$0.00,$0.00
50-27516,SUP,HCPCS C1713,,50-27516  -  SCREW BONE 2.7MM 16MM LOCKING XPIN EMERGENCY TITANIUM,$525.00,$0.00,$525.00,$236.25,$374.69,$0.00,$90.45,$0.00,$0.00,$91.92,$525.00,$0.00,$262.50,$415.80,$420.00,$0.00,$82.16,$0.00,$83.58,$0.00
50-27518,SUP,HCPCS C1713,,50-27518  -  SCREW BONE 2.7MM 18MM LOCKING XPIN EMERGENCY TITANIUM,$525.00,$0.00,$525.00,$236.25,$374.69,$0.00,$90.45,$0.00,$0.00,$91.92,$525.00,$0.00,$262.50,$415.80,$420.00,$0.00,$82.16,$0.00,$83.58,$0.00
5027-5-180,SUP,Custom 27203010,,5027-5-180  -  PIN HALF 180MM 4MM APEX CONTIN THRD 50MM,$123.75,$0.00,$123.75,$0.00,$88.32,$0.00,$0.00,$0.00,$0.00,$0.00,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$0.00,$0.00,$0.00,$0.00
50-27520,SUP,HCPCS C1713,,50-27520  -  SCREW BONE 2.7MM 20MM LOCKING XPIN EMERGENCY TITANIUM,$525.00,$0.00,$525.00,$236.25,$374.69,$0.00,$90.45,$0.00,$0.00,$91.92,$525.00,$0.00,$262.50,$415.80,$420.00,$0.00,$82.16,$0.00,$83.58,$0.00
5028-7-030,SUP,Custom 27203010,,5028-7-030  -  ROD EXFIX 174MM 8MM HFMN2 CARFBR CONNCTNG,$444.13,$0.00,$444.13,$0.00,$316.97,$0.00,$0.00,$0.00,$0.00,$0.00,$444.13,$0.00,$222.06,$351.75,$355.30,$0.00,$0.00,$0.00,$0.00,$0.00
5028-8-065,SUP,Custom 27203010,,5028-8-065  -  ROD EXFIX 65MM 8MM HFMN2 CARFBR CONNCTNG,$312.13,$0.00,$312.13,$0.00,$222.76,$0.00,$0.00,$0.00,$0.00,$0.00,$312.13,$0.00,$156.06,$247.21,$249.70,$0.00,$0.00,$0.00,$0.00,$0.00
5028-8-100,SUP,HCPCS C1713,,ROD 100MM 8MM CONNCTNG HFMN2 MRI CARB FBR EXFIXA,$312.13,$0.00,$312.13,$140.46,$222.76,$0.00,$53.78,$0.00,$0.00,$54.65,$312.13,$0.00,$156.06,$247.21,$249.70,$0.00,$48.85,$0.00,$49.69,$0.00
5028-8-150,SUP,Custom 27203010,,5028-8-150  -  ROD EXFIX 150MM 8MM HFMN2 CARFBR CONNCTNG,$312.13,$0.00,$312.13,$0.00,$222.76,$0.00,$0.00,$0.00,$0.00,$0.00,$312.13,$0.00,$156.06,$247.21,$249.70,$0.00,$0.00,$0.00,$0.00,$0.00
5028-8-200,SUP,Custom 27203010,,5028-8-200  -  ROD EXFIX 200MM 8MM HFMN2 CARFBR CONNCTNG,$320.38,$0.00,$320.38,$0.00,$228.65,$0.00,$0.00,$0.00,$0.00,$0.00,$320.38,$0.00,$160.19,$253.74,$256.30,$0.00,$0.00,$0.00,$0.00,$0.00
5028-8-250,SUP,Custom 27203010,,5028-8-250  -  ROD EXFIX 250MM 8MM HFMN2 CARFBR CONNCTNG,$320.38,$0.00,$320.38,$0.00,$228.65,$0.00,$0.00,$0.00,$0.00,$0.00,$320.38,$0.00,$160.19,$253.74,$256.30,$0.00,$0.00,$0.00,$0.00,$0.00
5028-8-350,SUP,Custom 27203010,,5028-8-350  -  ROD EXFIX 350MM 8MM HFMN2 CARFBR CONNCTNG,$328.63,$0.00,$328.63,$0.00,$234.54,$0.00,$0.00,$0.00,$0.00,$0.00,$328.63,$0.00,$164.31,$260.27,$262.90,$0.00,$0.00,$0.00,$0.00,$0.00
5029-8-720,SUP,Custom 27203010,,5029-8-720  -  ROD EXFIX 200MM 8MM HFMN2 CARB CONNCTNG,$253.00,$0.00,$253.00,$0.00,$180.57,$0.00,$0.00,$0.00,$0.00,$0.00,$253.00,$0.00,$126.50,$200.38,$202.40,$0.00,$0.00,$0.00,$0.00,$0.00
5029-8-725,SUP,Custom 27203010,,5029-8-725  -  ROD EXFIX 250MM 8MM HFMN2 CARB CONNCTNG,$253.00,$0.00,$253.00,$0.00,$180.57,$0.00,$0.00,$0.00,$0.00,$0.00,$253.00,$0.00,$126.50,$200.38,$202.40,$0.00,$0.00,$0.00,$0.00,$0.00
5029-8-805,SUP,Custom 27203010,,5029-8-805  -  ROD EXFIX 65MM 8MM HFMN2 CARFBR CONNCTNG BRAID,$233.75,$0.00,$233.75,$0.00,$166.83,$0.00,$0.00,$0.00,$0.00,$0.00,$233.75,$0.00,$116.88,$185.13,$187.00,$0.00,$0.00,$0.00,$0.00,$0.00
5029-8-810,SUP,Custom 27203010,,5029-8-810  -  ROD EXFIX 100MM 8MM HFMN2 CARFBR CONNCTNG BRAID,$233.75,$0.00,$233.75,$0.00,$166.83,$0.00,$0.00,$0.00,$0.00,$0.00,$233.75,$0.00,$116.88,$185.13,$187.00,$0.00,$0.00,$0.00,$0.00,$0.00
5029-8-815,SUP,Custom 27203010,,5029-8-815  -  ROD EXFIX 150MM 8MM HFMN2 CARFBR CONNCTNG BRAID,$233.75,$0.00,$233.75,$0.00,$166.83,$0.00,$0.00,$0.00,$0.00,$0.00,$233.75,$0.00,$116.88,$185.13,$187.00,$0.00,$0.00,$0.00,$0.00,$0.00
5029-8-820,SUP,Custom 27203010,,5029-8-820  -  ROD EXFIX 200MM 8MM HFMN2 CARFBR CONNCTNG BRAID,$253.00,$0.00,$253.00,$0.00,$180.57,$0.00,$0.00,$0.00,$0.00,$0.00,$253.00,$0.00,$126.50,$200.38,$202.40,$0.00,$0.00,$0.00,$0.00,$0.00
5029-8-825,SUP,Custom 27203010,,5029-8-825  -  ROD EXFIX 250MM 8MM HFMN2 CARFBR CONNCTNG BRAID,$253.00,$0.00,$253.00,$0.00,$180.57,$0.00,$0.00,$0.00,$0.00,$0.00,$253.00,$0.00,$126.50,$200.38,$202.40,$0.00,$0.00,$0.00,$0.00,$0.00
5029-8-830,SUP,Custom 27203010,,5029-8-830  -  ROD EXFIX 300MM 8MM HFMN2 CARFBR CONNCTNG BRAID,$253.00,$0.00,$253.00,$0.00,$180.57,$0.00,$0.00,$0.00,$0.00,$0.00,$253.00,$0.00,$126.50,$200.38,$202.40,$0.00,$0.00,$0.00,$0.00,$0.00
5029-8-835,SUP,Custom 27203010,,5029-8-835  -  ROD XTRNFX 8MM 350MM HFMN2 CNCT BRD CFBR,$272.25,$0.00,$272.25,$0.00,$194.30,$0.00,$0.00,$0.00,$0.00,$0.00,$272.25,$0.00,$136.13,$215.62,$217.80,$0.00,$0.00,$0.00,$0.00,$0.00
5029-8-840,SUP,Custom 27203010,,5029-8-840  -  ROD EXFIX 400MM 8MM HFMN2 CARFBR CONNCTNG,$272.25,$0.00,$272.25,$0.00,$194.30,$0.00,$0.00,$0.00,$0.00,$0.00,$272.25,$0.00,$136.13,$215.62,$217.80,$0.00,$0.00,$0.00,$0.00,$0.00
5029-8-845,SUP,Custom 27203010,,5029-8-845  -  ROD EXFIX 450MM 8MM HFMN2 CARFBR CONNCTNG BRAID,$313.50,$0.00,$313.50,$0.00,$223.74,$0.00,$0.00,$0.00,$0.00,$0.00,$313.50,$0.00,$156.75,$248.29,$250.80,$0.00,$0.00,$0.00,$0.00,$0.00
5029-8-850,SUP,Custom 27203010,,5029-8-850  -  ROD EXFIX 500MM 8MM HFMN2 CARFBR CONNCTNG BRAID,$313.50,$0.00,$313.50,$0.00,$223.74,$0.00,$0.00,$0.00,$0.00,$0.00,$313.50,$0.00,$156.75,$248.29,$250.80,$0.00,$0.00,$0.00,$0.00,$0.00
5030-3-200,SUP,Custom 27203010,,5030-3-200  -  PIN HALF 200MM 4MM APEX SS MDLR THRD TRNFX 35MM EXFIX SYS,$198.00,$0.00,$198.00,$0.00,$141.31,$0.00,$0.00,$0.00,$0.00,$0.00,$198.00,$0.00,$99.00,$156.82,$158.40,$0.00,$0.00,$0.00,$0.00,$0.00
5030-3-250,SUP,Custom 27203010,,5030-3-250  -  PIN HALF 250MM 4MM APEX SS MDLR THRD TRNFX 35MM EXFIX SYS,$198.00,$0.00,$198.00,$0.00,$141.31,$0.00,$0.00,$0.00,$0.00,$0.00,$198.00,$0.00,$99.00,$156.82,$158.40,$0.00,$0.00,$0.00,$0.00,$0.00
5030-4-200,SUP,Custom 27203010,,5030-4-200  -  PIN HALF 200MM 4MM APEX SS MDLR THRD TRNFX 40MM EXFIX SYS,$198.00,$0.00,$198.00,$0.00,$141.31,$0.00,$0.00,$0.00,$0.00,$0.00,$198.00,$0.00,$99.00,$156.82,$158.40,$0.00,$0.00,$0.00,$0.00,$0.00
5030-4-250,SUP,Custom 27203010,,5030-4-250  -  PIN HALF 250MM 4MM APEX SS MDLR THRD TRNFX 40MM EXFIX SYS,$198.00,$0.00,$198.00,$0.00,$141.31,$0.00,$0.00,$0.00,$0.00,$0.00,$198.00,$0.00,$99.00,$156.82,$158.40,$0.00,$0.00,$0.00,$0.00,$0.00
5030-4-300,SUP,Custom 27203010,,5030-4-300  -  PIN HLF 5MM 4MM 300MM NS 50MM APX TRNFX ST SLF DRL CNTR THRD,$198.00,$0.00,$198.00,$0.00,$141.31,$0.00,$0.00,$0.00,$0.00,$0.00,$198.00,$0.00,$99.00,$156.82,$158.40,$0.00,$0.00,$0.00,$0.00,$0.00
5030-5-200,SUP,Custom 27203010,,5030-5-200  -  PIN HALF 200MM 4MM APEX SS MDLR THRD TRNFX 50MM EXFIX SYS,$198.00,$0.00,$198.00,$0.00,$141.31,$0.00,$0.00,$0.00,$0.00,$0.00,$198.00,$0.00,$99.00,$156.82,$158.40,$0.00,$0.00,$0.00,$0.00,$0.00
5030-5-250,SUP,HCPCS C1713,,5030-5-250  -  TRAY STRL MDLR TRNFX 4 MM 250 MM PIN THRD,$198.00,$0.00,$198.00,$89.10,$141.31,$0.00,$34.11,$0.00,$0.00,$34.67,$198.00,$0.00,$99.00,$156.82,$158.40,$0.00,$30.99,$0.00,$31.52,$0.00
5030-5-300,SUP,Custom 27203010,,5030-5-300  -  PIN HLF 5MM 4MM 300MM NS 50MM HFMN2 APX TRNFX ST SLF DRL,$255.75,$0.00,$255.75,$0.00,$182.53,$0.00,$0.00,$0.00,$0.00,$0.00,$255.75,$0.00,$127.88,$202.55,$204.60,$0.00,$0.00,$0.00,$0.00,$0.00
5030-6-250,SUP,Custom 27203010,,5030-6-250  -  PIN HALF 250MM 4MM APEX SS MDLR THRD TRNFX 60MM EXFIX SYS,$198.00,$0.00,$198.00,$0.00,$141.31,$0.00,$0.00,$0.00,$0.00,$0.00,$198.00,$0.00,$99.00,$156.82,$158.40,$0.00,$0.00,$0.00,$0.00,$0.00
50-306-40-04,SUP,Custom 27803010,,50-306-40-04  -  RESORB MESH ORBITAL,"$1,500.00",$0.00,"$1,500.00",$0.00,"$1,070.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
5030-7-300,SUP,Custom 27203010,,5030-7-300  -  PIN FX 5MM 4MM 300MM 70MM APX TRNFX SS FT/ANKL CANC,$198.00,$0.00,$198.00,$0.00,$141.31,$0.00,$0.00,$0.00,$0.00,$0.00,$198.00,$0.00,$99.00,$156.82,$158.40,$0.00,$0.00,$0.00,$0.00,$0.00
50-310-27-09,SUP,Custom 27803010,,50-310-27-09  -  COVER BURR HOLE 17MM .3MM CNTOUR TITANIUM CRANIUM 1.5MM,$465.18,$0.00,$465.18,$0.00,$332.00,$0.00,$0.00,$0.00,$0.00,$0.00,$465.18,$0.00,$232.59,$368.42,$372.14,$0.00,$0.00,$0.00,$0.00,$0.00
50-320-08-09,SUP,HCPCS C1713,,50-320-08-09  -  PLATE BONE MINI REGULAR 1MM 8 HOLE RIGID LIGHTWEIGHT BLUE,$271.95,$0.00,$271.95,$122.38,$194.09,$0.00,$46.86,$0.00,$0.00,$47.62,$271.95,$0.00,$135.98,$215.38,$217.56,$0.00,$42.56,$0.00,$43.29,$0.00
50-321-04-09,SUP,HCPCS C1713,,50-321-04-09  -  PLATE BONE MINI MEDIUM 1MM 4 HOLE RIGID LIGHTWEIGHT BLUE,$222.75,$0.00,$222.75,$100.24,$158.98,$0.00,$38.38,$0.00,$0.00,$39.00,$222.75,$0.00,$111.38,$176.42,$178.20,$0.00,$34.86,$0.00,$35.46,$0.00
50-322-04-09,SUP,HCPCS C1713,,50-322-04-09  -  PLATE BONE LONG 1MM 4 HOLE RIGID LIGHTWEIGHT BLUE TITANIUM,$222.75,$0.00,$222.75,$100.24,$158.98,$0.00,$38.38,$0.00,$0.00,$39.00,$222.75,$0.00,$111.38,$176.42,$178.20,$0.00,$34.86,$0.00,$35.46,$0.00
50-325-01-07,SUP,Custom 27100030,,50-325-01-07  -  CLAMP SURG 6IN SHARP STAINLESS STEEL,$576.23,$0.00,$576.23,$0.00,$411.25,$0.00,$0.00,$0.00,$0.00,$0.00,$576.23,$0.00,$288.11,$456.37,$460.98,$0.00,$0.00,$0.00,$0.00,$0.00
50-330-06-09,SUP,HCPCS C1713,,50-330-06-09  -  PLATE BONE MINI MEDIUM CVD FLAT 1MM 6 HOLE SAGITTAL RIGID,$388.50,$0.00,$388.50,$174.83,$277.27,$0.00,$66.94,$0.00,$0.00,$68.02,$388.50,$0.00,$194.25,$307.69,$310.80,$0.00,$60.80,$0.00,$61.85,$0.00
50-331-06-09,SUP,HCPCS C1713,,50-331-06-09  -  PLATE BONE LONG CVD FLAT 1MM 6 HOLE SAGITTAL RIGID,$388.50,$0.00,$388.50,$174.83,$277.27,$0.00,$66.94,$0.00,$0.00,$68.02,$388.50,$0.00,$194.25,$307.69,$310.80,$0.00,$60.80,$0.00,$61.85,$0.00
50-332-06-09,SUP,HCPCS C1713,,50-332-06-09  -  PLATE BONE XLONG CVD FLAT 1MM 6 HOLE SAGITTAL RIGID,$388.50,$0.00,$388.50,$174.83,$277.27,$0.00,$66.94,$0.00,$0.00,$68.02,$388.50,$0.00,$194.25,$307.69,$310.80,$0.00,$60.80,$0.00,$61.85,$0.00
5036-1-080,SUP,Custom 27203010,,5036-1-080  -  PIN HALF 80MM 3MM APEX SS BLNT TIP 10MM EXFIX SYS,$123.75,$0.00,$123.75,$0.00,$88.32,$0.00,$0.00,$0.00,$0.00,$0.00,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$0.00,$0.00,$0.00,$0.00
5036-1-110,SUP,Custom 27203010,,5036-1-110  -  PIN HALF 110MM 3MM APEX SS BLNT TIP 10MM EXFIX SYS,$123.75,$0.00,$123.75,$0.00,$88.32,$0.00,$0.00,$0.00,$0.00,$0.00,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$0.00,$0.00,$0.00,$0.00
5036-1-580,SUP,Custom 27203010,,5036-1-580  -  PIN HALF 80MM 3MM APEX SS BLNT TIP 15MM EXFIX SYS,$123.75,$0.00,$123.75,$0.00,$88.32,$0.00,$0.00,$0.00,$0.00,$0.00,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$0.00,$0.00,$0.00,$0.00
5036-2-060,SUP,Custom 27203010,,5036-2-060  -  PIN HALF 60MM 3MM APEX SS BLNT TIP 10MM EXFIX SYS,$123.75,$0.00,$123.75,$0.00,$88.32,$0.00,$0.00,$0.00,$0.00,$0.00,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$0.00,$0.00,$0.00,$0.00
5036-2-080,SUP,Custom 27203010,,5036-2-080  -  PIN HALF 80MM 3MM APEX SS BLNT TIP 20MM EXFIX SYS,$123.75,$0.00,$123.75,$0.00,$88.32,$0.00,$0.00,$0.00,$0.00,$0.00,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$0.00,$0.00,$0.00,$0.00
5036-2-110,SUP,Custom 27203010,,5036-2-110  -  PIN HLF 3MM 110MM 25MM HFMN2 APX BLNT TIP SS,$123.75,$0.00,$123.75,$0.00,$88.32,$0.00,$0.00,$0.00,$0.00,$0.00,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$0.00,$0.00,$0.00,$0.00
50-368-16-91,SUP,HCPCS C1713,,50-368-16-91  -  PLATE BONE MINI REGULAR .6MM 16 HOLE LP TITANIUM MANDIB 2MM,$323.75,$0.00,$323.75,$145.69,$231.06,$0.00,$55.78,$0.00,$0.00,$56.69,$323.75,$0.00,$161.88,$256.41,$259.00,$0.00,$50.67,$0.00,$51.54,$0.00
50-369-06,SUP,HCPCS C1713,,50-369-06  -  X PLATE,$348.75,$0.00,$348.75,$156.94,$248.90,$0.00,$60.09,$0.00,$0.00,$61.06,$348.75,$0.00,$174.38,$276.21,$279.00,$0.00,$54.58,$0.00,$55.52,$0.00
50-375-04-91,SUP,HCPCS C1713,,50-375-04-91  -  PLATE BN MED MN L .6MM NS THREADLOCK TS 4 HL LOPRFL TI,$362.60,$0.00,$362.60,$163.17,$258.79,$0.00,$62.47,$0.00,$0.00,$63.49,$362.60,$0.00,$181.30,$287.18,$290.08,$0.00,$56.75,$0.00,$57.73,$0.00
50-377-04-91,SUP,HCPCS C1713,,50-377-04-91  -  PLATE BN MED MN L .6MM NS THREADLOCK TS 4 HL LOPRFL TI,$362.60,$0.00,$362.60,$163.17,$258.79,$0.00,$62.47,$0.00,$0.00,$63.49,$362.60,$0.00,$181.30,$287.18,$290.08,$0.00,$56.75,$0.00,$57.73,$0.00
50-379-04-91,SUP,HCPCS C1713,,50-379-04-91  -  PLATE BN LNG MN L .6MM NS THREADLOCK TS 4 HL LOPRFL TI,$362.60,$0.00,$362.60,$163.17,$258.79,$0.00,$62.47,$0.00,$0.00,$63.49,$362.60,$0.00,$181.30,$287.18,$290.08,$0.00,$56.75,$0.00,$57.73,$0.00
50-381-04-91,SUP,HCPCS C1713,,50-381-04-91  -  PLATE BN LNG MN L .6MM NS THREADLOCK TS 4 HL LOPRFL TI,$362.60,$0.00,$362.60,$163.17,$258.79,$0.00,$62.47,$0.00,$0.00,$63.49,$362.60,$0.00,$181.30,$287.18,$290.08,$0.00,$56.75,$0.00,$57.73,$0.00
50-381-05-09,SUP,HCPCS C1713,,50-381-05-09  -  PLATE BN LNG MN L .7MM NS THREADLOCK TS 5 HL LOPRFL TI,$362.60,$0.00,$362.60,$163.17,$258.79,$0.00,$62.47,$0.00,$0.00,$63.49,$362.60,$0.00,$181.30,$287.18,$290.08,$0.00,$56.75,$0.00,$57.73,$0.00
5038-1-080,SUP,Custom 27203010,,5038-1-080  -  PIN 3MM SLFDRILL SLFTAP THRD 80MM APEX SS 10MM,$123.75,$0.00,$123.75,$0.00,$88.32,$0.00,$0.00,$0.00,$0.00,$0.00,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$0.00,$0.00,$0.00,$0.00
5038-1-110,SUP,Custom 27203010,,5038-1-110  -  PIN HALF 110MM 3MM APEX SS SLFDRILL SLFTAP THRD 10MM EXFIX,$123.75,$0.00,$123.75,$0.00,$88.32,$0.00,$0.00,$0.00,$0.00,$0.00,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$0.00,$0.00,$0.00,$0.00
5038-2-080,SUP,Custom 27203010,,5038-2-080  -  PIN HALF 80MM 3MM APEX SS SLFDRILL SLFTAP THRD 15MM EXFIX,$123.75,$0.00,$123.75,$0.00,$88.32,$0.00,$0.00,$0.00,$0.00,$0.00,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$0.00,$0.00,$0.00,$0.00
5038-2-110,SUP,Custom 27203010,,5038-2-110  -  PIN HALF 110MM 3MM APEX SS SLFDRILL SLFTAP THRD 25MM EXFIX,$123.75,$0.00,$123.75,$0.00,$88.32,$0.00,$0.00,$0.00,$0.00,$0.00,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$0.00,$0.00,$0.00,$0.00
50-383-05-09,SUP,HCPCS C1713,,50-383-05-09  -  PLATE BN LNG MN L .7MM NS THREADLOCK TS 5 HL LOPRFL TI,$362.60,$0.00,$362.60,$163.17,$258.79,$0.00,$62.47,$0.00,$0.00,$63.49,$362.60,$0.00,$181.30,$287.18,$290.08,$0.00,$56.75,$0.00,$57.73,$0.00
5038-5-060,SUP,Custom 27203010,,5038-5-060  -  PIN HALF 60MM 3MM APEX SS SLFDRILL SLFTAP THRD 10MM EXFIX,$123.75,$0.00,$123.75,$0.00,$88.32,$0.00,$0.00,$0.00,$0.00,$0.00,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$0.00,$0.00,$0.00,$0.00
5038-5-080,SUP,Custom 27203010,,5038-5-080  -  PIN HALF 80MM 3MM APEX SS SLFDRILL SLFTAP THRD 20MM EXFIX,$123.75,$0.00,$123.75,$0.00,$88.32,$0.00,$0.00,$0.00,$0.00,$0.00,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$0.00,$0.00,$0.00,$0.00
5038-5-110,SUP,Custom 27203010,,5038-5-110  -  PIN HALF 11CM 3MM APEX HFMN2 ORTH CONTIN THRD 22MM EXFIX SYS,$89.38,$0.00,$89.38,$0.00,$63.79,$0.00,$0.00,$0.00,$0.00,$0.00,$89.38,$0.00,$44.69,$70.79,$71.50,$0.00,$0.00,$0.00,$0.00,$0.00
50-386-06-91,SUP,HCPCS C1713,,50-386-06-91  -  PLATE BONE T MINI REGULAR .6MM LP TITANIUM MANDIB 2MM SCREW,$362.60,$0.00,$362.60,$163.17,$258.79,$0.00,$62.47,$0.00,$0.00,$63.49,$362.60,$0.00,$181.30,$287.18,$290.08,$0.00,$56.75,$0.00,$57.73,$0.00
50-390-05-91,SUP,HCPCS C1713,,50-390-05-91  -  PLATE BN MN SHRT Y .6MM THREADLOCK TS 5 HL LOPRFL TI MXLFCL,$362.60,$0.00,$362.60,$163.17,$258.79,$0.00,$62.47,$0.00,$0.00,$63.49,$362.60,$0.00,$181.30,$287.18,$290.08,$0.00,$56.75,$0.00,$57.73,$0.00
50-395-04,SUP,HCPCS C1713,,50-395-04  -  L PLATE RIGHT,$325.50,$0.00,$325.50,$146.48,$232.31,$0.00,$56.08,$0.00,$0.00,$56.99,$325.50,$0.00,$162.75,$257.80,$260.40,$0.00,$50.94,$0.00,$51.82,$0.00
50-396-06-91,SUP,HCPCS C1713,,50-396-06-91  -  PLATE BONE MINI REGULAR Y LP .6MM 2 TITANIUM MANDIB 2MM,$388.50,$0.00,$388.50,$174.83,$277.27,$0.00,$66.94,$0.00,$0.00,$68.02,$388.50,$0.00,$194.25,$307.69,$310.80,$0.00,$60.80,$0.00,$61.85,$0.00
504-02-54C-L,SUP,HCPCS C1776,,504-02-54C-L  -  SHELL ACTB 54MM RSTR ANTM HIP LT,"$9,457.50",$0.00,"$9,457.50","$4,255.88","$5,158.80",$0.00,"$1,629.48",$0.00,$0.00,"$1,655.93","$9,457.50",$0.00,"$4,728.75","$7,490.34","$7,566.00",$0.00,"$1,480.10",$0.00,"$1,505.63",$0.00
504-02-54C-R,SUP,HCPCS C1776,,504-02-54C-R  -  SHELL ACTB 54MM RSTR ANTM HIP RT,"$9,457.50",$0.00,"$9,457.50","$4,255.88","$5,158.80",$0.00,"$1,629.48",$0.00,$0.00,"$1,655.93","$9,457.50",$0.00,"$4,728.75","$7,490.34","$7,566.00",$0.00,"$1,480.10",$0.00,"$1,505.63",$0.00
504-02-56D-L,SUP,HCPCS C1776,,504-02-56D-L  -  SHELL ACTB 56MM RSTR ANTM HIP LT,"$9,457.50",$0.00,"$9,457.50","$4,255.88","$5,158.80",$0.00,"$1,629.48",$0.00,$0.00,"$1,655.93","$9,457.50",$0.00,"$4,728.75","$7,490.34","$7,566.00",$0.00,"$1,480.10",$0.00,"$1,505.63",$0.00
504-02-56D-R,SUP,HCPCS C1776,,504-02-56D-R  -  SHELL ACTB 56MM RSTR ANTM HIP RT,"$9,457.50",$0.00,"$9,457.50","$4,255.88","$5,158.80",$0.00,"$1,629.48",$0.00,$0.00,"$1,655.93","$9,457.50",$0.00,"$4,728.75","$7,490.34","$7,566.00",$0.00,"$1,480.10",$0.00,"$1,505.63",$0.00
504-02-58D-L,SUP,HCPCS C1776,,504-02-58D-L  -  SHELL ACTB 58MM RSTR ANTM HIP LT,"$9,457.50",$0.00,"$9,457.50","$4,255.88","$5,158.80",$0.00,"$1,629.48",$0.00,$0.00,"$1,655.93","$9,457.50",$0.00,"$4,728.75","$7,490.34","$7,566.00",$0.00,"$1,480.10",$0.00,"$1,505.63",$0.00
504-02-58D-R,SUP,HCPCS C1776,,504-02-58D-R  -  SHELL ACTB 58MM RSTR ANTM HIP RT,"$9,457.50",$0.00,"$9,457.50","$4,255.88","$5,158.80",$0.00,"$1,629.48",$0.00,$0.00,"$1,655.93","$9,457.50",$0.00,"$4,728.75","$7,490.34","$7,566.00",$0.00,"$1,480.10",$0.00,"$1,505.63",$0.00
504-02-60D-L,SUP,HCPCS C1776,,504-02-60D-L  -  SHELL ACTB 60MM RSTR ANTM HIP LT,"$9,457.50",$0.00,"$9,457.50","$4,255.88","$5,158.80",$0.00,"$1,629.48",$0.00,$0.00,"$1,655.93","$9,457.50",$0.00,"$4,728.75","$7,490.34","$7,566.00",$0.00,"$1,480.10",$0.00,"$1,505.63",$0.00
504-02-60D-R,SUP,HCPCS C1776,,504-02-60D-R  -  SHELL ACTB 60MM RSTR ANTM HIP RT,"$9,457.50",$0.00,"$9,457.50","$4,255.88","$5,158.80",$0.00,"$1,629.48",$0.00,$0.00,"$1,655.93","$9,457.50",$0.00,"$4,728.75","$7,490.34","$7,566.00",$0.00,"$1,480.10",$0.00,"$1,505.63",$0.00
504-02-62E-L,SUP,HCPCS C1776,,504-02-62E-L  -  SHELL ACTB 62MM RSTR ANTM HIP LT,"$9,457.50",$0.00,"$9,457.50","$4,255.88","$5,158.80",$0.00,"$1,629.48",$0.00,$0.00,"$1,655.93","$9,457.50",$0.00,"$4,728.75","$7,490.34","$7,566.00",$0.00,"$1,480.10",$0.00,"$1,505.63",$0.00
504-02-62E-R,SUP,HCPCS C1776,,504-02-62E-R  -  SHELL ACTB 62MM RSTR ANTM HIP RT,"$9,457.50",$0.00,"$9,457.50","$4,255.88","$5,158.80",$0.00,"$1,629.48",$0.00,$0.00,"$1,655.93","$9,457.50",$0.00,"$4,728.75","$7,490.34","$7,566.00",$0.00,"$1,480.10",$0.00,"$1,505.63",$0.00
504-02-64E-L,SUP,HCPCS C1776,,504-02-64E-L  -  SHELL ACTB 64MM RSTR ANTM HIP LT,"$9,457.50",$0.00,"$9,457.50","$4,255.88","$5,158.80",$0.00,"$1,629.48",$0.00,$0.00,"$1,655.93","$9,457.50",$0.00,"$4,728.75","$7,490.34","$7,566.00",$0.00,"$1,480.10",$0.00,"$1,505.63",$0.00
504-02-64E-R,SUP,HCPCS C1776,,504-02-64E-R  -  SHELL ACTB 64MM RSTR ANTM HIP RT,"$9,457.50",$0.00,"$9,457.50","$4,255.88","$5,158.80",$0.00,"$1,629.48",$0.00,$0.00,"$1,655.93","$9,457.50",$0.00,"$4,728.75","$7,490.34","$7,566.00",$0.00,"$1,480.10",$0.00,"$1,505.63",$0.00
504-02-66F-L,SUP,HCPCS C1776,,504-02-66F-L  -  SHELL ACTB 66MM RSTR ANTM HIP LT,"$9,457.50",$0.00,"$9,457.50","$4,255.88","$5,158.80",$0.00,"$1,629.48",$0.00,$0.00,"$1,655.93","$9,457.50",$0.00,"$4,728.75","$7,490.34","$7,566.00",$0.00,"$1,480.10",$0.00,"$1,505.63",$0.00
504-02-66F-R,SUP,HCPCS C1776,,504-02-66F-R  -  SHELL ACTB 66MM RSTR ANTM HIP RT,"$9,457.50",$0.00,"$9,457.50","$4,255.88","$5,158.80",$0.00,"$1,629.48",$0.00,$0.00,"$1,655.93","$9,457.50",$0.00,"$4,728.75","$7,490.34","$7,566.00",$0.00,"$1,480.10",$0.00,"$1,505.63",$0.00
504-02-68F-L,SUP,HCPCS C1776,,504-02-68F-L  -  SHELL ACTB 68MM RSTR ANTM HIP LT,"$9,457.50",$0.00,"$9,457.50","$4,255.88","$5,158.80",$0.00,"$1,629.48",$0.00,$0.00,"$1,655.93","$9,457.50",$0.00,"$4,728.75","$7,490.34","$7,566.00",$0.00,"$1,480.10",$0.00,"$1,505.63",$0.00
504-02-68F-R,SUP,HCPCS C1776,,504-02-68F-R  -  SHELL ACTB 68MM RSTR ANTM HIP RT,"$9,457.50",$0.00,"$9,457.50","$4,255.88","$5,158.80",$0.00,"$1,629.48",$0.00,$0.00,"$1,655.93","$9,457.50",$0.00,"$4,728.75","$7,490.34","$7,566.00",$0.00,"$1,480.10",$0.00,"$1,505.63",$0.00
504-02-70G-L,SUP,HCPCS C1776,,504-02-70G-L  -  SHELL ACTB 70MM RSTR ANTM HIP LT,"$9,457.50",$0.00,"$9,457.50","$4,255.88","$5,158.80",$0.00,"$1,629.48",$0.00,$0.00,"$1,655.93","$9,457.50",$0.00,"$4,728.75","$7,490.34","$7,566.00",$0.00,"$1,480.10",$0.00,"$1,505.63",$0.00
504-02-70G-R,SUP,HCPCS C1776,,504-02-70G-R  -  SHELL ACTB 70MM RSTR ANTM HIP RT,"$9,457.50",$0.00,"$9,457.50","$4,255.88","$5,158.80",$0.00,"$1,629.48",$0.00,$0.00,"$1,655.93","$9,457.50",$0.00,"$4,728.75","$7,490.34","$7,566.00",$0.00,"$1,480.10",$0.00,"$1,505.63",$0.00
504-02-72G-L,SUP,HCPCS C1776,,504-02-72G-L  -  SHELL ACTB 72MM RSTR ANTM HIP LT,"$9,457.50",$0.00,"$9,457.50","$4,255.88","$5,158.80",$0.00,"$1,629.48",$0.00,$0.00,"$1,655.93","$9,457.50",$0.00,"$4,728.75","$7,490.34","$7,566.00",$0.00,"$1,480.10",$0.00,"$1,505.63",$0.00
504-02-72G-R,SUP,HCPCS C1776,,504-02-72G-R  -  SHELL ACTB 72MM RSTR ANTM HIP RT,"$9,457.50",$0.00,"$9,457.50","$4,255.88","$5,158.80",$0.00,"$1,629.48",$0.00,$0.00,"$1,655.93","$9,457.50",$0.00,"$4,728.75","$7,490.34","$7,566.00",$0.00,"$1,480.10",$0.00,"$1,505.63",$0.00
504-02-74H-L,SUP,HCPCS C1776,,504-02-74H-L  -  SHELL ACTB 74MM RSTR ANTM HIP LT,"$9,457.50",$0.00,"$9,457.50","$4,255.88","$5,158.80",$0.00,"$1,629.48",$0.00,$0.00,"$1,655.93","$9,457.50",$0.00,"$4,728.75","$7,490.34","$7,566.00",$0.00,"$1,480.10",$0.00,"$1,505.63",$0.00
504-02-74H-R,SUP,HCPCS C1776,,504-02-74H-R  -  SHELL ACTB 74MM RSTR ANTM HIP RT,"$9,457.50",$0.00,"$9,457.50","$4,255.88","$5,158.80",$0.00,"$1,629.48",$0.00,$0.00,"$1,655.93","$9,457.50",$0.00,"$4,728.75","$7,490.34","$7,566.00",$0.00,"$1,480.10",$0.00,"$1,505.63",$0.00
504-02-76H-L,SUP,HCPCS C1776,,504-02-76H-L  -  SHELL ACTB 76MM RSTR ANTM HIP LT,"$9,457.50",$0.00,"$9,457.50","$4,255.88","$5,158.80",$0.00,"$1,629.48",$0.00,$0.00,"$1,655.93","$9,457.50",$0.00,"$4,728.75","$7,490.34","$7,566.00",$0.00,"$1,480.10",$0.00,"$1,505.63",$0.00
504-02-76H-R,SUP,HCPCS C1776,,504-02-76H-R  -  SHELL ACTB 76MM RSTR ANTM HIP RT,"$9,457.50",$0.00,"$9,457.50","$4,255.88","$5,158.80",$0.00,"$1,629.48",$0.00,$0.00,"$1,655.93","$9,457.50",$0.00,"$4,728.75","$7,490.34","$7,566.00",$0.00,"$1,480.10",$0.00,"$1,505.63",$0.00
504-02-78H-L,SUP,HCPCS C1776,,504-02-78H-L  -  SHELL ACTB 78MM RSTR ANTM HIP LT,"$9,457.50",$0.00,"$9,457.50","$4,255.88","$5,158.80",$0.00,"$1,629.48",$0.00,$0.00,"$1,655.93","$9,457.50",$0.00,"$4,728.75","$7,490.34","$7,566.00",$0.00,"$1,480.10",$0.00,"$1,505.63",$0.00
504-02-78H-R,SUP,HCPCS C1776,,504-02-78H-R  -  SHELL ACTB 78MM RSTR ANTM HIP RT,"$9,457.50",$0.00,"$9,457.50","$4,255.88","$5,158.80",$0.00,"$1,629.48",$0.00,$0.00,"$1,655.93","$9,457.50",$0.00,"$4,728.75","$7,490.34","$7,566.00",$0.00,"$1,480.10",$0.00,"$1,505.63",$0.00
504-02-80H-L,SUP,HCPCS C1776,,504-02-80H-L  -  SHELL ACTB 80MM RSTR ANTM HIP LT,"$9,457.50",$0.00,"$9,457.50","$4,255.88","$5,158.80",$0.00,"$1,629.48",$0.00,$0.00,"$1,655.93","$9,457.50",$0.00,"$4,728.75","$7,490.34","$7,566.00",$0.00,"$1,480.10",$0.00,"$1,505.63",$0.00
504-02-80H-R,SUP,HCPCS C1776,,504-02-80H-R  -  SHELL ACTB 80MM RSTR ANTM HIP RT,"$9,457.50",$0.00,"$9,457.50","$4,255.88","$5,158.80",$0.00,"$1,629.48",$0.00,$0.00,"$1,655.93","$9,457.50",$0.00,"$4,728.75","$7,490.34","$7,566.00",$0.00,"$1,480.10",$0.00,"$1,505.63",$0.00
50-405-07-09,SUP,HCPCS C1713,,50-405-07-09  -  PLATE BONE 100D L MINI .7MM 7 HOLE TITANIUM MANDIB 2MM SCREW,$362.60,$0.00,$362.60,$163.17,$258.79,$0.00,$62.47,$0.00,$0.00,$63.49,$362.60,$0.00,$181.30,$287.18,$290.08,$0.00,$56.75,$0.00,$57.73,$0.00
50-405-09-09,SUP,HCPCS C1713,,50-405-09-09  -  PLATE BONE 100D L MINI .7MM 9 HOLE INSERT FRAC TITANIUM,$362.60,$0.00,$362.60,$163.17,$258.79,$0.00,$62.47,$0.00,$0.00,$63.49,$362.60,$0.00,$181.30,$287.18,$290.08,$0.00,$56.75,$0.00,$57.73,$0.00
50-405-12-09,SUP,HCPCS C1713,,50-405-12-09  -  PLATE BN MN .7MM THREADLOCK TS 12 HL LOPRFL TI ORBT FLR 2MM,$401.43,$0.00,$401.43,$180.64,$286.50,$0.00,$69.16,$0.00,$0.00,$70.29,$401.43,$0.00,$200.71,$317.93,$321.14,$0.00,$62.82,$0.00,$63.91,$0.00
50-405-17-09,SUP,HCPCS C1713,,50-405-17-09  -  PLATE BN MN STRG 1MM NS THREADLOCK TS 20 HL LOPRFL CMPR TI,$569.80,$0.00,$569.80,$256.41,$406.67,$0.00,$98.17,$0.00,$0.00,$99.77,$569.80,$0.00,$284.90,$451.28,$455.84,$0.00,$89.17,$0.00,$90.71,$0.00
50-406-04-91,SUP,HCPCS C1713,,50-406-04-91  -  PLATE BONE Z MINI 6MM LP TITANIUM LEFT MANDIB 2MM SCREW,$362.60,$0.00,$362.60,$163.17,$258.79,$0.00,$62.47,$0.00,$0.00,$63.49,$362.60,$0.00,$181.30,$287.18,$290.08,$0.00,$56.75,$0.00,$57.73,$0.00
50-406-17-09,SUP,HCPCS C1713,,50-406-17-09  -  PLATE BONE STR 1MM 17 HOLE RIGID LIGHTWEIGHT LP BLUE,$530.95,$0.00,$530.95,$238.93,$378.94,$0.00,$91.48,$0.00,$0.00,$92.97,$530.95,$0.00,$265.48,$420.51,$424.76,$0.00,$83.09,$0.00,$84.53,$0.00
50-407-07-09,SUP,HCPCS C1713,,50-407-07-09  -  PLATE BN MN STRG L .7MM THREADLOCK TS 20 HL LOPRFL TI MXLFCL,$362.60,$0.00,$362.60,$163.17,$258.79,$0.00,$62.47,$0.00,$0.00,$63.49,$362.60,$0.00,$181.30,$287.18,$290.08,$0.00,$56.75,$0.00,$57.73,$0.00
50-407-09-09,SUP,HCPCS C1713,,50-407-09-09  -  PLATE BONE 100D L MINI 9 HOLE INSERT FRAC TITANIUM MANDIB 2,$362.60,$0.00,$362.60,$163.17,$258.79,$0.00,$62.47,$0.00,$0.00,$63.49,$362.60,$0.00,$181.30,$287.18,$290.08,$0.00,$56.75,$0.00,$57.73,$0.00
50-408-04-91,SUP,HCPCS C1713,,50-408-04-91  -  PLATE BONE Z LEFT ANGLE LONG .6MM LP FRAC TITANIUM MANDIB,$362.60,$0.00,$362.60,$163.17,$258.79,$0.00,$62.47,$0.00,$0.00,$63.49,$362.60,$0.00,$181.30,$287.18,$290.08,$0.00,$56.75,$0.00,$57.73,$0.00
50-409-04-91,SUP,HCPCS C1713,,50-409-04-91  -  PLATE BN 100D LNG MN Z .6MM THREADLOCK TS 4 HL LOPRFL TI,$362.60,$0.00,$362.60,$163.17,$258.79,$0.00,$62.47,$0.00,$0.00,$63.49,$362.60,$0.00,$181.30,$287.18,$290.08,$0.00,$56.75,$0.00,$57.73,$0.00
5045-5-150,SUP,Custom 27203010,,5045-5-150  -  PIN HALF 150MM 3MM APEX SMTH TRNFX EXFIX SYS,$213.13,$0.00,$213.13,$0.00,$152.11,$0.00,$0.00,$0.00,$0.00,$0.00,$213.13,$0.00,$106.56,$168.80,$170.50,$0.00,$0.00,$0.00,$0.00,$0.00
5045-5-200,SUP,Custom 27203010,,5045-5-200  -  PIN HLF 3MM 200MM NS APX TRNFX ST SLF DRL THRD SS,$207.63,$0.00,$207.63,$0.00,$148.18,$0.00,$0.00,$0.00,$0.00,$0.00,$207.63,$0.00,$103.81,$164.44,$166.10,$0.00,$0.00,$0.00,$0.00,$0.00
50-4561,SUP,Custom 27203010,,BLADE RTRCTR 6X2IN BKWLTR MLBL,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
50-4567,SUP,Custom 27203010,,BLADE RTRCTR 6X3IN BKWLTR MLBL,"$1,307.50",$0.00,"$1,307.50",$0.00,$933.16,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,307.50",$0.00,$653.75,"$1,035.54","$1,046.00",$0.00,$0.00,$0.00,$0.00,$0.00
504605A,SUP,HCPCS C1894,,504605A  -  INTRODUCER SHTH STD HEXACUSPID 5FR 11CM GRY AVNT+ ROT SUT,$19.88,$0.00,$19.88,$10.79,$14.18,$0.00,$3.42,$0.00,$0.00,$3.48,$19.88,$0.00,$9.94,$15.74,$15.90,$0.00,$3.11,$0.00,$3.16,$0.00
504606A,SUP,HCPCS C1894,,504606A  -  INTROD SHTH 6FR 11CM W/O MINI GWIRE NO OBT AVNT+ .038IN GRN,$99.38,$0.00,$99.38,$53.96,$70.92,$0.00,$17.12,$0.00,$0.00,$17.40,$99.38,$0.00,$49.69,$78.71,$79.50,$0.00,$15.55,$0.00,$15.82,$0.00
504606T,SUP,HCPCS C1894,,504606T  -  INTRODUCER SHTH MID LGTH 6FR 23CM GRN AVNT+ NO MN GW NO OBT,$54.88,$0.00,$54.88,$29.80,$39.16,$0.00,$9.45,$0.00,$0.00,$9.61,$54.88,$0.00,$27.44,$43.46,$43.90,$0.00,$8.59,$0.00,$8.74,$0.00
5047-1-030,SUP,Custom 27203010,,5047-1-030  -  CAP END ORTH 3MM DISP,$72.88,$0.00,$72.88,$0.00,$52.01,$0.00,$0.00,$0.00,$0.00,$0.00,$72.88,$0.00,$36.44,$57.72,$58.30,$0.00,$0.00,$0.00,$0.00,$0.00
5048-5-065,SUP,Custom 27203010,,5048-5-065  -  ROD EXFIX 65MM 5MM HFMN2 MRI CMPCT CARB CONNCTNG STRL,$166.38,$0.00,$166.38,$0.00,$118.74,$0.00,$0.00,$0.00,$0.00,$0.00,$166.38,$0.00,$83.19,$131.77,$133.10,$0.00,$0.00,$0.00,$0.00,$0.00
5048-5-100,SUP,Custom 27203010,,5048-5-100  -  ROD EXFIX YLW 100MM 5MM HFMN2 C CARB CONNCTNG MRI SAFE,$166.38,$0.00,$166.38,$0.00,$118.74,$0.00,$0.00,$0.00,$0.00,$0.00,$166.38,$0.00,$83.19,$131.77,$133.10,$0.00,$0.00,$0.00,$0.00,$0.00
5048-5-150,SUP,Custom 27203010,,5048-5-150  -  ROD EXFIX YLW 150MM 5MM HFMN2 C CARB CONNCTNG MRI SAFE,$166.38,$0.00,$166.38,$0.00,$118.74,$0.00,$0.00,$0.00,$0.00,$0.00,$166.38,$0.00,$83.19,$131.77,$133.10,$0.00,$0.00,$0.00,$0.00,$0.00
5048-5-200,SUP,Custom 27203010,,5048-5-200  -  ROD EXFIX YLW 200MM 5MM HFMN2 C CARB CONNCTNG MRI SAFE,$166.38,$0.00,$166.38,$0.00,$118.74,$0.00,$0.00,$0.00,$0.00,$0.00,$166.38,$0.00,$83.19,$131.77,$133.10,$0.00,$0.00,$0.00,$0.00,$0.00
5048-5-250,SUP,Custom 27203010,,5048-5-250  -  ROD EXFIX 250MM 5MM HFMN2 MRI CMPCT CONNCTNG MRI SAFE,$166.38,$0.00,$166.38,$0.00,$118.74,$0.00,$0.00,$0.00,$0.00,$0.00,$166.38,$0.00,$83.19,$131.77,$133.10,$0.00,$0.00,$0.00,$0.00,$0.00
5048-5-300,SUP,Custom 27203010,,5048-5-300  -  ROD EXFIX 100MM 8MM HFMN2 C MRI CONNCTNG,$200.75,$0.00,$200.75,$0.00,$143.28,$0.00,$0.00,$0.00,$0.00,$0.00,$200.75,$0.00,$100.38,$158.99,$160.60,$0.00,$0.00,$0.00,$0.00,$0.00
5049-5-505,SUP,Custom 27203010,,5049-5-505  -  ROD EXFIX 100MM 5MM HFMN2 C CARFBR CONNCTNG,$103.13,$0.00,$103.13,$0.00,$73.60,$0.00,$0.00,$0.00,$0.00,$0.00,$103.13,$0.00,$51.56,$81.68,$82.50,$0.00,$0.00,$0.00,$0.00,$0.00
5049-5-510,SUP,Custom 27203010,,5049-5-510  -  ROD EXFIX 150MM 5MM HFMN2 C CARFBR CONNCTNG,$103.13,$0.00,$103.13,$0.00,$73.60,$0.00,$0.00,$0.00,$0.00,$0.00,$103.13,$0.00,$51.56,$81.68,$82.50,$0.00,$0.00,$0.00,$0.00,$0.00
5049-5-515,SUP,Custom 27203010,,5049-5-515  -  ROD EXFIX 150MM 5MM HFMN2 C CARFBR CONNCTNG,$115.50,$0.00,$115.50,$0.00,$82.43,$0.00,$0.00,$0.00,$0.00,$0.00,$115.50,$0.00,$57.75,$91.48,$92.40,$0.00,$0.00,$0.00,$0.00,$0.00
5049-5-520,SUP,Custom 27203010,,5049-5-520  -  ROD EXFIX 200MM 5MM HFMN2 C CARFBR CONNCTNG,$115.50,$0.00,$115.50,$0.00,$82.43,$0.00,$0.00,$0.00,$0.00,$0.00,$115.50,$0.00,$57.75,$91.48,$92.40,$0.00,$0.00,$0.00,$0.00,$0.00
5049-5-525,SUP,Custom 27803010,,5049-5-525  -  CONCTR ROD 250MM 5MM CMPCT CARB,$115.50,$0.00,$115.50,$0.00,$82.43,$0.00,$0.00,$0.00,$0.00,$0.00,$115.50,$0.00,$57.75,$91.48,$92.40,$0.00,$0.00,$0.00,$0.00,$0.00
5049-5-530,SUP,Custom 27203010,,5049-5-530  -  ROD EXFIX 300MM 5MM HFMN2 C CARFBR CONNCTNG,$125.13,$0.00,$125.13,$0.00,$89.30,$0.00,$0.00,$0.00,$0.00,$0.00,$125.13,$0.00,$62.56,$99.10,$100.10,$0.00,$0.00,$0.00,$0.00,$0.00
5049-7-018,SUP,Custom 27203010,,5049-7-018  -  ROD EXFIX 111MM HFMN2 C CVD SEM CIR CARFBR,$191.13,$0.00,$191.13,$0.00,$136.41,$0.00,$0.00,$0.00,$0.00,$0.00,$191.13,$0.00,$95.56,$151.37,$152.90,$0.00,$0.00,$0.00,$0.00,$0.00
5049-7-020,SUP,Custom 27203010,,5049-7-020  -  ROD EXFIX 146MM HFMN2 C CVD SEM CIR CARFBR,$178.75,$0.00,$178.75,$0.00,$127.57,$0.00,$0.00,$0.00,$0.00,$0.00,$178.75,$0.00,$89.38,$141.57,$143.00,$0.00,$0.00,$0.00,$0.00,$0.00
50-501-31-07,SUP,HCPCS C1713,,50-501-31-07  -  GUIDE DRILL LONG 2.7MM RECONSTRUCTION THREADLOCK TS,$348.13,$0.00,$348.13,$156.66,$248.46,$0.00,$59.98,$0.00,$0.00,$60.95,$348.13,$0.00,$174.06,$275.72,$278.50,$0.00,$54.48,$0.00,$55.42,$0.00
50-504-23-07,SUP,HCPCS C1713,,50-504-23-07  -  CUTTER SURG 8.5MM BENDER STAINLESS STEEL 1.5/2/3MM THICK,"$2,478.55",$0.00,"$2,478.55","$1,115.35","$1,768.94",$0.00,$427.04,$0.00,$0.00,$433.97,"$2,478.55",$0.00,"$1,239.28","$1,963.01","$1,982.84",$0.00,$387.89,$0.00,$394.59,$0.00
50-504-24-07,SUP,HCPCS C1713,,50-504-24-07  -  CUTTER SURG 8.5MM BENDER STAINLESS STEEL 1.5/2/3MM THICK,"$2,562.08",$0.00,"$2,562.08","$1,152.93","$1,828.55",$0.00,$441.43,$0.00,$0.00,$448.60,"$2,562.08",$0.00,"$1,281.04","$2,029.17","$2,049.66",$0.00,$400.96,$0.00,$407.88,$0.00
5050-4-300,SUP,HCPCS C1713,,5050-4-300  -  PIN FIX 5/6MM 300MM 40MM SLFDRILL THREAD APEX TRANSFIX,$380.00,$0.00,$380.00,$171.00,$271.21,$0.00,$65.47,$0.00,$0.00,$66.53,$380.00,$0.00,$190.00,$300.96,$304.00,$0.00,$59.47,$0.00,$60.50,$0.00
5050-5-250,SUP,Custom 27203010,,5050-5-250  -  PIN HALF 250MM 5MM 4MM APEX SS TRNFX 50MM NONSTRL,$258.50,$0.00,$258.50,$0.00,$184.49,$0.00,$0.00,$0.00,$0.00,$0.00,$258.50,$0.00,$129.25,$204.73,$206.80,$0.00,$0.00,$0.00,$0.00,$0.00
5050-5-300,SUP,Custom 27203010,,5050-5-300  -  PIN EXFIX 300MM 5MM HFMN2 THRD TRNFX 50MM NONSTRL,$244.75,$0.00,$244.75,$0.00,$174.68,$0.00,$0.00,$0.00,$0.00,$0.00,$244.75,$0.00,$122.38,$193.84,$195.80,$0.00,$0.00,$0.00,$0.00,$0.00
50-519-15-07,SUP,Custom 27100030,,50-519-15-07  -  DRILL TWIST 1.9MM 115MM J NOTCH STEEL 2/2.3MM SCREW,$290.05,$0.00,$290.05,$0.00,$207.01,$0.00,$0.00,$0.00,$0.00,$0.00,$290.05,$0.00,$145.03,$229.72,$232.04,$0.00,$0.00,$0.00,$0.00,$0.00
5054-2-001,SUP,Custom 27203010,,5054-2-001  -  INSRTR SURG THDL PIN,$288.75,$0.00,$288.75,$0.00,$206.08,$0.00,$0.00,$0.00,$0.00,$0.00,$288.75,$0.00,$144.38,$228.69,$231.00,$0.00,$0.00,$0.00,$0.00,$0.00
5054-2-002,SUP,Custom 27203010,,5054-2-002  -  SET EXFIX 2 DRLBT W/O CHK REUSE,$804.38,$0.00,$804.38,$0.00,$574.08,$0.00,$0.00,$0.00,$0.00,$0.00,$804.38,$0.00,$402.19,$637.07,$643.50,$0.00,$0.00,$0.00,$0.00,$0.00
5054-3-080,SUP,Custom 27203010,,5054-3-080  -  SLEEVE XTRNFX 3MM 80MM HFMN2 2 TROC,$433.13,$0.00,$433.13,$0.00,$309.12,$0.00,$0.00,$0.00,$0.00,$0.00,$433.13,$0.00,$216.56,$343.04,$346.50,$0.00,$0.00,$0.00,$0.00,$0.00
5054-3-093,SUP,Custom 27203010,,5054-3-093  -  TROCAR 3MM 93MM 2 SLV ASMBLY SURG,$378.13,$0.00,$378.13,$0.00,$269.87,$0.00,$0.00,$0.00,$0.00,$0.00,$378.13,$0.00,$189.06,$299.48,$302.50,$0.00,$0.00,$0.00,$0.00,$0.00
5054-4-120,SUP,Custom 27203010,,5054-4-120  -  SLEEVE XTRNFX 4MM 120MM HFMN2 2 TROC,$426.25,$0.00,$426.25,$0.00,$304.21,$0.00,$0.00,$0.00,$0.00,$0.00,$426.25,$0.00,$213.13,$337.59,$341.00,$0.00,$0.00,$0.00,$0.00,$0.00
5054-4-150,SUP,Custom 27203010,,5054-4-150  -  SLEEVE XTRNFX 4MM 150MM HFMN2 2 TROC,$422.13,$0.00,$422.13,$0.00,$301.27,$0.00,$0.00,$0.00,$0.00,$0.00,$422.13,$0.00,$211.06,$334.33,$337.70,$0.00,$0.00,$0.00,$0.00,$0.00
5054-4-180,SUP,Custom 27203010,,5054-4-180  -  SLEEVE XTRNFX 4MM 180MM HFMN2 2 TROC,$171.88,$0.00,$171.88,$0.00,$122.67,$0.00,$0.00,$0.00,$0.00,$0.00,$171.88,$0.00,$85.94,$136.13,$137.50,$0.00,$0.00,$0.00,$0.00,$0.00
5054-6-120,SUP,Custom 27203010,,5054-6-120  -  SET EXFIX 6MM HFMN2 TROCAR DUAL SLV ASMBLY,$479.88,$0.00,$479.88,$0.00,$342.49,$0.00,$0.00,$0.00,$0.00,$0.00,$479.88,$0.00,$239.94,$380.06,$383.90,$0.00,$0.00,$0.00,$0.00,$0.00
5054-6-150,SUP,Custom 27203010,,5054-6-150  -  TROCAR 6MM 150MM 2 SLV ASMBLY SURG,$479.88,$0.00,$479.88,$0.00,$342.49,$0.00,$0.00,$0.00,$0.00,$0.00,$479.88,$0.00,$239.94,$380.06,$383.90,$0.00,$0.00,$0.00,$0.00,$0.00
5054-6-180,SUP,Custom 27203010,,5054-6-180  -  TROCAR 6MM 180MM 2 SLV ASMBLY SURG,$479.88,$0.00,$479.88,$0.00,$342.49,$0.00,$0.00,$0.00,$0.00,$0.00,$479.88,$0.00,$239.94,$380.06,$383.90,$0.00,$0.00,$0.00,$0.00,$0.00
5054-6-200,SUP,Custom 27203010,,5054-6-200  -  TROCAR 6MM 200MM 2 SLV ASMBLY SURG,$479.88,$0.00,$479.88,$0.00,$342.49,$0.00,$0.00,$0.00,$0.00,$0.00,$479.88,$0.00,$239.94,$380.06,$383.90,$0.00,$0.00,$0.00,$0.00,$0.00
5057-0-100,SUP,Custom 27203010,,5057-0-100  -  GUIDE DRILL APEX ASMBLY,$173.25,$0.00,$173.25,$0.00,$123.65,$0.00,$0.00,$0.00,$0.00,$0.00,$173.25,$0.00,$86.63,$137.21,$138.60,$0.00,$0.00,$0.00,$0.00,$0.00
5057-0-200,SUP,Custom 27203010,,5057-0-200  -  ASMBLY DRILL BRC APEX,$816.75,$0.00,$816.75,$0.00,$582.91,$0.00,$0.00,$0.00,$0.00,$0.00,$816.75,$0.00,$408.38,$646.87,$653.40,$0.00,$0.00,$0.00,$0.00,$0.00
5057-0-300,SUP,Custom 27203010,,5057-0-300  -  ASMBLY DRILL 3-6MM BRC APEX,$765.88,$0.00,$765.88,$0.00,$546.60,$0.00,$0.00,$0.00,$0.00,$0.00,$765.88,$0.00,$382.94,$606.58,$612.70,$0.00,$0.00,$0.00,$0.00,$0.00
5057-1-117,SUP,Custom 27203010,,5057-1-117  -  GUIDE DRILL HFMN2 4 HOLE BLOCK CMPCT,$495.00,$0.00,$495.00,$0.00,$353.28,$0.00,$0.00,$0.00,$0.00,$0.00,$495.00,$0.00,$247.50,$392.04,$396.00,$0.00,$0.00,$0.00,$0.00,$0.00
5057-1-118,SUP,Custom 27203010,,5057-1-118  -  GUIDE DRILL HFMN2 C PERIART 4 HOLE BLOCK CLMP,$495.00,$0.00,$495.00,$0.00,$353.28,$0.00,$0.00,$0.00,$0.00,$0.00,$495.00,$0.00,$247.50,$392.04,$396.00,$0.00,$0.00,$0.00,$0.00,$0.00
5057-1-119,SUP,Custom 27203010,,5057-1-119  -  GUIDE DRILL BLUE RED MNTB TRX APEX 4 HOLE BLOCK,$468.88,$0.00,$468.88,$0.00,$334.64,$0.00,$0.00,$0.00,$0.00,$0.00,$468.88,$0.00,$234.44,$371.35,$375.10,$0.00,$0.00,$0.00,$0.00,$0.00
5057-1-120,SUP,Custom 27203010,,5057-1-120  -  GUIDE DRILL YLW MNTB TRX APEX 2 HOLE BLOCK,$468.88,$0.00,$468.88,$0.00,$334.64,$0.00,$0.00,$0.00,$0.00,$0.00,$468.88,$0.00,$234.44,$371.35,$375.10,$0.00,$0.00,$0.00,$0.00,$0.00
5057-3-000,SUP,Custom 27203010,,5057-3-000  -  ASSEMBLY DRL XSH 3MM PREDRILLING,$218.63,$0.00,$218.63,$0.00,$156.03,$0.00,$0.00,$0.00,$0.00,$0.00,$218.63,$0.00,$109.31,$173.15,$174.90,$0.00,$0.00,$0.00,$0.00,$0.00
5057-3-100,SUP,Custom 27203010,,5057-3-100  -  SLEEVE DRILL 3MM APEX SHRT PREDRILL,$231.00,$0.00,$231.00,$0.00,$164.86,$0.00,$0.00,$0.00,$0.00,$0.00,$231.00,$0.00,$115.50,$182.95,$184.80,$0.00,$0.00,$0.00,$0.00,$0.00
5057-3-200,SUP,Custom 27203010,,5057-3-200  -  SLEEVE DRILL 3MM APEX LNG PREDRILL,$231.00,$0.00,$231.00,$0.00,$164.86,$0.00,$0.00,$0.00,$0.00,$0.00,$231.00,$0.00,$115.50,$182.95,$184.80,$0.00,$0.00,$0.00,$0.00,$0.00
5057-4-000,SUP,Custom 27203010,,5057-4-000  -  GUIDE DRILL 35MM 4MM APEX XSH HYDRXAPT PREDRILLING ASMBLY,$235.13,$0.00,$235.13,$0.00,$167.81,$0.00,$0.00,$0.00,$0.00,$0.00,$235.13,$0.00,$117.56,$186.22,$188.10,$0.00,$0.00,$0.00,$0.00,$0.00
5057-4-100,SUP,Custom 27203010,,5057-4-100  -  SLEEVE DRILL 4MM APEX SHRT PREDRILL,$231.00,$0.00,$231.00,$0.00,$164.86,$0.00,$0.00,$0.00,$0.00,$0.00,$231.00,$0.00,$115.50,$182.95,$184.80,$0.00,$0.00,$0.00,$0.00,$0.00
5057-4-200,SUP,Custom 27203010,,5057-4-200  -  GUIDE DRILL 100MM 4MM APEX LNG HA PREDRILLING ASMBLY PRTC,$231.00,$0.00,$231.00,$0.00,$164.86,$0.00,$0.00,$0.00,$0.00,$0.00,$231.00,$0.00,$115.50,$182.95,$184.80,$0.00,$0.00,$0.00,$0.00,$0.00
5057-5-000,SUP,Custom 27203010,,5057-5-000  -  ASMBLY DRILL XSH 50MM PREDRILLING PRTC LGTH 5MM,$250.25,$0.00,$250.25,$0.00,$178.60,$0.00,$0.00,$0.00,$0.00,$0.00,$250.25,$0.00,$125.13,$198.20,$200.20,$0.00,$0.00,$0.00,$0.00,$0.00
5057-5-100,SUP,Custom 27203010,,5057-5-100  -  GUIDE 5MM SHRT PREDRILL TROCAR ASMBLY APEX SURG,$250.25,$0.00,$250.25,$0.00,$178.60,$0.00,$0.00,$0.00,$0.00,$0.00,$250.25,$0.00,$125.13,$198.20,$200.20,$0.00,$0.00,$0.00,$0.00,$0.00
5057-5-200,SUP,Custom 27203010,,5057-5-200  -  ASMBLY DRILL LNG 5MM,$250.25,$0.00,$250.25,$0.00,$178.60,$0.00,$0.00,$0.00,$0.00,$0.00,$250.25,$0.00,$125.13,$198.20,$200.20,$0.00,$0.00,$0.00,$0.00,$0.00
5057-6-000,SUP,Custom 27203010,,5057-6-000  -  ASMBLY DRILL XSH 60MM PREDRILLING PRTC LGTH 6MM,$266.75,$0.00,$266.75,$0.00,$190.38,$0.00,$0.00,$0.00,$0.00,$0.00,$266.75,$0.00,$133.38,$211.27,$213.40,$0.00,$0.00,$0.00,$0.00,$0.00
5057-6-100,SUP,Custom 27203010,,5057-6-100  -  ASMBLY DRILL 6MM SHRT PREDRILLING,$266.75,$0.00,$266.75,$0.00,$190.38,$0.00,$0.00,$0.00,$0.00,$0.00,$266.75,$0.00,$133.38,$211.27,$213.40,$0.00,$0.00,$0.00,$0.00,$0.00
5057-6-200,SUP,Custom 27203010,,5057-6-200  -  GUIDE DRILL 120MM 6MM APEX LNG HA PREDRILLING ASMBLY,$266.75,$0.00,$266.75,$0.00,$190.38,$0.00,$0.00,$0.00,$0.00,$0.00,$266.75,$0.00,$133.38,$211.27,$213.40,$0.00,$0.00,$0.00,$0.00,$0.00
5057-6-300,SUP,Custom 27203010,,5057-6-300  -  CUTTER PIN APEX 4-6MM EXTN HNDL,"$3,898.13",$0.00,"$3,898.13",$0.00,"$2,782.09",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,898.13",$0.00,"$1,949.06","$3,087.32","$3,118.50",$0.00,$0.00,$0.00,$0.00,$0.00
5057-9-900,SUP,Custom 27203010,,5057-9-900  -  TRAY STRL PIN AND INSTRUMENTATION STOR APEX,"$3,267.00",$0.00,"$3,267.00",$0.00,"$2,331.66",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,267.00",$0.00,"$1,633.50","$2,587.46","$2,613.60",$0.00,$0.00,$0.00,$0.00,$0.00
50638-311,SUP,Custom 27203010,,50638-311  -  BRACE PSTN GTT STOP ECON SPAN+AIDS 300 SER ANKL FT LATEX,$37.97,$0.00,$37.97,$0.00,$27.10,$0.00,$0.00,$0.00,$0.00,$0.00,$37.97,$0.00,$18.99,$30.07,$30.38,$0.00,$0.00,$0.00,$0.00,$0.00
5065-3-312,SUP,Custom 27203010,,5065-3-312  -  PIN HALF 12MM 2MM APEX SM BONE SS BLNT SLFTAP CONTIN THRD,$93.50,$0.00,$93.50,$0.00,$66.73,$0.00,$0.00,$0.00,$0.00,$0.00,$93.50,$0.00,$46.75,$74.05,$74.80,$0.00,$0.00,$0.00,$0.00,$0.00
5065-3-615,SUP,Custom 27203010,,5065-3-615  -  PIN HALF 36MM 2MM APEX SS BLNT SLFTAP CONTIN THRD 15MM,$93.50,$0.00,$93.50,$0.00,$66.73,$0.00,$0.00,$0.00,$0.00,$0.00,$93.50,$0.00,$46.75,$74.05,$74.80,$0.00,$0.00,$0.00,$0.00,$0.00
5065-3-918,SUP,Custom 27203010,,5065-3-918  -  PIN HALF 39MM 2MM APEX SS BLNT SLFTAP CONTIN THRD 18MM,$93.50,$0.00,$93.50,$0.00,$66.73,$0.00,$0.00,$0.00,$0.00,$0.00,$93.50,$0.00,$46.75,$74.05,$74.80,$0.00,$0.00,$0.00,$0.00,$0.00
5065-4-520,SUP,Custom 27203010,,5065-4-520  -  PIN HALF 45MM 2MM APEX MINI SS BLNT SLFTAP CONTIN THRD 20MM,$93.50,$0.00,$93.50,$0.00,$66.73,$0.00,$0.00,$0.00,$0.00,$0.00,$93.50,$0.00,$46.75,$74.05,$74.80,$0.00,$0.00,$0.00,$0.00,$0.00
5065-5-020,SUP,Custom 27203010,,5065-5-020  -  PIN HALF 50MM 2MM APEX SS BLNT SLFTAP CONTIN THRD 20MM,$93.50,$0.00,$93.50,$0.00,$66.73,$0.00,$0.00,$0.00,$0.00,$0.00,$93.50,$0.00,$46.75,$74.05,$74.80,$0.00,$0.00,$0.00,$0.00,$0.00
5065-6-020,SUP,Custom 27203010,,5065-6-020  -  PIN HALF 60MM 2MM APEX SS BLNT SLFTAP CONTIN THRD 20MM,$93.50,$0.00,$93.50,$0.00,$66.73,$0.00,$0.00,$0.00,$0.00,$0.00,$93.50,$0.00,$46.75,$74.05,$74.80,$0.00,$0.00,$0.00,$0.00,$0.00
5065-9-015,SUP,Custom 27203010,,5065-9-015  -  PIN HALF 90MM 2MM APEX SS BLNT SLFTAP CONTIN THRD 15MM,$93.50,$0.00,$93.50,$0.00,$66.73,$0.00,$0.00,$0.00,$0.00,$0.00,$93.50,$0.00,$46.75,$74.05,$74.80,$0.00,$0.00,$0.00,$0.00,$0.00
50-7000B,SUP,HCPCS A7042,,50-7000B  -  KIT DRAIN 15.5FR PLEURAL CATHETER CHLORAPREP APPLICATOR,"$2,412.71",$0.00,"$2,412.71",$0.00,"$1,721.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,412.71",$0.00,"$1,206.35","$1,910.87","$1,930.16",$0.00,$0.00,$0.00,$0.00,$0.00
5070-3-310,SUP,Custom 27203010,,5070-3-310  -  PIN EXFIX 33MM 2MM TRNFX SS SMTH 10MM,$137.50,$0.00,$137.50,$0.00,$98.13,$0.00,$0.00,$0.00,$0.00,$0.00,$137.50,$0.00,$68.75,$108.90,$110.00,$0.00,$0.00,$0.00,$0.00,$0.00
5070-3-810,SUP,Custom 27203010,,5070-3-810  -  PIN XTRNFX 2MM 38MM 10MM TRNFX SMTH SS,$130.63,$0.00,$130.63,$0.00,$93.23,$0.00,$0.00,$0.00,$0.00,$0.00,$130.63,$0.00,$65.31,$103.46,$104.50,$0.00,$0.00,$0.00,$0.00,$0.00
5070-4-312,SUP,Custom 27203010,,5070-4-312  -  PIN EXFIX 43MM 2MM TRNFX SS SMTH 13MM,$130.63,$0.00,$130.63,$0.00,$93.23,$0.00,$0.00,$0.00,$0.00,$0.00,$130.63,$0.00,$65.31,$103.46,$104.50,$0.00,$0.00,$0.00,$0.00,$0.00
5070-4-812,SUP,Custom 27203010,,5070-4-812  -  PIN EXFIX 48MM 2MM TRNFX SS SMTH 13MM,$130.63,$0.00,$130.63,$0.00,$93.23,$0.00,$0.00,$0.00,$0.00,$0.00,$130.63,$0.00,$65.31,$103.46,$104.50,$0.00,$0.00,$0.00,$0.00,$0.00
5070-5-312,SUP,Custom 27203010,,5070-5-312  -  PIN EXFIX 53MM 2MM TRNFX SS SMTH 13MM,$130.63,$0.00,$130.63,$0.00,$93.23,$0.00,$0.00,$0.00,$0.00,$0.00,$130.63,$0.00,$65.31,$103.46,$104.50,$0.00,$0.00,$0.00,$0.00,$0.00
5070-5-815,SUP,Custom 27203010,,5070-5-815  -  PIN EXFIX 58MM 2MM TRNFX SS SMTH 16MM,$130.63,$0.00,$130.63,$0.00,$93.23,$0.00,$0.00,$0.00,$0.00,$0.00,$130.63,$0.00,$65.31,$103.46,$104.50,$0.00,$0.00,$0.00,$0.00,$0.00
5070-6-315,SUP,Custom 27203010,,5070-6-315  -  PIN EXFIX 63MM 2MM TRNFX SS SMTH 16MM,$137.50,$0.00,$137.50,$0.00,$98.13,$0.00,$0.00,$0.00,$0.00,$0.00,$137.50,$0.00,$68.75,$108.90,$110.00,$0.00,$0.00,$0.00,$0.00,$0.00
5070-7-820,SUP,Custom 27203010,,5070-7-820  -  PIN EXFIX 78MM 2MM TRNFX SS SMTH 20MM,$137.50,$0.00,$137.50,$0.00,$98.13,$0.00,$0.00,$0.00,$0.00,$0.00,$137.50,$0.00,$68.75,$108.90,$110.00,$0.00,$0.00,$0.00,$0.00,$0.00
50-712-04-09,SUP,HCPCS C1713,,50-712-04-09  -  PLATE BONE 28MM 4 HOLE LOCKING FRAC TITANIUM MANDIB STERILE,$932.93,$0.00,$932.93,$419.82,$665.83,$0.00,$160.74,$0.00,$0.00,$163.35,$932.93,$0.00,$466.46,$738.88,$746.34,$0.00,$146.00,$0.00,$148.52,$0.00
5071-35,SUP,HCPCS C1898,,5071-35  -  LEAD PCNG 6.6FR 35CM IS-1 UNPLR FX SCR SIL MYOCARDIUM,"$1,012.50",$0.00,"$1,012.50",$455.63,$722.62,$0.00,$174.45,$0.00,$0.00,$177.28,"$1,012.50",$0.00,$506.25,$801.90,$810.00,$0.00,$158.46,$0.00,$161.19,$0.00
50-714-04-09,SUP,HCPCS C1713,,50-714-04-09  -  PLATE BONE 33MM 4 HOLE FRAC TITANIUM MANDIB STERILE,$974.73,$0.00,$974.73,$438.63,$695.66,$0.00,$167.94,$0.00,$0.00,$170.67,$974.73,$0.00,$487.36,$771.99,$779.78,$0.00,$152.54,$0.00,$155.18,$0.00
50-716-06-09,SUP,HCPCS C1713,,50-716-06-09  -  PLATE BONE 16MMX1.5IN 6 HOLE FRAC TITANIUM MANDIB,"$1,127.88",$0.00,"$1,127.88",$507.54,$804.96,$0.00,$194.33,$0.00,$0.00,$197.48,"$1,127.88",$0.00,$563.94,$893.28,$902.30,$0.00,$176.51,$0.00,$179.56,$0.00
50-722-12-09,SUP,HCPCS C1713,,50-722-12-09  -  PLATE BONE 1.5IN 2X6 HOLE LOCKING FRAC TITANIUM MANDIB,"$1,072.18",$0.00,"$1,072.18",$482.48,$765.21,$0.00,$184.73,$0.00,$0.00,$187.73,"$1,072.18",$0.00,$536.09,$849.17,$857.74,$0.00,$167.80,$0.00,$170.69,$0.00
50-723-12-09,SUP,HCPCS C1713,,50-723-12-09  -  PLATE BONE MINI CVD 1MM 12 HOLE LOCKING THREADLOCK TITANIUM,"$1,100.03",$0.00,"$1,100.03",$495.01,$785.09,$0.00,$189.53,$0.00,$0.00,$192.61,"$1,100.03",$0.00,$550.01,$871.22,$880.02,$0.00,$172.15,$0.00,$175.12,$0.00
50-730-04-09,SUP,HCPCS C1713,,50-730-04-09  -  PLATE BONE CVD SHORT 1.5MM LOCKING FRAC TITANIUM MANDIB,"$1,281.03",$0.00,"$1,281.03",$576.46,$914.27,$0.00,$220.71,$0.00,$0.00,$224.30,"$1,281.03",$0.00,$640.51,"$1,014.58","$1,024.82",$0.00,$200.48,$0.00,$203.94,$0.00
50-730-06-09,SUP,HCPCS C1713,,50-730-06-09  -  PLATE BONE CVD MEDIUM 1MM 6 HOLE LOCKING FRAC TITANIUM,$877.23,$0.00,$877.23,$394.75,$626.08,$0.00,$151.14,$0.00,$0.00,$153.60,$877.23,$0.00,$438.61,$694.77,$701.78,$0.00,$137.29,$0.00,$139.65,$0.00
50-731-06-09,SUP,HCPCS C1713,,50-731-06-09  -  PLATE BN CRV LNG 1MM THREADLOCK TS 6 HL LCK TI MNDB 2MM SCR,$877.23,$0.00,$877.23,$394.75,$626.08,$0.00,$151.14,$0.00,$0.00,$153.60,$877.23,$0.00,$438.61,$694.77,$701.78,$0.00,$137.29,$0.00,$139.65,$0.00
50-732-04-09,SUP,HCPCS C1713,,50-732-04-09  -  PLATE BONE CVD LONG 1.5MM 6 HOLE LOCKING FRAC TITANIUM,"$1,281.03",$0.00,"$1,281.03",$576.46,$914.27,$0.00,$220.71,$0.00,$0.00,$224.30,"$1,281.03",$0.00,$640.51,"$1,014.58","$1,024.82",$0.00,$200.48,$0.00,$203.94,$0.00
50-732-06-09,SUP,HCPCS C1713,,50-732-06-09  -  PLATE BONE CVD XLONG 1MM 6 HOLE LOCKING FRAC TITANIUM MANDIB,$877.23,$0.00,$877.23,$394.75,$626.08,$0.00,$151.14,$0.00,$0.00,$153.60,$877.23,$0.00,$438.61,$694.77,$701.78,$0.00,$137.29,$0.00,$139.65,$0.00
50-746-22-09,SUP,HCPCS C1713,,50-746-22-09  -  PLATE SM 2.8MM SMRT BONE RIGHT,"$7,531.88",$0.00,"$7,531.88","$3,389.34","$5,158.80",$0.00,"$1,297.70",$0.00,$0.00,"$1,318.77","$7,531.88",$0.00,"$3,765.94","$5,965.25","$6,025.50",$0.00,"$1,178.74",$0.00,"$1,199.07",$0.00
50-747-22-09,SUP,HCPCS C1713,,50-747-22-09  -  PLATE BN SM 2.8MM SMRT LT,"$7,531.88",$0.00,"$7,531.88","$3,389.34","$5,158.80",$0.00,"$1,297.70",$0.00,$0.00,"$1,318.77","$7,531.88",$0.00,"$3,765.94","$5,965.25","$6,025.50",$0.00,"$1,178.74",$0.00,"$1,199.07",$0.00
50-750-06-09,SUP,HCPCS C1713,,50-750-06-09  -  PLATE BONE ANGLED 1.5MM 3X3 HOLE LOCKING FRAC TITANIUM,"$1,782.30",$0.00,"$1,782.30",$802.04,"$1,272.03",$0.00,$307.08,$0.00,$0.00,$312.07,"$1,782.30",$0.00,$891.15,"$1,411.58","$1,425.84",$0.00,$278.93,$0.00,$283.74,$0.00
50-750-08-09,SUP,HCPCS C1713,,50-750-08-09  -  PLATE BONE ANGLED 1.5MM 4X4 HOLE LOCKING FRAC TITANIUM,"$1,810.18",$0.00,"$1,810.18",$814.58,"$1,291.92",$0.00,$311.88,$0.00,$0.00,$316.95,"$1,810.18",$0.00,$905.09,"$1,433.66","$1,448.14",$0.00,$283.29,$0.00,$288.18,$0.00
50-7505,SUP,Custom 27203010,,50-7505  -  DILATOR LARYNGEAL METAL 20F,$346.25,$0.00,$346.25,$0.00,$247.12,$0.00,$0.00,$0.00,$0.00,$0.00,$346.25,$0.00,$173.13,$274.23,$277.00,$0.00,$0.00,$0.00,$0.00,$0.00
50-7507,SUP,Custom 27203010,,50-7507  -  DILATOR LARYNGEAL METAL 24F,$332.60,$0.00,$332.60,$0.00,$237.38,$0.00,$0.00,$0.00,$0.00,$0.00,$332.60,$0.00,$166.30,$263.42,$266.08,$0.00,$0.00,$0.00,$0.00,$0.00
50-7509,SUP,Custom 27203010,,50-7509  -  DILATOR LARYNGEAL METAL 28F,$374.90,$0.00,$374.90,$0.00,$267.57,$0.00,$0.00,$0.00,$0.00,$0.00,$374.90,$0.00,$187.45,$296.92,$299.92,$0.00,$0.00,$0.00,$0.00,$0.00
50-7511,SUP,Custom 27203010,,50-7511  -  DILATOR LARYNGEAL METAL 32F,$355.73,$0.00,$355.73,$0.00,$253.88,$0.00,$0.00,$0.00,$0.00,$0.00,$355.73,$0.00,$177.86,$281.74,$284.58,$0.00,$0.00,$0.00,$0.00,$0.00
50-7513,SUP,Custom 27203010,,50-7513  -  DILATOR LARYNGEAL METAL 36F,$350.88,$0.00,$350.88,$0.00,$250.42,$0.00,$0.00,$0.00,$0.00,$0.00,$350.88,$0.00,$175.44,$277.90,$280.70,$0.00,$0.00,$0.00,$0.00,$0.00
50-7515,SUP,Custom 27203010,,50-7515  -  DILATOR LARYNGEAL METAL 40F,$337.20,$0.00,$337.20,$0.00,$240.66,$0.00,$0.00,$0.00,$0.00,$0.00,$337.20,$0.00,$168.60,$267.06,$269.76,$0.00,$0.00,$0.00,$0.00,$0.00
50-7517,SUP,Custom 27203010,,50-7517  -  DILATOR LARYNGEAL METAL 44F,$336.10,$0.00,$336.10,$0.00,$239.87,$0.00,$0.00,$0.00,$0.00,$0.00,$336.10,$0.00,$168.05,$266.19,$268.88,$0.00,$0.00,$0.00,$0.00,$0.00
50-754-05-09,SUP,HCPCS C1713,,50-754-05-09  -  PLATE BN MN LNG 110MM THREADLOCK TS LVL 1 4 HL LCK BAR TI,$854.95,$0.00,$854.95,$384.73,$610.18,$0.00,$147.30,$0.00,$0.00,$149.69,$854.95,$0.00,$427.48,$677.12,$683.96,$0.00,$133.80,$0.00,$136.11,$0.00
50-760-12-09,SUP,HCPCS C1713,,50-760-12-09  -  PLATE BONE STR 2.5MM LOCK 12 HOLE TITANIUM,"$2,796.00",$0.00,"$2,796.00","$1,258.20","$1,995.51",$0.00,$481.74,$0.00,$0.00,$489.56,"$2,796.00",$0.00,"$1,398.00","$2,214.43","$2,236.80",$0.00,$437.57,$0.00,$445.12,$0.00
50-760-20-09,SUP,HCPCS C1713,,50-760-20-09  -  PLATE BN STRG 2.5MM 20 HL LCK TI,"$4,074.25",$0.00,"$4,074.25","$1,833.41","$2,907.79",$0.00,$701.97,$0.00,$0.00,$713.37,"$4,074.25",$0.00,"$2,037.13","$3,226.81","$3,259.40",$0.00,$637.62,$0.00,$648.62,$0.00
50-764-04-09,SUP,HCPCS C1713,,50-764-04-09  -  LOCKING FRACTURE PLATE  4 HOLE  33MM  NON-COMPRESSION  2.0MM,"$1,241.75",$0.00,"$1,241.75",$558.79,$886.24,$0.00,$213.95,$0.00,$0.00,$217.42,"$1,241.75",$0.00,$620.88,$983.47,$993.40,$0.00,$194.33,$0.00,$197.69,$0.00
5076-52,SUP,HCPCS C1898,,5076-52  -  LEAD PACING 10MM SPACE SMALL STR 6.2FR 2MM 52CM 20-110CM,"$1,012.50",$0.00,"$1,012.50",$455.63,$722.62,$0.00,$174.45,$0.00,$0.00,$177.28,"$1,012.50",$0.00,$506.25,$801.90,$810.00,$0.00,$158.46,$0.00,$161.19,$0.00
5076-58,SUP,HCPCS C1898,,5076-58  -  LEAD PACING 10MM SPACE SMALL STR 6.2FR 2MM 58CM 20-110CM,"$1,012.50",$0.00,"$1,012.50",$455.63,$722.62,$0.00,$174.45,$0.00,$0.00,$177.28,"$1,012.50",$0.00,$506.25,$801.90,$810.00,$0.00,$158.46,$0.00,$161.19,$0.00
50-766-06-09,SUP,HCPCS C1713,,50-766-06-09  -  PLATE BN 43MMX2MM NS LVL 1 6 HL LCK TI CRNMXF 2MM SCR,"$1,241.75",$0.00,"$1,241.75",$558.79,$886.24,$0.00,$213.95,$0.00,$0.00,$217.42,"$1,241.75",$0.00,$620.88,$983.47,$993.40,$0.00,$194.33,$0.00,$197.69,$0.00
50-771-26-09,SUP,HCPCS C1713,,50-771-26-09  -  PLATE BONE PREBENT ANGLED 2MM 26 HOLE RECONSTRUCTION LOCKING,"$3,550.70",$0.00,"$3,550.70","$1,597.82","$2,534.13",$0.00,$611.77,$0.00,$0.00,$621.70,"$3,550.70",$0.00,"$1,775.35","$2,812.15","$2,840.56",$0.00,$555.68,$0.00,$565.27,$0.00
50-773-26-09,SUP,HCPCS C1713,,50-773-26-09  -  PLATE BONE PREBENT ANGLED 2MM 26 HOLE RECONSTRUCTION LOCKING,"$3,550.70",$0.00,"$3,550.70","$1,597.82","$2,534.13",$0.00,$611.77,$0.00,$0.00,$621.70,"$3,550.70",$0.00,"$1,775.35","$2,812.15","$2,840.56",$0.00,$555.68,$0.00,$565.27,$0.00
50-774-20-09,SUP,HCPCS C1713,,50-774-20-09  -  PLATE BN STRG 2MM THREADLOCK TS 20 HL RECON BRDG LCK TI MNDB,"$2,186.13",$0.00,"$2,186.13",$983.76,"$1,560.24",$0.00,$376.66,$0.00,$0.00,$382.77,"$2,186.13",$0.00,"$1,093.06","$1,731.41","$1,748.90",$0.00,$342.13,$0.00,$348.03,$0.00
50-775-26-09,SUP,HCPCS C1713,,50-775-26-09  -  PLATE BONE 2MM 26 HOLE PRIM RECONSTRUCTION THREADLOCK GREEN,"$3,481.10",$0.00,"$3,481.10","$1,566.50","$2,484.46",$0.00,$599.78,$0.00,$0.00,$609.51,"$3,481.10",$0.00,"$1,740.55","$2,757.03","$2,784.88",$0.00,$544.79,$0.00,$554.19,$0.00
50-777-26-09,SUP,HCPCS C1713,,50-777-26-09  -  PLATE BONE LEFT ANGLE 2MM 26 HOLE LOCKING RECONSTRUCTION,"$3,481.10",$0.00,"$3,481.10","$1,566.50","$2,484.46",$0.00,$599.78,$0.00,$0.00,$609.51,"$3,481.10",$0.00,"$1,740.55","$2,757.03","$2,784.88",$0.00,$544.79,$0.00,$554.19,$0.00
50-781-76-09,SUP,HCPCS C1713,,50-781-76-09  -  TEMPLATE SIZING PREBENT 26 HOLE RECONSTRUCTION LOCKING,$139.25,$0.00,$139.25,$62.66,$99.38,$0.00,$23.99,$0.00,$0.00,$24.38,$139.25,$0.00,$69.63,$110.29,$111.40,$0.00,$21.79,$0.00,$22.17,$0.00
50-784-70-09,SUP,HCPCS C1713,,50-784-70-09  -  TEMPLATE BNDRG 20MMX2.3MM LCK PLT,$139.25,$0.00,$139.25,$62.66,$99.38,$0.00,$23.99,$0.00,$0.00,$24.38,$139.25,$0.00,$69.63,$110.29,$111.40,$0.00,$21.79,$0.00,$22.17,$0.00
50-785-76-09,SUP,HCPCS C1713,,50-785-76-09  -  TEMPLATE BENDING 26 HOLE PRIM PLATE RECONSTRUCTION TITANIUM,$139.25,$0.00,$139.25,$62.66,$99.38,$0.00,$23.99,$0.00,$0.00,$24.38,$139.25,$0.00,$69.63,$110.29,$111.40,$0.00,$21.79,$0.00,$22.17,$0.00
50-790-06-09,SUP,HCPCS C1713,,50-790-06-09  -  PLATE BN 155D 3MM GRN NS THREADLOCK TS 6 HL RECON CX TI MNDB,"$2,339.28",$0.00,"$2,339.28","$1,052.67","$1,669.54",$0.00,$403.05,$0.00,$0.00,$409.59,"$2,339.28",$0.00,"$1,169.64","$1,852.71","$1,871.42",$0.00,$366.10,$0.00,$372.41,$0.00
5079-1-010,SUP,Custom 27203010,,5079-1-010  -  CLAMP EXFIX HFMN2 MINI SS SWVL,"$1,285.63",$0.00,"$1,285.63",$0.00,$917.55,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,285.63",$0.00,$642.81,"$1,018.22","$1,028.50",$0.00,$0.00,$0.00,$0.00,$0.00
5079-1-020,SUP,Custom 27203010,,5079-1-020  -  CLAMP EXFIX HFMN MINI SMPL HM20,$948.75,$0.00,$948.75,$0.00,$677.12,$0.00,$0.00,$0.00,$0.00,$0.00,$948.75,$0.00,$474.38,$751.41,$759.00,$0.00,$0.00,$0.00,$0.00,$0.00
50-791-26-09,SUP,HCPCS C1713,,50-791-26-09  -  PLATE BONE RIGHT ANG 3MM 26 HOLE RECONSTRUCTION TITANIUM,"$4,177.30",$0.00,"$4,177.30","$1,879.79","$2,981.34",$0.00,$719.73,$0.00,$0.00,$731.41,"$4,177.30",$0.00,"$2,088.65","$3,308.42","$3,341.84",$0.00,$653.75,$0.00,$665.03,$0.00
50-791-76-09,SUP,HCPCS C1713,,50-791-76-09  -  TEMPLATE BENDING PREBENT 26 HOLE THREADLOCK TITANIUM MANDIB,$139.25,$0.00,$139.25,$62.66,$99.38,$0.00,$23.99,$0.00,$0.00,$24.38,$139.25,$0.00,$69.63,$110.29,$111.40,$0.00,$21.79,$0.00,$22.17,$0.00
5079-2-031,SUP,Custom 27203010,,5079-2-031  -  FXTR EXFIX HFMN 31MM MINI HIP INSL VISE SMTH,$254.38,$0.00,$254.38,$0.00,$181.55,$0.00,$0.00,$0.00,$0.00,$0.00,$254.38,$0.00,$127.19,$201.47,$203.50,$0.00,$0.00,$0.00,$0.00,$0.00
5079-2-032,SUP,Custom 27203010,,5079-2-032  -  PIN XTRNFX 32MM MN HFMN INSL,$176.00,$0.00,$176.00,$0.00,$125.61,$0.00,$0.00,$0.00,$0.00,$0.00,$176.00,$0.00,$88.00,$139.39,$140.80,$0.00,$0.00,$0.00,$0.00,$0.00
5079-2-034,SUP,Custom 27203010,,5079-2-034  -  FIXATOR XTRNFX MN HFMN2 INSL,$178.75,$0.00,$178.75,$0.00,$127.57,$0.00,$0.00,$0.00,$0.00,$0.00,$178.75,$0.00,$89.38,$141.57,$143.00,$0.00,$0.00,$0.00,$0.00,$0.00
5079-2-035,SUP,Custom 27203010,,5079-2-035  -  VISE XTRNFX 35MM HFMN2 ROD 3 HL MDLR HM,$378.13,$0.00,$378.13,$0.00,$269.87,$0.00,$0.00,$0.00,$0.00,$0.00,$378.13,$0.00,$189.06,$299.48,$302.50,$0.00,$0.00,$0.00,$0.00,$0.00
5079-2-036,SUP,Custom 27203010,,5079-2-036  -  DEVICE EXFIX HFMN2 MINI 3 HOLE VISE 2 ROD,$378.13,$0.00,$378.13,$0.00,$269.87,$0.00,$0.00,$0.00,$0.00,$0.00,$378.13,$0.00,$189.06,$299.48,$302.50,$0.00,$0.00,$0.00,$0.00,$0.00
50-792-06-09,SUP,HCPCS C1713,,50-792-06-09  -  PLATE BONE 120D 3MM 6 HOLE RECONSTRUCTION THREADLOCK GREEN,"$2,339.28",$0.00,"$2,339.28","$1,052.67","$1,669.54",$0.00,$403.05,$0.00,$0.00,$409.59,"$2,339.28",$0.00,"$1,169.64","$1,852.71","$1,871.42",$0.00,$366.10,$0.00,$372.41,$0.00
50-792-08-09,SUP,HCPCS C1713,,50-792-08-09  -  PLATE BONE 120D 3MM 8 HOLE RECONSTRUCTION THREADLOCK GREEN,"$2,422.85",$0.00,"$2,422.85","$1,090.28","$1,729.19",$0.00,$417.44,$0.00,$0.00,$424.22,"$2,422.85",$0.00,"$1,211.43","$1,918.90","$1,938.28",$0.00,$379.18,$0.00,$385.72,$0.00
5079-2-113,SUP,Custom 27203010,,5079-2-113  -  CPLNG EXFIX 3X3MM HFMN 13MM LCK,$756.25,$0.00,$756.25,$0.00,$539.74,$0.00,$0.00,$0.00,$0.00,$0.00,$756.25,$0.00,$378.13,$598.95,$605.00,$0.00,$0.00,$0.00,$0.00,$0.00
5079-2-123,SUP,Custom 27203010,,5079-2-123  -  COUPLING XTRNFX 2MM MN 3MM HFMN ARTC CPL,$797.50,$0.00,$797.50,$0.00,$569.18,$0.00,$0.00,$0.00,$0.00,$0.00,$797.50,$0.00,$398.75,$631.62,$638.00,$0.00,$0.00,$0.00,$0.00,$0.00
5079-3-040,SUP,Custom 27203010,,5079-3-040  -  HOLDER IMPL HFMN2 PIN STR HM40 STRL,$261.25,$0.00,$261.25,$0.00,$186.45,$0.00,$0.00,$0.00,$0.00,$0.00,$261.25,$0.00,$130.63,$206.91,$209.00,$0.00,$0.00,$0.00,$0.00,$0.00
5079-3-041,SUP,Custom 27203010,,5079-3-041  -  HOLDER IMPL HFMN MINI OFFST HM41,$336.88,$0.00,$336.88,$0.00,$240.43,$0.00,$0.00,$0.00,$0.00,$0.00,$336.88,$0.00,$168.44,$266.81,$269.50,$0.00,$0.00,$0.00,$0.00,$0.00
5079-3-042,SUP,Custom 27203010,,5079-3-042  -  HOLDER IMPL HFMN2 MINI PIN OFFST STR,$336.88,$0.00,$336.88,$0.00,$240.43,$0.00,$0.00,$0.00,$0.00,$0.00,$336.88,$0.00,$168.44,$266.81,$269.50,$0.00,$0.00,$0.00,$0.00,$0.00
50-793-26-09,SUP,HCPCS C1713,,50-793-26-09  -  PLATE BONE PREBENT ANGLED 3MM 26 HOLE RECONSTRUCTION LOCKING,"$4,177.30",$0.00,"$4,177.30","$1,879.79","$2,981.34",$0.00,$719.73,$0.00,$0.00,$731.41,"$4,177.30",$0.00,"$2,088.65","$3,308.42","$3,341.84",$0.00,$653.75,$0.00,$665.03,$0.00
5079-3-413,SUP,Custom 27203010,,5079-3-413  -  BURR SURG 3MM HFMN MINI SHNK OFST HLD STRL,$336.88,$0.00,$336.88,$0.00,$240.43,$0.00,$0.00,$0.00,$0.00,$0.00,$336.88,$0.00,$168.44,$266.81,$269.50,$0.00,$0.00,$0.00,$0.00,$0.00
5079-4-012,SUP,Custom 27203010,,5079-4-012  -  DEVICE EXFIX HFMN2 2MMX3MM MINI PVT LINKING,$281.88,$0.00,$281.88,$0.00,$201.17,$0.00,$0.00,$0.00,$0.00,$0.00,$281.88,$0.00,$140.94,$223.25,$225.50,$0.00,$0.00,$0.00,$0.00,$0.00
5079-4-050,SUP,Custom 27203010,,5079-4-050  -  SOCKET XTRNFX 4MM MN 5MM HFMN INSL,$178.75,$0.00,$178.75,$0.00,$127.57,$0.00,$0.00,$0.00,$0.00,$0.00,$178.75,$0.00,$89.38,$141.57,$143.00,$0.00,$0.00,$0.00,$0.00,$0.00
50-794-20-09,SUP,HCPCS C1713,,50-794-20-09  -  PLATE BONE STR 3MM 20 HOLE RECONSTRUCTION THREADLOCK GREEN,"$2,770.93",$0.00,"$2,770.93","$1,246.92","$1,977.61",$0.00,$477.42,$0.00,$0.00,$485.17,"$2,770.93",$0.00,"$1,385.46","$2,194.58","$2,216.74",$0.00,$433.65,$0.00,$441.13,$0.00
50-794-70-09,SUP,HCPCS C1713,,50-794-70-09  -  TEMPLATE BENDING STR 20 HOLE THREADLOCK TITANIUM,$139.25,$0.00,$139.25,$62.66,$99.38,$0.00,$23.99,$0.00,$0.00,$24.38,$139.25,$0.00,$69.63,$110.29,$111.40,$0.00,$21.79,$0.00,$22.17,$0.00
5079-5-030,SUP,Custom 27203010,,5079-5-030  -  ROD EXFIX 30MM 3MM HFMN2 MIC SS CONNCTNG,$70.13,$0.00,$70.13,$0.00,$50.05,$0.00,$0.00,$0.00,$0.00,$0.00,$70.13,$0.00,$35.06,$55.54,$56.10,$0.00,$0.00,$0.00,$0.00,$0.00
5079-5-040,SUP,Custom 27203010,,5079-5-040  -  ROD EXFIX 40MM 3MM HFMN2 MIC SS CONNCTNG,$70.13,$0.00,$70.13,$0.00,$50.05,$0.00,$0.00,$0.00,$0.00,$0.00,$70.13,$0.00,$35.06,$55.54,$56.10,$0.00,$0.00,$0.00,$0.00,$0.00
5079-5-050,SUP,Custom 27203010,,5079-5-050  -  ROD EXFIX 50MM 3MM HFMN2 MIC SS CONNCTNG,$70.13,$0.00,$70.13,$0.00,$50.05,$0.00,$0.00,$0.00,$0.00,$0.00,$70.13,$0.00,$35.06,$55.54,$56.10,$0.00,$0.00,$0.00,$0.00,$0.00
5079-5-060,SUP,Custom 27203010,,5079-5-060  -  ROD EXFIX 60MM 3MM HFMN2 MIC SS CONNCTNG,$48.13,$0.00,$48.13,$0.00,$34.35,$0.00,$0.00,$0.00,$0.00,$0.00,$48.13,$0.00,$24.06,$38.12,$38.50,$0.00,$0.00,$0.00,$0.00,$0.00
5079-5-070,SUP,Custom 27203010,,5079-5-070  -  ROD EXFIX 70MM 3MM HFMN2 MIC SS CONNCTNG,$70.13,$0.00,$70.13,$0.00,$50.05,$0.00,$0.00,$0.00,$0.00,$0.00,$70.13,$0.00,$35.06,$55.54,$56.10,$0.00,$0.00,$0.00,$0.00,$0.00
5079-5-080,SUP,Custom 27203010,,5079-5-080  -  HM33/80 3MMX80MM,$34.38,$0.00,$34.38,$0.00,$24.53,$0.00,$0.00,$0.00,$0.00,$0.00,$34.38,$0.00,$17.19,$27.23,$27.50,$0.00,$0.00,$0.00,$0.00,$0.00
5079-5-090,SUP,Custom 27203010,,5079-5-090  -  ROD EXFIX 90MM 3MM HFMN2 MIC SS CONNCTNG,$70.13,$0.00,$70.13,$0.00,$50.05,$0.00,$0.00,$0.00,$0.00,$0.00,$70.13,$0.00,$35.06,$55.54,$56.10,$0.00,$0.00,$0.00,$0.00,$0.00
5079-5-120,SUP,Custom 27203010,,5079-5-120  -  ROD EXFIX 120MM 3MM HFMN2 MIC SS CONNCTNG,$70.13,$0.00,$70.13,$0.00,$50.05,$0.00,$0.00,$0.00,$0.00,$0.00,$70.13,$0.00,$35.06,$55.54,$56.10,$0.00,$0.00,$0.00,$0.00,$0.00
5079-5-150,SUP,Custom 27203010,,5079-5-150  -  ROD EXFIX 150MM 3MM HFMN2 MIC SS CONNCTNG,$70.13,$0.00,$70.13,$0.00,$50.05,$0.00,$0.00,$0.00,$0.00,$0.00,$70.13,$0.00,$35.06,$55.54,$56.10,$0.00,$0.00,$0.00,$0.00,$0.00
5079-5-180,SUP,Custom 27203010,,5079-5-180  -  3X180MM CONNECTING ROD,$70.13,$0.00,$70.13,$0.00,$50.05,$0.00,$0.00,$0.00,$0.00,$0.00,$70.13,$0.00,$35.06,$55.54,$56.10,$0.00,$0.00,$0.00,$0.00,$0.00
5079-5-250,SUP,Custom 27203010,,5079-5-250  -  ROD EXFIX 250MM 3MM HFMN2 MIC SS CONNCTNG,$75.63,$0.00,$75.63,$0.00,$53.97,$0.00,$0.00,$0.00,$0.00,$0.00,$75.63,$0.00,$37.81,$59.90,$60.50,$0.00,$0.00,$0.00,$0.00,$0.00
50-795-26-09,SUP,HCPCS C1713,,50-795-26-09  -  PLATE BONE RIGHT ANG 3MM 26 HOLE RECONSTRUCTION THREADLOCK,"$4,274.75",$0.00,"$4,274.75","$1,923.64","$3,050.89",$0.00,$736.52,$0.00,$0.00,$748.47,"$4,274.75",$0.00,"$2,137.38","$3,385.60","$3,419.80",$0.00,$669.00,$0.00,$680.54,$0.00
5079-5-300,SUP,Custom 27203010,,5079-5-300  -  ROD EXFIX 300MM 3MM HFMN2 MIC SS CONNCTNG,$68.75,$0.00,$68.75,$0.00,$49.07,$0.00,$0.00,$0.00,$0.00,$0.00,$68.75,$0.00,$34.38,$54.45,$55.00,$0.00,$0.00,$0.00,$0.00,$0.00
50-795-76-09,SUP,Custom 27203010,,50-795-76-09  -  TEMPLATE BENDING 26 HOLE THREADLOCK TITANIUM MANDIB,$139.25,$0.00,$139.25,$0.00,$99.38,$0.00,$0.00,$0.00,$0.00,$0.00,$139.25,$0.00,$69.63,$110.29,$111.40,$0.00,$0.00,$0.00,$0.00,$0.00
5079-6-030,SUP,Custom 27203010,,5079-6-030  -  ROD EXFIX 30MM 3MM HFMN2 MIC CARB CONNCTNG,$112.75,$0.00,$112.75,$0.00,$80.47,$0.00,$0.00,$0.00,$0.00,$0.00,$112.75,$0.00,$56.38,$89.30,$90.20,$0.00,$0.00,$0.00,$0.00,$0.00
5079-6-040,SUP,Custom 27203010,,5079-6-040  -  ROD EXFIX 40MM 3MM HFMN2 MIC CARB CONNCTNG,$112.75,$0.00,$112.75,$0.00,$80.47,$0.00,$0.00,$0.00,$0.00,$0.00,$112.75,$0.00,$56.38,$89.30,$90.20,$0.00,$0.00,$0.00,$0.00,$0.00
5079-6-050,SUP,Custom 27203010,,5079-6-050  -  ROD EXFIX 50MM 3MM HFMN2 MIC CARB CONNCTNG,$112.75,$0.00,$112.75,$0.00,$80.47,$0.00,$0.00,$0.00,$0.00,$0.00,$112.75,$0.00,$56.38,$89.30,$90.20,$0.00,$0.00,$0.00,$0.00,$0.00
5079-6-060,SUP,Custom 27203010,,5079-6-060  -  ROD EXFIX 60MM 3MM HFMN2 MIC CARB CONNCTNG,$112.75,$0.00,$112.75,$0.00,$80.47,$0.00,$0.00,$0.00,$0.00,$0.00,$112.75,$0.00,$56.38,$89.30,$90.20,$0.00,$0.00,$0.00,$0.00,$0.00
50-796-06-09,SUP,HCPCS C1713,,50-796-06-09  -  PLATE BN STRG 3MM GRN NS THREADLOCK TS 6 HL RECON BAR CX TI,"$1,991.18",$0.00,"$1,991.18",$896.03,"$1,421.10",$0.00,$343.07,$0.00,$0.00,$348.64,"$1,991.18",$0.00,$995.59,"$1,577.01","$1,592.94",$0.00,$311.62,$0.00,$317.00,$0.00
5079-6-090,SUP,Custom 27203010,,5079-6-090  -  ROD EXFIX 90MM 3MM HFMN2 MIC CARB CONNCTNG,$112.75,$0.00,$112.75,$0.00,$80.47,$0.00,$0.00,$0.00,$0.00,$0.00,$112.75,$0.00,$56.38,$89.30,$90.20,$0.00,$0.00,$0.00,$0.00,$0.00
5079-6-120,SUP,Custom 27203010,,5079-6-120  -  ROD EXFIX 120MM 3MM HFMN2 MIC CARB CONNCTNG,$112.75,$0.00,$112.75,$0.00,$80.47,$0.00,$0.00,$0.00,$0.00,$0.00,$112.75,$0.00,$56.38,$89.30,$90.20,$0.00,$0.00,$0.00,$0.00,$0.00
5079-6-150,SUP,Custom 27203010,,5079-6-150  -  ROD EXFIX 150MM 3MM HFMN2 MIC CARB CONNCTNG,$112.75,$0.00,$112.75,$0.00,$80.47,$0.00,$0.00,$0.00,$0.00,$0.00,$112.75,$0.00,$56.38,$89.30,$90.20,$0.00,$0.00,$0.00,$0.00,$0.00
50-797-26-09,SUP,HCPCS C1713,,50-797-26-09  -  PLATE BONE 3MM RECONSTRUCTION THREADLOCK GREEN TITANIUM LEFT,"$4,274.75",$0.00,"$4,274.75","$1,923.64","$3,050.89",$0.00,$736.52,$0.00,$0.00,$748.47,"$4,274.75",$0.00,"$2,137.38","$3,385.60","$3,419.80",$0.00,$669.00,$0.00,$680.54,$0.00
50-799-32-09,SUP,HCPCS C1713,,50-799-32-09  -  PLATE BONE 3MM 32 HOLE LOCKING RECONSTRUCTION TITANIUM,"$4,748.20",$0.00,"$4,748.20","$2,136.69","$3,388.79",$0.00,$818.09,$0.00,$0.00,$831.37,"$4,748.20",$0.00,"$2,374.10","$3,760.57","$3,798.56",$0.00,$743.09,$0.00,$755.91,$0.00
50-799-34-09,SUP,HCPCS C1713,,50-799-34-09  -  PLATE BN ANG 3MM LVL 1 34 HL LCK RECON TI CRNMXF 2.7MM SCR,"$5,082.38",$0.00,"$5,082.38","$2,287.07","$3,627.29",$0.00,$875.67,$0.00,$0.00,$889.88,"$5,082.38",$0.00,"$2,541.19","$4,025.24","$4,065.90",$0.00,$795.39,$0.00,$809.11,$0.00
50-8001,SUP,Custom 27011340,,50-8001  -  OXYGEN DELIVERY SYSTEM W/ADLT MASK 10/CS,$40.81,$0.00,$40.81,$0.00,$29.12,$0.00,$0.00,$0.00,$0.00,$0.00,$40.81,$0.00,$20.40,$32.32,$32.64,$0.00,$0.00,$0.00,$0.00,$0.00
5080-1-612,SUP,Custom 27203010,,5080-1-612  -  PIN HALF 12MM 45MM 1.65MM HFMN2 APEX MIC SS SLFDRILL SLFTAP,$115.50,$0.00,$115.50,$0.00,$82.43,$0.00,$0.00,$0.00,$0.00,$0.00,$115.50,$0.00,$57.75,$91.48,$92.40,$0.00,$0.00,$0.00,$0.00,$0.00
5080-1-620,SUP,Custom 27203010,,5080-1-620  -  PIN HALF 20MM 45MM 1.65MM HFMN2 APEX MIC SS SLFDRILL SLFTAP,$115.50,$0.00,$115.50,$0.00,$82.43,$0.00,$0.00,$0.00,$0.00,$0.00,$115.50,$0.00,$57.75,$91.48,$92.40,$0.00,$0.00,$0.00,$0.00,$0.00
5080-2-012,SUP,Custom 27203010,,5080-2-012  -  PIN HALF 45MM 2MM HFMN2 APEX MIC SS SLFDRILL SLFTAP THRD 12,$115.50,$0.00,$115.50,$0.00,$82.43,$0.00,$0.00,$0.00,$0.00,$0.00,$115.50,$0.00,$57.75,$91.48,$92.40,$0.00,$0.00,$0.00,$0.00,$0.00
5080-2-020,SUP,Custom 27203010,,5080-2-020  -  PIN HALF 45MM 2MM HFMN2 APEX MIC SS SLFDRILL SLFTAP THRD 20,$115.50,$0.00,$115.50,$0.00,$82.43,$0.00,$0.00,$0.00,$0.00,$0.00,$115.50,$0.00,$57.75,$91.48,$92.40,$0.00,$0.00,$0.00,$0.00,$0.00
508-11-42A,SUP,Custom 27803010,,508-11-42A  -  SHELL ACETAB A HEMISPHERE 42MM MULTIHOLE TRIDENT HIP,"$4,207.50",$0.00,"$4,207.50",$0.00,"$3,002.89",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,207.50",$0.00,"$2,103.75","$3,332.34","$3,366.00",$0.00,$0.00,$0.00,$0.00,$0.00
508-11-44B,SUP,Custom 27803010,,508-11-44B  -  SHELL ACETAB B HEMISPHERE 44MM MULTIHOLE TRIDENT HIP,"$4,207.50",$0.00,"$4,207.50",$0.00,"$3,002.89",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,207.50",$0.00,"$2,103.75","$3,332.34","$3,366.00",$0.00,$0.00,$0.00,$0.00,$0.00
508-11-46C,SUP,Custom 27803010,,508-11-46C  -  SHELL ACETAB C HEMISPHERE 46MM MULTIHOLE TRIDENT HIP,"$4,207.50",$0.00,"$4,207.50",$0.00,"$3,002.89",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,207.50",$0.00,"$2,103.75","$3,332.34","$3,366.00",$0.00,$0.00,$0.00,$0.00,$0.00
508-11-48D,SUP,Custom 27803010,,508-11-48D  -  SHELL ACETAB D HEMISPHERE 48MM MULTIHOLE TRIDENT HIP,"$4,207.50",$0.00,"$4,207.50",$0.00,"$3,002.89",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,207.50",$0.00,"$2,103.75","$3,332.34","$3,366.00",$0.00,$0.00,$0.00,$0.00,$0.00
508-11-50D,SUP,Custom 27803010,,508-11-50D  -  SHELL ACETAB D HEMISPHERE 50MM MULTIHOLE TRIDENT HIP,"$4,207.50",$0.00,"$4,207.50",$0.00,"$3,002.89",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,207.50",$0.00,"$2,103.75","$3,332.34","$3,366.00",$0.00,$0.00,$0.00,$0.00,$0.00
508-11-52E,SUP,Custom 27803010,,508-11-52E  -  SHELL ACETAB E HEMISPHERE 52MM MULTIHOLE TRIDENT HIP,"$4,207.50",$0.00,"$4,207.50",$0.00,"$3,002.89",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,207.50",$0.00,"$2,103.75","$3,332.34","$3,366.00",$0.00,$0.00,$0.00,$0.00,$0.00
508-11-54E,SUP,Custom 27803010,,508-11-54E  -  SHELL ACETAB E HEMISPHERE 54MM MULTIHOLE TRIDENT HIP,"$4,207.50",$0.00,"$4,207.50",$0.00,"$3,002.89",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,207.50",$0.00,"$2,103.75","$3,332.34","$3,366.00",$0.00,$0.00,$0.00,$0.00,$0.00
508-11-56F,SUP,Custom 27803010,,508-11-56F  -  SHELL ACETAB F HEMISPHERE 56MM MULTIHOLE TRIDENT HIP,"$4,207.50",$0.00,"$4,207.50",$0.00,"$3,002.89",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,207.50",$0.00,"$2,103.75","$3,332.34","$3,366.00",$0.00,$0.00,$0.00,$0.00,$0.00
508-11-58F,SUP,Custom 27803010,,508-11-58F  -  SHELL ACETAB F HEMISPHERE 58MM MULTIHOLE TRIDENT HIP,"$4,207.50",$0.00,"$4,207.50",$0.00,"$3,002.89",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,207.50",$0.00,"$2,103.75","$3,332.34","$3,366.00",$0.00,$0.00,$0.00,$0.00,$0.00
508-11-60G,SUP,Custom 27803010,,508-11-60G  -  SHELL ACETAB G HEMISPHERE 60MM MULTIHOLE TRIDENT HIP,"$4,207.50",$0.00,"$4,207.50",$0.00,"$3,002.89",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,207.50",$0.00,"$2,103.75","$3,332.34","$3,366.00",$0.00,$0.00,$0.00,$0.00,$0.00
508-11-62G,SUP,Custom 27803010,,508-11-62G  -  SHELL ACETAB G HEMISPHERE 62MM MULTIHOLE TRIDENT HIP,"$4,207.50",$0.00,"$4,207.50",$0.00,"$3,002.89",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,207.50",$0.00,"$2,103.75","$3,332.34","$3,366.00",$0.00,$0.00,$0.00,$0.00,$0.00
508-11-64H,SUP,Custom 27803010,,508-11-64H  -  SHELL ACETAB H HEMISPHERE 64MM MULTIHOLE TRIDENT HIP,"$4,207.50",$0.00,"$4,207.50",$0.00,"$3,002.89",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,207.50",$0.00,"$2,103.75","$3,332.34","$3,366.00",$0.00,$0.00,$0.00,$0.00,$0.00
508-11-66H,SUP,Custom 27803010,,508-11-66H  -  SHELL ACETAB H HEMISPHERE 66MM MULTIHOLE TRIDENT HIP,"$4,207.50",$0.00,"$4,207.50",$0.00,"$3,002.89",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,207.50",$0.00,"$2,103.75","$3,332.34","$3,366.00",$0.00,$0.00,$0.00,$0.00,$0.00
508-11-68I,SUP,Custom 27803010,,508-11-68I  -  SHELL ACETAB I HEMISPHERE 68MM MULTIHOLE TRIDENT HIP,"$4,207.50",$0.00,"$4,207.50",$0.00,"$3,002.89",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,207.50",$0.00,"$2,103.75","$3,332.34","$3,366.00",$0.00,$0.00,$0.00,$0.00,$0.00
508-11-70I,SUP,Custom 27803010,,508-11-70I  -  SHELL ACETAB I HEMISPHERE 70MM MULTIHOLE TRIDENT HIP,"$4,207.50",$0.00,"$4,207.50",$0.00,"$3,002.89",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,207.50",$0.00,"$2,103.75","$3,332.34","$3,366.00",$0.00,$0.00,$0.00,$0.00,$0.00
508-11-72J,SUP,Custom 27803010,,508-11-72J  -  SHELL ACETAB J HEMISPHERE 72MM MULTIHOLE TRIDENT HIP,"$4,207.50",$0.00,"$4,207.50",$0.00,"$3,002.89",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,207.50",$0.00,"$2,103.75","$3,332.34","$3,366.00",$0.00,$0.00,$0.00,$0.00,$0.00
508-11-74J,SUP,Custom 27803010,,508-11-74J  -  SHELL ACETAB J HEMISPHERE 74MM MULTIHOLE TRIDENT HIP,"$4,207.50",$0.00,"$4,207.50",$0.00,"$3,002.89",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,207.50",$0.00,"$2,103.75","$3,332.34","$3,366.00",$0.00,$0.00,$0.00,$0.00,$0.00
50-820-07-07,SUP,Custom 27100030,,50-820-07-07  -  DRILL TWIST 1.5MM 40MM 7MM HEXAGONAL ATTCH STOP STAINLESS,$311.90,$0.00,$311.90,$0.00,$222.60,$0.00,$0.00,$0.00,$0.00,$0.00,$311.90,$0.00,$155.95,$247.02,$249.52,$0.00,$0.00,$0.00,$0.00,$0.00
5082-200,SUP,Custom 27203010,,5082-200  -  BLOOD PRESSURE CONNECTOR/MALE,$50.00,$0.00,$50.00,$0.00,$35.69,$0.00,$0.00,$0.00,$0.00,$0.00,$50.00,$0.00,$25.00,$39.60,$40.00,$0.00,$0.00,$0.00,$0.00,$0.00
5084-1-100,SUP,Custom 27203010,,5084-1-100  -  GUIDE DRILL 1.5-2MM MINI,$515.63,$0.00,$515.63,$0.00,$368.00,$0.00,$0.00,$0.00,$0.00,$0.00,$515.63,$0.00,$257.81,$408.38,$412.50,$0.00,$0.00,$0.00,$0.00,$0.00
5085-2-015,SUP,Custom 27203010,,5085-2-015  -  BIT DRILL 75MM 1.5MM STRL,$88.00,$0.00,$88.00,$0.00,$62.81,$0.00,$0.00,$0.00,$0.00,$0.00,$88.00,$0.00,$44.00,$69.70,$70.40,$0.00,$0.00,$0.00,$0.00,$0.00
5090-2-120,SUP,Custom 27203010,,5090-2-120  -  PIN HALF 120MM 3MM 4MM APEX SLFDRILL,$207.63,$0.00,$207.63,$0.00,$148.18,$0.00,$0.00,$0.00,$0.00,$0.00,$207.63,$0.00,$103.81,$164.44,$166.10,$0.00,$0.00,$0.00,$0.00,$0.00
509-02-54E,SUP,Custom 27803010,,509-02-54E  -  SHELL ACETAB E HEMISPHERE 54MM MULTIHOLE RIM MDM TRIDENT,"$6,782.50",$0.00,"$6,782.50",$0.00,"$4,840.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,782.50",$0.00,"$3,391.25","$5,371.74","$5,426.00",$0.00,$0.00,$0.00,$0.00,$0.00
509-02-56E,SUP,Custom 27803010,,509-02-56E  -  SHELL ACETAB E HEMISPHERE 56MM MULTIHOLE RIM MDM TRIDENT,"$6,782.50",$0.00,"$6,782.50",$0.00,"$4,840.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,782.50",$0.00,"$3,391.25","$5,371.74","$5,426.00",$0.00,$0.00,$0.00,$0.00,$0.00
509-02-58F,SUP,Custom 27803010,,509-02-58F  -  SHELL ACETAB F HEMISPHERE 58MM MULTIHOLE RIM MDM TRIDENT,"$6,782.50",$0.00,"$6,782.50",$0.00,"$4,840.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,782.50",$0.00,"$3,391.25","$5,371.74","$5,426.00",$0.00,$0.00,$0.00,$0.00,$0.00
509-02-60F,SUP,Custom 27803010,,509-02-60F  -  SHELL ACETAB F HEMISPHERE 60MM MULTIHOLE RIM MDM TRIDENT,"$6,782.50",$0.00,"$6,782.50",$0.00,"$4,840.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,782.50",$0.00,"$3,391.25","$5,371.74","$5,426.00",$0.00,$0.00,$0.00,$0.00,$0.00
509-02-62G,SUP,Custom 27803010,,509-02-62G  -  SHELL ACETAB G HEMISPHERE 62MM MULTIHOLE RIM MDM TRIDENT,"$6,782.50",$0.00,"$6,782.50",$0.00,"$4,840.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,782.50",$0.00,"$3,391.25","$5,371.74","$5,426.00",$0.00,$0.00,$0.00,$0.00,$0.00
509-02-64G,SUP,Custom 27803010,,509-02-64G  -  SHELL ACETAB G HEMISPHERE 64MM MULTIHOLE RIM MDM TRIDENT,"$6,782.50",$0.00,"$6,782.50",$0.00,"$4,840.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,782.50",$0.00,"$3,391.25","$5,371.74","$5,426.00",$0.00,$0.00,$0.00,$0.00,$0.00
509-02-66H,SUP,Custom 27803010,,509-02-66H  -  SHELL ACETAB H HEMISPHERE 66MM MULTIHOLE RIM MDM TRIDENT,"$6,782.50",$0.00,"$6,782.50",$0.00,"$4,840.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,782.50",$0.00,"$3,391.25","$5,371.74","$5,426.00",$0.00,$0.00,$0.00,$0.00,$0.00
509-02-68H,SUP,Custom 27803010,,509-02-68H  -  SHELL ACETAB H HEMISPHERE 68MM MULTIHOLE RIM MDM TRIDENT,"$6,782.50",$0.00,"$6,782.50",$0.00,"$4,840.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,782.50",$0.00,"$3,391.25","$5,371.74","$5,426.00",$0.00,$0.00,$0.00,$0.00,$0.00
509-02-70I,SUP,Custom 27803010,,509-02-70I  -  SHELL ACETAB I HEMISPHERE 70MM MULTIHOLE RIM MDM TRIDENT,"$6,782.50",$0.00,"$6,782.50",$0.00,"$4,840.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,782.50",$0.00,"$3,391.25","$5,371.74","$5,426.00",$0.00,$0.00,$0.00,$0.00,$0.00
509-02-72I,SUP,Custom 27803010,,509-02-72I  -  SHELL ACETAB I HEMISPHERE 72MM MULTIHOLE RIM MDM TRIDENT,"$6,782.50",$0.00,"$6,782.50",$0.00,"$4,840.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,782.50",$0.00,"$3,391.25","$5,371.74","$5,426.00",$0.00,$0.00,$0.00,$0.00,$0.00
509-02-74J,SUP,Custom 27803010,,509-02-74J  -  SHELL ACETAB J HEMISPHERE 74MM MULTIHOLE RIM MDM TRIDENT,"$6,782.50",$0.00,"$6,782.50",$0.00,"$4,840.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,782.50",$0.00,"$3,391.25","$5,371.74","$5,426.00",$0.00,$0.00,$0.00,$0.00,$0.00
509-02-76J,SUP,Custom 27803010,,509-02-76J  -  SHELL ACETAB 76MM MULTIHOLE REVISION TRITANIUM,"$6,782.50",$0.00,"$6,782.50",$0.00,"$4,840.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,782.50",$0.00,"$3,391.25","$5,371.74","$5,426.00",$0.00,$0.00,$0.00,$0.00,$0.00
509-02-78J,SUP,Custom 27803010,,509-02-78J  -  SHELL ACETAB 78MM MULTIHOLE REVISION TRITANIUM,"$6,782.50",$0.00,"$6,782.50",$0.00,"$4,840.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,782.50",$0.00,"$3,391.25","$5,371.74","$5,426.00",$0.00,$0.00,$0.00,$0.00,$0.00
509-02-80J,SUP,Custom 27803010,,509-02-80J  -  SHELL ACETAB 80MM MULTIHOLE REVISION TRITANIUM,"$6,782.50",$0.00,"$6,782.50",$0.00,"$4,840.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,782.50",$0.00,"$3,391.25","$5,371.74","$5,426.00",$0.00,$0.00,$0.00,$0.00,$0.00
509-250-605,SUP,Custom 27203010,,SPECULUM 7X1.75IN GRV 2XL RT OPN VAG LTX,$202.50,$0.00,$202.50,$0.00,$144.52,$0.00,$0.00,$0.00,$0.00,$0.00,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$0.00,$0.00,$0.00,$0.00
5094-0-202,SUP,Custom 27203010,,5094-0-202  -  FIXATOR XTRNFX HFMN2 LENGTHEN SS,"$3,973.75",$0.00,"$3,973.75",$0.00,"$2,836.07",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,973.75",$0.00,"$1,986.88","$3,147.21","$3,179.00",$0.00,$0.00,$0.00,$0.00,$0.00
50960-584,SUP,Custom 27203010,,MATTRESS OVRLY 72X34X3.5IN FULL SFT SKN COVER LF GM,$108.83,$0.00,$108.83,$0.00,$77.67,$0.00,$0.00,$0.00,$0.00,$0.00,$108.83,$0.00,$54.41,$86.19,$87.06,$0.00,$0.00,$0.00,$0.00,$0.00
5096-4615,SUP,HCPCS C1776,,5096-4615  -  AUGMENT ACTB WDG 46MM 15MM RSTR HIP,"$4,817.50",$0.00,"$4,817.50","$2,167.88","$3,438.25",$0.00,$830.03,$0.00,$0.00,$843.51,"$4,817.50",$0.00,"$2,408.75","$3,815.46","$3,854.00",$0.00,$753.94,$0.00,$766.95,$0.00
5096-4620,SUP,HCPCS C1776,,5096-4620  -  AUGMENT ACTB WDG 46MM 20MM RSTR HIP,"$4,817.50",$0.00,"$4,817.50","$2,167.88","$3,438.25",$0.00,$830.03,$0.00,$0.00,$843.51,"$4,817.50",$0.00,"$2,408.75","$3,815.46","$3,854.00",$0.00,$753.94,$0.00,$766.95,$0.00
5096-5015,SUP,HCPCS C1776,,5096-5015  -  AUGMENT ACTB WDG 50MM 15MM RSTR HIP,"$4,817.50",$0.00,"$4,817.50","$2,167.88","$3,438.25",$0.00,$830.03,$0.00,$0.00,$843.51,"$4,817.50",$0.00,"$2,408.75","$3,815.46","$3,854.00",$0.00,$753.94,$0.00,$766.95,$0.00
5096-5020,SUP,HCPCS C1776,,5096-5020  -  AUGMENT ACTB WDG 50MM 20MM RSTR HIP,"$4,817.50",$0.00,"$4,817.50","$2,167.88","$3,438.25",$0.00,$830.03,$0.00,$0.00,$843.51,"$4,817.50",$0.00,"$2,408.75","$3,815.46","$3,854.00",$0.00,$753.94,$0.00,$766.95,$0.00
5096-5025,SUP,HCPCS C1776,,5096-5025  -  AUGMENT ACTB WDG 50MM 25MM RSTR HIP,"$4,817.50",$0.00,"$4,817.50","$2,167.88","$3,438.25",$0.00,$830.03,$0.00,$0.00,$843.51,"$4,817.50",$0.00,"$2,408.75","$3,815.46","$3,854.00",$0.00,$753.94,$0.00,$766.95,$0.00
5096-5415,SUP,HCPCS C1776,,5096-5415  -  AUGMENT ACTB WDG 54MM 15MM RSTR HIP,"$4,817.50",$0.00,"$4,817.50","$2,167.88","$3,438.25",$0.00,$830.03,$0.00,$0.00,$843.51,"$4,817.50",$0.00,"$2,408.75","$3,815.46","$3,854.00",$0.00,$753.94,$0.00,$766.95,$0.00
5096-5815,SUP,HCPCS C1776,,5096-5815  -  AUGMENT ACTB WDG 58MM 15MM RSTR HIP,"$4,817.50",$0.00,"$4,817.50","$2,167.88","$3,438.25",$0.00,$830.03,$0.00,$0.00,$843.51,"$4,817.50",$0.00,"$2,408.75","$3,815.46","$3,854.00",$0.00,$753.94,$0.00,$766.95,$0.00
5096-5825,SUP,HCPCS C1776,,5096-5825  -  AUGMENT ACTB WDG 58MM 25MM RSTR HIP,"$4,817.50",$0.00,"$4,817.50","$2,167.88","$3,438.25",$0.00,$830.03,$0.00,$0.00,$843.51,"$4,817.50",$0.00,"$2,408.75","$3,815.46","$3,854.00",$0.00,$753.94,$0.00,$766.95,$0.00
5096-6220,SUP,HCPCS C1776,,5096-6220  -  AUGMENT ACTB WDG 62MM 20MM RSTR HIP,"$4,817.50",$0.00,"$4,817.50","$2,167.88","$3,438.25",$0.00,$830.03,$0.00,$0.00,$843.51,"$4,817.50",$0.00,"$2,408.75","$3,815.46","$3,854.00",$0.00,$753.94,$0.00,$766.95,$0.00
5096-6225,SUP,HCPCS C1776,,5096-6225  -  AUGMENT ACTB WDG 62MM 25MM RSTR HIP,"$4,817.50",$0.00,"$4,817.50","$2,167.88","$3,438.25",$0.00,$830.03,$0.00,$0.00,$843.51,"$4,817.50",$0.00,"$2,408.75","$3,815.46","$3,854.00",$0.00,$753.94,$0.00,$766.95,$0.00
5096-6615,SUP,HCPCS C1776,,5096-6615  -  AUGMENT ACTB WDG 66MM 15MM RSTR HIP,"$4,817.50",$0.00,"$4,817.50","$2,167.88","$3,438.25",$0.00,$830.03,$0.00,$0.00,$843.51,"$4,817.50",$0.00,"$2,408.75","$3,815.46","$3,854.00",$0.00,$753.94,$0.00,$766.95,$0.00
5096-6620,SUP,HCPCS C1776,,5096-6620  -  AUGMENT ACTB WDG 66MM 20MM RSTR,"$4,817.50",$0.00,"$4,817.50","$2,167.88","$3,438.25",$0.00,$830.03,$0.00,$0.00,$843.51,"$4,817.50",$0.00,"$2,408.75","$3,815.46","$3,854.00",$0.00,$753.94,$0.00,$766.95,$0.00
5096-6625,SUP,HCPCS C1776,,5096-6625  -  AUGMENT ACTB WDG 66MM 25MM RSTR HIP,"$4,817.50",$0.00,"$4,817.50","$2,167.88","$3,438.25",$0.00,$830.03,$0.00,$0.00,$843.51,"$4,817.50",$0.00,"$2,408.75","$3,815.46","$3,854.00",$0.00,$753.94,$0.00,$766.95,$0.00
5100-001,SUP,HCPCS Q4116,,5100-001  -  GRAFT SKIN 0-175SQ CM CRYOPRESERVED SPLIT NONMESHED,$945.00,$0.00,$945.00,$425.25,$674.45,$0.00,$162.82,$0.00,$0.00,$165.46,$945.00,$0.00,$472.50,$748.44,$756.00,$0.00,$147.89,$0.00,$150.44,$0.00
5100-037-012,SUP,Custom 27203010,,5100-037-012  -  BLADE SAW SHORT LONG MICRO 33.5X.64MM RECIPROCATE TPS,$196.10,$0.00,$196.10,$0.00,$139.96,$0.00,$0.00,$0.00,$0.00,$0.00,$196.10,$0.00,$98.05,$155.31,$156.88,$0.00,$0.00,$0.00,$0.00,$0.00
5100-137-233,SUP,Custom 27203010,,5100-137-233  -  BLADE SAW SHORT 27X.38MM RECIPROCATING TAPERED PRECISION,$196.10,$0.00,$196.10,$0.00,$139.96,$0.00,$0.00,$0.00,$0.00,$0.00,$196.10,$0.00,$98.05,$155.31,$156.88,$0.00,$0.00,$0.00,$0.00,$0.00
510038SIM2,SUP,HCPCS C1725,,510038SIM2  -  CATHETER ANGIOGRAPHIC SIDEWINDER SIMMONS TECHNIQUE 2 CURVE 5,$30.00,$0.00,$30.00,$16.29,$21.41,$0.00,$5.17,$0.00,$0.00,$5.25,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$4.70,$0.00,$4.78,$0.00
5101-1-450,SUP,HCPCS C1713,,5101-1-450  -  WIRE XTRNFX 1.5MM 450MM KRSH,$108.63,$0.00,$108.63,$48.88,$77.53,$0.00,$18.72,$0.00,$0.00,$19.02,$108.63,$0.00,$54.31,$86.03,$86.90,$0.00,$17.00,$0.00,$17.29,$0.00
5101-2-450,SUP,HCPCS C1713,,5101-2-450  -  WIRE XTRNFX 2MM 450MM KRSH,$108.63,$0.00,$108.63,$48.88,$77.53,$0.00,$18.72,$0.00,$0.00,$19.02,$108.63,$0.00,$54.31,$86.03,$86.90,$0.00,$17.00,$0.00,$17.29,$0.00
5101302P2,SUP,HCPCS C1713,,5101302P2  -  CAGE SPNL 12D 30X10X11MM NS CRNT PEEK ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5101308P2,SUP,HCPCS C1713,,5101308P2  -  CAGE SPNL 8D 30X10X11MM NS CRNT PEEK ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5102-1-246,SUP,Custom 27203010,,5102-1-246  -  HOLDER IMPL M-S KWR SPCR KWR,$383.63,$0.00,$383.63,$0.00,$273.79,$0.00,$0.00,$0.00,$0.00,$0.00,$383.63,$0.00,$191.81,$303.83,$306.90,$0.00,$0.00,$0.00,$0.00,$0.00
5102-1-250,SUP,Custom 27203010,,5102-1-250  -  CLAMP XTRNFX M-S HBRD,"$1,218.25",$0.00,"$1,218.25",$0.00,$869.47,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,218.25",$0.00,$609.13,$964.85,$974.60,$0.00,$0.00,$0.00,$0.00,$0.00
5102-1-260,SUP,Custom 27203010,,5102-1-260  -  HOLDER KWR 60MM M-S 2,"$1,215.50",$0.00,"$1,215.50",$0.00,$867.50,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,215.50",$0.00,$607.75,$962.68,$972.40,$0.00,$0.00,$0.00,$0.00,$0.00
5102-1-270,SUP,Custom 27203010,,5102-1-270  -  HOLDER KWR 80MM M-S 2,"$1,215.50",$0.00,"$1,215.50",$0.00,$867.50,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,215.50",$0.00,$607.75,$962.68,$972.40,$0.00,$0.00,$0.00,$0.00,$0.00
5102-1-330,SUP,Custom 27203010,,5102-1-330  -  FIXATOR XTRNFX 70D M-S BALL JNT,$803.00,$0.00,$803.00,$0.00,$573.10,$0.00,$0.00,$0.00,$0.00,$0.00,$803.00,$0.00,$401.50,$635.98,$642.40,$0.00,$0.00,$0.00,$0.00,$0.00
5102-8-330,SUP,Custom 27203010,,5102-8-330  -  ROD EXFIX 330MM 8MM MNTB CONNCTNG THRD,$81.13,$0.00,$81.13,$0.00,$57.90,$0.00,$0.00,$0.00,$0.00,$0.00,$81.13,$0.00,$40.56,$64.25,$64.90,$0.00,$0.00,$0.00,$0.00,$0.00
5102-8-395,SUP,Custom 27203010,,5102-8-395  -  FXTR EXFIX 395MM 8MM M-S CONNCTNG ROD THRD,$82.50,$0.00,$82.50,$0.00,$58.88,$0.00,$0.00,$0.00,$0.00,$0.00,$82.50,$0.00,$41.25,$65.34,$66.00,$0.00,$0.00,$0.00,$0.00,$0.00
510410R,SUP,HCPCS C1758,,510410R  -  CATHETER URETHRAL 10FR LATEX ROBINSON RED RUBBER STERILE RRL,$10.58,$0.00,$10.58,$5.74,$7.55,$0.00,$1.82,$0.00,$0.00,$1.85,$10.58,$0.00,$5.29,$8.38,$8.46,$0.00,$1.65,$0.00,$1.68,$0.00
510420R,SUP,HCPCS C1758,,510420R  -  CATHETER URTH RBNSN 20FR 16IN 2 STGR EYLT XRY,$10.58,$0.00,$10.58,$5.74,$7.55,$0.00,$1.82,$0.00,$0.00,$1.85,$10.58,$0.00,$5.29,$8.38,$8.46,$0.00,$1.65,$0.00,$1.68,$0.00
5104308P2,SUP,HCPCS C1713,,5104308P2  -  CAGE SPNL 8D 30X10X14MM NS CRNT PEEK ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5109302P2,SUP,HCPCS C1713,,5109302P2  -  CAGE SPNL 12D 30X10X9MM NS CRNT PEEK ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5109308P2,SUP,HCPCS C1713,,5109308P2  -  CAGE SPNL 8D 30X10X9MM NS CRNT PEEK ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5111302P2,SUP,HCPCS C1713,,5111302P2  -  CAGE SPNL 12D 30X11X11MM NS CRNT PEEK ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5111308P2,SUP,HCPCS C1713,,5111308P2  -  CAGE SPNL 8D 30X11X11MM NS CRNT PEEK ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
51114V,SUP,Custom 27203010,,51114V  -  CLIP INTNL MED LG SMTR VESOLOCK,$851.23,$0.00,$851.23,$0.00,$607.52,$0.00,$0.00,$0.00,$0.00,$0.00,$851.23,$0.00,$425.61,$674.17,$680.98,$0.00,$0.00,$0.00,$0.00,$0.00
51-17304,SUP,HCPCS C1713,,51-17304  -  SCREW BONE 1.7MM 4MM EMERGENCY TITANIUM CRANIOMAXILLOFACIAL,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
5118-1-300,SUP,Custom 27203010,,5118-1-300  -  RING XTRNFX SM 147MM BLU M-S .75 HP,$642.13,$0.00,$642.13,$0.00,$458.28,$0.00,$0.00,$0.00,$0.00,$0.00,$642.13,$0.00,$321.06,$508.57,$513.70,$0.00,$0.00,$0.00,$0.00,$0.00
5118-1-301,SUP,Custom 27203010,,5118-1-301  -  RING XTRNFX SM 165MM GRN M-S .75 HP,$738.38,$0.00,$738.38,$0.00,$526.98,$0.00,$0.00,$0.00,$0.00,$0.00,$738.38,$0.00,$369.19,$584.80,$590.70,$0.00,$0.00,$0.00,$0.00,$0.00
5118-1-302,SUP,Custom 27203010,,5118-1-302  -  RING XTRNFX SM 187MM WHT M-S .75 HP,$796.13,$0.00,$796.13,$0.00,$568.19,$0.00,$0.00,$0.00,$0.00,$0.00,$796.13,$0.00,$398.06,$630.53,$636.90,$0.00,$0.00,$0.00,$0.00,$0.00
5118-1-303,SUP,Custom 27203010,,5118-1-303  -  RING XTRNFX SM 147MM BLU M-S .25 HP,$374.00,$0.00,$374.00,$0.00,$266.92,$0.00,$0.00,$0.00,$0.00,$0.00,$374.00,$0.00,$187.00,$296.21,$299.20,$0.00,$0.00,$0.00,$0.00,$0.00
5118-1-304,SUP,Custom 27203010,,5118-1-304  -  RING XTRNFX MED 165MM GRN M-S .25 HP,$441.38,$0.00,$441.38,$0.00,$315.01,$0.00,$0.00,$0.00,$0.00,$0.00,$441.38,$0.00,$220.69,$349.57,$353.10,$0.00,$0.00,$0.00,$0.00,$0.00
5118-1-305,SUP,Custom 27203010,,5118-1-305  -  RING XTRNFX LG 187MM WHT M-S .25 HP,$566.50,$0.00,$566.50,$0.00,$404.31,$0.00,$0.00,$0.00,$0.00,$0.00,$566.50,$0.00,$283.25,$448.67,$453.20,$0.00,$0.00,$0.00,$0.00,$0.00
5118-1-306,SUP,Custom 27203010,,5118-1-306  -  PIN XTRNFX 50MM KRSH M-S RECON CLP WRE HLDR,$265.38,$0.00,$265.38,$0.00,$189.40,$0.00,$0.00,$0.00,$0.00,$0.00,$265.38,$0.00,$132.69,$210.18,$212.30,$0.00,$0.00,$0.00,$0.00,$0.00
5118-1-307,SUP,Custom 27203010,,5118-1-307  -  PIN EXFIX 100MM CLMP,$320.38,$0.00,$320.38,$0.00,$228.65,$0.00,$0.00,$0.00,$0.00,$0.00,$320.38,$0.00,$160.19,$253.74,$256.30,$0.00,$0.00,$0.00,$0.00,$0.00
5118-1-308,SUP,Custom 27203010,,5118-1-308  -  CPLNG EXFIX ARTC,$735.63,$0.00,$735.63,$0.00,$525.02,$0.00,$0.00,$0.00,$0.00,$0.00,$735.63,$0.00,$367.81,$582.62,$588.50,$0.00,$0.00,$0.00,$0.00,$0.00
5118-1-311,SUP,Custom 27203010,,5118-1-311  -  HOLDER XTRNFX KRSH M-S ARTC CPLNG,$948.75,$0.00,$948.75,$0.00,$677.12,$0.00,$0.00,$0.00,$0.00,$0.00,$948.75,$0.00,$474.38,$751.41,$759.00,$0.00,$0.00,$0.00,$0.00,$0.00
5118-1-320,SUP,HCPCS C1713,,5118-1-320  -  WIRE XTRNFX OLV 1.5MM 450MM KRSH STP NUT SS,$217.25,$0.00,$217.25,$97.76,$155.05,$0.00,$37.43,$0.00,$0.00,$38.04,$217.25,$0.00,$108.63,$172.06,$173.80,$0.00,$34.00,$0.00,$34.59,$0.00
5118-1-340,SUP,HCPCS C1713,,5118-1-340  -  WIRE XTRNFX OLV 2MM 450MM KRSH STP SS,$217.25,$0.00,$217.25,$97.76,$155.05,$0.00,$37.43,$0.00,$0.00,$38.04,$217.25,$0.00,$108.63,$172.06,$173.80,$0.00,$34.00,$0.00,$34.59,$0.00
5118-1-350,SUP,Custom 27203010,,5118-1-350  -  HINGE XTRNFX M-S,$481.25,$0.00,$481.25,$0.00,$343.47,$0.00,$0.00,$0.00,$0.00,$0.00,$481.25,$0.00,$240.63,$381.15,$385.00,$0.00,$0.00,$0.00,$0.00,$0.00
5119302P2,SUP,HCPCS C1713,,5119302P2  -  CAGE SPNL 12D 30X11X9MM NS CRNT PEEK ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5119308P2,SUP,HCPCS C1713,,5119308P2  -  CAGE SPNL 8D 30X11X9MM NS CRNT PEEK ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5120-0-010,SUP,Custom 27203010,,5120-0-010  -  RING EXFIX GRY 100MM M-S .75 RING,$515.63,$0.00,$515.63,$0.00,$368.00,$0.00,$0.00,$0.00,$0.00,$0.00,$515.63,$0.00,$257.81,$408.38,$412.50,$0.00,$0.00,$0.00,$0.00,$0.00
5120-0-040,SUP,Custom 27203010,,5120-0-040  -  RING EXFIX 115MM M-S .25,$323.13,$0.00,$323.13,$0.00,$230.61,$0.00,$0.00,$0.00,$0.00,$0.00,$323.13,$0.00,$161.56,$255.92,$258.50,$0.00,$0.00,$0.00,$0.00,$0.00
5120-0-050,SUP,Custom 27203010,,5120-0-050  -  RING EXFIX 130MM M-S .75,$591.25,$0.00,$591.25,$0.00,$421.98,$0.00,$0.00,$0.00,$0.00,$0.00,$591.25,$0.00,$295.63,$468.27,$473.00,$0.00,$0.00,$0.00,$0.00,$0.00
5120-0-060,SUP,Custom 27203010,,5120-0-060  -  RING EXFIX RED 130MM M-S .25 RING,$367.13,$0.00,$367.13,$0.00,$262.02,$0.00,$0.00,$0.00,$0.00,$0.00,$367.13,$0.00,$183.56,$290.77,$293.70,$0.00,$0.00,$0.00,$0.00,$0.00
5120-0-070,SUP,Custom 27203010,,5120-0-070  -  RING EXFIX BRNZ 210MM M-S .75 RING,$782.38,$0.00,$782.38,$0.00,$558.38,$0.00,$0.00,$0.00,$0.00,$0.00,$782.38,$0.00,$391.19,$619.64,$625.90,$0.00,$0.00,$0.00,$0.00,$0.00
5120-0-080,SUP,Custom 27203010,,5120-0-080  -  RING EXFIX BRNZ 210MM M-S .25 RING,$622.88,$0.00,$622.88,$0.00,$444.55,$0.00,$0.00,$0.00,$0.00,$0.00,$622.88,$0.00,$311.44,$493.32,$498.30,$0.00,$0.00,$0.00,$0.00,$0.00
5121302P2,SUP,HCPCS C1713,,5121302P2  -  CAGE SPNL 12D 30X12X11MM NS CRNT PEEK ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5121308P2,SUP,HCPCS C1713,,5121308P2  -  CAGE SPNL 8D 30X12X11MM NS CRNT PEEK ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5124308P2,SUP,HCPCS C1713,,5124308P2  -  CAGE SPNL 8D 30X12X14MM NS CRNT PEEK ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5128-1220,SUP,Custom 27203010,,REAGENT MOL BIO HC2 TRNSPT MED 30ML,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
5129302P2,SUP,HCPCS C1713,,5129302P2  -  CAGE SPNL 12D 30X12X9MM NS CRNT PEEK ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5129308P2,SUP,HCPCS C1713,,5129308P2  -  CAGE SPNL 8D 30X12X9MM NS CRNT PEEK ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5130-080-030,SUP,Custom 27203010,,5130-080-030  -  RASP SURG LONG 3.2MM HELICOIDAL 3.2MM 18.3MM,$316.25,$0.00,$316.25,$0.00,$225.71,$0.00,$0.00,$0.00,$0.00,$0.00,$316.25,$0.00,$158.13,$250.47,$253.00,$0.00,$0.00,$0.00,$0.00,$0.00
5141302P2,SUP,HCPCS C1713,,5141302P2  -  CAGE SPNL 12D 30X14X11MM NS CRNT PEEK ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5141308P2,SUP,HCPCS C1713,,5141308P2  -  CAGE SPNL 8D 30X14X11MM NS CRNT PEEK ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5144308P2,SUP,HCPCS C1713,,5144308P2  -  CAGE SPNL 8D 30X14X14MM NS CRNT PEEK ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5149302P2,SUP,HCPCS C1713,,5149302P2  -  CAGE SPNL 12D 30X14X9MM NS CRNT PEEK ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5149308P2,SUP,HCPCS C1713,,5149308P2  -  CAGE SPNL 8D 30X9X14MM NS CRNT PEEK ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5150-0-400,SUP,Custom 27203010,,5150-0-400  -  TUBE XTRNFX 25MM RD MNTB TRX XTD DYNMC C,"$2,083.13",$0.00,"$2,083.13",$0.00,"$1,486.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,083.13",$0.00,"$1,041.56","$1,649.84","$1,666.50",$0.00,$0.00,$0.00,$0.00,$0.00
5150-0-410,SUP,Custom 27203010,,5150-0-410  -  TUBE XTRNFX 20MM RD MNTB TRX XTD DYNMC C,"$2,186.25",$0.00,"$2,186.25",$0.00,"$1,560.33",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,186.25",$0.00,"$1,093.13","$1,731.51","$1,749.00",$0.00,$0.00,$0.00,$0.00,$0.00
5150-0-420,SUP,Custom 27203010,,5150-0-420  -  TUBE XTRNFX 15MM RD MNTB TRX XTD DYNMC C,"$2,186.25",$0.00,"$2,186.25",$0.00,"$1,560.33",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,186.25",$0.00,"$1,093.13","$1,731.51","$1,749.00",$0.00,$0.00,$0.00,$0.00,$0.00
5150-0-465,SUP,Custom 27203010,,5150-0-465  -  TUBE XTRNFX SM 15MM YLW MNTB TRX DYNMC SNPFT C,"$2,844.88",$0.00,"$2,844.88",$0.00,"$2,030.39",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,844.88",$0.00,"$1,422.44","$2,253.14","$2,275.90",$0.00,$0.00,$0.00,$0.00,$0.00
5150-0-470,SUP,Custom 27203010,,5150-0-470  -  TUBE XTRNFX MED 20MM BLU MNTB TRX DYNMC C,"$3,011.25",$0.00,"$3,011.25",$0.00,"$2,149.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,011.25",$0.00,"$1,505.63","$2,384.91","$2,409.00",$0.00,$0.00,$0.00,$0.00,$0.00
5150-0-475,SUP,Custom 27203010,,5150-0-475  -  TUBE XTRNFX 25MM RD MNTB TRX DYNMC C,"$3,081.38",$0.00,"$3,081.38",$0.00,"$2,199.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,081.38",$0.00,"$1,540.69","$2,440.45","$2,465.10",$0.00,$0.00,$0.00,$0.00,$0.00
5150-0-575,SUP,Custom 27203010,,5150-0-575  -  TUBE XTRNFX 25MM RD MNTB TRX XTD DYNMC C,"$3,650.63",$0.00,"$3,650.63",$0.00,"$2,605.45",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,650.63",$0.00,"$1,825.31","$2,891.30","$2,920.50",$0.00,$0.00,$0.00,$0.00,$0.00
5150-2-520,SUP,HCPCS C1713,,5150-2-520  -  CAP END SPR 20MM TUBE MNTB TRX BLUE,$88.00,$0.00,$88.00,$39.60,$62.81,$0.00,$15.16,$0.00,$0.00,$15.41,$88.00,$0.00,$44.00,$69.70,$70.40,$0.00,$13.77,$0.00,$14.01,$0.00
5150-2-615,SUP,Custom 27203010,,5150-2-615  -  TUBE XTRNFX 15MM YLW MNTB TRX END CAP UNLAT C,$33.00,$0.00,$33.00,$0.00,$23.55,$0.00,$0.00,$0.00,$0.00,$0.00,$33.00,$0.00,$16.50,$26.14,$26.40,$0.00,$0.00,$0.00,$0.00,$0.00
5150-2-620,SUP,Custom 27203010,,5150-2-620  -  SET EXFIX BLUE 20MM CARB TUBE END CAP ASMBLY,$35.75,$0.00,$35.75,$0.00,$25.51,$0.00,$0.00,$0.00,$0.00,$0.00,$35.75,$0.00,$17.88,$28.31,$28.60,$0.00,$0.00,$0.00,$0.00,$0.00
5150-2-625,SUP,Custom 27203010,,5150-2-625  -  SET EXFIX RED CAP ASMBLY CARB TUBE,$44.00,$0.00,$44.00,$0.00,$31.40,$0.00,$0.00,$0.00,$0.00,$0.00,$44.00,$0.00,$22.00,$34.85,$35.20,$0.00,$0.00,$0.00,$0.00,$0.00
5150-3-015,SUP,Custom 27203010,,5150-3-015  -  CLAMP SURG 15MM PIN YLW,$823.63,$0.00,$823.63,$0.00,$587.82,$0.00,$0.00,$0.00,$0.00,$0.00,$823.63,$0.00,$411.81,$652.31,$658.90,$0.00,$0.00,$0.00,$0.00,$0.00
5150-3-020,SUP,Custom 27203010,,5150-3-020  -  CLAMP EXFIX BLUE 20MM MNTB TRX PIN,"$1,157.75",$0.00,"$1,157.75",$0.00,$826.29,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,157.75",$0.00,$578.88,$916.94,$926.20,$0.00,$0.00,$0.00,$0.00,$0.00
5150-3-025,SUP,Custom 27203010,,5150-3-025  -  CLAMP EXFIX RED 25MM MNTB TRX PIN,"$1,273.25",$0.00,"$1,273.25",$0.00,$908.72,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,273.25",$0.00,$636.63,"$1,008.41","$1,018.60",$0.00,$0.00,$0.00,$0.00,$0.00
5150-3-065,SUP,Custom 27203010,,5150-3-065  -  CLAMP EXFIX YLW 15MM MNTB TRX 1 PIN,$969.38,$0.00,$969.38,$0.00,$691.84,$0.00,$0.00,$0.00,$0.00,$0.00,$969.38,$0.00,$484.69,$767.75,$775.50,$0.00,$0.00,$0.00,$0.00,$0.00
5150-3-070,SUP,Custom 27203010,,5150-3-070  -  CLAMP EXFIX BLUE 20MM MNTB TRX 1 PIN,"$1,692.63",$0.00,"$1,692.63",$0.00,"$1,208.03",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,692.63",$0.00,$846.31,"$1,340.56","$1,354.10",$0.00,$0.00,$0.00,$0.00,$0.00
5150-3-075,SUP,Custom 27203010,,5150-3-075  -  CLAMP EXFIX RED 25MM MNTB TRX 1 PIN,"$2,000.63",$0.00,"$2,000.63",$0.00,"$1,427.85",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,000.63",$0.00,"$1,000.31","$1,584.50","$1,600.50",$0.00,$0.00,$0.00,$0.00,$0.00
5150-3-165,SUP,Custom 27203010,,5150-3-165  -  CLAMP EXFIX YLW 15MM MNTB TRX 1 PIN,"$1,045.00",$0.00,"$1,045.00",$0.00,$745.82,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,045.00",$0.00,$522.50,$827.64,$836.00,$0.00,$0.00,$0.00,$0.00,$0.00
5150-3-170,SUP,Custom 27203010,,5150-3-170  -  CLAMP EXFIX BLUE 20MM MNTB TRX 1 PIN,"$1,073.88",$0.00,"$1,073.88",$0.00,$766.42,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,073.88",$0.00,$536.94,$850.51,$859.10,$0.00,$0.00,$0.00,$0.00,$0.00
5150-3-175,SUP,Custom 27203010,,5150-3-175  -  CLAMP EXFIX RED 25MM MNTB TRX 1 PIN,"$1,105.50",$0.00,"$1,105.50",$0.00,$789.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,105.50",$0.00,$552.75,$875.56,$884.40,$0.00,$0.00,$0.00,$0.00,$0.00
5150-3-315,SUP,Custom 27203010,,5150-3-315  -  CLAMP EXFIX YLW MNTB TRX SM T ASMBLY,"$1,278.75",$0.00,"$1,278.75",$0.00,$912.64,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,278.75",$0.00,$639.38,"$1,012.77","$1,023.00",$0.00,$0.00,$0.00,$0.00,$0.00
5150-3-320,SUP,Custom 27203010,,5150-3-320  -  T-CLAMP ASSEMBLY MED. (BLUE),"$1,362.63",$0.00,"$1,362.63",$0.00,$972.51,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,362.63",$0.00,$681.31,"$1,079.20","$1,090.10",$0.00,$0.00,$0.00,$0.00,$0.00
5150-3-415,SUP,Custom 27203010,,5150-3-415  -  CPLNG EXFIX YLW SM TUBE TO TUBE,"$1,344.75",$0.00,"$1,344.75",$0.00,$959.75,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,344.75",$0.00,$672.38,"$1,065.04","$1,075.80",$0.00,$0.00,$0.00,$0.00,$0.00
5150-3-420,SUP,Custom 27203010,,5150-3-420  -  CPLNG EXFIX BLUE MED TUBE TO TUBE,"$1,398.38",$0.00,"$1,398.38",$0.00,$998.02,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,398.38",$0.00,$699.19,"$1,107.52","$1,118.70",$0.00,$0.00,$0.00,$0.00,$0.00
5150-3-425,SUP,Custom 27203010,,5150-3-425  -  CPLNG EXFIX RED LG TUBE TO TUBE,"$1,414.88",$0.00,"$1,414.88",$0.00,"$1,009.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,414.88",$0.00,$707.44,"$1,120.58","$1,131.90",$0.00,$0.00,$0.00,$0.00,$0.00
5150-3-435,SUP,Custom 27203010,,5150-3-435  -  CPLNG EXFIX BLUE YLW S/MED TUBE TO TUBE,"$1,398.38",$0.00,"$1,398.38",$0.00,$998.02,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,398.38",$0.00,$699.19,"$1,107.52","$1,118.70",$0.00,$0.00,$0.00,$0.00,$0.00
5150-3-445,SUP,Custom 27203010,,5150-3-445  -  CPLNG EXFIX BLUE RED MED LG TUBE TO TUBE,"$1,414.88",$0.00,"$1,414.88",$0.00,"$1,009.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,414.88",$0.00,$707.44,"$1,120.58","$1,131.90",$0.00,$0.00,$0.00,$0.00,$0.00
5150-4-065,SUP,Custom 27203010,,5150-4-065  -  ADAPTER XTRNFX T 15MM YLW MNTB TRX PIN CLP,$676.50,$0.00,$676.50,$0.00,$482.82,$0.00,$0.00,$0.00,$0.00,$0.00,$676.50,$0.00,$338.25,$535.79,$541.20,$0.00,$0.00,$0.00,$0.00,$0.00
5150-4-070,SUP,Custom 27203010,,5150-4-070  -  CLAMP EXFIX BLUE 20MM MNTB TRX T ADPR,$702.63,$0.00,$702.63,$0.00,$501.46,$0.00,$0.00,$0.00,$0.00,$0.00,$702.63,$0.00,$351.31,$556.48,$562.10,$0.00,$0.00,$0.00,$0.00,$0.00
5150-4-075,SUP,Custom 27203010,,5150-4-075  -  CLAMP EXFIX RED 25MM MNTB TRX T ADPR,$719.13,$0.00,$719.13,$0.00,$513.24,$0.00,$0.00,$0.00,$0.00,$0.00,$719.13,$0.00,$359.56,$569.55,$575.30,$0.00,$0.00,$0.00,$0.00,$0.00
5150-5-020,SUP,Custom 27203010,,5150-5-020  -  HOLDER XTRNFX 20MM BLU MNTB TRX PIN,"$2,864.13",$0.00,"$2,864.13",$0.00,"$2,044.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,864.13",$0.00,"$1,432.06","$2,268.39","$2,291.30",$0.00,$0.00,$0.00,$0.00,$0.00
5150-5-025,SUP,Custom 27203010,,5150-5-025  -  HOLDER XTRNFX 25MM RD MNTB TRX PIN,"$2,864.13",$0.00,"$2,864.13",$0.00,"$2,044.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,864.13",$0.00,"$1,432.06","$2,268.39","$2,291.30",$0.00,$0.00,$0.00,$0.00,$0.00
5150-7-020,SUP,Custom 27203010,,5150-7-020  -  O RING XTRNFX YLW MNTB TRX,$24.08,$0.00,$24.08,$0.00,$17.18,$0.00,$0.00,$0.00,$0.00,$0.00,$24.08,$0.00,$12.04,$19.07,$19.26,$0.00,$0.00,$0.00,$0.00,$0.00
5150-9-465,SUP,Custom 27203010,,5150-9-465  -  DEVICE CMPR DSTRCT 15MM MNTB TRX YLW,"$1,696.75",$0.00,"$1,696.75",$0.00,"$1,210.97",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,696.75",$0.00,$848.38,"$1,343.83","$1,357.40",$0.00,$0.00,$0.00,$0.00,$0.00
5150-9-535,SUP,Custom 27203010,,5150-9-535  -  SLEEVE DRILL MNTB SM 3 MMBLOCKS,$220.00,$0.00,$220.00,$0.00,$157.01,$0.00,$0.00,$0.00,$0.00,$0.00,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$0.00,$0.00,$0.00,$0.00
5150-9-545,SUP,Custom 27203010,,5150-9-545  -  SLEEVE DRILL MNTB SM 4 MMBLOCKS,$220.00,$0.00,$220.00,$0.00,$157.01,$0.00,$0.00,$0.00,$0.00,$0.00,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$0.00,$0.00,$0.00,$0.00
5150-9-950,SUP,Custom 27203010,,5150-9-950  -  KIT EXFIX YLW MNTB STRL,"$2,715.63",$0.00,"$2,715.63",$0.00,"$1,938.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,715.63",$0.00,"$1,357.81","$2,150.78","$2,172.50",$0.00,$0.00,$0.00,$0.00,$0.00
5150-9-960,SUP,Custom 27203010,,5150-9-960  -  SET EXFIX YLW 310X130X36MM 15MM MNTB TRX 310MMX130MMX36MM,"$2,509.38",$0.00,"$2,509.38",$0.00,"$1,790.94",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,509.38",$0.00,"$1,254.69","$1,987.43","$2,007.50",$0.00,$0.00,$0.00,$0.00,$0.00
515-203,SUP,HCPCS C1713,,515-203  -  PLATE 18MM TI BONE SPNL,$91.73,$0.00,$91.73,$41.28,$65.46,$0.00,$15.80,$0.00,$0.00,$16.06,$91.73,$0.00,$45.86,$72.65,$73.38,$0.00,$14.35,$0.00,$14.60,$0.00
515-204,SUP,HCPCS C1713,,515-204  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$91.73,$0.00,$91.73,$41.28,$65.46,$0.00,$15.80,$0.00,$0.00,$16.06,$91.73,$0.00,$45.86,$72.65,$73.38,$0.00,$14.35,$0.00,$14.60,$0.00
515-205,SUP,HCPCS C1713,,515-205  -  PLATE 18MM TI BONE SPNL,$96.33,$0.00,$96.33,$43.35,$68.75,$0.00,$16.60,$0.00,$0.00,$16.87,$96.33,$0.00,$48.16,$76.29,$77.06,$0.00,$15.07,$0.00,$15.33,$0.00
515-206,SUP,HCPCS C1713,,515-206  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$97.75,$0.00,$97.75,$43.99,$69.76,$0.00,$16.84,$0.00,$0.00,$17.12,$97.75,$0.00,$48.88,$77.42,$78.20,$0.00,$15.30,$0.00,$15.56,$0.00
515-633,SUP,HCPCS C1781,,515-633  -  PLATE 18MM TI BONE SPNL,$813.88,$0.00,$813.88,$366.24,$580.86,$0.00,$140.23,$0.00,$0.00,$142.50,$813.88,$0.00,$406.94,$644.59,$651.10,$0.00,$127.37,$0.00,$129.57,$0.00
5157M/S,SUP,HCPCS C1786,,5157M/S  -  PACEMAKER CARDIAC THK6MM 52X42MM 1 CHAMBER RATE RESPONSIVE,"$7,425.00",$0.00,"$7,425.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,425.00",$0.00,"$3,712.50","$5,880.60","$5,940.00",$0.00,$0.00,$0.00,$0.00,$0.00
51-672-01-09,SUP,Custom 27803010,,51-672-01-09  -  ROD EXFIX FULL PREBENT MANDIB,"$1,843.58",$0.00,"$1,843.58",$0.00,"$1,315.76",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,843.58",$0.00,$921.79,"$1,460.12","$1,474.86",$0.00,$0.00,$0.00,$0.00,$0.00
51-672-05-09,SUP,Custom 27803010,,51-672-05-09  -  ROD EXFIX .5 PREBENT MANDIB,"$1,317.25",$0.00,"$1,317.25",$0.00,$940.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,317.25",$0.00,$658.63,"$1,043.26","$1,053.80",$0.00,$0.00,$0.00,$0.00,$0.00
51-673-09-09,SUP,Custom 27803010,,51-673-09-09  -  PIN XTRNFX 4MM 2.7MM 80MM LF 9MM X-FX THRD TI CRNMXF,$543.05,$0.00,$543.05,$0.00,$387.57,$0.00,$0.00,$0.00,$0.00,$0.00,$543.05,$0.00,$271.53,$430.10,$434.44,$0.00,$0.00,$0.00,$0.00,$0.00
51-673-13-09,SUP,Custom 27803010,,51-673-13-09  -  PIN XTRNFX 4MM 2.7MM 80MM LF 13MM X-FX THRD TI CRNMXF,$543.05,$0.00,$543.05,$0.00,$387.57,$0.00,$0.00,$0.00,$0.00,$0.00,$543.05,$0.00,$271.53,$430.10,$434.44,$0.00,$0.00,$0.00,$0.00,$0.00
518-032,SUP,HCPCS C1887,,518-032  -  CATH GUID .014IN 6FR 5MM 135CM GWIRE RADIOPQ MRKR STRL QKCRS,$430.00,$0.00,$430.00,$233.49,$306.89,$0.00,$74.09,$0.00,$0.00,$75.29,$430.00,$0.00,$215.00,$340.56,$344.00,$0.00,$67.30,$0.00,$68.46,$0.00
518-033,SUP,HCPCS C1887,,518-033  -  CATH GUID .018IN 3.4-2.2FR 90CM LOW CX PRFL 3 RADIOPQ MRKR,$430.00,$0.00,$430.00,$233.49,$306.89,$0.00,$74.09,$0.00,$0.00,$75.29,$430.00,$0.00,$215.00,$340.56,$344.00,$0.00,$67.30,$0.00,$68.46,$0.00
518-034,SUP,HCPCS C1887,,518-034  -  CATH GUID .018IN 3.4-2.3FR 135CM RADIOPQ MRKR GWIRE SHFT,$430.00,$0.00,$430.00,$233.49,$306.89,$0.00,$74.09,$0.00,$0.00,$75.29,$430.00,$0.00,$215.00,$340.56,$344.00,$0.00,$67.30,$0.00,$68.46,$0.00
518-035,SUP,HCPCS C1887,,518-035  -  CATH GUID .018IN 15MM SPC 1.8FR 150CM RADIOPQ MRKR SMLS LP,$430.00,$0.00,$430.00,$233.49,$306.89,$0.00,$74.09,$0.00,$0.00,$75.29,$430.00,$0.00,$215.00,$340.56,$344.00,$0.00,$67.30,$0.00,$68.46,$0.00
518-036,SUP,HCPCS C1887,,518-036  -  CATHETER GUID .035IN 4.8-3.7FR 90CM LOW CROSSING PROFILE 3,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
518-037,SUP,HCPCS C1887,,518-037  -  CATH GUID .035IN 50MM SPC 3.1FR 135CM RADIOPQ MRKR SMLS LP,$430.00,$0.00,$430.00,$233.49,$306.89,$0.00,$74.09,$0.00,$0.00,$75.29,$430.00,$0.00,$215.00,$340.56,$344.00,$0.00,$67.30,$0.00,$68.46,$0.00
518-038,SUP,HCPCS C1887,,518-038  -  CATHETER GUID .035IN 5MM SPACING 3.1FR 150CM LP TAPERED TIP,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
518-065,SUP,HCPCS C1887,,518-065  -  CATH GUID .014IN 3-1.9FR 150CM 3 RADIOPQ MRKR LOW CX PRFL,$430.00,$0.00,$430.00,$233.49,$306.89,$0.00,$74.09,$0.00,$0.00,$75.29,$430.00,$0.00,$215.00,$340.56,$344.00,$0.00,$67.30,$0.00,$68.46,$0.00
518-066,SUP,HCPCS C1887,,518-066  -  CATH GUID .035IN 4.8-3.7FR 65CM LOW CX PRFL 3 RADIOPQ MRKR,$430.00,$0.00,$430.00,$233.49,$306.89,$0.00,$74.09,$0.00,$0.00,$75.29,$430.00,$0.00,$215.00,$340.56,$344.00,$0.00,$67.30,$0.00,$68.46,$0.00
518-076,SUP,HCPCS C1887,,518-076  -  CATH GUID .035IN 50MM SPC 4.5FR 65CM STR TIP RADIOPQ MRKR,$507.50,$0.00,$507.50,$275.57,$362.20,$0.00,$87.44,$0.00,$0.00,$88.86,$507.50,$0.00,$253.75,$401.94,$406.00,$0.00,$79.42,$0.00,$80.79,$0.00
518-077,SUP,HCPCS C1887,,518-077  -  CATH GUID .035IN 4FR 65CM ANG TIP QKCRS,$507.50,$0.00,$507.50,$275.57,$362.20,$0.00,$87.44,$0.00,$0.00,$88.86,$507.50,$0.00,$253.75,$401.94,$406.00,$0.00,$79.42,$0.00,$80.79,$0.00
518-078,SUP,HCPCS C1887,,518-078  -  CATH GUID .035IN 50MM SPC 4.5FR 90CM 70CM STR TIP RADIOPQ,$507.50,$0.00,$507.50,$275.57,$362.20,$0.00,$87.44,$0.00,$0.00,$88.86,$507.50,$0.00,$253.75,$401.94,$406.00,$0.00,$79.42,$0.00,$80.79,$0.00
518-079,SUP,HCPCS C1887,,518-079  -  CATH GUID .035IN 4FR 90CM SPRT ANG TIP QKCRS,$507.50,$0.00,$507.50,$275.57,$362.20,$0.00,$87.44,$0.00,$0.00,$88.86,$507.50,$0.00,$253.75,$401.94,$406.00,$0.00,$79.42,$0.00,$80.79,$0.00
518-080,SUP,HCPCS C1887,,518-080  -  CATHETER SPRT .035IN STRG 135CM QKCRS,$507.50,$0.00,$507.50,$275.57,$362.20,$0.00,$87.44,$0.00,$0.00,$88.86,$507.50,$0.00,$253.75,$401.94,$406.00,$0.00,$79.42,$0.00,$80.79,$0.00
518-081,SUP,HCPCS C1887,,518-081  -  CATH GUID 45D 50MM SPC LP .052-.059IN 135CM 7MM LV 3 RADIOPQ,$507.50,$0.00,$507.50,$275.57,$362.20,$0.00,$87.44,$0.00,$0.00,$88.86,$507.50,$0.00,$253.75,$401.94,$406.00,$0.00,$79.42,$0.00,$80.79,$0.00
518-082,SUP,HCPCS C1887,,518-082  -  CATH GUID .035IN 50MM SPC 4.5FR 150CM 130CM STR TIP RADIOPQ,$507.50,$0.00,$507.50,$275.57,$362.20,$0.00,$87.44,$0.00,$0.00,$88.86,$507.50,$0.00,$253.75,$401.94,$406.00,$0.00,$79.42,$0.00,$80.79,$0.00
518-083,SUP,HCPCS C1887,,518-083  -  CATH GUID .035IN 4FR 150CM 3 RADIOPQ MRKR SPRT ANG TIP,$507.50,$0.00,$507.50,$275.57,$362.20,$0.00,$87.44,$0.00,$0.00,$88.86,$507.50,$0.00,$253.75,$401.94,$406.00,$0.00,$79.42,$0.00,$80.79,$0.00
518-084,SUP,HCPCS C1887,,518-084  -  CATHETER GD 15MM SPC 1.9FR 135CM STRL QKCRS XTRM RADOPQ,$507.50,$0.00,$507.50,$275.57,$362.20,$0.00,$87.44,$0.00,$0.00,$88.86,$507.50,$0.00,$253.75,$401.94,$406.00,$0.00,$79.42,$0.00,$80.79,$0.00
518-085,SUP,HCPCS C1887,,518-085  -  CATH GUID 45D .014IN 15MM SPC 3.2FR 135CM 100CM ANG TIP,$507.50,$0.00,$507.50,$275.57,$362.20,$0.00,$87.44,$0.00,$0.00,$88.86,$507.50,$0.00,$253.75,$401.94,$406.00,$0.00,$79.42,$0.00,$80.79,$0.00
518-086,SUP,HCPCS C1887,,518-086  -  CATH GUID .014IN 15MM SPC 3.2FR 150CM 100CM STR TIP RADIOPQ,$507.50,$0.00,$507.50,$275.57,$362.20,$0.00,$87.44,$0.00,$0.00,$88.86,$507.50,$0.00,$253.75,$401.94,$406.00,$0.00,$79.42,$0.00,$80.79,$0.00
518-087,SUP,HCPCS C1887,,518-087  -  CATH GUID .014IN 150CM 3 RADIOPQ MRKR LOW CX PRFL SPRT QKCRS,$507.50,$0.00,$507.50,$275.57,$362.20,$0.00,$87.44,$0.00,$0.00,$88.86,$507.50,$0.00,$253.75,$401.94,$406.00,$0.00,$79.42,$0.00,$80.79,$0.00
518-088,SUP,HCPCS C1887,,518-088  -  CATH GUID .018IN 15MM SPC 3.4FR 90CM 60CM STR TIP RADIOPQ,$507.50,$0.00,$507.50,$275.57,$362.20,$0.00,$87.44,$0.00,$0.00,$88.86,$507.50,$0.00,$253.75,$401.94,$406.00,$0.00,$79.42,$0.00,$80.79,$0.00
518-089,SUP,HCPCS C1887,,518-089  -  CATH GUID .018IN 15MM SPC 3.4FR 90CM 60CM ANG TIP RADIOPQ,$507.50,$0.00,$507.50,$275.57,$362.20,$0.00,$87.44,$0.00,$0.00,$88.86,$507.50,$0.00,$253.75,$401.94,$406.00,$0.00,$79.42,$0.00,$80.79,$0.00
518-090,SUP,HCPCS C1887,,518-090  -  CATH GUID .018IN 15MM SPC 3.2FR 135CM 100CM STR TIP RADIOPQ,$507.50,$0.00,$507.50,$275.57,$362.20,$0.00,$87.44,$0.00,$0.00,$88.86,$507.50,$0.00,$253.75,$401.94,$406.00,$0.00,$79.42,$0.00,$80.79,$0.00
518-091,SUP,HCPCS C1887,,518-091  -  CATH GUID .018IN 15MM SPC 3.4FR 135CM 100CM ANG TIP RADIOPQ,$507.50,$0.00,$507.50,$275.57,$362.20,$0.00,$87.44,$0.00,$0.00,$88.86,$507.50,$0.00,$253.75,$401.94,$406.00,$0.00,$79.42,$0.00,$80.79,$0.00
518-092,SUP,HCPCS C1887,,518-092  -  CATH GUID .018IN 15MM SPC 3.4FR 150CM 100CM STR TIP RADIOPQ,$507.50,$0.00,$507.50,$275.57,$362.20,$0.00,$87.44,$0.00,$0.00,$88.86,$507.50,$0.00,$253.75,$401.94,$406.00,$0.00,$79.42,$0.00,$80.79,$0.00
5181302P2,SUP,HCPCS C1713,,5181302P2  -  CAGE SPNL 12D 30X8X11MM NS CRNT PEEK ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5181308P2,SUP,HCPCS C1713,,5181308P2  -  CAGE SPNL 8D 30X8X11MM NS CRNT PEEK ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
518-203,SUP,HCPCS C1713,,518-203  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$96.33,$0.00,$96.33,$43.35,$68.75,$0.00,$16.60,$0.00,$0.00,$16.87,$96.33,$0.00,$48.16,$76.29,$77.06,$0.00,$15.07,$0.00,$15.33,$0.00
518-205,SUP,HCPCS C1713,,518-205  -  PLATE 18MM TI BONE SPNL,$96.33,$0.00,$96.33,$43.35,$68.75,$0.00,$16.60,$0.00,$0.00,$16.87,$96.33,$0.00,$48.16,$76.29,$77.06,$0.00,$15.07,$0.00,$15.33,$0.00
518-306,SUP,HCPCS C1713,,518-306  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$79.70,$0.00,$79.70,$35.87,$56.88,$0.00,$13.73,$0.00,$0.00,$13.95,$79.70,$0.00,$39.85,$63.12,$63.76,$0.00,$12.47,$0.00,$12.69,$0.00
5184308P2,SUP,HCPCS C1713,,5184308P2  -  CAGE SPNL 8D 30X8X14MM NS CRNT PEEK ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5189302P2,SUP,HCPCS C1713,,5189302P2  -  CAGE SPNL 12D 30X8X9MM NS CRNT PEEK ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5189308P2,SUP,HCPCS C1713,,5189308P2  -  CAGE SPNL 8D 30X8X9MM NS CRNT PEEK ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5190-0-010,SUP,Custom 27203010,,5190-0-010  -  SET ORTH Y BODY ASMBLY,"$1,588.13",$0.00,"$1,588.13",$0.00,"$1,133.44",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,588.13",$0.00,$794.06,"$1,257.80","$1,270.50",$0.00,$0.00,$0.00,$0.00,$0.00
5190-0-020,SUP,Custom 27203010,,5190-0-020  -  CPLNG EXFIX PIN TO ROD,$598.13,$0.00,$598.13,$0.00,$426.88,$0.00,$0.00,$0.00,$0.00,$0.00,$598.13,$0.00,$299.06,$473.72,$478.50,$0.00,$0.00,$0.00,$0.00,$0.00
5190-0-110,SUP,Custom 27203010,,5190-0-110  -  SET ORTH STR BODY ASMBLY,"$1,051.88",$0.00,"$1,051.88",$0.00,$750.72,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,051.88",$0.00,$525.94,$833.09,$841.50,$0.00,$0.00,$0.00,$0.00,$0.00
5190-0-200,SUP,HCPCS C1713,,5190-0-200  -  PIN STOP COLLAR DSTRCT,$240.63,$0.00,$240.63,$108.28,$171.73,$0.00,$41.46,$0.00,$0.00,$42.13,$240.63,$0.00,$120.31,$190.58,$192.50,$0.00,$37.66,$0.00,$38.31,$0.00
5190-0-210,SUP,Custom 27203010,,5190-0-210  -  ROD EXFIX STR THRD,$130.63,$0.00,$130.63,$0.00,$93.23,$0.00,$0.00,$0.00,$0.00,$0.00,$130.63,$0.00,$65.31,$103.46,$104.50,$0.00,$0.00,$0.00,$0.00,$0.00
5191302P2,SUP,HCPCS C1713,,5191302P2  -  CAGE SPNL 12D 30X11X9MM NS CRNT PEEK ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5191308P2,SUP,HCPCS C1713,,5191308P2  -  CAGE SPNL 8D 30X11X9MM NS CRNT PEEK ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5195-000-010,SUP,Custom 27203010,,5195-000-010  -  BODY XTRNFX NS DJD II CMPNT,"$3,081.38",$0.00,"$3,081.38",$0.00,"$2,199.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,081.38",$0.00,"$1,540.69","$2,440.45","$2,465.10",$0.00,$0.00,$0.00,$0.00,$0.00
5195-1-011,SUP,Custom 27203010,,5195-1-011  -  SCREW XTRNFX DJD II GD HUM,$70.13,$0.00,$70.13,$0.00,$50.05,$0.00,$0.00,$0.00,$0.00,$0.00,$70.13,$0.00,$35.06,$55.54,$56.10,$0.00,$0.00,$0.00,$0.00,$0.00
5195-1-020,SUP,Custom 27203010,,5195-1-020  -  DRILL SURG OSTEOSTAT STRL,$158.13,$0.00,$158.13,$0.00,$112.85,$0.00,$0.00,$0.00,$0.00,$0.00,$158.13,$0.00,$79.06,$125.24,$126.50,$0.00,$0.00,$0.00,$0.00,$0.00
5195-1-030,SUP,Custom 27203010,,5195-1-030  -  GUIDE 4MM HING INS DJD 2 SURG DYNMC ELB JNT DISTRCT,$158.13,$0.00,$158.13,$0.00,$112.85,$0.00,$0.00,$0.00,$0.00,$0.00,$158.13,$0.00,$79.06,$125.24,$126.50,$0.00,$0.00,$0.00,$0.00,$0.00
5195-1-035,SUP,Custom 27203010,,5195-1-035  -  GUIDE FOR HALF-PINS,$158.13,$0.00,$158.13,$0.00,$112.85,$0.00,$0.00,$0.00,$0.00,$0.00,$158.13,$0.00,$79.06,$125.24,$126.50,$0.00,$0.00,$0.00,$0.00,$0.00
5199302P2,SUP,HCPCS C1713,,5199302P2  -  CAGE SPNL 12D 30X9X9MM NS CRNT PEEK ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5199308P2,SUP,HCPCS C1713,,5199308P2  -  CAGE SPNL 8D 30X9X9MM NS CRNT PEEK ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5201300P2,SUP,HCPCS C1713,,5201300P2  -  CAGE SPNL 0D 30X10X11MM NS CRNT TI ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5201302P2,SUP,HCPCS C1713,,5201302P2  -  CAGE SPNL 12D 30X10X11MM NS CRNT TI ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5201308P2,SUP,HCPCS C1713,,5201308P2  -  CAGE SPNL 8D 30X10X11MM NS CRNT TI ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
52-022-01,SUP,Custom 27203010,,52-022-01  -  DRILL BIT 2.7,$260.40,$0.00,$260.40,$0.00,$185.85,$0.00,$0.00,$0.00,$0.00,$0.00,$260.40,$0.00,$130.20,$206.24,$208.32,$0.00,$0.00,$0.00,$0.00,$0.00
5204300P2,SUP,HCPCS C1713,,5204300P2  -  CAGE SPNL 0D 30X10X14MM NS CRNT TI ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5204308P2,SUP,HCPCS C1713,,5204308P2  -  CAGE SPNL 8D 30X10X14MM NS CRNT TI ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5209300P2,SUP,HCPCS C1713,,5209300P2  -  CAGE SPNL 0D 30X10X9MM NS CRNT TI ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5209302P2,SUP,HCPCS C1713,,5209302P2  -  CAGE SPNL 12D 30X10X9MM NS CRNT TI ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5209308P2,SUP,HCPCS C1713,,5209308P2  -  CAGE SPNL 8D 30X10X9MM NS CRNT TI ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5210-3-165,SUP,HCPCS C1713,,5210-3-165  -  SCREW BONE 5MM 65MM FULTHD,$203.50,$0.00,$203.50,$91.58,$145.24,$0.00,$35.06,$0.00,$0.00,$35.63,$203.50,$0.00,$101.75,$161.17,$162.80,$0.00,$31.85,$0.00,$32.40,$0.00
5210-3-190,SUP,HCPCS C1713,,5210-3-190  -  SCREW BONE 5MM 90MM FULTHD,$203.50,$0.00,$203.50,$91.58,$145.24,$0.00,$35.06,$0.00,$0.00,$35.63,$203.50,$0.00,$101.75,$161.17,$162.80,$0.00,$31.85,$0.00,$32.40,$0.00
5211300P2,SUP,HCPCS C1713,,5211300P2  -  CAGE SPNL 0D 30X11X11MM NS CRNT TI ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5211302P2,SUP,HCPCS C1713,,5211302P2  -  CAGE SPNL 12D 30X11X11MM NS CRNT TI ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5211308P2,SUP,HCPCS C1713,,5211308P2  -  CAGE SPNL 8D 30X11X11MM NS CRNT TI ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5213-42,SUP,HCPCS C1776,,5213-42  -  COMPONENT GLENOID 40MM 42MM UHMWPE STERILE,"$2,055.08",$0.00,"$2,055.08",$924.78,"$1,466.71",$0.00,$354.08,$0.00,$0.00,$359.83,"$2,055.08",$0.00,"$1,027.54","$1,627.62","$1,644.06",$0.00,$321.62,$0.00,$327.17,$0.00
5213-44,SUP,HCPCS C1776,,5213-44  -  SOCKET GLENOID 44MM SHOULDER STERILE,"$2,055.08",$0.00,"$2,055.08",$924.78,"$1,466.71",$0.00,$354.08,$0.00,$0.00,$359.83,"$2,055.08",$0.00,"$1,027.54","$1,627.62","$1,644.06",$0.00,$321.62,$0.00,$327.17,$0.00
5213-46,SUP,HCPCS C1776,,5213-46  -  COMPONENT GLENOID 46MM UHMWPE STERILE,"$2,055.08",$0.00,"$2,055.08",$924.78,"$1,466.71",$0.00,$354.08,$0.00,$0.00,$359.83,"$2,055.08",$0.00,"$1,027.54","$1,627.62","$1,644.06",$0.00,$321.62,$0.00,$327.17,$0.00
5213-48,SUP,HCPCS C1776,,5213-48  -  COMPONENT GLENOID 48MM UHMWPE NONSTRL,"$2,055.08",$0.00,"$2,055.08",$924.78,"$1,466.71",$0.00,$354.08,$0.00,$0.00,$359.83,"$2,055.08",$0.00,"$1,027.54","$1,627.62","$1,644.06",$0.00,$321.62,$0.00,$327.17,$0.00
5213-50,SUP,HCPCS C1776,,5213-50  -  COMPONENT GLENOID 50MM UHMWPE NONSTRL,"$2,055.08",$0.00,"$2,055.08",$924.78,"$1,466.71",$0.00,$354.08,$0.00,$0.00,$359.83,"$2,055.08",$0.00,"$1,027.54","$1,627.62","$1,644.06",$0.00,$321.62,$0.00,$327.17,$0.00
5213-52,SUP,HCPCS C1776,,5213-52  -  COMPONENT GLENOID 52MM UHMWPE STERILE,"$2,055.08",$0.00,"$2,055.08",$924.78,"$1,466.71",$0.00,$354.08,$0.00,$0.00,$359.83,"$2,055.08",$0.00,"$1,027.54","$1,627.62","$1,644.06",$0.00,$321.62,$0.00,$327.17,$0.00
5213-54,SUP,HCPCS C1776,,5213-54  -  SOCKET GLENOID 54MM SHOULDER STERILE,"$2,094.83",$0.00,"$2,094.83",$942.67,"$1,495.08",$0.00,$360.93,$0.00,$0.00,$366.79,"$2,094.83",$0.00,"$1,047.41","$1,659.11","$1,675.86",$0.00,$327.84,$0.00,$333.50,$0.00
5213-56,SUP,HCPCS C1776,,5213-56  -  COMPONENT GLENOID 56MM UHMWPE STERILE,"$2,094.83",$0.00,"$2,094.83",$942.67,"$1,495.08",$0.00,$360.93,$0.00,$0.00,$366.79,"$2,094.83",$0.00,"$1,047.41","$1,659.11","$1,675.86",$0.00,$327.84,$0.00,$333.50,$0.00
5213-58,SUP,HCPCS C1776,,5213-58  -  COMPONENT GLENOID 58MM UHMWPE STERILE,"$2,094.83",$0.00,"$2,094.83",$942.67,"$1,495.08",$0.00,$360.93,$0.00,$0.00,$366.79,"$2,094.83",$0.00,"$1,047.41","$1,659.11","$1,675.86",$0.00,$327.84,$0.00,$333.50,$0.00
5219300P2,SUP,HCPCS C1713,,5219300P2  -  CAGE SPNL 0D 30X11X9MM NS CRNT TI ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5219302P2,SUP,HCPCS C1713,,5219302P2  -  CAGE SPNL 12D 30X11X9MM NS CRNT TI ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5219308P2,SUP,HCPCS C1713,,5219308P2  -  CAGE SPNL 8D 30X11X9MM NS CRNT TI ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
52-20358,SUP,HCPCS C1713,,52-20358  -  SCREW BONE 2MM 8MM SLFTAP XFIT TITANIUM INTERMAXILLARY,$437.50,$0.00,$437.50,$196.88,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
52-20364,SUP,HCPCS C1713,,52-20364  -  SCREW BONE 2MM 14MM SLFTAP XFIT CROSS-FIT TITANIUM,$437.50,$0.00,$437.50,$196.88,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
52-20616,SUP,HCPCS C1713,,52-20616  -  PEG 2MM 16MM DISTAL RADL LCK XPIN TI VARIAX NONSTRL,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
52-20618,SUP,HCPCS C1713,,52-20618  -  PEG FIX 2MM 18MM DISTAL RADL LCK VARIAX,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
52-20618E,SUP,HCPCS C1713,,52-20618E  -  PEG 2MM 18MM DISTAL RADL LCK XPIN TI VARIAX STRL,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
52-20620,SUP,HCPCS C1713,,52-20620  -  PEG FIX 2MM 20MM DISTAL RADL LCK VARIAX,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
52-20622,SUP,HCPCS C1713,,52-20622  -  PEG 2MM 22MM RADL LCK TI,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
52-20624,SUP,HCPCS C1713,,52-20624  -  PEG 2MM 24MM DISTAL RADL LCK XPIN TI VARIAX NONSTRL,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
52-20626,SUP,HCPCS C1713,,52-20626  -  PEG 2MM 26MM RADL LCK TI,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
5221300P2,SUP,HCPCS C1713,,5221300P2  -  CAGE SPNL 0D 30X12X11MM NS CRNT TI ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5221302P2,SUP,HCPCS C1713,,5221302P2  -  CAGE SPNL 12D 30X12X11MM NS CRNT TI ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5221308P2,SUP,HCPCS C1713,,5221308P2  -  CAGE SPNL 8D 30X12X11MM NS CRNT TI ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
52-23010,SUP,HCPCS C1713,,52-23010  -  SCREW BN 2.3MM 10MM VARIAX ST XPN TI DIST RDS LCK PLT SYS,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
52-23010E,SUP,HCPCS C1713,,52-23010E  -  SCREW BONE 2.3MM 10MM VARIAX TI DISTAL RADL HAND XPIN STRL,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
52-23012,SUP,HCPCS C1713,,52-23012  -  SCREW BONE 2.3MM 12MM TI RADL SLFTAP XPIN,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
52-23012E,SUP,HCPCS C1713,,52-23012E  -  SCREW BONE 2.3MM 12MM VARIAX TI DISTAL RADL HAND XPIN STRL,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
52-23014,SUP,HCPCS C1713,,52-23014  -  SCREW BONE 2.3MM 14MM SMARTLOCK VARIAX TI DISTAL RADL SLFTAP,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
52-23016,SUP,HCPCS C1713,,52-23016  -  SCREW BONE 2.3MM 16MM VARIAX TI DISTAL RAD XPIN,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
52-23016E,SUP,HCPCS C1713,,52-23016E  -  SCREW BONE 2.3MM 16MM VARIAX TI DISTAL RADL HAND XPIN STRL,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
52-23018,SUP,HCPCS C1713,,52-23018  -  SCREW BONE 2.3MM 18MM VARIAX TI DISTAL RADL LCK,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
52-23018E,SUP,HCPCS C1713,,52-23018E  -  SCREW BONE 2.3MM 18MM VARIAX TI DISTAL RADL HAND XPIN STRL,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
52-23020E,SUP,HCPCS C1713,,52-23020E  -  SCREW BONE 2.3MM 20MM VARIAX TI DISTAL RADL HAND XPIN STRL,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
52-23022,SUP,HCPCS C1713,,52-23022  -  SCREW BONE 2.3MM 22MM VARIAX TI DISTAL RAD LCK XPIN,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
52-23022E,SUP,HCPCS C1713,,52-23022E  -  SCREW BONE 2.3MM 22MM VARIAX TI ORTH LCK,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
52-23024,SUP,HCPCS C1713,,52-23024  -  SCREW TI 24MM 2.3MM MAXFACL LCK XPIN BONE VARIAX DISTAL RAD,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
52-23024E,SUP,HCPCS C1713,,52-23024E  -  SCREW BONE 2.3MM 24MM VARIAX TI LCK STRL,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
52-23026,SUP,HCPCS C1713,,52-23026  -  SCREW BONE 2.3MM 26MM SMARTLOCK TI RADL,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
52-23028,SUP,HCPCS C1713,,52-23028  -  SCREW BN 2.3MM 28MM VARIAX LCK TI DIST RADL,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
52-23028E,SUP,HCPCS C1713,,52-23028E  -  SCREW BN XPN BLNT 2.3MM 28MM STRL VARIAX OPTM AX STAB TI RDS,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
52-23030,SUP,HCPCS C1713,,52-23030  -  SCREW BONE 2.3MM 30MM VARIAX TI DISTAL RADL LCK,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
52-23030E,SUP,HCPCS C1713,,52-23030E  -  SCREW BONE 2.3MM 30MM VARIAX TI LCK STRL,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
52-23032,SUP,HCPCS C1713,,52-23032  -  SCREW BONE 2.3MM 32MM VARIAX TI DISTAL RADL LCK,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
52-23032E,SUP,HCPCS C1713,,52-23032E  -  SCREW BONE 2.3MM 32MM VARIAX TI RADL XPIN STRL,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
52-23034,SUP,HCPCS C1713,,52-23034  -  SCREW BONE 2.3MM 34MM VARIAX TI DISTAL RADL LCK,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
52-23034E,SUP,HCPCS C1713,,52-23034E  -  SCREW BONE 2.3MM 34MM VARIAX TI RADL XPIN STRL,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
52-23036,SUP,HCPCS C1713,,52-23036  -  SCREW BONE 2.3MM 36MM VARIAX TI DISTAL RADL LCK,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
52-23036E,SUP,HCPCS C1713,,52-23036E  -  SCREW BONE 2.3MM 36MM VARIAX TI RADL XPIN STRL,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
52-23038,SUP,HCPCS C1713,,52-23038  -  SCREW BONE 2.3MM 38MM VARIAX TI DISTAL RADL LCK,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
52-23038E,SUP,HCPCS C1713,,52-23038E  -  SCREW BONE 2.3MM 38MM VARIAX TI RADL XPIN STRL,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
52-23610,SUP,HCPCS C1713,,52-23610  -  SCREW BONE 2.3MM 10MM SMARTLOCK TI RADL LCK,$144.38,$0.00,$144.38,$64.97,$103.04,$0.00,$24.88,$0.00,$0.00,$25.28,$144.38,$0.00,$72.19,$114.35,$115.50,$0.00,$22.59,$0.00,$22.98,$0.00
52-23610E,SUP,HCPCS C1713,,52-23610E  -  SCREW BONE 2.3MM 10MM TI LCK STRL,$144.38,$0.00,$144.38,$64.97,$103.04,$0.00,$24.88,$0.00,$0.00,$25.28,$144.38,$0.00,$72.19,$114.35,$115.50,$0.00,$22.59,$0.00,$22.98,$0.00
52-23612,SUP,HCPCS C1713,,52-23612  -  SCREW BONE 2.3MM 12MM SMARTLOCK TI RADL LCK,$144.38,$0.00,$144.38,$64.97,$103.04,$0.00,$24.88,$0.00,$0.00,$25.28,$144.38,$0.00,$72.19,$114.35,$115.50,$0.00,$22.59,$0.00,$22.98,$0.00
52-23612E,SUP,HCPCS C1713,,52-23612E  -  SCREW BONE 2.3MM 12MM LCK,$144.38,$0.00,$144.38,$64.97,$103.04,$0.00,$24.88,$0.00,$0.00,$25.28,$144.38,$0.00,$72.19,$114.35,$115.50,$0.00,$22.59,$0.00,$22.98,$0.00
52-23614,SUP,HCPCS C1713,,52-23614  -  SCREW BONE 2.3MM 14MM VARIAX TI DISTAL RADL LCK XPIN,$144.38,$0.00,$144.38,$64.97,$103.04,$0.00,$24.88,$0.00,$0.00,$25.28,$144.38,$0.00,$72.19,$114.35,$115.50,$0.00,$22.59,$0.00,$22.98,$0.00
52-23614E,SUP,HCPCS C1713,,52-23614E  -  SCREW BONE 2.3MM 14MM VARIAX TI DISTAL RADL XPIN LCK PLT SYS,$144.38,$0.00,$144.38,$64.97,$103.04,$0.00,$24.88,$0.00,$0.00,$25.28,$144.38,$0.00,$72.19,$114.35,$115.50,$0.00,$22.59,$0.00,$22.98,$0.00
52-23616,SUP,HCPCS C1713,,52-23616  -  SCREW BONE 2.3MM 16MM SMARTLOCK TI DISTAL RADL LCK,$144.38,$0.00,$144.38,$64.97,$103.04,$0.00,$24.88,$0.00,$0.00,$25.28,$144.38,$0.00,$72.19,$114.35,$115.50,$0.00,$22.59,$0.00,$22.98,$0.00
52-23616E,SUP,HCPCS C1713,,52-23616E  -  SCREW BONE 2.3MM 16MM VARIAX TI DISTAL RADL LCK XPIN,$144.38,$0.00,$144.38,$64.97,$103.04,$0.00,$24.88,$0.00,$0.00,$25.28,$144.38,$0.00,$72.19,$114.35,$115.50,$0.00,$22.59,$0.00,$22.98,$0.00
52-23618,SUP,HCPCS C1713,,52-23618  -  SCREW BONE 2.3MM 18MM VARIAX TI DISTAL RADL LCK XPIN,$144.38,$0.00,$144.38,$64.97,$103.04,$0.00,$24.88,$0.00,$0.00,$25.28,$144.38,$0.00,$72.19,$114.35,$115.50,$0.00,$22.59,$0.00,$22.98,$0.00
52-23618E,SUP,HCPCS C1713,,52-23618E  -  SCREW BONE 2.3MM 18MM VARIAX TI DISTAL RADL LCK XPIN,$144.38,$0.00,$144.38,$64.97,$103.04,$0.00,$24.88,$0.00,$0.00,$25.28,$144.38,$0.00,$72.19,$114.35,$115.50,$0.00,$22.59,$0.00,$22.98,$0.00
52-23620,SUP,HCPCS C1713,,52-23620  -  SCREW BONE 2.3MM 20MM SMARTLOCK VARIAX TI DISTAL RADL,$144.38,$0.00,$144.38,$64.97,$103.04,$0.00,$24.88,$0.00,$0.00,$25.28,$144.38,$0.00,$72.19,$114.35,$115.50,$0.00,$22.59,$0.00,$22.98,$0.00
52-23620E,SUP,HCPCS C1713,,52-23620E  -  SCREW BONE 2.3MM 20MM VARIAX TI DISTAL RADL XPIN LCK STRL,$144.38,$0.00,$144.38,$64.97,$103.04,$0.00,$24.88,$0.00,$0.00,$25.28,$144.38,$0.00,$72.19,$114.35,$115.50,$0.00,$22.59,$0.00,$22.98,$0.00
52-23622,SUP,HCPCS C1713,,52-23622  -  SCREW BONE 2.3MM 22MM SMARTLOCK VARIAX TI RADL LCK,$144.38,$0.00,$144.38,$64.97,$103.04,$0.00,$24.88,$0.00,$0.00,$25.28,$144.38,$0.00,$72.19,$114.35,$115.50,$0.00,$22.59,$0.00,$22.98,$0.00
52-23624,SUP,HCPCS C1713,,52-23624  -  SCREW BONE 2.3MM 24MM SMARTLOCK VARIAX TI RADL LCK,$144.38,$0.00,$144.38,$64.97,$103.04,$0.00,$24.88,$0.00,$0.00,$25.28,$144.38,$0.00,$72.19,$114.35,$115.50,$0.00,$22.59,$0.00,$22.98,$0.00
52-23626,SUP,HCPCS C1713,,52-23626  -  SCREW BONE 2.3MM 26MM SMARTLOCK TI DISTAL RADL LCK,$144.38,$0.00,$144.38,$64.97,$103.04,$0.00,$24.88,$0.00,$0.00,$25.28,$144.38,$0.00,$72.19,$114.35,$115.50,$0.00,$22.59,$0.00,$22.98,$0.00
52-23626E,SUP,HCPCS C1713,,52-23626E  -  SCREW BONE 2.3MM 26MM VARIAX TI DISTAL RADL LCK,$144.38,$0.00,$144.38,$64.97,$103.04,$0.00,$24.88,$0.00,$0.00,$25.28,$144.38,$0.00,$72.19,$114.35,$115.50,$0.00,$22.59,$0.00,$22.98,$0.00
52-23628,SUP,HCPCS C1713,,52-23628  -  SCREW BONE 2.3MM 28MM SMARTLOCK VARIAX TI DISTAL RADL LCK,$144.38,$0.00,$144.38,$64.97,$103.04,$0.00,$24.88,$0.00,$0.00,$25.28,$144.38,$0.00,$72.19,$114.35,$115.50,$0.00,$22.59,$0.00,$22.98,$0.00
52-23628E,SUP,HCPCS C1713,,52-23628E  -  PLATE 28MM TI LCK SYS VARIAX BONE 2.3MM DISTAL RADL,$144.38,$0.00,$144.38,$64.97,$103.04,$0.00,$24.88,$0.00,$0.00,$25.28,$144.38,$0.00,$72.19,$114.35,$115.50,$0.00,$22.59,$0.00,$22.98,$0.00
52-23630,SUP,HCPCS C1713,,52-23630  -  SCREW BONE 2.3MM 30MM VARIAX TI DISTAL RADL LCK,$144.38,$0.00,$144.38,$64.97,$103.04,$0.00,$24.88,$0.00,$0.00,$25.28,$144.38,$0.00,$72.19,$114.35,$115.50,$0.00,$22.59,$0.00,$22.98,$0.00
52-23632,SUP,HCPCS C1713,,52-23632  -  SCREW BONE 2.3MM 32MM SMARTLOCK TI RADL LCK,$144.38,$0.00,$144.38,$64.97,$103.04,$0.00,$24.88,$0.00,$0.00,$25.28,$144.38,$0.00,$72.19,$114.35,$115.50,$0.00,$22.59,$0.00,$22.98,$0.00
52-23634,SUP,HCPCS C1713,,52-23634  -  SCREW BONE 2.3MM 34MM VARIAX TI DISTAL RADL LCK,$144.38,$0.00,$144.38,$64.97,$103.04,$0.00,$24.88,$0.00,$0.00,$25.28,$144.38,$0.00,$72.19,$114.35,$115.50,$0.00,$22.59,$0.00,$22.98,$0.00
52-23636,SUP,HCPCS C1713,,52-23636  -  SCREW BONE 2.3MM 36MM TI RADL LCK,$144.38,$0.00,$144.38,$64.97,$103.04,$0.00,$24.88,$0.00,$0.00,$25.28,$144.38,$0.00,$72.19,$114.35,$115.50,$0.00,$22.59,$0.00,$22.98,$0.00
52-23638,SUP,HCPCS C1713,,52-23638  -  SCREW BONE 2.3MM 38MM TI RADL LCK,$144.38,$0.00,$144.38,$64.97,$103.04,$0.00,$24.88,$0.00,$0.00,$25.28,$144.38,$0.00,$72.19,$114.35,$115.50,$0.00,$22.59,$0.00,$22.98,$0.00
5224300P2,SUP,HCPCS C1713,,5224300P2  -  CAGE SPNL 0D 30X12X14MM NS CRNT TI ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5224308P2,SUP,HCPCS C1713,,5224308P2  -  CAGE SPNL 8D 30X12X14MM NS CRNT TI ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
52-27010,SUP,HCPCS C1713,,52-27010  -  SCREW BONE 2.7MM 10MM VARIAX TI DISTAL RADL XPIN NONSTRL,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
52-27010E,SUP,HCPCS C1713,,52-27010E  -  SCREW BONE 2.7MM 10MM VARIAX TI DISTAL RADL XPIN STRL,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
52-27012,SUP,HCPCS C1713,,52-27012  -  SCREW BONE 2.7MM 12MM VARIAX TI DISTAL RADL,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
52-27012E,SUP,HCPCS C1713,,52-27012E  -  SCREW BONE 2.7MM 12MM VARIAX TI DISTAL RADL,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
52-27014,SUP,HCPCS C1713,,52-27014  -  SCREW BONE 2.7MM 14MM VARIAX TI DISTAL RADL WR HND XPIN,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
52-27014E,SUP,HCPCS C1713,,52-27014E  -  SCREW BONE 2.7MM 14MM VARIAX TI DISTAL RADL WR HND XPIN,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
52-27016,SUP,HCPCS C1713,,52-27016  -  2.7X16MM BONE SCREW_ RADIUS,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
52-27016E,SUP,HCPCS C1713,,52-27016E  -  SCREW BONE 2.7MM 16MM VARIAX TI DISTAL RADL WR HND XPIN,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
52-27018,SUP,HCPCS C1713,,52-27018  -  SCREW BN 2.7MM 18MM VARIAX LCK TI DIST RADL,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
52-27018E,SUP,HCPCS C1713,,52-27018E  -  SCREW BN 2.7MM 18MM STRL VARIAX XPN NLCKG TI DIST RADL WR,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
52-27020,SUP,HCPCS C1713,,52-27020  -  SCREW BONE 2.7MM 20MM VARIAX TI DISTAL RADL XPIN STRL,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
52-27022,SUP,HCPCS C1713,,52-27022  -  SCREW BONE 2.7MM 22MM VARIAX TI DISTAL RADL XPIN NONSTRL,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
52-27022E,SUP,HCPCS C1713,,52-27022E  -  SCREW BONE 2.7MM 22MM SMARTLOCK TI CORT RADL LCK,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
52-27024,SUP,HCPCS C1713,,52-27024  -  SCREW BONE 2.7MM 24MM VARIAX TI DISTAL RADL XPIN NONSTRL,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
52-27024E,SUP,HCPCS C1713,,52-27024E  -  SCREW BONE 2.7MM 24MM SMARTLOCK TI CORT RADL LCK,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
52-27026,SUP,HCPCS C1713,,52-27026  -  SCREW BONE 2.7MM 26MM SMARTLOCK TI RADL XPIN STRL,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
52-27026E,SUP,HCPCS C1713,,52-27026E  -  SCREW BONE 2.7MM 26MM VARIAX TI DISTAL RADL XPIN STRL,$123.75,$0.00,$123.75,$55.69,$88.32,$0.00,$21.32,$0.00,$0.00,$21.67,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$19.37,$0.00,$19.70,$0.00
52-27116,SUP,HCPCS C1713,,52-27116  -  SCREW BN 2.7MM 16MM VARIAX LCK P/T TI DIST RADL,$144.38,$0.00,$144.38,$64.97,$103.04,$0.00,$24.88,$0.00,$0.00,$25.28,$144.38,$0.00,$72.19,$114.35,$115.50,$0.00,$22.59,$0.00,$22.98,$0.00
52-27116E,SUP,HCPCS C1713,,52-27116E  -  SCREW BN P/T 2.7MM 16MM VARIAX NLCKG XPN TI DIST RDS,$144.38,$0.00,$144.38,$64.97,$103.04,$0.00,$24.88,$0.00,$0.00,$25.28,$144.38,$0.00,$72.19,$114.35,$115.50,$0.00,$22.59,$0.00,$22.98,$0.00
52-27118,SUP,HCPCS C1713,,52-27118  -  SCREW BONE 2.7MM 18MM VARIAX TI DISTAL RADL PTTHRD XPIN,$144.38,$0.00,$144.38,$64.97,$103.04,$0.00,$24.88,$0.00,$0.00,$25.28,$144.38,$0.00,$72.19,$114.35,$115.50,$0.00,$22.59,$0.00,$22.98,$0.00
52-27120,SUP,HCPCS C1713,,52-27120  -  SCREW BN 2.7MM 20MM VARIAX LCK P/T TI DIST RADL,$144.38,$0.00,$144.38,$64.97,$103.04,$0.00,$24.88,$0.00,$0.00,$25.28,$144.38,$0.00,$72.19,$114.35,$115.50,$0.00,$22.59,$0.00,$22.98,$0.00
52-27120E,SUP,HCPCS C1713,,52-27120E  -  SCREW BN P/T 2.7MM 20MM VARIAX NLCKG XPN TI DIST RDS,$144.38,$0.00,$144.38,$64.97,$103.04,$0.00,$24.88,$0.00,$0.00,$25.28,$144.38,$0.00,$72.19,$114.35,$115.50,$0.00,$22.59,$0.00,$22.98,$0.00
52-27122,SUP,HCPCS C1713,,52-27122  -  SCREW BN 2.7MM 22MM VARIAX LCK P/T TI DIST RADL,$144.38,$0.00,$144.38,$64.97,$103.04,$0.00,$24.88,$0.00,$0.00,$25.28,$144.38,$0.00,$72.19,$114.35,$115.50,$0.00,$22.59,$0.00,$22.98,$0.00
52-27122E,SUP,HCPCS C1713,,52-27122E  -  SCREW BN P/T 2.7MM 22MM VARIAX NLCKG XPN TI DIST RDS,$144.38,$0.00,$144.38,$64.97,$103.04,$0.00,$24.88,$0.00,$0.00,$25.28,$144.38,$0.00,$72.19,$114.35,$115.50,$0.00,$22.59,$0.00,$22.98,$0.00
52-27124,SUP,HCPCS C1713,,52-27124  -  SCREW BONE 2.7MM 24MM VARIAX TI DISTAL RADL PTTHRD XPIN,$144.38,$0.00,$144.38,$64.97,$103.04,$0.00,$24.88,$0.00,$0.00,$25.28,$144.38,$0.00,$72.19,$114.35,$115.50,$0.00,$22.59,$0.00,$22.98,$0.00
52-27126,SUP,HCPCS C1713,,52-27126  -  SCREW BONE 2.7MM 26MM VARIAX TI DISTAL RADL PTTHRD XPIN STRL,$144.38,$0.00,$144.38,$64.97,$103.04,$0.00,$24.88,$0.00,$0.00,$25.28,$144.38,$0.00,$72.19,$114.35,$115.50,$0.00,$22.59,$0.00,$22.98,$0.00
52-27208,SUP,HCPCS C1713,,52-27208  -  SCREW BONE 2.7MM 8MM TI RADL SLFTAP XFIT,$130.63,$0.00,$130.63,$58.78,$93.23,$0.00,$22.51,$0.00,$0.00,$22.87,$130.63,$0.00,$65.31,$103.46,$104.50,$0.00,$20.44,$0.00,$20.80,$0.00
52-27210,SUP,HCPCS C1713,,52-27210  -  SCREW BONE 2.7MM 10MM TI RADL SLFTAP XFIT,$130.63,$0.00,$130.63,$58.78,$93.23,$0.00,$22.51,$0.00,$0.00,$22.87,$130.63,$0.00,$65.31,$103.46,$104.50,$0.00,$20.44,$0.00,$20.80,$0.00
52-27212,SUP,HCPCS C1713,,52-27212  -  SCREW BONE 2.7MM 12MM MTRX-SMARTLOCK DISTAL RADL SLFTAP,$130.63,$0.00,$130.63,$58.78,$93.23,$0.00,$22.51,$0.00,$0.00,$22.87,$130.63,$0.00,$65.31,$103.46,$104.50,$0.00,$20.44,$0.00,$20.80,$0.00
52-27214,SUP,HCPCS C1713,,52-27214  -  SCREW BONE 2.7MM 14MM MTRX-SMARTLOCK DISTAL RADL SLFTAP,$130.63,$0.00,$130.63,$58.78,$93.23,$0.00,$22.51,$0.00,$0.00,$22.87,$130.63,$0.00,$65.31,$103.46,$104.50,$0.00,$20.44,$0.00,$20.80,$0.00
52-27216,SUP,HCPCS C1713,,52-27216  -  SCREW BONE 2.7MM 16MM MTRX-SMARTLOCK DISTAL RADL SLFTAP,$130.63,$0.00,$130.63,$58.78,$93.23,$0.00,$22.51,$0.00,$0.00,$22.87,$130.63,$0.00,$65.31,$103.46,$104.50,$0.00,$20.44,$0.00,$20.80,$0.00
52-27218,SUP,HCPCS C1713,,52-27218  -  SCREW BONE 2.7MM 18MM MTRX-SMARTLOCK DISTAL RADL SLFTAP,$151.25,$0.00,$151.25,$68.06,$107.95,$0.00,$26.06,$0.00,$0.00,$26.48,$151.25,$0.00,$75.63,$119.79,$121.00,$0.00,$23.67,$0.00,$24.08,$0.00
52-27220,SUP,HCPCS C1713,,52-27220  -  SCREW BONE 2.7MM 20MM MTRX-SMARTLOCK DISTAL RADL SLFTAP,$151.25,$0.00,$151.25,$68.06,$107.95,$0.00,$26.06,$0.00,$0.00,$26.48,$151.25,$0.00,$75.63,$119.79,$121.00,$0.00,$23.67,$0.00,$24.08,$0.00
52-27222,SUP,HCPCS C1713,,52-27222  -  SCREW BONE 2.7MM 22MM MTRX-SMARTLOCK DISTAL RADL SLFTAP,$151.25,$0.00,$151.25,$68.06,$107.95,$0.00,$26.06,$0.00,$0.00,$26.48,$151.25,$0.00,$75.63,$119.79,$121.00,$0.00,$23.67,$0.00,$24.08,$0.00
52-27224,SUP,HCPCS C1713,,52-27224  -  SCREW BONE 2.7MM 24MM MTRX-SMARTLOCK DISTAL RADL SLFTAP,$151.25,$0.00,$151.25,$68.06,$107.95,$0.00,$26.06,$0.00,$0.00,$26.48,$151.25,$0.00,$75.63,$119.79,$121.00,$0.00,$23.67,$0.00,$24.08,$0.00
52-27226,SUP,HCPCS C1713,,52-27226  -  SCREW BONE 2.7MM 26MM MTRX-SMARTLOCK DISTAL RADL SLFTAP,$151.25,$0.00,$151.25,$68.06,$107.95,$0.00,$26.06,$0.00,$0.00,$26.48,$151.25,$0.00,$75.63,$119.79,$121.00,$0.00,$23.67,$0.00,$24.08,$0.00
52-27228,SUP,HCPCS C1713,,52-27228  -  SCREW BONE 2.7MM 28MM MTRX-SMARTLOCK DISTAL RADL SLFTAP,$151.25,$0.00,$151.25,$68.06,$107.95,$0.00,$26.06,$0.00,$0.00,$26.48,$151.25,$0.00,$75.63,$119.79,$121.00,$0.00,$23.67,$0.00,$24.08,$0.00
52-27230,SUP,HCPCS C1713,,52-27230  -  SCREW BONE 2.7MM 30MM TI RADL SLFTAP XFIT,$151.25,$0.00,$151.25,$68.06,$107.95,$0.00,$26.06,$0.00,$0.00,$26.48,$151.25,$0.00,$75.63,$119.79,$121.00,$0.00,$23.67,$0.00,$24.08,$0.00
52-27232,SUP,HCPCS C1713,,52-27232  -  SCREW BONE 2.7MM 32MM TI RADL SLFTAP XFIT,$151.25,$0.00,$151.25,$68.06,$107.95,$0.00,$26.06,$0.00,$0.00,$26.48,$151.25,$0.00,$75.63,$119.79,$121.00,$0.00,$23.67,$0.00,$24.08,$0.00
52-27234,SUP,HCPCS C1713,,52-27234  -  SCREW BONE 2.7MM 34MM MTRX-SMARTLOCK DISTAL RADL SLFTAP,$165.00,$0.00,$165.00,$74.25,$117.76,$0.00,$28.43,$0.00,$0.00,$28.89,$165.00,$0.00,$82.50,$130.68,$132.00,$0.00,$25.82,$0.00,$26.27,$0.00
52-27236,SUP,HCPCS C1713,,52-27236  -  SCREW BONE 2.7MM 36MM TI RADL SLFTAP XFIT,$165.00,$0.00,$165.00,$74.25,$117.76,$0.00,$28.43,$0.00,$0.00,$28.89,$165.00,$0.00,$82.50,$130.68,$132.00,$0.00,$25.82,$0.00,$26.27,$0.00
52-27238,SUP,HCPCS C1713,,52-27238  -  SCREW BONE 2.7MM 38MM TI RADL SLFTAP XFIT,$165.00,$0.00,$165.00,$74.25,$117.76,$0.00,$28.43,$0.00,$0.00,$28.89,$165.00,$0.00,$82.50,$130.68,$132.00,$0.00,$25.82,$0.00,$26.27,$0.00
52-27610,SUP,HCPCS C1713,,52-27610  -  SCREW BONE 2.7MM 10MM VARIAX TI DISTAL RADL PTTHRD LCK STRL,$144.38,$0.00,$144.38,$64.97,$103.04,$0.00,$24.88,$0.00,$0.00,$25.28,$144.38,$0.00,$72.19,$114.35,$115.50,$0.00,$22.59,$0.00,$22.98,$0.00
52-27610E,SUP,HCPCS C1713,,52-27610E  -  SCREW BONE 2.7MM 10MM VARIAX TI DISTAL RADL PTTHRD LCK STRL,$144.38,$0.00,$144.38,$64.97,$103.04,$0.00,$24.88,$0.00,$0.00,$25.28,$144.38,$0.00,$72.19,$114.35,$115.50,$0.00,$22.59,$0.00,$22.98,$0.00
52-27612,SUP,HCPCS C1713,,52-27612  -  SCREW BONE 2.7MM 12MM VARIAX TI DISTAL RADL LCK STRL,$144.38,$0.00,$144.38,$64.97,$103.04,$0.00,$24.88,$0.00,$0.00,$25.28,$144.38,$0.00,$72.19,$114.35,$115.50,$0.00,$22.59,$0.00,$22.98,$0.00
52-27614,SUP,HCPCS C1713,,52-27614  -  SCREW BONE 2.7MM 14MM VARIAX TI DISTAL RADL XPIN LCK STRL,$144.38,$0.00,$144.38,$64.97,$103.04,$0.00,$24.88,$0.00,$0.00,$25.28,$144.38,$0.00,$72.19,$114.35,$115.50,$0.00,$22.59,$0.00,$22.98,$0.00
52-27614E,SUP,HCPCS C1713,,52-27614E  -  SCREW BONE 2.7MM 14MM VARIAX TI DISTAL RADL XPIN LCK STRL,$144.38,$0.00,$144.38,$64.97,$103.04,$0.00,$24.88,$0.00,$0.00,$25.28,$144.38,$0.00,$72.19,$114.35,$115.50,$0.00,$22.59,$0.00,$22.98,$0.00
52-27616,SUP,HCPCS C1713,,52-27616  -  SCREW BONE 2.7MM 16MM VARIAX TI DISTAL RADL XPIN LCK PLT SYS,$144.38,$0.00,$144.38,$64.97,$103.04,$0.00,$24.88,$0.00,$0.00,$25.28,$144.38,$0.00,$72.19,$114.35,$115.50,$0.00,$22.59,$0.00,$22.98,$0.00
52-27618,SUP,HCPCS C1713,,52-27618  -  SCREW BN 2.7MM 18MM VARIAX LCK TI DIST RADL,$144.38,$0.00,$144.38,$64.97,$103.04,$0.00,$24.88,$0.00,$0.00,$25.28,$144.38,$0.00,$72.19,$114.35,$115.50,$0.00,$22.59,$0.00,$22.98,$0.00
52-27618E,SUP,HCPCS C1713,,52-27618E  -  SCREW BN 2.7MM 18MM STRL LCK XPN TI RDS DIST VARIAX LCK PLT,$144.38,$0.00,$144.38,$64.97,$103.04,$0.00,$24.88,$0.00,$0.00,$25.28,$144.38,$0.00,$72.19,$114.35,$115.50,$0.00,$22.59,$0.00,$22.98,$0.00
52-27620,SUP,HCPCS C1713,,52-27620  -  SCREW BONE 2.7MM 20MM VARIAX TI DISTAL RADL PTTHRD LCK STRL,$144.38,$0.00,$144.38,$64.97,$103.04,$0.00,$24.88,$0.00,$0.00,$25.28,$144.38,$0.00,$72.19,$114.35,$115.50,$0.00,$22.59,$0.00,$22.98,$0.00
52-27620E,SUP,HCPCS C1713,,52-27620E  -  SCREW BONE 2.7MM 20MM VARIAX TI DISTAL RADL XPIN LCK STRL,$144.38,$0.00,$144.38,$64.97,$103.04,$0.00,$24.88,$0.00,$0.00,$25.28,$144.38,$0.00,$72.19,$114.35,$115.50,$0.00,$22.59,$0.00,$22.98,$0.00
52-27622,SUP,HCPCS C1713,,52-27622  -  SCREW BONE 2.7MM 22MM VARIAX TI DISTAL RADL XPIN LCK PLT SYS,$144.38,$0.00,$144.38,$64.97,$103.04,$0.00,$24.88,$0.00,$0.00,$25.28,$144.38,$0.00,$72.19,$114.35,$115.50,$0.00,$22.59,$0.00,$22.98,$0.00
52-27624,SUP,HCPCS C1713,,52-27624  -  SCREW BONE 2.7MM 24MM VARIAX TI DISTAL RADL XPIN LCK PLT SYS,$144.38,$0.00,$144.38,$64.97,$103.04,$0.00,$24.88,$0.00,$0.00,$25.28,$144.38,$0.00,$72.19,$114.35,$115.50,$0.00,$22.59,$0.00,$22.98,$0.00
52-27626,SUP,HCPCS C1713,,52-27626  -  SCREW BN 2.7MM 26MM VARIAX LCK TI DIST RADL,$144.38,$0.00,$144.38,$64.97,$103.04,$0.00,$24.88,$0.00,$0.00,$25.28,$144.38,$0.00,$72.19,$114.35,$115.50,$0.00,$22.59,$0.00,$22.98,$0.00
52-27626E,SUP,HCPCS C1713,,52-27626E  -  SCREW BN 2.7MM 26MM STRL LCK XPN TI RDS DIST VARIAX LCK PLT,$144.38,$0.00,$144.38,$64.97,$103.04,$0.00,$24.88,$0.00,$0.00,$25.28,$144.38,$0.00,$72.19,$114.35,$115.50,$0.00,$22.59,$0.00,$22.98,$0.00
52-27716,SUP,HCPCS C1713,,52-27716  -  PEG 2.7MM 16MM DISTAL RADL PTTHRD LCK TI VARIAX NONSTRL,$144.38,$0.00,$144.38,$64.97,$103.04,$0.00,$24.88,$0.00,$0.00,$25.28,$144.38,$0.00,$72.19,$114.35,$115.50,$0.00,$22.59,$0.00,$22.98,$0.00
52-27716E,SUP,HCPCS C1713,,52-27716E  -  PEG 2.7MM 16MM DISTAL RADL PTTHRD LCK TI VARIAX STRL,$144.38,$0.00,$144.38,$64.97,$103.04,$0.00,$24.88,$0.00,$0.00,$25.28,$144.38,$0.00,$72.19,$114.35,$115.50,$0.00,$22.59,$0.00,$22.98,$0.00
52-27718,SUP,HCPCS C1713,,52-27718  -  PEG 2.7MM 18MM DISTAL RADL PTTHRD LCK TI VARIAX NONSTRL,$144.38,$0.00,$144.38,$64.97,$103.04,$0.00,$24.88,$0.00,$0.00,$25.28,$144.38,$0.00,$72.19,$114.35,$115.50,$0.00,$22.59,$0.00,$22.98,$0.00
52-27718E,SUP,HCPCS C1713,,52-27718E  -  PEG 2.7MM 18MM DISTAL RADL PTTHRD LCK TI VARIAX STRL,$144.38,$0.00,$144.38,$64.97,$103.04,$0.00,$24.88,$0.00,$0.00,$25.28,$144.38,$0.00,$72.19,$114.35,$115.50,$0.00,$22.59,$0.00,$22.98,$0.00
52-27720,SUP,HCPCS C1713,,52-27720  -  PEG 2.7MM 20MM DISTAL RADL PTTHRD LCK TI VARIAX STRL,$144.38,$0.00,$144.38,$64.97,$103.04,$0.00,$24.88,$0.00,$0.00,$25.28,$144.38,$0.00,$72.19,$114.35,$115.50,$0.00,$22.59,$0.00,$22.98,$0.00
52-27722,SUP,HCPCS C1713,,52-27722  -  PEG 2.7MM 22MM ORTH LCK PTHRD TI SMARTLOCK,$144.38,$0.00,$144.38,$64.97,$103.04,$0.00,$24.88,$0.00,$0.00,$25.28,$144.38,$0.00,$72.19,$114.35,$115.50,$0.00,$22.59,$0.00,$22.98,$0.00
52-27722E,SUP,HCPCS C1713,,52-27722E  -  SCREW BONE 2.7MM 22MM VARIAX TI DISTAL RADL PTTHRD LCK STRL,$144.38,$0.00,$144.38,$64.97,$103.04,$0.00,$24.88,$0.00,$0.00,$25.28,$144.38,$0.00,$72.19,$114.35,$115.50,$0.00,$22.59,$0.00,$22.98,$0.00
52-27724,SUP,HCPCS C1713,,52-27724  -  PEG 2.7MM 24MM DISTAL RADL PTTHRD LCK TI VARIAX NONSTRL,$144.38,$0.00,$144.38,$64.97,$103.04,$0.00,$24.88,$0.00,$0.00,$25.28,$144.38,$0.00,$72.19,$114.35,$115.50,$0.00,$22.59,$0.00,$22.98,$0.00
52-27724E,SUP,HCPCS C1713,,52-27724E  -  PEG 2.7MM 24MM DISTAL RADL PTTHRD LCK TI VARIAX STRL,$144.38,$0.00,$144.38,$64.97,$103.04,$0.00,$24.88,$0.00,$0.00,$25.28,$144.38,$0.00,$72.19,$114.35,$115.50,$0.00,$22.59,$0.00,$22.98,$0.00
52-27726,SUP,HCPCS C1713,,52-27726  -  PEG 2.7MM 26MM DISTAL RADL PTTHRD LCK TI VARIAX NONSTRL,$144.38,$0.00,$144.38,$64.97,$103.04,$0.00,$24.88,$0.00,$0.00,$25.28,$144.38,$0.00,$72.19,$114.35,$115.50,$0.00,$22.59,$0.00,$22.98,$0.00
52-27726E,SUP,HCPCS C1713,,52-27726E  -  PEG 2.7MM 24MM DISTAL RADL PTTHRD LCK TI VARIAX STRL,$144.38,$0.00,$144.38,$64.97,$103.04,$0.00,$24.88,$0.00,$0.00,$25.28,$144.38,$0.00,$72.19,$114.35,$115.50,$0.00,$22.59,$0.00,$22.98,$0.00
52-27844,SUP,HCPCS C1713,,52-27844  -  SCREW BONE 2.7MM 14MM TI FRFT HEX,$125.13,$0.00,$125.13,$56.31,$89.30,$0.00,$21.56,$0.00,$0.00,$21.91,$125.13,$0.00,$62.56,$99.10,$100.10,$0.00,$19.58,$0.00,$19.92,$0.00
52-27846,SUP,HCPCS C1713,,52-27846  -  SCREW BONE 2.7MM 16MM TI FRFT HEX,$125.13,$0.00,$125.13,$56.31,$89.30,$0.00,$21.56,$0.00,$0.00,$21.91,$125.13,$0.00,$62.56,$99.10,$100.10,$0.00,$19.58,$0.00,$19.92,$0.00
52-27850,SUP,HCPCS C1713,,52-27850  -  SCREW BONE 2.7MM 20MM TI FRFT HEX,$125.13,$0.00,$125.13,$56.31,$89.30,$0.00,$21.56,$0.00,$0.00,$21.91,$125.13,$0.00,$62.56,$99.10,$100.10,$0.00,$19.58,$0.00,$19.92,$0.00
52-27852,SUP,HCPCS C1713,,52-27852  -  SCREW BONE 2.7MM 22MM TI FRFT HEX BUN TIAL,$121.00,$0.00,$121.00,$54.45,$86.36,$0.00,$20.85,$0.00,$0.00,$21.19,$121.00,$0.00,$60.50,$95.83,$96.80,$0.00,$18.94,$0.00,$19.26,$0.00
5229300P2,SUP,HCPCS C1713,,5229300P2  -  CAGE SPNL 0D 30X12X9MM NS CRNT TI ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5229302P2,SUP,HCPCS C1713,,5229302P2  -  CAGE SPNL 12D 30X12X9MM NS CRNT TI ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5229308P2,SUP,HCPCS C1713,,5229308P2  -  CAGE SPNL 8D 30X12X9MM NS CRNT TI ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
52-30056,SUP,HCPCS C1713,,52-30056  -  SCREW BONE 3MM 16MM TI FRFT HEX,$125.13,$0.00,$125.13,$56.31,$89.30,$0.00,$21.56,$0.00,$0.00,$21.91,$125.13,$0.00,$62.56,$99.10,$100.10,$0.00,$19.58,$0.00,$19.92,$0.00
52-30308,SUP,HCPCS C1713,,52-30308  -  SCREW BONE 3MM 8MM TI CANC RADL SLFTAP XFIT,$165.00,$0.00,$165.00,$74.25,$117.76,$0.00,$28.43,$0.00,$0.00,$28.89,$165.00,$0.00,$82.50,$130.68,$132.00,$0.00,$25.82,$0.00,$26.27,$0.00
52-30310,SUP,HCPCS C1713,,52-30310  -  SCREW BONE 3MM 10MM TI CANC RADL SLFTAP XFIT,$185.63,$0.00,$185.63,$83.53,$132.48,$0.00,$31.98,$0.00,$0.00,$32.50,$185.63,$0.00,$92.81,$147.02,$148.50,$0.00,$29.05,$0.00,$29.55,$0.00
52-30312,SUP,HCPCS C1713,,52-30312  -  SCREW BONE 3MM 12MM TI CANC RADL SLFTAP XFIT,$185.63,$0.00,$185.63,$83.53,$132.48,$0.00,$31.98,$0.00,$0.00,$32.50,$185.63,$0.00,$92.81,$147.02,$148.50,$0.00,$29.05,$0.00,$29.55,$0.00
52-30314,SUP,HCPCS C1713,,52-30314  -  SCREW BONE 3MM 14MM TI CANC RADL SLFTAP XFIT,$185.63,$0.00,$185.63,$83.53,$132.48,$0.00,$31.98,$0.00,$0.00,$32.50,$185.63,$0.00,$92.81,$147.02,$148.50,$0.00,$29.05,$0.00,$29.55,$0.00
52-30316,SUP,HCPCS C1713,,52-30316  -  SCREW BONE 3MM 16MM TI CANC RADL SLFTAP XFIT,$185.63,$0.00,$185.63,$83.53,$132.48,$0.00,$31.98,$0.00,$0.00,$32.50,$185.63,$0.00,$92.81,$147.02,$148.50,$0.00,$29.05,$0.00,$29.55,$0.00
52-30318,SUP,HCPCS C1713,,52-30318  -  SCREW BONE 3MM 18MM CANC,$206.25,$0.00,$206.25,$92.81,$147.20,$0.00,$35.54,$0.00,$0.00,$36.11,$206.25,$0.00,$103.13,$163.35,$165.00,$0.00,$32.28,$0.00,$32.84,$0.00
52-30320,SUP,HCPCS C1713,,52-30320  -  SCREW BONE 3MM 20MM TI CANC RADL SLFTAP XFIT,$206.25,$0.00,$206.25,$92.81,$147.20,$0.00,$35.54,$0.00,$0.00,$36.11,$206.25,$0.00,$103.13,$163.35,$165.00,$0.00,$32.28,$0.00,$32.84,$0.00
52-30322,SUP,HCPCS C1713,,52-30322  -  SCREW BONE 3MM 22MM TI CANC RADL SLFTAP XFIT,$206.25,$0.00,$206.25,$92.81,$147.20,$0.00,$35.54,$0.00,$0.00,$36.11,$206.25,$0.00,$103.13,$163.35,$165.00,$0.00,$32.28,$0.00,$32.84,$0.00
52-30324,SUP,HCPCS C1713,,52-30324  -  SCREW BONE 3MM 24MM TI CANC RADL SLFTAP XFIT,$206.25,$0.00,$206.25,$92.81,$147.20,$0.00,$35.54,$0.00,$0.00,$36.11,$206.25,$0.00,$103.13,$163.35,$165.00,$0.00,$32.28,$0.00,$32.84,$0.00
52-30326,SUP,HCPCS C1713,,52-30326  -  SCREW BONE 3MM 26MM TI CANC RADL SLFTAP XFIT,$206.25,$0.00,$206.25,$92.81,$147.20,$0.00,$35.54,$0.00,$0.00,$36.11,$206.25,$0.00,$103.13,$163.35,$165.00,$0.00,$32.28,$0.00,$32.84,$0.00
52-30328,SUP,HCPCS C1713,,52-30328  -  SCREW BONE 3MM 28MM TI CANC RADL SLFTAP XFIT,$206.25,$0.00,$206.25,$92.81,$147.20,$0.00,$35.54,$0.00,$0.00,$36.11,$206.25,$0.00,$103.13,$163.35,$165.00,$0.00,$32.28,$0.00,$32.84,$0.00
52-30330,SUP,HCPCS C1713,,52-30330  -  SCREW BONE 3MM 30MM TI CANC RADL SLFTAP XFIT,$206.25,$0.00,$206.25,$92.81,$147.20,$0.00,$35.54,$0.00,$0.00,$36.11,$206.25,$0.00,$103.13,$163.35,$165.00,$0.00,$32.28,$0.00,$32.84,$0.00
52-30332,SUP,HCPCS C1713,,52-30332  -  SCREW BONE 3MM 32MM TI CANC RADL SLFTAP XFIT,$206.25,$0.00,$206.25,$92.81,$147.20,$0.00,$35.54,$0.00,$0.00,$36.11,$206.25,$0.00,$103.13,$163.35,$165.00,$0.00,$32.28,$0.00,$32.84,$0.00
52-30334,SUP,HCPCS C1713,,52-30334  -  SCREW BONE 3MM 34MM TI CANC RADL SLFTAP XFIT,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
52-306-23,SUP,HCPCS C1781,,52-306-23  -  MESH SURG 26.2X.6MM PRFL 3ANG RX ORBTL FLR,"$1,416.25",$0.00,"$1,416.25",$637.31,"$1,010.78",$0.00,$244.01,$0.00,$0.00,$247.97,"$1,416.25",$0.00,$708.13,"$1,121.67","$1,133.00",$0.00,$221.64,$0.00,$225.47,$0.00
52-306-23-04,SUP,HCPCS C1781,,52-306-23-04  -  MESH CRNL 3ANG 23MMX.6MM STRL RSRBX PDLLA ORBT FLR,"$1,531.68",$0.00,"$1,531.68",$689.25,"$1,093.16",$0.00,$263.90,$0.00,$0.00,$268.18,"$1,531.68",$0.00,$765.84,"$1,213.09","$1,225.34",$0.00,$239.71,$0.00,$243.84,$0.00
52-306-40-04,SUP,HCPCS C1713,,52-306-40-04  -  MESH SURG 40X40X.6MM RX ORBTL FLOOR,"$1,670.93",$0.00,"$1,670.93",$751.92,"$1,192.54",$0.00,$287.89,$0.00,$0.00,$292.57,"$1,670.93",$0.00,$835.46,"$1,323.38","$1,336.74",$0.00,$261.50,$0.00,$266.01,$0.00
52-306-51-04,SUP,HCPCS C1781,,52-306-51-04  -  MESH DYNAMIC 51X51X.6MM RESORB LARGE GRID FLEXIBLE ROUNDED,"$2,227.90",$0.00,"$2,227.90","$1,002.56","$1,590.05",$0.00,$383.86,$0.00,$0.00,$390.09,"$2,227.90",$0.00,"$1,113.95","$1,764.50","$1,782.32",$0.00,$348.67,$0.00,$354.68,$0.00
52-310-31-04,SUP,HCPCS C1713,,52-310-31-04  -  MESH CRANIAL 106X31X1MM RESORB SMALL GRID RESORB-X SONICWELD,"$3,202.60",$0.00,"$3,202.60","$1,441.17","$2,285.70",$0.00,$551.79,$0.00,$0.00,$560.75,"$3,202.60",$0.00,"$1,601.30","$2,536.46","$2,562.08",$0.00,$501.21,$0.00,$509.85,$0.00
5235-1-846,SUP,Custom 27203010,,5235-1-846  -  BIT DRILL 250MM 4.3MM ALTA TRFLT,$188.38,$0.00,$188.38,$0.00,$134.44,$0.00,$0.00,$0.00,$0.00,$0.00,$188.38,$0.00,$94.19,$149.20,$150.70,$0.00,$0.00,$0.00,$0.00,$0.00
5235-1-916,SUP,Custom 27203010,,5235-1-916  -  GUIDE DRILL 4.3MM SLV,$468.88,$0.00,$468.88,$0.00,$334.64,$0.00,$0.00,$0.00,$0.00,$0.00,$468.88,$0.00,$234.44,$371.35,$375.10,$0.00,$0.00,$0.00,$0.00,$0.00
5235-7-110,SUP,HCPCS C1713,,5235-7-110  -  SCREW BONE ALTA LAG RMR ASSY,"$5,328.13",$0.00,"$5,328.13","$2,397.66","$3,802.68",$0.00,$918.01,$0.00,$0.00,$932.91,"$5,328.13",$0.00,"$2,664.06","$4,219.88","$4,262.50",$0.00,$833.85,$0.00,$848.24,$0.00
52-400-00,SUP,Custom 27203010,,52-400-00  -  PEN MRKNG TIP HEAT RSRBX,$212.50,$0.00,$212.50,$0.00,$151.66,$0.00,$0.00,$0.00,$0.00,$0.00,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$0.00,$0.00,$0.00,$0.00
5241300P2,SUP,HCPCS C1713,,5241300P2  -  CAGE SPNL 0D 30X14X11MM NS CRNT TI ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5241302P2,SUP,HCPCS C1713,,5241302P2  -  CAGE SPNL 12D 30X14X11MM NS CRNT TI ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5241308P2,SUP,HCPCS C1713,,5241308P2  -  CAGE SPNL 8D 30X14X11MM NS CRNT TI ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
52432-U,SUP,Custom 27203010,,SPECULUM OTSCP KLNSPC 2.75MM UNV 2.75MM PLST DX DISP,$0.05,$0.00,$0.05,$0.00,$0.04,$0.00,$0.00,$0.00,$0.00,$0.00,$0.05,$0.00,$0.03,$0.04,$0.04,$0.00,$0.00,$0.00,$0.00,$0.00
5244300P2,SUP,HCPCS C1713,,5244300P2  -  CAGE SPNL 0D 30X14X14MM NS CRNT TI ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5244308P2,SUP,HCPCS C1713,,5244308P2  -  CAGE SPNL 8D 30X14X14MM NS CRNT TI ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5249300P2,SUP,HCPCS C1713,,5249300P2  -  CAGE SPNL 0D 30X14X9MM NS CRNT TI ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5249302P2,SUP,HCPCS C1713,,5249302P2  -  CAGE SPNL 12D 30X14X9MM NS CRNT TI ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5249308P2,SUP,HCPCS C1713,,5249308P2  -  CAGE SPNL 8D 30X14X9MM NS CRNT TI ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5255-1-255,SUP,Custom 27203010,,5255-1-255  -  BIT DRILL 250MM 3.2MM AO,$188.38,$0.00,$188.38,$0.00,$134.44,$0.00,$0.00,$0.00,$0.00,$0.00,$188.38,$0.00,$94.19,$149.20,$150.70,$0.00,$0.00,$0.00,$0.00,$0.00
5260-4-000,SUP,Custom 27803010,,5260-4-000  -  SHELL ACETAB HIP SCR PLUG OSTLK APCL,$141.00,$0.00,$141.00,$0.00,$100.63,$0.00,$0.00,$0.00,$0.00,$0.00,$141.00,$0.00,$70.50,$111.67,$112.80,$0.00,$0.00,$0.00,$0.00,$0.00
5260-5-012,SUP,HCPCS C1713,,5260-5-012  -  SCREW ACETAB 6.5MM 12MM HEXAGON OSTEOLOCK TITANIUM HIP,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
5260-5-014,SUP,HCPCS C1713,,5260-5-014  -  SCREW ACETAB 6.5MM 14MM HEXAGON OSTEOLOCK TITANIUM HIP,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
5260-5-016,SUP,HCPCS C1713,,5260-5-016  -  SCREW BN 6.5MM 16MM OSTLK CANC,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
5260-5-018,SUP,HCPCS C1713,,5260-5-018  -  SCREW ACETAB 6.5MM 18MM HEXAGON OSTEOLOCK TITANIUM HIP,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
5260-5-020,SUP,HCPCS C1713,,5260-5-020  -  SCREW ACETAB 6.5MM 20MM HEXAGON OSTEOLOCK TITANIUM HIP,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
5260-5-022,SUP,HCPCS C1713,,5260-5-022  -  SCREW ACETAB 6.5MM 22MM HEXAGON OSTEOLOCK TITANIUM HIP,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
5260-5-024,SUP,HCPCS C1713,,5260-5-024  -  SCREW ACETAB 6.5MM 24MM HEXAGON OSTEOLOCK TITANIUM HIP,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
5260-5-026,SUP,HCPCS C1713,,5260-5-026  -  SCREW BONE HEXAGON 6.5MM 26MM WEDGE RSTOR OSTEOLOCK TITANIUM,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
5260-5-028,SUP,HCPCS C1713,,5260-5-028  -  SCREW BONE HEXAGON 6.5MM 28MM WEDGE RSTOR OSTEOLOCK TITANIUM,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
5260-5-030,SUP,HCPCS C1713,,5260-5-030  -  SCREW BONE HEXAGON 6.5MM 30MM WEDGE RSTOR OSTEOLOCK TITANIUM,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
5260-5-035,SUP,HCPCS C1713,,5260-5-035  -  SCREW BONE HEXAGON 6.5MM 35MM WEDGE RSTOR OSTEOLOCK TITANIUM,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
5260-5-040,SUP,HCPCS C1713,,5260-5-040  -  SCREW BONE HEXAGON 6.5MM 40MM WEDGE RSTOR OSTEOLOCK TITANIUM,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
5260-5-045,SUP,HCPCS C1713,,5260-5-045  -  SCREW BONE HEXAGON 6.5MM 45MM WEDGE RSTOR OSTEOLOCK TITANIUM,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
5260-5-050,SUP,HCPCS C1713,,5260-5-050  -  SCREW BONE HEXAGON 6.5MM 50MM WEDGE RSTOR OSTEOLOCK TITANIUM,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
5281300P2,SUP,HCPCS C1713,,5281300P2  -  CAGE SPNL 0D 30X8X11MM NS CRNT TI ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5281302P2,SUP,HCPCS C1713,,5281302P2  -  CAGE SPNL 12D 30X8X11MM NS CRNT TI ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5281308P2,SUP,HCPCS C1713,,5281308P2  -  CAGE SPNL 8D 30X8X11MM NS CRNT TI ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5284300P2,SUP,HCPCS C1713,,5284300P2  -  CAGE SPNL 0D 30X8X14MM NS CRNT TI ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5284308P2,SUP,HCPCS C1713,,5284308P2  -  CAGE SPNL 8D 30X8X14MM NS CRNT TI ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5289300P2,SUP,HCPCS C1713,,5289300P2  -  CAGE SPNL 0D 30X8X9MM NS CRNT TI ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5289302P2,SUP,HCPCS C1713,,5289302P2  -  CAGE SPNL 12D 30X8X9MM NS CRNT TI ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5289308P2,SUP,HCPCS C1713,,5289308P2  -  CAGE SPNL 8D 30X8X9MM NS CRNT TI ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5291300P2,SUP,HCPCS C1713,,5291300P2  -  CAGE SPNL 0D 30X9X11MM NS CRNT TI ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5291302P2,SUP,HCPCS C1713,,5291302P2  -  CAGE SPNL 12D 30X9X11MM NS CRNT TI ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5291308P2,SUP,HCPCS C1713,,5291308P2  -  CAGE SPNL 8D 30X9X11MM NS CRNT TI ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5299300P2,SUP,HCPCS C1713,,5299300P2  -  CAGE SPNL 0D 30X9X9MM NS CRNT TI ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5299302P2,SUP,HCPCS C1713,,5299302P2  -  CAGE SPNL 12D 30X9X9MM NS CRNT TI ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5299308P2,SUP,HCPCS C1713,,5299308P2  -  CAGE SPNL 8D 30X9X9MM NS CRNT TI ANT TLIF,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
5300-010-941,SUP,Custom 27203010,,5300-010-941  -  DERMABRADER SURG MEDIUM STR 4MM STR TPS STERILE,$190.80,$0.00,$190.80,$0.00,$136.17,$0.00,$0.00,$0.00,$0.00,$0.00,$190.80,$0.00,$95.40,$151.11,$152.64,$0.00,$0.00,$0.00,$0.00,$0.00
5300-010-943,SUP,Custom 27203010,,5300-010-943  -  DERMABRADER SURG MEDIUM STR 7MM STR X-CHANGE III,$190.80,$0.00,$190.80,$0.00,$136.17,$0.00,$0.00,$0.00,$0.00,$0.00,$190.80,$0.00,$95.40,$151.11,$152.64,$0.00,$0.00,$0.00,$0.00,$0.00
5300-010-945,SUP,Custom 27203010,,5300-010-945  -  DERMABRADER SURG MEDIUM STR 12MM 50MM BUR STR TPS STERILE,$190.80,$0.00,$190.80,$0.00,$136.17,$0.00,$0.00,$0.00,$0.00,$0.00,$190.80,$0.00,$95.40,$151.11,$152.64,$0.00,$0.00,$0.00,$0.00,$0.00
5300-010-947,SUP,Custom 27203010,,5300-010-947  -  DERMABRADER SURG MEDIUM 10MM TAPERED TPS STERILE,$190.80,$0.00,$190.80,$0.00,$136.17,$0.00,$0.00,$0.00,$0.00,$0.00,$190.80,$0.00,$95.40,$151.11,$152.64,$0.00,$0.00,$0.00,$0.00,$0.00
53-00324,SUP,HCPCS C1713,,53-00324  -  PLATE BN 47X29X.3MM UNV NEURO III CLS OUTR FRM TI TMPR 1.5MM,"$3,067.50",$0.00,"$3,067.50","$1,380.38","$2,189.27",$0.00,$528.51,$0.00,$0.00,$537.09,"$3,067.50",$0.00,"$1,533.75","$2,429.46","$2,454.00",$0.00,$480.06,$0.00,$488.35,$0.00
53-00466,SUP,HCPCS C1713,,53-00466  -  PLATE BN LG RND 58MM .4MM NS UNV NEURO III CLS OUTR FRM RGD,"$3,675.00",$0.00,"$3,675.00","$1,653.75","$2,622.85",$0.00,$633.18,$0.00,$0.00,$643.46,"$3,675.00",$0.00,"$1,837.50","$2,910.60","$2,940.00",$0.00,$575.14,$0.00,$585.06,$0.00
53-05164,SUP,HCPCS C1713,,53-05164  -  PLATE BONE STR LP 16 HOLE TITANIUM CRANIOMAXILLOFACIAL,"$1,080.00",$0.00,"$1,080.00",$486.00,$770.80,$0.00,$186.08,$0.00,$0.00,$189.10,"$1,080.00",$0.00,$540.00,$855.36,$864.00,$0.00,$169.02,$0.00,$171.94,$0.00
53-05212,SUP,HCPCS C1713,,53-05212  -  PLATE BN 12MM NS UNV NEURO II 2 HL LOPRFL BAR TI CRNMXF 1.5,$417.50,$0.00,$417.50,$187.88,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
53-05216,SUP,HCPCS C1713,,53-05216  -  PLATE BN 16MM NS UNV NEURO II 2 HL LOPRFL BAR TI CRNMXF 1.5,$510.00,$0.00,$510.00,$229.50,$363.99,$0.00,$87.87,$0.00,$0.00,$89.30,$510.00,$0.00,$255.00,$403.92,$408.00,$0.00,$79.82,$0.00,$81.19,$0.00
53-05228,SUP,HCPCS C1713,,53-05228  -  PLATE BN 3D BX 28MM NS UNV NEURO II 2X2 HL LOPRFL TI CRNMXF,$680.00,$0.00,$680.00,$306.00,$485.32,$0.00,$117.16,$0.00,$0.00,$119.06,$680.00,$0.00,$340.00,$538.56,$544.00,$0.00,$106.42,$0.00,$108.26,$0.00
53-05240,SUP,HCPCS C1713,,53-05240  -  PLATE BN 3D LG BX 40MM NS UNV NEURO II 2X2 HL LOPRFL TI,"$1,012.50",$0.00,"$1,012.50",$455.63,$722.62,$0.00,$174.45,$0.00,$0.00,$177.28,"$1,012.50",$0.00,$506.25,$801.90,$810.00,$0.00,$158.46,$0.00,$161.19,$0.00
53-05406,SUP,HCPCS C1713,,53-05406  -  PLATE BONE 6MM 4 HOLE LP BAR TITANIUM CRANIUM NONSTRL 1.5MM,$455.00,$0.00,$455.00,$204.75,$324.73,$0.00,$78.39,$0.00,$0.00,$79.67,$455.00,$0.00,$227.50,$360.36,$364.00,$0.00,$71.21,$0.00,$72.44,$0.00
53-05507,SUP,Custom 27803010,,53-05507  -  COVER BURR HOLE 7MM LP TAB TITANIUM CRANIOMAXILLOFACIAL,$807.50,$0.00,$807.50,$0.00,$576.31,$0.00,$0.00,$0.00,$0.00,$0.00,$807.50,$0.00,$403.75,$639.54,$646.00,$0.00,$0.00,$0.00,$0.00,$0.00
53-05510,SUP,Custom 27803010,,53-05510  -  COVER BURR HOLE MEDIUM 10MM LP TAB TITANIUM CRANIAL NONSTRL,$807.50,$0.00,$807.50,$0.00,$576.31,$0.00,$0.00,$0.00,$0.00,$0.00,$807.50,$0.00,$403.75,$639.54,$646.00,$0.00,$0.00,$0.00,$0.00,$0.00
53-05514,SUP,Custom 27803010,,53-05514  -  COVER BURR HOLE LP 14MM TAB TITANIUM CRANIOMAXILLOFACIAL,$807.50,$0.00,$807.50,$0.00,$576.31,$0.00,$0.00,$0.00,$0.00,$0.00,$807.50,$0.00,$403.75,$639.54,$646.00,$0.00,$0.00,$0.00,$0.00,$0.00
53-05520,SUP,Custom 27803010,,53-05520  -  COVER BURR HOLE 20MM LP TAB TITANIUM CRANIOMAXILLOFACIAL,$892.50,$0.00,$892.50,$0.00,$636.98,$0.00,$0.00,$0.00,$0.00,$0.00,$892.50,$0.00,$446.25,$706.86,$714.00,$0.00,$0.00,$0.00,$0.00,$0.00
53-05608,SUP,HCPCS C1713,,53-05608  -  PLATE BONE 2Y LP 8MM 6 HOLE GAP TITANIUM CRANIOMAXILLOFACIAL,$965.00,$0.00,$965.00,$434.25,$688.72,$0.00,$166.26,$0.00,$0.00,$168.96,$965.00,$0.00,$482.50,$764.28,$772.00,$0.00,$151.02,$0.00,$153.63,$0.00
53-05612,SUP,HCPCS C1713,,53-05612  -  PLATE BONE SMALL LP GAP TITANIUM CRANIOMAXILLOFACIAL NONSTRL,"$1,137.50",$0.00,"$1,137.50",$511.88,$811.83,$0.00,$195.99,$0.00,$0.00,$199.17,"$1,137.50",$0.00,$568.75,$900.90,$910.00,$0.00,$178.02,$0.00,$181.09,$0.00
53-05622,SUP,HCPCS C1713,,53-05622  -  PLATE BN LG GAP 22MM NS UNV NEURO II LOPRFL TI CRNMXF 1.5MM,"$1,247.50",$0.00,"$1,247.50",$561.38,$890.34,$0.00,$214.94,$0.00,$0.00,$218.43,"$1,247.50",$0.00,$623.75,$988.02,$998.00,$0.00,$195.23,$0.00,$198.60,$0.00
53-05630,SUP,HCPCS C1713,,53-05630  -  PLATE BONE X LP TITANIUM CRANIOMAXILLOFACIAL NONSTRL,$965.00,$0.00,$965.00,$434.25,$688.72,$0.00,$166.26,$0.00,$0.00,$168.96,$965.00,$0.00,$482.50,$764.28,$772.00,$0.00,$151.02,$0.00,$153.63,$0.00
53-05804,SUP,HCPCS C1713,,53-05804  -  PLATE BONE STR LP 8 HOLE TITANIUM CRANIOMAXILLOFACIAL,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
53-06212,SUP,HCPCS C1713,,53-06212  -  PLATE BN 12MM NS UNV NEURO II QUIKFLAP 2 HL BAR X RGD LOPRFL,$249.85,$0.00,$249.85,$112.43,$178.32,$0.00,$43.05,$0.00,$0.00,$43.75,$249.85,$0.00,$124.93,$197.88,$199.88,$0.00,$39.10,$0.00,$39.78,$0.00
53-1125,SUP,Custom 27203010,,RONGUER SURG 9IN LKSL 5MM CURVE REG DBL ACT LMI,"$2,175.23",$0.00,"$2,175.23",$0.00,"$1,552.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,175.23",$0.00,"$1,087.61","$1,722.78","$1,740.18",$0.00,$0.00,$0.00,$0.00,$0.00
53-17005,SUP,HCPCS C1713,,53-17005  -  SCREW BONE 1.7MM 5MM LCK SLFTAP CROSSPIN,$116.88,$0.00,$116.88,$52.59,$83.41,$0.00,$20.14,$0.00,$0.00,$20.46,$116.88,$0.00,$58.44,$92.57,$93.50,$0.00,$18.29,$0.00,$18.61,$0.00
53-17005E,SUP,HCPCS C1713,,53-17005E  -  SCREW BONE 1.7MM 5MM VARIAX TI HAND LCK SLFTAP CROSSPIN STRL,$116.88,$0.00,$116.88,$52.59,$83.41,$0.00,$20.14,$0.00,$0.00,$20.46,$116.88,$0.00,$58.44,$92.57,$93.50,$0.00,$18.29,$0.00,$18.61,$0.00
53-17006E,SUP,HCPCS C1713,,53-17006E  -  SCREW BONE 1.7MM 6MM HAND LCK SLFTAP CROSSPIN STRL,$116.88,$0.00,$116.88,$52.59,$83.41,$0.00,$20.14,$0.00,$0.00,$20.46,$116.88,$0.00,$58.44,$92.57,$93.50,$0.00,$18.29,$0.00,$18.61,$0.00
53-17007E,SUP,HCPCS C1713,,53-17007E  -  SCREW BONE 1.7MM 7MM LCK SLFTAP CROSSPIN,$116.88,$0.00,$116.88,$52.59,$83.41,$0.00,$20.14,$0.00,$0.00,$20.46,$116.88,$0.00,$58.44,$92.57,$93.50,$0.00,$18.29,$0.00,$18.61,$0.00
53-17008E,SUP,HCPCS C1713,,53-17008E  -  SCREW BONE 1.7MM 8MM CANC HIP LCK SLFTAP CROSSPIN,$116.88,$0.00,$116.88,$52.59,$83.41,$0.00,$20.14,$0.00,$0.00,$20.46,$116.88,$0.00,$58.44,$92.57,$93.50,$0.00,$18.29,$0.00,$18.61,$0.00
53-17009E,SUP,HCPCS C1713,,53-17009E  -  SCREW BONE 1.7MM 9MM LCK SLFTAP CROSSPIN,$116.88,$0.00,$116.88,$52.59,$83.41,$0.00,$20.14,$0.00,$0.00,$20.46,$116.88,$0.00,$58.44,$92.57,$93.50,$0.00,$18.29,$0.00,$18.61,$0.00
53-17010,SUP,HCPCS C1713,,53-17010  -  1.7X10MM LOCKING SCREWS_CROSS-PIN_SELF-T,$116.88,$0.00,$116.88,$52.59,$83.41,$0.00,$20.14,$0.00,$0.00,$20.46,$116.88,$0.00,$58.44,$92.57,$93.50,$0.00,$18.29,$0.00,$18.61,$0.00
53-17010E,SUP,HCPCS C1713,,53-17010E  -  SCREW BONE 1.7MM 10MM VARIAX HAND SLFTAP LCK,$116.88,$0.00,$116.88,$52.59,$83.41,$0.00,$20.14,$0.00,$0.00,$20.46,$116.88,$0.00,$58.44,$92.57,$93.50,$0.00,$18.29,$0.00,$18.61,$0.00
53-17011E,SUP,HCPCS C1713,,53-17011E  -  SCREW BONE 1.7MM 11MM ORTH LCK,$116.88,$0.00,$116.88,$52.59,$83.41,$0.00,$20.14,$0.00,$0.00,$20.46,$116.88,$0.00,$58.44,$92.57,$93.50,$0.00,$18.29,$0.00,$18.61,$0.00
53-17012E,SUP,HCPCS C1713,,53-17012E  -  SCREW BONE 1.7MM 12MM LCK SLFTAP CROSSPIN,$116.88,$0.00,$116.88,$52.59,$83.41,$0.00,$20.14,$0.00,$0.00,$20.46,$116.88,$0.00,$58.44,$92.57,$93.50,$0.00,$18.29,$0.00,$18.61,$0.00
53-17013E,SUP,HCPCS C1713,,53-17013E  -  SCREW BONE 1.7MM 13MM ORTH SLFTAP LCK,$116.88,$0.00,$116.88,$52.59,$83.41,$0.00,$20.14,$0.00,$0.00,$20.46,$116.88,$0.00,$58.44,$92.57,$93.50,$0.00,$18.29,$0.00,$18.61,$0.00
53-17014E,SUP,HCPCS C1713,,53-17014E  -  SCREW BONE 1.7MM 14MM LCK SLFTAP CROSSPIN,$116.88,$0.00,$116.88,$52.59,$83.41,$0.00,$20.14,$0.00,$0.00,$20.46,$116.88,$0.00,$58.44,$92.57,$93.50,$0.00,$18.29,$0.00,$18.61,$0.00
53-17015,SUP,HCPCS C1713,,53-17015  -  SCREW BONE 1.7MM 15MM LCK,$116.88,$0.00,$116.88,$52.59,$83.41,$0.00,$20.14,$0.00,$0.00,$20.46,$116.88,$0.00,$58.44,$92.57,$93.50,$0.00,$18.29,$0.00,$18.61,$0.00
53-17015E,SUP,HCPCS C1713,,53-17015E  -  SCREW BONE 1.7MM 15MM LCK SLFTAP CROSSPIN,$116.88,$0.00,$116.88,$52.59,$83.41,$0.00,$20.14,$0.00,$0.00,$20.46,$116.88,$0.00,$58.44,$92.57,$93.50,$0.00,$18.29,$0.00,$18.61,$0.00
53-17016,SUP,HCPCS C1713,,53-17016  -  SCREW BONE 1.7MM 16MM LCK,$116.88,$0.00,$116.88,$52.59,$83.41,$0.00,$20.14,$0.00,$0.00,$20.46,$116.88,$0.00,$58.44,$92.57,$93.50,$0.00,$18.29,$0.00,$18.61,$0.00
53-17016E,SUP,HCPCS C1713,,53-17016E  -  SCREW BONE 1.7MM 16MM ORTH SLFTAP LCK,$116.88,$0.00,$116.88,$52.59,$83.41,$0.00,$20.14,$0.00,$0.00,$20.46,$116.88,$0.00,$58.44,$92.57,$93.50,$0.00,$18.29,$0.00,$18.61,$0.00
53-17018,SUP,HCPCS C1713,,53-17018  -  SCREW BONE 1.7MM 18MM LCK,$116.88,$0.00,$116.88,$52.59,$83.41,$0.00,$20.14,$0.00,$0.00,$20.46,$116.88,$0.00,$58.44,$92.57,$93.50,$0.00,$18.29,$0.00,$18.61,$0.00
53-17018E,SUP,HCPCS C1713,,53-17018E  -  SCREW BONE 1.7MM 18MM VARIAX HAND SLFTAP LCK,$116.88,$0.00,$116.88,$52.59,$83.41,$0.00,$20.14,$0.00,$0.00,$20.46,$116.88,$0.00,$58.44,$92.57,$93.50,$0.00,$18.29,$0.00,$18.61,$0.00
53-17020,SUP,HCPCS C1713,,53-17020  -  SCREW BONE 1.7MM 20MM LCK,$116.88,$0.00,$116.88,$52.59,$83.41,$0.00,$20.14,$0.00,$0.00,$20.46,$116.88,$0.00,$58.44,$92.57,$93.50,$0.00,$18.29,$0.00,$18.61,$0.00
53-17020E,SUP,HCPCS C1713,,53-17020E  -  SCREW BONE 1.7MM 20MM ORTH SLFTAP LCK,$116.88,$0.00,$116.88,$52.59,$83.41,$0.00,$20.14,$0.00,$0.00,$20.46,$116.88,$0.00,$58.44,$92.57,$93.50,$0.00,$18.29,$0.00,$18.61,$0.00
53-17022,SUP,HCPCS C1713,,53-17022  -  SCREW BN 1.7MM 22MM NS VARIAX ST LCK XPN,$116.88,$0.00,$116.88,$52.59,$83.41,$0.00,$20.14,$0.00,$0.00,$20.46,$116.88,$0.00,$58.44,$92.57,$93.50,$0.00,$18.29,$0.00,$18.61,$0.00
53-17022E,SUP,HCPCS C1713,,53-17022E  -  SCREW BONE 1.7MM 22MM ORTH SLFTAP LCK,$116.88,$0.00,$116.88,$52.59,$83.41,$0.00,$20.14,$0.00,$0.00,$20.46,$116.88,$0.00,$58.44,$92.57,$93.50,$0.00,$18.29,$0.00,$18.61,$0.00
53-17024,SUP,HCPCS C1713,,53-17024  -  SCREW BN 1.7MM 24MM NS VARIAX ST LCK XPN,$116.88,$0.00,$116.88,$52.59,$83.41,$0.00,$20.14,$0.00,$0.00,$20.46,$116.88,$0.00,$58.44,$92.57,$93.50,$0.00,$18.29,$0.00,$18.61,$0.00
53-17024E,SUP,HCPCS C1713,,53-17024E  -  SCREW BONE 1.7MM 24MM ORTH SLFTAP LCK,$116.88,$0.00,$116.88,$52.59,$83.41,$0.00,$20.14,$0.00,$0.00,$20.46,$116.88,$0.00,$58.44,$92.57,$93.50,$0.00,$18.29,$0.00,$18.61,$0.00
53-20424,SUP,HCPCS C1713,,53-20424  -  SCREW BONE 2MM 24MM SLFTAP XPIN LAG TITANIUM MAXFACL,$277.50,$0.00,$277.50,$124.88,$198.05,$0.00,$47.81,$0.00,$0.00,$48.59,$277.50,$0.00,$138.75,$219.78,$222.00,$0.00,$43.43,$0.00,$44.18,$0.00
53-20427,SUP,HCPCS C1713,,53-20427  -  SCREW BONE 2MM 27MM SLFTAP XPIN LAG CRANIOMAXILLOFACIAL,$277.50,$0.00,$277.50,$124.88,$198.05,$0.00,$47.81,$0.00,$0.00,$48.59,$277.50,$0.00,$138.75,$219.78,$222.00,$0.00,$43.43,$0.00,$44.18,$0.00
53-20430,SUP,HCPCS C1713,,53-20430  -  SCREW BONE 2MM 30MM SLFTAP XPIN LAG TITANIUM MAXFACL,$277.50,$0.00,$277.50,$124.88,$198.05,$0.00,$47.81,$0.00,$0.00,$48.59,$277.50,$0.00,$138.75,$219.78,$222.00,$0.00,$43.43,$0.00,$44.18,$0.00
53-20433,SUP,HCPCS C1713,,53-20433  -  SCREW BONE 2MM 33MM SLFTAP XPIN LAG MAXFACL,$277.50,$0.00,$277.50,$124.88,$198.05,$0.00,$47.81,$0.00,$0.00,$48.59,$277.50,$0.00,$138.75,$219.78,$222.00,$0.00,$43.43,$0.00,$44.18,$0.00
53-20436,SUP,HCPCS C1713,,53-20436  -  SCREW BONE 2MM 36MM SLFTAP XPIN LAG TITANIUM MAXFACL,$277.50,$0.00,$277.50,$124.88,$198.05,$0.00,$47.81,$0.00,$0.00,$48.59,$277.50,$0.00,$138.75,$219.78,$222.00,$0.00,$43.43,$0.00,$44.18,$0.00
53-20439,SUP,HCPCS C1713,,53-20439  -  SCREW BONE 2MM 39MM SLFTAP XPIN LAG MANDIB NONSTRL,$277.50,$0.00,$277.50,$124.88,$198.05,$0.00,$47.81,$0.00,$0.00,$48.59,$277.50,$0.00,$138.75,$219.78,$222.00,$0.00,$43.43,$0.00,$44.18,$0.00
53-20442,SUP,HCPCS C1713,,53-20442  -  SCREW BONE 2MM 42MM SLFTAP XPIN LAG MANDIB NONSTRL,$277.50,$0.00,$277.50,$124.88,$198.05,$0.00,$47.81,$0.00,$0.00,$48.59,$277.50,$0.00,$138.75,$219.78,$222.00,$0.00,$43.43,$0.00,$44.18,$0.00
53-20616E,SUP,HCPCS C1713,,53-20616E  -  SCREW BONE 2MM 16MM TI LCK PG T7 DRV,$171.88,$0.00,$171.88,$77.34,$122.67,$0.00,$29.61,$0.00,$0.00,$30.09,$171.88,$0.00,$85.94,$136.13,$137.50,$0.00,$26.90,$0.00,$27.36,$0.00
53-20618E,SUP,HCPCS C1713,,53-20618E  -  SCREW BONE 2MM 18MM TI LCK PG T7 DRV,$171.88,$0.00,$171.88,$77.34,$122.67,$0.00,$29.61,$0.00,$0.00,$30.09,$171.88,$0.00,$85.94,$136.13,$137.50,$0.00,$26.90,$0.00,$27.36,$0.00
53-20620E,SUP,HCPCS C1713,,53-20620E  -  SCREW BONE 2MM 20MM TI LCK PG T7 DRV,$171.88,$0.00,$171.88,$77.34,$122.67,$0.00,$29.61,$0.00,$0.00,$30.09,$171.88,$0.00,$85.94,$136.13,$137.50,$0.00,$26.90,$0.00,$27.36,$0.00
53-20622E,SUP,HCPCS C1713,,53-20622E  -  SCREW BONE 2MM 22MM TI LCK PG T7 DRV,$171.88,$0.00,$171.88,$77.34,$122.67,$0.00,$29.61,$0.00,$0.00,$30.09,$171.88,$0.00,$85.94,$136.13,$137.50,$0.00,$26.90,$0.00,$27.36,$0.00
53-20624E,SUP,HCPCS C1713,,53-20624E  -  SCREW BONE 2MM 24MM TI LCK PG T7 DRV STRL,$171.88,$0.00,$171.88,$77.34,$122.67,$0.00,$29.61,$0.00,$0.00,$30.09,$171.88,$0.00,$85.94,$136.13,$137.50,$0.00,$26.90,$0.00,$27.36,$0.00
53-20626E,SUP,HCPCS C1713,,53-20626E  -  SCREW BONE 2MM 26MM TI LCK PG T7 DRV STRL,$171.88,$0.00,$171.88,$77.34,$122.67,$0.00,$29.61,$0.00,$0.00,$30.09,$171.88,$0.00,$85.94,$136.13,$137.50,$0.00,$26.90,$0.00,$27.36,$0.00
53-23006,SUP,HCPCS C1713,,53-23006  -  SCREW BONE 2.3MM 6MM HAND LCK,$116.88,$0.00,$116.88,$52.59,$83.41,$0.00,$20.14,$0.00,$0.00,$20.46,$116.88,$0.00,$58.44,$92.57,$93.50,$0.00,$18.29,$0.00,$18.61,$0.00
53-23006E,SUP,HCPCS C1713,,53-23006E  -  SCREW BONE 2.3MM 6MM CANC LCK SLFTAP CROSSPIN,$116.88,$0.00,$116.88,$52.59,$83.41,$0.00,$20.14,$0.00,$0.00,$20.46,$116.88,$0.00,$58.44,$92.57,$93.50,$0.00,$18.29,$0.00,$18.61,$0.00
53-23008,SUP,HCPCS C1713,,53-23008  -  SCREW BONE 2.3MM 8MM VARIAX HAND SLFTAP XPIN,$116.88,$0.00,$116.88,$52.59,$83.41,$0.00,$20.14,$0.00,$0.00,$20.46,$116.88,$0.00,$58.44,$92.57,$93.50,$0.00,$18.29,$0.00,$18.61,$0.00
53-23008E,SUP,HCPCS C1713,,53-23008E  -  SCREW BN 2.3MM 8MM STRL VARIAX ST LCK LOPRFL XPN HD TI HND,$116.88,$0.00,$116.88,$52.59,$83.41,$0.00,$20.14,$0.00,$0.00,$20.46,$116.88,$0.00,$58.44,$92.57,$93.50,$0.00,$18.29,$0.00,$18.61,$0.00
53-23009,SUP,HCPCS C1713,,53-23009  -  SCREW BN BLNT 2.3MM 9MM LCK ST XPN HD LOPRFL HND,$116.88,$0.00,$116.88,$52.59,$83.41,$0.00,$20.14,$0.00,$0.00,$20.46,$116.88,$0.00,$58.44,$92.57,$93.50,$0.00,$18.29,$0.00,$18.61,$0.00
53-23009E,SUP,HCPCS C1713,,53-23009E  -  SCREW BN LOPRFL 2.3MM 9MM NS VARIAX ST LCK XPN HD TI HND,$116.88,$0.00,$116.88,$52.59,$83.41,$0.00,$20.14,$0.00,$0.00,$20.46,$116.88,$0.00,$58.44,$92.57,$93.50,$0.00,$18.29,$0.00,$18.61,$0.00
53-23010,SUP,HCPCS C1713,,53-23010  -  SCREW BONE 2.3MM 10MM HAND LCK SLFTAP CROSSPIN,$116.88,$0.00,$116.88,$52.59,$83.41,$0.00,$20.14,$0.00,$0.00,$20.46,$116.88,$0.00,$58.44,$92.57,$93.50,$0.00,$18.29,$0.00,$18.61,$0.00
53-23010E,SUP,HCPCS C1713,,53-23010E  -  SCREW BN 2.3MM 10MM STRL VARIAX ST LCK LOPRFL XPN HD TI HND,$116.88,$0.00,$116.88,$52.59,$83.41,$0.00,$20.14,$0.00,$0.00,$20.46,$116.88,$0.00,$58.44,$92.57,$93.50,$0.00,$18.29,$0.00,$18.61,$0.00
53-23011,SUP,HCPCS C1713,,53-23011  -  SCREW BONE 2.3MM 11MM VARIAX HAND SLFTAP XPIN,$116.88,$0.00,$116.88,$52.59,$83.41,$0.00,$20.14,$0.00,$0.00,$20.46,$116.88,$0.00,$58.44,$92.57,$93.50,$0.00,$18.29,$0.00,$18.61,$0.00
53-23011E,SUP,HCPCS C1713,,53-23011E  -  SCREW BONE 2.3MM 11MM LCK SLFTAP CROSSPIN,$116.88,$0.00,$116.88,$52.59,$83.41,$0.00,$20.14,$0.00,$0.00,$20.46,$116.88,$0.00,$58.44,$92.57,$93.50,$0.00,$18.29,$0.00,$18.61,$0.00
53-23012,SUP,HCPCS C1713,,53-23012  -  SCREW BONE 2.3MM 12MM VARIAX HAND LCK XPIN,$116.88,$0.00,$116.88,$52.59,$83.41,$0.00,$20.14,$0.00,$0.00,$20.46,$116.88,$0.00,$58.44,$92.57,$93.50,$0.00,$18.29,$0.00,$18.61,$0.00
53-23012E,SUP,HCPCS C1713,,53-23012E  -  SCREW BN 2.3MM 12MM STRL VARIAX ST LCK LOPRFL CROSSPIN HD TI,$116.88,$0.00,$116.88,$52.59,$83.41,$0.00,$20.14,$0.00,$0.00,$20.46,$116.88,$0.00,$58.44,$92.57,$93.50,$0.00,$18.29,$0.00,$18.61,$0.00
53-23013E,SUP,HCPCS C1713,,53-23013E  -  SCREW BONE 2.3MM 13MM VARIAX TI HAND LCK SLFTAP CROSSPIN,$116.88,$0.00,$116.88,$52.59,$83.41,$0.00,$20.14,$0.00,$0.00,$20.46,$116.88,$0.00,$58.44,$92.57,$93.50,$0.00,$18.29,$0.00,$18.61,$0.00
53-23014,SUP,HCPCS C1713,,53-23014  -  SCREW BONE 2.3MM 14MM HAND LCK SLFTAP CROSSPIN,$116.88,$0.00,$116.88,$52.59,$83.41,$0.00,$20.14,$0.00,$0.00,$20.46,$116.88,$0.00,$58.44,$92.57,$93.50,$0.00,$18.29,$0.00,$18.61,$0.00
53-23015E,SUP,HCPCS C1713,,53-23015E  -  SCREW BONE 2.3MM 15MM HAND LCK SLFTAP CROSSPIN,$116.88,$0.00,$116.88,$52.59,$83.41,$0.00,$20.14,$0.00,$0.00,$20.46,$116.88,$0.00,$58.44,$92.57,$93.50,$0.00,$18.29,$0.00,$18.61,$0.00
53-23016,SUP,HCPCS C1713,,53-23016  -  SCREW BONE 2.3MM 16MM HAND LCK SLFTAP CROSSPIN,$116.88,$0.00,$116.88,$52.59,$83.41,$0.00,$20.14,$0.00,$0.00,$20.46,$116.88,$0.00,$58.44,$92.57,$93.50,$0.00,$18.29,$0.00,$18.61,$0.00
53-23016E,SUP,HCPCS C1713,,53-23016E  -  SCREW BONE 2.3MM 16MM HAND LCK SLFTAP CROSSPIN,$116.88,$0.00,$116.88,$52.59,$83.41,$0.00,$20.14,$0.00,$0.00,$20.46,$116.88,$0.00,$58.44,$92.57,$93.50,$0.00,$18.29,$0.00,$18.61,$0.00
53-23018,SUP,HCPCS C1713,,53-23018  -  SCREW BONE 2.3MM 18MM VARIAX HAND LCK SLFTAP XPIN,$116.88,$0.00,$116.88,$52.59,$83.41,$0.00,$20.14,$0.00,$0.00,$20.46,$116.88,$0.00,$58.44,$92.57,$93.50,$0.00,$18.29,$0.00,$18.61,$0.00
53-23018E,SUP,HCPCS C1713,,53-23018E  -  SCREW BONE 2.3MM 18MM HAND LCK SLFTAP CROSSPIN,$116.88,$0.00,$116.88,$52.59,$83.41,$0.00,$20.14,$0.00,$0.00,$20.46,$116.88,$0.00,$58.44,$92.57,$93.50,$0.00,$18.29,$0.00,$18.61,$0.00
53-23020,SUP,HCPCS C1713,,53-23020  -  SCREW BONE 2.3MM 20MM LCK,$116.88,$0.00,$116.88,$52.59,$83.41,$0.00,$20.14,$0.00,$0.00,$20.46,$116.88,$0.00,$58.44,$92.57,$93.50,$0.00,$18.29,$0.00,$18.61,$0.00
53-23020E,SUP,HCPCS C1713,,53-23020E  -  SCREW BONE 2.3MM 20MM LCK SLFTAP CROSSPIN,$116.88,$0.00,$116.88,$52.59,$83.41,$0.00,$20.14,$0.00,$0.00,$20.46,$116.88,$0.00,$58.44,$92.57,$93.50,$0.00,$18.29,$0.00,$18.61,$0.00
53-23022,SUP,HCPCS C1713,,53-23022  -  SCREW BONE 2MM 22MM RADL,$116.88,$0.00,$116.88,$52.59,$83.41,$0.00,$20.14,$0.00,$0.00,$20.46,$116.88,$0.00,$58.44,$92.57,$93.50,$0.00,$18.29,$0.00,$18.61,$0.00
53-23022E,SUP,HCPCS C1713,,53-23022E  -  SCREW BONE 2.3MM 22MM VARIAX HAND SLFTAP LCK,$116.88,$0.00,$116.88,$52.59,$83.41,$0.00,$20.14,$0.00,$0.00,$20.46,$116.88,$0.00,$58.44,$92.57,$93.50,$0.00,$18.29,$0.00,$18.61,$0.00
53-23024,SUP,HCPCS C1713,,53-23024  -  SCREW BN LOPRFL BLNT RND 2.3MM 24MM GRN VARIAX PRFL 1 STP,$116.88,$0.00,$116.88,$52.59,$83.41,$0.00,$20.14,$0.00,$0.00,$20.46,$116.88,$0.00,$58.44,$92.57,$93.50,$0.00,$18.29,$0.00,$18.61,$0.00
53-23024E,SUP,HCPCS C1713,,53-23024E  -  SCREW BN 2.3MM 24MM VARIAX LCK ST XPN HD LOPRFL TI WR HND,$116.88,$0.00,$116.88,$52.59,$83.41,$0.00,$20.14,$0.00,$0.00,$20.46,$116.88,$0.00,$58.44,$92.57,$93.50,$0.00,$18.29,$0.00,$18.61,$0.00
53-23026,SUP,HCPCS C1713,,53-23026  -  SCREW BONE 2.3MM 26MM LCK,$116.88,$0.00,$116.88,$52.59,$83.41,$0.00,$20.14,$0.00,$0.00,$20.46,$116.88,$0.00,$58.44,$92.57,$93.50,$0.00,$18.29,$0.00,$18.61,$0.00
53-23026E,SUP,HCPCS C1713,,53-23026E  -  SCREW BONE 2.3MM 26MM VARIAX HAND SLFTAP LCK,$116.88,$0.00,$116.88,$52.59,$83.41,$0.00,$20.14,$0.00,$0.00,$20.46,$116.88,$0.00,$58.44,$92.57,$93.50,$0.00,$18.29,$0.00,$18.61,$0.00
53-23210E,SUP,HCPCS C1713,,53-23210E  -  SCREW BONE 2.3MM 10MM TI LCK PG T7 DRV STRL,$171.88,$0.00,$171.88,$77.34,$122.67,$0.00,$29.61,$0.00,$0.00,$30.09,$171.88,$0.00,$85.94,$136.13,$137.50,$0.00,$26.90,$0.00,$27.36,$0.00
53-23212E,SUP,HCPCS C1713,,53-23212E  -  SCREW BONE 2.3MM 12MM VARIAX TI DISTAL RADL T7 DRV STRL LCK,$171.88,$0.00,$171.88,$77.34,$122.67,$0.00,$29.61,$0.00,$0.00,$30.09,$171.88,$0.00,$85.94,$136.13,$137.50,$0.00,$26.90,$0.00,$27.36,$0.00
53-23214E,SUP,HCPCS C1713,,53-23214E  -  SCREW BONE 2.3MM 14MM VARIAX TI DISTAL RADL T7 DRV STRL LCK,$171.88,$0.00,$171.88,$77.34,$122.67,$0.00,$29.61,$0.00,$0.00,$30.09,$171.88,$0.00,$85.94,$136.13,$137.50,$0.00,$26.90,$0.00,$27.36,$0.00
53-23216E,SUP,HCPCS C1713,,53-23216E  -  SCREW BONE 2.3MM 16MM VARIAX TI DISTAL RADL T7 DRV STRL LCK,$171.88,$0.00,$171.88,$77.34,$122.67,$0.00,$29.61,$0.00,$0.00,$30.09,$171.88,$0.00,$85.94,$136.13,$137.50,$0.00,$26.90,$0.00,$27.36,$0.00
53-23218E,SUP,HCPCS C1713,,53-23218E  -  SCREW BONE 2.3MM 18MM VARIAX TI DISTAL RADL T7 DRV STRL LCK,$171.88,$0.00,$171.88,$77.34,$122.67,$0.00,$29.61,$0.00,$0.00,$30.09,$171.88,$0.00,$85.94,$136.13,$137.50,$0.00,$26.90,$0.00,$27.36,$0.00
53-23220E,SUP,HCPCS C1713,,53-23220E  -  SCREW BONE 2.3MM 20MM VARIAX TI DISTAL RADL WR HND NLCKG T7,$171.88,$0.00,$171.88,$77.34,$122.67,$0.00,$29.61,$0.00,$0.00,$30.09,$171.88,$0.00,$85.94,$136.13,$137.50,$0.00,$26.90,$0.00,$27.36,$0.00
53-23222E,SUP,HCPCS C1713,,53-23222E  -  SCREW BONE 2.3MM 22MM VARIAX TI DISTAL RADL T7 DRV STRL LCK,$171.88,$0.00,$171.88,$77.34,$122.67,$0.00,$29.61,$0.00,$0.00,$30.09,$171.88,$0.00,$85.94,$136.13,$137.50,$0.00,$26.90,$0.00,$27.36,$0.00
53-23224E,SUP,HCPCS C1713,,53-23224E  -  SCREW BONE 2.3MM 24MM VARIAX TI DISTAL RADL LCK T7 DRV STRL,$171.88,$0.00,$171.88,$77.34,$122.67,$0.00,$29.61,$0.00,$0.00,$30.09,$171.88,$0.00,$85.94,$136.13,$137.50,$0.00,$26.90,$0.00,$27.36,$0.00
53-23226E,SUP,HCPCS C1713,,53-23226E  -  SCREW BONE 2.3MM 26MM VARIAX TI DISTAL RADL NLCKG T7 DRV,$171.88,$0.00,$171.88,$77.34,$122.67,$0.00,$29.61,$0.00,$0.00,$30.09,$171.88,$0.00,$85.94,$136.13,$137.50,$0.00,$26.90,$0.00,$27.36,$0.00
53-23228E,SUP,HCPCS C1713,,53-23228E  -  SCREW BONE 2.3MM 28MM VARIAX TI T7 DRV STRL,$171.88,$0.00,$171.88,$77.34,$122.67,$0.00,$29.61,$0.00,$0.00,$30.09,$171.88,$0.00,$85.94,$136.13,$137.50,$0.00,$26.90,$0.00,$27.36,$0.00
53-23230E,SUP,HCPCS C1713,,53-23230E  -  SCREW BONE 2.3MM 30MM TI LCK PG T7 DRV STRL,$171.88,$0.00,$171.88,$77.34,$122.67,$0.00,$29.61,$0.00,$0.00,$30.09,$171.88,$0.00,$85.94,$136.13,$137.50,$0.00,$26.90,$0.00,$27.36,$0.00
53-23232E,SUP,HCPCS C1713,,53-23232E  -  SCREW BONE 2.3MM 32MM TI LCK PG T7 DRV STRL,$171.88,$0.00,$171.88,$77.34,$122.67,$0.00,$29.61,$0.00,$0.00,$30.09,$171.88,$0.00,$85.94,$136.13,$137.50,$0.00,$26.90,$0.00,$27.36,$0.00
53-23234E,SUP,HCPCS C1713,,53-23234E  -  SCREW BONE 2.3MM 34MM TI LCK PG T7 DRV STRL,$171.88,$0.00,$171.88,$77.34,$122.67,$0.00,$29.61,$0.00,$0.00,$30.09,$171.88,$0.00,$85.94,$136.13,$137.50,$0.00,$26.90,$0.00,$27.36,$0.00
53-23236E,SUP,HCPCS C1713,,53-23236E  -  SCREW BONE 2.3MM 36MM TI LCK PG T7 DRV STRL,$171.88,$0.00,$171.88,$77.34,$122.67,$0.00,$29.61,$0.00,$0.00,$30.09,$171.88,$0.00,$85.94,$136.13,$137.50,$0.00,$26.90,$0.00,$27.36,$0.00
53-23238E,SUP,HCPCS C1713,,53-23238E  -  SCREW BONE 2.3MM 38MM TI LCK PG T7 DRV STRL,$171.88,$0.00,$171.88,$77.34,$122.67,$0.00,$29.61,$0.00,$0.00,$30.09,$171.88,$0.00,$85.94,$136.13,$137.50,$0.00,$26.90,$0.00,$27.36,$0.00
53-23610E,SUP,HCPCS C1713,,53-23610E  -  SCREW BONE 2.3MM 10MM VARIAX TI DISTAL RADL T7 DRV STRL LCK,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
53-23612E,SUP,HCPCS C1713,,53-23612E  -  SCREW BONE 2.3MM 12MM VARIAX TI DISTAL RADL T7 DRV STRL LCK,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
53-23614E,SUP,HCPCS C1713,,53-23614E  -  SCREW BONE 2.3MM 14MM VARIAX TI DISTAL RADL WR HND LCK T7,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
53-23616E,SUP,HCPCS C1713,,53-23616E  -  SCREW BONE 2.3MM 16MM VARIAX TI DISTAL RADL T7 DRV STRL LCK,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
53-23618E,SUP,HCPCS C1713,,53-23618E  -  SCREW BONE 2.3MM 18MM VARIAX TI DISTAL RADL T7 DRV STRL LCK,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
53-23620E,SUP,HCPCS C1713,,53-23620E  -  SCREW BONE 2.3MM 20MM VARIAX TI DISTAL RADL T7 DRV STRL LCK,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
53-23622E,SUP,HCPCS C1713,,53-23622E  -  SCREW BONE 2.3MM 22MM VARIAX TI DISTAL RADL T7 DRV STRL LCK,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
53-23624E,SUP,HCPCS C1713,,53-23624E  -  SCREW BONE 2.3MM 24MM VARIAX TI DISTAL RADL T7 DRV STRL LCK,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
53-23626E,SUP,HCPCS C1713,,53-23626E  -  SCREW BONE 2.3MM 26MM VARIAX TI LCK T7 DRV STRL,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
53-23628E,SUP,HCPCS C1713,,53-23628E  -  SCREW BONE 2.3MM 28MM VARIAX TI DISTAL RADL T7 DRV STRL LCK,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
53-23630E,SUP,HCPCS C1713,,53-23630E  -  SCREW BONE 2.3MM 30MM TI LCK T7 DRV STRL,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
53-23632E,SUP,HCPCS C1713,,53-23632E  -  SCREW BONE 2.3MM 32MM TI LCK T7 DRV STRL,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
53-23634E,SUP,HCPCS C1713,,53-23634E  -  SCREW BONE 2.3MM 34MM TI LCK T7 DRV STRL,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
53-23636E,SUP,HCPCS C1713,,53-23636E  -  SCREW BONE 2.3MM 36MM TI LCK T7 DRV STRL,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
53-23638E,SUP,HCPCS C1713,,53-23638E  -  SCREW BONE 2.3MM 38MM TI LCK T7 DRV STRL,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
532650S,SUP,HCPCS C1725,,532650S  -  CATHETER ANGIO PGTL CRV 6FR 110CM ST 6 SH BRD PU VNTRC ACPT,$105.63,$0.00,$105.63,$57.35,$75.38,$0.00,$18.20,$0.00,$0.00,$18.49,$105.63,$0.00,$52.81,$83.66,$84.50,$0.00,$16.53,$0.00,$16.82,$0.00
53-27116E,SUP,HCPCS C1713,,53-27116E  -  SCREW BONE 2.7MM 16MM VARIAX TI DISTAL RADL PTTHRD T7 DRV,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
53-27118E,SUP,HCPCS C1713,,53-27118E  -  SCREW BONE 2.7MM 18MM VARIAX TI DISTAL RADL PTTHRD T7 DRV,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
53-27120E,SUP,HCPCS C1713,,53-27120E  -  SCREW BONE 2.7MM 20MM TI PTHRD T7 DRV,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
53-27122E,SUP,HCPCS C1713,,53-27122E  -  SCREW BONE 2.7MM 22MM VARIAX TI DISTAL RADL PTTHRD T7 DRV,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
53-27124E,SUP,HCPCS C1713,,53-27124E  -  SCREW BONE 2.7MM 24MM VARIAX TI DISTAL RADL PTTHRD T7 DRV,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
53-27126E,SUP,HCPCS C1713,,53-27126E  -  SCREW BONE 2.7MM 26MM VARIAX TI DISTAL RADL PTTHRD T7 DRV,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
53-27210E,SUP,HCPCS C1713,,53-27210E  -  SCREW BONE 2.7MM 10MM VARIAX TI DISTAL RADL T7 DRV STRL LCK,$171.88,$0.00,$171.88,$77.34,$122.67,$0.00,$29.61,$0.00,$0.00,$30.09,$171.88,$0.00,$85.94,$136.13,$137.50,$0.00,$26.90,$0.00,$27.36,$0.00
53-27212E,SUP,HCPCS C1713,,53-27212E  -  SCREW BONE 2.7MM 12MM VARIAX TI DISTAL RADL WR HND NLCKG T7,$171.88,$0.00,$171.88,$77.34,$122.67,$0.00,$29.61,$0.00,$0.00,$30.09,$171.88,$0.00,$85.94,$136.13,$137.50,$0.00,$26.90,$0.00,$27.36,$0.00
53-27214E,SUP,HCPCS C1713,,53-27214E  -  SCREW BONE 2.7MM 14MM VARIAX TI DISTAL RADL WR HND NLCKG T7,$171.88,$0.00,$171.88,$77.34,$122.67,$0.00,$29.61,$0.00,$0.00,$30.09,$171.88,$0.00,$85.94,$136.13,$137.50,$0.00,$26.90,$0.00,$27.36,$0.00
53-27216E,SUP,HCPCS C1713,,53-27216E  -  SCREW BONE 2.7MM 16MM VARIAX TI DISTAL RADL T7 DRV STRL LCK,$171.88,$0.00,$171.88,$77.34,$122.67,$0.00,$29.61,$0.00,$0.00,$30.09,$171.88,$0.00,$85.94,$136.13,$137.50,$0.00,$26.90,$0.00,$27.36,$0.00
53-27218E,SUP,HCPCS C1713,,53-27218E  -  SCREW BONE 2.7MM 18MM VARIAX TI DISTAL RADL LCK T7 DRV STRL,$171.88,$0.00,$171.88,$77.34,$122.67,$0.00,$29.61,$0.00,$0.00,$30.09,$171.88,$0.00,$85.94,$136.13,$137.50,$0.00,$26.90,$0.00,$27.36,$0.00
53-27220E,SUP,HCPCS C1713,,53-27220E  -  SCREW BONE 2.7MM 20MM VARIAX TI DISTAL RADL T7 DRV STRL LCK,$171.88,$0.00,$171.88,$77.34,$122.67,$0.00,$29.61,$0.00,$0.00,$30.09,$171.88,$0.00,$85.94,$136.13,$137.50,$0.00,$26.90,$0.00,$27.36,$0.00
53-27222E,SUP,HCPCS C1713,,53-27222E  -  SCREW BONE 2.7MM 22MM VARIAX TI DISTAL RADL NLCKG T7 DRV,$171.88,$0.00,$171.88,$77.34,$122.67,$0.00,$29.61,$0.00,$0.00,$30.09,$171.88,$0.00,$85.94,$136.13,$137.50,$0.00,$26.90,$0.00,$27.36,$0.00
53-27224E,SUP,HCPCS C1713,,53-27224E  -  SCREW BONE 2.7MM 24MM VARIAX TI DISTAL RADL LCK T7 DRV STRL,$171.88,$0.00,$171.88,$77.34,$122.67,$0.00,$29.61,$0.00,$0.00,$30.09,$171.88,$0.00,$85.94,$136.13,$137.50,$0.00,$26.90,$0.00,$27.36,$0.00
53-27226E,SUP,HCPCS C1713,,53-27226E  -  SCREW BONE 2.7MM 26MM VARIAX TI DISTAL RADL LCK T7 DRV STRL,$171.88,$0.00,$171.88,$77.34,$122.67,$0.00,$29.61,$0.00,$0.00,$30.09,$171.88,$0.00,$85.94,$136.13,$137.50,$0.00,$26.90,$0.00,$27.36,$0.00
53-27610E,SUP,HCPCS C1713,,53-27610E  -  SCREW BONE 2.7MM 10MM VARIAX TI DISTAL RADL T7 DRV STRL LCK,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
53-27612E,SUP,HCPCS C1713,,53-27612E  -  SCREW BONE 2.7MM 12MM VARIAX TI DISTAL RADL T7 DRV STRL LCK,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
53-27614E,SUP,HCPCS C1713,,53-27614E  -  SCREW BONE 2.7MM 14MM VARIAX TI DISTAL RADL LCK T7 DRV STRL,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
53-27616E,SUP,HCPCS C1713,,53-27616E  -  SCREW BONE 2.7MM 16MM VARIAX TI DISTAL RADL T7 DRV STRL LCK,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
53-27618E,SUP,HCPCS C1713,,53-27618E  -  SCREW BONE 2.7MM 18MM VARIAX TI DISTAL RADL T7 DRV STRL LCK,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
53-27620E,SUP,HCPCS C1713,,53-27620E  -  SCREW BONE 2.7MM 20MM VARIAX TI DISTAL RADL LCK T7 DRV STRL,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
53-27622E,SUP,HCPCS C1713,,53-27622E  -  SCREW BN T7 FT 2.7MM 22MM NS VARIAX LCK TI DIST RDS LCK PLT,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
53-27624E,SUP,HCPCS C1713,,53-27624E  -  SCREW BONE 2.7MM 24MM VARIAX TI DISTAL RADL T7 DRV LCK,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
53-27626E,SUP,HCPCS C1713,,53-27626E  -  SCREW BONE 2.7MM 26MM TI T7 DRV,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
53-27716E,SUP,HCPCS C1713,,53-27716E  -  PEG 2.7MM 16MM PTTHRD LCK TI NONSTRL,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
53-27718E,SUP,HCPCS C1713,,53-27718E  -  PEG 2.7MM 18MM DISTAL RADL PTTHRD LCK TI VARIAX STRL,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
53-27720E,SUP,HCPCS C1713,,53-27720E  -  PEG 2.7MM 20MM DISTAL RADL PTTHRD LCK TI VARIAX STRL,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
53-27722E,SUP,HCPCS C1713,,53-27722E  -  PEG 2.7MM 22MM DISTAL RADL PTTHRD LCK TI VARIAX STRL,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
53-27724E,SUP,HCPCS C1713,,53-27724E  -  PEG 2.7MM 24MM DISTAL RADL PTTHRD LCK TI VARIAX STRL,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
53-27726E,SUP,HCPCS C1713,,53-27726E  -  PEG 2.7MM 26MM DISTAL RADL PTTHRD LCK TI VARIAX STRL,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
5331-40/15,SUP,HCPCS C1776,,5331-40/15  -  HEAD HUMERAL 40MM 15MM EPOCA COCR ALLOY SHOULDER STERILE,"$4,287.70",$0.00,"$4,287.70","$1,929.47","$3,060.13",$0.00,$738.75,$0.00,$0.00,$750.74,"$4,287.70",$0.00,"$2,143.85","$3,395.86","$3,430.16",$0.00,$671.03,$0.00,$682.60,$0.00
5331-42/15,SUP,HCPCS C1776,,5331-42/15  -  HEAD HUMERAL 42MM 15.75MM COCR SHOULDER NONSTRL,"$4,287.70",$0.00,"$4,287.70","$1,929.47","$3,060.13",$0.00,$738.75,$0.00,$0.00,$750.74,"$4,287.70",$0.00,"$2,143.85","$3,395.86","$3,430.16",$0.00,$671.03,$0.00,$682.60,$0.00
5331-44/16,SUP,HCPCS C1776,,5331-44/16  -  HEAD HUM 44MM 16.5MM STRL COCR SHLDR,"$4,287.70",$0.00,"$4,287.70","$1,929.47","$3,060.13",$0.00,$738.75,$0.00,$0.00,$750.74,"$4,287.70",$0.00,"$2,143.85","$3,395.86","$3,430.16",$0.00,$671.03,$0.00,$682.60,$0.00
5331-46/17,SUP,HCPCS C1776,,5331-46/17  -  HEAD HUM 46MM 17.25MM STRL COCR SHLDR,"$4,287.70",$0.00,"$4,287.70","$1,929.47","$3,060.13",$0.00,$738.75,$0.00,$0.00,$750.74,"$4,287.70",$0.00,"$2,143.85","$3,395.86","$3,430.16",$0.00,$671.03,$0.00,$682.60,$0.00
5331-48/18,SUP,HCPCS C1776,,5331-48/18  -  HEAD HUM 48MM 18MM STRL COCR SHLDR,"$4,287.70",$0.00,"$4,287.70","$1,929.47","$3,060.13",$0.00,$738.75,$0.00,$0.00,$750.74,"$4,287.70",$0.00,"$2,143.85","$3,395.86","$3,430.16",$0.00,$671.03,$0.00,$682.60,$0.00
5331-50/18,SUP,HCPCS C1776,,5331-50/18  -  HEAD HUM 50MM 18.75MM STRL COCR SHLDR,"$4,287.70",$0.00,"$4,287.70","$1,929.47","$3,060.13",$0.00,$738.75,$0.00,$0.00,$750.74,"$4,287.70",$0.00,"$2,143.85","$3,395.86","$3,430.16",$0.00,$671.03,$0.00,$682.60,$0.00
5331-52/19,SUP,HCPCS C1776,,5331-52/19  -  HEAD HUMERAL 52MM 19.5MM EPOCA COCR SHOULDER STERILE,"$4,287.70",$0.00,"$4,287.70","$1,929.47","$3,060.13",$0.00,$738.75,$0.00,$0.00,$750.74,"$4,287.70",$0.00,"$2,143.85","$3,395.86","$3,430.16",$0.00,$671.03,$0.00,$682.60,$0.00
5331-54/20,SUP,HCPCS C1776,,5331-54/20  -  HEAD HUMERAL 54MM 20.25MM COCR SHOULDER NONSTRL,"$4,287.70",$0.00,"$4,287.70","$1,929.47","$3,060.13",$0.00,$738.75,$0.00,$0.00,$750.74,"$4,287.70",$0.00,"$2,143.85","$3,395.86","$3,430.16",$0.00,$671.03,$0.00,$682.60,$0.00
5331-56/21,SUP,HCPCS C1776,,5331-56/21  -  HEAD FEMORAL 56MM 21MM COCR HIP STERILE,"$4,287.70",$0.00,"$4,287.70","$1,929.47","$3,060.13",$0.00,$738.75,$0.00,$0.00,$750.74,"$4,287.70",$0.00,"$2,143.85","$3,395.86","$3,430.16",$0.00,$671.03,$0.00,$682.60,$0.00
5331-58/22,SUP,HCPCS C1776,,5331-58/22  -  HEAD FEMORAL 58MM 21.75MM COCR HIP STERILE,"$4,287.70",$0.00,"$4,287.70","$1,929.47","$3,060.13",$0.00,$738.75,$0.00,$0.00,$750.74,"$4,287.70",$0.00,"$2,143.85","$3,395.86","$3,430.16",$0.00,$671.03,$0.00,$682.60,$0.00
53-34164,SUP,HCPCS C1713,,53-34164  -  PLATE BN STRG .4MM NS UNV NEURO III 16 HL LOPRFL TI CRNMXF,"$1,147.50",$0.00,"$1,147.50",$516.38,$818.97,$0.00,$197.71,$0.00,$0.00,$200.92,"$1,147.50",$0.00,$573.75,$908.82,$918.00,$0.00,$179.58,$0.00,$182.68,$0.00
53-34212,SUP,HCPCS C1713,,53-34212  -  PLATE BN STRG .4MM NS UNV NEURO III 2 HL LOPRFL BAR TAB TI,$457.50,$0.00,$457.50,$205.88,$326.52,$0.00,$78.82,$0.00,$0.00,$80.10,$457.50,$0.00,$228.75,$362.34,$366.00,$0.00,$71.60,$0.00,$72.83,$0.00
53-34216,SUP,HCPCS C1713,,53-34216  -  PLATE BN DOG 16MMX.4MM NS UNV NEURO III 2 HL LOPRFL BAR TI,$562.50,$0.00,$562.50,$253.13,$401.46,$0.00,$96.92,$0.00,$0.00,$98.49,$562.50,$0.00,$281.25,$445.50,$450.00,$0.00,$88.03,$0.00,$89.55,$0.00
53-34228,SUP,HCPCS C1713,,53-34228  -  PLATE BN SM BX .4MM NS UNV NEURO III 2X2 HL LOPRFL TI CRNMXF,$717.50,$0.00,$717.50,$322.88,$512.08,$0.00,$123.62,$0.00,$0.00,$125.63,$717.50,$0.00,$358.75,$568.26,$574.00,$0.00,$112.29,$0.00,$114.23,$0.00
53-34240,SUP,HCPCS C1713,,53-34240  -  PLATE BN LG BX .4MM NS UNV NEURO III 2X2 HL LOPRFL TI CRNMXF,"$1,112.50",$0.00,"$1,112.50",$500.63,$793.99,$0.00,$191.68,$0.00,$0.00,$194.79,"$1,112.50",$0.00,$556.25,$881.10,$890.00,$0.00,$174.11,$0.00,$177.11,$0.00
53-34300,SUP,HCPCS C1713,,53-34300  -  PLATE BN RECT .4MM NS UNV NEURO III 2X2 HL LOPRFL TI CRNMXF,"$1,092.50",$0.00,"$1,092.50",$491.63,$779.72,$0.00,$188.23,$0.00,$0.00,$191.29,"$1,092.50",$0.00,$546.25,$865.26,$874.00,$0.00,$170.98,$0.00,$173.93,$0.00
53-34406,SUP,HCPCS C1713,,53-34406  -  PLATE BN STRG 6MMX.4MM NS UNV NEURO III 4 HL LOPRFL BAR TI,$505.00,$0.00,$505.00,$227.25,$360.42,$0.00,$87.01,$0.00,$0.00,$88.42,$505.00,$0.00,$252.50,$399.96,$404.00,$0.00,$79.03,$0.00,$80.40,$0.00
53-34507,SUP,HCPCS C1713,,53-34507  -  COVER BUR HL LOPRFL 7MM STRL MDPR TAB TI,$915.00,$0.00,$915.00,$411.75,$653.04,$0.00,$157.65,$0.00,$0.00,$160.21,$915.00,$0.00,$457.50,$724.68,$732.00,$0.00,$143.20,$0.00,$145.67,$0.00
53-34510,SUP,HCPCS C1713,,53-34510  -  COVER BURR HOLE LP 10MM TAB UNIVERSAL NEURO III,$915.00,$0.00,$915.00,$411.75,$653.04,$0.00,$157.65,$0.00,$0.00,$160.21,$915.00,$0.00,$457.50,$724.68,$732.00,$0.00,$143.20,$0.00,$145.67,$0.00
53-34514,SUP,HCPCS C1713,,53-34514  -  COVER BURR HOLE LP 14MM TAB UNIVERSAL NEURO III,$915.00,$0.00,$915.00,$411.75,$653.04,$0.00,$157.65,$0.00,$0.00,$160.21,$915.00,$0.00,$457.50,$724.68,$732.00,$0.00,$143.20,$0.00,$145.67,$0.00
53-34608,SUP,HCPCS C1713,,53-34608  -  PLATE BN 2Y .4MM NS UNV NEURO III 6 HL LOPRFL BAR TI CRNMXF,"$1,002.50",$0.00,"$1,002.50",$451.13,$715.48,$0.00,$172.73,$0.00,$0.00,$175.53,"$1,002.50",$0.00,$501.25,$793.98,$802.00,$0.00,$156.89,$0.00,$159.60,$0.00
53-34612,SUP,HCPCS C1713,,53-34612  -  PLATE BN SM GAP .4MM NS UNV NEURO III 6 HL LOPRFL TI CRNMXF,"$1,240.00",$0.00,"$1,240.00",$558.00,$884.99,$0.00,$213.65,$0.00,$0.00,$217.11,"$1,240.00",$0.00,$620.00,$982.08,$992.00,$0.00,$194.06,$0.00,$197.41,$0.00
53-34614,SUP,HCPCS C1713,,53-34614  -  COVER BUR HL 14MMX.4MM NS UNV NEURO III LOPRFL SHNT TAB TI,"$1,002.50",$0.00,"$1,002.50",$451.13,$715.48,$0.00,$172.73,$0.00,$0.00,$175.53,"$1,002.50",$0.00,$501.25,$793.98,$802.00,$0.00,$156.89,$0.00,$159.60,$0.00
53-34620,SUP,HCPCS C1713,,53-34620  -  COVER BUR HL 20MMX.4MM NS UNV NEURO III LOPRFL SHNT TAB TI,"$1,100.00",$0.00,"$1,100.00",$495.00,$785.07,$0.00,$189.52,$0.00,$0.00,$192.60,"$1,100.00",$0.00,$550.00,$871.20,$880.00,$0.00,$172.15,$0.00,$175.12,$0.00
53-34622,SUP,HCPCS C1713,,53-34622  -  PLATE BN LG GAP .4MM NS UNV NEURO III 6 HL LOPRFL TI CRNMXF,"$1,320.00",$0.00,"$1,320.00",$594.00,$942.08,$0.00,$227.43,$0.00,$0.00,$231.12,"$1,320.00",$0.00,$660.00,"$1,045.44","$1,056.00",$0.00,$206.58,$0.00,$210.14,$0.00
53-34804,SUP,HCPCS C1713,,53-34804  -  PLATE BN STRG .4MM NS UNV NEURO III 8 HL LOPRFL TI CRNMXF,$655.00,$0.00,$655.00,$294.75,$467.47,$0.00,$112.85,$0.00,$0.00,$114.69,$655.00,$0.00,$327.50,$518.76,$524.00,$0.00,$102.51,$0.00,$104.28,$0.00
53-36212,SUP,HCPCS C1713,,53-36212  -  PLATE BN DOG 12MMX.6MM NS UNV NEURO III 2 HL LOPRFL RGD TI,$397.50,$0.00,$397.50,$178.88,$283.70,$0.00,$68.49,$0.00,$0.00,$69.60,$397.50,$0.00,$198.75,$314.82,$318.00,$0.00,$62.21,$0.00,$63.28,$0.00
5-34-002,SUP,Custom 27203010,,CHEMICAL ALGAECIDE LQ 4OZ,$37.50,$0.00,$37.50,$0.00,$26.76,$0.00,$0.00,$0.00,$0.00,$0.00,$37.50,$0.00,$18.75,$29.70,$30.00,$0.00,$0.00,$0.00,$0.00,$0.00
5357M/S,SUP,HCPCS C1785,,5357M/S  -  PACEMAKER CRD 11ML VR XL 2 CHMBR,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
539G,SUP,Custom 27203010,,539G  -  SUTURE SS 4-0 5-26 TS 14IN MFL DBL ARM BLK NABSB,$22.74,$0.00,$22.74,$0.00,$16.23,$0.00,$0.00,$0.00,$0.00,$0.00,$22.74,$0.00,$11.37,$18.01,$18.19,$0.00,$0.00,$0.00,$0.00,$0.00
54-00261,SUP,HCPCS C1713,,54-00261  -  PLATE BONE 120X60X.1MM MICROMESH TITANIUM,"$3,305.00",$0.00,"$3,305.00","$1,487.25","$2,358.78",$0.00,$569.43,$0.00,$0.00,$578.68,"$3,305.00",$0.00,"$1,652.50","$2,617.56","$2,644.00",$0.00,$517.23,$0.00,$526.16,$0.00
54-00262,SUP,HCPCS C1713,,54-00262  -  MESH DYNAMIC MICRO ULTRA-THIN 60X60X.1MM MALBLE UNIVERSAL,"$2,195.00",$0.00,"$2,195.00",$987.75,"$1,566.57",$0.00,$378.19,$0.00,$0.00,$384.33,"$2,195.00",$0.00,"$1,097.50","$1,738.44","$1,756.00",$0.00,$343.52,$0.00,$349.44,$0.00
54-00272,SUP,HCPCS C1713,,54-00272  -  MESH CRNL MIC 60X60X.2MM NS UNV NEURO III TI CRNMXF 1.2MM,"$2,195.00",$0.00,"$2,195.00",$987.75,"$1,566.57",$0.00,$378.19,$0.00,$0.00,$384.33,"$2,195.00",$0.00,"$1,097.50","$1,738.44","$1,756.00",$0.00,$343.52,$0.00,$349.44,$0.00
54-00345,SUP,HCPCS C1713,,54-00345  -  MESH DYNAMIC LP 120X120X.3MM MALBLE BLUE TITANIUM,"$10,045.00",$0.00,"$10,045.00","$4,520.25","$5,158.80",$0.00,"$1,730.70",$0.00,$0.00,"$1,758.80","$10,045.00",$0.00,"$5,022.50","$7,955.64","$8,036.00",$0.00,"$1,572.04",$0.00,"$1,599.16",$0.00
54-00346,SUP,HCPCS C1713,,54-00346  -  MESH DYNAMIC LP 90X90X.3MM MALBLE BLUE TITANIUM,"$6,375.00",$0.00,"$6,375.00","$2,868.75","$4,549.84",$0.00,"$1,098.38",$0.00,$0.00,"$1,116.21","$6,375.00",$0.00,"$3,187.50","$5,049.00","$5,100.00",$0.00,$997.69,$0.00,"$1,014.90",$0.00
54-00642,SUP,HCPCS C1713,,54-00642  -  PLATE BONE 90X90X.6MM DYNAMIC MESH TITANIUM,"$6,382.50",$0.00,"$6,382.50","$2,872.13","$4,555.19",$0.00,"$1,099.67",$0.00,$0.00,"$1,117.52","$6,382.50",$0.00,"$3,191.25","$5,054.94","$5,106.00",$0.00,$998.86,$0.00,"$1,016.09",$0.00
54-00643,SUP,HCPCS C1713,,54-00643  -  PLATE BONE STANDARD 120X120X.6MM DYNAMIC MESH TITANIUM,"$10,365.00",$0.00,"$10,365.00","$4,664.25","$5,158.80",$0.00,"$1,785.84",$0.00,$0.00,"$1,814.83","$10,365.00",$0.00,"$5,182.50","$8,209.08","$8,292.00",$0.00,"$1,622.12",$0.00,"$1,650.11",$0.00
54-00645,SUP,HCPCS C1713,,54-00645  -  MESH DYNAMIC STANDARD 120X120X.6MM GOLD TITANIUM,"$10,365.00",$0.00,"$10,365.00","$4,664.25","$5,158.80",$0.00,"$1,785.84",$0.00,$0.00,"$1,814.83","$10,365.00",$0.00,"$5,182.50","$8,209.08","$8,292.00",$0.00,"$1,622.12",$0.00,"$1,650.11",$0.00
54-00646,SUP,HCPCS C1713,,54-00646  -  MESH DYNAMIC STANDARD 90X90X.6MM GOLD TITANIUM,"$6,382.50",$0.00,"$6,382.50","$2,872.13","$4,555.19",$0.00,"$1,099.67",$0.00,$0.00,"$1,117.52","$6,382.50",$0.00,"$3,191.25","$5,054.94","$5,106.00",$0.00,$998.86,$0.00,"$1,016.09",$0.00
54-00647,SUP,HCPCS C1713,,54-00647  -  MESH DYNAMIC STANDARD 200X200X.6MM GOLD TITANIUM,"$29,330.00",$0.00,"$29,330.00","$13,198.50","$5,158.80",$0.00,"$5,053.41",$0.00,$0.00,"$5,135.45","$29,330.00",$0.00,"$14,665.00","$23,229.36","$23,464.00",$0.00,"$4,590.15",$0.00,"$4,669.34",$0.00
5400-701-000,SUP,Custom 27203010,,5400-701-000  -  MILL BONE BIOP MED BIOP DISP,"$1,000.00",$0.00,"$1,000.00",$0.00,$713.70,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,000.00",$0.00,$500.00,$792.00,$800.00,$0.00,$0.00,$0.00,$0.00,$0.00
540-11-40A,SUP,Custom 27803010,,540-11-40A  -  SHELL ACETAB A 40MM 41.8MM SOLID BACK RIM TRIDENT PSL HA HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
540-11-42B,SUP,Custom 27803010,,540-11-42B  -  SHELL ACETAB B 42MM 43.8MM SOLID BACK RIM TRIDENT PSL HA HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
540-11-44C,SUP,Custom 27803010,,540-11-44C  -  SHELL ACETAB C 44MM 45.8MM SOLID BACK RIM TRIDENT PSL HA HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
540-11-46D,SUP,Custom 27803010,,540-11-46D  -  SHELL ACETAB D 46MM 47.8MM SOLID BACK RIM TRIDENT PSL HA HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
540-11-48D,SUP,Custom 27803010,,540-11-48D  -  SHELL ACETAB D 48MM 49.8MM SOLID BACK RIM TRIDENT PSL HA HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
540-11-50E,SUP,Custom 27803010,,540-11-50E  -  SHELL ACETAB E 50MM 51.8MM SOLID BACK RIM TRIDENT PSL HA HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
540-11-52E,SUP,Custom 27803010,,540-11-52E  -  SHELL ACETAB E 52MM SOLID BACK DOME HOLE PLUG TRIDENT PSL HA,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
540-11-54F,SUP,Custom 27803010,,540-11-54F  -  SHELL ACETAB F 54MM 55.8MM SOLID BACK RIM TRIDENT PSL HA HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
540-11-56F,SUP,Custom 27803010,,540-11-56F  -  SHELL ACETAB F 56MM 57.8MM SOLID BACK RIM TRIDENT PSL HA HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
540-11-58G,SUP,Custom 27803010,,540-11-58G  -  SHELL ACETAB G 58MM 59.8MM SOLID BACK RIM TRIDENT PSL HA HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
540-11-60G,SUP,Custom 27803010,,540-11-60G  -  SHELL ACETAB G 60MM 61.8MM SOLID BACK RIM TRIDENT PSL HA HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
540-11-62H,SUP,Custom 27803010,,540-11-62H  -  SHELL ACETAB H 62MM 63.8MM SOLID BACK RIM TRIDENT PSL HA HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
540-11-64H,SUP,Custom 27803010,,540-11-64H  -  SHELL ACETAB H 64MM 65.8MM SOLID BACK RIM TRIDENT PSL HA HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
540-11-66I,SUP,Custom 27803010,,540-11-66I  -  SHELL ACETAB I 66MM 67.8MM SOLID BACK RIM TRIDENT PSL HA HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
540-11-68I,SUP,Custom 27803010,,540-11-68I  -  SHELL ACETAB I 68MM 69.8MM SOLID BACK RIM TRIDENT PSL HA HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
540-11-70J,SUP,Custom 27803010,,540-11-70J  -  SHELL ACETAB J 70MM 71.8MM SOLID BACK RIM TRIDENT PSL HA HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
540-11-72J,SUP,Custom 27803010,,540-11-72J  -  SHELL ACETAB J 72MM 73.8MM SOLID BACK RIM TRIDENT PSL HA HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
54-03000,SUP,HCPCS C1713,,54-03000  -  TEMPLATE SZ SM STD 1.2MM CMBN ORBT PLT,$225.00,$0.00,$225.00,$101.25,$160.58,$0.00,$38.77,$0.00,$0.00,$39.40,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$35.21,$0.00,$35.82,$0.00
54-03001,SUP,HCPCS C1713,,54-03001  -  PLATE BONE LARGE 39X34X.3MM COMPLEX TITANIUM ORBTL FLOOR 1.2,"$3,705.00",$0.00,"$3,705.00","$1,667.25","$2,644.26",$0.00,$638.35,$0.00,$0.00,$648.72,"$3,705.00",$0.00,"$1,852.50","$2,934.36","$2,964.00",$0.00,$579.83,$0.00,$589.84,$0.00
54-03002,SUP,HCPCS C1713,,54-03002  -  PLATE BONE MEDIUM .3MM MALBLE BASIC UPPER FACE ORBTL FLOOR,"$3,477.50",$0.00,"$3,477.50","$1,564.88","$2,481.89",$0.00,$599.16,$0.00,$0.00,$608.88,"$3,477.50",$0.00,"$1,738.75","$2,754.18","$2,782.00",$0.00,$544.23,$0.00,$553.62,$0.00
54-03003,SUP,HCPCS C1713,,54-03003  -  PLATE BONE SMALL 20X18X.3MM ISOLATED TITANIUM ORBTL FLOOR,"$3,260.00",$0.00,"$3,260.00","$1,467.00","$2,326.66",$0.00,$561.68,$0.00,$0.00,$570.80,"$3,260.00",$0.00,"$1,630.00","$2,581.92","$2,608.00",$0.00,$510.19,$0.00,$518.99,$0.00
54-04000,SUP,HCPCS C1713,,54-04000  -  TEMPLATE SZ LG STD 1.2MM CMBN ORBT PLT,$225.00,$0.00,$225.00,$101.25,$160.58,$0.00,$38.77,$0.00,$0.00,$39.40,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$35.21,$0.00,$35.82,$0.00
54-04001,SUP,HCPCS C1713,,54-04001  -  PLATE BONE LARGE 30X32X.4MM COMPLEX TITANIUM ORBTL FLOOR 1.2,"$3,705.00",$0.00,"$3,705.00","$1,667.25","$2,644.26",$0.00,$638.35,$0.00,$0.00,$648.72,"$3,705.00",$0.00,"$1,852.50","$2,934.36","$2,964.00",$0.00,$579.83,$0.00,$589.84,$0.00
54-04002,SUP,HCPCS C1713,,54-04002  -  PLATE BN MED BSC STD .4MM NS LEIBINGER UNV 2 TI ORBT FLR 1.2,"$3,477.50",$0.00,"$3,477.50","$1,564.88","$2,481.89",$0.00,$599.16,$0.00,$0.00,$608.88,"$3,477.50",$0.00,"$1,738.75","$2,754.18","$2,782.00",$0.00,$544.23,$0.00,$553.62,$0.00
54-04004,SUP,HCPCS C1713,,54-04004  -  PLATE BONE 3D SMALL PREBENT ORBTL FLOOR RIGHT,"$4,145.00",$0.00,"$4,145.00","$1,865.25","$2,958.29",$0.00,$714.16,$0.00,$0.00,$725.76,"$4,145.00",$0.00,"$2,072.50","$3,282.84","$3,316.00",$0.00,$648.69,$0.00,$659.88,$0.00
54-04007,SUP,HCPCS C1713,,54-04007  -  PLATE BONE 3D LARGE PREBENT ORBTL FLOOR LEFT,"$4,145.00",$0.00,"$4,145.00","$1,865.25","$2,958.29",$0.00,$714.16,$0.00,$0.00,$725.76,"$4,145.00",$0.00,"$2,072.50","$3,282.84","$3,316.00",$0.00,$648.69,$0.00,$659.88,$0.00
54-05100,SUP,Custom 27803010,,54-05100  -  CLIP FIX TITANIUM CRANIAL 1.5 MM 1.7 MM SCREW,$351.80,$0.00,$351.80,$0.00,$251.08,$0.00,$0.00,$0.00,$0.00,$0.00,$351.80,$0.00,$175.90,$278.63,$281.44,$0.00,$0.00,$0.00,$0.00,$0.00
54051T,SUP,HCPCS Q4108,,54051T  -  DRESSING WND THN 5X4IN STRL BVN CLGN GAG DISP,$457.19,$0.00,$457.19,$0.00,$326.30,$0.00,$78.77,$0.00,$0.00,$0.00,$457.19,$0.00,$228.60,$362.09,$365.75,$0.00,$39.86,$0.00,$0.00,$0.00
5407FA1015,SUP,Custom 27203010,,5407FA1015  -  ROUTER POWER TAPER 1.5MM 12MM LATEX FREE,$301.68,$0.00,$301.68,$0.00,$215.31,$0.00,$0.00,$0.00,$0.00,$0.00,$301.68,$0.00,$150.84,$238.93,$241.34,$0.00,$0.00,$0.00,$0.00,$0.00
5407FA2023,SUP,Custom 27203010,,5407FA2023  -  ROUTER POWER TAPER 2.3MM LATEX FREE,$280.00,$0.00,$280.00,$0.00,$199.84,$0.00,$0.00,$0.00,$0.00,$0.00,$280.00,$0.00,$140.00,$221.76,$224.00,$0.00,$0.00,$0.00,$0.00,$0.00
5407FA3030,SUP,Custom 27203010,,5407FA3030  -  BURR SRG TPR 3MM WHT ROUT,$288.78,$0.00,$288.78,$0.00,$206.10,$0.00,$0.00,$0.00,$0.00,$0.00,$288.78,$0.00,$144.39,$228.71,$231.02,$0.00,$0.00,$0.00,$0.00,$0.00
5413-20/5,SUP,HCPCS C1713,,5413-20/5  -  COMPONENT HUM STD ECCENTER STRL EPOCA TI SHLDR,"$1,004.35",$0.00,"$1,004.35",$451.96,$716.80,$0.00,$173.04,$0.00,$0.00,$175.85,"$1,004.35",$0.00,$502.18,$795.45,$803.48,$0.00,$157.18,$0.00,$159.89,$0.00
542-11-40A,SUP,Custom 27803010,,542-11-40A  -  SHELL ACETAB A 40MM 41.8MM 3 SCREW HOLE CLUSTER RIM TRIDENT,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
542-11-42B,SUP,Custom 27803010,,542-11-42B  -  SHELL ACETAB B 42MM 43.8MM 3 SCREW HOLE CLUSTER RIM TRIDENT,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
542-11-44C,SUP,Custom 27803010,,542-11-44C  -  SHELL ACETAB C 44MM 45.8MM 3 SCREW HOLE CLUSTER RIM TRIDENT,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
542-11-46D,SUP,Custom 27803010,,542-11-46D  -  SHELL ACETAB D 46MM 47.8MM 3 SCREW HOLE CLUSTER RIM TRIDENT,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
542-11-48D,SUP,Custom 27803010,,542-11-48D  -  SHELL ACETAB D 48MM 49.8MM 3 SCREW HOLE CLUSTER RIM TRIDENT,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
542-11-50E,SUP,Custom 27803010,,542-11-50E  -  SHELL ACETAB E 50MM 51.8MM 5 HOLE CLUSTER TRIDENT PSL,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
542-11-52E,SUP,Custom 27803010,,542-11-52E  -  SHELL ACETAB E 52MM 53.8MM 5 SCREW HOLE CLUSTER RIM TRIDENT,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
542-11-54F,SUP,Custom 27803010,,542-11-54F  -  SHELL ACETAB F 54MM 55.8MM 5 SCREW HOLE CLUSTER RIM TRIDENT,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
542-11-56F,SUP,Custom 27803010,,542-11-56F  -  SHELL ACETAB F 56MM 57.8MM 5 SCREW HOLE CLUSTER RIM TRIDENT,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
542-11-58G,SUP,Custom 27803010,,542-11-58G  -  SHELL ACETAB G 58MM 59.8MM 5 SCREW HOLE CLUSTER RIM TRIDENT,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
542-11-60G,SUP,Custom 27803010,,542-11-60G  -  SHELL ACETAB G 60MM 61.8MM 5 SCREW HOLE CLUSTER RIM TRIDENT,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
542-11-62H,SUP,Custom 27803010,,542-11-62H  -  SHELL ACETAB H 62MM 63.8MM 5 SCREW HOLE CLUSTER RIM TRIDENT,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
542-11-64H,SUP,Custom 27803010,,542-11-64H  -  SHELL ACETAB H 64MM 65.8MM 5 SCREW HOLE CLUSTER RIM TRIDENT,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
542-11-66I,SUP,Custom 27803010,,542-11-66I  -  SHELL ACETAB I 66MM 67.8MM 5 SCREW HOLE CLUSTER RIM TRIDENT,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
542-11-68I,SUP,Custom 27803010,,542-11-68I  -  SHELL ACETAB I 68MM 69.8MM 5 SCREW HOLE CLUSTER RIM TRIDENT,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
542-11-70J,SUP,Custom 27803010,,542-11-70J  -  SHELL ACETAB J 70MM 71.8MM 5 SCREW HOLE CLUSTER RIM TRIDENT,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
542-11-72J,SUP,Custom 27803010,,542-11-72J  -  SHELL ACETAB J 72MM 73.8MM 5 SCREW HOLE CLUSTER RIM TRIDENT,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
54-25240,SUP,HCPCS C1713,,54-25240  -  PLATE SHRT 2.7MM SCR 8 HOLE RECON BONE RIGHT RADL,$495.00,$0.00,$495.00,$222.75,$353.28,$0.00,$85.29,$0.00,$0.00,$86.67,$495.00,$0.00,$247.50,$392.04,$396.00,$0.00,$77.47,$0.00,$78.80,$0.00
54-25241,SUP,HCPCS C1713,,54-25241  -  PLATE SM 2.7MM SCR 8 HOLE RECON BONE RIGHT RADL,$495.00,$0.00,$495.00,$222.75,$353.28,$0.00,$85.29,$0.00,$0.00,$86.67,$495.00,$0.00,$247.50,$392.04,$396.00,$0.00,$77.47,$0.00,$78.80,$0.00
54-25242,SUP,HCPCS C1713,,54-25242  -  PLATE SHRT 2.7MM SCR 8 HOLE RECON BONE LEFT RADL,$495.00,$0.00,$495.00,$222.75,$353.28,$0.00,$85.29,$0.00,$0.00,$86.67,$495.00,$0.00,$247.50,$392.04,$396.00,$0.00,$77.47,$0.00,$78.80,$0.00
54-25243,SUP,HCPCS C1713,,54-25243  -  PLATE SM 2.7MM SCR 8 HOLE RECON BONE LEFT RADL,$495.00,$0.00,$495.00,$222.75,$353.28,$0.00,$85.29,$0.00,$0.00,$86.67,$495.00,$0.00,$247.50,$392.04,$396.00,$0.00,$77.47,$0.00,$78.80,$0.00
54-25244,SUP,HCPCS C1713,,54-25244  -  PLATE LNG 2.7MM SCR 11 HOLE RECON BONE RIGHT RADL,$591.25,$0.00,$591.25,$266.06,$421.98,$0.00,$101.87,$0.00,$0.00,$103.52,$591.25,$0.00,$295.63,$468.27,$473.00,$0.00,$92.53,$0.00,$94.13,$0.00
54-25246,SUP,HCPCS C1713,,54-25246  -  PLATE LNG 2.7MM SCR 11 HOLE RECON BONE LEFT RADL,$591.25,$0.00,$591.25,$266.06,$421.98,$0.00,$101.87,$0.00,$0.00,$103.52,$591.25,$0.00,$295.63,$468.27,$473.00,$0.00,$92.53,$0.00,$94.13,$0.00
54-25250,SUP,HCPCS C1713,,54-25250  -  PLATE REG 2.7MM SCR 6 HOLE RECON BONE RIGHT RADL,$433.13,$0.00,$433.13,$194.91,$309.12,$0.00,$74.63,$0.00,$0.00,$75.84,$433.13,$0.00,$216.56,$343.04,$346.50,$0.00,$67.78,$0.00,$68.95,$0.00
54-25251,SUP,HCPCS C1713,,54-25251  -  PLATE REG 2.7MM SCR 6 HOLE RECON BONE LEFT RADL,$433.13,$0.00,$433.13,$194.91,$309.12,$0.00,$74.63,$0.00,$0.00,$75.84,$433.13,$0.00,$216.56,$343.04,$346.50,$0.00,$67.78,$0.00,$68.95,$0.00
54-25252,SUP,HCPCS C1713,,54-25252  -  PLATE REG 2.7MM SCR 7 HOLE RECON BONE RIGHT RADL,$474.38,$0.00,$474.38,$213.47,$338.56,$0.00,$81.73,$0.00,$0.00,$83.06,$474.38,$0.00,$237.19,$375.71,$379.50,$0.00,$74.24,$0.00,$75.52,$0.00
54-25253,SUP,HCPCS C1713,,54-25253  -  PLATE REG 2.7MM SCR 7 HOLE RECON BONE LEFT RADL,$474.38,$0.00,$474.38,$213.47,$338.56,$0.00,$81.73,$0.00,$0.00,$83.06,$474.38,$0.00,$237.19,$375.71,$379.50,$0.00,$74.24,$0.00,$75.52,$0.00
54-25254,SUP,HCPCS C1713,,54-25254  -  PLATE REG 2.7MM SCR 8 HOLE RECON BONE RIGHT RADL,$577.50,$0.00,$577.50,$259.88,$412.16,$0.00,$99.50,$0.00,$0.00,$101.12,$577.50,$0.00,$288.75,$457.38,$462.00,$0.00,$90.38,$0.00,$91.94,$0.00
54-25255,SUP,HCPCS C1713,,54-25255  -  PLATE REG 2.7MM SCR 8 HOLE RECON BONE LEFT RADL,$577.50,$0.00,$577.50,$259.88,$412.16,$0.00,$99.50,$0.00,$0.00,$101.12,$577.50,$0.00,$288.75,$457.38,$462.00,$0.00,$90.38,$0.00,$91.94,$0.00
54-25270,SUP,HCPCS C1713,,54-25270  -  PLATE MED BONE PLMR RADL,$790.63,$0.00,$790.63,$355.78,$564.27,$0.00,$136.22,$0.00,$0.00,$138.43,$790.63,$0.00,$395.31,$626.18,$632.50,$0.00,$123.73,$0.00,$125.87,$0.00
54-25271,SUP,HCPCS C1713,,54-25271  -  PLATE MED BONE LEFT DORSAL RADL,$790.63,$0.00,$790.63,$355.78,$564.27,$0.00,$136.22,$0.00,$0.00,$138.43,$790.63,$0.00,$395.31,$626.18,$632.50,$0.00,$123.73,$0.00,$125.87,$0.00
54-25272,SUP,HCPCS C1713,,54-25272  -  PLATE MED BONE LEFT DORSAL RADL,$790.63,$0.00,$790.63,$355.78,$564.27,$0.00,$136.22,$0.00,$0.00,$138.43,$790.63,$0.00,$395.31,$626.18,$632.50,$0.00,$123.73,$0.00,$125.87,$0.00
54-25273,SUP,HCPCS C1713,,54-25273  -  PLATE LG BONE LEFT DORSAL RADL,$790.63,$0.00,$790.63,$355.78,$564.27,$0.00,$136.22,$0.00,$0.00,$138.43,$790.63,$0.00,$395.31,$626.18,$632.50,$0.00,$123.73,$0.00,$125.87,$0.00
54-25274,SUP,HCPCS C1713,,54-25274  -  PLATE MED BONE RIGHT DORSAL RADL,$790.63,$0.00,$790.63,$355.78,$564.27,$0.00,$136.22,$0.00,$0.00,$138.43,$790.63,$0.00,$395.31,$626.18,$632.50,$0.00,$123.73,$0.00,$125.87,$0.00
54-25275,SUP,HCPCS C1713,,54-25275  -  PLATE LG BONE RIGHT DORSAL RADL,$790.63,$0.00,$790.63,$355.78,$564.27,$0.00,$136.22,$0.00,$0.00,$138.43,$790.63,$0.00,$395.31,$626.18,$632.50,$0.00,$123.73,$0.00,$125.87,$0.00
54-25290,SUP,HCPCS C1713,,54-25290  -  PLATE BN STD VARIAX LCK TI RDS RT DIST DRSL,"$1,135.75",$0.00,"$1,135.75",$511.09,$810.58,$0.00,$195.68,$0.00,$0.00,$198.86,"$1,135.75",$0.00,$567.88,$899.51,$908.60,$0.00,$177.74,$0.00,$180.81,$0.00
54-25291,SUP,HCPCS C1713,,54-25291  -  PLATE MED STD ORBTL FLR BONE SMARTLOCK TI,"$1,135.75",$0.00,"$1,135.75",$511.09,$810.58,$0.00,$195.68,$0.00,$0.00,$198.86,"$1,135.75",$0.00,$567.88,$899.51,$908.60,$0.00,$177.74,$0.00,$180.81,$0.00
54-25292,SUP,HCPCS C1713,,54-25292  -  PLATE W TI LCK VARIAX BONE RIGHT DISTAL DORSAL RADL,"$1,135.75",$0.00,"$1,135.75",$511.09,$810.58,$0.00,$195.68,$0.00,$0.00,$198.86,"$1,135.75",$0.00,$567.88,$899.51,$908.60,$0.00,$177.74,$0.00,$180.81,$0.00
54-25293,SUP,HCPCS C1713,,54-25293  -  PLATE W LCK VARIAX BONE LEFT DISTAL DORSAL RADL,"$1,135.75",$0.00,"$1,135.75",$511.09,$810.58,$0.00,$195.68,$0.00,$0.00,$198.86,"$1,135.75",$0.00,$567.88,$899.51,$908.60,$0.00,$177.74,$0.00,$180.81,$0.00
54-25294,SUP,HCPCS C1713,,54-25294  -  PLATE STD XLNG LCK VARIAX BONE RIGHT DISTAL DORSAL RADL,"$1,291.13",$0.00,"$1,291.13",$581.01,$921.48,$0.00,$222.45,$0.00,$0.00,$226.07,"$1,291.13",$0.00,$645.56,"$1,022.57","$1,032.90",$0.00,$202.06,$0.00,$205.55,$0.00
54-25295,SUP,HCPCS C1713,,54-25295  -  PLATE STD XLNG LCK VARIAX BONE LEFT DISTAL DORSAL RADL,"$1,291.13",$0.00,"$1,291.13",$581.01,$921.48,$0.00,$222.45,$0.00,$0.00,$226.07,"$1,291.13",$0.00,$645.56,"$1,022.57","$1,032.90",$0.00,$202.06,$0.00,$205.55,$0.00
54-25296,SUP,HCPCS C1713,,54-25296  -  PLATE XLNG LCK W VARIAX BONE RIGHT DISTAL DORSAL RADL,"$1,291.13",$0.00,"$1,291.13",$581.01,$921.48,$0.00,$222.45,$0.00,$0.00,$226.07,"$1,291.13",$0.00,$645.56,"$1,022.57","$1,032.90",$0.00,$202.06,$0.00,$205.55,$0.00
54-25297,SUP,HCPCS C1713,,54-25297  -  PLATE XLNG LCK W VARIAX BONE LEFT DISTAL DORSAL RADL,"$1,291.13",$0.00,"$1,291.13",$581.01,$921.48,$0.00,$222.45,$0.00,$0.00,$226.07,"$1,291.13",$0.00,$645.56,"$1,022.57","$1,032.90",$0.00,$202.06,$0.00,$205.55,$0.00
54-25374,SUP,HCPCS C1713,,54-25374  -  PLATE NAR LCK PLT SYS ANTM VARIAX BONE LEFT DISTAL VOLR RADL,"$1,373.63",$0.00,"$1,373.63",$618.13,$980.36,$0.00,$236.67,$0.00,$0.00,$240.51,"$1,373.63",$0.00,$686.81,"$1,087.91","$1,098.90",$0.00,$214.97,$0.00,$218.68,$0.00
54-25375,SUP,HCPCS C1713,,54-25375  -  PLATE NAR LNG LCK ANTM VARIAX BONE LEFT DISTAL VOLR RADL,"$1,373.63",$0.00,"$1,373.63",$618.13,$980.36,$0.00,$236.67,$0.00,$0.00,$240.51,"$1,373.63",$0.00,$686.81,"$1,087.91","$1,098.90",$0.00,$214.97,$0.00,$218.68,$0.00
54-25376,SUP,HCPCS C1713,,54-25376  -  PLATE STD LCK SYS ANTM VARIAX BONE LEFT DISTAL VOLR RADL,"$1,373.63",$0.00,"$1,373.63",$618.13,$980.36,$0.00,$236.67,$0.00,$0.00,$240.51,"$1,373.63",$0.00,$686.81,"$1,087.91","$1,098.90",$0.00,$214.97,$0.00,$218.68,$0.00
54-25377,SUP,HCPCS C1713,,54-25377  -  PLATE STD LNG LCK PLT SYS ANTM VARIAX BONE LEFT DISTAL VOLR,"$1,373.63",$0.00,"$1,373.63",$618.13,$980.36,$0.00,$236.67,$0.00,$0.00,$240.51,"$1,373.63",$0.00,$686.81,"$1,087.91","$1,098.90",$0.00,$214.97,$0.00,$218.68,$0.00
54-25384,SUP,HCPCS C1713,,54-25384  -  PLATE NAR LCK SYS ANTM VARIAX BONE RIGHT DISTAL VOLR RADL,"$1,373.63",$0.00,"$1,373.63",$618.13,$980.36,$0.00,$236.67,$0.00,$0.00,$240.51,"$1,373.63",$0.00,$686.81,"$1,087.91","$1,098.90",$0.00,$214.97,$0.00,$218.68,$0.00
54-25385,SUP,HCPCS C1713,,54-25385  -  PLATE BN NAR LNG VARIAX ANTM LCK TI RADL RT DIST VOLR,"$1,373.63",$0.00,"$1,373.63",$618.13,$980.36,$0.00,$236.67,$0.00,$0.00,$240.51,"$1,373.63",$0.00,$686.81,"$1,087.91","$1,098.90",$0.00,$214.97,$0.00,$218.68,$0.00
54-25386,SUP,HCPCS C1713,,54-25386  -  PLATE STD LCK SYS ANTM VARIAX BONE RIGHT DISTAL VOLR RADL,"$1,373.63",$0.00,"$1,373.63",$618.13,$980.36,$0.00,$236.67,$0.00,$0.00,$240.51,"$1,373.63",$0.00,$686.81,"$1,087.91","$1,098.90",$0.00,$214.97,$0.00,$218.68,$0.00
54-25387,SUP,HCPCS C1713,,54-25387  -  PLATE STD LNG LCK SYS ANTM VARIAX BONE RIGHT DISTAL VOLR,"$1,373.63",$0.00,"$1,373.63",$618.13,$980.36,$0.00,$236.67,$0.00,$0.00,$240.51,"$1,373.63",$0.00,$686.81,"$1,087.91","$1,098.90",$0.00,$214.97,$0.00,$218.68,$0.00
54-25391,SUP,HCPCS C1713,,54-25391  -  PLATE NAR XLNG UNV TI LCK VARIAX BONE LEFT DISTAL VOLR RADL,"$1,373.63",$0.00,"$1,373.63",$618.13,$980.36,$0.00,$236.67,$0.00,$0.00,$240.51,"$1,373.63",$0.00,$686.81,"$1,087.91","$1,098.90",$0.00,$214.97,$0.00,$218.68,$0.00
54-25392,SUP,HCPCS C1713,,54-25392  -  PLATE XLNG STD UNV TI LCK VARIAX BONE LEFT DISTAL VOLR RADL,"$1,373.63",$0.00,"$1,373.63",$618.13,$980.36,$0.00,$236.67,$0.00,$0.00,$240.51,"$1,373.63",$0.00,$686.81,"$1,087.91","$1,098.90",$0.00,$214.97,$0.00,$218.68,$0.00
54-25393,SUP,HCPCS C1713,,54-25393  -  PLATE XLNG UNV TI LCK W VARIAX BONE LEFT DISTAL VOLR RADL,"$1,373.63",$0.00,"$1,373.63",$618.13,$980.36,$0.00,$236.67,$0.00,$0.00,$240.51,"$1,373.63",$0.00,$686.81,"$1,087.91","$1,098.90",$0.00,$214.97,$0.00,$218.68,$0.00
54-25394,SUP,HCPCS C1713,,54-25394  -  PLATE NAR SHRT TI LCK VARIAX BONE DISTAL VOLR RADL,"$1,291.13",$0.00,"$1,291.13",$581.01,$921.48,$0.00,$222.45,$0.00,$0.00,$226.07,"$1,291.13",$0.00,$645.56,"$1,022.57","$1,032.90",$0.00,$202.06,$0.00,$205.55,$0.00
54-25395,SUP,HCPCS C1713,,54-25395  -  PLATE NAR LNG UNV TI LCK VARIAX BONE LEFT DISTAL VOLR RADL,"$1,291.13",$0.00,"$1,291.13",$581.01,$921.48,$0.00,$222.45,$0.00,$0.00,$226.07,"$1,291.13",$0.00,$645.56,"$1,022.57","$1,032.90",$0.00,$202.06,$0.00,$205.55,$0.00
54-25396,SUP,HCPCS C1713,,54-25396  -  PLATE UNV STD SHRT LCK VARIAX BONE LEFT DISTAL VOLR RADL,"$1,291.13",$0.00,"$1,291.13",$581.01,$921.48,$0.00,$222.45,$0.00,$0.00,$226.07,"$1,291.13",$0.00,$645.56,"$1,022.57","$1,032.90",$0.00,$202.06,$0.00,$205.55,$0.00
54-25397,SUP,HCPCS C1713,,54-25397  -  PLATE UNV STD LNG LCK VARIAX BONE RADL DISTAL VOLR,"$1,291.13",$0.00,"$1,291.13",$581.01,$921.48,$0.00,$222.45,$0.00,$0.00,$226.07,"$1,291.13",$0.00,$645.56,"$1,022.57","$1,032.90",$0.00,$202.06,$0.00,$205.55,$0.00
54-25398,SUP,HCPCS C1713,,54-25398  -  PLATE UNV W SHRT LCK VARIAX BONE RADL DISTAL VOLR,"$1,291.13",$0.00,"$1,291.13",$581.01,$921.48,$0.00,$222.45,$0.00,$0.00,$226.07,"$1,291.13",$0.00,$645.56,"$1,022.57","$1,032.90",$0.00,$202.06,$0.00,$205.55,$0.00
54-25399,SUP,HCPCS C1713,,54-25399  -  PLATE UNV W LNG LCK VARIAX BONE RADL DISTAL VOLR,"$1,291.13",$0.00,"$1,291.13",$581.01,$921.48,$0.00,$222.45,$0.00,$0.00,$226.07,"$1,291.13",$0.00,$645.56,"$1,022.57","$1,032.90",$0.00,$202.06,$0.00,$205.55,$0.00
54-25400,SUP,HCPCS C1713,,54-25400  -  PLATE SHRT TI CLMN FRAG SPC VARIAX BONE RADL,$928.13,$0.00,$928.13,$417.66,$662.40,$0.00,$159.91,$0.00,$0.00,$162.51,$928.13,$0.00,$464.06,$735.08,$742.50,$0.00,$145.25,$0.00,$147.76,$0.00
54-25401,SUP,HCPCS C1713,,54-25401  -  PLATE LNG TI CLMN SMARTLOCK BONE VOLR RADL,$928.13,$0.00,$928.13,$417.66,$662.40,$0.00,$159.91,$0.00,$0.00,$162.51,$928.13,$0.00,$464.06,$735.08,$742.50,$0.00,$145.25,$0.00,$147.76,$0.00
54-25402,SUP,HCPCS C1713,,54-25402  -  PLATE SHRT TI CLMN SMARTLOCK BONE RIGHT DISTAL ULN,$928.13,$0.00,$928.13,$417.66,$662.40,$0.00,$159.91,$0.00,$0.00,$162.51,$928.13,$0.00,$464.06,$735.08,$742.50,$0.00,$145.25,$0.00,$147.76,$0.00
54-25403,SUP,HCPCS C1713,,54-25403  -  PLATE BN SHRT 40MMX1MM VARIAX LCK CLMN TI ULNA LT FRAG SPC,$928.13,$0.00,$928.13,$417.66,$662.40,$0.00,$159.91,$0.00,$0.00,$162.51,$928.13,$0.00,$464.06,$735.08,$742.50,$0.00,$145.25,$0.00,$147.76,$0.00
54-25404,SUP,HCPCS C1713,,54-25404  -  PLATE LNG LCK CLMN FRAG SPC VARIAX BONE RIGHT RADL DISTAL,$928.13,$0.00,$928.13,$417.66,$662.40,$0.00,$159.91,$0.00,$0.00,$162.51,$928.13,$0.00,$464.06,$735.08,$742.50,$0.00,$145.25,$0.00,$147.76,$0.00
54-25405,SUP,HCPCS C1713,,54-25405  -  PLATE LNG TI CLMN SMARTLOCK BONE LEFT RADL DISTAL ULN,$928.13,$0.00,$928.13,$417.66,$662.40,$0.00,$159.91,$0.00,$0.00,$162.51,$928.13,$0.00,$464.06,$735.08,$742.50,$0.00,$145.25,$0.00,$147.76,$0.00
54-25420S,SUP,HCPCS C1713,,54-25420S  -  PLATE 2XL THK3MM 189MM 15 HOLE ANTM STND BONE 2.7MM LEFT,"$2,708.75",$0.00,"$2,708.75","$1,218.94","$1,933.23",$0.00,$466.70,$0.00,$0.00,$474.28,"$2,708.75",$0.00,"$1,354.38","$2,145.33","$2,167.00",$0.00,$423.92,$0.00,$431.23,$0.00
54-25422S,SUP,HCPCS C1713,,54-25422S  -  PLATE 2XL THK3MM 189MM 15 HOLE ANTM STND BONE 2.7MM RIGHT,"$2,708.75",$0.00,"$2,708.75","$1,218.94","$1,933.23",$0.00,$466.70,$0.00,$0.00,$474.28,"$2,708.75",$0.00,"$1,354.38","$2,145.33","$2,167.00",$0.00,$423.92,$0.00,$431.23,$0.00
54-25424S,SUP,HCPCS C1713,,54-25424S  -  PLATE BN 2XL 189MMX3MM STRL 15 HL ANTM STND RADL RT DIST,"$2,585.00",$0.00,"$2,585.00","$1,163.25","$1,844.91",$0.00,$445.38,$0.00,$0.00,$452.61,"$2,585.00",$0.00,"$1,292.50","$2,047.32","$2,068.00",$0.00,$404.55,$0.00,$411.53,$0.00
54-25426S,SUP,HCPCS C1713,,54-25426S  -  PLATE STD 145MM 2.7MM SCR 11 HOLE BONE RIGHT DISTAL VOLR,"$2,585.00",$0.00,"$2,585.00","$1,163.25","$1,844.91",$0.00,$445.38,$0.00,$0.00,$452.61,"$2,585.00",$0.00,"$1,292.50","$2,047.32","$2,068.00",$0.00,$404.55,$0.00,$411.53,$0.00
54-25428S,SUP,HCPCS C1713,,54-25428S  -  PLATE 2XL THK3MM STD 100MM 8 HOLE ANTM BONE LEFT DISTAL VOLR,"$2,502.50",$0.00,"$2,502.50","$1,126.13","$1,786.03",$0.00,$431.17,$0.00,$0.00,$438.17,"$2,502.50",$0.00,"$1,251.25","$1,981.98","$2,002.00",$0.00,$391.64,$0.00,$398.40,$0.00
54-25430S,SUP,HCPCS C1713,,54-25430S  -  PLATE 2XL STD 100MMX3MM 2.7MM SCR 8 HOLE ANTM BONE RIGHT,"$2,502.50",$0.00,"$2,502.50","$1,126.13","$1,786.03",$0.00,$431.17,$0.00,$0.00,$438.17,"$2,502.50",$0.00,"$1,251.25","$1,981.98","$2,002.00",$0.00,$391.64,$0.00,$398.40,$0.00
54-25432S,SUP,HCPCS C1713,,54-25432S  -  PLATE 2XL THK3MM 74MM 2.7MM SCR 5 HOLE VARIAX BONE 2.7MM,"$2,420.00",$0.00,"$2,420.00","$1,089.00","$1,727.15",$0.00,$416.95,$0.00,$0.00,$423.72,"$2,420.00",$0.00,"$1,210.00","$1,916.64","$1,936.00",$0.00,$378.73,$0.00,$385.26,$0.00
54-25434S,SUP,HCPCS C1713,,54-25434S  -  PLATE 2XL THK3MM 74MM 5 HOLE ANTM STND BONE 2.7MM RIGHT VOLR,"$2,420.00",$0.00,"$2,420.00","$1,089.00","$1,727.15",$0.00,$416.95,$0.00,$0.00,$423.72,"$2,420.00",$0.00,"$1,210.00","$1,916.64","$1,936.00",$0.00,$378.73,$0.00,$385.26,$0.00
54-25436S,SUP,HCPCS C1713,,54-25436S  -  PLATE 2XL THK3MM 189MM 15 HOLE ANTM NAR BONE 2.7MM LEFT VOLR,"$2,640.00",$0.00,"$2,640.00","$1,188.00","$1,884.17",$0.00,$454.86,$0.00,$0.00,$462.24,"$2,640.00",$0.00,"$1,320.00","$2,090.88","$2,112.00",$0.00,$413.16,$0.00,$420.29,$0.00
54-25438S,SUP,HCPCS C1713,,54-25438S  -  PLATE 2XL THK3MM 189MM 15 HOLE ANTM NAR BONE 2.7MM RIGHT,"$2,640.00",$0.00,"$2,640.00","$1,188.00","$1,884.17",$0.00,$454.86,$0.00,$0.00,$462.24,"$2,640.00",$0.00,"$1,320.00","$2,090.88","$2,112.00",$0.00,$413.16,$0.00,$420.29,$0.00
54-25440S,SUP,HCPCS C1713,,54-25440S  -  PLATE 2XL THK3MM 145MM 11 HOLE ANTM NAR BONE 2.7MM LEFT VOLR,"$2,516.25",$0.00,"$2,516.25","$1,132.31","$1,795.85",$0.00,$433.54,$0.00,$0.00,$440.58,"$2,516.25",$0.00,"$1,258.13","$1,992.87","$2,013.00",$0.00,$393.79,$0.00,$400.59,$0.00
54-25442S,SUP,HCPCS C1713,,54-25442S  -  PLATE 2XL 145MMX3MM 2.7MM SCR 11 HOLE ANTM NAR VARIAX BONE,"$2,516.25",$0.00,"$2,516.25","$1,132.31","$1,795.85",$0.00,$433.54,$0.00,$0.00,$440.58,"$2,516.25",$0.00,"$1,258.13","$1,992.87","$2,013.00",$0.00,$393.79,$0.00,$400.59,$0.00
54-25444S,SUP,HCPCS C1713,,54-25444S  -  PLATE 2XL NAR 2.7MM SCR 8 HOLE ANTM BONE LEFT DISTAL VOLR,"$2,433.75",$0.00,"$2,433.75","$1,095.19","$1,736.97",$0.00,$419.32,$0.00,$0.00,$426.13,"$2,433.75",$0.00,"$1,216.88","$1,927.53","$1,947.00",$0.00,$380.88,$0.00,$387.45,$0.00
54-25446S,SUP,HCPCS C1713,,54-25446S  -  PLATE 2XL 100MMX3MM 2.7MM SCR 8 HOLE ANTM NAR VARIAX BONE,"$2,433.75",$0.00,"$2,433.75","$1,095.19","$1,736.97",$0.00,$419.32,$0.00,$0.00,$426.13,"$2,433.75",$0.00,"$1,216.88","$1,927.53","$1,947.00",$0.00,$380.88,$0.00,$387.45,$0.00
54-25448S,SUP,HCPCS C1713,,54-25448S  -  PLATE 2XL NAR 2.7MM SCR 5 HOLE ANTM BONE LEFT DISTAL VOLR,"$2,351.25",$0.00,"$2,351.25","$1,058.06","$1,678.09",$0.00,$405.11,$0.00,$0.00,$411.69,"$2,351.25",$0.00,"$1,175.63","$1,862.19","$1,881.00",$0.00,$367.97,$0.00,$374.32,$0.00
54-25450S,SUP,HCPCS C1713,,54-25450S  -  PLATE 2XL 74MMX3MM 2.7MM SCR 5 HOLE ANTM NAR VARIAX BONE,"$2,351.25",$0.00,"$2,351.25","$1,058.06","$1,678.09",$0.00,$405.11,$0.00,$0.00,$411.69,"$2,351.25",$0.00,"$1,175.63","$1,862.19","$1,881.00",$0.00,$367.97,$0.00,$374.32,$0.00
542T-11-42A,SUP,Custom 27803010,,542T-11-42A  -  SHELL ACETAB HYDRXAPT TR PSL T,"$2,409.00",$0.00,"$2,409.00",$0.00,"$1,719.30",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,409.00",$0.00,"$1,204.50","$1,907.93","$1,927.20",$0.00,$0.00,$0.00,$0.00,$0.00
542T-11-44B,SUP,Custom 27803010,,542T-11-44B  -  SHELL ACETAB HYDRXAPT TR PSL T,"$2,409.00",$0.00,"$2,409.00",$0.00,"$1,719.30",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,409.00",$0.00,"$1,204.50","$1,907.93","$1,927.20",$0.00,$0.00,$0.00,$0.00,$0.00
542T-11-46C,SUP,Custom 27803010,,542T-11-46C  -  SHELL ACETAB HYDRXAPT TR PSL T,"$2,409.00",$0.00,"$2,409.00",$0.00,"$1,719.30",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,409.00",$0.00,"$1,204.50","$1,907.93","$1,927.20",$0.00,$0.00,$0.00,$0.00,$0.00
542T-11-50D,SUP,Custom 27803010,,542T-11-50D  -  SHELL ACETAB HYDRXAPT TR PSL T,"$2,409.00",$0.00,"$2,409.00",$0.00,"$1,719.30",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,409.00",$0.00,"$1,204.50","$1,907.93","$1,927.20",$0.00,$0.00,$0.00,$0.00,$0.00
542T-11-54E,SUP,Custom 27803010,,542T-11-54E  -  SHELL ACETAB HYDRXAPT TR PSL T,"$2,409.00",$0.00,"$2,409.00",$0.00,"$1,719.30",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,409.00",$0.00,"$1,204.50","$1,907.93","$1,927.20",$0.00,$0.00,$0.00,$0.00,$0.00
542T-11-58F,SUP,Custom 27803010,,542T-11-58F  -  SHELL ACETAB HYDRXAPT TR PSL T,"$2,409.00",$0.00,"$2,409.00",$0.00,"$1,719.30",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,409.00",$0.00,"$1,204.50","$1,907.93","$1,927.20",$0.00,$0.00,$0.00,$0.00,$0.00
542T-11-62G,SUP,Custom 27803010,,542T-11-62G  -  SHELL ACETAB HYDRXAPT TR PSL T,"$2,409.00",$0.00,"$2,409.00",$0.00,"$1,719.30",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,409.00",$0.00,"$1,204.50","$1,907.93","$1,927.20",$0.00,$0.00,$0.00,$0.00,$0.00
542T-11-66H,SUP,Custom 27803010,,542T-11-66H  -  SHELL ACETAB HYDRXAPT TR PSL T,"$2,409.00",$0.00,"$2,409.00",$0.00,"$1,719.30",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,409.00",$0.00,"$1,204.50","$1,907.93","$1,927.20",$0.00,$0.00,$0.00,$0.00,$0.00
542T-11-70I,SUP,Custom 27803010,,542T-11-70I  -  SHELL ACETAB HYDRXAPT TR PSL T,"$2,409.00",$0.00,"$2,409.00",$0.00,"$1,719.30",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,409.00",$0.00,"$1,204.50","$1,907.93","$1,927.20",$0.00,$0.00,$0.00,$0.00,$0.00
5444-0-110,SUP,HCPCS C1895,,5444-0-110  -  GRAFT SYNTH TISSUE SMALL CUSTOMIZE MEDPOR,"$32,157.50",$0.00,"$32,157.50","$14,470.88","$5,158.80",$0.00,"$5,540.58",$0.00,$0.00,"$5,630.52","$32,157.50",$0.00,"$16,078.75","$25,468.74","$25,726.00",$0.00,"$5,032.65",$0.00,"$5,119.47",$0.00
5444-0-210,SUP,HCPCS C1895,,5444-0-210  -  GRAFT SYNTH TISSUE MEDIUM CUSTOMIZE MEDPOR,"$38,395.00",$0.00,"$38,395.00","$17,277.75","$5,158.80",$0.00,"$6,615.27",$0.00,$0.00,"$6,722.66","$38,395.00",$0.00,"$19,197.50","$30,408.84","$30,716.00",$0.00,"$6,008.82",$0.00,"$6,112.48",$0.00
5444-0-310,SUP,HCPCS C1895,,5444-0-310  -  GRAFT SYNTH TISSUE LARGE CUSTOMIZE MEDPOR,"$45,842.50",$0.00,"$45,842.50","$20,629.13","$5,158.80",$0.00,"$7,898.43",$0.00,$0.00,"$8,026.66","$45,842.50",$0.00,"$22,921.25","$36,307.26","$36,674.00",$0.00,"$7,174.35",$0.00,"$7,298.13",$0.00
5444-0-410,SUP,HCPCS C1895,,5444-0-410  -  GRAFT SYNTH TISSUE XL CUSTOMIZE MEDPOR,"$54,737.50",$0.00,"$54,737.50","$24,631.88","$5,158.80",$0.00,"$8,138.89",$0.00,$0.00,"$8,138.89","$54,737.50",$0.00,"$27,368.75","$43,352.10","$43,790.00",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
5444-0-510,SUP,HCPCS C1895,,5444-0-510  -  GRAFT SYNTH TISSUE CUSTOMIZE MEDPOR MIDFAC,"$42,120.00",$0.00,"$42,120.00","$18,954.00","$5,158.80",$0.00,"$7,257.07",$0.00,$0.00,"$7,374.88","$42,120.00",$0.00,"$21,060.00","$33,359.04","$33,696.00",$0.00,"$6,591.78",$0.00,"$6,705.50",$0.00
5444-0-610,SUP,HCPCS C1895,,5444-0-610  -  GRAFT SYNTH TISSUE CUSTOMIZE AUGMENTATION LATEX FREE MEDPOR,"$20,182.50",$0.00,"$20,182.50","$9,082.13","$5,158.80",$0.00,"$3,477.34",$0.00,$0.00,"$3,533.79","$20,182.50",$0.00,"$10,091.25","$15,984.54","$16,146.00",$0.00,"$3,158.56",$0.00,"$3,213.05",$0.00
5450-800-315,SUP,Custom 27203010,,5450-800-315  -  TIP ASP LNG 4.6IN STRL LF SPTZLR MIC CLW MIC CLW BN DISP,"$8,925.00",$0.00,"$8,925.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,925.00",$0.00,"$4,462.50","$7,068.60","$7,140.00",$0.00,$0.00,$0.00,$0.00,$0.00
55.26.25E,SUP,Custom 27203010,,55.26.25E  -  PROBE LSR 25GA STRL DRCT XTD DISP,$337.50,$0.00,$337.50,$0.00,$240.87,$0.00,$0.00,$0.00,$0.00,$0.00,$337.50,$0.00,$168.75,$267.30,$270.00,$0.00,$0.00,$0.00,$0.00,$0.00
55-0001,SUP,HCPCS C1713,,55-0001  -  NAIL HELICAL 20 MM IMPLANT,$657.50,$0.00,$657.50,$295.88,$469.26,$0.00,$113.28,$0.00,$0.00,$115.12,$657.50,$0.00,$328.75,$520.74,$526.00,$0.00,$102.90,$0.00,$104.67,$0.00
55-0002,SUP,HCPCS C1713,,55-0002  -  NAIL HELICAL 30 MM IMPLANT,$657.50,$0.00,$657.50,$295.88,$469.26,$0.00,$113.28,$0.00,$0.00,$115.12,$657.50,$0.00,$328.75,$520.74,$526.00,$0.00,$102.90,$0.00,$104.67,$0.00
55-0003,SUP,HCPCS C1713,,55-0003  -  NAIL HELICAL 40 MM IMPLANT,$657.50,$0.00,$657.50,$295.88,$469.26,$0.00,$113.28,$0.00,$0.00,$115.12,$657.50,$0.00,$328.75,$520.74,$526.00,$0.00,$102.90,$0.00,$104.67,$0.00
550-120,SUP,HCPCS C1713,,550-120  -  PLATE 18MM TI BONE SPNL,$242.25,$0.00,$242.25,$109.01,$172.89,$0.00,$41.74,$0.00,$0.00,$42.42,$242.25,$0.00,$121.13,$191.86,$193.80,$0.00,$37.91,$0.00,$38.57,$0.00
55-02950,SUP,HCPCS C1713,,55-02950  -  PLATE BN NS HBRD MMF MXLMNDB,$870.00,$0.00,$870.00,$391.50,$620.92,$0.00,$149.90,$0.00,$0.00,$152.33,$870.00,$0.00,$435.00,$689.04,$696.00,$0.00,$136.16,$0.00,$138.50,$0.00
55-02951,SUP,HCPCS C1713,,55-02951  -  PLATE BONE SMARTLOCK SMALL MAXILLOFACIAL HYBRID,$870.00,$0.00,$870.00,$391.50,$620.92,$0.00,$149.90,$0.00,$0.00,$152.33,$870.00,$0.00,$435.00,$689.04,$696.00,$0.00,$136.16,$0.00,$138.50,$0.00
55-03731,SUP,HCPCS C1713,,55-03731  -  PLATE BONE 3D LP .55MM 2X2 HOLE MALBLE UNIVERSAL 2 TITANIUM,$767.50,$0.00,$767.50,$345.38,$547.76,$0.00,$132.24,$0.00,$0.00,$134.38,$767.50,$0.00,$383.75,$607.86,$614.00,$0.00,$120.11,$0.00,$122.19,$0.00
55-03733,SUP,HCPCS C1713,,55-03733  -  PLATE BONE 3D LP .55MM 6X2 HOLE MALBLE UNIVERSAL 2 TITANIUM,"$1,970.00",$0.00,"$1,970.00",$886.50,"$1,405.99",$0.00,$339.42,$0.00,$0.00,$344.93,"$1,970.00",$0.00,$985.00,"$1,560.24","$1,576.00",$0.00,$308.31,$0.00,$313.62,$0.00
55-04218,SUP,HCPCS C1713,,55-04218  -  PLATE BONE STR LP .5MM 18 HOLE MALBLE UNIVERSAL 2 TITANIUM,"$2,117.50",$0.00,"$2,117.50",$952.88,"$1,511.26",$0.00,$364.83,$0.00,$0.00,$370.76,"$2,117.50",$0.00,"$1,058.75","$1,677.06","$1,694.00",$0.00,$331.39,$0.00,$337.11,$0.00
55-04231,SUP,HCPCS C1713,,55-04231  -  PLATE BONE 3D .5MM 2X2 HOLE MALBLE 3D TITANIUM UPPERFACIAL,$967.50,$0.00,$967.50,$435.38,$690.50,$0.00,$166.70,$0.00,$0.00,$169.40,$967.50,$0.00,$483.75,$766.26,$774.00,$0.00,$151.41,$0.00,$154.03,$0.00
55-04233,SUP,HCPCS C1713,,55-04233  -  PLATE BONE .5MM 6X2 HOLE MALBLE 3D TITANIUM UPPERFACIAL 1.2,"$1,742.50",$0.00,"$1,742.50",$784.13,"$1,243.62",$0.00,$300.22,$0.00,$0.00,$305.10,"$1,742.50",$0.00,$871.25,"$1,380.06","$1,394.00",$0.00,$272.70,$0.00,$277.41,$0.00
55-04235,SUP,HCPCS C1713,,55-04235  -  PLATE BONE 3D .5MM 6X6 HOLE MALBLE 3D UNIVERSAL2 TITANIUM,"$4,010.00",$0.00,"$4,010.00","$1,804.50","$2,861.94",$0.00,$690.90,$0.00,$0.00,$702.12,"$4,010.00",$0.00,"$2,005.00","$3,175.92","$3,208.00",$0.00,$627.57,$0.00,$638.39,$0.00
55-04237,SUP,HCPCS C1713,,55-04237  -  PLATE BONE .5MM 10X10 HOLE MALBLE 3D TITANIUM UPPERFACIAL,"$5,475.00",$0.00,"$5,475.00","$2,463.75","$3,907.51",$0.00,$943.32,$0.00,$0.00,$958.63,"$5,475.00",$0.00,"$2,737.50","$4,336.20","$4,380.00",$0.00,$856.84,$0.00,$871.62,$0.00
55-04240,SUP,HCPCS C1713,,55-04240  -  PLATE BONE 2Y LP .5MM 7 HOLE MALBLE UNIVERSAL 2 TITANIUM,$837.50,$0.00,$837.50,$376.88,$597.72,$0.00,$144.30,$0.00,$0.00,$146.64,$837.50,$0.00,$418.75,$663.30,$670.00,$0.00,$131.07,$0.00,$133.33,$0.00
55-04250,SUP,HCPCS C1713,,55-04250  -  PLATE BONE CURVE .5MM 10 HOLE MALBLE UNIVERSAL 2 TITANIUM,$947.50,$0.00,$947.50,$426.38,$676.23,$0.00,$163.25,$0.00,$0.00,$165.90,$947.50,$0.00,$473.75,$750.42,$758.00,$0.00,$148.28,$0.00,$150.84,$0.00
55-04424,SUP,HCPCS C1713,,55-04424  -  PLATE BONE .5MM 24 HOLE STR MALBLE CONDENSED TITANIUM,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
55-04720,SUP,HCPCS C1713,,55-04720  -  PLATE BONE STR .5MM 20 HOLE MALBLE TITANIUM MIDFAC 1.7MM,"$2,247.50",$0.00,"$2,247.50","$1,011.38","$1,604.04",$0.00,$387.23,$0.00,$0.00,$393.52,"$2,247.50",$0.00,"$1,123.75","$1,780.02","$1,798.00",$0.00,$351.73,$0.00,$357.80,$0.00
55-04724,SUP,HCPCS C1713,,55-04724  -  PLATE BONE 24 HOLE STR MALBLE CONDENSED TITANIUM MIDFAC 1.7,"$2,320.00",$0.00,"$2,320.00","$1,044.00","$1,655.78",$0.00,$399.72,$0.00,$0.00,$406.21,"$2,320.00",$0.00,"$1,160.00","$1,837.44","$1,856.00",$0.00,$363.08,$0.00,$369.34,$0.00
55-04760,SUP,HCPCS C1713,,55-04760  -  PLATE BONE 100D 2MM ADVANCEMENT 5 HOLE L MALBLE TITANIUM,$865.00,$0.00,$865.00,$389.25,$617.35,$0.00,$149.04,$0.00,$0.00,$151.45,$865.00,$0.00,$432.50,$685.08,$692.00,$0.00,$135.37,$0.00,$137.71,$0.00
55-04761,SUP,HCPCS C1713,,55-04761  -  PLATE BONE 100D 2MM ADVANCEMENT L 5 HOLE MALBLE RIGHT ANGLED,$865.00,$0.00,$865.00,$389.25,$617.35,$0.00,$149.04,$0.00,$0.00,$151.45,$865.00,$0.00,$432.50,$685.08,$692.00,$0.00,$135.37,$0.00,$137.71,$0.00
55-04762,SUP,HCPCS C1713,,55-04762  -  PLATE BONE 100D LEFT 5MM L 5 HOLE MALBLE TITANIUM MIDFAC 1.7,$890.00,$0.00,$890.00,$400.50,$635.19,$0.00,$153.34,$0.00,$0.00,$155.83,$890.00,$0.00,$445.00,$704.88,$712.00,$0.00,$139.29,$0.00,$141.69,$0.00
55-04763,SUP,HCPCS C1713,,55-04763  -  PLATE BONE 100D 5MM ADVANCEMENT L 5 HOLE MALBLE RIGHT ANGLED,$890.00,$0.00,$890.00,$400.50,$635.19,$0.00,$153.34,$0.00,$0.00,$155.83,$890.00,$0.00,$445.00,$704.88,$712.00,$0.00,$139.29,$0.00,$141.69,$0.00
55-04764,SUP,HCPCS C1713,,55-04764  -  PLATE BONE 100D 8MM ADVANCEMENT 6 HOLE L MALBLE TITANIUM,$917.50,$0.00,$917.50,$412.88,$654.82,$0.00,$158.08,$0.00,$0.00,$160.65,$917.50,$0.00,$458.75,$726.66,$734.00,$0.00,$143.59,$0.00,$146.07,$0.00
55-04765,SUP,HCPCS C1713,,55-04765  -  PLATE BONE 100D 8MM L 6 HOLE MALBLE TITANIUM MIDFAC RIGHT,$917.50,$0.00,$917.50,$412.88,$654.82,$0.00,$158.08,$0.00,$0.00,$160.65,$917.50,$0.00,$458.75,$726.66,$734.00,$0.00,$143.59,$0.00,$146.07,$0.00
55-04766,SUP,HCPCS C1713,,55-04766  -  PLATE BONE 100D 12MM ADVANCEMENT 6 HOLE L MALBLE TITANIUM,$942.50,$0.00,$942.50,$424.13,$672.66,$0.00,$162.39,$0.00,$0.00,$165.02,$942.50,$0.00,$471.25,$746.46,$754.00,$0.00,$147.50,$0.00,$150.05,$0.00
55-04767,SUP,HCPCS C1713,,55-04767  -  PLATE BONE 100D 12MM ADVANCEMENT 6 HOLE L MALBLE TITANIUM,$942.50,$0.00,$942.50,$424.13,$672.66,$0.00,$162.39,$0.00,$0.00,$165.02,$942.50,$0.00,$471.25,$746.46,$754.00,$0.00,$147.50,$0.00,$150.05,$0.00
55-05151,SUP,HCPCS C1713,,55-05151  -  PLATE BONE STANDARD Y 4MMX.6MM 5 HOLE BAR UNIVERSAL 2,$745.00,$0.00,$745.00,$335.25,$531.71,$0.00,$128.36,$0.00,$0.00,$130.44,$745.00,$0.00,$372.50,$590.04,$596.00,$0.00,$116.59,$0.00,$118.60,$0.00
55-05152,SUP,HCPCS C1713,,55-05152  -  PLATE BONE STANDARD Y 8MMX.6MM 5 HOLE BAR UNIVERSAL 2,$772.50,$0.00,$772.50,$347.63,$551.33,$0.00,$133.10,$0.00,$0.00,$135.26,$772.50,$0.00,$386.25,$611.82,$618.00,$0.00,$120.90,$0.00,$122.98,$0.00
55-05164,SUP,HCPCS C1713,,55-05164  -  PLATE BONE UNIVERSAL STANDARD 2Y .6MM 7 HOLE MALBLE TITANIUM,$877.50,$0.00,$877.50,$394.88,$626.27,$0.00,$151.19,$0.00,$0.00,$153.64,$877.50,$0.00,$438.75,$694.98,$702.00,$0.00,$137.33,$0.00,$139.70,$0.00
55-05188,SUP,HCPCS C1713,,55-05188  -  PLATE BONE STANDARD CURVE .6MM 6 HOLE BAR UNIVERSAL 2,$982.50,$0.00,$982.50,$442.13,$701.21,$0.00,$169.28,$0.00,$0.00,$172.03,$982.50,$0.00,$491.25,$778.14,$786.00,$0.00,$153.76,$0.00,$156.41,$0.00
55-05716,SUP,HCPCS C1713,,55-05716  -  PLATE BONE 16 HOLE LOCKING TITANIUM MIDFAC 1.7 MM SCREW,"$1,665.00",$0.00,"$1,665.00",$749.25,"$1,188.31",$0.00,$286.87,$0.00,$0.00,$291.53,"$1,665.00",$0.00,$832.50,"$1,318.68","$1,332.00",$0.00,$260.57,$0.00,$265.07,$0.00
55-05731,SUP,HCPCS C1713,,55-05731  -  PLATE BONE 3D .8MM 2X2 HOLE LOCK UNIVERSAL 2 TITANIUM MIDFAC,"$1,170.00",$0.00,"$1,170.00",$526.50,$835.03,$0.00,$201.59,$0.00,$0.00,$204.86,"$1,170.00",$0.00,$585.00,$926.64,$936.00,$0.00,$183.11,$0.00,$186.26,$0.00
55-05733,SUP,HCPCS C1713,,55-05733  -  PLATE BONE 2X6 HOLE LOCKING 3D TITANIUM MIDFAC 1.7 MM SCREW,"$2,622.50",$0.00,"$2,622.50","$1,180.13","$1,871.68",$0.00,$451.84,$0.00,$0.00,$459.18,"$2,622.50",$0.00,"$1,311.25","$2,077.02","$2,098.00",$0.00,$410.42,$0.00,$417.50,$0.00
55-05742,SUP,HCPCS C1713,,55-05742  -  PLATE BONE 2Y .8MM 7 HOLE LOCK UNIVERSAL 2 TITANIUM MIDFAC,"$1,310.00",$0.00,"$1,310.00",$589.50,$934.95,$0.00,$225.71,$0.00,$0.00,$229.37,"$1,310.00",$0.00,$655.00,"$1,037.52","$1,048.00",$0.00,$205.02,$0.00,$208.55,$0.00
55-05751,SUP,HCPCS C1713,,55-05751  -  PLATE BONE Y 4MMX.8MM 5 HOLE LOCK BAR UNIVERSAL 2 TITANIUM,"$1,032.50",$0.00,"$1,032.50",$464.63,$736.90,$0.00,$177.89,$0.00,$0.00,$180.78,"$1,032.50",$0.00,$516.25,$817.74,$826.00,$0.00,$161.59,$0.00,$164.37,$0.00
55-05752,SUP,HCPCS C1713,,55-05752  -  PLATE BONE 8MM ADVANCEMENT 8MM 5 HOLE Y LOCKING BAR TITANIUM,"$1,032.50",$0.00,"$1,032.50",$464.63,$736.90,$0.00,$177.89,$0.00,$0.00,$180.78,"$1,032.50",$0.00,$516.25,$817.74,$826.00,$0.00,$161.59,$0.00,$164.37,$0.00
55-05758,SUP,HCPCS C1713,,55-05758  -  PLATE BONE 8 HOLE CVD LOCKING TITANIUM MIDFAC 1.7 MM SCREW,$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
55-05761,SUP,HCPCS C1713,,55-05761  -  PLATE BONE 2MM ADVANCEMENT 2MMX.8MM 5 HOLE L LOCKING,$942.50,$0.00,$942.50,$424.13,$672.66,$0.00,$162.39,$0.00,$0.00,$165.02,$942.50,$0.00,$471.25,$746.46,$754.00,$0.00,$147.50,$0.00,$150.05,$0.00
55-05763,SUP,HCPCS C1713,,55-05763  -  PLATE BONE 5MM ADVANCEMENT L 5MMX.8MM 5 HOLE LOCK TITANIUM,"$1,000.00",$0.00,"$1,000.00",$450.00,$713.70,$0.00,$172.30,$0.00,$0.00,$175.09,"$1,000.00",$0.00,$500.00,$792.00,$800.00,$0.00,$156.50,$0.00,$159.20,$0.00
55-05765,SUP,HCPCS C1713,,55-05765  -  PLATE BONE 100D L 8MMX.8MM 6 HOLE LOCK BAR UNIVERSAL 2,"$1,055.00",$0.00,"$1,055.00",$474.75,$752.95,$0.00,$181.77,$0.00,$0.00,$184.72,"$1,055.00",$0.00,$527.50,$835.56,$844.00,$0.00,$165.11,$0.00,$167.96,$0.00
55-05767,SUP,HCPCS C1713,,55-05767  -  PLATE BONE 100D L 12MMX.8MM 6 HOLE LOCK BAR UNIVERSAL 2,"$1,082.50",$0.00,"$1,082.50",$487.13,$772.58,$0.00,$186.51,$0.00,$0.00,$189.54,"$1,082.50",$0.00,$541.25,$857.34,$866.00,$0.00,$169.41,$0.00,$172.33,$0.00
55-05779,SUP,HCPCS C1713,,55-05779  -  PLATE BONE Y .8MM 8 HOLE LOCK UNIVERSAL 2 TITANIUM MIDFAC,"$1,197.50",$0.00,"$1,197.50",$538.88,$854.66,$0.00,$206.32,$0.00,$0.00,$209.67,"$1,197.50",$0.00,$598.75,$948.42,$958.00,$0.00,$187.41,$0.00,$190.64,$0.00
55-06208,SUP,HCPCS C1713,,55-06208  -  PLATE BONE STANDARD STR .6MM 8 HOLE UNIVERSAL 2 TITANIUM,"$1,055.00",$0.00,"$1,055.00",$474.75,$752.95,$0.00,$181.77,$0.00,$0.00,$184.72,"$1,055.00",$0.00,$527.50,$835.56,$844.00,$0.00,$165.11,$0.00,$167.96,$0.00
55-06224,SUP,HCPCS C1713,,55-06224  -  PLATE BONE STANDARD STR .6MM 24 HOLE UNIVERSAL 2 TITANIUM,"$1,970.00",$0.00,"$1,970.00",$886.50,"$1,405.99",$0.00,$339.42,$0.00,$0.00,$344.93,"$1,970.00",$0.00,$985.00,"$1,560.24","$1,576.00",$0.00,$308.31,$0.00,$313.62,$0.00
55-06231,SUP,HCPCS C1713,,55-06231  -  PLATE BONE STANDARD 3D .6MM 2X2 HOLE UNIVERSAL 2 TITANIUM,$900.00,$0.00,$900.00,$405.00,$642.33,$0.00,$155.07,$0.00,$0.00,$157.58,$900.00,$0.00,$450.00,$712.80,$720.00,$0.00,$140.85,$0.00,$143.28,$0.00
55-06233,SUP,HCPCS C1713,,55-06233  -  PLATE BONE STANDARD .6MM 6X2 HOLE 3D TITANIUM UPPERFACIAL,"$1,610.00",$0.00,"$1,610.00",$724.50,"$1,149.06",$0.00,$277.39,$0.00,$0.00,$281.90,"$1,610.00",$0.00,$805.00,"$1,275.12","$1,288.00",$0.00,$251.97,$0.00,$256.31,$0.00
55-06235,SUP,HCPCS C1713,,55-06235  -  PLATE BONE STANDARD 3D .6MM 6X6 HOLE UNIVERSAL 2 TITANIUM,"$3,890.00",$0.00,"$3,890.00","$1,750.50","$2,776.29",$0.00,$670.23,$0.00,$0.00,$681.11,"$3,890.00",$0.00,"$1,945.00","$3,080.88","$3,112.00",$0.00,$608.79,$0.00,$619.29,$0.00
55-06237,SUP,HCPCS C1713,,55-06237  -  PLATE BONE 10X10 HOLE 3D TITANIUM UPPERFACIAL 1.2 MM SCREW,"$5,260.00",$0.00,"$5,260.00","$2,367.00","$3,754.06",$0.00,$906.27,$0.00,$0.00,$920.98,"$5,260.00",$0.00,"$2,630.00","$4,165.92","$4,208.00",$0.00,$823.19,$0.00,$837.39,$0.00
55-06240,SUP,HCPCS C1713,,55-06240  -  PLATE BONE STANDARD 2Y .6MM 7 HOLE UNIVERSAL 2 TITANIUM,$760.00,$0.00,$760.00,$342.00,$542.41,$0.00,$130.94,$0.00,$0.00,$133.07,$760.00,$0.00,$380.00,$601.92,$608.00,$0.00,$118.94,$0.00,$120.99,$0.00
55-06250,SUP,HCPCS C1713,,55-06250  -  PLATE BONE STANDARD CURVE .6MM 10 HOLE LEIBINGER UNIVERSAL 2,$947.50,$0.00,$947.50,$426.38,$676.23,$0.00,$163.25,$0.00,$0.00,$165.90,$947.50,$0.00,$473.75,$750.42,$758.00,$0.00,$148.28,$0.00,$150.84,$0.00
55-06254,SUP,HCPCS C1713,,55-06254  -  PLATE BONE STANDARD CURVE .6MM 4 HOLE LEIBINGER UNIVERSAL 2,$470.00,$0.00,$470.00,$211.50,$335.44,$0.00,$80.98,$0.00,$0.00,$82.29,$470.00,$0.00,$235.00,$372.24,$376.00,$0.00,$73.56,$0.00,$74.82,$0.00
55-06260,SUP,HCPCS C1713,,55-06260  -  PLATE BONE 90D .6MM 8 HOLE L TITANIUM LEFT UPPERFACIAL 1.2MM,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
55-06261,SUP,HCPCS C1713,,55-06261  -  PLATE BONE 90D STANDARD L .6MM 8 HOLE UNIVERSAL 2 TITANIUM,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
55-06270,SUP,HCPCS C1713,,55-06270  -  PLATE BONE STANDARD T .6MM 7 HOLE UNIVERSAL 2 TITANIUM,$747.50,$0.00,$747.50,$336.38,$533.49,$0.00,$128.79,$0.00,$0.00,$130.88,$747.50,$0.00,$373.75,$592.02,$598.00,$0.00,$116.98,$0.00,$119.00,$0.00
55-06310,SUP,HCPCS C1713,,55-06310  -  PLATE BONE MINI 3D SQUARE .6MM 2X2 HOLE UNIVERSAL 2 TITANIUM,$962.50,$0.00,$962.50,$433.13,$686.94,$0.00,$165.83,$0.00,$0.00,$168.53,$962.50,$0.00,$481.25,$762.30,$770.00,$0.00,$150.63,$0.00,$153.23,$0.00
55-06312,SUP,HCPCS C1713,,55-06312  -  PLATE BONE MINI 3D RECTANGLE .6MM 2X2 HOLE UNIVERSAL 2,$962.50,$0.00,$962.50,$433.13,$686.94,$0.00,$165.83,$0.00,$0.00,$168.53,$962.50,$0.00,$481.25,$762.30,$770.00,$0.00,$150.63,$0.00,$153.23,$0.00
55-06320,SUP,HCPCS C1713,,55-06320  -  PLATE BONE MINI 3D SQUARE .6MM 3X2 HOLE UNIVERSAL 2 TITANIUM,"$1,100.00",$0.00,"$1,100.00",$495.00,$785.07,$0.00,$189.52,$0.00,$0.00,$192.60,"$1,100.00",$0.00,$550.00,$871.20,$880.00,$0.00,$172.15,$0.00,$175.12,$0.00
55-06370,SUP,HCPCS C1713,,55-06370  -  PLATE BONE STANDARD 14MM BURR HOLE COVER TITANIUM MAXFACL,$900.00,$0.00,$900.00,$405.00,$642.33,$0.00,$155.07,$0.00,$0.00,$157.58,$900.00,$0.00,$450.00,$712.80,$720.00,$0.00,$140.85,$0.00,$143.28,$0.00
55-06371,SUP,HCPCS C1713,,55-06371  -  PLATE BONE 20MM BURR HOLE COVER MALBLE TITANIUM MAXFACL 1.2,"$1,005.00",$0.00,"$1,005.00",$452.25,$717.27,$0.00,$173.16,$0.00,$0.00,$175.97,"$1,005.00",$0.00,$502.50,$795.96,$804.00,$0.00,$157.28,$0.00,$160.00,$0.00
55-06372,SUP,HCPCS C1713,,55-06372  -  PLATE BONE STANDARD 10MM .6MM BURR HOLE COVER UNIVERSAL 2,$900.00,$0.00,$900.00,$405.00,$642.33,$0.00,$155.07,$0.00,$0.00,$157.58,$900.00,$0.00,$450.00,$712.80,$720.00,$0.00,$140.85,$0.00,$143.28,$0.00
55-06373,SUP,HCPCS C1713,,55-06373  -  PLATE BONE 14MM BURR HOLE COVER MALBLE TITANIUM MAXFACL 1.2,"$1,005.00",$0.00,"$1,005.00",$452.25,$717.27,$0.00,$173.16,$0.00,$0.00,$175.97,"$1,005.00",$0.00,$502.50,$795.96,$804.00,$0.00,$157.28,$0.00,$160.00,$0.00
55-06374,SUP,HCPCS C1713,,55-06374  -  PLATE BONE 10MM BURR HOLE COVER MALBLE TITANIUM MAXFACL 1.2,"$1,005.00",$0.00,"$1,005.00",$452.25,$717.27,$0.00,$173.16,$0.00,$0.00,$175.97,"$1,005.00",$0.00,$502.50,$795.96,$804.00,$0.00,$157.28,$0.00,$160.00,$0.00
55-06375,SUP,HCPCS C1713,,55-06375  -  PLATE BONE STANDARD 7MM BURR HOLE COVER TITANIUM MAXFACL 1.2,$900.00,$0.00,$900.00,$405.00,$642.33,$0.00,$155.07,$0.00,$0.00,$157.58,$900.00,$0.00,$450.00,$712.80,$720.00,$0.00,$140.85,$0.00,$143.28,$0.00
55-06376,SUP,HCPCS C1713,,55-06376  -  PLATE BONE 7MM BURR HOLE COVER MALBLE TITANIUM MAXFACL 1.2MM,$962.50,$0.00,$962.50,$433.13,$686.94,$0.00,$165.83,$0.00,$0.00,$168.53,$962.50,$0.00,$481.25,$762.30,$770.00,$0.00,$150.63,$0.00,$153.23,$0.00
55-06704,SUP,HCPCS C1713,,55-06704  -  PLATE BONE STANDARD STR .55MM 4 HOLE BAR UNIVERSAL 2,$495.00,$0.00,$495.00,$222.75,$353.28,$0.00,$85.29,$0.00,$0.00,$86.67,$495.00,$0.00,$247.50,$392.04,$396.00,$0.00,$77.47,$0.00,$78.80,$0.00
55-06708,SUP,HCPCS C1713,,55-06708  -  PLATE BONE STANDARD STR 8 HOLE UNIVERSAL 2 TITANIUM MIDFAC,"$1,090.00",$0.00,"$1,090.00",$490.50,$777.93,$0.00,$187.80,$0.00,$0.00,$190.85,"$1,090.00",$0.00,$545.00,$863.28,$872.00,$0.00,$170.59,$0.00,$173.53,$0.00
55-06724,SUP,HCPCS C1713,,55-06724  -  PLATE BONE STANDARD .6MM 24 HOLE STR TITANIUM MIDFAC 1.7MM,"$2,080.00",$0.00,"$2,080.00",$936.00,"$1,484.50",$0.00,$358.37,$0.00,$0.00,$364.19,"$2,080.00",$0.00,"$1,040.00","$1,647.36","$1,664.00",$0.00,$325.52,$0.00,$331.14,$0.00
55-06731,SUP,HCPCS C1713,,55-06731  -  PLATE BONE STANDARD .6MM 2X2 HOLE 3D TITANIUM MIDFAC 1.7MM,"$1,000.00",$0.00,"$1,000.00",$450.00,$713.70,$0.00,$172.30,$0.00,$0.00,$175.09,"$1,000.00",$0.00,$500.00,$792.00,$800.00,$0.00,$156.50,$0.00,$159.20,$0.00
55-06733,SUP,HCPCS C1713,,55-06733  -  PLATE BONE STANDARD .6MM 2X6 HOLE 3D TITANIUM MIDFAC 1.7MM,"$1,810.00",$0.00,"$1,810.00",$814.50,"$1,291.80",$0.00,$311.85,$0.00,$0.00,$316.92,"$1,810.00",$0.00,$905.00,"$1,433.52","$1,448.00",$0.00,$283.27,$0.00,$288.15,$0.00
55-06750,SUP,HCPCS C1713,,55-06750  -  PLATE BONE STANDARD CURVE .6MM 10 HOLE UNIVERSAL 2 TITANIUM,"$1,150.00",$0.00,"$1,150.00",$517.50,$820.76,$0.00,$198.14,$0.00,$0.00,$201.36,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$179.98,$0.00,$183.08,$0.00
55-06754,SUP,HCPCS C1713,,55-06754  -  PLATE BONE STANDARD 4 HOLE CVD BAR TITANIUM MIDFAC 1.7MM,$610.00,$0.00,$610.00,$274.50,$435.36,$0.00,$105.10,$0.00,$0.00,$106.81,$610.00,$0.00,$305.00,$483.12,$488.00,$0.00,$95.47,$0.00,$97.11,$0.00
55-06760,SUP,HCPCS C1713,,55-06760  -  PLATE BONE 100D STANDARD 2MM ADVANCEMENT 5 HOLE L TITANIUM,$795.00,$0.00,$795.00,$357.75,$567.39,$0.00,$136.97,$0.00,$0.00,$139.20,$795.00,$0.00,$397.50,$629.64,$636.00,$0.00,$124.42,$0.00,$126.56,$0.00
55-06761,SUP,HCPCS C1713,,55-06761  -  PLATE BONE 100D STANDARD 2MM ADVANCEMENT 5 HOLE L TITANIUM,$795.00,$0.00,$795.00,$357.75,$567.39,$0.00,$136.97,$0.00,$0.00,$139.20,$795.00,$0.00,$397.50,$629.64,$636.00,$0.00,$124.42,$0.00,$126.56,$0.00
55-06762,SUP,HCPCS C1713,,55-06762  -  PLATE BONE 100D 5 HOLE L TITANIUM LEFT MIDFAC,$822.50,$0.00,$822.50,$370.13,$587.02,$0.00,$141.71,$0.00,$0.00,$144.01,$822.50,$0.00,$411.25,$651.42,$658.00,$0.00,$128.72,$0.00,$130.94,$0.00
55-06763,SUP,HCPCS C1713,,55-06763  -  PLATE BONE 100D STANDARD 5MM 5 HOLE L BAR TITANIUM RIGHT,$822.50,$0.00,$822.50,$370.13,$587.02,$0.00,$141.71,$0.00,$0.00,$144.01,$822.50,$0.00,$411.25,$651.42,$658.00,$0.00,$128.72,$0.00,$130.94,$0.00
55-06764,SUP,HCPCS C1713,,55-06764  -  PLATE BONE 100D 6 HOLE L TITANIUM LEFT MIDFAC 1.7MM SCREW,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
55-06765,SUP,HCPCS C1713,,55-06765  -  PLATE BONE 100D 8MM 6 HOLE L TITANIUM RIGHT MAXFACL 1.7MM,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
55-06766,SUP,HCPCS C1713,,55-06766  -  PLATE BONE 100D STANDARD 12MM ADVANCEMENT 12MM 6 HOLE LEFT L,$920.00,$0.00,$920.00,$414.00,$656.60,$0.00,$158.51,$0.00,$0.00,$161.08,$920.00,$0.00,$460.00,$728.64,$736.00,$0.00,$143.98,$0.00,$146.46,$0.00
55-06767,SUP,HCPCS C1713,,55-06767  -  PLATE BONE 100D STANDARD 12MM BAR L .6MM 6 HOLE LEIBINGER,$920.00,$0.00,$920.00,$414.00,$656.60,$0.00,$158.51,$0.00,$0.00,$161.08,$920.00,$0.00,$460.00,$728.64,$736.00,$0.00,$143.98,$0.00,$146.46,$0.00
55-06771,SUP,HCPCS C1713,,55-06771  -  PLATE BONE STANDARD T 5 HOLE T TITANIUM MIDFAC 1.7MM SCREWS,$695.00,$0.00,$695.00,$312.75,$496.02,$0.00,$119.75,$0.00,$0.00,$121.69,$695.00,$0.00,$347.50,$550.44,$556.00,$0.00,$108.77,$0.00,$110.64,$0.00
55-07760,SUP,HCPCS C1713,,55-07760  -  PLATE BONE 100D 2MM ADVANCEMENT .6MM 5 HOLE L TITANIUM LEFT,$862.50,$0.00,$862.50,$388.13,$615.57,$0.00,$148.60,$0.00,$0.00,$151.02,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$134.98,$0.00,$137.31,$0.00
55-07761,SUP,HCPCS C1713,,55-07761  -  PLATE BONE 100D 2MM ADVANCEMENT .6MM 5 HOLE L TITANIUM RIGHT,$862.50,$0.00,$862.50,$388.13,$615.57,$0.00,$148.60,$0.00,$0.00,$151.02,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$134.98,$0.00,$137.31,$0.00
55-07762,SUP,HCPCS C1713,,55-07762  -  PLATE BONE 100D 5MM ADVANCEMENT .6MM 5 HOLE L TITANIUM LEFT,$887.50,$0.00,$887.50,$399.38,$633.41,$0.00,$152.91,$0.00,$0.00,$155.39,$887.50,$0.00,$443.75,$702.90,$710.00,$0.00,$138.89,$0.00,$141.29,$0.00
55-07763,SUP,HCPCS C1713,,55-07763  -  PLATE BONE 100D 5MM ADVANCEMENT .6MM 5 HOLE L TITANIUM RIGHT,$887.50,$0.00,$887.50,$399.38,$633.41,$0.00,$152.91,$0.00,$0.00,$155.39,$887.50,$0.00,$443.75,$702.90,$710.00,$0.00,$138.89,$0.00,$141.29,$0.00
55-07764,SUP,HCPCS C1713,,55-07764  -  PLATE BONE 100D 8MM ADVANCEMENT .8MM 6 HOLE L TITANIUM LEFT,$920.00,$0.00,$920.00,$414.00,$656.60,$0.00,$158.51,$0.00,$0.00,$161.08,$920.00,$0.00,$460.00,$728.64,$736.00,$0.00,$143.98,$0.00,$146.46,$0.00
55-07765,SUP,HCPCS C1713,,55-07765  -  PLATE BONE 100D 8MM ADVANCEMENT .8MM 6 HOLE L TITANIUM RIGHT,$920.00,$0.00,$920.00,$414.00,$656.60,$0.00,$158.51,$0.00,$0.00,$161.08,$920.00,$0.00,$460.00,$728.64,$736.00,$0.00,$143.98,$0.00,$146.46,$0.00
55-07766,SUP,HCPCS C1713,,55-07766  -  PLATE BONE 100D 12MM ADVANCEMENT .55MM 6 HOLE L TITANIUM,$940.00,$0.00,$940.00,$423.00,$670.88,$0.00,$161.96,$0.00,$0.00,$164.59,$940.00,$0.00,$470.00,$744.48,$752.00,$0.00,$147.11,$0.00,$149.65,$0.00
55-07767,SUP,HCPCS C1713,,55-07767  -  PLATE BONE 100D 12MM ADVANCEMENT .55MM 6 HOLE L TITANIUM,$940.00,$0.00,$940.00,$423.00,$670.88,$0.00,$161.96,$0.00,$0.00,$164.59,$940.00,$0.00,$470.00,$744.48,$752.00,$0.00,$147.11,$0.00,$149.65,$0.00
55-08203,SUP,HCPCS C1713,,55-08203  -  PLATE BONE MINI STR 4MMX1MM 4 HOLE BAR UNIVERSAL 2 TITANIUM,$742.50,$0.00,$742.50,$334.13,$529.92,$0.00,$127.93,$0.00,$0.00,$130.01,$742.50,$0.00,$371.25,$588.06,$594.00,$0.00,$116.20,$0.00,$118.21,$0.00
55-08204,SUP,HCPCS C1713,,55-08204  -  PLATE BONE MINI REGULAR STR 1MM 4 HOLE UNIVERSAL 2 TITANIUM,$635.00,$0.00,$635.00,$285.75,$453.20,$0.00,$109.41,$0.00,$0.00,$111.18,$635.00,$0.00,$317.50,$502.92,$508.00,$0.00,$99.38,$0.00,$101.09,$0.00
55-08205,SUP,HCPCS C1713,,55-08205  -  PLATE BONE MINI STR 8MMX1MM 4 HOLE BAR UNIVERSAL 2 TITANIUM,$742.50,$0.00,$742.50,$334.13,$529.92,$0.00,$127.93,$0.00,$0.00,$130.01,$742.50,$0.00,$371.25,$588.06,$594.00,$0.00,$116.20,$0.00,$118.21,$0.00
55-08206,SUP,HCPCS C1713,,55-08206  -  PLATE BONE MINI STR 6 HOLE STR TITANIUM LEFT,"$1,100.00",$0.00,"$1,100.00",$495.00,$785.07,$0.00,$189.52,$0.00,$0.00,$192.60,"$1,100.00",$0.00,$550.00,$871.20,$880.00,$0.00,$172.15,$0.00,$175.12,$0.00
55-08216,SUP,HCPCS C1713,,55-08216  -  PLATE BONE MINI REGULAR STR 1MM 16 HOLE UNIVERSAL 2 TITANIUM,"$2,080.00",$0.00,"$2,080.00",$936.00,"$1,484.50",$0.00,$358.37,$0.00,$0.00,$364.19,"$2,080.00",$0.00,"$1,040.00","$1,647.36","$1,664.00",$0.00,$325.52,$0.00,$331.14,$0.00
55-08230,SUP,HCPCS C1713,,55-08230  -  PLATE BONE MINI REGULAR L 1MM 4 HOLE UNIVERSAL 2 TITANIUM,$877.50,$0.00,$877.50,$394.88,$626.27,$0.00,$151.19,$0.00,$0.00,$153.64,$877.50,$0.00,$438.75,$694.98,$702.00,$0.00,$137.33,$0.00,$139.70,$0.00
55-08231,SUP,HCPCS C1713,,55-08231  -  PLATE BONE MINI REGULAR L 1MM 4 HOLE UNIVERSAL 2 TITANIUM,$877.50,$0.00,$877.50,$394.88,$626.27,$0.00,$151.19,$0.00,$0.00,$153.64,$877.50,$0.00,$438.75,$694.98,$702.00,$0.00,$137.33,$0.00,$139.70,$0.00
55-08232,SUP,HCPCS C1713,,55-08232  -  PLATE BONE 8MM 4 HOLE L BAR TITANIUM RIGHT,$922.50,$0.00,$922.50,$415.13,$658.39,$0.00,$158.94,$0.00,$0.00,$161.52,$922.50,$0.00,$461.25,$730.62,$738.00,$0.00,$144.37,$0.00,$146.86,$0.00
55-08233,SUP,HCPCS C1713,,55-08233  -  PLATE BONE 8MM 4 HOLE L BAR TITANIUM LEFT,$922.50,$0.00,$922.50,$415.13,$658.39,$0.00,$158.94,$0.00,$0.00,$161.52,$922.50,$0.00,$461.25,$730.62,$738.00,$0.00,$144.37,$0.00,$146.86,$0.00
55-08234,SUP,HCPCS C1713,,55-08234  -  PLATE BONE MINI L 4MMX1MM 4 HOLE BAR UNIVERSAL 2 TITANIUM,$962.50,$0.00,$962.50,$433.13,$686.94,$0.00,$165.83,$0.00,$0.00,$168.53,$962.50,$0.00,$481.25,$762.30,$770.00,$0.00,$150.63,$0.00,$153.23,$0.00
55-08235,SUP,HCPCS C1713,,55-08235  -  PLATE BONE 4MM 4 HOLE L BAR TITANIUM LEFT,$962.50,$0.00,$962.50,$433.13,$686.94,$0.00,$165.83,$0.00,$0.00,$168.53,$962.50,$0.00,$481.25,$762.30,$770.00,$0.00,$150.63,$0.00,$153.23,$0.00
55-08236,SUP,HCPCS C1713,,55-08236  -  PLATE BONE MINI L 8MMX1MM 5 HOLE BAR UNIVERSAL 2 TITANIUM,"$1,002.50",$0.00,"$1,002.50",$451.13,$715.48,$0.00,$172.73,$0.00,$0.00,$175.53,"$1,002.50",$0.00,$501.25,$793.98,$802.00,$0.00,$156.89,$0.00,$159.60,$0.00
55-08237,SUP,HCPCS C1713,,55-08237  -  PLATE BONE MINI L 8MMX1MM 5 HOLE BAR UNIVERSAL 2 TITANIUM,"$1,002.50",$0.00,"$1,002.50",$451.13,$715.48,$0.00,$172.73,$0.00,$0.00,$175.53,"$1,002.50",$0.00,$501.25,$793.98,$802.00,$0.00,$156.89,$0.00,$159.60,$0.00
55-08240,SUP,HCPCS C1713,,55-08240  -  PLATE BONE MINI REGULAR T 1MM 6 HOLE UNIVERSAL 2 TITANIUM,$715.00,$0.00,$715.00,$321.75,$510.30,$0.00,$123.19,$0.00,$0.00,$125.19,$715.00,$0.00,$357.50,$566.28,$572.00,$0.00,$111.90,$0.00,$113.83,$0.00
55-08250,SUP,HCPCS C1713,,55-08250  -  PLATE BONE MINI 5 HOLE Y W/O BAR TITANIUM MAXFACL,$845.00,$0.00,$845.00,$380.25,$603.08,$0.00,$145.59,$0.00,$0.00,$147.95,$845.00,$0.00,$422.50,$669.24,$676.00,$0.00,$132.24,$0.00,$134.52,$0.00
55-08251,SUP,HCPCS C1713,,55-08251  -  PLATE BONE MINI Y 8MMX1MM 5 HOLE BAR UNIVERSAL 2 TITANIUM,$845.00,$0.00,$845.00,$380.25,$603.08,$0.00,$145.59,$0.00,$0.00,$147.95,$845.00,$0.00,$422.50,$669.24,$676.00,$0.00,$132.24,$0.00,$134.52,$0.00
55-08260,SUP,HCPCS C1713,,55-08260  -  PLATE BONE 2Y 6 HOLE TITANIUM MAXFACL 2MM SCREW,$942.50,$0.00,$942.50,$424.13,$672.66,$0.00,$162.39,$0.00,$0.00,$165.02,$942.50,$0.00,$471.25,$746.46,$754.00,$0.00,$147.50,$0.00,$150.05,$0.00
55-08262,SUP,HCPCS C1713,,55-08262  -  PLATE BONE MINI 2Y 8MMX1MM 6 HOLE BAR UNIVERSAL 2 TITANIUM,$942.50,$0.00,$942.50,$424.13,$672.66,$0.00,$162.39,$0.00,$0.00,$165.02,$942.50,$0.00,$471.25,$746.46,$754.00,$0.00,$147.50,$0.00,$150.05,$0.00
55-08510,SUP,HCPCS C1713,,55-08510  -  PLATE BONE .75MM 30 HOLE STR LP TITANIUM MAXFACL,"$2,352.50",$0.00,"$2,352.50","$1,058.63","$1,678.98",$0.00,$405.32,$0.00,$0.00,$411.90,"$2,352.50",$0.00,"$1,176.25","$1,863.18","$1,882.00",$0.00,$368.17,$0.00,$374.52,$0.00
55-08520,SUP,HCPCS C1713,,55-08520  -  PLATE BONE 100D L .75MM 9 HOLE LP RIGHT ANGLED TITANIUM,"$1,117.50",$0.00,"$1,117.50",$502.88,$797.56,$0.00,$192.54,$0.00,$0.00,$195.67,"$1,117.50",$0.00,$558.75,$885.06,$894.00,$0.00,$174.89,$0.00,$177.91,$0.00
55-08521,SUP,HCPCS C1713,,55-08521  -  PLATE BONE 100D L .75MM 9 HOLE LP LEFT ANGLED TITANIUM,"$1,117.50",$0.00,"$1,117.50",$502.88,$797.56,$0.00,$192.54,$0.00,$0.00,$195.67,"$1,117.50",$0.00,$558.75,$885.06,$894.00,$0.00,$174.89,$0.00,$177.91,$0.00
55-08542,SUP,HCPCS C1713,,55-08542  -  PLATE BONE .75MM 8 HOLE T LP TITANIUM MAXFACL,"$1,100.00",$0.00,"$1,100.00",$495.00,$785.07,$0.00,$189.52,$0.00,$0.00,$192.60,"$1,100.00",$0.00,$550.00,$871.20,$880.00,$0.00,$172.15,$0.00,$175.12,$0.00
55-08579,SUP,HCPCS C1713,,55-08579  -  PLATE BONE .75MM 8 HOLE Y TITANIUM MAXFACL,"$1,100.00",$0.00,"$1,100.00",$495.00,$785.07,$0.00,$189.52,$0.00,$0.00,$192.60,"$1,100.00",$0.00,$550.00,$871.20,$880.00,$0.00,$172.15,$0.00,$175.12,$0.00
55-08586,SUP,HCPCS C1713,,55-08586  -  PLATE BONE CURVE .75MM 12 HOLE LP TITANIUM MAXFACL,"$1,150.00",$0.00,"$1,150.00",$517.50,$820.76,$0.00,$198.14,$0.00,$0.00,$201.36,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$179.98,$0.00,$183.08,$0.00
55-09104,SUP,HCPCS C1713,,55-09104  -  PLATE BONE 4MM BAR TITANIUM CHIN 2MM SCREW,"$1,100.00",$0.00,"$1,100.00",$495.00,$785.07,$0.00,$189.52,$0.00,$0.00,$192.60,"$1,100.00",$0.00,$550.00,$871.20,$880.00,$0.00,$172.15,$0.00,$175.12,$0.00
55-09106,SUP,HCPCS C1713,,55-09106  -  PLATE BONE 6MM BAR TITANIUM CHIN,"$1,150.00",$0.00,"$1,150.00",$517.50,$820.76,$0.00,$198.14,$0.00,$0.00,$201.36,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$179.98,$0.00,$183.08,$0.00
55-09108,SUP,HCPCS C1713,,55-09108  -  PLATE BONE 8MM BAR TITANIUM CHIN 2MM SCREW,"$1,210.00",$0.00,"$1,210.00",$544.50,$863.58,$0.00,$208.48,$0.00,$0.00,$211.86,"$1,210.00",$0.00,$605.00,$958.32,$968.00,$0.00,$189.37,$0.00,$192.63,$0.00
55-09110,SUP,HCPCS C1713,,55-09110  -  PLATE BONE 10MM BAR TITANIUM CHIN 2MM SCREW,"$1,240.00",$0.00,"$1,240.00",$558.00,$884.99,$0.00,$213.65,$0.00,$0.00,$217.11,"$1,240.00",$0.00,$620.00,$982.08,$992.00,$0.00,$194.06,$0.00,$197.41,$0.00
55-10503,SUP,HCPCS C1713,,55-10503  -  PLATE BONE LONG 4 HOLE LOCKING STR BAR TITANIUM MANDIB 2MM,$595.00,$0.00,$595.00,$267.75,$424.65,$0.00,$102.52,$0.00,$0.00,$104.18,$595.00,$0.00,$297.50,$471.24,$476.00,$0.00,$93.12,$0.00,$94.72,$0.00
55-10504,SUP,HCPCS C1713,,55-10504  -  PLATE BN MN STRG 1MM BLU SMRT LCK LEIBINGER UNV 2 4 HL TI,$397.50,$0.00,$397.50,$178.88,$283.70,$0.00,$68.49,$0.00,$0.00,$69.60,$397.50,$0.00,$198.75,$314.82,$318.00,$0.00,$62.21,$0.00,$63.28,$0.00
55-10505,SUP,HCPCS C1713,,55-10505  -  PLATE BN MN STRG 4MMX1MM BLU SMRT LCK LEIBINGER UNV 2 4 HL,$452.50,$0.00,$452.50,$203.63,$322.95,$0.00,$77.96,$0.00,$0.00,$79.23,$452.50,$0.00,$226.25,$358.38,$362.00,$0.00,$70.82,$0.00,$72.04,$0.00
55-10506,SUP,HCPCS C1713,,55-10506  -  PLATE BN MN STRG 1MM BLU SMRT LCK LEIBINGER UNV 2 6 HL TI,$517.50,$0.00,$517.50,$232.88,$369.34,$0.00,$89.16,$0.00,$0.00,$90.61,$517.50,$0.00,$258.75,$409.86,$414.00,$0.00,$80.99,$0.00,$82.39,$0.00
55-10507,SUP,HCPCS C1713,,55-10507  -  PLATE BN MN STRG 8MMX1MM BLU SMRT LCK LEIBINGER UNV 2 6 HL,"$1,000.00",$0.00,"$1,000.00",$450.00,$713.70,$0.00,$172.30,$0.00,$0.00,$175.09,"$1,000.00",$0.00,$500.00,$792.00,$800.00,$0.00,$156.50,$0.00,$159.20,$0.00
55-10515,SUP,HCPCS C1713,,55-10515  -  PLATE BONE MINI 8MM 16 HOLE STR CONDENSED TITANIUM MANDIB 2,"$1,802.50",$0.00,"$1,802.50",$811.13,"$1,286.44",$0.00,$310.56,$0.00,$0.00,$315.60,"$1,802.50",$0.00,$901.25,"$1,427.58","$1,442.00",$0.00,$282.09,$0.00,$286.96,$0.00
55-10516,SUP,HCPCS C1713,,55-10516  -  PLATE BONE STR MINI 16 HOLE LOCK TITANIUM MAXFACL 2/2.3MM,$707.50,$0.00,$707.50,$318.38,$504.94,$0.00,$121.90,$0.00,$0.00,$123.88,$707.50,$0.00,$353.75,$560.34,$566.00,$0.00,$110.72,$0.00,$112.63,$0.00
55-10532,SUP,HCPCS C1713,,55-10532  -  PLATE BONE MINI RECTANGLE 3X2 HOLE RECTANGULAR 3D TITANIUM,"$1,385.00",$0.00,"$1,385.00",$623.25,$988.47,$0.00,$238.63,$0.00,$0.00,$242.50,"$1,385.00",$0.00,$692.50,"$1,096.92","$1,108.00",$0.00,$216.75,$0.00,$220.49,$0.00
55-10542,SUP,HCPCS C1713,,55-10542  -  PLATE BONE 4X2 HOLE 3D LOCKING TITANIUM MAXFACL 2/2.3 MM,"$1,600.00",$0.00,"$1,600.00",$720.00,"$1,141.92",$0.00,$275.67,$0.00,$0.00,$280.15,"$1,600.00",$0.00,$800.00,"$1,267.20","$1,280.00",$0.00,$250.40,$0.00,$254.72,$0.00
55-10562,SUP,HCPCS C1713,,55-10562  -  PLATE BONE MINI CVD 6X2 HOLE 3D LOCKING CVD TITANIUM MAXFACL,"$1,742.50",$0.00,"$1,742.50",$784.13,"$1,243.62",$0.00,$300.22,$0.00,$0.00,$305.10,"$1,742.50",$0.00,$871.25,"$1,380.06","$1,394.00",$0.00,$272.70,$0.00,$277.41,$0.00
55-10563,SUP,HCPCS C1713,,55-10563  -  PLATE BONE MINI 4 HOLE REINFORCED BAR TITANIUM MANDIB 2/2.3,"$1,627.50",$0.00,"$1,627.50",$732.38,"$1,161.55",$0.00,$280.41,$0.00,$0.00,$284.96,"$1,627.50",$0.00,$813.75,"$1,288.98","$1,302.00",$0.00,$254.70,$0.00,$259.10,$0.00
5510-F-101,SUP,HCPCS C1776,,5510-F-101  -  COMPONENT FEMORAL 1 CRUCIATE RETAIN CEMENTED TRIATHLON KNEE,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5510-F-102,SUP,HCPCS C1776,,5510-F-102  -  COMPONENT FEMORAL 1 CRUCIATE RETAIN CEMENTED TRIATHLON KNEE,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5510-F-201,SUP,HCPCS C1776,,5510-F-201  -  COMPONENT FEMORAL 2 CRUCIATE RETAIN CEMENTED TRIATHLON KNEE,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5510-F-202,SUP,HCPCS C1776,,5510-F-202  -  COMPONENT FEMORAL 2 CRUCIATE RETAIN CEMENTED TRIATHLON KNEE,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5510-F-301,SUP,HCPCS C1776,,5510-F-301  -  COMPONENT FEMORAL 3 CRUCIATE RETAIN CEMENTED TRIATHLON KNEE,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5510-F-302,SUP,HCPCS C1776,,5510-F-302  -  COMPONENT FEMORAL 3 CRUCIATE RETAIN CEMENTED TRIATHLON KNEE,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5510-F-401,SUP,HCPCS C1776,,5510-F-401  -  COMPONENT FEMORAL 4 CRUCIATE RETAIN CEMENTED TRIATHLON KNEE,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5510-F-402,SUP,HCPCS C1776,,5510-F-402  -  COMPONENT FEMORAL 4 CRUCIATE RETAIN CEMENTED TRIATHLON KNEE,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5510-F-501,SUP,HCPCS C1776,,5510-F-501  -  COMPONENT FEMORAL 5 CRUCIATE RETAIN CEMENTED TRIATHLON KNEE,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5510-F-502,SUP,HCPCS C1776,,5510-F-502  -  COMPONENT FEMORAL 5 CRUCIATE RETAIN CEMENTED TRIATHLON KNEE,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5510-F-601,SUP,HCPCS C1776,,5510-F-601  -  COMPONENT FEMORAL 6 CRUCIATE RETAIN CEMENTED TRIATHLON KNEE,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5510-F-602,SUP,HCPCS C1776,,5510-F-602  -  COMPONENT FEMORAL 6 CRUCIATE RETAIN CEMENTED TRIATHLON KNEE,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5510-F-701,SUP,HCPCS C1776,,5510-F-701  -  COMPONENT FEMORAL 7 CRUCIATE RETAIN CEMENTED TRIATHLON KNEE,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5510-F-702,SUP,HCPCS C1776,,5510-F-702  -  COMPONENT FEMORAL 7 CRUCIATE RETAIN CEMENTED TRIATHLON KNEE,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5510-F-801,SUP,HCPCS C1776,,5510-F-801  -  COMPONENT FEMORAL 8 CRUCIATE RETAIN CEMENTED TRIATHLON KNEE,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5510-F-802,SUP,HCPCS C1776,,5510-F-802  -  COMPONENT FEMORAL 8 CRUCIATE RETAIN CEMENTED TRIATHLON KNEE,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5512-F-101,SUP,HCPCS C1776,,5512-F-101  -  COMPONENT FEMORAL 1 TOT STABILIZE TRIATHLON COCR KNEE LEFT,"$13,967.50",$0.00,"$13,967.50","$6,285.38","$5,158.80",$0.00,"$2,406.53",$0.00,$0.00,"$2,445.60","$13,967.50",$0.00,"$6,983.75","$11,062.26","$11,174.00",$0.00,"$2,185.91",$0.00,"$2,223.63",$0.00
5512-F-102,SUP,HCPCS C1776,,5512-F-102  -  COMPONENT FEMORAL 1 TOT STABILIZE TRIATHLON COCR KNEE RIGHT,"$13,967.50",$0.00,"$13,967.50","$6,285.38","$5,158.80",$0.00,"$2,406.53",$0.00,$0.00,"$2,445.60","$13,967.50",$0.00,"$6,983.75","$11,062.26","$11,174.00",$0.00,"$2,185.91",$0.00,"$2,223.63",$0.00
5512-F-201,SUP,HCPCS C1776,,5512-F-201  -  COMPONENT FEMORAL 2 TOT STABILIZE TRIATHLON COCR KNEE LEFT,"$13,967.50",$0.00,"$13,967.50","$6,285.38","$5,158.80",$0.00,"$2,406.53",$0.00,$0.00,"$2,445.60","$13,967.50",$0.00,"$6,983.75","$11,062.26","$11,174.00",$0.00,"$2,185.91",$0.00,"$2,223.63",$0.00
5512-F-202,SUP,HCPCS C1776,,5512-F-202  -  COMPONENT FEMORAL 2 TOT STABILIZE TRIATHLON COCR KNEE RIGHT,"$13,967.50",$0.00,"$13,967.50","$6,285.38","$5,158.80",$0.00,"$2,406.53",$0.00,$0.00,"$2,445.60","$13,967.50",$0.00,"$6,983.75","$11,062.26","$11,174.00",$0.00,"$2,185.91",$0.00,"$2,223.63",$0.00
5512-F-301,SUP,HCPCS C1776,,5512-F-301  -  COMPONENT FEMORAL 3 TOT STABILIZER TRIATHLON COCR KNEE LEFT,"$13,967.50",$0.00,"$13,967.50","$6,285.38","$5,158.80",$0.00,"$2,406.53",$0.00,$0.00,"$2,445.60","$13,967.50",$0.00,"$6,983.75","$11,062.26","$11,174.00",$0.00,"$2,185.91",$0.00,"$2,223.63",$0.00
5512-F-302,SUP,HCPCS C1776,,5512-F-302  -  COMPONENT FEMORAL 3 TOT STABILIZER TRIATHLON COCR KNEE RIGHT,"$13,967.50",$0.00,"$13,967.50","$6,285.38","$5,158.80",$0.00,"$2,406.53",$0.00,$0.00,"$2,445.60","$13,967.50",$0.00,"$6,983.75","$11,062.26","$11,174.00",$0.00,"$2,185.91",$0.00,"$2,223.63",$0.00
5512-F-401,SUP,HCPCS C1776,,5512-F-401  -  COMPONENT FEMORAL 4 TOT STABILIZER TRIATHLON COCR KNEE LEFT,"$13,967.50",$0.00,"$13,967.50","$6,285.38","$5,158.80",$0.00,"$2,406.53",$0.00,$0.00,"$2,445.60","$13,967.50",$0.00,"$6,983.75","$11,062.26","$11,174.00",$0.00,"$2,185.91",$0.00,"$2,223.63",$0.00
5512-F-402,SUP,HCPCS C1776,,5512-F-402  -  COMPONENT FEMORAL 4 TOT STABILIZER TRIATHLON COCR KNEE RIGHT,"$13,967.50",$0.00,"$13,967.50","$6,285.38","$5,158.80",$0.00,"$2,406.53",$0.00,$0.00,"$2,445.60","$13,967.50",$0.00,"$6,983.75","$11,062.26","$11,174.00",$0.00,"$2,185.91",$0.00,"$2,223.63",$0.00
5512-F-501,SUP,HCPCS C1776,,5512-F-501  -  COMPONENT FEMORAL 5 TOT STABILIZE TRIATHLON COCR KNEE LEFT,"$13,967.50",$0.00,"$13,967.50","$6,285.38","$5,158.80",$0.00,"$2,406.53",$0.00,$0.00,"$2,445.60","$13,967.50",$0.00,"$6,983.75","$11,062.26","$11,174.00",$0.00,"$2,185.91",$0.00,"$2,223.63",$0.00
5512-F-502,SUP,HCPCS C1776,,5512-F-502  -  COMPONENT FEMORAL 5 TOT STABILIZER TRIATHLON COCR KNEE RIGHT,"$13,967.50",$0.00,"$13,967.50","$6,285.38","$5,158.80",$0.00,"$2,406.53",$0.00,$0.00,"$2,445.60","$13,967.50",$0.00,"$6,983.75","$11,062.26","$11,174.00",$0.00,"$2,185.91",$0.00,"$2,223.63",$0.00
5512-F-601,SUP,HCPCS C1776,,5512-F-601  -  COMPONENT FEMORAL 6 TOT STABILIZE TRIATHLON COCR KNEE LEFT,"$13,967.50",$0.00,"$13,967.50","$6,285.38","$5,158.80",$0.00,"$2,406.53",$0.00,$0.00,"$2,445.60","$13,967.50",$0.00,"$6,983.75","$11,062.26","$11,174.00",$0.00,"$2,185.91",$0.00,"$2,223.63",$0.00
5512-F-602,SUP,HCPCS C1776,,5512-F-602  -  COMPONENT FEMORAL 6 TOT STABILIZE TRIATHLON COCR KNEE RIGHT,"$13,967.50",$0.00,"$13,967.50","$6,285.38","$5,158.80",$0.00,"$2,406.53",$0.00,$0.00,"$2,445.60","$13,967.50",$0.00,"$6,983.75","$11,062.26","$11,174.00",$0.00,"$2,185.91",$0.00,"$2,223.63",$0.00
5512-F-701,SUP,HCPCS C1776,,5512-F-701  -  COMPONENT FEMORAL 7 TOT STABILIZE TRIATHLON COCR KNEE LEFT,"$13,967.50",$0.00,"$13,967.50","$6,285.38","$5,158.80",$0.00,"$2,406.53",$0.00,$0.00,"$2,445.60","$13,967.50",$0.00,"$6,983.75","$11,062.26","$11,174.00",$0.00,"$2,185.91",$0.00,"$2,223.63",$0.00
5512-F-702,SUP,HCPCS C1776,,5512-F-702  -  COMPONENT FEMORAL 7 TOT STABILIZE TRIATHLON COCR KNEE RIGHT,"$13,967.50",$0.00,"$13,967.50","$6,285.38","$5,158.80",$0.00,"$2,406.53",$0.00,$0.00,"$2,445.60","$13,967.50",$0.00,"$6,983.75","$11,062.26","$11,174.00",$0.00,"$2,185.91",$0.00,"$2,223.63",$0.00
5512-F-801,SUP,HCPCS C1776,,5512-F-801  -  COMPONENT FEMORAL 8 TOT STABILIZE TRIATHLON COCR KNEE LEFT,"$13,967.50",$0.00,"$13,967.50","$6,285.38","$5,158.80",$0.00,"$2,406.53",$0.00,$0.00,"$2,445.60","$13,967.50",$0.00,"$6,983.75","$11,062.26","$11,174.00",$0.00,"$2,185.91",$0.00,"$2,223.63",$0.00
5512-F-802,SUP,HCPCS C1776,,5512-F-802  -  COMPONENT FEMORAL 8 TOT STABILIZE TRIATHLON COCR KNEE RIGHT,"$13,967.50",$0.00,"$13,967.50","$6,285.38","$5,158.80",$0.00,"$2,406.53",$0.00,$0.00,"$2,445.60","$13,967.50",$0.00,"$6,983.75","$11,062.26","$11,174.00",$0.00,"$2,185.91",$0.00,"$2,223.63",$0.00
5513-F-101,SUP,HCPCS C1776,,5513-F-101  -  COMPONENT FEMORAL 1 CRUCIATE RETAIN BEAD TRIATHLON KNEE LEFT,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
5513-F-102,SUP,HCPCS C1776,,5513-F-102  -  COMPONENT FEMORAL 1 CRUCIATE RETAIN BEAD TRIATHLON KNEE,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
5513-F-201,SUP,HCPCS C1776,,5513-F-201  -  COMPONENT FEMORAL 2 CRUCIATE RETAIN BEAD TRIATHLON KNEE LEFT,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
5513-F-202,SUP,HCPCS C1776,,5513-F-202  -  COMPONENT FEMORAL 2 CRUCIATE RETAIN BEAD TRIATHLON KNEE,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
5513-F-301,SUP,HCPCS C1776,,5513-F-301  -  COMPONENT FEMORAL 3 CRUCIATE RETAIN BEAD TRIATHLON KNEE LEFT,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
5513-F-302,SUP,HCPCS C1776,,5513-F-302  -  COMPONENT FEMORAL 3 CRUCIATE RETAIN BEAD TRIATHLON KNEE,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
5513-F-401,SUP,HCPCS C1776,,5513-F-401  -  COMPONENT FEMORAL 4 CRUCIATE RETAIN BEAD TRIATHLON KNEE LEFT,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
5513-F-402,SUP,HCPCS C1776,,5513-F-402  -  COMPONENT FEMORAL 4 CRUCIATE RETAIN BEAD TRIATHLON KNEE,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
5513-F-501,SUP,HCPCS C1776,,5513-F-501  -  COMPONENT FEMORAL 5 CRUCIATE RETAIN BEAD TRIATHLON KNEE LEFT,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
5513-F-502,SUP,HCPCS C1776,,5513-F-502  -  COMPONENT FEMORAL 5 CRUCIATE RETAIN BEAD TRIATHLON KNEE,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
5513-F-601,SUP,HCPCS C1776,,5513-F-601  -  COMPONENT FEMORAL 6 CRUCIATE RETAIN BEAD TRIATHLON KNEE LEFT,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
5513-F-602,SUP,HCPCS C1776,,5513-F-602  -  COMPONENT FEMORAL 6 CRUCIATE RETAIN BEAD TRIATHLON KNEE,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
5513-F-701,SUP,HCPCS C1776,,5513-F-701  -  COMPONENT FEMORAL 7 CRUCIATE RETAIN BEAD TRIATHLON KNEE LEFT,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
5513-F-702,SUP,HCPCS C1776,,5513-F-702  -  COMPONENT FEMORAL 7 CRUCIATE RETAIN BEAD TRIATHLON KNEE,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
5513-F-801,SUP,HCPCS C1776,,5513-F-801  -  COMPONENT FEMORAL 8 CRUCIATE RETAIN BEAD TRIATHLON KNEE LEFT,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
5513-F-802,SUP,HCPCS C1776,,5513-F-802  -  COMPONENT FEMORAL 8 CRUCIATE RETAIN BEAD TRIATHLON KNEE,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
5514-F-101,SUP,HCPCS C1776,,5514-F-101  -  COMPONENT FEMORAL 1 POSTERIOR STABILIZE BEAD TRIATHLON KNEE,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
5514-F-102,SUP,HCPCS C1776,,5514-F-102  -  COMPONENT FEMORAL 1 POSTERIOR STABILIZE BEAD TRIATHLON KNEE,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
5514-F-201,SUP,HCPCS C1776,,5514-F-201  -  COMPONENT FEMORAL 2 POSTERIOR STABILIZE BEAD TRIATHLON KNEE,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
5514-F-202,SUP,HCPCS C1776,,5514-F-202  -  COMPONENT FEMORAL 2 POSTERIOR STABILIZE BEAD TRIATHLON KNEE,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
5514-F-301,SUP,HCPCS C1776,,5514-F-301  -  COMPONENT FEMORAL 3 POSTERIOR STABILIZE BEAD TRIATHLON KNEE,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
5514-F-302,SUP,HCPCS C1776,,5514-F-302  -  COMPONENT FEMORAL 3 POSTERIOR STABILIZE BEAD TRIATHLON KNEE,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
5514-F-401,SUP,HCPCS C1776,,5514-F-401  -  COMPONENT FEMORAL 4 POSTERIOR STABILIZE BEAD TRIATHLON KNEE,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
5514-F-402,SUP,HCPCS C1776,,5514-F-402  -  COMPONENT FEMORAL 4 POSTERIOR STABILIZE BEAD TRIATHLON KNEE,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
5514-F-501,SUP,HCPCS C1776,,5514-F-501  -  COMPONENT FEMORAL 5 POSTERIOR STABILIZE BEAD TRIATHLON KNEE,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
5514-F-502,SUP,HCPCS C1776,,5514-F-502  -  COMPONENT FEMORAL 5 POSTERIOR STABILIZE BEAD TRIATHLON KNEE,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
5514-F-601,SUP,HCPCS C1776,,5514-F-601  -  COMPONENT FEMORAL 6 POSTERIOR STABILIZE BEAD TRIATHLON KNEE,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
5514-F-602,SUP,HCPCS C1776,,5514-F-602  -  COMPONENT FEMORAL 6 POSTERIOR STABILIZE BEAD TRIATHLON KNEE,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
5514-F-701,SUP,HCPCS C1776,,5514-F-701  -  COMPONENT FEMORAL 7 POSTERIOR STABILIZE BEAD TRIATHLON KNEE,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
5514-F-702,SUP,HCPCS C1776,,5514-F-702  -  COMPONENT FEMORAL 7 POSTERIOR STABILIZE BEAD TRIATHLON KNEE,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
5514-F-801,SUP,HCPCS C1776,,5514-F-801  -  COMPONENT FEMORAL 8 POSTERIOR STABILIZE BEAD TRIATHLON KNEE,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
5514-F-802,SUP,HCPCS C1776,,5514-F-802  -  COMPONENT FEMORAL 8 POSTERIOR STABILIZE BEAD TRIATHLON KNEE,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
55-15504,SUP,HCPCS C1713,,55-15504  -  PLATE BONE STR MINI 1.5MM 4 HOLE TITANIUM MAXFACL 2.3MM,"$1,600.00",$0.00,"$1,600.00",$720.00,"$1,141.92",$0.00,$275.67,$0.00,$0.00,$280.15,"$1,600.00",$0.00,$800.00,"$1,267.20","$1,280.00",$0.00,$250.40,$0.00,$254.72,$0.00
55-15505,SUP,HCPCS C1713,,55-15505  -  PLATE BONE 4 HOLE BAR LOCKING TITANIUM MAXFACL,"$1,610.00",$0.00,"$1,610.00",$724.50,"$1,149.06",$0.00,$277.39,$0.00,$0.00,$281.90,"$1,610.00",$0.00,$805.00,"$1,275.12","$1,288.00",$0.00,$251.97,$0.00,$256.31,$0.00
55-15506,SUP,HCPCS C1713,,55-15506  -  PLATE BONE 6 HOLE LOCKING TITANIUM MANDIB 2 MM SCREW,"$1,887.50",$0.00,"$1,887.50",$849.38,"$1,347.11",$0.00,$325.21,$0.00,$0.00,$330.49,"$1,887.50",$0.00,$943.75,"$1,494.90","$1,510.00",$0.00,$295.39,$0.00,$300.49,$0.00
55-15507,SUP,HCPCS C1713,,55-15507  -  PLATE BONE 6 HOLE BAR TITANIUM MANDIB 2.3/2.7 MM SCREW,"$2,045.00",$0.00,"$2,045.00",$920.25,"$1,459.52",$0.00,$352.34,$0.00,$0.00,$358.06,"$2,045.00",$0.00,"$1,022.50","$1,619.64","$1,636.00",$0.00,$320.04,$0.00,$325.56,$0.00
55-15514,SUP,HCPCS C1713,,55-15514  -  PLATE BONE 14 HOLE LOCKING TITANIUM MAXFACL 2.3/2.7 MM SCREW,"$3,010.00",$0.00,"$3,010.00","$1,354.50","$2,148.24",$0.00,$518.61,$0.00,$0.00,$527.03,"$3,010.00",$0.00,"$1,505.00","$2,383.92","$2,408.00",$0.00,$471.07,$0.00,$479.19,$0.00
55-15524,SUP,HCPCS C1713,,55-15524  -  PLATE BONE 4 HOLE TITANIUM MAXFACL,"$1,710.00",$0.00,"$1,710.00",$769.50,"$1,220.43",$0.00,$294.62,$0.00,$0.00,$299.41,"$1,710.00",$0.00,$855.00,"$1,354.32","$1,368.00",$0.00,$267.62,$0.00,$272.23,$0.00
55-15526,SUP,HCPCS C1713,,55-15526  -  PLATE BONE 115D 1.5MM 4 HOLE ANGLED TITANIUM MANDIB 2MM,"$2,840.00",$0.00,"$2,840.00","$1,278.00","$2,026.91",$0.00,$489.32,$0.00,$0.00,$497.26,"$2,840.00",$0.00,"$1,420.00","$2,249.28","$2,272.00",$0.00,$444.46,$0.00,$452.13,$0.00
55-15536,SUP,HCPCS C1713,,55-15536  -  PLATE BN 140D 1.5MM NS LEIBINGER UNV 2 6 HL BAR TI MNDB,"$2,820.00",$0.00,"$2,820.00","$1,269.00","$2,012.63",$0.00,$485.87,$0.00,$0.00,$493.76,"$2,820.00",$0.00,"$1,410.00","$2,233.44","$2,256.00",$0.00,$441.33,$0.00,$448.94,$0.00
55-15570,SUP,HCPCS C1713,,55-15570  -  PLATE BONE UNIVERSAL 1.5MM 4 HOLE COMPRESSION TITANIUM,"$1,325.00",$0.00,"$1,325.00",$596.25,$945.65,$0.00,$228.29,$0.00,$0.00,$232.00,"$1,325.00",$0.00,$662.50,"$1,049.40","$1,060.00",$0.00,$207.36,$0.00,$210.94,$0.00
55-15575,SUP,HCPCS C1713,,55-15575  -  PLATE BONE 4 HOLE COMPRESSION TITANIUM MANDIB 2.3 MM SCREWS,"$1,325.00",$0.00,"$1,325.00",$596.25,$945.65,$0.00,$228.29,$0.00,$0.00,$232.00,"$1,325.00",$0.00,$662.50,"$1,049.40","$1,060.00",$0.00,$207.36,$0.00,$210.94,$0.00
55-15580,SUP,HCPCS C1713,,55-15580  -  PLATE BONE STR 6 HOLE COMPRESSION TITANIUM MAXFACL 2MM SCREW,"$1,990.00",$0.00,"$1,990.00",$895.50,"$1,420.26",$0.00,$342.87,$0.00,$0.00,$348.43,"$1,990.00",$0.00,$995.00,"$1,576.08","$1,592.00",$0.00,$311.44,$0.00,$316.81,$0.00
55-15585,SUP,HCPCS C1713,,55-15585  -  PLATE BONE 6 HOLE COMPRESSION TITANIUM MANDIB 2.3 MM SCREWS,"$1,990.00",$0.00,"$1,990.00",$895.50,"$1,420.26",$0.00,$342.87,$0.00,$0.00,$348.43,"$1,990.00",$0.00,$995.00,"$1,576.08","$1,592.00",$0.00,$311.44,$0.00,$316.81,$0.00
55-15911,SUP,HCPCS C1713,,55-15911  -  PLATE BONE STR 11 HOLE PRIM RECONSTRUCTION TITANIUM MANDIB,"$3,082.50",$0.00,"$3,082.50","$1,387.13","$2,199.98",$0.00,$531.10,$0.00,$0.00,$539.72,"$3,082.50",$0.00,"$1,541.25","$2,441.34","$2,466.00",$0.00,$482.41,$0.00,$490.73,$0.00
55-15917,SUP,HCPCS C1713,,55-15917  -  PLATE BONE STR 17 HOLE PRIM RECONSTRUCTION TEMPLATE TITANIUM,"$3,912.50",$0.00,"$3,912.50","$1,760.63","$2,792.35",$0.00,$674.10,$0.00,$0.00,$685.05,"$3,912.50",$0.00,"$1,956.25","$3,098.70","$3,130.00",$0.00,$612.31,$0.00,$622.87,$0.00
55-15920,SUP,HCPCS C1713,,55-15920  -  PLATE BN HMSPHR 1.5MM AU SMRT LCK LEIBINGER UNV 2 5X17 HL TI,"$5,305.00",$0.00,"$5,305.00","$2,387.25","$3,786.18",$0.00,$914.02,$0.00,$0.00,$928.86,"$5,305.00",$0.00,"$2,652.50","$4,201.56","$4,244.00",$0.00,$830.23,$0.00,$844.56,$0.00
55-15922,SUP,HCPCS C1713,,55-15922  -  PLATE BN HMSPHR 1.5MM SMRT LCK LEIBINGER UNV 2 5X17 HL TI,"$5,305.00",$0.00,"$5,305.00","$2,387.25","$3,786.18",$0.00,$914.02,$0.00,$0.00,$928.86,"$5,305.00",$0.00,"$2,652.50","$4,201.56","$4,244.00",$0.00,$830.23,$0.00,$844.56,$0.00
5515-F-101,SUP,HCPCS C1776,,5515-F-101  -  COMPONENT FEMORAL 1 CEMENTED POSTERIOR STABILIZE TRIATHLON,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5515-F-102,SUP,HCPCS C1776,,5515-F-102  -  COMPONENT FEMORAL 1 CEMENTED POSTERIOR STABILIZE TRIATHLON,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5515-F-201,SUP,HCPCS C1776,,5515-F-201  -  COMPONENT FEMORAL 2 CEMENTED POSTERIOR STABILIZE TRIATHLON,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5515-F-202,SUP,HCPCS C1776,,5515-F-202  -  COMPONENT FEMORAL 2 CEMENTED POSTERIOR STABILIZE TRIATHLON,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5515-F-301,SUP,HCPCS C1776,,5515-F-301  -  COMPONENT FEMORAL 3 CEMENTED POSTERIOR STABILIZE TRIATHLON,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5515-F-302,SUP,HCPCS C1776,,5515-F-302  -  COMPONENT FEMORAL 3 CEMENTED POSTERIOR STABILIZE TRIATHLON,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5515-F-401,SUP,HCPCS C1776,,5515-F-401  -  COMPONENT FEMORAL 4 CEMENTED POSTERIOR STABILIZE TRIATHLON,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5515-F-402,SUP,HCPCS C1776,,5515-F-402  -  COMPONENT FEMORAL 4 CEMENTED POSTERIOR STABILIZE TRIATHLON,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5515-F-501,SUP,HCPCS C1776,,5515-F-501  -  COMPONENT FEMORAL 5 CEMENTED POSTERIOR STABILIZE TRIATHLON,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5515-F-502,SUP,HCPCS C1776,,5515-F-502  -  COMPONENT FEMORAL 5 CEMENTED POSTERIOR STABILIZE TRIATHLON,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5515-F-601,SUP,HCPCS C1776,,5515-F-601  -  COMPONENT FEMORAL 6 CEMENTED POSTERIOR STABILIZE TRIATHLON,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5515-F-602,SUP,HCPCS C1776,,5515-F-602  -  COMPONENT FEMORAL 6 CEMENTED POSTERIOR STABILIZE TRIATHLON,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5515-F-701,SUP,HCPCS C1776,,5515-F-701  -  COMPONENT FEMORAL 7 CEMENTED POSTERIOR STABILIZE TRIATHLON,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5515-F-702,SUP,HCPCS C1776,,5515-F-702  -  COMPONENT FEMORAL 7 CEMENTED POSTERIOR STABILIZE TRIATHLON,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5515-F-801,SUP,HCPCS C1776,,5515-F-801  -  COMPONENT FEMORAL 8 CEMENTED POSTERIOR STABILIZE TRIATHLON,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5515-F-802,SUP,HCPCS C1776,,5515-F-802  -  COMPONENT FEMORAL 8 CEMENTED POSTERIOR STABILIZE TRIATHLON,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5516-F-101,SUP,HCPCS C1776,,5516-F-101  -  COMPONENT FEMORAL 1 POSTERIOR STABILIZE BEAD TRIATHLON PA,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
5516-F-102,SUP,HCPCS C1776,,5516-F-102  -  COMPONENT FEMORAL 1 POSTERIOR STABILIZE BEAD TRIATHLON PA,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
5516-F-201,SUP,HCPCS C1776,,5516-F-201  -  COMPONENT FEMORAL 2 POSTERIOR STABILIZE BEAD TRIATHLON PA,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
5516-F-202,SUP,HCPCS C1776,,5516-F-202  -  COMPONENT FEMORAL 2 POSTERIOR STABILIZE BEAD TRIATHLON PA,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
5516-F-301,SUP,HCPCS C1776,,5516-F-301  -  COMPONENT FEMORAL 3 POSTERIOR STABILIZE BEAD TRIATHLON PA,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
5516-F-302,SUP,HCPCS C1776,,5516-F-302  -  COMPONENT FEMORAL 3 POSTERIOR STABILIZE BEAD TRIATHLON PA,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
5516-F-401,SUP,HCPCS C1776,,5516-F-401  -  COMPONENT FEMORAL 4 POSTERIOR STABILIZE BEAD TRIATHLON PA,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
5516-F-402,SUP,HCPCS C1776,,5516-F-402  -  COMPONENT FEMORAL 4 POSTERIOR STABILIZE BEAD TRIATHLON PA,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
5516-F-501,SUP,HCPCS C1776,,5516-F-501  -  COMPONENT FEMORAL 5 POSTERIOR STABILIZE BEAD TRIATHLON PA,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
5516-F-502,SUP,HCPCS C1776,,5516-F-502  -  COMPONENT FEMORAL 5 POSTERIOR STABILIZE BEAD TRIATHLON PA,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
5516-F-601,SUP,HCPCS C1776,,5516-F-601  -  COMPONENT FEMORAL 6 POSTERIOR STABILIZE BEAD TRIATHLON PA,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
5516-F-602,SUP,HCPCS C1776,,5516-F-602  -  COMPONENT FEMORAL 6 POSTERIOR STABILIZE BEAD TRIATHLON PA,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
5516-F-701,SUP,HCPCS C1776,,5516-F-701  -  COMPONENT FEMORAL 7 POSTERIOR STABILIZE BEAD TRIATHLON PA,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
5516-F-702,SUP,HCPCS C1776,,5516-F-702  -  COMPONENT FEMORAL 7 POSTERIOR STABILIZE BEAD TRIATHLON PA,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
5516-F-801,SUP,HCPCS C1776,,5516-F-801  -  COMPONENT FEMORAL 8 POSTERIOR STABILIZE BEAD TRIATHLON PA,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
5516-F-802,SUP,HCPCS C1776,,5516-F-802  -  COMPONENT FEMORAL 8 POSTERIOR STABILIZE BEAD TRIATHLON PA,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
5517-F-101,SUP,HCPCS C1776,,5517-F-101  -  COMPONENT FEMORAL 1 CRUCIATE RETAIN BEAD TRIATHLON PA KNEE,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
5517-F-102,SUP,HCPCS C1776,,5517-F-102  -  COMPONENT FEMORAL 1 CRUCIATE RETAIN BEAD TRIATHLON PA KNEE,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
5517-F-201,SUP,HCPCS C1776,,5517-F-201  -  COMPONENT FEMORAL 2 CRUCIATE RETAIN BEAD TRIATHLON PA KNEE,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
5517-F-202,SUP,HCPCS C1776,,5517-F-202  -  COMPONENT FEMORAL 2 CRUCIATE RETAIN BEAD TRIATHLON PA KNEE,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
5517-F-301,SUP,HCPCS C1776,,5517-F-301  -  COMPONENT FEMORAL 3 CRUCIATE RETAIN BEAD TRIATHLON PA KNEE,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
5517-F-302,SUP,HCPCS C1776,,5517-F-302  -  COMPONENT FEMORAL 3 CRUCIATE RETAIN BEAD TRIATHLON PA KNEE,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
5517-F-401,SUP,HCPCS C1776,,5517-F-401  -  COMPONENT FEMORAL 4 CRUCIATE RETAIN BEAD TRIATHLON PA KNEE,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
5517-F-402,SUP,HCPCS C1776,,5517-F-402  -  COMPONENT FEMORAL 4 CRUCIATE RETAIN BEAD TRIATHLON PA KNEE,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
5517-F-501,SUP,HCPCS C1776,,5517-F-501  -  COMPONENT FEMORAL 5 CRUCIATE RETAIN BEAD TRIATHLON PA KNEE,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
5517-F-502,SUP,HCPCS C1776,,5517-F-502  -  COMPONENT FEMORAL 5 CRUCIATE RETAIN BEAD TRIATHLON PA KNEE,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
5517-F-601,SUP,HCPCS C1776,,5517-F-601  -  COMPONENT FEMORAL 6 CRUCIATE RETAIN BEAD TRIATHLON PA KNEE,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
5517-F-602,SUP,HCPCS C1776,,5517-F-602  -  COMPONENT FEMORAL 6 CRUCIATE RETAIN BEAD TRIATHLON PA KNEE,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
5517-F-701,SUP,HCPCS C1776,,5517-F-701  -  COMPONENT FEMORAL 7 CRUCIATE RETAIN BEAD TRIATHLON PA KNEE,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
5517-F-702,SUP,HCPCS C1776,,5517-F-702  -  COMPONENT FEMORAL 7 CRUCIATE RETAIN BEAD TRIATHLON PA KNEE,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
5517-F-801,SUP,HCPCS C1776,,5517-F-801  -  COMPONENT FEMORAL 8 CRUCIATE RETAIN BEAD TRIATHLON PA KNEE,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
5517-F-802,SUP,HCPCS C1776,,5517-F-802  -  COMPONENT FEMORAL 8 CRUCIATE RETAIN BEAD TRIATHLON PA KNEE,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
5520-B-100,SUP,HCPCS C1776,,5520-B-100  -  BASEPLATE TIBIAL 1 PRIM CEMENT TRIATHLON KNEE,"$2,330.00",$0.00,"$2,330.00","$1,048.50","$1,662.92",$0.00,$401.45,$0.00,$0.00,$407.96,"$2,330.00",$0.00,"$1,165.00","$1,845.36","$1,864.00",$0.00,$364.65,$0.00,$370.94,$0.00
5520-B-200,SUP,HCPCS C1776,,5520-B-200  -  BASEPLATE TIBIAL 2 PRIM CEMENT TRIATHLON KNEE,"$2,330.00",$0.00,"$2,330.00","$1,048.50","$1,662.92",$0.00,$401.45,$0.00,$0.00,$407.96,"$2,330.00",$0.00,"$1,165.00","$1,845.36","$1,864.00",$0.00,$364.65,$0.00,$370.94,$0.00
5520-B-300,SUP,HCPCS C1776,,5520-B-300  -  BASEPLATE TIB 3 TRTHLN PRM CMNT KN,"$2,330.00",$0.00,"$2,330.00","$1,048.50","$1,662.92",$0.00,$401.45,$0.00,$0.00,$407.96,"$2,330.00",$0.00,"$1,165.00","$1,845.36","$1,864.00",$0.00,$364.65,$0.00,$370.94,$0.00
5520-B-400,SUP,HCPCS C1776,,5520-B-400  -  BASEPLATE TIBIAL 4 PRIM CEMENT TRIATHLON KNEE,"$2,330.00",$0.00,"$2,330.00","$1,048.50","$1,662.92",$0.00,$401.45,$0.00,$0.00,$407.96,"$2,330.00",$0.00,"$1,165.00","$1,845.36","$1,864.00",$0.00,$364.65,$0.00,$370.94,$0.00
5520-B-500,SUP,HCPCS C1776,,5520-B-500  -  BASEPLATE TIBIAL 5 PRIM CEMENT TRIATHLON KNEE,"$2,330.00",$0.00,"$2,330.00","$1,048.50","$1,662.92",$0.00,$401.45,$0.00,$0.00,$407.96,"$2,330.00",$0.00,"$1,165.00","$1,845.36","$1,864.00",$0.00,$364.65,$0.00,$370.94,$0.00
5520-B-600,SUP,HCPCS C1776,,5520-B-600  -  BASEPLATE TIBIAL 6 PRIM CEMENT TRIATHLON KNEE,"$2,330.00",$0.00,"$2,330.00","$1,048.50","$1,662.92",$0.00,$401.45,$0.00,$0.00,$407.96,"$2,330.00",$0.00,"$1,165.00","$1,845.36","$1,864.00",$0.00,$364.65,$0.00,$370.94,$0.00
5520-B-700,SUP,HCPCS C1776,,5520-B-700  -  BASEPLATE TIBIAL 7 PRIM CEMENT TRIATHLON KNEE,"$2,330.00",$0.00,"$2,330.00","$1,048.50","$1,662.92",$0.00,$401.45,$0.00,$0.00,$407.96,"$2,330.00",$0.00,"$1,165.00","$1,845.36","$1,864.00",$0.00,$364.65,$0.00,$370.94,$0.00
5520-B-800,SUP,HCPCS C1776,,5520-B-800  -  BASEPLATE TIBIAL 8 PRIM CEMENT TRIATHLON KNEE,"$2,330.00",$0.00,"$2,330.00","$1,048.50","$1,662.92",$0.00,$401.45,$0.00,$0.00,$407.96,"$2,330.00",$0.00,"$1,165.00","$1,845.36","$1,864.00",$0.00,$364.65,$0.00,$370.94,$0.00
5520-M-100,SUP,HCPCS C1776,,5520-M-100  -  BASEPLATE TIBIAL 1 LP TRIATHLON KNEE,"$2,330.00",$0.00,"$2,330.00","$1,048.50","$1,662.92",$0.00,$401.45,$0.00,$0.00,$407.96,"$2,330.00",$0.00,"$1,165.00","$1,845.36","$1,864.00",$0.00,$364.65,$0.00,$370.94,$0.00
5520-M-200,SUP,HCPCS C1776,,5520-M-200  -  BASEPLATE TIBIAL 2 LP TRIATHLON KNEE,"$2,330.00",$0.00,"$2,330.00","$1,048.50","$1,662.92",$0.00,$401.45,$0.00,$0.00,$407.96,"$2,330.00",$0.00,"$1,165.00","$1,845.36","$1,864.00",$0.00,$364.65,$0.00,$370.94,$0.00
5520-M-300,SUP,HCPCS C1776,,5520-M-300  -  BASEPLATE TIBIAL 3 LP TRIATHLON KNEE,"$2,330.00",$0.00,"$2,330.00","$1,048.50","$1,662.92",$0.00,$401.45,$0.00,$0.00,$407.96,"$2,330.00",$0.00,"$1,165.00","$1,845.36","$1,864.00",$0.00,$364.65,$0.00,$370.94,$0.00
5520-M-400,SUP,HCPCS C1776,,5520-M-400  -  BASEPLATE TIBIAL 4 LP TRIATHLON KNEE,"$2,330.00",$0.00,"$2,330.00","$1,048.50","$1,662.92",$0.00,$401.45,$0.00,$0.00,$407.96,"$2,330.00",$0.00,"$1,165.00","$1,845.36","$1,864.00",$0.00,$364.65,$0.00,$370.94,$0.00
5520-M-500,SUP,HCPCS C1776,,5520-M-500  -  BASEPLATE TIBIAL 5 LP TRIATHLON KNEE,"$2,330.00",$0.00,"$2,330.00","$1,048.50","$1,662.92",$0.00,$401.45,$0.00,$0.00,$407.96,"$2,330.00",$0.00,"$1,165.00","$1,845.36","$1,864.00",$0.00,$364.65,$0.00,$370.94,$0.00
5520-M-600,SUP,HCPCS C1776,,5520-M-600  -  BASEPLATE TIBIAL 6 LP TRIATHLON KNEE,"$2,330.00",$0.00,"$2,330.00","$1,048.50","$1,662.92",$0.00,$401.45,$0.00,$0.00,$407.96,"$2,330.00",$0.00,"$1,165.00","$1,845.36","$1,864.00",$0.00,$364.65,$0.00,$370.94,$0.00
5520-M-700,SUP,HCPCS C1776,,5520-M-700  -  BASEPLATE TIBIAL 7 LP TRIATHLON KNEE,"$2,330.00",$0.00,"$2,330.00","$1,048.50","$1,662.92",$0.00,$401.45,$0.00,$0.00,$407.96,"$2,330.00",$0.00,"$1,165.00","$1,845.36","$1,864.00",$0.00,$364.65,$0.00,$370.94,$0.00
5520-M-800,SUP,HCPCS C1776,,5520-M-800  -  BASEPLATE TIBIAL 8 LP TRIATHLON KNEE,"$2,330.00",$0.00,"$2,330.00","$1,048.50","$1,662.92",$0.00,$401.45,$0.00,$0.00,$407.96,"$2,330.00",$0.00,"$1,165.00","$1,845.36","$1,864.00",$0.00,$364.65,$0.00,$370.94,$0.00
5521-B-100,SUP,HCPCS C1776,,5521-B-100  -  BASEPLATE TIB 1 UNV TRTHLN COCR KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5521-B-200,SUP,HCPCS C1776,,5521-B-200  -  BASEPLATE TIB 2 UNV TRTHLN COCR KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5521-B-300,SUP,HCPCS C1776,,5521-B-300  -  BASEPLATE TIB 3 UNV TRTHLN COCR KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5521-B-400,SUP,HCPCS C1776,,5521-B-400  -  BASEPLATE TIB 4 UNV TRTHLN COCR KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5521-B-500,SUP,HCPCS C1776,,5521-B-500  -  BASEPLATE TIB 5 UNV TRTHLN COCR KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5521-B-600,SUP,HCPCS C1776,,5521-B-600  -  BASEPLATE TIB 6 UNV TRTHLN COCR KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5521-B-700,SUP,HCPCS C1776,,5521-B-700  -  BASEPLATE TIB 7 UNV TRTHLN COCR KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5521-B-800,SUP,HCPCS C1776,,5521-B-800  -  BASEPLATE TIB 8 UNV TRTHLN COCR KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5523-B-100,SUP,HCPCS C1776,,5523-B-100  -  BASEPLATE TIBIAL 1 PRIM BEADED TRIATHLON KNEE,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5523-B-200,SUP,HCPCS C1776,,5523-B-200  -  BASEPLATE TIBIAL 2 PRIM BEADED TRIATHLON KNEE,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5523-B-300,SUP,HCPCS C1776,,5523-B-300  -  BASEPLATE TIBIAL 3 PRIM BEADED TRIATHLON KNEE,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5523-B-400,SUP,HCPCS C1776,,5523-B-400  -  BASEPLATE TIBIAL 4 PRIM BEADED TRIATHLON KNEE,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5523-B-500,SUP,HCPCS C1776,,5523-B-500  -  BASEPLATE TIBIAL 5 PRIM BEADED TRIATHLON KNEE,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5523-B-600,SUP,HCPCS C1776,,5523-B-600  -  BASEPLATE TIBIAL 6 PRIM BEADED TRIATHLON KNEE,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5523-B-700,SUP,HCPCS C1776,,5523-B-700  -  BASEPLATE TIBIAL 7 PRIM BEADED TRIATHLON KNEE,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5523-B-800,SUP,HCPCS C1776,,5523-B-800  -  BASEPLATE TIBIAL 8 PRIM BEADED TRIATHLON KNEE,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5524-B-100,SUP,HCPCS C1776,,5524-B-100  -  BASEPLATE TIBIAL 1 CEMENTLESS TRIATHLON KNEE SCREW FIX,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5524-B-200,SUP,HCPCS C1776,,5524-B-200  -  BASEPLATE TIBIAL 2 CEMENTLESS TRIATHLON KNEE SCREW FIX,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5524-B-300,SUP,HCPCS C1776,,5524-B-300  -  BASEPLATE TIBIAL 3 BEAD TRIATHLON VITALLIUM KNEE,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5524-B-400,SUP,HCPCS C1776,,5524-B-400  -  BASEPLATE TIBIAL 4 CEMENTLESS TRIATHLON KNEE SCREW FIX,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5524-B-500,SUP,HCPCS C1776,,5524-B-500  -  BASEPLATE TIBIAL 5 CEMENTLESS TRIATHLON KNEE SCREW FIX,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5524-B-600,SUP,HCPCS C1776,,5524-B-600  -  BASEPLATE TIBIAL 6 CEMENTLESS TRIATHLON KNEE SCREW FIX,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5524-B-700,SUP,HCPCS C1776,,5524-B-700  -  BASEPLATE TIBIAL 7 CEMENTLESS TRIATHLON KNEE SCREW FIX,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5524-B-800,SUP,HCPCS C1776,,5524-B-800  -  BASEPLATE TIBIAL 8 CEMENTLESS TRIATHLON KNEE SCREW FIX,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5526-B-100,SUP,HCPCS C1776,,5526-B-100  -  BASEPLATE TIBIAL 1 PRIM BEADED TRIATHLON PERIAPT KNEE,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5526-B-200,SUP,HCPCS C1776,,5526-B-200  -  BASEPLATE TIBIAL 2 PRIM BEADED TRIATHLON PERIAPT KNEE,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5526-B-300,SUP,HCPCS C1776,,5526-B-300  -  BASEPLATE TIBIAL 3 PRIM BEADED TRIATHLON PERIAPT KNEE,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5526-B-400,SUP,HCPCS C1776,,5526-B-400  -  BASEPLATE TIBIAL 4 PRIM BEADED TRIATHLON PERIAPT KNEE,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5526-B-500,SUP,HCPCS C1776,,5526-B-500  -  BASEPLATE TIBIAL 5 PRIM BEADED TRIATHLON PERIAPT KNEE,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5526-B-600,SUP,HCPCS C1776,,5526-B-600  -  BASEPLATE TIBIAL 6 PRIM BEADED TRIATHLON PERIAPT KNEE,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5526-B-700,SUP,HCPCS C1776,,5526-B-700  -  BASEPLATE TIBIAL 7 PRIM BEADED TRIATHLON PERIAPT KNEE,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5526-B-800,SUP,HCPCS C1776,,5526-B-800  -  BASEPLATE TIBIAL 8 PRIM BEADED TRIATHLON PERIAPT KNEE,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5527-B-100,SUP,HCPCS C1776,,5527-B-100  -  BASEPLATE TIBIAL 1 CEMENTLESS TRIATHLON PERIAPT KNEE SCREW,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5527-B-200,SUP,HCPCS C1776,,5527-B-200  -  BASEPLATE TIBIAL 2 CEMENTLESS TRIATHLON PERIAPT KNEE SCREW,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5527-B-300,SUP,HCPCS C1776,,5527-B-300  -  BASEPLATE TIBIAL 3 CEMENTLESS TRIATHLON PERIAPT KNEE SCREW,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5527-B-400,SUP,HCPCS C1776,,5527-B-400  -  BASEPLATE TIBIAL 4 CEMENTLESS TRIATHLON PERIAPT KNEE SCREW,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5527-B-500,SUP,HCPCS C1776,,5527-B-500  -  BASEPLATE TIBIAL 5 CEMENTLESS TRIATHLON PERIAPT KNEE SCREW,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5527-B-600,SUP,HCPCS C1776,,5527-B-600  -  BASEPLATE TIBIAL 6 CEMENTLESS TRIATHLON PERIAPT KNEE SCREW,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5527-B-700,SUP,HCPCS C1776,,5527-B-700  -  BASEPLATE TIBIAL 7 CEMENTLESS TRIATHLON PERIAPT KNEE SCREW,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5527-B-800,SUP,HCPCS C1776,,5527-B-800  -  BASEPLATE TIBIAL 8 CEMENTLESS TRIATHLON PERIAPT KNEE SCREW,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
55-28911,SUP,HCPCS C1713,,55-28911  -  PLATE BONE 11 HOLE RECONSTRUCTION TEMPLATE TITANIUM MAXFACL,"$3,630.00",$0.00,"$3,630.00","$1,633.50","$2,590.73",$0.00,$625.43,$0.00,$0.00,$635.58,"$3,630.00",$0.00,"$1,815.00","$2,874.96","$2,904.00",$0.00,$568.10,$0.00,$577.90,$0.00
55-28917,SUP,HCPCS C1713,,55-28917  -  PLATE BONE 17 HOLE RECONSTRUCTION TEMPLATE TITANIUM MAXFACL,"$5,395.00",$0.00,"$5,395.00","$2,427.75","$3,850.41",$0.00,$929.53,$0.00,$0.00,$944.62,"$5,395.00",$0.00,"$2,697.50","$4,272.84","$4,316.00",$0.00,$844.32,$0.00,$858.88,$0.00
55-28920,SUP,HCPCS C1713,,55-28920  -  PLATE BONE 6X17 HOLE RECONSTRUCTION HEMISPHERE TEMPLATE,"$5,907.50",$0.00,"$5,907.50","$2,658.38","$4,216.18",$0.00,"$1,017.83",$0.00,$0.00,"$1,034.36","$5,907.50",$0.00,"$2,953.75","$4,678.74","$4,726.00",$0.00,$924.52,$0.00,$940.47,$0.00
55-28922,SUP,HCPCS C1713,,55-28922  -  PLATE BONE 6X17 HOLE RECONSTRUCTION HEMISPHERE TEMPLATE,"$5,907.50",$0.00,"$5,907.50","$2,658.38","$4,216.18",$0.00,"$1,017.83",$0.00,$0.00,"$1,034.36","$5,907.50",$0.00,"$2,953.75","$4,678.74","$4,726.00",$0.00,$924.52,$0.00,$940.47,$0.00
55-28925,SUP,HCPCS C1713,,55-28925  -  PLATE BN HMSPHR 1.5MM SMRT LCK LEIBINGER UNV 2 6X17 HL TI,"$5,907.50",$0.00,"$5,907.50","$2,658.38","$4,216.18",$0.00,"$1,017.83",$0.00,$0.00,"$1,034.36","$5,907.50",$0.00,"$2,953.75","$4,678.74","$4,726.00",$0.00,$924.52,$0.00,$940.47,$0.00
55-28926,SUP,HCPCS C1713,,55-28926  -  PLATE BN HMSPHR 1.5MM SMRT LCK LEIBINGER UNV 2 6X17 HL TI,"$5,907.50",$0.00,"$5,907.50","$2,658.38","$4,216.18",$0.00,"$1,017.83",$0.00,$0.00,"$1,034.36","$5,907.50",$0.00,"$2,953.75","$4,678.74","$4,726.00",$0.00,$924.52,$0.00,$940.47,$0.00
55-28930,SUP,HCPCS C1713,,55-28930  -  PLATE BONE 6+17+6 HOLE FULL TITANIUM MANDIB,"$7,240.00",$0.00,"$7,240.00","$3,258.00","$5,158.80",$0.00,"$1,247.42",$0.00,$0.00,"$1,267.67","$7,240.00",$0.00,"$3,620.00","$5,734.08","$5,792.00",$0.00,"$1,133.06",$0.00,"$1,152.61",$0.00
55-28932,SUP,HCPCS C1713,,55-28932  -  PLATE BONE 6X15X6 HOLE FULL RECONSTRUCTION TEMPLATE TITANIUM,"$6,977.50",$0.00,"$6,977.50","$3,139.88","$4,979.84",$0.00,"$1,202.19",$0.00,$0.00,"$1,221.70","$6,977.50",$0.00,"$3,488.75","$5,526.18","$5,582.00",$0.00,"$1,091.98",$0.00,"$1,110.82",$0.00
55-28934,SUP,HCPCS C1713,,55-28934  -  PLATE BONE 6+13+6 HOLE SECONDARY RECONSTRUCTION FULL,"$6,372.50",$0.00,"$6,372.50","$2,867.63","$4,548.05",$0.00,"$1,097.95",$0.00,$0.00,"$1,115.77","$6,372.50",$0.00,"$3,186.25","$5,047.02","$5,098.00",$0.00,$997.30,$0.00,"$1,014.50",$0.00
5530-G-109,SUP,Custom 27803010,,5530-G-109  -  INSERT TIBIAL 1 9MM CRUC RET TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5530-G-109-E,SUP,HCPCS C1776,,5530-G-109-E  -  INSERT TIB 1 9MM STRL TRTHLN BRNG CRCTE RTN KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5530-G-110-E,SUP,HCPCS C1776,,5530-G-110-E  -  INSERT TIB 1 10MM STRL TRTHLN BRNG CRCTE RTN KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5530-G-111,SUP,Custom 27803010,,5530-G-111  -  INSERT TIBIAL 1 11MM CRUC RET TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5530-G-111-E,SUP,HCPCS C1776,,5530-G-111-E  -  INSERT TIB 1 11MM STRL TRTHLN BRNG CRCTE RTN KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5530-G-112-E,SUP,HCPCS C1776,,5530-G-112-E  -  INSERT TIB 1 12MM STRL TRTHLN BRNG CRCTE RTN KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5530-G-113,SUP,Custom 27803010,,5530-G-113  -  INSERT TIBIAL 1 13MM CRUC RET TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5530-G-113-E,SUP,HCPCS C1776,,5530-G-113-E  -  INSERT TIB 1 13MM STRL TRTHLN BRNG CRCTE RTN KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5530-G-114-E,SUP,HCPCS C1776,,5530-G-114-E  -  INSERT TIB 1 14MM STRL TRTHLN BRNG CRCTE RTN KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5530-G-116,SUP,Custom 27803010,,5530-G-116  -  INSERT TIBIAL 1 16MM CRUC RET TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5530-G-116-E,SUP,HCPCS C1776,,5530-G-116-E  -  INSERT TIB 1 16MM STRL TRTHLN BRNG CRCTE RTN KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5530-G-119,SUP,Custom 27803010,,5530-G-119  -  INSERT TIBIAL 1 19MM CRUC RET TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5530-G-119-E,SUP,HCPCS C1776,,5530-G-119-E  -  INSERT TIB 1 19MM STRL TRTHLN BRNG CRCTE RTN KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5530-G-209,SUP,Custom 27803010,,5530-G-209  -  INSERT TIBIAL 2 9MM CRUC RET TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5530-G-209-E,SUP,HCPCS C1776,,5530-G-209-E  -  INSERT TIB 2 9MM STRL TRTHLN BRNG CRCTE RTN CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5530-G-210-E,SUP,HCPCS C1776,,5530-G-210-E  -  INSERT TIB 2 10MM STRL TRTHLN BRNG CRCTE RTN KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5530-G-211,SUP,Custom 27803010,,5530-G-211  -  INSERT TIBIAL 2 11MM CRUC RET TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5530-G-211-E,SUP,HCPCS C1776,,5530-G-211-E  -  INSERT TIB 2 11MM STRL TRTHLN BRNG CRCTE RTN CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5530-G-212-E,SUP,HCPCS C1776,,5530-G-212-E  -  INSERT TIB 2 12MM STRL TRTHLN BRNG CRCTE RTN KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5530-G-213,SUP,Custom 27803010,,5530-G-213  -  INSERT TIBIAL 2 13MM CRUC RET TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5530-G-213-E,SUP,HCPCS C1776,,5530-G-213-E  -  INSERT TIB 2 13MM STRL TRTHLN BRNG CRCTE RTN CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5530-G-214-E,SUP,HCPCS C1776,,5530-G-214-E  -  INSERT TIB 2 14MM STRL TRTHLN BRNG CRCTE RTN KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5530-G-216,SUP,Custom 27803010,,5530-G-216  -  INSERT TIBIAL 2 16MM CRUC RET TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5530-G-216-E,SUP,HCPCS C1776,,5530-G-216-E  -  INSERT TIB 2 16MM STRL TRTHLN BRNG CRCTE RTN KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5530-G-219,SUP,Custom 27803010,,5530-G-219  -  INSERT TIBIAL 2 19MM CRUC RET TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5530-G-219-E,SUP,HCPCS C1776,,5530-G-219-E  -  INSERT TIB 2 19MM STRL TRTHLN BRNG CRCTE RTN KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5530-G-309,SUP,Custom 27803010,,5530-G-309  -  INSERT TIBIAL 3 9MM CRUC RET TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5530-G-309-E,SUP,HCPCS C1776,,5530-G-309-E  -  INSERT TIB 3 9MM STRL TRTHLN BRNG CRCTE RTN KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5530-G-310-E,SUP,HCPCS C1776,,5530-G-310-E  -  INSERT TIB 3 10MM STRL TRTHLN BRNG CRCTE RTN KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5530-G-311,SUP,Custom 27803010,,5530-G-311  -  INSERT TIBIAL 3 11MM CRUC RET TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5530-G-311-E,SUP,HCPCS C1776,,5530-G-311-E  -  INSERT TIB 3 11MM STRL TRTHLN BRNG CRCTE RTN KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5530-G-312-E,SUP,HCPCS C1776,,5530-G-312-E  -  INSERT TIB 3 12MM STRL TRTHLN BRNG CRCTE RTN KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5530-G-313,SUP,Custom 27803010,,5530-G-313  -  INSERT TIBIAL 3 13MM CRUCIATE RETAIN TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5530-G-313-E,SUP,HCPCS C1776,,5530-G-313-E  -  INSERT TIB 3 13MM STRL TRTHLN BRNG CRCTE RTN KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5530-G-314-E,SUP,HCPCS C1776,,5530-G-314-E  -  INSERT TIB 3 14MM STRL TRTHLN BRNG CRCTE RTN KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5530-G-316,SUP,Custom 27803010,,5530-G-316  -  INSERT TIBIAL 3 16MM CRUC RET TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5530-G-316-E,SUP,HCPCS C1776,,5530-G-316-E  -  INSERT TIB 3 16MM STRL TRTHLN BRNG CRCTE RTN KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5530-G-319,SUP,Custom 27803010,,5530-G-319  -  INSERT TIBIAL 3 19MM CRUC RET TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5530-G-319-E,SUP,HCPCS C1776,,5530-G-319-E  -  INSERT TIB 3 19MM STRL TRTHLN BRNG CRCTE RTN KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5530-G-409,SUP,Custom 27803010,,5530-G-409  -  INSERT TIBIAL 4 9MM CRUC RET TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5530-G-409-E,SUP,HCPCS C1776,,5530-G-409-E  -  INSERT TIB 4 9MM STRL TRTHLN BRNG CRCTE RTN KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5530-G-410-E,SUP,HCPCS C1776,,5530-G-410-E  -  INSERT TIB 4 10MM STRL TRTHLN BRNG CRCTE RTN KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5530-G-411,SUP,Custom 27803010,,5530-G-411  -  INSERT TIBIAL 4 11MM CRUC RET TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5530-G-411-E,SUP,HCPCS C1776,,5530-G-411-E  -  INSERT TIB 4 11MM STRL TRTHLN BRNG CRCTE RTN KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5530-G-412-E,SUP,HCPCS C1776,,5530-G-412-E  -  INSERT TIB 4 12MM STRL TRTHLN BRNG CRCTE RTN KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5530-G-413,SUP,Custom 27803010,,5530-G-413  -  INSERT TIBIAL 4 13MM CRUC RET TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5530-G-413-E,SUP,HCPCS C1776,,5530-G-413-E  -  INSERT TIB 4 13MM STRL TRTHLN BRNG CRCTE RTN KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5530-G-414-E,SUP,HCPCS C1776,,5530-G-414-E  -  INSERT TIB 4 14MM STRL TRTHLN BRNG CRCTE RTN KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5530-G-416,SUP,Custom 27803010,,5530-G-416  -  INSERT TIBIAL 4 16MM CRUC RET TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5530-G-416-E,SUP,HCPCS C1776,,5530-G-416-E  -  INSERT TIB 4 16MM STRL TRTHLN BRNG CRCTE RTN KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5530-G-419,SUP,Custom 27803010,,5530-G-419  -  INSERT TIBIAL 4 19MM CRUC RET TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5530-G-419-E,SUP,HCPCS C1776,,5530-G-419-E  -  INSERT TIB 4 19MM STRL TRTHLN BRNG CRCTE RTN KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5530-G-509,SUP,Custom 27803010,,5530-G-509  -  INSERT TIBIAL 5 9MM CRUC RET TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5530-G-509-E,SUP,HCPCS C1776,,5530-G-509-E  -  INSERT TIB 5 9MM STRL TRTHLN BRNG CRCTE RTN KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5530-G-510-E,SUP,HCPCS C1776,,5530-G-510-E  -  INSERT TIB 5 10MM STRL TRTHLN BRNG CRCTE RTN KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5530-G-511,SUP,Custom 27803010,,5530-G-511  -  INSERT TIBIAL 5 11MM CRUC RET TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5530-G-511-E,SUP,HCPCS C1776,,5530-G-511-E  -  INSERT TIB 5 11MM STRL TRTHLN BRNG CRCTE RTN KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5530-G-512-E,SUP,HCPCS C1776,,5530-G-512-E  -  INSERT TIB 5 12MM STRL TRTHLN BRNG CRCTE RTN KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5530-G-513,SUP,Custom 27803010,,5530-G-513  -  INSERT TIBIAL 5 13MM CRUC RET TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5530-G-513-E,SUP,HCPCS C1776,,5530-G-513-E  -  INSERT TIB 5 13MM STRL TRTHLN BRNG CRCTE RTN KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5530-G-514-E,SUP,HCPCS C1776,,5530-G-514-E  -  INSERT TIB 5 14MM STRL TRTHLN BRNG CRCTE RTN KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5530-G-516,SUP,Custom 27803010,,5530-G-516  -  INSERT TIBIAL 5 16MM CRUC RET TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5530-G-516-E,SUP,HCPCS C1776,,5530-G-516-E  -  INSERT TIB 5 16MM STRL TRTHLN BRNG CRCTE RTN KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5530-G-519,SUP,Custom 27803010,,5530-G-519  -  INSERT TIBIAL 5 19MM CRUC RET TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5530-G-519-E,SUP,HCPCS C1776,,5530-G-519-E  -  INSERT TIB 5 19MM STRL TRTHLN BRNG CRCTE RTN KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5530-G-609,SUP,Custom 27803010,,5530-G-609  -  INSERT TIBIAL 6 9MM CRUC RET TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5530-G-609-E,SUP,HCPCS C1776,,5530-G-609-E  -  INSERT TIB 6 9MM STRL TRTHLN BRNG CRCTE RTN KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5530-G-610-E,SUP,HCPCS C1776,,5530-G-610-E  -  INSERT TIB 6 10MM STRL TRTHLN BRNG CRCTE RTN KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5530-G-611,SUP,Custom 27803010,,5530-G-611  -  INSERT TIBIAL 6 11MM CRUC RET TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5530-G-611-E,SUP,HCPCS C1776,,5530-G-611-E  -  INSERT TIB 6 11MM STRL TRTHLN BRNG CRCTE RTN KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5530-G-612-E,SUP,HCPCS C1776,,5530-G-612-E  -  INSERT TIB 6 12MM STRL TRTHLN BRNG CRCTE RTN KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5530-G-613,SUP,Custom 27803010,,5530-G-613  -  INSERT TIBIAL 6 13MM CRUC RET TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5530-G-613-E,SUP,HCPCS C1776,,5530-G-613-E  -  INSERT TIB 6 13MM STRL TRTHLN BRNG CRCTE RTN KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5530-G-614-E,SUP,HCPCS C1776,,5530-G-614-E  -  INSERT TIB 6 14MM STRL TRTHLN BRNG CRCTE RTN KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5530-G-616,SUP,Custom 27803010,,5530-G-616  -  INSERT TIBIAL 6 16MM CRUC RET TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5530-G-616-E,SUP,HCPCS C1776,,5530-G-616-E  -  INSERT TIB 6 16MM STRL TRTHLN BRNG CRCTE RTN KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5530-G-619,SUP,Custom 27803010,,5530-G-619  -  INSERT TIBIAL 6 19MM CRUC RET TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5530-G-619-E,SUP,HCPCS C1776,,5530-G-619-E  -  INSERT TIB 6 19MM STRL TRTHLN BRNG CRCTE RTN KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5530-G-709,SUP,Custom 27803010,,5530-G-709  -  INSERT TIBIAL 7 9MM CRUC RET TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5530-G-709-E,SUP,HCPCS C1776,,5530-G-709-E  -  INSERT TIB 7 9MM STRL TRTHLN BRNG CRCTE RTN KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5530-G-710-E,SUP,HCPCS C1776,,5530-G-710-E  -  INSERT TIB 7 10MM STRL TRTHLN BRNG CRCTE RTN KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5530-G-711,SUP,Custom 27803010,,5530-G-711  -  INSERT TIBIAL 7 11MM CRUC RET TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5530-G-711-E,SUP,HCPCS C1776,,5530-G-711-E  -  INSERT TIB 7 11MM STRL TRTHLN BRNG CRCTE RTN KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5530-G-712-E,SUP,HCPCS C1776,,5530-G-712-E  -  INSERT TIB 7 12MM STRL TRTHLN BRNG CRCTE RTN KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5530-G-713,SUP,Custom 27803010,,5530-G-713  -  INSERT TIBIAL 7 13MM CRUC RET TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5530-G-713-E,SUP,HCPCS C1776,,5530-G-713-E  -  INSERT TIB 7 13MM STRL TRTHLN BRNG CRCTE RTN KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5530-G-714-E,SUP,HCPCS C1776,,5530-G-714-E  -  INSERT TIB 7 14MM STRL TRTHLN BRNG CRCTE RTN KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5530-G-716,SUP,Custom 27803010,,5530-G-716  -  INSERT TIBIAL 7 16MM CRUC RET TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5530-G-716-E,SUP,HCPCS C1776,,5530-G-716-E  -  INSERT TIB 7 16MM STRL TRTHLN BRNG CRCTE RTN KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5530-G-719,SUP,Custom 27803010,,5530-G-719  -  INSERT TIBIAL 7 19MM CRUC RET TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5530-G-719-E,SUP,HCPCS C1776,,5530-G-719-E  -  INSERT TIB 7 19MM STRL TRTHLN BRNG CRCTE RTN KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5530-G-809,SUP,Custom 27803010,,5530-G-809  -  INSERT TIBIAL 8 9MM CRUC RET TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5530-G-809-E,SUP,HCPCS C1776,,5530-G-809-E  -  INSERT TIB 8 9MM STRL TRTHLN BRNG CRCTE RTN KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5530-G-810-E,SUP,HCPCS C1776,,5530-G-810-E  -  INSERT TIB 8 10MM STRL TRTHLN BRNG CRCTE RTN KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5530-G-811,SUP,Custom 27803010,,5530-G-811  -  INSERT TIBIAL 8 11MM CRUC RET TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5530-G-811-E,SUP,HCPCS C1776,,5530-G-811-E  -  INSERT TIB 8 11MM STRL TRTHLN BRNG CRCTE RTN KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5530-G-812-E,SUP,HCPCS C1776,,5530-G-812-E  -  INSERT TIB 8 12MM STRL TRTHLN BRNG CRCTE RTN KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5530-G-813,SUP,Custom 27803010,,5530-G-813  -  INSERT TIBIAL 8 13MM CRUC RET TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5530-G-813-E,SUP,HCPCS C1776,,5530-G-813-E  -  INSERT TIB 8 13MM STRL TRTHLN BRNG CRCTE RTN KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5530-G-814-E,SUP,HCPCS C1776,,5530-G-814-E  -  INSERT TIB 8 14MM STRL TRTHLN BRNG CRCTE RTN KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5530-G-816,SUP,Custom 27803010,,5530-G-816  -  INSERT TIBIAL 8 16MM CRUC RET TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5530-G-816-E,SUP,HCPCS C1776,,5530-G-816-E  -  INSERT TIB 8 16MM STRL TRTHLN BRNG CRCTE RTN KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5530-G-819,SUP,Custom 27803010,,5530-G-819  -  INSERT TIBIAL 8 19MM CRUC RET TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5530-G-819-E,SUP,HCPCS C1776,,5530-G-819-E  -  INSERT TIB 8 19MM STRL TRTHLN BRNG CRCTE RTN KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5530-P-109,SUP,Custom 27803010,,5530-P-109  -  INSERT TIBIAL 1 9MM CRUC RET TRIATHLON KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5530-P-110,SUP,HCPCS C1776,,5530-P-110  -  INSERT TIB 1 10MM STRL TRTHLN BRNG CRCTE RTN KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5530-P-111,SUP,Custom 27803010,,5530-P-111  -  INSERT TIBIAL 1 11MM CRUC RET TRIATHLON KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5530-P-112,SUP,HCPCS C1776,,5530-P-112  -  INSERT TIB 1 12MM STRL TRTHLN BRNG CRCTE RTN KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5530-P-113,SUP,Custom 27803010,,5530-P-113  -  INSERT TIBIAL 1 13MM CRUC RET TRIATHLON KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5530-P-114,SUP,HCPCS C1776,,5530-P-114  -  INSERT TIB 1 14MM STRL TRTHLN BRNG CRCTE RTN KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5530-P-116,SUP,Custom 27803010,,5530-P-116  -  INSERT TIBIAL 1 P 16MM CRUC RET TRIATHLON X3 KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5530-P-119,SUP,Custom 27803010,,5530-P-119  -  INSERT TIBIAL 1 P 19MM CRUC RET TRIATHLON X3 KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5530-P-209,SUP,Custom 27803010,,5530-P-209  -  INSERT TIBIAL 2 9MM CRUC RET TRIATHLON X3 KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5530-P-210,SUP,HCPCS C1776,,5530-P-210  -  INSERT TIB 2 10MM STRL LF TRTHLN BRNG CRCTE RTN KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5530-P-211,SUP,Custom 27803010,,5530-P-211  -  INSERT TIBIAL 2 11MM CRUC RET TRIATHLON KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5530-P-212,SUP,HCPCS C1776,,5530-P-212  -  INSERT TIB 2 12MM STRL LF TRTHLN BRNG CRCTE RTN KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5530-P-213,SUP,Custom 27803010,,5530-P-213  -  INSERT TIBIAL 2 13MM CRUC RET TRIATHLON KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5530-P-214,SUP,HCPCS C1776,,5530-P-214  -  INSERT TIB 2 14MM STRL LF TRTHLN BRNG CRCTE RTN KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5530-P-216,SUP,Custom 27803010,,5530-P-216  -  INSERT TIBIAL 2 16MM CRUC RET TRIATHLON KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5530-P-219,SUP,Custom 27803010,,5530-P-219  -  INSERT TIBIAL 2 P 19MM CRUC RET TRIATHLON X3 KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5530-P-309,SUP,Custom 27803010,,5530-P-309  -  INSERT TIBIAL 3 9MM CRUC RET TRIATHLON X3 KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5530-P-310,SUP,HCPCS C1776,,5530-P-310  -  INSERT TIB 3 10MM STRL LF TRTHLN BRNG CRCTE RTN KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5530-P-311,SUP,Custom 27803010,,5530-P-311  -  INSERT TIBIAL 3 11MM CRUC RET TRIATHLON KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5530-P-312,SUP,HCPCS C1776,,5530-P-312  -  INSERT TIB 3 12MM STRL LF TRTHLN BRNG CRCTE RTN KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5530-P-313,SUP,Custom 27803010,,5530-P-313  -  INSERT TIBIAL 3 13MM CRUC RET TRIATHLON KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5530-P-314,SUP,HCPCS C1776,,5530-P-314  -  INSERT TIB 3 14MM STRL LF TRTHLN BRNG CRCTE RTN KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5530-P-316,SUP,Custom 27803010,,5530-P-316  -  INSERT TIBIAL 3 16MM CRUC RET TRIATHLON KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5530-P-319,SUP,Custom 27803010,,5530-P-319  -  INSERT TIBIAL 3 19MM CRUC RET TRIATHLON KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5530-P-409,SUP,Custom 27803010,,5530-P-409  -  INSERT TIBIAL 4 9MM CRUC RET TRIATHLON X3 KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5530-P-410,SUP,HCPCS C1776,,5530-P-410  -  INSERT TIB 4 10MM STRL LF TRTHLN BRNG CRCTE RTN KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5530-P-411,SUP,Custom 27803010,,5530-P-411  -  INSERT TIBIAL 4 11MM CRUC RET TRIATHLON KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5530-P-412,SUP,HCPCS C1776,,5530-P-412  -  INSERT TIB 4 12MM STRL LF TRTHLN BRNG CRCTE RTN KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5530-P-413,SUP,Custom 27803010,,5530-P-413  -  INSERT TIBIAL 4 13MM CRUC RET TRIATHLON KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5530-P-414,SUP,HCPCS C1776,,5530-P-414  -  INSERT TIB 4 14MM STRL LF TRTHLN BRNG CRCTE RTN KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5530-P-416,SUP,Custom 27803010,,5530-P-416  -  INSERT TIBIAL 4 16MM CRUC RET TRIATHLON X3 KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5530-P-419,SUP,Custom 27803010,,5530-P-419  -  INSERT TIBIAL 4 19MM CRUC RET TRIATHLON KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5530-P-509,SUP,Custom 27803010,,5530-P-509  -  INSERT TIBIAL 5 9MM CRUC RET TRIATHLON X3 KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5530-P-510,SUP,HCPCS C1776,,5530-P-510  -  INSERT TIB 5 10MM STRL LF TRTHLN BRNG CRCTE RTN KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5530-P-511,SUP,Custom 27803010,,5530-P-511  -  INSERT TIBIAL 5 11MM CRUC RET TRIATHLON KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5530-P-512,SUP,HCPCS C1776,,5530-P-512  -  INSERT TIB 5 12MM STRL LF TRTHLN BRNG CRCTE RTN KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5530-P-513,SUP,Custom 27803010,,5530-P-513  -  INSERT TIBIAL 5 13MM CRUC RET TRIATHLON KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5530-P-514,SUP,HCPCS C1776,,5530-P-514  -  INSERT TIB 5 14MM STRL LF TRTHLN BRNG CRCTE RTN KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5530-P-516,SUP,Custom 27803010,,5530-P-516  -  INSERT TIBIAL 5 16MM CRUCIATE RETAIN TRIATHLON KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5530-P-519,SUP,Custom 27803010,,5530-P-519  -  INSERT TIBIAL 5 19MM CRUC RET TRIATHLON KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5530-P-609,SUP,Custom 27803010,,5530-P-609  -  INSERT TIBIAL 6 9MM CRUC RET TRIATHLON X3 KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5530-P-610,SUP,HCPCS C1776,,5530-P-610  -  INSERT TIB 6 10MM STRL LF TRTHLN BRNG CRCTE RTN KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5530-P-611,SUP,Custom 27803010,,5530-P-611  -  INSERT TIBIAL 6 11MM CRUC RET TRIATHLON X3 KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5530-P-612,SUP,HCPCS C1776,,5530-P-612  -  INSERT TIB 6 12MM STRL LF TRTHLN BRNG CRCTE RTN KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5530-P-613,SUP,Custom 27803010,,5530-P-613  -  INSERT TIBIAL 6 13MM CRUC RET TRIATHLON KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5530-P-614,SUP,HCPCS C1776,,5530-P-614  -  INSERT TIB 6 14MM STRL LF TRTHLN BRNG CRCTE RTN KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5530-P-616,SUP,Custom 27803010,,5530-P-616  -  INSERT TIBIAL 6 16MM CRUC RET TRIATHLON KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5530-P-619,SUP,Custom 27803010,,5530-P-619  -  INSERT TIBIAL 6 19MM CRUC RET TRIATHLON KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5530-P-709,SUP,Custom 27803010,,5530-P-709  -  INSERT TIBIAL 7 9MM CRUC RET TRIATHLON KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5530-P-710,SUP,HCPCS C1776,,5530-P-710  -  INSERT TIB 7 10MM STRL LF TRTHLN BRNG CRCTE RTN KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5530-P-711,SUP,Custom 27803010,,5530-P-711  -  INSERT TIBIAL 7 11MM CRUC RET TRIATHLON KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5530-P-712,SUP,HCPCS C1776,,5530-P-712  -  INSERT TIB 7 12MM STRL LF TRTHLN BRNG CRCTE RTN KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5530-P-713,SUP,Custom 27803010,,5530-P-713  -  INSERT TIBIAL 7 13MM CRUCIATE RETAIN TRIATHLON KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5530-P-714,SUP,HCPCS C1776,,5530-P-714  -  INSERT TIB 7 14MM STRL LF TRTHLN BRNG CRCTE RTN KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5530-P-716,SUP,Custom 27803010,,5530-P-716  -  INSERT TIBIAL 7 16MM CRUCIATE RETAIN TRIATHLON KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5530-P-719,SUP,Custom 27803010,,5530-P-719  -  INSERT TIBIAL 7 19MM CRUC RET TRIATHLON KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5530-P-809,SUP,Custom 27803010,,5530-P-809  -  INSERT TIBIAL 8 9MM CRUC RET TRIATHLON KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5530-P-810,SUP,HCPCS C1776,,5530-P-810  -  INSERT TIB 8 10MM STRL LF TRTHLN BRNG CRCTE RTN KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5530-P-811,SUP,Custom 27803010,,5530-P-811  -  INSERT TIBIAL 8 11MM CRUC RET TRIATHLON KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5530-P-812,SUP,HCPCS C1776,,5530-P-812  -  INSERT TIB 8 12MM STRL LF TRTHLN BRNG CRCTE RTN KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5530-P-813,SUP,Custom 27803010,,5530-P-813  -  INSERT TIBIAL 8 13MM CRUC RET TRIATHLON KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5530-P-814,SUP,HCPCS C1776,,5530-P-814  -  INSERT TIB 8 14MM STRL LF TRTHLN BRNG CRCTE RTN KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5530-P-816,SUP,Custom 27803010,,5530-P-816  -  INSERT TIBIAL 8 16MM CRUC RET TRIATHLON KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5530-P-819,SUP,Custom 27803010,,5530-P-819  -  INSERT TIBIAL 8 19MM CRUC RET TRIATHLON KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5531-G-109,SUP,Custom 27803010,,5531-G-109  -  INSERT TIBIAL 1 9MM CNDYLR STABILIZED TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5531-G-109-E,SUP,HCPCS C1776,,5531-G-109-E  -  INSERT TIB 1 9MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-110-E,SUP,HCPCS C1776,,5531-G-110-E  -  INSERT TIB 1 10MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-111,SUP,Custom 27803010,,5531-G-111  -  INSERT TIBIAL 1 G 11MM TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5531-G-111-E,SUP,HCPCS C1776,,5531-G-111-E  -  INSERT TIB 1 11MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-112-E,SUP,HCPCS C1776,,5531-G-112-E  -  INSERT TIB 1 12MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-113,SUP,Custom 27803010,,5531-G-113  -  INSERT TIBIAL 1 13MM CNDYLR STABILIZED TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5531-G-113-E,SUP,HCPCS C1776,,5531-G-113-E  -  INSERT TIB 1 13MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-114-E,SUP,HCPCS C1776,,5531-G-114-E  -  INSERT TIB 1 14MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-116,SUP,Custom 27803010,,5531-G-116  -  INSERT TIBIAL 1 16MM CRUC SUB TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5531-G-116-E,SUP,HCPCS C1776,,5531-G-116-E  -  INSERT TIB 1 16MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-119,SUP,Custom 27803010,,5531-G-119  -  INSERT TIBIAL 1 19MM CRUC SUB TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5531-G-119-E,SUP,HCPCS C1776,,5531-G-119-E  -  INSERT TIB 1 19MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-122,SUP,Custom 27803010,,5531-G-122  -  INSERT TIBIAL 1 22MM CRUC SUB TRIATHLON X3,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5531-G-122-E,SUP,HCPCS C1776,,5531-G-122-E  -  INSERT TIB 1 22MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-125,SUP,Custom 27803010,,5531-G-125  -  INSERT TIBIAL 1 25MM CRUC SUB TRIATHLON X3,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5531-G-209,SUP,Custom 27803010,,5531-G-209  -  INSERT TIBIAL 2 9MM CNDYLR STABILIZED TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5531-G-209-E,SUP,HCPCS C1776,,5531-G-209-E  -  INSERT TIB 2 9MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-210-E,SUP,HCPCS C1776,,5531-G-210-E  -  INSERT TIB 2 10MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-211,SUP,Custom 27803010,,5531-G-211  -  INSERT TIBIAL 2 11MM CNDYLR STABILIZED TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5531-G-211-E,SUP,HCPCS C1776,,5531-G-211-E  -  INSERT TIB 2 11MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-212-E,SUP,HCPCS C1776,,5531-G-212-E  -  INSERT TIB 2 12MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-213,SUP,Custom 27803010,,5531-G-213  -  INSERT TIBIAL 2 13MM CNDYLR STABILIZED TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5531-G-213-E,SUP,HCPCS C1776,,5531-G-213-E  -  INSERT TIB 2 13MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-214-E,SUP,HCPCS C1776,,5531-G-214-E  -  INSERT TIB 2 14MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-216,SUP,Custom 27803010,,5531-G-216  -  INSERT TIBIAL 2 16MM CRUC SUB REVISION FLEXION TRIATHLON X3,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5531-G-216-E,SUP,HCPCS C1776,,5531-G-216-E  -  INSERT TIB 2 16MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-219,SUP,Custom 27803010,,5531-G-219  -  INSERT TIBIAL 2 19MM CRUC SUB TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5531-G-219-E,SUP,HCPCS C1776,,5531-G-219-E  -  INSERT TIB 2 19MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-222,SUP,Custom 27803010,,5531-G-222  -  INSERT TIBIAL 2 22MM CRUC SUB TRIATHLON X3,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5531-G-222-E,SUP,HCPCS C1776,,5531-G-222-E  -  INSERT TIB 2 22MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-225,SUP,Custom 27803010,,5531-G-225  -  INSERT TIBIAL 2 25MM CRUC SUB TRIATHLON X3,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5531-G-309,SUP,Custom 27803010,,5531-G-309  -  INSERT TIBIAL 3 9MM CNDYLR STABILIZED TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5531-G-309-E,SUP,HCPCS C1776,,5531-G-309-E  -  INSERT TIB 3 9MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-310-E,SUP,HCPCS C1776,,5531-G-310-E  -  INSERT TIB 3 10MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-311,SUP,Custom 27803010,,5531-G-311  -  INSERT TIBIAL 3 11MM CNDYLR STABILIZED TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5531-G-311-E,SUP,HCPCS C1776,,5531-G-311-E  -  INSERT TIB 3 11MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-312-E,SUP,HCPCS C1776,,5531-G-312-E  -  INSERT TIB 3 12MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-313,SUP,Custom 27803010,,5531-G-313  -  INSERT TIBIAL 3 13MM CNDYLR STABILIZED TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5531-G-313-E,SUP,HCPCS C1776,,5531-G-313-E  -  INSERT TIB 3 13MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-314-E,SUP,HCPCS C1776,,5531-G-314-E  -  INSERT TIB 3 14MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-316,SUP,Custom 27803010,,5531-G-316  -  INSERT TIBIAL 3 16MM CRUC SUB TRIATHLON X3,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5531-G-316-E,SUP,HCPCS C1776,,5531-G-316-E  -  INSERT TIB 3 16MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-319,SUP,Custom 27803010,,5531-G-319  -  INSERT TIBIAL 3 19MM CNDYLR STABILIZED PRIM TRIATHLON X3,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5531-G-319-E,SUP,HCPCS C1776,,5531-G-319-E  -  INSERT TIB 3 19MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-322,SUP,Custom 27803010,,5531-G-322  -  INSERT TIBIAL 3 22MM CRUC SUB TRIATHLON X3,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5531-G-322-E,SUP,HCPCS C1776,,5531-G-322-E  -  INSERT TIB 3 22MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-325,SUP,Custom 27803010,,5531-G-325  -  INSERT TIBIAL 3 25MM CRUC SUB TRIATHLON X3,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5531-G-409,SUP,Custom 27803010,,5531-G-409  -  INSERT TIBIAL 4 9MM CNDYLR STABILIZED TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5531-G-409-E,SUP,HCPCS C1776,,5531-G-409-E  -  INSERT TIB 4 9MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-410-E,SUP,HCPCS C1776,,5531-G-410-E  -  INSERT TIB 4 10MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-411,SUP,Custom 27803010,,5531-G-411  -  INSERT TIBIAL 4 11MM CNDYLR STABILIZED PRIM TRIATHLON X3,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5531-G-411-E,SUP,HCPCS C1776,,5531-G-411-E  -  INSERT TIB 4 11MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-412-E,SUP,HCPCS C1776,,5531-G-412-E  -  INSERT TIB 4 12MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-413,SUP,Custom 27803010,,5531-G-413  -  INSERT TIBIAL 4 13MM CNDYLR STABILIZED TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5531-G-413-E,SUP,HCPCS C1776,,5531-G-413-E  -  INSERT TIB 4 13MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-414-E,SUP,HCPCS C1776,,5531-G-414-E  -  INSERT TIB 4 14MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-416,SUP,Custom 27803010,,5531-G-416  -  INSERT TIBIAL 4 16MM CNDYLR STABILIZED TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5531-G-416-E,SUP,HCPCS C1776,,5531-G-416-E  -  INSERT TIB 4 16MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-419,SUP,Custom 27803010,,5531-G-419  -  INSERT TIBIAL 4 19MM CRUC SUB TRIATHLON X3,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5531-G-419-E,SUP,HCPCS C1776,,5531-G-419-E  -  INSERT TIB 4 19MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-422,SUP,Custom 27803010,,5531-G-422  -  INSERT TIBIAL 4 22MM CRUC SUB TRIATHLON X3,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5531-G-422-E,SUP,HCPCS C1776,,5531-G-422-E  -  INSERT TIB 4 22MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-425,SUP,Custom 27803010,,5531-G-425  -  INSERT TIBIAL 4 25MM CNDYLR STABILIZED TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5531-G-509,SUP,Custom 27803010,,5531-G-509  -  INSERT TIBIAL 5 9MM CNDYLR STABILIZED TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5531-G-509-E,SUP,HCPCS C1776,,5531-G-509-E  -  INSERT TIB 5 9MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-510-E,SUP,HCPCS C1776,,5531-G-510-E  -  INSERT TIB 5 10MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-511,SUP,Custom 27803010,,5531-G-511  -  INSERT TIBIAL 5 11MM CNDYLR STABILIZED TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5531-G-511-E,SUP,HCPCS C1776,,5531-G-511-E  -  INSERT TIB 5 11MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-512-E,SUP,HCPCS C1776,,5531-G-512-E  -  INSERT TIB 5 12MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-513,SUP,Custom 27803010,,5531-G-513  -  INSERT TIBIAL 5 13MM CNDYLR STABILIZED TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5531-G-513-E,SUP,HCPCS C1776,,5531-G-513-E  -  INSERT TIB 5 13MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-514-E,SUP,HCPCS C1776,,5531-G-514-E  -  INSERT TIB 5 14MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-516,SUP,Custom 27803010,,5531-G-516  -  INSERT TIBIAL 5 16MM CNDYLR STABILIZED TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5531-G-516-E,SUP,HCPCS C1776,,5531-G-516-E  -  INSERT TIB 5 16MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-519,SUP,Custom 27803010,,5531-G-519  -  INSERT TIBIAL 5 19MM CRUC SUB TRIATHLON X3,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5531-G-519-E,SUP,HCPCS C1776,,5531-G-519-E  -  INSERT TIB 5 19MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-522,SUP,Custom 27803010,,5531-G-522  -  INSERT TIBIAL 5 22MM CRUC SUB TRIATHLON X3,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5531-G-522-E,SUP,HCPCS C1776,,5531-G-522-E  -  INSERT TIB 5 22MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-525,SUP,Custom 27803010,,5531-G-525  -  INSERT TIBIAL 5 25MM CRUC SUB TRIATHLON X3,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5531-G-609,SUP,Custom 27803010,,5531-G-609  -  INSERT TIBIAL 6 9MM CNDYLR STABILIZED PRIM TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5531-G-609-E,SUP,HCPCS C1776,,5531-G-609-E  -  INSERT TIB 6 9MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-610-E,SUP,HCPCS C1776,,5531-G-610-E  -  INSERT TIB 6 10MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-611,SUP,Custom 27803010,,5531-G-611  -  INSERT TIBIAL 6 11MM CNDYLR STABILIZED TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5531-G-611-E,SUP,HCPCS C1776,,5531-G-611-E  -  INSERT TIB 6 11MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-612-E,SUP,HCPCS C1776,,5531-G-612-E  -  INSERT TIB 6 12MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-613,SUP,Custom 27803010,,5531-G-613  -  INSERT TIBIAL 6 13MM CNDYLR STABILIZED TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5531-G-613-E,SUP,HCPCS C1776,,5531-G-613-E  -  INSERT TIB 6 13MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-614-E,SUP,HCPCS C1776,,5531-G-614-E  -  INSERT TIB 6 14MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-616,SUP,Custom 27803010,,5531-G-616  -  INSERT TIBIAL 6 16MM CNDYLR STABILIZED TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5531-G-616-E,SUP,HCPCS C1776,,5531-G-616-E  -  INSERT TIB 6 16MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-619,SUP,Custom 27803010,,5531-G-619  -  INSERT TIBIAL 6 19MM CRUC SUB TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5531-G-619-E,SUP,HCPCS C1776,,5531-G-619-E  -  INSERT TIB 6 19MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-622,SUP,Custom 27803010,,5531-G-622  -  INSERT TIBIAL 6 22MM CRUC SUB TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5531-G-622-E,SUP,HCPCS C1776,,5531-G-622-E  -  INSERT TIB 6 22MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-625,SUP,Custom 27803010,,5531-G-625  -  INSERT TIBIAL 6 25MM CRUC SUB TRIATHLON X3,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5531-G-709,SUP,Custom 27803010,,5531-G-709  -  INSERT TIBIAL 7 9MM CNDYLR STABILIZED TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5531-G-709-E,SUP,HCPCS C1776,,5531-G-709-E  -  INSERT TIB 7 9MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-710-E,SUP,HCPCS C1776,,5531-G-710-E  -  INSERT TIB 7 10MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-711,SUP,Custom 27803010,,5531-G-711  -  INSERT TIBIAL 7 11MM CNDYLR STABILIZED PRIM TRIATHLON X3,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5531-G-711-E,SUP,HCPCS C1776,,5531-G-711-E  -  INSERT TIB 7 11MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-712-E,SUP,HCPCS C1776,,5531-G-712-E  -  INSERT TIB 7 12MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-713,SUP,Custom 27803010,,5531-G-713  -  INSERT TIBIAL 7 13MM CRUC SUB TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5531-G-713-E,SUP,HCPCS C1776,,5531-G-713-E  -  INSERT TIB 7 13MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-714-E,SUP,HCPCS C1776,,5531-G-714-E  -  INSERT TIB 7 14MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-716,SUP,Custom 27803010,,5531-G-716  -  INSERT TIBIAL 7 16MM CNDYLR STABILIZED TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5531-G-716-E,SUP,HCPCS C1776,,5531-G-716-E  -  INSERT TIB 7 16MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-719,SUP,Custom 27803010,,5531-G-719  -  INSERT TIBIAL 7 19MM CRUC SUB TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5531-G-719-E,SUP,HCPCS C1776,,5531-G-719-E  -  INSERT TIB 7 19MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-722,SUP,Custom 27803010,,5531-G-722  -  INSERT TIBIAL 7 22MM CRUC SUB TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5531-G-722-E,SUP,HCPCS C1776,,5531-G-722-E  -  INSERT TIB 7 22MM STRL TRTHLN CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-725,SUP,Custom 27803010,,5531-G-725  -  INSERT TIBIAL 7 25MM CRUC SUB TRIATHLON X3,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5531-G-809,SUP,Custom 27803010,,5531-G-809  -  INSERT TIBIAL 8 9MM CNDYLR STABILIZED TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5531-G-809-E,SUP,HCPCS C1776,,5531-G-809-E  -  INSERT TIB 8 9MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-810-E,SUP,HCPCS C1776,,5531-G-810-E  -  INSERT TIB 8 10MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-811,SUP,Custom 27803010,,5531-G-811  -  INSERT TIBIAL 8 11MM CNDYLR STABILIZED TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5531-G-811-E,SUP,HCPCS C1776,,5531-G-811-E  -  INSERT TIB 8 11MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-812-E,SUP,HCPCS C1776,,5531-G-812-E  -  INSERT TIB 8 12MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-813,SUP,Custom 27803010,,5531-G-813  -  INSERT TIBIAL 8 13MM CNDYLR STABILIZED TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5531-G-813-E,SUP,HCPCS C1776,,5531-G-813-E  -  INSERT TIB 8 13MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-814-E,SUP,HCPCS C1776,,5531-G-814-E  -  INSERT TIB 8 14MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-816,SUP,Custom 27803010,,5531-G-816  -  INSERT TIBIAL 8 16MM CRUC SUB TRIATHLON X3,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5531-G-816-E,SUP,HCPCS C1776,,5531-G-816-E  -  INSERT TIB 8 16MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-819,SUP,Custom 27803010,,5531-G-819  -  INSERT TIBIAL 8 19MM CRUC SUB TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5531-G-819-E,SUP,HCPCS C1776,,5531-G-819-E  -  INSERT TIB 8 19MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-822,SUP,Custom 27803010,,5531-G-822  -  INSERT TIBIAL 8 22MM CRUC SUB TRIATHLON X3,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5531-G-822-E,SUP,HCPCS C1776,,5531-G-822-E  -  INSERT TIB 8 22MM STRL TRTHLN BRNG CNDRL STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5531-G-825,SUP,Custom 27803010,,5531-G-825  -  INSERT TIBIAL 8 25MM CRUC SUB TRIATHLON X3,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5531-P-109,SUP,Custom 27803010,,5531-P-109  -  INSERT TIBIAL 1 9MM STABILIZE TRIATHLON KNEE CONDYLE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5531-P-110,SUP,HCPCS C1776,,5531-P-110  -  INSERT TIB 1 10MM STRL LF TRTHLN BRNG CNDRL STAB KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5531-P-111,SUP,Custom 27803010,,5531-P-111  -  INSERT TIBIAL 1 11MM STABILIZE TRIATHLON KNEE CONDYLE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5531-P-112,SUP,HCPCS C1776,,5531-P-112  -  INSERT TIB 1 12MM STRL LF TRTHLN BRNG CNDRL STAB KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5531-P-113,SUP,Custom 27803010,,5531-P-113  -  INSERT TIBIAL 1 13MM STABILIZE TRIATHLON KNEE CONDYLE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5531-P-114,SUP,HCPCS C1776,,5531-P-114  -  INSERT TIB 1 14MM STRL LF TRTHLN BRNG CNDRL STAB KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5531-P-116,SUP,Custom 27803010,,5531-P-116  -  INSERT TIBIAL 1 16MM STABILIZE TRIATHLON KNEE CONDYLE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5531-P-119,SUP,Custom 27803010,,5531-P-119  -  INSERT TIBIAL 1 19MM STABILIZE TRIATHLON KNEE CONDYLE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5531-P-122,SUP,Custom 27803010,,5531-P-122  -  INSERT TIBIAL 1 22MM STABILIZE TRIATHLON KNEE CONDYLE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5531-P-125,SUP,Custom 27803010,,5531-P-125  -  INSERT TIBIAL 1 25MM STABILIZE TRIATHLON KNEE CONDYLE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5531-P-209,SUP,Custom 27803010,,5531-P-209  -  INSERT TIBIAL 2 9MM STABILIZE TRIATHLON KNEE CONDYLE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5531-P-210,SUP,HCPCS C1776,,5531-P-210  -  INSERT TIB 2 10MM STRL LF TRTHLN BRNG CNDRL STAB KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5531-P-211,SUP,Custom 27803010,,5531-P-211  -  INSERT TIBIAL 2 11MM STABILIZE TRIATHLON KNEE CONDYLE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5531-P-212,SUP,HCPCS C1776,,5531-P-212  -  INSERT TIB 2 12MM STRL LF TRTHLN BRNG CNDRL STAB KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5531-P-213,SUP,Custom 27803010,,5531-P-213  -  INSERT TIBIAL 2 13MM CRUC SUB TRIATHLON,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5531-P-214,SUP,HCPCS C1776,,5531-P-214  -  INSERT TIB 2 14MM STRL LF TRTHLN BRNG CNDRL STAB KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5531-P-216,SUP,Custom 27803010,,5531-P-216  -  INSERT TIBIAL 2 16MM CRUC SUB TRIATHLON,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5531-P-219,SUP,Custom 27803010,,5531-P-219  -  INSERT TIBIAL 2 19MM STABILIZE TRIATHLON KNEE CONDYLE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5531-P-222,SUP,Custom 27803010,,5531-P-222  -  INSERT TIBIAL 2 22MM STABILIZE TRIATHLON KNEE CONDYLE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5531-P-225,SUP,Custom 27803010,,5531-P-225  -  INSERT TIBIAL 2 25MM STABILIZE TRIATHLON KNEE CONDYLE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5531-P-309,SUP,Custom 27803010,,5531-P-309  -  INSERT TIBIAL 3 8-9MM TRIATHLON,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5531-P-310,SUP,HCPCS C1776,,5531-P-310  -  INSERT TIB 3 10MM STRL LF TRTHLN BRNG CNDRL STAB KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5531-P-311,SUP,Custom 27803010,,5531-P-311  -  INSERT TIBIAL 3 11MM BEARING TRIATHLON KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5531-P-312,SUP,HCPCS C1776,,5531-P-312  -  INSERT TIB 3 13MM STRL LF TRTHLN BRNG CNDRL STAB KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5531-P-313,SUP,Custom 27803010,,5531-P-313  -  INSERT TIBIAL 3 13MM TRIATHLON,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5531-P-314,SUP,HCPCS C1776,,5531-P-314  -  INSERT TIB 3 14MM STRL LF TRTHLN BRNG CNDRL STAB KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5531-P-316,SUP,Custom 27803010,,5531-P-316  -  INSERT TIBIAL 3 16MM STABILIZE TRIATHLON KNEE CONDYLE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5531-P-319,SUP,Custom 27803010,,5531-P-319  -  INSERT TIBIAL 3 19MM STABILIZE TRIATHLON KNEE CONDYLE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5531-P-322,SUP,Custom 27803010,,5531-P-322  -  INSERT TIBIAL 3 22MM STABILIZE TRIATHLON KNEE CONDYLE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5531-P-325,SUP,Custom 27803010,,5531-P-325  -  INSERT TIBIAL 3 25MM STABILIZE TRIATHLON KNEE CONDYLE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5531-P-409,SUP,Custom 27803010,,5531-P-409  -  INSERT TIBIAL 4 9MM STABILIZE TRIATHLON KNEE CONDYLE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5531-P-410,SUP,HCPCS C1776,,5531-P-410  -  INSERT TIB 4 10MM STRL LF TRTHLN BRNG CNDRL STAB KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5531-P-411,SUP,Custom 27803010,,5531-P-411  -  INSERT TIBIAL 4 11MM CRUC SUB TRIATHLON,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5531-P-412,SUP,HCPCS C1776,,5531-P-412  -  INSERT TIB 4 12MM STRL LF TRTHLN BRNG CNDRL STAB KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5531-P-413,SUP,Custom 27803010,,5531-P-413  -  INSERT TIBIAL 4 13MM CRUC SUB TRIATHLON,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5531-P-414,SUP,HCPCS C1776,,5531-P-414  -  INSERT TIB 4 14MM STRL LF TRTHLN BRNG CNDRL STAB KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5531-P-416,SUP,Custom 27803010,,5531-P-416  -  INSERT TIBIAL 4 16MM STABILIZE TRIATHLON KNEE CONDYLE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5531-P-419,SUP,Custom 27803010,,5531-P-419  -  INSERT TIBIAL 4 19MM STABILIZE TRIATHLON KNEE CONDYLE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5531-P-422,SUP,Custom 27803010,,5531-P-422  -  INSERT TIBIAL 4 22MM STABILIZE TRIATHLON KNEE CONDYLE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5531-P-425,SUP,Custom 27803010,,5531-P-425  -  INSERT TIBIAL 4 25MM STABILIZE TRIATHLON KNEE CONDYLE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5531-P-509,SUP,Custom 27803010,,5531-P-509  -  INSERT TIBIAL 5 9MM STABILIZE TRIATHLON KNEE CONDYLE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5531-P-510,SUP,HCPCS C1776,,5531-P-510  -  INSERT TIB 5 10MM STRL LF TRTHLN BRNG CNDRL STAB KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5531-P-511,SUP,Custom 27803010,,5531-P-511  -  INSERT TIBIAL 5 11MM STABILIZE TRIATHLON KNEE CONDYLE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5531-P-512,SUP,HCPCS C1776,,5531-P-512  -  INSERT TIB 5 12MM STRL LF TRTHLN BRNG CNDRL STAB KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5531-P-513,SUP,Custom 27803010,,5531-P-513  -  INSERT TIBIAL 5 13MM STABILIZE TRIATHLON KNEE CONDYLE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5531-P-514,SUP,HCPCS C1776,,5531-P-514  -  INSERT TIB 5 14MM STRL LF TRTHLN BRNG CNDRL STAB KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5531-P-516,SUP,Custom 27803010,,5531-P-516  -  INSERT TIBIAL 5 16MM STABILIZE TRIATHLON KNEE CONDYLE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5531-P-519,SUP,Custom 27803010,,5531-P-519  -  INSERT TIBIAL 5 19MM STABILIZE TRIATHLON KNEE CONDYLE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5531-P-522,SUP,Custom 27803010,,5531-P-522  -  INSERT TIBIAL 5 22MM STABILIZE TRIATHLON KNEE CONDYLE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5531-P-525,SUP,Custom 27803010,,5531-P-525  -  INSERT TIBIAL 5 25MM STABILIZE TRIATHLON KNEE CONDYLE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5531-P-609,SUP,Custom 27803010,,5531-P-609  -  INSERT TIBIAL 6 9MM STABILIZE TRIATHLON KNEE CONDYLE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5531-P-610,SUP,HCPCS C1776,,5531-P-610  -  INSERT TIB 6 10MM STRL LF TRTHLN BRNG CNDRL STAB KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5531-P-611,SUP,Custom 27803010,,5531-P-611  -  INSERT TIBIAL 6 11MM STABILIZE TRIATHLON KNEE CONDYLE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5531-P-612,SUP,HCPCS C1776,,5531-P-612  -  INSERT TIB 6 12MM STRL LF TRTHLN BRNG CNDRL STAB KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5531-P-613,SUP,Custom 27803010,,5531-P-613  -  INSERT TIBIAL 6 13MM STABILIZE TRIATHLON KNEE CONDYLE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5531-P-614,SUP,HCPCS C1776,,5531-P-614  -  INSERT TIB 6 14MM STRL LF TRTHLN BRNG CNDRL STAB KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5531-P-616,SUP,Custom 27803010,,5531-P-616  -  INSERT TIBIAL 6 16MM CRUC SUB TRIATHLON,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5531-P-619,SUP,Custom 27803010,,5531-P-619  -  INSERT TIBIAL 6 19MM STABILIZE TRIATHLON KNEE CONDYLE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5531-P-622,SUP,Custom 27803010,,5531-P-622  -  INSERT TIBIAL 6 22MM STABILIZE TRIATHLON KNEE CONDYLE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5531-P-625,SUP,Custom 27803010,,5531-P-625  -  INSERT TIBIAL 6 25MM STABILIZE TRIATHLON KNEE CONDYLE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5531-P-709,SUP,Custom 27803010,,5531-P-709  -  INSERT TIBIAL 7 9MM STABILIZE TRIATHLON KNEE CONDYLE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5531-P-710,SUP,HCPCS C1776,,5531-P-710  -  INSERT TIB 7 10MM STRL LF TRTHLN BRNG CNDRL STAB KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5531-P-711,SUP,Custom 27803010,,5531-P-711  -  INSERT TIBIAL 7 11MM STABILIZE TRIATHLON KNEE CONDYLE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5531-P-712,SUP,HCPCS C1776,,5531-P-712  -  INSERT TIB 7 12MM STRL LF TRTHLN BRNG CNDRL STAB KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5531-P-713,SUP,Custom 27803010,,5531-P-713  -  INSERT TIBIAL 7 13MM STABILIZE TRIATHLON KNEE CONDYLE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5531-P-714,SUP,HCPCS C1776,,5531-P-714  -  INSERT TIB 7 14MM STRL LF TRTHLN BRNG CNDRL STAB KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5531-P-716,SUP,Custom 27803010,,5531-P-716  -  INSERT TIBIAL 7 16MM STABILIZE TRIATHLON KNEE CONDYLE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5531-P-719,SUP,Custom 27803010,,5531-P-719  -  INSERT TIBIAL 7 19MM STABILIZE TRIATHLON KNEE CONDYLE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5531-P-722,SUP,Custom 27803010,,5531-P-722  -  INSERT TIBIAL 7 22MM STABILIZE TRIATHLON KNEE CONDYLE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5531-P-725,SUP,Custom 27803010,,5531-P-725  -  INSERT TIBIAL 7 25MM STABILIZE TRIATHLON KNEE CONDYLE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5531-P-809,SUP,Custom 27803010,,5531-P-809  -  INSERT TIBIAL 8 9MM STABILIZE TRIATHLON KNEE CONDYLE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5531-P-810,SUP,HCPCS C1776,,5531-P-810  -  INSERT TIB 8 10MM STRL LF TRTHLN BRNG CNDRL STAB KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5531-P-811,SUP,Custom 27803010,,5531-P-811  -  INSERT TIBIAL 8 11MM STABILIZE TRIATHLON KNEE CONDYLE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5531-P-812,SUP,HCPCS C1776,,5531-P-812  -  INSERT TIB 8 12MM STRL LF TRTHLN BRNG CNDRL STAB KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5531-P-813,SUP,Custom 27803010,,5531-P-813  -  INSERT TIBIAL 8 13MM STABILIZE TRIATHLON KNEE CONDYLE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5531-P-814,SUP,HCPCS C1776,,5531-P-814  -  INSERT TIB 8 14MM STRL LF TRTHLN BRNG CNDRL STAB KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5531-P-816,SUP,Custom 27803010,,5531-P-816  -  INSERT TIBIAL 8 16MM STABILIZE TRIATHLON KNEE CONDYLE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5531-P-819,SUP,Custom 27803010,,5531-P-819  -  INSERT TIBIAL 8 19MM STABILIZE TRIATHLON KNEE CONDYLE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5531-P-822,SUP,Custom 27803010,,5531-P-822  -  INSERT TIBIAL 8 22MM STABILIZE TRIATHLON KNEE CONDYLE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5531-P-825,SUP,Custom 27803010,,5531-P-825  -  INSERT TIBIAL 8 25MM STABILIZE TRIATHLON KNEE CONDYLE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5532-G-109,SUP,Custom 27803010,,5532-G-109  -  INSERT TIBIAL 1 9MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5532-G-109-E,SUP,HCPCS C1776,,5532-G-109-E  -  INSERT TIB 1 9MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-110-E,SUP,HCPCS C1776,,5532-G-110-E  -  INSERT TIB 1 10MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-111,SUP,Custom 27803010,,5532-G-111  -  INSERT TIBIAL 1 11MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5532-G-111-E,SUP,HCPCS C1776,,5532-G-111-E  -  INSERT TIB 1 11MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-112-E,SUP,HCPCS C1776,,5532-G-112-E  -  INSERT TIB 1 12MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-113,SUP,Custom 27803010,,5532-G-113  -  INSERT TIBIAL 1 13MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5532-G-113-E,SUP,HCPCS C1776,,5532-G-113-E  -  INSERT TIB 1 13MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-114-E,SUP,HCPCS C1776,,5532-G-114-E  -  INSERT TIB 1 14MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-116,SUP,Custom 27803010,,5532-G-116  -  INSERT TIBIAL 1 16MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5532-G-116-E,SUP,HCPCS C1776,,5532-G-116-E  -  INSERT TIB 1 16MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-119,SUP,Custom 27803010,,5532-G-119  -  INSERT TIBIAL 1 19MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5532-G-119-E,SUP,HCPCS C1776,,5532-G-119-E  -  INSERT TIB 1 19MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-122,SUP,Custom 27803010,,5532-G-122  -  INSERT TIBIAL 1 22MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5532-G-122-E,SUP,HCPCS C1776,,5532-G-122-E  -  INSERT TIB 1 22MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-125,SUP,Custom 27803010,,5532-G-125  -  INSERT TIBIAL 1 25MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5532-G-209,SUP,Custom 27803010,,5532-G-209  -  INSERT TIBIAL 2 9MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5532-G-209-E,SUP,HCPCS C1776,,5532-G-209-E  -  INSERT TIB 2 9MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-210-E,SUP,HCPCS C1776,,5532-G-210-E  -  INSERT TIB 2 10MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-211,SUP,Custom 27803010,,5532-G-211  -  INSERT TIBIAL 2 11MM POSTERIOR STABILIZE TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5532-G-211-E,SUP,HCPCS C1776,,5532-G-211-E  -  INSERT TIB 2 11MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-212-E,SUP,HCPCS C1776,,5532-G-212-E  -  INSERT TIB 2 12MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-213,SUP,Custom 27803010,,5532-G-213  -  INSERT TIBIAL 2 13MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5532-G-213-E,SUP,HCPCS C1776,,5532-G-213-E  -  INSERT TIB 2 13MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-214-E,SUP,HCPCS C1776,,5532-G-214-E  -  INSERT TIB 2 14MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-216,SUP,Custom 27803010,,5532-G-216  -  INSERT TIBIAL 2 16MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5532-G-216-E,SUP,HCPCS C1776,,5532-G-216-E  -  INSERT TIB 2 16MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-219,SUP,Custom 27803010,,5532-G-219  -  INSERT TIBIAL 2 19MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5532-G-219-E,SUP,HCPCS C1776,,5532-G-219-E  -  INSERT TIB 2 19MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-222,SUP,Custom 27803010,,5532-G-222  -  INSERT TIBIAL 2 22MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5532-G-222-E,SUP,HCPCS C1776,,5532-G-222-E  -  INSERT TIB 2 22MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-225,SUP,Custom 27803010,,5532-G-225  -  INSERT TIBIAL 2 25MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5532-G-309,SUP,Custom 27803010,,5532-G-309  -  INSERT TIBIAL 3 9MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5532-G-309-E,SUP,HCPCS C1776,,5532-G-309-E  -  INSERT TIB 3 9MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-310-E,SUP,HCPCS C1776,,5532-G-310-E  -  INSERT TIB 3 10MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-311,SUP,Custom 27803010,,5532-G-311  -  INSERT TIBIAL 3 11MM POSTERIOR STABILIZED PRIM TRIATHLON X3,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5532-G-311-E,SUP,HCPCS C1776,,5532-G-311-E  -  INSERT TIB 3 11MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-312-E,SUP,HCPCS C1776,,5532-G-312-E  -  INSERT TIB 3 12MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-313,SUP,Custom 27803010,,5532-G-313  -  INSERT TIBIAL 3 13MM BEARING POSTERIOR STABILIZE TRIATHLON,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5532-G-313-E,SUP,HCPCS C1776,,5532-G-313-E  -  INSERT TIB 3 13MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-314-E,SUP,HCPCS C1776,,5532-G-314-E  -  INSERT TIB 3 14MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-316,SUP,Custom 27803010,,5532-G-316  -  INSERT TIBIAL 3 16MM BEARING POSTERIOR STABILIZE TRIATHLON,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5532-G-316-E,SUP,HCPCS C1776,,5532-G-316-E  -  INSERT TIB 3 16MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-319,SUP,Custom 27803010,,5532-G-319  -  INSERT TIBIAL 3 19MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5532-G-319-E,SUP,HCPCS C1776,,5532-G-319-E  -  INSERT TIB 3 19MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-322,SUP,Custom 27803010,,5532-G-322  -  INSERT TIBIAL 3 22MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5532-G-322-E,SUP,HCPCS C1776,,5532-G-322-E  -  INSERT TIB 3 22MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-325,SUP,Custom 27803010,,5532-G-325  -  INSERT TIBIAL 3 25MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5532-G-409,SUP,Custom 27803010,,5532-G-409  -  INSERT TIBIAL 4 9MM POSTERIOR STABILIZE TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5532-G-409-E,SUP,HCPCS C1776,,5532-G-409-E  -  INSERT TIB 4 9MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-410-E,SUP,HCPCS C1776,,5532-G-410-E  -  INSERT TIB 4 10MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-411,SUP,Custom 27803010,,5532-G-411  -  INSERT TIBIAL 4 11MM BEARING POSTERIOR STABILIZE TRIATHLON,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5532-G-411-E,SUP,HCPCS C1776,,5532-G-411-E  -  INSERT TIB 4 11MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-412-E,SUP,HCPCS C1776,,5532-G-412-E  -  INSERT TIB 4 12MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-413,SUP,Custom 27803010,,5532-G-413  -  INSERT TIBIAL 4 13MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5532-G-413-E,SUP,HCPCS C1776,,5532-G-413-E  -  INSERT TIB 4 13MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-414-E,SUP,HCPCS C1776,,5532-G-414-E  -  INSERT TIB 4 14MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-416,SUP,Custom 27803010,,5532-G-416  -  INSERT TIBIAL 4 16MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5532-G-416-E,SUP,HCPCS C1776,,5532-G-416-E  -  INSERT TIB 4 16MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-419,SUP,Custom 27803010,,5532-G-419  -  INSERT TIBIAL 4 19MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5532-G-419-E,SUP,HCPCS C1776,,5532-G-419-E  -  INSERT TIB 4 19MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-422,SUP,Custom 27803010,,5532-G-422  -  INSERT TIBIAL 4 22MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5532-G-422-E,SUP,HCPCS C1776,,5532-G-422-E  -  INSERT TIB 4 22MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-425,SUP,Custom 27803010,,5532-G-425  -  INSERT TIBIAL 4 25MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5532-G-509,SUP,Custom 27803010,,5532-G-509  -  INSERT TIBIAL 5 9MM BEARING POSTERIOR STABILIZE TRIATHLON X3,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5532-G-509-E,SUP,HCPCS C1776,,5532-G-509-E  -  INSERT TIB 5 9MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-510-E,SUP,HCPCS C1776,,5532-G-510-E  -  INSERT TIB 5 10MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-511,SUP,Custom 27803010,,5532-G-511  -  INSERT TIBIAL 5 11MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5532-G-511-E,SUP,HCPCS C1776,,5532-G-511-E  -  INSERT TIB 5 11MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-512-E,SUP,HCPCS C1776,,5532-G-512-E  -  INSERT TIB 5 12MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-513,SUP,Custom 27803010,,5532-G-513  -  INSERT TIBIAL 5 13MM POSTERIOR STABILIZE BEARING TRIATHLON,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5532-G-513-E,SUP,HCPCS C1776,,5532-G-513-E  -  INSERT TIB 5 13MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-514-E,SUP,HCPCS C1776,,5532-G-514-E  -  INSERT TIB 5 14MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-516,SUP,Custom 27803010,,5532-G-516  -  INSERT TIBIAL 5 16MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5532-G-516-E,SUP,HCPCS C1776,,5532-G-516-E  -  INSERT TIB 5 16MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-519,SUP,Custom 27803010,,5532-G-519  -  INSERT TIBIAL 5 19MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5532-G-519-E,SUP,HCPCS C1776,,5532-G-519-E  -  INSERT TIB 5 19MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-522,SUP,Custom 27803010,,5532-G-522  -  INSERT TIBIAL 5 22MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5532-G-522-E,SUP,HCPCS C1776,,5532-G-522-E  -  INSERT TIB 5 22MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-525,SUP,Custom 27803010,,5532-G-525  -  INSERT TIBIAL 5 25MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5532-G-609,SUP,Custom 27803010,,5532-G-609  -  INSERT TIBIAL 6 9MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5532-G-609-E,SUP,HCPCS C1776,,5532-G-609-E  -  INSERT TIB 6 9MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-610-E,SUP,HCPCS C1776,,5532-G-610-E  -  INSERT TIB 6 10MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-611,SUP,Custom 27803010,,5532-G-611  -  INSERT TIBIAL 6 11MM BEARING POSTERIOR STABILIZE TRIATHLON,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5532-G-611-E,SUP,HCPCS C1776,,5532-G-611-E  -  INSERT TIB 6 11MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-612-E,SUP,HCPCS C1776,,5532-G-612-E  -  INSERT TIB 6 12MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-613,SUP,Custom 27803010,,5532-G-613  -  INSERT TIBIAL 6 13MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5532-G-613-E,SUP,HCPCS C1776,,5532-G-613-E  -  INSERT TIB 6 13MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-614-E,SUP,HCPCS C1776,,5532-G-614-E  -  INSERT TIB 6 14MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-616,SUP,Custom 27803010,,5532-G-616  -  INSERT TIBIAL 6 16MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5532-G-616-E,SUP,HCPCS C1776,,5532-G-616-E  -  INSERT TIB 6 16MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-619,SUP,Custom 27803010,,5532-G-619  -  INSERT TIBIAL 6 19MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5532-G-619-E,SUP,HCPCS C1776,,5532-G-619-E  -  INSERT TIB 6 19MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-622,SUP,Custom 27803010,,5532-G-622  -  INSERT TIBIAL 6 22MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5532-G-622-E,SUP,HCPCS C1776,,5532-G-622-E  -  INSERT TIB 6 22MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-625,SUP,Custom 27803010,,5532-G-625  -  INSERT TIBIAL 6 25MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5532-G-709,SUP,Custom 27803010,,5532-G-709  -  INSERT TIBIAL 7 9MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5532-G-709-E,SUP,HCPCS C1776,,5532-G-709-E  -  INSERT TIB 7 9MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-710-E,SUP,HCPCS C1776,,5532-G-710-E  -  INSERT TIB 7 10MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-711,SUP,Custom 27803010,,5532-G-711  -  INSERT TIBIAL 7 11MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5532-G-711-E,SUP,HCPCS C1776,,5532-G-711-E  -  INSERT TIB 7 11MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-712-E,SUP,HCPCS C1776,,5532-G-712-E  -  INSERT TIB 7 12MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-713,SUP,Custom 27803010,,5532-G-713  -  INSERT TIBIAL 7 13MM POSTERIOR STABILIZE TRIATHLON X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5532-G-713-E,SUP,HCPCS C1776,,5532-G-713-E  -  INSERT TIB 7 13MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-714-E,SUP,HCPCS C1776,,5532-G-714-E  -  INSERT TIB 7 14MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-716,SUP,Custom 27803010,,5532-G-716  -  INSERT TIBIAL 7 16MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5532-G-716-E,SUP,HCPCS C1776,,5532-G-716-E  -  INSERT TIB 7 16MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-719,SUP,Custom 27803010,,5532-G-719  -  INSERT TIBIAL 7 19MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5532-G-719-E,SUP,HCPCS C1776,,5532-G-719-E  -  INSERT TIB 7 19MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-722,SUP,Custom 27803010,,5532-G-722  -  INSERT TIBIAL 7 22MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5532-G-722-E,SUP,HCPCS C1776,,5532-G-722-E  -  INSERT TIB 7 22MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-725,SUP,Custom 27803010,,5532-G-725  -  INSERT TIBIAL 7 25MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5532-G-809,SUP,Custom 27803010,,5532-G-809  -  INSERT TIBIAL 8 9MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5532-G-809-E,SUP,HCPCS C1776,,5532-G-809-E  -  INSERT TIB 8 9MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-810-E,SUP,HCPCS C1776,,5532-G-810-E  -  INSERT TIB 8 10MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-811,SUP,Custom 27803010,,5532-G-811  -  INSERT TIBIAL 8 11MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5532-G-811-E,SUP,HCPCS C1776,,5532-G-811-E  -  INSERT TIB 8 11MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-812-E,SUP,HCPCS C1776,,5532-G-812-E  -  INSERT TIB 8 12MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-813,SUP,Custom 27803010,,5532-G-813  -  INSERT TIBIAL 8 13MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5532-G-813-E,SUP,HCPCS C1776,,5532-G-813-E  -  INSERT TIB 8 13MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-814-E,SUP,HCPCS C1776,,5532-G-814-E  -  INSERT TIB 8 14MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-816,SUP,Custom 27803010,,5532-G-816  -  INSERT TIBIAL 8 16MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5532-G-816-E,SUP,HCPCS C1776,,5532-G-816-E  -  INSERT TIB 8 16MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-819,SUP,Custom 27803010,,5532-G-819  -  INSERT TIBIAL 8 19MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5532-G-819-E,SUP,HCPCS C1776,,5532-G-819-E  -  INSERT TIB 8 19MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-822,SUP,Custom 27803010,,5532-G-822  -  INSERT TIBIAL 8 22MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5532-G-822-E,SUP,HCPCS C1776,,5532-G-822-E  -  INSERT TIB 8 22MM STRL TRTHLN BRNG POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
5532-G-825,SUP,Custom 27803010,,5532-G-825  -  INSERT TIBIAL 8 25MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
5532-P-109,SUP,Custom 27803010,,5532-P-109  -  INSERT TIBIAL 1 9MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5532-P-110,SUP,HCPCS C1776,,5532-P-110  -  INSERT TIB 1 10MM STRL LF TRTHLN BRNG POST STAB KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5532-P-111,SUP,Custom 27803010,,5532-P-111  -  INSERT TIBIAL 1 11MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5532-P-112,SUP,HCPCS C1776,,5532-P-112  -  INSERT TIB 1 12MM STRL LF TRTHLN BRNG POST STAB KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5532-P-113,SUP,Custom 27803010,,5532-P-113  -  INSERT TIBIAL 1 13MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5532-P-114,SUP,HCPCS C1776,,5532-P-114  -  INSERT TIB 1 14MM STRL LF TRTHLN BRNG POST STAB KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5532-P-116,SUP,Custom 27803010,,5532-P-116  -  INSERT TIBIAL 1 16MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5532-P-119,SUP,Custom 27803010,,5532-P-119  -  INSERT TIBIAL 1 19MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5532-P-122,SUP,Custom 27803010,,5532-P-122  -  INSERT TIBIAL 1 22MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5532-P-125,SUP,Custom 27803010,,5532-P-125  -  INSERT TIBIAL 1 25MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5532-P-209,SUP,Custom 27803010,,5532-P-209  -  INSERT TIBIAL 2 9MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5532-P-210,SUP,HCPCS C1776,,5532-P-210  -  INSERT TIB 2 10MM STRL LF TRTHLN BRNG POST STAB KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5532-P-211,SUP,Custom 27803010,,5532-P-211  -  INSERT TIBIAL 2 11MM POSTERIOR STABILIZE TRIATHLON KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5532-P-212,SUP,HCPCS C1776,,5532-P-212  -  INSERT TIB 2 12MM STRL LF TRTHLN BRNG POST STAB KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5532-P-213,SUP,Custom 27803010,,5532-P-213  -  INSERT TIBIAL 2 13MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5532-P-214,SUP,HCPCS C1776,,5532-P-214  -  INSERT TIB 2 14MM STRL LF TRTHLN BRNG POST STAB KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5532-P-216,SUP,Custom 27803010,,5532-P-216  -  INSERT TIBIAL 2 16MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5532-P-219,SUP,Custom 27803010,,5532-P-219  -  INSERT TIBIAL 2 P 19MM POSTERIOR STABILIZE TRIATHLON X3 KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5532-P-222,SUP,Custom 27803010,,5532-P-222  -  INSERT TIBIAL 2 22MM POSTERIOR STABILIZE TRIATHLON KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5532-P-225,SUP,Custom 27803010,,5532-P-225  -  INSERT TIBIAL 2 25MM POSTERIOR STABILIZE TRIATHLON KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5532-P-309,SUP,Custom 27803010,,5532-P-309  -  INSERT TIBIAL 3 9MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5532-P-310,SUP,HCPCS C1776,,5532-P-310  -  INSERT TIB 3 10MM STRL LF TRTHLN BRNG POST STAB KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5532-P-311,SUP,Custom 27803010,,5532-P-311  -  INSERT TIBIAL 3 11MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5532-P-312,SUP,HCPCS C1776,,5532-P-312  -  INSERT TIB 3 12MM STRL LF TRTHLN BRNG POST STAB KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5532-P-313,SUP,Custom 27803010,,5532-P-313  -  INSERT TIBIAL 3 13MM POSTERIOR STABILIZED PRIM TRIATHLON,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5532-P-314,SUP,HCPCS C1776,,5532-P-314  -  INSERT TIB 3 14MM STRL LF TRTHLN BRNG POST STAB KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5532-P-316,SUP,Custom 27803010,,5532-P-316  -  INSERT TIBIAL 3 16MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5532-P-319,SUP,Custom 27803010,,5532-P-319  -  INSERT TIBIAL 3 19MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5532-P-322,SUP,Custom 27803010,,5532-P-322  -  INSERT TIBIAL 3 22MM POSTERIOR STABILIZE TRIATHLON KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5532-P-325,SUP,Custom 27803010,,5532-P-325  -  INSERT TIBIAL 3 25MM POSTERIOR STABILIZE TRIATHLON KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5532-P-409,SUP,Custom 27803010,,5532-P-409  -  INSERT TIBIAL 4 9MM POSTERIOR STABILIZE BEARING TRIATHLON,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5532-P-410,SUP,HCPCS C1776,,5532-P-410  -  INSERT TIB 4 10MM STRL LF TRTHLN BRNG POST STAB KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5532-P-411,SUP,Custom 27803010,,5532-P-411  -  INSERT TIBIAL 4 11MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5532-P-412,SUP,HCPCS C1776,,5532-P-412  -  INSERT TIB 4 12MM STRL LF TRTHLN BRNG POST STAB KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5532-P-413,SUP,Custom 27803010,,5532-P-413  -  INSERT TIBIAL 4 13MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5532-P-416,SUP,Custom 27803010,,5532-P-416  -  INSERT TIBIAL 4 16MM POSTERIOR STABILIZE BEARING TRIATHLON,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5532-P-419,SUP,Custom 27803010,,5532-P-419  -  INSERT TIBIAL 4 19MM POSTERIOR STABILIZE BEARING TRIATHLON,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5532-P-422,SUP,Custom 27803010,,5532-P-422  -  INSERT TIBIAL 4 22MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5532-P-425,SUP,Custom 27803010,,5532-P-425  -  INSERT TIBIAL 4 25MM POSTERIOR STABILIZE TRIATHLON KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5532-P-509,SUP,Custom 27803010,,5532-P-509  -  INSERT TIBIAL 5 9MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5532-P-510,SUP,HCPCS C1776,,5532-P-510  -  INSERT TIB 5 10MM STRL LF TRTHLN BRNG POST STAB KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5532-P-511,SUP,Custom 27803010,,5532-P-511  -  INSERT TIBIAL 5 11MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5532-P-512,SUP,HCPCS C1776,,5532-P-512  -  INSERT TIB 5 12MM STRL LF TRTHLN BRNG POST STAB KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5532-P-513,SUP,Custom 27803010,,5532-P-513  -  INSERT TIBIAL 5 13MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5532-P-514,SUP,HCPCS C1776,,5532-P-514  -  INSERT TIB 5 14MM STRL LF TRTHLN BRNG POST STAB KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5532-P-516,SUP,Custom 27803010,,5532-P-516  -  INSERT TIBIAL 5 16MM POSTERIOR STABILIZED PRIM TRIATHLON,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5532-P-519,SUP,Custom 27803010,,5532-P-519  -  INSERT TIBIAL 5 P 19MM POSTERIOR STABILIZE TRIATHLON N2/VAC,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5532-P-522,SUP,Custom 27803010,,5532-P-522  -  INSERT TIBIAL 5 22MM POSTERIOR STABILIZE TRIATHLON KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5532-P-525,SUP,Custom 27803010,,5532-P-525  -  INSERT TIBIAL 5 25MM POSTERIOR STABILIZE TRIATHLON KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5532-P-609,SUP,Custom 27803010,,5532-P-609  -  INSERT TIBIAL 6 9IN POSTERIOR STABILIZED PLASMA SPRAY,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5532-P-610,SUP,HCPCS C1776,,5532-P-610  -  INSERT TIB 6 10MM STRL LF TRTHLN BRNG POST STAB KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5532-P-611,SUP,Custom 27803010,,5532-P-611  -  INSERT TIBIAL 6 11MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5532-P-612,SUP,HCPCS C1776,,5532-P-612  -  INSERT TIB 6 12MM STRL LF TRTHLN BRNG POST STAB KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5532-P-613,SUP,Custom 27803010,,5532-P-613  -  INSERT TIBIAL 6 13MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5532-P-614,SUP,HCPCS C1776,,5532-P-614  -  INSERT TIB 6 14MM STRL LF TRTHLN BRNG POST STAB KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5532-P-616,SUP,Custom 27803010,,5532-P-616  -  INSERT TIBIAL 6 16MM POSTERIOR STABILIZE BEARING TRIATHLON,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5532-P-619,SUP,Custom 27803010,,5532-P-619  -  INSERT TIBIAL 6 19MM POSTERIOR STABILIZE TRIATHLON NONSTRL,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5532-P-622,SUP,Custom 27803010,,5532-P-622  -  INSERT TIBIAL 6 22MM POSTERIOR STABILIZE TRIATHLON KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5532-P-625,SUP,Custom 27803010,,5532-P-625  -  INSERT TIBIAL POSTERIOR STABILIZE TRIATHLON,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5532-P-709,SUP,Custom 27803010,,5532-P-709  -  INSERT TIBIAL 7 9MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5532-P-710,SUP,HCPCS C1776,,5532-P-710  -  INSERT TIB 7 10MM STRL LF TRTHLN BRNG POST STAB KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5532-P-711,SUP,Custom 27803010,,5532-P-711  -  INSERT TIBIAL 7 11MM POSTERIOR STABILIZE BEARING TRIATHLON,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5532-P-712,SUP,HCPCS C1776,,5532-P-712  -  INSERT TIB 7 12MM STRL LF TRTHLN BRNG POST STAB KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5532-P-713,SUP,Custom 27803010,,5532-P-713  -  INSERT TIBIAL 13MM POSTERIOR STABILIZE TRIATHLON,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5532-P-714,SUP,HCPCS C1776,,5532-P-714  -  INSERT TIB 7 14MM STRL LF TRTHLN BRNG POST STAB KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5532-P-716,SUP,Custom 27803010,,5532-P-716  -  INSERT TIBIAL 7 16MM POSTERIOR STABILIZE BEARING TRIATHLON,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5532-P-719,SUP,Custom 27803010,,5532-P-719  -  INSERT TIBIAL 7 19MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5532-P-722,SUP,Custom 27803010,,5532-P-722  -  INSERT TIBIAL 7 22MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5532-P-725,SUP,Custom 27803010,,5532-P-725  -  INSERT TIBIAL 7 25MM POSTERIOR STABILIZE TRIATHLON KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5532-P-809,SUP,Custom 27803010,,5532-P-809  -  INSERT TIBIAL 8 9MM POSTERIOR STABILIZE BEARING TRIATHLON,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5532-P-810,SUP,HCPCS C1776,,5532-P-810  -  INSERT TIB 8 10MM STRL LF TRTHLN BRNG POST STAB KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5532-P-811,SUP,Custom 27803010,,5532-P-811  -  INSERT TIBIAL 8 11MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5532-P-812,SUP,HCPCS C1776,,5532-P-812  -  INSERT TIB 8 12MM STRL LF TRTHLN BRNG POST STAB KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5532-P-813,SUP,Custom 27803010,,5532-P-813  -  INSERT TIBIAL 8 13MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5532-P-814,SUP,HCPCS C1776,,5532-P-814  -  INSERT TIB 8 14MM STRL LF TRTHLN BRNG POST STAB KN,"$1,200.00",$0.00,"$1,200.00",$540.00,$856.44,$0.00,$206.75,$0.00,$0.00,$210.11,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$187.80,$0.00,$191.04,$0.00
5532-P-816,SUP,Custom 27803010,,5532-P-816  -  INSERT TIBIAL 8 16MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5532-P-819,SUP,Custom 27803010,,5532-P-819  -  INSERT TIBIAL 8 19MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5532-P-822,SUP,Custom 27803010,,5532-P-822  -  INSERT TIBIAL 8 22MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5532-P-825,SUP,Custom 27803010,,5532-P-825  -  INSERT TIBIAL 8 25MM POSTERIOR STABILIZED BEARING TRIATHLON,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
5534-A-109,SUP,HCPCS C1776,,5534-A-109  -  COMPONENT TIB 1 9MM CRCTE STAB ALL PE KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5534-A-111,SUP,HCPCS C1776,,5534-A-111  -  INSERT TIB 1 11MM CNDRL STAB ALL PE KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5534-A-113,SUP,HCPCS C1776,,5534-A-113  -  INSERT TIB 1 13MM CNDRL STAB ALL PE KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5534-A-116,SUP,HCPCS C1776,,5534-A-116  -  INSERT TIB 1 16MM CNDRL STAB ALL PE KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5534-A-209,SUP,HCPCS C1776,,5534-A-209  -  INSERT TIB 2 9MM CNDRL STAB ALL PE KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5534-A-211,SUP,HCPCS C1776,,5534-A-211  -  INSERT TIB 2 11MM CNDRL STAB ALL PE KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5534-A-213,SUP,HCPCS C1776,,5534-A-213  -  INSERT TIB 2 13MM CNDRL STAB ALL PE KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5534-A-216,SUP,HCPCS C1776,,5534-A-216  -  INSERT TIB 2 16MM CNDRL STAB ALL PE KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5534-A-309,SUP,HCPCS C1776,,5534-A-309  -  INSERT TIB 3 9MM CNDRL STAB ALL PE KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5534-A-311,SUP,HCPCS C1776,,5534-A-311  -  INSERT TIB 3 11MM CNDRL STAB ALL PE KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5534-A-313,SUP,HCPCS C1776,,5534-A-313  -  COMPONENT TIB 3 13MM CRCTE STAB ALL PE KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5534-A-316,SUP,HCPCS C1776,,5534-A-316  -  COMPONENT TIB 3 16MM CRCTE STAB ALL PE KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5534-A-409,SUP,HCPCS C1776,,5534-A-409  -  INSERT TIB 4 9MM CNDRL STAB ALL PE KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5534-A-411,SUP,HCPCS C1776,,5534-A-411  -  INSERT TIB 4 11MM CNDRL STAB ALL PE KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5534-A-413,SUP,HCPCS C1776,,5534-A-413  -  INSERT TIB 4 13MM CNDRL STAB ALL PE KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5534-A-416,SUP,HCPCS C1776,,5534-A-416  -  COMPONENT TIB 4 16MM CRCTE STAB ALL PE KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5534-A-509,SUP,HCPCS C1776,,5534-A-509  -  INSERT TIB 5 9MM CNDRL STAB ALL PE KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5534-A-511,SUP,HCPCS C1776,,5534-A-511  -  INSERT TIB 5 11MM CNDRL STAB ALL PE KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5534-A-513,SUP,HCPCS C1776,,5534-A-513  -  TRAY TIB 5 13MM STRL TRTHLN CNDRL STAB ALPLY KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5534-A-516,SUP,HCPCS C1776,,5534-A-516  -  INSERT TIB 5 16MM CNDRL STAB ALL PE KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5534-A-609,SUP,HCPCS C1776,,5534-A-609  -  INSERT TIB 6 9MM CNDRL STAB ALL PE KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5534-A-611,SUP,HCPCS C1776,,5534-A-611  -  INSERT TIB 6 11MM CNDRL STAB ALL PE KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5534-A-613,SUP,HCPCS C1776,,5534-A-613  -  INSERT TIB 6 13MM CNDRL STAB ALL PE KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5534-A-616,SUP,HCPCS C1776,,5534-A-616  -  INSERT TIB 6 16MM CNDRL STAB ALL PE KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5534-A-709,SUP,HCPCS C1776,,5534-A-709  -  INSERT TIB 7 9MM CNDRL STAB ALL PE KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5534-A-711,SUP,HCPCS C1776,,5534-A-711  -  INSERT TIB 7 11MM CNDRL STAB ALL PE KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5534-A-713,SUP,HCPCS C1776,,5534-A-713  -  INSERT TIB 7 13MM CNDRL STAB ALL PE KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5534-A-716,SUP,HCPCS C1776,,5534-A-716  -  TRAY TIB 7 16MM STRL TRTHLN CNDRL STAB ALPLY KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5534-A-809,SUP,HCPCS C1776,,5534-A-809  -  INSERT TIB 8 9MM CNDRL STAB ALL PE KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5534-A-811,SUP,HCPCS C1776,,5534-A-811  -  INSERT TIB 8 11MM CNDRL STAB ALL PE KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5534-A-813,SUP,HCPCS C1776,,5534-A-813  -  INSERT TIB 8 13MM CNDRL STAB ALL PE KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5534-A-816,SUP,HCPCS C1776,,5534-A-816  -  INSERT TIB 8 16MM CNDRL STAB ALL PE KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5535-A-109,SUP,HCPCS C1776,,5535-A-109  -  INSERT TIB 1 9MM POST STAB ALL PE KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5535-A-111,SUP,HCPCS C1776,,5535-A-111  -  INSERT TIB 1 11MM POST STAB ALL PE KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5535-A-113,SUP,HCPCS C1776,,5535-A-113  -  INSERT TIB 1 13MM POST STAB ALL PE KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5535-A-116,SUP,HCPCS C1776,,5535-A-116  -  INSERT TIB 1 16MM POST STAB ALL PE KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5535-A-209,SUP,HCPCS C1776,,5535-A-209  -  INSERT TIB 2 9MM POST STAB ALL PE KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5535-A-211,SUP,HCPCS C1776,,5535-A-211  -  INSERT TIB 2 11MM POST STAB ALL PE KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5535-A-213,SUP,HCPCS C1776,,5535-A-213  -  INSERT TIB 2 13MM POST STAB ALL PE KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5535-A-216,SUP,HCPCS C1776,,5535-A-216  -  INSERT TIB 2 16MM POST STAB ALL PE KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5535-A-309,SUP,HCPCS C1776,,5535-A-309  -  INSERT TIB 3 9MM POST STAB ALL PE KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5535-A-311,SUP,HCPCS C1776,,5535-A-311  -  COMPONENT TIB 3 11MM POST STAB PE,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5535-A-313,SUP,HCPCS C1776,,5535-A-313  -  INSERT TIB 3 13MM POST STAB ALL PE KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5535-A-316,SUP,HCPCS C1776,,5535-A-316  -  INSERT TIB 3 16MM POST STAB ALL PE KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5535-A-409,SUP,HCPCS C1776,,5535-A-409  -  INSERT TIB 4 9MM POST STAB ALL PE KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5535-A-411,SUP,HCPCS C1776,,5535-A-411  -  COMPONENT TIB 4 11MM POST STAB ALPLY KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5535-A-413,SUP,HCPCS C1776,,5535-A-413  -  TRAY TIB 4 13MM STRL TRTHLN POST STAB ALPLY KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5535-A-416,SUP,HCPCS C1776,,5535-A-416  -  INSERT TIB 4 16MM POST STAB ALL PE KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5535-A-509,SUP,HCPCS C1776,,5535-A-509  -  INSERT TIB 5 9MM POST STAB ALL PE KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5535-A-511,SUP,HCPCS C1776,,5535-A-511  -  COMPONENT TIB 5 11MM POST STAB ALPLY KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5535-A-513,SUP,HCPCS C1776,,5535-A-513  -  INSERT TIB 5 13MM POST STAB ALL PE KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5535-A-516,SUP,HCPCS C1776,,5535-A-516  -  INSERT TIB 5 16MM POST STAB ALL PE KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5535-A-609,SUP,HCPCS C1776,,5535-A-609  -  COMPONENT TIB 6 9MM POST STAB PE,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5535-A-611,SUP,HCPCS C1776,,5535-A-611  -  COMPONENT TIB 6 11MM POST STAB PE,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5535-A-613,SUP,HCPCS C1776,,5535-A-613  -  INSERT TIB 6 13MM POST STAB ALL PE KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5535-A-616,SUP,HCPCS C1776,,5535-A-616  -  INSERT TIB 6 16MM POST STAB ALL PE KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5535-A-709,SUP,HCPCS C1776,,5535-A-709  -  TRAY TIB 7 9MM STRL TRTHLN POST STAB ALPLY KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5535-A-711,SUP,HCPCS C1776,,5535-A-711  -  INSERT TIB 7 11MM POST STAB ALL PE KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5535-A-713,SUP,HCPCS C1776,,5535-A-713  -  INSERT TIB 7 13MM POST STAB ALL PE KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5535-A-716,SUP,HCPCS C1776,,5535-A-716  -  INSERT TIB 7 16MM POST STAB ALL PE KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5535-A-809,SUP,HCPCS C1776,,5535-A-809  -  INSERT TIB 8 9MM POST STAB ALL PE KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5535-A-811,SUP,HCPCS C1776,,5535-A-811  -  INSERT TIB 8 11MM POST STAB ALL PE KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5535-A-813,SUP,HCPCS C1776,,5535-A-813  -  INSERT TIB 8 13MM POST STAB ALL PE KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5535-A-816,SUP,HCPCS C1776,,5535-A-816  -  INSERT TIB 8 16MM POST STAB ALL PE KN,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
5536-B-100,SUP,HCPCS C1776,,5536-B-100  -  BASEPLATE TIB 1 7MM 40X40MM 61MM TRTHLN 4 CRFRM PG KEEL,"$3,602.50",$0.00,"$3,602.50","$1,621.13","$2,571.10",$0.00,$620.69,$0.00,$0.00,$630.77,"$3,602.50",$0.00,"$1,801.25","$2,853.18","$2,882.00",$0.00,$563.79,$0.00,$573.52,$0.00
5536-B-200,SUP,HCPCS C1776,,5536-B-200  -  COMPONENT TIB 2 STRL LF TRTHLN KN,"$3,602.50",$0.00,"$3,602.50","$1,621.13","$2,571.10",$0.00,$620.69,$0.00,$0.00,$630.77,"$3,602.50",$0.00,"$1,801.25","$2,853.18","$2,882.00",$0.00,$563.79,$0.00,$573.52,$0.00
5536-B-300,SUP,HCPCS C1776,,5536-B-300  -  BASEPLATE TIB 3 TRTHLN TRITANIUM KN,"$3,602.50",$0.00,"$3,602.50","$1,621.13","$2,571.10",$0.00,$620.69,$0.00,$0.00,$630.77,"$3,602.50",$0.00,"$1,801.25","$2,853.18","$2,882.00",$0.00,$563.79,$0.00,$573.52,$0.00
5536-B-400,SUP,HCPCS C1776,,5536-B-400  -  BASEPLATE TIB 4 TRTHLN TRITANIUM KN,"$3,602.50",$0.00,"$3,602.50","$1,621.13","$2,571.10",$0.00,$620.69,$0.00,$0.00,$630.77,"$3,602.50",$0.00,"$1,801.25","$2,853.18","$2,882.00",$0.00,$563.79,$0.00,$573.52,$0.00
5536-B-500,SUP,HCPCS C1776,,5536-B-500  -  BASEPLATE TIB 5 TRTHLN TRITANIUM KN,"$3,602.50",$0.00,"$3,602.50","$1,621.13","$2,571.10",$0.00,$620.69,$0.00,$0.00,$630.77,"$3,602.50",$0.00,"$1,801.25","$2,853.18","$2,882.00",$0.00,$563.79,$0.00,$573.52,$0.00
5536-B-600,SUP,HCPCS C1776,,5536-B-600  -  BASEPLATE TIB 6 TRTHLN TRITANIUM KN,"$3,602.50",$0.00,"$3,602.50","$1,621.13","$2,571.10",$0.00,$620.69,$0.00,$0.00,$630.77,"$3,602.50",$0.00,"$1,801.25","$2,853.18","$2,882.00",$0.00,$563.79,$0.00,$573.52,$0.00
5536-B-700,SUP,HCPCS C1776,,5536-B-700  -  BASEPLATE TIB 7 TRTHLN TRITANIUM KN,"$3,602.50",$0.00,"$3,602.50","$1,621.13","$2,571.10",$0.00,$620.69,$0.00,$0.00,$630.77,"$3,602.50",$0.00,"$1,801.25","$2,853.18","$2,882.00",$0.00,$563.79,$0.00,$573.52,$0.00
5536-B-800,SUP,HCPCS C1776,,5536-B-800  -  BASEPLATE TIB 8 TRTHLN TRITANIUM KN,"$3,602.50",$0.00,"$3,602.50","$1,621.13","$2,571.10",$0.00,$620.69,$0.00,$0.00,$630.77,"$3,602.50",$0.00,"$1,801.25","$2,853.18","$2,882.00",$0.00,$563.79,$0.00,$573.52,$0.00
5537-14/13,SUP,HCPCS C1776,,5537-14/13  -  STEM HUMERAL 14MM 135MM PRESS FIT HUMERAL TITANIUM SHOULDER,"$6,566.70",$0.00,"$6,566.70","$2,955.02","$4,686.65",$0.00,"$1,131.41",$0.00,$0.00,"$1,149.78","$6,566.70",$0.00,"$3,283.35","$5,200.83","$5,253.36",$0.00,"$1,027.69",$0.00,"$1,045.42",$0.00
5537-G-109,SUP,HCPCS C1776,,5537-G-109  -  INSERT TIBIAL 1 9MM TOT STABILIZE PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-109-E,SUP,HCPCS C1776,,5537-G-109-E  -  INSERT TIB 1 9MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-111,SUP,HCPCS C1776,,5537-G-111  -  INSERT TIBIAL 1 11MM TOT STABILIZE PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-111-E,SUP,HCPCS C1776,,5537-G-111-E  -  INSERT TIB 1 11MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-113,SUP,HCPCS C1776,,5537-G-113  -  INSERT TIBIAL 1 13MM TOT STABILIZE PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-113-E,SUP,HCPCS C1776,,5537-G-113-E  -  INSERT TIB 1 13MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-116,SUP,HCPCS C1776,,5537-G-116  -  INSERT TIBIAL 1 16MM TOT STABILIZE PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-116-E,SUP,HCPCS C1776,,5537-G-116-E  -  INSERT TIB 1 16MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-119,SUP,HCPCS C1776,,5537-G-119  -  INSERT TIBIAL 1 19MM TOT STABILIZE PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-119-E,SUP,HCPCS C1776,,5537-G-119-E  -  INSERT TIB 1 19MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-122,SUP,HCPCS C1776,,5537-G-122  -  INSERT TIBIAL 1 22MM TOT STABILIZE PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-122-E,SUP,HCPCS C1776,,5537-G-122-E  -  INSERT TIB 1 22MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-125,SUP,HCPCS C1776,,5537-G-125  -  INSERT TIBIAL 1 25MM TOT STABILIZE PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-125-E,SUP,HCPCS C1776,,5537-G-125-E  -  INSERT TIB 1 25MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-128,SUP,HCPCS C1776,,5537-G-128  -  INSERT TIBIAL 1 28MM TOT STABILIZE PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-128-E,SUP,HCPCS C1776,,5537-G-128-E  -  INSERT TIB 1 28MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-131,SUP,HCPCS C1776,,5537-G-131  -  INSERT TIBIAL 1 31MM TOT STABILIZE PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-131-E,SUP,HCPCS C1776,,5537-G-131-E  -  INSERT TIB 1 31MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-209,SUP,HCPCS C1776,,5537-G-209  -  INSERT TIBIAL 2 9MM TOT STABILIZE PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-209-E,SUP,HCPCS C1776,,5537-G-209-E  -  INSERT TIB 2 9MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-211,SUP,HCPCS C1776,,5537-G-211  -  INSERT TIBIAL 2 11MM TOT STABILIZE PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-211-E,SUP,HCPCS C1776,,5537-G-211-E  -  INSERT TIB 2 11MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-213,SUP,HCPCS C1776,,5537-G-213  -  INSERT TIBIAL 2 13MM TOT STABILIZE PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-213-E,SUP,HCPCS C1776,,5537-G-213-E  -  INSERT TIB 2 13MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-216,SUP,HCPCS C1776,,5537-G-216  -  INSERT TIBIAL 2 16MM TOT STABILIZE PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-216-E,SUP,HCPCS C1776,,5537-G-216-E  -  INSERT TIB 2 16MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-219,SUP,HCPCS C1776,,5537-G-219  -  INSERT TIBIAL 2 19MM TOT STABILIZE PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-219-E,SUP,HCPCS C1776,,5537-G-219-E  -  INSERT TIB 2 19MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-222,SUP,HCPCS C1776,,5537-G-222  -  INSERT TIBIAL 2 22MM TOT STABILIZE PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-222-E,SUP,HCPCS C1776,,5537-G-222-E  -  INSERT TIB 2 22MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-225,SUP,HCPCS C1776,,5537-G-225  -  INSERT TIBIAL 2 25MM TOT STABILIZE PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-225-E,SUP,HCPCS C1776,,5537-G-225-E  -  INSERT TIB 2 25MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-228,SUP,HCPCS C1776,,5537-G-228  -  INSERT TIBIAL 2 28MM TOT STABILIZE PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-228-E,SUP,HCPCS C1776,,5537-G-228-E  -  INSERT TIB 2 28MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-231,SUP,HCPCS C1776,,5537-G-231  -  INSERT TIBIAL 2 31MM TOT STABILIZE PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-231-E,SUP,HCPCS C1776,,5537-G-231-E  -  INSERT TIB 2 31MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-309,SUP,HCPCS C1776,,5537-G-309  -  INSERT TIBIAL 2 31MM TOT STABILIZE PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-309-E,SUP,HCPCS C1776,,5537-G-309-E  -  INSERT TIB 3 9MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-311,SUP,HCPCS C1776,,5537-G-311  -  INSERT TIBIAL 3 11MM TOT STABILIZED PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-311-E,SUP,HCPCS C1776,,5537-G-311-E  -  INSERT TIB 3 11MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-313,SUP,HCPCS C1776,,5537-G-313  -  INSERT TIBIAL 3 13MM TOT STABILIZE PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-313-E,SUP,HCPCS C1776,,5537-G-313-E  -  INSERT TIB 3 13MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-316,SUP,HCPCS C1776,,5537-G-316  -  INSERT TIBIAL 3 16MM TOT STABILIZED PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-316-E,SUP,HCPCS C1776,,5537-G-316-E  -  INSERT TIB 3 16MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-319,SUP,HCPCS C1776,,5537-G-319  -  INSERT TIBIAL 3 19MM TOT STABILIZED PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-319-E,SUP,HCPCS C1776,,5537-G-319-E  -  INSERT TIB 3 19MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-322,SUP,HCPCS C1776,,5537-G-322  -  INSERT TIBIAL 3 13MM TOT STABILIZE PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-322-E,SUP,HCPCS C1776,,5537-G-322-E  -  INSERT TIB 3 22MM STRL TRTHLN TS + X3 KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-325,SUP,HCPCS C1776,,5537-G-325  -  INSERT TIBIAL 3 25MM TOT STABILIZED PLUS TRIATHLON X3,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-325-E,SUP,HCPCS C1776,,5537-G-325-E  -  INSERT TIB 3 25MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-328,SUP,HCPCS C1776,,5537-G-328  -  INSERT TIBIAL 3 28MM TOT STABILIZE PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-328-E,SUP,HCPCS C1776,,5537-G-328-E  -  INSERT TIB 3 28MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-331,SUP,HCPCS C1776,,5537-G-331  -  INSERT TIBIAL 3 31MM TOT STABILIZE PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-331-E,SUP,HCPCS C1776,,5537-G-331-E  -  INSERT TIB 3 31MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-409,SUP,HCPCS C1776,,5537-G-409  -  INSERT TIBIAL 4 9MM TOT STABILIZE PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-409-E,SUP,HCPCS C1776,,5537-G-409-E  -  INSERT TIB 4 9MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-411,SUP,HCPCS C1776,,5537-G-411  -  INSERT TIBIAL 4 11MM TOT STABILIZED PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-411-E,SUP,HCPCS C1776,,5537-G-411-E  -  INSERT TIB 4 11MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-413,SUP,HCPCS C1776,,5537-G-413  -  INSERT TIBIAL 4 13MM TOT STABILIZED PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-413-E,SUP,HCPCS C1776,,5537-G-413-E  -  INSERT TIB 4 13MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-416,SUP,HCPCS C1776,,5537-G-416  -  INSERT TIBIAL 4 16MM TOT STABILIZE PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-416-E,SUP,HCPCS C1776,,5537-G-416-E  -  INSERT TIB 4 16MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-419,SUP,HCPCS C1776,,5537-G-419  -  INSERT TIBIAL 4 19MM TOT STABILIZE PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-419-E,SUP,HCPCS C1776,,5537-G-419-E  -  INSERT TIB 4 19MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-422,SUP,HCPCS C1776,,5537-G-422  -  INSERT TIBIAL 4 22MM TOT STABILIZE PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-422-E,SUP,HCPCS C1776,,5537-G-422-E  -  INSERT TIB 4 22MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-425,SUP,HCPCS C1776,,5537-G-425  -  INSERT TIBIAL 4 25MM TOT STABILIZED PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-425-E,SUP,HCPCS C1776,,5537-G-425-E  -  INSERT TIB 4 25MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-428,SUP,HCPCS C1776,,5537-G-428  -  INSERT TIBIAL 4 28MM TOT STABILIZED PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-428-E,SUP,HCPCS C1776,,5537-G-428-E  -  INSERT TIB 4 28MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-431,SUP,HCPCS C1776,,5537-G-431  -  INSERT TIBIAL 4 31MM TOT STABILIZE PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-431-E,SUP,HCPCS C1776,,5537-G-431-E  -  INSERT TIB 4 31MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-509,SUP,HCPCS C1776,,5537-G-509  -  INSERT TIBIAL 5 9MM TOT STABILIZE PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-509-E,SUP,HCPCS C1776,,5537-G-509-E  -  INSERT TIB 5 9MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-511,SUP,HCPCS C1776,,5537-G-511  -  INSERT TIBIAL 5 11MM TOT STABILIZE PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-511-E,SUP,HCPCS C1776,,5537-G-511-E  -  INSERT TIB 5 11MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-513,SUP,HCPCS C1776,,5537-G-513  -  INSERT TIBIAL 5 13MM TOT STABILIZE PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-513-E,SUP,HCPCS C1776,,5537-G-513-E  -  INSERT TIB 5 13MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-516,SUP,HCPCS C1776,,5537-G-516  -  INSERT TIBIAL 5 16MM TOT STABILIZE PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-516-E,SUP,HCPCS C1776,,5537-G-516-E  -  INSERT TIB 5 16MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-519,SUP,HCPCS C1776,,5537-G-519  -  INSERT TIBIAL 5 19MM TOT STABILIZE PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-519-E,SUP,HCPCS C1776,,5537-G-519-E  -  INSERT TIB 5 19MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-522,SUP,HCPCS C1776,,5537-G-522  -  INSERT TIBIAL 5 22MM TOT STABILIZE PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-522-E,SUP,HCPCS C1776,,5537-G-522-E  -  INSERT TIB 5 22MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-525,SUP,HCPCS C1776,,5537-G-525  -  INSERT TIBIAL 5 25MM TOT STABILIZE PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-525-E,SUP,HCPCS C1776,,5537-G-525-E  -  INSERT TIB 5 25MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-528,SUP,HCPCS C1776,,5537-G-528  -  INSERT TIBIAL 5 28MM TOT STABILIZE PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-528-E,SUP,HCPCS C1776,,5537-G-528-E  -  INSERT TIB 5 28MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-531,SUP,HCPCS C1776,,5537-G-531  -  INSERT TIBIAL 5 31MM TOT STABILIZE PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-531-E,SUP,HCPCS C1776,,5537-G-531-E  -  INSERT TIB 5 31MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-609,SUP,HCPCS C1776,,5537-G-609  -  INSERT TIBIAL 6 9MM TOT STABILIZE PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-609-E,SUP,HCPCS C1776,,5537-G-609-E  -  INSERT TIB 6 9MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-611,SUP,HCPCS C1776,,5537-G-611  -  INSERT TIBIAL 6 11MM TOT STABILIZE PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-611-E,SUP,HCPCS C1776,,5537-G-611-E  -  INSERT TIB 6 11MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-613,SUP,HCPCS C1776,,5537-G-613  -  INSERT TIBIAL 6 13MM TOT STABILIZE PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-613-E,SUP,HCPCS C1776,,5537-G-613-E  -  INSERT TIB 6 13MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-616,SUP,HCPCS C1776,,5537-G-616  -  INSERT TIBIAL 6 16MM TOT STABILIZE PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-616-E,SUP,HCPCS C1776,,5537-G-616-E  -  INSERT TIB 6 16MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-619,SUP,HCPCS C1776,,5537-G-619  -  INSERT TIBIAL 6 19MM TOT STABILIZED PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-619-E,SUP,HCPCS C1776,,5537-G-619-E  -  INSERT TIB 6 19MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-622,SUP,HCPCS C1776,,5537-G-622  -  INSERT TIBIAL 6 22MM TOT STABILIZE PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-622-E,SUP,HCPCS C1776,,5537-G-622-E  -  INSERT TIB 6 22MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-625,SUP,HCPCS C1776,,5537-G-625  -  INSERT TIBIAL 6 25MM TOT STABILIZE PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-625-E,SUP,HCPCS C1776,,5537-G-625-E  -  INSERT TIB 6 25MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-628,SUP,HCPCS C1776,,5537-G-628  -  INSERT TIBIAL 6 28MM TOT STABILIZE PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-628-E,SUP,HCPCS C1776,,5537-G-628-E  -  INSERT TIB 6 28MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-631,SUP,HCPCS C1776,,5537-G-631  -  INSERT TIBIAL 6 31MM TOT STABILIZE PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-631-E,SUP,HCPCS C1776,,5537-G-631-E  -  INSERT TIB 6 31MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-709,SUP,HCPCS C1776,,5537-G-709  -  INSERT TIBIAL 7 9MM TOT STABILIZE PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-709-E,SUP,HCPCS C1776,,5537-G-709-E  -  INSERT TIB 7 9MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-711,SUP,HCPCS C1776,,5537-G-711  -  INSERT TIBIAL 7 11MM TOT STABILIZE PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-711-E,SUP,HCPCS C1776,,5537-G-711-E  -  INSERT TIB 7 11MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-713,SUP,HCPCS C1776,,5537-G-713  -  INSERT TIBIAL 7 13MM TOT STABILIZE PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-713-E,SUP,HCPCS C1776,,5537-G-713-E  -  INSERT TIB 7 13MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-716,SUP,HCPCS C1776,,5537-G-716  -  INSERT TIBIAL 7 16MM TOT STABILIZE PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-716-E,SUP,HCPCS C1776,,5537-G-716-E  -  INSERT TIB 7 16MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-719,SUP,HCPCS C1776,,5537-G-719  -  INSERT TIBIAL 7 19MM TOT STABILIZE TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-719-E,SUP,HCPCS C1776,,5537-G-719-E  -  INSERT TIB 7 19MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-722,SUP,HCPCS C1776,,5537-G-722  -  INSERT TIBIAL 7 22MM TOT STABILIZE PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-722-E,SUP,HCPCS C1776,,5537-G-722-E  -  INSERT TIB 7 22MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-725,SUP,HCPCS C1776,,5537-G-725  -  INSERT TIBIAL 7 25MM TOT STABILIZE PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-725-E,SUP,HCPCS C1776,,5537-G-725-E  -  INSERT TIB 7 25MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-728,SUP,HCPCS C1776,,5537-G-728  -  INSERT TIBIAL 7 28MM TOT STABILIZE PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-728-E,SUP,HCPCS C1776,,5537-G-728-E  -  INSERT TIB 7 28MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-731,SUP,HCPCS C1776,,5537-G-731  -  INSERT TIBIAL 7 31MM TOT STABILIZE PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-731-E,SUP,HCPCS C1776,,5537-G-731-E  -  INSERT TIB 7 31MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-809,SUP,HCPCS C1776,,5537-G-809  -  INSERT TIBIAL 8 9MM TOT STABILIZE PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-809-E,SUP,HCPCS C1776,,5537-G-809-E  -  INSERT TIB 8 9MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-811,SUP,HCPCS C1776,,5537-G-811  -  INSERT TIBIAL 8 11MM TOT STABILIZE PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-811-E,SUP,HCPCS C1776,,5537-G-811-E  -  INSERT TIB 8 11MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-813,SUP,HCPCS C1776,,5537-G-813  -  INSERT TIBIAL 8 13MM TOT STABILIZE PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-813-E,SUP,HCPCS C1776,,5537-G-813-E  -  INSERT TIB 8 13MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-816,SUP,HCPCS C1776,,5537-G-816  -  INSERT TIBIAL 8 16MM TOT STABILIZE PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-816-E,SUP,HCPCS C1776,,5537-G-816-E  -  INSERT TIB 8 16MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-819,SUP,HCPCS C1776,,5537-G-819  -  INSERT TIBIAL 8 19MM TOT STABILIZE PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-819-E,SUP,HCPCS C1776,,5537-G-819-E  -  INSERT TIB 8 19MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-822,SUP,HCPCS C1776,,5537-G-822  -  INSERT TIBIAL 8 22MM TOT STABILIZE PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-822-E,SUP,HCPCS C1776,,5537-G-822-E  -  INSERT TIB 8 22MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-825,SUP,HCPCS C1776,,5537-G-825  -  INSERT TIBIAL 8 25MM TOT STABILIZE PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-825-E,SUP,HCPCS C1776,,5537-G-825-E  -  INSERT TIB 8 25MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-828,SUP,HCPCS C1776,,5537-G-828  -  INSERT TIBIAL 8 28MM TOT STABILIZE PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-828-E,SUP,HCPCS C1776,,5537-G-828-E  -  INSERT TIB 8 28MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-831,SUP,HCPCS C1776,,5537-G-831  -  INSERT TIBIAL 8 31MM TOT STABILIZE PLUS TRIATHLON X3 KNEE,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5537-G-831-E,SUP,HCPCS C1776,,5537-G-831-E  -  INSERT TIB 8 31MM STRL TRTHLN TS + KN,"$5,255.00",$0.00,"$5,255.00","$2,364.75","$3,750.49",$0.00,$905.41,$0.00,$0.00,$920.11,"$5,255.00",$0.00,"$2,627.50","$4,161.96","$4,204.00",$0.00,$822.41,$0.00,$836.60,$0.00
5539-91,SUP,HCPCS C1725,,CATHETER ANGIO .035IN 5FR .052IN 90CM PGTL FLSH 10 SDPRT,$33.75,$0.00,$33.75,$18.33,$24.09,$0.00,$5.81,$0.00,$0.00,$5.91,$33.75,$0.00,$16.88,$26.73,$27.00,$0.00,$5.28,$0.00,$5.37,$0.00
5540-14/13,SUP,HCPCS C1776,,5540-14/13  -  STEM HUMERAL 14MM 135MM PRESS FIT TITANIUM HA STERILE,"$6,943.00",$0.00,"$6,943.00","$3,124.35","$4,955.22",$0.00,"$1,196.24",$0.00,$0.00,"$1,215.66","$6,943.00",$0.00,"$3,471.50","$5,498.86","$5,554.40",$0.00,"$1,086.58",$0.00,"$1,105.33",$0.00
5540-A-101,SUP,Custom 27803010,,5540-A-101  -  AUGMENT FEMORAL 1 5MM TOT STABILIZE TRIATHLON KNEE LEFT,"$2,237.50",$0.00,"$2,237.50",$0.00,"$1,596.90",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$0.00,$0.00,$0.00,$0.00
5540-A-102,SUP,Custom 27803010,,5540-A-102  -  AUGMENT FEMORAL 1 5MM TOT STABILIZE TRIATHLON KNEE RIGHT,"$2,237.50",$0.00,"$2,237.50",$0.00,"$1,596.90",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$0.00,$0.00,$0.00,$0.00
5540-A-201,SUP,Custom 27803010,,5540-A-201  -  AUGMENT FEMORAL 2 5MM TOT STABILIZE TRIATHLON KNEE LEFT,"$2,237.50",$0.00,"$2,237.50",$0.00,"$1,596.90",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$0.00,$0.00,$0.00,$0.00
5540-A-202,SUP,Custom 27803010,,5540-A-202  -  AUGMENT FEMORAL 2 5MM TOT STABILIZE TRIATHLON KNEE RIGHT,"$2,237.50",$0.00,"$2,237.50",$0.00,"$1,596.90",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$0.00,$0.00,$0.00,$0.00
5540-A-301,SUP,Custom 27803010,,5540-A-301  -  AUGMENT FEMORAL 3 5MM TOT STABILIZE TRIATHLON KNEE LEFT,"$2,237.50",$0.00,"$2,237.50",$0.00,"$1,596.90",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$0.00,$0.00,$0.00,$0.00
5540-A-302,SUP,Custom 27803010,,5540-A-302  -  AUGMENT FEMORAL 3 5MM TOT STABILIZED TRIATHLON RIGHT DISTAL,"$2,237.50",$0.00,"$2,237.50",$0.00,"$1,596.90",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$0.00,$0.00,$0.00,$0.00
5540-A-401,SUP,Custom 27803010,,5540-A-401  -  AUGMENT FEMORAL 4 5MM TOT STABILIZE TRIATHLON KNEE LEFT,"$2,237.50",$0.00,"$2,237.50",$0.00,"$1,596.90",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$0.00,$0.00,$0.00,$0.00
5540-A-402,SUP,Custom 27803010,,5540-A-402  -  AUGMENT FEMORAL 4 5MM TOT STABILIZED TRIATHLON RIGHT DISTAL,"$2,237.50",$0.00,"$2,237.50",$0.00,"$1,596.90",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$0.00,$0.00,$0.00,$0.00
5540-A-501,SUP,Custom 27803010,,5540-A-501  -  AUGMENT FEMORAL 5 5MM TOT STABILIZE TRIATHLON KNEE LEFT,"$2,237.50",$0.00,"$2,237.50",$0.00,"$1,596.90",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$0.00,$0.00,$0.00,$0.00
5540-A-502,SUP,Custom 27803010,,5540-A-502  -  AUGMENT FEMORAL 5 5MM TOT STABILIZE TRIATHLON KNEE RIGHT,"$2,237.50",$0.00,"$2,237.50",$0.00,"$1,596.90",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$0.00,$0.00,$0.00,$0.00
5540-A-601,SUP,Custom 27803010,,5540-A-601  -  AUGMENT FEMORAL 6 5MM TOT STABILIZE TRIATHLON KNEE LEFT,"$2,237.50",$0.00,"$2,237.50",$0.00,"$1,596.90",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$0.00,$0.00,$0.00,$0.00
5540-A-602,SUP,Custom 27803010,,5540-A-602  -  AUGMENT FEMORAL 6 5MM TOT STABILIZE TRIATHLON KNEE RIGHT,"$2,237.50",$0.00,"$2,237.50",$0.00,"$1,596.90",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$0.00,$0.00,$0.00,$0.00
5540-A-701,SUP,Custom 27803010,,5540-A-701  -  AUGMENT FEMORAL 7 5MM TOT STABILIZE TRIATHLON KNEE LEFT,"$2,237.50",$0.00,"$2,237.50",$0.00,"$1,596.90",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$0.00,$0.00,$0.00,$0.00
5540-A-702,SUP,Custom 27803010,,5540-A-702  -  AUGMENT FEMORAL 7 5MM TOT STABILIZE TRIATHLON KNEE RIGHT,"$2,237.50",$0.00,"$2,237.50",$0.00,"$1,596.90",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$0.00,$0.00,$0.00,$0.00
5540-A-801,SUP,Custom 27803010,,5540-A-801  -  AUGMENT FEMORAL 8 5MM TOT STABILIZE TRIATHLON KNEE LEFT,"$2,237.50",$0.00,"$2,237.50",$0.00,"$1,596.90",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$0.00,$0.00,$0.00,$0.00
5540-A-802,SUP,Custom 27803010,,5540-A-802  -  AUGMENT FEMORAL 8 5MM TOT STABILIZE TRIATHLON KNEE RIGHT,"$2,237.50",$0.00,"$2,237.50",$0.00,"$1,596.90",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$0.00,$0.00,$0.00,$0.00
5541-A-101,SUP,Custom 27803010,,5541-A-101  -  AUGMENT FEMORAL 1 10MM TOT STABILIZE TRIATHLON KNEE LEFT,"$2,352.50",$0.00,"$2,352.50",$0.00,"$1,678.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,352.50",$0.00,"$1,176.25","$1,863.18","$1,882.00",$0.00,$0.00,$0.00,$0.00,$0.00
5541-A-102,SUP,Custom 27803010,,5541-A-102  -  AUGMENT FEMORAL 1 10MM TOT STABILIZE TRIATHLON KNEE RIGHT,"$2,352.50",$0.00,"$2,352.50",$0.00,"$1,678.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,352.50",$0.00,"$1,176.25","$1,863.18","$1,882.00",$0.00,$0.00,$0.00,$0.00,$0.00
5541-A-201,SUP,Custom 27803010,,5541-A-201  -  AUGMENT FEMORAL 2 10MM TOT STABILIZE TRIATHLON KNEE LEFT,"$2,352.50",$0.00,"$2,352.50",$0.00,"$1,678.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,352.50",$0.00,"$1,176.25","$1,863.18","$1,882.00",$0.00,$0.00,$0.00,$0.00,$0.00
5541-A-202,SUP,Custom 27803010,,5541-A-202  -  AUGMENT FEMORAL 2 10MM TOT STABILIZE TRIATHLON KNEE RIGHT,"$2,352.50",$0.00,"$2,352.50",$0.00,"$1,678.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,352.50",$0.00,"$1,176.25","$1,863.18","$1,882.00",$0.00,$0.00,$0.00,$0.00,$0.00
5541-A-301,SUP,Custom 27803010,,5541-A-301  -  AUGMENT FEMORAL 3 10MM TOT STABILIZE TRIATHLON KNEE LEFT,"$2,352.50",$0.00,"$2,352.50",$0.00,"$1,678.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,352.50",$0.00,"$1,176.25","$1,863.18","$1,882.00",$0.00,$0.00,$0.00,$0.00,$0.00
5541-A-302,SUP,Custom 27803010,,5541-A-302  -  AUGMENT FEMORAL 3 10MM TOT STABILIZE TRIATHLON KNEE RIGHT,"$2,352.50",$0.00,"$2,352.50",$0.00,"$1,678.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,352.50",$0.00,"$1,176.25","$1,863.18","$1,882.00",$0.00,$0.00,$0.00,$0.00,$0.00
5541-A-401,SUP,Custom 27803010,,5541-A-401  -  AUGMENT FEMORAL 4 10MM TOT STABILIZE TRIATHLON KNEE LEFT,"$2,352.50",$0.00,"$2,352.50",$0.00,"$1,678.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,352.50",$0.00,"$1,176.25","$1,863.18","$1,882.00",$0.00,$0.00,$0.00,$0.00,$0.00
5541-A-402,SUP,Custom 27803010,,5541-A-402  -  AUGMENT FEMORAL 4 10MM TOT STABILIZE TRIATHLON KNEE RIGHT,"$2,352.50",$0.00,"$2,352.50",$0.00,"$1,678.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,352.50",$0.00,"$1,176.25","$1,863.18","$1,882.00",$0.00,$0.00,$0.00,$0.00,$0.00
5541-A-501,SUP,Custom 27803010,,5541-A-501  -  AUGMENT FEMORAL 5 10MM TOT STABILIZE TRIATHLON KNEE LEFT,"$2,352.50",$0.00,"$2,352.50",$0.00,"$1,678.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,352.50",$0.00,"$1,176.25","$1,863.18","$1,882.00",$0.00,$0.00,$0.00,$0.00,$0.00
5541-A-502,SUP,Custom 27803010,,5541-A-502  -  AUGMENT FEMORAL 5 10MM TOT STABILIZE TRIATHLON KNEE RIGHT,"$2,352.50",$0.00,"$2,352.50",$0.00,"$1,678.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,352.50",$0.00,"$1,176.25","$1,863.18","$1,882.00",$0.00,$0.00,$0.00,$0.00,$0.00
5541-A-601,SUP,Custom 27803010,,5541-A-601  -  AUGMENT FEMORAL 6 10MM TOT STABILIZE TRIATHLON KNEE LEFT,"$2,352.50",$0.00,"$2,352.50",$0.00,"$1,678.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,352.50",$0.00,"$1,176.25","$1,863.18","$1,882.00",$0.00,$0.00,$0.00,$0.00,$0.00
5541-A-602,SUP,Custom 27803010,,5541-A-602  -  AUGMENT FEMORAL 6 10MM TOT STABILIZE TRIATHLON KNEE RIGHT,"$2,352.50",$0.00,"$2,352.50",$0.00,"$1,678.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,352.50",$0.00,"$1,176.25","$1,863.18","$1,882.00",$0.00,$0.00,$0.00,$0.00,$0.00
5541-A-701,SUP,Custom 27803010,,5541-A-701  -  AUGMENT FEMORAL 7 10MM TOT STABILIZE TRIATHLON KNEE LEFT,"$2,352.50",$0.00,"$2,352.50",$0.00,"$1,678.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,352.50",$0.00,"$1,176.25","$1,863.18","$1,882.00",$0.00,$0.00,$0.00,$0.00,$0.00
5541-A-702,SUP,Custom 27803010,,5541-A-702  -  AUGMENT FEMORAL 7 10MM TOT STABILIZE TRIATHLON KNEE RIGHT,"$2,352.50",$0.00,"$2,352.50",$0.00,"$1,678.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,352.50",$0.00,"$1,176.25","$1,863.18","$1,882.00",$0.00,$0.00,$0.00,$0.00,$0.00
5541-A-801,SUP,Custom 27803010,,5541-A-801  -  AUGMENT FEMORAL 8 10MM TOT STABILIZE TRIATHLON KNEE LEFT,"$2,352.50",$0.00,"$2,352.50",$0.00,"$1,678.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,352.50",$0.00,"$1,176.25","$1,863.18","$1,882.00",$0.00,$0.00,$0.00,$0.00,$0.00
5541-A-802,SUP,Custom 27803010,,5541-A-802  -  AUGMENT FEMORAL 8 10MM TOT STABILIZE TRIATHLON KNEE RIGHT,"$2,352.50",$0.00,"$2,352.50",$0.00,"$1,678.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,352.50",$0.00,"$1,176.25","$1,863.18","$1,882.00",$0.00,$0.00,$0.00,$0.00,$0.00
5542-A-101,SUP,Custom 27803010,,5542-A-101  -  AUGMENT FEMORAL 1 15MM TOT STABILIZE TRIATHLON KNEE LEFT,"$2,467.50",$0.00,"$2,467.50",$0.00,"$1,761.05",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,467.50",$0.00,"$1,233.75","$1,954.26","$1,974.00",$0.00,$0.00,$0.00,$0.00,$0.00
5542-A-102,SUP,Custom 27803010,,5542-A-102  -  AUGMENT FEMORAL 1 15MM TOT STABILIZE TRIATHLON KNEE RIGHT,"$2,467.50",$0.00,"$2,467.50",$0.00,"$1,761.05",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,467.50",$0.00,"$1,233.75","$1,954.26","$1,974.00",$0.00,$0.00,$0.00,$0.00,$0.00
5542-A-201,SUP,Custom 27803010,,5542-A-201  -  AUGMENT FEMORAL 2 15MM TOT STABILIZE TRIATHLON KNEE LEFT,"$2,467.50",$0.00,"$2,467.50",$0.00,"$1,761.05",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,467.50",$0.00,"$1,233.75","$1,954.26","$1,974.00",$0.00,$0.00,$0.00,$0.00,$0.00
5542-A-202,SUP,Custom 27803010,,5542-A-202  -  AUGMENT FEMORAL 2 15MM TOT STABILIZE TRIATHLON KNEE RIGHT,"$2,467.50",$0.00,"$2,467.50",$0.00,"$1,761.05",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,467.50",$0.00,"$1,233.75","$1,954.26","$1,974.00",$0.00,$0.00,$0.00,$0.00,$0.00
5542-A-301,SUP,Custom 27803010,,5542-A-301  -  AUGMENT FEMORAL 3 15MM TOT STABILIZE TRIATHLON KNEE LEFT,"$2,467.50",$0.00,"$2,467.50",$0.00,"$1,761.05",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,467.50",$0.00,"$1,233.75","$1,954.26","$1,974.00",$0.00,$0.00,$0.00,$0.00,$0.00
5542-A-302,SUP,Custom 27803010,,5542-A-302  -  AUGMENT FEMORAL 3 15MM TOT STABILIZE TRIATHLON KNEE RIGHT,"$2,467.50",$0.00,"$2,467.50",$0.00,"$1,761.05",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,467.50",$0.00,"$1,233.75","$1,954.26","$1,974.00",$0.00,$0.00,$0.00,$0.00,$0.00
5542-A-401,SUP,Custom 27803010,,5542-A-401  -  AUGMENT FEMORAL 4 15MM TOT STABILIZE TRIATHLON KNEE LEFT,"$2,467.50",$0.00,"$2,467.50",$0.00,"$1,761.05",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,467.50",$0.00,"$1,233.75","$1,954.26","$1,974.00",$0.00,$0.00,$0.00,$0.00,$0.00
5542-A-402,SUP,Custom 27803010,,5542-A-402  -  AUGMENT FEMORAL 4 15MM TOT STABILIZE TRIATHLON KNEEL RIGHT,"$2,467.50",$0.00,"$2,467.50",$0.00,"$1,761.05",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,467.50",$0.00,"$1,233.75","$1,954.26","$1,974.00",$0.00,$0.00,$0.00,$0.00,$0.00
5542-A-501,SUP,Custom 27803010,,5542-A-501  -  AUGMENT FEMORAL 5 15MM TOT STABILIZE TRIATHLON KNEE LEFT,"$2,467.50",$0.00,"$2,467.50",$0.00,"$1,761.05",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,467.50",$0.00,"$1,233.75","$1,954.26","$1,974.00",$0.00,$0.00,$0.00,$0.00,$0.00
5542-A-502,SUP,Custom 27803010,,5542-A-502  -  AUGMENT FEMORAL 5 15MM TOT STABILIZE TRIATHLON KNEE RIGHT,"$2,467.50",$0.00,"$2,467.50",$0.00,"$1,761.05",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,467.50",$0.00,"$1,233.75","$1,954.26","$1,974.00",$0.00,$0.00,$0.00,$0.00,$0.00
5542-A-601,SUP,Custom 27803010,,5542-A-601  -  AUGMENT FEMORAL 6 15MM TOT STABILIZE TRIATHLON KNEE LEFT,"$2,467.50",$0.00,"$2,467.50",$0.00,"$1,761.05",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,467.50",$0.00,"$1,233.75","$1,954.26","$1,974.00",$0.00,$0.00,$0.00,$0.00,$0.00
5542-A-602,SUP,Custom 27803010,,5542-A-602  -  AUGMENT FEMORAL 6 15MM TOT STABILIZE TRIATHLON KNEE RIGHT,"$2,467.50",$0.00,"$2,467.50",$0.00,"$1,761.05",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,467.50",$0.00,"$1,233.75","$1,954.26","$1,974.00",$0.00,$0.00,$0.00,$0.00,$0.00
5542-A-701,SUP,Custom 27803010,,5542-A-701  -  AUGMENT FEMORAL 7 15MM TOT STABILIZE TRIATHLON KNEE LEFT,"$2,467.50",$0.00,"$2,467.50",$0.00,"$1,761.05",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,467.50",$0.00,"$1,233.75","$1,954.26","$1,974.00",$0.00,$0.00,$0.00,$0.00,$0.00
5542-A-702,SUP,Custom 27803010,,5542-A-702  -  AUGMENT FEMORAL 7 15MM TOT STABILIZE TRIATHLON KNEE RIGHT,"$2,467.50",$0.00,"$2,467.50",$0.00,"$1,761.05",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,467.50",$0.00,"$1,233.75","$1,954.26","$1,974.00",$0.00,$0.00,$0.00,$0.00,$0.00
5542-A-801,SUP,Custom 27803010,,5542-A-801  -  AUGMENT FEMORAL 8 15MM TOT STABILIZE TRIATHLON KNEE LEFT,"$2,467.50",$0.00,"$2,467.50",$0.00,"$1,761.05",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,467.50",$0.00,"$1,233.75","$1,954.26","$1,974.00",$0.00,$0.00,$0.00,$0.00,$0.00
5542-A-802,SUP,Custom 27803010,,5542-A-802  -  AUGMENT FEMORAL 8 15MM TOT STABILIZE TRIATHLON KNEE RIGHT,"$2,467.50",$0.00,"$2,467.50",$0.00,"$1,761.05",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,467.50",$0.00,"$1,233.75","$1,954.26","$1,974.00",$0.00,$0.00,$0.00,$0.00,$0.00
5543-A-100,SUP,Custom 27803010,,5543-A-100  -  AUGMENT FEMORAL 1 5MM TOT STABILIZE TRIATHLON KNEE POSTERIOR,"$2,352.50",$0.00,"$2,352.50",$0.00,"$1,678.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,352.50",$0.00,"$1,176.25","$1,863.18","$1,882.00",$0.00,$0.00,$0.00,$0.00,$0.00
5543-A-200,SUP,Custom 27803010,,5543-A-200  -  AUGMENT FEMORAL 2 5MM TOT STABILIZE TRIATHLON KNEE POSTERIOR,"$2,352.50",$0.00,"$2,352.50",$0.00,"$1,678.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,352.50",$0.00,"$1,176.25","$1,863.18","$1,882.00",$0.00,$0.00,$0.00,$0.00,$0.00
5543-A-300,SUP,Custom 27803010,,5543-A-300  -  AUGMENT FEMORAL 3 5MM TOT STABILIZED TRIATHLON POSTERIOR,"$2,352.50",$0.00,"$2,352.50",$0.00,"$1,678.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,352.50",$0.00,"$1,176.25","$1,863.18","$1,882.00",$0.00,$0.00,$0.00,$0.00,$0.00
5543-A-400,SUP,Custom 27803010,,5543-A-400  -  AUGMENT FEMORAL 4 5MM TOT STABILIZE TRIATHLON KNEE POSTERIOR,"$2,352.50",$0.00,"$2,352.50",$0.00,"$1,678.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,352.50",$0.00,"$1,176.25","$1,863.18","$1,882.00",$0.00,$0.00,$0.00,$0.00,$0.00
5543-A-500,SUP,Custom 27803010,,5543-A-500  -  AUGMENT FEMORAL 5 5MM TOT STABILIZE TRIATHLON KNEE POSTERIOR,"$2,352.50",$0.00,"$2,352.50",$0.00,"$1,678.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,352.50",$0.00,"$1,176.25","$1,863.18","$1,882.00",$0.00,$0.00,$0.00,$0.00,$0.00
5543-A-600,SUP,Custom 27803010,,5543-A-600  -  AUGMENT FEMORAL 6 5MM TOT STABILIZE TRIATHLON KNEE POSTERIOR,"$2,352.50",$0.00,"$2,352.50",$0.00,"$1,678.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,352.50",$0.00,"$1,176.25","$1,863.18","$1,882.00",$0.00,$0.00,$0.00,$0.00,$0.00
5543-A-700,SUP,Custom 27803010,,5543-A-700  -  AUGMENT FEMORAL 7 5MM TOT STABILIZE TRIATHLON KNEE POSTERIOR,"$2,352.50",$0.00,"$2,352.50",$0.00,"$1,678.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,352.50",$0.00,"$1,176.25","$1,863.18","$1,882.00",$0.00,$0.00,$0.00,$0.00,$0.00
5543-A-800,SUP,Custom 27803010,,5543-A-800  -  AUGMENT FEMORAL 8 5MM TOT STABILIZE TRIATHLON KNEE POSTERIOR,"$2,352.50",$0.00,"$2,352.50",$0.00,"$1,678.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,352.50",$0.00,"$1,176.25","$1,863.18","$1,882.00",$0.00,$0.00,$0.00,$0.00,$0.00
5544-A-100,SUP,Custom 27803010,,5544-A-100  -  AUGMENT FEMORAL 1 10MM TOT STABILIZE TRIATHLON KNEE,"$2,352.50",$0.00,"$2,352.50",$0.00,"$1,678.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,352.50",$0.00,"$1,176.25","$1,863.18","$1,882.00",$0.00,$0.00,$0.00,$0.00,$0.00
5544-A-200,SUP,Custom 27803010,,5544-A-200  -  AUGMENT FEMORAL 2 10MM TOT STABILIZE TRIATHLON KNEE,"$2,352.50",$0.00,"$2,352.50",$0.00,"$1,678.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,352.50",$0.00,"$1,176.25","$1,863.18","$1,882.00",$0.00,$0.00,$0.00,$0.00,$0.00
5544-A-300,SUP,Custom 27803010,,5544-A-300  -  AUGMENT FEMORAL 3 10MM TOT STABILIZED BACKWARD BLOCK,"$2,352.50",$0.00,"$2,352.50",$0.00,"$1,678.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,352.50",$0.00,"$1,176.25","$1,863.18","$1,882.00",$0.00,$0.00,$0.00,$0.00,$0.00
5544-A-400,SUP,Custom 27803010,,5544-A-400  -  AUGMENT FEMORAL 4 10MM TOT STABILIZE TRIATHLON KNEE,"$2,352.50",$0.00,"$2,352.50",$0.00,"$1,678.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,352.50",$0.00,"$1,176.25","$1,863.18","$1,882.00",$0.00,$0.00,$0.00,$0.00,$0.00
5544-A-500,SUP,Custom 27803010,,5544-A-500  -  AUGMENT FEMORAL 5 10MM TOT STABILIZE TRIATHLON KNEE,"$2,352.50",$0.00,"$2,352.50",$0.00,"$1,678.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,352.50",$0.00,"$1,176.25","$1,863.18","$1,882.00",$0.00,$0.00,$0.00,$0.00,$0.00
5544-A-600,SUP,Custom 27803010,,5544-A-600  -  AUGMENT FEMORAL 6 10MM TOT STABILIZE TRIATHLON KNEE,"$2,352.50",$0.00,"$2,352.50",$0.00,"$1,678.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,352.50",$0.00,"$1,176.25","$1,863.18","$1,882.00",$0.00,$0.00,$0.00,$0.00,$0.00
5544-A-700,SUP,Custom 27803010,,5544-A-700  -  AUGMENT FEMORAL 7 10MM TOT STABILIZE TRIATHLON KNEE,"$2,352.50",$0.00,"$2,352.50",$0.00,"$1,678.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,352.50",$0.00,"$1,176.25","$1,863.18","$1,882.00",$0.00,$0.00,$0.00,$0.00,$0.00
5544-A-800,SUP,Custom 27803010,,5544-A-800  -  AUGMENT FEMORAL 8 10MM TOT STABILIZE TRIATHLON KNEE,"$2,352.50",$0.00,"$2,352.50",$0.00,"$1,678.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,352.50",$0.00,"$1,176.25","$1,863.18","$1,882.00",$0.00,$0.00,$0.00,$0.00,$0.00
5545-A-101,SUP,Custom 27803010,,5545-A-101  -  AUGMENT TIBIAL 1 5MM TOT STABILIZE TRIATHLON LEFT MEDIAL,"$2,130.00",$0.00,"$2,130.00",$0.00,"$1,520.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,130.00",$0.00,"$1,065.00","$1,686.96","$1,704.00",$0.00,$0.00,$0.00,$0.00,$0.00
5545-A-102,SUP,Custom 27803010,,5545-A-102  -  AUGMENT TIBIAL 1 5MM TOT STABILIZE TRIATHLON RIGHT MEDIAL,"$2,130.00",$0.00,"$2,130.00",$0.00,"$1,520.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,130.00",$0.00,"$1,065.00","$1,686.96","$1,704.00",$0.00,$0.00,$0.00,$0.00,$0.00
5545-A-201,SUP,Custom 27803010,,5545-A-201  -  AUGMENT TIBIAL 2 5MM TOT STABILIZE TRIATHLON LEFT MEDIAL,"$2,130.00",$0.00,"$2,130.00",$0.00,"$1,520.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,130.00",$0.00,"$1,065.00","$1,686.96","$1,704.00",$0.00,$0.00,$0.00,$0.00,$0.00
5545-A-202,SUP,Custom 27803010,,5545-A-202  -  AUGMENT TIBIAL 2 5MM TOT STABILIZE TRIATHLON RIGHT MEDIAL,"$2,130.00",$0.00,"$2,130.00",$0.00,"$1,520.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,130.00",$0.00,"$1,065.00","$1,686.96","$1,704.00",$0.00,$0.00,$0.00,$0.00,$0.00
5545-A-301,SUP,Custom 27803010,,5545-A-301  -  AUGMENT TIBIAL 3 5MM TOT STABILIZE TRIATHLON LEFT MEDIAL,"$2,130.00",$0.00,"$2,130.00",$0.00,"$1,520.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,130.00",$0.00,"$1,065.00","$1,686.96","$1,704.00",$0.00,$0.00,$0.00,$0.00,$0.00
5545-A-302,SUP,Custom 27803010,,5545-A-302  -  AUGMENT TIBIAL 3 5MM TOT STABILIZE TRIATHLON RIGHT MEDIAL,"$2,130.00",$0.00,"$2,130.00",$0.00,"$1,520.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,130.00",$0.00,"$1,065.00","$1,686.96","$1,704.00",$0.00,$0.00,$0.00,$0.00,$0.00
5545-A-401,SUP,Custom 27803010,,5545-A-401  -  AUGMENT TIBIAL 4 5MM TOT STABILIZE TRIATHLON LEFT MEDIAL,"$2,130.00",$0.00,"$2,130.00",$0.00,"$1,520.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,130.00",$0.00,"$1,065.00","$1,686.96","$1,704.00",$0.00,$0.00,$0.00,$0.00,$0.00
5545-A-402,SUP,Custom 27803010,,5545-A-402  -  AUGMENT TIBIAL 4 5MM TOT STABILIZE TRIATHLON RIGHT MEDIAL,"$2,130.00",$0.00,"$2,130.00",$0.00,"$1,520.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,130.00",$0.00,"$1,065.00","$1,686.96","$1,704.00",$0.00,$0.00,$0.00,$0.00,$0.00
5545-A-501,SUP,Custom 27803010,,5545-A-501  -  AUGMENT TIBIAL 5 5MM TOT STABILIZE TRIATHLON LEFT MEDIAL,"$2,130.00",$0.00,"$2,130.00",$0.00,"$1,520.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,130.00",$0.00,"$1,065.00","$1,686.96","$1,704.00",$0.00,$0.00,$0.00,$0.00,$0.00
5545-A-502,SUP,Custom 27803010,,5545-A-502  -  AUGMENT TIBIAL 5 5MM TRIATHLON RIGHT MEDIAL LEFT LATERAL,"$2,130.00",$0.00,"$2,130.00",$0.00,"$1,520.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,130.00",$0.00,"$1,065.00","$1,686.96","$1,704.00",$0.00,$0.00,$0.00,$0.00,$0.00
5545-A-601,SUP,Custom 27803010,,5545-A-601  -  AUGMENT TIBIAL 6 5MM TOT STABILIZE TRIATHLON LEFT MEDIAL,"$2,130.00",$0.00,"$2,130.00",$0.00,"$1,520.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,130.00",$0.00,"$1,065.00","$1,686.96","$1,704.00",$0.00,$0.00,$0.00,$0.00,$0.00
5545-A-602,SUP,Custom 27803010,,5545-A-602  -  AUGMENT TIBIAL 6 5MM TOT STABILIZE TRIATHLON RIGHT MEDIAL,"$2,130.00",$0.00,"$2,130.00",$0.00,"$1,520.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,130.00",$0.00,"$1,065.00","$1,686.96","$1,704.00",$0.00,$0.00,$0.00,$0.00,$0.00
5545-A-701,SUP,Custom 27803010,,5545-A-701  -  AUGMENT TIBIAL 7 5MM TOT STABILIZE TRIATHLON LEFT MEDIAL,"$2,130.00",$0.00,"$2,130.00",$0.00,"$1,520.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,130.00",$0.00,"$1,065.00","$1,686.96","$1,704.00",$0.00,$0.00,$0.00,$0.00,$0.00
5545-A-702,SUP,Custom 27803010,,5545-A-702  -  AUGMENT TIBIAL 7 5MM TOT STABILIZE TRIATHLON RIGHT MEDIAL,"$2,130.00",$0.00,"$2,130.00",$0.00,"$1,520.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,130.00",$0.00,"$1,065.00","$1,686.96","$1,704.00",$0.00,$0.00,$0.00,$0.00,$0.00
5545-A-801,SUP,Custom 27803010,,5545-A-801  -  AUGMENT TIBIAL 8 5MM TOT STABILIZE TRIATHLON LEFT MEDIAL,"$2,130.00",$0.00,"$2,130.00",$0.00,"$1,520.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,130.00",$0.00,"$1,065.00","$1,686.96","$1,704.00",$0.00,$0.00,$0.00,$0.00,$0.00
5545-A-802,SUP,Custom 27803010,,5545-A-802  -  AUGMENT TIBIAL 8 5MM TOT STABILIZE TRIATHLON RIGHT MEDIAL,"$2,130.00",$0.00,"$2,130.00",$0.00,"$1,520.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,130.00",$0.00,"$1,065.00","$1,686.96","$1,704.00",$0.00,$0.00,$0.00,$0.00,$0.00
5546-A-101,SUP,Custom 27803010,,5546-A-101  -  AUGMENT TIBIAL 1 10MM TOT STABILIZE TRIATHLON LEFT MEDIAL,"$2,095.00",$0.00,"$2,095.00",$0.00,"$1,495.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,095.00",$0.00,"$1,047.50","$1,659.24","$1,676.00",$0.00,$0.00,$0.00,$0.00,$0.00
5546-A-102,SUP,Custom 27803010,,5546-A-102  -  AUGMENT TIBIAL 1 10MM TOT STABILIZE TRIATHLON RIGHT MEDIAL,"$2,095.00",$0.00,"$2,095.00",$0.00,"$1,495.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,095.00",$0.00,"$1,047.50","$1,659.24","$1,676.00",$0.00,$0.00,$0.00,$0.00,$0.00
5546-A-201,SUP,Custom 27803010,,5546-A-201  -  AUGMENT TIBIAL 2 10MM TOT STABILIZE TRIATHLON LEFT MEDIAL,"$2,095.00",$0.00,"$2,095.00",$0.00,"$1,495.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,095.00",$0.00,"$1,047.50","$1,659.24","$1,676.00",$0.00,$0.00,$0.00,$0.00,$0.00
5546-A-202,SUP,Custom 27803010,,5546-A-202  -  AUGMENT TIBIAL 2 10MM TOT STABILIZE TRIATHLON RIGHT MEDIAL,"$2,095.00",$0.00,"$2,095.00",$0.00,"$1,495.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,095.00",$0.00,"$1,047.50","$1,659.24","$1,676.00",$0.00,$0.00,$0.00,$0.00,$0.00
5546-A-301,SUP,Custom 27803010,,5546-A-301  -  AUGMENT TIBIAL 3 10MM TOT STABILIZED FIXING SCREW TRIATHLON,"$2,095.00",$0.00,"$2,095.00",$0.00,"$1,495.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,095.00",$0.00,"$1,047.50","$1,659.24","$1,676.00",$0.00,$0.00,$0.00,$0.00,$0.00
5546-A-302,SUP,Custom 27803010,,5546-A-302  -  AUGMENT TIBIAL 3 10MM TOAL STABILIZED TRIATHLON RIGHT MEDIAL,"$2,095.00",$0.00,"$2,095.00",$0.00,"$1,495.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,095.00",$0.00,"$1,047.50","$1,659.24","$1,676.00",$0.00,$0.00,$0.00,$0.00,$0.00
5546-A-401,SUP,Custom 27803010,,5546-A-401  -  AUGMENT TIBIAL 4 10MM TOT STABILIZE TRIATHLON LEFT MEDIAL,"$2,095.00",$0.00,"$2,095.00",$0.00,"$1,495.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,095.00",$0.00,"$1,047.50","$1,659.24","$1,676.00",$0.00,$0.00,$0.00,$0.00,$0.00
5546-A-402,SUP,Custom 27803010,,5546-A-402  -  AUGMENT TIBIAL 4 10MM TOT STABILIZE TRIATHLON RIGHT MEDIAL,"$2,095.00",$0.00,"$2,095.00",$0.00,"$1,495.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,095.00",$0.00,"$1,047.50","$1,659.24","$1,676.00",$0.00,$0.00,$0.00,$0.00,$0.00
5546-A-501,SUP,Custom 27803010,,5546-A-501  -  AUGMENT TIBIAL 5 10MM TOT STABILIZE TRIATHLON LEFT MEDIAL,"$2,095.00",$0.00,"$2,095.00",$0.00,"$1,495.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,095.00",$0.00,"$1,047.50","$1,659.24","$1,676.00",$0.00,$0.00,$0.00,$0.00,$0.00
5546-A-502,SUP,Custom 27803010,,5546-A-502  -  AUGMENT TIBIAL 5 10MM TOT STABILIZE TRIATHLON RIGHT MEDIAL,"$2,095.00",$0.00,"$2,095.00",$0.00,"$1,495.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,095.00",$0.00,"$1,047.50","$1,659.24","$1,676.00",$0.00,$0.00,$0.00,$0.00,$0.00
5546-A-601,SUP,Custom 27803010,,5546-A-601  -  AUGMENT TIBIAL 6 10MM TOT STABILIZE TRIATHLON LEFT MEDIAL,"$2,095.00",$0.00,"$2,095.00",$0.00,"$1,495.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,095.00",$0.00,"$1,047.50","$1,659.24","$1,676.00",$0.00,$0.00,$0.00,$0.00,$0.00
5546-A-602,SUP,Custom 27803010,,5546-A-602  -  AUGMENT TIBIAL 6 10MM TOT STABILIZE TRIATHLON RIGHT MEDIAL,"$2,095.00",$0.00,"$2,095.00",$0.00,"$1,495.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,095.00",$0.00,"$1,047.50","$1,659.24","$1,676.00",$0.00,$0.00,$0.00,$0.00,$0.00
5546-A-701,SUP,Custom 27803010,,5546-A-701  -  AUGMENT TIBIAL 7 10MM TOT STABILIZE TRIATHLON LEFT MEDIAL,"$2,095.00",$0.00,"$2,095.00",$0.00,"$1,495.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,095.00",$0.00,"$1,047.50","$1,659.24","$1,676.00",$0.00,$0.00,$0.00,$0.00,$0.00
5546-A-702,SUP,Custom 27803010,,5546-A-702  -  AUGMENT TIBIAL 7 10MM TOT STABILIZE TRIATHLON RIGHT MEDIAL,"$2,095.00",$0.00,"$2,095.00",$0.00,"$1,495.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,095.00",$0.00,"$1,047.50","$1,659.24","$1,676.00",$0.00,$0.00,$0.00,$0.00,$0.00
5546-A-801,SUP,Custom 27803010,,5546-A-801  -  AUGMENT TIBIAL 8 10MM TOT STABILIZE TRIATHLON LEFT MEDIAL,"$2,095.00",$0.00,"$2,095.00",$0.00,"$1,495.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,095.00",$0.00,"$1,047.50","$1,659.24","$1,676.00",$0.00,$0.00,$0.00,$0.00,$0.00
5546-A-802,SUP,Custom 27803010,,5546-A-802  -  AUGMENT TIBIAL 8 10MM TOT STABILIZE TRIATHLON RIGHT MEDIAL,"$2,095.00",$0.00,"$2,095.00",$0.00,"$1,495.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,095.00",$0.00,"$1,047.50","$1,659.24","$1,676.00",$0.00,$0.00,$0.00,$0.00,$0.00
5549-A-110,SUP,HCPCS C1776,,5549-A-110  -  AUGMENT TIB A CONE STRL LF TRTHLN SMTR TRITANIUM,"$8,495.00",$0.00,"$8,495.00","$3,822.75","$5,158.80",$0.00,"$1,463.65",$0.00,$0.00,"$1,487.41","$8,495.00",$0.00,"$4,247.50","$6,728.04","$6,796.00",$0.00,"$1,329.47",$0.00,"$1,352.40",$0.00
5549-A-120,SUP,HCPCS C1776,,5549-A-120  -  AUGMENT TIB B CONE STRL LF TRTHLN SMTR TRITANIUM,"$8,495.00",$0.00,"$8,495.00","$3,822.75","$5,158.80",$0.00,"$1,463.65",$0.00,$0.00,"$1,487.41","$8,495.00",$0.00,"$4,247.50","$6,728.04","$6,796.00",$0.00,"$1,329.47",$0.00,"$1,352.40",$0.00
5549-A-140,SUP,HCPCS C1776,,5549-A-140  -  AUGMENT TIB D CONE TRTHLN SMTR REV TRITANIUM KN,"$8,495.00",$0.00,"$8,495.00","$3,822.75","$5,158.80",$0.00,"$1,463.65",$0.00,$0.00,"$1,487.41","$8,495.00",$0.00,"$4,247.50","$6,728.04","$6,796.00",$0.00,"$1,329.47",$0.00,"$1,352.40",$0.00
5549-A-150,SUP,HCPCS C1776,,5549-A-150  -  AUGMENT TIB E CONE TRTHLN SMTR REV TRITANIUM KN,"$8,495.00",$0.00,"$8,495.00","$3,822.75","$5,158.80",$0.00,"$1,463.65",$0.00,$0.00,"$1,487.41","$8,495.00",$0.00,"$4,247.50","$6,728.04","$6,796.00",$0.00,"$1,329.47",$0.00,"$1,352.40",$0.00
5549-A-221,SUP,HCPCS C1776,,5549-A-221  -  AUGMENT TIB B CONE TRTHLN ASYM TRITANIUM KN LT MDL RL REV,"$9,085.00",$0.00,"$9,085.00","$4,088.25","$5,158.80",$0.00,"$1,565.30",$0.00,$0.00,"$1,590.71","$9,085.00",$0.00,"$4,542.50","$7,195.32","$7,268.00",$0.00,"$1,421.80",$0.00,"$1,446.33",$0.00
5549-A-222,SUP,HCPCS C1776,,5549-A-222  -  AUGMENT TIB B CONE STRL TRTHLN ASYM TRITANIUM KN RMLL,"$9,085.00",$0.00,"$9,085.00","$4,088.25","$5,158.80",$0.00,"$1,565.30",$0.00,$0.00,"$1,590.71","$9,085.00",$0.00,"$4,542.50","$7,195.32","$7,268.00",$0.00,"$1,421.80",$0.00,"$1,446.33",$0.00
5549-A-231,SUP,HCPCS C1776,,5549-A-231  -  AUGMENT TIB C CONE TRTHLN ASYM TRITANIUM KN LT MDL RL REV,"$9,085.00",$0.00,"$9,085.00","$4,088.25","$5,158.80",$0.00,"$1,565.30",$0.00,$0.00,"$1,590.71","$9,085.00",$0.00,"$4,542.50","$7,195.32","$7,268.00",$0.00,"$1,421.80",$0.00,"$1,446.33",$0.00
5549-A-232,SUP,HCPCS C1776,,5549-A-232  -  AUGMENT TIB C CONE TRTHLN ASYM REV TRITANIUM KN RMLL,"$9,085.00",$0.00,"$9,085.00","$4,088.25","$5,158.80",$0.00,"$1,565.30",$0.00,$0.00,"$1,590.71","$9,085.00",$0.00,"$4,542.50","$7,195.32","$7,268.00",$0.00,"$1,421.80",$0.00,"$1,446.33",$0.00
5549-A-241,SUP,HCPCS C1776,,5549-A-241  -  AUGMENT TIB D CONE TRTHLN ASYM TRITANIUM KN LT MDL RL REV,"$9,085.00",$0.00,"$9,085.00","$4,088.25","$5,158.80",$0.00,"$1,565.30",$0.00,$0.00,"$1,590.71","$9,085.00",$0.00,"$4,542.50","$7,195.32","$7,268.00",$0.00,"$1,421.80",$0.00,"$1,446.33",$0.00
5549-A-242,SUP,HCPCS C1776,,5549-A-242  -  AUGMENT TIB D CONE TRTHLN ASYM TRITANIUM KN RMLL REV SYS,"$9,085.00",$0.00,"$9,085.00","$4,088.25","$5,158.80",$0.00,"$1,565.30",$0.00,$0.00,"$1,590.71","$9,085.00",$0.00,"$4,542.50","$7,195.32","$7,268.00",$0.00,"$1,421.80",$0.00,"$1,446.33",$0.00
5549-A-251,SUP,HCPCS C1776,,5549-A-251  -  AUGMENT TIB E CONE TRTHLN ASYM REV TRITANIUM KN LT MDL RL,"$9,085.00",$0.00,"$9,085.00","$4,088.25","$5,158.80",$0.00,"$1,565.30",$0.00,$0.00,"$1,590.71","$9,085.00",$0.00,"$4,542.50","$7,195.32","$7,268.00",$0.00,"$1,421.80",$0.00,"$1,446.33",$0.00
5549-A-252,SUP,HCPCS C1776,,5549-A-252  -  AUGMENT TIB E CONE TRTHLN ASYM REV TRITANIUM KN RMLL,"$9,085.00",$0.00,"$9,085.00","$4,088.25","$5,158.80",$0.00,"$1,565.30",$0.00,$0.00,"$1,590.71","$9,085.00",$0.00,"$4,542.50","$7,195.32","$7,268.00",$0.00,"$1,421.80",$0.00,"$1,446.33",$0.00
5549-A-321,SUP,HCPCS C1776,,5549-A-321  -  AUGMENT FEM 1 2 CONE TRTHLN TRITANIUM KN LT REV SYS,"$9,675.00",$0.00,"$9,675.00","$4,353.75","$5,158.80",$0.00,"$1,666.95",$0.00,$0.00,"$1,694.02","$9,675.00",$0.00,"$4,837.50","$7,662.60","$7,740.00",$0.00,"$1,514.14",$0.00,"$1,540.26",$0.00
5549-A-322,SUP,HCPCS C1776,,5549-A-322  -  AUGMENT FEM 1 2 CONE TRTHLN REV TRITANIUM KN RT,"$9,675.00",$0.00,"$9,675.00","$4,353.75","$5,158.80",$0.00,"$1,666.95",$0.00,$0.00,"$1,694.02","$9,675.00",$0.00,"$4,837.50","$7,662.60","$7,740.00",$0.00,"$1,514.14",$0.00,"$1,540.26",$0.00
5549-A-331,SUP,HCPCS C1776,,5549-A-331  -  AUGMENT FEM 3 CONE TRTHLN REV TRITANIUM KN LT,"$9,675.00",$0.00,"$9,675.00","$4,353.75","$5,158.80",$0.00,"$1,666.95",$0.00,$0.00,"$1,694.02","$9,675.00",$0.00,"$4,837.50","$7,662.60","$7,740.00",$0.00,"$1,514.14",$0.00,"$1,540.26",$0.00
5549-A-332,SUP,HCPCS C1776,,5549-A-332  -  AUGMENT FEM 3 CONE TRTHLN TRITANIUM KN RT REV SYS,"$9,675.00",$0.00,"$9,675.00","$4,353.75","$5,158.80",$0.00,"$1,666.95",$0.00,$0.00,"$1,694.02","$9,675.00",$0.00,"$4,837.50","$7,662.60","$7,740.00",$0.00,"$1,514.14",$0.00,"$1,540.26",$0.00
5549-A-341,SUP,HCPCS C1776,,5549-A-341  -  AUGMENT FEM 4 CONE TRTHLN REV TRITANIUM KN LT,"$9,675.00",$0.00,"$9,675.00","$4,353.75","$5,158.80",$0.00,"$1,666.95",$0.00,$0.00,"$1,694.02","$9,675.00",$0.00,"$4,837.50","$7,662.60","$7,740.00",$0.00,"$1,514.14",$0.00,"$1,540.26",$0.00
5549-A-342,SUP,HCPCS C1776,,5549-A-342  -  AUGMENT FEM 4 CONE TRTHLN TRITANIUM KN RT REV SYS,"$9,675.00",$0.00,"$9,675.00","$4,353.75","$5,158.80",$0.00,"$1,666.95",$0.00,$0.00,"$1,694.02","$9,675.00",$0.00,"$4,837.50","$7,662.60","$7,740.00",$0.00,"$1,514.14",$0.00,"$1,540.26",$0.00
5549-A-351,SUP,HCPCS C1776,,5549-A-351  -  AUGMENT FEM 5 CONE TRTHLN TRITANIUM KN LT REV SYS,"$9,675.00",$0.00,"$9,675.00","$4,353.75","$5,158.80",$0.00,"$1,666.95",$0.00,$0.00,"$1,694.02","$9,675.00",$0.00,"$4,837.50","$7,662.60","$7,740.00",$0.00,"$1,514.14",$0.00,"$1,540.26",$0.00
5549-A-352,SUP,HCPCS C1776,,5549-A-352  -  AUGMENT FEM 5 CONE TRTHLN REV TRITANIUM KN RT,"$9,675.00",$0.00,"$9,675.00","$4,353.75","$5,158.80",$0.00,"$1,666.95",$0.00,$0.00,"$1,694.02","$9,675.00",$0.00,"$4,837.50","$7,662.60","$7,740.00",$0.00,"$1,514.14",$0.00,"$1,540.26",$0.00
5549-A-361,SUP,HCPCS C1776,,5549-A-361  -  AUGMENT FEM 6 CONE TRTHLN REV TRITANIUM KN LT,"$9,675.00",$0.00,"$9,675.00","$4,353.75","$5,158.80",$0.00,"$1,666.95",$0.00,$0.00,"$1,694.02","$9,675.00",$0.00,"$4,837.50","$7,662.60","$7,740.00",$0.00,"$1,514.14",$0.00,"$1,540.26",$0.00
5549-A-362,SUP,HCPCS C1776,,5549-A-362  -  AUGMENT FEM 6 CONE TRTHLN REV TRITANIUM KN RT,"$9,675.00",$0.00,"$9,675.00","$4,353.75","$5,158.80",$0.00,"$1,666.95",$0.00,$0.00,"$1,694.02","$9,675.00",$0.00,"$4,837.50","$7,662.60","$7,740.00",$0.00,"$1,514.14",$0.00,"$1,540.26",$0.00
5549-A-371,SUP,HCPCS C1776,,5549-A-371  -  AUGMENT FEM 7 8 CONE TRTHLN TRITANIUM KN LT REV SYS,"$9,675.00",$0.00,"$9,675.00","$4,353.75","$5,158.80",$0.00,"$1,666.95",$0.00,$0.00,"$1,694.02","$9,675.00",$0.00,"$4,837.50","$7,662.60","$7,740.00",$0.00,"$1,514.14",$0.00,"$1,540.26",$0.00
5549-A-372,SUP,HCPCS C1776,,5549-A-372  -  AUGMENT FEM 7 8 CONE TRTHLN REV TRITANIUM KN RT,"$9,675.00",$0.00,"$9,675.00","$4,353.75","$5,158.80",$0.00,"$1,666.95",$0.00,$0.00,"$1,694.02","$9,675.00",$0.00,"$4,837.50","$7,662.60","$7,740.00",$0.00,"$1,514.14",$0.00,"$1,540.26",$0.00
5550-G-278,SUP,Custom 27803010,,5550-G-278  -  COMPONENT PATLR 27MM 8MM SYMMETRIC TRIATHLON X3 KNEE,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
5550-G-278-E,SUP,HCPCS C1776,,5550-G-278-E  -  COMPONENT PTLR 27MM 8MM STRL TRTHLN SMTR KN,$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
5550-G-298,SUP,Custom 27803010,,5550-G-298  -  COMPONENT PATLR 29MM 8MM SYMMETRIC TRIATHLON X3 TOT KNEE,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
5550-G-298-E,SUP,HCPCS C1776,,5550-G-298-E  -  COMPONENT PTLR 29MM 8MM STRL TRTHLN SMTR KN,$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
5550-G-319,SUP,Custom 27803010,,5550-G-319  -  COMPONENT PATLR 31MM 9MM SYMMETRIC TRIATHLON X3 KNEE,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
5550-G-319-E,SUP,HCPCS C1776,,5550-G-319-E  -  COMPONENT PTLR 31MM 9MM STRL TRTHLN SMTR KN,$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
5550-G-339,SUP,Custom 27803010,,5550-G-339  -  COMPONENT PATLR 33MM 9MM SYMMETRIC TRIATHLON X3 KNEE,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
5550-G-339-E,SUP,HCPCS C1776,,5550-G-339-E  -  COMPONENT PTLR 33MM 9MM STRL TRTHLN SMTR KN,$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
5550-G-360,SUP,Custom 27803010,,5550-G-360  -  COMPONENT PATLR 36MM 10MM SYMMETRIC TRIATHLON X3 KNEE,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
5550-G-360-E,SUP,HCPCS C1776,,5550-G-360-E  -  COMPONENT PTLR 36MM 10MM STRL TRTHLN SMTR KN,$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
5550-G-391,SUP,Custom 27803010,,5550-G-391  -  COMPONENT PATLR 39MM 11MM SYMMETRIC TRIATHLON X3 KNEE,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
5550-G-391-E,SUP,HCPCS C1776,,5550-G-391-E  -  COMPONENT PTLR 39MM 11MM STRL TRTHLN SMTR KN,$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
5550-L-278,SUP,Custom 27803010,,5550-L-278  -  COMPONENT PATLR 27MM 8MM SYMMETRIC TRIATHLON KNEE,$600.00,$0.00,$600.00,$0.00,$428.22,$0.00,$0.00,$0.00,$0.00,$0.00,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$0.00,$0.00,$0.00,$0.00
5550-L-298,SUP,Custom 27803010,,5550-L-298  -  COMPONENT PATLR 29MM 8MM SYMMETRIC TRIATHLON X3 KNEE,$600.00,$0.00,$600.00,$0.00,$428.22,$0.00,$0.00,$0.00,$0.00,$0.00,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$0.00,$0.00,$0.00,$0.00
5550-L-319,SUP,Custom 27803010,,5550-L-319  -  COMPONENT PATLR 31MM 9MM SYMMETRIC TRIATHLON X3 KNEE,$600.00,$0.00,$600.00,$0.00,$428.22,$0.00,$0.00,$0.00,$0.00,$0.00,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$0.00,$0.00,$0.00,$0.00
5550-L-339,SUP,Custom 27803010,,5550-L-339  -  COMPONENT PATLR 33MM 9MM SYMMETRIC TRIATHLON X3 KNEE,$600.00,$0.00,$600.00,$0.00,$428.22,$0.00,$0.00,$0.00,$0.00,$0.00,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$0.00,$0.00,$0.00,$0.00
5550-L-360,SUP,Custom 27803010,,5550-L-360  -  COMPONENT PATLR 36MM 10MM SYMMETRIC TRIATHLON X3 KNEE,$600.00,$0.00,$600.00,$0.00,$428.22,$0.00,$0.00,$0.00,$0.00,$0.00,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$0.00,$0.00,$0.00,$0.00
5550-L-391,SUP,Custom 27803010,,5550-L-391  -  COMPONENT PATLR 39MM 11MM SYMMETRIC TRIATHLON X3 KNEE,$600.00,$0.00,$600.00,$0.00,$428.22,$0.00,$0.00,$0.00,$0.00,$0.00,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$0.00,$0.00,$0.00,$0.00
5551-G-299,SUP,Custom 27803010,,5551-G-299  -  COMPONENT PATLR ASYMMETRIC 29MM 9MM TRIATHLON X3 TOT KNEE,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
5551-G-299-E,SUP,HCPCS C1776,,5551-G-299-E  -  COMPONENT PTLR 29MM 9MM STRL TRTHLN ASYM KN,$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
5551-G-320,SUP,Custom 27803010,,5551-G-320  -  COMPONENT PATLR ASYMMETRIC 32MM 10MM TRIATHLON X3 KNEE,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
5551-G-320-E,SUP,HCPCS C1776,,5551-G-320-E  -  COMPONENT PTLR 32MM 10MM STRL TRTHLN ASYM KN,$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
5551-G-350,SUP,Custom 27803010,,5551-G-350  -  COMPONENT PATLR 35MM 10MM ASYMMETRIC TRIATHLON X3 KNEE,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
5551-G-350-E,SUP,HCPCS C1776,,5551-G-350-E  -  COMPONENT PTLR 35MM 10MM STRL TRTHLN ASYM KN,$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
5551-G-381,SUP,Custom 27803010,,5551-G-381  -  COMPONENT PATLR 38MM 11MM ASYMMETRIC TRIATHLON X3 KNEE,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
5551-G-381-E,SUP,HCPCS C1776,,5551-G-381-E  -  COMPONENT PTLR 38MM 11MM STRL TRTHLN ASYM KN,$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
5551-G-401,SUP,Custom 27803010,,5551-G-401  -  COMPONENT PATLR 40MM 11MM ASYMMETRIC TRIATHLON X3 KNEE,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
5551-G-401-E,SUP,HCPCS C1776,,5551-G-401-E  -  COMPONENT PTLR 40MM 11MM STRL TRTHLN ASYM KN,$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
5551-L-299,SUP,Custom 27803010,,5551-L-299  -  COMPONENT PATLR 29MM 9MM ASYMMETRIC TRIATHLON X3 KNEE,$600.00,$0.00,$600.00,$0.00,$428.22,$0.00,$0.00,$0.00,$0.00,$0.00,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$0.00,$0.00,$0.00,$0.00
5551-L-320,SUP,Custom 27803010,,5551-L-320  -  COMPONENT PATLR 32MM 10MM ASYMMETRIC TRIATHLON KNEE,$600.00,$0.00,$600.00,$0.00,$428.22,$0.00,$0.00,$0.00,$0.00,$0.00,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$0.00,$0.00,$0.00,$0.00
5551-L-350,SUP,Custom 27803010,,5551-L-350  -  COMPONENT PATLR 35MM 10MM ASYMMETRIC TRIATHLON KNEE,$600.00,$0.00,$600.00,$0.00,$428.22,$0.00,$0.00,$0.00,$0.00,$0.00,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$0.00,$0.00,$0.00,$0.00
5551-L-381,SUP,Custom 27803010,,5551-L-381  -  COMPONENT PATLR 38MM 11MM ASYMMETRIC TRIATHLON,$600.00,$0.00,$600.00,$0.00,$428.22,$0.00,$0.00,$0.00,$0.00,$0.00,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$0.00,$0.00,$0.00,$0.00
5551-L-401,SUP,Custom 27803010,,5551-L-401  -  COMPONENT PATLR 40MM 11MM ASYMMETRIC TRIATHLON X3 KNEE,$600.00,$0.00,$600.00,$0.00,$428.22,$0.00,$0.00,$0.00,$0.00,$0.00,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$0.00,$0.00,$0.00,$0.00
5552-L-299,SUP,HCPCS C1776,,5552-L-299  -  COMPONENT PTLR 29MM 9MM TRITANIUM ASYM MTL KN,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
5552-L-320,SUP,HCPCS C1776,,5552-L-320  -  COMPONENT PTLR 32MM 10MM ASYM TRITANIUM,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
5552-L-350,SUP,HCPCS C1776,,5552-L-350  -  COMPONENT PTLR 35MM 10MM ASYM TRITANIUM MTL KN,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
5552-L-381,SUP,HCPCS C1776,,5552-L-381  -  COMPONENT PTLR 38MM 11MM TRITANIUM ASYM MTL KN,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
5552-L-401,SUP,HCPCS C1776,,5552-L-401  -  COMPONENT PTLR 40MM 11MM TRITANIUM ASYM MTL KN,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
5554-L-320,SUP,Custom 27803010,,5554-L-320  -  COMPONENT PATLR 32MM 10MM ASYMMETRIC METAL BACKED BEADED,"$1,500.00",$0.00,"$1,500.00",$0.00,"$1,070.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
5554-L-350,SUP,Custom 27803010,,5554-L-350  -  COMPONENT PATLR 35MM BEAD,"$1,500.00",$0.00,"$1,500.00",$0.00,"$1,070.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
5554-L-381,SUP,Custom 27803010,,5554-L-381  -  COMPONENT PATLR 38MM 11MM ASYMMETRIC METAL BACKED BEADED,"$1,500.00",$0.00,"$1,500.00",$0.00,"$1,070.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
5554-L-401,SUP,Custom 27803010,,5554-L-401  -  COMPONENT PATLR 40MM BEAD TRIATHLON PERI-APATITE KNEE,"$1,500.00",$0.00,"$1,500.00",$0.00,"$1,070.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
5555-2901,SUP,Custom 27203010,,5555-2901  -  BLOCK CUT TRTHLN PRCS,$89.00,$0.00,$89.00,$0.00,$63.52,$0.00,$0.00,$0.00,$0.00,$0.00,$89.00,$0.00,$44.50,$70.49,$71.20,$0.00,$0.00,$0.00,$0.00,$0.00
5555-2902,SUP,Custom 27203010,,5555-2902  -  BLOCK CUT TRTHLN PRCS,$89.00,$0.00,$89.00,$0.00,$63.52,$0.00,$0.00,$0.00,$0.00,$0.00,$89.00,$0.00,$44.50,$70.49,$71.20,$0.00,$0.00,$0.00,$0.00,$0.00
5555-2903,SUP,Custom 27203010,,5555-2903  -  BLOCK CUT TRTHLN PRCS,$89.00,$0.00,$89.00,$0.00,$63.52,$0.00,$0.00,$0.00,$0.00,$0.00,$89.00,$0.00,$44.50,$70.49,$71.20,$0.00,$0.00,$0.00,$0.00,$0.00
5555-2904,SUP,Custom 27203010,,5555-2904  -  BLOCK CUT TRTHLN PRCS,$89.00,$0.00,$89.00,$0.00,$63.52,$0.00,$0.00,$0.00,$0.00,$0.00,$89.00,$0.00,$44.50,$70.49,$71.20,$0.00,$0.00,$0.00,$0.00,$0.00
5555-2905,SUP,Custom 27203010,,5555-2905  -  BLOCK CUT TRTHLN PRCS,$89.00,$0.00,$89.00,$0.00,$63.52,$0.00,$0.00,$0.00,$0.00,$0.00,$89.00,$0.00,$44.50,$70.49,$71.20,$0.00,$0.00,$0.00,$0.00,$0.00
5555-2906,SUP,Custom 27203010,,5555-2906  -  BLOCK CUT TRTHLN PRCS,$89.00,$0.00,$89.00,$0.00,$63.52,$0.00,$0.00,$0.00,$0.00,$0.00,$89.00,$0.00,$44.50,$70.49,$71.20,$0.00,$0.00,$0.00,$0.00,$0.00
5555-2907,SUP,Custom 27203010,,5555-2907  -  BLOCK CUT TRTHLN PRCS,$89.00,$0.00,$89.00,$0.00,$63.52,$0.00,$0.00,$0.00,$0.00,$0.00,$89.00,$0.00,$44.50,$70.49,$71.20,$0.00,$0.00,$0.00,$0.00,$0.00
5555-2908,SUP,Custom 27203010,,5555-2908  -  BLOCK CUT TRTHLN PRCS,$89.00,$0.00,$89.00,$0.00,$63.52,$0.00,$0.00,$0.00,$0.00,$0.00,$89.00,$0.00,$44.50,$70.49,$71.20,$0.00,$0.00,$0.00,$0.00,$0.00
5555-3201,SUP,Custom 27203010,,5555-3201  -  SET TRAUMA FIX TIB KNEE CRUC RET PRCS TRTHLN,$168.00,$0.00,$168.00,$0.00,$119.90,$0.00,$0.00,$0.00,$0.00,$0.00,$168.00,$0.00,$84.00,$133.06,$134.40,$0.00,$0.00,$0.00,$0.00,$0.00
5555-3202,SUP,Custom 27203010,,5555-3202  -  SET TRAUMA FIX TIB KNEE CRUC RET PRCS TRTHLN,$168.00,$0.00,$168.00,$0.00,$119.90,$0.00,$0.00,$0.00,$0.00,$0.00,$168.00,$0.00,$84.00,$133.06,$134.40,$0.00,$0.00,$0.00,$0.00,$0.00
5555-3203,SUP,Custom 27203010,,5555-3203  -  SET TRAUMA FIX 3 TIB PRCS PREP KIT CR STD,$168.00,$0.00,$168.00,$0.00,$119.90,$0.00,$0.00,$0.00,$0.00,$0.00,$168.00,$0.00,$84.00,$133.06,$134.40,$0.00,$0.00,$0.00,$0.00,$0.00
5555-3204,SUP,Custom 27203010,,5555-3204  -  SET TRAUMA FIX 4 STD TIB CRUC RET PRCS PREP KIT TRTHLN,$168.00,$0.00,$168.00,$0.00,$119.90,$0.00,$0.00,$0.00,$0.00,$0.00,$168.00,$0.00,$84.00,$133.06,$134.40,$0.00,$0.00,$0.00,$0.00,$0.00
5555-3205,SUP,Custom 27203010,,5555-3205  -  SET ORTH TRTHLN 5 PRP,$168.00,$0.00,$168.00,$0.00,$119.90,$0.00,$0.00,$0.00,$0.00,$0.00,$168.00,$0.00,$84.00,$133.06,$134.40,$0.00,$0.00,$0.00,$0.00,$0.00
5555-3206,SUP,Custom 27203010,,5555-3206  -  KIT PRP TRTHLN 6 PRCS TIB CRUC RET STD,$168.00,$0.00,$168.00,$0.00,$119.90,$0.00,$0.00,$0.00,$0.00,$0.00,$168.00,$0.00,$84.00,$133.06,$134.40,$0.00,$0.00,$0.00,$0.00,$0.00
5555-3207,SUP,Custom 27203010,,5555-3207  -  SET TRAUMA FIX 7 STD TIB CRUC RET PRCS PREP KIT TRTHLN,$168.00,$0.00,$168.00,$0.00,$119.90,$0.00,$0.00,$0.00,$0.00,$0.00,$168.00,$0.00,$84.00,$133.06,$134.40,$0.00,$0.00,$0.00,$0.00,$0.00
5555-3208,SUP,HCPCS C1713,,5555-3208  -  SYSTEM BONE CMNT PRP KIT TIB BIOPREP,$168.00,$0.00,$168.00,$75.60,$119.90,$0.00,$28.95,$0.00,$0.00,$29.42,$168.00,$0.00,$84.00,$133.06,$134.40,$0.00,$26.29,$0.00,$26.75,$0.00
5555-3301,SUP,Custom 27203010,,5555-3301  -  SET TRAUMA FIX TIB KNEE CRUC RET PRCS TRTHLN,$126.00,$0.00,$126.00,$0.00,$89.93,$0.00,$0.00,$0.00,$0.00,$0.00,$126.00,$0.00,$63.00,$99.79,$100.80,$0.00,$0.00,$0.00,$0.00,$0.00
5555-3302,SUP,Custom 27203010,,5555-3302  -  SET TRAUMA FIX TIB KNEE CRUC RET PRCS TRTHLN,$126.00,$0.00,$126.00,$0.00,$89.93,$0.00,$0.00,$0.00,$0.00,$0.00,$126.00,$0.00,$63.00,$99.79,$100.80,$0.00,$0.00,$0.00,$0.00,$0.00
5555-3303,SUP,Custom 27203010,,5555-3303  -  SET TRAUMA FIX TIB KNEE CRUC RET PRCS TRTHLN,$126.00,$0.00,$126.00,$0.00,$89.93,$0.00,$0.00,$0.00,$0.00,$0.00,$126.00,$0.00,$63.00,$99.79,$100.80,$0.00,$0.00,$0.00,$0.00,$0.00
5555-3305,SUP,Custom 27203010,,5555-3305  -  SET ORTH TRTHLN ECT 5 PRP,$126.00,$0.00,$126.00,$0.00,$89.93,$0.00,$0.00,$0.00,$0.00,$0.00,$126.00,$0.00,$63.00,$99.79,$100.80,$0.00,$0.00,$0.00,$0.00,$0.00
5555-3306,SUP,Custom 27203010,,5555-3306  -  SET TRAUMA FIX TIB KNEE CRUC RET PRCS TRTHLN,$126.00,$0.00,$126.00,$0.00,$89.93,$0.00,$0.00,$0.00,$0.00,$0.00,$126.00,$0.00,$63.00,$99.79,$100.80,$0.00,$0.00,$0.00,$0.00,$0.00
5555-3307,SUP,Custom 27203010,,5555-3307  -  SET TRAUMA FIX TIB KNEE CRUC RET PRCS TRTHLN,$126.00,$0.00,$126.00,$0.00,$89.93,$0.00,$0.00,$0.00,$0.00,$0.00,$126.00,$0.00,$63.00,$99.79,$100.80,$0.00,$0.00,$0.00,$0.00,$0.00
5555-3308,SUP,Custom 27203010,,5555-3308  -  SET TRAUMA FIX TIB KNEE CRUC RET PRCS TRTHLN,$126.00,$0.00,$126.00,$0.00,$89.93,$0.00,$0.00,$0.00,$0.00,$0.00,$126.00,$0.00,$63.00,$99.79,$100.80,$0.00,$0.00,$0.00,$0.00,$0.00
5555-3501,SUP,Custom 27203010,,5555-3501  -  SET TRAUMA FIX TIB KNEE PS PRCS TRTHLN,$184.00,$0.00,$184.00,$0.00,$131.32,$0.00,$0.00,$0.00,$0.00,$0.00,$184.00,$0.00,$92.00,$145.73,$147.20,$0.00,$0.00,$0.00,$0.00,$0.00
5555-3502,SUP,Custom 27203010,,5555-3502  -  SET TRAUMA FIX TIB KNEE PS PRCS TRTHLN,$184.00,$0.00,$184.00,$0.00,$131.32,$0.00,$0.00,$0.00,$0.00,$0.00,$184.00,$0.00,$92.00,$145.73,$147.20,$0.00,$0.00,$0.00,$0.00,$0.00
5555-3503,SUP,HCPCS C1713,,5555-3503  -  SYSTEM BONE CMNT PREP KIT TIB 3,$184.00,$0.00,$184.00,$82.80,$131.32,$0.00,$31.70,$0.00,$0.00,$32.22,$184.00,$0.00,$92.00,$145.73,$147.20,$0.00,$28.80,$0.00,$29.29,$0.00
5555-3504,SUP,Custom 27203010,,5555-3504  -  SET TRAUMA FIX 4 STD TIB PS PRCS PREP KIT TRTHLN,$184.00,$0.00,$184.00,$0.00,$131.32,$0.00,$0.00,$0.00,$0.00,$0.00,$184.00,$0.00,$92.00,$145.73,$147.20,$0.00,$0.00,$0.00,$0.00,$0.00
5555-3505,SUP,Custom 27203010,,5555-3505  -  SET TRAUMA FIX 5 STD TIB PS PRCS PREP KIT TRTHLN,$184.00,$0.00,$184.00,$0.00,$131.32,$0.00,$0.00,$0.00,$0.00,$0.00,$184.00,$0.00,$92.00,$145.73,$147.20,$0.00,$0.00,$0.00,$0.00,$0.00
5555-3506,SUP,Custom 27203010,,5555-3506  -  SET TRAUMA FIX TIB KNEE PS PRCS TRTHLN,$184.00,$0.00,$184.00,$0.00,$131.32,$0.00,$0.00,$0.00,$0.00,$0.00,$184.00,$0.00,$92.00,$145.73,$147.20,$0.00,$0.00,$0.00,$0.00,$0.00
5555-3507,SUP,Custom 27203010,,5555-3507  -  SET TRAUMA FIX TIB KNEE PS PRCS TRTHLN,$184.00,$0.00,$184.00,$0.00,$131.32,$0.00,$0.00,$0.00,$0.00,$0.00,$184.00,$0.00,$92.00,$145.73,$147.20,$0.00,$0.00,$0.00,$0.00,$0.00
5555-3508,SUP,HCPCS C1713,,5555-3508  -  SYSTEM BONE CMNT PREP KIT TIB 8,$184.00,$0.00,$184.00,$82.80,$131.32,$0.00,$31.70,$0.00,$0.00,$32.22,$184.00,$0.00,$92.00,$145.73,$147.20,$0.00,$28.80,$0.00,$29.29,$0.00
5555-3701,SUP,Custom 27803010,,5555-3701  -  CMPNT TIB TRTHLN KNEE PS,$158.00,$0.00,$158.00,$0.00,$112.76,$0.00,$0.00,$0.00,$0.00,$0.00,$158.00,$0.00,$79.00,$125.14,$126.40,$0.00,$0.00,$0.00,$0.00,$0.00
5555-3702,SUP,Custom 27803010,,5555-3702  -  CMPNT TIB TRTHLN KNEE PS,$158.00,$0.00,$158.00,$0.00,$112.76,$0.00,$0.00,$0.00,$0.00,$0.00,$158.00,$0.00,$79.00,$125.14,$126.40,$0.00,$0.00,$0.00,$0.00,$0.00
5555-3703,SUP,Custom 27203010,,5555-3703  -  SET TRAUMA FIX TIB KNEE PS PRCS TRTHLN,$158.00,$0.00,$158.00,$0.00,$112.76,$0.00,$0.00,$0.00,$0.00,$0.00,$158.00,$0.00,$79.00,$125.14,$126.40,$0.00,$0.00,$0.00,$0.00,$0.00
5555-3704,SUP,Custom 27203010,,5555-3704  -  SET TRAUMA FIX TIB KNEE PS PRCS TRTHLN,$158.00,$0.00,$158.00,$0.00,$112.76,$0.00,$0.00,$0.00,$0.00,$0.00,$158.00,$0.00,$79.00,$125.14,$126.40,$0.00,$0.00,$0.00,$0.00,$0.00
5555-3705,SUP,Custom 27203010,,5555-3705  -  SET TRAUMA FIX TIB KNEE PS PRCS TRTHLN,$158.00,$0.00,$158.00,$0.00,$112.76,$0.00,$0.00,$0.00,$0.00,$0.00,$158.00,$0.00,$79.00,$125.14,$126.40,$0.00,$0.00,$0.00,$0.00,$0.00
5555-3706,SUP,Custom 27203010,,5555-3706  -  SET TRAUMA FIX TIB KNEE PS PRCS TRTHLN,$158.00,$0.00,$158.00,$0.00,$112.76,$0.00,$0.00,$0.00,$0.00,$0.00,$158.00,$0.00,$79.00,$125.14,$126.40,$0.00,$0.00,$0.00,$0.00,$0.00
5555-3707,SUP,Custom 27203010,,5555-3707  -  SET TRAUMA FIX TIB KNEE PS PRCS TRTHLN,$158.00,$0.00,$158.00,$0.00,$112.76,$0.00,$0.00,$0.00,$0.00,$0.00,$158.00,$0.00,$79.00,$125.14,$126.40,$0.00,$0.00,$0.00,$0.00,$0.00
5555-3708,SUP,Custom 27803010,,5555-3708  -  CMPNT TIB TRTHLN KNEE PS,$158.00,$0.00,$158.00,$0.00,$112.76,$0.00,$0.00,$0.00,$0.00,$0.00,$158.00,$0.00,$79.00,$125.14,$126.40,$0.00,$0.00,$0.00,$0.00,$0.00
5555-4201,SUP,Custom 27203010,,5555-4201  -  SET TRAUMA FIX FEM KNEE CRUC RET PRCS TRTHLN,$315.00,$0.00,$315.00,$0.00,$224.82,$0.00,$0.00,$0.00,$0.00,$0.00,$315.00,$0.00,$157.50,$249.48,$252.00,$0.00,$0.00,$0.00,$0.00,$0.00
5555-4202,SUP,Custom 27203010,,5555-4202  -  KIT THR TRTHLN 2 CRUC RET,$315.00,$0.00,$315.00,$0.00,$224.82,$0.00,$0.00,$0.00,$0.00,$0.00,$315.00,$0.00,$157.50,$249.48,$252.00,$0.00,$0.00,$0.00,$0.00,$0.00
5555-4203,SUP,Custom 27203010,,5555-4203  -  SET ORTH TRTHLN 3 FEM PRP,$315.00,$0.00,$315.00,$0.00,$224.82,$0.00,$0.00,$0.00,$0.00,$0.00,$315.00,$0.00,$157.50,$249.48,$252.00,$0.00,$0.00,$0.00,$0.00,$0.00
5555-4204,SUP,Custom 27203010,,5555-4204  -  SET TRAUMA FIX 4 FEM CRUC RET PRCS PREP KIT TRTHLN,$315.00,$0.00,$315.00,$0.00,$224.82,$0.00,$0.00,$0.00,$0.00,$0.00,$315.00,$0.00,$157.50,$249.48,$252.00,$0.00,$0.00,$0.00,$0.00,$0.00
5555-4205,SUP,Custom 27203010,,5555-4205  -  SET ORTH TRTHLN 5 TIB PRP,$315.00,$0.00,$315.00,$0.00,$224.82,$0.00,$0.00,$0.00,$0.00,$0.00,$315.00,$0.00,$157.50,$249.48,$252.00,$0.00,$0.00,$0.00,$0.00,$0.00
5555-4206,SUP,Custom 27203010,,5555-4206  -  SET TRAUMA FIX 6 FEM CRUC RET PRCS PREP KIT TRTHLN,$315.00,$0.00,$315.00,$0.00,$224.82,$0.00,$0.00,$0.00,$0.00,$0.00,$315.00,$0.00,$157.50,$249.48,$252.00,$0.00,$0.00,$0.00,$0.00,$0.00
5555-4207,SUP,Custom 27203010,,5555-4207  -  KIT PRP TRTHLN 7 PRCS FEM CRUC RET STD,$315.00,$0.00,$315.00,$0.00,$224.82,$0.00,$0.00,$0.00,$0.00,$0.00,$315.00,$0.00,$157.50,$249.48,$252.00,$0.00,$0.00,$0.00,$0.00,$0.00
5555-4208,SUP,HCPCS C1713,,5555-4208  -  SYSTEM BONE CMNT PRP KIT FEM BIOPREP,$315.00,$0.00,$315.00,$141.75,$224.82,$0.00,$54.27,$0.00,$0.00,$55.15,$315.00,$0.00,$157.50,$249.48,$252.00,$0.00,$49.30,$0.00,$50.15,$0.00
5555-4301,SUP,Custom 27203010,,5555-4301  -  TRIATHLON PS PRECISION FEMORAL PREP KIT SIZE 1,$341.00,$0.00,$341.00,$0.00,$243.37,$0.00,$0.00,$0.00,$0.00,$0.00,$341.00,$0.00,$170.50,$270.07,$272.80,$0.00,$0.00,$0.00,$0.00,$0.00
5555-4302,SUP,Custom 27203010,,5555-4302  -  SET TRAUMA FIX FEM KNEE PS PRCS TRTHLN,$341.00,$0.00,$341.00,$0.00,$243.37,$0.00,$0.00,$0.00,$0.00,$0.00,$341.00,$0.00,$170.50,$270.07,$272.80,$0.00,$0.00,$0.00,$0.00,$0.00
5555-4303,SUP,HCPCS C1713,,5555-4303  -  SYSTEM BONE CMNT PREP KIT FEM 3,$341.00,$0.00,$341.00,$153.45,$243.37,$0.00,$58.75,$0.00,$0.00,$59.71,$341.00,$0.00,$170.50,$270.07,$272.80,$0.00,$53.37,$0.00,$54.29,$0.00
5555-4304,SUP,Custom 27203010,,5555-4304  -  SET TRAUMA FIX 4 FEM PS PRCS PREP KIT TRTHLN,$341.00,$0.00,$341.00,$0.00,$243.37,$0.00,$0.00,$0.00,$0.00,$0.00,$341.00,$0.00,$170.50,$270.07,$272.80,$0.00,$0.00,$0.00,$0.00,$0.00
5555-4305,SUP,Custom 27203010,,5555-4305  -  SET TRAUMA FIX 5 FEM PS PRCS PREP KIT TRTHLN,$341.00,$0.00,$341.00,$0.00,$243.37,$0.00,$0.00,$0.00,$0.00,$0.00,$341.00,$0.00,$170.50,$270.07,$272.80,$0.00,$0.00,$0.00,$0.00,$0.00
5555-4306,SUP,HCPCS C1713,,5555-4306  -  SYSTEM BONE CMNT PREP KIT FEM 6,$341.00,$0.00,$341.00,$153.45,$243.37,$0.00,$58.75,$0.00,$0.00,$59.71,$341.00,$0.00,$170.50,$270.07,$272.80,$0.00,$53.37,$0.00,$54.29,$0.00
5555-4307,SUP,Custom 27203010,,5555-4307  -  SET TRAUMA FIX FEM KNEE PS PRCS TRTHLN,$341.00,$0.00,$341.00,$0.00,$243.37,$0.00,$0.00,$0.00,$0.00,$0.00,$341.00,$0.00,$170.50,$270.07,$272.80,$0.00,$0.00,$0.00,$0.00,$0.00
5555-4308,SUP,HCPCS C1713,,5555-4308  -  SYSTEM BONE CMNT PREP KIT FEM 8,$341.00,$0.00,$341.00,$153.45,$243.37,$0.00,$58.75,$0.00,$0.00,$59.71,$341.00,$0.00,$170.50,$270.07,$272.80,$0.00,$53.37,$0.00,$54.29,$0.00
5555-4600,SUP,Custom 27203010,,5555-4600  -  SYSTEM KN TRL 1-8 TRTHLN TIB,$100.00,$0.00,$100.00,$0.00,$71.37,$0.00,$0.00,$0.00,$0.00,$0.00,$100.00,$0.00,$50.00,$79.20,$80.00,$0.00,$0.00,$0.00,$0.00,$0.00
5556-L-319,SUP,HCPCS C1776,,5556-L-319  -  COMPONENT PTLR S 31X9MM STRL LF TRITANIUM,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
5556-L-339,SUP,HCPCS C1776,,5556-L-339  -  COMPONENT PTLR 33MM 9MM SMTR TRITANIUM KN,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
5556-L-360,SUP,HCPCS C1776,,5556-L-360  -  COMPONENT PTLR 36MM 10MM TRITANIUM SMTR MTL KN,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
5556-L-391,SUP,HCPCS C1776,,5556-L-391  -  COMPONENT PTLR 39MM 11MM TRITANIUM SMTR MTL KN,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
5560-S-109,SUP,Custom 27803010,,5560-S-109  -  STEM FEMORAL 9MM 50MM CEMENTED TOT STABILIZE TRIATHLON COCR,"$2,315.00",$0.00,"$2,315.00",$0.00,"$1,652.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,315.00",$0.00,"$1,157.50","$1,833.48","$1,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
5560-S-112,SUP,Custom 27803010,,5560-S-112  -  STEM FEMORAL 12MM 50MM CEMENTED TOT STABILIZED TRIATHLON,"$2,315.00",$0.00,"$2,315.00",$0.00,"$1,652.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,315.00",$0.00,"$1,157.50","$1,833.48","$1,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
5560-S-115,SUP,Custom 27803010,,5560-S-115  -  STEM FEMORAL 15MM 50MM CEMENTED TOT STABILIZE TRIATHLON COCR,"$2,315.00",$0.00,"$2,315.00",$0.00,"$1,652.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,315.00",$0.00,"$1,157.50","$1,833.48","$1,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
5560-S-209,SUP,Custom 27803010,,5560-S-209  -  STEM FEMORAL 9MM 100MM CEMENTED TOT STABILIZE TRIATHLON COCR,"$2,315.00",$0.00,"$2,315.00",$0.00,"$1,652.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,315.00",$0.00,"$1,157.50","$1,833.48","$1,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
5560-S-212,SUP,Custom 27803010,,5560-S-212  -  STEM FEMORAL 12MM 100MM CEMENTED TOT STABILIZED TRIATHLON,"$2,315.00",$0.00,"$2,315.00",$0.00,"$1,652.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,315.00",$0.00,"$1,157.50","$1,833.48","$1,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
5560-S-215,SUP,Custom 27803010,,5560-S-215  -  STEM FEMORAL 15MM 100MM CEMENTED TOT STABILIZE TRIATHLON,"$2,315.00",$0.00,"$2,315.00",$0.00,"$1,652.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,315.00",$0.00,"$1,157.50","$1,833.48","$1,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
5560-S-309,SUP,Custom 27803010,,5560-S-309  -  STEM FEMORAL 9MM 150MM CEMENTED TOT STABILIZE TRIATHLON COCR,"$2,315.00",$0.00,"$2,315.00",$0.00,"$1,652.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,315.00",$0.00,"$1,157.50","$1,833.48","$1,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
5560-S-312,SUP,Custom 27803010,,5560-S-312  -  STEM FEMORAL 12MM 150MM CEMENTED TOT STABILIZE TRIATHLON,"$2,315.00",$0.00,"$2,315.00",$0.00,"$1,652.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,315.00",$0.00,"$1,157.50","$1,833.48","$1,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
5560-S-315,SUP,Custom 27803010,,5560-S-315  -  STEM FEMORAL 15MM 150MM CEMENTED TOT STABILIZE TRIATHLON,"$2,315.00",$0.00,"$2,315.00",$0.00,"$1,652.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,315.00",$0.00,"$1,157.50","$1,833.48","$1,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
556-25890,SUP,HCPCS C1887,,556-25890  -  CATH GUID MPD CURVE 5FR .056IN 90CM PTFE ENV,$825.00,$0.00,$825.00,$447.98,$588.80,$0.00,$142.14,$0.00,$0.00,$144.45,$825.00,$0.00,$412.50,$653.40,$660.00,$0.00,$129.11,$0.00,$131.34,$0.00
5565-S-010,SUP,Custom 27803010,,5565-S-010  -  STEM FEMORAL 10MM 100MM CEMENTLESS TOT STABILIZE TRIATHLON,"$2,530.00",$0.00,"$2,530.00",$0.00,"$1,805.66",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,530.00",$0.00,"$1,265.00","$2,003.76","$2,024.00",$0.00,$0.00,$0.00,$0.00,$0.00
5565-S-011,SUP,Custom 27803010,,5565-S-011  -  STEM FEMORAL 11MM 100MM CEMENTLESS TOT STABILIZE TRIATHLON,"$2,530.00",$0.00,"$2,530.00",$0.00,"$1,805.66",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,530.00",$0.00,"$1,265.00","$2,003.76","$2,024.00",$0.00,$0.00,$0.00,$0.00,$0.00
5565-S-012,SUP,Custom 27803010,,5565-S-012  -  STEM FEMORAL 12MM 100MM CEMENTLESS TOT STABILIZED TRIATHLON,"$2,530.00",$0.00,"$2,530.00",$0.00,"$1,805.66",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,530.00",$0.00,"$1,265.00","$2,003.76","$2,024.00",$0.00,$0.00,$0.00,$0.00,$0.00
5565-S-013,SUP,Custom 27803010,,5565-S-013  -  STEM FEMORAL 13MM 100MM CEMENTLESS TOT STABILIZE TRIATHLON,"$2,530.00",$0.00,"$2,530.00",$0.00,"$1,805.66",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,530.00",$0.00,"$1,265.00","$2,003.76","$2,024.00",$0.00,$0.00,$0.00,$0.00,$0.00
5565-S-014,SUP,Custom 27803010,,5565-S-014  -  STEM FEMORAL 14MM 100MM CEMENTLESS TOT STABILIZE TRIATHLON,"$2,530.00",$0.00,"$2,530.00",$0.00,"$1,805.66",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,530.00",$0.00,"$1,265.00","$2,003.76","$2,024.00",$0.00,$0.00,$0.00,$0.00,$0.00
5565-S-015,SUP,Custom 27803010,,5565-S-015  -  STEM FEMORAL 15MM 100MM CEMENTLESS TOT STABILIZED TRIATHLON,"$2,530.00",$0.00,"$2,530.00",$0.00,"$1,805.66",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,530.00",$0.00,"$1,265.00","$2,003.76","$2,024.00",$0.00,$0.00,$0.00,$0.00,$0.00
5565-S-016,SUP,Custom 27803010,,5565-S-016  -  STEM FEMORAL 16MM 105MM CEMENTLESS TOT STABILIZED TRIATHLON,"$2,530.00",$0.00,"$2,530.00",$0.00,"$1,805.66",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,530.00",$0.00,"$1,265.00","$2,003.76","$2,024.00",$0.00,$0.00,$0.00,$0.00,$0.00
5565-S-017,SUP,Custom 27803010,,5565-S-017  -  STEM FEMORAL 17MM 100MM CEMENTLESS TOT STABILIZED TRIATHLON,"$2,530.00",$0.00,"$2,530.00",$0.00,"$1,805.66",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,530.00",$0.00,"$1,265.00","$2,003.76","$2,024.00",$0.00,$0.00,$0.00,$0.00,$0.00
5565-S-018,SUP,Custom 27803010,,5565-S-018  -  STEM FEMORAL 18MM 100MM CEMENTLESS TOT STABILIZE TRIATHLON,"$2,530.00",$0.00,"$2,530.00",$0.00,"$1,805.66",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,530.00",$0.00,"$1,265.00","$2,003.76","$2,024.00",$0.00,$0.00,$0.00,$0.00,$0.00
5565-S-019,SUP,Custom 27803010,,5565-S-019  -  STEM FEMORAL 19MM 100MM CEMENTLESS TOT STABILIZE TRIATHLON,"$2,530.00",$0.00,"$2,530.00",$0.00,"$1,805.66",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,530.00",$0.00,"$1,265.00","$2,003.76","$2,024.00",$0.00,$0.00,$0.00,$0.00,$0.00
5565-S-020,SUP,Custom 27803010,,5565-S-020  -  STEM FEMORAL 20MM 100MM CEMENTLESS TOT STABILIZE TRIATHLON,"$2,530.00",$0.00,"$2,530.00",$0.00,"$1,805.66",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,530.00",$0.00,"$1,265.00","$2,003.76","$2,024.00",$0.00,$0.00,$0.00,$0.00,$0.00
5565-S-021,SUP,Custom 27803010,,5565-S-021  -  STEM FEMORAL 21MM 100MM CEMENTLESS TOT STABILIZE TRIATHLON,"$2,530.00",$0.00,"$2,530.00",$0.00,"$1,805.66",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,530.00",$0.00,"$1,265.00","$2,003.76","$2,024.00",$0.00,$0.00,$0.00,$0.00,$0.00
5565-S-022,SUP,Custom 27803010,,5565-S-022  -  STEM FEMORAL 22MM 100MM CEMENTLESS TOT STABILIZE TRIATHLON,"$2,530.00",$0.00,"$2,530.00",$0.00,"$1,805.66",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,530.00",$0.00,"$1,265.00","$2,003.76","$2,024.00",$0.00,$0.00,$0.00,$0.00,$0.00
5565-S-023,SUP,Custom 27803010,,5565-S-023  -  STEM FEMORAL 23MM 100MM CEMENTLESS TOT STABILIZE TRIATHLON,"$2,530.00",$0.00,"$2,530.00",$0.00,"$1,805.66",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,530.00",$0.00,"$1,265.00","$2,003.76","$2,024.00",$0.00,$0.00,$0.00,$0.00,$0.00
5565-S-024,SUP,Custom 27803010,,5565-S-024  -  STEM FEMORAL 24MM 100MM CEMENTLESS TOT STABILIZE TRIATHLON,"$2,530.00",$0.00,"$2,530.00",$0.00,"$1,805.66",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,530.00",$0.00,"$1,265.00","$2,003.76","$2,024.00",$0.00,$0.00,$0.00,$0.00,$0.00
5565-S-025,SUP,Custom 27803010,,5565-S-025  -  STEM FEMORAL 25MM 100MM CEMENTLESS TOT STABILIZE TRIATHLON,"$2,530.00",$0.00,"$2,530.00",$0.00,"$1,805.66",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,530.00",$0.00,"$1,265.00","$2,003.76","$2,024.00",$0.00,$0.00,$0.00,$0.00,$0.00
5566-S-010,SUP,Custom 27803010,,5566-S-010  -  STEM FEMORAL 20MM 150MM CEMENTLESS TOT STABILIZE TRIATHLON,"$2,635.00",$0.00,"$2,635.00",$0.00,"$1,880.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,635.00",$0.00,"$1,317.50","$2,086.92","$2,108.00",$0.00,$0.00,$0.00,$0.00,$0.00
5566-S-011,SUP,Custom 27803010,,5566-S-011  -  STEM FEMORAL 11MM 150MM CEMENTLESS TOT STABILIZE TRIATHLON,"$2,635.00",$0.00,"$2,635.00",$0.00,"$1,880.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,635.00",$0.00,"$1,317.50","$2,086.92","$2,108.00",$0.00,$0.00,$0.00,$0.00,$0.00
5566-S-012,SUP,Custom 27803010,,5566-S-012  -  STEM FEMORAL 12MM 150MM CEMENTLESS TOT STABILIZE TRIATHLON,"$2,635.00",$0.00,"$2,635.00",$0.00,"$1,880.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,635.00",$0.00,"$1,317.50","$2,086.92","$2,108.00",$0.00,$0.00,$0.00,$0.00,$0.00
5566-S-013,SUP,Custom 27803010,,5566-S-013  -  STEM FEMORAL 13MM 150MM CEMENTLESS TOT STABILIZED TRIATHLON,"$2,635.00",$0.00,"$2,635.00",$0.00,"$1,880.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,635.00",$0.00,"$1,317.50","$2,086.92","$2,108.00",$0.00,$0.00,$0.00,$0.00,$0.00
5566-S-014,SUP,Custom 27803010,,5566-S-014  -  STEM FEMORAL 14MM 150MM CEMENTLESS TOT STABILIZE TRIATHLON,"$2,635.00",$0.00,"$2,635.00",$0.00,"$1,880.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,635.00",$0.00,"$1,317.50","$2,086.92","$2,108.00",$0.00,$0.00,$0.00,$0.00,$0.00
5566-S-015,SUP,Custom 27803010,,5566-S-015  -  STEM FEMORAL 15MM 150MM CEMENTLESS TOT STABILIZE TRIATHLON,"$2,635.00",$0.00,"$2,635.00",$0.00,"$1,880.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,635.00",$0.00,"$1,317.50","$2,086.92","$2,108.00",$0.00,$0.00,$0.00,$0.00,$0.00
5566-S-016,SUP,Custom 27803010,,5566-S-016  -  STEM FEMORAL 16MM 150MM CEMENTLESS TOT STABILIZE TRIATHLON,"$2,635.00",$0.00,"$2,635.00",$0.00,"$1,880.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,635.00",$0.00,"$1,317.50","$2,086.92","$2,108.00",$0.00,$0.00,$0.00,$0.00,$0.00
5566-S-017,SUP,Custom 27803010,,5566-S-017  -  STEM FEMORAL 17MM 150MM CEMENTLESS TOT STABILIZE TRIATHLON,"$2,635.00",$0.00,"$2,635.00",$0.00,"$1,880.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,635.00",$0.00,"$1,317.50","$2,086.92","$2,108.00",$0.00,$0.00,$0.00,$0.00,$0.00
5566-S-018,SUP,Custom 27803010,,5566-S-018  -  STEM FEMORAL 18MM 150MM CEMENTLESS TOT STABILIZE TRIATHLON,"$2,635.00",$0.00,"$2,635.00",$0.00,"$1,880.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,635.00",$0.00,"$1,317.50","$2,086.92","$2,108.00",$0.00,$0.00,$0.00,$0.00,$0.00
5566-S-019,SUP,Custom 27803010,,5566-S-019  -  STEM FEMORAL 19MM 150MM CEMENTLESS TOT STABILIZE TRIATHLON,"$2,635.00",$0.00,"$2,635.00",$0.00,"$1,880.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,635.00",$0.00,"$1,317.50","$2,086.92","$2,108.00",$0.00,$0.00,$0.00,$0.00,$0.00
5566-S-020,SUP,Custom 27803010,,5566-S-020  -  STEM FEMORAL 20MM 150MM CEMENTLESS TOT STABILIZE TRIATHLON,"$2,635.00",$0.00,"$2,635.00",$0.00,"$1,880.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,635.00",$0.00,"$1,317.50","$2,086.92","$2,108.00",$0.00,$0.00,$0.00,$0.00,$0.00
5566-S-021,SUP,Custom 27803010,,5566-S-021  -  STEM FEMORAL 21MM 150MM CEMENTLESS TOT STABILIZE TRIATHLON,"$2,635.00",$0.00,"$2,635.00",$0.00,"$1,880.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,635.00",$0.00,"$1,317.50","$2,086.92","$2,108.00",$0.00,$0.00,$0.00,$0.00,$0.00
5566-S-022,SUP,Custom 27803010,,5566-S-022  -  STEM FEMORAL 22MM 150MM CEMENTLESS TOT STABILIZE TRIATHLON,"$2,635.00",$0.00,"$2,635.00",$0.00,"$1,880.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,635.00",$0.00,"$1,317.50","$2,086.92","$2,108.00",$0.00,$0.00,$0.00,$0.00,$0.00
5566-S-023,SUP,Custom 27803010,,5566-S-023  -  STEM FEMORAL 23MM 150MM CEMENTLESS TOT STABILIZE TRIATHLON,"$2,635.00",$0.00,"$2,635.00",$0.00,"$1,880.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,635.00",$0.00,"$1,317.50","$2,086.92","$2,108.00",$0.00,$0.00,$0.00,$0.00,$0.00
5566-S-024,SUP,Custom 27803010,,5566-S-024  -  STEM FEMORAL 24MM 150MM CEMENTLESS TOT STABILIZE TRIATHLON,"$2,635.00",$0.00,"$2,635.00",$0.00,"$1,880.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,635.00",$0.00,"$1,317.50","$2,086.92","$2,108.00",$0.00,$0.00,$0.00,$0.00,$0.00
5566-S-025,SUP,Custom 27803010,,5566-S-025  -  STEM FEMORAL 25MM 150MM CEMENTLESS TOT STABILIZE TRIATHLON,"$2,635.00",$0.00,"$2,635.00",$0.00,"$1,880.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,635.00",$0.00,"$1,317.50","$2,086.92","$2,108.00",$0.00,$0.00,$0.00,$0.00,$0.00
5570-S-020,SUP,Custom 27803010,,5570-S-020  -  ADAPTER FEMORAL 2MM OFFST TOT STABILIZE TRIATHLON KNEE,"$2,582.50",$0.00,"$2,582.50",$0.00,"$1,843.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,582.50",$0.00,"$1,291.25","$2,045.34","$2,066.00",$0.00,$0.00,$0.00,$0.00,$0.00
5570-S-040,SUP,Custom 27803010,,5570-S-040  -  ADAPTER FEMORAL 4MM OFFST TOT STABILIZE TRIATHLON KNEE,"$2,582.50",$0.00,"$2,582.50",$0.00,"$1,843.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,582.50",$0.00,"$1,291.25","$2,045.34","$2,066.00",$0.00,$0.00,$0.00,$0.00,$0.00
5570-S-060,SUP,Custom 27803010,,5570-S-060  -  ADAPTER FEMORAL 6MM OFFST TOT STABILIZE TRIATHLON KNEE,"$2,582.50",$0.00,"$2,582.50",$0.00,"$1,843.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,582.50",$0.00,"$1,291.25","$2,045.34","$2,066.00",$0.00,$0.00,$0.00,$0.00,$0.00
5570-S-080,SUP,Custom 27803010,,5570-S-080  -  ADAPTER FEMORAL 8MM OFFST TOT STABILIZE TRIATHLON KNEE,"$2,582.50",$0.00,"$2,582.50",$0.00,"$1,843.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,582.50",$0.00,"$1,291.25","$2,045.34","$2,066.00",$0.00,$0.00,$0.00,$0.00,$0.00
5571-S-025,SUP,Custom 27803010,,5571-S-025  -  EXTENSION STEM 25MM TOT STABILIZE TRIATHLON KNEE FEMUR,"$2,402.50",$0.00,"$2,402.50",$0.00,"$1,714.66",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,402.50",$0.00,"$1,201.25","$1,902.78","$1,922.00",$0.00,$0.00,$0.00,$0.00,$0.00
5571-S-050,SUP,Custom 27803010,,5571-S-050  -  EXTENSION STEM 50MM TOT STABILIZE TRIATHLON KNEE FEMUR,"$2,402.50",$0.00,"$2,402.50",$0.00,"$1,714.66",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,402.50",$0.00,"$1,201.25","$1,902.78","$1,922.00",$0.00,$0.00,$0.00,$0.00,$0.00
5575-X-000,SUP,HCPCS C1713,,5575-X-000  -  PEG FIX MODULAR TRIATHLON DISTAL FEMUR KNEE,$880.00,$0.00,$880.00,$396.00,$628.06,$0.00,$151.62,$0.00,$0.00,$154.08,$880.00,$0.00,$440.00,$696.96,$704.00,$0.00,$137.72,$0.00,$140.10,$0.00
558-10-48D,SUP,Custom 27803010,,558-10-48D  -  SHELL ACETAB 48MM HIP PUREFIX HYDRXAPT ARC-2F TRDNT D,"$2,409.00",$0.00,"$2,409.00",$0.00,"$1,719.30",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,409.00",$0.00,"$1,204.50","$1,907.93","$1,927.20",$0.00,$0.00,$0.00,$0.00,$0.00
558-10-50D,SUP,Custom 27803010,,558-10-50D  -  SHELL ACETAB 50MM HIP PUREFIX HYDRXAPT ARC-2F TRDNT D,"$2,409.00",$0.00,"$2,409.00",$0.00,"$1,719.30",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,409.00",$0.00,"$1,204.50","$1,907.93","$1,927.20",$0.00,$0.00,$0.00,$0.00,$0.00
558-10-52E,SUP,Custom 27803010,,558-10-52E  -  SHELL ACETAB 52MM HIP PUREFIX HYDRXAPT ARC-2F TRDNT E,"$2,409.00",$0.00,"$2,409.00",$0.00,"$1,719.30",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,409.00",$0.00,"$1,204.50","$1,907.93","$1,927.20",$0.00,$0.00,$0.00,$0.00,$0.00
558-10-54E,SUP,Custom 27803010,,558-10-54E  -  SHELL ACETAB 54MM HIP PUREFIX HYDRXAPT ARC-2F TRDNT E,"$2,409.00",$0.00,"$2,409.00",$0.00,"$1,719.30",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,409.00",$0.00,"$1,204.50","$1,907.93","$1,927.20",$0.00,$0.00,$0.00,$0.00,$0.00
558-10-56F,SUP,Custom 27803010,,558-10-56F  -  SHELL ACETAB 56MM HIP PUREFIX HYDRXAPT ARC-2F TRDNT F,"$2,409.00",$0.00,"$2,409.00",$0.00,"$1,719.30",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,409.00",$0.00,"$1,204.50","$1,907.93","$1,927.20",$0.00,$0.00,$0.00,$0.00,$0.00
558-10-58F,SUP,Custom 27803010,,558-10-58F  -  SHELL ACETAB 58MM HIP PUREFIX HYDRXAPT ARC-2F TRDNT F,"$2,409.00",$0.00,"$2,409.00",$0.00,"$1,719.30",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,409.00",$0.00,"$1,204.50","$1,907.93","$1,927.20",$0.00,$0.00,$0.00,$0.00,$0.00
558-10-60G,SUP,Custom 27803010,,558-10-60G  -  SHELL ACETAB 60MM HIP PUREFIX HYDRXAPT ARC-2F TRDNT G,"$2,409.00",$0.00,"$2,409.00",$0.00,"$1,719.30",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,409.00",$0.00,"$1,204.50","$1,907.93","$1,927.20",$0.00,$0.00,$0.00,$0.00,$0.00
558-10-62G,SUP,Custom 27803010,,558-10-62G  -  SHELL ACETAB 62MM HIP PUREFIX HYDRXAPT ARC-2F TRDNT G,"$2,409.00",$0.00,"$2,409.00",$0.00,"$1,719.30",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,409.00",$0.00,"$1,204.50","$1,907.93","$1,927.20",$0.00,$0.00,$0.00,$0.00,$0.00
558-10-64H,SUP,Custom 27803010,,558-10-64H  -  SHELL ACETAB 62MM HIP PUREFIX HYDRXAPT ARC-2F TRDNT H,"$2,409.00",$0.00,"$2,409.00",$0.00,"$1,719.30",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,409.00",$0.00,"$1,204.50","$1,907.93","$1,927.20",$0.00,$0.00,$0.00,$0.00,$0.00
558-10-66H,SUP,Custom 27803010,,558-10-66H  -  SHELL ACETAB 66MM HIP PUREFIX HYDRXAPT ARC-2F TRDNT H,"$2,409.00",$0.00,"$2,409.00",$0.00,"$1,719.30",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,409.00",$0.00,"$1,204.50","$1,907.93","$1,927.20",$0.00,$0.00,$0.00,$0.00,$0.00
558-10-68I,SUP,Custom 27803010,,558-10-68I  -  SHELL ACETAB 68MM HIP PUREFIX HYDRXAPT ARC-2F TRDNT 1,"$2,409.00",$0.00,"$2,409.00",$0.00,"$1,719.30",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,409.00",$0.00,"$1,204.50","$1,907.93","$1,927.20",$0.00,$0.00,$0.00,$0.00,$0.00
558-10-70I,SUP,Custom 27803010,,558-10-70I  -  SHELL ACETAB 70MM HIP PUREFIX HYDRXAPT ARC-2F TRDNT 1,"$2,409.00",$0.00,"$2,409.00",$0.00,"$1,719.30",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,409.00",$0.00,"$1,204.50","$1,907.93","$1,927.20",$0.00,$0.00,$0.00,$0.00,$0.00
5583-A3,SUP,HCPCS C1725,,5583-A3  -  CATH ANGIO .035IN VERT CURVE 5FR .044IN 100CM BRAID SFTCH,$30.50,$0.00,$30.50,$16.56,$21.77,$0.00,$5.25,$0.00,$0.00,$5.34,$30.50,$0.00,$15.25,$24.16,$24.40,$0.00,$4.77,$0.00,$4.86,$0.00
5585-C-016,SUP,HCPCS C1713,,5585-C-016  -  SCREW BN 6.5MM 16MM TRTHLN VIT CANC T/K SYS,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
5585-C-020,SUP,HCPCS C1713,,5585-C-020  -  SCREW BASEPLATE 6.5MM 20MM TRIATHLON VITALLIUM KNEE TIBIA,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
5585-C-025,SUP,HCPCS C1713,,5585-C-025  -  SCREW BASEPLATE 6.5MM 25MM TRIATHLON VITALLIUM KNEE TIBIA,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
5585-C-030,SUP,HCPCS C1713,,5585-C-030  -  SCREW BASEPLATE 6.5MM 30MM TRIATHLON VITALLIUM KNEE TIBIA,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
5585-C-035,SUP,HCPCS C1713,,5585-C-035  -  SCREW BASEPLATE 6.5MM 35MM TRIATHLON VITALLIUM KNEE TIBIA,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
5585-C-040,SUP,HCPCS C1713,,5585-C-040  -  SCREW BASEPLATE 6.5MM 40MM TRIATHLON VITALLIUM KNEE TIBIA,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
5585-C-045,SUP,HCPCS C1713,,5585-C-045  -  SCREW BASEPLATE 6.5MM 45MM TRIATHLON VITALLIUM KNEE TIBIA,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
5585-C-050,SUP,HCPCS C1713,,5585-C-050  -  SCREW BASEPLATE 6.5MM 50MM TRIATHLON VITALLIUM KNEE TIBIA,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
5585-C-055,SUP,HCPCS C1713,,5585-C-055  -  SCREW BN 6.5MM 55MM TRTHLN VIT CANC,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
5585-C-060,SUP,HCPCS C1713,,5585-C-060  -  SCREW BN 6.5MM 60MM TRTHLN VIT CANC,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
5591-B3,SUP,HCPCS C1725,,5591-B3  -  CATHETER ANGIOGRAPHIC MOTARJEME CURVE 5FR .046IN 100CM BRAID,$29.65,$0.00,$29.65,$16.10,$21.16,$0.00,$5.11,$0.00,$0.00,$5.19,$29.65,$0.00,$14.83,$23.48,$23.72,$0.00,$4.64,$0.00,$4.72,$0.00
55-969-30-04,SUP,HCPCS C1713,,55-969-30-04  -  TRAY 30CM X30CM W/O LID FOR LEV 1 INST,"$2,412.78",$0.00,"$2,412.78","$1,085.75","$1,722.00",$0.00,$415.71,$0.00,$0.00,$422.46,"$2,412.78",$0.00,"$1,206.39","$1,910.92","$1,930.22",$0.00,$377.60,$0.00,$384.11,$0.00
55-969-98-04,SUP,Custom 27803010,,55-969-98-04  -  LOCK MOD 3 STACK LEFT LEVEL 1 SYSTEM,$579.38,$0.00,$579.38,$0.00,$413.50,$0.00,$0.00,$0.00,$0.00,$0.00,$579.38,$0.00,$289.69,$458.87,$463.50,$0.00,$0.00,$0.00,$0.00,$0.00
55-969-99-04,SUP,Custom 27803010,,55-969-99-04  -  LOCK MOD 3 STACK RIGHT LEVEL 1 SYSTEM,$579.38,$0.00,$579.38,$0.00,$413.50,$0.00,$0.00,$0.00,$0.00,$0.00,$579.38,$0.00,$289.69,$458.87,$463.50,$0.00,$0.00,$0.00,$0.00,$0.00
56-00400,SUP,HCPCS C1713,,56-00400  -  WASHER SPINAL BICONCAVE 4MM SALZBURG TITANIUM,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
5601-0-901,SUP,HCPCS C1713,,5601-0-901  -  TRAY STRL ICS SMTB PLT,$302.50,$0.00,$302.50,$136.13,$215.89,$0.00,$52.12,$0.00,$0.00,$52.97,$302.50,$0.00,$151.25,$239.58,$242.00,$0.00,$47.34,$0.00,$48.16,$0.00
5601-0-902,SUP,HCPCS C1713,,5601-0-902  -  TRAY STRL ICS NAR PLT,$302.50,$0.00,$302.50,$136.13,$215.89,$0.00,$52.12,$0.00,$0.00,$52.97,$302.50,$0.00,$151.25,$239.58,$242.00,$0.00,$47.34,$0.00,$48.16,$0.00
5601-0-903,SUP,HCPCS C1713,,5601-0-903  -  TRAY STRL ICS BRD PLT,$302.50,$0.00,$302.50,$136.13,$215.89,$0.00,$52.12,$0.00,$0.00,$52.97,$302.50,$0.00,$151.25,$239.58,$242.00,$0.00,$47.34,$0.00,$48.16,$0.00
5601-0-904,SUP,Custom 27203010,,5601-0-904  -  CASE STRL LG SCR,$459.25,$0.00,$459.25,$0.00,$327.77,$0.00,$0.00,$0.00,$0.00,$0.00,$459.25,$0.00,$229.63,$363.73,$367.40,$0.00,$0.00,$0.00,$0.00,$0.00
5601-0-908,SUP,Custom 27203010,,5601-0-908  -  TRAY STRL ICS DRILL TAPS,$481.25,$0.00,$481.25,$0.00,$343.47,$0.00,$0.00,$0.00,$0.00,$0.00,$481.25,$0.00,$240.63,$381.15,$385.00,$0.00,$0.00,$0.00,$0.00,$0.00
5601-0-909,SUP,Custom 27203010,,5601-0-909  -  TRAY STRL ICS DRILL GD,$302.50,$0.00,$302.50,$0.00,$215.89,$0.00,$0.00,$0.00,$0.00,$0.00,$302.50,$0.00,$151.25,$239.58,$242.00,$0.00,$0.00,$0.00,$0.00,$0.00
5601-1-900,SUP,Custom 27203010,,5601-1-900  -  CASE STRL ICS FRAGMENTATION,$460.63,$0.00,$460.63,$0.00,$328.75,$0.00,$0.00,$0.00,$0.00,$0.00,$460.63,$0.00,$230.31,$364.82,$368.50,$0.00,$0.00,$0.00,$0.00,$0.00
5601-1-901,SUP,Custom 27203010,,5601-1-901  -  RACK STRL SCR ICS SM,$726.00,$0.00,$726.00,$0.00,$518.15,$0.00,$0.00,$0.00,$0.00,$0.00,$726.00,$0.00,$363.00,$574.99,$580.80,$0.00,$0.00,$0.00,$0.00,$0.00
5601-1-902,SUP,HCPCS C1713,,5601-1-902  -  TRAY STRL ICS SM PLT,$481.25,$0.00,$481.25,$216.56,$343.47,$0.00,$82.92,$0.00,$0.00,$84.26,$481.25,$0.00,$240.63,$381.15,$385.00,$0.00,$75.32,$0.00,$76.62,$0.00
5601-1-911,SUP,Custom 27203010,,5601-1-911  -  TRAY STRL ICS SM TAP DRILL SLV,$357.50,$0.00,$357.50,$0.00,$255.15,$0.00,$0.00,$0.00,$0.00,$0.00,$357.50,$0.00,$178.75,$283.14,$286.00,$0.00,$0.00,$0.00,$0.00,$0.00
5601-1-912,SUP,Custom 27203010,,5601-1-912  -  TRAY STRL ICS FORCEP,$357.50,$0.00,$357.50,$0.00,$255.15,$0.00,$0.00,$0.00,$0.00,$0.00,$357.50,$0.00,$178.75,$283.14,$286.00,$0.00,$0.00,$0.00,$0.00,$0.00
5601-1-913,SUP,Custom 27203010,,5601-1-913  -  TRAY STRL ICS SM DRILL TAPS,$357.50,$0.00,$357.50,$0.00,$255.15,$0.00,$0.00,$0.00,$0.00,$0.00,$357.50,$0.00,$178.75,$283.14,$286.00,$0.00,$0.00,$0.00,$0.00,$0.00
5610-F-101,SUP,HCPCS C1776,,5610-F-101  -  COMPONENT FEM 1 TRTHLN PRT KN RSRFC KN LT MDL RL,"$3,302.50",$0.00,"$3,302.50","$1,486.13","$2,356.99",$0.00,$569.00,$0.00,$0.00,$578.24,"$3,302.50",$0.00,"$1,651.25","$2,615.58","$2,642.00",$0.00,$516.84,$0.00,$525.76,$0.00
5610-F-102,SUP,HCPCS C1776,,5610-F-102  -  COMPONENT FEM 1 TRTHLN RMLL,"$3,302.50",$0.00,"$3,302.50","$1,486.13","$2,356.99",$0.00,$569.00,$0.00,$0.00,$578.24,"$3,302.50",$0.00,"$1,651.25","$2,615.58","$2,642.00",$0.00,$516.84,$0.00,$525.76,$0.00
5610-F-201,SUP,HCPCS C1776,,5610-F-201  -  COMPONENT FEM 2 TRTHLN PRT KN RSRFC LT MDL RL,"$3,302.50",$0.00,"$3,302.50","$1,486.13","$2,356.99",$0.00,$569.00,$0.00,$0.00,$578.24,"$3,302.50",$0.00,"$1,651.25","$2,615.58","$2,642.00",$0.00,$516.84,$0.00,$525.76,$0.00
5610-F-202,SUP,HCPCS C1776,,5610-F-202  -  COMPONENT FEM 2 TRTHLN PRT KN RSRFC RMLL,"$3,302.50",$0.00,"$3,302.50","$1,486.13","$2,356.99",$0.00,$569.00,$0.00,$0.00,$578.24,"$3,302.50",$0.00,"$1,651.25","$2,615.58","$2,642.00",$0.00,$516.84,$0.00,$525.76,$0.00
5610-F-301,SUP,HCPCS C1776,,5610-F-301  -  COMPONENT FEM 3 TRTHLN PRT KN RSRFC LT MDL RL,"$3,302.50",$0.00,"$3,302.50","$1,486.13","$2,356.99",$0.00,$569.00,$0.00,$0.00,$578.24,"$3,302.50",$0.00,"$1,651.25","$2,615.58","$2,642.00",$0.00,$516.84,$0.00,$525.76,$0.00
5610-F-302,SUP,HCPCS C1776,,5610-F-302  -  COMPONENT FEM 3 TRTHLN PRT KN RSRFC RMLL,"$3,302.50",$0.00,"$3,302.50","$1,486.13","$2,356.99",$0.00,$569.00,$0.00,$0.00,$578.24,"$3,302.50",$0.00,"$1,651.25","$2,615.58","$2,642.00",$0.00,$516.84,$0.00,$525.76,$0.00
5610-F-401,SUP,HCPCS C1776,,5610-F-401  -  COMPONENT FEM 4 TRTHLN PRT KN RSRFC LT MDL RL,"$3,302.50",$0.00,"$3,302.50","$1,486.13","$2,356.99",$0.00,$569.00,$0.00,$0.00,$578.24,"$3,302.50",$0.00,"$1,651.25","$2,615.58","$2,642.00",$0.00,$516.84,$0.00,$525.76,$0.00
5610-F-402,SUP,HCPCS C1776,,5610-F-402  -  COMPONENT FEM 4 TRTHLN PRT KN RSRFC RMLL,"$3,302.50",$0.00,"$3,302.50","$1,486.13","$2,356.99",$0.00,$569.00,$0.00,$0.00,$578.24,"$3,302.50",$0.00,"$1,651.25","$2,615.58","$2,642.00",$0.00,$516.84,$0.00,$525.76,$0.00
5610-F-501,SUP,HCPCS C1776,,5610-F-501  -  COMPONENT FEM 5 TRTHLN PRT KN RSRFC LT MDL RL,"$3,302.50",$0.00,"$3,302.50","$1,486.13","$2,356.99",$0.00,$569.00,$0.00,$0.00,$578.24,"$3,302.50",$0.00,"$1,651.25","$2,615.58","$2,642.00",$0.00,$516.84,$0.00,$525.76,$0.00
5610-F-502,SUP,HCPCS C1776,,5610-F-502  -  COMPONENT FEM 5 TRTHLN PRT KN RSRFC RMLL,"$3,302.50",$0.00,"$3,302.50","$1,486.13","$2,356.99",$0.00,$569.00,$0.00,$0.00,$578.24,"$3,302.50",$0.00,"$1,651.25","$2,615.58","$2,642.00",$0.00,$516.84,$0.00,$525.76,$0.00
5610-F-601,SUP,HCPCS C1776,,5610-F-601  -  COMPONENT FEM 6 TRTHLN PRT KN RSRFC LT MDL RL,"$3,302.50",$0.00,"$3,302.50","$1,486.13","$2,356.99",$0.00,$569.00,$0.00,$0.00,$578.24,"$3,302.50",$0.00,"$1,651.25","$2,615.58","$2,642.00",$0.00,$516.84,$0.00,$525.76,$0.00
5610-F-602,SUP,HCPCS C1776,,5610-F-602  -  COMPONENT FEM 6 TRTHLN PRT KN RSRFC RMLL,"$3,302.50",$0.00,"$3,302.50","$1,486.13","$2,356.99",$0.00,$569.00,$0.00,$0.00,$578.24,"$3,302.50",$0.00,"$1,651.25","$2,615.58","$2,642.00",$0.00,$516.84,$0.00,$525.76,$0.00
56-15904,SUP,HCPCS C1713,,56-15904  -  SCREW BONE 1.5MM 4MM SELF DRILL UN3 CRANIOMAXILLOFACIAL,$247.50,$0.00,$247.50,$111.38,$176.64,$0.00,$42.64,$0.00,$0.00,$43.34,$247.50,$0.00,$123.75,$196.02,$198.00,$0.00,$38.73,$0.00,$39.40,$0.00
56-15934,SUP,HCPCS C1713,,56-15934  -  SCREW BN 1.5MM 4MM NS LF UNV NEURO 3 SLF DRL AX STAB,$247.50,$0.00,$247.50,$111.38,$176.64,$0.00,$42.64,$0.00,$0.00,$43.34,$247.50,$0.00,$123.75,$196.02,$198.00,$0.00,$38.73,$0.00,$39.40,$0.00
56-15935,SUP,HCPCS C1713,,56-15935  -  SCREW BN 1.5MM 5MM NS LF UNV NEURO 3 SLF DRL AX STAB,$247.50,$0.00,$247.50,$111.38,$176.64,$0.00,$42.64,$0.00,$0.00,$43.34,$247.50,$0.00,$123.75,$196.02,$198.00,$0.00,$38.73,$0.00,$39.40,$0.00
56-17005,SUP,HCPCS C1713,,56-17005  -  SCREW BN 1.7MM 5MM ST AX STAB LWR PRFL,$272.50,$0.00,$272.50,$122.63,$194.48,$0.00,$46.95,$0.00,$0.00,$47.71,$272.50,$0.00,$136.25,$215.82,$218.00,$0.00,$42.65,$0.00,$43.38,$0.00
56-17904,SUP,HCPCS C1713,,56-17904  -  SCREW BN 1.9MM 5MM ER AX STAB LWR PRFL,$305.00,$0.00,$305.00,$137.25,$217.68,$0.00,$52.55,$0.00,$0.00,$53.40,$305.00,$0.00,$152.50,$241.56,$244.00,$0.00,$47.73,$0.00,$48.56,$0.00
56-19005,SUP,HCPCS C1713,,56-19005  -  NAIL IM 11.5MM 36CM STRL TRGN 2M POST BW RT HINDFOOT FSN,$300.00,$0.00,$300.00,$135.00,$214.11,$0.00,$51.69,$0.00,$0.00,$52.53,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$46.95,$0.00,$47.76,$0.00
5620-B-101,SUP,HCPCS C1776,,5620-B-101  -  BASEPLATE TIB 1 TRTHLN PRT KN RSRFC LT MDL RL,"$2,402.50",$0.00,"$2,402.50","$1,081.13","$1,714.66",$0.00,$413.94,$0.00,$0.00,$420.66,"$2,402.50",$0.00,"$1,201.25","$1,902.78","$1,922.00",$0.00,$375.99,$0.00,$382.48,$0.00
5620-B-102,SUP,HCPCS C1776,,5620-B-102  -  BASEPLATE TIB 1 TRTHLN PRT KN RSRFC RMLL,"$2,402.50",$0.00,"$2,402.50","$1,081.13","$1,714.66",$0.00,$413.94,$0.00,$0.00,$420.66,"$2,402.50",$0.00,"$1,201.25","$1,902.78","$1,922.00",$0.00,$375.99,$0.00,$382.48,$0.00
5620-B-201,SUP,HCPCS C1776,,5620-B-201  -  BASEPLATE TIB 2 TRTHLN PRT KN RSRFC LT MDL RL,"$2,402.50",$0.00,"$2,402.50","$1,081.13","$1,714.66",$0.00,$413.94,$0.00,$0.00,$420.66,"$2,402.50",$0.00,"$1,201.25","$1,902.78","$1,922.00",$0.00,$375.99,$0.00,$382.48,$0.00
5620-B-202,SUP,HCPCS C1776,,5620-B-202  -  BASEPLATE TIB 2 TRTHLN PRT KN RSRFC RMLL,"$2,402.50",$0.00,"$2,402.50","$1,081.13","$1,714.66",$0.00,$413.94,$0.00,$0.00,$420.66,"$2,402.50",$0.00,"$1,201.25","$1,902.78","$1,922.00",$0.00,$375.99,$0.00,$382.48,$0.00
5620-B-301,SUP,HCPCS C1776,,5620-B-301  -  BASEPLATE TIB 3 TRTHLN PRT KN RSRFC LT MDL RL,"$2,402.50",$0.00,"$2,402.50","$1,081.13","$1,714.66",$0.00,$413.94,$0.00,$0.00,$420.66,"$2,402.50",$0.00,"$1,201.25","$1,902.78","$1,922.00",$0.00,$375.99,$0.00,$382.48,$0.00
5620-B-302,SUP,HCPCS C1776,,5620-B-302  -  BASEPLATE TIB 3 TRTHLN PRT KN RSRFC RMLL,"$2,402.50",$0.00,"$2,402.50","$1,081.13","$1,714.66",$0.00,$413.94,$0.00,$0.00,$420.66,"$2,402.50",$0.00,"$1,201.25","$1,902.78","$1,922.00",$0.00,$375.99,$0.00,$382.48,$0.00
5620-B-401,SUP,HCPCS C1776,,5620-B-401  -  BASEPLATE TIB 4 TRTHLN PRT KN RSRFC LT MDL RL,"$2,402.50",$0.00,"$2,402.50","$1,081.13","$1,714.66",$0.00,$413.94,$0.00,$0.00,$420.66,"$2,402.50",$0.00,"$1,201.25","$1,902.78","$1,922.00",$0.00,$375.99,$0.00,$382.48,$0.00
5620-B-402,SUP,HCPCS C1776,,5620-B-402  -  BASEPLATE TIB 4 TRTHLN PRT KN RSRFC RMLL,"$2,402.50",$0.00,"$2,402.50","$1,081.13","$1,714.66",$0.00,$413.94,$0.00,$0.00,$420.66,"$2,402.50",$0.00,"$1,201.25","$1,902.78","$1,922.00",$0.00,$375.99,$0.00,$382.48,$0.00
5620-B-501,SUP,HCPCS C1776,,5620-B-501  -  BASEPLATE TIB 5 TRTHLN PRT KN RSRFC LT MDL RL,"$2,402.50",$0.00,"$2,402.50","$1,081.13","$1,714.66",$0.00,$413.94,$0.00,$0.00,$420.66,"$2,402.50",$0.00,"$1,201.25","$1,902.78","$1,922.00",$0.00,$375.99,$0.00,$382.48,$0.00
5620-B-502,SUP,HCPCS C1776,,5620-B-502  -  BASEPLATE TIB 5 TRTHLN PRT KN RSRFC RMLL,"$2,402.50",$0.00,"$2,402.50","$1,081.13","$1,714.66",$0.00,$413.94,$0.00,$0.00,$420.66,"$2,402.50",$0.00,"$1,201.25","$1,902.78","$1,922.00",$0.00,$375.99,$0.00,$382.48,$0.00
5620-B-601,SUP,HCPCS C1776,,5620-B-601  -  BASEPLATE TIB 6 TRTHLN PRT KN RSRFC LT MDL RL,"$2,402.50",$0.00,"$2,402.50","$1,081.13","$1,714.66",$0.00,$413.94,$0.00,$0.00,$420.66,"$2,402.50",$0.00,"$1,201.25","$1,902.78","$1,922.00",$0.00,$375.99,$0.00,$382.48,$0.00
5620-B-602,SUP,HCPCS C1776,,5620-B-602  -  BASEPLATE TIB 6 TRTHLN PRT KN RSRFC RMLL,"$2,402.50",$0.00,"$2,402.50","$1,081.13","$1,714.66",$0.00,$413.94,$0.00,$0.00,$420.66,"$2,402.50",$0.00,"$1,201.25","$1,902.78","$1,922.00",$0.00,$375.99,$0.00,$382.48,$0.00
5624-10/16L,SUP,HCPCS C1776,,5624-10/16L  -  STEM HUMERAL 10MM 165MM CEMENTED IMPLANT COCR STERILE,"$6,511.05",$0.00,"$6,511.05","$2,929.97","$4,646.94",$0.00,"$1,121.82",$0.00,$0.00,"$1,140.03","$6,511.05",$0.00,"$3,255.53","$5,156.75","$5,208.84",$0.00,"$1,018.98",$0.00,"$1,036.56",$0.00
5624-10/20XL,SUP,HCPCS C1776,,5624-10/20XL  -  STEM HUMERAL 10MM 205MM CEMENTED IMPLANT COCR STERILE,"$7,003.95",$0.00,"$7,003.95","$3,151.78","$4,998.72",$0.00,"$1,206.75",$0.00,$0.00,"$1,226.34","$7,003.95",$0.00,"$3,501.98","$5,547.13","$5,603.16",$0.00,"$1,096.12",$0.00,"$1,115.03",$0.00
5624-12/17L,SUP,HCPCS C1776,,5624-12/17L  -  STEM HUMERAL 12MM 170MM CEMENTED IMPLANT COCR STERILE,"$6,511.05",$0.00,"$6,511.05","$2,929.97","$4,646.94",$0.00,"$1,121.82",$0.00,$0.00,"$1,140.03","$6,511.05",$0.00,"$3,255.53","$5,156.75","$5,208.84",$0.00,"$1,018.98",$0.00,"$1,036.56",$0.00
5624-12/21XL,SUP,HCPCS C1776,,5624-12/21XL  -  STEM HUMERAL 12MM 210MM CEMENTED IMPLANT COCR STERILE,"$7,003.95",$0.00,"$7,003.95","$3,151.78","$4,998.72",$0.00,"$1,206.75",$0.00,$0.00,"$1,226.34","$7,003.95",$0.00,"$3,501.98","$5,547.13","$5,603.16",$0.00,"$1,096.12",$0.00,"$1,115.03",$0.00
5624-14/13,SUP,HCPCS C1776,,5624-14/13  -  STEM HUMERAL 14 135MM CEMENTED ANATOMICAL COCR STERILE,"$5,769.05",$0.00,"$5,769.05","$2,596.07","$4,117.37",$0.00,$993.98,$0.00,$0.00,"$1,010.11","$5,769.05",$0.00,"$2,884.53","$4,569.09","$4,615.24",$0.00,$902.86,$0.00,$918.43,$0.00
5624-14/17L,SUP,HCPCS C1776,,5624-14/17L  -  STEM HUMERAL 14MM 175MM CEMENTED IMPLANT COCR STERILE,"$6,511.05",$0.00,"$6,511.05","$2,929.97","$4,646.94",$0.00,"$1,121.82",$0.00,$0.00,"$1,140.03","$6,511.05",$0.00,"$3,255.53","$5,156.75","$5,208.84",$0.00,"$1,018.98",$0.00,"$1,036.56",$0.00
5624-14/21XL,SUP,HCPCS C1776,,5624-14/21XL  -  STEM HUMERAL 14MM 215MM CEMENTED IMPLANT COCR STERILE,"$7,003.95",$0.00,"$7,003.95","$3,151.78","$4,998.72",$0.00,"$1,206.75",$0.00,$0.00,"$1,226.34","$7,003.95",$0.00,"$3,501.98","$5,547.13","$5,603.16",$0.00,"$1,096.12",$0.00,"$1,115.03",$0.00
5624-6/15L,SUP,HCPCS C1776,,5624-6/15L  -  STEM HUMERAL 6MM 155MM CEMENTED IMPLANT COCR STERILE,"$6,511.05",$0.00,"$6,511.05","$2,929.97","$4,646.94",$0.00,"$1,121.82",$0.00,$0.00,"$1,140.03","$6,511.05",$0.00,"$3,255.53","$5,156.75","$5,208.84",$0.00,"$1,018.98",$0.00,"$1,036.56",$0.00
5624-6/19XL,SUP,HCPCS C1776,,5624-6/19XL  -  STEM HUMERAL 6MM 195MM CEMENTED IMPLANT COCR STERILE,"$7,003.95",$0.00,"$7,003.95","$3,151.78","$4,998.72",$0.00,"$1,206.75",$0.00,$0.00,"$1,226.34","$7,003.95",$0.00,"$3,501.98","$5,547.13","$5,603.16",$0.00,"$1,096.12",$0.00,"$1,115.03",$0.00
5624-8/16L,SUP,HCPCS C1776,,5624-8/16L  -  STEM HUMERAL 8MM 160MM CEMENTED IMPLANT COCR STERILE,"$6,511.05",$0.00,"$6,511.05","$2,929.97","$4,646.94",$0.00,"$1,121.82",$0.00,$0.00,"$1,140.03","$6,511.05",$0.00,"$3,255.53","$5,156.75","$5,208.84",$0.00,"$1,018.98",$0.00,"$1,036.56",$0.00
5624-8/20XL,SUP,HCPCS C1776,,5624-8/20XL  -  STEM HUMERAL 8MM 200MM CEMENTED IMPLANT COCR STERILE,"$7,003.95",$0.00,"$7,003.95","$3,151.78","$4,998.72",$0.00,"$1,206.75",$0.00,$0.00,"$1,226.34","$7,003.95",$0.00,"$3,501.98","$5,547.13","$5,603.16",$0.00,"$1,096.12",$0.00,"$1,115.03",$0.00
56-25000,SUP,HCPCS C1713,,56-25000  -  SCREW BONE FASTENING TITANIUM CONDYLE MANDIB,$560.00,$0.00,$560.00,$252.00,$399.67,$0.00,$96.49,$0.00,$0.00,$98.05,$560.00,$0.00,$280.00,$443.52,$448.00,$0.00,$87.64,$0.00,$89.15,$0.00
56-25001,SUP,Custom 27803010,,56-25001  -  PROSTHESIS TEMPORARY MARX CONDYLE LEFT,"$4,770.00",$0.00,"$4,770.00",$0.00,"$3,404.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,770.00",$0.00,"$2,385.00","$3,777.84","$3,816.00",$0.00,$0.00,$0.00,$0.00,$0.00
56-25002,SUP,Custom 27803010,,56-25002  -  PROSTHESIS TEMPORARY MARX CONDYLE RIGHT,"$4,770.00",$0.00,"$4,770.00",$0.00,"$3,404.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,770.00",$0.00,"$2,385.00","$3,777.84","$3,816.00",$0.00,$0.00,$0.00,$0.00,$0.00
5630-G-108,SUP,HCPCS C1776,,5630-G-108  -  INSERT TIB 1 8MM TRTHLN PRT KN RSRFC X3 LT MDL RL,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
5630-G-109,SUP,HCPCS C1776,,5630-G-109  -  INSERT TIB 1 9MM TRTHLN X3 LT MDL RL,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
5630-G-110,SUP,HCPCS C1776,,5630-G-110  -  INSERT TIB 1 10MM TRTHLN X3 LT MDL RL,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
5630-G-112,SUP,HCPCS C1776,,5630-G-112  -  INSERT TIB 1 12MM TRTHLN X3 LT MDL RL,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
5630-G-120,SUP,HCPCS C1776,,5630-G-120  -  INSERT TIB 1 10MM TRTHLN X3 RMLL,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
5630-G-122,SUP,HCPCS C1776,,5630-G-122  -  INSERT TIB 1 12MM TRTHLN X3 RMLL,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
5630-G-128,SUP,HCPCS C1776,,5630-G-128  -  INSERT TIB 1 8MM TRTHLN X3 RMLL,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
5630-G-129,SUP,HCPCS C1776,,5630-G-129  -  INSERT TIB 1 9MM TRTHLN X3 RMLL,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
5630-G-208,SUP,HCPCS C1776,,5630-G-208  -  INSERT TIB 2 8MM TRTHLN PRT KN RSRFC X3 LT MDL RL,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
5630-G-209,SUP,HCPCS C1776,,5630-G-209  -  INSERT TIB 2 9MM TRTHLN STRG KN,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
5630-G-210,SUP,HCPCS C1776,,5630-G-210  -  INSERT TIB 2 10MM TRTHLN PRT KN RSRFC X3 LT MDL,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
5630-G-212,SUP,HCPCS C1776,,5630-G-212  -  INSERT TIB 2 12MM TRTHLN X3 LT MDL RL,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
5630-G-220,SUP,HCPCS C1776,,5630-G-220  -  INSERT TIB 2 10MM TRTHLN X3 RMLL,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
5630-G-222,SUP,HCPCS C1776,,5630-G-222  -  INSERT TIB 2 12MM TRTHLN X3 RMLL,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
5630-G-228,SUP,HCPCS C1776,,5630-G-228  -  INSERT TIB 2 8MM TRTHLN PRT KN RSRFC X3 RMLL,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
5630-G-229,SUP,HCPCS C1776,,5630-G-229  -  INSERT TIB 2 29MM TRTHLN PRT RSRFC X3 KN RT MDL,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
5630-G-308,SUP,HCPCS C1776,,5630-G-308  -  INSERT TIB 3 8MM TRTHLN PRT KN RSRFC X3 LT MDL RL,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
5630-G-309,SUP,HCPCS C1776,,5630-G-309  -  INSERT TIB 3 9MM TRTHLN PRT KN RSRFC X3 LT MDL RL,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
5630-G-310,SUP,HCPCS C1776,,5630-G-310  -  INSERT TIB 3 10MM TRTHLN X3 LT MDL RL,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
5630-G-312,SUP,HCPCS C1776,,5630-G-312  -  INSERT TIB 3 12MM TRTHLN X3 LT MDL RL,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
5630-G-320,SUP,HCPCS C1776,,5630-G-320  -  INSERT TIB 3 20MM TRTHLN PRT RSRFC X3 KN RT MDL,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
5630-G-322,SUP,HCPCS C1776,,5630-G-322  -  INSERT TIB 3 12MM TRTHLN X3 RMLL,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
5630-G-328,SUP,HCPCS C1776,,5630-G-328  -  INSERT TIB 3 8MM TRTHLN PRT KN RSRFC X3 RMLL,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
5630-G-329,SUP,HCPCS C1776,,5630-G-329  -  INSERT TIB 3 29MM TRTHLN PRT RSRFC X3 KN RT MDL,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
5630-G-408,SUP,HCPCS C1776,,5630-G-408  -  INSERT TIB 4 8MM TRTHLN PRT KN RSRFC X3 LT MDL RL,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
5630-G-409,SUP,HCPCS C1776,,5630-G-409  -  INSERT TIB 4 9MM TRTHLN PRT KN RSRFC X3 LT MDL RL,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
5630-G-410,SUP,HCPCS C1776,,5630-G-410  -  INSERT TIB 4 10MM TRTHLN X3 LT MDL RL KN,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
5630-G-412,SUP,HCPCS C1776,,5630-G-412  -  INSERT TIB 4 12MM TRTHLN X3 LT MDL RL,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
5630-G-420,SUP,HCPCS C1776,,5630-G-420  -  INSERT TIB 4 10MM TRTHLN X3 RMLL,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
5630-G-422,SUP,HCPCS C1776,,5630-G-422  -  INSERT TIB 4 12MM TRTHLN X3 RMLL,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
5630-G-428,SUP,HCPCS C1776,,5630-G-428  -  INSERT TIB 4 8MM TRTHLN PRT KN RSRFC X3 RMLL,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
5630-G-429,SUP,HCPCS C1776,,5630-G-429  -  INSERT TIB 4 9MM TRTHLN PRT KN RSRFC X3 RMLL,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
5630-G-508,SUP,HCPCS C1776,,5630-G-508  -  INSERT TIB 5 8MM TRTHLN PRT KN RSRFC X3 LT MDL RL,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
5630-G-509,SUP,HCPCS C1776,,5630-G-509  -  INSERT TIB 5 9MM TRTHLN X3 LT MDL RL KN,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
5630-G-510,SUP,HCPCS C1776,,5630-G-510  -  INSERT TIB 5 10MM TRTHLN X3 LT MDL RL,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
5630-G-512,SUP,HCPCS C1776,,5630-G-512  -  INSERT TIB 5 12MM TRTHLN X3 LT MDL RL,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
5630-G-520,SUP,HCPCS C1776,,5630-G-520  -  INSERT TIB 5 10MM TRTHLN X3 RMLL KN,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
5630-G-522,SUP,HCPCS C1776,,5630-G-522  -  INSERT TIB 5 12MM TRTHLN X3 RMLL,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
5630-G-528,SUP,HCPCS C1776,,5630-G-528  -  INSERT TIB 5 8MM TRTHLN PRT KN RSRFC X3 RMLL,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
5630-G-529,SUP,HCPCS C1776,,5630-G-529  -  INSERT TIB 5 9MM TRTHLN X3 RMLL,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
5630-G-608,SUP,HCPCS C1776,,5630-G-608  -  INSERT TIB 6 8MM TRTHLN PRT KN RSRFC X3 LT MDL RL,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
5630-G-609,SUP,HCPCS C1776,,5630-G-609  -  INSERT TIB 9 60MM TRTHLN STRG KN,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
5630-G-610,SUP,HCPCS C1776,,5630-G-610  -  INSERT TIB 6 10MM TRTHLN X3 LT MDL RL,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
5630-G-612,SUP,HCPCS C1776,,5630-G-612  -  INSERT TIB 6 12MM TRTHLN X3 LT MDL RL,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
5630-G-620,SUP,HCPCS C1776,,5630-G-620  -  INSERT TIB 62MM TRTHLN STRG KN,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
5630-G-622,SUP,HCPCS C1776,,5630-G-622  -  INSERT TIB 6 12MM TRTHLN X3 RMLL,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
5630-G-628,SUP,HCPCS C1776,,5630-G-628  -  INSERT TIB 6 TRTHLN PRT RSRFC X3 KN RT MDL,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
5630-G-629,SUP,HCPCS C1776,,5630-G-629  -  INSERT TIB 6 9MM TRTHLN KN,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
5639-0-010,SUP,HCPCS C1713,,5639-0-010  -  SCREW BONE 4MM 10MM 5MM PTHRD CANC HEX HEAD,$34.38,$0.00,$34.38,$15.47,$24.53,$0.00,$5.92,$0.00,$0.00,$6.02,$34.38,$0.00,$17.19,$27.23,$27.50,$0.00,$5.38,$0.00,$5.47,$0.00
5639-0-012,SUP,HCPCS C1713,,5639-0-012  -  SCREW BONE 4MM 12MM 5MM PTHRD CANC HEX HEAD,$34.38,$0.00,$34.38,$15.47,$24.53,$0.00,$5.92,$0.00,$0.00,$6.02,$34.38,$0.00,$17.19,$27.23,$27.50,$0.00,$5.38,$0.00,$5.47,$0.00
5639-0-014,SUP,HCPCS C1713,,5639-0-014  -  SCREW BONE 4MM 14MM 5MM PTHRD CANC HEX HEAD,$34.38,$0.00,$34.38,$15.47,$24.53,$0.00,$5.92,$0.00,$0.00,$6.02,$34.38,$0.00,$17.19,$27.23,$27.50,$0.00,$5.38,$0.00,$5.47,$0.00
5639-0-016,SUP,HCPCS C1713,,5639-0-016  -  SCREW BONE 4MM 16MM 6MM PTHRD CANC HEX HEAD,$34.38,$0.00,$34.38,$15.47,$24.53,$0.00,$5.92,$0.00,$0.00,$6.02,$34.38,$0.00,$17.19,$27.23,$27.50,$0.00,$5.38,$0.00,$5.47,$0.00
5639-0-018,SUP,HCPCS C1713,,5639-0-018  -  SCREW BONE 4MM 18MM 7MM PTHRD CANC HEX HEAD,$34.38,$0.00,$34.38,$15.47,$24.53,$0.00,$5.92,$0.00,$0.00,$6.02,$34.38,$0.00,$17.19,$27.23,$27.50,$0.00,$5.38,$0.00,$5.47,$0.00
5639-0-020,SUP,HCPCS C1713,,5639-0-020  -  SCREW BONE 4MM 20MM 8MM PTHRD CANC HEX HEAD,$34.38,$0.00,$34.38,$15.47,$24.53,$0.00,$5.92,$0.00,$0.00,$6.02,$34.38,$0.00,$17.19,$27.23,$27.50,$0.00,$5.38,$0.00,$5.47,$0.00
5639-0-022,SUP,HCPCS C1713,,5639-0-022  -  SCREW BONE 4MM 22MM 9MM PTHRD CANC HEX HEAD,$34.38,$0.00,$34.38,$15.47,$24.53,$0.00,$5.92,$0.00,$0.00,$6.02,$34.38,$0.00,$17.19,$27.23,$27.50,$0.00,$5.38,$0.00,$5.47,$0.00
5639-0-024,SUP,HCPCS C1713,,5639-0-024  -  SCREW BONE 4MM 24MM 10MM PTHRD CANC HEX HEAD,$34.38,$0.00,$34.38,$15.47,$24.53,$0.00,$5.92,$0.00,$0.00,$6.02,$34.38,$0.00,$17.19,$27.23,$27.50,$0.00,$5.38,$0.00,$5.47,$0.00
5639-0-026,SUP,HCPCS C1713,,5639-0-026  -  SCREW BONE 4MM 26MM 12MM PTHRD CANC HEX HEAD,$34.38,$0.00,$34.38,$15.47,$24.53,$0.00,$5.92,$0.00,$0.00,$6.02,$34.38,$0.00,$17.19,$27.23,$27.50,$0.00,$5.38,$0.00,$5.47,$0.00
5639-0-028,SUP,HCPCS C1713,,5639-0-028  -  SCREW BONE 4MM 28MM 14MM PTHRD CANC HEX HEAD,$34.38,$0.00,$34.38,$15.47,$24.53,$0.00,$5.92,$0.00,$0.00,$6.02,$34.38,$0.00,$17.19,$27.23,$27.50,$0.00,$5.38,$0.00,$5.47,$0.00
5639-0-030,SUP,HCPCS C1713,,5639-0-030  -  SCREW BONE 4MM 30MM 14MM PTHRD CANC HEX HEAD,$34.38,$0.00,$34.38,$15.47,$24.53,$0.00,$5.92,$0.00,$0.00,$6.02,$34.38,$0.00,$17.19,$27.23,$27.50,$0.00,$5.38,$0.00,$5.47,$0.00
5639-0-035,SUP,HCPCS C1713,,5639-0-035  -  SCREW BONE 4MM 35MM 14MM PTHRD CANC HEX HEAD,$34.38,$0.00,$34.38,$15.47,$24.53,$0.00,$5.92,$0.00,$0.00,$6.02,$34.38,$0.00,$17.19,$27.23,$27.50,$0.00,$5.38,$0.00,$5.47,$0.00
5639-0-040,SUP,HCPCS C1713,,5639-0-040  -  SCREW BONE 4MM 40MM 14MM PTHRD CANC HEX HEAD,$34.38,$0.00,$34.38,$15.47,$24.53,$0.00,$5.92,$0.00,$0.00,$6.02,$34.38,$0.00,$17.19,$27.23,$27.50,$0.00,$5.38,$0.00,$5.47,$0.00
5639-0-045,SUP,HCPCS C1713,,5639-0-045  -  SCREW BONE 4MM 45MM 15MM PTHRD CANC HEX HEAD,$34.38,$0.00,$34.38,$15.47,$24.53,$0.00,$5.92,$0.00,$0.00,$6.02,$34.38,$0.00,$17.19,$27.23,$27.50,$0.00,$5.38,$0.00,$5.47,$0.00
5639-0-050,SUP,HCPCS C1713,,5639-0-050  -  SCREW BONE 4MM 50MM 15MM PTHRD CANC HEX HEAD,$34.38,$0.00,$34.38,$15.47,$24.53,$0.00,$5.92,$0.00,$0.00,$6.02,$34.38,$0.00,$17.19,$27.23,$27.50,$0.00,$5.38,$0.00,$5.47,$0.00
563CAL,SUP,Custom 27203010,,MATTRESS COMPLETE UNIT /5,$712.00,$0.00,$712.00,$0.00,$508.15,$0.00,$0.00,$0.00,$0.00,$0.00,$712.00,$0.00,$356.00,$563.90,$569.60,$0.00,$0.00,$0.00,$0.00,$0.00
56-40281,SUP,Custom 27803010,,56-40281  -  WIRE FX 1.4MM 17MM KRSH OLV STP DIST RDS LCK PLT SYS,$38.50,$0.00,$38.50,$0.00,$27.48,$0.00,$0.00,$0.00,$0.00,$0.00,$38.50,$0.00,$19.25,$30.49,$30.80,$0.00,$0.00,$0.00,$0.00,$0.00
5645-0-0160,SUP,HCPCS C1713,,5645-0-0160  -  SCREW BONE 4.5MM 16MM SLFTAP CORTICAL,$22.00,$0.00,$22.00,$9.90,$15.70,$0.00,$3.79,$0.00,$0.00,$3.85,$22.00,$0.00,$11.00,$17.42,$17.60,$0.00,$3.44,$0.00,$3.50,$0.00
5645-1-014,SUP,HCPCS C1713,,5645-1-014  -  SCREW BONE 4.5MM 14MM TI CORTEX ORTH FULTHRD HEX HEAD SLFTAP,$46.75,$0.00,$46.75,$21.04,$33.37,$0.00,$8.05,$0.00,$0.00,$8.19,$46.75,$0.00,$23.38,$37.03,$37.40,$0.00,$7.32,$0.00,$7.44,$0.00
5645-1-016,SUP,HCPCS C1713,,5645-1-016  -  SCREW BONE 4.5MM 16MM CORT SLFTAP,$46.75,$0.00,$46.75,$21.04,$33.37,$0.00,$8.05,$0.00,$0.00,$8.19,$46.75,$0.00,$23.38,$37.03,$37.40,$0.00,$7.32,$0.00,$7.44,$0.00
5645-1-018,SUP,HCPCS C1713,,5645-1-018  -  SCREW BONE 4.5MM 18MM CORT SLFTAP,$46.75,$0.00,$46.75,$21.04,$33.37,$0.00,$8.05,$0.00,$0.00,$8.19,$46.75,$0.00,$23.38,$37.03,$37.40,$0.00,$7.32,$0.00,$7.44,$0.00
5645-1-020,SUP,HCPCS C1713,,5645-1-020  -  SCREW BONE 4.5MM 20MM CORT SLFTAP,$46.75,$0.00,$46.75,$21.04,$33.37,$0.00,$8.05,$0.00,$0.00,$8.19,$46.75,$0.00,$23.38,$37.03,$37.40,$0.00,$7.32,$0.00,$7.44,$0.00
5645-1-022,SUP,HCPCS C1713,,5645-1-022  -  SCREW BONE 4.5MM 22MM CORT SLFTAP,$46.75,$0.00,$46.75,$21.04,$33.37,$0.00,$8.05,$0.00,$0.00,$8.19,$46.75,$0.00,$23.38,$37.03,$37.40,$0.00,$7.32,$0.00,$7.44,$0.00
5645-1-024,SUP,HCPCS C1713,,5645-1-024  -  SCREW BONE 4.5MM 24MM FULTHD CORTEX SLFTAP HEX HEAD,$46.75,$0.00,$46.75,$21.04,$33.37,$0.00,$8.05,$0.00,$0.00,$8.19,$46.75,$0.00,$23.38,$37.03,$37.40,$0.00,$7.32,$0.00,$7.44,$0.00
5645-1-026,SUP,HCPCS C1713,,5645-1-026  -  SCREW BONE 4.5MM 26MM CORT SLFTAP,$46.75,$0.00,$46.75,$21.04,$33.37,$0.00,$8.05,$0.00,$0.00,$8.19,$46.75,$0.00,$23.38,$37.03,$37.40,$0.00,$7.32,$0.00,$7.44,$0.00
5645-1-028,SUP,HCPCS C1713,,5645-1-028  -  SCREW BONE 4.5MM 28MM CORT SLFTAP,$46.75,$0.00,$46.75,$21.04,$33.37,$0.00,$8.05,$0.00,$0.00,$8.19,$46.75,$0.00,$23.38,$37.03,$37.40,$0.00,$7.32,$0.00,$7.44,$0.00
5645-1-030,SUP,HCPCS C1713,,5645-1-030  -  SCREW BONE 4.5MM 30MM CORT SLFTAP,$46.75,$0.00,$46.75,$21.04,$33.37,$0.00,$8.05,$0.00,$0.00,$8.19,$46.75,$0.00,$23.38,$37.03,$37.40,$0.00,$7.32,$0.00,$7.44,$0.00
5645-1-032,SUP,HCPCS C1713,,5645-1-032  -  SCREW BONE 4.5MM 32MM CORT SLFTAP,$46.75,$0.00,$46.75,$21.04,$33.37,$0.00,$8.05,$0.00,$0.00,$8.19,$46.75,$0.00,$23.38,$37.03,$37.40,$0.00,$7.32,$0.00,$7.44,$0.00
5645-1-034,SUP,HCPCS C1713,,5645-1-034  -  SCREW BONE 4.5MM 34MM CORT SLFTAP,$46.75,$0.00,$46.75,$21.04,$33.37,$0.00,$8.05,$0.00,$0.00,$8.19,$46.75,$0.00,$23.38,$37.03,$37.40,$0.00,$7.32,$0.00,$7.44,$0.00
5645-1-036,SUP,HCPCS C1713,,5645-1-036  -  SCREW BONE 4.5MM 36MM CORT SLFTAP,$46.75,$0.00,$46.75,$21.04,$33.37,$0.00,$8.05,$0.00,$0.00,$8.19,$46.75,$0.00,$23.38,$37.03,$37.40,$0.00,$7.32,$0.00,$7.44,$0.00
5645-1-038,SUP,HCPCS C1713,,5645-1-038  -  SCREW BONE 4.5MM 38MM CORT SLFTAP,$46.75,$0.00,$46.75,$21.04,$33.37,$0.00,$8.05,$0.00,$0.00,$8.19,$46.75,$0.00,$23.38,$37.03,$37.40,$0.00,$7.32,$0.00,$7.44,$0.00
5645-1-040,SUP,HCPCS C1713,,5645-1-040  -  SCREW BONE 4.5MM 40MM CORT SLFTAP,$46.75,$0.00,$46.75,$21.04,$33.37,$0.00,$8.05,$0.00,$0.00,$8.19,$46.75,$0.00,$23.38,$37.03,$37.40,$0.00,$7.32,$0.00,$7.44,$0.00
5645-1-042,SUP,HCPCS C1713,,5645-1-042  -  SCREW BONE 4.5MM 42MM CORT SLFTAP,$46.75,$0.00,$46.75,$21.04,$33.37,$0.00,$8.05,$0.00,$0.00,$8.19,$46.75,$0.00,$23.38,$37.03,$37.40,$0.00,$7.32,$0.00,$7.44,$0.00
5645-1-044,SUP,HCPCS C1713,,5645-1-044  -  SCREW BONE 4.5MM 44MM CORT SLFTAP,$46.75,$0.00,$46.75,$21.04,$33.37,$0.00,$8.05,$0.00,$0.00,$8.19,$46.75,$0.00,$23.38,$37.03,$37.40,$0.00,$7.32,$0.00,$7.44,$0.00
5645-1-046,SUP,HCPCS C1713,,5645-1-046  -  SCREW BONE 4.5MM 46MM CORT SLFTAP,$46.75,$0.00,$46.75,$21.04,$33.37,$0.00,$8.05,$0.00,$0.00,$8.19,$46.75,$0.00,$23.38,$37.03,$37.40,$0.00,$7.32,$0.00,$7.44,$0.00
5645-1-048,SUP,HCPCS C1713,,5645-1-048  -  SCREW BONE 4.5MM 48MM CORT SLFTAP,$46.75,$0.00,$46.75,$21.04,$33.37,$0.00,$8.05,$0.00,$0.00,$8.19,$46.75,$0.00,$23.38,$37.03,$37.40,$0.00,$7.32,$0.00,$7.44,$0.00
5645-1-050,SUP,HCPCS C1713,,5645-1-050  -  SCREW BONE 4.5MM 50MM CORT SLFTAP,$46.75,$0.00,$46.75,$21.04,$33.37,$0.00,$8.05,$0.00,$0.00,$8.19,$46.75,$0.00,$23.38,$37.03,$37.40,$0.00,$7.32,$0.00,$7.44,$0.00
5645-1-052,SUP,HCPCS C1713,,5645-1-052  -  SCREW BONE 4.5MM 52MM CORT SLFTAP,$46.75,$0.00,$46.75,$21.04,$33.37,$0.00,$8.05,$0.00,$0.00,$8.19,$46.75,$0.00,$23.38,$37.03,$37.40,$0.00,$7.32,$0.00,$7.44,$0.00
5645-1-054,SUP,HCPCS C1713,,5645-1-054  -  SCREW BONE 4.5MM 54MM CORT SLFTAP,$46.75,$0.00,$46.75,$21.04,$33.37,$0.00,$8.05,$0.00,$0.00,$8.19,$46.75,$0.00,$23.38,$37.03,$37.40,$0.00,$7.32,$0.00,$7.44,$0.00
5645-1-056,SUP,HCPCS C1713,,5645-1-056  -  SCREW BONE 4.5MM 56MM CORT SLFTAP,$46.75,$0.00,$46.75,$21.04,$33.37,$0.00,$8.05,$0.00,$0.00,$8.19,$46.75,$0.00,$23.38,$37.03,$37.40,$0.00,$7.32,$0.00,$7.44,$0.00
5645-1-058,SUP,HCPCS C1713,,5645-1-058  -  SCREW BONE 4.5MM 58MM CORT SLFTAP,$46.75,$0.00,$46.75,$21.04,$33.37,$0.00,$8.05,$0.00,$0.00,$8.19,$46.75,$0.00,$23.38,$37.03,$37.40,$0.00,$7.32,$0.00,$7.44,$0.00
5645-1-060,SUP,HCPCS C1713,,5645-1-060  -  SCREW BONE 4.5MM 60MM CORT SLFTAP,$46.75,$0.00,$46.75,$21.04,$33.37,$0.00,$8.05,$0.00,$0.00,$8.19,$46.75,$0.00,$23.38,$37.03,$37.40,$0.00,$7.32,$0.00,$7.44,$0.00
5645-1-064,SUP,HCPCS C1713,,5645-1-064  -  SCREW BONE 4.5MM 64MM CORTEX HEX HEAD FULTHD SLFTAP,$46.75,$0.00,$46.75,$21.04,$33.37,$0.00,$8.05,$0.00,$0.00,$8.19,$46.75,$0.00,$23.38,$37.03,$37.40,$0.00,$7.32,$0.00,$7.44,$0.00
5645-1-070,SUP,HCPCS C1713,,5645-1-070  -  SCREW BONE 4.5MM 70MM FULTHD CORTEX SLFTAP HEX HEAD,$46.75,$0.00,$46.75,$21.04,$33.37,$0.00,$8.05,$0.00,$0.00,$8.19,$46.75,$0.00,$23.38,$37.03,$37.40,$0.00,$7.32,$0.00,$7.44,$0.00
5678-1-005,SUP,HCPCS C1713,,5678-1-005  -  PLATE 3.5 MM SCR 5 HOLE BONE CORT,$391.88,$0.00,$391.88,$176.34,$279.68,$0.00,$67.52,$0.00,$0.00,$68.61,$391.88,$0.00,$195.94,$310.37,$313.50,$0.00,$61.33,$0.00,$62.39,$0.00
5678-1-010,SUP,HCPCS C1713,,5678-1-010  -  PLATE 3.5 MM SCR 10 HOLE BONE CORT,$156.75,$0.00,$156.75,$70.54,$111.87,$0.00,$27.01,$0.00,$0.00,$27.45,$156.75,$0.00,$78.38,$124.15,$125.40,$0.00,$24.53,$0.00,$24.95,$0.00
5680-0-025,SUP,HCPCS C1713,,5680-0-025  -  SCREW BONE 6.5MM 25MM 16MM CANC CANC HEX HEAD PTTHRD,$60.50,$0.00,$60.50,$27.23,$43.18,$0.00,$10.42,$0.00,$0.00,$10.59,$60.50,$0.00,$30.25,$47.92,$48.40,$0.00,$9.47,$0.00,$9.63,$0.00
5680-0-030,SUP,HCPCS C1713,,5680-0-030  -  SCREW BONE 6.5MM 30MM 16MM CANC HEX HEAD PTHRD,$60.50,$0.00,$60.50,$27.23,$43.18,$0.00,$10.42,$0.00,$0.00,$10.59,$60.50,$0.00,$30.25,$47.92,$48.40,$0.00,$9.47,$0.00,$9.63,$0.00
5680-0-035,SUP,HCPCS C1713,,5680-0-035  -  SCREW BONE 6.5MM 35MM 16MM CANC HEX HEAD PTTHRD,$60.50,$0.00,$60.50,$27.23,$43.18,$0.00,$10.42,$0.00,$0.00,$10.59,$60.50,$0.00,$30.25,$47.92,$48.40,$0.00,$9.47,$0.00,$9.63,$0.00
5680-0-040,SUP,HCPCS C1713,,5680-0-040  -  SCREW BONE 6.5MM 40MM 16MM PTHRD CANC HEX HEAD,$60.50,$0.00,$60.50,$27.23,$43.18,$0.00,$10.42,$0.00,$0.00,$10.59,$60.50,$0.00,$30.25,$47.92,$48.40,$0.00,$9.47,$0.00,$9.63,$0.00
5680-0-045,SUP,HCPCS C1713,,5680-0-045  -  SCREW BONE 6.5MM 45MM 16MM PTHRD CANC HEX HEAD,$60.50,$0.00,$60.50,$27.23,$43.18,$0.00,$10.42,$0.00,$0.00,$10.59,$60.50,$0.00,$30.25,$47.92,$48.40,$0.00,$9.47,$0.00,$9.63,$0.00
5680-0-050,SUP,HCPCS C1713,,5680-0-050  -  SCREW BONE 6.5MM 50MM 16MM PTHRD CANC HEX HEAD,$60.50,$0.00,$60.50,$27.23,$43.18,$0.00,$10.42,$0.00,$0.00,$10.59,$60.50,$0.00,$30.25,$47.92,$48.40,$0.00,$9.47,$0.00,$9.63,$0.00
5680-0-055,SUP,HCPCS C1713,,5680-0-055  -  SCREW BONE 6.5MM 55MM 16MM PTHRD CANC HEX HEAD,$60.50,$0.00,$60.50,$27.23,$43.18,$0.00,$10.42,$0.00,$0.00,$10.59,$60.50,$0.00,$30.25,$47.92,$48.40,$0.00,$9.47,$0.00,$9.63,$0.00
5680-0-060,SUP,HCPCS C1713,,5680-0-060  -  SCREW BONE 6.5MM 60MM 16MM PTHRD CANC HEX HEAD,$60.50,$0.00,$60.50,$27.23,$43.18,$0.00,$10.42,$0.00,$0.00,$10.59,$60.50,$0.00,$30.25,$47.92,$48.40,$0.00,$9.47,$0.00,$9.63,$0.00
5680-0-065,SUP,HCPCS C1713,,5680-0-065  -  SCREW BONE 6.5MM 65MM 16MM PTHRD CANC HEX HEAD,$60.50,$0.00,$60.50,$27.23,$43.18,$0.00,$10.42,$0.00,$0.00,$10.59,$60.50,$0.00,$30.25,$47.92,$48.40,$0.00,$9.47,$0.00,$9.63,$0.00
5680-0-070,SUP,HCPCS C1713,,5680-0-070  -  SCREW BONE 6.5MM 70MM 16MM PTHRD CANC HEX HEAD,$60.50,$0.00,$60.50,$27.23,$43.18,$0.00,$10.42,$0.00,$0.00,$10.59,$60.50,$0.00,$30.25,$47.92,$48.40,$0.00,$9.47,$0.00,$9.63,$0.00
5680-0-075,SUP,HCPCS C1713,,5680-0-075  -  SCREW BONE 6.5MM 75MM 16MM PTHRD CANC HEX HEAD,$60.50,$0.00,$60.50,$27.23,$43.18,$0.00,$10.42,$0.00,$0.00,$10.59,$60.50,$0.00,$30.25,$47.92,$48.40,$0.00,$9.47,$0.00,$9.63,$0.00
5680-0-080,SUP,HCPCS C1713,,5680-0-080  -  SCREW BONE 6.5MM 80MM 16MM PTHRD CANC HEX HEAD,$60.50,$0.00,$60.50,$27.23,$43.18,$0.00,$10.42,$0.00,$0.00,$10.59,$60.50,$0.00,$30.25,$47.92,$48.40,$0.00,$9.47,$0.00,$9.63,$0.00
5680-0-085,SUP,HCPCS C1713,,5680-0-085  -  SCREW BONE 6.5MM 85MM 16MM CANC HX HD PRTL THRED,$60.50,$0.00,$60.50,$27.23,$43.18,$0.00,$10.42,$0.00,$0.00,$10.59,$60.50,$0.00,$30.25,$47.92,$48.40,$0.00,$9.47,$0.00,$9.63,$0.00
5680-0-090,SUP,HCPCS C1713,,5680-0-090  -  SCREW BONE 6.5MM 90MM 16MM CANC PTHRD HX HD,$60.50,$0.00,$60.50,$27.23,$43.18,$0.00,$10.42,$0.00,$0.00,$10.59,$60.50,$0.00,$30.25,$47.92,$48.40,$0.00,$9.47,$0.00,$9.63,$0.00
5680-0-095,SUP,HCPCS C1713,,5680-0-095  -  SCREW BONE 6.5MM 95MM 16MM CANC HEX HEAD PTHRD,$60.50,$0.00,$60.50,$27.23,$43.18,$0.00,$10.42,$0.00,$0.00,$10.59,$60.50,$0.00,$30.25,$47.92,$48.40,$0.00,$9.47,$0.00,$9.63,$0.00
5680-0-100,SUP,HCPCS C1713,,5680-0-100  -  SCREW BONE 6.5MM 110MM 16MM ALTA CANC HEX HEAD PTHRD,$60.50,$0.00,$60.50,$27.23,$43.18,$0.00,$10.42,$0.00,$0.00,$10.59,$60.50,$0.00,$30.25,$47.92,$48.40,$0.00,$9.47,$0.00,$9.63,$0.00
5680-0-105,SUP,HCPCS C1713,,5680-0-105  -  SCREW BONE 6.5MM 105MM 16MM CANC PTHRD HEX THRD,$60.50,$0.00,$60.50,$27.23,$43.18,$0.00,$10.42,$0.00,$0.00,$10.59,$60.50,$0.00,$30.25,$47.92,$48.40,$0.00,$9.47,$0.00,$9.63,$0.00
5680-0-110,SUP,HCPCS C1713,,5680-0-110  -  SCREW BONE 6.5MM 110MM 16MM TI CANC HEX HEAD PTTHRD STRYK,$60.50,$0.00,$60.50,$27.23,$43.18,$0.00,$10.42,$0.00,$0.00,$10.59,$60.50,$0.00,$30.25,$47.92,$48.40,$0.00,$9.47,$0.00,$9.63,$0.00
5681-0-030,SUP,HCPCS C1713,,5681-0-030  -  SCREW BONE 6.5MM 30MM 20MM CANC HX HD PTHRD,$60.50,$0.00,$60.50,$27.23,$43.18,$0.00,$10.42,$0.00,$0.00,$10.59,$60.50,$0.00,$30.25,$47.92,$48.40,$0.00,$9.47,$0.00,$9.63,$0.00
5681-0-035,SUP,HCPCS C1713,,5681-0-035  -  SCREW BONE 6.5MM 27MM CANC HEX HEAD PRTL THRD,$60.50,$0.00,$60.50,$27.23,$43.18,$0.00,$10.42,$0.00,$0.00,$10.59,$60.50,$0.00,$30.25,$47.92,$48.40,$0.00,$9.47,$0.00,$9.63,$0.00
5681-0-040,SUP,HCPCS C1713,,5681-0-040  -  SCREW BONE 6.5MM 40MM 32MM CANC HX HD PTHRD,$60.50,$0.00,$60.50,$27.23,$43.18,$0.00,$10.42,$0.00,$0.00,$10.59,$60.50,$0.00,$30.25,$47.92,$48.40,$0.00,$9.47,$0.00,$9.63,$0.00
5681-0-045,SUP,HCPCS C1713,,5681-0-045  -  SCREW BONE 6.5MM 45MM 32MM CANC PTTHRD HEX HEAD,$60.50,$0.00,$60.50,$27.23,$43.18,$0.00,$10.42,$0.00,$0.00,$10.59,$60.50,$0.00,$30.25,$47.92,$48.40,$0.00,$9.47,$0.00,$9.63,$0.00
5681-0-050,SUP,HCPCS C1713,,5681-0-050  -  SCREW BONE 6.5MM 50MM 32MM CANC CANC HAEXGONAL HEAD PRTL,$60.50,$0.00,$60.50,$27.23,$43.18,$0.00,$10.42,$0.00,$0.00,$10.59,$60.50,$0.00,$30.25,$47.92,$48.40,$0.00,$9.47,$0.00,$9.63,$0.00
5681-0-055,SUP,HCPCS C1713,,5681-0-055  -  SCREW BONE 6.5MM 55MM 32MM PTHRD CANC HEX HEAD,$60.50,$0.00,$60.50,$27.23,$43.18,$0.00,$10.42,$0.00,$0.00,$10.59,$60.50,$0.00,$30.25,$47.92,$48.40,$0.00,$9.47,$0.00,$9.63,$0.00
5681-0-060,SUP,HCPCS C1713,,5681-0-060  -  SCREW BONE 6.5MM 60MM 32MM PTHRD CANC HEX HEAD,$60.50,$0.00,$60.50,$27.23,$43.18,$0.00,$10.42,$0.00,$0.00,$10.59,$60.50,$0.00,$30.25,$47.92,$48.40,$0.00,$9.47,$0.00,$9.63,$0.00
5681-0-065,SUP,HCPCS C1713,,5681-0-065  -  SCREW BONE 6.5MM 65MM 32MM PTHRD CANC HEX HEAD,$60.50,$0.00,$60.50,$27.23,$43.18,$0.00,$10.42,$0.00,$0.00,$10.59,$60.50,$0.00,$30.25,$47.92,$48.40,$0.00,$9.47,$0.00,$9.63,$0.00
5681-0-070,SUP,HCPCS C1713,,5681-0-070  -  SCREW BONE 6.5MM 70MM 32MM PTHRD CANC HEX HEAD,$60.50,$0.00,$60.50,$27.23,$43.18,$0.00,$10.42,$0.00,$0.00,$10.59,$60.50,$0.00,$30.25,$47.92,$48.40,$0.00,$9.47,$0.00,$9.63,$0.00
5681-0-075,SUP,HCPCS C1713,,5681-0-075  -  SCREW BONE 6.5MM 75MM 32MM PTHRD CANC HEX HEAD,$60.50,$0.00,$60.50,$27.23,$43.18,$0.00,$10.42,$0.00,$0.00,$10.59,$60.50,$0.00,$30.25,$47.92,$48.40,$0.00,$9.47,$0.00,$9.63,$0.00
5681-0-080,SUP,HCPCS C1713,,5681-0-080  -  SCREW BONE 6.5MM 80MM 32MM PTHRD CANC HEX HEAD,$60.50,$0.00,$60.50,$27.23,$43.18,$0.00,$10.42,$0.00,$0.00,$10.59,$60.50,$0.00,$30.25,$47.92,$48.40,$0.00,$9.47,$0.00,$9.63,$0.00
5681-0-085,SUP,HCPCS C1713,,5681-0-085  -  SCREW BONE 6.5MM 85MM 32MM CANC HX HD PTHRD,$60.50,$0.00,$60.50,$27.23,$43.18,$0.00,$10.42,$0.00,$0.00,$10.59,$60.50,$0.00,$30.25,$47.92,$48.40,$0.00,$9.47,$0.00,$9.63,$0.00
5681-0-090,SUP,HCPCS C1713,,5681-0-090  -  SCREW BONE 6.5MM 90MM 32MM CANC HX HD PTTHRD,$60.50,$0.00,$60.50,$27.23,$43.18,$0.00,$10.42,$0.00,$0.00,$10.59,$60.50,$0.00,$30.25,$47.92,$48.40,$0.00,$9.47,$0.00,$9.63,$0.00
5681-0-095,SUP,HCPCS C1713,,5681-0-095  -  SCREW BONE 6.5MM 95MM 32MM TI CANC PTTHRD HX HD SLFTAP,$60.50,$0.00,$60.50,$27.23,$43.18,$0.00,$10.42,$0.00,$0.00,$10.59,$60.50,$0.00,$30.25,$47.92,$48.40,$0.00,$9.47,$0.00,$9.63,$0.00
5681-0-100,SUP,HCPCS C1713,,5681-0-100  -  SCREW BONE 4.2MM 100MM 32MM TI CANC HEX HEAD PTTHRD,$60.50,$0.00,$60.50,$27.23,$43.18,$0.00,$10.42,$0.00,$0.00,$10.59,$60.50,$0.00,$30.25,$47.92,$48.40,$0.00,$9.47,$0.00,$9.63,$0.00
5681-0-105,SUP,HCPCS C1713,,5681-0-105  -  SCREW BONE 6.5MM 32MM 32MM CANC HX HD PRTL THRD,$60.50,$0.00,$60.50,$27.23,$43.18,$0.00,$10.42,$0.00,$0.00,$10.59,$60.50,$0.00,$30.25,$47.92,$48.40,$0.00,$9.47,$0.00,$9.63,$0.00
5681-0-110,SUP,HCPCS C1713,,5681-0-110  -  SCREW BONE 6.5MM 110MM 32MM CANC HEX HEAD PTHRD,$60.50,$0.00,$60.50,$27.23,$43.18,$0.00,$10.42,$0.00,$0.00,$10.59,$60.50,$0.00,$30.25,$47.92,$48.40,$0.00,$9.47,$0.00,$9.63,$0.00
57-05101,SUP,HCPCS C1713,,57-05101  -  PLATE XS HYDRXAPT TI 1.2MM SCR 4 HOLE STR PRFL BONE,$215.88,$0.00,$215.88,$97.14,$154.07,$0.00,$37.19,$0.00,$0.00,$37.80,$215.88,$0.00,$107.94,$170.98,$172.70,$0.00,$33.78,$0.00,$34.37,$0.00
57-05116,SUP,HCPCS C1713,,57-05116  -  PLATE XS .55MM TI 1.2MM SCR 16 HOLE STR PRFL BONE HAND,$482.63,$0.00,$482.63,$217.18,$344.45,$0.00,$83.15,$0.00,$0.00,$84.50,$482.63,$0.00,$241.31,$382.24,$386.10,$0.00,$75.53,$0.00,$76.83,$0.00
57-05140,SUP,HCPCS C1713,,57-05140  -  PLATE XS NAR STD .55MM TI 1.2MM SCR 5 HOLE T PRFL BONE HAND,$287.38,$0.00,$287.38,$129.32,$205.10,$0.00,$49.51,$0.00,$0.00,$50.32,$287.38,$0.00,$143.69,$227.60,$229.90,$0.00,$44.97,$0.00,$45.75,$0.00
57-05142,SUP,HCPCS C1713,,57-05142  -  PLATE XS NAR STD .55MM 1.2MM SCR 8 HOLE T PRFL PRFL BONE,$347.88,$0.00,$347.88,$156.54,$248.28,$0.00,$59.94,$0.00,$0.00,$60.91,$347.88,$0.00,$173.94,$275.52,$278.30,$0.00,$54.44,$0.00,$55.38,$0.00
57-05150,SUP,HCPCS C1713,,57-05150  -  PLATE XS STD .55MM TI 1.2MM SCR T 5 HOLE OBLQ PRFL PRFL BONE,$328.63,$0.00,$328.63,$147.88,$234.54,$0.00,$56.62,$0.00,$0.00,$57.54,$328.63,$0.00,$164.31,$260.27,$262.90,$0.00,$51.43,$0.00,$52.32,$0.00
57-05151,SUP,HCPCS C1713,,57-05151  -  PLATE XS STD .55MM TI 1.2MM SCR 5 HOLE T OBLQ PRFL BONE LEFT,$328.63,$0.00,$328.63,$147.88,$234.54,$0.00,$56.62,$0.00,$0.00,$57.54,$328.63,$0.00,$164.31,$260.27,$262.90,$0.00,$51.43,$0.00,$52.32,$0.00
57-05170,SUP,HCPCS C1713,,57-05170  -  PLATE XS STD NAR .55MM TI 1.2MM SCR 5 HOLE Y PRFL BONE HAND,$308.00,$0.00,$308.00,$138.60,$219.82,$0.00,$53.07,$0.00,$0.00,$53.93,$308.00,$0.00,$154.00,$243.94,$246.40,$0.00,$48.20,$0.00,$49.03,$0.00
57-05190,SUP,HCPCS C1713,,57-05190  -  PLATE XS TI SM FRAG SYS 2X2 HOLE 3D MDLR FIX PRFL BONE HAND,$368.50,$0.00,$368.50,$165.83,$263.00,$0.00,$63.49,$0.00,$0.00,$64.52,$368.50,$0.00,$184.25,$291.85,$294.80,$0.00,$57.67,$0.00,$58.67,$0.00
57-05191,SUP,HCPCS C1713,,57-05191  -  PLATE XS STD .55MM TI 1.2MM SCR 3D 3X2HOLE PRFL PRFL BONE,$554.13,$0.00,$554.13,$249.36,$395.48,$0.00,$95.47,$0.00,$0.00,$97.02,$554.13,$0.00,$277.06,$438.87,$443.30,$0.00,$86.72,$0.00,$88.22,$0.00
57-05192,SUP,HCPCS C1713,,57-05192  -  PLATE XS STD .55MM TI 1.2MM SCR 4X2 HOLE 3D PRFL BONE HAND,$666.88,$0.00,$666.88,$300.09,$475.95,$0.00,$114.90,$0.00,$0.00,$116.76,$666.88,$0.00,$333.44,$528.17,$533.50,$0.00,$104.37,$0.00,$106.17,$0.00
57-05195,SUP,HCPCS C1713,,57-05195  -  PLATE XS STD .55MM TI 1.2MM SCR 3D 4X2 HOLE REPLANTATION,$625.63,$0.00,$625.63,$281.53,$446.51,$0.00,$107.79,$0.00,$0.00,$109.54,$625.63,$0.00,$312.81,$495.50,$500.50,$0.00,$97.91,$0.00,$99.60,$0.00
57-05197,SUP,HCPCS C1713,,57-05197  -  PLATE XS TI 1.2MM SCR 2X2+2 HOLE 3D PRFL PRFL BONE HAND WRST,$554.13,$0.00,$554.13,$249.36,$395.48,$0.00,$95.47,$0.00,$0.00,$97.02,$554.13,$0.00,$277.06,$438.87,$443.30,$0.00,$86.72,$0.00,$88.22,$0.00
57-05201,SUP,HCPCS C1713,,57-05201  -  PLATE SM .55MM TI 1.7MM SCR FRAG SYS 4 HOLE FIX STR MDLR,$226.88,$0.00,$226.88,$102.09,$161.92,$0.00,$39.09,$0.00,$0.00,$39.72,$226.88,$0.00,$113.44,$179.69,$181.50,$0.00,$35.51,$0.00,$36.12,$0.00
57-05202,SUP,HCPCS C1713,,57-05202  -  PLATE SM .55MM TI 1.7MM SCR FRAG SYS 4 HOLE FIX STR BAR MDLR,$226.88,$0.00,$226.88,$102.09,$161.92,$0.00,$39.09,$0.00,$0.00,$39.72,$226.88,$0.00,$113.44,$179.69,$181.50,$0.00,$35.51,$0.00,$36.12,$0.00
57-05210,SUP,HCPCS C1713,,57-05210  -  PLATE W STD .55MM 1.7MM SCR 8 HOLE T S MOD PRFL BONE HAND,$371.25,$0.00,$371.25,$167.06,$264.96,$0.00,$63.96,$0.00,$0.00,$65.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$58.10,$0.00,$59.10,$0.00
57-05216,SUP,HCPCS C1713,,57-05216  -  PLATE SM .55MM 1.7MM SCR FRAG SYS 16 HOLE FIX STR MDLR PRFL,$492.25,$0.00,$492.25,$221.51,$351.32,$0.00,$84.81,$0.00,$0.00,$86.19,$492.25,$0.00,$246.13,$389.86,$393.80,$0.00,$77.04,$0.00,$78.37,$0.00
57-05220,SUP,HCPCS C1713,,57-05220  -  PLATE 90D REG SM HYDRXAPT TI 1.7MM SCR 6 HOLE RIGHT L PRFL,$298.38,$0.00,$298.38,$134.27,$212.95,$0.00,$51.41,$0.00,$0.00,$52.24,$298.38,$0.00,$149.19,$236.32,$238.70,$0.00,$46.70,$0.00,$47.50,$0.00
57-05221,SUP,HCPCS C1713,,57-05221  -  PLATE SM .55MM TI 1.7MM SCR FRAG SYS 6 HOLE FIX L MDLR PRFL,$298.38,$0.00,$298.38,$134.27,$212.95,$0.00,$51.41,$0.00,$0.00,$52.24,$298.38,$0.00,$149.19,$236.32,$238.70,$0.00,$46.70,$0.00,$47.50,$0.00
57-05230,SUP,HCPCS C1713,,57-05230  -  PLATE SM .55MM TI 1.7MM SCR 6 HOLE L OBLQ PRFL BONE RIGHT,$298.38,$0.00,$298.38,$134.27,$212.95,$0.00,$51.41,$0.00,$0.00,$52.24,$298.38,$0.00,$149.19,$236.32,$238.70,$0.00,$46.70,$0.00,$47.50,$0.00
57-05231,SUP,HCPCS C1713,,57-05231  -  PLATE SM .55MM TI 1.7MM SCR 6 HOLE PRFL BONE LEFT OBLQ,$298.38,$0.00,$298.38,$134.27,$212.95,$0.00,$51.41,$0.00,$0.00,$52.24,$298.38,$0.00,$149.19,$236.32,$238.70,$0.00,$46.70,$0.00,$47.50,$0.00
57-05240,SUP,HCPCS C1713,,57-05240  -  PLATE SM TI 1.7MM SCR SM FRAG SYS 6 HOLE T MDLR FIX PRFL,$328.63,$0.00,$328.63,$147.88,$234.54,$0.00,$56.62,$0.00,$0.00,$57.54,$328.63,$0.00,$164.31,$260.27,$262.90,$0.00,$51.43,$0.00,$52.32,$0.00
57-05250,SUP,HCPCS C1713,,57-05250  -  PLATE SM TI SM FRAG SYS 6 HOLE T FX MDLR PRFL BONE HAND,$328.63,$0.00,$328.63,$147.88,$234.54,$0.00,$56.62,$0.00,$0.00,$57.54,$328.63,$0.00,$164.31,$260.27,$262.90,$0.00,$51.43,$0.00,$52.32,$0.00
57-05251,SUP,HCPCS C1713,,57-05251  -  PLATE SM NAR TI 1.7MM SCR 6 HOLE T OBLQ PRFL BONE LEFT HAND,$328.63,$0.00,$328.63,$147.88,$234.54,$0.00,$56.62,$0.00,$0.00,$57.54,$328.63,$0.00,$164.31,$260.27,$262.90,$0.00,$51.43,$0.00,$52.32,$0.00
57-05260,SUP,HCPCS C1713,,57-05260  -  PLATE STD TI 1.7MM SCR 7 HOLE T PRFL BONE HAND,$328.63,$0.00,$328.63,$147.88,$234.54,$0.00,$56.62,$0.00,$0.00,$57.54,$328.63,$0.00,$164.31,$260.27,$262.90,$0.00,$51.43,$0.00,$52.32,$0.00
57-05262,SUP,HCPCS C1713,,57-05262  -  PLATE SM STD NAR .55MM TI 1.7MM SCR 10 HOLE T FX PRFL BONE,$347.88,$0.00,$347.88,$156.54,$248.28,$0.00,$59.94,$0.00,$0.00,$60.91,$347.88,$0.00,$173.94,$275.52,$278.30,$0.00,$54.44,$0.00,$55.38,$0.00
57-05270,SUP,HCPCS C1713,,57-05270  -  PLATE SM .55MM TI 1.7MM SCR FRAG SYS 7 HOLE FIX Y MDLR PRFL,$360.25,$0.00,$360.25,$162.11,$257.11,$0.00,$62.07,$0.00,$0.00,$63.08,$360.25,$0.00,$180.13,$285.32,$288.20,$0.00,$56.38,$0.00,$57.35,$0.00
57-05279,SUP,HCPCS C1713,,57-05279  -  PLATE SM .55MM TI 1.7MM SCR 9 HOLE Z FIX PRFL BONE HAND,$430.38,$0.00,$430.38,$193.67,$307.16,$0.00,$74.15,$0.00,$0.00,$75.36,$430.38,$0.00,$215.19,$340.86,$344.30,$0.00,$67.35,$0.00,$68.52,$0.00
57-05280,SUP,HCPCS C1713,,57-05280  -  PLATE SM RIGHT CNDYLR HAND .55MM TI 1.7MM SCR FRAG SYS 5,$347.88,$0.00,$347.88,$156.54,$248.28,$0.00,$59.94,$0.00,$0.00,$60.91,$347.88,$0.00,$173.94,$275.52,$278.30,$0.00,$54.44,$0.00,$55.38,$0.00
57-05281,SUP,HCPCS C1713,,57-05281  -  PLATE SM LEFT CNDYLR HAND .55MM TI 1.7MM SCR FRAG SYS 5 HOLE,$347.88,$0.00,$347.88,$156.54,$248.28,$0.00,$59.94,$0.00,$0.00,$60.91,$347.88,$0.00,$173.94,$275.52,$278.30,$0.00,$54.44,$0.00,$55.38,$0.00
57-05282,SUP,HCPCS C1713,,57-05282  -  PLATE SM STD .55MM TI 1.7MM SCR 5 HOLE BLADE PRFL BONE RIGHT,$347.88,$0.00,$347.88,$156.54,$248.28,$0.00,$59.94,$0.00,$0.00,$60.91,$347.88,$0.00,$173.94,$275.52,$278.30,$0.00,$54.44,$0.00,$55.38,$0.00
57-05283,SUP,HCPCS C1713,,57-05283  -  PLATE SM STD .55MM TI 1.7MM SCR 5 HOLE BLADE PRFL BONE LEFT,$347.88,$0.00,$347.88,$156.54,$248.28,$0.00,$59.94,$0.00,$0.00,$60.91,$347.88,$0.00,$173.94,$275.52,$278.30,$0.00,$54.44,$0.00,$55.38,$0.00
57-05285,SUP,HCPCS C1713,,57-05285  -  PLATE SM STD .55MM TI 1.7MM SCR 1 HOLE PR PRFL BONE HAND,$360.25,$0.00,$360.25,$162.11,$257.11,$0.00,$62.07,$0.00,$0.00,$63.08,$360.25,$0.00,$180.13,$285.32,$288.20,$0.00,$56.38,$0.00,$57.35,$0.00
57-05290,SUP,HCPCS C1713,,57-05290  -  PLATE SM HYDRXAPT TI 1.7MM SCR 2X2 HOLE 3D PRFL BONE,$379.50,$0.00,$379.50,$170.78,$270.85,$0.00,$65.39,$0.00,$0.00,$66.45,$379.50,$0.00,$189.75,$300.56,$303.60,$0.00,$59.39,$0.00,$60.42,$0.00
57-05291,SUP,HCPCS C1713,,57-05291  -  PLATE SM STD .55MM TI 1.7MM SCR 3X2 HOLE 3D PRFL BONE HAND,$563.75,$0.00,$563.75,$253.69,$402.35,$0.00,$97.13,$0.00,$0.00,$98.71,$563.75,$0.00,$281.88,$446.49,$451.00,$0.00,$88.23,$0.00,$89.75,$0.00
57-05292,SUP,HCPCS C1713,,57-05292  -  PLATE SM STD .55MM TI 1.7MM SCR 4X2 HOLE 3D PRFL BONE HAND,$677.88,$0.00,$677.88,$305.04,$483.80,$0.00,$116.79,$0.00,$0.00,$118.69,$677.88,$0.00,$338.94,$536.88,$542.30,$0.00,$106.09,$0.00,$107.92,$0.00
57-05295,SUP,HCPCS C1713,,57-05295  -  PLATE SM STD .55MM TI 1.7MM SCR 4X2 HOLE 3D REPLANTATION,$677.88,$0.00,$677.88,$305.04,$483.80,$0.00,$116.79,$0.00,$0.00,$118.69,$677.88,$0.00,$338.94,$536.88,$542.30,$0.00,$106.09,$0.00,$107.92,$0.00
57-05297,SUP,HCPCS C1713,,57-05297  -  PLATE SM STD .55MM TI 1.7MM SCR 2X2+ 2 HOLE 3D PRFL BONE,$563.75,$0.00,$563.75,$253.69,$402.35,$0.00,$97.13,$0.00,$0.00,$98.71,$563.75,$0.00,$281.88,$446.49,$451.00,$0.00,$88.23,$0.00,$89.75,$0.00
57-08212,SUP,HCPCS C1713,,57-08212  -  PLATE TI 1.7 MM SCR 12 HOLE STR PRFL BONE RIGHT HAND,$482.63,$0.00,$482.63,$217.18,$344.45,$0.00,$83.15,$0.00,$0.00,$84.50,$482.63,$0.00,$241.31,$382.24,$386.10,$0.00,$75.53,$0.00,$76.83,$0.00
57-08213,SUP,HCPCS C1713,,57-08213  -  PLATE TI 1.7 MM SCR 12 HOLE STR PRFL BONE LEFT HAND,$482.63,$0.00,$482.63,$217.18,$344.45,$0.00,$83.15,$0.00,$0.00,$84.50,$482.63,$0.00,$241.31,$382.24,$386.10,$0.00,$75.53,$0.00,$76.83,$0.00
57-08216,SUP,HCPCS C1713,,57-08216  -  PLATE TI 1.7 MM SCR 16 HOLE STR PRFL BONE HAND,$503.25,$0.00,$503.25,$226.46,$359.17,$0.00,$86.71,$0.00,$0.00,$88.12,$503.25,$0.00,$251.63,$398.57,$402.60,$0.00,$78.76,$0.00,$80.12,$0.00
57-10101,SUP,HCPCS C1713,,57-10101  -  PLATE MED STD 1MM 2.3MM SCR 4 HOLE STR PRFL BONE HAND,$195.25,$0.00,$195.25,$87.86,$139.35,$0.00,$33.64,$0.00,$0.00,$34.19,$195.25,$0.00,$97.63,$154.64,$156.20,$0.00,$30.56,$0.00,$31.08,$0.00
57-10102,SUP,HCPCS C1713,,57-10102  -  PLATE TI SM FRAG SYS 4 HOLE STR BAR FIX MDLR PRFL BONE HAND,$195.25,$0.00,$195.25,$87.86,$139.35,$0.00,$33.64,$0.00,$0.00,$34.19,$195.25,$0.00,$97.63,$154.64,$156.20,$0.00,$30.56,$0.00,$31.08,$0.00
57-10116,SUP,HCPCS C1713,,57-10116  -  PLATE MED STD 1MM TI 2.3MM SCR 16 HOLE STR PRFL BONE HAND,$512.88,$0.00,$512.88,$230.79,$366.04,$0.00,$88.37,$0.00,$0.00,$89.80,$512.88,$0.00,$256.44,$406.20,$410.30,$0.00,$80.26,$0.00,$81.65,$0.00
57-10120,SUP,HCPCS C1713,,57-10120  -  PLATE MED STD 1MM TI 2.3MM SCR 6 HOLE L PRFL PRFL BONE RIGHT,$298.38,$0.00,$298.38,$134.27,$212.95,$0.00,$51.41,$0.00,$0.00,$52.24,$298.38,$0.00,$149.19,$236.32,$238.70,$0.00,$46.70,$0.00,$47.50,$0.00
57-10121,SUP,HCPCS C1713,,57-10121  -  PLATE MED STD 1MM TI 2.3MM SCR 6 HOLE L PRFL BONE LEFT HAND,$298.38,$0.00,$298.38,$134.27,$212.95,$0.00,$51.41,$0.00,$0.00,$52.24,$298.38,$0.00,$149.19,$236.32,$238.70,$0.00,$46.70,$0.00,$47.50,$0.00
57-10130,SUP,HCPCS C1713,,57-10130  -  PLATE MED 1MM 2.3MM SCR SM FRAG SYS 6 HOLE L PRFL BONE HAND,$298.38,$0.00,$298.38,$134.27,$212.95,$0.00,$51.41,$0.00,$0.00,$52.24,$298.38,$0.00,$149.19,$236.32,$238.70,$0.00,$46.70,$0.00,$47.50,$0.00
57-10131,SUP,HCPCS C1713,,57-10131  -  PLATE MED TI 2.3MM SCR 6 HOLE L OBLQ PRFL BONE LEFT HAND,$298.38,$0.00,$298.38,$134.27,$212.95,$0.00,$51.41,$0.00,$0.00,$52.24,$298.38,$0.00,$149.19,$236.32,$238.70,$0.00,$46.70,$0.00,$47.50,$0.00
57-10140,SUP,HCPCS C1713,,57-10140  -  PLATE MED STD NAR 1MM 2.3MM SCR SM FRAG SYS 6 HOLE T PRFL,$308.00,$0.00,$308.00,$138.60,$219.82,$0.00,$53.07,$0.00,$0.00,$53.93,$308.00,$0.00,$154.00,$243.94,$246.40,$0.00,$48.20,$0.00,$49.03,$0.00
57-10150,SUP,HCPCS C1713,,57-10150  -  PLATE MED 1MM 2.3MM SCR SM FRAG SYS 6 HOLE T PRFL BONE HAND,$308.00,$0.00,$308.00,$138.60,$219.82,$0.00,$53.07,$0.00,$0.00,$53.93,$308.00,$0.00,$154.00,$243.94,$246.40,$0.00,$48.20,$0.00,$49.03,$0.00
57-10151,SUP,HCPCS C1713,,57-10151  -  PLATE MED NAR TI 2.3MM SCR 6 HOLE T OBLQ PRFL BONE LEFT HAND,$308.00,$0.00,$308.00,$138.60,$219.82,$0.00,$53.07,$0.00,$0.00,$53.93,$308.00,$0.00,$154.00,$243.94,$246.40,$0.00,$48.20,$0.00,$49.03,$0.00
57-10160,SUP,HCPCS C1713,,57-10160  -  PLATE MED STD 1MM 2.3MM SCR SM FRAG SYS 7 HOLE T PRFL BONE,$339.63,$0.00,$339.63,$152.83,$242.39,$0.00,$58.52,$0.00,$0.00,$59.47,$339.63,$0.00,$169.81,$268.99,$271.70,$0.00,$53.15,$0.00,$54.07,$0.00
57-10161,SUP,HCPCS C1713,,57-10161  -  PLATE MED W STD 1MM 2.3MM SCR 8 HOLE T PRFL PRFL BONE HAND,$371.25,$0.00,$371.25,$167.06,$264.96,$0.00,$63.96,$0.00,$0.00,$65.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$58.10,$0.00,$59.10,$0.00
57-10170,SUP,HCPCS C1713,,57-10170  -  PLATE MED STD NAR 1MM 2.3MM SCR SM FRAG SYS 7 HOLE Y PRFL,$389.13,$0.00,$389.13,$175.11,$277.72,$0.00,$67.04,$0.00,$0.00,$68.13,$389.13,$0.00,$194.56,$308.19,$311.30,$0.00,$60.90,$0.00,$61.95,$0.00
57-10179,SUP,HCPCS C1713,,57-10179  -  PLATE MED STD NAR 1MM 2.3MM SCR SM FRAG SYS 13 HOLE Z PRFL,$430.38,$0.00,$430.38,$193.67,$307.16,$0.00,$74.15,$0.00,$0.00,$75.36,$430.38,$0.00,$215.19,$340.86,$344.30,$0.00,$67.35,$0.00,$68.52,$0.00
57-10180,SUP,HCPCS C1713,,57-10180  -  PLATE MED TI OBLQ FRAC M ROT PRFL BONE PHLNG MTCRPL,$809.88,$0.00,$809.88,$364.44,$578.01,$0.00,$139.54,$0.00,$0.00,$141.80,$809.88,$0.00,$404.94,$641.42,$647.90,$0.00,$126.75,$0.00,$128.93,$0.00
57-10185,SUP,HCPCS C1713,,57-10185  -  PLATE STD MED 1MM 2.3MM SCR 5 HOLE ROT PRFL BONE HAND,$721.88,$0.00,$721.88,$324.84,$515.20,$0.00,$124.38,$0.00,$0.00,$126.39,$721.88,$0.00,$360.94,$571.73,$577.50,$0.00,$112.97,$0.00,$114.92,$0.00
57-10190,SUP,HCPCS C1713,,57-10190  -  PLATE MED STD 1MM 2.3MM SCR SM FRAG SYS 2X2 HOLE 3D PRFL,$379.50,$0.00,$379.50,$170.78,$270.85,$0.00,$65.39,$0.00,$0.00,$66.45,$379.50,$0.00,$189.75,$300.56,$303.60,$0.00,$59.39,$0.00,$60.42,$0.00
57-10191,SUP,HCPCS C1713,,57-10191  -  PLATE MED STD 1MM 2.3MM SCR SM FRAG SYS 3X2 HOLE 3D PRFL,$563.75,$0.00,$563.75,$253.69,$402.35,$0.00,$97.13,$0.00,$0.00,$98.71,$563.75,$0.00,$281.88,$446.49,$451.00,$0.00,$88.23,$0.00,$89.75,$0.00
57-10192,SUP,HCPCS C1713,,57-10192  -  PLATE MED HYDRXAPT TI 2.3MM SCR 4X2 HOLE 3D PRFL BONE,$677.88,$0.00,$677.88,$305.04,$483.80,$0.00,$116.79,$0.00,$0.00,$118.69,$677.88,$0.00,$338.94,$536.88,$542.30,$0.00,$106.09,$0.00,$107.92,$0.00
57-10193,SUP,HCPCS C1713,,57-10193  -  PLATE MED TI 2.3MM SCR 3D PRFL BONE HAND WRST,$677.88,$0.00,$677.88,$305.04,$483.80,$0.00,$116.79,$0.00,$0.00,$118.69,$677.88,$0.00,$338.94,$536.88,$542.30,$0.00,$106.09,$0.00,$107.92,$0.00
57-10195,SUP,HCPCS C1713,,57-10195  -  PLATE MED 1MM TI 2.3MM SCR SM FRAG SYS 4X2 HOLE 3D FIX PRFL,$636.63,$0.00,$636.63,$286.48,$454.36,$0.00,$109.69,$0.00,$0.00,$111.47,$636.63,$0.00,$318.31,$504.21,$509.30,$0.00,$99.63,$0.00,$101.35,$0.00
57-10197,SUP,HCPCS C1713,,57-10197  -  PLATE MED 1MM TI 2.3MM SCR SM FRAG SYS 2X2+ 2 HOLE 3D FIX,$563.75,$0.00,$563.75,$253.69,$402.35,$0.00,$97.13,$0.00,$0.00,$98.71,$563.75,$0.00,$281.88,$446.49,$451.00,$0.00,$88.23,$0.00,$89.75,$0.00
57-10201,SUP,HCPCS C1713,,57-10201  -  PLATE MED TI 2.3MM SCR 4 HOLE STR CMPR PRFL BONE HAND WRST,$247.50,$0.00,$247.50,$111.38,$176.64,$0.00,$42.64,$0.00,$0.00,$43.34,$247.50,$0.00,$123.75,$196.02,$198.00,$0.00,$38.73,$0.00,$39.40,$0.00
57-10202,SUP,HCPCS C1713,,57-10202  -  PLATE MED TI 2.3MM SCR 4 HOLE STR CMPR BAR PRFL BONE HAND,$247.50,$0.00,$247.50,$111.38,$176.64,$0.00,$42.64,$0.00,$0.00,$43.34,$247.50,$0.00,$123.75,$196.02,$198.00,$0.00,$38.73,$0.00,$39.40,$0.00
57-10204,SUP,HCPCS C1713,,57-10204  -  PLATE MED 1MM TI SM FRAG SYS 5 HOLE CMPR STR PRFL BONE HAND,$247.50,$0.00,$247.50,$111.38,$176.64,$0.00,$42.64,$0.00,$0.00,$43.34,$247.50,$0.00,$123.75,$196.02,$198.00,$0.00,$38.73,$0.00,$39.40,$0.00
57-10207,SUP,HCPCS C1713,,57-10207  -  PLATE MED 1MM TI SM FRAG SYS 6 HOLE CMPR STR PRFL BONE HAND,$308.00,$0.00,$308.00,$138.60,$219.82,$0.00,$53.07,$0.00,$0.00,$53.93,$308.00,$0.00,$154.00,$243.94,$246.40,$0.00,$48.20,$0.00,$49.03,$0.00
57-10208,SUP,HCPCS C1713,,57-10208  -  PLATE MED TI 2.3MM SCR 7 HOLE STR CMPR PRFL BONE HAND,$308.00,$0.00,$308.00,$138.60,$219.82,$0.00,$53.07,$0.00,$0.00,$53.93,$308.00,$0.00,$154.00,$243.94,$246.40,$0.00,$48.20,$0.00,$49.03,$0.00
57-10220,SUP,HCPCS C1713,,57-10220  -  PLATE 90D MED TI 2.3MM SCR 6 HOLE L CMPR PRFL BONE RIGHT,$308.00,$0.00,$308.00,$138.60,$219.82,$0.00,$53.07,$0.00,$0.00,$53.93,$308.00,$0.00,$154.00,$243.94,$246.40,$0.00,$48.20,$0.00,$49.03,$0.00
57-10221,SUP,HCPCS C1713,,57-10221  -  PLATE 90D MED TI 2.3MM SCR 6 HOLE L CMPR PRFL BONE LEFT HAND,$308.00,$0.00,$308.00,$138.60,$219.82,$0.00,$53.07,$0.00,$0.00,$53.93,$308.00,$0.00,$154.00,$243.94,$246.40,$0.00,$48.20,$0.00,$49.03,$0.00
57-10230,SUP,HCPCS C1713,,57-10230  -  PLATE MED TI 2.3MM SCR 6 HOLE L OBLQ CMPR PRFL BONE RIGHT,$308.00,$0.00,$308.00,$138.60,$219.82,$0.00,$53.07,$0.00,$0.00,$53.93,$308.00,$0.00,$154.00,$243.94,$246.40,$0.00,$48.20,$0.00,$49.03,$0.00
57-10231,SUP,HCPCS C1713,,57-10231  -  PLATE MED TI 2.3MM SCR 6 HOLE L OBLQ CMPR PRFL BONE LEFT,$308.00,$0.00,$308.00,$138.60,$219.82,$0.00,$53.07,$0.00,$0.00,$53.93,$308.00,$0.00,$154.00,$243.94,$246.40,$0.00,$48.20,$0.00,$49.03,$0.00
57-10240,SUP,HCPCS C1713,,57-10240  -  PLATE MED 1MM TI SM FRAG SYS 6 HOLE CMPR T PRFL BONE HAND,$339.63,$0.00,$339.63,$152.83,$242.39,$0.00,$58.52,$0.00,$0.00,$59.47,$339.63,$0.00,$169.81,$268.99,$271.70,$0.00,$53.15,$0.00,$54.07,$0.00
57-10250,SUP,HCPCS C1713,,57-10250  -  PLATE MED NAR TI 2.3MM SCR 6 HOLE T OBLQ CMPR PRFL BONE,$339.63,$0.00,$339.63,$152.83,$242.39,$0.00,$58.52,$0.00,$0.00,$59.47,$339.63,$0.00,$169.81,$268.99,$271.70,$0.00,$53.15,$0.00,$54.07,$0.00
57-10251,SUP,HCPCS C1713,,57-10251  -  PLATE MED NAR TI 2.3MM SCR 6 HOLE T OBLQ CMPR PRFL BONE LEFT,$339.63,$0.00,$339.63,$152.83,$242.39,$0.00,$58.52,$0.00,$0.00,$59.47,$339.63,$0.00,$169.81,$268.99,$271.70,$0.00,$53.15,$0.00,$54.07,$0.00
57-10260,SUP,HCPCS C1713,,57-10260  -  PLATE 90D MED REG TI 2.3MM SCR 7 HOLE T CMPR PRFL BONE HAND,$360.25,$0.00,$360.25,$162.11,$257.11,$0.00,$62.07,$0.00,$0.00,$63.08,$360.25,$0.00,$180.13,$285.32,$288.20,$0.00,$56.38,$0.00,$57.35,$0.00
57-10262,SUP,HCPCS C1713,,57-10262  -  PLATE 90D REG TI 2.3MM SCR 10 HOLE T CMPR PRFL BONE HAND,$400.13,$0.00,$400.13,$180.06,$285.57,$0.00,$68.94,$0.00,$0.00,$70.06,$400.13,$0.00,$200.06,$316.90,$320.10,$0.00,$62.62,$0.00,$63.70,$0.00
57-10270,SUP,HCPCS C1713,,57-10270  -  PLATE MED 1MM TI SM FRAG SYS 7 HOLE CMPR Y PRFL BONE HAND,$400.13,$0.00,$400.13,$180.06,$285.57,$0.00,$68.94,$0.00,$0.00,$70.06,$400.13,$0.00,$200.06,$316.90,$320.10,$0.00,$62.62,$0.00,$63.70,$0.00
57-10280,SUP,HCPCS C1713,,57-10280  -  PLATE MED TI 2.3MM SCR 5 HOLE PRFL BONE RIGHT CNDYLR,$339.63,$0.00,$339.63,$152.83,$242.39,$0.00,$58.52,$0.00,$0.00,$59.47,$339.63,$0.00,$169.81,$268.99,$271.70,$0.00,$53.15,$0.00,$54.07,$0.00
57-10281,SUP,HCPCS C1713,,57-10281  -  PLATE MED TI 2.3MM SCR 5 HOLE PRFL BONE LEFT CNDYLR,$339.63,$0.00,$339.63,$152.83,$242.39,$0.00,$58.52,$0.00,$0.00,$59.47,$339.63,$0.00,$169.81,$268.99,$271.70,$0.00,$53.15,$0.00,$54.07,$0.00
57-10282,SUP,HCPCS C1713,,57-10282  -  PLATE MED TI 2.3MM SCR 6 HOLE PRFL BONE RIGHT CNDYLR,$339.63,$0.00,$339.63,$152.83,$242.39,$0.00,$58.52,$0.00,$0.00,$59.47,$339.63,$0.00,$169.81,$268.99,$271.70,$0.00,$53.15,$0.00,$54.07,$0.00
57-10283,SUP,HCPCS C1713,,57-10283  -  PLATE MED TI 2.3MM SCR 6 HOLE PRFL BONE LEFT CNDYLR,$339.63,$0.00,$339.63,$152.83,$242.39,$0.00,$58.52,$0.00,$0.00,$59.47,$339.63,$0.00,$169.81,$268.99,$271.70,$0.00,$53.15,$0.00,$54.07,$0.00
57-10284,SUP,HCPCS C1713,,57-10284  -  PLATE MED TI 2.3MM SCR 6 HOLE LNG PIN PRFL BONE RIGHT CNDYLR,$389.13,$0.00,$389.13,$175.11,$277.72,$0.00,$67.04,$0.00,$0.00,$68.13,$389.13,$0.00,$194.56,$308.19,$311.30,$0.00,$60.90,$0.00,$61.95,$0.00
57-10285,SUP,HCPCS C1713,,57-10285  -  PLATE MED TI 2.3MM SCR 6 HOLE LNG PIN PRFL BONE LEFT CNDYLR,$389.13,$0.00,$389.13,$175.11,$277.72,$0.00,$67.04,$0.00,$0.00,$68.13,$389.13,$0.00,$194.56,$308.19,$311.30,$0.00,$60.90,$0.00,$61.95,$0.00
57-10304,SUP,HCPCS C1713,,57-10304  -  PLATE SM 1MM 1.7MM SCR 4 HOLE STR LCK VARIAX BONE HAND,$254.38,$0.00,$254.38,$114.47,$181.55,$0.00,$43.83,$0.00,$0.00,$44.54,$254.38,$0.00,$127.19,$201.47,$203.50,$0.00,$39.81,$0.00,$40.50,$0.00
57-10310,SUP,HCPCS C1713,,57-10310  -  PLATE SM NAR 1MM 1.7MM SCR 10 HOLE T LCK PRFL VARIAX BONE,$391.88,$0.00,$391.88,$176.34,$279.68,$0.00,$67.52,$0.00,$0.00,$68.61,$391.88,$0.00,$195.94,$310.37,$313.50,$0.00,$61.33,$0.00,$62.39,$0.00
57-10316,SUP,HCPCS C1713,,57-10316  -  PLATE SM 1MM 1.7MM SCR 16 HOLE STR LCK PRFL VARIAX BONE HAND,$556.88,$0.00,$556.88,$250.59,$397.44,$0.00,$95.95,$0.00,$0.00,$97.50,$556.88,$0.00,$278.44,$441.05,$445.50,$0.00,$87.15,$0.00,$88.65,$0.00
57-10320,SUP,HCPCS C1713,,57-10320  -  PLATE SM 1MM 1.7MM SCR 6 HOLE L LCK VARIAX BONE 1.7MM RIGHT,$336.88,$0.00,$336.88,$151.59,$240.43,$0.00,$58.04,$0.00,$0.00,$58.98,$336.88,$0.00,$168.44,$266.81,$269.50,$0.00,$52.72,$0.00,$53.63,$0.00
57-10321,SUP,HCPCS C1713,,57-10321  -  PLATE SM 1MM 1.7MM SCR 6 HOLE L LCK VARIAX BONE 1.7MM LEFT,$336.88,$0.00,$336.88,$151.59,$240.43,$0.00,$58.04,$0.00,$0.00,$58.98,$336.88,$0.00,$168.44,$266.81,$269.50,$0.00,$52.72,$0.00,$53.63,$0.00
57-10340,SUP,HCPCS C1713,,57-10340  -  PLATE SM NAR 1MM 1.7MM SCR 6 HOLE T LCK PRFL VARIAX BONE,$371.25,$0.00,$371.25,$167.06,$264.96,$0.00,$63.96,$0.00,$0.00,$65.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$58.10,$0.00,$59.10,$0.00
57-10360,SUP,HCPCS C1713,,57-10360  -  PLATE SM 1MM 1.7MM SCR 7 HOLE T LCK PRFL VARIAX BONE HAND,$371.25,$0.00,$371.25,$167.06,$264.96,$0.00,$63.96,$0.00,$0.00,$65.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$58.10,$0.00,$59.10,$0.00
57-10368,SUP,HCPCS C1713,,57-10368  -  PLATE SM W 1MM 1.7MM SCR 8 HOLE T LCK PRFL VARIAX BONE HAND,$405.63,$0.00,$405.63,$182.53,$289.49,$0.00,$69.89,$0.00,$0.00,$71.02,$405.63,$0.00,$202.81,$321.26,$324.50,$0.00,$63.48,$0.00,$64.58,$0.00
57-10379,SUP,HCPCS C1713,,57-10379  -  PLATE SM NAR 1MM 1.7MM SCR 9 HOLE Z LCK PRFL VARIAX BONE,$488.13,$0.00,$488.13,$219.66,$348.37,$0.00,$84.10,$0.00,$0.00,$85.47,$488.13,$0.00,$244.06,$386.60,$390.50,$0.00,$76.39,$0.00,$77.71,$0.00
57-10380,SUP,HCPCS C1713,,57-10380  -  PLATE SM 1MM 1.7MM SCR 5 HOLE ROT LCK VARIAX BONE HAND,$763.13,$0.00,$763.13,$343.41,$544.64,$0.00,$131.48,$0.00,$0.00,$133.62,$763.13,$0.00,$381.56,$604.40,$610.50,$0.00,$119.43,$0.00,$121.49,$0.00
57-10390,SUP,HCPCS C1713,,57-10390  -  PLATE SM 1MM 1.7MM SCR 2X2 HOLE 3D LCK VARIAX BONE 1.7MM,$426.25,$0.00,$426.25,$191.81,$304.21,$0.00,$73.44,$0.00,$0.00,$74.63,$426.25,$0.00,$213.13,$337.59,$341.00,$0.00,$66.71,$0.00,$67.86,$0.00
57-10391,SUP,HCPCS C1713,,57-10391  -  PLATE 1MM 3X2 HOLE 3D VARIAX BONE 1.7MM HAND WRST,$632.50,$0.00,$632.50,$284.63,$451.42,$0.00,$108.98,$0.00,$0.00,$110.75,$632.50,$0.00,$316.25,$500.94,$506.00,$0.00,$98.99,$0.00,$100.69,$0.00
57-10392,SUP,HCPCS C1713,,57-10392  -  PLATE SM 1MM 1.7MM SCR 4X2 HOLE 3D LCK VARIAX BONE 1.7MM,$763.13,$0.00,$763.13,$343.41,$544.64,$0.00,$131.48,$0.00,$0.00,$133.62,$763.13,$0.00,$381.56,$604.40,$610.50,$0.00,$119.43,$0.00,$121.49,$0.00
57-10395,SUP,HCPCS C1713,,57-10395  -  PLATE SM 1MM 1.7MM SCR 8 HOLE 3D LCK PRFL REPLANTATION,$763.13,$0.00,$763.13,$343.41,$544.64,$0.00,$131.48,$0.00,$0.00,$133.62,$763.13,$0.00,$381.56,$604.40,$610.50,$0.00,$119.43,$0.00,$121.49,$0.00
57-10397,SUP,HCPCS C1713,,57-10397  -  PLATE SM 1MM 1.7MM SCR 2X2+2 HOLE 3D LCK VARIAX BONE HAND,$632.50,$0.00,$632.50,$284.63,$451.42,$0.00,$108.98,$0.00,$0.00,$110.75,$632.50,$0.00,$316.25,$500.94,$506.00,$0.00,$98.99,$0.00,$100.69,$0.00
57-10402,SUP,HCPCS C1713,,57-10402  -  PLATE MED 1MM 2.3MM SCR 4 HOLE STR CMPR PRFL BONE HAND,$281.88,$0.00,$281.88,$126.84,$201.17,$0.00,$48.57,$0.00,$0.00,$49.35,$281.88,$0.00,$140.94,$223.25,$225.50,$0.00,$44.11,$0.00,$44.87,$0.00
57-10407,SUP,HCPCS C1713,,57-10407  -  PLATE MED 1MM 2.3MM SCR 6 HOLE STR CMPR PRFL PRFL BONE HAND,$350.63,$0.00,$350.63,$157.78,$250.24,$0.00,$60.41,$0.00,$0.00,$61.39,$350.63,$0.00,$175.31,$277.70,$280.50,$0.00,$54.87,$0.00,$55.82,$0.00
57-10420,SUP,HCPCS C1713,,57-10420  -  PLATE MED 1MM 2.3MM SCR 6 HOLE L CMPR PRFL BONE RIGHT HAND,$350.63,$0.00,$350.63,$157.78,$250.24,$0.00,$60.41,$0.00,$0.00,$61.39,$350.63,$0.00,$175.31,$277.70,$280.50,$0.00,$54.87,$0.00,$55.82,$0.00
57-10421,SUP,HCPCS C1713,,57-10421  -  PLATE MED 1MM 2.3MM SCR 6 HOLE L CMPR PRFL BONE LEFT HAND,$350.63,$0.00,$350.63,$157.78,$250.24,$0.00,$60.41,$0.00,$0.00,$61.39,$350.63,$0.00,$175.31,$277.70,$280.50,$0.00,$54.87,$0.00,$55.82,$0.00
57-10440,SUP,HCPCS C1713,,57-10440  -  PLATE MED NAR 1MM 2.3MM SCR 6 HOLE T CMPR PRFL BONE HAND,$385.00,$0.00,$385.00,$173.25,$274.77,$0.00,$66.33,$0.00,$0.00,$67.41,$385.00,$0.00,$192.50,$304.92,$308.00,$0.00,$60.25,$0.00,$61.29,$0.00
57-10460,SUP,HCPCS C1713,,57-10460  -  PLATE MED 1MM 2.3MM SCR 7 HOLE T CMPR PRFL BONE HAND,$405.63,$0.00,$405.63,$182.53,$289.49,$0.00,$69.89,$0.00,$0.00,$71.02,$405.63,$0.00,$202.81,$321.26,$324.50,$0.00,$63.48,$0.00,$64.58,$0.00
57-10470,SUP,HCPCS C1713,,57-10470  -  PLATE NAR MED 1MM 2.3MM SCR 7 HOLE Y CMPR PRFL BONE HAND,$453.75,$0.00,$453.75,$204.19,$323.84,$0.00,$78.18,$0.00,$0.00,$79.45,$453.75,$0.00,$226.88,$359.37,$363.00,$0.00,$71.01,$0.00,$72.24,$0.00
57-10482,SUP,HCPCS C1713,,57-10482  -  PLATE MED 1MM 2.3MM SCR 6 HOLE BLADE CMPR PRFL BONE 2.3MM,$385.00,$0.00,$385.00,$173.25,$274.77,$0.00,$66.33,$0.00,$0.00,$67.41,$385.00,$0.00,$192.50,$304.92,$308.00,$0.00,$60.25,$0.00,$61.29,$0.00
57-10483,SUP,HCPCS C1713,,57-10483  -  PLATE MED 1MM 2.3MM SCR 6 HOLE BLADE CMPR PRFL BONE LEFT,$385.00,$0.00,$385.00,$173.25,$274.77,$0.00,$66.33,$0.00,$0.00,$67.41,$385.00,$0.00,$192.50,$304.92,$308.00,$0.00,$60.25,$0.00,$61.29,$0.00
57-13102,SUP,HCPCS C1713,,57-13102  -  PLATE LG 1.3MM TI SM FRAG SYS 4 HOLE STR BAR CMPR PRFL BONE,$287.38,$0.00,$287.38,$129.32,$205.10,$0.00,$49.51,$0.00,$0.00,$50.32,$287.38,$0.00,$143.69,$227.60,$229.90,$0.00,$44.97,$0.00,$45.75,$0.00
57-13105,SUP,HCPCS C1713,,57-13105  -  PLATE LG 1.3MM TI SM FRAG SYS 5 HOLE STR BAR CMPR PRFL BONE,$308.00,$0.00,$308.00,$138.60,$219.82,$0.00,$53.07,$0.00,$0.00,$53.93,$308.00,$0.00,$154.00,$243.94,$246.40,$0.00,$48.20,$0.00,$49.03,$0.00
57-13108,SUP,HCPCS C1713,,57-13108  -  PLATE LG 1.3MM TI SM FRAG SYS 6 HOLE STR BAR CMPR PRFL BONE,$360.25,$0.00,$360.25,$162.11,$257.11,$0.00,$62.07,$0.00,$0.00,$63.08,$360.25,$0.00,$180.13,$285.32,$288.20,$0.00,$56.38,$0.00,$57.35,$0.00
57-13109,SUP,HCPCS C1713,,57-13109  -  PLATE LG 1.3MM TI SM FRAG SYS 7 HOLE STR BAR CMPR PRFL BONE,$389.13,$0.00,$389.13,$175.11,$277.72,$0.00,$67.04,$0.00,$0.00,$68.13,$389.13,$0.00,$194.56,$308.19,$311.30,$0.00,$60.90,$0.00,$61.95,$0.00
57-13110,SUP,HCPCS C1713,,57-13110  -  PLATE LG 1.3MM TI SM FRAG SYS 8 HOLE STR BAR CMPR PRFL BONE,$420.75,$0.00,$420.75,$189.34,$300.29,$0.00,$72.49,$0.00,$0.00,$73.67,$420.75,$0.00,$210.38,$333.23,$336.60,$0.00,$65.85,$0.00,$66.98,$0.00
57-13120,SUP,HCPCS C1713,,57-13120  -  PLATE LG 1.3MM TI SM FRAG SYS 6 HOLE L CMPR PRFL BONE HAND,$368.50,$0.00,$368.50,$165.83,$263.00,$0.00,$63.49,$0.00,$0.00,$64.52,$368.50,$0.00,$184.25,$291.85,$294.80,$0.00,$57.67,$0.00,$58.67,$0.00
57-13121,SUP,HCPCS C1713,,57-13121  -  PLATE LG 1.3MM TI SM FRAG SYS 6 HOLE L CMPR PRFL BONE HAND,$368.50,$0.00,$368.50,$165.83,$263.00,$0.00,$63.49,$0.00,$0.00,$64.52,$368.50,$0.00,$184.25,$291.85,$294.80,$0.00,$57.67,$0.00,$58.67,$0.00
57-13140,SUP,HCPCS C1713,,57-13140  -  PLATE LG 1.3MM TI SM FRAG SYS 6 HOLE T CMPR PRFL BONE HAND,$368.50,$0.00,$368.50,$165.83,$263.00,$0.00,$63.49,$0.00,$0.00,$64.52,$368.50,$0.00,$184.25,$291.85,$294.80,$0.00,$57.67,$0.00,$58.67,$0.00
57-13142,SUP,HCPCS C1713,,57-13142  -  PLATE LG 1.3MM TI SM FRAG SYS 10 HOLE T BAR CMPR PRFL BONE,$400.13,$0.00,$400.13,$180.06,$285.57,$0.00,$68.94,$0.00,$0.00,$70.06,$400.13,$0.00,$200.06,$316.90,$320.10,$0.00,$62.62,$0.00,$63.70,$0.00
57-13150,SUP,HCPCS C1713,,57-13150  -  PLATE LG 1.3MM TI SM FRAG SYS 6 HOLE T CMPR PRFL BONE HAND,$368.50,$0.00,$368.50,$165.83,$263.00,$0.00,$63.49,$0.00,$0.00,$64.52,$368.50,$0.00,$184.25,$291.85,$294.80,$0.00,$57.67,$0.00,$58.67,$0.00
57-13151,SUP,HCPCS C1713,,57-13151  -  PLATE LG 1.3MM TI SM FRAG SYS 6 HOLE T CMPR PRFL BONE HAND,$368.50,$0.00,$368.50,$165.83,$263.00,$0.00,$63.49,$0.00,$0.00,$64.52,$368.50,$0.00,$184.25,$291.85,$294.80,$0.00,$57.67,$0.00,$58.67,$0.00
57-13180,SUP,HCPCS C1713,,57-13180  -  PLATE LG TI SM FRAG SET 5 HOLE MDLR ROT PRFL BONE HAND,$809.88,$0.00,$809.88,$364.44,$578.01,$0.00,$139.54,$0.00,$0.00,$141.80,$809.88,$0.00,$404.94,$641.42,$647.90,$0.00,$126.75,$0.00,$128.93,$0.00
57-13185,SUP,HCPCS C1713,,57-13185  -  PLATE STD W MED 1MM 5 HOLE ROT PRFL PRFL BONE 2.3MM HAND,$721.88,$0.00,$721.88,$324.84,$515.20,$0.00,$124.38,$0.00,$0.00,$126.39,$721.88,$0.00,$360.94,$571.73,$577.50,$0.00,$112.97,$0.00,$114.92,$0.00
57-13402,SUP,HCPCS C1713,,57-13402  -  PLATE 1.3MM 2.3MM SCR 4 HOLE L CMPR STR PRFL BONE HAND,$330.00,$0.00,$330.00,$148.50,$235.52,$0.00,$56.86,$0.00,$0.00,$57.78,$330.00,$0.00,$165.00,$261.36,$264.00,$0.00,$51.65,$0.00,$52.54,$0.00
57-13405,SUP,HCPCS C1713,,57-13405  -  PLATE 1.3MM 2.3MM SCR 5 HOLE L CMPR STR PRFL BONE HAND,$350.63,$0.00,$350.63,$157.78,$250.24,$0.00,$60.41,$0.00,$0.00,$61.39,$350.63,$0.00,$175.31,$277.70,$280.50,$0.00,$54.87,$0.00,$55.82,$0.00
57-13408,SUP,HCPCS C1713,,57-13408  -  PLATE LG 1.3MM 2.3MM SCR 6 HOLE L CMPR STR PRFL BONE 2.3MM,$405.63,$0.00,$405.63,$182.53,$289.49,$0.00,$69.89,$0.00,$0.00,$71.02,$405.63,$0.00,$202.81,$321.26,$324.50,$0.00,$63.48,$0.00,$64.58,$0.00
57-13410,SUP,HCPCS C1713,,57-13410  -  PLATE LG 1.3MM 2.3MM SCR 8 HOLE L CMPR STR PRFL BONE HAND,$440.00,$0.00,$440.00,$198.00,$314.03,$0.00,$75.81,$0.00,$0.00,$77.04,$440.00,$0.00,$220.00,$348.48,$352.00,$0.00,$68.86,$0.00,$70.05,$0.00
57-13420,SUP,HCPCS C1713,,57-13420  -  PLATE LG 1.3MM 2.3MM SCR 6 HOLE L CMPR PRFL BONE RIGHT,$419.38,$0.00,$419.38,$188.72,$299.31,$0.00,$72.26,$0.00,$0.00,$73.43,$419.38,$0.00,$209.69,$332.15,$335.50,$0.00,$65.63,$0.00,$66.76,$0.00
57-13421,SUP,HCPCS C1713,,57-13421  -  PLATE LG 1.3MM 2.3MM SCR 6 HOLE L CMPR PRFL BONE LEFT,$419.38,$0.00,$419.38,$188.72,$299.31,$0.00,$72.26,$0.00,$0.00,$73.43,$419.38,$0.00,$209.69,$332.15,$335.50,$0.00,$65.63,$0.00,$66.76,$0.00
57-13440,SUP,HCPCS C1713,,57-13440  -  PLATE NAR 1.3MM 2.3MM SCR 6 HOLE T CMPR PRFL BONE HAND,$419.38,$0.00,$419.38,$188.72,$299.31,$0.00,$72.26,$0.00,$0.00,$73.43,$419.38,$0.00,$209.69,$332.15,$335.50,$0.00,$65.63,$0.00,$66.76,$0.00
57-13442,SUP,HCPCS C1713,,57-13442  -  PLATE NAR 1.3MM 2.3MM SCR 10 HOLE T CMPR PRFL BONE 2.3MM,$453.75,$0.00,$453.75,$204.19,$323.84,$0.00,$78.18,$0.00,$0.00,$79.45,$453.75,$0.00,$226.88,$359.37,$363.00,$0.00,$71.01,$0.00,$72.24,$0.00
57-13450,SUP,HCPCS C1713,,57-13450  -  PLATE LG 1.3MM 2.3MM SCR 6 HOLE T CMPR OBLQ PRFL BONE RIGHT,$419.38,$0.00,$419.38,$188.72,$299.31,$0.00,$72.26,$0.00,$0.00,$73.43,$419.38,$0.00,$209.69,$332.15,$335.50,$0.00,$65.63,$0.00,$66.76,$0.00
57-13451,SUP,HCPCS C1713,,57-13451  -  PLATE LG 1.3MM 2.3MM SCR 6 HOLE T CMPR OBLQ PRFL BONE LEFT,$419.38,$0.00,$419.38,$188.72,$299.31,$0.00,$72.26,$0.00,$0.00,$73.43,$419.38,$0.00,$209.69,$332.15,$335.50,$0.00,$65.63,$0.00,$66.76,$0.00
57-13906,SUP,HCPCS C1713,,57-13906  -  PLATE LG 1.3MM 2.3MM SCR 6 HOLE T CMPR PRFL BONE HAND,$419.38,$0.00,$419.38,$188.72,$299.31,$0.00,$72.26,$0.00,$0.00,$73.43,$419.38,$0.00,$209.69,$332.15,$335.50,$0.00,$65.63,$0.00,$66.76,$0.00
57-15301,SUP,HCPCS C1713,,57-15301  -  PLATE BN MED STRG 1.5MM VARIAX 4 HL LCK PRECONTOUR HND 2.3MM,$275.00,$0.00,$275.00,$123.75,$196.27,$0.00,$47.38,$0.00,$0.00,$48.15,$275.00,$0.00,$137.50,$217.80,$220.00,$0.00,$43.04,$0.00,$43.78,$0.00
57-15302,SUP,HCPCS C1713,,57-15302  -  PLATE MED 1.5MM 2.3MM SCR 4 HOLE LCK STR BAR VARIAX BONE,$281.88,$0.00,$281.88,$126.84,$201.17,$0.00,$48.57,$0.00,$0.00,$49.35,$281.88,$0.00,$140.94,$223.25,$225.50,$0.00,$44.11,$0.00,$44.87,$0.00
57-15316,SUP,HCPCS C1713,,57-15316  -  PLATE MED 1.5MM 2.3MM SCR 16 HOLE LCK STR PRFL VARIAX BONE,$577.50,$0.00,$577.50,$259.88,$412.16,$0.00,$99.50,$0.00,$0.00,$101.12,$577.50,$0.00,$288.75,$457.38,$462.00,$0.00,$90.38,$0.00,$91.94,$0.00
57-15320,SUP,HCPCS C1713,,57-15320  -  PLATE MED RIGHT HAND 1.5MM 2.3MM SCR 6 HOLE L LCK VARIAX,$336.88,$0.00,$336.88,$151.59,$240.43,$0.00,$58.04,$0.00,$0.00,$58.98,$336.88,$0.00,$168.44,$266.81,$269.50,$0.00,$52.72,$0.00,$53.63,$0.00
57-15321,SUP,HCPCS C1713,,57-15321  -  PLATE MED LEFT HAND 1.5MM 2.3MM SCR 6 HOLE L LCK VARIAX BONE,$336.88,$0.00,$336.88,$151.59,$240.43,$0.00,$58.04,$0.00,$0.00,$58.98,$336.88,$0.00,$168.44,$266.81,$269.50,$0.00,$52.72,$0.00,$53.63,$0.00
57-15324,SUP,HCPCS C1713,,57-15324  -  PLATE 1.5MM 5 HOLE 5 VARIAX BONE 2.3MM LEFT HAND WRST,$914.38,$0.00,$914.38,$411.47,$652.59,$0.00,$157.54,$0.00,$0.00,$160.10,$914.38,$0.00,$457.19,$724.19,$731.50,$0.00,$143.10,$0.00,$145.57,$0.00
57-15325,SUP,HCPCS C1713,,57-15325  -  PLATE MED 1.5MM 2.3MM SCR 5 HOLE MC5 LCK VARIAX BONE 2.3MM,$914.38,$0.00,$914.38,$411.47,$652.59,$0.00,$157.54,$0.00,$0.00,$160.10,$914.38,$0.00,$457.19,$724.19,$731.50,$0.00,$143.10,$0.00,$145.57,$0.00
57-15340,SUP,HCPCS C1713,,57-15340  -  PLATE BN MED NAR T 1.5MM VARIAX 6 HL LCK PRECONTOUR HND 2.3,$350.63,$0.00,$350.63,$157.78,$250.24,$0.00,$60.41,$0.00,$0.00,$61.39,$350.63,$0.00,$175.31,$277.70,$280.50,$0.00,$54.87,$0.00,$55.82,$0.00
57-15360,SUP,HCPCS C1713,,57-15360  -  PLATE MED 1.5MM 2.3MM SCR 7 HOLE T LCK VARIAX BONE HAND,$385.00,$0.00,$385.00,$173.25,$274.77,$0.00,$66.33,$0.00,$0.00,$67.41,$385.00,$0.00,$192.50,$304.92,$308.00,$0.00,$60.25,$0.00,$61.29,$0.00
57-15361,SUP,HCPCS C1713,,57-15361  -  PLATE MED W 1.5MM 2.3MM SCR 8 HOLE T LCK VARIAX BONE HAND,$405.63,$0.00,$405.63,$182.53,$289.49,$0.00,$69.89,$0.00,$0.00,$71.02,$405.63,$0.00,$202.81,$321.26,$324.50,$0.00,$63.48,$0.00,$64.58,$0.00
57-15370,SUP,HCPCS C1713,,57-15370  -  PLATE BN MED NAR T 1.5MM VARIAX 7 HL LCK PRECONTOUR HND 2.3,$440.00,$0.00,$440.00,$198.00,$314.03,$0.00,$75.81,$0.00,$0.00,$77.04,$440.00,$0.00,$220.00,$348.48,$352.00,$0.00,$68.86,$0.00,$70.05,$0.00
57-15379,SUP,HCPCS C1713,,57-15379  -  PLATE MED NAR 1.5MM 2.3MM SCR 13 HOLE Z LCK PRFL VARIAX BONE,$488.13,$0.00,$488.13,$219.66,$348.37,$0.00,$84.10,$0.00,$0.00,$85.47,$488.13,$0.00,$244.06,$386.60,$390.50,$0.00,$76.39,$0.00,$77.71,$0.00
57-15385,SUP,HCPCS C1713,,57-15385  -  PLATE MED 1.5MM 2.3MM SCR 5 HOLE LCK ROT PRFL VARIAX BONE,$907.50,$0.00,$907.50,$408.38,$647.68,$0.00,$156.36,$0.00,$0.00,$158.90,$907.50,$0.00,$453.75,$718.74,$726.00,$0.00,$142.02,$0.00,$144.47,$0.00
57-15390,SUP,HCPCS C1713,,57-15390  -  PLATE MED 1.5MM 2.3MM SCR 2X2 HOLE 3D LCK VARIAX BONE 2.3MM,$591.25,$0.00,$591.25,$266.06,$421.98,$0.00,$101.87,$0.00,$0.00,$103.52,$591.25,$0.00,$295.63,$468.27,$473.00,$0.00,$92.53,$0.00,$94.13,$0.00
57-15391,SUP,HCPCS C1713,,57-15391  -  PLATE MED 1.5MM 2.3MM SCR 3X2 HOLE 3D LCK VARIAX BONE 2.3MM,$632.50,$0.00,$632.50,$284.63,$451.42,$0.00,$108.98,$0.00,$0.00,$110.75,$632.50,$0.00,$316.25,$500.94,$506.00,$0.00,$98.99,$0.00,$100.69,$0.00
57-15392,SUP,HCPCS C1713,,57-15392  -  PLATE MED 1.5MM 2.3MM SCR 4X2 HOLE 3D LCK PRFL VARIAX BONE,$763.13,$0.00,$763.13,$343.41,$544.64,$0.00,$131.48,$0.00,$0.00,$133.62,$763.13,$0.00,$381.56,$604.40,$610.50,$0.00,$119.43,$0.00,$121.49,$0.00
57-15395,SUP,HCPCS C1713,,57-15395  -  PLATE MED 1.5MM 2.3MM SCR 4X2 HOLE 3D LCK REPLANTATION PRFL,$715.00,$0.00,$715.00,$321.75,$510.30,$0.00,$123.19,$0.00,$0.00,$125.19,$715.00,$0.00,$357.50,$566.28,$572.00,$0.00,$111.90,$0.00,$113.83,$0.00
57-15397,SUP,HCPCS C1713,,57-15397  -  PLATE MED 1.5MM 2.3MM SCR 2X2+ 2 HOLE 3D LCK VARIAX BONE 2.3,$632.50,$0.00,$632.50,$284.63,$451.42,$0.00,$108.98,$0.00,$0.00,$110.75,$632.50,$0.00,$316.25,$500.94,$506.00,$0.00,$98.99,$0.00,$100.69,$0.00
57525P,SUP,HCPCS C1713,,57525P  -  SCREW BN 5.75MM 25MM SPRL R90D MULTIANGLE TI SPNE THORLMBR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
57525S,SUP,HCPCS C1713,,57525S  -  SCREW BN STD 5.75MM 25MM SPRL R90D LCK TI SPNE THORLMBR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
57530P,SUP,HCPCS C1713,,57530P  -  SCREW BN 5.75MM 30MM SPRL R90D MULTIANGLE TI SPNE THORLMBR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
57530S,SUP,HCPCS C1713,,57530S  -  SCREW BN STD 5.75MM 30MM SPRL R90D LCK TI SPNE THORLMBR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
57535P,SUP,HCPCS C1713,,57535P  -  SCREW BN 5.75MM 35MM SPRL R90D MULTIANGLE TI SPNE THORLMBR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
57535S,SUP,HCPCS C1713,,57535S  -  SCREW BN STD 5.75MM 35MM SPRL R90D LCK TI SPNE THORLMBR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
57540P,SUP,HCPCS C1713,,57540P  -  SCREW BN 5.75MM 40MM SPRL R90D MULTIANGLE TI SPNE THORLMBR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
57540S,SUP,HCPCS C1713,,57540S  -  SCREW BN STD 5.75MM 40MM SPRL R90D LCK TI SPNE THORLMBR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
57545P,SUP,HCPCS C1713,,57545P  -  SCREW BN 5.75MM 45MM SPRL R90D MULTIANGLE TI SPNE THORLMBR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
57545S,SUP,HCPCS C1713,,57545S  -  SCREW BN STD 5.75MM 45MM SPRL R90D LCK TI SPNE THORLMBR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
57550P,SUP,HCPCS C1713,,57550P  -  SCREW BN 5.75MM 50MM SPRL R90D MULTIANGLE TI SPNE THORLMBR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
57550S,SUP,HCPCS C1713,,57550S  -  SCREW BN STD 5.75MM 50MM SPRL R90D LCK TI SPNE THORLMBR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
57555P,SUP,HCPCS C1713,,57555P  -  SCREW BN 5.75MM 55MM SPRL R90D MULTIANGLE TI SPNE THORLMBR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
57555S,SUP,HCPCS C1713,,57555S  -  SCREW BN STD 5.75MM 55MM SPRL R90D LCK TI SPNE THORLMBR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
57560P,SUP,HCPCS C1713,,57560P  -  SCREW BN 5.75MM 60MM SPRL R90D MULTIANGLE TI SPNE THORLMBR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
57560S,SUP,HCPCS C1713,,57560S  -  SCREW BN STD 5.75MM 60MM SPRL R90D LCK TI SPNE THORLMBR,"$1,233.33",$0.00,"$1,233.33",$555.00,$880.22,$0.00,$212.50,$0.00,$0.00,$215.95,"$1,233.33",$0.00,$616.66,$976.80,$986.66,$0.00,$193.02,$0.00,$196.35,$0.00
57565P,SUP,HCPCS C1713,,57565P  -  SCREW BN 5.75MM 65MM SPRL R90D MULTIANGLE TI SPNE THORLMBR,"$1,621.98",$0.00,"$1,621.98",$729.89,"$1,157.60",$0.00,$279.46,$0.00,$0.00,$283.99,"$1,621.98",$0.00,$810.99,"$1,284.61","$1,297.58",$0.00,$253.84,$0.00,$258.22,$0.00
57565S,SUP,HCPCS C1713,,57565S  -  SCREW BN STD 5.75MM 65MM SPRL R90D LCK TI SPNE THORLMBR,"$1,233.33",$0.00,"$1,233.33",$555.00,$880.22,$0.00,$212.50,$0.00,$0.00,$215.95,"$1,233.33",$0.00,$616.66,$976.80,$986.66,$0.00,$193.02,$0.00,$196.35,$0.00
5770-1-000,SUP,Custom 27203010,,5770-1-000  -  SET ORTH 3.2MM DRILL GUIDE,$382.25,$0.00,$382.25,$0.00,$272.81,$0.00,$0.00,$0.00,$0.00,$0.00,$382.25,$0.00,$191.13,$302.74,$305.80,$0.00,$0.00,$0.00,$0.00,$0.00
5770-3-000,SUP,Custom 27203010,,5770-3-000  -  SET ORTH 3.2MM DRILL GUIDE NTRL,$137.50,$0.00,$137.50,$0.00,$98.13,$0.00,$0.00,$0.00,$0.00,$0.00,$137.50,$0.00,$68.75,$108.90,$110.00,$0.00,$0.00,$0.00,$0.00,$0.00
5770-4-000,SUP,Custom 27203010,,5770-4-000  -  SET ORTH 3.6MM DRILL GUIDE,$493.63,$0.00,$493.63,$0.00,$352.30,$0.00,$0.00,$0.00,$0.00,$0.00,$493.63,$0.00,$246.81,$390.95,$394.90,$0.00,$0.00,$0.00,$0.00,$0.00
5770-5-000,SUP,Custom 27203010,,5770-5-000  -  SET ORTH 2MM DRILL GUIDE,$422.13,$0.00,$422.13,$0.00,$301.27,$0.00,$0.00,$0.00,$0.00,$0.00,$422.13,$0.00,$211.06,$334.33,$337.70,$0.00,$0.00,$0.00,$0.00,$0.00
5780-0-035,SUP,HCPCS C1713,,5780-0-035  -  SCREW BONE CORT TAP,$105.88,$0.00,$105.88,$47.64,$75.56,$0.00,$18.24,$0.00,$0.00,$18.54,$105.88,$0.00,$52.94,$83.86,$84.70,$0.00,$16.57,$0.00,$16.86,$0.00
5780-0-045,SUP,HCPCS C1713,,5780-0-045  -  SCREW BONE CORT TAP,$411.13,$0.00,$411.13,$185.01,$293.42,$0.00,$70.83,$0.00,$0.00,$71.98,$411.13,$0.00,$205.56,$325.61,$328.90,$0.00,$64.34,$0.00,$65.45,$0.00
5780-1-045,SUP,Custom 27803010,,5780-1-045  -  TAP CORTICAL BONE SCREW,$411.13,$0.00,$411.13,$0.00,$293.42,$0.00,$0.00,$0.00,$0.00,$0.00,$411.13,$0.00,$205.56,$325.61,$328.90,$0.00,$0.00,$0.00,$0.00,$0.00
5781-0-014,SUP,Custom 27203010,,5781-0-014  -  SLEEVE DRILL 1.4-2MM ICS,$185.63,$0.00,$185.63,$0.00,$132.48,$0.00,$0.00,$0.00,$0.00,$0.00,$185.63,$0.00,$92.81,$147.02,$148.50,$0.00,$0.00,$0.00,$0.00,$0.00
5781-0-027,SUP,Custom 27203010,,5781-0-027  -  SLEEVE DRILL 2MM INS,$103.13,$0.00,$103.13,$0.00,$73.60,$0.00,$0.00,$0.00,$0.00,$0.00,$103.13,$0.00,$51.56,$81.68,$82.50,$0.00,$0.00,$0.00,$0.00,$0.00
5781-0-045,SUP,Custom 27203010,,5781-0-045  -  SLEEVE DRILL 4.5MM TAP,$180.13,$0.00,$180.13,$0.00,$128.56,$0.00,$0.00,$0.00,$0.00,$0.00,$180.13,$0.00,$90.06,$142.66,$144.10,$0.00,$0.00,$0.00,$0.00,$0.00
5781-0-480,SUP,Custom 27203010,,5781-0-480  -  SLEEVE DRILL 48MM,$89.38,$0.00,$89.38,$0.00,$63.79,$0.00,$0.00,$0.00,$0.00,$0.00,$89.38,$0.00,$44.69,$70.79,$71.50,$0.00,$0.00,$0.00,$0.00,$0.00
5781-0-530,SUP,Custom 27203010,,5781-0-530  -  SLEEVE DRILL 53MM,$89.38,$0.00,$89.38,$0.00,$63.79,$0.00,$0.00,$0.00,$0.00,$0.00,$89.38,$0.00,$44.69,$70.79,$71.50,$0.00,$0.00,$0.00,$0.00,$0.00
5781-3-035,SUP,Custom 27203010,,5781-3-035  -  GUIDE DRILL SM PNT,$165.00,$0.00,$165.00,$0.00,$117.76,$0.00,$0.00,$0.00,$0.00,$0.00,$165.00,$0.00,$82.50,$130.68,$132.00,$0.00,$0.00,$0.00,$0.00,$0.00
5781-3-045,SUP,Custom 27203010,,5781-3-045  -  GUIDE DRILL PNT,$240.63,$0.00,$240.63,$0.00,$171.73,$0.00,$0.00,$0.00,$0.00,$0.00,$240.63,$0.00,$120.31,$190.58,$192.50,$0.00,$0.00,$0.00,$0.00,$0.00
5785-0-002,SUP,Custom 27203010,,5785-0-002  -  FORCEP SURG LNG SCR,$67.38,$0.00,$67.38,$0.00,$48.09,$0.00,$0.00,$0.00,$0.00,$0.00,$67.38,$0.00,$33.69,$53.36,$53.90,$0.00,$0.00,$0.00,$0.00,$0.00
5785-0-003,SUP,Custom 27203010,,5785-0-003  -  FORCEP SURG ICS PLT,$287.38,$0.00,$287.38,$0.00,$205.10,$0.00,$0.00,$0.00,$0.00,$0.00,$287.38,$0.00,$143.69,$227.60,$229.90,$0.00,$0.00,$0.00,$0.00,$0.00
58-12004E,SUP,HCPCS C1713,,58-12004E  -  SCREW BONE 1.2MM 4MM HAND WRST STRL,$110.00,$0.00,$110.00,$49.50,$78.51,$0.00,$18.95,$0.00,$0.00,$19.26,$110.00,$0.00,$55.00,$87.12,$88.00,$0.00,$17.22,$0.00,$17.51,$0.00
58-12005E,SUP,HCPCS C1713,,58-12005E  -  SCREW BONE 1.2MM 5MM HAND WRST STRL,$110.00,$0.00,$110.00,$49.50,$78.51,$0.00,$18.95,$0.00,$0.00,$19.26,$110.00,$0.00,$55.00,$87.12,$88.00,$0.00,$17.22,$0.00,$17.51,$0.00
58-12006E,SUP,HCPCS C1713,,58-12006E  -  SCREW BONE 1.2MM 6MM HAND WRST STRL,$110.00,$0.00,$110.00,$49.50,$78.51,$0.00,$18.95,$0.00,$0.00,$19.26,$110.00,$0.00,$55.00,$87.12,$88.00,$0.00,$17.22,$0.00,$17.51,$0.00
58-12007E,SUP,HCPCS C1713,,58-12007E  -  SCREW BONE 1.2MM 7MM HAND NLCKG SLFTAP CROSSPIN STRL,$110.00,$0.00,$110.00,$49.50,$78.51,$0.00,$18.95,$0.00,$0.00,$19.26,$110.00,$0.00,$55.00,$87.12,$88.00,$0.00,$17.22,$0.00,$17.51,$0.00
58-12008E,SUP,HCPCS C1713,,58-12008E  -  SCREW BONE 1.2MM 8MM HAND,$110.00,$0.00,$110.00,$49.50,$78.51,$0.00,$18.95,$0.00,$0.00,$19.26,$110.00,$0.00,$55.00,$87.12,$88.00,$0.00,$17.22,$0.00,$17.51,$0.00
58-12009E,SUP,HCPCS C1713,,58-12009E  -  SCREW BONE 1.2MM 9MM STRL,$110.00,$0.00,$110.00,$49.50,$78.51,$0.00,$18.95,$0.00,$0.00,$19.26,$110.00,$0.00,$55.00,$87.12,$88.00,$0.00,$17.22,$0.00,$17.51,$0.00
58-12010E,SUP,HCPCS C1713,,58-12010E  -  SCREW BONE 1.2MM 10MM,$110.00,$0.00,$110.00,$49.50,$78.51,$0.00,$18.95,$0.00,$0.00,$19.26,$110.00,$0.00,$55.00,$87.12,$88.00,$0.00,$17.22,$0.00,$17.51,$0.00
58-12012E,SUP,HCPCS C1713,,58-12012E  -  SCREW BONE 1.2MM 12MM HAND NLCKG SLFTAP CROSSPIN STRL,$110.00,$0.00,$110.00,$49.50,$78.51,$0.00,$18.95,$0.00,$0.00,$19.26,$110.00,$0.00,$55.00,$87.12,$88.00,$0.00,$17.22,$0.00,$17.51,$0.00
58-12014E,SUP,HCPCS C1713,,58-12014E  -  SCREW BONE 1.2MM 14MM HAND NLCKG SLFTAP CROSSPIN STRL,$110.00,$0.00,$110.00,$49.50,$78.51,$0.00,$18.95,$0.00,$0.00,$19.26,$110.00,$0.00,$55.00,$87.12,$88.00,$0.00,$17.22,$0.00,$17.51,$0.00
58-12016E,SUP,HCPCS C1713,,58-12016E  -  SCREW BONE 1.2MM 16MM HAND NLCKG SLFTAP CROSSPIN STRL,$110.00,$0.00,$110.00,$49.50,$78.51,$0.00,$18.95,$0.00,$0.00,$19.26,$110.00,$0.00,$55.00,$87.12,$88.00,$0.00,$17.22,$0.00,$17.51,$0.00
58-12018E,SUP,HCPCS C1713,,58-12018E  -  SCREW BONE 1.2MM 18MM WR HND NLCKG STR CROSSPIN STRL,$110.00,$0.00,$110.00,$49.50,$78.51,$0.00,$18.95,$0.00,$0.00,$19.26,$110.00,$0.00,$55.00,$87.12,$88.00,$0.00,$17.22,$0.00,$17.51,$0.00
58-12020E,SUP,HCPCS C1713,,58-12020E  -  SCREW BONE 1.2MM 20MM WR HND NLCKG STR CROSSPIN STRL,$110.00,$0.00,$110.00,$49.50,$78.51,$0.00,$18.95,$0.00,$0.00,$19.26,$110.00,$0.00,$55.00,$87.12,$88.00,$0.00,$17.22,$0.00,$17.51,$0.00
58-14003E,SUP,HCPCS C1713,,58-14003E  -  SCREW BONE 1.4MM 3MM HAND NLCKG SLFTAP CROSSPIN STRL,$116.88,$0.00,$116.88,$52.59,$83.41,$0.00,$20.14,$0.00,$0.00,$20.46,$116.88,$0.00,$58.44,$92.57,$93.50,$0.00,$18.29,$0.00,$18.61,$0.00
58-14005E,SUP,HCPCS C1713,,58-14005E  -  SCREW BONE 1.4MM 5MM HAND NLCKG SLFTAP CROSSPIN STRL,$116.88,$0.00,$116.88,$52.59,$83.41,$0.00,$20.14,$0.00,$0.00,$20.46,$116.88,$0.00,$58.44,$92.57,$93.50,$0.00,$18.29,$0.00,$18.61,$0.00
58-14007E,SUP,HCPCS C1713,,58-14007E  -  SCREW BONE 1.4MM 7MM WR HND ER NLCKG STR CROSSPIN STRL,$116.88,$0.00,$116.88,$52.59,$83.41,$0.00,$20.14,$0.00,$0.00,$20.46,$116.88,$0.00,$58.44,$92.57,$93.50,$0.00,$18.29,$0.00,$18.61,$0.00
58-14009E,SUP,HCPCS C1713,,58-14009E  -  SCREW BONE 1.4MM 9MM IMPL ER STRL,$116.88,$0.00,$116.88,$52.59,$83.41,$0.00,$20.14,$0.00,$0.00,$20.46,$116.88,$0.00,$58.44,$92.57,$93.50,$0.00,$18.29,$0.00,$18.61,$0.00
58-17005,SUP,HCPCS C1713,,58-17005  -  SCREW BONE 1.7MM 5MM HAND,$96.25,$0.00,$96.25,$43.31,$68.69,$0.00,$16.58,$0.00,$0.00,$16.85,$96.25,$0.00,$48.13,$76.23,$77.00,$0.00,$15.06,$0.00,$15.32,$0.00
58-17005E,SUP,HCPCS C1713,,58-17005E  -  SCREW BONE 1.7MM 5MM HAND NLCKG SLFTAP CROSSPIN STRL,$110.00,$0.00,$110.00,$49.50,$78.51,$0.00,$18.95,$0.00,$0.00,$19.26,$110.00,$0.00,$55.00,$87.12,$88.00,$0.00,$17.22,$0.00,$17.51,$0.00
58-17006,SUP,HCPCS C1713,,58-17006  -  SCREW BONE 1.7MM 6MM,$96.25,$0.00,$96.25,$43.31,$68.69,$0.00,$16.58,$0.00,$0.00,$16.85,$96.25,$0.00,$48.13,$76.23,$77.00,$0.00,$15.06,$0.00,$15.32,$0.00
58-17007,SUP,HCPCS C1713,,58-17007  -  SCREW BN 1.7MM 7MM HND,$96.25,$0.00,$96.25,$43.31,$68.69,$0.00,$16.58,$0.00,$0.00,$16.85,$96.25,$0.00,$48.13,$76.23,$77.00,$0.00,$15.06,$0.00,$15.32,$0.00
58-17008,SUP,HCPCS C1713,,58-17008  -  SCREW BONE 1.7MM 8MM HAND,$96.25,$0.00,$96.25,$43.31,$68.69,$0.00,$16.58,$0.00,$0.00,$16.85,$96.25,$0.00,$48.13,$76.23,$77.00,$0.00,$15.06,$0.00,$15.32,$0.00
58-17008E,SUP,HCPCS C1713,,58-17008E  -  SCREW BONE 1.7MM 8MM HAND NLCKG SLFTAP CROSSPIN STRL,$110.00,$0.00,$110.00,$49.50,$78.51,$0.00,$18.95,$0.00,$0.00,$19.26,$110.00,$0.00,$55.00,$87.12,$88.00,$0.00,$17.22,$0.00,$17.51,$0.00
58-17009,SUP,HCPCS C1713,,58-17009  -  SCREW BONE 1.7MM 9MM,$96.25,$0.00,$96.25,$43.31,$68.69,$0.00,$16.58,$0.00,$0.00,$16.85,$96.25,$0.00,$48.13,$76.23,$77.00,$0.00,$15.06,$0.00,$15.32,$0.00
58-17010,SUP,HCPCS C1713,,58-17010  -  SCREW BONE 1.7MM 10MM HAND NLCKG SLFTAP CROSSPIN STRL,$96.25,$0.00,$96.25,$43.31,$68.69,$0.00,$16.58,$0.00,$0.00,$16.85,$96.25,$0.00,$48.13,$76.23,$77.00,$0.00,$15.06,$0.00,$15.32,$0.00
58-17011,SUP,HCPCS C1713,,58-17011  -  SCREW BONE 1.7MM 11MM HAND,$96.25,$0.00,$96.25,$43.31,$68.69,$0.00,$16.58,$0.00,$0.00,$16.85,$96.25,$0.00,$48.13,$76.23,$77.00,$0.00,$15.06,$0.00,$15.32,$0.00
58-17012,SUP,HCPCS C1713,,58-17012  -  SCREW BONE 1.7MM 12MM HAND NLCKG SLFTAP CROSSPIN STRL,$96.25,$0.00,$96.25,$43.31,$68.69,$0.00,$16.58,$0.00,$0.00,$16.85,$96.25,$0.00,$48.13,$76.23,$77.00,$0.00,$15.06,$0.00,$15.32,$0.00
58-17013,SUP,HCPCS C1713,,58-17013  -  SCREW BONE 1.7MM 13MM,$96.25,$0.00,$96.25,$43.31,$68.69,$0.00,$16.58,$0.00,$0.00,$16.85,$96.25,$0.00,$48.13,$76.23,$77.00,$0.00,$15.06,$0.00,$15.32,$0.00
58-17013E,SUP,HCPCS C1713,,58-17013E  -  SCREW BONE 1.7MM 13MM HAND WRST SLFTAP STRL,$110.00,$0.00,$110.00,$49.50,$78.51,$0.00,$18.95,$0.00,$0.00,$19.26,$110.00,$0.00,$55.00,$87.12,$88.00,$0.00,$17.22,$0.00,$17.51,$0.00
58-17014,SUP,HCPCS C1713,,58-17014  -  SCREW BONE 1.7MM 14MM HAND NLCKG SLFTAP CROSSPIN STRL,$96.25,$0.00,$96.25,$43.31,$68.69,$0.00,$16.58,$0.00,$0.00,$16.85,$96.25,$0.00,$48.13,$76.23,$77.00,$0.00,$15.06,$0.00,$15.32,$0.00
58-17015,SUP,HCPCS C1713,,58-17015  -  SCREW BONE 1.7MM 15MM XPIN,$96.25,$0.00,$96.25,$43.31,$68.69,$0.00,$16.58,$0.00,$0.00,$16.85,$96.25,$0.00,$48.13,$76.23,$77.00,$0.00,$15.06,$0.00,$15.32,$0.00
58-17015E,SUP,HCPCS C1713,,58-17015E  -  SCREW BONE 1.7MM 15MM HAND WRST SLFTAP STRL,$110.00,$0.00,$110.00,$49.50,$78.51,$0.00,$18.95,$0.00,$0.00,$19.26,$110.00,$0.00,$55.00,$87.12,$88.00,$0.00,$17.22,$0.00,$17.51,$0.00
58-17016,SUP,HCPCS C1713,,58-17016  -  SCREW BONE 1.7MM 16MM XPIN,$96.25,$0.00,$96.25,$43.31,$68.69,$0.00,$16.58,$0.00,$0.00,$16.85,$96.25,$0.00,$48.13,$76.23,$77.00,$0.00,$15.06,$0.00,$15.32,$0.00
58-17018,SUP,HCPCS C1713,,58-17018  -  SCREW BONE 1.7MM 18MM HAND,$96.25,$0.00,$96.25,$43.31,$68.69,$0.00,$16.58,$0.00,$0.00,$16.85,$96.25,$0.00,$48.13,$76.23,$77.00,$0.00,$15.06,$0.00,$15.32,$0.00
58-17018E,SUP,HCPCS C1713,,58-17018E  -  SCREW BONE 1.7MM 18MM HAND WRST SLFTAP STRL,$110.00,$0.00,$110.00,$49.50,$78.51,$0.00,$18.95,$0.00,$0.00,$19.26,$110.00,$0.00,$55.00,$87.12,$88.00,$0.00,$17.22,$0.00,$17.51,$0.00
58-17020,SUP,HCPCS C1713,,58-17020  -  SCREW BN 1.7MM 20MM NS VARIAX ST XPN,$96.25,$0.00,$96.25,$43.31,$68.69,$0.00,$16.58,$0.00,$0.00,$16.85,$96.25,$0.00,$48.13,$76.23,$77.00,$0.00,$15.06,$0.00,$15.32,$0.00
58-17020E,SUP,HCPCS C1713,,58-17020E  -  SCREW BONE 1.7MM 20MM HAND WRST SLFTAP STRL,$110.00,$0.00,$110.00,$49.50,$78.51,$0.00,$18.95,$0.00,$0.00,$19.26,$110.00,$0.00,$55.00,$87.12,$88.00,$0.00,$17.22,$0.00,$17.51,$0.00
58-17022,SUP,HCPCS C1713,,58-17022  -  SCREW BONE 1.7MM 22MM HAND,$96.25,$0.00,$96.25,$43.31,$68.69,$0.00,$16.58,$0.00,$0.00,$16.85,$96.25,$0.00,$48.13,$76.23,$77.00,$0.00,$15.06,$0.00,$15.32,$0.00
58-17022E,SUP,HCPCS C1713,,58-17022E  -  SCREW BONE 1.7MM 22MM HAND WRST SLFTAP STRL,$110.00,$0.00,$110.00,$49.50,$78.51,$0.00,$18.95,$0.00,$0.00,$19.26,$110.00,$0.00,$55.00,$87.12,$88.00,$0.00,$17.22,$0.00,$17.51,$0.00
58-17024,SUP,HCPCS C1713,,58-17024  -  SCREW BONE 1.7MM 24MM,$96.25,$0.00,$96.25,$43.31,$68.69,$0.00,$16.58,$0.00,$0.00,$16.85,$96.25,$0.00,$48.13,$76.23,$77.00,$0.00,$15.06,$0.00,$15.32,$0.00
58-17024E,SUP,HCPCS C1713,,58-17024E  -  SCREW BONE 1.7MM 24MM HAND WRST SLFTAP STRL,$110.00,$0.00,$110.00,$49.50,$78.51,$0.00,$18.95,$0.00,$0.00,$19.26,$110.00,$0.00,$55.00,$87.12,$88.00,$0.00,$17.22,$0.00,$17.51,$0.00
58-19005,SUP,HCPCS C1713,,58-19005  -  SCREW BONE 1.9MM 5MM ER,$96.25,$0.00,$96.25,$43.31,$68.69,$0.00,$16.58,$0.00,$0.00,$16.85,$96.25,$0.00,$48.13,$76.23,$77.00,$0.00,$15.06,$0.00,$15.32,$0.00
58-19005E,SUP,HCPCS C1713,,58-19005E  -  SCREW BONE 1.9MM 5MM HAND NLCKG SLFTAP CROSSPIN STRL,$116.88,$0.00,$116.88,$52.59,$83.41,$0.00,$20.14,$0.00,$0.00,$20.46,$116.88,$0.00,$58.44,$92.57,$93.50,$0.00,$18.29,$0.00,$18.61,$0.00
58-19008,SUP,HCPCS C1713,,58-19008  -  SCREW BONE 1.9MM 8MM ER,$96.25,$0.00,$96.25,$43.31,$68.69,$0.00,$16.58,$0.00,$0.00,$16.85,$96.25,$0.00,$48.13,$76.23,$77.00,$0.00,$15.06,$0.00,$15.32,$0.00
58-19008E,SUP,HCPCS C1713,,58-19008E  -  SCREW BONE 1.9MM 8MM HAND NLCKG SLFTAP CROSSPIN STRL,$116.88,$0.00,$116.88,$52.59,$83.41,$0.00,$20.14,$0.00,$0.00,$20.46,$116.88,$0.00,$58.44,$92.57,$93.50,$0.00,$18.29,$0.00,$18.61,$0.00
58-19010,SUP,HCPCS C1713,,58-19010  -  SCREW BONE 2.5MM 10MM,$96.25,$0.00,$96.25,$43.31,$68.69,$0.00,$16.58,$0.00,$0.00,$16.85,$96.25,$0.00,$48.13,$76.23,$77.00,$0.00,$15.06,$0.00,$15.32,$0.00
58-19010E,SUP,HCPCS C1713,,58-19010E  -  SCREW BONE 1.9MM 10MM CANC WR HND ER NLCKG STR CROSSPIN STRL,$116.88,$0.00,$116.88,$52.59,$83.41,$0.00,$20.14,$0.00,$0.00,$20.46,$116.88,$0.00,$58.44,$92.57,$93.50,$0.00,$18.29,$0.00,$18.61,$0.00
58-19012,SUP,HCPCS C1713,,58-19012  -  SCREW BONE 1.9MM 12MM ER,$96.25,$0.00,$96.25,$43.31,$68.69,$0.00,$16.58,$0.00,$0.00,$16.85,$96.25,$0.00,$48.13,$76.23,$77.00,$0.00,$15.06,$0.00,$15.32,$0.00
5820-009-030,SUP,Custom 27203010,,5820-009-030  -  BURR SURG 3MM PRECISION,$505.88,$0.00,$505.88,$0.00,$361.04,$0.00,$0.00,$0.00,$0.00,$0.00,$505.88,$0.00,$252.94,$400.66,$404.70,$0.00,$0.00,$0.00,$0.00,$0.00
5820-009-040,SUP,Custom 27203010,,5820-009-040  -  BURR SURG 4MM PRECISION,$505.88,$0.00,$505.88,$0.00,$361.04,$0.00,$0.00,$0.00,$0.00,$0.00,$505.88,$0.00,$252.94,$400.66,$404.70,$0.00,$0.00,$0.00,$0.00,$0.00
5820-009-050,SUP,Custom 27203010,,5820-009-050  -  BURR SURG 5MM PRECISION,$505.88,$0.00,$505.88,$0.00,$361.04,$0.00,$0.00,$0.00,$0.00,$0.00,$505.88,$0.00,$252.94,$400.66,$404.70,$0.00,$0.00,$0.00,$0.00,$0.00
5820-010-120,SUP,Custom 27203010,,5820-010-120  -  BURR SURG ROUND FLUTE 2MM 5 NOTCH SOFT TOUCH SMOOTH CUT GOOD,$288.75,$0.00,$288.75,$0.00,$206.08,$0.00,$0.00,$0.00,$0.00,$0.00,$288.75,$0.00,$144.38,$228.69,$231.00,$0.00,$0.00,$0.00,$0.00,$0.00
5820-010-130,SUP,Custom 27203010,,5820-010-130  -  BURR SURG ROUND FLUTE 3MM 5 NOTCH SOFT TOUCH SMOOTH CUT GOOD,$310.50,$0.00,$310.50,$0.00,$221.60,$0.00,$0.00,$0.00,$0.00,$0.00,$310.50,$0.00,$155.25,$245.92,$248.40,$0.00,$0.00,$0.00,$0.00,$0.00
5820-010-140,SUP,Custom 27203010,,5820-010-140  -  BURR SURG ROUND 4MM ROUND SOFT TOUCH LATEX FREE ELITE,$310.50,$0.00,$310.50,$0.00,$221.60,$0.00,$0.00,$0.00,$0.00,$0.00,$310.50,$0.00,$155.25,$245.92,$248.40,$0.00,$0.00,$0.00,$0.00,$0.00
5820-012-030,SUP,Custom 27203010,,5820-012-030  -  BURR SURG ROUND DIAMOND 3MM 5 STEP NOTCH NUMBERED SAFETY,$264.43,$0.00,$264.43,$0.00,$188.72,$0.00,$0.00,$0.00,$0.00,$0.00,$264.43,$0.00,$132.21,$209.43,$211.54,$0.00,$0.00,$0.00,$0.00,$0.00
5820-012-040,SUP,Custom 27203010,,5820-012-040  -  BURR SURG ROUND DIAMOND 4MM 5 NOTCH SMOOTH CUT GOOD CONTROL,$303.78,$0.00,$303.78,$0.00,$216.80,$0.00,$0.00,$0.00,$0.00,$0.00,$303.78,$0.00,$151.89,$240.59,$243.02,$0.00,$0.00,$0.00,$0.00,$0.00
5820-015-050,SUP,Custom 27203010,,5820-015-050  -  BURR 5.0MM EGG BURR,$310.50,$0.00,$310.50,$0.00,$221.60,$0.00,$0.00,$0.00,$0.00,$0.00,$310.50,$0.00,$155.25,$245.92,$248.40,$0.00,$0.00,$0.00,$0.00,$0.00
5820-015-060,SUP,Custom 27203010,,5820-015-060  -  BURR 6.0MM EGG,$310.50,$0.00,$310.50,$0.00,$221.60,$0.00,$0.00,$0.00,$0.00,$0.00,$310.50,$0.00,$155.25,$245.92,$248.40,$0.00,$0.00,$0.00,$0.00,$0.00
5820107430S1,SUP,Custom 27203010,,5820107430S1  -  BIT DRILL 3MM 3.8MM LESS AGGRESSIVE NEURO STERILE,$300.30,$0.00,$300.30,$0.00,$214.32,$0.00,$0.00,$0.00,$0.00,$0.00,$300.30,$0.00,$150.15,$237.84,$240.24,$0.00,$0.00,$0.00,$0.00,$0.00
5820107530S3,SUP,Custom 27203010,,5820107530S3  -  BIT DRILL 1.7MM NEURO,$288.75,$0.00,$288.75,$0.00,$206.08,$0.00,$0.00,$0.00,$0.00,$0.00,$288.75,$0.00,$144.38,$228.69,$231.00,$0.00,$0.00,$0.00,$0.00,$0.00
58-23006,SUP,HCPCS C1713,,58-23006  -  SCREW BONE 2.3MM 6MM HAND NLCKG SLFTAP CROSSPIN,$110.00,$0.00,$110.00,$49.50,$78.51,$0.00,$18.95,$0.00,$0.00,$19.26,$110.00,$0.00,$55.00,$87.12,$88.00,$0.00,$17.22,$0.00,$17.51,$0.00
58-23008,SUP,HCPCS C1713,,58-23008  -  SCREW BONE 2.3MM 8MM HAND NLCKG SLFTAP CROSSPIN STRL,$110.00,$0.00,$110.00,$49.50,$78.51,$0.00,$18.95,$0.00,$0.00,$19.26,$110.00,$0.00,$55.00,$87.12,$88.00,$0.00,$17.22,$0.00,$17.51,$0.00
58-23009,SUP,HCPCS C1713,,58-23009  -  SCREW BONE 2.3MM 9MM HAND,$110.00,$0.00,$110.00,$49.50,$78.51,$0.00,$18.95,$0.00,$0.00,$19.26,$110.00,$0.00,$55.00,$87.12,$88.00,$0.00,$17.22,$0.00,$17.51,$0.00
58-23009E,SUP,HCPCS C1713,,58-23009E  -  SCREW BONE 2.3MM 9MM HAND NLCKG SLFTAP CROSSPIN STRL,$110.00,$0.00,$110.00,$49.50,$78.51,$0.00,$18.95,$0.00,$0.00,$19.26,$110.00,$0.00,$55.00,$87.12,$88.00,$0.00,$17.22,$0.00,$17.51,$0.00
58-23010,SUP,HCPCS C1713,,58-23010  -  SCREW BONE 2.3MM 10MM HAND NLCKG SLFTAP CROSSPIN STRL,$110.00,$0.00,$110.00,$49.50,$78.51,$0.00,$18.95,$0.00,$0.00,$19.26,$110.00,$0.00,$55.00,$87.12,$88.00,$0.00,$17.22,$0.00,$17.51,$0.00
58-23011,SUP,HCPCS C1713,,58-23011  -  SCREW BONE 2.3MM 11MM HAND,$110.00,$0.00,$110.00,$49.50,$78.51,$0.00,$18.95,$0.00,$0.00,$19.26,$110.00,$0.00,$55.00,$87.12,$88.00,$0.00,$17.22,$0.00,$17.51,$0.00
58-23011E,SUP,HCPCS C1713,,58-23011E  -  SCREW BONE 2.3MM 11MM HAND NLCKG SLFTAP CROSSPIN STRL,$110.00,$0.00,$110.00,$49.50,$78.51,$0.00,$18.95,$0.00,$0.00,$19.26,$110.00,$0.00,$55.00,$87.12,$88.00,$0.00,$17.22,$0.00,$17.51,$0.00
58-23012,SUP,HCPCS C1713,,58-23012  -  SCREW BONE 2.3MM 12MM HAND NLCKG SLFTAP CROSSPIN STRL,$110.00,$0.00,$110.00,$49.50,$78.51,$0.00,$18.95,$0.00,$0.00,$19.26,$110.00,$0.00,$55.00,$87.12,$88.00,$0.00,$17.22,$0.00,$17.51,$0.00
58-23012E,SUP,HCPCS C1713,,58-23012E  -  SCREW BN 2.3MM 12MM STRL VARIAX PRFL ST LOPRFL RND XPN HD TI,$110.00,$0.00,$110.00,$49.50,$78.51,$0.00,$18.95,$0.00,$0.00,$19.26,$110.00,$0.00,$55.00,$87.12,$88.00,$0.00,$17.22,$0.00,$17.51,$0.00
58-23013E,SUP,HCPCS C1713,,58-23013E  -  SCREW BONE 2.3MM 13MM NLCKG SLFTAP CROSSPIN STRL,$110.00,$0.00,$110.00,$49.50,$78.51,$0.00,$18.95,$0.00,$0.00,$19.26,$110.00,$0.00,$55.00,$87.12,$88.00,$0.00,$17.22,$0.00,$17.51,$0.00
58-23014,SUP,HCPCS C1713,,58-23014  -  SCREW BONE 2.3MM 14MM NLCKG XPIN,$110.00,$0.00,$110.00,$49.50,$78.51,$0.00,$18.95,$0.00,$0.00,$19.26,$110.00,$0.00,$55.00,$87.12,$88.00,$0.00,$17.22,$0.00,$17.51,$0.00
58-23014E,SUP,HCPCS C1713,,58-23014E  -  SCREW BN 2.3MM 14MM STRL VARIAX PRFL ST LOPRFL RND XPN HD TI,$110.00,$0.00,$110.00,$49.50,$78.51,$0.00,$18.95,$0.00,$0.00,$19.26,$110.00,$0.00,$55.00,$87.12,$88.00,$0.00,$17.22,$0.00,$17.51,$0.00
58-23015,SUP,HCPCS C1713,,58-23015  -  SCREW BONE 2.3MM 15MM NLCKG SLFTAP CROSSPIN STRL,$110.00,$0.00,$110.00,$49.50,$78.51,$0.00,$18.95,$0.00,$0.00,$19.26,$110.00,$0.00,$55.00,$87.12,$88.00,$0.00,$17.22,$0.00,$17.51,$0.00
58-23015E,SUP,HCPCS C1713,,58-23015E  -  SCREW BONE 2.3MM 15MM NLCKG SLFTAP CROSSPIN STRL,$110.00,$0.00,$110.00,$49.50,$78.51,$0.00,$18.95,$0.00,$0.00,$19.26,$110.00,$0.00,$55.00,$87.12,$88.00,$0.00,$17.22,$0.00,$17.51,$0.00
58-23016,SUP,HCPCS C1713,,58-23016  -  SCREW BONE 2.3MM 16MM NLCKG XPIN,$110.00,$0.00,$110.00,$49.50,$78.51,$0.00,$18.95,$0.00,$0.00,$19.26,$110.00,$0.00,$55.00,$87.12,$88.00,$0.00,$17.22,$0.00,$17.51,$0.00
58-23016E,SUP,HCPCS C1713,,58-23016E  -  SCREW BONE 2.3MM 16MM NLCKG SLFTAP CROSSPIN STRL,$110.00,$0.00,$110.00,$49.50,$78.51,$0.00,$18.95,$0.00,$0.00,$19.26,$110.00,$0.00,$55.00,$87.12,$88.00,$0.00,$17.22,$0.00,$17.51,$0.00
58-23018,SUP,HCPCS C1713,,58-23018  -  SCREW BONE 2.3MM 18MM HAND NLCKG SLFTAP CROSSPIN,$110.00,$0.00,$110.00,$49.50,$78.51,$0.00,$18.95,$0.00,$0.00,$19.26,$110.00,$0.00,$55.00,$87.12,$88.00,$0.00,$17.22,$0.00,$17.51,$0.00
58-23018E,SUP,HCPCS C1713,,58-23018E  -  SCREW BONE 2.3MM 18MM NLCKG SLFTAP CROSSPIN,$110.00,$0.00,$110.00,$49.50,$78.51,$0.00,$18.95,$0.00,$0.00,$19.26,$110.00,$0.00,$55.00,$87.12,$88.00,$0.00,$17.22,$0.00,$17.51,$0.00
58-23020,SUP,HCPCS C1713,,58-23020  -  SCREW BONE 2.3MM 20MM HAND,$110.00,$0.00,$110.00,$49.50,$78.51,$0.00,$18.95,$0.00,$0.00,$19.26,$110.00,$0.00,$55.00,$87.12,$88.00,$0.00,$17.22,$0.00,$17.51,$0.00
58-23020E,SUP,HCPCS C1713,,58-23020E  -  SCREW BONE 2.3MM 20MM WR HND NLCKG STR CROSSPIN STRL,$110.00,$0.00,$110.00,$49.50,$78.51,$0.00,$18.95,$0.00,$0.00,$19.26,$110.00,$0.00,$55.00,$87.12,$88.00,$0.00,$17.22,$0.00,$17.51,$0.00
58-23022,SUP,HCPCS C1713,,58-23022  -  SCREW BONE 2.3MM 22MM ORTH,$110.00,$0.00,$110.00,$49.50,$78.51,$0.00,$18.95,$0.00,$0.00,$19.26,$110.00,$0.00,$55.00,$87.12,$88.00,$0.00,$17.22,$0.00,$17.51,$0.00
58-23022E,SUP,HCPCS C1713,,58-23022E  -  SCREW BONE 2.3MM 22MM HAND WRST SLFTAP STRL,$110.00,$0.00,$110.00,$49.50,$78.51,$0.00,$18.95,$0.00,$0.00,$19.26,$110.00,$0.00,$55.00,$87.12,$88.00,$0.00,$17.22,$0.00,$17.51,$0.00
58-23024,SUP,HCPCS C1713,,58-23024  -  SCREW BONE 2.3MM 24MM,$110.00,$0.00,$110.00,$49.50,$78.51,$0.00,$18.95,$0.00,$0.00,$19.26,$110.00,$0.00,$55.00,$87.12,$88.00,$0.00,$17.22,$0.00,$17.51,$0.00
58-23024E,SUP,HCPCS C1713,,58-23024E  -  SCREW BONE 2.3MM 24MM HAND WRST SLFTAP STRL,$110.00,$0.00,$110.00,$49.50,$78.51,$0.00,$18.95,$0.00,$0.00,$19.26,$110.00,$0.00,$55.00,$87.12,$88.00,$0.00,$17.22,$0.00,$17.51,$0.00
58-23026,SUP,HCPCS C1713,,58-23026  -  SCREW BONE 2.3MM 26MM,$110.00,$0.00,$110.00,$49.50,$78.51,$0.00,$18.95,$0.00,$0.00,$19.26,$110.00,$0.00,$55.00,$87.12,$88.00,$0.00,$17.22,$0.00,$17.51,$0.00
58-23026E,SUP,HCPCS C1713,,58-23026E  -  SCREW BONE 2.3MM 26MM WR HND NLCKG STR CROSSPIN STRL,$110.00,$0.00,$110.00,$49.50,$78.51,$0.00,$18.95,$0.00,$0.00,$19.26,$110.00,$0.00,$55.00,$87.12,$88.00,$0.00,$17.22,$0.00,$17.51,$0.00
58-25006,SUP,HCPCS C1713,,58-25006  -  SCREW BONE 2.5MM 6MM ER,$110.00,$0.00,$110.00,$49.50,$78.51,$0.00,$18.95,$0.00,$0.00,$19.26,$110.00,$0.00,$55.00,$87.12,$88.00,$0.00,$17.22,$0.00,$17.51,$0.00
58-25006E,SUP,HCPCS C1713,,58-25006E  -  SCREW BONE 2.5MM 6MM CANC WR HND ER NLCKG STR CROSSPIN STRL,$116.88,$0.00,$116.88,$52.59,$83.41,$0.00,$20.14,$0.00,$0.00,$20.46,$116.88,$0.00,$58.44,$92.57,$93.50,$0.00,$18.29,$0.00,$18.61,$0.00
58-25008,SUP,HCPCS C1713,,58-25008  -  SCREW BONE 2.5MM 8MM ER,$110.00,$0.00,$110.00,$49.50,$78.51,$0.00,$18.95,$0.00,$0.00,$19.26,$110.00,$0.00,$55.00,$87.12,$88.00,$0.00,$17.22,$0.00,$17.51,$0.00
58-25008E,SUP,HCPCS C1713,,58-25008E  -  SCREW BONE 2.5MM 8MM CANC WR HND ER NLCKG STR CROSSPIN STRL,$116.88,$0.00,$116.88,$52.59,$83.41,$0.00,$20.14,$0.00,$0.00,$20.46,$116.88,$0.00,$58.44,$92.57,$93.50,$0.00,$18.29,$0.00,$18.61,$0.00
58-25010,SUP,HCPCS C1713,,58-25010  -  SCREW BONE 2.5MM 10MM ER,$110.00,$0.00,$110.00,$49.50,$78.51,$0.00,$18.95,$0.00,$0.00,$19.26,$110.00,$0.00,$55.00,$87.12,$88.00,$0.00,$17.22,$0.00,$17.51,$0.00
58-25010E,SUP,HCPCS C1713,,58-25010E  -  SCREW BONE 2.5MM 10MM NLCKG SLFTAP CROSSPIN STRL,$116.88,$0.00,$116.88,$52.59,$83.41,$0.00,$20.14,$0.00,$0.00,$20.46,$116.88,$0.00,$58.44,$92.57,$93.50,$0.00,$18.29,$0.00,$18.61,$0.00
58-25012,SUP,HCPCS C1713,,58-25012  -  SCREW BONE 2.5MM 12MM ER,$110.00,$0.00,$110.00,$49.50,$78.51,$0.00,$18.95,$0.00,$0.00,$19.26,$110.00,$0.00,$55.00,$87.12,$88.00,$0.00,$17.22,$0.00,$17.51,$0.00
58-25012E,SUP,HCPCS C1713,,58-25012E  -  SCREW BONE 2.5MM 12MM CANC WR HND ER NLCKG STR CROSSPIN STRL,$116.88,$0.00,$116.88,$52.59,$83.41,$0.00,$20.14,$0.00,$0.00,$20.46,$116.88,$0.00,$58.44,$92.57,$93.50,$0.00,$18.29,$0.00,$18.61,$0.00
5858-0-000,SUP,Custom 27203010,,5858-0-000  -  GAUGE DEPTH SCR,"$1,024.38",$0.00,"$1,024.38",$0.00,$731.10,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,024.38",$0.00,$512.19,$811.31,$819.50,$0.00,$0.00,$0.00,$0.00,$0.00
5866-45,SUP,Custom 27203010,,5866-45  -  SLEEVE LEAD ACCES,$62.50,$0.00,$62.50,$0.00,$44.61,$0.00,$0.00,$0.00,$0.00,$0.00,$62.50,$0.00,$31.25,$49.50,$50.00,$0.00,$0.00,$0.00,$0.00,$0.00
5867-3M,SUP,Custom 27203010,,5867-3M  -  CAP LEAD 4.6-8.4FR 5MM 3.2MM IMPLTABLE PIN LOW PROFILE IS-1,$62.50,$0.00,$62.50,$0.00,$44.61,$0.00,$0.00,$0.00,$0.00,$0.00,$62.50,$0.00,$31.25,$49.50,$50.00,$0.00,$0.00,$0.00,$0.00,$0.00
59-12004,SUP,HCPCS C1713,,59-12004  -  SCREW BONE 1.2MM 4MM PRFL TI HAND MDLR SM FRAG SYS,$112.75,$0.00,$112.75,$50.74,$80.47,$0.00,$19.43,$0.00,$0.00,$19.74,$112.75,$0.00,$56.38,$89.30,$90.20,$0.00,$17.65,$0.00,$17.95,$0.00
59-12005,SUP,HCPCS C1713,,59-12005  -  SCREW BONE 1.2MM 5MM PRFL TI HAND SLFTAP XFIT MDLR SM FRAG,$112.75,$0.00,$112.75,$50.74,$80.47,$0.00,$19.43,$0.00,$0.00,$19.74,$112.75,$0.00,$56.38,$89.30,$90.20,$0.00,$17.65,$0.00,$17.95,$0.00
59-12006,SUP,HCPCS C1713,,59-12006  -  SCREW BONE 1.2MM 6MM PRFL TI HAND SLFTAP XFIT MDLR SM FRAG,$112.75,$0.00,$112.75,$50.74,$80.47,$0.00,$19.43,$0.00,$0.00,$19.74,$112.75,$0.00,$56.38,$89.30,$90.20,$0.00,$17.65,$0.00,$17.95,$0.00
59-12007,SUP,HCPCS C1713,,59-12007  -  SCREW BONE 1.2MM 7MM PRFL TI HAND MDLR SM FRAG SYS,$112.75,$0.00,$112.75,$50.74,$80.47,$0.00,$19.43,$0.00,$0.00,$19.74,$112.75,$0.00,$56.38,$89.30,$90.20,$0.00,$17.65,$0.00,$17.95,$0.00
59-12008,SUP,HCPCS C1713,,59-12008  -  SCREW BONE 1.2MM 8MM PRFL TI HAND SLFTAP XFIT MDLR SM FRAG,$112.75,$0.00,$112.75,$50.74,$80.47,$0.00,$19.43,$0.00,$0.00,$19.74,$112.75,$0.00,$56.38,$89.30,$90.20,$0.00,$17.65,$0.00,$17.95,$0.00
59-12009,SUP,HCPCS C1713,,59-12009  -  SCREW BONE 1.2MM 9MM PRFL TI HAND SLFTAP XFIT,$112.75,$0.00,$112.75,$50.74,$80.47,$0.00,$19.43,$0.00,$0.00,$19.74,$112.75,$0.00,$56.38,$89.30,$90.20,$0.00,$17.65,$0.00,$17.95,$0.00
59-12010,SUP,HCPCS C1713,,59-12010  -  SCREW BONE 1.2MM 10MM PRFL TI HAND SLFTAP XFIT,$112.75,$0.00,$112.75,$50.74,$80.47,$0.00,$19.43,$0.00,$0.00,$19.74,$112.75,$0.00,$56.38,$89.30,$90.20,$0.00,$17.65,$0.00,$17.95,$0.00
59-12011,SUP,HCPCS C1713,,59-12011  -  SCREW BONE 1.2MM 11MM PRFL TI HAND SLFTAP XFIT,$112.75,$0.00,$112.75,$50.74,$80.47,$0.00,$19.43,$0.00,$0.00,$19.74,$112.75,$0.00,$56.38,$89.30,$90.20,$0.00,$17.65,$0.00,$17.95,$0.00
59-12012,SUP,HCPCS C1713,,59-12012  -  SCREW BONE 1.2MM 12MM PRFL TI HAND SLFTAP XFIT,$112.75,$0.00,$112.75,$50.74,$80.47,$0.00,$19.43,$0.00,$0.00,$19.74,$112.75,$0.00,$56.38,$89.30,$90.20,$0.00,$17.65,$0.00,$17.95,$0.00
59-12013,SUP,HCPCS C1713,,59-12013  -  SCREW BONE 1.2MM 13MM PRFL TI HAND SLFTAP XFIT,$112.75,$0.00,$112.75,$50.74,$80.47,$0.00,$19.43,$0.00,$0.00,$19.74,$112.75,$0.00,$56.38,$89.30,$90.20,$0.00,$17.65,$0.00,$17.95,$0.00
59-12014,SUP,HCPCS C1713,,59-12014  -  SCREW BONE 1.2MM 14MM PRFL TI HAND SLFTAP XFIT MDLR SM FRAG,$112.75,$0.00,$112.75,$50.74,$80.47,$0.00,$19.43,$0.00,$0.00,$19.74,$112.75,$0.00,$56.38,$89.30,$90.20,$0.00,$17.65,$0.00,$17.95,$0.00
59-12016,SUP,HCPCS C1713,,59-12016  -  SCREW BONE 1.2MM 16MM PRFL TI HAND WRST SLFTAP XFIT SM FRAG,$112.75,$0.00,$112.75,$50.74,$80.47,$0.00,$19.43,$0.00,$0.00,$19.74,$112.75,$0.00,$56.38,$89.30,$90.20,$0.00,$17.65,$0.00,$17.95,$0.00
59-12018,SUP,HCPCS C1713,,59-12018  -  PLATE 18MM TI SLFTAP XFIT PRFL BONE 1.2MM HAND,$112.75,$0.00,$112.75,$50.74,$80.47,$0.00,$19.43,$0.00,$0.00,$19.74,$112.75,$0.00,$56.38,$89.30,$90.20,$0.00,$17.65,$0.00,$17.95,$0.00
59-12020,SUP,HCPCS C1713,,59-12020  -  PLATE 20MM TI SLFTAP XFIT PRFL BONE 1.2MM HAND,$112.75,$0.00,$112.75,$50.74,$80.47,$0.00,$19.43,$0.00,$0.00,$19.74,$112.75,$0.00,$56.38,$89.30,$90.20,$0.00,$17.65,$0.00,$17.95,$0.00
59-12049,SUP,HCPCS C1713,,59-12049  -  WASHER 1.2MM WRST PRFL ORTH,$48.13,$0.00,$48.13,$21.66,$34.35,$0.00,$8.29,$0.00,$0.00,$8.43,$48.13,$0.00,$24.06,$38.12,$38.50,$0.00,$7.53,$0.00,$7.66,$0.00
59-12049E,SUP,HCPCS C1713,,59-12049E  -  WASHER FOR 1.2 MM BONE SCREWS,$41.25,$0.00,$41.25,$18.56,$29.44,$0.00,$7.11,$0.00,$0.00,$7.22,$41.25,$0.00,$20.63,$32.67,$33.00,$0.00,$6.46,$0.00,$6.57,$0.00
59-14003,SUP,HCPCS C1713,,59-14003  -  SCREW BONE 1.4MM 3MM PRFL TI HAND SLFTAP XFIT ER SM FRAG SYS,$121.00,$0.00,$121.00,$54.45,$86.36,$0.00,$20.85,$0.00,$0.00,$21.19,$121.00,$0.00,$60.50,$95.83,$96.80,$0.00,$18.94,$0.00,$19.26,$0.00
59-14005,SUP,HCPCS C1713,,59-14005  -  SCREW BONE 1.4MM 5MM PRFL TI HAND SLFTAP XFIT ER SM FRAG SYS,$121.00,$0.00,$121.00,$54.45,$86.36,$0.00,$20.85,$0.00,$0.00,$21.19,$121.00,$0.00,$60.50,$95.83,$96.80,$0.00,$18.94,$0.00,$19.26,$0.00
59-14007,SUP,HCPCS C1713,,59-14007  -  SCREW BONE 1.4MM 7MM PRFL TI HAND SLFTAP XFIT ER SM FRAG SYS,$121.00,$0.00,$121.00,$54.45,$86.36,$0.00,$20.85,$0.00,$0.00,$21.19,$121.00,$0.00,$60.50,$95.83,$96.80,$0.00,$18.94,$0.00,$19.26,$0.00
59-14009,SUP,HCPCS C1713,,59-14009  -  SCREW BONE 1.4MM 9MM PRFL TI HAND SLFTAP XFIT ER SM FRAG SYS,$121.00,$0.00,$121.00,$54.45,$86.36,$0.00,$20.85,$0.00,$0.00,$21.19,$121.00,$0.00,$60.50,$95.83,$96.80,$0.00,$18.94,$0.00,$19.26,$0.00
59-17005,SUP,HCPCS C1713,,59-17005  -  SCREW BONE 1.7MM 5MM PRFL TI HAND SLFTAP XFIT,$112.75,$0.00,$112.75,$50.74,$80.47,$0.00,$19.43,$0.00,$0.00,$19.74,$112.75,$0.00,$56.38,$89.30,$90.20,$0.00,$17.65,$0.00,$17.95,$0.00
59-17006,SUP,HCPCS C1713,,59-17006  -  SCREW BONE 1.7MM 6MM PRFL TI HAND SLFTAP XFIT,$112.75,$0.00,$112.75,$50.74,$80.47,$0.00,$19.43,$0.00,$0.00,$19.74,$112.75,$0.00,$56.38,$89.30,$90.20,$0.00,$17.65,$0.00,$17.95,$0.00
59-17007,SUP,HCPCS C1713,,59-17007  -  SCREW BONE 1.7MM 7MM PRFL TI HAND SLFTAP XFIT MDLR SM FRAG,$112.75,$0.00,$112.75,$50.74,$80.47,$0.00,$19.43,$0.00,$0.00,$19.74,$112.75,$0.00,$56.38,$89.30,$90.20,$0.00,$17.65,$0.00,$17.95,$0.00
59-17008,SUP,HCPCS C1713,,59-17008  -  SCREW BONE 1.7MM 8MM PRFL TI HAND SLFTAP XFIT MDLR SM FRAG,$112.75,$0.00,$112.75,$50.74,$80.47,$0.00,$19.43,$0.00,$0.00,$19.74,$112.75,$0.00,$56.38,$89.30,$90.20,$0.00,$17.65,$0.00,$17.95,$0.00
59-17009,SUP,HCPCS C1713,,59-17009  -  SCREW BONE 1.7MM 9MM PRFL TI HAND SLFTAP XFIT MDLR SM FRAG,$112.75,$0.00,$112.75,$50.74,$80.47,$0.00,$19.43,$0.00,$0.00,$19.74,$112.75,$0.00,$56.38,$89.30,$90.20,$0.00,$17.65,$0.00,$17.95,$0.00
59-17010,SUP,HCPCS C1713,,59-17010  -  SCREW BONE 1.7MM 10MM PRFL TI HAND SLFTAP XFIT MDLR SM FRAG,$112.75,$0.00,$112.75,$50.74,$80.47,$0.00,$19.43,$0.00,$0.00,$19.74,$112.75,$0.00,$56.38,$89.30,$90.20,$0.00,$17.65,$0.00,$17.95,$0.00
59-17011,SUP,HCPCS C1713,,59-17011  -  SCREW BONE 1.7MM 11MM PRFL TI HAND SLFTAP XFIT MDLR SM FRAG,$112.75,$0.00,$112.75,$50.74,$80.47,$0.00,$19.43,$0.00,$0.00,$19.74,$112.75,$0.00,$56.38,$89.30,$90.20,$0.00,$17.65,$0.00,$17.95,$0.00
59-17012,SUP,HCPCS C1713,,59-17012  -  SCREW BONE 1.7MM 12MM PRFL TI HAND SLFTAP XFIT MDLR SM FRAG,$112.75,$0.00,$112.75,$50.74,$80.47,$0.00,$19.43,$0.00,$0.00,$19.74,$112.75,$0.00,$56.38,$89.30,$90.20,$0.00,$17.65,$0.00,$17.95,$0.00
59-17013,SUP,HCPCS C1713,,59-17013  -  SCREW BONE 1.7MM 13MM PRFL TI HAND MDLR,$112.75,$0.00,$112.75,$50.74,$80.47,$0.00,$19.43,$0.00,$0.00,$19.74,$112.75,$0.00,$56.38,$89.30,$90.20,$0.00,$17.65,$0.00,$17.95,$0.00
59-17014,SUP,HCPCS C1713,,59-17014  -  SCREW BONE 1.7MM 14MM PRFL TI HAND SLFTAP XFIT MDLR SM FRAG,$112.75,$0.00,$112.75,$50.74,$80.47,$0.00,$19.43,$0.00,$0.00,$19.74,$112.75,$0.00,$56.38,$89.30,$90.20,$0.00,$17.65,$0.00,$17.95,$0.00
59-17015,SUP,HCPCS C1713,,59-17015  -  SCREW BONE 1.7MM 15MM PRFL TI HAND SLFTAP XFIT MDLR SM FRAG,$96.25,$0.00,$96.25,$43.31,$68.69,$0.00,$16.58,$0.00,$0.00,$16.85,$96.25,$0.00,$48.13,$76.23,$77.00,$0.00,$15.06,$0.00,$15.32,$0.00
59-17016,SUP,HCPCS C1713,,59-17016  -  SCREW BONE 1.7MM 16MM PRFL TI HAND MDLR SM FRAG SYS,$112.75,$0.00,$112.75,$50.74,$80.47,$0.00,$19.43,$0.00,$0.00,$19.74,$112.75,$0.00,$56.38,$89.30,$90.20,$0.00,$17.65,$0.00,$17.95,$0.00
59-17017,SUP,HCPCS C1713,,59-17017  -  SCREW BONE 1.7MM 17MM PRFL TI HAND SLFTAP XFIT,$112.75,$0.00,$112.75,$50.74,$80.47,$0.00,$19.43,$0.00,$0.00,$19.74,$112.75,$0.00,$56.38,$89.30,$90.20,$0.00,$17.65,$0.00,$17.95,$0.00
59-17018,SUP,HCPCS C1713,,59-17018  -  SCREW BONE 1.7MM 18MM PRFL TI HAND SLFTAP XFIT MDLR SM FRAG,$112.75,$0.00,$112.75,$50.74,$80.47,$0.00,$19.43,$0.00,$0.00,$19.74,$112.75,$0.00,$56.38,$89.30,$90.20,$0.00,$17.65,$0.00,$17.95,$0.00
59-17019,SUP,HCPCS C1713,,59-17019  -  SCREW BONE 1.7MM 19MM PRFL TI HAND SLFTAP XFIT MDLR SM FRAG,$112.75,$0.00,$112.75,$50.74,$80.47,$0.00,$19.43,$0.00,$0.00,$19.74,$112.75,$0.00,$56.38,$89.30,$90.20,$0.00,$17.65,$0.00,$17.95,$0.00
59-17020,SUP,HCPCS C1713,,59-17020  -  SCREW BONE 1.7MM 20MM PRFL TI HAND SLFTAP XFIT,$112.75,$0.00,$112.75,$50.74,$80.47,$0.00,$19.43,$0.00,$0.00,$19.74,$112.75,$0.00,$56.38,$89.30,$90.20,$0.00,$17.65,$0.00,$17.95,$0.00
59-17021,SUP,HCPCS C1713,,59-17021  -  SCREW BONE 1.7MM 21MM PRFL TI HAND SLFTAP XFIT MDLR SM FRAG,$112.75,$0.00,$112.75,$50.74,$80.47,$0.00,$19.43,$0.00,$0.00,$19.74,$112.75,$0.00,$56.38,$89.30,$90.20,$0.00,$17.65,$0.00,$17.95,$0.00
59-17022,SUP,HCPCS C1713,,59-17022  -  SCREW BONE 1.7MM 22MM PRFL TI HAND WRST SLFTAP XFIT MDLR SM,$112.75,$0.00,$112.75,$50.74,$80.47,$0.00,$19.43,$0.00,$0.00,$19.74,$112.75,$0.00,$56.38,$89.30,$90.20,$0.00,$17.65,$0.00,$17.95,$0.00
59-17023,SUP,HCPCS C1713,,59-17023  -  SCREW BONE 1.7MM 23MM PRFL TI HAND WRST SLFTAP XFIT MDLR SM,$112.75,$0.00,$112.75,$50.74,$80.47,$0.00,$19.43,$0.00,$0.00,$19.74,$112.75,$0.00,$56.38,$89.30,$90.20,$0.00,$17.65,$0.00,$17.95,$0.00
59-17024,SUP,HCPCS C1713,,59-17024  -  SCREW BONE 1.7MM 24MM PRFL TI HAND SLFTAP XFIT MDLR SM FRAG,$112.75,$0.00,$112.75,$50.74,$80.47,$0.00,$19.43,$0.00,$0.00,$19.74,$112.75,$0.00,$56.38,$89.30,$90.20,$0.00,$17.65,$0.00,$17.95,$0.00
59-17049,SUP,HCPCS C1713,,59-17049  -  WASHER 1.7MM PRFL ORTH TI,$48.13,$0.00,$48.13,$21.66,$34.35,$0.00,$8.29,$0.00,$0.00,$8.43,$48.13,$0.00,$24.06,$38.12,$38.50,$0.00,$7.53,$0.00,$7.66,$0.00
59-17049E,SUP,HCPCS C1713,,59-17049E  -  WASHER HAND WRST ORTH 1.7 MM SCR STRL,$41.25,$0.00,$41.25,$18.56,$29.44,$0.00,$7.11,$0.00,$0.00,$7.22,$41.25,$0.00,$20.63,$32.67,$33.00,$0.00,$6.46,$0.00,$6.57,$0.00
59-19005,SUP,HCPCS C1713,,59-19005  -  SCREW BONE 1.9MM 5MM PRFL TI HAND XFIT SLFTAP ER SM FRAG SYS,$121.00,$0.00,$121.00,$54.45,$86.36,$0.00,$20.85,$0.00,$0.00,$21.19,$121.00,$0.00,$60.50,$95.83,$96.80,$0.00,$18.94,$0.00,$19.26,$0.00
59-19008,SUP,HCPCS C1713,,59-19008  -  SCREW BONE 1.9MM 8MM PRFL TI HAND XFIT SLFTAP ER SM FRAG SYS,$121.00,$0.00,$121.00,$54.45,$86.36,$0.00,$20.85,$0.00,$0.00,$21.19,$121.00,$0.00,$60.50,$95.83,$96.80,$0.00,$18.94,$0.00,$19.26,$0.00
59-19010,SUP,HCPCS C1713,,59-19010  -  SCREW BONE 1.9MM 10MM PRFL TI HAND WRST SLFTAP XFIT MDLR SM,$121.00,$0.00,$121.00,$54.45,$86.36,$0.00,$20.85,$0.00,$0.00,$21.19,$121.00,$0.00,$60.50,$95.83,$96.80,$0.00,$18.94,$0.00,$19.26,$0.00
59-19012,SUP,HCPCS C1713,,59-19012  -  SCREW BONE 1.9MM 12MM PRFL TI HAND XFIT SLFTAP ER SM FRAG,$121.00,$0.00,$121.00,$54.45,$86.36,$0.00,$20.85,$0.00,$0.00,$21.19,$121.00,$0.00,$60.50,$95.83,$96.80,$0.00,$18.94,$0.00,$19.26,$0.00
59-23006,SUP,HCPCS C1713,,59-23006  -  SCREW BONE 2.3MM 6MM PRFL TI HAND SLFTAP XFIT,$112.75,$0.00,$112.75,$50.74,$80.47,$0.00,$19.43,$0.00,$0.00,$19.74,$112.75,$0.00,$56.38,$89.30,$90.20,$0.00,$17.65,$0.00,$17.95,$0.00
59-23007,SUP,HCPCS C1713,,59-23007  -  SCREW BONE 2.3MM 7MM PRFL TI HAND XFIT SLFTAP MDLR SM FRAG,$112.75,$0.00,$112.75,$50.74,$80.47,$0.00,$19.43,$0.00,$0.00,$19.74,$112.75,$0.00,$56.38,$89.30,$90.20,$0.00,$17.65,$0.00,$17.95,$0.00
59-23008,SUP,HCPCS C1713,,59-23008  -  SCREW BONE 2.3MM 8MM PRFL TI HAND XFIT SLFTAP MDLR SM FRAG,$112.75,$0.00,$112.75,$50.74,$80.47,$0.00,$19.43,$0.00,$0.00,$19.74,$112.75,$0.00,$56.38,$89.30,$90.20,$0.00,$17.65,$0.00,$17.95,$0.00
59-23009,SUP,HCPCS C1713,,59-23009  -  SCREW BONE 2.3MM 9MM PRFL TI HAND XFIT SLFTAP MDLR SM FRAG,$112.75,$0.00,$112.75,$50.74,$80.47,$0.00,$19.43,$0.00,$0.00,$19.74,$112.75,$0.00,$56.38,$89.30,$90.20,$0.00,$17.65,$0.00,$17.95,$0.00
59-23010,SUP,HCPCS C1713,,59-23010  -  SCREW BONE 2.3MM 10MM PRFL TI HAND WRST SLFTAP XFIT MDLR SM,$112.75,$0.00,$112.75,$50.74,$80.47,$0.00,$19.43,$0.00,$0.00,$19.74,$112.75,$0.00,$56.38,$89.30,$90.20,$0.00,$17.65,$0.00,$17.95,$0.00
59-23011,SUP,HCPCS C1713,,59-23011  -  SCREW BONE 2.3MM 11MM PRFL TI HAND SLFTAP XFIT SM FRAG SYS,$112.75,$0.00,$112.75,$50.74,$80.47,$0.00,$19.43,$0.00,$0.00,$19.74,$112.75,$0.00,$56.38,$89.30,$90.20,$0.00,$17.65,$0.00,$17.95,$0.00
59-23012,SUP,HCPCS C1713,,59-23012  -  SCREW BONE 2.3MM 12MM PRFL TI HAND SLFTAP XFIT,$112.75,$0.00,$112.75,$50.74,$80.47,$0.00,$19.43,$0.00,$0.00,$19.74,$112.75,$0.00,$56.38,$89.30,$90.20,$0.00,$17.65,$0.00,$17.95,$0.00
59-23013,SUP,HCPCS C1713,,59-23013  -  SCREW BONE 2.3MM 13MM PRFL TI HAND WRST SLFTAP XFIT MDLR SM,$112.75,$0.00,$112.75,$50.74,$80.47,$0.00,$19.43,$0.00,$0.00,$19.74,$112.75,$0.00,$56.38,$89.30,$90.20,$0.00,$17.65,$0.00,$17.95,$0.00
59-23014,SUP,HCPCS C1713,,59-23014  -  SCREW BONE 2.3MM 14MM PRFL TI HAND SLFTAP XFIT MDLR SM FRAG,$112.75,$0.00,$112.75,$50.74,$80.47,$0.00,$19.43,$0.00,$0.00,$19.74,$112.75,$0.00,$56.38,$89.30,$90.20,$0.00,$17.65,$0.00,$17.95,$0.00
59-23015,SUP,HCPCS C1713,,59-23015  -  SCREW BONE 2.3MM 15MM PRFL TI HAND SLFTAP XFIT MDLR SM FRAG,$112.75,$0.00,$112.75,$50.74,$80.47,$0.00,$19.43,$0.00,$0.00,$19.74,$112.75,$0.00,$56.38,$89.30,$90.20,$0.00,$17.65,$0.00,$17.95,$0.00
59-23016,SUP,HCPCS C1713,,59-23016  -  SCREW BONE 2.3MM 16MM PRFL TI HAND XFIT SLFTAP MDLR SM FRAG,$112.75,$0.00,$112.75,$50.74,$80.47,$0.00,$19.43,$0.00,$0.00,$19.74,$112.75,$0.00,$56.38,$89.30,$90.20,$0.00,$17.65,$0.00,$17.95,$0.00
59-23017,SUP,HCPCS C1713,,59-23017  -  SCREW BONE 2.3MM 17MM PRFL TI HAND SLFTAP XFIT,$112.75,$0.00,$112.75,$50.74,$80.47,$0.00,$19.43,$0.00,$0.00,$19.74,$112.75,$0.00,$56.38,$89.30,$90.20,$0.00,$17.65,$0.00,$17.95,$0.00
59-23018,SUP,HCPCS C1713,,59-23018  -  SCREW BONE 2.3MM 18MM PRFL TI HAND SLFTAP XFIT,$112.75,$0.00,$112.75,$50.74,$80.47,$0.00,$19.43,$0.00,$0.00,$19.74,$112.75,$0.00,$56.38,$89.30,$90.20,$0.00,$17.65,$0.00,$17.95,$0.00
59-23019,SUP,HCPCS C1713,,59-23019  -  SCREW BONE 2.3MM 19MM PRFL TI HAND XFIT SLFTAP MDLR SM FRAG,$112.75,$0.00,$112.75,$50.74,$80.47,$0.00,$19.43,$0.00,$0.00,$19.74,$112.75,$0.00,$56.38,$89.30,$90.20,$0.00,$17.65,$0.00,$17.95,$0.00
59-23020,SUP,HCPCS C1713,,59-23020  -  SCREW BONE 2.3MM 20MM PRFL TI HAND WRST SLFTAP XFIT MDLR SM,$112.75,$0.00,$112.75,$50.74,$80.47,$0.00,$19.43,$0.00,$0.00,$19.74,$112.75,$0.00,$56.38,$89.30,$90.20,$0.00,$17.65,$0.00,$17.95,$0.00
59-23021,SUP,HCPCS C1713,,59-23021  -  SCREW BONE 2.3MM 21MM PRFL TI HAND XFIT SLFTAP MDLR SM FRAG,$112.75,$0.00,$112.75,$50.74,$80.47,$0.00,$19.43,$0.00,$0.00,$19.74,$112.75,$0.00,$56.38,$89.30,$90.20,$0.00,$17.65,$0.00,$17.95,$0.00
59-23022,SUP,HCPCS C1713,,59-23022  -  SCREW BONE 2.3MM 22MM PRFL TI HAND XFIT SLFTAP MDLR SM FRAG,$112.75,$0.00,$112.75,$50.74,$80.47,$0.00,$19.43,$0.00,$0.00,$19.74,$112.75,$0.00,$56.38,$89.30,$90.20,$0.00,$17.65,$0.00,$17.95,$0.00
59-23023,SUP,HCPCS C1713,,59-23023  -  SCREW BONE 2.3MM 23MM PRFL TI HAND XFIT SLFTAP MDLR SM FRAG,$112.75,$0.00,$112.75,$50.74,$80.47,$0.00,$19.43,$0.00,$0.00,$19.74,$112.75,$0.00,$56.38,$89.30,$90.20,$0.00,$17.65,$0.00,$17.95,$0.00
59-23024,SUP,HCPCS C1713,,59-23024  -  SCREW BONE 2.3MM 24MM PRFL TI HAND SLFTAP XFIT,$112.75,$0.00,$112.75,$50.74,$80.47,$0.00,$19.43,$0.00,$0.00,$19.74,$112.75,$0.00,$56.38,$89.30,$90.20,$0.00,$17.65,$0.00,$17.95,$0.00
59-23026,SUP,HCPCS C1713,,59-23026  -  SCREW BONE 2.3MM 26MM PRFL TI HAND XFIT SLFTAP MDLR SM FRAG,$112.75,$0.00,$112.75,$50.74,$80.47,$0.00,$19.43,$0.00,$0.00,$19.74,$112.75,$0.00,$56.38,$89.30,$90.20,$0.00,$17.65,$0.00,$17.95,$0.00
59-23028,SUP,HCPCS C1713,,59-23028  -  SCREW BONE 2.3MM 28MM PRFL TI HAND XFIT SLFTAP MDLR SM FRAG,$112.75,$0.00,$112.75,$50.74,$80.47,$0.00,$19.43,$0.00,$0.00,$19.74,$112.75,$0.00,$56.38,$89.30,$90.20,$0.00,$17.65,$0.00,$17.95,$0.00
59-23030,SUP,HCPCS C1713,,59-23030  -  SCREW BONE 2.3MM 30MM PRFL TI HAND XFIT SLFTAP MDLR SM FRAG,$112.75,$0.00,$112.75,$50.74,$80.47,$0.00,$19.43,$0.00,$0.00,$19.74,$112.75,$0.00,$56.38,$89.30,$90.20,$0.00,$17.65,$0.00,$17.95,$0.00
59-23032,SUP,HCPCS C1713,,59-23032  -  SCREW BONE 2.3MM 32MM PRFL TI HAND WRST SLFTAP XFIT MDLR SM,$112.75,$0.00,$112.75,$50.74,$80.47,$0.00,$19.43,$0.00,$0.00,$19.74,$112.75,$0.00,$56.38,$89.30,$90.20,$0.00,$17.65,$0.00,$17.95,$0.00
59-23034,SUP,HCPCS C1713,,59-23034  -  SCREW BONE 2.3MM 34MM PRFL TI HAND WRST SLFTAP XFIT MDLR SM,$112.75,$0.00,$112.75,$50.74,$80.47,$0.00,$19.43,$0.00,$0.00,$19.74,$112.75,$0.00,$56.38,$89.30,$90.20,$0.00,$17.65,$0.00,$17.95,$0.00
59-23036,SUP,HCPCS C1713,,59-23036  -  SCREW BONE 2.3MM 36MM PRFL TI HAND WRST SLFTAP XFIT MDLR SM,$112.75,$0.00,$112.75,$50.74,$80.47,$0.00,$19.43,$0.00,$0.00,$19.74,$112.75,$0.00,$56.38,$89.30,$90.20,$0.00,$17.65,$0.00,$17.95,$0.00
59-23038,SUP,HCPCS C1713,,59-23038  -  SCREW BONE 2.3MM 38MM PRFL TI HAND WRST SLFTAP XFIT MDLR SM,$112.75,$0.00,$112.75,$50.74,$80.47,$0.00,$19.43,$0.00,$0.00,$19.74,$112.75,$0.00,$56.38,$89.30,$90.20,$0.00,$17.65,$0.00,$17.95,$0.00
59-23049,SUP,HCPCS C1713,,59-23049  -  WASHER 2.3MM PLT PRFL ORTH NONSTRL,$48.13,$0.00,$48.13,$21.66,$34.35,$0.00,$8.29,$0.00,$0.00,$8.43,$48.13,$0.00,$24.06,$38.12,$38.50,$0.00,$7.53,$0.00,$7.66,$0.00
59-23049E,SUP,HCPCS C1713,,59-23049E  -  WASHER BONE ORTH 2.3 MM SCR STRL,$41.25,$0.00,$41.25,$18.56,$29.44,$0.00,$7.11,$0.00,$0.00,$7.22,$41.25,$0.00,$20.63,$32.67,$33.00,$0.00,$6.46,$0.00,$6.57,$0.00
59-25006,SUP,HCPCS C1713,,59-25006  -  SCREW BONE 2.5MM 6MM PRFL TI HAND MDLR XFIT SLFTAP ER SM,$121.00,$0.00,$121.00,$54.45,$86.36,$0.00,$20.85,$0.00,$0.00,$21.19,$121.00,$0.00,$60.50,$95.83,$96.80,$0.00,$18.94,$0.00,$19.26,$0.00
59-25008,SUP,HCPCS C1713,,59-25008  -  SCREW BONE 2.5MM 8MM PRFL TI HAND ER SM FRAG SYS,$121.00,$0.00,$121.00,$54.45,$86.36,$0.00,$20.85,$0.00,$0.00,$21.19,$121.00,$0.00,$60.50,$95.83,$96.80,$0.00,$18.94,$0.00,$19.26,$0.00
59-25010,SUP,HCPCS C1713,,59-25010  -  SCREW BONE 2.5MM 10MM PRFL TI HAND MDLR XFIT SLFTAP ER SM,$121.00,$0.00,$121.00,$54.45,$86.36,$0.00,$20.85,$0.00,$0.00,$21.19,$121.00,$0.00,$60.50,$95.83,$96.80,$0.00,$18.94,$0.00,$19.26,$0.00
59-25012,SUP,HCPCS C1713,,59-25012  -  SCREW BONE 2.5MM 12MM PRFL TI HAND MDLR XFIT SLFTAP ER SM,$121.00,$0.00,$121.00,$54.45,$86.36,$0.00,$20.85,$0.00,$0.00,$21.19,$121.00,$0.00,$60.50,$95.83,$96.80,$0.00,$18.94,$0.00,$19.26,$0.00
595000S,SUP,HCPCS C1713,,595000S  -  SCREW BONE OHS OCS ORTH HIP CMPR,$99.00,$0.00,$99.00,$44.55,$70.66,$0.00,$17.06,$0.00,$0.00,$17.33,$99.00,$0.00,$49.50,$78.41,$79.20,$0.00,$15.49,$0.00,$15.76,$0.00
596001S,SUP,HCPCS C1713,,596001S  -  SCREW BONE 3MM 32.2MM OMEGA 2 SS ORTH HIP CMPR STRL,$130.63,$0.00,$130.63,$58.78,$93.23,$0.00,$22.51,$0.00,$0.00,$22.87,$130.63,$0.00,$65.31,$103.46,$104.50,$0.00,$20.44,$0.00,$20.80,$0.00
597002S,SUP,HCPCS C1713,,597002S  -  PLATE 130D STD BRL 47MM SS 2 HOLE KEY OMEGA 3 BONE HIP STRL,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597003S,SUP,HCPCS C1713,,597003S  -  SCREW BONE 47MM OMEGA 3 130D STD BRL HIP 3 HOLE CMPR KEY,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597004S,SUP,HCPCS C1713,,597004S  -  PLATE 130D STD BRL 79MM SS 4 HOLE KEY OMEGA 3 BONE HIP STRL,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597005S,SUP,HCPCS C1713,,597005S  -  PLATE 130D STD BRL 95MM SS 5 HOLE KEY OMEGA 3 BONE HIP STRL,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597006S,SUP,HCPCS C1713,,597006S  -  PLATE 130D 111MM SS 6 HOLE STD BRL KEY OMEGA 3 BONE HIP,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597008S,SUP,HCPCS C1713,,597008S  -  PLATE 130D STD BRL 143MM SS 8 HOLE KEY OMEGA 3 BONE HIP STRL,$948.75,$0.00,$948.75,$426.94,$677.12,$0.00,$163.46,$0.00,$0.00,$166.12,$948.75,$0.00,$474.38,$751.41,$759.00,$0.00,$148.48,$0.00,$151.04,$0.00
597010S,SUP,HCPCS C1713,,597010S  -  PLATE 130D STD BRL 175MM SS 10 HOLE KEY OMEGA 3 BONE HIP,$948.75,$0.00,$948.75,$426.94,$677.12,$0.00,$163.46,$0.00,$0.00,$166.12,$948.75,$0.00,$474.38,$751.41,$759.00,$0.00,$148.48,$0.00,$151.04,$0.00
597012S,SUP,HCPCS C1713,,597012S  -  PLATE 130D STD BRL 207MM SS 12 HOLE KEY OMEGA 3 BONE HIP,$948.75,$0.00,$948.75,$426.94,$677.12,$0.00,$163.46,$0.00,$0.00,$166.12,$948.75,$0.00,$474.38,$751.41,$759.00,$0.00,$148.48,$0.00,$151.04,$0.00
597022S,SUP,HCPCS C1713,,597022S  -  PLATE 135D STD BRL 47MM SS SYS 2 HOLE KEY LP OMEGA3 CHS BONE,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597023S,SUP,HCPCS C1713,,597023S  -  PLATE 135D STD BRL 63MM SS 3 HOLE KEY OMEGA 3 BONE HIP STRL,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597024S,SUP,HCPCS C1713,,597024S  -  PLATE 130D STD BRL OMEGA 3 BONE HIP STRL,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597025S,SUP,HCPCS C1713,,597025S  -  PLATE 135D STD BRL 95MM SS 5 HOLE KEY OMEGA 3 BONE HIP STRL,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597026S,SUP,HCPCS C1713,,597026S  -  PLATE 135D STD BRL 111MM SS 6 HOLE KEY OMEGA 3 BONE HIP STRL,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597028S,SUP,HCPCS C1713,,597028S  -  PLATE 135D STD BRL 143MM SS 8 HOLE KEY OMEGA 3 BONE HIP STRL,$948.75,$0.00,$948.75,$426.94,$677.12,$0.00,$163.46,$0.00,$0.00,$166.12,$948.75,$0.00,$474.38,$751.41,$759.00,$0.00,$148.48,$0.00,$151.04,$0.00
597030S,SUP,HCPCS C1713,,597030S  -  PLATE 135D STD BRL 175MM SS 10 HOLE KEY OMEGA 3 BONE HIP,$948.75,$0.00,$948.75,$426.94,$677.12,$0.00,$163.46,$0.00,$0.00,$166.12,$948.75,$0.00,$474.38,$751.41,$759.00,$0.00,$148.48,$0.00,$151.04,$0.00
597032S,SUP,HCPCS C1713,,597032S  -  PLATE 135D STD BRL 207MM SS 12 HOLE KEY OMEGA 3 BONE HIP,$948.75,$0.00,$948.75,$426.94,$677.12,$0.00,$163.46,$0.00,$0.00,$166.12,$948.75,$0.00,$474.38,$751.41,$759.00,$0.00,$148.48,$0.00,$151.04,$0.00
597042S,SUP,HCPCS C1713,,597042S  -  PLATE 140D STD BRL 47MM SS 2 HOLE KEY OMEGA 3 BONE HIP STRL,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597043S,SUP,HCPCS C1713,,597043S  -  PLATE 140D STD BRL 63MM SS 3 HOLE KEY OMEGA 3 BONE HIP STRL,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597044S,SUP,HCPCS C1713,,597044S  -  PLATE 140D STD BRL 79MM SS 4 HOLE KEY OMEGA 3 BONE HIP STRL,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597045S,SUP,HCPCS C1713,,597045S  -  PLATE 140D STD BRL 95MM SS 5 HOLE KEY OMEGA 3 BONE HIP STRL,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597046S,SUP,HCPCS C1713,,597046S  -  PLATE 140D STD BRL 111MM SS 6 HOLE KEY OMEGA 3 BONE HIP STRL,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597048S,SUP,HCPCS C1713,,597048S  -  PLATE 140D STD BRL 143MM SS 8 HOLE KEY OMEGA 3 BONE HIP STRL,$948.75,$0.00,$948.75,$426.94,$677.12,$0.00,$163.46,$0.00,$0.00,$166.12,$948.75,$0.00,$474.38,$751.41,$759.00,$0.00,$148.48,$0.00,$151.04,$0.00
597050S,SUP,HCPCS C1713,,597050S  -  PLATE 140D STD BRL 175MM SS 10 HOLE KEY OMEGA 3 BONE HIP,$948.75,$0.00,$948.75,$426.94,$677.12,$0.00,$163.46,$0.00,$0.00,$166.12,$948.75,$0.00,$474.38,$751.41,$759.00,$0.00,$148.48,$0.00,$151.04,$0.00
597052S,SUP,HCPCS C1713,,597052S  -  PLATE 140D STD BRL 207MM SS 12 HOLE KEY OMEGA 3 BONE HIP,$948.75,$0.00,$948.75,$426.94,$677.12,$0.00,$163.46,$0.00,$0.00,$166.12,$948.75,$0.00,$474.38,$751.41,$759.00,$0.00,$148.48,$0.00,$151.04,$0.00
597062S,SUP,HCPCS C1713,,597062S  -  PLATE 145D STD BRL 47MM SS 2 HOLE KEY OMEGA 3 BONE HIP STRL,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597063S,SUP,HCPCS C1713,,597063S  -  PLATE 145D STD BRL 63MM SS 3 HOLE ANG KYLS CMPR OMEGA 3 BONE,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597064S,SUP,HCPCS C1713,,597064S  -  PLATE 145D STD BRL 79MM SS 4 HOLE KEY OMEGA 3 BONE HIP STRL,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597065S,SUP,HCPCS C1713,,597065S  -  PLATE 145D STD BRL 95MM 5 HOLE KEY OMEGA 3 BONE HIP STRL,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597066S,SUP,HCPCS C1713,,597066S  -  PLATE 145D STD BRL 111MM SS 6 HOLE KEY OMEGA 3 BONE HIP STRL,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597068S,SUP,HCPCS C1713,,597068S  -  PLATE 145D STD BRL 143MM SS 8 HOLE ANG KYLS CMPR OMEGA 3,$948.75,$0.00,$948.75,$426.94,$677.12,$0.00,$163.46,$0.00,$0.00,$166.12,$948.75,$0.00,$474.38,$751.41,$759.00,$0.00,$148.48,$0.00,$151.04,$0.00
597070S,SUP,HCPCS C1713,,597070S  -  PLATE 145D STD BRL 175MM SS 10 HOLE ANG KYLS CMPR OMEGA 3,$948.75,$0.00,$948.75,$426.94,$677.12,$0.00,$163.46,$0.00,$0.00,$166.12,$948.75,$0.00,$474.38,$751.41,$759.00,$0.00,$148.48,$0.00,$151.04,$0.00
597072S,SUP,HCPCS C1713,,597072S  -  PLATE 145D STD BRL 207MM SS 12 HOLE ANG KYLS CMPR OMEGA 3,$948.75,$0.00,$948.75,$426.94,$677.12,$0.00,$163.46,$0.00,$0.00,$166.12,$948.75,$0.00,$474.38,$751.41,$759.00,$0.00,$148.48,$0.00,$151.04,$0.00
597082S,SUP,HCPCS C1713,,597082S  -  PLATE 150D STD BRL 47MM SS 2 HOLE ANG KYLS CMPR OMEGA 3 BONE,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597083S,SUP,HCPCS C1713,,597083S  -  PLATE 150D STD BRL 63MM SS 3 HOLE ANG KYLS CMPR OMEGA 3 BONE,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597084S,SUP,HCPCS C1713,,597084S  -  PLATE 150D STD BRL 79MM SS 4 HOLE KEY OMEGA 3 BONE HIP STRL,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597085S,SUP,HCPCS C1713,,597085S  -  PLATE 150D STD BRL 95MM SS 5 HOLE KEY OMEGA 3 BONE HIP STRL,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597086S,SUP,HCPCS C1713,,597086S  -  PLATE 150D STD BRL 111MM SS 6 HOLE KEY OMEGA 3 BONE HIP STRL,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597088S,SUP,HCPCS C1713,,597088S  -  PLATE 150D STD BRL 143MM SS 8 HOLE KEY OMEGA 3 BONE HIP STRL,$948.75,$0.00,$948.75,$426.94,$677.12,$0.00,$163.46,$0.00,$0.00,$166.12,$948.75,$0.00,$474.38,$751.41,$759.00,$0.00,$148.48,$0.00,$151.04,$0.00
597090S,SUP,HCPCS C1713,,597090S  -  PLATE 150D STD BRL 175MM SS 10 HOLE ANG KYLS CMPR OMEGA 3,$948.75,$0.00,$948.75,$426.94,$677.12,$0.00,$163.46,$0.00,$0.00,$166.12,$948.75,$0.00,$474.38,$751.41,$759.00,$0.00,$148.48,$0.00,$151.04,$0.00
597092S,SUP,HCPCS C1713,,597092S  -  PLATE 150D STD BRL 207MM SS 12 HOLE ANG KYLS CMPR OMEGA 3,$948.75,$0.00,$948.75,$426.94,$677.12,$0.00,$163.46,$0.00,$0.00,$166.12,$948.75,$0.00,$474.38,$751.41,$759.00,$0.00,$148.48,$0.00,$151.04,$0.00
597102S,SUP,HCPCS C1713,,597102S  -  PLATE 130D STD BRL 47MM SS 2 HOLE KYLS LP OMEGA 3 BONE HIP,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597103S,SUP,HCPCS C1713,,597103S  -  PLATE 130D STD BRL SS 3 HOLE OMEGA 3 BONE HIP STRL,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597104S,SUP,HCPCS C1713,,597104S  -  PLATE 135D STD BRL 32MM SS 4 HOLE KEY OMEGA 3 BONE HIP STRL,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597105S,SUP,HCPCS C1713,,597105S  -  PLATE 130D STD BRL 95MM SS 5 HOLE KYLS OMEGA 3 BONE HIP STRL,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597106S,SUP,HCPCS C1713,,597106S  -  PLATE 130D STD BRL 111MM SS 6 HOLE KYLS LP OMEGA 3 BONE HIP,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597108S,SUP,HCPCS C1713,,597108S  -  PLATE 130D STD BRL 143MM SS 8 HOLE LP KYLS OMEGA 3 BONE HIP,$948.75,$0.00,$948.75,$426.94,$677.12,$0.00,$163.46,$0.00,$0.00,$166.12,$948.75,$0.00,$474.38,$751.41,$759.00,$0.00,$148.48,$0.00,$151.04,$0.00
597110S,SUP,HCPCS C1713,,597110S  -  PLATE 130D STD BRL 10 HOLE KYLS OMEGA 3 BONE HIP STRL,$948.75,$0.00,$948.75,$426.94,$677.12,$0.00,$163.46,$0.00,$0.00,$166.12,$948.75,$0.00,$474.38,$751.41,$759.00,$0.00,$148.48,$0.00,$151.04,$0.00
597112S,SUP,HCPCS C1713,,597112S  -  PLATE 130D STD BRL 207MM SS 12 HOLE ANG KYLS CMPR OMEGA 3,$948.75,$0.00,$948.75,$426.94,$677.12,$0.00,$163.46,$0.00,$0.00,$166.12,$948.75,$0.00,$474.38,$751.41,$759.00,$0.00,$148.48,$0.00,$151.04,$0.00
597122S,SUP,HCPCS C1713,,597122S  -  PLATE 135D STD BRL 47MM SS 2 HOLE KYLS LP OMEGA 3 BONE HIP,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597123S,SUP,HCPCS C1713,,597123S  -  PLATE 135D 3 HOLE OMEGA 3 BONE KNEE STRL,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597124S,SUP,HCPCS C1713,,597124S  -  PLATE 135D STD BRL 79MM SS 4 HOLE KYLS OMEGA 3 BONE HIP STRL,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597125S,SUP,HCPCS C1713,,597125S  -  PLATE 135D 5 HOLE OMEGA 3 BONE STRL,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597126S,SUP,HCPCS C1713,,597126S  -  PLATE STD BRL KYLS OMEGA 3 BONE HIP STRL,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597128S,SUP,HCPCS C1713,,597128S  -  PLATE 8 HOLE OMEGA 3 BONE HIP STRL,$948.75,$0.00,$948.75,$426.94,$677.12,$0.00,$163.46,$0.00,$0.00,$166.12,$948.75,$0.00,$474.38,$751.41,$759.00,$0.00,$148.48,$0.00,$151.04,$0.00
597130S,SUP,HCPCS C1713,,597130S  -  PLATE 135D STD BRL 175MM SS 10 HOLE KYLS LP OMEGA 3 BONE HIP,$948.75,$0.00,$948.75,$426.94,$677.12,$0.00,$163.46,$0.00,$0.00,$166.12,$948.75,$0.00,$474.38,$751.41,$759.00,$0.00,$148.48,$0.00,$151.04,$0.00
597132S,SUP,HCPCS C1713,,597132S  -  PLATE 135D STD BRL 135MM 12 HOLE KYLS LP OMEGA 3 BONE HIP,$948.75,$0.00,$948.75,$426.94,$677.12,$0.00,$163.46,$0.00,$0.00,$166.12,$948.75,$0.00,$474.38,$751.41,$759.00,$0.00,$148.48,$0.00,$151.04,$0.00
597142S,SUP,HCPCS C1713,,597142S  -  PLATE 140D STD BRL 47MM SS 2 HOLE ANG KYLS CMPR OMEGA 3 BONE,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597143S,SUP,HCPCS C1713,,597143S  -  PLATE 140D STD BRL 63MM SS 3 HOLE KYLS OMEGA 3 BONE HIP STRL,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597144S,SUP,HCPCS C1713,,597144S  -  PLATE 140D STD BRL 79MM 4 HOLE KYLS OMEGA 3 BONE HIP STRL,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597145S,SUP,HCPCS C1713,,597145S  -  PLATE 140D STD BRL SS 5 HOLE OMEGA 3 BONE HIP STRL,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597146S,SUP,HCPCS C1713,,597146S  -  PLATE 140D STD BRL 111MM 6 HOLE KYLS LP OMEGA 3 BONE HIP,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597148S,SUP,HCPCS C1713,,597148S  -  PLATE 140D STD BRL 143MM 8 HOLE KYLS LP OMEGA 3 BONE HIP,$948.75,$0.00,$948.75,$426.94,$677.12,$0.00,$163.46,$0.00,$0.00,$166.12,$948.75,$0.00,$474.38,$751.41,$759.00,$0.00,$148.48,$0.00,$151.04,$0.00
597150S,SUP,HCPCS C1713,,597150S  -  PLATE 140D STD BRL 175MM SS 10 HOLE KYLS OMEGA 3 BONE HIP,$948.75,$0.00,$948.75,$426.94,$677.12,$0.00,$163.46,$0.00,$0.00,$166.12,$948.75,$0.00,$474.38,$751.41,$759.00,$0.00,$148.48,$0.00,$151.04,$0.00
597152S,SUP,HCPCS C1713,,597152S  -  PLATE 140D STD BRL 207MM SS 12 HOLE KYLS OMEGA 3 BONE HIP,$948.75,$0.00,$948.75,$426.94,$677.12,$0.00,$163.46,$0.00,$0.00,$166.12,$948.75,$0.00,$474.38,$751.41,$759.00,$0.00,$148.48,$0.00,$151.04,$0.00
597162S,SUP,HCPCS C1713,,597162S  -  PLATE 145D STD BRL 47MM SS 2 HOLE KYLS OMEGA 3 BONE HIP STRL,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597163S,SUP,HCPCS C1713,,597163S  -  PLATE 145D STD BRL 63MM SS 3 HOLE KYLS OMEGA 3 BONE HIP STRL,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597164S,SUP,HCPCS C1713,,597164S  -  PLATE STD BRL 4 HOLE KYLS OMEGA 3 BONE HIP STRL,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597165S,SUP,HCPCS C1713,,597165S  -  PLATE 145D STD BRL 95MM SS 5 HOLE KYLS OMEGA 3 BONE HIP STRL,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597166S,SUP,HCPCS C1713,,597166S  -  PLATE 145D STD BRL 111MM 6 HOLE KYLS LP OMEGA 3 BONE HIP,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597168S,SUP,HCPCS C1713,,597168S  -  PLATE 145D STD BRL 143MM SS 8 HOLE KYLS OMEGA 3 BONE HIP,$948.75,$0.00,$948.75,$426.94,$677.12,$0.00,$163.46,$0.00,$0.00,$166.12,$948.75,$0.00,$474.38,$751.41,$759.00,$0.00,$148.48,$0.00,$151.04,$0.00
597170S,SUP,HCPCS C1713,,597170S  -  PLATE 145D STD BRL 175MM SS 10 HOLE KYLS OMEGA 3 BONE HIP,$948.75,$0.00,$948.75,$426.94,$677.12,$0.00,$163.46,$0.00,$0.00,$166.12,$948.75,$0.00,$474.38,$751.41,$759.00,$0.00,$148.48,$0.00,$151.04,$0.00
597172S,SUP,HCPCS C1713,,597172S  -  PLATE 145D STD BRL 207MM SS 12 HOLE KYLS OMEGA 3 BONE HIP,$948.75,$0.00,$948.75,$426.94,$677.12,$0.00,$163.46,$0.00,$0.00,$166.12,$948.75,$0.00,$474.38,$751.41,$759.00,$0.00,$148.48,$0.00,$151.04,$0.00
597182S,SUP,HCPCS C1713,,597182S  -  PLATE 150D STD BRL 47MM SS 2 HOLE KYLS OMEGA 3 BONE HIP STRL,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597183S,SUP,HCPCS C1713,,597183S  -  PLATE 150D STD BARRREL 63MM SS 3 HOLE KYLS OMEGA 3 BONE HIP,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597184S,SUP,HCPCS C1713,,597184S  -  PLATE 150D STD BARRREL 79MM SS 4 HOLE KYLS OMEGA 3 BONE HIP,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597185S,SUP,HCPCS C1713,,597185S  -  PLATE 150D STD BARRREL 95MM SS 5 HOLE KYLS OMEGA 3 BONE HIP,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597186S,SUP,HCPCS C1713,,597186S  -  PLATE 150D STD BRL 111MM 6 HOLE KYLS LP OMEGA 3 BONE HIP,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597188S,SUP,HCPCS C1713,,597188S  -  PLATE 150D STD BARRREL 143MM SS 8 HOLE KYLS OMEGA 3 BONE HIP,$948.75,$0.00,$948.75,$426.94,$677.12,$0.00,$163.46,$0.00,$0.00,$166.12,$948.75,$0.00,$474.38,$751.41,$759.00,$0.00,$148.48,$0.00,$151.04,$0.00
597190S,SUP,HCPCS C1713,,597190S  -  PLATE 150D STD BARRREL 175MM SS 10 HOLE KYLS OMEGA 3 BONE,$948.75,$0.00,$948.75,$426.94,$677.12,$0.00,$163.46,$0.00,$0.00,$166.12,$948.75,$0.00,$474.38,$751.41,$759.00,$0.00,$148.48,$0.00,$151.04,$0.00
597192S,SUP,HCPCS C1713,,597192S  -  PLATE 150D STD BARRREL 207MM SS 12 HOLE KYLS OMEGA 3 BONE,$948.75,$0.00,$948.75,$426.94,$677.12,$0.00,$163.46,$0.00,$0.00,$166.12,$948.75,$0.00,$474.38,$751.41,$759.00,$0.00,$148.48,$0.00,$151.04,$0.00
597202S,SUP,HCPCS C1713,,597202S  -  PLATE 130D SHRT BRL 47MM SS 2 HOLE KEY OMEGA 3 BONE HIP STRL,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597203S,SUP,HCPCS C1713,,597203S  -  PLATE 130D SHRT BRL SS 3 HOLE ANG KEY OMEGA 3 BONE HIP STRL,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597204S,SUP,HCPCS C1713,,597204S  -  PLATE 130D SHRT BRL 79MM SS 4 HOLE KEY OMEGA 3 BONE HIP STRL,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597205S,SUP,HCPCS C1713,,597205S  -  PLATE 130D SHRT BRL 95MM SS 5 HOLE KEY OMEGA 3 BONE HIP STRL,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597212S,SUP,HCPCS C1713,,597212S  -  PLATE 135D SHRT BRL SS 2 HOLE ANG KEY OMEGA 3 BONE HIP STRL,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597213S,SUP,HCPCS C1713,,597213S  -  PLATE 135D SHRT BRL SS 3 HOLE ANG KEY OMEGA 3 BONE HIP STRL,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597214S,SUP,HCPCS C1713,,597214S  -  PLATE 135D SHRT BRL 79MM SS 4 HOLE KEY OMEGA 3 BONE HIP STRL,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597215S,SUP,HCPCS C1713,,597215S  -  PLATE 135D SHRT BRL 95MM SS 5 HOLE KEY OMEGA 3 BONE HIP STRL,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597222S,SUP,HCPCS C1713,,597222S  -  PLATE 140D SHRT BARRREL 47MM SS 2 HOLE KEY OMEGA 3 BONE HIP,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597223S,SUP,HCPCS C1713,,597223S  -  PLATE 140D SHRT BARRREL 63MM SS 3 HOLE KEY OMEGA 3 BONE HIP,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597224S,SUP,HCPCS C1713,,597224S  -  PLATE 140D SHRT BRL 79MM SS 4 HOLE KEY OMEGA 3 BONE HIP STRL,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597225S,SUP,HCPCS C1713,,597225S  -  PLATE 140D SHRT BRL 95MM SS 5 HOLE KEY OMEGA 3 BONE HIP STRL,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597232S,SUP,HCPCS C1713,,597232S  -  PLATE 145D SHRT BARRREL 47MM SS 2 HOLE KEY OMEGA 3 BONE HIP,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597233S,SUP,HCPCS C1713,,597233S  -  PLATE 145D SHRT BARRREL 63MM SS 3 HOLE KEY OMEGA 3 BONE HIP,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597234S,SUP,HCPCS C1713,,597234S  -  PLATE 145D SHRT BRL 79MM SS 4 HOLE KEY OMEGA 3 BONE HIP STRL,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597235S,SUP,HCPCS C1713,,597235S  -  PLATE 145D SHRT BRL 95MM SS 5 HOLE KEY OMEGA 3 BONE HIP STRL,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597242S,SUP,HCPCS C1713,,597242S  -  PLATE 150D SHRT BARRREL 47MM SS 2 HOLE KEY OMEGA 3 BONE HIP,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597243S,SUP,HCPCS C1713,,597243S  -  PLATE 150D SHRT BARRREL 63MM SS 3 HOLE KEY OMEGA 3 BONE HIP,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597244S,SUP,HCPCS C1713,,597244S  -  PLATE 150D SHRT BRL 79MM SS 4 HOLE KEY OMEGA 3 BONE HIP STRL,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597245S,SUP,HCPCS C1713,,597245S  -  PLATE 150D SHRT BRL 95MM SS 5 HOLE KEY OMEGA 3 BONE HIP STRL,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597254S,SUP,HCPCS C1713,,597254S  -  PLATE 130D SHRT BRL KYLS BONE HIP STRL,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597255S,SUP,HCPCS C1713,,597255S  -  PLATE 130D SHRT BRL 95MM SS 5 HOLE KYLS CMPR OMEGA 3 BONE,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597264S,SUP,HCPCS C1713,,597264S  -  PLATE 135D SHRT BRL 79MM 5 HOLE KYLS LP OMEGA 3 BONE HIP,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597265S,SUP,HCPCS C1713,,597265S  -  PLATE 135D SHRT BRL 95MM SS 5 HOLE KYLS LP OMEGA 3 BONE HIP,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597274S,SUP,HCPCS C1713,,597274S  -  PLATE 140D SHRT BRL SS 4 HOLE OMEGA 3 BONE HIP STRL,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597275S,SUP,HCPCS C1713,,597275S  -  PLATE 140D SHRT BARRREL 95MM SS 5 HOLE KYLS OMEGA 3 BONE HIP,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597284S,SUP,HCPCS C1713,,597284S  -  PLATE 145D SHRT BRL 79MM SS 4 HOLE KYLS LP OMEGA 3 BONE HIP,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597285S,SUP,HCPCS C1713,,597285S  -  PLATE 145D SHRT BARRREL 95MM SS 5 HOLE KYLS OMEGA 3 BONE HIP,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597294S,SUP,HCPCS C1713,,597294S  -  PLATE 150D SHRT BARRREL 79MM SS 4 HOLE KYLS OMEGA 3 BONE HIP,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597295S,SUP,HCPCS C1713,,597295S  -  PLATE 150D SHRT BARRREL 25MM SS 5 HOLE KYLS OMEGA 3 BONE HIP,$749.38,$0.00,$749.38,$337.22,$534.83,$0.00,$129.11,$0.00,$0.00,$131.21,$749.38,$0.00,$374.69,$593.51,$599.50,$0.00,$117.28,$0.00,$119.30,$0.00
597404S,SUP,HCPCS C1713,,597404S  -  PLATE 135D 150MM SS 4 HOLE STAB OMEGA 3 BONE HIP STRL,"$1,271.88",$0.00,"$1,271.88",$572.34,$907.74,$0.00,$219.14,$0.00,$0.00,$222.70,"$1,271.88",$0.00,$635.94,"$1,007.33","$1,017.50",$0.00,$199.05,$0.00,$202.48,$0.00
5A0002,SUP,HCPCS C1725,,5A0002  -  CATHETER ANGIO JR4 CRV 5FR 100CM STSR,$21.88,$0.00,$21.88,$11.88,$15.61,$0.00,$3.77,$0.00,$0.00,$3.83,$21.88,$0.00,$10.94,$17.33,$17.50,$0.00,$3.42,$0.00,$3.48,$0.00
5A0007,SUP,HCPCS C1725,,5A0007  -  CATHETER ANGIOGRAPHIC 3DRCB CURVE 5FR 100CM SITESEER,$21.88,$0.00,$21.88,$11.88,$15.61,$0.00,$3.77,$0.00,$0.00,$3.83,$21.88,$0.00,$10.94,$17.33,$17.50,$0.00,$3.42,$0.00,$3.48,$0.00
5A0018,SUP,HCPCS C1725,,5A0018  -  CATHETER ANGIO AL1 CRV 5FR 100CM STSR,$21.88,$0.00,$21.88,$11.88,$15.61,$0.00,$3.77,$0.00,$0.00,$3.83,$21.88,$0.00,$10.94,$17.33,$17.50,$0.00,$3.42,$0.00,$3.48,$0.00
5A0021,SUP,HCPCS C1725,,5A0021  -  CATHETER ANGIOGRAPHIC MPA1 CURVE 5FR 100CM SITESEER,$21.88,$0.00,$21.88,$11.88,$15.61,$0.00,$3.77,$0.00,$0.00,$3.83,$21.88,$0.00,$10.94,$17.33,$17.50,$0.00,$3.42,$0.00,$3.48,$0.00
5A0031,SUP,HCPCS C1725,,5A0031  -  CATHETER ANGIOGRAPHIC IM CURVE 5FR 100CM SITESEER,$21.88,$0.00,$21.88,$11.88,$15.61,$0.00,$3.77,$0.00,$0.00,$3.83,$21.88,$0.00,$10.94,$17.33,$17.50,$0.00,$3.42,$0.00,$3.48,$0.00
5A0070,SUP,HCPCS C1725,,5A0070  -  CATHETER ANGIOGRAPHIC PIGTAIL 145 CURVE 5FR 110CM 6 SIDEHOLE,$21.88,$0.00,$21.88,$11.88,$15.61,$0.00,$3.77,$0.00,$0.00,$3.83,$21.88,$0.00,$10.94,$17.33,$17.50,$0.00,$3.42,$0.00,$3.48,$0.00
5A0084,SUP,HCPCS C1725,,5A0084  -  CATHETER ANGIO JL3.5 CRV 5FR 100CM STSR,$21.88,$0.00,$21.88,$11.88,$15.61,$0.00,$3.77,$0.00,$0.00,$3.83,$21.88,$0.00,$10.94,$17.33,$17.50,$0.00,$3.42,$0.00,$3.48,$0.00
5A0085,SUP,HCPCS C1725,,5A0085  -  CATHETER ANGIOGRAPHIC JL4 CURVE 5FR 100CM SITESEER,$21.88,$0.00,$21.88,$11.88,$15.61,$0.00,$3.77,$0.00,$0.00,$3.83,$21.88,$0.00,$10.94,$17.33,$17.50,$0.00,$3.42,$0.00,$3.48,$0.00
5A0087,SUP,HCPCS C1725,,5A0087  -  CATHETER ANGIOGRAPHIC JL5 CURVE 5FR 100CM SITESEER,$21.88,$0.00,$21.88,$11.88,$15.61,$0.00,$3.77,$0.00,$0.00,$3.83,$21.88,$0.00,$10.94,$17.33,$17.50,$0.00,$3.42,$0.00,$3.48,$0.00
5B5136,SUP,Custom 25803010,,SOLUTION IV PERITONEAL,$123.75,$0.00,$123.75,$0.00,$88.32,$0.00,$0.00,$0.00,$0.00,$0.00,$123.75,$0.00,$61.88,$98.01,$99.00,$0.00,$0.00,$0.00,$0.00,$0.00
5MAXACE132,SUP,HCPCS C1887,,5MAXACE132  -  CATHETER REPERFUSION,"$6,175.00",$0.00,"$6,175.00","$3,353.03","$4,407.10",$0.00,"$1,063.92",$0.00,$0.00,"$1,081.19","$6,175.00",$0.00,"$3,087.50","$4,890.60","$4,940.00",$0.00,$966.39,$0.00,$983.06,$0.00
5MAXACE132KIT,SUP,HCPCS C1887,,5MAXACE132KIT  -  CATHETER REPERFUSION,"$6,062.50",$0.00,"$6,062.50","$3,291.94","$4,326.81",$0.00,"$1,044.54",$0.00,$0.00,"$1,061.50","$6,062.50",$0.00,"$3,031.25","$4,801.50","$4,850.00",$0.00,$948.78,$0.00,$965.15,$0.00
6 LGT,SUP,Custom 27203010,,6 LGT  -  TUBE 50MM 11.1MM 6.4MM UNCUF LRNTMY SHLY TRCH 6 STRL LATEX,$143.01,$0.00,$143.01,$0.00,$102.07,$0.00,$0.00,$0.00,$0.00,$0.00,$143.01,$0.00,$71.51,$113.26,$114.41,$0.00,$0.00,$0.00,$0.00,$0.00
60.116.521,SUP,HCPCS C1713,,60.116.521  -  PIN PUSH SCREW TYPE VAR ANG LOCKING GRAPHIC CASES NONSTRL,$113.25,$0.00,$113.25,$50.96,$80.83,$0.00,$19.51,$0.00,$0.00,$19.83,$113.25,$0.00,$56.63,$89.69,$90.60,$0.00,$17.72,$0.00,$18.03,$0.00
60-00120,SUP,Custom 27203010,,60-00120  -  GUIDE DRILL 14.5CM 2 END,$646.25,$0.00,$646.25,$0.00,$461.23,$0.00,$0.00,$0.00,$0.00,$0.00,$646.25,$0.00,$323.13,$511.83,$517.00,$0.00,$0.00,$0.00,$0.00,$0.00
6000-215,SUP,HCPCS C1713,,6000-215  -  SUB BNGFT 40X15MM PLEXUR 15D BCMPS VOID FILR WDG RESORB,"$1,370.00",$0.00,"$1,370.00",$616.50,$977.77,$0.00,$236.04,$0.00,$0.00,$239.88,"$1,370.00",$0.00,$685.00,"$1,085.04","$1,096.00",$0.00,$214.41,$0.00,$218.10,$0.00
6000BL,SUP,Custom 27803010,,6000BL  -  HOOK SPNL SPRL R90D LT OBLQ TI,"$1,662.43",$0.00,"$1,662.43",$0.00,"$1,186.47",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,662.43",$0.00,$831.21,"$1,316.64","$1,329.94",$0.00,$0.00,$0.00,$0.00,$0.00
6000BR,SUP,Custom 27803010,,6000BR  -  HOOK SPNL SPRL R90D RT OBLQ TI,"$1,662.43",$0.00,"$1,662.43",$0.00,"$1,186.47",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,662.43",$0.00,$831.21,"$1,316.64","$1,329.94",$0.00,$0.00,$0.00,$0.00,$0.00
6000LL,SUP,Custom 27803010,,6000LL  -  HOOK SPNL LG SPRL R90D TI LMR,"$1,662.43",$0.00,"$1,662.43",$0.00,"$1,186.47",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,662.43",$0.00,$831.21,"$1,316.64","$1,329.94",$0.00,$0.00,$0.00,$0.00,$0.00
6000LP,SUP,Custom 27803010,,6000LP  -  HOOK SPNL LG SPRL R90D TI PDCL,"$1,662.43",$0.00,"$1,662.43",$0.00,"$1,186.47",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,662.43",$0.00,$831.21,"$1,316.64","$1,329.94",$0.00,$0.00,$0.00,$0.00,$0.00
6000ME,SUP,Custom 27803010,,6000ME  -  HOOK SPNL MED SPRL R90D XTD TI LMR THOR,"$1,745.55",$0.00,"$1,745.55",$0.00,"$1,245.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,745.55",$0.00,$872.78,"$1,382.48","$1,396.44",$0.00,$0.00,$0.00,$0.00,$0.00
6000ML,SUP,Custom 27803010,,6000ML  -  HOOK SPNL MED SPRL R90D TI LMR,"$1,662.43",$0.00,"$1,662.43",$0.00,"$1,186.47",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,662.43",$0.00,$831.21,"$1,316.64","$1,329.94",$0.00,$0.00,$0.00,$0.00,$0.00
6000MW,SUP,Custom 27803010,,6000MW  -  HOOK SPNL MED SPRL R90D W TI LMR,"$1,662.43",$0.00,"$1,662.43",$0.00,"$1,186.47",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,662.43",$0.00,$831.21,"$1,316.64","$1,329.94",$0.00,$0.00,$0.00,$0.00,$0.00
6000SE,SUP,Custom 27803010,,6000SE  -  HOOK SPNL SM SPRL R90D XTD TI LMR,"$1,745.55",$0.00,"$1,745.55",$0.00,"$1,245.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,745.55",$0.00,$872.78,"$1,382.48","$1,396.44",$0.00,$0.00,$0.00,$0.00,$0.00
6000SL,SUP,Custom 27803010,,6000SL  -  HOOK SPNL SM SPRL R90D TI LMR,"$1,662.43",$0.00,"$1,662.43",$0.00,"$1,186.47",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,662.43",$0.00,$831.21,"$1,316.64","$1,329.94",$0.00,$0.00,$0.00,$0.00,$0.00
6000SP,SUP,Custom 27803010,,6000SP  -  HOOK SPNL SM SPRL R90D TI PDCL,"$1,662.43",$0.00,"$1,662.43",$0.00,"$1,186.47",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,662.43",$0.00,$831.21,"$1,316.64","$1,329.94",$0.00,$0.00,$0.00,$0.00,$0.00
6000SW,SUP,Custom 27803010,,6000SW  -  HOOK SPNL SM SPRL R90D W TI LMR,"$1,662.43",$0.00,"$1,662.43",$0.00,"$1,186.47",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,662.43",$0.00,$831.21,"$1,316.64","$1,329.94",$0.00,$0.00,$0.00,$0.00,$0.00
6000TH,SUP,Custom 27803010,,6000TH  -  HOOK SPNL SPRL R90D TI LMR THOR,"$1,662.43",$0.00,"$1,662.43",$0.00,"$1,186.47",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,662.43",$0.00,$831.21,"$1,316.64","$1,329.94",$0.00,$0.00,$0.00,$0.00,$0.00
6001-2200,SUP,Custom 27803010,,6001-2200  -  HEAD FEMORAL +0MM C TAPER 22MM COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6001-2205,SUP,Custom 27803010,,6001-2205  -  HEAD FEMORAL +5MM C TAPER 22MM COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6001-2600,SUP,Custom 27803010,,6001-2600  -  HEAD FEMORAL +0MM C TAPER 26MM COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6001-2605,SUP,Custom 27803010,,6001-2605  -  HEAD FEMORAL +5MM C TAPER 26MM COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6001-2610,SUP,Custom 27803010,,6001-2610  -  HEAD FEMORAL +10MM C TAPER 26MM COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6001-2800,SUP,Custom 27803010,,6001-2800  -  HEAD FEMORAL +0MM C TAPER 28MM COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6001-2805,SUP,Custom 27803010,,6001-2805  -  HEAD FEMORAL +5MM C TAPER 28MM COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6001-2810,SUP,Custom 27803010,,6001-2810  -  HEAD FEMORAL +10MM C TAPER 28MM COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6001-3200,SUP,Custom 27803010,,6001-3200  -  HEAD FEMORAL +0MM C TAPER 32MM COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6001-3205,SUP,Custom 27803010,,6001-3205  -  HEAD FEMORAL +5MM C TAPER 32MM COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6001-3210,SUP,Custom 27803010,,6001-3210  -  HEAD FEMORAL +10MM C TAPER 32MM COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6001-3299,SUP,Custom 27803010,,6001-3299  -  HEAD FEMORAL -5MM C TAPER 32MM COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6003-003-090,SUP,HCPCS C1713,,6003-003-090  -  PIN FIX .125IN 3.54IN PRELOADED PINABALL NONSTRL,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
6005LO,SUP,Custom 27803010,,6005LO  -  HOOK SPNL 5MM SPRL R90D LT OFST TI,"$1,745.55",$0.00,"$1,745.55",$0.00,"$1,245.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,745.55",$0.00,$872.78,"$1,382.48","$1,396.44",$0.00,$0.00,$0.00,$0.00,$0.00
6005RO,SUP,Custom 27803010,,6005RO  -  HOOK SPNL 5MM SPRL R90D RT OFST TI,"$1,745.55",$0.00,"$1,745.55",$0.00,"$1,245.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,745.55",$0.00,$872.78,"$1,382.48","$1,396.44",$0.00,$0.00,$0.00,$0.00,$0.00
60-09504,SUP,Custom 27100030,,60-09504  -  DRILL TWST .9MM 46MM 4MM STRYK SHFT 1.2MM SCR,$555.00,$0.00,$555.00,$0.00,$396.10,$0.00,$0.00,$0.00,$0.00,$0.00,$555.00,$0.00,$277.50,$439.56,$444.00,$0.00,$0.00,$0.00,$0.00,$0.00
60-10115,SUP,Custom 27203010,,60-10115  -  BIT DRILL 83MM 1MM TWST STRL,$163.63,$0.00,$163.63,$0.00,$116.78,$0.00,$0.00,$0.00,$0.00,$0.00,$163.63,$0.00,$81.81,$129.59,$130.90,$0.00,$0.00,$0.00,$0.00,$0.00
60-10122,SUP,Custom 27203010,,60-10122  -  BIT DRILL 90MM 1MM TWST STOP SHFT END 22MM STRL,$159.50,$0.00,$159.50,$0.00,$113.84,$0.00,$0.00,$0.00,$0.00,$0.00,$159.50,$0.00,$79.75,$126.32,$127.60,$0.00,$0.00,$0.00,$0.00,$0.00
60-10315,SUP,Custom 27203010,,60-10315  -  BIT DRILL 76MM 1MM TWST AO STRL,$163.63,$0.00,$163.63,$0.00,$116.78,$0.00,$0.00,$0.00,$0.00,$0.00,$163.63,$0.00,$81.81,$129.59,$130.90,$0.00,$0.00,$0.00,$0.00,$0.00
60-10322,SUP,Custom 27203010,,60-10322  -  BIT DRL 22MM AO SHFT QCK 1.2MM SCR,$171.88,$0.00,$171.88,$0.00,$122.67,$0.00,$0.00,$0.00,$0.00,$0.00,$171.88,$0.00,$85.94,$136.13,$137.50,$0.00,$0.00,$0.00,$0.00,$0.00
60-10415,SUP,Custom 27203010,,60-10415  -  DRILL DNTL 1MM 16MM BIT TWST STOP,$163.63,$0.00,$163.63,$0.00,$116.78,$0.00,$0.00,$0.00,$0.00,$0.00,$163.63,$0.00,$81.81,$129.59,$130.90,$0.00,$0.00,$0.00,$0.00,$0.00
60-10422,SUP,Custom 27203010,,60-10422  -  BIT DRILL 73MM 1MM 22MM STOP TWST DNTL SHFT END STRL,$159.50,$0.00,$159.50,$0.00,$113.84,$0.00,$0.00,$0.00,$0.00,$0.00,$159.50,$0.00,$79.75,$126.32,$127.60,$0.00,$0.00,$0.00,$0.00,$0.00
60-10506,SUP,Custom 27100030,,60-10506  -  BIT DRILL TWIST 1MM 50MM 6MM STOP PROFYLE HAND STERILE SMALL,$540.00,$0.00,$540.00,$0.00,$385.40,$0.00,$0.00,$0.00,$0.00,$0.00,$540.00,$0.00,$270.00,$427.68,$432.00,$0.00,$0.00,$0.00,$0.00,$0.00
60-10512,SUP,Custom 27100030,,60-10512  -  BIT DRILL 12MM STOP 1MM 54MM 12MM TWIST STOP STERILE,$555.00,$0.00,$555.00,$0.00,$396.10,$0.00,$0.00,$0.00,$0.00,$0.00,$555.00,$0.00,$277.50,$439.56,$444.00,$0.00,$0.00,$0.00,$0.00,$0.00
6010LO,SUP,Custom 27803010,,6010LO  -  HOOK SPNL 10MM SPRL R90D LT OFST TI,"$1,745.55",$0.00,"$1,745.55",$0.00,"$1,245.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,745.55",$0.00,$872.78,"$1,382.48","$1,396.44",$0.00,$0.00,$0.00,$0.00,$0.00
6010RO,SUP,Custom 27803010,,6010RO  -  HOOK SPNL 10MM SPRL R90D RT OFST TI,"$1,745.55",$0.00,"$1,745.55",$0.00,"$1,245.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,745.55",$0.00,$872.78,"$1,382.48","$1,396.44",$0.00,$0.00,$0.00,$0.00,$0.00
6012-0711,SUP,HCPCS C1776,,6012-0711  -  STEM FEMORAL 7 11MM 155MM RSTOR TITANIUM HA HIP,"$13,152.50",$0.00,"$13,152.50","$5,918.63","$5,158.80",$0.00,"$2,266.11",$0.00,$0.00,"$2,302.90","$13,152.50",$0.00,"$6,576.25","$10,416.78","$10,522.00",$0.00,"$2,058.37",$0.00,"$2,093.88",$0.00
6012-0713,SUP,HCPCS C1776,,6012-0713  -  STEM FEMORAL 7 13MM 155MM RSTOR TITANIUM HA HIP,"$13,152.50",$0.00,"$13,152.50","$5,918.63","$5,158.80",$0.00,"$2,266.11",$0.00,$0.00,"$2,302.90","$13,152.50",$0.00,"$6,576.25","$10,416.78","$10,522.00",$0.00,"$2,058.37",$0.00,"$2,093.88",$0.00
6012-0812,SUP,HCPCS C1776,,6012-0812  -  STEM FEMORAL 8 12MM 155MM RSTOR TITANIUM HA HIP,"$13,152.50",$0.00,"$13,152.50","$5,918.63","$5,158.80",$0.00,"$2,266.11",$0.00,$0.00,"$2,302.90","$13,152.50",$0.00,"$6,576.25","$10,416.78","$10,522.00",$0.00,"$2,058.37",$0.00,"$2,093.88",$0.00
6012-0814,SUP,HCPCS C1776,,6012-0814  -  STEM FEMORAL 8 14MM 155MM RSTOR TITANIUM HA HIP,"$13,152.50",$0.00,"$13,152.50","$5,918.63","$5,158.80",$0.00,"$2,266.11",$0.00,$0.00,"$2,302.90","$13,152.50",$0.00,"$6,576.25","$10,416.78","$10,522.00",$0.00,"$2,058.37",$0.00,"$2,093.88",$0.00
6012-0913,SUP,HCPCS C1776,,6012-0913  -  STEM FEMORAL 9 13MM 155MM RSTOR TITANIUM HA HIP,"$13,152.50",$0.00,"$13,152.50","$5,918.63","$5,158.80",$0.00,"$2,266.11",$0.00,$0.00,"$2,302.90","$13,152.50",$0.00,"$6,576.25","$10,416.78","$10,522.00",$0.00,"$2,058.37",$0.00,"$2,093.88",$0.00
6012-0915,SUP,HCPCS C1776,,6012-0915  -  STEM FEMORAL 9 15MM 155MM RSTOR TITANIUM HA HIP,"$13,152.50",$0.00,"$13,152.50","$5,918.63","$5,158.80",$0.00,"$2,266.11",$0.00,$0.00,"$2,302.90","$13,152.50",$0.00,"$6,576.25","$10,416.78","$10,522.00",$0.00,"$2,058.37",$0.00,"$2,093.88",$0.00
6012-1014,SUP,HCPCS C1776,,6012-1014  -  STEM FEMORAL 10 14MM 155MM RSTOR TITANIUM HA HIP,"$13,152.50",$0.00,"$13,152.50","$5,918.63","$5,158.80",$0.00,"$2,266.11",$0.00,$0.00,"$2,302.90","$13,152.50",$0.00,"$6,576.25","$10,416.78","$10,522.00",$0.00,"$2,058.37",$0.00,"$2,093.88",$0.00
6012-1016,SUP,HCPCS C1776,,6012-1016  -  STEM FEMORAL 10 16MM 155MM RSTOR TITANIUM HA HIP,"$13,152.50",$0.00,"$13,152.50","$5,918.63","$5,158.80",$0.00,"$2,266.11",$0.00,$0.00,"$2,302.90","$13,152.50",$0.00,"$6,576.25","$10,416.78","$10,522.00",$0.00,"$2,058.37",$0.00,"$2,093.88",$0.00
6012-1115,SUP,HCPCS C1776,,6012-1115  -  STEM FEMORAL 11 15MM 155MM RSTOR TITANIUM HA HIP,"$13,152.50",$0.00,"$13,152.50","$5,918.63","$5,158.80",$0.00,"$2,266.11",$0.00,$0.00,"$2,302.90","$13,152.50",$0.00,"$6,576.25","$10,416.78","$10,522.00",$0.00,"$2,058.37",$0.00,"$2,093.88",$0.00
6012-1117,SUP,HCPCS C1776,,6012-1117  -  STEM FEMORAL 11 17MM 155MM RSTOR TITANIUM HA HIP,"$13,152.50",$0.00,"$13,152.50","$5,918.63","$5,158.80",$0.00,"$2,266.11",$0.00,$0.00,"$2,302.90","$13,152.50",$0.00,"$6,576.25","$10,416.78","$10,522.00",$0.00,"$2,058.37",$0.00,"$2,093.88",$0.00
6012-1216,SUP,HCPCS C1776,,6012-1216  -  STEM FEMORAL 12 16MM 155MM RSTOR TITANIUM HA HIP,"$13,152.50",$0.00,"$13,152.50","$5,918.63","$5,158.80",$0.00,"$2,266.11",$0.00,$0.00,"$2,302.90","$13,152.50",$0.00,"$6,576.25","$10,416.78","$10,522.00",$0.00,"$2,058.37",$0.00,"$2,093.88",$0.00
6012-1218,SUP,HCPCS C1776,,6012-1218  -  STEM FEMORAL 12 18MM 155MM RSTOR TITANIUM HA HIP,"$13,152.50",$0.00,"$13,152.50","$5,918.63","$5,158.80",$0.00,"$2,266.11",$0.00,$0.00,"$2,302.90","$13,152.50",$0.00,"$6,576.25","$10,416.78","$10,522.00",$0.00,"$2,058.37",$0.00,"$2,093.88",$0.00
601-251,SUP,HCPCS C1887,,MICROCATHETER RAPIDTRANSIT 150CM,"$1,760.00",$0.00,"$1,760.00",$955.68,"$1,256.11",$0.00,$303.24,$0.00,$0.00,$308.16,"$1,760.00",$0.00,$880.00,"$1,393.92","$1,408.00",$0.00,$275.44,$0.00,$280.19,$0.00
601251X,SUP,HCPCS C1751,,601251X  -  MICROCATHETER CRBRVASC 2.3-2.8FR .021IN 150CM 50CM,"$1,775.10",$0.00,"$1,775.10",$798.80,"$1,266.89",$0.00,$305.84,$0.00,$0.00,$310.81,"$1,775.10",$0.00,$887.55,"$1,405.88","$1,420.08",$0.00,$277.80,$0.00,$282.60,$0.00
6013-0812,SUP,HCPCS C1776,,6013-0812  -  STEM FEMORAL 8 12MM 205MM RSTOR TITANIUM HA HIP,"$12,550.00",$0.00,"$12,550.00","$5,647.50","$5,158.80",$0.00,"$2,162.30",$0.00,$0.00,"$2,197.40","$12,550.00",$0.00,"$6,275.00","$9,939.60","$10,040.00",$0.00,"$1,964.08",$0.00,"$1,997.96",$0.00
6013-0814,SUP,HCPCS C1776,,6013-0814  -  STEM FEMORAL 8 14MM 205MM RSTOR TITANIUM HA HIP,"$12,550.00",$0.00,"$12,550.00","$5,647.50","$5,158.80",$0.00,"$2,162.30",$0.00,$0.00,"$2,197.40","$12,550.00",$0.00,"$6,275.00","$9,939.60","$10,040.00",$0.00,"$1,964.08",$0.00,"$1,997.96",$0.00
6013-0913,SUP,HCPCS C1776,,6013-0913  -  STEM FEMORAL 9 13MM 205MM RSTOR TITANIUM HA HIP,"$12,550.00",$0.00,"$12,550.00","$5,647.50","$5,158.80",$0.00,"$2,162.30",$0.00,$0.00,"$2,197.40","$12,550.00",$0.00,"$6,275.00","$9,939.60","$10,040.00",$0.00,"$1,964.08",$0.00,"$1,997.96",$0.00
6013-0915,SUP,HCPCS C1776,,6013-0915  -  STEM FEMORAL 9 15MM 205MM RSTOR TITANIUM HA HIP,"$12,550.00",$0.00,"$12,550.00","$5,647.50","$5,158.80",$0.00,"$2,162.30",$0.00,$0.00,"$2,197.40","$12,550.00",$0.00,"$6,275.00","$9,939.60","$10,040.00",$0.00,"$1,964.08",$0.00,"$1,997.96",$0.00
6013-1014,SUP,HCPCS C1776,,6013-1014  -  STEM FEMORAL 10 14MM 205MM RSTOR TITANIUM HA HIP,"$12,550.00",$0.00,"$12,550.00","$5,647.50","$5,158.80",$0.00,"$2,162.30",$0.00,$0.00,"$2,197.40","$12,550.00",$0.00,"$6,275.00","$9,939.60","$10,040.00",$0.00,"$1,964.08",$0.00,"$1,997.96",$0.00
6013-1016,SUP,HCPCS C1776,,6013-1016  -  STEM FEMORAL 10 16MM 205MM RSTOR TITANIUM HA HIP,"$12,550.00",$0.00,"$12,550.00","$5,647.50","$5,158.80",$0.00,"$2,162.30",$0.00,$0.00,"$2,197.40","$12,550.00",$0.00,"$6,275.00","$9,939.60","$10,040.00",$0.00,"$1,964.08",$0.00,"$1,997.96",$0.00
6013-1115,SUP,HCPCS C1776,,6013-1115  -  STEM FEMORAL 11 15MM 205MM RSTOR TITANIUM HA HIP,"$12,550.00",$0.00,"$12,550.00","$5,647.50","$5,158.80",$0.00,"$2,162.30",$0.00,$0.00,"$2,197.40","$12,550.00",$0.00,"$6,275.00","$9,939.60","$10,040.00",$0.00,"$1,964.08",$0.00,"$1,997.96",$0.00
6013-1117,SUP,HCPCS C1776,,6013-1117  -  STEM FEMORAL 11 17MM 205MM RSTOR TITANIUM HA HIP,"$12,550.00",$0.00,"$12,550.00","$5,647.50","$5,158.80",$0.00,"$2,162.30",$0.00,$0.00,"$2,197.40","$12,550.00",$0.00,"$6,275.00","$9,939.60","$10,040.00",$0.00,"$1,964.08",$0.00,"$1,997.96",$0.00
6013-1216,SUP,HCPCS C1776,,6013-1216  -  STEM FEMORAL 12 16MM 205MM RSTOR TITANIUM HA HIP,"$12,550.00",$0.00,"$12,550.00","$5,647.50","$5,158.80",$0.00,"$2,162.30",$0.00,$0.00,"$2,197.40","$12,550.00",$0.00,"$6,275.00","$9,939.60","$10,040.00",$0.00,"$1,964.08",$0.00,"$1,997.96",$0.00
6013-1218,SUP,HCPCS C1776,,6013-1218  -  STEM FEMORAL 12 18MM 205MM RSTOR TITANIUM HA HIP,"$12,550.00",$0.00,"$12,550.00","$5,647.50","$5,158.80",$0.00,"$2,162.30",$0.00,$0.00,"$2,197.40","$12,550.00",$0.00,"$6,275.00","$9,939.60","$10,040.00",$0.00,"$1,964.08",$0.00,"$1,997.96",$0.00
6013-1317,SUP,HCPCS C1776,,6013-1317  -  STEM FEMORAL 13 17MM 205MM RSTOR TITANIUM HA HIP,"$12,550.00",$0.00,"$12,550.00","$5,647.50","$5,158.80",$0.00,"$2,162.30",$0.00,$0.00,"$2,197.40","$12,550.00",$0.00,"$6,275.00","$9,939.60","$10,040.00",$0.00,"$1,964.08",$0.00,"$1,997.96",$0.00
6013-1319,SUP,HCPCS C1776,,6013-1319  -  STEM FEMORAL 13 19MM 205MM RSTOR TITANIUM HA HIP,"$12,550.00",$0.00,"$12,550.00","$5,647.50","$5,158.80",$0.00,"$2,162.30",$0.00,$0.00,"$2,197.40","$12,550.00",$0.00,"$6,275.00","$9,939.60","$10,040.00",$0.00,"$1,964.08",$0.00,"$1,997.96",$0.00
6013-1418,SUP,HCPCS C1776,,6013-1418  -  STEM FEMORAL 14 18MM 205MM RSTOR TITANIUM HA HIP,"$12,550.00",$0.00,"$12,550.00","$5,647.50","$5,158.80",$0.00,"$2,162.30",$0.00,$0.00,"$2,197.40","$12,550.00",$0.00,"$6,275.00","$9,939.60","$10,040.00",$0.00,"$1,964.08",$0.00,"$1,997.96",$0.00
6013-1420,SUP,HCPCS C1776,,6013-1420  -  STEM FEMORAL 14 20MM 205MM RSTOR TITANIUM HA HIP,"$12,550.00",$0.00,"$12,550.00","$5,647.50","$5,158.80",$0.00,"$2,162.30",$0.00,$0.00,"$2,197.40","$12,550.00",$0.00,"$6,275.00","$9,939.60","$10,040.00",$0.00,"$1,964.08",$0.00,"$1,997.96",$0.00
60-13506,SUP,Custom 27100030,,60-13506  -  BIT DRILL 6MM STOP 1.3MM 50MM 6MM TWIST STOP STERILE,$550.00,$0.00,$550.00,$0.00,$392.54,$0.00,$0.00,$0.00,$0.00,$0.00,$550.00,$0.00,$275.00,$435.60,$440.00,$0.00,$0.00,$0.00,$0.00,$0.00
60-13512,SUP,Custom 27100030,,60-13512  -  DRILL TWST 1.3MM 54MM STRL 12MM LEIBINGER UNV 2 12MM SCR,$550.00,$0.00,$550.00,$0.00,$392.54,$0.00,$0.00,$0.00,$0.00,$0.00,$550.00,$0.00,$275.00,$435.60,$440.00,$0.00,$0.00,$0.00,$0.00,$0.00
60-13570,SUP,Custom 27100030,,60-13570  -  BIT DRILL 12MM STOP 1.3MM 79MM TWIST STERILE,$550.00,$0.00,$550.00,$0.00,$392.54,$0.00,$0.00,$0.00,$0.00,$0.00,$550.00,$0.00,$275.00,$435.60,$440.00,$0.00,$0.00,$0.00,$0.00,$0.00
60-13712,SUP,Custom 27100030,,60-13712  -  BIT DRILL STERILE 12 MM SCREW,$550.00,$0.00,$550.00,$0.00,$392.54,$0.00,$0.00,$0.00,$0.00,$0.00,$550.00,$0.00,$275.00,$435.60,$440.00,$0.00,$0.00,$0.00,$0.00,$0.00
60-14008,SUP,Custom 27100030,,60-14008  -  BIT DRILL 1.4MM 8MM TWIST STERILE,$612.50,$0.00,$612.50,$0.00,$437.14,$0.00,$0.00,$0.00,$0.00,$0.00,$612.50,$0.00,$306.25,$485.10,$490.00,$0.00,$0.00,$0.00,$0.00,$0.00
6014-0812L,SUP,HCPCS C1776,,6014-0812L  -  STEM FEM 255MM 12MM BW RSTOR HYDRXAPT 8 LEFT HIP,"$13,745.88",$0.00,"$13,745.88","$6,185.64","$5,158.80",$0.00,"$2,368.35",$0.00,$0.00,"$2,406.79","$13,745.88",$0.00,"$6,872.94","$10,886.74","$10,996.70",$0.00,"$2,151.23",$0.00,"$2,188.34",$0.00
6014-0812R,SUP,HCPCS C1776,,6014-0812R  -  STEM FEM 255MM 12MM RSTOR HYDRXAPT 8 RIGHT HIP,"$13,745.88",$0.00,"$13,745.88","$6,185.64","$5,158.80",$0.00,"$2,368.35",$0.00,$0.00,"$2,406.79","$13,745.88",$0.00,"$6,872.94","$10,886.74","$10,996.70",$0.00,"$2,151.23",$0.00,"$2,188.34",$0.00
6014-0913L,SUP,HCPCS C1776,,6014-0913L  -  STEM FEM 255MM 13MM BW RSTOR HYDRXAPT 9 LEFT HIP,"$13,745.88",$0.00,"$13,745.88","$6,185.64","$5,158.80",$0.00,"$2,368.35",$0.00,$0.00,"$2,406.79","$13,745.88",$0.00,"$6,872.94","$10,886.74","$10,996.70",$0.00,"$2,151.23",$0.00,"$2,188.34",$0.00
6014-0913R,SUP,HCPCS C1776,,6014-0913R  -  STEM FEM 255MM 13MM BW RSTOR HYDRXAPT 9 RIGHT HIP,"$13,745.88",$0.00,"$13,745.88","$6,185.64","$5,158.80",$0.00,"$2,368.35",$0.00,$0.00,"$2,406.79","$13,745.88",$0.00,"$6,872.94","$10,886.74","$10,996.70",$0.00,"$2,151.23",$0.00,"$2,188.34",$0.00
6014-1014L,SUP,HCPCS C1776,,6014-1014L  -  STEM FEM 255MM 14MM BW RSTOR HYDRXAPT 10 LEFT HIP,"$13,745.88",$0.00,"$13,745.88","$6,185.64","$5,158.80",$0.00,"$2,368.35",$0.00,$0.00,"$2,406.79","$13,745.88",$0.00,"$6,872.94","$10,886.74","$10,996.70",$0.00,"$2,151.23",$0.00,"$2,188.34",$0.00
6014-1014R,SUP,HCPCS C1776,,6014-1014R  -  STEM FEM 255MM 14MM BW RSTOR HYDRXAPT 10 RIGHT HIP,"$13,745.88",$0.00,"$13,745.88","$6,185.64","$5,158.80",$0.00,"$2,368.35",$0.00,$0.00,"$2,406.79","$13,745.88",$0.00,"$6,872.94","$10,886.74","$10,996.70",$0.00,"$2,151.23",$0.00,"$2,188.34",$0.00
6014-1115L,SUP,HCPCS C1776,,6014-1115L  -  STEM FEM 255MM 15MM BW RSTOR HYDRXAPT 11 LEFT HIP,"$13,745.88",$0.00,"$13,745.88","$6,185.64","$5,158.80",$0.00,"$2,368.35",$0.00,$0.00,"$2,406.79","$13,745.88",$0.00,"$6,872.94","$10,886.74","$10,996.70",$0.00,"$2,151.23",$0.00,"$2,188.34",$0.00
6014-1115R,SUP,HCPCS C1776,,6014-1115R  -  STEM FEM 255MM 15MM BW RSTOR HYDRXAPT 11 RIGHT,"$13,745.88",$0.00,"$13,745.88","$6,185.64","$5,158.80",$0.00,"$2,368.35",$0.00,$0.00,"$2,406.79","$13,745.88",$0.00,"$6,872.94","$10,886.74","$10,996.70",$0.00,"$2,151.23",$0.00,"$2,188.34",$0.00
6014-1216L,SUP,HCPCS C1776,,6014-1216L  -  STEM FEM 255MM 16MM BW RSTOR HA 12 LNG LEFT HIP,"$13,745.88",$0.00,"$13,745.88","$6,185.64","$5,158.80",$0.00,"$2,368.35",$0.00,$0.00,"$2,406.79","$13,745.88",$0.00,"$6,872.94","$10,886.74","$10,996.70",$0.00,"$2,151.23",$0.00,"$2,188.34",$0.00
6014-1216R,SUP,HCPCS C1776,,6014-1216R  -  STEM FEM 255MM 16MM BW RSTOR HYDRXAPT 12 RIGHT HIP,"$13,745.88",$0.00,"$13,745.88","$6,185.64","$5,158.80",$0.00,"$2,368.35",$0.00,$0.00,"$2,406.79","$13,745.88",$0.00,"$6,872.94","$10,886.74","$10,996.70",$0.00,"$2,151.23",$0.00,"$2,188.34",$0.00
60-14126,SUP,Custom 27203010,,60-14126  -  BIT DRILL 94MM 1.4MM TWST STOP SHFT END 27MM STRL,$159.50,$0.00,$159.50,$0.00,$113.84,$0.00,$0.00,$0.00,$0.00,$0.00,$159.50,$0.00,$79.75,$126.32,$127.60,$0.00,$0.00,$0.00,$0.00,$0.00
6014-1317L,SUP,HCPCS C1776,,6014-1317L  -  STEM FEM 255MM 17MM BW RSTOR HYDRXAPT 13 LEFT HIP,"$13,745.88",$0.00,"$13,745.88","$6,185.64","$5,158.80",$0.00,"$2,368.35",$0.00,$0.00,"$2,406.79","$13,745.88",$0.00,"$6,872.94","$10,886.74","$10,996.70",$0.00,"$2,151.23",$0.00,"$2,188.34",$0.00
6014-1317R,SUP,HCPCS C1776,,6014-1317R  -  STEM FEM 255MM 17MM BW RSTOR HYDRXAPT 13 RIGHT HIP,"$13,745.88",$0.00,"$13,745.88","$6,185.64","$5,158.80",$0.00,"$2,368.35",$0.00,$0.00,"$2,406.79","$13,745.88",$0.00,"$6,872.94","$10,886.74","$10,996.70",$0.00,"$2,151.23",$0.00,"$2,188.34",$0.00
6014-1418L,SUP,HCPCS C1776,,6014-1418L  -  STEM FEM 255MM 18MM BW RSTOR HYDRXAPT 14 LEFT HIP,"$13,745.88",$0.00,"$13,745.88","$6,185.64","$5,158.80",$0.00,"$2,368.35",$0.00,$0.00,"$2,406.79","$13,745.88",$0.00,"$6,872.94","$10,886.74","$10,996.70",$0.00,"$2,151.23",$0.00,"$2,188.34",$0.00
6014-1418R,SUP,HCPCS C1776,,6014-1418R  -  STEM FEM 255MM 18MM BW RSTOR HYDRXAPT 14 RIGHT HIP,"$13,745.88",$0.00,"$13,745.88","$6,185.64","$5,158.80",$0.00,"$2,368.35",$0.00,$0.00,"$2,406.79","$13,745.88",$0.00,"$6,872.94","$10,886.74","$10,996.70",$0.00,"$2,151.23",$0.00,"$2,188.34",$0.00
60-14326,SUP,Custom 27203010,,60-14326  -  BIT DRILL 87MM 1.4MM TWST AO STRL,$159.50,$0.00,$159.50,$0.00,$113.84,$0.00,$0.00,$0.00,$0.00,$0.00,$159.50,$0.00,$79.75,$126.32,$127.60,$0.00,$0.00,$0.00,$0.00,$0.00
60-14426,SUP,Custom 27203010,,60-14426  -  BIT DRILL 77MM 1.4MM 27MM STOP TWST DNTL SHFT END STRL,$159.50,$0.00,$159.50,$0.00,$113.84,$0.00,$0.00,$0.00,$0.00,$0.00,$159.50,$0.00,$79.75,$126.32,$127.60,$0.00,$0.00,$0.00,$0.00,$0.00
60-15008,SUP,Custom 27100030,,60-15008  -  BIT DRILL 1.5MM 50MM 8MM TWIST STOP STERILE,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
60-15020,SUP,Custom 27100030,,60-15020  -  BIT DRILL TWIST 1.5MM 58MM 20MM STOP STERILE 20MM SCREW,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
6015-0814L,SUP,HCPCS C1776,,6015-0814L  -  STEM FEM 205MM 14MM BW RSTOR HYDRXAPT 8 LEFT HIP,"$13,281.13",$0.00,"$13,281.13","$5,976.51","$5,158.80",$0.00,"$2,288.27",$0.00,$0.00,"$2,325.42","$13,281.13",$0.00,"$6,640.56","$10,518.65","$10,624.90",$0.00,"$2,078.50",$0.00,"$2,114.36",$0.00
6015-0814R,SUP,HCPCS C1776,,6015-0814R  -  STEM FEM 205MM 14MM BW RSTOR HYDRXAPT 8 RIGHT HIP,"$13,281.13",$0.00,"$13,281.13","$5,976.51","$5,158.80",$0.00,"$2,288.27",$0.00,$0.00,"$2,325.42","$13,281.13",$0.00,"$6,640.56","$10,518.65","$10,624.90",$0.00,"$2,078.50",$0.00,"$2,114.36",$0.00
6015-0915L,SUP,HCPCS C1776,,6015-0915L  -  STEM FEM 205MM 15MM BW RSTOR HYDRXAPT 9 LEFT HIP,"$13,281.13",$0.00,"$13,281.13","$5,976.51","$5,158.80",$0.00,"$2,288.27",$0.00,$0.00,"$2,325.42","$13,281.13",$0.00,"$6,640.56","$10,518.65","$10,624.90",$0.00,"$2,078.50",$0.00,"$2,114.36",$0.00
6015-0915R,SUP,HCPCS C1776,,6015-0915R  -  STEM FEM 205MM 15MM BW RSTOR HYDRXAPT 9 RIGHT HIP,"$13,281.13",$0.00,"$13,281.13","$5,976.51","$5,158.80",$0.00,"$2,288.27",$0.00,$0.00,"$2,325.42","$13,281.13",$0.00,"$6,640.56","$10,518.65","$10,624.90",$0.00,"$2,078.50",$0.00,"$2,114.36",$0.00
6015-1016L,SUP,HCPCS C1776,,6015-1016L  -  STEM FEM 205MM 16MM BW RSTOR HYDRXAPT 10 LEFT HIP,"$13,281.13",$0.00,"$13,281.13","$5,976.51","$5,158.80",$0.00,"$2,288.27",$0.00,$0.00,"$2,325.42","$13,281.13",$0.00,"$6,640.56","$10,518.65","$10,624.90",$0.00,"$2,078.50",$0.00,"$2,114.36",$0.00
6015-1016R,SUP,HCPCS C1776,,6015-1016R  -  STEM FEM 205MM 16MM BW RSTOR HYDRXAPT 10 RIGHT HIP,"$13,281.13",$0.00,"$13,281.13","$5,976.51","$5,158.80",$0.00,"$2,288.27",$0.00,$0.00,"$2,325.42","$13,281.13",$0.00,"$6,640.56","$10,518.65","$10,624.90",$0.00,"$2,078.50",$0.00,"$2,114.36",$0.00
60-15105,SUP,Custom 27100030,,60-15105  -  BIT DRILL 5MM STOP 1.5MM 50MM 5MM TWIST STERILE 5MM SCREW,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
6015-1117L,SUP,HCPCS C1776,,6015-1117L  -  STEM FEM 205MM 17MM BW RSTOR HYDRXAPT 11 LEFT HIP,"$13,281.13",$0.00,"$13,281.13","$5,976.51","$5,158.80",$0.00,"$2,288.27",$0.00,$0.00,"$2,325.42","$13,281.13",$0.00,"$6,640.56","$10,518.65","$10,624.90",$0.00,"$2,078.50",$0.00,"$2,114.36",$0.00
6015-1117R,SUP,HCPCS C1776,,6015-1117R  -  STEM FEM 205MM 17MM BW RSTOR HYDRXAPT 11 RIGHT HIP,"$13,281.13",$0.00,"$13,281.13","$5,976.51","$5,158.80",$0.00,"$2,288.27",$0.00,$0.00,"$2,325.42","$13,281.13",$0.00,"$6,640.56","$10,518.65","$10,624.90",$0.00,"$2,078.50",$0.00,"$2,114.36",$0.00
6015-1218L,SUP,HCPCS C1776,,6015-1218L  -  STEM FEM 205MM 18MM BW RSTOR HYDRXAPT 12 LEFT HIP,"$13,281.13",$0.00,"$13,281.13","$5,976.51","$5,158.80",$0.00,"$2,288.27",$0.00,$0.00,"$2,325.42","$13,281.13",$0.00,"$6,640.56","$10,518.65","$10,624.90",$0.00,"$2,078.50",$0.00,"$2,114.36",$0.00
6015-1218R,SUP,HCPCS C1776,,6015-1218R  -  STEM FEM 205 18MM BW RSTOR HYDRXAPT 12 RIGHT HIP,"$13,281.13",$0.00,"$13,281.13","$5,976.51","$5,158.80",$0.00,"$2,288.27",$0.00,$0.00,"$2,325.42","$13,281.13",$0.00,"$6,640.56","$10,518.65","$10,624.90",$0.00,"$2,078.50",$0.00,"$2,114.36",$0.00
6015-1319L,SUP,HCPCS C1776,,6015-1319L  -  STEM FEM 205MM 19MM BW RSTOR HYDRXAPT 13 LEFT HIP,"$13,281.13",$0.00,"$13,281.13","$5,976.51","$5,158.80",$0.00,"$2,288.27",$0.00,$0.00,"$2,325.42","$13,281.13",$0.00,"$6,640.56","$10,518.65","$10,624.90",$0.00,"$2,078.50",$0.00,"$2,114.36",$0.00
6015-1319R,SUP,HCPCS C1776,,6015-1319R  -  STEM FEM 205MM 19MM BW RSTOR HYDRXAPT 13 RIGHT HIP,"$13,281.13",$0.00,"$13,281.13","$5,976.51","$5,158.80",$0.00,"$2,288.27",$0.00,$0.00,"$2,325.42","$13,281.13",$0.00,"$6,640.56","$10,518.65","$10,624.90",$0.00,"$2,078.50",$0.00,"$2,114.36",$0.00
6015-1420L,SUP,HCPCS C1776,,6015-1420L  -  STEM FEM 205MM 20MM BW RSTOR HYDRXAPT 14 LEFT HIP,"$13,281.13",$0.00,"$13,281.13","$5,976.51","$5,158.80",$0.00,"$2,288.27",$0.00,$0.00,"$2,325.42","$13,281.13",$0.00,"$6,640.56","$10,518.65","$10,624.90",$0.00,"$2,078.50",$0.00,"$2,114.36",$0.00
6015-1420R,SUP,HCPCS C1776,,6015-1420R  -  STEM FEM 205MM 20MM BW RSTOR HYDRXAPT 14 RIGHT HIP,"$13,281.13",$0.00,"$13,281.13","$5,976.51","$5,158.80",$0.00,"$2,288.27",$0.00,$0.00,"$2,325.42","$13,281.13",$0.00,"$6,640.56","$10,518.65","$10,624.90",$0.00,"$2,078.50",$0.00,"$2,114.36",$0.00
60-15920,SUP,Custom 27100030,,60-15920  -  BIT DRILL 20MM STOP 1.5MM 107MM TWIST STERILE,$762.50,$0.00,$762.50,$0.00,$544.20,$0.00,$0.00,$0.00,$0.00,$0.00,$762.50,$0.00,$381.25,$603.90,$610.00,$0.00,$0.00,$0.00,$0.00,$0.00
60-15998,SUP,Custom 27203010,,60-15998  -  DRILL TWST 1.5MM 19MM 8MM,$827.50,$0.00,$827.50,$0.00,$590.59,$0.00,$0.00,$0.00,$0.00,$0.00,$827.50,$0.00,$413.75,$655.38,$662.00,$0.00,$0.00,$0.00,$0.00,$0.00
60-16005,SUP,Custom 27203010,,60-16005  -  BIT DRILL 50MM 1.6MM 5MM STOP TWST 5MM STRL,$268.13,$0.00,$268.13,$0.00,$191.36,$0.00,$0.00,$0.00,$0.00,$0.00,$268.13,$0.00,$134.06,$212.36,$214.50,$0.00,$0.00,$0.00,$0.00,$0.00
60-16007,SUP,Custom 27203010,,60-16007  -  DRILL TWST 1.6MM 50MM STRL 7MM STP,$570.00,$0.00,$570.00,$0.00,$406.81,$0.00,$0.00,$0.00,$0.00,$0.00,$570.00,$0.00,$285.00,$451.44,$456.00,$0.00,$0.00,$0.00,$0.00,$0.00
60-16035,SUP,Custom 27100030,,60-16035  -  BIT DRILL 1.6MM 115MM TWIST NONSTRL 20MM SCREW,$642.50,$0.00,$642.50,$0.00,$458.55,$0.00,$0.00,$0.00,$0.00,$0.00,$642.50,$0.00,$321.25,$508.86,$514.00,$0.00,$0.00,$0.00,$0.00,$0.00
60-16050,SUP,Custom 27100030,,60-16050  -  BIT DRILL 1.6MM 125MM PILOT SHAFT END STERILE 50MM SCREW,$682.50,$0.00,$682.50,$0.00,$487.10,$0.00,$0.00,$0.00,$0.00,$0.00,$682.50,$0.00,$341.25,$540.54,$546.00,$0.00,$0.00,$0.00,$0.00,$0.00
60-16407,SUP,Custom 27100030,,60-16407  -  BIT DRL 1.6MM 50MM NS 7MM DNTL SHFT END 2/2.3MM SCR,$592.50,$0.00,$592.50,$0.00,$422.87,$0.00,$0.00,$0.00,$0.00,$0.00,$592.50,$0.00,$296.25,$469.26,$474.00,$0.00,$0.00,$0.00,$0.00,$0.00
60-16435,SUP,Custom 27100030,,60-16435  -  BIT DRL 1.6MM 115MM NS 20MM DNTL SHFT END 2/2.3MM SCR,$682.50,$0.00,$682.50,$0.00,$487.10,$0.00,$0.00,$0.00,$0.00,$0.00,$682.50,$0.00,$341.25,$540.54,$546.00,$0.00,$0.00,$0.00,$0.00,$0.00
60-16526,SUP,Custom 27203010,,60-16526  -  BIT DRILL TWIST 1.6MM 58MM 20MM STOP LEIBINGER HAND STERILE,$600.00,$0.00,$600.00,$0.00,$428.22,$0.00,$0.00,$0.00,$0.00,$0.00,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$0.00,$0.00,$0.00,$0.00
60-16535,SUP,Custom 27100030,,60-16535  -  BIT DRILL TWIST 1.6MM 85MM 26MM STOP STERILE 20MM SCREW,$600.00,$0.00,$600.00,$0.00,$428.22,$0.00,$0.00,$0.00,$0.00,$0.00,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$0.00,$0.00,$0.00,$0.00
60-16908,SUP,Custom 27100030,,60-16908  -  BIT DRILL 90D 8MM STOP 1.6MM 19MM 8MM DENTAL END STERILE 8MM,$507.50,$0.00,$507.50,$0.00,$362.20,$0.00,$0.00,$0.00,$0.00,$0.00,$507.50,$0.00,$253.75,$401.94,$406.00,$0.00,$0.00,$0.00,$0.00,$0.00
60-16918,SUP,Custom 27100030,,60-16918  -  BIT DRL 1.6MM 29MM NS 18MM DNTL SHFT END 2/2.3MM SCR,$507.50,$0.00,$507.50,$0.00,$362.20,$0.00,$0.00,$0.00,$0.00,$0.00,$507.50,$0.00,$253.75,$401.94,$406.00,$0.00,$0.00,$0.00,$0.00,$0.00
6017-0425A,SUP,HCPCS C1776,,6017-0425A  -  STEM FEMORAL 4 25MM C TAPER OMNIFIT HYDRXAPT HIP,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6017-0525A,SUP,HCPCS C1776,,6017-0525A  -  STEM FEMORAL 5 25MM C TAPER OMNIFIT HYDRXAPT HIP,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6017-0625A,SUP,HCPCS C1776,,6017-0625A  -  STEM FEMORAL 6 25MM C TAPER OMNIFIT HYDRXAPT HIP,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6017-0730A,SUP,HCPCS C1776,,6017-0730A  -  STEM FEMORAL 7 30MM C TAPER OMNIFIT HYDRXAPT HIP,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6017-0830A,SUP,HCPCS C1776,,6017-0830A  -  STEM FEMORAL 8 30MM C TAPER OMNIFIT HYDRXAPT HIP,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6017-0935A,SUP,HCPCS C1776,,6017-0935A  -  STEM FEMORAL 9 35MM C TAPER OMNIFIT HA HIP,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6017-1035A,SUP,HCPCS C1776,,6017-1035A  -  STEM FEMORAL 10 35MM C TAPER OMNIFIT HYDRXAPT HIP,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6017-1140A,SUP,HCPCS C1776,,6017-1140A  -  STEM FEMORAL 11 40MM C TAPER OMNIFIT HYDRXAPT HIP,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6017-1240A,SUP,HCPCS C1776,,6017-1240A  -  STEM FEMORAL 12 40MM C TAPER OMNIFIT HYDRXAPT HIP,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6017-1340A,SUP,HCPCS C1776,,6017-1340A  -  STEM FEMORAL 13 40MM C TAPER OMNIFIT HYDRXAPT HIP,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6017-1440A,SUP,HCPCS C1776,,6017-1440A  -  STEM FEMORAL 14 40MM C TAPER OMNIFIT HYDRXAPT HIP,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6018-0814,SUP,HCPCS C1776,,6018-0814  -  STEM FEMORAL 1.5 14MM 205MM RSTOR HYDRXAPT CALCAR HIP,"$15,140.00",$0.00,"$15,140.00","$6,813.00","$5,158.80",$0.00,"$2,608.55",$0.00,$0.00,"$2,650.89","$15,140.00",$0.00,"$7,570.00","$11,990.88","$12,112.00",$0.00,"$2,369.41",$0.00,"$2,410.29",$0.00
6018-0915,SUP,HCPCS C1776,,6018-0915  -  STEM FEMORAL 9 15MM 205MM REPLACEMENT RESECTION LEVEL SYSTEM,"$15,140.00",$0.00,"$15,140.00","$6,813.00","$5,158.80",$0.00,"$2,608.55",$0.00,$0.00,"$2,650.89","$15,140.00",$0.00,"$7,570.00","$11,990.88","$12,112.00",$0.00,"$2,369.41",$0.00,"$2,410.29",$0.00
6018-1016,SUP,HCPCS C1776,,6018-1016  -  STEM FEMORAL 10 16MM 205MM REPLACEMENT RESECTION LEVEL,"$15,140.00",$0.00,"$15,140.00","$6,813.00","$5,158.80",$0.00,"$2,608.55",$0.00,$0.00,"$2,650.89","$15,140.00",$0.00,"$7,570.00","$11,990.88","$12,112.00",$0.00,"$2,369.41",$0.00,"$2,410.29",$0.00
6018-1117,SUP,HCPCS C1776,,6018-1117  -  STEM FEMORAL 11 17MM 205MM REVISION RSTOR HYDRXAPT CALCAR,"$15,140.00",$0.00,"$15,140.00","$6,813.00","$5,158.80",$0.00,"$2,608.55",$0.00,$0.00,"$2,650.89","$15,140.00",$0.00,"$7,570.00","$11,990.88","$12,112.00",$0.00,"$2,369.41",$0.00,"$2,410.29",$0.00
6018-1218,SUP,HCPCS C1776,,6018-1218  -  STEM FEMORAL 12 18MM 205MM RSTOR HYDRXAPT CALCAR HIP,"$15,140.00",$0.00,"$15,140.00","$6,813.00","$5,158.80",$0.00,"$2,608.55",$0.00,$0.00,"$2,650.89","$15,140.00",$0.00,"$7,570.00","$11,990.88","$12,112.00",$0.00,"$2,369.41",$0.00,"$2,410.29",$0.00
6018-1319,SUP,HCPCS C1776,,6018-1319  -  STEM FEMORAL 13 19MM 205MM REVISION RSTOR HYDRXAPT CALCAR,"$15,140.00",$0.00,"$15,140.00","$6,813.00","$5,158.80",$0.00,"$2,608.55",$0.00,$0.00,"$2,650.89","$15,140.00",$0.00,"$7,570.00","$11,990.88","$12,112.00",$0.00,"$2,369.41",$0.00,"$2,410.29",$0.00
6018-1420,SUP,HCPCS C1776,,6018-1420  -  STEM FEMORAL 14 20MM 205MM REVISION RSTOR HYDRXAPT CALCAR,"$15,140.00",$0.00,"$15,140.00","$6,813.00","$5,158.80",$0.00,"$2,608.55",$0.00,$0.00,"$2,650.89","$15,140.00",$0.00,"$7,570.00","$11,990.88","$12,112.00",$0.00,"$2,369.41",$0.00,"$2,410.29",$0.00
60-19035,SUP,Custom 27100030,,60-19035  -  BIT DRILL TWIST 1.9MM 115MM 35MM SHAFT END STOP STERILE,$717.50,$0.00,$717.50,$0.00,$512.08,$0.00,$0.00,$0.00,$0.00,$0.00,$717.50,$0.00,$358.75,$568.26,$574.00,$0.00,$0.00,$0.00,$0.00,$0.00
6019-0814,SUP,HCPCS C1776,,6019-0814  -  STEM FEM 205MM 14MM RSTOR HYDRXAPT 3 CLCR HIP,"$13,979.88",$0.00,"$13,979.88","$6,290.94","$5,158.80",$0.00,"$2,408.66",$0.00,$0.00,"$2,447.76","$13,979.88",$0.00,"$6,989.94","$11,072.06","$11,183.90",$0.00,"$2,187.85",$0.00,"$2,225.60",$0.00
6019-0915,SUP,HCPCS C1776,,6019-0915  -  STEM FEM RSTOR HYDRXAPT 3 CLCR,"$13,979.88",$0.00,"$13,979.88","$6,290.94","$5,158.80",$0.00,"$2,408.66",$0.00,$0.00,"$2,447.76","$13,979.88",$0.00,"$6,989.94","$11,072.06","$11,183.90",$0.00,"$2,187.85",$0.00,"$2,225.60",$0.00
6019-1016,SUP,HCPCS C1776,,6019-1016  -  STEM FEM 205MM 16MM RSTOR HYDRXAPT 3 CLCR HIP,"$13,979.88",$0.00,"$13,979.88","$6,290.94","$5,158.80",$0.00,"$2,408.66",$0.00,$0.00,"$2,447.76","$13,979.88",$0.00,"$6,989.94","$11,072.06","$11,183.90",$0.00,"$2,187.85",$0.00,"$2,225.60",$0.00
6019-1117,SUP,HCPCS C1776,,6019-1117  -  STEM FEM 205MM 17MM REV RSTOR HYDRXAPT 11 CLCR HIP,"$13,979.88",$0.00,"$13,979.88","$6,290.94","$5,158.80",$0.00,"$2,408.66",$0.00,$0.00,"$2,447.76","$13,979.88",$0.00,"$6,989.94","$11,072.06","$11,183.90",$0.00,"$2,187.85",$0.00,"$2,225.60",$0.00
6019-1218,SUP,HCPCS C1776,,6019-1218  -  STEM FEM 205MM 18MM REV RSTOR HYDRXAPT 12 CLCR HIP,"$13,979.88",$0.00,"$13,979.88","$6,290.94","$5,158.80",$0.00,"$2,408.66",$0.00,$0.00,"$2,447.76","$13,979.88",$0.00,"$6,989.94","$11,072.06","$11,183.90",$0.00,"$2,187.85",$0.00,"$2,225.60",$0.00
60-19126,SUP,Custom 27203010,,60-19126  -  DRILL TWST 1.9MM 27MM STRYK END,$159.50,$0.00,$159.50,$0.00,$113.84,$0.00,$0.00,$0.00,$0.00,$0.00,$159.50,$0.00,$79.75,$126.32,$127.60,$0.00,$0.00,$0.00,$0.00,$0.00
6019-1319,SUP,HCPCS C1776,,6019-1319  -  STEM FEM 205MM 19MM REV RSTOR HYDRXAPT 13 CLCR HIP,"$13,979.88",$0.00,"$13,979.88","$6,290.94","$5,158.80",$0.00,"$2,408.66",$0.00,$0.00,"$2,447.76","$13,979.88",$0.00,"$6,989.94","$11,072.06","$11,183.90",$0.00,"$2,187.85",$0.00,"$2,225.60",$0.00
60-19140,SUP,Custom 27203010,,60-19140  -  BIT DRILL 108MM 1.9MM VARIAX TWST SHFT END,$166.38,$0.00,$166.38,$0.00,$118.74,$0.00,$0.00,$0.00,$0.00,$0.00,$166.38,$0.00,$83.19,$131.77,$133.10,$0.00,$0.00,$0.00,$0.00,$0.00
6019-1420,SUP,HCPCS C1776,,6019-1420  -  STEM FEM 205MM 20MM REV RSTOR HYDRXAPT 14 CLCR HIP,"$13,979.88",$0.00,"$13,979.88","$6,290.94","$5,158.80",$0.00,"$2,408.66",$0.00,$0.00,"$2,447.76","$13,979.88",$0.00,"$6,989.94","$11,072.06","$11,183.90",$0.00,"$2,187.85",$0.00,"$2,225.60",$0.00
60-19326,SUP,Custom 27203010,,60-19326  -  BIT DRILL 87MM 1.9MM 27MM STOP TWST AO SHFT END STRL,$159.50,$0.00,$159.50,$0.00,$113.84,$0.00,$0.00,$0.00,$0.00,$0.00,$159.50,$0.00,$79.75,$126.32,$127.60,$0.00,$0.00,$0.00,$0.00,$0.00
60-19340,SUP,Custom 27203010,,60-19340  -  BIT DRILL 105MM 1.9MM VARIAX DISTAL AO SHFT END RAD NONSTRL,$166.38,$0.00,$166.38,$0.00,$118.74,$0.00,$0.00,$0.00,$0.00,$0.00,$166.38,$0.00,$83.19,$131.77,$133.10,$0.00,$0.00,$0.00,$0.00,$0.00
60-19426,SUP,Custom 27203010,,60-19426  -  BIT DRILL 77MM 1.9MM TWST DNTL SHFT END DISP,$159.50,$0.00,$159.50,$0.00,$113.84,$0.00,$0.00,$0.00,$0.00,$0.00,$159.50,$0.00,$79.75,$126.32,$127.60,$0.00,$0.00,$0.00,$0.00,$0.00
60-19435,SUP,Custom 27100030,,60-19435  -  DRILL TWIST 1.9MM 115MM 35MM STOP STERILE 2.3MM SCREW,$765.00,$0.00,$765.00,$0.00,$545.98,$0.00,$0.00,$0.00,$0.00,$0.00,$765.00,$0.00,$382.50,$605.88,$612.00,$0.00,$0.00,$0.00,$0.00,$0.00
60-19440,SUP,Custom 27203010,,60-19440  -  BIT DRILL 91MM 1.9MM 41MM STOP TWST DNTL SHFT END STRL,$185.63,$0.00,$185.63,$0.00,$132.48,$0.00,$0.00,$0.00,$0.00,$0.00,$185.63,$0.00,$92.81,$147.02,$148.50,$0.00,$0.00,$0.00,$0.00,$0.00
60-19526,SUP,Custom 27203010,,60-19526  -  BIT DRILL 1.9MM 58MM SHAFT END STERILE 20MM SCREW,$710.00,$0.00,$710.00,$0.00,$506.73,$0.00,$0.00,$0.00,$0.00,$0.00,$710.00,$0.00,$355.00,$562.32,$568.00,$0.00,$0.00,$0.00,$0.00,$0.00
60-19535,SUP,Custom 27100030,,60-19535  -  BIT DRILL 1.9MM 85MM SHAFT END STERILE 20MM SCREW,$552.50,$0.00,$552.50,$0.00,$394.32,$0.00,$0.00,$0.00,$0.00,$0.00,$552.50,$0.00,$276.25,$437.58,$442.00,$0.00,$0.00,$0.00,$0.00,$0.00
60-19908,SUP,Custom 27100030,,60-19908  -  BIT DRILL 90D 8MM STOP 1.9MM 19MM DENTAL END STERILE 8MM,$507.50,$0.00,$507.50,$0.00,$362.20,$0.00,$0.00,$0.00,$0.00,$0.00,$507.50,$0.00,$253.75,$401.94,$406.00,$0.00,$0.00,$0.00,$0.00,$0.00
60-19918,SUP,Custom 27100030,,60-19918  -  BIT DRILL 90D 18MM STOP 1.9MM 29MM DENTAL END STERILE 18MM,$507.50,$0.00,$507.50,$0.00,$362.20,$0.00,$0.00,$0.00,$0.00,$0.00,$507.50,$0.00,$253.75,$401.94,$406.00,$0.00,$0.00,$0.00,$0.00,$0.00
6020-0030,SUP,HCPCS C1776,,6020-0030  -  STEM FEMORAL 132D 0 33MM OFFST 86MM 30MM CEMENTLESS NECK,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
60-20012,SUP,Custom 27100030,,60-20012  -  BIT DRILL TWIST 2MM 62MM 13MM REPOSITION PIN STOP STERILE,$670.00,$0.00,$670.00,$0.00,$478.18,$0.00,$0.00,$0.00,$0.00,$0.00,$670.00,$0.00,$335.00,$530.64,$536.00,$0.00,$0.00,$0.00,$0.00,$0.00
6020-0130,SUP,HCPCS C1776,,6020-0130  -  STEM FEMORAL 132D 1 34MM OFFST 110MM 30MM CEMENTLESS NECK,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6020-0230,SUP,HCPCS C1776,,6020-0230  -  STEM FEMORAL 130D 2 35MM OFFST 115MM 30MM CEMENTLESS NECK,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6020-0335,SUP,HCPCS C1776,,6020-0335  -  STEM FEMORAL 132D 3 39MM OFFST 120MM 35MM CEMENTLESS NECK,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6020-0435,SUP,HCPCS C1776,,6020-0435  -  STEM FEMORAL 132D 4 40MM OFFST 125MM 35MM CEMENTLESS NECK,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
60-20050,SUP,Custom 27100030,,60-20050  -  BIT DRL 2MM 125MM NS 50MM STRYK SHFT END 2MM LG SCR,$785.00,$0.00,$785.00,$0.00,$560.25,$0.00,$0.00,$0.00,$0.00,$0.00,$785.00,$0.00,$392.50,$621.72,$628.00,$0.00,$0.00,$0.00,$0.00,$0.00
6020-0537,SUP,HCPCS C1776,,6020-0537  -  STEM FEMORAL 132D 5 44MM OFFST 130MM 37MM CEMENTLESS NECK,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6020-0637,SUP,HCPCS C1776,,6020-0637  -  STEM FEMORAL 132D 6 45MM OFFST 135MM 37MM CEMENTLESS NECK,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6020-0740,SUP,HCPCS C1776,,6020-0740  -  STEM FEMORAL 132D 7 48MM OFFST 140MM 40MM CEMENTLESS NECK,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6020-0840,SUP,HCPCS C1776,,6020-0840  -  STEM FEMORAL 132D 8 49MM OFFST 145MM 40MM CEMENTLESS NECK,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
60-20185,SUP,Custom 27203010,,60-20185  -  BIT DRILL 100MM 2MM 40MM STOP TWST DNTL SHFT END STRL,$166.38,$0.00,$166.38,$0.00,$118.74,$0.00,$0.00,$0.00,$0.00,$0.00,$166.38,$0.00,$83.19,$131.77,$133.10,$0.00,$0.00,$0.00,$0.00,$0.00
6020-2530,SUP,HCPCS C1776,,6020-2530  -  STEM FEMORAL 132D 2.5 36MM OFFST 118MM 30MM CEMENTLESS NECK,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6020-3535,SUP,HCPCS C1776,,6020-3535  -  STEM FEMORAL 132D 3.5 39MM OFFST 124MM 35MM CEMENTLESS NECK,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
60-20385,SUP,Custom 27203010,,60-20385  -  DRILL TWST 2MM 105MM STRL 40MM AO SHFT END STP DIST VARIAX,$166.38,$0.00,$166.38,$0.00,$118.74,$0.00,$0.00,$0.00,$0.00,$0.00,$166.38,$0.00,$83.19,$131.77,$133.10,$0.00,$0.00,$0.00,$0.00,$0.00
6020-4535,SUP,HCPCS C1776,,6020-4535  -  STEM FEMORAL 132D 4.5 41MM OFFST 129MM 35MM CEMENTLESS NECK,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
60-20485,SUP,Custom 27203010,,60-20485  -  BIT DRILL 100MM 2MM 40MM STOP TWST DNTL SHFT END STRL,$165.00,$0.00,$165.00,$0.00,$117.76,$0.00,$0.00,$0.00,$0.00,$0.00,$165.00,$0.00,$82.50,$130.68,$132.00,$0.00,$0.00,$0.00,$0.00,$0.00
6020-5537,SUP,HCPCS C1776,,6020-5537  -  STEM FEMORAL 132D 5.5 45MM OFFST 133MM 37MM CEMENTLESS NECK,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6021-0030,SUP,HCPCS C1776,,6021-0030  -  STEM FEMORAL 127D 0 37MM OFFST 86MM 30MM CEMENTLESS NECK,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6021-0130,SUP,HCPCS C1776,,6021-0130  -  STEM FEMORAL 127D 1 38MM OFFST 110MM 30MM CEMENTLESS NECK,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6021-0230,SUP,HCPCS C1776,,6021-0230  -  STEM FEMORAL 127D 2 39MM OFFST 115MM 30MM CEMENTLESS NECK,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6021-0335,SUP,HCPCS C1776,,6021-0335  -  STEM FEMORAL 127D 3 43MM OFFST 120MM 35MM CEMENTLESS NECK,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6021-0435,SUP,HCPCS C1776,,6021-0435  -  STEM FEMORAL 127D 4 44MM OFFST 125MM 35MM CEMENTLESS NECK,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6021-0537,SUP,HCPCS C1776,,6021-0537  -  STEM FEMORAL 127D 5 48MM OFFST 130MM 37MM CEMENTLESS NECK,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6021-0637,SUP,HCPCS C1776,,6021-0637  -  STEM FEMORAL 127D 6 49MM OFFST 135MM 37MM CEMENTLESS NECK,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6021-0740,SUP,HCPCS C1776,,6021-0740  -  STEM FEMORAL 127D 7 53MM OFFST 140MM 40MM CEMENTLESS NECK,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6021-0840,SUP,HCPCS C1776,,6021-0840  -  STEM FEMORAL 127D 8 54MM OFFST 145MM 40MM CEMENTLESS NECK,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6021-2530,SUP,HCPCS C1776,,6021-2530  -  STEM FEMORAL 127D 2.5 40MM OFFST 118MM 30MM CEMENTLESS NECK,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6021-3535,SUP,HCPCS C1776,,6021-3535  -  STEM FEMORAL 127D 3.5 43MM OFFST 124MM 35MM CEMENTLESS NECK,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6021-4535,SUP,HCPCS C1776,,6021-4535  -  STEM FEMORAL 127D 4.5 45MM OFFST 129MM 35MM CEMENTLESS NECK,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6021-5537,SUP,HCPCS C1776,,6021-5537  -  STEM FEMORAL 127D 5.5 49MM OFFST 133MM 37MM CEMENTLESS NECK,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
60-23141,SUP,Custom 27203010,,60-23141  -  DRILL TWST 2.3MM,$165.00,$0.00,$165.00,$0.00,$117.76,$0.00,$0.00,$0.00,$0.00,$0.00,$165.00,$0.00,$82.50,$130.68,$132.00,$0.00,$0.00,$0.00,$0.00,$0.00
60-23341,SUP,Custom 27203010,,60-23341  -  DRILL TWST 2.3MM VARIAX DISTAL AO SHFT END RAD STRL,$171.88,$0.00,$171.88,$0.00,$122.67,$0.00,$0.00,$0.00,$0.00,$0.00,$171.88,$0.00,$85.94,$136.13,$137.50,$0.00,$0.00,$0.00,$0.00,$0.00
60-23441,SUP,Custom 27203010,,60-23441  -  DRILL TWST 2.3MM DNTL SHFT END,$165.00,$0.00,$165.00,$0.00,$117.76,$0.00,$0.00,$0.00,$0.00,$0.00,$165.00,$0.00,$82.50,$130.68,$132.00,$0.00,$0.00,$0.00,$0.00,$0.00
60-25126,SUP,Custom 27203010,,60-25126  -  BIT DRILL 94MM 2.5MM 26MM STOP TWST STRL,$159.50,$0.00,$159.50,$0.00,$113.84,$0.00,$0.00,$0.00,$0.00,$0.00,$159.50,$0.00,$79.75,$126.32,$127.60,$0.00,$0.00,$0.00,$0.00,$0.00
60-25326,SUP,Custom 27203010,,60-25326  -  BIT DRILL 87MM 2.5MM PRFL HAND MDLR AO SHFT END 26MM SM FRAG,$159.50,$0.00,$159.50,$0.00,$113.84,$0.00,$0.00,$0.00,$0.00,$0.00,$159.50,$0.00,$79.75,$126.32,$127.60,$0.00,$0.00,$0.00,$0.00,$0.00
60-25426,SUP,Custom 27203010,,60-25426  -  DRILL TWST 25MM 27MM WKG LN,$159.50,$0.00,$159.50,$0.00,$113.84,$0.00,$0.00,$0.00,$0.00,$0.00,$159.50,$0.00,$79.75,$126.32,$127.60,$0.00,$0.00,$0.00,$0.00,$0.00
602640S,SUP,HCPCS C1713,,602640S  -  SCREW BN THRD 6.5MM 40MM STRL 20MM ASNS III CNN THRD TI HIP,$604.00,$0.00,$604.00,$271.80,$431.07,$0.00,$104.07,$0.00,$0.00,$105.76,$604.00,$0.00,$302.00,$478.37,$483.20,$0.00,$94.53,$0.00,$96.16,$0.00
6033-0425,SUP,HCPCS C1776,,6033-0425  -  STEM FEMORAL 4 25MM CEMENTED COLLARLESS NORMALIZE OMNIFIT,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
6033-0525,SUP,HCPCS C1776,,6033-0525  -  STEM FEMORAL 5 25MM CEMENTED COLLARLESS NORMALIZE OMNIFIT,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
6033-0625,SUP,HCPCS C1776,,6033-0625  -  STEM FEMORAL 6 25MM CEMENTED COLLARLESS NORMALIZE OMNIFIT,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
6033-0730,SUP,HCPCS C1776,,6033-0730  -  STEM FEMORAL 7 30MM CEMENTED COLLARLESS NORMALIZE OMNIFIT,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
6033-0830,SUP,HCPCS C1776,,6033-0830  -  STEM FEMORAL 8 30MM CEMENTED COLLARLESS NORMALIZE OMNIFIT,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
6033-0935,SUP,HCPCS C1776,,6033-0935  -  STEM FEMORAL 9 35MM CEMENTED COLLARLESS NORMALIZE OMNIFIT,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
6033-1035,SUP,HCPCS C1776,,6033-1035  -  STEM FEMORAL 10 35MM CEMENTED COLLARLESS NORMALIZE OMNIFIT,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
6033-1140,SUP,HCPCS C1776,,6033-1140  -  STEM FEMORAL 11 40MM CEMENTED COLLARLESS NORMALIZE OMNIFIT,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
6033-1240,SUP,HCPCS C1776,,6033-1240  -  STEM FEMORAL 12 40MM CEMENTED COLLARLESS NORMALIZE OMNIFIT,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
6033-1340,SUP,HCPCS C1776,,6033-1340  -  STEM FEMORAL 13 40MM CEMENTED COLLARLESS NORMALIZE OMNIFIT,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
6034-0425,SUP,HCPCS C1776,,6034-0425  -  STEM FEMORAL 4 25MM CEMENTED COLLAR NORMALIZE OMNIFIT HIP,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
6034-0525,SUP,HCPCS C1776,,6034-0525  -  STEM FEMORAL 5 25MM CEMENTED COLLAR NORMALIZE OMNIFIT HIP,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
6034-0625,SUP,HCPCS C1776,,6034-0625  -  STEM FEMORAL 6 25MM CEMENTED COLLAR NORMALIZE OMNIFIT HIP,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
6034-0730,SUP,HCPCS C1776,,6034-0730  -  STEM FEMORAL 7 30MM CEMENTED COLLAR NORMALIZE OMNIFIT HIP,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
6034-0830,SUP,HCPCS C1776,,6034-0830  -  STEM FEMORAL 8 30MM CEMENTED COLLAR NORMALIZE OMNIFIT HIP,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
6034-0935,SUP,HCPCS C1776,,6034-0935  -  STEM FEMORAL 9 35MM CEMENTED COLLAR NORMALIZE OMNIFIT HIP,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
6034-1035,SUP,HCPCS C1776,,6034-1035  -  STEM FEMORAL 10 35MM CEMENTED COLLAR NORMALIZE OMNIFIT HIP,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
6034-1140,SUP,HCPCS C1776,,6034-1140  -  STEM FEMORAL 11 40MM CEMENTED COLLAR NORMALIZE OMNIFIT HIP,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
6034-1240,SUP,HCPCS C1776,,6034-1240  -  STEM FEMORAL 12 40MM CEMENTED COLLAR NORMALIZE OMNIFIT HIP,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
6034-1340,SUP,HCPCS C1776,,6034-1340  -  STEM FEMORAL 13 40MM CEMENTED COLLAR NORMALIZE OMNIFIT HIP,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
6041-1140,SUP,HCPCS C1776,,6041-1140  -  STEM FEM 40MM OMFT HYDRXAPT 11 HIP,"$5,592.00",$0.00,"$5,592.00","$2,516.40","$3,991.01",$0.00,$963.47,$0.00,$0.00,$979.11,"$5,592.00",$0.00,"$2,796.00","$4,428.86","$4,473.60",$0.00,$875.15,$0.00,$890.25,$0.00
6041-1240,SUP,HCPCS C1776,,6041-1240  -  STEM FEM 40MM 12MM MRS TPR OSTNC HYDRXAPT HIP,"$5,592.00",$0.00,"$5,592.00","$2,516.40","$3,991.01",$0.00,$963.47,$0.00,$0.00,$979.11,"$5,592.00",$0.00,"$2,796.00","$4,428.86","$4,473.60",$0.00,$875.15,$0.00,$890.25,$0.00
6046-0625,SUP,HCPCS C1776,,6046-0625  -  STEM FEM OMFLX HYDRXAPT 6 HIP,"$6,546.00",$0.00,"$6,546.00","$2,945.70","$4,671.88",$0.00,"$1,127.84",$0.00,$0.00,"$1,146.15","$6,546.00",$0.00,"$3,273.00","$5,184.43","$5,236.80",$0.00,"$1,024.45",$0.00,"$1,042.12",$0.00
6046-0830,SUP,HCPCS C1776,,6046-0830  -  STEM FEM OMFLX HYDRXAPT 8 HIP,"$6,546.00",$0.00,"$6,546.00","$2,945.70","$4,671.88",$0.00,"$1,127.84",$0.00,$0.00,"$1,146.15","$6,546.00",$0.00,"$3,273.00","$5,184.43","$5,236.80",$0.00,"$1,024.45",$0.00,"$1,042.12",$0.00
6046-1440,SUP,HCPCS C1776,,6046-1440  -  STEM FEM OMFLX HYDRXAPT 14 HIP,"$6,546.00",$0.00,"$6,546.00","$2,945.70","$4,671.88",$0.00,"$1,127.84",$0.00,$0.00,"$1,146.15","$6,546.00",$0.00,"$3,273.00","$5,184.43","$5,236.80",$0.00,"$1,024.45",$0.00,"$1,042.12",$0.00
6048-58,SUP,Custom 27203010,,6048-58  -  KIT STYLET BLUNT STR .014IN 58CM LEAD KNOB GREEN,$77.50,$0.00,$77.50,$0.00,$55.31,$0.00,$0.00,$0.00,$0.00,$0.00,$77.50,$0.00,$38.75,$61.38,$62.00,$0.00,$0.00,$0.00,$0.00,$0.00
6050-0530,SUP,HCPCS C1776,,6050-0530  -  STEM FEMORAL 5 30MM HEAD NECK OMNIFIT HIP,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
6050-0735,SUP,HCPCS C1776,,6050-0735  -  IMPLANT KN 69 68.9MM ANT/POSTERIORX70.1MM MEDI STRL IB2MKS,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
6050-0745,SUP,HCPCS C1776,,6050-0745  -  STEM FEMORAL 7 45MM CEMENTED HEAD/NECK OMNIFIT HIP,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
6050-0935,SUP,HCPCS C1776,,6050-0935  -  STEM FEMORAL 9 C TAPER 12MM 160MM 35MM OMNIFIT HEAD NECK HIP,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
6050-0945,SUP,HCPCS C1776,,6050-0945  -  STEM FEMORAL 9 45MM 160MM CEMENTED HEAD/NECK OMNIFIT HIP,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
6050-0955,SUP,HCPCS C1776,,6050-0955  -  STEM FEMORAL 55MM 55MM 9MM HEAD NECK OMNIFIT HIP,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
6050-1135,SUP,HCPCS C1776,,6050-1135  -  STEM FEMORAL 11 CEMENT OMNIFIT HIP,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
6051-0425A,SUP,HCPCS C1776,,6051-0425A  -  STEM FEM 100MM 8.1MM CMNTLS SECFIT HYDRXAPT 4 25MM HIP,"$6,665.00",$0.00,"$6,665.00","$2,999.25","$4,756.81",$0.00,"$1,148.35",$0.00,$0.00,"$1,166.99","$6,665.00",$0.00,"$3,332.50","$5,278.68","$5,332.00",$0.00,"$1,043.07",$0.00,"$1,061.07",$0.00
6051-0425S,SUP,HCPCS C1776,,6051-0425S  -  STEM FEMORAL 132D 4 29MM OFFST 8.1MM 100MM 25MM NECK SECFIT,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6051-0525A,SUP,HCPCS C1776,,6051-0525A  -  STEM FEM 110MM 8.9MM CMNTLS SECFIT HYDRXAPT 5 25MM HIP,"$6,328.00",$0.00,"$6,328.00","$2,847.60","$4,516.29",$0.00,"$1,090.28",$0.00,$0.00,"$1,107.98","$6,328.00",$0.00,"$3,164.00","$5,011.78","$5,062.40",$0.00,$990.33,$0.00,"$1,007.42",$0.00
6051-0525S,SUP,HCPCS C1776,,6051-0525S  -  STEM FEMORAL 132D 5 29MM OFFST 8.9MM 110MM 25MM NECK SECFIT,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6051-0625A,SUP,HCPCS C1776,,6051-0625A  -  STEM FEM CMNTLS CTPR CLRLS SECFIT HYDRXAPT 6 25MM HIP,"$6,328.00",$0.00,"$6,328.00","$2,847.60","$4,516.29",$0.00,"$1,090.28",$0.00,$0.00,"$1,107.98","$6,328.00",$0.00,"$3,164.00","$5,011.78","$5,062.40",$0.00,$990.33,$0.00,"$1,007.42",$0.00
6051-0625S,SUP,HCPCS C1776,,6051-0625S  -  STEM FEMORAL 132D 6 30MM OFFST 9.6MM 120MM 25MM NECK SECFIT,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6051-0730A,SUP,HCPCS C1776,,6051-0730A  -  STEM FEM 7 10.4MM 13CM 30MM SCRFT BS NK DIST TIP HA HIP,"$6,328.00",$0.00,"$6,328.00","$2,847.60","$4,516.29",$0.00,"$1,090.28",$0.00,$0.00,"$1,107.98","$6,328.00",$0.00,"$3,164.00","$5,011.78","$5,062.40",$0.00,$990.33,$0.00,"$1,007.42",$0.00
6051-0730S,SUP,HCPCS C1776,,6051-0730S  -  STEM FEMORAL 132D 7 35MM OFFST 10.4MM 130MM 30MM NECK SECFIT,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6051-0830A,SUP,HCPCS C1776,,6051-0830A  -  STEM FEM 140MM 11.2MM CMNTLS SECFIT HYDRXAPT 8 30MM HIP STRL,"$6,328.00",$0.00,"$6,328.00","$2,847.60","$4,516.29",$0.00,"$1,090.28",$0.00,$0.00,"$1,107.98","$6,328.00",$0.00,"$3,164.00","$5,011.78","$5,062.40",$0.00,$990.33,$0.00,"$1,007.42",$0.00
6051-0830S,SUP,HCPCS C1776,,6051-0830S  -  STEM FEMORAL 132D 8 36MM OFFST 11.2MM 140MM 30MM NECK SECFIT,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6051-0935A,SUP,HCPCS C1776,,6051-0935A  -  STEM FEM 11.9MM SECFIT HYDRXAPT 9 35MM HIP STRL,"$6,328.00",$0.00,"$6,328.00","$2,847.60","$4,516.29",$0.00,"$1,090.28",$0.00,$0.00,"$1,107.98","$6,328.00",$0.00,"$3,164.00","$5,011.78","$5,062.40",$0.00,$990.33,$0.00,"$1,007.42",$0.00
6051-0935S,SUP,HCPCS C1776,,6051-0935S  -  STEM FEMORAL 132D 9 40.8MM 11.9MM 15CM 35MM SECFIT MAX HA,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6051-1035A,SUP,HCPCS C1776,,6051-1035A  -  STEM FEM 160MM 12.7MM CMNTLS SECFIT HYDRXAPT 10 35MM HIP,"$6,328.00",$0.00,"$6,328.00","$2,847.60","$4,516.29",$0.00,"$1,090.28",$0.00,$0.00,"$1,107.98","$6,328.00",$0.00,"$3,164.00","$5,011.78","$5,062.40",$0.00,$990.33,$0.00,"$1,007.42",$0.00
6051-1035S,SUP,HCPCS C1776,,6051-1035S  -  STEM FEMORAL 132D 10 42MM OFFST 12.7MM 160MM 35MM NECK,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6051-1140A,SUP,HCPCS C1776,,6051-1140A  -  STEM FEM 40MM SECFIT MXHYDRXAPT 11 40MM HIP STRL,"$6,328.00",$0.00,"$6,328.00","$2,847.60","$4,516.29",$0.00,"$1,090.28",$0.00,$0.00,"$1,107.98","$6,328.00",$0.00,"$3,164.00","$5,011.78","$5,062.40",$0.00,$990.33,$0.00,"$1,007.42",$0.00
6051-1140S,SUP,HCPCS C1776,,6051-1140S  -  STEM FEMORAL 132D 11 46.5MM 13.5MM 17CM 40MM SECFIT MAX HA,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6051-1240A,SUP,HCPCS C1776,,6051-1240A  -  STEM FEM 170MM 14.7MM CMNTLS SECFIT HYDRXAPT 12 40MM HIP,"$6,328.00",$0.00,"$6,328.00","$2,847.60","$4,516.29",$0.00,"$1,090.28",$0.00,$0.00,"$1,107.98","$6,328.00",$0.00,"$3,164.00","$5,011.78","$5,062.40",$0.00,$990.33,$0.00,"$1,007.42",$0.00
6051-1240S,SUP,HCPCS C1776,,6051-1240S  -  STEM FEMORAL 132D 12 47MM OFFST 14.7MM 170MM 40MM NECK,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6051-1340A,SUP,HCPCS C1776,,6051-1340A  -  STEM FEM 13 48.2MM OFST 16MM 17CM 40MM SCRFT HA HIP,"$6,665.00",$0.00,"$6,665.00","$2,999.25","$4,756.81",$0.00,"$1,148.35",$0.00,$0.00,"$1,166.99","$6,665.00",$0.00,"$3,332.50","$5,278.68","$5,332.00",$0.00,"$1,043.07",$0.00,"$1,061.07",$0.00
6051-1340S,SUP,HCPCS C1776,,6051-1340S  -  STEM FEM 13 16MM 17CM 40MM SCRFT BS OFST HAP HIP,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6051-1440A,SUP,HCPCS C1776,,6051-1440A  -  STEM FEM 170MM 17.2MM CMNTLS SECFIT HYDRXAPT 14 40MM HIP,"$6,665.00",$0.00,"$6,665.00","$2,999.25","$4,756.81",$0.00,"$1,148.35",$0.00,$0.00,"$1,166.99","$6,665.00",$0.00,"$3,332.50","$5,278.68","$5,332.00",$0.00,"$1,043.07",$0.00,"$1,061.07",$0.00
6051-1440S,SUP,HCPCS C1776,,6051-1440S  -  STEM FEMORAL 132D 14 49MM OFFST 17.2MM 170MM 40MM NECK,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6052-0625A,SUP,HCPCS C1776,,6052-0625A  -  STEM FEM CMNTLS SECFIT HYDRXAPT 6 HIP,"$6,328.00",$0.00,"$6,328.00","$2,847.60","$4,516.29",$0.00,"$1,090.28",$0.00,$0.00,"$1,107.98","$6,328.00",$0.00,"$3,164.00","$5,011.78","$5,062.40",$0.00,$990.33,$0.00,"$1,007.42",$0.00
6052-0625S,SUP,HCPCS C1776,,6052-0625S  -  STEM FEMORAL 127D 6 33MM OFFST 9.6MM 120MM 25MM NECK SECFIT,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6052-0730A,SUP,HCPCS C1776,,6052-0730A  -  STEM FEM 30MM SECFIT MXHYDRXAPT 7 HIP,"$6,328.00",$0.00,"$6,328.00","$2,847.60","$4,516.29",$0.00,"$1,090.28",$0.00,$0.00,"$1,107.98","$6,328.00",$0.00,"$3,164.00","$5,011.78","$5,062.40",$0.00,$990.33,$0.00,"$1,007.42",$0.00
6052-0730S,SUP,HCPCS C1776,,6052-0730S  -  STEM FEMORAL 127D 7 39MM OFFST 10.4MM 130MM 30MM NECK SECFIT,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6052-0830A,SUP,HCPCS C1776,,6052-0830A  -  STEM FEM SECFIT HYDRXAPT 8 HIP,"$6,328.00",$0.00,"$6,328.00","$2,847.60","$4,516.29",$0.00,"$1,090.28",$0.00,$0.00,"$1,107.98","$6,328.00",$0.00,"$3,164.00","$5,011.78","$5,062.40",$0.00,$990.33,$0.00,"$1,007.42",$0.00
6052-0830S,SUP,HCPCS C1776,,6052-0830S  -  STEM FEMORAL 127D 8 40MM OFFST 11.2MM 140MM 30MM NECK SECFIT,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6052-0935A,SUP,HCPCS C1776,,6052-0935A  -  STEM FEM SECFIT HYDRXAPT 127D 9 HIP,"$6,328.00",$0.00,"$6,328.00","$2,847.60","$4,516.29",$0.00,"$1,090.28",$0.00,$0.00,"$1,107.98","$6,328.00",$0.00,"$3,164.00","$5,011.78","$5,062.40",$0.00,$990.33,$0.00,"$1,007.42",$0.00
6052-0935S,SUP,HCPCS C1776,,6052-0935S  -  STEM FEMORAL 127D 9 45MM OFFST 11.9MM 150MM 35MM NECK SECFIT,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6052-1035A,SUP,HCPCS C1776,,6052-1035A  -  STEM FEM SECFIT HYDRXAPT 127D 10 HIP,"$6,328.00",$0.00,"$6,328.00","$2,847.60","$4,516.29",$0.00,"$1,090.28",$0.00,$0.00,"$1,107.98","$6,328.00",$0.00,"$3,164.00","$5,011.78","$5,062.40",$0.00,$990.33,$0.00,"$1,007.42",$0.00
6052-1035S,SUP,HCPCS C1776,,6052-1035S  -  STEM FEMORAL 127D 10 46MM OFFST 12.7MM 160MM 35MM NECK,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6052-1140A,SUP,HCPCS C1776,,6052-1140A  -  STEM FEM SECFIT HYDRXAPT 127D 11 HIP,"$6,328.00",$0.00,"$6,328.00","$2,847.60","$4,516.29",$0.00,"$1,090.28",$0.00,$0.00,"$1,107.98","$6,328.00",$0.00,"$3,164.00","$5,011.78","$5,062.40",$0.00,$990.33,$0.00,"$1,007.42",$0.00
6052-1140S,SUP,HCPCS C1776,,6052-1140S  -  STEM FEMORAL 127D 11 51MM OFFST 13.5MM 170MM 40MM NECK,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6052-1240A,SUP,HCPCS C1776,,6052-1240A  -  STEM FEM CMNTLS SECFIT HYDRXAPT 127D 12 HIP,"$6,328.00",$0.00,"$6,328.00","$2,847.60","$4,516.29",$0.00,"$1,090.28",$0.00,$0.00,"$1,107.98","$6,328.00",$0.00,"$3,164.00","$5,011.78","$5,062.40",$0.00,$990.33,$0.00,"$1,007.42",$0.00
6052-1240S,SUP,HCPCS C1776,,6052-1240S  -  STEM FEMORAL 127D 12 52MM OFFST 14.7MM 170MM 40MM NECK,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6052-1340A,SUP,HCPCS C1776,,6052-1340A  -  STEM FEM CMNTLS SECFIT HYDRXAPT 127D 13 HIP,"$6,665.00",$0.00,"$6,665.00","$2,999.25","$4,756.81",$0.00,"$1,148.35",$0.00,$0.00,"$1,166.99","$6,665.00",$0.00,"$3,332.50","$5,278.68","$5,332.00",$0.00,"$1,043.07",$0.00,"$1,061.07",$0.00
6052-1340S,SUP,HCPCS C1776,,6052-1340S  -  STEM FEMORAL 127D 13 53MM OFFST 16MM 170MM 40MM NECK SECFIT,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6054-0509A,SUP,HCPCS C1776,,6054-0509A  -  STEM FEM 5 32MM OFST 9MM 110MM 25MM SCRFT + PRM HA HIP,"$6,861.00",$0.00,"$6,861.00","$3,087.45","$4,896.70",$0.00,"$1,182.12",$0.00,$0.00,"$1,201.31","$6,861.00",$0.00,"$3,430.50","$5,433.91","$5,488.80",$0.00,"$1,073.75",$0.00,"$1,092.27",$0.00
6054-0509S,SUP,HCPCS C1776,,6054-0509S  -  STEM FEM 127D 5 32MM OFST 9MM 110MM 25MM SCRFT+ MX PLSH NK,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6054-0511A,SUP,HCPCS C1776,,6054-0511A  -  STEM FEM 5 32MM OFST 11MM 110MM 25MM SCRFT + PRM HA HIP,"$6,861.00",$0.00,"$6,861.00","$3,087.45","$4,896.70",$0.00,"$1,182.12",$0.00,$0.00,"$1,201.31","$6,861.00",$0.00,"$3,430.50","$5,433.91","$5,488.80",$0.00,"$1,073.75",$0.00,"$1,092.27",$0.00
6054-0511S,SUP,HCPCS C1776,,6054-0511S  -  STEM FEM 5 11MM STRL SCRFT + HIP,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6054-0610A,SUP,HCPCS C1776,,6054-0610A  -  STEM FEM 10MM PRIM SECFIT PLUS HYDRXAPT 6 HIP,"$6,861.00",$0.00,"$6,861.00","$3,087.45","$4,896.70",$0.00,"$1,182.12",$0.00,$0.00,"$1,201.31","$6,861.00",$0.00,"$3,430.50","$5,433.91","$5,488.80",$0.00,"$1,073.75",$0.00,"$1,092.27",$0.00
6054-0610S,SUP,HCPCS C1776,,6054-0610S  -  STEM FEMORAL 127D 6 33MM OFFST 10MM 120MM 25MM POLISH NECK,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6054-0612A,SUP,HCPCS C1776,,6054-0612A  -  STEM FEM 12MM CMNTLS PRIM SECFIT PLUS HYDRXAPT 6 HIP,"$6,861.00",$0.00,"$6,861.00","$3,087.45","$4,896.70",$0.00,"$1,182.12",$0.00,$0.00,"$1,201.31","$6,861.00",$0.00,"$3,430.50","$5,433.91","$5,488.80",$0.00,"$1,073.75",$0.00,"$1,092.27",$0.00
6054-0612S,SUP,HCPCS C1776,,6054-0612S  -  STEM FEMORAL 127D 6 33MM OFFST 12MM 120MM 25MM POLISH NECK,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6054-0711A,SUP,HCPCS C1776,,6054-0711A  -  STEM FEM 11MM PRIM SECFIT MXHYDRXAPT 7 HIP,"$6,538.00",$0.00,"$6,538.00","$2,942.10","$4,666.17",$0.00,"$1,126.46",$0.00,$0.00,"$1,144.75","$6,538.00",$0.00,"$3,269.00","$5,178.10","$5,230.40",$0.00,"$1,023.20",$0.00,"$1,040.85",$0.00
6054-0711S,SUP,HCPCS C1776,,6054-0711S  -  STEM FEMORAL 127D 7 39MM OFFST 11MM 130MM 30MM POLISH NECK,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6054-0713A,SUP,HCPCS C1776,,6054-0713A  -  STEM FEM 13MM PRIM SECFIT PLUS HYDRXAPT 7 HIP,"$6,538.00",$0.00,"$6,538.00","$2,942.10","$4,666.17",$0.00,"$1,126.46",$0.00,$0.00,"$1,144.75","$6,538.00",$0.00,"$3,269.00","$5,178.10","$5,230.40",$0.00,"$1,023.20",$0.00,"$1,040.85",$0.00
6054-0713S,SUP,HCPCS C1776,,6054-0713S  -  STEM FEMORAL 127D 7 39MM OFFST 13MM 130MM 30MM POLISH NECK,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6054-0812A,SUP,HCPCS C1776,,6054-0812A  -  STEM FEM 12MM PRIM SECFIT PLUS HYDRXAPT 8 HIP,"$6,538.00",$0.00,"$6,538.00","$2,942.10","$4,666.17",$0.00,"$1,126.46",$0.00,$0.00,"$1,144.75","$6,538.00",$0.00,"$3,269.00","$5,178.10","$5,230.40",$0.00,"$1,023.20",$0.00,"$1,040.85",$0.00
6054-0812S,SUP,HCPCS C1776,,6054-0812S  -  STEM FEMORAL 127D 8 40MM OFFST 12MM 140MM 30MM POLISH NECK,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6054-0814A,SUP,HCPCS C1776,,6054-0814A  -  STEM FEM SECFIT PLUS 8 HIP,"$6,538.00",$0.00,"$6,538.00","$2,942.10","$4,666.17",$0.00,"$1,126.46",$0.00,$0.00,"$1,144.75","$6,538.00",$0.00,"$3,269.00","$5,178.10","$5,230.40",$0.00,"$1,023.20",$0.00,"$1,040.85",$0.00
6054-0814S,SUP,HCPCS C1776,,6054-0814S  -  STEM FEMORAL 127D 8 40MM OFFST 14MM 140MM 30MM POLISH NECK,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6054-0913A,SUP,HCPCS C1776,,6054-0913A  -  STEM FEM 13MM PRIM SECFIT MXHYDRXAPT 9 HIP,"$6,538.00",$0.00,"$6,538.00","$2,942.10","$4,666.17",$0.00,"$1,126.46",$0.00,$0.00,"$1,144.75","$6,538.00",$0.00,"$3,269.00","$5,178.10","$5,230.40",$0.00,"$1,023.20",$0.00,"$1,040.85",$0.00
6054-0913S,SUP,HCPCS C1776,,6054-0913S  -  STEM FEMORAL 127D 9 45MM OFFST 13MM 150MM 35MM POLISH NECK,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6054-0915A,SUP,HCPCS C1776,,6054-0915A  -  STEM FEM PRIM CMNTLS SECFIT PLUS 9 HIP,"$6,538.00",$0.00,"$6,538.00","$2,942.10","$4,666.17",$0.00,"$1,126.46",$0.00,$0.00,"$1,144.75","$6,538.00",$0.00,"$3,269.00","$5,178.10","$5,230.40",$0.00,"$1,023.20",$0.00,"$1,040.85",$0.00
6054-0915S,SUP,HCPCS C1776,,6054-0915S  -  STEM FEMORAL 127D 9 45MM OFFST 15MM 150MM 35MM POLISH NECK,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6054-1014A,SUP,HCPCS C1776,,6054-1014A  -  STEM FEM 14MM PRIM SECFIT PLUS HYDRXAPT 10 HIP,"$6,538.00",$0.00,"$6,538.00","$2,942.10","$4,666.17",$0.00,"$1,126.46",$0.00,$0.00,"$1,144.75","$6,538.00",$0.00,"$3,269.00","$5,178.10","$5,230.40",$0.00,"$1,023.20",$0.00,"$1,040.85",$0.00
6054-1014S,SUP,HCPCS C1776,,6054-1014S  -  STEM FEMORAL 127D 10 46MM OFFST 14MM 160MM 35MM POLISH NECK,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6054-1016A,SUP,HCPCS C1776,,6054-1016A  -  STEM FEM 16MM PRIM SECFIT PLUS HYDRXAPT 10 HIP,"$6,538.00",$0.00,"$6,538.00","$2,942.10","$4,666.17",$0.00,"$1,126.46",$0.00,$0.00,"$1,144.75","$6,538.00",$0.00,"$3,269.00","$5,178.10","$5,230.40",$0.00,"$1,023.20",$0.00,"$1,040.85",$0.00
6054-1016S,SUP,HCPCS C1776,,6054-1016S  -  STEM FEMORAL 127D 10 46MM OFFST 16MM 160MM 35MM POLISH NECK,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6054-1115A,SUP,HCPCS C1776,,6054-1115A  -  STEM FEM 15MM PRIM SECFIT PLUS HYDRXAPT 11 HIP,"$6,538.00",$0.00,"$6,538.00","$2,942.10","$4,666.17",$0.00,"$1,126.46",$0.00,$0.00,"$1,144.75","$6,538.00",$0.00,"$3,269.00","$5,178.10","$5,230.40",$0.00,"$1,023.20",$0.00,"$1,040.85",$0.00
6054-1115S,SUP,HCPCS C1776,,6054-1115S  -  STEM FEMORAL 127D 11 51MM OFFST 15MM 170MM 40MM POLISH NECK,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6054-1117A,SUP,HCPCS C1776,,6054-1117A  -  STEM FEM 17MM PRIM SECFIT PLUS HYDRXAPT 11 HIP,"$6,538.00",$0.00,"$6,538.00","$2,942.10","$4,666.17",$0.00,"$1,126.46",$0.00,$0.00,"$1,144.75","$6,538.00",$0.00,"$3,269.00","$5,178.10","$5,230.40",$0.00,"$1,023.20",$0.00,"$1,040.85",$0.00
6054-1117S,SUP,HCPCS C1776,,6054-1117S  -  STEM FEMORAL 127D 11 51MM OFFST 17MM 170MM 40MM POLISH NECK,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6054-1216S,SUP,HCPCS C1776,,6054-1216S  -  STEM FEMORAL 127D 12 52MM OFFST 16MM 170MM 40MM POLISH NECK,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6054-1218A,SUP,HCPCS C1776,,6054-1218A  -  STEM FEM 18MM CMNTLS PRIM SECFIT PLUS HYDRXAPT 12 HIP,"$6,538.00",$0.00,"$6,538.00","$2,942.10","$4,666.17",$0.00,"$1,126.46",$0.00,$0.00,"$1,144.75","$6,538.00",$0.00,"$3,269.00","$5,178.10","$5,230.40",$0.00,"$1,023.20",$0.00,"$1,040.85",$0.00
6054-1218S,SUP,HCPCS C1776,,6054-1218S  -  STEM FEMORAL 127D 12 52MM OFFST 18MM 170MM 40MM POLISH NECK,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6054-1317S,SUP,HCPCS C1776,,6054-1317S  -  STEM FEMORAL 13 17MM PRIM SECFIT PLUS HYDRXAPT HIP,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6054-1319S,SUP,HCPCS C1776,,6054-1319S  -  STEM FEMORAL 127D 13 53MM OFFST 19MM 170MM 40MM POLISH NECK,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6054-1418S,SUP,HCPCS C1776,,6054-1418S  -  STEM FEMORAL 14 18MM CEMENTLESS PRIM SECFIT PLUS HYDRXAPT,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6054-1420S,SUP,HCPCS C1776,,6054-1420S  -  STEM FEMORAL 127D 14 54MM OFFST 20MM 170MM 40MM POLISH NECK,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6054-58,SUP,HCPCS C1765,,6054-58  -  STYLET LEAD KT BALL TIP TPR,$100.00,$0.00,$100.00,$0.00,$71.37,$0.00,$17.23,$0.00,$0.00,$17.51,$100.00,$0.00,$50.00,$79.20,$80.00,$0.00,$15.65,$0.00,$0.00,$0.00
6057-0230D,SUP,HCPCS C1776,,6057-0230D  -  STEM FEMORAL 127D 2 39MM OFFST 124MM 30MM CEMENTED NECK,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
6057-0335D,SUP,HCPCS C1776,,6057-0335D  -  STEM FEMORAL 127D 3 43MM OFFST 131MM 35MM CEMENTED NECK,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
6057-0435D,SUP,HCPCS C1776,,6057-0435D  -  STEM FEMORAL 127D 4 46MM OFFST 137MM 35MM CEMENTED NECK,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
6057-0537D,SUP,HCPCS C1776,,6057-0537D  -  STEM FEMORAL 127D 5 48MM OFFST 145MM 37MM NECK CEMENTED,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
6057-0637D,SUP,HCPCS C1776,,6057-0637D  -  STEM FEMORAL 127D 6 49MM OFFST 158MM 37MM CEMENTED NECK,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
6057-0740D,SUP,HCPCS C1776,,6057-0740D  -  STEM FEMORAL 127D 7 52MM OFFST 158MM 40MM CEMENTED NECK,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
6057-52,SUP,Custom 27203010,,6057-52  -  STYLET LEAD STR BALL .014IN 52CM KIT EXTENDED TAPER BLUE,$77.50,$0.00,$77.50,$0.00,$55.31,$0.00,$0.00,$0.00,$0.00,$0.00,$77.50,$0.00,$38.75,$61.38,$62.00,$0.00,$0.00,$0.00,$0.00,$0.00
6057-58,SUP,HCPCS C1765,,6057-58  -  STYLET LEAD 58CM .014IN KT BALL TIP BLUE KNOB,$100.00,$0.00,$100.00,$0.00,$71.37,$0.00,$17.23,$0.00,$0.00,$17.51,$100.00,$0.00,$50.00,$79.20,$80.00,$0.00,$15.65,$0.00,$0.00,$0.00
6058-0230D,SUP,HCPCS C1776,,6058-0230D  -  STEM FEMORAL 132D 2 35MM OFFST 124MM 30MM CEMENTED NECK,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
6058-0335D,SUP,HCPCS C1776,,6058-0335D  -  STEM FEMORAL 132D 3 39MM OFFST 131MM 35MM CEMENTED NECK,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
6058-0435D,SUP,HCPCS C1776,,6058-0435D  -  STEM FEMORAL 132D 4 42MM OFFST 137MM 35MM CEMENTED NECK,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
6058-0537D,SUP,HCPCS C1776,,6058-0537D  -  STEM FEMORAL 132D 5 44MM OFFST 145MM 37MM CEMENTED NECK,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
6058-0637D,SUP,HCPCS C1776,,6058-0637D  -  STEM FEMORAL 132D 6 45MM OFFST 158MM 37MM CEMENTED NECK,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
6058-0740D,SUP,HCPCS C1776,,6058-0740D  -  STEM FEMORAL 132D 4 48MM OFFST 158MM 40MM CEMENTED NECK,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
606-004-103,SUP,HCPCS Q4130,,606-004-103  -  MATRIX TISS THK1MM SEMIOVAL 16X8CM STRL SURGIMEND PRS,"$7,520.00",$0.00,"$7,520.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,520.00",$0.00,"$3,760.00","$5,955.84","$6,016.00",$0.00,$0.00,$0.00,$0.00,$0.00
60-6085-200A,SUP,Custom 27203010,,60-6085-200A  -  RETRACTOR/ELEVATOR LAPSCP SM 32MM STRL LF VCARE 2 CUP LCK,$233.40,$0.00,$233.40,$0.00,$166.58,$0.00,$0.00,$0.00,$0.00,$0.00,$233.40,$0.00,$116.70,$184.85,$186.72,$0.00,$0.00,$0.00,$0.00,$0.00
60-6085-201A,SUP,Custom 27203010,,60-6085-201A  -  RETRACTOR/ELEVATOR LAPSCOP MEDIUM 34MM 2 CUP LOCK SCREW HOLE,$233.40,$0.00,$233.40,$0.00,$166.58,$0.00,$0.00,$0.00,$0.00,$0.00,$233.40,$0.00,$116.70,$184.85,$186.72,$0.00,$0.00,$0.00,$0.00,$0.00
60-6085-202,SUP,Custom 27203010,,60-6085-202  -  RETRACTOR/ELEVATOR LAPSCOP LARGE 37MM 2 CUP HOLE MANIPULATOR,$198.99,$0.00,$198.99,$0.00,$142.02,$0.00,$0.00,$0.00,$0.00,$0.00,$198.99,$0.00,$99.50,$157.60,$159.19,$0.00,$0.00,$0.00,$0.00,$0.00
606-151X,SUP,HCPCS C1729,,CATHETER INFUS .014IN STRG 2.3-1.9FR .0165IN 150CM 50CM MCTH,"$1,747.50",$0.00,"$1,747.50",$948.89,"$1,247.19",$0.00,$301.09,$0.00,$0.00,$305.97,"$1,747.50",$0.00,$873.75,"$1,384.02","$1,398.00",$0.00,$273.48,$0.00,$278.20,$0.00
606-200-004,SUP,HCPCS C9360,,606-200-004  -  MATRIX TISSUE SURGIMEND BOVINE COLLAGEN THK2 MM RECTANGLE L1,"$4,140.00",$0.00,"$4,140.00",$0.00,"$2,954.72",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,140.00",$0.00,"$2,070.00","$3,278.88","$3,312.00",$0.00,$0.00,$0.00,$0.00,$0.00
60-660-01-04,SUP,HCPCS C1713,,60-660-01-04  -  PLATE BONE CSTM PROPHYLACTIC CRANIAL IRR,"$17,487.50",$0.00,"$17,487.50","$7,869.38","$5,158.80",$0.00,"$3,013.01",$0.00,$0.00,"$3,061.92","$17,487.50",$0.00,"$8,743.75","$13,850.10","$13,990.00",$0.00,"$2,736.79",$0.00,"$2,784.01",$0.00
606S255MX,SUP,HCPCS C1725,,606S255MX  -  MICROCATHETER CRBRVASC 90D 2.3-2.8FR .021IN 150CM 5CM PRWLR,"$2,027.30",$0.00,"$2,027.30","$1,100.82","$1,446.88",$0.00,$349.29,$0.00,$0.00,$354.96,"$2,027.30",$0.00,"$1,013.65","$1,605.62","$1,621.84",$0.00,$317.27,$0.00,$322.75,$0.00
606-S255X,SUP,HCPCS C1729,,CATHETER INFUS 2.8-2.3FR .021IN 150CM 5CM MCTH DUAL MRKR,"$1,965.00",$0.00,"$1,965.00","$1,067.00","$1,402.42",$0.00,$338.56,$0.00,$0.00,$344.06,"$1,965.00",$0.00,$982.50,"$1,556.28","$1,572.00",$0.00,$307.52,$0.00,$312.83,$0.00
6070-0525A,SUP,Custom 27803010,,6070-0525A  -  STEM FEMORAL 132D 5 25MM PRIM OMNIFIT HFX HIP,"$2,877.50",$0.00,"$2,877.50",$0.00,"$2,053.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,877.50",$0.00,"$1,438.75","$2,278.98","$2,302.00",$0.00,$0.00,$0.00,$0.00,$0.00
6070-0625A,SUP,Custom 27803010,,6070-0625A  -  STEM FEMORAL 132D 6 30MM OFFST 120MM 25MM CEMENTED NECK,"$2,877.50",$0.00,"$2,877.50",$0.00,"$2,053.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,877.50",$0.00,"$1,438.75","$2,278.98","$2,302.00",$0.00,$0.00,$0.00,$0.00,$0.00
6070-0730A,SUP,Custom 27803010,,6070-0730A  -  STEM FEMORAL 132D 7 35MM OFFST 130MM 30MM CEMENTED NECK,"$2,877.50",$0.00,"$2,877.50",$0.00,"$2,053.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,877.50",$0.00,"$1,438.75","$2,278.98","$2,302.00",$0.00,$0.00,$0.00,$0.00,$0.00
6070-0830A,SUP,Custom 27803010,,6070-0830A  -  STEM FEMORAL 132D 8 36MM OFFST 140MM 30MM CEMENTED NECK,"$2,877.50",$0.00,"$2,877.50",$0.00,"$2,053.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,877.50",$0.00,"$1,438.75","$2,278.98","$2,302.00",$0.00,$0.00,$0.00,$0.00,$0.00
6070-0935A,SUP,Custom 27803010,,6070-0935A  -  STEM FEMORAL 132D 9 41MM OFFST 150MM 35MM CEMENTED NECK,"$2,877.50",$0.00,"$2,877.50",$0.00,"$2,053.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,877.50",$0.00,"$1,438.75","$2,278.98","$2,302.00",$0.00,$0.00,$0.00,$0.00,$0.00
6070-1035A,SUP,Custom 27803010,,6070-1035A  -  STEM FEMORAL 132D 10 35MM CEMENT OMNIFIT HFX HIP,"$2,877.50",$0.00,"$2,877.50",$0.00,"$2,053.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,877.50",$0.00,"$1,438.75","$2,278.98","$2,302.00",$0.00,$0.00,$0.00,$0.00,$0.00
6070-1140A,SUP,Custom 27803010,,6070-1140A  -  STEM FEMORAL 132D 11 46MM OFFST 170MM 40MM CEMENTED NECK,"$2,877.50",$0.00,"$2,877.50",$0.00,"$2,053.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,877.50",$0.00,"$1,438.75","$2,278.98","$2,302.00",$0.00,$0.00,$0.00,$0.00,$0.00
6072-0625,SUP,Custom 27803010,,6072-0625  -  STEM FEM CMNT ODC-FX 6 HIP,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
6072-0730,SUP,Custom 27803010,,6072-0730  -  STEM FEM CMNT ODC-FX 7 HIP,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
6072-0830,SUP,Custom 27803010,,6072-0830  -  STEM FEM CMNT ODC-FX 8 HIP,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
6072-0935,SUP,Custom 27803010,,6072-0935  -  STEM FEM CMNT ODC-FX 9 HIP,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
6072-1035,SUP,Custom 27803010,,6072-1035  -  STEM FEM CMNT OMFT 10 HIP,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
6073-0525,SUP,Custom 27803010,,6073-0525  -  STEM FEM ODC HIP,"$2,024.00",$0.00,"$2,024.00",$0.00,"$1,444.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,024.00",$0.00,"$1,012.00","$1,603.01","$1,619.20",$0.00,$0.00,$0.00,$0.00,$0.00
6073-0625,SUP,Custom 27803010,,6073-0625  -  STEM FEM ODC HIP,"$2,024.00",$0.00,"$2,024.00",$0.00,"$1,444.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,024.00",$0.00,"$1,012.00","$1,603.01","$1,619.20",$0.00,$0.00,$0.00,$0.00,$0.00
6073-0730,SUP,Custom 27803010,,6073-0730  -  STEM FEM ODC HIP,"$2,024.00",$0.00,"$2,024.00",$0.00,"$1,444.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,024.00",$0.00,"$1,012.00","$1,603.01","$1,619.20",$0.00,$0.00,$0.00,$0.00,$0.00
6073-0830,SUP,Custom 27803010,,6073-0830  -  STEM FEM ODC HIP,"$2,024.00",$0.00,"$2,024.00",$0.00,"$1,444.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,024.00",$0.00,"$1,012.00","$1,603.01","$1,619.20",$0.00,$0.00,$0.00,$0.00,$0.00
6073-0935,SUP,Custom 27803010,,6073-0935  -  STEM FEM ODC HIP,"$2,024.00",$0.00,"$2,024.00",$0.00,"$1,444.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,024.00",$0.00,"$1,012.00","$1,603.01","$1,619.20",$0.00,$0.00,$0.00,$0.00,$0.00
6073-1035,SUP,Custom 27803010,,6073-1035  -  STEM FEM ODC HIP,"$2,024.00",$0.00,"$2,024.00",$0.00,"$1,444.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,024.00",$0.00,"$1,012.00","$1,603.01","$1,619.20",$0.00,$0.00,$0.00,$0.00,$0.00
6073-1140,SUP,Custom 27803010,,6073-1140  -  STEM FEM ODC HIP,"$2,024.00",$0.00,"$2,024.00",$0.00,"$1,444.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,024.00",$0.00,"$1,012.00","$1,603.01","$1,619.20",$0.00,$0.00,$0.00,$0.00,$0.00
6076-0525A,SUP,Custom 27803010,,6076-0525A  -  STEM FEMORAL 127D 5 35MM 110MM 25MM CEMENT HFX OMNIFIT HIP,"$2,877.50",$0.00,"$2,877.50",$0.00,"$2,053.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,877.50",$0.00,"$1,438.75","$2,278.98","$2,302.00",$0.00,$0.00,$0.00,$0.00,$0.00
6076-0625A,SUP,Custom 27803010,,6076-0625A  -  STEM FEMORAL 127D 6 120MM 25MM CEMENT OMNIFIT HFX HIP,"$2,877.50",$0.00,"$2,877.50",$0.00,"$2,053.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,877.50",$0.00,"$1,438.75","$2,278.98","$2,302.00",$0.00,$0.00,$0.00,$0.00,$0.00
6076-0730A,SUP,Custom 27803010,,6076-0730A  -  STEM FEMORAL 7 OMNIFIT HFX HIP,"$2,877.50",$0.00,"$2,877.50",$0.00,"$2,053.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,877.50",$0.00,"$1,438.75","$2,278.98","$2,302.00",$0.00,$0.00,$0.00,$0.00,$0.00
6076-0830A,SUP,Custom 27803010,,6076-0830A  -  STEM FEMORAL 127D 8 135MM 30MM CEMENT OMNIFIT HFX HIP,"$2,877.50",$0.00,"$2,877.50",$0.00,"$2,053.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,877.50",$0.00,"$1,438.75","$2,278.98","$2,302.00",$0.00,$0.00,$0.00,$0.00,$0.00
6076-0935A,SUP,Custom 27803010,,6076-0935A  -  STEM FEMORAL 127D 9 140MM 35MM CEMENT OMNIFIT HFX HIP,"$2,877.50",$0.00,"$2,877.50",$0.00,"$2,053.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,877.50",$0.00,"$1,438.75","$2,278.98","$2,302.00",$0.00,$0.00,$0.00,$0.00,$0.00
6076-1035A,SUP,Custom 27803010,,6076-1035A  -  STEM FEMORAL 127D 10 145MM 35MM CEMENT OMNIFIT HFX HIP,"$2,877.50",$0.00,"$2,877.50",$0.00,"$2,053.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,877.50",$0.00,"$1,438.75","$2,278.98","$2,302.00",$0.00,$0.00,$0.00,$0.00,$0.00
6077-0130,SUP,Custom 27803010,,6077-0130  -  STEM FEMORAL 127D 1 38MM OFFST 110MM 30MM CEMENTLESS NECK,"$2,877.50",$0.00,"$2,877.50",$0.00,"$2,053.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,877.50",$0.00,"$1,438.75","$2,278.98","$2,302.00",$0.00,$0.00,$0.00,$0.00,$0.00
6077-0230,SUP,Custom 27803010,,6077-0230  -  STEM FEMORAL 127D 2 39MM OFFST 115MM 30MM CEMENTLESS NECK,"$2,877.50",$0.00,"$2,877.50",$0.00,"$2,053.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,877.50",$0.00,"$1,438.75","$2,278.98","$2,302.00",$0.00,$0.00,$0.00,$0.00,$0.00
6077-0335,SUP,Custom 27803010,,6077-0335  -  STEM FEMORAL 127D 3 43MM OFFST 120MM 35MM CEMENTLESS NECK,"$2,877.50",$0.00,"$2,877.50",$0.00,"$2,053.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,877.50",$0.00,"$1,438.75","$2,278.98","$2,302.00",$0.00,$0.00,$0.00,$0.00,$0.00
6077-0435,SUP,Custom 27803010,,6077-0435  -  STEM FEMORAL 127D 4 44MM OFFST 125MM 35MM CEMENTLESS NECK,"$2,877.50",$0.00,"$2,877.50",$0.00,"$2,053.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,877.50",$0.00,"$1,438.75","$2,278.98","$2,302.00",$0.00,$0.00,$0.00,$0.00,$0.00
6077-0537,SUP,Custom 27803010,,6077-0537  -  STEM FEMORAL 127D 5 48MM OFFST 130MM 37MM CEMENTLESS NECK,"$2,877.50",$0.00,"$2,877.50",$0.00,"$2,053.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,877.50",$0.00,"$1,438.75","$2,278.98","$2,302.00",$0.00,$0.00,$0.00,$0.00,$0.00
6077-0637,SUP,Custom 27803010,,6077-0637  -  STEM FEMORAL 127D 6 49MM OFFST 135MM 37MM CEMENTLESS NECK,"$2,877.50",$0.00,"$2,877.50",$0.00,"$2,053.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,877.50",$0.00,"$1,438.75","$2,278.98","$2,302.00",$0.00,$0.00,$0.00,$0.00,$0.00
6077-0740,SUP,Custom 27803010,,6077-0740  -  STEM FEMORAL 127D 7 53MM OFFST 140MM 40MM CEMENTLESS NECK,"$2,877.50",$0.00,"$2,877.50",$0.00,"$2,053.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,877.50",$0.00,"$1,438.75","$2,278.98","$2,302.00",$0.00,$0.00,$0.00,$0.00,$0.00
6077-0840,SUP,Custom 27803010,,6077-0840  -  STEM FEMORAL 127D 8 54MM OFFST 145MM 40MM CEMENTLESS NECK,"$2,877.50",$0.00,"$2,877.50",$0.00,"$2,053.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,877.50",$0.00,"$1,438.75","$2,278.98","$2,302.00",$0.00,$0.00,$0.00,$0.00,$0.00
6080-0530-200L,SUP,HCPCS C1776,,6080-0530-200L  -  STEM FEM OMFT LNG LEFT HDNK,"$10,099.38",$0.00,"$10,099.38","$4,544.72","$5,158.80",$0.00,"$1,740.07",$0.00,$0.00,"$1,768.32","$10,099.38",$0.00,"$5,049.69","$7,998.71","$8,079.50",$0.00,"$1,580.55",$0.00,"$1,607.82",$0.00
6080-0530-200R,SUP,HCPCS C1776,,6080-0530-200R  -  STEM FEM 200MM 12MM HDNK OMFT 5 LNG 30MM RIGHT,"$10,099.38",$0.00,"$10,099.38","$4,544.72","$5,158.80",$0.00,"$1,740.07",$0.00,$0.00,"$1,768.32","$10,099.38",$0.00,"$5,049.69","$7,998.71","$8,079.50",$0.00,"$1,580.55",$0.00,"$1,607.82",$0.00
6080-0735-200L,SUP,HCPCS C1776,,6080-0735-200L  -  STEM FEM 200MM 14.5MM HDNK PRTCL ADD SYS OMFT 7 LNG 35MM,"$10,099.38",$0.00,"$10,099.38","$4,544.72","$5,158.80",$0.00,"$1,740.07",$0.00,$0.00,"$1,768.32","$10,099.38",$0.00,"$5,049.69","$7,998.71","$8,079.50",$0.00,"$1,580.55",$0.00,"$1,607.82",$0.00
6080-0735-200R,SUP,HCPCS C1776,,6080-0735-200R  -  STEM FEM 200MM 12.4MM CMNT HDNK OMFT 7 LNG 35MM RIGHT HIP,"$10,099.38",$0.00,"$10,099.38","$4,544.72","$5,158.80",$0.00,"$1,740.07",$0.00,$0.00,"$1,768.32","$10,099.38",$0.00,"$5,049.69","$7,998.71","$8,079.50",$0.00,"$1,580.55",$0.00,"$1,607.82",$0.00
6080-0745-200L,SUP,HCPCS C1776,,6080-0745-200L  -  STEM FEM 200MM CMNT HDNK OMFT 12.4MM 7 LNG 45MM LEFT HIP,"$10,099.38",$0.00,"$10,099.38","$4,544.72","$5,158.80",$0.00,"$1,740.07",$0.00,$0.00,"$1,768.32","$10,099.38",$0.00,"$5,049.69","$7,998.71","$8,079.50",$0.00,"$1,580.55",$0.00,"$1,607.82",$0.00
6080-0745-200R,SUP,HCPCS C1776,,6080-0745-200R  -  STEM FEM 200MM 14.5MM HDNK PRTCL ADD SYS OMFT 7 LNG 45MM,"$10,099.38",$0.00,"$10,099.38","$4,544.72","$5,158.80",$0.00,"$1,740.07",$0.00,$0.00,"$1,768.32","$10,099.38",$0.00,"$5,049.69","$7,998.71","$8,079.50",$0.00,"$1,580.55",$0.00,"$1,607.82",$0.00
6080-0935-250L,SUP,HCPCS C1776,,6080-0935-250L  -  STEM FEM 250MM OMFT 9 LNG 35MM HDNK,"$10,099.38",$0.00,"$10,099.38","$4,544.72","$5,158.80",$0.00,"$1,740.07",$0.00,$0.00,"$1,768.32","$10,099.38",$0.00,"$5,049.69","$7,998.71","$8,079.50",$0.00,"$1,580.55",$0.00,"$1,607.82",$0.00
6080-0935-250R,SUP,HCPCS C1776,,6080-0935-250R  -  STEM FEM 200MM 14MM CMNT HDNK OMFT 9 LNG 35MM RIGHT HIP,"$10,099.38",$0.00,"$10,099.38","$4,544.72","$5,158.80",$0.00,"$1,740.07",$0.00,$0.00,"$1,768.32","$10,099.38",$0.00,"$5,049.69","$7,998.71","$8,079.50",$0.00,"$1,580.55",$0.00,"$1,607.82",$0.00
6080-0945-250L,SUP,HCPCS C1776,,6080-0945-250L  -  STEM FEM 250MM 14MM CMNT HDNK OMFT 9 LNG 45MM LEFT HIP,"$10,099.38",$0.00,"$10,099.38","$4,544.72","$5,158.80",$0.00,"$1,740.07",$0.00,$0.00,"$1,768.32","$10,099.38",$0.00,"$5,049.69","$7,998.71","$8,079.50",$0.00,"$1,580.55",$0.00,"$1,607.82",$0.00
6080-0945-250R,SUP,HCPCS C1776,,6080-0945-250R  -  STEM FEM 250MM 14MM CMNT HDNK OMFT 9 LNG 45MM RIGHT HIP,"$10,099.38",$0.00,"$10,099.38","$4,544.72","$5,158.80",$0.00,"$1,740.07",$0.00,$0.00,"$1,768.32","$10,099.38",$0.00,"$5,049.69","$7,998.71","$8,079.50",$0.00,"$1,580.55",$0.00,"$1,607.82",$0.00
60-80317,SUP,Custom 27203010,,60-80317  -  CNTRSNK DRILL 47 AO SHFT END,$213.13,$0.00,$213.13,$0.00,$152.11,$0.00,$0.00,$0.00,$0.00,$0.00,$213.13,$0.00,$106.56,$168.80,$170.50,$0.00,$0.00,$0.00,$0.00,$0.00
60-80323,SUP,Custom 27203010,,60-80323  -  CNTRSNK DRILL 48MM AO SHFT END STRL,$213.13,$0.00,$213.13,$0.00,$152.11,$0.00,$0.00,$0.00,$0.00,$0.00,$213.13,$0.00,$106.56,$168.80,$170.50,$0.00,$0.00,$0.00,$0.00,$0.00
6082-52,SUP,Custom 27203010,,6082-52  -  STYLET LEAD .014IN 52CM KIT STR BALL TIP EXTENDED TAPER GRAY,$77.50,$0.00,$77.50,$0.00,$55.31,$0.00,$0.00,$0.00,$0.00,$0.00,$77.50,$0.00,$38.75,$61.38,$62.00,$0.00,$0.00,$0.00,$0.00,$0.00
6082-65,SUP,Custom 27203010,,6082-65  -  KIT STY STRG XTD TPR .014IN 65CM GRY BALL TIP KNOB,$77.50,$0.00,$77.50,$0.00,$55.31,$0.00,$0.00,$0.00,$0.00,$0.00,$77.50,$0.00,$38.75,$61.38,$62.00,$0.00,$0.00,$0.00,$0.00,$0.00
6088-0525-200L,SUP,HCPCS C1776,,6088-0525-200L  -  STEM FEMORAL 5 LONG 10.9MM 200MM 25MM CEMENT OMNIFIT LEFT,"$11,872.50",$0.00,"$11,872.50","$5,342.63","$5,158.80",$0.00,"$2,045.57",$0.00,$0.00,"$2,078.78","$11,872.50",$0.00,"$5,936.25","$9,403.02","$9,498.00",$0.00,"$1,858.05",$0.00,"$1,890.10",$0.00
6088-0525-200R,SUP,HCPCS C1776,,6088-0525-200R  -  STEM FEMORAL 5 LONG 10.9MM 200MM 25MM CEMENT OMNIFIT RIGHT,"$11,872.50",$0.00,"$11,872.50","$5,342.63","$5,158.80",$0.00,"$2,045.57",$0.00,$0.00,"$2,078.78","$11,872.50",$0.00,"$5,936.25","$9,403.02","$9,498.00",$0.00,"$1,858.05",$0.00,"$1,890.10",$0.00
6088-0525-250L,SUP,HCPCS C1776,,6088-0525-250L  -  STEM FEMORAL 5 LONG 10.9MM 250MM 25MM CEMENT OMNIFIT LEFT,"$11,872.50",$0.00,"$11,872.50","$5,342.63","$5,158.80",$0.00,"$2,045.57",$0.00,$0.00,"$2,078.78","$11,872.50",$0.00,"$5,936.25","$9,403.02","$9,498.00",$0.00,"$1,858.05",$0.00,"$1,890.10",$0.00
6088-0525-250R,SUP,HCPCS C1776,,6088-0525-250R  -  STEM FEMORAL 5 LONG 250MM CEMENTED REVISION OMNIFIT DISTAL,"$11,872.50",$0.00,"$11,872.50","$5,342.63","$5,158.80",$0.00,"$2,045.57",$0.00,$0.00,"$2,078.78","$11,872.50",$0.00,"$5,936.25","$9,403.02","$9,498.00",$0.00,"$1,858.05",$0.00,"$1,890.10",$0.00
6088-0525-300L,SUP,HCPCS C1776,,6088-0525-300L  -  STEM FEMORAL 5 LONG 10.9MM 300MM 25MM CEMENT OMNIFIT LEFT,"$11,872.50",$0.00,"$11,872.50","$5,342.63","$5,158.80",$0.00,"$2,045.57",$0.00,$0.00,"$2,078.78","$11,872.50",$0.00,"$5,936.25","$9,403.02","$9,498.00",$0.00,"$1,858.05",$0.00,"$1,890.10",$0.00
6088-0525-300R,SUP,HCPCS C1776,,6088-0525-300R  -  STEM FEMORAL 5 LONG 10.9MM 300MM 25MM CEMENT OMNIFIT RIGHT,"$11,872.50",$0.00,"$11,872.50","$5,342.63","$5,158.80",$0.00,"$2,045.57",$0.00,$0.00,"$2,078.78","$11,872.50",$0.00,"$5,936.25","$9,403.02","$9,498.00",$0.00,"$1,858.05",$0.00,"$1,890.10",$0.00
6088-0525-350L,SUP,HCPCS C1776,,6088-0525-350L  -  TRIAL SURG 350MM 10.9MM OMFT LNG LEFT STM CMNT IMPL 25MM,"$10,099.38",$0.00,"$10,099.38","$4,544.72","$5,158.80",$0.00,"$1,740.07",$0.00,$0.00,"$1,768.32","$10,099.38",$0.00,"$5,049.69","$7,998.71","$8,079.50",$0.00,"$1,580.55",$0.00,"$1,607.82",$0.00
6088-0525-350R,SUP,HCPCS C1776,,6088-0525-350R  -  STEM FEM 350MM 10.9MM CMNT OMFT 5 LNG 25MM RIGHT HIP,"$10,099.38",$0.00,"$10,099.38","$4,544.72","$5,158.80",$0.00,"$1,740.07",$0.00,$0.00,"$1,768.32","$10,099.38",$0.00,"$5,049.69","$7,998.71","$8,079.50",$0.00,"$1,580.55",$0.00,"$1,607.82",$0.00
6088-0730-200L,SUP,HCPCS C1776,,6088-0730-200L  -  STEM FEMORAL 7 LONG 12.4MM 200MM 30MM CEMENT OMNIFIT LEFT,"$11,872.50",$0.00,"$11,872.50","$5,342.63","$5,158.80",$0.00,"$2,045.57",$0.00,$0.00,"$2,078.78","$11,872.50",$0.00,"$5,936.25","$9,403.02","$9,498.00",$0.00,"$1,858.05",$0.00,"$1,890.10",$0.00
6088-0730-200R,SUP,HCPCS C1776,,6088-0730-200R  -  STEM FEMORAL 7 LONG 12.4MM 200MM 30MM CEMENT OMNIFIT RIGHT,"$11,872.50",$0.00,"$11,872.50","$5,342.63","$5,158.80",$0.00,"$2,045.57",$0.00,$0.00,"$2,078.78","$11,872.50",$0.00,"$5,936.25","$9,403.02","$9,498.00",$0.00,"$1,858.05",$0.00,"$1,890.10",$0.00
6088-0730-250L,SUP,HCPCS C1776,,6088-0730-250L  -  STEM FEMORAL 7 LONG 12.4MM 250MM 30MM CEMENT OMNIFIT LEFT,"$11,872.50",$0.00,"$11,872.50","$5,342.63","$5,158.80",$0.00,"$2,045.57",$0.00,$0.00,"$2,078.78","$11,872.50",$0.00,"$5,936.25","$9,403.02","$9,498.00",$0.00,"$1,858.05",$0.00,"$1,890.10",$0.00
6088-0730-250R,SUP,HCPCS C1776,,6088-0730-250R  -  STEM FEMORAL 7 LONG 12.4MM 250MM 30MM CEMENT OMNIFIT RIGHT,"$11,872.50",$0.00,"$11,872.50","$5,342.63","$5,158.80",$0.00,"$2,045.57",$0.00,$0.00,"$2,078.78","$11,872.50",$0.00,"$5,936.25","$9,403.02","$9,498.00",$0.00,"$1,858.05",$0.00,"$1,890.10",$0.00
6088-0730-300L,SUP,HCPCS C1776,,6088-0730-300L  -  STEM FEMORAL 7 LONG 12.4MM 300MM 30MM CEMENT OMNIFIT LEFT,"$11,872.50",$0.00,"$11,872.50","$5,342.63","$5,158.80",$0.00,"$2,045.57",$0.00,$0.00,"$2,078.78","$11,872.50",$0.00,"$5,936.25","$9,403.02","$9,498.00",$0.00,"$1,858.05",$0.00,"$1,890.10",$0.00
6088-0730-300R,SUP,HCPCS C1776,,6088-0730-300R  -  STEM FEMORAL 7 LONG 12.4MM 300MM 30MM CEMENT OMNIFIT RIGHT,"$11,872.50",$0.00,"$11,872.50","$5,342.63","$5,158.80",$0.00,"$2,045.57",$0.00,$0.00,"$2,078.78","$11,872.50",$0.00,"$5,936.25","$9,403.02","$9,498.00",$0.00,"$1,858.05",$0.00,"$1,890.10",$0.00
6088-0730-350L,SUP,HCPCS C1776,,6088-0730-350L  -  STEM FEM 350MM 12.4MM CMNT OMFT 7 LNG 30MM LEFT HIP,"$10,099.38",$0.00,"$10,099.38","$4,544.72","$5,158.80",$0.00,"$1,740.07",$0.00,$0.00,"$1,768.32","$10,099.38",$0.00,"$5,049.69","$7,998.71","$8,079.50",$0.00,"$1,580.55",$0.00,"$1,607.82",$0.00
6088-0730-350R,SUP,HCPCS C1776,,6088-0730-350R  -  STEM FEM 350MM 12.4MM CMNT OMFT LNG 30MM HIP,"$10,099.38",$0.00,"$10,099.38","$4,544.72","$5,158.80",$0.00,"$1,740.07",$0.00,$0.00,"$1,768.32","$10,099.38",$0.00,"$5,049.69","$7,998.71","$8,079.50",$0.00,"$1,580.55",$0.00,"$1,607.82",$0.00
6088-0935-200L,SUP,HCPCS C1776,,6088-0935-200L  -  STEM FEMORAL 9 LONG 14MM 200MM 35MM CEMENT OMNIFIT LEFT,"$11,872.50",$0.00,"$11,872.50","$5,342.63","$5,158.80",$0.00,"$2,045.57",$0.00,$0.00,"$2,078.78","$11,872.50",$0.00,"$5,936.25","$9,403.02","$9,498.00",$0.00,"$1,858.05",$0.00,"$1,890.10",$0.00
6088-0935-200R,SUP,HCPCS C1776,,6088-0935-200R  -  STEM FEM 200MM 14MM REV CMNT NECK TRL OMFT 9 LNG 35MM HIP,"$11,872.50",$0.00,"$11,872.50","$5,342.63","$5,158.80",$0.00,"$2,045.57",$0.00,$0.00,"$2,078.78","$11,872.50",$0.00,"$5,936.25","$9,403.02","$9,498.00",$0.00,"$1,858.05",$0.00,"$1,890.10",$0.00
6088-0935-250L,SUP,HCPCS C1776,,6088-0935-250L  -  STEM FEMORAL 9 LONG 14MM 250MM 35MM CEMENT OMNIFIT LEFT HIP,"$11,872.50",$0.00,"$11,872.50","$5,342.63","$5,158.80",$0.00,"$2,045.57",$0.00,$0.00,"$2,078.78","$11,872.50",$0.00,"$5,936.25","$9,403.02","$9,498.00",$0.00,"$1,858.05",$0.00,"$1,890.10",$0.00
6088-0935-250R,SUP,HCPCS C1776,,6088-0935-250R  -  STEM FEMORAL 9 LONG 14MM 250MM 35MM CEMENT OMNIFIT HIP RIGHT,"$11,872.50",$0.00,"$11,872.50","$5,342.63","$5,158.80",$0.00,"$2,045.57",$0.00,$0.00,"$2,078.78","$11,872.50",$0.00,"$5,936.25","$9,403.02","$9,498.00",$0.00,"$1,858.05",$0.00,"$1,890.10",$0.00
6088-0935-300L,SUP,HCPCS C1776,,6088-0935-300L  -  STEM FEMORAL 9 LONG 14MM 300MM 35MM CEMENT OMNIFIT LEFT HIP,"$11,872.50",$0.00,"$11,872.50","$5,342.63","$5,158.80",$0.00,"$2,045.57",$0.00,$0.00,"$2,078.78","$11,872.50",$0.00,"$5,936.25","$9,403.02","$9,498.00",$0.00,"$1,858.05",$0.00,"$1,890.10",$0.00
6088-0935-300R,SUP,HCPCS C1776,,6088-0935-300R  -  STEM FEMORAL 9 LONG 14MM 300MM 35MM CEMENT OMNIFIT RIGHT,"$11,872.50",$0.00,"$11,872.50","$5,342.63","$5,158.80",$0.00,"$2,045.57",$0.00,$0.00,"$2,078.78","$11,872.50",$0.00,"$5,936.25","$9,403.02","$9,498.00",$0.00,"$1,858.05",$0.00,"$1,890.10",$0.00
6088-0935-350L,SUP,HCPCS C1776,,6088-0935-350L  -  STEM FEM 350MM 14MM CMNT OMFT 9 LNG 35MM LEFT HIP,"$10,099.38",$0.00,"$10,099.38","$4,544.72","$5,158.80",$0.00,"$1,740.07",$0.00,$0.00,"$1,768.32","$10,099.38",$0.00,"$5,049.69","$7,998.71","$8,079.50",$0.00,"$1,580.55",$0.00,"$1,607.82",$0.00
6088-0935-350R,SUP,HCPCS C1776,,6088-0935-350R  -  STEM FEM 350MM 14MM CMNT OMFT 9 LNG 35MM RIGHT HIP,"$10,099.38",$0.00,"$10,099.38","$4,544.72","$5,158.80",$0.00,"$1,740.07",$0.00,$0.00,"$1,768.32","$10,099.38",$0.00,"$5,049.69","$7,998.71","$8,079.50",$0.00,"$1,580.55",$0.00,"$1,607.82",$0.00
6088-1140-200L,SUP,HCPCS C1776,,6088-1140-200L  -  STEM FEMORAL 11 LONG 15.5MM 200MM 40MM CEMENT OMNIFIT LEFT,"$11,872.50",$0.00,"$11,872.50","$5,342.63","$5,158.80",$0.00,"$2,045.57",$0.00,$0.00,"$2,078.78","$11,872.50",$0.00,"$5,936.25","$9,403.02","$9,498.00",$0.00,"$1,858.05",$0.00,"$1,890.10",$0.00
6088-1140-200R,SUP,HCPCS C1776,,6088-1140-200R  -  STEM FEMORAL 11 LONG 15.5MM 200MM 40MM CEMENT OMNIFIT RIGHT,"$11,872.50",$0.00,"$11,872.50","$5,342.63","$5,158.80",$0.00,"$2,045.57",$0.00,$0.00,"$2,078.78","$11,872.50",$0.00,"$5,936.25","$9,403.02","$9,498.00",$0.00,"$1,858.05",$0.00,"$1,890.10",$0.00
6088-1140-250L,SUP,HCPCS C1776,,6088-1140-250L  -  STEM FEMORAL 11 LONG 15.5MM 250MM 40MM CEMENT OMNIFIT LEFT,"$11,872.50",$0.00,"$11,872.50","$5,342.63","$5,158.80",$0.00,"$2,045.57",$0.00,$0.00,"$2,078.78","$11,872.50",$0.00,"$5,936.25","$9,403.02","$9,498.00",$0.00,"$1,858.05",$0.00,"$1,890.10",$0.00
6088-1140-250R,SUP,HCPCS C1776,,6088-1140-250R  -  STEM FEMORAL 11 LONG 15.5MM 250MM 40MM CEMENT OMNIFIT RIGHT,"$11,872.50",$0.00,"$11,872.50","$5,342.63","$5,158.80",$0.00,"$2,045.57",$0.00,$0.00,"$2,078.78","$11,872.50",$0.00,"$5,936.25","$9,403.02","$9,498.00",$0.00,"$1,858.05",$0.00,"$1,890.10",$0.00
6088-1140-300L,SUP,HCPCS C1776,,6088-1140-300L  -  STEM FEMORAL 11 LONG 15.5MM 300MM 40MM CEMENT OMNIFIT LEFT,"$11,872.50",$0.00,"$11,872.50","$5,342.63","$5,158.80",$0.00,"$2,045.57",$0.00,$0.00,"$2,078.78","$11,872.50",$0.00,"$5,936.25","$9,403.02","$9,498.00",$0.00,"$1,858.05",$0.00,"$1,890.10",$0.00
6088-1140-300R,SUP,HCPCS C1776,,6088-1140-300R  -  STEM FEMORAL 11 LONG 15.5MM 300MM 40MM CEMENT OMNIFIT RIGHT,"$11,872.50",$0.00,"$11,872.50","$5,342.63","$5,158.80",$0.00,"$2,045.57",$0.00,$0.00,"$2,078.78","$11,872.50",$0.00,"$5,936.25","$9,403.02","$9,498.00",$0.00,"$1,858.05",$0.00,"$1,890.10",$0.00
6088-1140-350L,SUP,HCPCS C1776,,6088-1140-350L  -  STEM FEM 350MM CMNT OMFT 11 LNG 40MM HIP,"$10,099.38",$0.00,"$10,099.38","$4,544.72","$5,158.80",$0.00,"$1,740.07",$0.00,$0.00,"$1,768.32","$10,099.38",$0.00,"$5,049.69","$7,998.71","$8,079.50",$0.00,"$1,580.55",$0.00,"$1,607.82",$0.00
6088-1140-350R,SUP,HCPCS C1776,,6088-1140-350R  -  STEM FEM 350MM 15.5MM CMNT OMFT 11 LNG 40MM RIGHT HIP,"$10,099.38",$0.00,"$10,099.38","$4,544.72","$5,158.80",$0.00,"$1,740.07",$0.00,$0.00,"$1,768.32","$10,099.38",$0.00,"$5,049.69","$7,998.71","$8,079.50",$0.00,"$1,580.55",$0.00,"$1,607.82",$0.00
60-94120,SUP,HCPCS C1713,,60-94120  -  COUNTERSINK DRILL BICONCAVE WASHER,$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
6097-0425,SUP,HCPCS C1776,,6097-0425  -  STEM FEMORAL 127D 4 33MM OFFST 8.1MM 100MM 25MM CEMENTED,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
6097-0530,SUP,HCPCS C1776,,6097-0530  -  STEM FEMORAL 127D 5 39MM OFFST 8.9MM 110MM 30MM CEMENTED,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
6097-0630,SUP,HCPCS C1776,,6097-0630  -  STEM FEMORAL 127D 6 40MM OFFST 9.6MM 120MM 30MM CEMENTED,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
6097-0735,SUP,HCPCS C1776,,6097-0735  -  STEM FEMORAL 127D 7 45MM OFFST 10.4MM 130MM 35MM CEMENTED,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
6097-0835,SUP,HCPCS C1776,,6097-0835  -  STEM FEMORAL 127D 8 46MM OFFST 11.3MM 135MM 35MM CEMENTED,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
6097-0940,SUP,HCPCS C1776,,6097-0940  -  STEM FEMORAL 127D 9 51MM OFFST 12.6MM 140MM 40MM CEMENTED,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
6097-1040,SUP,HCPCS C1776,,6097-1040  -  STEM FEMORAL 127D 10 52MM OFFST 13.8MM 145MM 40MM CEMENTED,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
6097-1140,SUP,HCPCS C1776,,6097-1140  -  STEM FEMORAL 127D 11 53MM OFFST 14.8MM 150MM 40MM CEMENTED,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
6098-0425,SUP,HCPCS C1776,,6098-0425  -  STEM FEMORAL 132D 4 29MM OFFST 8.1MM 100MM 25MM CEMENTED,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
6098-0530,SUP,HCPCS C1776,,6098-0530  -  STEM FEMORAL 132D 5 35MM OFFST 8.9MM 110MM 30MM CEMENTED,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
6098-0630,SUP,HCPCS C1776,,6098-0630  -  STEM FEMORAL 132D 6 36MM OFFST 9.6MM 120MM 30MM CEMENTED,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
6098-0735,SUP,HCPCS C1776,,6098-0735  -  STEM FEMORAL 132D 7 41MM OFFST 10.4MM 130MM 35MM CEMENTED,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
6098-0835,SUP,HCPCS C1776,,6098-0835  -  STEM FEMORAL 132D 8 42MM OFFST 11.3MM 135MM 35MM CEMENTED,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
6098-0940,SUP,HCPCS C1776,,6098-0940  -  STEM FEMORAL 132D 9 46MM OFFST 12.6MM 140MM 40MM CEMENTED,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
6098-1040,SUP,HCPCS C1776,,6098-1040  -  STEM FEMORAL 132D 10 47MM OFFST 13.8MM 145MM 40MM CEMENTED,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
6098-1140,SUP,HCPCS C1776,,6098-1140  -  STEM FEMORAL 132D 11 48MM OFFST 14.8MM 150MM 40MM CEMENTED,"$4,317.50",$0.00,"$4,317.50","$1,942.88","$3,081.40",$0.00,$743.88,$0.00,$0.00,$755.96,"$4,317.50",$0.00,"$2,158.75","$3,419.46","$3,454.00",$0.00,$675.69,$0.00,$687.35,$0.00
60XLTCD,SUP,Custom 27203010,,60XLTCD  -  TUBE TRCH 38MM 49MM 11MM 6MM 95MM STRL LF 8MM SHLY XLT CUF,$162.05,$0.00,$162.05,$0.00,$115.65,$0.00,$0.00,$0.00,$0.00,$0.00,$162.05,$0.00,$81.02,$128.34,$129.64,$0.00,$0.00,$0.00,$0.00,$0.00
60XLTCP,SUP,HCPCS A7520,,60XLTCP  -  TUBE TRCH 38MM 34MM 11MM 6MM 95MM STRL LF 23MM SHLY XLT CUF,$162.05,$0.00,$162.05,$0.00,$115.65,$0.00,$0.00,$0.00,$0.00,$0.00,$162.05,$0.00,$81.02,$128.34,$129.64,$0.00,$0.00,$0.00,$0.00,$0.00
60XLTUD,SUP,Custom 27203010,,60XLTUD  -  TUBE TRCH 38MM 49MM 11MM 6MM 95MM STRL LF 8MM SHLY XLT CUFLS,$162.05,$0.00,$162.05,$0.00,$115.65,$0.00,$0.00,$0.00,$0.00,$0.00,$162.05,$0.00,$81.02,$128.34,$129.64,$0.00,$0.00,$0.00,$0.00,$0.00
60XLTUP,SUP,Custom 27203010,,60XLTUP  -  TUBE TRCH 38MM 34MM 11MM 6MM 95MM STRL LF 23MM SHLY XLT,$162.05,$0.00,$162.05,$0.00,$115.65,$0.00,$0.00,$0.00,$0.00,$0.00,$162.05,$0.00,$81.02,$128.34,$129.64,$0.00,$0.00,$0.00,$0.00,$0.00
61.231.017,SUP,HCPCS C1713,,61.231.017  -  GRAPHIC CASE FOR 4.5MM VA-LCP INSTRUMENT AND SCREW SET,"$4,566.45",$0.00,"$4,566.45","$2,054.90","$3,259.08",$0.00,$763.86,$0.00,$0.00,$799.55,"$4,566.45",$0.00,"$2,283.23","$3,616.63","$3,653.16",$0.00,$693.83,$0.00,$726.98,$0.00
611.105.01S,SUP,Custom 27803010,,611.105.01S  -  CABLE ORTHOPEDIC 1.7MM 750MM TITANIUM CRIMP CERCLAGE COCR,$893.90,$0.00,$893.90,$0.00,$637.98,$0.00,$0.00,$0.00,$0.00,$0.00,$893.90,$0.00,$446.95,$707.97,$715.12,$0.00,$0.00,$0.00,$0.00,$0.00
61114V,SUP,Custom 27203010,,61114V  -  CLIP INTNL LG SMTR VESOLOCK,$62.41,$0.00,$62.41,$0.00,$44.54,$0.00,$0.00,$0.00,$0.00,$0.00,$62.41,$0.00,$31.20,$49.43,$49.93,$0.00,$0.00,$0.00,$0.00,$0.00
6-1221,SUP,Custom 27803010,,6-1221  -  CAGE SPNL 12MM 21MM RYTFC UNT THRD CNCT TI PLIF TLIF,"$8,031.25",$0.00,"$8,031.25",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,031.25",$0.00,"$4,015.63","$6,360.75","$6,425.00",$0.00,$0.00,$0.00,$0.00,$0.00
61-2244,SUP,Custom 27803010,,61-2244  -  CUP ACETAB 44MM 22MM CEMENTED UHMWPE HIP,$928.00,$0.00,$928.00,$0.00,$662.31,$0.00,$0.00,$0.00,$0.00,$0.00,$928.00,$0.00,$464.00,$734.98,$742.40,$0.00,$0.00,$0.00,$0.00,$0.00
61-2248,SUP,Custom 27803010,,61-2248  -  CUP ACETAB 48MM 22MM CEMENTED UHMWPE HIP,$928.00,$0.00,$928.00,$0.00,$662.31,$0.00,$0.00,$0.00,$0.00,$0.00,$928.00,$0.00,$464.00,$734.98,$742.40,$0.00,$0.00,$0.00,$0.00,$0.00
61-2252,SUP,Custom 27803010,,61-2252  -  CUP ACETAB 52MM 22MM CEMENTED UHMWPE HIP,$928.00,$0.00,$928.00,$0.00,$662.31,$0.00,$0.00,$0.00,$0.00,$0.00,$928.00,$0.00,$464.00,$734.98,$742.40,$0.00,$0.00,$0.00,$0.00,$0.00
61-2256,SUP,Custom 27803010,,61-2256  -  CUP ACETAB 56MM 22MM CEMENTED UHMWPE HIP,$928.00,$0.00,$928.00,$0.00,$662.31,$0.00,$0.00,$0.00,$0.00,$0.00,$928.00,$0.00,$464.00,$734.98,$742.40,$0.00,$0.00,$0.00,$0.00,$0.00
6-1226,SUP,Custom 27803010,,6-1226  -  CAGE SPNL 12MM 26MM RYTFC UNT THRD CNCT TI PLIF TLIF,"$8,031.25",$0.00,"$8,031.25",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,031.25",$0.00,"$4,015.63","$6,360.75","$6,425.00",$0.00,$0.00,$0.00,$0.00,$0.00
61-2261,SUP,Custom 27803010,,61-2261  -  CUP ACETAB 61MM 22MM CEMENTED UHMWPE HIP,$928.00,$0.00,$928.00,$0.00,$662.31,$0.00,$0.00,$0.00,$0.00,$0.00,$928.00,$0.00,$464.00,$734.98,$742.40,$0.00,$0.00,$0.00,$0.00,$0.00
61-2644,SUP,Custom 27803010,,61-2644  -  CUP ACETAB 44MM 26MM CEMENTED UHMWPE HIP,$928.00,$0.00,$928.00,$0.00,$662.31,$0.00,$0.00,$0.00,$0.00,$0.00,$928.00,$0.00,$464.00,$734.98,$742.40,$0.00,$0.00,$0.00,$0.00,$0.00
61-2646,SUP,Custom 27803010,,61-2646  -  CUP ACETAB 46MM 26MM CEMENTED UHMWPE HIP,$928.00,$0.00,$928.00,$0.00,$662.31,$0.00,$0.00,$0.00,$0.00,$0.00,$928.00,$0.00,$464.00,$734.98,$742.40,$0.00,$0.00,$0.00,$0.00,$0.00
61-2648,SUP,Custom 27803010,,61-2648  -  CUP ACETAB 48MM 26MM CEMENTED UHMWPE HIP,$928.00,$0.00,$928.00,$0.00,$662.31,$0.00,$0.00,$0.00,$0.00,$0.00,$928.00,$0.00,$464.00,$734.98,$742.40,$0.00,$0.00,$0.00,$0.00,$0.00
61-2652,SUP,Custom 27803010,,61-2652  -  CUP ACETAB 52MM 26MM CEMENTED UHMWPE HIP,$928.00,$0.00,$928.00,$0.00,$662.31,$0.00,$0.00,$0.00,$0.00,$0.00,$928.00,$0.00,$464.00,$734.98,$742.40,$0.00,$0.00,$0.00,$0.00,$0.00
61-2656,SUP,Custom 27803010,,61-2656  -  CUP ACETAB 56MM 26MM CEMENTED UHMWPE HIP,$928.00,$0.00,$928.00,$0.00,$662.31,$0.00,$0.00,$0.00,$0.00,$0.00,$928.00,$0.00,$464.00,$734.98,$742.40,$0.00,$0.00,$0.00,$0.00,$0.00
61-2658,SUP,Custom 27803010,,61-2658  -  CUP ACETAB 58MM 26MM CEMENTED UHMWPE HIP,$928.00,$0.00,$928.00,$0.00,$662.31,$0.00,$0.00,$0.00,$0.00,$0.00,$928.00,$0.00,$464.00,$734.98,$742.40,$0.00,$0.00,$0.00,$0.00,$0.00
61-2661,SUP,Custom 27803010,,61-2661  -  CUP ACETAB 61MM 26MM CEMENTED UHMWPE HIP,$928.00,$0.00,$928.00,$0.00,$662.31,$0.00,$0.00,$0.00,$0.00,$0.00,$928.00,$0.00,$464.00,$734.98,$742.40,$0.00,$0.00,$0.00,$0.00,$0.00
61-2844,SUP,Custom 27803010,,61-2844  -  CUP ACETAB 44MM 28MM CEMENTED UHMWPE HIP,$928.00,$0.00,$928.00,$0.00,$662.31,$0.00,$0.00,$0.00,$0.00,$0.00,$928.00,$0.00,$464.00,$734.98,$742.40,$0.00,$0.00,$0.00,$0.00,$0.00
61-2846,SUP,Custom 27803010,,61-2846  -  CUP ACETAB 46MM 28MM CEMENTED UHMWPE HIP,$928.00,$0.00,$928.00,$0.00,$662.31,$0.00,$0.00,$0.00,$0.00,$0.00,$928.00,$0.00,$464.00,$734.98,$742.40,$0.00,$0.00,$0.00,$0.00,$0.00
61-2848,SUP,Custom 27803010,,61-2848  -  CUP ACETAB 48MM 28MM CEMENTED UHMWPE HIP,$928.00,$0.00,$928.00,$0.00,$662.31,$0.00,$0.00,$0.00,$0.00,$0.00,$928.00,$0.00,$464.00,$734.98,$742.40,$0.00,$0.00,$0.00,$0.00,$0.00
61-2850,SUP,Custom 27803010,,61-2850  -  CUP ACETAB 50MM 28MM CEMENTED UHMWPE HIP,$928.00,$0.00,$928.00,$0.00,$662.31,$0.00,$0.00,$0.00,$0.00,$0.00,$928.00,$0.00,$464.00,$734.98,$742.40,$0.00,$0.00,$0.00,$0.00,$0.00
61-2852,SUP,Custom 27803010,,61-2852  -  CUP ACETAB 52MM 28MM CEMENTED UHMWPE HIP,$928.00,$0.00,$928.00,$0.00,$662.31,$0.00,$0.00,$0.00,$0.00,$0.00,$928.00,$0.00,$464.00,$734.98,$742.40,$0.00,$0.00,$0.00,$0.00,$0.00
61-2854,SUP,Custom 27803010,,61-2854  -  CUP ACETAB 54MM 28MM CEMENTED UHMWPE HIP,$928.00,$0.00,$928.00,$0.00,$662.31,$0.00,$0.00,$0.00,$0.00,$0.00,$928.00,$0.00,$464.00,$734.98,$742.40,$0.00,$0.00,$0.00,$0.00,$0.00
61-2856,SUP,Custom 27803010,,61-2856  -  CUP ACETAB 56MM 28MM CEMENTED UHMWPE HIP,$928.00,$0.00,$928.00,$0.00,$662.31,$0.00,$0.00,$0.00,$0.00,$0.00,$928.00,$0.00,$464.00,$734.98,$742.40,$0.00,$0.00,$0.00,$0.00,$0.00
61-2858,SUP,Custom 27803010,,61-2858  -  CUP ACETAB 58MM 28MM CEMENTED UHMWPE HIP,$928.00,$0.00,$928.00,$0.00,$662.31,$0.00,$0.00,$0.00,$0.00,$0.00,$928.00,$0.00,$464.00,$734.98,$742.40,$0.00,$0.00,$0.00,$0.00,$0.00
61-2861,SUP,Custom 27803010,,61-2861  -  CUP ACETAB 61MM 28MM CEMENTED UHMWPE HIP,$928.00,$0.00,$928.00,$0.00,$662.31,$0.00,$0.00,$0.00,$0.00,$0.00,$928.00,$0.00,$464.00,$734.98,$742.40,$0.00,$0.00,$0.00,$0.00,$0.00
613.03.01S,SUP,HCPCS C1713,,613.03.01S  -  CEMENT BONE NRN CRS FST ST 3ML PTTY STRL,"$2,151.00",$0.00,"$2,151.00",$967.95,"$1,535.17",$0.00,$370.61,$0.00,$0.00,$376.62,"$2,151.00",$0.00,"$1,075.50","$1,703.59","$1,720.80",$0.00,$336.63,$0.00,$342.44,$0.00
613.05.01S,SUP,HCPCS C1713,,613.05.01S  -  CEMENT BONE NRN CRS FST ST 5ML PTTY STRL,"$3,532.50",$0.00,"$3,532.50","$1,589.63","$2,521.15",$0.00,$608.63,$0.00,$0.00,$618.51,"$3,532.50",$0.00,"$1,766.25","$2,797.74","$2,826.00",$0.00,$552.84,$0.00,$562.37,$0.00
613.10.01S,SUP,HCPCS C1713,,613.10.01S  -  CEMENT BONE NRN CRS FST ST 10ML PTTY STRL,"$6,945.75",$0.00,"$6,945.75","$3,125.59","$4,957.18",$0.00,"$1,196.72",$0.00,$0.00,"$1,216.15","$6,945.75",$0.00,"$3,472.88","$5,501.03","$5,556.60",$0.00,"$1,087.01",$0.00,"$1,105.76",$0.00
613.15.01S,SUP,HCPCS C1713,,613.15.01S  -  CEMENT BONE NRN CRS FST ST 15ML PTTY STRL,"$10,194.75",$0.00,"$10,194.75","$4,587.64","$5,158.80",$0.00,"$1,756.50",$0.00,$0.00,"$1,785.02","$10,194.75",$0.00,"$5,097.38","$8,074.24","$8,155.80",$0.00,"$1,595.48",$0.00,"$1,623.00",$0.00
61-3248,SUP,Custom 27803010,,61-3248  -  CUP ACETAB 48MM 32MM CEMENTED UHMWPE HIP,$928.00,$0.00,$928.00,$0.00,$662.31,$0.00,$0.00,$0.00,$0.00,$0.00,$928.00,$0.00,$464.00,$734.98,$742.40,$0.00,$0.00,$0.00,$0.00,$0.00
61-3252,SUP,Custom 27803010,,61-3252  -  CUP ACETAB 52MM 32MM CEMENTED UHMWPE HIP,$928.00,$0.00,$928.00,$0.00,$662.31,$0.00,$0.00,$0.00,$0.00,$0.00,$928.00,$0.00,$464.00,$734.98,$742.40,$0.00,$0.00,$0.00,$0.00,$0.00
61-3254,SUP,Custom 27803010,,61-3254  -  CUP ACETAB 54MM 32MM CEMENTED UHMWPE HIP,$928.00,$0.00,$928.00,$0.00,$662.31,$0.00,$0.00,$0.00,$0.00,$0.00,$928.00,$0.00,$464.00,$734.98,$742.40,$0.00,$0.00,$0.00,$0.00,$0.00
61-3256,SUP,Custom 27803010,,61-3256  -  CUP ACETAB 56MM 32MM CEMENTED UHMWPE HIP,$928.00,$0.00,$928.00,$0.00,$662.31,$0.00,$0.00,$0.00,$0.00,$0.00,$928.00,$0.00,$464.00,$734.98,$742.40,$0.00,$0.00,$0.00,$0.00,$0.00
61-3258,SUP,Custom 27803010,,61-3258  -  CUP ACETAB 58MM 32MM CEMENTED UHMWPE HIP,$928.00,$0.00,$928.00,$0.00,$662.31,$0.00,$0.00,$0.00,$0.00,$0.00,$928.00,$0.00,$464.00,$734.98,$742.40,$0.00,$0.00,$0.00,$0.00,$0.00
61-3261,SUP,Custom 27803010,,61-3261  -  CUP ACETAB 61MM 32MM CEMENTED UHMWPE HIP,$928.00,$0.00,$928.00,$0.00,$662.31,$0.00,$0.00,$0.00,$0.00,$0.00,$928.00,$0.00,$464.00,$734.98,$742.40,$0.00,$0.00,$0.00,$0.00,$0.00
614.03.01S,SUP,HCPCS C1713,,614.03.01S  -  CEMENT BONE NRN CRS 3ML ROTATORY MX STRL,"$2,151.00",$0.00,"$2,151.00",$967.95,"$1,535.17",$0.00,$370.61,$0.00,$0.00,$376.62,"$2,151.00",$0.00,"$1,075.50","$1,703.59","$1,720.80",$0.00,$336.63,$0.00,$342.44,$0.00
614.05.01S,SUP,HCPCS C1713,,614.05.01S  -  CEMENT BONE NRN CRS 5ML ROTATORY MX STRL,"$3,532.50",$0.00,"$3,532.50","$1,589.63","$2,521.15",$0.00,$608.63,$0.00,$0.00,$618.51,"$3,532.50",$0.00,"$1,766.25","$2,797.74","$2,826.00",$0.00,$552.84,$0.00,$562.37,$0.00
614.10.01S,SUP,HCPCS C1713,,614.10.01S  -  CEMENT BONE NRN CRS 10ML ROTATORY MX STRL,"$6,945.75",$0.00,"$6,945.75","$3,125.59","$4,957.18",$0.00,"$1,196.72",$0.00,$0.00,"$1,216.15","$6,945.75",$0.00,"$3,472.88","$5,501.03","$5,556.60",$0.00,"$1,087.01",$0.00,"$1,105.76",$0.00
6-1426,SUP,Custom 27803010,,6-1426  -  CAGE SPNL 14MM 26MM RYTFC UNT THRD CNCT TI PLIF TLIF,"$8,031.25",$0.00,"$8,031.25",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,031.25",$0.00,"$4,015.63","$6,360.75","$6,425.00",$0.00,$0.00,$0.00,$0.00,$0.00
615-02,SUP,Custom 27203010,,615-02  -  PLATE 18MM TI BONE SPNL,$267.75,$0.00,$267.75,$0.00,$191.09,$0.00,$0.00,$0.00,$0.00,$0.00,$267.75,$0.00,$133.88,$212.06,$214.20,$0.00,$0.00,$0.00,$0.00,$0.00
6154-50-32,SUP,HCPCS C1776,,6154-50-32  -  LINER ACETAB TRLG STD 6.3MM 50/52/54MM 32MM TIV,"$7,425.00",$0.00,"$7,425.00","$3,341.25","$5,158.80",$0.00,"$1,279.29",$0.00,$0.00,"$1,300.06","$7,425.00",$0.00,"$3,712.50","$5,880.60","$5,940.00",$0.00,"$1,162.01",$0.00,"$1,182.06",$0.00
6-1626,SUP,Custom 27803010,,6-1626  -  CAGE SPNL 16MM 26MM RYTFC UNT THRD CNCT TI PLIF TLIF,"$8,031.25",$0.00,"$8,031.25",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,031.25",$0.00,"$4,015.63","$6,360.75","$6,425.00",$0.00,$0.00,$0.00,$0.00,$0.00
617-01,SUP,Custom 25003010,,ANTIBODY CLONE OC 125 LAB,"$1,207.50",$0.00,"$1,207.50",$0.00,$861.79,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,207.50",$0.00,$603.75,$956.34,$966.00,$0.00,$0.00,$0.00,$0.00,$0.00
617-03,SUP,Custom 27203010,,617-03  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$274.13,$0.00,$274.13,$0.00,$195.64,$0.00,$0.00,$0.00,$0.00,$0.00,$274.13,$0.00,$137.06,$217.11,$219.30,$0.00,$0.00,$0.00,$0.00,$0.00
617-12,SUP,Custom 27203010,,617-12  -  PLATE 18MM TI BONE SPNL,$267.75,$0.00,$267.75,$0.00,$191.09,$0.00,$0.00,$0.00,$0.00,$0.00,$267.75,$0.00,$133.88,$212.06,$214.20,$0.00,$0.00,$0.00,$0.00,$0.00
6-1821,SUP,Custom 27803010,,6-1821  -  CAGE SPNL 18MM 21MM RYTFC UNT THRD CNCT TI PLIF TLIF,"$8,031.25",$0.00,"$8,031.25",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,031.25",$0.00,"$4,015.63","$6,360.75","$6,425.00",$0.00,$0.00,$0.00,$0.00,$0.00
6-1826,SUP,Custom 27803010,,6-1826  -  CAGE SPNL 18MM 26MM RYTFC UNT THRD CNCT TI PLIF TLIF,"$8,031.25",$0.00,"$8,031.25",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,031.25",$0.00,"$4,015.63","$6,360.75","$6,425.00",$0.00,$0.00,$0.00,$0.00,$0.00
6183-2-006,SUP,HCPCS C1762,,6183-2-006  -  SPACER ALGRF 6MM ALLOCRAFT C DBM ACDF,"$6,675.00",$0.00,"$6,675.00",$0.00,"$4,763.95",$0.00,"$1,150.07",$0.00,$0.00,$0.00,"$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,"$1,044.64",$0.00,$0.00,$0.00
6183-2-007,SUP,HCPCS C1762,,6183-2-007  -  SPACER ALGRF 7MM ALLOCRAFT C DBM ACDF,"$6,675.00",$0.00,"$6,675.00",$0.00,"$4,763.95",$0.00,"$1,150.07",$0.00,$0.00,$0.00,"$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,"$1,044.64",$0.00,$0.00,$0.00
6183-2-008,SUP,Custom 27803010,,6183-2-008  -  SPACER ALGRF 8MM ALLOCRAFT C DBM ACDF,"$6,675.00",$0.00,"$6,675.00",$0.00,"$4,763.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,$0.00,$0.00,$0.00,$0.00
6183-3-006,SUP,HCPCS C1762,,6183-3-006  -  GRAFT BONE ALLOCRAFT CERV 6MM,"$2,625.68",$0.00,"$2,625.68",$0.00,"$1,873.94",$0.00,$452.39,$0.00,$0.00,$0.00,"$2,625.68",$0.00,"$1,312.84","$2,079.54","$2,100.54",$0.00,$410.92,$0.00,$0.00,$0.00
6183-3-007,SUP,HCPCS C1762,,6183-3-007  -  GRAFT BONE ALLOCRAFT CERV 7MM,"$2,625.68",$0.00,"$2,625.68",$0.00,"$1,873.94",$0.00,$452.39,$0.00,$0.00,$0.00,"$2,625.68",$0.00,"$1,312.84","$2,079.54","$2,100.54",$0.00,$410.92,$0.00,$0.00,$0.00
6183-3-008,SUP,HCPCS C1762,,6183-3-008  -  RNGR SURG 8MM CERV BONE,"$2,625.68",$0.00,"$2,625.68",$0.00,"$1,873.94",$0.00,$452.39,$0.00,$0.00,$0.00,"$2,625.68",$0.00,"$1,312.84","$2,079.54","$2,100.54",$0.00,$410.92,$0.00,$0.00,$0.00
6183-3-010,SUP,HCPCS C1762,,6183-3-010  -  GRAFT BONE ALLOCRAFT DBM SPCR ANT CERV INTRBD FS C-RING 10MM,"$2,625.68",$0.00,"$2,625.68",$0.00,"$1,873.94",$0.00,$452.39,$0.00,$0.00,$0.00,"$2,625.68",$0.00,"$1,312.84","$2,079.54","$2,100.54",$0.00,$410.92,$0.00,$0.00,$0.00
6183-4-006,SUP,HCPCS C1762,,6183-4-006  -  GRAFT BONE ALLOCRAFT CERV 6MM,"$3,534.58",$0.00,"$3,534.58",$0.00,"$2,522.63",$0.00,$608.99,$0.00,$0.00,$0.00,"$3,534.58",$0.00,"$1,767.29","$2,799.39","$2,827.66",$0.00,$553.16,$0.00,$0.00,$0.00
6183-4-007,SUP,HCPCS C1762,,6183-4-007  -  GRAFT BONE ALLOCRAFT CERV 7MM,"$3,534.58",$0.00,"$3,534.58",$0.00,"$2,522.63",$0.00,$608.99,$0.00,$0.00,$0.00,"$3,534.58",$0.00,"$1,767.29","$2,799.39","$2,827.66",$0.00,$553.16,$0.00,$0.00,$0.00
6183-5-005,SUP,HCPCS C1762,,6183-5-005  -  GRAFT BONE 5MM LORDOTIC CERV,"$6,675.00",$0.00,"$6,675.00",$0.00,"$4,763.95",$0.00,"$1,150.07",$0.00,$0.00,$0.00,"$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,"$1,044.64",$0.00,$0.00,$0.00
6183-5-006,SUP,HCPCS C1762,,6183-5-006  -  SPACER ALLOGRAFT 6MM ANTERIOR CERV INTERBODY FUSION LORDOTIC,"$6,675.00",$0.00,"$6,675.00",$0.00,"$4,763.95",$0.00,"$1,150.07",$0.00,$0.00,$0.00,"$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,"$1,044.64",$0.00,$0.00,$0.00
6183-5-007,SUP,Custom 27803010,,6183-5-007  -  SPACER ALLOGRAFT 7MM ANTERIOR CERV INTERBODY FUSION LORDOTIC,"$6,675.00",$0.00,"$6,675.00",$0.00,"$4,763.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,$0.00,$0.00,$0.00,$0.00
6183-5-008,SUP,Custom 27803010,,6183-5-008  -  SPACER ALGRF 8MM ALLOCRAFT CL DBM ACDF,"$6,675.00",$0.00,"$6,675.00",$0.00,"$4,763.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,$0.00,$0.00,$0.00,$0.00
6183-5-009,SUP,HCPCS C1762,,6183-5-009  -  SPACER ALLOGRAFT 9MM ANTERIOR CERV INTERBODY FUSION LORDOTIC,"$6,675.00",$0.00,"$6,675.00",$0.00,"$4,763.95",$0.00,"$1,150.07",$0.00,$0.00,$0.00,"$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,"$1,044.64",$0.00,$0.00,$0.00
6183-6-007,SUP,HCPCS C1762,,6183-6-007  -  GRAFT BONE 7MM CERV SPN,"$6,675.00",$0.00,"$6,675.00",$0.00,"$4,763.95",$0.00,"$1,150.07",$0.00,$0.00,$0.00,"$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,"$1,044.64",$0.00,$0.00,$0.00
6183-7-005,SUP,HCPCS C1762,,6183-7-005  -  GRAFT BONE 14X11X5MM LORDOTIC CANCELLOUS,"$6,675.00",$0.00,"$6,675.00",$0.00,"$4,763.95",$0.00,"$1,150.07",$0.00,$0.00,$0.00,"$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,"$1,044.64",$0.00,$0.00,$0.00
6183-7-006,SUP,HCPCS C1762,,6183-7-006  -  GRAFT BONE LORDOTIC 14X11X6MM ALLOCRAFT CANCELLOUS,"$6,675.00",$0.00,"$6,675.00",$0.00,"$4,763.95",$0.00,"$1,150.07",$0.00,$0.00,$0.00,"$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,"$1,044.64",$0.00,$0.00,$0.00
6183-7-007,SUP,HCPCS C1762,,6183-7-007  -  GRAFT BONE LORDOTIC 14X11X7MM ALLOGRAFT ALLOCRAFT CANCELLOUS,"$6,675.00",$0.00,"$6,675.00",$0.00,"$4,763.95",$0.00,"$1,150.07",$0.00,$0.00,$0.00,"$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,"$1,044.64",$0.00,$0.00,$0.00
6183-7-008,SUP,HCPCS C1762,,6183-7-008  -  GRAFT BONE 14X11X8MM LORDOTIC ALLOGRAFT CANCELLOUS CERV,"$6,675.00",$0.00,"$6,675.00",$0.00,"$4,763.95",$0.00,"$1,150.07",$0.00,$0.00,$0.00,"$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,"$1,044.64",$0.00,$0.00,$0.00
6183-7-009,SUP,HCPCS C1762,,6183-7-009  -  GRAFT BONE 14X11X9MM LORDOTIC CANCELLOUS,"$6,675.00",$0.00,"$6,675.00",$0.00,"$4,763.95",$0.00,"$1,150.07",$0.00,$0.00,$0.00,"$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,"$1,044.64",$0.00,$0.00,$0.00
6183-7-010,SUP,HCPCS C1762,,6183-7-010  -  GRAFT BONE 14X11X10MM LORDOTIC CANCELLOUS,"$6,675.00",$0.00,"$6,675.00",$0.00,"$4,763.95",$0.00,"$1,150.07",$0.00,$0.00,$0.00,"$6,675.00",$0.00,"$3,337.50","$5,286.60","$5,340.00",$0.00,"$1,044.64",$0.00,$0.00,$0.00
6184-0-025,SUP,HCPCS C1713,,6184-0-025  -  CEMENT BONE BNSRC CALCIUM PHOS HYDRXAPT 2.5GM PST,"$1,078.80",$0.00,"$1,078.80",$485.46,$769.94,$0.00,$185.87,$0.00,$0.00,$188.89,"$1,078.80",$0.00,$539.40,$854.41,$863.04,$0.00,$168.83,$0.00,$171.74,$0.00
6184-0-050,SUP,HCPCS C1713,,6184-0-050  -  CEMENT BONE BNSRC CALCIUM PHOS HYDRXAPT 5GM PST,"$1,815.83",$0.00,"$1,815.83",$817.12,"$1,295.95",$0.00,$312.86,$0.00,$0.00,$317.94,"$1,815.83",$0.00,$907.91,"$1,438.14","$1,452.66",$0.00,$284.18,$0.00,$289.08,$0.00
6184-0-100,SUP,HCPCS C1713,,6184-0-100  -  CEMENT BONE BNSRC HYDRXAPT 10GM PST FILR STRL,"$3,554.93",$0.00,"$3,554.93","$1,599.72","$2,537.15",$0.00,$612.50,$0.00,$0.00,$622.44,"$3,554.93",$0.00,"$1,777.46","$2,815.50","$2,843.94",$0.00,$556.35,$0.00,$565.94,$0.00
6184-0-250,SUP,HCPCS C1713,,6184-0-250  -  CEMENT BONE BNSRC HYDRXAPT 25GM PST FILR STRL,"$7,616.70",$0.00,"$7,616.70","$3,427.52","$5,158.80",$0.00,"$1,312.32",$0.00,$0.00,"$1,333.62","$7,616.70",$0.00,"$3,808.35","$6,032.43","$6,093.36",$0.00,"$1,192.01",$0.00,"$1,212.58",$0.00
6184-0-500,SUP,HCPCS C1713,,6184-0-500  -  CEMENT BONE BNSRC 50GM PST STRL,"$12,682.88",$0.00,"$12,682.88","$5,707.29","$5,158.80",$0.00,"$2,185.20",$0.00,$0.00,"$2,220.67","$12,682.88",$0.00,"$6,341.44","$10,044.84","$10,146.30",$0.00,"$1,984.87",$0.00,"$2,019.11",$0.00
6184-1-003,SUP,HCPCS C1713,,6184-1-003  -  CEMENT BONE BCMPT INJ OSTCNDC HYDROSET BONE SUB VOID FILR,"$2,362.20",$0.00,"$2,362.20","$1,062.99","$1,685.90",$0.00,$407.00,$0.00,$0.00,$413.60,"$2,362.20",$0.00,"$1,181.10","$1,870.86","$1,889.76",$0.00,$369.68,$0.00,$376.06,$0.00
6184-1-005,SUP,HCPCS C1713,,6184-1-005  -  CEMENT BONE HYDROSET SUB VOID FILR CALCIUM PHOS 5ML ORTH,"$3,785.10",$0.00,"$3,785.10","$1,703.30","$2,701.43",$0.00,$652.15,$0.00,$0.00,$662.74,"$3,785.10",$0.00,"$1,892.55","$2,997.80","$3,028.08",$0.00,$592.37,$0.00,$602.59,$0.00
6184-1-010,SUP,HCPCS C1713,,6184-1-010  -  CEMENT BONE HYDROSET SUB VOID FILR CALCIUM PHOS 10ML INJ,"$7,286.55",$0.00,"$7,286.55","$3,278.95","$5,158.80",$0.00,"$1,255.44",$0.00,$0.00,"$1,275.82","$7,286.55",$0.00,"$3,643.28","$5,770.95","$5,829.24",$0.00,"$1,140.35",$0.00,"$1,160.02",$0.00
6184-1-015,SUP,HCPCS C1713,,6184-1-015  -  CEMENT BONE INJ BCMPT STRL HYDROSET BONE SUB VOID FILR,"$10,460.18",$0.00,"$10,460.18","$4,707.08","$5,158.80",$0.00,"$1,802.24",$0.00,$0.00,"$1,831.49","$10,460.18",$0.00,"$5,230.09","$8,284.46","$8,368.14",$0.00,"$1,637.02",$0.00,"$1,665.26",$0.00
6184-5-100,SUP,HCPCS C1762,,6184-5-100  -  BONE STACK 5MM X 100 PELLETS,"$1,274.10",$0.00,"$1,274.10",$0.00,$909.33,$0.00,$219.52,$0.00,$0.00,$0.00,"$1,274.10",$0.00,$637.05,"$1,009.09","$1,019.28",$0.00,$199.40,$0.00,$0.00,$0.00
6184-5-300,SUP,HCPCS C1762,,6184-5-300  -  BONE STACK 5MM X 300 PELLETS,"$2,262.23",$0.00,"$2,262.23",$0.00,"$1,614.55",$0.00,$389.77,$0.00,$0.00,$0.00,"$2,262.23",$0.00,"$1,131.11","$1,791.69","$1,809.78",$0.00,$354.04,$0.00,$0.00,$0.00
6184-9-220,SUP,HCPCS C1713,,6184-9-220  -  CEMENT BONE BONESAVE 4-6MM TCP HYDRXAPT 20ML GRNL,"$3,073.65",$0.00,"$3,073.65","$1,383.14","$2,193.66",$0.00,$529.57,$0.00,$0.00,$538.17,"$3,073.65",$0.00,"$1,536.83","$2,434.33","$2,458.92",$0.00,$481.03,$0.00,$489.33,$0.00
6188-1-001,SUP,HCPCS C1713,,6188-1-001  -  CEMENT BONE RADIOPQ HALF DOSE SIMPLEX P,$130.00,$0.00,$130.00,$58.50,$92.78,$0.00,$22.40,$0.00,$0.00,$22.76,$130.00,$0.00,$65.00,$102.96,$104.00,$0.00,$20.35,$0.00,$20.70,$0.00
6188-1-010,SUP,HCPCS C1713,,6188-1-010  -  CEMENT BONE RADIOPQ HALF DOSE SIMPLEX P STERILE,$130.00,$0.00,$130.00,$58.50,$92.78,$0.00,$22.40,$0.00,$0.00,$22.76,$130.00,$0.00,$65.00,$102.96,$104.00,$0.00,$20.35,$0.00,$20.70,$0.00
6191-1-001,SUP,HCPCS C1713,,6191-1-001  -  CEMENT BONE RADIOPQ FULL DOSE SIMPLEX P,$170.00,$0.00,$170.00,$76.50,$121.33,$0.00,$29.29,$0.00,$0.00,$29.77,$170.00,$0.00,$85.00,$134.64,$136.00,$0.00,$26.61,$0.00,$27.06,$0.00
6191-1-010,SUP,HCPCS C1713,,6191-1-010  -  CEMENT BONE RADIOPQ FULL DOSE SIMPLEX P STERILE,$170.00,$0.00,$170.00,$76.50,$121.33,$0.00,$29.29,$0.00,$0.00,$29.77,$170.00,$0.00,$85.00,$134.64,$136.00,$0.00,$26.61,$0.00,$27.06,$0.00
6192-1-001,SUP,HCPCS C1713,,6192-1-001  -  CEMENT BONE FULL DOSE INDIVIDUAL SIMPLEX P SPEEDSET,$170.00,$0.00,$170.00,$76.50,$121.33,$0.00,$29.29,$0.00,$0.00,$29.77,$170.00,$0.00,$85.00,$134.64,$136.00,$0.00,$26.61,$0.00,$27.06,$0.00
6192-1-010,SUP,HCPCS C1713,,6192-1-010  -  CEMENT BONE SMPX P SPEEDSET FD FST SET STRL,$170.00,$0.00,$170.00,$76.50,$121.33,$0.00,$29.29,$0.00,$0.00,$29.77,$170.00,$0.00,$85.00,$134.64,$136.00,$0.00,$26.61,$0.00,$27.06,$0.00
6194-1-001,SUP,HCPCS C1713,,6194-1-001  -  CEMENT BN SMPX HVISC,$170.00,$0.00,$170.00,$76.50,$121.33,$0.00,$29.29,$0.00,$0.00,$29.77,$170.00,$0.00,$85.00,$134.64,$136.00,$0.00,$26.61,$0.00,$27.06,$0.00
6194-1-010,SUP,HCPCS C1713,,6194-1-010  -  CEMENT BN 20ML STRL SMPX HVISC 40GM,$170.00,$0.00,$170.00,$76.50,$121.33,$0.00,$29.29,$0.00,$0.00,$29.77,$170.00,$0.00,$85.00,$134.64,$136.00,$0.00,$26.61,$0.00,$27.06,$0.00
6195-1-001,SUP,HCPCS C1713,,6195-1-001  -  CEMENT BN SMPX HVISC GNTA 40GM,$462.50,$0.00,$462.50,$208.13,$330.09,$0.00,$79.69,$0.00,$0.00,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
6195-1-010,SUP,HCPCS C1713,,6195-1-010  -  CEMENT BN 20ML STRL SMPX HVISC GNTA 40GM,$462.50,$0.00,$462.50,$208.13,$330.09,$0.00,$79.69,$0.00,$0.00,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
6197-9-001,SUP,HCPCS C1713,,6197-9-001  -  CEMENT BONE SMPX P RADIOPQ FD TBR STRL,$810.88,$0.00,$810.88,$364.89,$578.72,$0.00,$139.71,$0.00,$0.00,$141.98,$810.88,$0.00,$405.44,$642.22,$648.70,$0.00,$126.90,$0.00,$129.09,$0.00
6197-9-010,SUP,HCPCS C1713,,6197-9-010  -  CEMENT BONE FULL DOSE RADIOPQ PREBLEND SIMPLEX P TOBRAMYCIN,$700.00,$0.00,$700.00,$315.00,$499.59,$0.00,$120.61,$0.00,$0.00,$122.56,$700.00,$0.00,$350.00,$554.40,$560.00,$0.00,$109.55,$0.00,$111.44,$0.00
61C-2242,SUP,Custom 27803010,,61C-2242  -  CUP ACETAB UHMWPE XFIRE,"$1,125.00",$0.00,"$1,125.00",$0.00,$802.91,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$0.00,$0.00,$0.00,$0.00
61C-2244,SUP,Custom 27803010,,61C-2244  -  CUP ACETAB UHMWPE,"$1,125.00",$0.00,"$1,125.00",$0.00,$802.91,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$0.00,$0.00,$0.00,$0.00
61C-2246,SUP,Custom 27803010,,61C-2246  -  CUP ACETAB UHMWPE XFIRE,"$1,125.00",$0.00,"$1,125.00",$0.00,$802.91,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$0.00,$0.00,$0.00,$0.00
61C-2248,SUP,Custom 27803010,,61C-2248  -  CUP ACETAB UHMWPE,"$1,125.00",$0.00,"$1,125.00",$0.00,$802.91,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$0.00,$0.00,$0.00,$0.00
61C-2250,SUP,Custom 27803010,,61C-2250  -  CUP ACETAB UHMWPE XFIRE,"$1,125.00",$0.00,"$1,125.00",$0.00,$802.91,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$0.00,$0.00,$0.00,$0.00
61C-2252,SUP,Custom 27803010,,61C-2252  -  CUP ACETAB UHMWPE,"$1,125.00",$0.00,"$1,125.00",$0.00,$802.91,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$0.00,$0.00,$0.00,$0.00
61C-2254,SUP,Custom 27803010,,61C-2254  -  CUP ACETAB UHMWPE XFIRE,"$1,125.00",$0.00,"$1,125.00",$0.00,$802.91,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$0.00,$0.00,$0.00,$0.00
61C-2256,SUP,Custom 27803010,,61C-2256  -  CUP ACETAB UHMWPE,"$1,125.00",$0.00,"$1,125.00",$0.00,$802.91,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$0.00,$0.00,$0.00,$0.00
61C-2258,SUP,Custom 27803010,,61C-2258  -  CUP ACETAB UHMWPE XFIRE,"$1,125.00",$0.00,"$1,125.00",$0.00,$802.91,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$0.00,$0.00,$0.00,$0.00
61C-2261,SUP,Custom 27803010,,61C-2261  -  CUP ACETAB UHMWPE XFIRE,"$1,125.00",$0.00,"$1,125.00",$0.00,$802.91,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$0.00,$0.00,$0.00,$0.00
61C-2642,SUP,Custom 27803010,,61C-2642  -  CUP ACETAB UHMWPE,"$1,125.00",$0.00,"$1,125.00",$0.00,$802.91,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$0.00,$0.00,$0.00,$0.00
61C-2644,SUP,Custom 27803010,,61C-2644  -  CUP ACETAB UHMWPE,"$1,125.00",$0.00,"$1,125.00",$0.00,$802.91,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$0.00,$0.00,$0.00,$0.00
61C-2646,SUP,Custom 27803010,,61C-2646  -  CUP ACETAB UHMWPE,"$1,125.00",$0.00,"$1,125.00",$0.00,$802.91,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$0.00,$0.00,$0.00,$0.00
61C-2648,SUP,Custom 27803010,,61C-2648  -  CUP ACETAB UHMWPE,"$1,125.00",$0.00,"$1,125.00",$0.00,$802.91,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$0.00,$0.00,$0.00,$0.00
61C-2650,SUP,Custom 27803010,,61C-2650  -  CUP ACETAB UHMWPE,"$1,125.00",$0.00,"$1,125.00",$0.00,$802.91,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$0.00,$0.00,$0.00,$0.00
61C-2652,SUP,Custom 27803010,,61C-2652  -  CUP ACETAB UHMWPE,"$1,125.00",$0.00,"$1,125.00",$0.00,$802.91,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$0.00,$0.00,$0.00,$0.00
61C-2654,SUP,Custom 27803010,,61C-2654  -  CUP ACETAB UHMWPE,"$1,125.00",$0.00,"$1,125.00",$0.00,$802.91,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$0.00,$0.00,$0.00,$0.00
61C-2656,SUP,Custom 27803010,,61C-2656  -  CUP ACETAB UHMWPE,"$1,125.00",$0.00,"$1,125.00",$0.00,$802.91,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$0.00,$0.00,$0.00,$0.00
61C-2658,SUP,Custom 27803010,,61C-2658  -  CUP ACETAB UHMWPE,"$1,125.00",$0.00,"$1,125.00",$0.00,$802.91,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$0.00,$0.00,$0.00,$0.00
61C-2661,SUP,Custom 27803010,,61C-2661  -  CUP ACETAB UHMWPE,"$1,125.00",$0.00,"$1,125.00",$0.00,$802.91,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$0.00,$0.00,$0.00,$0.00
61C-2844,SUP,Custom 27803010,,61C-2844  -  CUP ACETAB LOW HIP UHMWPE,"$1,125.00",$0.00,"$1,125.00",$0.00,$802.91,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$0.00,$0.00,$0.00,$0.00
61C-2846,SUP,Custom 27803010,,61C-2846  -  CUP ACETAB UHMWPE,"$1,125.00",$0.00,"$1,125.00",$0.00,$802.91,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$0.00,$0.00,$0.00,$0.00
61C-2848,SUP,Custom 27803010,,61C-2848  -  CUP ACETAB ALPLY XFIRE,"$1,125.00",$0.00,"$1,125.00",$0.00,$802.91,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$0.00,$0.00,$0.00,$0.00
61C-2850,SUP,Custom 27803010,,61C-2850  -  CUP ACETAB ALPLY XFIRE,"$1,125.00",$0.00,"$1,125.00",$0.00,$802.91,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$0.00,$0.00,$0.00,$0.00
61C-2852,SUP,Custom 27803010,,61C-2852  -  CUP ACETAB ALPLY XFIRE,"$1,125.00",$0.00,"$1,125.00",$0.00,$802.91,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$0.00,$0.00,$0.00,$0.00
61C-2854,SUP,Custom 27803010,,61C-2854  -  CUP ACETAB ALPLY XFIRE,"$1,125.00",$0.00,"$1,125.00",$0.00,$802.91,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$0.00,$0.00,$0.00,$0.00
61C-2856,SUP,Custom 27803010,,61C-2856  -  CUP ACETAB ALPLY XFIRE,"$1,125.00",$0.00,"$1,125.00",$0.00,$802.91,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$0.00,$0.00,$0.00,$0.00
61C-2858,SUP,Custom 27803010,,61C-2858  -  CUP ACETAB ALPLY XFIRE,"$1,125.00",$0.00,"$1,125.00",$0.00,$802.91,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$0.00,$0.00,$0.00,$0.00
61C-2861,SUP,Custom 27803010,,61C-2861  -  CUP ACETAB ALPLY XFIRE,"$1,125.00",$0.00,"$1,125.00",$0.00,$802.91,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$0.00,$0.00,$0.00,$0.00
61C3,SUP,Custom 27203010,,CONTROL SPHL RPR IMP RPR 1ML SERO,$51.20,$0.00,$51.20,$0.00,$36.54,$0.00,$0.00,$0.00,$0.00,$0.00,$51.20,$0.00,$25.60,$40.55,$40.96,$0.00,$0.00,$0.00,$0.00,$0.00
620-00-28D,SUP,Custom 27803010,,620-00-28D  -  INSERT ACETAB 28MM 0D D HIP PE TRDNT,"$1,195.00",$0.00,"$1,195.00",$0.00,$852.87,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,195.00",$0.00,$597.50,$946.44,$956.00,$0.00,$0.00,$0.00,$0.00,$0.00
620-00-28E,SUP,Custom 27803010,,620-00-28E  -  INSERT ACETAB 28MM 0D E HIP PE TRDNT,"$1,195.00",$0.00,"$1,195.00",$0.00,$852.87,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,195.00",$0.00,$597.50,$946.44,$956.00,$0.00,$0.00,$0.00,$0.00,$0.00
620-00-28F,SUP,Custom 27803010,,620-00-28F  -  INSERT ACETAB 28MM 0D F HIP PE TRDNT,"$1,195.00",$0.00,"$1,195.00",$0.00,$852.87,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,195.00",$0.00,$597.50,$946.44,$956.00,$0.00,$0.00,$0.00,$0.00,$0.00
620-00-28G,SUP,Custom 27803010,,620-00-28G  -  INSERT ACETAB 28MM 0D G HIP PE TRDNT,"$1,195.00",$0.00,"$1,195.00",$0.00,$852.87,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,195.00",$0.00,$597.50,$946.44,$956.00,$0.00,$0.00,$0.00,$0.00,$0.00
620-00-28H,SUP,Custom 27803010,,620-00-28H  -  INSERT ACETAB 28MM 0D H HIP PE TRDNT,"$1,195.00",$0.00,"$1,195.00",$0.00,$852.87,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,195.00",$0.00,$597.50,$946.44,$956.00,$0.00,$0.00,$0.00,$0.00,$0.00
620-00-28I,SUP,Custom 27803010,,620-00-28I  -  INSERT ACETAB 28MM 0D 1 HIP PE TRDNT,"$1,195.00",$0.00,"$1,195.00",$0.00,$852.87,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,195.00",$0.00,$597.50,$946.44,$956.00,$0.00,$0.00,$0.00,$0.00,$0.00
620-00-28J,SUP,Custom 27803010,,620-00-28J  -  INSERT ACETAB 28MM 0D J HIP PE TRDNT,"$1,195.00",$0.00,"$1,195.00",$0.00,$852.87,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,195.00",$0.00,$597.50,$946.44,$956.00,$0.00,$0.00,$0.00,$0.00,$0.00
620-005,SUP,HCPCS C1713,,620-005  -  CEMENT BN 5ML STIMULAN RPD CURE KT,"$2,425.00",$0.00,"$2,425.00","$1,091.25","$1,730.72",$0.00,$417.82,$0.00,$0.00,$424.60,"$2,425.00",$0.00,"$1,212.50","$1,920.60","$1,940.00",$0.00,$379.51,$0.00,$386.06,$0.00
620-010,SUP,HCPCS C9359,,620-010  -  FILLER BN VOID CA SLF,"$3,125.00",$0.00,"$3,125.00",$0.00,"$2,230.31",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,125.00",$0.00,"$1,562.50","$2,475.00","$2,500.00",$0.00,$0.00,$0.00,$0.00,$0.00
62-00146,SUP,Custom 27100030,,62-00146  -  GUIDE DRILL 1.6MM LAG PILOT,"$1,822.50",$0.00,"$1,822.50",$0.00,"$1,300.72",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,822.50",$0.00,$911.25,"$1,443.42","$1,458.00",$0.00,$0.00,$0.00,$0.00,$0.00
62-00148,SUP,Custom 27100030,,62-00148  -  GUIDE DRILL 2MM LAG OVERDRILL,"$1,847.50",$0.00,"$1,847.50",$0.00,"$1,318.56",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,847.50",$0.00,$923.75,"$1,463.22","$1,478.00",$0.00,$0.00,$0.00,$0.00,$0.00
620-020,SUP,HCPCS C1713,,620-020  -  CEMENT BONE STIMULAN RPD CURE CALCIUM SLF 20ML KIT,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
62-00231,SUP,Custom 27203010,,62-00231  -  GUIDE DRILL XS SRR CENTRIC,$163.63,$0.00,$163.63,$0.00,$116.78,$0.00,$0.00,$0.00,$0.00,$0.00,$163.63,$0.00,$81.81,$129.59,$130.90,$0.00,$0.00,$0.00,$0.00,$0.00
62-00233,SUP,Custom 27203010,,62-00233  -  GUIDE DRILL SM SRR CENTRIC LEIBINGER,$163.63,$0.00,$163.63,$0.00,$116.78,$0.00,$0.00,$0.00,$0.00,$0.00,$163.63,$0.00,$81.81,$129.59,$130.90,$0.00,$0.00,$0.00,$0.00,$0.00
62-00235,SUP,Custom 27203010,,62-00235  -  GUIDE MED LG DRILL SRR CENTRIC SURG,$163.63,$0.00,$163.63,$0.00,$116.78,$0.00,$0.00,$0.00,$0.00,$0.00,$163.63,$0.00,$81.81,$129.59,$130.90,$0.00,$0.00,$0.00,$0.00,$0.00
62-00237,SUP,Custom 27203010,,62-00237  -  GUIDE MED DRILL ECNTRC SURG,$138.88,$0.00,$138.88,$0.00,$99.12,$0.00,$0.00,$0.00,$0.00,$0.00,$138.88,$0.00,$69.44,$109.99,$111.10,$0.00,$0.00,$0.00,$0.00,$0.00
62-00239,SUP,Custom 27203010,,62-00239  -  GUIDE LG DRILL ECNTRC SURG,$138.88,$0.00,$138.88,$0.00,$99.12,$0.00,$0.00,$0.00,$0.00,$0.00,$138.88,$0.00,$69.44,$109.99,$111.10,$0.00,$0.00,$0.00,$0.00,$0.00
62-00241,SUP,Custom 27203010,,62-00241  -  GUIDE DRILL 2.7MM ECNTRC,$82.50,$0.00,$82.50,$0.00,$58.88,$0.00,$0.00,$0.00,$0.00,$0.00,$82.50,$0.00,$41.25,$65.34,$66.00,$0.00,$0.00,$0.00,$0.00,$0.00
62-00249,SUP,Custom 27203010,,62-00249  -  GUIDE DRILL 2.7MM SRR CENTRIC,$204.88,$0.00,$204.88,$0.00,$146.22,$0.00,$0.00,$0.00,$0.00,$0.00,$204.88,$0.00,$102.44,$162.26,$163.90,$0.00,$0.00,$0.00,$0.00,$0.00
62-00254,SUP,Custom 27203010,,62-00254  -  GUIDE DRILL HNDL CENTRIC SURG,$687.50,$0.00,$687.50,$0.00,$490.67,$0.00,$0.00,$0.00,$0.00,$0.00,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$0.00,$0.00,$0.00,$0.00
62-00270,SUP,Custom 27203010,,62-00270  -  GUIDE DRILL REDX,$171.88,$0.00,$171.88,$0.00,$122.67,$0.00,$0.00,$0.00,$0.00,$0.00,$171.88,$0.00,$85.94,$136.13,$137.50,$0.00,$0.00,$0.00,$0.00,$0.00
62-00605,SUP,Custom 27803010,,62-00605  -  SPACER SPNL HBRD MMF,"$1,000.00",$0.00,"$1,000.00",$0.00,$713.70,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,000.00",$0.00,$500.00,$792.00,$800.00,$0.00,$0.00,$0.00,$0.00,$0.00
620-10-28D,SUP,Custom 27803010,,620-10-28D  -  INSERT ACETAB 28MM 10D D HIP PE TRDNT,"$1,195.00",$0.00,"$1,195.00",$0.00,$852.87,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,195.00",$0.00,$597.50,$946.44,$956.00,$0.00,$0.00,$0.00,$0.00,$0.00
620-10-28E,SUP,Custom 27803010,,620-10-28E  -  INSERT ACETAB 28MM 10D E HIP PE TRDNT,"$1,195.00",$0.00,"$1,195.00",$0.00,$852.87,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,195.00",$0.00,$597.50,$946.44,$956.00,$0.00,$0.00,$0.00,$0.00,$0.00
620-10-28F,SUP,Custom 27803010,,620-10-28F  -  INSERT ACETAB 28MM 10D F HIP PE TRDNT,"$1,195.00",$0.00,"$1,195.00",$0.00,$852.87,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,195.00",$0.00,$597.50,$946.44,$956.00,$0.00,$0.00,$0.00,$0.00,$0.00
620-10-28G,SUP,Custom 27803010,,620-10-28G  -  INSERT ACETAB 10D HIP DUR S12,"$1,195.00",$0.00,"$1,195.00",$0.00,$852.87,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,195.00",$0.00,$597.50,$946.44,$956.00,$0.00,$0.00,$0.00,$0.00,$0.00
620-10-28H,SUP,Custom 27803010,,620-10-28H  -  INSERT ACETAB 28MM 10D H HIP PE TRDNT,"$1,195.00",$0.00,"$1,195.00",$0.00,$852.87,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,195.00",$0.00,$597.50,$946.44,$956.00,$0.00,$0.00,$0.00,$0.00,$0.00
620-10-28I,SUP,Custom 27803010,,620-10-28I  -  INSERT ACETAB 10D HIP CNSTRN ECNTRC POLY XFIRE OMFT S12,"$1,195.00",$0.00,"$1,195.00",$0.00,$852.87,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,195.00",$0.00,$597.50,$946.44,$956.00,$0.00,$0.00,$0.00,$0.00,$0.00
62-01245,SUP,Custom 27203010,,62-01245  -  GUIDE DRILL FEM 2.3 MM SCR,$534.88,$0.00,$534.88,$0.00,$381.74,$0.00,$0.00,$0.00,$0.00,$0.00,$534.88,$0.00,$267.44,$423.62,$427.90,$0.00,$0.00,$0.00,$0.00,$0.00
62-01246,SUP,Custom 27203010,,62-01246  -  GUIDE DRILL FEM 2.7 MM SCR,$534.88,$0.00,$534.88,$0.00,$381.74,$0.00,$0.00,$0.00,$0.00,$0.00,$534.88,$0.00,$267.44,$423.62,$427.90,$0.00,$0.00,$0.00,$0.00,$0.00
62-01250,SUP,Custom 27203010,,62-01250  -  GUIDE CENTRIC DRILL HNDL SURG,$484.00,$0.00,$484.00,$0.00,$345.43,$0.00,$0.00,$0.00,$0.00,$0.00,$484.00,$0.00,$242.00,$383.33,$387.20,$0.00,$0.00,$0.00,$0.00,$0.00
6201FAS,SUP,HCPCS C1760,,6201FAS  -  TOOL LEAD DELIVERY 15MM 22CM FLEXIBLE FASTAC,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
6208-3-010,SUP,HCPCS C1713,,6208-3-010  -  PLUG BONE CMNT SDL 10MM IM,$165.00,$0.00,$165.00,$74.25,$117.76,$0.00,$28.43,$0.00,$0.00,$28.89,$165.00,$0.00,$82.50,$130.68,$132.00,$0.00,$25.82,$0.00,$26.27,$0.00
6208-3-016,SUP,HCPCS C1713,,6208-3-016  -  PLUG BONE CMNT SDL 16MM IM,$165.00,$0.00,$165.00,$74.25,$117.76,$0.00,$28.43,$0.00,$0.00,$28.89,$165.00,$0.00,$82.50,$130.68,$132.00,$0.00,$25.82,$0.00,$26.27,$0.00
621-00-22A,SUP,Custom 27803010,,621-00-22A  -  INSERT ACETAB 0D A 22MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-00-22B,SUP,Custom 27803010,,621-00-22B  -  INSERT ACETAB 0D B 22MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-00-22C,SUP,Custom 27803010,,621-00-22C  -  INSERT ACETAB 0D C 22MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-00-22D,SUP,Custom 27803010,,621-00-22D  -  INSERT ACETAB 0D D 22MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-00-22E,SUP,Custom 27803010,,621-00-22E  -  INSERT ACETAB 0D E 22MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-00-22F,SUP,Custom 27803010,,621-00-22F  -  INSERT ACETAB 0D F 22MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-00-22G,SUP,Custom 27803010,,621-00-22G  -  INSERT ACETAB 0D G 22MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-00-22H,SUP,Custom 27803010,,621-00-22H  -  INSERT ACETAB 0D H 22MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-00-22I,SUP,Custom 27803010,,621-00-22I  -  INSERT ACETAB 0D I 22MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-00-22J,SUP,Custom 27803010,,621-00-22J  -  INSERT ACETAB 0D J 22MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-00-26C,SUP,Custom 27803010,,621-00-26C  -  INSERT ACETAB 0D C 26MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-00-26D,SUP,Custom 27803010,,621-00-26D  -  INSERT ACETAB 0D D 26MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-00-26E,SUP,Custom 27803010,,621-00-26E  -  INSERT ACETAB 0D E 26MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-00-26F,SUP,Custom 27803010,,621-00-26F  -  INSERT ACETAB 0D F 26MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-00-26G,SUP,Custom 27803010,,621-00-26G  -  INSERT ACETAB 0D G 26MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-00-26H,SUP,Custom 27803010,,621-00-26H  -  INSERT ACETAB 0D H 26MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-00-26I,SUP,Custom 27803010,,621-00-26I  -  INSERT ACETAB 0D I 26MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-00-26J,SUP,Custom 27803010,,621-00-26J  -  INSERT ACETAB 0D J 26MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-00-28C,SUP,Custom 27803010,,621-00-28C  -  INSERT ACETAB 0D C 28MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-00-28D,SUP,Custom 27803010,,621-00-28D  -  INSERT ACETAB 0D D 28MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-00-28E,SUP,Custom 27803010,,621-00-28E  -  INSERT ACETAB 0D E 28MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-00-28F,SUP,Custom 27803010,,621-00-28F  -  INSERT ACETAB 0D F 28MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-00-28G,SUP,Custom 27803010,,621-00-28G  -  INSERT ACETAB 0D G 28MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-00-28H,SUP,Custom 27803010,,621-00-28H  -  INSERT ACETAB 0D H 28MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-00-28I,SUP,Custom 27803010,,621-00-28I  -  INSERT ACETAB 0D I 28MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-00-28J,SUP,Custom 27803010,,621-00-28J  -  INSERT ACETAB 0D J 28MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-00-32D,SUP,Custom 27803010,,621-00-32D  -  INSERT ACETAB 0D D 32MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-00-32E,SUP,Custom 27803010,,621-00-32E  -  INSERT ACETAB 0D E 32MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-00-32F,SUP,Custom 27803010,,621-00-32F  -  INSERT ACETAB 0D F 32MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-00-32G,SUP,Custom 27803010,,621-00-32G  -  INSERT ACETAB 0D G 32MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-00-32H,SUP,Custom 27803010,,621-00-32H  -  INSERT ACETAB 0D H 32MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-00-32I,SUP,Custom 27803010,,621-00-32I  -  INSERT ACETAB 0D I 32MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-00-32J,SUP,Custom 27803010,,621-00-32J  -  INSERT ACETAB 0D J 32MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-00-36E,SUP,Custom 27803010,,621-00-36E  -  INSERT ACETAB 0D E 36MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-00-36F,SUP,Custom 27803010,,621-00-36F  -  INSERT ACETAB 0D F 36MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-00-36G,SUP,Custom 27803010,,621-00-36G  -  INSERT ACETAB 0D G 36MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-00-36H,SUP,Custom 27803010,,621-00-36H  -  INSERT ACETAB 0D H 36MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-00-36I,SUP,Custom 27803010,,621-00-36I  -  INSERT ACETAB 0D I 36MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-00-36J,SUP,Custom 27803010,,621-00-36J  -  INSERT ACETAB 0D J 36MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
6210-0-710,SUP,Custom 27203010,,6210-0-710  -  OSTEOTOME SURG 12MM 120MM FLEXIBLE GRAY STERILE,"$1,422.50",$0.00,"$1,422.50",$0.00,"$1,015.24",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,422.50",$0.00,$711.25,"$1,126.62","$1,138.00",$0.00,$0.00,$0.00,$0.00,$0.00
6210-0-740,SUP,Custom 27203010,,6210-0-740  -  OSTEOTOME SURG 12MMX93MM FLEXIBLE GRAY STERILE,"$1,422.50",$0.00,"$1,422.50",$0.00,"$1,015.24",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,422.50",$0.00,$711.25,"$1,126.62","$1,138.00",$0.00,$0.00,$0.00,$0.00,$0.00
621-10-22A,SUP,Custom 27803010,,621-10-22A  -  INSERT ACETAB 10D A 22MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-10-22B,SUP,Custom 27803010,,621-10-22B  -  INSERT ACETAB 10D B 22MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-10-22C,SUP,Custom 27803010,,621-10-22C  -  INSERT ACETAB 10D C 22MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-10-22D,SUP,Custom 27803010,,621-10-22D  -  INSERT ACETAB 10D D 22MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-10-22E,SUP,Custom 27803010,,621-10-22E  -  INSERT ACETAB 10D E 22MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-10-22F,SUP,Custom 27803010,,621-10-22F  -  INSERT ACETAB 10D F 22MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-10-22G,SUP,Custom 27803010,,621-10-22G  -  INSERT ACETAB 10D G 22MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-10-22H,SUP,Custom 27803010,,621-10-22H  -  INSERT ACETAB 10D H 22MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-10-22I,SUP,Custom 27803010,,621-10-22I  -  INSERT ACETAB 10D I 22MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-10-22J,SUP,Custom 27803010,,621-10-22J  -  INSERT ACETAB 10D J 22MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-10-26C,SUP,Custom 27803010,,621-10-26C  -  INSERT ACETAB 10D C 26MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-10-26D,SUP,Custom 27803010,,621-10-26D  -  INSERT ACETAB 10D D 26MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-10-26E,SUP,Custom 27803010,,621-10-26E  -  INSERT ACETAB 10D E 26MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-10-26F,SUP,Custom 27803010,,621-10-26F  -  INSERT ACETAB 10D F 26MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-10-26G,SUP,Custom 27803010,,621-10-26G  -  INSERT ACETAB 10D G 26MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-10-26H,SUP,Custom 27803010,,621-10-26H  -  INSERT ACETAB 10D H 26MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-10-26I,SUP,Custom 27803010,,621-10-26I  -  INSERT ACETAB 10D I 26MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-10-26J,SUP,Custom 27803010,,621-10-26J  -  INSERT ACETAB 10D J 26MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-10-28C,SUP,Custom 27803010,,621-10-28C  -  INSERT ACETAB 10D C 28MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-10-28D,SUP,Custom 27803010,,621-10-28D  -  INSERT ACETAB 10D D 28MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-10-28E,SUP,Custom 27803010,,621-10-28E  -  INSERT ACETAB 10D E 28MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-10-28F,SUP,Custom 27803010,,621-10-28F  -  INSERT ACETAB 10D F 28MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-10-28G,SUP,Custom 27803010,,621-10-28G  -  INSERT ACETAB 10D G 28MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-10-28H,SUP,Custom 27803010,,621-10-28H  -  INSERT ACETAB 10D H 28MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-10-28I,SUP,Custom 27803010,,621-10-28I  -  INSERT ACETAB 10D I 28MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-10-28J,SUP,Custom 27803010,,621-10-28J  -  INSERT ACETAB 10D J 28MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-10-32D,SUP,Custom 27803010,,621-10-32D  -  INSERT ACETAB 10D D 32MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-10-32E,SUP,Custom 27803010,,621-10-32E  -  INSERT ACETAB 10D E 32MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-10-32F,SUP,Custom 27803010,,621-10-32F  -  INSERT ACETAB 10D F 32MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-10-32G,SUP,Custom 27803010,,621-10-32G  -  INSERT ACETAB 10D G 32MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-10-32H,SUP,HCPCS C1713,,621-10-32H  -  INSERT ACETAB 10D H 32MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$517.50,$820.76,$0.00,$198.14,$0.00,$0.00,$201.36,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$179.98,$0.00,$183.08,$0.00
621-10-32I,SUP,Custom 27803010,,621-10-32I  -  INSERT ACETAB 10D I 32MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-10-32J,SUP,Custom 27803010,,621-10-32J  -  INSERT ACETAB 10D J 32MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-10-36E,SUP,Custom 27803010,,621-10-36E  -  INSERT ACETAB 10D E 36MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-10-36F,SUP,Custom 27803010,,621-10-36F  -  INSERT ACETAB 10D F 36MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-10-36G,SUP,Custom 27803010,,621-10-36G  -  INSERT ACETAB 10D G 36MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-10-36H,SUP,Custom 27803010,,621-10-36H  -  INSERT ACETAB 10D H 36MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-10-36I,SUP,Custom 27803010,,621-10-36I  -  INSERT ACETAB 10D I 36MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
621-10-36J,SUP,Custom 27803010,,621-10-36J  -  INSERT ACETAB 10D J 36MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
62-12002,SUP,Custom 27203010,,62-12002  -  BLADE XFIT DNTL SHFT END 1.2MM SCRDRVR,$361.63,$0.00,$361.63,$0.00,$258.09,$0.00,$0.00,$0.00,$0.00,$0.00,$361.63,$0.00,$180.81,$286.41,$289.30,$0.00,$0.00,$0.00,$0.00,$0.00
62-12333,SUP,Custom 27203010,,62-12333  -  BLADE 1.2MM XPIN SCRDRVR,$275.00,$0.00,$275.00,$0.00,$196.27,$0.00,$0.00,$0.00,$0.00,$0.00,$275.00,$0.00,$137.50,$217.80,$220.00,$0.00,$0.00,$0.00,$0.00,$0.00
62-12335,SUP,Custom 27203010,,62-12335  -  BLADE 1.2MM REM SCRDRVR,$343.75,$0.00,$343.75,$0.00,$245.33,$0.00,$0.00,$0.00,$0.00,$0.00,$343.75,$0.00,$171.88,$272.25,$275.00,$0.00,$0.00,$0.00,$0.00,$0.00
62-12503,SUP,Custom 27803010,,62-12503  -  TAP SURG 1.2 MM SCR,$199.38,$0.00,$199.38,$0.00,$142.29,$0.00,$0.00,$0.00,$0.00,$0.00,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$0.00,$0.00,$0.00,$0.00
6215-5-001,SUP,HCPCS C1713,,6215-5-001  -  PLUG BN CMNT SM 18.5MM STRL IM CNL,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
6215-5-011,SUP,HCPCS C1713,,6215-5-011  -  PLUG BN CMNT MED 25MM STRL IM CNL,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
6215-5-021,SUP,HCPCS C1713,,6215-5-021  -  PLUG BN CMNT LG 30MM STRL IM CNL,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
621573S,SUP,HCPCS C1713,,621573S  -  PLATE 81MM TI 3.5MM/4MM SCR 3 HOLE SM FRAG SET SHFT BONE FIB,$312.13,$0.00,$312.13,$140.46,$222.76,$0.00,$53.78,$0.00,$0.00,$54.65,$312.13,$0.00,$156.06,$247.21,$249.70,$0.00,$48.85,$0.00,$49.69,$0.00
621574S,SUP,HCPCS C1713,,621574S  -  PLATE 93MM TI 3.5MM/4MM SCR 4 HOLE SM FRAG SET SHFT BONE FIB,$312.13,$0.00,$312.13,$140.46,$222.76,$0.00,$53.78,$0.00,$0.00,$54.65,$312.13,$0.00,$156.06,$247.21,$249.70,$0.00,$48.85,$0.00,$49.69,$0.00
621575S,SUP,HCPCS C1713,,621575S  -  PLATE 105MM TI 3.5MM/4MM SCR 5 HOLE SM FRAG SET SHFT BONE,$312.13,$0.00,$312.13,$140.46,$222.76,$0.00,$53.78,$0.00,$0.00,$54.65,$312.13,$0.00,$156.06,$247.21,$249.70,$0.00,$48.85,$0.00,$49.69,$0.00
621576S,SUP,HCPCS C1713,,621576S  -  PLATE 117MM TI 3.5MM/4MM SCR 6 HOLE SM FRAG SET SHFT BONE,$312.13,$0.00,$312.13,$140.46,$222.76,$0.00,$53.78,$0.00,$0.00,$54.65,$312.13,$0.00,$156.06,$247.21,$249.70,$0.00,$48.85,$0.00,$49.69,$0.00
621577S,SUP,HCPCS C1713,,621577S  -  PLATE 129MM TI 3.5MM/4MM SCR 7 HOLE SM FRAG SET SHFT BONE,$312.13,$0.00,$312.13,$140.46,$222.76,$0.00,$53.78,$0.00,$0.00,$54.65,$312.13,$0.00,$156.06,$247.21,$249.70,$0.00,$48.85,$0.00,$49.69,$0.00
621578S,SUP,HCPCS C1713,,621578S  -  PLATE 141MM TI 3.5MM/4MM SCR 8 HOLE SM FRAG SET SHFT BONE,$312.13,$0.00,$312.13,$140.46,$222.76,$0.00,$53.78,$0.00,$0.00,$54.65,$312.13,$0.00,$156.06,$247.21,$249.70,$0.00,$48.85,$0.00,$49.69,$0.00
621579S,SUP,HCPCS C1713,,621579S  -  PLATE 153MM TI 3.5MM/4MM SCR 9 HOLE SM FRAG SET SHFT BONE,$312.13,$0.00,$312.13,$140.46,$222.76,$0.00,$53.78,$0.00,$0.00,$54.65,$312.13,$0.00,$156.06,$247.21,$249.70,$0.00,$48.85,$0.00,$49.69,$0.00
62-17005,SUP,Custom 27203010,,62-17005  -  BLADE SCRDRVR 1.7MM XFT,$361.63,$0.00,$361.63,$0.00,$258.09,$0.00,$0.00,$0.00,$0.00,$0.00,$361.63,$0.00,$180.81,$286.41,$289.30,$0.00,$0.00,$0.00,$0.00,$0.00
62-17333,SUP,Custom 27203010,,62-17333  -  BLADE 1.7MM XPIN SCRDRVR,$240.63,$0.00,$240.63,$0.00,$171.73,$0.00,$0.00,$0.00,$0.00,$0.00,$240.63,$0.00,$120.31,$190.58,$192.50,$0.00,$0.00,$0.00,$0.00,$0.00
62-17335,SUP,Custom 27203010,,62-17335  -  BLADE 1.7MM REM SCRDRVR,$343.75,$0.00,$343.75,$0.00,$245.33,$0.00,$0.00,$0.00,$0.00,$0.00,$343.75,$0.00,$171.88,$272.25,$275.00,$0.00,$0.00,$0.00,$0.00,$0.00
62-17503,SUP,Custom 27803010,,62-17503  -  TAP 1.7MM SURG MAXFACL,$199.38,$0.00,$199.38,$0.00,$142.29,$0.00,$0.00,$0.00,$0.00,$0.00,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$0.00,$0.00,$0.00,$0.00
62-20125,SUP,Custom 27203010,,62-20125  -  CUTTER SURG PLT,"$2,420.00",$0.00,"$2,420.00",$0.00,"$1,727.15",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,420.00",$0.00,"$1,210.00","$1,916.64","$1,936.00",$0.00,$0.00,$0.00,$0.00,$0.00
62-21723,SUP,HCPCS C1713,,62-21723  -  IRON BNDRG PLT,$728.75,$0.00,$728.75,$327.94,$520.11,$0.00,$125.56,$0.00,$0.00,$127.60,$728.75,$0.00,$364.38,$577.17,$583.00,$0.00,$114.05,$0.00,$116.02,$0.00
62-23005,SUP,Custom 27203010,,62-23005  -  BLADE 2.3MM XFIT DNTL SHFT END SCRDRVR,$361.63,$0.00,$361.63,$0.00,$258.09,$0.00,$0.00,$0.00,$0.00,$0.00,$361.63,$0.00,$180.81,$286.41,$289.30,$0.00,$0.00,$0.00,$0.00,$0.00
62-23333,SUP,Custom 27203010,,62-23333  -  BLADE 2.3MM XPIN SCRDRVR,$240.63,$0.00,$240.63,$0.00,$171.73,$0.00,$0.00,$0.00,$0.00,$0.00,$240.63,$0.00,$120.31,$190.58,$192.50,$0.00,$0.00,$0.00,$0.00,$0.00
62-23335,SUP,HCPCS C1713,,62-23335  -  SCREW REMOVAL BLADE 2.3 DENTAL,$343.75,$0.00,$343.75,$154.69,$245.33,$0.00,$59.23,$0.00,$0.00,$60.19,$343.75,$0.00,$171.88,$272.25,$275.00,$0.00,$53.80,$0.00,$54.73,$0.00
62-23503,SUP,Custom 27803010,,62-23503  -  TAP SURG 2.3 MM SCR,$213.13,$0.00,$213.13,$0.00,$152.11,$0.00,$0.00,$0.00,$0.00,$0.00,$213.13,$0.00,$106.56,$168.80,$170.50,$0.00,$0.00,$0.00,$0.00,$0.00
62-27015,SUP,Custom 27203010,,62-27015  -  BLADE T7 SCRDRVR 2.3MM 2.7MM SCR,$501.88,$0.00,$501.88,$0.00,$358.19,$0.00,$0.00,$0.00,$0.00,$0.00,$501.88,$0.00,$250.94,$397.49,$401.50,$0.00,$0.00,$0.00,$0.00,$0.00
6227DEF04,SUP,Custom 27203010,,6227DEF04  -  CATHETER GD 9.9FR 45CM STRL LF ATN PRVL LD DLV SYS DFLC CS,"$1,242.50",$0.00,"$1,242.50",$0.00,$886.77,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,242.50",$0.00,$621.25,$984.06,$994.00,$0.00,$0.00,$0.00,$0.00,$0.00
623-00-22A,SUP,Custom 27803010,,623-00-22A  -  LINER ACETAB 0D A 22MM 7.8MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-00-22B,SUP,Custom 27803010,,623-00-22B  -  LINER ACETAB 0D B 22MM 8.8MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-00-22C,SUP,Custom 27803010,,623-00-22C  -  LINER ACETAB 0D C 22MM 9.8MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-00-22D,SUP,Custom 27803010,,623-00-22D  -  LINER ACETAB 0D D 22MM 10.8MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-00-22E,SUP,Custom 27803010,,623-00-22E  -  LINER ACETAB 0D E 22MM 12.8MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-00-22F,SUP,Custom 27803010,,623-00-22F  -  LINER ACETAB 0D F 22MM 14.8MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-00-22G,SUP,Custom 27803010,,623-00-22G  -  LINER ACETAB 0D G 22MM 16.3MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-00-22H,SUP,Custom 27803010,,623-00-22H  -  LINER ACETAB 0D H 22MM 18.1MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-00-22I,SUP,Custom 27803010,,623-00-22I  -  LINER ACETAB 0D I 22MM 19.6MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-00-22J,SUP,Custom 27803010,,623-00-22J  -  LINER ACETAB 0D J 22MM 21.6MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-00-26C,SUP,Custom 27803010,,623-00-26C  -  LINER ACETAB 0D C 26MM 7.9MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-00-26D,SUP,Custom 27803010,,623-00-26D  -  LINER ACETAB 0D D 26MM 8.9MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-00-26E,SUP,Custom 27803010,,623-00-26E  -  LINER ACETAB 0D E 26MM 10.9MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-00-26F,SUP,Custom 27803010,,623-00-26F  -  LINER ACETAB 0D F 26MM 12.9MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-00-26G,SUP,Custom 27803010,,623-00-26G  -  LINER ACETAB 0D G 26MM 14.4MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-00-26H,SUP,Custom 27803010,,623-00-26H  -  LINER ACETAB 0D H 26MM 16.2MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-00-26I,SUP,Custom 27803010,,623-00-26I  -  LINER ACETAB 0D I 26MM 17.7MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-00-26J,SUP,Custom 27803010,,623-00-26J  -  LINER ACETAB 0D J 26MM 19.7MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-00-28A,SUP,Custom 27803010,,623-00-28A  -  LINER ACETAB 0D A 28MM 4.9MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-00-28B,SUP,Custom 27803010,,623-00-28B  -  LINER ACETAB 0D B 28MM 5.9MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-00-28C,SUP,Custom 27803010,,623-00-28C  -  LINER ACETAB 0D C 28MM 6.9MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-00-28D,SUP,Custom 27803010,,623-00-28D  -  LINER ACETAB 0D D 28MM 7.9MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-00-28E,SUP,Custom 27803010,,623-00-28E  -  LINER ACETAB 0D E 28MM 9.9MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-00-28F,SUP,Custom 27803010,,623-00-28F  -  LINER ACETAB 0D F 28MM 11.9MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-00-28G,SUP,Custom 27803010,,623-00-28G  -  LINER ACETAB 0D G 28MM 13.4MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-00-28H,SUP,Custom 27803010,,623-00-28H  -  LINER ACETAB 0D H 28MM 15.2MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-00-28I,SUP,Custom 27803010,,623-00-28I  -  LINER ACETAB 0D I 28MM 16.7MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-00-28J,SUP,Custom 27803010,,623-00-28J  -  LINER ACETAB 0D J 28MM 18.7MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-00-32B,SUP,Custom 27803010,,623-00-32B  -  LINER ACETAB 0D B 32MM 3.9MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-00-32C,SUP,Custom 27803010,,623-00-32C  -  LINER ACETAB 0D C 32MM 4.9MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-00-32D,SUP,Custom 27803010,,623-00-32D  -  LINER ACETAB 0D D 32MM 5.9MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-00-32E,SUP,Custom 27803010,,623-00-32E  -  LINER ACETAB 0D E 32MM 7.9MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-00-32F,SUP,Custom 27803010,,623-00-32F  -  LINER ACETAB 0D F 32MM 9.9MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-00-32G,SUP,Custom 27803010,,623-00-32G  -  LINER ACETAB 0D G 32MM 11.4MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-00-32H,SUP,Custom 27803010,,623-00-32H  -  LINER ACETAB 0D H 32MM 13.2MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-00-32I,SUP,Custom 27803010,,623-00-32I  -  LINER ACETAB 0D I 32MM 14.7MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-00-32J,SUP,Custom 27803010,,623-00-32J  -  LINER ACETAB 0D J 32MM 16.7MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-00-36D,SUP,Custom 27803010,,623-00-36D  -  LINER ACETAB 0D D 36MM 3.9MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-00-36E,SUP,Custom 27803010,,623-00-36E  -  LINER ACETAB 0D E 36MM 5.9MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-00-36F,SUP,Custom 27803010,,623-00-36F  -  LINER ACETAB 0D F 36MM 7.9MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-00-36G,SUP,Custom 27803010,,623-00-36G  -  LINER ACETAB 0D G 36MM 9.4MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-00-36H,SUP,Custom 27803010,,623-00-36H  -  LINER ACETAB 0D H 36MM 11.2MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-00-36I,SUP,Custom 27803010,,623-00-36I  -  LINER ACETAB 0D I 36MM 12.7MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-00-36J,SUP,Custom 27803010,,623-00-36J  -  LINER ACETAB 0D J 36MM 14.7MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-00-40E,SUP,Custom 27803010,,623-00-40E  -  INSERT ACETAB 0D E 40MM TRIDENT X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-00-40F,SUP,Custom 27803010,,623-00-40F  -  LINER ACETAB 0D F 40MM 5.8MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-00-40G,SUP,Custom 27803010,,623-00-40G  -  LINER ACETAB 0D G 40MM 7.4MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-00-40H,SUP,Custom 27803010,,623-00-40H  -  LINER ACETAB 0D H 40MM 9.1MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-00-40I,SUP,Custom 27803010,,623-00-40I  -  LINER ACETAB 0D I 40MM 10.6MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-00-40J,SUP,Custom 27803010,,623-00-40J  -  LINER ACETAB 0D J 40MM 12.6MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-00-44F,SUP,Custom 27803010,,623-00-44F  -  LINER ACETAB 0D B F 44MM 3.8MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-00-44G,SUP,Custom 27803010,,623-00-44G  -  LINER ACETAB 0D G 44MM 5.4MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-00-44H,SUP,Custom 27803010,,623-00-44H  -  LINER ACETAB 0D H 44MM 7.1MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-00-44I,SUP,Custom 27803010,,623-00-44I  -  LINER ACETAB 0D I 44MM 8.6MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-00-44J,SUP,Custom 27803010,,623-00-44J  -  LINER ACETAB 0D J 44MM 10.6MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
6230UNI,SUP,Custom 27203010,,6230UNI  -  SLITTER CATHETER UNIVERSAL UNIVERSAL II,$70.00,$0.00,$70.00,$0.00,$49.96,$0.00,$0.00,$0.00,$0.00,$0.00,$70.00,$0.00,$35.00,$55.44,$56.00,$0.00,$0.00,$0.00,$0.00,$0.00
623-10-22A,SUP,Custom 27803010,,623-10-22A  -  LINER ACETAB 10D A 22MM 7.8MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-10-22B,SUP,Custom 27803010,,623-10-22B  -  LINER ACETAB 10D B 22MM 8.8MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-10-22C,SUP,Custom 27803010,,623-10-22C  -  LINER ACETAB 10D C 22MM 9.8MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-10-22D,SUP,Custom 27803010,,623-10-22D  -  LINER ACETAB 10D D 22MM 10.8MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-10-22E,SUP,Custom 27803010,,623-10-22E  -  LINER ACETAB 10D E 22MM 12.8MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-10-22F,SUP,Custom 27803010,,623-10-22F  -  LINER ACETAB 10D F 22MM 14.8MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-10-22G,SUP,Custom 27803010,,623-10-22G  -  LINER ACETAB 10D G 22MM 16.3MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-10-22H,SUP,Custom 27803010,,623-10-22H  -  LINER ACETAB 10D H 22MM 18.1MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-10-22I,SUP,Custom 27803010,,623-10-22I  -  LINER ACETAB 10D I 22MM 19.6MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-10-22J,SUP,Custom 27803010,,623-10-22J  -  LINER ACETAB 10D J 22MM 21.6MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-10-26C,SUP,Custom 27803010,,623-10-26C  -  LINER ACETAB 10D C 26MM 7.9MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-10-26D,SUP,Custom 27803010,,623-10-26D  -  LINER ACETAB 10D D 26MM 8.9MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-10-26E,SUP,Custom 27803010,,623-10-26E  -  LINER ACETAB 10D E 26MM 10.9MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-10-26F,SUP,Custom 27803010,,623-10-26F  -  LINER ACETAB 10D F 26MM 12.9MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-10-26G,SUP,Custom 27803010,,623-10-26G  -  LINER ACETAB 10D G 26MM 14.4MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-10-26H,SUP,Custom 27803010,,623-10-26H  -  LINER ACETAB 10D H 26MM 16.2MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-10-26I,SUP,Custom 27803010,,623-10-26I  -  LINER ACETAB 10D I 26MM 17.7MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-10-26J,SUP,Custom 27803010,,623-10-26J  -  LINER ACETAB 10D J 26MM 19.7MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-10-28C,SUP,Custom 27803010,,623-10-28C  -  LINER ACETAB 10D C 28MM 6.9MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-10-28D,SUP,Custom 27803010,,623-10-28D  -  LINER ACETAB 10D D 28MM 7.9MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-10-28E,SUP,Custom 27803010,,623-10-28E  -  LINER ACETAB 10D E 28MM 9.9MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-10-28F,SUP,Custom 27803010,,623-10-28F  -  LINER ACETAB 10D F 28MM 11.9MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-10-28G,SUP,Custom 27803010,,623-10-28G  -  LINER ACETAB 10D G 28MM 13.4MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-10-28H,SUP,Custom 27803010,,623-10-28H  -  LINER ACETAB 10D H 28MM 15.2MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-10-28I,SUP,Custom 27803010,,623-10-28I  -  LINER ACETAB 10D I 28MM 16.7MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-10-28J,SUP,Custom 27803010,,623-10-28J  -  LINER ACETAB 10D J 28MM 18.7MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-10-32D,SUP,Custom 27803010,,623-10-32D  -  LINER ACETAB 10D D 32MM 5.9MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-10-32E,SUP,Custom 27803010,,623-10-32E  -  INSERT ACETAB 10D E 32MM PRIM TRIDENT X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-10-32F,SUP,Custom 27803010,,623-10-32F  -  LINER ACETAB 10D F 32MM 9.9MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-10-32G,SUP,Custom 27803010,,623-10-32G  -  LINER ACETAB 10D G 32MM 11.4MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-10-32H,SUP,Custom 27803010,,623-10-32H  -  LINER ACETAB 10D H 32MM 13.2MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-10-32I,SUP,Custom 27803010,,623-10-32I  -  LINER ACETAB 10D I 32MM 14.7MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-10-32J,SUP,Custom 27803010,,623-10-32J  -  LINER ACETAB 10D J 32MM 16.7MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-10-36E,SUP,Custom 27803010,,623-10-36E  -  INSERT ACETAB 10D E 36MM TRIDENT X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-10-36F,SUP,Custom 27803010,,623-10-36F  -  LINER ACETAB 10D F 36MM 7.9MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-10-36G,SUP,Custom 27803010,,623-10-36G  -  LINER ACETAB 10D G 36MM 9.4MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-10-36H,SUP,Custom 27803010,,623-10-36H  -  LINER ACETAB 10D H 36MM 11.2MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-10-36I,SUP,Custom 27803010,,623-10-36I  -  LINER ACETAB 10D I 36MM 12.7MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
623-10-36J,SUP,Custom 27803010,,623-10-36J  -  LINER ACETAB 10D J 36MM 14.7MM X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
62-32440,SUP,Custom 27803010,,62-32440  -  POSITIONER IMPL 3.2MM UNV REPOSITION PIN,"$1,892.50",$0.00,"$1,892.50",$0.00,"$1,350.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,892.50",$0.00,$946.25,"$1,498.86","$1,514.00",$0.00,$0.00,$0.00,$0.00,$0.00
6232ADJ,SUP,Custom 27203010,,6232ADJ  -  SLITTER CATHETER ADJUSTABLE SHEATH,$70.00,$0.00,$70.00,$0.00,$49.96,$0.00,$0.00,$0.00,$0.00,$0.00,$70.00,$0.00,$35.00,$55.44,$56.00,$0.00,$0.00,$0.00,$0.00,$0.00
624.027S,SUP,Custom 27203010,,624.027S  -  KIT SURG PEDICLE ACCES SPN REVERE,"$2,827.50",$0.00,"$2,827.50",$0.00,"$2,017.99",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,827.50",$0.00,"$1,413.75","$2,239.38","$2,262.00",$0.00,$0.00,$0.00,$0.00,$0.00
6248130D02,SUP,Custom 27203010,,6248130D02  -  CATHETER GD 130D 7.1FR 65CM STRL LF ATN SLCT II SUREVALVE,$350.00,$0.00,$350.00,$0.00,$249.80,$0.00,$0.00,$0.00,$0.00,$0.00,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$0.00,$0.00,$0.00,$0.00
624890D02,SUP,Custom 27203010,,624890D02  -  CATHETER GD 90D 7.1FR 65CM STRL LF ATN SLCT II SUREVALVE,$350.00,$0.00,$350.00,$0.00,$249.80,$0.00,$0.00,$0.00,$0.00,$0.00,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$0.00,$0.00,$0.00,$0.00
62-50201,SUP,Custom 27203010,,62-50201  -  PACK BTRY VARISPEED,$780.00,$0.00,$780.00,$0.00,$556.69,$0.00,$0.00,$0.00,$0.00,$0.00,$780.00,$0.00,$390.00,$617.76,$624.00,$0.00,$0.00,$0.00,$0.00,$0.00
6250EH02,SUP,Custom 27203010,,6250EH02  -  CATHETER GD EH CRV 9FR 50CM STRL LF ATN CMND SUREVALVE 2 BRD,$460.00,$0.00,$460.00,$0.00,$328.30,$0.00,$0.00,$0.00,$0.00,$0.00,$460.00,$0.00,$230.00,$364.32,$368.00,$0.00,$0.00,$0.00,$0.00,$0.00
6250MB202,SUP,Custom 27203010,,6250MB202  -  CATHETER GD MB2 CRV 9FR 45CM STRL LF ATN CMND SUREVALVE 2,$460.00,$0.00,$460.00,$0.00,$328.30,$0.00,$0.00,$0.00,$0.00,$0.00,$460.00,$0.00,$230.00,$364.32,$368.00,$0.00,$0.00,$0.00,$0.00,$0.00
625-0T-28D,SUP,Custom 27803010,,625-0T-28D  -  INSERT ACETAB D 28MM TRIDENT ALUM CERAMIC HIP,"$1,725.00",$0.00,"$1,725.00",$0.00,"$1,231.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$0.00,$0.00,$0.00,$0.00
625-0T-32E,SUP,Custom 27803010,,625-0T-32E  -  INSERT ACETAB E 32MM TRIDENT ALUM CERAMIC HIP,"$1,725.00",$0.00,"$1,725.00",$0.00,"$1,231.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$0.00,$0.00,$0.00,$0.00
625-0T-32F,SUP,Custom 27803010,,625-0T-32F  -  INSERT ACETAB F 32MM TRIDENT ALUM CERAMIC HIP,"$1,725.00",$0.00,"$1,725.00",$0.00,"$1,231.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$0.00,$0.00,$0.00,$0.00
625-0T-36G,SUP,Custom 27803010,,625-0T-36G  -  INSERT ACETAB G 36MM TRIDENT ALUM CERAMIC HIP,"$1,725.00",$0.00,"$1,725.00",$0.00,"$1,231.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$0.00,$0.00,$0.00,$0.00
625-0T-36H,SUP,Custom 27803010,,625-0T-36H  -  INSERT ACETAB H 36MM TRIDENT ALUM CERAMIC HIP,"$1,725.00",$0.00,"$1,725.00",$0.00,"$1,231.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$0.00,$0.00,$0.00,$0.00
625-0T-36I,SUP,Custom 27803010,,625-0T-36I  -  INSERT ACETAB I 36MM TRIDENT ALUM CERAMIC HIP,"$1,725.00",$0.00,"$1,725.00",$0.00,"$1,231.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$0.00,$0.00,$0.00,$0.00
62-51217,SUP,Custom 27203010,,62-51217  -  GUIDE DRILL 1.2MM 1.7MM STD,$687.50,$0.00,$687.50,$0.00,$490.67,$0.00,$0.00,$0.00,$0.00,$0.00,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$0.00,$0.00,$0.00,$0.00
62-51723,SUP,Custom 27203010,,62-51723  -  GUIDE DRILL 1.7MM 2.3MM POLYAX LCK,$666.88,$0.00,$666.88,$0.00,$475.95,$0.00,$0.00,$0.00,$0.00,$0.00,$666.88,$0.00,$333.44,$528.17,$533.50,$0.00,$0.00,$0.00,$0.00,$0.00
62-52323,SUP,Custom 27203010,,62-52323  -  GUIDE DRILL 2.3MM CMPR,$735.63,$0.00,$735.63,$0.00,$525.02,$0.00,$0.00,$0.00,$0.00,$0.00,$735.63,$0.00,$367.81,$582.62,$588.50,$0.00,$0.00,$0.00,$0.00,$0.00
62-52325,SUP,Custom 27203010,,62-52325  -  GUIDE DRILL 2.3MM 2.5MM STD,$687.50,$0.00,$687.50,$0.00,$490.67,$0.00,$0.00,$0.00,$0.00,$0.00,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$0.00,$0.00,$0.00,$0.00
6259-8-080,SUP,Custom 27803010,,6259-8-080  -  CNTRLZR STM 8MM RLNC DISTAL FEM,$168.00,$0.00,$168.00,$0.00,$119.90,$0.00,$0.00,$0.00,$0.00,$0.00,$168.00,$0.00,$84.00,$133.06,$134.40,$0.00,$0.00,$0.00,$0.00,$0.00
6259-8-090,SUP,Custom 27803010,,6259-8-090  -  CNTRLZR STM 9MM RLNC DISTAL FEM,$168.00,$0.00,$168.00,$0.00,$119.90,$0.00,$0.00,$0.00,$0.00,$0.00,$168.00,$0.00,$84.00,$133.06,$134.40,$0.00,$0.00,$0.00,$0.00,$0.00
6259-8-100,SUP,Custom 27803010,,6259-8-100  -  CENTRALIZER STEM 10MM RELIANCE HIP FEMUR FRAC PRODUCTS F R,$112.50,$0.00,$112.50,$0.00,$80.29,$0.00,$0.00,$0.00,$0.00,$0.00,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$0.00,$0.00,$0.00,$0.00
6259-8-110,SUP,HCPCS C1713,,6259-8-110  -  CENTRALIZER STEM 11MM PRIM RELIANCE HIP FEMUR,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
6259-8-120,SUP,Custom 27803010,,6259-8-120  -  CENTRALIZER STEM 12MM PRIM RELIANCE DISTAL FEMUR HIP,$112.50,$0.00,$112.50,$0.00,$80.29,$0.00,$0.00,$0.00,$0.00,$0.00,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$0.00,$0.00,$0.00,$0.00
6259-8-130,SUP,HCPCS C1713,,6259-8-130  -  CENTRALIZER STEM 13MM PRIM RELIANCE HIP FEMUR,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
6259-8-140,SUP,HCPCS C1713,,6259-8-140  -  CENTRALIZER STEM 14MM RELIANCE HIP FEMUR,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
6259-8-150,SUP,HCPCS C1713,,6259-8-150  -  CENTRALIZER STEM 15MM RELIANCE HIP FEMUR,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
6259-8-160,SUP,Custom 27803010,,6259-8-160  -  CENTRALIZER STEM 16MM 16MM ACCESSORIES BONE PLUG CENTRALIZER,$112.50,$0.00,$112.50,$0.00,$80.29,$0.00,$0.00,$0.00,$0.00,$0.00,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$0.00,$0.00,$0.00,$0.00
6259-8-170,SUP,Custom 27803010,,6259-8-170  -  CENTRALIZER STEM 17MM 17MM BONE PLUGS ACCESSORIES HIP FRAC,$112.50,$0.00,$112.50,$0.00,$80.29,$0.00,$0.00,$0.00,$0.00,$0.00,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$0.00,$0.00,$0.00,$0.00
6259-8-180,SUP,Custom 27803010,,6259-8-180  -  CENTRALIZER STEM 18MM RELIANCE HIP FEMUR DISTAL,$112.50,$0.00,$112.50,$0.00,$80.29,$0.00,$0.00,$0.00,$0.00,$0.00,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$0.00,$0.00,$0.00,$0.00
626-00-36C,SUP,HCPCS C1776,,626-00-36C  -  LINER ACTB C 36MM MDM COCR HIP 22.2MM FEM HD,"$2,347.50",$0.00,"$2,347.50","$1,056.38","$1,675.41",$0.00,$404.46,$0.00,$0.00,$411.03,"$2,347.50",$0.00,"$1,173.75","$1,859.22","$1,878.00",$0.00,$367.38,$0.00,$373.72,$0.00
626-00-38D,SUP,HCPCS C1776,,626-00-38D  -  LINER ACTB D 38MM MDLR 2 MBL COCR HIP,"$2,347.50",$0.00,"$2,347.50","$1,056.38","$1,675.41",$0.00,$404.46,$0.00,$0.00,$411.03,"$2,347.50",$0.00,"$1,173.75","$1,859.22","$1,878.00",$0.00,$367.38,$0.00,$373.72,$0.00
626-00-42E,SUP,HCPCS C1776,,626-00-42E  -  LINER ACTB E 42MM MDM 2 MBL MDLR COCR HIP,"$2,347.50",$0.00,"$2,347.50","$1,056.38","$1,675.41",$0.00,$404.46,$0.00,$0.00,$411.03,"$2,347.50",$0.00,"$1,173.75","$1,859.22","$1,878.00",$0.00,$367.38,$0.00,$373.72,$0.00
626-00-52H,SUP,HCPCS C1776,,626-00-52H  -  LINER ACTB H 52MM MDM COCR HIP 28MM FEM HD,"$2,347.50",$0.00,"$2,347.50","$1,056.38","$1,675.41",$0.00,$404.46,$0.00,$0.00,$411.03,"$2,347.50",$0.00,"$1,173.75","$1,859.22","$1,878.00",$0.00,$367.38,$0.00,$373.72,$0.00
626-00-54I,SUP,HCPCS C1776,,626-00-54I  -  LINER ACTB I 54MM MDM COCR HIP 28MM FEM HD,"$2,347.50",$0.00,"$2,347.50","$1,056.38","$1,675.41",$0.00,$404.46,$0.00,$0.00,$411.03,"$2,347.50",$0.00,"$1,173.75","$1,859.22","$1,878.00",$0.00,$367.38,$0.00,$373.72,$0.00
626-00-58J,SUP,HCPCS C1776,,626-00-58J  -  LINER ACTB J 58MM MDM COCR HIP 28MM FEM HD,"$2,347.50",$0.00,"$2,347.50","$1,056.38","$1,675.41",$0.00,$404.46,$0.00,$0.00,$411.03,"$2,347.50",$0.00,"$1,173.75","$1,859.22","$1,878.00",$0.00,$367.38,$0.00,$373.72,$0.00
6260-1-212,SUP,HCPCS C1776,,6260-1-212  -  STEM FEM 237MM PS BW RSTOR TI 2/12 LNG LEFT HIP,"$12,943.13",$0.00,"$12,943.13","$5,824.41","$5,158.80",$0.00,"$2,230.04",$0.00,$0.00,"$2,266.24","$12,943.13",$0.00,"$6,471.56","$10,250.96","$10,354.50",$0.00,"$2,025.60",$0.00,"$2,060.55",$0.00
6260-1-313,SUP,HCPCS C1776,,6260-1-313  -  STEM FEM 235MM PS BW RSTOR TI 3/13 LNG LEFT HIP,"$12,943.13",$0.00,"$12,943.13","$5,824.41","$5,158.80",$0.00,"$2,230.04",$0.00,$0.00,"$2,266.24","$12,943.13",$0.00,"$6,471.56","$10,250.96","$10,354.50",$0.00,"$2,025.60",$0.00,"$2,060.55",$0.00
6260-1-414,SUP,HCPCS C1776,,6260-1-414  -  STEM FEM 234MM 14MM PS BW RSTOR TI 4 LNG LEFT HIP,"$12,943.13",$0.00,"$12,943.13","$5,824.41","$5,158.80",$0.00,"$2,230.04",$0.00,$0.00,"$2,266.24","$12,943.13",$0.00,"$6,471.56","$10,250.96","$10,354.50",$0.00,"$2,025.60",$0.00,"$2,060.55",$0.00
6260-1-515,SUP,HCPCS C1776,,6260-1-515  -  STEM HUM 15MM 5MM MNBLCK RSTOR TI LNG LEFT T1,"$12,943.13",$0.00,"$12,943.13","$5,824.41","$5,158.80",$0.00,"$2,230.04",$0.00,$0.00,"$2,266.24","$12,943.13",$0.00,"$6,471.56","$10,250.96","$10,354.50",$0.00,"$2,025.60",$0.00,"$2,060.55",$0.00
6260-1-616,SUP,HCPCS C1776,,6260-1-616  -  STEM HUM 16MM 6MM MNBLCK RSTOR TI LNG LEFT T1,"$12,943.13",$0.00,"$12,943.13","$5,824.41","$5,158.80",$0.00,"$2,230.04",$0.00,$0.00,"$2,266.24","$12,943.13",$0.00,"$6,471.56","$10,250.96","$10,354.50",$0.00,"$2,025.60",$0.00,"$2,060.55",$0.00
6260-1-717,SUP,HCPCS C1776,,6260-1-717  -  STEM FEM 241MM 17MM PS BW RSTOR TI 7 LNG LEFT HIP,"$12,943.13",$0.00,"$12,943.13","$5,824.41","$5,158.80",$0.00,"$2,230.04",$0.00,$0.00,"$2,266.24","$12,943.13",$0.00,"$6,471.56","$10,250.96","$10,354.50",$0.00,"$2,025.60",$0.00,"$2,060.55",$0.00
6260-1-719,SUP,HCPCS C1776,,6260-1-719  -  STEM FEM 251MM 19MM PS BW RSTOR TI 7 LNG LEFT HIP,"$12,943.13",$0.00,"$12,943.13","$5,824.41","$5,158.80",$0.00,"$2,230.04",$0.00,$0.00,"$2,266.24","$12,943.13",$0.00,"$6,471.56","$10,250.96","$10,354.50",$0.00,"$2,025.60",$0.00,"$2,060.55",$0.00
6260-1-818,SUP,HCPCS C1776,,6260-1-818  -  STEM FEM 240MM 18MM PS BW RSTOR TI 8 LNG LEFT HIP,"$12,943.13",$0.00,"$12,943.13","$5,824.41","$5,158.80",$0.00,"$2,230.04",$0.00,$0.00,"$2,266.24","$12,943.13",$0.00,"$6,471.56","$10,250.96","$10,354.50",$0.00,"$2,025.60",$0.00,"$2,060.55",$0.00
6260-1-820,SUP,HCPCS C1776,,6260-1-820  -  STEM FEM 251MM 20MM PS BW RSTOR TI 8 LNG LEFT HIP,"$12,943.13",$0.00,"$12,943.13","$5,824.41","$5,158.80",$0.00,"$2,230.04",$0.00,$0.00,"$2,266.24","$12,943.13",$0.00,"$6,471.56","$10,250.96","$10,354.50",$0.00,"$2,025.60",$0.00,"$2,060.55",$0.00
6260-1-921,SUP,HCPCS C1776,,6260-1-921  -  STEM FEM 250MM 21MM PS BW RSTOR TI 9 LNG LEFT HIP,"$12,943.13",$0.00,"$12,943.13","$5,824.41","$5,158.80",$0.00,"$2,230.04",$0.00,$0.00,"$2,266.24","$12,943.13",$0.00,"$6,471.56","$10,250.96","$10,354.50",$0.00,"$2,025.60",$0.00,"$2,060.55",$0.00
6260-2-212,SUP,HCPCS C1776,,6260-2-212  -  STEM HUM 12MM 2MM MNBLCK RSTOR TI LNG LEFT T1,"$12,943.13",$0.00,"$12,943.13","$5,824.41","$5,158.80",$0.00,"$2,230.04",$0.00,$0.00,"$2,266.24","$12,943.13",$0.00,"$6,471.56","$10,250.96","$10,354.50",$0.00,"$2,025.60",$0.00,"$2,060.55",$0.00
6260-2-313,SUP,HCPCS C1776,,6260-2-313  -  STEM FEM 235MM 13MM PS BW RSTOR TI LNG RIGHT HIP,"$12,943.13",$0.00,"$12,943.13","$5,824.41","$5,158.80",$0.00,"$2,230.04",$0.00,$0.00,"$2,266.24","$12,943.13",$0.00,"$6,471.56","$10,250.96","$10,354.50",$0.00,"$2,025.60",$0.00,"$2,060.55",$0.00
6260-2-414,SUP,HCPCS C1776,,6260-2-414  -  STEM FEM 234MM PS BW RSTOR TI 4/14 LNG RIGHT HIP,"$12,943.13",$0.00,"$12,943.13","$5,824.41","$5,158.80",$0.00,"$2,230.04",$0.00,$0.00,"$2,266.24","$12,943.13",$0.00,"$6,471.56","$10,250.96","$10,354.50",$0.00,"$2,025.60",$0.00,"$2,060.55",$0.00
6260-2-515,SUP,HCPCS C1776,,6260-2-515  -  STEM FEM 233MM 15MM PS BW RSTOR TI 5 LNG RIGHT HIP,"$12,943.13",$0.00,"$12,943.13","$5,824.41","$5,158.80",$0.00,"$2,230.04",$0.00,$0.00,"$2,266.24","$12,943.13",$0.00,"$6,471.56","$10,250.96","$10,354.50",$0.00,"$2,025.60",$0.00,"$2,060.55",$0.00
6260-2-616,SUP,HCPCS C1776,,6260-2-616  -  STEM FEM 242MM 16MM PS BW RSTOR TI 6 LNG RIGHT HIP,"$12,943.13",$0.00,"$12,943.13","$5,824.41","$5,158.80",$0.00,"$2,230.04",$0.00,$0.00,"$2,266.24","$12,943.13",$0.00,"$6,471.56","$10,250.96","$10,354.50",$0.00,"$2,025.60",$0.00,"$2,060.55",$0.00
6260-2-717,SUP,HCPCS C1776,,6260-2-717  -  STEM FEM 241MM PS BW RSTOR TI 7/17 LNG RIGHT HIP,"$12,943.13",$0.00,"$12,943.13","$5,824.41","$5,158.80",$0.00,"$2,230.04",$0.00,$0.00,"$2,266.24","$12,943.13",$0.00,"$6,471.56","$10,250.96","$10,354.50",$0.00,"$2,025.60",$0.00,"$2,060.55",$0.00
6260-2-719,SUP,HCPCS C1776,,6260-2-719  -  STEM FEM 251MM 19MM PS BW RSTOR TI 7 LNG RIGHT HIP,"$12,943.13",$0.00,"$12,943.13","$5,824.41","$5,158.80",$0.00,"$2,230.04",$0.00,$0.00,"$2,266.24","$12,943.13",$0.00,"$6,471.56","$10,250.96","$10,354.50",$0.00,"$2,025.60",$0.00,"$2,060.55",$0.00
6260-2-818,SUP,HCPCS C1776,,6260-2-818  -  STEM FEM 240MM 18MM PS BW RSTOR TI 8 LNG RIGHT HIP,"$12,943.13",$0.00,"$12,943.13","$5,824.41","$5,158.80",$0.00,"$2,230.04",$0.00,$0.00,"$2,266.24","$12,943.13",$0.00,"$6,471.56","$10,250.96","$10,354.50",$0.00,"$2,025.60",$0.00,"$2,060.55",$0.00
6260-2-820,SUP,HCPCS C1776,,6260-2-820  -  STEM FEM 251MM 20MM PS BW RSTOR TI 8 LNG RIGHT HIP,"$12,943.13",$0.00,"$12,943.13","$5,824.41","$5,158.80",$0.00,"$2,230.04",$0.00,$0.00,"$2,266.24","$12,943.13",$0.00,"$6,471.56","$10,250.96","$10,354.50",$0.00,"$2,025.60",$0.00,"$2,060.55",$0.00
6260-2-921,SUP,HCPCS C1776,,6260-2-921  -  STEM HUM 21MM 9MM MNBLCK RSTOR TI LNG RIGHT T1,"$12,943.13",$0.00,"$12,943.13","$5,824.41","$5,158.80",$0.00,"$2,230.04",$0.00,$0.00,"$2,266.24","$12,943.13",$0.00,"$6,471.56","$10,250.96","$10,354.50",$0.00,"$2,025.60",$0.00,"$2,060.55",$0.00
6260-4-122,SUP,Custom 27803010,,6260-4-122  -  HEAD FEM +0MM 22.2MM V40 COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6260-4-222,SUP,Custom 27803010,,6260-4-222  -  HEAD FEM +3MM 22.2MM V40 COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6260-4-322,SUP,Custom 27803010,,6260-4-322  -  HEAD FEMORAL +8MM TAPER 22.2MM V40 COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6260-5-026,SUP,Custom 27803010,,6260-5-026  -  HEAD FEMORAL -3MM TAPER 26MM V40 COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6260-5-028,SUP,Custom 27803010,,6260-5-028  -  HEAD FEMORAL -4MM TAPER 28MM V40 COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6260-5-032,SUP,Custom 27803010,,6260-5-032  -  HEAD FEMORAL -4MM TAPER 32MM V40 COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6260-5-126,SUP,Custom 27803010,,6260-5-126  -  HEAD FEMORAL +0MM TAPER 26MM V40 COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6260-5-128,SUP,Custom 27803010,,6260-5-128  -  HEAD FEMORAL +0MM TAPER 28MM V40 COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6260-5-132,SUP,Custom 27803010,,6260-5-132  -  HEAD FEMORAL +0MM TAPER 32MM V40 COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6260-5-226,SUP,Custom 27803010,,6260-5-226  -  HEAD FEMORAL +4MM TAPER 26MM V40 COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6260-5-228,SUP,Custom 27803010,,6260-5-228  -  HEAD FEMORAL +4MM TAPER 28MM V40 COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6260-5-232,SUP,Custom 27803010,,6260-5-232  -  HEAD FEMORAL +4MM TAPER 32MM V40 COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6260-5-326,SUP,Custom 27803010,,6260-5-326  -  HEAD FEMORAL +8MM TAPER 26MM V40 COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6260-5-328,SUP,Custom 27803010,,6260-5-328  -  HEAD FEMORAL +8MM TAPER 28MM V40 COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6260-5-332,SUP,Custom 27803010,,6260-5-332  -  HEAD FEMORAL +8MM TAPER 32MM V40 COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6260-5-426,SUP,Custom 27803010,,6260-5-426  -  HEAD FEMORAL +1MM TAPER 26MM V40 COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6260-5-428,SUP,Custom 27803010,,6260-5-428  -  HEAD FEMORAL +12MM TAPER 28MM V40 COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6260-5-432,SUP,Custom 27803010,,6260-5-432  -  HEAD FEMORAL +12MM TAPER 32MM V40 COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6260-5-628,SUP,Custom 27803010,,6260-5-628  -  HEAD FEMORAL +6MM TAPER 28MM V40 COCR HIP,"$1,302.50",$0.00,"$1,302.50",$0.00,$929.59,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,302.50",$0.00,$651.25,"$1,031.58","$1,042.00",$0.00,$0.00,$0.00,$0.00,$0.00
6260-6-111,SUP,HCPCS C1776,,6260-6-111  -  STEM FEMORAL 1 STR 11MM 165MM RSTOR TITANIUM PLASMA SPRAY,"$13,152.50",$0.00,"$13,152.50","$5,918.63","$5,158.80",$0.00,"$2,266.11",$0.00,$0.00,"$2,302.90","$13,152.50",$0.00,"$6,576.25","$10,416.78","$10,522.00",$0.00,"$2,058.37",$0.00,"$2,093.88",$0.00
6260-6-113,SUP,HCPCS C1776,,6260-6-113  -  STEM FEMORAL 1 STR 13MM 165MM RSTOR TITANIUM PLASMA SPRAY,"$13,152.50",$0.00,"$13,152.50","$5,918.63","$5,158.80",$0.00,"$2,266.11",$0.00,$0.00,"$2,302.90","$13,152.50",$0.00,"$6,576.25","$10,416.78","$10,522.00",$0.00,"$2,058.37",$0.00,"$2,093.88",$0.00
6260-6-212,SUP,HCPCS C1776,,6260-6-212  -  STEM FEMORAL 2 STR 12MM 165MM RSTOR TITANIUM PLASMA SPRAY,"$13,152.50",$0.00,"$13,152.50","$5,918.63","$5,158.80",$0.00,"$2,266.11",$0.00,$0.00,"$2,302.90","$13,152.50",$0.00,"$6,576.25","$10,416.78","$10,522.00",$0.00,"$2,058.37",$0.00,"$2,093.88",$0.00
6260-6-214,SUP,HCPCS C1776,,6260-6-214  -  STEM FEMORAL 2 STR 14MM 165MM RSTOR TITANIUM PLASMA SPRAY,"$13,152.50",$0.00,"$13,152.50","$5,918.63","$5,158.80",$0.00,"$2,266.11",$0.00,$0.00,"$2,302.90","$13,152.50",$0.00,"$6,576.25","$10,416.78","$10,522.00",$0.00,"$2,058.37",$0.00,"$2,093.88",$0.00
6260-6-313,SUP,HCPCS C1776,,6260-6-313  -  STEM FEMORAL 3 STR 13MM 165MM RSTOR TITANIUM PLASMA SPRAY,"$13,152.50",$0.00,"$13,152.50","$5,918.63","$5,158.80",$0.00,"$2,266.11",$0.00,$0.00,"$2,302.90","$13,152.50",$0.00,"$6,576.25","$10,416.78","$10,522.00",$0.00,"$2,058.37",$0.00,"$2,093.88",$0.00
6260-6-315,SUP,HCPCS C1776,,6260-6-315  -  STEM FEMORAL 3 STR 15MM 165MM RSTOR TITANIUM PLASMA SPRAY,"$13,152.50",$0.00,"$13,152.50","$5,918.63","$5,158.80",$0.00,"$2,266.11",$0.00,$0.00,"$2,302.90","$13,152.50",$0.00,"$6,576.25","$10,416.78","$10,522.00",$0.00,"$2,058.37",$0.00,"$2,093.88",$0.00
6260-6-414,SUP,HCPCS C1776,,6260-6-414  -  STEM FEMORAL 4 STR 14MM 165MM RSTOR TITANIUM PLASMA SPRAY,"$13,152.50",$0.00,"$13,152.50","$5,918.63","$5,158.80",$0.00,"$2,266.11",$0.00,$0.00,"$2,302.90","$13,152.50",$0.00,"$6,576.25","$10,416.78","$10,522.00",$0.00,"$2,058.37",$0.00,"$2,093.88",$0.00
6260-6-416,SUP,HCPCS C1776,,6260-6-416  -  STEM FEMORAL 4 STR 16MM 165MM RSTOR TITANIUM PLASMA SPRAY,"$13,152.50",$0.00,"$13,152.50","$5,918.63","$5,158.80",$0.00,"$2,266.11",$0.00,$0.00,"$2,302.90","$13,152.50",$0.00,"$6,576.25","$10,416.78","$10,522.00",$0.00,"$2,058.37",$0.00,"$2,093.88",$0.00
6260-6-515,SUP,HCPCS C1776,,6260-6-515  -  STEM FEMORAL 5 STR 15MM 165MM RSTOR TITANIUM PLASMA SPRAY,"$13,152.50",$0.00,"$13,152.50","$5,918.63","$5,158.80",$0.00,"$2,266.11",$0.00,$0.00,"$2,302.90","$13,152.50",$0.00,"$6,576.25","$10,416.78","$10,522.00",$0.00,"$2,058.37",$0.00,"$2,093.88",$0.00
6260-6-517,SUP,HCPCS C1776,,6260-6-517  -  STEM FEMORAL 5 STR 17MM 165MM RSTOR TITANIUM PLASMA SPRAY,"$13,152.50",$0.00,"$13,152.50","$5,918.63","$5,158.80",$0.00,"$2,266.11",$0.00,$0.00,"$2,302.90","$13,152.50",$0.00,"$6,576.25","$10,416.78","$10,522.00",$0.00,"$2,058.37",$0.00,"$2,093.88",$0.00
6260-6-616,SUP,HCPCS C1776,,6260-6-616  -  STEM FEMORAL 6 STR 16MM 165MM RSTOR TITANIUM PLASMA SPRAY,"$13,152.50",$0.00,"$13,152.50","$5,918.63","$5,158.80",$0.00,"$2,266.11",$0.00,$0.00,"$2,302.90","$13,152.50",$0.00,"$6,576.25","$10,416.78","$10,522.00",$0.00,"$2,058.37",$0.00,"$2,093.88",$0.00
6260-6-618,SUP,HCPCS C1776,,6260-6-618  -  STEM FEMORAL 6 STR 18MM 165MM RSTOR TITANIUM PLASMA SPRAY,"$13,152.50",$0.00,"$13,152.50","$5,918.63","$5,158.80",$0.00,"$2,266.11",$0.00,$0.00,"$2,302.90","$13,152.50",$0.00,"$6,576.25","$10,416.78","$10,522.00",$0.00,"$2,058.37",$0.00,"$2,093.88",$0.00
6260-6-717,SUP,HCPCS C1776,,6260-6-717  -  STEM FEMORAL 7 STR 17MM 165MM RSTOR TITANIUM PLASMA SPRAY,"$13,152.50",$0.00,"$13,152.50","$5,918.63","$5,158.80",$0.00,"$2,266.11",$0.00,$0.00,"$2,302.90","$13,152.50",$0.00,"$6,576.25","$10,416.78","$10,522.00",$0.00,"$2,058.37",$0.00,"$2,093.88",$0.00
6260-6-719,SUP,HCPCS C1776,,6260-6-719  -  STEM FEMORAL 7 STR 19MM 165MM RSTOR TITANIUM PLASMA SPRAY,"$13,152.50",$0.00,"$13,152.50","$5,918.63","$5,158.80",$0.00,"$2,266.11",$0.00,$0.00,"$2,302.90","$13,152.50",$0.00,"$6,576.25","$10,416.78","$10,522.00",$0.00,"$2,058.37",$0.00,"$2,093.88",$0.00
6260-6-818,SUP,HCPCS C1776,,6260-6-818  -  STEM FEMORAL 8 STR 18MM 165MM RSTOR TITANIUM PLASMA SPRAY,"$13,152.50",$0.00,"$13,152.50","$5,918.63","$5,158.80",$0.00,"$2,266.11",$0.00,$0.00,"$2,302.90","$13,152.50",$0.00,"$6,576.25","$10,416.78","$10,522.00",$0.00,"$2,058.37",$0.00,"$2,093.88",$0.00
6260-6-820,SUP,HCPCS C1776,,6260-6-820  -  STEM FEMORAL 8 STR 20MM 165MM RSTOR TITANIUM PLASMA SPRAY,"$13,152.50",$0.00,"$13,152.50","$5,918.63","$5,158.80",$0.00,"$2,266.11",$0.00,$0.00,"$2,302.90","$13,152.50",$0.00,"$6,576.25","$10,416.78","$10,522.00",$0.00,"$2,058.37",$0.00,"$2,093.88",$0.00
6260-6-921,SUP,HCPCS C1776,,6260-6-921  -  STEM FEMORAL 9 STR 21MM 165MM RSTOR TITANIUM PLASMA SPRAY,"$13,152.50",$0.00,"$13,152.50","$5,918.63","$5,158.80",$0.00,"$2,266.11",$0.00,$0.00,"$2,302.90","$13,152.50",$0.00,"$6,576.25","$10,416.78","$10,522.00",$0.00,"$2,058.37",$0.00,"$2,093.88",$0.00
6260-8-036,SUP,Custom 27803010,,6260-8-036  -  HEAD FEM -4MM 36MM HIP COCR V40 LFIT,"$2,035.00",$0.00,"$2,035.00",$0.00,"$1,452.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,035.00",$0.00,"$1,017.50","$1,611.72","$1,628.00",$0.00,$0.00,$0.00,$0.00,$0.00
6260-8-111,SUP,HCPCS C1776,,6260-8-111  -  STEM FEMORAL 1 STR 11MM 203MM RSTOR TITANIUM PLASMA SPRAY,"$13,152.50",$0.00,"$13,152.50","$5,918.63","$5,158.80",$0.00,"$2,266.11",$0.00,$0.00,"$2,302.90","$13,152.50",$0.00,"$6,576.25","$10,416.78","$10,522.00",$0.00,"$2,058.37",$0.00,"$2,093.88",$0.00
6260-8-113,SUP,HCPCS C1776,,6260-8-113  -  STEM FEMORAL 1 STR 13MM 203MM RSTOR TITANIUM PLASMA SPRAY,"$13,152.50",$0.00,"$13,152.50","$5,918.63","$5,158.80",$0.00,"$2,266.11",$0.00,$0.00,"$2,302.90","$13,152.50",$0.00,"$6,576.25","$10,416.78","$10,522.00",$0.00,"$2,058.37",$0.00,"$2,093.88",$0.00
6260-8-212,SUP,HCPCS C1776,,6260-8-212  -  STEM FEMORAL 2 STR 12MM 203MM RSTOR TITANIUM PLASMA SPRAY,"$13,152.50",$0.00,"$13,152.50","$5,918.63","$5,158.80",$0.00,"$2,266.11",$0.00,$0.00,"$2,302.90","$13,152.50",$0.00,"$6,576.25","$10,416.78","$10,522.00",$0.00,"$2,058.37",$0.00,"$2,093.88",$0.00
6260-8-214,SUP,HCPCS C1776,,6260-8-214  -  STEM FEMORAL 2 STR 14MM 203MM RSTOR TITANIUM PLASMA SPRAY,"$13,152.50",$0.00,"$13,152.50","$5,918.63","$5,158.80",$0.00,"$2,266.11",$0.00,$0.00,"$2,302.90","$13,152.50",$0.00,"$6,576.25","$10,416.78","$10,522.00",$0.00,"$2,058.37",$0.00,"$2,093.88",$0.00
6260-8-236,SUP,Custom 27803010,,6260-8-236  -  HEAD FEM +4MM 36MM HIP COCR V40 LFIT,"$2,035.00",$0.00,"$2,035.00",$0.00,"$1,452.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,035.00",$0.00,"$1,017.50","$1,611.72","$1,628.00",$0.00,$0.00,$0.00,$0.00,$0.00
6260-8-313,SUP,HCPCS C1776,,6260-8-313  -  STEM FEMORAL 3 STR 13MM 203MM RSTOR TITANIUM PLASMA SPRAY,"$13,152.50",$0.00,"$13,152.50","$5,918.63","$5,158.80",$0.00,"$2,266.11",$0.00,$0.00,"$2,302.90","$13,152.50",$0.00,"$6,576.25","$10,416.78","$10,522.00",$0.00,"$2,058.37",$0.00,"$2,093.88",$0.00
6260-8-315,SUP,HCPCS C1776,,6260-8-315  -  STEM FEMORAL 3 STR 15MM 203MM RSTOR TITANIUM PLASMA SPRAY,"$13,152.50",$0.00,"$13,152.50","$5,918.63","$5,158.80",$0.00,"$2,266.11",$0.00,$0.00,"$2,302.90","$13,152.50",$0.00,"$6,576.25","$10,416.78","$10,522.00",$0.00,"$2,058.37",$0.00,"$2,093.88",$0.00
6260-8-336,SUP,Custom 27803010,,6260-8-336  -  HEAD FEM +8MM 36MM HIP COCR V40 LFIT,"$2,035.00",$0.00,"$2,035.00",$0.00,"$1,452.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,035.00",$0.00,"$1,017.50","$1,611.72","$1,628.00",$0.00,$0.00,$0.00,$0.00,$0.00
6260-8-414,SUP,HCPCS C1776,,6260-8-414  -  STEM FEMORAL 4 STR 14MM 203MM RSTOR TITANIUM PLASMA SPRAY,"$13,152.50",$0.00,"$13,152.50","$5,918.63","$5,158.80",$0.00,"$2,266.11",$0.00,$0.00,"$2,302.90","$13,152.50",$0.00,"$6,576.25","$10,416.78","$10,522.00",$0.00,"$2,058.37",$0.00,"$2,093.88",$0.00
6260-8-416,SUP,HCPCS C1776,,6260-8-416  -  STEM FEMORAL 4 STR 16MM 203MM RSTOR TITANIUM PLASMA SPRAY,"$13,152.50",$0.00,"$13,152.50","$5,918.63","$5,158.80",$0.00,"$2,266.11",$0.00,$0.00,"$2,302.90","$13,152.50",$0.00,"$6,576.25","$10,416.78","$10,522.00",$0.00,"$2,058.37",$0.00,"$2,093.88",$0.00
6260-8-515,SUP,HCPCS C1776,,6260-8-515  -  STEM FEMORAL 5 STR 15MM 203MM RSTOR TITANIUM PLASMA SPRAY,"$13,152.50",$0.00,"$13,152.50","$5,918.63","$5,158.80",$0.00,"$2,266.11",$0.00,$0.00,"$2,302.90","$13,152.50",$0.00,"$6,576.25","$10,416.78","$10,522.00",$0.00,"$2,058.37",$0.00,"$2,093.88",$0.00
6260-8-517,SUP,HCPCS C1776,,6260-8-517  -  STEM FEMORAL 5 STR 17MM 203MM RSTOR TITANIUM PLASMA SPRAY,"$13,152.50",$0.00,"$13,152.50","$5,918.63","$5,158.80",$0.00,"$2,266.11",$0.00,$0.00,"$2,302.90","$13,152.50",$0.00,"$6,576.25","$10,416.78","$10,522.00",$0.00,"$2,058.37",$0.00,"$2,093.88",$0.00
6260-8-616,SUP,HCPCS C1776,,6260-8-616  -  STEM FEMORAL 6 STR 16MM 203MM RSTOR TITANIUM PLASMA SPRAY,"$13,152.50",$0.00,"$13,152.50","$5,918.63","$5,158.80",$0.00,"$2,266.11",$0.00,$0.00,"$2,302.90","$13,152.50",$0.00,"$6,576.25","$10,416.78","$10,522.00",$0.00,"$2,058.37",$0.00,"$2,093.88",$0.00
6260-8-618,SUP,HCPCS C1776,,6260-8-618  -  STEM FEMORAL 6 STR 18MM 203MM RSTOR TITANIUM PLASMA SPRAY,"$13,152.50",$0.00,"$13,152.50","$5,918.63","$5,158.80",$0.00,"$2,266.11",$0.00,$0.00,"$2,302.90","$13,152.50",$0.00,"$6,576.25","$10,416.78","$10,522.00",$0.00,"$2,058.37",$0.00,"$2,093.88",$0.00
6260-8-717,SUP,HCPCS C1776,,6260-8-717  -  STEM FEMORAL 7 STR 17MM 203MM RSTOR TITANIUM PLASMA SPRAY,"$13,152.50",$0.00,"$13,152.50","$5,918.63","$5,158.80",$0.00,"$2,266.11",$0.00,$0.00,"$2,302.90","$13,152.50",$0.00,"$6,576.25","$10,416.78","$10,522.00",$0.00,"$2,058.37",$0.00,"$2,093.88",$0.00
6260-8-719,SUP,HCPCS C1776,,6260-8-719  -  STEM FEMORAL 7 STR 19MM 203MM RSTOR TITANIUM PLASMA SPRAY,"$13,152.50",$0.00,"$13,152.50","$5,918.63","$5,158.80",$0.00,"$2,266.11",$0.00,$0.00,"$2,302.90","$13,152.50",$0.00,"$6,576.25","$10,416.78","$10,522.00",$0.00,"$2,058.37",$0.00,"$2,093.88",$0.00
6260-8-818,SUP,HCPCS C1776,,6260-8-818  -  STEM FEMORAL 8 STR 18MM 203MM RSTOR TITANIUM PLASMA SPRAY,"$13,152.50",$0.00,"$13,152.50","$5,918.63","$5,158.80",$0.00,"$2,266.11",$0.00,$0.00,"$2,302.90","$13,152.50",$0.00,"$6,576.25","$10,416.78","$10,522.00",$0.00,"$2,058.37",$0.00,"$2,093.88",$0.00
6260-8-820,SUP,HCPCS C1776,,6260-8-820  -  STEM FEMORAL 8 STR 20MM 203MM RSTOR TITANIUM PLASMA SPRAY,"$13,152.50",$0.00,"$13,152.50","$5,918.63","$5,158.80",$0.00,"$2,266.11",$0.00,$0.00,"$2,302.90","$13,152.50",$0.00,"$6,576.25","$10,416.78","$10,522.00",$0.00,"$2,058.37",$0.00,"$2,093.88",$0.00
6260-8-921,SUP,HCPCS C1776,,6260-8-921  -  STEM FEMORAL 9 STR 21MM 203MM RSTOR TITANIUM PLASMA SPRAY,"$13,152.50",$0.00,"$13,152.50","$5,918.63","$5,158.80",$0.00,"$2,266.11",$0.00,$0.00,"$2,302.90","$13,152.50",$0.00,"$6,576.25","$10,416.78","$10,522.00",$0.00,"$2,058.37",$0.00,"$2,093.88",$0.00
6260-9-026,SUP,Custom 27803010,,6260-9-026  -  HEAD FEMORAL -3MM OFFST TAPER 26MM PRIM V40 LFIT COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6260-9-028,SUP,Custom 27803010,,6260-9-028  -  HEAD FEM -4MM OFST TPR 28MM V40 LFIT COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6260-9-032,SUP,Custom 27803010,,6260-9-032  -  HEAD FEM -4MM OFST 32MM V40 LFIT COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6260-9-036,SUP,Custom 27803010,,6260-9-036  -  HEAD FEM -5MM OFST TPR 36MM V40 LFIT COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6260-9-040,SUP,Custom 27803010,,6260-9-040  -  HEAD FEM -4MM OFST TPR 40MM V40 LFIT COCR HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
6260-9-044,SUP,Custom 27803010,,6260-9-044  -  HEAD FEM -4MM OFST TPR 44MM V40 LFIT COCR HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
6260-9-122,SUP,Custom 27803010,,6260-9-122  -  HEAD FEM +0MM OFST TPR 22MM V40 LFIT COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6260-9-126,SUP,Custom 27803010,,6260-9-126  -  HEAD FEMORAL +0MM OFFST TAPER 26MM PRIM V40 LFIT COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6260-9-128,SUP,Custom 27803010,,6260-9-128  -  HEAD FEM +0MM OFST 28MM V40 LFIT COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6260-9-132,SUP,Custom 27803010,,6260-9-132  -  HEAD FEMORAL +0MM OFFST TAPER 32MM PRIM V40 LFIT COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6260-9-136,SUP,Custom 27803010,,6260-9-136  -  HEAD FEMORAL +0MM OFFST TAPER 36MM PRIM ANATOMIC V40 LFIT,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6260-9-140,SUP,Custom 27803010,,6260-9-140  -  HEAD FEMORAL +0MM OFFST TAPER 40MM PRIM ANATOMIC V40 LFIT,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
6260-9-144,SUP,Custom 27803010,,6260-9-144  -  HEAD FEM +0MM OFST TPR 44MM V40 LFIT COCR HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
6260-9-222,SUP,Custom 27803010,,6260-9-222  -  HEAD FEM +3MM OFST 22.2MM V40 LFIT COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6260-9-226,SUP,Custom 27803010,,6260-9-226  -  HEAD FEMORAL +4MM OFFST TAPER 26MM PRIM V40 LFIT COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6260-9-228,SUP,Custom 27803010,,6260-9-228  -  HEAD FEM +4MM OFST 28MM V40 LFIT COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6260-9-232,SUP,Custom 27803010,,6260-9-232  -  HEAD FEM +4MM OFST TPR 32MM V40 LFIT COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6260-9-236,SUP,Custom 27803010,,6260-9-236  -  HEAD FEM +5MM OFST TPR 36MM V40 LFIT COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6260-9-240,SUP,Custom 27803010,,6260-9-240  -  HEAD FEMORAL +4MM OFFST TAPER 40MM PRIM ANATOMIC V40 LFIT,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
6260-9-244,SUP,Custom 27803010,,6260-9-244  -  HEAD FEMORAL +4MM OFFST TAPER 44MM PRIM ANATOMIC V40 LFIT,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
6260-9-322,SUP,Custom 27803010,,6260-9-322  -  HEAD FEM +8MM OFST TPR 22MM V40 LFIT COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6260-9-326,SUP,Custom 27803010,,6260-9-326  -  HEAD FEMORAL +8MM OFFST TAPER 26MM PRIM V40 LFIT COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6260-9-328,SUP,Custom 27803010,,6260-9-328  -  HEAD FEM +8MM OFST TPR 28MM V40 LFIT COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6260-9-332,SUP,Custom 27803010,,6260-9-332  -  HEAD FEMORAL +8MM OFFST TAPER 32MM PRIM V40 LFIT COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6260-9-336,SUP,Custom 27803010,,6260-9-336  -  HEAD FEM +10MM OFST TPR 36MM V40 LFIT COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6260-9-340,SUP,Custom 27803010,,6260-9-340  -  HEAD FEM +8MM OFST TPR 40MM V40 LFIT COCR HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
6260-9-344,SUP,Custom 27803010,,6260-9-344  -  HEAD FEMORAL +8MM OFFST TAPER 44MM PRIM ANATOMIC V40 LFIT,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
6260-9-426,SUP,Custom 27803010,,6260-9-426  -  HEAD FEMORAL +12MM OFFST TAPER 26MM PRIM V40 LFIT COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6260-9-428,SUP,Custom 27803010,,6260-9-428  -  HEAD FEM +12MM OFST TPR 28MM V40 LFIT COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6260-9-432,SUP,Custom 27803010,,6260-9-432  -  HEAD FEM +12MM OFST TPR 32MM V40 LFIT COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6260-9-440,SUP,Custom 27803010,,6260-9-440  -  HEAD FEM +12MM OFST TPR 40MM V40 LFIT COCR HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
6260-9-444,SUP,Custom 27803010,,6260-9-444  -  HEAD FEMORAL +12MM OFFST TAPER 44MM PRIM ANATOMIC V40 LFIT,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
6260-9-628,SUP,Custom 27803010,,6260-9-628  -  HEAD FEMORAL +6MM 28MM V40 LFIT COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6261-0-001,SUP,HCPCS C1776,,6261-0-001  -  STEM FEM 9MM CMNTLS MRDN PERIAPT 00 HIP,"$6,861.00",$0.00,"$6,861.00","$3,087.45","$4,896.70",$0.00,"$1,182.12",$0.00,$0.00,"$1,201.31","$6,861.00",$0.00,"$3,430.50","$5,433.91","$5,488.80",$0.00,"$1,073.75",$0.00,"$1,092.27",$0.00
6261-0-002,SUP,HCPCS C1776,,6261-0-002  -  STEM FEM 10MM CMNTLS MRDN PERIAPT HIP,"$6,861.00",$0.00,"$6,861.00","$3,087.45","$4,896.70",$0.00,"$1,182.12",$0.00,$0.00,"$1,201.31","$6,861.00",$0.00,"$3,430.50","$5,433.91","$5,488.80",$0.00,"$1,073.75",$0.00,"$1,092.27",$0.00
6261-0-003,SUP,HCPCS C1776,,6261-0-003  -  STEM FEM 11MM CMNTLS MRDN PERIAPT 1 HIP,"$6,538.00",$0.00,"$6,538.00","$2,942.10","$4,666.17",$0.00,"$1,126.46",$0.00,$0.00,"$1,144.75","$6,538.00",$0.00,"$3,269.00","$5,178.10","$5,230.40",$0.00,"$1,023.20",$0.00,"$1,040.85",$0.00
6261-0-004,SUP,HCPCS C1776,,6261-0-004  -  STEM FEM 130MM 10MM CMNTLS MRDN PERIAPT 2 HIP,"$6,538.00",$0.00,"$6,538.00","$2,942.10","$4,666.17",$0.00,"$1,126.46",$0.00,$0.00,"$1,144.75","$6,538.00",$0.00,"$3,269.00","$5,178.10","$5,230.40",$0.00,"$1,023.20",$0.00,"$1,040.85",$0.00
6261-0-005,SUP,HCPCS C1776,,6261-0-005  -  STEM FEM 12MM CMNTLS MRDN PERIAPT 2 HIP,"$6,538.00",$0.00,"$6,538.00","$2,942.10","$4,666.17",$0.00,"$1,126.46",$0.00,$0.00,"$1,144.75","$6,538.00",$0.00,"$3,269.00","$5,178.10","$5,230.40",$0.00,"$1,023.20",$0.00,"$1,040.85",$0.00
6261-0-006,SUP,HCPCS C1776,,6261-0-006  -  STEM FEM 11MM CMNTLS MRDN PERIAPT 3 HIP,"$6,538.00",$0.00,"$6,538.00","$2,942.10","$4,666.17",$0.00,"$1,126.46",$0.00,$0.00,"$1,144.75","$6,538.00",$0.00,"$3,269.00","$5,178.10","$5,230.40",$0.00,"$1,023.20",$0.00,"$1,040.85",$0.00
6261-0-007,SUP,HCPCS C1776,,6261-0-007  -  STEM FEM 13MM MRDN PERIAPT 3 HIP,"$6,538.00",$0.00,"$6,538.00","$2,942.10","$4,666.17",$0.00,"$1,126.46",$0.00,$0.00,"$1,144.75","$6,538.00",$0.00,"$3,269.00","$5,178.10","$5,230.40",$0.00,"$1,023.20",$0.00,"$1,040.85",$0.00
6261-0-008,SUP,HCPCS C1776,,6261-0-008  -  STEM FEM 12MM CMNTLS MRDN PERIAPT 4 HIP,"$6,538.00",$0.00,"$6,538.00","$2,942.10","$4,666.17",$0.00,"$1,126.46",$0.00,$0.00,"$1,144.75","$6,538.00",$0.00,"$3,269.00","$5,178.10","$5,230.40",$0.00,"$1,023.20",$0.00,"$1,040.85",$0.00
6261-0-009,SUP,HCPCS C1776,,6261-0-009  -  STEM FEM 14MM CMNTLS MRDN PERIAPT 4 HIP,"$6,538.00",$0.00,"$6,538.00","$2,942.10","$4,666.17",$0.00,"$1,126.46",$0.00,$0.00,"$1,144.75","$6,538.00",$0.00,"$3,269.00","$5,178.10","$5,230.40",$0.00,"$1,023.20",$0.00,"$1,040.85",$0.00
6261-0-010,SUP,HCPCS C1776,,6261-0-010  -  STEM FEM 13MM CMNTLS MRDN PERIAPT 5 HIP,"$6,538.00",$0.00,"$6,538.00","$2,942.10","$4,666.17",$0.00,"$1,126.46",$0.00,$0.00,"$1,144.75","$6,538.00",$0.00,"$3,269.00","$5,178.10","$5,230.40",$0.00,"$1,023.20",$0.00,"$1,040.85",$0.00
6261-0-011,SUP,HCPCS C1776,,6261-0-011  -  STEM FEM 15MM CMNTLS MRDN PERIAPT 5 HIP,"$6,538.00",$0.00,"$6,538.00","$2,942.10","$4,666.17",$0.00,"$1,126.46",$0.00,$0.00,"$1,144.75","$6,538.00",$0.00,"$3,269.00","$5,178.10","$5,230.40",$0.00,"$1,023.20",$0.00,"$1,040.85",$0.00
6261-0-012,SUP,HCPCS C1776,,6261-0-012  -  STEM FEM 14MM CMNTLS MRDN PERIAPT 6 HIP,"$6,538.00",$0.00,"$6,538.00","$2,942.10","$4,666.17",$0.00,"$1,126.46",$0.00,$0.00,"$1,144.75","$6,538.00",$0.00,"$3,269.00","$5,178.10","$5,230.40",$0.00,"$1,023.20",$0.00,"$1,040.85",$0.00
6261-0-013,SUP,HCPCS C1776,,6261-0-013  -  STEM FEM 150MM 16MM MRDN PERIAPT 132D 6 HIP,"$6,538.00",$0.00,"$6,538.00","$2,942.10","$4,666.17",$0.00,"$1,126.46",$0.00,$0.00,"$1,144.75","$6,538.00",$0.00,"$3,269.00","$5,178.10","$5,230.40",$0.00,"$1,023.20",$0.00,"$1,040.85",$0.00
6261-0-014,SUP,HCPCS C1776,,6261-0-014  -  STEM FEM 15MM CMNTLS MRDN PERIAPT 7 HIP,"$6,538.00",$0.00,"$6,538.00","$2,942.10","$4,666.17",$0.00,"$1,126.46",$0.00,$0.00,"$1,144.75","$6,538.00",$0.00,"$3,269.00","$5,178.10","$5,230.40",$0.00,"$1,023.20",$0.00,"$1,040.85",$0.00
6261-0-015,SUP,HCPCS C1776,,6261-0-015  -  STEM FEM 17MM CMNTLS MRDN PERIAPT 7 HIP,"$6,538.00",$0.00,"$6,538.00","$2,942.10","$4,666.17",$0.00,"$1,126.46",$0.00,$0.00,"$1,144.75","$6,538.00",$0.00,"$3,269.00","$5,178.10","$5,230.40",$0.00,"$1,023.20",$0.00,"$1,040.85",$0.00
6261-0-016,SUP,HCPCS C1776,,6261-0-016  -  STEM FEM 16MM CMNTLS MRDN PERIAPT 8 HIP,"$6,861.00",$0.00,"$6,861.00","$3,087.45","$4,896.70",$0.00,"$1,182.12",$0.00,$0.00,"$1,201.31","$6,861.00",$0.00,"$3,430.50","$5,433.91","$5,488.80",$0.00,"$1,073.75",$0.00,"$1,092.27",$0.00
6261-0-017,SUP,HCPCS C1776,,6261-0-017  -  STEM FEM 18MM CMNTLS MRDN PERIAPT 8 HIP,"$6,861.00",$0.00,"$6,861.00","$3,087.45","$4,896.70",$0.00,"$1,182.12",$0.00,$0.00,"$1,201.31","$6,861.00",$0.00,"$3,430.50","$5,433.91","$5,488.80",$0.00,"$1,073.75",$0.00,"$1,092.27",$0.00
6261-0-018,SUP,HCPCS C1776,,6261-0-018  -  STEM FEM 19MM CMNTLS MRDN PERIAPT 9 HIP,"$6,861.00",$0.00,"$6,861.00","$3,087.45","$4,896.70",$0.00,"$1,182.12",$0.00,$0.00,"$1,201.31","$6,861.00",$0.00,"$3,430.50","$5,433.91","$5,488.80",$0.00,"$1,073.75",$0.00,"$1,092.27",$0.00
6265-0-010,SUP,HCPCS C1776,,6265-0-010  -  STEM FEM 13MM CMNTLS MRDN ST VIT POR 5 HIP,"$6,538.00",$0.00,"$6,538.00","$2,942.10","$4,666.17",$0.00,"$1,126.46",$0.00,$0.00,"$1,144.75","$6,538.00",$0.00,"$3,269.00","$5,178.10","$5,230.40",$0.00,"$1,023.20",$0.00,"$1,040.85",$0.00
6265-1-001,SUP,HCPCS C1776,,6265-1-001  -  STEM FEM 9MM MRDN TMZF 00 HIP,"$6,665.00",$0.00,"$6,665.00","$2,999.25","$4,756.81",$0.00,"$1,148.35",$0.00,$0.00,"$1,166.99","$6,665.00",$0.00,"$3,332.50","$5,278.68","$5,332.00",$0.00,"$1,043.07",$0.00,"$1,061.07",$0.00
6265-1-002,SUP,HCPCS C1776,,6265-1-002  -  STEM FEM 10MM CMNTLS MRDN TMZF 0 HIP,"$6,665.00",$0.00,"$6,665.00","$2,999.25","$4,756.81",$0.00,"$1,148.35",$0.00,$0.00,"$1,166.99","$6,665.00",$0.00,"$3,332.50","$5,278.68","$5,332.00",$0.00,"$1,043.07",$0.00,"$1,061.07",$0.00
6265-1-003,SUP,HCPCS C1776,,6265-1-003  -  STEM FEM 11MM MRDN TMZF 1 HIP,"$6,328.00",$0.00,"$6,328.00","$2,847.60","$4,516.29",$0.00,"$1,090.28",$0.00,$0.00,"$1,107.98","$6,328.00",$0.00,"$3,164.00","$5,011.78","$5,062.40",$0.00,$990.33,$0.00,"$1,007.42",$0.00
6265-1-004,SUP,HCPCS C1776,,6265-1-004  -  STEM FEM 10MM MRDN TMZF 2 HIP,"$6,328.00",$0.00,"$6,328.00","$2,847.60","$4,516.29",$0.00,"$1,090.28",$0.00,$0.00,"$1,107.98","$6,328.00",$0.00,"$3,164.00","$5,011.78","$5,062.40",$0.00,$990.33,$0.00,"$1,007.42",$0.00
6265-1-005,SUP,HCPCS C1776,,6265-1-005  -  STEM FEM 12MM MRDN TMZF 2 HIP,"$6,328.00",$0.00,"$6,328.00","$2,847.60","$4,516.29",$0.00,"$1,090.28",$0.00,$0.00,"$1,107.98","$6,328.00",$0.00,"$3,164.00","$5,011.78","$5,062.40",$0.00,$990.33,$0.00,"$1,007.42",$0.00
6265-1-006,SUP,HCPCS C1776,,6265-1-006  -  STEM FEM 3-11MM,"$6,328.00",$0.00,"$6,328.00","$2,847.60","$4,516.29",$0.00,"$1,090.28",$0.00,$0.00,"$1,107.98","$6,328.00",$0.00,"$3,164.00","$5,011.78","$5,062.40",$0.00,$990.33,$0.00,"$1,007.42",$0.00
6265-1-007,SUP,HCPCS C1776,,6265-1-007  -  STEM FEM 13MM MRDN TMZF 3 HIP,"$6,328.00",$0.00,"$6,328.00","$2,847.60","$4,516.29",$0.00,"$1,090.28",$0.00,$0.00,"$1,107.98","$6,328.00",$0.00,"$3,164.00","$5,011.78","$5,062.40",$0.00,$990.33,$0.00,"$1,007.42",$0.00
6265-1-008,SUP,HCPCS C1776,,6265-1-008  -  STEM FEM 4-12MM,"$6,328.00",$0.00,"$6,328.00","$2,847.60","$4,516.29",$0.00,"$1,090.28",$0.00,$0.00,"$1,107.98","$6,328.00",$0.00,"$3,164.00","$5,011.78","$5,062.40",$0.00,$990.33,$0.00,"$1,007.42",$0.00
6265-1-009,SUP,HCPCS C1776,,6265-1-009  -  STEM FEM 14MM MRDN TMZF 4 HIP,"$6,328.00",$0.00,"$6,328.00","$2,847.60","$4,516.29",$0.00,"$1,090.28",$0.00,$0.00,"$1,107.98","$6,328.00",$0.00,"$3,164.00","$5,011.78","$5,062.40",$0.00,$990.33,$0.00,"$1,007.42",$0.00
6265-1-010,SUP,HCPCS C1776,,6265-1-010  -  STEM FEM 13MM MRDN TMZF 5 HIP,"$6,328.00",$0.00,"$6,328.00","$2,847.60","$4,516.29",$0.00,"$1,090.28",$0.00,$0.00,"$1,107.98","$6,328.00",$0.00,"$3,164.00","$5,011.78","$5,062.40",$0.00,$990.33,$0.00,"$1,007.42",$0.00
6265-1-011,SUP,HCPCS C1776,,6265-1-011  -  STEM FEM 15MM CMNTLS MRDN TMZF 5 HIP,"$6,328.00",$0.00,"$6,328.00","$2,847.60","$4,516.29",$0.00,"$1,090.28",$0.00,$0.00,"$1,107.98","$6,328.00",$0.00,"$3,164.00","$5,011.78","$5,062.40",$0.00,$990.33,$0.00,"$1,007.42",$0.00
6265-1-012,SUP,HCPCS C1776,,6265-1-012  -  STEM FEM 14MM MRDN TMZF 6 HIP,"$6,328.00",$0.00,"$6,328.00","$2,847.60","$4,516.29",$0.00,"$1,090.28",$0.00,$0.00,"$1,107.98","$6,328.00",$0.00,"$3,164.00","$5,011.78","$5,062.40",$0.00,$990.33,$0.00,"$1,007.42",$0.00
6265-1-013,SUP,HCPCS C1776,,6265-1-013  -  STEM FEM 16MM MRDN TMZF 6 HIP,"$6,328.00",$0.00,"$6,328.00","$2,847.60","$4,516.29",$0.00,"$1,090.28",$0.00,$0.00,"$1,107.98","$6,328.00",$0.00,"$3,164.00","$5,011.78","$5,062.40",$0.00,$990.33,$0.00,"$1,007.42",$0.00
6265-1-014,SUP,HCPCS C1776,,6265-1-014  -  STEM FEM 15MM CMNTLS MRDN TMZF 7 HIP,"$6,328.00",$0.00,"$6,328.00","$2,847.60","$4,516.29",$0.00,"$1,090.28",$0.00,$0.00,"$1,107.98","$6,328.00",$0.00,"$3,164.00","$5,011.78","$5,062.40",$0.00,$990.33,$0.00,"$1,007.42",$0.00
6265-1-015,SUP,HCPCS C1776,,6265-1-015  -  STEM FEM 17MM CMNTLS MRDN TMZF 7 HIP,"$6,328.00",$0.00,"$6,328.00","$2,847.60","$4,516.29",$0.00,"$1,090.28",$0.00,$0.00,"$1,107.98","$6,328.00",$0.00,"$3,164.00","$5,011.78","$5,062.40",$0.00,$990.33,$0.00,"$1,007.42",$0.00
6265-1-016,SUP,HCPCS C1776,,6265-1-016  -  STEM FEM 16MM CMNTLS MRDN TMZF 8 HIP,"$6,665.00",$0.00,"$6,665.00","$2,999.25","$4,756.81",$0.00,"$1,148.35",$0.00,$0.00,"$1,166.99","$6,665.00",$0.00,"$3,332.50","$5,278.68","$5,332.00",$0.00,"$1,043.07",$0.00,"$1,061.07",$0.00
6265-1-017,SUP,HCPCS C1776,,6265-1-017  -  STEM FEM 18MM CMNTLS MRDN TMZF 8 HIP,"$6,665.00",$0.00,"$6,665.00","$2,999.25","$4,756.81",$0.00,"$1,148.35",$0.00,$0.00,"$1,166.99","$6,665.00",$0.00,"$3,332.50","$5,278.68","$5,332.00",$0.00,"$1,043.07",$0.00,"$1,061.07",$0.00
6265-1-018,SUP,HCPCS C1776,,6265-1-018  -  STEM FEM 19MM CMNTLS MRDN TMZF 9 HIP,"$6,665.00",$0.00,"$6,665.00","$2,999.25","$4,756.81",$0.00,"$1,148.35",$0.00,$0.00,"$1,166.99","$6,665.00",$0.00,"$3,332.50","$5,278.68","$5,332.00",$0.00,"$1,043.07",$0.00,"$1,061.07",$0.00
6265-2-000,SUP,Custom 27803010,,6265-2-000  -  STEM FEMORAL 132D 0 10MM 115MM 31MM COLLAR PRESS FIT,"$2,877.50",$0.00,"$2,877.50",$0.00,"$2,053.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,877.50",$0.00,"$1,438.75","$2,278.98","$2,302.00",$0.00,$0.00,$0.00,$0.00,$0.00
6265-2-001,SUP,Custom 27803010,,6265-2-001  -  STEM FEMORAL 132D 1 11MM 115MM 31MM COLLAR PRESS FIT,"$2,877.50",$0.00,"$2,877.50",$0.00,"$2,053.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,877.50",$0.00,"$1,438.75","$2,278.98","$2,302.00",$0.00,$0.00,$0.00,$0.00,$0.00
6265-2-002,SUP,Custom 27803010,,6265-2-002  -  STEM FEMORAL 132D 2 12MM 130MM 32MM COLLAR PRESS FIT,"$2,877.50",$0.00,"$2,877.50",$0.00,"$2,053.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,877.50",$0.00,"$1,438.75","$2,278.98","$2,302.00",$0.00,$0.00,$0.00,$0.00,$0.00
6265-2-003,SUP,Custom 27803010,,6265-2-003  -  STEM FEMORAL 132D 3 13MM 130MM 34MM COLLAR PRESS FIT,"$2,877.50",$0.00,"$2,877.50",$0.00,"$2,053.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,877.50",$0.00,"$1,438.75","$2,278.98","$2,302.00",$0.00,$0.00,$0.00,$0.00,$0.00
6265-2-004,SUP,Custom 27803010,,6265-2-004  -  STEM FEMORAL 132D 4 14MM 140MM 35MM COLLAR PRESS FIT,"$2,877.50",$0.00,"$2,877.50",$0.00,"$2,053.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,877.50",$0.00,"$1,438.75","$2,278.98","$2,302.00",$0.00,$0.00,$0.00,$0.00,$0.00
6265-2-005,SUP,Custom 27803010,,6265-2-005  -  STEM FEMORAL 5 15MM CEMENTED COLLARED PRESS FIT RELIANCE PF,"$2,877.50",$0.00,"$2,877.50",$0.00,"$2,053.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,877.50",$0.00,"$1,438.75","$2,278.98","$2,302.00",$0.00,$0.00,$0.00,$0.00,$0.00
6265-2-006,SUP,Custom 27803010,,6265-2-006  -  STEM FEMORAL 132D 6 16MM 150MM 37MM COLLAR PRESS FIT,"$2,877.50",$0.00,"$2,877.50",$0.00,"$2,053.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,877.50",$0.00,"$1,438.75","$2,278.98","$2,302.00",$0.00,$0.00,$0.00,$0.00,$0.00
6265-2-007,SUP,Custom 27803010,,6265-2-007  -  STEM FEMORAL 132D 7 17MM 150MM 39MM COLLAR PRESS FIT,"$2,877.50",$0.00,"$2,877.50",$0.00,"$2,053.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,877.50",$0.00,"$1,438.75","$2,278.98","$2,302.00",$0.00,$0.00,$0.00,$0.00,$0.00
6265-3-099,SUP,Custom 27803010,,6265-3-099  -  STEM FEM CMNT DFN PM 0 HIP,"$4,488.00",$0.00,"$4,488.00",$0.00,"$3,203.09",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,488.00",$0.00,"$2,244.00","$3,554.50","$3,590.40",$0.00,$0.00,$0.00,$0.00,$0.00
6265-3-100,SUP,Custom 27803010,,6265-3-100  -  STEM FEM CMNT DFN PM 0 HIP,"$4,488.00",$0.00,"$4,488.00",$0.00,"$3,203.09",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,488.00",$0.00,"$2,244.00","$3,554.50","$3,590.40",$0.00,$0.00,$0.00,$0.00,$0.00
6265-3-101,SUP,Custom 27803010,,6265-3-101  -  STEM FEM 132D 1 34MM OFST 10MM 115MM 26MM CITN PUREFIX TMZF,"$4,123.00",$0.00,"$4,123.00",$0.00,"$2,942.59",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,123.00",$0.00,"$2,061.50","$3,265.42","$3,298.40",$0.00,$0.00,$0.00,$0.00,$0.00
6265-3-102,SUP,Custom 27803010,,6265-3-102  -  STEM FEM CMNT DFN PM 2 HIP,"$4,123.00",$0.00,"$4,123.00",$0.00,"$2,942.59",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,123.00",$0.00,"$2,061.50","$3,265.42","$3,298.40",$0.00,$0.00,$0.00,$0.00,$0.00
6265-3-103,SUP,Custom 27803010,,6265-3-103  -  STEM FEM CMNT DFN PM 3 HIP,"$4,123.00",$0.00,"$4,123.00",$0.00,"$2,942.59",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,123.00",$0.00,"$2,061.50","$3,265.42","$3,298.40",$0.00,$0.00,$0.00,$0.00,$0.00
6265-3-104,SUP,Custom 27803010,,6265-3-104  -  STEM FEM CMNT DFN PM 4 HIP,"$4,123.00",$0.00,"$4,123.00",$0.00,"$2,942.59",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,123.00",$0.00,"$2,061.50","$3,265.42","$3,298.40",$0.00,$0.00,$0.00,$0.00,$0.00
6265-3-105,SUP,Custom 27803010,,6265-3-105  -  STEM FEM CMNT DFN PM 5 HIP,"$4,123.00",$0.00,"$4,123.00",$0.00,"$2,942.59",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,123.00",$0.00,"$2,061.50","$3,265.42","$3,298.40",$0.00,$0.00,$0.00,$0.00,$0.00
6265-3-106,SUP,Custom 27803010,,6265-3-106  -  STEM FEM CMNT DFN PM 6 HIP,"$4,123.00",$0.00,"$4,123.00",$0.00,"$2,942.59",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,123.00",$0.00,"$2,061.50","$3,265.42","$3,298.40",$0.00,$0.00,$0.00,$0.00,$0.00
6265-3-107,SUP,Custom 27803010,,6265-3-107  -  STEM FEM CMNT DFN PM 7 HIP,"$4,123.00",$0.00,"$4,123.00",$0.00,"$2,942.59",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,123.00",$0.00,"$2,061.50","$3,265.42","$3,298.40",$0.00,$0.00,$0.00,$0.00,$0.00
6265-3-111,SUP,Custom 27803010,,6265-3-111  -  STEM FEMORAL 132D 1 34MM OFFST 100MM 31MM BASE HEAD CEMENT,"$2,877.50",$0.00,"$2,877.50",$0.00,"$2,053.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,877.50",$0.00,"$1,438.75","$2,278.98","$2,302.00",$0.00,$0.00,$0.00,$0.00,$0.00
6265-3-112,SUP,Custom 27803010,,6265-3-112  -  STEM FEMORAL 132D 2 36MM OFFST 115MM 32MM BASE HEAD CEMENT,"$2,877.50",$0.00,"$2,877.50",$0.00,"$2,053.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,877.50",$0.00,"$1,438.75","$2,278.98","$2,302.00",$0.00,$0.00,$0.00,$0.00,$0.00
6265-3-113,SUP,Custom 27803010,,6265-3-113  -  STEM FEMORAL 132D 3 40MM OFFST 115MM 34MM BASE HEAD CEMENT,"$2,877.50",$0.00,"$2,877.50",$0.00,"$2,053.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,877.50",$0.00,"$1,438.75","$2,278.98","$2,302.00",$0.00,$0.00,$0.00,$0.00,$0.00
6265-3-114,SUP,Custom 27803010,,6265-3-114  -  STEM FEMORAL 132D 4 44MM OFFST 125MM 35MM BASE HEAD CEMENT,"$2,877.50",$0.00,"$2,877.50",$0.00,"$2,053.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,877.50",$0.00,"$1,438.75","$2,278.98","$2,302.00",$0.00,$0.00,$0.00,$0.00,$0.00
6265-3-115,SUP,Custom 27803010,,6265-3-115  -  STEM FEMORAL 132D 5 47MM OFFST 125MM 37MM BASE HEAD CEMENT,"$2,877.50",$0.00,"$2,877.50",$0.00,"$2,053.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,877.50",$0.00,"$1,438.75","$2,278.98","$2,302.00",$0.00,$0.00,$0.00,$0.00,$0.00
6265-4-010,SUP,Custom 27803010,,6265-4-010  -  CNTRLZR STM 10MM DFN DISTAL FEM HIP TYPE AA TPR,$188.00,$0.00,$188.00,$0.00,$134.18,$0.00,$0.00,$0.00,$0.00,$0.00,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$0.00,$0.00,$0.00,$0.00
6265-4-011,SUP,Custom 27803010,,6265-4-011  -  CNTRLZR STM 11MM DFN DISTAL FEM HIP TYPE AA TPR,$188.00,$0.00,$188.00,$0.00,$134.18,$0.00,$0.00,$0.00,$0.00,$0.00,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$0.00,$0.00,$0.00,$0.00
6265-4-103,SUP,HCPCS C1776,,6265-4-103  -  STEM FEM DFN 3 HIP,"$4,123.00",$0.00,"$4,123.00","$1,855.35","$2,942.59",$0.00,$710.37,$0.00,$0.00,$721.90,"$4,123.00",$0.00,"$2,061.50","$3,265.42","$3,298.40",$0.00,$645.25,$0.00,$656.38,$0.00
6265-4-105,SUP,HCPCS C1776,,6265-4-105  -  STEM FEM DFN 5 HIP,"$4,123.00",$0.00,"$4,123.00","$1,855.35","$2,942.59",$0.00,$710.37,$0.00,$0.00,$721.90,"$4,123.00",$0.00,"$2,061.50","$3,265.42","$3,298.40",$0.00,$645.25,$0.00,$656.38,$0.00
6265-4-411,SUP,Custom 27803010,,6265-4-411  -  CNTRLZR STM 11MM DISTAL HIP TYPE A MOD,$188.00,$0.00,$188.00,$0.00,$134.18,$0.00,$0.00,$0.00,$0.00,$0.00,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$0.00,$0.00,$0.00,$0.00
6265-4-412,SUP,Custom 27803010,,6265-4-412  -  CNTRLZR STM 12MM DISTAL HIP TYPE A MOD,$188.00,$0.00,$188.00,$0.00,$134.18,$0.00,$0.00,$0.00,$0.00,$0.00,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$0.00,$0.00,$0.00,$0.00
6265-4-413,SUP,Custom 27803010,,6265-4-413  -  CNTRLZR STM 13MM DISTAL HIP TYPE A MOD,$188.00,$0.00,$188.00,$0.00,$134.18,$0.00,$0.00,$0.00,$0.00,$0.00,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$0.00,$0.00,$0.00,$0.00
6265-4-414,SUP,Custom 27803010,,6265-4-414  -  CNTRLZR STM 14MM DISTAL MOD TYPE A,$188.00,$0.00,$188.00,$0.00,$134.18,$0.00,$0.00,$0.00,$0.00,$0.00,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$0.00,$0.00,$0.00,$0.00
6265-4-415,SUP,Custom 27803010,,6265-4-415  -  CNTRLZR STM 15MM DISTAL HIP TYPE A MOD,$188.00,$0.00,$188.00,$0.00,$134.18,$0.00,$0.00,$0.00,$0.00,$0.00,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$0.00,$0.00,$0.00,$0.00
6265-4-416,SUP,Custom 27803010,,6265-4-416  -  CNTRLZR STM 16MM DFN DISTAL FEM HIP MOD TYPE A,$188.00,$0.00,$188.00,$0.00,$134.18,$0.00,$0.00,$0.00,$0.00,$0.00,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$0.00,$0.00,$0.00,$0.00
6265-4-417,SUP,Custom 27803010,,6265-4-417  -  CNTRLZR STM 17MM DFN DISTAL FEM HIP TYPE A MOD,$188.00,$0.00,$188.00,$0.00,$134.18,$0.00,$0.00,$0.00,$0.00,$0.00,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$0.00,$0.00,$0.00,$0.00
6265-4-418,SUP,Custom 27803010,,6265-4-418  -  CNTRLZR STM 18MM DFN DISTAL FEM HIP MOD TYPE A,$188.00,$0.00,$188.00,$0.00,$134.18,$0.00,$0.00,$0.00,$0.00,$0.00,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$0.00,$0.00,$0.00,$0.00
6265-4-515,SUP,Custom 27803010,,6265-4-515  -  CNTRLZR STM 15MM DFN DISTAL FEM HIP TYPE B MOD,$188.00,$0.00,$188.00,$0.00,$134.18,$0.00,$0.00,$0.00,$0.00,$0.00,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$0.00,$0.00,$0.00,$0.00
6265-4-516,SUP,Custom 27803010,,6265-4-516  -  CNTRLZR STM 16MM MODIFI DISTAL FEM TYPE B,$188.00,$0.00,$188.00,$0.00,$134.18,$0.00,$0.00,$0.00,$0.00,$0.00,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$0.00,$0.00,$0.00,$0.00
6265-4-517,SUP,Custom 27803010,,6265-4-517  -  CNTRLZR STM 17MM DFN DISTAL FEM HIP TYPE A MOD,$188.00,$0.00,$188.00,$0.00,$134.18,$0.00,$0.00,$0.00,$0.00,$0.00,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$0.00,$0.00,$0.00,$0.00
6265-4-518,SUP,Custom 27803010,,6265-4-518  -  CNTRLZR STM 18MM DFN DISTAL FEM HIP TYPE B MOD,$188.00,$0.00,$188.00,$0.00,$134.18,$0.00,$0.00,$0.00,$0.00,$0.00,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$0.00,$0.00,$0.00,$0.00
6265-4-519,SUP,Custom 27803010,,6265-4-519  -  CNTRLZR STM 19MM DFN DISTAL FEM HIP TYPE B MOD,$188.00,$0.00,$188.00,$0.00,$134.18,$0.00,$0.00,$0.00,$0.00,$0.00,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$0.00,$0.00,$0.00,$0.00
6265-4-520,SUP,Custom 27803010,,6265-4-520  -  CONC CNTRF YLW FLTR COLLECT VL 0.5ML,$188.00,$0.00,$188.00,$0.00,$134.18,$0.00,$0.00,$0.00,$0.00,$0.00,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$0.00,$0.00,$0.00,$0.00
6265-4-521,SUP,Custom 27803010,,6265-4-521  -  CNTRLZR STM 21MM DFN DISTAL FEM HIP TYPE B MOD,$188.00,$0.00,$188.00,$0.00,$134.18,$0.00,$0.00,$0.00,$0.00,$0.00,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$0.00,$0.00,$0.00,$0.00
6265-4-522,SUP,Custom 27803010,,6265-4-522  -  CNTRLZR STM 22MM DFN DISTAL FEM HIP TYPE B MOD,$188.00,$0.00,$188.00,$0.00,$134.18,$0.00,$0.00,$0.00,$0.00,$0.00,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$0.00,$0.00,$0.00,$0.00
6265-5-100,SUP,HCPCS C1776,,6265-5-100  -  STEM FEMORAL 132D 0 34MM OFFST 9MM 110MM 26MM CITATION,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6265-5-101,SUP,HCPCS C1776,,6265-5-101  -  STEM FEMORAL 132D 1 34MM OFFST 10MM 115MM 26MM CITATION,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6265-5-102,SUP,HCPCS C1776,,6265-5-102  -  STEM FEMORAL 132D 2 36MM OFFST 11MM 120MM 26MM CITATION,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6265-5-103,SUP,HCPCS C1776,,6265-5-103  -  STEM FEMORAL 132D 3 40MM OFFST 12MM 125MM 28MM CITATION,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6265-5-104,SUP,HCPCS C1776,,6265-5-104  -  STEM FEMORAL 132D 4 44MM OFFST 13MM 130MM 30MM CITATION,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6265-5-105,SUP,HCPCS C1776,,6265-5-105  -  STEM FEMORAL 132D 5 47MM OFFST 14MM 135MM 31MM CITATION,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6265-5-106,SUP,HCPCS C1776,,6265-5-106  -  STEM FEMORAL 132D 6 50MM OFFST 15MM 140MM 32MM CITATION,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6265-5-107,SUP,HCPCS C1776,,6265-5-107  -  STEM FEMORAL 132D 7 52MM OFFST 16MM 140MM 34MM CITATION,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6265-5-108,SUP,HCPCS C1776,,6265-5-108  -  STEM FEMORAL 132D 8 55MM OFFST 17MM 145MM 39MM CITATION,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6265-5-109,SUP,HCPCS C1776,,6265-5-109  -  STEM FEMORAL 132D 9 55MM OFFST 18MM 150MM 39MM CITATION,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6265-5-110,SUP,HCPCS C1776,,6265-5-110  -  STEM FEMORAL 132D 0 34MM OFFST 9MM 110MM 26MM CITATION,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6265-5-111,SUP,HCPCS C1776,,6265-5-111  -  STEM FEMORAL 132D 1 34MM OFFST 10MM 115MM 26MM CITATION,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6265-5-112,SUP,HCPCS C1776,,6265-5-112  -  STEM FEMORAL 132D 2 36MM OFFST 11MM 120MM 26MM CITATION,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6265-5-113,SUP,HCPCS C1776,,6265-5-113  -  STEM FEMORAL 132D 3 40MM OFFST 12MM 125MM 28MM CITATION,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6265-5-114,SUP,HCPCS C1776,,6265-5-114  -  STEM FEMORAL 132D 4 44MM OFFST 13MM 130MM 30MM CITATION,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6265-5-115,SUP,HCPCS C1776,,6265-5-115  -  STEM FEMORAL 132D 5 47MM OFFST 14MM 135MM 31MM CITATION,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6265-5-116,SUP,HCPCS C1776,,6265-5-116  -  STEM FEMORAL 132D 6 50MM OFFST 15MM 140MM 32MM CITATION,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6265-5-117,SUP,HCPCS C1776,,6265-5-117  -  STEM FEMORAL 132D 7 52MM OFFST 16MM 140MM 34MM CITATION,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6265-5-118,SUP,HCPCS C1776,,6265-5-118  -  STEM FEMORAL 132D 8 55MM OFFST 17MM 145MM 39MM CITATION,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6265-5-119,SUP,HCPCS C1776,,6265-5-119  -  STEM FEMORAL 132D 9 55MM OFFST 18MM 150MM 39MM CITATION,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6265-5200,SUP,HCPCS C1776,,6265-5200  -  STEM FEMORAL 0 SHORT CITATION TMZF HYDRXAPT LEFT,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6265-5201,SUP,HCPCS C1776,,6265-5201  -  STEM FEMORAL 1 SHORT CITATION TMZF HYDRXAPT LEFT,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6265-5202,SUP,HCPCS C1776,,6265-5202  -  STEM FEMORAL 2 SHORT CITATION TMZF HYDRXAPT LEFT HIP,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6265-5203,SUP,HCPCS C1776,,6265-5203  -  STEM FEMORAL 3 SHORT CITATION TMZF HYDRXAPT LEFT,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6265-5204,SUP,HCPCS C1776,,6265-5204  -  STEM FEMORAL 4 SHORT CITATION TMZF HYDRXAPT LEFT,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6265-5205,SUP,HCPCS C1776,,6265-5205  -  STEM FEMORAL 5 SHORT CITATION TMZF HYDRXAPT LEFT,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6265-5206,SUP,HCPCS C1776,,6265-5206  -  STEM FEMORAL 6 SHORT CITATION TMZF HYDRXAPT LEFT HIP,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6265-5207,SUP,HCPCS C1776,,6265-5207  -  STEM FEMORAL 7 SHORT CITATION TMZF HYDRXAPT LEFT,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6265-5208,SUP,HCPCS C1776,,6265-5208  -  STEM FEMORAL 8 SHORT CITATION TMZF HYDRXAPT LEFT,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6265-5209,SUP,HCPCS C1776,,6265-5209  -  STEM FEMORAL 9 SHORT CITATION TMZF HYDRXAPT LEFT,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6265-5210,SUP,HCPCS C1776,,6265-5210  -  STEM FEMORAL 0 SHORT CITATION TMZF HYDRXAPT RIGHT,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6265-5211,SUP,HCPCS C1776,,6265-5211  -  STEM FEMORAL 1 SHORT CITATION TMZF HYDRXAPT RIGHT,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6265-5212,SUP,HCPCS C1776,,6265-5212  -  STEM FEMORAL 2 SHORT CITATION TMZF HYDRXAPT RIGHT,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6265-5213,SUP,HCPCS C1776,,6265-5213  -  STEM FEMORAL 3 SHORT CITATION TMZF HYDRXAPT RIGHT,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6265-5214,SUP,HCPCS C1776,,6265-5214  -  STEM FEMORAL 4 SHORT CITATION TMZF HYDRXAPT RIGHT,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6265-5215,SUP,HCPCS C1776,,6265-5215  -  STEM FEMORAL 5 SHORT CITATION TMZF HYDRXAPT RIGHT,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6265-5216,SUP,HCPCS C1776,,6265-5216  -  STEM FEMORAL 6 SHORT CITATION TMZF HYDRXAPT RIGHT,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6265-5217,SUP,HCPCS C1776,,6265-5217  -  STEM FEMORAL 7 SHORT CITATION TMZF HYDRXAPT RIGHT,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6265-5218,SUP,HCPCS C1776,,6265-5218  -  STEM FEMORAL 8 SHORT CITATION TMZF HYDRXAPT RIGHT,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
6265-5219,SUP,HCPCS C1776,,6265-5219  -  STEM FEMORAL 9 SHORT CITATION TMZF HYDRXAPT RIGHT,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
626631US,SUP,Custom 27803010,,626631US  -  KIT PRESSURE MONITR 14GA BASIC TRANSDUCER TUOHY NEEDLE,"$2,095.40",$0.00,"$2,095.40",$0.00,"$1,495.49",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,095.40",$0.00,"$1,047.70","$1,659.56","$1,676.32",$0.00,$0.00,$0.00,$0.00,$0.00
6269-1-212,SUP,HCPCS C1776,,6269-1-212  -  STEM FEM 10IN 12MM BW RSTOR TI 2 LEFT HIP,"$13,745.88",$0.00,"$13,745.88","$6,185.64","$5,158.80",$0.00,"$2,368.35",$0.00,$0.00,"$2,406.79","$13,745.88",$0.00,"$6,872.94","$10,886.74","$10,996.70",$0.00,"$2,151.23",$0.00,"$2,188.34",$0.00
6269-1-414,SUP,HCPCS C1776,,6269-1-414  -  STEM FEM 10IN 14MM BW RSTOR TI 4 LEFT HIP,"$13,745.88",$0.00,"$13,745.88","$6,185.64","$5,158.80",$0.00,"$2,368.35",$0.00,$0.00,"$2,406.79","$13,745.88",$0.00,"$6,872.94","$10,886.74","$10,996.70",$0.00,"$2,151.23",$0.00,"$2,188.34",$0.00
6269-1-719,SUP,HCPCS C1776,,6269-1-719  -  STEM FEM 10IN 19MM BW RSTOR TI 7 LEFT HIP,"$13,745.88",$0.00,"$13,745.88","$6,185.64","$5,158.80",$0.00,"$2,368.35",$0.00,$0.00,"$2,406.79","$13,745.88",$0.00,"$6,872.94","$10,886.74","$10,996.70",$0.00,"$2,151.23",$0.00,"$2,188.34",$0.00
6269-1-818,SUP,HCPCS C1776,,6269-1-818  -  STEM FEM 10IN 18MM BW RSTOR TI 8 LEFT HIP,"$13,745.88",$0.00,"$13,745.88","$6,185.64","$5,158.80",$0.00,"$2,368.35",$0.00,$0.00,"$2,406.79","$13,745.88",$0.00,"$6,872.94","$10,886.74","$10,996.70",$0.00,"$2,151.23",$0.00,"$2,188.34",$0.00
6269-1-820,SUP,HCPCS C1776,,6269-1-820  -  STEM FEM 10IN 20MM BW RSTOR TI 8 LEFT HIP,"$13,745.88",$0.00,"$13,745.88","$6,185.64","$5,158.80",$0.00,"$2,368.35",$0.00,$0.00,"$2,406.79","$13,745.88",$0.00,"$6,872.94","$10,886.74","$10,996.70",$0.00,"$2,151.23",$0.00,"$2,188.34",$0.00
6269-1-921,SUP,HCPCS C1776,,6269-1-921  -  STEM FEM 10IN 21MM BW RSTOR TI 9 LEFT HIP,"$13,745.88",$0.00,"$13,745.88","$6,185.64","$5,158.80",$0.00,"$2,368.35",$0.00,$0.00,"$2,406.79","$13,745.88",$0.00,"$6,872.94","$10,886.74","$10,996.70",$0.00,"$2,151.23",$0.00,"$2,188.34",$0.00
6269-2-212,SUP,HCPCS C1776,,6269-2-212  -  STEM FEM 10IN 12MM BW RSTOR TI 2 RIGHT HIP,"$13,745.88",$0.00,"$13,745.88","$6,185.64","$5,158.80",$0.00,"$2,368.35",$0.00,$0.00,"$2,406.79","$13,745.88",$0.00,"$6,872.94","$10,886.74","$10,996.70",$0.00,"$2,151.23",$0.00,"$2,188.34",$0.00
6269-2-313,SUP,HCPCS C1776,,6269-2-313  -  STEM FEM 10IN 13MM BW RSTOR TI 3 RIGHT HIP,"$13,745.88",$0.00,"$13,745.88","$6,185.64","$5,158.80",$0.00,"$2,368.35",$0.00,$0.00,"$2,406.79","$13,745.88",$0.00,"$6,872.94","$10,886.74","$10,996.70",$0.00,"$2,151.23",$0.00,"$2,188.34",$0.00
6269-2-414,SUP,HCPCS C1776,,6269-2-414  -  STEM FEM 10IN 14MM BW RSTOR TI 4 RIGHT HIP,"$13,745.88",$0.00,"$13,745.88","$6,185.64","$5,158.80",$0.00,"$2,368.35",$0.00,$0.00,"$2,406.79","$13,745.88",$0.00,"$6,872.94","$10,886.74","$10,996.70",$0.00,"$2,151.23",$0.00,"$2,188.34",$0.00
6269-2-515,SUP,HCPCS C1776,,6269-2-515  -  STEM FEM 10IN 15MM BW RSTOR TI 5 RIGHT HIP,"$13,745.88",$0.00,"$13,745.88","$6,185.64","$5,158.80",$0.00,"$2,368.35",$0.00,$0.00,"$2,406.79","$13,745.88",$0.00,"$6,872.94","$10,886.74","$10,996.70",$0.00,"$2,151.23",$0.00,"$2,188.34",$0.00
6269-2-616,SUP,HCPCS C1776,,6269-2-616  -  STEM FEM 10IN 16MM BW RSTOR TI 6 RIGHT HIP,"$13,745.88",$0.00,"$13,745.88","$6,185.64","$5,158.80",$0.00,"$2,368.35",$0.00,$0.00,"$2,406.79","$13,745.88",$0.00,"$6,872.94","$10,886.74","$10,996.70",$0.00,"$2,151.23",$0.00,"$2,188.34",$0.00
6269-2-717,SUP,HCPCS C1776,,6269-2-717  -  STEM FEM 10IN 17MM BW RSTOR TI 7 RIGHT HIP,"$13,745.88",$0.00,"$13,745.88","$6,185.64","$5,158.80",$0.00,"$2,368.35",$0.00,$0.00,"$2,406.79","$13,745.88",$0.00,"$6,872.94","$10,886.74","$10,996.70",$0.00,"$2,151.23",$0.00,"$2,188.34",$0.00
6269-2-719,SUP,HCPCS C1776,,6269-2-719  -  STEM FEM 10IN 19MM BW RSTOR TI 7 RIGHT HIP,"$13,745.88",$0.00,"$13,745.88","$6,185.64","$5,158.80",$0.00,"$2,368.35",$0.00,$0.00,"$2,406.79","$13,745.88",$0.00,"$6,872.94","$10,886.74","$10,996.70",$0.00,"$2,151.23",$0.00,"$2,188.34",$0.00
6269-2-818,SUP,HCPCS C1776,,6269-2-818  -  STEM FEM 10IN 18MM BW RSTOR TI 8 RIGHT HIP,"$13,745.88",$0.00,"$13,745.88","$6,185.64","$5,158.80",$0.00,"$2,368.35",$0.00,$0.00,"$2,406.79","$13,745.88",$0.00,"$6,872.94","$10,886.74","$10,996.70",$0.00,"$2,151.23",$0.00,"$2,188.34",$0.00
6269-2-820,SUP,HCPCS C1776,,6269-2-820  -  STEM FEM 10IN 20MM BW RSTOR TI 8 RIGHT HIP,"$13,745.88",$0.00,"$13,745.88","$6,185.64","$5,158.80",$0.00,"$2,368.35",$0.00,$0.00,"$2,406.79","$13,745.88",$0.00,"$6,872.94","$10,886.74","$10,996.70",$0.00,"$2,151.23",$0.00,"$2,188.34",$0.00
6269-2-921,SUP,HCPCS C1776,,6269-2-921  -  STEM FEM 10IN 21MM BW RSTOR TI 9 RIGHT HIP,"$13,745.88",$0.00,"$13,745.88","$6,185.64","$5,158.80",$0.00,"$2,368.35",$0.00,$0.00,"$2,406.79","$13,745.88",$0.00,"$6,872.94","$10,886.74","$10,996.70",$0.00,"$2,151.23",$0.00,"$2,188.34",$0.00
6269-3-111,SUP,HCPCS C1776,,6269-3-111  -  STEM FEM 8IN 11MM BW RSTOR TI 1 LEFT HIP,"$13,281.13",$0.00,"$13,281.13","$5,976.51","$5,158.80",$0.00,"$2,288.27",$0.00,$0.00,"$2,325.42","$13,281.13",$0.00,"$6,640.56","$10,518.65","$10,624.90",$0.00,"$2,078.50",$0.00,"$2,114.36",$0.00
6269-3-113,SUP,HCPCS C1776,,6269-3-113  -  STEM FEM 8IN 13MM BW RSTOR TI 1 LEFT HIP,"$13,281.13",$0.00,"$13,281.13","$5,976.51","$5,158.80",$0.00,"$2,288.27",$0.00,$0.00,"$2,325.42","$13,281.13",$0.00,"$6,640.56","$10,518.65","$10,624.90",$0.00,"$2,078.50",$0.00,"$2,114.36",$0.00
6269-3-212,SUP,HCPCS C1776,,6269-3-212  -  STEM FEM 8IN 12MM BW RSTOR TI 2 LEFT HIP,"$13,281.13",$0.00,"$13,281.13","$5,976.51","$5,158.80",$0.00,"$2,288.27",$0.00,$0.00,"$2,325.42","$13,281.13",$0.00,"$6,640.56","$10,518.65","$10,624.90",$0.00,"$2,078.50",$0.00,"$2,114.36",$0.00
6269-3-214,SUP,HCPCS C1776,,6269-3-214  -  STEM FEM 8IN 14MM BW RSTOR TI 2 LEFT HIP,"$13,281.13",$0.00,"$13,281.13","$5,976.51","$5,158.80",$0.00,"$2,288.27",$0.00,$0.00,"$2,325.42","$13,281.13",$0.00,"$6,640.56","$10,518.65","$10,624.90",$0.00,"$2,078.50",$0.00,"$2,114.36",$0.00
6269-3-313,SUP,HCPCS C1776,,6269-3-313  -  STEM FEM 8IN 13MM BW RSTOR TI 3 LEFT HIP,"$13,281.13",$0.00,"$13,281.13","$5,976.51","$5,158.80",$0.00,"$2,288.27",$0.00,$0.00,"$2,325.42","$13,281.13",$0.00,"$6,640.56","$10,518.65","$10,624.90",$0.00,"$2,078.50",$0.00,"$2,114.36",$0.00
6269-3-315,SUP,HCPCS C1776,,6269-3-315  -  STEM FEM 8IN 15MM BW RSTOR TI 3 LEFT HIP,"$13,281.13",$0.00,"$13,281.13","$5,976.51","$5,158.80",$0.00,"$2,288.27",$0.00,$0.00,"$2,325.42","$13,281.13",$0.00,"$6,640.56","$10,518.65","$10,624.90",$0.00,"$2,078.50",$0.00,"$2,114.36",$0.00
6269-3-414,SUP,HCPCS C1776,,6269-3-414  -  STEM FEM 8IN 14MM BW RSTOR TI 4 LEFT HIP,"$13,281.13",$0.00,"$13,281.13","$5,976.51","$5,158.80",$0.00,"$2,288.27",$0.00,$0.00,"$2,325.42","$13,281.13",$0.00,"$6,640.56","$10,518.65","$10,624.90",$0.00,"$2,078.50",$0.00,"$2,114.36",$0.00
6269-3-416,SUP,HCPCS C1776,,6269-3-416  -  STEM FEM 8IN 16MM BW RSTOR TI 4 LEFT HIP,"$13,281.13",$0.00,"$13,281.13","$5,976.51","$5,158.80",$0.00,"$2,288.27",$0.00,$0.00,"$2,325.42","$13,281.13",$0.00,"$6,640.56","$10,518.65","$10,624.90",$0.00,"$2,078.50",$0.00,"$2,114.36",$0.00
6269-3-515,SUP,HCPCS C1776,,6269-3-515  -  STEM FEM 8IN 15MM BW RSTOR TI 5 LEFT HIP,"$13,281.13",$0.00,"$13,281.13","$5,976.51","$5,158.80",$0.00,"$2,288.27",$0.00,$0.00,"$2,325.42","$13,281.13",$0.00,"$6,640.56","$10,518.65","$10,624.90",$0.00,"$2,078.50",$0.00,"$2,114.36",$0.00
6269-3-517,SUP,HCPCS C1776,,6269-3-517  -  STEM FEM 8IN 17MM BW RSTOR TI 5 LEFT HIP,"$13,281.13",$0.00,"$13,281.13","$5,976.51","$5,158.80",$0.00,"$2,288.27",$0.00,$0.00,"$2,325.42","$13,281.13",$0.00,"$6,640.56","$10,518.65","$10,624.90",$0.00,"$2,078.50",$0.00,"$2,114.36",$0.00
6269-3-616,SUP,HCPCS C1776,,6269-3-616  -  STEM FEM 8IN 16MM BW RSTOR TI 6 LEFT HIP,"$13,281.13",$0.00,"$13,281.13","$5,976.51","$5,158.80",$0.00,"$2,288.27",$0.00,$0.00,"$2,325.42","$13,281.13",$0.00,"$6,640.56","$10,518.65","$10,624.90",$0.00,"$2,078.50",$0.00,"$2,114.36",$0.00
6269-3-618,SUP,HCPCS C1776,,6269-3-618  -  STEM FEM 8IN 18MM BW RSTOR TI 6 LEFT HIP,"$13,281.13",$0.00,"$13,281.13","$5,976.51","$5,158.80",$0.00,"$2,288.27",$0.00,$0.00,"$2,325.42","$13,281.13",$0.00,"$6,640.56","$10,518.65","$10,624.90",$0.00,"$2,078.50",$0.00,"$2,114.36",$0.00
6269-3-717,SUP,HCPCS C1776,,6269-3-717  -  STEM FEM 8IN 17MM BW RSTOR TI 7 LEFT HIP,"$13,281.13",$0.00,"$13,281.13","$5,976.51","$5,158.80",$0.00,"$2,288.27",$0.00,$0.00,"$2,325.42","$13,281.13",$0.00,"$6,640.56","$10,518.65","$10,624.90",$0.00,"$2,078.50",$0.00,"$2,114.36",$0.00
6269-3-818,SUP,HCPCS C1776,,6269-3-818  -  STEM FEM 8IN 18MM BW RSTOR TI 8 LEFT HIP,"$13,281.13",$0.00,"$13,281.13","$5,976.51","$5,158.80",$0.00,"$2,288.27",$0.00,$0.00,"$2,325.42","$13,281.13",$0.00,"$6,640.56","$10,518.65","$10,624.90",$0.00,"$2,078.50",$0.00,"$2,114.36",$0.00
6269-3-820,SUP,HCPCS C1776,,6269-3-820  -  STEM FEM 8IN 20MM BW RSTOR TI 8 LEFT HIP,"$13,281.13",$0.00,"$13,281.13","$5,976.51","$5,158.80",$0.00,"$2,288.27",$0.00,$0.00,"$2,325.42","$13,281.13",$0.00,"$6,640.56","$10,518.65","$10,624.90",$0.00,"$2,078.50",$0.00,"$2,114.36",$0.00
6269-4-111,SUP,HCPCS C1776,,6269-4-111  -  STEM FEM 8IN 11MM BW RSTOR TI 1 RIGHT HIP,"$13,281.13",$0.00,"$13,281.13","$5,976.51","$5,158.80",$0.00,"$2,288.27",$0.00,$0.00,"$2,325.42","$13,281.13",$0.00,"$6,640.56","$10,518.65","$10,624.90",$0.00,"$2,078.50",$0.00,"$2,114.36",$0.00
6269-4-113,SUP,HCPCS C1776,,6269-4-113  -  STEM FEM 8IN 13MM BW RSTOR TI 1 RIGHT HIP,"$13,281.13",$0.00,"$13,281.13","$5,976.51","$5,158.80",$0.00,"$2,288.27",$0.00,$0.00,"$2,325.42","$13,281.13",$0.00,"$6,640.56","$10,518.65","$10,624.90",$0.00,"$2,078.50",$0.00,"$2,114.36",$0.00
6269-4-212,SUP,HCPCS C1776,,6269-4-212  -  STEM FEM 8IN 12MM BW RSTOR TI 2 RIGHT HIP,"$13,281.13",$0.00,"$13,281.13","$5,976.51","$5,158.80",$0.00,"$2,288.27",$0.00,$0.00,"$2,325.42","$13,281.13",$0.00,"$6,640.56","$10,518.65","$10,624.90",$0.00,"$2,078.50",$0.00,"$2,114.36",$0.00
6269-4-214,SUP,HCPCS C1776,,6269-4-214  -  STEM FEM 8IN 14MM BW RSTOR TI 2 RIGHT HIP,"$13,281.13",$0.00,"$13,281.13","$5,976.51","$5,158.80",$0.00,"$2,288.27",$0.00,$0.00,"$2,325.42","$13,281.13",$0.00,"$6,640.56","$10,518.65","$10,624.90",$0.00,"$2,078.50",$0.00,"$2,114.36",$0.00
6269-4-313,SUP,HCPCS C1776,,6269-4-313  -  STEM FEM 8IN 13MM BW RSTOR TI 3 RIGHT HIP,"$13,281.13",$0.00,"$13,281.13","$5,976.51","$5,158.80",$0.00,"$2,288.27",$0.00,$0.00,"$2,325.42","$13,281.13",$0.00,"$6,640.56","$10,518.65","$10,624.90",$0.00,"$2,078.50",$0.00,"$2,114.36",$0.00
6269-4-315,SUP,HCPCS C1776,,6269-4-315  -  STEM FEM 8IN 15MM BW RSTOR TI 3 RIGHT HIP,"$13,281.13",$0.00,"$13,281.13","$5,976.51","$5,158.80",$0.00,"$2,288.27",$0.00,$0.00,"$2,325.42","$13,281.13",$0.00,"$6,640.56","$10,518.65","$10,624.90",$0.00,"$2,078.50",$0.00,"$2,114.36",$0.00
6269-4-414,SUP,HCPCS C1776,,6269-4-414  -  STEM FEM 8IN 14MM BW PS RSTOR TI 4 RIGHT,"$13,281.13",$0.00,"$13,281.13","$5,976.51","$5,158.80",$0.00,"$2,288.27",$0.00,$0.00,"$2,325.42","$13,281.13",$0.00,"$6,640.56","$10,518.65","$10,624.90",$0.00,"$2,078.50",$0.00,"$2,114.36",$0.00
6269-4-416,SUP,HCPCS C1776,,6269-4-416  -  STEM FEM 8IN 16MM BW RSTOR TI 4 RIGHT HIP,"$13,281.13",$0.00,"$13,281.13","$5,976.51","$5,158.80",$0.00,"$2,288.27",$0.00,$0.00,"$2,325.42","$13,281.13",$0.00,"$6,640.56","$10,518.65","$10,624.90",$0.00,"$2,078.50",$0.00,"$2,114.36",$0.00
6269-4-515,SUP,HCPCS C1776,,6269-4-515  -  STEM FEM 8IN 15MM BW RSTOR TI 5 RIGHT HIP,"$13,281.13",$0.00,"$13,281.13","$5,976.51","$5,158.80",$0.00,"$2,288.27",$0.00,$0.00,"$2,325.42","$13,281.13",$0.00,"$6,640.56","$10,518.65","$10,624.90",$0.00,"$2,078.50",$0.00,"$2,114.36",$0.00
6269-4-517,SUP,HCPCS C1776,,6269-4-517  -  STEM FEM 8IN 17MM BW RSTOR TI 5 RIGHT HIP,"$13,281.13",$0.00,"$13,281.13","$5,976.51","$5,158.80",$0.00,"$2,288.27",$0.00,$0.00,"$2,325.42","$13,281.13",$0.00,"$6,640.56","$10,518.65","$10,624.90",$0.00,"$2,078.50",$0.00,"$2,114.36",$0.00
6269-4-616,SUP,HCPCS C1776,,6269-4-616  -  STEM FEM 8IN 16MM BW RSTOR TI 6 RIGHT HIP,"$13,281.13",$0.00,"$13,281.13","$5,976.51","$5,158.80",$0.00,"$2,288.27",$0.00,$0.00,"$2,325.42","$13,281.13",$0.00,"$6,640.56","$10,518.65","$10,624.90",$0.00,"$2,078.50",$0.00,"$2,114.36",$0.00
6269-4-618,SUP,HCPCS C1776,,6269-4-618  -  STEM FEM 8IN 18MM BW RSTOR TI 6 RIGHT HIP,"$13,281.13",$0.00,"$13,281.13","$5,976.51","$5,158.80",$0.00,"$2,288.27",$0.00,$0.00,"$2,325.42","$13,281.13",$0.00,"$6,640.56","$10,518.65","$10,624.90",$0.00,"$2,078.50",$0.00,"$2,114.36",$0.00
6269-4-717,SUP,HCPCS C1776,,6269-4-717  -  STEM FEM 8IN 17MM BW RSTOR TI 7 RIGHT HIP,"$13,281.13",$0.00,"$13,281.13","$5,976.51","$5,158.80",$0.00,"$2,288.27",$0.00,$0.00,"$2,325.42","$13,281.13",$0.00,"$6,640.56","$10,518.65","$10,624.90",$0.00,"$2,078.50",$0.00,"$2,114.36",$0.00
6269-4-719,SUP,HCPCS C1776,,6269-4-719  -  STEM FEM 8IN 19MM BW RSTOR TI 7 RIGHT HIP,"$13,281.13",$0.00,"$13,281.13","$5,976.51","$5,158.80",$0.00,"$2,288.27",$0.00,$0.00,"$2,325.42","$13,281.13",$0.00,"$6,640.56","$10,518.65","$10,624.90",$0.00,"$2,078.50",$0.00,"$2,114.36",$0.00
6269-4-818,SUP,HCPCS C1776,,6269-4-818  -  STEM FEM 8IN 18MM BW RSTOR TI 8 RIGHT HIP,"$13,281.13",$0.00,"$13,281.13","$5,976.51","$5,158.80",$0.00,"$2,288.27",$0.00,$0.00,"$2,325.42","$13,281.13",$0.00,"$6,640.56","$10,518.65","$10,624.90",$0.00,"$2,078.50",$0.00,"$2,114.36",$0.00
6269-4-820,SUP,HCPCS C1776,,6269-4-820  -  STEM FEM 8IN 20MM BW RSTOR TI 8 RIGHT HIP,"$13,281.13",$0.00,"$13,281.13","$5,976.51","$5,158.80",$0.00,"$2,288.27",$0.00,$0.00,"$2,325.42","$13,281.13",$0.00,"$6,640.56","$10,518.65","$10,624.90",$0.00,"$2,078.50",$0.00,"$2,114.36",$0.00
6269-4-921,SUP,HCPCS C1776,,6269-4-921  -  STEM FEM 8IN 21MM BW RSTOR TI 9 RIGHT HIP,"$13,281.13",$0.00,"$13,281.13","$5,976.51","$5,158.80",$0.00,"$2,288.27",$0.00,$0.00,"$2,325.42","$13,281.13",$0.00,"$6,640.56","$10,518.65","$10,624.90",$0.00,"$2,078.50",$0.00,"$2,114.36",$0.00
6276-1-019,SUP,HCPCS C1776,,6276-1-019  -  BODY CONE +0MM STANDARD 19MM MODULAR REVISION RSTOR HIP,"$9,422.50",$0.00,"$9,422.50","$4,240.13","$5,158.80",$0.00,"$1,623.45",$0.00,$0.00,"$1,649.80","$9,422.50",$0.00,"$4,711.25","$7,462.62","$7,538.00",$0.00,"$1,474.62",$0.00,"$1,500.06",$0.00
6276-1-021,SUP,HCPCS C1776,,6276-1-021  -  BODY CONE +0MM STANDARD 21MM MODULAR REVISION BOLT RSTOR HIP,"$9,422.50",$0.00,"$9,422.50","$4,240.13","$5,158.80",$0.00,"$1,623.45",$0.00,$0.00,"$1,649.80","$9,422.50",$0.00,"$4,711.25","$7,462.62","$7,538.00",$0.00,"$1,474.62",$0.00,"$1,500.06",$0.00
6276-1-023,SUP,HCPCS C1776,,6276-1-023  -  BODY CONE +0MM STANDARD 23MM 23MM MODULAR REVISION RSTOR HIP,"$9,422.50",$0.00,"$9,422.50","$4,240.13","$5,158.80",$0.00,"$1,623.45",$0.00,$0.00,"$1,649.80","$9,422.50",$0.00,"$4,711.25","$7,462.62","$7,538.00",$0.00,"$1,474.62",$0.00,"$1,500.06",$0.00
6276-1-025,SUP,HCPCS C1776,,6276-1-025  -  BODY CONE +0MM STANDARD 25MM MODULAR REVISION RSTOR HIP,"$9,422.50",$0.00,"$9,422.50","$4,240.13","$5,158.80",$0.00,"$1,623.45",$0.00,$0.00,"$1,649.80","$9,422.50",$0.00,"$4,711.25","$7,462.62","$7,538.00",$0.00,"$1,474.62",$0.00,"$1,500.06",$0.00
6276-1-027,SUP,HCPCS C1776,,6276-1-027  -  BODY CONE +0MM STANDARD 27MM MODULAR REVISION RSTOR HIP,"$9,422.50",$0.00,"$9,422.50","$4,240.13","$5,158.80",$0.00,"$1,623.45",$0.00,$0.00,"$1,649.80","$9,422.50",$0.00,"$4,711.25","$7,462.62","$7,538.00",$0.00,"$1,474.62",$0.00,"$1,500.06",$0.00
6276-1-029,SUP,HCPCS C1776,,6276-1-029  -  BODY CONE +0MM STANDARD 29MM MODULAR REVISION RSTOR HIP,"$9,422.50",$0.00,"$9,422.50","$4,240.13","$5,158.80",$0.00,"$1,623.45",$0.00,$0.00,"$1,649.80","$9,422.50",$0.00,"$4,711.25","$7,462.62","$7,538.00",$0.00,"$1,474.62",$0.00,"$1,500.06",$0.00
6276-1-031,SUP,HCPCS C1776,,6276-1-031  -  BODY CONE +0MM STANDARD 31MM MODULAR REVISION RSTOR HIP,"$9,422.50",$0.00,"$9,422.50","$4,240.13","$5,158.80",$0.00,"$1,623.45",$0.00,$0.00,"$1,649.80","$9,422.50",$0.00,"$4,711.25","$7,462.62","$7,538.00",$0.00,"$1,474.62",$0.00,"$1,500.06",$0.00
6276-1-119,SUP,HCPCS C1776,,6276-1-119  -  BODY CONE +10MM 19MM MODULAR RSTOR HIP,"$9,422.50",$0.00,"$9,422.50","$4,240.13","$5,158.80",$0.00,"$1,623.45",$0.00,$0.00,"$1,649.80","$9,422.50",$0.00,"$4,711.25","$7,462.62","$7,538.00",$0.00,"$1,474.62",$0.00,"$1,500.06",$0.00
6276-1-121,SUP,HCPCS C1776,,6276-1-121  -  BODY CONE +10MM 21MM MODULAR REVISION RSTOR HIP,"$9,422.50",$0.00,"$9,422.50","$4,240.13","$5,158.80",$0.00,"$1,623.45",$0.00,$0.00,"$1,649.80","$9,422.50",$0.00,"$4,711.25","$7,462.62","$7,538.00",$0.00,"$1,474.62",$0.00,"$1,500.06",$0.00
6276-1-123,SUP,HCPCS C1776,,6276-1-123  -  BODY CONE +10MM 23MM RSTR MDLR REV TI HIP,"$9,422.50",$0.00,"$9,422.50","$4,240.13","$5,158.80",$0.00,"$1,623.45",$0.00,$0.00,"$1,649.80","$9,422.50",$0.00,"$4,711.25","$7,462.62","$7,538.00",$0.00,"$1,474.62",$0.00,"$1,500.06",$0.00
6276-1-125,SUP,HCPCS C1776,,6276-1-125  -  BODY CONE +10MM 25MM MODULAR REVISION RSTOR HIP,"$9,422.50",$0.00,"$9,422.50","$4,240.13","$5,158.80",$0.00,"$1,623.45",$0.00,$0.00,"$1,649.80","$9,422.50",$0.00,"$4,711.25","$7,462.62","$7,538.00",$0.00,"$1,474.62",$0.00,"$1,500.06",$0.00
6276-1-127,SUP,HCPCS C1776,,6276-1-127  -  BODY CONE +10MM 27MM MODULAR REVISION RSTOR HIP,"$9,422.50",$0.00,"$9,422.50","$4,240.13","$5,158.80",$0.00,"$1,623.45",$0.00,$0.00,"$1,649.80","$9,422.50",$0.00,"$4,711.25","$7,462.62","$7,538.00",$0.00,"$1,474.62",$0.00,"$1,500.06",$0.00
6276-1-129,SUP,HCPCS C1776,,6276-1-129  -  BODY CONE +10MM 29MM MODULAR REVISION RSTOR HIP,"$9,422.50",$0.00,"$9,422.50","$4,240.13","$5,158.80",$0.00,"$1,623.45",$0.00,$0.00,"$1,649.80","$9,422.50",$0.00,"$4,711.25","$7,462.62","$7,538.00",$0.00,"$1,474.62",$0.00,"$1,500.06",$0.00
6276-1-131,SUP,HCPCS C1776,,6276-1-131  -  BODY CONE +10MM 31MM MODULAR REVISION RSTOR HIP,"$9,422.50",$0.00,"$9,422.50","$4,240.13","$5,158.80",$0.00,"$1,623.45",$0.00,$0.00,"$1,649.80","$9,422.50",$0.00,"$4,711.25","$7,462.62","$7,538.00",$0.00,"$1,474.62",$0.00,"$1,500.06",$0.00
6276-1-219,SUP,HCPCS C1776,,6276-1-219  -  BODY CONE +20MM 19MM MODULAR REVISION RSTOR HIP,"$9,422.50",$0.00,"$9,422.50","$4,240.13","$5,158.80",$0.00,"$1,623.45",$0.00,$0.00,"$1,649.80","$9,422.50",$0.00,"$4,711.25","$7,462.62","$7,538.00",$0.00,"$1,474.62",$0.00,"$1,500.06",$0.00
6276-1-221,SUP,HCPCS C1776,,6276-1-221  -  BODY CONE +20MM 21MM MODULAR REVISION RSTOR HIP,"$9,422.50",$0.00,"$9,422.50","$4,240.13","$5,158.80",$0.00,"$1,623.45",$0.00,$0.00,"$1,649.80","$9,422.50",$0.00,"$4,711.25","$7,462.62","$7,538.00",$0.00,"$1,474.62",$0.00,"$1,500.06",$0.00
6276-1-223,SUP,HCPCS C1776,,6276-1-223  -  BODY CONE +20MM 23MM MODULAR REVISION RSTOR HIP,"$9,422.50",$0.00,"$9,422.50","$4,240.13","$5,158.80",$0.00,"$1,623.45",$0.00,$0.00,"$1,649.80","$9,422.50",$0.00,"$4,711.25","$7,462.62","$7,538.00",$0.00,"$1,474.62",$0.00,"$1,500.06",$0.00
6276-1-225,SUP,HCPCS C1776,,6276-1-225  -  BODY CONE +20MM 25MM MODULAR REVISION RSTOR HIP,"$9,422.50",$0.00,"$9,422.50","$4,240.13","$5,158.80",$0.00,"$1,623.45",$0.00,$0.00,"$1,649.80","$9,422.50",$0.00,"$4,711.25","$7,462.62","$7,538.00",$0.00,"$1,474.62",$0.00,"$1,500.06",$0.00
6276-1-227,SUP,HCPCS C1776,,6276-1-227  -  BODY CONE +20MM 27MM MODULAR REVISION RSTOR HIP,"$9,422.50",$0.00,"$9,422.50","$4,240.13","$5,158.80",$0.00,"$1,623.45",$0.00,$0.00,"$1,649.80","$9,422.50",$0.00,"$4,711.25","$7,462.62","$7,538.00",$0.00,"$1,474.62",$0.00,"$1,500.06",$0.00
6276-1-229,SUP,HCPCS C1776,,6276-1-229  -  BODY CONE +20MM 29MM MODULAR REVISION RSTOR HIP,"$9,422.50",$0.00,"$9,422.50","$4,240.13","$5,158.80",$0.00,"$1,623.45",$0.00,$0.00,"$1,649.80","$9,422.50",$0.00,"$4,711.25","$7,462.62","$7,538.00",$0.00,"$1,474.62",$0.00,"$1,500.06",$0.00
6276-1-231,SUP,HCPCS C1776,,6276-1-231  -  BODY CONE +20MM 31MM MODULAR REVISION RSTOR HIP,"$9,422.50",$0.00,"$9,422.50","$4,240.13","$5,158.80",$0.00,"$1,623.45",$0.00,$0.00,"$1,649.80","$9,422.50",$0.00,"$4,711.25","$7,462.62","$7,538.00",$0.00,"$1,474.62",$0.00,"$1,500.06",$0.00
6276-1-319,SUP,HCPCS C1776,,6276-1-319  -  BODY CONE +30MM 19MM MODULAR RSTOR HIP,"$9,422.50",$0.00,"$9,422.50","$4,240.13","$5,158.80",$0.00,"$1,623.45",$0.00,$0.00,"$1,649.80","$9,422.50",$0.00,"$4,711.25","$7,462.62","$7,538.00",$0.00,"$1,474.62",$0.00,"$1,500.06",$0.00
6276-1-321,SUP,HCPCS C1776,,6276-1-321  -  BODY CONE +30MM 21MM MODULAR REVISION RSTOR HIP,"$9,422.50",$0.00,"$9,422.50","$4,240.13","$5,158.80",$0.00,"$1,623.45",$0.00,$0.00,"$1,649.80","$9,422.50",$0.00,"$4,711.25","$7,462.62","$7,538.00",$0.00,"$1,474.62",$0.00,"$1,500.06",$0.00
6276-1-323,SUP,HCPCS C1776,,6276-1-323  -  BODY CONE +30MM 23MM MODULAR REVISION RSTOR HIP,"$9,422.50",$0.00,"$9,422.50","$4,240.13","$5,158.80",$0.00,"$1,623.45",$0.00,$0.00,"$1,649.80","$9,422.50",$0.00,"$4,711.25","$7,462.62","$7,538.00",$0.00,"$1,474.62",$0.00,"$1,500.06",$0.00
6276-1-325,SUP,HCPCS C1776,,6276-1-325  -  BODY CONE +30MM 25MM MODULAR REVISION RSTOR HIP,"$9,422.50",$0.00,"$9,422.50","$4,240.13","$5,158.80",$0.00,"$1,623.45",$0.00,$0.00,"$1,649.80","$9,422.50",$0.00,"$4,711.25","$7,462.62","$7,538.00",$0.00,"$1,474.62",$0.00,"$1,500.06",$0.00
6276-1-327,SUP,HCPCS C1776,,6276-1-327  -  BODY CONE +30MM 27MM MODULAR REVISION RSTOR HIP,"$9,422.50",$0.00,"$9,422.50","$4,240.13","$5,158.80",$0.00,"$1,623.45",$0.00,$0.00,"$1,649.80","$9,422.50",$0.00,"$4,711.25","$7,462.62","$7,538.00",$0.00,"$1,474.62",$0.00,"$1,500.06",$0.00
6276-1-329,SUP,HCPCS C1776,,6276-1-329  -  BODY CONE +30MM 29MM MODULAR REVISION RSTOR HIP,"$9,422.50",$0.00,"$9,422.50","$4,240.13","$5,158.80",$0.00,"$1,623.45",$0.00,$0.00,"$1,649.80","$9,422.50",$0.00,"$4,711.25","$7,462.62","$7,538.00",$0.00,"$1,474.62",$0.00,"$1,500.06",$0.00
6276-1-331,SUP,HCPCS C1776,,6276-1-331  -  BODY CONE +30MM 31MM MODULAR REVISION RSTOR HIP,"$9,422.50",$0.00,"$9,422.50","$4,240.13","$5,158.80",$0.00,"$1,623.45",$0.00,$0.00,"$1,649.80","$9,422.50",$0.00,"$4,711.25","$7,462.62","$7,538.00",$0.00,"$1,474.62",$0.00,"$1,500.06",$0.00
6276-2-019,SUP,HCPCS C1776,,6276-2-019  -  BODY MILLED 19MM MODULAR SHALLOW RSTOR HIP FEMUR,"$9,422.50",$0.00,"$9,422.50","$4,240.13","$5,158.80",$0.00,"$1,623.45",$0.00,$0.00,"$1,649.80","$9,422.50",$0.00,"$4,711.25","$7,462.62","$7,538.00",$0.00,"$1,474.62",$0.00,"$1,500.06",$0.00
6276-2-021,SUP,HCPCS C1776,,6276-2-021  -  BODY MILLED 21MM MODULAR SHALLOW RSTOR HIP FEMUR,"$9,422.50",$0.00,"$9,422.50","$4,240.13","$5,158.80",$0.00,"$1,623.45",$0.00,$0.00,"$1,649.80","$9,422.50",$0.00,"$4,711.25","$7,462.62","$7,538.00",$0.00,"$1,474.62",$0.00,"$1,500.06",$0.00
6276-2-023,SUP,HCPCS C1776,,6276-2-023  -  BODY MILLED 23MM MODULAR SHALLOW RSTOR HIP FEMUR,"$9,422.50",$0.00,"$9,422.50","$4,240.13","$5,158.80",$0.00,"$1,623.45",$0.00,$0.00,"$1,649.80","$9,422.50",$0.00,"$4,711.25","$7,462.62","$7,538.00",$0.00,"$1,474.62",$0.00,"$1,500.06",$0.00
6276-2-025,SUP,HCPCS C1776,,6276-2-025  -  BODY MILLED 25MM MODULAR SHALLOW RSTOR HIP FEMUR,"$9,422.50",$0.00,"$9,422.50","$4,240.13","$5,158.80",$0.00,"$1,623.45",$0.00,$0.00,"$1,649.80","$9,422.50",$0.00,"$4,711.25","$7,462.62","$7,538.00",$0.00,"$1,474.62",$0.00,"$1,500.06",$0.00
6276-2-027,SUP,HCPCS C1776,,6276-2-027  -  BODY MILLED 27MM MODULAR SHALLOW RSTOR HIP FEMUR,"$9,422.50",$0.00,"$9,422.50","$4,240.13","$5,158.80",$0.00,"$1,623.45",$0.00,$0.00,"$1,649.80","$9,422.50",$0.00,"$4,711.25","$7,462.62","$7,538.00",$0.00,"$1,474.62",$0.00,"$1,500.06",$0.00
6276-2-029,SUP,HCPCS C1776,,6276-2-029  -  BODY MILLED 29MM MODULAR SHALLOW RSTOR HIP FEMUR,"$9,422.50",$0.00,"$9,422.50","$4,240.13","$5,158.80",$0.00,"$1,623.45",$0.00,$0.00,"$1,649.80","$9,422.50",$0.00,"$4,711.25","$7,462.62","$7,538.00",$0.00,"$1,474.62",$0.00,"$1,500.06",$0.00
6276-2-031,SUP,HCPCS C1776,,6276-2-031  -  BODY MILLED 31MM MODULAR SHALLOW RSTOR HIP FEMUR,"$9,422.50",$0.00,"$9,422.50","$4,240.13","$5,158.80",$0.00,"$1,623.45",$0.00,$0.00,"$1,649.80","$9,422.50",$0.00,"$4,711.25","$7,462.62","$7,538.00",$0.00,"$1,474.62",$0.00,"$1,500.06",$0.00
6276-2-119,SUP,HCPCS C1776,,6276-2-119  -  BODY MILLED 19MM MODULAR DEEP RSTOR HIP FEMUR,"$9,422.50",$0.00,"$9,422.50","$4,240.13","$5,158.80",$0.00,"$1,623.45",$0.00,$0.00,"$1,649.80","$9,422.50",$0.00,"$4,711.25","$7,462.62","$7,538.00",$0.00,"$1,474.62",$0.00,"$1,500.06",$0.00
6276-2-121,SUP,HCPCS C1776,,6276-2-121  -  BODY MILLED 21MM MODULAR DEEP RSTOR HIP FEMUR,"$9,422.50",$0.00,"$9,422.50","$4,240.13","$5,158.80",$0.00,"$1,623.45",$0.00,$0.00,"$1,649.80","$9,422.50",$0.00,"$4,711.25","$7,462.62","$7,538.00",$0.00,"$1,474.62",$0.00,"$1,500.06",$0.00
6276-2-123,SUP,HCPCS C1776,,6276-2-123  -  BODY MILLED 23MM MODULAR DEEP RSTOR HIP FEMUR,"$9,422.50",$0.00,"$9,422.50","$4,240.13","$5,158.80",$0.00,"$1,623.45",$0.00,$0.00,"$1,649.80","$9,422.50",$0.00,"$4,711.25","$7,462.62","$7,538.00",$0.00,"$1,474.62",$0.00,"$1,500.06",$0.00
6276-2-125,SUP,HCPCS C1776,,6276-2-125  -  BODY MILLED 25MM MODULAR DEEP RSTOR HIP FEMUR,"$9,422.50",$0.00,"$9,422.50","$4,240.13","$5,158.80",$0.00,"$1,623.45",$0.00,$0.00,"$1,649.80","$9,422.50",$0.00,"$4,711.25","$7,462.62","$7,538.00",$0.00,"$1,474.62",$0.00,"$1,500.06",$0.00
6276-2-127,SUP,HCPCS C1776,,6276-2-127  -  BODY MILLED 27MM MODULAR DEEP RSTOR HIP FEMUR,"$9,422.50",$0.00,"$9,422.50","$4,240.13","$5,158.80",$0.00,"$1,623.45",$0.00,$0.00,"$1,649.80","$9,422.50",$0.00,"$4,711.25","$7,462.62","$7,538.00",$0.00,"$1,474.62",$0.00,"$1,500.06",$0.00
6276-2-129,SUP,HCPCS C1776,,6276-2-129  -  BODY MILLED 29MM MODULAR DEEP RSTOR HIP FEMUR,"$9,422.50",$0.00,"$9,422.50","$4,240.13","$5,158.80",$0.00,"$1,623.45",$0.00,$0.00,"$1,649.80","$9,422.50",$0.00,"$4,711.25","$7,462.62","$7,538.00",$0.00,"$1,474.62",$0.00,"$1,500.06",$0.00
6276-2-131,SUP,HCPCS C1776,,6276-2-131  -  BODY MILLED 31MM MODULAR DEEP RSTOR HIP FEMUR,"$9,422.50",$0.00,"$9,422.50","$4,240.13","$5,158.80",$0.00,"$1,623.45",$0.00,$0.00,"$1,649.80","$9,422.50",$0.00,"$4,711.25","$7,462.62","$7,538.00",$0.00,"$1,474.62",$0.00,"$1,500.06",$0.00
6276-2-227,SUP,HCPCS C1776,,6276-2-227  -  BODY MILLED 27MM MODULAR EXTRA DEEP RSTOR HIP FEMUR,"$9,422.50",$0.00,"$9,422.50","$4,240.13","$5,158.80",$0.00,"$1,623.45",$0.00,$0.00,"$1,649.80","$9,422.50",$0.00,"$4,711.25","$7,462.62","$7,538.00",$0.00,"$1,474.62",$0.00,"$1,500.06",$0.00
6276-2-229,SUP,HCPCS C1776,,6276-2-229  -  BODY MILLED 29MM MODULAR EXTRA DEEP RSTOR HIP FEMUR,"$9,422.50",$0.00,"$9,422.50","$4,240.13","$5,158.80",$0.00,"$1,623.45",$0.00,$0.00,"$1,649.80","$9,422.50",$0.00,"$4,711.25","$7,462.62","$7,538.00",$0.00,"$1,474.62",$0.00,"$1,500.06",$0.00
6276-2-231,SUP,HCPCS C1776,,6276-2-231  -  BODY MILLED 31MM MODULAR EXTRA DEEP RSTOR HIP FEMUR,"$9,422.50",$0.00,"$9,422.50","$4,240.13","$5,158.80",$0.00,"$1,623.45",$0.00,$0.00,"$1,649.80","$9,422.50",$0.00,"$4,711.25","$7,462.62","$7,538.00",$0.00,"$1,474.62",$0.00,"$1,500.06",$0.00
6276-3-001,SUP,HCPCS C1776,,6276-3-001  -  BODY BROACHED 1 REVISION MODULAR RSTOR HIP FEMUR PROXIMAL,"$9,422.50",$0.00,"$9,422.50","$4,240.13","$5,158.80",$0.00,"$1,623.45",$0.00,$0.00,"$1,649.80","$9,422.50",$0.00,"$4,711.25","$7,462.62","$7,538.00",$0.00,"$1,474.62",$0.00,"$1,500.06",$0.00
6276-3-002,SUP,HCPCS C1776,,6276-3-002  -  BODY BROACHED 2 REVISION MODULAR RSTOR HIP FEMUR PROXIMAL,"$9,422.50",$0.00,"$9,422.50","$4,240.13","$5,158.80",$0.00,"$1,623.45",$0.00,$0.00,"$1,649.80","$9,422.50",$0.00,"$4,711.25","$7,462.62","$7,538.00",$0.00,"$1,474.62",$0.00,"$1,500.06",$0.00
6276-3-003,SUP,HCPCS C1776,,6276-3-003  -  BODY BROACHED 3 REVISION MODULAR RSTOR HIP FEMUR PROXIMAL,"$9,422.50",$0.00,"$9,422.50","$4,240.13","$5,158.80",$0.00,"$1,623.45",$0.00,$0.00,"$1,649.80","$9,422.50",$0.00,"$4,711.25","$7,462.62","$7,538.00",$0.00,"$1,474.62",$0.00,"$1,500.06",$0.00
6276-3-004,SUP,HCPCS C1776,,6276-3-004  -  BODY BROACHED 4 REVISION MODULAR RSTOR HIP FEMUR PROXIMAL,"$9,422.50",$0.00,"$9,422.50","$4,240.13","$5,158.80",$0.00,"$1,623.45",$0.00,$0.00,"$1,649.80","$9,422.50",$0.00,"$4,711.25","$7,462.62","$7,538.00",$0.00,"$1,474.62",$0.00,"$1,500.06",$0.00
6276-3-005,SUP,HCPCS C1776,,6276-3-005  -  BODY BROACHED 5 REVISION MODULAR RSTOR HIP FEMUR PROXIMAL,"$9,422.50",$0.00,"$9,422.50","$4,240.13","$5,158.80",$0.00,"$1,623.45",$0.00,$0.00,"$1,649.80","$9,422.50",$0.00,"$4,711.25","$7,462.62","$7,538.00",$0.00,"$1,474.62",$0.00,"$1,500.06",$0.00
6276-3-006,SUP,HCPCS C1776,,6276-3-006  -  BODY BROACHED 6 REVISION MODULAR RSTOR HIP FEMUR PROXIMAL,"$9,422.50",$0.00,"$9,422.50","$4,240.13","$5,158.80",$0.00,"$1,623.45",$0.00,$0.00,"$1,649.80","$9,422.50",$0.00,"$4,711.25","$7,462.62","$7,538.00",$0.00,"$1,474.62",$0.00,"$1,500.06",$0.00
6276-3-007,SUP,HCPCS C1776,,6276-3-007  -  BODY BROACHED 7 REVISION MODULAR RSTOR HIP FEMUR,"$9,422.50",$0.00,"$9,422.50","$4,240.13","$5,158.80",$0.00,"$1,623.45",$0.00,$0.00,"$1,649.80","$9,422.50",$0.00,"$4,711.25","$7,462.62","$7,538.00",$0.00,"$1,474.62",$0.00,"$1,500.06",$0.00
6276-3-008,SUP,HCPCS C1776,,6276-3-008  -  BODY BROACHED 8 REVISION MODULAR RSTOR HIP FEMUR PROXIMAL,"$9,422.50",$0.00,"$9,422.50","$4,240.13","$5,158.80",$0.00,"$1,623.45",$0.00,$0.00,"$1,649.80","$9,422.50",$0.00,"$4,711.25","$7,462.62","$7,538.00",$0.00,"$1,474.62",$0.00,"$1,500.06",$0.00
6276-4-119,SUP,HCPCS C1776,,6276-4-119  -  BODY CALCAR +10MM OFFST 19MM MODULAR RSTOR HIP,"$9,827.50",$0.00,"$9,827.50","$4,422.38","$5,158.80",$0.00,"$1,693.23",$0.00,$0.00,"$1,720.72","$9,827.50",$0.00,"$4,913.75","$7,783.38","$7,862.00",$0.00,"$1,538.00",$0.00,"$1,564.54",$0.00
6276-4-121,SUP,HCPCS C1776,,6276-4-121  -  BODY CALCAR +10MM OFFST 21MM MODULAR RSTOR HIP,"$9,827.50",$0.00,"$9,827.50","$4,422.38","$5,158.80",$0.00,"$1,693.23",$0.00,$0.00,"$1,720.72","$9,827.50",$0.00,"$4,913.75","$7,783.38","$7,862.00",$0.00,"$1,538.00",$0.00,"$1,564.54",$0.00
6276-4-123,SUP,HCPCS C1776,,6276-4-123  -  BODY CALCAR +10MM OFFST 23MM MODULAR RSTOR HIP,"$9,827.50",$0.00,"$9,827.50","$4,422.38","$5,158.80",$0.00,"$1,693.23",$0.00,$0.00,"$1,720.72","$9,827.50",$0.00,"$4,913.75","$7,783.38","$7,862.00",$0.00,"$1,538.00",$0.00,"$1,564.54",$0.00
6276-4-125,SUP,HCPCS C1776,,6276-4-125  -  BODY CALCAR +10MM OFFST 25MM MODULAR RSTOR HIP,"$9,827.50",$0.00,"$9,827.50","$4,422.38","$5,158.80",$0.00,"$1,693.23",$0.00,$0.00,"$1,720.72","$9,827.50",$0.00,"$4,913.75","$7,783.38","$7,862.00",$0.00,"$1,538.00",$0.00,"$1,564.54",$0.00
6276-4-127,SUP,HCPCS C1776,,6276-4-127  -  BODY CALCAR +10MM OFFST 27MM MODULAR RSTOR HIP,"$9,827.50",$0.00,"$9,827.50","$4,422.38","$5,158.80",$0.00,"$1,693.23",$0.00,$0.00,"$1,720.72","$9,827.50",$0.00,"$4,913.75","$7,783.38","$7,862.00",$0.00,"$1,538.00",$0.00,"$1,564.54",$0.00
6276-4-129,SUP,HCPCS C1776,,6276-4-129  -  BODY CALCAR +10MM OFFST 29MM MODULAR RSTOR HIP,"$9,827.50",$0.00,"$9,827.50","$4,422.38","$5,158.80",$0.00,"$1,693.23",$0.00,$0.00,"$1,720.72","$9,827.50",$0.00,"$4,913.75","$7,783.38","$7,862.00",$0.00,"$1,538.00",$0.00,"$1,564.54",$0.00
6276-4-131,SUP,HCPCS C1776,,6276-4-131  -  BODY CALCAR +10MM OFFST 31MM MODULAR RSTOR HIP,"$9,827.50",$0.00,"$9,827.50","$4,422.38","$5,158.80",$0.00,"$1,693.23",$0.00,$0.00,"$1,720.72","$9,827.50",$0.00,"$4,913.75","$7,783.38","$7,862.00",$0.00,"$1,538.00",$0.00,"$1,564.54",$0.00
6276-4-219,SUP,HCPCS C1776,,6276-4-219  -  BODY CALCAR +20MM OFFST 19MM MODULAR RSTOR HIP,"$9,827.50",$0.00,"$9,827.50","$4,422.38","$5,158.80",$0.00,"$1,693.23",$0.00,$0.00,"$1,720.72","$9,827.50",$0.00,"$4,913.75","$7,783.38","$7,862.00",$0.00,"$1,538.00",$0.00,"$1,564.54",$0.00
6276-4-221,SUP,HCPCS C1776,,6276-4-221  -  BODY CALCAR +20MM OFFST 21MM MODULAR RSTOR HIP,"$9,827.50",$0.00,"$9,827.50","$4,422.38","$5,158.80",$0.00,"$1,693.23",$0.00,$0.00,"$1,720.72","$9,827.50",$0.00,"$4,913.75","$7,783.38","$7,862.00",$0.00,"$1,538.00",$0.00,"$1,564.54",$0.00
6276-4-223,SUP,HCPCS C1776,,6276-4-223  -  BODY CALCAR +20MM OFFST 23MM MODULAR RSTOR HIP,"$9,827.50",$0.00,"$9,827.50","$4,422.38","$5,158.80",$0.00,"$1,693.23",$0.00,$0.00,"$1,720.72","$9,827.50",$0.00,"$4,913.75","$7,783.38","$7,862.00",$0.00,"$1,538.00",$0.00,"$1,564.54",$0.00
6276-4-225,SUP,HCPCS C1776,,6276-4-225  -  BODY CALCAR +20MM OFFST 25MM MODULAR RSTOR HIP,"$9,827.50",$0.00,"$9,827.50","$4,422.38","$5,158.80",$0.00,"$1,693.23",$0.00,$0.00,"$1,720.72","$9,827.50",$0.00,"$4,913.75","$7,783.38","$7,862.00",$0.00,"$1,538.00",$0.00,"$1,564.54",$0.00
6276-4-227,SUP,HCPCS C1776,,6276-4-227  -  BODY CALCAR +20MM OFFST 27MM MODULAR RSTOR HIP,"$9,827.50",$0.00,"$9,827.50","$4,422.38","$5,158.80",$0.00,"$1,693.23",$0.00,$0.00,"$1,720.72","$9,827.50",$0.00,"$4,913.75","$7,783.38","$7,862.00",$0.00,"$1,538.00",$0.00,"$1,564.54",$0.00
6276-4-229,SUP,HCPCS C1776,,6276-4-229  -  BODY CALCAR +20MM OFFST 29MM MODULAR RSTOR HIP,"$9,827.50",$0.00,"$9,827.50","$4,422.38","$5,158.80",$0.00,"$1,693.23",$0.00,$0.00,"$1,720.72","$9,827.50",$0.00,"$4,913.75","$7,783.38","$7,862.00",$0.00,"$1,538.00",$0.00,"$1,564.54",$0.00
6276-4-231,SUP,HCPCS C1776,,6276-4-231  -  BODY CALCAR +20MM OFFST 31MM MODULAR RSTOR HIP,"$9,827.50",$0.00,"$9,827.50","$4,422.38","$5,158.80",$0.00,"$1,693.23",$0.00,$0.00,"$1,720.72","$9,827.50",$0.00,"$4,913.75","$7,783.38","$7,862.00",$0.00,"$1,538.00",$0.00,"$1,564.54",$0.00
6276-4-319,SUP,HCPCS C1776,,6276-4-319  -  BODY CALCAR +30MM OFFST 19MM MODULAR RSTOR HIP,"$9,827.50",$0.00,"$9,827.50","$4,422.38","$5,158.80",$0.00,"$1,693.23",$0.00,$0.00,"$1,720.72","$9,827.50",$0.00,"$4,913.75","$7,783.38","$7,862.00",$0.00,"$1,538.00",$0.00,"$1,564.54",$0.00
6276-4-321,SUP,HCPCS C1776,,6276-4-321  -  BODY CALCAR +30MM OFFST 21MM MODULAR RSTOR HIP,"$9,827.50",$0.00,"$9,827.50","$4,422.38","$5,158.80",$0.00,"$1,693.23",$0.00,$0.00,"$1,720.72","$9,827.50",$0.00,"$4,913.75","$7,783.38","$7,862.00",$0.00,"$1,538.00",$0.00,"$1,564.54",$0.00
6276-4-323,SUP,HCPCS C1776,,6276-4-323  -  BODY CALCAR +30MM OFFST 23MM MODULAR RSTOR HIP,"$9,827.50",$0.00,"$9,827.50","$4,422.38","$5,158.80",$0.00,"$1,693.23",$0.00,$0.00,"$1,720.72","$9,827.50",$0.00,"$4,913.75","$7,783.38","$7,862.00",$0.00,"$1,538.00",$0.00,"$1,564.54",$0.00
6276-4-325,SUP,HCPCS C1776,,6276-4-325  -  BODY CALCAR +30MM OFFST 25MM MODULAR RSTOR HIP,"$9,827.50",$0.00,"$9,827.50","$4,422.38","$5,158.80",$0.00,"$1,693.23",$0.00,$0.00,"$1,720.72","$9,827.50",$0.00,"$4,913.75","$7,783.38","$7,862.00",$0.00,"$1,538.00",$0.00,"$1,564.54",$0.00
6276-4-327,SUP,HCPCS C1776,,6276-4-327  -  BODY CALCAR +30MM OFFST 27MM MODULAR RSTOR HIP,"$9,827.50",$0.00,"$9,827.50","$4,422.38","$5,158.80",$0.00,"$1,693.23",$0.00,$0.00,"$1,720.72","$9,827.50",$0.00,"$4,913.75","$7,783.38","$7,862.00",$0.00,"$1,538.00",$0.00,"$1,564.54",$0.00
6276-4-329,SUP,HCPCS C1776,,6276-4-329  -  BODY CALCAR +30MM OFFST 29MM MODULAR RSTOR HIP,"$9,827.50",$0.00,"$9,827.50","$4,422.38","$5,158.80",$0.00,"$1,693.23",$0.00,$0.00,"$1,720.72","$9,827.50",$0.00,"$4,913.75","$7,783.38","$7,862.00",$0.00,"$1,538.00",$0.00,"$1,564.54",$0.00
6276-4-331,SUP,HCPCS C1776,,6276-4-331  -  BODY CALCAR +30MM OFFST 31MM MODULAR RSTOR HIP,"$9,827.50",$0.00,"$9,827.50","$4,422.38","$5,158.80",$0.00,"$1,693.23",$0.00,$0.00,"$1,720.72","$9,827.50",$0.00,"$4,913.75","$7,783.38","$7,862.00",$0.00,"$1,538.00",$0.00,"$1,564.54",$0.00
6276-5-011,SUP,HCPCS C1776,,6276-5-011  -  STEM FEMORAL STR 11MM 127MM MODULAR RSTOR HA POROUS PLASMA,"$7,417.50",$0.00,"$7,417.50","$3,337.88","$5,158.80",$0.00,"$1,278.00",$0.00,$0.00,"$1,298.74","$7,417.50",$0.00,"$3,708.75","$5,874.66","$5,934.00",$0.00,"$1,160.84",$0.00,"$1,180.87",$0.00
6276-5-012,SUP,HCPCS C1776,,6276-5-012  -  STEM FEMORAL STR 12MM 127MM MODULAR RSTOR HA POROUS PLASMA,"$7,417.50",$0.00,"$7,417.50","$3,337.88","$5,158.80",$0.00,"$1,278.00",$0.00,$0.00,"$1,298.74","$7,417.50",$0.00,"$3,708.75","$5,874.66","$5,934.00",$0.00,"$1,160.84",$0.00,"$1,180.87",$0.00
6276-5-013,SUP,HCPCS C1776,,6276-5-013  -  STEM FEMORAL STR 13MM 127MM MODULAR RSTOR HA POROUS PLASMA,"$7,417.50",$0.00,"$7,417.50","$3,337.88","$5,158.80",$0.00,"$1,278.00",$0.00,$0.00,"$1,298.74","$7,417.50",$0.00,"$3,708.75","$5,874.66","$5,934.00",$0.00,"$1,160.84",$0.00,"$1,180.87",$0.00
6276-5-014,SUP,HCPCS C1776,,6276-5-014  -  STEM FEMORAL STR 14MM 127MM MODULAR RSTOR HA POROUS PLASMA,"$7,417.50",$0.00,"$7,417.50","$3,337.88","$5,158.80",$0.00,"$1,278.00",$0.00,$0.00,"$1,298.74","$7,417.50",$0.00,"$3,708.75","$5,874.66","$5,934.00",$0.00,"$1,160.84",$0.00,"$1,180.87",$0.00
6276-5-015,SUP,HCPCS C1776,,6276-5-015  -  STEM FEMORAL STR 15MM 127MM MODULAR RSTOR HA POROUS PLASMA,"$7,417.50",$0.00,"$7,417.50","$3,337.88","$5,158.80",$0.00,"$1,278.00",$0.00,$0.00,"$1,298.74","$7,417.50",$0.00,"$3,708.75","$5,874.66","$5,934.00",$0.00,"$1,160.84",$0.00,"$1,180.87",$0.00
6276-5-016,SUP,HCPCS C1776,,6276-5-016  -  STEM FEMORAL STR 16MM 127MM MODULAR RSTOR HA POROUS PLASMA,"$7,417.50",$0.00,"$7,417.50","$3,337.88","$5,158.80",$0.00,"$1,278.00",$0.00,$0.00,"$1,298.74","$7,417.50",$0.00,"$3,708.75","$5,874.66","$5,934.00",$0.00,"$1,160.84",$0.00,"$1,180.87",$0.00
6276-5-017,SUP,HCPCS C1776,,6276-5-017  -  STEM FEMORAL STR 17MM 127MM MODULAR RSTOR HA POROUS PLASMA,"$7,417.50",$0.00,"$7,417.50","$3,337.88","$5,158.80",$0.00,"$1,278.00",$0.00,$0.00,"$1,298.74","$7,417.50",$0.00,"$3,708.75","$5,874.66","$5,934.00",$0.00,"$1,160.84",$0.00,"$1,180.87",$0.00
6276-5-018,SUP,HCPCS C1776,,6276-5-018  -  STEM FEMORAL STR 18MM 127MM MODULAR RSTOR HA POROUS PLASMA,"$7,417.50",$0.00,"$7,417.50","$3,337.88","$5,158.80",$0.00,"$1,278.00",$0.00,$0.00,"$1,298.74","$7,417.50",$0.00,"$3,708.75","$5,874.66","$5,934.00",$0.00,"$1,160.84",$0.00,"$1,180.87",$0.00
6276-5-019,SUP,HCPCS C1776,,6276-5-019  -  STEM FEMORAL STR 19MM 127MM MODULAR RSTOR HA POROUS PLASMA,"$7,417.50",$0.00,"$7,417.50","$3,337.88","$5,158.80",$0.00,"$1,278.00",$0.00,$0.00,"$1,298.74","$7,417.50",$0.00,"$3,708.75","$5,874.66","$5,934.00",$0.00,"$1,160.84",$0.00,"$1,180.87",$0.00
6276-5-020,SUP,HCPCS C1776,,6276-5-020  -  STEM FEMORAL STR 20MM 127MM MODULAR RSTOR HA POROUS PLASMA,"$7,417.50",$0.00,"$7,417.50","$3,337.88","$5,158.80",$0.00,"$1,278.00",$0.00,$0.00,"$1,298.74","$7,417.50",$0.00,"$3,708.75","$5,874.66","$5,934.00",$0.00,"$1,160.84",$0.00,"$1,180.87",$0.00
6276-5-021,SUP,HCPCS C1776,,6276-5-021  -  STEM FEMORAL STR 21MM 127MM MODULAR RSTOR HA POROUS PLASMA,"$7,417.50",$0.00,"$7,417.50","$3,337.88","$5,158.80",$0.00,"$1,278.00",$0.00,$0.00,"$1,298.74","$7,417.50",$0.00,"$3,708.75","$5,874.66","$5,934.00",$0.00,"$1,160.84",$0.00,"$1,180.87",$0.00
6276-5-022,SUP,HCPCS C1776,,6276-5-022  -  STEM FEMORAL STR 22MM 127MM MODULAR RSTOR HA POROUS PLASMA,"$7,417.50",$0.00,"$7,417.50","$3,337.88","$5,158.80",$0.00,"$1,278.00",$0.00,$0.00,"$1,298.74","$7,417.50",$0.00,"$3,708.75","$5,874.66","$5,934.00",$0.00,"$1,160.84",$0.00,"$1,180.87",$0.00
6276-5-023,SUP,HCPCS C1776,,6276-5-023  -  STEM FEMORAL STR 23MM 127MM MODULAR RSTOR HA POROUS PLASMA,"$7,417.50",$0.00,"$7,417.50","$3,337.88","$5,158.80",$0.00,"$1,278.00",$0.00,$0.00,"$1,298.74","$7,417.50",$0.00,"$3,708.75","$5,874.66","$5,934.00",$0.00,"$1,160.84",$0.00,"$1,180.87",$0.00
6276-5-024,SUP,HCPCS C1776,,6276-5-024  -  STEM FEMORAL STR 24MM 127MM MODULAR RSTOR HA POROUS PLASMA,"$7,417.50",$0.00,"$7,417.50","$3,337.88","$5,158.80",$0.00,"$1,278.00",$0.00,$0.00,"$1,298.74","$7,417.50",$0.00,"$3,708.75","$5,874.66","$5,934.00",$0.00,"$1,160.84",$0.00,"$1,180.87",$0.00
6276-5-025,SUP,HCPCS C1776,,6276-5-025  -  STEM FEMORAL STR 25MM 127MM MODULAR RSTOR HA POROUS PLASMA,"$7,417.50",$0.00,"$7,417.50","$3,337.88","$5,158.80",$0.00,"$1,278.00",$0.00,$0.00,"$1,298.74","$7,417.50",$0.00,"$3,708.75","$5,874.66","$5,934.00",$0.00,"$1,160.84",$0.00,"$1,180.87",$0.00
6276-5-026,SUP,HCPCS C1776,,6276-5-026  -  STEM FEMORAL STR 26MM 127MM MODULAR RSTOR HA POROUS PLASMA,"$7,417.50",$0.00,"$7,417.50","$3,337.88","$5,158.80",$0.00,"$1,278.00",$0.00,$0.00,"$1,298.74","$7,417.50",$0.00,"$3,708.75","$5,874.66","$5,934.00",$0.00,"$1,160.84",$0.00,"$1,180.87",$0.00
6276-5-111,SUP,HCPCS C1776,,6276-5-111  -  STEM FEMORAL 11MM 167MM MODULAR STR PLASMA RSTOR DISTAL,"$7,417.50",$0.00,"$7,417.50","$3,337.88","$5,158.80",$0.00,"$1,278.00",$0.00,$0.00,"$1,298.74","$7,417.50",$0.00,"$3,708.75","$5,874.66","$5,934.00",$0.00,"$1,160.84",$0.00,"$1,180.87",$0.00
6276-5-112,SUP,HCPCS C1776,,6276-5-112  -  STEM FEMORAL STR 12MM 167MM MODULAR RSTOR HA POROUS PLASMA,"$7,417.50",$0.00,"$7,417.50","$3,337.88","$5,158.80",$0.00,"$1,278.00",$0.00,$0.00,"$1,298.74","$7,417.50",$0.00,"$3,708.75","$5,874.66","$5,934.00",$0.00,"$1,160.84",$0.00,"$1,180.87",$0.00
6276-5-113,SUP,HCPCS C1776,,6276-5-113  -  STEM FEMORAL STR 13MM 167MM MODULAR RSTOR HA POROUS PLASMA,"$7,417.50",$0.00,"$7,417.50","$3,337.88","$5,158.80",$0.00,"$1,278.00",$0.00,$0.00,"$1,298.74","$7,417.50",$0.00,"$3,708.75","$5,874.66","$5,934.00",$0.00,"$1,160.84",$0.00,"$1,180.87",$0.00
6276-5-114,SUP,HCPCS C1776,,6276-5-114  -  STEM FEMORAL STR 14MM 167MM MODULAR RSTOR HA POROUS PLASMA,"$7,417.50",$0.00,"$7,417.50","$3,337.88","$5,158.80",$0.00,"$1,278.00",$0.00,$0.00,"$1,298.74","$7,417.50",$0.00,"$3,708.75","$5,874.66","$5,934.00",$0.00,"$1,160.84",$0.00,"$1,180.87",$0.00
6276-5-115,SUP,HCPCS C1776,,6276-5-115  -  STEM FEMORAL STR 15MM 167MM MODULAR RSTOR HA POROUS PLASMA,"$7,417.50",$0.00,"$7,417.50","$3,337.88","$5,158.80",$0.00,"$1,278.00",$0.00,$0.00,"$1,298.74","$7,417.50",$0.00,"$3,708.75","$5,874.66","$5,934.00",$0.00,"$1,160.84",$0.00,"$1,180.87",$0.00
6276-5-116,SUP,HCPCS C1776,,6276-5-116  -  STEM FEMORAL STR 16MM 167MM MODULAR RSTOR HA POROUS PLASMA,"$7,417.50",$0.00,"$7,417.50","$3,337.88","$5,158.80",$0.00,"$1,278.00",$0.00,$0.00,"$1,298.74","$7,417.50",$0.00,"$3,708.75","$5,874.66","$5,934.00",$0.00,"$1,160.84",$0.00,"$1,180.87",$0.00
6276-5-117,SUP,HCPCS C1776,,6276-5-117  -  STEM FEMORAL STR 17MM 167MM MODULAR RSTOR HA POROUS PLASMA,"$7,417.50",$0.00,"$7,417.50","$3,337.88","$5,158.80",$0.00,"$1,278.00",$0.00,$0.00,"$1,298.74","$7,417.50",$0.00,"$3,708.75","$5,874.66","$5,934.00",$0.00,"$1,160.84",$0.00,"$1,180.87",$0.00
6276-5-118,SUP,HCPCS C1776,,6276-5-118  -  STEM FEMORAL STR 18MM 167MM MODULAR RSTOR HA POROUS PLASMA,"$7,417.50",$0.00,"$7,417.50","$3,337.88","$5,158.80",$0.00,"$1,278.00",$0.00,$0.00,"$1,298.74","$7,417.50",$0.00,"$3,708.75","$5,874.66","$5,934.00",$0.00,"$1,160.84",$0.00,"$1,180.87",$0.00
6276-5-119,SUP,HCPCS C1776,,6276-5-119  -  STEM FEMORAL STR 19MM 167MM MODULAR RSTOR HA POROUS PLASMA,"$7,417.50",$0.00,"$7,417.50","$3,337.88","$5,158.80",$0.00,"$1,278.00",$0.00,$0.00,"$1,298.74","$7,417.50",$0.00,"$3,708.75","$5,874.66","$5,934.00",$0.00,"$1,160.84",$0.00,"$1,180.87",$0.00
6276-5-120,SUP,HCPCS C1776,,6276-5-120  -  STEM FEMORAL STR 20MM 167MM MODULAR RSTOR HA POROUS PLASMA,"$7,417.50",$0.00,"$7,417.50","$3,337.88","$5,158.80",$0.00,"$1,278.00",$0.00,$0.00,"$1,298.74","$7,417.50",$0.00,"$3,708.75","$5,874.66","$5,934.00",$0.00,"$1,160.84",$0.00,"$1,180.87",$0.00
6276-5-121,SUP,HCPCS C1776,,6276-5-121  -  STEM FEMORAL STR 21MM 167MM MODULAR RSTOR HA POROUS PLASMA,"$7,417.50",$0.00,"$7,417.50","$3,337.88","$5,158.80",$0.00,"$1,278.00",$0.00,$0.00,"$1,298.74","$7,417.50",$0.00,"$3,708.75","$5,874.66","$5,934.00",$0.00,"$1,160.84",$0.00,"$1,180.87",$0.00
6276-5-122,SUP,HCPCS C1776,,6276-5-122  -  STEM FEMORAL STR 22MM 167MM MODULAR RSTOR HA POROUS PLASMA,"$7,417.50",$0.00,"$7,417.50","$3,337.88","$5,158.80",$0.00,"$1,278.00",$0.00,$0.00,"$1,298.74","$7,417.50",$0.00,"$3,708.75","$5,874.66","$5,934.00",$0.00,"$1,160.84",$0.00,"$1,180.87",$0.00
6276-5-123,SUP,HCPCS C1776,,6276-5-123  -  STEM FEMORAL STR 23MM 167MM MODULAR RSTOR HA POROUS PLASMA,"$7,417.50",$0.00,"$7,417.50","$3,337.88","$5,158.80",$0.00,"$1,278.00",$0.00,$0.00,"$1,298.74","$7,417.50",$0.00,"$3,708.75","$5,874.66","$5,934.00",$0.00,"$1,160.84",$0.00,"$1,180.87",$0.00
6276-5-124,SUP,HCPCS C1776,,6276-5-124  -  STEM FEMORAL STR 24MM 167MM MODULAR RSTOR HA POROUS PLASMA,"$7,417.50",$0.00,"$7,417.50","$3,337.88","$5,158.80",$0.00,"$1,278.00",$0.00,$0.00,"$1,298.74","$7,417.50",$0.00,"$3,708.75","$5,874.66","$5,934.00",$0.00,"$1,160.84",$0.00,"$1,180.87",$0.00
6276-5-125,SUP,HCPCS C1776,,6276-5-125  -  STEM FEMORAL STR 25MM 167MM MODULAR RSTOR HA POROUS PLASMA,"$7,417.50",$0.00,"$7,417.50","$3,337.88","$5,158.80",$0.00,"$1,278.00",$0.00,$0.00,"$1,298.74","$7,417.50",$0.00,"$3,708.75","$5,874.66","$5,934.00",$0.00,"$1,160.84",$0.00,"$1,180.87",$0.00
6276-5-126,SUP,HCPCS C1776,,6276-5-126  -  STEM FEMORAL STR 26MM 167MM MODULAR RSTOR HA POROUS PLASMA,"$7,417.50",$0.00,"$7,417.50","$3,337.88","$5,158.80",$0.00,"$1,278.00",$0.00,$0.00,"$1,298.74","$7,417.50",$0.00,"$3,708.75","$5,874.66","$5,934.00",$0.00,"$1,160.84",$0.00,"$1,180.87",$0.00
6276-5-211,SUP,HCPCS C1776,,6276-5-211  -  STEM FEMORAL BOWED 11MM 167MM MODULAR PLASMA SPRAYED RSTOR,"$8,420.00",$0.00,"$8,420.00","$3,789.00","$5,158.80",$0.00,"$1,450.72",$0.00,$0.00,"$1,474.27","$8,420.00",$0.00,"$4,210.00","$6,668.64","$6,736.00",$0.00,"$1,317.73",$0.00,"$1,340.46",$0.00
6276-5-212,SUP,HCPCS C1776,,6276-5-212  -  STEM FEMORAL BOWED 12MM 167MM MODULAR PLASMA SPRAYED RSTOR,"$8,420.00",$0.00,"$8,420.00","$3,789.00","$5,158.80",$0.00,"$1,450.72",$0.00,$0.00,"$1,474.27","$8,420.00",$0.00,"$4,210.00","$6,668.64","$6,736.00",$0.00,"$1,317.73",$0.00,"$1,340.46",$0.00
6276-5-213,SUP,HCPCS C1776,,6276-5-213  -  STEM FEMORAL BOWED 13MM 167MM MODULAR PLASMA SPRAYED RSTOR,"$8,420.00",$0.00,"$8,420.00","$3,789.00","$5,158.80",$0.00,"$1,450.72",$0.00,$0.00,"$1,474.27","$8,420.00",$0.00,"$4,210.00","$6,668.64","$6,736.00",$0.00,"$1,317.73",$0.00,"$1,340.46",$0.00
6276-5-214,SUP,HCPCS C1776,,6276-5-214  -  STEM FEMORAL BOWED 14MM 167MM MODULAR PLASMA SPRAYED RSTOR,"$8,420.00",$0.00,"$8,420.00","$3,789.00","$5,158.80",$0.00,"$1,450.72",$0.00,$0.00,"$1,474.27","$8,420.00",$0.00,"$4,210.00","$6,668.64","$6,736.00",$0.00,"$1,317.73",$0.00,"$1,340.46",$0.00
6276-5-215,SUP,HCPCS C1776,,6276-5-215  -  STEM FEMORAL BOWED 15MM 167MM MODULAR PLASMA SPRAYED RSTOR,"$8,420.00",$0.00,"$8,420.00","$3,789.00","$5,158.80",$0.00,"$1,450.72",$0.00,$0.00,"$1,474.27","$8,420.00",$0.00,"$4,210.00","$6,668.64","$6,736.00",$0.00,"$1,317.73",$0.00,"$1,340.46",$0.00
6276-5-216,SUP,HCPCS C1776,,6276-5-216  -  STEM FEMORAL BOWED 16MM 167MM MODULAR PLASMA SPRAYED RSTOR,"$8,420.00",$0.00,"$8,420.00","$3,789.00","$5,158.80",$0.00,"$1,450.72",$0.00,$0.00,"$1,474.27","$8,420.00",$0.00,"$4,210.00","$6,668.64","$6,736.00",$0.00,"$1,317.73",$0.00,"$1,340.46",$0.00
6276-5-217,SUP,HCPCS C1776,,6276-5-217  -  STEM FEMORAL BOWED 17MM 167MM MODULAR PLASMA SPRAYED RSTOR,"$8,420.00",$0.00,"$8,420.00","$3,789.00","$5,158.80",$0.00,"$1,450.72",$0.00,$0.00,"$1,474.27","$8,420.00",$0.00,"$4,210.00","$6,668.64","$6,736.00",$0.00,"$1,317.73",$0.00,"$1,340.46",$0.00
6276-5-218,SUP,HCPCS C1776,,6276-5-218  -  STEM FEMORAL BOWED 18MM 167MM MODULAR PLASMA SPRAYED RSTOR,"$8,420.00",$0.00,"$8,420.00","$3,789.00","$5,158.80",$0.00,"$1,450.72",$0.00,$0.00,"$1,474.27","$8,420.00",$0.00,"$4,210.00","$6,668.64","$6,736.00",$0.00,"$1,317.73",$0.00,"$1,340.46",$0.00
6276-5-219,SUP,HCPCS C1776,,6276-5-219  -  STEM FEMORAL BOWED 19MM 167MM MODULAR PLASMA SPRAYED RSTOR,"$8,420.00",$0.00,"$8,420.00","$3,789.00","$5,158.80",$0.00,"$1,450.72",$0.00,$0.00,"$1,474.27","$8,420.00",$0.00,"$4,210.00","$6,668.64","$6,736.00",$0.00,"$1,317.73",$0.00,"$1,340.46",$0.00
6276-5-220,SUP,HCPCS C1776,,6276-5-220  -  STEM FEMORAL BOWED 20MM 167MM MODULAR PLASMA SPRAYED RSTOR,"$8,420.00",$0.00,"$8,420.00","$3,789.00","$5,158.80",$0.00,"$1,450.72",$0.00,$0.00,"$1,474.27","$8,420.00",$0.00,"$4,210.00","$6,668.64","$6,736.00",$0.00,"$1,317.73",$0.00,"$1,340.46",$0.00
6276-5-221,SUP,HCPCS C1776,,6276-5-221  -  STEM FEMORAL BOWED 21MM 167MM MODULAR PLASMA SPRAYED RSTOR,"$8,420.00",$0.00,"$8,420.00","$3,789.00","$5,158.80",$0.00,"$1,450.72",$0.00,$0.00,"$1,474.27","$8,420.00",$0.00,"$4,210.00","$6,668.64","$6,736.00",$0.00,"$1,317.73",$0.00,"$1,340.46",$0.00
6276-5-222,SUP,HCPCS C1776,,6276-5-222  -  STEM FEMORAL BOWED 22MM 167MM MODULAR PLASMA SPRAYED RSTOR,"$8,420.00",$0.00,"$8,420.00","$3,789.00","$5,158.80",$0.00,"$1,450.72",$0.00,$0.00,"$1,474.27","$8,420.00",$0.00,"$4,210.00","$6,668.64","$6,736.00",$0.00,"$1,317.73",$0.00,"$1,340.46",$0.00
6276-5-223,SUP,HCPCS C1776,,6276-5-223  -  STEM FEMORAL BOWED 23MM 167MM MODULAR PLASMA SPRAYED RSTOR,"$8,420.00",$0.00,"$8,420.00","$3,789.00","$5,158.80",$0.00,"$1,450.72",$0.00,$0.00,"$1,474.27","$8,420.00",$0.00,"$4,210.00","$6,668.64","$6,736.00",$0.00,"$1,317.73",$0.00,"$1,340.46",$0.00
6276-5-224,SUP,HCPCS C1776,,6276-5-224  -  STEM FEMORAL BOWED 24MM 167MM MODULAR PLASMA SPRAYED RSTOR,"$8,420.00",$0.00,"$8,420.00","$3,789.00","$5,158.80",$0.00,"$1,450.72",$0.00,$0.00,"$1,474.27","$8,420.00",$0.00,"$4,210.00","$6,668.64","$6,736.00",$0.00,"$1,317.73",$0.00,"$1,340.46",$0.00
6276-5-225,SUP,HCPCS C1776,,6276-5-225  -  STEM FEMORAL BOWED 25MM 167MM MODULAR PLASMA SPRAYED RSTOR,"$8,420.00",$0.00,"$8,420.00","$3,789.00","$5,158.80",$0.00,"$1,450.72",$0.00,$0.00,"$1,474.27","$8,420.00",$0.00,"$4,210.00","$6,668.64","$6,736.00",$0.00,"$1,317.73",$0.00,"$1,340.46",$0.00
6276-5-226,SUP,HCPCS C1776,,6276-5-226  -  STEM FEMORAL BOWED 26MM 167MM MODULAR PLASMA SPRAYED RSTOR,"$8,420.00",$0.00,"$8,420.00","$3,789.00","$5,158.80",$0.00,"$1,450.72",$0.00,$0.00,"$1,474.27","$8,420.00",$0.00,"$4,210.00","$6,668.64","$6,736.00",$0.00,"$1,317.73",$0.00,"$1,340.46",$0.00
6276-5-411,SUP,HCPCS C1776,,6276-5-411  -  STEM FEMORAL BOWED 11MM 217MM MODULAR PLASMA SPRAYED RSTOR,"$8,420.00",$0.00,"$8,420.00","$3,789.00","$5,158.80",$0.00,"$1,450.72",$0.00,$0.00,"$1,474.27","$8,420.00",$0.00,"$4,210.00","$6,668.64","$6,736.00",$0.00,"$1,317.73",$0.00,"$1,340.46",$0.00
6276-5-412,SUP,HCPCS C1776,,6276-5-412  -  STEM FEMORAL BOWED 12MM 217MM MODULAR PLASMA SPRAYED RSTOR,"$8,420.00",$0.00,"$8,420.00","$3,789.00","$5,158.80",$0.00,"$1,450.72",$0.00,$0.00,"$1,474.27","$8,420.00",$0.00,"$4,210.00","$6,668.64","$6,736.00",$0.00,"$1,317.73",$0.00,"$1,340.46",$0.00
6276-5-413,SUP,HCPCS C1776,,6276-5-413  -  STEM FEMORAL BOWED 13MM 217MM MODULAR PLASMA SPRAYED RSTOR,"$8,420.00",$0.00,"$8,420.00","$3,789.00","$5,158.80",$0.00,"$1,450.72",$0.00,$0.00,"$1,474.27","$8,420.00",$0.00,"$4,210.00","$6,668.64","$6,736.00",$0.00,"$1,317.73",$0.00,"$1,340.46",$0.00
6276-5-414,SUP,HCPCS C1776,,6276-5-414  -  STEM FEMORAL BOWED 14MM 217MM MODULAR PLASMA SPRAYED RSTOR,"$8,420.00",$0.00,"$8,420.00","$3,789.00","$5,158.80",$0.00,"$1,450.72",$0.00,$0.00,"$1,474.27","$8,420.00",$0.00,"$4,210.00","$6,668.64","$6,736.00",$0.00,"$1,317.73",$0.00,"$1,340.46",$0.00
6276-5-415,SUP,HCPCS C1776,,6276-5-415  -  STEM FEMORAL BOWED 15MM 217MM MODULAR PLASMA SPRAYED RSTOR,"$8,420.00",$0.00,"$8,420.00","$3,789.00","$5,158.80",$0.00,"$1,450.72",$0.00,$0.00,"$1,474.27","$8,420.00",$0.00,"$4,210.00","$6,668.64","$6,736.00",$0.00,"$1,317.73",$0.00,"$1,340.46",$0.00
6276-5-416,SUP,HCPCS C1776,,6276-5-416  -  STEM FEMORAL BOWED 16MM 217MM MODULAR PLASMA SPRAYED RSTOR,"$8,420.00",$0.00,"$8,420.00","$3,789.00","$5,158.80",$0.00,"$1,450.72",$0.00,$0.00,"$1,474.27","$8,420.00",$0.00,"$4,210.00","$6,668.64","$6,736.00",$0.00,"$1,317.73",$0.00,"$1,340.46",$0.00
6276-5-417,SUP,HCPCS C1776,,6276-5-417  -  STEM FEMORAL BOWED 17MM 217MM MODULAR PLASMA SPRAYED RSTOR,"$8,420.00",$0.00,"$8,420.00","$3,789.00","$5,158.80",$0.00,"$1,450.72",$0.00,$0.00,"$1,474.27","$8,420.00",$0.00,"$4,210.00","$6,668.64","$6,736.00",$0.00,"$1,317.73",$0.00,"$1,340.46",$0.00
6276-5-418,SUP,HCPCS C1776,,6276-5-418  -  STEM FEMORAL BOWED 18MM 217MM MODULAR PLASMA SPRAYED RSTOR,"$8,420.00",$0.00,"$8,420.00","$3,789.00","$5,158.80",$0.00,"$1,450.72",$0.00,$0.00,"$1,474.27","$8,420.00",$0.00,"$4,210.00","$6,668.64","$6,736.00",$0.00,"$1,317.73",$0.00,"$1,340.46",$0.00
6276-5-419,SUP,HCPCS C1776,,6276-5-419  -  STEM FEMORAL BOWED 19MM 217MM MODULAR PLASMA SPRAYED RSTOR,"$8,420.00",$0.00,"$8,420.00","$3,789.00","$5,158.80",$0.00,"$1,450.72",$0.00,$0.00,"$1,474.27","$8,420.00",$0.00,"$4,210.00","$6,668.64","$6,736.00",$0.00,"$1,317.73",$0.00,"$1,340.46",$0.00
6276-5-420,SUP,HCPCS C1776,,6276-5-420  -  STEM FEMORAL BOWED 20MM 217MM MODULAR PLASMA SPRAYED RSTOR,"$8,420.00",$0.00,"$8,420.00","$3,789.00","$5,158.80",$0.00,"$1,450.72",$0.00,$0.00,"$1,474.27","$8,420.00",$0.00,"$4,210.00","$6,668.64","$6,736.00",$0.00,"$1,317.73",$0.00,"$1,340.46",$0.00
6276-5-421,SUP,HCPCS C1776,,6276-5-421  -  STEM FEMORAL BOWED 21MM 217MM MODULAR PLASMA SPRAYED RSTOR,"$8,420.00",$0.00,"$8,420.00","$3,789.00","$5,158.80",$0.00,"$1,450.72",$0.00,$0.00,"$1,474.27","$8,420.00",$0.00,"$4,210.00","$6,668.64","$6,736.00",$0.00,"$1,317.73",$0.00,"$1,340.46",$0.00
6276-5-422,SUP,HCPCS C1776,,6276-5-422  -  STEM FEMORAL BOWED 22MM 217MM MODULAR PLASMA SPRAYED RSTOR,"$8,420.00",$0.00,"$8,420.00","$3,789.00","$5,158.80",$0.00,"$1,450.72",$0.00,$0.00,"$1,474.27","$8,420.00",$0.00,"$4,210.00","$6,668.64","$6,736.00",$0.00,"$1,317.73",$0.00,"$1,340.46",$0.00
6276-5-423,SUP,HCPCS C1776,,6276-5-423  -  STEM FEMORAL BOWED 23MM 217MM MODULAR PLASMA SPRAYED RSTOR,"$8,420.00",$0.00,"$8,420.00","$3,789.00","$5,158.80",$0.00,"$1,450.72",$0.00,$0.00,"$1,474.27","$8,420.00",$0.00,"$4,210.00","$6,668.64","$6,736.00",$0.00,"$1,317.73",$0.00,"$1,340.46",$0.00
6276-5-424,SUP,HCPCS C1776,,6276-5-424  -  STEM FEMORAL BOWED 24MM 217MM MODULAR PLASMA SPRAYED RSTOR,"$8,420.00",$0.00,"$8,420.00","$3,789.00","$5,158.80",$0.00,"$1,450.72",$0.00,$0.00,"$1,474.27","$8,420.00",$0.00,"$4,210.00","$6,668.64","$6,736.00",$0.00,"$1,317.73",$0.00,"$1,340.46",$0.00
6276-5-425,SUP,HCPCS C1776,,6276-5-425  -  STEM FEMORAL BOWED 25MM 217MM MODULAR PLASMA SPRAYED RSTOR,"$8,420.00",$0.00,"$8,420.00","$3,789.00","$5,158.80",$0.00,"$1,450.72",$0.00,$0.00,"$1,474.27","$8,420.00",$0.00,"$4,210.00","$6,668.64","$6,736.00",$0.00,"$1,317.73",$0.00,"$1,340.46",$0.00
6276-5-426,SUP,HCPCS C1776,,6276-5-426  -  STEM FEMORAL BOWED 26MM 217MM MODULAR PLASMA SPRAYED RSTOR,"$8,420.00",$0.00,"$8,420.00","$3,789.00","$5,158.80",$0.00,"$1,450.72",$0.00,$0.00,"$1,474.27","$8,420.00",$0.00,"$4,210.00","$6,668.64","$6,736.00",$0.00,"$1,317.73",$0.00,"$1,340.46",$0.00
6276-5-511,SUP,HCPCS C1776,,6276-5-511  -  STEM FEMORAL 11MM 267MM BOWED PLASMA REVISION MODULAR RSTOR,"$8,420.00",$0.00,"$8,420.00","$3,789.00","$5,158.80",$0.00,"$1,450.72",$0.00,$0.00,"$1,474.27","$8,420.00",$0.00,"$4,210.00","$6,668.64","$6,736.00",$0.00,"$1,317.73",$0.00,"$1,340.46",$0.00
6276-5-512,SUP,HCPCS C1776,,6276-5-512  -  STEM FEMORAL 12MM 267MM MODULAR BOWED PLASMA RSTOR DISTAL,"$8,420.00",$0.00,"$8,420.00","$3,789.00","$5,158.80",$0.00,"$1,450.72",$0.00,$0.00,"$1,474.27","$8,420.00",$0.00,"$4,210.00","$6,668.64","$6,736.00",$0.00,"$1,317.73",$0.00,"$1,340.46",$0.00
6276-5-513,SUP,HCPCS C1776,,6276-5-513  -  STEM FEMORAL 13MM 267MM BOWED PLASMA REVISION MODULAR RSTOR,"$8,420.00",$0.00,"$8,420.00","$3,789.00","$5,158.80",$0.00,"$1,450.72",$0.00,$0.00,"$1,474.27","$8,420.00",$0.00,"$4,210.00","$6,668.64","$6,736.00",$0.00,"$1,317.73",$0.00,"$1,340.46",$0.00
6276-5-514,SUP,HCPCS C1776,,6276-5-514  -  STEM FEMORAL 14MM 267MM BOWED PLASMA REVISION MODULAR RSTOR,"$8,420.00",$0.00,"$8,420.00","$3,789.00","$5,158.80",$0.00,"$1,450.72",$0.00,$0.00,"$1,474.27","$8,420.00",$0.00,"$4,210.00","$6,668.64","$6,736.00",$0.00,"$1,317.73",$0.00,"$1,340.46",$0.00
6276-5-515,SUP,HCPCS C1776,,6276-5-515  -  STEM FEMORAL 15MM 267MM BOWED PLASMA REVISION MODULAR RSTOR,"$8,420.00",$0.00,"$8,420.00","$3,789.00","$5,158.80",$0.00,"$1,450.72",$0.00,$0.00,"$1,474.27","$8,420.00",$0.00,"$4,210.00","$6,668.64","$6,736.00",$0.00,"$1,317.73",$0.00,"$1,340.46",$0.00
6276-5-516,SUP,HCPCS C1776,,6276-5-516  -  STEM FEMORAL 16MM 267MM BOWED PLASMA REVISION MODULAR RSTOR,"$8,420.00",$0.00,"$8,420.00","$3,789.00","$5,158.80",$0.00,"$1,450.72",$0.00,$0.00,"$1,474.27","$8,420.00",$0.00,"$4,210.00","$6,668.64","$6,736.00",$0.00,"$1,317.73",$0.00,"$1,340.46",$0.00
6276-5-517,SUP,HCPCS C1776,,6276-5-517  -  STEM FEMORAL 17MM 267MM BOWED PLASMA REVISION MODULAR RSTOR,"$8,420.00",$0.00,"$8,420.00","$3,789.00","$5,158.80",$0.00,"$1,450.72",$0.00,$0.00,"$1,474.27","$8,420.00",$0.00,"$4,210.00","$6,668.64","$6,736.00",$0.00,"$1,317.73",$0.00,"$1,340.46",$0.00
6276-5-518,SUP,HCPCS C1776,,6276-5-518  -  STEM FEMORAL 18MM 267MM BOWED PLASMA MODULAR RSTOR DISTAL,"$8,420.00",$0.00,"$8,420.00","$3,789.00","$5,158.80",$0.00,"$1,450.72",$0.00,$0.00,"$1,474.27","$8,420.00",$0.00,"$4,210.00","$6,668.64","$6,736.00",$0.00,"$1,317.73",$0.00,"$1,340.46",$0.00
6276-5-519,SUP,HCPCS C1776,,6276-5-519  -  STEM FEMORAL 19MM 267MM BOWED PLASMA MODULAR REVISION RSTOR,"$8,420.00",$0.00,"$8,420.00","$3,789.00","$5,158.80",$0.00,"$1,450.72",$0.00,$0.00,"$1,474.27","$8,420.00",$0.00,"$4,210.00","$6,668.64","$6,736.00",$0.00,"$1,317.73",$0.00,"$1,340.46",$0.00
6276-5-520,SUP,HCPCS C1776,,6276-5-520  -  STEM FEMORAL 20MM 267MM BOWED PLASMA MODULAR RSTOR DISTAL,"$8,420.00",$0.00,"$8,420.00","$3,789.00","$5,158.80",$0.00,"$1,450.72",$0.00,$0.00,"$1,474.27","$8,420.00",$0.00,"$4,210.00","$6,668.64","$6,736.00",$0.00,"$1,317.73",$0.00,"$1,340.46",$0.00
6276-5-521,SUP,HCPCS C1776,,6276-5-521  -  STEM FEMORAL 21MM 267MM BOWED PLASMA MODULAR REVISION RSTOR,"$8,420.00",$0.00,"$8,420.00","$3,789.00","$5,158.80",$0.00,"$1,450.72",$0.00,$0.00,"$1,474.27","$8,420.00",$0.00,"$4,210.00","$6,668.64","$6,736.00",$0.00,"$1,317.73",$0.00,"$1,340.46",$0.00
6276-5-522,SUP,HCPCS C1776,,6276-5-522  -  STEM FEMORAL 22MM 267MM BOWED PLASMA MODULAR REVISION RSTOR,"$8,420.00",$0.00,"$8,420.00","$3,789.00","$5,158.80",$0.00,"$1,450.72",$0.00,$0.00,"$1,474.27","$8,420.00",$0.00,"$4,210.00","$6,668.64","$6,736.00",$0.00,"$1,317.73",$0.00,"$1,340.46",$0.00
6276-5-523,SUP,HCPCS C1776,,6276-5-523  -  STEM FEMORAL 23MM 267MM BOWED PLASMA MODULAR REVISION RSTOR,"$8,420.00",$0.00,"$8,420.00","$3,789.00","$5,158.80",$0.00,"$1,450.72",$0.00,$0.00,"$1,474.27","$8,420.00",$0.00,"$4,210.00","$6,668.64","$6,736.00",$0.00,"$1,317.73",$0.00,"$1,340.46",$0.00
6276-5-524,SUP,HCPCS C1776,,6276-5-524  -  STEM FEMORAL 24MM 267MM BOWED PLASMA MODULAR REVISION RSTOR,"$8,420.00",$0.00,"$8,420.00","$3,789.00","$5,158.80",$0.00,"$1,450.72",$0.00,$0.00,"$1,474.27","$8,420.00",$0.00,"$4,210.00","$6,668.64","$6,736.00",$0.00,"$1,317.73",$0.00,"$1,340.46",$0.00
6276-5-525,SUP,HCPCS C1776,,6276-5-525  -  STEM FEMORAL 25MM 267MM BOWED PLASMA MODULAR REVISION RSTOR,"$8,420.00",$0.00,"$8,420.00","$3,789.00","$5,158.80",$0.00,"$1,450.72",$0.00,$0.00,"$1,474.27","$8,420.00",$0.00,"$4,210.00","$6,668.64","$6,736.00",$0.00,"$1,317.73",$0.00,"$1,340.46",$0.00
6276-5-526,SUP,HCPCS C1776,,6276-5-526  -  STEM FEMORAL 26MM 267MM BOWED PLASMA MODULAR REVISION RSTOR,"$8,420.00",$0.00,"$8,420.00","$3,789.00","$5,158.80",$0.00,"$1,450.72",$0.00,$0.00,"$1,474.27","$8,420.00",$0.00,"$4,210.00","$6,668.64","$6,736.00",$0.00,"$1,317.73",$0.00,"$1,340.46",$0.00
6276-5-611,SUP,HCPCS C1776,,6276-5-611  -  STEM FEMORAL 11MM 317MM BOWED PLASMA MODULAR REVISION RSTOR,"$8,420.00",$0.00,"$8,420.00","$3,789.00","$5,158.80",$0.00,"$1,450.72",$0.00,$0.00,"$1,474.27","$8,420.00",$0.00,"$4,210.00","$6,668.64","$6,736.00",$0.00,"$1,317.73",$0.00,"$1,340.46",$0.00
6276-5-612,SUP,HCPCS C1776,,6276-5-612  -  STEM FEMORAL 12MM 317MM BOWED PLASMA MODULAR REVISION RSTOR,"$8,420.00",$0.00,"$8,420.00","$3,789.00","$5,158.80",$0.00,"$1,450.72",$0.00,$0.00,"$1,474.27","$8,420.00",$0.00,"$4,210.00","$6,668.64","$6,736.00",$0.00,"$1,317.73",$0.00,"$1,340.46",$0.00
6276-5-613,SUP,HCPCS C1776,,6276-5-613  -  STEM FEMORAL 13MM 317MM BOWED PLASMA MODULAR REVISION RSTOR,"$8,420.00",$0.00,"$8,420.00","$3,789.00","$5,158.80",$0.00,"$1,450.72",$0.00,$0.00,"$1,474.27","$8,420.00",$0.00,"$4,210.00","$6,668.64","$6,736.00",$0.00,"$1,317.73",$0.00,"$1,340.46",$0.00
6276-5-614,SUP,HCPCS C1776,,6276-5-614  -  STEM FEMORAL 14MM 317MM BOWED PLASMA MODULAR REVISION RSTOR,"$8,420.00",$0.00,"$8,420.00","$3,789.00","$5,158.80",$0.00,"$1,450.72",$0.00,$0.00,"$1,474.27","$8,420.00",$0.00,"$4,210.00","$6,668.64","$6,736.00",$0.00,"$1,317.73",$0.00,"$1,340.46",$0.00
6276-5-615,SUP,HCPCS C1776,,6276-5-615  -  STEM FEMORAL 15MM 317MM BOWED PLASMA MODULAR REVISION RSTOR,"$8,420.00",$0.00,"$8,420.00","$3,789.00","$5,158.80",$0.00,"$1,450.72",$0.00,$0.00,"$1,474.27","$8,420.00",$0.00,"$4,210.00","$6,668.64","$6,736.00",$0.00,"$1,317.73",$0.00,"$1,340.46",$0.00
6276-5-616,SUP,HCPCS C1776,,6276-5-616  -  STEM FEMORAL 16MM 317MM BOWED PLASMA MODULAR REVISION RSTOR,"$8,420.00",$0.00,"$8,420.00","$3,789.00","$5,158.80",$0.00,"$1,450.72",$0.00,$0.00,"$1,474.27","$8,420.00",$0.00,"$4,210.00","$6,668.64","$6,736.00",$0.00,"$1,317.73",$0.00,"$1,340.46",$0.00
6276-5-617,SUP,HCPCS C1776,,6276-5-617  -  STEM FEMORAL 17MM 317MM BOWED PLASMA MODULAR REVISION RSTOR,"$8,420.00",$0.00,"$8,420.00","$3,789.00","$5,158.80",$0.00,"$1,450.72",$0.00,$0.00,"$1,474.27","$8,420.00",$0.00,"$4,210.00","$6,668.64","$6,736.00",$0.00,"$1,317.73",$0.00,"$1,340.46",$0.00
6276-5-618,SUP,HCPCS C1776,,6276-5-618  -  STEM FEMORAL 18MM 317MM BOWED PLASMA MODULAR REVISION RSTOR,"$8,420.00",$0.00,"$8,420.00","$3,789.00","$5,158.80",$0.00,"$1,450.72",$0.00,$0.00,"$1,474.27","$8,420.00",$0.00,"$4,210.00","$6,668.64","$6,736.00",$0.00,"$1,317.73",$0.00,"$1,340.46",$0.00
6276-5-619,SUP,HCPCS C1776,,6276-5-619  -  STEM FEMORAL 19MM 317MM BOWED PLASMA MODULAR REVISION RSTOR,"$8,420.00",$0.00,"$8,420.00","$3,789.00","$5,158.80",$0.00,"$1,450.72",$0.00,$0.00,"$1,474.27","$8,420.00",$0.00,"$4,210.00","$6,668.64","$6,736.00",$0.00,"$1,317.73",$0.00,"$1,340.46",$0.00
6276-5-620,SUP,HCPCS C1776,,6276-5-620  -  STEM FEMORAL 20MM 317MM BOWED PLASMA MODULAR REVISION RSTOR,"$8,420.00",$0.00,"$8,420.00","$3,789.00","$5,158.80",$0.00,"$1,450.72",$0.00,$0.00,"$1,474.27","$8,420.00",$0.00,"$4,210.00","$6,668.64","$6,736.00",$0.00,"$1,317.73",$0.00,"$1,340.46",$0.00
6276-5-621,SUP,HCPCS C1776,,6276-5-621  -  STEM FEMORAL 21MM 317MM BOWED PLASMA MODULAR REVISION RSTOR,"$8,420.00",$0.00,"$8,420.00","$3,789.00","$5,158.80",$0.00,"$1,450.72",$0.00,$0.00,"$1,474.27","$8,420.00",$0.00,"$4,210.00","$6,668.64","$6,736.00",$0.00,"$1,317.73",$0.00,"$1,340.46",$0.00
6276-5-622,SUP,HCPCS C1776,,6276-5-622  -  STEM FEMORAL 22MM 317MM BOWED PLASMA MODULAR REVISION RSTOR,"$8,420.00",$0.00,"$8,420.00","$3,789.00","$5,158.80",$0.00,"$1,450.72",$0.00,$0.00,"$1,474.27","$8,420.00",$0.00,"$4,210.00","$6,668.64","$6,736.00",$0.00,"$1,317.73",$0.00,"$1,340.46",$0.00
6276-5-623,SUP,HCPCS C1776,,6276-5-623  -  STEM FEMORAL 23MM 317MM BOWED PLASMA MODULAR REVISION RSTOR,"$8,420.00",$0.00,"$8,420.00","$3,789.00","$5,158.80",$0.00,"$1,450.72",$0.00,$0.00,"$1,474.27","$8,420.00",$0.00,"$4,210.00","$6,668.64","$6,736.00",$0.00,"$1,317.73",$0.00,"$1,340.46",$0.00
6276-5-624,SUP,HCPCS C1776,,6276-5-624  -  STEM FEMORAL 24MM 317MM BOWED PLASMA MODULAR REVISION RSTOR,"$8,420.00",$0.00,"$8,420.00","$3,789.00","$5,158.80",$0.00,"$1,450.72",$0.00,$0.00,"$1,474.27","$8,420.00",$0.00,"$4,210.00","$6,668.64","$6,736.00",$0.00,"$1,317.73",$0.00,"$1,340.46",$0.00
6276-5-625,SUP,HCPCS C1776,,6276-5-625  -  STEM FEMORAL 25MM 317MM BOWED PLASMA MODULAR REVISION RSTOR,"$8,420.00",$0.00,"$8,420.00","$3,789.00","$5,158.80",$0.00,"$1,450.72",$0.00,$0.00,"$1,474.27","$8,420.00",$0.00,"$4,210.00","$6,668.64","$6,736.00",$0.00,"$1,317.73",$0.00,"$1,340.46",$0.00
6276-5-626,SUP,HCPCS C1776,,6276-5-626  -  STEM FEMORAL 26MM 317MM BOWED PLASMA MODULAR REVISION RSTOR,"$8,420.00",$0.00,"$8,420.00","$3,789.00","$5,158.80",$0.00,"$1,450.72",$0.00,$0.00,"$1,474.27","$8,420.00",$0.00,"$4,210.00","$6,668.64","$6,736.00",$0.00,"$1,317.73",$0.00,"$1,340.46",$0.00
6276-6-011,SUP,HCPCS C1776,,6276-6-011  -  STEM FEMORAL STR FLUTE 11MM 127MM MODULAR RSTOR HIP,"$5,762.50",$0.00,"$5,762.50","$2,593.13","$4,112.70",$0.00,$992.85,$0.00,$0.00,"$1,008.97","$5,762.50",$0.00,"$2,881.25","$4,563.90","$4,610.00",$0.00,$901.83,$0.00,$917.39,$0.00
6276-6-012,SUP,HCPCS C1776,,6276-6-012  -  STEM FEMORAL STR FLUTE 12MM 127MM MODULAR RSTOR HIP,"$5,762.50",$0.00,"$5,762.50","$2,593.13","$4,112.70",$0.00,$992.85,$0.00,$0.00,"$1,008.97","$5,762.50",$0.00,"$2,881.25","$4,563.90","$4,610.00",$0.00,$901.83,$0.00,$917.39,$0.00
6276-6-013,SUP,HCPCS C1776,,6276-6-013  -  STEM FEMORAL STR FLUTE 13MM 127MM MODULAR RSTOR HIP,"$5,762.50",$0.00,"$5,762.50","$2,593.13","$4,112.70",$0.00,$992.85,$0.00,$0.00,"$1,008.97","$5,762.50",$0.00,"$2,881.25","$4,563.90","$4,610.00",$0.00,$901.83,$0.00,$917.39,$0.00
6276-6-014,SUP,HCPCS C1776,,6276-6-014  -  STEM FEMORAL STR FLUTE 14MM 127MM MODULAR RSTOR HIP,"$5,762.50",$0.00,"$5,762.50","$2,593.13","$4,112.70",$0.00,$992.85,$0.00,$0.00,"$1,008.97","$5,762.50",$0.00,"$2,881.25","$4,563.90","$4,610.00",$0.00,$901.83,$0.00,$917.39,$0.00
6276-6-015,SUP,HCPCS C1776,,6276-6-015  -  STEM FEMORAL STR FLUTE 15MM 127MM MODULAR RSTOR HIP,"$5,762.50",$0.00,"$5,762.50","$2,593.13","$4,112.70",$0.00,$992.85,$0.00,$0.00,"$1,008.97","$5,762.50",$0.00,"$2,881.25","$4,563.90","$4,610.00",$0.00,$901.83,$0.00,$917.39,$0.00
6276-6-016,SUP,HCPCS C1776,,6276-6-016  -  STEM FEMORAL STR FLUTE 16MM 127MM MODULAR RSTOR HIP,"$5,762.50",$0.00,"$5,762.50","$2,593.13","$4,112.70",$0.00,$992.85,$0.00,$0.00,"$1,008.97","$5,762.50",$0.00,"$2,881.25","$4,563.90","$4,610.00",$0.00,$901.83,$0.00,$917.39,$0.00
6276-6-017,SUP,HCPCS C1776,,6276-6-017  -  STEM FEMORAL STR FLUTE 17MM 127MM MODULAR RSTOR HIP,"$5,762.50",$0.00,"$5,762.50","$2,593.13","$4,112.70",$0.00,$992.85,$0.00,$0.00,"$1,008.97","$5,762.50",$0.00,"$2,881.25","$4,563.90","$4,610.00",$0.00,$901.83,$0.00,$917.39,$0.00
6276-6-018,SUP,HCPCS C1776,,6276-6-018  -  STEM FEMORAL STR FLUTE 18MM 127MM MODULAR RSTOR HIP,"$5,762.50",$0.00,"$5,762.50","$2,593.13","$4,112.70",$0.00,$992.85,$0.00,$0.00,"$1,008.97","$5,762.50",$0.00,"$2,881.25","$4,563.90","$4,610.00",$0.00,$901.83,$0.00,$917.39,$0.00
6276-6-019,SUP,HCPCS C1776,,6276-6-019  -  STEM FEMORAL STR FLUTE 19MM 127MM MODULAR RSTOR HIP,"$5,762.50",$0.00,"$5,762.50","$2,593.13","$4,112.70",$0.00,$992.85,$0.00,$0.00,"$1,008.97","$5,762.50",$0.00,"$2,881.25","$4,563.90","$4,610.00",$0.00,$901.83,$0.00,$917.39,$0.00
6276-6-020,SUP,HCPCS C1776,,6276-6-020  -  STEM FEMORAL STR FLUTE 20MM 127MM MODULAR RSTOR HIP,"$5,762.50",$0.00,"$5,762.50","$2,593.13","$4,112.70",$0.00,$992.85,$0.00,$0.00,"$1,008.97","$5,762.50",$0.00,"$2,881.25","$4,563.90","$4,610.00",$0.00,$901.83,$0.00,$917.39,$0.00
6276-6-021,SUP,HCPCS C1776,,6276-6-021  -  STEM FEMORAL STR FLUTE 21MM 127MM MODULAR RSTOR HIP,"$5,762.50",$0.00,"$5,762.50","$2,593.13","$4,112.70",$0.00,$992.85,$0.00,$0.00,"$1,008.97","$5,762.50",$0.00,"$2,881.25","$4,563.90","$4,610.00",$0.00,$901.83,$0.00,$917.39,$0.00
6276-6-022,SUP,HCPCS C1776,,6276-6-022  -  STEM FEMORAL STR FLUTE 22MM 127MM MODULAR RSTOR HIP,"$5,762.50",$0.00,"$5,762.50","$2,593.13","$4,112.70",$0.00,$992.85,$0.00,$0.00,"$1,008.97","$5,762.50",$0.00,"$2,881.25","$4,563.90","$4,610.00",$0.00,$901.83,$0.00,$917.39,$0.00
6276-6-023,SUP,HCPCS C1776,,6276-6-023  -  STEM FEMORAL STR FLUTE 23MM 127MM MODULAR RSTOR HIP,"$5,762.50",$0.00,"$5,762.50","$2,593.13","$4,112.70",$0.00,$992.85,$0.00,$0.00,"$1,008.97","$5,762.50",$0.00,"$2,881.25","$4,563.90","$4,610.00",$0.00,$901.83,$0.00,$917.39,$0.00
6276-6-024,SUP,HCPCS C1776,,6276-6-024  -  STEM FEMORAL STR FLUTE 24MM 127MM MODULAR RSTOR HIP,"$5,762.50",$0.00,"$5,762.50","$2,593.13","$4,112.70",$0.00,$992.85,$0.00,$0.00,"$1,008.97","$5,762.50",$0.00,"$2,881.25","$4,563.90","$4,610.00",$0.00,$901.83,$0.00,$917.39,$0.00
6276-6-025,SUP,HCPCS C1776,,6276-6-025  -  STEM FEMORAL STR FLUTE 25MM 127MM MODULAR RSTOR HIP,"$5,762.50",$0.00,"$5,762.50","$2,593.13","$4,112.70",$0.00,$992.85,$0.00,$0.00,"$1,008.97","$5,762.50",$0.00,"$2,881.25","$4,563.90","$4,610.00",$0.00,$901.83,$0.00,$917.39,$0.00
6276-6-026,SUP,HCPCS C1776,,6276-6-026  -  STEM FEMORAL STR FLUTE 26MM 127MM MODULAR RSTOR HIP,"$5,762.50",$0.00,"$5,762.50","$2,593.13","$4,112.70",$0.00,$992.85,$0.00,$0.00,"$1,008.97","$5,762.50",$0.00,"$2,881.25","$4,563.90","$4,610.00",$0.00,$901.83,$0.00,$917.39,$0.00
6276-6-111,SUP,HCPCS C1776,,6276-6-111  -  STEM FEMORAL STR FLUTE 11MM 167MM MODULAR RSTOR HIP,"$5,762.50",$0.00,"$5,762.50","$2,593.13","$4,112.70",$0.00,$992.85,$0.00,$0.00,"$1,008.97","$5,762.50",$0.00,"$2,881.25","$4,563.90","$4,610.00",$0.00,$901.83,$0.00,$917.39,$0.00
6276-6-112,SUP,HCPCS C1776,,6276-6-112  -  STEM FEMORAL STR FLUTE 12MM 167MM MODULAR RSTOR HIP,"$5,762.50",$0.00,"$5,762.50","$2,593.13","$4,112.70",$0.00,$992.85,$0.00,$0.00,"$1,008.97","$5,762.50",$0.00,"$2,881.25","$4,563.90","$4,610.00",$0.00,$901.83,$0.00,$917.39,$0.00
6276-6-113,SUP,HCPCS C1776,,6276-6-113  -  STEM FEMORAL STR FLUTE 13MM 167MM MODULAR RSTOR HIP,"$5,762.50",$0.00,"$5,762.50","$2,593.13","$4,112.70",$0.00,$992.85,$0.00,$0.00,"$1,008.97","$5,762.50",$0.00,"$2,881.25","$4,563.90","$4,610.00",$0.00,$901.83,$0.00,$917.39,$0.00
6276-6-114,SUP,HCPCS C1776,,6276-6-114  -  STEM FEMORAL STR FLUTE 14MM 167MM MODULAR RSTOR HIP,"$5,762.50",$0.00,"$5,762.50","$2,593.13","$4,112.70",$0.00,$992.85,$0.00,$0.00,"$1,008.97","$5,762.50",$0.00,"$2,881.25","$4,563.90","$4,610.00",$0.00,$901.83,$0.00,$917.39,$0.00
6276-6-115,SUP,HCPCS C1776,,6276-6-115  -  STEM FEMORAL STR FLUTE 15MM 167MM MODULAR RSTOR HIP,"$5,762.50",$0.00,"$5,762.50","$2,593.13","$4,112.70",$0.00,$992.85,$0.00,$0.00,"$1,008.97","$5,762.50",$0.00,"$2,881.25","$4,563.90","$4,610.00",$0.00,$901.83,$0.00,$917.39,$0.00
6276-6-116,SUP,HCPCS C1776,,6276-6-116  -  STEM FEMORAL STR FLUTE 16MM 167MM MODULAR RSTOR HIP,"$5,762.50",$0.00,"$5,762.50","$2,593.13","$4,112.70",$0.00,$992.85,$0.00,$0.00,"$1,008.97","$5,762.50",$0.00,"$2,881.25","$4,563.90","$4,610.00",$0.00,$901.83,$0.00,$917.39,$0.00
6276-6-117,SUP,HCPCS C1776,,6276-6-117  -  STEM FEMORAL STR FLUTE 17MM 167MM MODULAR RSTOR HIP,"$5,762.50",$0.00,"$5,762.50","$2,593.13","$4,112.70",$0.00,$992.85,$0.00,$0.00,"$1,008.97","$5,762.50",$0.00,"$2,881.25","$4,563.90","$4,610.00",$0.00,$901.83,$0.00,$917.39,$0.00
6276-6-118,SUP,HCPCS C1776,,6276-6-118  -  STEM FEMORAL STR FLUTE 18MM 167MM MODULAR RSTOR HIP,"$5,762.50",$0.00,"$5,762.50","$2,593.13","$4,112.70",$0.00,$992.85,$0.00,$0.00,"$1,008.97","$5,762.50",$0.00,"$2,881.25","$4,563.90","$4,610.00",$0.00,$901.83,$0.00,$917.39,$0.00
6276-6-119,SUP,HCPCS C1776,,6276-6-119  -  STEM FEMORAL STR FLUTE 19MM 167MM MODULAR RSTOR HIP,"$5,762.50",$0.00,"$5,762.50","$2,593.13","$4,112.70",$0.00,$992.85,$0.00,$0.00,"$1,008.97","$5,762.50",$0.00,"$2,881.25","$4,563.90","$4,610.00",$0.00,$901.83,$0.00,$917.39,$0.00
6276-6-120,SUP,HCPCS C1776,,6276-6-120  -  STEM FEMORAL STR FLUTE 20MM 167MM MODULAR RSTOR HIP,"$5,762.50",$0.00,"$5,762.50","$2,593.13","$4,112.70",$0.00,$992.85,$0.00,$0.00,"$1,008.97","$5,762.50",$0.00,"$2,881.25","$4,563.90","$4,610.00",$0.00,$901.83,$0.00,$917.39,$0.00
6276-6-121,SUP,HCPCS C1776,,6276-6-121  -  STEM FEMORAL STR FLUTE 21MM 167MM MODULAR RSTOR HIP,"$5,762.50",$0.00,"$5,762.50","$2,593.13","$4,112.70",$0.00,$992.85,$0.00,$0.00,"$1,008.97","$5,762.50",$0.00,"$2,881.25","$4,563.90","$4,610.00",$0.00,$901.83,$0.00,$917.39,$0.00
6276-6-122,SUP,HCPCS C1776,,6276-6-122  -  STEM FEMORAL STR FLUTE 22MM 167MM MODULAR RSTOR HIP,"$5,762.50",$0.00,"$5,762.50","$2,593.13","$4,112.70",$0.00,$992.85,$0.00,$0.00,"$1,008.97","$5,762.50",$0.00,"$2,881.25","$4,563.90","$4,610.00",$0.00,$901.83,$0.00,$917.39,$0.00
6276-6-123,SUP,HCPCS C1776,,6276-6-123  -  STEM FEMORAL STR FLUTE 23MM 167MM MODULAR RSTOR HIP,"$5,762.50",$0.00,"$5,762.50","$2,593.13","$4,112.70",$0.00,$992.85,$0.00,$0.00,"$1,008.97","$5,762.50",$0.00,"$2,881.25","$4,563.90","$4,610.00",$0.00,$901.83,$0.00,$917.39,$0.00
6276-6-124,SUP,HCPCS C1776,,6276-6-124  -  STEM FEMORAL STR FLUTE 24MM 167MM MODULAR RSTOR HIP,"$5,762.50",$0.00,"$5,762.50","$2,593.13","$4,112.70",$0.00,$992.85,$0.00,$0.00,"$1,008.97","$5,762.50",$0.00,"$2,881.25","$4,563.90","$4,610.00",$0.00,$901.83,$0.00,$917.39,$0.00
6276-6-125,SUP,HCPCS C1776,,6276-6-125  -  STEM FEMORAL STR FLUTE 25MM 167MM MODULAR RSTOR HIP,"$5,762.50",$0.00,"$5,762.50","$2,593.13","$4,112.70",$0.00,$992.85,$0.00,$0.00,"$1,008.97","$5,762.50",$0.00,"$2,881.25","$4,563.90","$4,610.00",$0.00,$901.83,$0.00,$917.39,$0.00
6276-6-126,SUP,HCPCS C1776,,6276-6-126  -  STEM FEMORAL STR FLUTE 26MM 167MM MODULAR RSTOR HIP,"$5,762.50",$0.00,"$5,762.50","$2,593.13","$4,112.70",$0.00,$992.85,$0.00,$0.00,"$1,008.97","$5,762.50",$0.00,"$2,881.25","$4,563.90","$4,610.00",$0.00,$901.83,$0.00,$917.39,$0.00
6276-6-211,SUP,HCPCS C1776,,6276-6-211  -  STEM FEMORAL 11MM 167MM BOWED FLUTED MODULAR RSTOR DISTAL,"$7,760.00",$0.00,"$7,760.00","$3,492.00","$5,158.80",$0.00,"$1,337.01",$0.00,$0.00,"$1,358.71","$7,760.00",$0.00,"$3,880.00","$6,145.92","$6,208.00",$0.00,"$1,214.44",$0.00,"$1,235.39",$0.00
6276-6-212,SUP,HCPCS C1776,,6276-6-212  -  STEM FEMORAL 12MM 167MM BOWED FLUTED MODULAR RSTOR DISTAL,"$7,760.00",$0.00,"$7,760.00","$3,492.00","$5,158.80",$0.00,"$1,337.01",$0.00,$0.00,"$1,358.71","$7,760.00",$0.00,"$3,880.00","$6,145.92","$6,208.00",$0.00,"$1,214.44",$0.00,"$1,235.39",$0.00
6276-6-213,SUP,HCPCS C1776,,6276-6-213  -  STEM FEMORAL 13MM 167MM BOWED FLUTED MODULAR RSTOR DISTAL,"$7,760.00",$0.00,"$7,760.00","$3,492.00","$5,158.80",$0.00,"$1,337.01",$0.00,$0.00,"$1,358.71","$7,760.00",$0.00,"$3,880.00","$6,145.92","$6,208.00",$0.00,"$1,214.44",$0.00,"$1,235.39",$0.00
6276-6-214,SUP,HCPCS C1776,,6276-6-214  -  STEM FEMORAL 14MM 167MM BOWED FLUTED MODULAR RSTOR DISTAL,"$7,760.00",$0.00,"$7,760.00","$3,492.00","$5,158.80",$0.00,"$1,337.01",$0.00,$0.00,"$1,358.71","$7,760.00",$0.00,"$3,880.00","$6,145.92","$6,208.00",$0.00,"$1,214.44",$0.00,"$1,235.39",$0.00
6276-6-215,SUP,HCPCS C1776,,6276-6-215  -  STEM FEMORAL 15MM 167MM BOWED FLUTED MODULAR RSTOR DISTAL,"$7,760.00",$0.00,"$7,760.00","$3,492.00","$5,158.80",$0.00,"$1,337.01",$0.00,$0.00,"$1,358.71","$7,760.00",$0.00,"$3,880.00","$6,145.92","$6,208.00",$0.00,"$1,214.44",$0.00,"$1,235.39",$0.00
6276-6-216,SUP,HCPCS C1776,,6276-6-216  -  STEM FEMORAL 16MM 167MM BOWED FLUTED MODULAR RSTOR DISTAL,"$7,760.00",$0.00,"$7,760.00","$3,492.00","$5,158.80",$0.00,"$1,337.01",$0.00,$0.00,"$1,358.71","$7,760.00",$0.00,"$3,880.00","$6,145.92","$6,208.00",$0.00,"$1,214.44",$0.00,"$1,235.39",$0.00
6276-6-217,SUP,HCPCS C1776,,6276-6-217  -  STEM FEMORAL 17MM 167MM BOWED FLUTED MODULAR RSTOR DISTAL,"$7,760.00",$0.00,"$7,760.00","$3,492.00","$5,158.80",$0.00,"$1,337.01",$0.00,$0.00,"$1,358.71","$7,760.00",$0.00,"$3,880.00","$6,145.92","$6,208.00",$0.00,"$1,214.44",$0.00,"$1,235.39",$0.00
6276-6-218,SUP,HCPCS C1776,,6276-6-218  -  STEM FEMORAL 18MM 167MM BOWED FLUTED MODULAR RSTOR DISTAL,"$7,760.00",$0.00,"$7,760.00","$3,492.00","$5,158.80",$0.00,"$1,337.01",$0.00,$0.00,"$1,358.71","$7,760.00",$0.00,"$3,880.00","$6,145.92","$6,208.00",$0.00,"$1,214.44",$0.00,"$1,235.39",$0.00
6276-6-219,SUP,HCPCS C1776,,6276-6-219  -  STEM FEMORAL 19MM 167MM BOWED FLUTED MODULAR RSTOR DISTAL,"$7,760.00",$0.00,"$7,760.00","$3,492.00","$5,158.80",$0.00,"$1,337.01",$0.00,$0.00,"$1,358.71","$7,760.00",$0.00,"$3,880.00","$6,145.92","$6,208.00",$0.00,"$1,214.44",$0.00,"$1,235.39",$0.00
6276-6-220,SUP,HCPCS C1776,,6276-6-220  -  STEM FEMORAL 20MM 167MM BOWED FLUTED MODULAR RSTOR DISTAL,"$7,760.00",$0.00,"$7,760.00","$3,492.00","$5,158.80",$0.00,"$1,337.01",$0.00,$0.00,"$1,358.71","$7,760.00",$0.00,"$3,880.00","$6,145.92","$6,208.00",$0.00,"$1,214.44",$0.00,"$1,235.39",$0.00
6276-6-221,SUP,HCPCS C1776,,6276-6-221  -  STEM FEMORAL 21MM 167MM BOWED FLUTED MODULAR RSTOR DISTAL,"$7,760.00",$0.00,"$7,760.00","$3,492.00","$5,158.80",$0.00,"$1,337.01",$0.00,$0.00,"$1,358.71","$7,760.00",$0.00,"$3,880.00","$6,145.92","$6,208.00",$0.00,"$1,214.44",$0.00,"$1,235.39",$0.00
6276-6-222,SUP,HCPCS C1776,,6276-6-222  -  STEM FEMORAL 22MM 167MM BOWED FLUTED MODULAR RSTOR DISTAL,"$7,760.00",$0.00,"$7,760.00","$3,492.00","$5,158.80",$0.00,"$1,337.01",$0.00,$0.00,"$1,358.71","$7,760.00",$0.00,"$3,880.00","$6,145.92","$6,208.00",$0.00,"$1,214.44",$0.00,"$1,235.39",$0.00
6276-6-223,SUP,HCPCS C1776,,6276-6-223  -  STEM FEMORAL 23MM 167MM BOWED FLUTED MODULAR RSTOR DISTAL,"$7,760.00",$0.00,"$7,760.00","$3,492.00","$5,158.80",$0.00,"$1,337.01",$0.00,$0.00,"$1,358.71","$7,760.00",$0.00,"$3,880.00","$6,145.92","$6,208.00",$0.00,"$1,214.44",$0.00,"$1,235.39",$0.00
6276-6-224,SUP,HCPCS C1776,,6276-6-224  -  STEM FEMORAL 24MM 167MM BOWED FLUTED MODULAR RSTOR DISTAL,"$7,760.00",$0.00,"$7,760.00","$3,492.00","$5,158.80",$0.00,"$1,337.01",$0.00,$0.00,"$1,358.71","$7,760.00",$0.00,"$3,880.00","$6,145.92","$6,208.00",$0.00,"$1,214.44",$0.00,"$1,235.39",$0.00
6276-6-225,SUP,HCPCS C1776,,6276-6-225  -  STEM FEMORAL 25MM 167MM BOWED FLUTED MODULAR RSTOR DISTAL,"$7,760.00",$0.00,"$7,760.00","$3,492.00","$5,158.80",$0.00,"$1,337.01",$0.00,$0.00,"$1,358.71","$7,760.00",$0.00,"$3,880.00","$6,145.92","$6,208.00",$0.00,"$1,214.44",$0.00,"$1,235.39",$0.00
6276-6-226,SUP,HCPCS C1776,,6276-6-226  -  STEM FEMORAL 26MM 167MM BOWED FLUTED MODULAR RSTOR DISTAL,"$7,760.00",$0.00,"$7,760.00","$3,492.00","$5,158.80",$0.00,"$1,337.01",$0.00,$0.00,"$1,358.71","$7,760.00",$0.00,"$3,880.00","$6,145.92","$6,208.00",$0.00,"$1,214.44",$0.00,"$1,235.39",$0.00
6276-6-411,SUP,HCPCS C1776,,6276-6-411  -  STEM FEMORAL 11MM 217MM BOWED FLUTED MODULAR RSTOR DISTAL,"$7,760.00",$0.00,"$7,760.00","$3,492.00","$5,158.80",$0.00,"$1,337.01",$0.00,$0.00,"$1,358.71","$7,760.00",$0.00,"$3,880.00","$6,145.92","$6,208.00",$0.00,"$1,214.44",$0.00,"$1,235.39",$0.00
6276-6-412,SUP,HCPCS C1776,,6276-6-412  -  STEM FEMORAL 12MM 217MM BOWED FLUTED MODULAR RSTOR DISTAL,"$7,760.00",$0.00,"$7,760.00","$3,492.00","$5,158.80",$0.00,"$1,337.01",$0.00,$0.00,"$1,358.71","$7,760.00",$0.00,"$3,880.00","$6,145.92","$6,208.00",$0.00,"$1,214.44",$0.00,"$1,235.39",$0.00
6276-6-413,SUP,HCPCS C1776,,6276-6-413  -  STEM FEMORAL 13MM 217MM BOWED FLUTED MODULAR RSTOR DISTAL,"$7,760.00",$0.00,"$7,760.00","$3,492.00","$5,158.80",$0.00,"$1,337.01",$0.00,$0.00,"$1,358.71","$7,760.00",$0.00,"$3,880.00","$6,145.92","$6,208.00",$0.00,"$1,214.44",$0.00,"$1,235.39",$0.00
6276-6-414,SUP,HCPCS C1776,,6276-6-414  -  STEM FEMORAL 14MM 217MM BOWED FLUTED MODULAR RSTOR DISTAL,"$7,760.00",$0.00,"$7,760.00","$3,492.00","$5,158.80",$0.00,"$1,337.01",$0.00,$0.00,"$1,358.71","$7,760.00",$0.00,"$3,880.00","$6,145.92","$6,208.00",$0.00,"$1,214.44",$0.00,"$1,235.39",$0.00
6276-6-415,SUP,HCPCS C1776,,6276-6-415  -  STEM FEMORAL 15MM 217MM BOWED FLUTED MODULAR RSTOR DISTAL,"$7,760.00",$0.00,"$7,760.00","$3,492.00","$5,158.80",$0.00,"$1,337.01",$0.00,$0.00,"$1,358.71","$7,760.00",$0.00,"$3,880.00","$6,145.92","$6,208.00",$0.00,"$1,214.44",$0.00,"$1,235.39",$0.00
6276-6-416,SUP,HCPCS C1776,,6276-6-416  -  STEM FEMORAL 16MM 217MM BOWED FLUTED MODULAR RSTOR DISTAL,"$7,760.00",$0.00,"$7,760.00","$3,492.00","$5,158.80",$0.00,"$1,337.01",$0.00,$0.00,"$1,358.71","$7,760.00",$0.00,"$3,880.00","$6,145.92","$6,208.00",$0.00,"$1,214.44",$0.00,"$1,235.39",$0.00
6276-6-417,SUP,HCPCS C1776,,6276-6-417  -  STEM FEMORAL 17MM 217MM BOWED FLUTED MODULAR RSTOR DISTAL,"$7,760.00",$0.00,"$7,760.00","$3,492.00","$5,158.80",$0.00,"$1,337.01",$0.00,$0.00,"$1,358.71","$7,760.00",$0.00,"$3,880.00","$6,145.92","$6,208.00",$0.00,"$1,214.44",$0.00,"$1,235.39",$0.00
6276-6-418,SUP,HCPCS C1776,,6276-6-418  -  STEM FEMORAL 18MM 217MM BOWED FLUTED MODULAR RSTOR DISTAL,"$7,760.00",$0.00,"$7,760.00","$3,492.00","$5,158.80",$0.00,"$1,337.01",$0.00,$0.00,"$1,358.71","$7,760.00",$0.00,"$3,880.00","$6,145.92","$6,208.00",$0.00,"$1,214.44",$0.00,"$1,235.39",$0.00
6276-6-419,SUP,HCPCS C1776,,6276-6-419  -  STEM FEMORAL 19MM 217MM BOWED FLUTED MODULAR RSTOR DISTAL,"$7,760.00",$0.00,"$7,760.00","$3,492.00","$5,158.80",$0.00,"$1,337.01",$0.00,$0.00,"$1,358.71","$7,760.00",$0.00,"$3,880.00","$6,145.92","$6,208.00",$0.00,"$1,214.44",$0.00,"$1,235.39",$0.00
6276-6-420,SUP,HCPCS C1776,,6276-6-420  -  STEM FEMORAL 20MM 217MM BOWED FLUTED MODULAR RSTOR DISTAL,"$7,760.00",$0.00,"$7,760.00","$3,492.00","$5,158.80",$0.00,"$1,337.01",$0.00,$0.00,"$1,358.71","$7,760.00",$0.00,"$3,880.00","$6,145.92","$6,208.00",$0.00,"$1,214.44",$0.00,"$1,235.39",$0.00
6276-6-421,SUP,HCPCS C1776,,6276-6-421  -  STEM FEMORAL 21MM 217MM BOWED FLUTED MODULAR RSTOR DISTAL,"$7,760.00",$0.00,"$7,760.00","$3,492.00","$5,158.80",$0.00,"$1,337.01",$0.00,$0.00,"$1,358.71","$7,760.00",$0.00,"$3,880.00","$6,145.92","$6,208.00",$0.00,"$1,214.44",$0.00,"$1,235.39",$0.00
6276-6-422,SUP,HCPCS C1776,,6276-6-422  -  STEM FEMORAL 22MM 217MM BOWED FLUTED MODULAR RSTOR DISTAL,"$7,760.00",$0.00,"$7,760.00","$3,492.00","$5,158.80",$0.00,"$1,337.01",$0.00,$0.00,"$1,358.71","$7,760.00",$0.00,"$3,880.00","$6,145.92","$6,208.00",$0.00,"$1,214.44",$0.00,"$1,235.39",$0.00
6276-6-423,SUP,HCPCS C1776,,6276-6-423  -  STEM FEMORAL 23MM 217MM BOWED FLUTED MODULAR RSTOR DISTAL,"$7,760.00",$0.00,"$7,760.00","$3,492.00","$5,158.80",$0.00,"$1,337.01",$0.00,$0.00,"$1,358.71","$7,760.00",$0.00,"$3,880.00","$6,145.92","$6,208.00",$0.00,"$1,214.44",$0.00,"$1,235.39",$0.00
6276-6-424,SUP,HCPCS C1776,,6276-6-424  -  STEM FEMORAL 24MM 217MM BOWED FLUTED MODULAR RSTOR DISTAL,"$7,760.00",$0.00,"$7,760.00","$3,492.00","$5,158.80",$0.00,"$1,337.01",$0.00,$0.00,"$1,358.71","$7,760.00",$0.00,"$3,880.00","$6,145.92","$6,208.00",$0.00,"$1,214.44",$0.00,"$1,235.39",$0.00
6276-6-425,SUP,HCPCS C1776,,6276-6-425  -  STEM FEMORAL 25MM 217MM BOWED FLUTED MODULAR RSTOR DISTAL,"$7,760.00",$0.00,"$7,760.00","$3,492.00","$5,158.80",$0.00,"$1,337.01",$0.00,$0.00,"$1,358.71","$7,760.00",$0.00,"$3,880.00","$6,145.92","$6,208.00",$0.00,"$1,214.44",$0.00,"$1,235.39",$0.00
6276-6-426,SUP,HCPCS C1776,,6276-6-426  -  STEM FEMORAL 26MM 217MM BOWED FLUTED MODULAR RSTOR DISTAL,"$7,760.00",$0.00,"$7,760.00","$3,492.00","$5,158.80",$0.00,"$1,337.01",$0.00,$0.00,"$1,358.71","$7,760.00",$0.00,"$3,880.00","$6,145.92","$6,208.00",$0.00,"$1,214.44",$0.00,"$1,235.39",$0.00
6276-6-511,SUP,HCPCS C1776,,6276-6-511  -  STEM FEMORAL 11MM 267MM BOWED FLUTED MODULAR RSTOR DISTAL,"$7,547.50",$0.00,"$7,547.50","$3,396.38","$5,158.80",$0.00,"$1,300.40",$0.00,$0.00,"$1,321.51","$7,547.50",$0.00,"$3,773.75","$5,977.62","$6,038.00",$0.00,"$1,181.18",$0.00,"$1,201.56",$0.00
6276-6-512,SUP,HCPCS C1776,,6276-6-512  -  STEM FEMORAL 12MM 267MM BOWED FLUTED MODULAR RSTOR DISTAL,"$7,547.50",$0.00,"$7,547.50","$3,396.38","$5,158.80",$0.00,"$1,300.40",$0.00,$0.00,"$1,321.51","$7,547.50",$0.00,"$3,773.75","$5,977.62","$6,038.00",$0.00,"$1,181.18",$0.00,"$1,201.56",$0.00
6276-6-513,SUP,HCPCS C1776,,6276-6-513  -  STEM FEMORAL 13MM 267MM BOWED FLUTED MODULAR RSTOR DISTAL,"$7,547.50",$0.00,"$7,547.50","$3,396.38","$5,158.80",$0.00,"$1,300.40",$0.00,$0.00,"$1,321.51","$7,547.50",$0.00,"$3,773.75","$5,977.62","$6,038.00",$0.00,"$1,181.18",$0.00,"$1,201.56",$0.00
6276-6-514,SUP,HCPCS C1776,,6276-6-514  -  STEM FEMORAL 14MM 267MM BOWED FLUTED MODULAR RSTOR DISTAL,"$7,547.50",$0.00,"$7,547.50","$3,396.38","$5,158.80",$0.00,"$1,300.40",$0.00,$0.00,"$1,321.51","$7,547.50",$0.00,"$3,773.75","$5,977.62","$6,038.00",$0.00,"$1,181.18",$0.00,"$1,201.56",$0.00
6276-6-515,SUP,HCPCS C1776,,6276-6-515  -  STEM FEMORAL 15MM 267MM BOWED FLUTED MODULAR RSTOR DISTAL,"$7,547.50",$0.00,"$7,547.50","$3,396.38","$5,158.80",$0.00,"$1,300.40",$0.00,$0.00,"$1,321.51","$7,547.50",$0.00,"$3,773.75","$5,977.62","$6,038.00",$0.00,"$1,181.18",$0.00,"$1,201.56",$0.00
6276-6-516,SUP,HCPCS C1776,,6276-6-516  -  STEM FEMORAL 16MM 267MM BOWED FLUTED MODULAR RSTOR DISTAL,"$7,547.50",$0.00,"$7,547.50","$3,396.38","$5,158.80",$0.00,"$1,300.40",$0.00,$0.00,"$1,321.51","$7,547.50",$0.00,"$3,773.75","$5,977.62","$6,038.00",$0.00,"$1,181.18",$0.00,"$1,201.56",$0.00
6276-6-517,SUP,HCPCS C1776,,6276-6-517  -  STEM FEMORAL 17MM 267MM BOWED FLUTED MODULAR RSTOR DISTAL,"$7,547.50",$0.00,"$7,547.50","$3,396.38","$5,158.80",$0.00,"$1,300.40",$0.00,$0.00,"$1,321.51","$7,547.50",$0.00,"$3,773.75","$5,977.62","$6,038.00",$0.00,"$1,181.18",$0.00,"$1,201.56",$0.00
6276-6-518,SUP,HCPCS C1776,,6276-6-518  -  STEM FEMORAL 18MM 267MM BOWED FLUTED MODULAR RSTOR DISTAL,"$7,547.50",$0.00,"$7,547.50","$3,396.38","$5,158.80",$0.00,"$1,300.40",$0.00,$0.00,"$1,321.51","$7,547.50",$0.00,"$3,773.75","$5,977.62","$6,038.00",$0.00,"$1,181.18",$0.00,"$1,201.56",$0.00
6276-6-519,SUP,HCPCS C1776,,6276-6-519  -  STEM FEMORAL 19MM 267MM BOWED FLUTED MODULAR RSTOR DISTAL,"$7,547.50",$0.00,"$7,547.50","$3,396.38","$5,158.80",$0.00,"$1,300.40",$0.00,$0.00,"$1,321.51","$7,547.50",$0.00,"$3,773.75","$5,977.62","$6,038.00",$0.00,"$1,181.18",$0.00,"$1,201.56",$0.00
6276-6-520,SUP,HCPCS C1776,,6276-6-520  -  STEM FEMORAL 20MM 267MM BOWED FLUTED MODULAR RSTOR DISTAL,"$7,547.50",$0.00,"$7,547.50","$3,396.38","$5,158.80",$0.00,"$1,300.40",$0.00,$0.00,"$1,321.51","$7,547.50",$0.00,"$3,773.75","$5,977.62","$6,038.00",$0.00,"$1,181.18",$0.00,"$1,201.56",$0.00
6276-6-521,SUP,HCPCS C1776,,6276-6-521  -  STEM FEMORAL 21MM 267MM BOWED FLUTED MODULAR RSTOR DISTAL,"$7,547.50",$0.00,"$7,547.50","$3,396.38","$5,158.80",$0.00,"$1,300.40",$0.00,$0.00,"$1,321.51","$7,547.50",$0.00,"$3,773.75","$5,977.62","$6,038.00",$0.00,"$1,181.18",$0.00,"$1,201.56",$0.00
6276-6-522,SUP,HCPCS C1776,,6276-6-522  -  STEM FEMORAL 22MM 267MM BOWED FLUTED MODULAR RSTOR DISTAL,"$7,547.50",$0.00,"$7,547.50","$3,396.38","$5,158.80",$0.00,"$1,300.40",$0.00,$0.00,"$1,321.51","$7,547.50",$0.00,"$3,773.75","$5,977.62","$6,038.00",$0.00,"$1,181.18",$0.00,"$1,201.56",$0.00
6276-6-523,SUP,HCPCS C1776,,6276-6-523  -  STEM FEMORAL 23MM 267MM BOWED FLUTED MODULAR RSTOR DISTAL,"$7,547.50",$0.00,"$7,547.50","$3,396.38","$5,158.80",$0.00,"$1,300.40",$0.00,$0.00,"$1,321.51","$7,547.50",$0.00,"$3,773.75","$5,977.62","$6,038.00",$0.00,"$1,181.18",$0.00,"$1,201.56",$0.00
6276-6-524,SUP,HCPCS C1776,,6276-6-524  -  STEM FEMORAL 24MM 267MM BOWED FLUTED MODULAR RSTOR DISTAL,"$7,547.50",$0.00,"$7,547.50","$3,396.38","$5,158.80",$0.00,"$1,300.40",$0.00,$0.00,"$1,321.51","$7,547.50",$0.00,"$3,773.75","$5,977.62","$6,038.00",$0.00,"$1,181.18",$0.00,"$1,201.56",$0.00
6276-6-525,SUP,HCPCS C1776,,6276-6-525  -  STEM FEMORAL 25MM 267MM BOWED FLUTED MODULAR RSTOR DISTAL,"$7,547.50",$0.00,"$7,547.50","$3,396.38","$5,158.80",$0.00,"$1,300.40",$0.00,$0.00,"$1,321.51","$7,547.50",$0.00,"$3,773.75","$5,977.62","$6,038.00",$0.00,"$1,181.18",$0.00,"$1,201.56",$0.00
6276-6-526,SUP,HCPCS C1776,,6276-6-526  -  STEM FEMORAL 26MM 267MM BOWED FLUTED MODULAR RSTOR DISTAL,"$7,547.50",$0.00,"$7,547.50","$3,396.38","$5,158.80",$0.00,"$1,300.40",$0.00,$0.00,"$1,321.51","$7,547.50",$0.00,"$3,773.75","$5,977.62","$6,038.00",$0.00,"$1,181.18",$0.00,"$1,201.56",$0.00
6276-6-611,SUP,HCPCS C1776,,6276-6-611  -  STEM FEMORAL 11MM 317MM BOWED FLUTED MODULAR RSTOR DISTAL,"$7,547.50",$0.00,"$7,547.50","$3,396.38","$5,158.80",$0.00,"$1,300.40",$0.00,$0.00,"$1,321.51","$7,547.50",$0.00,"$3,773.75","$5,977.62","$6,038.00",$0.00,"$1,181.18",$0.00,"$1,201.56",$0.00
6276-6-612,SUP,HCPCS C1776,,6276-6-612  -  STEM FEMORAL 12MM 317MM BOWED FLUTED MODULAR RSTOR DISTAL,"$7,547.50",$0.00,"$7,547.50","$3,396.38","$5,158.80",$0.00,"$1,300.40",$0.00,$0.00,"$1,321.51","$7,547.50",$0.00,"$3,773.75","$5,977.62","$6,038.00",$0.00,"$1,181.18",$0.00,"$1,201.56",$0.00
6276-6-613,SUP,HCPCS C1776,,6276-6-613  -  STEM FEMORAL 13MM 317MM BOWED FLUTED MODULAR RSTOR DISTAL,"$7,547.50",$0.00,"$7,547.50","$3,396.38","$5,158.80",$0.00,"$1,300.40",$0.00,$0.00,"$1,321.51","$7,547.50",$0.00,"$3,773.75","$5,977.62","$6,038.00",$0.00,"$1,181.18",$0.00,"$1,201.56",$0.00
6276-6-614,SUP,HCPCS C1776,,6276-6-614  -  STEM FEMORAL 14MM 317MM BOWED FLUTED MODULAR RSTOR DISTAL,"$7,547.50",$0.00,"$7,547.50","$3,396.38","$5,158.80",$0.00,"$1,300.40",$0.00,$0.00,"$1,321.51","$7,547.50",$0.00,"$3,773.75","$5,977.62","$6,038.00",$0.00,"$1,181.18",$0.00,"$1,201.56",$0.00
6276-6-615,SUP,HCPCS C1776,,6276-6-615  -  STEM FEMORAL 15MM 317MM BOWED FLUTED MODULAR RSTOR DISTAL,"$7,547.50",$0.00,"$7,547.50","$3,396.38","$5,158.80",$0.00,"$1,300.40",$0.00,$0.00,"$1,321.51","$7,547.50",$0.00,"$3,773.75","$5,977.62","$6,038.00",$0.00,"$1,181.18",$0.00,"$1,201.56",$0.00
6276-6-616,SUP,HCPCS C1776,,6276-6-616  -  STEM FEMORAL 16MM 317MM BOWED FLUTED MODULAR RSTOR DISTAL,"$7,547.50",$0.00,"$7,547.50","$3,396.38","$5,158.80",$0.00,"$1,300.40",$0.00,$0.00,"$1,321.51","$7,547.50",$0.00,"$3,773.75","$5,977.62","$6,038.00",$0.00,"$1,181.18",$0.00,"$1,201.56",$0.00
6276-6-617,SUP,HCPCS C1776,,6276-6-617  -  STEM FEMORAL 17MM 317MM BOWED FLUTED MODULAR RSTOR DISTAL,"$7,547.50",$0.00,"$7,547.50","$3,396.38","$5,158.80",$0.00,"$1,300.40",$0.00,$0.00,"$1,321.51","$7,547.50",$0.00,"$3,773.75","$5,977.62","$6,038.00",$0.00,"$1,181.18",$0.00,"$1,201.56",$0.00
6276-6-618,SUP,HCPCS C1776,,6276-6-618  -  STEM FEMORAL 18MM 317MM BOWED FLUTED MODULAR RSTOR DISTAL,"$7,547.50",$0.00,"$7,547.50","$3,396.38","$5,158.80",$0.00,"$1,300.40",$0.00,$0.00,"$1,321.51","$7,547.50",$0.00,"$3,773.75","$5,977.62","$6,038.00",$0.00,"$1,181.18",$0.00,"$1,201.56",$0.00
6276-6-619,SUP,HCPCS C1776,,6276-6-619  -  STEM FEMORAL 19MM 317MM BOWED FLUTED MODULAR RSTOR DISTAL,"$7,547.50",$0.00,"$7,547.50","$3,396.38","$5,158.80",$0.00,"$1,300.40",$0.00,$0.00,"$1,321.51","$7,547.50",$0.00,"$3,773.75","$5,977.62","$6,038.00",$0.00,"$1,181.18",$0.00,"$1,201.56",$0.00
6276-6-620,SUP,HCPCS C1776,,6276-6-620  -  STEM FEMORAL 20MM 317MM BOWED FLUTED MODULAR RSTOR DISTAL,"$7,547.50",$0.00,"$7,547.50","$3,396.38","$5,158.80",$0.00,"$1,300.40",$0.00,$0.00,"$1,321.51","$7,547.50",$0.00,"$3,773.75","$5,977.62","$6,038.00",$0.00,"$1,181.18",$0.00,"$1,201.56",$0.00
6276-6-621,SUP,HCPCS C1776,,6276-6-621  -  STEM FEMORAL 21MM 317MM BOWED FLUTED MODULAR RSTOR DISTAL,"$7,547.50",$0.00,"$7,547.50","$3,396.38","$5,158.80",$0.00,"$1,300.40",$0.00,$0.00,"$1,321.51","$7,547.50",$0.00,"$3,773.75","$5,977.62","$6,038.00",$0.00,"$1,181.18",$0.00,"$1,201.56",$0.00
6276-6-622,SUP,HCPCS C1776,,6276-6-622  -  STEM FEMORAL 22MM 317MM BOWED FLUTED MODULAR RSTOR DISTAL,"$7,547.50",$0.00,"$7,547.50","$3,396.38","$5,158.80",$0.00,"$1,300.40",$0.00,$0.00,"$1,321.51","$7,547.50",$0.00,"$3,773.75","$5,977.62","$6,038.00",$0.00,"$1,181.18",$0.00,"$1,201.56",$0.00
6276-6-623,SUP,HCPCS C1776,,6276-6-623  -  STEM FEMORAL 23MM 317MM BOWED FLUTED MODULAR RSTOR DISTAL,"$7,547.50",$0.00,"$7,547.50","$3,396.38","$5,158.80",$0.00,"$1,300.40",$0.00,$0.00,"$1,321.51","$7,547.50",$0.00,"$3,773.75","$5,977.62","$6,038.00",$0.00,"$1,181.18",$0.00,"$1,201.56",$0.00
6276-6-624,SUP,HCPCS C1776,,6276-6-624  -  STEM FEMORAL 24MM 317MM BOWED FLUTED MODULAR RSTOR DISTAL,"$7,547.50",$0.00,"$7,547.50","$3,396.38","$5,158.80",$0.00,"$1,300.40",$0.00,$0.00,"$1,321.51","$7,547.50",$0.00,"$3,773.75","$5,977.62","$6,038.00",$0.00,"$1,181.18",$0.00,"$1,201.56",$0.00
6276-6-625,SUP,HCPCS C1776,,6276-6-625  -  STEM FEMORAL 25MM 317MM BOWED FLUTED MODULAR RSTOR DISTAL,"$7,547.50",$0.00,"$7,547.50","$3,396.38","$5,158.80",$0.00,"$1,300.40",$0.00,$0.00,"$1,321.51","$7,547.50",$0.00,"$3,773.75","$5,977.62","$6,038.00",$0.00,"$1,181.18",$0.00,"$1,201.56",$0.00
6276-6-626,SUP,HCPCS C1776,,6276-6-626  -  STEM FEMORAL 26MM 317MM BOWED FLUTED MODULAR RSTOR DISTAL,"$7,547.50",$0.00,"$7,547.50","$3,396.38","$5,158.80",$0.00,"$1,300.40",$0.00,$0.00,"$1,321.51","$7,547.50",$0.00,"$3,773.75","$5,977.62","$6,038.00",$0.00,"$1,181.18",$0.00,"$1,201.56",$0.00
6276-7-014,SUP,HCPCS C1776,,6276-7-014  -  STEM FEMORAL STR CONE 14MM 155MM MODULAR RSTOR HA HIP,"$6,752.50",$0.00,"$6,752.50","$3,038.63","$4,819.26",$0.00,"$1,163.42",$0.00,$0.00,"$1,182.31","$6,752.50",$0.00,"$3,376.25","$5,347.98","$5,402.00",$0.00,"$1,056.77",$0.00,"$1,075.00",$0.00
6276-7-015,SUP,HCPCS C1776,,6276-7-015  -  STEM FEMORAL CONICAL 15MM 155MM MODULAR DISTAL HIP,"$6,752.50",$0.00,"$6,752.50","$3,038.63","$4,819.26",$0.00,"$1,163.42",$0.00,$0.00,"$1,182.31","$6,752.50",$0.00,"$3,376.25","$5,347.98","$5,402.00",$0.00,"$1,056.77",$0.00,"$1,075.00",$0.00
6276-7-016,SUP,HCPCS C1776,,6276-7-016  -  STEM FEMORAL CONICAL 16MM 155MM MODULAR DISTAL HIP,"$6,752.50",$0.00,"$6,752.50","$3,038.63","$4,819.26",$0.00,"$1,163.42",$0.00,$0.00,"$1,182.31","$6,752.50",$0.00,"$3,376.25","$5,347.98","$5,402.00",$0.00,"$1,056.77",$0.00,"$1,075.00",$0.00
6276-7-017,SUP,HCPCS C1776,,6276-7-017  -  STEM FEMORAL CONICAL 17MM 155MM MODULAR RSTOR HA DISTAL HIP,"$6,752.50",$0.00,"$6,752.50","$3,038.63","$4,819.26",$0.00,"$1,163.42",$0.00,$0.00,"$1,182.31","$6,752.50",$0.00,"$3,376.25","$5,347.98","$5,402.00",$0.00,"$1,056.77",$0.00,"$1,075.00",$0.00
6276-7-018,SUP,HCPCS C1776,,6276-7-018  -  STEM FEMORAL STR CONE 18MM 155MM MODULAR RSTOR HA HIP,"$6,752.50",$0.00,"$6,752.50","$3,038.63","$4,819.26",$0.00,"$1,163.42",$0.00,$0.00,"$1,182.31","$6,752.50",$0.00,"$3,376.25","$5,347.98","$5,402.00",$0.00,"$1,056.77",$0.00,"$1,075.00",$0.00
6276-7-019,SUP,HCPCS C1776,,6276-7-019  -  STEM FEMORAL CONICAL 19MM 155MM MODULAR RSTOR HA DISTAL HIP,"$6,752.50",$0.00,"$6,752.50","$3,038.63","$4,819.26",$0.00,"$1,163.42",$0.00,$0.00,"$1,182.31","$6,752.50",$0.00,"$3,376.25","$5,347.98","$5,402.00",$0.00,"$1,056.77",$0.00,"$1,075.00",$0.00
6276-7-020,SUP,HCPCS C1776,,6276-7-020  -  STEM FEMORAL STR CONE 20MM 155MM MODULAR RSTOR HA HIP,"$6,752.50",$0.00,"$6,752.50","$3,038.63","$4,819.26",$0.00,"$1,163.42",$0.00,$0.00,"$1,182.31","$6,752.50",$0.00,"$3,376.25","$5,347.98","$5,402.00",$0.00,"$1,056.77",$0.00,"$1,075.00",$0.00
6276-7-021,SUP,HCPCS C1776,,6276-7-021  -  STEM FEMORAL STR CONE 21MM 155MM MODULAR RSTOR HA HIP,"$6,752.50",$0.00,"$6,752.50","$3,038.63","$4,819.26",$0.00,"$1,163.42",$0.00,$0.00,"$1,182.31","$6,752.50",$0.00,"$3,376.25","$5,347.98","$5,402.00",$0.00,"$1,056.77",$0.00,"$1,075.00",$0.00
6276-7-022,SUP,HCPCS C1776,,6276-7-022  -  STEM FEMORAL STR CONE 22MM 155MM MODULAR RSTOR HA HIP,"$6,752.50",$0.00,"$6,752.50","$3,038.63","$4,819.26",$0.00,"$1,163.42",$0.00,$0.00,"$1,182.31","$6,752.50",$0.00,"$3,376.25","$5,347.98","$5,402.00",$0.00,"$1,056.77",$0.00,"$1,075.00",$0.00
6276-7-023,SUP,HCPCS C1776,,6276-7-023  -  STEM FEMORAL STR CONE 23MM 155MM MODULAR RSTOR HA HIP,"$6,752.50",$0.00,"$6,752.50","$3,038.63","$4,819.26",$0.00,"$1,163.42",$0.00,$0.00,"$1,182.31","$6,752.50",$0.00,"$3,376.25","$5,347.98","$5,402.00",$0.00,"$1,056.77",$0.00,"$1,075.00",$0.00
6276-7-024,SUP,HCPCS C1776,,6276-7-024  -  STEM FEMORAL STR CONE 24MM 155MM MODULAR RSTOR HA HIP,"$6,752.50",$0.00,"$6,752.50","$3,038.63","$4,819.26",$0.00,"$1,163.42",$0.00,$0.00,"$1,182.31","$6,752.50",$0.00,"$3,376.25","$5,347.98","$5,402.00",$0.00,"$1,056.77",$0.00,"$1,075.00",$0.00
6276-7-025,SUP,HCPCS C1776,,6276-7-025  -  STEM FEMORAL STR CONE 25MM 155MM MODULAR RSTOR HA HIP,"$6,752.50",$0.00,"$6,752.50","$3,038.63","$4,819.26",$0.00,"$1,163.42",$0.00,$0.00,"$1,182.31","$6,752.50",$0.00,"$3,376.25","$5,347.98","$5,402.00",$0.00,"$1,056.77",$0.00,"$1,075.00",$0.00
6276-7-026,SUP,HCPCS C1776,,6276-7-026  -  STEM FEMORAL STR CONE 26MM 155MM MODULAR RSTOR HA HIP,"$6,752.50",$0.00,"$6,752.50","$3,038.63","$4,819.26",$0.00,"$1,163.42",$0.00,$0.00,"$1,182.31","$6,752.50",$0.00,"$3,376.25","$5,347.98","$5,402.00",$0.00,"$1,056.77",$0.00,"$1,075.00",$0.00
6276-7-027,SUP,HCPCS C1776,,6276-7-027  -  STEM FEMORAL STR CONE 27MM 155MM MODULAR RSTOR HA HIP,"$6,752.50",$0.00,"$6,752.50","$3,038.63","$4,819.26",$0.00,"$1,163.42",$0.00,$0.00,"$1,182.31","$6,752.50",$0.00,"$3,376.25","$5,347.98","$5,402.00",$0.00,"$1,056.77",$0.00,"$1,075.00",$0.00
6276-7-028,SUP,HCPCS C1776,,6276-7-028  -  STEM FEMORAL STR CONE 28MM 155MM MODULAR RSTOR HA HIP,"$6,752.50",$0.00,"$6,752.50","$3,038.63","$4,819.26",$0.00,"$1,163.42",$0.00,$0.00,"$1,182.31","$6,752.50",$0.00,"$3,376.25","$5,347.98","$5,402.00",$0.00,"$1,056.77",$0.00,"$1,075.00",$0.00
6276-7-114,SUP,HCPCS C1776,,6276-7-114  -  STEM FEMORAL STR CONE 14MM 195MM MODULAR RSTOR HA HIP,"$7,150.00",$0.00,"$7,150.00","$3,217.50","$5,102.96",$0.00,"$1,231.91",$0.00,$0.00,"$1,251.91","$7,150.00",$0.00,"$3,575.00","$5,662.80","$5,720.00",$0.00,"$1,118.98",$0.00,"$1,138.28",$0.00
6276-7-115,SUP,HCPCS C1776,,6276-7-115  -  STEM FEMORAL STR CONE 15MM 195MM MODULAR RSTOR HA HIP,"$7,150.00",$0.00,"$7,150.00","$3,217.50","$5,102.96",$0.00,"$1,231.91",$0.00,$0.00,"$1,251.91","$7,150.00",$0.00,"$3,575.00","$5,662.80","$5,720.00",$0.00,"$1,118.98",$0.00,"$1,138.28",$0.00
6276-7-116,SUP,HCPCS C1776,,6276-7-116  -  STEM FEMORAL CONE STR 16MM 195MM MODULAR RSTOR HA HIP DISTAL,"$7,150.00",$0.00,"$7,150.00","$3,217.50","$5,102.96",$0.00,"$1,231.91",$0.00,$0.00,"$1,251.91","$7,150.00",$0.00,"$3,575.00","$5,662.80","$5,720.00",$0.00,"$1,118.98",$0.00,"$1,138.28",$0.00
6276-7-117,SUP,HCPCS C1776,,6276-7-117  -  STEM FEMORAL STR CONE 17MM 195MM MODULAR RSTOR HA HIP,"$7,150.00",$0.00,"$7,150.00","$3,217.50","$5,102.96",$0.00,"$1,231.91",$0.00,$0.00,"$1,251.91","$7,150.00",$0.00,"$3,575.00","$5,662.80","$5,720.00",$0.00,"$1,118.98",$0.00,"$1,138.28",$0.00
6276-7-118,SUP,HCPCS C1776,,6276-7-118  -  STEM FEMORAL STR CONE 18MM 195MM MODULAR RSTOR HA HIP,"$7,150.00",$0.00,"$7,150.00","$3,217.50","$5,102.96",$0.00,"$1,231.91",$0.00,$0.00,"$1,251.91","$7,150.00",$0.00,"$3,575.00","$5,662.80","$5,720.00",$0.00,"$1,118.98",$0.00,"$1,138.28",$0.00
6276-7-119,SUP,HCPCS C1776,,6276-7-119  -  STEM FEMORAL STR CONE 19MM 195MM MODULAR RSTOR HA HIP,"$7,150.00",$0.00,"$7,150.00","$3,217.50","$5,102.96",$0.00,"$1,231.91",$0.00,$0.00,"$1,251.91","$7,150.00",$0.00,"$3,575.00","$5,662.80","$5,720.00",$0.00,"$1,118.98",$0.00,"$1,138.28",$0.00
6276-7-120,SUP,HCPCS C1776,,6276-7-120  -  STEM FEMORAL STR CONE 20MM 195MM MODULAR RSTOR HIP,"$7,150.00",$0.00,"$7,150.00","$3,217.50","$5,102.96",$0.00,"$1,231.91",$0.00,$0.00,"$1,251.91","$7,150.00",$0.00,"$3,575.00","$5,662.80","$5,720.00",$0.00,"$1,118.98",$0.00,"$1,138.28",$0.00
6276-7-121,SUP,HCPCS C1776,,6276-7-121  -  STEM FEMORAL STR CONE 21MM 195MM MODULAR RSTOR HIP,"$7,150.00",$0.00,"$7,150.00","$3,217.50","$5,102.96",$0.00,"$1,231.91",$0.00,$0.00,"$1,251.91","$7,150.00",$0.00,"$3,575.00","$5,662.80","$5,720.00",$0.00,"$1,118.98",$0.00,"$1,138.28",$0.00
6276-7-122,SUP,HCPCS C1776,,6276-7-122  -  STEM FEMORAL STR CONE 22MM 195MM MODULAR RSTOR HIP,"$7,150.00",$0.00,"$7,150.00","$3,217.50","$5,102.96",$0.00,"$1,231.91",$0.00,$0.00,"$1,251.91","$7,150.00",$0.00,"$3,575.00","$5,662.80","$5,720.00",$0.00,"$1,118.98",$0.00,"$1,138.28",$0.00
6276-7-123,SUP,HCPCS C1776,,6276-7-123  -  STEM FEMORAL STR CONE 23MM 195MM MODULAR RSTOR HIP,"$7,150.00",$0.00,"$7,150.00","$3,217.50","$5,102.96",$0.00,"$1,231.91",$0.00,$0.00,"$1,251.91","$7,150.00",$0.00,"$3,575.00","$5,662.80","$5,720.00",$0.00,"$1,118.98",$0.00,"$1,138.28",$0.00
6276-7-124,SUP,HCPCS C1776,,6276-7-124  -  STEM FEMORAL STR CONE 24MM 195MM MODULAR RSTOR HIP,"$7,150.00",$0.00,"$7,150.00","$3,217.50","$5,102.96",$0.00,"$1,231.91",$0.00,$0.00,"$1,251.91","$7,150.00",$0.00,"$3,575.00","$5,662.80","$5,720.00",$0.00,"$1,118.98",$0.00,"$1,138.28",$0.00
6276-7-125,SUP,HCPCS C1776,,6276-7-125  -  STEM FEMORAL STR CONE 25MM 195MM MODULAR RSTOR HIP,"$7,150.00",$0.00,"$7,150.00","$3,217.50","$5,102.96",$0.00,"$1,231.91",$0.00,$0.00,"$1,251.91","$7,150.00",$0.00,"$3,575.00","$5,662.80","$5,720.00",$0.00,"$1,118.98",$0.00,"$1,138.28",$0.00
6276-7-126,SUP,HCPCS C1776,,6276-7-126  -  STEM FEMORAL STR CONE 26MM 195MM MODULAR RSTOR HIP,"$7,150.00",$0.00,"$7,150.00","$3,217.50","$5,102.96",$0.00,"$1,231.91",$0.00,$0.00,"$1,251.91","$7,150.00",$0.00,"$3,575.00","$5,662.80","$5,720.00",$0.00,"$1,118.98",$0.00,"$1,138.28",$0.00
6276-7-127,SUP,HCPCS C1776,,6276-7-127  -  STEM FEMORAL STR CONE 27MM 195MM MODULAR RSTOR HIP,"$7,150.00",$0.00,"$7,150.00","$3,217.50","$5,102.96",$0.00,"$1,231.91",$0.00,$0.00,"$1,251.91","$7,150.00",$0.00,"$3,575.00","$5,662.80","$5,720.00",$0.00,"$1,118.98",$0.00,"$1,138.28",$0.00
6276-7-128,SUP,HCPCS C1776,,6276-7-128  -  STEM FEMORAL STR CONE 28MM 195MM MODULAR RSTOR HIP,"$7,150.00",$0.00,"$7,150.00","$3,217.50","$5,102.96",$0.00,"$1,231.91",$0.00,$0.00,"$1,251.91","$7,150.00",$0.00,"$3,575.00","$5,662.80","$5,720.00",$0.00,"$1,118.98",$0.00,"$1,138.28",$0.00
6276-7-214,SUP,HCPCS C1776,,6276-7-214  -  STEM FEMORAL CONICAL 14MM 195MM MODULAR RSTOR DISTAL HIP,"$7,547.50",$0.00,"$7,547.50","$3,396.38","$5,158.80",$0.00,"$1,300.40",$0.00,$0.00,"$1,321.51","$7,547.50",$0.00,"$3,773.75","$5,977.62","$6,038.00",$0.00,"$1,181.18",$0.00,"$1,201.56",$0.00
6276-7-215,SUP,HCPCS C1776,,6276-7-215  -  STEM FEMORAL CONICAL 15MM 195MM BOWED MODULAR RSTOR HIP,"$7,547.50",$0.00,"$7,547.50","$3,396.38","$5,158.80",$0.00,"$1,300.40",$0.00,$0.00,"$1,321.51","$7,547.50",$0.00,"$3,773.75","$5,977.62","$6,038.00",$0.00,"$1,181.18",$0.00,"$1,201.56",$0.00
6276-7-216,SUP,HCPCS C1776,,6276-7-216  -  STEM FEMORAL BOW CONE 16MM 195MM MODULAR REVISION RSTOR,"$7,547.50",$0.00,"$7,547.50","$3,396.38","$5,158.80",$0.00,"$1,300.40",$0.00,$0.00,"$1,321.51","$7,547.50",$0.00,"$3,773.75","$5,977.62","$6,038.00",$0.00,"$1,181.18",$0.00,"$1,201.56",$0.00
6276-7-217,SUP,HCPCS C1776,,6276-7-217  -  STEM FEMORAL BOWED CONICAL 17MM 195MM MODULAR RSTOR DISTAL,"$7,547.50",$0.00,"$7,547.50","$3,396.38","$5,158.80",$0.00,"$1,300.40",$0.00,$0.00,"$1,321.51","$7,547.50",$0.00,"$3,773.75","$5,977.62","$6,038.00",$0.00,"$1,181.18",$0.00,"$1,201.56",$0.00
6276-7-218,SUP,HCPCS C1776,,6276-7-218  -  STEM FEMORAL CONICAL 18MM 195MM BOWED MODULAR RSTOR HA HIP,"$7,547.50",$0.00,"$7,547.50","$3,396.38","$5,158.80",$0.00,"$1,300.40",$0.00,$0.00,"$1,321.51","$7,547.50",$0.00,"$3,773.75","$5,977.62","$6,038.00",$0.00,"$1,181.18",$0.00,"$1,201.56",$0.00
6276-7-219,SUP,HCPCS C1776,,6276-7-219  -  STEM FEMORAL BOWED CONICAL 19MM 195MM MODULAR RSTOR DISTAL,"$7,547.50",$0.00,"$7,547.50","$3,396.38","$5,158.80",$0.00,"$1,300.40",$0.00,$0.00,"$1,321.51","$7,547.50",$0.00,"$3,773.75","$5,977.62","$6,038.00",$0.00,"$1,181.18",$0.00,"$1,201.56",$0.00
6276-7-220,SUP,HCPCS C1776,,6276-7-220  -  STEM FEMORAL CONICAL 20MM 195MM BOWED MODULAR RSTOR HIP,"$7,547.50",$0.00,"$7,547.50","$3,396.38","$5,158.80",$0.00,"$1,300.40",$0.00,$0.00,"$1,321.51","$7,547.50",$0.00,"$3,773.75","$5,977.62","$6,038.00",$0.00,"$1,181.18",$0.00,"$1,201.56",$0.00
6276-7-221,SUP,HCPCS C1776,,6276-7-221  -  STEM FEMORAL BOWED CONICAL 21MM 195MM MODULAR RSTOR DISTAL,"$7,547.50",$0.00,"$7,547.50","$3,396.38","$5,158.80",$0.00,"$1,300.40",$0.00,$0.00,"$1,321.51","$7,547.50",$0.00,"$3,773.75","$5,977.62","$6,038.00",$0.00,"$1,181.18",$0.00,"$1,201.56",$0.00
6276-7-222,SUP,HCPCS C1776,,6276-7-222  -  STEM FEMORAL BOWED CONICAL 22MM 195MM MODULAR RSTOR DISTAL,"$7,547.50",$0.00,"$7,547.50","$3,396.38","$5,158.80",$0.00,"$1,300.40",$0.00,$0.00,"$1,321.51","$7,547.50",$0.00,"$3,773.75","$5,977.62","$6,038.00",$0.00,"$1,181.18",$0.00,"$1,201.56",$0.00
6276-7-223,SUP,HCPCS C1776,,6276-7-223  -  STEM FEMORAL BOWED CONICAL 23MM 195MM MODULAR RSTOR DISTAL,"$7,547.50",$0.00,"$7,547.50","$3,396.38","$5,158.80",$0.00,"$1,300.40",$0.00,$0.00,"$1,321.51","$7,547.50",$0.00,"$3,773.75","$5,977.62","$6,038.00",$0.00,"$1,181.18",$0.00,"$1,201.56",$0.00
6276-7-224,SUP,HCPCS C1776,,6276-7-224  -  STEM FEMORAL BOWED CONICAL 24MM 195MM MODULAR RSTOR DISTAL,"$7,547.50",$0.00,"$7,547.50","$3,396.38","$5,158.80",$0.00,"$1,300.40",$0.00,$0.00,"$1,321.51","$7,547.50",$0.00,"$3,773.75","$5,977.62","$6,038.00",$0.00,"$1,181.18",$0.00,"$1,201.56",$0.00
6276-7-225,SUP,HCPCS C1776,,6276-7-225  -  STEM FEMORAL CONE 25MM 195MM MODULAR REVISION RSTOR HIP,"$7,547.50",$0.00,"$7,547.50","$3,396.38","$5,158.80",$0.00,"$1,300.40",$0.00,$0.00,"$1,321.51","$7,547.50",$0.00,"$3,773.75","$5,977.62","$6,038.00",$0.00,"$1,181.18",$0.00,"$1,201.56",$0.00
6276-7-226,SUP,HCPCS C1776,,6276-7-226  -  STEM FEMORAL BOWED CONICAL 26MM 195MM MODULAR RSTOR DISTAL,"$7,547.50",$0.00,"$7,547.50","$3,396.38","$5,158.80",$0.00,"$1,300.40",$0.00,$0.00,"$1,321.51","$7,547.50",$0.00,"$3,773.75","$5,977.62","$6,038.00",$0.00,"$1,181.18",$0.00,"$1,201.56",$0.00
6276-7-227,SUP,HCPCS C1776,,6276-7-227  -  STEM FEMORAL BOWED CONICAL 27MM 195MM MODULAR RSTOR DISTAL,"$7,547.50",$0.00,"$7,547.50","$3,396.38","$5,158.80",$0.00,"$1,300.40",$0.00,$0.00,"$1,321.51","$7,547.50",$0.00,"$3,773.75","$5,977.62","$6,038.00",$0.00,"$1,181.18",$0.00,"$1,201.56",$0.00
6276-7-228,SUP,HCPCS C1776,,6276-7-228  -  STEM FEMORAL BOWED CONICAL 28MM 195MM MODULAR RSTOR DISTAL,"$7,547.50",$0.00,"$7,547.50","$3,396.38","$5,158.80",$0.00,"$1,300.40",$0.00,$0.00,"$1,321.51","$7,547.50",$0.00,"$3,773.75","$5,977.62","$6,038.00",$0.00,"$1,181.18",$0.00,"$1,201.56",$0.00
6276-7-314,SUP,HCPCS C1776,,6276-7-314  -  STEM FEMORAL BOWED CONICAL 14MM 235MM MODULAR RSTOR DISTAL,"$7,942.50",$0.00,"$7,942.50","$3,574.13","$5,158.80",$0.00,"$1,368.45",$0.00,$0.00,"$1,390.67","$7,942.50",$0.00,"$3,971.25","$6,290.46","$6,354.00",$0.00,"$1,243.00",$0.00,"$1,264.45",$0.00
6276-7-315,SUP,HCPCS C1776,,6276-7-315  -  STEM FEMORAL BOWED CONICAL 15MM 235MM MODULAR RSTOR DISTAL,"$7,942.50",$0.00,"$7,942.50","$3,574.13","$5,158.80",$0.00,"$1,368.45",$0.00,$0.00,"$1,390.67","$7,942.50",$0.00,"$3,971.25","$6,290.46","$6,354.00",$0.00,"$1,243.00",$0.00,"$1,264.45",$0.00
6276-7-316,SUP,HCPCS C1776,,6276-7-316  -  STEM FEMORAL BOWED CONICAL 16MM 235MM MODULAR RSTOR DISTAL,"$7,942.50",$0.00,"$7,942.50","$3,574.13","$5,158.80",$0.00,"$1,368.45",$0.00,$0.00,"$1,390.67","$7,942.50",$0.00,"$3,971.25","$6,290.46","$6,354.00",$0.00,"$1,243.00",$0.00,"$1,264.45",$0.00
6276-7-317,SUP,HCPCS C1776,,6276-7-317  -  STEM FEMORAL BOWED CONICAL 17MM 235MM MODULAR RSTOR DISTAL,"$7,942.50",$0.00,"$7,942.50","$3,574.13","$5,158.80",$0.00,"$1,368.45",$0.00,$0.00,"$1,390.67","$7,942.50",$0.00,"$3,971.25","$6,290.46","$6,354.00",$0.00,"$1,243.00",$0.00,"$1,264.45",$0.00
6276-7-318,SUP,HCPCS C1776,,6276-7-318  -  STEM FEMORAL BOWED CONICAL 18MM 235MM MODULAR RSTOR DISTAL,"$7,942.50",$0.00,"$7,942.50","$3,574.13","$5,158.80",$0.00,"$1,368.45",$0.00,$0.00,"$1,390.67","$7,942.50",$0.00,"$3,971.25","$6,290.46","$6,354.00",$0.00,"$1,243.00",$0.00,"$1,264.45",$0.00
6276-7-319,SUP,HCPCS C1776,,6276-7-319  -  STEM FEMORAL BOWED CONICAL 19MM 235MM MODULAR RSTOR DISTAL,"$7,942.50",$0.00,"$7,942.50","$3,574.13","$5,158.80",$0.00,"$1,368.45",$0.00,$0.00,"$1,390.67","$7,942.50",$0.00,"$3,971.25","$6,290.46","$6,354.00",$0.00,"$1,243.00",$0.00,"$1,264.45",$0.00
6276-7-320,SUP,HCPCS C1776,,6276-7-320  -  STEM FEMORAL BOWED CONICAL 20MM 235MM MODULAR RSTOR DISTAL,"$7,942.50",$0.00,"$7,942.50","$3,574.13","$5,158.80",$0.00,"$1,368.45",$0.00,$0.00,"$1,390.67","$7,942.50",$0.00,"$3,971.25","$6,290.46","$6,354.00",$0.00,"$1,243.00",$0.00,"$1,264.45",$0.00
6276-7-321,SUP,HCPCS C1776,,6276-7-321  -  STEM FEMORAL BOWED CONICAL 21MM 235MM MODULAR RSTOR DISTAL,"$7,942.50",$0.00,"$7,942.50","$3,574.13","$5,158.80",$0.00,"$1,368.45",$0.00,$0.00,"$1,390.67","$7,942.50",$0.00,"$3,971.25","$6,290.46","$6,354.00",$0.00,"$1,243.00",$0.00,"$1,264.45",$0.00
6276-7-322,SUP,HCPCS C1776,,6276-7-322  -  STEM FEMORAL BOWED CONICAL 22MM 235MM MODULAR RSTOR DISTAL,"$7,942.50",$0.00,"$7,942.50","$3,574.13","$5,158.80",$0.00,"$1,368.45",$0.00,$0.00,"$1,390.67","$7,942.50",$0.00,"$3,971.25","$6,290.46","$6,354.00",$0.00,"$1,243.00",$0.00,"$1,264.45",$0.00
6276-7-323,SUP,HCPCS C1776,,6276-7-323  -  STEM FEMORAL BOWED CONICAL 23MM 235MM MODULAR RSTOR DISTAL,"$7,942.50",$0.00,"$7,942.50","$3,574.13","$5,158.80",$0.00,"$1,368.45",$0.00,$0.00,"$1,390.67","$7,942.50",$0.00,"$3,971.25","$6,290.46","$6,354.00",$0.00,"$1,243.00",$0.00,"$1,264.45",$0.00
6276-7-324,SUP,HCPCS C1776,,6276-7-324  -  STEM FEMORAL BOWED CONICAL 24MM 235MM MODULAR RSTOR DISTAL,"$7,942.50",$0.00,"$7,942.50","$3,574.13","$5,158.80",$0.00,"$1,368.45",$0.00,$0.00,"$1,390.67","$7,942.50",$0.00,"$3,971.25","$6,290.46","$6,354.00",$0.00,"$1,243.00",$0.00,"$1,264.45",$0.00
6276-7-325,SUP,HCPCS C1776,,6276-7-325  -  STEM FEMORAL BOWED CONICAL 25MM 235MM MODULAR RSTOR DISTAL,"$7,942.50",$0.00,"$7,942.50","$3,574.13","$5,158.80",$0.00,"$1,368.45",$0.00,$0.00,"$1,390.67","$7,942.50",$0.00,"$3,971.25","$6,290.46","$6,354.00",$0.00,"$1,243.00",$0.00,"$1,264.45",$0.00
6276-7-326,SUP,HCPCS C1776,,6276-7-326  -  STEM FEMORAL BOWED CONICAL 26MM 235MM MODULAR RSTOR DISTAL,"$7,942.50",$0.00,"$7,942.50","$3,574.13","$5,158.80",$0.00,"$1,368.45",$0.00,$0.00,"$1,390.67","$7,942.50",$0.00,"$3,971.25","$6,290.46","$6,354.00",$0.00,"$1,243.00",$0.00,"$1,264.45",$0.00
6276-7-327,SUP,HCPCS C1776,,6276-7-327  -  STEM FEMORAL BOWED CONICAL 27MM 235MM MODULAR RSTOR DISTAL,"$7,942.50",$0.00,"$7,942.50","$3,574.13","$5,158.80",$0.00,"$1,368.45",$0.00,$0.00,"$1,390.67","$7,942.50",$0.00,"$3,971.25","$6,290.46","$6,354.00",$0.00,"$1,243.00",$0.00,"$1,264.45",$0.00
6276-7-328,SUP,HCPCS C1776,,6276-7-328  -  STEM FEMORAL BOWED CONICAL 28MM 235MM MODULAR RSTOR DISTAL,"$7,942.50",$0.00,"$7,942.50","$3,574.13","$5,158.80",$0.00,"$1,368.45",$0.00,$0.00,"$1,390.67","$7,942.50",$0.00,"$3,971.25","$6,290.46","$6,354.00",$0.00,"$1,243.00",$0.00,"$1,264.45",$0.00
6276-8-213,SUP,HCPCS C1776,,6276-8-213  -  STEM FEMORAL 13MM 167MM BOWED SLOTTED PLASMA HIP,"$8,260.00",$0.00,"$8,260.00","$3,717.00","$5,158.80",$0.00,"$1,423.16",$0.00,$0.00,"$1,446.26","$8,260.00",$0.00,"$4,130.00","$6,541.92","$6,608.00",$0.00,"$1,292.69",$0.00,"$1,314.99",$0.00
6276-8-214,SUP,HCPCS C1776,,6276-8-214  -  STEM FEMORAL 14MM 167MM BOWED SLOTTED PLASMA HIP,"$8,260.00",$0.00,"$8,260.00","$3,717.00","$5,158.80",$0.00,"$1,423.16",$0.00,$0.00,"$1,446.26","$8,260.00",$0.00,"$4,130.00","$6,541.92","$6,608.00",$0.00,"$1,292.69",$0.00,"$1,314.99",$0.00
6276-8-215,SUP,HCPCS C1776,,6276-8-215  -  STEM FEMORAL 15MM 167MM BOWED SLOTTED PLASMA HIP,"$8,260.00",$0.00,"$8,260.00","$3,717.00","$5,158.80",$0.00,"$1,423.16",$0.00,$0.00,"$1,446.26","$8,260.00",$0.00,"$4,130.00","$6,541.92","$6,608.00",$0.00,"$1,292.69",$0.00,"$1,314.99",$0.00
6276-8-216,SUP,HCPCS C1776,,6276-8-216  -  STEM FEMORAL 16MM 167MM BOWED SLOTTED PLASMA HIP,"$8,260.00",$0.00,"$8,260.00","$3,717.00","$5,158.80",$0.00,"$1,423.16",$0.00,$0.00,"$1,446.26","$8,260.00",$0.00,"$4,130.00","$6,541.92","$6,608.00",$0.00,"$1,292.69",$0.00,"$1,314.99",$0.00
6276-8-217,SUP,HCPCS C1776,,6276-8-217  -  STEM FEMORAL 17MM 167MM BOWED SLOTTED PLASMA HIP,"$8,260.00",$0.00,"$8,260.00","$3,717.00","$5,158.80",$0.00,"$1,423.16",$0.00,$0.00,"$1,446.26","$8,260.00",$0.00,"$4,130.00","$6,541.92","$6,608.00",$0.00,"$1,292.69",$0.00,"$1,314.99",$0.00
6276-8-218,SUP,HCPCS C1776,,6276-8-218  -  STEM FEMORAL 18MM 167MM BOWED SLOTTED PLASMA HIP,"$8,260.00",$0.00,"$8,260.00","$3,717.00","$5,158.80",$0.00,"$1,423.16",$0.00,$0.00,"$1,446.26","$8,260.00",$0.00,"$4,130.00","$6,541.92","$6,608.00",$0.00,"$1,292.69",$0.00,"$1,314.99",$0.00
6276-8-219,SUP,HCPCS C1776,,6276-8-219  -  STEM FEMORAL 19MM 167MM BOWED SLOTTED PLASMA HIP,"$8,260.00",$0.00,"$8,260.00","$3,717.00","$5,158.80",$0.00,"$1,423.16",$0.00,$0.00,"$1,446.26","$8,260.00",$0.00,"$4,130.00","$6,541.92","$6,608.00",$0.00,"$1,292.69",$0.00,"$1,314.99",$0.00
6276-8-220,SUP,HCPCS C1776,,6276-8-220  -  STEM FEMORAL 20MM 167MM BOWED SLOTTED PLASMA HIP,"$8,260.00",$0.00,"$8,260.00","$3,717.00","$5,158.80",$0.00,"$1,423.16",$0.00,$0.00,"$1,446.26","$8,260.00",$0.00,"$4,130.00","$6,541.92","$6,608.00",$0.00,"$1,292.69",$0.00,"$1,314.99",$0.00
6276-8-221,SUP,HCPCS C1776,,6276-8-221  -  STEM FEMORAL 21MM 167MM BOWED SLOTTED PLASMA HIP,"$8,260.00",$0.00,"$8,260.00","$3,717.00","$5,158.80",$0.00,"$1,423.16",$0.00,$0.00,"$1,446.26","$8,260.00",$0.00,"$4,130.00","$6,541.92","$6,608.00",$0.00,"$1,292.69",$0.00,"$1,314.99",$0.00
6276-8-222,SUP,HCPCS C1776,,6276-8-222  -  STEM FEMORAL 22MM 167MM BOWED SLOTTED PLASMA HIP,"$8,260.00",$0.00,"$8,260.00","$3,717.00","$5,158.80",$0.00,"$1,423.16",$0.00,$0.00,"$1,446.26","$8,260.00",$0.00,"$4,130.00","$6,541.92","$6,608.00",$0.00,"$1,292.69",$0.00,"$1,314.99",$0.00
6276-8-223,SUP,HCPCS C1776,,6276-8-223  -  STEM FEMORAL 23MM 167MM BOWED SLOTTED PLASMA HIP,"$8,260.00",$0.00,"$8,260.00","$3,717.00","$5,158.80",$0.00,"$1,423.16",$0.00,$0.00,"$1,446.26","$8,260.00",$0.00,"$4,130.00","$6,541.92","$6,608.00",$0.00,"$1,292.69",$0.00,"$1,314.99",$0.00
6276-8-224,SUP,HCPCS C1776,,6276-8-224  -  STEM FEMORAL 24MM 167MM BOWED SLOTTED PLASMA HIP,"$8,260.00",$0.00,"$8,260.00","$3,717.00","$5,158.80",$0.00,"$1,423.16",$0.00,$0.00,"$1,446.26","$8,260.00",$0.00,"$4,130.00","$6,541.92","$6,608.00",$0.00,"$1,292.69",$0.00,"$1,314.99",$0.00
6276-8-225,SUP,HCPCS C1776,,6276-8-225  -  STEM FEMORAL 25MM 167MM BOWED SLOTTED PLASMA HIP,"$8,260.00",$0.00,"$8,260.00","$3,717.00","$5,158.80",$0.00,"$1,423.16",$0.00,$0.00,"$1,446.26","$8,260.00",$0.00,"$4,130.00","$6,541.92","$6,608.00",$0.00,"$1,292.69",$0.00,"$1,314.99",$0.00
6276-8-226,SUP,HCPCS C1776,,6276-8-226  -  STEM FEMORAL 26MM 167MM BOWED SLOTTED PLASMA HIP,"$8,260.00",$0.00,"$8,260.00","$3,717.00","$5,158.80",$0.00,"$1,423.16",$0.00,$0.00,"$1,446.26","$8,260.00",$0.00,"$4,130.00","$6,541.92","$6,608.00",$0.00,"$1,292.69",$0.00,"$1,314.99",$0.00
6276-8-413,SUP,HCPCS C1776,,6276-8-413  -  STEM FEMORAL 13MM 217MM BOWED SLOTTED PLASMA HIP,"$8,640.00",$0.00,"$8,640.00","$3,888.00","$5,158.80",$0.00,"$1,488.63",$0.00,$0.00,"$1,512.79","$8,640.00",$0.00,"$4,320.00","$6,842.88","$6,912.00",$0.00,"$1,352.16",$0.00,"$1,375.49",$0.00
6276-8-414,SUP,HCPCS C1776,,6276-8-414  -  STEM FEMORAL 14MM 217MM BOWED SLOTTED PLASMA HIP,"$8,640.00",$0.00,"$8,640.00","$3,888.00","$5,158.80",$0.00,"$1,488.63",$0.00,$0.00,"$1,512.79","$8,640.00",$0.00,"$4,320.00","$6,842.88","$6,912.00",$0.00,"$1,352.16",$0.00,"$1,375.49",$0.00
6276-8-415,SUP,HCPCS C1776,,6276-8-415  -  STEM FEMORAL 15MM 217MM BOWED SLOTTED PLASMA HIP,"$8,640.00",$0.00,"$8,640.00","$3,888.00","$5,158.80",$0.00,"$1,488.63",$0.00,$0.00,"$1,512.79","$8,640.00",$0.00,"$4,320.00","$6,842.88","$6,912.00",$0.00,"$1,352.16",$0.00,"$1,375.49",$0.00
6276-8-416,SUP,HCPCS C1776,,6276-8-416  -  STEM FEMORAL 16MM 1217MM BOWED SLOTTED PLASMA HIP,"$8,640.00",$0.00,"$8,640.00","$3,888.00","$5,158.80",$0.00,"$1,488.63",$0.00,$0.00,"$1,512.79","$8,640.00",$0.00,"$4,320.00","$6,842.88","$6,912.00",$0.00,"$1,352.16",$0.00,"$1,375.49",$0.00
6276-8-417,SUP,HCPCS C1776,,6276-8-417  -  STEM FEMORAL 17MM 217MM BOWED SLOTTED PLASMA HIP,"$8,640.00",$0.00,"$8,640.00","$3,888.00","$5,158.80",$0.00,"$1,488.63",$0.00,$0.00,"$1,512.79","$8,640.00",$0.00,"$4,320.00","$6,842.88","$6,912.00",$0.00,"$1,352.16",$0.00,"$1,375.49",$0.00
6276-8-418,SUP,HCPCS C1776,,6276-8-418  -  STEM FEMORAL 18MM 217MM BOWED SLOTTED PLASMA HIP,"$8,640.00",$0.00,"$8,640.00","$3,888.00","$5,158.80",$0.00,"$1,488.63",$0.00,$0.00,"$1,512.79","$8,640.00",$0.00,"$4,320.00","$6,842.88","$6,912.00",$0.00,"$1,352.16",$0.00,"$1,375.49",$0.00
6276-8-419,SUP,HCPCS C1776,,6276-8-419  -  STEM FEMORAL 19MM 1217MM BOWED SLOTTED PLASMA HIP,"$8,640.00",$0.00,"$8,640.00","$3,888.00","$5,158.80",$0.00,"$1,488.63",$0.00,$0.00,"$1,512.79","$8,640.00",$0.00,"$4,320.00","$6,842.88","$6,912.00",$0.00,"$1,352.16",$0.00,"$1,375.49",$0.00
6276-8-420,SUP,HCPCS C1776,,6276-8-420  -  STEM FEMORAL 20MM 1217MM BOWED SLOTTED PLASMA HIP,"$8,640.00",$0.00,"$8,640.00","$3,888.00","$5,158.80",$0.00,"$1,488.63",$0.00,$0.00,"$1,512.79","$8,640.00",$0.00,"$4,320.00","$6,842.88","$6,912.00",$0.00,"$1,352.16",$0.00,"$1,375.49",$0.00
6276-8-421,SUP,HCPCS C1776,,6276-8-421  -  STEM FEMORAL 21MM 1217MM BOWED SLOTTED PLASMA HIP,"$8,640.00",$0.00,"$8,640.00","$3,888.00","$5,158.80",$0.00,"$1,488.63",$0.00,$0.00,"$1,512.79","$8,640.00",$0.00,"$4,320.00","$6,842.88","$6,912.00",$0.00,"$1,352.16",$0.00,"$1,375.49",$0.00
6276-8-422,SUP,HCPCS C1776,,6276-8-422  -  STEM FEMORAL 22MM 217MM BOWED SLOTTED PLASMA HIP,"$8,640.00",$0.00,"$8,640.00","$3,888.00","$5,158.80",$0.00,"$1,488.63",$0.00,$0.00,"$1,512.79","$8,640.00",$0.00,"$4,320.00","$6,842.88","$6,912.00",$0.00,"$1,352.16",$0.00,"$1,375.49",$0.00
6276-8-423,SUP,HCPCS C1776,,6276-8-423  -  STEM FEMORAL 23MM 217MM BOWED SLOTTED PLASMA HIP,"$8,640.00",$0.00,"$8,640.00","$3,888.00","$5,158.80",$0.00,"$1,488.63",$0.00,$0.00,"$1,512.79","$8,640.00",$0.00,"$4,320.00","$6,842.88","$6,912.00",$0.00,"$1,352.16",$0.00,"$1,375.49",$0.00
6276-8-424,SUP,HCPCS C1776,,6276-8-424  -  STEM FEMORAL 24MM 217MM BOWED SLOTTED PLASMA HIP,"$8,640.00",$0.00,"$8,640.00","$3,888.00","$5,158.80",$0.00,"$1,488.63",$0.00,$0.00,"$1,512.79","$8,640.00",$0.00,"$4,320.00","$6,842.88","$6,912.00",$0.00,"$1,352.16",$0.00,"$1,375.49",$0.00
6276-8-425,SUP,HCPCS C1776,,6276-8-425  -  STEM FEMORAL 25MM 217MM BOWED SLOTTED PLASMA HIP,"$8,640.00",$0.00,"$8,640.00","$3,888.00","$5,158.80",$0.00,"$1,488.63",$0.00,$0.00,"$1,512.79","$8,640.00",$0.00,"$4,320.00","$6,842.88","$6,912.00",$0.00,"$1,352.16",$0.00,"$1,375.49",$0.00
6276-8-426,SUP,HCPCS C1776,,6276-8-426  -  STEM FEMORAL 26MM 217MM BOWED SLOTTED PLASMA HIP,"$8,640.00",$0.00,"$8,640.00","$3,888.00","$5,158.80",$0.00,"$1,488.63",$0.00,$0.00,"$1,512.79","$8,640.00",$0.00,"$4,320.00","$6,842.88","$6,912.00",$0.00,"$1,352.16",$0.00,"$1,375.49",$0.00
6276-8-513,SUP,HCPCS C1776,,6276-8-513  -  STEM FEMORAL 13MM 267MM BOWED SLOTTED PLASMA HIP,"$9,027.50",$0.00,"$9,027.50","$4,062.38","$5,158.80",$0.00,"$1,555.39",$0.00,$0.00,"$1,580.64","$9,027.50",$0.00,"$4,513.75","$7,149.78","$7,222.00",$0.00,"$1,412.80",$0.00,"$1,437.18",$0.00
6276-8-514,SUP,HCPCS C1776,,6276-8-514  -  STEM FEMORAL 14MM 267MM BOWED SLOTTED PLASMA HIP,"$9,027.50",$0.00,"$9,027.50","$4,062.38","$5,158.80",$0.00,"$1,555.39",$0.00,$0.00,"$1,580.64","$9,027.50",$0.00,"$4,513.75","$7,149.78","$7,222.00",$0.00,"$1,412.80",$0.00,"$1,437.18",$0.00
6276-8-515,SUP,HCPCS C1776,,6276-8-515  -  STEM FEMORAL 15MM 267MM BOWED SLOTTED PLASMA HIP,"$9,027.50",$0.00,"$9,027.50","$4,062.38","$5,158.80",$0.00,"$1,555.39",$0.00,$0.00,"$1,580.64","$9,027.50",$0.00,"$4,513.75","$7,149.78","$7,222.00",$0.00,"$1,412.80",$0.00,"$1,437.18",$0.00
6276-8-516,SUP,HCPCS C1776,,6276-8-516  -  STEM FEMORAL 16MM 267MM BOWED SLOTTED PLASMA HIP,"$9,027.50",$0.00,"$9,027.50","$4,062.38","$5,158.80",$0.00,"$1,555.39",$0.00,$0.00,"$1,580.64","$9,027.50",$0.00,"$4,513.75","$7,149.78","$7,222.00",$0.00,"$1,412.80",$0.00,"$1,437.18",$0.00
6276-8-517,SUP,HCPCS C1776,,6276-8-517  -  STEM FEMORAL 17MM 267MM BOWED SLOTTED PLASMA HIP,"$9,027.50",$0.00,"$9,027.50","$4,062.38","$5,158.80",$0.00,"$1,555.39",$0.00,$0.00,"$1,580.64","$9,027.50",$0.00,"$4,513.75","$7,149.78","$7,222.00",$0.00,"$1,412.80",$0.00,"$1,437.18",$0.00
6276-8-518,SUP,HCPCS C1776,,6276-8-518  -  STEM FEMORAL 18MM 267MM BOWED SLOTTED PLASMA HIP,"$9,027.50",$0.00,"$9,027.50","$4,062.38","$5,158.80",$0.00,"$1,555.39",$0.00,$0.00,"$1,580.64","$9,027.50",$0.00,"$4,513.75","$7,149.78","$7,222.00",$0.00,"$1,412.80",$0.00,"$1,437.18",$0.00
6276-8-519,SUP,HCPCS C1776,,6276-8-519  -  STEM FEMORAL 19MM 267MM BOWED SLOTTED PLASMA HIP,"$9,027.50",$0.00,"$9,027.50","$4,062.38","$5,158.80",$0.00,"$1,555.39",$0.00,$0.00,"$1,580.64","$9,027.50",$0.00,"$4,513.75","$7,149.78","$7,222.00",$0.00,"$1,412.80",$0.00,"$1,437.18",$0.00
6276-8-520,SUP,HCPCS C1776,,6276-8-520  -  STEM FEMORAL 20MM 267MM BOWED SLOTTED PLASMA HIP,"$9,027.50",$0.00,"$9,027.50","$4,062.38","$5,158.80",$0.00,"$1,555.39",$0.00,$0.00,"$1,580.64","$9,027.50",$0.00,"$4,513.75","$7,149.78","$7,222.00",$0.00,"$1,412.80",$0.00,"$1,437.18",$0.00
6276-8-521,SUP,HCPCS C1776,,6276-8-521  -  STEM FEMORAL 21MM 267MM BOWED SLOTTED PLASMA HIP,"$9,027.50",$0.00,"$9,027.50","$4,062.38","$5,158.80",$0.00,"$1,555.39",$0.00,$0.00,"$1,580.64","$9,027.50",$0.00,"$4,513.75","$7,149.78","$7,222.00",$0.00,"$1,412.80",$0.00,"$1,437.18",$0.00
6276-8-522,SUP,HCPCS C1776,,6276-8-522  -  STEM FEMORAL 22MM 267MM BOWED SLOTTED PLASMA HIP,"$9,027.50",$0.00,"$9,027.50","$4,062.38","$5,158.80",$0.00,"$1,555.39",$0.00,$0.00,"$1,580.64","$9,027.50",$0.00,"$4,513.75","$7,149.78","$7,222.00",$0.00,"$1,412.80",$0.00,"$1,437.18",$0.00
6276-8-523,SUP,HCPCS C1776,,6276-8-523  -  STEM FEMORAL 23MM 267MM BOWED SLOTTED PLASMA HIP,"$9,027.50",$0.00,"$9,027.50","$4,062.38","$5,158.80",$0.00,"$1,555.39",$0.00,$0.00,"$1,580.64","$9,027.50",$0.00,"$4,513.75","$7,149.78","$7,222.00",$0.00,"$1,412.80",$0.00,"$1,437.18",$0.00
6276-8-524,SUP,HCPCS C1776,,6276-8-524  -  STEM FEMORAL 24MM 267MM BOWED SLOTTED PLASMA HIP,"$9,027.50",$0.00,"$9,027.50","$4,062.38","$5,158.80",$0.00,"$1,555.39",$0.00,$0.00,"$1,580.64","$9,027.50",$0.00,"$4,513.75","$7,149.78","$7,222.00",$0.00,"$1,412.80",$0.00,"$1,437.18",$0.00
6276-8-525,SUP,HCPCS C1776,,6276-8-525  -  STEM FEMORAL 25MM 267MM BOWED SLOTTED PLASMA HIP,"$9,027.50",$0.00,"$9,027.50","$4,062.38","$5,158.80",$0.00,"$1,555.39",$0.00,$0.00,"$1,580.64","$9,027.50",$0.00,"$4,513.75","$7,149.78","$7,222.00",$0.00,"$1,412.80",$0.00,"$1,437.18",$0.00
6276-8-526,SUP,HCPCS C1776,,6276-8-526  -  STEM FEMORAL 26MM 267MM BOWED SLOTTED PLASMA HIP,"$9,027.50",$0.00,"$9,027.50","$4,062.38","$5,158.80",$0.00,"$1,555.39",$0.00,$0.00,"$1,580.64","$9,027.50",$0.00,"$4,513.75","$7,149.78","$7,222.00",$0.00,"$1,412.80",$0.00,"$1,437.18",$0.00
6276-8-613,SUP,HCPCS C1776,,6276-8-613  -  STEM FEMORAL 13MM 317MM BOWED SLOTTED PLASMA HIP,"$9,410.00",$0.00,"$9,410.00","$4,234.50","$5,158.80",$0.00,"$1,621.30",$0.00,$0.00,"$1,647.62","$9,410.00",$0.00,"$4,705.00","$7,452.72","$7,528.00",$0.00,"$1,472.67",$0.00,"$1,498.07",$0.00
6276-8-614,SUP,HCPCS C1776,,6276-8-614  -  STEM FEMORAL 14MM 317MM BOWED SLOTTED PLASMA HIP,"$9,410.00",$0.00,"$9,410.00","$4,234.50","$5,158.80",$0.00,"$1,621.30",$0.00,$0.00,"$1,647.62","$9,410.00",$0.00,"$4,705.00","$7,452.72","$7,528.00",$0.00,"$1,472.67",$0.00,"$1,498.07",$0.00
6276-8-615,SUP,HCPCS C1776,,6276-8-615  -  STEM FEMORAL 15MM 317MM BOWED SLOTTED PLASMA HIP,"$9,410.00",$0.00,"$9,410.00","$4,234.50","$5,158.80",$0.00,"$1,621.30",$0.00,$0.00,"$1,647.62","$9,410.00",$0.00,"$4,705.00","$7,452.72","$7,528.00",$0.00,"$1,472.67",$0.00,"$1,498.07",$0.00
6276-8-616,SUP,HCPCS C1776,,6276-8-616  -  STEM FEMORAL 16MM 317MM BOWED SLOTTED PLASMA HIP,"$9,410.00",$0.00,"$9,410.00","$4,234.50","$5,158.80",$0.00,"$1,621.30",$0.00,$0.00,"$1,647.62","$9,410.00",$0.00,"$4,705.00","$7,452.72","$7,528.00",$0.00,"$1,472.67",$0.00,"$1,498.07",$0.00
6276-8-617,SUP,HCPCS C1776,,6276-8-617  -  STEM FEMORAL 17MM 317MM BOWED SLOTTED PLASMA HIP,"$9,410.00",$0.00,"$9,410.00","$4,234.50","$5,158.80",$0.00,"$1,621.30",$0.00,$0.00,"$1,647.62","$9,410.00",$0.00,"$4,705.00","$7,452.72","$7,528.00",$0.00,"$1,472.67",$0.00,"$1,498.07",$0.00
6276-8-618,SUP,HCPCS C1776,,6276-8-618  -  STEM FEMORAL 18MM 317MM BOWED SLOTTED PLASMA HIP,"$9,410.00",$0.00,"$9,410.00","$4,234.50","$5,158.80",$0.00,"$1,621.30",$0.00,$0.00,"$1,647.62","$9,410.00",$0.00,"$4,705.00","$7,452.72","$7,528.00",$0.00,"$1,472.67",$0.00,"$1,498.07",$0.00
6276-8-619,SUP,HCPCS C1776,,6276-8-619  -  STEM FEMORAL 19MM 317MM BOWED SLOTTED PLASMA HIP,"$9,410.00",$0.00,"$9,410.00","$4,234.50","$5,158.80",$0.00,"$1,621.30",$0.00,$0.00,"$1,647.62","$9,410.00",$0.00,"$4,705.00","$7,452.72","$7,528.00",$0.00,"$1,472.67",$0.00,"$1,498.07",$0.00
6276-8-620,SUP,HCPCS C1776,,6276-8-620  -  STEM FEMORAL 20MM 317MM BOWED SLOTTED PLASMA HIP,"$9,410.00",$0.00,"$9,410.00","$4,234.50","$5,158.80",$0.00,"$1,621.30",$0.00,$0.00,"$1,647.62","$9,410.00",$0.00,"$4,705.00","$7,452.72","$7,528.00",$0.00,"$1,472.67",$0.00,"$1,498.07",$0.00
6276-8-621,SUP,HCPCS C1776,,6276-8-621  -  STEM FEMORAL 21MM 317MM BOWED SLOTTED PLASMA HIP,"$9,410.00",$0.00,"$9,410.00","$4,234.50","$5,158.80",$0.00,"$1,621.30",$0.00,$0.00,"$1,647.62","$9,410.00",$0.00,"$4,705.00","$7,452.72","$7,528.00",$0.00,"$1,472.67",$0.00,"$1,498.07",$0.00
6276-8-622,SUP,HCPCS C1776,,6276-8-622  -  STEM FEMORAL 22MM 317MM BOWED SLOTTED PLASMA HIP,"$9,410.00",$0.00,"$9,410.00","$4,234.50","$5,158.80",$0.00,"$1,621.30",$0.00,$0.00,"$1,647.62","$9,410.00",$0.00,"$4,705.00","$7,452.72","$7,528.00",$0.00,"$1,472.67",$0.00,"$1,498.07",$0.00
6276-8-623,SUP,HCPCS C1776,,6276-8-623  -  STEM FEMORAL 23MM 317MM BOWED SLOTTED PLASMA HIP,"$9,410.00",$0.00,"$9,410.00","$4,234.50","$5,158.80",$0.00,"$1,621.30",$0.00,$0.00,"$1,647.62","$9,410.00",$0.00,"$4,705.00","$7,452.72","$7,528.00",$0.00,"$1,472.67",$0.00,"$1,498.07",$0.00
6276-8-624,SUP,HCPCS C1776,,6276-8-624  -  STEM FEMORAL 24MM 317MM BOWED SLOTTED PLASMA HIP,"$9,410.00",$0.00,"$9,410.00","$4,234.50","$5,158.80",$0.00,"$1,621.30",$0.00,$0.00,"$1,647.62","$9,410.00",$0.00,"$4,705.00","$7,452.72","$7,528.00",$0.00,"$1,472.67",$0.00,"$1,498.07",$0.00
6276-8-625,SUP,HCPCS C1776,,6276-8-625  -  STEM FEMORAL 25MM 317MM BOWED SLOTTED PLASMA HIP,"$9,410.00",$0.00,"$9,410.00","$4,234.50","$5,158.80",$0.00,"$1,621.30",$0.00,$0.00,"$1,647.62","$9,410.00",$0.00,"$4,705.00","$7,452.72","$7,528.00",$0.00,"$1,472.67",$0.00,"$1,498.07",$0.00
6276-8-626,SUP,HCPCS C1776,,6276-8-626  -  STEM FEMORAL 26MM 317MM BOWED SLOTTED PLASMA HIP,"$9,410.00",$0.00,"$9,410.00","$4,234.50","$5,158.80",$0.00,"$1,621.30",$0.00,$0.00,"$1,647.62","$9,410.00",$0.00,"$4,705.00","$7,452.72","$7,528.00",$0.00,"$1,472.67",$0.00,"$1,498.07",$0.00
6280-0-036,SUP,Custom 27803010,,6280-0-036  -  HEAD FEM -3MM 36MM PCA OFST,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6280-0-126,SUP,Custom 27803010,,6280-0-126  -  HEAD FEMORAL STANDARD OFFST 26MM PCA VITALLIUM HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6280-0-128,SUP,Custom 27803010,,6280-0-128  -  HEAD FEM +0MM OFST 28MM STRL PCA VIT HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6280-0-132,SUP,Custom 27803010,,6280-0-132  -  HEAD FEM +0MM OFST 32MM STRL PCA VIT HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6280-0-136,SUP,Custom 27803010,,6280-0-136  -  HEAD FEM 36MM PCA,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6280-0-226,SUP,Custom 27803010,,6280-0-226  -  HEAD FEMORAL +5MM 26MM PCA VITALLIUM HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6280-0-228,SUP,Custom 27803010,,6280-0-228  -  HEAD FEM +5MM OFST 28MM STRL PCA VIT HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6280-0-232,SUP,Custom 27803010,,6280-0-232  -  HEAD FEM +5MM OFST 32MM STRL PCA VIT HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6280-0-236,SUP,Custom 27803010,,6280-0-236  -  HEAD FEM +5MM OFST 36MM STRL PCA VIT HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6280-0-326,SUP,Custom 27803010,,6280-0-326  -  HEAD FEMORAL +10MM 26MM PCA VITALLIUM HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6280-0-328,SUP,Custom 27803010,,6280-0-328  -  HEAD FEM +10MM OFST 28MM PCA HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6280-0-332,SUP,Custom 27803010,,6280-0-332  -  HEAD FEMORAL +10MM TAPER 32MM PCA VITALLIUM HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6280-0-336,SUP,Custom 27803010,,6280-0-336  -  HEAD FEM +10MM 36MM HIP OFFST PCA,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6280-0-436,SUP,Custom 27803010,,6280-0-436  -  HEAD FEM +15MM 36MM OFFST PCA,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6280-0-622,SUP,Custom 27803010,,6280-0-622  -  HEAD FEM +2MM OFST 22.2MM STRL PCA VIT HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6280-0-722,SUP,Custom 27803010,,6280-0-722  -  HEAD FEMORAL +5MM 22.2MM PCA VITALLIUM HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6280-0-822,SUP,Custom 27803010,,6280-0-822  -  HEAD FEMORAL +10MM 22MM PCA VITALLIUM HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6280-3-032,SUP,Custom 27803010,,6280-3-032  -  HEAD FEMORAL +3MM 32MM PCA VITALLIUM HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6290-7-012,SUP,HCPCS C1713,,6290-7-012  -  SCREW BONE 6.2MM 12MM CANC SLFTAP,$152.00,$0.00,$152.00,$68.40,$108.48,$0.00,$26.19,$0.00,$0.00,$26.61,$152.00,$0.00,$76.00,$120.38,$121.60,$0.00,$23.79,$0.00,$24.20,$0.00
6290-7-015,SUP,HCPCS C1713,,6290-7-015  -  SCREW BONE 6.2MM 15MM CANC SLFTAP HEX HEAD,$152.00,$0.00,$152.00,$68.40,$108.48,$0.00,$26.19,$0.00,$0.00,$26.61,$152.00,$0.00,$76.00,$120.38,$121.60,$0.00,$23.79,$0.00,$24.20,$0.00
6290-7-020,SUP,HCPCS C1713,,6290-7-020  -  SCREW BONE 6.2MM 20MM CANC SLFTAP HEX HEAD,$152.00,$0.00,$152.00,$68.40,$108.48,$0.00,$26.19,$0.00,$0.00,$26.61,$152.00,$0.00,$76.00,$120.38,$121.60,$0.00,$23.79,$0.00,$24.20,$0.00
6290-7-025,SUP,HCPCS C1713,,6290-7-025  -  SCREW BONE 6.2MM 25MM CANC SLFTAP,$152.00,$0.00,$152.00,$68.40,$108.48,$0.00,$26.19,$0.00,$0.00,$26.61,$152.00,$0.00,$76.00,$120.38,$121.60,$0.00,$23.79,$0.00,$24.20,$0.00
6290-7-030,SUP,HCPCS C1713,,6290-7-030  -  SCREW BONE 6.2MM 30MM CANC SLFTAP,$152.00,$0.00,$152.00,$68.40,$108.48,$0.00,$26.19,$0.00,$0.00,$26.61,$152.00,$0.00,$76.00,$120.38,$121.60,$0.00,$23.79,$0.00,$24.20,$0.00
6290-7-035,SUP,HCPCS C1713,,6290-7-035  -  SCREW BONE 6.2MM 35MM CANC SLFTAP,$152.00,$0.00,$152.00,$68.40,$108.48,$0.00,$26.19,$0.00,$0.00,$26.61,$152.00,$0.00,$76.00,$120.38,$121.60,$0.00,$23.79,$0.00,$24.20,$0.00
6290-7-040,SUP,HCPCS C1713,,6290-7-040  -  SCREW BONE 6.2MM 40MM CANC SLFTAP HEX HEAD,$152.00,$0.00,$152.00,$68.40,$108.48,$0.00,$26.19,$0.00,$0.00,$26.61,$152.00,$0.00,$76.00,$120.38,$121.60,$0.00,$23.79,$0.00,$24.20,$0.00
6290-7-045,SUP,HCPCS C1713,,6290-7-045  -  SCREW BONE 6.2MM 45MM CANC SLFTAP,$152.00,$0.00,$152.00,$68.40,$108.48,$0.00,$26.19,$0.00,$0.00,$26.61,$152.00,$0.00,$76.00,$120.38,$121.60,$0.00,$23.79,$0.00,$24.20,$0.00
6290-7-050,SUP,HCPCS C1713,,6290-7-050  -  SCREW BONE 6.2MM 50MM CANC SLFTAP,$152.00,$0.00,$152.00,$68.40,$108.48,$0.00,$26.19,$0.00,$0.00,$26.61,$152.00,$0.00,$76.00,$120.38,$121.60,$0.00,$23.79,$0.00,$24.20,$0.00
6290-7-055,SUP,HCPCS C1713,,6290-7-055  -  SCREW BONE 6.2MM 55MM CANC SLFTAP,$152.00,$0.00,$152.00,$68.40,$108.48,$0.00,$26.19,$0.00,$0.00,$26.61,$152.00,$0.00,$76.00,$120.38,$121.60,$0.00,$23.79,$0.00,$24.20,$0.00
6290-7-060,SUP,HCPCS C1713,,6290-7-060  -  SCREW BONE 6.2MM 60MM CANC SLFTAP,$152.00,$0.00,$152.00,$68.40,$108.48,$0.00,$26.19,$0.00,$0.00,$26.61,$152.00,$0.00,$76.00,$120.38,$121.60,$0.00,$23.79,$0.00,$24.20,$0.00
6290-7-065,SUP,HCPCS C1713,,6290-7-065  -  SCREW BONE 6.2MM 65MM CANC SLFTAP,$152.00,$0.00,$152.00,$68.40,$108.48,$0.00,$26.19,$0.00,$0.00,$26.61,$152.00,$0.00,$76.00,$120.38,$121.60,$0.00,$23.79,$0.00,$24.20,$0.00
6290-8-620,SUP,HCPCS C1713,,6290-8-620  -  WASHER 6.2MM SCR ORTH VIT,$75.00,$0.00,$75.00,$33.75,$53.53,$0.00,$12.92,$0.00,$0.00,$13.13,$75.00,$0.00,$37.50,$59.40,$60.00,$0.00,$11.74,$0.00,$11.94,$0.00
629210S,SUP,HCPCS C1713,,629210S  -  PLATE 176MM TI 10 SHFT HOLE LCK VARIAX BONE LEFT DISTAL LAT,"$2,131.25",$0.00,"$2,131.25",$959.06,"$1,521.07",$0.00,$367.20,$0.00,$0.00,$373.16,"$2,131.25",$0.00,"$1,065.63","$1,687.95","$1,705.00",$0.00,$333.54,$0.00,$339.30,$0.00
629212S,SUP,HCPCS C1713,,629212S  -  PLATE 203MM TI 12 SHFT HOLE LCK VARIAX BONE LEFT DISTAL LAT,"$2,241.25",$0.00,"$2,241.25","$1,008.56","$1,599.58",$0.00,$386.16,$0.00,$0.00,$392.42,"$2,241.25",$0.00,"$1,120.63","$1,775.07","$1,793.00",$0.00,$350.76,$0.00,$356.81,$0.00
629230S,SUP,HCPCS C1713,,629230S  -  PLATE 176MM TI 10 SHFT HOLE LCK VARIAX BONE RIGHT DISTAL LAT,"$2,131.25",$0.00,"$2,131.25",$959.06,"$1,521.07",$0.00,$367.20,$0.00,$0.00,$373.16,"$2,131.25",$0.00,"$1,065.63","$1,687.95","$1,705.00",$0.00,$333.54,$0.00,$339.30,$0.00
629232S,SUP,HCPCS C1713,,629232S  -  PLATE 203MM TI 12 SHFT HOLE REDX CLMP SLFTAP BONE RL STRL,"$2,241.25",$0.00,"$2,241.25","$1,008.56","$1,599.58",$0.00,$386.16,$0.00,$0.00,$392.42,"$2,241.25",$0.00,"$1,120.63","$1,775.07","$1,793.00",$0.00,$350.76,$0.00,$356.81,$0.00
629250S,SUP,HCPCS C1713,,629250S  -  PLATE BN 173MM STRL VARIAX 10 HL TI HUM LT P/L,"$2,131.25",$0.00,"$2,131.25",$959.06,"$1,521.07",$0.00,$367.20,$0.00,$0.00,$373.16,"$2,131.25",$0.00,"$1,065.63","$1,687.95","$1,705.00",$0.00,$333.54,$0.00,$339.30,$0.00
629252S,SUP,HCPCS C1713,,629252S  -  PLATE BN 196MM STRL VARIAX 12 HL TI HUM LT P/L,"$2,241.25",$0.00,"$2,241.25","$1,008.56","$1,599.58",$0.00,$386.16,$0.00,$0.00,$392.42,"$2,241.25",$0.00,"$1,120.63","$1,775.07","$1,793.00",$0.00,$350.76,$0.00,$356.81,$0.00
629254S,SUP,HCPCS C1713,,629254S  -  DISTAL POSTERIOR LATERAL PLATE  14 HOLE / LEFT,"$2,406.25",$0.00,"$2,406.25","$1,082.81","$1,717.34",$0.00,$414.58,$0.00,$0.00,$421.32,"$2,406.25",$0.00,"$1,203.13","$1,905.75","$1,925.00",$0.00,$376.58,$0.00,$383.08,$0.00
629270S,SUP,HCPCS C1713,,629270S  -  PLATE BN 173MM STRL VARIAX 10 HL TI HUM RT P/L,"$2,131.25",$0.00,"$2,131.25",$959.06,"$1,521.07",$0.00,$367.20,$0.00,$0.00,$373.16,"$2,131.25",$0.00,"$1,065.63","$1,687.95","$1,705.00",$0.00,$333.54,$0.00,$339.30,$0.00
629272S,SUP,HCPCS C1713,,629272S  -  PLATE BN 196MM STRL VARIAX 12 HL TI HUM RT P/L,"$2,241.25",$0.00,"$2,241.25","$1,008.56","$1,599.58",$0.00,$386.16,$0.00,$0.00,$392.42,"$2,241.25",$0.00,"$1,120.63","$1,775.07","$1,793.00",$0.00,$350.76,$0.00,$356.81,$0.00
629274S,SUP,HCPCS C1713,,629274S  -  PLATE BN 218MM STRL VARIAX 14 HL TI HUM RT P/L,"$2,406.25",$0.00,"$2,406.25","$1,082.81","$1,717.34",$0.00,$414.58,$0.00,$0.00,$421.32,"$2,406.25",$0.00,"$1,203.13","$1,905.75","$1,925.00",$0.00,$376.58,$0.00,$383.08,$0.00
629290S,SUP,HCPCS C1713,,629290S  -  PLATE 167MM TI 10 SHFT HOLE LCK XTD VARIAX BONE L/R MDL HUM,"$2,131.25",$0.00,"$2,131.25",$959.06,"$1,521.07",$0.00,$367.20,$0.00,$0.00,$373.16,"$2,131.25",$0.00,"$1,065.63","$1,687.95","$1,705.00",$0.00,$333.54,$0.00,$339.30,$0.00
629292S,SUP,HCPCS C1713,,629292S  -  PLATE 191MM TI 12 HOLE XTD VARIAX BONE MDL ELB STRL,"$2,241.25",$0.00,"$2,241.25","$1,008.56","$1,599.58",$0.00,$386.16,$0.00,$0.00,$392.42,"$2,241.25",$0.00,"$1,120.63","$1,775.07","$1,793.00",$0.00,$350.76,$0.00,$356.81,$0.00
629294S,SUP,HCPCS C1713,,629294S  -  PLATE 215MM TI 14 SHFT HOLE LCK XTD VARIAX BONE L/R MDL HUM,"$2,406.25",$0.00,"$2,406.25","$1,082.81","$1,717.34",$0.00,$414.58,$0.00,$0.00,$421.32,"$2,406.25",$0.00,"$1,203.13","$1,905.75","$1,925.00",$0.00,$376.58,$0.00,$383.08,$0.00
6293-0-000,SUP,Custom 27803010,,6293-0-000  -  HEAD FEM STD 32MM HIP PCA,"$2,180.00",$0.00,"$2,180.00",$0.00,"$1,555.87",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,180.00",$0.00,"$1,090.00","$1,726.56","$1,744.00",$0.00,$0.00,$0.00,$0.00,$0.00
6293-0-005,SUP,Custom 27803010,,6293-0-005  -  HEAD FEM +5 32MM HIP PCA,"$2,180.00",$0.00,"$2,180.00",$0.00,"$1,555.87",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,180.00",$0.00,"$1,090.00","$1,726.56","$1,744.00",$0.00,$0.00,$0.00,$0.00,$0.00
629310S,SUP,HCPCS C1713,,629310S  -  PLATE 175MM TI 10 SHFT HOLE BONE LEFT POST MDL STRL,"$2,131.25",$0.00,"$2,131.25",$959.06,"$1,521.07",$0.00,$367.20,$0.00,$0.00,$373.16,"$2,131.25",$0.00,"$1,065.63","$1,687.95","$1,705.00",$0.00,$333.54,$0.00,$339.30,$0.00
629312S,SUP,HCPCS C1713,,629312S  -  PLATE 199MM TI 12 SHFT HOLE LCK VARIAX BONE LEFT POST MDL,"$2,241.25",$0.00,"$2,241.25","$1,008.56","$1,599.58",$0.00,$386.16,$0.00,$0.00,$392.42,"$2,241.25",$0.00,"$1,120.63","$1,775.07","$1,793.00",$0.00,$350.76,$0.00,$356.81,$0.00
629330S,SUP,HCPCS C1713,,629330S  -  PLATE 175MM TI 10 SHFT HOLE LCK VARIAX BONE RIGHT POST MDL,"$2,131.25",$0.00,"$2,131.25",$959.06,"$1,521.07",$0.00,$367.20,$0.00,$0.00,$373.16,"$2,131.25",$0.00,"$1,065.63","$1,687.95","$1,705.00",$0.00,$333.54,$0.00,$339.30,$0.00
629332S,SUP,HCPCS C1713,,629332S  -  PLATE 199MM TI 12 HOLE LCK VARIAX BONE RIGHT POST MDL ELB,"$2,241.25",$0.00,"$2,241.25","$1,008.56","$1,599.58",$0.00,$386.16,$0.00,$0.00,$392.42,"$2,241.25",$0.00,"$1,120.63","$1,775.07","$1,793.00",$0.00,$350.76,$0.00,$356.81,$0.00
629350S,SUP,HCPCS C1713,,629350S  -  PLATE BN 161MM NS VARIAX 10 HL TI OLCRN LT,"$1,925.00",$0.00,"$1,925.00",$866.25,"$1,373.87",$0.00,$331.67,$0.00,$0.00,$337.05,"$1,925.00",$0.00,$962.50,"$1,524.60","$1,540.00",$0.00,$301.26,$0.00,$306.46,$0.00
629352S,SUP,HCPCS C1713,,629352S  -  PLATE 184MM TI 12 SHFT HOLE LCK VARIAX BONE LEFT OLCRN ELB,"$2,021.25",$0.00,"$2,021.25",$909.56,"$1,442.57",$0.00,$348.25,$0.00,$0.00,$353.90,"$2,021.25",$0.00,"$1,010.63","$1,600.83","$1,617.00",$0.00,$316.33,$0.00,$321.78,$0.00
629370S,SUP,HCPCS C1713,,629370S  -  PLATE 161MM TI 12 SHFT HOLE LCK VARIAX BONE RIGHT OLCRN ELB,"$1,925.00",$0.00,"$1,925.00",$866.25,"$1,373.87",$0.00,$331.67,$0.00,$0.00,$337.05,"$1,925.00",$0.00,$962.50,"$1,524.60","$1,540.00",$0.00,$301.26,$0.00,$306.46,$0.00
629372S,SUP,HCPCS C1713,,629372S  -  PLATE 184MM TI 12 SHFT HOLE LCK VARIAX BONE RIGHT OLCRN ELB,"$2,021.25",$0.00,"$2,021.25",$909.56,"$1,442.57",$0.00,$348.25,$0.00,$0.00,$353.90,"$2,021.25",$0.00,"$1,010.63","$1,600.83","$1,617.00",$0.00,$316.33,$0.00,$321.78,$0.00
629390S,SUP,HCPCS C1713,,629390S  -  PLATE 163MM TI 10 HOLE LCK VARIAX BONE MDL ELB STRL,"$2,131.25",$0.00,"$2,131.25",$959.06,"$1,521.07",$0.00,$367.20,$0.00,$0.00,$373.16,"$2,131.25",$0.00,"$1,065.63","$1,687.95","$1,705.00",$0.00,$333.54,$0.00,$339.30,$0.00
629392S,SUP,HCPCS C1713,,629392S  -  PLATE 187MM TI 12 SHFT HOLE LCK VARIAX BONE L/R DISTAL MDL,"$2,241.25",$0.00,"$2,241.25","$1,008.56","$1,599.58",$0.00,$386.16,$0.00,$0.00,$392.42,"$2,241.25",$0.00,"$1,120.63","$1,775.07","$1,793.00",$0.00,$350.76,$0.00,$356.81,$0.00
629394S,SUP,HCPCS C1713,,629394S  -  PLATE 211MM TI 14 SHFT HOLE LCK VARIAX BONE L/R DISTAL MDL,"$2,406.25",$0.00,"$2,406.25","$1,082.81","$1,717.34",$0.00,$414.58,$0.00,$0.00,$421.32,"$2,406.25",$0.00,"$1,203.13","$1,905.75","$1,925.00",$0.00,$376.58,$0.00,$383.08,$0.00
6299-2-403,SUP,Custom 27803010,,6299-2-403  -  INSERT ACETAB 0D NEUTRAL 40-43MM 26MM PCA DUR HIP,"$2,117.50",$0.00,"$2,117.50",$0.00,"$1,511.26",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,117.50",$0.00,"$1,058.75","$1,677.06","$1,694.00",$0.00,$0.00,$0.00,$0.00,$0.00
6299-2-469,SUP,Custom 27803010,,6299-2-469  -  INSERT ACETAB 0D NEUTRAL 46-49MM 26MM PCA DUR HIP,"$2,117.50",$0.00,"$2,117.50",$0.00,"$1,511.26",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,117.50",$0.00,"$1,058.75","$1,677.06","$1,694.00",$0.00,$0.00,$0.00,$0.00,$0.00
6299-2-525,SUP,Custom 27803010,,6299-2-525  -  INSERT ACETAB 0D NEUTRAL 52-55MM 26MM PCA DUR HIP,"$2,117.50",$0.00,"$2,117.50",$0.00,"$1,511.26",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,117.50",$0.00,"$1,058.75","$1,677.06","$1,694.00",$0.00,$0.00,$0.00,$0.00,$0.00
6299-2-581,SUP,Custom 27803010,,6299-2-581  -  INSERT ACETAB 0D NEUTRAL 58-61MM 26MM PCA DUR HIP,"$2,117.50",$0.00,"$2,117.50",$0.00,"$1,511.26",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,117.50",$0.00,"$1,058.75","$1,677.06","$1,694.00",$0.00,$0.00,$0.00,$0.00,$0.00
6299-3-469,SUP,Custom 27803010,,6299-3-469  -  INSERT ACETAB 0D NEUTRAL 46-49MM 28MM PCA DUR HIP,"$2,117.50",$0.00,"$2,117.50",$0.00,"$1,511.26",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,117.50",$0.00,"$1,058.75","$1,677.06","$1,694.00",$0.00,$0.00,$0.00,$0.00,$0.00
6299-3-525,SUP,Custom 27803010,,6299-3-525  -  INSERT ACETAB 0D NEUTRAL 52-55MM 28MM PCA DUR HIP,"$2,117.50",$0.00,"$2,117.50",$0.00,"$1,511.26",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,117.50",$0.00,"$1,058.75","$1,677.06","$1,694.00",$0.00,$0.00,$0.00,$0.00,$0.00
6299-3-581,SUP,Custom 27803010,,6299-3-581  -  INSERT ACETAB 0D NEUTRAL 58-61MM 28MM PCA DUR HIP,"$2,117.50",$0.00,"$2,117.50",$0.00,"$1,511.26",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,117.50",$0.00,"$1,058.75","$1,677.06","$1,694.00",$0.00,$0.00,$0.00,$0.00,$0.00
6299-3-647,SUP,Custom 27803010,,6299-3-647  -  INSERT ACETAB 0D NEUTRAL 64-67MM 28MM PCA DUR HIP,"$2,117.50",$0.00,"$2,117.50",$0.00,"$1,511.26",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,117.50",$0.00,"$1,058.75","$1,677.06","$1,694.00",$0.00,$0.00,$0.00,$0.00,$0.00
6299-4-469,SUP,Custom 27803010,,6299-4-469  -  INSERT ACETAB 0D NEUTRAL 46-49MM 32MM PCA DUR HIP,"$2,117.50",$0.00,"$2,117.50",$0.00,"$1,511.26",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,117.50",$0.00,"$1,058.75","$1,677.06","$1,694.00",$0.00,$0.00,$0.00,$0.00,$0.00
6299-4-525,SUP,Custom 27803010,,6299-4-525  -  INSERT ACETAB 0D NEUTRAL 52-55MM 32MM PCA DUR HIP,"$2,117.50",$0.00,"$2,117.50",$0.00,"$1,511.26",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,117.50",$0.00,"$1,058.75","$1,677.06","$1,694.00",$0.00,$0.00,$0.00,$0.00,$0.00
6299-4-581,SUP,Custom 27803010,,6299-4-581  -  INSERT ACETAB 0D NEUTRAL 58-61MM 32MM PCA DUR HIP,"$2,117.50",$0.00,"$2,117.50",$0.00,"$1,511.26",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,117.50",$0.00,"$1,058.75","$1,677.06","$1,694.00",$0.00,$0.00,$0.00,$0.00,$0.00
6299-4-647,SUP,Custom 27803010,,6299-4-647  -  INSERT ACETAB 0D NEUTRAL 64-67MM 32MM PCA DUR HIP,"$2,117.50",$0.00,"$2,117.50",$0.00,"$1,511.26",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,117.50",$0.00,"$1,058.75","$1,677.06","$1,694.00",$0.00,$0.00,$0.00,$0.00,$0.00
6299-5-403,SUP,Custom 27803010,,6299-5-403  -  INSERT ACETAB 10D 40-43MM 26MM PCA DUR HIP,"$2,117.50",$0.00,"$2,117.50",$0.00,"$1,511.26",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,117.50",$0.00,"$1,058.75","$1,677.06","$1,694.00",$0.00,$0.00,$0.00,$0.00,$0.00
6299-5-469,SUP,Custom 27803010,,6299-5-469  -  INSERT ACETAB 10D 46-49MM 26MM PCA DUR HIP,"$2,117.50",$0.00,"$2,117.50",$0.00,"$1,511.26",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,117.50",$0.00,"$1,058.75","$1,677.06","$1,694.00",$0.00,$0.00,$0.00,$0.00,$0.00
6299-5-525,SUP,Custom 27803010,,6299-5-525  -  INSERT ACETAB 10D 52-55MM 26MM PCA DUR HIP,"$2,117.50",$0.00,"$2,117.50",$0.00,"$1,511.26",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,117.50",$0.00,"$1,058.75","$1,677.06","$1,694.00",$0.00,$0.00,$0.00,$0.00,$0.00
6299-5-581,SUP,Custom 27803010,,6299-5-581  -  INSERT ACETAB 10D 58-61MM 26MM PCA DUR HIP,"$2,117.50",$0.00,"$2,117.50",$0.00,"$1,511.26",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,117.50",$0.00,"$1,058.75","$1,677.06","$1,694.00",$0.00,$0.00,$0.00,$0.00,$0.00
6299-6-469,SUP,Custom 27803010,,6299-6-469  -  INSERT ACETAB 10D 46-49MM 28MM PCA DUR HIP,"$2,117.50",$0.00,"$2,117.50",$0.00,"$1,511.26",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,117.50",$0.00,"$1,058.75","$1,677.06","$1,694.00",$0.00,$0.00,$0.00,$0.00,$0.00
6299-6-525,SUP,Custom 27803010,,6299-6-525  -  INSERT ACETAB 10D 52-55MM 28MM PCA DUR HIP,"$2,117.50",$0.00,"$2,117.50",$0.00,"$1,511.26",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,117.50",$0.00,"$1,058.75","$1,677.06","$1,694.00",$0.00,$0.00,$0.00,$0.00,$0.00
6299-6-581,SUP,Custom 27803010,,6299-6-581  -  INSERT ACETAB 10D 58-61MM 28MM PCA DUR HIP,"$2,117.50",$0.00,"$2,117.50",$0.00,"$1,511.26",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,117.50",$0.00,"$1,058.75","$1,677.06","$1,694.00",$0.00,$0.00,$0.00,$0.00,$0.00
6299-6-647,SUP,Custom 27803010,,6299-6-647  -  INSERT ACETAB 10D 64-67MM 28MM PCA DUR HIP,"$2,117.50",$0.00,"$2,117.50",$0.00,"$1,511.26",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,117.50",$0.00,"$1,058.75","$1,677.06","$1,694.00",$0.00,$0.00,$0.00,$0.00,$0.00
6299-7-469,SUP,Custom 27803010,,6299-7-469  -  INSERT ACETAB 10D 46-49MM 32MM PCA DUR HIP,"$2,117.50",$0.00,"$2,117.50",$0.00,"$1,511.26",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,117.50",$0.00,"$1,058.75","$1,677.06","$1,694.00",$0.00,$0.00,$0.00,$0.00,$0.00
6299-7-525,SUP,Custom 27803010,,6299-7-525  -  INSERT ACETAB 10D 52-55MM 32MM PCA DUR HIP,"$2,117.50",$0.00,"$2,117.50",$0.00,"$1,511.26",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,117.50",$0.00,"$1,058.75","$1,677.06","$1,694.00",$0.00,$0.00,$0.00,$0.00,$0.00
6299-7-581,SUP,Custom 27803010,,6299-7-581  -  INSERT ACETAB 10D 58-61MM 32MM PCA DUR HIP,"$2,117.50",$0.00,"$2,117.50",$0.00,"$1,511.26",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,117.50",$0.00,"$1,058.75","$1,677.06","$1,694.00",$0.00,$0.00,$0.00,$0.00,$0.00
6299-7-647,SUP,Custom 27803010,,6299-7-647  -  INSERT ACETAB 10D 64-67MM 32MM PCA DUR HIP,"$2,117.50",$0.00,"$2,117.50",$0.00,"$1,511.26",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,117.50",$0.00,"$1,058.75","$1,677.06","$1,694.00",$0.00,$0.00,$0.00,$0.00,$0.00
6299-8-403,SUP,Custom 27803010,,6299-8-403  -  INSERT ACETAB 10D 40-43MM 22MM PCA DUR HIP,"$2,117.50",$0.00,"$2,117.50",$0.00,"$1,511.26",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,117.50",$0.00,"$1,058.75","$1,677.06","$1,694.00",$0.00,$0.00,$0.00,$0.00,$0.00
6299-8-469,SUP,Custom 27803010,,6299-8-469  -  INSERT ACETAB 10D 46-49MM 22MM PCA DUR HIP,"$2,117.50",$0.00,"$2,117.50",$0.00,"$1,511.26",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,117.50",$0.00,"$1,058.75","$1,677.06","$1,694.00",$0.00,$0.00,$0.00,$0.00,$0.00
6299-8-525,SUP,Custom 27803010,,6299-8-525  -  INSERT ACETAB 10D 52-55MM 22MM PCA DUR HIP,"$2,117.50",$0.00,"$2,117.50",$0.00,"$1,511.26",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,117.50",$0.00,"$1,058.75","$1,677.06","$1,694.00",$0.00,$0.00,$0.00,$0.00,$0.00
6299-8-581,SUP,Custom 27803010,,6299-8-581  -  INSERT ACETAB 10D 52-55MM 22MM PCA DUR HIP,"$2,117.50",$0.00,"$2,117.50",$0.00,"$1,511.26",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,117.50",$0.00,"$1,058.75","$1,677.06","$1,694.00",$0.00,$0.00,$0.00,$0.00,$0.00
6299-H-332,SUP,Custom 27803010,,6299-H-332  -  LINER ACETAB PCA 10D C 32MM HIP CNSTRN,"$2,950.00",$0.00,"$2,950.00",$0.00,"$2,105.42",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,950.00",$0.00,"$1,475.00","$2,336.40","$2,360.00",$0.00,$0.00,$0.00,$0.00,$0.00
6299-N-332,SUP,Custom 27803010,,6299-N-332  -  LINER ACETAB PCA NTRL 32MM HIP CNSTRN,"$2,950.00",$0.00,"$2,950.00",$0.00,"$2,105.42",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,950.00",$0.00,"$1,475.00","$2,336.40","$2,360.00",$0.00,$0.00,$0.00,$0.00,$0.00
6302-3-012,SUP,HCPCS C1713,,6302-3-012  -  SCREW BONE 6.5MM 12MM VTLK VIT PLUG,$152.00,$0.00,$152.00,$68.40,$108.48,$0.00,$26.19,$0.00,$0.00,$26.61,$152.00,$0.00,$76.00,$120.38,$121.60,$0.00,$23.79,$0.00,$24.20,$0.00
6302-3-014,SUP,HCPCS C1713,,6302-3-014  -  SCREW ACETAB 14MM 6.5MM VTLK VITALIUM PLUG,$152.00,$0.00,$152.00,$68.40,$108.48,$0.00,$26.19,$0.00,$0.00,$26.61,$152.00,$0.00,$76.00,$120.38,$121.60,$0.00,$23.79,$0.00,$24.20,$0.00
6302-3-016,SUP,HCPCS C1713,,6302-3-016  -  SCREW BONE 6.5MM 16MM VTLK VIT ACETUBULAR PLG VIT,$152.00,$0.00,$152.00,$68.40,$108.48,$0.00,$26.19,$0.00,$0.00,$26.61,$152.00,$0.00,$76.00,$120.38,$121.60,$0.00,$23.79,$0.00,$24.20,$0.00
6302-3-018,SUP,HCPCS C1713,,6302-3-018  -  SCREW ACETAB 18MM 6.5MM VTLK VIT PLG,$152.00,$0.00,$152.00,$68.40,$108.48,$0.00,$26.19,$0.00,$0.00,$26.61,$152.00,$0.00,$76.00,$120.38,$121.60,$0.00,$23.79,$0.00,$24.20,$0.00
6302-3-020,SUP,HCPCS C1713,,6302-3-020  -  SCREW BONE 6.5MM 20MM VTLK VIT ACETAB SLFTAP,$152.00,$0.00,$152.00,$68.40,$108.48,$0.00,$26.19,$0.00,$0.00,$26.61,$152.00,$0.00,$76.00,$120.38,$121.60,$0.00,$23.79,$0.00,$24.20,$0.00
6302-3-022,SUP,HCPCS C1713,,6302-3-022  -  SCREW ACETAB 22MM 6.5MM VTLK VIT PLUG,$152.00,$0.00,$152.00,$68.40,$108.48,$0.00,$26.19,$0.00,$0.00,$26.61,$152.00,$0.00,$76.00,$120.38,$121.60,$0.00,$23.79,$0.00,$24.20,$0.00
6302-3-024,SUP,HCPCS C1713,,6302-3-024  -  SCREW BONE 6.5MM 24MM VTLK VIT ACETAB SLFTAP,$152.00,$0.00,$152.00,$68.40,$108.48,$0.00,$26.19,$0.00,$0.00,$26.61,$152.00,$0.00,$76.00,$120.38,$121.60,$0.00,$23.79,$0.00,$24.20,$0.00
6302-3-026,SUP,HCPCS C1713,,6302-3-026  -  SCREW BONE 6.5MM 26MM VTLK VIT SLFTAP,$152.00,$0.00,$152.00,$68.40,$108.48,$0.00,$26.19,$0.00,$0.00,$26.61,$152.00,$0.00,$76.00,$120.38,$121.60,$0.00,$23.79,$0.00,$24.20,$0.00
6302-3-028,SUP,HCPCS C1713,,6302-3-028  -  SCREW BONE 6.8MM 28MM VTLK VIT PLG,$152.00,$0.00,$152.00,$68.40,$108.48,$0.00,$26.19,$0.00,$0.00,$26.61,$152.00,$0.00,$76.00,$120.38,$121.60,$0.00,$23.79,$0.00,$24.20,$0.00
6302-3-030,SUP,HCPCS C1713,,6302-3-030  -  SCREW BONE 6.5MM 30MM VTLK VIT ACETAB SLFTAP,$152.00,$0.00,$152.00,$68.40,$108.48,$0.00,$26.19,$0.00,$0.00,$26.61,$152.00,$0.00,$76.00,$120.38,$121.60,$0.00,$23.79,$0.00,$24.20,$0.00
6302-3-035,SUP,HCPCS C1713,,6302-3-035  -  SCREW BONE 6.5MM 35MM VTLK VIT ACETABULLAR SLFTAP,$152.00,$0.00,$152.00,$68.40,$108.48,$0.00,$26.19,$0.00,$0.00,$26.61,$152.00,$0.00,$76.00,$120.38,$121.60,$0.00,$23.79,$0.00,$24.20,$0.00
6302-3-040,SUP,HCPCS C1713,,6302-3-040  -  SCREW BONE 6.5MM 40MM VTLK VIT PLUG,$152.00,$0.00,$152.00,$68.40,$108.48,$0.00,$26.19,$0.00,$0.00,$26.61,$152.00,$0.00,$76.00,$120.38,$121.60,$0.00,$23.79,$0.00,$24.20,$0.00
6302-3-045,SUP,HCPCS C1713,,6302-3-045  -  SCREW ACETAB 45MM 6.5MM VTLK VIT PLUG,$152.00,$0.00,$152.00,$68.40,$108.48,$0.00,$26.19,$0.00,$0.00,$26.61,$152.00,$0.00,$76.00,$120.38,$121.60,$0.00,$23.79,$0.00,$24.20,$0.00
6302-3-050,SUP,HCPCS C1713,,6302-3-050  -  SCREW ACETAB 50MM 6.5MM VTLK VIT PLG,$152.00,$0.00,$152.00,$68.40,$108.48,$0.00,$26.19,$0.00,$0.00,$26.61,$152.00,$0.00,$76.00,$120.38,$121.60,$0.00,$23.79,$0.00,$24.20,$0.00
6302-4-000,SUP,HCPCS C1713,,6302-4-000  -  PLUG DOME HL PRM RECON VIT APCL,$152.00,$0.00,$152.00,$68.40,$108.48,$0.00,$26.19,$0.00,$0.00,$26.61,$152.00,$0.00,$76.00,$120.38,$121.60,$0.00,$23.79,$0.00,$24.20,$0.00
6302-5-000,SUP,Custom 27803010,,6302-5-000  -  INSERT ACETAB 22.2MM 0D P0 NTRL HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-001,SUP,Custom 27803010,,6302-5-001  -  INSERT ACETAB 22.2MM P1 NTRL HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-002,SUP,Custom 27803010,,6302-5-002  -  INSERT ACETAB 22.2MM P2 NTRL HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-003,SUP,Custom 27803010,,6302-5-003  -  INSERT ACETAB 22.2MM P3 NTRL HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-004,SUP,Custom 27803010,,6302-5-004  -  INSERT ACETAB 22.2MM P4 NTRL HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-005,SUP,Custom 27803010,,6302-5-005  -  INSERT ACETAB 22.2MM P5 NTRL HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-006,SUP,Custom 27803010,,6302-5-006  -  INSERT ACETAB 22.2MM P6 NTRL HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-007,SUP,Custom 27803010,,6302-5-007  -  INSERT ACETAB 22.2MM P7 NTRL HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-008,SUP,Custom 27803010,,6302-5-008  -  INSERT ACETAB 22.2MM P8 NTRL HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-009,SUP,Custom 27803010,,6302-5-009  -  INSERT ACETAB 22.2MM P9 NTRL HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-010,SUP,Custom 27803010,,6302-5-010  -  INSERT ACETAB 22.2MM 10D P0 HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-011,SUP,Custom 27803010,,6302-5-011  -  INSERT ACETAB 22.2MM 10D P1 HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-012,SUP,Custom 27803010,,6302-5-012  -  INSERT ACETAB 22.2MM 10D P2 HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-013,SUP,Custom 27803010,,6302-5-013  -  INSERT ACETAB 22.2MM 10D P3 HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-014,SUP,Custom 27803010,,6302-5-014  -  INSERT ACETAB 22.2MM 10D P4 HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-015,SUP,Custom 27803010,,6302-5-015  -  INSERT ACETAB 22.2MM 10D P5 HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-016,SUP,Custom 27803010,,6302-5-016  -  INSERT ACETAB 22.2MM 10D P6 HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-017,SUP,Custom 27803010,,6302-5-017  -  INSERT ACETAB 22.2MM 10D P7 HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-018,SUP,Custom 27803010,,6302-5-018  -  INSERT ACETAB 22.2MM 10D P8 NTRL HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-019,SUP,Custom 27803010,,6302-5-019  -  INSERT ACETAB 22.2MM 10D P9 NTRL HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-020,SUP,Custom 27803010,,6302-5-020  -  INSERT ACETAB 22.2MM 15D P0 NTRL HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-021,SUP,Custom 27803010,,6302-5-021  -  INSERT ACETAB 22.2MM 15D P1 NTRL HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-022,SUP,Custom 27803010,,6302-5-022  -  INSERT ACETAB 22.2MM 15D P2 NTRL HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-023,SUP,Custom 27803010,,6302-5-023  -  INSERT ACETAB 22.2MM 15D P3 NTRL HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-024,SUP,Custom 27803010,,6302-5-024  -  INSERT ACETAB 22.2MM 15D P4 NTRL HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-025,SUP,Custom 27803010,,6302-5-025  -  INSERT ACETAB 22.2MM 15D P5 NTRL HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-026,SUP,Custom 27803010,,6302-5-026  -  INSERT ACETAB 22.2MM 15D P6 NTRL HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-027,SUP,Custom 27803010,,6302-5-027  -  INSERT ACETAB 22.2MM 15D P7 NTRL HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-028,SUP,Custom 27803010,,6302-5-028  -  INSERT ACETAB 22.2MM 15D P8 NTRL HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-029,SUP,Custom 27803010,,6302-5-029  -  INSERT ACETAB 22.2MM 15D P9 NTRL HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-030,SUP,Custom 27803010,,6302-5-030  -  INSERT ACETAB 26MM P1 NTRL HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-032,SUP,Custom 27803010,,6302-5-032  -  INSERT ACETAB 26MM P2 NTRL HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-033,SUP,Custom 27803010,,6302-5-033  -  INSERT ACETAB 26MM P3 NTRL HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-034,SUP,Custom 27803010,,6302-5-034  -  INSERT ACETAB 26MM P4 NTRL HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-035,SUP,Custom 27803010,,6302-5-035  -  INSERT ACETAB 26MM P5 NTRL HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-036,SUP,Custom 27803010,,6302-5-036  -  INSERT ACETAB 26MM P6 NTRL HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-037,SUP,Custom 27803010,,6302-5-037  -  INSERT ACETAB 26MM P7 NTRL HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-038,SUP,Custom 27803010,,6302-5-038  -  INSERT ACETAB 26MM P8 NTRL HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-039,SUP,Custom 27803010,,6302-5-039  -  INSERT ACETAB 26MM P9 NTRL HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-040,SUP,Custom 27803010,,6302-5-040  -  INSERT ACETAB 26MM 10D P1 HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-042,SUP,Custom 27803010,,6302-5-042  -  INSERT ACETAB 26MM 10D P2 HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-043,SUP,Custom 27803010,,6302-5-043  -  INSERT ACETAB 26MM 10D P3 HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-044,SUP,Custom 27803010,,6302-5-044  -  INSERT ACETAB 26MM 10D P4 HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-045,SUP,Custom 27803010,,6302-5-045  -  INSERT ACETAB 26MM 10D P5 HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-046,SUP,Custom 27803010,,6302-5-046  -  INSERT ACETAB 26MM 10D P6 HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-047,SUP,Custom 27803010,,6302-5-047  -  INSERT ACETAB 26MM 10D P7 HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-048,SUP,Custom 27803010,,6302-5-048  -  INSERT ACETAB 26MM 10D P8 HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-049,SUP,Custom 27803010,,6302-5-049  -  INSERT ACETAB 26MM 10D P9 HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-050,SUP,Custom 27803010,,6302-5-050  -  INSERT ACETAB 26MM 15D P1 HIP DUR PE S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-052,SUP,Custom 27803010,,6302-5-052  -  INSERT ACETAB 26MM 15D P2 HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-053,SUP,Custom 27803010,,6302-5-053  -  INSERT ACETAB 26MM 15D P3 HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-054,SUP,Custom 27803010,,6302-5-054  -  INSERT ACETAB 26MM 15D P4 HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-055,SUP,Custom 27803010,,6302-5-055  -  INSERT ACETAB 26MM 15D P5 HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-056,SUP,Custom 27803010,,6302-5-056  -  INSERT ACETAB 26MM 15D P6 HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-057,SUP,Custom 27803010,,6302-5-057  -  INSERT ACETAB 26MM 15D P7 HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-058,SUP,Custom 27803010,,6302-5-058  -  INSERT ACETAB 26MM 15D P8 HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-059,SUP,Custom 27803010,,6302-5-059  -  INSERT ACETAB 26MM 15D P9 HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-062,SUP,Custom 27803010,,6302-5-062  -  INSERT ACETAB 28MM P2 NTRL HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-063,SUP,Custom 27803010,,6302-5-063  -  INSERT ACETAB 28MM P3 NTRL HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-064,SUP,Custom 27803010,,6302-5-064  -  INSERT ACETAB 28MM P4 NTRL HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-065,SUP,Custom 27803010,,6302-5-065  -  INSERT ACETAB 28MM P5 NTRL HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-066,SUP,Custom 27803010,,6302-5-066  -  INSERT ACETAB 28MM P6 NTRL HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-067,SUP,Custom 27803010,,6302-5-067  -  INSERT ACETAB 28MM P7 NTRL HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-068,SUP,Custom 27803010,,6302-5-068  -  INSERT ACETAB 28MM P8 NTRL HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-069,SUP,Custom 27803010,,6302-5-069  -  INSERT ACETAB 28MM P9 NTRL HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-072,SUP,Custom 27803010,,6302-5-072  -  INSERT ACETAB 28MM 10D P2 HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-073,SUP,Custom 27803010,,6302-5-073  -  INSERT ACETAB 28MM 10D P3 HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-074,SUP,Custom 27803010,,6302-5-074  -  INSERT ACETAB 28MM 10D P4 HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-075,SUP,Custom 27803010,,6302-5-075  -  INSERT ACETAB 28MM 10D P5 HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-076,SUP,Custom 27803010,,6302-5-076  -  INSERT ACETAB 28MM 10D P6 HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-077,SUP,Custom 27803010,,6302-5-077  -  INSERT ACETAB 28MM 10D P7 HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-078,SUP,Custom 27803010,,6302-5-078  -  INSERT ACETAB 28MM 10D P8 HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-079,SUP,Custom 27803010,,6302-5-079  -  INSERT ACETAB 28MM 10D P9 HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-082,SUP,Custom 27803010,,6302-5-082  -  INSERT ACETAB 15D P2 28MM SYSTEM 12 OSTEOLOCK DUR HIP,"$1,942.50",$0.00,"$1,942.50",$0.00,"$1,386.36",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,942.50",$0.00,$971.25,"$1,538.46","$1,554.00",$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-083,SUP,Custom 27803010,,6302-5-083  -  INSERT ACETAB 28MM 15D P3 HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-084,SUP,Custom 27803010,,6302-5-084  -  INSERT ACETAB 28MM 15D P4 HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-085,SUP,Custom 27803010,,6302-5-085  -  INSERT ACETAB 28MM 15D P5 HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-086,SUP,Custom 27803010,,6302-5-086  -  INSERT ACETAB 28MM 15D P6 HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-087,SUP,Custom 27803010,,6302-5-087  -  INSERT ACETAB 28MM 15D P7 HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-088,SUP,Custom 27803010,,6302-5-088  -  INSERT ACETAB 28MM 15D P8 HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-089,SUP,Custom 27803010,,6302-5-089  -  INSERT ACETAB 28MM 15D P9 HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-093,SUP,Custom 27803010,,6302-5-093  -  INSERT ACETAB 15D P3 32MM SYSTEM 12 OSTEOLOCK DUR HIP,"$1,942.50",$0.00,"$1,942.50",$0.00,"$1,386.36",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,942.50",$0.00,$971.25,"$1,538.46","$1,554.00",$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-094,SUP,Custom 27803010,,6302-5-094  -  INSERT ACETAB 32MM P4 NTRL HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-095,SUP,Custom 27803010,,6302-5-095  -  INSERT ACETAB 15D P5 32MM SYSTEM 12 OSTEOLOCK DUR HIP,"$1,942.50",$0.00,"$1,942.50",$0.00,"$1,386.36",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,942.50",$0.00,$971.25,"$1,538.46","$1,554.00",$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-096,SUP,Custom 27803010,,6302-5-096  -  INSERT ACETAB 15D P6 32MM SYSTEM 12 OSTEOLOCK DUR HIP,"$1,942.50",$0.00,"$1,942.50",$0.00,"$1,386.36",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,942.50",$0.00,$971.25,"$1,538.46","$1,554.00",$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-097,SUP,Custom 27803010,,6302-5-097  -  INSERT ACETAB 28MM P7 NTRL HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-098,SUP,Custom 27803010,,6302-5-098  -  INSERT ACETAB 32MM P8 NTRL HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-099,SUP,Custom 27803010,,6302-5-099  -  INSERT ACETAB 32MM P9 NTRL HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-103,SUP,Custom 27803010,,6302-5-103  -  INSERT ACETAB 10D P3 32MM SYSTEM 12 DUR HIP,"$1,942.50",$0.00,"$1,942.50",$0.00,"$1,386.36",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,942.50",$0.00,$971.25,"$1,538.46","$1,554.00",$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-104,SUP,Custom 27803010,,6302-5-104  -  INSERT ACETAB 10D P4 32MM SYSTEM 12 DUR HIP,"$1,942.50",$0.00,"$1,942.50",$0.00,"$1,386.36",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,942.50",$0.00,$971.25,"$1,538.46","$1,554.00",$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-105,SUP,Custom 27803010,,6302-5-105  -  INSERT ACETAB 10D P5 32MM SYSTEM 12 DUR HIP,"$1,942.50",$0.00,"$1,942.50",$0.00,"$1,386.36",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,942.50",$0.00,$971.25,"$1,538.46","$1,554.00",$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-106,SUP,Custom 27803010,,6302-5-106  -  INSERT ACETAB 32MM 10D P6 HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-107,SUP,Custom 27803010,,6302-5-107  -  INSERT ACETAB 10D P7 32MM SYSTEM 12 DUR HIP,"$1,942.50",$0.00,"$1,942.50",$0.00,"$1,386.36",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,942.50",$0.00,$971.25,"$1,538.46","$1,554.00",$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-108,SUP,Custom 27803010,,6302-5-108  -  INSERT ACETAB 10D P8 32MM SYSTEM 12 DUR HIP,"$1,942.50",$0.00,"$1,942.50",$0.00,"$1,386.36",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,942.50",$0.00,$971.25,"$1,538.46","$1,554.00",$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-109,SUP,Custom 27803010,,6302-5-109  -  INSERT ACETAB 10D P9 32MM SYSTEM 12 DUR HIP,"$1,942.50",$0.00,"$1,942.50",$0.00,"$1,386.36",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,942.50",$0.00,$971.25,"$1,538.46","$1,554.00",$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-113,SUP,Custom 27803010,,6302-5-113  -  INSERT ACETAB 10D P3 32MM SYSTEM 12 DUR HIP,"$1,942.50",$0.00,"$1,942.50",$0.00,"$1,386.36",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,942.50",$0.00,$971.25,"$1,538.46","$1,554.00",$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-114,SUP,Custom 27803010,,6302-5-114  -  INSERT ACETAB 15D P4 32MM SYSTEM 12 DUR HIP,"$1,942.50",$0.00,"$1,942.50",$0.00,"$1,386.36",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,942.50",$0.00,$971.25,"$1,538.46","$1,554.00",$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-115,SUP,Custom 27803010,,6302-5-115  -  INSERT ACETAB 15D P5 32MM SYSTEM 12 DUR HIP,"$1,942.50",$0.00,"$1,942.50",$0.00,"$1,386.36",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,942.50",$0.00,$971.25,"$1,538.46","$1,554.00",$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-116,SUP,Custom 27803010,,6302-5-116  -  INSERT ACETAB 15D P6 32MM SYSTEM 12 DUR HIP,"$1,942.50",$0.00,"$1,942.50",$0.00,"$1,386.36",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,942.50",$0.00,$971.25,"$1,538.46","$1,554.00",$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-117,SUP,Custom 27803010,,6302-5-117  -  INSERT ACETAB 32MM 15D P7 HIP DUR S12,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-118,SUP,Custom 27803010,,6302-5-118  -  INSERT ACETAB 15D P8 32MM SYSTEM 12 DUR HIP,"$1,942.50",$0.00,"$1,942.50",$0.00,"$1,386.36",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,942.50",$0.00,$971.25,"$1,538.46","$1,554.00",$0.00,$0.00,$0.00,$0.00,$0.00
6302-5-119,SUP,Custom 27803010,,6302-5-119  -  INSERT ACETAB 15D P9 32MM SYSTEM 12 DUR HIP,"$1,942.50",$0.00,"$1,942.50",$0.00,"$1,386.36",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,942.50",$0.00,$971.25,"$1,538.46","$1,554.00",$0.00,$0.00,$0.00,$0.00,$0.00
6302-6-007,SUP,Custom 27803010,,6302-6-007  -  INSERT ACETAB 10D P7 26MM SYSTEM 12 DUR HIP,"$2,315.00",$0.00,"$2,315.00",$0.00,"$1,652.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,315.00",$0.00,"$1,157.50","$1,833.48","$1,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
6302-6-008,SUP,Custom 27803010,,6302-6-008  -  INSERT ACETAB 10D +4MM P8 26MM SYSTEM 12 HIP,"$2,315.00",$0.00,"$2,315.00",$0.00,"$1,652.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,315.00",$0.00,"$1,157.50","$1,833.48","$1,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
6302-6-009,SUP,Custom 27803010,,6302-6-009  -  INSERT ACETAB 10D +4MM P9 26MM SYSTEM 12 HIP,"$2,315.00",$0.00,"$2,315.00",$0.00,"$1,652.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,315.00",$0.00,"$1,157.50","$1,833.48","$1,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
6302-6-102,SUP,Custom 27803010,,6302-6-102  -  INSERT ACETAB 10D +4MM P2 28MM SYSTEM 12 HIP,"$2,315.00",$0.00,"$2,315.00",$0.00,"$1,652.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,315.00",$0.00,"$1,157.50","$1,833.48","$1,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
6302-6-103,SUP,Custom 27803010,,6302-6-103  -  INSERT ACETAB 10D +4MM P3 28MM SYSTEM 12 HIP,"$2,315.00",$0.00,"$2,315.00",$0.00,"$1,652.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,315.00",$0.00,"$1,157.50","$1,833.48","$1,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
6302-6-104,SUP,Custom 27803010,,6302-6-104  -  INSERT ACETAB 10D +4MM P4 28MM SYSTEM 12 HIP,"$2,315.00",$0.00,"$2,315.00",$0.00,"$1,652.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,315.00",$0.00,"$1,157.50","$1,833.48","$1,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
6302-6-105,SUP,Custom 27803010,,6302-6-105  -  INSERT ACETAB 10D +4MM P5 28MM SYSTEM 12 HIP,"$2,315.00",$0.00,"$2,315.00",$0.00,"$1,652.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,315.00",$0.00,"$1,157.50","$1,833.48","$1,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
6302-6-106,SUP,Custom 27803010,,6302-6-106  -  INSERT ACETAB 10D +4MM P6 28MM SYSTEM 12 HIP,"$2,315.00",$0.00,"$2,315.00",$0.00,"$1,652.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,315.00",$0.00,"$1,157.50","$1,833.48","$1,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
6302-6-107,SUP,Custom 27803010,,6302-6-107  -  INSERT ACETAB 10D +4MM P7 28MM SYSTEM 12 HIP,"$2,315.00",$0.00,"$2,315.00",$0.00,"$1,652.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,315.00",$0.00,"$1,157.50","$1,833.48","$1,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
6302-6-108,SUP,Custom 27803010,,6302-6-108  -  INSERT ACETAB 10D +4MM P8 28MM SYSTEM 12 HIP,"$2,315.00",$0.00,"$2,315.00",$0.00,"$1,652.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,315.00",$0.00,"$1,157.50","$1,833.48","$1,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
6302-6-109,SUP,Custom 27803010,,6302-6-109  -  INSERT ACETAB 10D +4MM P9 28MM SYSTEM 12 HIP,"$2,315.00",$0.00,"$2,315.00",$0.00,"$1,652.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,315.00",$0.00,"$1,157.50","$1,833.48","$1,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
6302-6-220,SUP,Custom 27803010,,6302-6-220  -  INSERT ACETAB 22.2MM 4MM P0 NTRL,$928.00,$0.00,$928.00,$0.00,$662.31,$0.00,$0.00,$0.00,$0.00,$0.00,$928.00,$0.00,$464.00,$734.98,$742.40,$0.00,$0.00,$0.00,$0.00,$0.00
6302-6-303,SUP,Custom 27803010,,6302-6-303  -  INSERT ACETAB 10D +4MM P3 32MM SYSTEM 12 HIP,"$2,315.00",$0.00,"$2,315.00",$0.00,"$1,652.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,315.00",$0.00,"$1,157.50","$1,833.48","$1,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
6302-6-304,SUP,Custom 27803010,,6302-6-304  -  INSERT ACETAB 10D +4MM P4 32MM SYSTEM 12 HIP,"$2,315.00",$0.00,"$2,315.00",$0.00,"$1,652.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,315.00",$0.00,"$1,157.50","$1,833.48","$1,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
6302-6-305,SUP,Custom 27803010,,6302-6-305  -  INSERT ACTB 10D P4 32MM S12 LATRILIZING RT,"$2,315.00",$0.00,"$2,315.00",$0.00,"$1,652.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,315.00",$0.00,"$1,157.50","$1,833.48","$1,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
6302-6-306,SUP,Custom 27803010,,6302-6-306  -  INSERT ACETAB 10D +4MM P6 32MM SYSTEM 12 HIP,"$2,315.00",$0.00,"$2,315.00",$0.00,"$1,652.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,315.00",$0.00,"$1,157.50","$1,833.48","$1,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
6302-6-307,SUP,Custom 27803010,,6302-6-307  -  INSERT ACETAB 10D +4MM P7 32MM SYSTEM 12 HIP,"$2,315.00",$0.00,"$2,315.00",$0.00,"$1,652.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,315.00",$0.00,"$1,157.50","$1,833.48","$1,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
6302-6-308,SUP,Custom 27803010,,6302-6-308  -  INSERT ACETAB 10D +4MM P8 32MM SYSTEM 12 HIP,"$2,315.00",$0.00,"$2,315.00",$0.00,"$1,652.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,315.00",$0.00,"$1,157.50","$1,833.48","$1,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
6302-6-309,SUP,Custom 27803010,,6302-6-309  -  INSERT ACETAB 10D +4MM P9 32MM SYSTEM 12 HIP,"$2,315.00",$0.00,"$2,315.00",$0.00,"$1,652.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,315.00",$0.00,"$1,157.50","$1,833.48","$1,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
6302-H-328,SUP,Custom 27803010,,6302-H-328  -  LINER ACETAB 10D 28MM HIP CNSTRN,"$2,950.00",$0.00,"$2,950.00",$0.00,"$2,105.42",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,950.00",$0.00,"$1,475.00","$2,336.40","$2,360.00",$0.00,$0.00,$0.00,$0.00,$0.00
6302-H-428,SUP,Custom 27803010,,6302-H-428  -  LINER ACETAB 10D 28MM HIP CNSTRN,"$2,950.00",$0.00,"$2,950.00",$0.00,"$2,105.42",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,950.00",$0.00,"$1,475.00","$2,336.40","$2,360.00",$0.00,$0.00,$0.00,$0.00,$0.00
6302-H-432,SUP,Custom 27803010,,6302-H-432  -  LINER ACETAB 10D 32MM HIP CNSTRN,"$2,950.00",$0.00,"$2,950.00",$0.00,"$2,105.42",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,950.00",$0.00,"$1,475.00","$2,336.40","$2,360.00",$0.00,$0.00,$0.00,$0.00,$0.00
6302-H-528,SUP,Custom 27803010,,6302-H-528  -  LINER ACETAB 10D 28MM HIP CNSTRN,"$2,950.00",$0.00,"$2,950.00",$0.00,"$2,105.42",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,950.00",$0.00,"$1,475.00","$2,336.40","$2,360.00",$0.00,$0.00,$0.00,$0.00,$0.00
6302-H-532,SUP,Custom 27803010,,6302-H-532  -  LINER ACETAB 10D 32MM HIP CNSTRN,"$2,950.00",$0.00,"$2,950.00",$0.00,"$2,105.42",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,950.00",$0.00,"$1,475.00","$2,336.40","$2,360.00",$0.00,$0.00,$0.00,$0.00,$0.00
6302-H-628,SUP,Custom 27803010,,6302-H-628  -  LINER ACETAB 10D 28MM HIP CNSTRN,"$2,950.00",$0.00,"$2,950.00",$0.00,"$2,105.42",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,950.00",$0.00,"$1,475.00","$2,336.40","$2,360.00",$0.00,$0.00,$0.00,$0.00,$0.00
6302-H-632,SUP,Custom 27803010,,6302-H-632  -  LINER ACETAB 10D 32MM HIP CNSTRN,"$2,950.00",$0.00,"$2,950.00",$0.00,"$2,105.42",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,950.00",$0.00,"$1,475.00","$2,336.40","$2,360.00",$0.00,$0.00,$0.00,$0.00,$0.00
6302-N-222,SUP,Custom 27803010,,6302-N-222  -  LINER ACETAB NTRL 22MM HIP CNSTRN,"$2,950.00",$0.00,"$2,950.00",$0.00,"$2,105.42",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,950.00",$0.00,"$1,475.00","$2,336.40","$2,360.00",$0.00,$0.00,$0.00,$0.00,$0.00
6302-N-328,SUP,Custom 27803010,,6302-N-328  -  LINER ACETAB TRDNT NTRL 28MM CNSTRN,"$2,950.00",$0.00,"$2,950.00",$0.00,"$2,105.42",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,950.00",$0.00,"$1,475.00","$2,336.40","$2,360.00",$0.00,$0.00,$0.00,$0.00,$0.00
6302-N-426,SUP,Custom 27803010,,6302-N-426  -  LINER ACETAB NTRL 26MM HIP CNSTRN,"$2,950.00",$0.00,"$2,950.00",$0.00,"$2,105.42",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,950.00",$0.00,"$1,475.00","$2,336.40","$2,360.00",$0.00,$0.00,$0.00,$0.00,$0.00
6302-N-428,SUP,Custom 27803010,,6302-N-428  -  LINER ACETAB NTRL 28MM HIP CNSTRN,"$2,950.00",$0.00,"$2,950.00",$0.00,"$2,105.42",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,950.00",$0.00,"$1,475.00","$2,336.40","$2,360.00",$0.00,$0.00,$0.00,$0.00,$0.00
6302-N-432,SUP,Custom 27803010,,6302-N-432  -  LINER ACETAB NTRL 32MM HIP CNSTRN,"$2,950.00",$0.00,"$2,950.00",$0.00,"$2,105.42",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,950.00",$0.00,"$1,475.00","$2,336.40","$2,360.00",$0.00,$0.00,$0.00,$0.00,$0.00
6302-N-532,SUP,Custom 27803010,,6302-N-532  -  LINER ACETAB NTRL 32MM HIP CNSTRN,"$2,950.00",$0.00,"$2,950.00",$0.00,"$2,105.42",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,950.00",$0.00,"$1,475.00","$2,336.40","$2,360.00",$0.00,$0.00,$0.00,$0.00,$0.00
6302-N-632,SUP,Custom 27803010,,6302-N-632  -  LINER ACETAB NTRL 32MM HIP CNSTRN,"$2,950.00",$0.00,"$2,950.00",$0.00,"$2,105.42",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,950.00",$0.00,"$1,475.00","$2,336.40","$2,360.00",$0.00,$0.00,$0.00,$0.00,$0.00
6309-2-240,SUP,HCPCS C1776,,6309-2-240  -  CUP ACTB 40MM 22MM STRL EXTR RIMFIT X3,"$2,327.50",$0.00,"$2,327.50","$1,047.38","$1,661.14",$0.00,$401.02,$0.00,$0.00,$407.53,"$2,327.50",$0.00,"$1,163.75","$1,843.38","$1,862.00",$0.00,$364.25,$0.00,$370.54,$0.00
6309-2-242,SUP,HCPCS C1776,,6309-2-242  -  CUP ACTB 42MM 22MM STRL EXTR RIMFIT X3,"$2,327.50",$0.00,"$2,327.50","$1,047.38","$1,661.14",$0.00,$401.02,$0.00,$0.00,$407.53,"$2,327.50",$0.00,"$1,163.75","$1,843.38","$1,862.00",$0.00,$364.25,$0.00,$370.54,$0.00
6309-2-244,SUP,HCPCS C1776,,6309-2-244  -  CUP ACTB 44MM 22MM STRL EXTR RIMFIT X3,"$2,327.50",$0.00,"$2,327.50","$1,047.38","$1,661.14",$0.00,$401.02,$0.00,$0.00,$407.53,"$2,327.50",$0.00,"$1,163.75","$1,843.38","$1,862.00",$0.00,$364.25,$0.00,$370.54,$0.00
6309-2-844,SUP,HCPCS C1776,,6309-2-844  -  CUP ACTB 44MM 28MM STRL EXTR RIMFIT X3,"$2,327.50",$0.00,"$2,327.50","$1,047.38","$1,661.14",$0.00,$401.02,$0.00,$0.00,$407.53,"$2,327.50",$0.00,"$1,163.75","$1,843.38","$1,862.00",$0.00,$364.25,$0.00,$370.54,$0.00
6309-2-846,SUP,HCPCS C1776,,6309-2-846  -  CUP ACTB 46MM 28MM STRL EXTR RIMFIT X3,"$2,327.50",$0.00,"$2,327.50","$1,047.38","$1,661.14",$0.00,$401.02,$0.00,$0.00,$407.53,"$2,327.50",$0.00,"$1,163.75","$1,843.38","$1,862.00",$0.00,$364.25,$0.00,$370.54,$0.00
6309-2-848,SUP,HCPCS C1776,,6309-2-848  -  CUP ACTB 48MM 28MM STRL EXTR RIMFIT X3,"$2,327.50",$0.00,"$2,327.50","$1,047.38","$1,661.14",$0.00,$401.02,$0.00,$0.00,$407.53,"$2,327.50",$0.00,"$1,163.75","$1,843.38","$1,862.00",$0.00,$364.25,$0.00,$370.54,$0.00
6309-2-850,SUP,HCPCS C1776,,6309-2-850  -  CUP ACTB 50MM 28MM STRL EXTR RIMFIT X3,"$2,327.50",$0.00,"$2,327.50","$1,047.38","$1,661.14",$0.00,$401.02,$0.00,$0.00,$407.53,"$2,327.50",$0.00,"$1,163.75","$1,843.38","$1,862.00",$0.00,$364.25,$0.00,$370.54,$0.00
6309-2-852,SUP,HCPCS C1776,,6309-2-852  -  CUP ACTB 52MM 28MM STRL EXTR RIMFIT X3,"$2,327.50",$0.00,"$2,327.50","$1,047.38","$1,661.14",$0.00,$401.02,$0.00,$0.00,$407.53,"$2,327.50",$0.00,"$1,163.75","$1,843.38","$1,862.00",$0.00,$364.25,$0.00,$370.54,$0.00
6309-2-854,SUP,HCPCS C1776,,6309-2-854  -  CUP ACTB 54MM 28MM STRL EXTR RIMFIT X3,"$2,327.50",$0.00,"$2,327.50","$1,047.38","$1,661.14",$0.00,$401.02,$0.00,$0.00,$407.53,"$2,327.50",$0.00,"$1,163.75","$1,843.38","$1,862.00",$0.00,$364.25,$0.00,$370.54,$0.00
6309-2-856,SUP,HCPCS C1776,,6309-2-856  -  CUP ACTB 56MM 28MM STRL EXTR RIMFIT X3,"$2,327.50",$0.00,"$2,327.50","$1,047.38","$1,661.14",$0.00,$401.02,$0.00,$0.00,$407.53,"$2,327.50",$0.00,"$1,163.75","$1,843.38","$1,862.00",$0.00,$364.25,$0.00,$370.54,$0.00
6309-2-858,SUP,HCPCS C1776,,6309-2-858  -  CUP ACTB 58MM 28MM STRL EXTR RIMFIT X3,"$2,327.50",$0.00,"$2,327.50","$1,047.38","$1,661.14",$0.00,$401.02,$0.00,$0.00,$407.53,"$2,327.50",$0.00,"$1,163.75","$1,843.38","$1,862.00",$0.00,$364.25,$0.00,$370.54,$0.00
6309-2-860,SUP,HCPCS C1776,,6309-2-860  -  CUP ACTB 60MM 28MM STRL EXTR RIMFIT X3,"$2,327.50",$0.00,"$2,327.50","$1,047.38","$1,661.14",$0.00,$401.02,$0.00,$0.00,$407.53,"$2,327.50",$0.00,"$1,163.75","$1,843.38","$1,862.00",$0.00,$364.25,$0.00,$370.54,$0.00
6309-3-248,SUP,HCPCS C1776,,6309-3-248  -  CUP ACTB 48MM 32MM EXTR RIMFIT X3 HIP,"$2,327.50",$0.00,"$2,327.50","$1,047.38","$1,661.14",$0.00,$401.02,$0.00,$0.00,$407.53,"$2,327.50",$0.00,"$1,163.75","$1,843.38","$1,862.00",$0.00,$364.25,$0.00,$370.54,$0.00
6309-3-250,SUP,HCPCS C1776,,6309-3-250  -  CUP ACTB 50MM 32MM EXTR RIMFIT X3 HIP,"$2,327.50",$0.00,"$2,327.50","$1,047.38","$1,661.14",$0.00,$401.02,$0.00,$0.00,$407.53,"$2,327.50",$0.00,"$1,163.75","$1,843.38","$1,862.00",$0.00,$364.25,$0.00,$370.54,$0.00
6309-3-252,SUP,HCPCS C1776,,6309-3-252  -  CUP ACTB 52MM 32MM EXTR X3 RIMFIT HIP,"$2,327.50",$0.00,"$2,327.50","$1,047.38","$1,661.14",$0.00,$401.02,$0.00,$0.00,$407.53,"$2,327.50",$0.00,"$1,163.75","$1,843.38","$1,862.00",$0.00,$364.25,$0.00,$370.54,$0.00
6309-3-254,SUP,HCPCS C1776,,6309-3-254  -  CUP ACTB 54MM 32MM EXTR X3 RIMFIT HIP,"$2,327.50",$0.00,"$2,327.50","$1,047.38","$1,661.14",$0.00,$401.02,$0.00,$0.00,$407.53,"$2,327.50",$0.00,"$1,163.75","$1,843.38","$1,862.00",$0.00,$364.25,$0.00,$370.54,$0.00
6309-3-256,SUP,HCPCS C1776,,6309-3-256  -  CUP ACTB 56MM 32MM EXTR X3 RIMFIT HIP,"$2,327.50",$0.00,"$2,327.50","$1,047.38","$1,661.14",$0.00,$401.02,$0.00,$0.00,$407.53,"$2,327.50",$0.00,"$1,163.75","$1,843.38","$1,862.00",$0.00,$364.25,$0.00,$370.54,$0.00
6309-3-258,SUP,HCPCS C1776,,6309-3-258  -  CUP ACTB 58MM 32MM STRL EXTR RIMFIT X3,"$2,327.50",$0.00,"$2,327.50","$1,047.38","$1,661.14",$0.00,$401.02,$0.00,$0.00,$407.53,"$2,327.50",$0.00,"$1,163.75","$1,843.38","$1,862.00",$0.00,$364.25,$0.00,$370.54,$0.00
6309-3-260,SUP,HCPCS C1776,,6309-3-260  -  CUP ACTB 60MM 32MM STRL EXTR RIMFIT X3,"$2,327.50",$0.00,"$2,327.50","$1,047.38","$1,661.14",$0.00,$401.02,$0.00,$0.00,$407.53,"$2,327.50",$0.00,"$1,163.75","$1,843.38","$1,862.00",$0.00,$364.25,$0.00,$370.54,$0.00
6309-3-652,SUP,HCPCS C1776,,6309-3-652  -  CUP ACTB 52MM 36MM EXTR RIMFIT X3 HIP,"$2,327.50",$0.00,"$2,327.50","$1,047.38","$1,661.14",$0.00,$401.02,$0.00,$0.00,$407.53,"$2,327.50",$0.00,"$1,163.75","$1,843.38","$1,862.00",$0.00,$364.25,$0.00,$370.54,$0.00
6309-3-654,SUP,HCPCS C1776,,6309-3-654  -  CUP ACTB 54MM 36MM EXTR X3 RIMFIT HIP,"$2,327.50",$0.00,"$2,327.50","$1,047.38","$1,661.14",$0.00,$401.02,$0.00,$0.00,$407.53,"$2,327.50",$0.00,"$1,163.75","$1,843.38","$1,862.00",$0.00,$364.25,$0.00,$370.54,$0.00
6309-3-656,SUP,HCPCS C1776,,6309-3-656  -  CUP ACTB 56MM 36MM EXTR RIMFIT X3 HIP,"$2,327.50",$0.00,"$2,327.50","$1,047.38","$1,661.14",$0.00,$401.02,$0.00,$0.00,$407.53,"$2,327.50",$0.00,"$1,163.75","$1,843.38","$1,862.00",$0.00,$364.25,$0.00,$370.54,$0.00
6309-3-658,SUP,HCPCS C1776,,6309-3-658  -  CUP ACTB 58MM 36MM STRL EXTR RIMFIT X3,"$2,327.50",$0.00,"$2,327.50","$1,047.38","$1,661.14",$0.00,$401.02,$0.00,$0.00,$407.53,"$2,327.50",$0.00,"$1,163.75","$1,843.38","$1,862.00",$0.00,$364.25,$0.00,$370.54,$0.00
6309-3-660,SUP,HCPCS C1776,,6309-3-660  -  CUP ACTB 60MM 36MM EXTR RIMFIT X3 HIP,"$2,327.50",$0.00,"$2,327.50","$1,047.38","$1,661.14",$0.00,$401.02,$0.00,$0.00,$407.53,"$2,327.50",$0.00,"$1,163.75","$1,843.38","$1,862.00",$0.00,$364.25,$0.00,$370.54,$0.00
6309-4-056,SUP,HCPCS C1776,,6309-4-056  -  CUP ACTB 56MM 40MM EXTR RIMFIT X3 HIP,"$2,327.50",$0.00,"$2,327.50","$1,047.38","$1,661.14",$0.00,$401.02,$0.00,$0.00,$407.53,"$2,327.50",$0.00,"$1,163.75","$1,843.38","$1,862.00",$0.00,$364.25,$0.00,$370.54,$0.00
6309-4-058,SUP,HCPCS C1776,,6309-4-058  -  CUP ACTB 58MM 40MM STRL EXTR RIMFIT X3,"$2,327.50",$0.00,"$2,327.50","$1,047.38","$1,661.14",$0.00,$401.02,$0.00,$0.00,$407.53,"$2,327.50",$0.00,"$1,163.75","$1,843.38","$1,862.00",$0.00,$364.25,$0.00,$370.54,$0.00
6309-4-060,SUP,HCPCS C1776,,6309-4-060  -  CUP ACTB 58MM 60MM STRL EXTR RIMFIT X3,"$2,327.50",$0.00,"$2,327.50","$1,047.38","$1,661.14",$0.00,$401.02,$0.00,$0.00,$407.53,"$2,327.50",$0.00,"$1,163.75","$1,843.38","$1,862.00",$0.00,$364.25,$0.00,$370.54,$0.00
632.414S,SUP,Custom 27803010,,632.414S  -  PORT RTRCT BVL 22MM 40MM MRS,$897.50,$0.00,$897.50,$0.00,$640.55,$0.00,$0.00,$0.00,$0.00,$0.00,$897.50,$0.00,$448.75,$710.82,$718.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.415S,SUP,Custom 27803010,,632.415S  -  PORT RTRCT BVL 22MM 50MM MRS,$897.50,$0.00,$897.50,$0.00,$640.55,$0.00,$0.00,$0.00,$0.00,$0.00,$897.50,$0.00,$448.75,$710.82,$718.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.416S,SUP,Custom 27803010,,"632.416S  -  22MM PORT, BEVELED, 60MM",$897.50,$0.00,$897.50,$0.00,$640.55,$0.00,$0.00,$0.00,$0.00,$0.00,$897.50,$0.00,$448.75,$710.82,$718.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.417S,SUP,Custom 27803010,,632.417S  -  PORT RTRCT BVL 22MM 70MM MRS,"$1,055.00",$0.00,"$1,055.00",$0.00,$752.95,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,055.00",$0.00,$527.50,$835.56,$844.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.418S,SUP,Custom 27803010,,632.418S  -  PORT RTRCT BVL 22MM 80MM MRS,"$1,055.00",$0.00,"$1,055.00",$0.00,$752.95,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,055.00",$0.00,$527.50,$835.56,$844.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.419S,SUP,Custom 27803010,,632.419S  -  PORT RTRCT BVL 22MM 90MM MRS,"$1,055.00",$0.00,"$1,055.00",$0.00,$752.95,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,055.00",$0.00,$527.50,$835.56,$844.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.420S,SUP,Custom 27803010,,632.420S  -  PORT RTRCT BVL 22MM 100MM MRS,"$1,232.50",$0.00,"$1,232.50",$0.00,$879.64,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,232.50",$0.00,$616.25,$976.14,$986.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.421S,SUP,Custom 27803010,,632.421S  -  PORT RTRCT BVL 22MM 110MM MRS,"$1,232.50",$0.00,"$1,232.50",$0.00,$879.64,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,232.50",$0.00,$616.25,$976.14,$986.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.422S,SUP,Custom 27803010,,632.422S  -  PORT RTRCT BVL 22MM 120MM MRS,"$1,232.50",$0.00,"$1,232.50",$0.00,$879.64,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,232.50",$0.00,$616.25,$976.14,$986.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.424S,SUP,Custom 27803010,,632.424S  -  PORT RTRCT STRG 22MM 40MM MRS,$860.00,$0.00,$860.00,$0.00,$613.78,$0.00,$0.00,$0.00,$0.00,$0.00,$860.00,$0.00,$430.00,$681.12,$688.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.425S,SUP,Custom 27803010,,"632.425S  -  22MM PORT, STRAIGHT, 50MM",$860.00,$0.00,$860.00,$0.00,$613.78,$0.00,$0.00,$0.00,$0.00,$0.00,$860.00,$0.00,$430.00,$681.12,$688.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.426S,SUP,Custom 27803010,,"632.426S  -  22MM PORT, STRAIGHT, 60MM",$860.00,$0.00,$860.00,$0.00,$613.78,$0.00,$0.00,$0.00,$0.00,$0.00,$860.00,$0.00,$430.00,$681.12,$688.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.427S,SUP,Custom 27803010,,632.427S  -  PORT RTRCT STRG 22MM 70MM,$975.00,$0.00,$975.00,$0.00,$695.86,$0.00,$0.00,$0.00,$0.00,$0.00,$975.00,$0.00,$487.50,$772.20,$780.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.428S,SUP,Custom 27803010,,632.428S  -  PORT RTRCT STRG 22MM 80MM MRS,$975.00,$0.00,$975.00,$0.00,$695.86,$0.00,$0.00,$0.00,$0.00,$0.00,$975.00,$0.00,$487.50,$772.20,$780.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.429S,SUP,Custom 27803010,,632.429S  -  PORT RTRCT STRG 22MM 90MM MRS,$975.00,$0.00,$975.00,$0.00,$695.86,$0.00,$0.00,$0.00,$0.00,$0.00,$975.00,$0.00,$487.50,$772.20,$780.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.430S,SUP,Custom 27803010,,632.430S  -  PORT RTRCT STRG 22MM 100MM MRS,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.431S,SUP,Custom 27803010,,632.431S  -  PORT RTRCT STRG 22MM 110MM MRS,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.432S,SUP,Custom 27803010,,632.432S  -  PORT RTRCT STRG 22MM 120MM MRS,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.434S,SUP,Custom 27803010,,632.434S  -  PORT RTRCT BVL 19MM 40MM MRS,$897.50,$0.00,$897.50,$0.00,$640.55,$0.00,$0.00,$0.00,$0.00,$0.00,$897.50,$0.00,$448.75,$710.82,$718.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.435S,SUP,Custom 27803010,,632.435S  -  PORT RTRCT BVL 19MM 50MM MRS,$897.50,$0.00,$897.50,$0.00,$640.55,$0.00,$0.00,$0.00,$0.00,$0.00,$897.50,$0.00,$448.75,$710.82,$718.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.436S,SUP,Custom 27803010,,632.436S  -  PORT RTRCT BVL 19MM 60MM MRS,$897.50,$0.00,$897.50,$0.00,$640.55,$0.00,$0.00,$0.00,$0.00,$0.00,$897.50,$0.00,$448.75,$710.82,$718.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.437S,SUP,Custom 27803010,,632.437S  -  PORT RTRCT BVL 19MM 70MM MRS,"$1,055.00",$0.00,"$1,055.00",$0.00,$752.95,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,055.00",$0.00,$527.50,$835.56,$844.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.438S,SUP,Custom 27803010,,632.438S  -  PORT RTRCT BVL 19MM 80MM MRS,"$1,055.00",$0.00,"$1,055.00",$0.00,$752.95,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,055.00",$0.00,$527.50,$835.56,$844.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.439S,SUP,Custom 27803010,,"632.439S  -  19MM PORT, BEVELED, 90MM","$1,055.00",$0.00,"$1,055.00",$0.00,$752.95,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,055.00",$0.00,$527.50,$835.56,$844.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.440S,SUP,Custom 27803010,,632.440S  -  PORT RTRCT BVL 19MM 100MM MRS,"$1,232.50",$0.00,"$1,232.50",$0.00,$879.64,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,232.50",$0.00,$616.25,$976.14,$986.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.441S,SUP,Custom 27803010,,632.441S  -  PORT RTRCT BVL 19MM 110MM MRS,"$1,232.50",$0.00,"$1,232.50",$0.00,$879.64,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,232.50",$0.00,$616.25,$976.14,$986.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.442S,SUP,Custom 27803010,,632.442S  -  PORT RTRCT BVL 19MM 120MM MRS,"$1,232.50",$0.00,"$1,232.50",$0.00,$879.64,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,232.50",$0.00,$616.25,$976.14,$986.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.444S,SUP,Custom 27803010,,632.444S  -  PORT RTRCT STRG 19MM 40MM MRS,$860.00,$0.00,$860.00,$0.00,$613.78,$0.00,$0.00,$0.00,$0.00,$0.00,$860.00,$0.00,$430.00,$681.12,$688.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.445S,SUP,Custom 27803010,,632.445S  -  PORT RTRCT STRG 19MM 50MM MRS,$860.00,$0.00,$860.00,$0.00,$613.78,$0.00,$0.00,$0.00,$0.00,$0.00,$860.00,$0.00,$430.00,$681.12,$688.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.446S,SUP,Custom 27803010,,632.446S  -  PORT RTRCT STRG 19MM 60MM,$860.00,$0.00,$860.00,$0.00,$613.78,$0.00,$0.00,$0.00,$0.00,$0.00,$860.00,$0.00,$430.00,$681.12,$688.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.447S,SUP,Custom 27803010,,632.447S  -  PORT RTRCT STRG 19MM 70MM MRS,$975.00,$0.00,$975.00,$0.00,$695.86,$0.00,$0.00,$0.00,$0.00,$0.00,$975.00,$0.00,$487.50,$772.20,$780.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.448S,SUP,Custom 27803010,,632.448S  -  PORT RTRCT STRG 19MM 80MM MRS,$975.00,$0.00,$975.00,$0.00,$695.86,$0.00,$0.00,$0.00,$0.00,$0.00,$975.00,$0.00,$487.50,$772.20,$780.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.449S,SUP,Custom 27803010,,632.449S  -  PORT RTRCT STRG 19MM 90MM MRS,$975.00,$0.00,$975.00,$0.00,$695.86,$0.00,$0.00,$0.00,$0.00,$0.00,$975.00,$0.00,$487.50,$772.20,$780.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.450S,SUP,Custom 27803010,,632.450S  -  PORT RTRCT STRG 19MM 100MM MRS,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.451S,SUP,Custom 27803010,,632.451S  -  PORT RTRCT STRG 19MM 110MM MRS,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.452S,SUP,Custom 27803010,,632.452S  -  PORT RTRCT STRG 19MM 120MM MRS,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.454S,SUP,Custom 27803010,,632.454S  -  PORT RTRCT BVL 26MM 40MM MRS,"$1,197.50",$0.00,"$1,197.50",$0.00,$854.66,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,197.50",$0.00,$598.75,$948.42,$958.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.455S,SUP,Custom 27803010,,632.455S  -  PORT RTRCT BVL 26MM 50MM MRS,"$1,197.50",$0.00,"$1,197.50",$0.00,$854.66,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,197.50",$0.00,$598.75,$948.42,$958.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.456S,SUP,Custom 27803010,,632.456S  -  PORT RTRCT BVL 26MM 60MM MRS,"$1,197.50",$0.00,"$1,197.50",$0.00,$854.66,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,197.50",$0.00,$598.75,$948.42,$958.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.457S,SUP,Custom 27803010,,632.457S  -  PORT RTRCT BVL 26MM 70MM MRS,"$1,307.50",$0.00,"$1,307.50",$0.00,$933.16,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,307.50",$0.00,$653.75,"$1,035.54","$1,046.00",$0.00,$0.00,$0.00,$0.00,$0.00
632.458S,SUP,Custom 27803010,,632.458S  -  PORT RTRCT BVL 26MM 80MM MRS,"$1,307.50",$0.00,"$1,307.50",$0.00,$933.16,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,307.50",$0.00,$653.75,"$1,035.54","$1,046.00",$0.00,$0.00,$0.00,$0.00,$0.00
632.459S,SUP,Custom 27803010,,632.459S  -  PORT RTRCT BVL 26MM 90MM MRS,"$1,307.50",$0.00,"$1,307.50",$0.00,$933.16,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,307.50",$0.00,$653.75,"$1,035.54","$1,046.00",$0.00,$0.00,$0.00,$0.00,$0.00
632.460S,SUP,Custom 27803010,,632.460S  -  PORT RTRCT BVL 26MM 100MM MRS,"$1,400.00",$0.00,"$1,400.00",$0.00,$999.18,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,400.00",$0.00,$700.00,"$1,108.80","$1,120.00",$0.00,$0.00,$0.00,$0.00,$0.00
632.461S,SUP,Custom 27803010,,632.461S  -  PORT RTRCT BVL 26MM 110MM MRS,"$1,400.00",$0.00,"$1,400.00",$0.00,$999.18,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,400.00",$0.00,$700.00,"$1,108.80","$1,120.00",$0.00,$0.00,$0.00,$0.00,$0.00
632.462S,SUP,Custom 27803010,,632.462S  -  PORT RTRCT BVL 26MM 120MM MRS,"$1,400.00",$0.00,"$1,400.00",$0.00,$999.18,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,400.00",$0.00,$700.00,"$1,108.80","$1,120.00",$0.00,$0.00,$0.00,$0.00,$0.00
632.464S,SUP,Custom 27803010,,632.464S  -  PORT RTRCT STRG 26MM 40MM MRS,"$1,167.50",$0.00,"$1,167.50",$0.00,$833.24,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,167.50",$0.00,$583.75,$924.66,$934.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.465S,SUP,Custom 27803010,,632.465S  -  PORT RTRCT STRG 26MM 50MM MRS,"$1,167.50",$0.00,"$1,167.50",$0.00,$833.24,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,167.50",$0.00,$583.75,$924.66,$934.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.466S,SUP,Custom 27803010,,632.466S  -  PORT RTRCT STRG 26MM 60MM MRS,"$1,167.50",$0.00,"$1,167.50",$0.00,$833.24,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,167.50",$0.00,$583.75,$924.66,$934.00,$0.00,$0.00,$0.00,$0.00,$0.00
632.467S,SUP,Custom 27803010,,632.467S  -  PORT RTRCT STRG 26MM 70MM MRS,"$1,307.50",$0.00,"$1,307.50",$0.00,$933.16,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,307.50",$0.00,$653.75,"$1,035.54","$1,046.00",$0.00,$0.00,$0.00,$0.00,$0.00
632.468S,SUP,Custom 27803010,,632.468S  -  PORT RTRCT STRG 26MM 80MM STRL MRS SPNE,"$1,307.50",$0.00,"$1,307.50",$0.00,$933.16,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,307.50",$0.00,$653.75,"$1,035.54","$1,046.00",$0.00,$0.00,$0.00,$0.00,$0.00
632.469S,SUP,Custom 27803010,,632.469S  -  PORT RTRCT STRG 26MM 90MM MRS,"$1,307.50",$0.00,"$1,307.50",$0.00,$933.16,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,307.50",$0.00,$653.75,"$1,035.54","$1,046.00",$0.00,$0.00,$0.00,$0.00,$0.00
632.470S,SUP,Custom 27803010,,632.470S  -  PORT RTRCT STRG 26MM 100MM MRS,"$1,400.00",$0.00,"$1,400.00",$0.00,$999.18,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,400.00",$0.00,$700.00,"$1,108.80","$1,120.00",$0.00,$0.00,$0.00,$0.00,$0.00
632.471S,SUP,Custom 27803010,,632.471S  -  PORT RTRCT STRG 26MM 110MM MRS,"$1,400.00",$0.00,"$1,400.00",$0.00,$999.18,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,400.00",$0.00,$700.00,"$1,108.80","$1,120.00",$0.00,$0.00,$0.00,$0.00,$0.00
632.472S,SUP,Custom 27803010,,632.472S  -  PORT RTRCT STRG 26MM 120MM MRS,"$1,400.00",$0.00,"$1,400.00",$0.00,$999.18,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,400.00",$0.00,$700.00,"$1,108.80","$1,120.00",$0.00,$0.00,$0.00,$0.00,$0.00
633-350,SUP,HCPCS C1884,,COIL EMBL 6MM TRFL PSH CMPLX SHP,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
6352-5-062,SUP,Custom 27803010,,6352-5-062  -  INSERT ACETAB 0D P2 46/48MM 28MM LINER CONGRUENT ROBUST LOCK,"$2,642.50",$0.00,"$2,642.50",$0.00,"$1,885.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,642.50",$0.00,"$1,321.25","$2,092.86","$2,114.00",$0.00,$0.00,$0.00,$0.00,$0.00
6352-5-063,SUP,Custom 27803010,,6352-5-063  -  INSERT ACETAB 0D 28MM LINER CONGRUENT ROBUST LOCK SYSTEM 12,"$2,642.50",$0.00,"$2,642.50",$0.00,"$1,885.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,642.50",$0.00,"$1,321.25","$2,092.86","$2,114.00",$0.00,$0.00,$0.00,$0.00,$0.00
6352-5-064,SUP,Custom 27803010,,6352-5-064  -  INSERT ACETAB 0D 28MM LINER CONGRUENT ROBUST LOCK SYSTEM 12,"$2,642.50",$0.00,"$2,642.50",$0.00,"$1,885.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,642.50",$0.00,"$1,321.25","$2,092.86","$2,114.00",$0.00,$0.00,$0.00,$0.00,$0.00
6352-5-065,SUP,Custom 27803010,,6352-5-065  -  INSERT ACETAB 0D 28MM LINER CONGRUENT ROBUST LOCK SYSTEM 12,"$2,642.50",$0.00,"$2,642.50",$0.00,"$1,885.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,642.50",$0.00,"$1,321.25","$2,092.86","$2,114.00",$0.00,$0.00,$0.00,$0.00,$0.00
6352-5-065300,SUP,Custom 27803010,,6352-5-065300  -  INSERT ACETAB 28MM 0D XFIRE S12,"$1,707.00",$0.00,"$1,707.00",$0.00,"$1,218.29",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,707.00",$0.00,$853.50,"$1,351.94","$1,365.60",$0.00,$0.00,$0.00,$0.00,$0.00
6352-5-066,SUP,Custom 27803010,,6352-5-066  -  INSERT ACETAB 0D 28MM LINER CONGRUENT ROBUST LOCK SYSTEM 12,"$2,642.50",$0.00,"$2,642.50",$0.00,"$1,885.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,642.50",$0.00,"$1,321.25","$2,092.86","$2,114.00",$0.00,$0.00,$0.00,$0.00,$0.00
6352-5-066300,SUP,Custom 27803010,,6352-5-066300  -  INSERT ACETAB 28MM 0D XFIRE S12,"$1,707.00",$0.00,"$1,707.00",$0.00,"$1,218.29",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,707.00",$0.00,$853.50,"$1,351.94","$1,365.60",$0.00,$0.00,$0.00,$0.00,$0.00
6352-5-072,SUP,Custom 27803010,,6352-5-072  -  INSERT ACETAB 0D P2 46/48MM 28MM 5MM LINER CONGRUENT ROBUST,"$2,642.50",$0.00,"$2,642.50",$0.00,"$1,885.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,642.50",$0.00,"$1,321.25","$2,092.86","$2,114.00",$0.00,$0.00,$0.00,$0.00,$0.00
6352-5-073,SUP,HCPCS C1776,,6352-5-073  -  INSERT ACTB 10D P3 50/52MM 28MM S12 LINR CNGR RBST LCK XFR,"$2,642.50",$0.00,"$2,642.50","$1,189.13","$1,885.95",$0.00,$455.29,$0.00,$0.00,$462.68,"$2,642.50",$0.00,"$1,321.25","$2,092.86","$2,114.00",$0.00,$413.55,$0.00,$420.69,$0.00
6352-5-073300,SUP,Custom 27803010,,6352-5-073300  -  INSERT ACETAB 28MM 10D XFIRE S12,"$1,707.00",$0.00,"$1,707.00",$0.00,"$1,218.29",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,707.00",$0.00,$853.50,"$1,351.94","$1,365.60",$0.00,$0.00,$0.00,$0.00,$0.00
6352-5-074,SUP,HCPCS C1776,,6352-5-074  -  INSERT ACTB 10D P4 54/46MM 28MM S12 LINR CNGR RBST LCK XFR,"$2,642.50",$0.00,"$2,642.50","$1,189.13","$1,885.95",$0.00,$455.29,$0.00,$0.00,$462.68,"$2,642.50",$0.00,"$1,321.25","$2,092.86","$2,114.00",$0.00,$413.55,$0.00,$420.69,$0.00
6352-5-074300,SUP,Custom 27803010,,6352-5-074300  -  INSERT ACETAB 28MM 10D HIP XFIRE S12,"$1,707.00",$0.00,"$1,707.00",$0.00,"$1,218.29",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,707.00",$0.00,$853.50,"$1,351.94","$1,365.60",$0.00,$0.00,$0.00,$0.00,$0.00
6352-5-075,SUP,Custom 27803010,,6352-5-075  -  INSERT ACETAB 10D P5 58/60MM 28MM LINER CONGRUENT ROBUST,"$2,642.50",$0.00,"$2,642.50",$0.00,"$1,885.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,642.50",$0.00,"$1,321.25","$2,092.86","$2,114.00",$0.00,$0.00,$0.00,$0.00,$0.00
6352-5-076,SUP,HCPCS C1776,,6352-5-076  -  INSERT ACTB 10D P6 62/64MM 28MM S12 LINR CNGR RBST LCK XFR,"$2,642.50",$0.00,"$2,642.50","$1,189.13","$1,885.95",$0.00,$455.29,$0.00,$0.00,$462.68,"$2,642.50",$0.00,"$1,321.25","$2,092.86","$2,114.00",$0.00,$413.55,$0.00,$420.69,$0.00
6352-5-076300,SUP,Custom 27803010,,6352-5-076300  -  INSERT ACETAB 28MM 10D XFIRE S12,"$1,707.00",$0.00,"$1,707.00",$0.00,"$1,218.29",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,707.00",$0.00,$853.50,"$1,351.94","$1,365.60",$0.00,$0.00,$0.00,$0.00,$0.00
6352-5-093,SUP,Custom 27803010,,6352-5-093  -  INSERT ACETAB 0D P3 50/52MM 32MM LINER CONGRUENT ROBUST LOCK,"$2,642.50",$0.00,"$2,642.50",$0.00,"$1,885.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,642.50",$0.00,"$1,321.25","$2,092.86","$2,114.00",$0.00,$0.00,$0.00,$0.00,$0.00
6352-5-094,SUP,Custom 27803010,,6352-5-094  -  INSERT ACETAB 0D P4 54/46MM 32MM LINER CONGRUENT ROBUST LOCK,"$2,642.50",$0.00,"$2,642.50",$0.00,"$1,885.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,642.50",$0.00,"$1,321.25","$2,092.86","$2,114.00",$0.00,$0.00,$0.00,$0.00,$0.00
6352-5-095,SUP,Custom 27803010,,6352-5-095  -  INSERT ACETAB 0D P5 58/60MM 32MM 8MM LINER CONGRUENT ROBUST,"$2,642.50",$0.00,"$2,642.50",$0.00,"$1,885.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,642.50",$0.00,"$1,321.25","$2,092.86","$2,114.00",$0.00,$0.00,$0.00,$0.00,$0.00
6352-5-096,SUP,Custom 27803010,,6352-5-096  -  INSERT ACETAB 0D 32MM LINER CONGRUENT ROBUST LOCK SYSTEM 12,"$2,642.50",$0.00,"$2,642.50",$0.00,"$1,885.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,642.50",$0.00,"$1,321.25","$2,092.86","$2,114.00",$0.00,$0.00,$0.00,$0.00,$0.00
6352-5-097,SUP,HCPCS C1776,,6352-5-097  -  INSERT ACTB 0D P7 32MM STRL S12 LINR CNGR RBST LCK XFR HIP,"$2,642.50",$0.00,"$2,642.50","$1,189.13","$1,885.95",$0.00,$455.29,$0.00,$0.00,$462.68,"$2,642.50",$0.00,"$1,321.25","$2,092.86","$2,114.00",$0.00,$413.55,$0.00,$420.69,$0.00
6352-5-097300,SUP,Custom 27803010,,6352-5-097300  -  INSERT ACETAB 32MM 0D HIP XFIRE S12,"$1,707.00",$0.00,"$1,707.00",$0.00,"$1,218.29",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,707.00",$0.00,$853.50,"$1,351.94","$1,365.60",$0.00,$0.00,$0.00,$0.00,$0.00
6352-5-098,SUP,HCPCS C1776,,6352-5-098  -  INSERT ACTB 0D P8 70/72MM 32MM S12 LINR CNGR XFR HIP,"$2,642.50",$0.00,"$2,642.50","$1,189.13","$1,885.95",$0.00,$455.29,$0.00,$0.00,$462.68,"$2,642.50",$0.00,"$1,321.25","$2,092.86","$2,114.00",$0.00,$413.55,$0.00,$420.69,$0.00
6352-5-098300,SUP,Custom 27803010,,6352-5-098300  -  INSERT ACETAB 32MM 0D P8 HIP XFIRE S12,"$1,707.00",$0.00,"$1,707.00",$0.00,"$1,218.29",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,707.00",$0.00,$853.50,"$1,351.94","$1,365.60",$0.00,$0.00,$0.00,$0.00,$0.00
6352-5-103,SUP,Custom 27803010,,6352-5-103  -  INSERT ACETAB 10D P3 50/52MM 32MM LINER CONGRUENT ROBUST,"$2,642.50",$0.00,"$2,642.50",$0.00,"$1,885.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,642.50",$0.00,"$1,321.25","$2,092.86","$2,114.00",$0.00,$0.00,$0.00,$0.00,$0.00
6352-5-104,SUP,Custom 27803010,,6352-5-104  -  INSERT ACETAB 10D 32MM LINER CONGRUENT ROBUST LOCK SYSTEM 12,"$2,642.50",$0.00,"$2,642.50",$0.00,"$1,885.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,642.50",$0.00,"$1,321.25","$2,092.86","$2,114.00",$0.00,$0.00,$0.00,$0.00,$0.00
6352-5-105,SUP,Custom 27803010,,6352-5-105  -  INSERT ACETAB 10D P5 58/60MM 32MM LINER CONGRUENT ROBUST,"$2,642.50",$0.00,"$2,642.50",$0.00,"$1,885.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,642.50",$0.00,"$1,321.25","$2,092.86","$2,114.00",$0.00,$0.00,$0.00,$0.00,$0.00
6352-5-106,SUP,Custom 27803010,,6352-5-106  -  INSERT ACETAB 10D P6 62/64MM 32MM LINER CONGRUENT ROBUST,"$2,642.50",$0.00,"$2,642.50",$0.00,"$1,885.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,642.50",$0.00,"$1,321.25","$2,092.86","$2,114.00",$0.00,$0.00,$0.00,$0.00,$0.00
6352-5-107,SUP,Custom 27803010,,6352-5-107  -  INSERT ACETAB 10D 32MM LINER CONGRUENT ROBUST LOCK SYSTEM 12,"$2,642.50",$0.00,"$2,642.50",$0.00,"$1,885.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,642.50",$0.00,"$1,321.25","$2,092.86","$2,114.00",$0.00,$0.00,$0.00,$0.00,$0.00
6352-5-108,SUP,Custom 27803010,,6352-5-108  -  INSERT ACETAB 10D P8 70/72MM 32MM LINER CONGRUENT ROBUST,"$2,642.50",$0.00,"$2,642.50",$0.00,"$1,885.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,642.50",$0.00,"$1,321.25","$2,092.86","$2,114.00",$0.00,$0.00,$0.00,$0.00,$0.00
6364-2-026,SUP,Custom 27803010,,6364-2-026  -  HEAD FEMORAL -3MM 26MM NECK V40 ORTHINOX HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6364-2-028,SUP,Custom 27803010,,6364-2-028  -  HEAD FEMORAL -4MM 28MM NECK V40 ORTHINOX HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6364-2-032,SUP,Custom 27803010,,6364-2-032  -  HEAD FEMORAL -4MM 32MM TAPER V40 ORTHINOX HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6364-2-036,SUP,Custom 27803010,,6364-2-036  -  HEAD FEMORAL -5MM 36MM TAPER V40 ORTHINOX HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6364-2-122,SUP,Custom 27803010,,6364-2-122  -  HEAD FEMORAL 0MM 22MM V40 ORTHINOX HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6364-2-126,SUP,Custom 27803010,,6364-2-126  -  HEAD FEMORAL 0MM 26MM TAPER V40 ORTHINOX HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6364-2-128,SUP,Custom 27803010,,6364-2-128  -  HEAD FEMORAL 0MM 28MM TAPER V40 ORTHINOX HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6364-2-132,SUP,Custom 27803010,,6364-2-132  -  HEAD FEMORAL 0MM 32MM TAPER V40 ORTHINOX HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6364-2-136,SUP,Custom 27803010,,6364-2-136  -  HEAD FEMORAL 0MM 36MM V40 ORTHINOX HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6364-2-226,SUP,Custom 27803010,,6364-2-226  -  HEAD FEMORAL +4MM 26MM NECK V40 ORTHINOX HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6364-2-228,SUP,Custom 27803010,,6364-2-228  -  HEAD FEMORAL +4MM 28MM TAPER V40 ORTHINOX HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6364-2-232,SUP,Custom 27803010,,6364-2-232  -  HEAD FEMORAL +4MM TAPER 32MM V40 ORTHINOX HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6364-2-236,SUP,Custom 27803010,,6364-2-236  -  HEAD FEMORAL +5MM 36MM TAPER V40 ORTHINOX HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6364-2-322,SUP,Custom 27803010,,6364-2-322  -  HEAD FEMORAL +8MM 22MM V40 ORTHINOX HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6364-2-326,SUP,Custom 27803010,,6364-2-326  -  HEAD FEMORAL +8MM 26MM NECK V40 ORTHINOX HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6364-2-328,SUP,Custom 27803010,,6364-2-328  -  HEAD FEMORAL +8MM 28MM V40 ORTHINOX HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6364-2-332,SUP,Custom 27803010,,6364-2-332  -  HEAD FEMORAL +8MM 32MM EXETER V40 ORTHINOX HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
6366-9-220,SUP,HCPCS C1776,,6366-9-220  -  GUIDE PIN ORTH HMRS AXIS,"$2,030.00",$0.00,"$2,030.00",$913.50,"$1,448.81",$0.00,$349.76,$0.00,$0.00,$355.44,"$2,030.00",$0.00,"$1,015.00","$1,607.76","$1,624.00",$0.00,$317.70,$0.00,$323.18,$0.00
640301S,SUP,HCPCS C1713,,640301S  -  SCREW BONE T2 STD CMPR STRL,$189.75,$0.00,$189.75,$85.39,$135.42,$0.00,$32.69,$0.00,$0.00,$33.22,$189.75,$0.00,$94.88,$150.28,$151.80,$0.00,$29.70,$0.00,$30.21,$0.00
640302S,SUP,HCPCS C1713,,640302S  -  SCREW BONE T2 2 SPNL CMPR STRL,$199.38,$0.00,$199.38,$89.72,$142.29,$0.00,$34.35,$0.00,$0.00,$34.91,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$31.20,$0.00,$31.74,$0.00
640303S,SUP,HCPCS C1713,,640303S  -  SCREW BONE T2 3 SPNL CMPR STRL,$170.50,$0.00,$170.50,$76.73,$121.69,$0.00,$29.38,$0.00,$0.00,$29.85,$170.50,$0.00,$85.25,$135.04,$136.40,$0.00,$26.68,$0.00,$27.14,$0.00
640304S,SUP,HCPCS C1713,,640304S  -  SCREW BONE T2 4 SPNL CMPR STRL,$170.50,$0.00,$170.50,$76.73,$121.69,$0.00,$29.38,$0.00,$0.00,$29.85,$170.50,$0.00,$85.25,$135.04,$136.40,$0.00,$26.68,$0.00,$27.14,$0.00
640320S,SUP,HCPCS C1713,,640320S  -  WASHER SCR T2 ORTH STRL,$60.50,$0.00,$60.50,$27.23,$43.18,$0.00,$10.42,$0.00,$0.00,$10.59,$60.50,$0.00,$30.25,$47.92,$48.40,$0.00,$9.47,$0.00,$9.63,$0.00
641-00-28C,SUP,Custom 27803010,,641-00-28C  -  INSERT ACETAB C 28MM ELEVATED RIM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
641-00-28D,SUP,Custom 27803010,,641-00-28D  -  INSERT ACETAB D 28MM ELEVATED RIM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
641-00-28E,SUP,Custom 27803010,,641-00-28E  -  INSERT ACETAB E 28MM ELEVATED RIM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
641-00-28F,SUP,Custom 27803010,,641-00-28F  -  INSERT ACETAB F 28MM ELEVATED RIM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
641-00-28G,SUP,Custom 27803010,,641-00-28G  -  INSERT ACETAB G 28MM ELEVATED RIM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
641-00-28H,SUP,Custom 27803010,,641-00-28H  -  INSERT ACETAB H 28MM ELEVATED RIM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
641-00-28I,SUP,Custom 27803010,,641-00-28I  -  INSERT ACETAB I 28MM ELEVATED RIM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
641-00-28J,SUP,Custom 27803010,,641-00-28J  -  INSERT ACETAB J 28MM ELEVATED RIM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
641-00-32E,SUP,Custom 27803010,,641-00-32E  -  INSERT ACETAB 0D E 32MM ELEVATED RIM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
641-00-32F,SUP,Custom 27803010,,641-00-32F  -  INSERT ACETAB F 32MM ELEVATED RIM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
641-00-32G,SUP,Custom 27803010,,641-00-32G  -  INSERT ACETAB G 32MM ELEVATED RIM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
641-00-32H,SUP,Custom 27803010,,641-00-32H  -  INSERT ACETAB H 32MM ELEVATED RIM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
641-00-32I,SUP,Custom 27803010,,641-00-32I  -  INSERT ACETAB I 32MM ELEVATED RIM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
641-00-32J,SUP,Custom 27803010,,641-00-32J  -  INSERT ACETAB J 32MM ELEVATED RIM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
641-00-36E,SUP,Custom 27803010,,641-00-36E  -  INSERT ACETAB E 36MM ELEVATED RIM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
641-00-36F,SUP,Custom 27803010,,641-00-36F  -  INSERT ACETAB F 36MM ELEVATED RIM TRIDENT X3 HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
641-00-36G,SUP,Custom 27803010,,641-00-36G  -  INSERT ACETAB G 36MM ELEVATED RIM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
641-00-36H,SUP,Custom 27803010,,641-00-36H  -  INSERT ACETAB H 36MM ELEVATED RIM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
641-00-36I,SUP,Custom 27803010,,641-00-36I  -  INSERT ACETAB I 36MM ELEVATED RIM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
641-00-36J,SUP,Custom 27803010,,641-00-36J  -  INSERT ACETAB J 36MM ELEVATED RIM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
64122-06,SUP,Custom 27203010,,FIXATIVE B5 HISTOLGY,$300.00,$0.00,$300.00,$0.00,$214.11,$0.00,$0.00,$0.00,$0.00,$0.00,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$0.00,$0.00,$0.00,$0.00
6430-0-020,SUP,Custom 27803010,,6430-0-020  -  COMPONENT PATLR SMALL 20MM AVON KNEE,"$2,170.00",$0.00,"$2,170.00",$0.00,"$1,548.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,170.00",$0.00,"$1,085.00","$1,718.64","$1,736.00",$0.00,$0.00,$0.00,$0.00,$0.00
6430-0-030,SUP,Custom 27803010,,6430-0-030  -  COMPONENT PATLR MEDIUM 30MM AVON KNEE,"$2,170.00",$0.00,"$2,170.00",$0.00,"$1,548.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,170.00",$0.00,"$1,085.00","$1,718.64","$1,736.00",$0.00,$0.00,$0.00,$0.00,$0.00
6430-0-040,SUP,Custom 27803010,,6430-0-040  -  COMPONENT PATLR LARGE 40MM AVON KNEE,"$2,170.00",$0.00,"$2,170.00",$0.00,"$1,548.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,170.00",$0.00,"$1,085.00","$1,718.64","$1,736.00",$0.00,$0.00,$0.00,$0.00,$0.00
6430-0-050,SUP,HCPCS C1776,,6430-0-050  -  COMPONENT FEMORAL XS 50MM AVON KNEE,"$9,682.50",$0.00,"$9,682.50","$4,357.13","$5,158.80",$0.00,"$1,668.25",$0.00,$0.00,"$1,695.33","$9,682.50",$0.00,"$4,841.25","$7,668.54","$7,746.00",$0.00,"$1,515.31",$0.00,"$1,541.45",$0.00
6430-0-100,SUP,HCPCS C1776,,6430-0-100  -  COMPONENT FEMORAL SMALL AVON KNEE,"$9,682.50",$0.00,"$9,682.50","$4,357.13","$5,158.80",$0.00,"$1,668.25",$0.00,$0.00,"$1,695.33","$9,682.50",$0.00,"$4,841.25","$7,668.54","$7,746.00",$0.00,"$1,515.31",$0.00,"$1,541.45",$0.00
6430-0-200,SUP,HCPCS C1776,,6430-0-200  -  COMPONENT FEMORAL MEDIUM AVON KNEE,"$9,682.50",$0.00,"$9,682.50","$4,357.13","$5,158.80",$0.00,"$1,668.25",$0.00,$0.00,"$1,695.33","$9,682.50",$0.00,"$4,841.25","$7,668.54","$7,746.00",$0.00,"$1,515.31",$0.00,"$1,541.45",$0.00
643-00-28C,SUP,Custom 27803010,,643-00-28C  -  INSERT ACETAB C 28MM ELEVATE RIM TRIDENT X3 HIP,"$3,130.00",$0.00,"$3,130.00",$0.00,"$2,233.88",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,130.00",$0.00,"$1,565.00","$2,478.96","$2,504.00",$0.00,$0.00,$0.00,$0.00,$0.00
643-00-28D,SUP,Custom 27803010,,643-00-28D  -  INSERT ACETAB D 28MM ELEVATE RIM TRIDENT X3 HIP,"$3,130.00",$0.00,"$3,130.00",$0.00,"$2,233.88",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,130.00",$0.00,"$1,565.00","$2,478.96","$2,504.00",$0.00,$0.00,$0.00,$0.00,$0.00
643-00-28E,SUP,Custom 27803010,,643-00-28E  -  INSERT ACETAB E 28MM ELEVATE RIM TRIDENT X3 HIP,"$3,130.00",$0.00,"$3,130.00",$0.00,"$2,233.88",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,130.00",$0.00,"$1,565.00","$2,478.96","$2,504.00",$0.00,$0.00,$0.00,$0.00,$0.00
643-00-28F,SUP,Custom 27803010,,643-00-28F  -  INSERT ACETAB F 28MM ELEVATE RIM TRIDENT X3 HIP,"$3,130.00",$0.00,"$3,130.00",$0.00,"$2,233.88",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,130.00",$0.00,"$1,565.00","$2,478.96","$2,504.00",$0.00,$0.00,$0.00,$0.00,$0.00
643-00-28G,SUP,Custom 27803010,,643-00-28G  -  INSERT ACETAB G 28MM ELEVATE RIM TRIDENT X3 HIP,"$3,130.00",$0.00,"$3,130.00",$0.00,"$2,233.88",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,130.00",$0.00,"$1,565.00","$2,478.96","$2,504.00",$0.00,$0.00,$0.00,$0.00,$0.00
643-00-28H,SUP,Custom 27803010,,643-00-28H  -  INSERT ACETAB H 28MM ELEVATE RIM TRIDENT X3 HIP,"$3,130.00",$0.00,"$3,130.00",$0.00,"$2,233.88",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,130.00",$0.00,"$1,565.00","$2,478.96","$2,504.00",$0.00,$0.00,$0.00,$0.00,$0.00
643-00-28I,SUP,Custom 27803010,,643-00-28I  -  INSERT ACETAB I 28MM ELEVATE RIM TRIDENT X3 HIP,"$3,130.00",$0.00,"$3,130.00",$0.00,"$2,233.88",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,130.00",$0.00,"$1,565.00","$2,478.96","$2,504.00",$0.00,$0.00,$0.00,$0.00,$0.00
643-00-28J,SUP,Custom 27803010,,643-00-28J  -  INSERT ACETAB J 28MM ELEVATE RIM TRIDENT X3 HIP,"$3,130.00",$0.00,"$3,130.00",$0.00,"$2,233.88",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,130.00",$0.00,"$1,565.00","$2,478.96","$2,504.00",$0.00,$0.00,$0.00,$0.00,$0.00
6430-0-300,SUP,HCPCS C1776,,6430-0-300  -  COMPONENT FEMORAL LARGE AVON KNEE,"$9,682.50",$0.00,"$9,682.50","$4,357.13","$5,158.80",$0.00,"$1,668.25",$0.00,$0.00,"$1,695.33","$9,682.50",$0.00,"$4,841.25","$7,668.54","$7,746.00",$0.00,"$1,515.31",$0.00,"$1,541.45",$0.00
643-00-32E,SUP,Custom 27803010,,643-00-32E  -  INSERT ACETAB E 32MM ELEVATE RIM TRIDENT X3 HIP,"$3,130.00",$0.00,"$3,130.00",$0.00,"$2,233.88",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,130.00",$0.00,"$1,565.00","$2,478.96","$2,504.00",$0.00,$0.00,$0.00,$0.00,$0.00
643-00-32F,SUP,Custom 27803010,,643-00-32F  -  INSERT ACETAB F 32MM ELEVATE RIM TRIDENT X3 HIP,"$3,130.00",$0.00,"$3,130.00",$0.00,"$2,233.88",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,130.00",$0.00,"$1,565.00","$2,478.96","$2,504.00",$0.00,$0.00,$0.00,$0.00,$0.00
643-00-32G,SUP,Custom 27803010,,643-00-32G  -  INSERT ACETAB G 32MM ELEVATE RIM TRIDENT X3 HIP,"$3,130.00",$0.00,"$3,130.00",$0.00,"$2,233.88",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,130.00",$0.00,"$1,565.00","$2,478.96","$2,504.00",$0.00,$0.00,$0.00,$0.00,$0.00
643-00-32H,SUP,Custom 27803010,,643-00-32H  -  INSERT ACETAB H 32MM ELEVATE RIM TRIDENT X3 HIP,"$3,130.00",$0.00,"$3,130.00",$0.00,"$2,233.88",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,130.00",$0.00,"$1,565.00","$2,478.96","$2,504.00",$0.00,$0.00,$0.00,$0.00,$0.00
643-00-32I,SUP,Custom 27803010,,643-00-32I  -  INSERT ACETAB I 32MM ELEVATE RIM TRIDENT X3 HIP,"$3,130.00",$0.00,"$3,130.00",$0.00,"$2,233.88",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,130.00",$0.00,"$1,565.00","$2,478.96","$2,504.00",$0.00,$0.00,$0.00,$0.00,$0.00
643-00-32J,SUP,Custom 27803010,,643-00-32J  -  INSERT ACETAB J 32MM ELEVATE RIM TRIDENT X3 HIP,"$3,130.00",$0.00,"$3,130.00",$0.00,"$2,233.88",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,130.00",$0.00,"$1,565.00","$2,478.96","$2,504.00",$0.00,$0.00,$0.00,$0.00,$0.00
643-00-36E,SUP,Custom 27803010,,643-00-36E  -  INSERT ACETAB E 36MM ELEVATE RIM TRIDENT X3 HIP,"$3,345.00",$0.00,"$3,345.00",$0.00,"$2,387.33",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,345.00",$0.00,"$1,672.50","$2,649.24","$2,676.00",$0.00,$0.00,$0.00,$0.00,$0.00
643-00-36F,SUP,Custom 27803010,,643-00-36F  -  INSERT ACETAB F 36MM ELEVATE RIM TRIDENT X3 HIP,"$3,345.00",$0.00,"$3,345.00",$0.00,"$2,387.33",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,345.00",$0.00,"$1,672.50","$2,649.24","$2,676.00",$0.00,$0.00,$0.00,$0.00,$0.00
643-00-36G,SUP,Custom 27803010,,643-00-36G  -  INSERT ACETAB G 36MM ELEVATE RIM TRIDENT X3 HIP,"$3,345.00",$0.00,"$3,345.00",$0.00,"$2,387.33",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,345.00",$0.00,"$1,672.50","$2,649.24","$2,676.00",$0.00,$0.00,$0.00,$0.00,$0.00
643-00-36H,SUP,Custom 27803010,,643-00-36H  -  INSERT ACETAB H 36MM ELEVATE RIM TRIDENT X3 HIP,"$3,345.00",$0.00,"$3,345.00",$0.00,"$2,387.33",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,345.00",$0.00,"$1,672.50","$2,649.24","$2,676.00",$0.00,$0.00,$0.00,$0.00,$0.00
643-00-36I,SUP,Custom 27803010,,643-00-36I  -  INSERT ACETAB I 36MM ELEVATE RIM TRIDENT X3 HIP,"$3,345.00",$0.00,"$3,345.00",$0.00,"$2,387.33",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,345.00",$0.00,"$1,672.50","$2,649.24","$2,676.00",$0.00,$0.00,$0.00,$0.00,$0.00
643-00-36J,SUP,Custom 27803010,,643-00-36J  -  INSERT ACETAB J 36MM ELEVATE RIM TRIDENT X3 HIP,"$3,345.00",$0.00,"$3,345.00",$0.00,"$2,387.33",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,345.00",$0.00,"$1,672.50","$2,649.24","$2,676.00",$0.00,$0.00,$0.00,$0.00,$0.00
6471-0-808,SUP,Custom 27803010,,6471-0-808  -  INSERT TIB XS 8MM CNDYLR MDLR K-2,"$2,192.13",$0.00,"$2,192.13",$0.00,"$1,564.52",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,192.13",$0.00,"$1,096.06","$1,736.17","$1,753.70",$0.00,$0.00,$0.00,$0.00,$0.00
6471-0-811,SUP,Custom 27803010,,6471-0-811  -  INSERT TIB XS 11MM CNDYLR MDLR K-2,"$2,192.13",$0.00,"$2,192.13",$0.00,"$1,564.52",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,192.13",$0.00,"$1,096.06","$1,736.17","$1,753.70",$0.00,$0.00,$0.00,$0.00,$0.00
6471-0-813,SUP,Custom 27803010,,6471-0-813  -  INSERT TIB XS 13MM CNDYLR MDLR K-2,"$2,192.13",$0.00,"$2,192.13",$0.00,"$1,564.52",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,192.13",$0.00,"$1,096.06","$1,736.17","$1,753.70",$0.00,$0.00,$0.00,$0.00,$0.00
6471-0-816,SUP,Custom 27803010,,6471-0-816  -  INSERT TIB XS 16MM CNDYLR MDLR K-2,"$2,192.13",$0.00,"$2,192.13",$0.00,"$1,564.52",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,192.13",$0.00,"$1,096.06","$1,736.17","$1,753.70",$0.00,$0.00,$0.00,$0.00,$0.00
6471-1-808,SUP,Custom 27803010,,6471-1-808  -  INSERT TIB SM 8MM CNDYLR MDLR K-2,"$1,509.63",$0.00,"$1,509.63",$0.00,"$1,077.42",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,509.63",$0.00,$754.81,"$1,195.63","$1,207.70",$0.00,$0.00,$0.00,$0.00,$0.00
6471-1-811,SUP,Custom 27803010,,6471-1-811  -  INSERT TIB SM 11MM CNDYLR MDLR K-2,"$2,283.13",$0.00,"$2,283.13",$0.00,"$1,629.47",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,283.13",$0.00,"$1,141.56","$1,808.24","$1,826.50",$0.00,$0.00,$0.00,$0.00,$0.00
6471-1-813,SUP,Custom 27803010,,6471-1-813  -  INSERT TIB SM 13MM CNDYLR MDLR K-2,"$1,509.63",$0.00,"$1,509.63",$0.00,"$1,077.42",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,509.63",$0.00,$754.81,"$1,195.63","$1,207.70",$0.00,$0.00,$0.00,$0.00,$0.00
6471-1-816,SUP,Custom 27803010,,6471-1-816  -  INSERT TIB SM 16MM CNDYLR MDLR K-2,"$1,509.63",$0.00,"$1,509.63",$0.00,"$1,077.42",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,509.63",$0.00,$754.81,"$1,195.63","$1,207.70",$0.00,$0.00,$0.00,$0.00,$0.00
6471-3-808,SUP,Custom 27803010,,6471-3-808  -  INSERT TIB MED 8MM CNDYLR MDLR K-2,"$1,509.63",$0.00,"$1,509.63",$0.00,"$1,077.42",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,509.63",$0.00,$754.81,"$1,195.63","$1,207.70",$0.00,$0.00,$0.00,$0.00,$0.00
6471-3-811,SUP,Custom 27803010,,6471-3-811  -  INSERT TIB MED 11MM CNDYLR MDLR K-2,"$1,509.63",$0.00,"$1,509.63",$0.00,"$1,077.42",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,509.63",$0.00,$754.81,"$1,195.63","$1,207.70",$0.00,$0.00,$0.00,$0.00,$0.00
6471-3-813,SUP,Custom 27803010,,6471-3-813  -  INSERT TIB MED 13MM CNDYLR MDLR K-2,"$1,509.63",$0.00,"$1,509.63",$0.00,"$1,077.42",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,509.63",$0.00,$754.81,"$1,195.63","$1,207.70",$0.00,$0.00,$0.00,$0.00,$0.00
6471-3-816,SUP,Custom 27803010,,6471-3-816  -  INSERT TIB MED 16MM CNDYLR MDLR K-2,"$1,509.63",$0.00,"$1,509.63",$0.00,"$1,077.42",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,509.63",$0.00,$754.81,"$1,195.63","$1,207.70",$0.00,$0.00,$0.00,$0.00,$0.00
6471-5-808,SUP,Custom 27803010,,6471-5-808  -  INSERT TIB LG 8MM CNDYLR MDLR K-2,"$1,509.63",$0.00,"$1,509.63",$0.00,"$1,077.42",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,509.63",$0.00,$754.81,"$1,195.63","$1,207.70",$0.00,$0.00,$0.00,$0.00,$0.00
6471-5-811,SUP,Custom 27803010,,6471-5-811  -  INSERT TIB LG 11MM CNDYLR MDLR K-2,"$2,283.13",$0.00,"$2,283.13",$0.00,"$1,629.47",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,283.13",$0.00,"$1,141.56","$1,808.24","$1,826.50",$0.00,$0.00,$0.00,$0.00,$0.00
6471-5-813,SUP,Custom 27803010,,6471-5-813  -  INSERT TIB LG 13MM CNDYLR MDLR K-2,"$1,509.63",$0.00,"$1,509.63",$0.00,"$1,077.42",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,509.63",$0.00,$754.81,"$1,195.63","$1,207.70",$0.00,$0.00,$0.00,$0.00,$0.00
6471-5-816,SUP,Custom 27803010,,6471-5-816  -  INSERT TIB LG 16MM CNDYLR MDLR K-2,"$1,509.63",$0.00,"$1,509.63",$0.00,"$1,077.42",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,509.63",$0.00,$754.81,"$1,195.63","$1,207.70",$0.00,$0.00,$0.00,$0.00,$0.00
6471-6-808,SUP,Custom 27803010,,6471-6-808  -  INSERT TIB XL 8MM CNDYLR KNEE MDLR K-2,"$1,349.00",$0.00,"$1,349.00",$0.00,$962.78,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,349.00",$0.00,$674.50,"$1,068.41","$1,079.20",$0.00,$0.00,$0.00,$0.00,$0.00
6471-6-811,SUP,Custom 27803010,,6471-6-811  -  INSERT TIB XL 11MM CNDYLR MDLR K-2,"$2,192.13",$0.00,"$2,192.13",$0.00,"$1,564.52",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,192.13",$0.00,"$1,096.06","$1,736.17","$1,753.70",$0.00,$0.00,$0.00,$0.00,$0.00
6471-6-813,SUP,Custom 27803010,,6471-6-813  -  INSERT TIB XL 13MM CNDYLR MDLR K-2,"$1,349.00",$0.00,"$1,349.00",$0.00,$962.78,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,349.00",$0.00,$674.50,"$1,068.41","$1,079.20",$0.00,$0.00,$0.00,$0.00,$0.00
6471-6-816,SUP,Custom 27803010,,6471-6-816  -  INSERT TIB XL 16MM CNDYLR MDLR K-2,"$1,116.00",$0.00,"$1,116.00",$0.00,$796.49,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,116.00",$0.00,$558.00,$883.87,$892.80,$0.00,$0.00,$0.00,$0.00,$0.00
6472-0-808,SUP,Custom 27803010,,6472-0-808  -  INSERT TIB XS 8MM KNEE STAB MDLR,"$1,398.00",$0.00,"$1,398.00",$0.00,$997.75,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,398.00",$0.00,$699.00,"$1,107.22","$1,118.40",$0.00,$0.00,$0.00,$0.00,$0.00
6472-0-813,SUP,Custom 27803010,,6472-0-813  -  INSERT TIB XS 13MM KNEE STAB MDLR,"$1,398.00",$0.00,"$1,398.00",$0.00,$997.75,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,398.00",$0.00,$699.00,"$1,107.22","$1,118.40",$0.00,$0.00,$0.00,$0.00,$0.00
6472-0-816,SUP,Custom 27803010,,6472-0-816  -  INSERT TIB XS 16MM KNEE STAB MDLR,"$1,398.00",$0.00,"$1,398.00",$0.00,$997.75,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,398.00",$0.00,$699.00,"$1,107.22","$1,118.40",$0.00,$0.00,$0.00,$0.00,$0.00
6472-1-808,SUP,Custom 27803010,,6472-1-808  -  INSERT TIB SM 8MM KNEE STAB MDLR,"$1,398.00",$0.00,"$1,398.00",$0.00,$997.75,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,398.00",$0.00,$699.00,"$1,107.22","$1,118.40",$0.00,$0.00,$0.00,$0.00,$0.00
6472-1-816,SUP,Custom 27803010,,6472-1-816  -  INSERT TIB SM 16MM KNEE STAB MDLR,"$1,398.00",$0.00,"$1,398.00",$0.00,$997.75,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,398.00",$0.00,$699.00,"$1,107.22","$1,118.40",$0.00,$0.00,$0.00,$0.00,$0.00
6472-6-808,SUP,Custom 27803010,,6472-6-808  -  INSERT TIB XL 8MM KNEE STAB MDLR,"$1,456.00",$0.00,"$1,456.00",$0.00,"$1,039.15",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,456.00",$0.00,$728.00,"$1,153.15","$1,164.80",$0.00,$0.00,$0.00,$0.00,$0.00
6472-6-811,SUP,Custom 27803010,,6472-6-811  -  INSERT TIB XL 11MM KNEE STAB MDLR,"$1,456.00",$0.00,"$1,456.00",$0.00,"$1,039.15",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,456.00",$0.00,$728.00,"$1,153.15","$1,164.80",$0.00,$0.00,$0.00,$0.00,$0.00
6472-6-813,SUP,Custom 27803010,,6472-6-813  -  INSERT TIB XL 13MM KNEE STAB MDLR,"$1,456.00",$0.00,"$1,456.00",$0.00,"$1,039.15",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,456.00",$0.00,$728.00,"$1,153.15","$1,164.80",$0.00,$0.00,$0.00,$0.00,$0.00
6472-6-816,SUP,Custom 27803010,,6472-6-816  -  INSERT TIB XL 16MM KNEE STAB MDLR,"$1,398.00",$0.00,"$1,398.00",$0.00,$997.75,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,398.00",$0.00,$699.00,"$1,107.22","$1,118.40",$0.00,$0.00,$0.00,$0.00,$0.00
6475-3-933,SUP,HCPCS C1776,,6475-3-933  -  BEARING TIBIAL LONG COMPRESSION ROTATE HINGE MRS MRH KNEE,"$5,895.00",$0.00,"$5,895.00","$2,652.75","$4,207.26",$0.00,"$1,015.68",$0.00,$0.00,"$1,032.17","$5,895.00",$0.00,"$2,947.50","$4,668.84","$4,716.00",$0.00,$922.57,$0.00,$938.48,$0.00
6475-3-940,SUP,Custom 27803010,,6475-3-940  -  AXLE FEMORAL STANDARD ROTATE HINGE MRS KINEMATIC KNEE,"$2,065.00",$0.00,"$2,065.00",$0.00,"$1,473.79",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,065.00",$0.00,"$1,032.50","$1,635.48","$1,652.00",$0.00,$0.00,$0.00,$0.00,$0.00
6476-0-100,SUP,Custom 27803010,,6476-0-100  -  WEDGE TIB 10MM KNMX PLUS XS FULL,"$1,439.00",$0.00,"$1,439.00",$0.00,"$1,027.01",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,439.00",$0.00,$719.50,"$1,139.69","$1,151.20",$0.00,$0.00,$0.00,$0.00,$0.00
6476-0-110,SUP,Custom 27203010,,6476-0-110  -  TRIAL SURG BLK 10MM KNMX XS LL/RM HALF BLOCK WDG,$776.00,$0.00,$776.00,$0.00,$553.83,$0.00,$0.00,$0.00,$0.00,$0.00,$776.00,$0.00,$388.00,$614.59,$620.80,$0.00,$0.00,$0.00,$0.00,$0.00
6476-0-120,SUP,Custom 27803010,,6476-0-120  -  WEDGE TIB 10MM KX+ XS LEFT MDL RIGHT LAT BLOCK,$808.00,$0.00,$808.00,$0.00,$576.67,$0.00,$0.00,$0.00,$0.00,$0.00,$808.00,$0.00,$404.00,$639.94,$646.40,$0.00,$0.00,$0.00,$0.00,$0.00
6476-0-130,SUP,Custom 27803010,,6476-0-130  -  WEDGE TIB 5MM KX+ XS LL/RM BLOCK,$776.00,$0.00,$776.00,$0.00,$553.83,$0.00,$0.00,$0.00,$0.00,$0.00,$776.00,$0.00,$388.00,$614.59,$620.80,$0.00,$0.00,$0.00,$0.00,$0.00
6476-0-140,SUP,Custom 27803010,,6476-0-140  -  WEDGE TIB 5MM KX+ XS LEFT MDL RIGHT LAT BLOCK,$776.00,$0.00,$776.00,$0.00,$553.83,$0.00,$0.00,$0.00,$0.00,$0.00,$776.00,$0.00,$388.00,$614.59,$620.80,$0.00,$0.00,$0.00,$0.00,$0.00
6476-0-150,SUP,Custom 27803010,,6476-0-150  -  WEDGE TIB KX+ XS LL/RM FULL ANG,"$1,500.00",$0.00,"$1,500.00",$0.00,"$1,070.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
6476-0-160,SUP,Custom 27803010,,6476-0-160  -  WEDGE TIB KX+ XS LEFT MDL RIGHT LAT FULL ANG,"$1,439.00",$0.00,"$1,439.00",$0.00,"$1,027.01",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,439.00",$0.00,$719.50,"$1,139.69","$1,151.20",$0.00,$0.00,$0.00,$0.00,$0.00
6476-0-310,SUP,Custom 27803010,,6476-0-310  -  BSPLT TIB KNMX K2 XS MDLR,"$2,274.00",$0.00,"$2,274.00",$0.00,"$1,622.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,274.00",$0.00,"$1,137.00","$1,801.01","$1,819.20",$0.00,$0.00,$0.00,$0.00,$0.00
6476-0-400,SUP,Custom 27803010,,6476-0-400  -  BSPLT TIB KMX+ 4 XS KNEE,"$3,125.00",$0.00,"$3,125.00",$0.00,"$2,230.31",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,125.00",$0.00,"$1,562.50","$2,475.00","$2,500.00",$0.00,$0.00,$0.00,$0.00,$0.00
6476-1-100,SUP,Custom 27803010,,6476-1-100  -  WEDGE TIBIAL 10MM FULL BLOCK KINEMAX PLUS SMALL LEFT MEDIAL,"$1,500.00",$0.00,"$1,500.00",$0.00,"$1,070.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
6476-1-110,SUP,Custom 27803010,,6476-1-110  -  WEDGE TIB 10MM KX+ SM LL/RM BLOCK,$808.00,$0.00,$808.00,$0.00,$576.67,$0.00,$0.00,$0.00,$0.00,$0.00,$808.00,$0.00,$404.00,$639.94,$646.40,$0.00,$0.00,$0.00,$0.00,$0.00
6476-1-120,SUP,Custom 27803010,,6476-1-120  -  WEDGE TIB 10MM KX+ SM LEFT MDL RIGHT LAT BLOCK,$808.00,$0.00,$808.00,$0.00,$576.67,$0.00,$0.00,$0.00,$0.00,$0.00,$808.00,$0.00,$404.00,$639.94,$646.40,$0.00,$0.00,$0.00,$0.00,$0.00
6476-1-130,SUP,Custom 27803010,,6476-1-130  -  WEDGE TIB 5MM KX+ SM LL/RM BLOCK,$673.00,$0.00,$673.00,$0.00,$480.32,$0.00,$0.00,$0.00,$0.00,$0.00,$673.00,$0.00,$336.50,$533.02,$538.40,$0.00,$0.00,$0.00,$0.00,$0.00
6476-1-140,SUP,Custom 27803010,,6476-1-140  -  WEDGE TIB 5MM KX+ SM LEFT MDL RIGHT LAT BLOCK,$808.00,$0.00,$808.00,$0.00,$576.67,$0.00,$0.00,$0.00,$0.00,$0.00,$808.00,$0.00,$404.00,$639.94,$646.40,$0.00,$0.00,$0.00,$0.00,$0.00
6476-1-150,SUP,Custom 27803010,,6476-1-150  -  WEDGE TIB KX+ SM LL/RM FULL ANG,"$1,248.00",$0.00,"$1,248.00",$0.00,$890.70,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,248.00",$0.00,$624.00,$988.42,$998.40,$0.00,$0.00,$0.00,$0.00,$0.00
6476-1-160,SUP,Custom 27803010,,6476-1-160  -  WEDGE TIB KX+ SM LEFT MDL RIGHT LAT FULL ANG,"$1,439.00",$0.00,"$1,439.00",$0.00,"$1,027.01",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,439.00",$0.00,$719.50,"$1,139.69","$1,151.20",$0.00,$0.00,$0.00,$0.00,$0.00
6476-1-310,SUP,Custom 27803010,,6476-1-310  -  BSPLT TIB KNMX SM REG KNEE STM,"$2,146.00",$0.00,"$2,146.00",$0.00,"$1,531.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,146.00",$0.00,"$1,073.00","$1,699.63","$1,716.80",$0.00,$0.00,$0.00,$0.00,$0.00
6476-1-400,SUP,Custom 27803010,,6476-1-400  -  BASEPLATE TIBIAL SMALL KINEMAX PLUS KNEE,"$4,920.00",$0.00,"$4,920.00",$0.00,"$3,511.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,920.00",$0.00,"$2,460.00","$3,896.64","$3,936.00",$0.00,$0.00,$0.00,$0.00,$0.00
6476-3-100,SUP,Custom 27803010,,6476-3-100  -  WEDGE TIB 10MM KNMX PLUS MED FULL,"$1,500.00",$0.00,"$1,500.00",$0.00,"$1,070.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
6476-3-110,SUP,Custom 27803010,,6476-3-110  -  WEDGE TIB 10MM KX+ MED LL/RM BLOCK,$808.00,$0.00,$808.00,$0.00,$576.67,$0.00,$0.00,$0.00,$0.00,$0.00,$808.00,$0.00,$404.00,$639.94,$646.40,$0.00,$0.00,$0.00,$0.00,$0.00
6476-3-120,SUP,Custom 27803010,,6476-3-120  -  WEDGE TIB 10MM KX+ MED LEFT MDL RIGHT LAT BLOCK,$808.00,$0.00,$808.00,$0.00,$576.67,$0.00,$0.00,$0.00,$0.00,$0.00,$808.00,$0.00,$404.00,$639.94,$646.40,$0.00,$0.00,$0.00,$0.00,$0.00
6476-3-130,SUP,Custom 27803010,,6476-3-130  -  WEDGE TIB 5MM KX+ MED LL/RM BLOCK,$808.00,$0.00,$808.00,$0.00,$576.67,$0.00,$0.00,$0.00,$0.00,$0.00,$808.00,$0.00,$404.00,$639.94,$646.40,$0.00,$0.00,$0.00,$0.00,$0.00
6476-3-140,SUP,Custom 27803010,,6476-3-140  -  WEDGE TIB 5MM KX+ MED LEFT MDL RIGHT LAT BLOCK,$808.00,$0.00,$808.00,$0.00,$576.67,$0.00,$0.00,$0.00,$0.00,$0.00,$808.00,$0.00,$404.00,$639.94,$646.40,$0.00,$0.00,$0.00,$0.00,$0.00
6476-3-150,SUP,Custom 27803010,,6476-3-150  -  WEDGE TIB KX+ MED LL/RM FULL ANG,"$1,439.00",$0.00,"$1,439.00",$0.00,"$1,027.01",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,439.00",$0.00,$719.50,"$1,139.69","$1,151.20",$0.00,$0.00,$0.00,$0.00,$0.00
6476-3-160,SUP,Custom 27803010,,6476-3-160  -  WEDGE TIBIAL KINEMAX PLUS MEDIUM FULL ANGLE RIGHT MEDIAL,"$1,439.00",$0.00,"$1,439.00",$0.00,"$1,027.01",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,439.00",$0.00,$719.50,"$1,139.69","$1,151.20",$0.00,$0.00,$0.00,$0.00,$0.00
6476-3-310,SUP,Custom 27803010,,6476-3-310  -  BSPLT TIB KNMX K2 MED KNEE MDLR,"$2,146.00",$0.00,"$2,146.00",$0.00,"$1,531.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,146.00",$0.00,"$1,073.00","$1,699.63","$1,716.80",$0.00,$0.00,$0.00,$0.00,$0.00
6476-3-400,SUP,Custom 27803010,,6476-3-400  -  BSPLT TIB KMX+ MED KNEE ASMBLY,"$2,996.00",$0.00,"$2,996.00",$0.00,"$2,138.25",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,996.00",$0.00,"$1,498.00","$2,372.83","$2,396.80",$0.00,$0.00,$0.00,$0.00,$0.00
6476-5-100,SUP,Custom 27803010,,6476-5-100  -  WEDGE TIB 10MM KNMX PLUS LG FULL,"$1,500.00",$0.00,"$1,500.00",$0.00,"$1,070.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
6476-5-110,SUP,Custom 27803010,,6476-5-110  -  WEDGE TIB 10MM KX+ LG LL/RM BLOCK,$808.00,$0.00,$808.00,$0.00,$576.67,$0.00,$0.00,$0.00,$0.00,$0.00,$808.00,$0.00,$404.00,$639.94,$646.40,$0.00,$0.00,$0.00,$0.00,$0.00
6476-5-120,SUP,Custom 27803010,,6476-5-120  -  WEDGE TIB 10MM KX+ LG LEFT MDL RIGHT LAT BLOCK,$673.00,$0.00,$673.00,$0.00,$480.32,$0.00,$0.00,$0.00,$0.00,$0.00,$673.00,$0.00,$336.50,$533.02,$538.40,$0.00,$0.00,$0.00,$0.00,$0.00
6476-5-130,SUP,Custom 27803010,,6476-5-130  -  WEDGE TIB 5MM KX+ LG LL/RM BLOCK,$808.00,$0.00,$808.00,$0.00,$576.67,$0.00,$0.00,$0.00,$0.00,$0.00,$808.00,$0.00,$404.00,$639.94,$646.40,$0.00,$0.00,$0.00,$0.00,$0.00
6476-5-140,SUP,Custom 27803010,,6476-5-140  -  WEDGE TIB 5MM KX+ LG LEFT MDL RIGHT LAT BLOCK,$808.00,$0.00,$808.00,$0.00,$576.67,$0.00,$0.00,$0.00,$0.00,$0.00,$808.00,$0.00,$404.00,$639.94,$646.40,$0.00,$0.00,$0.00,$0.00,$0.00
6476-5-150,SUP,Custom 27803010,,6476-5-150  -  WEDGE TIB KX+ LG LL/RM FULL ANG,"$1,439.00",$0.00,"$1,439.00",$0.00,"$1,027.01",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,439.00",$0.00,$719.50,"$1,139.69","$1,151.20",$0.00,$0.00,$0.00,$0.00,$0.00
6476-5-160,SUP,Custom 27803010,,6476-5-160  -  WEDGE TIB KX+ LG LEFT MDL RIGHT LAT FULL ANG,"$1,439.00",$0.00,"$1,439.00",$0.00,"$1,027.01",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,439.00",$0.00,$719.50,"$1,139.69","$1,151.20",$0.00,$0.00,$0.00,$0.00,$0.00
6476-5-310,SUP,Custom 27803010,,6476-5-310  -  BSPLT TIB KNMX LG KNEE MODULLAR,"$2,146.00",$0.00,"$2,146.00",$0.00,"$1,531.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,146.00",$0.00,"$1,073.00","$1,699.63","$1,716.80",$0.00,$0.00,$0.00,$0.00,$0.00
6476-5-400,SUP,Custom 27803010,,6476-5-400  -  BSPLT TIB KMX+ LG KNEE ASMBLY,"$2,996.00",$0.00,"$2,996.00",$0.00,"$2,138.25",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,996.00",$0.00,"$1,498.00","$2,372.83","$2,396.80",$0.00,$0.00,$0.00,$0.00,$0.00
6476-6-100,SUP,Custom 27803010,,6476-6-100  -  WEDGE TIB 10MM KNMX PLUS XL FULL,"$1,439.00",$0.00,"$1,439.00",$0.00,"$1,027.01",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,439.00",$0.00,$719.50,"$1,139.69","$1,151.20",$0.00,$0.00,$0.00,$0.00,$0.00
6476-6-110,SUP,Custom 27803010,,6476-6-110  -  WEDGE TIB 10MM KX+ XL LL/RM BLOCK,$776.00,$0.00,$776.00,$0.00,$553.83,$0.00,$0.00,$0.00,$0.00,$0.00,$776.00,$0.00,$388.00,$614.59,$620.80,$0.00,$0.00,$0.00,$0.00,$0.00
6476-6-120,SUP,Custom 27803010,,6476-6-120  -  WEDGE TIB 10MM KX+ XL LEFT MDL RIGHT LAT BLOCK,$776.00,$0.00,$776.00,$0.00,$553.83,$0.00,$0.00,$0.00,$0.00,$0.00,$776.00,$0.00,$388.00,$614.59,$620.80,$0.00,$0.00,$0.00,$0.00,$0.00
6476-6-130,SUP,Custom 27803010,,6476-6-130  -  WEDGE TIB 5MM KX+ XL LL/RM BLOCK,$776.00,$0.00,$776.00,$0.00,$553.83,$0.00,$0.00,$0.00,$0.00,$0.00,$776.00,$0.00,$388.00,$614.59,$620.80,$0.00,$0.00,$0.00,$0.00,$0.00
6476-6-140,SUP,Custom 27803010,,6476-6-140  -  WEDGE TIB 5MM KX+ XL LEFT MDL RIGHT LAT BLOCK,$776.00,$0.00,$776.00,$0.00,$553.83,$0.00,$0.00,$0.00,$0.00,$0.00,$776.00,$0.00,$388.00,$614.59,$620.80,$0.00,$0.00,$0.00,$0.00,$0.00
6476-6-150,SUP,Custom 27803010,,6476-6-150  -  WEDGE TIB KX+ XL LL/RM FULL ANG,"$1,439.00",$0.00,"$1,439.00",$0.00,"$1,027.01",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,439.00",$0.00,$719.50,"$1,139.69","$1,151.20",$0.00,$0.00,$0.00,$0.00,$0.00
6476-6-160,SUP,Custom 27803010,,6476-6-160  -  WEDGE TIB KX+ XL LEFT MDL RIGHT LAT FULL ANG,"$1,439.00",$0.00,"$1,439.00",$0.00,"$1,027.01",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,439.00",$0.00,$719.50,"$1,139.69","$1,151.20",$0.00,$0.00,$0.00,$0.00,$0.00
6476-6-310,SUP,Custom 27803010,,6476-6-310  -  BSPLT TIB KNMX XL KNEE MDLR,"$2,274.00",$0.00,"$2,274.00",$0.00,"$1,622.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,274.00",$0.00,"$1,137.00","$1,801.01","$1,819.20",$0.00,$0.00,$0.00,$0.00,$0.00
6476-6-400,SUP,Custom 27803010,,6476-6-400  -  BSPLT TIB KMX+ XL ORTH ASMBLY,"$3,125.00",$0.00,"$3,125.00",$0.00,"$2,230.31",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,125.00",$0.00,"$1,562.50","$2,475.00","$2,500.00",$0.00,$0.00,$0.00,$0.00,$0.00
6476-8-170,SUP,Custom 27803010,,6476-8-170  -  WEDGE TIB KMX+ FIX SCR,$103.00,$0.00,$103.00,$0.00,$73.51,$0.00,$0.00,$0.00,$0.00,$0.00,$103.00,$0.00,$51.50,$81.58,$82.40,$0.00,$0.00,$0.00,$0.00,$0.00
6476-8-180,SUP,Custom 27803010,,6476-8-180  -  WEDGE TIB 15MM KNMX PLUS FIX PG,$218.00,$0.00,$218.00,$0.00,$155.59,$0.00,$0.00,$0.00,$0.00,$0.00,$218.00,$0.00,$109.00,$172.66,$174.40,$0.00,$0.00,$0.00,$0.00,$0.00
6476-8-242,SUP,Custom 27803010,,6476-8-242  -  STEM FEM 40MM CMNT COCR XS FEM/TIB KNEE,"$1,839.50",$0.00,"$1,839.50",$0.00,"$1,312.85",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,839.50",$0.00,$919.75,"$1,456.88","$1,471.60",$0.00,$0.00,$0.00,$0.00,$0.00
6476-8-244,SUP,Custom 27803010,,6476-8-244  -  STEM FEM 80MM CMNT COCR XS TIB KNEE,"$1,839.50",$0.00,"$1,839.50",$0.00,"$1,312.85",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,839.50",$0.00,$919.75,"$1,456.88","$1,471.60",$0.00,$0.00,$0.00,$0.00,$0.00
6476-8-246,SUP,Custom 27803010,,6476-8-246  -  STEM FEM 155MM CMNT COCR XS TIB KNEE,"$1,860.63",$0.00,"$1,860.63",$0.00,"$1,327.93",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,860.63",$0.00,$930.31,"$1,473.62","$1,488.50",$0.00,$0.00,$0.00,$0.00,$0.00
6476-8-250,SUP,Custom 27803010,,6476-8-250  -  EXTENSION STEM XS 40MM CEMENTED KINEMAX COCR KNEE FEMORAL,"$1,915.00",$0.00,"$1,915.00",$0.00,"$1,366.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,915.00",$0.00,$957.50,"$1,516.68","$1,532.00",$0.00,$0.00,$0.00,$0.00,$0.00
6476-8-260,SUP,Custom 27803010,,6476-8-260  -  STEM FEMORAL 80MM CEMENT KINEMAX COCR KNEE,"$1,915.00",$0.00,"$1,915.00",$0.00,"$1,366.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,915.00",$0.00,$957.50,"$1,516.68","$1,532.00",$0.00,$0.00,$0.00,$0.00,$0.00
6476-8-270,SUP,Custom 27803010,,6476-8-270  -  EXTENSION STEM XS 155MM CEMENTED KINEMAX COCR KNEE FEMORAL,"$1,915.00",$0.00,"$1,915.00",$0.00,"$1,366.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,915.00",$0.00,$957.50,"$1,516.68","$1,532.00",$0.00,$0.00,$0.00,$0.00,$0.00
6476-8-315,SUP,Custom 27803010,,6476-8-315  -  WEDGE TIB KMX+ LG,$659.00,$0.00,$659.00,$0.00,$470.33,$0.00,$0.00,$0.00,$0.00,$0.00,$659.00,$0.00,$329.50,$521.93,$527.20,$0.00,$0.00,$0.00,$0.00,$0.00
6476-8-320,SUP,Custom 27803010,,6476-8-320  -  WEDGE TIB KMX+ XL,$808.00,$0.00,$808.00,$0.00,$576.67,$0.00,$0.00,$0.00,$0.00,$0.00,$808.00,$0.00,$404.00,$639.94,$646.40,$0.00,$0.00,$0.00,$0.00,$0.00
6478-6-020,SUP,Custom 27803010,,6478-6-020  -  INSERT TIB 20MM KNEE PEG KMX+,$446.00,$0.00,$446.00,$0.00,$318.31,$0.00,$0.00,$0.00,$0.00,$0.00,$446.00,$0.00,$223.00,$353.23,$356.80,$0.00,$0.00,$0.00,$0.00,$0.00
6478-6-100,SUP,Custom 27803010,,6478-6-100  -  WEDGE TIB KNMX PLUS SM XS SS,$687.00,$0.00,$687.00,$0.00,$490.31,$0.00,$0.00,$0.00,$0.00,$0.00,$687.00,$0.00,$343.50,$544.10,$549.60,$0.00,$0.00,$0.00,$0.00,$0.00
6478-6-110,SUP,Custom 27803010,,6478-6-110  -  WEDGE TIB SM KNEE SS MDLR PLUS KX,$659.00,$0.00,$659.00,$0.00,$470.33,$0.00,$0.00,$0.00,$0.00,$0.00,$659.00,$0.00,$329.50,$521.93,$527.20,$0.00,$0.00,$0.00,$0.00,$0.00
6478-6-120,SUP,Custom 27803010,,6478-6-120  -  WEDGE TIB KNMX L+ MED KNEE SS WDG SUP STAB,$687.00,$0.00,$687.00,$0.00,$490.31,$0.00,$0.00,$0.00,$0.00,$0.00,$687.00,$0.00,$343.50,$544.10,$549.60,$0.00,$0.00,$0.00,$0.00,$0.00
6478-6-395,SUP,Custom 27803010,,6478-6-395  -  EXTENSION STEM 10MM 80MM 1 AXIS PRESS FIT CEMENTED SCORPIO,"$1,915.00",$0.00,"$1,915.00",$0.00,"$1,366.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,915.00",$0.00,$957.50,"$1,516.68","$1,532.00",$0.00,$0.00,$0.00,$0.00,$0.00
6478-6-396,SUP,Custom 27803010,,6478-6-396  -  EXTENSION STEM 11MM 80MM 1 AXIS PRESS FIT CEMENTED SCORPIO,"$1,915.00",$0.00,"$1,915.00",$0.00,"$1,366.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,915.00",$0.00,$957.50,"$1,516.68","$1,532.00",$0.00,$0.00,$0.00,$0.00,$0.00
6478-6-397,SUP,Custom 27803010,,6478-6-397  -  EXTENSION STEM 12MM 80MM 1 AXIS PRESS FIT CEMENTED SCORPIO,"$1,915.00",$0.00,"$1,915.00",$0.00,"$1,366.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,915.00",$0.00,$957.50,"$1,516.68","$1,532.00",$0.00,$0.00,$0.00,$0.00,$0.00
6478-6-398,SUP,Custom 27803010,,6478-6-398  -  TRIAL KNEE 13MM 80MM 1 AXIS PRESS FIT CEMENTED STEM EXTN,"$1,915.00",$0.00,"$1,915.00",$0.00,"$1,366.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,915.00",$0.00,$957.50,"$1,516.68","$1,532.00",$0.00,$0.00,$0.00,$0.00,$0.00
6478-6-399,SUP,Custom 27803010,,6478-6-399  -  EXTENSION STEM 14MM 80MM 1 AXIS PRESS FIT CEMENTED SCORPIO,"$1,915.00",$0.00,"$1,915.00",$0.00,"$1,366.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,915.00",$0.00,$957.50,"$1,516.68","$1,532.00",$0.00,$0.00,$0.00,$0.00,$0.00
6478-6-400,SUP,Custom 27803010,,6478-6-400  -  TRIAL KNEE 15MM 80MM 1 AXIS PRESS FIT CEMENTED STEM EXTN,"$1,915.00",$0.00,"$1,915.00",$0.00,"$1,366.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,915.00",$0.00,$957.50,"$1,516.68","$1,532.00",$0.00,$0.00,$0.00,$0.00,$0.00
6478-6-405,SUP,Custom 27803010,,6478-6-405  -  EXTENSION STEM 16MM 80MM 1 AXIS PRESS FIT CEMENTED SCORPIO,"$1,915.00",$0.00,"$1,915.00",$0.00,"$1,366.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,915.00",$0.00,$957.50,"$1,516.68","$1,532.00",$0.00,$0.00,$0.00,$0.00,$0.00
6478-6-410,SUP,Custom 27803010,,6478-6-410  -  EXTENSION STEM 17MM 80MM 1 AXIS PRESS FIT CEMENTED SCORPIO,"$1,915.00",$0.00,"$1,915.00",$0.00,"$1,366.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,915.00",$0.00,$957.50,"$1,516.68","$1,532.00",$0.00,$0.00,$0.00,$0.00,$0.00
6478-6-415,SUP,Custom 27803010,,6478-6-415  -  EXTENSION STEM 18MM 80MM 1 AXIS PRESS FIT CEMENTED SCORPIO,"$1,915.00",$0.00,"$1,915.00",$0.00,"$1,366.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,915.00",$0.00,$957.50,"$1,516.68","$1,532.00",$0.00,$0.00,$0.00,$0.00,$0.00
6478-6-420,SUP,Custom 27803010,,6478-6-420  -  EXTENSION STEM 19MM 80MM 1 AXIS PRESS FIT CEMENTED SCORPIO,"$1,915.00",$0.00,"$1,915.00",$0.00,"$1,366.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,915.00",$0.00,$957.50,"$1,516.68","$1,532.00",$0.00,$0.00,$0.00,$0.00,$0.00
6478-6-425,SUP,Custom 27803010,,6478-6-425  -  EXTENSION STEM 21MM 80MM 1 AXIS PRESS FIT CEMENTED SCORPIO,"$1,915.00",$0.00,"$1,915.00",$0.00,"$1,366.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,915.00",$0.00,$957.50,"$1,516.68","$1,532.00",$0.00,$0.00,$0.00,$0.00,$0.00
6478-6-430,SUP,Custom 27803010,,6478-6-430  -  EXTENSION STEM 23MM 80MM 1 AXIS PRESS FIT CEMENTED SCORPIO,"$1,915.00",$0.00,"$1,915.00",$0.00,"$1,366.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,915.00",$0.00,$957.50,"$1,516.68","$1,532.00",$0.00,$0.00,$0.00,$0.00,$0.00
6478-6-435,SUP,Custom 27803010,,6478-6-435  -  EXTENSION STEM 10MM 155MM 1 AXIS PRESS FIT CEMENTED SCORPIO,"$1,915.00",$0.00,"$1,915.00",$0.00,"$1,366.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,915.00",$0.00,$957.50,"$1,516.68","$1,532.00",$0.00,$0.00,$0.00,$0.00,$0.00
6478-6-436,SUP,Custom 27803010,,6478-6-436  -  EXTENSION STEM 11MM 155MM 1 AXIS PRESS FIT CEMENTED SCORPIO,"$1,915.00",$0.00,"$1,915.00",$0.00,"$1,366.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,915.00",$0.00,$957.50,"$1,516.68","$1,532.00",$0.00,$0.00,$0.00,$0.00,$0.00
6478-6-437,SUP,Custom 27803010,,6478-6-437  -  TRIAL KNEE 12MM 155MM 1 AXIS PRESS FIT CEMENTED STEM EXTN,"$1,915.00",$0.00,"$1,915.00",$0.00,"$1,366.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,915.00",$0.00,$957.50,"$1,516.68","$1,532.00",$0.00,$0.00,$0.00,$0.00,$0.00
6478-6-438,SUP,Custom 27803010,,6478-6-438  -  EXTENSION STEM 13MM 155MM 1 AXIS PRESS FIT CEMENTED SCORPIO,"$1,915.00",$0.00,"$1,915.00",$0.00,"$1,366.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,915.00",$0.00,$957.50,"$1,516.68","$1,532.00",$0.00,$0.00,$0.00,$0.00,$0.00
6478-6-439,SUP,Custom 27803010,,6478-6-439  -  EXTENSION STEM 14MM 155MM 1 AXIS PRESS FIT CEMENTED SCORPIO,"$1,915.00",$0.00,"$1,915.00",$0.00,"$1,366.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,915.00",$0.00,$957.50,"$1,516.68","$1,532.00",$0.00,$0.00,$0.00,$0.00,$0.00
6478-6-440,SUP,Custom 27803010,,6478-6-440  -  EXTENSION STEM 15MM 155MM 1 AXIS PRESS FIT CEMENTED SCORPIO,"$1,915.00",$0.00,"$1,915.00",$0.00,"$1,366.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,915.00",$0.00,$957.50,"$1,516.68","$1,532.00",$0.00,$0.00,$0.00,$0.00,$0.00
6478-6-445,SUP,Custom 27803010,,6478-6-445  -  EXTENSION STEM 16MM 155MM 1 AXIS PRESS FIT CEMENTED SCORPIO,"$1,915.00",$0.00,"$1,915.00",$0.00,"$1,366.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,915.00",$0.00,$957.50,"$1,516.68","$1,532.00",$0.00,$0.00,$0.00,$0.00,$0.00
6478-6-450,SUP,Custom 27803010,,6478-6-450  -  EXTENSION STEM 17MM 155MM 1 AXIS PRESS FIT CEMENTED SCORPIO,"$1,915.00",$0.00,"$1,915.00",$0.00,"$1,366.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,915.00",$0.00,$957.50,"$1,516.68","$1,532.00",$0.00,$0.00,$0.00,$0.00,$0.00
6478-6-455,SUP,Custom 27803010,,6478-6-455  -  EXTENSION STEM 18MM 155MM 1 AXIS PRESS FIT CEMENTED SCORPIO,"$1,915.00",$0.00,"$1,915.00",$0.00,"$1,366.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,915.00",$0.00,$957.50,"$1,516.68","$1,532.00",$0.00,$0.00,$0.00,$0.00,$0.00
6478-6-460,SUP,Custom 27803010,,6478-6-460  -  EXTENSION STEM 19MM 155MM 1 AXIS PRESS FIT CEMENTED SCORPIO,"$1,915.00",$0.00,"$1,915.00",$0.00,"$1,366.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,915.00",$0.00,$957.50,"$1,516.68","$1,532.00",$0.00,$0.00,$0.00,$0.00,$0.00
6478-6-465,SUP,Custom 27803010,,6478-6-465  -  EXTENSION STEM 21MM 155MM 1 AXIS PRESS FIT CEMENTED SCORPIO,"$1,915.00",$0.00,"$1,915.00",$0.00,"$1,366.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,915.00",$0.00,$957.50,"$1,516.68","$1,532.00",$0.00,$0.00,$0.00,$0.00,$0.00
6478-6-470,SUP,Custom 27803010,,6478-6-470  -  EXTENSION STEM 23MM 155MM 1 AXIS PRESS FIT CEMENTED SCORPIO,"$1,915.00",$0.00,"$1,915.00",$0.00,"$1,366.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,915.00",$0.00,$957.50,"$1,516.68","$1,532.00",$0.00,$0.00,$0.00,$0.00,$0.00
6478-6-490,SUP,Custom 27803010,,6478-6-490  -  ADAPTER STEM 4MM OFFST JAM NUT SCORPIO KNEE,"$2,220.00",$0.00,"$2,220.00",$0.00,"$1,584.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,220.00",$0.00,"$1,110.00","$1,758.24","$1,776.00",$0.00,$0.00,$0.00,$0.00,$0.00
6478-6-495,SUP,Custom 27803010,,6478-6-495  -  ADAPTER STM 6MM OFST SCRP JAM NUT TIB 1 AXIS KN SYS,"$2,220.00",$0.00,"$2,220.00",$0.00,"$1,584.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,220.00",$0.00,"$1,110.00","$1,758.24","$1,776.00",$0.00,$0.00,$0.00,$0.00,$0.00
6478-6-500,SUP,Custom 27803010,,6478-6-500  -  ADAPTER STM 8MM OFST SCRP JAM NUT TIB 1 AXIS KN SYS,"$2,220.00",$0.00,"$2,220.00",$0.00,"$1,584.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,220.00",$0.00,"$1,110.00","$1,758.24","$1,776.00",$0.00,$0.00,$0.00,$0.00,$0.00
6478-6-585,SUP,Custom 27803010,,6478-6-585  -  ADAPTER STM 2MM OFST SCRP JAM NUT FEM 1 AXIS KN SYS,"$2,220.00",$0.00,"$2,220.00",$0.00,"$1,584.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,220.00",$0.00,"$1,110.00","$1,758.24","$1,776.00",$0.00,$0.00,$0.00,$0.00,$0.00
6478-6-600,SUP,Custom 27803010,,6478-6-600  -  STEM TIBIAL FLUTE 10MM 80MM GMRS TITANIUM KNEE PROXIMAL,"$2,342.50",$0.00,"$2,342.50",$0.00,"$1,671.84",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,342.50",$0.00,"$1,171.25","$1,855.26","$1,874.00",$0.00,$0.00,$0.00,$0.00,$0.00
6478-6-605,SUP,Custom 27803010,,6478-6-605  -  STEM TIBIAL FLUTE 11MM 80MM GMRS TITANIUM KNEE PROXIMAL,"$2,342.50",$0.00,"$2,342.50",$0.00,"$1,671.84",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,342.50",$0.00,"$1,171.25","$1,855.26","$1,874.00",$0.00,$0.00,$0.00,$0.00,$0.00
6478-6-610,SUP,Custom 27803010,,6478-6-610  -  STEM TIBIAL FLUTE 12MM 80MM GMRS TITANIUM KNEE PROXIMAL,"$2,342.50",$0.00,"$2,342.50",$0.00,"$1,671.84",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,342.50",$0.00,"$1,171.25","$1,855.26","$1,874.00",$0.00,$0.00,$0.00,$0.00,$0.00
6478-6-615,SUP,Custom 27803010,,6478-6-615  -  STEM TIBIAL FLUTE 13MM 80MM GMRS TITANIUM KNEE PROXIMAL,"$2,342.50",$0.00,"$2,342.50",$0.00,"$1,671.84",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,342.50",$0.00,"$1,171.25","$1,855.26","$1,874.00",$0.00,$0.00,$0.00,$0.00,$0.00
6478-6-620,SUP,Custom 27803010,,6478-6-620  -  STEM TIBIAL FLUTE 14MM 80MM GMRS TITANIUM KNEE PROXIMAL,"$2,342.50",$0.00,"$2,342.50",$0.00,"$1,671.84",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,342.50",$0.00,"$1,171.25","$1,855.26","$1,874.00",$0.00,$0.00,$0.00,$0.00,$0.00
6478-6-625,SUP,Custom 27803010,,6478-6-625  -  STEM TIBIAL FLUTE 15MM 80MM GMRS TITANIUM KNEE PROXIMAL,"$2,342.50",$0.00,"$2,342.50",$0.00,"$1,671.84",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,342.50",$0.00,"$1,171.25","$1,855.26","$1,874.00",$0.00,$0.00,$0.00,$0.00,$0.00
6478-6-630,SUP,Custom 27803010,,6478-6-630  -  STEM TIBIAL FLUTE 16MM 80MM GMRS TITANIUM KNEE PROXIMAL,"$2,342.50",$0.00,"$2,342.50",$0.00,"$1,671.84",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,342.50",$0.00,"$1,171.25","$1,855.26","$1,874.00",$0.00,$0.00,$0.00,$0.00,$0.00
6478-6-635,SUP,Custom 27803010,,6478-6-635  -  STEM TIBIAL FLUTE 17MM 80MM GMRS TITANIUM KNEE PROXIMAL,"$2,342.50",$0.00,"$2,342.50",$0.00,"$1,671.84",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,342.50",$0.00,"$1,171.25","$1,855.26","$1,874.00",$0.00,$0.00,$0.00,$0.00,$0.00
6478-6-640,SUP,Custom 27803010,,6478-6-640  -  STEM TIBIAL FLUTE 18MM 80MM GMRS TITANIUM KNEE PROXIMAL,"$2,342.50",$0.00,"$2,342.50",$0.00,"$1,671.84",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,342.50",$0.00,"$1,171.25","$1,855.26","$1,874.00",$0.00,$0.00,$0.00,$0.00,$0.00
6478-6-645,SUP,Custom 27803010,,6478-6-645  -  STEM TIBIAL FLUTE 19MM 80MM GMRS TITANIUM KNEE PROXIMAL,"$2,342.50",$0.00,"$2,342.50",$0.00,"$1,671.84",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,342.50",$0.00,"$1,171.25","$1,855.26","$1,874.00",$0.00,$0.00,$0.00,$0.00,$0.00
6478-6-655,SUP,Custom 27803010,,6478-6-655  -  STEM TIBIAL FLUTE 21MM 80MM GMRS TITANIUM KNEE PROXIMAL,"$2,342.50",$0.00,"$2,342.50",$0.00,"$1,671.84",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,342.50",$0.00,"$1,171.25","$1,855.26","$1,874.00",$0.00,$0.00,$0.00,$0.00,$0.00
6478-6-665,SUP,Custom 27803010,,6478-6-665  -  STEM TIBIAL FLUTE 23MM 80MM GMRS TITANIUM KNEE PROXIMAL,"$2,342.50",$0.00,"$2,342.50",$0.00,"$1,671.84",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,342.50",$0.00,"$1,171.25","$1,855.26","$1,874.00",$0.00,$0.00,$0.00,$0.00,$0.00
6478-6-680,SUP,Custom 27803010,,6478-6-680  -  STEM TIBIAL FLUTE 10MM 115MM GMRS TITANIUM KNEE PROXIMAL,"$2,342.50",$0.00,"$2,342.50",$0.00,"$1,671.84",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,342.50",$0.00,"$1,171.25","$1,855.26","$1,874.00",$0.00,$0.00,$0.00,$0.00,$0.00
6478-6-685,SUP,Custom 27803010,,6478-6-685  -  STEM TIBIAL FLUTE 11MM 115MM GMRS TITANIUM KNEE PROXIMAL,"$2,342.50",$0.00,"$2,342.50",$0.00,"$1,671.84",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,342.50",$0.00,"$1,171.25","$1,855.26","$1,874.00",$0.00,$0.00,$0.00,$0.00,$0.00
6478-6-690,SUP,Custom 27803010,,6478-6-690  -  STEM TIBIAL FLUTE 12MM 115MM GMRS TITANIUM KNEE PROXIMAL,"$2,342.50",$0.00,"$2,342.50",$0.00,"$1,671.84",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,342.50",$0.00,"$1,171.25","$1,855.26","$1,874.00",$0.00,$0.00,$0.00,$0.00,$0.00
6478-6-695,SUP,Custom 27803010,,6478-6-695  -  STEM TIBIAL FLUTE 13MM 115MM GMRS TITANIUM KNEE PROXIMAL,"$2,342.50",$0.00,"$2,342.50",$0.00,"$1,671.84",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,342.50",$0.00,"$1,171.25","$1,855.26","$1,874.00",$0.00,$0.00,$0.00,$0.00,$0.00
6478-6-705,SUP,Custom 27803010,,6478-6-705  -  STEM TIBIAL FLUTE 14MM 115MM GMRS TITANIUM KNEE PROXIMAL,"$2,342.50",$0.00,"$2,342.50",$0.00,"$1,671.84",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,342.50",$0.00,"$1,171.25","$1,855.26","$1,874.00",$0.00,$0.00,$0.00,$0.00,$0.00
6478-6-710,SUP,Custom 27803010,,6478-6-710  -  STEM TIBIAL FLUTE 15MM 115MM GMRS TITANIUM KNEE PROXIMAL,"$2,342.50",$0.00,"$2,342.50",$0.00,"$1,671.84",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,342.50",$0.00,"$1,171.25","$1,855.26","$1,874.00",$0.00,$0.00,$0.00,$0.00,$0.00
6478-6-715,SUP,Custom 27803010,,6478-6-715  -  STEM TIBIAL FLUTE 16MM 115MM GMRS TITANIUM KNEE PROXIMAL,"$2,342.50",$0.00,"$2,342.50",$0.00,"$1,671.84",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,342.50",$0.00,"$1,171.25","$1,855.26","$1,874.00",$0.00,$0.00,$0.00,$0.00,$0.00
6478-6-720,SUP,Custom 27803010,,6478-6-720  -  STEM TIBIAL FLUTE 17MM 115MM GMRS TITANIUM KNEE PROXIMAL,"$2,342.50",$0.00,"$2,342.50",$0.00,"$1,671.84",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,342.50",$0.00,"$1,171.25","$1,855.26","$1,874.00",$0.00,$0.00,$0.00,$0.00,$0.00
6478-6-725,SUP,Custom 27803010,,6478-6-725  -  STEM TIBIAL FLUTE 18MM 115MM GMRS TITANIUM KNEE PROXIMAL,"$2,342.50",$0.00,"$2,342.50",$0.00,"$1,671.84",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,342.50",$0.00,"$1,171.25","$1,855.26","$1,874.00",$0.00,$0.00,$0.00,$0.00,$0.00
6478-6-730,SUP,Custom 27803010,,6478-6-730  -  STEM TIBIAL FLUTE 19MM 115MM GMRS TITANIUM KNEE PROXIMAL,"$2,342.50",$0.00,"$2,342.50",$0.00,"$1,671.84",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,342.50",$0.00,"$1,171.25","$1,855.26","$1,874.00",$0.00,$0.00,$0.00,$0.00,$0.00
6478-6-740,SUP,Custom 27803010,,6478-6-740  -  STEM TIBIAL FLUTE 21MM 115MM GMRS TITANIUM KNEE PROXIMAL,"$2,342.50",$0.00,"$2,342.50",$0.00,"$1,671.84",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,342.50",$0.00,"$1,171.25","$1,855.26","$1,874.00",$0.00,$0.00,$0.00,$0.00,$0.00
6478-6-750,SUP,Custom 27803010,,6478-6-750  -  STEM TIBIAL FLUTE 23MM 115MM GMRS TITANIUM KNEE PROXIMAL,"$2,342.50",$0.00,"$2,342.50",$0.00,"$1,671.84",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,342.50",$0.00,"$1,171.25","$1,855.26","$1,874.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-0-050,SUP,HCPCS C1776,,6479-0-050  -  CMPNT FEM XS CNDYLR KMX+ NPOR,"$3,596.00",$0.00,"$3,596.00","$1,618.20","$2,566.47",$0.00,$619.57,$0.00,$0.00,$629.63,"$3,596.00",$0.00,"$1,798.00","$2,848.03","$2,876.80",$0.00,$562.77,$0.00,$572.48,$0.00
6479-0-100,SUP,HCPCS C1776,,6479-0-100  -  CMPNT FEM SM CNDYLR KMX+ NPOR,"$3,467.00",$0.00,"$3,467.00","$1,560.15","$2,474.40",$0.00,$597.35,$0.00,$0.00,$607.04,"$3,467.00",$0.00,"$1,733.50","$2,745.86","$2,773.60",$0.00,$542.59,$0.00,$551.95,$0.00
6479-0-150,SUP,HCPCS C1776,,6479-0-150  -  CMPNT FEM MED CNDYLR KMX+ NPOR,"$3,467.00",$0.00,"$3,467.00","$1,560.15","$2,474.40",$0.00,$597.35,$0.00,$0.00,$607.04,"$3,467.00",$0.00,"$1,733.50","$2,745.86","$2,773.60",$0.00,$542.59,$0.00,$551.95,$0.00
6479-0-200,SUP,HCPCS C1776,,6479-0-200  -  CMPNT FEM LG CNDYLR KMX+ NPOR,"$3,467.00",$0.00,"$3,467.00","$1,560.15","$2,474.40",$0.00,$597.35,$0.00,$0.00,$607.04,"$3,467.00",$0.00,"$1,733.50","$2,745.86","$2,773.60",$0.00,$542.59,$0.00,$551.95,$0.00
6479-0-250,SUP,HCPCS C1776,,6479-0-250  -  CMPNT FEM XL CNDYLR KMX+ NPOR,"$3,467.00",$0.00,"$3,467.00","$1,560.15","$2,474.40",$0.00,$597.35,$0.00,$0.00,$607.04,"$3,467.00",$0.00,"$1,733.50","$2,745.86","$2,773.60",$0.00,$542.59,$0.00,$551.95,$0.00
6479-0-300,SUP,HCPCS C1776,,6479-0-300  -  CMPNT FEM 2XL CNDYLR KMX+ NPOR,"$3,596.00",$0.00,"$3,596.00","$1,618.20","$2,566.47",$0.00,$619.57,$0.00,$0.00,$629.63,"$3,596.00",$0.00,"$1,798.00","$2,848.03","$2,876.80",$0.00,$562.77,$0.00,$572.48,$0.00
6479-4-900,SUP,Custom 27803010,,6479-4-900  -  CMPNT PATLR SM KMX+ DUR,"$1,133.00",$0.00,"$1,133.00",$0.00,$808.62,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,133.00",$0.00,$566.50,$897.34,$906.40,$0.00,$0.00,$0.00,$0.00,$0.00
6479-4-911,SUP,Custom 27803010,,6479-4-911  -  CMPNT PATLR MED KMX+ DUR,"$1,133.00",$0.00,"$1,133.00",$0.00,$808.62,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,133.00",$0.00,$566.50,$897.34,$906.40,$0.00,$0.00,$0.00,$0.00,$0.00
6479-4-920,SUP,Custom 27803010,,6479-4-920  -  INSERT TIB LG PTLR DUR KX+,"$1,133.00",$0.00,"$1,133.00",$0.00,$808.62,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,133.00",$0.00,$566.50,$897.34,$906.40,$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-008,SUP,Custom 27803010,,6479-5-008  -  INSERT TIBIAL XS 65X41X8MM LATERAL STABILIZE CRUCIATE RETAIN,"$2,265.00",$0.00,"$2,265.00",$0.00,"$1,616.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,265.00",$0.00,"$1,132.50","$1,793.88","$1,812.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-010,SUP,Custom 27803010,,6479-5-010  -  INSERT TIBIAL XS 65X41X10MM LATERAL STABILIZE CRUCIATE,"$2,265.00",$0.00,"$2,265.00",$0.00,"$1,616.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,265.00",$0.00,"$1,132.50","$1,793.88","$1,812.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-012,SUP,Custom 27803010,,6479-5-012  -  INSERT TIBIAL XS 65X41X12MM LATERAL STABILIZE CRUCIATE,"$2,265.00",$0.00,"$2,265.00",$0.00,"$1,616.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,265.00",$0.00,"$1,132.50","$1,793.88","$1,812.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-015,SUP,Custom 27803010,,6479-5-015  -  INSERT TIBIAL XS 65X41X15MM LATERAL STABILIZE CRUCIATE,"$2,265.00",$0.00,"$2,265.00",$0.00,"$1,616.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,265.00",$0.00,"$1,132.50","$1,793.88","$1,812.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-018,SUP,Custom 27803010,,6479-5-018  -  INSERT TIBIAL XS 65X41X18MM LATERAL STABILIZE CRUCIATE,"$2,265.00",$0.00,"$2,265.00",$0.00,"$1,616.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,265.00",$0.00,"$1,132.50","$1,793.88","$1,812.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-021,SUP,Custom 27803010,,6479-5-021  -  INSERT TIBIAL XS 21MM LATERAL STABILIZED CRUC RET KINEMAX,"$2,265.00",$0.00,"$2,265.00",$0.00,"$1,616.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,265.00",$0.00,"$1,132.50","$1,793.88","$1,812.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-025,SUP,Custom 27803010,,6479-5-025  -  INSERT TIBIAL XS 65X41X25MM LATERAL STABILIZE CRUCIATE,"$2,265.00",$0.00,"$2,265.00",$0.00,"$1,616.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,265.00",$0.00,"$1,132.50","$1,793.88","$1,812.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-108,SUP,Custom 27803010,,6479-5-108  -  INSERT TIBIAL SMALL 8MM LATERAL STABILIZED KINEMAX PLUS DUR,"$2,265.00",$0.00,"$2,265.00",$0.00,"$1,616.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,265.00",$0.00,"$1,132.50","$1,793.88","$1,812.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-110,SUP,Custom 27803010,,6479-5-110  -  INSERT TIBIAL SMALL 10MM LATERAL STABILIZED KINEMAX PLUS DUR,"$2,265.00",$0.00,"$2,265.00",$0.00,"$1,616.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,265.00",$0.00,"$1,132.50","$1,793.88","$1,812.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-112,SUP,Custom 27803010,,6479-5-112  -  INSERT TIBIAL SMALL 12MM LATERAL STABILIZED KINEMAX PLUS DUR,"$2,265.00",$0.00,"$2,265.00",$0.00,"$1,616.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,265.00",$0.00,"$1,132.50","$1,793.88","$1,812.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-115,SUP,Custom 27803010,,6479-5-115  -  INSERT TIBIAL SMALL 15MM LATERAL STABILIZED KINEMAX PLUS DUR,"$2,265.00",$0.00,"$2,265.00",$0.00,"$1,616.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,265.00",$0.00,"$1,132.50","$1,793.88","$1,812.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-118,SUP,Custom 27803010,,6479-5-118  -  INSERT TIBIAL SMALL 71X44X18MM LATERAL STABILIZE CRUCIATE,"$2,265.00",$0.00,"$2,265.00",$0.00,"$1,616.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,265.00",$0.00,"$1,132.50","$1,793.88","$1,812.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-121,SUP,Custom 27803010,,6479-5-121  -  INSERT TIBIAL SMALL 21MM LATERAL STABILIZED CRUC RET KINEMAX,"$2,265.00",$0.00,"$2,265.00",$0.00,"$1,616.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,265.00",$0.00,"$1,132.50","$1,793.88","$1,812.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-125,SUP,Custom 27803010,,6479-5-125  -  INSERT TIBIAL SMALL 71X44X25MM LATERAL STABILIZE CRUCIATE,"$2,265.00",$0.00,"$2,265.00",$0.00,"$1,616.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,265.00",$0.00,"$1,132.50","$1,793.88","$1,812.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-208,SUP,Custom 27803010,,6479-5-208  -  INSERT TIBIAL MEDIUM 8MM LATERAL STABILIZED KINEMAX PLUS DUR,"$2,265.00",$0.00,"$2,265.00",$0.00,"$1,616.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,265.00",$0.00,"$1,132.50","$1,793.88","$1,812.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-210,SUP,Custom 27803010,,6479-5-210  -  INSERT TIBIAL MEDIUM 76X48X10MM LATERAL STABILIZE CRUCIATE,"$2,265.00",$0.00,"$2,265.00",$0.00,"$1,616.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,265.00",$0.00,"$1,132.50","$1,793.88","$1,812.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-212,SUP,Custom 27803010,,6479-5-212  -  INSERT TIBIAL MEDIUM 12MM LATERAL STABILIZED KINEMAX PLUS,"$2,265.00",$0.00,"$2,265.00",$0.00,"$1,616.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,265.00",$0.00,"$1,132.50","$1,793.88","$1,812.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-215,SUP,Custom 27803010,,6479-5-215  -  INSERT TIBIAL MEDIUM 15MM LATERAL STABILIZED KINEMAX PLUS,"$2,265.00",$0.00,"$2,265.00",$0.00,"$1,616.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,265.00",$0.00,"$1,132.50","$1,793.88","$1,812.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-218,SUP,Custom 27803010,,6479-5-218  -  INSERT TIBIAL MEDIUM 18MM LATERAL STABILIZED KINEMAX PLUS,"$2,265.00",$0.00,"$2,265.00",$0.00,"$1,616.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,265.00",$0.00,"$1,132.50","$1,793.88","$1,812.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-221,SUP,Custom 27803010,,6479-5-221  -  INSERT TIBIAL MEDIUM 76X48X21MM LATERAL STABILIZE CRUCIATE,"$2,265.00",$0.00,"$2,265.00",$0.00,"$1,616.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,265.00",$0.00,"$1,132.50","$1,793.88","$1,812.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-225,SUP,Custom 27803010,,6479-5-225  -  INSERT TIBIAL MEDIUM 76X48X25MM LATERAL STABILIZE CRUCIATE,"$2,265.00",$0.00,"$2,265.00",$0.00,"$1,616.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,265.00",$0.00,"$1,132.50","$1,793.88","$1,812.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-308,SUP,Custom 27803010,,6479-5-308  -  INSERT TIBIAL LARGE 8MM LATERAL STABILIZED KINEMAX PLUS DUR,"$2,265.00",$0.00,"$2,265.00",$0.00,"$1,616.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,265.00",$0.00,"$1,132.50","$1,793.88","$1,812.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-310,SUP,Custom 27803010,,6479-5-310  -  INSERT TIBIAL LARGE 81X51X10MM LATERAL STABILIZE CRUCIATE,"$2,265.00",$0.00,"$2,265.00",$0.00,"$1,616.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,265.00",$0.00,"$1,132.50","$1,793.88","$1,812.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-312,SUP,Custom 27803010,,6479-5-312  -  INSERT TIBIAL LARGE 12MM LATERAL STABILIZED KINEMAX PLUS DUR,"$2,265.00",$0.00,"$2,265.00",$0.00,"$1,616.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,265.00",$0.00,"$1,132.50","$1,793.88","$1,812.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-315,SUP,Custom 27803010,,6479-5-315  -  INSERT TIBIAL LARGE 81X51X15MM LATERAL STABILIZE CRUCIATE,"$2,265.00",$0.00,"$2,265.00",$0.00,"$1,616.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,265.00",$0.00,"$1,132.50","$1,793.88","$1,812.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-318,SUP,Custom 27803010,,6479-5-318  -  INSERT TIBIAL LARGE 81X51X18MM LATERAL STABILIZE CRUCIATE,"$2,265.00",$0.00,"$2,265.00",$0.00,"$1,616.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,265.00",$0.00,"$1,132.50","$1,793.88","$1,812.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-321,SUP,Custom 27803010,,6479-5-321  -  INSERT TIBIAL LARGE 81X51X21MM LATERAL STABILIZE CRUCIATE,"$2,265.00",$0.00,"$2,265.00",$0.00,"$1,616.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,265.00",$0.00,"$1,132.50","$1,793.88","$1,812.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-325,SUP,Custom 27803010,,6479-5-325  -  INSERT TIBIAL LARGE 81X51X25MM LATERAL STABILIZE CRUCIATE,"$2,265.00",$0.00,"$2,265.00",$0.00,"$1,616.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,265.00",$0.00,"$1,132.50","$1,793.88","$1,812.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-408,SUP,Custom 27803010,,6479-5-408  -  INSERT TIBIAL XL 86X54X8MM LATERAL STABILIZE CRUCIATE RETAIN,"$2,265.00",$0.00,"$2,265.00",$0.00,"$1,616.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,265.00",$0.00,"$1,132.50","$1,793.88","$1,812.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-410,SUP,Custom 27803010,,6479-5-410  -  INSERT TIBIAL XL 86X54X10MM LATERAL STABILIZE CRUCIATE,"$2,265.00",$0.00,"$2,265.00",$0.00,"$1,616.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,265.00",$0.00,"$1,132.50","$1,793.88","$1,812.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-412,SUP,Custom 27803010,,6479-5-412  -  INSERT TIBIAL XL 86X54X12MM LATERAL STABILIZE CRUCIATE,"$2,265.00",$0.00,"$2,265.00",$0.00,"$1,616.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,265.00",$0.00,"$1,132.50","$1,793.88","$1,812.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-415,SUP,Custom 27803010,,6479-5-415  -  INSERT TIBIAL XL 86X54X15MM LATERAL STABILIZE CRUCIATE,"$2,265.00",$0.00,"$2,265.00",$0.00,"$1,616.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,265.00",$0.00,"$1,132.50","$1,793.88","$1,812.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-418,SUP,Custom 27803010,,6479-5-418  -  INSERT TIBIAL XL 86X54X18MM LATERAL STABILIZE CRUCIATE,"$2,265.00",$0.00,"$2,265.00",$0.00,"$1,616.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,265.00",$0.00,"$1,132.50","$1,793.88","$1,812.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-421,SUP,Custom 27803010,,6479-5-421  -  INSERT TIBIAL XL 86X54X21MM LATERAL STABILIZE CRUCIATE,"$2,265.00",$0.00,"$2,265.00",$0.00,"$1,616.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,265.00",$0.00,"$1,132.50","$1,793.88","$1,812.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-425,SUP,Custom 27803010,,6479-5-425  -  INSERT TIBIAL XL 25MM LATERAL STABILIZED KINEMAX PLUS DUR,"$2,265.00",$0.00,"$2,265.00",$0.00,"$1,616.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,265.00",$0.00,"$1,132.50","$1,793.88","$1,812.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-508,SUP,Custom 27803010,,6479-5-508  -  INSERT TIBIAL XS 65X41X8MM POSTERIOR STABILIZE KINEMAX PLUS,"$2,347.50",$0.00,"$2,347.50",$0.00,"$1,675.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,347.50",$0.00,"$1,173.75","$1,859.22","$1,878.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-510,SUP,Custom 27803010,,6479-5-510  -  INSERT TIBIAL XS 65X41X10MM POSTERIOR STABILIZE KINEMAX PLUS,"$2,347.50",$0.00,"$2,347.50",$0.00,"$1,675.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,347.50",$0.00,"$1,173.75","$1,859.22","$1,878.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-512,SUP,Custom 27803010,,6479-5-512  -  INSERT TIBIAL XS 65X41X12MM POSTERIOR STABILIZE KINEMAX PLUS,"$2,347.50",$0.00,"$2,347.50",$0.00,"$1,675.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,347.50",$0.00,"$1,173.75","$1,859.22","$1,878.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-515,SUP,Custom 27803010,,6479-5-515  -  INSERT TIBIAL XS 65X41X15MM POSTERIOR STABILIZE KINEMAX PLUS,"$2,347.50",$0.00,"$2,347.50",$0.00,"$1,675.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,347.50",$0.00,"$1,173.75","$1,859.22","$1,878.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-518,SUP,Custom 27803010,,6479-5-518  -  INSERT TIBIAL XS 65X41X18MM POSTERIOR STABILIZE KINEMAX PLUS,"$2,347.50",$0.00,"$2,347.50",$0.00,"$1,675.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,347.50",$0.00,"$1,173.75","$1,859.22","$1,878.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-521,SUP,Custom 27803010,,6479-5-521  -  INSERT TIBIAL XS 65X41X21MM POSTERIOR STABILIZE KINEMAX PLUS,"$2,347.50",$0.00,"$2,347.50",$0.00,"$1,675.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,347.50",$0.00,"$1,173.75","$1,859.22","$1,878.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-525,SUP,Custom 27803010,,6479-5-525  -  INSERT TIBIAL XS 65X41X25MM POSTERIOR STABILIZE KINEMAX PLUS,"$2,347.50",$0.00,"$2,347.50",$0.00,"$1,675.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,347.50",$0.00,"$1,173.75","$1,859.22","$1,878.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-608,SUP,Custom 27803010,,6479-5-608  -  INSERT TIBIAL SMALL 70X45X8MM POSTERIOR STABILIZE KINEMAX,"$2,347.50",$0.00,"$2,347.50",$0.00,"$1,675.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,347.50",$0.00,"$1,173.75","$1,859.22","$1,878.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-610,SUP,Custom 27803010,,6479-5-610  -  INSERT TIBIAL SMALL 10MM LATERAL STABILIZED KINEMAX PLUS DUR,"$2,347.50",$0.00,"$2,347.50",$0.00,"$1,675.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,347.50",$0.00,"$1,173.75","$1,859.22","$1,878.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-612,SUP,Custom 27803010,,6479-5-612  -  INSERT TIBIAL SMALL 12MM LATERAL STABILIZED KINEMAX PLUS DUR,"$2,347.50",$0.00,"$2,347.50",$0.00,"$1,675.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,347.50",$0.00,"$1,173.75","$1,859.22","$1,878.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-615,SUP,Custom 27803010,,6479-5-615  -  INSERT TIBIAL SMALL 70X45X15MM POSTERIOR STABILIZE KINEMAX,"$2,347.50",$0.00,"$2,347.50",$0.00,"$1,675.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,347.50",$0.00,"$1,173.75","$1,859.22","$1,878.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-618,SUP,Custom 27803010,,6479-5-618  -  INSERT TIBIAL SMALL 70X45X18MM POSTERIOR STABILIZE KINEMAX,"$2,347.50",$0.00,"$2,347.50",$0.00,"$1,675.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,347.50",$0.00,"$1,173.75","$1,859.22","$1,878.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-621,SUP,Custom 27803010,,6479-5-621  -  INSERT TIBIAL SMALL 70X45X21MM POSTERIOR STABILIZE KINEMAX,"$2,347.50",$0.00,"$2,347.50",$0.00,"$1,675.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,347.50",$0.00,"$1,173.75","$1,859.22","$1,878.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-625,SUP,Custom 27803010,,6479-5-625  -  INSERT TIBIAL SMALL 70X45X25MM POSTERIOR STABILIZE KINEMAX,"$2,347.50",$0.00,"$2,347.50",$0.00,"$1,675.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,347.50",$0.00,"$1,173.75","$1,859.22","$1,878.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-708,SUP,Custom 27803010,,6479-5-708  -  INSERT TIBIAL MEDIUM 76X48X8MM POSTERIOR STABILIZE KINEMAX,"$2,347.50",$0.00,"$2,347.50",$0.00,"$1,675.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,347.50",$0.00,"$1,173.75","$1,859.22","$1,878.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-710,SUP,Custom 27803010,,6479-5-710  -  INSERT TIBIAL MEDIUM 76X48X10MM POSTERIOR STABILIZE KINEMAX,"$2,347.50",$0.00,"$2,347.50",$0.00,"$1,675.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,347.50",$0.00,"$1,173.75","$1,859.22","$1,878.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-712,SUP,Custom 27803010,,6479-5-712  -  INSERT TIBIAL MEDIUM 76X48X12MM POSTERIOR STABILIZE KINEMAX,"$2,347.50",$0.00,"$2,347.50",$0.00,"$1,675.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,347.50",$0.00,"$1,173.75","$1,859.22","$1,878.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-715,SUP,Custom 27803010,,6479-5-715  -  INSERT TIBIAL MEDIUM 76X48X15MM POSTERIOR STABILIZE KINEMAX,"$2,347.50",$0.00,"$2,347.50",$0.00,"$1,675.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,347.50",$0.00,"$1,173.75","$1,859.22","$1,878.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-718,SUP,Custom 27803010,,6479-5-718  -  INSERT TIBIAL MEDIUM 18MM LATERAL STABILIZED KINEMAX PLUS,"$2,347.50",$0.00,"$2,347.50",$0.00,"$1,675.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,347.50",$0.00,"$1,173.75","$1,859.22","$1,878.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-721,SUP,Custom 27803010,,6479-5-721  -  INSERT TIBIAL MEDIUM 76X48X21MM POSTERIOR STABILIZE KINEMAX,"$2,347.50",$0.00,"$2,347.50",$0.00,"$1,675.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,347.50",$0.00,"$1,173.75","$1,859.22","$1,878.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-725,SUP,Custom 27803010,,6479-5-725  -  INSERT TIBIAL MEDIUM 76X48X25MM POSTERIOR STABILIZE KINEMAX,"$2,347.50",$0.00,"$2,347.50",$0.00,"$1,675.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,347.50",$0.00,"$1,173.75","$1,859.22","$1,878.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-808,SUP,Custom 27803010,,6479-5-808  -  INSERT TIBIAL LARGE 81X51X8MM POSTERIOR STABILIZE KINEMAX,"$2,347.50",$0.00,"$2,347.50",$0.00,"$1,675.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,347.50",$0.00,"$1,173.75","$1,859.22","$1,878.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-810,SUP,Custom 27803010,,6479-5-810  -  INSERT TIBIAL LARGE 81X51X10MM POSTERIOR STABILIZE KINEMAX,"$2,347.50",$0.00,"$2,347.50",$0.00,"$1,675.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,347.50",$0.00,"$1,173.75","$1,859.22","$1,878.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-812,SUP,Custom 27803010,,6479-5-812  -  INSERT TIBIAL LARGE 81X51X12MM POSTERIOR STABILIZE KINEMAX,"$2,347.50",$0.00,"$2,347.50",$0.00,"$1,675.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,347.50",$0.00,"$1,173.75","$1,859.22","$1,878.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-815,SUP,Custom 27803010,,6479-5-815  -  INSERT TIBIAL LARGE 81X51X15MM POSTERIOR STABILIZE KINEMAX,"$2,347.50",$0.00,"$2,347.50",$0.00,"$1,675.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,347.50",$0.00,"$1,173.75","$1,859.22","$1,878.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-818,SUP,Custom 27803010,,6479-5-818  -  INSERT TIBIAL LARGE 81X51X18MM POSTERIOR STABILIZE KINEMAX,"$2,347.50",$0.00,"$2,347.50",$0.00,"$1,675.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,347.50",$0.00,"$1,173.75","$1,859.22","$1,878.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-821,SUP,Custom 27803010,,6479-5-821  -  INSERT TIBIAL LARGE 81X51X21MM POSTERIOR STABILIZE KINEMAX,"$2,347.50",$0.00,"$2,347.50",$0.00,"$1,675.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,347.50",$0.00,"$1,173.75","$1,859.22","$1,878.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-825,SUP,Custom 27803010,,6479-5-825  -  INSERT TIBIAL LARGE 81X51X25MM POSTERIOR STABILIZE KINEMAX,"$2,347.50",$0.00,"$2,347.50",$0.00,"$1,675.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,347.50",$0.00,"$1,173.75","$1,859.22","$1,878.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-908,SUP,Custom 27803010,,6479-5-908  -  INSERT TIBIAL XL 86X54X8MM POSTERIOR STABILIZE KINEMAX PLUS,"$2,347.50",$0.00,"$2,347.50",$0.00,"$1,675.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,347.50",$0.00,"$1,173.75","$1,859.22","$1,878.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-910,SUP,Custom 27803010,,6479-5-910  -  INSERT TIBIAL XL 86X54X10MM POSTERIOR STABILIZE KINEMAX PLUS,"$2,347.50",$0.00,"$2,347.50",$0.00,"$1,675.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,347.50",$0.00,"$1,173.75","$1,859.22","$1,878.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-912,SUP,Custom 27803010,,6479-5-912  -  INSERT TIBIAL XL 86X54X12MM POSTERIOR STABILIZE KINEMAX PLUS,"$2,347.50",$0.00,"$2,347.50",$0.00,"$1,675.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,347.50",$0.00,"$1,173.75","$1,859.22","$1,878.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-915,SUP,Custom 27803010,,6479-5-915  -  INSERT TIBIAL XL 86X54X15MM POSTERIOR STABILIZE KINEMAX PLUS,"$2,347.50",$0.00,"$2,347.50",$0.00,"$1,675.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,347.50",$0.00,"$1,173.75","$1,859.22","$1,878.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-918,SUP,Custom 27803010,,6479-5-918  -  INSERT TIBIAL XL 86X54X18MM POSTERIOR STABILIZE KINEMAX PLUS,"$2,347.50",$0.00,"$2,347.50",$0.00,"$1,675.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,347.50",$0.00,"$1,173.75","$1,859.22","$1,878.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-921,SUP,Custom 27803010,,6479-5-921  -  INSERT TIBIAL XL 86X54X21MM POSTERIOR STABILIZE KINEMAX PLUS,"$2,347.50",$0.00,"$2,347.50",$0.00,"$1,675.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,347.50",$0.00,"$1,173.75","$1,859.22","$1,878.00",$0.00,$0.00,$0.00,$0.00,$0.00
6479-5-925,SUP,Custom 27803010,,6479-5-925  -  INSERT TIBIAL XL 86X54X25MM POSTERIOR STABILIZE KINEMAX PLUS,"$2,347.50",$0.00,"$2,347.50",$0.00,"$1,675.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,347.50",$0.00,"$1,173.75","$1,859.22","$1,878.00",$0.00,$0.00,$0.00,$0.00,$0.00
6480-0-050,SUP,HCPCS C1776,,6480-0-050  -  COMPONENT FEMORAL XS STABILIZE KINEMAX PLUS KNEE,"$5,787.50",$0.00,"$5,787.50","$2,604.38","$4,130.54",$0.00,$997.16,$0.00,$0.00,"$1,013.34","$5,787.50",$0.00,"$2,893.75","$4,583.70","$4,630.00",$0.00,$905.74,$0.00,$921.37,$0.00
6480-0-100,SUP,HCPCS C1776,,6480-0-100  -  COMPONENT FEMORAL SMALL STABILIZE KINEMAX PLUS KNEE,"$5,787.50",$0.00,"$5,787.50","$2,604.38","$4,130.54",$0.00,$997.16,$0.00,$0.00,"$1,013.34","$5,787.50",$0.00,"$2,893.75","$4,583.70","$4,630.00",$0.00,$905.74,$0.00,$921.37,$0.00
6480-0-150,SUP,HCPCS C1776,,6480-0-150  -  COMPONENT FEMORAL MEDIUM STABILIZE KINEMAX PLUS KNEE,"$5,787.50",$0.00,"$5,787.50","$2,604.38","$4,130.54",$0.00,$997.16,$0.00,$0.00,"$1,013.34","$5,787.50",$0.00,"$2,893.75","$4,583.70","$4,630.00",$0.00,$905.74,$0.00,$921.37,$0.00
6480-0-200,SUP,HCPCS C1776,,6480-0-200  -  COMPONENT FEMORAL LARGE STABILIZE KINEMAX PLUS KNEE,"$5,787.50",$0.00,"$5,787.50","$2,604.38","$4,130.54",$0.00,$997.16,$0.00,$0.00,"$1,013.34","$5,787.50",$0.00,"$2,893.75","$4,583.70","$4,630.00",$0.00,$905.74,$0.00,$921.37,$0.00
6480-0-250,SUP,HCPCS C1776,,6480-0-250  -  COMPONENT FEMORAL XL STABILIZE KINEMAX PLUS KNEE,"$5,787.50",$0.00,"$5,787.50","$2,604.38","$4,130.54",$0.00,$997.16,$0.00,$0.00,"$1,013.34","$5,787.50",$0.00,"$2,893.75","$4,583.70","$4,630.00",$0.00,$905.74,$0.00,$921.37,$0.00
6480-0-300,SUP,HCPCS C1776,,6480-0-300  -  COMPONENT FEMORAL 2XL STABILIZE KINEMAX PLUS KNEE,"$5,787.50",$0.00,"$5,787.50","$2,604.38","$4,130.54",$0.00,$997.16,$0.00,$0.00,"$1,013.34","$5,787.50",$0.00,"$2,893.75","$4,583.70","$4,630.00",$0.00,$905.74,$0.00,$921.37,$0.00
6481-1-100,SUP,HCPCS C1776,,6481-1-100  -  COMPONENT FEMORAL XS 60X54MM MODULAR ROTATE HINGE KNEE LEFT,"$10,780.00",$0.00,"$10,780.00","$4,851.00","$5,158.80",$0.00,"$1,857.34",$0.00,$0.00,"$1,887.49","$10,780.00",$0.00,"$5,390.00","$8,537.76","$8,624.00",$0.00,"$1,687.07",$0.00,"$1,716.18",$0.00
6481-1-101,SUP,HCPCS C1776,,6481-1-101  -  COMPONENT FEMORAL XS 60X54MM MODULAR ROTATE HINGE GMRS,"$10,780.00",$0.00,"$10,780.00","$4,851.00","$5,158.80",$0.00,"$1,857.34",$0.00,$0.00,"$1,887.49","$10,780.00",$0.00,"$5,390.00","$8,537.76","$8,624.00",$0.00,"$1,687.07",$0.00,"$1,716.18",$0.00
6481-1-110,SUP,HCPCS C1776,,6481-1-110  -  COMPONENT FEMORAL SMALL 65X55MM MODULAR ROTATE HINGE GMRS,"$10,780.00",$0.00,"$10,780.00","$4,851.00","$5,158.80",$0.00,"$1,857.34",$0.00,$0.00,"$1,887.49","$10,780.00",$0.00,"$5,390.00","$8,537.76","$8,624.00",$0.00,"$1,687.07",$0.00,"$1,716.18",$0.00
6481-1-111,SUP,HCPCS C1776,,6481-1-111  -  COMPONENT FEMORAL SMALL 65X55MM MODULAR ROTATE HINGE GMRS,"$10,780.00",$0.00,"$10,780.00","$4,851.00","$5,158.80",$0.00,"$1,857.34",$0.00,$0.00,"$1,887.49","$10,780.00",$0.00,"$5,390.00","$8,537.76","$8,624.00",$0.00,"$1,687.07",$0.00,"$1,716.18",$0.00
6481-1-120,SUP,HCPCS C1776,,6481-1-120  -  COMPONENT FEMORAL MEDIUM 70X61MM MODULAR ROTATE HINGE GMRS,"$10,780.00",$0.00,"$10,780.00","$4,851.00","$5,158.80",$0.00,"$1,857.34",$0.00,$0.00,"$1,887.49","$10,780.00",$0.00,"$5,390.00","$8,537.76","$8,624.00",$0.00,"$1,687.07",$0.00,"$1,716.18",$0.00
6481-1-121,SUP,HCPCS C1776,,6481-1-121  -  COMPONENT FEMORAL MEDIUM 70X61MM MODULAR ROTATE HINGE GMRS,"$10,780.00",$0.00,"$10,780.00","$4,851.00","$5,158.80",$0.00,"$1,857.34",$0.00,$0.00,"$1,887.49","$10,780.00",$0.00,"$5,390.00","$8,537.76","$8,624.00",$0.00,"$1,687.07",$0.00,"$1,716.18",$0.00
6481-1-130,SUP,HCPCS C1776,,6481-1-130  -  COMPONENT FEMORAL LARGE 75X64MM MODULAR ROTATE HINGE GMRS,"$10,780.00",$0.00,"$10,780.00","$4,851.00","$5,158.80",$0.00,"$1,857.34",$0.00,$0.00,"$1,887.49","$10,780.00",$0.00,"$5,390.00","$8,537.76","$8,624.00",$0.00,"$1,687.07",$0.00,"$1,716.18",$0.00
6481-1-131,SUP,HCPCS C1776,,6481-1-131  -  COMPONENT FEMORAL LARGE 75X64MM MODULAR ROTATE HINGE GMRS,"$10,780.00",$0.00,"$10,780.00","$4,851.00","$5,158.80",$0.00,"$1,857.34",$0.00,$0.00,"$1,887.49","$10,780.00",$0.00,"$5,390.00","$8,537.76","$8,624.00",$0.00,"$1,687.07",$0.00,"$1,716.18",$0.00
6481-1-140,SUP,HCPCS C1776,,6481-1-140  -  COMPONENT FEMORAL XL 80X66MM MODULAR ROTATE HINGE GMRS,"$10,780.00",$0.00,"$10,780.00","$4,851.00","$5,158.80",$0.00,"$1,857.34",$0.00,$0.00,"$1,887.49","$10,780.00",$0.00,"$5,390.00","$8,537.76","$8,624.00",$0.00,"$1,687.07",$0.00,"$1,716.18",$0.00
6481-1-141,SUP,HCPCS C1776,,6481-1-141  -  COMPONENT FEMORAL XL 80X66MM MODULAR ROTATE HINGE GMRS,"$10,780.00",$0.00,"$10,780.00","$4,851.00","$5,158.80",$0.00,"$1,857.34",$0.00,$0.00,"$1,887.49","$10,780.00",$0.00,"$5,390.00","$8,537.76","$8,624.00",$0.00,"$1,687.07",$0.00,"$1,716.18",$0.00
6481-1-200,SUP,Custom 27803010,,6481-1-200  -  BLOCK AUGMENTATION XS 10MM GMRS FEMORAL DISTAL,"$1,455.00",$0.00,"$1,455.00",$0.00,"$1,038.43",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,455.00",$0.00,$727.50,"$1,152.36","$1,164.00",$0.00,$0.00,$0.00,$0.00,$0.00
6481-1-210,SUP,Custom 27803010,,6481-1-210  -  BLOCK AUGMENTATION SMALL 10MM GMRS FEMORAL DISTAL,"$1,455.00",$0.00,"$1,455.00",$0.00,"$1,038.43",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,455.00",$0.00,$727.50,"$1,152.36","$1,164.00",$0.00,$0.00,$0.00,$0.00,$0.00
6481-1-220,SUP,Custom 27803010,,6481-1-220  -  BLOCK AUGMENTATION MEDIUM 10MM GMRS FEMORAL DISTAL,"$1,455.00",$0.00,"$1,455.00",$0.00,"$1,038.43",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,455.00",$0.00,$727.50,"$1,152.36","$1,164.00",$0.00,$0.00,$0.00,$0.00,$0.00
6481-1-230,SUP,Custom 27803010,,6481-1-230  -  BLOCK AUGMENTATION LARGE 10MM GMRS FEMORAL DISTAL,"$1,455.00",$0.00,"$1,455.00",$0.00,"$1,038.43",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,455.00",$0.00,$727.50,"$1,152.36","$1,164.00",$0.00,$0.00,$0.00,$0.00,$0.00
6481-1-240,SUP,Custom 27803010,,6481-1-240  -  BLOCK AUGMENTATION XL 10MM GMRS FEMORAL DISTAL,"$1,455.00",$0.00,"$1,455.00",$0.00,"$1,038.43",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,455.00",$0.00,$727.50,"$1,152.36","$1,164.00",$0.00,$0.00,$0.00,$0.00,$0.00
6481-2-100,SUP,HCPCS C1776,,6481-2-100  -  COMPONENT TIB XS-XL MNGR MDLR ROT HNG KN,"$6,265.00",$0.00,"$6,265.00","$2,819.25","$4,471.33",$0.00,"$1,079.43",$0.00,$0.00,"$1,096.95","$6,265.00",$0.00,"$3,132.50","$4,961.88","$5,012.00",$0.00,$980.47,$0.00,$997.39,$0.00
6481-2-101,SUP,HCPCS C1776,,6481-2-101  -  COMPONENT TIBIAL LARGE XL MOBILE ROTATE HINGE MRS KNEE,"$6,265.00",$0.00,"$6,265.00","$2,819.25","$4,471.33",$0.00,"$1,079.43",$0.00,$0.00,"$1,096.95","$6,265.00",$0.00,"$3,132.50","$4,961.88","$5,012.00",$0.00,$980.47,$0.00,$997.39,$0.00
6481-2-103,SUP,HCPCS C1776,,6481-2-103  -  COMPONENT TIBIAL XS LONG XL BEARING CROSSOVER MODULAR ROTATE,"$6,265.00",$0.00,"$6,265.00","$2,819.25","$4,471.33",$0.00,"$1,079.43",$0.00,$0.00,"$1,096.95","$6,265.00",$0.00,"$3,132.50","$4,961.88","$5,012.00",$0.00,$980.47,$0.00,$997.39,$0.00
6481-2-104,SUP,HCPCS C1776,,6481-2-104  -  COMPONENT TIBIAL XS XL SHORT BEARING CROSSOVER MODULAR,"$6,265.00",$0.00,"$6,265.00","$2,819.25","$4,471.33",$0.00,"$1,079.43",$0.00,$0.00,"$1,096.95","$6,265.00",$0.00,"$3,132.50","$4,961.88","$5,012.00",$0.00,$980.47,$0.00,$997.39,$0.00
6481-2-107,SUP,HCPCS C1776,,6481-2-107  -  COMPONENT TIBIAL BEARING GMRS ALL POLY PEDIATRIC KNEE,"$5,752.50",$0.00,"$5,752.50","$2,588.63","$4,105.56",$0.00,$991.13,$0.00,$0.00,"$1,007.22","$5,752.50",$0.00,"$2,876.25","$4,555.98","$4,602.00",$0.00,$900.27,$0.00,$915.80,$0.00
6481-2-108,SUP,HCPCS C1776,,6481-2-108  -  COMPONENT TIBIAL BEARING CROSSOVER MODULAR ROTATE HINGE MRS,"$6,265.00",$0.00,"$6,265.00","$2,819.25","$4,471.33",$0.00,"$1,079.43",$0.00,$0.00,"$1,096.95","$6,265.00",$0.00,"$3,132.50","$4,961.88","$5,012.00",$0.00,$980.47,$0.00,$997.39,$0.00
6481-2-110,SUP,Custom 27803010,,6481-2-110  -  BUSHING FEMORAL MODULAR ROTATE HINGE KNEE,$617.50,$0.00,$617.50,$0.00,$440.71,$0.00,$0.00,$0.00,$0.00,$0.00,$617.50,$0.00,$308.75,$489.06,$494.00,$0.00,$0.00,$0.00,$0.00,$0.00
6481-2-120,SUP,Custom 27803010,,6481-2-120  -  AXLE FEMORAL MODULAR ROTATE HINGE KNEE,"$2,122.50",$0.00,"$2,122.50",$0.00,"$1,514.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,122.50",$0.00,"$1,061.25","$1,681.02","$1,698.00",$0.00,$0.00,$0.00,$0.00,$0.00
6481-2-130,SUP,Custom 27803010,,6481-2-130  -  INSERT BUMPER NEUTRAL MODULAR ROTATE HINGE GMRS KNEE,"$1,272.50",$0.00,"$1,272.50",$0.00,$908.18,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,272.50",$0.00,$636.25,"$1,007.82","$1,018.00",$0.00,$0.00,$0.00,$0.00,$0.00
6481-2-133,SUP,Custom 27803010,,6481-2-133  -  INSERT BUMPER 3D MODULAR ROTATE HINGE GMRS KNEE PROXIMAL,"$1,272.50",$0.00,"$1,272.50",$0.00,$908.18,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,272.50",$0.00,$636.25,"$1,007.82","$1,018.00",$0.00,$0.00,$0.00,$0.00,$0.00
6481-2-140,SUP,Custom 27203010,,6481-2-140  -  SLEEVE TIBIAL MODULAR ROTATE HINGE KNEE,"$1,065.00",$0.00,"$1,065.00",$0.00,$760.09,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,065.00",$0.00,$532.50,$843.48,$852.00,$0.00,$0.00,$0.00,$0.00,$0.00
6481-2-150,SUP,HCPCS C1776,,6481-2-150  -  COMPONENT FEMORAL PACK CROSSLINK GMRS POLYETHYLENE KNEE,"$3,347.50",$0.00,"$3,347.50","$1,506.38","$2,389.11",$0.00,$576.76,$0.00,$0.00,$586.12,"$3,347.50",$0.00,"$1,673.75","$2,651.22","$2,678.00",$0.00,$523.88,$0.00,$532.92,$0.00
6481-3-110,SUP,HCPCS C1776,,6481-3-110  -  BASEPLATE TIB 1 SM MDLR ROT HNG KN,"$6,730.00",$0.00,"$6,730.00","$3,028.50","$4,803.20",$0.00,"$1,159.55",$0.00,$0.00,"$1,178.37","$6,730.00",$0.00,"$3,365.00","$5,330.16","$5,384.00",$0.00,"$1,053.25",$0.00,"$1,071.42",$0.00
6481-3-111,SUP,HCPCS C1776,,6481-3-111  -  BASEPLATE TIB 2 SM MDLR ROT HNG KN,"$6,730.00",$0.00,"$6,730.00","$3,028.50","$4,803.20",$0.00,"$1,159.55",$0.00,$0.00,"$1,178.37","$6,730.00",$0.00,"$3,365.00","$5,330.16","$5,384.00",$0.00,"$1,053.25",$0.00,"$1,071.42",$0.00
6481-3-112,SUP,HCPCS C1776,,6481-3-112  -  BASEPLATE TIB 2 MED MDLR ROT HNG KN,"$6,730.00",$0.00,"$6,730.00","$3,028.50","$4,803.20",$0.00,"$1,159.55",$0.00,$0.00,"$1,178.37","$6,730.00",$0.00,"$3,365.00","$5,330.16","$5,384.00",$0.00,"$1,053.25",$0.00,"$1,071.42",$0.00
6481-3-113,SUP,HCPCS C1776,,6481-3-113  -  BASEPLATE TIB 2 LG MDLR ROT HNG KN,"$6,730.00",$0.00,"$6,730.00","$3,028.50","$4,803.20",$0.00,"$1,159.55",$0.00,$0.00,"$1,178.37","$6,730.00",$0.00,"$3,365.00","$5,330.16","$5,384.00",$0.00,"$1,053.25",$0.00,"$1,071.42",$0.00
6481-3-210,SUP,Custom 27803010,,6481-3-210  -  INSERT TIBIAL THK10MM S1 S2 MODULAR ROTATE HINGE GMRS,"$2,367.50",$0.00,"$2,367.50",$0.00,"$1,689.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,367.50",$0.00,"$1,183.75","$1,875.06","$1,894.00",$0.00,$0.00,$0.00,$0.00,$0.00
6481-3-213,SUP,Custom 27803010,,6481-3-213  -  INSERT TIBIAL THK13MM S1 S2 MODULAR ROTATE HINGE GMRS,"$2,367.50",$0.00,"$2,367.50",$0.00,"$1,689.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,367.50",$0.00,"$1,183.75","$1,875.06","$1,894.00",$0.00,$0.00,$0.00,$0.00,$0.00
6481-3-216,SUP,Custom 27803010,,6481-3-216  -  INSERT TIBIAL THK16MM S1 S2 MODULAR ROTATE HINGE GMRS,"$2,367.50",$0.00,"$2,367.50",$0.00,"$1,689.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,367.50",$0.00,"$1,183.75","$1,875.06","$1,894.00",$0.00,$0.00,$0.00,$0.00,$0.00
6481-3-220,SUP,Custom 27803010,,6481-3-220  -  INSERT TIBIAL THK20MM S1 S2 MODULAR ROTATE HINGE GMRS,"$2,367.50",$0.00,"$2,367.50",$0.00,"$1,689.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,367.50",$0.00,"$1,183.75","$1,875.06","$1,894.00",$0.00,$0.00,$0.00,$0.00,$0.00
6481-3-224,SUP,Custom 27803010,,6481-3-224  -  INSERT TIBIAL THK24MM S1 S2 MODULAR ROTATE HINGE GMRS,"$2,367.50",$0.00,"$2,367.50",$0.00,"$1,689.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,367.50",$0.00,"$1,183.75","$1,875.06","$1,894.00",$0.00,$0.00,$0.00,$0.00,$0.00
6481-3-310,SUP,Custom 27803010,,6481-3-310  -  INSERT TIBIAL MEDIUM LARGE M2 2 10MM BEARING MODULAR,"$2,387.50",$0.00,"$2,387.50",$0.00,"$1,703.96",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,387.50",$0.00,"$1,193.75","$1,890.90","$1,910.00",$0.00,$0.00,$0.00,$0.00,$0.00
6481-3-313,SUP,Custom 27803010,,6481-3-313  -  INSERT TIBIAL THK13MM M2 2 BEARING MODULAR ROTATE HINGE GMRS,"$2,387.50",$0.00,"$2,387.50",$0.00,"$1,703.96",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,387.50",$0.00,"$1,193.75","$1,890.90","$1,910.00",$0.00,$0.00,$0.00,$0.00,$0.00
6481-3-316,SUP,Custom 27803010,,6481-3-316  -  INSERT TIBIAL THK16MM M2 2 BEARING MODULAR ROTATE HINGE GMRS,"$2,387.50",$0.00,"$2,387.50",$0.00,"$1,703.96",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,387.50",$0.00,"$1,193.75","$1,890.90","$1,910.00",$0.00,$0.00,$0.00,$0.00,$0.00
6481-3-320,SUP,Custom 27803010,,6481-3-320  -  INSERT TIBIAL THK20MM M2 2 BEARING MODULAR ROTATE HINGE GMRS,"$2,387.50",$0.00,"$2,387.50",$0.00,"$1,703.96",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,387.50",$0.00,"$1,193.75","$1,890.90","$1,910.00",$0.00,$0.00,$0.00,$0.00,$0.00
6481-3-324,SUP,Custom 27803010,,6481-3-324  -  INSERT TIBIAL THK24MM M2 2 BEARING MODULAR ROTATE HINGE GMRS,"$2,387.50",$0.00,"$2,387.50",$0.00,"$1,703.96",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,387.50",$0.00,"$1,193.75","$1,890.90","$1,910.00",$0.00,$0.00,$0.00,$0.00,$0.00
6485-0-020,SUP,HCPCS C1776,,6485-0-020  -  CMPNT FEM CNDYLR RIGHT MDLR ROT HNG MRS,"$14,192.75",$0.00,"$14,192.75","$6,386.74","$5,158.80",$0.00,"$2,445.34",$0.00,$0.00,"$2,485.04","$14,192.75",$0.00,"$7,096.38","$11,240.66","$11,354.20",$0.00,"$2,221.17",$0.00,"$2,259.49",$0.00
6485-0-025,SUP,HCPCS C1776,,6485-0-025  -  STEM FEM 75MM CNDYLR MRH MRS SM LEFT PRD,"$14,192.75",$0.00,"$14,192.75","$6,386.74","$5,158.80",$0.00,"$2,445.34",$0.00,$0.00,"$2,485.04","$14,192.75",$0.00,"$7,096.38","$11,240.66","$11,354.20",$0.00,"$2,221.17",$0.00,"$2,259.49",$0.00
6485-0-045,SUP,HCPCS C1776,,6485-0-045  -  CMPNT FEM SM 85MM LEFT CNDYLR MRS,"$14,192.75",$0.00,"$14,192.75","$6,386.74","$5,158.80",$0.00,"$2,445.34",$0.00,$0.00,"$2,485.04","$14,192.75",$0.00,"$7,096.38","$11,240.66","$11,354.20",$0.00,"$2,221.17",$0.00,"$2,259.49",$0.00
6485-0-050,SUP,HCPCS C1776,,6485-0-050  -  CMPNT FEM XS LEFT REV STAB KMX+,"$5,216.00",$0.00,"$5,216.00","$2,347.20","$3,722.66",$0.00,$898.69,$0.00,$0.00,$913.28,"$5,216.00",$0.00,"$2,608.00","$4,131.07","$4,172.80",$0.00,$816.30,$0.00,$830.39,$0.00
6485-0-060,SUP,HCPCS C1776,,6485-0-060  -  CMPNT FEM XS RIGHT REV STAB KNMX PLUS,"$5,189.00",$0.00,"$5,189.00","$2,335.05","$3,703.39",$0.00,$894.04,$0.00,$0.00,$908.55,"$5,189.00",$0.00,"$2,594.50","$4,109.69","$4,151.20",$0.00,$812.08,$0.00,$826.09,$0.00
6485-0-075,SUP,HCPCS C1776,,6485-0-075  -  CMPNT FEM SM 95MM RIGHT CNDYLR MRS,"$10,856.63",$0.00,"$10,856.63","$4,885.48","$5,158.80",$0.00,"$1,870.54",$0.00,$0.00,"$1,900.91","$10,856.63",$0.00,"$5,428.31","$8,598.45","$8,685.30",$0.00,"$1,699.06",$0.00,"$1,728.37",$0.00
6485-0-100,SUP,HCPCS C1776,,6485-0-100  -  CMPNT FEM SM LEFT REV STAB KMX+,"$5,407.00",$0.00,"$5,407.00","$2,433.15","$3,858.98",$0.00,$931.60,$0.00,$0.00,$946.72,"$5,407.00",$0.00,"$2,703.50","$4,282.34","$4,325.60",$0.00,$846.20,$0.00,$860.79,$0.00
6485-0-110,SUP,HCPCS C1776,,6485-0-110  -  CMPNT FEM SM RIGHT REV STAB KMX+,"$5,189.00",$0.00,"$5,189.00","$2,335.05","$3,703.39",$0.00,$894.04,$0.00,$0.00,$908.55,"$5,189.00",$0.00,"$2,594.50","$4,109.69","$4,151.20",$0.00,$812.08,$0.00,$826.09,$0.00
6485-0-150,SUP,HCPCS C1776,,6485-0-150  -  CMPNT FEM MED LEFT REV STAB KMX+,"$5,407.00",$0.00,"$5,407.00","$2,433.15","$3,858.98",$0.00,$931.60,$0.00,$0.00,$946.72,"$5,407.00",$0.00,"$2,703.50","$4,282.34","$4,325.60",$0.00,$846.20,$0.00,$860.79,$0.00
6485-0-160,SUP,HCPCS C1776,,6485-0-160  -  CMPNT FEM MED RIGHT REV STAB KMX+,"$5,407.00",$0.00,"$5,407.00","$2,433.15","$3,858.98",$0.00,$931.60,$0.00,$0.00,$946.72,"$5,407.00",$0.00,"$2,703.50","$4,282.34","$4,325.60",$0.00,$846.20,$0.00,$860.79,$0.00
6485-0-200,SUP,HCPCS C1776,,6485-0-200  -  CMPNT FEM LG LEFT REV STAB KMX+,"$5,407.00",$0.00,"$5,407.00","$2,433.15","$3,858.98",$0.00,$931.60,$0.00,$0.00,$946.72,"$5,407.00",$0.00,"$2,703.50","$4,282.34","$4,325.60",$0.00,$846.20,$0.00,$860.79,$0.00
6485-0-210,SUP,HCPCS C1776,,6485-0-210  -  CMPNT FEM LG RIGHT REV STAB KMX+,"$5,407.00",$0.00,"$5,407.00","$2,433.15","$3,858.98",$0.00,$931.60,$0.00,$0.00,$946.72,"$5,407.00",$0.00,"$2,703.50","$4,282.34","$4,325.60",$0.00,$846.20,$0.00,$860.79,$0.00
6485-0-250,SUP,HCPCS C1776,,6485-0-250  -  CMPNT FEM XL LEFT KNEE MDLR STABLILZED ASMBLY KMX+ LATEX,"$5,407.00",$0.00,"$5,407.00","$2,433.15","$3,858.98",$0.00,$931.60,$0.00,$0.00,$946.72,"$5,407.00",$0.00,"$2,703.50","$4,282.34","$4,325.60",$0.00,$846.20,$0.00,$860.79,$0.00
6485-0-260,SUP,HCPCS C1776,,6485-0-260  -  CMPNT FEM XL RIGHT REV STAB KMX+,"$4,552.00",$0.00,"$4,552.00","$2,048.40","$3,248.76",$0.00,$784.29,$0.00,$0.00,$797.02,"$4,552.00",$0.00,"$2,276.00","$3,605.18","$3,641.60",$0.00,$712.39,$0.00,$724.68,$0.00
6485-1-915,SUP,Custom 27803010,,6485-1-915  -  COMPONENT PATLR SMALL ROTATE HINGE KRH DUR,"$1,705.00",$0.00,"$1,705.00",$0.00,"$1,216.86",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,705.00",$0.00,$852.50,"$1,350.36","$1,364.00",$0.00,$0.00,$0.00,$0.00,$0.00
6485-2-008,SUP,HCPCS C1776,,6485-2-008  -  INSERT TIBIAL XS 8MM GMRS ALL POLY,"$3,142.50",$0.00,"$3,142.50","$1,414.13","$2,242.80",$0.00,$541.44,$0.00,$0.00,$550.23,"$3,142.50",$0.00,"$1,571.25","$2,488.86","$2,514.00",$0.00,$491.80,$0.00,$500.29,$0.00
6485-2-011,SUP,HCPCS C1776,,6485-2-011  -  INSERT TIBIAL XS 11MM GMRS ALL POLY,"$3,142.50",$0.00,"$3,142.50","$1,414.13","$2,242.80",$0.00,$541.44,$0.00,$0.00,$550.23,"$3,142.50",$0.00,"$1,571.25","$2,488.86","$2,514.00",$0.00,$491.80,$0.00,$500.29,$0.00
6485-2-016,SUP,HCPCS C1776,,6485-2-016  -  INSERT TIBIAL XS 16MM GMRS ALL POLY,"$3,142.50",$0.00,"$3,142.50","$1,414.13","$2,242.80",$0.00,$541.44,$0.00,$0.00,$550.23,"$3,142.50",$0.00,"$1,571.25","$2,488.86","$2,514.00",$0.00,$491.80,$0.00,$500.29,$0.00
6485-2-021,SUP,HCPCS C1776,,6485-2-021  -  INSERT TIBIAL XS 21MM GMRS ALL POLY,"$3,142.50",$0.00,"$3,142.50","$1,414.13","$2,242.80",$0.00,$541.44,$0.00,$0.00,$550.23,"$3,142.50",$0.00,"$1,571.25","$2,488.86","$2,514.00",$0.00,$491.80,$0.00,$500.29,$0.00
6485-2-108,SUP,HCPCS C1776,,6485-2-108  -  INSERT TIBIAL SMALL 8MM GMRS ALL POLY,"$3,142.50",$0.00,"$3,142.50","$1,414.13","$2,242.80",$0.00,$541.44,$0.00,$0.00,$550.23,"$3,142.50",$0.00,"$1,571.25","$2,488.86","$2,514.00",$0.00,$491.80,$0.00,$500.29,$0.00
6485-2-111,SUP,HCPCS C1776,,6485-2-111  -  INSERT TIBIAL SMALL 11MM GMRS ALL POLY,"$3,142.50",$0.00,"$3,142.50","$1,414.13","$2,242.80",$0.00,$541.44,$0.00,$0.00,$550.23,"$3,142.50",$0.00,"$1,571.25","$2,488.86","$2,514.00",$0.00,$491.80,$0.00,$500.29,$0.00
6485-2-116,SUP,HCPCS C1776,,6485-2-116  -  INSERT TIBIAL SMALL 16MM GMRS ALL POLY,"$3,142.50",$0.00,"$3,142.50","$1,414.13","$2,242.80",$0.00,$541.44,$0.00,$0.00,$550.23,"$3,142.50",$0.00,"$1,571.25","$2,488.86","$2,514.00",$0.00,$491.80,$0.00,$500.29,$0.00
6485-2-121,SUP,HCPCS C1776,,6485-2-121  -  INSERT TIBIAL SMALL 21MM GMRS ALL POLY,"$3,142.50",$0.00,"$3,142.50","$1,414.13","$2,242.80",$0.00,$541.44,$0.00,$0.00,$550.23,"$3,142.50",$0.00,"$1,571.25","$2,488.86","$2,514.00",$0.00,$491.80,$0.00,$500.29,$0.00
6485-2-208,SUP,HCPCS C1776,,6485-2-208  -  INSERT TIBIAL MEDIUM 8MM GMRS ALL POLY,"$3,142.50",$0.00,"$3,142.50","$1,414.13","$2,242.80",$0.00,$541.44,$0.00,$0.00,$550.23,"$3,142.50",$0.00,"$1,571.25","$2,488.86","$2,514.00",$0.00,$491.80,$0.00,$500.29,$0.00
6485-2-211,SUP,HCPCS C1776,,6485-2-211  -  COMPONENT TIBIAL MEDIUM 11MM ROTATING HINGE KRH ALL POLY,"$3,142.50",$0.00,"$3,142.50","$1,414.13","$2,242.80",$0.00,$541.44,$0.00,$0.00,$550.23,"$3,142.50",$0.00,"$1,571.25","$2,488.86","$2,514.00",$0.00,$491.80,$0.00,$500.29,$0.00
6485-2-216,SUP,HCPCS C1776,,6485-2-216  -  INSERT TIBIAL MEDIUM 16MM GMRS ALL POLY,"$3,142.50",$0.00,"$3,142.50","$1,414.13","$2,242.80",$0.00,$541.44,$0.00,$0.00,$550.23,"$3,142.50",$0.00,"$1,571.25","$2,488.86","$2,514.00",$0.00,$491.80,$0.00,$500.29,$0.00
6485-2-221,SUP,HCPCS C1776,,6485-2-221  -  INSERT TIBIAL MEDIUM 21MM GMRS ALL POLY,"$3,142.50",$0.00,"$3,142.50","$1,414.13","$2,242.80",$0.00,$541.44,$0.00,$0.00,$550.23,"$3,142.50",$0.00,"$1,571.25","$2,488.86","$2,514.00",$0.00,$491.80,$0.00,$500.29,$0.00
6485-2-308,SUP,HCPCS C1776,,6485-2-308  -  INSERT TIBIAL LARGE 8MM GMRS ALL POLY,"$3,142.50",$0.00,"$3,142.50","$1,414.13","$2,242.80",$0.00,$541.44,$0.00,$0.00,$550.23,"$3,142.50",$0.00,"$1,571.25","$2,488.86","$2,514.00",$0.00,$491.80,$0.00,$500.29,$0.00
6485-2-311,SUP,HCPCS C1776,,6485-2-311  -  INSERT TIBIAL LARGE 11MM GMRS ALL POLY,"$3,142.50",$0.00,"$3,142.50","$1,414.13","$2,242.80",$0.00,$541.44,$0.00,$0.00,$550.23,"$3,142.50",$0.00,"$1,571.25","$2,488.86","$2,514.00",$0.00,$491.80,$0.00,$500.29,$0.00
6485-2-316,SUP,HCPCS C1776,,6485-2-316  -  INSERT TIBIAL LARGE 16MM GMRS ALL POLY,"$3,142.50",$0.00,"$3,142.50","$1,414.13","$2,242.80",$0.00,$541.44,$0.00,$0.00,$550.23,"$3,142.50",$0.00,"$1,571.25","$2,488.86","$2,514.00",$0.00,$491.80,$0.00,$500.29,$0.00
6485-2-321,SUP,HCPCS C1776,,6485-2-321  -  INSERT TIBIAL LARGE 21MM GMRS ALL POLY,"$3,142.50",$0.00,"$3,142.50","$1,414.13","$2,242.80",$0.00,$541.44,$0.00,$0.00,$550.23,"$3,142.50",$0.00,"$1,571.25","$2,488.86","$2,514.00",$0.00,$491.80,$0.00,$500.29,$0.00
6485-2-408,SUP,HCPCS C1776,,6485-2-408  -  INSERT TIBIAL XL 8MM GMRS ALL POLY,"$3,142.50",$0.00,"$3,142.50","$1,414.13","$2,242.80",$0.00,$541.44,$0.00,$0.00,$550.23,"$3,142.50",$0.00,"$1,571.25","$2,488.86","$2,514.00",$0.00,$491.80,$0.00,$500.29,$0.00
6485-2-411,SUP,HCPCS C1776,,6485-2-411  -  INSERT TIBIAL XL 11MM GMRS ALL POLY,"$3,142.50",$0.00,"$3,142.50","$1,414.13","$2,242.80",$0.00,$541.44,$0.00,$0.00,$550.23,"$3,142.50",$0.00,"$1,571.25","$2,488.86","$2,514.00",$0.00,$491.80,$0.00,$500.29,$0.00
6485-2-416,SUP,HCPCS C1776,,6485-2-416  -  INSERT TIBIAL XL 16MM GMRS ALL POLY,"$3,142.50",$0.00,"$3,142.50","$1,414.13","$2,242.80",$0.00,$541.44,$0.00,$0.00,$550.23,"$3,142.50",$0.00,"$1,571.25","$2,488.86","$2,514.00",$0.00,$491.80,$0.00,$500.29,$0.00
6485-2-421,SUP,HCPCS C1776,,6485-2-421  -  INSERT TIBIAL XL 21MM GMRS ALL POLY,"$3,142.50",$0.00,"$3,142.50","$1,414.13","$2,242.80",$0.00,$541.44,$0.00,$0.00,$550.23,"$3,142.50",$0.00,"$1,571.25","$2,488.86","$2,514.00",$0.00,$491.80,$0.00,$500.29,$0.00
6485-2-460,SUP,Custom 27803010,,6485-2-460  -  BUSHING FEMORAL STANDARD ROTATE HINGE KINEMATIC DUR,$632.50,$0.00,$632.50,$0.00,$451.42,$0.00,$0.00,$0.00,$0.00,$0.00,$632.50,$0.00,$316.25,$500.94,$506.00,$0.00,$0.00,$0.00,$0.00,$0.00
6485-2-465,SUP,Custom 27803010,,6485-2-465  -  BUSHING FEMORAL SMALL ROTATE HINGE KINEMATIC DUR,$632.50,$0.00,$632.50,$0.00,$451.42,$0.00,$0.00,$0.00,$0.00,$0.00,$632.50,$0.00,$316.25,$500.94,$506.00,$0.00,$0.00,$0.00,$0.00,$0.00
6485-2-508,SUP,HCPCS C1776,,6485-2-508  -  INSERT TIBIAL 3XS 8MM MRS POLYETHYLENE KNEE,"$3,142.50",$0.00,"$3,142.50","$1,414.13","$2,242.80",$0.00,$541.44,$0.00,$0.00,$550.23,"$3,142.50",$0.00,"$1,571.25","$2,488.86","$2,514.00",$0.00,$491.80,$0.00,$500.29,$0.00
6485-2-511,SUP,HCPCS C1776,,6485-2-511  -  COMPONENT TIBIAL 3XS PT1 11MM MRS MRH KRH DUR,"$3,142.50",$0.00,"$3,142.50","$1,414.13","$2,242.80",$0.00,$541.44,$0.00,$0.00,$550.23,"$3,142.50",$0.00,"$1,571.25","$2,488.86","$2,514.00",$0.00,$491.80,$0.00,$500.29,$0.00
6485-2-608,SUP,HCPCS C1776,,6485-2-608  -  INSERT TIBIAL 2XS 8MM MRS POLYETHYLENE KNEE,"$3,142.50",$0.00,"$3,142.50","$1,414.13","$2,242.80",$0.00,$541.44,$0.00,$0.00,$550.23,"$3,142.50",$0.00,"$1,571.25","$2,488.86","$2,514.00",$0.00,$491.80,$0.00,$500.29,$0.00
6485-2-611,SUP,HCPCS C1776,,6485-2-611  -  COMPONENT TIBIAL 2XS PT2 11MM KRH ALL POLY,"$3,142.50",$0.00,"$3,142.50","$1,414.13","$2,242.80",$0.00,$541.44,$0.00,$0.00,$550.23,"$3,142.50",$0.00,"$1,571.25","$2,488.86","$2,514.00",$0.00,$491.80,$0.00,$500.29,$0.00
6485-3-000,SUP,HCPCS C1776,,6485-3-000  -  STEM FEMORAL SMALL 10MM 102MM MRS HIP,"$7,977.50",$0.00,"$7,977.50","$3,589.88","$5,158.80",$0.00,"$1,374.48",$0.00,$0.00,"$1,396.80","$7,977.50",$0.00,"$3,988.75","$6,318.18","$6,382.00",$0.00,"$1,248.48",$0.00,"$1,270.02",$0.00
6485-3-008,SUP,HCPCS C1776,,6485-3-008  -  STEM FEMORAL SMALL 8MM 102MM MRS HIP,"$7,977.50",$0.00,"$7,977.50","$3,589.88","$5,158.80",$0.00,"$1,374.48",$0.00,$0.00,"$1,396.80","$7,977.50",$0.00,"$3,988.75","$6,318.18","$6,382.00",$0.00,"$1,248.48",$0.00,"$1,270.02",$0.00
6485-3-009,SUP,HCPCS C1776,,6485-3-009  -  STEM FEMORAL SMALL 9MM 102MM MRS HIP,"$7,977.50",$0.00,"$7,977.50","$3,589.88","$5,158.80",$0.00,"$1,374.48",$0.00,$0.00,"$1,396.80","$7,977.50",$0.00,"$3,988.75","$6,318.18","$6,382.00",$0.00,"$1,248.48",$0.00,"$1,270.02",$0.00
6485-3-010,SUP,HCPCS C1776,,6485-3-010  -  STEM FEMORAL SMALL 10MM 102MM MRS HIP,"$5,780.00",$0.00,"$5,780.00","$2,601.00","$4,125.19",$0.00,$995.87,$0.00,$0.00,"$1,012.03","$5,780.00",$0.00,"$2,890.00","$4,577.76","$4,624.00",$0.00,$904.57,$0.00,$920.18,$0.00
6485-3-011,SUP,HCPCS C1776,,6485-3-011  -  STEM FEMORAL STANDARD STR 11MM 127MM CEMENTED BODY SECTION,"$7,977.50",$0.00,"$7,977.50","$3,589.88","$5,158.80",$0.00,"$1,374.48",$0.00,$0.00,"$1,396.80","$7,977.50",$0.00,"$3,988.75","$6,318.18","$6,382.00",$0.00,"$1,248.48",$0.00,"$1,270.02",$0.00
6485-3-013,SUP,HCPCS C1776,,6485-3-013  -  STEM FEMORAL STANDARD STR 13MM 127MM CEMENTED BODY SECTION,"$7,977.50",$0.00,"$7,977.50","$3,589.88","$5,158.80",$0.00,"$1,374.48",$0.00,$0.00,"$1,396.80","$7,977.50",$0.00,"$3,988.75","$6,318.18","$6,382.00",$0.00,"$1,248.48",$0.00,"$1,270.02",$0.00
6485-3-015,SUP,HCPCS C1776,,6485-3-015  -  STEM FEMORAL STANDARD 15MM 127MM MODULAR ROTATE HINGE MRS,"$7,977.50",$0.00,"$7,977.50","$3,589.88","$5,158.80",$0.00,"$1,374.48",$0.00,$0.00,"$1,396.80","$7,977.50",$0.00,"$3,988.75","$6,318.18","$6,382.00",$0.00,"$1,248.48",$0.00,"$1,270.02",$0.00
6485-3-017,SUP,HCPCS C1776,,6485-3-017  -  STEM FEMORAL 17MM 127MM CEMENTED BODY SECTION MRS HIP,"$7,977.50",$0.00,"$7,977.50","$3,589.88","$5,158.80",$0.00,"$1,374.48",$0.00,$0.00,"$1,396.80","$7,977.50",$0.00,"$3,988.75","$6,318.18","$6,382.00",$0.00,"$1,248.48",$0.00,"$1,270.02",$0.00
6485-3-018,SUP,HCPCS C1776,,6485-3-018  -  STEM FEMORAL SMALL 8MM 102MM MRS HIP,"$5,780.00",$0.00,"$5,780.00","$2,601.00","$4,125.19",$0.00,$995.87,$0.00,$0.00,"$1,012.03","$5,780.00",$0.00,"$2,890.00","$4,577.76","$4,624.00",$0.00,$904.57,$0.00,$920.18,$0.00
6485-3-019,SUP,HCPCS C1776,,6485-3-019  -  STEM FEMORAL SMALL 9MM 102MM MRS HIP,"$5,780.00",$0.00,"$5,780.00","$2,601.00","$4,125.19",$0.00,$995.87,$0.00,$0.00,"$1,012.03","$5,780.00",$0.00,"$2,890.00","$4,577.76","$4,624.00",$0.00,$904.57,$0.00,$920.18,$0.00
6485-3-111,SUP,HCPCS C1776,,6485-3-111  -  STEM FEMORAL 11MM 127MM MRS KNEE,"$5,780.00",$0.00,"$5,780.00","$2,601.00","$4,125.19",$0.00,$995.87,$0.00,$0.00,"$1,012.03","$5,780.00",$0.00,"$2,890.00","$4,577.76","$4,624.00",$0.00,$904.57,$0.00,$920.18,$0.00
6485-3-113,SUP,HCPCS C1776,,6485-3-113  -  STEM FEMORAL STR 13MM 127MM CEMENTED BODY SECTION GMRS HIP,"$5,780.00",$0.00,"$5,780.00","$2,601.00","$4,125.19",$0.00,$995.87,$0.00,$0.00,"$1,012.03","$5,780.00",$0.00,"$2,890.00","$4,577.76","$4,624.00",$0.00,$904.57,$0.00,$920.18,$0.00
6485-3-115,SUP,HCPCS C1776,,6485-3-115  -  STEM FEMORAL STR 15MM 127MM CEMENTED BODY SECTION MRS KNEE,"$5,780.00",$0.00,"$5,780.00","$2,601.00","$4,125.19",$0.00,$995.87,$0.00,$0.00,"$1,012.03","$5,780.00",$0.00,"$2,890.00","$4,577.76","$4,624.00",$0.00,$904.57,$0.00,$920.18,$0.00
6485-3-117,SUP,HCPCS C1776,,6485-3-117  -  STEM FEMORAL 17MM 127MM MRS KNEE,"$5,780.00",$0.00,"$5,780.00","$2,601.00","$4,125.19",$0.00,$995.87,$0.00,$0.00,"$1,012.03","$5,780.00",$0.00,"$2,890.00","$4,577.76","$4,624.00",$0.00,$904.57,$0.00,$920.18,$0.00
6485-3-211,SUP,HCPCS C1776,,6485-3-211  -  STEM FEMORAL TAPER 11MM 127MM MRS HIP,"$5,275.00",$0.00,"$5,275.00","$2,373.75","$3,764.77",$0.00,$908.86,$0.00,$0.00,$923.61,"$5,275.00",$0.00,"$2,637.50","$4,177.80","$4,220.00",$0.00,$825.54,$0.00,$839.78,$0.00
6485-3-213,SUP,HCPCS C1776,,6485-3-213  -  STEM FEMORAL TAPER 13MM 127MM MRS HIP,"$5,275.00",$0.00,"$5,275.00","$2,373.75","$3,764.77",$0.00,$908.86,$0.00,$0.00,$923.61,"$5,275.00",$0.00,"$2,637.50","$4,177.80","$4,220.00",$0.00,$825.54,$0.00,$839.78,$0.00
6485-3-215,SUP,HCPCS C1776,,6485-3-215  -  STEM FEMORAL TAPER 15MM 127MM MRS HIP,"$5,275.00",$0.00,"$5,275.00","$2,373.75","$3,764.77",$0.00,$908.86,$0.00,$0.00,$923.61,"$5,275.00",$0.00,"$2,637.50","$4,177.80","$4,220.00",$0.00,$825.54,$0.00,$839.78,$0.00
6485-3-217,SUP,HCPCS C1776,,6485-3-217  -  STEM FEMORAL TAPER 17MM 127MM MRS HIP,"$5,275.00",$0.00,"$5,275.00","$2,373.75","$3,764.77",$0.00,$908.86,$0.00,$0.00,$923.61,"$5,275.00",$0.00,"$2,637.50","$4,177.80","$4,220.00",$0.00,$825.54,$0.00,$839.78,$0.00
6485-3-300,SUP,HCPCS C1776,,6485-3-300  -  STEM FEMORAL SMALL CURVE 10MM 102MM MRS HIP,"$7,977.50",$0.00,"$7,977.50","$3,589.88","$5,158.80",$0.00,"$1,374.48",$0.00,$0.00,"$1,396.80","$7,977.50",$0.00,"$3,988.75","$6,318.18","$6,382.00",$0.00,"$1,248.48",$0.00,"$1,270.02",$0.00
6485-3-308,SUP,HCPCS C1776,,6485-3-308  -  STEM FEMORAL SMALL CURVE 8MM 102MM MRS HIP,"$7,977.50",$0.00,"$7,977.50","$3,589.88","$5,158.80",$0.00,"$1,374.48",$0.00,$0.00,"$1,396.80","$7,977.50",$0.00,"$3,988.75","$6,318.18","$6,382.00",$0.00,"$1,248.48",$0.00,"$1,270.02",$0.00
6485-3-309,SUP,HCPCS C1776,,6485-3-309  -  STEM FEMORAL SMALL CURVE 9MM 102MM MRS HIP,"$7,977.50",$0.00,"$7,977.50","$3,589.88","$5,158.80",$0.00,"$1,374.48",$0.00,$0.00,"$1,396.80","$7,977.50",$0.00,"$3,988.75","$6,318.18","$6,382.00",$0.00,"$1,248.48",$0.00,"$1,270.02",$0.00
6485-3-310,SUP,HCPCS C1776,,6485-3-310  -  STEM FEMORAL SMALL CURVE 10MM 102MM MRS KNEE,"$5,780.00",$0.00,"$5,780.00","$2,601.00","$4,125.19",$0.00,$995.87,$0.00,$0.00,"$1,012.03","$5,780.00",$0.00,"$2,890.00","$4,577.76","$4,624.00",$0.00,$904.57,$0.00,$920.18,$0.00
6485-3-311,SUP,HCPCS C1776,,6485-3-311  -  STEM FEMORAL 11MM 203MM MRS KNEE,"$10,430.00",$0.00,"$10,430.00","$4,693.50","$5,158.80",$0.00,"$1,797.04",$0.00,$0.00,"$1,826.21","$10,430.00",$0.00,"$5,215.00","$8,260.56","$8,344.00",$0.00,"$1,632.30",$0.00,"$1,660.46",$0.00
6485-3-313,SUP,HCPCS C1776,,6485-3-313  -  STEM FEMORAL LONG BOW 13MM 203MM CEMENTED BODY SECTION GMRS,"$10,430.00",$0.00,"$10,430.00","$4,693.50","$5,158.80",$0.00,"$1,797.04",$0.00,$0.00,"$1,826.21","$10,430.00",$0.00,"$5,215.00","$8,260.56","$8,344.00",$0.00,"$1,632.30",$0.00,"$1,660.46",$0.00
6485-3-315,SUP,HCPCS C1776,,6485-3-315  -  STEM FEMORAL LONG BOW 15MM 203MM CEMENTED BODY SECTION GMRS,"$10,430.00",$0.00,"$10,430.00","$4,693.50","$5,158.80",$0.00,"$1,797.04",$0.00,$0.00,"$1,826.21","$10,430.00",$0.00,"$5,215.00","$8,260.56","$8,344.00",$0.00,"$1,632.30",$0.00,"$1,660.46",$0.00
6485-3-317,SUP,HCPCS C1776,,6485-3-317  -  STEM FEMORAL 17MM 203MM MRS KNEE,"$10,430.00",$0.00,"$10,430.00","$4,693.50","$5,158.80",$0.00,"$1,797.04",$0.00,$0.00,"$1,826.21","$10,430.00",$0.00,"$5,215.00","$8,260.56","$8,344.00",$0.00,"$1,632.30",$0.00,"$1,660.46",$0.00
6485-3-318,SUP,HCPCS C1776,,6485-3-318  -  STEM FEMORAL SMALL CURVE 8MM 102MM MRS HIP,"$5,780.00",$0.00,"$5,780.00","$2,601.00","$4,125.19",$0.00,$995.87,$0.00,$0.00,"$1,012.03","$5,780.00",$0.00,"$2,890.00","$4,577.76","$4,624.00",$0.00,$904.57,$0.00,$920.18,$0.00
6485-3-319,SUP,HCPCS C1776,,6485-3-319  -  STEM FEMORAL SMALL CURVE 9MM 102MM MRS HIP,"$5,780.00",$0.00,"$5,780.00","$2,601.00","$4,125.19",$0.00,$995.87,$0.00,$0.00,"$1,012.03","$5,780.00",$0.00,"$2,890.00","$4,577.76","$4,624.00",$0.00,$904.57,$0.00,$920.18,$0.00
6485-3-611,SUP,HCPCS C1776,,6485-3-611  -  STEM FEMORAL LONG CURVE 11MM 203MM CEMENTED BODY SECTION,"$8,115.00",$0.00,"$8,115.00","$3,651.75","$5,158.80",$0.00,"$1,398.17",$0.00,$0.00,"$1,420.87","$8,115.00",$0.00,"$4,057.50","$6,427.08","$6,492.00",$0.00,"$1,270.00",$0.00,"$1,291.91",$0.00
6485-3-613,SUP,HCPCS C1776,,6485-3-613  -  STEM FEMORAL LONG CURVE 13MM 203MM CEMENT GMRS HIP DISTAL,"$8,115.00",$0.00,"$8,115.00","$3,651.75","$5,158.80",$0.00,"$1,398.17",$0.00,$0.00,"$1,420.87","$8,115.00",$0.00,"$4,057.50","$6,427.08","$6,492.00",$0.00,"$1,270.00",$0.00,"$1,291.91",$0.00
6485-3-615,SUP,HCPCS C1776,,6485-3-615  -  STEM FEMORAL LONG BOW CURVE 15MM 203MM CEMENTED BODY SECTION,"$8,115.00",$0.00,"$8,115.00","$3,651.75","$5,158.80",$0.00,"$1,398.17",$0.00,$0.00,"$1,420.87","$8,115.00",$0.00,"$4,057.50","$6,427.08","$6,492.00",$0.00,"$1,270.00",$0.00,"$1,291.91",$0.00
6485-3-617,SUP,HCPCS C1776,,6485-3-617  -  STEM FEMORAL LONG BOW 17MM 203MM CEMENTED BODY SECTION GMRS,"$8,115.00",$0.00,"$8,115.00","$3,651.75","$5,158.80",$0.00,"$1,398.17",$0.00,$0.00,"$1,420.87","$8,115.00",$0.00,"$4,057.50","$6,427.08","$6,492.00",$0.00,"$1,270.00",$0.00,"$1,291.91",$0.00
6485-3-711,SUP,HCPCS C1776,,6485-3-711  -  STEM FEMORAL CURVE 11MM 127MM MRS KNEE,"$7,977.50",$0.00,"$7,977.50","$3,589.88","$5,158.80",$0.00,"$1,374.48",$0.00,$0.00,"$1,396.80","$7,977.50",$0.00,"$3,988.75","$6,318.18","$6,382.00",$0.00,"$1,248.48",$0.00,"$1,270.02",$0.00
6485-3-713,SUP,HCPCS C1776,,6485-3-713  -  STEM FEMORAL CURVE 13MM 127MM MRS KNEE,"$7,977.50",$0.00,"$7,977.50","$3,589.88","$5,158.80",$0.00,"$1,374.48",$0.00,$0.00,"$1,396.80","$7,977.50",$0.00,"$3,988.75","$6,318.18","$6,382.00",$0.00,"$1,248.48",$0.00,"$1,270.02",$0.00
6485-3-715,SUP,HCPCS C1776,,6485-3-715  -  STEM FEMORAL CURVE 15MM 127MM MRS KNEE,"$7,977.50",$0.00,"$7,977.50","$3,589.88","$5,158.80",$0.00,"$1,374.48",$0.00,$0.00,"$1,396.80","$7,977.50",$0.00,"$3,988.75","$6,318.18","$6,382.00",$0.00,"$1,248.48",$0.00,"$1,270.02",$0.00
6485-3-717,SUP,HCPCS C1776,,6485-3-717  -  STEM FEMORAL CURVE 17MM 127MM MRS HIP,"$7,977.50",$0.00,"$7,977.50","$3,589.88","$5,158.80",$0.00,"$1,374.48",$0.00,$0.00,"$1,396.80","$7,977.50",$0.00,"$3,988.75","$6,318.18","$6,382.00",$0.00,"$1,248.48",$0.00,"$1,270.02",$0.00
6485-3-811,SUP,HCPCS C1776,,6485-3-811  -  STEM FEMORAL CURVE 11MM 127MM MRS KNEE,"$5,780.00",$0.00,"$5,780.00","$2,601.00","$4,125.19",$0.00,$995.87,$0.00,$0.00,"$1,012.03","$5,780.00",$0.00,"$2,890.00","$4,577.76","$4,624.00",$0.00,$904.57,$0.00,$920.18,$0.00
6485-3-813,SUP,HCPCS C1776,,6485-3-813  -  STEM FEMORAL CURVE 13MM 127MM MRS KNEE,"$5,780.00",$0.00,"$5,780.00","$2,601.00","$4,125.19",$0.00,$995.87,$0.00,$0.00,"$1,012.03","$5,780.00",$0.00,"$2,890.00","$4,577.76","$4,624.00",$0.00,$904.57,$0.00,$920.18,$0.00
6485-3-815,SUP,HCPCS C1776,,6485-3-815  -  STEM FEMORAL CURVE 15MM 127MM MRS HIP,"$5,780.00",$0.00,"$5,780.00","$2,601.00","$4,125.19",$0.00,$995.87,$0.00,$0.00,"$1,012.03","$5,780.00",$0.00,"$2,890.00","$4,577.76","$4,624.00",$0.00,$904.57,$0.00,$920.18,$0.00
6485-3-817,SUP,HCPCS C1776,,6485-3-817  -  STEM FEMORAL CURVE 17MM 127MM MRS HIP,"$5,780.00",$0.00,"$5,780.00","$2,601.00","$4,125.19",$0.00,$995.87,$0.00,$0.00,"$1,012.03","$5,780.00",$0.00,"$2,890.00","$4,577.76","$4,624.00",$0.00,$904.57,$0.00,$920.18,$0.00
6485-3-915,SUP,Custom 27803010,,6485-3-915  -  COMPONENT PATLR MEDIUM ROTATE HINGE KRH DUR,"$1,705.00",$0.00,"$1,705.00",$0.00,"$1,216.86",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,705.00",$0.00,$852.50,"$1,350.36","$1,364.00",$0.00,$0.00,$0.00,$0.00,$0.00
6485-4-100,SUP,Custom 27803010,,6485-4-100  -  COMPONENT FEMORAL STANDARD 10MM ROTATE HINGE BUMPER,"$1,282.50",$0.00,"$1,282.50",$0.00,$915.32,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,282.50",$0.00,$641.25,"$1,015.74","$1,026.00",$0.00,$0.00,$0.00,$0.00,$0.00
6485-4-111,SUP,Custom 27803010,,6485-4-111  -  INSERT TIBIAL SMALL 11MM MRS DUR METASUL KNEE ENCAPSULATE,"$3,120.00",$0.00,"$3,120.00",$0.00,"$2,226.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,120.00",$0.00,"$1,560.00","$2,471.04","$2,496.00",$0.00,$0.00,$0.00,$0.00,$0.00
6485-4-113,SUP,Custom 27803010,,6485-4-113  -  INSERT TIBIAL SMALL 13MM MRS DUR METASUL KNEE ENCAPSULATE,"$3,120.00",$0.00,"$3,120.00",$0.00,"$2,226.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,120.00",$0.00,"$1,560.00","$2,471.04","$2,496.00",$0.00,$0.00,$0.00,$0.00,$0.00
6485-4-116,SUP,Custom 27803010,,6485-4-116  -  INSERT TIBIAL SMALL 16MM MRS DUR KNEE ENCAP,"$3,120.00",$0.00,"$3,120.00",$0.00,"$2,226.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,120.00",$0.00,"$1,560.00","$2,471.04","$2,496.00",$0.00,$0.00,$0.00,$0.00,$0.00
6485-4-121,SUP,Custom 27803010,,6485-4-121  -  INSERT TIBIAL SMALL 21MM MRS DUR KNEE ENCAP,"$3,120.00",$0.00,"$3,120.00",$0.00,"$2,226.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,120.00",$0.00,"$1,560.00","$2,471.04","$2,496.00",$0.00,$0.00,$0.00,$0.00,$0.00
6485-4-125,SUP,Custom 27803010,,6485-4-125  -  INSERT TIBIAL 12.5MM BUMPER KRH DUR KNEE,"$1,282.50",$0.00,"$1,282.50",$0.00,$915.32,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,282.50",$0.00,$641.25,"$1,015.74","$1,026.00",$0.00,$0.00,$0.00,$0.00,$0.00
6485-4-145,SUP,Custom 27803010,,6485-4-145  -  INSERT TIBIAL 14.5MM 14.5MM BUMPER MRS MRH KRH DUR,"$1,282.50",$0.00,"$1,282.50",$0.00,$915.32,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,282.50",$0.00,$641.25,"$1,015.74","$1,026.00",$0.00,$0.00,$0.00,$0.00,$0.00
6485-4-160,SUP,Custom 27803010,,6485-4-160  -  INSERT TIBIAL 16MM BUMPER KRH DUR KNEE,"$1,282.50",$0.00,"$1,282.50",$0.00,$915.32,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,282.50",$0.00,$641.25,"$1,015.74","$1,026.00",$0.00,$0.00,$0.00,$0.00,$0.00
6485-4-211,SUP,Custom 27803010,,6485-4-211  -  INSERT TIBIAL MEDIUM 11MM MRS DUR KNEE ENCAP,"$3,120.00",$0.00,"$3,120.00",$0.00,"$2,226.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,120.00",$0.00,"$1,560.00","$2,471.04","$2,496.00",$0.00,$0.00,$0.00,$0.00,$0.00
6485-4-213,SUP,Custom 27803010,,6485-4-213  -  INSERT TIBIAL MEDIUM 13MM MRS DUR KNEE ENCAP,"$3,120.00",$0.00,"$3,120.00",$0.00,"$2,226.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,120.00",$0.00,"$1,560.00","$2,471.04","$2,496.00",$0.00,$0.00,$0.00,$0.00,$0.00
6485-4-216,SUP,Custom 27803010,,6485-4-216  -  INSERT TIBIAL MEDIUM 16MM MRS DUR KNEE ENCAP,"$3,120.00",$0.00,"$3,120.00",$0.00,"$2,226.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,120.00",$0.00,"$1,560.00","$2,471.04","$2,496.00",$0.00,$0.00,$0.00,$0.00,$0.00
6485-4-221,SUP,Custom 27803010,,6485-4-221  -  INSERT TIBIAL MEDIUM 21MM MRS DUR KNEE ENCAP,"$3,120.00",$0.00,"$3,120.00",$0.00,"$2,226.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,120.00",$0.00,"$1,560.00","$2,471.04","$2,496.00",$0.00,$0.00,$0.00,$0.00,$0.00
6485-5-010,SUP,Custom 27803010,,6485-5-010  -  SPACER FEM 10MM KMX+ LCK SCR,$98.00,$0.00,$98.00,$0.00,$69.94,$0.00,$0.00,$0.00,$0.00,$0.00,$98.00,$0.00,$49.00,$77.62,$78.40,$0.00,$0.00,$0.00,$0.00,$0.00
6485-5-050,SUP,Custom 27803010,,6485-5-050  -  SPACER FEM 5MM KNMX XS LEFT DISTAL MDL,$549.00,$0.00,$549.00,$0.00,$391.82,$0.00,$0.00,$0.00,$0.00,$0.00,$549.00,$0.00,$274.50,$434.81,$439.20,$0.00,$0.00,$0.00,$0.00,$0.00
6485-5-051,SUP,Custom 27803010,,6485-5-051  -  SPACER FEM 10MM KNMX XS LEFT DISTAL MDL,$687.00,$0.00,$687.00,$0.00,$490.31,$0.00,$0.00,$0.00,$0.00,$0.00,$687.00,$0.00,$343.50,$544.10,$549.60,$0.00,$0.00,$0.00,$0.00,$0.00
6485-5-052,SUP,Custom 27803010,,6485-5-052  -  SPACER FEM 10MM KMX+ XS RIGHT DISTAL MDL,$659.00,$0.00,$659.00,$0.00,$470.33,$0.00,$0.00,$0.00,$0.00,$0.00,$659.00,$0.00,$329.50,$521.93,$527.20,$0.00,$0.00,$0.00,$0.00,$0.00
6485-5-053,SUP,Custom 27803010,,6485-5-053  -  SPACER FEM 10MM KMX+ XS RIGHT DISTAL MDL,$549.00,$0.00,$549.00,$0.00,$391.82,$0.00,$0.00,$0.00,$0.00,$0.00,$549.00,$0.00,$274.50,$434.81,$439.20,$0.00,$0.00,$0.00,$0.00,$0.00
6485-5-060,SUP,Custom 27803010,,6485-5-060  -  SPACER FEM 5MM KNMX XS RIGHT DISTAL MDL,$659.00,$0.00,$659.00,$0.00,$470.33,$0.00,$0.00,$0.00,$0.00,$0.00,$659.00,$0.00,$329.50,$521.93,$527.20,$0.00,$0.00,$0.00,$0.00,$0.00
6485-5-061,SUP,Custom 27803010,,6485-5-061  -  SPACER FEM 10MM KMX+ XS RIGHT DISTAL MDL,$659.00,$0.00,$659.00,$0.00,$470.33,$0.00,$0.00,$0.00,$0.00,$0.00,$659.00,$0.00,$329.50,$521.93,$527.20,$0.00,$0.00,$0.00,$0.00,$0.00
6485-5-062,SUP,Custom 27803010,,6485-5-062  -  SPACER FEM 10MM KMX+ MED XS DISTAL KNEE,$549.00,$0.00,$549.00,$0.00,$391.82,$0.00,$0.00,$0.00,$0.00,$0.00,$549.00,$0.00,$274.50,$434.81,$439.20,$0.00,$0.00,$0.00,$0.00,$0.00
6485-5-063,SUP,Custom 27803010,,6485-5-063  -  SPACER FEM 10MM KMX+ XS RIGHT DISTAL MDL,$549.00,$0.00,$549.00,$0.00,$391.82,$0.00,$0.00,$0.00,$0.00,$0.00,$549.00,$0.00,$274.50,$434.81,$439.20,$0.00,$0.00,$0.00,$0.00,$0.00
6485-5-100,SUP,Custom 27803010,,6485-5-100  -  SPACER FEM 5MM KNMX SM LEFT DISTAL MDL,$687.00,$0.00,$687.00,$0.00,$490.31,$0.00,$0.00,$0.00,$0.00,$0.00,$687.00,$0.00,$343.50,$544.10,$549.60,$0.00,$0.00,$0.00,$0.00,$0.00
6485-5-101,SUP,Custom 27803010,,6485-5-101  -  SPACER FEM 10MM KMX+ SM LEFT DISTAL MDL,$659.00,$0.00,$659.00,$0.00,$470.33,$0.00,$0.00,$0.00,$0.00,$0.00,$659.00,$0.00,$329.50,$521.93,$527.20,$0.00,$0.00,$0.00,$0.00,$0.00
6485-5-102,SUP,Custom 27803010,,6485-5-102  -  SPACER FEM 10MM KMX+ SM RIGHT DISTAL MDL,$659.00,$0.00,$659.00,$0.00,$470.33,$0.00,$0.00,$0.00,$0.00,$0.00,$659.00,$0.00,$329.50,$521.93,$527.20,$0.00,$0.00,$0.00,$0.00,$0.00
6485-5-103,SUP,Custom 27803010,,6485-5-103  -  SPACER FEM 10MM KMX+ SM RIGHT DISTAL MDL,$549.00,$0.00,$549.00,$0.00,$391.82,$0.00,$0.00,$0.00,$0.00,$0.00,$549.00,$0.00,$274.50,$434.81,$439.20,$0.00,$0.00,$0.00,$0.00,$0.00
6485-5-110,SUP,Custom 27803010,,6485-5-110  -  SPACER FEM 5MM KNMX SM RIGHT DISTAL MDL,$659.00,$0.00,$659.00,$0.00,$470.33,$0.00,$0.00,$0.00,$0.00,$0.00,$659.00,$0.00,$329.50,$521.93,$527.20,$0.00,$0.00,$0.00,$0.00,$0.00
6485-5-111,SUP,Custom 27803010,,6485-5-111  -  SPACER FEM 10MM KMX+ SM RIGHT DISTAL MDL,$659.00,$0.00,$659.00,$0.00,$470.33,$0.00,$0.00,$0.00,$0.00,$0.00,$659.00,$0.00,$329.50,$521.93,$527.20,$0.00,$0.00,$0.00,$0.00,$0.00
6485-5-112,SUP,Custom 27803010,,6485-5-112  -  SPACER FEM 10MM KMX+ SM RIGHT DISTAL MDL,$687.00,$0.00,$687.00,$0.00,$490.31,$0.00,$0.00,$0.00,$0.00,$0.00,$687.00,$0.00,$343.50,$544.10,$549.60,$0.00,$0.00,$0.00,$0.00,$0.00
6485-5-113,SUP,Custom 27803010,,6485-5-113  -  SPACER FEM 10MM KMX+ SM RIGHT DISTAL MDL,$659.00,$0.00,$659.00,$0.00,$470.33,$0.00,$0.00,$0.00,$0.00,$0.00,$659.00,$0.00,$329.50,$521.93,$527.20,$0.00,$0.00,$0.00,$0.00,$0.00
6485-5-150,SUP,Custom 27803010,,6485-5-150  -  SPACER FEM 5MM KMX+ MED LEFT DISTAL MDL,$816.00,$0.00,$816.00,$0.00,$582.38,$0.00,$0.00,$0.00,$0.00,$0.00,$816.00,$0.00,$408.00,$646.27,$652.80,$0.00,$0.00,$0.00,$0.00,$0.00
6485-5-151,SUP,Custom 27803010,,6485-5-151  -  SPACER FEM 10MM KNMX MED LEFT DISTAL MDL,$816.00,$0.00,$816.00,$0.00,$582.38,$0.00,$0.00,$0.00,$0.00,$0.00,$816.00,$0.00,$408.00,$646.27,$652.80,$0.00,$0.00,$0.00,$0.00,$0.00
6485-5-152,SUP,Custom 27803010,,6485-5-152  -  SPACER FEM 10MM KNMX MED RIGHT DISTAL MDL,$659.00,$0.00,$659.00,$0.00,$470.33,$0.00,$0.00,$0.00,$0.00,$0.00,$659.00,$0.00,$329.50,$521.93,$527.20,$0.00,$0.00,$0.00,$0.00,$0.00
6485-5-153,SUP,Custom 27803010,,6485-5-153  -  SPACER FEM 10MM KMX+ MED RIGHT DISTAL MDL,$816.00,$0.00,$816.00,$0.00,$582.38,$0.00,$0.00,$0.00,$0.00,$0.00,$816.00,$0.00,$408.00,$646.27,$652.80,$0.00,$0.00,$0.00,$0.00,$0.00
6485-5-160,SUP,Custom 27803010,,6485-5-160  -  SPACER FEM 5MM KNMX MED RIGHT DISTAL MDL,$816.00,$0.00,$816.00,$0.00,$582.38,$0.00,$0.00,$0.00,$0.00,$0.00,$816.00,$0.00,$408.00,$646.27,$652.80,$0.00,$0.00,$0.00,$0.00,$0.00
6485-5-161,SUP,Custom 27803010,,6485-5-161  -  SPACER FEM 10MM KNMX MED RIGHT DISTAL MDL,$816.00,$0.00,$816.00,$0.00,$582.38,$0.00,$0.00,$0.00,$0.00,$0.00,$816.00,$0.00,$408.00,$646.27,$652.80,$0.00,$0.00,$0.00,$0.00,$0.00
6485-5-162,SUP,Custom 27803010,,6485-5-162  -  SPACER FEM 10MM KNMX MED RIGHT DISTAL MDL,$816.00,$0.00,$816.00,$0.00,$582.38,$0.00,$0.00,$0.00,$0.00,$0.00,$816.00,$0.00,$408.00,$646.27,$652.80,$0.00,$0.00,$0.00,$0.00,$0.00
6485-5-163,SUP,Custom 27803010,,6485-5-163  -  SPACER FEM 10MM KNMX MED RIGHT DISTAL MDL,$816.00,$0.00,$816.00,$0.00,$582.38,$0.00,$0.00,$0.00,$0.00,$0.00,$816.00,$0.00,$408.00,$646.27,$652.80,$0.00,$0.00,$0.00,$0.00,$0.00
6485-5-200,SUP,Custom 27803010,,6485-5-200  -  SPACER FEM 5MM KMX+ LG LEFT DISTAL MDL,$687.00,$0.00,$687.00,$0.00,$490.31,$0.00,$0.00,$0.00,$0.00,$0.00,$687.00,$0.00,$343.50,$544.10,$549.60,$0.00,$0.00,$0.00,$0.00,$0.00
6485-5-201,SUP,Custom 27803010,,6485-5-201  -  SPACER FEM 10MM KMX+ LG LEFT DISTAL MDL,$572.00,$0.00,$572.00,$0.00,$408.24,$0.00,$0.00,$0.00,$0.00,$0.00,$572.00,$0.00,$286.00,$453.02,$457.60,$0.00,$0.00,$0.00,$0.00,$0.00
6485-5-202,SUP,Custom 27803010,,6485-5-202  -  SPACER FEM 10MM KMX+ LG RIGHT DISTAL MDL,$659.00,$0.00,$659.00,$0.00,$470.33,$0.00,$0.00,$0.00,$0.00,$0.00,$659.00,$0.00,$329.50,$521.93,$527.20,$0.00,$0.00,$0.00,$0.00,$0.00
6485-5-203,SUP,Custom 27803010,,6485-5-203  -  SPACER FEM 10MM KMX+ MED RIGHT DISTAL MDL,$659.00,$0.00,$659.00,$0.00,$470.33,$0.00,$0.00,$0.00,$0.00,$0.00,$659.00,$0.00,$329.50,$521.93,$527.20,$0.00,$0.00,$0.00,$0.00,$0.00
6485-5-210,SUP,Custom 27803010,,6485-5-210  -  SPACER FEM 5MM KMX+ LG RIGHT DISTAL MDL,$572.00,$0.00,$572.00,$0.00,$408.24,$0.00,$0.00,$0.00,$0.00,$0.00,$572.00,$0.00,$286.00,$453.02,$457.60,$0.00,$0.00,$0.00,$0.00,$0.00
6485-5-211,SUP,Custom 27803010,,6485-5-211  -  SPACER FEM 10MM KMX+ MED RIGHT DISTAL MDL,$687.00,$0.00,$687.00,$0.00,$490.31,$0.00,$0.00,$0.00,$0.00,$0.00,$687.00,$0.00,$343.50,$544.10,$549.60,$0.00,$0.00,$0.00,$0.00,$0.00
6485-5-212,SUP,Custom 27803010,,6485-5-212  -  SPACER FEM 10MM KMX+ LG RIGHT DISTAL MDL,$659.00,$0.00,$659.00,$0.00,$470.33,$0.00,$0.00,$0.00,$0.00,$0.00,$659.00,$0.00,$329.50,$521.93,$527.20,$0.00,$0.00,$0.00,$0.00,$0.00
6485-5-213,SUP,Custom 27803010,,6485-5-213  -  SPACER FEM 10MM KMX+ LG RIGHT DISTAL MDL,$659.00,$0.00,$659.00,$0.00,$470.33,$0.00,$0.00,$0.00,$0.00,$0.00,$659.00,$0.00,$329.50,$521.93,$527.20,$0.00,$0.00,$0.00,$0.00,$0.00
6485-5-250,SUP,Custom 27803010,,6485-5-250  -  SPACER FEM 5MM KMX+ XL LEFT DISTAL MDL,$549.00,$0.00,$549.00,$0.00,$391.82,$0.00,$0.00,$0.00,$0.00,$0.00,$549.00,$0.00,$274.50,$434.81,$439.20,$0.00,$0.00,$0.00,$0.00,$0.00
6485-5-251,SUP,Custom 27803010,,6485-5-251  -  SPACER FEM 10MM KMX+ MED XL DISTAL KNEE,$659.00,$0.00,$659.00,$0.00,$470.33,$0.00,$0.00,$0.00,$0.00,$0.00,$659.00,$0.00,$329.50,$521.93,$527.20,$0.00,$0.00,$0.00,$0.00,$0.00
6485-5-252,SUP,Custom 27803010,,6485-5-252  -  SPACER FEM 10MM KMX+ XL RIGHT DISTAL MDL,$659.00,$0.00,$659.00,$0.00,$470.33,$0.00,$0.00,$0.00,$0.00,$0.00,$659.00,$0.00,$329.50,$521.93,$527.20,$0.00,$0.00,$0.00,$0.00,$0.00
6485-5-253,SUP,Custom 27803010,,6485-5-253  -  SPACER FEM 10MM KMX+ XL RIGHT DISTAL MDL,$659.00,$0.00,$659.00,$0.00,$470.33,$0.00,$0.00,$0.00,$0.00,$0.00,$659.00,$0.00,$329.50,$521.93,$527.20,$0.00,$0.00,$0.00,$0.00,$0.00
6485-5-260,SUP,Custom 27803010,,6485-5-260  -  SPACER FEM 5MM KNMX 2XL RIGHT DISTAL MDL,$816.00,$0.00,$816.00,$0.00,$582.38,$0.00,$0.00,$0.00,$0.00,$0.00,$816.00,$0.00,$408.00,$646.27,$652.80,$0.00,$0.00,$0.00,$0.00,$0.00
6485-5-261,SUP,Custom 27803010,,6485-5-261  -  SPACER FEM 10MM KMX+ XL RIGHT DISTAL MDL,$549.00,$0.00,$549.00,$0.00,$391.82,$0.00,$0.00,$0.00,$0.00,$0.00,$549.00,$0.00,$274.50,$434.81,$439.20,$0.00,$0.00,$0.00,$0.00,$0.00
6485-5-262,SUP,Custom 27803010,,6485-5-262  -  SPACER FEM 10MM KMX+ XL RIGHT DISTAL MDL,$687.00,$0.00,$687.00,$0.00,$490.31,$0.00,$0.00,$0.00,$0.00,$0.00,$687.00,$0.00,$343.50,$544.10,$549.60,$0.00,$0.00,$0.00,$0.00,$0.00
6485-5-263,SUP,Custom 27803010,,6485-5-263  -  SPACER FEM 10MM KMX+ XL RIGHT DISTAL MDL,$659.00,$0.00,$659.00,$0.00,$470.33,$0.00,$0.00,$0.00,$0.00,$0.00,$659.00,$0.00,$329.50,$521.93,$527.20,$0.00,$0.00,$0.00,$0.00,$0.00
6485-5-915,SUP,Custom 27803010,,6485-5-915  -  CMPNT PATLR LG KNMTC,"$1,639.63",$0.00,"$1,639.63",$0.00,"$1,170.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,639.63",$0.00,$819.81,"$1,298.59","$1,311.70",$0.00,$0.00,$0.00,$0.00,$0.00
6485-6-409,SUP,HCPCS C1776,,6485-6-409  -  STEM TIBIAL 9MM MRS KNEE,"$7,905.00",$0.00,"$7,905.00","$3,557.25","$5,158.80",$0.00,"$1,361.99",$0.00,$0.00,"$1,384.10","$7,905.00",$0.00,"$3,952.50","$6,260.76","$6,324.00",$0.00,"$1,237.13",$0.00,"$1,258.48",$0.00
6485-6-411,SUP,HCPCS C1776,,6485-6-411  -  STEM TIBIAL 11MM MRS KNEE,"$7,905.00",$0.00,"$7,905.00","$3,557.25","$5,158.80",$0.00,"$1,361.99",$0.00,$0.00,"$1,384.10","$7,905.00",$0.00,"$3,952.50","$6,260.76","$6,324.00",$0.00,"$1,237.13",$0.00,"$1,258.48",$0.00
6485-6-413,SUP,HCPCS C1776,,6485-6-413  -  STEM TIBIAL 13MM MRS KNEE,"$7,905.00",$0.00,"$7,905.00","$3,557.25","$5,158.80",$0.00,"$1,361.99",$0.00,$0.00,"$1,384.10","$7,905.00",$0.00,"$3,952.50","$6,260.76","$6,324.00",$0.00,"$1,237.13",$0.00,"$1,258.48",$0.00
6485-6-509,SUP,HCPCS C1776,,6485-6-509  -  STEM TIBIAL 9MM 127MM MRS KNEE,"$5,722.50",$0.00,"$5,722.50","$2,575.13","$4,084.15",$0.00,$985.96,$0.00,$0.00,"$1,001.96","$5,722.50",$0.00,"$2,861.25","$4,532.22","$4,578.00",$0.00,$895.57,$0.00,$911.02,$0.00
6485-6-511,SUP,HCPCS C1776,,6485-6-511  -  STEM TIBIAL 11MM 127MM MRS KNEE,"$5,722.50",$0.00,"$5,722.50","$2,575.13","$4,084.15",$0.00,$985.96,$0.00,$0.00,"$1,001.96","$5,722.50",$0.00,"$2,861.25","$4,532.22","$4,578.00",$0.00,$895.57,$0.00,$911.02,$0.00
6485-6-513,SUP,HCPCS C1776,,6485-6-513  -  STEM TIBIAL 13MM MRS KNEE,"$5,722.50",$0.00,"$5,722.50","$2,575.13","$4,084.15",$0.00,$985.96,$0.00,$0.00,"$1,001.96","$5,722.50",$0.00,"$2,861.25","$4,532.22","$4,578.00",$0.00,$895.57,$0.00,$911.02,$0.00
6485-8-435,SUP,HCPCS C1776,,6485-8-435  -  COMPONENT TIBIAL SHORT BEARING MRS KNEE,"$6,005.00",$0.00,"$6,005.00","$2,702.25","$4,285.77",$0.00,"$1,034.63",$0.00,$0.00,"$1,051.43","$6,005.00",$0.00,"$3,002.50","$4,755.96","$4,804.00",$0.00,$939.78,$0.00,$956.00,$0.00
6485-8-450,SUP,HCPCS C1776,,6485-8-450  -  COMPONENT TIBIAL 3XS BEARING KRH KNEE,"$6,122.50",$0.00,"$6,122.50","$2,755.13","$4,369.63",$0.00,"$1,054.88",$0.00,$0.00,"$1,072.00","$6,122.50",$0.00,"$3,061.25","$4,849.02","$4,898.00",$0.00,$958.17,$0.00,$974.70,$0.00
6485-8-460,SUP,HCPCS C1895,,6485-8-460  -  AXLE FEMORAL SMALL ROTATE HINGE MODULE KINEMATIC KNEE,"$2,182.50",$0.00,"$2,182.50",$982.13,"$1,557.65",$0.00,$376.03,$0.00,$0.00,$382.14,"$2,182.50",$0.00,"$1,091.25","$1,728.54","$1,746.00",$0.00,$341.56,$0.00,$347.45,$0.00
6487-1-040,SUP,HCPCS C1776,,6487-1-040  -  BODY HUMERAL TAPER 40MM MALE TO FMALE MRS,"$5,680.00",$0.00,"$5,680.00","$2,556.00","$4,053.82",$0.00,$978.64,$0.00,$0.00,$994.52,"$5,680.00",$0.00,"$2,840.00","$4,498.56","$4,544.00",$0.00,$888.92,$0.00,$904.26,$0.00
6487-1-060,SUP,HCPCS C1776,,6487-1-060  -  BODY HUMERAL TAPER 60MM MALE TO FMALE MRS,"$5,680.00",$0.00,"$5,680.00","$2,556.00","$4,053.82",$0.00,$978.64,$0.00,$0.00,$994.52,"$5,680.00",$0.00,"$2,840.00","$4,498.56","$4,544.00",$0.00,$888.92,$0.00,$904.26,$0.00
6487-1-080,SUP,HCPCS C1776,,6487-1-080  -  BODY HUMERAL 80MM MALE/FMALE TAPERED MRS SHOULDER,"$5,680.00",$0.00,"$5,680.00","$2,556.00","$4,053.82",$0.00,$978.64,$0.00,$0.00,$994.52,"$5,680.00",$0.00,"$2,840.00","$4,498.56","$4,544.00",$0.00,$888.92,$0.00,$904.26,$0.00
6487-1-100,SUP,HCPCS C1776,,6487-1-100  -  BODY HUMERAL TAPER 100MM MALE TO FMALE MRS,"$5,680.00",$0.00,"$5,680.00","$2,556.00","$4,053.82",$0.00,$978.64,$0.00,$0.00,$994.52,"$5,680.00",$0.00,"$2,840.00","$4,498.56","$4,544.00",$0.00,$888.92,$0.00,$904.26,$0.00
6487-1-120,SUP,HCPCS C1776,,6487-1-120  -  BODY HUMERAL TAPER 120MM MALE TO FMALE MRS,"$5,680.00",$0.00,"$5,680.00","$2,556.00","$4,053.82",$0.00,$978.64,$0.00,$0.00,$994.52,"$5,680.00",$0.00,"$2,840.00","$4,498.56","$4,544.00",$0.00,$888.92,$0.00,$904.26,$0.00
6487-1-140,SUP,HCPCS C1776,,6487-1-140  -  BODY HUMERAL TAPER 140MM MALE TO FMALE MRS,"$5,680.00",$0.00,"$5,680.00","$2,556.00","$4,053.82",$0.00,$978.64,$0.00,$0.00,$994.52,"$5,680.00",$0.00,"$2,840.00","$4,498.56","$4,544.00",$0.00,$888.92,$0.00,$904.26,$0.00
6487-2-075,SUP,HCPCS C1776,,6487-2-075  -  STEM HUMERAL 7MM 75MM MRS MRH SHOULDER,"$7,480.00",$0.00,"$7,480.00","$3,366.00","$5,158.80",$0.00,"$1,288.77",$0.00,$0.00,"$1,309.69","$7,480.00",$0.00,"$3,740.00","$5,924.16","$5,984.00",$0.00,"$1,170.62",$0.00,"$1,190.82",$0.00
6487-2-115,SUP,HCPCS C1776,,6487-2-115  -  STEM HUMERAL 7MM 115MM MRS SHOULDER,"$7,480.00",$0.00,"$7,480.00","$3,366.00","$5,158.80",$0.00,"$1,288.77",$0.00,$0.00,"$1,309.69","$7,480.00",$0.00,"$3,740.00","$5,924.16","$5,984.00",$0.00,"$1,170.62",$0.00,"$1,190.82",$0.00
6487-3-075,SUP,HCPCS C1776,,6487-3-075  -  STEM HUMERAL 9MM 75MM MRS SHOULDER,"$7,480.00",$0.00,"$7,480.00","$3,366.00","$5,158.80",$0.00,"$1,288.77",$0.00,$0.00,"$1,309.69","$7,480.00",$0.00,"$3,740.00","$5,924.16","$5,984.00",$0.00,"$1,170.62",$0.00,"$1,190.82",$0.00
6487-3-115,SUP,HCPCS C1776,,6487-3-115  -  STEM HUMERAL 9MM 115MM MRS SHOULDER,"$7,480.00",$0.00,"$7,480.00","$3,366.00","$5,158.80",$0.00,"$1,288.77",$0.00,$0.00,"$1,309.69","$7,480.00",$0.00,"$3,740.00","$5,924.16","$5,984.00",$0.00,"$1,170.62",$0.00,"$1,190.82",$0.00
6487-4-075,SUP,HCPCS C1776,,6487-4-075  -  STEM HUMERAL 11MM 75MM MRS SHOULDER,"$7,480.00",$0.00,"$7,480.00","$3,366.00","$5,158.80",$0.00,"$1,288.77",$0.00,$0.00,"$1,309.69","$7,480.00",$0.00,"$3,740.00","$5,924.16","$5,984.00",$0.00,"$1,170.62",$0.00,"$1,190.82",$0.00
6487-4-115,SUP,HCPCS C1776,,6487-4-115  -  STEM HUMERAL 11MM 115MM MRS SHOULDER,"$7,480.00",$0.00,"$7,480.00","$3,366.00","$5,158.80",$0.00,"$1,288.77",$0.00,$0.00,"$1,309.69","$7,480.00",$0.00,"$3,740.00","$5,924.16","$5,984.00",$0.00,"$1,170.62",$0.00,"$1,190.82",$0.00
6487-5-010,SUP,HCPCS C1713,,6487-5-010  -  SCREW BONE INTERCALARY MRS HUMERUS,$932.50,$0.00,$932.50,$419.63,$665.53,$0.00,$160.67,$0.00,$0.00,$163.27,$932.50,$0.00,$466.25,$738.54,$746.00,$0.00,$145.94,$0.00,$148.45,$0.00
6487-5-040,SUP,HCPCS C1776,,6487-5-040  -  HEAD HUM 40MM STRL MRS SHLDR PROX,"$7,317.50",$0.00,"$7,317.50","$3,292.88","$5,158.80",$0.00,"$1,260.77",$0.00,$0.00,"$1,281.24","$7,317.50",$0.00,"$3,658.75","$5,795.46","$5,854.00",$0.00,"$1,145.19",$0.00,"$1,164.95",$0.00
6487-5-044,SUP,HCPCS C1776,,6487-5-044  -  HEAD HUM 44MM STRL MRS SHLDR PROX,"$7,317.50",$0.00,"$7,317.50","$3,292.88","$5,158.80",$0.00,"$1,260.77",$0.00,$0.00,"$1,281.24","$7,317.50",$0.00,"$3,658.75","$5,795.46","$5,854.00",$0.00,"$1,145.19",$0.00,"$1,164.95",$0.00
6487-5-051,SUP,HCPCS C1776,,6487-5-051  -  STEM HUM 50MM BODY MRS 25MM SHLDR,"$4,054.38",$0.00,"$4,054.38","$1,824.47","$2,893.61",$0.00,$698.55,$0.00,$0.00,$709.89,"$4,054.38",$0.00,"$2,027.19","$3,211.07","$3,243.50",$0.00,$634.51,$0.00,$645.46,$0.00
6487-5-075,SUP,HCPCS C1776,,6487-5-075  -  STEM HUMERAL 7MM 75MM MRS SHOULDER,"$5,420.00",$0.00,"$5,420.00","$2,439.00","$3,868.25",$0.00,$933.84,$0.00,$0.00,$949.00,"$5,420.00",$0.00,"$2,710.00","$4,292.64","$4,336.00",$0.00,$848.23,$0.00,$862.86,$0.00
6487-5-076,SUP,HCPCS C1776,,6487-5-076  -  STEM HUMERAL 75MM 25MM BODY MRS MRH SHOULDER,"$5,420.00",$0.00,"$5,420.00","$2,439.00","$3,868.25",$0.00,$933.84,$0.00,$0.00,$949.00,"$5,420.00",$0.00,"$2,710.00","$4,292.64","$4,336.00",$0.00,$848.23,$0.00,$862.86,$0.00
6487-5-101,SUP,HCPCS C1776,,6487-5-101  -  STEM HUMERAL 100MM 25MM BODY MRS SHOULDER,"$5,420.00",$0.00,"$5,420.00","$2,439.00","$3,868.25",$0.00,$933.84,$0.00,$0.00,$949.00,"$5,420.00",$0.00,"$2,710.00","$4,292.64","$4,336.00",$0.00,$848.23,$0.00,$862.86,$0.00
6487-5-115,SUP,HCPCS C1776,,6487-5-115  -  STEM HUMERAL 7MM 115MM MRS,"$5,420.00",$0.00,"$5,420.00","$2,439.00","$3,868.25",$0.00,$933.84,$0.00,$0.00,$949.00,"$5,420.00",$0.00,"$2,710.00","$4,292.64","$4,336.00",$0.00,$848.23,$0.00,$862.86,$0.00
6487-5-126,SUP,HCPCS C1776,,6487-5-126  -  STEM HUM 125MM BODY MRS 25MM SHLDR,"$4,054.38",$0.00,"$4,054.38","$1,824.47","$2,893.61",$0.00,$698.55,$0.00,$0.00,$709.89,"$4,054.38",$0.00,"$2,027.19","$3,211.07","$3,243.50",$0.00,$634.51,$0.00,$645.46,$0.00
6487-6-051,SUP,HCPCS C1776,,6487-6-051  -  STEM HUM 50MM BODY MRS 50MM SHLDR,"$4,054.38",$0.00,"$4,054.38","$1,824.47","$2,893.61",$0.00,$698.55,$0.00,$0.00,$709.89,"$4,054.38",$0.00,"$2,027.19","$3,211.07","$3,243.50",$0.00,$634.51,$0.00,$645.46,$0.00
6487-6-075,SUP,HCPCS C1776,,6487-6-075  -  STEM HUMERAL 9MM 75MM MRS,"$5,420.00",$0.00,"$5,420.00","$2,439.00","$3,868.25",$0.00,$933.84,$0.00,$0.00,$949.00,"$5,420.00",$0.00,"$2,710.00","$4,292.64","$4,336.00",$0.00,$848.23,$0.00,$862.86,$0.00
6487-6-076,SUP,HCPCS C1776,,6487-6-076  -  STEM HUMERAL 50MM 75MM BODY MRS,"$5,420.00",$0.00,"$5,420.00","$2,439.00","$3,868.25",$0.00,$933.84,$0.00,$0.00,$949.00,"$5,420.00",$0.00,"$2,710.00","$4,292.64","$4,336.00",$0.00,$848.23,$0.00,$862.86,$0.00
6487-6-101,SUP,HCPCS C1776,,6487-6-101  -  STEM HUMERAL 50MM 100MM BODY MRS SHOULDER,"$5,420.00",$0.00,"$5,420.00","$2,439.00","$3,868.25",$0.00,$933.84,$0.00,$0.00,$949.00,"$5,420.00",$0.00,"$2,710.00","$4,292.64","$4,336.00",$0.00,$848.23,$0.00,$862.86,$0.00
6487-6-115,SUP,HCPCS C1776,,6487-6-115  -  STEM HUMERAL 9MM 115MM MRS SHOULDER,"$5,420.00",$0.00,"$5,420.00","$2,439.00","$3,868.25",$0.00,$933.84,$0.00,$0.00,$949.00,"$5,420.00",$0.00,"$2,710.00","$4,292.64","$4,336.00",$0.00,$848.23,$0.00,$862.86,$0.00
6487-6-126,SUP,HCPCS C1776,,6487-6-126  -  STEM HUM 125MM BODY MRS 50MM SHLDR,"$4,054.38",$0.00,"$4,054.38","$1,824.47","$2,893.61",$0.00,$698.55,$0.00,$0.00,$709.89,"$4,054.38",$0.00,"$2,027.19","$3,211.07","$3,243.50",$0.00,$634.51,$0.00,$645.46,$0.00
6487-7-051,SUP,HCPCS C1776,,6487-7-051  -  STEM HUM 50MM BODY MRS 75MM SHLDR,"$4,054.38",$0.00,"$4,054.38","$1,824.47","$2,893.61",$0.00,$698.55,$0.00,$0.00,$709.89,"$4,054.38",$0.00,"$2,027.19","$3,211.07","$3,243.50",$0.00,$634.51,$0.00,$645.46,$0.00
6487-7-075,SUP,HCPCS C1776,,6487-7-075  -  STEM HUMERAL 11MM 75MM MRS SHOULDER,"$5,420.00",$0.00,"$5,420.00","$2,439.00","$3,868.25",$0.00,$933.84,$0.00,$0.00,$949.00,"$5,420.00",$0.00,"$2,710.00","$4,292.64","$4,336.00",$0.00,$848.23,$0.00,$862.86,$0.00
6487-7-076,SUP,HCPCS C1776,,6487-7-076  -  STEM HUMERAL 75MM 75MM BODY MRS SHOULDER,"$5,420.00",$0.00,"$5,420.00","$2,439.00","$3,868.25",$0.00,$933.84,$0.00,$0.00,$949.00,"$5,420.00",$0.00,"$2,710.00","$4,292.64","$4,336.00",$0.00,$848.23,$0.00,$862.86,$0.00
6487-7-101,SUP,HCPCS C1776,,6487-7-101  -  STEM HUMERAL 100MM 75MM BODY MRS MRH SHOULDER,"$5,420.00",$0.00,"$5,420.00","$2,439.00","$3,868.25",$0.00,$933.84,$0.00,$0.00,$949.00,"$5,420.00",$0.00,"$2,710.00","$4,292.64","$4,336.00",$0.00,$848.23,$0.00,$862.86,$0.00
6487-7-115,SUP,HCPCS C1776,,6487-7-115  -  STEM HUMERAL 11MM 115MM BODY MRS SHOULDER,"$5,420.00",$0.00,"$5,420.00","$2,439.00","$3,868.25",$0.00,$933.84,$0.00,$0.00,$949.00,"$5,420.00",$0.00,"$2,710.00","$4,292.64","$4,336.00",$0.00,$848.23,$0.00,$862.86,$0.00
6487-8-051,SUP,HCPCS C1776,,6487-8-051  -  STEM HUMERAL 100MM 50MM BODY MRS MRH SHOULDER,"$5,420.00",$0.00,"$5,420.00","$2,439.00","$3,868.25",$0.00,$933.84,$0.00,$0.00,$949.00,"$5,420.00",$0.00,"$2,710.00","$4,292.64","$4,336.00",$0.00,$848.23,$0.00,$862.86,$0.00
6487-9-051,SUP,HCPCS C1776,,6487-9-051  -  CAP END 50MM MRS HUMERAL PROXIMAL,"$2,635.00",$0.00,"$2,635.00","$1,185.75","$1,880.60",$0.00,$454.00,$0.00,$0.00,$461.37,"$2,635.00",$0.00,"$1,317.50","$2,086.92","$2,108.00",$0.00,$412.38,$0.00,$419.49,$0.00
6495-1-001,SUP,HCPCS C1776,,6495-1-001  -  COMPONENT FEMORAL STANDARD NEUTRAL GMRS COCR HIP,"$10,355.00",$0.00,"$10,355.00","$4,659.75","$5,158.80",$0.00,"$1,784.11",$0.00,$0.00,"$1,813.08","$10,355.00",$0.00,"$5,177.50","$8,201.16","$8,284.00",$0.00,"$1,620.56",$0.00,"$1,648.52",$0.00
6495-1-002,SUP,HCPCS C1776,,6495-1-002  -  COMPONENT FEMORAL NEUTRAL GMRS HIP TROCHANTER,"$10,355.00",$0.00,"$10,355.00","$4,659.75","$5,158.80",$0.00,"$1,784.11",$0.00,$0.00,"$1,813.08","$10,355.00",$0.00,"$5,177.50","$8,201.16","$8,284.00",$0.00,"$1,620.56",$0.00,"$1,648.52",$0.00
6495-1-101,SUP,HCPCS C1776,,6495-1-101  -  COMPONENT FEMORAL 15D ANTEVERT STANDARD GMRS KNEE LEFT,"$10,355.00",$0.00,"$10,355.00","$4,659.75","$5,158.80",$0.00,"$1,784.11",$0.00,$0.00,"$1,813.08","$10,355.00",$0.00,"$5,177.50","$8,201.16","$8,284.00",$0.00,"$1,620.56",$0.00,"$1,648.52",$0.00
6495-1-102,SUP,HCPCS C1776,,6495-1-102  -  COMPONENT FEMORAL 15D ANTEVERT GMRS KNEE LEFT TROCHANTER,"$10,355.00",$0.00,"$10,355.00","$4,659.75","$5,158.80",$0.00,"$1,784.11",$0.00,$0.00,"$1,813.08","$10,355.00",$0.00,"$5,177.50","$8,201.16","$8,284.00",$0.00,"$1,620.56",$0.00,"$1,648.52",$0.00
6495-1-201,SUP,HCPCS C1776,,6495-1-201  -  COMPONENT FEMORAL 15D ANTEVERT STANDARD GMRS KNEE RIGHT,"$10,355.00",$0.00,"$10,355.00","$4,659.75","$5,158.80",$0.00,"$1,784.11",$0.00,$0.00,"$1,813.08","$10,355.00",$0.00,"$5,177.50","$8,201.16","$8,284.00",$0.00,"$1,620.56",$0.00,"$1,648.52",$0.00
6495-1-202,SUP,HCPCS C1776,,6495-1-202  -  COMPONENT FEMORAL 15D ANTEVERT GMRS KNEE RIGHT TROCHANTER,"$10,355.00",$0.00,"$10,355.00","$4,659.75","$5,158.80",$0.00,"$1,784.11",$0.00,$0.00,"$1,813.08","$10,355.00",$0.00,"$5,177.50","$8,201.16","$8,284.00",$0.00,"$1,620.56",$0.00,"$1,648.52",$0.00
6495-2-010,SUP,HCPCS C1776,,6495-2-010  -  COMPONENT FEMORAL SMALL 65MM GMRS COCR KNEE LEFT,"$14,922.50",$0.00,"$14,922.50","$6,715.13","$5,158.80",$0.00,"$2,571.07",$0.00,$0.00,"$2,612.81","$14,922.50",$0.00,"$7,461.25","$11,818.62","$11,938.00",$0.00,"$2,335.37",$0.00,"$2,375.66",$0.00
6495-2-020,SUP,HCPCS C1776,,6495-2-020  -  COMPONENT FEMORAL SMALL 65MM GMRS DISTAL RIGHT,"$14,922.50",$0.00,"$14,922.50","$6,715.13","$5,158.80",$0.00,"$2,571.07",$0.00,$0.00,"$2,612.81","$14,922.50",$0.00,"$7,461.25","$11,818.62","$11,938.00",$0.00,"$2,335.37",$0.00,"$2,375.66",$0.00
6495-2-030,SUP,HCPCS C1776,,6495-2-030  -  COMPONENT FEMORAL STANDARD 65MM GMRS COCR KNEE LEFT,"$14,787.50",$0.00,"$14,787.50","$6,654.38","$5,158.80",$0.00,"$2,547.81",$0.00,$0.00,"$2,589.17","$14,787.50",$0.00,"$7,393.75","$11,711.70","$11,830.00",$0.00,"$2,314.24",$0.00,"$2,354.17",$0.00
6495-2-040,SUP,HCPCS C1776,,6495-2-040  -  COMPONENT FEMORAL STANDARD 65MM GMRS COCR KNEE RIGHT,"$14,787.50",$0.00,"$14,787.50","$6,654.38","$5,158.80",$0.00,"$2,547.81",$0.00,$0.00,"$2,589.17","$14,787.50",$0.00,"$7,393.75","$11,711.70","$11,830.00",$0.00,"$2,314.24",$0.00,"$2,354.17",$0.00
6495-2-105,SUP,Custom 27803010,,6495-2-105  -  BUSHING FEMORAL SMALL GMRS KNEE,$640.00,$0.00,$640.00,$0.00,$456.77,$0.00,$0.00,$0.00,$0.00,$0.00,$640.00,$0.00,$320.00,$506.88,$512.00,$0.00,$0.00,$0.00,$0.00,$0.00
6495-2-115,SUP,Custom 27803010,,6495-2-115  -  AXLE FEMORAL SMALL GMRS KNEE,"$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
6495-3-010,SUP,Custom 27803010,,6495-3-010  -  INSERT TIBIAL SMALL 10MM GMRS PROXIMAL,"$2,367.50",$0.00,"$2,367.50",$0.00,"$1,689.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,367.50",$0.00,"$1,183.75","$1,875.06","$1,894.00",$0.00,$0.00,$0.00,$0.00,$0.00
6495-3-013,SUP,Custom 27803010,,6495-3-013  -  INSERT TIBIAL SMALL 13MM GMRS PROXIMAL,"$2,367.50",$0.00,"$2,367.50",$0.00,"$1,689.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,367.50",$0.00,"$1,183.75","$1,875.06","$1,894.00",$0.00,$0.00,$0.00,$0.00,$0.00
6495-3-016,SUP,Custom 27803010,,6495-3-016  -  INSERT TIBIAL SMALL 16MM GMRS PROXIMAL,"$2,367.50",$0.00,"$2,367.50",$0.00,"$1,689.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,367.50",$0.00,"$1,183.75","$1,875.06","$1,894.00",$0.00,$0.00,$0.00,$0.00,$0.00
6495-3-020,SUP,Custom 27803010,,6495-3-020  -  INSERT TIBIAL SMALL 20MM GMRS PROXIMAL,"$2,367.50",$0.00,"$2,367.50",$0.00,"$1,689.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,367.50",$0.00,"$1,183.75","$1,875.06","$1,894.00",$0.00,$0.00,$0.00,$0.00,$0.00
6495-3-024,SUP,Custom 27803010,,6495-3-024  -  INSERT TIBIAL SMALL 24MM GMRS PROXIMAL,"$2,367.50",$0.00,"$2,367.50",$0.00,"$1,689.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,367.50",$0.00,"$1,183.75","$1,875.06","$1,894.00",$0.00,$0.00,$0.00,$0.00,$0.00
6495-3-101,SUP,HCPCS C1776,,6495-3-101  -  COMPONENT TIBIAL SMALL GMRS PROXIMAL,"$14,895.00",$0.00,"$14,895.00","$6,702.75","$5,158.80",$0.00,"$2,566.33",$0.00,$0.00,"$2,608.00","$14,895.00",$0.00,"$7,447.50","$11,796.84","$11,916.00",$0.00,"$2,331.07",$0.00,"$2,371.28",$0.00
6495-3-102,SUP,HCPCS C1776,,6495-3-102  -  COMPONENT TIBIAL STANDARD GMRS PROXIMAL,"$14,895.00",$0.00,"$14,895.00","$6,702.75","$5,158.80",$0.00,"$2,566.33",$0.00,$0.00,"$2,608.00","$14,895.00",$0.00,"$7,447.50","$11,796.84","$11,916.00",$0.00,"$2,331.07",$0.00,"$2,371.28",$0.00
6495-3-601,SUP,HCPCS C1776,,6495-3-601  -  COMPONENT TIBIAL SMALL ROTATE GMRS TITANIUM KNEE PROXIMAL,"$6,122.50",$0.00,"$6,122.50","$2,755.13","$4,369.63",$0.00,"$1,054.88",$0.00,$0.00,"$1,072.00","$6,122.50",$0.00,"$3,061.25","$4,849.02","$4,898.00",$0.00,$958.17,$0.00,$974.70,$0.00
6495-5-011,SUP,HCPCS C1776,,6495-5-011  -  STEM FEMORAL STR FLUTE 11MM 125MM PRESSFIT GMRS COCR HIP,"$9,450.00",$0.00,"$9,450.00","$4,252.50","$5,158.80",$0.00,"$1,628.19",$0.00,$0.00,"$1,654.62","$9,450.00",$0.00,"$4,725.00","$7,484.40","$7,560.00",$0.00,"$1,478.93",$0.00,"$1,504.44",$0.00
6495-5-012,SUP,HCPCS C1776,,6495-5-012  -  STEM FEMORAL STR FLUTE 12MM 125MM PRESSFIT GMRS COCR HIP,"$9,450.00",$0.00,"$9,450.00","$4,252.50","$5,158.80",$0.00,"$1,628.19",$0.00,$0.00,"$1,654.62","$9,450.00",$0.00,"$4,725.00","$7,484.40","$7,560.00",$0.00,"$1,478.93",$0.00,"$1,504.44",$0.00
6495-5-013,SUP,HCPCS C1776,,6495-5-013  -  STEM FEMORAL STR FLUTE 13MM 125MM PRESSFIT GMRS COCR HIP,"$9,450.00",$0.00,"$9,450.00","$4,252.50","$5,158.80",$0.00,"$1,628.19",$0.00,$0.00,"$1,654.62","$9,450.00",$0.00,"$4,725.00","$7,484.40","$7,560.00",$0.00,"$1,478.93",$0.00,"$1,504.44",$0.00
6495-5-014,SUP,HCPCS C1776,,6495-5-014  -  STEM FEMORAL STR FLUTE 14MM 125MM PRESSFIT GMRS COCR HIP,"$9,450.00",$0.00,"$9,450.00","$4,252.50","$5,158.80",$0.00,"$1,628.19",$0.00,$0.00,"$1,654.62","$9,450.00",$0.00,"$4,725.00","$7,484.40","$7,560.00",$0.00,"$1,478.93",$0.00,"$1,504.44",$0.00
6495-5-015,SUP,HCPCS C1776,,6495-5-015  -  STEM FEMORAL STR FLUTE 15MM 125MM PRESSFIT GMRS COCR HIP,"$9,450.00",$0.00,"$9,450.00","$4,252.50","$5,158.80",$0.00,"$1,628.19",$0.00,$0.00,"$1,654.62","$9,450.00",$0.00,"$4,725.00","$7,484.40","$7,560.00",$0.00,"$1,478.93",$0.00,"$1,504.44",$0.00
6495-5-016,SUP,HCPCS C1776,,6495-5-016  -  STEM FEMORAL STR FLUTE 16MM 125MM PRESSFIT GMRS COCR HIP,"$9,450.00",$0.00,"$9,450.00","$4,252.50","$5,158.80",$0.00,"$1,628.19",$0.00,$0.00,"$1,654.62","$9,450.00",$0.00,"$4,725.00","$7,484.40","$7,560.00",$0.00,"$1,478.93",$0.00,"$1,504.44",$0.00
6495-5-017,SUP,HCPCS C1776,,6495-5-017  -  STEM FEMORAL STR FLUTE 17MM 125MM PRESSFIT GMRS COCR HIP,"$9,450.00",$0.00,"$9,450.00","$4,252.50","$5,158.80",$0.00,"$1,628.19",$0.00,$0.00,"$1,654.62","$9,450.00",$0.00,"$4,725.00","$7,484.40","$7,560.00",$0.00,"$1,478.93",$0.00,"$1,504.44",$0.00
6495-5-018,SUP,HCPCS C1776,,6495-5-018  -  STEM FEMORAL STR FLUTE 18MM 125MM PRESSFIT GMRS COCR HIP,"$9,450.00",$0.00,"$9,450.00","$4,252.50","$5,158.80",$0.00,"$1,628.19",$0.00,$0.00,"$1,654.62","$9,450.00",$0.00,"$4,725.00","$7,484.40","$7,560.00",$0.00,"$1,478.93",$0.00,"$1,504.44",$0.00
6495-5-019,SUP,HCPCS C1776,,6495-5-019  -  STEM FEMORAL STR FLUTE 19MM 125MM PRESSFIT GMRS COCR HIP,"$9,450.00",$0.00,"$9,450.00","$4,252.50","$5,158.80",$0.00,"$1,628.19",$0.00,$0.00,"$1,654.62","$9,450.00",$0.00,"$4,725.00","$7,484.40","$7,560.00",$0.00,"$1,478.93",$0.00,"$1,504.44",$0.00
6495-5-111,SUP,HCPCS C1776,,6495-5-111  -  STEM FEMORAL LONG BOW 11MM 200MM PRESSFIT GMRS HIP,"$9,962.50",$0.00,"$9,962.50","$4,483.13","$5,158.80",$0.00,"$1,716.49",$0.00,$0.00,"$1,744.35","$9,962.50",$0.00,"$4,981.25","$7,890.30","$7,970.00",$0.00,"$1,559.13",$0.00,"$1,586.03",$0.00
6495-5-112,SUP,HCPCS C1776,,6495-5-112  -  STEM FEMORAL LONG BOW 12MM 200MM PRESSFIT GMRS HIP,"$9,962.50",$0.00,"$9,962.50","$4,483.13","$5,158.80",$0.00,"$1,716.49",$0.00,$0.00,"$1,744.35","$9,962.50",$0.00,"$4,981.25","$7,890.30","$7,970.00",$0.00,"$1,559.13",$0.00,"$1,586.03",$0.00
6495-5-113,SUP,HCPCS C1776,,6495-5-113  -  STEM FEMORAL LONG BOW 13MM 200MM PRESSFIT GMRS HIP,"$9,962.50",$0.00,"$9,962.50","$4,483.13","$5,158.80",$0.00,"$1,716.49",$0.00,$0.00,"$1,744.35","$9,962.50",$0.00,"$4,981.25","$7,890.30","$7,970.00",$0.00,"$1,559.13",$0.00,"$1,586.03",$0.00
6495-5-114,SUP,HCPCS C1776,,6495-5-114  -  STEM FEMORAL LONG BOW 14MM 200MM PRESSFIT GMRS HIP,"$9,962.50",$0.00,"$9,962.50","$4,483.13","$5,158.80",$0.00,"$1,716.49",$0.00,$0.00,"$1,744.35","$9,962.50",$0.00,"$4,981.25","$7,890.30","$7,970.00",$0.00,"$1,559.13",$0.00,"$1,586.03",$0.00
6495-5-115,SUP,HCPCS C1776,,6495-5-115  -  STEM FEMORAL LONG BOW 15MM 200MM PRESSFIT GMRS HIP,"$9,962.50",$0.00,"$9,962.50","$4,483.13","$5,158.80",$0.00,"$1,716.49",$0.00,$0.00,"$1,744.35","$9,962.50",$0.00,"$4,981.25","$7,890.30","$7,970.00",$0.00,"$1,559.13",$0.00,"$1,586.03",$0.00
6495-5-116,SUP,HCPCS C1776,,6495-5-116  -  STEM FEMORAL LONG BOW 16MM 200MM PRESSFIT GMRS HIP,"$9,962.50",$0.00,"$9,962.50","$4,483.13","$5,158.80",$0.00,"$1,716.49",$0.00,$0.00,"$1,744.35","$9,962.50",$0.00,"$4,981.25","$7,890.30","$7,970.00",$0.00,"$1,559.13",$0.00,"$1,586.03",$0.00
6495-5-117,SUP,HCPCS C1776,,6495-5-117  -  STEM FEMORAL LONG BOW 17MM 200MM PRESSFIT GMRS HIP,"$9,962.50",$0.00,"$9,962.50","$4,483.13","$5,158.80",$0.00,"$1,716.49",$0.00,$0.00,"$1,744.35","$9,962.50",$0.00,"$4,981.25","$7,890.30","$7,970.00",$0.00,"$1,559.13",$0.00,"$1,586.03",$0.00
6495-5-118,SUP,HCPCS C1776,,6495-5-118  -  STEM FEMORAL LONG BOW 18MM 200MM PRESSFIT GMRS HIP,"$9,962.50",$0.00,"$9,962.50","$4,483.13","$5,158.80",$0.00,"$1,716.49",$0.00,$0.00,"$1,744.35","$9,962.50",$0.00,"$4,981.25","$7,890.30","$7,970.00",$0.00,"$1,559.13",$0.00,"$1,586.03",$0.00
6495-5-119,SUP,HCPCS C1776,,6495-5-119  -  STEM FEMORAL LONG BOW 19MM 200MM PRESSFIT GMRS HIP,"$9,962.50",$0.00,"$9,962.50","$4,483.13","$5,158.80",$0.00,"$1,716.49",$0.00,$0.00,"$1,744.35","$9,962.50",$0.00,"$4,981.25","$7,890.30","$7,970.00",$0.00,"$1,559.13",$0.00,"$1,586.03",$0.00
6495-5-211,SUP,HCPCS C1776,,6495-5-211  -  STEM FEMORAL BOW 11MM 150MM PRESSFIT GMRS HIP,"$9,962.50",$0.00,"$9,962.50","$4,483.13","$5,158.80",$0.00,"$1,716.49",$0.00,$0.00,"$1,744.35","$9,962.50",$0.00,"$4,981.25","$7,890.30","$7,970.00",$0.00,"$1,559.13",$0.00,"$1,586.03",$0.00
6495-5-212,SUP,HCPCS C1776,,6495-5-212  -  STEM FEMORAL BOW 12MM 150MM PRESSFIT GMRS HIP,"$9,962.50",$0.00,"$9,962.50","$4,483.13","$5,158.80",$0.00,"$1,716.49",$0.00,$0.00,"$1,744.35","$9,962.50",$0.00,"$4,981.25","$7,890.30","$7,970.00",$0.00,"$1,559.13",$0.00,"$1,586.03",$0.00
6495-5-213,SUP,HCPCS C1776,,6495-5-213  -  STEM FEMORAL BOW 13MM 150MM PRESSFIT GMRS HIP,"$9,962.50",$0.00,"$9,962.50","$4,483.13","$5,158.80",$0.00,"$1,716.49",$0.00,$0.00,"$1,744.35","$9,962.50",$0.00,"$4,981.25","$7,890.30","$7,970.00",$0.00,"$1,559.13",$0.00,"$1,586.03",$0.00
6495-5-214,SUP,HCPCS C1776,,6495-5-214  -  STEM FEMORAL BOW 14MM 150MM PRESSFIT GMRS HIP,"$9,962.50",$0.00,"$9,962.50","$4,483.13","$5,158.80",$0.00,"$1,716.49",$0.00,$0.00,"$1,744.35","$9,962.50",$0.00,"$4,981.25","$7,890.30","$7,970.00",$0.00,"$1,559.13",$0.00,"$1,586.03",$0.00
6495-5-215,SUP,HCPCS C1776,,6495-5-215  -  STEM FEMORAL BOW 15MM 150MM PRESSFIT GMRS HIP,"$9,962.50",$0.00,"$9,962.50","$4,483.13","$5,158.80",$0.00,"$1,716.49",$0.00,$0.00,"$1,744.35","$9,962.50",$0.00,"$4,981.25","$7,890.30","$7,970.00",$0.00,"$1,559.13",$0.00,"$1,586.03",$0.00
6495-5-216,SUP,HCPCS C1776,,6495-5-216  -  STEM FEMORAL BOW 16MM 150MM PRESSFIT GMRS HIP,"$9,962.50",$0.00,"$9,962.50","$4,483.13","$5,158.80",$0.00,"$1,716.49",$0.00,$0.00,"$1,744.35","$9,962.50",$0.00,"$4,981.25","$7,890.30","$7,970.00",$0.00,"$1,559.13",$0.00,"$1,586.03",$0.00
6495-5-217,SUP,HCPCS C1776,,6495-5-217  -  STEM FEMORAL BOW 17MM 150MM PRESSFIT GMRS HIP,"$9,962.50",$0.00,"$9,962.50","$4,483.13","$5,158.80",$0.00,"$1,716.49",$0.00,$0.00,"$1,744.35","$9,962.50",$0.00,"$4,981.25","$7,890.30","$7,970.00",$0.00,"$1,559.13",$0.00,"$1,586.03",$0.00
6495-5-218,SUP,HCPCS C1776,,6495-5-218  -  STEM FEMORAL BOW 18MM 150MM PRESSFIT GMRS HIP,"$9,962.50",$0.00,"$9,962.50","$4,483.13","$5,158.80",$0.00,"$1,716.49",$0.00,$0.00,"$1,744.35","$9,962.50",$0.00,"$4,981.25","$7,890.30","$7,970.00",$0.00,"$1,559.13",$0.00,"$1,586.03",$0.00
6495-5-219,SUP,HCPCS C1776,,6495-5-219  -  STEM FEMORAL BOW 19MM 150MM PRESSFIT GMRS HIP,"$9,962.50",$0.00,"$9,962.50","$4,483.13","$5,158.80",$0.00,"$1,716.49",$0.00,$0.00,"$1,744.35","$9,962.50",$0.00,"$4,981.25","$7,890.30","$7,970.00",$0.00,"$1,559.13",$0.00,"$1,586.03",$0.00
6495-6-008,SUP,HCPCS C1776,,6495-6-008  -  COMPONENT FEMORAL 80MM CONCTR GMRS KNEE LEFT,"$9,002.50",$0.00,"$9,002.50","$4,051.13","$5,158.80",$0.00,"$1,551.09",$0.00,$0.00,"$1,576.27","$9,002.50",$0.00,"$4,501.25","$7,129.98","$7,202.00",$0.00,"$1,408.89",$0.00,"$1,433.20",$0.00
6495-6-009,SUP,HCPCS C1776,,6495-6-009  -  COMPONENT FEMORAL 90MM CONNECT PIECE GMRS KNEE LEFT,"$9,002.50",$0.00,"$9,002.50","$4,051.13","$5,158.80",$0.00,"$1,551.09",$0.00,$0.00,"$1,576.27","$9,002.50",$0.00,"$4,501.25","$7,129.98","$7,202.00",$0.00,"$1,408.89",$0.00,"$1,433.20",$0.00
6495-6-018,SUP,HCPCS C1776,,6495-6-018  -  COMPONENT FEMORAL 80MM CONNECT PIECE GMRS TITANIUM HIP RIGHT,"$9,087.50",$0.00,"$9,087.50","$4,089.38","$5,158.80",$0.00,"$1,565.73",$0.00,$0.00,"$1,591.15","$9,087.50",$0.00,"$4,543.75","$7,197.30","$7,270.00",$0.00,"$1,422.19",$0.00,"$1,446.73",$0.00
6495-6-019,SUP,HCPCS C1776,,6495-6-019  -  COMPONENT FEMORAL 90MM CONNECT PIECE GMRS KNEE RIGHT,"$9,087.50",$0.00,"$9,087.50","$4,089.38","$5,158.80",$0.00,"$1,565.73",$0.00,$0.00,"$1,591.15","$9,087.50",$0.00,"$4,543.75","$7,197.30","$7,270.00",$0.00,"$1,422.19",$0.00,"$1,446.73",$0.00
6495-6-030,SUP,HCPCS C1776,,6495-6-030  -  EXTENSION FEMORAL 30MM GMRS COCR KNEE DISTAL,"$6,257.50",$0.00,"$6,257.50","$2,815.88","$4,465.98",$0.00,"$1,078.14",$0.00,$0.00,"$1,095.64","$6,257.50",$0.00,"$3,128.75","$4,955.94","$5,006.00",$0.00,$979.30,$0.00,$996.19,$0.00
6495-6-040,SUP,HCPCS C1776,,6495-6-040  -  EXTENSION FEMORAL 40MM GMRS COCR KNEE DISTAL,"$6,257.50",$0.00,"$6,257.50","$2,815.88","$4,465.98",$0.00,"$1,078.14",$0.00,$0.00,"$1,095.64","$6,257.50",$0.00,"$3,128.75","$4,955.94","$5,006.00",$0.00,$979.30,$0.00,$996.19,$0.00
6495-6-050,SUP,HCPCS C1776,,6495-6-050  -  EXTENSION FEMORAL 50MM GMRS COCR KNEE DISTAL,"$6,257.50",$0.00,"$6,257.50","$2,815.88","$4,465.98",$0.00,"$1,078.14",$0.00,$0.00,"$1,095.64","$6,257.50",$0.00,"$3,128.75","$4,955.94","$5,006.00",$0.00,$979.30,$0.00,$996.19,$0.00
6495-6-060,SUP,HCPCS C1776,,6495-6-060  -  EXTENSION FEMORAL 60MM GMRS COCR KNEE DISTAL,"$6,257.50",$0.00,"$6,257.50","$2,815.88","$4,465.98",$0.00,"$1,078.14",$0.00,$0.00,"$1,095.64","$6,257.50",$0.00,"$3,128.75","$4,955.94","$5,006.00",$0.00,$979.30,$0.00,$996.19,$0.00
6495-6-070,SUP,HCPCS C1776,,6495-6-070  -  EXTENSION FEMORAL 70MM GMRS COCR KNEE DISTAL,"$6,257.50",$0.00,"$6,257.50","$2,815.88","$4,465.98",$0.00,"$1,078.14",$0.00,$0.00,"$1,095.64","$6,257.50",$0.00,"$3,128.75","$4,955.94","$5,006.00",$0.00,$979.30,$0.00,$996.19,$0.00
6495-6-080,SUP,HCPCS C1776,,6495-6-080  -  EXTENSION FEMORAL 80MM GMRS COCR KNEE DISTAL,"$6,257.50",$0.00,"$6,257.50","$2,815.88","$4,465.98",$0.00,"$1,078.14",$0.00,$0.00,"$1,095.64","$6,257.50",$0.00,"$3,128.75","$4,955.94","$5,006.00",$0.00,$979.30,$0.00,$996.19,$0.00
6495-6-100,SUP,HCPCS C1776,,6495-6-100  -  EXTENSION FEMORAL 100MM GMRS COCR KNEE DISTAL,"$6,257.50",$0.00,"$6,257.50","$2,815.88","$4,465.98",$0.00,"$1,078.14",$0.00,$0.00,"$1,095.64","$6,257.50",$0.00,"$3,128.75","$4,955.94","$5,006.00",$0.00,$979.30,$0.00,$996.19,$0.00
6495-6-120,SUP,HCPCS C1776,,6495-6-120  -  EXTENSION FEMORAL 120MM GMRS COCR KNEE DISTAL,"$6,257.50",$0.00,"$6,257.50","$2,815.88","$4,465.98",$0.00,"$1,078.14",$0.00,$0.00,"$1,095.64","$6,257.50",$0.00,"$3,128.75","$4,955.94","$5,006.00",$0.00,$979.30,$0.00,$996.19,$0.00
6495-6-140,SUP,HCPCS C1776,,6495-6-140  -  EXTENSION FEMORAL 140MM GMRS COCR KNEE DISTAL,"$6,257.50",$0.00,"$6,257.50","$2,815.88","$4,465.98",$0.00,"$1,078.14",$0.00,$0.00,"$1,095.64","$6,257.50",$0.00,"$3,128.75","$4,955.94","$5,006.00",$0.00,$979.30,$0.00,$996.19,$0.00
6495-6-160,SUP,HCPCS C1776,,6495-6-160  -  EXTENSION STEM 160MM GMRS COCR KNEE FEMUR,"$6,257.50",$0.00,"$6,257.50","$2,815.88","$4,465.98",$0.00,"$1,078.14",$0.00,$0.00,"$1,095.64","$6,257.50",$0.00,"$3,128.75","$4,955.94","$5,006.00",$0.00,$979.30,$0.00,$996.19,$0.00
6495-6-180,SUP,HCPCS C1776,,6495-6-180  -  EXTENSION FEMORAL 180MM GMRS COCR KNEE DISTAL,"$6,257.50",$0.00,"$6,257.50","$2,815.88","$4,465.98",$0.00,"$1,078.14",$0.00,$0.00,"$1,095.64","$6,257.50",$0.00,"$3,128.75","$4,955.94","$5,006.00",$0.00,$979.30,$0.00,$996.19,$0.00
6495-6-200,SUP,HCPCS C1776,,6495-6-200  -  EXTENSION FEMORAL 200MM GMRS COCR KNEE DISTAL,"$6,257.50",$0.00,"$6,257.50","$2,815.88","$4,465.98",$0.00,"$1,078.14",$0.00,$0.00,"$1,095.64","$6,257.50",$0.00,"$3,128.75","$4,955.94","$5,006.00",$0.00,$979.30,$0.00,$996.19,$0.00
6495-6-220,SUP,HCPCS C1776,,6495-6-220  -  EXTENSION FEMORAL 220MM GMRS COCR KNEE DISTAL,"$6,257.50",$0.00,"$6,257.50","$2,815.88","$4,465.98",$0.00,"$1,078.14",$0.00,$0.00,"$1,095.64","$6,257.50",$0.00,"$3,128.75","$4,955.94","$5,006.00",$0.00,$979.30,$0.00,$996.19,$0.00
6500-000-009,SUP,Custom 27100030,,6500-000-009 -  MODEL ANTM CLRVW ADLT SKL,"$11,250.00",$0.00,"$11,250.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,250.00",$0.00,"$5,625.00","$8,910.00","$9,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
65-0003-S,SUP,Custom 27803010,,65-0003-S  -  FILLER BN VOID 3ML CALLOS,"$2,962.50",$0.00,"$2,962.50",$0.00,"$2,114.34",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,962.50",$0.00,"$1,481.25","$2,346.30","$2,370.00",$0.00,$0.00,$0.00,$0.00,$0.00
65-0005-S,SUP,Custom 27803010,,65-0005-S  -  SYSTEM BN CMNT 5ML CALLOS INJ,"$3,920.00",$0.00,"$3,920.00",$0.00,"$2,797.70",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,920.00",$0.00,"$1,960.00","$3,104.64","$3,136.00",$0.00,$0.00,$0.00,$0.00,$0.00
65-0010-S,SUP,Custom 27803010,,65-0010-S  -  FILLER BN VOID 10ML CALLOS,"$7,750.00",$0.00,"$7,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,750.00",$0.00,"$3,875.00","$6,138.00","$6,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
65-0099-S,SUP,Custom 27203010,,65-0099-S  -  KIT DLV INJ,$255.00,$0.00,$255.00,$0.00,$181.99,$0.00,$0.00,$0.00,$0.00,$0.00,$255.00,$0.00,$127.50,$201.96,$204.00,$0.00,$0.00,$0.00,$0.00,$0.00
650-1057,SUP,HCPCS C1776,,650-1057  -  HEAD FEM 36MM G7 BLX D OPTN HIP,"$10,177.50",$0.00,"$10,177.50","$4,579.88","$5,158.80",$0.00,"$1,753.53",$0.00,$0.00,"$1,782.00","$10,177.50",$0.00,"$5,088.75","$8,060.58","$8,142.00",$0.00,"$1,592.78",$0.00,"$1,620.26",$0.00
65-0105-S,SUP,Custom 27803010,,65-0105-S  -  FILLER BN VOID 5ML CALLOS,"$3,920.00",$0.00,"$3,920.00",$0.00,"$2,797.70",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,920.00",$0.00,"$1,960.00","$3,104.64","$3,136.00",$0.00,$0.00,$0.00,$0.00,$0.00
650-1066,SUP,HCPCS C1776,,650-1066  -  SLEEVE FEMORAL STANDARD TAPER TYPE 1 OPTION BIOLOX DELTA,"$1,030.00",$0.00,"$1,030.00",$463.50,$735.11,$0.00,$177.46,$0.00,$0.00,$180.34,"$1,030.00",$0.00,$515.00,$815.76,$824.00,$0.00,$161.20,$0.00,$163.98,$0.00
65-0110-S,SUP,Custom 27803010,,65-0110-S  -  FILLER BN VOID 10ML CALLOS,"$7,750.00",$0.00,"$7,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,750.00",$0.00,"$3,875.00","$6,138.00","$6,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
65-018-E4S,SUP,Custom 27203010,,65-018-E4S  -  CATHETER INFS 4 4/3FR 65CM CLARIVEIN,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
65-0199-S,SUP,Custom 27203010,,65-0199-S  -  SYSTEM BONE CMNT IMPCT KIT CALLOS,$255.00,$0.00,$255.00,$0.00,$181.99,$0.00,$0.00,$0.00,$0.00,$0.00,$255.00,$0.00,$127.50,$201.96,$204.00,$0.00,$0.00,$0.00,$0.00,$0.00
6515-0814L,SUP,HCPCS C1776,,6515-0814L  -  STEM FEM 205MM 14MM BW RSTOR HYDRXAPT -5MM LEFT HIP,"$12,943.13",$0.00,"$12,943.13","$5,824.41","$5,158.80",$0.00,"$2,230.04",$0.00,$0.00,"$2,266.24","$12,943.13",$0.00,"$6,471.56","$10,250.96","$10,354.50",$0.00,"$2,025.60",$0.00,"$2,060.55",$0.00
6515-0814R,SUP,HCPCS C1776,,6515-0814R  -  STEM FEM 205MM 14MM BW RSTOR HYDRXAPT -5MM RIGHT HIP,"$12,943.13",$0.00,"$12,943.13","$5,824.41","$5,158.80",$0.00,"$2,230.04",$0.00,$0.00,"$2,266.24","$12,943.13",$0.00,"$6,471.56","$10,250.96","$10,354.50",$0.00,"$2,025.60",$0.00,"$2,060.55",$0.00
6515-0915L,SUP,HCPCS C1776,,6515-0915L  -  STEM FEM 205MM 15MM BW RSTOR HYDRXAPT -5MM LEFT HIP,"$12,943.13",$0.00,"$12,943.13","$5,824.41","$5,158.80",$0.00,"$2,230.04",$0.00,$0.00,"$2,266.24","$12,943.13",$0.00,"$6,471.56","$10,250.96","$10,354.50",$0.00,"$2,025.60",$0.00,"$2,060.55",$0.00
6515-0915R,SUP,HCPCS C1776,,6515-0915R  -  STEM FEM 205MM 15MM BW RSTOR HYDRXAPT -5MM RIGHT HIP,"$12,943.13",$0.00,"$12,943.13","$5,824.41","$5,158.80",$0.00,"$2,230.04",$0.00,$0.00,"$2,266.24","$12,943.13",$0.00,"$6,471.56","$10,250.96","$10,354.50",$0.00,"$2,025.60",$0.00,"$2,060.55",$0.00
6515-1016L,SUP,HCPCS C1776,,6515-1016L  -  STEM FEM 205MM 16MM BW RSTOR HYDRXAPT -5MM LEFT HIP,"$12,943.13",$0.00,"$12,943.13","$5,824.41","$5,158.80",$0.00,"$2,230.04",$0.00,$0.00,"$2,266.24","$12,943.13",$0.00,"$6,471.56","$10,250.96","$10,354.50",$0.00,"$2,025.60",$0.00,"$2,060.55",$0.00
6515-1016R,SUP,HCPCS C1776,,6515-1016R  -  STEM FEM 205MM 16MM BW RSTOR HYDRXAPT -5MM RIGHT HIP,"$12,943.13",$0.00,"$12,943.13","$5,824.41","$5,158.80",$0.00,"$2,230.04",$0.00,$0.00,"$2,266.24","$12,943.13",$0.00,"$6,471.56","$10,250.96","$10,354.50",$0.00,"$2,025.60",$0.00,"$2,060.55",$0.00
6515-1117L,SUP,HCPCS C1776,,6515-1117L  -  STEM FEM 205MM 17MM BW RSTOR HYDRXAPT -5MM LEFT HIP,"$12,943.13",$0.00,"$12,943.13","$5,824.41","$5,158.80",$0.00,"$2,230.04",$0.00,$0.00,"$2,266.24","$12,943.13",$0.00,"$6,471.56","$10,250.96","$10,354.50",$0.00,"$2,025.60",$0.00,"$2,060.55",$0.00
6515-1117R,SUP,HCPCS C1776,,6515-1117R  -  STEM FEM 205MM 17MM BW RSTOR HYDRXAPT -5MM RIGHT HIP,"$12,943.13",$0.00,"$12,943.13","$5,824.41","$5,158.80",$0.00,"$2,230.04",$0.00,$0.00,"$2,266.24","$12,943.13",$0.00,"$6,471.56","$10,250.96","$10,354.50",$0.00,"$2,025.60",$0.00,"$2,060.55",$0.00
6515-1218L,SUP,HCPCS C1776,,6515-1218L  -  STEM REV 205MM 18MM RSTOR -5MM LEFT HIP HYDRXAPT BW,"$12,943.13",$0.00,"$12,943.13","$5,824.41","$5,158.80",$0.00,"$2,230.04",$0.00,$0.00,"$2,266.24","$12,943.13",$0.00,"$6,471.56","$10,250.96","$10,354.50",$0.00,"$2,025.60",$0.00,"$2,060.55",$0.00
6515-1218R,SUP,HCPCS C1776,,6515-1218R  -  STEM FEM 205MM 18MM BW RSTOR HYDRXAPT -5MM RIGHT HIP,"$12,943.13",$0.00,"$12,943.13","$5,824.41","$5,158.80",$0.00,"$2,230.04",$0.00,$0.00,"$2,266.24","$12,943.13",$0.00,"$6,471.56","$10,250.96","$10,354.50",$0.00,"$2,025.60",$0.00,"$2,060.55",$0.00
6515-1319L,SUP,HCPCS C1776,,6515-1319L  -  STEM FEM 205MM 19MM BW RSTOR HYDRXAPT -5MM LEFT HIP,"$12,943.13",$0.00,"$12,943.13","$5,824.41","$5,158.80",$0.00,"$2,230.04",$0.00,$0.00,"$2,266.24","$12,943.13",$0.00,"$6,471.56","$10,250.96","$10,354.50",$0.00,"$2,025.60",$0.00,"$2,060.55",$0.00
6515-1319R,SUP,HCPCS C1776,,6515-1319R  -  STEM FEM 205MM 19MM BW RSTOR HYDRXAPT -5MM RIGHT HIP,"$12,943.13",$0.00,"$12,943.13","$5,824.41","$5,158.80",$0.00,"$2,230.04",$0.00,$0.00,"$2,266.24","$12,943.13",$0.00,"$6,471.56","$10,250.96","$10,354.50",$0.00,"$2,025.60",$0.00,"$2,060.55",$0.00
6515-1420L,SUP,HCPCS C1776,,6515-1420L  -  STEM FEM 205MM 20MM BW RSTOR HYDRXAPT -5MM LEFT HIP,"$12,943.13",$0.00,"$12,943.13","$5,824.41","$5,158.80",$0.00,"$2,230.04",$0.00,$0.00,"$2,266.24","$12,943.13",$0.00,"$6,471.56","$10,250.96","$10,354.50",$0.00,"$2,025.60",$0.00,"$2,060.55",$0.00
6515-1420R,SUP,HCPCS C1776,,6515-1420R  -  STEM FEM 205MM 20MM BW RSTOR HYDRXAPT -5MM RIGHT HIP,"$12,943.13",$0.00,"$12,943.13","$5,824.41","$5,158.80",$0.00,"$2,230.04",$0.00,$0.00,"$2,266.24","$12,943.13",$0.00,"$6,471.56","$10,250.96","$10,354.50",$0.00,"$2,025.60",$0.00,"$2,060.55",$0.00
6515-1422L,SUP,HCPCS C1776,,6515-1422L  -  STEM FEM 205MM 22MM BW RSTOR HYDRXAPT -5MM LEFT HIP,"$12,943.13",$0.00,"$12,943.13","$5,824.41","$5,158.80",$0.00,"$2,230.04",$0.00,$0.00,"$2,266.24","$12,943.13",$0.00,"$6,471.56","$10,250.96","$10,354.50",$0.00,"$2,025.60",$0.00,"$2,060.55",$0.00
6515-1422R,SUP,HCPCS C1776,,6515-1422R  -  STEM FEM 205MM 22MM BW RSTOR HYDRXAPT -5MM RIGHT HIP,"$12,943.13",$0.00,"$12,943.13","$5,824.41","$5,158.80",$0.00,"$2,230.04",$0.00,$0.00,"$2,266.24","$12,943.13",$0.00,"$6,471.56","$10,250.96","$10,354.50",$0.00,"$2,025.60",$0.00,"$2,060.55",$0.00
6516-0814L,SUP,HCPCS C1776,,6516-0814L  -  STEM FEM 14MM 14MM RED NECK RSTOR HYDRXAPT -5MM 8 HIP,"$12,943.13",$0.00,"$12,943.13","$5,824.41","$5,158.80",$0.00,"$2,230.04",$0.00,$0.00,"$2,266.24","$12,943.13",$0.00,"$6,471.56","$10,250.96","$10,354.50",$0.00,"$2,025.60",$0.00,"$2,060.55",$0.00
6516-0814R,SUP,HCPCS C1776,,6516-0814R  -  STEM FEM 255MM STR RED NECK RSTOR HYDRXAPT -5MM HIP,"$12,943.13",$0.00,"$12,943.13","$5,824.41","$5,158.80",$0.00,"$2,230.04",$0.00,$0.00,"$2,266.24","$12,943.13",$0.00,"$6,471.56","$10,250.96","$10,354.50",$0.00,"$2,025.60",$0.00,"$2,060.55",$0.00
6516-0915L,SUP,HCPCS C1776,,6516-0915L  -  NECK FEM 15MM RSTOR LEFT HIP HYDRXAPT RED,"$12,943.13",$0.00,"$12,943.13","$5,824.41","$5,158.80",$0.00,"$2,230.04",$0.00,$0.00,"$2,266.24","$12,943.13",$0.00,"$6,471.56","$10,250.96","$10,354.50",$0.00,"$2,025.60",$0.00,"$2,060.55",$0.00
6516-0915R,SUP,HCPCS C1776,,6516-0915R  -  STEM FEM 15MM RED NECK RSTOR HYDRXAPT RIGHT HIP,"$12,943.13",$0.00,"$12,943.13","$5,824.41","$5,158.80",$0.00,"$2,230.04",$0.00,$0.00,"$2,266.24","$12,943.13",$0.00,"$6,471.56","$10,250.96","$10,354.50",$0.00,"$2,025.60",$0.00,"$2,060.55",$0.00
6516-1016L,SUP,HCPCS C1776,,6516-1016L  -  STEM FEM 16MM RED NECK RSTOR HYDRXAPT LEFT HIP,"$12,943.13",$0.00,"$12,943.13","$5,824.41","$5,158.80",$0.00,"$2,230.04",$0.00,$0.00,"$2,266.24","$12,943.13",$0.00,"$6,471.56","$10,250.96","$10,354.50",$0.00,"$2,025.60",$0.00,"$2,060.55",$0.00
6516-1016R,SUP,HCPCS C1776,,6516-1016R  -  STEM FEM 16MM RED NECK RSTOR HYDRXAPT RIGHT HIP,"$12,943.13",$0.00,"$12,943.13","$5,824.41","$5,158.80",$0.00,"$2,230.04",$0.00,$0.00,"$2,266.24","$12,943.13",$0.00,"$6,471.56","$10,250.96","$10,354.50",$0.00,"$2,025.60",$0.00,"$2,060.55",$0.00
6516-1117L,SUP,HCPCS C1776,,6516-1117L  -  STEM FEM 17MM 17MM NO DISTAL SLOT RED NECK SYS RSTOR,"$12,943.13",$0.00,"$12,943.13","$5,824.41","$5,158.80",$0.00,"$2,230.04",$0.00,$0.00,"$2,266.24","$12,943.13",$0.00,"$6,471.56","$10,250.96","$10,354.50",$0.00,"$2,025.60",$0.00,"$2,060.55",$0.00
6516-1117R,SUP,HCPCS C1776,,6516-1117R  -  STEM FEM 17MM RED NECK RSTOR HYDRXAPT RIGHT HIP,"$12,943.13",$0.00,"$12,943.13","$5,824.41","$5,158.80",$0.00,"$2,230.04",$0.00,$0.00,"$2,266.24","$12,943.13",$0.00,"$6,471.56","$10,250.96","$10,354.50",$0.00,"$2,025.60",$0.00,"$2,060.55",$0.00
6516-1218L,SUP,HCPCS C1776,,6516-1218L  -  STEM FEM 18MM RED RSTOR HYDRXAPT LEFT HIP,"$12,943.13",$0.00,"$12,943.13","$5,824.41","$5,158.80",$0.00,"$2,230.04",$0.00,$0.00,"$2,266.24","$12,943.13",$0.00,"$6,471.56","$10,250.96","$10,354.50",$0.00,"$2,025.60",$0.00,"$2,060.55",$0.00
6516-1218R,SUP,HCPCS C1776,,6516-1218R  -  STEM FEM 18MM 18MM RED NECK NO DISTAL SLOT RSTOR HYDRXAPT -5,"$12,943.13",$0.00,"$12,943.13","$5,824.41","$5,158.80",$0.00,"$2,230.04",$0.00,$0.00,"$2,266.24","$12,943.13",$0.00,"$6,471.56","$10,250.96","$10,354.50",$0.00,"$2,025.60",$0.00,"$2,060.55",$0.00
6516-1319L,SUP,HCPCS C1776,,6516-1319L  -  STEM FEM 19MM RED NECK RSTOR HYDRXAPT LEFT HIP,"$12,943.13",$0.00,"$12,943.13","$5,824.41","$5,158.80",$0.00,"$2,230.04",$0.00,$0.00,"$2,266.24","$12,943.13",$0.00,"$6,471.56","$10,250.96","$10,354.50",$0.00,"$2,025.60",$0.00,"$2,060.55",$0.00
6516-1319R,SUP,HCPCS C1776,,6516-1319R  -  STEM FEM 19MM 19MM RED NECK NO DISTAL SLOT RSTOR HYDRXAPT 13,"$12,943.13",$0.00,"$12,943.13","$5,824.41","$5,158.80",$0.00,"$2,230.04",$0.00,$0.00,"$2,266.24","$12,943.13",$0.00,"$6,471.56","$10,250.96","$10,354.50",$0.00,"$2,025.60",$0.00,"$2,060.55",$0.00
6516-1420L,SUP,HCPCS C1776,,6516-1420L  -  STEM FEM 20MM RED NECK RSTOR HYDRXAPT LEFT HIP,"$12,943.13",$0.00,"$12,943.13","$5,824.41","$5,158.80",$0.00,"$2,230.04",$0.00,$0.00,"$2,266.24","$12,943.13",$0.00,"$6,471.56","$10,250.96","$10,354.50",$0.00,"$2,025.60",$0.00,"$2,060.55",$0.00
6516-1420R,SUP,HCPCS C1776,,6516-1420R  -  STEM FEM 20MM RED NECK NO DISTAL SLOT RSTOR HYDRXAPT RIGHT,"$12,943.13",$0.00,"$12,943.13","$5,824.41","$5,158.80",$0.00,"$2,230.04",$0.00,$0.00,"$2,266.24","$12,943.13",$0.00,"$6,471.56","$10,250.96","$10,354.50",$0.00,"$2,025.60",$0.00,"$2,060.55",$0.00
6516-1422L,SUP,HCPCS C1776,,6516-1422L  -  STEM FEM 22MM 22MM NO DISTAL SLOT RED NECK SYS RSTOR,"$12,943.13",$0.00,"$12,943.13","$5,824.41","$5,158.80",$0.00,"$2,230.04",$0.00,$0.00,"$2,266.24","$12,943.13",$0.00,"$6,471.56","$10,250.96","$10,354.50",$0.00,"$2,025.60",$0.00,"$2,060.55",$0.00
6516-1422R,SUP,HCPCS C1776,,6516-1422R  -  STEM FEM 22MM RED NECK RSTOR HYDRXAPT RIGHT HIP,"$12,943.13",$0.00,"$12,943.13","$5,824.41","$5,158.80",$0.00,"$2,230.04",$0.00,$0.00,"$2,266.24","$12,943.13",$0.00,"$6,471.56","$10,250.96","$10,354.50",$0.00,"$2,025.60",$0.00,"$2,060.55",$0.00
6519-1-028,SUP,Custom 27803010,,6519-1-028  -  HEAD FEM +0MM UNV TPR 28MM STRL BLX D HIP,"$1,725.00",$0.00,"$1,725.00",$0.00,"$1,231.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$0.00,$0.00,$0.00,$0.00
6519-1-032,SUP,Custom 27803010,,6519-1-032  -  HEAD FEM +0MM UNV TPR 32MM STRL BLX D HIP,"$1,725.00",$0.00,"$1,725.00",$0.00,"$1,231.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$0.00,$0.00,$0.00,$0.00
6519-1-036,SUP,Custom 27803010,,6519-1-036  -  HEAD FEM +0MM UNV TPR 36MM STRL BLX D HIP,"$1,725.00",$0.00,"$1,725.00",$0.00,"$1,231.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$0.00,$0.00,$0.00,$0.00
6519-1-040,SUP,Custom 27803010,,6519-1-040  -  HEAD FEM +0MM UNV TPR 40MM STRL BLX D HIP,"$1,725.00",$0.00,"$1,725.00",$0.00,"$1,231.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$0.00,$0.00,$0.00,$0.00
6519-1-044,SUP,Custom 27803010,,6519-1-044  -  HEAD FEM +0MM UNV TPR 44MM STRL BLX D HIP,"$1,725.00",$0.00,"$1,725.00",$0.00,"$1,231.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$0.00,$0.00,$0.00,$0.00
6519-T-025,SUP,Custom 27803010,,6519-T-025  -  SLEEVE ADAPTER -2.5MM OFFST UNIVERSAL TAPER V40 TITANIUM HIP,$112.50,$0.00,$112.50,$0.00,$80.29,$0.00,$0.00,$0.00,$0.00,$0.00,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$0.00,$0.00,$0.00,$0.00
6519-T-100,SUP,Custom 27803010,,6519-T-100  -  SLEEVE ADAPTER +0MM OFFST UNIVERSAL TAPER V40 TITANIUM HIP,$112.50,$0.00,$112.50,$0.00,$80.29,$0.00,$0.00,$0.00,$0.00,$0.00,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$0.00,$0.00,$0.00,$0.00
6519-T-204,SUP,Custom 27803010,,6519-T-204  -  SLEEVE ADAPTER +4MM OFFST UNIVERSAL TAPER V40 TITANIUM HIP,$112.50,$0.00,$112.50,$0.00,$80.29,$0.00,$0.00,$0.00,$0.00,$0.00,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$0.00,$0.00,$0.00,$0.00
6522-0509,SUP,HCPCS C1776,,6522-0509  -  STEM FEM 145MM 9MM CTPR RSTOR TI HYDRXAPT HIP,"$11,474.13",$0.00,"$11,474.13","$5,163.36","$5,158.80",$0.00,"$1,976.93",$0.00,$0.00,"$2,009.03","$11,474.13",$0.00,"$5,737.06","$9,087.51","$9,179.30",$0.00,"$1,795.70",$0.00,"$1,826.68",$0.00
6522-0511,SUP,HCPCS C1776,,6522-0511  -  STEM FEM 145MM 11MM CTPR RSTOR TI HYDRXAPT HIP,"$11,474.13",$0.00,"$11,474.13","$5,163.36","$5,158.80",$0.00,"$1,976.93",$0.00,$0.00,"$2,009.03","$11,474.13",$0.00,"$5,737.06","$9,087.51","$9,179.30",$0.00,"$1,795.70",$0.00,"$1,826.68",$0.00
6522-0610,SUP,HCPCS C1776,,6522-0610  -  STEM FEM 145MM 10MM CTPR RSTOR TI HYDRXAPT HIP,"$11,474.13",$0.00,"$11,474.13","$5,163.36","$5,158.80",$0.00,"$1,976.93",$0.00,$0.00,"$2,009.03","$11,474.13",$0.00,"$5,737.06","$9,087.51","$9,179.30",$0.00,"$1,795.70",$0.00,"$1,826.68",$0.00
6522-0612,SUP,HCPCS C1776,,6522-0612  -  STEM FEM 145MM 12MM CTPR RSTOR TI HYDRXAPT HIP,"$11,474.13",$0.00,"$11,474.13","$5,163.36","$5,158.80",$0.00,"$1,976.93",$0.00,$0.00,"$2,009.03","$11,474.13",$0.00,"$5,737.06","$9,087.51","$9,179.30",$0.00,"$1,795.70",$0.00,"$1,826.68",$0.00
6522-0711,SUP,HCPCS C1776,,6522-0711  -  STEM FEM 145MM CTPR RSTOR HYDRXAPT,"$10,684.38",$0.00,"$10,684.38","$4,807.97","$5,158.80",$0.00,"$1,840.86",$0.00,$0.00,"$1,870.75","$10,684.38",$0.00,"$5,342.19","$8,462.03","$8,547.50",$0.00,"$1,672.10",$0.00,"$1,700.95",$0.00
6522-0713,SUP,HCPCS C1776,,6522-0713  -  STEM FEM 145MM CTPR RSTOR HYDRXAPT,"$10,684.38",$0.00,"$10,684.38","$4,807.97","$5,158.80",$0.00,"$1,840.86",$0.00,$0.00,"$1,870.75","$10,684.38",$0.00,"$5,342.19","$8,462.03","$8,547.50",$0.00,"$1,672.10",$0.00,"$1,700.95",$0.00
6522-0812,SUP,HCPCS C1776,,6522-0812  -  STEM FEM 145MM CTPR RSTOR HYDRXAPT,"$10,684.38",$0.00,"$10,684.38","$4,807.97","$5,158.80",$0.00,"$1,840.86",$0.00,$0.00,"$1,870.75","$10,684.38",$0.00,"$5,342.19","$8,462.03","$8,547.50",$0.00,"$1,672.10",$0.00,"$1,700.95",$0.00
6522-0814,SUP,HCPCS C1776,,6522-0814  -  STEM FEM 145MM CTPR RSTOR HYDRXAPT,"$10,684.38",$0.00,"$10,684.38","$4,807.97","$5,158.80",$0.00,"$1,840.86",$0.00,$0.00,"$1,870.75","$10,684.38",$0.00,"$5,342.19","$8,462.03","$8,547.50",$0.00,"$1,672.10",$0.00,"$1,700.95",$0.00
6522-0913,SUP,HCPCS C1776,,6522-0913  -  STEM FEM 145MM CTPR RSTOR HYDRXAPT,"$10,684.38",$0.00,"$10,684.38","$4,807.97","$5,158.80",$0.00,"$1,840.86",$0.00,$0.00,"$1,870.75","$10,684.38",$0.00,"$5,342.19","$8,462.03","$8,547.50",$0.00,"$1,672.10",$0.00,"$1,700.95",$0.00
6522-0915,SUP,HCPCS C1776,,6522-0915  -  STEM FEM 145MM CTPR RSTOR HYDRXAPT,"$10,684.38",$0.00,"$10,684.38","$4,807.97","$5,158.80",$0.00,"$1,840.86",$0.00,$0.00,"$1,870.75","$10,684.38",$0.00,"$5,342.19","$8,462.03","$8,547.50",$0.00,"$1,672.10",$0.00,"$1,700.95",$0.00
6522-1014,SUP,HCPCS C1776,,6522-1014  -  STEM FEM 145MM CTPR RSTOR HYDRXAPT,"$10,684.38",$0.00,"$10,684.38","$4,807.97","$5,158.80",$0.00,"$1,840.86",$0.00,$0.00,"$1,870.75","$10,684.38",$0.00,"$5,342.19","$8,462.03","$8,547.50",$0.00,"$1,672.10",$0.00,"$1,700.95",$0.00
6522-1016,SUP,HCPCS C1776,,6522-1016  -  STEM FEM 145MM CTPR RSTOR HYDRXAPT,"$10,684.38",$0.00,"$10,684.38","$4,807.97","$5,158.80",$0.00,"$1,840.86",$0.00,$0.00,"$1,870.75","$10,684.38",$0.00,"$5,342.19","$8,462.03","$8,547.50",$0.00,"$1,672.10",$0.00,"$1,700.95",$0.00
6522-1115,SUP,HCPCS C1776,,6522-1115  -  STEM FEM 145MM CTPR RSTOR HYDRXAPT,"$10,684.38",$0.00,"$10,684.38","$4,807.97","$5,158.80",$0.00,"$1,840.86",$0.00,$0.00,"$1,870.75","$10,684.38",$0.00,"$5,342.19","$8,462.03","$8,547.50",$0.00,"$1,672.10",$0.00,"$1,700.95",$0.00
6522-1117,SUP,HCPCS C1776,,6522-1117  -  STEM FEM 145MM CTPR RSTOR HYDRXAPT,"$10,684.38",$0.00,"$10,684.38","$4,807.97","$5,158.80",$0.00,"$1,840.86",$0.00,$0.00,"$1,870.75","$10,684.38",$0.00,"$5,342.19","$8,462.03","$8,547.50",$0.00,"$1,672.10",$0.00,"$1,700.95",$0.00
6523-0509,SUP,HCPCS C1776,,6523-0509  -  STEM FEM 175MM 9MM CTPR RSTOR TI HYDRXAPT HIP,"$12,150.13",$0.00,"$12,150.13","$5,467.56","$5,158.80",$0.00,"$2,093.41",$0.00,$0.00,"$2,127.39","$12,150.13",$0.00,"$6,075.06","$9,622.90","$9,720.10",$0.00,"$1,901.49",$0.00,"$1,934.30",$0.00
6523-0511,SUP,HCPCS C1776,,6523-0511  -  STEM FEM 175MM 11MM CTPR RSTOR TI HYDRXAPT HIP,"$12,150.13",$0.00,"$12,150.13","$5,467.56","$5,158.80",$0.00,"$2,093.41",$0.00,$0.00,"$2,127.39","$12,150.13",$0.00,"$6,075.06","$9,622.90","$9,720.10",$0.00,"$1,901.49",$0.00,"$1,934.30",$0.00
6523-0610,SUP,HCPCS C1776,,6523-0610  -  STEM FEM 175MM 10MM CTPR RSTOR TI HYDRXAPT HIP,"$12,150.13",$0.00,"$12,150.13","$5,467.56","$5,158.80",$0.00,"$2,093.41",$0.00,$0.00,"$2,127.39","$12,150.13",$0.00,"$6,075.06","$9,622.90","$9,720.10",$0.00,"$1,901.49",$0.00,"$1,934.30",$0.00
6523-0612,SUP,HCPCS C1776,,6523-0612  -  STEM FEM 175MM 12MM CTPR RSTOR TI HYDRXAPT HIP,"$12,150.13",$0.00,"$12,150.13","$5,467.56","$5,158.80",$0.00,"$2,093.41",$0.00,$0.00,"$2,127.39","$12,150.13",$0.00,"$6,075.06","$9,622.90","$9,720.10",$0.00,"$1,901.49",$0.00,"$1,934.30",$0.00
6523-0711,SUP,HCPCS C1776,,6523-0711  -  STEM FEM 175MM CTPR RSTOR HYDRXAPT,"$11,313.25",$0.00,"$11,313.25","$5,090.96","$5,158.80",$0.00,"$1,949.22",$0.00,$0.00,"$1,980.86","$11,313.25",$0.00,"$5,656.63","$8,960.09","$9,050.60",$0.00,"$1,770.52",$0.00,"$1,801.07",$0.00
6523-0713,SUP,HCPCS C1776,,6523-0713  -  STEM FEM 175MM CTPR RSTOR HYDRXAPT,"$11,313.25",$0.00,"$11,313.25","$5,090.96","$5,158.80",$0.00,"$1,949.22",$0.00,$0.00,"$1,980.86","$11,313.25",$0.00,"$5,656.63","$8,960.09","$9,050.60",$0.00,"$1,770.52",$0.00,"$1,801.07",$0.00
6523-0812,SUP,HCPCS C1776,,6523-0812  -  STEM FEM 175MM CTPR RSTOR HYDRXAPT,"$11,313.25",$0.00,"$11,313.25","$5,090.96","$5,158.80",$0.00,"$1,949.22",$0.00,$0.00,"$1,980.86","$11,313.25",$0.00,"$5,656.63","$8,960.09","$9,050.60",$0.00,"$1,770.52",$0.00,"$1,801.07",$0.00
6523-0814,SUP,HCPCS C1776,,6523-0814  -  STEM FEM 175MM CTPR RSTOR HYDRXAPT,"$11,313.25",$0.00,"$11,313.25","$5,090.96","$5,158.80",$0.00,"$1,949.22",$0.00,$0.00,"$1,980.86","$11,313.25",$0.00,"$5,656.63","$8,960.09","$9,050.60",$0.00,"$1,770.52",$0.00,"$1,801.07",$0.00
6523-0913,SUP,HCPCS C1776,,6523-0913  -  STEM FEM 175MM CTPR RSTOR HYDRXAPT,"$11,313.25",$0.00,"$11,313.25","$5,090.96","$5,158.80",$0.00,"$1,949.22",$0.00,$0.00,"$1,980.86","$11,313.25",$0.00,"$5,656.63","$8,960.09","$9,050.60",$0.00,"$1,770.52",$0.00,"$1,801.07",$0.00
6523-0915,SUP,HCPCS C1776,,6523-0915  -  STEM FEM 175MM CTPR RSTOR HYDRXAPT,"$11,313.25",$0.00,"$11,313.25","$5,090.96","$5,158.80",$0.00,"$1,949.22",$0.00,$0.00,"$1,980.86","$11,313.25",$0.00,"$5,656.63","$8,960.09","$9,050.60",$0.00,"$1,770.52",$0.00,"$1,801.07",$0.00
6523-1014,SUP,HCPCS C1776,,6523-1014  -  STEM HUM 205MM CTPR RSTOR HYDRXAPT,"$11,313.25",$0.00,"$11,313.25","$5,090.96","$5,158.80",$0.00,"$1,949.22",$0.00,$0.00,"$1,980.86","$11,313.25",$0.00,"$5,656.63","$8,960.09","$9,050.60",$0.00,"$1,770.52",$0.00,"$1,801.07",$0.00
6523-1016,SUP,HCPCS C1776,,6523-1016  -  STEM FEM 175MM CTPR RSTOR HYDRXAPT,"$11,313.25",$0.00,"$11,313.25","$5,090.96","$5,158.80",$0.00,"$1,949.22",$0.00,$0.00,"$1,980.86","$11,313.25",$0.00,"$5,656.63","$8,960.09","$9,050.60",$0.00,"$1,770.52",$0.00,"$1,801.07",$0.00
6523-1115,SUP,HCPCS C1776,,6523-1115  -  STEM FEM 175MM CTPR RSTOR HYDRXAPT,"$11,313.25",$0.00,"$11,313.25","$5,090.96","$5,158.80",$0.00,"$1,949.22",$0.00,$0.00,"$1,980.86","$11,313.25",$0.00,"$5,656.63","$8,960.09","$9,050.60",$0.00,"$1,770.52",$0.00,"$1,801.07",$0.00
6523-1117,SUP,HCPCS C1776,,6523-1117  -  STEM FEM 175MM CTPR RSTOR HYDRXAPT,"$11,313.25",$0.00,"$11,313.25","$5,090.96","$5,158.80",$0.00,"$1,949.22",$0.00,$0.00,"$1,980.86","$11,313.25",$0.00,"$5,656.63","$8,960.09","$9,050.60",$0.00,"$1,770.52",$0.00,"$1,801.07",$0.00
6524-0511L,SUP,HCPCS C1776,,6524-0511L  -  STEM FEM 205MM BW RSTOR HYDRXAPT LEFT,"$11,938.88",$0.00,"$11,938.88","$5,372.49","$5,158.80",$0.00,"$2,057.01",$0.00,$0.00,"$2,090.40","$11,938.88",$0.00,"$5,969.44","$9,455.59","$9,551.10",$0.00,"$1,868.43",$0.00,"$1,900.67",$0.00
6524-0511R,SUP,HCPCS C1776,,6524-0511R  -  STEM FEM 205MM BW RSTOR HYDRXAPT RIGHT,"$11,938.88",$0.00,"$11,938.88","$5,372.49","$5,158.80",$0.00,"$2,057.01",$0.00,$0.00,"$2,090.40","$11,938.88",$0.00,"$5,969.44","$9,455.59","$9,551.10",$0.00,"$1,868.43",$0.00,"$1,900.67",$0.00
6524-0612L,SUP,HCPCS C1776,,6524-0612L  -  STEM FEM 205MM BW RSTOR HYDRXAPT LEFT,"$11,938.88",$0.00,"$11,938.88","$5,372.49","$5,158.80",$0.00,"$2,057.01",$0.00,$0.00,"$2,090.40","$11,938.88",$0.00,"$5,969.44","$9,455.59","$9,551.10",$0.00,"$1,868.43",$0.00,"$1,900.67",$0.00
6524-0612R,SUP,HCPCS C1776,,6524-0612R  -  STEM FEM 205MM BW RSTOR HYDRXAPT RIGHT,"$11,938.88",$0.00,"$11,938.88","$5,372.49","$5,158.80",$0.00,"$2,057.01",$0.00,$0.00,"$2,090.40","$11,938.88",$0.00,"$5,969.44","$9,455.59","$9,551.10",$0.00,"$1,868.43",$0.00,"$1,900.67",$0.00
6524-0713L,SUP,HCPCS C1776,,6524-0713L  -  STEM FEM 205MM BW RSTOR HYDRXAPT LEFT,"$12,161.50",$0.00,"$12,161.50","$5,472.68","$5,158.80",$0.00,"$2,095.37",$0.00,$0.00,"$2,129.38","$12,161.50",$0.00,"$6,080.75","$9,631.91","$9,729.20",$0.00,"$1,903.27",$0.00,"$1,936.11",$0.00
6524-0713R,SUP,HCPCS C1776,,6524-0713R  -  STEM FEM 205MM BW RSTOR HYDRXAPT RIGHT,"$11,938.88",$0.00,"$11,938.88","$5,372.49","$5,158.80",$0.00,"$2,057.01",$0.00,$0.00,"$2,090.40","$11,938.88",$0.00,"$5,969.44","$9,455.59","$9,551.10",$0.00,"$1,868.43",$0.00,"$1,900.67",$0.00
6524-0814L,SUP,HCPCS C1776,,6524-0814L  -  STEM FEM 205MM BW RSTOR HYDRXAPT LEFT,"$11,938.88",$0.00,"$11,938.88","$5,372.49","$5,158.80",$0.00,"$2,057.01",$0.00,$0.00,"$2,090.40","$11,938.88",$0.00,"$5,969.44","$9,455.59","$9,551.10",$0.00,"$1,868.43",$0.00,"$1,900.67",$0.00
6524-0814R,SUP,HCPCS C1776,,6524-0814R  -  STEM FEM 205MM BW RSTOR HYDRXAPT RIGHT,"$11,938.88",$0.00,"$11,938.88","$5,372.49","$5,158.80",$0.00,"$2,057.01",$0.00,$0.00,"$2,090.40","$11,938.88",$0.00,"$5,969.44","$9,455.59","$9,551.10",$0.00,"$1,868.43",$0.00,"$1,900.67",$0.00
6524-0915L,SUP,HCPCS C1776,,6524-0915L  -  STEM FEM 205MM BW RSTOR HYDRXAPT LEFT,"$11,938.88",$0.00,"$11,938.88","$5,372.49","$5,158.80",$0.00,"$2,057.01",$0.00,$0.00,"$2,090.40","$11,938.88",$0.00,"$5,969.44","$9,455.59","$9,551.10",$0.00,"$1,868.43",$0.00,"$1,900.67",$0.00
6524-0915R,SUP,HCPCS C1776,,6524-0915R  -  STEM FEM 205MM BW RSTOR HYDRXAPT RIGHT,"$11,938.88",$0.00,"$11,938.88","$5,372.49","$5,158.80",$0.00,"$2,057.01",$0.00,$0.00,"$2,090.40","$11,938.88",$0.00,"$5,969.44","$9,455.59","$9,551.10",$0.00,"$1,868.43",$0.00,"$1,900.67",$0.00
6524-1016L,SUP,HCPCS C1776,,6524-1016L  -  STEM FEM 205MM BW RSTOR HYDRXAPT LEFT,"$11,938.88",$0.00,"$11,938.88","$5,372.49","$5,158.80",$0.00,"$2,057.01",$0.00,$0.00,"$2,090.40","$11,938.88",$0.00,"$5,969.44","$9,455.59","$9,551.10",$0.00,"$1,868.43",$0.00,"$1,900.67",$0.00
6524-1016R,SUP,HCPCS C1776,,6524-1016R  -  STEM FEM 205MM BW RSTOR HYDRXAPT RIGHT,"$11,938.88",$0.00,"$11,938.88","$5,372.49","$5,158.80",$0.00,"$2,057.01",$0.00,$0.00,"$2,090.40","$11,938.88",$0.00,"$5,969.44","$9,455.59","$9,551.10",$0.00,"$1,868.43",$0.00,"$1,900.67",$0.00
6524-1117L,SUP,HCPCS C1776,,6524-1117L  -  STEM FEM 205MM BW RSTOR HYDRXAPT LEFT,"$11,938.88",$0.00,"$11,938.88","$5,372.49","$5,158.80",$0.00,"$2,057.01",$0.00,$0.00,"$2,090.40","$11,938.88",$0.00,"$5,969.44","$9,455.59","$9,551.10",$0.00,"$1,868.43",$0.00,"$1,900.67",$0.00
6524-1117R,SUP,HCPCS C1776,,6524-1117R  -  STEM FEM 205MM BW RSTOR HYDRXAPT RIGHT,"$11,938.88",$0.00,"$11,938.88","$5,372.49","$5,158.80",$0.00,"$2,057.01",$0.00,$0.00,"$2,090.40","$11,938.88",$0.00,"$5,969.44","$9,455.59","$9,551.10",$0.00,"$1,868.43",$0.00,"$1,900.67",$0.00
6528-0511,SUP,HCPCS C1776,,6528-0511  -  STEM FEM 175MM RSTOR HYDRXAPT CLCR 1,"$12,689.63",$0.00,"$12,689.63","$5,710.33","$5,158.80",$0.00,"$2,186.36",$0.00,$0.00,"$2,221.85","$12,689.63",$0.00,"$6,344.81","$10,050.19","$10,151.70",$0.00,"$1,985.93",$0.00,"$2,020.19",$0.00
6528-0612,SUP,HCPCS C1776,,6528-0612  -  STEM FEM 175MM RSTOR HYDRXAPT CLCR 1,"$12,689.63",$0.00,"$12,689.63","$5,710.33","$5,158.80",$0.00,"$2,186.36",$0.00,$0.00,"$2,221.85","$12,689.63",$0.00,"$6,344.81","$10,050.19","$10,151.70",$0.00,"$1,985.93",$0.00,"$2,020.19",$0.00
6528-0713,SUP,HCPCS C1776,,6528-0713  -  STEM FEM 175MM RSTOR HYDRXAPT CLCR 1,"$12,689.63",$0.00,"$12,689.63","$5,710.33","$5,158.80",$0.00,"$2,186.36",$0.00,$0.00,"$2,221.85","$12,689.63",$0.00,"$6,344.81","$10,050.19","$10,151.70",$0.00,"$1,985.93",$0.00,"$2,020.19",$0.00
6528-0814,SUP,HCPCS C1776,,6528-0814  -  STEM FEM 175MM RSTOR HYDRXAPT CLCR 1,"$12,689.63",$0.00,"$12,689.63","$5,710.33","$5,158.80",$0.00,"$2,186.36",$0.00,$0.00,"$2,221.85","$12,689.63",$0.00,"$6,344.81","$10,050.19","$10,151.70",$0.00,"$1,985.93",$0.00,"$2,020.19",$0.00
6528-0915,SUP,HCPCS C1776,,6528-0915  -  CMPNT FEM 175MM CLCR 2 RSTOR HYDRXAPT,"$12,689.63",$0.00,"$12,689.63","$5,710.33","$5,158.80",$0.00,"$2,186.36",$0.00,$0.00,"$2,221.85","$12,689.63",$0.00,"$6,344.81","$10,050.19","$10,151.70",$0.00,"$1,985.93",$0.00,"$2,020.19",$0.00
6528-1016,SUP,HCPCS C1776,,6528-1016  -  STEM FEM 145MM 15MM RSTOR HYDRXAPT 10/16 CLCR,"$12,689.63",$0.00,"$12,689.63","$5,710.33","$5,158.80",$0.00,"$2,186.36",$0.00,$0.00,"$2,221.85","$12,689.63",$0.00,"$6,344.81","$10,050.19","$10,151.70",$0.00,"$1,985.93",$0.00,"$2,020.19",$0.00
6528-1117,SUP,HCPCS C1776,,6528-1117  -  CMPNT FEM 11/17 175MM CLCR 2 RSTOR HYDRXAPT 15MM,"$12,689.63",$0.00,"$12,689.63","$5,710.33","$5,158.80",$0.00,"$2,186.36",$0.00,$0.00,"$2,221.85","$12,689.63",$0.00,"$6,344.81","$10,050.19","$10,151.70",$0.00,"$1,985.93",$0.00,"$2,020.19",$0.00
6528-1218,SUP,HCPCS C1776,,6528-1218  -  CMPNT FEM 12/18 175MM CLCR RSTOR HYDRXAPT 15MM,"$12,689.63",$0.00,"$12,689.63","$5,710.33","$5,158.80",$0.00,"$2,186.36",$0.00,$0.00,"$2,221.85","$12,689.63",$0.00,"$6,344.81","$10,050.19","$10,151.70",$0.00,"$1,985.93",$0.00,"$2,020.19",$0.00
6529-0511,SUP,HCPCS C1776,,6529-0511  -  STEM FEM 175MM 30MM RSTOR HYDRXAPT 5/11 CLCR 2,"$12,689.63",$0.00,"$12,689.63","$5,710.33","$5,158.80",$0.00,"$2,186.36",$0.00,$0.00,"$2,221.85","$12,689.63",$0.00,"$6,344.81","$10,050.19","$10,151.70",$0.00,"$1,985.93",$0.00,"$2,020.19",$0.00
6529-0612,SUP,HCPCS C1776,,6529-0612  -  CMPNT FEM 6/12 175MM CLCR 2 RSTOR HYDRXAPT 30MM,"$12,689.63",$0.00,"$12,689.63","$5,710.33","$5,158.80",$0.00,"$2,186.36",$0.00,$0.00,"$2,221.85","$12,689.63",$0.00,"$6,344.81","$10,050.19","$10,151.70",$0.00,"$1,985.93",$0.00,"$2,020.19",$0.00
6529-0713,SUP,HCPCS C1776,,6529-0713  -  STEM FEM 175MM 30MM RSTOR HYDRXAPT 7/13 CLCR 2,"$12,689.63",$0.00,"$12,689.63","$5,710.33","$5,158.80",$0.00,"$2,186.36",$0.00,$0.00,"$2,221.85","$12,689.63",$0.00,"$6,344.81","$10,050.19","$10,151.70",$0.00,"$1,985.93",$0.00,"$2,020.19",$0.00
6529-0814,SUP,HCPCS C1776,,6529-0814  -  STEM FEM 175MM 30MM RSTOR HYDRXAPT 8/14 CLCR,"$12,689.63",$0.00,"$12,689.63","$5,710.33","$5,158.80",$0.00,"$2,186.36",$0.00,$0.00,"$2,221.85","$12,689.63",$0.00,"$6,344.81","$10,050.19","$10,151.70",$0.00,"$1,985.93",$0.00,"$2,020.19",$0.00
6529-0915,SUP,HCPCS C1776,,6529-0915  -  CMPNT FEM 9/15 175MM CLCR 2 RSTOR HYDRXAPT 30MM,"$12,689.63",$0.00,"$12,689.63","$5,710.33","$5,158.80",$0.00,"$2,186.36",$0.00,$0.00,"$2,221.85","$12,689.63",$0.00,"$6,344.81","$10,050.19","$10,151.70",$0.00,"$1,985.93",$0.00,"$2,020.19",$0.00
6529-1016,SUP,HCPCS C1776,,6529-1016  -  STEM FEM 175MM 30MM RSTOR HYDRXAPT 10/16 CLCR 2,"$12,689.63",$0.00,"$12,689.63","$5,710.33","$5,158.80",$0.00,"$2,186.36",$0.00,$0.00,"$2,221.85","$12,689.63",$0.00,"$6,344.81","$10,050.19","$10,151.70",$0.00,"$1,985.93",$0.00,"$2,020.19",$0.00
6529-1117,SUP,HCPCS C1776,,6529-1117  -  CMPNT FEM 11/17 175MM CLCR 2 RSTOR HYDRXAPT 30MM,"$12,689.63",$0.00,"$12,689.63","$5,710.33","$5,158.80",$0.00,"$2,186.36",$0.00,$0.00,"$2,221.85","$12,689.63",$0.00,"$6,344.81","$10,050.19","$10,151.70",$0.00,"$1,985.93",$0.00,"$2,020.19",$0.00
6565-0-028,SUP,Custom 27803010,,6565-0-028  -  HEAD FEMORAL -2.7MM OFFST TAPER 28MM V40 ALUM CERAMIC HIP,"$1,725.00",$0.00,"$1,725.00",$0.00,"$1,231.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$0.00,$0.00,$0.00,$0.00
6565-0-032,SUP,Custom 27803010,,6565-0-032  -  HEAD FEMORAL -4MM OFFST TAPER 32MM V40 ALUM CERAMIC HIP,"$1,725.00",$0.00,"$1,725.00",$0.00,"$1,231.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$0.00,$0.00,$0.00,$0.00
6565-0-036,SUP,Custom 27803010,,6565-0-036  -  HEAD FEMORAL -5MM OFFST TAPER 36MM V40 ALUM CERAMIC HIP,"$1,725.00",$0.00,"$1,725.00",$0.00,"$1,231.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$0.00,$0.00,$0.00,$0.00
6565-0-128,SUP,Custom 27803010,,6565-0-128  -  HEAD FEMORAL +0MM OFFST TAPER 28MM V40 ALUM CERAMIC HIP,"$1,725.00",$0.00,"$1,725.00",$0.00,"$1,231.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$0.00,$0.00,$0.00,$0.00
6565-0-132,SUP,Custom 27803010,,6565-0-132  -  HEAD FEM +0MM OFST TPR 32MM STRL V40 AL CERM HIP,"$1,725.00",$0.00,"$1,725.00",$0.00,"$1,231.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$0.00,$0.00,$0.00,$0.00
6565-0-136,SUP,Custom 27803010,,6565-0-136  -  HEAD FEMORAL +0MM OFFST TAPER 36MM V40 ALUM CERAMIC HIP,"$1,725.00",$0.00,"$1,725.00",$0.00,"$1,231.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$0.00,$0.00,$0.00,$0.00
6565-0-228,SUP,Custom 27803010,,6565-0-228  -  HEAD FEMORAL +4MM OFFST TAPER 28MM V40 ALUM CERAMIC HIP,"$1,725.00",$0.00,"$1,725.00",$0.00,"$1,231.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$0.00,$0.00,$0.00,$0.00
6565-0-232,SUP,Custom 27803010,,6565-0-232  -  HEAD FEMORAL +4MM OFFST TAPER 32MM V40 ALUM CERAMIC HIP,"$1,725.00",$0.00,"$1,725.00",$0.00,"$1,231.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$0.00,$0.00,$0.00,$0.00
6565-0-236,SUP,Custom 27803010,,6565-0-236  -  HEAD FEM +5MM OFST TPR 36MM STRL V40 AL CERM HIP,"$1,725.00",$0.00,"$1,725.00",$0.00,"$1,231.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$0.00,$0.00,$0.00,$0.00
65652-512,SUP,Custom 27203010,,CANISTER SCT 1L CURVE INTNL ON/OFF VLV XTD BKT HLDR REUSE LF,$64.00,$0.00,$64.00,$0.00,$45.68,$0.00,$0.00,$0.00,$0.00,$0.00,$64.00,$0.00,$32.00,$50.69,$51.20,$0.00,$0.00,$0.00,$0.00,$0.00
6570-0-028,SUP,Custom 27803010,,6570-0-028  -  HEAD FEM -4MM OFST TPR 28MM STRL V40 BLX D HIP,"$1,725.00",$0.00,"$1,725.00",$0.00,"$1,231.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$0.00,$0.00,$0.00,$0.00
6570-0-032,SUP,Custom 27803010,,6570-0-032  -  HEAD FEM -4MM OFST TPR 32MM STRL V40 BLX D HIP,"$1,725.00",$0.00,"$1,725.00",$0.00,"$1,231.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$0.00,$0.00,$0.00,$0.00
6570-0-036,SUP,Custom 27803010,,6570-0-036  -  HEAD FEM -5MM OFST TPR 36MM V40 ANTM BLX D HIP,"$1,725.00",$0.00,"$1,725.00",$0.00,"$1,231.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$0.00,$0.00,$0.00,$0.00
6570-0-128,SUP,Custom 27803010,,6570-0-128  -  HEAD FEMORAL 0MM OFFST TAPER 28MM V40 BIOLOX DELTA HIP,"$1,725.00",$0.00,"$1,725.00",$0.00,"$1,231.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$0.00,$0.00,$0.00,$0.00
6570-0-132,SUP,Custom 27803010,,6570-0-132  -  HEAD FEM +0MM OFST TPR 32MM V40 BLX D HIP,"$1,725.00",$0.00,"$1,725.00",$0.00,"$1,231.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$0.00,$0.00,$0.00,$0.00
6570-0-136,SUP,Custom 27803010,,6570-0-136  -  HEAD FEM +0MM OFST TPR 36MM V40 ANTM BLX D HIP,"$1,725.00",$0.00,"$1,725.00",$0.00,"$1,231.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$0.00,$0.00,$0.00,$0.00
6570-0-228,SUP,Custom 27803010,,6570-0-228  -  HEAD FEM +4MM OFST TPR 28MM STRL V40 BLX D HIP,"$1,725.00",$0.00,"$1,725.00",$0.00,"$1,231.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$0.00,$0.00,$0.00,$0.00
6570-0-232,SUP,Custom 27803010,,6570-0-232  -  HEAD FEM +4MM OFST TPR 32MM STRL V40 BLX D HIP,"$1,725.00",$0.00,"$1,725.00",$0.00,"$1,231.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$0.00,$0.00,$0.00,$0.00
6570-0-236,SUP,Custom 27803010,,6570-0-236  -  HEAD FEM +5MM OFST TPR 36MM V40 ANTM BLX D HIP,"$1,725.00",$0.00,"$1,725.00",$0.00,"$1,231.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$0.00,$0.00,$0.00,$0.00
6570-0-328,SUP,Custom 27803010,,6570-0-328  -  HEAD FEM -2.7MM OFST TPR 28MM STRL V40 BLX D HIP,"$1,725.00",$0.00,"$1,725.00",$0.00,"$1,231.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$0.00,$0.00,$0.00,$0.00
6570-0-436,SUP,Custom 27803010,,6570-0-436  -  HEAD FEM -2.5MM OFST TPR 36MM V40 ANTM BLX D HIP,"$1,725.00",$0.00,"$1,725.00",$0.00,"$1,231.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$0.00,$0.00,$0.00,$0.00
6570-0-536,SUP,Custom 27803010,,6570-0-536  -  HEAD FEM +2.5MM OFST TPR 36MM V40 ANTM BLX D HIP,"$1,725.00",$0.00,"$1,725.00",$0.00,"$1,231.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$0.00,$0.00,$0.00,$0.00
6570-0-736,SUP,Custom 27803010,,6570-0-736  -  HEAD FEM +7.5MM OFST TPR 36MM STRL V40 BLX D HIP,"$1,725.00",$0.00,"$1,725.00",$0.00,"$1,231.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$0.00,$0.00,$0.00,$0.00
65C-2240,SUP,Custom 27803010,,65C-2240  -  CUP ACETAB 40MM 22MM 6.4MM TRIDENT XFIRE HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
65C-2242,SUP,Custom 27803010,,65C-2242  -  CUP ACETAB 42MM 22MM 7.4MM TRIDENT XFIRE HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
65C-2244,SUP,Custom 27803010,,65C-2244  -  CUP ACETAB 44MM 22MM 7.9MM TRIDENT XFIRE HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
65C-2246,SUP,Custom 27803010,,65C-2246  -  CUP ACETAB 46MM 22MM TRIDENT XFIRE HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
65C-2248,SUP,Custom 27803010,,65C-2248  -  CUP ACETAB 48MM 22MM TRIDENT XFIRE HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
65C-2250,SUP,Custom 27803010,,65C-2250  -  CUP ACETAB 50MM 22MM TRIDENT XFIRE HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
65C-2252,SUP,Custom 27803010,,65C-2252  -  CUP ACETAB 52MM 22MM TRIDENT XFIRE HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
65C-2642,SUP,Custom 27803010,,65C-2642  -  CUP ACETAB 42MM 26MM 5.5MM TRIDENT XFIRE HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
65C-2644,SUP,Custom 27803010,,65C-2644  -  CUP ACETAB 44MM 26MM 6.5MM TRIDENT XFIRE HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
65C-2646,SUP,Custom 27803010,,65C-2646  -  CUP ACETAB 46MM 26MM 7.5MM TRIDENT XFIRE HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
65C-2648,SUP,Custom 27803010,,65C-2648  -  CUP ACETAB 48MM 26MM 8MM TRIDENT XFIRE HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
65C-2650,SUP,Custom 27803010,,65C-2650  -  CUP ACETAB 50MM 26MM TRIDENT XFIRE HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
65C-2652,SUP,Custom 27803010,,65C-2652  -  CUP ACETAB 52MM 26MM TRIDENT XFIRE HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
65C-2654,SUP,Custom 27803010,,65C-2654  -  CUP ACETAB 54MM 26MM TRIDENT XFIRE HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
65C-2844,SUP,Custom 27803010,,65C-2844  -  CUP ACETAB 44MM 28MM 5.5MM TRIDENT XFIRE HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
65C-2846,SUP,Custom 27803010,,65C-2846  -  CUP ACETAB 46MM 28MM 6.5MM TRIDENT XFIRE HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
65C-2848,SUP,Custom 27803010,,65C-2848  -  CUP ACETAB 48MM 28MM 7.5MM TRIDENT XFIRE HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
65C-2850,SUP,Custom 27803010,,65C-2850  -  CUP ACETAB 50MM 28MM 8MM TRIDENT XFIRE HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
65C-2852,SUP,Custom 27803010,,65C-2852  -  CUP ACETAB 52MM 28MM 8.5MM TRIDENT XFIRE HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
65C-2854,SUP,Custom 27803010,,65C-2854  -  CUP ACETAB 54MM 28MM 9.5MM TRIDENT XFIRE HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
65C-2856,SUP,Custom 27803010,,65C-2856  -  CUP ACETAB 56MM 28MM 10.5MM TRIDENT XFIRE HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
65C-2858,SUP,Custom 27803010,,65C-2858  -  CUP ACETAB 58MM 28MM 11.5MM TRIDENT XFIRE HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
65C-2860,SUP,Custom 27803010,,65C-2860  -  CUP ACETAB 60MM 28MM 12.5MM TRIDENT XFIRE HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
65C-2863,SUP,Custom 27803010,,65C-2863  -  CUP ACETAB 63MM 28MM 14MM TRIDENT XFIRE HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
65C-2866,SUP,Custom 27803010,,65C-2866  -  CUP ACETAB 66MM 28MM 15.5MM TRIDENT XFIRE HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
65C-3248,SUP,Custom 27803010,,65C-3248  -  CUP ACETAB 48MM 32MM 5.5MM TRIDENT XFIRE HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
65C-3250,SUP,Custom 27803010,,65C-3250  -  CUP ACETAB 50MM 32MM 6.5MM TRIDENT XFIRE HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
65C-3252,SUP,Custom 27803010,,65C-3252  -  CUP ACETAB 52MM 32MM 7.5MM TRIDENT XFIRE HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
65C-3254,SUP,Custom 27803010,,65C-3254  -  CUP ACETAB 54MM 32MM 8MM TRIDENT XFIRE HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
65C-3256,SUP,Custom 27803010,,65C-3256  -  CUP ACETAB 56MM 32MM 8.5MM TRIDENT XFIRE HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
65C-3258,SUP,Custom 27803010,,65C-3258  -  CUP ACETAB 58MM 32MM 9.5MM TRIDENT XFIRE HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
65C-3260,SUP,Custom 27803010,,65C-3260  -  CUP ACETAB 60MM 32MM 10.5MM TRIDENT XFIRE HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
65C-3263,SUP,Custom 27803010,,65C-3263  -  CUP ACETAB 63MM 32MM 12MM TRIDENT XFIRE HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
65C-3266,SUP,Custom 27803010,,65C-3266  -  CUP ACETAB 66MM 32MM 13.5MM TRIDENT XFIRE HIP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
661-00-28B,SUP,Custom 27803010,,661-00-28B  -  INSERT ACETAB 0D B ECCENTRIC 28MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
661-00-28C,SUP,Custom 27803010,,661-00-28C  -  INSERT ACETAB 0D C ECCENTRIC 28MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
661-00-28D,SUP,Custom 27803010,,661-00-28D  -  INSERT ACETAB 0D D ECCENTRIC 28MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
661-00-28E,SUP,Custom 27803010,,661-00-28E  -  INSERT ACETAB 0D E ECCENTRIC 28MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
661-00-28F,SUP,Custom 27803010,,661-00-28F  -  INSERT ACETAB 0D F ECCENTRIC 28MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
661-00-28G,SUP,Custom 27803010,,661-00-28G  -  INSERT ACETAB 0D G ECCENTRIC 28MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
661-00-28H,SUP,Custom 27803010,,661-00-28H  -  INSERT ACETAB 0D H ECCENTRIC 28MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
661-00-28I,SUP,Custom 27803010,,661-00-28I  -  INSERT ACETAB 0D I ECCENTRIC 28MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
661-00-28J,SUP,Custom 27803010,,661-00-28J  -  INSERT ACETAB 0D J ECCENTRIC 28MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
661-00-32D,SUP,Custom 27803010,,661-00-32D  -  INSERT ACETAB 0D D ECCENTRIC 32MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
661-00-32E,SUP,Custom 27803010,,661-00-32E  -  INSERT ACETAB 0D E ECCENTRIC 32MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
661-00-32F,SUP,Custom 27803010,,661-00-32F  -  INSERT ACETAB 0D F ECCENTRIC 32MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
661-00-32G,SUP,Custom 27803010,,661-00-32G  -  INSERT ACETAB 0D G ECCENTRIC 32MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
661-00-32H,SUP,Custom 27803010,,661-00-32H  -  INSERT ACETAB 0D H ECCENTRIC 32MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
661-00-32I,SUP,Custom 27803010,,661-00-32I  -  INSERT ACETAB 0D I ECCENTRIC 32MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
661-00-32J,SUP,Custom 27803010,,661-00-32J  -  INSERT ACETAB 0D J ECCENTRIC 32MM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
661-00-36E,SUP,Custom 27803010,,661-00-36E  -  INSERT ACETAB 0D E 36MM ECCENTRIC TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
661-00-36F,SUP,Custom 27803010,,661-00-36F  -  INSERT ACETAB 0D F 36MM ECCENTRIC TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
661-00-36G,SUP,Custom 27803010,,661-00-36G  -  INSERT ACETAB 0D G 36MM ECCENTRIC TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
661-00-36H,SUP,Custom 27803010,,661-00-36H  -  INSERT ACETAB 0D H 36MM ECCENTRIC TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
661-00-36I,SUP,Custom 27803010,,661-00-36I  -  INSERT ACETAB 0D I 36MM ECCENTRIC TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
661-00-36J,SUP,Custom 27803010,,661-00-36J  -  INSERT ACETAB 0D J 36MM ECCENTRIC TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
661-10-28C,SUP,Custom 27803010,,661-10-28C  -  INSERT ACETAB 10D C ECCENTRIC 28MM PRIM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
661-10-28D,SUP,Custom 27803010,,661-10-28D  -  INSERT ACETAB 10D D ECCENTRIC 28MM PRIM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
661-10-28E,SUP,Custom 27803010,,661-10-28E  -  INSERT ACETAB 10D E ECCENTRIC 28MM PRIM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
661-10-28F,SUP,Custom 27803010,,661-10-28F  -  INSERT ACETAB 10D F ECCENTRIC 28MM PRIM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
661-10-28G,SUP,Custom 27803010,,661-10-28G  -  INSERT ACETAB 10D G ECCENTRIC 28MM PRIM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
661-10-28H,SUP,Custom 27803010,,661-10-28H  -  INSERT ACETAB 10D H ECCENTRIC 28MM PRIM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
661-10-28I,SUP,Custom 27803010,,661-10-28I  -  INSERT ACETAB 10D I ECCENTRIC 28MM PRIM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
661-10-28J,SUP,Custom 27803010,,661-10-28J  -  INSERT ACETAB 10D J ECCENTRIC 28MM PRIM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
661-10-32D,SUP,Custom 27803010,,661-10-32D  -  INSERT ACETAB 10D D ECCENTRIC 32MM PRIM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
661-10-32E,SUP,Custom 27803010,,661-10-32E  -  INSERT ACETAB 10D E ECCENTRIC 32MM PRIM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
661-10-32F,SUP,Custom 27803010,,661-10-32F  -  INSERT ACETAB 10D F ECCENTRIC 32MM PRIM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
661-10-32G,SUP,Custom 27803010,,661-10-32G  -  INSERT ACETAB 10D G ECCENTRIC 32MM PRIM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
661-10-32H,SUP,Custom 27803010,,661-10-32H  -  INSERT ACETAB 10D H ECCENTRIC 32MM PRIM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
661-10-32I,SUP,Custom 27803010,,661-10-32I  -  INSERT ACETAB 10D I ECCENTRIC 32MM PRIM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
661-10-32J,SUP,Custom 27803010,,661-10-32J  -  INSERT ACETAB 10D J ECCENTRIC 32MM PRIM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
661-10-36E,SUP,Custom 27803010,,661-10-36E  -  INSERT ACETAB 10D E ECCENTRIC 36MM PRIM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
661-10-36F,SUP,Custom 27803010,,661-10-36F  -  INSERT ACETAB 10D F ECCENTRIC 36MM PRIM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
661-10-36G,SUP,Custom 27803010,,661-10-36G  -  INSERT ACETAB 10D G ECCENTRIC 36MM PRIM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
661-10-36H,SUP,Custom 27803010,,661-10-36H  -  INSERT ACETAB 10D H ECCENTRIC 36MM PRIM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
661-10-36I,SUP,Custom 27803010,,661-10-36I  -  INSERT ACETAB 10D I ECCENTRIC 36MM PRIM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
661-10-36J,SUP,Custom 27803010,,661-10-36J  -  INSERT ACETAB 10D J ECCENTRIC 36MM PRIM TRIDENT XFIRE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
6630-0-010,SUP,HCPCS C1776,,6630-0-010  -  CMPNT FEM 2XS LEFT KNEE BEADED DRCN,"$4,464.00",$0.00,"$4,464.00","$2,008.80","$3,185.96",$0.00,$769.12,$0.00,$0.00,$781.61,"$4,464.00",$0.00,"$2,232.00","$3,535.49","$3,571.20",$0.00,$698.62,$0.00,$710.67,$0.00
6630-0-015,SUP,HCPCS C1776,,6630-0-015  -  CMPNT FEM 1 2XS LEFT KNEE NBD DRCN,"$3,525.00",$0.00,"$3,525.00","$1,586.25","$2,515.79",$0.00,$607.34,$0.00,$0.00,$617.20,"$3,525.00",$0.00,"$1,762.50","$2,791.80","$2,820.00",$0.00,$551.66,$0.00,$561.18,$0.00
6630-0-020,SUP,HCPCS C1776,,6630-0-020  -  CMPNT FEM 2XS RIGHT BEADED DRCN,"$4,464.00",$0.00,"$4,464.00","$2,008.80","$3,185.96",$0.00,$769.12,$0.00,$0.00,$781.61,"$4,464.00",$0.00,"$2,232.00","$3,535.49","$3,571.20",$0.00,$698.62,$0.00,$710.67,$0.00
6630-0-025,SUP,HCPCS C1776,,6630-0-025  -  CMPNT FEM 1 2XS RIGHT KNEE NBD DRCN,"$3,525.00",$0.00,"$3,525.00","$1,586.25","$2,515.79",$0.00,$607.34,$0.00,$0.00,$617.20,"$3,525.00",$0.00,"$1,762.50","$2,791.80","$2,820.00",$0.00,$551.66,$0.00,$561.18,$0.00
6630-0-110,SUP,HCPCS C1776,,6630-0-110  -  CMPNT FEM XS LEFT BEADED DRCN,"$4,464.00",$0.00,"$4,464.00","$2,008.80","$3,185.96",$0.00,$769.12,$0.00,$0.00,$781.61,"$4,464.00",$0.00,"$2,232.00","$3,535.49","$3,571.20",$0.00,$698.62,$0.00,$710.67,$0.00
6630-0-115,SUP,HCPCS C1776,,6630-0-115  -  CMPNT FEM 2 XS LEFT KNEE NBD DRCN,"$3,525.00",$0.00,"$3,525.00","$1,586.25","$2,515.79",$0.00,$607.34,$0.00,$0.00,$617.20,"$3,525.00",$0.00,"$1,762.50","$2,791.80","$2,820.00",$0.00,$551.66,$0.00,$561.18,$0.00
6630-0-120,SUP,HCPCS C1776,,6630-0-120  -  CMPNT FEM XS RIGHT BEADED DRCN,"$4,464.00",$0.00,"$4,464.00","$2,008.80","$3,185.96",$0.00,$769.12,$0.00,$0.00,$781.61,"$4,464.00",$0.00,"$2,232.00","$3,535.49","$3,571.20",$0.00,$698.62,$0.00,$710.67,$0.00
6630-0-125,SUP,HCPCS C1776,,6630-0-125  -  CMPNT FEM XS STD RIGHT KNEE NBD DRCN,"$3,525.00",$0.00,"$3,525.00","$1,586.25","$2,515.79",$0.00,$607.34,$0.00,$0.00,$617.20,"$3,525.00",$0.00,"$1,762.50","$2,791.80","$2,820.00",$0.00,$551.66,$0.00,$561.18,$0.00
6630-0-210,SUP,HCPCS C1776,,6630-0-210  -  CMPNT FEM SM LEFT BEADED DRCN,"$4,385.00",$0.00,"$4,385.00","$1,973.25","$3,129.57",$0.00,$755.51,$0.00,$0.00,$767.78,"$4,385.00",$0.00,"$2,192.50","$3,472.92","$3,508.00",$0.00,$686.25,$0.00,$698.09,$0.00
6630-0-215,SUP,HCPCS C1776,,6630-0-215  -  CMPNT FEM SM LEFT NBD DRCN,"$3,464.00",$0.00,"$3,464.00","$1,558.80","$2,472.26",$0.00,$596.83,$0.00,$0.00,$606.52,"$3,464.00",$0.00,"$1,732.00","$2,743.49","$2,771.20",$0.00,$542.12,$0.00,$551.47,$0.00
6630-0-220,SUP,HCPCS C1776,,6630-0-220  -  CMPNT FEM SM RIGHT BEADED DRCN,"$4,385.00",$0.00,"$4,385.00","$1,973.25","$3,129.57",$0.00,$755.51,$0.00,$0.00,$767.78,"$4,385.00",$0.00,"$2,192.50","$3,472.92","$3,508.00",$0.00,$686.25,$0.00,$698.09,$0.00
6630-0-225,SUP,HCPCS C1776,,6630-0-225  -  CMPNT FEM SM RIGHT NBD DRCN,"$3,464.00",$0.00,"$3,464.00","$1,558.80","$2,472.26",$0.00,$596.83,$0.00,$0.00,$606.52,"$3,464.00",$0.00,"$1,732.00","$2,743.49","$2,771.20",$0.00,$542.12,$0.00,$551.47,$0.00
663-00-28B,SUP,Custom 27803010,,663-00-28B  -  INSERT ACETAB 0D B ECCENTRIC 28MM TRIDENT X3 HIP,"$3,585.00",$0.00,"$3,585.00",$0.00,"$2,558.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,585.00",$0.00,"$1,792.50","$2,839.32","$2,868.00",$0.00,$0.00,$0.00,$0.00,$0.00
663-00-28C,SUP,Custom 27803010,,663-00-28C  -  INSERT ACETAB 0D C ECCENTRIC 28MM TRIDENT X3 HIP,"$3,585.00",$0.00,"$3,585.00",$0.00,"$2,558.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,585.00",$0.00,"$1,792.50","$2,839.32","$2,868.00",$0.00,$0.00,$0.00,$0.00,$0.00
663-00-28D,SUP,Custom 27803010,,663-00-28D  -  INSERT ACETAB 0D D ECCENTRIC 28MM TRIDENT X3 HIP,"$3,585.00",$0.00,"$3,585.00",$0.00,"$2,558.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,585.00",$0.00,"$1,792.50","$2,839.32","$2,868.00",$0.00,$0.00,$0.00,$0.00,$0.00
663-00-28E,SUP,Custom 27803010,,663-00-28E  -  INSERT ACETAB 0D E ECCENTRIC 28MM TRIDENT X3 HIP,"$3,585.00",$0.00,"$3,585.00",$0.00,"$2,558.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,585.00",$0.00,"$1,792.50","$2,839.32","$2,868.00",$0.00,$0.00,$0.00,$0.00,$0.00
663-00-28F,SUP,Custom 27803010,,663-00-28F  -  INSERT ACETAB 0D F ECCENTRIC 28MM TRIDENT X3 HIP,"$3,585.00",$0.00,"$3,585.00",$0.00,"$2,558.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,585.00",$0.00,"$1,792.50","$2,839.32","$2,868.00",$0.00,$0.00,$0.00,$0.00,$0.00
663-00-28G,SUP,Custom 27803010,,663-00-28G  -  INSERT ACETAB 0D G ECCENTRIC 28MM TRIDENT X3 HIP,"$3,585.00",$0.00,"$3,585.00",$0.00,"$2,558.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,585.00",$0.00,"$1,792.50","$2,839.32","$2,868.00",$0.00,$0.00,$0.00,$0.00,$0.00
663-00-28H,SUP,Custom 27803010,,663-00-28H  -  INSERT ACETAB 0D H ECCENTRIC 28MM TRIDENT X3 HIP,"$3,585.00",$0.00,"$3,585.00",$0.00,"$2,558.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,585.00",$0.00,"$1,792.50","$2,839.32","$2,868.00",$0.00,$0.00,$0.00,$0.00,$0.00
663-00-28I,SUP,Custom 27803010,,663-00-28I  -  INSERT ACETAB 0D I ECCENTRIC 28MM TRIDENT X3 HIP,"$3,585.00",$0.00,"$3,585.00",$0.00,"$2,558.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,585.00",$0.00,"$1,792.50","$2,839.32","$2,868.00",$0.00,$0.00,$0.00,$0.00,$0.00
663-00-28J,SUP,Custom 27803010,,663-00-28J  -  INSERT ACETAB 0D J ECCENTRIC 28MM TRIDENT X3 HIP,"$3,585.00",$0.00,"$3,585.00",$0.00,"$2,558.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,585.00",$0.00,"$1,792.50","$2,839.32","$2,868.00",$0.00,$0.00,$0.00,$0.00,$0.00
6630-0-310,SUP,HCPCS C1776,,6630-0-310  -  CMPNT FEM MED LEFT BEADED DRCN,"$4,385.00",$0.00,"$4,385.00","$1,973.25","$3,129.57",$0.00,$755.51,$0.00,$0.00,$767.78,"$4,385.00",$0.00,"$2,192.50","$3,472.92","$3,508.00",$0.00,$686.25,$0.00,$698.09,$0.00
6630-0-315,SUP,HCPCS C1776,,6630-0-315  -  CMPNT FEM MED LEFT NBD DRCN,"$3,464.00",$0.00,"$3,464.00","$1,558.80","$2,472.26",$0.00,$596.83,$0.00,$0.00,$606.52,"$3,464.00",$0.00,"$1,732.00","$2,743.49","$2,771.20",$0.00,$542.12,$0.00,$551.47,$0.00
6630-0-320,SUP,HCPCS C1776,,6630-0-320  -  CMPNT FEM MED RIGHT BEADED DRCN,"$4,385.00",$0.00,"$4,385.00","$1,973.25","$3,129.57",$0.00,$755.51,$0.00,$0.00,$767.78,"$4,385.00",$0.00,"$2,192.50","$3,472.92","$3,508.00",$0.00,$686.25,$0.00,$698.09,$0.00
6630-0-325,SUP,HCPCS C1776,,6630-0-325  -  CMPNT FEM MED RIGHT NBD DRCN,"$3,464.00",$0.00,"$3,464.00","$1,558.80","$2,472.26",$0.00,$596.83,$0.00,$0.00,$606.52,"$3,464.00",$0.00,"$1,732.00","$2,743.49","$2,771.20",$0.00,$542.12,$0.00,$551.47,$0.00
663-00-32D,SUP,Custom 27803010,,663-00-32D  -  INSERT ACETAB 0D D ECCENTRIC 32MM TRIDENT X3 HIP,"$3,585.00",$0.00,"$3,585.00",$0.00,"$2,558.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,585.00",$0.00,"$1,792.50","$2,839.32","$2,868.00",$0.00,$0.00,$0.00,$0.00,$0.00
663-00-32E,SUP,Custom 27803010,,663-00-32E  -  INSERT ACETAB 0D E ECCENTRIC 32MM TRIDENT X3 HIP,"$3,585.00",$0.00,"$3,585.00",$0.00,"$2,558.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,585.00",$0.00,"$1,792.50","$2,839.32","$2,868.00",$0.00,$0.00,$0.00,$0.00,$0.00
663-00-32F,SUP,Custom 27803010,,663-00-32F  -  INSERT ACETAB 0D F ECCENTRIC 32MM TRIDENT X3 HIP,"$3,585.00",$0.00,"$3,585.00",$0.00,"$2,558.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,585.00",$0.00,"$1,792.50","$2,839.32","$2,868.00",$0.00,$0.00,$0.00,$0.00,$0.00
663-00-32G,SUP,Custom 27803010,,663-00-32G  -  INSERT ACETAB 0D G ECCENTRIC 32MM TRIDENT X3 HIP,"$3,585.00",$0.00,"$3,585.00",$0.00,"$2,558.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,585.00",$0.00,"$1,792.50","$2,839.32","$2,868.00",$0.00,$0.00,$0.00,$0.00,$0.00
663-00-32H,SUP,Custom 27803010,,663-00-32H  -  INSERT ACETAB 0D H ECCENTRIC 32MM TRIDENT X3 HIP,"$3,585.00",$0.00,"$3,585.00",$0.00,"$2,558.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,585.00",$0.00,"$1,792.50","$2,839.32","$2,868.00",$0.00,$0.00,$0.00,$0.00,$0.00
663-00-32I,SUP,Custom 27803010,,663-00-32I  -  INSERT ACETAB 0D I ECCENTRIC 32MM TRIDENT X3 HIP,"$3,585.00",$0.00,"$3,585.00",$0.00,"$2,558.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,585.00",$0.00,"$1,792.50","$2,839.32","$2,868.00",$0.00,$0.00,$0.00,$0.00,$0.00
663-00-32J,SUP,Custom 27803010,,663-00-32J  -  INSERT ACETAB 0D J ECCENTRIC 32MM TRIDENT X3 HIP,"$3,585.00",$0.00,"$3,585.00",$0.00,"$2,558.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,585.00",$0.00,"$1,792.50","$2,839.32","$2,868.00",$0.00,$0.00,$0.00,$0.00,$0.00
663-00-36E,SUP,Custom 27803010,,663-00-36E  -  INSERT ACETAB 0D E ECCENTRIC 36MM TRIDENT X3 HIP,"$3,830.00",$0.00,"$3,830.00",$0.00,"$2,733.47",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,830.00",$0.00,"$1,915.00","$3,033.36","$3,064.00",$0.00,$0.00,$0.00,$0.00,$0.00
663-00-36F,SUP,Custom 27803010,,663-00-36F  -  INSERT ACETAB 0D F ECCENTRIC 36MM TRIDENT X3 HIP,"$3,830.00",$0.00,"$3,830.00",$0.00,"$2,733.47",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,830.00",$0.00,"$1,915.00","$3,033.36","$3,064.00",$0.00,$0.00,$0.00,$0.00,$0.00
663-00-36G,SUP,Custom 27803010,,663-00-36G  -  INSERT ACETAB 0D G ECCENTRIC 36MM TRIDENT X3 HIP,"$3,830.00",$0.00,"$3,830.00",$0.00,"$2,733.47",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,830.00",$0.00,"$1,915.00","$3,033.36","$3,064.00",$0.00,$0.00,$0.00,$0.00,$0.00
663-00-36H,SUP,Custom 27803010,,663-00-36H  -  INSERT ACETAB 0D H ECCENTRIC 36MM TRIDENT X3 HIP,"$3,830.00",$0.00,"$3,830.00",$0.00,"$2,733.47",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,830.00",$0.00,"$1,915.00","$3,033.36","$3,064.00",$0.00,$0.00,$0.00,$0.00,$0.00
663-00-36I,SUP,Custom 27803010,,663-00-36I  -  INSERT ACETAB 0D I ECCENTRIC 36MM TRIDENT X3 HIP,"$3,830.00",$0.00,"$3,830.00",$0.00,"$2,733.47",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,830.00",$0.00,"$1,915.00","$3,033.36","$3,064.00",$0.00,$0.00,$0.00,$0.00,$0.00
663-00-36J,SUP,Custom 27803010,,663-00-36J  -  INSERT ACETAB 0D J ECCENTRIC 36MM TRIDENT X3 HIP,"$3,830.00",$0.00,"$3,830.00",$0.00,"$2,733.47",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,830.00",$0.00,"$1,915.00","$3,033.36","$3,064.00",$0.00,$0.00,$0.00,$0.00,$0.00
6630-0-410,SUP,HCPCS C1776,,6630-0-410  -  CMPNT FEM MED LG LEFT BEADED DRCN,"$4,385.00",$0.00,"$4,385.00","$1,973.25","$3,129.57",$0.00,$755.51,$0.00,$0.00,$767.78,"$4,385.00",$0.00,"$2,192.50","$3,472.92","$3,508.00",$0.00,$686.25,$0.00,$698.09,$0.00
6630-0-415,SUP,HCPCS C1776,,6630-0-415  -  CMPNT FEM MED LG LEFT NBD DRCN,"$3,464.00",$0.00,"$3,464.00","$1,558.80","$2,472.26",$0.00,$596.83,$0.00,$0.00,$606.52,"$3,464.00",$0.00,"$1,732.00","$2,743.49","$2,771.20",$0.00,$542.12,$0.00,$551.47,$0.00
6630-0-420,SUP,HCPCS C1776,,6630-0-420  -  CMPNT FEM MED LG RIGHT BEADED DRCN,"$4,385.00",$0.00,"$4,385.00","$1,973.25","$3,129.57",$0.00,$755.51,$0.00,$0.00,$767.78,"$4,385.00",$0.00,"$2,192.50","$3,472.92","$3,508.00",$0.00,$686.25,$0.00,$698.09,$0.00
6630-0-425,SUP,HCPCS C1776,,6630-0-425  -  CMPNT FEM MED LG RIGHT NBD DRCN,"$3,464.00",$0.00,"$3,464.00","$1,558.80","$2,472.26",$0.00,$596.83,$0.00,$0.00,$606.52,"$3,464.00",$0.00,"$1,732.00","$2,743.49","$2,771.20",$0.00,$542.12,$0.00,$551.47,$0.00
6630-0-510,SUP,HCPCS C1776,,6630-0-510  -  CMPNT FEM LG LEFT BEADED DRCN,"$4,385.00",$0.00,"$4,385.00","$1,973.25","$3,129.57",$0.00,$755.51,$0.00,$0.00,$767.78,"$4,385.00",$0.00,"$2,192.50","$3,472.92","$3,508.00",$0.00,$686.25,$0.00,$698.09,$0.00
6630-0-515,SUP,HCPCS C1776,,6630-0-515  -  CMPNT FEM LG LEFT NBD DRCN,"$3,464.00",$0.00,"$3,464.00","$1,558.80","$2,472.26",$0.00,$596.83,$0.00,$0.00,$606.52,"$3,464.00",$0.00,"$1,732.00","$2,743.49","$2,771.20",$0.00,$542.12,$0.00,$551.47,$0.00
6630-0-520,SUP,HCPCS C1776,,6630-0-520  -  CMPNT FEM LG RIGHT BEADED DRCN,"$4,385.00",$0.00,"$4,385.00","$1,973.25","$3,129.57",$0.00,$755.51,$0.00,$0.00,$767.78,"$4,385.00",$0.00,"$2,192.50","$3,472.92","$3,508.00",$0.00,$686.25,$0.00,$698.09,$0.00
6630-0-525,SUP,HCPCS C1776,,6630-0-525  -  CMPNT FEM LG RIGHT NBD DRCN,"$3,464.00",$0.00,"$3,464.00","$1,558.80","$2,472.26",$0.00,$596.83,$0.00,$0.00,$606.52,"$3,464.00",$0.00,"$1,732.00","$2,743.49","$2,771.20",$0.00,$542.12,$0.00,$551.47,$0.00
6630-0-610,SUP,HCPCS C1776,,6630-0-610  -  CMPNT FEM XL LEFT BEADED DRCN,"$4,464.00",$0.00,"$4,464.00","$2,008.80","$3,185.96",$0.00,$769.12,$0.00,$0.00,$781.61,"$4,464.00",$0.00,"$2,232.00","$3,535.49","$3,571.20",$0.00,$698.62,$0.00,$710.67,$0.00
6630-0-615,SUP,HCPCS C1776,,6630-0-615  -  CMPNT FEM 1 XL LEFT NBD DRCN,"$3,525.00",$0.00,"$3,525.00","$1,586.25","$2,515.79",$0.00,$607.34,$0.00,$0.00,$617.20,"$3,525.00",$0.00,"$1,762.50","$2,791.80","$2,820.00",$0.00,$551.66,$0.00,$561.18,$0.00
6630-0-620,SUP,HCPCS C1776,,6630-0-620  -  CMPNT FEM XL RIGHT BEADED DRCN,"$4,464.00",$0.00,"$4,464.00","$2,008.80","$3,185.96",$0.00,$769.12,$0.00,$0.00,$781.61,"$4,464.00",$0.00,"$2,232.00","$3,535.49","$3,571.20",$0.00,$698.62,$0.00,$710.67,$0.00
6630-0-625,SUP,HCPCS C1776,,6630-0-625  -  CMPNT FEM 1 XL RIGHT NBD DRCN,"$3,525.00",$0.00,"$3,525.00","$1,586.25","$2,515.79",$0.00,$607.34,$0.00,$0.00,$617.20,"$3,525.00",$0.00,"$1,762.50","$2,791.80","$2,820.00",$0.00,$551.66,$0.00,$561.18,$0.00
6630-0-710,SUP,HCPCS C1776,,6630-0-710  -  CMPNT FEM 2XL STD LEFT KNEE BEADED DRCN,"$4,464.00",$0.00,"$4,464.00","$2,008.80","$3,185.96",$0.00,$769.12,$0.00,$0.00,$781.61,"$4,464.00",$0.00,"$2,232.00","$3,535.49","$3,571.20",$0.00,$698.62,$0.00,$710.67,$0.00
6630-0-715,SUP,HCPCS C1776,,6630-0-715  -  CMPNT FEM 2XL LEFT NBD DRCN,"$3,525.00",$0.00,"$3,525.00","$1,586.25","$2,515.79",$0.00,$607.34,$0.00,$0.00,$617.20,"$3,525.00",$0.00,"$1,762.50","$2,791.80","$2,820.00",$0.00,$551.66,$0.00,$561.18,$0.00
6630-0-720,SUP,HCPCS C1776,,6630-0-720  -  CMPNT FEM 2XL RIGHT BEADED DRCN,"$4,464.00",$0.00,"$4,464.00","$2,008.80","$3,185.96",$0.00,$769.12,$0.00,$0.00,$781.61,"$4,464.00",$0.00,"$2,232.00","$3,535.49","$3,571.20",$0.00,$698.62,$0.00,$710.67,$0.00
6630-0-725,SUP,HCPCS C1776,,6630-0-725  -  CMPNT FEM 2XL RIGHT NBD DRCN,"$3,525.00",$0.00,"$3,525.00","$1,586.25","$2,515.79",$0.00,$607.34,$0.00,$0.00,$617.20,"$3,525.00",$0.00,"$1,762.50","$2,791.80","$2,820.00",$0.00,$551.66,$0.00,$561.18,$0.00
6630-6-105,SUP,Custom 27803010,,6630-6-105  -  WEDGE TIBIAL S1 FLAT 5MM REVISION DURACON KNEE RIGHT,"$1,885.00",$0.00,"$1,885.00",$0.00,"$1,345.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,885.00",$0.00,$942.50,"$1,492.92","$1,508.00",$0.00,$0.00,$0.00,$0.00,$0.00
6630-6-110,SUP,Custom 27803010,,6630-6-110  -  WEDGE TIBIAL S1 HEMIFLAT 10MM REVISION DURACON KNEE RIGHT,"$1,885.00",$0.00,"$1,885.00",$0.00,"$1,345.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,885.00",$0.00,$942.50,"$1,492.92","$1,508.00",$0.00,$0.00,$0.00,$0.00,$0.00
6630-6-125,SUP,Custom 27803010,,6630-6-125  -  WEDGE TIBIAL S1 FLAT 5MM REVISION DURACON KNEE LEFT,"$1,885.00",$0.00,"$1,885.00",$0.00,"$1,345.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,885.00",$0.00,$942.50,"$1,492.92","$1,508.00",$0.00,$0.00,$0.00,$0.00,$0.00
6630-6-130,SUP,Custom 27803010,,6630-6-130  -  WEDGE TIBIAL S1 FLAT 10MM REVISION DURACON KNEE LEFT,"$1,885.00",$0.00,"$1,885.00",$0.00,"$1,345.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,885.00",$0.00,$942.50,"$1,492.92","$1,508.00",$0.00,$0.00,$0.00,$0.00,$0.00
6630-6-150,SUP,Custom 27803010,,6630-6-150  -  WEDGE TIBIAL S2 HEMIFLAT 5MM REVISION DURACON KNEE RIGHT,"$1,885.00",$0.00,"$1,885.00",$0.00,"$1,345.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,885.00",$0.00,$942.50,"$1,492.92","$1,508.00",$0.00,$0.00,$0.00,$0.00,$0.00
6630-6-155,SUP,Custom 27803010,,6630-6-155  -  WEDGE TIBIAL S2 HEMIFLAT 10MM REVISION DURACON KNEE RIGHT,"$1,885.00",$0.00,"$1,885.00",$0.00,"$1,345.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,885.00",$0.00,$942.50,"$1,492.92","$1,508.00",$0.00,$0.00,$0.00,$0.00,$0.00
6630-6-170,SUP,Custom 27803010,,6630-6-170  -  WEDGE TIBIAL S2 HEMIFLAT 5MM REVISION DURACON KNEE LEFT,"$1,885.00",$0.00,"$1,885.00",$0.00,"$1,345.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,885.00",$0.00,$942.50,"$1,492.92","$1,508.00",$0.00,$0.00,$0.00,$0.00,$0.00
6630-6-175,SUP,Custom 27803010,,6630-6-175  -  WEDGE TIBIAL S2 FLAT 10MM REVISION DURACON KNEE LEFT,"$1,885.00",$0.00,"$1,885.00",$0.00,"$1,345.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,885.00",$0.00,$942.50,"$1,492.92","$1,508.00",$0.00,$0.00,$0.00,$0.00,$0.00
6630-6-205,SUP,Custom 27803010,,6630-6-205  -  WEDGE TIBIAL M1 FLAT 5MM REVISION DURACON KNEE RIGHT,"$1,885.00",$0.00,"$1,885.00",$0.00,"$1,345.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,885.00",$0.00,$942.50,"$1,492.92","$1,508.00",$0.00,$0.00,$0.00,$0.00,$0.00
6630-6-210,SUP,Custom 27803010,,6630-6-210  -  WEDGE TIBIAL M1 FLAT 10MM REVISION DURACON KNEE RIGHT,"$1,885.00",$0.00,"$1,885.00",$0.00,"$1,345.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,885.00",$0.00,$942.50,"$1,492.92","$1,508.00",$0.00,$0.00,$0.00,$0.00,$0.00
6630-6-225,SUP,Custom 27803010,,6630-6-225  -  WEDGE TIBIAL M1 FLAT 5MM REVISION DURACON KNEE LEFT,"$1,885.00",$0.00,"$1,885.00",$0.00,"$1,345.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,885.00",$0.00,$942.50,"$1,492.92","$1,508.00",$0.00,$0.00,$0.00,$0.00,$0.00
6630-6-230,SUP,Custom 27803010,,6630-6-230  -  WEDGE TIBIAL M1 FLAT 10MM REVISION DURACON KNEE LEFT,"$1,885.00",$0.00,"$1,885.00",$0.00,"$1,345.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,885.00",$0.00,$942.50,"$1,492.92","$1,508.00",$0.00,$0.00,$0.00,$0.00,$0.00
6630-6-250,SUP,Custom 27803010,,6630-6-250  -  WEDGE TIBIAL M2 HEMIFLAT 5MM REVISION DURACON KNEE RIGHT,"$1,885.00",$0.00,"$1,885.00",$0.00,"$1,345.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,885.00",$0.00,$942.50,"$1,492.92","$1,508.00",$0.00,$0.00,$0.00,$0.00,$0.00
6630-6-255,SUP,Custom 27803010,,6630-6-255  -  WEDGE TIBIAL M2 HEMIFLAT 10MM REVISION DURACON KNEE RIGHT,"$1,885.00",$0.00,"$1,885.00",$0.00,"$1,345.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,885.00",$0.00,$942.50,"$1,492.92","$1,508.00",$0.00,$0.00,$0.00,$0.00,$0.00
6630-6-270,SUP,Custom 27803010,,6630-6-270  -  WEDGE TIBIAL M2 HEMIFLAT 5MM REVISION DURACON KNEE LEFT,"$1,885.00",$0.00,"$1,885.00",$0.00,"$1,345.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,885.00",$0.00,$942.50,"$1,492.92","$1,508.00",$0.00,$0.00,$0.00,$0.00,$0.00
6630-6-275,SUP,Custom 27803010,,6630-6-275  -  WEDGE TIBIAL M2 HEMIFLAT 10MM REVISION DURACON KNEE LEFT,"$1,885.00",$0.00,"$1,885.00",$0.00,"$1,345.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,885.00",$0.00,$942.50,"$1,492.92","$1,508.00",$0.00,$0.00,$0.00,$0.00,$0.00
6630-6-305,SUP,Custom 27803010,,6630-6-305  -  WEDGE TIBIAL 1 FLAT 5MM REVISION DURACON KNEE RIGHT,"$1,885.00",$0.00,"$1,885.00",$0.00,"$1,345.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,885.00",$0.00,$942.50,"$1,492.92","$1,508.00",$0.00,$0.00,$0.00,$0.00,$0.00
6630-6-310,SUP,Custom 27803010,,6630-6-310  -  WEDGE TIBIAL 1 FLAT 10MM REVISION DURACON KNEE RIGHT,"$1,885.00",$0.00,"$1,885.00",$0.00,"$1,345.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,885.00",$0.00,$942.50,"$1,492.92","$1,508.00",$0.00,$0.00,$0.00,$0.00,$0.00
6630-6-325,SUP,Custom 27803010,,6630-6-325  -  WEDGE TIBIAL 1 FLAT 5MM REVISION DURACON KNEE LEFT,"$1,885.00",$0.00,"$1,885.00",$0.00,"$1,345.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,885.00",$0.00,$942.50,"$1,492.92","$1,508.00",$0.00,$0.00,$0.00,$0.00,$0.00
6630-6-330,SUP,Custom 27803010,,6630-6-330  -  WEDGE TIBIAL 1 FLAT 10MM REVISION DURACON KNEE LEFT,"$1,885.00",$0.00,"$1,885.00",$0.00,"$1,345.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,885.00",$0.00,$942.50,"$1,492.92","$1,508.00",$0.00,$0.00,$0.00,$0.00,$0.00
6630-6-350,SUP,Custom 27803010,,6630-6-350  -  WEDGE TIBIAL 2 HEMIFLAT 5MM REVISION DURACON KNEE RIGHT,"$1,885.00",$0.00,"$1,885.00",$0.00,"$1,345.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,885.00",$0.00,$942.50,"$1,492.92","$1,508.00",$0.00,$0.00,$0.00,$0.00,$0.00
6630-6-355,SUP,Custom 27803010,,6630-6-355  -  WEDGE TIBIAL 2 HEMIFLAT 10MM REVISION DURACON KNEE RIGHT,"$1,885.00",$0.00,"$1,885.00",$0.00,"$1,345.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,885.00",$0.00,$942.50,"$1,492.92","$1,508.00",$0.00,$0.00,$0.00,$0.00,$0.00
6630-6-370,SUP,Custom 27803010,,6630-6-370  -  WEDGE TIBIAL 2 HEMIFLAT 5MM REVISION DURACON KNEE LEFT,"$1,885.00",$0.00,"$1,885.00",$0.00,"$1,345.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,885.00",$0.00,$942.50,"$1,492.92","$1,508.00",$0.00,$0.00,$0.00,$0.00,$0.00
6630-6-375,SUP,Custom 27803010,,6630-6-375  -  WEDGE TIBIAL 2 HEMIFLAT 10MM REVISION DURACON KNEE LEFT,"$1,885.00",$0.00,"$1,885.00",$0.00,"$1,345.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,885.00",$0.00,$942.50,"$1,492.92","$1,508.00",$0.00,$0.00,$0.00,$0.00,$0.00
6630-6-405,SUP,Custom 27803010,,6630-6-405  -  WEDGE TIBIAL X1 FLAT 5MM REVISION DURACON KNEE RIGHT,"$1,885.00",$0.00,"$1,885.00",$0.00,"$1,345.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,885.00",$0.00,$942.50,"$1,492.92","$1,508.00",$0.00,$0.00,$0.00,$0.00,$0.00
6630-6-410,SUP,Custom 27803010,,6630-6-410  -  WEDGE TIBIAL X1 FLAT 10MM REVISION DURACON KNEE RIGHT,"$1,885.00",$0.00,"$1,885.00",$0.00,"$1,345.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,885.00",$0.00,$942.50,"$1,492.92","$1,508.00",$0.00,$0.00,$0.00,$0.00,$0.00
6630-6-425,SUP,Custom 27803010,,6630-6-425  -  WEDGE TIBIAL X1 FLAT 5MM REVISION DURACON KNEE LEFT,"$1,885.00",$0.00,"$1,885.00",$0.00,"$1,345.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,885.00",$0.00,$942.50,"$1,492.92","$1,508.00",$0.00,$0.00,$0.00,$0.00,$0.00
6630-6-430,SUP,Custom 27803010,,6630-6-430  -  WEDGE TIBIAL X1 FLAT 10MM REVISION DURACON KNEE LEFT,"$1,885.00",$0.00,"$1,885.00",$0.00,"$1,345.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,885.00",$0.00,$942.50,"$1,492.92","$1,508.00",$0.00,$0.00,$0.00,$0.00,$0.00
6630-6-450,SUP,Custom 27803010,,6630-6-450  -  WEDGE TIBIAL X2 FLAT 5MM REVISION DURACON KNEE RIGHT,"$1,885.00",$0.00,"$1,885.00",$0.00,"$1,345.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,885.00",$0.00,$942.50,"$1,492.92","$1,508.00",$0.00,$0.00,$0.00,$0.00,$0.00
6630-6-455,SUP,Custom 27803010,,6630-6-455  -  WEDGE TIBIAL X2 FLAT 10MM REVISION DURACON KNEE RIGHT,"$1,885.00",$0.00,"$1,885.00",$0.00,"$1,345.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,885.00",$0.00,$942.50,"$1,492.92","$1,508.00",$0.00,$0.00,$0.00,$0.00,$0.00
6630-6-470,SUP,Custom 27803010,,6630-6-470  -  WEDGE TIBIAL X2 FLAT 5MM REVISION DURACON KNEE LEFT,"$1,885.00",$0.00,"$1,885.00",$0.00,"$1,345.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,885.00",$0.00,$942.50,"$1,492.92","$1,508.00",$0.00,$0.00,$0.00,$0.00,$0.00
6630-6-475,SUP,Custom 27803010,,6630-6-475  -  WEDGE TIBIAL X2 FLAT 10MM REVISION DURACON KNEE LEFT,"$1,885.00",$0.00,"$1,885.00",$0.00,"$1,345.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,885.00",$0.00,$942.50,"$1,492.92","$1,508.00",$0.00,$0.00,$0.00,$0.00,$0.00
6630-6-510,SUP,Custom 27803010,,6630-6-510  -  WEDGE TIBIAL S1 FULL FLAT 10MM REVISION DURACON KNEE,"$3,147.50",$0.00,"$3,147.50",$0.00,"$2,246.37",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,147.50",$0.00,"$1,573.75","$2,492.82","$2,518.00",$0.00,$0.00,$0.00,$0.00,$0.00
6630-6-515,SUP,Custom 27803010,,6630-6-515  -  WEDGE TIBIAL S2 FULL 10MM REVISION DURACON KNEE,"$3,147.50",$0.00,"$3,147.50",$0.00,"$2,246.37",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,147.50",$0.00,"$1,573.75","$2,492.82","$2,518.00",$0.00,$0.00,$0.00,$0.00,$0.00
6630-6-520,SUP,Custom 27803010,,6630-6-520  -  WEDGE TIBIAL M1 FULL 10MM REVISION DURACON KNEE,"$3,147.50",$0.00,"$3,147.50",$0.00,"$2,246.37",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,147.50",$0.00,"$1,573.75","$2,492.82","$2,518.00",$0.00,$0.00,$0.00,$0.00,$0.00
6630-6-525,SUP,Custom 27803010,,6630-6-525  -  WEDGE TIBIAL M2 FULL FLAT 10MM REVISION DURACON KNEE,"$3,147.50",$0.00,"$3,147.50",$0.00,"$2,246.37",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,147.50",$0.00,"$1,573.75","$2,492.82","$2,518.00",$0.00,$0.00,$0.00,$0.00,$0.00
6630-6-530,SUP,Custom 27803010,,6630-6-530  -  WEDGE TIBIAL 1 FULL FLAT 10MM REVISION DURACON KNEE,"$3,147.50",$0.00,"$3,147.50",$0.00,"$2,246.37",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,147.50",$0.00,"$1,573.75","$2,492.82","$2,518.00",$0.00,$0.00,$0.00,$0.00,$0.00
6630-6-535,SUP,Custom 27803010,,6630-6-535  -  WEDGE TIBIAL 2 FULL FLAT 10MM REVISION DURACON KNEE,"$3,147.50",$0.00,"$3,147.50",$0.00,"$2,246.37",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,147.50",$0.00,"$1,573.75","$2,492.82","$2,518.00",$0.00,$0.00,$0.00,$0.00,$0.00
6630-6-545,SUP,Custom 27803010,,6630-6-545  -  WEDGE TIBIAL X1 FULL 10MM REVISION DURACON KNEE,"$3,147.50",$0.00,"$3,147.50",$0.00,"$2,246.37",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,147.50",$0.00,"$1,573.75","$2,492.82","$2,518.00",$0.00,$0.00,$0.00,$0.00,$0.00
6630-6-550,SUP,Custom 27803010,,6630-6-550  -  WEDGE TIBIAL X2 FULL 10MM REVISION DURACON KNEE,"$3,147.50",$0.00,"$3,147.50",$0.00,"$2,246.37",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,147.50",$0.00,"$1,573.75","$2,492.82","$2,518.00",$0.00,$0.00,$0.00,$0.00,$0.00
6630-8-005,SUP,HCPCS C1776,,6630-8-005  -  CMPNT FEM 2XS LEFT KNEE BEADED DRCN PERIAPT,"$5,209.00",$0.00,"$5,209.00","$2,344.05","$3,717.66",$0.00,$897.48,$0.00,$0.00,$912.05,"$5,209.00",$0.00,"$2,604.50","$4,125.53","$4,167.20",$0.00,$815.21,$0.00,$829.27,$0.00
6630-8-010,SUP,HCPCS C1776,,6630-8-010  -  CMPNT FEM 2XS RIGHT KNEE BEADED DRCN PERIAPT,"$5,209.00",$0.00,"$5,209.00","$2,344.05","$3,717.66",$0.00,$897.48,$0.00,$0.00,$912.05,"$5,209.00",$0.00,"$2,604.50","$4,125.53","$4,167.20",$0.00,$815.21,$0.00,$829.27,$0.00
6630-8-015,SUP,HCPCS C1776,,6630-8-015  -  CMPNT FEM XS LEFT KNEE BEADED DRCN PERIAPT,"$5,209.00",$0.00,"$5,209.00","$2,344.05","$3,717.66",$0.00,$897.48,$0.00,$0.00,$912.05,"$5,209.00",$0.00,"$2,604.50","$4,125.53","$4,167.20",$0.00,$815.21,$0.00,$829.27,$0.00
6630-8-020,SUP,HCPCS C1776,,6630-8-020  -  CMPNT FEM XS RIGHT KNEE BEADED DRCN PERIAPT,"$5,209.00",$0.00,"$5,209.00","$2,344.05","$3,717.66",$0.00,$897.48,$0.00,$0.00,$912.05,"$5,209.00",$0.00,"$2,604.50","$4,125.53","$4,167.20",$0.00,$815.21,$0.00,$829.27,$0.00
6630-8-025,SUP,HCPCS C1776,,6630-8-025  -  CMPNT FEM SM LEFT KNEE BEADED DRCN PERIAPT,"$5,167.00",$0.00,"$5,167.00","$2,325.15","$3,687.69",$0.00,$890.25,$0.00,$0.00,$904.70,"$5,167.00",$0.00,"$2,583.50","$4,092.26","$4,133.60",$0.00,$808.64,$0.00,$822.59,$0.00
6630-8-030,SUP,HCPCS C1776,,6630-8-030  -  CMPNT FEM SM RIGHT KNEE BEADED DRCN PERIAPT,"$5,167.00",$0.00,"$5,167.00","$2,325.15","$3,687.69",$0.00,$890.25,$0.00,$0.00,$904.70,"$5,167.00",$0.00,"$2,583.50","$4,092.26","$4,133.60",$0.00,$808.64,$0.00,$822.59,$0.00
6630-8-035,SUP,HCPCS C1776,,6630-8-035  -  CMPNT FEM MED LEFT KNEE BEADED DRCN PERIAPT,"$5,167.00",$0.00,"$5,167.00","$2,325.15","$3,687.69",$0.00,$890.25,$0.00,$0.00,$904.70,"$5,167.00",$0.00,"$2,583.50","$4,092.26","$4,133.60",$0.00,$808.64,$0.00,$822.59,$0.00
6630-8-040,SUP,HCPCS C1776,,6630-8-040  -  CMPNT FEM MED RIGHT KNEE BEADED DRCN PERIAPT,"$5,167.00",$0.00,"$5,167.00","$2,325.15","$3,687.69",$0.00,$890.25,$0.00,$0.00,$904.70,"$5,167.00",$0.00,"$2,583.50","$4,092.26","$4,133.60",$0.00,$808.64,$0.00,$822.59,$0.00
6630-8-045,SUP,HCPCS C1776,,6630-8-045  -  CMPNT FEM MED LG LEFT KNEE BEADED DRCN PERIAPT,"$5,167.00",$0.00,"$5,167.00","$2,325.15","$3,687.69",$0.00,$890.25,$0.00,$0.00,$904.70,"$5,167.00",$0.00,"$2,583.50","$4,092.26","$4,133.60",$0.00,$808.64,$0.00,$822.59,$0.00
6630-8-050,SUP,HCPCS C1776,,6630-8-050  -  CMPNT FEM MED LG RIGHT KNEE BEADED DRCN PERIAPT,"$5,167.00",$0.00,"$5,167.00","$2,325.15","$3,687.69",$0.00,$890.25,$0.00,$0.00,$904.70,"$5,167.00",$0.00,"$2,583.50","$4,092.26","$4,133.60",$0.00,$808.64,$0.00,$822.59,$0.00
6630-8-055,SUP,HCPCS C1776,,6630-8-055  -  CMPNT FEM LG LEFT KNEE BEADED DRCN PERIAPT,"$5,167.00",$0.00,"$5,167.00","$2,325.15","$3,687.69",$0.00,$890.25,$0.00,$0.00,$904.70,"$5,167.00",$0.00,"$2,583.50","$4,092.26","$4,133.60",$0.00,$808.64,$0.00,$822.59,$0.00
6630-8-060,SUP,HCPCS C1776,,6630-8-060  -  BSPLT TIB DRCN LG FEM RIGHT BEADED PERIAPT 28MM,"$5,167.00",$0.00,"$5,167.00","$2,325.15","$3,687.69",$0.00,$890.25,$0.00,$0.00,$904.70,"$5,167.00",$0.00,"$2,583.50","$4,092.26","$4,133.60",$0.00,$808.64,$0.00,$822.59,$0.00
6630-8-065,SUP,HCPCS C1776,,6630-8-065  -  CMPNT FEM XL LEFT KNEE BEADED DRCN PERIAPT,"$5,209.00",$0.00,"$5,209.00","$2,344.05","$3,717.66",$0.00,$897.48,$0.00,$0.00,$912.05,"$5,209.00",$0.00,"$2,604.50","$4,125.53","$4,167.20",$0.00,$815.21,$0.00,$829.27,$0.00
6630-8-070,SUP,HCPCS C1776,,6630-8-070  -  CMPNT FEM XL RIGHT KNEE BEADED DRCN PERIAPT,"$5,209.00",$0.00,"$5,209.00","$2,344.05","$3,717.66",$0.00,$897.48,$0.00,$0.00,$912.05,"$5,209.00",$0.00,"$2,604.50","$4,125.53","$4,167.20",$0.00,$815.21,$0.00,$829.27,$0.00
6630-8-075,SUP,HCPCS C1776,,6630-8-075  -  CMPNT FEM 2XL LEFT KNEE BEADED DRCN PERIAPT,"$5,209.00",$0.00,"$5,209.00","$2,344.05","$3,717.66",$0.00,$897.48,$0.00,$0.00,$912.05,"$5,209.00",$0.00,"$2,604.50","$4,125.53","$4,167.20",$0.00,$815.21,$0.00,$829.27,$0.00
6630-8-080,SUP,HCPCS C1776,,6630-8-080  -  CMPNT FEM 2XL RIGHT KNEE BEADED DRCN PERIAPT,"$5,209.00",$0.00,"$5,209.00","$2,344.05","$3,717.66",$0.00,$897.48,$0.00,$0.00,$912.05,"$5,209.00",$0.00,"$2,604.50","$4,125.53","$4,167.20",$0.00,$815.21,$0.00,$829.27,$0.00
663-10-28C,SUP,Custom 27803010,,663-10-28C  -  INSERT ACETAB 10D C ECCENTRIC 28MM TRIDENT X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
663-10-28D,SUP,Custom 27803010,,663-10-28D  -  INSERT ACETAB 10D D ECCENTRIC 28MM TRIDENT X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
663-10-28E,SUP,Custom 27803010,,663-10-28E  -  INSERT ACETAB 10D E ECCENTRIC 28MM TRIDENT X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
663-10-28F,SUP,Custom 27803010,,663-10-28F  -  INSERT ACETAB 10D F ECCENTRIC 28MM TRIDENT X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
663-10-28G,SUP,Custom 27803010,,663-10-28G  -  INSERT ACETAB 10D G ECCENTRIC 28MM TRIDENT X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
663-10-28H,SUP,Custom 27803010,,663-10-28H  -  INSERT ACETAB 10D H ECCENTRIC 28MM TRIDENT X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
663-10-28I,SUP,Custom 27803010,,663-10-28I  -  INSERT ACETAB 10D I ECCENTRIC 28MM TRIDENT X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
663-10-28J,SUP,Custom 27803010,,663-10-28J  -  INSERT ACETAB 10D J ECCENTRIC 28MM TRIDENT X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
663-10-32D,SUP,Custom 27803010,,663-10-32D  -  INSERT ACETAB 10D D ECCENTRIC 32MM TRIDENT X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
663-10-32E,SUP,Custom 27803010,,663-10-32E  -  INSERT ACETAB 10D E ECCENTRIC 32MM TRIDENT X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
663-10-32F,SUP,Custom 27803010,,663-10-32F  -  INSERT ACETAB 10D F ECCENTRIC 32MM TRIDENT X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
663-10-32G,SUP,Custom 27803010,,663-10-32G  -  INSERT ACETAB 10D G ECCENTRIC 32MM TRIDENT X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
663-10-32H,SUP,Custom 27803010,,663-10-32H  -  INSERT ACETAB 10D H ECCENTRIC 32MM TRIDENT X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
663-10-32I,SUP,Custom 27803010,,663-10-32I  -  INSERT ACETAB 10D I ECCENTRIC 32MM TRIDENT X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
663-10-32J,SUP,Custom 27803010,,663-10-32J  -  INSERT ACETAB 10D J ECCENTRIC 32MM TRIDENT X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
663-10-36E,SUP,Custom 27803010,,663-10-36E  -  INSERT ACETAB 10D E ECCENTRIC 36MM TRIDENT X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
663-10-36F,SUP,Custom 27803010,,663-10-36F  -  INSERT ACETAB 10D F ECCENTRIC 36MM TRIDENT X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
663-10-36G,SUP,Custom 27803010,,663-10-36G  -  INSERT ACETAB 10D G ECCENTRIC 36MM TRIDENT X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
663-10-36H,SUP,Custom 27803010,,663-10-36H  -  INSERT ACETAB 10D H ECCENTRIC 36MM TRIDENT X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
663-10-36I,SUP,Custom 27803010,,663-10-36I  -  INSERT ACETAB 10D I ECCENTRIC 36MM TRIDENT X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
663-10-36J,SUP,Custom 27803010,,663-10-36J  -  INSERT ACETAB 10D J ECCENTRIC 36MM TRIDENT X3 HIP,"$1,440.00",$0.00,"$1,440.00",$0.00,"$1,027.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,440.00",$0.00,$720.00,"$1,140.48","$1,152.00",$0.00,$0.00,$0.00,$0.00,$0.00
6632-0-208,SUP,Custom 27803010,,6632-0-208  -  STAB SURG XS DRCN POR CMNT MONO FEM LEFT,"$5,490.00",$0.00,"$5,490.00",$0.00,"$3,918.21",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,490.00",$0.00,"$2,745.00","$4,348.08","$4,392.00",$0.00,$0.00,$0.00,$0.00,$0.00
6632-0-210,SUP,HCPCS C1776,,6632-0-210  -  CMPNT FEM SM LEFT KNEE BEADED STAB MDLR DRCN,"$7,057.38",$0.00,"$7,057.38","$3,175.82","$5,036.85",$0.00,"$1,215.95",$0.00,$0.00,"$1,235.69","$7,057.38",$0.00,"$3,528.69","$5,589.44","$5,645.90",$0.00,"$1,104.48",$0.00,"$1,123.53",$0.00
6632-0-215,SUP,HCPCS C1776,,6632-0-215  -  CMPNT FEM SM LEFT MDLR NBD ASYM DRCN NONSTRL,"$3,437.00",$0.00,"$3,437.00","$1,546.65","$2,452.99",$0.00,$592.18,$0.00,$0.00,$601.79,"$3,437.00",$0.00,"$1,718.50","$2,722.10","$2,749.60",$0.00,$537.89,$0.00,$547.17,$0.00
6632-0-218,SUP,HCPCS C1776,,6632-0-218  -  CMPNT FEM XS RIGHT KNEE CMNT MONO STAB DRCN POR,"$5,490.00",$0.00,"$5,490.00","$2,470.50","$3,918.21",$0.00,$945.90,$0.00,$0.00,$961.26,"$5,490.00",$0.00,"$2,745.00","$4,348.08","$4,392.00",$0.00,$859.19,$0.00,$874.01,$0.00
6632-0-220,SUP,HCPCS C1776,,6632-0-220  -  CMPNT FEM SM RIGHT KNEE CRUC RET MDLR BEADED ASMBLY DRCN,"$7,057.38",$0.00,"$7,057.38","$3,175.82","$5,036.85",$0.00,"$1,215.95",$0.00,$0.00,"$1,235.69","$7,057.38",$0.00,"$3,528.69","$5,589.44","$5,645.90",$0.00,"$1,104.48",$0.00,"$1,123.53",$0.00
6632-0-225,SUP,HCPCS C1776,,6632-0-225  -  CMPNT FEM SM RIGHT KNEE CRUC RET MDLR NBD ASMBLY DRCN,"$3,437.00",$0.00,"$3,437.00","$1,546.65","$2,452.99",$0.00,$592.18,$0.00,$0.00,$601.79,"$3,437.00",$0.00,"$1,718.50","$2,722.10","$2,749.60",$0.00,$537.89,$0.00,$547.17,$0.00
6632-0-310,SUP,HCPCS C1776,,6632-0-310  -  CMPNT FEM MED LEFT KNEE CRUC RET MDLR BEADED ASMBLY DRCN,"$7,057.38",$0.00,"$7,057.38","$3,175.82","$5,036.85",$0.00,"$1,215.95",$0.00,$0.00,"$1,235.69","$7,057.38",$0.00,"$3,528.69","$5,589.44","$5,645.90",$0.00,"$1,104.48",$0.00,"$1,123.53",$0.00
6632-0-315,SUP,HCPCS C1776,,6632-0-315  -  CMPNT FEM MED LEFT MDLR NBD ASYM DRCN NONSTRL,"$3,437.00",$0.00,"$3,437.00","$1,546.65","$2,452.99",$0.00,$592.18,$0.00,$0.00,$601.79,"$3,437.00",$0.00,"$1,718.50","$2,722.10","$2,749.60",$0.00,$537.89,$0.00,$547.17,$0.00
6632-0-317,SUP,HCPCS C1776,,6632-0-317  -  CMPNT FEM MED NTRL LEFT KNEE CRUC RET NBD MDLR STAB ASMBLY,"$3,314.00",$0.00,"$3,314.00","$1,491.30","$2,365.20",$0.00,$570.99,$0.00,$0.00,$580.25,"$3,314.00",$0.00,"$1,657.00","$2,624.69","$2,651.20",$0.00,$518.64,$0.00,$527.59,$0.00
6632-0-325,SUP,HCPCS C1776,,6632-0-325  -  STEM FEM NBD ASY DRCN MED RIGHT NONSTRL,"$3,437.00",$0.00,"$3,437.00","$1,546.65","$2,452.99",$0.00,$592.18,$0.00,$0.00,$601.79,"$3,437.00",$0.00,"$1,718.50","$2,722.10","$2,749.60",$0.00,$537.89,$0.00,$547.17,$0.00
6632-0-327,SUP,HCPCS C1776,,6632-0-327  -  CMPNT FEM MED NTRL RIGHT KNEE CRUC RET NBD MDLR STAB ASMBLY,"$3,314.00",$0.00,"$3,314.00","$1,491.30","$2,365.20",$0.00,$570.99,$0.00,$0.00,$580.25,"$3,314.00",$0.00,"$1,657.00","$2,624.69","$2,651.20",$0.00,$518.64,$0.00,$527.59,$0.00
6632-0-410,SUP,HCPCS C1776,,6632-0-410  -  CMPNT FEM MED LG LEFT KNEE CRUC RET MDLR BEADED ASMBLY DRCN,"$7,057.38",$0.00,"$7,057.38","$3,175.82","$5,036.85",$0.00,"$1,215.95",$0.00,$0.00,"$1,235.69","$7,057.38",$0.00,"$3,528.69","$5,589.44","$5,645.90",$0.00,"$1,104.48",$0.00,"$1,123.53",$0.00
6632-0-415,SUP,HCPCS C1776,,6632-0-415  -  CMPNT FEM MED LG LEFT KNEE CRUC RET MDLR NBD ASMBLY DRCN,"$3,437.00",$0.00,"$3,437.00","$1,546.65","$2,452.99",$0.00,$592.18,$0.00,$0.00,$601.79,"$3,437.00",$0.00,"$1,718.50","$2,722.10","$2,749.60",$0.00,$537.89,$0.00,$547.17,$0.00
6632-0-425,SUP,HCPCS C1776,,6632-0-425  -  CMPNT FEM MED LG RIGHT MDLR NBD ASMBLY DRCN,"$3,437.00",$0.00,"$3,437.00","$1,546.65","$2,452.99",$0.00,$592.18,$0.00,$0.00,$601.79,"$3,437.00",$0.00,"$1,718.50","$2,722.10","$2,749.60",$0.00,$537.89,$0.00,$547.17,$0.00
6632-0-515,SUP,HCPCS C1776,,6632-0-515  -  CMPNT FEM LG LEFT KNEE NBD ASMBLY MDLR DRCN NPOR,"$3,437.00",$0.00,"$3,437.00","$1,546.65","$2,452.99",$0.00,$592.18,$0.00,$0.00,$601.79,"$3,437.00",$0.00,"$1,718.50","$2,722.10","$2,749.60",$0.00,$537.89,$0.00,$547.17,$0.00
6632-0-525,SUP,HCPCS C1776,,6632-0-525  -  CMPNT FEM LG RIGHT NBD MDLR ASMBLY DRCN,"$3,437.00",$0.00,"$3,437.00","$1,546.65","$2,452.99",$0.00,$592.18,$0.00,$0.00,$601.79,"$3,437.00",$0.00,"$1,718.50","$2,722.10","$2,749.60",$0.00,$537.89,$0.00,$547.17,$0.00
6632-0-610,SUP,HCPCS C1776,,6632-0-610  -  CMPNT FEM XL LEFT BEADED MDLR ASMBLY DRCN,"$7,192.25",$0.00,"$7,192.25","$3,236.51","$5,133.11",$0.00,"$1,239.19",$0.00,$0.00,"$1,259.31","$7,192.25",$0.00,"$3,596.13","$5,696.26","$5,753.80",$0.00,"$1,125.59",$0.00,"$1,145.01",$0.00
6632-0-615,SUP,HCPCS C1776,,6632-0-615  -  CMPNT FEM XL LEFT MDLR NBD ASMBLY DRCN,"$3,499.00",$0.00,"$3,499.00","$1,574.55","$2,497.24",$0.00,$602.86,$0.00,$0.00,$612.65,"$3,499.00",$0.00,"$1,749.50","$2,771.21","$2,799.20",$0.00,$547.59,$0.00,$557.04,$0.00
6632-0-620,SUP,HCPCS C1776,,6632-0-620  -  CMPNT FEM XL RIGHT BEADED MDLR ASMBLY DRCN,"$7,192.25",$0.00,"$7,192.25","$3,236.51","$5,133.11",$0.00,"$1,239.19",$0.00,$0.00,"$1,259.31","$7,192.25",$0.00,"$3,596.13","$5,696.26","$5,753.80",$0.00,"$1,125.59",$0.00,"$1,145.01",$0.00
6632-0-625,SUP,HCPCS C1776,,6632-0-625  -  CMPNT FEM XL RIGHT KNEE CRUC RET NBD MDLR DRCN,"$3,499.00",$0.00,"$3,499.00","$1,574.55","$2,497.24",$0.00,$602.86,$0.00,$0.00,$612.65,"$3,499.00",$0.00,"$1,749.50","$2,771.21","$2,799.20",$0.00,$547.59,$0.00,$557.04,$0.00
6632-0-710,SUP,HCPCS C1776,,6632-0-710  -  CMPNT FEM 2XL LEFT KNEE CRUC RET BEADED MDLR DRCN,"$7,192.25",$0.00,"$7,192.25","$3,236.51","$5,133.11",$0.00,"$1,239.19",$0.00,$0.00,"$1,259.31","$7,192.25",$0.00,"$3,596.13","$5,696.26","$5,753.80",$0.00,"$1,125.59",$0.00,"$1,145.01",$0.00
6632-0-715,SUP,HCPCS C1776,,6632-0-715  -  CMPNT FEM 2XL LEFT KNEE NBD ASMBLY MDLR DRCN NPOR,"$3,499.00",$0.00,"$3,499.00","$1,574.55","$2,497.24",$0.00,$602.86,$0.00,$0.00,$612.65,"$3,499.00",$0.00,"$1,749.50","$2,771.21","$2,799.20",$0.00,$547.59,$0.00,$557.04,$0.00
6632-0-720,SUP,HCPCS C1776,,6632-0-720  -  CMPNT FEM 2XL RIGHT BEADED MDLR ASMBLY DRCN,"$7,192.25",$0.00,"$7,192.25","$3,236.51","$5,133.11",$0.00,"$1,239.19",$0.00,$0.00,"$1,259.31","$7,192.25",$0.00,"$3,596.13","$5,696.26","$5,753.80",$0.00,"$1,125.59",$0.00,"$1,145.01",$0.00
6632-0-725,SUP,HCPCS C1776,,6632-0-725  -  CMPNT FEM 2XL RIGHT KNEE NBD ASMBLY MDLR DRCN NPOR,"$3,499.00",$0.00,"$3,499.00","$1,574.55","$2,497.24",$0.00,$602.86,$0.00,$0.00,$612.65,"$3,499.00",$0.00,"$1,749.50","$2,771.21","$2,799.20",$0.00,$547.59,$0.00,$557.04,$0.00
6632-0-750,SUP,HCPCS C1713,,6632-0-750  -  PEG FIX FEM MDLR REPL,$524.00,$0.00,$524.00,$235.80,$373.98,$0.00,$90.28,$0.00,$0.00,$91.75,$524.00,$0.00,$262.00,$415.01,$419.20,$0.00,$82.01,$0.00,$83.42,$0.00
6632-0-810,SUP,HCPCS C1776,,6632-0-810  -  CMPNT FEM SM LEFT MNLTH STAB DRCN,"$3,869.00",$0.00,"$3,869.00","$1,741.05","$2,761.31",$0.00,$666.61,$0.00,$0.00,$677.43,"$3,869.00",$0.00,"$1,934.50","$3,064.25","$3,095.20",$0.00,$605.50,$0.00,$615.94,$0.00
6632-0-811,SUP,HCPCS C1776,,6632-0-811  -  CMPNT FEM SM LEFT KNEE CMNT MNLTH STAB DRCN VIT,"$3,437.00",$0.00,"$3,437.00","$1,546.65","$2,452.99",$0.00,$592.18,$0.00,$0.00,$601.79,"$3,437.00",$0.00,"$1,718.50","$2,722.10","$2,749.60",$0.00,$537.89,$0.00,$547.17,$0.00
6632-0-815,SUP,HCPCS C1776,,6632-0-815  -  CMPNT FEM SM RIGHT MNLTH STAB DRCN VIT,"$3,869.00",$0.00,"$3,869.00","$1,741.05","$2,761.31",$0.00,$666.61,$0.00,$0.00,$677.43,"$3,869.00",$0.00,"$1,934.50","$3,064.25","$3,095.20",$0.00,$605.50,$0.00,$615.94,$0.00
6632-0-820,SUP,HCPCS C1776,,6632-0-820  -  CMPNT FEM MED LEFT MONOLITHIX STAB DRCN,"$3,869.00",$0.00,"$3,869.00","$1,741.05","$2,761.31",$0.00,$666.61,$0.00,$0.00,$677.43,"$3,869.00",$0.00,"$1,934.50","$3,064.25","$3,095.20",$0.00,$605.50,$0.00,$615.94,$0.00
6632-0-821,SUP,HCPCS C1776,,6632-0-821  -  CMPNT FEM MED LEFT KNEE CMNT MNLTH STAB DRCN VIT,"$3,437.00",$0.00,"$3,437.00","$1,546.65","$2,452.99",$0.00,$592.18,$0.00,$0.00,$601.79,"$3,437.00",$0.00,"$1,718.50","$2,722.10","$2,749.60",$0.00,$537.89,$0.00,$547.17,$0.00
6632-0-825,SUP,HCPCS C1776,,6632-0-825  -  COMPONENT FEM MED DRCN CMNT MNLTH STAB KN RT,"$3,869.00",$0.00,"$3,869.00","$1,741.05","$2,761.31",$0.00,$666.61,$0.00,$0.00,$677.43,"$3,869.00",$0.00,"$1,934.50","$3,064.25","$3,095.20",$0.00,$605.50,$0.00,$615.94,$0.00
6632-0-826,SUP,HCPCS C1776,,6632-0-826  -  COMPONENT FEM MED DRCN CMNT MNLTH STAB KN RT,"$3,437.00",$0.00,"$3,437.00","$1,546.65","$2,452.99",$0.00,$592.18,$0.00,$0.00,$601.79,"$3,437.00",$0.00,"$1,718.50","$2,722.10","$2,749.60",$0.00,$537.89,$0.00,$547.17,$0.00
6632-0-830,SUP,HCPCS C1776,,6632-0-830  -  COMPONENT FEM MED LG DRCN CMNT MNLTH STAB KN LT,"$3,869.00",$0.00,"$3,869.00","$1,741.05","$2,761.31",$0.00,$666.61,$0.00,$0.00,$677.43,"$3,869.00",$0.00,"$1,934.50","$3,064.25","$3,095.20",$0.00,$605.50,$0.00,$615.94,$0.00
6632-0-831,SUP,HCPCS C1776,,6632-0-831  -  COMPONENT FEM MED LG DRCN CMNT MNLTH STAB KN LT,"$3,437.00",$0.00,"$3,437.00","$1,546.65","$2,452.99",$0.00,$592.18,$0.00,$0.00,$601.79,"$3,437.00",$0.00,"$1,718.50","$2,722.10","$2,749.60",$0.00,$537.89,$0.00,$547.17,$0.00
6632-0-835,SUP,HCPCS C1776,,6632-0-835  -  COMPONENT FEM MED LG DRCN CMNT MNLTH STAB KN RT,"$3,869.00",$0.00,"$3,869.00","$1,741.05","$2,761.31",$0.00,$666.61,$0.00,$0.00,$677.43,"$3,869.00",$0.00,"$1,934.50","$3,064.25","$3,095.20",$0.00,$605.50,$0.00,$615.94,$0.00
6632-0-836,SUP,HCPCS C1776,,6632-0-836  -  COMPONENT FEM MED LG DRCN CMNT MNLTH STAB KN RT,"$3,437.00",$0.00,"$3,437.00","$1,546.65","$2,452.99",$0.00,$592.18,$0.00,$0.00,$601.79,"$3,437.00",$0.00,"$1,718.50","$2,722.10","$2,749.60",$0.00,$537.89,$0.00,$547.17,$0.00
6632-0-840,SUP,HCPCS C1776,,6632-0-840  -  CMPNT FEM LG LEFT MNLTH STAB DRCN VIT,"$3,869.00",$0.00,"$3,869.00","$1,741.05","$2,761.31",$0.00,$666.61,$0.00,$0.00,$677.43,"$3,869.00",$0.00,"$1,934.50","$3,064.25","$3,095.20",$0.00,$605.50,$0.00,$615.94,$0.00
6632-0-845,SUP,HCPCS C1776,,6632-0-845  -  CMPNT FEM LG RIGHT MNLTH STAB DRCN,"$3,869.00",$0.00,"$3,869.00","$1,741.05","$2,761.31",$0.00,$666.61,$0.00,$0.00,$677.43,"$3,869.00",$0.00,"$1,934.50","$3,064.25","$3,095.20",$0.00,$605.50,$0.00,$615.94,$0.00
6632-0-855,SUP,HCPCS C1776,,6632-0-855  -  STAB FEM DRCN XL RIGHT MONO,"$3,941.00",$0.00,"$3,941.00","$1,773.45","$2,812.69",$0.00,$679.01,$0.00,$0.00,$690.04,"$3,941.00",$0.00,"$1,970.50","$3,121.27","$3,152.80",$0.00,$616.77,$0.00,$627.41,$0.00
6632-0-860,SUP,HCPCS C1776,,6632-0-860  -  CMPNT FEM 2XL LEFT MNLTH STAB DRCN BLK,"$3,941.00",$0.00,"$3,941.00","$1,773.45","$2,812.69",$0.00,$679.01,$0.00,$0.00,$690.04,"$3,941.00",$0.00,"$1,970.50","$3,121.27","$3,152.80",$0.00,$616.77,$0.00,$627.41,$0.00
6632-0-865,SUP,HCPCS C1776,,6632-0-865  -  CMPNT FEM 2XL RIGHT MNLTH STAB DRCN,"$3,941.00",$0.00,"$3,941.00","$1,773.45","$2,812.69",$0.00,$679.01,$0.00,$0.00,$690.04,"$3,941.00",$0.00,"$1,970.50","$3,121.27","$3,152.80",$0.00,$616.77,$0.00,$627.41,$0.00
6632-3-301,SUP,HCPCS C1776,,6632-3-301  -  BSPLT TIB DRCN XS1 BEADED CRCIFRM NPOR,"$2,891.00",$0.00,"$2,891.00","$1,300.95","$2,063.31",$0.00,$498.10,$0.00,$0.00,$506.19,"$2,891.00",$0.00,"$1,445.50","$2,289.67","$2,312.80",$0.00,$452.44,$0.00,$460.25,$0.00
6632-3-303,SUP,HCPCS C1776,,6632-3-303  -  BSPLT TIB DRCN 2 XS KNEE CRCIFRM BEADED POR,"$2,891.00",$0.00,"$2,891.00","$1,300.95","$2,063.31",$0.00,$498.10,$0.00,$0.00,$506.19,"$2,891.00",$0.00,"$1,445.50","$2,289.67","$2,312.80",$0.00,$452.44,$0.00,$460.25,$0.00
6632-3-305,SUP,HCPCS C1776,,6632-3-305  -  BSPLT TIB DRCN 1 SM CRCIFRM BSPLT POR,"$2,838.00",$0.00,"$2,838.00","$1,277.10","$2,025.48",$0.00,$488.97,$0.00,$0.00,$496.91,"$2,838.00",$0.00,"$1,419.00","$2,247.70","$2,270.40",$0.00,$444.15,$0.00,$451.81,$0.00
6632-3-310,SUP,HCPCS C1776,,6632-3-310  -  BSPLT TIB DRCN 2 SM KNEE BEADED CRCIFRM POR,"$2,838.00",$0.00,"$2,838.00","$1,277.10","$2,025.48",$0.00,$488.97,$0.00,$0.00,$496.91,"$2,838.00",$0.00,"$1,419.00","$2,247.70","$2,270.40",$0.00,$444.15,$0.00,$451.81,$0.00
6632-3-315,SUP,HCPCS C1776,,6632-3-315  -  BSPLT TIB DRCN 1 MED KNEE BEADED CRCIFRM POR,"$2,838.00",$0.00,"$2,838.00","$1,277.10","$2,025.48",$0.00,$488.97,$0.00,$0.00,$496.91,"$2,838.00",$0.00,"$1,419.00","$2,247.70","$2,270.40",$0.00,$444.15,$0.00,$451.81,$0.00
6632-3-320,SUP,HCPCS C1776,,6632-3-320  -  BSPLT TIB DRCN 2 MED KNEE CRCIFRM POR,"$2,838.00",$0.00,"$2,838.00","$1,277.10","$2,025.48",$0.00,$488.97,$0.00,$0.00,$496.91,"$2,838.00",$0.00,"$1,419.00","$2,247.70","$2,270.40",$0.00,$444.15,$0.00,$451.81,$0.00
6632-3-325,SUP,HCPCS C1776,,6632-3-325  -  BSPLT TIB DRCN 1 LG KNEE BEADED CRCIFRM POR,"$2,838.00",$0.00,"$2,838.00","$1,277.10","$2,025.48",$0.00,$488.97,$0.00,$0.00,$496.91,"$2,838.00",$0.00,"$1,419.00","$2,247.70","$2,270.40",$0.00,$444.15,$0.00,$451.81,$0.00
6632-3-330,SUP,HCPCS C1776,,6632-3-330  -  BSPLT TIB DRCN 2 LG KNEE BEADED CRCIFRM POR,"$2,838.00",$0.00,"$2,838.00","$1,277.10","$2,025.48",$0.00,$488.97,$0.00,$0.00,$496.91,"$2,838.00",$0.00,"$1,419.00","$2,247.70","$2,270.40",$0.00,$444.15,$0.00,$451.81,$0.00
6632-3-335,SUP,HCPCS C1776,,6632-3-335  -  BSPLT TIB DRCN 1 XL KNEE BEADED CRCIFRM POR,"$2,891.00",$0.00,"$2,891.00","$1,300.95","$2,063.31",$0.00,$498.10,$0.00,$0.00,$506.19,"$2,891.00",$0.00,"$1,445.50","$2,289.67","$2,312.80",$0.00,$452.44,$0.00,$460.25,$0.00
6632-3-340,SUP,HCPCS C1776,,6632-3-340  -  BSPLT TIB DRCN 2 XL KNEE BEADED CRCIFRM POR,"$2,891.00",$0.00,"$2,891.00","$1,300.95","$2,063.31",$0.00,$498.10,$0.00,$0.00,$506.19,"$2,891.00",$0.00,"$1,445.50","$2,289.67","$2,312.80",$0.00,$452.44,$0.00,$460.25,$0.00
6632-3-401,SUP,HCPCS C1776,,6632-3-401  -  BSPLT TIB DRCN 1 XS NBD CRCIFRM,"$1,918.00",$0.00,"$1,918.00",$863.10,"$1,368.88",$0.00,$330.46,$0.00,$0.00,$335.83,"$1,918.00",$0.00,$959.00,"$1,519.06","$1,534.40",$0.00,$300.17,$0.00,$305.35,$0.00
6632-3-403,SUP,HCPCS C1776,,6632-3-403  -  BSPLT TIB DRCN 2 XS NBD CRCIFRM,"$2,149.00",$0.00,"$2,149.00",$967.05,"$1,533.74",$0.00,$370.26,$0.00,$0.00,$376.27,"$2,149.00",$0.00,"$1,074.50","$1,702.01","$1,719.20",$0.00,$336.32,$0.00,$342.12,$0.00
6632-3-405,SUP,HCPCS C1776,,6632-3-405  -  BSPLT TIB DRCN S1 NBD CRCIFRM NPOR,"$2,167.00",$0.00,"$2,167.00",$975.15,"$1,546.59",$0.00,$373.36,$0.00,$0.00,$379.42,"$2,167.00",$0.00,"$1,083.50","$1,716.26","$1,733.60",$0.00,$339.14,$0.00,$344.99,$0.00
6632-3-410,SUP,HCPCS C1776,,6632-3-410  -  BSPLT TIB DRCN S2 NBD CRCIFRM NPOR,"$2,167.00",$0.00,"$2,167.00",$975.15,"$1,546.59",$0.00,$373.36,$0.00,$0.00,$379.42,"$2,167.00",$0.00,"$1,083.50","$1,716.26","$1,733.60",$0.00,$339.14,$0.00,$344.99,$0.00
6632-3-415,SUP,HCPCS C1776,,6632-3-415  -  BSPLT TIB DRCN M1 NBD CRCIFRM NPOR,"$2,131.00",$0.00,"$2,131.00",$958.95,"$1,520.89",$0.00,$367.16,$0.00,$0.00,$373.12,"$2,131.00",$0.00,"$1,065.50","$1,687.75","$1,704.80",$0.00,$333.50,$0.00,$339.26,$0.00
6632-3-420,SUP,HCPCS C1776,,6632-3-420  -  BSPLT TIB DRCN M2 NBD CRCIFRM NPOR,"$2,131.00",$0.00,"$2,131.00",$958.95,"$1,520.89",$0.00,$367.16,$0.00,$0.00,$373.12,"$2,131.00",$0.00,"$1,065.50","$1,687.75","$1,704.80",$0.00,$333.50,$0.00,$339.26,$0.00
6632-3-425,SUP,HCPCS C1776,,6632-3-425  -  BSPLT TIB DRCN 1 NBD CRCIFRM NPOR,"$2,131.00",$0.00,"$2,131.00",$958.95,"$1,520.89",$0.00,$367.16,$0.00,$0.00,$373.12,"$2,131.00",$0.00,"$1,065.50","$1,687.75","$1,704.80",$0.00,$333.50,$0.00,$339.26,$0.00
6632-3-430,SUP,HCPCS C1776,,6632-3-430  -  BSPLT TIB DRCN 2 NBD CRCIFRM NPOR,"$2,131.00",$0.00,"$2,131.00",$958.95,"$1,520.89",$0.00,$367.16,$0.00,$0.00,$373.12,"$2,131.00",$0.00,"$1,065.50","$1,687.75","$1,704.80",$0.00,$333.50,$0.00,$339.26,$0.00
6632-3-435,SUP,HCPCS C1776,,6632-3-435  -  BSPLT TIB DRCN X1 NBD CRCIFRM NPOR,"$2,167.00",$0.00,"$2,167.00",$975.15,"$1,546.59",$0.00,$373.36,$0.00,$0.00,$379.42,"$2,167.00",$0.00,"$1,083.50","$1,716.26","$1,733.60",$0.00,$339.14,$0.00,$344.99,$0.00
6632-3-440,SUP,HCPCS C1776,,6632-3-440  -  BSPLT TIB DRCN 2 XL KNEE NBD CRCIFRM NPOR,"$2,167.00",$0.00,"$2,167.00",$975.15,"$1,546.59",$0.00,$373.36,$0.00,$0.00,$379.42,"$2,167.00",$0.00,"$1,083.50","$1,716.26","$1,733.60",$0.00,$339.14,$0.00,$344.99,$0.00
6632-3-505,SUP,HCPCS C1776,,6632-3-505  -  BSPLT TIB DRCN 1 SM KNEE BEADED CRCIFRM PERIAPT,"$3,355.00",$0.00,"$3,355.00","$1,509.75","$2,394.46",$0.00,$578.05,$0.00,$0.00,$587.43,"$3,355.00",$0.00,"$1,677.50","$2,657.16","$2,684.00",$0.00,$525.06,$0.00,$534.12,$0.00
6632-3-510,SUP,HCPCS C1776,,6632-3-510  -  BSPLT TIB DRCN S2 BEADED CRCIFRM PERIAPT,"$3,355.00",$0.00,"$3,355.00","$1,509.75","$2,394.46",$0.00,$578.05,$0.00,$0.00,$587.43,"$3,355.00",$0.00,"$1,677.50","$2,657.16","$2,684.00",$0.00,$525.06,$0.00,$534.12,$0.00
6632-3-515,SUP,HCPCS C1776,,6632-3-515  -  BSPLT TIB DRCN M1 BEADED CRCIFRM PERIAPT,"$3,339.00",$0.00,"$3,339.00","$1,502.55","$2,383.04",$0.00,$575.29,$0.00,$0.00,$584.63,"$3,339.00",$0.00,"$1,669.50","$2,644.49","$2,671.20",$0.00,$522.55,$0.00,$531.57,$0.00
6632-3-520,SUP,HCPCS C1776,,6632-3-520  -  BSPLT TIB DRCN M2 BEADED CRCIFRM PERIAPT,"$3,339.00",$0.00,"$3,339.00","$1,502.55","$2,383.04",$0.00,$575.29,$0.00,$0.00,$584.63,"$3,339.00",$0.00,"$1,669.50","$2,644.49","$2,671.20",$0.00,$522.55,$0.00,$531.57,$0.00
6632-3-525,SUP,HCPCS C1776,,6632-3-525  -  BSPLT TIB DRCN 1 LG KNEE BEADED CRCIFRM PERIAPT,"$3,339.00",$0.00,"$3,339.00","$1,502.55","$2,383.04",$0.00,$575.29,$0.00,$0.00,$584.63,"$3,339.00",$0.00,"$1,669.50","$2,644.49","$2,671.20",$0.00,$522.55,$0.00,$531.57,$0.00
6632-3-530,SUP,HCPCS C1776,,6632-3-530  -  BSPLT TIB DRCN 2 LG KNEE BEADED CRCIFRM PERIAPT,"$3,339.00",$0.00,"$3,339.00","$1,502.55","$2,383.04",$0.00,$575.29,$0.00,$0.00,$584.63,"$3,339.00",$0.00,"$1,669.50","$2,644.49","$2,671.20",$0.00,$522.55,$0.00,$531.57,$0.00
6632-3-535,SUP,HCPCS C1776,,6632-3-535  -  BSPLT TIB DRCN 1 XL KNEE BEADED CRCIFRM PERIAPT,"$3,355.00",$0.00,"$3,355.00","$1,509.75","$2,394.46",$0.00,$578.05,$0.00,$0.00,$587.43,"$3,355.00",$0.00,"$1,677.50","$2,657.16","$2,684.00",$0.00,$525.06,$0.00,$534.12,$0.00
6632-3-540,SUP,HCPCS C1776,,6632-3-540  -  BSPLT TIB DRCN 2 XL KNEE BEADED CRCIFRM PERIAPT,"$3,355.00",$0.00,"$3,355.00","$1,509.75","$2,394.46",$0.00,$578.05,$0.00,$0.00,$587.43,"$3,355.00",$0.00,"$1,677.50","$2,657.16","$2,684.00",$0.00,$525.06,$0.00,$534.12,$0.00
6632-3-603,SUP,HCPCS C1776,,6632-3-603  -  BSPLT TIB DRCN 1 MED UNV KNEE NBD CRCIFRM NPOR,"$2,169.00",$0.00,"$2,169.00",$976.05,"$1,548.02",$0.00,$373.71,$0.00,$0.00,$379.77,"$2,169.00",$0.00,"$1,084.50","$1,717.85","$1,735.20",$0.00,$339.45,$0.00,$345.30,$0.00
6632-3-605,SUP,HCPCS C1776,,6632-3-605  -  BSPLT TIB DRCN S1 UNV NBD CRCIFRM NPOR,"$2,130.00",$0.00,"$2,130.00",$958.50,"$1,520.18",$0.00,$366.99,$0.00,$0.00,$372.95,"$2,130.00",$0.00,"$1,065.00","$1,686.96","$1,704.00",$0.00,$333.35,$0.00,$339.10,$0.00
6632-3-610,SUP,HCPCS C1776,,6632-3-610  -  BSPLT TIB DRCN S2 NBD CRCIFRM NPOR,"$2,130.00",$0.00,"$2,130.00",$958.50,"$1,520.18",$0.00,$366.99,$0.00,$0.00,$372.95,"$2,130.00",$0.00,"$1,065.00","$1,686.96","$1,704.00",$0.00,$333.35,$0.00,$339.10,$0.00
6632-3-615,SUP,HCPCS C1776,,6632-3-615  -  BSPLT TIB M1 NPOR HWMDC,"$2,130.00",$0.00,"$2,130.00",$958.50,"$1,520.18",$0.00,$366.99,$0.00,$0.00,$372.95,"$2,130.00",$0.00,"$1,065.00","$1,686.96","$1,704.00",$0.00,$333.35,$0.00,$339.10,$0.00
6632-3-620,SUP,HCPCS C1776,,6632-3-620  -  BSPLT TIB DRCN 2 MED UNV KNEE NBD CRCIFRM NPOR,"$2,130.00",$0.00,"$2,130.00",$958.50,"$1,520.18",$0.00,$366.99,$0.00,$0.00,$372.95,"$2,130.00",$0.00,"$1,065.00","$1,686.96","$1,704.00",$0.00,$333.35,$0.00,$339.10,$0.00
6632-3-625,SUP,HCPCS C1776,,6632-3-625  -  BSPLT TIB DRCN 1 NBD CRCIFRM NPOR,"$2,130.00",$0.00,"$2,130.00",$958.50,"$1,520.18",$0.00,$366.99,$0.00,$0.00,$372.95,"$2,130.00",$0.00,"$1,065.00","$1,686.96","$1,704.00",$0.00,$333.35,$0.00,$339.10,$0.00
6632-3-630,SUP,HCPCS C1776,,6632-3-630  -  BSPLT TIB DRCN 2 LG UNV KNEE NBD CRCIFRM NPOR,"$2,130.00",$0.00,"$2,130.00",$958.50,"$1,520.18",$0.00,$366.99,$0.00,$0.00,$372.95,"$2,130.00",$0.00,"$1,065.00","$1,686.96","$1,704.00",$0.00,$333.35,$0.00,$339.10,$0.00
6632-3-635,SUP,HCPCS C1776,,6632-3-635  -  BSPLT TIB DRCN 1 XL UNV KNEE NBD CRCIFRM NPOR,"$2,169.00",$0.00,"$2,169.00",$976.05,"$1,548.02",$0.00,$373.71,$0.00,$0.00,$379.77,"$2,169.00",$0.00,"$1,084.50","$1,717.85","$1,735.20",$0.00,$339.45,$0.00,$345.30,$0.00
6632-3-640,SUP,HCPCS C1776,,6632-3-640  -  BSPLT TIB DRCN X2 NBD CRCIFRM NPOR,"$2,169.00",$0.00,"$2,169.00",$976.05,"$1,548.02",$0.00,$373.71,$0.00,$0.00,$379.77,"$2,169.00",$0.00,"$1,084.50","$1,717.85","$1,735.20",$0.00,$339.45,$0.00,$345.30,$0.00
6632-3-701,SUP,HCPCS C1776,,6632-3-701  -  BSPLT TIB DRCN XS1 UNV KNEE BEADED POR 62X37MM,"$2,919.00",$0.00,"$2,919.00","$1,313.55","$2,083.29",$0.00,$502.93,$0.00,$0.00,$511.09,"$2,919.00",$0.00,"$1,459.50","$2,311.85","$2,335.20",$0.00,$456.82,$0.00,$464.70,$0.00
6632-3-703,SUP,HCPCS C1776,,6632-3-703  -  BSPLT TIB DRCN XS2 UNV KNEE BEADED POR 64X39MM,"$2,919.00",$0.00,"$2,919.00","$1,313.55","$2,083.29",$0.00,$502.93,$0.00,$0.00,$511.09,"$2,919.00",$0.00,"$1,459.50","$2,311.85","$2,335.20",$0.00,$456.82,$0.00,$464.70,$0.00
6632-3-705,SUP,HCPCS C1776,,6632-3-705  -  BSPLT TIB DRCN S1 UNV KNEE BEADED POR 67X42MM,"$2,865.00",$0.00,"$2,865.00","$1,289.25","$2,044.75",$0.00,$493.63,$0.00,$0.00,$501.64,"$2,865.00",$0.00,"$1,432.50","$2,269.08","$2,292.00",$0.00,$448.37,$0.00,$456.11,$0.00
6632-3-710,SUP,HCPCS C1776,,6632-3-710  -  BSPLT TIB DRCN S2 UNV KNEE BEADED POR 69X45MM,"$2,865.00",$0.00,"$2,865.00","$1,289.25","$2,044.75",$0.00,$493.63,$0.00,$0.00,$501.64,"$2,865.00",$0.00,"$1,432.50","$2,269.08","$2,292.00",$0.00,$448.37,$0.00,$456.11,$0.00
6632-3-715,SUP,HCPCS C1776,,6632-3-715  -  BSPLT TIB DRCN M1 UNV KNEE BEADED POR 72X48MM,"$2,865.00",$0.00,"$2,865.00","$1,289.25","$2,044.75",$0.00,$493.63,$0.00,$0.00,$501.64,"$2,865.00",$0.00,"$1,432.50","$2,269.08","$2,292.00",$0.00,$448.37,$0.00,$456.11,$0.00
6632-3-720,SUP,HCPCS C1776,,6632-3-720  -  BSPLT TIB DRCN M2 BEADED CRCIFRM NPOR,"$2,865.00",$0.00,"$2,865.00","$1,289.25","$2,044.75",$0.00,$493.63,$0.00,$0.00,$501.64,"$2,865.00",$0.00,"$1,432.50","$2,269.08","$2,292.00",$0.00,$448.37,$0.00,$456.11,$0.00
6632-3-725,SUP,HCPCS C1776,,6632-3-725  -  BSPLT TIB DRCN UNV KNEE SCR POR 77X53MM HWMDC X 1,"$2,865.00",$0.00,"$2,865.00","$1,289.25","$2,044.75",$0.00,$493.63,$0.00,$0.00,$501.64,"$2,865.00",$0.00,"$1,432.50","$2,269.08","$2,292.00",$0.00,$448.37,$0.00,$456.11,$0.00
6632-3-730,SUP,HCPCS C1776,,6632-3-730  -  BSPLT TIB DRCN X2 UNV KNEE SCR FIX POR 79X55MM,"$2,865.00",$0.00,"$2,865.00","$1,289.25","$2,044.75",$0.00,$493.63,$0.00,$0.00,$501.64,"$2,865.00",$0.00,"$1,432.50","$2,269.08","$2,292.00",$0.00,$448.37,$0.00,$456.11,$0.00
6632-3-735,SUP,HCPCS C1776,,6632-3-735  -  BSPLT TIB DRCN X1 UNV KNEE BEADED POR 82X58MM,"$2,919.00",$0.00,"$2,919.00","$1,313.55","$2,083.29",$0.00,$502.93,$0.00,$0.00,$511.09,"$2,919.00",$0.00,"$1,459.50","$2,311.85","$2,335.20",$0.00,$456.82,$0.00,$464.70,$0.00
6632-3-740,SUP,HCPCS C1776,,6632-3-740  -  BSPLT TIB DRCN X2 UNV KNEE SCR FIX POR 85X60MM,"$2,919.00",$0.00,"$2,919.00","$1,313.55","$2,083.29",$0.00,$502.93,$0.00,$0.00,$511.09,"$2,919.00",$0.00,"$1,459.50","$2,311.85","$2,335.20",$0.00,$456.82,$0.00,$464.70,$0.00
6632-5-080,SUP,Custom 27803010,,6632-5-080  -  SPACER FEM 5MM LEFT MDL KNEE,"$1,794.00",$0.00,"$1,794.00",$0.00,"$1,280.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,794.00",$0.00,$897.00,"$1,420.85","$1,435.20",$0.00,$0.00,$0.00,$0.00,$0.00
6632-5-085,SUP,Custom 27803010,,6632-5-085  -  SPACER FEM 5MM RIGHT MDL KNEE,"$1,794.00",$0.00,"$1,794.00",$0.00,"$1,280.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,794.00",$0.00,$897.00,"$1,420.85","$1,435.20",$0.00,$0.00,$0.00,$0.00,$0.00
6632-5-090,SUP,Custom 27803010,,6632-5-090  -  SPACER FEM 5MM DRCN XS LEFT DISTAL LAT,"$1,737.13",$0.00,"$1,737.13",$0.00,"$1,239.79",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,737.13",$0.00,$868.56,"$1,375.81","$1,389.70",$0.00,$0.00,$0.00,$0.00,$0.00
6632-5-100,SUP,Custom 27803010,,6632-5-100  -  SPACER FEM 5MM DRCN SM LEFT DISTAL MDL VIT,"$1,865.50",$0.00,"$1,865.50",$0.00,"$1,331.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,865.50",$0.00,$932.75,"$1,477.48","$1,492.40",$0.00,$0.00,$0.00,$0.00,$0.00
6632-5-105,SUP,Custom 27803010,,6632-5-105  -  SPACER FEM 5MM DRCN SM RIGHT DISTAL MDL,"$1,865.50",$0.00,"$1,865.50",$0.00,"$1,331.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,865.50",$0.00,$932.75,"$1,477.48","$1,492.40",$0.00,$0.00,$0.00,$0.00,$0.00
6632-5-110,SUP,Custom 27803010,,6632-5-110  -  SPACER FEM 5MM DRCN SM LEFT DISTAL LAT,"$1,865.50",$0.00,"$1,865.50",$0.00,"$1,331.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,865.50",$0.00,$932.75,"$1,477.48","$1,492.40",$0.00,$0.00,$0.00,$0.00,$0.00
6632-5-115,SUP,Custom 27803010,,6632-5-115  -  SPACER FEM 5MM DRCN SM RIGHT DISTAL LAT,"$1,865.50",$0.00,"$1,865.50",$0.00,"$1,331.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,865.50",$0.00,$932.75,"$1,477.48","$1,492.40",$0.00,$0.00,$0.00,$0.00,$0.00
6632-5-120,SUP,Custom 27803010,,6632-5-120  -  SPACER FEM 5MM DRCN MED LEFT DISTAL MDL,"$1,865.50",$0.00,"$1,865.50",$0.00,"$1,331.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,865.50",$0.00,$932.75,"$1,477.48","$1,492.40",$0.00,$0.00,$0.00,$0.00,$0.00
6632-5-125,SUP,Custom 27803010,,6632-5-125  -  SPACER FEM 5MM DRCN MED RIGHT DISTAL MDL,"$1,865.50",$0.00,"$1,865.50",$0.00,"$1,331.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,865.50",$0.00,$932.75,"$1,477.48","$1,492.40",$0.00,$0.00,$0.00,$0.00,$0.00
6632-5-130,SUP,Custom 27803010,,6632-5-130  -  SPACER FEM 5MM DRCN MED LEFT DISTAL LAT VIT,"$1,865.50",$0.00,"$1,865.50",$0.00,"$1,331.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,865.50",$0.00,$932.75,"$1,477.48","$1,492.40",$0.00,$0.00,$0.00,$0.00,$0.00
6632-5-135,SUP,Custom 27803010,,6632-5-135  -  SPACER FEM 5MM DRCN MED RIGHT DISTAL LAT,"$1,865.50",$0.00,"$1,865.50",$0.00,"$1,331.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,865.50",$0.00,$932.75,"$1,477.48","$1,492.40",$0.00,$0.00,$0.00,$0.00,$0.00
6632-5-140,SUP,Custom 27803010,,6632-5-140  -  SPACER FEM 5MM DRCN MED LG LEFT DISTAL MDL VIT,"$1,865.50",$0.00,"$1,865.50",$0.00,"$1,331.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,865.50",$0.00,$932.75,"$1,477.48","$1,492.40",$0.00,$0.00,$0.00,$0.00,$0.00
6632-5-145,SUP,Custom 27803010,,6632-5-145  -  SPACER FEM 5MM DRCN MED LG RIGHT DISTAL MDL VIT,"$1,865.50",$0.00,"$1,865.50",$0.00,"$1,331.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,865.50",$0.00,$932.75,"$1,477.48","$1,492.40",$0.00,$0.00,$0.00,$0.00,$0.00
6632-5-150,SUP,Custom 27803010,,6632-5-150  -  SPACER FEM 5MM DRCN MED LG LEFT DISTAL LAT,"$1,865.50",$0.00,"$1,865.50",$0.00,"$1,331.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,865.50",$0.00,$932.75,"$1,477.48","$1,492.40",$0.00,$0.00,$0.00,$0.00,$0.00
6632-5-155,SUP,Custom 27803010,,6632-5-155  -  SPACER FEM 5MM DRCN MED LG RIGHT DISTAL LAT,"$1,865.50",$0.00,"$1,865.50",$0.00,"$1,331.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,865.50",$0.00,$932.75,"$1,477.48","$1,492.40",$0.00,$0.00,$0.00,$0.00,$0.00
6632-5-160,SUP,Custom 27803010,,6632-5-160  -  SPACER FEM 5MM DRCN LG LEFT DISTAL MDL,"$1,865.50",$0.00,"$1,865.50",$0.00,"$1,331.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,865.50",$0.00,$932.75,"$1,477.48","$1,492.40",$0.00,$0.00,$0.00,$0.00,$0.00
6632-5-165,SUP,Custom 27803010,,6632-5-165  -  SPACER FEM 5MM DRCN LG RIGHT DISTAL MDL,"$1,865.50",$0.00,"$1,865.50",$0.00,"$1,331.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,865.50",$0.00,$932.75,"$1,477.48","$1,492.40",$0.00,$0.00,$0.00,$0.00,$0.00
6632-5-170,SUP,Custom 27803010,,6632-5-170  -  SPACER FEM 5MM DRCN LG LEFT DISTAL LAT,"$1,865.50",$0.00,"$1,865.50",$0.00,"$1,331.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,865.50",$0.00,$932.75,"$1,477.48","$1,492.40",$0.00,$0.00,$0.00,$0.00,$0.00
6632-5-175,SUP,Custom 27803010,,6632-5-175  -  SPACER FEM 5MM DRCN LG RIGHT DISTAL LAT,"$1,865.50",$0.00,"$1,865.50",$0.00,"$1,331.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,865.50",$0.00,$932.75,"$1,477.48","$1,492.40",$0.00,$0.00,$0.00,$0.00,$0.00
6632-5-180,SUP,Custom 27803010,,6632-5-180  -  SPACER FEM 5MM DRCN XL LEFT DISTAL MDL VIT,"$1,961.38",$0.00,"$1,961.38",$0.00,"$1,399.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,961.38",$0.00,$980.69,"$1,553.41","$1,569.10",$0.00,$0.00,$0.00,$0.00,$0.00
6632-5-185,SUP,Custom 27803010,,6632-5-185  -  SPACER FEM 5MM DRCN XL RIGHT DISTAL MDL VIT,"$1,961.38",$0.00,"$1,961.38",$0.00,"$1,399.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,961.38",$0.00,$980.69,"$1,553.41","$1,569.10",$0.00,$0.00,$0.00,$0.00,$0.00
6632-5-190,SUP,Custom 27803010,,6632-5-190  -  SPACER FEM 5MM DRCN XL LEFT DISTAL LAT,"$1,961.38",$0.00,"$1,961.38",$0.00,"$1,399.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,961.38",$0.00,$980.69,"$1,553.41","$1,569.10",$0.00,$0.00,$0.00,$0.00,$0.00
6632-5-195,SUP,Custom 27803010,,6632-5-195  -  SPACER FEM 5MM DRCN XL RIGHT DISTAL LAT VIT,"$1,961.38",$0.00,"$1,961.38",$0.00,"$1,399.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,961.38",$0.00,$980.69,"$1,553.41","$1,569.10",$0.00,$0.00,$0.00,$0.00,$0.00
6632-5-450,SUP,Custom 27803010,,6632-5-450  -  STABILIZER SRG S/MED ML DRCN MDLR KN,$414.00,$0.00,$414.00,$0.00,$295.47,$0.00,$0.00,$0.00,$0.00,$0.00,$414.00,$0.00,$207.00,$327.89,$331.20,$0.00,$0.00,$0.00,$0.00,$0.00
6632-5-600,SUP,HCPCS C1713,,6632-5-600  -  SCREW BONE 5MM DRCN VIT DISTAL FEM LCK SMPL,$120.00,$0.00,$120.00,$54.00,$85.64,$0.00,$20.68,$0.00,$0.00,$21.01,$120.00,$0.00,$60.00,$95.04,$96.00,$0.00,$18.78,$0.00,$19.10,$0.00
6632-6-100,SUP,Custom 27803010,,6632-6-100  -  SPACER FEM SM 10MM DRCN KN LT MDL,"$1,865.50",$0.00,"$1,865.50",$0.00,"$1,331.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,865.50",$0.00,$932.75,"$1,477.48","$1,492.40",$0.00,$0.00,$0.00,$0.00,$0.00
6632-6-105,SUP,Custom 27803010,,6632-6-105  -  SPACER FEM 10MM DRCN SM RIGHT MDL DP VIT,"$1,865.50",$0.00,"$1,865.50",$0.00,"$1,331.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,865.50",$0.00,$932.75,"$1,477.48","$1,492.40",$0.00,$0.00,$0.00,$0.00,$0.00
6632-6-110,SUP,Custom 27803010,,6632-6-110  -  SPACER FEM 10MM DRCN SM L/L DP,"$1,865.50",$0.00,"$1,865.50",$0.00,"$1,331.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,865.50",$0.00,$932.75,"$1,477.48","$1,492.40",$0.00,$0.00,$0.00,$0.00,$0.00
6632-6-115,SUP,Custom 27803010,,6632-6-115  -  SPACER FEM 10MM DRCN SM RIGHT LAT DP,"$1,865.50",$0.00,"$1,865.50",$0.00,"$1,331.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,865.50",$0.00,$932.75,"$1,477.48","$1,492.40",$0.00,$0.00,$0.00,$0.00,$0.00
6632-6-120,SUP,Custom 27803010,,6632-6-120  -  SPACER FEM 10MM DRCN MED LEFT MDL DP,"$1,865.50",$0.00,"$1,865.50",$0.00,"$1,331.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,865.50",$0.00,$932.75,"$1,477.48","$1,492.40",$0.00,$0.00,$0.00,$0.00,$0.00
6632-6-125,SUP,Custom 27803010,,6632-6-125  -  SPACER FEM 10MM DRCN MED RIGHT MDL DP,"$1,865.50",$0.00,"$1,865.50",$0.00,"$1,331.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,865.50",$0.00,$932.75,"$1,477.48","$1,492.40",$0.00,$0.00,$0.00,$0.00,$0.00
6632-6-130,SUP,Custom 27803010,,6632-6-130  -  SPACER FEM 10MM DRCN MED L/L DP,"$1,865.50",$0.00,"$1,865.50",$0.00,"$1,331.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,865.50",$0.00,$932.75,"$1,477.48","$1,492.40",$0.00,$0.00,$0.00,$0.00,$0.00
6632-6-135,SUP,Custom 27803010,,6632-6-135  -  SPACER FEM 10MM DRCN MED RIGHT LAT DP,"$1,865.50",$0.00,"$1,865.50",$0.00,"$1,331.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,865.50",$0.00,$932.75,"$1,477.48","$1,492.40",$0.00,$0.00,$0.00,$0.00,$0.00
6632-6-140,SUP,Custom 27803010,,6632-6-140  -  SPACER FEM 10MM DRCN MED LG LEFT MDL DP,"$1,865.50",$0.00,"$1,865.50",$0.00,"$1,331.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,865.50",$0.00,$932.75,"$1,477.48","$1,492.40",$0.00,$0.00,$0.00,$0.00,$0.00
6632-6-145,SUP,Custom 27803010,,6632-6-145  -  SPACER FEM 10MM DRCN MED LG RIGHT MDL DP VIT,"$1,865.50",$0.00,"$1,865.50",$0.00,"$1,331.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,865.50",$0.00,$932.75,"$1,477.48","$1,492.40",$0.00,$0.00,$0.00,$0.00,$0.00
6632-6-150,SUP,Custom 27803010,,6632-6-150  -  SPACER FEM 10MM DRCN MED LG L/L DP,"$1,865.50",$0.00,"$1,865.50",$0.00,"$1,331.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,865.50",$0.00,$932.75,"$1,477.48","$1,492.40",$0.00,$0.00,$0.00,$0.00,$0.00
6632-6-155,SUP,Custom 27803010,,6632-6-155  -  SPACER FEM 10MM DRCN MED LG RIGHT LAT DP VIT SPCR STAB,"$1,865.50",$0.00,"$1,865.50",$0.00,"$1,331.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,865.50",$0.00,$932.75,"$1,477.48","$1,492.40",$0.00,$0.00,$0.00,$0.00,$0.00
6632-6-160,SUP,Custom 27803010,,6632-6-160  -  SPACER FEM 10MM DRCN LG LEFT MDL DP,"$1,865.50",$0.00,"$1,865.50",$0.00,"$1,331.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,865.50",$0.00,$932.75,"$1,477.48","$1,492.40",$0.00,$0.00,$0.00,$0.00,$0.00
6632-6-165,SUP,Custom 27803010,,6632-6-165  -  SPACER FEM 10MM DRCN LG RIGHT MDL DP,"$1,865.50",$0.00,"$1,865.50",$0.00,"$1,331.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,865.50",$0.00,$932.75,"$1,477.48","$1,492.40",$0.00,$0.00,$0.00,$0.00,$0.00
6632-6-170,SUP,Custom 27803010,,6632-6-170  -  SPACER FEM 10MM DRCN LG L/L DP,"$1,865.50",$0.00,"$1,865.50",$0.00,"$1,331.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,865.50",$0.00,$932.75,"$1,477.48","$1,492.40",$0.00,$0.00,$0.00,$0.00,$0.00
6632-6-175,SUP,Custom 27803010,,6632-6-175  -  SPACER FEM 10MM DRCN LG RIGHT LAT DP,"$1,865.50",$0.00,"$1,865.50",$0.00,"$1,331.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,865.50",$0.00,$932.75,"$1,477.48","$1,492.40",$0.00,$0.00,$0.00,$0.00,$0.00
6632-6-180,SUP,Custom 27803010,,6632-6-180  -  SPACER FEM 10MM DRCN XL LEFT MDL DP,"$1,961.38",$0.00,"$1,961.38",$0.00,"$1,399.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,961.38",$0.00,$980.69,"$1,553.41","$1,569.10",$0.00,$0.00,$0.00,$0.00,$0.00
6632-6-185,SUP,Custom 27803010,,6632-6-185  -  SPACER FEM 10MM DRCN XL RIGHT MDL DP,"$1,961.38",$0.00,"$1,961.38",$0.00,"$1,399.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,961.38",$0.00,$980.69,"$1,553.41","$1,569.10",$0.00,$0.00,$0.00,$0.00,$0.00
6632-6-190,SUP,Custom 27803010,,6632-6-190  -  SPACER FEM 10MM DRCN XL L/L DP,"$1,961.38",$0.00,"$1,961.38",$0.00,"$1,399.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,961.38",$0.00,$980.69,"$1,553.41","$1,569.10",$0.00,$0.00,$0.00,$0.00,$0.00
6632-6-195,SUP,Custom 27803010,,6632-6-195  -  SPACER FEM 10MM DRCN XL RIGHT LAT DP,"$1,961.38",$0.00,"$1,961.38",$0.00,"$1,399.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,961.38",$0.00,$980.69,"$1,553.41","$1,569.10",$0.00,$0.00,$0.00,$0.00,$0.00
6632-6-410,SUP,Custom 27803010,,6632-6-410  -  SPACER FEM 10MM DRCN SM POST,"$1,868.75",$0.00,"$1,868.75",$0.00,"$1,333.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,868.75",$0.00,$934.38,"$1,480.05","$1,495.00",$0.00,$0.00,$0.00,$0.00,$0.00
6632-6-415,SUP,Custom 27803010,,6632-6-415  -  SPACER FEM 5MM DRCN SM POST,"$1,868.75",$0.00,"$1,868.75",$0.00,"$1,333.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,868.75",$0.00,$934.38,"$1,480.05","$1,495.00",$0.00,$0.00,$0.00,$0.00,$0.00
6632-6-420,SUP,Custom 27803010,,6632-6-420  -  SPACER FEM 10MM DRCN MED POST,"$1,581.13",$0.00,"$1,581.13",$0.00,"$1,128.45",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,581.13",$0.00,$790.56,"$1,252.25","$1,264.90",$0.00,$0.00,$0.00,$0.00,$0.00
6632-6-425,SUP,Custom 27803010,,6632-6-425  -  SPACER FEM 5MM DRCN MED POST,"$1,868.75",$0.00,"$1,868.75",$0.00,"$1,333.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,868.75",$0.00,$934.38,"$1,480.05","$1,495.00",$0.00,$0.00,$0.00,$0.00,$0.00
6632-6-430,SUP,Custom 27803010,,6632-6-430  -  SPACER FEM 10MM DRCN MED LG POST,"$1,868.75",$0.00,"$1,868.75",$0.00,"$1,333.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,868.75",$0.00,$934.38,"$1,480.05","$1,495.00",$0.00,$0.00,$0.00,$0.00,$0.00
6632-6-435,SUP,Custom 27803010,,6632-6-435  -  SPACER FEM 5MM DRCN MED LG POST VIT FULL,"$1,868.75",$0.00,"$1,868.75",$0.00,"$1,333.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,868.75",$0.00,$934.38,"$1,480.05","$1,495.00",$0.00,$0.00,$0.00,$0.00,$0.00
6632-6-440,SUP,Custom 27803010,,6632-6-440  -  SPACER FEM 10MM DRCN LG POST,"$1,868.75",$0.00,"$1,868.75",$0.00,"$1,333.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,868.75",$0.00,$934.38,"$1,480.05","$1,495.00",$0.00,$0.00,$0.00,$0.00,$0.00
6632-6-445,SUP,Custom 27803010,,6632-6-445  -  SPACER FEM 5MM DRCN LG POST,"$1,868.75",$0.00,"$1,868.75",$0.00,"$1,333.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,868.75",$0.00,$934.38,"$1,480.05","$1,495.00",$0.00,$0.00,$0.00,$0.00,$0.00
6632-6-450,SUP,Custom 27803010,,6632-6-450  -  SPACER FEM 10MM DRCN XL POST,"$1,961.38",$0.00,"$1,961.38",$0.00,"$1,399.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,961.38",$0.00,$980.69,"$1,553.41","$1,569.10",$0.00,$0.00,$0.00,$0.00,$0.00
6632-6-455,SUP,Custom 27803010,,6632-6-455  -  SPACER FEM 5MM DRCN XL POST VIT FULL,"$1,961.38",$0.00,"$1,961.38",$0.00,"$1,399.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,961.38",$0.00,$980.69,"$1,553.41","$1,569.10",$0.00,$0.00,$0.00,$0.00,$0.00
6632-6-460,SUP,Custom 27803010,,6632-6-460  -  SPACER FEM 10MM DRCN 2XL POST FULL,"$1,961.38",$0.00,"$1,961.38",$0.00,"$1,399.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,961.38",$0.00,$980.69,"$1,553.41","$1,569.10",$0.00,$0.00,$0.00,$0.00,$0.00
6632-6-465,SUP,Custom 27803010,,6632-6-465  -  SPACER FEM 5MM DRCN 2XL POST FULL,"$1,961.38",$0.00,"$1,961.38",$0.00,"$1,399.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,961.38",$0.00,$980.69,"$1,553.41","$1,569.10",$0.00,$0.00,$0.00,$0.00,$0.00
6632-6-600,SUP,HCPCS C1713,,6632-6-600  -  SCREW BONE 10MM 10MM DRCN DISTAL FEM LCK,$120.00,$0.00,$120.00,$54.00,$85.64,$0.00,$20.68,$0.00,$0.00,$21.01,$120.00,$0.00,$60.00,$95.04,$96.00,$0.00,$18.78,$0.00,$19.10,$0.00
6632-6-705,SUP,Custom 27803010,,6632-6-705  -  SPACER FEM 5MM DRCN XS POST HALF,"$1,961.38",$0.00,"$1,961.38",$0.00,"$1,399.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,961.38",$0.00,$980.69,"$1,553.41","$1,569.10",$0.00,$0.00,$0.00,$0.00,$0.00
6632-6-710,SUP,Custom 27803010,,6632-6-710  -  SPACER FEM 10MM DRCN SM POST HALF,"$1,868.75",$0.00,"$1,868.75",$0.00,"$1,333.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,868.75",$0.00,$934.38,"$1,480.05","$1,495.00",$0.00,$0.00,$0.00,$0.00,$0.00
6632-6-715,SUP,Custom 27803010,,6632-6-715  -  SPACER FEM 5MM DRCN SM POST HALF,"$1,868.75",$0.00,"$1,868.75",$0.00,"$1,333.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,868.75",$0.00,$934.38,"$1,480.05","$1,495.00",$0.00,$0.00,$0.00,$0.00,$0.00
6632-6-720,SUP,Custom 27803010,,6632-6-720  -  SPACER FEM 10MM DRCN MED POST HALF,"$1,868.75",$0.00,"$1,868.75",$0.00,"$1,333.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,868.75",$0.00,$934.38,"$1,480.05","$1,495.00",$0.00,$0.00,$0.00,$0.00,$0.00
6632-6-725,SUP,Custom 27803010,,6632-6-725  -  SPACER FEM 5MM DRCN MED POST HALF,"$1,868.75",$0.00,"$1,868.75",$0.00,"$1,333.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,868.75",$0.00,$934.38,"$1,480.05","$1,495.00",$0.00,$0.00,$0.00,$0.00,$0.00
6632-6-730,SUP,Custom 27803010,,6632-6-730  -  SPACER FEM 10MM DRCN MED LG POST HALF,"$1,868.75",$0.00,"$1,868.75",$0.00,"$1,333.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,868.75",$0.00,$934.38,"$1,480.05","$1,495.00",$0.00,$0.00,$0.00,$0.00,$0.00
6632-6-735,SUP,Custom 27803010,,6632-6-735  -  SPACER FEM 5MM DRCN MED LG POST HALF,"$1,868.75",$0.00,"$1,868.75",$0.00,"$1,333.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,868.75",$0.00,$934.38,"$1,480.05","$1,495.00",$0.00,$0.00,$0.00,$0.00,$0.00
6632-6-740,SUP,Custom 27803010,,6632-6-740  -  SPACER FEM 10MM DRCN LG POST HALF,"$1,868.75",$0.00,"$1,868.75",$0.00,"$1,333.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,868.75",$0.00,$934.38,"$1,480.05","$1,495.00",$0.00,$0.00,$0.00,$0.00,$0.00
6632-6-745,SUP,Custom 27803010,,6632-6-745  -  SPACER FEM 5MM DRCN LG POST HALF,"$1,868.75",$0.00,"$1,868.75",$0.00,"$1,333.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,868.75",$0.00,$934.38,"$1,480.05","$1,495.00",$0.00,$0.00,$0.00,$0.00,$0.00
6632-6-750,SUP,Custom 27803010,,6632-6-750  -  SPACER FEM 10MM DRCN XL POST HALF,"$1,961.38",$0.00,"$1,961.38",$0.00,"$1,399.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,961.38",$0.00,$980.69,"$1,553.41","$1,569.10",$0.00,$0.00,$0.00,$0.00,$0.00
6632-6-755,SUP,Custom 27803010,,6632-6-755  -  SPACER FEM XL HLF 5MM DRCN KN POST,"$1,961.38",$0.00,"$1,961.38",$0.00,"$1,399.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,961.38",$0.00,$980.69,"$1,553.41","$1,569.10",$0.00,$0.00,$0.00,$0.00,$0.00
6632-6-760,SUP,Custom 27803010,,6632-6-760  -  SPACER FEM 10MM DRCN 2XL POST KNEE HALF,"$1,961.38",$0.00,"$1,961.38",$0.00,"$1,399.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,961.38",$0.00,$980.69,"$1,553.41","$1,569.10",$0.00,$0.00,$0.00,$0.00,$0.00
6632-6-765,SUP,Custom 27803010,,6632-6-765  -  SPACER FEM 5MM DRCN XL POST HALF,"$1,961.38",$0.00,"$1,961.38",$0.00,"$1,399.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,961.38",$0.00,$980.69,"$1,553.41","$1,569.10",$0.00,$0.00,$0.00,$0.00,$0.00
6632-8-800,SUP,HCPCS C1776,,6632-8-800  -  CMPNT FEM XS LEFT TOT STAB,"$10,811.13",$0.00,"$10,811.13","$4,865.01","$5,158.80",$0.00,"$1,862.70",$0.00,$0.00,"$1,892.94","$10,811.13",$0.00,"$5,405.56","$8,562.41","$8,648.90",$0.00,"$1,691.94",$0.00,"$1,721.13",$0.00
6632-8-805,SUP,HCPCS C1776,,6632-8-805  -  CMPNT FEM XS RIGHT KNEE TOT STAB DRCN,"$10,811.13",$0.00,"$10,811.13","$4,865.01","$5,158.80",$0.00,"$1,862.70",$0.00,$0.00,"$1,892.94","$10,811.13",$0.00,"$5,405.56","$8,562.41","$8,648.90",$0.00,"$1,691.94",$0.00,"$1,721.13",$0.00
6632-8-810,SUP,HCPCS C1776,,6632-8-810  -  CMPNT FEM SM LEFT TOT STAB,"$10,619.38",$0.00,"$10,619.38","$4,778.72","$5,158.80",$0.00,"$1,829.67",$0.00,$0.00,"$1,859.37","$10,619.38",$0.00,"$5,309.69","$8,410.55","$8,495.50",$0.00,"$1,661.93",$0.00,"$1,690.60",$0.00
6632-8-815,SUP,HCPCS C1776,,6632-8-815  -  CMPNT FEM SM RIGHT TOT STAB,"$10,619.38",$0.00,"$10,619.38","$4,778.72","$5,158.80",$0.00,"$1,829.67",$0.00,$0.00,"$1,859.37","$10,619.38",$0.00,"$5,309.69","$8,410.55","$8,495.50",$0.00,"$1,661.93",$0.00,"$1,690.60",$0.00
6632-8-820,SUP,HCPCS C1776,,6632-8-820  -  CMPNT FEM MED LEFT TOT STAB,"$10,619.38",$0.00,"$10,619.38","$4,778.72","$5,158.80",$0.00,"$1,829.67",$0.00,$0.00,"$1,859.37","$10,619.38",$0.00,"$5,309.69","$8,410.55","$8,495.50",$0.00,"$1,661.93",$0.00,"$1,690.60",$0.00
6632-8-825,SUP,HCPCS C1776,,6632-8-825  -  CMPNT FEM MED RIGHT TOT STAB,"$10,619.38",$0.00,"$10,619.38","$4,778.72","$5,158.80",$0.00,"$1,829.67",$0.00,$0.00,"$1,859.37","$10,619.38",$0.00,"$5,309.69","$8,410.55","$8,495.50",$0.00,"$1,661.93",$0.00,"$1,690.60",$0.00
6632-8-830,SUP,HCPCS C1776,,6632-8-830  -  CMPNT FEM MED LG LEFT TOT STAB,"$10,619.38",$0.00,"$10,619.38","$4,778.72","$5,158.80",$0.00,"$1,829.67",$0.00,$0.00,"$1,859.37","$10,619.38",$0.00,"$5,309.69","$8,410.55","$8,495.50",$0.00,"$1,661.93",$0.00,"$1,690.60",$0.00
6632-8-835,SUP,HCPCS C1776,,6632-8-835  -  CMPNT FEM MED LG RIGHT TOT STAB,"$10,619.38",$0.00,"$10,619.38","$4,778.72","$5,158.80",$0.00,"$1,829.67",$0.00,$0.00,"$1,859.37","$10,619.38",$0.00,"$5,309.69","$8,410.55","$8,495.50",$0.00,"$1,661.93",$0.00,"$1,690.60",$0.00
6632-8-840,SUP,HCPCS C1776,,6632-8-840  -  CMPNT FEM LG LEFT TOT STAB,"$10,619.38",$0.00,"$10,619.38","$4,778.72","$5,158.80",$0.00,"$1,829.67",$0.00,$0.00,"$1,859.37","$10,619.38",$0.00,"$5,309.69","$8,410.55","$8,495.50",$0.00,"$1,661.93",$0.00,"$1,690.60",$0.00
6632-8-845,SUP,HCPCS C1776,,6632-8-845  -  CMPNT FEM LG RIGHT TOT STAB,"$10,619.38",$0.00,"$10,619.38","$4,778.72","$5,158.80",$0.00,"$1,829.67",$0.00,$0.00,"$1,859.37","$10,619.38",$0.00,"$5,309.69","$8,410.55","$8,495.50",$0.00,"$1,661.93",$0.00,"$1,690.60",$0.00
6632-8-850,SUP,HCPCS C1776,,6632-8-850  -  CMPNT FEM XL LEFT TOT STAB,"$10,811.13",$0.00,"$10,811.13","$4,865.01","$5,158.80",$0.00,"$1,862.70",$0.00,$0.00,"$1,892.94","$10,811.13",$0.00,"$5,405.56","$8,562.41","$8,648.90",$0.00,"$1,691.94",$0.00,"$1,721.13",$0.00
6632-8-855,SUP,HCPCS C1776,,6632-8-855  -  CMPNT FEM XL RIGHT TOT STAB,"$10,811.13",$0.00,"$10,811.13","$4,865.01","$5,158.80",$0.00,"$1,862.70",$0.00,$0.00,"$1,892.94","$10,811.13",$0.00,"$5,405.56","$8,562.41","$8,648.90",$0.00,"$1,691.94",$0.00,"$1,721.13",$0.00
6634-0-330,SUP,Custom 27803010,,6634-0-330  -  CMPNT FEM UNV SM LEFT MDL RIGHT LAT DRCN,"$1,856.00",$0.00,"$1,856.00",$0.00,"$1,324.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,856.00",$0.00,$928.00,"$1,469.95","$1,484.80",$0.00,$0.00,$0.00,$0.00,$0.00
6637-0-009,SUP,HCPCS C1776,,6637-0-009  -  INSERT TIBIAL SMALL 9MM REVISION PCA DURACON KNEE LEFT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-011,SUP,HCPCS C1776,,6637-0-011  -  INSERT TIBIAL SMALL 11MM REVISION PCA DURACON KNEE LEFT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-013,SUP,HCPCS C1776,,6637-0-013  -  INSERT TIBIAL SMALL 13MM REVISION PCA DURACON KNEE LEFT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-016,SUP,HCPCS C1776,,6637-0-016  -  INSERT TIBIAL SMALL 16MM REVISION PCA DURACON KNEE LEFT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-019,SUP,HCPCS C1776,,6637-0-019  -  INSERT TIBIAL SMALL 19MM REVISION PCA DURACON KNEE LEFT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-022,SUP,HCPCS C1776,,6637-0-022  -  INSERT TIBIAL SMALL 22MM REVISION PCA DURACON KNEE LEFT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-025,SUP,HCPCS C1776,,6637-0-025  -  INSERT TIBIAL SMALL 25MM REVISION PCA DURACON KNEE LEFT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-028,SUP,HCPCS C1776,,6637-0-028  -  INSERT TIBIAL SMALL 28MM REVISION PCA DURACON KNEE LEFT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-031,SUP,HCPCS C1776,,6637-0-031  -  INSERT TIBIAL SMALL 31MM REVISION PCA DURACON KNEE LEFT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-109,SUP,HCPCS C1776,,6637-0-109  -  INSERT TIBIAL MEDIUM 9MM REVISION PCA DURACON KNEE LEFT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-111,SUP,HCPCS C1776,,6637-0-111  -  INSERT TIBIAL MEDIUM 11MM REVISION PCA DURACON KNEE LEFT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-113,SUP,HCPCS C1776,,6637-0-113  -  INSERT TIBIAL MEDIUM 13MM REVISION PCA DURACON KNEE LEFT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-116,SUP,HCPCS C1776,,6637-0-116  -  INSERT TIBIAL MEDIUM 16MM REVISION PCA DURACON KNEE LEFT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-119,SUP,HCPCS C1776,,6637-0-119  -  INSERT TIBIAL MEDIUM 19MM REVISION PCA DURACON KNEE LEFT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-122,SUP,HCPCS C1776,,6637-0-122  -  INSERT TIBIAL MEDIUM 22MM REVISION PCA DURACON KNEE LEFT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-125,SUP,HCPCS C1776,,6637-0-125  -  INSERT TIBIAL MEDIUM 25MM REVISION PCA DURACON KNEE LEFT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-128,SUP,HCPCS C1776,,6637-0-128  -  INSERT TIBIAL MEDIUM 28MM REVISION PCA DURACON KNEE LEFT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-131,SUP,HCPCS C1776,,6637-0-131  -  INSERT TIBIAL MEDIUM 31MM REVISION PCA DURACON KNEE LEFT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-209,SUP,HCPCS C1776,,6637-0-209  -  INSERT TIBIAL LARGE 9MM REVISION PCA DURACON KNEE LEFT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-211,SUP,HCPCS C1776,,6637-0-211  -  INSERT TIBIAL LARGE 11MM REVISION PCA DURACON KNEE LEFT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-213,SUP,HCPCS C1776,,6637-0-213  -  INSERT TIBIAL LARGE 13MM REVISION PCA DURACON KNEE LEFT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-216,SUP,HCPCS C1776,,6637-0-216  -  INSERT TIBIAL LARGE 16MM REVISION PCA DURACON KNEE LEFT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-219,SUP,HCPCS C1776,,6637-0-219  -  INSERT TIBIAL LARGE 19MM REVISION PCA DURACON KNEE LEFT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-222,SUP,HCPCS C1776,,6637-0-222  -  INSERT TIBIAL LARGE 22MM REVISION PCA DURACON KNEE LEFT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-225,SUP,HCPCS C1776,,6637-0-225  -  INSERT TIBIAL LARGE 25MM REVISION PCA DURACON KNEE LEFT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-228,SUP,HCPCS C1776,,6637-0-228  -  INSERT TIBIAL LARGE 28MM REVISION PCA DURACON KNEE LEFT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-231,SUP,HCPCS C1776,,6637-0-231  -  INSERT TIBIAL LARGE 31MM REVISION PCA DURACON KNEE LEFT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-309,SUP,HCPCS C1776,,6637-0-309  -  INSERT TIBIAL XL 9MM REVISION PCA DURACON KNEE LEFT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-311,SUP,HCPCS C1776,,6637-0-311  -  INSERT TIBIAL XL 11MM REVISION PCA DURACON KNEE LEFT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-313,SUP,HCPCS C1776,,6637-0-313  -  INSERT TIBIAL XL 13MM REVISION PCA DURACON KNEE LEFT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-316,SUP,HCPCS C1776,,6637-0-316  -  INSERT TIBIAL XL 16MM REVISION PCA DURACON KNEE LEFT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-319,SUP,HCPCS C1776,,6637-0-319  -  INSERT TIBIAL XL 19MM REVISION PCA DURACON KNEE LEFT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-322,SUP,HCPCS C1776,,6637-0-322  -  INSERT TIBIAL XL 22MM REVISION PCA DURACON KNEE LEFT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-325,SUP,HCPCS C1776,,6637-0-325  -  INSERT TIBIAL XL 25MM REVISION PCA DURACON KNEE LEFT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-328,SUP,HCPCS C1776,,6637-0-328  -  INSERT TIBIAL XL 28MM REVISION PCA DURACON KNEE LEFT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-331,SUP,HCPCS C1776,,6637-0-331  -  INSERT TIBIAL XL 31MM REVISION PCA DURACON KNEE LEFT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-609,SUP,HCPCS C1776,,6637-0-609  -  INSERT TIBIAL SMALL 9MM REVISION PCA DURACON KNEE RIGHT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-611,SUP,HCPCS C1776,,6637-0-611  -  INSERT TIBIAL SMALL 11MM REVISION PCA DURACON KNEE RIGHT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-613,SUP,HCPCS C1776,,6637-0-613  -  INSERT TIBIAL SMALL 13MM REVISION PCA DURACON KNEE RIGHT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-616,SUP,HCPCS C1776,,6637-0-616  -  INSERT TIBIAL SMALL 16MM REVISION PCA DURACON KNEE RIGHT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-619,SUP,HCPCS C1776,,6637-0-619  -  INSERT TIBIAL SMALL 19MM REVISION PCA DURACON KNEE RIGHT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-622,SUP,HCPCS C1776,,6637-0-622  -  INSERT TIBIAL SMALL 22MM REVISION PCA DURACON KNEE RIGHT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-625,SUP,HCPCS C1776,,6637-0-625  -  INSERT TIBIAL SMALL 25MM REVISION PCA DURACON KNEE RIGHT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-628,SUP,HCPCS C1776,,6637-0-628  -  INSERT TIBIAL SMALL 28MM REVISION PCA DURACON KNEE RIGHT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-631,SUP,HCPCS C1776,,6637-0-631  -  INSERT TIBIAL SMALL 31MM REVISION PCA DURACON KNEE RIGHT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-709,SUP,HCPCS C1776,,6637-0-709  -  INSERT TIBIAL MEDIUM 9MM REVISION PCA DURACON KNEE RIGHT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-711,SUP,HCPCS C1776,,6637-0-711  -  INSERT TIBIAL MEDIUM 11MM REVISION PCA DURACON KNEE RIGHT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-713,SUP,HCPCS C1776,,6637-0-713  -  INSERT TIBIAL MEDIUM 13MM REVISION PCA DURACON KNEE RIGHT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-716,SUP,HCPCS C1776,,6637-0-716  -  INSERT TIBIAL MEDIUM 16MM REVISION PCA DURACON KNEE RIGHT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-719,SUP,HCPCS C1776,,6637-0-719  -  INSERT TIBIAL MEDIUM 19MM REVISION PCA DURACON KNEE RIGHT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-722,SUP,HCPCS C1776,,6637-0-722  -  INSERT TIBIAL MEDIUM 22MM REVISION PCA DURACON KNEE RIGHT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-725,SUP,HCPCS C1776,,6637-0-725  -  INSERT TIBIAL MEDIUM 25MM REVISION PCA DURACON KNEE RIGHT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-728,SUP,HCPCS C1776,,6637-0-728  -  INSERT TIBIAL MEDIUM 28MM REVISION PCA DURACON KNEE RIGHT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-731,SUP,HCPCS C1776,,6637-0-731  -  INSERT TIBIAL MEDIUM 31MM REVISION PCA DURACON KNEE RIGHT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-809,SUP,HCPCS C1776,,6637-0-809  -  INSERT TIBIAL LARGE 9MM REVISION PCA DURACON KNEE RIGHT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-811,SUP,HCPCS C1776,,6637-0-811  -  INSERT TIBIAL LARGE 11MM REVISION PCA DURACON KNEE RIGHT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-813,SUP,HCPCS C1776,,6637-0-813  -  INSERT TIBIAL LARGE 13MM REVISION PCA DURACON KNEE LEFT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-816,SUP,HCPCS C1776,,6637-0-816  -  INSERT TIBIAL LARGE 16MM REVISION PCA DURACON KNEE LEFT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-819,SUP,HCPCS C1776,,6637-0-819  -  INSERT TIBIAL LARGE 16MM REVISION PCA DURACON KNEE LEFT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-822,SUP,HCPCS C1776,,6637-0-822  -  INSERT TIBIAL LARGE 22MM REVISION PCA DURACON KNEE LEFT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-825,SUP,HCPCS C1776,,6637-0-825  -  INSERT TIBIAL LARGE 25MM REVISION PCA DURACON KNEE LEFT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-828,SUP,HCPCS C1776,,6637-0-828  -  INSERT TIBIAL LARGE 28MM REVISION PCA DURACON KNEE LEFT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-831,SUP,HCPCS C1776,,6637-0-831  -  INSERT TIBIAL LARGE 31MM REVISION PCA DURACON KNEE LEFT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-909,SUP,HCPCS C1776,,6637-0-909  -  INSERT TIBIAL XL 9MM REVISION PCA DURACON KNEE RIGHT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-911,SUP,HCPCS C1776,,6637-0-911  -  INSERT TIBIAL XL 11MM REVISION PCA DURACON KNEE RIGHT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-913,SUP,HCPCS C1776,,6637-0-913  -  INSERT TIBIAL XL 13MM REVISION PCA DURACON KNEE RIGHT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-916,SUP,HCPCS C1776,,6637-0-916  -  INSERT TIBIAL XL 16MM REVISION PCA DURACON KNEE RIGHT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-919,SUP,HCPCS C1776,,6637-0-919  -  INSERT TIBIAL XL 19MM REVISION PCA DURACON KNEE RIGHT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-922,SUP,HCPCS C1776,,6637-0-922  -  INSERT TIBIAL XL 22MM REVISION PCA DURACON KNEE RIGHT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-925,SUP,HCPCS C1776,,6637-0-925  -  INSERT TIBIAL XL 25MM REVISION PCA DURACON KNEE RIGHT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-928,SUP,HCPCS C1776,,6637-0-928  -  INSERT TIBIAL XL 28MM REVISION PCA DURACON KNEE RIGHT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-0-931,SUP,HCPCS C1776,,6637-0-931  -  INSERT TIBIAL XL 31MM REVISION PCA DURACON KNEE RIGHT,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-4-009,SUP,HCPCS C1776,,6637-4-009  -  INSERT TIBIAL SMALL NEUTRAL 9MM REVISION PCA DURACON KNEE,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-4-011,SUP,HCPCS C1776,,6637-4-011  -  INSERT TIBIAL SMALL NEUTRAL 11MM REVISION PCA DURACON KNEE,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-4-013,SUP,HCPCS C1776,,6637-4-013  -  INSERT TIBIAL SMALL NEUTRAL 13MM REVISION PCA DURACON KNEE,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-4-016,SUP,HCPCS C1776,,6637-4-016  -  INSERT TIBIAL SMALL NEUTRAL 16MM REVISION PCA DURACON KNEE,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-4-019,SUP,HCPCS C1776,,6637-4-019  -  INSERT TIBIAL SMALL NEUTRAL 19MM REVISION PCA DURACON KNEE,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-4-022,SUP,HCPCS C1776,,6637-4-022  -  INSERT TIBIAL SMALL NEUTRAL 22MM REVISION PCA DURACON KNEE,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-4-025,SUP,HCPCS C1776,,6637-4-025  -  INSERT TIBIAL SMALL NEUTRAL 25MM REVISION PCA DURACON KNEE,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-4-028,SUP,HCPCS C1776,,6637-4-028  -  INSERT TIBIAL SMALL NEUTRAL 28MM REVISION PCA DURACON KNEE,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-4-031,SUP,HCPCS C1776,,6637-4-031  -  INSERT TIBIAL SMALL NEUTRAL 31MM REVISION PCA DURACON KNEE,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-4-109,SUP,HCPCS C1776,,6637-4-109  -  INSERT TIBIAL MEDIUM NEUTRAL 9MM REVISION PCA DURACON KNEE,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-4-111,SUP,HCPCS C1776,,6637-4-111  -  INSERT TIBIAL MEDIUM NEUTRAL 11MM REVISION PCA DURACON KNEE,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-4-113,SUP,HCPCS C1776,,6637-4-113  -  INSERT TIBIAL MEDIUM NEUTRAL 13MM REVISION PCA DURACON KNEE,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-4-116,SUP,HCPCS C1776,,6637-4-116  -  INSERT TIBIAL MEDIUM NEUTRAL 16MM REVISION PCA DURACON KNEE,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-4-119,SUP,HCPCS C1776,,6637-4-119  -  INSERT TIBIAL MEDIUM NEUTRAL 19MM REVISION PCA DURACON KNEE,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-4-122,SUP,HCPCS C1776,,6637-4-122  -  INSERT TIBIAL MEDIUM NEUTRAL 22MM REVISION PCA DURACON KNEE,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-4-125,SUP,HCPCS C1776,,6637-4-125  -  INSERT TIBIAL MEDIUM NEUTRAL 25MM REVISION PCA DURACON KNEE,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-4-128,SUP,HCPCS C1776,,6637-4-128  -  INSERT TIBIAL MEDIUM NEUTRAL 28MM REVISION PCA DURACON KNEE,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-4-131,SUP,HCPCS C1776,,6637-4-131  -  INSERT TIBIAL MEDIUM NEUTRAL 31MM REVISION PCA DURACON KNEE,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-4-209,SUP,HCPCS C1776,,6637-4-209  -  INSERT TIBIAL LARGE NEUTRAL 9MM REVISION PCA DURACON KNEE,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-4-211,SUP,HCPCS C1776,,6637-4-211  -  INSERT TIBIAL LARGE NEUTRAL 11MM REVISION PCA DURACON KNEE,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-4-213,SUP,HCPCS C1776,,6637-4-213  -  INSERT TIBIAL LARGE NEUTRAL 13MM REVISION PCA DURACON KNEE,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-4-216,SUP,HCPCS C1776,,6637-4-216  -  INSERT TIBIAL LARGE NEUTRAL 16MM REVISION PCA DURACON KNEE,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-4-219,SUP,HCPCS C1776,,6637-4-219  -  INSERT TIBIAL LARGE NEUTRAL 19MM REVISION PCA DURACON KNEE,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-4-222,SUP,HCPCS C1776,,6637-4-222  -  INSERT TIBIAL LARGE NEUTRAL 22MM REVISION PCA DURACON KNEE,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-4-225,SUP,HCPCS C1776,,6637-4-225  -  INSERT TIBIAL LARGE NEUTRAL 25MM REVISION PCA DURACON KNEE,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-4-228,SUP,HCPCS C1776,,6637-4-228  -  INSERT TIBIAL LARGE NEUTRAL 28MM REVISION PCA DURACON KNEE,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-4-231,SUP,HCPCS C1776,,6637-4-231  -  INSERT TIBIAL LARGE NEUTRAL 31MM REVISION PCA DURACON KNEE,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-4-309,SUP,HCPCS C1776,,6637-4-309  -  INSERT TIBIAL XL NEUTRAL 9MM REVISION PCA DURACON KNEE,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-4-311,SUP,HCPCS C1776,,6637-4-311  -  INSERT TIBIAL XL NEUTRAL 11MM REVISION PCA DURACON KNEE,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-4-313,SUP,HCPCS C1776,,6637-4-313  -  INSERT TIBIAL XL NEUTRAL 13MM REVISION PCA DURACON KNEE,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-4-316,SUP,HCPCS C1776,,6637-4-316  -  INSERT TIBIAL XL NEUTRAL 16MM REVISION PCA DURACON KNEE,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-4-319,SUP,HCPCS C1776,,6637-4-319  -  INSERT TIBIAL XL NEUTRAL 19MM REVISION PCA DURACON KNEE,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-4-322,SUP,HCPCS C1776,,6637-4-322  -  INSERT TIBIAL XL NEUTRAL 22MM REVISION PCA DURACON KNEE,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-4-325,SUP,HCPCS C1776,,6637-4-325  -  INSERT TIBIAL XL NEUTRAL 25MM REVISION PCA DURACON KNEE,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-4-328,SUP,HCPCS C1776,,6637-4-328  -  INSERT TIBIAL XL NEUTRAL 28MM REVISION PCA DURACON KNEE,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6637-4-331,SUP,HCPCS C1776,,6637-4-331  -  INSERT TIBIAL XL NEUTRAL 31MM REVISION PCA DURACON KNEE,"$5,517.50",$0.00,"$5,517.50","$2,482.88","$3,937.84",$0.00,$950.64,$0.00,$0.00,$966.07,"$5,517.50",$0.00,"$2,758.75","$4,369.86","$4,414.00",$0.00,$863.49,$0.00,$878.39,$0.00
6642-1-009,SUP,Custom 27803010,,6642-1-009  -  INSERT TIB XS 9MM CNDYLR KNEE DUR DRCN,"$1,214.00",$0.00,"$1,214.00",$0.00,$866.43,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,214.00",$0.00,$607.00,$961.49,$971.20,$0.00,$0.00,$0.00,$0.00,$0.00
6642-1-011,SUP,Custom 27803010,,6642-1-011  -  INSERT TIB XS 11MM CNDYLR KNEE DUR DRCN,"$1,214.00",$0.00,"$1,214.00",$0.00,$866.43,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,214.00",$0.00,$607.00,$961.49,$971.20,$0.00,$0.00,$0.00,$0.00,$0.00
6642-1-013,SUP,Custom 27803010,,6642-1-013  -  INSERT TIB XS 13MM CNDYLR KNEE DUR DRCN,"$1,214.00",$0.00,"$1,214.00",$0.00,$866.43,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,214.00",$0.00,$607.00,$961.49,$971.20,$0.00,$0.00,$0.00,$0.00,$0.00
6642-1-016,SUP,Custom 27803010,,6642-1-016  -  INSERT TIB XS 16MM CNDYLR KNEE DUR DRCN,"$1,214.00",$0.00,"$1,214.00",$0.00,$866.43,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,214.00",$0.00,$607.00,$961.49,$971.20,$0.00,$0.00,$0.00,$0.00,$0.00
6642-1-109,SUP,Custom 27803010,,6642-1-109  -  INSERT TIB SM 9MM CNDYLR DUR DRCN,"$1,191.00",$0.00,"$1,191.00",$0.00,$850.02,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,191.00",$0.00,$595.50,$943.27,$952.80,$0.00,$0.00,$0.00,$0.00,$0.00
6642-1-111,SUP,Custom 27803010,,6642-1-111  -  INSERT TIB SM 11MM CNDYLR DUR DRCN,"$1,191.00",$0.00,"$1,191.00",$0.00,$850.02,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,191.00",$0.00,$595.50,$943.27,$952.80,$0.00,$0.00,$0.00,$0.00,$0.00
6642-1-113,SUP,Custom 27803010,,6642-1-113  -  INSERT TIB SM 13MM CNDYLR DUR DRCN,"$1,191.00",$0.00,"$1,191.00",$0.00,$850.02,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,191.00",$0.00,$595.50,$943.27,$952.80,$0.00,$0.00,$0.00,$0.00,$0.00
6642-1-116,SUP,Custom 27803010,,6642-1-116  -  INSERT TIB SM 16MM CNDYLR KNEE DUR DRCN,"$1,191.00",$0.00,"$1,191.00",$0.00,$850.02,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,191.00",$0.00,$595.50,$943.27,$952.80,$0.00,$0.00,$0.00,$0.00,$0.00
6642-1-119,SUP,Custom 27803010,,6642-1-119  -  INSERT TIB SM 19MM CNDYLR KNEE DUR DRCN,"$1,191.00",$0.00,"$1,191.00",$0.00,$850.02,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,191.00",$0.00,$595.50,$943.27,$952.80,$0.00,$0.00,$0.00,$0.00,$0.00
6642-1-209,SUP,Custom 27803010,,6642-1-209  -  INSERT TIB MED 9MM CNDYLR DUR DRCN,"$1,191.00",$0.00,"$1,191.00",$0.00,$850.02,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,191.00",$0.00,$595.50,$943.27,$952.80,$0.00,$0.00,$0.00,$0.00,$0.00
6642-1-211,SUP,Custom 27803010,,6642-1-211  -  INSERT TIB MED 11MM CNDYLR DUR DRCN,"$1,191.00",$0.00,"$1,191.00",$0.00,$850.02,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,191.00",$0.00,$595.50,$943.27,$952.80,$0.00,$0.00,$0.00,$0.00,$0.00
6642-1-213,SUP,Custom 27803010,,6642-1-213  -  INSERT TIB MED 13MM CNDYLR DUR DRCN,"$1,191.00",$0.00,"$1,191.00",$0.00,$850.02,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,191.00",$0.00,$595.50,$943.27,$952.80,$0.00,$0.00,$0.00,$0.00,$0.00
6642-1-216,SUP,Custom 27803010,,6642-1-216  -  INSERT TIB MED 16MM CNDYLR KNEE DUR DRCN,"$1,191.00",$0.00,"$1,191.00",$0.00,$850.02,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,191.00",$0.00,$595.50,$943.27,$952.80,$0.00,$0.00,$0.00,$0.00,$0.00
6642-1-219,SUP,Custom 27803010,,6642-1-219  -  INSERT TIB MED 19MM CNDYLR KNEE DUR CNDYLR STAB DRCN,"$1,191.00",$0.00,"$1,191.00",$0.00,$850.02,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,191.00",$0.00,$595.50,$943.27,$952.80,$0.00,$0.00,$0.00,$0.00,$0.00
6642-1-309,SUP,Custom 27803010,,6642-1-309  -  INSERT TIB LG 9MM CNDYLR DUR DRCN,"$1,191.00",$0.00,"$1,191.00",$0.00,$850.02,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,191.00",$0.00,$595.50,$943.27,$952.80,$0.00,$0.00,$0.00,$0.00,$0.00
6642-1-311,SUP,Custom 27803010,,6642-1-311  -  INSERT TIB LG 11MM CNDYLR DUR,"$1,191.00",$0.00,"$1,191.00",$0.00,$850.02,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,191.00",$0.00,$595.50,$943.27,$952.80,$0.00,$0.00,$0.00,$0.00,$0.00
6642-1-313,SUP,Custom 27803010,,6642-1-313  -  INSERT TIB LG 13MM CNDYLR KNEE DUR DRCN,"$1,191.00",$0.00,"$1,191.00",$0.00,$850.02,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,191.00",$0.00,$595.50,$943.27,$952.80,$0.00,$0.00,$0.00,$0.00,$0.00
6642-1-316,SUP,Custom 27803010,,6642-1-316  -  INSERT TIB LG 16MM CNDYLR KNEE DUR DRCN,"$1,191.00",$0.00,"$1,191.00",$0.00,$850.02,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,191.00",$0.00,$595.50,$943.27,$952.80,$0.00,$0.00,$0.00,$0.00,$0.00
6642-1-319,SUP,Custom 27803010,,6642-1-319  -  INSERT TIB LG 19MM CNDYLR KNEE DUR DRCN,"$1,191.00",$0.00,"$1,191.00",$0.00,$850.02,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,191.00",$0.00,$595.50,$943.27,$952.80,$0.00,$0.00,$0.00,$0.00,$0.00
6642-1-409,SUP,Custom 27803010,,6642-1-409  -  INSERT TIB XL 9MM CNDYLR DUR DRCN,"$1,214.00",$0.00,"$1,214.00",$0.00,$866.43,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,214.00",$0.00,$607.00,$961.49,$971.20,$0.00,$0.00,$0.00,$0.00,$0.00
6642-1-411,SUP,Custom 27803010,,6642-1-411  -  INSERT TIB XL 11MM CNDYLR KNEE DUR DRCN,"$1,214.00",$0.00,"$1,214.00",$0.00,$866.43,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,214.00",$0.00,$607.00,$961.49,$971.20,$0.00,$0.00,$0.00,$0.00,$0.00
6642-1-413,SUP,Custom 27803010,,6642-1-413  -  INSERT TIB XL 13MM CNDYLR KNEE DUR DRCN,"$1,214.00",$0.00,"$1,214.00",$0.00,$866.43,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,214.00",$0.00,$607.00,$961.49,$971.20,$0.00,$0.00,$0.00,$0.00,$0.00
6642-1-416,SUP,Custom 27803010,,6642-1-416  -  INSERT TIB XL 16MM CNDYLR KNEE DUR DRCN,"$1,214.00",$0.00,"$1,214.00",$0.00,$866.43,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,214.00",$0.00,$607.00,$961.49,$971.20,$0.00,$0.00,$0.00,$0.00,$0.00
6642-1-419,SUP,Custom 27803010,,6642-1-419  -  INSERT TIB XL 19MM CNDYLR KNEE DUR DRCN,"$1,214.00",$0.00,"$1,214.00",$0.00,$866.43,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,214.00",$0.00,$607.00,$961.49,$971.20,$0.00,$0.00,$0.00,$0.00,$0.00
6642-1-509,SUP,Custom 27803010,,6642-1-509  -  INSERT TIBIAL XS 9MM ANTERIOR/POSTERIOR LIPPED DURACON DUR,"$1,917.50",$0.00,"$1,917.50",$0.00,"$1,368.52",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,917.50",$0.00,$958.75,"$1,518.66","$1,534.00",$0.00,$0.00,$0.00,$0.00,$0.00
6642-1-511,SUP,Custom 27803010,,6642-1-511  -  INSERT TIBIAL XS 11MM ANTERIOR/POSTERIOR LIPPED DURACON DUR,"$1,917.50",$0.00,"$1,917.50",$0.00,"$1,368.52",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,917.50",$0.00,$958.75,"$1,518.66","$1,534.00",$0.00,$0.00,$0.00,$0.00,$0.00
6642-1-513,SUP,Custom 27803010,,6642-1-513  -  INSERT TIBIAL XS 13MM ANTERIOR/POSTERIOR LIPPED DURACON DUR,"$1,917.50",$0.00,"$1,917.50",$0.00,"$1,368.52",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,917.50",$0.00,$958.75,"$1,518.66","$1,534.00",$0.00,$0.00,$0.00,$0.00,$0.00
6642-1-516,SUP,Custom 27803010,,6642-1-516  -  INSERT TIBIAL XS 16MM ANTERIOR/POSTERIOR LIPPED DURACON DUR,"$1,917.50",$0.00,"$1,917.50",$0.00,"$1,368.52",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,917.50",$0.00,$958.75,"$1,518.66","$1,534.00",$0.00,$0.00,$0.00,$0.00,$0.00
6642-1-609,SUP,Custom 27803010,,6642-1-609  -  INSERT TIBIAL SMALL 9MM DURACON DUR ANTERIOR POSTERIOR KNEE,"$1,917.50",$0.00,"$1,917.50",$0.00,"$1,368.52",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,917.50",$0.00,$958.75,"$1,518.66","$1,534.00",$0.00,$0.00,$0.00,$0.00,$0.00
6642-1-611,SUP,Custom 27803010,,6642-1-611  -  INSERT TIBIAL SMALL 11MM LIPPED REVISION RECONSTRUCTION,"$1,917.50",$0.00,"$1,917.50",$0.00,"$1,368.52",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,917.50",$0.00,$958.75,"$1,518.66","$1,534.00",$0.00,$0.00,$0.00,$0.00,$0.00
6642-1-613,SUP,Custom 27803010,,6642-1-613  -  INSERT TIBIAL SMALL 13MM DURACON DUR ANTERIOR POSTERIOR KNEE,"$1,917.50",$0.00,"$1,917.50",$0.00,"$1,368.52",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,917.50",$0.00,$958.75,"$1,518.66","$1,534.00",$0.00,$0.00,$0.00,$0.00,$0.00
6642-1-616,SUP,Custom 27803010,,6642-1-616  -  INSERT TIBIAL SMALL 16MM DURACON DUR ANTERIOR POSTERIOR KNEE,"$1,917.50",$0.00,"$1,917.50",$0.00,"$1,368.52",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,917.50",$0.00,$958.75,"$1,518.66","$1,534.00",$0.00,$0.00,$0.00,$0.00,$0.00
6642-1-619,SUP,Custom 27803010,,6642-1-619  -  INSERT TIBIAL SMALL 19MM DURACON DUR KNEE ANTERIOR POSTERIOR,"$1,917.50",$0.00,"$1,917.50",$0.00,"$1,368.52",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,917.50",$0.00,$958.75,"$1,518.66","$1,534.00",$0.00,$0.00,$0.00,$0.00,$0.00
6642-1-622,SUP,Custom 27803010,,6642-1-622  -  INSERT TIBIAL SMALL 22MM LIP DURACON DUR KNEE,"$1,917.50",$0.00,"$1,917.50",$0.00,"$1,368.52",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,917.50",$0.00,$958.75,"$1,518.66","$1,534.00",$0.00,$0.00,$0.00,$0.00,$0.00
6642-1-625,SUP,Custom 27803010,,6642-1-625  -  INSERT TIBIAL SMALL 25MM DURACON DUR KNEE ANTERIOR POSTERIOR,"$1,917.50",$0.00,"$1,917.50",$0.00,"$1,368.52",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,917.50",$0.00,$958.75,"$1,518.66","$1,534.00",$0.00,$0.00,$0.00,$0.00,$0.00
6642-1-709,SUP,Custom 27803010,,6642-1-709  -  INSERT TIBIAL MEDIUM 9MM LIPPED DURACON DUR ANTERIOR,"$1,917.50",$0.00,"$1,917.50",$0.00,"$1,368.52",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,917.50",$0.00,$958.75,"$1,518.66","$1,534.00",$0.00,$0.00,$0.00,$0.00,$0.00
6642-1-711,SUP,Custom 27803010,,6642-1-711  -  INSERT TIBIAL MEDIUM 11MM DURACON DUR ANTERIOR POSTERIOR,"$1,917.50",$0.00,"$1,917.50",$0.00,"$1,368.52",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,917.50",$0.00,$958.75,"$1,518.66","$1,534.00",$0.00,$0.00,$0.00,$0.00,$0.00
6642-1-713,SUP,Custom 27803010,,6642-1-713  -  INSERT TIBIAL MEDIUM 13MM DURACON DUR ANTERIOR POSTERIOR,"$1,917.50",$0.00,"$1,917.50",$0.00,"$1,368.52",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,917.50",$0.00,$958.75,"$1,518.66","$1,534.00",$0.00,$0.00,$0.00,$0.00,$0.00
6642-1-716,SUP,Custom 27803010,,6642-1-716  -  INSERT TIBIAL MEDIUM 16MM LIPPED REVISION RECONSTRUCTION,"$1,917.50",$0.00,"$1,917.50",$0.00,"$1,368.52",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,917.50",$0.00,$958.75,"$1,518.66","$1,534.00",$0.00,$0.00,$0.00,$0.00,$0.00
6642-1-719,SUP,Custom 27803010,,6642-1-719  -  INSERT TIBIAL MEDIUM 19MM DURACON DUR ANTERIOR POSTERIOR,"$1,917.50",$0.00,"$1,917.50",$0.00,"$1,368.52",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,917.50",$0.00,$958.75,"$1,518.66","$1,534.00",$0.00,$0.00,$0.00,$0.00,$0.00
6642-1-722,SUP,Custom 27803010,,6642-1-722  -  INSERT TIBIAL MEDIUM 22MM DURACON DUR KNEE ANTERIOR,"$1,917.50",$0.00,"$1,917.50",$0.00,"$1,368.52",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,917.50",$0.00,$958.75,"$1,518.66","$1,534.00",$0.00,$0.00,$0.00,$0.00,$0.00
6642-1-725,SUP,Custom 27803010,,6642-1-725  -  INSERT TIBIAL MEDIUM 25MM DURACON DUR KNEE ANTERIOR,"$1,917.50",$0.00,"$1,917.50",$0.00,"$1,368.52",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,917.50",$0.00,$958.75,"$1,518.66","$1,534.00",$0.00,$0.00,$0.00,$0.00,$0.00
6642-1-809,SUP,Custom 27803010,,6642-1-809  -  INSERT TIBIAL LARGE 9MM DURACON DUR ANTERIOR POSTERIOR KNEE,"$1,917.50",$0.00,"$1,917.50",$0.00,"$1,368.52",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,917.50",$0.00,$958.75,"$1,518.66","$1,534.00",$0.00,$0.00,$0.00,$0.00,$0.00
6642-1-811,SUP,Custom 27803010,,6642-1-811  -  INSERT TIBIAL LARGE 11MM DURACON DUR ANTERIOR POSTERIOR KNEE,"$1,917.50",$0.00,"$1,917.50",$0.00,"$1,368.52",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,917.50",$0.00,$958.75,"$1,518.66","$1,534.00",$0.00,$0.00,$0.00,$0.00,$0.00
6642-1-813,SUP,Custom 27803010,,6642-1-813  -  INSERT TIBIAL LARGE 13MM LIPPED REVISION RECONSTRUCTION,"$1,917.50",$0.00,"$1,917.50",$0.00,"$1,368.52",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,917.50",$0.00,$958.75,"$1,518.66","$1,534.00",$0.00,$0.00,$0.00,$0.00,$0.00
6642-1-816,SUP,Custom 27803010,,6642-1-816  -  INSERT TIBIAL LARGE 16MM LIPPED REVISION RECONSTRUCTION,"$1,917.50",$0.00,"$1,917.50",$0.00,"$1,368.52",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,917.50",$0.00,$958.75,"$1,518.66","$1,534.00",$0.00,$0.00,$0.00,$0.00,$0.00
6642-1-819,SUP,Custom 27803010,,6642-1-819  -  INSERT TIBIAL LARGE 19MM DURACON DUR KNEE ANTERIOR POSTERIOR,"$1,917.50",$0.00,"$1,917.50",$0.00,"$1,368.52",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,917.50",$0.00,$958.75,"$1,518.66","$1,534.00",$0.00,$0.00,$0.00,$0.00,$0.00
6642-1-822,SUP,Custom 27803010,,6642-1-822  -  INSERT TIBIAL LARGE 22MM DURACON DUR KNEE ANTERIOR POSTERIOR,"$1,917.50",$0.00,"$1,917.50",$0.00,"$1,368.52",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,917.50",$0.00,$958.75,"$1,518.66","$1,534.00",$0.00,$0.00,$0.00,$0.00,$0.00
6642-1-825,SUP,Custom 27803010,,6642-1-825  -  INSERT TIBIAL LARGE 25MM DURACON DUR KNEE ANTERIOR POSTERIOR,"$1,917.50",$0.00,"$1,917.50",$0.00,"$1,368.52",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,917.50",$0.00,$958.75,"$1,518.66","$1,534.00",$0.00,$0.00,$0.00,$0.00,$0.00
6642-1-909,SUP,Custom 27803010,,6642-1-909  -  INSERT TIBIAL XL 9MM LIPPED REVISION RECONSTRUCTION DURACON,"$1,917.50",$0.00,"$1,917.50",$0.00,"$1,368.52",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,917.50",$0.00,$958.75,"$1,518.66","$1,534.00",$0.00,$0.00,$0.00,$0.00,$0.00
6642-1-911,SUP,Custom 27803010,,6642-1-911  -  INSERT TIBIAL XL 11MM DURACON DUR ANTERIOR POSTERIOR KNEE,"$1,917.50",$0.00,"$1,917.50",$0.00,"$1,368.52",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,917.50",$0.00,$958.75,"$1,518.66","$1,534.00",$0.00,$0.00,$0.00,$0.00,$0.00
6642-1-913,SUP,Custom 27803010,,6642-1-913  -  INSERT TIBIAL XL 13MM DURACON DUR ANTERIOR POSTERIOR KNEE,"$1,917.50",$0.00,"$1,917.50",$0.00,"$1,368.52",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,917.50",$0.00,$958.75,"$1,518.66","$1,534.00",$0.00,$0.00,$0.00,$0.00,$0.00
6642-1-916,SUP,Custom 27803010,,6642-1-916  -  INSERT TIBIAL XL 16MM DURACON DUR ANTERIOR POSTERIOR KNEE,"$1,917.50",$0.00,"$1,917.50",$0.00,"$1,368.52",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,917.50",$0.00,$958.75,"$1,518.66","$1,534.00",$0.00,$0.00,$0.00,$0.00,$0.00
6642-1-919,SUP,Custom 27803010,,6642-1-919  -  INSERT TIBIAL XL 19MM DURACON DUR KNEE ANTERIOR POSTERIOR,"$1,917.50",$0.00,"$1,917.50",$0.00,"$1,368.52",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,917.50",$0.00,$958.75,"$1,518.66","$1,534.00",$0.00,$0.00,$0.00,$0.00,$0.00
6642-1-922,SUP,Custom 27803010,,6642-1-922  -  INSERT TIBIAL XL 22MM DURACON DUR KNEE ANTERIOR POSTERIOR,"$1,917.50",$0.00,"$1,917.50",$0.00,"$1,368.52",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,917.50",$0.00,$958.75,"$1,518.66","$1,534.00",$0.00,$0.00,$0.00,$0.00,$0.00
6642-1-925,SUP,Custom 27803010,,6642-1-925  -  INSERT TIBIAL XL 25MM DURACON DUR KNEE ANTERIOR POSTERIOR,"$1,917.50",$0.00,"$1,917.50",$0.00,"$1,368.52",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,917.50",$0.00,$958.75,"$1,518.66","$1,534.00",$0.00,$0.00,$0.00,$0.00,$0.00
6642-2-040,SUP,Custom 27803010,,6642-2-040  -  COMPONENT PATLR XS 29MM HDPE RESIN KNEE,$600.00,$0.00,$600.00,$0.00,$428.22,$0.00,$0.00,$0.00,$0.00,$0.00,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$0.00,$0.00,$0.00,$0.00
6642-2-050,SUP,Custom 27803010,,6642-2-050  -  COMPONENT PATLR SMALL 32MM HDPE RESIN KNEE,$600.00,$0.00,$600.00,$0.00,$428.22,$0.00,$0.00,$0.00,$0.00,$0.00,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$0.00,$0.00,$0.00,$0.00
6642-2-100,SUP,Custom 27803010,,6642-2-100  -  COMPONENT PATLR MEDIUM 35MM HDPE RESIN KNEE,$600.00,$0.00,$600.00,$0.00,$428.22,$0.00,$0.00,$0.00,$0.00,$0.00,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$0.00,$0.00,$0.00,$0.00
6642-2-140,SUP,Custom 27803010,,6642-2-140  -  CMPNT PATLR 33MM MTLBLK DRCN DUR,"$1,316.00",$0.00,"$1,316.00",$0.00,$939.23,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,316.00",$0.00,$658.00,"$1,042.27","$1,052.80",$0.00,$0.00,$0.00,$0.00,$0.00
6642-2-145,SUP,Custom 27803010,,6642-2-145  -  CMPNT PATLR 33MM DRCN,"$1,571.00",$0.00,"$1,571.00",$0.00,"$1,121.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,571.00",$0.00,$785.50,"$1,244.23","$1,256.80",$0.00,$0.00,$0.00,$0.00,$0.00
6642-2-150,SUP,Custom 27803010,,6642-2-150  -  COMPONENT PATLR LARGE 11MM DURACON DUR ALL POLY KNEE,$600.00,$0.00,$600.00,$0.00,$428.22,$0.00,$0.00,$0.00,$0.00,$0.00,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$0.00,$0.00,$0.00,$0.00
6642-2-200,SUP,Custom 27803010,,6642-2-200  -  COMPONENT PATLR XL 11MM DURACON DUR ALL POLY KNEE,$600.00,$0.00,$600.00,$0.00,$428.22,$0.00,$0.00,$0.00,$0.00,$0.00,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$0.00,$0.00,$0.00,$0.00
6642-2-300,SUP,Custom 27803010,,6642-2-300  -  CMPNT PATLR SM MTLBLK DRCN DUR,"$1,316.00",$0.00,"$1,316.00",$0.00,$939.23,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,316.00",$0.00,$658.00,"$1,042.27","$1,052.80",$0.00,$0.00,$0.00,$0.00,$0.00
6642-2-350,SUP,Custom 27803010,,6642-2-350  -  CMPNT PATLR MED MTLBLK DRCN DUR,"$1,316.00",$0.00,"$1,316.00",$0.00,$939.23,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,316.00",$0.00,$658.00,"$1,042.27","$1,052.80",$0.00,$0.00,$0.00,$0.00,$0.00
6642-2-400,SUP,Custom 27803010,,6642-2-400  -  CMPNT PATLR LG ASYM MTLBLK DRCN DUR,"$1,316.00",$0.00,"$1,316.00",$0.00,$939.23,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,316.00",$0.00,$658.00,"$1,042.27","$1,052.80",$0.00,$0.00,$0.00,$0.00,$0.00
6642-2-600,SUP,Custom 27803010,,6642-2-600  -  INSERT TIBIAL 8MM 27MM SYMMETRIC DURACON DUR,$600.00,$0.00,$600.00,$0.00,$428.22,$0.00,$0.00,$0.00,$0.00,$0.00,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$0.00,$0.00,$0.00,$0.00
6642-2-610,SUP,Custom 27803010,,6642-2-610  -  INSERT TIBIAL 8MM 29MM SYMMETRIC DURACON DUR,$600.00,$0.00,$600.00,$0.00,$428.22,$0.00,$0.00,$0.00,$0.00,$0.00,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$0.00,$0.00,$0.00,$0.00
6642-2-620,SUP,Custom 27803010,,6642-2-620  -  COMPONENT PATLR 31MM 9MM SYMMETRIC DURACON DUR,$600.00,$0.00,$600.00,$0.00,$428.22,$0.00,$0.00,$0.00,$0.00,$0.00,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$0.00,$0.00,$0.00,$0.00
6642-2-626,SUP,Custom 27203010,,6642-2-626  -  TRIAL SURG 25MM 10MM INSET DURACON DUR PATELLA,$600.00,$0.00,$600.00,$0.00,$428.22,$0.00,$0.00,$0.00,$0.00,$0.00,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$0.00,$0.00,$0.00,$0.00
6642-2-627,SUP,Custom 27803010,,6642-2-627  -  COMPONENT PATLR 27MM 10MM SYMMETRIC DURACON DUR KNEE,$600.00,$0.00,$600.00,$0.00,$428.22,$0.00,$0.00,$0.00,$0.00,$0.00,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$0.00,$0.00,$0.00,$0.00
6642-2-629,SUP,Custom 27803010,,6642-2-629  -  COMPONENT PATLR 29MM 10MM INSET DURACON DUR,$600.00,$0.00,$600.00,$0.00,$428.22,$0.00,$0.00,$0.00,$0.00,$0.00,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$0.00,$0.00,$0.00,$0.00
6642-2-630,SUP,Custom 27803010,,6642-2-630  -  INSERT TIBIAL 9MM 33MM SYMMETRIC DURACON DUR KNEE,$600.00,$0.00,$600.00,$0.00,$428.22,$0.00,$0.00,$0.00,$0.00,$0.00,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$0.00,$0.00,$0.00,$0.00
6642-2-631,SUP,Custom 27803010,,6642-2-631  -  COMPONENT PATLR 31MM 10MM SYMMETRIC DURACON DUR,$600.00,$0.00,$600.00,$0.00,$428.22,$0.00,$0.00,$0.00,$0.00,$0.00,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$0.00,$0.00,$0.00,$0.00
6642-2-633,SUP,Custom 27803010,,6642-2-633  -  COMPONENT PATLR 33MM 10MM INSET DURACON DUR,$600.00,$0.00,$600.00,$0.00,$428.22,$0.00,$0.00,$0.00,$0.00,$0.00,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$0.00,$0.00,$0.00,$0.00
6642-2-640,SUP,Custom 27803010,,6642-2-640  -  COMPONENT PATLR 36MM 10MM SYMMETRIC DURACON DUR,$600.00,$0.00,$600.00,$0.00,$428.22,$0.00,$0.00,$0.00,$0.00,$0.00,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$0.00,$0.00,$0.00,$0.00
6642-2-645,SUP,Custom 27803010,,6642-2-645  -  INSERT TIBIAL 11MM 39MM SYMMETRIC DURACON DUR,$600.00,$0.00,$600.00,$0.00,$428.22,$0.00,$0.00,$0.00,$0.00,$0.00,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$0.00,$0.00,$0.00,$0.00
6642-2-700,SUP,Custom 27803010,,6642-2-700  -  CMPNT PATLR SM CNVR DRCN DUR,"$1,634.00",$0.00,"$1,634.00",$0.00,"$1,166.19",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,634.00",$0.00,$817.00,"$1,294.13","$1,307.20",$0.00,$0.00,$0.00,$0.00,$0.00
6642-2-705,SUP,Custom 27803010,,6642-2-705  -  CMPNT PATLR MED CNVR DRCN DUR,"$1,634.00",$0.00,"$1,634.00",$0.00,"$1,166.19",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,634.00",$0.00,$817.00,"$1,294.13","$1,307.20",$0.00,$0.00,$0.00,$0.00,$0.00
6642-2-710,SUP,Custom 27803010,,6642-2-710  -  CMPNT PATLR LG CNVX DRCN DUR,"$1,634.00",$0.00,"$1,634.00",$0.00,"$1,166.19",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,634.00",$0.00,$817.00,"$1,294.13","$1,307.20",$0.00,$0.00,$0.00,$0.00,$0.00
6642-2-715,SUP,Custom 27803010,,6642-2-715  -  CMPNT PATLR XL CNVX DRCN DUR UHMWPE,"$1,634.00",$0.00,"$1,634.00",$0.00,"$1,166.19",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,634.00",$0.00,$817.00,"$1,294.13","$1,307.20",$0.00,$0.00,$0.00,$0.00,$0.00
6642-2-720,SUP,Custom 27803010,,6642-2-720  -  INSERT TIB SM 20MM KNEE DUR CNVX DRCN 7MM,$677.00,$0.00,$677.00,$0.00,$483.17,$0.00,$0.00,$0.00,$0.00,$0.00,$677.00,$0.00,$338.50,$536.18,$541.60,$0.00,$0.00,$0.00,$0.00,$0.00
6642-2-725,SUP,Custom 27803010,,6642-2-725  -  INSERT TIB MED 25MM KNEE DUR CNVX DRCN 7MM,$677.00,$0.00,$677.00,$0.00,$483.17,$0.00,$0.00,$0.00,$0.00,$0.00,$677.00,$0.00,$338.50,$536.18,$541.60,$0.00,$0.00,$0.00,$0.00,$0.00
6642-2-730,SUP,Custom 27803010,,6642-2-730  -  INSERT TIB LG 30MM KNEE DUR CNVX DRCN 7MM,$677.00,$0.00,$677.00,$0.00,$483.17,$0.00,$0.00,$0.00,$0.00,$0.00,$677.00,$0.00,$338.50,$536.18,$541.60,$0.00,$0.00,$0.00,$0.00,$0.00
6642-2-735,SUP,Custom 27803010,,6642-2-735  -  INSERT TIB XL 35MM KNEE DUR CNVX DRCN 7MM,$677.00,$0.00,$677.00,$0.00,$483.17,$0.00,$0.00,$0.00,$0.00,$0.00,$677.00,$0.00,$338.50,$536.18,$541.60,$0.00,$0.00,$0.00,$0.00,$0.00
6642-2-740,SUP,Custom 27803010,,6642-2-740  -  CMPNT PATLR SM DRCN,"$1,768.00",$0.00,"$1,768.00",$0.00,"$1,261.82",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,768.00",$0.00,$884.00,"$1,400.26","$1,414.40",$0.00,$0.00,$0.00,$0.00,$0.00
6642-2-745,SUP,Custom 27803010,,6642-2-745  -  CMPNT PATLR MED DRCN,"$1,842.00",$0.00,"$1,842.00",$0.00,"$1,314.64",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,842.00",$0.00,$921.00,"$1,458.86","$1,473.60",$0.00,$0.00,$0.00,$0.00,$0.00
6642-2-750,SUP,Custom 27803010,,6642-2-750  -  CMPNT PATLR ASYM DUR,"$1,842.00",$0.00,"$1,842.00",$0.00,"$1,314.64",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,842.00",$0.00,$921.00,"$1,458.86","$1,473.60",$0.00,$0.00,$0.00,$0.00,$0.00
6642-2-755,SUP,Custom 27803010,,6642-2-755  -  CMPNT PATLR XL DRCN,"$1,842.00",$0.00,"$1,842.00",$0.00,"$1,314.64",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,842.00",$0.00,$921.00,"$1,458.86","$1,473.60",$0.00,$0.00,$0.00,$0.00,$0.00
6642-5-111,SUP,HCPCS C1776,,6642-5-111  -  INSERT TIBIAL SMALL 11MM TOT STABILIZE DURACON DUR KNEE,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
6642-5-113,SUP,HCPCS C1776,,6642-5-113  -  INSERT TIBIAL SMALL 13MM TOT STABILIZED DURACON DUR KNEE,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
6642-5-116,SUP,HCPCS C1776,,6642-5-116  -  INSERT TIBIAL SMALL 16MM TOT STABILIZED DURACON DUR KNEE,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
6642-5-119,SUP,HCPCS C1776,,6642-5-119  -  INSERT TIBIAL SMALL 19MM TOT STABILIZED DURACON DUR KNEE,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
6642-5-122,SUP,HCPCS C1776,,6642-5-122  -  INSERT TIBIAL SMALL 22MM TOT STABILIZED DURACON DUR KNEE,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
6642-5-125,SUP,HCPCS C1776,,6642-5-125  -  INSERT TIBIAL SMALL 25MM TOT STABILIZE DURACON DUR KNEE,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
6642-5-128,SUP,HCPCS C1776,,6642-5-128  -  INSERT TIBIAL SMALL 28MM TOT STABILIZE DURACON DUR KNEE,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
6642-5-131,SUP,HCPCS C1776,,6642-5-131  -  INSERT TIBIAL SMALL 31MM TOT STABILIZE DURACON DUR KNEE,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
6642-5-211,SUP,HCPCS C1776,,6642-5-211  -  INSERT TIBIAL MEDIUM 11MM TOT STABILIZED DURACON DUR KNEE,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
6642-5-213,SUP,HCPCS C1776,,6642-5-213  -  INSERT TIBIAL MEDIUM 13MM TOT STABILIZED DURACON DUR KNEE,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
6642-5-216,SUP,HCPCS C1776,,6642-5-216  -  INSERT TIBIAL MEDIUM 16MM TOT STABILIZED DURACON DUR KNEE,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
6642-5-219,SUP,HCPCS C1776,,6642-5-219  -  INSERT TIBIAL MEDIUM 19MM TOT STABILIZED DURACON DUR KNEE,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
6642-5-222,SUP,HCPCS C1776,,6642-5-222  -  INSERT TIBIAL MEDIUM 22MM TOT STABILIZED DURACON DUR KNEE,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
6642-5-225,SUP,HCPCS C1776,,6642-5-225  -  INSERT TIBIAL MEDIUM 25MM TOT STABILIZED DURACON DUR KNEE,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
6642-5-228,SUP,HCPCS C1776,,6642-5-228  -  INSERT TIBIAL MEDIUM 28MM TOT STABILIZED DURACON DUR KNEE,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
6642-5-231,SUP,HCPCS C1776,,6642-5-231  -  INSERT TIBIAL MEDIUM 31MM TOT STABILIZE DURACON DUR KNEE,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
6642-5-311,SUP,HCPCS C1776,,6642-5-311  -  INSERT TIBIAL LARGE 11MM TOT STABILIZE DURACON DUR KNEE,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
6642-5-313,SUP,HCPCS C1776,,6642-5-313  -  INSERT TIBIAL LARGE 13MM TOT STABILIZED DURACON DUR KNEE,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
6642-5-316,SUP,HCPCS C1776,,6642-5-316  -  INSERT TIBIAL LARGE 16MM TOT STABILIZE DURACON DUR KNEE,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
6642-5-319,SUP,HCPCS C1776,,6642-5-319  -  INSERT TIBIAL LARGE 19MM TOT STABILIZE DURACON DUR KNEE,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
6642-5-322,SUP,HCPCS C1776,,6642-5-322  -  INSERT TIBIAL LARGE 22MM TOT STABILIZE DURACON DUR KNEE,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
6642-5-325,SUP,HCPCS C1776,,6642-5-325  -  INSERT TIBIAL LARGE 25MM TOT STABILIZE DURACON DUR KNEE,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
6642-5-328,SUP,HCPCS C1776,,6642-5-328  -  INSERT TIBIAL LARGE 28MM TOT STABILIZE DURACON DUR KNEE,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
6642-5-331,SUP,HCPCS C1776,,6642-5-331  -  INSERT TIBIAL LARGE 31MM TOT STABILIZE DURACON DUR KNEE,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
6642-5-411,SUP,HCPCS C1776,,6642-5-411  -  INSERT TIBIAL XL 11MM TOT STABILIZE DURACON DUR KNEE,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
6642-5-413,SUP,HCPCS C1776,,6642-5-413  -  INSERT TIBIAL XL 13MM TOT STABILIZE DURACON DUR KNEE,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
6642-5-416,SUP,HCPCS C1776,,6642-5-416  -  INSERT TIBIAL XL 16MM TOT STABILIZE DURACON DUR KNEE,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
6642-5-419,SUP,HCPCS C1776,,6642-5-419  -  INSERT TIBIAL XL 19MM TOT STABILIZED DURACON DUR KNEE,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
6642-5-422,SUP,HCPCS C1776,,6642-5-422  -  INSERT TIBIAL XL 22MM TOT STABILIZE DURACON DUR KNEE,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
6642-5-425,SUP,HCPCS C1776,,6642-5-425  -  INSERT TIBIAL XL 25MM TOT STABILIZE DURACON DUR KNEE,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
6642-5-428,SUP,HCPCS C1776,,6642-5-428  -  INSERT TIBIAL XL 28MM TOT STABILIZED DURACON DUR KNEE,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
6642-5-431,SUP,HCPCS C1776,,6642-5-431  -  INSERT TIBIAL XL 31MM TOT STABILIZE DURACON DUR KNEE,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
6642-9-009,SUP,Custom 27803010,,6642-9-009  -  INSERT TIB XS STD 9MM KNEE DUR DRCN,"$2,075.13",$0.00,"$2,075.13",$0.00,"$1,481.02",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,075.13",$0.00,"$1,037.56","$1,643.50","$1,660.10",$0.00,$0.00,$0.00,$0.00,$0.00
6642-9-011,SUP,HCPCS C1776,,6642-9-011  -  INSERT TIB XS STD 11MM KNEE DUR DRCN,"$5,026.13",$0.00,"$5,026.13","$2,261.76","$3,587.15",$0.00,$865.98,$0.00,$0.00,$880.03,"$5,026.13",$0.00,"$2,513.06","$3,980.69","$4,020.90",$0.00,$786.59,$0.00,$800.16,$0.00
6642-9-013,SUP,HCPCS C1776,,6642-9-013  -  INSERT TIB XS STD 13MM KNEE DUR DRCN,"$5,026.13",$0.00,"$5,026.13","$2,261.76","$3,587.15",$0.00,$865.98,$0.00,$0.00,$880.03,"$5,026.13",$0.00,"$2,513.06","$3,980.69","$4,020.90",$0.00,$786.59,$0.00,$800.16,$0.00
6642-9-016,SUP,HCPCS C1776,,6642-9-016  -  INSERT TIB XS STD 16MM KNEE DUR DRCN,"$5,026.13",$0.00,"$5,026.13","$2,261.76","$3,587.15",$0.00,$865.98,$0.00,$0.00,$880.03,"$5,026.13",$0.00,"$2,513.06","$3,980.69","$4,020.90",$0.00,$786.59,$0.00,$800.16,$0.00
6642-9-019,SUP,HCPCS C1776,,6642-9-019  -  INSERT TIB XS STD 19MM KNEE DUR DRCN,"$5,026.13",$0.00,"$5,026.13","$2,261.76","$3,587.15",$0.00,$865.98,$0.00,$0.00,$880.03,"$5,026.13",$0.00,"$2,513.06","$3,980.69","$4,020.90",$0.00,$786.59,$0.00,$800.16,$0.00
6642-9-109,SUP,HCPCS C1776,,6642-9-109  -  INSERT TIB STD SM 9MM KNEE DUR TOT STAB DRCN OTHR,"$5,026.13",$0.00,"$5,026.13","$2,261.76","$3,587.15",$0.00,$865.98,$0.00,$0.00,$880.03,"$5,026.13",$0.00,"$2,513.06","$3,980.69","$4,020.90",$0.00,$786.59,$0.00,$800.16,$0.00
6642-9-111,SUP,HCPCS C1776,,6642-9-111  -  INSERT TIB SM STD 11MM KNEE DUR TOT STAB DRCN,"$5,026.13",$0.00,"$5,026.13","$2,261.76","$3,587.15",$0.00,$865.98,$0.00,$0.00,$880.03,"$5,026.13",$0.00,"$2,513.06","$3,980.69","$4,020.90",$0.00,$786.59,$0.00,$800.16,$0.00
6642-9-113,SUP,HCPCS C1776,,6642-9-113  -  INSERT TIB SM STD 13MM KNEE DUR TOT STAB DRCN OTHR,"$5,026.13",$0.00,"$5,026.13","$2,261.76","$3,587.15",$0.00,$865.98,$0.00,$0.00,$880.03,"$5,026.13",$0.00,"$2,513.06","$3,980.69","$4,020.90",$0.00,$786.59,$0.00,$800.16,$0.00
6642-9-116,SUP,HCPCS C1776,,6642-9-116  -  INSERT TIB SM STD 16MM KNEE DUR TOT STAB DRCN,"$5,026.13",$0.00,"$5,026.13","$2,261.76","$3,587.15",$0.00,$865.98,$0.00,$0.00,$880.03,"$5,026.13",$0.00,"$2,513.06","$3,980.69","$4,020.90",$0.00,$786.59,$0.00,$800.16,$0.00
6642-9-119,SUP,HCPCS C1776,,6642-9-119  -  INSERT TIB STD SM 19MM KNEE DUR TOT STAB DRCN OTHR,"$5,026.13",$0.00,"$5,026.13","$2,261.76","$3,587.15",$0.00,$865.98,$0.00,$0.00,$880.03,"$5,026.13",$0.00,"$2,513.06","$3,980.69","$4,020.90",$0.00,$786.59,$0.00,$800.16,$0.00
6642-9-209,SUP,HCPCS C1776,,6642-9-209  -  INSERT TIB STD MED 9MM KNEE DUR DRCN,"$5,026.13",$0.00,"$5,026.13","$2,261.76","$3,587.15",$0.00,$865.98,$0.00,$0.00,$880.03,"$5,026.13",$0.00,"$2,513.06","$3,980.69","$4,020.90",$0.00,$786.59,$0.00,$800.16,$0.00
6642-9-211,SUP,HCPCS C1776,,6642-9-211  -  INSERT TIB MED 11MM KNEE DUR STD DRCN 11MM,"$5,026.13",$0.00,"$5,026.13","$2,261.76","$3,587.15",$0.00,$865.98,$0.00,$0.00,$880.03,"$5,026.13",$0.00,"$2,513.06","$3,980.69","$4,020.90",$0.00,$786.59,$0.00,$800.16,$0.00
6642-9-213,SUP,HCPCS C1776,,6642-9-213  -  INSERT TIB MED 13MM KNEE DUR DRCN,"$5,026.13",$0.00,"$5,026.13","$2,261.76","$3,587.15",$0.00,$865.98,$0.00,$0.00,$880.03,"$5,026.13",$0.00,"$2,513.06","$3,980.69","$4,020.90",$0.00,$786.59,$0.00,$800.16,$0.00
6642-9-216,SUP,HCPCS C1776,,6642-9-216  -  INSERT TIB STD MED 16MM KNEE DUR OTHR INS DRCN,"$5,026.13",$0.00,"$5,026.13","$2,261.76","$3,587.15",$0.00,$865.98,$0.00,$0.00,$880.03,"$5,026.13",$0.00,"$2,513.06","$3,980.69","$4,020.90",$0.00,$786.59,$0.00,$800.16,$0.00
6642-9-219,SUP,HCPCS C1776,,6642-9-219  -  INSERT TIB STD 19MM KNEE DUR DRCN 4 016,"$5,026.13",$0.00,"$5,026.13","$2,261.76","$3,587.15",$0.00,$865.98,$0.00,$0.00,$880.03,"$5,026.13",$0.00,"$2,513.06","$3,980.69","$4,020.90",$0.00,$786.59,$0.00,$800.16,$0.00
6642-9-309,SUP,HCPCS C1776,,6642-9-309  -  INSERT TIB STD 9MM KNEE DUR DRCN,"$5,026.13",$0.00,"$5,026.13","$2,261.76","$3,587.15",$0.00,$865.98,$0.00,$0.00,$880.03,"$5,026.13",$0.00,"$2,513.06","$3,980.69","$4,020.90",$0.00,$786.59,$0.00,$800.16,$0.00
6642-9-311,SUP,HCPCS C1776,,6642-9-311  -  INSERT TIB STD 11MM LEG DUR DRCN,"$5,026.13",$0.00,"$5,026.13","$2,261.76","$3,587.15",$0.00,$865.98,$0.00,$0.00,$880.03,"$5,026.13",$0.00,"$2,513.06","$3,980.69","$4,020.90",$0.00,$786.59,$0.00,$800.16,$0.00
6642-9-313,SUP,HCPCS C1776,,6642-9-313  -  INSERT TIB LG 13MM KNEE COCR CNDYLR STAB LIP DRCN,"$5,026.13",$0.00,"$5,026.13","$2,261.76","$3,587.15",$0.00,$865.98,$0.00,$0.00,$880.03,"$5,026.13",$0.00,"$2,513.06","$3,980.69","$4,020.90",$0.00,$786.59,$0.00,$800.16,$0.00
6642-9-316,SUP,HCPCS C1776,,6642-9-316  -  INSERT TIB STD LG 16MM KNEE DUR DRCN,"$5,026.13",$0.00,"$5,026.13","$2,261.76","$3,587.15",$0.00,$865.98,$0.00,$0.00,$880.03,"$5,026.13",$0.00,"$2,513.06","$3,980.69","$4,020.90",$0.00,$786.59,$0.00,$800.16,$0.00
6642-9-319,SUP,HCPCS C1776,,6642-9-319  -  INSERT TIB STD 19MM KNEE DUR DRCN,"$5,026.13",$0.00,"$5,026.13","$2,261.76","$3,587.15",$0.00,$865.98,$0.00,$0.00,$880.03,"$5,026.13",$0.00,"$2,513.06","$3,980.69","$4,020.90",$0.00,$786.59,$0.00,$800.16,$0.00
6642-9-609,SUP,Custom 27803010,,6642-9-609  -  INSERT TIBIAL SMALL 9MM CONSTRAIN DURACON DUR KNEE OTHER,"$5,080.00",$0.00,"$5,080.00",$0.00,"$3,625.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,080.00",$0.00,"$2,540.00","$4,023.36","$4,064.00",$0.00,$0.00,$0.00,$0.00,$0.00
6642-9-611,SUP,Custom 27803010,,6642-9-611  -  INSERT TIBIAL SMALL 11MM CONSTRAIN DURACON DUR KNEE,"$5,080.00",$0.00,"$5,080.00",$0.00,"$3,625.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,080.00",$0.00,"$2,540.00","$4,023.36","$4,064.00",$0.00,$0.00,$0.00,$0.00,$0.00
6642-9-613,SUP,Custom 27803010,,6642-9-613  -  INSERT TIBIAL SMALL 13MM CONSTRAIN DURACON DUR KNEE,"$5,080.00",$0.00,"$5,080.00",$0.00,"$3,625.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,080.00",$0.00,"$2,540.00","$4,023.36","$4,064.00",$0.00,$0.00,$0.00,$0.00,$0.00
6642-9-616,SUP,Custom 27803010,,6642-9-616  -  INSERT TIBIAL SMALL 16MM CONSTRAIN DURACON DUR KNEE,"$5,080.00",$0.00,"$5,080.00",$0.00,"$3,625.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,080.00",$0.00,"$2,540.00","$4,023.36","$4,064.00",$0.00,$0.00,$0.00,$0.00,$0.00
6642-9-619,SUP,Custom 27803010,,6642-9-619  -  INSERT TIBIAL SMALL 19MM CONSTRAIN DURACON DUR KNEE,"$5,080.00",$0.00,"$5,080.00",$0.00,"$3,625.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,080.00",$0.00,"$2,540.00","$4,023.36","$4,064.00",$0.00,$0.00,$0.00,$0.00,$0.00
6642-9-622,SUP,Custom 27803010,,6642-9-622  -  INSERT TIBIAL SMALL 22MM CONSTRAIN DURACON DUR KNEE OTHER,"$5,080.00",$0.00,"$5,080.00",$0.00,"$3,625.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,080.00",$0.00,"$2,540.00","$4,023.36","$4,064.00",$0.00,$0.00,$0.00,$0.00,$0.00
6642-9-625,SUP,Custom 27803010,,6642-9-625  -  INSERT TIBIAL SMALL 25MM CONSTRAIN DURACON DUR KNEE,"$5,080.00",$0.00,"$5,080.00",$0.00,"$3,625.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,080.00",$0.00,"$2,540.00","$4,023.36","$4,064.00",$0.00,$0.00,$0.00,$0.00,$0.00
6642-9-709,SUP,Custom 27803010,,6642-9-709  -  INSERT TIBIAL MEDIUM 9MM CONSTRAIN DURACON DUR KNEE,"$5,080.00",$0.00,"$5,080.00",$0.00,"$3,625.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,080.00",$0.00,"$2,540.00","$4,023.36","$4,064.00",$0.00,$0.00,$0.00,$0.00,$0.00
6642-9-711,SUP,HCPCS C1776,,6642-9-711  -  INSERT TIBIAL MEDIUM 11MM CONSTRAIN DURACON DUR KNEE OTHER,"$5,080.00",$0.00,"$5,080.00","$2,286.00","$3,625.60",$0.00,$875.26,$0.00,$0.00,$889.47,"$5,080.00",$0.00,"$2,540.00","$4,023.36","$4,064.00",$0.00,$795.02,$0.00,$808.74,$0.00
6642-9-713,SUP,Custom 27803010,,6642-9-713  -  INSERT TIBIAL MEDIUM 13MM CONSTRAIN DURACON DUR KNEE,"$5,080.00",$0.00,"$5,080.00",$0.00,"$3,625.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,080.00",$0.00,"$2,540.00","$4,023.36","$4,064.00",$0.00,$0.00,$0.00,$0.00,$0.00
6642-9-716,SUP,Custom 27803010,,6642-9-716  -  INSERT TIBIAL MEDIUM 16MM CONSTRAIN DURACON DUR KNEE,"$5,080.00",$0.00,"$5,080.00",$0.00,"$3,625.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,080.00",$0.00,"$2,540.00","$4,023.36","$4,064.00",$0.00,$0.00,$0.00,$0.00,$0.00
6642-9-719,SUP,Custom 27803010,,6642-9-719  -  INSERT TIBIAL MEDIUM 19MM CONSTRAIN DURACON DUR KNEE,"$5,080.00",$0.00,"$5,080.00",$0.00,"$3,625.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,080.00",$0.00,"$2,540.00","$4,023.36","$4,064.00",$0.00,$0.00,$0.00,$0.00,$0.00
6642-9-722,SUP,Custom 27803010,,6642-9-722  -  INSERT TIBIAL MEDIUM 22MM CONSTRAIN DURACON DUR KNEE,"$5,080.00",$0.00,"$5,080.00",$0.00,"$3,625.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,080.00",$0.00,"$2,540.00","$4,023.36","$4,064.00",$0.00,$0.00,$0.00,$0.00,$0.00
6642-9-725,SUP,Custom 27803010,,6642-9-725  -  INSERT TIBIAL MEDIUM 25MM CONSTRAIN DURACON DUR KNEE,"$5,080.00",$0.00,"$5,080.00",$0.00,"$3,625.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,080.00",$0.00,"$2,540.00","$4,023.36","$4,064.00",$0.00,$0.00,$0.00,$0.00,$0.00
6642-9-809,SUP,Custom 27803010,,6642-9-809  -  INSERT TIBIAL LARGE 9MM CONSTRAIN DURACON DUR KNEE,"$5,080.00",$0.00,"$5,080.00",$0.00,"$3,625.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,080.00",$0.00,"$2,540.00","$4,023.36","$4,064.00",$0.00,$0.00,$0.00,$0.00,$0.00
6642-9-811,SUP,Custom 27803010,,6642-9-811  -  INSERT TIBIAL LARGE 11MM CONSTRAIN DURACON DUR KNEE,"$5,080.00",$0.00,"$5,080.00",$0.00,"$3,625.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,080.00",$0.00,"$2,540.00","$4,023.36","$4,064.00",$0.00,$0.00,$0.00,$0.00,$0.00
6642-9-813,SUP,Custom 27803010,,6642-9-813  -  INSERT TIBIAL LARGE 13MM CONSTRAIN DURACON DUR KNEE,"$5,080.00",$0.00,"$5,080.00",$0.00,"$3,625.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,080.00",$0.00,"$2,540.00","$4,023.36","$4,064.00",$0.00,$0.00,$0.00,$0.00,$0.00
6642-9-816,SUP,Custom 27803010,,6642-9-816  -  INSERT TIBIAL LARGE 16MM CONSTRAIN DURACON DUR KNEE,"$5,080.00",$0.00,"$5,080.00",$0.00,"$3,625.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,080.00",$0.00,"$2,540.00","$4,023.36","$4,064.00",$0.00,$0.00,$0.00,$0.00,$0.00
6642-9-819,SUP,Custom 27803010,,6642-9-819  -  INSERT TIBIAL LARGE 19MM CONSTRAIN DURACON DUR KNEE,"$5,080.00",$0.00,"$5,080.00",$0.00,"$3,625.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,080.00",$0.00,"$2,540.00","$4,023.36","$4,064.00",$0.00,$0.00,$0.00,$0.00,$0.00
6642-9-822,SUP,Custom 27803010,,6642-9-822  -  INSERT TIBIAL LARGE 22MM CONSTRAIN DURACON DUR KNEE,"$5,080.00",$0.00,"$5,080.00",$0.00,"$3,625.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,080.00",$0.00,"$2,540.00","$4,023.36","$4,064.00",$0.00,$0.00,$0.00,$0.00,$0.00
6642-9-825,SUP,Custom 27803010,,6642-9-825  -  INSERT TIBIAL LARGE 25MM CONSTRAIN DURACON DUR KNEE,"$5,080.00",$0.00,"$5,080.00",$0.00,"$3,625.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,080.00",$0.00,"$2,540.00","$4,023.36","$4,064.00",$0.00,$0.00,$0.00,$0.00,$0.00
6647-1-018,SUP,HCPCS C1776,,6647-1-018  -  CMPNT FEM CMPR WCHT 18MM,"$7,213.38",$0.00,"$7,213.38","$3,246.02","$5,148.19",$0.00,"$1,242.83",$0.00,$0.00,"$1,263.00","$7,213.38",$0.00,"$3,606.69","$5,713.00","$5,770.70",$0.00,"$1,128.89",$0.00,"$1,148.37",$0.00
6647-2-012,SUP,HCPCS C1713,,6647-2-012  -  NAIL 12MM HUM TIB WCHT IM,"$5,000.13",$0.00,"$5,000.13","$2,250.06","$3,568.59",$0.00,$861.50,$0.00,$0.00,$875.48,"$5,000.13",$0.00,"$2,500.06","$3,960.10","$4,000.10",$0.00,$782.52,$0.00,$796.02,$0.00
6647-3-000,SUP,HCPCS C1713,,6647-3-000  -  SCREW BONE WCHT FULTHD KNEE CMPR FSN NAIL,"$3,519.75",$0.00,"$3,519.75","$1,583.89","$2,512.05",$0.00,$606.44,$0.00,$0.00,$616.28,"$3,519.75",$0.00,"$1,759.88","$2,787.64","$2,815.80",$0.00,$550.84,$0.00,$560.34,$0.00
6647-3-125,SUP,HCPCS C1713,,6647-3-125  -  SCREW BONE 6MM 25MM WCHT FULTHD ORTH SLFTAP,$494.00,$0.00,$494.00,$222.30,$352.57,$0.00,$85.11,$0.00,$0.00,$86.50,$494.00,$0.00,$247.00,$391.25,$395.20,$0.00,$77.31,$0.00,$78.64,$0.00
6647-3-130,SUP,HCPCS C1713,,6647-3-130  -  SCREW BONE 6MM 30MM WCHT FULTHD KNEE CMPR FSN NAIL,$500.50,$0.00,$500.50,$225.23,$357.21,$0.00,$86.23,$0.00,$0.00,$87.63,$500.50,$0.00,$250.25,$396.40,$400.40,$0.00,$78.33,$0.00,$79.68,$0.00
6647-3-135,SUP,HCPCS C1713,,6647-3-135  -  SCREW BONE 6MM 35MM WCHT FULTHRD IM NAIL,$500.50,$0.00,$500.50,$225.23,$357.21,$0.00,$86.23,$0.00,$0.00,$87.63,$500.50,$0.00,$250.25,$396.40,$400.40,$0.00,$78.33,$0.00,$79.68,$0.00
6647-3-140,SUP,HCPCS C1713,,6647-3-140  -  SCREW BONE 6MM 40MM WCHT FULTHD KNEE CMPR FSN NAIL,$500.50,$0.00,$500.50,$225.23,$357.21,$0.00,$86.23,$0.00,$0.00,$87.63,$500.50,$0.00,$250.25,$396.40,$400.40,$0.00,$78.33,$0.00,$79.68,$0.00
6647-3-145,SUP,HCPCS C1713,,6647-3-145  -  SCREW BONE 6MM 45MM WCHT FULTHD KNEE CMPR FSN NAIL,$500.50,$0.00,$500.50,$225.23,$357.21,$0.00,$86.23,$0.00,$0.00,$87.63,$500.50,$0.00,$250.25,$396.40,$400.40,$0.00,$78.33,$0.00,$79.68,$0.00
6647-3-150,SUP,HCPCS C1713,,6647-3-150  -  SCREW BONE 6MM 50MM WCHT FULTHD KNEE CMPR FSN NAIL,$500.50,$0.00,$500.50,$225.23,$357.21,$0.00,$86.23,$0.00,$0.00,$87.63,$500.50,$0.00,$250.25,$396.40,$400.40,$0.00,$78.33,$0.00,$79.68,$0.00
6647-3-155,SUP,HCPCS C1713,,6647-3-155  -  SCREW BONE 6MM 55MM WCHT FULTHD KNEE FSN NAIL,$500.50,$0.00,$500.50,$225.23,$357.21,$0.00,$86.23,$0.00,$0.00,$87.63,$500.50,$0.00,$250.25,$396.40,$400.40,$0.00,$78.33,$0.00,$79.68,$0.00
6647-3-160,SUP,HCPCS C1713,,6647-3-160  -  SCREW BONE 6MM 60MM WCHT FULTHD KNEE FSN NAIL,$500.50,$0.00,$500.50,$225.23,$357.21,$0.00,$86.23,$0.00,$0.00,$87.63,$500.50,$0.00,$250.25,$396.40,$400.40,$0.00,$78.33,$0.00,$79.68,$0.00
670000B,SUP,HCPCS C1713,,670000B  -  SCREW BONE 6.5MM 30MM OPUS SPNL CYLND,"$1,556.83",$0.00,"$1,556.83",$700.57,"$1,111.11",$0.00,$268.23,$0.00,$0.00,$272.59,"$1,556.83",$0.00,$778.41,"$1,233.01","$1,245.46",$0.00,$243.64,$0.00,$247.85,$0.00
670001B,SUP,HCPCS C1713,,670001B  -  SCREW BONE 6.5MM 35MM OPUS SPNL CYLND,"$1,556.83",$0.00,"$1,556.83",$700.57,"$1,111.11",$0.00,$268.23,$0.00,$0.00,$272.59,"$1,556.83",$0.00,$778.41,"$1,233.01","$1,245.46",$0.00,$243.64,$0.00,$247.85,$0.00
670002B,SUP,HCPCS C1713,,670002B  -  SCREW BONE 6.5MM 40MM OPUS SPNL CYLND,"$1,556.83",$0.00,"$1,556.83",$700.57,"$1,111.11",$0.00,$268.23,$0.00,$0.00,$272.59,"$1,556.83",$0.00,$778.41,"$1,233.01","$1,245.46",$0.00,$243.64,$0.00,$247.85,$0.00
670003B,SUP,HCPCS C1713,,670003B  -  SCREW BONE 6.5MM 45MM OPUS SPNL CYLND,"$1,556.83",$0.00,"$1,556.83",$700.57,"$1,111.11",$0.00,$268.23,$0.00,$0.00,$272.59,"$1,556.83",$0.00,$778.41,"$1,233.01","$1,245.46",$0.00,$243.64,$0.00,$247.85,$0.00
670004B,SUP,HCPCS C1713,,670004B  -  SCREW BONE 6.5MM 50MM OPUS SPNL CYLND,"$1,556.83",$0.00,"$1,556.83",$700.57,"$1,111.11",$0.00,$268.23,$0.00,$0.00,$272.59,"$1,556.83",$0.00,$778.41,"$1,233.01","$1,245.46",$0.00,$243.64,$0.00,$247.85,$0.00
670005B,SUP,HCPCS C1713,,670005B  -  SCREW BONE 7.5MM 35MM OPUS SPNL CYLND,"$1,556.83",$0.00,"$1,556.83",$700.57,"$1,111.11",$0.00,$268.23,$0.00,$0.00,$272.59,"$1,556.83",$0.00,$778.41,"$1,233.01","$1,245.46",$0.00,$243.64,$0.00,$247.85,$0.00
670006B,SUP,HCPCS C1713,,670006B  -  SCREW BONE 7.5MM 40MM OPUS SPNL CYLND,"$1,556.83",$0.00,"$1,556.83",$700.57,"$1,111.11",$0.00,$268.23,$0.00,$0.00,$272.59,"$1,556.83",$0.00,$778.41,"$1,233.01","$1,245.46",$0.00,$243.64,$0.00,$247.85,$0.00
670007B,SUP,HCPCS C1713,,670007B  -  SCREW BONE 7.5MM 45MM OPUS SPNL CYLND,"$1,556.83",$0.00,"$1,556.83",$700.57,"$1,111.11",$0.00,$268.23,$0.00,$0.00,$272.59,"$1,556.83",$0.00,$778.41,"$1,233.01","$1,245.46",$0.00,$243.64,$0.00,$247.85,$0.00
670008B,SUP,HCPCS C1713,,670008B  -  SCREW BONE 7.5MM 50MM OPUS SPNL CYLND,"$1,556.83",$0.00,"$1,556.83",$700.57,"$1,111.11",$0.00,$268.23,$0.00,$0.00,$272.59,"$1,556.83",$0.00,$778.41,"$1,233.01","$1,245.46",$0.00,$243.64,$0.00,$247.85,$0.00
670009B,SUP,HCPCS C1713,,670009B  -  SCREW BONE 7.5MM 55MM OPUS SPNL CYLND,"$1,556.83",$0.00,"$1,556.83",$700.57,"$1,111.11",$0.00,$268.23,$0.00,$0.00,$272.59,"$1,556.83",$0.00,$778.41,"$1,233.01","$1,245.46",$0.00,$243.64,$0.00,$247.85,$0.00
670010B,SUP,HCPCS C1713,,670010B  -  SCREW BONE 7.5MM 60MM OPUS SPNL CYLND,"$1,556.83",$0.00,"$1,556.83",$700.57,"$1,111.11",$0.00,$268.23,$0.00,$0.00,$272.59,"$1,556.83",$0.00,$778.41,"$1,233.01","$1,245.46",$0.00,$243.64,$0.00,$247.85,$0.00
670015B,SUP,HCPCS C1713,,670015B  -  SCREW BONE 6.5MM 55MM OPUS SPNL CYLND,"$1,556.83",$0.00,"$1,556.83",$700.57,"$1,111.11",$0.00,$268.23,$0.00,$0.00,$272.59,"$1,556.83",$0.00,$778.41,"$1,233.01","$1,245.46",$0.00,$243.64,$0.00,$247.85,$0.00
670016B,SUP,HCPCS C1713,,670016B  -  SCREW BONE 6.5MM 60MM OPUS SPNL CYLND,"$1,556.83",$0.00,"$1,556.83",$700.57,"$1,111.11",$0.00,$268.23,$0.00,$0.00,$272.59,"$1,556.83",$0.00,$778.41,"$1,233.01","$1,245.46",$0.00,$243.64,$0.00,$247.85,$0.00
670017B,SUP,HCPCS C1713,,670017B  -  SCREW BONE 7.5MM 30MM OPUS SPNL CYLND,"$1,556.83",$0.00,"$1,556.83",$700.57,"$1,111.11",$0.00,$268.23,$0.00,$0.00,$272.59,"$1,556.83",$0.00,$778.41,"$1,233.01","$1,245.46",$0.00,$243.64,$0.00,$247.85,$0.00
670-044-00,SUP,HCPCS C1887,,CATHETER GUID AL 1ST TIP SHP 6FR .070IN 100CM PTFE VSBR BLUE,$139.93,$0.00,$139.93,$75.98,$99.86,$0.00,$24.11,$0.00,$0.00,$24.50,$139.93,$0.00,$69.96,$110.82,$111.94,$0.00,$21.90,$0.00,$22.28,$0.00
670061B,SUP,HCPCS C1713,,670061B  -  SCREW BONE 5.5MM 30MM OPUS LNG SPNL HEX CYLND,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
670062B,SUP,HCPCS C1713,,670062B  -  SCREW BONE 5.5MM 35MM OPUS LNG SPNL HEX CYLND,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
670063B,SUP,HCPCS C1713,,670063B  -  SCREW BONE 5.5MM 40MM OPUS LNG SPNL HEX CYLND,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
670070B,SUP,HCPCS C1713,,670070B  -  SCREW BONE 6.5MM 30MM OPUS LNG SPNL HEX CYLND,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
670071B,SUP,HCPCS C1713,,670071B  -  SCREW BONE 6.5MM 35MM OPUS LNG SPNL HEX CYLND,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
670072B,SUP,HCPCS C1713,,670072B  -  SCREW BONE 6.5MM 40MM OPUS LNG SPNL HEX CYLND,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
670073B,SUP,HCPCS C1713,,670073B  -  SCREW BONE 6.5MM 45MM OPUS LNG SPNL HEX CYLND,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
670074B,SUP,HCPCS C1713,,670074B  -  SCREW BONE 6.5MM 50MM OPUS LNG SPNL HEX CYLND,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
670075B,SUP,HCPCS C1713,,670075B  -  SCREW BONE 6.5MM 55MM OPUS LNG SPNL HEX CYLND,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
670076B,SUP,HCPCS C1713,,670076B  -  SCREW BONE 6.5MM 60MM OPUS LNG SPNL HEX CYLND,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
670080B,SUP,HCPCS C1713,,670080B  -  SCREW BONE 7.5MM 30MM OPUS LNG SPNL HEX CYLND,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
670081B,SUP,HCPCS C1713,,670081B  -  SCREW BONE 7.5MM 35MM OPUS LNG SPNL HEX CYLND,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
670082B,SUP,HCPCS C1713,,670082B  -  SCREW BONE 7.5MM 40MM OPUS LNG SPNL HEX CYLND,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
670083B,SUP,HCPCS C1713,,670083B  -  SCREW BONE 7.5MM 45MM OPUS LNG SPNL HEX CYLND,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
670084B,SUP,HCPCS C1713,,670084B  -  SCREW BONE 7.5MM 50MM OPUS LNG SPNL HEX CYLND,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
670086B,SUP,HCPCS C1713,,670086B  -  SCREW BONE 7.5MM 55MM OPUS LNG SPNL HEX CYLND,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
670087B,SUP,HCPCS C1713,,670087B  -  SCREW BONE 7.5MM 60MM OPUS LNG SPNL HEX CYLND,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
670-090-00,SUP,HCPCS C1887,,CATHETER GUID JR4ST CURVE 6FR .070IN 100CM PTFE VSBR BLUE,$139.93,$0.00,$139.93,$75.98,$99.86,$0.00,$24.11,$0.00,$0.00,$24.50,$139.93,$0.00,$69.96,$110.82,$111.94,$0.00,$21.90,$0.00,$22.28,$0.00
670110B,SUP,HCPCS C1713,,670110B  -  SCREW BONE 9MM 30MM OPUS SPNL CYLND,"$1,556.83",$0.00,"$1,556.83",$700.57,"$1,111.11",$0.00,$268.23,$0.00,$0.00,$272.59,"$1,556.83",$0.00,$778.41,"$1,233.01","$1,245.46",$0.00,$243.64,$0.00,$247.85,$0.00
670111B,SUP,HCPCS C1713,,670111B  -  SCREW BONE 9MM 35MM OPUS SPNL CYLND,"$1,556.83",$0.00,"$1,556.83",$700.57,"$1,111.11",$0.00,$268.23,$0.00,$0.00,$272.59,"$1,556.83",$0.00,$778.41,"$1,233.01","$1,245.46",$0.00,$243.64,$0.00,$247.85,$0.00
670112B,SUP,HCPCS C1713,,670112B  -  SCREW BONE 9MM 40MM OPUS SPNL CYLND,"$1,556.83",$0.00,"$1,556.83",$700.57,"$1,111.11",$0.00,$268.23,$0.00,$0.00,$272.59,"$1,556.83",$0.00,$778.41,"$1,233.01","$1,245.46",$0.00,$243.64,$0.00,$247.85,$0.00
670113B,SUP,HCPCS C1713,,670113B  -  SCREW BONE 9MM 45MM OPUS SPNL CYLND,"$1,556.83",$0.00,"$1,556.83",$700.57,"$1,111.11",$0.00,$268.23,$0.00,$0.00,$272.59,"$1,556.83",$0.00,$778.41,"$1,233.01","$1,245.46",$0.00,$243.64,$0.00,$247.85,$0.00
670114B,SUP,HCPCS C1713,,670114B  -  SCREW BONE 9MM 50MM OPUS SPNL CYLND,"$1,556.83",$0.00,"$1,556.83",$700.57,"$1,111.11",$0.00,$268.23,$0.00,$0.00,$272.59,"$1,556.83",$0.00,$778.41,"$1,233.01","$1,245.46",$0.00,$243.64,$0.00,$247.85,$0.00
670115B,SUP,HCPCS C1713,,670115B  -  SCREW BONE 9MM 55MM OPUS SPNL CYLND,"$1,556.83",$0.00,"$1,556.83",$700.57,"$1,111.11",$0.00,$268.23,$0.00,$0.00,$272.59,"$1,556.83",$0.00,$778.41,"$1,233.01","$1,245.46",$0.00,$243.64,$0.00,$247.85,$0.00
670116B,SUP,HCPCS C1713,,670116B  -  SCREW BONE 9MM 60MM OPUS SPNL CYLND,"$1,556.83",$0.00,"$1,556.83",$700.57,"$1,111.11",$0.00,$268.23,$0.00,$0.00,$272.59,"$1,556.83",$0.00,$778.41,"$1,233.01","$1,245.46",$0.00,$243.64,$0.00,$247.85,$0.00
670212B,SUP,HCPCS C1713,,670212B  -  SCREW BONE 5.5MM 30MM OPUS SPNL CYLND,"$1,556.83",$0.00,"$1,556.83",$700.57,"$1,111.11",$0.00,$268.23,$0.00,$0.00,$272.59,"$1,556.83",$0.00,$778.41,"$1,233.01","$1,245.46",$0.00,$243.64,$0.00,$247.85,$0.00
670213B,SUP,HCPCS C1713,,670213B  -  SCREW BONE 5.5MM 35MM OPUS SPNL CYLND,"$1,556.83",$0.00,"$1,556.83",$700.57,"$1,111.11",$0.00,$268.23,$0.00,$0.00,$272.59,"$1,556.83",$0.00,$778.41,"$1,233.01","$1,245.46",$0.00,$243.64,$0.00,$247.85,$0.00
670214B,SUP,HCPCS C1713,,670214B  -  SCREW BONE 5.5MM 40MM OPUS SPNL CYLND,"$1,556.83",$0.00,"$1,556.83",$700.57,"$1,111.11",$0.00,$268.23,$0.00,$0.00,$272.59,"$1,556.83",$0.00,$778.41,"$1,233.01","$1,245.46",$0.00,$243.64,$0.00,$247.85,$0.00
670215B,SUP,HCPCS C1713,,670215B  -  SCREW BONE 5.5MM 45MM OPUS THOR SPN,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
670223C,SUP,HCPCS C1713,,670223C  -  PLATE SHRT 3 HOLE OPUS BONE SPNL,"$2,772.18",$0.00,"$2,772.18","$1,247.48","$1,978.50",$0.00,$477.63,$0.00,$0.00,$485.39,"$2,772.18",$0.00,"$1,386.09","$2,195.57","$2,217.74",$0.00,$433.85,$0.00,$441.33,$0.00
670-26090,SUP,HCPCS C1887,,CATHETER GUID STRG ENVOY 6FR .90CM,$785.00,$0.00,$785.00,$426.26,$560.25,$0.00,$135.25,$0.00,$0.00,$137.45,$785.00,$0.00,$392.50,$621.72,$628.00,$0.00,$122.85,$0.00,$124.97,$0.00
670300B,SUP,HCPCS C1713,,670300B  -  SCREW BONE 6.5MM 30MM OPUS SPNL LNG TOP CYLND,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
670301B,SUP,HCPCS C1713,,670301B  -  SCREW BONE 6.5MM 35MM OPUS SPNL LNG TOP CYLND,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
670302B,SUP,HCPCS C1713,,670302B  -  SCREW BONE 6.5MM 40MM OPUS SPNL LNG TOP CYLND,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
670303B,SUP,HCPCS C1713,,670303B  -  SCREW BONE 6.5MM 45MM OPUS SPNL LNG TOP CYLND,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
670304B,SUP,HCPCS C1713,,670304B  -  SCREW BONE 6.5MM 50MM OPUS SPNL LNG TOP CYLND,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
670305B,SUP,HCPCS C1713,,670305B  -  SCREW BONE 6.5MM 55MM OPUS SPNL LNG TOP CYLND,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
6703-1-018,SUP,Custom 27203010,,6703-1-018  -  WIRE SUT .032IN VIT 6 PER TUBE,$50.38,$0.00,$50.38,$0.00,$35.95,$0.00,$0.00,$0.00,$0.00,$0.00,$50.38,$0.00,$25.19,$39.90,$40.30,$0.00,$0.00,$0.00,$0.00,$0.00
670310B,SUP,HCPCS C1713,,670310B  -  SCREW BONE 7.5MM 30MM OPUS SPNL LNG TOP CYLND,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
670311B,SUP,HCPCS C1713,,670311B  -  SCREW BONE 7.5MM 35MM OPUS SPNL LNG TOP CYLND,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
670312B,SUP,HCPCS C1713,,670312B  -  SCREW BONE 7.5MM 40MM OPUS SPNL LNG TOP CYLND,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
670313B,SUP,HCPCS C1713,,670313B  -  SCREW BONE 7.5MM 45MM OPUS SPNL LNG TOP CYLND,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
670314B,SUP,HCPCS C1713,,670314B  -  SCREW BONE 7.5MM 50MM OPUS SPNL LNG TOP CYLND,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
670315B,SUP,HCPCS C1713,,670315B  -  SCREW BONE 7.5MM 55MM OPUS SPNL LNG TOP CYLND,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
670316B,SUP,HCPCS C1713,,670316B  -  SCREW BONE 7.5MM 60MM OPUS SPNL LNG TOP CYLND,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
6703-2-120,SUP,Custom 27203010,,6703-2-120  -  WIRE SUT .032IN VIT,$217.75,$0.00,$217.75,$0.00,$155.41,$0.00,$0.00,$0.00,$0.00,$0.00,$217.75,$0.00,$108.88,$172.46,$174.20,$0.00,$0.00,$0.00,$0.00,$0.00
670370B,SUP,HCPCS C1713,,670370B  -  SCREW BONE 6.5MM 30MM OPUS SPNL LNG TOP LNG HEX CYLND,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
670371B,SUP,HCPCS C1713,,670371B  -  SCREW BONE 6.5MM 35MM OPUS SPNL LNG TOP LNG HEX CYLND,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
670372B,SUP,HCPCS C1713,,670372B  -  SCREW BONE 6.5MM 40MM OPUS SPNL LNG TOP LNG HEX CYLND,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
670373B,SUP,HCPCS C1713,,670373B  -  SCREW BONE 6.5MM 45MM OPUS SPNL LNG TOP LNG HEX CYLND,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
670374B,SUP,HCPCS C1713,,670374B  -  SCREW BONE 6.5MM 50MM OPUS SPNL LNG TOP LNG HEX CYLND,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
670375B,SUP,HCPCS C1713,,670375B  -  SCREW BONE 6.5MM 55MM OPUS SPNL LNG TOP LNG HEX CYLND,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
670376B,SUP,HCPCS C1713,,670376B  -  SCREW BONE 6.5MM 60MM OPUS SPNL LNG TOP LNG HEX CYLND,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
670380B,SUP,HCPCS C1713,,670380B  -  SCREW BONE 7.5MM 30MM OPUS SPNL LNG TOP LNG HEX CYLND,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
670381B,SUP,HCPCS C1713,,670381B  -  SCREW BONE 7.5MM 35MM OPUS SPNL LNG TOP LNG HEX CYLND,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
670382B,SUP,HCPCS C1713,,670382B  -  SCREW BONE 7.5MM 40MM OPUS SPNL LNG TOP LNG HEX CYLND,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
670383B,SUP,HCPCS C1713,,670383B  -  SCREW BONE 7.5MM 45MM OPUS SPNL LNG TOP LNG HEX CYLND,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
670384B,SUP,HCPCS C1713,,670384B  -  SCREW BONE 7.5MM 50MM OPUS SPNL LNG TOP LNG HEX CYLND,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
670385B,SUP,HCPCS C1713,,670385B  -  SCREW BONE 7.5MM 55MM OPUS SPNL LNG TOP LNG HEX CYLND,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
670386B,SUP,HCPCS C1713,,670386B  -  SCREW BONE 7.5MM 60MM OPUS SPNL LNG TOP LNG HEX CYLND,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
6704-0-110,SUP,HCPCS C1713,,6704-0-110  -  CABLE ORTHOPEDIC 2 1.6MM HOMOGENOUS GRIP DALL-MILES,"$2,022.50",$0.00,"$2,022.50",$910.13,"$1,443.46",$0.00,$348.47,$0.00,$0.00,$354.12,"$2,022.50",$0.00,"$1,011.25","$1,601.82","$1,618.00",$0.00,$316.52,$0.00,$321.98,$0.00
6704-0-210,SUP,HCPCS C1713,,6704-0-210  -  CABLE ORTHOPEDIC 2 2MM HOMOGENOUS GRIP DALL-MILES VITALLIUM,"$2,022.50",$0.00,"$2,022.50",$910.13,"$1,443.46",$0.00,$348.47,$0.00,$0.00,$354.12,"$2,022.50",$0.00,"$1,011.25","$1,601.82","$1,618.00",$0.00,$316.52,$0.00,$321.98,$0.00
6704-0-310,SUP,HCPCS C1713,,6704-0-310  -  CABLE ORTHOPEDIC 2 LARGE 2MM 22MM GRIP DALL-MILES VITALLIUM,"$2,022.50",$0.00,"$2,022.50",$910.13,"$1,443.46",$0.00,$348.47,$0.00,$0.00,$354.12,"$2,022.50",$0.00,"$1,011.25","$1,601.82","$1,618.00",$0.00,$316.52,$0.00,$321.98,$0.00
6704-0-410,SUP,HCPCS C1713,,6704-0-410  -  CABLE ORTHOPEDIC 1.6MM SET SLEEVE DALL-MILES VITALLIUM HIP,$690.00,$0.00,$690.00,$310.50,$492.45,$0.00,$118.88,$0.00,$0.00,$120.81,$690.00,$0.00,$345.00,$546.48,$552.00,$0.00,$107.99,$0.00,$109.85,$0.00
6704-0-420,SUP,HCPCS C1713,,6704-0-420  -  CABLE ORTHOPEDIC 1.6MM SET SLEEVE BEADED DALL-MILES,$740.00,$0.00,$740.00,$333.00,$528.14,$0.00,$127.50,$0.00,$0.00,$129.57,$740.00,$0.00,$370.00,$586.08,$592.00,$0.00,$115.81,$0.00,$117.81,$0.00
6704-0-510,SUP,Custom 27803010,,6704-0-510  -  CABLE ORTHOPEDIC 2 2MM HOMOGENOUS DALL-MILES VITALLIUM HIP,$690.00,$0.00,$690.00,$0.00,$492.45,$0.00,$0.00,$0.00,$0.00,$0.00,$690.00,$0.00,$345.00,$546.48,$552.00,$0.00,$0.00,$0.00,$0.00,$0.00
6704-0-520,SUP,HCPCS C1713,,6704-0-520  -  CABLE ORTHOPEDIC 2MM SET SLEEVE BEAD DALL-MILES VITALLIUM,$740.00,$0.00,$740.00,$333.00,$528.14,$0.00,$127.50,$0.00,$0.00,$129.57,$740.00,$0.00,$370.00,$586.08,$592.00,$0.00,$115.81,$0.00,$117.81,$0.00
6704-1-018,SUP,Custom 27203010,,6704-1-018  -  WIRE SUT .04IN 18IN DLMLS VIT 6 PER TUBE,$48.75,$0.00,$48.75,$0.00,$34.79,$0.00,$0.00,$0.00,$0.00,$0.00,$48.75,$0.00,$24.38,$38.61,$39.00,$0.00,$0.00,$0.00,$0.00,$0.00
6704-2-120,SUP,Custom 27203010,,6704-2-120  -  WIRE FX .04IN SUT VIT,$253.50,$0.00,$253.50,$0.00,$180.92,$0.00,$0.00,$0.00,$0.00,$0.00,$253.50,$0.00,$126.75,$200.77,$202.80,$0.00,$0.00,$0.00,$0.00,$0.00
6704-3-070,SUP,HCPCS C1713,,6704-3-070  -  GRIP CBL 2MM SM DLMLS 2 CBL VIT HIP TROCH,"$2,552.50",$0.00,"$2,552.50","$1,148.63","$1,821.72",$0.00,$439.78,$0.00,$0.00,$446.92,"$2,552.50",$0.00,"$1,276.25","$2,021.58","$2,042.00",$0.00,$399.47,$0.00,$406.36,$0.00
6704-3-080,SUP,HCPCS C1713,,6704-3-080  -  GRIP CABLE 2MM MEDIUM 2MM DALL-MILES VITALLIUM HIP,"$2,552.50",$0.00,"$2,552.50","$1,148.63","$1,821.72",$0.00,$439.78,$0.00,$0.00,$446.92,"$2,552.50",$0.00,"$1,276.25","$2,021.58","$2,042.00",$0.00,$399.47,$0.00,$406.36,$0.00
6704-3-081,SUP,HCPCS C1713,,6704-3-081  -  PLATE BONE 2MM MEDIUM 100MM 2 CABLE GRIP DALL-MILES,"$2,552.50",$0.00,"$2,552.50","$1,148.63","$1,821.72",$0.00,$439.78,$0.00,$0.00,$446.92,"$2,552.50",$0.00,"$1,276.25","$2,021.58","$2,042.00",$0.00,$399.47,$0.00,$406.36,$0.00
6704-3-082,SUP,HCPCS C1713,,6704-3-082  -  PLATE BN 2MM MED 150MM DLMLS 2 CBL GRP VIT HIP TROCH,"$3,325.00",$0.00,"$3,325.00","$1,496.25","$2,373.05",$0.00,$572.88,$0.00,$0.00,$582.18,"$3,325.00",$0.00,"$1,662.50","$2,633.40","$2,660.00",$0.00,$520.36,$0.00,$529.34,$0.00
6704-3-083,SUP,HCPCS C1713,,6704-3-083  -  PLATE BN 2MM MED 200MM DLMLS 2 CBL GRP VIT HIP TROCH,"$4,115.00",$0.00,"$4,115.00","$1,851.75","$2,936.88",$0.00,$708.99,$0.00,$0.00,$720.50,"$4,115.00",$0.00,"$2,057.50","$3,259.08","$3,292.00",$0.00,$644.00,$0.00,$655.11,$0.00
6704-3-090,SUP,HCPCS C1713,,6704-3-090  -  GRIP CABLE 2MM LARGE DALL-MILES VITALLIUM HIP,"$2,552.50",$0.00,"$2,552.50","$1,148.63","$1,821.72",$0.00,$439.78,$0.00,$0.00,$446.92,"$2,552.50",$0.00,"$1,276.25","$2,021.58","$2,042.00",$0.00,$399.47,$0.00,$406.36,$0.00
6704-3-091,SUP,HCPCS C1713,,6704-3-091  -  PLATE BN 2MM LG 110MM DLMLS 2 CBL GRP VIT HIP TROCH,"$2,552.50",$0.00,"$2,552.50","$1,148.63","$1,821.72",$0.00,$439.78,$0.00,$0.00,$446.92,"$2,552.50",$0.00,"$1,276.25","$2,021.58","$2,042.00",$0.00,$399.47,$0.00,$406.36,$0.00
6704-3-092,SUP,HCPCS C1713,,6704-3-092  -  PLATE BONE 2MM LARGE 160MM 2 CABLE GRIP DALL-MILES VITALLIUM,"$3,325.00",$0.00,"$3,325.00","$1,496.25","$2,373.05",$0.00,$572.88,$0.00,$0.00,$582.18,"$3,325.00",$0.00,"$1,662.50","$2,633.40","$2,660.00",$0.00,$520.36,$0.00,$529.34,$0.00
6704-3-093,SUP,HCPCS C1713,,6704-3-093  -  PLATE BONE 2MM LARGE 210MM 2 CABLE GRIP DALL-MILES VITALLIUM,"$4,115.00",$0.00,"$4,115.00","$1,851.75","$2,936.88",$0.00,$708.99,$0.00,$0.00,$720.50,"$4,115.00",$0.00,"$2,057.50","$3,259.08","$3,292.00",$0.00,$644.00,$0.00,$655.11,$0.00
6704-3-120,SUP,HCPCS C1713,,6704-3-120  -  WIRE FX .046IN HVY GA VIT,$253.50,$0.00,$253.50,$114.08,$180.92,$0.00,$43.68,$0.00,$0.00,$44.39,$253.50,$0.00,$126.75,$200.77,$202.80,$0.00,$39.67,$0.00,$40.36,$0.00
6704-4-016,SUP,HCPCS C1713,,6704-4-016  -  SLEEVE CABLE SMALL 1.6MM CRIMP DALL-MILES VITALLIUM HIP,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
6704-4-020,SUP,HCPCS C1713,,6704-4-020  -  SLEEVE CABLE MEDIUM 2MM GRIP CRIMP DALL-MILES VITALLIUM HIP,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
6704-5-016,SUP,HCPCS C1713,,6704-5-016  -  GRIP CABLE SMALL 1.6MM HOLE DALL-MILES VITALLIUM HIP STERILE,"$1,195.00",$0.00,"$1,195.00",$537.75,$852.87,$0.00,$205.89,$0.00,$0.00,$209.23,"$1,195.00",$0.00,$597.50,$946.44,$956.00,$0.00,$187.02,$0.00,$190.24,$0.00
6704-6-020,SUP,HCPCS C1713,,6704-6-020  -  GRIP CABLE MEDIUM 2MM HOLE DALL-MILES VITALLIUM HIP STERILE,"$1,195.00",$0.00,"$1,195.00",$537.75,$852.87,$0.00,$205.89,$0.00,$0.00,$209.23,"$1,195.00",$0.00,$597.50,$946.44,$956.00,$0.00,$187.02,$0.00,$190.24,$0.00
6704-6-110,SUP,HCPCS C1713,,6704-6-110  -  BUTTON FIX GROOVE LOCK DALL-MILES VITALLIUM HIP,$647.50,$0.00,$647.50,$291.38,$462.12,$0.00,$111.56,$0.00,$0.00,$113.37,$647.50,$0.00,$323.75,$512.82,$518.00,$0.00,$101.33,$0.00,$103.08,$0.00
6704-7-020,SUP,Custom 27803010,,6704-7-020  -  GRIP CABLE LARGE 2MM DALL-MILES VITALLIUM HIP STERILE,"$1,195.00",$0.00,"$1,195.00",$0.00,$852.87,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,195.00",$0.00,$597.50,$946.44,$956.00,$0.00,$0.00,$0.00,$0.00,$0.00
6704-8-030,SUP,HCPCS C1713,,6704-8-030  -  CABLE ORTHOPEDIC MINI SLEEVE DALL-MILES VITALLIUM HIP,$555.00,$0.00,$555.00,$249.75,$396.10,$0.00,$95.62,$0.00,$0.00,$97.18,$555.00,$0.00,$277.50,$439.56,$444.00,$0.00,$86.86,$0.00,$88.36,$0.00
6704-8-236,SUP,HCPCS C1713,,6704-8-236  -  CABLE ORTHOPEDIC 1.6MM 750MM GRIP DALL-MILES VITALLIUM HIP,$622.50,$0.00,$622.50,$280.13,$444.28,$0.00,$107.25,$0.00,$0.00,$108.99,$622.50,$0.00,$311.25,$493.02,$498.00,$0.00,$97.42,$0.00,$99.10,$0.00
6704-8-240,SUP,HCPCS C1713,,6704-8-240  -  CABLE ORTHOPEDIC 2MM 750MM GRIP DALL-MILES VITALLIUM HIP,$622.50,$0.00,$622.50,$280.13,$444.28,$0.00,$107.25,$0.00,$0.00,$108.99,$622.50,$0.00,$311.25,$493.02,$498.00,$0.00,$97.42,$0.00,$99.10,$0.00
6707920P2,SUP,HCPCS C1713,,6707920P2  -  IMPLANT SPNL 4D 20X7X9MM LF CRNT LI,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6707926P2,SUP,HCPCS C1713,,6707926P2  -  IMPLANT SPNL 4D 26X7X9MM LF CRNT LI,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6708520P2,SUP,HCPCS C1713,,6708520P2  -  CAGE SPNL 15D LG TPR 20X9X8MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6708820P2,SUP,HCPCS C1713,,6708820P2  -  CAGE SPNL 8D LG TPR 20X9X8MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6708920P2,SUP,HCPCS C1713,,6708920P2  -  CAGE SPNL 4D LG IMPCT 20X9X8MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6708926P2,SUP,HCPCS C1713,,6708926P2  -  CAGE SPNL 4D LG IMPCT 26X9X8MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6708932P2,SUP,HCPCS C1713,,6708932P2  -  CAGE SPNL 4D LG IMPCT 32X9X8MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6709920P2,SUP,HCPCS C1713,,6709920P2  -  CAGE SPNL 4D LG IMPCT 20X9X9MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6709926P2,SUP,HCPCS C1713,,6709926P2  -  CAGE SPNL 4D LG IMPCT 26X9X9MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6709932P2,SUP,HCPCS C1713,,6709932P2  -  CAGE SPNL 4D LG IMPCT 32X9X9MM NS LF CRNT PEEK-OPTM,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6710520P2,SUP,HCPCS C1713,,6710520P2  -  CAGE SPNL 15D LG TPR 20X10X9MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6710820P2,SUP,HCPCS C1713,,6710820P2  -  CAGE SPNL 8D LG TPR 20X10X9MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6710920P2,SUP,HCPCS C1713,,6710920P2  -  CAGE SPNL 4D LG IMPCT 20X10X9MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6710926P2,SUP,HCPCS C1713,,6710926P2  -  CAGE SPNL 4D LG IMPCT 26X10X9MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6710932P2,SUP,HCPCS C1713,,6710932P2  -  CAGE SPNL 4D LG IMPCT 32X10X9MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6711920P2,SUP,HCPCS C1713,,6711920P2  -  CAGE SPNL 4D LG IMPCT 20X11X9MM NS LF CRNT PEEK-OPTM,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6711926P2,SUP,HCPCS C1713,,6711926P2  -  CAGE SPNL 4D LG IMPCT 26X11X9MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6711932P2,SUP,HCPCS C1713,,6711932P2  -  CAGE SPNL 4D LG IMPCT 32X11X9MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6712520P2,SUP,HCPCS C1713,,6712520P2  -  CAGE SPNL 15D LG TPR 20X12X9MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6712820P2,SUP,HCPCS C1713,,6712820P2  -  CAGE SPNL 8D LG TPR 20X12X9MM NS LF CRNT PEEK-OPTM,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6712920P2,SUP,HCPCS C1713,,6712920P2  -  CAGE SPNL 4D LG IMPCT 20X12X9MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6712926P2,SUP,HCPCS C1713,,6712926P2  -  CAGE SPNL 4D LG IMPCT 26X12X9MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6712932P2,SUP,HCPCS C1713,,6712932P2  -  CAGE SPNL 4D LG IMPCT 32X12X9MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6713920P2,SUP,HCPCS C1713,,6713920P2  -  CAGE SPNL 4D LG IMPCT LRDTC 20X13X9MM NS LF CRNT PEEK,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6713926P2,SUP,HCPCS C1713,,6713926P2  -  CAGE SPNL 4D LG IMPCT 26X13X9MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6713932P2,SUP,HCPCS C1713,,6713932P2  -  CAGE SPNL 4D LG IMPCT 32X13X9MM NS LF CRNT PEEK-OPTM,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6714820P2,SUP,HCPCS C1713,,6714820P2  -  CAGE SPNL 8D LG TPR 20X14X9MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6714920P2,SUP,HCPCS C1713,,6714920P2  -  CAGE SPNL 4D LG IMPCT 20X14X9MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6714926P2,SUP,HCPCS C1713,,6714926P2  -  CAGE SPNL 4D LG IMPCT 26X14X9MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6714932P2,SUP,HCPCS C1713,,6714932P2  -  CAGE SPNL 4D LG IMPCT 32X14X9MM NS LF CRNT PEEK-OPTM,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6715920P2,SUP,HCPCS C1713,,6715920P2  -  CAGE SPNL 4D LG IMPCT 20X9X15MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6715926P2,SUP,HCPCS C1713,,6715926P2  -  CAGE SPNL 4D LG IMPCT 26X9X15MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6716920P2,SUP,HCPCS C1713,,6716920P2  -  CAGE SPNL 4D LG IMPCT 20X9X16MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6716926P2,SUP,HCPCS C1713,,6716926P2  -  CAGE SPNL 4D LG IMPCT 26X9X16MM NS LF CRNT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
6720-0027,SUP,HCPCS C1776,,6720-0027  -  STEM FEM 132D 0 28MM STD OFST 93MM STRL ACLD II V40 PRFT,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
6720-0127,SUP,HCPCS C1776,,6720-0127  -  STEM FEM 132D 1 29MM STD OFST 96MM STRL ACLD II V40 PRFT,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
6720-0230,SUP,HCPCS C1776,,6720-0230  -  STEM FEM 132D 2 33MM STD OFST 99MM STRL ACLD II V40 PRFT,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
6720-0330,SUP,HCPCS C1776,,6720-0330  -  STEM FEM 132D 3 35MM STD OFST 102MM STRL ACLD II V40 PRFT,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
6720-0435,SUP,HCPCS C1776,,6720-0435  -  STEM FEM 132D 4 38MM STD OFST 105MM STRL ACLD II V40 PRFT,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
6720-0535,SUP,HCPCS C1776,,6720-0535  -  STEM FEM 132D 5 40MM STD OFST 108MM STRL ACLD II V40 PRFT,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
6720-0635,SUP,HCPCS C1776,,6720-0635  -  STEM FEM 132D 6 41MM STD OFST 111MM STRL ACLD II V40 PRFT,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
6720-0737,SUP,HCPCS C1776,,6720-0737  -  STEM FEM 132D 7 46MM STD OFST 114MM STRL ACLD II V40 PRFT,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
6720-0837,SUP,HCPCS C1776,,6720-0837  -  STEM FEM 132D 8 47MM STD OFST 117MM STRL ACLD II V40 PRFT,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
6720-0937,SUP,HCPCS C1776,,6720-0937  -  STEM FEM 132D 9 49MM STD OFST 120MM STRL ACLD II V40 PRFT,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
6720-1040,SUP,HCPCS C1776,,6720-1040  -  STEM FEM 132D 10 51MM STD OFST 123MM STRL ACLD II V40 PRFT,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
6720-1140,SUP,HCPCS C1776,,6720-1140  -  STEM FEM 132D 11 53MM STD OFST 126MM STRL ACLD II V40 PRFT,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
6721-0027,SUP,HCPCS C1776,,6721-0027  -  STEM FEM 127D 0 32MM HI OFST 93MM STRL ACLD II V40 PRFT,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
6721-0330,SUP,HCPCS C1776,,6721-0330  -  STEM FEM ACLD II 3 127D,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
6721-0435,SUP,HCPCS C1713,,6721-0435  -  STEM FEM ACLD II 4 127D,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
6721-0535,SUP,HCPCS C1713,,6721-0535  -  STEM FEM ACLD II 5 127D,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
6721-0635,SUP,HCPCS C1776,,6721-0635  -  STEM FEM 127D 6 TPR 111MM STRL 35MM ACLD MDLR HIP,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
6721-0837,SUP,HCPCS C1776,,6721-0837  -  STEM FEM 127D 8 TPR 117MM STRL 37MM ACLD II MDLR HIP,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
6721-1140,SUP,HCPCS C1776,,6721-1140  -  STEM FEM 127D 11 58MM HI OFST 126MM STRL ACLD II V40 PRFT,"$5,357.50",$0.00,"$5,357.50","$2,410.88","$3,823.65",$0.00,$923.07,$0.00,$0.00,$938.06,"$5,357.50",$0.00,"$2,678.75","$4,243.14","$4,286.00",$0.00,$838.45,$0.00,$852.91,$0.00
6728-1-609,SUP,HCPCS C1776,,6728-1-609  -  INSERT TIBIAL SMALL 9MM REVISION PCA KNEE LEFT,"$5,410.00",$0.00,"$5,410.00","$2,434.50","$3,861.12",$0.00,$932.12,$0.00,$0.00,$947.25,"$5,410.00",$0.00,"$2,705.00","$4,284.72","$4,328.00",$0.00,$846.67,$0.00,$861.27,$0.00
6728-1-611,SUP,HCPCS C1776,,6728-1-611  -  INSERT TIBIAL SMALL 11MM REVISION PCA KNEE LEFT,"$5,410.00",$0.00,"$5,410.00","$2,434.50","$3,861.12",$0.00,$932.12,$0.00,$0.00,$947.25,"$5,410.00",$0.00,"$2,705.00","$4,284.72","$4,328.00",$0.00,$846.67,$0.00,$861.27,$0.00
6728-1-613,SUP,HCPCS C1776,,6728-1-613  -  INSERT TIBIAL SMALL 13MM REVISION PCA KNEE LEFT,"$5,410.00",$0.00,"$5,410.00","$2,434.50","$3,861.12",$0.00,$932.12,$0.00,$0.00,$947.25,"$5,410.00",$0.00,"$2,705.00","$4,284.72","$4,328.00",$0.00,$846.67,$0.00,$861.27,$0.00
6728-1-616,SUP,HCPCS C1776,,6728-1-616  -  INSERT TIBIAL SMALL 16MM REVISION PCA KNEE LEFT,"$5,410.00",$0.00,"$5,410.00","$2,434.50","$3,861.12",$0.00,$932.12,$0.00,$0.00,$947.25,"$5,410.00",$0.00,"$2,705.00","$4,284.72","$4,328.00",$0.00,$846.67,$0.00,$861.27,$0.00
6728-1-619,SUP,HCPCS C1776,,6728-1-619  -  INSERT TIBIAL SMALL 19MM REVISION PCA KNEE LEFT,"$5,410.00",$0.00,"$5,410.00","$2,434.50","$3,861.12",$0.00,$932.12,$0.00,$0.00,$947.25,"$5,410.00",$0.00,"$2,705.00","$4,284.72","$4,328.00",$0.00,$846.67,$0.00,$861.27,$0.00
6728-1-622,SUP,HCPCS C1776,,6728-1-622  -  INSERT TIBIAL SMALL 22MM REVISION PCA KNEE LEFT,"$5,410.00",$0.00,"$5,410.00","$2,434.50","$3,861.12",$0.00,$932.12,$0.00,$0.00,$947.25,"$5,410.00",$0.00,"$2,705.00","$4,284.72","$4,328.00",$0.00,$846.67,$0.00,$861.27,$0.00
6728-1-625,SUP,HCPCS C1776,,6728-1-625  -  INSERT TIBIAL SMALL 25MM REVISION PCA KNEE LEFT,"$5,410.00",$0.00,"$5,410.00","$2,434.50","$3,861.12",$0.00,$932.12,$0.00,$0.00,$947.25,"$5,410.00",$0.00,"$2,705.00","$4,284.72","$4,328.00",$0.00,$846.67,$0.00,$861.27,$0.00
6728-1-709,SUP,HCPCS C1776,,6728-1-709  -  INSERT TIBIAL SMALL 9MM REVISION PCA KNEE RIGHT,"$5,410.00",$0.00,"$5,410.00","$2,434.50","$3,861.12",$0.00,$932.12,$0.00,$0.00,$947.25,"$5,410.00",$0.00,"$2,705.00","$4,284.72","$4,328.00",$0.00,$846.67,$0.00,$861.27,$0.00
6728-1-711,SUP,HCPCS C1776,,6728-1-711  -  INSERT TIBIAL SMALL 11MM REVISION PCA KNEE RIGHT,"$5,410.00",$0.00,"$5,410.00","$2,434.50","$3,861.12",$0.00,$932.12,$0.00,$0.00,$947.25,"$5,410.00",$0.00,"$2,705.00","$4,284.72","$4,328.00",$0.00,$846.67,$0.00,$861.27,$0.00
6728-1-713,SUP,HCPCS C1776,,6728-1-713  -  INSERT TIBIAL SMALL 13MM REVISION PCA KNEE RIGHT,"$5,410.00",$0.00,"$5,410.00","$2,434.50","$3,861.12",$0.00,$932.12,$0.00,$0.00,$947.25,"$5,410.00",$0.00,"$2,705.00","$4,284.72","$4,328.00",$0.00,$846.67,$0.00,$861.27,$0.00
6728-1-716,SUP,HCPCS C1776,,6728-1-716  -  INSERT TIBIAL SMALL 16MM REVISION PCA KNEE RIGHT,"$5,410.00",$0.00,"$5,410.00","$2,434.50","$3,861.12",$0.00,$932.12,$0.00,$0.00,$947.25,"$5,410.00",$0.00,"$2,705.00","$4,284.72","$4,328.00",$0.00,$846.67,$0.00,$861.27,$0.00
6728-1-719,SUP,HCPCS C1776,,6728-1-719  -  INSERT TIBIAL SMALL 19MM REVISION PCA KNEE RIGHT,"$5,410.00",$0.00,"$5,410.00","$2,434.50","$3,861.12",$0.00,$932.12,$0.00,$0.00,$947.25,"$5,410.00",$0.00,"$2,705.00","$4,284.72","$4,328.00",$0.00,$846.67,$0.00,$861.27,$0.00
6728-1-722,SUP,HCPCS C1776,,6728-1-722  -  INSERT TIBIAL SMALL 22MM REVISION PCA KNEE RIGHT,"$5,410.00",$0.00,"$5,410.00","$2,434.50","$3,861.12",$0.00,$932.12,$0.00,$0.00,$947.25,"$5,410.00",$0.00,"$2,705.00","$4,284.72","$4,328.00",$0.00,$846.67,$0.00,$861.27,$0.00
6728-1-725,SUP,HCPCS C1776,,6728-1-725  -  INSERT TIBIAL SMALL 25MM REVISION PCA KNEE RIGHT,"$5,410.00",$0.00,"$5,410.00","$2,434.50","$3,861.12",$0.00,$932.12,$0.00,$0.00,$947.25,"$5,410.00",$0.00,"$2,705.00","$4,284.72","$4,328.00",$0.00,$846.67,$0.00,$861.27,$0.00
6728-1-940,SUP,Custom 27803010,,6728-1-940  -  COMPONENT PATLR SMALL PRIM REVISION CUP PCA KNEE,"$3,630.00",$0.00,"$3,630.00",$0.00,"$2,590.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,630.00",$0.00,"$1,815.00","$2,874.96","$2,904.00",$0.00,$0.00,$0.00,$0.00,$0.00
6728-2-609,SUP,HCPCS C1776,,6728-2-609  -  INSERT TIBIAL MEDIUM 9MM REVISION PCA KNEE LEFT,"$5,410.00",$0.00,"$5,410.00","$2,434.50","$3,861.12",$0.00,$932.12,$0.00,$0.00,$947.25,"$5,410.00",$0.00,"$2,705.00","$4,284.72","$4,328.00",$0.00,$846.67,$0.00,$861.27,$0.00
6728-2-611,SUP,HCPCS C1776,,6728-2-611  -  INSERT TIBIAL MEDIUM 11MM REVISION PCA KNEE LEFT,"$5,410.00",$0.00,"$5,410.00","$2,434.50","$3,861.12",$0.00,$932.12,$0.00,$0.00,$947.25,"$5,410.00",$0.00,"$2,705.00","$4,284.72","$4,328.00",$0.00,$846.67,$0.00,$861.27,$0.00
6728-2-613,SUP,HCPCS C1776,,6728-2-613  -  INSERT TIBIAL MEDIUM 13MM REVISION PCA KNEE LEFT,"$5,410.00",$0.00,"$5,410.00","$2,434.50","$3,861.12",$0.00,$932.12,$0.00,$0.00,$947.25,"$5,410.00",$0.00,"$2,705.00","$4,284.72","$4,328.00",$0.00,$846.67,$0.00,$861.27,$0.00
6728-2-616,SUP,HCPCS C1776,,6728-2-616  -  INSERT TIBIAL MEDIUM 16MM REVISION PCA KNEE LEFT,"$5,410.00",$0.00,"$5,410.00","$2,434.50","$3,861.12",$0.00,$932.12,$0.00,$0.00,$947.25,"$5,410.00",$0.00,"$2,705.00","$4,284.72","$4,328.00",$0.00,$846.67,$0.00,$861.27,$0.00
6728-2-619,SUP,HCPCS C1776,,6728-2-619  -  INSERT TIBIAL MEDIUM 19MM REVISION PCA KNEE LEFT,"$5,410.00",$0.00,"$5,410.00","$2,434.50","$3,861.12",$0.00,$932.12,$0.00,$0.00,$947.25,"$5,410.00",$0.00,"$2,705.00","$4,284.72","$4,328.00",$0.00,$846.67,$0.00,$861.27,$0.00
6728-2-622,SUP,HCPCS C1776,,6728-2-622  -  INSERT TIBIAL MEDIUM 22MM REVISION PCA KNEE LEFT,"$5,410.00",$0.00,"$5,410.00","$2,434.50","$3,861.12",$0.00,$932.12,$0.00,$0.00,$947.25,"$5,410.00",$0.00,"$2,705.00","$4,284.72","$4,328.00",$0.00,$846.67,$0.00,$861.27,$0.00
6728-2-625,SUP,HCPCS C1776,,6728-2-625  -  INSERT TIBIAL MEDIUM 25MM REVISION PCA KNEE LEFT,"$5,410.00",$0.00,"$5,410.00","$2,434.50","$3,861.12",$0.00,$932.12,$0.00,$0.00,$947.25,"$5,410.00",$0.00,"$2,705.00","$4,284.72","$4,328.00",$0.00,$846.67,$0.00,$861.27,$0.00
6728-2-709,SUP,HCPCS C1776,,6728-2-709  -  INSERT TIBIAL MEDIUM 9MM REVISION PCA KNEE RIGHT,"$5,410.00",$0.00,"$5,410.00","$2,434.50","$3,861.12",$0.00,$932.12,$0.00,$0.00,$947.25,"$5,410.00",$0.00,"$2,705.00","$4,284.72","$4,328.00",$0.00,$846.67,$0.00,$861.27,$0.00
6728-2-711,SUP,HCPCS C1776,,6728-2-711  -  INSERT TIBIAL MEDIUM 11MM REVISION PCA KNEE RIGHT,"$5,410.00",$0.00,"$5,410.00","$2,434.50","$3,861.12",$0.00,$932.12,$0.00,$0.00,$947.25,"$5,410.00",$0.00,"$2,705.00","$4,284.72","$4,328.00",$0.00,$846.67,$0.00,$861.27,$0.00
6728-2-713,SUP,HCPCS C1776,,6728-2-713  -  INSERT TIBIAL MEDIUM 13MM REVISION PCA KNEE RIGHT,"$5,410.00",$0.00,"$5,410.00","$2,434.50","$3,861.12",$0.00,$932.12,$0.00,$0.00,$947.25,"$5,410.00",$0.00,"$2,705.00","$4,284.72","$4,328.00",$0.00,$846.67,$0.00,$861.27,$0.00
6728-2-716,SUP,HCPCS C1776,,6728-2-716  -  INSERT TIBIAL MEDIUM 16MM REVISION PCA KNEE RIGHT,"$5,410.00",$0.00,"$5,410.00","$2,434.50","$3,861.12",$0.00,$932.12,$0.00,$0.00,$947.25,"$5,410.00",$0.00,"$2,705.00","$4,284.72","$4,328.00",$0.00,$846.67,$0.00,$861.27,$0.00
6728-2-719,SUP,HCPCS C1776,,6728-2-719  -  INSERT TIBIAL MEDIUM 19MM REVISION PCA KNEE RIGHT,"$5,410.00",$0.00,"$5,410.00","$2,434.50","$3,861.12",$0.00,$932.12,$0.00,$0.00,$947.25,"$5,410.00",$0.00,"$2,705.00","$4,284.72","$4,328.00",$0.00,$846.67,$0.00,$861.27,$0.00
6728-2-722,SUP,HCPCS C1776,,6728-2-722  -  INSERT TIBIAL MEDIUM 22MM REVISION PCA KNEE RIGHT,"$5,410.00",$0.00,"$5,410.00","$2,434.50","$3,861.12",$0.00,$932.12,$0.00,$0.00,$947.25,"$5,410.00",$0.00,"$2,705.00","$4,284.72","$4,328.00",$0.00,$846.67,$0.00,$861.27,$0.00
6728-2-725,SUP,HCPCS C1776,,6728-2-725  -  INSERT TIBIAL MEDIUM 25MM REVISION PCA KNEE RIGHT,"$5,410.00",$0.00,"$5,410.00","$2,434.50","$3,861.12",$0.00,$932.12,$0.00,$0.00,$947.25,"$5,410.00",$0.00,"$2,705.00","$4,284.72","$4,328.00",$0.00,$846.67,$0.00,$861.27,$0.00
6728-2-940,SUP,HCPCS C1776,,6728-2-940  -  COMPONENT PATLR MEDIUM PRIM REVISION CUP PCA KNEE,"$3,630.00",$0.00,"$3,630.00","$1,633.50","$2,590.73",$0.00,$625.43,$0.00,$0.00,$635.58,"$3,630.00",$0.00,"$1,815.00","$2,874.96","$2,904.00",$0.00,$568.10,$0.00,$577.90,$0.00
6728-4-609,SUP,HCPCS C1776,,6728-4-609  -  INSERT TIBIAL LARGE 9MM REVISION PCA KNEE LEFT,"$5,410.00",$0.00,"$5,410.00","$2,434.50","$3,861.12",$0.00,$932.12,$0.00,$0.00,$947.25,"$5,410.00",$0.00,"$2,705.00","$4,284.72","$4,328.00",$0.00,$846.67,$0.00,$861.27,$0.00
6728-4-611,SUP,HCPCS C1776,,6728-4-611  -  INSERT TIBIAL LARGE 11MM REVISION PCA KNEE LEFT,"$5,410.00",$0.00,"$5,410.00","$2,434.50","$3,861.12",$0.00,$932.12,$0.00,$0.00,$947.25,"$5,410.00",$0.00,"$2,705.00","$4,284.72","$4,328.00",$0.00,$846.67,$0.00,$861.27,$0.00
6728-4-613,SUP,HCPCS C1776,,6728-4-613  -  INSERT TIBIAL LARGE 13MM REVISION PCA KNEE LEFT,"$5,410.00",$0.00,"$5,410.00","$2,434.50","$3,861.12",$0.00,$932.12,$0.00,$0.00,$947.25,"$5,410.00",$0.00,"$2,705.00","$4,284.72","$4,328.00",$0.00,$846.67,$0.00,$861.27,$0.00
6728-4-616,SUP,HCPCS C1776,,6728-4-616  -  INSERT TIBIAL LARGE 16MM REVISION PCA KNEE LEFT,"$5,410.00",$0.00,"$5,410.00","$2,434.50","$3,861.12",$0.00,$932.12,$0.00,$0.00,$947.25,"$5,410.00",$0.00,"$2,705.00","$4,284.72","$4,328.00",$0.00,$846.67,$0.00,$861.27,$0.00
6728-4-619,SUP,HCPCS C1776,,6728-4-619  -  INSERT TIBIAL LARGE 19MM REVISION PCA KNEE LEFT,"$5,410.00",$0.00,"$5,410.00","$2,434.50","$3,861.12",$0.00,$932.12,$0.00,$0.00,$947.25,"$5,410.00",$0.00,"$2,705.00","$4,284.72","$4,328.00",$0.00,$846.67,$0.00,$861.27,$0.00
6728-4-622,SUP,HCPCS C1776,,6728-4-622  -  INSERT TIBIAL LARGE 22MM REVISION PCA KNEE LEFT,"$5,410.00",$0.00,"$5,410.00","$2,434.50","$3,861.12",$0.00,$932.12,$0.00,$0.00,$947.25,"$5,410.00",$0.00,"$2,705.00","$4,284.72","$4,328.00",$0.00,$846.67,$0.00,$861.27,$0.00
6728-4-625,SUP,HCPCS C1776,,6728-4-625  -  INSERT TIBIAL LARGE 25MM REVISION PCA KNEE LEFT,"$5,410.00",$0.00,"$5,410.00","$2,434.50","$3,861.12",$0.00,$932.12,$0.00,$0.00,$947.25,"$5,410.00",$0.00,"$2,705.00","$4,284.72","$4,328.00",$0.00,$846.67,$0.00,$861.27,$0.00
6728-4-709,SUP,HCPCS C1776,,6728-4-709  -  INSERT TIBIAL LARGE 9MM REVISION PCA KNEE RIGHT,"$5,410.00",$0.00,"$5,410.00","$2,434.50","$3,861.12",$0.00,$932.12,$0.00,$0.00,$947.25,"$5,410.00",$0.00,"$2,705.00","$4,284.72","$4,328.00",$0.00,$846.67,$0.00,$861.27,$0.00
6728-4-711,SUP,HCPCS C1776,,6728-4-711  -  INSERT TIBIAL LARGE 11MM REVISION PCA KNEE RIGHT,"$5,410.00",$0.00,"$5,410.00","$2,434.50","$3,861.12",$0.00,$932.12,$0.00,$0.00,$947.25,"$5,410.00",$0.00,"$2,705.00","$4,284.72","$4,328.00",$0.00,$846.67,$0.00,$861.27,$0.00
6728-4-713,SUP,HCPCS C1776,,6728-4-713  -  INSERT TIBIAL LARGE 13MM REVISION PCA KNEE RIGHT,"$5,410.00",$0.00,"$5,410.00","$2,434.50","$3,861.12",$0.00,$932.12,$0.00,$0.00,$947.25,"$5,410.00",$0.00,"$2,705.00","$4,284.72","$4,328.00",$0.00,$846.67,$0.00,$861.27,$0.00
6728-4-716,SUP,HCPCS C1776,,6728-4-716  -  INSERT TIBIAL LARGE 16MM REVISION PCA KNEE RIGHT,"$5,410.00",$0.00,"$5,410.00","$2,434.50","$3,861.12",$0.00,$932.12,$0.00,$0.00,$947.25,"$5,410.00",$0.00,"$2,705.00","$4,284.72","$4,328.00",$0.00,$846.67,$0.00,$861.27,$0.00
6728-4-719,SUP,HCPCS C1776,,6728-4-719  -  INSERT TIBIAL LARGE 19MM REVISION PCA KNEE RIGHT,"$5,410.00",$0.00,"$5,410.00","$2,434.50","$3,861.12",$0.00,$932.12,$0.00,$0.00,$947.25,"$5,410.00",$0.00,"$2,705.00","$4,284.72","$4,328.00",$0.00,$846.67,$0.00,$861.27,$0.00
6728-4-722,SUP,HCPCS C1776,,6728-4-722  -  INSERT TIBIAL LARGE 22MM REVISION PCA KNEE RIGHT,"$5,410.00",$0.00,"$5,410.00","$2,434.50","$3,861.12",$0.00,$932.12,$0.00,$0.00,$947.25,"$5,410.00",$0.00,"$2,705.00","$4,284.72","$4,328.00",$0.00,$846.67,$0.00,$861.27,$0.00
6728-4-725,SUP,HCPCS C1776,,6728-4-725  -  INSERT TIBIAL LARGE 25MM REVISION PCA KNEE RIGHT,"$5,410.00",$0.00,"$5,410.00","$2,434.50","$3,861.12",$0.00,$932.12,$0.00,$0.00,$947.25,"$5,410.00",$0.00,"$2,705.00","$4,284.72","$4,328.00",$0.00,$846.67,$0.00,$861.27,$0.00
6728-4-940,SUP,Custom 27803010,,6728-4-940  -  COMPONENT PATLR LARGE PRIM REVISION PCA,"$3,630.00",$0.00,"$3,630.00",$0.00,"$2,590.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,630.00",$0.00,"$1,815.00","$2,874.96","$2,904.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-1-109,SUP,Custom 27803010,,6742-1-109  -  INSERT TIBIAL SMALL 9MM POSTERIOR STABILIZE LIP DURACON DUR,"$2,230.00",$0.00,"$2,230.00",$0.00,"$1,591.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,230.00",$0.00,"$1,115.00","$1,766.16","$1,784.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-1-111,SUP,Custom 27803010,,6742-1-111  -  INSERT TIBIAL SMALL 11MM POSTERIOR STABILIZE LIP DURACON DUR,"$2,230.00",$0.00,"$2,230.00",$0.00,"$1,591.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,230.00",$0.00,"$1,115.00","$1,766.16","$1,784.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-1-113,SUP,Custom 27803010,,6742-1-113  -  INSERT TIBIAL SMALL 13MM POSTERIOR STABILIZE LIP DURACON DUR,"$2,230.00",$0.00,"$2,230.00",$0.00,"$1,591.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,230.00",$0.00,"$1,115.00","$1,766.16","$1,784.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-1-116,SUP,Custom 27803010,,6742-1-116  -  INSERT TIBIAL SMALL 16MM POSTERIOR STABILIZE LIP DURACON DUR,"$2,230.00",$0.00,"$2,230.00",$0.00,"$1,591.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,230.00",$0.00,"$1,115.00","$1,766.16","$1,784.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-1-119,SUP,Custom 27803010,,6742-1-119  -  INSERT TIBIAL SMALL 19MM POSTERIOR STABILIZE LIP DURACON DUR,"$2,230.00",$0.00,"$2,230.00",$0.00,"$1,591.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,230.00",$0.00,"$1,115.00","$1,766.16","$1,784.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-1-122,SUP,Custom 27803010,,6742-1-122  -  INSERT TIBIAL SMALL 22MM POSTERIOR STABILIZE LIP DURACON DUR,"$2,230.00",$0.00,"$2,230.00",$0.00,"$1,591.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,230.00",$0.00,"$1,115.00","$1,766.16","$1,784.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-1-125,SUP,Custom 27803010,,6742-1-125  -  INSERT TIBIAL SMALL 25MM POSTERIOR STABILIZE LIP DURACON DUR,"$2,230.00",$0.00,"$2,230.00",$0.00,"$1,591.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,230.00",$0.00,"$1,115.00","$1,766.16","$1,784.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-1-209,SUP,Custom 27803010,,6742-1-209  -  INSERT TIBIAL MEDIUM 9MM POSTERIOR STABILIZE LIP DURACON DUR,"$2,230.00",$0.00,"$2,230.00",$0.00,"$1,591.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,230.00",$0.00,"$1,115.00","$1,766.16","$1,784.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-1-211,SUP,Custom 27803010,,6742-1-211  -  INSERT TIBIAL MEDIUM 11MM POSTERIOR STABILIZE LIP DURACON,"$2,230.00",$0.00,"$2,230.00",$0.00,"$1,591.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,230.00",$0.00,"$1,115.00","$1,766.16","$1,784.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-1-213,SUP,Custom 27803010,,6742-1-213  -  INSERT TIBIAL MEDIUM 13MM POSTERIOR STABILIZE LIP DURACON,"$2,230.00",$0.00,"$2,230.00",$0.00,"$1,591.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,230.00",$0.00,"$1,115.00","$1,766.16","$1,784.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-1-216,SUP,Custom 27803010,,6742-1-216  -  INSERT TIBIAL MEDIUM 16MM POSTERIOR STABILIZE LIP DURACON,"$2,230.00",$0.00,"$2,230.00",$0.00,"$1,591.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,230.00",$0.00,"$1,115.00","$1,766.16","$1,784.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-1-219,SUP,Custom 27803010,,6742-1-219  -  INSERT TIBIAL MEDIUM 19MM POSTERIOR STABILIZE LIP DURACON,"$2,230.00",$0.00,"$2,230.00",$0.00,"$1,591.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,230.00",$0.00,"$1,115.00","$1,766.16","$1,784.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-1-222,SUP,Custom 27803010,,6742-1-222  -  INSERT TIBIAL MEDIUM 12MM POSTERIOR STABILIZE LIP DURACON,"$2,230.00",$0.00,"$2,230.00",$0.00,"$1,591.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,230.00",$0.00,"$1,115.00","$1,766.16","$1,784.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-1-225,SUP,Custom 27803010,,6742-1-225  -  INSERT TIBIAL MEDIUM 25MM POSTERIOR STABILIZE LIP DURACON,"$2,230.00",$0.00,"$2,230.00",$0.00,"$1,591.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,230.00",$0.00,"$1,115.00","$1,766.16","$1,784.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-1-309,SUP,Custom 27803010,,6742-1-309  -  INSERT TIBIAL LARGE 9MM POSTERIOR STABILIZE LIPPED DURACON,"$2,230.00",$0.00,"$2,230.00",$0.00,"$1,591.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,230.00",$0.00,"$1,115.00","$1,766.16","$1,784.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-1-311,SUP,Custom 27803010,,6742-1-311  -  INSERT TIBIAL LARGE 11MM POSTERIOR STABILIZE LIP DURACON DUR,"$2,230.00",$0.00,"$2,230.00",$0.00,"$1,591.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,230.00",$0.00,"$1,115.00","$1,766.16","$1,784.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-1-313,SUP,Custom 27803010,,6742-1-313  -  INSERT TIBIAL LARGE 13MM POSTERIOR STABILIZE LIP DURACON DUR,"$2,230.00",$0.00,"$2,230.00",$0.00,"$1,591.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,230.00",$0.00,"$1,115.00","$1,766.16","$1,784.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-1-316,SUP,Custom 27803010,,6742-1-316  -  INSERT TIBIAL LARGE 16MM POSTERIOR STABILIZE LIP DURACON DUR,"$2,230.00",$0.00,"$2,230.00",$0.00,"$1,591.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,230.00",$0.00,"$1,115.00","$1,766.16","$1,784.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-1-319,SUP,Custom 27803010,,6742-1-319  -  INSERT TIBIAL LARGE 19MM POSTERIOR STABILIZE LIP DURACON,"$2,230.00",$0.00,"$2,230.00",$0.00,"$1,591.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,230.00",$0.00,"$1,115.00","$1,766.16","$1,784.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-1-322,SUP,Custom 27803010,,6742-1-322  -  INSERT TIBIAL LARGE 22MM POSTERIOR STABILIZE LIP DURACON,"$2,230.00",$0.00,"$2,230.00",$0.00,"$1,591.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,230.00",$0.00,"$1,115.00","$1,766.16","$1,784.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-1-325,SUP,Custom 27803010,,6742-1-325  -  INSERT TIBIAL LARGE 25MM POSTERIOR STABILIZE LIP DURACON,"$2,230.00",$0.00,"$2,230.00",$0.00,"$1,591.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,230.00",$0.00,"$1,115.00","$1,766.16","$1,784.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-1-409,SUP,Custom 27803010,,6742-1-409  -  INSERT TIBIAL XL 9MM POSTERIOR STABILIZE LIP DURACON KNEE,"$2,230.00",$0.00,"$2,230.00",$0.00,"$1,591.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,230.00",$0.00,"$1,115.00","$1,766.16","$1,784.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-1-411,SUP,Custom 27803010,,6742-1-411  -  INSERT TIBIAL XL 11MM POSTERIOR STABILIZE LIP DURACON KNEE,"$2,230.00",$0.00,"$2,230.00",$0.00,"$1,591.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,230.00",$0.00,"$1,115.00","$1,766.16","$1,784.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-1-413,SUP,Custom 27803010,,6742-1-413  -  INSERT TIBIAL XL 13MM POSTERIOR STABILIZE LIP DURACON KNEE,"$2,230.00",$0.00,"$2,230.00",$0.00,"$1,591.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,230.00",$0.00,"$1,115.00","$1,766.16","$1,784.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-1-416,SUP,Custom 27803010,,6742-1-416  -  INSERT TIBIAL XL 16MM POSTERIOR STABILIZE LIP DURACON KNEE,"$2,230.00",$0.00,"$2,230.00",$0.00,"$1,591.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,230.00",$0.00,"$1,115.00","$1,766.16","$1,784.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-1-419,SUP,Custom 27803010,,6742-1-419  -  INSERT TIBIAL XL 19MM POSTERIOR STABILIZE LIP DURACON KNEE,"$2,230.00",$0.00,"$2,230.00",$0.00,"$1,591.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,230.00",$0.00,"$1,115.00","$1,766.16","$1,784.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-1-422,SUP,Custom 27803010,,6742-1-422  -  INSERT TIBIAL XL 22MM POSTERIOR STABILIZE LIP DURACON KNEE,"$2,230.00",$0.00,"$2,230.00",$0.00,"$1,591.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,230.00",$0.00,"$1,115.00","$1,766.16","$1,784.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-1-425,SUP,Custom 27803010,,6742-1-425  -  INSERT TIBIAL XL 25MM POSTERIOR STABILIZE LIP DURACON KNEE,"$2,230.00",$0.00,"$2,230.00",$0.00,"$1,591.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,230.00",$0.00,"$1,115.00","$1,766.16","$1,784.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-4-009,SUP,Custom 27803010,,6742-4-009  -  INSERT TIBIAL XS 9MM STABILIZE LIP DURACON DUR KNEE CONDYLE,"$2,230.00",$0.00,"$2,230.00",$0.00,"$1,591.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,230.00",$0.00,"$1,115.00","$1,766.16","$1,784.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-4-011,SUP,Custom 27803010,,6742-4-011  -  INSERT TIBIAL XS 11MM STABILIZE LIP DURACON DUR KNEE CONDYLE,"$2,230.00",$0.00,"$2,230.00",$0.00,"$1,591.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,230.00",$0.00,"$1,115.00","$1,766.16","$1,784.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-4-013,SUP,Custom 27803010,,6742-4-013  -  INSERT TIBIAL XS 13MM STABILIZE LIP DURACON DUR KNEE CONDYLE,"$2,230.00",$0.00,"$2,230.00",$0.00,"$1,591.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,230.00",$0.00,"$1,115.00","$1,766.16","$1,784.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-4-016,SUP,Custom 27803010,,6742-4-016  -  INSERT TIBIAL XS 16MM STABILIZE LIP DURACON DUR KNEE CONDYLE,"$2,230.00",$0.00,"$2,230.00",$0.00,"$1,591.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,230.00",$0.00,"$1,115.00","$1,766.16","$1,784.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-4-109,SUP,Custom 27803010,,6742-4-109  -  INSERT TIBIAL SMALL 9MM STABILIZE DURACON KNEE CONDYLE,"$2,230.00",$0.00,"$2,230.00",$0.00,"$1,591.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,230.00",$0.00,"$1,115.00","$1,766.16","$1,784.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-4-111,SUP,Custom 27803010,,6742-4-111  -  INSERT TIBIAL SMALL 11MM STABILIZE DURACON KNEE CONDYLE,"$2,230.00",$0.00,"$2,230.00",$0.00,"$1,591.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,230.00",$0.00,"$1,115.00","$1,766.16","$1,784.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-4-113,SUP,Custom 27803010,,6742-4-113  -  INSERT TIBIAL SMALL 13MM STABILIZE DURACON KNEE CONDYLE,"$2,230.00",$0.00,"$2,230.00",$0.00,"$1,591.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,230.00",$0.00,"$1,115.00","$1,766.16","$1,784.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-4-116,SUP,Custom 27803010,,6742-4-116  -  INSERT TIBIAL SMALL 16MM STABILIZE DURACON KNEE CONDYLE,"$2,230.00",$0.00,"$2,230.00",$0.00,"$1,591.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,230.00",$0.00,"$1,115.00","$1,766.16","$1,784.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-4-119,SUP,Custom 27803010,,6742-4-119  -  INSERT TIBIAL SMALL 19MM STABILIZE LIP DURACON DUR KNEE,"$2,230.00",$0.00,"$2,230.00",$0.00,"$1,591.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,230.00",$0.00,"$1,115.00","$1,766.16","$1,784.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-4-122,SUP,Custom 27803010,,6742-4-122  -  INSERT TIBIAL SMALL 22MM STABILIZE LIP DURACON DUR KNEE,"$2,230.00",$0.00,"$2,230.00",$0.00,"$1,591.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,230.00",$0.00,"$1,115.00","$1,766.16","$1,784.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-4-125,SUP,Custom 27803010,,6742-4-125  -  INSERT TIBIAL SMALL 25MM STABILIZE LIP DURACON DUR KNEE,"$2,230.00",$0.00,"$2,230.00",$0.00,"$1,591.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,230.00",$0.00,"$1,115.00","$1,766.16","$1,784.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-4-209,SUP,Custom 27803010,,6742-4-209  -  INSERT TIBIAL MEDIUM 9MM STABILIZE DURACON KNEE CONDYLE,"$2,230.00",$0.00,"$2,230.00",$0.00,"$1,591.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,230.00",$0.00,"$1,115.00","$1,766.16","$1,784.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-4-209X,SUP,Custom 27803010,,6742-4-209X  -  INSERT TIBIAL MEDIUM 9MM STABILIZE DURACON X3 KNEE CONDYLE,"$5,025.00",$0.00,"$5,025.00",$0.00,"$3,586.34",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,025.00",$0.00,"$2,512.50","$3,979.80","$4,020.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-4-211,SUP,Custom 27803010,,6742-4-211  -  INSERT TIBIAL MEDIUM 11MM STABILIZE DURACON KNEE CONDYLE,"$3,055.00",$0.00,"$3,055.00",$0.00,"$2,180.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,055.00",$0.00,"$1,527.50","$2,419.56","$2,444.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-4-211X,SUP,Custom 27803010,,6742-4-211X  -  INSERT TIBIAL MEDIUM 11MM STABILIZE DURACON X3 KNEE CONDYLE,"$5,025.00",$0.00,"$5,025.00",$0.00,"$3,586.34",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,025.00",$0.00,"$2,512.50","$3,979.80","$4,020.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-4-213,SUP,Custom 27803010,,6742-4-213  -  INSERT TIBIAL MEDIUM 13MM STABILIZE DURACON KNEE CONDYLE,"$3,055.00",$0.00,"$3,055.00",$0.00,"$2,180.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,055.00",$0.00,"$1,527.50","$2,419.56","$2,444.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-4-213X,SUP,Custom 27803010,,6742-4-213X  -  INSERT TIBIAL MEDIUM 13MM STABILIZE DURACON X3 KNEE CONDYLE,"$5,025.00",$0.00,"$5,025.00",$0.00,"$3,586.34",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,025.00",$0.00,"$2,512.50","$3,979.80","$4,020.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-4-216,SUP,Custom 27803010,,6742-4-216  -  INSERT TIBIAL MEDIUM 16MM STABILIZE DURACON DUR KNEE CONDYLE,"$3,055.00",$0.00,"$3,055.00",$0.00,"$2,180.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,055.00",$0.00,"$1,527.50","$2,419.56","$2,444.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-4-219,SUP,Custom 27803010,,6742-4-219  -  INSERT TIBIAL MEDIUM 19MM STABILIZE DURACON DUR KNEE CONDYLE,"$3,055.00",$0.00,"$3,055.00",$0.00,"$2,180.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,055.00",$0.00,"$1,527.50","$2,419.56","$2,444.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-4-222,SUP,Custom 27803010,,6742-4-222  -  INSERT TIBIAL MEDIUM 22MM STABILIZE LIP DURACON DUR KNEE,"$3,055.00",$0.00,"$3,055.00",$0.00,"$2,180.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,055.00",$0.00,"$1,527.50","$2,419.56","$2,444.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-4-225,SUP,Custom 27803010,,6742-4-225  -  INSERT TIBIAL MEDIUM 25MM STABILIZE DURACON DUR KNEE CONDYLE,"$3,055.00",$0.00,"$3,055.00",$0.00,"$2,180.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,055.00",$0.00,"$1,527.50","$2,419.56","$2,444.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-4-309,SUP,Custom 27803010,,6742-4-309  -  INSERT TIBIAL LARGE 9MM STABILIZE DURACON DUR KNEE CONDYLE,"$3,055.00",$0.00,"$3,055.00",$0.00,"$2,180.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,055.00",$0.00,"$1,527.50","$2,419.56","$2,444.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-4-309X,SUP,Custom 27803010,,6742-4-309X  -  INSERT TIBIAL LARGE 9MM STABILIZE DURACON X3 KNEE CONDYLE,"$5,025.00",$0.00,"$5,025.00",$0.00,"$3,586.34",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,025.00",$0.00,"$2,512.50","$3,979.80","$4,020.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-4-311,SUP,Custom 27803010,,6742-4-311  -  INSERT TIBIAL LARGE 11MM STABILIZE DURACON DUR KNEE CONDYLE,"$3,055.00",$0.00,"$3,055.00",$0.00,"$2,180.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,055.00",$0.00,"$1,527.50","$2,419.56","$2,444.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-4-311X,SUP,Custom 27803010,,6742-4-311X  -  INSERT TIBIAL LARGE 11MM STABILIZE DURACON X3 KNEE CONDYLE,"$5,025.00",$0.00,"$5,025.00",$0.00,"$3,586.34",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,025.00",$0.00,"$2,512.50","$3,979.80","$4,020.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-4-313,SUP,Custom 27803010,,6742-4-313  -  INSERT TIBIAL LARGE 13MM STABILIZE DURACON DUR KNEE CONDYLE,"$3,055.00",$0.00,"$3,055.00",$0.00,"$2,180.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,055.00",$0.00,"$1,527.50","$2,419.56","$2,444.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-4-313X,SUP,Custom 27803010,,6742-4-313X  -  INSERT TIBIAL LARGE 13MM STABILIZE DURACON X3 KNEE CONDYLE,"$5,025.00",$0.00,"$5,025.00",$0.00,"$3,586.34",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,025.00",$0.00,"$2,512.50","$3,979.80","$4,020.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-4-316,SUP,Custom 27803010,,6742-4-316  -  INSERT TIBIAL LARGE 16MM STABILIZE DURACON KNEE CONDYLE,"$3,055.00",$0.00,"$3,055.00",$0.00,"$2,180.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,055.00",$0.00,"$1,527.50","$2,419.56","$2,444.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-4-319,SUP,Custom 27803010,,6742-4-319  -  INSERT TIBIAL LARGE 19MM STABILIZE LIP DURACON DUR KNEE,"$3,055.00",$0.00,"$3,055.00",$0.00,"$2,180.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,055.00",$0.00,"$1,527.50","$2,419.56","$2,444.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-4-322,SUP,Custom 27803010,,6742-4-322  -  INSERT TIBIAL LARGE 22MM STABILIZE LIP DURACON DUR KNEE,"$3,055.00",$0.00,"$3,055.00",$0.00,"$2,180.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,055.00",$0.00,"$1,527.50","$2,419.56","$2,444.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-4-325,SUP,Custom 27803010,,6742-4-325  -  INSERT TIBIAL LARGE 25MM STABILIZE LIP DURACON DUR KNEE,"$3,055.00",$0.00,"$3,055.00",$0.00,"$2,180.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,055.00",$0.00,"$1,527.50","$2,419.56","$2,444.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-4-409,SUP,Custom 27803010,,6742-4-409  -  INSERT TIBIAL XL 9MM STABILIZE DURACON KNEE CONDYLE,"$3,055.00",$0.00,"$3,055.00",$0.00,"$2,180.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,055.00",$0.00,"$1,527.50","$2,419.56","$2,444.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-4-409X,SUP,Custom 27803010,,6742-4-409X  -  INSERT TIBIAL XL 9MM STABILIZE DURACON X3 KNEE CONDYLE,"$5,025.00",$0.00,"$5,025.00",$0.00,"$3,586.34",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,025.00",$0.00,"$2,512.50","$3,979.80","$4,020.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-4-411,SUP,Custom 27803010,,6742-4-411  -  INSERT TIBIAL XL 11MM STABILIZE DURACON KNEE CONDYLE,"$3,055.00",$0.00,"$3,055.00",$0.00,"$2,180.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,055.00",$0.00,"$1,527.50","$2,419.56","$2,444.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-4-411X,SUP,Custom 27803010,,6742-4-411X  -  INSERT TIBIAL XL 11MM STABILIZE DURACON X3 KNEE CONDYLE,"$5,025.00",$0.00,"$5,025.00",$0.00,"$3,586.34",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,025.00",$0.00,"$2,512.50","$3,979.80","$4,020.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-4-413,SUP,Custom 27803010,,6742-4-413  -  INSERT TIBIAL XL 13MM STABILIZE DURACON KNEE CONDYLE,"$3,055.00",$0.00,"$3,055.00",$0.00,"$2,180.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,055.00",$0.00,"$1,527.50","$2,419.56","$2,444.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-4-413X,SUP,Custom 27803010,,6742-4-413X  -  INSERT TIBIAL XL 13MM STABILIZE DURACON X3 KNEE CONDYLE,"$5,025.00",$0.00,"$5,025.00",$0.00,"$3,586.34",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,025.00",$0.00,"$2,512.50","$3,979.80","$4,020.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-4-416,SUP,Custom 27803010,,6742-4-416  -  INSERT TIBIAL XL 16MM CNDYLR STABILIZED DURACON RIGHT,"$3,055.00",$0.00,"$3,055.00",$0.00,"$2,180.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,055.00",$0.00,"$1,527.50","$2,419.56","$2,444.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-4-419,SUP,Custom 27803010,,6742-4-419  -  INSERT TIBIAL XL 19MM CNDYLR STABILIZED DURACON RIGHT,"$3,055.00",$0.00,"$3,055.00",$0.00,"$2,180.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,055.00",$0.00,"$1,527.50","$2,419.56","$2,444.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-4-422,SUP,Custom 27803010,,6742-4-422  -  INSERT TIBIAL XL 22MM STABILIZE LIP DURACON DUR KNEE CONDYLE,"$3,055.00",$0.00,"$3,055.00",$0.00,"$2,180.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,055.00",$0.00,"$1,527.50","$2,419.56","$2,444.00",$0.00,$0.00,$0.00,$0.00,$0.00
6742-4-425,SUP,Custom 27803010,,6742-4-425  -  INSERT TIBIAL XL 25MM STABILIZE LIP DURACON DUR KNEE CONDYLE,"$3,055.00",$0.00,"$3,055.00",$0.00,"$2,180.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,055.00",$0.00,"$1,527.50","$2,419.56","$2,444.00",$0.00,$0.00,$0.00,$0.00,$0.00
6752-5-111,SUP,Custom 27803010,,6752-5-111  -  INSERT TIB SM 11MM KNEE PS CNSTRN MRS,"$1,763.00",$0.00,"$1,763.00",$0.00,"$1,258.25",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,763.00",$0.00,$881.50,"$1,396.30","$1,410.40",$0.00,$0.00,$0.00,$0.00,$0.00
6752-5-113,SUP,Custom 27803010,,6752-5-113  -  INSERT TIB SM 13MM KNEE PS CNSTRN MRS,"$1,763.00",$0.00,"$1,763.00",$0.00,"$1,258.25",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,763.00",$0.00,$881.50,"$1,396.30","$1,410.40",$0.00,$0.00,$0.00,$0.00,$0.00
6752-5-116,SUP,Custom 27803010,,6752-5-116  -  INSERT TIB SM 16MM KNEE PS CNSTRN MRS,"$1,763.00",$0.00,"$1,763.00",$0.00,"$1,258.25",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,763.00",$0.00,$881.50,"$1,396.30","$1,410.40",$0.00,$0.00,$0.00,$0.00,$0.00
6752-5-119,SUP,Custom 27803010,,6752-5-119  -  INSERT TIB SM 19MM KNEE PS CNSTRN,"$1,412.00",$0.00,"$1,412.00",$0.00,"$1,007.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,412.00",$0.00,$706.00,"$1,118.30","$1,129.60",$0.00,$0.00,$0.00,$0.00,$0.00
6752-5-122,SUP,Custom 27803010,,6752-5-122  -  INSERT TIB SM 22MM KNEE PS CNSTRN,"$1,439.00",$0.00,"$1,439.00",$0.00,"$1,027.01",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,439.00",$0.00,$719.50,"$1,139.69","$1,151.20",$0.00,$0.00,$0.00,$0.00,$0.00
6752-5-125,SUP,Custom 27803010,,6752-5-125  -  INSERT TIB SM 25MM KNEE PS CNSTRN MRS,"$1,381.00",$0.00,"$1,381.00",$0.00,$985.62,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,381.00",$0.00,$690.50,"$1,093.75","$1,104.80",$0.00,$0.00,$0.00,$0.00,$0.00
6752-5-128,SUP,Custom 27803010,,6752-5-128  -  INSERT TIB SM 28MM KNEE PS CNSTRN MRS,"$1,439.00",$0.00,"$1,439.00",$0.00,"$1,027.01",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,439.00",$0.00,$719.50,"$1,139.69","$1,151.20",$0.00,$0.00,$0.00,$0.00,$0.00
6752-5-131,SUP,Custom 27803010,,6752-5-131  -  INSERT TIB SM 31MM KNEE PS CNSTRN MRS,"$1,439.00",$0.00,"$1,439.00",$0.00,"$1,027.01",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,439.00",$0.00,$719.50,"$1,139.69","$1,151.20",$0.00,$0.00,$0.00,$0.00,$0.00
6752-5-211,SUP,Custom 27803010,,6752-5-211  -  INSERT TIB MED 11MM KNEE PS CNSTRN,"$1,763.00",$0.00,"$1,763.00",$0.00,"$1,258.25",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,763.00",$0.00,$881.50,"$1,396.30","$1,410.40",$0.00,$0.00,$0.00,$0.00,$0.00
6752-5-213,SUP,Custom 27803010,,6752-5-213  -  INSERT TIB MED 13MM KNEE PS CNSTRN MRS,"$1,763.00",$0.00,"$1,763.00",$0.00,"$1,258.25",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,763.00",$0.00,$881.50,"$1,396.30","$1,410.40",$0.00,$0.00,$0.00,$0.00,$0.00
6752-5-216,SUP,Custom 27803010,,6752-5-216  -  INSERT TIB MED 16MM KNEE PS CNSTRN MRS,"$1,763.00",$0.00,"$1,763.00",$0.00,"$1,258.25",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,763.00",$0.00,$881.50,"$1,396.30","$1,410.40",$0.00,$0.00,$0.00,$0.00,$0.00
6752-5-219,SUP,Custom 27803010,,6752-5-219  -  INSERT TIB MED 19MM KNEE PS CNSTRN MRS,"$1,763.00",$0.00,"$1,763.00",$0.00,"$1,258.25",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,763.00",$0.00,$881.50,"$1,396.30","$1,410.40",$0.00,$0.00,$0.00,$0.00,$0.00
6752-5-222,SUP,Custom 27803010,,6752-5-222  -  INSERT TIB MED 22MM KNEE PS CNSTRN,"$1,439.00",$0.00,"$1,439.00",$0.00,"$1,027.01",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,439.00",$0.00,$719.50,"$1,139.69","$1,151.20",$0.00,$0.00,$0.00,$0.00,$0.00
6752-5-225,SUP,Custom 27803010,,6752-5-225  -  INSERT TIB MED 25MM KNEE PS CNSTRN,"$1,439.00",$0.00,"$1,439.00",$0.00,"$1,027.01",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,439.00",$0.00,$719.50,"$1,139.69","$1,151.20",$0.00,$0.00,$0.00,$0.00,$0.00
6752-5-228,SUP,Custom 27803010,,6752-5-228  -  INSERT TIB MED 28MM KNEE PS CNSTRN,"$1,439.00",$0.00,"$1,439.00",$0.00,"$1,027.01",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,439.00",$0.00,$719.50,"$1,139.69","$1,151.20",$0.00,$0.00,$0.00,$0.00,$0.00
6752-5-231,SUP,Custom 27803010,,6752-5-231  -  INSERT TIB MED 31MM KNEE PS CNSTRN,"$1,439.00",$0.00,"$1,439.00",$0.00,"$1,027.01",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,439.00",$0.00,$719.50,"$1,139.69","$1,151.20",$0.00,$0.00,$0.00,$0.00,$0.00
6752-5-311,SUP,Custom 27803010,,6752-5-311  -  INSERT TIB LG 11MM KNEE PS CNSTRN,"$1,763.00",$0.00,"$1,763.00",$0.00,"$1,258.25",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,763.00",$0.00,$881.50,"$1,396.30","$1,410.40",$0.00,$0.00,$0.00,$0.00,$0.00
6752-5-313,SUP,Custom 27803010,,6752-5-313  -  INSERT TIB LG 13MM KNEE PS CNSTRN MRS,"$1,763.00",$0.00,"$1,763.00",$0.00,"$1,258.25",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,763.00",$0.00,$881.50,"$1,396.30","$1,410.40",$0.00,$0.00,$0.00,$0.00,$0.00
6752-5-316,SUP,Custom 27803010,,6752-5-316  -  INSERT TIB LG 16MM KNEE PS CNSTRN MRS,"$1,763.00",$0.00,"$1,763.00",$0.00,"$1,258.25",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,763.00",$0.00,$881.50,"$1,396.30","$1,410.40",$0.00,$0.00,$0.00,$0.00,$0.00
6752-5-319,SUP,Custom 27803010,,6752-5-319  -  INSERT TIB LG 19MM KNEE PS CNSTRN MRS,"$1,412.00",$0.00,"$1,412.00",$0.00,"$1,007.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,412.00",$0.00,$706.00,"$1,118.30","$1,129.60",$0.00,$0.00,$0.00,$0.00,$0.00
6752-5-322,SUP,Custom 27803010,,6752-5-322  -  INSERT TIB LG 22MM KNEE PS CNSTRN,"$1,439.00",$0.00,"$1,439.00",$0.00,"$1,027.01",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,439.00",$0.00,$719.50,"$1,139.69","$1,151.20",$0.00,$0.00,$0.00,$0.00,$0.00
6752-5-325,SUP,Custom 27803010,,6752-5-325  -  INSERT TIB LG 25MM KNEE PS CNSTRN MRS,"$1,439.00",$0.00,"$1,439.00",$0.00,"$1,027.01",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,439.00",$0.00,$719.50,"$1,139.69","$1,151.20",$0.00,$0.00,$0.00,$0.00,$0.00
6752-5-328,SUP,Custom 27803010,,6752-5-328  -  INSERT TIB LG 28MM KNEE PS CNSTRN,"$1,381.00",$0.00,"$1,381.00",$0.00,$985.62,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,381.00",$0.00,$690.50,"$1,093.75","$1,104.80",$0.00,$0.00,$0.00,$0.00,$0.00
6752-5-331,SUP,Custom 27803010,,6752-5-331  -  INSERT TIB LG 31MM KNEE PS CNSTRN MRS,"$1,381.00",$0.00,"$1,381.00",$0.00,$985.62,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,381.00",$0.00,$690.50,"$1,093.75","$1,104.80",$0.00,$0.00,$0.00,$0.00,$0.00
6752-5-411,SUP,Custom 27803010,,6752-5-411  -  INSERT TIB XL 11MM KNEE PS CNSTRN,"$1,763.00",$0.00,"$1,763.00",$0.00,"$1,258.25",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,763.00",$0.00,$881.50,"$1,396.30","$1,410.40",$0.00,$0.00,$0.00,$0.00,$0.00
6752-5-413,SUP,Custom 27803010,,6752-5-413  -  INSERT TIB XL 13MM KNEE PS CNSTRN MRS,"$1,763.00",$0.00,"$1,763.00",$0.00,"$1,258.25",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,763.00",$0.00,$881.50,"$1,396.30","$1,410.40",$0.00,$0.00,$0.00,$0.00,$0.00
6752-5-416,SUP,Custom 27803010,,6752-5-416  -  INSERT TIB XL 16MM KNEE PS CNSTRN MRS,"$1,763.00",$0.00,"$1,763.00",$0.00,"$1,258.25",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,763.00",$0.00,$881.50,"$1,396.30","$1,410.40",$0.00,$0.00,$0.00,$0.00,$0.00
6752-5-419,SUP,Custom 27803010,,6752-5-419  -  INSERT TIB XL 19MM KNEE PS CNSTRN MRS,"$1,763.00",$0.00,"$1,763.00",$0.00,"$1,258.25",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,763.00",$0.00,$881.50,"$1,396.30","$1,410.40",$0.00,$0.00,$0.00,$0.00,$0.00
6752-5-422,SUP,Custom 27803010,,6752-5-422  -  INSERT TIB XL 22MM KNEE PS CNSTRN MRS,"$1,439.00",$0.00,"$1,439.00",$0.00,"$1,027.01",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,439.00",$0.00,$719.50,"$1,139.69","$1,151.20",$0.00,$0.00,$0.00,$0.00,$0.00
6752-5-425,SUP,Custom 27803010,,6752-5-425  -  INSERT TIB XL 25MM KNEE PS CNSTRN MRS,"$1,439.00",$0.00,"$1,439.00",$0.00,"$1,027.01",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,439.00",$0.00,$719.50,"$1,139.69","$1,151.20",$0.00,$0.00,$0.00,$0.00,$0.00
67525P,SUP,HCPCS C1713,,67525P  -  SCREW BN 6.75MM 25MM SPRL R90D MULTIANGLE TI SPNE THORLMBR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
67525S,SUP,HCPCS C1713,,67525S  -  SCREW BN STD 6.75MM 25MM SPRL R90D LCK TI SPNE THORLMBR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
67530P,SUP,HCPCS C1713,,67530P  -  SCREW BN 6.75MM 30MM SPRL R90D MULTIANGLE TI SPNE THORLMBR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
67530S,SUP,HCPCS C1713,,67530S  -  SCREW BN STD 6.75MM 30MM SPRL R90D LCK TI SPNE THORLMBR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
67535P,SUP,HCPCS C1713,,67535P  -  SCREW BN 6.75MM 35MM SPRL R90D MULTIANGLE TI SPNE THORLMBR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
67535S,SUP,HCPCS C1713,,67535S  -  SCREW BN STD 6.75MM 35MM SPRL R90D LCK TI SPNE THORLMBR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
67540P,SUP,HCPCS C1713,,67540P  -  SCREW BN 6.75MM 40MM SPRL R90D MULTIANGLE TI SPNE THORLMBR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
67540S,SUP,HCPCS C1713,,67540S  -  SCREW BN STD 6.75MM 40MM SPRL R90D LCK TI SPNE THORLMBR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
67545P,SUP,HCPCS C1713,,67545P  -  SCREW BN 6.75MM 45MM SPRL R90D MULTIANGLE TI SPNE THORLMBR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
67545S,SUP,HCPCS C1713,,67545S  -  SCREW BN STD 6.75MM 45MM SPRL R90D LCK TI SPNE THORLMBR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
67550P,SUP,HCPCS C1713,,67550P  -  SCREW BN 6.75MM 50MM SPRL R90D MULTIANGLE TI SPNE THORLMBR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
67550S,SUP,HCPCS C1713,,67550S  -  SCREW BN STD 6.75MM 50MM SPRL R90D LCK TI SPNE THORLMBR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
67555P,SUP,HCPCS C1713,,67555P  -  SCREW BN 6.75MM 55MM SPRL R90D MULTIANGLE TI SPNE THORLMBR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
67555S,SUP,HCPCS C1713,,67555S  -  SCREW BN STD 6.75MM 55MM SPRL R90D LCK TI SPNE THORLMBR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
67560P,SUP,HCPCS C1713,,67560P  -  SCREW BN 6.75MM 60MM SPRL R90D MULTIANGLE TI SPNE THORLMBR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
67560S,SUP,HCPCS C1713,,67560S  -  SCREW BN STD 6.75MM 60MM SPRL R90D LCK SPNE THORLMBR,"$2,228.53",$0.00,"$2,228.53","$1,002.84","$1,590.50",$0.00,$383.96,$0.00,$0.00,$390.20,"$2,228.53",$0.00,"$1,114.26","$1,765.00","$1,782.82",$0.00,$348.76,$0.00,$354.78,$0.00
67565P,SUP,HCPCS C1713,,67565P  -  SCREW BN 6.75MM 65MM SPRL R90D MULTIANGLE TI SPNE THORLMBR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
67565S,SUP,HCPCS C1713,,67565S  -  SCREW BN STD 6.75MM 65MM SPRL R90D LCK SPNE THORLMBR,"$1,233.33",$0.00,"$1,233.33",$555.00,$880.22,$0.00,$212.50,$0.00,$0.00,$215.95,"$1,233.33",$0.00,$616.66,$976.80,$986.66,$0.00,$193.02,$0.00,$196.35,$0.00
68-1405,SUP,Custom 27203010,,FORCEPS SURG DBKY 5MM ATRM CURVE 330 MD,"$1,507.50",$0.00,"$1,507.50",$0.00,"$1,075.90",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,507.50",$0.00,$753.75,"$1,193.94","$1,206.00",$0.00,$0.00,$0.00,$0.00,$0.00
68-1415,SUP,Custom 27203010,,FORCEPS SURG CLN 30MM 10MM JAW 330,"$1,530.00",$0.00,"$1,530.00",$0.00,"$1,091.96",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,530.00",$0.00,$765.00,"$1,211.76","$1,224.00",$0.00,$0.00,$0.00,$0.00,$0.00
690-00-22D,SUP,Custom 27803010,,690-00-22D  -  INSERT ACETAB 0D D 40MM 36MM 22MM 5.6MM CONSTRAIN RING LOCK,"$6,590.00",$0.00,"$6,590.00",$0.00,"$4,703.28",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,590.00",$0.00,"$3,295.00","$5,219.28","$5,272.00",$0.00,$0.00,$0.00,$0.00,$0.00
690-00-22E,SUP,Custom 27803010,,690-00-22E  -  INSERT ACETAB 0D E 44MM 36MM 22MM 7.5MM CONSTRAIN LOCK RING,"$6,590.00",$0.00,"$6,590.00",$0.00,"$4,703.28",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,590.00",$0.00,"$3,295.00","$5,219.28","$5,272.00",$0.00,$0.00,$0.00,$0.00,$0.00
690-00-28F,SUP,Custom 27803010,,690-00-28F  -  INSERT ACETAB 0D F 42MM 28MM CONSTRAIN TRIDENT UHMWPE HIP,"$6,590.00",$0.00,"$6,590.00",$0.00,"$4,703.28",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,590.00",$0.00,"$3,295.00","$5,219.28","$5,272.00",$0.00,$0.00,$0.00,$0.00,$0.00
690-00-28G,SUP,Custom 27803010,,690-00-28G  -  INSERT ACETAB 0D G 51.5MM 42MM 28MM 5.6MM CONSTRAIN LOCK,"$6,590.00",$0.00,"$6,590.00",$0.00,"$4,703.28",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,590.00",$0.00,"$3,295.00","$5,219.28","$5,272.00",$0.00,$0.00,$0.00,$0.00,$0.00
690-00-32H,SUP,Custom 27803010,,690-00-32H  -  INSERT ACETAB 0D H 55MM 46MM 32MM 7.8MM CONSTRAIN LOCK RING,"$6,590.00",$0.00,"$6,590.00",$0.00,"$4,703.28",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,590.00",$0.00,"$3,295.00","$5,219.28","$5,272.00",$0.00,$0.00,$0.00,$0.00,$0.00
690-00-32I,SUP,Custom 27803010,,690-00-32I  -  INSERT ACETAB 0D I 58MM 46MM 32MM CONSTRAIN BIPOL SPLIT RING,"$6,590.00",$0.00,"$6,590.00",$0.00,"$4,703.28",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,590.00",$0.00,"$3,295.00","$5,219.28","$5,272.00",$0.00,$0.00,$0.00,$0.00,$0.00
690-00-32J,SUP,Custom 27803010,,690-00-32J  -  INSERT ACETAB 0D J 62MM 46MM 32MM CONSTRAIN BIPOL SPLIT RING,"$6,590.00",$0.00,"$6,590.00",$0.00,"$4,703.28",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,590.00",$0.00,"$3,295.00","$5,219.28","$5,272.00",$0.00,$0.00,$0.00,$0.00,$0.00
6900PTFX,SUP,Custom 27203010,,6900PTFX  -  SIZER VLV 29MM CRP-ED PRIMNT PLUS 33MM PRICRD HRT PRICRD,"$20,695.00",$0.00,"$20,695.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$20,695.00",$0.00,"$10,347.50","$16,390.44","$16,556.00",$0.00,$0.00,$0.00,$0.00,$0.00
6900PTFX 29,SUP,Custom 27803010,,6900PTFX 29  -  VALVE MTRL 29MM C-E PRM+ BPRTH THERMAFIX TRICENTRIX HLDR,"$18,487.50",$0.00,"$18,487.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$18,487.50",$0.00,"$9,243.75","$14,642.10","$14,790.00",$0.00,$0.00,$0.00,$0.00,$0.00
690-10-22E,SUP,Custom 27803010,,690-10-22E  -  INSERT ACETAB 10D E 22MM CONSTRAIN TRIDENT HIP,"$6,590.00",$0.00,"$6,590.00",$0.00,"$4,703.28",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,590.00",$0.00,"$3,295.00","$5,219.28","$5,272.00",$0.00,$0.00,$0.00,$0.00,$0.00
690-10-22F,SUP,Custom 27803010,,690-10-22F  -  INSERT ACETAB 10D H 48.4MM 36MM 22MM 9.9MM CONSTRAIN BIPOL,"$6,590.00",$0.00,"$6,590.00",$0.00,"$4,703.28",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,590.00",$0.00,"$3,295.00","$5,219.28","$5,272.00",$0.00,$0.00,$0.00,$0.00,$0.00
690-10-28G,SUP,Custom 27803010,,690-10-28G  -  INSERT ACETAB 10D G 51.5MM 42MM 28MM 8.4MM CONSTRAIN BIPOL,"$6,590.00",$0.00,"$6,590.00",$0.00,"$4,703.28",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,590.00",$0.00,"$3,295.00","$5,219.28","$5,272.00",$0.00,$0.00,$0.00,$0.00,$0.00
690-10-28H,SUP,Custom 27803010,,690-10-28H  -  INSERT ACETAB 10D H 55MM 42MM 28MM 10.2MM CONSTRAIN BIPOL,"$6,590.00",$0.00,"$6,590.00",$0.00,"$4,703.28",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,590.00",$0.00,"$3,295.00","$5,219.28","$5,272.00",$0.00,$0.00,$0.00,$0.00,$0.00
690-10-28I,SUP,Custom 27803010,,690-10-28I  -  INSERT ACETAB 10D I 58MM 42MM 28MM 11.6MM CONSTRAIN RING,"$6,590.00",$0.00,"$6,590.00",$0.00,"$4,703.28",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,590.00",$0.00,"$3,295.00","$5,219.28","$5,272.00",$0.00,$0.00,$0.00,$0.00,$0.00
690-10-28J,SUP,Custom 27803010,,690-10-28J  -  INSERT ACETAB 10D J 62MM 42MM 28MM 13.7MM CONSTRAIN RING,"$6,590.00",$0.00,"$6,590.00",$0.00,"$4,703.28",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,590.00",$0.00,"$3,295.00","$5,219.28","$5,272.00",$0.00,$0.00,$0.00,$0.00,$0.00
690-10-28K,SUP,Custom 27803010,,690-10-28K  -  INSERT ACETAB 10D K 42MM 28MM CONSTRAIN BIPOL SPLIT RING,"$6,590.00",$0.00,"$6,590.00",$0.00,"$4,703.28",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,590.00",$0.00,"$3,295.00","$5,219.28","$5,272.00",$0.00,$0.00,$0.00,$0.00,$0.00
69-2244,SUP,Custom 27803010,,69-2244  -  INSERT ACETAB 0D 44MM 36MM 22MM 7.3MM CONSTRAIN SPLIT RING,"$6,797.50",$0.00,"$6,797.50",$0.00,"$4,851.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,797.50",$0.00,"$3,398.75","$5,383.62","$5,438.00",$0.00,$0.00,$0.00,$0.00,$0.00
69-2246,SUP,Custom 27803010,,69-2246  -  INSERT ACETAB 0D 46MM 36MM 22MM 8.3MM CONSTRAIN SPLIT RING,"$6,797.50",$0.00,"$6,797.50",$0.00,"$4,851.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,797.50",$0.00,"$3,398.75","$5,383.62","$5,438.00",$0.00,$0.00,$0.00,$0.00,$0.00
69-2248,SUP,Custom 27803010,,69-2248  -  INSERT ACETAB 0D 48MM 36MM 22MM CONSTRAIN BIPOL SPLIT RING,"$6,797.50",$0.00,"$6,797.50",$0.00,"$4,851.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,797.50",$0.00,"$3,398.75","$5,383.62","$5,438.00",$0.00,$0.00,$0.00,$0.00,$0.00
69-2850,SUP,Custom 27803010,,69-2850  -  INSERT ACETAB 0D 50MM 42MM 28MM 7.3MM CONSTRAIN SPLIT RING,"$6,797.50",$0.00,"$6,797.50",$0.00,"$4,851.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,797.50",$0.00,"$3,398.75","$5,383.62","$5,438.00",$0.00,$0.00,$0.00,$0.00,$0.00
69-2852,SUP,Custom 27803010,,69-2852  -  INSERT ACETAB 0D 52MM 42MM 28MM 8.3MM CONSTRAIN SPLIT RING,"$6,797.50",$0.00,"$6,797.50",$0.00,"$4,851.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,797.50",$0.00,"$3,398.75","$5,383.62","$5,438.00",$0.00,$0.00,$0.00,$0.00,$0.00
69-2854,SUP,Custom 27803010,,69-2854  -  INSERT ACETAB 0D 54MM 42MM 28MM 9.3MM CONSTRAIN SPLIT RING,"$6,797.50",$0.00,"$6,797.50",$0.00,"$4,851.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,797.50",$0.00,"$3,398.75","$5,383.62","$5,438.00",$0.00,$0.00,$0.00,$0.00,$0.00
69-3256,SUP,Custom 27803010,,69-3256  -  INSERT ACETAB 0D 56MM 46MM 32MM 8.3MM CONSTRAIN SPLIT RING,"$6,797.50",$0.00,"$6,797.50",$0.00,"$4,851.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,797.50",$0.00,"$3,398.75","$5,383.62","$5,438.00",$0.00,$0.00,$0.00,$0.00,$0.00
69-3258,SUP,Custom 27803010,,69-3258  -  INSERT ACETAB 0D 58MM 46MM 32MM 9.3MM CONSTRAIN SPLIT RING,"$6,797.50",$0.00,"$6,797.50",$0.00,"$4,851.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,797.50",$0.00,"$3,398.75","$5,383.62","$5,438.00",$0.00,$0.00,$0.00,$0.00,$0.00
69-3260,SUP,Custom 27803010,,69-3260  -  INSERT ACETAB 0D 60MM 46MM 32MM CONSTRAIN BIPOL SPLIT RING,"$6,797.50",$0.00,"$6,797.50",$0.00,"$4,851.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,797.50",$0.00,"$3,398.75","$5,383.62","$5,438.00",$0.00,$0.00,$0.00,$0.00,$0.00
6936-0-380,SUP,Custom 27803010,,6936-0-380  -  HEAD FEM 105MM 38MM THMPSN REG HIP ENDOPRSTH FR,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6936-0-400,SUP,Custom 27803010,,6936-0-400  -  HEAD FEM 105MM 40MM THMPSN REG HIP FENST FR,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6936-0-410,SUP,Custom 27803010,,6936-0-410  -  HEAD FEM 41MM HIP ENDOPRSTH UNPLR ZML MOORE ODC OMFT RLNC,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6936-0-420,SUP,Custom 27803010,,6936-0-420  -  HEAD FEM 42MM THMPSN HIP ENDOPRSTH FR,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6936-0-430,SUP,Custom 27803010,,6936-0-430  -  STEM FEM 105MM 43MM ENDOPRSTH MOORE ODC OMFT RLNC UHR UNPLR,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6936-0-440,SUP,Custom 27803010,,6936-0-440  -  HEAD FEM 44MM THMPSN HIP ENDOPRSTH FR,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6936-0-450,SUP,Custom 27803010,,6936-0-450  -  HEAD FEM 105MM 45MM MOORE ODC OMFT RLNC UHR UNTRX REG HIP,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6936-0-460,SUP,Custom 27803010,,6936-0-460  -  HEAD FEM 46MM MOORE ODC OMFT RLNC UHR UNTRX HIP ENDOPRSTH FR,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6936-0-470,SUP,Custom 27803010,,6936-0-470  -  HEAD FEM 47MM THMPSN HIP ENDOPRSTH FR,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6936-0-480,SUP,Custom 27803010,,6936-0-480  -  HEAD FEM REG 48MM HIP ENDOPRSTH FRAC PRD FR. THMPSN,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6936-0-490,SUP,Custom 27803010,,6936-0-490  -  HEAD FEM 105MM 49MM MOORE ODC OMFT RLNC UHR UNTRX REG HIP,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6936-0-500,SUP,Custom 27803010,,6936-0-500  -  STEM FEM 105MM 50MM ENDOPRSTH MOORE ODC OMFT RLNC UHR UNPLR,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6936-0-510,SUP,Custom 27803010,,6936-0-510  -  STEM FEM 105MM 51MM ENDOPRSTH MOORE ODC OMFT RLNC UHR UNPLR,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6936-0-520,SUP,Custom 27803010,,6936-0-520  -  HEAD FEM 105MM 52MM MOORE ODC OMFT RLNC UHR UNTRX REG HIP,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6936-0-530,SUP,Custom 27803010,,6936-0-530  -  STEM FEM 105MM 53MM ENDOPRSTH MOORE ODC OMFT RLNC UHR UNPLR,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6936-0-540,SUP,Custom 27803010,,6936-0-540  -  HEAD FEM 105MM 54MM MOORE ODC OMFT RLNC UHR UNTRX REG HIP,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6936-0-550,SUP,Custom 27803010,,6936-0-550  -  STEM FEM 105MM 55MM FENST MOORE ODC OMFT RLNC UHR UNPLR,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6936-0-570,SUP,Custom 27803010,,6936-0-570  -  HEAD FEM 57MM THMPSN FEM HIP ENDOPRSTH FR,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6939-0-380,SUP,Custom 27803010,,6939-0-380  -  STEM FEM 130MM 38MM CVD FENST A-M HIP,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6939-0-400,SUP,Custom 27803010,,6939-0-400  -  STEM FEM 130MM 40MM CVD FENST ENDOPRSTH A-M HIP,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6939-0-410,SUP,Custom 27803010,,6939-0-410  -  STEM FEM 130MM 41MM CVD FENST ENDOPRSTH A-MVIT HIP,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6939-0-420,SUP,Custom 27803010,,6939-0-420  -  STEM FEM 130MM 42MM CVD FENST ENDOPRSTH A-M HIP,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6939-0-430,SUP,Custom 27803010,,6939-0-430  -  STEM FEM 43MM CVD FENST ENDOPRSTH MOORE HIP,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6939-0-440,SUP,Custom 27803010,,6939-0-440  -  STEM FEM 130MM 44MM CVD FENST ENDOPRSTH A-M HIP,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6939-0-450,SUP,Custom 27803010,,6939-0-450  -  STEM FEM 140MM 45MM CVD FENST ENDOPRSTH A-M HIP,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6939-0-460,SUP,Custom 27803010,,6939-0-460  -  STEM FEM 140MM 46MM CVD FENST ENDOPRSTH A-M HIP,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6939-0-470,SUP,Custom 27803010,,6939-0-470  -  STEM FEM 140MM 47MM CVD FENST ENDOPRSTH A-M HIP,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6939-0-480,SUP,Custom 27803010,,6939-0-480  -  STEM FEM 140MM 48MM CVD FENST ENDOPRSTH A-M HIP,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6939-0-490,SUP,Custom 27803010,,6939-0-490  -  STEM FEM 140MM 49MM CVD FENST ENDOPRSTH A-M HIP,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6939-0-500,SUP,Custom 27803010,,6939-0-500  -  STEM FEM 150MM 50MM CVD FENST ENDOPRSTH A-M HIP,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6939-0-510,SUP,Custom 27803010,,6939-0-510  -  STEM FEM 150MM 51MM CVD FENST ENDOPRSTH A-M HIP,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6939-0-520,SUP,Custom 27803010,,6939-0-520  -  STEM FEM 150MM 52MM CVD FENST ENDOPRSTH A-M HIP,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6939-0-530,SUP,Custom 27803010,,6939-0-530  -  STEM FEM 53MM CVD FENST ENDOPRSTH MOORE HIP,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6939-0-540,SUP,Custom 27803010,,6939-0-540  -  STEM FEM 150MM 54MM CVD FENST A-M HIP,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6939-0-550,SUP,Custom 27803010,,6939-0-550  -  HEAD FEM 150MM 55MM A-M FEM HIP FENST CURVE FR,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6939-0-560,SUP,Custom 27803010,,6939-0-560  -  HEAD FEM 56MM HIP FENST CVD MOORE,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6939-0-570,SUP,Custom 27803010,,6939-0-570  -  STEM FEM 150MM 57MM CVD FENST A-M HIP,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6939-0-600,SUP,Custom 27803010,,6939-0-600  -  STEM FEM 60MM 60MM CVD FENST ENDOPRSTH A-M HIP,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6939-0-630,SUP,Custom 27803010,,6939-0-630  -  STEM FEM 150MM 63MM CVD FENST A-M HIP,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6939-1-380,SUP,Custom 27803010,,6939-1-380  -  STEM FEM 135MM 38MM CVD FENST NAR A-M NAR HIP,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6939-1-400,SUP,Custom 27803010,,6939-1-400  -  STEM FEM 40MM 40MM CVD FENST ENDOPRSTH A-M NAR HIP,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6939-1-410,SUP,Custom 27803010,,6939-1-410  -  STEM FEM 135MM 41MM CVD FENST ENDOPRSTH A-M NAR HIP,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6939-1-420,SUP,Custom 27803010,,6939-1-420  -  STEM FEM 135MM 42MM CVD FENST NAR A-M NAR HIP,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6939-1-430,SUP,Custom 27803010,,6939-1-430  -  STEM FEM 135MM 43MM CVD FENST NAR A-M NAR HIP,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6939-1-440,SUP,Custom 27803010,,6939-1-440  -  STEM FEM 135MM 44MM CVD FENST NAR A-M HIP,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6939-1-450,SUP,Custom 27803010,,6939-1-450  -  STEM FEM 135MM 45MM CVD FENST A-M NAR HIP,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6939-1-460,SUP,Custom 27803010,,6939-1-460  -  STEM FEM 135MM 46MM CVD FENST A-M NAR HIP,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6939-1-470,SUP,Custom 27803010,,6939-1-470  -  STEM FEM 47MM CVD FENST ENDOPRSTH MOORE NAR,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6939-1-480,SUP,Custom 27803010,,6939-1-480  -  STEM FEM 135MM 48MM CVD FENST A-M NAR HIP,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6939-1-490,SUP,Custom 27803010,,6939-1-490  -  STEM FEM 135MM 49MM CVD FENST A-M NAR HIP,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6939-1-500,SUP,Custom 27803010,,6939-1-500  -  STEM FEM 135MM 50MM CVD FENST A-M NAR HIP,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6939-1-510,SUP,Custom 27803010,,6939-1-510  -  STEM FEM 135MM 51MM CVD FENST A-M NAR HIP,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6939-5-400,SUP,Custom 27803010,,6939-5-400  -  STEM FEM 40MM MOORE HIP ENDOPRSTH CVD SLD FRAC,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6939-5-410,SUP,Custom 27803010,,6939-5-410  -  STEM FEM 41MM ENDOPRSTH CVD SLD FRAC MOORE HIP,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6939-5-420,SUP,Custom 27803010,,6939-5-420  -  STEM FEM 42MM ENDOPRSTH CVD SLD FRAC MOORE HIP,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6939-5-430,SUP,Custom 27803010,,6939-5-430  -  STEM FEM 43MM SLD CVD MOORE HIP,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6939-5-440,SUP,Custom 27803010,,6939-5-440  -  STEM FEM 44MM SLD CVD MOORE HIP,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6939-5-450,SUP,Custom 27803010,,6939-5-450  -  STEM FEM 45MM SLD CVD MOORE HIP,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6939-5-460,SUP,Custom 27803010,,6939-5-460  -  STEM FEM 46MM CVD SLD ENDOPRSTH MOORE,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6939-5-470,SUP,Custom 27803010,,6939-5-470  -  STEM FEM 47MM ENDOPRSTH CVD SLD FRAC MOORE HIP,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6939-5-480,SUP,Custom 27803010,,6939-5-480  -  STEM FEM 48MM CVD SLD ENDOPRSTH MOORE,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6939-5-490,SUP,Custom 27803010,,6939-5-490  -  STEM FEM 49MM ENDOPRSTH CVD SLD FRAC MOORE HIP,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6939-5-500,SUP,Custom 27803010,,6939-5-500  -  STEM FEM 50MM CVD SLD ENDOPRSTH MOORE,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6939-5-510,SUP,Custom 27803010,,6939-5-510  -  STEM FEM 51MM ENDOPRSTH CVD SLD FRAC MOORE HIP,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6939-5-520,SUP,Custom 27803010,,6939-5-520  -  STEM FEM 52MM ENDOPRSTH MDLR CVD SLD MOORE HIP FRAC PRD,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6939-5-530,SUP,Custom 27803010,,6939-5-530  -  STEM FEM 53MM CVD SLD ENDOPRSTH MOORE,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6939-5-540,SUP,Custom 27803010,,6939-5-540  -  STEM FEM 54MM CVD SLD ENDOPRSTH MOORE,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6939-5-550,SUP,Custom 27803010,,6939-5-550  -  STEM FEM 55MM SLD CVD ENDOPRSTH MOORE,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6939-5-570,SUP,Custom 27803010,,6939-5-570  -  STEM FEM 57MM SLD CVD MOORE HIP,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6940-0-380,SUP,Custom 27803010,,6940-0-380  -  STEM FEM 165MM 38MM STR FENST A-M HIP,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6940-0-400,SUP,Custom 27803010,,6940-0-400  -  STEM FEM 165MM 40MM STR FENST A-M HIP,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6940-0-410,SUP,Custom 27803010,,6940-0-410  -  HEAD UNPLR 165MM 41MM MOORE ODC OMFT RLNC UHR UNTRX FEM HIP,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6940-0-420,SUP,Custom 27803010,,6940-0-420  -  HEAD FEM 42MM MOORE FEM HIP FENST STR FR,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6940-0-430,SUP,Custom 27803010,,6940-0-430  -  HEAD FEM 43MM A-M FEM HIP STR FENST FR,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6940-0-440,SUP,Custom 27803010,,6940-0-440  -  STEM FEM 165MM 44MM FENST ENDOPRSTH STR MOORE ODC OMFT RLNC,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6940-0-450,SUP,Custom 27803010,,6940-0-450  -  HEAD FEM 165MM 45MM MOORE ODC OMFT RLNC UHR UNTRX HIP STR,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6940-0-460,SUP,Custom 27803010,,6940-0-460  -  HEAD FEM 165MM 46MM A-M HIP FENST FR STRL,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6940-0-470,SUP,Custom 27803010,,6940-0-470  -  HEAD FEM 165MM 43MM MOORE ODC OMFT RLNC UHR UNTRX HIP FENST,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6940-0-480,SUP,Custom 27803010,,6940-0-480  -  HEAD FEM 48MM 48MM MOORE FEM HIP PENESTRATED FR STRL,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6940-0-490,SUP,Custom 27803010,,6940-0-490  -  HEAD FEM 165MM 49MM A-M FEM HIP STR FENST FR,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6940-0-500,SUP,Custom 27803010,,6940-0-500  -  STEM FEM 190MM 50MM ENDOPRSTH STR FENST MOORE ODC OMFT RLNC,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6940-0-510,SUP,Custom 27803010,,6940-0-510  -  STEM FEM 190MM 51MM STR FENST ENDOPRSTH A-M HIP,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6940-0-520,SUP,Custom 27803010,,6940-0-520  -  HEAD UNPLR 190MM 52MM MOORE ODC OMFT RLNC UHR UNTRX FEM HIP,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6940-0-530,SUP,Custom 27803010,,6940-0-530  -  HEAD UNPLR 190MM 53MM MOORE ODC OMFT RLNC UHR UNTRX FEM HIP,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6940-0-540,SUP,Custom 27803010,,6940-0-540  -  HEAD UNPLR 54MM 54MM MOORE ODC OMFT RLNC UHR UNTRX FEM HIP,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6940-0-550,SUP,Custom 27803010,,6940-0-550  -  HEAD FEM 190MM 55MM A-M HIP FENST FR STRL,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6940-0-570,SUP,Custom 27803010,,6940-0-570  -  HEAD FEM 190MM 57MM A-M HIP FENST STR,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6940-0-600,SUP,Custom 27803010,,6940-0-600  -  STEM FEM 190MM 60MM ENDOPRSTH STR FENST MOORE ODC OMFT RLNC,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6940-0-630,SUP,Custom 27803010,,6940-0-630  -  STEM FEM 190MM 63MM STR FENST A-M HIP,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6940-1-380,SUP,Custom 27803010,,6940-1-380  -  STEM FEM 38MM STR FENST ENDOPRSTH MOORE NAR HIP,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6940-1-400,SUP,Custom 27803010,,6940-1-400  -  STEM FEM 40MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT RLNC,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6940-1-410,SUP,Custom 27803010,,6940-1-410  -  STEM FEM 41MM STR FENST ENDOPRSTH MOORE NAR HIP,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6940-1-420,SUP,Custom 27803010,,6940-1-420  -  STEM FEM 42MM STR FENST ENDOPRSTH MOORE NAR HIP,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6940-1-430,SUP,Custom 27803010,,6940-1-430  -  STEM FEM 43MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT RLNC,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6940-1-440,SUP,Custom 27803010,,6940-1-440  -  STEM FEM 44MM STR FENST ENDOPRSTH MOORE NAR HIP,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6940-1-450,SUP,Custom 27803010,,6940-1-450  -  STEM FEM 45MM STR FENST ENDOPRSTH MOORE NAR HIP,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6940-1-460,SUP,Custom 27803010,,6940-1-460  -  STEM FEM 46MM STR FENST ENDOPRSTH MOORE NAR HIP,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6940-1-470,SUP,Custom 27803010,,6940-1-470  -  STEM FEM 47MM STR FENST ENDOPRSTH MOORE NAR HIP,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6940-1-480,SUP,Custom 27803010,,6940-1-480  -  STEM FEM 48MM STR FENST ENDOPRSTH MOORE NAR HIP,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6940-1-490,SUP,Custom 27803010,,6940-1-490  -  STEM FEM 49MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT RLNC,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6940-1-500,SUP,Custom 27803010,,6940-1-500  -  STEM FEM 50MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT RLNC,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6940-1-510,SUP,Custom 27803010,,6940-1-510  -  STEM FEM 51MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT RLNC,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6940-2-380,SUP,Custom 27803010,,6940-2-380  -  STEM FEM 300MM 38MM ENDOPRSTH STR FENST FRAC MOORE HIP,"$1,544.00",$0.00,"$1,544.00",$0.00,"$1,101.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,544.00",$0.00,$772.00,"$1,222.85","$1,235.20",$0.00,$0.00,$0.00,$0.00,$0.00
6940-2-400,SUP,Custom 27803010,,6940-2-400  -  STEM FEM 300MM 40MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT,"$1,544.00",$0.00,"$1,544.00",$0.00,"$1,101.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,544.00",$0.00,$772.00,"$1,222.85","$1,235.20",$0.00,$0.00,$0.00,$0.00,$0.00
6940-2-410,SUP,Custom 27803010,,6940-2-410  -  STEM FEM 300MM 41MM ENDOPRSTH STR FENST FRAC MOORE HIP,"$1,544.00",$0.00,"$1,544.00",$0.00,"$1,101.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,544.00",$0.00,$772.00,"$1,222.85","$1,235.20",$0.00,$0.00,$0.00,$0.00,$0.00
6940-2-420,SUP,Custom 27803010,,6940-2-420  -  STEM FEM 300MM 42MM STR FENST ENDOPRSTH A-M ODC OMFT RLNC,"$1,544.00",$0.00,"$1,544.00",$0.00,"$1,101.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,544.00",$0.00,$772.00,"$1,222.85","$1,235.20",$0.00,$0.00,$0.00,$0.00,$0.00
6940-2-450,SUP,Custom 27803010,,6940-2-450  -  STEM FEM 300MM 45MM ENDOPRSTH STR FENST FRAC MOORE HIP,"$1,544.00",$0.00,"$1,544.00",$0.00,"$1,101.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,544.00",$0.00,$772.00,"$1,222.85","$1,235.20",$0.00,$0.00,$0.00,$0.00,$0.00
6940-2-460,SUP,Custom 27803010,,6940-2-460  -  STEM FEM 300MM 46MM ENDOPRSTH STR FENST FRAC MOORE HIP,"$1,544.00",$0.00,"$1,544.00",$0.00,"$1,101.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,544.00",$0.00,$772.00,"$1,222.85","$1,235.20",$0.00,$0.00,$0.00,$0.00,$0.00
6940-2-470,SUP,Custom 27803010,,6940-2-470  -  STEM FEM 300MM 47MM ENDOPRSTH STR FENST FRAC MOORE HIP,"$1,544.00",$0.00,"$1,544.00",$0.00,"$1,101.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,544.00",$0.00,$772.00,"$1,222.85","$1,235.20",$0.00,$0.00,$0.00,$0.00,$0.00
6940-2-480,SUP,Custom 27803010,,6940-2-480  -  STEM FEM 300MM 48MM STR FENST ENDOPRSTH A-M ODC OMFT RLNC,"$1,544.00",$0.00,"$1,544.00",$0.00,"$1,101.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,544.00",$0.00,$772.00,"$1,222.85","$1,235.20",$0.00,$0.00,$0.00,$0.00,$0.00
6940-2-490,SUP,Custom 27803010,,6940-2-490  -  STEM FEM 300MM 49MM STR FENST ENDOPRSTH MOORE,"$1,544.00",$0.00,"$1,544.00",$0.00,"$1,101.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,544.00",$0.00,$772.00,"$1,222.85","$1,235.20",$0.00,$0.00,$0.00,$0.00,$0.00
6940-2-500,SUP,Custom 27803010,,6940-2-500  -  STEM FEM 300MM 50MM STR FENST ENDOPRSTH MOORE,"$1,544.00",$0.00,"$1,544.00",$0.00,"$1,101.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,544.00",$0.00,$772.00,"$1,222.85","$1,235.20",$0.00,$0.00,$0.00,$0.00,$0.00
6940-2-510,SUP,Custom 27803010,,6940-2-510  -  STEM FEM 300MM 51MM STR FENST ENDOPRSTH MOORE HIP,"$1,544.00",$0.00,"$1,544.00",$0.00,"$1,101.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,544.00",$0.00,$772.00,"$1,222.85","$1,235.20",$0.00,$0.00,$0.00,$0.00,$0.00
6940-2-520,SUP,Custom 27803010,,6940-2-520  -  STEM FEM 300MM 52MM ENDOPRSTH STR FENST FRAC MOORE HIP,"$1,544.00",$0.00,"$1,544.00",$0.00,"$1,101.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,544.00",$0.00,$772.00,"$1,222.85","$1,235.20",$0.00,$0.00,$0.00,$0.00,$0.00
6940-2-540,SUP,Custom 27803010,,6940-2-540  -  STEM FEM 300MM 54MM ENDOPRSTH STR FENST FRAC MOORE HIP,"$1,544.00",$0.00,"$1,544.00",$0.00,"$1,101.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,544.00",$0.00,$772.00,"$1,222.85","$1,235.20",$0.00,$0.00,$0.00,$0.00,$0.00
6940-2-550,SUP,Custom 27803010,,6940-2-550  -  STEM FEM 300MM 55MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT,"$1,544.00",$0.00,"$1,544.00",$0.00,"$1,101.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,544.00",$0.00,$772.00,"$1,222.85","$1,235.20",$0.00,$0.00,$0.00,$0.00,$0.00
6940-2-600,SUP,Custom 27803010,,6940-2-600  -  STEM FEM 300MM 60MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT,"$1,544.00",$0.00,"$1,544.00",$0.00,"$1,101.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,544.00",$0.00,$772.00,"$1,222.85","$1,235.20",$0.00,$0.00,$0.00,$0.00,$0.00
6940-2-630,SUP,Custom 27803010,,6940-2-630  -  STEM FEM 300MM 63MM ENDOPRSTH STR FENST MOORE ODC OMFT RLNC,"$1,544.00",$0.00,"$1,544.00",$0.00,"$1,101.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,544.00",$0.00,$772.00,"$1,222.85","$1,235.20",$0.00,$0.00,$0.00,$0.00,$0.00
6940-5-400,SUP,Custom 27803010,,6940-5-400  -  HEAD FEM 40MM HIP SLD STR MOORE,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6940-5-410,SUP,Custom 27803010,,6940-5-410  -  HEAD FEM 41MM HIP SLD STR MOORE,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6940-5-420,SUP,Custom 27803010,,6940-5-420  -  HEAD FEM 42MM HIP SLD STR MOORE,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6940-5-430,SUP,Custom 27803010,,6940-5-430  -  HEAD FEM 43MM HIP ENDOPRSTH STR SLD UNPLR MOORE ODC OMFT,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6940-5-440,SUP,Custom 27803010,,6940-5-440  -  HEAD FEM 44MM HIP SLD STR MOORE,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6940-5-460,SUP,Custom 27803010,,6940-5-460  -  HEAD FEM 46MM HIP SLD STR MOORE,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6940-5-470,SUP,Custom 27803010,,6940-5-470  -  STEM FEM 47MM SLD ENDOPRSTH A-M STRL,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6940-5-490,SUP,Custom 27803010,,6940-5-490  -  HEAD FEM 49MM HIP ENDOPRSTH STR SLD UNPLR MOORE ODC OMFT,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6940-5-500,SUP,Custom 27803010,,6940-5-500  -  HEAD FEM 50MM HIP SLD STR MOORE,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6940-5-510,SUP,Custom 27803010,,6940-5-510  -  HEAD FEM 51MM HIP ENDOPRSTH STR SLD UNPLR MOORE ODC OMFT,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6940-5-520,SUP,Custom 27803010,,6940-5-520  -  HEAD FEM 52MM HIP ENDOPRSTH STR SLD UNPLR MOORE ODC OMFT,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6940-5-530,SUP,Custom 27803010,,6940-5-530  -  STEM FEM 53MM SLD ENDOPRSTH A-M STRL,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6940-5-540,SUP,Custom 27803010,,6940-5-540  -  HEAD FEM 54MM HIP SLD STR MOORE,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6940-5-550,SUP,Custom 27803010,,6940-5-550  -  HEAD FEM 55MM HIP SLD STR MOORE,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6940-5-570,SUP,Custom 27803010,,6940-5-570  -  HEAD FEM 57MM HIP SLD STR MOORE,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6940-5-600,SUP,Custom 27803010,,6940-5-600  -  HEAD FEM 60MM HIP ENDOPRSTH STR SLD UNPLR MOORE ODC OMFT,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6940-5-630,SUP,Custom 27803010,,6940-5-630  -  HEAD FEM 63MM HIP SLD STR MOORE,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6940-6-410,SUP,Custom 27803010,,6940-6-410  -  STEM FEM 41MM ENDOPRSTH STR SLD FRAC MOORE ODC OMFT RLNC UHR,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6940-6-420,SUP,Custom 27803010,,6940-6-420  -  STEM FEM 42MM STR SLD ENDOPRSTH MOORE,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6940-6-440,SUP,Custom 27803010,,6940-6-440  -  STEM FEM 44MM ENDOPRSTH STR SLD FRAC MOORE ODC OMFT RLNC UHR,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6940-6-450,SUP,Custom 27803010,,6940-6-450  -  STEM FEM 45MM ENDOPRSTH STR SLD FRAC MOORE ODC OMFT RLNC UHR,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6940-6-460,SUP,Custom 27803010,,6940-6-460  -  STEM FEM 46MM ENDOPRSTH STR SLD FRAC MOORE ODC OMFT RLNC UHR,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6940-6-470,SUP,Custom 27803010,,6940-6-470  -  STEM FEM 47MM ENDOPRSTH STR SLD FRAC MOORE ODC OMFT RLNC UHR,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6940-6-480,SUP,Custom 27803010,,6940-6-480  -  STEM FEM 48MM ENDOPRSTH STR SLD FRAC MOORE ODC OMFT RLNC UHR,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6940-6-490,SUP,Custom 27803010,,6940-6-490  -  STEM FEM 49MM ENDOPRSTH STR SLD FRAC MOORE ODC OMFT RLNC UHR,"$1,257.00",$0.00,"$1,257.00",$0.00,$897.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.00",$0.00,$628.50,$995.54,"$1,005.60",$0.00,$0.00,$0.00,$0.00,$0.00
6940-8-380,SUP,Custom 27803010,,6940-8-380  -  STEM FEM 200MM 38MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT,"$1,544.00",$0.00,"$1,544.00",$0.00,"$1,101.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,544.00",$0.00,$772.00,"$1,222.85","$1,235.20",$0.00,$0.00,$0.00,$0.00,$0.00
6940-8-400,SUP,Custom 27803010,,6940-8-400  -  STEM FEM 200MM 40MM STR FENST ENDOPRSTH MOORE,"$1,544.00",$0.00,"$1,544.00",$0.00,"$1,101.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,544.00",$0.00,$772.00,"$1,222.85","$1,235.20",$0.00,$0.00,$0.00,$0.00,$0.00
6940-8-410,SUP,Custom 27803010,,6940-8-410  -  STEM FEM 200MM 41MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT,"$1,544.00",$0.00,"$1,544.00",$0.00,"$1,101.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,544.00",$0.00,$772.00,"$1,222.85","$1,235.20",$0.00,$0.00,$0.00,$0.00,$0.00
6940-8-420,SUP,Custom 27803010,,6940-8-420  -  STEM FEM 200MM 42MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT,"$1,544.00",$0.00,"$1,544.00",$0.00,"$1,101.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,544.00",$0.00,$772.00,"$1,222.85","$1,235.20",$0.00,$0.00,$0.00,$0.00,$0.00
6940-8-430,SUP,Custom 27803010,,6940-8-430  -  STEM FEM 200MM 43MM ENDOPRSTH A-M HIP,"$1,544.00",$0.00,"$1,544.00",$0.00,"$1,101.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,544.00",$0.00,$772.00,"$1,222.85","$1,235.20",$0.00,$0.00,$0.00,$0.00,$0.00
6940-8-440,SUP,Custom 27803010,,6940-8-440  -  STEM FEM 200MM 44MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT,"$1,544.00",$0.00,"$1,544.00",$0.00,"$1,101.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,544.00",$0.00,$772.00,"$1,222.85","$1,235.20",$0.00,$0.00,$0.00,$0.00,$0.00
6940-8-450,SUP,Custom 27803010,,6940-8-450  -  STEM FEM 200MM 45MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT,"$1,544.00",$0.00,"$1,544.00",$0.00,"$1,101.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,544.00",$0.00,$772.00,"$1,222.85","$1,235.20",$0.00,$0.00,$0.00,$0.00,$0.00
6940-8-460,SUP,Custom 27803010,,6940-8-460  -  STEM FEM 200MM 46MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT,"$1,544.00",$0.00,"$1,544.00",$0.00,"$1,101.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,544.00",$0.00,$772.00,"$1,222.85","$1,235.20",$0.00,$0.00,$0.00,$0.00,$0.00
6940-8-470,SUP,Custom 27803010,,6940-8-470  -  STEM FEM 200MM 47MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT,"$1,544.00",$0.00,"$1,544.00",$0.00,"$1,101.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,544.00",$0.00,$772.00,"$1,222.85","$1,235.20",$0.00,$0.00,$0.00,$0.00,$0.00
6940-8-500,SUP,Custom 27803010,,6940-8-500  -  STEM FEM 200MM 50MM ENDOPRSTH STR FENST MOORE ODC OMFT RLNC,"$1,544.00",$0.00,"$1,544.00",$0.00,"$1,101.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,544.00",$0.00,$772.00,"$1,222.85","$1,235.20",$0.00,$0.00,$0.00,$0.00,$0.00
6940-8-510,SUP,Custom 27803010,,6940-8-510  -  STEM FEM 200MM 51MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT,"$1,544.00",$0.00,"$1,544.00",$0.00,"$1,101.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,544.00",$0.00,$772.00,"$1,222.85","$1,235.20",$0.00,$0.00,$0.00,$0.00,$0.00
6940-8-530,SUP,Custom 27803010,,6940-8-530  -  STEM FEM 200MM 53MM STR FENST A-M HIP,"$1,544.00",$0.00,"$1,544.00",$0.00,"$1,101.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,544.00",$0.00,$772.00,"$1,222.85","$1,235.20",$0.00,$0.00,$0.00,$0.00,$0.00
6940-8-540,SUP,Custom 27803010,,6940-8-540  -  STEM FEM 200MM 54MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT,"$1,544.00",$0.00,"$1,544.00",$0.00,"$1,101.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,544.00",$0.00,$772.00,"$1,222.85","$1,235.20",$0.00,$0.00,$0.00,$0.00,$0.00
6940-8-550,SUP,Custom 27803010,,6940-8-550  -  STEM FEM 200MM 55MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT,"$1,544.00",$0.00,"$1,544.00",$0.00,"$1,101.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,544.00",$0.00,$772.00,"$1,222.85","$1,235.20",$0.00,$0.00,$0.00,$0.00,$0.00
6940-8-570,SUP,Custom 27803010,,6940-8-570  -  STEM FEM 200MM 57MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT,"$1,544.00",$0.00,"$1,544.00",$0.00,"$1,101.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,544.00",$0.00,$772.00,"$1,222.85","$1,235.20",$0.00,$0.00,$0.00,$0.00,$0.00
6940-8-600,SUP,Custom 27803010,,6940-8-600  -  STEM FEM 200MM 60MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT,"$1,544.00",$0.00,"$1,544.00",$0.00,"$1,101.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,544.00",$0.00,$772.00,"$1,222.85","$1,235.20",$0.00,$0.00,$0.00,$0.00,$0.00
6940-8-630,SUP,Custom 27803010,,6940-8-630  -  STEM FEM 200MM 63MM ENDOPRSTH STR FENST MOORE ODC OMFT RLNC,"$1,544.00",$0.00,"$1,544.00",$0.00,"$1,101.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,544.00",$0.00,$772.00,"$1,222.85","$1,235.20",$0.00,$0.00,$0.00,$0.00,$0.00
6940-9-380,SUP,Custom 27803010,,6940-9-380  -  STEM FEM 225MM 38MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT,"$1,544.00",$0.00,"$1,544.00",$0.00,"$1,101.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,544.00",$0.00,$772.00,"$1,222.85","$1,235.20",$0.00,$0.00,$0.00,$0.00,$0.00
6940-9-410,SUP,Custom 27803010,,6940-9-410  -  STEM FEM 225MM 41MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT,"$1,544.00",$0.00,"$1,544.00",$0.00,"$1,101.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,544.00",$0.00,$772.00,"$1,222.85","$1,235.20",$0.00,$0.00,$0.00,$0.00,$0.00
6940-9-440,SUP,Custom 27803010,,6940-9-440  -  STEM FEM 225MM 44MM ENDOPRSTH STR FENST MOORE ODC OMFT RLNC,"$1,544.00",$0.00,"$1,544.00",$0.00,"$1,101.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,544.00",$0.00,$772.00,"$1,222.85","$1,235.20",$0.00,$0.00,$0.00,$0.00,$0.00
6940-9-460,SUP,Custom 27803010,,6940-9-460  -  STEM FEM 225MM 46MM STR FENST ASTN-MOORE HIP,"$1,544.00",$0.00,"$1,544.00",$0.00,"$1,101.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,544.00",$0.00,$772.00,"$1,222.85","$1,235.20",$0.00,$0.00,$0.00,$0.00,$0.00
6940-9-480,SUP,Custom 27803010,,6940-9-480  -  STEM FEM 225MM 48MM ENDOPRSTH STR FENST MOORE ODC OMFT RLNC,"$1,544.00",$0.00,"$1,544.00",$0.00,"$1,101.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,544.00",$0.00,$772.00,"$1,222.85","$1,235.20",$0.00,$0.00,$0.00,$0.00,$0.00
6940-9-490,SUP,Custom 27803010,,6940-9-490  -  STEM FEM 225MM 49MM ENDOPRSTH STR FENST MOORE ODC OMFT RLNC,"$1,544.00",$0.00,"$1,544.00",$0.00,"$1,101.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,544.00",$0.00,$772.00,"$1,222.85","$1,235.20",$0.00,$0.00,$0.00,$0.00,$0.00
6940-9-510,SUP,Custom 27803010,,6940-9-510  -  STEM FEM 225MM 51MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT,"$1,544.00",$0.00,"$1,544.00",$0.00,"$1,101.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,544.00",$0.00,$772.00,"$1,222.85","$1,235.20",$0.00,$0.00,$0.00,$0.00,$0.00
6940-9-520,SUP,Custom 27803010,,6940-9-520  -  STEM FEM 225MM 52MM ENDOPRSTH STR FENST MOORE ODC OMFT RLNC,"$1,544.00",$0.00,"$1,544.00",$0.00,"$1,101.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,544.00",$0.00,$772.00,"$1,222.85","$1,235.20",$0.00,$0.00,$0.00,$0.00,$0.00
6940-9-530,SUP,Custom 27803010,,6940-9-530  -  STEM FEM 225MM 53MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT,"$1,544.00",$0.00,"$1,544.00",$0.00,"$1,101.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,544.00",$0.00,$772.00,"$1,222.85","$1,235.20",$0.00,$0.00,$0.00,$0.00,$0.00
6940-9-550,SUP,Custom 27803010,,6940-9-550  -  STEM FEM 225MM 55MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT,"$1,544.00",$0.00,"$1,544.00",$0.00,"$1,101.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,544.00",$0.00,$772.00,"$1,222.85","$1,235.20",$0.00,$0.00,$0.00,$0.00,$0.00
6940-9-570,SUP,Custom 27803010,,6940-9-570  -  STEM FEM 225MM 57MM ENDOPRSTH STR FENST MOORE ODC OMFT RLNC,"$1,544.00",$0.00,"$1,544.00",$0.00,"$1,101.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,544.00",$0.00,$772.00,"$1,222.85","$1,235.20",$0.00,$0.00,$0.00,$0.00,$0.00
6940-9-630,SUP,Custom 27803010,,6940-9-630  -  STEM FEM 225MM 63MM ENDOPRSTH STR FENST FRAC MOORE ODC OMFT,"$1,544.00",$0.00,"$1,544.00",$0.00,"$1,101.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,544.00",$0.00,$772.00,"$1,222.85","$1,235.20",$0.00,$0.00,$0.00,$0.00,$0.00
6942-5-038,SUP,Custom 27803010,,6942-5-038  -  HEAD UNPLR 38MM STRL UNTRX MDLR EPRSTH HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
6942-5-040,SUP,Custom 27803010,,6942-5-040  -  HEAD UNPLR 40MM STRL UNTRX MDLR EPRSTH HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
6942-5-041,SUP,Custom 27803010,,6942-5-041  -  HEAD UNPLR 41MM STRL UNTRX MDLR EPRSTH HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
6942-5-042,SUP,Custom 27803010,,6942-5-042  -  HEAD UNPLR 42MM UNTRX FEM HIP MDLR ENDOPRSTH FR STRL,$548.00,$0.00,$548.00,$0.00,$391.11,$0.00,$0.00,$0.00,$0.00,$0.00,$548.00,$0.00,$274.00,$434.02,$438.40,$0.00,$0.00,$0.00,$0.00,$0.00
6942-5-043,SUP,Custom 27803010,,6942-5-043  -  HEAD UNIPOLAR 43MM MODULAR THOMPSON MOORE ODC OMNIFIT HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
6942-5-044,SUP,Custom 27803010,,6942-5-044  -  HEAD UNPLR 44MM UNTRX HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
6942-5-045,SUP,Custom 27803010,,6942-5-045  -  HEAD UNPLR 45MM UNTRX FEM HIP MDLR ENDOPRSTH FR,$548.00,$0.00,$548.00,$0.00,$391.11,$0.00,$0.00,$0.00,$0.00,$0.00,$548.00,$0.00,$274.00,$434.02,$438.40,$0.00,$0.00,$0.00,$0.00,$0.00
6942-5-046,SUP,Custom 27803010,,6942-5-046  -  HEAD UNPLR 46MM STRL UNTRX MDLR EPRSTH HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
6942-5-047,SUP,Custom 27803010,,6942-5-047  -  HEAD UNIPOLAR 47MM MODULAR UNITRAX HIP FEMORAL EXETER V40,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
6942-5-048,SUP,Custom 27803010,,6942-5-048  -  HEAD UNPLR 48MM STRL UNTRX MDLR EPRSTH HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
6942-5-049,SUP,Custom 27803010,,6942-5-049  -  HEAD UNPLR 49MM STRL UNTRX MDLR EPRSTH HIP,$548.00,$0.00,$548.00,$0.00,$391.11,$0.00,$0.00,$0.00,$0.00,$0.00,$548.00,$0.00,$274.00,$434.02,$438.40,$0.00,$0.00,$0.00,$0.00,$0.00
6942-5-050,SUP,Custom 27803010,,6942-5-050  -  HEAD UNPLR 50MM STRL UNTRX MDLR EPRSTH HIP,$548.00,$0.00,$548.00,$0.00,$391.11,$0.00,$0.00,$0.00,$0.00,$0.00,$548.00,$0.00,$274.00,$434.02,$438.40,$0.00,$0.00,$0.00,$0.00,$0.00
6942-5-051,SUP,Custom 27803010,,6942-5-051  -  HEAD UNPLR 51MM STRL UNTRX MDLR EPRSTH HIP,$548.00,$0.00,$548.00,$0.00,$391.11,$0.00,$0.00,$0.00,$0.00,$0.00,$548.00,$0.00,$274.00,$434.02,$438.40,$0.00,$0.00,$0.00,$0.00,$0.00
6942-5-052,SUP,Custom 27803010,,6942-5-052  -  HEAD UNPLR 52MM STRL UNTRX MDLR EPRSTH HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
6942-5-053,SUP,Custom 27803010,,6942-5-053  -  HEAD UNPLR 53MM STRL UNTRX MDLR EPRSTH HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
6942-5-054,SUP,Custom 27803010,,6942-5-054  -  HEAD UNPLR 54MM STRL UNTRX MDLR EPRSTH HIP,$548.00,$0.00,$548.00,$0.00,$391.11,$0.00,$0.00,$0.00,$0.00,$0.00,$548.00,$0.00,$274.00,$434.02,$438.40,$0.00,$0.00,$0.00,$0.00,$0.00
6942-5-055,SUP,Custom 27803010,,6942-5-055  -  HEAD UNPLR 55MM STRL UNTRX MDLR EPRSTH HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
6942-5-056,SUP,Custom 27803010,,6942-5-056  -  HEAD UNPLR 56MM STRL UNTRX MDLR EPRSTH HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
6942-5-057,SUP,Custom 27803010,,6942-5-057  -  HEAD UNPLR 57MM UNTRX FEM HIP MDLR ENDOPRSTH,$548.00,$0.00,$548.00,$0.00,$391.11,$0.00,$0.00,$0.00,$0.00,$0.00,$548.00,$0.00,$274.00,$434.02,$438.40,$0.00,$0.00,$0.00,$0.00,$0.00
6942-5-058,SUP,Custom 27803010,,6942-5-058  -  HEAD UNPLR 58MM STRL UNTRX MDLR EPRSTH HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
6942-5-060,SUP,Custom 27803010,,6942-5-060  -  HEAD UNPLR 60MM UNTRX FEM HIP MDLR ENDOPRSTH,$548.00,$0.00,$548.00,$0.00,$391.11,$0.00,$0.00,$0.00,$0.00,$0.00,$548.00,$0.00,$274.00,$434.02,$438.40,$0.00,$0.00,$0.00,$0.00,$0.00
6942-5-061,SUP,Custom 27803010,,6942-5-061  -  HEAD UNIPOLAR 61MM MODULAR UNITRAX HIP FEMORAL EXETER V40,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
6942-5-063,SUP,Custom 27803010,,6942-5-063  -  HEAD UNPLR 63MM UNTRX FEM HIP MDLR ENDOPRSTH,$548.00,$0.00,$548.00,$0.00,$391.11,$0.00,$0.00,$0.00,$0.00,$0.00,$548.00,$0.00,$274.00,$434.02,$438.40,$0.00,$0.00,$0.00,$0.00,$0.00
6942-6-010,SUP,Custom 27803010,,6942-6-010  -  SLEEVE CENTERING U PCA +0MM FEM HIP,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
6942-6-020,SUP,Custom 27803010,,6942-6-020  -  SLEEVE CENTERING +5MM UNITRAX PCA HIP FEMUR,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
6942-6-030,SUP,Custom 27803010,,6942-6-030  -  SLEEVE CENTERING +10MM UNITRAX PCA HIP FEMUR,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
6942-6-050,SUP,Custom 27803010,,6942-6-050  -  SLEEVE CENTERING -4MM UNITRAX PCA HIP FEMUR,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
6942-6-060,SUP,Custom 27803010,,6942-6-060  -  SLEEVE CENTERING -4MM UNIPOLAR UNITRAX V40 HIP,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
6942-6-065,SUP,Custom 27803010,,6942-6-065  -  SLEEVE CENTERING +0MM TAPER UNIPOLAR UNITRAX V40 EXETER HIP,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
6942-6-070,SUP,Custom 27803010,,6942-6-070  -  SLEEVE CENTERING +4MM TAPER UNIPOLAR UNITRAX V40 EXETER HIP,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
6942-6-075,SUP,Custom 27803010,,6942-6-075  -  SLEEVE CENTERING +8MM TAPER UNIPOLAR UNITRAX V40 EXETER HIP,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
6942-6-080,SUP,Custom 27803010,,6942-6-080  -  SLEEVE CENTERING +12MM UNIPOLAR UNITRAX V40 HIP,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
6942-7-060,SUP,Custom 27803010,,6942-7-060  -  SLEEVE CENTERING -3MM C TAPER UNITRAX HIP FEMUR,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
6942-7-065,SUP,Custom 27803010,,6942-7-065  -  SLEEVE CENTERING +0MM C TAPER UNITRAX HIP FEMUR,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
6942-7-075,SUP,Custom 27803010,,6942-7-075  -  SLEEVE CENTERING UNTRX +5MM HIP CTPR NECK,$226.00,$0.00,$226.00,$0.00,$161.30,$0.00,$0.00,$0.00,$0.00,$0.00,$226.00,$0.00,$113.00,$178.99,$180.80,$0.00,$0.00,$0.00,$0.00,$0.00
6942-7-080,SUP,Custom 27803010,,6942-7-080  -  SLEEVE CENTERING UNTRX 7.5MM CTPR,$226.00,$0.00,$226.00,$0.00,$161.30,$0.00,$0.00,$0.00,$0.00,$0.00,$226.00,$0.00,$113.00,$178.99,$180.80,$0.00,$0.00,$0.00,$0.00,$0.00
6942-7-085,SUP,Custom 27203010,,6942-7-085  -  SLEEVE ADJ UNTRX +10MM FEM HIP CTPR,$226.00,$0.00,$226.00,$0.00,$161.30,$0.00,$0.00,$0.00,$0.00,$0.00,$226.00,$0.00,$113.00,$178.99,$180.80,$0.00,$0.00,$0.00,$0.00,$0.00
6951-0-036,SUP,Custom 27803010,,6951-0-036  -  SHELL ACETAB 44MM 40MM HIP VIT,"$1,326.00",$0.00,"$1,326.00",$0.00,$946.37,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,326.00",$0.00,$663.00,"$1,050.19","$1,060.80",$0.00,$0.00,$0.00,$0.00,$0.00
6951-0-040,SUP,Custom 27803010,,6951-0-040  -  SHELL ACETAB 48MM 44MM HIP,"$1,326.00",$0.00,"$1,326.00",$0.00,$946.37,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,326.00",$0.00,$663.00,"$1,050.19","$1,060.80",$0.00,$0.00,$0.00,$0.00,$0.00
6951-0-045,SUP,Custom 27803010,,6951-0-045  -  SHELL ACETAB 53MM 49MM HIP,"$1,326.00",$0.00,"$1,326.00",$0.00,$946.37,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,326.00",$0.00,$663.00,"$1,050.19","$1,060.80",$0.00,$0.00,$0.00,$0.00,$0.00
6951-0-050,SUP,Custom 27803010,,6951-0-050  -  SHELL ACETAB 58MM 54MM HIP PRTRS,"$1,326.00",$0.00,"$1,326.00",$0.00,$946.37,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,326.00",$0.00,$663.00,"$1,050.19","$1,060.80",$0.00,$0.00,$0.00,$0.00,$0.00
6951-0-054,SUP,Custom 27803010,,6951-0-054  -  SHELL ACETAB 62MM 58MM HIP VIT,"$1,326.00",$0.00,"$1,326.00",$0.00,$946.37,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,326.00",$0.00,$663.00,"$1,050.19","$1,060.80",$0.00,$0.00,$0.00,$0.00,$0.00
6955975L,SUP,HCPCS C1713,,6955975L  -  HOOK SPNL 4.5MM NS VRTX MX LT OFST TI LMN RECON SYS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
6955975R,SUP,HCPCS C1713,,6955975R  -  HOOK SPNL 4.5MM NS VRTX MX RT OFST TI LMN RECON SYS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
6955977L,SUP,HCPCS C1713,,6955977L  -  HOOK SPNL 6MM NS VRTX MX LT OFST TI LMN RECON SYS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
6955977R,SUP,HCPCS C1713,,6955977R  -  HOOK SPNL 6MM NS VRTX MX RT OFST TI LMN RECON SYS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
6958718PT,SUP,HCPCS C1713,,6958718PT  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958720PT,SUP,HCPCS C1713,,6958720PT  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958722PT,SUP,HCPCS C1713,,6958722PT  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958724PT,SUP,HCPCS C1713,,6958724PT  -  SCREW BN P/T 3.5MM 24MM GRN NS VRTX MX MA TI SPNE RECON SYS,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958726PT,SUP,HCPCS C1713,,6958726PT  -  SCREW BN P/T 3.5MM 26MM GRN NS VRTX MX MA TI SPNE THOR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958728PT,SUP,HCPCS C1713,,6958728PT  -  SCREW BN P/T 3.5MM 28MM GRN NS VRTX MX MA TI SPNE THOR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958730PT,SUP,HCPCS C1713,,6958730PT  -  SCREW BN P/T 3.5MM 30MM GRN NS VRTX MX MA TI SPNE RECON SYS,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958732PT,SUP,HCPCS C1713,,6958732PT  -  SCREW BN P/T 3.5MM 32MM GRN NS VRTX MX MA TI SPNE RECON SYS,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958734PT,SUP,HCPCS C1713,,6958734PT  -  SCREW BN P/T 3.5MM 34MM GRN NS VRTX MX MA TI SPNE RECON SYS,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958736PT,SUP,HCPCS C1713,,6958736PT  -  SCREW BN P/T 3.5MM 36MM GRN NS VRTX MX MA TI SPNE THOR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958738PT,SUP,HCPCS C1713,,6958738PT  -  SCREW BN P/T 3.5MM 38MM GRN NS VRTX MX MA TI SPNE THOR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958740PT,SUP,HCPCS C1713,,6958740PT  -  SCREW BN P/T 3.5MM 40MM GRN NS VRTX MX MA TI SPNE THOR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958742PT,SUP,HCPCS C1713,,6958742PT  -  SCREW BN P/T 3.5MM 42MM VRTX MX MA TI SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958744PT,SUP,HCPCS C1713,,6958744PT  -  SCREW BN P/T 3.5MM 44MM VRTX MX MA TI SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958746PT,SUP,HCPCS C1713,,6958746PT  -  SCREW BN P/T 3.5MM 46MM VRTX MX MA TI SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958748PT,SUP,HCPCS C1713,,6958748PT  -  SCREW BN P/T 3.5MM 48MM VRTX MX MA TI SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958750PT,SUP,HCPCS C1713,,6958750PT  -  SCREW BN P/T 3.5MM 50MM VRTX MX MA TI SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958752PT,SUP,HCPCS C1713,,6958752PT  -  SCREW BN P/T 3.5MM 52MM VRTX MX MA TI SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958818PT,SUP,HCPCS C1713,,6958818PT  -  SCREW BN P/T 4MM 18MM AU NS VRTX MX MA TI SPNE THOR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958820PT,SUP,HCPCS C1713,,6958820PT  -  SCREW BN P/T 4MM 20MM AU NS VRTX MX MA TI SPNE THOR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958822PT,SUP,HCPCS C1713,,6958822PT  -  SCREW BN P/T 4MM 22MM AU NS VRTX MX MA TI SPNE THOR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958824PT,SUP,HCPCS C1713,,6958824PT  -  SCREW BN P/T 4MM 24MM AU NS VRTX MX MA TI SPNE THOR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958826PT,SUP,HCPCS C1713,,6958826PT  -  SCREW BN P/T 4MM 26MM AU NS VRTX MX MA TI SPNE RECON SYS,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958828PT,SUP,HCPCS C1713,,6958828PT  -  SCREW BN P/T 4MM 28MM AU NS VRTX MX MA TI SPNE RECON SYS,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958830PT,SUP,HCPCS C1713,,6958830PT  -  SCREW BN P/T 4MM 30MM AU 15MM VRTX MX TI SPNE OCPTL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958832PT,SUP,HCPCS C1713,,6958832PT  -  SCREW BN P/T 4MM 32MM AU NS VRTX MX MA TI SPNE RECON SYS,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958834PT,SUP,HCPCS C1713,,6958834PT  -  SCREW BN P/T 4MM 34MM AU NS VRTX MX MA TI SPNE RECON SYS,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958836PT,SUP,HCPCS C1713,,6958836PT  -  SCREW BN P/T 4MM 36MM AU NS VRTX MX MA TI SPNE THOR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958838PT,SUP,HCPCS C1713,,6958838PT  -  SCREW BN P/T 4MM 38MM AU NS VRTX MX MA TI SPNE THOR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958840PT,SUP,HCPCS C1713,,6958840PT  -  SCREW BN P/T 4MM 40MM AU NS VRTX MX MA TI SPNE THOR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958842PT,SUP,HCPCS C1713,,6958842PT  -  SCREW BN P/T 4MM 42MM AU VRTX MX MA TI SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958844PT,SUP,HCPCS C1713,,6958844PT  -  SCREW BN P/T 4MM 44MM AU VRTX MX MA TI SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958846PT,SUP,HCPCS C1713,,6958846PT  -  SCREW BN P/T 4MM 46MM AU VRTX MX MA TI SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958848PT,SUP,HCPCS C1713,,6958848PT  -  SCREW BN P/T 4MM 48MM AU VRTX MX MA TI SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958850PT,SUP,HCPCS C1713,,6958850PT  -  SCREW BN P/T 4MM 50MM AU VRTX MX MA TI SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6958852PT,SUP,HCPCS C1713,,6958852PT  -  SCREW BN P/T 4MM 52MM AU VRTX MX MA TI SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
6959420PT,SUP,HCPCS C1713,,6959420PT  -  SCREW BN P/T 4MM 20MM MA CNN TI SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6959422PT,SUP,HCPCS C1713,,6959422PT  -  SCREW BN P/T 4MM 22MM MA CNN TI SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6959424PT,SUP,HCPCS C1713,,6959424PT  -  SCREW BN P/T 4MM 24MM MA CNN TI SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6959426PT,SUP,HCPCS C1713,,6959426PT  -  SCREW BN P/T 4MM 26MM MA CNN TI SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6959428PT,SUP,HCPCS C1713,,6959428PT  -  SCREW BN P/T 4MM 28MM MA CNN TI SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6959430PT,SUP,HCPCS C1713,,6959430PT  -  SCREW BN P/T 4MM 30MM MA CNN TI SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6959432PT,SUP,HCPCS C1713,,6959432PT  -  SCREW BN P/T 4MM 32MM MA CNN TI SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6959434PT,SUP,HCPCS C1713,,6959434PT  -  SCREW BN P/T 4MM 34MM MA CNN TI SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6959436PT,SUP,HCPCS C1713,,6959436PT  -  SCREW BN P/T 4MM 36MM MA CNN TI SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6959438PT,SUP,HCPCS C1713,,6959438PT  -  SCREW BN P/T 4MM 38MM MA CNN TI SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6959440PT,SUP,HCPCS C1713,,6959440PT  -  SCREW BN P/T 4MM 40MM MA CNN TI SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
6971250CK,SUP,HCPCS C1713,,6971250CK  -  DISC INTVRTB 5MM 12MM SPNE CRV,"$10,200.00",$0.00,"$10,200.00","$4,590.00","$5,158.80",$0.00,"$1,757.41",$0.00,$0.00,"$1,785.94","$10,200.00",$0.00,"$5,100.00","$8,078.40","$8,160.00",$0.00,"$1,596.30",$0.00,"$1,623.84",$0.00
6971270CK,SUP,HCPCS C1713,,6971270CK  -  DISC INTVRTB 7MM 12MM SPNE CRV,"$10,200.00",$0.00,"$10,200.00","$4,590.00","$5,158.80",$0.00,"$1,757.41",$0.00,$0.00,"$1,785.94","$10,200.00",$0.00,"$5,100.00","$8,078.40","$8,160.00",$0.00,"$1,596.30",$0.00,"$1,623.84",$0.00
6971450CK,SUP,HCPCS C1713,,6971450CK  -  DISC INTVRTB 5MM 14MM SPNE CRV,"$10,200.00",$0.00,"$10,200.00","$4,590.00","$5,158.80",$0.00,"$1,757.41",$0.00,$0.00,"$1,785.94","$10,200.00",$0.00,"$5,100.00","$8,078.40","$8,160.00",$0.00,"$1,596.30",$0.00,"$1,623.84",$0.00
6971470CK,SUP,HCPCS C1713,,6971470CK  -  DISC INTVRTB 7MM 14MM SPNE CRV,"$10,200.00",$0.00,"$10,200.00","$4,590.00","$5,158.80",$0.00,"$1,757.41",$0.00,$0.00,"$1,785.94","$10,200.00",$0.00,"$5,100.00","$8,078.40","$8,160.00",$0.00,"$1,596.30",$0.00,"$1,623.84",$0.00
6971480CK,SUP,HCPCS C1713,,6971480CK  -  DISC INTVRTB 8MM 14MM SPNE CRV,"$10,200.00",$0.00,"$10,200.00","$4,590.00","$5,158.80",$0.00,"$1,757.41",$0.00,$0.00,"$1,785.94","$10,200.00",$0.00,"$5,100.00","$8,078.40","$8,160.00",$0.00,"$1,596.30",$0.00,"$1,623.84",$0.00
6971650CK,SUP,HCPCS C1713,,6971650CK  -  DISC INTVRTB 5MM 16MM SPNE CRV,"$10,200.00",$0.00,"$10,200.00","$4,590.00","$5,158.80",$0.00,"$1,757.41",$0.00,$0.00,"$1,785.94","$10,200.00",$0.00,"$5,100.00","$8,078.40","$8,160.00",$0.00,"$1,596.30",$0.00,"$1,623.84",$0.00
6971670CK,SUP,HCPCS C1713,,6971670CK  -  DISC INTVRTB 7MM 16MM SPNE CRV,"$10,200.00",$0.00,"$10,200.00","$4,590.00","$5,158.80",$0.00,"$1,757.41",$0.00,$0.00,"$1,785.94","$10,200.00",$0.00,"$5,100.00","$8,078.40","$8,160.00",$0.00,"$1,596.30",$0.00,"$1,623.84",$0.00
6971680CK,SUP,HCPCS C1713,,6971680CK  -  DISC INTVRTB 8MM 16MM SPNE CRV,"$10,200.00",$0.00,"$10,200.00","$4,590.00","$5,158.80",$0.00,"$1,757.41",$0.00,$0.00,"$1,785.94","$10,200.00",$0.00,"$5,100.00","$8,078.40","$8,160.00",$0.00,"$1,596.30",$0.00,"$1,623.84",$0.00
6971870CK,SUP,HCPCS C1713,,6971870CK  -  DISC INTVRTB 7MM 18MM SPNE CRV,"$10,200.00",$0.00,"$10,200.00","$4,590.00","$5,158.80",$0.00,"$1,757.41",$0.00,$0.00,"$1,785.94","$10,200.00",$0.00,"$5,100.00","$8,078.40","$8,160.00",$0.00,"$1,596.30",$0.00,"$1,623.84",$0.00
6971880CK,SUP,HCPCS C1713,,6971880CK  -  DISC INTVRTB 8MM 18MM SPNE CRV,"$10,200.00",$0.00,"$10,200.00","$4,590.00","$5,158.80",$0.00,"$1,757.41",$0.00,$0.00,"$1,785.94","$10,200.00",$0.00,"$5,100.00","$8,078.40","$8,160.00",$0.00,"$1,596.30",$0.00,"$1,623.84",$0.00
698.600S,SUP,Custom 27803010,,698.600S  -  MARS 3V DISPOSABLE KIT,"$7,440.00",$0.00,"$7,440.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,440.00",$0.00,"$3,720.00","$5,892.48","$5,952.00",$0.00,$0.00,$0.00,$0.00,$0.00
6980-5-030,SUP,Custom 27803010,,6980-5-030  -  SRFC ARTC 30MM 1STP DISTAL KNEE,"$1,817.00",$0.00,"$1,817.00",$0.00,"$1,296.79",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,817.00",$0.00,$908.50,"$1,439.06","$1,453.60",$0.00,$0.00,$0.00,$0.00,$0.00
6980-5-035,SUP,HCPCS C1713,,6980-5-035  -  STAPLE BONE DISTAL IMPL 35MM DISTAL KNEE 1STP,"$1,817.00",$0.00,"$1,817.00",$817.65,"$1,296.79",$0.00,$313.06,$0.00,$0.00,$318.14,"$1,817.00",$0.00,$908.50,"$1,439.06","$1,453.60",$0.00,$284.36,$0.00,$289.27,$0.00
6980-5-040,SUP,HCPCS C1713,,6980-5-040  -  STAPLE BONE 40MM DISTAL TIB 1STP,"$1,817.00",$0.00,"$1,817.00",$817.65,"$1,296.79",$0.00,$313.06,$0.00,$0.00,$318.14,"$1,817.00",$0.00,$908.50,"$1,439.06","$1,453.60",$0.00,$284.36,$0.00,$289.27,$0.00
6980-5-045,SUP,Custom 27803010,,6980-5-045  -  SRFC ARTC 45MM 1STP DISTAL,"$1,817.00",$0.00,"$1,817.00",$0.00,"$1,296.79",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,817.00",$0.00,$908.50,"$1,439.06","$1,453.60",$0.00,$0.00,$0.00,$0.00,$0.00
6980-5-050,SUP,HCPCS C1713,,6980-5-050  -  STAPLE BONE 50MM DISTAL 1STP,"$1,817.00",$0.00,"$1,817.00",$817.65,"$1,296.79",$0.00,$313.06,$0.00,$0.00,$318.14,"$1,817.00",$0.00,$908.50,"$1,439.06","$1,453.60",$0.00,$284.36,$0.00,$289.27,$0.00
6980-5-055,SUP,HCPCS C1713,,6980-5-055  -  STAPLE BONE 55MM DISTAL TIB 1STP,"$1,817.00",$0.00,"$1,817.00",$817.65,"$1,296.79",$0.00,$313.06,$0.00,$0.00,$318.14,"$1,817.00",$0.00,$908.50,"$1,439.06","$1,453.60",$0.00,$284.36,$0.00,$289.27,$0.00
6980-5-060,SUP,HCPCS C1713,,6980-5-060  -  STAPLE BONE 60MM DISTAL FIRSTSTEP,"$1,817.00",$0.00,"$1,817.00",$817.65,"$1,296.79",$0.00,$313.06,$0.00,$0.00,$318.14,"$1,817.00",$0.00,$908.50,"$1,439.06","$1,453.60",$0.00,$284.36,$0.00,$289.27,$0.00
6980-5-065,SUP,HCPCS C1713,,6980-5-065  -  STAPLE BONE 65MM DISTAL KNEE FIRSTSTEP,"$1,817.00",$0.00,"$1,817.00",$817.65,"$1,296.79",$0.00,$313.06,$0.00,$0.00,$318.14,"$1,817.00",$0.00,$908.50,"$1,439.06","$1,453.60",$0.00,$284.36,$0.00,$289.27,$0.00
6981-5-060,SUP,HCPCS C1713,,6981-5-060  -  STAPLE BONE 60X15MM PROX KNEE 1STP,"$1,137.00",$0.00,"$1,137.00",$511.65,$811.48,$0.00,$195.90,$0.00,$0.00,$199.08,"$1,137.00",$0.00,$568.50,$900.50,$909.60,$0.00,$177.94,$0.00,$181.01,$0.00
6981-5-065,SUP,HCPCS C1713,,6981-5-065  -  STAPLE BONE 65X15MM PROX KNEE 1STP,"$1,137.00",$0.00,"$1,137.00",$511.65,$811.48,$0.00,$195.90,$0.00,$0.00,$199.08,"$1,137.00",$0.00,$568.50,$900.50,$909.60,$0.00,$177.94,$0.00,$181.01,$0.00
6981-5-070,SUP,HCPCS C1713,,6981-5-070  -  STAPLE BONE 70X15MM PROX KNEE 1STP,"$1,137.00",$0.00,"$1,137.00",$511.65,$811.48,$0.00,$195.90,$0.00,$0.00,$199.08,"$1,137.00",$0.00,$568.50,$900.50,$909.60,$0.00,$177.94,$0.00,$181.01,$0.00
6981-5-075,SUP,HCPCS C1713,,6981-5-075  -  STAPLE BONE 75 MMX 15MM PROX KNEE 1STP,"$1,137.00",$0.00,"$1,137.00",$511.65,$811.48,$0.00,$195.90,$0.00,$0.00,$199.08,"$1,137.00",$0.00,$568.50,$900.50,$909.60,$0.00,$177.94,$0.00,$181.01,$0.00
6981-5-080,SUP,HCPCS C1713,,6981-5-080  -  STAPLE BONE 80X15MM PROX KNEE 1STP,"$1,137.00",$0.00,"$1,137.00",$511.65,$811.48,$0.00,$195.90,$0.00,$0.00,$199.08,"$1,137.00",$0.00,$568.50,$900.50,$909.60,$0.00,$177.94,$0.00,$181.01,$0.00
6981-5-085,SUP,HCPCS C1713,,6981-5-085  -  STAPLE BONE 85X15MM PROX KNEE 1STP,"$1,137.00",$0.00,"$1,137.00",$511.65,$811.48,$0.00,$195.90,$0.00,$0.00,$199.08,"$1,137.00",$0.00,$568.50,$900.50,$909.60,$0.00,$177.94,$0.00,$181.01,$0.00
6981-5-090,SUP,HCPCS C1713,,6981-5-090  -  STAPLE BONE 90X15MM PROX KNEE 1STP,"$1,137.00",$0.00,"$1,137.00",$511.65,$811.48,$0.00,$195.90,$0.00,$0.00,$199.08,"$1,137.00",$0.00,$568.50,$900.50,$909.60,$0.00,$177.94,$0.00,$181.01,$0.00
6981-6-060,SUP,HCPCS C1713,,6981-6-060  -  STAPLE BONE 60X10MM PROX KNEE 1STP,"$1,137.00",$0.00,"$1,137.00",$511.65,$811.48,$0.00,$195.90,$0.00,$0.00,$199.08,"$1,137.00",$0.00,$568.50,$900.50,$909.60,$0.00,$177.94,$0.00,$181.01,$0.00
6981-6-065,SUP,HCPCS C1713,,6981-6-065  -  STAPLE BONE 65X10MM PROX KNEE 1STP,"$1,137.00",$0.00,"$1,137.00",$511.65,$811.48,$0.00,$195.90,$0.00,$0.00,$199.08,"$1,137.00",$0.00,$568.50,$900.50,$909.60,$0.00,$177.94,$0.00,$181.01,$0.00
6981-6-070,SUP,HCPCS C1713,,6981-6-070  -  STAPLE BONE 70X10MM PROX KNEE 1STP,"$1,137.00",$0.00,"$1,137.00",$511.65,$811.48,$0.00,$195.90,$0.00,$0.00,$199.08,"$1,137.00",$0.00,$568.50,$900.50,$909.60,$0.00,$177.94,$0.00,$181.01,$0.00
6981-6-075,SUP,Custom 27803010,,6981-6-075  -  SRFC ARTC 75X10MM 1STP PROX,"$1,137.00",$0.00,"$1,137.00",$0.00,$811.48,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,137.00",$0.00,$568.50,$900.50,$909.60,$0.00,$0.00,$0.00,$0.00,$0.00
6981-6-080,SUP,HCPCS C1713,,6981-6-080  -  STAPLE BONE 80X10MM PROX KNEE 1STP,"$1,137.00",$0.00,"$1,137.00",$511.65,$811.48,$0.00,$195.90,$0.00,$0.00,$199.08,"$1,137.00",$0.00,$568.50,$900.50,$909.60,$0.00,$177.94,$0.00,$181.01,$0.00
6981-6-085,SUP,HCPCS C1713,,6981-6-085  -  STAPLE BONE 85X10MM PROX KNEE 1STP,"$1,137.00",$0.00,"$1,137.00",$511.65,$811.48,$0.00,$195.90,$0.00,$0.00,$199.08,"$1,137.00",$0.00,$568.50,$900.50,$909.60,$0.00,$177.94,$0.00,$181.01,$0.00
6981-6-090,SUP,HCPCS C1713,,6981-6-090  -  STAPLE BONE 90X10MM PROX KNEE 1STP,"$1,137.00",$0.00,"$1,137.00",$511.65,$811.48,$0.00,$195.90,$0.00,$0.00,$199.08,"$1,137.00",$0.00,$568.50,$900.50,$909.60,$0.00,$177.94,$0.00,$181.01,$0.00
6981-7-060,SUP,HCPCS C1713,,6981-7-060  -  STAPLE BONE 60MMX5MM PROX KNEE 1STP,"$1,137.00",$0.00,"$1,137.00",$511.65,$811.48,$0.00,$195.90,$0.00,$0.00,$199.08,"$1,137.00",$0.00,$568.50,$900.50,$909.60,$0.00,$177.94,$0.00,$181.01,$0.00
6981-7-065,SUP,HCPCS C1713,,6981-7-065  -  STAPLE BONE 65X5MM PROX KNEE 1STP,"$1,137.00",$0.00,"$1,137.00",$511.65,$811.48,$0.00,$195.90,$0.00,$0.00,$199.08,"$1,137.00",$0.00,$568.50,$900.50,$909.60,$0.00,$177.94,$0.00,$181.01,$0.00
6981-7-070,SUP,HCPCS C1713,,6981-7-070  -  STAPLE BONE 70MMX5MM PROX KNEE 1STP,"$1,137.00",$0.00,"$1,137.00",$511.65,$811.48,$0.00,$195.90,$0.00,$0.00,$199.08,"$1,137.00",$0.00,$568.50,$900.50,$909.60,$0.00,$177.94,$0.00,$181.01,$0.00
6981-7-075,SUP,HCPCS C1713,,6981-7-075  -  STAPLE BONE 75MMX5MM PROX KNEE 1STP,"$1,137.00",$0.00,"$1,137.00",$511.65,$811.48,$0.00,$195.90,$0.00,$0.00,$199.08,"$1,137.00",$0.00,$568.50,$900.50,$909.60,$0.00,$177.94,$0.00,$181.01,$0.00
6981-7-080,SUP,HCPCS C1713,,6981-7-080  -  STAPLE BONE 80MMX5MM PROX KNEE 1STP,"$1,137.00",$0.00,"$1,137.00",$511.65,$811.48,$0.00,$195.90,$0.00,$0.00,$199.08,"$1,137.00",$0.00,$568.50,$900.50,$909.60,$0.00,$177.94,$0.00,$181.01,$0.00
6981-7-085,SUP,HCPCS C1713,,6981-7-085  -  STAPLE BONE 85X5MM PROX KNEE 1STP,"$1,137.00",$0.00,"$1,137.00",$511.65,$811.48,$0.00,$195.90,$0.00,$0.00,$199.08,"$1,137.00",$0.00,$568.50,$900.50,$909.60,$0.00,$177.94,$0.00,$181.01,$0.00
6981-7-090,SUP,HCPCS C1713,,6981-7-090  -  STAPLE BONE 90X5MM PROX FIRSTSTEP,"$1,137.00",$0.00,"$1,137.00",$511.65,$811.48,$0.00,$195.90,$0.00,$0.00,$199.08,"$1,137.00",$0.00,$568.50,$900.50,$909.60,$0.00,$177.94,$0.00,$181.01,$0.00
6985M,SUP,Custom 27203010,,KIT EXTENDER LEAD,$212.50,$0.00,$212.50,$0.00,$151.66,$0.00,$0.00,$0.00,$0.00,$0.00,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$0.00,$0.00,$0.00,$0.00
6A0001,SUP,HCPCS C1725,,CATHETER 6FR JR 3.5,$87.50,$0.00,$87.50,$47.51,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
6A0014,SUP,HCPCS C1725,,CATHETER ANGIO JR6 CURVE 6FR 100CM STSR,$17.50,$0.00,$17.50,$9.50,$12.49,$0.00,$3.02,$0.00,$0.00,$3.06,$17.50,$0.00,$8.75,$13.86,$14.00,$0.00,$2.74,$0.00,$2.79,$0.00
6A0019,SUP,HCPCS C1725,,CATHETER ANGIO AR2 CURVE 6FR 100CM STSR,$17.50,$0.00,$17.50,$9.50,$12.49,$0.00,$3.02,$0.00,$0.00,$3.06,$17.50,$0.00,$8.75,$13.86,$14.00,$0.00,$2.74,$0.00,$2.79,$0.00
6A002,SUP,HCPCS C1725,,CATHETER 6FR JR4,$35.00,$0.00,$35.00,$19.01,$24.98,$0.00,$6.03,$0.00,$0.00,$6.13,$35.00,$0.00,$17.50,$27.72,$28.00,$0.00,$5.48,$0.00,$5.57,$0.00
6A0021,SUP,HCPCS C1725,,CATHETER ANGIO AL2 CURVE 6FR 100CM STSR,$17.50,$0.00,$17.50,$9.50,$12.49,$0.00,$3.02,$0.00,$0.00,$3.06,$17.50,$0.00,$8.75,$13.86,$14.00,$0.00,$2.74,$0.00,$2.79,$0.00
6A0024,SUP,HCPCS C1725,,CATHETER ANGIO 6FR 100CM 2 SH STSR,$17.50,$0.00,$17.50,$9.50,$12.49,$0.00,$3.02,$0.00,$0.00,$3.06,$17.50,$0.00,$8.75,$13.86,$14.00,$0.00,$2.74,$0.00,$2.79,$0.00
6A003,SUP,HCPCS C1725,,CATHETER 6FR JR5,$17.50,$0.00,$17.50,$9.50,$12.49,$0.00,$3.02,$0.00,$0.00,$3.06,$17.50,$0.00,$8.75,$13.86,$14.00,$0.00,$2.74,$0.00,$2.79,$0.00
6A0033,SUP,HCPCS C1725,,CATHETER ANGIO IMA CURVE 6FR 100CM STSR,$17.50,$0.00,$17.50,$9.50,$12.49,$0.00,$3.02,$0.00,$0.00,$3.06,$17.50,$0.00,$8.75,$13.86,$14.00,$0.00,$2.74,$0.00,$2.79,$0.00
6A0034,SUP,HCPCS C1725,,CATHETER ANGIO LCB CURVE 6FR 100CM STSR,$17.50,$0.00,$17.50,$9.50,$12.49,$0.00,$3.02,$0.00,$0.00,$3.06,$17.50,$0.00,$8.75,$13.86,$14.00,$0.00,$2.74,$0.00,$2.79,$0.00
6A0080,SUP,HCPCS C1725,,CATHETER ANGIO JL3.5 CURVE 6FR 100CM STSR,$17.50,$0.00,$17.50,$9.50,$12.49,$0.00,$3.02,$0.00,$0.00,$3.06,$17.50,$0.00,$8.75,$13.86,$14.00,$0.00,$2.74,$0.00,$2.79,$0.00
6A0083,SUP,HCPCS C1725,,CATHETER ANGIO JL5 CURVE 6FR 100CM STSR,$17.50,$0.00,$17.50,$9.50,$12.49,$0.00,$3.02,$0.00,$0.00,$3.06,$17.50,$0.00,$8.75,$13.86,$14.00,$0.00,$2.74,$0.00,$2.79,$0.00
6A0085,SUP,HCPCS C1725,,CATHETER ANGIO JL4 CURVE 6FR 100CM STSR,$17.50,$0.00,$17.50,$9.50,$12.49,$0.00,$3.02,$0.00,$0.00,$3.06,$17.50,$0.00,$8.75,$13.86,$14.00,$0.00,$2.74,$0.00,$2.79,$0.00
6DCFN,SUP,Custom 27203010,,6DCFN  -  TUBE TRCH 6 10.8MM 6.4MM 74MM STRL LF SHLY CUFLS DISP INR,$83.74,$0.00,$83.74,$0.00,$59.76,$0.00,$0.00,$0.00,$0.00,$0.00,$83.74,$0.00,$41.87,$66.32,$66.99,$0.00,$0.00,$0.00,$0.00,$0.00
6DCFS,SUP,Custom 27203010,,6DCFS  -  TUBE TRCH 6 10.8MM 6.4MM 74MM STRL LF SHLY CUFLS DISP INR,$89.90,$0.00,$89.90,$0.00,$64.16,$0.00,$0.00,$0.00,$0.00,$0.00,$89.90,$0.00,$44.95,$71.20,$71.92,$0.00,$0.00,$0.00,$0.00,$0.00
6DCT,SUP,Custom 27203010,,6DCT  -  TUBE TRCH 6 10.8MM 6.4MM 74MM STRL LF SHLY CUF DISP INR CNN,$95.08,$0.00,$95.08,$0.00,$67.86,$0.00,$0.00,$0.00,$0.00,$0.00,$95.08,$0.00,$47.54,$75.30,$76.06,$0.00,$0.00,$0.00,$0.00,$0.00
6DFEN,SUP,Custom 27203010,,6DFEN  -  TUBE TRCH 6 10.8MM 6.4MM 74MM STRL LF SHLY CUF DISP INR CNN,$100.92,$0.00,$100.92,$0.00,$72.02,$0.00,$0.00,$0.00,$0.00,$0.00,$100.92,$0.00,$50.46,$79.93,$80.73,$0.00,$0.00,$0.00,$0.00,$0.00
6E1322,SUP,Custom 25803010,,SOLUTION IV 0.9% NA CHLOR 250ML AVIVA LF,$7.70,$0.00,$7.70,$0.00,$5.50,$0.00,$0.00,$0.00,$0.00,$0.00,$7.70,$0.00,$3.85,$6.10,$6.16,$0.00,$0.00,$0.00,$0.00,$0.00
6L215,SUP,Custom 27203010,,BELT 5 THK7/16IN 101IN B TYPE WRP 21/32IN,$81.35,$0.00,$81.35,$0.00,$58.06,$0.00,$0.00,$0.00,$0.00,$0.00,$81.35,$0.00,$40.68,$64.43,$65.08,$0.00,$0.00,$0.00,$0.00,$0.00
6LGT,SUP,Custom 27203010,,6LGT  -  TUBE 50MM 11.1MM 6.4MM UNCUF LRNTMY SHLY TRCH 6 STRL LATEX,$116.45,$0.00,$119.98,$0.00,$85.63,$0.00,$0.00,$0.00,$0.00,$0.00,$119.98,$0.00,$59.99,$92.23,$95.98,$0.00,$0.00,$0.00,$0.00,$0.00
6LGT,SUP,Custom 27203010,,TUBE 6.4MM UNCUF LRNTMY SHLY TRCH 6,$119.98,$0.00,$119.98,$0.00,$85.63,$0.00,$0.00,$0.00,$0.00,$0.00,$119.98,$0.00,$59.99,$95.02,$95.98,$0.00,$0.00,$0.00,$0.00,$0.00
6M02A,SUP,Custom 27203010,,6M02A  -  SUTURE NONABSORBABLE CV-6 TTC-9 30IN 2 ARM MONOFILAMENT,$842.50,$0.00,$842.50,$0.00,$601.29,$0.00,$0.00,$0.00,$0.00,$0.00,$842.50,$0.00,$421.25,$667.26,$674.00,$0.00,$0.00,$0.00,$0.00,$0.00
6SCT,SUP,Custom 27203010,,6SCT  -  TUBE TRCH 6 8.3MM 6MM 67MM LF SHLY CUF SGL CNN RND TIP OBT,$72.45,$0.00,$72.45,$0.00,$51.70,$0.00,$0.00,$0.00,$0.00,$0.00,$72.45,$0.00,$36.22,$57.38,$57.96,$0.00,$0.00,$0.00,$0.00,$0.00
70-0007,SUP,HCPCS C1713,,70-0007  -  PLATE BN 5 HL 1ST TARSOMETATARSAL,"$1,022.50",$0.00,"$1,022.50",$460.13,$729.76,$0.00,$176.17,$0.00,$0.00,$179.03,"$1,022.50",$0.00,$511.25,$809.82,$818.00,$0.00,$160.02,$0.00,$162.78,$0.00
70-0008,SUP,HCPCS C1713,,70-0008  -  PLATE BN 4 HL 1ST TARSOMETATARSAL,"$1,022.50",$0.00,"$1,022.50",$460.13,$729.76,$0.00,$176.17,$0.00,$0.00,$179.03,"$1,022.50",$0.00,$511.25,$809.82,$818.00,$0.00,$160.02,$0.00,$162.78,$0.00
70-0009,SUP,HCPCS C1713,,70-0009  -  PLATE BN 4 HL 2ND AND 3RD TARSOMETATARSAL,"$1,022.50",$0.00,"$1,022.50",$460.13,$729.76,$0.00,$176.17,$0.00,$0.00,$179.03,"$1,022.50",$0.00,$511.25,$809.82,$818.00,$0.00,$160.02,$0.00,$162.78,$0.00
70-0010,SUP,HCPCS C1713,,70-0010  -  PLATE BN LCK LT PROX MTP,"$1,280.00",$0.00,"$1,280.00",$576.00,$913.54,$0.00,$220.54,$0.00,$0.00,$224.12,"$1,280.00",$0.00,$640.00,"$1,013.76","$1,024.00",$0.00,$200.32,$0.00,$203.78,$0.00
70-0011,SUP,HCPCS C1713,,70-0011  -  PLATE BN LCK RT PROX MTP,"$1,280.00",$0.00,"$1,280.00",$576.00,$913.54,$0.00,$220.54,$0.00,$0.00,$224.12,"$1,280.00",$0.00,$640.00,"$1,013.76","$1,024.00",$0.00,$200.32,$0.00,$203.78,$0.00
70-0012,SUP,HCPCS C1713,,70-0012  -  PLATE BN LCK FSN LT DRSL 1ST MTP,"$1,022.50",$0.00,"$1,022.50",$460.13,$729.76,$0.00,$176.17,$0.00,$0.00,$179.03,"$1,022.50",$0.00,$511.25,$809.82,$818.00,$0.00,$160.02,$0.00,$162.78,$0.00
70-0013,SUP,HCPCS C1713,,70-0013  -  PLATE BN LCK FSN RT DRSL 1ST MTP,"$1,022.50",$0.00,"$1,022.50",$460.13,$729.76,$0.00,$176.17,$0.00,$0.00,$179.03,"$1,022.50",$0.00,$511.25,$809.82,$818.00,$0.00,$160.02,$0.00,$162.78,$0.00
70-0018,SUP,HCPCS C1713,,70-0018  -  PLATE BN REV LCK FSN LT 1ST MTP,"$1,022.50",$0.00,"$1,022.50",$460.13,$729.76,$0.00,$176.17,$0.00,$0.00,$179.03,"$1,022.50",$0.00,$511.25,$809.82,$818.00,$0.00,$160.02,$0.00,$162.78,$0.00
70-0019,SUP,HCPCS C1713,,70-0019  -  PLATE BN REV LCK FSN RT 1ST MTP,"$1,022.50",$0.00,"$1,022.50",$460.13,$729.76,$0.00,$176.17,$0.00,$0.00,$179.03,"$1,022.50",$0.00,$511.25,$809.82,$818.00,$0.00,$160.02,$0.00,$162.78,$0.00
70-0022,SUP,HCPCS C1713,,70-0022  -  PLATE SM TI LCK BONE LEFT CALC NONSTRL,"$3,520.00",$0.00,"$3,520.00","$1,584.00","$2,512.22",$0.00,$606.48,$0.00,$0.00,$616.32,"$3,520.00",$0.00,"$1,760.00","$2,787.84","$2,816.00",$0.00,$550.88,$0.00,$560.38,$0.00
70-0023,SUP,HCPCS C1713,,70-0023  -  PLATE SM LCK BONE RIGHT CALC,"$3,520.00",$0.00,"$3,520.00","$1,584.00","$2,512.22",$0.00,$606.48,$0.00,$0.00,$616.32,"$3,520.00",$0.00,"$1,760.00","$2,787.84","$2,816.00",$0.00,$550.88,$0.00,$560.38,$0.00
70-0024,SUP,HCPCS C1713,,70-0024  -  PLATE MED BONE LEFT CALC,"$3,520.00",$0.00,"$3,520.00","$1,584.00","$2,512.22",$0.00,$606.48,$0.00,$0.00,$616.32,"$3,520.00",$0.00,"$1,760.00","$2,787.84","$2,816.00",$0.00,$550.88,$0.00,$560.38,$0.00
70-0025,SUP,HCPCS C1713,,70-0025  -  PLATE BONE RIGHT CALC,"$3,520.00",$0.00,"$3,520.00","$1,584.00","$2,512.22",$0.00,$606.48,$0.00,$0.00,$616.32,"$3,520.00",$0.00,"$1,760.00","$2,787.84","$2,816.00",$0.00,$550.88,$0.00,$560.38,$0.00
70-0026,SUP,HCPCS C1713,,70-0026  -  PLATE LG LCK BONE LEFT CALC NONSTRL,"$3,520.00",$0.00,"$3,520.00","$1,584.00","$2,512.22",$0.00,$606.48,$0.00,$0.00,$616.32,"$3,520.00",$0.00,"$1,760.00","$2,787.84","$2,816.00",$0.00,$550.88,$0.00,$560.38,$0.00
70-0027,SUP,HCPCS C1713,,70-0027  -  PLATE LG LCK BONE CALC RIGHT,"$3,520.00",$0.00,"$3,520.00","$1,584.00","$2,512.22",$0.00,$606.48,$0.00,$0.00,$616.32,"$3,520.00",$0.00,"$1,760.00","$2,787.84","$2,816.00",$0.00,$550.88,$0.00,$560.38,$0.00
70-0036,SUP,HCPCS C1713,,70-0036  -  PLATE BN MPJ 5 HL CMB FSN LCK LT 1ST MTP,"$1,280.00",$0.00,"$1,280.00",$576.00,$913.54,$0.00,$220.54,$0.00,$0.00,$224.12,"$1,280.00",$0.00,$640.00,"$1,013.76","$1,024.00",$0.00,$200.32,$0.00,$203.78,$0.00
70-0037,SUP,HCPCS C1713,,70-0037  -  PLATE 5 HOLE PRIM BONE RIGHT MTP,"$1,280.00",$0.00,"$1,280.00",$576.00,$913.54,$0.00,$220.54,$0.00,$0.00,$224.12,"$1,280.00",$0.00,$640.00,"$1,013.76","$1,024.00",$0.00,$200.32,$0.00,$203.78,$0.00
700-04-42A,SUP,HCPCS C1776,,700-04-42A  -  SHELL ACTB A 42MM STRL TRDNT II SB TRITANIUM HIP,"$2,302.50",$0.00,"$2,302.50","$1,036.13","$1,643.29",$0.00,$396.71,$0.00,$0.00,$403.15,"$2,302.50",$0.00,"$1,151.25","$1,823.58","$1,842.00",$0.00,$360.34,$0.00,$366.56,$0.00
700-04-44B,SUP,HCPCS C1776,,700-04-44B  -  SHELL ACTB B 44MM STRL TRDNT II SB TRITANIUM HIP,"$2,302.50",$0.00,"$2,302.50","$1,036.13","$1,643.29",$0.00,$396.71,$0.00,$0.00,$403.15,"$2,302.50",$0.00,"$1,151.25","$1,823.58","$1,842.00",$0.00,$360.34,$0.00,$366.56,$0.00
700-04-46C,SUP,HCPCS C1776,,700-04-46C  -  SHELL ACTB C 46MM STRL TRDNT II SB TRITANIUM HIP,"$2,302.50",$0.00,"$2,302.50","$1,036.13","$1,643.29",$0.00,$396.71,$0.00,$0.00,$403.15,"$2,302.50",$0.00,"$1,151.25","$1,823.58","$1,842.00",$0.00,$360.34,$0.00,$366.56,$0.00
700-04-48D,SUP,HCPCS C1776,,700-04-48D  -  SHELL ACTB D 48MM STRL TRDNT II SB TRITANIUM HIP,"$2,302.50",$0.00,"$2,302.50","$1,036.13","$1,643.29",$0.00,$396.71,$0.00,$0.00,$403.15,"$2,302.50",$0.00,"$1,151.25","$1,823.58","$1,842.00",$0.00,$360.34,$0.00,$366.56,$0.00
70-0045,SUP,HCPCS C1713,,70-0045  -  PLATE BN STD NS ACLC LOPRFL LCK SHFT FX ANG SCR HL KWR HL TI,"$2,575.00",$0.00,"$2,575.00","$1,158.75","$1,837.78",$0.00,$443.66,$0.00,$0.00,$450.86,"$2,575.00",$0.00,"$1,287.50","$2,039.40","$2,060.00",$0.00,$402.99,$0.00,$409.94,$0.00
700-04-50D,SUP,HCPCS C1776,,700-04-50D  -  SHELL ACTB D 50MM STRL TRDNT II SB TRITANIUM HIP,"$2,302.50",$0.00,"$2,302.50","$1,036.13","$1,643.29",$0.00,$396.71,$0.00,$0.00,$403.15,"$2,302.50",$0.00,"$1,151.25","$1,823.58","$1,842.00",$0.00,$360.34,$0.00,$366.56,$0.00
700-04-52E,SUP,HCPCS C1776,,700-04-52E  -  SHELL ACTB E 52MM STRL TRDNT II SB TRITANIUM HIP,"$2,302.50",$0.00,"$2,302.50","$1,036.13","$1,643.29",$0.00,$396.71,$0.00,$0.00,$403.15,"$2,302.50",$0.00,"$1,151.25","$1,823.58","$1,842.00",$0.00,$360.34,$0.00,$366.56,$0.00
700-04-54E,SUP,HCPCS C1776,,700-04-54E  -  SHELL ACTB E 54MM STRL TRDNT II SB TRITANIUM HIP,"$2,302.50",$0.00,"$2,302.50","$1,036.13","$1,643.29",$0.00,$396.71,$0.00,$0.00,$403.15,"$2,302.50",$0.00,"$1,151.25","$1,823.58","$1,842.00",$0.00,$360.34,$0.00,$366.56,$0.00
700-04-56F,SUP,HCPCS C1776,,700-04-56F  -  SHELL ACTB F 56MM STRL TRDNT II SB TRITANIUM HIP,"$2,302.50",$0.00,"$2,302.50","$1,036.13","$1,643.29",$0.00,$396.71,$0.00,$0.00,$403.15,"$2,302.50",$0.00,"$1,151.25","$1,823.58","$1,842.00",$0.00,$360.34,$0.00,$366.56,$0.00
700-04-58F,SUP,HCPCS C1776,,700-04-58F  -  SHELL ACTB F 58MM STRL TRDNT II SB TRITANIUM HIP,"$2,302.50",$0.00,"$2,302.50","$1,036.13","$1,643.29",$0.00,$396.71,$0.00,$0.00,$403.15,"$2,302.50",$0.00,"$1,151.25","$1,823.58","$1,842.00",$0.00,$360.34,$0.00,$366.56,$0.00
70-0046,SUP,HCPCS C1713,,70-0046  -  PLATE BN STD RT DIST VOLR ULN,"$2,575.00",$0.00,"$2,575.00","$1,158.75","$1,837.78",$0.00,$443.66,$0.00,$0.00,$450.86,"$2,575.00",$0.00,"$1,287.50","$2,039.40","$2,060.00",$0.00,$402.99,$0.00,$409.94,$0.00
700-04-60G,SUP,HCPCS C1776,,700-04-60G  -  SHELL ACTB G 60MM STRL TRDNT II SB TRITANIUM HIP,"$2,302.50",$0.00,"$2,302.50","$1,036.13","$1,643.29",$0.00,$396.71,$0.00,$0.00,$403.15,"$2,302.50",$0.00,"$1,151.25","$1,823.58","$1,842.00",$0.00,$360.34,$0.00,$366.56,$0.00
700-04-62G,SUP,HCPCS C1776,,700-04-62G  -  SHELL ACTB G 62MM STRL TRDNT II SB TRITANIUM HIP,"$2,302.50",$0.00,"$2,302.50","$1,036.13","$1,643.29",$0.00,$396.71,$0.00,$0.00,$403.15,"$2,302.50",$0.00,"$1,151.25","$1,823.58","$1,842.00",$0.00,$360.34,$0.00,$366.56,$0.00
700-04-64H,SUP,HCPCS C1776,,700-04-64H  -  SHELL ACTB H 64MM STRL TRDNT II SB TRITANIUM HIP,"$2,302.50",$0.00,"$2,302.50","$1,036.13","$1,643.29",$0.00,$396.71,$0.00,$0.00,$403.15,"$2,302.50",$0.00,"$1,151.25","$1,823.58","$1,842.00",$0.00,$360.34,$0.00,$366.56,$0.00
700-04-66H,SUP,HCPCS C1776,,700-04-66H  -  SHELL ACTB H 66MM STRL TRDNT II SB TRITANIUM HIP,"$2,302.50",$0.00,"$2,302.50","$1,036.13","$1,643.29",$0.00,$396.71,$0.00,$0.00,$403.15,"$2,302.50",$0.00,"$1,151.25","$1,823.58","$1,842.00",$0.00,$360.34,$0.00,$366.56,$0.00
70-0047,SUP,HCPCS C1713,,70-0047  -  PLATE BN LNG LG DIST ULN,"$2,575.00",$0.00,"$2,575.00","$1,158.75","$1,837.78",$0.00,$443.66,$0.00,$0.00,$450.86,"$2,575.00",$0.00,"$1,287.50","$2,039.40","$2,060.00",$0.00,$402.99,$0.00,$409.94,$0.00
70-0048,SUP,HCPCS C1713,,70-0048  -  PLATE BN LNG NS ACLC LOPRFL LCK SHFT FX ANG SCR HL KWR HL TI,"$2,575.00",$0.00,"$2,575.00","$1,158.75","$1,837.78",$0.00,$443.66,$0.00,$0.00,$450.86,"$2,575.00",$0.00,"$1,287.50","$2,039.40","$2,060.00",$0.00,$402.99,$0.00,$409.94,$0.00
70-0049,SUP,HCPCS C1713,,70-0049  -  PLATE 8 HOLE LCK BONE 1ST TARSOMETATARSAL,"$1,280.00",$0.00,"$1,280.00",$576.00,$913.54,$0.00,$220.54,$0.00,$0.00,$224.12,"$1,280.00",$0.00,$640.00,"$1,013.76","$1,024.00",$0.00,$200.32,$0.00,$203.78,$0.00
70-005,SUP,HCPCS C1713,,70-005  -  PLATE STD ACLC BONE DORSAL DISTAL RADL,"$2,362.50",$0.00,"$2,362.50","$1,063.13","$1,686.12",$0.00,$407.05,$0.00,$0.00,$413.65,"$2,362.50",$0.00,"$1,181.25","$1,871.10","$1,890.00",$0.00,$369.73,$0.00,$376.11,$0.00
70-0050,SUP,HCPCS C1713,,70-0050  -  PLATE 7 HOLE LCK BONE 1ST TARSOMETATARSAL,"$1,280.00",$0.00,"$1,280.00",$576.00,$913.54,$0.00,$220.54,$0.00,$0.00,$224.12,"$1,280.00",$0.00,$640.00,"$1,013.76","$1,024.00",$0.00,$200.32,$0.00,$203.78,$0.00
70-0051,SUP,HCPCS C1713,,70-0051  -  PLATE 7 HOLE LCK BONE SEC 3RD TARSOMETATARSAL,"$1,280.00",$0.00,"$1,280.00",$576.00,$913.54,$0.00,$220.54,$0.00,$0.00,$224.12,"$1,280.00",$0.00,$640.00,"$1,013.76","$1,024.00",$0.00,$200.32,$0.00,$203.78,$0.00
70-0052,SUP,HCPCS C1713,,70-0052  -  PLATE MPJ LOW PROFILE 4 DEGREE L,"$1,280.00",$0.00,"$1,280.00",$576.00,$913.54,$0.00,$220.54,$0.00,$0.00,$224.12,"$1,280.00",$0.00,$640.00,"$1,013.76","$1,024.00",$0.00,$200.32,$0.00,$203.78,$0.00
70-0053,SUP,HCPCS C1713,,70-0053  -  PLATE MPJ LOW PROFILE 4 DEGREE R,"$1,280.00",$0.00,"$1,280.00",$576.00,$913.54,$0.00,$220.54,$0.00,$0.00,$224.12,"$1,280.00",$0.00,$640.00,"$1,013.76","$1,024.00",$0.00,$200.32,$0.00,$203.78,$0.00
70-0055,SUP,HCPCS C1713,,70-0055  -  PLATE STD TI ACLC BONE LEFT DISTAL DORSAL RADL STRL,"$2,575.00",$0.00,"$2,575.00","$1,158.75","$1,837.78",$0.00,$443.66,$0.00,$0.00,$450.86,"$2,575.00",$0.00,"$1,287.50","$2,039.40","$2,060.00",$0.00,$402.99,$0.00,$409.94,$0.00
70-0056,SUP,HCPCS C1713,,70-0056  -  PLATE BN STD ACLC TI RT DRSL,"$2,575.00",$0.00,"$2,575.00","$1,158.75","$1,837.78",$0.00,$443.66,$0.00,$0.00,$450.86,"$2,575.00",$0.00,"$1,287.50","$2,039.40","$2,060.00",$0.00,$402.99,$0.00,$409.94,$0.00
70-0057,SUP,HCPCS C1713,,70-0057  -  PLATE BN NAR NS ACLC LOPRFL LCK SHFT FX ANG SCR HL KWR HL TI,"$2,575.00",$0.00,"$2,575.00","$1,158.75","$1,837.78",$0.00,$443.66,$0.00,$0.00,$450.86,"$2,575.00",$0.00,"$1,287.50","$2,039.40","$2,060.00",$0.00,$402.99,$0.00,$409.94,$0.00
70-0058,SUP,HCPCS C1713,,70-0058  -  PLATE BN NAR ACLC RT DRSL,"$2,575.00",$0.00,"$2,575.00","$1,158.75","$1,837.78",$0.00,$443.66,$0.00,$0.00,$450.86,"$2,575.00",$0.00,"$1,287.50","$2,039.40","$2,060.00",$0.00,$402.99,$0.00,$409.94,$0.00
70-0063,SUP,HCPCS C1713,,70-0063  -  PLATE BN STD STRL ACLC XTD,"$2,575.00",$0.00,"$2,575.00","$1,158.75","$1,837.78",$0.00,$443.66,$0.00,$0.00,$450.86,"$2,575.00",$0.00,"$1,287.50","$2,039.40","$2,060.00",$0.00,$402.99,$0.00,$409.94,$0.00
70-0064,SUP,HCPCS C1713,,70-0064  -  PLATE NAR TI ACLC BONE LEFT DISTAL VOLR ULN,"$2,575.00",$0.00,"$2,575.00","$1,158.75","$1,837.78",$0.00,$443.66,$0.00,$0.00,$450.86,"$2,575.00",$0.00,"$1,287.50","$2,039.40","$2,060.00",$0.00,$402.99,$0.00,$409.94,$0.00
70-0066,SUP,HCPCS C1713,,70-0066  -  PLATE 80MM 6 HOLE MIDSHAFT ACUMED BONE VOLR RADL STRL,"$2,315.00",$0.00,"$2,315.00","$1,041.75","$1,652.22",$0.00,$398.86,$0.00,$0.00,$405.34,"$2,315.00",$0.00,"$1,157.50","$1,833.48","$1,852.00",$0.00,$362.30,$0.00,$368.55,$0.00
70-0067,SUP,HCPCS C1713,,70-0067  -  PLATE TI 8 HOLE MIDSHAFT BONE VOLR RADL,"$2,315.00",$0.00,"$2,315.00","$1,041.75","$1,652.22",$0.00,$398.86,$0.00,$0.00,$405.34,"$2,315.00",$0.00,"$1,157.50","$1,833.48","$1,852.00",$0.00,$362.30,$0.00,$368.55,$0.00
70-0068,SUP,HCPCS C1713,,70-0068  -  PLATE 10 HOLE MIDSHAFT ACUMED BONE VOLR RADL STRL,"$2,315.00",$0.00,"$2,315.00","$1,041.75","$1,652.22",$0.00,$398.86,$0.00,$0.00,$405.34,"$2,315.00",$0.00,"$1,157.50","$1,833.48","$1,852.00",$0.00,$362.30,$0.00,$368.55,$0.00
70-0069,SUP,HCPCS C1713,,70-0069  -  PLATE 160MM 12 HOLE MIDSHAFT BONE VOLR RADL,"$2,315.00",$0.00,"$2,315.00","$1,041.75","$1,652.22",$0.00,$398.86,$0.00,$0.00,$405.34,"$2,315.00",$0.00,"$1,157.50","$1,833.48","$1,852.00",$0.00,$362.30,$0.00,$368.55,$0.00
70-0070,SUP,HCPCS C1713,,70-0070  -  PLATE BN 80MM NS 6 HL MIDSHAFT LOPRFL ULNA,"$2,315.00",$0.00,"$2,315.00","$1,041.75","$1,652.22",$0.00,$398.86,$0.00,$0.00,$405.34,"$2,315.00",$0.00,"$1,157.50","$1,833.48","$1,852.00",$0.00,$362.30,$0.00,$368.55,$0.00
70-0071,SUP,HCPCS C1713,,70-0071  -  PLATE BN 100MM NS 8 HL MIDSHAFT LOPRFL ULNA,"$2,315.00",$0.00,"$2,315.00","$1,041.75","$1,652.22",$0.00,$398.86,$0.00,$0.00,$405.34,"$2,315.00",$0.00,"$1,157.50","$1,833.48","$1,852.00",$0.00,$362.30,$0.00,$368.55,$0.00
70-0072,SUP,HCPCS C1713,,70-0072  -  PLATE TI 10 HOLE BONE ULN,"$2,315.00",$0.00,"$2,315.00","$1,041.75","$1,652.22",$0.00,$398.86,$0.00,$0.00,$405.34,"$2,315.00",$0.00,"$1,157.50","$1,833.48","$1,852.00",$0.00,$362.30,$0.00,$368.55,$0.00
70-0073,SUP,HCPCS C1713,,70-0073  -  PLATE 12 HOLE MIDSHAFT BONE ULN,"$2,315.00",$0.00,"$2,315.00","$1,041.75","$1,652.22",$0.00,$398.86,$0.00,$0.00,$405.34,"$2,315.00",$0.00,"$1,157.50","$1,833.48","$1,852.00",$0.00,$362.30,$0.00,$368.55,$0.00
70-0074,SUP,HCPCS C1713,,70-0074  -  PLATE 6 HOLE MIDSHAFT BONE ULN,"$2,315.00",$0.00,"$2,315.00","$1,041.75","$1,652.22",$0.00,$398.86,$0.00,$0.00,$405.34,"$2,315.00",$0.00,"$1,157.50","$1,833.48","$1,852.00",$0.00,$362.30,$0.00,$368.55,$0.00
70-0075,SUP,HCPCS C1713,,70-0075  -  PLATE BN 100MM NS 8 HL MIDSHAFT LOPRFL RDS DORSOLATERAL,"$2,315.00",$0.00,"$2,315.00","$1,041.75","$1,652.22",$0.00,$398.86,$0.00,$0.00,$405.34,"$2,315.00",$0.00,"$1,157.50","$1,833.48","$1,852.00",$0.00,$362.30,$0.00,$368.55,$0.00
70-0076,SUP,HCPCS C1713,,70-0076  -  PLATE 10 HOLE BONE DORSOLATERAL RADL,"$2,315.00",$0.00,"$2,315.00","$1,041.75","$1,652.22",$0.00,$398.86,$0.00,$0.00,$405.34,"$2,315.00",$0.00,"$1,157.50","$1,833.48","$1,852.00",$0.00,$362.30,$0.00,$368.55,$0.00
70-0077,SUP,HCPCS C1713,,70-0077  -  PLATE 12 HOLE BONE DORSOLATERAL RADL,"$2,315.00",$0.00,"$2,315.00","$1,041.75","$1,652.22",$0.00,$398.86,$0.00,$0.00,$405.34,"$2,315.00",$0.00,"$1,157.50","$1,833.48","$1,852.00",$0.00,$362.30,$0.00,$368.55,$0.00
70-0078,SUP,HCPCS C1713,,70-0078  -  PLATE MPJ PETIETE 4 DEGREE L,"$1,280.00",$0.00,"$1,280.00",$576.00,$913.54,$0.00,$220.54,$0.00,$0.00,$224.12,"$1,280.00",$0.00,$640.00,"$1,013.76","$1,024.00",$0.00,$200.32,$0.00,$203.78,$0.00
70-0079,SUP,HCPCS C1713,,70-0079  -  PLATE MPJ PETIETE 4 DEGREE R,"$1,280.00",$0.00,"$1,280.00",$576.00,$913.54,$0.00,$220.54,$0.00,$0.00,$224.12,"$1,280.00",$0.00,$640.00,"$1,013.76","$1,024.00",$0.00,$200.32,$0.00,$203.78,$0.00
70-0097,SUP,HCPCS C1713,,70-0097  -  PLATE BN STD CRVTR 31MM NS 3 HL LCK RADL HD,"$2,652.50",$0.00,"$2,652.50","$1,193.63","$1,893.09",$0.00,$457.01,$0.00,$0.00,$464.43,"$2,652.50",$0.00,"$1,326.25","$2,100.78","$2,122.00",$0.00,$415.12,$0.00,$422.28,$0.00
70-0098,SUP,HCPCS C1713,,70-0098  -  PLATE BN 5 HLE/HD LCK RDS,"$2,652.50",$0.00,"$2,652.50","$1,193.63","$1,893.09",$0.00,$457.01,$0.00,$0.00,$464.43,"$2,652.50",$0.00,"$1,326.25","$2,100.78","$2,122.00",$0.00,$415.12,$0.00,$422.28,$0.00
70-0099,SUP,HCPCS C1713,,70-0099  -  PLATE BN SM CRV 3 HL LCK RDS HD,"$2,652.50",$0.00,"$2,652.50","$1,193.63","$1,893.09",$0.00,$457.01,$0.00,$0.00,$464.43,"$2,652.50",$0.00,"$1,326.25","$2,100.78","$2,122.00",$0.00,$415.12,$0.00,$422.28,$0.00
7000AC,SUP,Custom 27803010,,7000AC  -  CLAMP SPNL SPRL R90D,"$1,615.25",$0.00,"$1,615.25",$0.00,"$1,152.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,615.25",$0.00,$807.63,"$1,279.28","$1,292.20",$0.00,$0.00,$0.00,$0.00,$0.00
7000OC,SUP,Custom 27803010,,7000OC  -  CLIP FX SPRL R90D OFST CRNL,"$2,147.68",$0.00,"$2,147.68",$0.00,"$1,532.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,147.68",$0.00,"$1,073.84","$1,700.96","$1,718.14",$0.00,$0.00,$0.00,$0.00,$0.00
7000SOL,SUP,HCPCS C1713,,7000SOL  -  SCREW BN LG SPRL R90D OFST TI THORLMBR SPNE,"$1,534.38",$0.00,"$1,534.38",$690.47,"$1,095.08",$0.00,$264.37,$0.00,$0.00,$268.66,"$1,534.38",$0.00,$767.19,"$1,215.23","$1,227.50",$0.00,$240.13,$0.00,$244.27,$0.00
7000SOS,SUP,HCPCS C1713,,7000SOS  -  SCREW BN SHRT SPRL R90D OFST TI THORLMBR SPNE,"$1,534.38",$0.00,"$1,534.38",$690.47,"$1,095.08",$0.00,$264.37,$0.00,$0.00,$268.66,"$1,534.38",$0.00,$767.19,"$1,215.23","$1,227.50",$0.00,$240.13,$0.00,$244.27,$0.00
70-0100,SUP,HCPCS C1713,,70-0100  -  PLATE SM 5 HOLE LCK CRVTR BONE RADL HEAD STRL,"$2,652.50",$0.00,"$2,652.50","$1,193.63","$1,893.09",$0.00,$457.01,$0.00,$0.00,$464.43,"$2,652.50",$0.00,"$1,326.25","$2,100.78","$2,122.00",$0.00,$415.12,$0.00,$422.28,$0.00
70-0109,SUP,HCPCS C1713,,70-0109  -  PLATE BONE LEFT TIB MTP,"$1,280.00",$0.00,"$1,280.00",$576.00,$913.54,$0.00,$220.54,$0.00,$0.00,$224.12,"$1,280.00",$0.00,$640.00,"$1,013.76","$1,024.00",$0.00,$200.32,$0.00,$203.78,$0.00
70-0110,SUP,HCPCS C1713,,70-0110  -  PLATE BONE RIGHT TIB MTP,"$1,280.00",$0.00,"$1,280.00",$576.00,$913.54,$0.00,$220.54,$0.00,$0.00,$224.12,"$1,280.00",$0.00,$640.00,"$1,013.76","$1,024.00",$0.00,$200.32,$0.00,$203.78,$0.00
70-0111,SUP,HCPCS C1713,,70-0111  -  PLATE BN 12 HL LCK LT DIST 3.5 MM SCR,"$2,057.50",$0.00,"$2,057.50",$925.88,"$1,468.44",$0.00,$354.50,$0.00,$0.00,$360.25,"$2,057.50",$0.00,"$1,028.75","$1,629.54","$1,646.00",$0.00,$322.00,$0.00,$327.55,$0.00
70-0112,SUP,HCPCS C1713,,70-0112  -  PLATE BN 12 HL LCK LT DIST 3.5 MM SCR,"$2,057.50",$0.00,"$2,057.50",$925.88,"$1,468.44",$0.00,$354.50,$0.00,$0.00,$360.25,"$2,057.50",$0.00,"$1,028.75","$1,629.54","$1,646.00",$0.00,$322.00,$0.00,$327.55,$0.00
70-0116,SUP,HCPCS C1713,,70-0116  -  PLATE BN 9 HL LCK LT DIST 3.5 MM SCR,"$2,057.50",$0.00,"$2,057.50",$925.88,"$1,468.44",$0.00,$354.50,$0.00,$0.00,$360.25,"$2,057.50",$0.00,"$1,028.75","$1,629.54","$1,646.00",$0.00,$322.00,$0.00,$327.55,$0.00
70-0117,SUP,HCPCS C1713,,70-0117  -  PLATE BN DIST CLVCL,"$2,057.50",$0.00,"$2,057.50",$925.88,"$1,468.44",$0.00,$354.50,$0.00,$0.00,$360.25,"$2,057.50",$0.00,"$1,028.75","$1,629.54","$1,646.00",$0.00,$322.00,$0.00,$327.55,$0.00
70-0118,SUP,HCPCS C1713,,70-0118  -  PLATE BN 8 HL LAT ANT,"$2,057.50",$0.00,"$2,057.50",$925.88,"$1,468.44",$0.00,$354.50,$0.00,$0.00,$360.25,"$2,057.50",$0.00,"$1,028.75","$1,629.54","$1,646.00",$0.00,$322.00,$0.00,$327.55,$0.00
70-0119,SUP,HCPCS C1713,,70-0119  -  PLATE BN 8 HL LCK ANT MDL,"$2,057.50",$0.00,"$2,057.50",$925.88,"$1,468.44",$0.00,$354.50,$0.00,$0.00,$360.25,"$2,057.50",$0.00,"$1,028.75","$1,629.54","$1,646.00",$0.00,$322.00,$0.00,$327.55,$0.00
70-0120,SUP,HCPCS C1713,,70-0120  -  PLATE BN 6 HL LCK ANT MDL,"$2,057.50",$0.00,"$2,057.50",$925.88,"$1,468.44",$0.00,$354.50,$0.00,$0.00,$360.25,"$2,057.50",$0.00,"$1,028.75","$1,629.54","$1,646.00",$0.00,$322.00,$0.00,$327.55,$0.00
70-0121,SUP,HCPCS C1713,,70-0121  -  PLATE BN 10 HL ANT CLVCL,"$2,057.50",$0.00,"$2,057.50",$925.88,"$1,468.44",$0.00,$354.50,$0.00,$0.00,$360.25,"$2,057.50",$0.00,"$1,028.75","$1,629.54","$1,646.00",$0.00,$322.00,$0.00,$327.55,$0.00
70-0122,SUP,HCPCS C1713,,70-0122  -  PLATE BN 6 HL LCK ANT LAT,"$2,057.50",$0.00,"$2,057.50",$925.88,"$1,468.44",$0.00,$354.50,$0.00,$0.00,$360.25,"$2,057.50",$0.00,"$1,028.75","$1,629.54","$1,646.00",$0.00,$322.00,$0.00,$327.55,$0.00
70-0123,SUP,HCPCS C1713,,70-0123  -  PLATE BN 16 HL LCK RT DIST 2.3 MM SCR,"$2,057.50",$0.00,"$2,057.50",$925.88,"$1,468.44",$0.00,$354.50,$0.00,$0.00,$360.25,"$2,057.50",$0.00,"$1,028.75","$1,629.54","$1,646.00",$0.00,$322.00,$0.00,$327.55,$0.00
70-0124,SUP,HCPCS C1713,,70-0124  -  PLATE BN 101X11MM NS 16 HL LCK LOPRFL TI CLVCL LT DIST 2.3MM,"$2,057.50",$0.00,"$2,057.50",$925.88,"$1,468.44",$0.00,$354.50,$0.00,$0.00,$360.25,"$2,057.50",$0.00,"$1,028.75","$1,629.54","$1,646.00",$0.00,$322.00,$0.00,$327.55,$0.00
70-0125,SUP,HCPCS C1713,,70-0125  -  PLATE BN 13 HL LCK RT DIST 2.3 MM SCR,"$2,057.50",$0.00,"$2,057.50",$925.88,"$1,468.44",$0.00,$354.50,$0.00,$0.00,$360.25,"$2,057.50",$0.00,"$1,028.75","$1,629.54","$1,646.00",$0.00,$322.00,$0.00,$327.55,$0.00
70-0126,SUP,HCPCS C1713,,70-0126  -  PLATE BN 68X11MM NS 13 HL LCK LOPRFL TI CLVCL LT DIST 2.3MM,"$2,057.50",$0.00,"$2,057.50",$925.88,"$1,468.44",$0.00,$354.50,$0.00,$0.00,$360.25,"$2,057.50",$0.00,"$1,028.75","$1,629.54","$1,646.00",$0.00,$322.00,$0.00,$327.55,$0.00
70-0141,SUP,HCPCS C1713,,70-0141  -  PLATE 4D BONE LEFT MTP,"$1,280.00",$0.00,"$1,280.00",$576.00,$913.54,$0.00,$220.54,$0.00,$0.00,$224.12,"$1,280.00",$0.00,$640.00,"$1,013.76","$1,024.00",$0.00,$200.32,$0.00,$203.78,$0.00
70-0142,SUP,HCPCS C1713,,70-0142  -  PLATE 4D BONE RIGHT MTP,"$1,280.00",$0.00,"$1,280.00",$576.00,$913.54,$0.00,$220.54,$0.00,$0.00,$224.12,"$1,280.00",$0.00,$640.00,"$1,013.76","$1,024.00",$0.00,$200.32,$0.00,$203.78,$0.00
70-0143,SUP,HCPCS C1713,,70-0143  -  PLATE REV BONE LEFT MTP,"$1,280.00",$0.00,"$1,280.00",$576.00,$913.54,$0.00,$220.54,$0.00,$0.00,$224.12,"$1,280.00",$0.00,$640.00,"$1,013.76","$1,024.00",$0.00,$200.32,$0.00,$203.78,$0.00
70-0144,SUP,HCPCS C1713,,70-0144  -  PLATE REV BONE RIGHT MTP,"$1,280.00",$0.00,"$1,280.00",$576.00,$913.54,$0.00,$220.54,$0.00,$0.00,$224.12,"$1,280.00",$0.00,$640.00,"$1,013.76","$1,024.00",$0.00,$200.32,$0.00,$203.78,$0.00
70-0145,SUP,HCPCS C1713,,70-0145  -  PLATE 5 HOLE BONE FIB,"$3,222.50",$0.00,"$3,222.50","$1,450.13","$2,299.90",$0.00,$555.22,$0.00,$0.00,$564.23,"$3,222.50",$0.00,"$1,611.25","$2,552.22","$2,578.00",$0.00,$504.32,$0.00,$513.02,$0.00
70-0147,SUP,HCPCS C1713,,70-0147  -  PLATE 7 HOLE LCK BONE LAT FIB,"$3,222.50",$0.00,"$3,222.50","$1,450.13","$2,299.90",$0.00,$555.22,$0.00,$0.00,$564.23,"$3,222.50",$0.00,"$1,611.25","$2,552.22","$2,578.00",$0.00,$504.32,$0.00,$513.02,$0.00
70-0149,SUP,HCPCS C1713,,70-0149  -  PLATE 9 HOLE LP LCK BONE LAT FIB ANKL,"$3,222.50",$0.00,"$3,222.50","$1,450.13","$2,299.90",$0.00,$555.22,$0.00,$0.00,$564.23,"$3,222.50",$0.00,"$1,611.25","$2,552.22","$2,578.00",$0.00,$504.32,$0.00,$513.02,$0.00
70-0151,SUP,HCPCS C1713,,70-0151  -  PLATE 11 HOLE LCK LP TYPE 2 ANODIZE FNSH BONE LAT FIB ANKL,"$3,222.50",$0.00,"$3,222.50","$1,450.13","$2,299.90",$0.00,$555.22,$0.00,$0.00,$564.23,"$3,222.50",$0.00,"$1,611.25","$2,552.22","$2,578.00",$0.00,$504.32,$0.00,$513.02,$0.00
70-0153,SUP,HCPCS C1713,,70-0153  -  PLATE 13 HOLE LCK LP BONE LAT FIB ANKL NONSTRL,"$3,222.50",$0.00,"$3,222.50","$1,450.13","$2,299.90",$0.00,$555.22,$0.00,$0.00,$564.23,"$3,222.50",$0.00,"$1,611.25","$2,552.22","$2,578.00",$0.00,$504.32,$0.00,$513.02,$0.00
70-0169,SUP,HCPCS C1713,,70-0169  -  PLATE BN STD 9 HL LCK LAT FIB,"$3,222.50",$0.00,"$3,222.50","$1,450.13","$2,299.90",$0.00,$555.22,$0.00,$0.00,$564.23,"$3,222.50",$0.00,"$1,611.25","$2,552.22","$2,578.00",$0.00,$504.32,$0.00,$513.02,$0.00
70-0171,SUP,HCPCS C1713,,70-0171  -  PLATE 11 HOLE LCK BONE LAT FIB ANKL NONSTRL,"$3,222.50",$0.00,"$3,222.50","$1,450.13","$2,299.90",$0.00,$555.22,$0.00,$0.00,$564.23,"$3,222.50",$0.00,"$1,611.25","$2,552.22","$2,578.00",$0.00,$504.32,$0.00,$513.02,$0.00
70-0173,SUP,HCPCS C1713,,70-0173  -  PLATE 13 HOLE LCK BONE LAT FIB ANKL,"$3,222.50",$0.00,"$3,222.50","$1,450.13","$2,299.90",$0.00,$555.22,$0.00,$0.00,$564.23,"$3,222.50",$0.00,"$1,611.25","$2,552.22","$2,578.00",$0.00,$504.32,$0.00,$513.02,$0.00
70-0227,SUP,HCPCS C1713,,70-0227  -  PLATE 7 HOLE LCK LP BONE MDL TIB NONSTRL,"$3,222.50",$0.00,"$3,222.50","$1,450.13","$2,299.90",$0.00,$555.22,$0.00,$0.00,$564.23,"$3,222.50",$0.00,"$1,611.25","$2,552.22","$2,578.00",$0.00,$504.32,$0.00,$513.02,$0.00
70-0229,SUP,HCPCS C1713,,70-0229  -  PLATE 9 HOLE BONE MDL TIB,"$3,222.50",$0.00,"$3,222.50","$1,450.13","$2,299.90",$0.00,$555.22,$0.00,$0.00,$564.23,"$3,222.50",$0.00,"$1,611.25","$2,552.22","$2,578.00",$0.00,$504.32,$0.00,$513.02,$0.00
70-0245,SUP,HCPCS C1713,,70-0245  -  PLATE 5 HOLE LCK LP BONE ANT TIB NONSTRL,"$3,222.50",$0.00,"$3,222.50","$1,450.13","$2,299.90",$0.00,$555.22,$0.00,$0.00,$564.23,"$3,222.50",$0.00,"$1,611.25","$2,552.22","$2,578.00",$0.00,$504.32,$0.00,$513.02,$0.00
70-0247,SUP,HCPCS C1713,,70-0247  -  PLATE 7 HOLE LCK LP BONE ANT TIB NONSTRL,"$3,222.50",$0.00,"$3,222.50","$1,450.13","$2,299.90",$0.00,$555.22,$0.00,$0.00,$564.23,"$3,222.50",$0.00,"$1,611.25","$2,552.22","$2,578.00",$0.00,$504.32,$0.00,$513.02,$0.00
70-0286,SUP,HCPCS C1713,,70-0286  -  PLATE BN 8 HL STRG LOPRFL CLVCL,"$2,057.50",$0.00,"$2,057.50",$925.88,"$1,468.44",$0.00,$354.50,$0.00,$0.00,$360.25,"$2,057.50",$0.00,"$1,028.75","$1,629.54","$1,646.00",$0.00,$322.00,$0.00,$327.55,$0.00
70-0287,SUP,HCPCS C1713,,70-0287  -  PLATE BN 8 HL LOPRFL STRG RT CLVCL,"$2,057.50",$0.00,"$2,057.50",$925.88,"$1,468.44",$0.00,$354.50,$0.00,$0.00,$360.25,"$2,057.50",$0.00,"$1,028.75","$1,629.54","$1,646.00",$0.00,$322.00,$0.00,$327.55,$0.00
70-0288,SUP,HCPCS C1713,,70-0288  -  PLATE BN LNG 8 HL LOPRFL LT CLVCL,"$2,057.50",$0.00,"$2,057.50",$925.88,"$1,468.44",$0.00,$354.50,$0.00,$0.00,$360.25,"$2,057.50",$0.00,"$1,028.75","$1,629.54","$1,646.00",$0.00,$322.00,$0.00,$327.55,$0.00
70-0289,SUP,HCPCS C1713,,70-0289  -  PLATE BN LNG 8 HL LOPRFL RT CLVCL,"$2,057.50",$0.00,"$2,057.50",$925.88,"$1,468.44",$0.00,$354.50,$0.00,$0.00,$360.25,"$2,057.50",$0.00,"$1,028.75","$1,629.54","$1,646.00",$0.00,$322.00,$0.00,$327.55,$0.00
70-0290,SUP,HCPCS C1713,,70-0290  -  PLATE BN 8 HL LT CLVCL,"$2,057.50",$0.00,"$2,057.50",$925.88,"$1,468.44",$0.00,$354.50,$0.00,$0.00,$360.25,"$2,057.50",$0.00,"$1,028.75","$1,629.54","$1,646.00",$0.00,$322.00,$0.00,$327.55,$0.00
70-0291,SUP,HCPCS C1713,,70-0291  -  PLATE BN MED 8 HL LOPRFL RT CLVCL,"$2,057.50",$0.00,"$2,057.50",$925.88,"$1,468.44",$0.00,$354.50,$0.00,$0.00,$360.25,"$2,057.50",$0.00,"$1,028.75","$1,629.54","$1,646.00",$0.00,$322.00,$0.00,$327.55,$0.00
70-0292,SUP,HCPCS C1713,,70-0292  -  PLATE BN SM 8 HL LOPRFL LT CLVCL,"$2,057.50",$0.00,"$2,057.50",$925.88,"$1,468.44",$0.00,$354.50,$0.00,$0.00,$360.25,"$2,057.50",$0.00,"$1,028.75","$1,629.54","$1,646.00",$0.00,$322.00,$0.00,$327.55,$0.00
70-0293,SUP,HCPCS C1713,,70-0293  -  PLATE BN SM 8 HL LOPRFL RT CLVCL,"$2,057.50",$0.00,"$2,057.50",$925.88,"$1,468.44",$0.00,$354.50,$0.00,$0.00,$360.25,"$2,057.50",$0.00,"$1,028.75","$1,629.54","$1,646.00",$0.00,$322.00,$0.00,$327.55,$0.00
70-0294,SUP,HCPCS C1713,,70-0294  -  PLATE BN LG 121X11MM NS 10 HL LCK MIDSHAFT LOPRFL TI CLVCL,"$2,057.50",$0.00,"$2,057.50",$925.88,"$1,468.44",$0.00,$354.50,$0.00,$0.00,$360.25,"$2,057.50",$0.00,"$1,028.75","$1,629.54","$1,646.00",$0.00,$322.00,$0.00,$327.55,$0.00
70-0295,SUP,HCPCS C1713,,70-0295  -  PLATE BN 10 HL LOPRFL RT CLVCL,"$2,057.50",$0.00,"$2,057.50",$925.88,"$1,468.44",$0.00,$354.50,$0.00,$0.00,$360.25,"$2,057.50",$0.00,"$1,028.75","$1,629.54","$1,646.00",$0.00,$322.00,$0.00,$327.55,$0.00
70-0296,SUP,HCPCS C1713,,70-0296  -  PLATE BN 6 HL LT CLVCL,"$2,057.50",$0.00,"$2,057.50",$925.88,"$1,468.44",$0.00,$354.50,$0.00,$0.00,$360.25,"$2,057.50",$0.00,"$1,028.75","$1,629.54","$1,646.00",$0.00,$322.00,$0.00,$327.55,$0.00
70-0297,SUP,HCPCS C1713,,70-0297  -  PLATE BN NAR 6 HL LOPRFL RT CLVCL,"$2,057.50",$0.00,"$2,057.50",$925.88,"$1,468.44",$0.00,$354.50,$0.00,$0.00,$360.25,"$2,057.50",$0.00,"$1,028.75","$1,629.54","$1,646.00",$0.00,$322.00,$0.00,$327.55,$0.00
70-0298,SUP,HCPCS C1713,,70-0298  -  PLATE BN 8 HL STRG LT CLVCL,"$2,057.50",$0.00,"$2,057.50",$925.88,"$1,468.44",$0.00,$354.50,$0.00,$0.00,$360.25,"$2,057.50",$0.00,"$1,028.75","$1,629.54","$1,646.00",$0.00,$322.00,$0.00,$327.55,$0.00
70-0299,SUP,HCPCS C1713,,70-0299  -  PLATE BN NAR 8 HL LOPRFL STRG RT CLVCL,"$2,057.50",$0.00,"$2,057.50",$925.88,"$1,468.44",$0.00,$354.50,$0.00,$0.00,$360.25,"$2,057.50",$0.00,"$1,028.75","$1,629.54","$1,646.00",$0.00,$322.00,$0.00,$327.55,$0.00
70-0300,SUP,HCPCS C1713,,70-0300  -  PLATE BN 8 HL LT CLVCL,"$2,057.50",$0.00,"$2,057.50",$925.88,"$1,468.44",$0.00,$354.50,$0.00,$0.00,$360.25,"$2,057.50",$0.00,"$1,028.75","$1,629.54","$1,646.00",$0.00,$322.00,$0.00,$327.55,$0.00
70-0301,SUP,HCPCS C1713,,70-0301  -  PLATE BN NAR 8 HL LOPRFL RT CLVCL,"$2,057.50",$0.00,"$2,057.50",$925.88,"$1,468.44",$0.00,$354.50,$0.00,$0.00,$360.25,"$2,057.50",$0.00,"$1,028.75","$1,629.54","$1,646.00",$0.00,$322.00,$0.00,$327.55,$0.00
70-0302,SUP,HCPCS C1713,,70-0302  -  PLATE BN STD 65MM NS 3 HL LOPRFL OLCRN LT,"$3,137.50",$0.00,"$3,137.50","$1,411.88","$2,239.23",$0.00,$540.58,$0.00,$0.00,$549.35,"$3,137.50",$0.00,"$1,568.75","$2,484.90","$2,510.00",$0.00,$491.02,$0.00,$499.49,$0.00
70-0303,SUP,HCPCS C1713,,70-0303  -  PLATE BN STD 65MM NS 3 HL LOPRFL OLCRN RT,"$3,137.50",$0.00,"$3,137.50","$1,411.88","$2,239.23",$0.00,$540.58,$0.00,$0.00,$549.35,"$3,137.50",$0.00,"$1,568.75","$2,484.90","$2,510.00",$0.00,$491.02,$0.00,$499.49,$0.00
70-0304,SUP,HCPCS C1713,,70-0304  -  PLATE BN STD 90MM NS 5 HL LOPRFL OLCRN LT,"$3,137.50",$0.00,"$3,137.50","$1,411.88","$2,239.23",$0.00,$540.58,$0.00,$0.00,$549.35,"$3,137.50",$0.00,"$1,568.75","$2,484.90","$2,510.00",$0.00,$491.02,$0.00,$499.49,$0.00
70-0305,SUP,HCPCS C1713,,70-0305  -  PLATE BN STD 90MM NS 5 HL LOPRFL OLCRN RT,"$3,137.50",$0.00,"$3,137.50","$1,411.88","$2,239.23",$0.00,$540.58,$0.00,$0.00,$549.35,"$3,137.50",$0.00,"$1,568.75","$2,484.90","$2,510.00",$0.00,$491.02,$0.00,$499.49,$0.00
70-0306,SUP,HCPCS C1713,,70-0306  -  PLATE BN STD 110MM NS 7 HL LOPRFL DIST TPR LMT CNTCT OLCRN,"$3,137.50",$0.00,"$3,137.50","$1,411.88","$2,239.23",$0.00,$540.58,$0.00,$0.00,$549.35,"$3,137.50",$0.00,"$1,568.75","$2,484.90","$2,510.00",$0.00,$491.02,$0.00,$499.49,$0.00
70-0307,SUP,HCPCS C1713,,70-0307  -  PLATE BN STD 110MM NS 7 HL LOPRFL OLCRN RT,"$3,137.50",$0.00,"$3,137.50","$1,411.88","$2,239.23",$0.00,$540.58,$0.00,$0.00,$549.35,"$3,137.50",$0.00,"$1,568.75","$2,484.90","$2,510.00",$0.00,$491.02,$0.00,$499.49,$0.00
70-0308,SUP,HCPCS C1713,,70-0308  -  PLATE BN STD 150MM NS 11 HL LOPRFL OLCRN LT,"$3,137.50",$0.00,"$3,137.50","$1,411.88","$2,239.23",$0.00,$540.58,$0.00,$0.00,$549.35,"$3,137.50",$0.00,"$1,568.75","$2,484.90","$2,510.00",$0.00,$491.02,$0.00,$499.49,$0.00
70-0309,SUP,HCPCS C1713,,70-0309  -  PLATE STD 11 HOLE BONE RIGHT OLCRN,"$3,137.50",$0.00,"$3,137.50","$1,411.88","$2,239.23",$0.00,$540.58,$0.00,$0.00,$549.35,"$3,137.50",$0.00,"$1,568.75","$2,484.90","$2,510.00",$0.00,$491.02,$0.00,$499.49,$0.00
70-0310,SUP,HCPCS C1713,,70-0310  -  PLATE 15 HOLE BONE CLVCL,"$3,137.50",$0.00,"$3,137.50","$1,411.88","$2,239.23",$0.00,$540.58,$0.00,$0.00,$549.35,"$3,137.50",$0.00,"$1,568.75","$2,484.90","$2,510.00",$0.00,$491.02,$0.00,$499.49,$0.00
70-0311,SUP,HCPCS C1713,,70-0311  -  PLATE STD 190MM 15 HOLE PRECONTOURED LP TAP-LOC TCH ANTM,"$3,137.50",$0.00,"$3,137.50","$1,411.88","$2,239.23",$0.00,$540.58,$0.00,$0.00,$549.35,"$3,137.50",$0.00,"$1,568.75","$2,484.90","$2,510.00",$0.00,$491.02,$0.00,$499.49,$0.00
70-0312,SUP,HCPCS C1713,,70-0312  -  PLATE BN 90MM NS 5 HL LOPRFL XTD OLCRN LT,"$3,137.50",$0.00,"$3,137.50","$1,411.88","$2,239.23",$0.00,$540.58,$0.00,$0.00,$549.35,"$3,137.50",$0.00,"$1,568.75","$2,484.90","$2,510.00",$0.00,$491.02,$0.00,$499.49,$0.00
70-0313,SUP,HCPCS C1713,,70-0313  -  PLATE BN 90MM NS 5 HL LOPRFL XTD OLCRN RT,"$3,137.50",$0.00,"$3,137.50","$1,411.88","$2,239.23",$0.00,$540.58,$0.00,$0.00,$549.35,"$3,137.50",$0.00,"$1,568.75","$2,484.90","$2,510.00",$0.00,$491.02,$0.00,$499.49,$0.00
70-0314,SUP,HCPCS C1713,,70-0314  -  PLATE 9 HOLE EXTN BONE OLCRN,"$3,137.50",$0.00,"$3,137.50","$1,411.88","$2,239.23",$0.00,$540.58,$0.00,$0.00,$549.35,"$3,137.50",$0.00,"$1,568.75","$2,484.90","$2,510.00",$0.00,$491.02,$0.00,$499.49,$0.00
70-0315,SUP,HCPCS C1713,,70-0315  -  PLATE 9 HOLE XTD BONE OLCRN,"$3,137.50",$0.00,"$3,137.50","$1,411.88","$2,239.23",$0.00,$540.58,$0.00,$0.00,$549.35,"$3,137.50",$0.00,"$1,568.75","$2,484.90","$2,510.00",$0.00,$491.02,$0.00,$499.49,$0.00
70-0316,SUP,HCPCS C1713,,70-0316  -  PLATE NAR 85MM 5 HOLE BONE LEFT OLCRN,"$3,137.50",$0.00,"$3,137.50","$1,411.88","$2,239.23",$0.00,$540.58,$0.00,$0.00,$549.35,"$3,137.50",$0.00,"$1,568.75","$2,484.90","$2,510.00",$0.00,$491.02,$0.00,$499.49,$0.00
70-0317,SUP,HCPCS C1713,,70-0317  -  PLATE NAR 85MM 5 HOLE OPTN DISTAL TPR DSGN LMT CNTCT PR BONE,"$3,137.50",$0.00,"$3,137.50","$1,411.88","$2,239.23",$0.00,$540.58,$0.00,$0.00,$549.35,"$3,137.50",$0.00,"$1,568.75","$2,484.90","$2,510.00",$0.00,$491.02,$0.00,$499.49,$0.00
70-0319,SUP,HCPCS C1713,,70-0319  -  PLATE BN J LOPRFL LT CLVCL,"$2,057.50",$0.00,"$2,057.50",$925.88,"$1,468.44",$0.00,$354.50,$0.00,$0.00,$360.25,"$2,057.50",$0.00,"$1,028.75","$1,629.54","$1,646.00",$0.00,$322.00,$0.00,$327.55,$0.00
70-0320,SUP,HCPCS C1713,,70-0320  -  PLATE BN J LOPRFL RT CLVCL,"$2,057.50",$0.00,"$2,057.50",$925.88,"$1,468.44",$0.00,$354.50,$0.00,$0.00,$360.25,"$2,057.50",$0.00,"$1,028.75","$1,629.54","$1,646.00",$0.00,$322.00,$0.00,$327.55,$0.00
70-0323,SUP,HCPCS C1713,,70-0323  -  PLATE EXTN OSTMY BONE LEFT,"$1,280.00",$0.00,"$1,280.00",$576.00,$913.54,$0.00,$220.54,$0.00,$0.00,$224.12,"$1,280.00",$0.00,$640.00,"$1,013.76","$1,024.00",$0.00,$200.32,$0.00,$203.78,$0.00
70-0324,SUP,HCPCS C1713,,70-0324  -  PLATE EXTN OSTMY BONE RIGHT,"$1,280.00",$0.00,"$1,280.00",$576.00,$913.54,$0.00,$220.54,$0.00,$0.00,$224.12,"$1,280.00",$0.00,$640.00,"$1,013.76","$1,024.00",$0.00,$200.32,$0.00,$203.78,$0.00
70-0329,SUP,HCPCS C1713,,70-0329  -  PLATE BN 4D PET LCK MTP LT,"$1,280.00",$0.00,"$1,280.00",$576.00,$913.54,$0.00,$220.54,$0.00,$0.00,$224.12,"$1,280.00",$0.00,$640.00,"$1,013.76","$1,024.00",$0.00,$200.32,$0.00,$203.78,$0.00
70-0330,SUP,HCPCS C1713,,70-0330  -  PLATE BN 4D PET MPJ LCK RT MTP,"$1,280.00",$0.00,"$1,280.00",$576.00,$913.54,$0.00,$220.54,$0.00,$0.00,$224.12,"$1,280.00",$0.00,$640.00,"$1,013.76","$1,024.00",$0.00,$200.32,$0.00,$203.78,$0.00
70-0331,SUP,HCPCS C1713,,70-0331  -  PLATE BONE RADL STYLOID,"$2,315.00",$0.00,"$2,315.00","$1,041.75","$1,652.22",$0.00,$398.86,$0.00,$0.00,$405.34,"$2,315.00",$0.00,"$1,157.50","$1,833.48","$1,852.00",$0.00,$362.30,$0.00,$368.55,$0.00
70-0334,SUP,HCPCS C1713,,70-0334  -  PLATE BN NS ACLC 2 SUT RDS LUNATE VOLR DIST,"$2,237.50",$0.00,"$2,237.50","$1,006.88","$1,596.90",$0.00,$385.51,$0.00,$0.00,$391.77,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$350.17,$0.00,$356.21,$0.00
70-0335,SUP,HCPCS C1713,,70-0335  -  PLATE BN BTRS NS ACLC 2 RIM RDS RT DIST DRSL,"$2,237.50",$0.00,"$2,237.50","$1,006.88","$1,596.90",$0.00,$385.51,$0.00,$0.00,$391.77,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$350.17,$0.00,$356.21,$0.00
70-0336,SUP,HCPCS C1713,,70-0336  -  PLATE FRAC SYS BTRS RIM BONE LEFT DISTAL DORSAL RADL,"$2,237.50",$0.00,"$2,237.50","$1,006.88","$1,596.90",$0.00,$385.51,$0.00,$0.00,$391.77,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$350.17,$0.00,$356.21,$0.00
70-0337,SUP,HCPCS C1713,,70-0337  -  PLATE FRAC SYS BTRS RIM BONE RIGHT DISTAL DORSAL LUNATE RADL,"$2,237.50",$0.00,"$2,237.50","$1,006.88","$1,596.90",$0.00,$385.51,$0.00,$0.00,$391.77,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$350.17,$0.00,$356.21,$0.00
70-0338,SUP,HCPCS C1713,,70-0338  -  PLATE BONE LEFT DORSAL,"$2,237.50",$0.00,"$2,237.50","$1,006.88","$1,596.90",$0.00,$385.51,$0.00,$0.00,$391.77,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$350.17,$0.00,$356.21,$0.00
70-0350,SUP,HCPCS C1713,,70-0350  -  PLATE BN STD 49X24MM NS ACLC 2 VA RDS LT VOLR DIST 2.3MM SCR,"$2,237.50",$0.00,"$2,237.50","$1,006.88","$1,596.90",$0.00,$385.51,$0.00,$0.00,$391.77,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$350.17,$0.00,$356.21,$0.00
70-0351,SUP,HCPCS C1713,,70-0351  -  PLATE BN STD 49X24MM NS ACLC 2 VA RDS RT VOLR DIST 2.3MM SCR,"$2,237.50",$0.00,"$2,237.50","$1,006.88","$1,596.90",$0.00,$385.51,$0.00,$0.00,$391.77,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$350.17,$0.00,$356.21,$0.00
70-0352,SUP,HCPCS C1713,,70-0352  -  PLATE LNG NAR ACLC 2 BONE PROX DISTAL VOLR RADL,"$2,237.50",$0.00,"$2,237.50","$1,006.88","$1,596.90",$0.00,$385.51,$0.00,$0.00,$391.77,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$350.17,$0.00,$356.21,$0.00
70-0353,SUP,HCPCS C1713,,70-0353  -  PLATE ACLC BONE RIGHT DISTAL VOLR PROX,"$2,237.50",$0.00,"$2,237.50","$1,006.88","$1,596.90",$0.00,$385.51,$0.00,$0.00,$391.77,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$350.17,$0.00,$356.21,$0.00
70-0354,SUP,HCPCS C1713,,70-0354  -  PLATE BN ACLC 2 W LT PROX,"$2,237.50",$0.00,"$2,237.50","$1,006.88","$1,596.90",$0.00,$385.51,$0.00,$0.00,$391.77,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$350.17,$0.00,$356.21,$0.00
70-0355,SUP,HCPCS C1713,,70-0355  -  PLATE BN W ACLC 2 RT PROX DIST VOLR RADL,"$2,237.50",$0.00,"$2,237.50","$1,006.88","$1,596.90",$0.00,$385.51,$0.00,$0.00,$391.77,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$350.17,$0.00,$356.21,$0.00
70-0356,SUP,HCPCS C1713,,70-0356  -  PLATE BN STD SLVR NS ACLC 2 LT DIST VOLR RADL,"$2,237.50",$0.00,"$2,237.50","$1,006.88","$1,596.90",$0.00,$385.51,$0.00,$0.00,$391.77,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$350.17,$0.00,$356.21,$0.00
70-0357,SUP,HCPCS C1713,,70-0357  -  PLATE BN STD REG ACLC 2 RT VOLR DIST RADL,"$2,237.50",$0.00,"$2,237.50","$1,006.88","$1,596.90",$0.00,$385.51,$0.00,$0.00,$391.77,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$350.17,$0.00,$356.21,$0.00
70-0358,SUP,HCPCS C1713,,70-0358  -  PLATE BN NAR STRL ACLC 2 LT DIST VOLR RADL,"$2,237.50",$0.00,"$2,237.50","$1,006.88","$1,596.90",$0.00,$385.51,$0.00,$0.00,$391.77,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$350.17,$0.00,$356.21,$0.00
70-0359,SUP,HCPCS C1713,,70-0359  -  PLATE BN NAR STRL ACLC 2 RT DIST VOLR RADL,"$2,237.50",$0.00,"$2,237.50","$1,006.88","$1,596.90",$0.00,$385.51,$0.00,$0.00,$391.77,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$350.17,$0.00,$356.21,$0.00
70-0360,SUP,HCPCS C1713,,70-0360  -  PLATE BN W STRL ACLC 2 LT DIST VOLR RADL,"$2,237.50",$0.00,"$2,237.50","$1,006.88","$1,596.90",$0.00,$385.51,$0.00,$0.00,$391.77,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$350.17,$0.00,$356.21,$0.00
70-0361,SUP,HCPCS C1713,,70-0361  -  PLATE BN W ACLC 2 RT VOLR DIST RADL,"$2,237.50",$0.00,"$2,237.50","$1,006.88","$1,596.90",$0.00,$385.51,$0.00,$0.00,$391.77,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$350.17,$0.00,$356.21,$0.00
70-0364,SUP,HCPCS C1713,,70-0364  -  PLATE NTRL ACLC 2 BONE PROX DISTAL VOLR RADL,"$2,237.50",$0.00,"$2,237.50","$1,006.88","$1,596.90",$0.00,$385.51,$0.00,$0.00,$391.77,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$350.17,$0.00,$356.21,$0.00
70-0365,SUP,HCPCS C1713,,70-0365  -  PLATE LNG EXTN ACLC 2 BONE LEFT DISTAL VOLR RADL,"$2,237.50",$0.00,"$2,237.50","$1,006.88","$1,596.90",$0.00,$385.51,$0.00,$0.00,$391.77,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$350.17,$0.00,$356.21,$0.00
70-0366,SUP,HCPCS C1713,,70-0366  -  PLATE LNG EXTN ACLC 2 BONE RIGHT DISTAL VOLR RADL,"$2,237.50",$0.00,"$2,237.50","$1,006.88","$1,596.90",$0.00,$385.51,$0.00,$0.00,$391.77,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$350.17,$0.00,$356.21,$0.00
70-0368,SUP,HCPCS C1713,,70-0368  -  PLATE BN LNG STD ACLC 2 LT DIST VOLR RADL,"$2,237.50",$0.00,"$2,237.50","$1,006.88","$1,596.90",$0.00,$385.51,$0.00,$0.00,$391.77,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$350.17,$0.00,$356.21,$0.00
70-0369,SUP,HCPCS C1713,,70-0369  -  PLATE LNG STD ACLC 2 BONE RIGHT DISTAL RADL,"$2,237.50",$0.00,"$2,237.50","$1,006.88","$1,596.90",$0.00,$385.51,$0.00,$0.00,$391.77,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$350.17,$0.00,$356.21,$0.00
70-0370,SUP,HCPCS C1713,,70-0370  -  PLATE LNG NAR ACLC 2 BONE LEFT DISTAL VOLR RADL,"$2,237.50",$0.00,"$2,237.50","$1,006.88","$1,596.90",$0.00,$385.51,$0.00,$0.00,$391.77,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$350.17,$0.00,$356.21,$0.00
70-0371,SUP,HCPCS C1713,,70-0371  -  PLATE LNG NAR 65MM OPTM DSGN ACLC 2 BONE RIGHT DISTAL VOLR,"$2,237.50",$0.00,"$2,237.50","$1,006.88","$1,596.90",$0.00,$385.51,$0.00,$0.00,$391.77,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$350.17,$0.00,$356.21,$0.00
70-0372,SUP,HCPCS C1713,,70-0372  -  PLATE BN LNG STD ACLC 2 LT PROX DIST VOLR RADL,"$2,237.50",$0.00,"$2,237.50","$1,006.88","$1,596.90",$0.00,$385.51,$0.00,$0.00,$391.77,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$350.17,$0.00,$356.21,$0.00
70-0373,SUP,HCPCS C1713,,70-0373  -  PLATE BN LNG STD ACLC 2 RT PROX DIST VOLR RADL,"$2,237.50",$0.00,"$2,237.50","$1,006.88","$1,596.90",$0.00,$385.51,$0.00,$0.00,$391.77,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$350.17,$0.00,$356.21,$0.00
70-0374,SUP,HCPCS C1713,,70-0374  -  PLATE 5 HOLE BONE LEFT DISTAL POSTLAT HUM,"$3,437.50",$0.00,"$3,437.50","$1,546.88","$2,453.34",$0.00,$592.26,$0.00,$0.00,$601.88,"$3,437.50",$0.00,"$1,718.75","$2,722.50","$2,750.00",$0.00,$537.97,$0.00,$547.25,$0.00
70-0375,SUP,HCPCS C1713,,70-0375  -  PLATE 78MM 5 HOLE BONE RIGHT P/L HUM,"$3,437.50",$0.00,"$3,437.50","$1,546.88","$2,453.34",$0.00,$592.26,$0.00,$0.00,$601.88,"$3,437.50",$0.00,"$1,718.75","$2,722.50","$2,750.00",$0.00,$537.97,$0.00,$547.25,$0.00
70-0376,SUP,HCPCS C1713,,70-0376  -  PLATE 103MM 7 HOLE BONE LEFT DISTAL POSTLAT HUM NONSTRL,"$3,437.50",$0.00,"$3,437.50","$1,546.88","$2,453.34",$0.00,$592.26,$0.00,$0.00,$601.88,"$3,437.50",$0.00,"$1,718.75","$2,722.50","$2,750.00",$0.00,$537.97,$0.00,$547.25,$0.00
70-0377,SUP,HCPCS C1713,,70-0377  -  PLATE 7 HOLE BONE RIGHT DISTAL POSTLAT HUM,"$3,437.50",$0.00,"$3,437.50","$1,546.88","$2,453.34",$0.00,$592.26,$0.00,$0.00,$601.88,"$3,437.50",$0.00,"$1,718.75","$2,722.50","$2,750.00",$0.00,$537.97,$0.00,$547.25,$0.00
70-0378,SUP,HCPCS C1713,,70-0378  -  PLATE 152MM 11 HOLE BONE LEFT DISTAL POSTLAT HUM NONSTRL,"$3,437.50",$0.00,"$3,437.50","$1,546.88","$2,453.34",$0.00,$592.26,$0.00,$0.00,$601.88,"$3,437.50",$0.00,"$1,718.75","$2,722.50","$2,750.00",$0.00,$537.97,$0.00,$547.25,$0.00
70-0379,SUP,HCPCS C1713,,70-0379  -  PLATE 152MM 11 HOLE BONE RIGHT DISTAL POSTLAT HUM NONSTRL,"$3,437.50",$0.00,"$3,437.50","$1,546.88","$2,453.34",$0.00,$592.26,$0.00,$0.00,$601.88,"$3,437.50",$0.00,"$1,718.75","$2,722.50","$2,750.00",$0.00,$537.97,$0.00,$547.25,$0.00
70-0380,SUP,HCPCS C1713,,70-0380  -  PLATE 203MM 15 HOLE BONE LEFT DISTAL POSTLAT HUM NONSTRL,"$3,437.50",$0.00,"$3,437.50","$1,546.88","$2,453.34",$0.00,$592.26,$0.00,$0.00,$601.88,"$3,437.50",$0.00,"$1,718.75","$2,722.50","$2,750.00",$0.00,$537.97,$0.00,$547.25,$0.00
70-0381,SUP,HCPCS C1713,,70-0381  -  PLATE 203MM 15 HOLE BONE RIGHT DISTAL POSTLAT HUM NONSTRL,"$3,437.50",$0.00,"$3,437.50","$1,546.88","$2,453.34",$0.00,$592.26,$0.00,$0.00,$601.88,"$3,437.50",$0.00,"$1,718.75","$2,722.50","$2,750.00",$0.00,$537.97,$0.00,$547.25,$0.00
70-0382,SUP,HCPCS C1713,,70-0382  -  PLATE NAR LNG ACLC 2 BONE LEFT PROX DISTAL VOLR RADL,"$2,237.50",$0.00,"$2,237.50","$1,006.88","$1,596.90",$0.00,$385.51,$0.00,$0.00,$391.77,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$350.17,$0.00,$356.21,$0.00
70-0383,SUP,HCPCS C1713,,70-0383  -  PLATE LNG NAR ACLC 2 BONE LEFT PROX DISTAL VOLR RADL,"$2,237.50",$0.00,"$2,237.50","$1,006.88","$1,596.90",$0.00,$385.51,$0.00,$0.00,$391.77,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$350.17,$0.00,$356.21,$0.00
70-0386,SUP,HCPCS C1713,,70-0386  -  PLATE MED BONE LEFT ANT CALC,"$3,052.50",$0.00,"$3,052.50","$1,373.63","$2,178.57",$0.00,$525.93,$0.00,$0.00,$534.47,"$3,052.50",$0.00,"$1,526.25","$2,417.58","$2,442.00",$0.00,$477.72,$0.00,$485.96,$0.00
70-0387,SUP,HCPCS C1713,,70-0387  -  PLATE MED BONE RIGHT ANT CALC,"$3,052.50",$0.00,"$3,052.50","$1,373.63","$2,178.57",$0.00,$525.93,$0.00,$0.00,$534.47,"$3,052.50",$0.00,"$1,526.25","$2,417.58","$2,442.00",$0.00,$477.72,$0.00,$485.96,$0.00
70-0388,SUP,HCPCS C1713,,70-0388  -  PLATE BONE LEFT ANT CALC,"$3,052.50",$0.00,"$3,052.50","$1,373.63","$2,178.57",$0.00,$525.93,$0.00,$0.00,$534.47,"$3,052.50",$0.00,"$1,526.25","$2,417.58","$2,442.00",$0.00,$477.72,$0.00,$485.96,$0.00
70-0389,SUP,HCPCS C1713,,70-0389  -  PLATE LG BONE RIGHT ANT CALC,"$3,052.50",$0.00,"$3,052.50","$1,373.63","$2,178.57",$0.00,$525.93,$0.00,$0.00,$534.47,"$3,052.50",$0.00,"$1,526.25","$2,417.58","$2,442.00",$0.00,$477.72,$0.00,$485.96,$0.00
70-0394,SUP,HCPCS C1713,,70-0394  -  PLATE LG 5 HOLE TUBE BONE POST CALC,"$3,052.50",$0.00,"$3,052.50","$1,373.63","$2,178.57",$0.00,$525.93,$0.00,$0.00,$534.47,"$3,052.50",$0.00,"$1,526.25","$2,417.58","$2,442.00",$0.00,$477.72,$0.00,$485.96,$0.00
70-0395,SUP,HCPCS C1713,,70-0395  -  PLATE 5 HOLE BONE RIGHT POST CALC,"$3,052.50",$0.00,"$3,052.50","$1,373.63","$2,178.57",$0.00,$525.93,$0.00,$0.00,$534.47,"$3,052.50",$0.00,"$1,526.25","$2,417.58","$2,442.00",$0.00,$477.72,$0.00,$485.96,$0.00
70-0396,SUP,HCPCS C1713,,70-0396  -  PLATE 6 HOLE BONE LEFT POST CALC,"$3,052.50",$0.00,"$3,052.50","$1,373.63","$2,178.57",$0.00,$525.93,$0.00,$0.00,$534.47,"$3,052.50",$0.00,"$1,526.25","$2,417.58","$2,442.00",$0.00,$477.72,$0.00,$485.96,$0.00
70-0397,SUP,HCPCS C1713,,70-0397  -  PLATE 6 HOLE BONE RIGHT POST CALC,"$3,052.50",$0.00,"$3,052.50","$1,373.63","$2,178.57",$0.00,$525.93,$0.00,$0.00,$534.47,"$3,052.50",$0.00,"$1,526.25","$2,417.58","$2,442.00",$0.00,$477.72,$0.00,$485.96,$0.00
70-0400,SUP,HCPCS C1713,,70-0400  -  PLATE 8 HOLE BONE LEFT CALC,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
70-0401,SUP,HCPCS C1713,,70-0401  -  PLATE MED 8 HOLE COMBO BONE RIGHT CALC,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
70-0404,SUP,HCPCS C1713,,70-0404  -  PLATE 8 HOLE COMBO BONE LEFT CLVCL,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
70-0405,SUP,HCPCS C1713,,70-0405  -  PLATE 8 HOLE BONE RL NONSTRL,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
70-0406,SUP,HCPCS C1713,,70-0406  -  PLATE 4 HOLE COMBO BONE LEFT CALC,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
70-0407,SUP,HCPCS C1713,,70-0407  -  PLATE LG 9 HOLE COMBO BONE RIGHT CALC,"$3,250.00",$0.00,"$3,250.00","$1,462.50","$2,319.53",$0.00,$559.96,$0.00,$0.00,$569.05,"$3,250.00",$0.00,"$1,625.00","$2,574.00","$2,600.00",$0.00,$508.63,$0.00,$517.40,$0.00
7005-08003,SUP,HCPCS C1713,,7005-08003  -  PLATE BN T .8MM NS LOPRFL TI HND,"$1,365.00",$0.00,"$1,365.00",$614.25,$974.20,$0.00,$235.18,$0.00,$0.00,$239.00,"$1,365.00",$0.00,$682.50,"$1,081.08","$1,092.00",$0.00,$213.62,$0.00,$217.31,$0.00
7005-08006,SUP,HCPCS C1713,,7005-08006  -  PLATE BN .8MM NS 6 HL CMPR TI HND,"$1,185.00",$0.00,"$1,185.00",$533.25,$845.73,$0.00,$204.17,$0.00,$0.00,$207.48,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$185.45,$0.00,$188.65,$0.00
7005-13005,SUP,HCPCS C1713,,7005-13005  -  PLATE BN NS ROT CRRT HND 1.3 MM SCR,$945.00,$0.00,$945.00,$425.25,$674.45,$0.00,$162.82,$0.00,$0.00,$165.46,$945.00,$0.00,$472.50,$748.44,$756.00,$0.00,$147.89,$0.00,$150.44,$0.00
7005-13006,SUP,HCPCS C1713,,7005-13006  -  PLATE BONE 6 HOLE COMPRESSION HAND NONSTRL 1.3 MM SCREW,"$1,365.00",$0.00,"$1,365.00",$614.25,$974.20,$0.00,$235.18,$0.00,$0.00,$239.00,"$1,365.00",$0.00,$682.50,"$1,081.08","$1,092.00",$0.00,$213.62,$0.00,$217.31,$0.00
70-1050,SUP,Custom 27203010,,ELECTRODE 3010B SER ANALY,"$2,600.00",$0.00,"$2,600.00",$0.00,"$1,855.62",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,600.00",$0.00,"$1,300.00","$2,059.20","$2,080.00",$0.00,$0.00,$0.00,$0.00,$0.00
7014-5927,SUP,HCPCS L8613,,7014-5927  -  PISTON OSS .6MM 4.25MM SMRT RECON OVR CRMP NTNL FLRPLAS,$752.40,$0.00,$752.40,$0.00,$536.99,$0.00,$0.00,$0.00,$0.00,$0.00,$752.40,$0.00,$376.20,$595.90,$601.92,$0.00,$0.00,$0.00,$0.00,$0.00
7014-5928,SUP,HCPCS L8613,,7014-5928  -  PISTON OSS .6MM 4.5MM SMRT NTNL FLRPLAS EAR STPS,$752.40,$0.00,$752.40,$0.00,$536.99,$0.00,$0.00,$0.00,$0.00,$0.00,$752.40,$0.00,$376.20,$595.90,$601.92,$0.00,$0.00,$0.00,$0.00,$0.00
7016RR,SUP,Custom 27803010,,7016RR  -  CONNECTOR ROD 16MM SPRL R90D 2 SD TI THORLMBR SPNE,"$2,075.80",$0.00,"$2,075.80",$0.00,"$1,481.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,075.80",$0.00,"$1,037.90","$1,644.03","$1,660.64",$0.00,$0.00,$0.00,$0.00,$0.00
702-04-42A,SUP,HCPCS C1776,,702-04-42A  -  SHELL ACTB A 42MM STRL TRDNT II 3 SCR HL CLSTR TRITANIUM HIP,"$2,302.50",$0.00,"$2,302.50","$1,036.13","$1,643.29",$0.00,$396.71,$0.00,$0.00,$403.15,"$2,302.50",$0.00,"$1,151.25","$1,823.58","$1,842.00",$0.00,$360.34,$0.00,$366.56,$0.00
702-04-44B,SUP,HCPCS C1776,,702-04-44B  -  SHELL ACTB B 44MM STRL TRDNT II 3 SCR HL CLSTR TRITANIUM HIP,"$2,302.50",$0.00,"$2,302.50","$1,036.13","$1,643.29",$0.00,$396.71,$0.00,$0.00,$403.15,"$2,302.50",$0.00,"$1,151.25","$1,823.58","$1,842.00",$0.00,$360.34,$0.00,$366.56,$0.00
702-04-46C,SUP,HCPCS C1776,,702-04-46C  -  SHELL ACTB C 46MM STRL TRDNT II 3 SCR HL CLSTR TRITANIUM HIP,"$2,302.50",$0.00,"$2,302.50","$1,036.13","$1,643.29",$0.00,$396.71,$0.00,$0.00,$403.15,"$2,302.50",$0.00,"$1,151.25","$1,823.58","$1,842.00",$0.00,$360.34,$0.00,$366.56,$0.00
702-04-48D,SUP,HCPCS C1776,,702-04-48D  -  SHELL ACTB D 48MM STRL TRDNT II 3 SCR HL CLSTR TRITANIUM HIP,"$2,302.50",$0.00,"$2,302.50","$1,036.13","$1,643.29",$0.00,$396.71,$0.00,$0.00,$403.15,"$2,302.50",$0.00,"$1,151.25","$1,823.58","$1,842.00",$0.00,$360.34,$0.00,$366.56,$0.00
702-04-50D,SUP,HCPCS C1776,,702-04-50D  -  SHELL ACTB D 50MM STRL TRDNT II 3 SCR HL CLSTR TRITANIUM HIP,"$2,302.50",$0.00,"$2,302.50","$1,036.13","$1,643.29",$0.00,$396.71,$0.00,$0.00,$403.15,"$2,302.50",$0.00,"$1,151.25","$1,823.58","$1,842.00",$0.00,$360.34,$0.00,$366.56,$0.00
702-04-52E,SUP,HCPCS C1776,,702-04-52E  -  SHELL ACTB E 52MM STRL TRDNT II 5 SCR HL CLSTR TRITANIUM HIP,"$2,302.50",$0.00,"$2,302.50","$1,036.13","$1,643.29",$0.00,$396.71,$0.00,$0.00,$403.15,"$2,302.50",$0.00,"$1,151.25","$1,823.58","$1,842.00",$0.00,$360.34,$0.00,$366.56,$0.00
702-04-54E,SUP,HCPCS C1776,,702-04-54E  -  SHELL ACTB E 54MM STRL TRDNT II 5 SCR HL CLSTR TRITANIUM HIP,"$2,302.50",$0.00,"$2,302.50","$1,036.13","$1,643.29",$0.00,$396.71,$0.00,$0.00,$403.15,"$2,302.50",$0.00,"$1,151.25","$1,823.58","$1,842.00",$0.00,$360.34,$0.00,$366.56,$0.00
702-04-56F,SUP,HCPCS C1776,,702-04-56F  -  SHELL ACTB F 56MM STRL TRDNT II 5 SCR HL CLSTR TRITANIUM HIP,"$2,302.50",$0.00,"$2,302.50","$1,036.13","$1,643.29",$0.00,$396.71,$0.00,$0.00,$403.15,"$2,302.50",$0.00,"$1,151.25","$1,823.58","$1,842.00",$0.00,$360.34,$0.00,$366.56,$0.00
702-04-58F,SUP,HCPCS C1776,,702-04-58F  -  SHELL ACTB F 58MM STRL TRDNT II 5 SCR HL CLSTR TRITANIUM HIP,"$2,302.50",$0.00,"$2,302.50","$1,036.13","$1,643.29",$0.00,$396.71,$0.00,$0.00,$403.15,"$2,302.50",$0.00,"$1,151.25","$1,823.58","$1,842.00",$0.00,$360.34,$0.00,$366.56,$0.00
702-04-60G,SUP,HCPCS C1776,,702-04-60G  -  SHELL ACTB G 60MM STRL TRDNT II 5 SCR HL CLSTR TRITANIUM HIP,"$2,302.50",$0.00,"$2,302.50","$1,036.13","$1,643.29",$0.00,$396.71,$0.00,$0.00,$403.15,"$2,302.50",$0.00,"$1,151.25","$1,823.58","$1,842.00",$0.00,$360.34,$0.00,$366.56,$0.00
702-04-62G,SUP,HCPCS C1776,,702-04-62G  -  SHELL ACTB G 62MM STRL TRDNT II 5 SCR HL CLSTR TRITANIUM HIP,"$2,302.50",$0.00,"$2,302.50","$1,036.13","$1,643.29",$0.00,$396.71,$0.00,$0.00,$403.15,"$2,302.50",$0.00,"$1,151.25","$1,823.58","$1,842.00",$0.00,$360.34,$0.00,$366.56,$0.00
702-04-64H,SUP,HCPCS C1776,,702-04-64H  -  SHELL ACTB H 64MM STRL TRDNT II 5 SCR HL CLSTR TRITANIUM HIP,"$2,302.50",$0.00,"$2,302.50","$1,036.13","$1,643.29",$0.00,$396.71,$0.00,$0.00,$403.15,"$2,302.50",$0.00,"$1,151.25","$1,823.58","$1,842.00",$0.00,$360.34,$0.00,$366.56,$0.00
702-04-66H,SUP,HCPCS C1776,,702-04-66H  -  SHELL ACTB H 66MM STRL TRDNT II 5 SCR HL CLSTR TRITANIUM HIP,"$2,302.50",$0.00,"$2,302.50","$1,036.13","$1,643.29",$0.00,$396.71,$0.00,$0.00,$403.15,"$2,302.50",$0.00,"$1,151.25","$1,823.58","$1,842.00",$0.00,$360.34,$0.00,$366.56,$0.00
702-11-42A,SUP,HCPCS C1776,,702-11-42A  -  SHELL ACTB A 42MM TRDNT II CH HA HIP,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
702-11-44B,SUP,HCPCS C1776,,702-11-44B  -  SHELL ACTB B 44MM TRDNT II CH HA HIP,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
702-11-46C,SUP,HCPCS C1776,,702-11-46C  -  SHELL ACTB C 46MM TRDNT II CH HA HIP,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
702-11-48D,SUP,HCPCS C1776,,702-11-48D  -  SHELL ACTB D 48MM TRDNT II CH HA HIP,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
702-11-50D,SUP,HCPCS C1776,,702-11-50D  -  SHELL ACTB D 50MM TRDNT II CH HA HIP,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
702-11-52E,SUP,HCPCS C1776,,702-11-52E  -  SHELL ACTB E 52MM TRDNT II CH HA HIP,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
702-11-54E,SUP,HCPCS C1776,,702-11-54E  -  SHELL ACTB E 54MM TRDNT II CH HA HIP,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
702-11-56F,SUP,HCPCS C1776,,702-11-56F  -  SHELL ACTB F 56MM TRDNT II CH HA HIP,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
702-11-58F,SUP,HCPCS C1776,,702-11-58F  -  SHELL ACTB F 58MM STRL TRDNT II CLSTR 5 HL HA HIP,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
702-11-60G,SUP,HCPCS C1776,,702-11-60G  -  SHELL ACTB G 60MM STRL TRDNT II CLSTR 5 HL HA HIP,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
702-11-62G,SUP,HCPCS C1776,,702-11-62G  -  SHELL ACTB G 62MM STRL TRDNT II CLSTR 5 HL HA HIP,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
702-11-64H,SUP,HCPCS C1776,,702-11-64H  -  SHELL ACTB H 64MM STRL TRDNT II CLSTR 5 HL HA HIP,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
702-11-66H,SUP,HCPCS C1776,,702-11-66H  -  SHELL ACTB H 66MM STRL TRDNT II CLSTR 5 HL HA HIP,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
702301-5,SUP,HCPCS C1713,,702301-5  -  SCREW BN ALTA CNCT ORTH,$185.63,$0.00,$185.63,$83.53,$132.48,$0.00,$31.98,$0.00,$0.00,$32.50,$185.63,$0.00,$92.81,$147.02,$148.50,$0.00,$29.05,$0.00,$29.55,$0.00
702336S,SUP,HCPCS C1769,,702336S  -  GWIRE ORTH 100MM 3MM SS BALL TIP STRL,$259.88,$0.00,$259.88,$141.11,$185.47,$0.00,$44.78,$0.00,$0.00,$45.50,$259.88,$0.00,$129.94,$205.82,$207.90,$0.00,$40.67,$0.00,$41.37,$0.00
702341-2,SUP,Custom 27203010,,702341-2  -  SLEEVE PRTC REPL,$550.00,$0.00,$550.00,$0.00,$392.54,$0.00,$0.00,$0.00,$0.00,$0.00,$550.00,$0.00,$275.00,$435.60,$440.00,$0.00,$0.00,$0.00,$0.00,$0.00
702460S,SUP,HCPCS C1769,,702460S  -  GWIRE ORTH 150MM 2MM ASNS 3 FEM HIP THRD 5MM NONSTRL DISP,$163.63,$0.00,$163.63,$88.85,$116.78,$0.00,$28.19,$0.00,$0.00,$28.65,$163.63,$0.00,$81.81,$129.59,$130.90,$0.00,$25.61,$0.00,$26.05,$0.00
702627S,SUP,HCPCS C1769,,702627S  -  GWIRE ORTH 300MM 3.2MM CLBRT FIT STRL,$281.88,$0.00,$281.88,$153.06,$201.17,$0.00,$48.57,$0.00,$0.00,$49.35,$281.88,$0.00,$140.94,$223.25,$225.50,$0.00,$44.11,$0.00,$44.87,$0.00
702716-2,SUP,HCPCS C1713,,702716-2  -  SCREW BONE 4MM AXSOS HUM AIM BLOCK LCK PLT SYS,$94.88,$0.00,$94.88,$42.69,$67.71,$0.00,$16.35,$0.00,$0.00,$16.61,$94.88,$0.00,$47.44,$75.14,$75.90,$0.00,$14.85,$0.00,$15.10,$0.00
702718-2,SUP,HCPCS C1713,,702718-2  -  SCREW BN SET SPR AIM BLCK FEM DIST,$99.00,$0.00,$99.00,$44.55,$70.66,$0.00,$17.06,$0.00,$0.00,$17.33,$99.00,$0.00,$49.50,$78.41,$79.20,$0.00,$15.49,$0.00,$15.76,$0.00
702720-2,SUP,HCPCS C1713,,702720-2  -  SCREW BONE 4MM AXSOS TIB AIM BLOCK LCK PLT SYS,$193.88,$0.00,$193.88,$87.24,$138.37,$0.00,$33.40,$0.00,$0.00,$33.95,$193.88,$0.00,$96.94,$153.55,$155.10,$0.00,$30.34,$0.00,$30.86,$0.00
702858-1,SUP,Custom 27803010,,702858-1  -  DRIVER SRG 4MM VARIAX RING HD LCK,$570.63,$0.00,$570.63,$0.00,$407.26,$0.00,$0.00,$0.00,$0.00,$0.00,$570.63,$0.00,$285.31,$451.94,$456.50,$0.00,$0.00,$0.00,$0.00,$0.00
702970-2,SUP,Custom 27803010,,702970-2  -  SCREW BONE AXSOS SPR SET HUM AIM BLOCK LCK PALTE SYS,$199.38,$0.00,$199.38,$0.00,$142.29,$0.00,$0.00,$0.00,$0.00,$0.00,$199.38,$0.00,$99.69,$157.91,$159.50,$0.00,$0.00,$0.00,$0.00,$0.00
70-3003L,SUP,HCPCS C1776,,70-3003L  -  CMPNT FEM 3 LEFT KNEE CMNT CRUC RET BASIC SCRP,"$3,074.00",$0.00,"$3,074.00","$1,383.30","$2,193.91",$0.00,$529.63,$0.00,$0.00,$538.23,"$3,074.00",$0.00,"$1,537.00","$2,434.61","$2,459.20",$0.00,$481.08,$0.00,$489.38,$0.00
70-3003R,SUP,HCPCS C1776,,70-3003R  -  CMPNT FEM 3 RIGHT KNEE CMNT CRUC RET BASIC SCRP,"$3,074.00",$0.00,"$3,074.00","$1,383.30","$2,193.91",$0.00,$529.63,$0.00,$0.00,$538.23,"$3,074.00",$0.00,"$1,537.00","$2,434.61","$2,459.20",$0.00,$481.08,$0.00,$489.38,$0.00
70-3004L,SUP,HCPCS C1776,,70-3004L  -  CMPNT FEM 4 LEFT KNEE CMNT CRUC RET BASIC SCRP,"$3,029.00",$0.00,"$3,029.00","$1,363.05","$2,161.80",$0.00,$521.88,$0.00,$0.00,$530.35,"$3,029.00",$0.00,"$1,514.50","$2,398.97","$2,423.20",$0.00,$474.04,$0.00,$482.22,$0.00
70-3004R,SUP,HCPCS C1776,,70-3004R  -  CMPNT FEM 4 RIGHT KNEE CMNT CRUC RET BASIC SCRP,"$3,029.00",$0.00,"$3,029.00","$1,363.05","$2,161.80",$0.00,$521.88,$0.00,$0.00,$530.35,"$3,029.00",$0.00,"$1,514.50","$2,398.97","$2,423.20",$0.00,$474.04,$0.00,$482.22,$0.00
70-3005L,SUP,HCPCS C1776,,70-3005L  -  CMPNT FEM 5 LEFT KNEE CRUC RET BASIC SCRP,"$3,029.00",$0.00,"$3,029.00","$1,363.05","$2,161.80",$0.00,$521.88,$0.00,$0.00,$530.35,"$3,029.00",$0.00,"$1,514.50","$2,398.97","$2,423.20",$0.00,$474.04,$0.00,$482.22,$0.00
70-3005R,SUP,HCPCS C1776,,70-3005R  -  CMPNT FEM 5 RIGHT KNEE CRUC RET BASIC SCRP,"$3,029.00",$0.00,"$3,029.00","$1,363.05","$2,161.80",$0.00,$521.88,$0.00,$0.00,$530.35,"$3,029.00",$0.00,"$1,514.50","$2,398.97","$2,423.20",$0.00,$474.04,$0.00,$482.22,$0.00
70-3006L,SUP,HCPCS C1776,,70-3006L  -  CMPNT FEM 6 LEFT KNEE CMNT CRUC RET BASIC SCRP,"$3,029.00",$0.00,"$3,029.00","$1,363.05","$2,161.80",$0.00,$521.88,$0.00,$0.00,$530.35,"$3,029.00",$0.00,"$1,514.50","$2,398.97","$2,423.20",$0.00,$474.04,$0.00,$482.22,$0.00
70-3006R,SUP,HCPCS C1776,,70-3006R  -  CMPNT FEM 6 RIGHT KNEE CMNT CRUC RET BASIC SCRP,"$3,029.00",$0.00,"$3,029.00","$1,363.05","$2,161.80",$0.00,$521.88,$0.00,$0.00,$530.35,"$3,029.00",$0.00,"$1,514.50","$2,398.97","$2,423.20",$0.00,$474.04,$0.00,$482.22,$0.00
70-3007L,SUP,HCPCS C1776,,70-3007L  -  CMPNT FEM 7 LEFT KNEE CRUC RET BASIC SCRP,"$3,029.00",$0.00,"$3,029.00","$1,363.05","$2,161.80",$0.00,$521.88,$0.00,$0.00,$530.35,"$3,029.00",$0.00,"$1,514.50","$2,398.97","$2,423.20",$0.00,$474.04,$0.00,$482.22,$0.00
70-3007R,SUP,HCPCS C1776,,70-3007R  -  CMPNT FEM 7 RIGHT KNEE CRUC RET BASIC SCRP,"$3,029.00",$0.00,"$3,029.00","$1,363.05","$2,161.80",$0.00,$521.88,$0.00,$0.00,$530.35,"$3,029.00",$0.00,"$1,514.50","$2,398.97","$2,423.20",$0.00,$474.04,$0.00,$482.22,$0.00
70-3009L,SUP,HCPCS C1776,,70-3009L  -  CMPNT FEM 9 LEFT KNEE CRUC RET BASIC SCRP,"$3,029.00",$0.00,"$3,029.00","$1,363.05","$2,161.80",$0.00,$521.88,$0.00,$0.00,$530.35,"$3,029.00",$0.00,"$1,514.50","$2,398.97","$2,423.20",$0.00,$474.04,$0.00,$482.22,$0.00
70-3009R,SUP,HCPCS C1776,,70-3009R  -  CMPNT FEM 9 RIGHT KNEE CRUC RET BASIC SCRP,"$3,029.00",$0.00,"$3,029.00","$1,363.05","$2,161.80",$0.00,$521.88,$0.00,$0.00,$530.35,"$3,029.00",$0.00,"$1,514.50","$2,398.97","$2,423.20",$0.00,$474.04,$0.00,$482.22,$0.00
70-3011L,SUP,HCPCS C1776,,70-3011L  -  CMPNT FEM 11 LEFT KNEE CRUC RET BASIC SCRP,"$3,029.00",$0.00,"$3,029.00","$1,363.05","$2,161.80",$0.00,$521.88,$0.00,$0.00,$530.35,"$3,029.00",$0.00,"$1,514.50","$2,398.97","$2,423.20",$0.00,$474.04,$0.00,$482.22,$0.00
70-3011R,SUP,HCPCS C1776,,70-3011R  -  CMPNT FEM 11 RIGHT KNEE CRUC RET BASIC SCRP,"$3,029.00",$0.00,"$3,029.00","$1,363.05","$2,161.80",$0.00,$521.88,$0.00,$0.00,$530.35,"$3,029.00",$0.00,"$1,514.50","$2,398.97","$2,423.20",$0.00,$474.04,$0.00,$482.22,$0.00
70-3013L,SUP,HCPCS C1776,,70-3013L  -  CMPNT FEM 13 LEFT KNEE CRUC RET BASIC SCRP,"$3,074.00",$0.00,"$3,074.00","$1,383.30","$2,193.91",$0.00,$529.63,$0.00,$0.00,$538.23,"$3,074.00",$0.00,"$1,537.00","$2,434.61","$2,459.20",$0.00,$481.08,$0.00,$489.38,$0.00
70-3013R,SUP,HCPCS C1776,,70-3013R  -  CMPNT FEM 13 RIGHT KNEE CRUC RET BASIC SCRP,"$3,074.00",$0.00,"$3,074.00","$1,383.30","$2,193.91",$0.00,$529.63,$0.00,$0.00,$538.23,"$3,074.00",$0.00,"$1,537.00","$2,434.61","$2,459.20",$0.00,$481.08,$0.00,$489.38,$0.00
7030-6515,SUP,HCPCS C1713,,7030-6515  -  SCREW BN 6.5MM 15MM STRL TRDNT II LOPRFL HEX,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
7030-6520,SUP,HCPCS C1713,,7030-6520  -  SCREW BN 6.5MM 20MM STRL TRDNT II LOPRFL HEX,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
7030-6525,SUP,HCPCS C1713,,7030-6525  -  SCREW BN 6.5MM 25MM STRL TRDNT II LOPRFL HEX,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
7030-6530,SUP,HCPCS C1713,,7030-6530  -  SCREW BN 6.5MM 30MM STRL TRDNT II LOPRFL HEX,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
7030-6535,SUP,HCPCS C1713,,7030-6535  -  SCREW BN 6.5MM 35MM STRL TRDNT II LOPRFL HEX,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
7030-6540,SUP,HCPCS C1713,,7030-6540  -  SCREW BN 6.5MM 40MM STRL TRDNT II LOPRFL HEX,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
7030-6545,SUP,HCPCS C1713,,7030-6545  -  SCREW BN 6.5MM 45MM STRL TRDNT II LOPRFL HEX,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
7030-6550,SUP,HCPCS C1713,,7030-6550  -  SCREW BN 6.5MM 50MM STRL TRDNT II LOPRFL HEX,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
7030-6555,SUP,HCPCS C1713,,7030-6555  -  SCREW BN 6.5MM 55MM STRL TRDNT II LOPRFL HEX,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
7030-6560,SUP,HCPCS C1713,,7030-6560  -  SCREW BN 6.5MM 60MM STRL TRDNT II LOPRFL HEX,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
703165-20,SUP,Custom 27203010,,703165-20  -  SLEEVE DRILL ANT FEM RTN,$559.63,$0.00,$559.63,$0.00,$399.40,$0.00,$0.00,$0.00,$0.00,$0.00,$559.63,$0.00,$279.81,$443.23,$447.70,$0.00,$0.00,$0.00,$0.00,$0.00
70-3191,SUP,Custom 27203010,,ELECTRODE ANALY SLVR CHLOR REF WIRE 3010B SER,$255.00,$0.00,$255.00,$0.00,$181.99,$0.00,$0.00,$0.00,$0.00,$0.00,$255.00,$0.00,$127.50,$201.96,$204.00,$0.00,$0.00,$0.00,$0.00,$0.00
70-3849,SUP,Custom 27203010,,CONTROL BLOOD LEAD LVL 1 HMTL,$165.00,$0.00,$165.00,$0.00,$117.76,$0.00,$0.00,$0.00,$0.00,$0.00,$165.00,$0.00,$82.50,$130.68,$132.00,$0.00,$0.00,$0.00,$0.00,$0.00
70-3850,SUP,Custom 27203010,,CONTROL BLOOD LEAD LVL 2 HMTL,$165.00,$0.00,$165.00,$0.00,$117.76,$0.00,$0.00,$0.00,$0.00,$0.00,$165.00,$0.00,$82.50,$130.68,$132.00,$0.00,$0.00,$0.00,$0.00,$0.00
70-3851,SUP,Custom 27203010,,CONTROL CHM HI,$165.00,$0.00,$165.00,$0.00,$117.76,$0.00,$0.00,$0.00,$0.00,$0.00,$165.00,$0.00,$82.50,$130.68,$132.00,$0.00,$0.00,$0.00,$0.00,$0.00
704001-1,SUP,Custom 27203010,,704001-1  -  IMPCTR SURG OMEGA HIP HEAD,$371.25,$0.00,$371.25,$0.00,$264.96,$0.00,$0.00,$0.00,$0.00,$0.00,$371.25,$0.00,$185.63,$294.03,$297.00,$0.00,$0.00,$0.00,$0.00,$0.00
704005-10,SUP,Custom 27203010,,704005-10  -  REAMER SURG DRILL COMBO,$701.25,$0.00,$701.25,$0.00,$500.48,$0.00,$0.00,$0.00,$0.00,$0.00,$701.25,$0.00,$350.63,$555.39,$561.00,$0.00,$0.00,$0.00,$0.00,$0.00
704011S,SUP,HCPCS C1713,,704011S  -  PIN SURG GUIDE,$75.63,$0.00,$75.63,$34.03,$53.97,$0.00,$13.03,$0.00,$0.00,$13.24,$75.63,$0.00,$37.81,$59.90,$60.50,$0.00,$11.84,$0.00,$12.04,$0.00
704012S,SUP,HCPCS C1769,,704012S  -  GWIRE ORTH 230MM 2.8MM THRD TIP QC,$226.88,$0.00,$226.88,$123.19,$161.92,$0.00,$39.09,$0.00,$0.00,$39.72,$226.88,$0.00,$113.44,$179.69,$181.50,$0.00,$35.51,$0.00,$36.12,$0.00
70-4103L,SUP,HCPCS C1776,,70-4103L  -  COMPONENT FEMORAL 3 CRUCIATE RETAIN CEMENTED WAFFLE POST,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
70-4103R,SUP,HCPCS C1776,,70-4103R  -  COMPONENT FEMORAL 3 CRUCIATE RETAIN CEMENTED WAFFLE POST,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
70-4104L,SUP,HCPCS C1776,,70-4104L  -  COMPONENT FEMORAL 4 CRUCIATE RETAIN CEMENTED WAFFLE POST,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
70-4104R,SUP,HCPCS C1776,,70-4104R  -  COMPONENT FEMORAL 4 CRUCIATE RETAIN CEMENTED WAFFLE POST,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
70-4105L,SUP,HCPCS C1776,,70-4105L  -  COMPONENT FEMORAL 5 CRUCIATE RETAIN CEMENTED WAFFLE POST,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
70-4105R,SUP,HCPCS C1776,,70-4105R  -  COMPONENT FEMORAL 5 CRUCIATE RETAIN CEMENTED WAFFLE POST,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
70-4106L,SUP,HCPCS C1776,,70-4106L  -  COMPONENT FEMORAL 6 CRUCIATE RETAIN CEMENTED WAFFLE POST,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
70-4106R,SUP,HCPCS C1776,,70-4106R  -  COMPONENT FEMORAL 6 CRUCIATE RETAIN CEMENTED WAFFLE POST,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
70-4107L,SUP,HCPCS C1776,,70-4107L  -  COMPONENT FEMORAL 7 CRUCIATE RETAIN CEMENTED WAFFLE POST,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
70-4107R,SUP,HCPCS C1776,,70-4107R  -  COMPONENT FEMORAL 7 CRUCIATE RETAIN CEMENTED WAFFLE POST,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
70-4109L,SUP,HCPCS C1776,,70-4109L  -  COMPONENT FEMORAL 9 CRUCIATE RETAIN CEMENTED WAFFLE POST,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
70-4109R,SUP,HCPCS C1776,,70-4109R  -  COMPONENT FEMORAL 9 CRUCIATE RETAIN CEMENTED WAFFLE POST,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
70-4111L,SUP,HCPCS C1776,,70-4111L  -  COMPONENT FEMORAL 11 CRUCIATE RETAIN CEMENTED WAFFLE POST,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
70-4111R,SUP,HCPCS C1776,,70-4111R  -  COMPONENT FEMORAL 11 CRUCIATE RETAIN CEMENTED WAFFLE POST,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
70-4113L,SUP,HCPCS C1776,,70-4113L  -  COMPONENT FEMORAL 13 CRUCIATE RETAIN CEMENTED WAFFLE POST,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
70-4113R,SUP,HCPCS C1776,,70-4113R  -  COMPONENT FEMORAL 13 CRUCIATE RETAIN CEMENTED WAFFLE POST,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
70-5003L,SUP,HCPCS C1776,,70-5003L  -  CMPNT FEM 3 LEFT KNEE MCSTRCT CRUC RET NON LFIT SCRP,"$4,906.00",$0.00,"$4,906.00","$2,207.70","$3,501.41",$0.00,$845.28,$0.00,$0.00,$859.00,"$4,906.00",$0.00,"$2,453.00","$3,885.55","$3,924.80",$0.00,$767.79,$0.00,$781.04,$0.00
70-5003R,SUP,HCPCS C1776,,70-5003R  -  CMPNT FEM 3 RIGHT KNEE MCSTRCT CRUC RET NON LFIT SCRP,"$4,906.00",$0.00,"$4,906.00","$2,207.70","$3,501.41",$0.00,$845.28,$0.00,$0.00,$859.00,"$4,906.00",$0.00,"$2,453.00","$3,885.55","$3,924.80",$0.00,$767.79,$0.00,$781.04,$0.00
70-5004L,SUP,HCPCS C1776,,70-5004L  -  CMPNT FEM 4 LEFT KNEE MCSTRCT CRUC RET NON LFIT SCRP,"$4,777.00",$0.00,"$4,777.00","$2,149.65","$3,409.34",$0.00,$823.05,$0.00,$0.00,$836.41,"$4,777.00",$0.00,"$2,388.50","$3,783.38","$3,821.60",$0.00,$747.60,$0.00,$760.50,$0.00
70-5004R,SUP,HCPCS C1776,,70-5004R  -  CMPNT FEM 4 RIGHT KNEE MCSTRCT CRUC RET NON LFIT SCRP,"$4,777.00",$0.00,"$4,777.00","$2,149.65","$3,409.34",$0.00,$823.05,$0.00,$0.00,$836.41,"$4,777.00",$0.00,"$2,388.50","$3,783.38","$3,821.60",$0.00,$747.60,$0.00,$760.50,$0.00
70-5005L,SUP,HCPCS C1776,,70-5005L  -  CMPNT FEM 5 LEFT KNEE MCSTRCT CRUC RET NON LFIT SCRP,"$4,777.00",$0.00,"$4,777.00","$2,149.65","$3,409.34",$0.00,$823.05,$0.00,$0.00,$836.41,"$4,777.00",$0.00,"$2,388.50","$3,783.38","$3,821.60",$0.00,$747.60,$0.00,$760.50,$0.00
70-5005R,SUP,HCPCS C1776,,70-5005R  -  CMPNT FEM 5 RIGHT KNEE MCSTRCT CRUC RET NON LFIT SCRP,"$4,777.00",$0.00,"$4,777.00","$2,149.65","$3,409.34",$0.00,$823.05,$0.00,$0.00,$836.41,"$4,777.00",$0.00,"$2,388.50","$3,783.38","$3,821.60",$0.00,$747.60,$0.00,$760.50,$0.00
70-5006L,SUP,HCPCS C1776,,70-5006L  -  CMPNT FEM 6 LEFT KNEE MCSTRCT CRUC RET NON LFIT SCRP,"$4,777.00",$0.00,"$4,777.00","$2,149.65","$3,409.34",$0.00,$823.05,$0.00,$0.00,$836.41,"$4,777.00",$0.00,"$2,388.50","$3,783.38","$3,821.60",$0.00,$747.60,$0.00,$760.50,$0.00
70-5006R,SUP,HCPCS C1776,,70-5006R  -  CMPNT FEM 6 RIGHT KNEE MCSTRCT CRUC RET NON LFIT SCRP,"$4,777.00",$0.00,"$4,777.00","$2,149.65","$3,409.34",$0.00,$823.05,$0.00,$0.00,$836.41,"$4,777.00",$0.00,"$2,388.50","$3,783.38","$3,821.60",$0.00,$747.60,$0.00,$760.50,$0.00
70-5007L,SUP,HCPCS C1776,,70-5007L  -  CMPNT FEM 7 LEFT KNEE MCSTRCT CRUC RET NON LFIT SCRP,"$4,777.00",$0.00,"$4,777.00","$2,149.65","$3,409.34",$0.00,$823.05,$0.00,$0.00,$836.41,"$4,777.00",$0.00,"$2,388.50","$3,783.38","$3,821.60",$0.00,$747.60,$0.00,$760.50,$0.00
70-5007R,SUP,HCPCS C1776,,70-5007R  -  CMPNT FEM 7 RIGHT KNEE MCSTRCT CRUC RET NON LFIT SCRP,"$4,777.00",$0.00,"$4,777.00","$2,149.65","$3,409.34",$0.00,$823.05,$0.00,$0.00,$836.41,"$4,777.00",$0.00,"$2,388.50","$3,783.38","$3,821.60",$0.00,$747.60,$0.00,$760.50,$0.00
70-5009L,SUP,HCPCS C1776,,70-5009L  -  CMPNT FEM 9 LEFT KNEE MCSTRCT CRUC RET NON LFIT SCRP,"$4,777.00",$0.00,"$4,777.00","$2,149.65","$3,409.34",$0.00,$823.05,$0.00,$0.00,$836.41,"$4,777.00",$0.00,"$2,388.50","$3,783.38","$3,821.60",$0.00,$747.60,$0.00,$760.50,$0.00
70-5009R,SUP,HCPCS C1776,,70-5009R  -  CMPNT FEM 9 RIGHT KNEE MCSTRCT CRUC RET NON LFIT SCRP,"$4,777.00",$0.00,"$4,777.00","$2,149.65","$3,409.34",$0.00,$823.05,$0.00,$0.00,$836.41,"$4,777.00",$0.00,"$2,388.50","$3,783.38","$3,821.60",$0.00,$747.60,$0.00,$760.50,$0.00
70-5011L,SUP,HCPCS C1776,,70-5011L  -  CMPNT FEM 11 LEFT KNEE MCSTRCT CRUC RET NON LFIT SCRP,"$4,777.00",$0.00,"$4,777.00","$2,149.65","$3,409.34",$0.00,$823.05,$0.00,$0.00,$836.41,"$4,777.00",$0.00,"$2,388.50","$3,783.38","$3,821.60",$0.00,$747.60,$0.00,$760.50,$0.00
70-5011R,SUP,HCPCS C1776,,70-5011R  -  CMPNT FEM 11 RIGHT KNEE MCSTRCT CRUC RET NON LFIT SCRP,"$4,777.00",$0.00,"$4,777.00","$2,149.65","$3,409.34",$0.00,$823.05,$0.00,$0.00,$836.41,"$4,777.00",$0.00,"$2,388.50","$3,783.38","$3,821.60",$0.00,$747.60,$0.00,$760.50,$0.00
70-5013L,SUP,HCPCS C1776,,70-5013L  -  CMPNT FEM 13 LEFT KNEE MCSTRCT CRUC RET NON LFIT SCRP,"$4,906.00",$0.00,"$4,906.00","$2,207.70","$3,501.41",$0.00,$845.28,$0.00,$0.00,$859.00,"$4,906.00",$0.00,"$2,453.00","$3,885.55","$3,924.80",$0.00,$767.79,$0.00,$781.04,$0.00
70-5013R,SUP,HCPCS C1776,,70-5013R  -  CMPNT FEM 13 RIGHT KNEE CRUC RET MCSTRCT NON LFIT SCRP,"$4,906.00",$0.00,"$4,906.00","$2,207.70","$3,501.41",$0.00,$845.28,$0.00,$0.00,$859.00,"$4,906.00",$0.00,"$2,453.00","$3,885.55","$3,924.80",$0.00,$767.79,$0.00,$781.04,$0.00
70-5103L,SUP,HCPCS C1776,,70-5103L  -  CMPNT FEM 3 LEFT KNEE CRUC RET MCSTRCT SCRP LFIT,"$4,647.00",$0.00,"$4,647.00","$2,091.15","$3,316.56",$0.00,$800.65,$0.00,$0.00,$813.65,"$4,647.00",$0.00,"$2,323.50","$3,680.42","$3,717.60",$0.00,$727.26,$0.00,$739.80,$0.00
70-5103R,SUP,HCPCS C1776,,70-5103R  -  CMPNT FEM 3 RIGHT KNEE CRUC RET MCSTRCT SCRP LFIT,"$4,647.00",$0.00,"$4,647.00","$2,091.15","$3,316.56",$0.00,$800.65,$0.00,$0.00,$813.65,"$4,647.00",$0.00,"$2,323.50","$3,680.42","$3,717.60",$0.00,$727.26,$0.00,$739.80,$0.00
70-5104L,SUP,HCPCS C1776,,70-5104L  -  CMPNT FEM 4 LEFT KNEE CRUC RET MCSTRCT LFIT SCRP,"$4,565.00",$0.00,"$4,565.00","$2,054.25","$3,258.04",$0.00,$786.53,$0.00,$0.00,$799.29,"$4,565.00",$0.00,"$2,282.50","$3,615.48","$3,652.00",$0.00,$714.42,$0.00,$726.75,$0.00
70-5104R,SUP,HCPCS C1776,,70-5104R  -  CMPNT FEM 4 RIGHT KNEE CRUC RET MCSTRCT LFIT SCRP,"$4,565.00",$0.00,"$4,565.00","$2,054.25","$3,258.04",$0.00,$786.53,$0.00,$0.00,$799.29,"$4,565.00",$0.00,"$2,282.50","$3,615.48","$3,652.00",$0.00,$714.42,$0.00,$726.75,$0.00
70-5105L,SUP,HCPCS C1776,,70-5105L  -  CMPNT FEM 5 LEFT KNEE CRUC RET MCSTRCT SCRP LFIT,"$4,565.00",$0.00,"$4,565.00","$2,054.25","$3,258.04",$0.00,$786.53,$0.00,$0.00,$799.29,"$4,565.00",$0.00,"$2,282.50","$3,615.48","$3,652.00",$0.00,$714.42,$0.00,$726.75,$0.00
70-5105R,SUP,HCPCS C1776,,70-5105R  -  CMPNT FEM 5 RIGHT KNEE CRUC RET MCSTRCT SCRP LFIT,"$4,565.00",$0.00,"$4,565.00","$2,054.25","$3,258.04",$0.00,$786.53,$0.00,$0.00,$799.29,"$4,565.00",$0.00,"$2,282.50","$3,615.48","$3,652.00",$0.00,$714.42,$0.00,$726.75,$0.00
70-5106L,SUP,HCPCS C1776,,70-5106L  -  CMPNT FEM 6 LEFT KNEE CRUC RET MCSTRCT LFIT SCRP,"$4,565.00",$0.00,"$4,565.00","$2,054.25","$3,258.04",$0.00,$786.53,$0.00,$0.00,$799.29,"$4,565.00",$0.00,"$2,282.50","$3,615.48","$3,652.00",$0.00,$714.42,$0.00,$726.75,$0.00
70-5106R,SUP,HCPCS C1776,,70-5106R  -  CMPNT FEM 6 RIGHT KNEE CRUC RET MCSTRCT LFIT SCRP,"$4,565.00",$0.00,"$4,565.00","$2,054.25","$3,258.04",$0.00,$786.53,$0.00,$0.00,$799.29,"$4,565.00",$0.00,"$2,282.50","$3,615.48","$3,652.00",$0.00,$714.42,$0.00,$726.75,$0.00
70-5107L,SUP,HCPCS C1776,,70-5107L  -  CMPNT FEM 7 LEFT KNEE CRUC RET MCSTRCT SCRP LFIT,"$4,565.00",$0.00,"$4,565.00","$2,054.25","$3,258.04",$0.00,$786.53,$0.00,$0.00,$799.29,"$4,565.00",$0.00,"$2,282.50","$3,615.48","$3,652.00",$0.00,$714.42,$0.00,$726.75,$0.00
70-5107R,SUP,HCPCS C1776,,70-5107R  -  CMPNT FEM 7 RIGHT KNEE CRUC RET MCSTRCT SCRP LFIT,"$4,565.00",$0.00,"$4,565.00","$2,054.25","$3,258.04",$0.00,$786.53,$0.00,$0.00,$799.29,"$4,565.00",$0.00,"$2,282.50","$3,615.48","$3,652.00",$0.00,$714.42,$0.00,$726.75,$0.00
70-5109L,SUP,HCPCS C1776,,70-5109L  -  CMPNT FEM 9 LEFT KNEE CRUC RET MCSTRCT SCRP LFIT,"$4,565.00",$0.00,"$4,565.00","$2,054.25","$3,258.04",$0.00,$786.53,$0.00,$0.00,$799.29,"$4,565.00",$0.00,"$2,282.50","$3,615.48","$3,652.00",$0.00,$714.42,$0.00,$726.75,$0.00
70-5109R,SUP,HCPCS C1776,,70-5109R  -  CMPNT FEM 9 RIGHT KNEE CRUC RET MCSTRCT SCRP LFIT,"$4,565.00",$0.00,"$4,565.00","$2,054.25","$3,258.04",$0.00,$786.53,$0.00,$0.00,$799.29,"$4,565.00",$0.00,"$2,282.50","$3,615.48","$3,652.00",$0.00,$714.42,$0.00,$726.75,$0.00
70-5111L,SUP,HCPCS C1776,,70-5111L  -  CMPNT FEM 11 LEFT KNEE CRUC RET MCSTRCT SCRP LFIT,"$4,565.00",$0.00,"$4,565.00","$2,054.25","$3,258.04",$0.00,$786.53,$0.00,$0.00,$799.29,"$4,565.00",$0.00,"$2,282.50","$3,615.48","$3,652.00",$0.00,$714.42,$0.00,$726.75,$0.00
70-5111R,SUP,HCPCS C1776,,70-5111R  -  CMPNT FEM 11 RIGHT KNEE CRUC RET MCSTRCT SCRP LFIT,"$4,565.00",$0.00,"$4,565.00","$2,054.25","$3,258.04",$0.00,$786.53,$0.00,$0.00,$799.29,"$4,565.00",$0.00,"$2,282.50","$3,615.48","$3,652.00",$0.00,$714.42,$0.00,$726.75,$0.00
70-5113L,SUP,HCPCS C1776,,70-5113L  -  CMPNT FEM 13 LEFT KNEE CRUC RET MCSTRCT SCRP LFIT,"$4,647.00",$0.00,"$4,647.00","$2,091.15","$3,316.56",$0.00,$800.65,$0.00,$0.00,$813.65,"$4,647.00",$0.00,"$2,323.50","$3,680.42","$3,717.60",$0.00,$727.26,$0.00,$739.80,$0.00
70-5113R,SUP,HCPCS C1776,,70-5113R  -  CMPNT FEM 13 RIGHT KNEE CRUC RET MCSTRCT SCRP LFIT,"$4,647.00",$0.00,"$4,647.00","$2,091.15","$3,316.56",$0.00,$800.65,$0.00,$0.00,$813.65,"$4,647.00",$0.00,"$2,323.50","$3,680.42","$3,717.60",$0.00,$727.26,$0.00,$739.80,$0.00
70-5203L,SUP,HCPCS C1776,,70-5203L  -  COMPONENT FEMORAL 3 CRUCIATE RETAIN MICROSTRUCTURE PRIM,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
70-5203R,SUP,HCPCS C1776,,70-5203R  -  COMPONENT FEMORAL 3 CRUCIATE RETAIN MICROSTRUCTURE PRIM,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
70-5205L,SUP,HCPCS C1776,,70-5205L  -  COMPONENT FEMORAL 5 CRUCIATE RETAIN MICROSTRUCTURE PRIM,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
70-5205R,SUP,HCPCS C1776,,70-5205R  -  COMPONENT FEMORAL 5 CRUCIATE RETAIN MICROSTRUCTURE PRIM,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
70-5207L,SUP,HCPCS C1776,,70-5207L  -  COMPONENT FEMORAL 7 CRUCIATE RETAIN MICROSTRUCTURE PRIM,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
70-5207R,SUP,HCPCS C1776,,70-5207R  -  COMPONENT FEMORAL 7 CRUCIATE RETAIN MICROSTRUCTURE PRIM,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
70-5209L,SUP,HCPCS C1776,,70-5209L  -  COMPONENT FEMORAL 9 CRUCIATE RETAIN MICROSTRUCTURE PRIM,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
70-5209R,SUP,HCPCS C1776,,70-5209R  -  COMPONENT FEMORAL 9 CRUCIATE RETAIN MICROSTRUCTURE PRIM,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
70-5211L,SUP,HCPCS C1776,,70-5211L  -  COMPONENT FEMORAL 11 CRUCIATE RETAIN MICROSTRUCTURE PRIM,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
70-5211R,SUP,HCPCS C1776,,70-5211R  -  COMPONENT FEMORAL 11 CRUCIATE RETAIN MICROSTRUCTURE PRIM,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
70-5213L,SUP,HCPCS C1776,,70-5213L  -  COMPONENT FEMORAL 13 CRUCIATE RETAIN MICROSTRUCTURE PRIM,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
70-5213R,SUP,HCPCS C1776,,70-5213R  -  COMPONENT FEMORAL 13 CRUCIATE RETAIN MICROSTRUCTURE PRIM,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
7060-0000,SUP,HCPCS C1713,,7060-0000  -  PLUG DOME HL HEX STRL LF TRDNT II DISP,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
7066-24,SUP,Custom 27203010,,SPLINT ORTH UNV 24IN KNEE SUP PRFR FOAM,$66.85,$0.00,$66.85,$0.00,$47.71,$0.00,$0.00,$0.00,$0.00,$0.00,$66.85,$0.00,$33.43,$52.95,$53.48,$0.00,$0.00,$0.00,$0.00,$0.00
709-04-42A,SUP,HCPCS C1776,,709-04-42A  -  SHELL ACTB A 42MM STRL TRDNT II 8 HL TRITANIUM HIP,"$6,782.50",$0.00,"$6,782.50","$3,052.13","$4,840.67",$0.00,"$1,168.59",$0.00,$0.00,"$1,187.56","$6,782.50",$0.00,"$3,391.25","$5,371.74","$5,426.00",$0.00,"$1,061.46",$0.00,"$1,079.77",$0.00
709-04-44B,SUP,HCPCS C1776,,709-04-44B  -  SHELL ACTB B 44MM STRL TRDNT II 8 HL TRITANIUM HIP,"$6,782.50",$0.00,"$6,782.50","$3,052.13","$4,840.67",$0.00,"$1,168.59",$0.00,$0.00,"$1,187.56","$6,782.50",$0.00,"$3,391.25","$5,371.74","$5,426.00",$0.00,"$1,061.46",$0.00,"$1,079.77",$0.00
709-04-46C,SUP,HCPCS C1776,,709-04-46C  -  SHELL ACTB C 46MM STRL TRDNT II 8 HL TRITANIUM HIP,"$6,782.50",$0.00,"$6,782.50","$3,052.13","$4,840.67",$0.00,"$1,168.59",$0.00,$0.00,"$1,187.56","$6,782.50",$0.00,"$3,391.25","$5,371.74","$5,426.00",$0.00,"$1,061.46",$0.00,"$1,079.77",$0.00
709-04-48D,SUP,HCPCS C1776,,709-04-48D  -  SHELL ACTB D 48MM STRL TRDNT II 9 HL TRITANIUM HIP,"$6,782.50",$0.00,"$6,782.50","$3,052.13","$4,840.67",$0.00,"$1,168.59",$0.00,$0.00,"$1,187.56","$6,782.50",$0.00,"$3,391.25","$5,371.74","$5,426.00",$0.00,"$1,061.46",$0.00,"$1,079.77",$0.00
709-04-50D,SUP,HCPCS C1776,,709-04-50D  -  SHELL ACTB D 50MM STRL TRDNT II 9 HL TRITANIUM HIP,"$6,782.50",$0.00,"$6,782.50","$3,052.13","$4,840.67",$0.00,"$1,168.59",$0.00,$0.00,"$1,187.56","$6,782.50",$0.00,"$3,391.25","$5,371.74","$5,426.00",$0.00,"$1,061.46",$0.00,"$1,079.77",$0.00
709-04-52E,SUP,HCPCS C1776,,709-04-52E  -  SHELL ACTB E 52MM STRL TRDNT II 11 HL TRITANIUM HIP,"$6,782.50",$0.00,"$6,782.50","$3,052.13","$4,840.67",$0.00,"$1,168.59",$0.00,$0.00,"$1,187.56","$6,782.50",$0.00,"$3,391.25","$5,371.74","$5,426.00",$0.00,"$1,061.46",$0.00,"$1,079.77",$0.00
709-04-54E,SUP,HCPCS C1776,,709-04-54E  -  SHELL ACTB E 54MM STRL TRDNT II 11 HL TRITANIUM HIP,"$6,782.50",$0.00,"$6,782.50","$3,052.13","$4,840.67",$0.00,"$1,168.59",$0.00,$0.00,"$1,187.56","$6,782.50",$0.00,"$3,391.25","$5,371.74","$5,426.00",$0.00,"$1,061.46",$0.00,"$1,079.77",$0.00
709-04-56F,SUP,HCPCS C1776,,709-04-56F  -  SHELL ACTB F 56MM STRL TRDNT II 13 HL TRITANIUM HIP,"$6,782.50",$0.00,"$6,782.50","$3,052.13","$4,840.67",$0.00,"$1,168.59",$0.00,$0.00,"$1,187.56","$6,782.50",$0.00,"$3,391.25","$5,371.74","$5,426.00",$0.00,"$1,061.46",$0.00,"$1,079.77",$0.00
709-04-58F,SUP,HCPCS C1776,,709-04-58F  -  SHELL ACTB F 58MM STRL TRDNT II 13 HL TRITANIUM HIP,"$6,782.50",$0.00,"$6,782.50","$3,052.13","$4,840.67",$0.00,"$1,168.59",$0.00,$0.00,"$1,187.56","$6,782.50",$0.00,"$3,391.25","$5,371.74","$5,426.00",$0.00,"$1,061.46",$0.00,"$1,079.77",$0.00
709-04-60G,SUP,HCPCS C1776,,709-04-60G  -  SHELL ACTB G 60MM STRL TRDNT II 13 HL TRITANIUM HIP,"$6,782.50",$0.00,"$6,782.50","$3,052.13","$4,840.67",$0.00,"$1,168.59",$0.00,$0.00,"$1,187.56","$6,782.50",$0.00,"$3,391.25","$5,371.74","$5,426.00",$0.00,"$1,061.46",$0.00,"$1,079.77",$0.00
709-04-62G,SUP,HCPCS C1776,,709-04-62G  -  SHELL ACTB G 62MM STRL TRDNT II 13 HL TRITANIUM HIP,"$6,782.50",$0.00,"$6,782.50","$3,052.13","$4,840.67",$0.00,"$1,168.59",$0.00,$0.00,"$1,187.56","$6,782.50",$0.00,"$3,391.25","$5,371.74","$5,426.00",$0.00,"$1,061.46",$0.00,"$1,079.77",$0.00
709-04-64H,SUP,HCPCS C1776,,709-04-64H  -  SHELL ACTB H 64MM STRL TRDNT II 13 HL TRITANIUM HIP,"$6,782.50",$0.00,"$6,782.50","$3,052.13","$4,840.67",$0.00,"$1,168.59",$0.00,$0.00,"$1,187.56","$6,782.50",$0.00,"$3,391.25","$5,371.74","$5,426.00",$0.00,"$1,061.46",$0.00,"$1,079.77",$0.00
709-04-66H,SUP,HCPCS C1776,,709-04-66H  -  SHELL ACTB H 66MM STRL TRDNT II 13 HL TRITANIUM HIP,"$6,782.50",$0.00,"$6,782.50","$3,052.13","$4,840.67",$0.00,"$1,168.59",$0.00,$0.00,"$1,187.56","$6,782.50",$0.00,"$3,391.25","$5,371.74","$5,426.00",$0.00,"$1,061.46",$0.00,"$1,079.77",$0.00
709-04-68I,SUP,HCPCS C1776,,709-04-68I  -  SHELL ACTB I 68MM STRL TRDNT II 13 HL TRITANIUM HIP,"$6,782.50",$0.00,"$6,782.50","$3,052.13","$4,840.67",$0.00,"$1,168.59",$0.00,$0.00,"$1,187.56","$6,782.50",$0.00,"$3,391.25","$5,371.74","$5,426.00",$0.00,"$1,061.46",$0.00,"$1,079.77",$0.00
709-04-70I,SUP,HCPCS C1776,,709-04-70I  -  SHELL ACTB I 70MM STRL TRDNT II 13 HL TRITANIUM HIP,"$6,782.50",$0.00,"$6,782.50","$3,052.13","$4,840.67",$0.00,"$1,168.59",$0.00,$0.00,"$1,187.56","$6,782.50",$0.00,"$3,391.25","$5,371.74","$5,426.00",$0.00,"$1,061.46",$0.00,"$1,079.77",$0.00
709-04-72J,SUP,HCPCS C1776,,709-04-72J  -  SHELL ACTB J 72MM STRL TRDNT II 13 HL TRITANIUM HIP,"$6,782.50",$0.00,"$6,782.50","$3,052.13","$4,840.67",$0.00,"$1,168.59",$0.00,$0.00,"$1,187.56","$6,782.50",$0.00,"$3,391.25","$5,371.74","$5,426.00",$0.00,"$1,061.46",$0.00,"$1,079.77",$0.00
70-DO55,SUP,HCPCS C1713,,70-DO55  -  PLATE STD BONE LEFT DISTAL RADL,"$2,237.50",$0.00,"$2,237.50","$1,006.88","$1,596.90",$0.00,$385.51,$0.00,$0.00,$391.77,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$350.17,$0.00,$356.21,$0.00
70XLTCD,SUP,Custom 27203010,,70XLTCD  -  TUBE TRCH 39MM 49MM 12.3MM 7MM 100MM STRL LF 12MM SHLY XLT,$162.05,$0.00,$162.05,$0.00,$115.65,$0.00,$0.00,$0.00,$0.00,$0.00,$162.05,$0.00,$81.02,$128.34,$129.64,$0.00,$0.00,$0.00,$0.00,$0.00
70XLTUP,SUP,Custom 27203010,,70XLTUP  -  TUBE TRCH 39MM 34MM 12.3MM 7MM 100MM STRL LF 27MM SHLY XLT,$162.05,$0.00,$162.05,$0.00,$115.65,$0.00,$0.00,$0.00,$0.00,$0.00,$162.05,$0.00,$81.02,$128.34,$129.64,$0.00,$0.00,$0.00,$0.00,$0.00
710.000.98S,SUP,HCPCS C1763,,710.000.98S  -  SUBSTITUTE BNGFT XS VOID FILR GRANULES CHRONOS BTCP .5ML,$216.25,$0.00,$216.25,$97.31,$154.34,$0.00,$37.26,$0.00,$0.00,$37.86,$216.25,$0.00,$108.13,$171.27,$173.00,$0.00,$33.84,$0.00,$34.43,$0.00
710.001.98S,SUP,HCPCS C1763,,710.001.98S  -  SUBSTITUTE BNGFT SMALL .7-1.4MM VOID FILR GRANULES CHRONOS,$216.25,$0.00,$216.25,$97.31,$154.34,$0.00,$37.26,$0.00,$0.00,$37.86,$216.25,$0.00,$108.13,$171.27,$173.00,$0.00,$33.84,$0.00,$34.43,$0.00
710.002.98S,SUP,HCPCS C1713,,710.002.98S  -  CEMENT BONE .7-1.4MM/1CC GRANULES BETA-TRICALCIUM PHOSPHATE,$400.00,$0.00,$400.00,$180.00,$285.48,$0.00,$68.92,$0.00,$0.00,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
710.003.98S,SUP,HCPCS C1763,,710.003.98S  -  SUBSTITUTE BNGFT SMALL .7-1.4MM VOID FILR GRANULES CHRONOS,$887.50,$0.00,$887.50,$399.38,$633.41,$0.00,$152.91,$0.00,$0.00,$155.39,$887.50,$0.00,$443.75,$702.90,$710.00,$0.00,$138.89,$0.00,$141.29,$0.00
710.011.98S,SUP,HCPCS C1763,,710.011.98S  -  SUBSTITUTE BNGFT MEDIUM 1.4-2.8MM VOID FILR GRANULES CHRONOS,$887.50,$0.00,$887.50,$399.38,$633.41,$0.00,$152.91,$0.00,$0.00,$155.39,$887.50,$0.00,$443.75,$702.90,$710.00,$0.00,$138.89,$0.00,$141.29,$0.00
710.014.98S,SUP,HCPCS C1763,,710.014.98S  -  SUBSTITUTE BNGFT MEDIUM 1.4-2.8MM VOID FILR GRANULES CHRONOS,"$1,242.50",$0.00,"$1,242.50",$559.13,$886.77,$0.00,$214.08,$0.00,$0.00,$217.55,"$1,242.50",$0.00,$621.25,$984.06,$994.00,$0.00,$194.45,$0.00,$197.81,$0.00
710.019.97S,SUP,HCPCS C1713,,710.019.97S  -  SUBSTITUTE BNGFT 1.4-2.8MM CHRNS MED BTCP VOID,"$1,796.08",$0.00,"$1,796.08",$808.23,"$1,281.86",$0.00,$300.44,$0.00,$0.00,$314.48,"$1,796.08",$0.00,$898.04,"$1,422.50","$1,436.86",$0.00,$272.90,$0.00,$285.94,$0.00
710.021.97S,SUP,HCPCS C1713,,710.021.97S  -  SUBSTITUTE BNGFT 1.4-2.8MM CHRNS MED BTCP VOID,"$2,564.70",$0.00,"$2,564.70","$1,154.12","$1,830.43",$0.00,$429.01,$0.00,$0.00,$449.06,"$2,564.70",$0.00,"$1,282.35","$2,031.24","$2,051.76",$0.00,$389.69,$0.00,$408.30,$0.00
710.042.98S,SUP,HCPCS C1763,,710.042.98S  -  SUBSTITUTE BNGFT 10X5X5MM VOID FILR BLOCK CHRONOS BTCP,$672.50,$0.00,$672.50,$302.63,$479.96,$0.00,$115.87,$0.00,$0.00,$117.75,$672.50,$0.00,$336.25,$532.62,$538.00,$0.00,$105.25,$0.00,$107.06,$0.00
710.045.97S,SUP,HCPCS C1763,,710.045.97S  -  SUBSTITUTE BNGFT 12.5X12.5X10MM VOID FILR BLOCK,$898.03,$0.00,$898.03,$404.11,$640.92,$0.00,$150.22,$0.00,$0.00,$157.24,$898.03,$0.00,$449.01,$711.24,$718.42,$0.00,$136.45,$0.00,$142.97,$0.00
710.047.97S,SUP,HCPCS C1763,,710.047.97S  -  SUBSTITUTE BNGFT 20X20X10MM VOID FILR BLOCK OSTEOCONDUCTIVE,"$1,765.18",$0.00,"$1,765.18",$794.33,"$1,259.81",$0.00,$295.27,$0.00,$0.00,$309.07,"$1,765.18",$0.00,$882.59,"$1,398.02","$1,412.14",$0.00,$268.20,$0.00,$281.02,$0.00
710.047.98S,SUP,HCPCS C1763,,710.047.98S  -  SUBSTITUTE BNGFT 20X20X10MM VOID FILR BLOCK CHRONOS BETA,"$2,355.00",$0.00,"$2,355.00","$1,059.75","$1,680.76",$0.00,$405.75,$0.00,$0.00,$412.34,"$2,355.00",$0.00,"$1,177.50","$1,865.16","$1,884.00",$0.00,$368.56,$0.00,$374.92,$0.00
710.050.97S,SUP,HCPCS C1763,,710.050.97S  -  SUBSTITUTE BNGFT 10D RECTANGLE 25X20X6.5MM VOID FILR WEDGE,"$1,784.48",$0.00,"$1,784.48",$803.01,"$1,273.58",$0.00,$298.50,$0.00,$0.00,$312.45,"$1,784.48",$0.00,$892.24,"$1,413.31","$1,427.58",$0.00,$271.14,$0.00,$284.09,$0.00
710.050.98S,SUP,HCPCS C1713,,710.050.98S  -  SUBSTITUTE BNGFT 10D RECTANGLE 25X20MM WEDGE CHRONOS BTCP,"$2,380.00",$0.00,"$2,380.00","$1,071.00","$1,698.61",$0.00,$410.06,$0.00,$0.00,$416.72,"$2,380.00",$0.00,"$1,190.00","$1,884.96","$1,904.00",$0.00,$372.47,$0.00,$378.90,$0.00
710.051.97S,SUP,HCPCS C1763,,710.051.97S  -  SUBSTITUTE BNGFT 14D RECTANGLE 25X20X8MM VOID FILR WEDGE,"$1,881.05",$0.00,"$1,881.05",$846.47,"$1,342.51",$0.00,$314.65,$0.00,$0.00,$329.36,"$1,881.05",$0.00,$940.53,"$1,489.79","$1,504.84",$0.00,$285.81,$0.00,$299.46,$0.00
710.052.97S,SUP,HCPCS C1763,,710.052.97S  -  SUBSTITUTE BNGFT 18D RECTANGULAR 25X20X10MM VOID FILR WEDGE,"$1,998.85",$0.00,"$1,998.85",$899.48,"$1,426.58",$0.00,$334.36,$0.00,$0.00,$349.98,"$1,998.85",$0.00,$999.43,"$1,583.09","$1,599.08",$0.00,$303.71,$0.00,$318.22,$0.00
710.053.97S,SUP,HCPCS C1763,,710.053.97S  -  SUBSTITUTE BNGFT 22D RECTANGLE 25X20X12MM VOID FILR WEDGE,"$2,107.00",$0.00,"$2,107.00",$948.15,"$1,503.77",$0.00,$352.45,$0.00,$0.00,$368.92,"$2,107.00",$0.00,"$1,053.50","$1,668.74","$1,685.60",$0.00,$320.14,$0.00,$335.43,$0.00
710.057.97S,SUP,HCPCS C1763,,710.057.97S  -  SUBSTITUTE BNGFT 7D SEMICIRCLE 35X25X7MM VOID FILR WEDGE,"$2,107.00",$0.00,"$2,107.00",$948.15,"$1,503.77",$0.00,$352.45,$0.00,$0.00,$368.92,"$2,107.00",$0.00,"$1,053.50","$1,668.74","$1,685.60",$0.00,$320.14,$0.00,$335.43,$0.00
710.057.98S,SUP,HCPCS C1763,,710.057.98S  -  SUBSTITUTE BNGFT 7D VOID FILR WEDGE SEMICIRCULAR CHRONOS,"$2,810.00",$0.00,"$2,810.00","$1,264.50","$2,005.50",$0.00,$484.15,$0.00,$0.00,$492.01,"$2,810.00",$0.00,"$1,405.00","$2,225.52","$2,248.00",$0.00,$439.77,$0.00,$447.35,$0.00
710.060.97S,SUP,HCPCS C1763,,710.060.97S  -  SUBSTITUTE BNGFT 10D VOID FILR WEDGE ANGLED SEMICIRCULAR,"$2,180.38",$0.00,"$2,180.38",$981.17,"$1,556.13",$0.00,$364.73,$0.00,$0.00,$381.77,"$2,180.38",$0.00,"$1,090.19","$1,726.86","$1,744.30",$0.00,$331.29,$0.00,$347.12,$0.00
710.063.97S,SUP,HCPCS C1763,,710.063.97S  -  SUBSTITUTE BNGFT 13D SEMICIRCLE 35X25X13MM WEDGE,"$2,286.60",$0.00,"$2,286.60","$1,028.97","$1,631.95",$0.00,$382.49,$0.00,$0.00,$400.37,"$2,286.60",$0.00,"$1,143.30","$1,810.99","$1,829.28",$0.00,$347.43,$0.00,$364.03,$0.00
71063108S,SUP,HCPCS C1713,,71063108S  -  PIN HLF 3MM 10MM JTX TI NTRD,$424.00,$0.00,$424.00,$190.80,$302.61,$0.00,$73.05,$0.00,$0.00,$74.24,$424.00,$0.00,$212.00,$335.81,$339.20,$0.00,$66.36,$0.00,$67.50,$0.00
71063158S,SUP,HCPCS C1713,,71063158S  -  PIN HLF 3MM 15MM JTX TI NTRD,$424.00,$0.00,$424.00,$190.80,$302.61,$0.00,$73.05,$0.00,$0.00,$74.24,$424.00,$0.00,$212.00,$335.81,$339.20,$0.00,$66.36,$0.00,$67.50,$0.00
71063208S,SUP,HCPCS C1713,,71063208S  -  PIN HLF 3MM 20MM JTX TI NTRD,$424.00,$0.00,$424.00,$190.80,$302.61,$0.00,$73.05,$0.00,$0.00,$74.24,$424.00,$0.00,$212.00,$335.81,$339.20,$0.00,$66.36,$0.00,$67.50,$0.00
71063258S,SUP,HCPCS C1713,,71063258S  -  PIN HLF 3MM 25MM JTX TI NTRD,$424.00,$0.00,$424.00,$190.80,$302.61,$0.00,$73.05,$0.00,$0.00,$74.24,$424.00,$0.00,$212.00,$335.81,$339.20,$0.00,$66.36,$0.00,$67.50,$0.00
71064158S,SUP,HCPCS C1713,,71064158S  -  PIN HLF 4MM 15MM JTX TI NTRD,$456.00,$0.00,$456.00,$205.20,$325.45,$0.00,$78.57,$0.00,$0.00,$79.84,$456.00,$0.00,$228.00,$361.15,$364.80,$0.00,$71.36,$0.00,$72.60,$0.00
71064208S,SUP,HCPCS C1713,,71064208S  -  PIN HLF 4MM 20MM JTX TI NTRD,$456.00,$0.00,$456.00,$205.20,$325.45,$0.00,$78.57,$0.00,$0.00,$79.84,$456.00,$0.00,$228.00,$361.15,$364.80,$0.00,$71.36,$0.00,$72.60,$0.00
71064258S,SUP,HCPCS C1713,,71064258S  -  PIN HLF 4MM 25MM JTX TI NTRD,$456.00,$0.00,$456.00,$205.20,$325.45,$0.00,$78.57,$0.00,$0.00,$79.84,$456.00,$0.00,$228.00,$361.15,$364.80,$0.00,$71.36,$0.00,$72.60,$0.00
71064308S,SUP,HCPCS C1713,,71064308S  -  PIN HLF 4MM 30MM JTX TI NTRD,$456.00,$0.00,$456.00,$205.20,$325.45,$0.00,$78.57,$0.00,$0.00,$79.84,$456.00,$0.00,$228.00,$361.15,$364.80,$0.00,$71.36,$0.00,$72.60,$0.00
71064358S,SUP,HCPCS C1713,,71064358S  -  PIN HLF 4MM 35MM JTX TI NTRD,$456.00,$0.00,$456.00,$205.20,$325.45,$0.00,$78.57,$0.00,$0.00,$79.84,$456.00,$0.00,$228.00,$361.15,$364.80,$0.00,$71.36,$0.00,$72.60,$0.00
7106-5300,SUP,HCPCS C1713,,7106-5300  -  PIN HLF SHRT 5MM 30MM ORTH,$608.00,$0.00,$608.00,$273.60,$433.93,$0.00,$104.76,$0.00,$0.00,$106.46,$608.00,$0.00,$304.00,$481.54,$486.40,$0.00,$95.15,$0.00,$96.79,$0.00
71065304S,SUP,HCPCS C1713,,71065304S  -  PIN HLF XSH 5MM 30MM STRL JTX TI NTRD,$584.00,$0.00,$584.00,$262.80,$416.80,$0.00,$100.62,$0.00,$0.00,$102.25,$584.00,$0.00,$292.00,$462.53,$467.20,$0.00,$91.40,$0.00,$92.97,$0.00
71065308S,SUP,HCPCS C1713,,71065308S  -  PIN HLF SHRT 5MM 30MM STRL JTX TI NTRD,$618.00,$0.00,$618.00,$278.10,$441.07,$0.00,$106.48,$0.00,$0.00,$108.21,$618.00,$0.00,$309.00,$489.46,$494.40,$0.00,$96.72,$0.00,$98.39,$0.00
71065309S,SUP,HCPCS C1713,,71065309S  -  PIN HLF LNG 5MM 30MM STRL JTX TI NTRD,$618.00,$0.00,$618.00,$278.10,$441.07,$0.00,$106.48,$0.00,$0.00,$108.21,$618.00,$0.00,$309.00,$489.46,$494.40,$0.00,$96.72,$0.00,$98.39,$0.00
71065354S,SUP,HCPCS C1713,,71065354S  -  PIN HLF XSH 5MM 35MM STRL JTX TI NTRD,$556.00,$0.00,$556.00,$250.20,$396.82,$0.00,$95.80,$0.00,$0.00,$97.35,$556.00,$0.00,$278.00,$440.35,$444.80,$0.00,$87.01,$0.00,$88.52,$0.00
71065358S,SUP,HCPCS C1713,,71065358S  -  PIN HLF SHRT 5MM 35MM STRL JTX TI NTRD,$618.00,$0.00,$618.00,$278.10,$441.07,$0.00,$106.48,$0.00,$0.00,$108.21,$618.00,$0.00,$309.00,$489.46,$494.40,$0.00,$96.72,$0.00,$98.39,$0.00
71065359S,SUP,HCPCS C1713,,71065359S  -  PIN HLF LNG 5MM 35MM STRL JTX TI NTRD,$618.00,$0.00,$618.00,$278.10,$441.07,$0.00,$106.48,$0.00,$0.00,$108.21,$618.00,$0.00,$309.00,$489.46,$494.40,$0.00,$96.72,$0.00,$98.39,$0.00
71065404S,SUP,HCPCS C1713,,71065404S  -  PIN HLF XSH 5MM 40MM STRL JTX TI NTRD,$584.00,$0.00,$584.00,$262.80,$416.80,$0.00,$100.62,$0.00,$0.00,$102.25,$584.00,$0.00,$292.00,$462.53,$467.20,$0.00,$91.40,$0.00,$92.97,$0.00
71065407S,SUP,HCPCS C1713,,71065407S  -  PIN HLF XSH 1.6MM 40MM STRL JTX CNN TI NTRD,$790.00,$0.00,$790.00,$355.50,$563.82,$0.00,$136.11,$0.00,$0.00,$138.32,$790.00,$0.00,$395.00,$625.68,$632.00,$0.00,$123.64,$0.00,$125.77,$0.00
71065408S,SUP,HCPCS C1713,,71065408S  -  PIN HLF SHRT 5MM 40MM STRL JTX TI NTRD,$618.00,$0.00,$618.00,$278.10,$441.07,$0.00,$106.48,$0.00,$0.00,$108.21,$618.00,$0.00,$309.00,$489.46,$494.40,$0.00,$96.72,$0.00,$98.39,$0.00
71065409S,SUP,HCPCS C1713,,71065409S  -  PIN HLF LNG 5MM 40MM STRL JTX TI NTRD,$618.00,$0.00,$618.00,$278.10,$441.07,$0.00,$106.48,$0.00,$0.00,$108.21,$618.00,$0.00,$309.00,$489.46,$494.40,$0.00,$96.72,$0.00,$98.39,$0.00
71065454S,SUP,HCPCS C1713,,71065454S  -  PIN HLF XSH 5MM 45MM STRL JTX TI NTRD,$556.00,$0.00,$556.00,$250.20,$396.82,$0.00,$95.80,$0.00,$0.00,$97.35,$556.00,$0.00,$278.00,$440.35,$444.80,$0.00,$87.01,$0.00,$88.52,$0.00
71065458S,SUP,HCPCS C1713,,71065458S  -  PIN HLF SHRT 5MM 45MM STRL JTX TI NTRD,$618.00,$0.00,$618.00,$278.10,$441.07,$0.00,$106.48,$0.00,$0.00,$108.21,$618.00,$0.00,$309.00,$489.46,$494.40,$0.00,$96.72,$0.00,$98.39,$0.00
71065459S,SUP,HCPCS C1713,,71065459S  -  PIN HLF LNG 5MM 45MM STRL JTX TI NTRD,$618.00,$0.00,$618.00,$278.10,$441.07,$0.00,$106.48,$0.00,$0.00,$108.21,$618.00,$0.00,$309.00,$489.46,$494.40,$0.00,$96.72,$0.00,$98.39,$0.00
71065507S,SUP,HCPCS C1713,,71065507S  -  PIN HLF 5MM 50MM STRL JTX TRC TI NTRD,"$1,132.00",$0.00,"$1,132.00",$509.40,$807.91,$0.00,$195.04,$0.00,$0.00,$198.20,"$1,132.00",$0.00,$566.00,$896.54,$905.60,$0.00,$177.16,$0.00,$180.21,$0.00
71065508S,SUP,HCPCS C1713,,71065508S  -  PIN HLF SHRT 5MM 50MM STRL JTX TI NTRD,$618.00,$0.00,$618.00,$278.10,$441.07,$0.00,$106.48,$0.00,$0.00,$108.21,$618.00,$0.00,$309.00,$489.46,$494.40,$0.00,$96.72,$0.00,$98.39,$0.00
71065509S,SUP,HCPCS C1713,,71065509S  -  PIN HLF LNG 5MM 50MM STRL JTX TI NTRD,$618.00,$0.00,$618.00,$278.10,$441.07,$0.00,$106.48,$0.00,$0.00,$108.21,$618.00,$0.00,$309.00,$489.46,$494.40,$0.00,$96.72,$0.00,$98.39,$0.00
71065558S,SUP,HCPCS C1713,,71065558S  -  PIN HLF SHRT 5MM 55MM STRL JTX TI NTRD,$618.00,$0.00,$618.00,$278.10,$441.07,$0.00,$106.48,$0.00,$0.00,$108.21,$618.00,$0.00,$309.00,$489.46,$494.40,$0.00,$96.72,$0.00,$98.39,$0.00
71065559S,SUP,HCPCS C1713,,71065559S  -  PIN HLF LNG 5MM 55MM STRL JTX TI NTRD,$618.00,$0.00,$618.00,$278.10,$441.07,$0.00,$106.48,$0.00,$0.00,$108.21,$618.00,$0.00,$309.00,$489.46,$494.40,$0.00,$96.72,$0.00,$98.39,$0.00
71065608S,SUP,HCPCS C1713,,71065608S  -  PIN HLF SHRT 5MM 60MM STRL JTX TI NTRD,$618.00,$0.00,$618.00,$278.10,$441.07,$0.00,$106.48,$0.00,$0.00,$108.21,$618.00,$0.00,$309.00,$489.46,$494.40,$0.00,$96.72,$0.00,$98.39,$0.00
71065609S,SUP,HCPCS C1713,,71065609S  -  PIN HLF LNG 5MM 60MM STRL JTX TI NTRD,$618.00,$0.00,$618.00,$278.10,$441.07,$0.00,$106.48,$0.00,$0.00,$108.21,$618.00,$0.00,$309.00,$489.46,$494.40,$0.00,$96.72,$0.00,$98.39,$0.00
71065658S,SUP,HCPCS C1713,,71065658S  -  PIN HLF SHRT 5MM 65MM STRL JTX TI NTRD,$618.00,$0.00,$618.00,$278.10,$441.07,$0.00,$106.48,$0.00,$0.00,$108.21,$618.00,$0.00,$309.00,$489.46,$494.40,$0.00,$96.72,$0.00,$98.39,$0.00
71065659S,SUP,HCPCS C1713,,71065659S  -  PIN HLF LNG 5MM 65MM STRL JTX TI NTRD,$618.00,$0.00,$618.00,$278.10,$441.07,$0.00,$106.48,$0.00,$0.00,$108.21,$618.00,$0.00,$309.00,$489.46,$494.40,$0.00,$96.72,$0.00,$98.39,$0.00
71065708S,SUP,HCPCS C1713,,71065708S  -  PIN HLF SHRT 5MM 70MM STRL JTX TI NTRD,$618.00,$0.00,$618.00,$278.10,$441.07,$0.00,$106.48,$0.00,$0.00,$108.21,$618.00,$0.00,$309.00,$489.46,$494.40,$0.00,$96.72,$0.00,$98.39,$0.00
71065709S,SUP,HCPCS C1713,,71065709S  -  PIN HLF LNG 5MM 70MM STRL JTX TI NTRD,$618.00,$0.00,$618.00,$278.10,$441.07,$0.00,$106.48,$0.00,$0.00,$108.21,$618.00,$0.00,$309.00,$489.46,$494.40,$0.00,$96.72,$0.00,$98.39,$0.00
71066409S,SUP,HCPCS C1713,,71066409S  -  PIN HLF LNG 6MM 40MM STRL JTX TI NTRD,$630.00,$0.00,$630.00,$283.50,$449.63,$0.00,$108.55,$0.00,$0.00,$110.31,$630.00,$0.00,$315.00,$498.96,$504.00,$0.00,$98.60,$0.00,$100.30,$0.00
71066459S,SUP,HCPCS C1713,,71066459S  -  PIN HLF LNG 6MM 45MM STRL JTX TI NTRD,$630.00,$0.00,$630.00,$283.50,$449.63,$0.00,$108.55,$0.00,$0.00,$110.31,$630.00,$0.00,$315.00,$498.96,$504.00,$0.00,$98.60,$0.00,$100.30,$0.00
71066509S,SUP,HCPCS C1713,,71066509S  -  PIN HLF LNG 6MM 50MM STRL JTX TI NTRD,$630.00,$0.00,$630.00,$283.50,$449.63,$0.00,$108.55,$0.00,$0.00,$110.31,$630.00,$0.00,$315.00,$498.96,$504.00,$0.00,$98.60,$0.00,$100.30,$0.00
71066559S,SUP,HCPCS C1713,,71066559S  -  PIN HLF LNG 6MM 55MM STRL JTX TI NTRD,$630.00,$0.00,$630.00,$283.50,$449.63,$0.00,$108.55,$0.00,$0.00,$110.31,$630.00,$0.00,$315.00,$498.96,$504.00,$0.00,$98.60,$0.00,$100.30,$0.00
71066609S,SUP,HCPCS C1713,,71066609S  -  PIN HLF LNG 6MM 60MM JTX TI NTRD,$318.50,$0.00,$318.50,$143.33,$227.31,$0.00,$54.88,$0.00,$0.00,$55.77,$318.50,$0.00,$159.25,$252.25,$254.80,$0.00,$49.85,$0.00,$50.71,$0.00
71070115X,SUP,Custom 27011340,,71070115X  -  RING EXFIX 180MM FULL CIR FT TLT SP,"$3,468.00",$0.00,"$3,468.00",$0.00,"$2,475.11",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,468.00",$0.00,"$1,734.00","$2,746.66","$2,774.40",$0.00,$0.00,$0.00,$0.00,$0.00
71071306X,SUP,HCPCS C1713,,71071306X  -  RING XTRNFX 2/3 155MM,"$3,315.00",$0.00,"$3,315.00","$1,491.75","$2,365.92",$0.00,$571.16,$0.00,$0.00,$580.43,"$3,315.00",$0.00,"$1,657.50","$2,625.48","$2,652.00",$0.00,$518.80,$0.00,$527.75,$0.00
71101545S,SUP,HCPCS C1713,,71101545S  -  WASHER ORTH 6MM STRL,$109.00,$0.00,$109.00,$49.05,$77.79,$0.00,$18.78,$0.00,$0.00,$19.09,$109.00,$0.00,$54.50,$86.33,$87.20,$0.00,$17.06,$0.00,$17.35,$0.00
71101690S,SUP,HCPCS C1713,,71101690S  -  WASHER ORTH 12.7MM RND,$132.30,$0.00,$132.30,$59.54,$94.42,$0.00,$22.79,$0.00,$0.00,$23.16,$132.30,$0.00,$66.15,$104.78,$105.84,$0.00,$20.70,$0.00,$21.06,$0.00
71101693S,SUP,HCPCS C1713,,71101693S  -  WASHER ORTH 21.7MM STRL BTRFLY SS LG CNN SCR SYS,$219.45,$0.00,$219.45,$98.75,$156.62,$0.00,$37.81,$0.00,$0.00,$38.42,$219.45,$0.00,$109.73,$173.80,$175.56,$0.00,$34.34,$0.00,$34.94,$0.00
71103000S,SUP,HCPCS C1713,,71103000S  -  WASHER ORTH 12.7MM RND TI,$77.13,$0.00,$77.13,$34.71,$55.04,$0.00,$13.29,$0.00,$0.00,$13.50,$77.13,$0.00,$38.56,$61.09,$61.70,$0.00,$12.07,$0.00,$12.28,$0.00
71103003S,SUP,HCPCS C1713,,71103003S  -  WASHER ORTH 21.7MM BTRFLY TI,$527.10,$0.00,$527.10,$237.20,$376.19,$0.00,$90.82,$0.00,$0.00,$92.29,$527.10,$0.00,$263.55,$417.46,$421.68,$0.00,$82.49,$0.00,$83.91,$0.00
71106230S,SUP,HCPCS C1713,,71106230S  -  SCREW BN FT 6.5MM 30MM STRL CNN SS LNG BN SM BN,$435.75,$0.00,$435.75,$196.09,$310.99,$0.00,$75.08,$0.00,$0.00,$76.30,$435.75,$0.00,$217.88,$345.11,$348.60,$0.00,$68.19,$0.00,$69.37,$0.00
71106235S,SUP,HCPCS C1713,,71106235S  -  SCREW BN FT 6.5MM 35MM STRL CNN SS LNG BN SM BN,$435.75,$0.00,$435.75,$196.09,$310.99,$0.00,$75.08,$0.00,$0.00,$76.30,$435.75,$0.00,$217.88,$345.11,$348.60,$0.00,$68.19,$0.00,$69.37,$0.00
71106240S,SUP,HCPCS C1713,,71106240S  -  SCREW BN FT 6.5MM 40MM STRL CNN SS LNG BN SM BN,$435.75,$0.00,$435.75,$196.09,$310.99,$0.00,$75.08,$0.00,$0.00,$76.30,$435.75,$0.00,$217.88,$345.11,$348.60,$0.00,$68.19,$0.00,$69.37,$0.00
71106245S,SUP,HCPCS C1713,,71106245S  -  SCREW BN FT 6.5MM 45MM STRL CNN SS LNG BN SM BN,$435.75,$0.00,$435.75,$196.09,$310.99,$0.00,$75.08,$0.00,$0.00,$76.30,$435.75,$0.00,$217.88,$345.11,$348.60,$0.00,$68.19,$0.00,$69.37,$0.00
71106250S,SUP,HCPCS C1713,,71106250S  -  SCREW BN FT 6.5MM 50MM STRL CNN SS LNG BN SM BN,$435.75,$0.00,$435.75,$196.09,$310.99,$0.00,$75.08,$0.00,$0.00,$76.30,$435.75,$0.00,$217.88,$345.11,$348.60,$0.00,$68.19,$0.00,$69.37,$0.00
71106255S,SUP,HCPCS C1713,,71106255S  -  SCREW BN FT 6.5MM 55MM STRL CNN SS LNG BN SM BN,$435.75,$0.00,$435.75,$196.09,$310.99,$0.00,$75.08,$0.00,$0.00,$76.30,$435.75,$0.00,$217.88,$345.11,$348.60,$0.00,$68.19,$0.00,$69.37,$0.00
71106260S,SUP,HCPCS C1713,,71106260S  -  SCREW BN FT 6.5MM 60MM STRL CNN SS LNG BN SM BN,$435.75,$0.00,$435.75,$196.09,$310.99,$0.00,$75.08,$0.00,$0.00,$76.30,$435.75,$0.00,$217.88,$345.11,$348.60,$0.00,$68.19,$0.00,$69.37,$0.00
71106265S,SUP,HCPCS C1713,,71106265S  -  SCREW BN FT 6.5MM 65MM STRL CNN SS LNG BN SM BN,$435.75,$0.00,$435.75,$196.09,$310.99,$0.00,$75.08,$0.00,$0.00,$76.30,$435.75,$0.00,$217.88,$345.11,$348.60,$0.00,$68.19,$0.00,$69.37,$0.00
71106270S,SUP,HCPCS C1713,,71106270S  -  SCREW BN FT 6.5MM 70MM STRL CNN SS LNG BN SM BN,$435.75,$0.00,$435.75,$196.09,$310.99,$0.00,$75.08,$0.00,$0.00,$76.30,$435.75,$0.00,$217.88,$345.11,$348.60,$0.00,$68.19,$0.00,$69.37,$0.00
71106275S,SUP,HCPCS C1713,,71106275S  -  SCREW BN FT 6.5MM 75MM STRL CNN SS LNG BN SM BN,$435.75,$0.00,$435.75,$196.09,$310.99,$0.00,$75.08,$0.00,$0.00,$76.30,$435.75,$0.00,$217.88,$345.11,$348.60,$0.00,$68.19,$0.00,$69.37,$0.00
71106280S,SUP,HCPCS C1713,,71106280S  -  SCREW BN FT 6.5MM 80MM STRL CNN SS LNG BN SM BN,$435.75,$0.00,$435.75,$196.09,$310.99,$0.00,$75.08,$0.00,$0.00,$76.30,$435.75,$0.00,$217.88,$345.11,$348.60,$0.00,$68.19,$0.00,$69.37,$0.00
71106285S,SUP,HCPCS C1713,,71106285S  -  SCREW BN 6.5MM 85MM CNN FT SS,$435.75,$0.00,$435.75,$196.09,$310.99,$0.00,$75.08,$0.00,$0.00,$76.30,$435.75,$0.00,$217.88,$345.11,$348.60,$0.00,$68.19,$0.00,$69.37,$0.00
71106290S,SUP,HCPCS C1713,,71106290S  -  SCREW BN FT 6.5MM 90MM STRL CNN SS LNG BN SM BN,$435.75,$0.00,$435.75,$196.09,$310.99,$0.00,$75.08,$0.00,$0.00,$76.30,$435.75,$0.00,$217.88,$345.11,$348.60,$0.00,$68.19,$0.00,$69.37,$0.00
71106295S,SUP,HCPCS C1713,,71106295S  -  SCREW BN FT 6.5MM 95MM STRL CNN SS LNG BN SM BN,$435.75,$0.00,$435.75,$196.09,$310.99,$0.00,$75.08,$0.00,$0.00,$76.30,$435.75,$0.00,$217.88,$345.11,$348.60,$0.00,$68.19,$0.00,$69.37,$0.00
71106300S,SUP,HCPCS C1713,,71106300S  -  SCREW BN FT 6.5MM 100MM STRL CNN SS LNG BN SM BN,$435.75,$0.00,$435.75,$196.09,$310.99,$0.00,$75.08,$0.00,$0.00,$76.30,$435.75,$0.00,$217.88,$345.11,$348.60,$0.00,$68.19,$0.00,$69.37,$0.00
71106305S,SUP,HCPCS C1713,,71106305S  -  SCREW BN FT 6.5MM 105MM STRL CNN SS LNG BN SM BN,$435.75,$0.00,$435.75,$196.09,$310.99,$0.00,$75.08,$0.00,$0.00,$76.30,$435.75,$0.00,$217.88,$345.11,$348.60,$0.00,$68.19,$0.00,$69.37,$0.00
71106310S,SUP,HCPCS C1713,,71106310S  -  SCREW BN FT 6.5MM 110MM STRL CNN SS LNG BN SM BN,$435.75,$0.00,$435.75,$196.09,$310.99,$0.00,$75.08,$0.00,$0.00,$76.30,$435.75,$0.00,$217.88,$345.11,$348.60,$0.00,$68.19,$0.00,$69.37,$0.00
71106315S,SUP,HCPCS C1713,,71106315S  -  SCREW BN FT 6.5MM 115MM STRL CNN SS LNG BN SM BN,$435.75,$0.00,$435.75,$196.09,$310.99,$0.00,$75.08,$0.00,$0.00,$76.30,$435.75,$0.00,$217.88,$345.11,$348.60,$0.00,$68.19,$0.00,$69.37,$0.00
71106320S,SUP,HCPCS C1713,,71106320S  -  SCREW BN FT 6.5MM 120MM STRL CNN SS LNG BN SM BN,$435.75,$0.00,$435.75,$196.09,$310.99,$0.00,$75.08,$0.00,$0.00,$76.30,$435.75,$0.00,$217.88,$345.11,$348.60,$0.00,$68.19,$0.00,$69.37,$0.00
71106325S,SUP,HCPCS C1713,,71106325S  -  SCREW BN FT 6.5MM 125MM STRL CNN SS LNG BN SM BN,$435.75,$0.00,$435.75,$196.09,$310.99,$0.00,$75.08,$0.00,$0.00,$76.30,$435.75,$0.00,$217.88,$345.11,$348.60,$0.00,$68.19,$0.00,$69.37,$0.00
71106330S,SUP,HCPCS C1713,,71106330S  -  SCREW BN FT 6.5MM 130MM STRL CNN SS LNG BN SM BN,$502.95,$0.00,$502.95,$226.33,$358.96,$0.00,$86.66,$0.00,$0.00,$88.06,$502.95,$0.00,$251.48,$398.34,$402.36,$0.00,$78.71,$0.00,$80.07,$0.00
71106335S,SUP,HCPCS C1713,,71106335S  -  SCREW BN FT 6.5MM 135MM STRL CNN SS LNG BN SM BN,$502.95,$0.00,$502.95,$226.33,$358.96,$0.00,$86.66,$0.00,$0.00,$88.06,$502.95,$0.00,$251.48,$398.34,$402.36,$0.00,$78.71,$0.00,$80.07,$0.00
71106340S,SUP,HCPCS C1713,,71106340S  -  SCREW BN FT 6.5MM 140MM STRL CNN SS LNG BN SM BN,$502.95,$0.00,$502.95,$226.33,$358.96,$0.00,$86.66,$0.00,$0.00,$88.06,$502.95,$0.00,$251.48,$398.34,$402.36,$0.00,$78.71,$0.00,$80.07,$0.00
71106345S,SUP,HCPCS C1713,,71106345S  -  SCREW BN FT 6.5MM 145MM STRL CNN SS LNG BN SM BN,$502.95,$0.00,$502.95,$226.33,$358.96,$0.00,$86.66,$0.00,$0.00,$88.06,$502.95,$0.00,$251.48,$398.34,$402.36,$0.00,$78.71,$0.00,$80.07,$0.00
71106350S,SUP,HCPCS C1713,,71106350S  -  SCREW BN FT 6.5MM 150MM STRL CNN SS LNG BN SM BN,$502.95,$0.00,$502.95,$226.33,$358.96,$0.00,$86.66,$0.00,$0.00,$88.06,$502.95,$0.00,$251.48,$398.34,$402.36,$0.00,$78.71,$0.00,$80.07,$0.00
71106355S,SUP,HCPCS C1713,,71106355S  -  SCREW BN FT 6.5MM 155MM STRL CNN SS LNG BN SM BN,$502.95,$0.00,$502.95,$226.33,$358.96,$0.00,$86.66,$0.00,$0.00,$88.06,$502.95,$0.00,$251.48,$398.34,$402.36,$0.00,$78.71,$0.00,$80.07,$0.00
71106360S,SUP,HCPCS C1713,,71106360S  -  SCREW BN FT 6.5MM 160MM STRL CNN SS LNG BN SM BN,$502.95,$0.00,$502.95,$226.33,$358.96,$0.00,$86.66,$0.00,$0.00,$88.06,$502.95,$0.00,$251.48,$398.34,$402.36,$0.00,$78.71,$0.00,$80.07,$0.00
71106365S,SUP,HCPCS C1713,,71106365S  -  SCREW BN FT 6.5MM 165MM STRL CNN SS LNG BN SM BN,$502.95,$0.00,$502.95,$226.33,$358.96,$0.00,$86.66,$0.00,$0.00,$88.06,$502.95,$0.00,$251.48,$398.34,$402.36,$0.00,$78.71,$0.00,$80.07,$0.00
71106370S,SUP,HCPCS C1713,,71106370S  -  SCREW BN FT 6.5MM 170MM STRL CNN SS LNG BN SM BN,$502.95,$0.00,$502.95,$226.33,$358.96,$0.00,$86.66,$0.00,$0.00,$88.06,$502.95,$0.00,$251.48,$398.34,$402.36,$0.00,$78.71,$0.00,$80.07,$0.00
71106375S,SUP,HCPCS C1713,,71106375S  -  SCREW BN FT 6.5MM 175MM STRL CNN SS LNG BN SM BN,$502.95,$0.00,$502.95,$226.33,$358.96,$0.00,$86.66,$0.00,$0.00,$88.06,$502.95,$0.00,$251.48,$398.34,$402.36,$0.00,$78.71,$0.00,$80.07,$0.00
71106380S,SUP,HCPCS C1713,,71106380S  -  SCREW BN FT 6.5MM 180MM STRL CNN SS LNG BN SM BN,$502.95,$0.00,$502.95,$226.33,$358.96,$0.00,$86.66,$0.00,$0.00,$88.06,$502.95,$0.00,$251.48,$398.34,$402.36,$0.00,$78.71,$0.00,$80.07,$0.00
71106530S,SUP,HCPCS C1713,,71106530S  -  SCREW BN 6.5MM 30MM STRL 22MM CNN SS LNG BN SM BN,$435.75,$0.00,$435.75,$196.09,$310.99,$0.00,$75.08,$0.00,$0.00,$76.30,$435.75,$0.00,$217.88,$345.11,$348.60,$0.00,$68.19,$0.00,$69.37,$0.00
71106535S,SUP,HCPCS C1713,,71106535S  -  SCREW BN 6.5MM 35MM STRL 22MM CNN SS LNG BN SM BN,$435.75,$0.00,$435.75,$196.09,$310.99,$0.00,$75.08,$0.00,$0.00,$76.30,$435.75,$0.00,$217.88,$345.11,$348.60,$0.00,$68.19,$0.00,$69.37,$0.00
71106540S,SUP,HCPCS C1713,,71106540S  -  SCREW BN 6.5MM 40MM STRL 22MM CNN SS LNG BN SM BN,$435.75,$0.00,$435.75,$196.09,$310.99,$0.00,$75.08,$0.00,$0.00,$76.30,$435.75,$0.00,$217.88,$345.11,$348.60,$0.00,$68.19,$0.00,$69.37,$0.00
71106545S,SUP,HCPCS C1713,,71106545S  -  SCREW BN 6.5MM 45MM STRL 22MM CNN SS LNG BN SM BN,$435.75,$0.00,$435.75,$196.09,$310.99,$0.00,$75.08,$0.00,$0.00,$76.30,$435.75,$0.00,$217.88,$345.11,$348.60,$0.00,$68.19,$0.00,$69.37,$0.00
71106550S,SUP,HCPCS C1713,,71106550S  -  SCREW BN 6.5MM 50MM STRL 22MM CNN SS LNG BN SM BN,$435.75,$0.00,$435.75,$196.09,$310.99,$0.00,$75.08,$0.00,$0.00,$76.30,$435.75,$0.00,$217.88,$345.11,$348.60,$0.00,$68.19,$0.00,$69.37,$0.00
71106555S,SUP,HCPCS C1713,,71106555S  -  SCREW BN 6.5MM 55MM STRL 22MM CNN SS LNG BN SM BN,$435.75,$0.00,$435.75,$196.09,$310.99,$0.00,$75.08,$0.00,$0.00,$76.30,$435.75,$0.00,$217.88,$345.11,$348.60,$0.00,$68.19,$0.00,$69.37,$0.00
71106560S,SUP,HCPCS C1713,,71106560S  -  SCREW BN 6.5MM 60MM STRL 22MM CNN SS LNG BN SM BN,$435.75,$0.00,$435.75,$196.09,$310.99,$0.00,$75.08,$0.00,$0.00,$76.30,$435.75,$0.00,$217.88,$345.11,$348.60,$0.00,$68.19,$0.00,$69.37,$0.00
71106565S,SUP,HCPCS C1713,,71106565S  -  SCREW BN 6.5MM 65MM STRL 22MM CNN SS LNG BN SM BN,$435.75,$0.00,$435.75,$196.09,$310.99,$0.00,$75.08,$0.00,$0.00,$76.30,$435.75,$0.00,$217.88,$345.11,$348.60,$0.00,$68.19,$0.00,$69.37,$0.00
71106570S,SUP,HCPCS C1713,,71106570S  -  SCREW BN 6.5MM 70MM STRL 22MM CNN SS LNG BN SM BN,$435.75,$0.00,$435.75,$196.09,$310.99,$0.00,$75.08,$0.00,$0.00,$76.30,$435.75,$0.00,$217.88,$345.11,$348.60,$0.00,$68.19,$0.00,$69.37,$0.00
71106575S,SUP,HCPCS C1713,,71106575S  -  SCREW BN 6.5MM 75MM STRL 22MM CNN SS LNG BN SM BN,$435.75,$0.00,$435.75,$196.09,$310.99,$0.00,$75.08,$0.00,$0.00,$76.30,$435.75,$0.00,$217.88,$345.11,$348.60,$0.00,$68.19,$0.00,$69.37,$0.00
71106580S,SUP,HCPCS C1713,,71106580S  -  SCREW BN 6.5MM 80MM STRL 22MM CNN SS LNG BN SM BN,$435.75,$0.00,$435.75,$196.09,$310.99,$0.00,$75.08,$0.00,$0.00,$76.30,$435.75,$0.00,$217.88,$345.11,$348.60,$0.00,$68.19,$0.00,$69.37,$0.00
71106585S,SUP,HCPCS C1713,,71106585S  -  SCREW BN 6.5MM 85MM STRL 22MM CNN SS LNG BN SM BN,$435.75,$0.00,$435.75,$196.09,$310.99,$0.00,$75.08,$0.00,$0.00,$76.30,$435.75,$0.00,$217.88,$345.11,$348.60,$0.00,$68.19,$0.00,$69.37,$0.00
71106590S,SUP,HCPCS C1713,,71106590S  -  SCREW BN 6.5MM 90MM STRL 22MM CNN SS ORTH,$435.75,$0.00,$435.75,$196.09,$310.99,$0.00,$75.08,$0.00,$0.00,$76.30,$435.75,$0.00,$217.88,$345.11,$348.60,$0.00,$68.19,$0.00,$69.37,$0.00
71106595S,SUP,HCPCS C1713,,71106595S  -  SCREW BN 6.5MM 95MM STRL 22MM CNN SS LNG BN SM BN,$435.75,$0.00,$435.75,$196.09,$310.99,$0.00,$75.08,$0.00,$0.00,$76.30,$435.75,$0.00,$217.88,$345.11,$348.60,$0.00,$68.19,$0.00,$69.37,$0.00
71106600S,SUP,HCPCS C1713,,71106600S  -  SCREW BN 6.5MM 100MM STRL 22MM CNN SS LNG BN SM BN,$435.75,$0.00,$435.75,$196.09,$310.99,$0.00,$75.08,$0.00,$0.00,$76.30,$435.75,$0.00,$217.88,$345.11,$348.60,$0.00,$68.19,$0.00,$69.37,$0.00
71106605S,SUP,HCPCS C1713,,71106605S  -  SCREW BN 6.5MM 105MM STRL 22MM CNN SS LNG BN SM BN,$435.75,$0.00,$435.75,$196.09,$310.99,$0.00,$75.08,$0.00,$0.00,$76.30,$435.75,$0.00,$217.88,$345.11,$348.60,$0.00,$68.19,$0.00,$69.37,$0.00
71106610S,SUP,HCPCS C1713,,71106610S  -  SCREW BN 6.5MM 110MM STRL 22MM CNN SS LNG BN SM BN,$435.75,$0.00,$435.75,$196.09,$310.99,$0.00,$75.08,$0.00,$0.00,$76.30,$435.75,$0.00,$217.88,$345.11,$348.60,$0.00,$68.19,$0.00,$69.37,$0.00
71106615S,SUP,HCPCS C1713,,71106615S  -  SCREW BN 6.5MM 115MM STRL 22MM CNN SS LNG BN SM BN,$435.75,$0.00,$435.75,$196.09,$310.99,$0.00,$75.08,$0.00,$0.00,$76.30,$435.75,$0.00,$217.88,$345.11,$348.60,$0.00,$68.19,$0.00,$69.37,$0.00
71106620S,SUP,HCPCS C1713,,71106620S  -  SCREW BN 6.5MM 120MM STRL 22MM CNN SS LNG BN SM BN,$435.75,$0.00,$435.75,$196.09,$310.99,$0.00,$75.08,$0.00,$0.00,$76.30,$435.75,$0.00,$217.88,$345.11,$348.60,$0.00,$68.19,$0.00,$69.37,$0.00
71106625S,SUP,HCPCS C1713,,71106625S  -  SCREW BN 6.5MM 125MM STRL 22MM CNN SS LNG BN SM BN,$435.75,$0.00,$435.75,$196.09,$310.99,$0.00,$75.08,$0.00,$0.00,$76.30,$435.75,$0.00,$217.88,$345.11,$348.60,$0.00,$68.19,$0.00,$69.37,$0.00
71106630S,SUP,HCPCS C1713,,71106630S  -  SCREW BN 6.5MM 130MM STRL 22MM CNN SS LNG BN SM BN,$502.95,$0.00,$502.95,$226.33,$358.96,$0.00,$86.66,$0.00,$0.00,$88.06,$502.95,$0.00,$251.48,$398.34,$402.36,$0.00,$78.71,$0.00,$80.07,$0.00
71106635S,SUP,HCPCS C1713,,71106635S  -  SCREW BN 6.5MM 135MM STRL 22MM CNN SS LNG BN SM BN,$502.95,$0.00,$502.95,$226.33,$358.96,$0.00,$86.66,$0.00,$0.00,$88.06,$502.95,$0.00,$251.48,$398.34,$402.36,$0.00,$78.71,$0.00,$80.07,$0.00
71106640S,SUP,HCPCS C1713,,71106640S  -  SCREW BN 6.5MM 140MM STRL 22MM CNN SS LNG BN SM BN,$502.95,$0.00,$502.95,$226.33,$358.96,$0.00,$86.66,$0.00,$0.00,$88.06,$502.95,$0.00,$251.48,$398.34,$402.36,$0.00,$78.71,$0.00,$80.07,$0.00
71106645S,SUP,HCPCS C1713,,71106645S  -  SCREW BN 6.5MM 145MM STRL 22MM CNN SS LNG BN SM BN,$502.95,$0.00,$502.95,$226.33,$358.96,$0.00,$86.66,$0.00,$0.00,$88.06,$502.95,$0.00,$251.48,$398.34,$402.36,$0.00,$78.71,$0.00,$80.07,$0.00
71106650S,SUP,HCPCS C1713,,71106650S  -  SCREW BN 6.5MM 150MM STRL 22MM CNN SS LNG BN SM BN,$502.95,$0.00,$502.95,$226.33,$358.96,$0.00,$86.66,$0.00,$0.00,$88.06,$502.95,$0.00,$251.48,$398.34,$402.36,$0.00,$78.71,$0.00,$80.07,$0.00
71106655S,SUP,HCPCS C1713,,71106655S  -  SCREW BN 6.5MM 155MM STRL 22MM CNN SS LNG BN SM BN,$502.95,$0.00,$502.95,$226.33,$358.96,$0.00,$86.66,$0.00,$0.00,$88.06,$502.95,$0.00,$251.48,$398.34,$402.36,$0.00,$78.71,$0.00,$80.07,$0.00
71106660S,SUP,HCPCS C1713,,71106660S  -  SCREW BN 6.5MM 160MM STRL 22MM CNN SS LNG BN SM BN,$502.95,$0.00,$502.95,$226.33,$358.96,$0.00,$86.66,$0.00,$0.00,$88.06,$502.95,$0.00,$251.48,$398.34,$402.36,$0.00,$78.71,$0.00,$80.07,$0.00
71106665S,SUP,HCPCS C1713,,71106665S  -  SCREW BN 6.5MM 165MM STRL 22MM CNN SS LNG BN SM BN,$502.95,$0.00,$502.95,$226.33,$358.96,$0.00,$86.66,$0.00,$0.00,$88.06,$502.95,$0.00,$251.48,$398.34,$402.36,$0.00,$78.71,$0.00,$80.07,$0.00
71106670S,SUP,HCPCS C1713,,71106670S  -  SCREW BN 6.5MM 170MM STRL 22MM CNN SS LNG BN SM BN,$502.95,$0.00,$502.95,$226.33,$358.96,$0.00,$86.66,$0.00,$0.00,$88.06,$502.95,$0.00,$251.48,$398.34,$402.36,$0.00,$78.71,$0.00,$80.07,$0.00
71106675S,SUP,HCPCS C1713,,71106675S  -  SCREW BN 6.5MM 175MM STRL 22MM CNN SS LNG BN SM BN,$502.95,$0.00,$502.95,$226.33,$358.96,$0.00,$86.66,$0.00,$0.00,$88.06,$502.95,$0.00,$251.48,$398.34,$402.36,$0.00,$78.71,$0.00,$80.07,$0.00
71106680S,SUP,HCPCS C1713,,71106680S  -  SCREW BN 6.5MM 180MM STRL 22MM CNN SS LNG BN SM BN,$502.95,$0.00,$502.95,$226.33,$358.96,$0.00,$86.66,$0.00,$0.00,$88.06,$502.95,$0.00,$251.48,$398.34,$402.36,$0.00,$78.71,$0.00,$80.07,$0.00
71106755S,SUP,HCPCS C1713,,71106755S  -  SCREW BN 6.5MM 55MM STRL 46MM CNN SS LNG BN SM BN,$435.75,$0.00,$435.75,$196.09,$310.99,$0.00,$75.08,$0.00,$0.00,$76.30,$435.75,$0.00,$217.88,$345.11,$348.60,$0.00,$68.19,$0.00,$69.37,$0.00
71106760S,SUP,HCPCS C1713,,71106760S  -  SCREW BN 6.5MM 60MM STRL 46MM CNN SS LNG BN SM BN,$435.75,$0.00,$435.75,$196.09,$310.99,$0.00,$75.08,$0.00,$0.00,$76.30,$435.75,$0.00,$217.88,$345.11,$348.60,$0.00,$68.19,$0.00,$69.37,$0.00
71106765S,SUP,HCPCS C1713,,71106765S  -  SCREW BN 6.5MM 65MM STRL 46MM CNN SS LNG BN SM BN,$435.75,$0.00,$435.75,$196.09,$310.99,$0.00,$75.08,$0.00,$0.00,$76.30,$435.75,$0.00,$217.88,$345.11,$348.60,$0.00,$68.19,$0.00,$69.37,$0.00
71106770S,SUP,HCPCS C1713,,71106770S  -  SCREW BN 6.5MM 70MM STRL 46MM CNN SS LNG BN SM BN,$435.75,$0.00,$435.75,$196.09,$310.99,$0.00,$75.08,$0.00,$0.00,$76.30,$435.75,$0.00,$217.88,$345.11,$348.60,$0.00,$68.19,$0.00,$69.37,$0.00
71106775S,SUP,HCPCS C1713,,71106775S  -  SCREW BN 6.5MM 75MM STRL 46MM CNN SS LNG BN SM BN,$435.75,$0.00,$435.75,$196.09,$310.99,$0.00,$75.08,$0.00,$0.00,$76.30,$435.75,$0.00,$217.88,$345.11,$348.60,$0.00,$68.19,$0.00,$69.37,$0.00
71106780S,SUP,HCPCS C1713,,71106780S  -  SCREW BN 6.5MM 80MM STRL 46MM CNN SS LNG BN SM BN,$435.75,$0.00,$435.75,$196.09,$310.99,$0.00,$75.08,$0.00,$0.00,$76.30,$435.75,$0.00,$217.88,$345.11,$348.60,$0.00,$68.19,$0.00,$69.37,$0.00
71106785S,SUP,HCPCS C1713,,71106785S  -  SCREW BN 6.5MM 85MM STRL 46MM CNN SS LNG BN SM BN,$435.75,$0.00,$435.75,$196.09,$310.99,$0.00,$75.08,$0.00,$0.00,$76.30,$435.75,$0.00,$217.88,$345.11,$348.60,$0.00,$68.19,$0.00,$69.37,$0.00
71106790S,SUP,HCPCS C1713,,71106790S  -  SCREW BN 6.5MM 90MM STRL 46MM CNN SS LNG BN SM BN,$435.75,$0.00,$435.75,$196.09,$310.99,$0.00,$75.08,$0.00,$0.00,$76.30,$435.75,$0.00,$217.88,$345.11,$348.60,$0.00,$68.19,$0.00,$69.37,$0.00
71106795S,SUP,HCPCS C1713,,71106795S  -  SCREW BN 6.5MM 95MM STRL 46MM CNN SS LNG BN SM BN,$435.75,$0.00,$435.75,$196.09,$310.99,$0.00,$75.08,$0.00,$0.00,$76.30,$435.75,$0.00,$217.88,$345.11,$348.60,$0.00,$68.19,$0.00,$69.37,$0.00
71106800S,SUP,HCPCS C1713,,71106800S  -  SCREW BN 6.5MM 100MM STRL 46MM CNN SS LNG BN SM BN,$435.75,$0.00,$435.75,$196.09,$310.99,$0.00,$75.08,$0.00,$0.00,$76.30,$435.75,$0.00,$217.88,$345.11,$348.60,$0.00,$68.19,$0.00,$69.37,$0.00
71106805S,SUP,HCPCS C1713,,71106805S  -  SCREW BN 6.5MM 105MM STRL 46MM CNN SS LNG BN SM BN,$435.75,$0.00,$435.75,$196.09,$310.99,$0.00,$75.08,$0.00,$0.00,$76.30,$435.75,$0.00,$217.88,$345.11,$348.60,$0.00,$68.19,$0.00,$69.37,$0.00
71106810S,SUP,HCPCS C1713,,71106810S  -  SCREW BN 6.5MM 110MM STRL 46MM CNN SS LNG BN SM BN,$435.75,$0.00,$435.75,$196.09,$310.99,$0.00,$75.08,$0.00,$0.00,$76.30,$435.75,$0.00,$217.88,$345.11,$348.60,$0.00,$68.19,$0.00,$69.37,$0.00
71106815S,SUP,HCPCS C1713,,71106815S  -  SCREW BN 6.5MM 115MM STRL 46MM CNN SS LNG BN SM BN,$435.75,$0.00,$435.75,$196.09,$310.99,$0.00,$75.08,$0.00,$0.00,$76.30,$435.75,$0.00,$217.88,$345.11,$348.60,$0.00,$68.19,$0.00,$69.37,$0.00
71106820S,SUP,HCPCS C1713,,71106820S  -  SCREW BN 6.5MM 120MM STRL 46MM CNN SS LNG BN SM BN,$435.75,$0.00,$435.75,$196.09,$310.99,$0.00,$75.08,$0.00,$0.00,$76.30,$435.75,$0.00,$217.88,$345.11,$348.60,$0.00,$68.19,$0.00,$69.37,$0.00
71106825S,SUP,HCPCS C1713,,71106825S  -  SCREW BN 6.5MM 125MM STRL 46MM CNN SS LNG BN SM BN,$435.75,$0.00,$435.75,$196.09,$310.99,$0.00,$75.08,$0.00,$0.00,$76.30,$435.75,$0.00,$217.88,$345.11,$348.60,$0.00,$68.19,$0.00,$69.37,$0.00
71106830S,SUP,HCPCS C1713,,71106830S  -  SCREW BN 6.5MM 130MM STRL 40MM CNN SS LNG BN SM BN,$502.95,$0.00,$502.95,$226.33,$358.96,$0.00,$86.66,$0.00,$0.00,$88.06,$502.95,$0.00,$251.48,$398.34,$402.36,$0.00,$78.71,$0.00,$80.07,$0.00
71106835S,SUP,HCPCS C1713,,71106835S  -  SCREW BN 6.5MM 135MM STRL 40MM CNN SS LNG BN SM BN,$502.95,$0.00,$502.95,$226.33,$358.96,$0.00,$86.66,$0.00,$0.00,$88.06,$502.95,$0.00,$251.48,$398.34,$402.36,$0.00,$78.71,$0.00,$80.07,$0.00
71106840S,SUP,HCPCS C1713,,71106840S  -  SCREW BN 6.5MM 140MM STRL 40MM CNN SS LNG BN SM BN,$502.95,$0.00,$502.95,$226.33,$358.96,$0.00,$86.66,$0.00,$0.00,$88.06,$502.95,$0.00,$251.48,$398.34,$402.36,$0.00,$78.71,$0.00,$80.07,$0.00
71106845S,SUP,HCPCS C1713,,71106845S  -  SCREW BN 6.5MM 145MM STRL 40MM CNN SS LNG BN SM BN,$502.95,$0.00,$502.95,$226.33,$358.96,$0.00,$86.66,$0.00,$0.00,$88.06,$502.95,$0.00,$251.48,$398.34,$402.36,$0.00,$78.71,$0.00,$80.07,$0.00
71106850S,SUP,HCPCS C1713,,71106850S  -  SCREW BN 6.5MM 150MM STRL 40MM CNN SS LNG BN SM BN,$502.95,$0.00,$502.95,$226.33,$358.96,$0.00,$86.66,$0.00,$0.00,$88.06,$502.95,$0.00,$251.48,$398.34,$402.36,$0.00,$78.71,$0.00,$80.07,$0.00
71106855S,SUP,HCPCS C1713,,71106855S  -  SCREW BN 6.5MM 155MM STRL 46MM CNN SS LNG BN SM BN,$502.95,$0.00,$502.95,$226.33,$358.96,$0.00,$86.66,$0.00,$0.00,$88.06,$502.95,$0.00,$251.48,$398.34,$402.36,$0.00,$78.71,$0.00,$80.07,$0.00
71106860S,SUP,HCPCS C1713,,71106860S  -  SCREW BN 6.5MM 160MM STRL 46MM CNN SS LNG BN SM BN,$502.95,$0.00,$502.95,$226.33,$358.96,$0.00,$86.66,$0.00,$0.00,$88.06,$502.95,$0.00,$251.48,$398.34,$402.36,$0.00,$78.71,$0.00,$80.07,$0.00
71106865S,SUP,HCPCS C1713,,71106865S  -  SCREW BN 6.5MM 165MM STRL 46MM CNN SS LNG BN SM BN,$502.95,$0.00,$502.95,$226.33,$358.96,$0.00,$86.66,$0.00,$0.00,$88.06,$502.95,$0.00,$251.48,$398.34,$402.36,$0.00,$78.71,$0.00,$80.07,$0.00
71106870S,SUP,HCPCS C1713,,71106870S  -  SCREW BN 6.5MM 170MM STRL 46MM CNN SS LNG BN SM BN,$502.95,$0.00,$502.95,$226.33,$358.96,$0.00,$86.66,$0.00,$0.00,$88.06,$502.95,$0.00,$251.48,$398.34,$402.36,$0.00,$78.71,$0.00,$80.07,$0.00
71106875S,SUP,HCPCS C1713,,71106875S  -  SCREW BN 6.5MM 175MM STRL 46MM CNN SS LNG BN SM BN,$502.95,$0.00,$502.95,$226.33,$358.96,$0.00,$86.66,$0.00,$0.00,$88.06,$502.95,$0.00,$251.48,$398.34,$402.36,$0.00,$78.71,$0.00,$80.07,$0.00
71106880S,SUP,HCPCS C1713,,71106880S  -  SCREW BN 6.5MM 180MM STRL 46MM CNN SS LNG BN SM BN,$502.95,$0.00,$502.95,$226.33,$358.96,$0.00,$86.66,$0.00,$0.00,$88.06,$502.95,$0.00,$251.48,$398.34,$402.36,$0.00,$78.71,$0.00,$80.07,$0.00
71107230S,SUP,HCPCS C1713,,71107230S  -  SCREW BN 6.5MM 30MM CNN FT TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71107235S,SUP,HCPCS C1713,,71107235S  -  SCREW BN 6.5MM 35MM CNN FT TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71107240S,SUP,HCPCS C1713,,71107240S  -  SCREW BN 6.5MM 40MM CNN FT TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71107245S,SUP,HCPCS C1713,,71107245S  -  SCREW BN 6.5MM 45MM CNN FT TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71107250S,SUP,HCPCS C1713,,71107250S  -  SCREW BN 6.5MM 50MM CNN FT TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71107255S,SUP,HCPCS C1713,,71107255S  -  SCREW BN 6.5MM 55MM CNN FT TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71107260S,SUP,HCPCS C1713,,71107260S  -  SCREW BN 6.5MM 60MM CNN FT TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71107265S,SUP,HCPCS C1713,,71107265S  -  SCREW BN 6.5MM 65MM CNN FT TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71107270S,SUP,HCPCS C1713,,71107270S  -  SCREW BN 6.5MM 70MM CNN FT TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71107275S,SUP,HCPCS C1713,,71107275S  -  SCREW BN 6.5MM 75MM CNN FT TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71107280S,SUP,HCPCS C1713,,71107280S  -  SCREW BN 6.5MM 80MM CNN FT TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71107285S,SUP,HCPCS C1713,,71107285S  -  SCREW BN 6.5MM 85MM CNN FT TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71107290S,SUP,HCPCS C1713,,71107290S  -  SCREW BN 6.5MM 90MM CNN FT TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71107295S,SUP,HCPCS C1713,,71107295S  -  SCREW BN 6.5MM 95MM CNN FT TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71107300S,SUP,HCPCS C1713,,71107300S  -  SCREW BN 6.5MM 100MM CNN FT TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71107305S,SUP,HCPCS C1713,,71107305S  -  SCREW BN 6.5MM 105MM CNN FT TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71107310S,SUP,HCPCS C1713,,71107310S  -  SCREW BN 6.5MM 110MM CNN FT TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71107315S,SUP,HCPCS C1713,,71107315S  -  SCREW BN 6.5MM 115MM CNN FT TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71107320S,SUP,HCPCS C1713,,71107320S  -  SCREW BN 6.5MM 120MM CNN FT TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71107325S,SUP,HCPCS C1713,,71107325S  -  SCREW BN FT 6.5MM 125MM CNN SET TI ANKL ASCP ARTHDS,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71107330S,SUP,HCPCS C1713,,71107330S  -  SCREW BN 6.5MM 130MM CNN FT TI,$492.45,$0.00,$492.45,$221.60,$351.46,$0.00,$84.85,$0.00,$0.00,$86.22,$492.45,$0.00,$246.23,$390.02,$393.96,$0.00,$77.07,$0.00,$78.40,$0.00
71107335S,SUP,HCPCS C1713,,71107335S  -  SCREW BN 6.5MM 135MM CNN FT TI,$492.45,$0.00,$492.45,$221.60,$351.46,$0.00,$84.85,$0.00,$0.00,$86.22,$492.45,$0.00,$246.23,$390.02,$393.96,$0.00,$77.07,$0.00,$78.40,$0.00
71107340S,SUP,HCPCS C1713,,71107340S  -  SCREW BN 6.5MM 140MM CNN FT TI,$492.45,$0.00,$492.45,$221.60,$351.46,$0.00,$84.85,$0.00,$0.00,$86.22,$492.45,$0.00,$246.23,$390.02,$393.96,$0.00,$77.07,$0.00,$78.40,$0.00
71107345S,SUP,HCPCS C1713,,71107345S  -  SCREW BN 6.5MM 145MM CNN FT TI,$492.45,$0.00,$492.45,$221.60,$351.46,$0.00,$84.85,$0.00,$0.00,$86.22,$492.45,$0.00,$246.23,$390.02,$393.96,$0.00,$77.07,$0.00,$78.40,$0.00
71107350S,SUP,HCPCS C1713,,71107350S  -  SCREW BN 6.5MM 150MM CNN FT TI,$492.45,$0.00,$492.45,$221.60,$351.46,$0.00,$84.85,$0.00,$0.00,$86.22,$492.45,$0.00,$246.23,$390.02,$393.96,$0.00,$77.07,$0.00,$78.40,$0.00
71107355S,SUP,HCPCS C1713,,71107355S  -  SCREW BN 6.5MM 155MM CNN FT TI,$492.45,$0.00,$492.45,$221.60,$351.46,$0.00,$84.85,$0.00,$0.00,$86.22,$492.45,$0.00,$246.23,$390.02,$393.96,$0.00,$77.07,$0.00,$78.40,$0.00
71107360S,SUP,HCPCS C1713,,71107360S  -  SCREW BN 6.5MM 160MM CNN FT TI,$492.45,$0.00,$492.45,$221.60,$351.46,$0.00,$84.85,$0.00,$0.00,$86.22,$492.45,$0.00,$246.23,$390.02,$393.96,$0.00,$77.07,$0.00,$78.40,$0.00
71107365S,SUP,HCPCS C1713,,71107365S  -  SCREW BN 6.5MM 165MM CNN FT TI,$492.45,$0.00,$492.45,$221.60,$351.46,$0.00,$84.85,$0.00,$0.00,$86.22,$492.45,$0.00,$246.23,$390.02,$393.96,$0.00,$77.07,$0.00,$78.40,$0.00
71107370S,SUP,HCPCS C1713,,71107370S  -  SCREW BN 6.5MM 170MM CNN FT TI,$492.45,$0.00,$492.45,$221.60,$351.46,$0.00,$84.85,$0.00,$0.00,$86.22,$492.45,$0.00,$246.23,$390.02,$393.96,$0.00,$77.07,$0.00,$78.40,$0.00
71107375S,SUP,HCPCS C1713,,71107375S  -  SCREW BN 6.5MM 175MM CNN FT TI,$492.45,$0.00,$492.45,$221.60,$351.46,$0.00,$84.85,$0.00,$0.00,$86.22,$492.45,$0.00,$246.23,$390.02,$393.96,$0.00,$77.07,$0.00,$78.40,$0.00
71107380S,SUP,HCPCS C1713,,71107380S  -  SCREW BN 6.5MM 180MM CNN FT TI,$492.45,$0.00,$492.45,$221.60,$351.46,$0.00,$84.85,$0.00,$0.00,$86.22,$492.45,$0.00,$246.23,$390.02,$393.96,$0.00,$77.07,$0.00,$78.40,$0.00
71107530S,SUP,HCPCS C1713,,71107530S  -  SCREW BN 6.5MM 30MM 20MM CNN P/T TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71107535S,SUP,HCPCS C1713,,71107535S  -  SCREW BN 6.5MM 35MM 22MM CNN P/T TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71107540S,SUP,HCPCS C1713,,71107540S  -  SCREW BN 6.5MM 40MM 22MM CNN P/T TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71107545S,SUP,HCPCS C1713,,71107545S  -  SCREW BN 6.5MM 45MM 22MM CNN P/T TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71107550S,SUP,HCPCS C1713,,71107550S  -  SCREW BN 6.5MM 50MM 22MM CNN P/T TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71107555S,SUP,HCPCS C1713,,71107555S  -  SCREW BN 6.5MM 55MM 22MM CNN P/T TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71107560S,SUP,HCPCS C1713,,71107560S  -  SCREW BN 6.5MM 60MM 22MM CNN P/T TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71107565S,SUP,HCPCS C1713,,71107565S  -  SCREW BN 6.5MM 65MM 22MM CNN P/T TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71107570S,SUP,HCPCS C1713,,71107570S  -  SCREW BN 6.5MM 70MM 22MM CNN P/T,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71107575S,SUP,HCPCS C1713,,71107575S  -  SCREW BN 6.5MM 75MM 22MM CNN P/T,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71107580S,SUP,HCPCS C1713,,71107580S  -  SCREW BN 6.5MM 80MM 22MM CNN P/T,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71107585S,SUP,HCPCS C1713,,71107585S  -  SCREW BN 6.5MM 85MM 22MM CNN P/T TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71107590S,SUP,HCPCS C1713,,71107590S  -  SCREW BN 6.5MM 90MM 22MM P/T CNN TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71107595S,SUP,HCPCS C1713,,71107595S  -  SCREW BN 6.5MM 95MM 22MM P/T CNN TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71107600S,SUP,HCPCS C1713,,71107600S  -  SCREW BN 6.5MM 100MM 22MM P/T CNN TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71107605S,SUP,HCPCS C1713,,71107605S  -  SCREW BN 6.5MM 105MM 22MM P/T CNN TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71107610S,SUP,HCPCS C1713,,71107610S  -  SCREW BN 6.5MM 110MM 22MM P/T CNN TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71107615S,SUP,HCPCS C1713,,71107615S  -  SCREW BN 6.5MM 115MM 22MM P/T CNN TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71107620S,SUP,HCPCS C1713,,71107620S  -  SCREW BN 6.5MM 120MM 22MM P/T CNN TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71107625S,SUP,HCPCS C1713,,71107625S  -  SCREW BN 6.5MM 125MM 22MM P/T CNN TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71107630S,SUP,HCPCS C1713,,71107630S  -  SCREW BN 6.5MM 130MM 22MM CNN P/T,$564.90,$0.00,$564.90,$254.21,$403.17,$0.00,$97.33,$0.00,$0.00,$98.91,$564.90,$0.00,$282.45,$447.40,$451.92,$0.00,$88.41,$0.00,$89.93,$0.00
71107635S,SUP,HCPCS C1713,,71107635S  -  SCREW BN 6.5MM 135MM 22MM CNN P/T,$564.90,$0.00,$564.90,$254.21,$403.17,$0.00,$97.33,$0.00,$0.00,$98.91,$564.90,$0.00,$282.45,$447.40,$451.92,$0.00,$88.41,$0.00,$89.93,$0.00
71107640S,SUP,HCPCS C1713,,71107640S  -  SCREW BN 6.5MM 140MM 22MM CNN P/T,$564.90,$0.00,$564.90,$254.21,$403.17,$0.00,$97.33,$0.00,$0.00,$98.91,$564.90,$0.00,$282.45,$447.40,$451.92,$0.00,$88.41,$0.00,$89.93,$0.00
71107645S,SUP,HCPCS C1713,,71107645S  -  SCREW BN 6.5MM 145MM 22MM CNN P/T,$564.90,$0.00,$564.90,$254.21,$403.17,$0.00,$97.33,$0.00,$0.00,$98.91,$564.90,$0.00,$282.45,$447.40,$451.92,$0.00,$88.41,$0.00,$89.93,$0.00
71107650S,SUP,HCPCS C1713,,71107650S  -  SCREW BN 6.5MM 150MM 22MM CNN P/T,$564.90,$0.00,$564.90,$254.21,$403.17,$0.00,$97.33,$0.00,$0.00,$98.91,$564.90,$0.00,$282.45,$447.40,$451.92,$0.00,$88.41,$0.00,$89.93,$0.00
71107655S,SUP,HCPCS C1713,,71107655S  -  SCREW BN 6.5MM 155MM 22MM CNN P/T,$492.45,$0.00,$492.45,$221.60,$351.46,$0.00,$84.85,$0.00,$0.00,$86.22,$492.45,$0.00,$246.23,$390.02,$393.96,$0.00,$77.07,$0.00,$78.40,$0.00
71107660S,SUP,HCPCS C1713,,71107660S  -  SCREW BN 6.5MM 160MM 22MM CNN P/T,$564.90,$0.00,$564.90,$254.21,$403.17,$0.00,$97.33,$0.00,$0.00,$98.91,$564.90,$0.00,$282.45,$447.40,$451.92,$0.00,$88.41,$0.00,$89.93,$0.00
71107665S,SUP,HCPCS C1713,,71107665S  -  SCREW BN 6.5MM 165MM 22MM CNN P/T,$492.45,$0.00,$492.45,$221.60,$351.46,$0.00,$84.85,$0.00,$0.00,$86.22,$492.45,$0.00,$246.23,$390.02,$393.96,$0.00,$77.07,$0.00,$78.40,$0.00
71107670S,SUP,HCPCS C1713,,71107670S  -  SCREW BN 6.5MM 170MM 22MM CNN P/T,$564.90,$0.00,$564.90,$254.21,$403.17,$0.00,$97.33,$0.00,$0.00,$98.91,$564.90,$0.00,$282.45,$447.40,$451.92,$0.00,$88.41,$0.00,$89.93,$0.00
71107675S,SUP,HCPCS C1713,,71107675S  -  SCREW BN 6.5MM 175MM 22MM CNN P/T,$564.90,$0.00,$564.90,$254.21,$403.17,$0.00,$97.33,$0.00,$0.00,$98.91,$564.90,$0.00,$282.45,$447.40,$451.92,$0.00,$88.41,$0.00,$89.93,$0.00
71107680S,SUP,HCPCS C1713,,71107680S  -  SCREW BN 6.5MM 180MM 22MM CNN P/T,$492.45,$0.00,$492.45,$221.60,$351.46,$0.00,$84.85,$0.00,$0.00,$86.22,$492.45,$0.00,$246.23,$390.02,$393.96,$0.00,$77.07,$0.00,$78.40,$0.00
71107755S,SUP,HCPCS C1713,,71107755S  -  SCREW BN 6.5MM 55MM 46MM P/T CNN TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71107760S,SUP,HCPCS C1713,,71107760S  -  SCREW BN 6.5MM 60MM 46MM P/T CNN TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71107765S,SUP,HCPCS C1713,,71107765S  -  SCREW BN 6.5MM 65MM 46MM P/T CNN TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71107770S,SUP,HCPCS C1713,,71107770S  -  SCREW BN 6.5MM 70MM 46MM P/T CNN TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71107775S,SUP,HCPCS C1713,,71107775S  -  SCREW BN 6.5MM 75MM 46MM P/T CNN TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71107780S,SUP,HCPCS C1713,,71107780S  -  SCREW BN 6.5MM 80MM 46MM P/T CNN TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71107785S,SUP,HCPCS C1713,,71107785S  -  SCREW BN 6.5MM 85MM 46MM P/T CNN TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71107790S,SUP,HCPCS C1713,,71107790S  -  SCREW BN 6.5MM 90MM 46MM P/T CNN TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71107795S,SUP,HCPCS C1713,,71107795S  -  SCREW BN 6.5MM 95MM 46MM P/T CNN TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71107800S,SUP,HCPCS C1713,,71107800S  -  SCREW BN 6.5MM 100MM 46MM P/T CNN TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71107805S,SUP,HCPCS C1713,,71107805S  -  SCREW BN 6.5MM 105MM 46MM P/T CNN TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71107810S,SUP,HCPCS C1713,,71107810S  -  SCREW BN 6.5MM 110MM 46MM P/T CNN TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71107815S,SUP,HCPCS C1713,,71107815S  -  SCREW BN 6.5MM 115MM 46MM P/T CNN TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71107820S,SUP,HCPCS C1713,,71107820S  -  SCREW BN 6.5MM 120MM 46MM P/T CNN TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71107825S,SUP,HCPCS C1713,,71107825S  -  SCREW BN 6.5MM 125MM 46MM P/T CNN TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71107830S,SUP,HCPCS C1713,,71107830S  -  SCREW BN 6.5MM 130MM 46MM CNN P/T,$492.45,$0.00,$492.45,$221.60,$351.46,$0.00,$84.85,$0.00,$0.00,$86.22,$492.45,$0.00,$246.23,$390.02,$393.96,$0.00,$77.07,$0.00,$78.40,$0.00
71107835S,SUP,HCPCS C1713,,71107835S  -  SCREW BN 6.5MM 135MM 46MM CNN P/T,$492.45,$0.00,$492.45,$221.60,$351.46,$0.00,$84.85,$0.00,$0.00,$86.22,$492.45,$0.00,$246.23,$390.02,$393.96,$0.00,$77.07,$0.00,$78.40,$0.00
71107840S,SUP,HCPCS C1713,,71107840S  -  SCREW BN 6.5MM 140MM 46MM CNN P/T,$564.90,$0.00,$564.90,$254.21,$403.17,$0.00,$97.33,$0.00,$0.00,$98.91,$564.90,$0.00,$282.45,$447.40,$451.92,$0.00,$88.41,$0.00,$89.93,$0.00
71107845S,SUP,HCPCS C1713,,71107845S  -  SCREW BN 6.5MM 145MM 46MM CNN P/T,$492.45,$0.00,$492.45,$221.60,$351.46,$0.00,$84.85,$0.00,$0.00,$86.22,$492.45,$0.00,$246.23,$390.02,$393.96,$0.00,$77.07,$0.00,$78.40,$0.00
71107850S,SUP,HCPCS C1713,,71107850S  -  SCREW BN 6.5MM 150MM 46MM CNN P/T,$492.45,$0.00,$492.45,$221.60,$351.46,$0.00,$84.85,$0.00,$0.00,$86.22,$492.45,$0.00,$246.23,$390.02,$393.96,$0.00,$77.07,$0.00,$78.40,$0.00
71107855S,SUP,HCPCS C1713,,71107855S  -  SCREW BN 6.5MM 155MM 46MM CNN P/T,$492.45,$0.00,$492.45,$221.60,$351.46,$0.00,$84.85,$0.00,$0.00,$86.22,$492.45,$0.00,$246.23,$390.02,$393.96,$0.00,$77.07,$0.00,$78.40,$0.00
71107860S,SUP,HCPCS C1713,,71107860S  -  SCREW BN 6.5MM 160MM 46MM CNN P/T,$564.90,$0.00,$564.90,$254.21,$403.17,$0.00,$97.33,$0.00,$0.00,$98.91,$564.90,$0.00,$282.45,$447.40,$451.92,$0.00,$88.41,$0.00,$89.93,$0.00
71107865S,SUP,HCPCS C1713,,71107865S  -  SCREW BN 6.5MM 165MM 46MM CNN P/T,$492.45,$0.00,$492.45,$221.60,$351.46,$0.00,$84.85,$0.00,$0.00,$86.22,$492.45,$0.00,$246.23,$390.02,$393.96,$0.00,$77.07,$0.00,$78.40,$0.00
71107870S,SUP,HCPCS C1713,,71107870S  -  SCREW BN 6.5MM 170MM 46MM CNN P/T,$492.45,$0.00,$492.45,$221.60,$351.46,$0.00,$84.85,$0.00,$0.00,$86.22,$492.45,$0.00,$246.23,$390.02,$393.96,$0.00,$77.07,$0.00,$78.40,$0.00
71107875S,SUP,HCPCS C1713,,71107875S  -  SCREW BN 6.5MM 175MM 46MM CNN P/T,$492.45,$0.00,$492.45,$221.60,$351.46,$0.00,$84.85,$0.00,$0.00,$86.22,$492.45,$0.00,$246.23,$390.02,$393.96,$0.00,$77.07,$0.00,$78.40,$0.00
71107880S,SUP,HCPCS C1713,,71107880S  -  SCREW BN 6.5MM 180MM 46MM CNN P/T,$492.45,$0.00,$492.45,$221.60,$351.46,$0.00,$84.85,$0.00,$0.00,$86.22,$492.45,$0.00,$246.23,$390.02,$393.96,$0.00,$77.07,$0.00,$78.40,$0.00
71108240S,SUP,HCPCS C1713,,71108240S  -  SCREW BN FT 8MM 40MM STRL CNN SS LNG BN SM BN,$444.15,$0.00,$444.15,$199.87,$316.99,$0.00,$76.52,$0.00,$0.00,$77.77,$444.15,$0.00,$222.08,$351.77,$355.32,$0.00,$69.51,$0.00,$70.71,$0.00
71108245S,SUP,HCPCS C1713,,71108245S  -  SCREW BN FT 8MM 45MM STRL CNN SS LNG BN SM BN,$444.15,$0.00,$444.15,$199.87,$316.99,$0.00,$76.52,$0.00,$0.00,$77.77,$444.15,$0.00,$222.08,$351.77,$355.32,$0.00,$69.51,$0.00,$70.71,$0.00
71108250S,SUP,HCPCS C1713,,71108250S  -  SCREW BN FT 8MM 50MM STRL CNN SS LNG BN SM BN,$444.15,$0.00,$444.15,$199.87,$316.99,$0.00,$76.52,$0.00,$0.00,$77.77,$444.15,$0.00,$222.08,$351.77,$355.32,$0.00,$69.51,$0.00,$70.71,$0.00
71108255S,SUP,HCPCS C1713,,71108255S  -  SCREW BN FT 8MM 55MM STRL CNN SS LNG BN SM BN,$444.15,$0.00,$444.15,$199.87,$316.99,$0.00,$76.52,$0.00,$0.00,$77.77,$444.15,$0.00,$222.08,$351.77,$355.32,$0.00,$69.51,$0.00,$70.71,$0.00
71108260S,SUP,HCPCS C1713,,71108260S  -  SCREW BN FT 8MM 60MM STRL CNN SS LNG BN SM BN,$444.15,$0.00,$444.15,$199.87,$316.99,$0.00,$76.52,$0.00,$0.00,$77.77,$444.15,$0.00,$222.08,$351.77,$355.32,$0.00,$69.51,$0.00,$70.71,$0.00
71108265S,SUP,HCPCS C1713,,71108265S  -  SCREW BN FT 8MM 65MM STRL CNN SS LNG BN SM BN,$444.15,$0.00,$444.15,$199.87,$316.99,$0.00,$76.52,$0.00,$0.00,$77.77,$444.15,$0.00,$222.08,$351.77,$355.32,$0.00,$69.51,$0.00,$70.71,$0.00
71108270S,SUP,HCPCS C1713,,71108270S  -  SCREW BN FT 8MM 70MM STRL CNN SS LNG BN SM BN,$444.15,$0.00,$444.15,$199.87,$316.99,$0.00,$76.52,$0.00,$0.00,$77.77,$444.15,$0.00,$222.08,$351.77,$355.32,$0.00,$69.51,$0.00,$70.71,$0.00
71108275S,SUP,HCPCS C1713,,71108275S  -  SCREW BN FT 8MM 75MM STRL CNN SS LNG BN SM BN,$444.15,$0.00,$444.15,$199.87,$316.99,$0.00,$76.52,$0.00,$0.00,$77.77,$444.15,$0.00,$222.08,$351.77,$355.32,$0.00,$69.51,$0.00,$70.71,$0.00
71108280S,SUP,HCPCS C1713,,71108280S  -  SCREW BN LG FT LOPRFL 8MM 80MM STRL CNN ST SLFDRL REVCT FLUT,$444.15,$0.00,$444.15,$199.87,$316.99,$0.00,$76.52,$0.00,$0.00,$77.77,$444.15,$0.00,$222.08,$351.77,$355.32,$0.00,$69.51,$0.00,$70.71,$0.00
71108285S,SUP,HCPCS C1713,,71108285S  -  SCREW BN FT 8MM 85MM STRL CNN SS LNG BN SM BN,$444.15,$0.00,$444.15,$199.87,$316.99,$0.00,$76.52,$0.00,$0.00,$77.77,$444.15,$0.00,$222.08,$351.77,$355.32,$0.00,$69.51,$0.00,$70.71,$0.00
71108290S,SUP,HCPCS C1713,,71108290S  -  SCREW BN FT 8MM 90MM STRL CNN SS LNG BN SM BN,$444.15,$0.00,$444.15,$199.87,$316.99,$0.00,$76.52,$0.00,$0.00,$77.77,$444.15,$0.00,$222.08,$351.77,$355.32,$0.00,$69.51,$0.00,$70.71,$0.00
71108295S,SUP,HCPCS C1713,,71108295S  -  SCREW BN FT 8MM 95MM STRL CNN SS LNG BN SM BN,$444.15,$0.00,$444.15,$199.87,$316.99,$0.00,$76.52,$0.00,$0.00,$77.77,$444.15,$0.00,$222.08,$351.77,$355.32,$0.00,$69.51,$0.00,$70.71,$0.00
71108300S,SUP,HCPCS C1713,,71108300S  -  SCREW BN LG FT LOPRFL 8MM 100MM STRL CNN ST SLFDRL REVCT,$444.15,$0.00,$444.15,$199.87,$316.99,$0.00,$76.52,$0.00,$0.00,$77.77,$444.15,$0.00,$222.08,$351.77,$355.32,$0.00,$69.51,$0.00,$70.71,$0.00
71108305S,SUP,HCPCS C1713,,71108305S  -  SCREW BN FT 8MM 105MM STRL CNN SS LNG BN SM BN,$444.15,$0.00,$444.15,$199.87,$316.99,$0.00,$76.52,$0.00,$0.00,$77.77,$444.15,$0.00,$222.08,$351.77,$355.32,$0.00,$69.51,$0.00,$70.71,$0.00
71108310S,SUP,HCPCS C1713,,71108310S  -  SCREW BN FT 8MM 110MM STRL CNN SS LNG BN SM BN,$444.15,$0.00,$444.15,$199.87,$316.99,$0.00,$76.52,$0.00,$0.00,$77.77,$444.15,$0.00,$222.08,$351.77,$355.32,$0.00,$69.51,$0.00,$70.71,$0.00
71108315S,SUP,HCPCS C1713,,71108315S  -  SCREW BN FT 8MM 115MM STRL CNN SS LNG BN SM BN,$444.15,$0.00,$444.15,$199.87,$316.99,$0.00,$76.52,$0.00,$0.00,$77.77,$444.15,$0.00,$222.08,$351.77,$355.32,$0.00,$69.51,$0.00,$70.71,$0.00
71108320S,SUP,HCPCS C1713,,71108320S  -  SCREW BN FT 8MM 120MM STRL CNN SS LNG BN SM BN,$444.15,$0.00,$444.15,$199.87,$316.99,$0.00,$76.52,$0.00,$0.00,$77.77,$444.15,$0.00,$222.08,$351.77,$355.32,$0.00,$69.51,$0.00,$70.71,$0.00
71108325S,SUP,HCPCS C1713,,71108325S  -  SCREW BN FT 8MM 125MM STRL CNN SS LNG BN SM BN,$444.15,$0.00,$444.15,$199.87,$316.99,$0.00,$76.52,$0.00,$0.00,$77.77,$444.15,$0.00,$222.08,$351.77,$355.32,$0.00,$69.51,$0.00,$70.71,$0.00
71108330S,SUP,HCPCS C1713,,71108330S  -  SCREW BN FT 8MM 130MM STRL CNN SS LNG BN SM BN,$510.30,$0.00,$510.30,$229.64,$364.20,$0.00,$87.92,$0.00,$0.00,$89.35,$510.30,$0.00,$255.15,$404.16,$408.24,$0.00,$79.86,$0.00,$81.24,$0.00
71108335S,SUP,HCPCS C1713,,71108335S  -  SCREW BN FT 8MM 135MM STRL CNN SS LNG BN SM BN,$510.30,$0.00,$510.30,$229.64,$364.20,$0.00,$87.92,$0.00,$0.00,$89.35,$510.30,$0.00,$255.15,$404.16,$408.24,$0.00,$79.86,$0.00,$81.24,$0.00
71108340S,SUP,HCPCS C1713,,71108340S  -  SCREW BN FT 8MM 140MM STRL CNN SS LNG BN SM BN,$510.30,$0.00,$510.30,$229.64,$364.20,$0.00,$87.92,$0.00,$0.00,$89.35,$510.30,$0.00,$255.15,$404.16,$408.24,$0.00,$79.86,$0.00,$81.24,$0.00
71108345S,SUP,HCPCS C1713,,71108345S  -  SCREW BN FT 8MM 145MM STRL CNN SS LNG BN SM BN,$510.30,$0.00,$510.30,$229.64,$364.20,$0.00,$87.92,$0.00,$0.00,$89.35,$510.30,$0.00,$255.15,$404.16,$408.24,$0.00,$79.86,$0.00,$81.24,$0.00
71108350S,SUP,HCPCS C1713,,71108350S  -  SCREW BN FT 8MM 150MM STRL CNN SS LNG BN SM BN,$510.30,$0.00,$510.30,$229.64,$364.20,$0.00,$87.92,$0.00,$0.00,$89.35,$510.30,$0.00,$255.15,$404.16,$408.24,$0.00,$79.86,$0.00,$81.24,$0.00
71108355S,SUP,HCPCS C1713,,71108355S  -  SCREW BN 8MM 155MM STRL CNN SS LNG BN SM BN,$510.30,$0.00,$510.30,$229.64,$364.20,$0.00,$87.92,$0.00,$0.00,$89.35,$510.30,$0.00,$255.15,$404.16,$408.24,$0.00,$79.86,$0.00,$81.24,$0.00
71108360S,SUP,HCPCS C1713,,71108360S  -  SCREW BN 8MM 160MM STRL CNN SS LNG BN SM BN,$510.30,$0.00,$510.30,$229.64,$364.20,$0.00,$87.92,$0.00,$0.00,$89.35,$510.30,$0.00,$255.15,$404.16,$408.24,$0.00,$79.86,$0.00,$81.24,$0.00
71108365S,SUP,HCPCS C1713,,71108365S  -  SCREW BN 8MM 165MM STRL CNN SS LNG BN SM BN,$510.30,$0.00,$510.30,$229.64,$364.20,$0.00,$87.92,$0.00,$0.00,$89.35,$510.30,$0.00,$255.15,$404.16,$408.24,$0.00,$79.86,$0.00,$81.24,$0.00
71108370S,SUP,HCPCS C1713,,71108370S  -  SCREW BN 8MM 170MM STRL CNN SS LNG BN SM BN,$510.30,$0.00,$510.30,$229.64,$364.20,$0.00,$87.92,$0.00,$0.00,$89.35,$510.30,$0.00,$255.15,$404.16,$408.24,$0.00,$79.86,$0.00,$81.24,$0.00
71108375S,SUP,HCPCS C1713,,71108375S  -  SCREW BN 8MM 175MM STRL CNN SS LNG BN SM BN,$510.30,$0.00,$510.30,$229.64,$364.20,$0.00,$87.92,$0.00,$0.00,$89.35,$510.30,$0.00,$255.15,$404.16,$408.24,$0.00,$79.86,$0.00,$81.24,$0.00
71108380S,SUP,HCPCS C1713,,71108380S  -  SCREW BN 8MM 180MM STRL CNN SS LNG BN SM BN,$510.30,$0.00,$510.30,$229.64,$364.20,$0.00,$87.92,$0.00,$0.00,$89.35,$510.30,$0.00,$255.15,$404.16,$408.24,$0.00,$79.86,$0.00,$81.24,$0.00
71108540S,SUP,HCPCS C1713,,71108540S  -  SCREW BN 8MM 40MM STRL 22MM CNN SS LNG BN SM BN,$444.15,$0.00,$444.15,$199.87,$316.99,$0.00,$76.52,$0.00,$0.00,$77.77,$444.15,$0.00,$222.08,$351.77,$355.32,$0.00,$69.51,$0.00,$70.71,$0.00
71108545S,SUP,HCPCS C1713,,71108545S  -  SCREW BN 8MM 45MM STRL 24MM CNN SS LNG BN SM BN,$444.15,$0.00,$444.15,$199.87,$316.99,$0.00,$76.52,$0.00,$0.00,$77.77,$444.15,$0.00,$222.08,$351.77,$355.32,$0.00,$69.51,$0.00,$70.71,$0.00
71108550S,SUP,HCPCS C1713,,71108550S  -  SCREW BN 8MM 50MM STRL 24MM CNN SS LNG BN SM BN,$444.15,$0.00,$444.15,$199.87,$316.99,$0.00,$76.52,$0.00,$0.00,$77.77,$444.15,$0.00,$222.08,$351.77,$355.32,$0.00,$69.51,$0.00,$70.71,$0.00
71108555S,SUP,HCPCS C1713,,71108555S  -  SCREW BN 8MM 55MM STRL 24MM CNN SS LNG BN SM BN,$444.15,$0.00,$444.15,$199.87,$316.99,$0.00,$76.52,$0.00,$0.00,$77.77,$444.15,$0.00,$222.08,$351.77,$355.32,$0.00,$69.51,$0.00,$70.71,$0.00
71108560S,SUP,HCPCS C1713,,71108560S  -  SCREW BN 8MM 60MM STRL 24MM CNN SS LNG BN SM BN,$444.15,$0.00,$444.15,$199.87,$316.99,$0.00,$76.52,$0.00,$0.00,$77.77,$444.15,$0.00,$222.08,$351.77,$355.32,$0.00,$69.51,$0.00,$70.71,$0.00
71108565S,SUP,HCPCS C1713,,71108565S  -  SCREW BN 8MM 65MM STRL 22MM CNN SS LNG BN SM BN,$444.15,$0.00,$444.15,$199.87,$316.99,$0.00,$76.52,$0.00,$0.00,$77.77,$444.15,$0.00,$222.08,$351.77,$355.32,$0.00,$69.51,$0.00,$70.71,$0.00
71108570S,SUP,HCPCS C1713,,71108570S  -  SCREW BN 8MM 70MM STRL 24MM CNN SS LNG BN SM BN,$444.15,$0.00,$444.15,$199.87,$316.99,$0.00,$76.52,$0.00,$0.00,$77.77,$444.15,$0.00,$222.08,$351.77,$355.32,$0.00,$69.51,$0.00,$70.71,$0.00
71108575S,SUP,HCPCS C1713,,71108575S  -  SCREW BN 8MM 75MM STRL 22MM CNN SS LNG BN SM BN,$444.15,$0.00,$444.15,$199.87,$316.99,$0.00,$76.52,$0.00,$0.00,$77.77,$444.15,$0.00,$222.08,$351.77,$355.32,$0.00,$69.51,$0.00,$70.71,$0.00
71108580S,SUP,HCPCS C1713,,71108580S  -  SCREW BN 8MM 80MM STRL 22MM CNN SS LNG BN SM BN,$444.15,$0.00,$444.15,$199.87,$316.99,$0.00,$76.52,$0.00,$0.00,$77.77,$444.15,$0.00,$222.08,$351.77,$355.32,$0.00,$69.51,$0.00,$70.71,$0.00
71108585S,SUP,HCPCS C1713,,71108585S  -  SCREW BN 8MM 85MM STRL 22MM CNN SS LNG BN SM BN,$444.15,$0.00,$444.15,$199.87,$316.99,$0.00,$76.52,$0.00,$0.00,$77.77,$444.15,$0.00,$222.08,$351.77,$355.32,$0.00,$69.51,$0.00,$70.71,$0.00
71108590S,SUP,HCPCS C1713,,71108590S  -  SCREW BN 8MM 90MM STRL 24MM CNN SS LNG BN SM BN,$444.15,$0.00,$444.15,$199.87,$316.99,$0.00,$76.52,$0.00,$0.00,$77.77,$444.15,$0.00,$222.08,$351.77,$355.32,$0.00,$69.51,$0.00,$70.71,$0.00
71108595S,SUP,HCPCS C1713,,71108595S  -  SCREW BN LG P/T LOPRFL 8MM 95MM STRL 22MM CNN ST SLFDRL,$444.15,$0.00,$444.15,$199.87,$316.99,$0.00,$76.52,$0.00,$0.00,$77.77,$444.15,$0.00,$222.08,$351.77,$355.32,$0.00,$69.51,$0.00,$70.71,$0.00
71108600S,SUP,HCPCS C1713,,71108600S  -  SCREW BN LG P/T LOPRFL 8MM 100MM STRL 22MM CNN ST SLFDRL,$444.15,$0.00,$444.15,$199.87,$316.99,$0.00,$76.52,$0.00,$0.00,$77.77,$444.15,$0.00,$222.08,$351.77,$355.32,$0.00,$69.51,$0.00,$70.71,$0.00
71108605S,SUP,HCPCS C1713,,71108605S  -  SCREW BN 8MM 105MM STRL 22MM CNN SS LNG BN SM BN,$444.15,$0.00,$444.15,$199.87,$316.99,$0.00,$76.52,$0.00,$0.00,$77.77,$444.15,$0.00,$222.08,$351.77,$355.32,$0.00,$69.51,$0.00,$70.71,$0.00
71108610S,SUP,HCPCS C1713,,71108610S  -  SCREW BN 8MM 110MM STRL 24MM CNN SS LNG BN SM BN,$444.15,$0.00,$444.15,$199.87,$316.99,$0.00,$76.52,$0.00,$0.00,$77.77,$444.15,$0.00,$222.08,$351.77,$355.32,$0.00,$69.51,$0.00,$70.71,$0.00
71108615S,SUP,HCPCS C1713,,71108615S  -  SCREW BN 8MM 115MM STRL 22MM CNN SS LNG BN SM BN,$444.15,$0.00,$444.15,$199.87,$316.99,$0.00,$76.52,$0.00,$0.00,$77.77,$444.15,$0.00,$222.08,$351.77,$355.32,$0.00,$69.51,$0.00,$70.71,$0.00
71108620S,SUP,HCPCS C1713,,71108620S  -  SCREW BN 8MM 120MM STRL 24MM CNN SS LNG BN SM BN,$444.15,$0.00,$444.15,$199.87,$316.99,$0.00,$76.52,$0.00,$0.00,$77.77,$444.15,$0.00,$222.08,$351.77,$355.32,$0.00,$69.51,$0.00,$70.71,$0.00
71108625S,SUP,HCPCS C1713,,71108625S  -  SCREW BN 8MM 125MM STRL 24MM CNN SS LNG BN SM BN,$444.15,$0.00,$444.15,$199.87,$316.99,$0.00,$76.52,$0.00,$0.00,$77.77,$444.15,$0.00,$222.08,$351.77,$355.32,$0.00,$69.51,$0.00,$70.71,$0.00
71108630S,SUP,HCPCS C1713,,71108630S  -  SCREW BN 8MM 130MM STRL 24MM CNN SS LNG BN SM BN,$510.30,$0.00,$510.30,$229.64,$364.20,$0.00,$87.92,$0.00,$0.00,$89.35,$510.30,$0.00,$255.15,$404.16,$408.24,$0.00,$79.86,$0.00,$81.24,$0.00
71108635S,SUP,HCPCS C1713,,71108635S  -  SCREW BN 8MM 135MM STRL 24MM CNN SS LNG BN SM BN,$510.30,$0.00,$510.30,$229.64,$364.20,$0.00,$87.92,$0.00,$0.00,$89.35,$510.30,$0.00,$255.15,$404.16,$408.24,$0.00,$79.86,$0.00,$81.24,$0.00
71108640S,SUP,HCPCS C1713,,71108640S  -  SCREW BN 8MM 140MM STRL 24MM CNN SS LNG BN SM BN,$510.30,$0.00,$510.30,$229.64,$364.20,$0.00,$87.92,$0.00,$0.00,$89.35,$510.30,$0.00,$255.15,$404.16,$408.24,$0.00,$79.86,$0.00,$81.24,$0.00
71108645S,SUP,HCPCS C1713,,71108645S  -  SCREW BN LG P/T LOPRFL 8MM 145MM STRL 22MM CNN ST SLFDRL,$510.30,$0.00,$510.30,$229.64,$364.20,$0.00,$87.92,$0.00,$0.00,$89.35,$510.30,$0.00,$255.15,$404.16,$408.24,$0.00,$79.86,$0.00,$81.24,$0.00
71108650S,SUP,HCPCS C1713,,71108650S  -  SCREW BN 8MM 150MM STRL 24MM CNN SS LNG BN SM BN,$510.30,$0.00,$510.30,$229.64,$364.20,$0.00,$87.92,$0.00,$0.00,$89.35,$510.30,$0.00,$255.15,$404.16,$408.24,$0.00,$79.86,$0.00,$81.24,$0.00
71108655S,SUP,HCPCS C1713,,71108655S  -  SCREW BN 8MM 155MM STRL 22MM CNN SS LNG BN SM BN,$510.30,$0.00,$510.30,$229.64,$364.20,$0.00,$87.92,$0.00,$0.00,$89.35,$510.30,$0.00,$255.15,$404.16,$408.24,$0.00,$79.86,$0.00,$81.24,$0.00
71108660S,SUP,HCPCS C1713,,71108660S  -  SCREW BN 8MM 160MM STRL 22MM CNN SS LNG BN SM BN,$510.30,$0.00,$510.30,$229.64,$364.20,$0.00,$87.92,$0.00,$0.00,$89.35,$510.30,$0.00,$255.15,$404.16,$408.24,$0.00,$79.86,$0.00,$81.24,$0.00
71108665S,SUP,HCPCS C1713,,71108665S  -  SCREW BN 8MM 165MM STRL 22MM CNN SS LNG BN SM BN,$510.30,$0.00,$510.30,$229.64,$364.20,$0.00,$87.92,$0.00,$0.00,$89.35,$510.30,$0.00,$255.15,$404.16,$408.24,$0.00,$79.86,$0.00,$81.24,$0.00
71108670S,SUP,HCPCS C1713,,71108670S  -  SCREW BN 8MM 170MM STRL 22MM CNN SS LNG BN SM BN,$510.30,$0.00,$510.30,$229.64,$364.20,$0.00,$87.92,$0.00,$0.00,$89.35,$510.30,$0.00,$255.15,$404.16,$408.24,$0.00,$79.86,$0.00,$81.24,$0.00
71108675S,SUP,HCPCS C1713,,71108675S  -  SCREW BN 8MM 175MM STRL 22MM CNN SS LNG BN SM BN,$510.30,$0.00,$510.30,$229.64,$364.20,$0.00,$87.92,$0.00,$0.00,$89.35,$510.30,$0.00,$255.15,$404.16,$408.24,$0.00,$79.86,$0.00,$81.24,$0.00
71108680S,SUP,HCPCS C1713,,71108680S  -  SCREW BN 8MM 180MM STRL 22MM CNN SS LNG BN SM BN,$510.30,$0.00,$510.30,$229.64,$364.20,$0.00,$87.92,$0.00,$0.00,$89.35,$510.30,$0.00,$255.15,$404.16,$408.24,$0.00,$79.86,$0.00,$81.24,$0.00
71108755S,SUP,HCPCS C1713,,71108755S  -  SCREW BN LG P/T LOPRFL 8MM 55MM STRL 46MM CNN ST SLFDRL,$444.15,$0.00,$444.15,$199.87,$316.99,$0.00,$76.52,$0.00,$0.00,$77.77,$444.15,$0.00,$222.08,$351.77,$355.32,$0.00,$69.51,$0.00,$70.71,$0.00
71108760S,SUP,HCPCS C1713,,71108760S  -  SCREW BN LG P/T LOPRFL 8MM 60MM STRL 46MM CNN ST SLFDRL,$444.15,$0.00,$444.15,$199.87,$316.99,$0.00,$76.52,$0.00,$0.00,$77.77,$444.15,$0.00,$222.08,$351.77,$355.32,$0.00,$69.51,$0.00,$70.71,$0.00
71108765S,SUP,HCPCS C1713,,71108765S  -  SCREW BN 8MM 65MM STRL 40MM CNN SS LNG BN SM BN,$444.15,$0.00,$444.15,$199.87,$316.99,$0.00,$76.52,$0.00,$0.00,$77.77,$444.15,$0.00,$222.08,$351.77,$355.32,$0.00,$69.51,$0.00,$70.71,$0.00
71108770S,SUP,HCPCS C1713,,71108770S  -  SCREW BN 8MM 70MM STRL 40MM CNN SS LNG BN SM BN,$444.15,$0.00,$444.15,$199.87,$316.99,$0.00,$76.52,$0.00,$0.00,$77.77,$444.15,$0.00,$222.08,$351.77,$355.32,$0.00,$69.51,$0.00,$70.71,$0.00
71108775S,SUP,HCPCS C1713,,71108775S  -  SCREW BN LG P/T LOPRFL 8MM 75MM STRL 46MM CNN ST SLFDRL,$444.15,$0.00,$444.15,$199.87,$316.99,$0.00,$76.52,$0.00,$0.00,$77.77,$444.15,$0.00,$222.08,$351.77,$355.32,$0.00,$69.51,$0.00,$70.71,$0.00
71108780S,SUP,HCPCS C1713,,71108780S  -  SCREW BN 8MM 80MM STRL 46MM CNN SS LNG BN SM BN,$444.15,$0.00,$444.15,$199.87,$316.99,$0.00,$76.52,$0.00,$0.00,$77.77,$444.15,$0.00,$222.08,$351.77,$355.32,$0.00,$69.51,$0.00,$70.71,$0.00
71108785S,SUP,HCPCS C1713,,71108785S  -  SCREW BN P/T 8MM 85MM CNN SS FEM TIB,$444.15,$0.00,$444.15,$199.87,$316.99,$0.00,$76.52,$0.00,$0.00,$77.77,$444.15,$0.00,$222.08,$351.77,$355.32,$0.00,$69.51,$0.00,$70.71,$0.00
71108790S,SUP,HCPCS C1713,,71108790S  -  SCREW BN 8MM 90MM STRL 46MM CNN SS LNG BN SM BN,$444.15,$0.00,$444.15,$199.87,$316.99,$0.00,$76.52,$0.00,$0.00,$77.77,$444.15,$0.00,$222.08,$351.77,$355.32,$0.00,$69.51,$0.00,$70.71,$0.00
71108795S,SUP,HCPCS C1713,,71108795S  -  SCREW BN LG P/T LOPRFL 8MM 95MM STRL 46MM CNN ST SLFDRL,$444.15,$0.00,$444.15,$199.87,$316.99,$0.00,$76.52,$0.00,$0.00,$77.77,$444.15,$0.00,$222.08,$351.77,$355.32,$0.00,$69.51,$0.00,$70.71,$0.00
71108800S,SUP,HCPCS C1713,,71108800S  -  SCREW BN 8MM 100MM STRL 46MM CNN SS LNG BN SM BN,$444.15,$0.00,$444.15,$199.87,$316.99,$0.00,$76.52,$0.00,$0.00,$77.77,$444.15,$0.00,$222.08,$351.77,$355.32,$0.00,$69.51,$0.00,$70.71,$0.00
71108805S,SUP,HCPCS C1713,,71108805S  -  SCREW BN LG P/T LOPRFL 8MM 105MM STRL 46MM CNN ST SLFDRL,$444.15,$0.00,$444.15,$199.87,$316.99,$0.00,$76.52,$0.00,$0.00,$77.77,$444.15,$0.00,$222.08,$351.77,$355.32,$0.00,$69.51,$0.00,$70.71,$0.00
71108810S,SUP,HCPCS C1713,,71108810S  -  SCREW BN 8MM 110MM STRL 46MM CNN SS LNG BN SM BN,$444.15,$0.00,$444.15,$199.87,$316.99,$0.00,$76.52,$0.00,$0.00,$77.77,$444.15,$0.00,$222.08,$351.77,$355.32,$0.00,$69.51,$0.00,$70.71,$0.00
71108815S,SUP,HCPCS C1713,,71108815S  -  SCREW BN LG P/T LOPRFL 8MM 115MM STRL 46MM CNN ST SLFDRL,$444.15,$0.00,$444.15,$199.87,$316.99,$0.00,$76.52,$0.00,$0.00,$77.77,$444.15,$0.00,$222.08,$351.77,$355.32,$0.00,$69.51,$0.00,$70.71,$0.00
71108820S,SUP,HCPCS C1713,,71108820S  -  SCREW BN LG P/T LOPRFL 8MM 120MM STRL 46MM CNN ST SLFDRL,$444.15,$0.00,$444.15,$199.87,$316.99,$0.00,$76.52,$0.00,$0.00,$77.77,$444.15,$0.00,$222.08,$351.77,$355.32,$0.00,$69.51,$0.00,$70.71,$0.00
71108825S,SUP,HCPCS C1713,,71108825S  -  SCREW BN 8MM 125MM STRL 46MM CNN SS LNG BN SM BN,$444.15,$0.00,$444.15,$199.87,$316.99,$0.00,$76.52,$0.00,$0.00,$77.77,$444.15,$0.00,$222.08,$351.77,$355.32,$0.00,$69.51,$0.00,$70.71,$0.00
71108830S,SUP,HCPCS C1713,,71108830S  -  SCREW BN 8MM 130MM STRL 46MM CNN SS LNG BN SM BN,$510.30,$0.00,$510.30,$229.64,$364.20,$0.00,$87.92,$0.00,$0.00,$89.35,$510.30,$0.00,$255.15,$404.16,$408.24,$0.00,$79.86,$0.00,$81.24,$0.00
71108835S,SUP,HCPCS C1713,,71108835S  -  SCREW BN 8MM 135MM STRL 46MM CNN SS LNG BN SM BN,$510.30,$0.00,$510.30,$229.64,$364.20,$0.00,$87.92,$0.00,$0.00,$89.35,$510.30,$0.00,$255.15,$404.16,$408.24,$0.00,$79.86,$0.00,$81.24,$0.00
71108840S,SUP,HCPCS C1713,,71108840S  -  SCREW BN 8MM 140MM STRL 46MM CNN SS LNG BN SM BN,$510.30,$0.00,$510.30,$229.64,$364.20,$0.00,$87.92,$0.00,$0.00,$89.35,$510.30,$0.00,$255.15,$404.16,$408.24,$0.00,$79.86,$0.00,$81.24,$0.00
71108845S,SUP,HCPCS C1713,,71108845S  -  SCREW BN 8MM 145MM STRL 46MM CNN SS LNG BN SM BN,$510.30,$0.00,$510.30,$229.64,$364.20,$0.00,$87.92,$0.00,$0.00,$89.35,$510.30,$0.00,$255.15,$404.16,$408.24,$0.00,$79.86,$0.00,$81.24,$0.00
71108850S,SUP,HCPCS C1713,,71108850S  -  SCREW BN 8MM 150MM STRL 46MM CNN SS LNG BN SM BN,$510.30,$0.00,$510.30,$229.64,$364.20,$0.00,$87.92,$0.00,$0.00,$89.35,$510.30,$0.00,$255.15,$404.16,$408.24,$0.00,$79.86,$0.00,$81.24,$0.00
71108855S,SUP,HCPCS C1713,,71108855S  -  SCREW BN 8MM 155MM STRL 46MM CNN SS LNG BN SM BN,$510.30,$0.00,$510.30,$229.64,$364.20,$0.00,$87.92,$0.00,$0.00,$89.35,$510.30,$0.00,$255.15,$404.16,$408.24,$0.00,$79.86,$0.00,$81.24,$0.00
71108860S,SUP,HCPCS C1713,,71108860S  -  SCREW BN 8MM 160MM STRL 46MM CNN SS LNG BN SM BN,$510.30,$0.00,$510.30,$229.64,$364.20,$0.00,$87.92,$0.00,$0.00,$89.35,$510.30,$0.00,$255.15,$404.16,$408.24,$0.00,$79.86,$0.00,$81.24,$0.00
71108865S,SUP,HCPCS C1713,,71108865S  -  SCREW BN 8MM 165MM STRL 46MM CNN SS LNG BN SM BN,$510.30,$0.00,$510.30,$229.64,$364.20,$0.00,$87.92,$0.00,$0.00,$89.35,$510.30,$0.00,$255.15,$404.16,$408.24,$0.00,$79.86,$0.00,$81.24,$0.00
71108870S,SUP,HCPCS C1713,,71108870S  -  SCREW BN 8MM 170MM STRL 46MM CNN SS LNG BN SM BN,$510.30,$0.00,$510.30,$229.64,$364.20,$0.00,$87.92,$0.00,$0.00,$89.35,$510.30,$0.00,$255.15,$404.16,$408.24,$0.00,$79.86,$0.00,$81.24,$0.00
71108875S,SUP,HCPCS C1713,,71108875S  -  SCREW BN 8MM 175MM STRL 46MM CNN SS LNG BN SM BN,$510.30,$0.00,$510.30,$229.64,$364.20,$0.00,$87.92,$0.00,$0.00,$89.35,$510.30,$0.00,$255.15,$404.16,$408.24,$0.00,$79.86,$0.00,$81.24,$0.00
71108880S,SUP,HCPCS C1713,,71108880S  -  SCREW BN 8MM 180MM STRL 46MM CNN SS LNG BN SM BN,$510.30,$0.00,$510.30,$229.64,$364.20,$0.00,$87.92,$0.00,$0.00,$89.35,$510.30,$0.00,$255.15,$404.16,$408.24,$0.00,$79.86,$0.00,$81.24,$0.00
71109240S,SUP,HCPCS C1713,,71109240S  -  SCREW BN 8MM 40MM FT CNN TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71109245S,SUP,HCPCS C1713,,71109245S  -  SCREW BN FT 8MM 45MM CNN SET TI ANKL,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71109250S,SUP,HCPCS C1713,,71109250S  -  SCREW BN 8MM 50MM FT CNN TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71109255S,SUP,HCPCS C1713,,71109255S  -  SCREW BN 8MM 55MM FT CNN TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71109260S,SUP,HCPCS C1713,,71109260S  -  SCREW BN 8MM 60MM FT CNN TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71109265S,SUP,HCPCS C1713,,71109265S  -  SCREW BN 8MM 65MM FT CNN TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71109270S,SUP,HCPCS C1713,,71109270S  -  SCREW BN 8MM 70MM FT CNN TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71109275S,SUP,HCPCS C1713,,71109275S  -  SCREW BN 8MM 75MM FT CNN TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71109280S,SUP,HCPCS C1713,,71109280S  -  SCREW BN 8MM 80MM FT CNN TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71109285S,SUP,HCPCS C1713,,71109285S  -  SCREW BN 8MM 85MM FT CNN TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71109290S,SUP,HCPCS C1713,,71109290S  -  SCREW BN 8MM 90MM FT CNN TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71109295S,SUP,HCPCS C1713,,71109295S  -  SCREW BN 8MM 95MM FT CNN TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71109300S,SUP,HCPCS C1713,,71109300S  -  SCREW BN 8MM 100MM FT CNN TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71109305S,SUP,HCPCS C1713,,71109305S  -  SCREW BN 8MM 105MM FT CNN TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71109310S,SUP,HCPCS C1713,,71109310S  -  SCREW BN 8MM 110MM FT CNN TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71109315S,SUP,HCPCS C1713,,71109315S  -  SCREW BN 8MM 115MM FT CNN TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71109320S,SUP,HCPCS C1713,,71109320S  -  SCREW BN 8MM 120MM FT CNN TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71109325S,SUP,HCPCS C1713,,71109325S  -  SCREW BN 8MM 125MM CNN FT TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71109330S,SUP,HCPCS C1713,,71109330S  -  SCREW BN 8MM 130MM CNN FT TI,$513.45,$0.00,$513.45,$231.05,$366.45,$0.00,$88.46,$0.00,$0.00,$89.90,$513.45,$0.00,$256.73,$406.65,$410.76,$0.00,$80.35,$0.00,$81.74,$0.00
71109335S,SUP,HCPCS C1713,,71109335S  -  SCREW BN 8MM 135MM CNN FT TI,$513.45,$0.00,$513.45,$231.05,$366.45,$0.00,$88.46,$0.00,$0.00,$89.90,$513.45,$0.00,$256.73,$406.65,$410.76,$0.00,$80.35,$0.00,$81.74,$0.00
71109340S,SUP,HCPCS C1713,,71109340S  -  SCREW BN 8MM 140MM CNN FT TI,$591.15,$0.00,$591.15,$266.02,$421.90,$0.00,$101.85,$0.00,$0.00,$103.51,$591.15,$0.00,$295.58,$468.19,$472.92,$0.00,$92.51,$0.00,$94.11,$0.00
71109345S,SUP,HCPCS C1713,,71109345S  -  SCREW BN 8MM 145MM CNN FT TI,$513.45,$0.00,$513.45,$231.05,$366.45,$0.00,$88.46,$0.00,$0.00,$89.90,$513.45,$0.00,$256.73,$406.65,$410.76,$0.00,$80.35,$0.00,$81.74,$0.00
71109350S,SUP,HCPCS C1713,,71109350S  -  SCREW BN 8MM 150MM CNN FT TI,$591.15,$0.00,$591.15,$266.02,$421.90,$0.00,$101.85,$0.00,$0.00,$103.51,$591.15,$0.00,$295.58,$468.19,$472.92,$0.00,$92.51,$0.00,$94.11,$0.00
71109355S,SUP,HCPCS C1713,,71109355S  -  SCREW BN 8MM 155MM CNN FT TI,$513.45,$0.00,$513.45,$231.05,$366.45,$0.00,$88.46,$0.00,$0.00,$89.90,$513.45,$0.00,$256.73,$406.65,$410.76,$0.00,$80.35,$0.00,$81.74,$0.00
71109360S,SUP,HCPCS C1713,,71109360S  -  SCREW BN 8MM 160MM STRL CNN FT TI,$591.15,$0.00,$591.15,$266.02,$421.90,$0.00,$101.85,$0.00,$0.00,$103.51,$591.15,$0.00,$295.58,$468.19,$472.92,$0.00,$92.51,$0.00,$94.11,$0.00
71109365S,SUP,HCPCS C1713,,71109365S  -  SCREW BN 8MM 165MM STRL CNN FT TI,$591.15,$0.00,$591.15,$266.02,$421.90,$0.00,$101.85,$0.00,$0.00,$103.51,$591.15,$0.00,$295.58,$468.19,$472.92,$0.00,$92.51,$0.00,$94.11,$0.00
71109370S,SUP,HCPCS C1713,,71109370S  -  SCREW BN 8MM 170MM STRL CNN FT TI,$591.15,$0.00,$591.15,$266.02,$421.90,$0.00,$101.85,$0.00,$0.00,$103.51,$591.15,$0.00,$295.58,$468.19,$472.92,$0.00,$92.51,$0.00,$94.11,$0.00
71109375S,SUP,HCPCS C1713,,71109375S  -  SCREW BN 8MM 175MM STRL CNN FT TI,$591.15,$0.00,$591.15,$266.02,$421.90,$0.00,$101.85,$0.00,$0.00,$103.51,$591.15,$0.00,$295.58,$468.19,$472.92,$0.00,$92.51,$0.00,$94.11,$0.00
71109380S,SUP,HCPCS C1713,,71109380S  -  SCREW BN 8MM 180MM STRL CNN FT TI,$591.15,$0.00,$591.15,$266.02,$421.90,$0.00,$101.85,$0.00,$0.00,$103.51,$591.15,$0.00,$295.58,$468.19,$472.92,$0.00,$92.51,$0.00,$94.11,$0.00
71109540S,SUP,HCPCS C1713,,71109540S  -  SCREW BN 8MM 40MM STRL 22MM CNN P/T TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71109545S,SUP,HCPCS C1713,,71109545S  -  SCREW BN 8MM 45MM STRL 22MM CNN P/T TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71109550S,SUP,HCPCS C1713,,71109550S  -  SCREW BN 8MM 50MM STRL 22MM CNN P/T TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71109555S,SUP,HCPCS C1713,,71109555S  -  SCREW BN 8MM 55MM STRL 22MM CNN P/T TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71109560S,SUP,HCPCS C1713,,71109560S  -  SCREW BN 8MM 60MM STRL 22MM CNN P/T TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71109565S,SUP,HCPCS C1713,,71109565S  -  SCREW BN 8MM 65MM STRL 22MM CNN P/T TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71109570S,SUP,HCPCS C1713,,71109570S  -  SCREW BN 8MM 70MM STRL 22MM CNN P/T TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71109575S,SUP,HCPCS C1713,,71109575S  -  SCREW BN 8MM 75MM STRL 22MM CNN P/T TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71109580S,SUP,HCPCS C1713,,71109580S  -  SCREW BN 8MM 80MM STRL 22MM CNN P/T TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71109585S,SUP,HCPCS C1713,,71109585S  -  SCREW BN 8MM 85MM STRL 22MM CNN P/T TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71109590S,SUP,HCPCS C1713,,71109590S  -  SCREW BN 8MM 90MM STRL 22MM CNN P/T TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71109595S,SUP,HCPCS C1713,,71109595S  -  SCREW BN 8MM 95MM STRL 22MM CNN P/T TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71109600S,SUP,HCPCS C1713,,71109600S  -  SCREW BN 8MM 100MM STRL 22MM CNN P/T TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71109605S,SUP,HCPCS C1713,,71109605S  -  SCREW BN 8MM 105MM STRL 22MM CNN P/T TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71109610S,SUP,HCPCS C1713,,71109610S  -  SCREW BN P/T 8MM 110MM 22MM CNN SLFDRL ST SS HND MIDFOOT,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71109615S,SUP,HCPCS C1713,,71109615S  -  SCREW BN 8MM 115MM 22MM CNN P/T TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71109620S,SUP,HCPCS C1713,,71109620S  -  SCREW BN 8MM 120MM 22MM CNN P/T TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71109625S,SUP,HCPCS C1713,,71109625S  -  SCREW BN 8MM 125MM STRL 22MM CNN P/T TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71109630S,SUP,HCPCS C1713,,71109630S  -  SCREW BN 8MM 130MM STRL 22MM CNN P/T TI,$591.15,$0.00,$591.15,$266.02,$421.90,$0.00,$101.85,$0.00,$0.00,$103.51,$591.15,$0.00,$295.58,$468.19,$472.92,$0.00,$92.51,$0.00,$94.11,$0.00
71109635S,SUP,HCPCS C1713,,71109635S  -  SCREW BN 8MM 135MM STRL 22MM CNN P/T TI,$591.15,$0.00,$591.15,$266.02,$421.90,$0.00,$101.85,$0.00,$0.00,$103.51,$591.15,$0.00,$295.58,$468.19,$472.92,$0.00,$92.51,$0.00,$94.11,$0.00
71109640S,SUP,HCPCS C1713,,71109640S  -  SCREW BN 8MM 140MM 22MM CNN P/T TI,$513.45,$0.00,$513.45,$231.05,$366.45,$0.00,$88.46,$0.00,$0.00,$89.90,$513.45,$0.00,$256.73,$406.65,$410.76,$0.00,$80.35,$0.00,$81.74,$0.00
71109645S,SUP,HCPCS C1713,,71109645S  -  SCREW BN 8MM 145MM STRL 22MM CNN P/T TI,$591.15,$0.00,$591.15,$266.02,$421.90,$0.00,$101.85,$0.00,$0.00,$103.51,$591.15,$0.00,$295.58,$468.19,$472.92,$0.00,$92.51,$0.00,$94.11,$0.00
71109650S,SUP,HCPCS C1713,,71109650S  -  SCREW BN 8MM 150MM STRL 22MM P/T CNN TI,$513.45,$0.00,$513.45,$231.05,$366.45,$0.00,$88.46,$0.00,$0.00,$89.90,$513.45,$0.00,$256.73,$406.65,$410.76,$0.00,$80.35,$0.00,$81.74,$0.00
71109655S,SUP,HCPCS C1713,,71109655S  -  SCREW BN P/T 8MM 155MM 22MM CNN TI ANKL,$513.45,$0.00,$513.45,$231.05,$366.45,$0.00,$88.46,$0.00,$0.00,$89.90,$513.45,$0.00,$256.73,$406.65,$410.76,$0.00,$80.35,$0.00,$81.74,$0.00
71109660S,SUP,HCPCS C1713,,71109660S  -  SCREW BN 8MM 160MM 22MM CNN P/T TI,$591.15,$0.00,$591.15,$266.02,$421.90,$0.00,$101.85,$0.00,$0.00,$103.51,$591.15,$0.00,$295.58,$468.19,$472.92,$0.00,$92.51,$0.00,$94.11,$0.00
71109665S,SUP,HCPCS C1713,,71109665S  -  SCREW BN 8MM 165MM 22MM CNN P/T TI,$591.15,$0.00,$591.15,$266.02,$421.90,$0.00,$101.85,$0.00,$0.00,$103.51,$591.15,$0.00,$295.58,$468.19,$472.92,$0.00,$92.51,$0.00,$94.11,$0.00
71109670S,SUP,HCPCS C1713,,71109670S  -  SCREW BN 8MM 170MM 22MM CNN P/T TI,$591.15,$0.00,$591.15,$266.02,$421.90,$0.00,$101.85,$0.00,$0.00,$103.51,$591.15,$0.00,$295.58,$468.19,$472.92,$0.00,$92.51,$0.00,$94.11,$0.00
71109675S,SUP,HCPCS C1713,,71109675S  -  SCREW BN 8MM 175MM 22MM CNN P/T TI,$591.15,$0.00,$591.15,$266.02,$421.90,$0.00,$101.85,$0.00,$0.00,$103.51,$591.15,$0.00,$295.58,$468.19,$472.92,$0.00,$92.51,$0.00,$94.11,$0.00
71109680S,SUP,HCPCS C1713,,71109680S  -  SCREW BN 8MM 180MM 22MM CNN P/T TI,$591.15,$0.00,$591.15,$266.02,$421.90,$0.00,$101.85,$0.00,$0.00,$103.51,$591.15,$0.00,$295.58,$468.19,$472.92,$0.00,$92.51,$0.00,$94.11,$0.00
71109755S,SUP,HCPCS C1713,,71109755S  -  SCREW BN 8MM 55MM 46MM CNN P/T TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71109760S,SUP,HCPCS C1713,,71109760S  -  SCREW BN 8MM 60MM 46MM CNN P/T TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71109765S,SUP,HCPCS C1713,,71109765S  -  SCREW BN 8MM 65MM 46MM CNN P/T TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71109770S,SUP,HCPCS C1713,,71109770S  -  SCREW BN 8MM 70MM 46MM CNN P/T TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71109775S,SUP,HCPCS C1713,,71109775S  -  SCREW BN 8MM 75MM 46MM CNN P/T TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71109780S,SUP,HCPCS C1713,,71109780S  -  SCREW BN 6.5MM 80MM CNN,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71109785S,SUP,HCPCS C1713,,71109785S  -  SCREW BN 8MM 85MM 46MM CNN P/T TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71109790S,SUP,HCPCS C1713,,71109790S  -  SCREW BN 8MM 90MM 46MM P/T CNN TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71109795S,SUP,HCPCS C1713,,71109795S  -  SCREW BN 8MM 95MM 46MM P/T CNN TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71109800S,SUP,HCPCS C1713,,71109800S  -  SCREW BN 8MM 100MM 46MM P/T CNN TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71109805S,SUP,HCPCS C1713,,71109805S  -  SCREW BN 8MM 105MM 46MM P/T,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71109810S,SUP,HCPCS C1713,,71109810S  -  SCREW BN 8MM 110MM 46MM P/T CNN TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71109815S,SUP,HCPCS C1713,,71109815S  -  SCREW BN 8MM 115MM 46MM P/T CNN TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71109820S,SUP,HCPCS C1713,,71109820S  -  SCREW BN 8MM 120MM 46MM P/T CNN TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71109825S,SUP,HCPCS C1713,,71109825S  -  SCREW BN 8MM 125MM 46MM P/T CNN TI,$540.75,$0.00,$540.75,$243.34,$385.93,$0.00,$93.17,$0.00,$0.00,$94.68,$540.75,$0.00,$270.38,$428.27,$432.60,$0.00,$84.63,$0.00,$86.09,$0.00
71109830S,SUP,HCPCS C1713,,71109830S  -  SCREW BN 8MM 130MM 46MM P/T CNN TI,$591.15,$0.00,$591.15,$266.02,$421.90,$0.00,$101.85,$0.00,$0.00,$103.51,$591.15,$0.00,$295.58,$468.19,$472.92,$0.00,$92.51,$0.00,$94.11,$0.00
71109835S,SUP,HCPCS C1713,,71109835S  -  SCREW BN 8MM 135MM 46MM P/T CNN TI,$513.45,$0.00,$513.45,$231.05,$366.45,$0.00,$88.46,$0.00,$0.00,$89.90,$513.45,$0.00,$256.73,$406.65,$410.76,$0.00,$80.35,$0.00,$81.74,$0.00
71109840S,SUP,HCPCS C1713,,71109840S  -  SCREW BN 8MM 140MM 46MM P/T CNN TI,$591.15,$0.00,$591.15,$266.02,$421.90,$0.00,$101.85,$0.00,$0.00,$103.51,$591.15,$0.00,$295.58,$468.19,$472.92,$0.00,$92.51,$0.00,$94.11,$0.00
71109845S,SUP,HCPCS C1713,,71109845S  -  SCREW BN 8MM 145MM 46MM P/T CNN TI,$591.15,$0.00,$591.15,$266.02,$421.90,$0.00,$101.85,$0.00,$0.00,$103.51,$591.15,$0.00,$295.58,$468.19,$472.92,$0.00,$92.51,$0.00,$94.11,$0.00
71109850S,SUP,HCPCS C1713,,71109850S  -  SCREW BN 8MM 150MM 46MM P/T CNN TI,$591.15,$0.00,$591.15,$266.02,$421.90,$0.00,$101.85,$0.00,$0.00,$103.51,$591.15,$0.00,$295.58,$468.19,$472.92,$0.00,$92.51,$0.00,$94.11,$0.00
71109855S,SUP,HCPCS C1713,,71109855S  -  SCREW BN 8MM 155MM 46MM P/T CNN TI,$513.45,$0.00,$513.45,$231.05,$366.45,$0.00,$88.46,$0.00,$0.00,$89.90,$513.45,$0.00,$256.73,$406.65,$410.76,$0.00,$80.35,$0.00,$81.74,$0.00
71109860S,SUP,HCPCS C1713,,71109860S  -  SCREW BN 8MM 160MM 46MM P/T CNN TI,$591.15,$0.00,$591.15,$266.02,$421.90,$0.00,$101.85,$0.00,$0.00,$103.51,$591.15,$0.00,$295.58,$468.19,$472.92,$0.00,$92.51,$0.00,$94.11,$0.00
71109865S,SUP,HCPCS C1713,,71109865S  -  SCREW BN 8MM 165MM 46MM P/T CNN TI,$591.15,$0.00,$591.15,$266.02,$421.90,$0.00,$101.85,$0.00,$0.00,$103.51,$591.15,$0.00,$295.58,$468.19,$472.92,$0.00,$92.51,$0.00,$94.11,$0.00
71109870S,SUP,HCPCS C1713,,71109870S  -  SCREW BN 8MM 170MM 46MM P/T CNN TI,$591.15,$0.00,$591.15,$266.02,$421.90,$0.00,$101.85,$0.00,$0.00,$103.51,$591.15,$0.00,$295.58,$468.19,$472.92,$0.00,$92.51,$0.00,$94.11,$0.00
71109875S,SUP,HCPCS C1713,,71109875S  -  SCREW BN 8MM 175MM 46MM P/T CNN TI,$591.15,$0.00,$591.15,$266.02,$421.90,$0.00,$101.85,$0.00,$0.00,$103.51,$591.15,$0.00,$295.58,$468.19,$472.92,$0.00,$92.51,$0.00,$94.11,$0.00
71109880S,SUP,HCPCS C1713,,71109880S  -  SCREW BN 8MM 180MM 46MM P/T CNN TI,$591.15,$0.00,$591.15,$266.02,$421.90,$0.00,$101.85,$0.00,$0.00,$103.51,$591.15,$0.00,$295.58,$468.19,$472.92,$0.00,$92.51,$0.00,$94.11,$0.00
71114V,SUP,Custom 27203010,,71114V  -  CLIP INTNL XLARGE CLIPS (6 CARTRIDGE) ( 14 CARTRIDGES BX)Ÿ,$67.77,$0.00,$67.77,$0.00,$48.36,$0.00,$0.00,$0.00,$0.00,$0.00,$67.77,$0.00,$33.88,$53.67,$54.21,$0.00,$0.00,$0.00,$0.00,$0.00
71149308M,SUP,HCPCS C1713,,71149308M  -  SCREW BN 2MM 4MM 8MM TC100 ST HEX HD SS CORT MN FRAG SYS,$106.80,$0.00,$106.80,$48.06,$76.22,$0.00,$18.40,$0.00,$0.00,$18.70,$106.80,$0.00,$53.40,$84.59,$85.44,$0.00,$16.71,$0.00,$17.00,$0.00
71149310M,SUP,HCPCS C1713,,71149310M  -  SCREW BN 2MM 4MM 10MM TC100 ST HEX HD SS CORT MN FRAG SYS,$106.80,$0.00,$106.80,$48.06,$76.22,$0.00,$18.40,$0.00,$0.00,$18.70,$106.80,$0.00,$53.40,$84.59,$85.44,$0.00,$16.71,$0.00,$17.00,$0.00
71149312M,SUP,HCPCS C1713,,71149312M  -  SCREW BN 2MM 12MM TC100 ST CORT,$106.80,$0.00,$106.80,$48.06,$76.22,$0.00,$18.40,$0.00,$0.00,$18.70,$106.80,$0.00,$53.40,$84.59,$85.44,$0.00,$16.71,$0.00,$17.00,$0.00
71149314M,SUP,HCPCS C1713,,71149314M  -  SCREW BN 2MM 14MM TC100 ST CORT,$106.80,$0.00,$106.80,$48.06,$76.22,$0.00,$18.40,$0.00,$0.00,$18.70,$106.80,$0.00,$53.40,$84.59,$85.44,$0.00,$16.71,$0.00,$17.00,$0.00
71149316M,SUP,HCPCS C1713,,71149316M  -  SCREW BN 2MM 16MM TC100 ST CORT,$106.80,$0.00,$106.80,$48.06,$76.22,$0.00,$18.40,$0.00,$0.00,$18.70,$106.80,$0.00,$53.40,$84.59,$85.44,$0.00,$16.71,$0.00,$17.00,$0.00
71149410M,SUP,HCPCS C1713,,71149410M  -  SCREW BN 2.7MM 5MM 10MM TC100 ST HEX SCKT SS METACARPUS,$93.20,$0.00,$93.20,$41.94,$66.52,$0.00,$16.06,$0.00,$0.00,$16.32,$93.20,$0.00,$46.60,$73.81,$74.56,$0.00,$14.59,$0.00,$14.84,$0.00
71149412M,SUP,HCPCS C1713,,71149412M  -  SCREW BN 2.7MM 5MM 12MM TC100 ST HEX SCKT SS METACARPUS,$93.20,$0.00,$93.20,$41.94,$66.52,$0.00,$16.06,$0.00,$0.00,$16.32,$93.20,$0.00,$46.60,$73.81,$74.56,$0.00,$14.59,$0.00,$14.84,$0.00
71149414M,SUP,HCPCS C1713,,71149414M  -  SCREW BN 2.7MM 5MM 14MM TC100 ST HEX SCKT SS METACARPUS,$93.20,$0.00,$93.20,$41.94,$66.52,$0.00,$16.06,$0.00,$0.00,$16.32,$93.20,$0.00,$46.60,$73.81,$74.56,$0.00,$14.59,$0.00,$14.84,$0.00
71149418M,SUP,HCPCS C1713,,71149418M  -  SCREW BN 2.7MM 5MM 18MM TC100 ST HEX SCKT SS METACARPUS,$93.20,$0.00,$93.20,$41.94,$66.52,$0.00,$16.06,$0.00,$0.00,$16.32,$93.20,$0.00,$46.60,$73.81,$74.56,$0.00,$14.59,$0.00,$14.84,$0.00
71149420M,SUP,HCPCS C1713,,71149420M  -  SCREW BN 2.7MM 5MM 20MM TC100 ST HEX SCKT SS METACARPUS,$93.20,$0.00,$93.20,$41.94,$66.52,$0.00,$16.06,$0.00,$0.00,$16.32,$93.20,$0.00,$46.60,$73.81,$74.56,$0.00,$14.59,$0.00,$14.84,$0.00
71149422M,SUP,HCPCS C1713,,71149422M  -  SCREW BN 2.7MM 5MM 22MM TC100 ST HEX SCKT SS METACARPUS,$93.20,$0.00,$93.20,$41.94,$66.52,$0.00,$16.06,$0.00,$0.00,$16.32,$93.20,$0.00,$46.60,$73.81,$74.56,$0.00,$14.59,$0.00,$14.84,$0.00
71149424M,SUP,HCPCS C1713,,71149424M  -  SCREW BN 2.7MM 5MM 24MM TC100 ST HEX SCKT SS METACARPUS,$93.20,$0.00,$93.20,$41.94,$66.52,$0.00,$16.06,$0.00,$0.00,$16.32,$93.20,$0.00,$46.60,$73.81,$74.56,$0.00,$14.59,$0.00,$14.84,$0.00
71149510A,SUP,HCPCS C1713,,71149510A  -  SCREW BN 3.5MM 6MM 10MM TC100 ST HEX SCKT SS CORT SM FRAG,$86.40,$0.00,$86.40,$38.88,$61.66,$0.00,$14.89,$0.00,$0.00,$15.13,$86.40,$0.00,$43.20,$68.43,$69.12,$0.00,$13.52,$0.00,$13.75,$0.00
71149510M,SUP,HCPCS C1713,,71149510M  -  SCREW BN 3.5MM 6MM 10MM TC100 ST HEX SCKT SS CORT SM FRAG,$101.20,$0.00,$101.20,$45.54,$72.23,$0.00,$17.44,$0.00,$0.00,$17.72,$101.20,$0.00,$50.60,$80.15,$80.96,$0.00,$15.84,$0.00,$16.11,$0.00
71149512A,SUP,HCPCS C1713,,71149512A  -  SCREW BN 3.5MM 6MM 12MM TC100 ST HEX SCKT SS CORT SM FRAG,$86.40,$0.00,$86.40,$38.88,$61.66,$0.00,$14.89,$0.00,$0.00,$15.13,$86.40,$0.00,$43.20,$68.43,$69.12,$0.00,$13.52,$0.00,$13.75,$0.00
71149514A,SUP,HCPCS C1713,,71149514A  -  SCREW BN 3.5MM 6MM 14MM TC100 ST HEX SCKT SS CORT SM FRAG,$86.40,$0.00,$86.40,$38.88,$61.66,$0.00,$14.89,$0.00,$0.00,$15.13,$86.40,$0.00,$43.20,$68.43,$69.12,$0.00,$13.52,$0.00,$13.75,$0.00
71149516A,SUP,HCPCS C1713,,71149516A  -  SCREW BN 3.5MM 6MM 16MM TC100 ST HEX SCKT SS CORT SM FRAG,$86.40,$0.00,$86.40,$38.88,$61.66,$0.00,$14.89,$0.00,$0.00,$15.13,$86.40,$0.00,$43.20,$68.43,$69.12,$0.00,$13.52,$0.00,$13.75,$0.00
71149518A,SUP,HCPCS C1713,,71149518A  -  SCREW BN 3.5MM 6MM 18MM TC100 ST HEX SCKT SS CORT SM FRAG,$86.40,$0.00,$86.40,$38.88,$61.66,$0.00,$14.89,$0.00,$0.00,$15.13,$86.40,$0.00,$43.20,$68.43,$69.12,$0.00,$13.52,$0.00,$13.75,$0.00
71149520A,SUP,HCPCS C1713,,71149520A  -  SCREW BN 3.5MM 6MM 20MM TC100 ST HEX SCKT SS CORT SM FRAG,$86.40,$0.00,$86.40,$38.88,$61.66,$0.00,$14.89,$0.00,$0.00,$15.13,$86.40,$0.00,$43.20,$68.43,$69.12,$0.00,$13.52,$0.00,$13.75,$0.00
71149520M,SUP,HCPCS C1713,,71149520M  -  SCREW BN 3.5MM 6MM 20MM TC100 ST HEX SCKT SS CORT SM FRAG,$101.20,$0.00,$101.20,$45.54,$72.23,$0.00,$17.44,$0.00,$0.00,$17.72,$101.20,$0.00,$50.60,$80.15,$80.96,$0.00,$15.84,$0.00,$16.11,$0.00
71149522A,SUP,HCPCS C1713,,71149522A  -  SCREW BN 3.5MM 6MM 22MM TC100 ST HEX SCKT SS CORT SM FRAG,$86.40,$0.00,$86.40,$38.88,$61.66,$0.00,$14.89,$0.00,$0.00,$15.13,$86.40,$0.00,$43.20,$68.43,$69.12,$0.00,$13.52,$0.00,$13.75,$0.00
71149522M,SUP,HCPCS C1713,,71149522M  -  SCREW BN 3.5MM 22MM TC100 ST CORT,$101.20,$0.00,$101.20,$45.54,$72.23,$0.00,$17.44,$0.00,$0.00,$17.72,$101.20,$0.00,$50.60,$80.15,$80.96,$0.00,$15.84,$0.00,$16.11,$0.00
71149524A,SUP,HCPCS C1713,,71149524A  -  SCREW BN 3.5MM 6MM 24MM TC100 ST HEX SCKT SS CORT SM FRAG,$86.40,$0.00,$86.40,$38.88,$61.66,$0.00,$14.89,$0.00,$0.00,$15.13,$86.40,$0.00,$43.20,$68.43,$69.12,$0.00,$13.52,$0.00,$13.75,$0.00
71149526A,SUP,HCPCS C1713,,71149526A  -  SCREW BN 3.5MM 6MM 26MM TC100 ST HEX SCKT SS CORT SM FRAG,$86.40,$0.00,$86.40,$38.88,$61.66,$0.00,$14.89,$0.00,$0.00,$15.13,$86.40,$0.00,$43.20,$68.43,$69.12,$0.00,$13.52,$0.00,$13.75,$0.00
71149526M,SUP,HCPCS C1713,,71149526M  -  SCREW BN 3.5MM 6MM 26MM TC100 ST HEX SCKT SS CORT SM FRAG,$101.20,$0.00,$101.20,$45.54,$72.23,$0.00,$17.44,$0.00,$0.00,$17.72,$101.20,$0.00,$50.60,$80.15,$80.96,$0.00,$15.84,$0.00,$16.11,$0.00
71149528A,SUP,HCPCS C1713,,71149528A  -  SCREW BN 3.5MM 28MM TC100 ST CORT,$86.40,$0.00,$86.40,$38.88,$61.66,$0.00,$14.89,$0.00,$0.00,$15.13,$86.40,$0.00,$43.20,$68.43,$69.12,$0.00,$13.52,$0.00,$13.75,$0.00
71149528M,SUP,HCPCS C1713,,71149528M  -  SCREW BN 3.5MM 6MM 28MM TC100 ST HEX SCKT SS CORT SM FRAG,$101.20,$0.00,$101.20,$45.54,$72.23,$0.00,$17.44,$0.00,$0.00,$17.72,$101.20,$0.00,$50.60,$80.15,$80.96,$0.00,$15.84,$0.00,$16.11,$0.00
71149530M,SUP,HCPCS C1713,,71149530M  -  SCREW BN 3.5MM 6MM 30MM TC100 ST HEX SCKT SS CORT SM FRAG,$101.20,$0.00,$101.20,$45.54,$72.23,$0.00,$17.44,$0.00,$0.00,$17.72,$101.20,$0.00,$50.60,$80.15,$80.96,$0.00,$15.84,$0.00,$16.11,$0.00
71149532A,SUP,HCPCS C1713,,71149532A  -  SCREW BN 3.5MM 6MM 32MM TC100 ST HEX SCKT SS CORT SM FRAG,$86.40,$0.00,$86.40,$38.88,$61.66,$0.00,$14.89,$0.00,$0.00,$15.13,$86.40,$0.00,$43.20,$68.43,$69.12,$0.00,$13.52,$0.00,$13.75,$0.00
71149532M,SUP,HCPCS C1713,,71149532M  -  SCREW BN 3.5MM 32MM TC100 ST CORT,$101.20,$0.00,$101.20,$45.54,$72.23,$0.00,$17.44,$0.00,$0.00,$17.72,$101.20,$0.00,$50.60,$80.15,$80.96,$0.00,$15.84,$0.00,$16.11,$0.00
71149534A,SUP,HCPCS C1713,,71149534A  -  SCREW BN 3.5MM 34MM TC100 ST CORT,$86.40,$0.00,$86.40,$38.88,$61.66,$0.00,$14.89,$0.00,$0.00,$15.13,$86.40,$0.00,$43.20,$68.43,$69.12,$0.00,$13.52,$0.00,$13.75,$0.00
71149534M,SUP,HCPCS C1713,,71149534M  -  SCREW BN 3.5MM 6MM 34MM TC100 ST HEX SCKT SS CORT SM FRAG,$101.20,$0.00,$101.20,$45.54,$72.23,$0.00,$17.44,$0.00,$0.00,$17.72,$101.20,$0.00,$50.60,$80.15,$80.96,$0.00,$15.84,$0.00,$16.11,$0.00
71149536A,SUP,HCPCS C1713,,71149536A  -  SCREW BN 3.5MM 6MM 36MM TC100 ST HEX SCKT SS CORT SM FRAG,$86.40,$0.00,$86.40,$38.88,$61.66,$0.00,$14.89,$0.00,$0.00,$15.13,$86.40,$0.00,$43.20,$68.43,$69.12,$0.00,$13.52,$0.00,$13.75,$0.00
71149536M,SUP,HCPCS C1713,,71149536M  -  SCREW BN 3.5MM 36MM TC100 ST CORT,$101.20,$0.00,$101.20,$45.54,$72.23,$0.00,$17.44,$0.00,$0.00,$17.72,$101.20,$0.00,$50.60,$80.15,$80.96,$0.00,$15.84,$0.00,$16.11,$0.00
71149538A,SUP,HCPCS C1713,,71149538A  -  SCREW BN 3.5MM 6MM 38MM TC100 ST HEX SCKT SS CORT SM FRAG,$86.40,$0.00,$86.40,$38.88,$61.66,$0.00,$14.89,$0.00,$0.00,$15.13,$86.40,$0.00,$43.20,$68.43,$69.12,$0.00,$13.52,$0.00,$13.75,$0.00
71149538M,SUP,HCPCS C1713,,71149538M  -  SCREW BN 3.5MM 38MM TC100 ST CORT,$101.20,$0.00,$101.20,$45.54,$72.23,$0.00,$17.44,$0.00,$0.00,$17.72,$101.20,$0.00,$50.60,$80.15,$80.96,$0.00,$15.84,$0.00,$16.11,$0.00
71149540A,SUP,HCPCS C1713,,71149540A  -  SCREW BN 3.5MM 6MM 40MM TC100 ST HEX SCKT SS CORT SM FRAG,$86.40,$0.00,$86.40,$38.88,$61.66,$0.00,$14.89,$0.00,$0.00,$15.13,$86.40,$0.00,$43.20,$68.43,$69.12,$0.00,$13.52,$0.00,$13.75,$0.00
71149540M,SUP,HCPCS C1713,,71149540M  -  SCREW BN 3.5MM 40MM TC100 ST CORT,$101.20,$0.00,$101.20,$45.54,$72.23,$0.00,$17.44,$0.00,$0.00,$17.72,$101.20,$0.00,$50.60,$80.15,$80.96,$0.00,$15.84,$0.00,$16.11,$0.00
71149545A,SUP,HCPCS C1713,,71149545A  -  SCREW BN 3.5MM 6MM 45MM TC100 ST HEX SCKT SS CORT SM FRAG,$86.40,$0.00,$86.40,$38.88,$61.66,$0.00,$14.89,$0.00,$0.00,$15.13,$86.40,$0.00,$43.20,$68.43,$69.12,$0.00,$13.52,$0.00,$13.75,$0.00
71149545M,SUP,HCPCS C1713,,71149545M  -  SCREW BN 3.5MM 6MM 45MM TC100 ST HEX SCKT SS CORT SM FRAG,$101.20,$0.00,$101.20,$45.54,$72.23,$0.00,$17.44,$0.00,$0.00,$17.72,$101.20,$0.00,$50.60,$80.15,$80.96,$0.00,$15.84,$0.00,$16.11,$0.00
71149550A,SUP,HCPCS C1713,,71149550A  -  SCREW BN 3.5MM 6MM 50MM TC100 ST HEX SCKT SS CORT SM FRAG,$86.40,$0.00,$86.40,$38.88,$61.66,$0.00,$14.89,$0.00,$0.00,$15.13,$86.40,$0.00,$43.20,$68.43,$69.12,$0.00,$13.52,$0.00,$13.75,$0.00
71149550M,SUP,HCPCS C1713,,71149550M  -  SCREW BN 3.5MM 6MM 50MM TC100 ST HEX SCKT SS CORT SM FRAG,$101.20,$0.00,$101.20,$45.54,$72.23,$0.00,$17.44,$0.00,$0.00,$17.72,$101.20,$0.00,$50.60,$80.15,$80.96,$0.00,$15.84,$0.00,$16.11,$0.00
71149555M,SUP,HCPCS C1713,,71149555M  -  SCREW BN 3.5MM 6MM 55MM TC100 ST HEX SCKT SS CORT SM FRAG,$101.20,$0.00,$101.20,$45.54,$72.23,$0.00,$17.44,$0.00,$0.00,$17.72,$101.20,$0.00,$50.60,$80.15,$80.96,$0.00,$15.84,$0.00,$16.11,$0.00
71149714M,SUP,HCPCS C1713,,71149714M  -  SCREW BN 4.5MM 14MM TC100 ST HEX SCKT SS CORT LG FRAG SYS,$101.20,$0.00,$101.20,$45.54,$72.23,$0.00,$17.44,$0.00,$0.00,$17.72,$101.20,$0.00,$50.60,$80.15,$80.96,$0.00,$15.84,$0.00,$16.11,$0.00
71149716M,SUP,HCPCS C1713,,71149716M  -  SCREW BN 4.5MM 16MM TC100 ST HEX SCKT SS CORT LG FRAG SYS,$101.20,$0.00,$101.20,$45.54,$72.23,$0.00,$17.44,$0.00,$0.00,$17.72,$101.20,$0.00,$50.60,$80.15,$80.96,$0.00,$15.84,$0.00,$16.11,$0.00
71149718M,SUP,HCPCS C1713,,71149718M  -  SCREW BN 4.5MM 18MM TC100 ST HEX SCKT SS CORT LG FRAG SYS,$101.20,$0.00,$101.20,$45.54,$72.23,$0.00,$17.44,$0.00,$0.00,$17.72,$101.20,$0.00,$50.60,$80.15,$80.96,$0.00,$15.84,$0.00,$16.11,$0.00
71149720M,SUP,HCPCS C1713,,71149720M  -  SCREW BN 4.5MM 20MM TC100 ST HEX SCKT SS CORT LG FRAG SYS,$101.20,$0.00,$101.20,$45.54,$72.23,$0.00,$17.44,$0.00,$0.00,$17.72,$101.20,$0.00,$50.60,$80.15,$80.96,$0.00,$15.84,$0.00,$16.11,$0.00
71149722M,SUP,HCPCS C1713,,71149722M  -  SCREW BN 4.5MM 22MM TC100 ST HEX SCKT SS CORT LG FRAG SYS,$101.20,$0.00,$101.20,$45.54,$72.23,$0.00,$17.44,$0.00,$0.00,$17.72,$101.20,$0.00,$50.60,$80.15,$80.96,$0.00,$15.84,$0.00,$16.11,$0.00
71149724M,SUP,HCPCS C1713,,71149724M  -  SCREW BN 4.5MM 24MM TC100 ST HEX SCKT SS CORT LG FRAG SYS,$101.20,$0.00,$101.20,$45.54,$72.23,$0.00,$17.44,$0.00,$0.00,$17.72,$101.20,$0.00,$50.60,$80.15,$80.96,$0.00,$15.84,$0.00,$16.11,$0.00
71149726M,SUP,HCPCS C1713,,71149726M  -  SCREW BN 4.5MM 26MM TC100 ST HEX SCKT SS CORT LG FRAG SYS,$101.20,$0.00,$101.20,$45.54,$72.23,$0.00,$17.44,$0.00,$0.00,$17.72,$101.20,$0.00,$50.60,$80.15,$80.96,$0.00,$15.84,$0.00,$16.11,$0.00
71149728M,SUP,HCPCS C1713,,71149728M  -  SCREW BN 4.5MM 28MM TC100 ST HEX SCKT SS CORT LG FRAG SYS,$101.20,$0.00,$101.20,$45.54,$72.23,$0.00,$17.44,$0.00,$0.00,$17.72,$101.20,$0.00,$50.60,$80.15,$80.96,$0.00,$15.84,$0.00,$16.11,$0.00
71149730M,SUP,HCPCS C1713,,71149730M  -  SCREW BN 4.5MM 30MM TC100 ST HEX SCKT SS CORT LG FRAG SYS,$101.20,$0.00,$101.20,$45.54,$72.23,$0.00,$17.44,$0.00,$0.00,$17.72,$101.20,$0.00,$50.60,$80.15,$80.96,$0.00,$15.84,$0.00,$16.11,$0.00
71149732M,SUP,HCPCS C1713,,71149732M  -  SCREW BN 4.5MM 32MM TC100 ST HEX SCKT SS CORT LG FRAG SYS,$101.20,$0.00,$101.20,$45.54,$72.23,$0.00,$17.44,$0.00,$0.00,$17.72,$101.20,$0.00,$50.60,$80.15,$80.96,$0.00,$15.84,$0.00,$16.11,$0.00
71149734M,SUP,HCPCS C1713,,71149734M  -  SCREW BN 4.5MM 34MM TC100 ST HEX SCKT SS CORT LG FRAG SYS,$101.20,$0.00,$101.20,$45.54,$72.23,$0.00,$17.44,$0.00,$0.00,$17.72,$101.20,$0.00,$50.60,$80.15,$80.96,$0.00,$15.84,$0.00,$16.11,$0.00
71149736M,SUP,HCPCS C1713,,71149736M  -  SCREW BN 4.5MM 36MM TC100 ST HEX SCKT SS CORT LG FRAG SYS,$101.20,$0.00,$101.20,$45.54,$72.23,$0.00,$17.44,$0.00,$0.00,$17.72,$101.20,$0.00,$50.60,$80.15,$80.96,$0.00,$15.84,$0.00,$16.11,$0.00
71149738M,SUP,HCPCS C1713,,71149738M  -  SCREW BN 4.5MM 38MM TC100 ST HEX SCKT SS CORT LG FRAG SYS,$101.20,$0.00,$101.20,$45.54,$72.23,$0.00,$17.44,$0.00,$0.00,$17.72,$101.20,$0.00,$50.60,$80.15,$80.96,$0.00,$15.84,$0.00,$16.11,$0.00
71149740M,SUP,HCPCS C1713,,71149740M  -  SCREW BN 4.5MM 40MM TC100 ST HEX SCKT SS CORT LG FRAG SYS,$101.20,$0.00,$101.20,$45.54,$72.23,$0.00,$17.44,$0.00,$0.00,$17.72,$101.20,$0.00,$50.60,$80.15,$80.96,$0.00,$15.84,$0.00,$16.11,$0.00
71149742M,SUP,HCPCS C1713,,71149742M  -  SCREW BN 4.5MM 42MM TC100 ST HEX SCKT SS CORT LG FRAG SYS,$101.20,$0.00,$101.20,$45.54,$72.23,$0.00,$17.44,$0.00,$0.00,$17.72,$101.20,$0.00,$50.60,$80.15,$80.96,$0.00,$15.84,$0.00,$16.11,$0.00
71149744M,SUP,HCPCS C1713,,71149744M  -  SCREW BN 4.5MM 44MM TC100 ST HEX SCKT SS CORT LG FRAG SYS,$101.20,$0.00,$101.20,$45.54,$72.23,$0.00,$17.44,$0.00,$0.00,$17.72,$101.20,$0.00,$50.60,$80.15,$80.96,$0.00,$15.84,$0.00,$16.11,$0.00
71149746M,SUP,HCPCS C1713,,71149746M  -  SCREW BN 4.5MM 46MM TC100 ST HEX SCKT SS CORT LG FRAG SYS,$101.20,$0.00,$101.20,$45.54,$72.23,$0.00,$17.44,$0.00,$0.00,$17.72,$101.20,$0.00,$50.60,$80.15,$80.96,$0.00,$15.84,$0.00,$16.11,$0.00
71149748M,SUP,HCPCS C1713,,71149748M  -  SCREW BN 4.5MM 48MM TC100 ST HEX SCKT SS CORT LG FRAG SYS,$101.20,$0.00,$101.20,$45.54,$72.23,$0.00,$17.44,$0.00,$0.00,$17.72,$101.20,$0.00,$50.60,$80.15,$80.96,$0.00,$15.84,$0.00,$16.11,$0.00
71149750M,SUP,HCPCS C1713,,71149750M  -  SCREW BN 4.5MM 50MM TC100 ST HEX SCKT SS CORT LG FRAG SYS,$101.20,$0.00,$101.20,$45.54,$72.23,$0.00,$17.44,$0.00,$0.00,$17.72,$101.20,$0.00,$50.60,$80.15,$80.96,$0.00,$15.84,$0.00,$16.11,$0.00
71149752M,SUP,HCPCS C1713,,71149752M  -  SCREW BN 4.5MM 52MM TC100 ST CORT,$101.20,$0.00,$101.20,$45.54,$72.23,$0.00,$17.44,$0.00,$0.00,$17.72,$101.20,$0.00,$50.60,$80.15,$80.96,$0.00,$15.84,$0.00,$16.11,$0.00
71149754M,SUP,HCPCS C1713,,71149754M  -  SCREW BN 4.5MM 54MM TC100 ST HEX SCKT SS CORT LG FRAG SYS,$101.20,$0.00,$101.20,$45.54,$72.23,$0.00,$17.44,$0.00,$0.00,$17.72,$101.20,$0.00,$50.60,$80.15,$80.96,$0.00,$15.84,$0.00,$16.11,$0.00
71149756M,SUP,HCPCS C1713,,71149756M  -  SCREW BN 4.5MM 56MM TC100 ST HEX SCKT SS CORT LG FRAG SYS,$101.20,$0.00,$101.20,$45.54,$72.23,$0.00,$17.44,$0.00,$0.00,$17.72,$101.20,$0.00,$50.60,$80.15,$80.96,$0.00,$15.84,$0.00,$16.11,$0.00
71149758M,SUP,HCPCS C1713,,71149758M  -  SCREW BN 4.5MM 58MM TC100 ST HEX SCKT SS CORT LG FRAG SYS,$101.20,$0.00,$101.20,$45.54,$72.23,$0.00,$17.44,$0.00,$0.00,$17.72,$101.20,$0.00,$50.60,$80.15,$80.96,$0.00,$15.84,$0.00,$16.11,$0.00
71149760M,SUP,HCPCS C1713,,71149760M  -  SCREW BN 4.5MM 60MM TC100 ST CORT,$101.20,$0.00,$101.20,$45.54,$72.23,$0.00,$17.44,$0.00,$0.00,$17.72,$101.20,$0.00,$50.60,$80.15,$80.96,$0.00,$15.84,$0.00,$16.11,$0.00
71149762M,SUP,HCPCS C1713,,71149762M  -  SCREW BN 4.5MM 62MM TC100 ST HEX SCKT SS CORT LG FRAG SYS,$101.20,$0.00,$101.20,$45.54,$72.23,$0.00,$17.44,$0.00,$0.00,$17.72,$101.20,$0.00,$50.60,$80.15,$80.96,$0.00,$15.84,$0.00,$16.11,$0.00
71149764M,SUP,HCPCS C1713,,71149764M  -  SCREW BN 4.5MM 64MM TC100 ST HEX SCKT SS CORT LG FRAG SYS,$101.20,$0.00,$101.20,$45.54,$72.23,$0.00,$17.44,$0.00,$0.00,$17.72,$101.20,$0.00,$50.60,$80.15,$80.96,$0.00,$15.84,$0.00,$16.11,$0.00
71149766M,SUP,HCPCS C1713,,71149766M  -  SCREW BN 4.5MM 66MM TC100 ST HEX SCKT SS CORT LG FRAG SYS,$101.20,$0.00,$101.20,$45.54,$72.23,$0.00,$17.44,$0.00,$0.00,$17.72,$101.20,$0.00,$50.60,$80.15,$80.96,$0.00,$15.84,$0.00,$16.11,$0.00
71149768M,SUP,HCPCS C1713,,71149768M  -  SCREW BN 4.5MM 68MM TC100 ST HEX SCKT SS CORT LG FRAG SYS,$101.20,$0.00,$101.20,$45.54,$72.23,$0.00,$17.44,$0.00,$0.00,$17.72,$101.20,$0.00,$50.60,$80.15,$80.96,$0.00,$15.84,$0.00,$16.11,$0.00
71149770M,SUP,HCPCS C1713,,71149770M  -  SCREW BN 4.5MM 70MM TC100 ST HEX SCKT SS CORT LG FRAG SYS,$101.20,$0.00,$101.20,$45.54,$72.23,$0.00,$17.44,$0.00,$0.00,$17.72,$101.20,$0.00,$50.60,$80.15,$80.96,$0.00,$15.84,$0.00,$16.11,$0.00
71149772M,SUP,HCPCS C1713,,71149772M  -  SCREW BN 4.5MM 72MM TC100 ST HEX SCKT SS CORT LG FRAG SYS,$167.20,$0.00,$167.20,$75.24,$119.33,$0.00,$28.81,$0.00,$0.00,$29.28,$167.20,$0.00,$83.60,$132.42,$133.76,$0.00,$26.17,$0.00,$26.62,$0.00
71149776M,SUP,HCPCS C1713,,71149776M  -  SCREW BN 4.5MM 76MM TC100 ST HEX SCKT SS CORT LG FRAG SYS,$167.20,$0.00,$167.20,$75.24,$119.33,$0.00,$28.81,$0.00,$0.00,$29.28,$167.20,$0.00,$83.60,$132.42,$133.76,$0.00,$26.17,$0.00,$26.62,$0.00
71149780M,SUP,HCPCS C1713,,71149780M  -  SCREW BN 4.5MM 8MM 80MM TC100 ST HEX SCKT SS METACARPUS,$105.00,$0.00,$105.00,$47.25,$74.94,$0.00,$18.09,$0.00,$0.00,$18.38,$105.00,$0.00,$52.50,$83.16,$84.00,$0.00,$16.43,$0.00,$16.72,$0.00
71149785M,SUP,HCPCS C1713,,71149785M  -  SCREW BN 4.5MM 85MM TC100 ST HEX SCKT SS CORT LG FRAG SYS,$167.20,$0.00,$167.20,$75.24,$119.33,$0.00,$28.81,$0.00,$0.00,$29.28,$167.20,$0.00,$83.60,$132.42,$133.76,$0.00,$26.17,$0.00,$26.62,$0.00
71149790M,SUP,HCPCS C1713,,71149790M  -  SCREW BN 4.5MM 8MM 90MM TC100 ST HEX SCKT SS METACARPUS,$105.00,$0.00,$105.00,$47.25,$74.94,$0.00,$18.09,$0.00,$0.00,$18.38,$105.00,$0.00,$52.50,$83.16,$84.00,$0.00,$16.43,$0.00,$16.72,$0.00
7115-0003,SUP,HCPCS C1776,,7115-0003  -  COMPONENT TIBIAL TRAY 3 STANDARD CEMENT SCORPIO KNEE 7000,"$2,330.00",$0.00,"$2,330.00","$1,048.50","$1,662.92",$0.00,$401.45,$0.00,$0.00,$407.96,"$2,330.00",$0.00,"$1,165.00","$1,845.36","$1,864.00",$0.00,$364.65,$0.00,$370.94,$0.00
7115-0004,SUP,HCPCS C1776,,7115-0004  -  COMPONENT TIBIAL TRAY STANDARD SERIES 7000,"$2,330.00",$0.00,"$2,330.00","$1,048.50","$1,662.92",$0.00,$401.45,$0.00,$0.00,$407.96,"$2,330.00",$0.00,"$1,165.00","$1,845.36","$1,864.00",$0.00,$364.65,$0.00,$370.94,$0.00
7115-0005,SUP,HCPCS C1776,,7115-0005  -  COMPONENT TIBIAL TRAY 5 1 AXIS PRIM POSTERIOR STABILIZED,"$2,330.00",$0.00,"$2,330.00","$1,048.50","$1,662.92",$0.00,$401.45,$0.00,$0.00,$407.96,"$2,330.00",$0.00,"$1,165.00","$1,845.36","$1,864.00",$0.00,$364.65,$0.00,$370.94,$0.00
7115-0006,SUP,HCPCS C1776,,7115-0006  -  COMPONENT TIBIAL TRAY STANDARD 1 AXIS PRIM POSTERIOR,"$2,330.00",$0.00,"$2,330.00","$1,048.50","$1,662.92",$0.00,$401.45,$0.00,$0.00,$407.96,"$2,330.00",$0.00,"$1,165.00","$1,845.36","$1,864.00",$0.00,$364.65,$0.00,$370.94,$0.00
7115-0007,SUP,HCPCS C1776,,7115-0007  -  COMPONENT TIBIAL TRAY 7 1 AXIS PRIM POSTERIOR STABILIZE,"$2,330.00",$0.00,"$2,330.00","$1,048.50","$1,662.92",$0.00,$401.45,$0.00,$0.00,$407.96,"$2,330.00",$0.00,"$1,165.00","$1,845.36","$1,864.00",$0.00,$364.65,$0.00,$370.94,$0.00
7115-0009,SUP,HCPCS C1776,,7115-0009  -  COMPONENT TIBIAL TRAY 9 1 AXIS PRIM POSTERIOR STABILIZED,"$2,330.00",$0.00,"$2,330.00","$1,048.50","$1,662.92",$0.00,$401.45,$0.00,$0.00,$407.96,"$2,330.00",$0.00,"$1,165.00","$1,845.36","$1,864.00",$0.00,$364.65,$0.00,$370.94,$0.00
7115-0011,SUP,HCPCS C1776,,7115-0011  -  COMPONENT TIBIAL TRAY 11 1 AXIS PRIM POSTERIOR STABILIZED,"$2,330.00",$0.00,"$2,330.00","$1,048.50","$1,662.92",$0.00,$401.45,$0.00,$0.00,$407.96,"$2,330.00",$0.00,"$1,165.00","$1,845.36","$1,864.00",$0.00,$364.65,$0.00,$370.94,$0.00
7115-0013,SUP,HCPCS C1776,,7115-0013  -  COMPONENT TIBIAL TRAY 13 STANDARD 1 AXIS PRIM POSTERIOR,"$2,330.00",$0.00,"$2,330.00","$1,048.50","$1,662.92",$0.00,$401.45,$0.00,$0.00,$407.96,"$2,330.00",$0.00,"$1,165.00","$1,845.36","$1,864.00",$0.00,$364.65,$0.00,$370.94,$0.00
7120/60,SUP,HCPCS C1895,,7120/60  -  LEAD PCNG 7FR 60CM DURATA TRUE BP ACTFX 2 COIL STRD,"$8,775.00",$0.00,"$8,775.00","$3,948.75","$5,158.80",$0.00,"$1,511.89",$0.00,$0.00,"$1,536.43","$8,775.00",$0.00,"$4,387.50","$6,949.80","$7,020.00",$0.00,"$1,373.29",$0.00,"$1,396.98",$0.00
7120/65,SUP,HCPCS C1895,,7120/65  -  LEAD PACING 7FR 65CM 2 COIL DF-4 CONCTR TRUE BIPOL,"$8,775.00",$0.00,"$8,775.00","$3,948.75","$5,158.80",$0.00,"$1,511.89",$0.00,$0.00,"$1,536.43","$8,775.00",$0.00,"$4,387.50","$6,949.80","$7,020.00",$0.00,"$1,373.29",$0.00,"$1,396.98",$0.00
7120/75,SUP,HCPCS C1895,,7120/75  -  DURATA+++PMM#:87533,"$10,500.00",$0.00,"$10,500.00","$4,725.00","$5,158.80",$0.00,"$1,809.10",$0.00,$0.00,"$1,838.47","$10,500.00",$0.00,"$5,250.00","$8,316.00","$8,400.00",$0.00,"$1,643.25",$0.00,"$1,671.60",$0.00
7120Q/52,SUP,HCPCS C1895,,7120Q/52  -  LEAD DEFIBRILLATOR 17CM 7FR 52CM 2 COIL DF-4 CONCTR TRUE,"$8,775.00",$0.00,"$8,775.00","$3,948.75","$5,158.80",$0.00,"$1,511.89",$0.00,$0.00,"$1,536.43","$8,775.00",$0.00,"$4,387.50","$6,949.80","$7,020.00",$0.00,"$1,373.29",$0.00,"$1,396.98",$0.00
7120Q/58,SUP,HCPCS C1895,,7120Q/58  -  LEAD ICD 7FR 58CM DURATA OPTIM DF4 CNCT 2 COIL BP,"$8,775.00",$0.00,"$8,775.00","$3,948.75","$5,158.80",$0.00,"$1,511.89",$0.00,$0.00,"$1,536.43","$8,775.00",$0.00,"$4,387.50","$6,949.80","$7,020.00",$0.00,"$1,373.29",$0.00,"$1,396.98",$0.00
7120Q/65,SUP,HCPCS C1895,,7120Q/65  -  LEAD PACING 7FR 65CM 2 COIL DF-4 TRUE BIPOL ACTIVE FIX,"$8,775.00",$0.00,"$8,775.00","$3,948.75","$5,158.80",$0.00,"$1,511.89",$0.00,$0.00,"$1,536.43","$8,775.00",$0.00,"$4,387.50","$6,949.80","$7,020.00",$0.00,"$1,373.29",$0.00,"$1,396.98",$0.00
7121/60,SUP,HCPCS C1895,,7121/60  -  LEAD DFBR 7FR 60CM 21CM DURATA 2 COIL IS-1 CNCT TRUE BP,"$8,775.00",$0.00,"$8,775.00","$3,948.75","$5,158.80",$0.00,"$1,511.89",$0.00,$0.00,"$1,536.43","$8,775.00",$0.00,"$4,387.50","$6,949.80","$7,020.00",$0.00,"$1,373.29",$0.00,"$1,396.98",$0.00
7121/65,SUP,HCPCS C1895,,7121/65  -  LEAD PCNG 7FR 65CM DURATA 2 COIL ACTFX IMPL CARDVRT DFBR,"$8,775.00",$0.00,"$8,775.00","$3,948.75","$5,158.80",$0.00,"$1,511.89",$0.00,$0.00,"$1,536.43","$8,775.00",$0.00,"$4,387.50","$6,949.80","$7,020.00",$0.00,"$1,373.29",$0.00,"$1,396.98",$0.00
71-2100,SUP,Custom 27011340,,71-2100  -  ADPR SCT MTL DISS,$144.00,$0.00,$144.00,$0.00,$102.77,$0.00,$0.00,$0.00,$0.00,$0.00,$144.00,$0.00,$72.00,$114.05,$115.20,$0.00,$0.00,$0.00,$0.00,$0.00
7121Q/52,SUP,HCPCS C1895,,7121Q/52  -  LEAD PACING 21CM SPACE 7FR 52CM 2 COIL TRUE BIPOL,"$8,775.00",$0.00,"$8,775.00","$3,948.75","$5,158.80",$0.00,"$1,511.89",$0.00,$0.00,"$1,536.43","$8,775.00",$0.00,"$4,387.50","$6,949.80","$7,020.00",$0.00,"$1,373.29",$0.00,"$1,396.98",$0.00
7121Q/58,SUP,HCPCS C1895,,7121Q/58  -  LEAD PACING 21CM SPACE 7FR 58CM 2 COIL TRUE BIPOL,"$8,775.00",$0.00,"$8,775.00","$3,948.75","$5,158.80",$0.00,"$1,511.89",$0.00,$0.00,"$1,536.43","$8,775.00",$0.00,"$4,387.50","$6,949.80","$7,020.00",$0.00,"$1,373.29",$0.00,"$1,396.98",$0.00
7121Q/65,SUP,HCPCS C1895,,7121Q/65  -  LEAD PCNG 7FR 65CM DURATA DF4 CNCT TRUE BP ACTFX IMPL,"$8,775.00",$0.00,"$8,775.00","$3,948.75","$5,158.80",$0.00,"$1,511.89",$0.00,$0.00,"$1,536.43","$8,775.00",$0.00,"$4,387.50","$6,949.80","$7,020.00",$0.00,"$1,373.29",$0.00,"$1,396.98",$0.00
7122/60,SUP,HCPCS C1895,,7122/60  -  LEAD DFBR 7FR 60CM DURATA 1 COIL DF1 IS-1 CNCT TRUE BP SNS,"$8,775.00",$0.00,"$8,775.00","$3,948.75","$5,158.80",$0.00,"$1,511.89",$0.00,$0.00,"$1,536.43","$8,775.00",$0.00,"$4,387.50","$6,949.80","$7,020.00",$0.00,"$1,373.29",$0.00,"$1,396.98",$0.00
7122/65,SUP,HCPCS C1895,,7122/65  -  LEAD PACING 7FR 65CM 1 COIL TRUE BIPOL CARDIOVERTER,"$8,775.00",$0.00,"$8,775.00","$3,948.75","$5,158.80",$0.00,"$1,511.89",$0.00,$0.00,"$1,536.43","$8,775.00",$0.00,"$4,387.50","$6,949.80","$7,020.00",$0.00,"$1,373.29",$0.00,"$1,396.98",$0.00
71222010M,SUP,HCPCS C1713,,71222010M  -  SCREW BN 3.5MM 6MM 10MM TC100 SS CORT SM FRAG SYS,$76.80,$0.00,$76.80,$34.56,$54.81,$0.00,$13.23,$0.00,$0.00,$13.45,$76.80,$0.00,$38.40,$60.83,$61.44,$0.00,$12.02,$0.00,$12.23,$0.00
71222012M,SUP,HCPCS C1713,,71222012M  -  SCREW BN 3.5MM 6MM 12MM TC100 SS CORT SM FRAG SYS,$76.80,$0.00,$76.80,$34.56,$54.81,$0.00,$13.23,$0.00,$0.00,$13.45,$76.80,$0.00,$38.40,$60.83,$61.44,$0.00,$12.02,$0.00,$12.23,$0.00
71222016M,SUP,HCPCS C1713,,71222016M  -  SCREW BN 3.5MM 6MM 16MM TC100 SS CORT SM FRAG SYS,$76.80,$0.00,$76.80,$34.56,$54.81,$0.00,$13.23,$0.00,$0.00,$13.45,$76.80,$0.00,$38.40,$60.83,$61.44,$0.00,$12.02,$0.00,$12.23,$0.00
71222018M,SUP,HCPCS C1713,,71222018M  -  SCREW BN 3.5MM 6MM 18MM TC100 SS CORT SM FRAG SYS,$76.80,$0.00,$76.80,$34.56,$54.81,$0.00,$13.23,$0.00,$0.00,$13.45,$76.80,$0.00,$38.40,$60.83,$61.44,$0.00,$12.02,$0.00,$12.23,$0.00
71222020M,SUP,HCPCS C1713,,71222020M  -  SCREW BN 3.5MM 6MM 20MM TC100 SS CORT SM FRAG SYS,$76.80,$0.00,$76.80,$34.56,$54.81,$0.00,$13.23,$0.00,$0.00,$13.45,$76.80,$0.00,$38.40,$60.83,$61.44,$0.00,$12.02,$0.00,$12.23,$0.00
71222022M,SUP,HCPCS C1713,,71222022M  -  SCREW BN 3.5MM 6MM 22MM TC100 SS CORT SM FRAG SYS,$76.80,$0.00,$76.80,$34.56,$54.81,$0.00,$13.23,$0.00,$0.00,$13.45,$76.80,$0.00,$38.40,$60.83,$61.44,$0.00,$12.02,$0.00,$12.23,$0.00
71222024M,SUP,HCPCS C1713,,71222024M  -  SCREW BN 3.5MM 6MM 22MM TC100 SS CORT SM FRAG SYS,$76.80,$0.00,$76.80,$34.56,$54.81,$0.00,$13.23,$0.00,$0.00,$13.45,$76.80,$0.00,$38.40,$60.83,$61.44,$0.00,$12.02,$0.00,$12.23,$0.00
71222026M,SUP,HCPCS C1713,,71222026M  -  SCREW BN 3.5MM 6MM 26MM TC100 SS CORT SM FRAG SYS,$76.80,$0.00,$76.80,$34.56,$54.81,$0.00,$13.23,$0.00,$0.00,$13.45,$76.80,$0.00,$38.40,$60.83,$61.44,$0.00,$12.02,$0.00,$12.23,$0.00
71222028M,SUP,HCPCS C1713,,71222028M  -  SCREW BN 3.5MM 6MM 28MM TC100 SS CORT SM FRAG SYS,$76.80,$0.00,$76.80,$34.56,$54.81,$0.00,$13.23,$0.00,$0.00,$13.45,$76.80,$0.00,$38.40,$60.83,$61.44,$0.00,$12.02,$0.00,$12.23,$0.00
71222030M,SUP,HCPCS C1713,,71222030M  -  SCREW BN 3.5MM 6MM 30MM TC100 SS CORT SM FRAG SYS,$76.80,$0.00,$76.80,$34.56,$54.81,$0.00,$13.23,$0.00,$0.00,$13.45,$76.80,$0.00,$38.40,$60.83,$61.44,$0.00,$12.02,$0.00,$12.23,$0.00
71222032M,SUP,HCPCS C1713,,71222032M  -  SCREW BN 3.5MM 6MM 32MM TC100 SS CORT SM FRAG SYS,$76.80,$0.00,$76.80,$34.56,$54.81,$0.00,$13.23,$0.00,$0.00,$13.45,$76.80,$0.00,$38.40,$60.83,$61.44,$0.00,$12.02,$0.00,$12.23,$0.00
71222034M,SUP,HCPCS C1713,,71222034M  -  SCREW BN 3.5MM 6MM 34MM TC100 SS CORT SM FRAG SYS,$76.80,$0.00,$76.80,$34.56,$54.81,$0.00,$13.23,$0.00,$0.00,$13.45,$76.80,$0.00,$38.40,$60.83,$61.44,$0.00,$12.02,$0.00,$12.23,$0.00
71222036M,SUP,HCPCS C1713,,71222036M  -  SCREW BN 3.5MM 6MM 36MM TC100 SS CORT SM FRAG SYS,$76.80,$0.00,$76.80,$34.56,$54.81,$0.00,$13.23,$0.00,$0.00,$13.45,$76.80,$0.00,$38.40,$60.83,$61.44,$0.00,$12.02,$0.00,$12.23,$0.00
71222038M,SUP,HCPCS C1713,,71222038M  -  SCREW BN 3.5MM 6MM 38MM TC100 SS CORT SM FRAG SYS,$76.80,$0.00,$76.80,$34.56,$54.81,$0.00,$13.23,$0.00,$0.00,$13.45,$76.80,$0.00,$38.40,$60.83,$61.44,$0.00,$12.02,$0.00,$12.23,$0.00
71222040M,SUP,HCPCS C1713,,71222040M  -  SCREW BN 3.5MM 6MM 40MM TC100 SS CORT SM FRAG SYS,$76.80,$0.00,$76.80,$34.56,$54.81,$0.00,$13.23,$0.00,$0.00,$13.45,$76.80,$0.00,$38.40,$60.83,$61.44,$0.00,$12.02,$0.00,$12.23,$0.00
71222045M,SUP,HCPCS C1713,,71222045M  -  SCREW BN 3.5MM 6MM 45MM TC100 SS CORT SM FRAG SYS,$76.80,$0.00,$76.80,$34.56,$54.81,$0.00,$13.23,$0.00,$0.00,$13.45,$76.80,$0.00,$38.40,$60.83,$61.44,$0.00,$12.02,$0.00,$12.23,$0.00
71223010M,SUP,HCPCS C1713,,71223010M  -  SCREW BN FT 4MM 6MM 10MM TC100 SS CANC SM FRAG SYS,$82.80,$0.00,$82.80,$37.26,$59.09,$0.00,$14.27,$0.00,$0.00,$14.50,$82.80,$0.00,$41.40,$65.58,$66.24,$0.00,$12.96,$0.00,$13.18,$0.00
71223012M,SUP,HCPCS C1713,,71223012M  -  SCREW BN FT 4MM 6MM 12MM TC100 SS CANC SM FRAG SYS,$82.80,$0.00,$82.80,$37.26,$59.09,$0.00,$14.27,$0.00,$0.00,$14.50,$82.80,$0.00,$41.40,$65.58,$66.24,$0.00,$12.96,$0.00,$13.18,$0.00
71223014M,SUP,HCPCS C1713,,71223014M  -  SCREW BN FT 4MM 6MM 14MM TC100 SS CANC SM FRAG SYS,$82.80,$0.00,$82.80,$37.26,$59.09,$0.00,$14.27,$0.00,$0.00,$14.50,$82.80,$0.00,$41.40,$65.58,$66.24,$0.00,$12.96,$0.00,$13.18,$0.00
71223016M,SUP,HCPCS C1713,,71223016M  -  SCREW BN FT 4MM 6MM 16MM TC100 SS CANC SM FRAG SYS,$82.80,$0.00,$82.80,$37.26,$59.09,$0.00,$14.27,$0.00,$0.00,$14.50,$82.80,$0.00,$41.40,$65.58,$66.24,$0.00,$12.96,$0.00,$13.18,$0.00
71223018M,SUP,HCPCS C1713,,71223018M  -  SCREW BN FT 4MM 6MM 18MM TC100 SS CANC SM FRAG SYS,$82.80,$0.00,$82.80,$37.26,$59.09,$0.00,$14.27,$0.00,$0.00,$14.50,$82.80,$0.00,$41.40,$65.58,$66.24,$0.00,$12.96,$0.00,$13.18,$0.00
71223020M,SUP,HCPCS C1713,,71223020M  -  SCREW BN FT 4MM 6MM 20MM TC100 SS CANC SM FRAG SYS,$82.80,$0.00,$82.80,$37.26,$59.09,$0.00,$14.27,$0.00,$0.00,$14.50,$82.80,$0.00,$41.40,$65.58,$66.24,$0.00,$12.96,$0.00,$13.18,$0.00
71223024M,SUP,HCPCS C1713,,71223024M  -  SCREW BN FT 4MM 6MM 24MM TC100 SS CANC SM FRAG SYS,$82.80,$0.00,$82.80,$37.26,$59.09,$0.00,$14.27,$0.00,$0.00,$14.50,$82.80,$0.00,$41.40,$65.58,$66.24,$0.00,$12.96,$0.00,$13.18,$0.00
71223026M,SUP,HCPCS C1713,,71223026M  -  SCREW BN FT 4MM 6MM 26MM TC100 SS CANC SM FRAG SYS,$82.80,$0.00,$82.80,$37.26,$59.09,$0.00,$14.27,$0.00,$0.00,$14.50,$82.80,$0.00,$41.40,$65.58,$66.24,$0.00,$12.96,$0.00,$13.18,$0.00
71223028M,SUP,HCPCS C1713,,71223028M  -  SCREW BN FT 4MM 6MM 28MM TC100 SS CANC SM FRAG SYS,$82.80,$0.00,$82.80,$37.26,$59.09,$0.00,$14.27,$0.00,$0.00,$14.50,$82.80,$0.00,$41.40,$65.58,$66.24,$0.00,$12.96,$0.00,$13.18,$0.00
71223030M,SUP,HCPCS C1713,,71223030M  -  SCREW BN FT 4MM 6MM 30MM TC100 SS CANC SM FRAG SYS,$82.80,$0.00,$82.80,$37.26,$59.09,$0.00,$14.27,$0.00,$0.00,$14.50,$82.80,$0.00,$41.40,$65.58,$66.24,$0.00,$12.96,$0.00,$13.18,$0.00
71223032M,SUP,HCPCS C1713,,71223032M  -  SCREW BN FT 4MM 6MM 32MM TC100 SS CANC SM FRAG SYS,$82.80,$0.00,$82.80,$37.26,$59.09,$0.00,$14.27,$0.00,$0.00,$14.50,$82.80,$0.00,$41.40,$65.58,$66.24,$0.00,$12.96,$0.00,$13.18,$0.00
71223035M,SUP,HCPCS C1713,,71223035M  -  SCREW BN SM FT 4MM 6MM 35MM TC100 SS CANC,$72.40,$0.00,$72.40,$32.58,$51.67,$0.00,$12.47,$0.00,$0.00,$12.68,$72.40,$0.00,$36.20,$57.34,$57.92,$0.00,$11.33,$0.00,$11.53,$0.00
71223036M,SUP,HCPCS C1713,,71223036M  -  SCREW BN FT 4MM 6MM 36MM TC100 SS CANC SM FRAG SYS,$82.80,$0.00,$82.80,$37.26,$59.09,$0.00,$14.27,$0.00,$0.00,$14.50,$82.80,$0.00,$41.40,$65.58,$66.24,$0.00,$12.96,$0.00,$13.18,$0.00
71223040M,SUP,HCPCS C1713,,71223040M  -  SCREW BN FT 4MM 6MM 40MM TC100 SS CANC SM FRAG SYS,$82.80,$0.00,$82.80,$37.26,$59.09,$0.00,$14.27,$0.00,$0.00,$14.50,$82.80,$0.00,$41.40,$65.58,$66.24,$0.00,$12.96,$0.00,$13.18,$0.00
71223045M,SUP,HCPCS C1713,,71223045M  -  SCREW BN FT 4MM 6MM 45MM TC100 SS CANC SM FRAG SYS,$82.80,$0.00,$82.80,$37.26,$59.09,$0.00,$14.27,$0.00,$0.00,$14.50,$82.80,$0.00,$41.40,$65.58,$66.24,$0.00,$12.96,$0.00,$13.18,$0.00
71223050M,SUP,HCPCS C1713,,71223050M  -  SCREW BN FT 4MM 6MM 50MM TC100 SS CANC SM FRAG SYS,$82.80,$0.00,$82.80,$37.26,$59.09,$0.00,$14.27,$0.00,$0.00,$14.50,$82.80,$0.00,$41.40,$65.58,$66.24,$0.00,$12.96,$0.00,$13.18,$0.00
71223055M,SUP,HCPCS C1713,,71223055M  -  SCREW BN FT 4MM 6MM 55MM TC100 SS CANC SM FRAG SYS,$82.80,$0.00,$82.80,$37.26,$59.09,$0.00,$14.27,$0.00,$0.00,$14.50,$82.80,$0.00,$41.40,$65.58,$66.24,$0.00,$12.96,$0.00,$13.18,$0.00
71223060M,SUP,HCPCS C1713,,71223060M  -  SCREW BN FT 4MM 6MM 60MM TC100 SS CANC SM FRAG SYS,$82.80,$0.00,$82.80,$37.26,$59.09,$0.00,$14.27,$0.00,$0.00,$14.50,$82.80,$0.00,$41.40,$65.58,$66.24,$0.00,$12.96,$0.00,$13.18,$0.00
71223210M,SUP,HCPCS C1713,,71223210M  -  SCREW BN P/T 4MM 6MM 10MM TC100 SS CANC SM FRAG SYS,$80.80,$0.00,$80.80,$36.36,$57.67,$0.00,$13.92,$0.00,$0.00,$14.15,$80.80,$0.00,$40.40,$63.99,$64.64,$0.00,$12.65,$0.00,$12.86,$0.00
71223212M,SUP,HCPCS C1713,,71223212M  -  SCREW BN P/T 4MM 6MM 12MM TC100 SS CANC SM FRAG SYS,$80.80,$0.00,$80.80,$36.36,$57.67,$0.00,$13.92,$0.00,$0.00,$14.15,$80.80,$0.00,$40.40,$63.99,$64.64,$0.00,$12.65,$0.00,$12.86,$0.00
71223214M,SUP,HCPCS C1713,,71223214M  -  SCREW BN P/T 4MM 6MM 14MM TC100 SS CANC SM FRAG SYS,$80.80,$0.00,$80.80,$36.36,$57.67,$0.00,$13.92,$0.00,$0.00,$14.15,$80.80,$0.00,$40.40,$63.99,$64.64,$0.00,$12.65,$0.00,$12.86,$0.00
71223216M,SUP,HCPCS C1713,,71223216M  -  SCREW BN P/T 4MM 6MM 16MM TC100 SS CANC SM FRAG SYS,$80.80,$0.00,$80.80,$36.36,$57.67,$0.00,$13.92,$0.00,$0.00,$14.15,$80.80,$0.00,$40.40,$63.99,$64.64,$0.00,$12.65,$0.00,$12.86,$0.00
71223218M,SUP,HCPCS C1713,,71223218M  -  SCREW BN P/T 4MM 6MM 18MM TC100 SS CANC SM FRAG SYS,$80.80,$0.00,$80.80,$36.36,$57.67,$0.00,$13.92,$0.00,$0.00,$14.15,$80.80,$0.00,$40.40,$63.99,$64.64,$0.00,$12.65,$0.00,$12.86,$0.00
71223220M,SUP,HCPCS C1713,,71223220M  -  SCREW BN P/T 4MM 6MM 20MM TC100 SS CANC SM FRAG SYS,$80.80,$0.00,$80.80,$36.36,$57.67,$0.00,$13.92,$0.00,$0.00,$14.15,$80.80,$0.00,$40.40,$63.99,$64.64,$0.00,$12.65,$0.00,$12.86,$0.00
71223222M,SUP,HCPCS C1713,,71223222M  -  SCREW BN P/T 4MM 6MM 22MM TC100 SS CANC SM FRAG SYS,$80.80,$0.00,$80.80,$36.36,$57.67,$0.00,$13.92,$0.00,$0.00,$14.15,$80.80,$0.00,$40.40,$63.99,$64.64,$0.00,$12.65,$0.00,$12.86,$0.00
71223224M,SUP,HCPCS C1713,,71223224M  -  SCREW BN P/T 4MM 6MM 24MM TC100 SS CANC SM FRAG SYS,$80.80,$0.00,$80.80,$36.36,$57.67,$0.00,$13.92,$0.00,$0.00,$14.15,$80.80,$0.00,$40.40,$63.99,$64.64,$0.00,$12.65,$0.00,$12.86,$0.00
71223226M,SUP,HCPCS C1713,,71223226M  -  SCREW BN P/T 4MM 6MM 26MM TC100 SS CANC SM FRAG SYS,$80.80,$0.00,$80.80,$36.36,$57.67,$0.00,$13.92,$0.00,$0.00,$14.15,$80.80,$0.00,$40.40,$63.99,$64.64,$0.00,$12.65,$0.00,$12.86,$0.00
71223228M,SUP,HCPCS C1713,,71223228M  -  SCREW BN P/T 4MM 6MM 28MM TC100 SS CANC SM FRAG SYS,$80.80,$0.00,$80.80,$36.36,$57.67,$0.00,$13.92,$0.00,$0.00,$14.15,$80.80,$0.00,$40.40,$63.99,$64.64,$0.00,$12.65,$0.00,$12.86,$0.00
71223230M,SUP,HCPCS C1713,,71223230M  -  SCREW BN P/T 4MM 6MM 30MM TC100 SS CANC SM FRAG SYS,$80.80,$0.00,$80.80,$36.36,$57.67,$0.00,$13.92,$0.00,$0.00,$14.15,$80.80,$0.00,$40.40,$63.99,$64.64,$0.00,$12.65,$0.00,$12.86,$0.00
71223235M,SUP,HCPCS C1713,,71223235M  -  SCREW BN P/T 4MM 6MM 35MM TC100 SS CANC SM FRAG SYS,$80.80,$0.00,$80.80,$36.36,$57.67,$0.00,$13.92,$0.00,$0.00,$14.15,$80.80,$0.00,$40.40,$63.99,$64.64,$0.00,$12.65,$0.00,$12.86,$0.00
71223240M,SUP,HCPCS C1713,,71223240M  -  SCREW BN P/T 4MM 6MM 40MM TC100 SS CANC SM FRAG SYS,$80.80,$0.00,$80.80,$36.36,$57.67,$0.00,$13.92,$0.00,$0.00,$14.15,$80.80,$0.00,$40.40,$63.99,$64.64,$0.00,$12.65,$0.00,$12.86,$0.00
71223245M,SUP,HCPCS C1713,,71223245M  -  SCREW BN P/T 4MM 6MM 45MM TC100 SS CANC SM FRAG SYS,$80.80,$0.00,$80.80,$36.36,$57.67,$0.00,$13.92,$0.00,$0.00,$14.15,$80.80,$0.00,$40.40,$63.99,$64.64,$0.00,$12.65,$0.00,$12.86,$0.00
71223250M,SUP,HCPCS C1713,,71223250M  -  SCREW BN P/T 4MM 6MM 50MM TC100 SS CANC SM FRAG SYS,$80.80,$0.00,$80.80,$36.36,$57.67,$0.00,$13.92,$0.00,$0.00,$14.15,$80.80,$0.00,$40.40,$63.99,$64.64,$0.00,$12.65,$0.00,$12.86,$0.00
71225026M,SUP,HCPCS C1713,,71225026M  -  SCREW BN 4.5MM 8MM 26MM TC100 SS CORT LG FRAG SYS,$76.80,$0.00,$76.80,$34.56,$54.81,$0.00,$13.23,$0.00,$0.00,$13.45,$76.80,$0.00,$38.40,$60.83,$61.44,$0.00,$12.02,$0.00,$12.23,$0.00
71225028M,SUP,HCPCS C1713,,71225028M  -  SCREW BN 4.5MM 8MM 28MM TC100 SS CORT LG FRAG SYS,$76.80,$0.00,$76.80,$34.56,$54.81,$0.00,$13.23,$0.00,$0.00,$13.45,$76.80,$0.00,$38.40,$60.83,$61.44,$0.00,$12.02,$0.00,$12.23,$0.00
71225030M,SUP,HCPCS C1713,,71225030M  -  SCREW BN 4.5MM 8MM 30MM TC100 SS CORT LG FRAG SYS,$76.80,$0.00,$76.80,$34.56,$54.81,$0.00,$13.23,$0.00,$0.00,$13.45,$76.80,$0.00,$38.40,$60.83,$61.44,$0.00,$12.02,$0.00,$12.23,$0.00
71225032M,SUP,HCPCS C1713,,71225032M  -  SCREW BN 4.5MM 8MM 32MM TC100 SS CORT LG FRAG SYS,$76.80,$0.00,$76.80,$34.56,$54.81,$0.00,$13.23,$0.00,$0.00,$13.45,$76.80,$0.00,$38.40,$60.83,$61.44,$0.00,$12.02,$0.00,$12.23,$0.00
71225034M,SUP,HCPCS C1713,,71225034M  -  SCREW BN 4.5MM 8MM 34MM TC100 SS CORT LG FRAG SYS,$76.80,$0.00,$76.80,$34.56,$54.81,$0.00,$13.23,$0.00,$0.00,$13.45,$76.80,$0.00,$38.40,$60.83,$61.44,$0.00,$12.02,$0.00,$12.23,$0.00
71225036M,SUP,HCPCS C1713,,71225036M  -  SCREW BN 4.5MM 8MM 36MM TC100 SS CORT LG FRAG SYS,$76.80,$0.00,$76.80,$34.56,$54.81,$0.00,$13.23,$0.00,$0.00,$13.45,$76.80,$0.00,$38.40,$60.83,$61.44,$0.00,$12.02,$0.00,$12.23,$0.00
71225038M,SUP,HCPCS C1713,,71225038M  -  SCREW BN 4.5MM 8MM 38MM TC100 SS CORT LG FRAG SYS,$76.80,$0.00,$76.80,$34.56,$54.81,$0.00,$13.23,$0.00,$0.00,$13.45,$76.80,$0.00,$38.40,$60.83,$61.44,$0.00,$12.02,$0.00,$12.23,$0.00
71225040M,SUP,HCPCS C1713,,71225040M  -  SCREW BN 4.5MM 8MM 40MM TC100 SS CORT LG FRAG SYS,$76.80,$0.00,$76.80,$34.56,$54.81,$0.00,$13.23,$0.00,$0.00,$13.45,$76.80,$0.00,$38.40,$60.83,$61.44,$0.00,$12.02,$0.00,$12.23,$0.00
71225042M,SUP,HCPCS C1713,,71225042M  -  SCREW BN 4.5MM 8MM 42MM TC100 SS CORT LG FRAG SYS,$76.80,$0.00,$76.80,$34.56,$54.81,$0.00,$13.23,$0.00,$0.00,$13.45,$76.80,$0.00,$38.40,$60.83,$61.44,$0.00,$12.02,$0.00,$12.23,$0.00
71225044M,SUP,HCPCS C1713,,71225044M  -  SCREW BN 4.5MM 8MM 44MM TC100 SS CORT LG FRAG SYS,$76.80,$0.00,$76.80,$34.56,$54.81,$0.00,$13.23,$0.00,$0.00,$13.45,$76.80,$0.00,$38.40,$60.83,$61.44,$0.00,$12.02,$0.00,$12.23,$0.00
71225046M,SUP,HCPCS C1713,,71225046M  -  SCREW BN 4.5MM 8MM 46MM TC100 SS CORT LG FRAG SYS,$76.80,$0.00,$76.80,$34.56,$54.81,$0.00,$13.23,$0.00,$0.00,$13.45,$76.80,$0.00,$38.40,$60.83,$61.44,$0.00,$12.02,$0.00,$12.23,$0.00
71226030M,SUP,HCPCS C1713,,71226030M  -  SCREW BN P/T 6.5MM 8MM 30MM 16MM TC100 SS CANC LG FRAG SYS,$164.80,$0.00,$164.80,$74.16,$117.62,$0.00,$28.39,$0.00,$0.00,$28.86,$164.80,$0.00,$82.40,$130.52,$131.84,$0.00,$25.79,$0.00,$26.24,$0.00
71226035M,SUP,HCPCS C1713,,71226035M  -  SCREW BN P/T 6.5MM 8MM 35MM 16MM TC100 SS CANC LG FRAG SYS,$164.80,$0.00,$164.80,$74.16,$117.62,$0.00,$28.39,$0.00,$0.00,$28.86,$164.80,$0.00,$82.40,$130.52,$131.84,$0.00,$25.79,$0.00,$26.24,$0.00
71226040M,SUP,HCPCS C1713,,71226040M  -  SCREW BN P/T 6.5MM 8MM 40MM 16MM TC100 SS CANC LG FRAG SYS,$164.80,$0.00,$164.80,$74.16,$117.62,$0.00,$28.39,$0.00,$0.00,$28.86,$164.80,$0.00,$82.40,$130.52,$131.84,$0.00,$25.79,$0.00,$26.24,$0.00
71226045M,SUP,HCPCS C1713,,71226045M  -  SCREW BN P/T 6.5MM 8MM 45MM 16MM TC100 SS CANC LG FRAG SYS,$164.80,$0.00,$164.80,$74.16,$117.62,$0.00,$28.39,$0.00,$0.00,$28.86,$164.80,$0.00,$82.40,$130.52,$131.84,$0.00,$25.79,$0.00,$26.24,$0.00
71226055M,SUP,HCPCS C1713,,71226055M  -  SCREW BN P/T 6.5MM 8MM 55MM 16MM TC100 SS CANC LG FRAG SYS,$164.80,$0.00,$164.80,$74.16,$117.62,$0.00,$28.39,$0.00,$0.00,$28.86,$164.80,$0.00,$82.40,$130.52,$131.84,$0.00,$25.79,$0.00,$26.24,$0.00
71226060M,SUP,HCPCS C1713,,71226060M  -  SCREW BN P/T 6.5MM 8MM 60MM 16MM TC100 SS CANC LG FRAG SYS,$164.80,$0.00,$164.80,$74.16,$117.62,$0.00,$28.39,$0.00,$0.00,$28.86,$164.80,$0.00,$82.40,$130.52,$131.84,$0.00,$25.79,$0.00,$26.24,$0.00
71226065M,SUP,HCPCS C1713,,71226065M  -  SCREW BN P/T 6.5MM 8MM 65MM 16MM TC100 SS CANC LG FRAG SYS,$164.80,$0.00,$164.80,$74.16,$117.62,$0.00,$28.39,$0.00,$0.00,$28.86,$164.80,$0.00,$82.40,$130.52,$131.84,$0.00,$25.79,$0.00,$26.24,$0.00
71226070M,SUP,HCPCS C1713,,71226070M  -  SCREW BN P/T 6.5MM 8MM 70MM 16MM TC100 SS CANC LG FRAG SYS,$164.80,$0.00,$164.80,$74.16,$117.62,$0.00,$28.39,$0.00,$0.00,$28.86,$164.80,$0.00,$82.40,$130.52,$131.84,$0.00,$25.79,$0.00,$26.24,$0.00
71226075M,SUP,HCPCS C1713,,71226075M  -  SCREW BN P/T 6.5MM 8MM 75MM 16MM TC100 SS CANC LG FRAG SYS,$164.80,$0.00,$164.80,$74.16,$117.62,$0.00,$28.39,$0.00,$0.00,$28.86,$164.80,$0.00,$82.40,$130.52,$131.84,$0.00,$25.79,$0.00,$26.24,$0.00
71226080M,SUP,HCPCS C1713,,71226080M  -  SCREW BN P/T 6.5MM 80MM 16MM TC100 CANC,$164.80,$0.00,$164.80,$74.16,$117.62,$0.00,$28.39,$0.00,$0.00,$28.86,$164.80,$0.00,$82.40,$130.52,$131.84,$0.00,$25.79,$0.00,$26.24,$0.00
71229075M,SUP,HCPCS C1713,,71229075M  -  SCREW BN FT 6.5MM 8MM 75MM TC100 SS CANC LG FRAG SYS,$164.80,$0.00,$164.80,$74.16,$117.62,$0.00,$28.39,$0.00,$0.00,$28.86,$164.80,$0.00,$82.40,$130.52,$131.84,$0.00,$25.79,$0.00,$26.24,$0.00
71229080M,SUP,HCPCS C1713,,71229080M  -  SCREW BN FT 6.5MM 8MM 80MM TC100 SS CANC LG FRAG SYS,$180.80,$0.00,$180.80,$81.36,$129.04,$0.00,$31.15,$0.00,$0.00,$31.66,$180.80,$0.00,$90.40,$143.19,$144.64,$0.00,$28.30,$0.00,$28.78,$0.00
71229085M,SUP,HCPCS C1713,,71229085M  -  SCREW BN FT 6.5MM 8MM 85MM TC100 SS CANC LG FRAG SYS,$180.80,$0.00,$180.80,$81.36,$129.04,$0.00,$31.15,$0.00,$0.00,$31.66,$180.80,$0.00,$90.40,$143.19,$144.64,$0.00,$28.30,$0.00,$28.78,$0.00
71229090M,SUP,HCPCS C1713,,71229090M  -  SCREW BN FT 6.5MM 8MM 90MM TC100 SS CANC LG FRAG SYS,$164.80,$0.00,$164.80,$74.16,$117.62,$0.00,$28.39,$0.00,$0.00,$28.86,$164.80,$0.00,$82.40,$130.52,$131.84,$0.00,$25.79,$0.00,$26.24,$0.00
7122Q/52,SUP,HCPCS C1777,,7122Q/52  -  LEAD PCNG 11MM SPC 6.8FR 58CM DURATA 1 COIL TRUE BP ACTFX,"$8,775.00",$0.00,"$8,775.00","$3,948.75","$5,158.80",$0.00,"$1,511.89",$0.00,$0.00,"$1,536.43","$8,775.00",$0.00,"$4,387.50","$6,949.80","$7,020.00",$0.00,"$1,373.29",$0.00,"$1,396.98",$0.00
7122Q/58,SUP,HCPCS C1777,,7122Q/58  -  LEAD PCNG 58CM 6.8FR 11MM SPC ECRDL 1 COIL DFBR ACT FIX TRUE,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
7122Q/65,SUP,HCPCS C1777,,7122Q/65  -  LEAD PACING 11MM SPACING 6.8FR 65CM TRUE BIPOL ACTIVE FIX,"$8,775.00",$0.00,"$8,775.00","$3,948.75","$5,158.80",$0.00,"$1,511.89",$0.00,$0.00,"$1,536.43","$8,775.00",$0.00,"$4,387.50","$6,949.80","$7,020.00",$0.00,"$1,373.29",$0.00,"$1,396.98",$0.00
7125-0003,SUP,HCPCS C1776,,7125-0003  -  COMPONENT TIBIAL TRAY STANDARD MICROSTRUCTURED SCORPIO KNEE,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
7125-0004,SUP,HCPCS C1776,,7125-0004  -  COMPONENT TIBIAL TRAY STANDARD 4MM MICROSTRUCTURED SERIES,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
7125-0005,SUP,HCPCS C1776,,7125-0005  -  COMPONENT TIBIAL TRAY 5 STANDARD 66X44MM 30MM STEM WAFFLE,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
7125-0006,SUP,HCPCS C1776,,7125-0006  -  COMPONENT TIBIAL TRAY 6 STANDARD MICROSTRUCTURED CEMENTED,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
7125-0007,SUP,HCPCS C1776,,7125-0007  -  COMPONENT TIBIAL TRAY STANDARD DELTAFIT MICROSTRUCTURE,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
7125-0009,SUP,HCPCS C1776,,7125-0009  -  COMPONENT TIBIAL TRAY STANDARD DELTAFIT MICROSTRUCTURED,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
7125-0011,SUP,HCPCS C1776,,7125-0011  -  COMPONENT TIBIAL TRAY STANDARD DELTAFIT MICROSTRUCTURED,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
7125-0013,SUP,HCPCS C1776,,7125-0013  -  COMPONENT TIBIAL TRAY STANDARD MICROSTRUCTURED SCORPIO KNEE,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
7130/60,SUP,HCPCS C1895,,7130/60  -  LEAD DFBR 6.8FR 60CM STRL LF 17MM DURATA DISP,"$8,775.00",$0.00,"$8,775.00","$3,948.75","$5,158.80",$0.00,"$1,511.89",$0.00,$0.00,"$1,536.43","$8,775.00",$0.00,"$4,387.50","$6,949.80","$7,020.00",$0.00,"$1,373.29",$0.00,"$1,396.98",$0.00
7130/65,SUP,HCPCS C1895,,7130/65  -  DURATA+++PMM#:96295,"$10,500.00",$0.00,"$10,500.00","$4,725.00","$5,158.80",$0.00,"$1,809.10",$0.00,$0.00,"$1,838.47","$10,500.00",$0.00,"$5,250.00","$8,316.00","$8,400.00",$0.00,"$1,643.25",$0.00,"$1,671.60",$0.00
71-3003L,SUP,HCPCS C1776,,71-3003L  -  CMPNT FEM 3 LEFT KNEE CMNT PS BASIC SCRP,"$3,176.00",$0.00,"$3,176.00","$1,429.20","$2,266.71",$0.00,$547.21,$0.00,$0.00,$556.09,"$3,176.00",$0.00,"$1,588.00","$2,515.39","$2,540.80",$0.00,$497.04,$0.00,$505.62,$0.00
71-3003R,SUP,HCPCS C1776,,71-3003R  -  CMPNT FEM 3 RIGHT KNEE CMNT PS BASIC SCRP,"$3,176.00",$0.00,"$3,176.00","$1,429.20","$2,266.71",$0.00,$547.21,$0.00,$0.00,$556.09,"$3,176.00",$0.00,"$1,588.00","$2,515.39","$2,540.80",$0.00,$497.04,$0.00,$505.62,$0.00
71-3005L,SUP,HCPCS C1776,,71-3005L  -  CMPNT FEM 5 LEFT KNEE CMNT PS BASIC SCRP,"$3,110.00",$0.00,"$3,110.00","$1,399.50","$2,219.61",$0.00,$535.84,$0.00,$0.00,$544.54,"$3,110.00",$0.00,"$1,555.00","$2,463.12","$2,488.00",$0.00,$486.72,$0.00,$495.11,$0.00
71-3005R,SUP,HCPCS C1776,,71-3005R  -  CMPNT FEM 5 RIGHT KNEE CMNT PS BASIC SCRP,"$3,110.00",$0.00,"$3,110.00","$1,399.50","$2,219.61",$0.00,$535.84,$0.00,$0.00,$544.54,"$3,110.00",$0.00,"$1,555.00","$2,463.12","$2,488.00",$0.00,$486.72,$0.00,$495.11,$0.00
71-3007L,SUP,HCPCS C1776,,71-3007L  -  CMPNT FEM 7 LEFT KNEE PS CMNT BASIC SCRP NPOR,"$3,110.00",$0.00,"$3,110.00","$1,399.50","$2,219.61",$0.00,$535.84,$0.00,$0.00,$544.54,"$3,110.00",$0.00,"$1,555.00","$2,463.12","$2,488.00",$0.00,$486.72,$0.00,$495.11,$0.00
71-3007R,SUP,HCPCS C1776,,71-3007R  -  CMPNT FEM 7 RIGHT KNEE PS BASIC SCRP,"$3,110.00",$0.00,"$3,110.00","$1,399.50","$2,219.61",$0.00,$535.84,$0.00,$0.00,$544.54,"$3,110.00",$0.00,"$1,555.00","$2,463.12","$2,488.00",$0.00,$486.72,$0.00,$495.11,$0.00
71-3009L,SUP,HCPCS C1776,,71-3009L  -  CMPNT FEM 9 LEFT KNEE CMNT PS BASIC SCRP,"$3,110.00",$0.00,"$3,110.00","$1,399.50","$2,219.61",$0.00,$535.84,$0.00,$0.00,$544.54,"$3,110.00",$0.00,"$1,555.00","$2,463.12","$2,488.00",$0.00,$486.72,$0.00,$495.11,$0.00
71-3009R,SUP,HCPCS C1776,,71-3009R  -  CMPNT FEM 9 RIGHT KNEE CMNT PS BASIC SCRP,"$3,110.00",$0.00,"$3,110.00","$1,399.50","$2,219.61",$0.00,$535.84,$0.00,$0.00,$544.54,"$3,110.00",$0.00,"$1,555.00","$2,463.12","$2,488.00",$0.00,$486.72,$0.00,$495.11,$0.00
71-3011L,SUP,HCPCS C1776,,71-3011L  -  CMPNT FEM 11 LEFT KNEE CMNT PS BASIC SCRP,"$3,110.00",$0.00,"$3,110.00","$1,399.50","$2,219.61",$0.00,$535.84,$0.00,$0.00,$544.54,"$3,110.00",$0.00,"$1,555.00","$2,463.12","$2,488.00",$0.00,$486.72,$0.00,$495.11,$0.00
71-3011R,SUP,HCPCS C1776,,71-3011R  -  CMPNT FEM 11 RIGHT KNEE CMNT PS BASIC SCRP,"$3,110.00",$0.00,"$3,110.00","$1,399.50","$2,219.61",$0.00,$535.84,$0.00,$0.00,$544.54,"$3,110.00",$0.00,"$1,555.00","$2,463.12","$2,488.00",$0.00,$486.72,$0.00,$495.11,$0.00
71-3013L,SUP,HCPCS C1776,,71-3013L  -  CMPNT FEM 13 LEFT KNEE CMNT PS BASIC SCRP,"$3,176.00",$0.00,"$3,176.00","$1,429.20","$2,266.71",$0.00,$547.21,$0.00,$0.00,$556.09,"$3,176.00",$0.00,"$1,588.00","$2,515.39","$2,540.80",$0.00,$497.04,$0.00,$505.62,$0.00
71-3013R,SUP,HCPCS C1776,,71-3013R  -  CMPNT FEM 13 RIGHT KNEE CMNT PS BASIC SCRP,"$3,176.00",$0.00,"$3,176.00","$1,429.20","$2,266.71",$0.00,$547.21,$0.00,$0.00,$556.09,"$3,176.00",$0.00,"$1,588.00","$2,515.39","$2,540.80",$0.00,$497.04,$0.00,$505.62,$0.00
7131/60,SUP,HCPCS C1895,,7131/60  -  LEAD DFBR 60CM STRL LF 21CM DURATA DISP,"$10,500.00",$0.00,"$10,500.00","$4,725.00","$5,158.80",$0.00,"$1,809.10",$0.00,$0.00,"$1,838.47","$10,500.00",$0.00,"$5,250.00","$8,316.00","$8,400.00",$0.00,"$1,643.25",$0.00,"$1,671.60",$0.00
7131/65,SUP,HCPCS C1895,,7131/65  -  LEAD PACING 21MM SPACE 6.8FR 65CM 2 COIL INTEGRATE BIPOL,"$8,775.00",$0.00,"$8,775.00","$3,948.75","$5,158.80",$0.00,"$1,511.89",$0.00,$0.00,"$1,536.43","$8,775.00",$0.00,"$4,387.50","$6,949.80","$7,020.00",$0.00,"$1,373.29",$0.00,"$1,396.98",$0.00
71-4103L,SUP,HCPCS C1776,,71-4103L  -  CMPNT FEM 3 LEFT KNEE PS WFL POST SCRP LFIT,"$3,657.00",$0.00,"$3,657.00","$1,645.65","$2,610.00",$0.00,$630.08,$0.00,$0.00,$640.31,"$3,657.00",$0.00,"$1,828.50","$2,896.34","$2,925.60",$0.00,$572.32,$0.00,$582.19,$0.00
71-4103R,SUP,HCPCS C1776,,71-4103R  -  CMPNT FEM 3 RIGHT KNEE PS WFL POST SCRP LFIT,"$3,657.00",$0.00,"$3,657.00","$1,645.65","$2,610.00",$0.00,$630.08,$0.00,$0.00,$640.31,"$3,657.00",$0.00,"$1,828.50","$2,896.34","$2,925.60",$0.00,$572.32,$0.00,$582.19,$0.00
71-4104L,SUP,HCPCS C1776,,71-4104L  -  CMPNT FEM PS WFL SCRP LFIT,"$3,625.00",$0.00,"$3,625.00","$1,631.25","$2,587.16",$0.00,$624.57,$0.00,$0.00,$634.71,"$3,625.00",$0.00,"$1,812.50","$2,871.00","$2,900.00",$0.00,$567.31,$0.00,$577.10,$0.00
71-4104R,SUP,HCPCS C1776,,71-4104R  -  CMPNT FEM PS WFL SCRP LFIT,"$3,625.00",$0.00,"$3,625.00","$1,631.25","$2,587.16",$0.00,$624.57,$0.00,$0.00,$634.71,"$3,625.00",$0.00,"$1,812.50","$2,871.00","$2,900.00",$0.00,$567.31,$0.00,$577.10,$0.00
71-4105L,SUP,HCPCS C1776,,71-4105L  -  CMPNT FEM 5 LEFT PS WFL SCRP LFIT,"$3,625.00",$0.00,"$3,625.00","$1,631.25","$2,587.16",$0.00,$624.57,$0.00,$0.00,$634.71,"$3,625.00",$0.00,"$1,812.50","$2,871.00","$2,900.00",$0.00,$567.31,$0.00,$577.10,$0.00
71-4105R,SUP,HCPCS C1776,,71-4105R  -  CMPNT FEM 5 RIGHT PS WFL SCRP LFIT,"$3,625.00",$0.00,"$3,625.00","$1,631.25","$2,587.16",$0.00,$624.57,$0.00,$0.00,$634.71,"$3,625.00",$0.00,"$1,812.50","$2,871.00","$2,900.00",$0.00,$567.31,$0.00,$577.10,$0.00
71-4106L,SUP,HCPCS C1776,,71-4106L  -  CMPNT FEM PS WFL SCRP LFIT,"$3,625.00",$0.00,"$3,625.00","$1,631.25","$2,587.16",$0.00,$624.57,$0.00,$0.00,$634.71,"$3,625.00",$0.00,"$1,812.50","$2,871.00","$2,900.00",$0.00,$567.31,$0.00,$577.10,$0.00
71-4106R,SUP,HCPCS C1776,,71-4106R  -  CMPNT FEM 6 RIGHT PS WFL SCRP LFIT,"$3,625.00",$0.00,"$3,625.00","$1,631.25","$2,587.16",$0.00,$624.57,$0.00,$0.00,$634.71,"$3,625.00",$0.00,"$1,812.50","$2,871.00","$2,900.00",$0.00,$567.31,$0.00,$577.10,$0.00
71-4107L,SUP,HCPCS C1776,,71-4107L  -  COMPONENT FEM 7 LFIT SCRP CMNT POST STAB WFL KN LT,"$3,625.00",$0.00,"$3,625.00","$1,631.25","$2,587.16",$0.00,$624.57,$0.00,$0.00,$634.71,"$3,625.00",$0.00,"$1,812.50","$2,871.00","$2,900.00",$0.00,$567.31,$0.00,$577.10,$0.00
71-4107R,SUP,HCPCS C1776,,71-4107R  -  COMPONENT FEM 7 LFIT SCRP CMNT POST STAB WFL KN RT,"$3,625.00",$0.00,"$3,625.00","$1,631.25","$2,587.16",$0.00,$624.57,$0.00,$0.00,$634.71,"$3,625.00",$0.00,"$1,812.50","$2,871.00","$2,900.00",$0.00,$567.31,$0.00,$577.10,$0.00
71-4109L,SUP,HCPCS C1776,,71-4109L  -  CMPNT FEM 9 LEFT PS WFL SCRP LFIT,"$3,625.00",$0.00,"$3,625.00","$1,631.25","$2,587.16",$0.00,$624.57,$0.00,$0.00,$634.71,"$3,625.00",$0.00,"$1,812.50","$2,871.00","$2,900.00",$0.00,$567.31,$0.00,$577.10,$0.00
71-4109R,SUP,HCPCS C1776,,71-4109R  -  CMPNT FEM 9 RIGHT PS WFL SCRP LFIT,"$3,625.00",$0.00,"$3,625.00","$1,631.25","$2,587.16",$0.00,$624.57,$0.00,$0.00,$634.71,"$3,625.00",$0.00,"$1,812.50","$2,871.00","$2,900.00",$0.00,$567.31,$0.00,$577.10,$0.00
71-4111L,SUP,HCPCS C1776,,71-4111L  -  CMPNT FEM 11 LEFT PS WFL SCRP LFIT,"$3,625.00",$0.00,"$3,625.00","$1,631.25","$2,587.16",$0.00,$624.57,$0.00,$0.00,$634.71,"$3,625.00",$0.00,"$1,812.50","$2,871.00","$2,900.00",$0.00,$567.31,$0.00,$577.10,$0.00
71-4111R,SUP,HCPCS C1776,,71-4111R  -  CMPNT FEM 11 RIGHT WFL PS SCRP LFIT,"$3,625.00",$0.00,"$3,625.00","$1,631.25","$2,587.16",$0.00,$624.57,$0.00,$0.00,$634.71,"$3,625.00",$0.00,"$1,812.50","$2,871.00","$2,900.00",$0.00,$567.31,$0.00,$577.10,$0.00
71-4113L,SUP,HCPCS C1776,,71-4113L  -  CMPNT FEM 13 LEFT PS WFL SCRP LFIT,"$3,657.00",$0.00,"$3,657.00","$1,645.65","$2,610.00",$0.00,$630.08,$0.00,$0.00,$640.31,"$3,657.00",$0.00,"$1,828.50","$2,896.34","$2,925.60",$0.00,$572.32,$0.00,$582.19,$0.00
71-4113R,SUP,HCPCS C1776,,71-4113R  -  CMPNT FEM 13 RIGHT KNEE PS WFL POST SCRP LFIT,"$3,657.00",$0.00,"$3,657.00","$1,645.65","$2,610.00",$0.00,$630.08,$0.00,$0.00,$640.31,"$3,657.00",$0.00,"$1,828.50","$2,896.34","$2,925.60",$0.00,$572.32,$0.00,$582.19,$0.00
7145-0003,SUP,HCPCS C1776,,7145-0003  -  COMPONENT TIBIAL TRAY STANDARD MICROSTRUCTURED PERIAPT,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
7145-0005,SUP,HCPCS C1776,,7145-0005  -  COMPONENT TIBIAL TRAY STANDARD MICROSTRUCTURED PERIAPT,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
7145-0007,SUP,HCPCS C1776,,7145-0007  -  COMPONENT TIBIAL TRAY STANDARD MICROSTRUCTURED PERIAPT,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
7145-0009,SUP,HCPCS C1776,,7145-0009  -  COMPONENT TIBIAL TRAY STANDARD MICROSTRUCTURED PERIAPT,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
7145-0011,SUP,HCPCS C1776,,7145-0011  -  COMPONENT TIBIAL TRAY STANDARD MICROSTRUCTURED PERIAPT,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
7145-0013,SUP,HCPCS C1776,,7145-0013  -  COMPONENT TIBIAL TRAY STANDARD MICROSTRUCTURED PERIAPT,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
71-4503L,SUP,HCPCS C1776,,71-4503L  -  COMPONENT FEMORAL 3 56X35MM 1 AXIS POSTERIOR STABILIZE,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
71-4503R,SUP,HCPCS C1776,,71-4503R  -  COMPONENT FEMORAL 3 56X35MM 1 AXIS POSTERIOR STABILIZE,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
71-4504L,SUP,HCPCS C1776,,71-4504L  -  COMPONENT FEMORAL 4 1 AXIS POSTERIOR STABILIZE WAFFLE POST,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
71-4504R,SUP,HCPCS C1776,,71-4504R  -  COMPONENT FEMORAL 4 1 AXIS POSTERIOR STABILIZE WAFFLE POST,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
71-4505L,SUP,HCPCS C1776,,71-4505L  -  COMPONENT FEMORAL 5 61X39MM 1 AXIS POSTERIOR STABILIZE,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
71-4505R,SUP,HCPCS C1776,,71-4505R  -  COMPONENT FEMORAL 5 61X39MM 1 AXIS POSTERIOR STABILIZE,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
71-4506L,SUP,HCPCS C1776,,71-4506L  -  COMPONENT FEMORAL 6 1 AXIS POSTERIOR STABILIZE WAFFLE POST,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
71-4506R,SUP,HCPCS C1776,,71-4506R  -  COMPONENT FEMORAL 6 1 AXIS POSTERIOR STABILIZE WAFFLE POST,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
71-4507L,SUP,HCPCS C1776,,71-4507L  -  COMPONENT FEMORAL 7 66X44MM 1 AXIS POSTERIOR STABILIZE,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
71-4507R,SUP,HCPCS C1776,,71-4507R  -  COMPONENT FEMORAL 7 66X44MM 1 AXIS POSTERIOR STABILIZE,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
71-4509L,SUP,HCPCS C1776,,71-4509L  -  COMPONENT FEMORAL 9 71X49MM 1 AXIS POSTERIOR STABILIZE,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
71-4509R,SUP,HCPCS C1776,,71-4509R  -  COMPONENT FEMORAL 9 71X49MM 1 AXIS POSTERIOR STABILIZE,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
71-4511L,SUP,HCPCS C1776,,71-4511L  -  COMPONENT FEMORAL 11 76X53MM 1 AXIS POSTERIOR STABILIZE,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
71-4511R,SUP,HCPCS C1776,,71-4511R  -  COMPONENT FEMORAL 11 76X53MM 1 AXIS POSTERIOR STABILIZE,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
71-4513L,SUP,HCPCS C1776,,71-4513L  -  COMPONENT FEMORAL 13 81X58MM CEMENTED POSTERIOR STABILIZE,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
71-4513R,SUP,HCPCS C1776,,71-4513R  -  COMPONENT FEMORAL 13 81X58MM 1 AXIS POSTERIOR STABILIZE,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
71-5003L,SUP,HCPCS C1776,,71-5003L  -  CMPNT FEM 3 LEFT KNEE PS MCSTRCT NON LFIT SCRP,"$5,199.00",$0.00,"$5,199.00","$2,339.55","$3,710.53",$0.00,$895.76,$0.00,$0.00,$910.30,"$5,199.00",$0.00,"$2,599.50","$4,117.61","$4,159.20",$0.00,$813.64,$0.00,$827.68,$0.00
71-5003R,SUP,HCPCS C1776,,71-5003R  -  CMPNT FEM 3 RIGHT KNEE PS MCSTRCT NON LFIT SCRP,"$5,199.00",$0.00,"$5,199.00","$2,339.55","$3,710.53",$0.00,$895.76,$0.00,$0.00,$910.30,"$5,199.00",$0.00,"$2,599.50","$4,117.61","$4,159.20",$0.00,$813.64,$0.00,$827.68,$0.00
71-5004L,SUP,HCPCS C1776,,71-5004L  -  CMPNT FEM 4 LEFT KNEE PS MCSTRCT NON LFIT SCRP,"$5,096.00",$0.00,"$5,096.00","$2,293.20","$3,637.02",$0.00,$878.02,$0.00,$0.00,$892.27,"$5,096.00",$0.00,"$2,548.00","$4,036.03","$4,076.80",$0.00,$797.52,$0.00,$811.28,$0.00
71-5004R,SUP,HCPCS C1776,,71-5004R  -  CMPNT FEM 4 RIGHT KNEE PS MCSTRCT NON LFIT SCRP,"$5,096.00",$0.00,"$5,096.00","$2,293.20","$3,637.02",$0.00,$878.02,$0.00,$0.00,$892.27,"$5,096.00",$0.00,"$2,548.00","$4,036.03","$4,076.80",$0.00,$797.52,$0.00,$811.28,$0.00
71-5005L,SUP,HCPCS C1776,,71-5005L  -  CMPNT FEM 5 LEFT KNEE PS MCSTRCT NON LFIT SCRP,"$5,096.00",$0.00,"$5,096.00","$2,293.20","$3,637.02",$0.00,$878.02,$0.00,$0.00,$892.27,"$5,096.00",$0.00,"$2,548.00","$4,036.03","$4,076.80",$0.00,$797.52,$0.00,$811.28,$0.00
71-5005R,SUP,HCPCS C1776,,71-5005R  -  CMPNT FEM 5 RIGHT KNEE PS MCSTRCT NON LFIT SCRP,"$5,096.00",$0.00,"$5,096.00","$2,293.20","$3,637.02",$0.00,$878.02,$0.00,$0.00,$892.27,"$5,096.00",$0.00,"$2,548.00","$4,036.03","$4,076.80",$0.00,$797.52,$0.00,$811.28,$0.00
71-5006L,SUP,HCPCS C1776,,71-5006L  -  CMPNT FEM 6 LEFT KNEE PS MCSTRCT NON LFIT SCRP,"$5,096.00",$0.00,"$5,096.00","$2,293.20","$3,637.02",$0.00,$878.02,$0.00,$0.00,$892.27,"$5,096.00",$0.00,"$2,548.00","$4,036.03","$4,076.80",$0.00,$797.52,$0.00,$811.28,$0.00
71-5006R,SUP,HCPCS C1776,,71-5006R  -  CMPNT FEM 6 RIGHT KNEE PS MCSTRCT NON LFIT SCRP,"$5,096.00",$0.00,"$5,096.00","$2,293.20","$3,637.02",$0.00,$878.02,$0.00,$0.00,$892.27,"$5,096.00",$0.00,"$2,548.00","$4,036.03","$4,076.80",$0.00,$797.52,$0.00,$811.28,$0.00
71-5007L,SUP,HCPCS C1776,,71-5007L  -  CMPNT FEM 7 LEFT KNEE PS MCSTRCT NON LFIT SCRP,"$5,096.00",$0.00,"$5,096.00","$2,293.20","$3,637.02",$0.00,$878.02,$0.00,$0.00,$892.27,"$5,096.00",$0.00,"$2,548.00","$4,036.03","$4,076.80",$0.00,$797.52,$0.00,$811.28,$0.00
71-5007R,SUP,HCPCS C1776,,71-5007R  -  CMPNT FEM 7 RIGHT KNEE PS MCSTRCT NON LFIT SCRP,"$5,096.00",$0.00,"$5,096.00","$2,293.20","$3,637.02",$0.00,$878.02,$0.00,$0.00,$892.27,"$5,096.00",$0.00,"$2,548.00","$4,036.03","$4,076.80",$0.00,$797.52,$0.00,$811.28,$0.00
71-5009L,SUP,HCPCS C1776,,71-5009L  -  CMPNT FEM 9 LEFT KNEE PS MCSTRCT NON LFIT SCRP,"$5,096.00",$0.00,"$5,096.00","$2,293.20","$3,637.02",$0.00,$878.02,$0.00,$0.00,$892.27,"$5,096.00",$0.00,"$2,548.00","$4,036.03","$4,076.80",$0.00,$797.52,$0.00,$811.28,$0.00
71-5009R,SUP,HCPCS C1776,,71-5009R  -  CMPNT FEM 9 RIGHT KNEE PS MCSTRCT NON LFIT SCRP,"$5,096.00",$0.00,"$5,096.00","$2,293.20","$3,637.02",$0.00,$878.02,$0.00,$0.00,$892.27,"$5,096.00",$0.00,"$2,548.00","$4,036.03","$4,076.80",$0.00,$797.52,$0.00,$811.28,$0.00
71-5011L,SUP,HCPCS C1776,,71-5011L  -  CMPNT FEM 11 LEFT KNEE PS MCSTRCT NON LFIT SCRP,"$5,096.00",$0.00,"$5,096.00","$2,293.20","$3,637.02",$0.00,$878.02,$0.00,$0.00,$892.27,"$5,096.00",$0.00,"$2,548.00","$4,036.03","$4,076.80",$0.00,$797.52,$0.00,$811.28,$0.00
71-5011R,SUP,HCPCS C1776,,71-5011R  -  CMPNT FEM 11 RIGHT KNEE PS MCSTRCT NON LFIT SCRP,"$5,096.00",$0.00,"$5,096.00","$2,293.20","$3,637.02",$0.00,$878.02,$0.00,$0.00,$892.27,"$5,096.00",$0.00,"$2,548.00","$4,036.03","$4,076.80",$0.00,$797.52,$0.00,$811.28,$0.00
71-5013L,SUP,HCPCS C1776,,71-5013L  -  CMPNT FEM 13 LEFT KNEE PS MCSTRCT NON LFIT SCRP,"$5,199.00",$0.00,"$5,199.00","$2,339.55","$3,710.53",$0.00,$895.76,$0.00,$0.00,$910.30,"$5,199.00",$0.00,"$2,599.50","$4,117.61","$4,159.20",$0.00,$813.64,$0.00,$827.68,$0.00
71-5013R,SUP,HCPCS C1776,,71-5013R  -  CMPNT FEM 13 RIGHT KNEE PS MCSTRCT NON LFIT SCRP,"$5,199.00",$0.00,"$5,199.00","$2,339.55","$3,710.53",$0.00,$895.76,$0.00,$0.00,$910.30,"$5,199.00",$0.00,"$2,599.50","$4,117.61","$4,159.20",$0.00,$813.64,$0.00,$827.68,$0.00
71-5103L,SUP,HCPCS C1776,,71-5103L  -  CMPNT FEM 3 LEFT KNEE PS MCSTRCT SCRP LFIT,"$4,839.00",$0.00,"$4,839.00","$2,177.55","$3,453.59",$0.00,$833.74,$0.00,$0.00,$847.27,"$4,839.00",$0.00,"$2,419.50","$3,832.49","$3,871.20",$0.00,$757.30,$0.00,$770.37,$0.00
71-5103R,SUP,HCPCS C1776,,71-5103R  -  CMPNT FEM 3 RIGHT KNEE PS MCSTRCT SCRP LFIT,"$4,839.00",$0.00,"$4,839.00","$2,177.55","$3,453.59",$0.00,$833.74,$0.00,$0.00,$847.27,"$4,839.00",$0.00,"$2,419.50","$3,832.49","$3,871.20",$0.00,$757.30,$0.00,$770.37,$0.00
71-5104L,SUP,HCPCS C1776,,71-5104L  -  CMPNT FEM LEFT KNEE PS MCSTRCT SCRP LFIT,"$4,780.00",$0.00,"$4,780.00","$2,151.00","$3,411.49",$0.00,$823.57,$0.00,$0.00,$836.94,"$4,780.00",$0.00,"$2,390.00","$3,785.76","$3,824.00",$0.00,$748.07,$0.00,$760.98,$0.00
71-5104R,SUP,HCPCS C1776,,71-5104R  -  CMPNT FEM 4 RIGHT KNEE PS MCSTRCT SCRP LFIT,"$4,780.00",$0.00,"$4,780.00","$2,151.00","$3,411.49",$0.00,$823.57,$0.00,$0.00,$836.94,"$4,780.00",$0.00,"$2,390.00","$3,785.76","$3,824.00",$0.00,$748.07,$0.00,$760.98,$0.00
71-5105L,SUP,HCPCS C1776,,71-5105L  -  CMPNT FEM 5 LEFT KNEE PS MCSTRCT SCRP LFIT,"$4,780.00",$0.00,"$4,780.00","$2,151.00","$3,411.49",$0.00,$823.57,$0.00,$0.00,$836.94,"$4,780.00",$0.00,"$2,390.00","$3,785.76","$3,824.00",$0.00,$748.07,$0.00,$760.98,$0.00
71-5105R,SUP,HCPCS C1776,,71-5105R  -  CMPNT FEM 5 RIGHT KNEE PS MCSTRCT SCRP LFIT,"$4,780.00",$0.00,"$4,780.00","$2,151.00","$3,411.49",$0.00,$823.57,$0.00,$0.00,$836.94,"$4,780.00",$0.00,"$2,390.00","$3,785.76","$3,824.00",$0.00,$748.07,$0.00,$760.98,$0.00
71-5106L,SUP,HCPCS C1776,,71-5106L  -  CMPNT FEM 6 LEFT KNEE PS MCSTRCT SCRP LFIT,"$4,780.00",$0.00,"$4,780.00","$2,151.00","$3,411.49",$0.00,$823.57,$0.00,$0.00,$836.94,"$4,780.00",$0.00,"$2,390.00","$3,785.76","$3,824.00",$0.00,$748.07,$0.00,$760.98,$0.00
71-5106R,SUP,HCPCS C1776,,71-5106R  -  CMPNT FEM 6 RIGHT KNEE PS MCSTRCT SCRP LFIT,"$4,780.00",$0.00,"$4,780.00","$2,151.00","$3,411.49",$0.00,$823.57,$0.00,$0.00,$836.94,"$4,780.00",$0.00,"$2,390.00","$3,785.76","$3,824.00",$0.00,$748.07,$0.00,$760.98,$0.00
71-5107L,SUP,HCPCS C1776,,71-5107L  -  CMPNT FEM 7 LEFT KNEE PS MCSTRCT SCRP LFIT,"$4,780.00",$0.00,"$4,780.00","$2,151.00","$3,411.49",$0.00,$823.57,$0.00,$0.00,$836.94,"$4,780.00",$0.00,"$2,390.00","$3,785.76","$3,824.00",$0.00,$748.07,$0.00,$760.98,$0.00
71-5107R,SUP,HCPCS C1776,,71-5107R  -  CMPNT FEM 7 RIGHT KNEE PS MCSTRCT SCRP LFIT,"$4,780.00",$0.00,"$4,780.00","$2,151.00","$3,411.49",$0.00,$823.57,$0.00,$0.00,$836.94,"$4,780.00",$0.00,"$2,390.00","$3,785.76","$3,824.00",$0.00,$748.07,$0.00,$760.98,$0.00
71-5109L,SUP,HCPCS C1776,,71-5109L  -  CMPNT FEM 9 LEFT KNEE PS MCSTRCT SCRP LFIT,"$4,780.00",$0.00,"$4,780.00","$2,151.00","$3,411.49",$0.00,$823.57,$0.00,$0.00,$836.94,"$4,780.00",$0.00,"$2,390.00","$3,785.76","$3,824.00",$0.00,$748.07,$0.00,$760.98,$0.00
71-5109R,SUP,HCPCS C1776,,71-5109R  -  CMPNT FEM 9 RIGHT KNEE PS MCSTRCT SCRP LFIT,"$4,780.00",$0.00,"$4,780.00","$2,151.00","$3,411.49",$0.00,$823.57,$0.00,$0.00,$836.94,"$4,780.00",$0.00,"$2,390.00","$3,785.76","$3,824.00",$0.00,$748.07,$0.00,$760.98,$0.00
71-5111L,SUP,HCPCS C1776,,71-5111L  -  CMPNT FEM 11 LEFT KNEE PS MCSTRCT SCRP LFIT,"$4,780.00",$0.00,"$4,780.00","$2,151.00","$3,411.49",$0.00,$823.57,$0.00,$0.00,$836.94,"$4,780.00",$0.00,"$2,390.00","$3,785.76","$3,824.00",$0.00,$748.07,$0.00,$760.98,$0.00
71-5111R,SUP,HCPCS C1776,,71-5111R  -  CMPNT FEM 11 RIGHT KNEE PS MCSTRCT SCRP LFIT,"$4,780.00",$0.00,"$4,780.00","$2,151.00","$3,411.49",$0.00,$823.57,$0.00,$0.00,$836.94,"$4,780.00",$0.00,"$2,390.00","$3,785.76","$3,824.00",$0.00,$748.07,$0.00,$760.98,$0.00
71-5113L,SUP,HCPCS C1776,,71-5113L  -  CMPNT FEM 13 LEFT KNEE PS MCSTRCT SCRP LFIT,"$4,839.00",$0.00,"$4,839.00","$2,177.55","$3,453.59",$0.00,$833.74,$0.00,$0.00,$847.27,"$4,839.00",$0.00,"$2,419.50","$3,832.49","$3,871.20",$0.00,$757.30,$0.00,$770.37,$0.00
71-5113R,SUP,HCPCS C1776,,71-5113R  -  CMPNT FEM 13 RIGHT KNEE PS MCSTRCT SCRP LFIT,"$4,839.00",$0.00,"$4,839.00","$2,177.55","$3,453.59",$0.00,$833.74,$0.00,$0.00,$847.27,"$4,839.00",$0.00,"$2,419.50","$3,832.49","$3,871.20",$0.00,$757.30,$0.00,$770.37,$0.00
71511V,SUP,Custom 27203010,,71511V  -  CLIP INTNL REMOVER MED LARGE - LARGE  STRAIGHT 11INŸŸ,$412.48,$0.00,$412.48,$0.00,$294.38,$0.00,$0.00,$0.00,$0.00,$0.00,$412.48,$0.00,$206.24,$326.68,$329.98,$0.00,$0.00,$0.00,$0.00,$0.00
71512V,SUP,Custom 27203010,,71512V  -  APPLIER MED LARGE  CURVED 11INŸŸ,$378.73,$0.00,$378.73,$0.00,$270.30,$0.00,$0.00,$0.00,$0.00,$0.00,$378.73,$0.00,$189.36,$299.95,$302.98,$0.00,$0.00,$0.00,$0.00,$0.00
71517V,SUP,Custom 27203010,,71517V  -  APPLIER MED LARGE  70 DEGREE 11INŸŸ,$378.73,$0.00,$378.73,$0.00,$270.30,$0.00,$0.00,$0.00,$0.00,$0.00,$378.73,$0.00,$189.36,$299.95,$302.98,$0.00,$0.00,$0.00,$0.00,$0.00
71-5203L,SUP,HCPCS C1776,,71-5203L  -  COMPONENT FEMORAL 3 POSTERIOR STABILIZE MICROSTRUCTURE PRIM,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
71-5203R,SUP,HCPCS C1776,,71-5203R  -  COMPONENT FEMORAL 3 POSTERIOR STABILIZE MICROSTRUCTURE PRIM,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
71-5205L,SUP,HCPCS C1776,,71-5205L  -  COMPONENT FEMORAL 5 POSTERIOR STABILIZE MICROSTRUCTURE PRIM,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
71-5205R,SUP,HCPCS C1776,,71-5205R  -  COMPONENT FEMORAL 5 POSTERIOR STABILIZE MICROSTRUCTURE PRIM,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
71-5207L,SUP,HCPCS C1776,,71-5207L  -  COMPONENT FEMORAL 7 POSTERIOR STABILIZE MICROSTRUCTURE PRIM,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
71-5207R,SUP,HCPCS C1776,,71-5207R  -  COMPONENT FEMORAL 7 POSTERIOR STABILIZE MICROSTRUCTURE PRIM,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
71-5209L,SUP,HCPCS C1776,,71-5209L  -  COMPONENT FEMORAL 9 POSTERIOR STABILIZE MICROSTRUCTURE PRIM,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
71-5209R,SUP,HCPCS C1776,,71-5209R  -  COMPONENT FEMORAL 9 POSTERIOR STABILIZE MICROSTRUCTURE PRIM,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
71-5211L,SUP,HCPCS C1776,,71-5211L  -  COMPONENT FEMORAL 11 POSTERIOR STABILIZE MICROSTRUCTURE PRIM,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
71-5211R,SUP,HCPCS C1776,,71-5211R  -  COMPONENT FEMORAL 11 POSTERIOR STABILIZE MICROSTRUCTURE PRIM,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
71-5213L,SUP,HCPCS C1776,,71-5213L  -  COMPONENT FEMORAL 13 POSTERIOR STABILIZE MICROSTRUCTURE PRIM,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
71-5213R,SUP,HCPCS C1776,,71-5213R  -  COMPONENT FEMORAL 13 POSTERIOR STABILIZE MICROSTRUCTURE PRIM,"$4,505.00",$0.00,"$4,505.00","$2,027.25","$3,215.22",$0.00,$776.19,$0.00,$0.00,$788.79,"$4,505.00",$0.00,"$2,252.50","$3,567.96","$3,604.00",$0.00,$705.03,$0.00,$717.20,$0.00
71582V,SUP,Custom 27203010,,71582V  -  APPLIER MED LARGE  CURVED 8INŸŸ,$378.73,$0.00,$378.73,$0.00,$270.30,$0.00,$0.00,$0.00,$0.00,$0.00,$378.73,$0.00,$189.36,$299.95,$302.98,$0.00,$0.00,$0.00,$0.00,$0.00
71587V,SUP,Custom 27203010,,71587V  -  APPLIER MED LARGE  70 DEGREE 8INŸŸ,$378.73,$0.00,$378.73,$0.00,$270.30,$0.00,$0.00,$0.00,$0.00,$0.00,$378.73,$0.00,$189.36,$299.95,$302.98,$0.00,$0.00,$0.00,$0.00,$0.00
7160-20,SUP,Custom 27203010,,7160-20  -  KIT PEG 20FR 4X4IN SPONGE FEED TUBE EXTERNAL RETENTION RING,$228.53,$0.00,$228.53,$0.00,$163.10,$0.00,$0.00,$0.00,$0.00,$0.00,$228.53,$0.00,$114.26,$181.00,$182.82,$0.00,$0.00,$0.00,$0.00,$0.00
71612V,SUP,Custom 27203010,,71612V  -  APPLIER LARGE  CURVED 11INŸŸ,$378.73,$0.00,$378.73,$0.00,$270.30,$0.00,$0.00,$0.00,$0.00,$0.00,$378.73,$0.00,$189.36,$299.95,$302.98,$0.00,$0.00,$0.00,$0.00,$0.00
71617V,SUP,Custom 27203010,,71617V  -  APPLIER LARGE  70 DEGREE 11INŸŸ,$378.73,$0.00,$378.73,$0.00,$270.30,$0.00,$0.00,$0.00,$0.00,$0.00,$378.73,$0.00,$189.36,$299.95,$302.98,$0.00,$0.00,$0.00,$0.00,$0.00
71682510L,SUP,HCPCS C1713,,71682510L  -  NAIL IM 125D STD 10MM 19.5CM IMHS CP SS LT HIP,"$3,329.38",$0.00,"$3,329.38","$1,498.22","$2,376.17",$0.00,$573.63,$0.00,$0.00,$582.95,"$3,329.38",$0.00,"$1,664.69","$2,636.87","$2,663.50",$0.00,$521.05,$0.00,$530.04,$0.00
71682510R,SUP,HCPCS C1713,,71682510R  -  NAIL IM 125D STD 10MM 19.5CM IMHS CP SS HIP RT,"$3,329.38",$0.00,"$3,329.38","$1,498.22","$2,376.17",$0.00,$573.63,$0.00,$0.00,$582.95,"$3,329.38",$0.00,"$1,664.69","$2,636.87","$2,663.50",$0.00,$521.05,$0.00,$530.04,$0.00
71682512L,SUP,HCPCS C1713,,71682512L  -  NAIL IM 125D STD 12MM 19.5CM IMHS CP SS HIP LT,"$3,329.38",$0.00,"$3,329.38","$1,498.22","$2,376.17",$0.00,$573.63,$0.00,$0.00,$582.95,"$3,329.38",$0.00,"$1,664.69","$2,636.87","$2,663.50",$0.00,$521.05,$0.00,$530.04,$0.00
71682512R,SUP,HCPCS C1713,,71682512R  -  NAIL IM 125D STD 12MM 19.5CM IMHS CP SS RT HIP,"$3,342.50",$0.00,"$3,342.50","$1,504.13","$2,385.54",$0.00,$575.90,$0.00,$0.00,$585.25,"$3,342.50",$0.00,"$1,671.25","$2,647.26","$2,674.00",$0.00,$523.10,$0.00,$532.13,$0.00
71682514L,SUP,HCPCS C1713,,71682514L  -  NAIL IM 125D STD 14MM 19.5CM IMHS CP SS LT HIP,"$3,342.50",$0.00,"$3,342.50","$1,504.13","$2,385.54",$0.00,$575.90,$0.00,$0.00,$585.25,"$3,342.50",$0.00,"$1,671.25","$2,647.26","$2,674.00",$0.00,$523.10,$0.00,$532.13,$0.00
71682514R,SUP,HCPCS C1713,,71682514R  -  NAIL IM 125D STD 14MM 19.5CM IMHS CP SS RT HIP,"$3,342.50",$0.00,"$3,342.50","$1,504.13","$2,385.54",$0.00,$575.90,$0.00,$0.00,$585.25,"$3,342.50",$0.00,"$1,671.25","$2,647.26","$2,674.00",$0.00,$523.10,$0.00,$532.13,$0.00
71682516L,SUP,HCPCS C1713,,71682516L  -  NAIL IM 125D STD 16MM 19.5CM IMHS CP SS LT HIP,"$3,342.50",$0.00,"$3,342.50","$1,504.13","$2,385.54",$0.00,$575.90,$0.00,$0.00,$585.25,"$3,342.50",$0.00,"$1,671.25","$2,647.26","$2,674.00",$0.00,$523.10,$0.00,$532.13,$0.00
71682516R,SUP,HCPCS C1713,,71682516R  -  NAIL IM 125D STD 16MM 19.5CM IMHS CP SS RT HIP,"$3,342.50",$0.00,"$3,342.50","$1,504.13","$2,385.54",$0.00,$575.90,$0.00,$0.00,$585.25,"$3,342.50",$0.00,"$1,671.25","$2,647.26","$2,674.00",$0.00,$523.10,$0.00,$532.13,$0.00
71682532L,SUP,HCPCS C1713,,71682532L  -  NAIL IM 125D LNG 10MM 32CM IMHS CP SS LT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71682532R,SUP,HCPCS C1713,,71682532R  -  NAIL IM 125D LNG 10MM 32CM IMHS CP SS RT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71682534L,SUP,HCPCS C1713,,71682534L  -  NAIL IM 125D LNG 10MM 34CM IMHS CP SS FEM LT,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71682534R,SUP,HCPCS C1713,,71682534R  -  NAIL IM 125D LNG 10MM 34CM IMHS CP SS RT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71682536L,SUP,HCPCS C1713,,71682536L  -  NAIL IM 125D LNG 10MM 36CM IMHS CP SS LT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71682536R,SUP,HCPCS C1713,,71682536R  -  NAIL IM 125D LNG 10MM 36CM IMHS CP SS RT,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71682538L,SUP,HCPCS C1713,,71682538L  -  NAIL IM 125D LNG 10MM 38CM IMHS CP SS LT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71682538R,SUP,HCPCS C1713,,71682538R  -  NAIL IM 125D LNG 10MM 38CM IMHS CP SS RT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71682540L,SUP,HCPCS C1713,,71682540L  -  NAIL IM 125D LNG 10MM 40CM IMHS CP SS LT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71682540R,SUP,HCPCS C1713,,71682540R  -  NAIL IM 125D LNG 10MM 40CM IMHS CP SS RT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71682542L,SUP,HCPCS C1713,,71682542L  -  NAIL IM 125D LNG 10MM 42CM IMHS CP SS LT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71682542R,SUP,HCPCS C1713,,71682542R  -  NAIL IM 125D LNG 10MM 42CM IMHS CP SS RT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71682544L,SUP,HCPCS C1713,,71682544L  -  NAIL IM 125D LNG 10MM 44CM IMHS CP SS LT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71682544R,SUP,HCPCS C1713,,71682544R  -  NAIL IM 125D LNG 10MM 44CM IMHS CP SS RT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71682632L,SUP,HCPCS C1713,,71682632L  -  NAIL IM 125D LNG 12MM 32CM IMHS CP SS LT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71682632R,SUP,HCPCS C1713,,71682632R  -  NAIL IM 125D LNG 12MM 32CM IMHS CP SS RT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71682634L,SUP,HCPCS C1713,,71682634L  -  NAIL IM 125D 12MM 34CM IMHS SS LT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71682634R,SUP,HCPCS C1713,,71682634R  -  NAIL IM 125D LNG 12MM 34CM IMHS CP SS RT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71682636L,SUP,HCPCS C1713,,71682636L  -  NAIL IM 125D LNG 12MM 36CM IMHS CP SS LT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71682636R,SUP,HCPCS C1713,,71682636R  -  NAIL IM 125D LNG 12MM 36CM IMHS CP SS RT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71682638L,SUP,HCPCS C1713,,71682638L  -  NAIL IM 125D LNG 12MM 38CM IMHS CP SS LT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71682638R,SUP,HCPCS C1713,,71682638R  -  NAIL IM 125D LNG 12MM 38CM IMHS CP SS RT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71682640L,SUP,HCPCS C1713,,71682640L  -  NAIL IM 125D LNG 12MM 40CM IMHS CP SS LT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71682640R,SUP,HCPCS C1713,,71682640R  -  NAIL IM 125D LNG 12MM 40CM IMHS CP SS RT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71682642L,SUP,HCPCS C1713,,71682642L  -  NAIL IM 125D LNG 12MM 42CM IMHS CP SS LT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71682642R,SUP,HCPCS C1713,,71682642R  -  NAIL IM 125D LNG 12MM 42CM IMHS CP SS RT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71682644L,SUP,HCPCS C1713,,71682644L  -  NAIL IM 125D LNG 12MM 44CM IMHS CP SS LT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71682644R,SUP,HCPCS C1713,,71682644R  -  NAIL IM 125D LNG 12MM 44CM IMHS CP SS RT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71682734R,SUP,HCPCS C1713,,71682734R  -  NAIL IM 125D 14MM 34CM IMHS CP SS RT HIP,"$6,269.38",$0.00,"$6,269.38","$2,821.22","$4,474.45",$0.00,"$1,080.18",$0.00,$0.00,"$1,097.72","$6,269.38",$0.00,"$3,134.69","$4,965.35","$5,015.50",$0.00,$981.16,$0.00,$998.08,$0.00
71682736L,SUP,HCPCS C1713,,71682736L  -  NAIL IM 125D 14MM 36CM IMHS CP SS LT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71682744L,SUP,HCPCS C1713,,71682744L  -  NAIL IM 125D 14MM 44CM IMHS CP SS LT HIP,"$6,269.38",$0.00,"$6,269.38","$2,821.22","$4,474.45",$0.00,"$1,080.18",$0.00,$0.00,"$1,097.72","$6,269.38",$0.00,"$3,134.69","$4,965.35","$5,015.50",$0.00,$981.16,$0.00,$998.08,$0.00
71682744R,SUP,HCPCS C1713,,71682744R  -  NAIL IM 125D 14MM 44CM IMHS CP SS RT HIP,"$6,269.38",$0.00,"$6,269.38","$2,821.22","$4,474.45",$0.00,"$1,080.18",$0.00,$0.00,"$1,097.72","$6,269.38",$0.00,"$3,134.69","$4,965.35","$5,015.50",$0.00,$981.16,$0.00,$998.08,$0.00
71682V,SUP,Custom 27203010,,71682V  -  APPLIER LARGE  CURVED 8INŸŸ,$378.73,$0.00,$378.73,$0.00,$270.30,$0.00,$0.00,$0.00,$0.00,$0.00,$378.73,$0.00,$189.36,$299.95,$302.98,$0.00,$0.00,$0.00,$0.00,$0.00
71683010L,SUP,HCPCS C1713,,71683010L  -  NAIL IM 130D 10MM 19.5CM IMHS CP SS HIP LT,"$3,329.38",$0.00,"$3,329.38","$1,498.22","$2,376.17",$0.00,$573.63,$0.00,$0.00,$582.95,"$3,329.38",$0.00,"$1,664.69","$2,636.87","$2,663.50",$0.00,$521.05,$0.00,$530.04,$0.00
71683012L,SUP,HCPCS C1713,,71683012L  -  NAIL IM 130D 12MM 19.5CM IMHS SS LT HIP,"$3,329.38",$0.00,"$3,329.38","$1,498.22","$2,376.17",$0.00,$573.63,$0.00,$0.00,$582.95,"$3,329.38",$0.00,"$1,664.69","$2,636.87","$2,663.50",$0.00,$521.05,$0.00,$530.04,$0.00
71683012R,SUP,HCPCS C1713,,71683012R  -  NAIL IM 130D STD 12MM 19.5CM IMHS SS RT HIP,"$3,342.50",$0.00,"$3,342.50","$1,504.13","$2,385.54",$0.00,$575.90,$0.00,$0.00,$585.25,"$3,342.50",$0.00,"$1,671.25","$2,647.26","$2,674.00",$0.00,$523.10,$0.00,$532.13,$0.00
71683014L,SUP,HCPCS C1713,,71683014L  -  NAIL IM 130D 14MM 19.5CM IMHS SS LT HIP,"$3,329.38",$0.00,"$3,329.38","$1,498.22","$2,376.17",$0.00,$573.63,$0.00,$0.00,$582.95,"$3,329.38",$0.00,"$1,664.69","$2,636.87","$2,663.50",$0.00,$521.05,$0.00,$530.04,$0.00
71683014R,SUP,HCPCS C1713,,71683014R  -  NAIL IM 130D STD 14MM 19.5CM IMHS CP SS RT HIP,"$3,342.50",$0.00,"$3,342.50","$1,504.13","$2,385.54",$0.00,$575.90,$0.00,$0.00,$585.25,"$3,342.50",$0.00,"$1,671.25","$2,647.26","$2,674.00",$0.00,$523.10,$0.00,$532.13,$0.00
71683016L,SUP,HCPCS C1713,,71683016L  -  NAIL IM 130D STD 16MM 19.5CM IMHS CP SS HIP LT,"$3,342.50",$0.00,"$3,342.50","$1,504.13","$2,385.54",$0.00,$575.90,$0.00,$0.00,$585.25,"$3,342.50",$0.00,"$1,671.25","$2,647.26","$2,674.00",$0.00,$523.10,$0.00,$532.13,$0.00
71683016R,SUP,HCPCS C1713,,71683016R  -  NAIL IM 130D STD 16MM 19.5CM IMHS CP SS RT HIP,"$3,342.50",$0.00,"$3,342.50","$1,504.13","$2,385.54",$0.00,$575.90,$0.00,$0.00,$585.25,"$3,342.50",$0.00,"$1,671.25","$2,647.26","$2,674.00",$0.00,$523.10,$0.00,$532.13,$0.00
71683032L,SUP,HCPCS C1713,,71683032L  -  NAIL IM 130D LNG 10MM 32CM IMHS CP SS LT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71683032R,SUP,HCPCS C1713,,71683032R  -  NAIL IM 130D LNG 10MM 32CM IMHS CP SS RT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71683034L,SUP,HCPCS C1713,,71683034L  -  NAIL IM 130D LNG 10MM 34CM IMHS CP SS LT,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71683034R,SUP,HCPCS C1713,,71683034R  -  NAIL IM 130D LNG 10MM 34CM IMHS CP SS RT,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71683036L,SUP,HCPCS C1713,,71683036L  -  NAIL IM 130D LNG 10MM 36CM IMHS CP SS LT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71683036R,SUP,HCPCS C1713,,71683036R  -  NAIL IM 130D LNG 10MM 36CM IMHS CP SS RT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71683038L,SUP,HCPCS C1713,,71683038L  -  NAIL IM 130D LNG 10MM 38CM IMHS CP SS LT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71683038R,SUP,HCPCS C1713,,71683038R  -  NAIL IM 130D LNG 10MM 38CM IMHS CP SS RT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71683040L,SUP,HCPCS C1713,,71683040L  -  NAIL IM 130D LNG 10MM 40CM IMHS CP SS LT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71683040R,SUP,HCPCS C1713,,71683040R  -  NAIL IM 130D 10MM 40CM IMHS SS RT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71683042L,SUP,HCPCS C1713,,71683042L  -  NAIL IM 130D LNG 10MM 42CM IMHS CP SS HIP LT,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71683042R,SUP,HCPCS C1713,,71683042R  -  NAIL IM 130D LNG 10MM 42CM IMHS CP SS RT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71683044L,SUP,HCPCS C1713,,71683044L  -  NAIL IM 130D LNG 10MM 44CM IMHS CP SS LT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71683044R,SUP,HCPCS C1713,,71683044R  -  NAIL IM 130D LNG 10MM 44CM IMHS CP SS RT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71683132L,SUP,HCPCS C1713,,71683132L  -  NAIL IM 130D LNG 12MM 32CM IMHS CP SS LT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71683132R,SUP,HCPCS C1713,,71683132R  -  NAIL IM 130D LNG 12MM 32CM IMHS CP SS RT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71683134L,SUP,HCPCS C1713,,71683134L  -  NAIL IM 130D LNG 12MM 34CM IMHS CP SS LT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71683134R,SUP,HCPCS C1713,,71683134R  -  NAIL IM 130D 12MM 34CM IMHS CP SS RT,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71683136L,SUP,HCPCS C1713,,71683136L  -  NAIL IM 130D 12MM 36CM IMHS SS LT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71683136R,SUP,HCPCS C1713,,71683136R  -  NAIL IM 130D LNG 12MM 36CM IMHS CP SS RT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71683138L,SUP,HCPCS C1713,,71683138L  -  NAIL IM 130D LNG 12MM 38CM IMHS CP SS LT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71683138R,SUP,HCPCS C1713,,71683138R  -  NAIL IM 130D LNG 12MM 38CM IMHS CP SS RT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71683140L,SUP,HCPCS C1713,,71683140L  -  NAIL IM 130D LNG 12MM 40CM IMHS CP SS LT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71683140R,SUP,HCPCS C1713,,71683140R  -  NAIL IM 130D LNG 12MM 40CM IMHS CP SS RT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71683142L,SUP,HCPCS C1713,,71683142L  -  NAIL IM 130D LNG 12MM 42CM IMHS CP SS HIP LT,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71683142R,SUP,HCPCS C1713,,71683142R  -  NAIL IM 130D LNG 12MM 42CM IMHS CP SS RT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71683144L,SUP,HCPCS C1713,,71683144L  -  NAIL IM 130D LNG 12MM 44CM IMHS CP SS HIP LT,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71683144R,SUP,HCPCS C1713,,71683144R  -  NAIL IM 130D LNG 12MM 44CM IMHS CP SS RT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71683510L,SUP,HCPCS C1713,,71683510L  -  NAIL IM 135D STD 10MM 19.5CM IMHS CP SS LT HIP,"$3,329.38",$0.00,"$3,329.38","$1,498.22","$2,376.17",$0.00,$573.63,$0.00,$0.00,$582.95,"$3,329.38",$0.00,"$1,664.69","$2,636.87","$2,663.50",$0.00,$521.05,$0.00,$530.04,$0.00
71683510R,SUP,HCPCS C1713,,71683510R  -  NAIL IM 135D STD 10MM 19.5CM IMHS CP SS RT HIP,"$3,329.38",$0.00,"$3,329.38","$1,498.22","$2,376.17",$0.00,$573.63,$0.00,$0.00,$582.95,"$3,329.38",$0.00,"$1,664.69","$2,636.87","$2,663.50",$0.00,$521.05,$0.00,$530.04,$0.00
71683512L,SUP,HCPCS C1713,,71683512L  -  NAIL IM 135D STD 12MM 19.5CM IMHS CP SS LT HIP,"$3,329.38",$0.00,"$3,329.38","$1,498.22","$2,376.17",$0.00,$573.63,$0.00,$0.00,$582.95,"$3,329.38",$0.00,"$1,664.69","$2,636.87","$2,663.50",$0.00,$521.05,$0.00,$530.04,$0.00
71683512R,SUP,HCPCS C1713,,71683512R  -  NAIL IM 135D STD 12MM 19.5CM IMHS CP SS RT HIP,"$3,342.50",$0.00,"$3,342.50","$1,504.13","$2,385.54",$0.00,$575.90,$0.00,$0.00,$585.25,"$3,342.50",$0.00,"$1,671.25","$2,647.26","$2,674.00",$0.00,$523.10,$0.00,$532.13,$0.00
71683514L,SUP,HCPCS C1713,,71683514L  -  NAIL IM 135D STD 14MM 19.5CM IMHS CP SS LT HIP,"$3,342.50",$0.00,"$3,342.50","$1,504.13","$2,385.54",$0.00,$575.90,$0.00,$0.00,$585.25,"$3,342.50",$0.00,"$1,671.25","$2,647.26","$2,674.00",$0.00,$523.10,$0.00,$532.13,$0.00
71683514R,SUP,HCPCS C1713,,71683514R  -  NAIL IM 135D STD 14MM 19.5CM IMHS CP SS RT HIP,"$3,342.50",$0.00,"$3,342.50","$1,504.13","$2,385.54",$0.00,$575.90,$0.00,$0.00,$585.25,"$3,342.50",$0.00,"$1,671.25","$2,647.26","$2,674.00",$0.00,$523.10,$0.00,$532.13,$0.00
71683516L,SUP,HCPCS C1713,,71683516L  -  NAIL IM 135D 16MM 19.5CM IMHS CP SS LT HIP,"$3,342.50",$0.00,"$3,342.50","$1,504.13","$2,385.54",$0.00,$575.90,$0.00,$0.00,$585.25,"$3,342.50",$0.00,"$1,671.25","$2,647.26","$2,674.00",$0.00,$523.10,$0.00,$532.13,$0.00
71683516R,SUP,HCPCS C1713,,71683516R  -  NAIL IM 135D 16MM 19.5CM IMHS CP SS RT HIP,"$3,342.50",$0.00,"$3,342.50","$1,504.13","$2,385.54",$0.00,$575.90,$0.00,$0.00,$585.25,"$3,342.50",$0.00,"$1,671.25","$2,647.26","$2,674.00",$0.00,$523.10,$0.00,$532.13,$0.00
71683532L,SUP,HCPCS C1713,,71683532L  -  NAIL IM 135D LNG 10MM 32CM IMHS CP SS LT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71683532R,SUP,HCPCS C1713,,71683532R  -  NAIL IM 135D LNG 10MM 32CM IMHS CP SS RT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71683534L,SUP,HCPCS C1713,,71683534L  -  NAIL IM 135D LNG 10MM 34CM IMHS CP SS LT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71683534R,SUP,HCPCS C1713,,71683534R  -  NAIL IM 135D LNG 10MM 34CM IMHS CP SS RT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71683536L,SUP,HCPCS C1713,,71683536L  -  NAIL IM 135D LNG 10MM 36CM IMHS CP SS LT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71683536R,SUP,HCPCS C1713,,71683536R  -  NAIL IM 135D LNG 10MM 36CM IMHS CP SS RT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71683538L,SUP,HCPCS C1713,,71683538L  -  NAIL IM 135D LNG 10MM 38CM IMHS CP SS LT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71683538R,SUP,HCPCS C1713,,71683538R  -  NAIL IM 135D LNG 10MM 38CM IMHS CP SS RT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71683540L,SUP,HCPCS C1713,,71683540L  -  NAIL IM 135D LNG 10MM 40CM IMHS CP SS LT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71683540R,SUP,HCPCS C1713,,71683540R  -  NAIL IM 135D LNG 10MM 40CM IMHS CP SS RT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71683542L,SUP,HCPCS C1713,,71683542L  -  NAIL IM 135D LNG 10MM 42CM IMHS CP SS LT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71683542R,SUP,HCPCS C1713,,71683542R  -  NAIL IM 135D LNG 10MM 42CM IMHS CP SS RT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71683544L,SUP,HCPCS C1713,,71683544L  -  NAIL IM 135D LNG 10MM 44CM IMHS CP SS LT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71683544R,SUP,HCPCS C1713,,71683544R  -  NAIL IM 135D LNG 10MM 44CM IMHS CP SS RT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71683632L,SUP,HCPCS C1713,,71683632L  -  NAIL IM 135D LNG 12MM 32CM IMHS CP SS LT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71683632R,SUP,HCPCS C1713,,71683632R  -  NAIL IM 135D 12MM 32CM IMHS CP SS RT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71683634L,SUP,HCPCS C1713,,71683634L  -  NAIL IM 135D LNG 12MM 34CM IMHS CP SS LT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71683634R,SUP,HCPCS C1713,,71683634R  -  NAIL IM 135D LNG 12MM 34CM IMHS CP SS RT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71683636L,SUP,HCPCS C1713,,71683636L  -  NAIL IM 135D LNG 12MM 36CM IMHS CP SS LT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71683636R,SUP,HCPCS C1713,,71683636R  -  NAIL IM 135D LNG 12MM 36CM IMHS CP SS RT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71683638L,SUP,HCPCS C1713,,71683638L  -  NAIL IM 135D LNG 12MM 38CM IMHS CP SS LT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71683638R,SUP,HCPCS C1713,,71683638R  -  NAIL IM 135D LNG 12MM 38CM IMHS CP SS RT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71683640L,SUP,HCPCS C1713,,71683640L  -  NAIL IM 135D LNG 12MM 40CM IMHS CP SS LT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71683640R,SUP,HCPCS C1713,,71683640R  -  NAIL IM 135D LNG 12MM 40CM IMHS CP SS RT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71683642L,SUP,HCPCS C1713,,71683642L  -  NAIL IM 135D LNG 12MM 42CM IMHS CP SS LT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71683642R,SUP,HCPCS C1713,,71683642R  -  NAIL IM 135D LNG 12MM 42CM IMHS CP SS RT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71683644L,SUP,HCPCS C1713,,71683644L  -  NAIL IM 135D LNG 12MM 44CM IMHS CP SS LT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71683644R,SUP,HCPCS C1713,,71683644R  -  NAIL IM 135D LNG 12MM 44CM IMHS CP SS RT HIP,"$6,671.88",$0.00,"$6,671.88","$3,002.34","$4,761.72",$0.00,"$1,149.53",$0.00,$0.00,"$1,168.19","$6,671.88",$0.00,"$3,335.94","$5,284.13","$5,337.50",$0.00,"$1,044.15",$0.00,"$1,062.16",$0.00
71687V,SUP,Custom 27203010,,71687V  -  APPLIER LARGE  70 DEGREE 8INŸŸ,$378.73,$0.00,$378.73,$0.00,$270.30,$0.00,$0.00,$0.00,$0.00,$0.00,$378.73,$0.00,$189.36,$299.95,$302.98,$0.00,$0.00,$0.00,$0.00,$0.00
71701016L,SUP,HCPCS C1713,,71701016L  -  NAIL IM 12-10MM 16CM LIME TRGN FSN RND XSECT DC SLOT TI,"$5,613.75",$0.00,"$5,613.75","$2,526.19","$4,006.53",$0.00,$967.22,$0.00,$0.00,$982.92,"$5,613.75",$0.00,"$2,806.88","$4,446.09","$4,491.00",$0.00,$878.55,$0.00,$893.71,$0.00
71701016R,SUP,HCPCS C1713,,71701016R  -  NAIL IM 10MM 16CM TRGN FSN TI RT HINDFOOT,"$5,613.75",$0.00,"$5,613.75","$2,526.19","$4,006.53",$0.00,$967.22,$0.00,$0.00,$982.92,"$5,613.75",$0.00,"$2,806.88","$4,446.09","$4,491.00",$0.00,$878.55,$0.00,$893.71,$0.00
71701020L,SUP,HCPCS C1713,,71701020L  -  NAIL INTRAMEDULLARY 10MM 20CM FUSION TRIGEN LEFT HINDFOOT,"$5,613.75",$0.00,"$5,613.75","$2,526.19","$4,006.53",$0.00,$967.22,$0.00,$0.00,$982.92,"$5,613.75",$0.00,"$2,806.88","$4,446.09","$4,491.00",$0.00,$878.55,$0.00,$893.71,$0.00
71701020R,SUP,HCPCS C1713,,71701020R  -  NAIL IM 12-10MM 20CM ROSE TRGN FSN RND XSECT DC SLOT TI,"$5,613.75",$0.00,"$5,613.75","$2,526.19","$4,006.53",$0.00,$967.22,$0.00,$0.00,$982.92,"$5,613.75",$0.00,"$2,806.88","$4,446.09","$4,491.00",$0.00,$878.55,$0.00,$893.71,$0.00
71701025L,SUP,HCPCS C1713,,71701025L  -  NAIL IM 10MM 25CM TRGN TI LT HINDFOOT,"$5,613.75",$0.00,"$5,613.75","$2,526.19","$4,006.53",$0.00,$967.22,$0.00,$0.00,$982.92,"$5,613.75",$0.00,"$2,806.88","$4,446.09","$4,491.00",$0.00,$878.55,$0.00,$893.71,$0.00
71701025R,SUP,HCPCS C1713,,71701025R  -  NAIL IM 10MM 25CM TRGN FSN TI RT HINDFOOT,"$5,613.75",$0.00,"$5,613.75","$2,526.19","$4,006.53",$0.00,$967.22,$0.00,$0.00,$982.92,"$5,613.75",$0.00,"$2,806.88","$4,446.09","$4,491.00",$0.00,$878.55,$0.00,$893.71,$0.00
71701116R,SUP,HCPCS C1713,,71701116R  -  NAIL INTRAMEDULLARY 11.5MM 16CM FUSION TRIGEN RIGHT HINDFOOT,"$5,613.75",$0.00,"$5,613.75","$2,526.19","$4,006.53",$0.00,$967.22,$0.00,$0.00,$982.92,"$5,613.75",$0.00,"$2,806.88","$4,446.09","$4,491.00",$0.00,$878.55,$0.00,$893.71,$0.00
71701120L,SUP,HCPCS C1713,,71701120L  -  NAIL INTRAMEDULLARY 11.5MM 20CM FUSION TRIGEN TITANIUM LEFT,"$5,613.75",$0.00,"$5,613.75","$2,526.19","$4,006.53",$0.00,$967.22,$0.00,$0.00,$982.92,"$5,613.75",$0.00,"$2,806.88","$4,446.09","$4,491.00",$0.00,$878.55,$0.00,$893.71,$0.00
71701120R,SUP,HCPCS C1713,,71701120R  -  NAIL INTRAMEDULLARY 11.5MM 20CM FUSION TRIGEN TITANIUM RIGHT,"$5,613.75",$0.00,"$5,613.75","$2,526.19","$4,006.53",$0.00,$967.22,$0.00,$0.00,$982.92,"$5,613.75",$0.00,"$2,806.88","$4,446.09","$4,491.00",$0.00,$878.55,$0.00,$893.71,$0.00
71701125L,SUP,HCPCS C1713,,71701125L  -  NAIL IM 11.5MM 25CM TRGN TI HINDFOOT LT,"$5,613.75",$0.00,"$5,613.75","$2,526.19","$4,006.53",$0.00,$967.22,$0.00,$0.00,$982.92,"$5,613.75",$0.00,"$2,806.88","$4,446.09","$4,491.00",$0.00,$878.55,$0.00,$893.71,$0.00
71701125R,SUP,HCPCS C1713,,71701125R  -  TRIGIN HINDFOOT FUSION NAIL (R) 11.5x25CM,"$5,613.75",$0.00,"$5,613.75","$2,526.19","$4,006.53",$0.00,$967.22,$0.00,$0.00,$982.92,"$5,613.75",$0.00,"$2,806.88","$4,446.09","$4,491.00",$0.00,$878.55,$0.00,$893.71,$0.00
7170-20,SUP,Custom 27203010,,7170-20  -  KIT PG 20FR MIC PUSH,$229.50,$0.00,$229.50,$0.00,$163.79,$0.00,$0.00,$0.00,$0.00,$0.00,$229.50,$0.00,$114.75,$181.76,$183.60,$0.00,$0.00,$0.00,$0.00,$0.00
7170-24,SUP,Custom 27203010,,7170-24  -  KIT PG 24FR 12ML STRL LF MC SLK PUSH RADOPQ MED PORT SIL,$229.50,$0.00,$229.50,$0.00,$163.79,$0.00,$0.00,$0.00,$0.00,$0.00,$229.50,$0.00,$114.75,$181.76,$183.60,$0.00,$0.00,$0.00,$0.00,$0.00
7170Q/52,SUP,HCPCS C1895,,7170Q/52  -  DURATA SJ4 - PASSIVE,"$10,500.00",$0.00,"$10,500.00","$4,725.00","$5,158.80",$0.00,"$1,809.10",$0.00,$0.00,"$1,838.47","$10,500.00",$0.00,"$5,250.00","$8,316.00","$8,400.00",$0.00,"$1,643.25",$0.00,"$1,671.60",$0.00
7170Q/58,SUP,HCPCS C1895,,7170Q/58  -  LEAD PACING 7FR 58CM 17CM TRUE BIPOL ACTIVE FIX 2 COIL,"$8,775.00",$0.00,"$8,775.00","$3,948.75","$5,158.80",$0.00,"$1,511.89",$0.00,$0.00,"$1,536.43","$8,775.00",$0.00,"$4,387.50","$6,949.80","$7,020.00",$0.00,"$1,373.29",$0.00,"$1,396.98",$0.00
7170Q/65,SUP,HCPCS C1895,,7170Q/65  -  LEAD DFBR 17CM 65CM DURATA TINE FX 2 COIL DF4 CNCT TRUE BP,"$8,775.00",$0.00,"$8,775.00","$3,948.75","$5,158.80",$0.00,"$1,511.89",$0.00,$0.00,"$1,536.43","$8,775.00",$0.00,"$4,387.50","$6,949.80","$7,020.00",$0.00,"$1,373.29",$0.00,"$1,396.98",$0.00
71711V,SUP,Custom 27203010,,71711V  -  CLIP INTNL REMOVER LARGE - XLARGE  STRAIGHT 11INŸŸ,$412.48,$0.00,$412.48,$0.00,$294.38,$0.00,$0.00,$0.00,$0.00,$0.00,$412.48,$0.00,$206.24,$326.68,$329.98,$0.00,$0.00,$0.00,$0.00,$0.00
71712V,SUP,Custom 27203010,,71712V  -  APPLIER XLARGE  CURVED 11INŸŸ,$378.73,$0.00,$378.73,$0.00,$270.30,$0.00,$0.00,$0.00,$0.00,$0.00,$378.73,$0.00,$189.36,$299.95,$302.98,$0.00,$0.00,$0.00,$0.00,$0.00
71717V,SUP,Custom 27203010,,71717V  -  APPLIER XLARGE  70 DEGREE 11INŸŸ,$378.73,$0.00,$378.73,$0.00,$270.30,$0.00,$0.00,$0.00,$0.00,$0.00,$378.73,$0.00,$189.36,$299.95,$302.98,$0.00,$0.00,$0.00,$0.00,$0.00
7171Q/52,SUP,HCPCS C1895,,7171Q/52  -  DURATA SJ4 - PASSIVE,"$10,500.00",$0.00,"$10,500.00","$4,725.00","$5,158.80",$0.00,"$1,809.10",$0.00,$0.00,"$1,838.47","$10,500.00",$0.00,"$5,250.00","$8,316.00","$8,400.00",$0.00,"$1,643.25",$0.00,"$1,671.60",$0.00
7171Q/58,SUP,HCPCS C1895,,7171Q/58  -  LEAD DFBR 7FR 58CM 21CM DURATA 2 COIL DF4 CNCT TRUE BP ACTFX,"$8,775.00",$0.00,"$8,775.00","$3,948.75","$5,158.80",$0.00,"$1,511.89",$0.00,$0.00,"$1,536.43","$8,775.00",$0.00,"$4,387.50","$6,949.80","$7,020.00",$0.00,"$1,373.29",$0.00,"$1,396.98",$0.00
7171Q/65,SUP,HCPCS C1895,,7171Q/65  -  LEAD DFBR 65CM DURATA 2 COIL TRUE BP TINE FX DF4 CNCT OPTIM,"$8,775.00",$0.00,"$8,775.00","$3,948.75","$5,158.80",$0.00,"$1,511.89",$0.00,$0.00,"$1,536.43","$8,775.00",$0.00,"$4,387.50","$6,949.80","$7,020.00",$0.00,"$1,373.29",$0.00,"$1,396.98",$0.00
7180025A,SUP,HCPCS C1713,,7180025A  -  END CAP SPNL 18MM 20-25MM NS X-COR 2 ATLCK TI,"$13,962.50",$0.00,"$13,962.50","$6,283.13","$5,158.80",$0.00,"$2,405.67",$0.00,$0.00,"$2,444.72","$13,962.50",$0.00,"$6,981.25","$11,058.30","$11,170.00",$0.00,"$2,185.13",$0.00,"$2,222.83",$0.00
7180027A,SUP,HCPCS C1713,,7180027A  -  END CAP SPNL 18MM 21-27MM NS X-COR 2 ATLCK TI,"$13,962.50",$0.00,"$13,962.50","$6,283.13","$5,158.80",$0.00,"$2,405.67",$0.00,$0.00,"$2,444.72","$13,962.50",$0.00,"$6,981.25","$11,058.30","$11,170.00",$0.00,"$2,185.13",$0.00,"$2,222.83",$0.00
7180033A,SUP,HCPCS C1713,,7180033A  -  END CAP SPNL 18MM 24-33MM NS X-COR 2 ATLCK TI,"$13,962.50",$0.00,"$13,962.50","$6,283.13","$5,158.80",$0.00,"$2,405.67",$0.00,$0.00,"$2,444.72","$13,962.50",$0.00,"$6,981.25","$11,058.30","$11,170.00",$0.00,"$2,185.13",$0.00,"$2,222.83",$0.00
7180041A,SUP,HCPCS C1713,,7180041A  -  END CAP SPNL 18MM 28-41MM NS X-COR 2 ATLCK TI,"$13,962.50",$0.00,"$13,962.50","$6,283.13","$5,158.80",$0.00,"$2,405.67",$0.00,$0.00,"$2,444.72","$13,962.50",$0.00,"$6,981.25","$11,058.30","$11,170.00",$0.00,"$2,185.13",$0.00,"$2,222.83",$0.00
7180055A,SUP,HCPCS C1713,,7180055A  -  END CAP SPNL 18MM 35-55MM NS X-COR 2 ATLCK TI,"$13,962.50",$0.00,"$13,962.50","$6,283.13","$5,158.80",$0.00,"$2,405.67",$0.00,$0.00,"$2,444.72","$13,962.50",$0.00,"$6,981.25","$11,058.30","$11,170.00",$0.00,"$2,185.13",$0.00,"$2,222.83",$0.00
7180067A,SUP,HCPCS C1713,,7180067A  -  END CAP SPNL 18MM 41-67MM NS X-COR 2 ATLCK TI,"$13,962.50",$0.00,"$13,962.50","$6,283.13","$5,158.80",$0.00,"$2,405.67",$0.00,$0.00,"$2,444.72","$13,962.50",$0.00,"$6,981.25","$11,058.30","$11,170.00",$0.00,"$2,185.13",$0.00,"$2,222.83",$0.00
7180079A,SUP,HCPCS C1713,,7180079A  -  END CAP SPNL 18MM 47-79MM NS X-COR 2 ATLCK TI,"$13,962.50",$0.00,"$13,962.50","$6,283.13","$5,158.80",$0.00,"$2,405.67",$0.00,$0.00,"$2,444.72","$13,962.50",$0.00,"$6,981.25","$11,058.30","$11,170.00",$0.00,"$2,185.13",$0.00,"$2,222.83",$0.00
7180-20,SUP,Custom 27203010,,7180-20  -  KIT PG 20FR 4X4IN 12ML STRL LF SECUR-LOK MIC SPNG FDTB XTRN,$312.60,$0.00,$312.60,$0.00,$223.10,$0.00,$0.00,$0.00,$0.00,$0.00,$312.60,$0.00,$156.30,$247.58,$250.08,$0.00,$0.00,$0.00,$0.00,$0.00
7180-24,SUP,Custom 27203010,,7180-24  -  KIT PG 24FR 12ML STRL LF MC SLK PUL RADOPQ MED PORT SIL DISP,$312.60,$0.00,$312.60,$0.00,$223.10,$0.00,$0.00,$0.00,$0.00,$0.00,$312.60,$0.00,$156.30,$247.58,$250.08,$0.00,$0.00,$0.00,$0.00,$0.00
71A003,SUP,Custom 27804086,,71A003  -  GRAFT BONE SMALL 40-65MM CORTICAL SEGMENT,"$1,617.50",$0.00,"$1,617.50",$0.00,"$1,154.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,617.50",$0.00,$808.75,"$1,281.06","$1,294.00",$0.00,$0.00,$0.00,$0.00,$0.00
71A004,SUP,Custom 27804086,,71A004  -  GRAFT BONE LARGE 66-99MM CORTICAL SEGMENT,"$1,707.50",$0.00,"$1,707.50",$0.00,"$1,218.64",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,707.50",$0.00,$853.75,"$1,352.34","$1,366.00",$0.00,$0.00,$0.00,$0.00,$0.00
720088-01,SUP,HCPCS C1771,,720088-01  -  SLING UROLOGICAL ADVANCE MALE,"$14,150.00",$0.00,"$14,150.00","$6,367.50","$5,158.80",$0.00,"$2,437.97",$0.00,$0.00,"$2,477.55","$14,150.00",$0.00,"$7,075.00","$11,206.80","$11,320.00",$0.00,"$2,214.48",$0.00,"$2,252.68",$0.00
720185-01,SUP,HCPCS C1813,,720185-01  -  PROSTHESIS PENILE PRECONNECT INFLATABLE RESERVOIR AMS 700 MS,"$4,672.50",$0.00,"$4,672.50","$2,102.63","$3,334.76",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,672.50",$0.00,"$2,336.25","$3,700.62","$3,738.00",$0.00,$0.00,$0.00,$743.86,$0.00
72-12-0308,SUP,Custom 27803010,,72-12-0308  -  INSERT TIBIAL 3 8MM CRUC RET HYPREX SCORPIO KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-12-0310,SUP,Custom 27803010,,72-12-0310  -  INSERT TIBIAL 3 10MM CRUC RET HYPREX SCORPIO KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-12-0312,SUP,Custom 27803010,,72-12-0312  -  INSERT TIBIAL 3 12MM CRUC RET HYPREX SCORPIO KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-12-0315,SUP,Custom 27803010,,72-12-0315  -  INSERT TIBIAL 3 15MM CRUC RET HYPREX SCORPIO KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-12-0318,SUP,Custom 27803010,,72-12-0318  -  INSERT TIBIAL 3 18MM CRUC RET HYPREX SCORPIO KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-12-0321,SUP,Custom 27803010,,72-12-0321  -  INSERT TIBIAL 3 21MM CRUC RET HYPREX SCORPIO KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-12-0324,SUP,Custom 27803010,,72-12-0324  -  INSERT TIBIAL 3 24MM CRUC RET HYPREX SCORPIO KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-12-0508,SUP,Custom 27803010,,72-12-0508  -  INSERT TIBIAL 5 8MM CRUC RET SCORPIO KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-12-0510,SUP,Custom 27803010,,72-12-0510  -  INSERT TIBIAL 5 10MM CRUC RET HYPREX SCORPIO KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-12-0512,SUP,Custom 27803010,,72-12-0512  -  INSERT TIBIAL 5 12MM CRUC RET HYPREX SCORPIO KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-12-0515,SUP,Custom 27803010,,72-12-0515  -  INSERT TIBIAL 5 15MM CRUC RET HYPREX SCORPIO KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-12-0518,SUP,Custom 27803010,,72-12-0518  -  INSERT TIBIAL 5 18MM CRUC RET HYPREX SCORPIO KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-12-0521,SUP,Custom 27803010,,72-12-0521  -  INSERT TIBIAL 5 21MM CRUC RET HYPREX SCORPIO KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-12-0524,SUP,Custom 27803010,,72-12-0524  -  INSERT TIBIAL 5 24MM CRUC RET HYPREX SCORPIO KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-12-0708,SUP,Custom 27803010,,72-12-0708  -  INSERT TIBIAL 7 8MM CRUC RET SCORPIO KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-12-0710,SUP,Custom 27803010,,72-12-0710  -  INSERT TIBIAL 7 10MM CRUC RET SCORPIO KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-12-0712,SUP,Custom 27803010,,72-12-0712  -  INSERT TIBIAL 7 12MM CRUC RET SCORPIO N2/VAC KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-12-0715,SUP,Custom 27803010,,72-12-0715  -  INSERT TIBIAL 7 15MM CRUC RET SCORPIO N2/VAC KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-12-0718,SUP,Custom 27803010,,72-12-0718  -  INSERT TIBIAL 7 18MM CRUC RET HYPREX SCORPIO KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-12-0721,SUP,Custom 27803010,,72-12-0721  -  INSERT TIBIAL 7 21MM CRUC RET HYPREX SCORPIO KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-12-0724,SUP,Custom 27803010,,72-12-0724  -  INSERT TIBIAL 7 24MM CRUC RET HYPREX SCORPIO KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-12-0908,SUP,Custom 27803010,,72-12-0908  -  INSERT TIBIAL 9 8MM CRUC RET SCORPIO KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-12-0910,SUP,Custom 27803010,,72-12-0910  -  INSERT TIBIAL 9 10MM CRUC RET HYPREX SCORPIO KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-12-0912,SUP,Custom 27803010,,72-12-0912  -  INSERT TIBIAL 9 12MM CRUC RET HYPREX SCORPIO KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-12-0915,SUP,Custom 27803010,,72-12-0915  -  INSERT TIBIAL 9 15MM CRUC RET HYPREX SCORPIO KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-12-0918,SUP,Custom 27803010,,72-12-0918  -  INSERT TIBIAL 9 18MM CRUC RET HYPREX SCORPIO KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-12-0921,SUP,Custom 27803010,,72-12-0921  -  INSERT TIBIAL 9 21MM CRUC RET HYPREX SCORPIO KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-12-0924,SUP,Custom 27803010,,72-12-0924  -  INSERT TIBIAL 9 24MM CRUC RET HYPREX SCORPIO KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-12-1108,SUP,Custom 27803010,,72-12-1108  -  INSERT TIBIAL 11 8MM CRUC RET HYPREX SCORPIO KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-12-1110,SUP,Custom 27803010,,72-12-1110  -  INSERT TIBIAL 11 10MM CRUC RET HYPREX SCORPIO KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-12-1112,SUP,Custom 27803010,,72-12-1112  -  INSERT TIBIAL 11 12MM CRUC RET HYPREX SCORPIO KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-12-1115,SUP,Custom 27803010,,72-12-1115  -  INSERT TIBIAL 11 15MM CRUC RET HYPREX SCORPIO KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-12-1118,SUP,Custom 27803010,,72-12-1118  -  INSERT TIBIAL 11 18MM CRUC RET SCORPIO POLYETHYLENE KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-12-1121,SUP,Custom 27803010,,72-12-1121  -  INSERT TIBIAL 11 21MM CRUC RET HYPREX SCORPIO KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-12-1124,SUP,Custom 27803010,,72-12-1124  -  INSERT TIBIAL 11 24MM CRUC RET HYPREX SCORPIO KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-13-0308,SUP,Custom 27803010,,72-13-0308  -  INSERT TIBIAL 3 8MM POSTERIOR STABILIZED HYPREX SCORPIO KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-13-0310,SUP,Custom 27803010,,72-13-0310  -  INSERT TIBIAL 3 10MM POSTERIOR STABILIZED HYPREX SCORPIO,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-13-0312,SUP,Custom 27803010,,72-13-0312  -  INSERT TIBIAL 3 12MM POSTERIOR STABILIZED HYPREX SCORPIO,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-13-0315,SUP,Custom 27803010,,72-13-0315  -  INSERT TIBIAL 3 15MM POSTERIOR STABILIZED HYPREX SCORPIO,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-13-0318,SUP,Custom 27803010,,72-13-0318  -  INSERT TIBIAL POSTERIOR STABILIZED HYPREX SCORPIO,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-13-0321,SUP,Custom 27803010,,72-13-0321  -  INSERT TIBIAL POSTERIOR STABILIZED HYPREX SCORPIO,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-13-0324,SUP,Custom 27803010,,72-13-0324  -  INSERT TIBIAL 3 24MM POSTERIOR STABILIZED HYPREX SCORPIO,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-13-0508,SUP,Custom 27803010,,72-13-0508  -  INSERT TIBIAL 5 8MM POSTERIOR STABILIZED HYPREX SCORPIO KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-13-0510,SUP,Custom 27803010,,72-13-0510  -  INSERT TIBIAL 5 10MM POSTERIOR STABILIZED HYPREX SCORPIO,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-13-0512,SUP,Custom 27803010,,72-13-0512  -  INSERT TIBIAL 5 12MM POSTERIOR STABILIZED HYPREX SCORPIO,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-13-0515,SUP,Custom 27803010,,72-13-0515  -  INSERT TIBIAL 5 15MM POSTERIOR STABILIZED HYPREX SCORPIO,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-13-0518,SUP,Custom 27803010,,72-13-0518  -  INSERT TIBIAL 5 18MM POSTERIOR STABILIZED HYPREX SCORPIO,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-13-0521,SUP,Custom 27803010,,72-13-0521  -  INSERT TIBIAL POSTERIOR STABILIZED HYPREX SCORPIO,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-13-0524,SUP,Custom 27803010,,72-13-0524  -  INSERT TIBIAL POSTERIOR STABILIZED HYPREX SCORPIO,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-13-0708,SUP,Custom 27803010,,72-13-0708  -  INSERT TIBIAL 7 8MM POSTERIOR STABILIZED HYPREX SCORPIO,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-13-0710,SUP,Custom 27803010,,72-13-0710  -  INSERT TIBIAL 7 10MM POSTERIOR STABILIZED HYPREX SCORPIO,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-13-0712,SUP,Custom 27803010,,72-13-0712  -  INSERT TIBIAL 7 12MM POSTERIOR STABILIZE SCORPIO,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-13-0715,SUP,Custom 27803010,,72-13-0715  -  INSERT TIBIAL POSTERIOR STABILIZE SCORPIO,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-13-0718,SUP,Custom 27803010,,72-13-0718  -  INSERT TIBIAL 7 18MM POSTERIOR STABILIZED HYPREX SCORPIO,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-13-0721,SUP,Custom 27803010,,72-13-0721  -  INSERT TIBIAL POSTERIOR STABILIZED HYPREX SCORPIO,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-13-0724,SUP,Custom 27803010,,72-13-0724  -  INSERT TIBIAL POSTERIOR STABILIZED HYPREX SCORPIO,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-13-0908,SUP,Custom 27803010,,72-13-0908  -  INSERT TIBIAL POSTERIOR STABILIZED HYPREX SCORPIO KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-13-0910,SUP,Custom 27803010,,72-13-0910  -  INSERT TIBIAL 9 10MM POSTERIOR STABILIZED HYPREX SCORPIO,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-13-0912,SUP,Custom 27803010,,72-13-0912  -  INSERT TIBIAL 9 12MM POSTERIOR STABILIZED HYPREX SCORPIO,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-13-0915,SUP,Custom 27803010,,72-13-0915  -  INSERT TIBIAL 9 15MM POSTERIOR STABILIZED HYPREX SCORPIO,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-13-0918,SUP,Custom 27803010,,72-13-0918  -  INSERT TIBIAL 9 18MM POSTERIOR STABILIZED HYPREX SCORPIO,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-13-0921,SUP,Custom 27803010,,72-13-0921  -  INSERT TIBIAL POSTERIOR STABILIZED HYPREX SCORPIO,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-13-0924,SUP,Custom 27803010,,72-13-0924  -  INSERT TIBIAL POSTERIOR STABILIZED HYPREX SCORPIO,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-13-1108,SUP,Custom 27803010,,72-13-1108  -  INSERT TIBIAL 11 8MM POSTERIOR STABILIZED HYPREX SCORPIO,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-13-1110,SUP,Custom 27803010,,72-13-1110  -  INSERT TIBIAL 11 10MM POSTERIOR STABILIZED HYPREX SCORPIO,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-13-1112,SUP,Custom 27803010,,72-13-1112  -  INSERT TIBIAL POSTERIOR STABILIZED HYPREX SCORPIO,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-13-1115,SUP,Custom 27803010,,72-13-1115  -  INSERT TIBIAL 11 15MM POSTERIOR STABILIZED HYPREX SCORPIO,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-13-1118,SUP,Custom 27803010,,72-13-1118  -  INSERT TIBIAL POSTERIOR STABILIZED HYPREX SCORPIO,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-13-1121,SUP,Custom 27803010,,72-13-1121  -  INSERT TIBIAL POSTERIOR STABILIZED HYPREX SCORPIO,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-13-1124,SUP,Custom 27803010,,72-13-1124  -  INSERT TIBIAL POSTERIOR STABILIZED HYPREX SCORPIO,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-15-0308,SUP,Custom 27803010,,72-15-0308  -  INSERT TIBIAL 3 8MM POSTERIOR STABILIZED HYPREX SCRPFLX,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-15-0310,SUP,Custom 27803010,,72-15-0310  -  INSERT TIBIAL 3 10MM POSTERIOR STABILIZED HYPREX SCRPFLX,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-15-0312,SUP,Custom 27803010,,72-15-0312  -  INSERT TIBIAL 3 12MM POSTERIOR STABILIZED HYPREX SCRPFLX,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-15-0315,SUP,Custom 27803010,,72-15-0315  -  INSERT TIBIAL 3 15MM POSTERIOR STABILIZED HYPREX SCRPFLX,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-15-0318,SUP,Custom 27803010,,72-15-0318  -  INSERT TIBIAL 3 18MM POSTERIOR STABILIZED HYPREX SCRPFLX,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-15-0321,SUP,Custom 27803010,,72-15-0321  -  INSERT TIBIAL 3 21MM POSTERIOR STABILIZED HYPREX SCRPFLX,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-15-0324,SUP,Custom 27803010,,72-15-0324  -  INSERT TIBIAL 3 24MM POSTERIOR STABILIZED HYPREX SCRPFLX,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-15-0508,SUP,Custom 27803010,,72-15-0508  -  INSERT TIBIAL 5 8MM POSTERIOR STABILIZED HYPREX SCRPFLX,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-15-0510,SUP,Custom 27803010,,72-15-0510  -  INSERT TIBIAL 5 10MM POSTERIOR STABILIZED HYPREX SCRPFLX,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-15-0512,SUP,Custom 27803010,,72-15-0512  -  INSERT TIBIAL 5 12MM POSTERIOR STABILIZED HYPREX SCORPIO,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-15-0515,SUP,Custom 27803010,,72-15-0515  -  INSERT TIBIAL 5 15MM POSTERIOR STABILIZED HYPREX SCRPFLX,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-15-0518,SUP,Custom 27803010,,72-15-0518  -  INSERT TIBIAL 5 18MM POSTERIOR STABILIZED HYPREX SCRPFLX,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-15-0521,SUP,Custom 27803010,,72-15-0521  -  INSERT TIBIAL 5 21MM POSTERIOR STABILIZED HYPREX SCRPFLX,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-15-0524,SUP,Custom 27803010,,72-15-0524  -  INSERT TIBIAL 5 24MM POSTERIOR STABILIZED HYPREX SCRPFLX,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-15-0708,SUP,Custom 27803010,,72-15-0708  -  INSERT TIBIAL 7 8MM POSTERIOR STABILIZED HYPREX SCRPFLX,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-15-0710,SUP,Custom 27803010,,72-15-0710  -  INSERT TIBIAL 7 10MM POSTERIOR STABILIZED HYPREX SCRPFLX,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-15-0712,SUP,Custom 27803010,,72-15-0712  -  INSERT TIBIAL 7 12MM POSTERIOR STABILIZED HYPREX SCRPFLX,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-15-0715,SUP,Custom 27803010,,72-15-0715  -  INSERT TIBIAL 7 15MM POSTERIOR STABILIZED HYPREX SCRPFLX,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-15-0718,SUP,Custom 27803010,,72-15-0718  -  INSERT TIBIAL 7 18MM POSTERIOR STABILIZED HYPREX SCRPFLX,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-15-0721,SUP,Custom 27803010,,72-15-0721  -  INSERT TIBIAL POSTERIOR STABILIZED HYPER EXTN SCRPFLX,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-15-0724,SUP,Custom 27803010,,72-15-0724  -  INSERT TIBIAL 7 24MM POSTERIOR STABILIZED HYPREX SCRPFLX,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-15-0908,SUP,Custom 27803010,,72-15-0908  -  INSERT TIBIAL 9 8MM POSTERIOR STABILIZED HYPREX SCRPFLX,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-15-0910,SUP,Custom 27803010,,72-15-0910  -  INSERT TIBIAL 9 10MM POSTERIOR STABILIZED HYPREX SCRPFLX,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-15-0912,SUP,Custom 27803010,,72-15-0912  -  INSERT TIBIAL 9 12MM POSTERIOR STABILIZE SCORPIO KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-15-0915,SUP,Custom 27803010,,72-15-0915  -  INSERT TIBIAL 9 15MM POSTERIOR STABILIZED HYPREX SCRPFLX,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-15-0918,SUP,Custom 27803010,,72-15-0918  -  INSERT TIBIAL 9 18MM POSTERIOR STABILIZED HYPREX SCRPFLX,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-15-0921,SUP,Custom 27803010,,72-15-0921  -  INSERT TIBIAL 9 21MM POSTERIOR STABILIZED HYPREX SCRPFLX,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-15-0924,SUP,Custom 27803010,,72-15-0924  -  INSERT TIBIAL 9 24MM POSTERIOR STABILIZED HYPREX SCRPFLX,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-15-1108,SUP,Custom 27803010,,72-15-1108  -  INSERT TIBIAL 11 8MM POSTERIOR STABILIZED HYPREX SCRPFLX,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-15-1110,SUP,Custom 27803010,,72-15-1110  -  INSERT TIBIAL 11 10MM POSTERIOR STABILIZED HYPREX SCRPFLX,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-15-1112,SUP,Custom 27803010,,72-15-1112  -  INSERT TIBIAL 11 12MM POSTERIOR STABILIZED HYPREX SCRPFLX,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-15-1115,SUP,Custom 27803010,,72-15-1115  -  INSERT TIBIAL 11 15MM POSTERIOR STABILIZED HYPREX SCRPFLX,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-15-1118,SUP,Custom 27803010,,72-15-1118  -  INSERT TIBIAL 11 18MM POSTERIOR STABILIZED HYPREX SCRPFLX,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-15-1121,SUP,Custom 27803010,,72-15-1121  -  INSERT TIBIAL 11 21MM POSTERIOR STABILIZED HYPREX SCRPFLX,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-15-1124,SUP,Custom 27803010,,72-15-1124  -  INSERT TIBIAL 11 24MM POSTERIOR STABILIZED HYPREX SCRPFLX,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-16-0308,SUP,Custom 27803010,,72-16-0308  -  INSERT TIBIAL CRUC RET HYPER EXTN SCRPFLX,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-16-0310,SUP,Custom 27803010,,72-16-0310  -  INSERT TIBIAL CRUC RET HYPER EXTN SCRPFLX,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-16-0312,SUP,Custom 27803010,,72-16-0312  -  INSERT TIBIAL CRUC RET HYPER EXTN SCRPFLX,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-16-0315,SUP,Custom 27803010,,72-16-0315  -  INSERT TIBIAL CRUC RET HYPREX SCRPFLX,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-16-0318,SUP,Custom 27803010,,72-16-0318  -  INSERT TIBIAL CRUC RET HYPREX SCRPFLX,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-16-0321,SUP,Custom 27803010,,72-16-0321  -  INSERT TIBIAL CRUC RET HYPREX SCRPFLX,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-16-0324,SUP,Custom 27803010,,72-16-0324  -  INSERT TIBIAL CRUC RET HYPREX SCRPFLX,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-16-0508,SUP,Custom 27803010,,72-16-0508  -  INSERT TIBIAL 5 8MM CRUC RET SCRPFLX POLYETHYLENE KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-16-0510,SUP,Custom 27803010,,72-16-0510  -  INSERT TIBIAL 5 10MM CRUC RET SCRPFLX POLYETHYLENE KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-16-0512,SUP,Custom 27803010,,72-16-0512  -  INSERT TIBIAL 5 12MM CRUC RET SCRPFLX POLYETHYLENE KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-16-0515,SUP,Custom 27803010,,72-16-0515  -  INSERT TIBIAL CRUC RET HYPREX SCRPFLX,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-16-0518,SUP,Custom 27803010,,72-16-0518  -  INSERT TIBIAL 5 18MM CRUC RET SCRPFLX POLYETHYLENE KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-16-0521,SUP,Custom 27803010,,72-16-0521  -  INSERT TIBIAL CRUC RET HYPREX SCRPFLX,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-16-0524,SUP,Custom 27803010,,72-16-0524  -  INSERT TIBIAL CRUC RET HYPREX SCRPFLX,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-16-0708,SUP,Custom 27803010,,72-16-0708  -  INSERT TIBIAL 7 8MM CRUC RET SCORPIO KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-16-0710,SUP,Custom 27803010,,72-16-0710  -  INSERT TIBIAL 7 10MM CRUC RET SCRPFLX POLYETHYLENE KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-16-0712,SUP,Custom 27803010,,72-16-0712  -  INSERT TIBIAL 7 12MM CRUC RET SCRPFLX POLYETHYLENE KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-16-0715,SUP,Custom 27803010,,72-16-0715  -  INSERT TIBIAL 7 15MM CRUC RET SCRPFLX POLYETHYLENE KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-16-0718,SUP,Custom 27803010,,72-16-0718  -  INSERT TIBIAL CRUC RET HYPREX SCRPFLX,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-16-0721,SUP,Custom 27803010,,72-16-0721  -  INSERT TIBIAL CRUC RET HYPREX SCRPFLX,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-16-0724,SUP,Custom 27803010,,72-16-0724  -  INSERT TIBIAL CRUC RET HYPREX SCRPFLX,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-16-0908,SUP,Custom 27803010,,72-16-0908  -  INSERT TIBIAL 9 8MM CRUC RET SCRPFLX POLYETHYLENE KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-16-0910,SUP,Custom 27803010,,72-16-0910  -  INSERT TIBIAL 9 10MM CRUC RET SCRPFLX POLYETHYLENE KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-16-0912,SUP,Custom 27803010,,72-16-0912  -  INSERT TIBIAL 9 12MM CRUC RET SCRPFLX POLYETHYLENE KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-16-0915,SUP,Custom 27803010,,72-16-0915  -  INSERT TIBIAL 9 15MM CRUC RET SCRPFLX POLYETHYLENE KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-16-0918,SUP,Custom 27803010,,72-16-0918  -  INSERT TIBIAL CRUC RET HYPREX SCRPFLX,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-16-0921,SUP,Custom 27803010,,72-16-0921  -  INSERT TIBIAL CRUC RET HYPREX SCRPFLX,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-16-0924,SUP,Custom 27803010,,72-16-0924  -  INSERT TIBIAL CRUC RET HYPREX SCRPFLX,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-16-0924300,SUP,Custom 27803010,,72-16-0924300  -  INSERT TIB CRUC RET HPR EXTN SCRPFLX,"$2,013.00",$0.00,"$2,013.00",$0.00,"$1,436.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,013.00",$0.00,"$1,006.50","$1,594.30","$1,610.40",$0.00,$0.00,$0.00,$0.00,$0.00
72-16-1108,SUP,Custom 27803010,,72-16-1108  -  INSERT TIBIAL 11 8MM CRUC RET SCRPFLX POLYETHYLENE KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-16-1110,SUP,Custom 27803010,,72-16-1110  -  INSERT TIBIAL 11 10MM CRUC RET SCRPFLX POLYETHYLENE KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-16-1112,SUP,Custom 27803010,,72-16-1112  -  INSERT TIBIAL CRUC RET HYPREX SCRPFLX,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-16-1115,SUP,Custom 27803010,,72-16-1115  -  INSERT TIBIAL CRUC RET HYPREX SCRPFLX,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-16-1118,SUP,Custom 27803010,,72-16-1118  -  INSERT TIBIAL CRUC RET HYPREX SCRPFLX,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-16-1121,SUP,Custom 27803010,,72-16-1121  -  INSERT TIBIAL CRUC RET HYPREX SCRPFLX,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-16-1124,SUP,Custom 27803010,,72-16-1124  -  INSERT TIBIAL CRUC RET HYPREX SCRPFLX,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
7220025A,SUP,HCPCS C1713,,7220025A  -  END CAP SPNL 22MM 20-25MM NS X-COR 2 ATLCK TI,"$13,962.50",$0.00,"$13,962.50","$6,283.13","$5,158.80",$0.00,"$2,405.67",$0.00,$0.00,"$2,444.72","$13,962.50",$0.00,"$6,981.25","$11,058.30","$11,170.00",$0.00,"$2,185.13",$0.00,"$2,222.83",$0.00
7220027A,SUP,HCPCS C1713,,7220027A  -  END CAP SPNL 22MM 21-27MM NS X-COR 2 ATLCK TI,"$13,962.50",$0.00,"$13,962.50","$6,283.13","$5,158.80",$0.00,"$2,405.67",$0.00,$0.00,"$2,444.72","$13,962.50",$0.00,"$6,981.25","$11,058.30","$11,170.00",$0.00,"$2,185.13",$0.00,"$2,222.83",$0.00
7220033A,SUP,HCPCS C1713,,7220033A  -  END CAP SPNL 22MM 24-33MM NS X-COR 2 ATLCK TI,"$13,962.50",$0.00,"$13,962.50","$6,283.13","$5,158.80",$0.00,"$2,405.67",$0.00,$0.00,"$2,444.72","$13,962.50",$0.00,"$6,981.25","$11,058.30","$11,170.00",$0.00,"$2,185.13",$0.00,"$2,222.83",$0.00
7220041A,SUP,HCPCS C1713,,7220041A  -  END CAP SPNL 22MM 28-41MM NS X-COR 2 ATLCK TI,"$13,962.50",$0.00,"$13,962.50","$6,283.13","$5,158.80",$0.00,"$2,405.67",$0.00,$0.00,"$2,444.72","$13,962.50",$0.00,"$6,981.25","$11,058.30","$11,170.00",$0.00,"$2,185.13",$0.00,"$2,222.83",$0.00
7220055A,SUP,HCPCS C1713,,7220055A  -  END CAP SPNL 22MM 35-55MM NS X-COR 2 ATLCK TI,"$13,962.50",$0.00,"$13,962.50","$6,283.13","$5,158.80",$0.00,"$2,405.67",$0.00,$0.00,"$2,444.72","$13,962.50",$0.00,"$6,981.25","$11,058.30","$11,170.00",$0.00,"$2,185.13",$0.00,"$2,222.83",$0.00
7220067A,SUP,HCPCS C1713,,7220067A  -  END CAP SPNL 22MM 41-67MM NS X-COR 2 ATLCK TI,"$13,962.50",$0.00,"$13,962.50","$6,283.13","$5,158.80",$0.00,"$2,405.67",$0.00,$0.00,"$2,444.72","$13,962.50",$0.00,"$6,981.25","$11,058.30","$11,170.00",$0.00,"$2,185.13",$0.00,"$2,222.83",$0.00
7220079A,SUP,HCPCS C1713,,7220079A  -  END CAP SPNL 22MM 47-79MM NS X-COR 2 ATLCK TI,"$13,962.50",$0.00,"$13,962.50","$6,283.13","$5,158.80",$0.00,"$2,405.67",$0.00,$0.00,"$2,444.72","$13,962.50",$0.00,"$6,981.25","$11,058.30","$11,170.00",$0.00,"$2,185.13",$0.00,"$2,222.83",$0.00
7220121A,SUP,HCPCS C1713,,7220121A  -  END CAP SPNL 22MM 68-121MM NS X-COR 2 ATLCK TI,"$13,962.50",$0.00,"$13,962.50","$6,283.13","$5,158.80",$0.00,"$2,405.67",$0.00,$0.00,"$2,444.72","$13,962.50",$0.00,"$6,981.25","$11,058.30","$11,170.00",$0.00,"$2,185.13",$0.00,"$2,222.83",$0.00
72-2049,SUP,Custom 27203010,,72-2049  -  DRILL SURG 1.5MM 5MM STOP HIGH SPEED MANDIB IQ,$615.00,$0.00,$615.00,$0.00,$438.93,$0.00,$0.00,$0.00,$0.00,$0.00,$615.00,$0.00,$307.50,$487.08,$492.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-2055,SUP,Custom 27203010,,72-2055  -  DRILL SURG 1.5MM 22MM STOP MANDIB,$615.00,$0.00,$615.00,$0.00,$438.93,$0.00,$0.00,$0.00,$0.00,$0.00,$615.00,$0.00,$307.50,$487.08,$492.00,$0.00,$0.00,$0.00,$0.00,$0.00
72-25-0308,SUP,Custom 27803010,,72-25-0308  -  INSERT TIBIAL 3 8MM POSTERIOR STABILIZE SCRPFLX X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-25-0310,SUP,Custom 27803010,,72-25-0310  -  INSERT TIBIAL 3 10MM POSTERIOR STABILIZE SCRPFLX X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-25-0312,SUP,HCPCS C1776,,72-25-0312  -  INSERT TIB 3 12MM SCRPFLX POST STAB PE KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
72-25-0315,SUP,HCPCS C1776,,72-25-0315  -  INSERT TIB 3 15MM SCRPFLX POST STAB X3 KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
72-25-0318,SUP,HCPCS C1776,,72-25-0318  -  INSERT TIB 3 18MM SCRPFLX POST STAB X3 KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
72-25-0321,SUP,HCPCS C1776,,72-25-0321  -  INSERT TIB 3 21MM SCRPFLX POST STAB X3 KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
72-25-0324,SUP,HCPCS C1776,,72-25-0324  -  INSERT TIB 3 24MM SCRPFLX POST STAB X3 KN,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
72-25-0508,SUP,Custom 27803010,,72-25-0508  -  INSERT TIBIAL 5 8MM POSTERIOR STABILIZE SCRPFLX X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-25-0510,SUP,Custom 27803010,,72-25-0510  -  INSERT TIBIAL 5 10MM POSTERIOR STABILIZE SCRPFLX X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-25-0512,SUP,Custom 27803010,,72-25-0512  -  INSERT TIBIAL 5 12MM POSTERIOR STABILIZE SCRPFLX X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-25-0515,SUP,Custom 27803010,,72-25-0515  -  INSERT TIBIAL 5 15MM POSTERIOR STABILIZE SCRPFLX X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-25-0518,SUP,HCPCS C1776,,72-25-0518  -  INSERT TIB SCRPFLX POST STAB X3,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
72-25-0521,SUP,Custom 27803010,,72-25-0521  -  INSERT TIB 5 21MM SCRP SFLX POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-25-0524,SUP,Custom 27803010,,72-25-0524  -  INSERT TIB 5 24MM SCRPFLX POST STAB X3 ARTC KN,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-25-0708,SUP,Custom 27803010,,72-25-0708  -  INSERT TIBIAL 7 8MM POSTERIOR STABILIZE SCRPFLX X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-25-0710,SUP,Custom 27803010,,72-25-0710  -  INSERT TIBIAL 7 10MM POSTERIOR STABILIZE SCRPFLX X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-25-0712,SUP,Custom 27803010,,72-25-0712  -  INSERT TIBIAL 7 12MM POSTERIOR STABILIZE SCRPFLX X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-25-0715,SUP,Custom 27803010,,72-25-0715  -  INSERT TIBIAL 7 15MM POSTERIOR STABILIZE SCRPFLX X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-25-0718,SUP,Custom 27803010,,72-25-0718  -  INSERT TIBIAL POSTERIOR STABILIZE SCRPFLX X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-25-0721,SUP,Custom 27803010,,72-25-0721  -  INSERT TIB 7 21MM SCRP SFLX POST STAB KN,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-25-0724,SUP,Custom 27803010,,72-25-0724  -  INSERT TIB 7 24MM SCRPFLX POST STAB X3 KN,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-25-0908,SUP,Custom 27803010,,72-25-0908  -  INSERT TIBIAL 9 8MM POSTERIOR STABILIZE SCRPFLX X3 RIGHT,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-25-0910,SUP,Custom 27803010,,72-25-0910  -  INSERT TIBIAL 9 10MM POSTERIOR STABILIZE SCRPFLX X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-25-0912,SUP,Custom 27803010,,72-25-0912  -  INSERT TIBIAL 9 12MM POSTERIOR STABILIZE SCRPFLX X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-25-0915,SUP,Custom 27803010,,72-25-0915  -  INSERT TIBIAL 9 15MM POSTERIOR STABILIZE SCRPFLX X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-25-0918,SUP,Custom 27803010,,72-25-0918  -  INSERT TIB 9 18MM SCRPFLX POST STAB X3 ARTC,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-25-0921,SUP,Custom 27803010,,72-25-0921  -  INSERT TIB 9 21MM SCRPFLX POST STAB X3 ARTC KN,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-25-0924,SUP,Custom 27803010,,72-25-0924  -  INSERT TIB 9 24MM STRL SCRPFLX POST STAB X3 KN,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-25-1108,SUP,Custom 27803010,,72-25-1108  -  INSERT TIBIAL 11 8MM POSTERIOR STABILIZE SCORPIO SUPERFLEX,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-25-1110,SUP,Custom 27803010,,72-25-1110  -  INSERT TIBIAL 11 10MM POSTERIOR STABILIZE SCRPFLX X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-25-1112,SUP,Custom 27803010,,72-25-1112  -  INSERT TIBIAL 11 12MM POSTERIOR STABILIZE SCRPFLX X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-25-1115,SUP,Custom 27803010,,72-25-1115  -  INSERT TIBIAL 11 15MM POSTERIOR STABILIZE SCRPFLX X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-25-1118,SUP,Custom 27803010,,72-25-1118  -  INSERT TIBIAL 11 18MM POSTERIOR STABILIZE SCRPFLX,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-25-1121,SUP,Custom 27803010,,72-25-1121  -  INSERT TIBIAL 11 21MM POSTERIOR STABILIZE SCRPFLX X3,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-25-1124,SUP,Custom 27803010,,72-25-1124  -  INSERT TIBIAL 11 24MM POSTERIOR STABILIZE SCRPFLX X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-26-0308,SUP,Custom 27803010,,72-26-0308  -  INSERT TIBIAL 3 8MM CRUC RET SCRPFLX POLYETHYLENE KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-26-0310,SUP,Custom 27803010,,72-26-0310  -  INSERT TIBIAL 3 10MM CRUCIATE RETAIN SCORPIO SUPERFLEX KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-26-0312,SUP,Custom 27803010,,72-26-0312  -  INSERT TIBIAL 3 12MM CRUC RET SCORPIO SUPERFLEX KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-26-0315,SUP,Custom 27803010,,72-26-0315  -  INSERT TIBIAL 3 15MM CRUCIATE RETAIN SCORPIO SUPERFLEX KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-26-0318,SUP,Custom 27803010,,72-26-0318  -  INSERT TIBIAL 3 18MM CRUCIATE RETAIN SCORPIO SUPERFLEX KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-26-0321,SUP,Custom 27803010,,72-26-0321  -  INSERT TIBIAL 3 21MM CRUCIATE RETAIN SCORPIO SUPERFLEX KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-26-0324,SUP,Custom 27803010,,72-26-0324  -  INSERT TIBIAL 3 24MM CRUC RET SCORPIO SUPERFLEX KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-26-0508,SUP,Custom 27803010,,72-26-0508  -  INSERT TIBIAL 5 8MM CRUC RET POSTERIOR STABILIZED SCRPFLX X3,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-26-0510,SUP,Custom 27803010,,72-26-0510  -  INSERT TIBIAL 5 10MM CRUC RET SCORPIO SUPERFLEX KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-26-0512,SUP,Custom 27803010,,72-26-0512  -  INSERT TIBIAL 5 12MM CRUC RET SCRPFLX KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-26-0515,SUP,Custom 27803010,,72-26-0515  -  INSERT TIB 5 15MM STRL SCRPFLX CR X3 KN,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-26-0518,SUP,Custom 27803010,,72-26-0518  -  INSERT TIBIAL 5 18MM CRUCIATE RETAIN SCORPIO SUPERFLEX KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-26-0521,SUP,Custom 27803010,,72-26-0521  -  INSERT TIBIAL CRUC RET SCORPIO SUPERFLEX,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-26-0524,SUP,Custom 27803010,,72-26-0524  -  INSERT TIBIAL CRUC RET SCORPIO SUPERFLEX,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-26-0708,SUP,Custom 27803010,,72-26-0708  -  INSERT TIBIAL 7 8MM CRUC RET POSTERIOR STABILIZED SCRPFLX X3,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-26-0710,SUP,Custom 27803010,,72-26-0710  -  INSERT TIBIAL 7 10MM CRUC RET POSTERIOR STABILIZED SCRPFLX,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-26-0712,SUP,Custom 27803010,,72-26-0712  -  INSERT TIBIAL 7 12MM CRUC RET POSTERIOR STABILIZED SCRPFLX,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-26-0715,SUP,Custom 27803010,,72-26-0715  -  INSERT TIBIAL 7 15MM CRUC RET SCORPIO SUPERFLEX KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-26-0718,SUP,Custom 27803010,,72-26-0718  -  INSERT TIBIAL CRUC RET SCORPIO SUPERFLEX,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-26-0721,SUP,Custom 27803010,,72-26-0721  -  INSERT TIBIAL 7 21MM CRUCIATE RETAIN SCORPIO SUPERFLEX KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-26-0724,SUP,Custom 27803010,,72-26-0724  -  INSERT TIBIAL 7 24MM CRUCIATE RETAIN SCORPIO SUPERFLEX KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-26-0908,SUP,Custom 27803010,,72-26-0908  -  INSERT TIBIAL 9 8MM POSTERIOR STABILIZE SCRPFLX X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-26-0910,SUP,Custom 27803010,,72-26-0910  -  INSERT TIBIAL 9 10MM CRUC RET SCORPIO SUPERFLEX KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-26-0912,SUP,Custom 27803010,,72-26-0912  -  INSERT TIBIAL 9 12MM CRUC RET SCORPIO SUPERFLEX POLYETHYLENE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-26-0915,SUP,Custom 27803010,,72-26-0915  -  INSERT TIBIAL 9 15MM CRUC RET SCORPIO SUPERFLEX KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-26-0918,SUP,Custom 27803010,,72-26-0918  -  INSERT TIBIAL 9 18MM CRUCIATE RETAIN SCORPIO SUPERFLEX KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-26-0921,SUP,Custom 27803010,,72-26-0921  -  INSERT TIBIAL 9 21MM CRUCIATE RETAIN SCORPIO SUPERFLEX KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-26-0924,SUP,Custom 27803010,,72-26-0924  -  INSERT TIBIAL 9 24MM CRUCIATE RETAIN SCORPIO SUPERFLEX KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-26-1108,SUP,Custom 27803010,,72-26-1108  -  INSERT TIBIAL 11 8MM CRUC RET SCORPIO SUPERFLEX KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-26-1110,SUP,Custom 27803010,,72-26-1110  -  INSERT TIB 11 10MM SCRP SFLX CRCTE RTN KN,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-26-1112,SUP,Custom 27803010,,72-26-1112  -  INSERT TIBIAL 11 12MM CRUC RET SCORPIO SUPERFLEX KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-26-1115,SUP,Custom 27803010,,72-26-1115  -  INSERT TIBIAL CRUC RET SCRPFLX,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-26-1118,SUP,Custom 27803010,,72-26-1118  -  INSERT TIBIAL 11 18MM CRUCIATE RETAIN SCORPIO SUPERFLEX KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-26-1121,SUP,Custom 27803010,,72-26-1121  -  INSERT TIBIAL 11 21MM CRUCIATE RETAIN SCORPIO SUPERFLEX KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-26-1124,SUP,Custom 27803010,,72-26-1124  -  INSERT TIBIAL 11 24MM CRUC RET SCORPIO SUPERFLEX KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
72402408N,SUP,HCPCS C1713,,72402408N  -  SCREW BONE 2.4MM 3.8MM 8MM EVOS MINI SS CORT ST T7,$118.75,$0.00,$118.75,$53.44,$84.75,$0.00,$20.46,$0.00,$0.00,$20.79,$118.75,$0.00,$59.38,$94.05,$95.00,$0.00,$18.58,$0.00,$18.91,$0.00
72402409N,SUP,HCPCS C1713,,72402409N  -  SCREW BONE 2.4MM 3.8MM 9MM EVOS MINI SS CORT ST T7,$118.75,$0.00,$118.75,$53.44,$84.75,$0.00,$20.46,$0.00,$0.00,$20.79,$118.75,$0.00,$59.38,$94.05,$95.00,$0.00,$18.58,$0.00,$18.91,$0.00
72402410N,SUP,HCPCS C1713,,72402410N  -  SCREW BONE 2.4MM 3.8MM 10MM EVOS MINI SS CORTEX T7,$118.75,$0.00,$118.75,$53.44,$84.75,$0.00,$20.46,$0.00,$0.00,$20.79,$118.75,$0.00,$59.38,$94.05,$95.00,$0.00,$18.58,$0.00,$18.91,$0.00
72402420N,SUP,HCPCS C1713,,72402420N  -  SCREW BONE 2.4MM 3.8MM 20MM EVOS SS 1.6MM SM BONE,$118.75,$0.00,$118.75,$53.44,$84.75,$0.00,$20.46,$0.00,$0.00,$20.79,$118.75,$0.00,$59.38,$94.05,$95.00,$0.00,$18.58,$0.00,$18.91,$0.00
72-4-0310,SUP,Custom 27203010,,72-4-0310  -  TRIAL SURG 3 10MM INSERT TOT STABILITY CONSTRAINED SCORPIO,"$3,492.50",$0.00,"$3,492.50",$0.00,"$2,492.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,492.50",$0.00,"$1,746.25","$2,766.06","$2,794.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-4-0312,SUP,Custom 27203010,,72-4-0312  -  TRIAL SURG 3 12MM INSERT TOT STABILITY CONSTRAINED SCORPIO,"$3,492.50",$0.00,"$3,492.50",$0.00,"$2,492.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,492.50",$0.00,"$1,746.25","$2,766.06","$2,794.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-4-0314,SUP,Custom 27203010,,72-4-0314  -  TRIAL SURG 3 14MM INSERT TOT STABILITY CONSTRAINED SCORPIO,"$3,492.50",$0.00,"$3,492.50",$0.00,"$2,492.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,492.50",$0.00,"$1,746.25","$2,766.06","$2,794.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-4-0316,SUP,Custom 27203010,,72-4-0316  -  TRIAL SURG 3 16MM INSERT TOT STABILITY CONSTRAINED SCORPIO,"$3,492.50",$0.00,"$3,492.50",$0.00,"$2,492.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,492.50",$0.00,"$1,746.25","$2,766.06","$2,794.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-4-0318,SUP,Custom 27203010,,72-4-0318  -  INSERT TIBIAL 3 18MM CONSTRAIN TOT STABILIZE SCORPIO,"$3,492.50",$0.00,"$3,492.50",$0.00,"$2,492.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,492.50",$0.00,"$1,746.25","$2,766.06","$2,794.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-4-0321,SUP,Custom 27203010,,72-4-0321  -  TRIAL SURG 3 21MM INSERT TOT STABILITY CONSTRAINED SCORPIO,"$3,492.50",$0.00,"$3,492.50",$0.00,"$2,492.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,492.50",$0.00,"$1,746.25","$2,766.06","$2,794.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-4-0324,SUP,HCPCS C1776,,72-4-0324  -  INSERT TIBIAL 3 24MM CONSTRAIN TOT STABILIZE SCORPIO,"$3,492.50",$0.00,"$3,492.50","$1,571.63","$2,492.60",$0.00,$601.74,$0.00,$0.00,$611.51,"$3,492.50",$0.00,"$1,746.25","$2,766.06","$2,794.00",$0.00,$546.58,$0.00,$556.01,$0.00
72-4-0510,SUP,Custom 27203010,,72-4-0510  -  TRIAL SURG 5 10MM INSERT TOT STABILITY CONSTRAINED SCORPIO,"$3,492.50",$0.00,"$3,492.50",$0.00,"$2,492.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,492.50",$0.00,"$1,746.25","$2,766.06","$2,794.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-4-0512,SUP,Custom 27203010,,72-4-0512  -  INSERT TIBIAL 5 12MM CONSTRAIN TOT STABILIZE SCORPIO,"$3,492.50",$0.00,"$3,492.50",$0.00,"$2,492.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,492.50",$0.00,"$1,746.25","$2,766.06","$2,794.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-4-0514,SUP,HCPCS C1776,,72-4-0514  -  INSERT TIBIAL 5 14MM CONSTRAIN TOT STABILIZE SCORPIO,"$3,492.50",$0.00,"$3,492.50","$1,571.63","$2,492.60",$0.00,$601.74,$0.00,$0.00,$611.51,"$3,492.50",$0.00,"$1,746.25","$2,766.06","$2,794.00",$0.00,$546.58,$0.00,$556.01,$0.00
72-4-0516,SUP,HCPCS C1776,,72-4-0516  -  INSERT TIBIAL 5 16MM CONSTRAIN TOT STABILIZE SCORPIO,"$3,492.50",$0.00,"$3,492.50","$1,571.63","$2,492.60",$0.00,$601.74,$0.00,$0.00,$611.51,"$3,492.50",$0.00,"$1,746.25","$2,766.06","$2,794.00",$0.00,$546.58,$0.00,$556.01,$0.00
72-4-0518,SUP,HCPCS C1776,,72-4-0518  -  INSERT TIBIAL 5 18MM CONSTRAIN TOT STABILIZE SCORPIO,"$3,492.50",$0.00,"$3,492.50","$1,571.63","$2,492.60",$0.00,$601.74,$0.00,$0.00,$611.51,"$3,492.50",$0.00,"$1,746.25","$2,766.06","$2,794.00",$0.00,$546.58,$0.00,$556.01,$0.00
72-4-0521,SUP,HCPCS C1776,,72-4-0521  -  INSERT TIBIAL 5 21MM CONSTRAIN TOT STABILIZE SCORPIO,"$3,492.50",$0.00,"$3,492.50","$1,571.63","$2,492.60",$0.00,$601.74,$0.00,$0.00,$611.51,"$3,492.50",$0.00,"$1,746.25","$2,766.06","$2,794.00",$0.00,$546.58,$0.00,$556.01,$0.00
72-4-0524,SUP,Custom 27203010,,72-4-0524  -  TRIAL SURG 5 24MM INSERT TOT STABILITY CONSTRAINED SCORPIO,"$3,492.50",$0.00,"$3,492.50",$0.00,"$2,492.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,492.50",$0.00,"$1,746.25","$2,766.06","$2,794.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-4-0710,SUP,HCPCS C1776,,72-4-0710  -  INSERT TIBIAL 7 10MM CONSTRAIN TOT STABILIZE SCORPIO,"$3,492.50",$0.00,"$3,492.50","$1,571.63","$2,492.60",$0.00,$601.74,$0.00,$0.00,$611.51,"$3,492.50",$0.00,"$1,746.25","$2,766.06","$2,794.00",$0.00,$546.58,$0.00,$556.01,$0.00
72-4-0712,SUP,HCPCS C1776,,72-4-0712  -  INSERT TIBIAL 7 12MM CONSTRAIN TOT STABILIZE SCORPIO,"$3,492.50",$0.00,"$3,492.50","$1,571.63","$2,492.60",$0.00,$601.74,$0.00,$0.00,$611.51,"$3,492.50",$0.00,"$1,746.25","$2,766.06","$2,794.00",$0.00,$546.58,$0.00,$556.01,$0.00
72-4-0714,SUP,HCPCS C1776,,72-4-0714  -  INSERT TIBIAL 7 14MM CONSTRAIN TOT STABILIZE SCORPIO,"$3,492.50",$0.00,"$3,492.50","$1,571.63","$2,492.60",$0.00,$601.74,$0.00,$0.00,$611.51,"$3,492.50",$0.00,"$1,746.25","$2,766.06","$2,794.00",$0.00,$546.58,$0.00,$556.01,$0.00
72-4-0716,SUP,HCPCS C1776,,72-4-0716  -  INSERT TIBIAL 7 16MM CONSTRAIN TOT STABILIZE SCORPIO,"$3,492.50",$0.00,"$3,492.50","$1,571.63","$2,492.60",$0.00,$601.74,$0.00,$0.00,$611.51,"$3,492.50",$0.00,"$1,746.25","$2,766.06","$2,794.00",$0.00,$546.58,$0.00,$556.01,$0.00
72-4-0718,SUP,HCPCS C1776,,72-4-0718  -  INSERT TIBIAL 7 18MM CONSTRAIN TOT STABILIZE SCORPIO,"$3,492.50",$0.00,"$3,492.50","$1,571.63","$2,492.60",$0.00,$601.74,$0.00,$0.00,$611.51,"$3,492.50",$0.00,"$1,746.25","$2,766.06","$2,794.00",$0.00,$546.58,$0.00,$556.01,$0.00
72-4-0721,SUP,HCPCS C1776,,72-4-0721  -  INSERT TIBIAL 7 21MM CONSTRAIN TOT STABILIZE SCORPIO,"$3,492.50",$0.00,"$3,492.50","$1,571.63","$2,492.60",$0.00,$601.74,$0.00,$0.00,$611.51,"$3,492.50",$0.00,"$1,746.25","$2,766.06","$2,794.00",$0.00,$546.58,$0.00,$556.01,$0.00
72-4-0724,SUP,HCPCS C1776,,72-4-0724  -  INSERT TIBIAL 7 24MM CONSTRAIN TOT STABILIZE SCORPIO,"$3,492.50",$0.00,"$3,492.50","$1,571.63","$2,492.60",$0.00,$601.74,$0.00,$0.00,$611.51,"$3,492.50",$0.00,"$1,746.25","$2,766.06","$2,794.00",$0.00,$546.58,$0.00,$556.01,$0.00
72-4-0910,SUP,Custom 27203010,,72-4-0910  -  TRIAL SURG 9 10MM INSERT TOT STABILITY CONSTRAINED SCORPIO,"$3,492.50",$0.00,"$3,492.50",$0.00,"$2,492.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,492.50",$0.00,"$1,746.25","$2,766.06","$2,794.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-4-0912,SUP,HCPCS C1776,,72-4-0912  -  INSERT TIBIAL 9 12MM CONSTRAIN TOT STABILIZE SCORPIO,"$3,492.50",$0.00,"$3,492.50","$1,571.63","$2,492.60",$0.00,$601.74,$0.00,$0.00,$611.51,"$3,492.50",$0.00,"$1,746.25","$2,766.06","$2,794.00",$0.00,$546.58,$0.00,$556.01,$0.00
72-4-0914,SUP,HCPCS C1776,,72-4-0914  -  INSERT TIBIAL 9 14MM CONSTRAINED TOT STABILIZED SCORPIO,"$3,492.50",$0.00,"$3,492.50","$1,571.63","$2,492.60",$0.00,$601.74,$0.00,$0.00,$611.51,"$3,492.50",$0.00,"$1,746.25","$2,766.06","$2,794.00",$0.00,$546.58,$0.00,$556.01,$0.00
72-4-0916,SUP,HCPCS C1776,,72-4-0916  -  INSERT TIBIAL 9 16MM CONSTRAIN TOT STABILIZE SCORPIO,"$3,492.50",$0.00,"$3,492.50","$1,571.63","$2,492.60",$0.00,$601.74,$0.00,$0.00,$611.51,"$3,492.50",$0.00,"$1,746.25","$2,766.06","$2,794.00",$0.00,$546.58,$0.00,$556.01,$0.00
72-4-0918,SUP,HCPCS C1776,,72-4-0918  -  INSERT TIBIAL 9 18MM CONSTRAIN TOT STABILIZE SCORPIO,"$3,492.50",$0.00,"$3,492.50","$1,571.63","$2,492.60",$0.00,$601.74,$0.00,$0.00,$611.51,"$3,492.50",$0.00,"$1,746.25","$2,766.06","$2,794.00",$0.00,$546.58,$0.00,$556.01,$0.00
72-4-0921,SUP,HCPCS C1776,,72-4-0921  -  INSERT TIBIAL 9 21MM CONSTRAIN TOT STABILIZE SCORPIO,"$3,492.50",$0.00,"$3,492.50","$1,571.63","$2,492.60",$0.00,$601.74,$0.00,$0.00,$611.51,"$3,492.50",$0.00,"$1,746.25","$2,766.06","$2,794.00",$0.00,$546.58,$0.00,$556.01,$0.00
72-4-0924,SUP,Custom 27203010,,72-4-0924  -  TRIAL SURG 9 24MM INSERT TOT STABILITY CONSTRAINED SCORPIO,"$3,492.50",$0.00,"$3,492.50",$0.00,"$2,492.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,492.50",$0.00,"$1,746.25","$2,766.06","$2,794.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-4-1110,SUP,HCPCS C1776,,72-4-1110  -  INSERT TIBIAL 11 10MM CONSTRAIN TOT STABILIZE SCORPIO,"$3,492.50",$0.00,"$3,492.50","$1,571.63","$2,492.60",$0.00,$601.74,$0.00,$0.00,$611.51,"$3,492.50",$0.00,"$1,746.25","$2,766.06","$2,794.00",$0.00,$546.58,$0.00,$556.01,$0.00
72-4-1112,SUP,HCPCS C1776,,72-4-1112  -  INSERT TIBIAL 11 12MM CONSTRAIN TOT STABILIZE SCORPIO,"$3,492.50",$0.00,"$3,492.50","$1,571.63","$2,492.60",$0.00,$601.74,$0.00,$0.00,$611.51,"$3,492.50",$0.00,"$1,746.25","$2,766.06","$2,794.00",$0.00,$546.58,$0.00,$556.01,$0.00
72-4-1114,SUP,HCPCS C1776,,72-4-1114  -  INSERT TIBIAL 11 14MM CONSTRAIN TOT STABILIZE SCORPIO,"$3,492.50",$0.00,"$3,492.50","$1,571.63","$2,492.60",$0.00,$601.74,$0.00,$0.00,$611.51,"$3,492.50",$0.00,"$1,746.25","$2,766.06","$2,794.00",$0.00,$546.58,$0.00,$556.01,$0.00
72-4-1116,SUP,HCPCS C1776,,72-4-1116  -  INSERT TIBIAL 11 16MM CONSTRAIN TOT STABILIZE SCORPIO,"$3,492.50",$0.00,"$3,492.50","$1,571.63","$2,492.60",$0.00,$601.74,$0.00,$0.00,$611.51,"$3,492.50",$0.00,"$1,746.25","$2,766.06","$2,794.00",$0.00,$546.58,$0.00,$556.01,$0.00
72-4-1118,SUP,HCPCS C1776,,72-4-1118  -  INSERT TIBIAL 11 18MM CONSTRAIN TOT STABILIZE SCORPIO,"$3,492.50",$0.00,"$3,492.50","$1,571.63","$2,492.60",$0.00,$601.74,$0.00,$0.00,$611.51,"$3,492.50",$0.00,"$1,746.25","$2,766.06","$2,794.00",$0.00,$546.58,$0.00,$556.01,$0.00
72-4-1121,SUP,HCPCS C1776,,72-4-1121  -  INSERT TIBIAL 11 21MM CONSTRAIN TOT STABILIZE SCORPIO,"$3,492.50",$0.00,"$3,492.50","$1,571.63","$2,492.60",$0.00,$601.74,$0.00,$0.00,$611.51,"$3,492.50",$0.00,"$1,746.25","$2,766.06","$2,794.00",$0.00,$546.58,$0.00,$556.01,$0.00
72-4-1124,SUP,HCPCS C1776,,72-4-1124  -  INSERT TIBIAL 11 24MM CONSTRAIN TOT STABILIZE SCORPIO,"$3,492.50",$0.00,"$3,492.50","$1,571.63","$2,492.60",$0.00,$601.74,$0.00,$0.00,$611.51,"$3,492.50",$0.00,"$1,746.25","$2,766.06","$2,794.00",$0.00,$546.58,$0.00,$556.01,$0.00
72412410N,SUP,HCPCS C1713,,72412410N  -  SCREW BONE 2.4MM 3.8MM 10MM EVOS SS LNG BONE SM,$382.50,$0.00,$382.50,$172.13,$272.99,$0.00,$65.90,$0.00,$0.00,$66.97,$382.50,$0.00,$191.25,$302.94,$306.00,$0.00,$59.86,$0.00,$60.89,$0.00
72-4-1910,SUP,HCPCS C1776,,72-4-1910  -  INSERT TIBIAL 19 10MM CONSTRAIN TOT STABILIZE SCORPIO,"$3,492.50",$0.00,"$3,492.50","$1,571.63","$2,492.60",$0.00,$601.74,$0.00,$0.00,$611.51,"$3,492.50",$0.00,"$1,746.25","$2,766.06","$2,794.00",$0.00,$546.58,$0.00,$556.01,$0.00
72-4-1912,SUP,HCPCS C1776,,72-4-1912  -  INSERT TIBIAL 19 12MM CONSTRAIN TOT STABILIZE SCORPIO,"$3,492.50",$0.00,"$3,492.50","$1,571.63","$2,492.60",$0.00,$601.74,$0.00,$0.00,$611.51,"$3,492.50",$0.00,"$1,746.25","$2,766.06","$2,794.00",$0.00,$546.58,$0.00,$556.01,$0.00
72-4-1914,SUP,HCPCS C1776,,72-4-1914  -  INSERT TIBIAL 19 14MM CONSTRAIN TOT STABILIZE SCORPIO,"$3,492.50",$0.00,"$3,492.50","$1,571.63","$2,492.60",$0.00,$601.74,$0.00,$0.00,$611.51,"$3,492.50",$0.00,"$1,746.25","$2,766.06","$2,794.00",$0.00,$546.58,$0.00,$556.01,$0.00
72-4-1916,SUP,HCPCS C1776,,72-4-1916  -  INSERT TIBIAL 19 16MM CONSTRAIN TOT STABILIZE SCORPIO,"$3,492.50",$0.00,"$3,492.50","$1,571.63","$2,492.60",$0.00,$601.74,$0.00,$0.00,$611.51,"$3,492.50",$0.00,"$1,746.25","$2,766.06","$2,794.00",$0.00,$546.58,$0.00,$556.01,$0.00
72-4-1918,SUP,HCPCS C1776,,72-4-1918  -  INSERT TIBIAL 19 18MM CONSTRAIN TOT STABILIZE SCORPIO,"$3,492.50",$0.00,"$3,492.50","$1,571.63","$2,492.60",$0.00,$601.74,$0.00,$0.00,$611.51,"$3,492.50",$0.00,"$1,746.25","$2,766.06","$2,794.00",$0.00,$546.58,$0.00,$556.01,$0.00
72-4-1921,SUP,HCPCS C1776,,72-4-1921  -  INSERT TIBIAL 19 21MM CONSTRAIN TOT STABILIZE SCORPIO,"$3,492.50",$0.00,"$3,492.50","$1,571.63","$2,492.60",$0.00,$601.74,$0.00,$0.00,$611.51,"$3,492.50",$0.00,"$1,746.25","$2,766.06","$2,794.00",$0.00,$546.58,$0.00,$556.01,$0.00
72-4-1924,SUP,HCPCS C1776,,72-4-1924  -  INSERT TIBIAL 19 24MM CONSTRAIN TOT STABILIZE SCORPIO,"$3,492.50",$0.00,"$3,492.50","$1,571.63","$2,492.60",$0.00,$601.74,$0.00,$0.00,$611.51,"$3,492.50",$0.00,"$1,746.25","$2,766.06","$2,794.00",$0.00,$546.58,$0.00,$556.01,$0.00
72-4-5710,SUP,HCPCS C1776,,72-4-5710  -  INSERT TIBIAL 7 10MM TOT STABILIZE SCORPIO POLYETHYLENE KNEE,"$3,492.50",$0.00,"$3,492.50","$1,571.63","$2,492.60",$0.00,$601.74,$0.00,$0.00,$611.51,"$3,492.50",$0.00,"$1,746.25","$2,766.06","$2,794.00",$0.00,$546.58,$0.00,$556.01,$0.00
72-4-5712,SUP,HCPCS C1776,,72-4-5712  -  INSERT TIBIAL 7 12MM CONSTRAIN TOT STABILIZE SCORPIO,"$3,492.50",$0.00,"$3,492.50","$1,571.63","$2,492.60",$0.00,$601.74,$0.00,$0.00,$611.51,"$3,492.50",$0.00,"$1,746.25","$2,766.06","$2,794.00",$0.00,$546.58,$0.00,$556.01,$0.00
72-4-5714,SUP,HCPCS C1776,,72-4-5714  -  INSERT TIBIAL 7 14MM CONSTRAIN TOT STABILIZE SCORPIO,"$3,492.50",$0.00,"$3,492.50","$1,571.63","$2,492.60",$0.00,$601.74,$0.00,$0.00,$611.51,"$3,492.50",$0.00,"$1,746.25","$2,766.06","$2,794.00",$0.00,$546.58,$0.00,$556.01,$0.00
72-4-5716,SUP,HCPCS C1776,,72-4-5716  -  INSERT TIBIAL 7 16MM CONSTRAIN TOT STABILIZE SCORPIO,"$3,492.50",$0.00,"$3,492.50","$1,571.63","$2,492.60",$0.00,$601.74,$0.00,$0.00,$611.51,"$3,492.50",$0.00,"$1,746.25","$2,766.06","$2,794.00",$0.00,$546.58,$0.00,$556.01,$0.00
72-4-5718,SUP,HCPCS C1776,,72-4-5718  -  INSERT TIBIAL 7 18MM CONSTRAIN TOT STABILIZE SCORPIO,"$3,492.50",$0.00,"$3,492.50","$1,571.63","$2,492.60",$0.00,$601.74,$0.00,$0.00,$611.51,"$3,492.50",$0.00,"$1,746.25","$2,766.06","$2,794.00",$0.00,$546.58,$0.00,$556.01,$0.00
72-4-5721,SUP,HCPCS C1776,,72-4-5721  -  INSERT TIBIAL 7 21MM CONSTRAIN TOT STABILIZE SCORPIO,"$3,492.50",$0.00,"$3,492.50","$1,571.63","$2,492.60",$0.00,$601.74,$0.00,$0.00,$611.51,"$3,492.50",$0.00,"$1,746.25","$2,766.06","$2,794.00",$0.00,$546.58,$0.00,$556.01,$0.00
72-4-5724,SUP,HCPCS C1776,,72-4-5724  -  INSERT TIBIAL 7 24MM CONSTRAIN TOT STABILIZE SCORPIO,"$3,492.50",$0.00,"$3,492.50","$1,571.63","$2,492.60",$0.00,$601.74,$0.00,$0.00,$611.51,"$3,492.50",$0.00,"$1,746.25","$2,766.06","$2,794.00",$0.00,$546.58,$0.00,$556.01,$0.00
72-4-7512,SUP,HCPCS C1776,,72-4-7512  -  INSERT TIBIAL 7F/5T 12MM CONSTRAIN TOT STABILIZE SCORPIO,"$3,492.50",$0.00,"$3,492.50","$1,571.63","$2,492.60",$0.00,$601.74,$0.00,$0.00,$611.51,"$3,492.50",$0.00,"$1,746.25","$2,766.06","$2,794.00",$0.00,$546.58,$0.00,$556.01,$0.00
72-4-7514,SUP,HCPCS C1776,,72-4-7514  -  INSERT TIBIAL 7F/5T 14MM CONSTRAIN TOT STABILIZE SCORPIO,"$3,492.50",$0.00,"$3,492.50","$1,571.63","$2,492.60",$0.00,$601.74,$0.00,$0.00,$611.51,"$3,492.50",$0.00,"$1,746.25","$2,766.06","$2,794.00",$0.00,$546.58,$0.00,$556.01,$0.00
72-4-7516,SUP,HCPCS C1776,,72-4-7516  -  INSERT TIBIAL 7F/5T 16MM CONSTRAIN TOT STABILIZE SCORPIO,"$3,492.50",$0.00,"$3,492.50","$1,571.63","$2,492.60",$0.00,$601.74,$0.00,$0.00,$611.51,"$3,492.50",$0.00,"$1,746.25","$2,766.06","$2,794.00",$0.00,$546.58,$0.00,$556.01,$0.00
72-4-7518,SUP,HCPCS C1776,,72-4-7518  -  INSERT TIBIAL 7F/5T 18MM CONSTRAIN TOT STABILIZE SCORPIO,"$3,492.50",$0.00,"$3,492.50","$1,571.63","$2,492.60",$0.00,$601.74,$0.00,$0.00,$611.51,"$3,492.50",$0.00,"$1,746.25","$2,766.06","$2,794.00",$0.00,$546.58,$0.00,$556.01,$0.00
72-4-7521,SUP,HCPCS C1776,,72-4-7521  -  INSERT TIBIAL 7F/5T 21MM CONSTRAIN TOT STABILIZE SCORPIO,"$3,492.50",$0.00,"$3,492.50","$1,571.63","$2,492.60",$0.00,$601.74,$0.00,$0.00,$611.51,"$3,492.50",$0.00,"$1,746.25","$2,766.06","$2,794.00",$0.00,$546.58,$0.00,$556.01,$0.00
72-4-7524,SUP,HCPCS C1776,,72-4-7524  -  INSERT TIBIAL 7F/5T 24MM CONSTRAIN TOT STABILIZE SCORPIO,"$3,492.50",$0.00,"$3,492.50","$1,571.63","$2,492.60",$0.00,$601.74,$0.00,$0.00,$611.51,"$3,492.50",$0.00,"$1,746.25","$2,766.06","$2,794.00",$0.00,$546.58,$0.00,$556.01,$0.00
72-4-9110,SUP,HCPCS C1776,,72-4-9110  -  INSERT TIBIAL 9F/11T 10MM CONSTRAIN TOT STABILIZE SCORPIO,"$3,492.50",$0.00,"$3,492.50","$1,571.63","$2,492.60",$0.00,$601.74,$0.00,$0.00,$611.51,"$3,492.50",$0.00,"$1,746.25","$2,766.06","$2,794.00",$0.00,$546.58,$0.00,$556.01,$0.00
72-4-9112,SUP,HCPCS C1776,,72-4-9112  -  INSERT TIBIAL 9F/11T 12MM CONSTRAIN TOT STABILIZE SCORPIO,"$3,492.50",$0.00,"$3,492.50","$1,571.63","$2,492.60",$0.00,$601.74,$0.00,$0.00,$611.51,"$3,492.50",$0.00,"$1,746.25","$2,766.06","$2,794.00",$0.00,$546.58,$0.00,$556.01,$0.00
72-4-9114,SUP,HCPCS C1776,,72-4-9114  -  INSERT TIBIAL 9F/11T 14MM CONSTRAIN TOT STABILIZE SCORPIO,"$3,492.50",$0.00,"$3,492.50","$1,571.63","$2,492.60",$0.00,$601.74,$0.00,$0.00,$611.51,"$3,492.50",$0.00,"$1,746.25","$2,766.06","$2,794.00",$0.00,$546.58,$0.00,$556.01,$0.00
72-4-9116,SUP,HCPCS C1776,,72-4-9116  -  INSERT TIBIAL 9F/11T 16MM CONSTRAIN TOT STABILIZE SCORPIO,"$3,492.50",$0.00,"$3,492.50","$1,571.63","$2,492.60",$0.00,$601.74,$0.00,$0.00,$611.51,"$3,492.50",$0.00,"$1,746.25","$2,766.06","$2,794.00",$0.00,$546.58,$0.00,$556.01,$0.00
72-4-9118,SUP,HCPCS C1776,,72-4-9118  -  INSERT TIBIAL 9F/11T 18MM CONSTRAIN TOT STABILIZE SCORPIO,"$3,492.50",$0.00,"$3,492.50","$1,571.63","$2,492.60",$0.00,$601.74,$0.00,$0.00,$611.51,"$3,492.50",$0.00,"$1,746.25","$2,766.06","$2,794.00",$0.00,$546.58,$0.00,$556.01,$0.00
72-4-9121,SUP,HCPCS C1776,,72-4-9121  -  INSERT TIBIAL 9F/11T 21MM CONSTRAIN TOT STABILIZE SCORPIO,"$3,492.50",$0.00,"$3,492.50","$1,571.63","$2,492.60",$0.00,$601.74,$0.00,$0.00,$611.51,"$3,492.50",$0.00,"$1,746.25","$2,766.06","$2,794.00",$0.00,$546.58,$0.00,$556.01,$0.00
72-4-9124,SUP,HCPCS C1776,,72-4-9124  -  INSERT TIBIAL 9F/11T 24MM CONSTRAIN TOT STABILIZE SCORPIO,"$3,492.50",$0.00,"$3,492.50","$1,571.63","$2,492.60",$0.00,$601.74,$0.00,$0.00,$611.51,"$3,492.50",$0.00,"$1,746.25","$2,766.06","$2,794.00",$0.00,$546.58,$0.00,$556.01,$0.00
72-5-0508,SUP,Custom 27803010,,72-5-0508  -  INSERT TIB 5 8MM KNEE PS SCRP SFLX,"$1,930.00",$0.00,"$1,930.00",$0.00,"$1,377.44",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,930.00",$0.00,$965.00,"$1,528.56","$1,544.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-5-0510,SUP,Custom 27803010,,72-5-0510  -  INSERT TIB 5 10MM KNEE PS SCRP SFLX,"$1,930.00",$0.00,"$1,930.00",$0.00,"$1,377.44",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,930.00",$0.00,$965.00,"$1,528.56","$1,544.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-5-0512,SUP,Custom 27803010,,72-5-0512  -  INSERT TIB 5 12MM KNEE PS SCRP SFLX,"$1,930.00",$0.00,"$1,930.00",$0.00,"$1,377.44",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,930.00",$0.00,$965.00,"$1,528.56","$1,544.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-5-0515,SUP,Custom 27803010,,72-5-0515  -  INSERT TIB 5 15MM KNEE PS SCRP SFLX,"$1,930.00",$0.00,"$1,930.00",$0.00,"$1,377.44",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,930.00",$0.00,$965.00,"$1,528.56","$1,544.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-5-0518,SUP,Custom 27803010,,72-5-0518  -  INSERT TIB 5 18MM KNEE PS SCRP SFLX,"$1,930.00",$0.00,"$1,930.00",$0.00,"$1,377.44",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,930.00",$0.00,$965.00,"$1,528.56","$1,544.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-5-0521,SUP,Custom 27803010,,72-5-0521  -  INSERT TIB 5 21MM KNEE PS SCRP SFLX,"$2,013.00",$0.00,"$2,013.00",$0.00,"$1,436.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,013.00",$0.00,"$1,006.50","$1,594.30","$1,610.40",$0.00,$0.00,$0.00,$0.00,$0.00
72-5-0524,SUP,Custom 27803010,,72-5-0524  -  INSERT TIB 5 44X66X24MM SCRPFLX 1 AXIS PS PE KN,"$2,013.00",$0.00,"$2,013.00",$0.00,"$1,436.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,013.00",$0.00,"$1,006.50","$1,594.30","$1,610.40",$0.00,$0.00,$0.00,$0.00,$0.00
72-5-0708,SUP,Custom 27803010,,72-5-0708  -  INSERT TIB 7 8MM KNEE PS SCRP SFLX,"$1,930.00",$0.00,"$1,930.00",$0.00,"$1,377.44",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,930.00",$0.00,$965.00,"$1,528.56","$1,544.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-5-0710,SUP,Custom 27803010,,72-5-0710  -  INSERT TIB KNEE PS SCRPFLX,"$1,930.00",$0.00,"$1,930.00",$0.00,"$1,377.44",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,930.00",$0.00,$965.00,"$1,528.56","$1,544.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-5-0712,SUP,Custom 27803010,,72-5-0712  -  INSERT TIB 7 12MM KNEE PS SCRP SFLX,"$1,930.00",$0.00,"$1,930.00",$0.00,"$1,377.44",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,930.00",$0.00,$965.00,"$1,528.56","$1,544.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-5-0715,SUP,Custom 27803010,,72-5-0715  -  INSERT TIB 7 15MM KNEE PS SCRP SFLX,"$1,930.00",$0.00,"$1,930.00",$0.00,"$1,377.44",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,930.00",$0.00,$965.00,"$1,528.56","$1,544.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-5-0718,SUP,Custom 27803010,,72-5-0718  -  INSERT TIB 7 18MM KNEE PS SCRP SFLX,"$1,930.00",$0.00,"$1,930.00",$0.00,"$1,377.44",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,930.00",$0.00,$965.00,"$1,528.56","$1,544.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-5-0721,SUP,Custom 27803010,,72-5-0721  -  INSERT TIB 7 21MM SCRP SFLX POST STAB KN,"$2,013.00",$0.00,"$2,013.00",$0.00,"$1,436.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,013.00",$0.00,"$1,006.50","$1,594.30","$1,610.40",$0.00,$0.00,$0.00,$0.00,$0.00
72-5-0724,SUP,Custom 27803010,,72-5-0724  -  INSERT TIB 7 24MM SCRPFLX POST STAB X3 KN,"$2,013.00",$0.00,"$2,013.00",$0.00,"$1,436.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,013.00",$0.00,"$1,006.50","$1,594.30","$1,610.40",$0.00,$0.00,$0.00,$0.00,$0.00
72-5-0908,SUP,HCPCS C1776,,72-5-0908  -  CMPNT TIB 8MM SCRP 9 KNEE PE PS,"$1,930.00",$0.00,"$1,930.00",$868.50,"$1,377.44",$0.00,$332.53,$0.00,$0.00,$337.93,"$1,930.00",$0.00,$965.00,"$1,528.56","$1,544.00",$0.00,$302.05,$0.00,$307.26,$0.00
72-5-0910,SUP,Custom 27803010,,72-5-0910  -  INSERT TIB 9 10MM RIGHT KNEE PS SCRP SFLX,"$1,930.00",$0.00,"$1,930.00",$0.00,"$1,377.44",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,930.00",$0.00,$965.00,"$1,528.56","$1,544.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-5-0912,SUP,Custom 27803010,,72-5-0912  -  INSERT TIB 9 12MM KNEE PS SCRP SFLX,"$1,930.00",$0.00,"$1,930.00",$0.00,"$1,377.44",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,930.00",$0.00,$965.00,"$1,528.56","$1,544.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-5-0915,SUP,Custom 27803010,,72-5-0915  -  INSERT TIB 9 15MM KNEE PS SCRP SFLX,"$1,930.00",$0.00,"$1,930.00",$0.00,"$1,377.44",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,930.00",$0.00,$965.00,"$1,528.56","$1,544.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-5-0918,SUP,Custom 27803010,,72-5-0918  -  INSERT TIB 9 18MM SCRP SFLX POST STAB ARTC KN,"$1,930.00",$0.00,"$1,930.00",$0.00,"$1,377.44",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,930.00",$0.00,$965.00,"$1,528.56","$1,544.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-5-0921,SUP,Custom 27803010,,72-5-0921  -  INSERT TIB 9 21MM SCRP SFLX POST STAB ARTC KN,"$2,013.00",$0.00,"$2,013.00",$0.00,"$1,436.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,013.00",$0.00,"$1,006.50","$1,594.30","$1,610.40",$0.00,$0.00,$0.00,$0.00,$0.00
72-5-0924,SUP,Custom 27803010,,72-5-0924  -  INSERT TIB 9 24MM SCRP SFLX POST STAB KN,"$2,013.00",$0.00,"$2,013.00",$0.00,"$1,436.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,013.00",$0.00,"$1,006.50","$1,594.30","$1,610.40",$0.00,$0.00,$0.00,$0.00,$0.00
72-5-1110,SUP,Custom 27803010,,72-5-1110  -  INSERT TIB 11 10MM KNEE PS SCRP SFLX,"$1,930.00",$0.00,"$1,930.00",$0.00,"$1,377.44",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,930.00",$0.00,$965.00,"$1,528.56","$1,544.00",$0.00,$0.00,$0.00,$0.00,$0.00
72-6-0515,SUP,Custom 27803010,,72-6-0515  -  INSERT TIB 5 15MM SCRP SFLX CRCTE RTN KN,"$1,922.00",$0.00,"$1,922.00",$0.00,"$1,371.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,922.00",$0.00,$961.00,"$1,522.22","$1,537.60",$0.00,$0.00,$0.00,$0.00,$0.00
72-6-0708,SUP,Custom 27803010,,72-6-0708  -  INSERT TIB 7 8MM KNEE CRUC RET SCRP SFLX,"$1,922.00",$0.00,"$1,922.00",$0.00,"$1,371.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,922.00",$0.00,$961.00,"$1,522.22","$1,537.60",$0.00,$0.00,$0.00,$0.00,$0.00
72-6-0710,SUP,Custom 27803010,,72-6-0710  -  INSERT TIB KNEE CRUC RET SCRP SFLX,"$1,922.00",$0.00,"$1,922.00",$0.00,"$1,371.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,922.00",$0.00,$961.00,"$1,522.22","$1,537.60",$0.00,$0.00,$0.00,$0.00,$0.00
72-6-0908,SUP,Custom 27803010,,72-6-0908  -  INSERT TIB 9 8MM KNEE CRUC RET SCRP SFLX,"$1,922.00",$0.00,"$1,922.00",$0.00,"$1,371.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,922.00",$0.00,$961.00,"$1,522.22","$1,537.60",$0.00,$0.00,$0.00,$0.00,$0.00
72-6-1110,SUP,Custom 27803010,,72-6-1110  -  INSERT TIB 11 10MM SCRP SFLX CRCTE RTN KN,"$1,922.00",$0.00,"$1,922.00",$0.00,"$1,371.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,922.00",$0.00,$961.00,"$1,522.22","$1,537.60",$0.00,$0.00,$0.00,$0.00,$0.00
72821012S,SUP,HCPCS C1713,,72821012S  -  PLATE BN 20X11MM STRL VLP LT MDL LAT TALUS 2.5MM SCR,"$2,062.50",$0.00,"$2,062.50",$928.13,"$1,472.01",$0.00,$355.36,$0.00,$0.00,$361.13,"$2,062.50",$0.00,"$1,031.25","$1,633.50","$1,650.00",$0.00,$322.78,$0.00,$328.35,$0.00
72821013S,SUP,HCPCS C1713,,72821013S  -  PLATE BN 20X11MM STRL VLP RT MDL LAT TALUS 2.5MM SCR,"$2,062.50",$0.00,"$2,062.50",$928.13,"$1,472.01",$0.00,$355.36,$0.00,$0.00,$361.13,"$2,062.50",$0.00,"$1,031.25","$1,633.50","$1,650.00",$0.00,$322.78,$0.00,$328.35,$0.00
72821014S,SUP,HCPCS C1713,,72821014S  -  PLATE BN 22X16MM STRL VLP 3 HL L/L TALUS 2.5MM SCR,"$2,062.50",$0.00,"$2,062.50",$928.13,"$1,472.01",$0.00,$355.36,$0.00,$0.00,$361.13,"$2,062.50",$0.00,"$1,031.25","$1,633.50","$1,650.00",$0.00,$322.78,$0.00,$328.35,$0.00
72821015S,SUP,HCPCS C1713,,72821015S  -  PLATE BN 22X16MM STRL VLP 3 HL RL TALUS 2.5MM SCR,"$2,062.50",$0.00,"$2,062.50",$928.13,"$1,472.01",$0.00,$355.36,$0.00,$0.00,$361.13,"$2,062.50",$0.00,"$1,031.25","$1,633.50","$1,650.00",$0.00,$322.78,$0.00,$328.35,$0.00
72821016S,SUP,HCPCS C1713,,72821016S  -  PLATE BN 25X16MM STRL VLP 4 HL L/L TALUS 2.5MM SCR,"$2,275.00",$0.00,"$2,275.00","$1,023.75","$1,623.67",$0.00,$391.97,$0.00,$0.00,$398.33,"$2,275.00",$0.00,"$1,137.50","$1,801.80","$1,820.00",$0.00,$356.04,$0.00,$362.18,$0.00
72821017S,SUP,HCPCS C1713,,72821017S  -  PLATE BN 25X16MM STRL VLP 4 HL RL TALUS FT 2.5MM SCR,"$2,275.00",$0.00,"$2,275.00","$1,023.75","$1,623.67",$0.00,$391.97,$0.00,$0.00,$398.33,"$2,275.00",$0.00,"$1,137.50","$1,801.80","$1,820.00",$0.00,$356.04,$0.00,$362.18,$0.00
72821018S,SUP,HCPCS C1713,,72821018S  -  PLATE BN SM 55MM STRL VLP LT CALCANEUS FT 2.7MM SCR PERC,"$2,306.25",$0.00,"$2,306.25","$1,037.81","$1,645.97",$0.00,$397.36,$0.00,$0.00,$403.81,"$2,306.25",$0.00,"$1,153.13","$1,826.55","$1,845.00",$0.00,$360.93,$0.00,$367.16,$0.00
72821019S,SUP,HCPCS C1713,,72821019S  -  PLATE BN SM 55MM STRL VLP RT CALCANEUS 2.7MM SCR PERC,"$2,306.25",$0.00,"$2,306.25","$1,037.81","$1,645.97",$0.00,$397.36,$0.00,$0.00,$403.81,"$2,306.25",$0.00,"$1,153.13","$1,826.55","$1,845.00",$0.00,$360.93,$0.00,$367.16,$0.00
72821020S,SUP,HCPCS C1713,,72821020S  -  PLATE BN LG 62 STRL VLP LT CALCANEUS FT 2.7MM SCR PERC,"$2,512.50",$0.00,"$2,512.50","$1,130.63","$1,793.17",$0.00,$432.89,$0.00,$0.00,$439.92,"$2,512.50",$0.00,"$1,256.25","$1,989.90","$2,010.00",$0.00,$393.21,$0.00,$399.99,$0.00
72821021S,SUP,HCPCS C1713,,72821021S  -  PLATE BN LG 62 STRL VLP RT CALCANEUS FT 2.7MM SCR PERC,"$2,512.50",$0.00,"$2,512.50","$1,130.63","$1,793.17",$0.00,$432.89,$0.00,$0.00,$439.92,"$2,512.50",$0.00,"$1,256.25","$1,989.90","$2,010.00",$0.00,$393.21,$0.00,$399.99,$0.00
72821022S,SUP,HCPCS C1713,,72821022S  -  PLATE BN 67MM STRL 3 HL FSN PRM RT ANT ANKL 3.5MM SCR,"$2,375.00",$0.00,"$2,375.00","$1,068.75","$1,695.04",$0.00,$409.20,$0.00,$0.00,$415.84,"$2,375.00",$0.00,"$1,187.50","$1,881.00","$1,900.00",$0.00,$371.69,$0.00,$378.10,$0.00
72821023S,SUP,HCPCS C1713,,72821023S  -  PLATE BN 67MM STRL 3 HL FSN PRM LT ANT ANKL 3.5MM SCR,"$2,375.00",$0.00,"$2,375.00","$1,068.75","$1,695.04",$0.00,$409.20,$0.00,$0.00,$415.84,"$2,375.00",$0.00,"$1,187.50","$1,881.00","$1,900.00",$0.00,$371.69,$0.00,$378.10,$0.00
72821024S,SUP,HCPCS C1713,,72821024S  -  PLATE BN 92MM STRL 5 HL FSN PRM RT ANT ANKL 3.5MM SCR,"$2,437.50",$0.00,"$2,437.50","$1,096.88","$1,739.64",$0.00,$419.97,$0.00,$0.00,$426.79,"$2,437.50",$0.00,"$1,218.75","$1,930.50","$1,950.00",$0.00,$381.47,$0.00,$388.05,$0.00
72821025S,SUP,HCPCS C1713,,72821025S  -  PLATE BN 92MM STRL 5 HL FSN PRM LT ANT ANKL 3.5MM SCR,"$2,437.50",$0.00,"$2,437.50","$1,096.88","$1,739.64",$0.00,$419.97,$0.00,$0.00,$426.79,"$2,437.50",$0.00,"$1,218.75","$1,930.50","$1,950.00",$0.00,$381.47,$0.00,$388.05,$0.00
72821026S,SUP,HCPCS C1713,,72821026S  -  PLATE BN 79MM STRL 3 HL FSN UTL RT ANKL HINDFOOT 3.5MM SCR,"$2,575.00",$0.00,"$2,575.00","$1,158.75","$1,837.78",$0.00,$443.66,$0.00,$0.00,$450.86,"$2,575.00",$0.00,"$1,287.50","$2,039.40","$2,060.00",$0.00,$402.99,$0.00,$409.94,$0.00
72821027S,SUP,HCPCS C1713,,72821027S  -  PLATE BN 79MM STRL 3 HL FSN UTL LT ANKL HINDFOOT 3.5MM SCR,"$2,575.00",$0.00,"$2,575.00","$1,158.75","$1,837.78",$0.00,$443.66,$0.00,$0.00,$450.86,"$2,575.00",$0.00,"$1,287.50","$2,039.40","$2,060.00",$0.00,$402.99,$0.00,$409.94,$0.00
72821028S,SUP,HCPCS C1713,,72821028S  -  PLATE BN 5 FSN UTL RT ANKL HINDFOOT 3.5MM SCR,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,$0.00,$0.00,$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
72821029S,SUP,HCPCS C1713,,72821029S  -  PLATE BN 79MM STRL 5 HL FSN UTL LT ANKL HINDFOOT 3.5MM SCR,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,$0.00,$0.00,$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
72821030S,SUP,HCPCS C1713,,72821030S  -  PLATE BN 120MM STRL PRLC FSN RL TIB TALOCALCANEUS ANKL 4.5MM,"$2,437.50",$0.00,"$2,437.50","$1,096.88","$1,739.64",$0.00,$419.97,$0.00,$0.00,$426.79,"$2,437.50",$0.00,"$1,218.75","$1,930.50","$1,950.00",$0.00,$381.47,$0.00,$388.05,$0.00
72821031S,SUP,HCPCS C1713,,72821031S  -  PLATE BN 120MM STRL PRLC FSN L/L TIB TALOCALCANEUS ANKL 4.5,"$2,437.50",$0.00,"$2,437.50","$1,096.88","$1,739.64",$0.00,$419.97,$0.00,$0.00,$426.79,"$2,437.50",$0.00,"$1,218.75","$1,930.50","$1,950.00",$0.00,$381.47,$0.00,$388.05,$0.00
72821034S,SUP,HCPCS C1713,,72821034S  -  PLATE BN 80MMX3.8-5.3MM STRL PRLC FSN RT POST ANKL 3.5MM SCR,"$2,375.00",$0.00,"$2,375.00","$1,068.75","$1,695.04",$0.00,$409.20,$0.00,$0.00,$415.84,"$2,375.00",$0.00,"$1,187.50","$1,881.00","$1,900.00",$0.00,$371.69,$0.00,$378.10,$0.00
72821035S,SUP,HCPCS C1713,,72821035S  -  PLATE BN 80MM STRL PRLC FSN LT POST ANKL 3.5MM SCR SM FRAG,"$2,375.00",$0.00,"$2,375.00","$1,068.75","$1,695.04",$0.00,$409.20,$0.00,$0.00,$415.84,"$2,375.00",$0.00,"$1,187.50","$1,881.00","$1,900.00",$0.00,$371.69,$0.00,$378.10,$0.00
72821036S,SUP,HCPCS C1713,,72821036S  -  PLATE BONE MEDIUM 58MM VLP LEFT CALCANEUS FT STERILE 2.7MM,"$2,400.00",$0.00,"$2,400.00","$1,080.00","$1,712.88",$0.00,$413.51,$0.00,$0.00,$420.22,"$2,400.00",$0.00,"$1,200.00","$1,900.80","$1,920.00",$0.00,$375.60,$0.00,$382.08,$0.00
72821037S,SUP,HCPCS C1713,,72821037S  -  PLATE BN MED 58MM STRL VLP RT CALCANEUS FT 2.7MM SCR PERC,"$2,400.00",$0.00,"$2,400.00","$1,080.00","$1,712.88",$0.00,$413.51,$0.00,$0.00,$420.22,"$2,400.00",$0.00,"$1,200.00","$1,900.80","$1,920.00",$0.00,$375.60,$0.00,$382.08,$0.00
72821040S,SUP,HCPCS C1713,,72821040S  -  PLATE BN 20X17MM STRL VLP LT MDL LAT TALUS TIB 2.5MM SCR,"$2,275.00",$0.00,"$2,275.00","$1,023.75","$1,623.67",$0.00,$391.97,$0.00,$0.00,$398.33,"$2,275.00",$0.00,"$1,137.50","$1,801.80","$1,820.00",$0.00,$356.04,$0.00,$362.18,$0.00
72821041S,SUP,HCPCS C1713,,72821041S  -  PLATE BN 20X17MM STRL VLP RT DIST MDL TALUS 2.5MM SCR,"$2,275.00",$0.00,"$2,275.00","$1,023.75","$1,623.67",$0.00,$391.97,$0.00,$0.00,$398.33,"$2,275.00",$0.00,"$1,137.50","$1,801.80","$1,820.00",$0.00,$356.04,$0.00,$362.18,$0.00
72821042S,SUP,HCPCS C1713,,72821042S  -  PLATE BN 67MM STRL PRLC 3 HL FSN PRM CMPR SLOT ANKL RT ANT,"$2,375.00",$0.00,"$2,375.00","$1,068.75","$1,695.04",$0.00,$409.20,$0.00,$0.00,$415.84,"$2,375.00",$0.00,"$1,187.50","$1,881.00","$1,900.00",$0.00,$371.69,$0.00,$378.10,$0.00
72821043S,SUP,HCPCS C1713,,72821043S  -  PLATE BN 67MM STRL PRLC 3 HL FSN PRM CMPR SLOT ANKL LT ANT,"$2,375.00",$0.00,"$2,375.00","$1,068.75","$1,695.04",$0.00,$409.20,$0.00,$0.00,$415.84,"$2,375.00",$0.00,"$1,187.50","$1,881.00","$1,900.00",$0.00,$371.69,$0.00,$378.10,$0.00
72821044S,SUP,HCPCS C1713,,72821044S  -  PLATE BN 92MM STRL ANCHORAGE 5 HL PRM FSN CMPR RT ANT,"$2,437.50",$0.00,"$2,437.50","$1,096.88","$1,739.64",$0.00,$419.97,$0.00,$0.00,$426.79,"$2,437.50",$0.00,"$1,218.75","$1,930.50","$1,950.00",$0.00,$381.47,$0.00,$388.05,$0.00
72821045S,SUP,HCPCS C1713,,72821045S  -  PLATE BN 92MM STRL PRLC 5 HL FSN PRM CMPR SLOT ANKL LT 3.5MM,"$2,437.50",$0.00,"$2,437.50","$1,096.88","$1,739.64",$0.00,$419.97,$0.00,$0.00,$426.79,"$2,437.50",$0.00,"$1,218.75","$1,930.50","$1,950.00",$0.00,$381.47,$0.00,$388.05,$0.00
72821046S,SUP,HCPCS C1713,,72821046S  -  PLATE BN 5 FSN UTL CMPR RT ANKL HINDFOOT 3.5MM SCR,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,$0.00,$0.00,$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
72821047S,SUP,HCPCS C1713,,72821047S  -  PLATE BN 104MM STRL PER-LOC 5 HL FSN UTL CMPR SLOT LT,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,$0.00,$0.00,$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
72821048S,SUP,HCPCS C1713,,72821048S  -  PLATE BN XL 68X33.5X1.27MM STRL VLP VA FT LT CALCANEUS PERC,"$2,606.25",$0.00,"$2,606.25","$1,172.81","$1,860.08",$0.00,$449.04,$0.00,$0.00,$456.33,"$2,606.25",$0.00,"$1,303.13","$2,064.15","$2,085.00",$0.00,$407.88,$0.00,$414.92,$0.00
72821049S,SUP,HCPCS C1713,,72821049S  -  PLATE BN XL 68MM VLP RT CALCANEUS FT 2.7MM SCR PERC,"$2,606.25",$0.00,"$2,606.25","$1,172.81","$1,860.08",$0.00,$449.04,$0.00,$0.00,$456.33,"$2,606.25",$0.00,"$1,303.13","$2,064.15","$2,085.00",$0.00,$407.88,$0.00,$414.92,$0.00
72822206S,SUP,HCPCS C1713,,72822206S  -  SCREW BN 2.5MM 6MM STRL VLP ST T7 STRDR RCS FT,$286.25,$0.00,$286.25,$128.81,$204.30,$0.00,$49.32,$0.00,$0.00,$50.12,$286.25,$0.00,$143.13,$226.71,$229.00,$0.00,$44.80,$0.00,$45.57,$0.00
72822208S,SUP,HCPCS C1713,,72822208S  -  SCREW BN 2.5MM 8MM STRL VLP ST T7 STRDR RCS FT,$286.25,$0.00,$286.25,$128.81,$204.30,$0.00,$49.32,$0.00,$0.00,$50.12,$286.25,$0.00,$143.13,$226.71,$229.00,$0.00,$44.80,$0.00,$45.57,$0.00
72822210S,SUP,HCPCS C1713,,72822210S  -  SCREW BN 2.5MM 10MM STRL VLP ST T7 STRDR RCS FT,$286.25,$0.00,$286.25,$128.81,$204.30,$0.00,$49.32,$0.00,$0.00,$50.12,$286.25,$0.00,$143.13,$226.71,$229.00,$0.00,$44.80,$0.00,$45.57,$0.00
72822212S,SUP,HCPCS C1713,,72822212S  -  SCREW BN 2.5MM 12MM STRL VLP ST T7 STRDR RCS FT,$286.25,$0.00,$286.25,$128.81,$204.30,$0.00,$49.32,$0.00,$0.00,$50.12,$286.25,$0.00,$143.13,$226.71,$229.00,$0.00,$44.80,$0.00,$45.57,$0.00
72822214S,SUP,HCPCS C1713,,72822214S  -  SCREW BN 2.5MM 14MM STRL VLP ST T7 STRDR RCS FT,$286.25,$0.00,$286.25,$128.81,$204.30,$0.00,$49.32,$0.00,$0.00,$50.12,$286.25,$0.00,$143.13,$226.71,$229.00,$0.00,$44.80,$0.00,$45.57,$0.00
72822216S,SUP,HCPCS C1713,,72822216S  -  SCREW BN 2.5MM 16MM STRL VLP ST T7 STRDR RCS FT,$286.25,$0.00,$286.25,$128.81,$204.30,$0.00,$49.32,$0.00,$0.00,$50.12,$286.25,$0.00,$143.13,$226.71,$229.00,$0.00,$44.80,$0.00,$45.57,$0.00
72822218S,SUP,HCPCS C1713,,72822218S  -  SCREW BN 2.5MM 18MM STRL VLP ST T7 STRDR RCS FT,$286.25,$0.00,$286.25,$128.81,$204.30,$0.00,$49.32,$0.00,$0.00,$50.12,$286.25,$0.00,$143.13,$226.71,$229.00,$0.00,$44.80,$0.00,$45.57,$0.00
72822220S,SUP,HCPCS C1713,,72822220S  -  SCREW BN 2.5MM 20MM STRL VLP ST T7 STRDR RCS FT,$286.25,$0.00,$286.25,$128.81,$204.30,$0.00,$49.32,$0.00,$0.00,$50.12,$286.25,$0.00,$143.13,$226.71,$229.00,$0.00,$44.80,$0.00,$45.57,$0.00
72822222S,SUP,HCPCS C1713,,72822222S  -  SCREW BN 2.5MM 22MM STRL VLP ST T7 STRDR RCS FT,$286.25,$0.00,$286.25,$128.81,$204.30,$0.00,$49.32,$0.00,$0.00,$50.12,$286.25,$0.00,$143.13,$226.71,$229.00,$0.00,$44.80,$0.00,$45.57,$0.00
72822224S,SUP,HCPCS C1713,,72822224S  -  SCREW BN 2.5MM 24MM STRL VLP ST T7 STRDR RCS FT,$286.25,$0.00,$286.25,$128.81,$204.30,$0.00,$49.32,$0.00,$0.00,$50.12,$286.25,$0.00,$143.13,$226.71,$229.00,$0.00,$44.80,$0.00,$45.57,$0.00
72822226S,SUP,HCPCS C1713,,72822226S  -  SCREW BN 2.5MM 26MM STRL VLP ST T7 STRDR RCS FT,$286.25,$0.00,$286.25,$128.81,$204.30,$0.00,$49.32,$0.00,$0.00,$50.12,$286.25,$0.00,$143.13,$226.71,$229.00,$0.00,$44.80,$0.00,$45.57,$0.00
72822228S,SUP,HCPCS C1713,,72822228S  -  SCREW BN 2.5MM 28MM STRL VLP ST T7 STRDR RCS FT,$286.25,$0.00,$286.25,$128.81,$204.30,$0.00,$49.32,$0.00,$0.00,$50.12,$286.25,$0.00,$143.13,$226.71,$229.00,$0.00,$44.80,$0.00,$45.57,$0.00
72822230S,SUP,HCPCS C1713,,72822230S  -  SCREW BN 2.5MM 30MM STRL VLP ST T7 STRDR RCS FT,$286.25,$0.00,$286.25,$128.81,$204.30,$0.00,$49.32,$0.00,$0.00,$50.12,$286.25,$0.00,$143.13,$226.71,$229.00,$0.00,$44.80,$0.00,$45.57,$0.00
72822232S,SUP,HCPCS C1713,,72822232S  -  SCREW BN 2.5MM 32MM STRL VLP ST T7 STRDR RCS FT,$286.25,$0.00,$286.25,$128.81,$204.30,$0.00,$49.32,$0.00,$0.00,$50.12,$286.25,$0.00,$143.13,$226.71,$229.00,$0.00,$44.80,$0.00,$45.57,$0.00
72822234S,SUP,HCPCS C1713,,72822234S  -  SCREW BN 2.5MM 34MM STRL VLP ST T7 STRDR RCS FT,$286.25,$0.00,$286.25,$128.81,$204.30,$0.00,$49.32,$0.00,$0.00,$50.12,$286.25,$0.00,$143.13,$226.71,$229.00,$0.00,$44.80,$0.00,$45.57,$0.00
72822236S,SUP,HCPCS C1713,,72822236S  -  SCREW BN 2.5MM 36MM STRL VLP ST T7 STRDR RCS FT,$286.25,$0.00,$286.25,$128.81,$204.30,$0.00,$49.32,$0.00,$0.00,$50.12,$286.25,$0.00,$143.13,$226.71,$229.00,$0.00,$44.80,$0.00,$45.57,$0.00
72822238S,SUP,HCPCS C1713,,72822238S  -  SCREW BN 2.5MM 38MM STRL VLP ST T7 STRDR RCS FT,$286.25,$0.00,$286.25,$128.81,$204.30,$0.00,$49.32,$0.00,$0.00,$50.12,$286.25,$0.00,$143.13,$226.71,$229.00,$0.00,$44.80,$0.00,$45.57,$0.00
72822240S,SUP,HCPCS C1713,,72822240S  -  SCREW BN 2.5MM 40MM STRL VLP ST T7 STRDR RCS FT,$286.25,$0.00,$286.25,$128.81,$204.30,$0.00,$49.32,$0.00,$0.00,$50.12,$286.25,$0.00,$143.13,$226.71,$229.00,$0.00,$44.80,$0.00,$45.57,$0.00
72822245S,SUP,HCPCS C1713,,72822245S  -  SCREW BN 2.5MM 45MM STRL VLP ST T7 STRDR RCS FT,$286.25,$0.00,$286.25,$128.81,$204.30,$0.00,$49.32,$0.00,$0.00,$50.12,$286.25,$0.00,$143.13,$226.71,$229.00,$0.00,$44.80,$0.00,$45.57,$0.00
72822250S,SUP,HCPCS C1713,,72822250S  -  SCREW BN 2.5MM 50MM STRL VLP ST T7 STRDR RCS FT,$286.25,$0.00,$286.25,$128.81,$204.30,$0.00,$49.32,$0.00,$0.00,$50.12,$286.25,$0.00,$143.13,$226.71,$229.00,$0.00,$44.80,$0.00,$45.57,$0.00
72823003S,SUP,HCPCS C1713,,72823003S  -  PLATE BN STRL PRLC VLP 3 HL 1/3 TBLR 3.5 MM SCR,$505.00,$0.00,$505.00,$227.25,$360.42,$0.00,$87.01,$0.00,$0.00,$88.42,$505.00,$0.00,$252.50,$399.96,$404.00,$0.00,$79.03,$0.00,$80.40,$0.00
72823004S,SUP,HCPCS C1713,,72823004S  -  PLATE BN 1/3 TBLR STRL PRLC VLP 4 HL 3.5MM SCR,$505.00,$0.00,$505.00,$227.25,$360.42,$0.00,$87.01,$0.00,$0.00,$88.42,$505.00,$0.00,$252.50,$399.96,$404.00,$0.00,$79.03,$0.00,$80.40,$0.00
72823106S,SUP,HCPCS C1713,,72823106S  -  SCREW BN ST 2.7MM 6MM STRL VLP LCK CORT FT,$297.50,$0.00,$297.50,$133.88,$212.33,$0.00,$51.26,$0.00,$0.00,$52.09,$297.50,$0.00,$148.75,$235.62,$238.00,$0.00,$46.56,$0.00,$47.36,$0.00
72823108S,SUP,HCPCS C1713,,72823108S  -  SCREW BN ST 2.7MM 8MM STRL VLP ST LCK FT CORT,$297.50,$0.00,$297.50,$133.88,$212.33,$0.00,$51.26,$0.00,$0.00,$52.09,$297.50,$0.00,$148.75,$235.62,$238.00,$0.00,$46.56,$0.00,$47.36,$0.00
72823110S,SUP,HCPCS C1713,,72823110S  -  SCREW BN 5MM 38MM VLP ST LCK CORT FOREFOOT MIDFOOT,$297.50,$0.00,$297.50,$133.88,$212.33,$0.00,$51.26,$0.00,$0.00,$52.09,$297.50,$0.00,$148.75,$235.62,$238.00,$0.00,$46.56,$0.00,$47.36,$0.00
72823112S,SUP,HCPCS C1713,,72823112S  -  SCREW BN 2.7MM 12MM STRL VLP ST LCK CORT FOREFOOT MIDFOOT,$297.50,$0.00,$297.50,$133.88,$212.33,$0.00,$51.26,$0.00,$0.00,$52.09,$297.50,$0.00,$148.75,$235.62,$238.00,$0.00,$46.56,$0.00,$47.36,$0.00
72823114S,SUP,HCPCS C1713,,72823114S  -  SCREW BN 2.7MM 14MM STRL VLP ST LCK CORT FOREFOOT MIDFOOT,$297.50,$0.00,$297.50,$133.88,$212.33,$0.00,$51.26,$0.00,$0.00,$52.09,$297.50,$0.00,$148.75,$235.62,$238.00,$0.00,$46.56,$0.00,$47.36,$0.00
72823116S,SUP,HCPCS C1713,,72823116S  -  SCREW BN 2.7MM 16MM STRL VLP ST LCK CORT FOREFOOT MIDFOOT,$297.50,$0.00,$297.50,$133.88,$212.33,$0.00,$51.26,$0.00,$0.00,$52.09,$297.50,$0.00,$148.75,$235.62,$238.00,$0.00,$46.56,$0.00,$47.36,$0.00
72823118S,SUP,HCPCS C1713,,72823118S  -  SCREW BN 2.7MM 18MM STRL VLP ST LCK CORT FOREFOOT MIDFOOT,$297.50,$0.00,$297.50,$133.88,$212.33,$0.00,$51.26,$0.00,$0.00,$52.09,$297.50,$0.00,$148.75,$235.62,$238.00,$0.00,$46.56,$0.00,$47.36,$0.00
72823120S,SUP,HCPCS C1713,,72823120S  -  SCREW BN 2.7MM 20MM STRL VLP ST LCK CORT FOREFOOT MIDFOOT,$297.50,$0.00,$297.50,$133.88,$212.33,$0.00,$51.26,$0.00,$0.00,$52.09,$297.50,$0.00,$148.75,$235.62,$238.00,$0.00,$46.56,$0.00,$47.36,$0.00
72823122S,SUP,HCPCS C1713,,72823122S  -  SCREW BN 2.7MM 22MM STRL VLP ST LCK CORT FOREFOOT MIDFOOT,$297.50,$0.00,$297.50,$133.88,$212.33,$0.00,$51.26,$0.00,$0.00,$52.09,$297.50,$0.00,$148.75,$235.62,$238.00,$0.00,$46.56,$0.00,$47.36,$0.00
72823124S,SUP,HCPCS C1713,,72823124S  -  SCREW BN 2.7MM 24MM STRL VLP ST LCK CORT FOREFOOT MIDFOOT,$297.50,$0.00,$297.50,$133.88,$212.33,$0.00,$51.26,$0.00,$0.00,$52.09,$297.50,$0.00,$148.75,$235.62,$238.00,$0.00,$46.56,$0.00,$47.36,$0.00
72823126S,SUP,HCPCS C1713,,72823126S  -  SCREW BN 2.7MM 26MM STRL VLP ST LCK CORT FOREFOOT MIDFOOT,$297.50,$0.00,$297.50,$133.88,$212.33,$0.00,$51.26,$0.00,$0.00,$52.09,$297.50,$0.00,$148.75,$235.62,$238.00,$0.00,$46.56,$0.00,$47.36,$0.00
72823128S,SUP,HCPCS C1713,,72823128S  -  SCREW BN 2.7MM 28MM STRL VLP ST LCK CORT FOREFOOT MIDFOOT,$297.50,$0.00,$297.50,$133.88,$212.33,$0.00,$51.26,$0.00,$0.00,$52.09,$297.50,$0.00,$148.75,$235.62,$238.00,$0.00,$46.56,$0.00,$47.36,$0.00
72823130S,SUP,HCPCS C1713,,72823130S  -  SCREW BN 2.7MM 30MM STRL VLP ST LCK CORT FOREFOOT MIDFOOT,$297.50,$0.00,$297.50,$133.88,$212.33,$0.00,$51.26,$0.00,$0.00,$52.09,$297.50,$0.00,$148.75,$235.62,$238.00,$0.00,$46.56,$0.00,$47.36,$0.00
72823132S,SUP,HCPCS C1713,,72823132S  -  SCREW BN 2.7MM 32MM STRL VLP ST LCK CORT FOREFOOT MIDFOOT,$297.50,$0.00,$297.50,$133.88,$212.33,$0.00,$51.26,$0.00,$0.00,$52.09,$297.50,$0.00,$148.75,$235.62,$238.00,$0.00,$46.56,$0.00,$47.36,$0.00
72823134S,SUP,HCPCS C1713,,72823134S  -  SCREW BN 2.7MM 34MM STRL VLP ST LCK CORT FOREFOOT MIDFOOT,$297.50,$0.00,$297.50,$133.88,$212.33,$0.00,$51.26,$0.00,$0.00,$52.09,$297.50,$0.00,$148.75,$235.62,$238.00,$0.00,$46.56,$0.00,$47.36,$0.00
72823136S,SUP,HCPCS C1713,,72823136S  -  SCREW BN 2.7MM 36MM STRL VLP ST LCK CORT FOREFOOT MIDFOOT,$297.50,$0.00,$297.50,$133.88,$212.33,$0.00,$51.26,$0.00,$0.00,$52.09,$297.50,$0.00,$148.75,$235.62,$238.00,$0.00,$46.56,$0.00,$47.36,$0.00
72823138S,SUP,HCPCS C1713,,72823138S  -  SCREW BN 2.7MM 38MM STRL VLP ST LCK CORT FOREFOOT MIDFOOT,$297.50,$0.00,$297.50,$133.88,$212.33,$0.00,$51.26,$0.00,$0.00,$52.09,$297.50,$0.00,$148.75,$235.62,$238.00,$0.00,$46.56,$0.00,$47.36,$0.00
72823140S,SUP,HCPCS C1713,,72823140S  -  SCREW BN 2.7MM 40MM STRL VLP ST LCK CORT FOREFOOT MIDFOOT,$297.50,$0.00,$297.50,$133.88,$212.33,$0.00,$51.26,$0.00,$0.00,$52.09,$297.50,$0.00,$148.75,$235.62,$238.00,$0.00,$46.56,$0.00,$47.36,$0.00
72823142S,SUP,HCPCS C1713,,72823142S  -  SCREW BN 3 FLUT 2.7MM 4.9MM 42MM STRL VLP ST LCK CORT FT,$297.50,$0.00,$297.50,$133.88,$212.33,$0.00,$51.26,$0.00,$0.00,$52.09,$297.50,$0.00,$148.75,$235.62,$238.00,$0.00,$46.56,$0.00,$47.36,$0.00
72823144S,SUP,HCPCS C1713,,72823144S  -  SCREW BN 3 FLUT LOPRFL 2.7MM 4.9MM 44MM STRL VLP ST LCK CORT,$297.50,$0.00,$297.50,$133.88,$212.33,$0.00,$51.26,$0.00,$0.00,$52.09,$297.50,$0.00,$148.75,$235.62,$238.00,$0.00,$46.56,$0.00,$47.36,$0.00
72823146S,SUP,HCPCS C1713,,72823146S  -  SCREW BN 3 FLUT LOPRFL 2.7MM 4.9MM 46MM STRL VLP ST LCK CORT,$297.50,$0.00,$297.50,$133.88,$212.33,$0.00,$51.26,$0.00,$0.00,$52.09,$297.50,$0.00,$148.75,$235.62,$238.00,$0.00,$46.56,$0.00,$47.36,$0.00
72823148S,SUP,HCPCS C1713,,72823148S  -  SCREW BN 3 FLUT LOPRFL 2.7MM 4.9MM 48MM STRL VLP ST LCK CORT,$297.50,$0.00,$297.50,$133.88,$212.33,$0.00,$51.26,$0.00,$0.00,$52.09,$297.50,$0.00,$148.75,$235.62,$238.00,$0.00,$46.56,$0.00,$47.36,$0.00
72823150S,SUP,HCPCS C1713,,72823150S  -  SCREW BN 2.7MM 4.9MM 50MM STRL VLP 3 FLT ST LCK FT CORT PERC,$297.50,$0.00,$297.50,$133.88,$212.33,$0.00,$51.26,$0.00,$0.00,$52.09,$297.50,$0.00,$148.75,$235.62,$238.00,$0.00,$46.56,$0.00,$47.36,$0.00
72823206S,SUP,HCPCS C1713,,72823206S  -  SCREW BN FT 4MM 6MM STRL VLP FT OSTEOPENIA,$150.00,$0.00,$150.00,$67.50,$107.06,$0.00,$25.84,$0.00,$0.00,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
72823208S,SUP,HCPCS C1713,,72823208S  -  SCREW BN FT 4MM 8MM STRL VLP FT OSTEOPENIA,$150.00,$0.00,$150.00,$67.50,$107.06,$0.00,$25.84,$0.00,$0.00,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
72823210S,SUP,HCPCS C1713,,72823210S  -  SCREW BN 4MM 10MM STRL VLP FT FOREFOOT MIDFOOT OSTEOPENIA,$152.50,$0.00,$152.50,$68.63,$108.84,$0.00,$26.27,$0.00,$0.00,$26.70,$152.50,$0.00,$76.25,$120.78,$122.00,$0.00,$23.87,$0.00,$24.28,$0.00
72823212S,SUP,HCPCS C1713,,72823212S  -  SCREW BN 4MM 12MM STRL VLP FT FOREFOOT MIDFOOT OSTEOPENIA,$152.50,$0.00,$152.50,$68.63,$108.84,$0.00,$26.27,$0.00,$0.00,$26.70,$152.50,$0.00,$76.25,$120.78,$122.00,$0.00,$23.87,$0.00,$24.28,$0.00
72823214S,SUP,HCPCS C1713,,72823214S  -  SCREW BN 4MM 14MM STRL VLP FT FOREFOOT MIDFOOT OSTEOPENIA,$152.50,$0.00,$152.50,$68.63,$108.84,$0.00,$26.27,$0.00,$0.00,$26.70,$152.50,$0.00,$76.25,$120.78,$122.00,$0.00,$23.87,$0.00,$24.28,$0.00
72823216S,SUP,HCPCS C1713,,72823216S  -  SCREW BN 4MM 16MM STRL VLP FT FOREFOOT MIDFOOT OSTEOPENIA,$152.50,$0.00,$152.50,$68.63,$108.84,$0.00,$26.27,$0.00,$0.00,$26.70,$152.50,$0.00,$76.25,$120.78,$122.00,$0.00,$23.87,$0.00,$24.28,$0.00
72823218S,SUP,HCPCS C1713,,72823218S  -  SCREW BN 4MM 18MM STRL VLP FT FOREFOOT MIDFOOT OSTEOPENIA,$152.50,$0.00,$152.50,$68.63,$108.84,$0.00,$26.27,$0.00,$0.00,$26.70,$152.50,$0.00,$76.25,$120.78,$122.00,$0.00,$23.87,$0.00,$24.28,$0.00
72823220S,SUP,HCPCS C1713,,72823220S  -  SCREW BN 4MM 20MM STRL VLP FT FOREFOOT MIDFOOT OSTEOPENIA,$152.50,$0.00,$152.50,$68.63,$108.84,$0.00,$26.27,$0.00,$0.00,$26.70,$152.50,$0.00,$76.25,$120.78,$122.00,$0.00,$23.87,$0.00,$24.28,$0.00
72823222S,SUP,HCPCS C1713,,72823222S  -  SCREW BN 4MM 22MM STRL VLP FT FOREFOOT MIDFOOT OSTEOPENIA,$152.50,$0.00,$152.50,$68.63,$108.84,$0.00,$26.27,$0.00,$0.00,$26.70,$152.50,$0.00,$76.25,$120.78,$122.00,$0.00,$23.87,$0.00,$24.28,$0.00
72823224S,SUP,HCPCS C1713,,72823224S  -  SCREW BN 4MM 24MM STRL VLP FT FOREFOOT MIDFOOT OSTEOPENIA,$152.50,$0.00,$152.50,$68.63,$108.84,$0.00,$26.27,$0.00,$0.00,$26.70,$152.50,$0.00,$76.25,$120.78,$122.00,$0.00,$23.87,$0.00,$24.28,$0.00
72823226S,SUP,HCPCS C1713,,72823226S  -  SCREW BN 4MM 26MM STRL VLP FT FOREFOOT MIDFOOT OSTEOPENIA,$152.50,$0.00,$152.50,$68.63,$108.84,$0.00,$26.27,$0.00,$0.00,$26.70,$152.50,$0.00,$76.25,$120.78,$122.00,$0.00,$23.87,$0.00,$24.28,$0.00
72823228S,SUP,HCPCS C1713,,72823228S  -  SCREW BN 4MM 28MM STRL VLP FT FOREFOOT MIDFOOT OSTEOPENIA,$152.50,$0.00,$152.50,$68.63,$108.84,$0.00,$26.27,$0.00,$0.00,$26.70,$152.50,$0.00,$76.25,$120.78,$122.00,$0.00,$23.87,$0.00,$24.28,$0.00
72823230S,SUP,HCPCS C1713,,72823230S  -  SCREW BN 4MM 30MM STRL VLP FT FOREFOOT MIDFOOT OSTEOPENIA,$152.50,$0.00,$152.50,$68.63,$108.84,$0.00,$26.27,$0.00,$0.00,$26.70,$152.50,$0.00,$76.25,$120.78,$122.00,$0.00,$23.87,$0.00,$24.28,$0.00
72823232S,SUP,HCPCS C1713,,72823232S  -  SCREW BN 4MM 32MM STRL VLP FT FOREFOOT MIDFOOT OSTEOPENIA,$152.50,$0.00,$152.50,$68.63,$108.84,$0.00,$26.27,$0.00,$0.00,$26.70,$152.50,$0.00,$76.25,$120.78,$122.00,$0.00,$23.87,$0.00,$24.28,$0.00
72823234S,SUP,HCPCS C1713,,72823234S  -  SCREW BN 4MM 34MM STRL VLP FT FOREFOOT MIDFOOT OSTEOPENIA,$152.50,$0.00,$152.50,$68.63,$108.84,$0.00,$26.27,$0.00,$0.00,$26.70,$152.50,$0.00,$76.25,$120.78,$122.00,$0.00,$23.87,$0.00,$24.28,$0.00
72823236S,SUP,HCPCS C1713,,72823236S  -  SCREW BN 4MM 36MM STRL VLP FT FOREFOOT MIDFOOT OSTEOPENIA,$152.50,$0.00,$152.50,$68.63,$108.84,$0.00,$26.27,$0.00,$0.00,$26.70,$152.50,$0.00,$76.25,$120.78,$122.00,$0.00,$23.87,$0.00,$24.28,$0.00
72823238S,SUP,HCPCS C1713,,72823238S  -  SCREW BN FT 4MM 38MM STRL VLP FT OSTEOPENIA,$152.50,$0.00,$152.50,$68.63,$108.84,$0.00,$26.27,$0.00,$0.00,$26.70,$152.50,$0.00,$76.25,$120.78,$122.00,$0.00,$23.87,$0.00,$24.28,$0.00
72823240S,SUP,HCPCS C1713,,72823240S  -  SCREW BN 4MM 40MM STRL VLP FT FOREFOOT MIDFOOT OSTEOPENIA,$152.50,$0.00,$152.50,$68.63,$108.84,$0.00,$26.27,$0.00,$0.00,$26.70,$152.50,$0.00,$76.25,$120.78,$122.00,$0.00,$23.87,$0.00,$24.28,$0.00
72823242S,SUP,HCPCS C1713,,72823242S  -  SCREW BN FT 4MM 5MM 42MM STRL VLP FT OSTEOPENIA PERC,$152.50,$0.00,$152.50,$68.63,$108.84,$0.00,$26.27,$0.00,$0.00,$26.70,$152.50,$0.00,$76.25,$120.78,$122.00,$0.00,$23.87,$0.00,$24.28,$0.00
72823244S,SUP,HCPCS C1713,,72823244S  -  SCREW BN FT 4MM 5MM 44MM STRL VLP FT OSTEOPENIA PERC,$152.50,$0.00,$152.50,$68.63,$108.84,$0.00,$26.27,$0.00,$0.00,$26.70,$152.50,$0.00,$76.25,$120.78,$122.00,$0.00,$23.87,$0.00,$24.28,$0.00
72823246S,SUP,HCPCS C1713,,72823246S  -  SCREW BN FT LOPRFL 4MM 5MM 46MM STRL VLP FT OSTEOPENIA PERC,$152.50,$0.00,$152.50,$68.63,$108.84,$0.00,$26.27,$0.00,$0.00,$26.70,$152.50,$0.00,$76.25,$120.78,$122.00,$0.00,$23.87,$0.00,$24.28,$0.00
72823248S,SUP,HCPCS C1713,,72823248S  -  SCREW BN FT LOPRFL 4MM 5MM 48MM STRL VLP FT OSTEOPENIA PERC,$152.50,$0.00,$152.50,$68.63,$108.84,$0.00,$26.27,$0.00,$0.00,$26.70,$152.50,$0.00,$76.25,$120.78,$122.00,$0.00,$23.87,$0.00,$24.28,$0.00
72823250S,SUP,HCPCS C1713,,72823250S  -  SCREW BN FT LOPRFL 4MM 5MM 50MM STRL VLP FT OSTEOPENIA PERC,$152.50,$0.00,$152.50,$68.63,$108.84,$0.00,$26.27,$0.00,$0.00,$26.70,$152.50,$0.00,$76.25,$120.78,$122.00,$0.00,$23.87,$0.00,$24.28,$0.00
72823326S,SUP,HCPCS C1713,,72823326S  -  SCREW BN 4MM 26MM STRL VLP P/T FOREFOOT MIDFOOT OSTEOPENIA,$152.50,$0.00,$152.50,$68.63,$108.84,$0.00,$26.27,$0.00,$0.00,$26.70,$152.50,$0.00,$76.25,$120.78,$122.00,$0.00,$23.87,$0.00,$24.28,$0.00
72823328S,SUP,HCPCS C1713,,72823328S  -  SCREW BN 4MM 28MM STRL VLP P/T FOREFOOT MIDFOOT OSTEOPENIA,$152.50,$0.00,$152.50,$68.63,$108.84,$0.00,$26.27,$0.00,$0.00,$26.70,$152.50,$0.00,$76.25,$120.78,$122.00,$0.00,$23.87,$0.00,$24.28,$0.00
72823330S,SUP,HCPCS C1713,,72823330S  -  SCREW BN 4MM 30MM STRL VLP P/T FOREFOOT MIDFOOT OSTEOPENIA,$152.50,$0.00,$152.50,$68.63,$108.84,$0.00,$26.27,$0.00,$0.00,$26.70,$152.50,$0.00,$76.25,$120.78,$122.00,$0.00,$23.87,$0.00,$24.28,$0.00
72823332S,SUP,HCPCS C1713,,72823332S  -  SCREW BN 4MM 32MM STRL VLP P/T FOREFOOT MIDFOOT OSTEOPENIA,$152.50,$0.00,$152.50,$68.63,$108.84,$0.00,$26.27,$0.00,$0.00,$26.70,$152.50,$0.00,$76.25,$120.78,$122.00,$0.00,$23.87,$0.00,$24.28,$0.00
72823334S,SUP,HCPCS C1713,,72823334S  -  SCREW BN 4MM 34MM STRL VLP P/T FOREFOOT MIDFOOT OSTEOPENIA,$152.50,$0.00,$152.50,$68.63,$108.84,$0.00,$26.27,$0.00,$0.00,$26.70,$152.50,$0.00,$76.25,$120.78,$122.00,$0.00,$23.87,$0.00,$24.28,$0.00
72823336S,SUP,HCPCS C1713,,72823336S  -  SCREW BN 4MM 36MM STRL VLP P/T FOREFOOT MIDFOOT OSTEOPENIA,$152.50,$0.00,$152.50,$68.63,$108.84,$0.00,$26.27,$0.00,$0.00,$26.70,$152.50,$0.00,$76.25,$120.78,$122.00,$0.00,$23.87,$0.00,$24.28,$0.00
72823338S,SUP,HCPCS C1713,,72823338S  -  SCREW BN P/T 4MM 5MM 38MMX2.5MM STRL 14MM VLP FOREFOOT,$152.50,$0.00,$152.50,$68.63,$108.84,$0.00,$26.27,$0.00,$0.00,$26.70,$152.50,$0.00,$76.25,$120.78,$122.00,$0.00,$23.87,$0.00,$24.28,$0.00
72823340S,SUP,HCPCS C1713,,72823340S  -  SCREW BN P/T 4MM 5MM 40MMX2.5MM STRL 14MM VLP FOREFOOT,$152.50,$0.00,$152.50,$68.63,$108.84,$0.00,$26.27,$0.00,$0.00,$26.70,$152.50,$0.00,$76.25,$120.78,$122.00,$0.00,$23.87,$0.00,$24.28,$0.00
72823342S,SUP,HCPCS C1713,,72823342S  -  SCREW BN P/T LOPRFL 4MM 5MM 42MM STRL VLP FT OSTEOPENIA PERC,$152.50,$0.00,$152.50,$68.63,$108.84,$0.00,$26.27,$0.00,$0.00,$26.70,$152.50,$0.00,$76.25,$120.78,$122.00,$0.00,$23.87,$0.00,$24.28,$0.00
72823344S,SUP,HCPCS C1713,,72823344S  -  SCREW BN P/T LOPRFL 4MM 5MM 44MM STRL VLP FT OSTEOPENIA PERC,$152.50,$0.00,$152.50,$68.63,$108.84,$0.00,$26.27,$0.00,$0.00,$26.70,$152.50,$0.00,$76.25,$120.78,$122.00,$0.00,$23.87,$0.00,$24.28,$0.00
72823346S,SUP,HCPCS C1713,,72823346S  -  SCREW BN P/T LOPRFL 4MM 5MM 46MM STRL VLP FT OSTEOPENIA PERC,$152.50,$0.00,$152.50,$68.63,$108.84,$0.00,$26.27,$0.00,$0.00,$26.70,$152.50,$0.00,$76.25,$120.78,$122.00,$0.00,$23.87,$0.00,$24.28,$0.00
72823348S,SUP,HCPCS C1713,,72823348S  -  SCREW BN P/T LOPRFL 4MM 5MM 48MM STRL VLP FT OSTEOPENIA PERC,$152.50,$0.00,$152.50,$68.63,$108.84,$0.00,$26.27,$0.00,$0.00,$26.70,$152.50,$0.00,$76.25,$120.78,$122.00,$0.00,$23.87,$0.00,$24.28,$0.00
72823350S,SUP,HCPCS C1713,,72823350S  -  SCREW BN P/T LOPRFL 4MM 5MM 50MM STRL VLP FT OSTEOPENIA PERC,$152.50,$0.00,$152.50,$68.63,$108.84,$0.00,$26.27,$0.00,$0.00,$26.70,$152.50,$0.00,$76.25,$120.78,$122.00,$0.00,$23.87,$0.00,$24.28,$0.00
72823406S,SUP,HCPCS C1713,,72823406S  -  SCREW BN 4MM 6MM STRL VLP LCK FT OSTEOPENIA,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823408S,SUP,HCPCS C1713,,72823408S  -  SCREW BN 4MM 8MM STRL VLP LCK FT OSTEOPENIA,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823410S,SUP,HCPCS C1713,,72823410S  -  SCREW BN 4MM 10MM STRL VLP LCK FOREFOOT MIDFOOT OSTEOPENIA,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823412S,SUP,HCPCS C1713,,72823412S  -  SCREW BN 4MM 12MM STRL VLP LCK FOREFOOT MIDFOOT OSTEOPENIA,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823414S,SUP,HCPCS C1713,,72823414S  -  SCREW BN 4MM 14MM STRL VLP LCK FOREFOOT MIDFOOT OSTEOPENIA,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823416S,SUP,HCPCS C1713,,72823416S  -  SCREW BN 4MM 16MM STRL VLP LCK FOREFOOT MIDFOOT OSTEOPENIA,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823418S,SUP,HCPCS C1713,,72823418S  -  SCREW BN 4MM 18MM STRL VLP LCK FOREFOOT MIDFOOT OSTEOPENIA,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823420S,SUP,HCPCS C1713,,72823420S  -  SCREW BN 4MM 20MM STRL VLP LCK FOREFOOT MIDFOOT OSTEOPENIA,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823422S,SUP,HCPCS C1713,,72823422S  -  SCREW BN 4MM 22MM STRL VLP LCK FOREFOOT MIDFOOT OSTEOPENIA,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823424S,SUP,HCPCS C1713,,72823424S  -  SCREW BN 4MM 24MM STRL VLP LCK FOREFOOT MIDFOOT OSTEOPENIA,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823426S,SUP,HCPCS C1713,,72823426S  -  SCREW BN 4MM 26MM STRL VLP LCK FOREFOOT MIDFOOT OSTEOPENIA,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823428S,SUP,HCPCS C1713,,72823428S  -  SCREW BN 4MM 28MM STRL VLP LCK FOREFOOT MIDFOOT OSTEOPENIA,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823430S,SUP,HCPCS C1713,,72823430S  -  SCREW BN 4MM 30MM STRL VLP LCK FOREFOOT MIDFOOT OSTEOPENIA,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823432S,SUP,HCPCS C1713,,72823432S  -  SCREW BN 4MM 32MM STRL VLP LCK FOREFOOT MIDFOOT OSTEOPENIA,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823434S,SUP,HCPCS C1713,,72823434S  -  SCREW BN 4MM 34MM STRL VLP LCK FOREFOOT MIDFOOT OSTEOPENIA,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823436S,SUP,HCPCS C1713,,72823436S  -  SCREW BN 4MM 36MM STRL VLP LCK FOREFOOT MIDFOOT OSTEOPENIA,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823438S,SUP,HCPCS C1713,,72823438S  -  SCREW BN 4MM 38MM STRL VLP LCK FOREFOOT MIDFOOT OSTEOPENIA,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823440S,SUP,HCPCS C1713,,72823440S  -  SCREW BN 4MM 40MM STRL VLP LCK FOREFOOT MIDFOOT OSTEOPENIA,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823442S,SUP,HCPCS C1713,,72823442S  -  SCREW BN 4MM 4.9MM 42MM STRL VLP LCK FT OSTEOPENIA PERC,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823444S,SUP,HCPCS C1713,,72823444S  -  SCREW BN LOPRFL 4MM 4.9MM 44MM STRL VLP LCK FT OSTEOPENIA,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823446S,SUP,HCPCS C1713,,72823446S  -  SCREW BN LOPRFL 4MM 4.9MM 46MM STRL VLP LCK FT OSTEOPENIA,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823448S,SUP,HCPCS C1713,,72823448S  -  SCREW BN LOPRFL 4MM 4.9MM 48MM STRL VLP LCK FT OSTEOPENIA,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823450S,SUP,HCPCS C1713,,72823450S  -  SCREW BN LOPRFL 4MM 4.9MM 50MM STRL VLP LCK FT OSTEOPENIA,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823510S,SUP,HCPCS C1713,,72823510S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 10MMX3.3MM STRL VLP LCK LOPRFL,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823512S,SUP,HCPCS C1713,,72823512S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 12MMX3.3MM STRL VLP LCK LOPRFL,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823514S,SUP,HCPCS C1713,,72823514S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 14MMX3.3MM STRL VLP LCK LOPRFL,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823516S,SUP,HCPCS C1713,,72823516S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 16MMX3.3MM STRL VLP LCK LOPRFL,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823518S,SUP,HCPCS C1713,,72823518S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 18MMX3.3MM STRL VLP LCK LOPRFL,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823520S,SUP,HCPCS C1713,,72823520S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 20MMX3.3MM STRL VLP LCK LOPRFL,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823522S,SUP,HCPCS C1713,,72823522S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 22MMX3.3MM STRL VLP LCK LOPRFL,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823524S,SUP,HCPCS C1713,,72823524S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 24MMX3.3MM STRL VLP LCK LOPRFL,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823526S,SUP,HCPCS C1713,,72823526S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 26MMX3.3MM STRL VLP LCK LOPRFL,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823528S,SUP,HCPCS C1713,,72823528S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 28MMX3.3MM STRL VLP LCK LOPRFL,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823530S,SUP,HCPCS C1713,,72823530S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 30MMX3.3MM STRL VLP LCK LOPRFL,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823532S,SUP,HCPCS C1713,,72823532S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 32MMX3.3MM STRL VLP LCK LOPRFL,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823534S,SUP,HCPCS C1713,,72823534S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 34MMX3.3MM STRL VLP LCK LOPRFL,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823536S,SUP,HCPCS C1713,,72823536S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 36MMX3.3MM STRL VLP LCK LOPRFL,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823538S,SUP,HCPCS C1713,,72823538S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 38MMX3.3MM STRL VLP LCK LOPRFL,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823540S,SUP,HCPCS C1713,,72823540S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 40MMX3.3MM STRL VLP LCK LOPRFL,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823542S,SUP,HCPCS C1713,,72823542S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 42MMX3.3MM STRL VLP LCK LOPRFL,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823544S,SUP,HCPCS C1713,,72823544S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 44MMX3.3MM STRL VLP LCK LOPRFL,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823546S,SUP,HCPCS C1713,,72823546S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 46MMX3.3MM STRL VLP LCK LOPRFL,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823548S,SUP,HCPCS C1713,,72823548S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 48MMX3.3MM STRL VLP LCK LOPRFL,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823550S,SUP,HCPCS C1713,,72823550S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 50MMX3.3MM STRL VLP LCK LOPRFL,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823555S,SUP,HCPCS C1713,,72823555S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 55MMX3.3MM STRL VLP LCK LOPRFL,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72823560S,SUP,HCPCS C1713,,72823560S  -  SCREW BN 15D 2.5MM 5MM 5.4MM 60MMX3.3MM STRL VLP LCK LOPRFL,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
72824001S,SUP,HCPCS C1713,,72824001S  -  PLATE BN T STRL VLP LCK VA FT 2.7MM SCR,"$1,262.50",$0.00,"$1,262.50",$568.13,$901.05,$0.00,$217.52,$0.00,$0.00,$221.05,"$1,262.50",$0.00,$631.25,$999.90,"$1,010.00",$0.00,$197.58,$0.00,$200.99,$0.00
72824002S,SUP,HCPCS C1713,,72824002S  -  PLATE BN L STRL PRLC VLP SS LT MTP FOREFOOT MIDFOOT 2.7MM,"$1,021.25",$0.00,"$1,021.25",$459.56,$728.87,$0.00,$175.96,$0.00,$0.00,$178.81,"$1,021.25",$0.00,$510.63,$808.83,$817.00,$0.00,$159.83,$0.00,$162.58,$0.00
72824003S,SUP,HCPCS C1713,,72824003S  -  PLATE BN L STRL PRLC VLP SS RT MTP FOREFOOT MIDFOOT 2.7MM,"$1,021.25",$0.00,"$1,021.25",$459.56,$728.87,$0.00,$175.96,$0.00,$0.00,$178.81,"$1,021.25",$0.00,$510.63,$808.83,$817.00,$0.00,$159.83,$0.00,$162.58,$0.00
72824004S,SUP,HCPCS C1713,,72824004S  -  PLATE BN H STRL PRLC VLP 5 HL SS FOREFOOT MIDFOOT 2.7MM SCR,"$1,775.00",$0.00,"$1,775.00",$798.75,"$1,266.82",$0.00,$305.82,$0.00,$0.00,$310.79,"$1,775.00",$0.00,$887.50,"$1,405.80","$1,420.00",$0.00,$277.79,$0.00,$282.58,$0.00
72824005S,SUP,HCPCS C1713,,72824005S  -  PLATE BN STRL PRLC VLP H 8 HL 2.7 MM SCR,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
72824006S,SUP,HCPCS C1713,,72824006S  -  PLATE BN .25 TBLR STRL PRLC VLP 3 HL SS FOREFOOT MIDFOOT 2.7,$968.75,$0.00,$968.75,$435.94,$691.40,$0.00,$166.91,$0.00,$0.00,$169.62,$968.75,$0.00,$484.38,$767.25,$775.00,$0.00,$151.61,$0.00,$154.23,$0.00
72824007S,SUP,HCPCS C1713,,72824007S  -  PLATE BN STRL PRLC VLP 4 HL QT TBLR MTP 2.7 MM SCR,$968.75,$0.00,$968.75,$435.94,$691.40,$0.00,$166.91,$0.00,$0.00,$169.62,$968.75,$0.00,$484.38,$767.25,$775.00,$0.00,$151.61,$0.00,$154.23,$0.00
72824008S,SUP,HCPCS C1713,,72824008S  -  PLATE BN .25 TBLR 39.8X8X1.5MM STRL VLP 5 HL FOREFOOT,$968.75,$0.00,$968.75,$435.94,$691.40,$0.00,$166.91,$0.00,$0.00,$169.62,$968.75,$0.00,$484.38,$767.25,$775.00,$0.00,$151.61,$0.00,$154.23,$0.00
72824009S,SUP,HCPCS C1713,,72824009S  -  PLATE BN STRL PRLC VLP 6 HL QT TBLR MTP 2.7 MM SCR,$968.75,$0.00,$968.75,$435.94,$691.40,$0.00,$166.91,$0.00,$0.00,$169.62,$968.75,$0.00,$484.38,$767.25,$775.00,$0.00,$151.61,$0.00,$154.23,$0.00
72824010S,SUP,HCPCS C1713,,72824010S  -  PLATE BN STRL PRLC VLP 7 HL QT TBLR MTP 2.7 MM SCR,$968.75,$0.00,$968.75,$435.94,$691.40,$0.00,$166.91,$0.00,$0.00,$169.62,$968.75,$0.00,$484.38,$767.25,$775.00,$0.00,$151.61,$0.00,$154.23,$0.00
72824011S,SUP,HCPCS C1713,,72824011S  -  PLATE BN .25 TBLR STRL PRLC VLP 8 HL SS FOREFOOT MIDFOOT 2.7,$968.75,$0.00,$968.75,$435.94,$691.40,$0.00,$166.91,$0.00,$0.00,$169.62,$968.75,$0.00,$484.38,$767.25,$775.00,$0.00,$151.61,$0.00,$154.23,$0.00
72824012S,SUP,HCPCS C1713,,72824012S  -  PLATE BN .25 TBLR STRL PRLC VLP 3 HL CMPR SS FOREFOOT,"$1,518.75",$0.00,"$1,518.75",$683.44,"$1,083.93",$0.00,$261.67,$0.00,$0.00,$265.92,"$1,518.75",$0.00,$759.38,"$1,202.85","$1,215.00",$0.00,$237.68,$0.00,$241.79,$0.00
72824013S,SUP,HCPCS C1713,,72824013S  -  PLATE BN STRL PRLC VLP 5 HL QT TBLR CMPR 2.7 MM SCR,"$1,687.50",$0.00,"$1,687.50",$759.38,"$1,204.37",$0.00,$290.75,$0.00,$0.00,$295.47,"$1,687.50",$0.00,$843.75,"$1,336.50","$1,350.00",$0.00,$264.09,$0.00,$268.65,$0.00
72824014S,SUP,HCPCS C1713,,72824014S  -  PLATE BN .25 TBLR STRL PRLC VLP 7 HL CMPR SS FOREFOOT,"$1,775.00",$0.00,"$1,775.00",$798.75,"$1,266.82",$0.00,$305.82,$0.00,$0.00,$310.79,"$1,775.00",$0.00,$887.50,"$1,405.80","$1,420.00",$0.00,$277.79,$0.00,$282.58,$0.00
72824015S,SUP,HCPCS C1713,,72824015S  -  PLATE BN STRL PRLC VLP PRM SS LT MTP FOREFOOT MIDFOOT 2.7 MM,"$1,775.00",$0.00,"$1,775.00",$798.75,"$1,266.82",$0.00,$305.82,$0.00,$0.00,$310.79,"$1,775.00",$0.00,$887.50,"$1,405.80","$1,420.00",$0.00,$277.79,$0.00,$282.58,$0.00
72824016S,SUP,HCPCS C1713,,72824016S  -  PLATE BN 53.1MMX1.27MM STRL 11MM VLP PRM RT MTP FOREFOOT,"$1,775.00",$0.00,"$1,775.00",$798.75,"$1,266.82",$0.00,$305.82,$0.00,$0.00,$310.79,"$1,775.00",$0.00,$887.50,"$1,405.80","$1,420.00",$0.00,$277.79,$0.00,$282.58,$0.00
72824017S,SUP,HCPCS C1713,,72824017S  -  PLATE BN STRL PRLC VLP REV LT MTP 2.7 MM SCR,"$2,262.50",$0.00,"$2,262.50","$1,018.13","$1,614.75",$0.00,$389.82,$0.00,$0.00,$396.15,"$2,262.50",$0.00,"$1,131.25","$1,791.90","$1,810.00",$0.00,$354.08,$0.00,$360.19,$0.00
72824018S,SUP,HCPCS C1713,,72824018S  -  PLATE BN STRL PRLC VLP REV SS RT MTP FOREFOOT MIDFOOT 2.7 MM,"$2,262.50",$0.00,"$2,262.50","$1,018.13","$1,614.75",$0.00,$389.82,$0.00,$0.00,$396.15,"$2,262.50",$0.00,"$1,131.25","$1,791.90","$1,810.00",$0.00,$354.08,$0.00,$360.19,$0.00
72824019S,SUP,HCPCS C1713,,72824019S  -  PLATE BN SHRT STRL VLP FSN LCK VA TARSOMETATARSAL FT 2.7MM,"$1,775.00",$0.00,"$1,775.00",$798.75,"$1,266.82",$0.00,$305.82,$0.00,$0.00,$310.79,"$1,775.00",$0.00,$887.50,"$1,405.80","$1,420.00",$0.00,$277.79,$0.00,$282.58,$0.00
72824020S,SUP,HCPCS C1713,,72824020S  -  PLATE BN LNG STRL PRLC VLP FSN TARSOMETATARSAL 2.7MM SCR,"$2,143.75",$0.00,"$2,143.75",$964.69,"$1,529.99",$0.00,$369.36,$0.00,$0.00,$375.35,"$2,143.75",$0.00,"$1,071.88","$1,697.85","$1,715.00",$0.00,$335.50,$0.00,$341.29,$0.00
72824021S,SUP,HCPCS C1713,,72824021S  -  PLATE BN 18.1X7.1X1.5MM STRL VLP BRBL FOREFOOT MIDFOOT 2.7MM,"$1,193.75",$0.00,"$1,193.75",$537.19,$851.98,$0.00,$205.68,$0.00,$0.00,$209.02,"$1,193.75",$0.00,$596.88,$945.45,$955.00,$0.00,$186.82,$0.00,$190.05,$0.00
72824022S,SUP,HCPCS C1713,,72824022S  -  PLATE BN SM 24X18X1.5MM STRL VLP UTL FOREFOOT MIDFOOT 2.7MM,"$2,012.50",$0.00,"$2,012.50",$905.63,"$1,436.32",$0.00,$346.74,$0.00,$0.00,$352.37,"$2,012.50",$0.00,"$1,006.25","$1,593.90","$1,610.00",$0.00,$314.96,$0.00,$320.39,$0.00
72824023S,SUP,HCPCS C1713,,72824023S  -  PLATE BN MED STRL PRLC VLP UTL MTP 2.7MM SCR,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
72824024S,SUP,HCPCS C1713,,72824024S  -  PLATE BN LG STRL PRLC VLP UTL SS FOREFOOT MIDFOOT 2.7MM SCR,"$2,262.50",$0.00,"$2,262.50","$1,018.13","$1,614.75",$0.00,$389.82,$0.00,$0.00,$396.15,"$2,262.50",$0.00,"$1,131.25","$1,791.90","$1,810.00",$0.00,$354.08,$0.00,$360.19,$0.00
72824025S,SUP,HCPCS C1713,,72824025S  -  PLATE BN STRL PRLC VLP 3 HL 1/3 TBLR CMPR MTP 3.5 MM SCR,"$1,518.75",$0.00,"$1,518.75",$683.44,"$1,083.93",$0.00,$261.67,$0.00,$0.00,$265.92,"$1,518.75",$0.00,$759.38,"$1,202.85","$1,215.00",$0.00,$237.68,$0.00,$241.79,$0.00
72824026S,SUP,HCPCS C1713,,72824026S  -  PLATE BN STRL PRLC VLP 5 HL 1/3 TBLR CMPR 3.5 MM SCR,"$1,687.50",$0.00,"$1,687.50",$759.38,"$1,204.37",$0.00,$290.75,$0.00,$0.00,$295.47,"$1,687.50",$0.00,$843.75,"$1,336.50","$1,350.00",$0.00,$264.09,$0.00,$268.65,$0.00
72824027S,SUP,HCPCS C1713,,72824027S  -  PLATE BN STRL PRLC VLP 7 HL 1/3 TBLR CMPR 3.5 MM SCR,"$1,775.00",$0.00,"$1,775.00",$798.75,"$1,266.82",$0.00,$305.82,$0.00,$0.00,$310.79,"$1,775.00",$0.00,$887.50,"$1,405.80","$1,420.00",$0.00,$277.79,$0.00,$282.58,$0.00
72824028S,SUP,HCPCS C1713,,72824028S  -  PLATE BN SM STRL PRLC VLP LT CALCANEUS 3.5MM SCR,"$2,018.75",$0.00,"$2,018.75",$908.44,"$1,440.78",$0.00,$347.82,$0.00,$0.00,$353.47,"$2,018.75",$0.00,"$1,009.38","$1,598.85","$1,615.00",$0.00,$315.93,$0.00,$321.39,$0.00
72824029S,SUP,HCPCS C1713,,72824029S  -  PLATE BN SM STRL PRLC VLP VA LCK RT CALCANEUS 3.5MM SCR,"$2,018.75",$0.00,"$2,018.75",$908.44,"$1,440.78",$0.00,$347.82,$0.00,$0.00,$353.47,"$2,018.75",$0.00,"$1,009.38","$1,598.85","$1,615.00",$0.00,$315.93,$0.00,$321.39,$0.00
72824030S,SUP,HCPCS C1713,,72824030S  -  PLATE BN LG STRL PRLC VLP LT CALCANEUS MIDFOOT HINDFOOT 3.5,"$2,087.50",$0.00,"$2,087.50",$939.38,"$1,489.85",$0.00,$359.67,$0.00,$0.00,$365.50,"$2,087.50",$0.00,"$1,043.75","$1,653.30","$1,670.00",$0.00,$326.69,$0.00,$332.33,$0.00
72824031S,SUP,HCPCS C1713,,72824031S  -  PLATE BN LG STRL PRLC VLP VA LCK SS RT CALCANEUS 3.5MM SCR,"$2,087.50",$0.00,"$2,087.50",$939.38,"$1,489.85",$0.00,$359.67,$0.00,$0.00,$365.50,"$2,087.50",$0.00,"$1,043.75","$1,653.30","$1,670.00",$0.00,$326.69,$0.00,$332.33,$0.00
72824032S,SUP,HCPCS C1713,,72824032S  -  PLATE BN STRL PRLC VLP FSN MTP 3.5 MM SCR,"$2,012.50",$0.00,"$2,012.50",$905.63,"$1,436.32",$0.00,$346.74,$0.00,$0.00,$352.37,"$2,012.50",$0.00,"$1,006.25","$1,593.90","$1,610.00",$0.00,$314.96,$0.00,$320.39,$0.00
72824033S,SUP,HCPCS C1713,,72824033S  -  PLATE BN LNG STRL PRLC VLP FSN 3.5MM SCR,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
72824034S,SUP,HCPCS C1713,,72824034S  -  PLATE BN STRL PRLC VLP CLMN FSN 3.5 MM SCR,"$2,993.75",$0.00,"$2,993.75","$1,347.19","$2,136.64",$0.00,$515.81,$0.00,$0.00,$524.18,"$2,993.75",$0.00,"$1,496.88","$2,371.05","$2,395.00",$0.00,$468.52,$0.00,$476.61,$0.00
72824035S,SUP,HCPCS C1713,,72824035S  -  PLATE BN STRL VLP 6 HL MLT FRAG MIDFOOT HINDFOOT 3.5 MM SCR,"$1,775.00",$0.00,"$1,775.00",$798.75,"$1,266.82",$0.00,$305.82,$0.00,$0.00,$310.79,"$1,775.00",$0.00,$887.50,"$1,405.80","$1,420.00",$0.00,$277.79,$0.00,$282.58,$0.00
72824036S,SUP,HCPCS C1713,,72824036S  -  PLATE BN STRL PRLC VLP 10 HL MLT FRAG MTP 3.5 MM SCR,"$2,443.75",$0.00,"$2,443.75","$1,099.69","$1,744.10",$0.00,$421.05,$0.00,$0.00,$427.88,"$2,443.75",$0.00,"$1,221.88","$1,935.45","$1,955.00",$0.00,$382.45,$0.00,$389.05,$0.00
72824037S,SUP,HCPCS C1713,,72824037S  -  PLATE BN STRL PRLC VLP 14 HL MLT FRAG VARAIBLE ANG MIDFOOT,"$2,925.00",$0.00,"$2,925.00","$1,316.25","$2,087.57",$0.00,$503.96,$0.00,$0.00,$512.14,"$2,925.00",$0.00,"$1,462.50","$2,316.60","$2,340.00",$0.00,$457.76,$0.00,$465.66,$0.00
72824038S,SUP,HCPCS C1713,,72824038S  -  PLATE BN VLP 4 HL MULTIFRAGMENT MIDFOOT HINDFOOT 3.5 MM SCR,"$1,687.50",$0.00,"$1,687.50",$759.38,"$1,204.37",$0.00,$290.75,$0.00,$0.00,$295.47,"$1,687.50",$0.00,$843.75,"$1,336.50","$1,350.00",$0.00,$264.09,$0.00,$268.65,$0.00
72824039S,SUP,HCPCS C1713,,72824039S  -  PLATE BN MED STRL VLP LT CALCANEUS MIDFOOT HINDFOOT 3.5MM,"$2,225.00",$0.00,"$2,225.00","$1,001.25","$1,587.98",$0.00,$383.36,$0.00,$0.00,$389.58,"$2,225.00",$0.00,"$1,112.50","$1,762.20","$1,780.00",$0.00,$348.21,$0.00,$354.22,$0.00
72824040S,SUP,HCPCS C1713,,72824040S  -  PLATE BN MED STRL VLP RT CALCANEUS MIDFOOT HINDFOOT 3.5MM,"$2,225.00",$0.00,"$2,225.00","$1,001.25","$1,587.98",$0.00,$383.36,$0.00,$0.00,$389.58,"$2,225.00",$0.00,"$1,112.50","$1,762.20","$1,780.00",$0.00,$348.21,$0.00,$354.22,$0.00
72824041S,SUP,HCPCS C1713,,72824041S  -  PLATE BN XL STRL VLP LT CALCANEUS MIDFOOT HINDFOOT 3.5MM SCR,"$2,331.25",$0.00,"$2,331.25","$1,049.06","$1,663.81",$0.00,$401.66,$0.00,$0.00,$408.18,"$2,331.25",$0.00,"$1,165.63","$1,846.35","$1,865.00",$0.00,$364.84,$0.00,$371.14,$0.00
72824042S,SUP,HCPCS C1713,,72824042S  -  PLATE BN XL RT CALC 3.5MM SCR,"$2,331.25",$0.00,"$2,331.25","$1,049.06","$1,663.81",$0.00,$401.66,$0.00,$0.00,$408.18,"$2,331.25",$0.00,"$1,165.63","$1,846.35","$1,865.00",$0.00,$364.84,$0.00,$371.14,$0.00
7291-0108,SUP,Custom 27803010,,7291-0108  -  INSERT TIB 1 8MM KNEE PS BRNG SER 1,"$1,299.00",$0.00,"$1,299.00",$0.00,$927.10,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,299.00",$0.00,$649.50,"$1,028.81","$1,039.20",$0.00,$0.00,$0.00,$0.00,$0.00
7291-0110,SUP,Custom 27803010,,7291-0110  -  INSERT TIB 1 10MM KNEE PS BRNG SER 1,"$1,298.00",$0.00,"$1,298.00",$0.00,$926.38,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,298.00",$0.00,$649.00,"$1,028.02","$1,038.40",$0.00,$0.00,$0.00,$0.00,$0.00
7291-0115,SUP,Custom 27803010,,7291-0115  -  INSERT TIB 1 15MM KNEE PS BRNG SER 1,"$1,299.00",$0.00,"$1,299.00",$0.00,$927.10,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,299.00",$0.00,$649.50,"$1,028.81","$1,039.20",$0.00,$0.00,$0.00,$0.00,$0.00
7291-0118,SUP,Custom 27803010,,7291-0118  -  INSERT TIB 1 18MM KNEE PS BRNG SER 1,"$1,298.00",$0.00,"$1,298.00",$0.00,$926.38,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,298.00",$0.00,$649.00,"$1,028.02","$1,038.40",$0.00,$0.00,$0.00,$0.00,$0.00
7291-0121,SUP,Custom 27803010,,7291-0121  -  INSERT TIB 1 21MM KNEE PS BRNG SER 1,"$1,246.00",$0.00,"$1,246.00",$0.00,$889.27,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,246.00",$0.00,$623.00,$986.83,$996.80,$0.00,$0.00,$0.00,$0.00,$0.00
7291-0124,SUP,Custom 27803010,,7291-0124  -  INSERT TIB 1 24MM KNEE PS BRNG SER 1,"$1,246.00",$0.00,"$1,246.00",$0.00,$889.27,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,246.00",$0.00,$623.00,$986.83,$996.80,$0.00,$0.00,$0.00,$0.00,$0.00
7291-0308,SUP,Custom 27803010,,7291-0308  -  INSERT TIB 3 8MM KNEE PS BRNG SER 1,"$1,246.00",$0.00,"$1,246.00",$0.00,$889.27,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,246.00",$0.00,$623.00,$986.83,$996.80,$0.00,$0.00,$0.00,$0.00,$0.00
7291-0310,SUP,Custom 27803010,,7291-0310  -  INSERT TIB 3 10MM KNEE PS BRNG SER 1,"$1,246.00",$0.00,"$1,246.00",$0.00,$889.27,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,246.00",$0.00,$623.00,$986.83,$996.80,$0.00,$0.00,$0.00,$0.00,$0.00
7291-0312,SUP,Custom 27803010,,7291-0312  -  INSERT TIB 3 12MM KNEE PS BRNG SER 1,"$1,246.00",$0.00,"$1,246.00",$0.00,$889.27,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,246.00",$0.00,$623.00,$986.83,$996.80,$0.00,$0.00,$0.00,$0.00,$0.00
7291-0315,SUP,Custom 27803010,,7291-0315  -  INSERT TIB 3 15MM KNEE PS BRNG SER 1,"$1,246.00",$0.00,"$1,246.00",$0.00,$889.27,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,246.00",$0.00,$623.00,$986.83,$996.80,$0.00,$0.00,$0.00,$0.00,$0.00
7291-0318,SUP,Custom 27803010,,7291-0318  -  INSERT TIB 3 18MM KNEE PS BRNG SER 1,"$1,246.00",$0.00,"$1,246.00",$0.00,$889.27,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,246.00",$0.00,$623.00,$986.83,$996.80,$0.00,$0.00,$0.00,$0.00,$0.00
7291-0321,SUP,Custom 27803010,,7291-0321  -  INSERT TIB 3 21MM KNEE PS BRNG SER 1,"$1,298.00",$0.00,"$1,298.00",$0.00,$926.38,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,298.00",$0.00,$649.00,"$1,028.02","$1,038.40",$0.00,$0.00,$0.00,$0.00,$0.00
7291-0324,SUP,Custom 27803010,,7291-0324  -  INSERT TIB 3 24MM KNEE PS BRNG SER 1,"$1,246.00",$0.00,"$1,246.00",$0.00,$889.27,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,246.00",$0.00,$623.00,$986.83,$996.80,$0.00,$0.00,$0.00,$0.00,$0.00
7291-0512,SUP,Custom 27803010,,7291-0512  -  INSERT TIB 5 12MM KNEE PS BRNG SER 1,"$1,246.00",$0.00,"$1,246.00",$0.00,$889.27,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,246.00",$0.00,$623.00,$986.83,$996.80,$0.00,$0.00,$0.00,$0.00,$0.00
7291-0515,SUP,Custom 27803010,,7291-0515  -  INSERT TIB 5 15MM KNEE PS BRNG SER 1,"$1,299.00",$0.00,"$1,299.00",$0.00,$927.10,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,299.00",$0.00,$649.50,"$1,028.81","$1,039.20",$0.00,$0.00,$0.00,$0.00,$0.00
7291-0518,SUP,Custom 27803010,,7291-0518  -  INSERT TIB 5 18MM KNEE PS BRNG SER 1,"$1,299.00",$0.00,"$1,299.00",$0.00,$927.10,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,299.00",$0.00,$649.50,"$1,028.81","$1,039.20",$0.00,$0.00,$0.00,$0.00,$0.00
7291-0521,SUP,Custom 27803010,,7291-0521  -  INSERT TIB 5 21MM KNEE PS BRNG SER 1,"$1,298.00",$0.00,"$1,298.00",$0.00,$926.38,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,298.00",$0.00,$649.00,"$1,028.02","$1,038.40",$0.00,$0.00,$0.00,$0.00,$0.00
7291-0524,SUP,Custom 27803010,,7291-0524  -  INSERT TIB 5 24MM KNEE PS BRNG SER 1,"$1,246.00",$0.00,"$1,246.00",$0.00,$889.27,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,246.00",$0.00,$623.00,$986.83,$996.80,$0.00,$0.00,$0.00,$0.00,$0.00
7291-0708,SUP,Custom 27803010,,7291-0708  -  INSERT TIB 7 8MM KNEE PS BRNG SER 1,"$1,299.00",$0.00,"$1,299.00",$0.00,$927.10,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,299.00",$0.00,$649.50,"$1,028.81","$1,039.20",$0.00,$0.00,$0.00,$0.00,$0.00
7291-0710,SUP,Custom 27803010,,7291-0710  -  INSERT TIB 7 10MM KNEE PS BRNG SER 1,"$1,298.00",$0.00,"$1,298.00",$0.00,$926.38,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,298.00",$0.00,$649.00,"$1,028.02","$1,038.40",$0.00,$0.00,$0.00,$0.00,$0.00
7291-0712,SUP,Custom 27803010,,7291-0712  -  INSERT TIB 7 12MM KNEE PS BRNG SER 1,"$1,298.00",$0.00,"$1,298.00",$0.00,$926.38,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,298.00",$0.00,$649.00,"$1,028.02","$1,038.40",$0.00,$0.00,$0.00,$0.00,$0.00
7291-0718,SUP,Custom 27803010,,7291-0718  -  INSERT TIB 7 18MM KNEE PS BRNG SER 1,"$1,298.00",$0.00,"$1,298.00",$0.00,$926.38,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,298.00",$0.00,$649.00,"$1,028.02","$1,038.40",$0.00,$0.00,$0.00,$0.00,$0.00
7291-0721,SUP,Custom 27803010,,7291-0721  -  INSERT TIB 7 21MM KNEE PS BRNG SER 1,"$1,246.00",$0.00,"$1,246.00",$0.00,$889.27,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,246.00",$0.00,$623.00,$986.83,$996.80,$0.00,$0.00,$0.00,$0.00,$0.00
7291-0724,SUP,Custom 27803010,,7291-0724  -  INSERT TIB 7 24MM KNEE PS BRNG SER 1,"$1,246.00",$0.00,"$1,246.00",$0.00,$889.27,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,246.00",$0.00,$623.00,$986.83,$996.80,$0.00,$0.00,$0.00,$0.00,$0.00
7291-0908,SUP,Custom 27803010,,7291-0908  -  INSERT TIB 9 8MM KNEE PS BRNG SER 1,"$1,298.00",$0.00,"$1,298.00",$0.00,$926.38,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,298.00",$0.00,$649.00,"$1,028.02","$1,038.40",$0.00,$0.00,$0.00,$0.00,$0.00
7291-0910,SUP,Custom 27803010,,7291-0910  -  INSERT TIB 9 10MM KNEE PS BRNG SER 1,"$1,299.00",$0.00,"$1,299.00",$0.00,$927.10,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,299.00",$0.00,$649.50,"$1,028.81","$1,039.20",$0.00,$0.00,$0.00,$0.00,$0.00
7291-0915,SUP,Custom 27803010,,7291-0915  -  INSERT TIB 9 15MM KNEE PS BRNG SER 1,"$1,299.00",$0.00,"$1,299.00",$0.00,$927.10,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,299.00",$0.00,$649.50,"$1,028.81","$1,039.20",$0.00,$0.00,$0.00,$0.00,$0.00
7291-0918,SUP,Custom 27803010,,7291-0918  -  INSERT TIB 9 18MM KNEE PS BRNG SER 1,"$1,246.00",$0.00,"$1,246.00",$0.00,$889.27,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,246.00",$0.00,$623.00,$986.83,$996.80,$0.00,$0.00,$0.00,$0.00,$0.00
7291-0921,SUP,Custom 27803010,,7291-0921  -  INSERT TIB 9 21MM KNEE PS BRNG SER 1,"$1,299.00",$0.00,"$1,299.00",$0.00,$927.10,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,299.00",$0.00,$649.50,"$1,028.81","$1,039.20",$0.00,$0.00,$0.00,$0.00,$0.00
7291-0924,SUP,Custom 27803010,,7291-0924  -  INSERT TIB 9 24MM KNEE PS BRNG SER 1,"$1,246.00",$0.00,"$1,246.00",$0.00,$889.27,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,246.00",$0.00,$623.00,$986.83,$996.80,$0.00,$0.00,$0.00,$0.00,$0.00
72A002,SUP,Custom 27804086,,72A002  -  GRAFT BONE SMALL 100-125MM FREEZE DRIED SHAFT CORTICAL,"$1,760.00",$0.00,"$1,760.00",$0.00,"$1,256.11",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,760.00",$0.00,$880.00,"$1,393.92","$1,408.00",$0.00,$0.00,$0.00,$0.00,$0.00
72B006,SUP,HCPCS C1762,,72B006  -  GRAFT BONE LARGE 126MM FROZEN SHAFT CORTICAL,"$2,057.50",$0.00,"$2,057.50",$0.00,"$1,468.44",$0.00,$354.50,$0.00,$0.00,$0.00,"$2,057.50",$0.00,"$1,028.75","$1,629.54","$1,646.00",$0.00,$322.00,$0.00,$0.00,$0.00
730032ADP,SUP,Custom 27803010,,730032ADP  -  GRAFT CV 42MM 32MM 15CM 32MM GLWV VSLV WVN GELTN AOR ROOT,"$6,437.50",$0.00,"$6,437.50",$0.00,"$4,594.44",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,437.50",$0.00,"$3,218.75","$5,098.50","$5,150.00",$0.00,$0.00,$0.00,$0.00,$0.00
7300TFX25MM,SUP,Custom 27803010,,7300TFX25MM  -  VALVE MTRL 25MM CRP-ED PRIMNT MAGNA BPRTH EASE HRT,"$22,275.00",$0.00,"$22,275.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$22,275.00",$0.00,"$11,137.50","$17,641.80","$17,820.00",$0.00,$0.00,$0.00,$0.00,$0.00
7300TFX29MM,SUP,Custom 27803010,,7300TFX29MM  -  VALVE MTRL 29MM CRP-ED PRIMNT MG HRT PRICRD EASE,"$22,275.00",$0.00,"$22,275.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$22,275.00",$0.00,"$11,137.50","$17,641.80","$17,820.00",$0.00,$0.00,$0.00,$0.00,$0.00
7300TFX31MM,SUP,Custom 27803010,,7300TFX31MM  -  VALVE MITRAL 31MM BIOPROSTHESIS EASE CARPENTIER-EDWARDS,"$22,275.00",$0.00,"$22,275.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$22,275.00",$0.00,"$11,137.50","$17,641.80","$17,820.00",$0.00,$0.00,$0.00,$0.00,$0.00
7300TFX33MM,SUP,Custom 27803010,,7300TFX33MM  -  VALVE MTRL 33MM CRP-ED PRIMNT MG EASE PRICRD HRT,"$22,275.00",$0.00,"$22,275.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$22,275.00",$0.00,"$11,137.50","$17,641.80","$17,820.00",$0.00,$0.00,$0.00,$0.00,$0.00
73-0110,SUP,Custom 27803010,,73-0110  -  COMPONENT PATLR 11 10MM MEDIALIZED DOME SCORPIO N2/VAC,$600.00,$0.00,$600.00,$0.00,$428.22,$0.00,$0.00,$0.00,$0.00,$0.00,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$0.00,$0.00,$0.00,$0.00
73-020S,SUP,HCPCS C1713,,73-020S  -  SCREW CANNULATED FULLY THREADED 7.3MM X 20MM,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-025S,SUP,HCPCS C1713,,73-025S  -  SCREW CANNULATED FULLY THREADED 7.3MM X 25MM,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-030S,SUP,HCPCS C1713,,73-030S  -  SCREW CANNULATED FULLY THREADED 7.3MM X 30MM,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-035S,SUP,HCPCS C1713,,73-035S  -  SCREW CANNULATED FULLY THREADED 7.3MM X 35MM,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-040S,SUP,HCPCS C1713,,73-040S  -  SCREW CANNULATED FULLY THREADED 7.3MM X 40MM,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-045S,SUP,HCPCS C1713,,73-045S  -  SCREW CANNULATED FULLY THREADED 7.3MM X 45MM,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-050S,SUP,HCPCS C1713,,73-050S  -  SCREW CANNULATED FULLY THREADED 7.3MM X 50MM,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-0510,SUP,Custom 27803010,,73-0510  -  COMPONENT PATLR 5 1.5MM OFFST 32/35MM 5MM 5MMX10MM MEDIALIZE,$600.00,$0.00,$600.00,$0.00,$428.22,$0.00,$0.00,$0.00,$0.00,$0.00,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$0.00,$0.00,$0.00,$0.00
73-055S,SUP,HCPCS C1713,,73-055S  -  SCREW CANNULATED FULLY THREADED 7.3MM X 55MM,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-060S,SUP,HCPCS C1713,,73-060S  -  SCREW CANNULATED FULLY THREADED 7.3MM X 60MM,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-065S,SUP,HCPCS C1713,,73-065S  -  SCREW CANNULATED FULLY THREADED 7.3MM X 65MM,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-070S,SUP,HCPCS C1713,,73-070S  -  SCREW  CANNULATED FULLY THREADED 7.3MM X 70MM,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-0710,SUP,Custom 27803010,,73-0710  -  COMPONENT PATLR 7 1.5MM OFFST 34/38MM 5MM 5MMX10MM MEDIALIZE,$600.00,$0.00,$600.00,$0.00,$428.22,$0.00,$0.00,$0.00,$0.00,$0.00,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$0.00,$0.00,$0.00,$0.00
73-075S,SUP,HCPCS C1713,,73-075S  -  SCREW CANNULATED FULLY THREADED 7.3MM X 75MM,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-080S,SUP,HCPCS C1713,,73-080S  -  SCREW CANNULATED FULLY THREADED 7.3MM X 80MM,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-085S,SUP,HCPCS C1713,,73-085S  -  SCREW CANNULATED FULLY THREADED 7.3MM X 85MM,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-090S,SUP,HCPCS C1713,,73-090S  -  SCREW CANNULATED FULLY THREADED 7.3MM X 90MM,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-0910,SUP,Custom 27803010,,73-0910  -  COMPONENT PATLR 7 1.5MM OFFST 36/41MM 5MM 5MMX10MM MEDIALIZE,$600.00,$0.00,$600.00,$0.00,$428.22,$0.00,$0.00,$0.00,$0.00,$0.00,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$0.00,$0.00,$0.00,$0.00
73-095S,SUP,HCPCS C1713,,73-095S  -  SCREW CANNULATED FULLY THREADED 7.3MM X 95MM,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-100S,SUP,HCPCS C1713,,73-100S  -  SCREW CANNULATED FULLY THREADED 7.3MM X 100MM,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-105S,SUP,HCPCS C1713,,73-105S  -  SCREW CANNULATED FULLY THREADED 7.3MM X 105MM,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-110S,SUP,HCPCS C1713,,73-110S  -  SCREW CANNULATED FULLY THREADED 7.3MM X 110MM,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-115S,SUP,HCPCS C1713,,73-115S  -  SCREW CANNULATED FULLY THREADED 7.3MM X 115MM,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-120S,SUP,HCPCS C1713,,73-120S  -  SCREW CANNULATED FULLY THREADED 7.3MM X 120MM,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-125S,SUP,HCPCS C1713,,73-125S  -  SCREW CANNULATED FULLY THREADED 7.3MM X 125MM,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-130S,SUP,HCPCS C1713,,73-130S  -  SCREW CANNULATED FULLY THREADED 7.3MM X 130MM,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-16030S,SUP,HCPCS C1713,,73-16030S  -  SCREW 7.3MM X 30MM CANNULATED SCREW 16MM THREAD,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-16035S,SUP,HCPCS C1713,,73-16035S  -  SCREW 7.3MM X 35MM CANNULATED SCREW 16MM THREAD,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-16040S,SUP,HCPCS C1713,,73-16040S  -  SCREW CANNULATED 7.3MM X 40MM 16MM THREAD,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-16045S,SUP,HCPCS C1713,,73-16045S  -  SCREW CANNULATED 7.3MM X 45MM 16MM THREAD,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-16050S,SUP,HCPCS C1713,,73-16050S  -  SCREW CANNULATED 7.3MM X 50MM 16MM THREAD,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-16055S,SUP,HCPCS C1713,,73-16055S  -  SCREW CANNULATED 7.3MM X 55MM 16MM THREAD,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-16060S,SUP,HCPCS C1713,,73-16060S  -  SCREW CANNULATED 7.3MM X 60MM 16MM THREAD,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-16065S,SUP,HCPCS C1713,,73-16065S  -  SCREW CANNULATED 7.3MM X 65MM 16MM THREAD,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-16070S,SUP,HCPCS C1713,,73-16070S  -  SCREW CANNULATED 7.3MM X 70MM 16MM THREAD,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-16075S,SUP,HCPCS C1713,,73-16075S  -  SCREW CANNULATED 7.3MM X 75MM 16MM THREAD,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-16080S,SUP,HCPCS C1713,,73-16080S  -  SCREW CANNULATED 7.3MM X 80MM 16MM THREAD,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-16085S,SUP,HCPCS C1713,,73-16085S  -  SCREW CANNULATED 7.3MM X 85MM 16MM THREAD,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-16090S,SUP,HCPCS C1713,,73-16090S  -  SCREW CANNULATED 7.3MM X 90MM 16MM THREAD,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-16095S,SUP,HCPCS C1713,,73-16095S  -  SCREW CANNULATED 7.3MM X 95MM 16MM THREAD,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-16100S,SUP,HCPCS C1713,,73-16100S  -  SCREW CANNULATED 7.3MM X 100MM 16MM THREAD,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-16105S,SUP,HCPCS C1713,,73-16105S  -  SCREW CANNULATED 7.3MM X 105MM 16MM THREAD,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-16110S,SUP,HCPCS C1713,,73-16110S  -  SCREW CANNULATED 7.3MM X 110MM 16MM THREAD,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-16115S,SUP,HCPCS C1713,,73-16115S  -  SCREW CANNULATED 7.3MM X 115MM 16MM THREAD,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-16120S,SUP,HCPCS C1713,,73-16120S  -  SCREW CANNULATED 7.3MM X 120MM 16MM THREAD,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-16125S,SUP,HCPCS C1713,,73-16125S  -  SCREW CANNULATED 7.3MM X 125MM 16MM THREAD,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-16130S,SUP,HCPCS C1713,,73-16130S  -  SCREW CANNULATED 7.3MM X 130MM 16MM THREAD,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-16135S,SUP,HCPCS C1713,,73-16135S  -  SCREW CANNULATED 7.3MM X 135MM 16MM THREAD,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-16140S,SUP,HCPCS C1713,,73-16140S  -  SCREW CANNULATED 7.3MM X 140MM 16MM THREAD,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-16145S,SUP,HCPCS C1713,,73-16145S  -  SCREW CANNULATED 7.3MM X 145MM 16MM THREAD,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-16150S,SUP,HCPCS C1713,,73-16150S  -  SCREW CANNULATED 7.3MM X 150MM 16MM THREAD,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-1952,SUP,HCPCS C1713,,73-1952  -  PLATE BN STERNALOCK BLU 8 HL STRG STRNM,"$2,562.50",$0.00,"$2,562.50","$1,153.13","$1,828.86",$0.00,$441.51,$0.00,$0.00,$448.67,"$2,562.50",$0.00,"$1,281.25","$2,029.50","$2,050.00",$0.00,$401.03,$0.00,$407.95,$0.00
73-20-0110,SUP,Custom 27803010,,73-20-0110  -  COMPONENT PATLR 1 10MM MEDIALIZED DOME SCORPIO X3,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
73-20-0510,SUP,Custom 27803010,,73-20-0510  -  COMPONENT PATLR 5 10MM MEDIALIZED DOME SCORPIO X3,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
73-20-0710,SUP,Custom 27803010,,73-20-0710  -  COMPONENT PATLR 7 MEDIALIZE DOME SCORPIO X3,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
73-20-0910,SUP,Custom 27803010,,73-20-0910  -  COMPONENT PATLR 9 10MM MEDIALIZED DOME SCORPIO X3,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
73-20-2110,SUP,Custom 27803010,,73-20-2110  -  COMPONENT PATLR 11 10MM CONCENTRIC DOME SCORPIO X3,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
73-20-2510,SUP,Custom 27803010,,73-20-2510  -  COMPONENT PATLR 5 10MM CONCENTRIC DOME SCORPIO X3,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
73-20-2710,SUP,Custom 27803010,,73-20-2710  -  COMPONENT PATLR 7 10MM CONCENTRIC DOME SCORPIO X3,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
73-20-2910,SUP,Custom 27803010,,73-20-2910  -  COMPONENT PATLR 9 10MM CONCENTRIC DOME SCORPIO X3,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
73-20-3110,SUP,Custom 27803010,,73-20-3110  -  COMPONENT PATLR 11 10MM UNIVERSAL DOME SCORPIO X3,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
73-20-3308,SUP,Custom 27803010,,73-20-3308  -  COMPONENT PATLR UNIVERSAL DOME SCORPIO X3,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
73-20-3508,SUP,Custom 27803010,,73-20-3508  -  COMPONENT PATLR 5 8MM UNIVERSAL DOME SCORPIO X3,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
73-20-3708,SUP,Custom 27803010,,73-20-3708  -  COMPONENT PATLR 7 8MM UNIVERSAL DOME SCORPIO X3,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
73-20-3710,SUP,Custom 27803010,,73-20-3710  -  COMPONENT PTLR 7 UNV DOME 34MM 10MM STRL SCRP X3,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
73-20-3910,SUP,Custom 27803010,,73-20-3910  -  COMPONENT PTLR 9 UNV DOME 36MM 10MM STRL SCRP X3,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
73-20-4026,SUP,Custom 27803010,,73-20-4026  -  COMPONENT PATLR 26MM RECESSED SCORPIO X3,"$1,500.00",$0.00,"$1,500.00",$0.00,"$1,070.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
73-20-4028,SUP,Custom 27803010,,73-20-4028  -  COMPONENT PATLR 28MM SCORPIO X3,"$1,500.00",$0.00,"$1,500.00",$0.00,"$1,070.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
73-20-4030,SUP,Custom 27803010,,73-20-4030  -  COMPONENT PATLR 30MM RECESSED SCORPIO X3,"$1,500.00",$0.00,"$1,500.00",$0.00,"$1,070.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
73-20-4032,SUP,Custom 27803010,,73-20-4032  -  COMPONENT PATLR 32MM RECESSED SCORPIO X3,"$1,500.00",$0.00,"$1,500.00",$0.00,"$1,070.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
73-20-5030,SUP,Custom 27803010,,73-20-5030  -  CMPNT PATLR 30MM SCRP X3,"$1,205.00",$0.00,"$1,205.00",$0.00,$860.01,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,205.00",$0.00,$602.50,$954.36,$964.00,$0.00,$0.00,$0.00,$0.00,$0.00
73-20-5032,SUP,Custom 27803010,,73-20-5032  -  CMPNT PATLR 32MM INSET SCRP X3,"$1,205.00",$0.00,"$1,205.00",$0.00,$860.01,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,205.00",$0.00,$602.50,$954.36,$964.00,$0.00,$0.00,$0.00,$0.00,$0.00
73-2110,SUP,Custom 27803010,,73-2110  -  COMPONENT PATLR 11 10MM CONCENTRIC DOME SCORPIO N2/VAC,$600.00,$0.00,$600.00,$0.00,$428.22,$0.00,$0.00,$0.00,$0.00,$0.00,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$0.00,$0.00,$0.00,$0.00
73-2408,SUP,HCPCS C1713,,73-2408  -  SCREW BN 2.4MM 8MM AU STERNALOCK BLU SLF DRL LCK STRNM CANC,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
73-2410,SUP,HCPCS C1713,,73-2410  -  SCREW BN 2.4MM 10MM AU STERNALOCK BLU SLF DRL LCK STRNM CANC,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
73-2412,SUP,HCPCS C1713,,73-2412  -  SCREW BN 2.4MM 12MM AU STERNALOCK BLU SLF DRL LCK STRNM CANC,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
73-2414,SUP,HCPCS C1713,,73-2414  -  SCREW BN 2.4MM 14MM AU STERNALOCK BLU SLF DRL LCK STRNM CANC,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
73-2416,SUP,HCPCS C1713,,73-2416  -  SCREW BN 2.4MM 16MM AU STERNALOCK BLU SLF DRL LCK STRNM CANC,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
73-2418,SUP,HCPCS C1713,,73-2418  -  SCREW BN 2.4MM 18MM AU STERNALOCK BLU SLF DRL LCK STRNM CANC,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
73-2420,SUP,HCPCS C1713,,73-2420  -  SCREW BN 2.4MM 20MM AU STERNALOCK BLU SLF DRL LCK STRNM CANC,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
73-2510,SUP,Custom 27803010,,73-2510  -  COMPONENT PATLR 5 10MM CONCENTRIC DOME SCORPIO N2/VAC,$600.00,$0.00,$600.00,$0.00,$428.22,$0.00,$0.00,$0.00,$0.00,$0.00,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$0.00,$0.00,$0.00,$0.00
73-2610,SUP,Custom 27803010,,73-2610  -  INSERT TIB 6 10MM PATLR N2 VAC INSET SCRP 26MM,$851.00,$0.00,$851.00,$0.00,$607.36,$0.00,$0.00,$0.00,$0.00,$0.00,$851.00,$0.00,$425.50,$673.99,$680.80,$0.00,$0.00,$0.00,$0.00,$0.00
73-2622,SUP,HCPCS C1713,,73-2622  -  PLATE BN SQ STERNALOCK BLU 4 HL STRNM,"$1,537.50",$0.00,"$1,537.50",$691.88,"$1,097.31",$0.00,$264.90,$0.00,$0.00,$269.20,"$1,537.50",$0.00,$768.75,"$1,217.70","$1,230.00",$0.00,$240.62,$0.00,$244.77,$0.00
73-2623,SUP,HCPCS C1713,,73-2623  -  PLATE BN STERNALOCK BLU 8 HL STRNM,"$2,077.50",$0.00,"$2,077.50",$934.88,"$1,482.71",$0.00,$357.94,$0.00,$0.00,$363.75,"$2,077.50",$0.00,"$1,038.75","$1,645.38","$1,662.00",$0.00,$325.13,$0.00,$330.74,$0.00
73-2632,SUP,HCPCS C1713,,73-2632  -  PLATE BN NAR STERNALOCK BLU 12 HL STRNM 2.4MM SCR,"$2,175.00",$0.00,"$2,175.00",$978.75,"$1,552.30",$0.00,$374.74,$0.00,$0.00,$380.83,"$2,175.00",$0.00,"$1,087.50","$1,722.60","$1,740.00",$0.00,$340.39,$0.00,$346.26,$0.00
73-2634,SUP,HCPCS C1713,,73-2634  -  PLATE BN W STERNALOCK BLU 12 HL STRNM 2.4MM SCR,"$2,175.00",$0.00,"$2,175.00",$978.75,"$1,552.30",$0.00,$374.74,$0.00,$0.00,$380.83,"$2,175.00",$0.00,"$1,087.50","$1,722.60","$1,740.00",$0.00,$340.39,$0.00,$346.26,$0.00
73-2636,SUP,HCPCS C1713,,73-2636  -  PLATE BN STRG STERNALOCK BLU 4 HL STRNM 2.4MM SCR,"$1,537.50",$0.00,"$1,537.50",$691.88,"$1,097.31",$0.00,$264.90,$0.00,$0.00,$269.20,"$1,537.50",$0.00,$768.75,"$1,217.70","$1,230.00",$0.00,$240.62,$0.00,$244.77,$0.00
73-2643,SUP,HCPCS C1713,,73-2643  -  PLATE BN 100D L STERNALOCK BLU 4 HL STRNM,"$1,537.50",$0.00,"$1,537.50",$691.88,"$1,097.31",$0.00,$264.90,$0.00,$0.00,$269.20,"$1,537.50",$0.00,$768.75,"$1,217.70","$1,230.00",$0.00,$240.62,$0.00,$244.77,$0.00
73-2645,SUP,HCPCS C1713,,73-2645  -  PLATE BN JL STERNALOCK BLU 8 HL STRNM PRM CLSR SYS,"$1,945.00",$0.00,"$1,945.00",$875.25,"$1,388.15",$0.00,$335.11,$0.00,$0.00,$340.55,"$1,945.00",$0.00,$972.50,"$1,540.44","$1,556.00",$0.00,$304.39,$0.00,$309.64,$0.00
73-2708,SUP,HCPCS C1713,,73-2708  -  SCREW BN 2.7MM 8MM MAG STERNALOCK BLU SLF DRL LCK STRNM CANC,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
73-2710,SUP,HCPCS C1713,,73-2710  -  COMPONENT PTLR 7 CONC DOME 34/38MM 10MM SCRP N2/VAC,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
73-2712,SUP,HCPCS C1713,,73-2712  -  SCREW BN 2.7MM 12MM MAG STERNALOCK BLU SLF DRL LCK STRNM,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
73-2714,SUP,HCPCS C1713,,73-2714  -  SCREW BN 2.7MM 14MM MAG STERNALOCK BLU SLF DRL LCK STRNM,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
73-2716,SUP,HCPCS C1713,,73-2716  -  SCREW BN 2.7MM 16MM MAG STERNALOCK BLU SLF DRL LCK STRNM,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
73-2718,SUP,HCPCS C1713,,73-2718  -  SCREW BN 2.7MM 18MM MAG STERNALOCK BLU SLF DRL LCK STRNM,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
73-2720,SUP,HCPCS C1713,,73-2720  -  SCREW BN 2.7MM 20MM MAG STERNALOCK BLU SLF DRL LCK STRNM,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
73-2810,SUP,Custom 27803010,,73-2810  -  CMPNT PATLR 8 10MM 28MM INSET SCRP,$851.00,$0.00,$851.00,$0.00,$607.36,$0.00,$0.00,$0.00,$0.00,$0.00,$851.00,$0.00,$425.50,$673.99,$680.80,$0.00,$0.00,$0.00,$0.00,$0.00
73281488/8ARM,SUP,HCPCS C1768,,73281488/8ARM  -  GRAFT CARDIOVASCULAR PLEXUS 28MM 14X8X8,"$6,612.50",$0.00,"$6,612.50","$2,975.63","$4,719.34",$0.00,"$1,139.30",$0.00,$0.00,"$1,157.80","$6,612.50",$0.00,"$3,306.25","$5,237.10","$5,290.00",$0.00,"$1,034.86",$0.00,"$1,052.71",$0.00
73-2910,SUP,Custom 27803010,,73-2910  -  COMPONENT PATLR 9 CONCENTRIC DOME 10MM SCORPIO N2/VAC,$600.00,$0.00,$600.00,$0.00,$428.22,$0.00,$0.00,$0.00,$0.00,$0.00,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$0.00,$0.00,$0.00,$0.00
73-3010,SUP,Custom 27803010,,73-3010  -  CMPNT PATLR INSET SCRP,$851.00,$0.00,$851.00,$0.00,$607.36,$0.00,$0.00,$0.00,$0.00,$0.00,$851.00,$0.00,$425.50,$673.99,$680.80,$0.00,$0.00,$0.00,$0.00,$0.00
73301488/8ARM,SUP,HCPCS C1768,,73301488/8ARM  -  4 BRANCH TOTAL ARC GRAFT 30MM,"$6,612.50",$0.00,"$6,612.50","$2,975.63","$4,719.34",$0.00,"$1,139.30",$0.00,$0.00,"$1,157.80","$6,612.50",$0.00,"$3,306.25","$5,237.10","$5,290.00",$0.00,"$1,034.86",$0.00,"$1,052.71",$0.00
73-3110,SUP,Custom 27803010,,73-3110  -  COMPONENT PATLR 11MM 10MM UNIVERSAL DOME SCORPIO N2/VAC,$600.00,$0.00,$600.00,$0.00,$428.22,$0.00,$0.00,$0.00,$0.00,$0.00,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$0.00,$0.00,$0.00,$0.00
73-32045S,SUP,HCPCS C1713,,73-32045S  -  SCREW CANNULATED 7.3MM X 45MM 32MM THREAD,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-32050S,SUP,HCPCS C1713,,73-32050S  -  SCREW CANNULATED 7.3MM X 50MM 32MM THREAD,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-32055S,SUP,HCPCS C1713,,73-32055S  -  SCREW CANNULATED 7.3MM X 55MM 32MM THREAD,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-32060S,SUP,HCPCS C1713,,73-32060S  -  SCREW CANNULATED 7.3MM X 60MM 32MM THREAD,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-32065S,SUP,HCPCS C1713,,73-32065S  -  SCREW CANNULATED 7.3MM X 65MM 32MM THREAD,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-32070S,SUP,HCPCS C1713,,73-32070S  -  SCREW CANNULATED 7.3MM X 70MM 32MM THREAD,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-32075S,SUP,HCPCS C1713,,73-32075S  -  SCREW CANNULATED 7.3MM X 75MM 32MM THREAD,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-32080S,SUP,HCPCS C1713,,73-32080S  -  SCREW CANNULATED 7.3MM X 80MM 32MM THREAD,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-32085S,SUP,HCPCS C1713,,73-32085S  -  SCREW CANNULATED 7.3MM X 85MM 32MM THREAD,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-32090S,SUP,HCPCS C1713,,73-32090S  -  SCREW CANNULATED 7.3MM X 90MM 32MM THREAD,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-32095S,SUP,HCPCS C1713,,73-32095S  -  SCREW CANNULATED 7.3MM X 95MM 32MM THREAD,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-3210,SUP,Custom 27803010,,73-3210  -  CMPNT PATLR 2 10MM 32MM INSET SCRP,$851.00,$0.00,$851.00,$0.00,$607.36,$0.00,$0.00,$0.00,$0.00,$0.00,$851.00,$0.00,$425.50,$673.99,$680.80,$0.00,$0.00,$0.00,$0.00,$0.00
73-32100S,SUP,HCPCS C1713,,73-32100S  -  SCREW CANNULATED 7.3MM X 100MM 32MM THREAD,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-32105S,SUP,HCPCS C1713,,73-32105S  -  SCREW CANNULATED 7.3MM X 105MM 32MM THREAD,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-32110S,SUP,HCPCS C1713,,73-32110S  -  SCREW CANNULATED 7.3MM X 110MM 32MM THREAD,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-32115S,SUP,HCPCS C1713,,73-32115S  -  SCREW CANNULATED 32MM THREAD 7.3MM X 115MM,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-32120S,SUP,HCPCS C1713,,73-32120S  -  SCREW CANNULATED 32MM THREAD 7.3MM X 120MM,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-32125S,SUP,HCPCS C1713,,73-32125S  -  SCREW CANNULATED 32MM THREAD 7.3MM X 125MM,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-32130S,SUP,HCPCS C1713,,73-32130S  -  SCREW CANNULATED 32MM THREAD 7.3MM X 130MM,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-32135S,SUP,HCPCS C1713,,73-32135S  -  SCREW CANNULATED 32MM THREAD 7.3MM X 135MM,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-32140S,SUP,HCPCS C1713,,73-32140S  -  SCREW CANNULATED 32MM THREAD 7.3MM X 140MM,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-32145S,SUP,HCPCS C1713,,73-32145S  -  SCREW CANNULATED 32MM THREAD 7.3MM X 145MM,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-32150S,SUP,HCPCS C1713,,73-32150S  -  SCREW CANNULATED 32MM THREAD 7.3MM X 150MM,$235.00,$0.00,$235.00,$105.75,$167.72,$0.00,$40.49,$0.00,$0.00,$41.15,$235.00,$0.00,$117.50,$186.12,$188.00,$0.00,$36.78,$0.00,$37.41,$0.00
73-3308,SUP,Custom 27803010,,73-3308  -  COMPONENT PATLR 3 8MM UNIVERSAL DOME SCORPIO N2/VAC,$600.00,$0.00,$600.00,$0.00,$428.22,$0.00,$0.00,$0.00,$0.00,$0.00,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$0.00,$0.00,$0.00,$0.00
73-3508,SUP,Custom 27803010,,73-3508  -  COMPONENT PATLR 5 32MM 5MM 8MM 4MM UNIVERSAL DOME PEGGED,$600.00,$0.00,$600.00,$0.00,$428.22,$0.00,$0.00,$0.00,$0.00,$0.00,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$0.00,$0.00,$0.00,$0.00
73-3708,SUP,Custom 27803010,,73-3708  -  COMPONENT PATLR 7 8MM 8MM UNIVERSAL DOME SCORPIO N2/VAC,$600.00,$0.00,$600.00,$0.00,$428.22,$0.00,$0.00,$0.00,$0.00,$0.00,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$0.00,$0.00,$0.00,$0.00
73-3710,SUP,Custom 27803010,,73-3710  -  COMPONENT PTLR 7 UNV DOME 34MM 10MM SCRP PG N2/VAC 1 AXIS KN,$600.00,$0.00,$600.00,$0.00,$428.22,$0.00,$0.00,$0.00,$0.00,$0.00,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$0.00,$0.00,$0.00,$0.00
73-3910,SUP,Custom 27803010,,73-3910  -  COMPONENT PTLR 5 UNV DOME 36MM 10MM SCRP PG N2/VAC 1 AXIS KN,$600.00,$0.00,$600.00,$0.00,$428.22,$0.00,$0.00,$0.00,$0.00,$0.00,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$0.00,$0.00,$0.00,$0.00
734024/8,SUP,HCPCS C1768,,734024/8  -  GRAFT CARDIO 8MM 24MM 8MM 40CM 15CM ANTE-FLO VASCUTEK,"$3,225.00",$0.00,"$3,225.00","$1,451.25","$2,301.68",$0.00,$555.65,$0.00,$0.00,$564.67,"$3,225.00",$0.00,"$1,612.50","$2,554.20","$2,580.00",$0.00,$504.71,$0.00,$513.42,$0.00
734026/8,SUP,HCPCS C1768,,734026/8  -  GRAFT CARDIO 8MM 26MM 8MM 40CM 15CM PERFUSION SIDE BRANCH,"$4,050.00",$0.00,"$4,050.00","$1,822.50","$2,890.49",$0.00,$697.79,$0.00,$0.00,$709.12,"$4,050.00",$0.00,"$2,025.00","$3,207.60","$3,240.00",$0.00,$633.83,$0.00,$644.76,$0.00
734028/8,SUP,HCPCS C1768,,734028/8  -  GRAFT CARDIO 40CM 28MM 8MM AORTIC ARCH WVN SIDE BRCH GLWV,"$1,338.75",$0.00,"$1,338.75",$602.44,$955.47,$0.00,$230.66,$0.00,$0.00,$234.40,"$1,338.75",$0.00,$669.38,"$1,060.29","$1,071.00",$0.00,$209.51,$0.00,$213.13,$0.00
734030/8,SUP,HCPCS C1768,,734030/8  -  GRAFT CARDIO 30MM 8MM 40CM 15CM ANTEFLO PERFUSION SIDE,"$4,050.00",$0.00,"$4,050.00","$1,822.50","$2,890.49",$0.00,$697.79,$0.00,$0.00,$709.12,"$4,050.00",$0.00,"$2,025.00","$3,207.60","$3,240.00",$0.00,$633.83,$0.00,$644.76,$0.00
734032/8,SUP,HCPCS C1768,,734032/8  -  GRAFT CARDIO 32MM 8MM 40CM 15CM PERFUSION SIDE BRANCH GRAFT,"$4,050.00",$0.00,"$4,050.00","$1,822.50","$2,890.49",$0.00,$697.79,$0.00,$0.00,$709.12,"$4,050.00",$0.00,"$2,025.00","$3,207.60","$3,240.00",$0.00,$633.83,$0.00,$644.76,$0.00
734034/8,SUP,HCPCS C1768,,734034/8  -  GRAFT CARDIO 34MM 8MM 40CM 15CM ANTEFLO PERFUSION SIDE,"$3,387.50",$0.00,"$3,387.50","$1,524.38","$2,417.66",$0.00,$583.65,$0.00,$0.00,$593.12,"$3,387.50",$0.00,"$1,693.75","$2,682.90","$2,710.00",$0.00,$530.14,$0.00,$539.29,$0.00
74-2-0510,SUP,Custom 27803010,,74-2-0510  -  INSERT TIB 5 10MM KNEE ALPLY CRUC RET SCRP,"$1,431.00",$0.00,"$1,431.00",$0.00,"$1,021.30",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,431.00",$0.00,$715.50,"$1,133.35","$1,144.80",$0.00,$0.00,$0.00,$0.00,$0.00
74-2-0512,SUP,Custom 27803010,,74-2-0512  -  INSERT TIB 5 12MM KNEE ALPLY N2 VAC CRUC RET SCRP,"$1,431.00",$0.00,"$1,431.00",$0.00,"$1,021.30",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,431.00",$0.00,$715.50,"$1,133.35","$1,144.80",$0.00,$0.00,$0.00,$0.00,$0.00
74-2-0515,SUP,HCPCS C1776,,74-2-0515  -  CMPNT TIB 15MM SCRP 5 KNEE ALPLY CRUC RET,"$1,431.00",$0.00,"$1,431.00",$643.95,"$1,021.30",$0.00,$246.55,$0.00,$0.00,$250.56,"$1,431.00",$0.00,$715.50,"$1,133.35","$1,144.80",$0.00,$223.95,$0.00,$227.82,$0.00
74-2-0710,SUP,Custom 27803010,,74-2-0710  -  INSERT TIB 7 10MM KNEE PE N2 VAC CRUC RET STY SCRP,"$1,431.00",$0.00,"$1,431.00",$0.00,"$1,021.30",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,431.00",$0.00,$715.50,"$1,133.35","$1,144.80",$0.00,$0.00,$0.00,$0.00,$0.00
74-2-0712,SUP,Custom 27803010,,74-2-0712  -  INSERT TIB 7 12MM KNEE ALPLY N2 VAC CRUC RET SCRP,"$1,431.00",$0.00,"$1,431.00",$0.00,"$1,021.30",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,431.00",$0.00,$715.50,"$1,133.35","$1,144.80",$0.00,$0.00,$0.00,$0.00,$0.00
74-2-0715,SUP,Custom 27803010,,74-2-0715  -  INSERT TIB 7 15MM KNEE ALPLY N2 VAC CRUC RET SCRP,"$1,431.00",$0.00,"$1,431.00",$0.00,"$1,021.30",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,431.00",$0.00,$715.50,"$1,133.35","$1,144.80",$0.00,$0.00,$0.00,$0.00,$0.00
74-2-0910,SUP,HCPCS C1776,,74-2-0910  -  CMPNT TIB 10MM SCRP 9 KNEE ALPLY CRUC RET,"$1,431.00",$0.00,"$1,431.00",$643.95,"$1,021.30",$0.00,$246.55,$0.00,$0.00,$250.56,"$1,431.00",$0.00,$715.50,"$1,133.35","$1,144.80",$0.00,$223.95,$0.00,$227.82,$0.00
74-2-0912,SUP,Custom 27803010,,74-2-0912  -  INSERT TIB 9 12MM KNEE ALPLY N2 VAC CRUC RET SCRP,"$1,431.00",$0.00,"$1,431.00",$0.00,"$1,021.30",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,431.00",$0.00,$715.50,"$1,133.35","$1,144.80",$0.00,$0.00,$0.00,$0.00,$0.00
74-2-0915,SUP,Custom 27803010,,74-2-0915  -  INSERT TIB 9 15MM KNEE ALPLY N2 VAC CRUC RET SCRP,"$1,431.00",$0.00,"$1,431.00",$0.00,"$1,021.30",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,431.00",$0.00,$715.50,"$1,133.35","$1,144.80",$0.00,$0.00,$0.00,$0.00,$0.00
74-2-1110,SUP,Custom 27803010,,74-2-1110  -  INSERT TIB 11 10MM KNEE ALPLY N2 VAC CRUC RET SCRP,"$1,431.00",$0.00,"$1,431.00",$0.00,"$1,021.30",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,431.00",$0.00,$715.50,"$1,133.35","$1,144.80",$0.00,$0.00,$0.00,$0.00,$0.00
74-2-1112,SUP,Custom 27803010,,74-2-1112  -  INSERT TIB 11 12MM KNEE ALPLY N2 VAC CRUC RET SCRP,"$1,431.00",$0.00,"$1,431.00",$0.00,"$1,021.30",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,431.00",$0.00,$715.50,"$1,133.35","$1,144.80",$0.00,$0.00,$0.00,$0.00,$0.00
74-2-1115,SUP,Custom 27803010,,74-2-1115  -  INSERT TIB 11 15MM KNEE ALPLY N2 VAC CRUC RET SCRP,"$1,431.00",$0.00,"$1,431.00",$0.00,"$1,021.30",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,431.00",$0.00,$715.50,"$1,133.35","$1,144.80",$0.00,$0.00,$0.00,$0.00,$0.00
742-11-42A,SUP,HCPCS C1776,,742-11-42A  -  SHELL ACTB A 42MM STRL TRDNT II PSL 3 HL CH HA HIP,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
742-11-44B,SUP,HCPCS C1776,,742-11-44B  -  SHELL ACTB B 44MM STRL TRDNT II PSL 3 HL CH HA HIP,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
742-11-46C,SUP,HCPCS C1776,,742-11-46C  -  SHELL ACTB C 46MM STRL TRDNT II PSL 3 HL CH HA HIP,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
742-11-48D,SUP,HCPCS C1776,,742-11-48D  -  SHELL ACTB D 48MM STRL TRDNT II PSL CH HA HIP,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
742-11-50D,SUP,HCPCS C1776,,742-11-50D  -  SHELL ACTB D 50MM STRL TRDNT II PSL CH HA HIP,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
742-11-52E,SUP,HCPCS C1776,,742-11-52E  -  SHELL ACTB E 52MM STRL TRDNT II PSL CH HA HIP,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
742-11-54E,SUP,HCPCS C1776,,742-11-54E  -  SHELL ACTB E 54MM STRL TRDNT II PSL CH HA HIP,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
742-11-56F,SUP,HCPCS C1776,,742-11-56F  -  SHELL ACTB F 56MM STRL TRDNT II PSL CH HA HIP,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
742-11-58F,SUP,HCPCS C1776,,742-11-58F  -  SHELL ACTB F 58MM STRL TRDNT II PSL CH HA HIP,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
742-11-60G,SUP,HCPCS C1776,,742-11-60G  -  SHELL ACTB G 60MM STRL TRDNT II PSL CH HA HIP,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
742-11-62G,SUP,HCPCS C1776,,742-11-62G  -  SHELL ACTB G 62MM STRL TRDNT II PSL CH HA HIP,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
742-11-64H,SUP,HCPCS C1776,,742-11-64H  -  SHELL ACTB H 64MM STRL TRDNT II PSL CH HA HIP,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
742-11-66H,SUP,HCPCS C1776,,742-11-66H  -  SHELL ACTB H 66MM STRL TRDNT II PSL CH HA HIP,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
74-3-0510,SUP,HCPCS C1776,,74-3-0510  -  CMPNT TIB 10MM 5 KNEE ALPLY PS,"$1,470.00",$0.00,"$1,470.00",$661.50,"$1,049.14",$0.00,$253.27,$0.00,$0.00,$257.39,"$1,470.00",$0.00,$735.00,"$1,164.24","$1,176.00",$0.00,$230.06,$0.00,$234.02,$0.00
74-3-0512,SUP,HCPCS C1776,,74-3-0512  -  CMPNT TIB 12MM 5 KNEE ALPLY PS,"$1,470.00",$0.00,"$1,470.00",$661.50,"$1,049.14",$0.00,$253.27,$0.00,$0.00,$257.39,"$1,470.00",$0.00,$735.00,"$1,164.24","$1,176.00",$0.00,$230.06,$0.00,$234.02,$0.00
74-3-0515,SUP,HCPCS C1776,,74-3-0515  -  CMPNT TIB 15MM 5 KNEE ALPLY PS,"$1,470.00",$0.00,"$1,470.00",$661.50,"$1,049.14",$0.00,$253.27,$0.00,$0.00,$257.39,"$1,470.00",$0.00,$735.00,"$1,164.24","$1,176.00",$0.00,$230.06,$0.00,$234.02,$0.00
74-3-0710,SUP,HCPCS C1776,,74-3-0710  -  CMPNT TIB 10MM 7 KNEE ALPLY PS STY,"$1,470.00",$0.00,"$1,470.00",$661.50,"$1,049.14",$0.00,$253.27,$0.00,$0.00,$257.39,"$1,470.00",$0.00,$735.00,"$1,164.24","$1,176.00",$0.00,$230.06,$0.00,$234.02,$0.00
74-3-0712,SUP,HCPCS C1776,,74-3-0712  -  CMPNT TIB 12MM 7 KNEE ALPLY PS,"$1,470.00",$0.00,"$1,470.00",$661.50,"$1,049.14",$0.00,$253.27,$0.00,$0.00,$257.39,"$1,470.00",$0.00,$735.00,"$1,164.24","$1,176.00",$0.00,$230.06,$0.00,$234.02,$0.00
74-3-0715,SUP,HCPCS C1776,,74-3-0715  -  CMPNT TIB 15MM 7 KNEE ALPLY PS,"$1,470.00",$0.00,"$1,470.00",$661.50,"$1,049.14",$0.00,$253.27,$0.00,$0.00,$257.39,"$1,470.00",$0.00,$735.00,"$1,164.24","$1,176.00",$0.00,$230.06,$0.00,$234.02,$0.00
74-3-0910,SUP,HCPCS C1776,,74-3-0910  -  CMPNT TIB 10MM 9 KNEE ALPLY PS,"$1,470.00",$0.00,"$1,470.00",$661.50,"$1,049.14",$0.00,$253.27,$0.00,$0.00,$257.39,"$1,470.00",$0.00,$735.00,"$1,164.24","$1,176.00",$0.00,$230.06,$0.00,$234.02,$0.00
74-3-0912,SUP,HCPCS C1776,,74-3-0912  -  CMPNT TIB 12MM 9 KNEE ALPLY PS,"$1,470.00",$0.00,"$1,470.00",$661.50,"$1,049.14",$0.00,$253.27,$0.00,$0.00,$257.39,"$1,470.00",$0.00,$735.00,"$1,164.24","$1,176.00",$0.00,$230.06,$0.00,$234.02,$0.00
74-3-0915,SUP,HCPCS C1776,,74-3-0915  -  CMPNT TIB 15MM 9 KNEE ALPLY PS,"$1,470.00",$0.00,"$1,470.00",$661.50,"$1,049.14",$0.00,$253.27,$0.00,$0.00,$257.39,"$1,470.00",$0.00,$735.00,"$1,164.24","$1,176.00",$0.00,$230.06,$0.00,$234.02,$0.00
74-3-1110,SUP,HCPCS C1776,,74-3-1110  -  CMPNT TIB 10MM 11 KNEE ALPLY PS,"$1,470.00",$0.00,"$1,470.00",$661.50,"$1,049.14",$0.00,$253.27,$0.00,$0.00,$257.39,"$1,470.00",$0.00,$735.00,"$1,164.24","$1,176.00",$0.00,$230.06,$0.00,$234.02,$0.00
74-3-1112,SUP,HCPCS C1776,,74-3-1112  -  CMPNT TIB 12MM 11 KNEE ALPLY PS,"$1,470.00",$0.00,"$1,470.00",$661.50,"$1,049.14",$0.00,$253.27,$0.00,$0.00,$257.39,"$1,470.00",$0.00,$735.00,"$1,164.24","$1,176.00",$0.00,$230.06,$0.00,$234.02,$0.00
74-3-1115,SUP,HCPCS C1776,,74-3-1115  -  CMPNT TIB 15MM 11 KNEE ALPLY PS,"$1,470.00",$0.00,"$1,470.00",$661.50,"$1,049.14",$0.00,$253.27,$0.00,$0.00,$257.39,"$1,470.00",$0.00,$735.00,"$1,164.24","$1,176.00",$0.00,$230.06,$0.00,$234.02,$0.00
74402006N,SUP,HCPCS C1713,,74402006N  -  SCREW BN T6 2MM 1.4MM 6MM NS VLP MN-MOD ST TI OSTEOPENIA,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402007N,SUP,HCPCS C1713,,74402007N  -  SCREW BN T6 2MM 1.4MM 7MM NS VLP MN-MOD ST TI CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402008N,SUP,HCPCS C1713,,74402008N  -  SCREW BN T6 2MM 1.4MM 8MM NS VLP MN-MOD ST DRV MECH TI CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402009N,SUP,HCPCS C1713,,74402009N  -  SCREW BN T6 2MM 1.4MM 9MM NS VLP MN-MOD ST TI OSTEOPENIA,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402010N,SUP,HCPCS C1713,,74402010N  -  SCREW BN T6 2MM 1.4MM 10MM NS VLP MN-MOD ST TI CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402011N,SUP,HCPCS C1713,,74402011N  -  SCREW BN T6 2MM 1.4MM 11MM NS VLP MN-MOD ST TI CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402012N,SUP,HCPCS C1713,,74402012N  -  SCREW BN 2MM 1.4MM 12MM PUR NS VLP MN-MOD T6 DRVR ST TI CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402013N,SUP,HCPCS C1713,,74402013N  -  SCREW BN T6 2MM 1.4MM 13MM NS VLP MN-MOD ST TI OSTEOPENIA,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402014N,SUP,HCPCS C1713,,74402014N  -  SCREW BN 2MM 1.4MM 14MM PUR NS VLP MN-MOD T6 DRVR ST TI CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402016N,SUP,HCPCS C1713,,74402016N  -  SCREW BN 2MM 1.4MM 16MM PUR NS VLP MN-MOD T6 DRVR ST TI CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402018N,SUP,HCPCS C1713,,74402018N  -  SCREW BN 2MM 1.4MM 18MM PUR NS VLP MN-MOD T6 DRVR ST TI CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402020N,SUP,HCPCS C1713,,74402020N  -  SCREW BN 2MM 1.4MM 20MM PUR NS VLP MN-MOD T6 DRVR ST TI CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402022N,SUP,HCPCS C1713,,74402022N  -  SCREW BN T6 2MM 1.4MM 22MM NS VLP MN-MOD ST TI OSTEOPENIA,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402024N,SUP,HCPCS C1713,,74402024N  -  SCREW BN T6 2MM 1.4MM 24MM NS VLP MN-MOD ST TI CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402026N,SUP,HCPCS C1713,,74402026N  -  SCREW BN T6 2MM 1.4MM 26MM NS VLP MN-MOD ST TI CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402028N,SUP,HCPCS C1713,,74402028N  -  SCREW BN T6 2MM 1.4MM 28MM NS VLP MN-MOD ST TI CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402030N,SUP,HCPCS C1713,,74402030N  -  SCREW BN T6 2MM 1.4MM 30MM NS VLP MN-MOD ST TI CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402032N,SUP,HCPCS C1713,,74402032N  -  SCREW BN T6 2MM 1.4MM 32MM NS VLP MN-MOD ST TI OSTEOPENIA,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402034N,SUP,HCPCS C1713,,74402034N  -  SCREW BN T6 2MM 1.4MM 34MM NS VLP MN-MOD ST TI CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402036N,SUP,HCPCS C1713,,74402036N  -  SCREW BN T6 2MM 1.4MM 36MM NS VLP MN-MOD ST TI OSTEOPENIA,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402406N,SUP,HCPCS C1713,,74402406N  -  SCREW BN T7 2.4MM 1.7MM 6MM NS VLP MN-MOD ST TI OSTEOPENIA,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402407N,SUP,HCPCS C1713,,74402407N  -  SCREW BN T7 2.4MM 1.7MM 7MM NS VLP MN-MOD ST TI CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402409N,SUP,HCPCS C1713,,74402409N  -  SCREW BN T7 2.4MM 1.7MM 9MM GRN NS VLP ST LO HD PRFL TI CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402410N,SUP,HCPCS C1713,,74402410N  -  SCREW BN T7 2.4MM 1.7MM 10MM GRN NS VLP ST LO HD PRFL TI,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402411N,SUP,HCPCS C1713,,74402411N  -  SCREW BN T7 2.4MM 1.7MM 11MM NS VLP MN-MOD ST TI CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402412N,SUP,HCPCS C1713,,74402412N  -  SCREW BN 2.4MM 1.7MM 12MM GRN NS VLP MN-MOD T7 DRVR ST TI,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402413N,SUP,HCPCS C1713,,74402413N  -  SCREW BN T7 2.4MM 1.7MM 13MM GRN NS VLP ST LO HD PRFL TI,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402414N,SUP,HCPCS C1713,,74402414N  -  SCREW BN 2.4MM 1.7MM 14MM GRN NS VLP MN-MOD T7 DRVR ST TI,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402415N,SUP,HCPCS C1713,,74402415N  -  SCREW BN 2.4MM 1.7MM 15MM GRN NS VLP MN-MOD T7 DRVR ST TI,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402416N,SUP,HCPCS C1713,,74402416N  -  SCREW BN T7 2.4MM 1.7MM 16MM GRN NS VLP ST LOPRFL HD TI CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402418N,SUP,HCPCS C1713,,74402418N  -  SCREW BN T7 2.4MM 1.7MM 18MM GRN NS VLP ST LO HD PRFL TI,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402420N,SUP,HCPCS C1713,,74402420N  -  SCREW BN T7 2.4MM 1.7MM 20MM GRN NS VLP ST LO HD PRFL TI,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402422N,SUP,HCPCS C1713,,74402422N  -  SCREW BN T7 2.4MM 1.7MM 22MM GRN NS VLP ST LO HD PRFL TI,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402424N,SUP,HCPCS C1713,,74402424N  -  SCREW BN T7 2.4MM 1.7MM 24MM GRN NS VLP ST LOPRFL HD TI CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402426N,SUP,HCPCS C1713,,74402426N  -  SCREW BN T7 2.4MM 26MM NS VLP MN-MOD ST TI CORT,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402428N,SUP,HCPCS C1713,,74402428N  -  SCREW BN T7 2.4MM 1.7MM 28MM GRN NS VLP ST LO HD PRFL TI,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402430N,SUP,HCPCS C1713,,74402430N  -  SCREW BN T7 2.4MM 1.7MM 30MM GRN NS VLP ST LO HD PRFL TI,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402432N,SUP,HCPCS C1713,,74402432N  -  SCREW BN T7 2.4MM 1.7MM 32MM GRN NS VLP ST LO HD PRFL TI,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402434N,SUP,HCPCS C1713,,74402434N  -  SCREW BN T7 2.4MM 1.7MM 34MM GRN NS VLP ST LO HD PRFL TI,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402436N,SUP,HCPCS C1713,,74402436N  -  SCREW BN T7 2.4MM 1.7MM 36MM GRN NS VLP ST LO HD PRFL TI,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402438N,SUP,HCPCS C1713,,74402438N  -  SCREW BN T7 2.4MM 1.7MM 38MM GRN NS VLP ST LO HD PRFL TI,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402440N,SUP,HCPCS C1713,,74402440N  -  SCREW BN T7 2.4MM 1.7MM 40MM GRN NS VLP ST LO HD PRFL TI,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402442N,SUP,HCPCS C1713,,74402442N  -  SCREW BN T7 2.4MM 1.7MM 42MM GRN NS VLP ST LO HD PRFL TI,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402444N,SUP,HCPCS C1713,,74402444N  -  SCREW BN T7 2.4MM 1.7MM 44MM GRN NS VLP ST LO HD PRFL TI,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74402446N,SUP,HCPCS C1713,,74402446N  -  SCREW BN T7 2.4MM 1.7MM 46MM GRN NS VLP ST LO HD PRFL TI,$112.48,$0.00,$112.48,$50.61,$80.27,$0.00,$19.38,$0.00,$0.00,$19.69,$112.48,$0.00,$56.24,$89.08,$89.98,$0.00,$17.60,$0.00,$17.91,$0.00
74412006N,SUP,HCPCS C1713,,74412006N  -  SCREW BN T6 2MM 1.4MM 6MM PUR NS VLP LCK ST LOPRFL HD TI,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412007N,SUP,HCPCS C1713,,74412007N  -  SCREW BN T6 2MM 1.4MM 7MM PUR NS VLP LCK ST LOPRFL HD TI,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412008N,SUP,HCPCS C1713,,74412008N  -  SCREW BN 2MM 8MM NS VLP LCK ST T6 DRVR TI SM BN,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412009N,SUP,HCPCS C1713,,74412009N  -  SCREW BN T6 2MM 1.4MM 9MM PUR NS VLP LCK ST LOPRFL HD TI,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412010N,SUP,HCPCS C1713,,74412010N  -  SCREW BN 2MM 10MM NS VLP LCK ST T6 DRVR TI SM BN,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412011N,SUP,HCPCS C1713,,74412011N  -  SCREW BN 2MM 1.4MM 11MM PUR NS VLP MN-MOD T6 DRVR ST LCK TI,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412012N,SUP,HCPCS C1713,,74412012N  -  SCREW BN 2MM 1.4MM 12MM PUR NS VLP MN-MOD T6 DRVR ST LCK TI,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412013N,SUP,HCPCS C1713,,74412013N  -  SCREW BN T6 2MM 1.4MM 13MM PUR NS VLP LCK ST LOPRFL HD TI,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412014N,SUP,HCPCS C1713,,74412014N  -  SCREW BN 2MM 14MM NS VLP LCK ST T6 DRVR TI SM BN,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412016N,SUP,HCPCS C1713,,74412016N  -  SCREW BN T6 2MM 1.4MM 16MM PUR NS VLP LCK ST LOPRFL HD TI,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412018N,SUP,HCPCS C1713,,74412018N  -  SCREW BN T6 2MM 1.4MM 18MM PUR NS VLP LCK ST LOPRFL HD TI,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412020N,SUP,HCPCS C1713,,74412020N  -  SCREW BN T6 2MM 1.4MM 20MM PUR NS VLP LCK ST LOPRFL HD TI,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412022N,SUP,HCPCS C1713,,74412022N  -  SCREW BN T6 2MM 1.4MM 22MM PUR NS VLP LCK ST LOPRFL HD TI,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412024N,SUP,HCPCS C1713,,74412024N  -  SCREW BN T6 2MM 1.4MM 24MM PUR NS VLP LCK ST LOPRFL HD TI,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412026N,SUP,HCPCS C1713,,74412026N  -  SCREW BN T6 2MM 1.4MM 26MM PUR NS VLP LCK ST LO HD PRFL TI,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412028N,SUP,HCPCS C1713,,74412028N  -  SCREW BN T6 2MM 1.4MM 28MM PUR NS VLP LCK ST LOPRFL HD TI,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412030N,SUP,HCPCS C1713,,74412030N  -  SCREW BN T6 2MM 1.4MM 30MM PUR NS VLP LCK ST LOPRFL HD TI,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412032N,SUP,HCPCS C1713,,74412032N  -  SCREW BN T6 2MM 1.4MM 32MM PUR NS VLP LCK ST LO HD PRFL TI,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412034N,SUP,HCPCS C1713,,74412034N  -  SCREW BN T6 2MM 1.4MM 34MM PUR NS VLP LCK ST LOPRFL HD TI,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412036N,SUP,HCPCS C1713,,74412036N  -  SCREW BN T6 2MM 1.4MM 36MM PUR NS VLP LCK ST LOPRFL HD TI,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412406N,SUP,HCPCS C1713,,74412406N  -  SCREW BN T7 2.4MM 1.7MM 6MM NS VLP MN-MOD ST LCK TI CORT,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412407N,SUP,HCPCS C1713,,74412407N  -  SCREW BN T7 2.4MM 1.7MM 7MM NS VLP MN-MOD ST LCK TI,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412408N,SUP,HCPCS C1713,,74412408N  -  SCREW BN T7 2.4MM 8MM NS VLP MN-MOD ST LCK TI,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412409N,SUP,HCPCS C1713,,74412409N  -  SCREW BN T7 2.4MM 1.7MM 9MM NS VLP MN-MOD ST LCK TI,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412410N,SUP,HCPCS C1713,,74412410N  -  SCREW BN T7 2.4MM 10MM NS VLP MN-MOD ST LCK LOPRFL HD TI FT,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412411N,SUP,HCPCS C1713,,74412411N  -  SCREW BN T7 2.4MM 1.7MM 11MM NS VLP MN-MOD ST LCK TI,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412412N,SUP,HCPCS C1713,,74412412N  -  SCREW BN T7 2.4MM 1.7MM 12MM NS VLP ST LCK TI CORT MN-MOD SM,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412413N,SUP,HCPCS C1713,,74412413N  -  SCREW BN T7 2.4MM 1.7MM 13MM NS VLP MN-MOD ST LCK TI,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412414N,SUP,HCPCS C1713,,74412414N  -  SCREW BN T7 2.4MM 1.7MM 14MM NS VLP MN-MOD ST LCK TI,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412415N,SUP,HCPCS C1713,,74412415N  -  SCREW BN T7 2.4MM 1.7MM 15MM NS VLP MN-MOD ST LCK TI,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412416N,SUP,HCPCS C1713,,74412416N  -  SCREW BN 2.4MM 1.7MM 16MM GRN NS VLP MN-MOD T7 DRVR ST LCK,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412418N,SUP,HCPCS C1713,,74412418N  -  SCREW BN T7 2.4MM 18MM NS VLP ST LCK TI,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412420N,SUP,HCPCS C1713,,74412420N  -  SCREW BN T7 2.4MM 1.7MM 20MM NS VLP MN-MOD ST LCK TI,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412422N,SUP,HCPCS C1713,,74412422N  -  SCREW BN T7 2.4MM 22MM GRN NS VLP ST DRVR TI FT SM BN PLT,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412424N,SUP,HCPCS C1713,,74412424N  -  SCREW BN T7 2.4MM 24MM GRN NS VLP ST DRVR TI FT SM BN PLT,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412426N,SUP,HCPCS C1713,,74412426N  -  SCREW BN T7 2.4MM 1.7MM 26MM NS VLP MN-MOD ST LCK TI,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412428N,SUP,HCPCS C1713,,74412428N  -  SCREW BN T7 2.4MM 1.7MM 28MM NS VLP MN-MOD ST LCK TI,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412430N,SUP,HCPCS C1713,,74412430N  -  SCREW BN T7 2.4MM 1.7MM 30MM NS VLP MN-MOD ST LCK TI,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412432N,SUP,HCPCS C1713,,74412432N  -  SCREW BN T7 2.4MM 1.7MM 32MM NS VLP MN-MOD ST LCK TI,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412434N,SUP,HCPCS C1713,,74412434N  -  SCREW BN T7 2.4MM 1.7MM 34MM NS VLP MN-MOD ST LCK TI,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412436N,SUP,HCPCS C1713,,74412436N  -  SCREW BN T7 2.4MM 1.7MM 36MM NS VLP MN-MOD ST LCK TI,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412438N,SUP,HCPCS C1713,,74412438N  -  SCREW BN T7 2.4MM 1.7MM 38MM NS VLP MN-MOD ST LCK TI,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412440N,SUP,HCPCS C1713,,74412440N  -  SCREW BN T7 2.4MM 1.7MM 40MM NS VLP MN-MOD ST LCK TI,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412442N,SUP,HCPCS C1713,,74412442N  -  SCREW BN T7 2.4MM 1.7MM 42MM NS VLP MN-MOD ST LCK TI,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412444N,SUP,HCPCS C1713,,74412444N  -  SCREW BN T7 2.4MM 1.7MM 44MM NS VLP MN-MOD ST LCK TI,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
74412446N,SUP,HCPCS C1713,,74412446N  -  SCREW BN T7 2.4MM 1.7MM 46MM NS VLP MN-MOD ST LCK TI,$237.88,$0.00,$237.88,$107.04,$169.77,$0.00,$40.98,$0.00,$0.00,$41.65,$237.88,$0.00,$118.94,$188.40,$190.30,$0.00,$37.23,$0.00,$37.87,$0.00
746F8,SUP,HCPCS C1751,,746F8  -  CATHETER PA STD 8FR 110CM SG C VIP TD,"$1,006.70",$0.00,"$1,006.70",$453.02,$718.48,$0.00,$173.45,$0.00,$0.00,$176.27,"$1,006.70",$0.00,$503.35,$797.31,$805.36,$0.00,$157.55,$0.00,$160.27,$0.00
746HF8,SUP,Custom 27203010,,746HF8  -  CATHETER ART LN 8FR 110CM SG C VIP 7 LUM CCO AMC THRMBSH,$537.50,$0.00,$537.50,$0.00,$383.61,$0.00,$0.00,$0.00,$0.00,$0.00,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$0.00,$0.00,$0.00,$0.00
74703-02,SUP,Custom 27203010,,74703-02  -  TUBING PACK,$636.25,$0.00,$636.25,$0.00,$454.09,$0.00,$0.00,$0.00,$0.00,$0.00,$636.25,$0.00,$318.13,$503.91,$509.00,$0.00,$0.00,$0.00,$0.00,$0.00
7492-0108,SUP,Custom 27803010,,7492-0108  -  BRNG INS PS TIB,"$1,293.00",$0.00,"$1,293.00",$0.00,$922.81,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,293.00",$0.00,$646.50,"$1,024.06","$1,034.40",$0.00,$0.00,$0.00,$0.00,$0.00
7492-0110,SUP,Custom 27803010,,7492-0110  -  INSERT TIB KNEE PS 2 BRNG,"$1,293.00",$0.00,"$1,293.00",$0.00,$922.81,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,293.00",$0.00,$646.50,"$1,024.06","$1,034.40",$0.00,$0.00,$0.00,$0.00,$0.00
7492-0112,SUP,Custom 27803010,,7492-0112  -  INSERT TIB KNEE PS 2 BRNG,"$1,293.00",$0.00,"$1,293.00",$0.00,$922.81,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,293.00",$0.00,$646.50,"$1,024.06","$1,034.40",$0.00,$0.00,$0.00,$0.00,$0.00
7492-0115,SUP,Custom 27803010,,7492-0115  -  INSERT TIB KNEE PS 2 BRNG,"$1,293.00",$0.00,"$1,293.00",$0.00,$922.81,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,293.00",$0.00,$646.50,"$1,024.06","$1,034.40",$0.00,$0.00,$0.00,$0.00,$0.00
7492-0118,SUP,Custom 27803010,,7492-0118  -  INSERT TIB KNEE PS 2 BRNG,"$1,293.00",$0.00,"$1,293.00",$0.00,$922.81,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,293.00",$0.00,$646.50,"$1,024.06","$1,034.40",$0.00,$0.00,$0.00,$0.00,$0.00
7492-0121,SUP,Custom 27803010,,7492-0121  -  INSERT TIB KNEE PS 2 BRNG,"$1,293.00",$0.00,"$1,293.00",$0.00,$922.81,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,293.00",$0.00,$646.50,"$1,024.06","$1,034.40",$0.00,$0.00,$0.00,$0.00,$0.00
7492-0124,SUP,Custom 27803010,,7492-0124  -  INSERT TIB KNEE PS 2 BRNG,"$1,347.00",$0.00,"$1,347.00",$0.00,$961.35,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,347.00",$0.00,$673.50,"$1,066.82","$1,077.60",$0.00,$0.00,$0.00,$0.00,$0.00
7492-0308,SUP,Custom 27803010,,7492-0308  -  INSERT TIB KNEE PS 2 BRNG,"$1,293.00",$0.00,"$1,293.00",$0.00,$922.81,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,293.00",$0.00,$646.50,"$1,024.06","$1,034.40",$0.00,$0.00,$0.00,$0.00,$0.00
7492-0310,SUP,Custom 27803010,,7492-0310  -  INSERT TIB KNEE PS 2 BRNG,"$1,293.00",$0.00,"$1,293.00",$0.00,$922.81,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,293.00",$0.00,$646.50,"$1,024.06","$1,034.40",$0.00,$0.00,$0.00,$0.00,$0.00
7492-0312,SUP,Custom 27803010,,7492-0312  -  INSERT TIB KNEE PS 2 BRNG,"$1,293.00",$0.00,"$1,293.00",$0.00,$922.81,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,293.00",$0.00,$646.50,"$1,024.06","$1,034.40",$0.00,$0.00,$0.00,$0.00,$0.00
7492-0315,SUP,Custom 27803010,,7492-0315  -  INSERT TIB KNEE PS 2 BRNG,"$1,293.00",$0.00,"$1,293.00",$0.00,$922.81,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,293.00",$0.00,$646.50,"$1,024.06","$1,034.40",$0.00,$0.00,$0.00,$0.00,$0.00
7492-0318,SUP,Custom 27803010,,7492-0318  -  INSERT TIB KNEE PS 2 BRNG,"$1,293.00",$0.00,"$1,293.00",$0.00,$922.81,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,293.00",$0.00,$646.50,"$1,024.06","$1,034.40",$0.00,$0.00,$0.00,$0.00,$0.00
7492-0321,SUP,Custom 27803010,,7492-0321  -  INSERT TIB KNEE PS 2 BRNG,"$1,293.00",$0.00,"$1,293.00",$0.00,$922.81,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,293.00",$0.00,$646.50,"$1,024.06","$1,034.40",$0.00,$0.00,$0.00,$0.00,$0.00
7492-0324,SUP,Custom 27803010,,7492-0324  -  INSERT TIB KNEE PS 2 BRNG,"$1,293.00",$0.00,"$1,293.00",$0.00,$922.81,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,293.00",$0.00,$646.50,"$1,024.06","$1,034.40",$0.00,$0.00,$0.00,$0.00,$0.00
7492-0508,SUP,Custom 27803010,,7492-0508  -  INSERT TIB KNEE PS 2 BRNG,"$1,293.00",$0.00,"$1,293.00",$0.00,$922.81,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,293.00",$0.00,$646.50,"$1,024.06","$1,034.40",$0.00,$0.00,$0.00,$0.00,$0.00
7492-0510,SUP,Custom 27803010,,7492-0510  -  INSERT TIB KNEE PS 2 BRNG,"$1,293.00",$0.00,"$1,293.00",$0.00,$922.81,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,293.00",$0.00,$646.50,"$1,024.06","$1,034.40",$0.00,$0.00,$0.00,$0.00,$0.00
7492-0512,SUP,Custom 27803010,,7492-0512  -  INSERT TIB KNEE PS 2 BRNG,"$1,293.00",$0.00,"$1,293.00",$0.00,$922.81,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,293.00",$0.00,$646.50,"$1,024.06","$1,034.40",$0.00,$0.00,$0.00,$0.00,$0.00
7492-0515,SUP,Custom 27803010,,7492-0515  -  INSERT TIB KNEE PS 2 BRNG,"$1,347.00",$0.00,"$1,347.00",$0.00,$961.35,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,347.00",$0.00,$673.50,"$1,066.82","$1,077.60",$0.00,$0.00,$0.00,$0.00,$0.00
7492-0518,SUP,Custom 27803010,,7492-0518  -  INSERT TIB KNEE PS 2 BRNG,"$1,347.00",$0.00,"$1,347.00",$0.00,$961.35,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,347.00",$0.00,$673.50,"$1,066.82","$1,077.60",$0.00,$0.00,$0.00,$0.00,$0.00
7492-0521,SUP,Custom 27803010,,7492-0521  -  INSERT TIB KNEE PS 2 BRNG,"$1,293.00",$0.00,"$1,293.00",$0.00,$922.81,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,293.00",$0.00,$646.50,"$1,024.06","$1,034.40",$0.00,$0.00,$0.00,$0.00,$0.00
7492-0524,SUP,Custom 27803010,,7492-0524  -  INSERT TIB KNEE PS 2 BRNG,"$1,293.00",$0.00,"$1,293.00",$0.00,$922.81,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,293.00",$0.00,$646.50,"$1,024.06","$1,034.40",$0.00,$0.00,$0.00,$0.00,$0.00
7492-0708,SUP,Custom 27803010,,7492-0708  -  INSERT TIB KNEE PS 2 BRNG,"$1,293.00",$0.00,"$1,293.00",$0.00,$922.81,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,293.00",$0.00,$646.50,"$1,024.06","$1,034.40",$0.00,$0.00,$0.00,$0.00,$0.00
7492-0710,SUP,Custom 27803010,,7492-0710  -  INSERT TIB KNEE PS 2 BRNG,"$1,347.00",$0.00,"$1,347.00",$0.00,$961.35,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,347.00",$0.00,$673.50,"$1,066.82","$1,077.60",$0.00,$0.00,$0.00,$0.00,$0.00
7492-0712,SUP,Custom 27803010,,7492-0712  -  INSERT TIB 7 12MM KNEE BRNG,"$1,347.00",$0.00,"$1,347.00",$0.00,$961.35,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,347.00",$0.00,$673.50,"$1,066.82","$1,077.60",$0.00,$0.00,$0.00,$0.00,$0.00
7492-0715,SUP,Custom 27803010,,7492-0715  -  INSERT TIB KNEE PS 2 BRNG,"$1,347.00",$0.00,"$1,347.00",$0.00,$961.35,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,347.00",$0.00,$673.50,"$1,066.82","$1,077.60",$0.00,$0.00,$0.00,$0.00,$0.00
7492-0718,SUP,Custom 27803010,,7492-0718  -  INSERT TIB KNEE PS 2 BRNG,"$1,347.00",$0.00,"$1,347.00",$0.00,$961.35,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,347.00",$0.00,$673.50,"$1,066.82","$1,077.60",$0.00,$0.00,$0.00,$0.00,$0.00
7492-0721,SUP,Custom 27803010,,7492-0721  -  INSERT TIB PS 2 BRNG,"$1,347.00",$0.00,"$1,347.00",$0.00,$961.35,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,347.00",$0.00,$673.50,"$1,066.82","$1,077.60",$0.00,$0.00,$0.00,$0.00,$0.00
7492-0724,SUP,Custom 27803010,,7492-0724  -  INSERT TIB PS 2 BRNG,"$1,293.00",$0.00,"$1,293.00",$0.00,$922.81,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,293.00",$0.00,$646.50,"$1,024.06","$1,034.40",$0.00,$0.00,$0.00,$0.00,$0.00
7492-0908,SUP,Custom 27803010,,7492-0908  -  INSERT TIB PS 2 BRNG,"$1,347.00",$0.00,"$1,347.00",$0.00,$961.35,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,347.00",$0.00,$673.50,"$1,066.82","$1,077.60",$0.00,$0.00,$0.00,$0.00,$0.00
7492-0910,SUP,Custom 27803010,,7492-0910  -  INSERT TIB 9 KNEE 10MM,"$1,293.00",$0.00,"$1,293.00",$0.00,$922.81,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,293.00",$0.00,$646.50,"$1,024.06","$1,034.40",$0.00,$0.00,$0.00,$0.00,$0.00
7492-0912,SUP,Custom 27803010,,7492-0912  -  INSERT TIB PS 2 BRNG,"$1,293.00",$0.00,"$1,293.00",$0.00,$922.81,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,293.00",$0.00,$646.50,"$1,024.06","$1,034.40",$0.00,$0.00,$0.00,$0.00,$0.00
7492-0915,SUP,Custom 27803010,,7492-0915  -  INSERT TIB PS 2 BRNG,"$1,293.00",$0.00,"$1,293.00",$0.00,$922.81,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,293.00",$0.00,$646.50,"$1,024.06","$1,034.40",$0.00,$0.00,$0.00,$0.00,$0.00
7492-0918,SUP,Custom 27803010,,7492-0918  -  INSERT TIB PS 2 BRNG,"$1,293.00",$0.00,"$1,293.00",$0.00,$922.81,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,293.00",$0.00,$646.50,"$1,024.06","$1,034.40",$0.00,$0.00,$0.00,$0.00,$0.00
7492-0921,SUP,Custom 27803010,,7492-0921  -  INSERT TIB PS 2 BRNG,"$1,293.00",$0.00,"$1,293.00",$0.00,$922.81,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,293.00",$0.00,$646.50,"$1,024.06","$1,034.40",$0.00,$0.00,$0.00,$0.00,$0.00
7492-0924,SUP,Custom 27803010,,7492-0924  -  INSERT TIB PS 2 BRNG,"$1,293.00",$0.00,"$1,293.00",$0.00,$922.81,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,293.00",$0.00,$646.50,"$1,024.06","$1,034.40",$0.00,$0.00,$0.00,$0.00,$0.00
7493-0108,SUP,Custom 27803010,,7493-0108  -  INSERT TIBIAL 1 8MM POSTERIOR STABILIZE BEARING KNEE S7000,"$2,350.00",$0.00,"$2,350.00",$0.00,"$1,677.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,350.00",$0.00,"$1,175.00","$1,861.20","$1,880.00",$0.00,$0.00,$0.00,$0.00,$0.00
7493-0110,SUP,Custom 27803010,,7493-0110  -  INSERT TIBIAL 1 10MM POSTERIOR STABILIZE BEARING KNEE S7000,"$2,350.00",$0.00,"$2,350.00",$0.00,"$1,677.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,350.00",$0.00,"$1,175.00","$1,861.20","$1,880.00",$0.00,$0.00,$0.00,$0.00,$0.00
7493-0112,SUP,Custom 27803010,,7493-0112  -  INSERT TIBIAL 1 12MM POSTERIOR STABILIZE BEARING KNEE S7000,"$2,350.00",$0.00,"$2,350.00",$0.00,"$1,677.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,350.00",$0.00,"$1,175.00","$1,861.20","$1,880.00",$0.00,$0.00,$0.00,$0.00,$0.00
7493-0115,SUP,Custom 27803010,,7493-0115  -  INSERT TIBIAL 1 15MM POSTERIOR STABILIZE BEARING KNEE S7000,"$2,350.00",$0.00,"$2,350.00",$0.00,"$1,677.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,350.00",$0.00,"$1,175.00","$1,861.20","$1,880.00",$0.00,$0.00,$0.00,$0.00,$0.00
7493-0118,SUP,Custom 27803010,,7493-0118  -  INSERT TIBIAL 1 18MM POSTERIOR STABILIZE BEARING KNEE S7000,"$2,350.00",$0.00,"$2,350.00",$0.00,"$1,677.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,350.00",$0.00,"$1,175.00","$1,861.20","$1,880.00",$0.00,$0.00,$0.00,$0.00,$0.00
7493-0121,SUP,Custom 27803010,,7493-0121  -  INSERT TIBIAL 1 21MM POSTERIOR STABILIZE BEARING KNEE S7000,"$2,350.00",$0.00,"$2,350.00",$0.00,"$1,677.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,350.00",$0.00,"$1,175.00","$1,861.20","$1,880.00",$0.00,$0.00,$0.00,$0.00,$0.00
7493-0124,SUP,Custom 27803010,,7493-0124  -  INSERT TIBIAL 1 24MM POSTERIOR STABILIZE BEARING KNEE S7000,"$2,350.00",$0.00,"$2,350.00",$0.00,"$1,677.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,350.00",$0.00,"$1,175.00","$1,861.20","$1,880.00",$0.00,$0.00,$0.00,$0.00,$0.00
7493-0308,SUP,Custom 27803010,,7493-0308  -  INSERT TIBIAL 3 8MM POSTERIOR STABILIZE BEARING KNEE S7000,"$2,350.00",$0.00,"$2,350.00",$0.00,"$1,677.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,350.00",$0.00,"$1,175.00","$1,861.20","$1,880.00",$0.00,$0.00,$0.00,$0.00,$0.00
7493-0310,SUP,Custom 27803010,,7493-0310  -  INSERT TIBIAL 3 10MM POSTERIOR STABILIZE BEARING KNEE S7000,"$2,350.00",$0.00,"$2,350.00",$0.00,"$1,677.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,350.00",$0.00,"$1,175.00","$1,861.20","$1,880.00",$0.00,$0.00,$0.00,$0.00,$0.00
7493-0312,SUP,Custom 27803010,,7493-0312  -  INSERT TIBIAL 3 12MM POSTERIOR STABILIZE BEARING KNEE S7000,"$2,350.00",$0.00,"$2,350.00",$0.00,"$1,677.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,350.00",$0.00,"$1,175.00","$1,861.20","$1,880.00",$0.00,$0.00,$0.00,$0.00,$0.00
7493-0315,SUP,Custom 27803010,,7493-0315  -  INSERT TIBIAL 3 15MM POSTERIOR STABILIZE BEARING KNEE S7000,"$2,350.00",$0.00,"$2,350.00",$0.00,"$1,677.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,350.00",$0.00,"$1,175.00","$1,861.20","$1,880.00",$0.00,$0.00,$0.00,$0.00,$0.00
7493-0318,SUP,Custom 27803010,,7493-0318  -  INSERT TIBIAL 3 18MM POSTERIOR STABILIZE BEARING KNEE S7000,"$2,350.00",$0.00,"$2,350.00",$0.00,"$1,677.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,350.00",$0.00,"$1,175.00","$1,861.20","$1,880.00",$0.00,$0.00,$0.00,$0.00,$0.00
7493-0321,SUP,Custom 27803010,,7493-0321  -  INSERT TIBIAL 3 21MM POSTERIOR STABILIZE BEARING KNEE S7000,"$2,350.00",$0.00,"$2,350.00",$0.00,"$1,677.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,350.00",$0.00,"$1,175.00","$1,861.20","$1,880.00",$0.00,$0.00,$0.00,$0.00,$0.00
7493-0324,SUP,Custom 27803010,,7493-0324  -  INSERT TIBIAL 3 24MM POSTERIOR STABILIZE BEARING KNEE S7000,"$2,350.00",$0.00,"$2,350.00",$0.00,"$1,677.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,350.00",$0.00,"$1,175.00","$1,861.20","$1,880.00",$0.00,$0.00,$0.00,$0.00,$0.00
7493-0508,SUP,Custom 27803010,,7493-0508  -  INSERT TIBIAL 5 8MM POSTERIOR STABILIZE BEARING KNEE S7000,"$2,350.00",$0.00,"$2,350.00",$0.00,"$1,677.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,350.00",$0.00,"$1,175.00","$1,861.20","$1,880.00",$0.00,$0.00,$0.00,$0.00,$0.00
7493-0510,SUP,Custom 27803010,,7493-0510  -  INSERT TIBIAL 5 10MM POSTERIOR STABILIZE BEARING KNEE S7000,"$2,350.00",$0.00,"$2,350.00",$0.00,"$1,677.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,350.00",$0.00,"$1,175.00","$1,861.20","$1,880.00",$0.00,$0.00,$0.00,$0.00,$0.00
7493-0512,SUP,Custom 27803010,,7493-0512  -  INSERT TIBIAL 5 12MM POSTERIOR STABILIZE BEARING KNEE S7000,"$2,350.00",$0.00,"$2,350.00",$0.00,"$1,677.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,350.00",$0.00,"$1,175.00","$1,861.20","$1,880.00",$0.00,$0.00,$0.00,$0.00,$0.00
7493-0515,SUP,Custom 27803010,,7493-0515  -  INSERT TIBIAL 5 15MM POSTERIOR STABILIZE BEARING KNEE S7000,"$2,350.00",$0.00,"$2,350.00",$0.00,"$1,677.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,350.00",$0.00,"$1,175.00","$1,861.20","$1,880.00",$0.00,$0.00,$0.00,$0.00,$0.00
7493-0518,SUP,Custom 27803010,,7493-0518  -  INSERT TIBIAL 5 18MM POSTERIOR STABILIZE BEARING KNEE S7000,"$2,350.00",$0.00,"$2,350.00",$0.00,"$1,677.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,350.00",$0.00,"$1,175.00","$1,861.20","$1,880.00",$0.00,$0.00,$0.00,$0.00,$0.00
7493-0521,SUP,Custom 27803010,,7493-0521  -  INSERT TIBIAL 5 21MM POSTERIOR STABILIZE BEARING KNEE S7000,"$2,350.00",$0.00,"$2,350.00",$0.00,"$1,677.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,350.00",$0.00,"$1,175.00","$1,861.20","$1,880.00",$0.00,$0.00,$0.00,$0.00,$0.00
7493-0524,SUP,Custom 27803010,,7493-0524  -  INSERT TIBIAL 5 24MM POSTERIOR STABILIZE BEARING KNEE S7000,"$2,350.00",$0.00,"$2,350.00",$0.00,"$1,677.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,350.00",$0.00,"$1,175.00","$1,861.20","$1,880.00",$0.00,$0.00,$0.00,$0.00,$0.00
7493-0708,SUP,Custom 27803010,,7493-0708  -  INSERT TIBIAL 7 8MM POSTERIOR STABILIZE BEARING KNEE S7000,"$2,350.00",$0.00,"$2,350.00",$0.00,"$1,677.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,350.00",$0.00,"$1,175.00","$1,861.20","$1,880.00",$0.00,$0.00,$0.00,$0.00,$0.00
7493-0710,SUP,Custom 27803010,,7493-0710  -  INSERT TIBIAL 7 10MM POSTERIOR STABILIZE BEARING KNEE S7000,"$2,350.00",$0.00,"$2,350.00",$0.00,"$1,677.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,350.00",$0.00,"$1,175.00","$1,861.20","$1,880.00",$0.00,$0.00,$0.00,$0.00,$0.00
7493-0712,SUP,Custom 27803010,,7493-0712  -  INSERT TIBIAL 7 12MM POSTERIOR STABILIZE BEARING KNEE S7000,"$2,350.00",$0.00,"$2,350.00",$0.00,"$1,677.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,350.00",$0.00,"$1,175.00","$1,861.20","$1,880.00",$0.00,$0.00,$0.00,$0.00,$0.00
7493-0715,SUP,Custom 27803010,,7493-0715  -  INSERT TIBIAL 7 15MM POSTERIOR STABILIZE BEARING KNEE S7000,"$2,350.00",$0.00,"$2,350.00",$0.00,"$1,677.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,350.00",$0.00,"$1,175.00","$1,861.20","$1,880.00",$0.00,$0.00,$0.00,$0.00,$0.00
7493-0718,SUP,Custom 27803010,,7493-0718  -  INSERT TIBIAL 7 18MM POSTERIOR STABILIZE BEARING KNEE S7000,"$2,350.00",$0.00,"$2,350.00",$0.00,"$1,677.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,350.00",$0.00,"$1,175.00","$1,861.20","$1,880.00",$0.00,$0.00,$0.00,$0.00,$0.00
7493-0721,SUP,Custom 27803010,,7493-0721  -  INSERT TIBIAL 7 21MM POSTERIOR STABILIZE BEARING KNEE S7000,"$2,350.00",$0.00,"$2,350.00",$0.00,"$1,677.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,350.00",$0.00,"$1,175.00","$1,861.20","$1,880.00",$0.00,$0.00,$0.00,$0.00,$0.00
7493-0724,SUP,Custom 27803010,,7493-0724  -  INSERT TIBIAL 7 24MM POSTERIOR STABILIZE BEARING KNEE S7000,"$2,350.00",$0.00,"$2,350.00",$0.00,"$1,677.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,350.00",$0.00,"$1,175.00","$1,861.20","$1,880.00",$0.00,$0.00,$0.00,$0.00,$0.00
7493-0908,SUP,Custom 27803010,,7493-0908  -  INSERT TIBIAL 9 8MM POSTERIOR STABILIZE BEARING KNEE S7000,"$2,350.00",$0.00,"$2,350.00",$0.00,"$1,677.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,350.00",$0.00,"$1,175.00","$1,861.20","$1,880.00",$0.00,$0.00,$0.00,$0.00,$0.00
7493-0910,SUP,Custom 27803010,,7493-0910  -  INSERT TIBIAL 9 10MM POSTERIOR STABILIZE BEARING KNEE S7000,"$2,350.00",$0.00,"$2,350.00",$0.00,"$1,677.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,350.00",$0.00,"$1,175.00","$1,861.20","$1,880.00",$0.00,$0.00,$0.00,$0.00,$0.00
7493-0912,SUP,Custom 27803010,,7493-0912  -  INSERT TIBIAL 9 12MM POSTERIOR STABILIZE BEARING KNEE S7000,"$2,350.00",$0.00,"$2,350.00",$0.00,"$1,677.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,350.00",$0.00,"$1,175.00","$1,861.20","$1,880.00",$0.00,$0.00,$0.00,$0.00,$0.00
7493-0915,SUP,Custom 27803010,,7493-0915  -  INSERT TIBIAL 9 15MM POSTERIOR STABILIZE BEARING KNEE S7000,"$2,350.00",$0.00,"$2,350.00",$0.00,"$1,677.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,350.00",$0.00,"$1,175.00","$1,861.20","$1,880.00",$0.00,$0.00,$0.00,$0.00,$0.00
7493-0918,SUP,Custom 27803010,,7493-0918  -  INSERT TIBIAL 9 18MM POSTERIOR STABILIZE BEARING KNEE S7000,"$2,350.00",$0.00,"$2,350.00",$0.00,"$1,677.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,350.00",$0.00,"$1,175.00","$1,861.20","$1,880.00",$0.00,$0.00,$0.00,$0.00,$0.00
7493-0921,SUP,Custom 27803010,,7493-0921  -  INSERT TIBIAL 9 21MM POSTERIOR STABILIZE BEARING KNEE S7000,"$2,350.00",$0.00,"$2,350.00",$0.00,"$1,677.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,350.00",$0.00,"$1,175.00","$1,861.20","$1,880.00",$0.00,$0.00,$0.00,$0.00,$0.00
7493-0924,SUP,Custom 27803010,,7493-0924  -  INSERT TIBIAL 9 24MM POSTERIOR STABILIZE BEARING KNEE S7000,"$2,350.00",$0.00,"$2,350.00",$0.00,"$1,677.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,350.00",$0.00,"$1,175.00","$1,861.20","$1,880.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-1-0305,SUP,Custom 27803010,,75-1-0305  -  BLOCK AUGMENTATION 3 5MM 1 AXIS CRUC RET POSTERIOR TOT,"$2,292.50",$0.00,"$2,292.50",$0.00,"$1,636.16",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,292.50",$0.00,"$1,146.25","$1,815.66","$1,834.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-1-0310,SUP,Custom 27803010,,75-1-0310  -  BLOCK AUGMENTATION 3 10MM 1 AXIS CRUC RET POSTERIOR TOT,"$2,292.50",$0.00,"$2,292.50",$0.00,"$1,636.16",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,292.50",$0.00,"$1,146.25","$1,815.66","$1,834.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-1-0315,SUP,Custom 27803010,,75-1-0315  -  BLOCK AUGMENTATION 3 15MM 1 AXIS CRUC RET POSTERIOR TOT,"$2,292.50",$0.00,"$2,292.50",$0.00,"$1,636.16",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,292.50",$0.00,"$1,146.25","$1,815.66","$1,834.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-1-0405,SUP,Custom 27803010,,75-1-0405  -  BLOCK AUGMENTATION 4 5MM 1 AXIS CRUC RET POSTERIOR TOT,"$2,292.50",$0.00,"$2,292.50",$0.00,"$1,636.16",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,292.50",$0.00,"$1,146.25","$1,815.66","$1,834.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-1-0410,SUP,Custom 27803010,,75-1-0410  -  BLOCK AUGMENTATION 4 10MM 1 AXIS CRUC RET POSTERIOR TOT,"$2,292.50",$0.00,"$2,292.50",$0.00,"$1,636.16",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,292.50",$0.00,"$1,146.25","$1,815.66","$1,834.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-1-0415,SUP,Custom 27803010,,75-1-0415  -  BLOCK AUGMENTATION 4 15MM 1 AXIS CRUC RET POSTERIOR TOT,"$2,292.50",$0.00,"$2,292.50",$0.00,"$1,636.16",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,292.50",$0.00,"$1,146.25","$1,815.66","$1,834.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-1-0505,SUP,Custom 27803010,,75-1-0505  -  BLOCK AUGMENTATION 5 5MM 1 AXIS CRUC RET POSTERIOR TOT,"$2,292.50",$0.00,"$2,292.50",$0.00,"$1,636.16",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,292.50",$0.00,"$1,146.25","$1,815.66","$1,834.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-1-0510,SUP,Custom 27803010,,75-1-0510  -  BLOCK AUGMENTATION 4 10MM 1 AXIS CRUC RET POSTERIOR TOT,"$2,292.50",$0.00,"$2,292.50",$0.00,"$1,636.16",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,292.50",$0.00,"$1,146.25","$1,815.66","$1,834.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-1-0515,SUP,Custom 27803010,,75-1-0515  -  BLOCK AUGMENTATION 5 15MM 1 AXIS CRUC RET POSTERIOR TOT,"$2,292.50",$0.00,"$2,292.50",$0.00,"$1,636.16",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,292.50",$0.00,"$1,146.25","$1,815.66","$1,834.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-1-0605,SUP,Custom 27803010,,75-1-0605  -  BLOCK AUGMENTATION 6 5MM 1 AXIS CRUC RET POSTERIOR TOT,"$2,292.50",$0.00,"$2,292.50",$0.00,"$1,636.16",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,292.50",$0.00,"$1,146.25","$1,815.66","$1,834.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-1-0610,SUP,Custom 27803010,,75-1-0610  -  BLOCK AUGMENTATION 6 10MM 1 AXIS CRUC RET POSTERIOR TOT,"$2,292.50",$0.00,"$2,292.50",$0.00,"$1,636.16",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,292.50",$0.00,"$1,146.25","$1,815.66","$1,834.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-1-0615,SUP,Custom 27803010,,75-1-0615  -  BLOCK AUGMENTATION 6 15MM 1 AXIS CRUC RET POSTERIOR TOT,"$2,292.50",$0.00,"$2,292.50",$0.00,"$1,636.16",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,292.50",$0.00,"$1,146.25","$1,815.66","$1,834.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-1-0705,SUP,Custom 27803010,,75-1-0705  -  BLOCK AUGMENTATION 7 5MM 1 AXIS CRUC RET POSTERIOR TOT,"$2,292.50",$0.00,"$2,292.50",$0.00,"$1,636.16",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,292.50",$0.00,"$1,146.25","$1,815.66","$1,834.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-1-0710,SUP,Custom 27803010,,75-1-0710  -  BLOCK AUGMENTATION 7 10MM 1 AXIS CRUC RET POSTERIOR TOT,"$2,292.50",$0.00,"$2,292.50",$0.00,"$1,636.16",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,292.50",$0.00,"$1,146.25","$1,815.66","$1,834.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-1-0715,SUP,Custom 27803010,,75-1-0715  -  BLOCK AUGMENTATION 7 15MM 1 AXIS CRUC RET POSTERIOR TOT,"$2,292.50",$0.00,"$2,292.50",$0.00,"$1,636.16",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,292.50",$0.00,"$1,146.25","$1,815.66","$1,834.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-1-0905,SUP,Custom 27803010,,75-1-0905  -  BLOCK AUGMENTATION 9 5MM 1 AXIS CRUC RET POSTERIOR TOT,"$2,292.50",$0.00,"$2,292.50",$0.00,"$1,636.16",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,292.50",$0.00,"$1,146.25","$1,815.66","$1,834.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-1-0910,SUP,Custom 27803010,,75-1-0910  -  BLOCK AUGMENTATION 9 10MM 1 AXIS CRUC RET POSTERIOR TOT,"$2,292.50",$0.00,"$2,292.50",$0.00,"$1,636.16",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,292.50",$0.00,"$1,146.25","$1,815.66","$1,834.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-1-0915,SUP,Custom 27803010,,75-1-0915  -  BLOCK AUGMENTATION 9 15MM 1 AXIS CRUC RET POSTERIOR TOT,"$2,292.50",$0.00,"$2,292.50",$0.00,"$1,636.16",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,292.50",$0.00,"$1,146.25","$1,815.66","$1,834.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-1-1105,SUP,Custom 27803010,,75-1-1105  -  BLOCK AUGMENTATION 11 5MM 1 AXIS CRUC RET POSTERIOR TOT,"$2,292.50",$0.00,"$2,292.50",$0.00,"$1,636.16",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,292.50",$0.00,"$1,146.25","$1,815.66","$1,834.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-1-1110,SUP,Custom 27803010,,75-1-1110  -  BLOCK AUGMENTATION 11 10MM 1 AXIS CRUC RET POSTERIOR TOT,"$2,292.50",$0.00,"$2,292.50",$0.00,"$1,636.16",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,292.50",$0.00,"$1,146.25","$1,815.66","$1,834.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-1-1115,SUP,Custom 27803010,,75-1-1115  -  BLOCK AUGMENTATION 11 15MM 1 AXIS CRUC RET POSTERIOR TOT,"$2,292.50",$0.00,"$2,292.50",$0.00,"$1,636.16",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,292.50",$0.00,"$1,146.25","$1,815.66","$1,834.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-1-1305,SUP,Custom 27803010,,75-1-1305  -  BLOCK AUGMENTATION 13 5MM 1 AXIS CRUC RET POSTERIOR TOT,"$2,292.50",$0.00,"$2,292.50",$0.00,"$1,636.16",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,292.50",$0.00,"$1,146.25","$1,815.66","$1,834.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-1-1310,SUP,Custom 27803010,,75-1-1310  -  BLOCK AUGMENTATION 13 10MM 1 AXIS CRUC RET POSTERIOR TOT,"$2,292.50",$0.00,"$2,292.50",$0.00,"$1,636.16",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,292.50",$0.00,"$1,146.25","$1,815.66","$1,834.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-1-1315,SUP,Custom 27803010,,75-1-1315  -  BLOCK AUGMENTATION 13 15MM 1 AXIS CRUC RET POSTERIOR TOT,"$2,292.50",$0.00,"$2,292.50",$0.00,"$1,636.16",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,292.50",$0.00,"$1,146.25","$1,815.66","$1,834.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-2-0305,SUP,Custom 27803010,,75-2-0305  -  BLOCK AUGMENTATION 3 5MM 1 AXIS CRUC RET POSTERIOR TOT,"$2,292.50",$0.00,"$2,292.50",$0.00,"$1,636.16",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,292.50",$0.00,"$1,146.25","$1,815.66","$1,834.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-2-0310,SUP,Custom 27803010,,75-2-0310  -  BLOCK AUGMENTATION 3 10MM 1 AXIS CRUC RET POSTERIOR TOT,"$2,292.50",$0.00,"$2,292.50",$0.00,"$1,636.16",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,292.50",$0.00,"$1,146.25","$1,815.66","$1,834.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-2-0405,SUP,Custom 27803010,,75-2-0405  -  BLOCK AUGMENTATION 4 5MM 1 AXIS CRUC RET POSTERIOR TOT,"$2,292.50",$0.00,"$2,292.50",$0.00,"$1,636.16",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,292.50",$0.00,"$1,146.25","$1,815.66","$1,834.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-2-0410,SUP,Custom 27803010,,75-2-0410  -  BLOCK AUGMENTATION 4 10MM 1 AXIS CRUC RET POSTERIOR TOT,"$2,292.50",$0.00,"$2,292.50",$0.00,"$1,636.16",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,292.50",$0.00,"$1,146.25","$1,815.66","$1,834.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-2-0505,SUP,Custom 27803010,,75-2-0505  -  BLOCK AUGMENTATION 5 5MM 1 AXIS CRUC RET POSTERIOR TOT,"$2,292.50",$0.00,"$2,292.50",$0.00,"$1,636.16",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,292.50",$0.00,"$1,146.25","$1,815.66","$1,834.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-2-0510,SUP,Custom 27803010,,75-2-0510  -  BLOCK AUGMENTATION 4 10MM 1 AXIS CRUC RET POSTERIOR TOT,"$2,292.50",$0.00,"$2,292.50",$0.00,"$1,636.16",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,292.50",$0.00,"$1,146.25","$1,815.66","$1,834.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-2-0605,SUP,Custom 27803010,,75-2-0605  -  BLOCK AUGMENTATION 9 5MM 1 AXIS CRUC RET POSTERIOR TOT,"$2,292.50",$0.00,"$2,292.50",$0.00,"$1,636.16",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,292.50",$0.00,"$1,146.25","$1,815.66","$1,834.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-2-0610,SUP,Custom 27803010,,75-2-0610  -  BLOCK AUGMENTATION 6 10MM 1 AXIS CRUC RET POSTERIOR TOT,"$2,292.50",$0.00,"$2,292.50",$0.00,"$1,636.16",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,292.50",$0.00,"$1,146.25","$1,815.66","$1,834.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-2-0705,SUP,Custom 27803010,,75-2-0705  -  BLOCK AUGMENTATION 7 5MM 1 AXIS CRUC RET POSTERIOR TOT,"$2,292.50",$0.00,"$2,292.50",$0.00,"$1,636.16",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,292.50",$0.00,"$1,146.25","$1,815.66","$1,834.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-2-0710,SUP,Custom 27803010,,75-2-0710  -  BLOCK AUGMENTATION 7 10MM 1 AXIS CRUC RET POSTERIOR TOT,"$2,292.50",$0.00,"$2,292.50",$0.00,"$1,636.16",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,292.50",$0.00,"$1,146.25","$1,815.66","$1,834.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-2-0905,SUP,Custom 27803010,,75-2-0905  -  BLOCK AUGMENTATION 9 5MM 1 AXIS CRUC RET POSTERIOR TOT,"$2,292.50",$0.00,"$2,292.50",$0.00,"$1,636.16",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,292.50",$0.00,"$1,146.25","$1,815.66","$1,834.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-2-0910,SUP,Custom 27803010,,75-2-0910  -  BLOCK AUGMENTATION 9 10MM 1 AXIS CRUC RET POSTERIOR TOT,"$2,292.50",$0.00,"$2,292.50",$0.00,"$1,636.16",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,292.50",$0.00,"$1,146.25","$1,815.66","$1,834.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-2-1105,SUP,Custom 27803010,,75-2-1105  -  BLOCK AUGMENTATION 11 5MM 1 AXIS CRUC RET POSTERIOR TOT,"$2,292.50",$0.00,"$2,292.50",$0.00,"$1,636.16",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,292.50",$0.00,"$1,146.25","$1,815.66","$1,834.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-2-1110,SUP,Custom 27803010,,75-2-1110  -  BLOCK AUGMENTATION 11 10MM 1 AXIS CRUC RET POSTERIOR TOT,"$2,292.50",$0.00,"$2,292.50",$0.00,"$1,636.16",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,292.50",$0.00,"$1,146.25","$1,815.66","$1,834.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-2-1305,SUP,Custom 27803010,,75-2-1305  -  BLOCK AUGMENTATION 13 5MM 1 AXIS CRUC RET POSTERIOR TOT,"$2,292.50",$0.00,"$2,292.50",$0.00,"$1,636.16",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,292.50",$0.00,"$1,146.25","$1,815.66","$1,834.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-2-1310,SUP,Custom 27803010,,75-2-1310  -  BLOCK AUGMENTATION 13 10MM 1 AXIS CRUC RET POSTERIOR TOT,"$2,292.50",$0.00,"$2,292.50",$0.00,"$1,636.16",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,292.50",$0.00,"$1,146.25","$1,815.66","$1,834.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-3-0305,SUP,Custom 27803010,,75-3-0305  -  BLOCK AUGMENTATION 3 HALF 5MM 1 AXIS CRUC RET POSTERIOR TOT,"$2,472.50",$0.00,"$2,472.50",$0.00,"$1,764.62",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,472.50",$0.00,"$1,236.25","$1,958.22","$1,978.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-3-0310,SUP,Custom 27803010,,75-3-0310  -  BLOCK AUGMENTATION 3 HALF 10MM 1 AXIS CRUC RET POSTERIOR TOT,"$2,472.50",$0.00,"$2,472.50",$0.00,"$1,764.62",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,472.50",$0.00,"$1,236.25","$1,958.22","$1,978.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-3-0405,SUP,Custom 27203010,,75-3-0405  -  TRIAL KN 4 5MM SCRP AUG HLF BLCK TIB LT,"$2,472.50",$0.00,"$2,472.50",$0.00,"$1,764.62",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,472.50",$0.00,"$1,236.25","$1,958.22","$1,978.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-3-0410,SUP,Custom 27203010,,75-3-0410  -  TRIAL KN 4 10MM SCRP AUG HLF BLCK TIB LT,"$2,472.50",$0.00,"$2,472.50",$0.00,"$1,764.62",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,472.50",$0.00,"$1,236.25","$1,958.22","$1,978.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-3-0505,SUP,Custom 27803010,,75-3-0505  -  BLOCK AUGMENTATION 5 HALF 5MM 1 AXIS CRUC RET POSTERIOR TOT,"$2,472.50",$0.00,"$2,472.50",$0.00,"$1,764.62",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,472.50",$0.00,"$1,236.25","$1,958.22","$1,978.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-3-0510,SUP,Custom 27203010,,75-3-0510  -  BLOCK AUGMENTATION 5 HALF 10MM 1 AXIS CRUC RET POSTERIOR TOT,"$2,472.50",$0.00,"$2,472.50",$0.00,"$1,764.62",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,472.50",$0.00,"$1,236.25","$1,958.22","$1,978.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-3-0605,SUP,Custom 27803010,,75-3-0605  -  BLOCK AUGMENTATION 6 HALF 5MM 1 AXIS CRUC RET POSTERIOR TOT,"$2,472.50",$0.00,"$2,472.50",$0.00,"$1,764.62",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,472.50",$0.00,"$1,236.25","$1,958.22","$1,978.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-3-0610,SUP,Custom 27203010,,75-3-0610  -  TRIAL KN 6 10MM SCRP AUG HLF BLCK TIB LT,"$2,472.50",$0.00,"$2,472.50",$0.00,"$1,764.62",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,472.50",$0.00,"$1,236.25","$1,958.22","$1,978.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-3-0705,SUP,Custom 27803010,,75-3-0705  -  BLOCK AUGMENTATION 7 HALF 5MM 1 AXIS CRUC RET POSTERIOR TOT,"$2,472.50",$0.00,"$2,472.50",$0.00,"$1,764.62",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,472.50",$0.00,"$1,236.25","$1,958.22","$1,978.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-3-0710,SUP,Custom 27203010,,75-3-0710  -  BLOCK AUGMENTATION 7 10MM TOT STABILIZED HALF SCORPIO KNEE,"$2,472.50",$0.00,"$2,472.50",$0.00,"$1,764.62",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,472.50",$0.00,"$1,236.25","$1,958.22","$1,978.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-3-0905,SUP,Custom 27803010,,75-3-0905  -  BLOCK AUGMENTATION 9 HALF 5MM 1 AXIS CRUC RET POSTERIOR TOT,"$2,472.50",$0.00,"$2,472.50",$0.00,"$1,764.62",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,472.50",$0.00,"$1,236.25","$1,958.22","$1,978.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-3-0910,SUP,Custom 27803010,,75-3-0910  -  BLOCK AUGMENTATION 9 HALF 10MM 1 AXIS CRUC RET POSTERIOR TOT,"$2,472.50",$0.00,"$2,472.50",$0.00,"$1,764.62",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,472.50",$0.00,"$1,236.25","$1,958.22","$1,978.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-3-1105,SUP,Custom 27803010,,75-3-1105  -  BLOCK AUGMENTATION 11 HALF 5MM 1 AXIS CRUC RET POSTERIOR TOT,"$2,472.50",$0.00,"$2,472.50",$0.00,"$1,764.62",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,472.50",$0.00,"$1,236.25","$1,958.22","$1,978.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-3-1110,SUP,Custom 27203010,,75-3-1110  -  BLOCK AUGMENTATION 11 HALF 10MM 1 AXIS CRUC RET POSTERIOR,"$2,472.50",$0.00,"$2,472.50",$0.00,"$1,764.62",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,472.50",$0.00,"$1,236.25","$1,958.22","$1,978.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-3-1305,SUP,Custom 27803010,,75-3-1305  -  BLOCK AUGMENTATION 13 HALF 5MM 1 AXIS CRUC RET POSTERIOR TOT,"$2,472.50",$0.00,"$2,472.50",$0.00,"$1,764.62",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,472.50",$0.00,"$1,236.25","$1,958.22","$1,978.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-3-1310,SUP,Custom 27803010,,75-3-1310  -  BLOCK AUGMENTATION 13 HALF 10MM 1 AXIS CRUC RET POSTERIOR,"$2,472.50",$0.00,"$2,472.50",$0.00,"$1,764.62",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,472.50",$0.00,"$1,236.25","$1,958.22","$1,978.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-4-0310,SUP,Custom 27803010,,75-4-0310  -  BLOCK AUGMENTATION 3 FULL 10MM 1 AXIS CRUC RET POSTERIOR TOT,"$3,585.00",$0.00,"$3,585.00",$0.00,"$2,558.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,585.00",$0.00,"$1,792.50","$2,839.32","$2,868.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-4-0410,SUP,Custom 27803010,,75-4-0410  -  BLOCK AUGMENTATION 4 10MM FULL SCORPIO TIBIA,"$3,585.00",$0.00,"$3,585.00",$0.00,"$2,558.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,585.00",$0.00,"$1,792.50","$2,839.32","$2,868.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-4-0510,SUP,Custom 27803010,,75-4-0510  -  BLOCK AUGMENTATION 5 FULL 10MM 1 AXIS CRUC RET POSTERIOR TOT,"$3,585.00",$0.00,"$3,585.00",$0.00,"$2,558.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,585.00",$0.00,"$1,792.50","$2,839.32","$2,868.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-4-0610,SUP,Custom 27803010,,75-4-0610  -  BLOCK AUGMENTATION 6 10MM FULL SCORPIO TIBIA,"$3,585.00",$0.00,"$3,585.00",$0.00,"$2,558.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,585.00",$0.00,"$1,792.50","$2,839.32","$2,868.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-4-0710,SUP,Custom 27803010,,75-4-0710  -  BLOCK AUGMENTATION 7 FULL 10MM 1 AXIS CRUC RET POSTERIOR TOT,"$3,585.00",$0.00,"$3,585.00",$0.00,"$2,558.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,585.00",$0.00,"$1,792.50","$2,839.32","$2,868.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-4-0910,SUP,Custom 27803010,,75-4-0910  -  BLOCK AUGMENTATION 9 FULL 5MM 1 AXIS CRUC RET POSTERIOR TOT,"$3,585.00",$0.00,"$3,585.00",$0.00,"$2,558.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,585.00",$0.00,"$1,792.50","$2,839.32","$2,868.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-4-1110,SUP,Custom 27803010,,75-4-1110  -  BLOCK AUGMENTATION 11 10MM FULL TOT STABILIZED SCORPIO FEMUR,"$3,585.00",$0.00,"$3,585.00",$0.00,"$2,558.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,585.00",$0.00,"$1,792.50","$2,839.32","$2,868.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-4-1310,SUP,Custom 27803010,,75-4-1310  -  BLOCK AUGMENTATION 13 10MM FULL TOT STABILIZED SCORPIO FEMUR,"$3,585.00",$0.00,"$3,585.00",$0.00,"$2,558.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,585.00",$0.00,"$1,792.50","$2,839.32","$2,868.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-5-0305,SUP,Custom 27803010,,75-5-0305  -  BLOCK AUGMENTATION 5D FULL WEDGE 3MM CRUCIATE RETAIN TOT,"$3,585.00",$0.00,"$3,585.00",$0.00,"$2,558.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,585.00",$0.00,"$1,792.50","$2,839.32","$2,868.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-5-0405,SUP,Custom 27803010,,75-5-0405  -  TRIAL SURG 4.5D FULL WEDGE,"$3,585.00",$0.00,"$3,585.00",$0.00,"$2,558.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,585.00",$0.00,"$1,792.50","$2,839.32","$2,868.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-5-0505,SUP,Custom 27803010,,75-5-0505  -  WEDGE TIBIAL 5D FULL 5 TOT STABILIZE SCORPIO KNEE,"$3,585.00",$0.00,"$3,585.00",$0.00,"$2,558.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,585.00",$0.00,"$1,792.50","$2,839.32","$2,868.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-5-0605,SUP,Custom 27203010,,75-5-0605  -  TRIAL SURG FULL WEDGE 6.5D,"$3,585.00",$0.00,"$3,585.00",$0.00,"$2,558.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,585.00",$0.00,"$1,792.50","$2,839.32","$2,868.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-5-0705,SUP,Custom 27803010,,75-5-0705  -  WEDGE TIBIAL 5D FULL 7 10MM TOT STABILIZE SCORPIO KNEE,"$3,585.00",$0.00,"$3,585.00",$0.00,"$2,558.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,585.00",$0.00,"$1,792.50","$2,839.32","$2,868.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-5-0905,SUP,Custom 27803010,,75-5-0905  -  BLOCK AUGMENTATION 5D FULL WEDGE 9MM CRUCIATE RETAIN TOT,"$3,585.00",$0.00,"$3,585.00",$0.00,"$2,558.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,585.00",$0.00,"$1,792.50","$2,839.32","$2,868.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-5-1105,SUP,Custom 27803010,,75-5-1105  -  WEDGE TIB 11MM SCRP 5D KNEE TOT STAB FULL,"$3,445.00",$0.00,"$3,445.00",$0.00,"$2,458.70",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,445.00",$0.00,"$1,722.50","$2,728.44","$2,756.00",$0.00,$0.00,$0.00,$0.00,$0.00
75-5-1305,SUP,Custom 27803010,,75-5-1305  -  WEDGE TIB 13MM SCRP 5D KNEE TOT STAB FULL,"$3,615.63",$0.00,"$3,615.63",$0.00,"$2,580.47",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,615.63",$0.00,"$1,807.81","$2,863.58","$2,892.50",$0.00,$0.00,$0.00,$0.00,$0.00
75AC50,SUP,Custom 27203010,,75AC50  -  PLATE 18MM TI BONE SPNL,$303.88,$0.00,$303.88,$0.00,$216.88,$0.00,$0.00,$0.00,$0.00,$0.00,$303.88,$0.00,$151.94,$240.67,$243.10,$0.00,$0.00,$0.00,$0.00,$0.00
75AC60,SUP,Custom 27203010,,75AC60  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$303.88,$0.00,$303.88,$0.00,$216.88,$0.00,$0.00,$0.00,$0.00,$0.00,$303.88,$0.00,$151.94,$240.67,$243.10,$0.00,$0.00,$0.00,$0.00,$0.00
75BA05,SUP,Custom 27203010,,75BA05  -  PLATE 18MM TI BONE SPNL,$293.25,$0.00,$293.25,$0.00,$209.29,$0.00,$0.00,$0.00,$0.00,$0.00,$293.25,$0.00,$146.63,$232.25,$234.60,$0.00,$0.00,$0.00,$0.00,$0.00
75BA05L,SUP,Custom 27203010,,75BA05L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$293.25,$0.00,$293.25,$0.00,$209.29,$0.00,$0.00,$0.00,$0.00,$0.00,$293.25,$0.00,$146.63,$232.25,$234.60,$0.00,$0.00,$0.00,$0.00,$0.00
75BA06DL,SUP,Custom 27203010,,75BA06DL  -  PLATE 18MM TI BONE SPNL,$316.63,$0.00,$316.63,$0.00,$225.98,$0.00,$0.00,$0.00,$0.00,$0.00,$316.63,$0.00,$158.31,$250.77,$253.30,$0.00,$0.00,$0.00,$0.00,$0.00
75BA08DL,SUP,Custom 27203010,,75BA08DL  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$316.63,$0.00,$316.63,$0.00,$225.98,$0.00,$0.00,$0.00,$0.00,$0.00,$316.63,$0.00,$158.31,$250.77,$253.30,$0.00,$0.00,$0.00,$0.00,$0.00
75BA10,SUP,Custom 27203010,,75BA10  -  PLATE 18MM TI BONE SPNL,$293.25,$0.00,$293.25,$0.00,$209.29,$0.00,$0.00,$0.00,$0.00,$0.00,$293.25,$0.00,$146.63,$232.25,$234.60,$0.00,$0.00,$0.00,$0.00,$0.00
75BA10D,SUP,Custom 27203010,,75BA10D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$316.63,$0.00,$316.63,$0.00,$225.98,$0.00,$0.00,$0.00,$0.00,$0.00,$316.63,$0.00,$158.31,$250.77,$253.30,$0.00,$0.00,$0.00,$0.00,$0.00
75BA10DC,SUP,Custom 27203010,,75BA10DC  -  PLATE 18MM TI BONE SPNL,$323.00,$0.00,$323.00,$0.00,$230.53,$0.00,$0.00,$0.00,$0.00,$0.00,$323.00,$0.00,$161.50,$255.82,$258.40,$0.00,$0.00,$0.00,$0.00,$0.00
75BA10DCL,SUP,Custom 27203010,,75BA10DCL  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$323.00,$0.00,$323.00,$0.00,$230.53,$0.00,$0.00,$0.00,$0.00,$0.00,$323.00,$0.00,$161.50,$255.82,$258.40,$0.00,$0.00,$0.00,$0.00,$0.00
75BA10DL,SUP,Custom 27203010,,75BA10DL  -  PLATE 18MM TI BONE SPNL,$316.63,$0.00,$316.63,$0.00,$225.98,$0.00,$0.00,$0.00,$0.00,$0.00,$316.63,$0.00,$158.31,$250.77,$253.30,$0.00,$0.00,$0.00,$0.00,$0.00
75BA10DLF,SUP,Custom 27203010,,75BA10DLF  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$316.63,$0.00,$316.63,$0.00,$225.98,$0.00,$0.00,$0.00,$0.00,$0.00,$316.63,$0.00,$158.31,$250.77,$253.30,$0.00,$0.00,$0.00,$0.00,$0.00
75BA10L,SUP,Custom 27203010,,75BA10L  -  PLATE 18MM TI BONE SPNL,$293.25,$0.00,$293.25,$0.00,$209.29,$0.00,$0.00,$0.00,$0.00,$0.00,$293.25,$0.00,$146.63,$232.25,$234.60,$0.00,$0.00,$0.00,$0.00,$0.00
75BA12DL,SUP,Custom 27203010,,75BA12DL  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$316.63,$0.00,$316.63,$0.00,$225.98,$0.00,$0.00,$0.00,$0.00,$0.00,$316.63,$0.00,$158.31,$250.77,$253.30,$0.00,$0.00,$0.00,$0.00,$0.00
75BA15,SUP,Custom 27203010,,75BA15  -  PLATE 18MM TI BONE SPNL,$293.25,$0.00,$293.25,$0.00,$209.29,$0.00,$0.00,$0.00,$0.00,$0.00,$293.25,$0.00,$146.63,$232.25,$234.60,$0.00,$0.00,$0.00,$0.00,$0.00
75BA15D,SUP,Custom 27203010,,75BA15D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$316.63,$0.00,$316.63,$0.00,$225.98,$0.00,$0.00,$0.00,$0.00,$0.00,$316.63,$0.00,$158.31,$250.77,$253.30,$0.00,$0.00,$0.00,$0.00,$0.00
75BA15DC,SUP,Custom 27203010,,75BA15DC  -  PLATE 18MM TI BONE SPNL,$323.00,$0.00,$323.00,$0.00,$230.53,$0.00,$0.00,$0.00,$0.00,$0.00,$323.00,$0.00,$161.50,$255.82,$258.40,$0.00,$0.00,$0.00,$0.00,$0.00
75BA15DCL,SUP,Custom 27203010,,75BA15DCL  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$323.00,$0.00,$323.00,$0.00,$230.53,$0.00,$0.00,$0.00,$0.00,$0.00,$323.00,$0.00,$161.50,$255.82,$258.40,$0.00,$0.00,$0.00,$0.00,$0.00
75BA15DL,SUP,Custom 27203010,,75BA15DL  -  PLATE 18MM TI BONE SPNL,$316.63,$0.00,$316.63,$0.00,$225.98,$0.00,$0.00,$0.00,$0.00,$0.00,$316.63,$0.00,$158.31,$250.77,$253.30,$0.00,$0.00,$0.00,$0.00,$0.00
75BA15DLF,SUP,Custom 27203010,,75BA15DLF  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$316.63,$0.00,$316.63,$0.00,$225.98,$0.00,$0.00,$0.00,$0.00,$0.00,$316.63,$0.00,$158.31,$250.77,$253.30,$0.00,$0.00,$0.00,$0.00,$0.00
75BA15L,SUP,Custom 27203010,,75BA15L  -  PLATE 18MM TI BONE SPNL,$293.25,$0.00,$293.25,$0.00,$209.29,$0.00,$0.00,$0.00,$0.00,$0.00,$293.25,$0.00,$146.63,$232.25,$234.60,$0.00,$0.00,$0.00,$0.00,$0.00
75BA20,SUP,Custom 27203010,,75BA20  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$293.25,$0.00,$293.25,$0.00,$209.29,$0.00,$0.00,$0.00,$0.00,$0.00,$293.25,$0.00,$146.63,$232.25,$234.60,$0.00,$0.00,$0.00,$0.00,$0.00
75BA20D,SUP,Custom 27203010,,75BA20D  -  PLATE 18MM TI BONE SPNL,$316.63,$0.00,$316.63,$0.00,$225.98,$0.00,$0.00,$0.00,$0.00,$0.00,$316.63,$0.00,$158.31,$250.77,$253.30,$0.00,$0.00,$0.00,$0.00,$0.00
75BA20DC,SUP,Custom 27203010,,75BA20DC  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$323.00,$0.00,$323.00,$0.00,$230.53,$0.00,$0.00,$0.00,$0.00,$0.00,$323.00,$0.00,$161.50,$255.82,$258.40,$0.00,$0.00,$0.00,$0.00,$0.00
75BA20DCL,SUP,Custom 27203010,,75BA20DCL  -  PLATE 18MM TI BONE SPNL,$323.00,$0.00,$323.00,$0.00,$230.53,$0.00,$0.00,$0.00,$0.00,$0.00,$323.00,$0.00,$161.50,$255.82,$258.40,$0.00,$0.00,$0.00,$0.00,$0.00
75BA20DF,SUP,Custom 27203010,,75BA20DF  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$316.63,$0.00,$316.63,$0.00,$225.98,$0.00,$0.00,$0.00,$0.00,$0.00,$316.63,$0.00,$158.31,$250.77,$253.30,$0.00,$0.00,$0.00,$0.00,$0.00
75BA20DL,SUP,Custom 27203010,,75BA20DL  -  PLATE 18MM TI BONE SPNL,$316.63,$0.00,$316.63,$0.00,$225.98,$0.00,$0.00,$0.00,$0.00,$0.00,$316.63,$0.00,$158.31,$250.77,$253.30,$0.00,$0.00,$0.00,$0.00,$0.00
75BA20DLF,SUP,Custom 27203010,,75BA20DLF  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$316.63,$0.00,$316.63,$0.00,$225.98,$0.00,$0.00,$0.00,$0.00,$0.00,$316.63,$0.00,$158.31,$250.77,$253.30,$0.00,$0.00,$0.00,$0.00,$0.00
75BA20F,SUP,Custom 27203010,,75BA20F  -  PLATE 18MM TI BONE SPNL,$293.25,$0.00,$293.25,$0.00,$209.29,$0.00,$0.00,$0.00,$0.00,$0.00,$293.25,$0.00,$146.63,$232.25,$234.60,$0.00,$0.00,$0.00,$0.00,$0.00
75BA20L,SUP,Custom 27203010,,75BA20L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$293.25,$0.00,$293.25,$0.00,$209.29,$0.00,$0.00,$0.00,$0.00,$0.00,$293.25,$0.00,$146.63,$232.25,$234.60,$0.00,$0.00,$0.00,$0.00,$0.00
75BA20LF,SUP,Custom 27203010,,75BA20LF  -  PLATE 18MM TI BONE SPNL,$293.25,$0.00,$293.25,$0.00,$209.29,$0.00,$0.00,$0.00,$0.00,$0.00,$293.25,$0.00,$146.63,$232.25,$234.60,$0.00,$0.00,$0.00,$0.00,$0.00
75BA25,SUP,Custom 27203010,,75BA25  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$293.25,$0.00,$293.25,$0.00,$209.29,$0.00,$0.00,$0.00,$0.00,$0.00,$293.25,$0.00,$146.63,$232.25,$234.60,$0.00,$0.00,$0.00,$0.00,$0.00
75BA25D,SUP,Custom 27203010,,75BA25D  -  PLATE 18MM TI BONE SPNL,$316.63,$0.00,$316.63,$0.00,$225.98,$0.00,$0.00,$0.00,$0.00,$0.00,$316.63,$0.00,$158.31,$250.77,$253.30,$0.00,$0.00,$0.00,$0.00,$0.00
75BA25DC,SUP,Custom 27203010,,75BA25DC  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$323.00,$0.00,$323.00,$0.00,$230.53,$0.00,$0.00,$0.00,$0.00,$0.00,$323.00,$0.00,$161.50,$255.82,$258.40,$0.00,$0.00,$0.00,$0.00,$0.00
75BA25DCL,SUP,Custom 27203010,,75BA25DCL  -  PLATE 18MM TI BONE SPNL,$323.00,$0.00,$323.00,$0.00,$230.53,$0.00,$0.00,$0.00,$0.00,$0.00,$323.00,$0.00,$161.50,$255.82,$258.40,$0.00,$0.00,$0.00,$0.00,$0.00
75BA25DL,SUP,Custom 27203010,,75BA25DL  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$316.63,$0.00,$316.63,$0.00,$225.98,$0.00,$0.00,$0.00,$0.00,$0.00,$316.63,$0.00,$158.31,$250.77,$253.30,$0.00,$0.00,$0.00,$0.00,$0.00
75BA25DLF,SUP,Custom 27203010,,75BA25DLF  -  PLATE 18MM TI BONE SPNL,$316.63,$0.00,$316.63,$0.00,$225.98,$0.00,$0.00,$0.00,$0.00,$0.00,$316.63,$0.00,$158.31,$250.77,$253.30,$0.00,$0.00,$0.00,$0.00,$0.00
75BA25F,SUP,Custom 27203010,,75BA25F  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$293.25,$0.00,$293.25,$0.00,$209.29,$0.00,$0.00,$0.00,$0.00,$0.00,$293.25,$0.00,$146.63,$232.25,$234.60,$0.00,$0.00,$0.00,$0.00,$0.00
75BA25L,SUP,Custom 27203010,,75BA25L  -  PLATE 18MM TI BONE SPNL,$293.25,$0.00,$293.25,$0.00,$209.29,$0.00,$0.00,$0.00,$0.00,$0.00,$293.25,$0.00,$146.63,$232.25,$234.60,$0.00,$0.00,$0.00,$0.00,$0.00
75BA25LF,SUP,Custom 27203010,,75BA25LF  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$293.25,$0.00,$293.25,$0.00,$209.29,$0.00,$0.00,$0.00,$0.00,$0.00,$293.25,$0.00,$146.63,$232.25,$234.60,$0.00,$0.00,$0.00,$0.00,$0.00
75BA30,SUP,Custom 27203010,,75BA30  -  PLATE 18MM TI BONE SPNL,$293.25,$0.00,$293.25,$0.00,$209.29,$0.00,$0.00,$0.00,$0.00,$0.00,$293.25,$0.00,$146.63,$232.25,$234.60,$0.00,$0.00,$0.00,$0.00,$0.00
75BA30D,SUP,Custom 27203010,,75BA30D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$316.63,$0.00,$316.63,$0.00,$225.98,$0.00,$0.00,$0.00,$0.00,$0.00,$316.63,$0.00,$158.31,$250.77,$253.30,$0.00,$0.00,$0.00,$0.00,$0.00
75BA30DC,SUP,Custom 27203010,,75BA30DC  -  PLATE 18MM TI BONE SPNL,$323.00,$0.00,$323.00,$0.00,$230.53,$0.00,$0.00,$0.00,$0.00,$0.00,$323.00,$0.00,$161.50,$255.82,$258.40,$0.00,$0.00,$0.00,$0.00,$0.00
75BA30DCL,SUP,Custom 27203010,,75BA30DCL  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$323.00,$0.00,$323.00,$0.00,$230.53,$0.00,$0.00,$0.00,$0.00,$0.00,$323.00,$0.00,$161.50,$255.82,$258.40,$0.00,$0.00,$0.00,$0.00,$0.00
75BA30DF,SUP,Custom 27203010,,75BA30DF  -  PLATE 18MM TI BONE SPNL,$316.63,$0.00,$316.63,$0.00,$225.98,$0.00,$0.00,$0.00,$0.00,$0.00,$316.63,$0.00,$158.31,$250.77,$253.30,$0.00,$0.00,$0.00,$0.00,$0.00
75BA30DL,SUP,Custom 27203010,,75BA30DL  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$316.63,$0.00,$316.63,$0.00,$225.98,$0.00,$0.00,$0.00,$0.00,$0.00,$316.63,$0.00,$158.31,$250.77,$253.30,$0.00,$0.00,$0.00,$0.00,$0.00
75BA30DLF,SUP,Custom 27203010,,75BA30DLF  -  PLATE 18MM TI BONE SPNL,$316.63,$0.00,$316.63,$0.00,$225.98,$0.00,$0.00,$0.00,$0.00,$0.00,$316.63,$0.00,$158.31,$250.77,$253.30,$0.00,$0.00,$0.00,$0.00,$0.00
75BA30F,SUP,Custom 27203010,,75BA30F  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$293.25,$0.00,$293.25,$0.00,$209.29,$0.00,$0.00,$0.00,$0.00,$0.00,$293.25,$0.00,$146.63,$232.25,$234.60,$0.00,$0.00,$0.00,$0.00,$0.00
75BA30L,SUP,Custom 27203010,,75BA30L  -  PLATE 18MM TI BONE SPNL,$293.25,$0.00,$293.25,$0.00,$209.29,$0.00,$0.00,$0.00,$0.00,$0.00,$293.25,$0.00,$146.63,$232.25,$234.60,$0.00,$0.00,$0.00,$0.00,$0.00
75BA30LF,SUP,Custom 27203010,,75BA30LF  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$293.25,$0.00,$293.25,$0.00,$209.29,$0.00,$0.00,$0.00,$0.00,$0.00,$293.25,$0.00,$146.63,$232.25,$234.60,$0.00,$0.00,$0.00,$0.00,$0.00
75BA35,SUP,Custom 27203010,,75BA35  -  PLATE 18MM TI BONE SPNL,$293.25,$0.00,$293.25,$0.00,$209.29,$0.00,$0.00,$0.00,$0.00,$0.00,$293.25,$0.00,$146.63,$232.25,$234.60,$0.00,$0.00,$0.00,$0.00,$0.00
75BA35D,SUP,Custom 27203010,,75BA35D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$316.63,$0.00,$316.63,$0.00,$225.98,$0.00,$0.00,$0.00,$0.00,$0.00,$316.63,$0.00,$158.31,$250.77,$253.30,$0.00,$0.00,$0.00,$0.00,$0.00
75BA35DCL,SUP,Custom 27203010,,75BA35DCL  -  PLATE 18MM TI BONE SPNL,$323.00,$0.00,$323.00,$0.00,$230.53,$0.00,$0.00,$0.00,$0.00,$0.00,$323.00,$0.00,$161.50,$255.82,$258.40,$0.00,$0.00,$0.00,$0.00,$0.00
75BA35DL,SUP,Custom 27203010,,75BA35DL  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$316.63,$0.00,$316.63,$0.00,$225.98,$0.00,$0.00,$0.00,$0.00,$0.00,$316.63,$0.00,$158.31,$250.77,$253.30,$0.00,$0.00,$0.00,$0.00,$0.00
75BA35F,SUP,Custom 27203010,,75BA35F  -  PLATE 18MM TI BONE SPNL,$293.25,$0.00,$293.25,$0.00,$209.29,$0.00,$0.00,$0.00,$0.00,$0.00,$293.25,$0.00,$146.63,$232.25,$234.60,$0.00,$0.00,$0.00,$0.00,$0.00
75BA35L,SUP,Custom 27203010,,75BA35L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$293.25,$0.00,$293.25,$0.00,$209.29,$0.00,$0.00,$0.00,$0.00,$0.00,$293.25,$0.00,$146.63,$232.25,$234.60,$0.00,$0.00,$0.00,$0.00,$0.00
75BA35LF,SUP,Custom 27203010,,75BA35LF  -  PLATE 18MM TI BONE SPNL,$293.25,$0.00,$293.25,$0.00,$209.29,$0.00,$0.00,$0.00,$0.00,$0.00,$293.25,$0.00,$146.63,$232.25,$234.60,$0.00,$0.00,$0.00,$0.00,$0.00
75BA40,SUP,Custom 27203010,,75BA40  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$293.25,$0.00,$293.25,$0.00,$209.29,$0.00,$0.00,$0.00,$0.00,$0.00,$293.25,$0.00,$146.63,$232.25,$234.60,$0.00,$0.00,$0.00,$0.00,$0.00
75BA40D,SUP,Custom 27203010,,75BA40D  -  PLATE 18MM TI BONE SPNL,$316.63,$0.00,$316.63,$0.00,$225.98,$0.00,$0.00,$0.00,$0.00,$0.00,$316.63,$0.00,$158.31,$250.77,$253.30,$0.00,$0.00,$0.00,$0.00,$0.00
75BA40DC,SUP,Custom 27203010,,75BA40DC  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$323.00,$0.00,$323.00,$0.00,$230.53,$0.00,$0.00,$0.00,$0.00,$0.00,$323.00,$0.00,$161.50,$255.82,$258.40,$0.00,$0.00,$0.00,$0.00,$0.00
75BA40DF,SUP,Custom 27203010,,75BA40DF  -  PLATE 18MM TI BONE SPNL,$316.63,$0.00,$316.63,$0.00,$225.98,$0.00,$0.00,$0.00,$0.00,$0.00,$316.63,$0.00,$158.31,$250.77,$253.30,$0.00,$0.00,$0.00,$0.00,$0.00
75BA40DL,SUP,Custom 27203010,,75BA40DL  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$320.88,$0.00,$320.88,$0.00,$229.01,$0.00,$0.00,$0.00,$0.00,$0.00,$320.88,$0.00,$160.44,$254.14,$256.70,$0.00,$0.00,$0.00,$0.00,$0.00
75BA40DX,SUP,Custom 27203010,,75BA40DX  -  PLATE 18MM TI BONE SPNL,$323.00,$0.00,$323.00,$0.00,$230.53,$0.00,$0.00,$0.00,$0.00,$0.00,$323.00,$0.00,$161.50,$255.82,$258.40,$0.00,$0.00,$0.00,$0.00,$0.00
75BA40F,SUP,Custom 27203010,,75BA40F  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$293.25,$0.00,$293.25,$0.00,$209.29,$0.00,$0.00,$0.00,$0.00,$0.00,$293.25,$0.00,$146.63,$232.25,$234.60,$0.00,$0.00,$0.00,$0.00,$0.00
75BA40L,SUP,Custom 27203010,,75BA40L  -  PLATE 18MM TI BONE SPNL,$297.50,$0.00,$297.50,$0.00,$212.33,$0.00,$0.00,$0.00,$0.00,$0.00,$297.50,$0.00,$148.75,$235.62,$238.00,$0.00,$0.00,$0.00,$0.00,$0.00
75BA50,SUP,Custom 27203010,,75BA50  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$293.25,$0.00,$293.25,$0.00,$209.29,$0.00,$0.00,$0.00,$0.00,$0.00,$293.25,$0.00,$146.63,$232.25,$234.60,$0.00,$0.00,$0.00,$0.00,$0.00
75BA50D,SUP,Custom 27203010,,75BA50D  -  PLATE 18MM TI BONE SPNL,$316.63,$0.00,$316.63,$0.00,$225.98,$0.00,$0.00,$0.00,$0.00,$0.00,$316.63,$0.00,$158.31,$250.77,$253.30,$0.00,$0.00,$0.00,$0.00,$0.00
75BA50DC,SUP,Custom 27203010,,75BA50DC  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$323.00,$0.00,$323.00,$0.00,$230.53,$0.00,$0.00,$0.00,$0.00,$0.00,$323.00,$0.00,$161.50,$255.82,$258.40,$0.00,$0.00,$0.00,$0.00,$0.00
75BA50DF,SUP,Custom 27203010,,75BA50DF  -  PLATE 18MM TI BONE SPNL,$316.63,$0.00,$316.63,$0.00,$225.98,$0.00,$0.00,$0.00,$0.00,$0.00,$316.63,$0.00,$158.31,$250.77,$253.30,$0.00,$0.00,$0.00,$0.00,$0.00
75BA50DX,SUP,Custom 27203010,,75BA50DX  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$323.00,$0.00,$323.00,$0.00,$230.53,$0.00,$0.00,$0.00,$0.00,$0.00,$323.00,$0.00,$161.50,$255.82,$258.40,$0.00,$0.00,$0.00,$0.00,$0.00
75BA50F,SUP,Custom 27203010,,75BA50F  -  PLATE 18MM TI BONE SPNL,$293.25,$0.00,$293.25,$0.00,$209.29,$0.00,$0.00,$0.00,$0.00,$0.00,$293.25,$0.00,$146.63,$232.25,$234.60,$0.00,$0.00,$0.00,$0.00,$0.00
75BA60,SUP,Custom 27203010,,75BA60  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$293.25,$0.00,$293.25,$0.00,$209.29,$0.00,$0.00,$0.00,$0.00,$0.00,$293.25,$0.00,$146.63,$232.25,$234.60,$0.00,$0.00,$0.00,$0.00,$0.00
75BA60D,SUP,Custom 27203010,,75BA60D  -  PLATE 18MM TI BONE SPNL,$316.63,$0.00,$316.63,$0.00,$225.98,$0.00,$0.00,$0.00,$0.00,$0.00,$316.63,$0.00,$158.31,$250.77,$253.30,$0.00,$0.00,$0.00,$0.00,$0.00
75BA60DC,SUP,Custom 27203010,,75BA60DC  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$323.00,$0.00,$323.00,$0.00,$230.53,$0.00,$0.00,$0.00,$0.00,$0.00,$323.00,$0.00,$161.50,$255.82,$258.40,$0.00,$0.00,$0.00,$0.00,$0.00
75BA60DX,SUP,Custom 27203010,,75BA60DX  -  PLATE 18MM TI BONE SPNL,$323.00,$0.00,$323.00,$0.00,$230.53,$0.00,$0.00,$0.00,$0.00,$0.00,$323.00,$0.00,$161.50,$255.82,$258.40,$0.00,$0.00,$0.00,$0.00,$0.00
75BA60F,SUP,Custom 27203010,,75BA60F  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$293.25,$0.00,$293.25,$0.00,$209.29,$0.00,$0.00,$0.00,$0.00,$0.00,$293.25,$0.00,$146.63,$232.25,$234.60,$0.00,$0.00,$0.00,$0.00,$0.00
75BA70,SUP,Custom 27203010,,75BA70  -  PLATE 18MM TI BONE SPNL,$293.25,$0.00,$293.25,$0.00,$209.29,$0.00,$0.00,$0.00,$0.00,$0.00,$293.25,$0.00,$146.63,$232.25,$234.60,$0.00,$0.00,$0.00,$0.00,$0.00
75BA80,SUP,Custom 27203010,,75BA80  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$293.25,$0.00,$293.25,$0.00,$209.29,$0.00,$0.00,$0.00,$0.00,$0.00,$293.25,$0.00,$146.63,$232.25,$234.60,$0.00,$0.00,$0.00,$0.00,$0.00
75BA80D,SUP,Custom 27203010,,75BA80D  -  PLATE 18MM TI BONE SPNL,$316.63,$0.00,$316.63,$0.00,$225.98,$0.00,$0.00,$0.00,$0.00,$0.00,$316.63,$0.00,$158.31,$250.77,$253.30,$0.00,$0.00,$0.00,$0.00,$0.00
75BA80DC,SUP,Custom 27203010,,75BA80DC  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$323.00,$0.00,$323.00,$0.00,$230.53,$0.00,$0.00,$0.00,$0.00,$0.00,$323.00,$0.00,$161.50,$255.82,$258.40,$0.00,$0.00,$0.00,$0.00,$0.00
75CY65DX,SUP,Custom 27203010,,75CY65DX  -  PLATE 18MM TI BONE SPNL,$325.13,$0.00,$325.13,$0.00,$232.04,$0.00,$0.00,$0.00,$0.00,$0.00,$325.13,$0.00,$162.56,$257.50,$260.10,$0.00,$0.00,$0.00,$0.00,$0.00
75MH22,SUP,Custom 27203010,,75MH22  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$303.88,$0.00,$303.88,$0.00,$216.88,$0.00,$0.00,$0.00,$0.00,$0.00,$303.88,$0.00,$151.94,$240.67,$243.10,$0.00,$0.00,$0.00,$0.00,$0.00
75MH22D,SUP,Custom 27203010,,75MH22D  -  PLATE 18MM TI BONE SPNL,$325.13,$0.00,$325.13,$0.00,$232.04,$0.00,$0.00,$0.00,$0.00,$0.00,$325.13,$0.00,$162.56,$257.50,$260.10,$0.00,$0.00,$0.00,$0.00,$0.00
75MH30,SUP,Custom 27203010,,75MH30  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$303.88,$0.00,$303.88,$0.00,$216.88,$0.00,$0.00,$0.00,$0.00,$0.00,$303.88,$0.00,$151.94,$240.67,$243.10,$0.00,$0.00,$0.00,$0.00,$0.00
75MH30D,SUP,Custom 27203010,,75MH30D  -  PLATE 18MM TI BONE SPNL,$325.13,$0.00,$325.13,$0.00,$232.04,$0.00,$0.00,$0.00,$0.00,$0.00,$325.13,$0.00,$162.56,$257.50,$260.10,$0.00,$0.00,$0.00,$0.00,$0.00
75OV40,SUP,Custom 27203010,,75OV40  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$303.88,$0.00,$303.88,$0.00,$216.88,$0.00,$0.00,$0.00,$0.00,$0.00,$303.88,$0.00,$151.94,$240.67,$243.10,$0.00,$0.00,$0.00,$0.00,$0.00
76-0007,SUP,HCPCS C1713,,76-0007  -  SCREW BN 2.4MM 10MM RIBFIX BLU LCK TI STRNM,$615.00,$0.00,$615.00,$276.75,$438.93,$0.00,$105.96,$0.00,$0.00,$107.68,$615.00,$0.00,$307.50,$487.08,$492.00,$0.00,$96.25,$0.00,$97.91,$0.00
76-0010,SUP,HCPCS C1713,,76-0010  -  SCREW BN 2.4MM 12MM RIBFIX BLU DRL LCK STRNM SCAPULA,$605.00,$0.00,$605.00,$272.25,$431.79,$0.00,$104.24,$0.00,$0.00,$105.93,$605.00,$0.00,$302.50,$479.16,$484.00,$0.00,$94.68,$0.00,$96.32,$0.00
7602-20M,SUP,HCPCS C1725,,7602-20M  -  CATHETER ANGIOGRAPHIC PIGTAIL CURVE 5FR .052IN 100CM SIZING,$226.28,$0.00,$226.28,$122.87,$161.49,$0.00,$38.99,$0.00,$0.00,$39.62,$226.28,$0.00,$113.14,$179.21,$181.02,$0.00,$35.41,$0.00,$36.02,$0.00
7602-2M65,SUP,HCPCS C1725,,7602-2M65  -  CATH ANGIO .035IN PGTL CURVE 5FR .052IN 65CM 10 SDPRT 2 BAND,$69.13,$0.00,$69.13,$37.53,$49.33,$0.00,$11.91,$0.00,$0.00,$12.10,$69.13,$0.00,$34.56,$54.75,$55.30,$0.00,$10.82,$0.00,$11.00,$0.00
7602-51,SUP,HCPCS C1725,,7602-51  -  CATHETER ANGIO PGTL CRV 5FR 90CM STRL PRFM 10 SH RADOPQ BRD,$29.65,$0.00,$29.65,$16.10,$21.16,$0.00,$5.11,$0.00,$0.00,$5.19,$29.65,$0.00,$14.83,$23.48,$23.72,$0.00,$4.64,$0.00,$4.72,$0.00
76-2001,SUP,HCPCS C1713,,76-2001  -  SCREW BN 2.4MM 34MM X DRV,"$1,127.50",$0.00,"$1,127.50",$507.38,$804.70,$0.00,$194.26,$0.00,$0.00,$197.42,"$1,127.50",$0.00,$563.75,$892.98,$902.00,$0.00,$176.45,$0.00,$179.50,$0.00
76-2408,SUP,HCPCS C1713,,76-2408  -  SCREW BN 2.4MM 8MM RIBFIX BLU SLF DRL LCK RB,$367.50,$0.00,$367.50,$165.38,$262.28,$0.00,$63.32,$0.00,$0.00,$64.35,$367.50,$0.00,$183.75,$291.06,$294.00,$0.00,$57.51,$0.00,$58.51,$0.00
76-2410,SUP,HCPCS C1713,,76-2410  -  SCREW BN 2.4MM 10MM RIBFIX BLU ST LCK,$367.50,$0.00,$367.50,$165.38,$262.28,$0.00,$63.32,$0.00,$0.00,$64.35,$367.50,$0.00,$183.75,$291.06,$294.00,$0.00,$57.51,$0.00,$58.51,$0.00
76-2412,SUP,HCPCS C1713,,76-2412  -  Screw S/d-lk 2.4x12mm,$367.50,$0.00,$367.50,$165.38,$262.28,$0.00,$63.32,$0.00,$0.00,$64.35,$367.50,$0.00,$183.75,$291.06,$294.00,$0.00,$57.51,$0.00,$58.51,$0.00
76-2414,SUP,HCPCS C1713,,76-2414  -  SCREW BN 2.4MM 14MM RIBFIX BLU ST LCK TI THOR,$367.50,$0.00,$367.50,$165.38,$262.28,$0.00,$63.32,$0.00,$0.00,$64.35,$367.50,$0.00,$183.75,$291.06,$294.00,$0.00,$57.51,$0.00,$58.51,$0.00
76-2416,SUP,HCPCS C1713,,76-2416  -  SCREW BN 2.4MM 16MM RIBFIX BLU SLF DRL LCK RB,$367.50,$0.00,$367.50,$165.38,$262.28,$0.00,$63.32,$0.00,$0.00,$64.35,$367.50,$0.00,$183.75,$291.06,$294.00,$0.00,$57.51,$0.00,$58.51,$0.00
76-2601,SUP,HCPCS C1713,,76-2601  -  PLATE BN STRG NS RIBFIX BLU 8 HL TI RB,"$2,497.50",$0.00,"$2,497.50","$1,123.88","$1,782.47",$0.00,$430.31,$0.00,$0.00,$437.29,"$2,497.50",$0.00,"$1,248.75","$1,978.02","$1,998.00",$0.00,$390.86,$0.00,$397.60,$0.00
76-2602,SUP,HCPCS C1713,,76-2602  -  SCREW BN PREBNT 2.4MM 14MM SLF DRL LCK TI RB,"$3,125.00",$0.00,"$3,125.00","$1,406.25","$2,230.31",$0.00,$538.42,$0.00,$0.00,$547.16,"$3,125.00",$0.00,"$1,562.50","$2,475.00","$2,500.00",$0.00,$489.06,$0.00,$497.50,$0.00
76-2603,SUP,HCPCS C1713,,76-2603  -  PLATE BN PREBNT NS RIBFIX BLU 16 HL TI RB,"$3,747.50",$0.00,"$3,747.50","$1,686.38","$2,674.59",$0.00,$645.68,$0.00,$0.00,$656.16,"$3,747.50",$0.00,"$1,873.75","$2,968.02","$2,998.00",$0.00,$586.48,$0.00,$596.60,$0.00
76-2708,SUP,HCPCS C1713,,76-2708  -  SCREW BN 2.7MM 8MM ER TI RB,$367.50,$0.00,$367.50,$165.38,$262.28,$0.00,$63.32,$0.00,$0.00,$64.35,$367.50,$0.00,$183.75,$291.06,$294.00,$0.00,$57.51,$0.00,$58.51,$0.00
76-2710,SUP,HCPCS C1713,,76-2710  -  SCREW BN 2.7MM 10MM ER TI RB,$367.50,$0.00,$367.50,$165.38,$262.28,$0.00,$63.32,$0.00,$0.00,$64.35,$367.50,$0.00,$183.75,$291.06,$294.00,$0.00,$57.51,$0.00,$58.51,$0.00
76-2712,SUP,HCPCS C1713,,76-2712  -  SCREW BN 2.7MM 12MM ER RB,$367.50,$0.00,$367.50,$165.38,$262.28,$0.00,$63.32,$0.00,$0.00,$64.35,$367.50,$0.00,$183.75,$291.06,$294.00,$0.00,$57.51,$0.00,$58.51,$0.00
76-2714,SUP,HCPCS C1713,,76-2714  -  SCREW BN 2.7MM 14MM ER RB,$367.50,$0.00,$367.50,$165.38,$262.28,$0.00,$63.32,$0.00,$0.00,$64.35,$367.50,$0.00,$183.75,$291.06,$294.00,$0.00,$57.51,$0.00,$58.51,$0.00
76-4003L,SUP,HCPCS C1776,,76-4003L  -  CMPNT FEM LEFT KNEE TOT STAB W/O LFIT SCRP,"$10,226.13",$0.00,"$10,226.13","$4,601.76","$5,158.80",$0.00,"$1,761.91",$0.00,$0.00,"$1,790.51","$10,226.13",$0.00,"$5,113.06","$8,099.09","$8,180.90",$0.00,"$1,600.39",$0.00,"$1,628.00",$0.00
76-4003R,SUP,HCPCS C1776,,76-4003R  -  CMPNT FEM RIGHT KNEE TOT STAB W/O LFIT SCRP,"$10,226.13",$0.00,"$10,226.13","$4,601.76","$5,158.80",$0.00,"$1,761.91",$0.00,$0.00,"$1,790.51","$10,226.13",$0.00,"$5,113.06","$8,099.09","$8,180.90",$0.00,"$1,600.39",$0.00,"$1,628.00",$0.00
76-4004L,SUP,HCPCS C1776,,76-4004L  -  CMPNT FEM LEFT KNEE TOT STAB W/O LFIT SCRP,"$10,226.13",$0.00,"$10,226.13","$4,601.76","$5,158.80",$0.00,"$1,761.91",$0.00,$0.00,"$1,790.51","$10,226.13",$0.00,"$5,113.06","$8,099.09","$8,180.90",$0.00,"$1,600.39",$0.00,"$1,628.00",$0.00
76-4004R,SUP,HCPCS C1776,,76-4004R  -  CMPNT FEM RIGHT KNEE TOT STAB W/O LFIT SCRP,"$10,226.13",$0.00,"$10,226.13","$4,601.76","$5,158.80",$0.00,"$1,761.91",$0.00,$0.00,"$1,790.51","$10,226.13",$0.00,"$5,113.06","$8,099.09","$8,180.90",$0.00,"$1,600.39",$0.00,"$1,628.00",$0.00
76-4005L,SUP,HCPCS C1776,,76-4005L  -  CMPNT FEM LEFT KNEE TOT STAB W/O LFIT SCRP,"$9,995.38",$0.00,"$9,995.38","$4,497.92","$5,158.80",$0.00,"$1,722.15",$0.00,$0.00,"$1,750.11","$9,995.38",$0.00,"$4,997.69","$7,916.34","$7,996.30",$0.00,"$1,564.28",$0.00,"$1,591.26",$0.00
76-4005R,SUP,HCPCS C1776,,76-4005R  -  CMPNT FEM RIGHT KNEE TOT STAB W/O LFIT SCRP,"$9,995.38",$0.00,"$9,995.38","$4,497.92","$5,158.80",$0.00,"$1,722.15",$0.00,$0.00,"$1,750.11","$9,995.38",$0.00,"$4,997.69","$7,916.34","$7,996.30",$0.00,"$1,564.28",$0.00,"$1,591.26",$0.00
76-4006L,SUP,HCPCS C1776,,76-4006L  -  CMPNT FEM LEFT KNEE TOT STAB W/O LFIT SCRP,"$10,226.13",$0.00,"$10,226.13","$4,601.76","$5,158.80",$0.00,"$1,761.91",$0.00,$0.00,"$1,790.51","$10,226.13",$0.00,"$5,113.06","$8,099.09","$8,180.90",$0.00,"$1,600.39",$0.00,"$1,628.00",$0.00
76-4006R,SUP,HCPCS C1776,,76-4006R  -  CMPNT FEM RIGHT KNEE TOT STAB W/O LFIT SCRP,"$10,226.13",$0.00,"$10,226.13","$4,601.76","$5,158.80",$0.00,"$1,761.91",$0.00,$0.00,"$1,790.51","$10,226.13",$0.00,"$5,113.06","$8,099.09","$8,180.90",$0.00,"$1,600.39",$0.00,"$1,628.00",$0.00
76-4007L,SUP,HCPCS C1776,,76-4007L  -  CMPNT FEM LEFT KNEE TOT STAB W/O LFIT SCRP,"$9,995.38",$0.00,"$9,995.38","$4,497.92","$5,158.80",$0.00,"$1,722.15",$0.00,$0.00,"$1,750.11","$9,995.38",$0.00,"$4,997.69","$7,916.34","$7,996.30",$0.00,"$1,564.28",$0.00,"$1,591.26",$0.00
76-4007R,SUP,HCPCS C1776,,76-4007R  -  CMPNT FEM RIGHT KNEE TOT STAB W/O LFIT SCRP,"$9,995.38",$0.00,"$9,995.38","$4,497.92","$5,158.80",$0.00,"$1,722.15",$0.00,$0.00,"$1,750.11","$9,995.38",$0.00,"$4,997.69","$7,916.34","$7,996.30",$0.00,"$1,564.28",$0.00,"$1,591.26",$0.00
76-4009L,SUP,HCPCS C1776,,76-4009L  -  CMPNT FEM LEFT KNEE TOT STAB W/O LFIT SCRP,"$9,995.38",$0.00,"$9,995.38","$4,497.92","$5,158.80",$0.00,"$1,722.15",$0.00,$0.00,"$1,750.11","$9,995.38",$0.00,"$4,997.69","$7,916.34","$7,996.30",$0.00,"$1,564.28",$0.00,"$1,591.26",$0.00
76-4009R,SUP,HCPCS C1776,,76-4009R  -  CMPNT FEM RIGHT KNEE TOT STAB W/O LFIT SCRP,"$9,995.38",$0.00,"$9,995.38","$4,497.92","$5,158.80",$0.00,"$1,722.15",$0.00,$0.00,"$1,750.11","$9,995.38",$0.00,"$4,997.69","$7,916.34","$7,996.30",$0.00,"$1,564.28",$0.00,"$1,591.26",$0.00
76-4011L,SUP,HCPCS C1776,,76-4011L  -  CMPNT FEM LEFT KNEE TOT STAB W/O LFIT SCRP,"$9,995.38",$0.00,"$9,995.38","$4,497.92","$5,158.80",$0.00,"$1,722.15",$0.00,$0.00,"$1,750.11","$9,995.38",$0.00,"$4,997.69","$7,916.34","$7,996.30",$0.00,"$1,564.28",$0.00,"$1,591.26",$0.00
76-4011R,SUP,HCPCS C1776,,76-4011R  -  CMPNT FEM RIGHT KNEE TOT STAB W/O LFIT SCRP,"$9,995.38",$0.00,"$9,995.38","$4,497.92","$5,158.80",$0.00,"$1,722.15",$0.00,$0.00,"$1,750.11","$9,995.38",$0.00,"$4,997.69","$7,916.34","$7,996.30",$0.00,"$1,564.28",$0.00,"$1,591.26",$0.00
76-4013L,SUP,HCPCS C1776,,76-4013L  -  CMPNT FEM LEFT KNEE TOT STAB W/O LFIT SCRP,"$8,567.00",$0.00,"$8,567.00","$3,855.15","$5,158.80",$0.00,"$1,476.05",$0.00,$0.00,"$1,500.01","$8,567.00",$0.00,"$4,283.50","$6,785.06","$6,853.60",$0.00,"$1,340.74",$0.00,"$1,363.87",$0.00
76-4013R,SUP,HCPCS C1776,,76-4013R  -  CMPNT FEM RIGHT KNEE TOT STAB W/O LFIT SCRP,"$8,567.00",$0.00,"$8,567.00","$3,855.15","$5,158.80",$0.00,"$1,476.05",$0.00,$0.00,"$1,500.01","$8,567.00",$0.00,"$4,283.50","$6,785.06","$6,853.60",$0.00,"$1,340.74",$0.00,"$1,363.87",$0.00
76-4103L,SUP,HCPCS C1776,,76-4103L  -  COMPONENT FEMORAL 3 56X35MM MODULAR TOT STABILIZE REVISION,"$12,130.00",$0.00,"$12,130.00","$5,458.50","$5,158.80",$0.00,"$2,089.94",$0.00,$0.00,"$2,123.87","$12,130.00",$0.00,"$6,065.00","$9,606.96","$9,704.00",$0.00,"$1,898.35",$0.00,"$1,931.10",$0.00
76-4103R,SUP,HCPCS C1776,,76-4103R  -  COMPONENT FEMORAL 3 56X35MM MODULAR TOT STABILIZE REVISION,"$12,130.00",$0.00,"$12,130.00","$5,458.50","$5,158.80",$0.00,"$2,089.94",$0.00,$0.00,"$2,123.87","$12,130.00",$0.00,"$6,065.00","$9,606.96","$9,704.00",$0.00,"$1,898.35",$0.00,"$1,931.10",$0.00
76-4105L,SUP,HCPCS C1776,,76-4105L  -  COMPONENT FEMORAL 5 61X39MM MODULAR TOT STABILIZE REVISION,"$12,130.00",$0.00,"$12,130.00","$5,458.50","$5,158.80",$0.00,"$2,089.94",$0.00,$0.00,"$2,123.87","$12,130.00",$0.00,"$6,065.00","$9,606.96","$9,704.00",$0.00,"$1,898.35",$0.00,"$1,931.10",$0.00
76-4105R,SUP,HCPCS C1776,,76-4105R  -  COMPONENT FEMORAL 5 61X39MM MODULAR TOT STABILIZE REVISION,"$12,130.00",$0.00,"$12,130.00","$5,458.50","$5,158.80",$0.00,"$2,089.94",$0.00,$0.00,"$2,123.87","$12,130.00",$0.00,"$6,065.00","$9,606.96","$9,704.00",$0.00,"$1,898.35",$0.00,"$1,931.10",$0.00
76-4107L,SUP,HCPCS C1776,,76-4107L  -  COMPONENT FEMORAL 7 66X44MM MODULAR TOT STABILIZE REVISION,"$12,130.00",$0.00,"$12,130.00","$5,458.50","$5,158.80",$0.00,"$2,089.94",$0.00,$0.00,"$2,123.87","$12,130.00",$0.00,"$6,065.00","$9,606.96","$9,704.00",$0.00,"$1,898.35",$0.00,"$1,931.10",$0.00
76-4107R,SUP,HCPCS C1776,,76-4107R  -  COMPONENT FEMORAL 7 66X44MM MODULAR TOT STABILIZE REVISION,"$12,130.00",$0.00,"$12,130.00","$5,458.50","$5,158.80",$0.00,"$2,089.94",$0.00,$0.00,"$2,123.87","$12,130.00",$0.00,"$6,065.00","$9,606.96","$9,704.00",$0.00,"$1,898.35",$0.00,"$1,931.10",$0.00
76-4109L,SUP,HCPCS C1776,,76-4109L  -  COMPONENT FEMORAL 9 71X49MM MODULAR TOT STABILIZE REVISION,"$12,130.00",$0.00,"$12,130.00","$5,458.50","$5,158.80",$0.00,"$2,089.94",$0.00,$0.00,"$2,123.87","$12,130.00",$0.00,"$6,065.00","$9,606.96","$9,704.00",$0.00,"$1,898.35",$0.00,"$1,931.10",$0.00
76-4109R,SUP,HCPCS C1776,,76-4109R  -  COMPONENT FEMORAL 9 71X49MM MODULAR TOT STABILIZE REVISION,"$12,130.00",$0.00,"$12,130.00","$5,458.50","$5,158.80",$0.00,"$2,089.94",$0.00,$0.00,"$2,123.87","$12,130.00",$0.00,"$6,065.00","$9,606.96","$9,704.00",$0.00,"$1,898.35",$0.00,"$1,931.10",$0.00
76-4111L,SUP,HCPCS C1776,,76-4111L  -  COMPONENT FEMORAL 11 76X53MM MODULAR TOT STABILIZE REVISION,"$12,130.00",$0.00,"$12,130.00","$5,458.50","$5,158.80",$0.00,"$2,089.94",$0.00,$0.00,"$2,123.87","$12,130.00",$0.00,"$6,065.00","$9,606.96","$9,704.00",$0.00,"$1,898.35",$0.00,"$1,931.10",$0.00
76-4111R,SUP,HCPCS C1776,,76-4111R  -  COMPONENT FEMORAL 11 76X53MM MODULAR TOT STABILIZE REVISION,"$12,130.00",$0.00,"$12,130.00","$5,458.50","$5,158.80",$0.00,"$2,089.94",$0.00,$0.00,"$2,123.87","$12,130.00",$0.00,"$6,065.00","$9,606.96","$9,704.00",$0.00,"$1,898.35",$0.00,"$1,931.10",$0.00
76-4113L,SUP,HCPCS C1776,,76-4113L  -  COMPONENT FEMORAL 13 81X58MM MODULAR TOT STABILIZE REVISION,"$12,130.00",$0.00,"$12,130.00","$5,458.50","$5,158.80",$0.00,"$2,089.94",$0.00,$0.00,"$2,123.87","$12,130.00",$0.00,"$6,065.00","$9,606.96","$9,704.00",$0.00,"$1,898.35",$0.00,"$1,931.10",$0.00
76-4113R,SUP,HCPCS C1776,,76-4113R  -  COMPONENT FEMORAL 13 81X58MM MODULAR TOT STABILIZE REVISION,"$12,130.00",$0.00,"$12,130.00","$5,458.50","$5,158.80",$0.00,"$2,089.94",$0.00,$0.00,"$2,123.87","$12,130.00",$0.00,"$6,065.00","$9,606.96","$9,704.00",$0.00,"$1,898.35",$0.00,"$1,931.10",$0.00
7650-2038A,SUP,Custom 27203010,,7650-2038A  -  PIN FIX FLUTE SQUARE 1/8IN 3.5IN STAINLESS STEEL KNEE,$737.50,$0.00,$737.50,$0.00,$526.35,$0.00,$0.00,$0.00,$0.00,$0.00,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$0.00,$0.00,$0.00,$0.00
76791-MX,SUP,HCPCS C1725,,THERMOMETER SYSTEM DIAG INTEGRATED 767,"$2,070.45",$0.00,"$2,070.45","$1,124.25","$1,477.68",$0.00,$356.73,$0.00,$0.00,$362.52,"$2,070.45",$0.00,"$1,035.23","$1,639.80","$1,656.36",$0.00,$324.03,$0.00,$329.62,$0.00
7679922P,SUP,Custom 27203010,,7679922P  -  REAMER SRG 3.15MM STRL PCM MRC SPNE,$960.00,$0.00,$960.00,$0.00,$685.15,$0.00,$0.00,$0.00,$0.00,$0.00,$960.00,$0.00,$480.00,$760.32,$768.00,$0.00,$0.00,$0.00,$0.00,$0.00
7679925P,SUP,Custom 27203010,,7679925P  -  REAMER SRG 3.5MM STRL PCM ANS SPNE,$960.00,$0.00,$960.00,$0.00,$685.15,$0.00,$0.00,$0.00,$0.00,$0.00,$960.00,$0.00,$480.00,$760.32,$768.00,$0.00,$0.00,$0.00,$0.00,$0.00
7679926P,SUP,Custom 27203010,,7679926P  -  REAMER SRG 3.5MM STRL PCM MRL SPNE,$960.00,$0.00,$960.00,$0.00,$685.15,$0.00,$0.00,$0.00,$0.00,$0.00,$960.00,$0.00,$480.00,$760.32,$768.00,$0.00,$0.00,$0.00,$0.00,$0.00
7679927P,SUP,Custom 27203010,,7679927P  -  REAMER SRG 3.5MM STRL PCM HXL SPNE,$960.00,$0.00,$960.00,$0.00,$685.15,$0.00,$0.00,$0.00,$0.00,$0.00,$960.00,$0.00,$480.00,$760.32,$768.00,$0.00,$0.00,$0.00,$0.00,$0.00
7679930P,SUP,Custom 27203010,,7679930P  -  REAMER SRG 3.5MM STRL PCM JC SPNE,$960.00,$0.00,$960.00,$0.00,$685.15,$0.00,$0.00,$0.00,$0.00,$0.00,$960.00,$0.00,$480.00,$760.32,$768.00,$0.00,$0.00,$0.00,$0.00,$0.00
7679934P,SUP,Custom 27203010,,7679934P  -  REAMER SRG 3.5MM STRL PCM TSPE SPNE,$960.00,$0.00,$960.00,$0.00,$685.15,$0.00,$0.00,$0.00,$0.00,$0.00,$960.00,$0.00,$480.00,$760.32,$768.00,$0.00,$0.00,$0.00,$0.00,$0.00
768G,SUP,Custom 27203010,,768G  -  SUTURE NONABSORBABLE 7-0 G-6 18IN 2 ARM BRAID NEEDLE,$33.12,$0.00,$33.12,$0.00,$23.64,$0.00,$0.00,$0.00,$0.00,$0.00,$33.12,$0.00,$16.56,$26.23,$26.50,$0.00,$0.00,$0.00,$0.00,$0.00
76-9102,SUP,HCPCS C1713,,76-9102  -  SCREW BN 2.7MM 8MM ER LCK RB,$185.00,$0.00,$185.00,$83.25,$132.03,$0.00,$31.87,$0.00,$0.00,$32.39,$185.00,$0.00,$92.50,$146.52,$148.00,$0.00,$28.95,$0.00,$29.45,$0.00
76-9103,SUP,HCPCS C1713,,76-9103  -  PLATE BN 16 HL TMPLT RB,$185.00,$0.00,$185.00,$83.25,$132.03,$0.00,$31.87,$0.00,$0.00,$32.39,$185.00,$0.00,$92.50,$146.52,$148.00,$0.00,$28.95,$0.00,$29.45,$0.00
76-9104,SUP,HCPCS C1713,,76-9104  -  TEMPLATE SZ 16 HL PLT,$185.00,$0.00,$185.00,$83.25,$132.03,$0.00,$31.87,$0.00,$0.00,$32.39,$185.00,$0.00,$92.50,$146.52,$148.00,$0.00,$28.95,$0.00,$29.45,$0.00
769G,SUP,Custom 27203010,,769G  -  SUTURE NABSB 6-0 G-6 18IN BLK PRMHND MICROPOINT 2 ARM BRD,$32.87,$0.00,$32.87,$0.00,$23.46,$0.00,$0.00,$0.00,$0.00,$0.00,$32.87,$0.00,$16.44,$26.03,$26.30,$0.00,$0.00,$0.00,$0.00,$0.00
77-1003,SUP,HCPCS C1776,,77-1003  -  CMPNT TIBTRY 3MM KNEE LP SCRP,"$2,308.00",$0.00,"$2,308.00","$1,038.60","$1,647.22",$0.00,$397.66,$0.00,$0.00,$404.11,"$2,308.00",$0.00,"$1,154.00","$1,827.94","$1,846.40",$0.00,$361.20,$0.00,$367.43,$0.00
77-1004,SUP,HCPCS C1776,,77-1004  -  CMPNT TIBTRY 4MM KNEE LP SCRP,"$2,308.00",$0.00,"$2,308.00","$1,038.60","$1,647.22",$0.00,$397.66,$0.00,$0.00,$404.11,"$2,308.00",$0.00,"$1,154.00","$1,827.94","$1,846.40",$0.00,$361.20,$0.00,$367.43,$0.00
77-1006,SUP,HCPCS C1776,,77-1006  -  CMPNT TIBTRY 6MM KNEE LP SCRP,"$2,308.00",$0.00,"$2,308.00","$1,038.60","$1,647.22",$0.00,$397.66,$0.00,$0.00,$404.11,"$2,308.00",$0.00,"$1,154.00","$1,827.94","$1,846.40",$0.00,$361.20,$0.00,$367.43,$0.00
77-1007,SUP,HCPCS C1776,,77-1007  -  CMPNT TIBTRY 7MM KNEE LP SCRP,"$2,308.00",$0.00,"$2,308.00","$1,038.60","$1,647.22",$0.00,$397.66,$0.00,$0.00,$404.11,"$2,308.00",$0.00,"$1,154.00","$1,827.94","$1,846.40",$0.00,$361.20,$0.00,$367.43,$0.00
77-1009,SUP,HCPCS C1776,,77-1009  -  CMPNT TIB 9MM SCRP KNEE LP,"$2,308.00",$0.00,"$2,308.00","$1,038.60","$1,647.22",$0.00,$397.66,$0.00,$0.00,$404.11,"$2,308.00",$0.00,"$1,154.00","$1,827.94","$1,846.40",$0.00,$361.20,$0.00,$367.43,$0.00
7717G,SUP,Custom 27203010,,7717G  -  SUTURE NONABSORBABLE 9-0 TG140-8 12IN 2 ARM MONOFILAMENT,$34.27,$0.00,$34.27,$0.00,$24.46,$0.00,$0.00,$0.00,$0.00,$0.00,$34.27,$0.00,$17.14,$27.14,$27.42,$0.00,$0.00,$0.00,$0.00,$0.00
7731G,SUP,Custom 27203010,,7731G  -  SUTURE NABSB 5-0 S-24 18IN BLK ETH SBLC 2 ARM MFL,$34.49,$0.00,$34.49,$0.00,$24.61,$0.00,$0.00,$0.00,$0.00,$0.00,$34.49,$0.00,$17.24,$27.32,$27.59,$0.00,$0.00,$0.00,$0.00,$0.00
77-4003,SUP,HCPCS C1776,,77-4003  -  TRAY TIBIAL 3 40/61MM 35MM 1 AXIS TOT STABILIZE STEM END CAP,"$5,837.50",$0.00,"$5,837.50","$2,626.88","$4,166.22",$0.00,"$1,005.77",$0.00,$0.00,"$1,022.10","$5,837.50",$0.00,"$2,918.75","$4,623.30","$4,670.00",$0.00,$913.57,$0.00,$929.33,$0.00
77-4004,SUP,HCPCS C1776,,77-4004  -  TRAY TIBIAL 4 TOT STABILIZE MODULAR SCORPIO KNEE,"$5,837.50",$0.00,"$5,837.50","$2,626.88","$4,166.22",$0.00,"$1,005.77",$0.00,$0.00,"$1,022.10","$5,837.50",$0.00,"$2,918.75","$4,623.30","$4,670.00",$0.00,$913.57,$0.00,$929.33,$0.00
77-4005,SUP,HCPCS C1776,,77-4005  -  TRAY TIBIAL 5 44/66MM 35MM 1 AXIS TOT STABILIZE STEM END CAP,"$5,837.50",$0.00,"$5,837.50","$2,626.88","$4,166.22",$0.00,"$1,005.77",$0.00,$0.00,"$1,022.10","$5,837.50",$0.00,"$2,918.75","$4,623.30","$4,670.00",$0.00,$913.57,$0.00,$929.33,$0.00
77-4006,SUP,HCPCS C1776,,77-4006  -  TRAY TIBIAL 6 TOT STABILIZE MODULAR SCORPIO KNEE,"$5,837.50",$0.00,"$5,837.50","$2,626.88","$4,166.22",$0.00,"$1,005.77",$0.00,$0.00,"$1,022.10","$5,837.50",$0.00,"$2,918.75","$4,623.30","$4,670.00",$0.00,$913.57,$0.00,$929.33,$0.00
77-4007,SUP,HCPCS C1776,,77-4007  -  TRAY TIBIAL 7 47/71MM 37MM 1 AXIS TOT STABILIZE STEM END CAP,"$5,837.50",$0.00,"$5,837.50","$2,626.88","$4,166.22",$0.00,"$1,005.77",$0.00,$0.00,"$1,022.10","$5,837.50",$0.00,"$2,918.75","$4,623.30","$4,670.00",$0.00,$913.57,$0.00,$929.33,$0.00
77-4009,SUP,HCPCS C1776,,77-4009  -  TRAY TIBIAL 9 51/77MM 37MM 1 AXIS TOT STABILIZE STEM END CAP,"$5,837.50",$0.00,"$5,837.50","$2,626.88","$4,166.22",$0.00,"$1,005.77",$0.00,$0.00,"$1,022.10","$5,837.50",$0.00,"$2,918.75","$4,623.30","$4,670.00",$0.00,$913.57,$0.00,$929.33,$0.00
77-4011,SUP,HCPCS C1776,,77-4011  -  TRAY TIBIAL 11 54/82MM 43MM 1 AXIS TOT STABILIZE STEM END,"$5,837.50",$0.00,"$5,837.50","$2,626.88","$4,166.22",$0.00,"$1,005.77",$0.00,$0.00,"$1,022.10","$5,837.50",$0.00,"$2,918.75","$4,623.30","$4,670.00",$0.00,$913.57,$0.00,$929.33,$0.00
77-4013,SUP,HCPCS C1776,,77-4013  -  TRAY TIBIAL 13 58/88MM 43MM 1 AXIS TOT STABILIZE STEM END,"$5,837.50",$0.00,"$5,837.50","$2,626.88","$4,166.22",$0.00,"$1,005.77",$0.00,$0.00,"$1,022.10","$5,837.50",$0.00,"$2,918.75","$4,623.30","$4,670.00",$0.00,$913.57,$0.00,$929.33,$0.00
7751710EP,SUP,HCPCS C1713,,7751710EP  -  PLATE 18MM TI BONE SPNL,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751712EP,SUP,HCPCS C1713,,7751712EP  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751714EP,SUP,HCPCS C1713,,7751714EP  -  PLATE 18MM TI BONE SPNL,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751716EP,SUP,HCPCS C1713,,7751716EP  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751718EP,SUP,HCPCS C1713,,7751718EP  -  PLATE 18MM TI BONE SPNL,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751720EP,SUP,HCPCS C1713,,7751720EP  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751722EP,SUP,HCPCS C1713,,7751722EP  -  PLATE 18MM TI BONE SPNL,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751724EP,SUP,HCPCS C1713,,7751724EP  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751724PT,SUP,HCPCS C1713,,7751724PT  -  PLATE 18MM TI BONE SPNL,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751726PT,SUP,HCPCS C1713,,7751726PT  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751728PT,SUP,HCPCS C1713,,7751728PT  -  PLATE 18MM TI BONE SPNL,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751730PT,SUP,HCPCS C1713,,7751730PT  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751732PT,SUP,HCPCS C1713,,7751732PT  -  PLATE 18MM TI BONE SPNL,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751734PT,SUP,HCPCS C1713,,7751734PT  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751810EP,SUP,HCPCS C1713,,7751810EP  -  PLATE 18MM TI BONE SPNL,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751812EP,SUP,HCPCS C1713,,7751812EP  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751814EP,SUP,HCPCS C1713,,7751814EP  -  PLATE 18MM TI BONE SPNL,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751816EP,SUP,HCPCS C1713,,7751816EP  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751818EP,SUP,HCPCS C1713,,7751818EP  -  PLATE 18MM TI BONE SPNL,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751820EP,SUP,HCPCS C1713,,7751820EP  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751822EP,SUP,HCPCS C1713,,7751822EP  -  PLATE 18MM TI BONE SPNL,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751824EP,SUP,HCPCS C1713,,7751824EP  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751824PT,SUP,HCPCS C1713,,7751824PT  -  PLATE 18MM TI BONE SPNL,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751826EP,SUP,HCPCS C1713,,7751826EP  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751826PT,SUP,HCPCS C1713,,7751826PT  -  PLATE 18MM TI BONE SPNL,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751828EP,SUP,HCPCS C1713,,7751828EP  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751828PT,SUP,HCPCS C1713,,7751828PT  -  PLATE 18MM TI BONE SPNL,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751830EP,SUP,HCPCS C1713,,7751830EP  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751830PT,SUP,HCPCS C1713,,7751830PT  -  PLATE 18MM TI BONE SPNL,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751832EP,SUP,HCPCS C1713,,7751832EP  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751832PT,SUP,HCPCS C1713,,7751832PT  -  PLATE 18MM TI BONE SPNL,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751834EP,SUP,HCPCS C1713,,7751834EP  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751834PT,SUP,HCPCS C1713,,7751834PT  -  PLATE 18MM TI BONE SPNL,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751924EP,SUP,HCPCS C1713,,7751924EP  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751926EP,SUP,HCPCS C1713,,7751926EP  -  PLATE 18MM TI BONE SPNL,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751928EP,SUP,HCPCS C1713,,7751928EP  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751930EP,SUP,HCPCS C1713,,7751930EP  -  PLATE 18MM TI BONE SPNL,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751932EP,SUP,HCPCS C1713,,7751932EP  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
7751934EP,SUP,HCPCS C1713,,7751934EP  -  PLATE 18MM TI BONE SPNL,$983.68,$0.00,$983.68,$442.65,$702.05,$0.00,$169.48,$0.00,$0.00,$172.23,$983.68,$0.00,$491.84,$779.07,$786.94,$0.00,$153.95,$0.00,$156.60,$0.00
77525P,SUP,HCPCS C1713,,77525P  -  SCREW BN 7.75MM 25MM SPRL R90D MULTIANGLE TI SPNE THORLMBR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
77525S,SUP,HCPCS C1713,,77525S  -  SCREW BN STD 7.75MM 25MM SPRL R90D LCK TI SPNE THORLMBR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
77530P,SUP,HCPCS C1713,,77530P  -  SCREW BN 7.75MM 30MM SPRL R90D MULTIANGLE TI SPNE THORLMBR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
77530S,SUP,HCPCS C1713,,77530S  -  SCREW BN STD 7.75MM 30MM SPRL R90D LCK TI SPNE THORLMBR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
77535P,SUP,HCPCS C1713,,77535P  -  SCREW BN 7.75MM 35MM SPRL R90D MULTIANGLE TI SPNE THORLMBR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
77535S,SUP,HCPCS C1713,,77535S  -  SCREW BN STD 7.75MM 35MM SPRL R90D LCK TI SPNE THORLMBR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
77540P,SUP,HCPCS C1713,,77540P  -  SCREW BN 7.75MM 40MM SPRL R90D MULTIANGLE TI SPNE THORLMBR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
77540S,SUP,HCPCS C1713,,77540S  -  SCREW BN STD 7.75MM 40MM SPRL R90D LCK TI SPNE THORLMBR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
77545P,SUP,HCPCS C1713,,77545P  -  SCREW BN 7.75MM 45MM SPRL R90D MULTIANGLE TI SPNE THORLMBR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
77545S,SUP,HCPCS C1713,,77545S  -  SCREW BN STD 7.75MM 45MM SPRL R90D LCK TI SPNE THORLMBR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
77550P,SUP,HCPCS C1713,,77550P  -  SCREW BN 7.75MM 50MM SPRL R90D MULTIANGLE TI SPNE THORLMBR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
77550S,SUP,HCPCS C1713,,77550S  -  SCREW BN STD 7.75MM 50MM SPRL R90D LCK TI SPNE THORLMBR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
77555P,SUP,HCPCS C1713,,77555P  -  SCREW BN 7.75MM 55MM SPRL R90D MULTIANGLE TI SPNE THORLMBR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
77555S,SUP,HCPCS C1713,,77555S  -  SCREW BN STD 7.75MM 55MM SPRL R90D LCK TI SPNE THORLMBR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
7756073L,SUP,HCPCS C1713,,7756073L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7756073R,SUP,HCPCS C1713,,7756073R  -  PLATE 18MM TI BONE SPNL,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7756074L,SUP,HCPCS C1713,,7756074L  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
7756074R,SUP,HCPCS C1713,,7756074R  -  PLATE 18MM TI BONE SPNL,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
77560P,SUP,HCPCS C1713,,77560P  -  SCREW BN 7.75MM 60MM SPRL R90D MULTIANGLE TI SPNE THORLMBR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
77560S,SUP,HCPCS C1713,,77560S  -  SCREW BN STD 7.75MM 60MM SPRL R90D LCK TI SPNE THORLMBR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
77565P,SUP,HCPCS C1713,,77565P  -  SCREW BN 7.75MM 65MM SPRL R90D MULTIANGLE TI SPNE THORLMBR,"$1,621.98",$0.00,"$1,621.98",$729.89,"$1,157.60",$0.00,$279.46,$0.00,$0.00,$283.99,"$1,621.98",$0.00,$810.99,"$1,284.61","$1,297.58",$0.00,$253.84,$0.00,$258.22,$0.00
77565S,SUP,HCPCS C1713,,77565S  -  SCREW BN STD 7.75MM 65MM SPRL R90D LCK TI SPNE THORLMBR,"$1,233.33",$0.00,"$1,233.33",$555.00,$880.22,$0.00,$212.50,$0.00,$0.00,$215.95,"$1,233.33",$0.00,$616.66,$976.80,$986.66,$0.00,$193.02,$0.00,$196.35,$0.00
77570P,SUP,HCPCS C1713,,77570P  -  SCREW BN 7.75MM 70MM SPRL R90D MULTIANGLE TI SPNE THORLMBR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
77580P,SUP,HCPCS C1713,,77580P  -  SCREW BN 7.75MM 80MM SPRL R90D MULTIANGLE TI SPNE THORLMBR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
77590P,SUP,HCPCS C1713,,77590P  -  SCREW BN 7.75MM 90MM SPRL R90D MULTIANGLE TI SPNE THORLMBR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
778-014-00,SUP,HCPCS C1887,,CATHETER GUID JL4ST CURVE 7FR .078IN 100CM PTFE VSBR BLUE,$139.93,$0.00,$139.93,$75.98,$99.86,$0.00,$24.11,$0.00,$0.00,$24.50,$139.93,$0.00,$69.96,$110.82,$111.94,$0.00,$21.90,$0.00,$22.28,$0.00
778-081-00,SUP,HCPCS C1887,,CATHETER GUID JR3.5 CURVE 7FR .078IN 100CM SH PTFE VSBR BLUE,$139.93,$0.00,$139.93,$75.98,$99.86,$0.00,$24.11,$0.00,$0.00,$24.50,$139.93,$0.00,$69.96,$110.82,$111.94,$0.00,$21.90,$0.00,$22.28,$0.00
778-181-00,SUP,HCPCS C1887,,CATHETER GUID LCB CURVE 7FR .078IN 100CM SH PTFE VSBR BLUE,$139.93,$0.00,$139.93,$75.98,$99.86,$0.00,$24.11,$0.00,$0.00,$24.50,$139.93,$0.00,$69.96,$110.82,$111.94,$0.00,$21.90,$0.00,$22.28,$0.00
78-10030,SUP,HCPCS C1713,,78-10030  -  IMPLANT CRNL LG KT CSTM,"$43,877.50",$0.00,"$43,877.50","$19,744.88","$5,158.80",$0.00,"$7,559.87",$0.00,$0.00,"$7,682.60","$43,877.50",$0.00,"$21,938.75","$34,750.98","$35,102.00",$0.00,"$6,866.83",$0.00,"$6,985.30",$0.00
7850-1-000,SUP,HCPCS C1776,,7850-1-000  -  STEM FEM HIPSTAR 135D 0 HIP,"$6,665.00",$0.00,"$6,665.00","$2,999.25","$4,756.81",$0.00,"$1,148.35",$0.00,$0.00,"$1,166.99","$6,665.00",$0.00,"$3,332.50","$5,278.68","$5,332.00",$0.00,"$1,043.07",$0.00,"$1,061.07",$0.00
7850-1-001,SUP,HCPCS C1776,,7850-1-001  -  STEM FEM HIPSTAR 135D 1 HIP,"$6,665.00",$0.00,"$6,665.00","$2,999.25","$4,756.81",$0.00,"$1,148.35",$0.00,$0.00,"$1,166.99","$6,665.00",$0.00,"$3,332.50","$5,278.68","$5,332.00",$0.00,"$1,043.07",$0.00,"$1,061.07",$0.00
7850-1-002,SUP,HCPCS C1776,,7850-1-002  -  STEM FEM HIPSTAR 135D 2 HIP,"$6,328.00",$0.00,"$6,328.00","$2,847.60","$4,516.29",$0.00,"$1,090.28",$0.00,$0.00,"$1,107.98","$6,328.00",$0.00,"$3,164.00","$5,011.78","$5,062.40",$0.00,$990.33,$0.00,"$1,007.42",$0.00
7850-1-003,SUP,HCPCS C1776,,7850-1-003  -  STEM FEM HIPSTAR TMZF 135D 3 HIP,"$6,328.00",$0.00,"$6,328.00","$2,847.60","$4,516.29",$0.00,"$1,090.28",$0.00,$0.00,"$1,107.98","$6,328.00",$0.00,"$3,164.00","$5,011.78","$5,062.40",$0.00,$990.33,$0.00,"$1,007.42",$0.00
7850-1-004,SUP,HCPCS C1776,,7850-1-004  -  STEM FEM HIPSTAR HIP,"$6,328.00",$0.00,"$6,328.00","$2,847.60","$4,516.29",$0.00,"$1,090.28",$0.00,$0.00,"$1,107.98","$6,328.00",$0.00,"$3,164.00","$5,011.78","$5,062.40",$0.00,$990.33,$0.00,"$1,007.42",$0.00
7850-1-005,SUP,HCPCS C1776,,7850-1-005  -  STEM FEM HIPSTAR TMZF 135D 5 HIP,"$6,328.00",$0.00,"$6,328.00","$2,847.60","$4,516.29",$0.00,"$1,090.28",$0.00,$0.00,"$1,107.98","$6,328.00",$0.00,"$3,164.00","$5,011.78","$5,062.40",$0.00,$990.33,$0.00,"$1,007.42",$0.00
7850-1-006,SUP,HCPCS C1776,,7850-1-006  -  STEM FEM HIPSTAR 135D 6 HIP,"$6,328.00",$0.00,"$6,328.00","$2,847.60","$4,516.29",$0.00,"$1,090.28",$0.00,$0.00,"$1,107.98","$6,328.00",$0.00,"$3,164.00","$5,011.78","$5,062.40",$0.00,$990.33,$0.00,"$1,007.42",$0.00
7850-1-007,SUP,HCPCS C1776,,7850-1-007  -  STEM FEM HIPSTAR 135D 7 HIP,"$6,328.00",$0.00,"$6,328.00","$2,847.60","$4,516.29",$0.00,"$1,090.28",$0.00,$0.00,"$1,107.98","$6,328.00",$0.00,"$3,164.00","$5,011.78","$5,062.40",$0.00,$990.33,$0.00,"$1,007.42",$0.00
7850-1-008,SUP,HCPCS C1776,,7850-1-008  -  STEM FEM HIPSTAR 135D 8 HIP,"$6,328.00",$0.00,"$6,328.00","$2,847.60","$4,516.29",$0.00,"$1,090.28",$0.00,$0.00,"$1,107.98","$6,328.00",$0.00,"$3,164.00","$5,011.78","$5,062.40",$0.00,$990.33,$0.00,"$1,007.42",$0.00
7850-1-009,SUP,HCPCS C1776,,7850-1-009  -  STEM FEM HIPSTAR 135D 9 HIP,"$6,328.00",$0.00,"$6,328.00","$2,847.60","$4,516.29",$0.00,"$1,090.28",$0.00,$0.00,"$1,107.98","$6,328.00",$0.00,"$3,164.00","$5,011.78","$5,062.40",$0.00,$990.33,$0.00,"$1,007.42",$0.00
7850-1-010,SUP,HCPCS C1776,,7850-1-010  -  STEM FEM HIPSTAR 135D 10 HIP,"$6,328.00",$0.00,"$6,328.00","$2,847.60","$4,516.29",$0.00,"$1,090.28",$0.00,$0.00,"$1,107.98","$6,328.00",$0.00,"$3,164.00","$5,011.78","$5,062.40",$0.00,$990.33,$0.00,"$1,007.42",$0.00
7850-1-011,SUP,HCPCS C1776,,7850-1-011  -  STEM FEM HIPSTAR 135D 11 HIP,"$6,665.00",$0.00,"$6,665.00","$2,999.25","$4,756.81",$0.00,"$1,148.35",$0.00,$0.00,"$1,166.99","$6,665.00",$0.00,"$3,332.50","$5,278.68","$5,332.00",$0.00,"$1,043.07",$0.00,"$1,061.07",$0.00
7850-1-012,SUP,HCPCS C1776,,7850-1-012  -  STEM FEM HIPSTAR 135D 12 HIP,"$6,665.00",$0.00,"$6,665.00","$2,999.25","$4,756.81",$0.00,"$1,148.35",$0.00,$0.00,"$1,166.99","$6,665.00",$0.00,"$3,332.50","$5,278.68","$5,332.00",$0.00,"$1,043.07",$0.00,"$1,061.07",$0.00
7850-5-000,SUP,HCPCS C1776,,7850-5-000  -  STEM FEM HIPSTAR 127D 0 HIP,"$6,665.00",$0.00,"$6,665.00","$2,999.25","$4,756.81",$0.00,"$1,148.35",$0.00,$0.00,"$1,166.99","$6,665.00",$0.00,"$3,332.50","$5,278.68","$5,332.00",$0.00,"$1,043.07",$0.00,"$1,061.07",$0.00
7850-5-001,SUP,HCPCS C1776,,7850-5-001  -  STEM FEM HIPSTAR 127D 1 HIP,"$6,665.00",$0.00,"$6,665.00","$2,999.25","$4,756.81",$0.00,"$1,148.35",$0.00,$0.00,"$1,166.99","$6,665.00",$0.00,"$3,332.50","$5,278.68","$5,332.00",$0.00,"$1,043.07",$0.00,"$1,061.07",$0.00
7850-5-002,SUP,HCPCS C1776,,7850-5-002  -  STEM FEM HIPSTAR 127D 2 HIP,"$6,328.00",$0.00,"$6,328.00","$2,847.60","$4,516.29",$0.00,"$1,090.28",$0.00,$0.00,"$1,107.98","$6,328.00",$0.00,"$3,164.00","$5,011.78","$5,062.40",$0.00,$990.33,$0.00,"$1,007.42",$0.00
7850-5-003,SUP,HCPCS C1776,,7850-5-003  -  STEM FEM HIPSTAR 127D 3 HIP,"$6,328.00",$0.00,"$6,328.00","$2,847.60","$4,516.29",$0.00,"$1,090.28",$0.00,$0.00,"$1,107.98","$6,328.00",$0.00,"$3,164.00","$5,011.78","$5,062.40",$0.00,$990.33,$0.00,"$1,007.42",$0.00
7850-5-004,SUP,HCPCS C1776,,7850-5-004  -  STEM FEM HIPSTAR 127D 4 HIP,"$6,328.00",$0.00,"$6,328.00","$2,847.60","$4,516.29",$0.00,"$1,090.28",$0.00,$0.00,"$1,107.98","$6,328.00",$0.00,"$3,164.00","$5,011.78","$5,062.40",$0.00,$990.33,$0.00,"$1,007.42",$0.00
7850-5-005,SUP,HCPCS C1776,,7850-5-005  -  STEM FEM HIPSTAR 127D 5 HIP,"$6,328.00",$0.00,"$6,328.00","$2,847.60","$4,516.29",$0.00,"$1,090.28",$0.00,$0.00,"$1,107.98","$6,328.00",$0.00,"$3,164.00","$5,011.78","$5,062.40",$0.00,$990.33,$0.00,"$1,007.42",$0.00
7850-5-006,SUP,HCPCS C1776,,7850-5-006  -  STEM FEM HIPSTAR 127D 6 HIP,"$6,328.00",$0.00,"$6,328.00","$2,847.60","$4,516.29",$0.00,"$1,090.28",$0.00,$0.00,"$1,107.98","$6,328.00",$0.00,"$3,164.00","$5,011.78","$5,062.40",$0.00,$990.33,$0.00,"$1,007.42",$0.00
7850-5-007,SUP,HCPCS C1776,,7850-5-007  -  STEM FEM HIPSTAR 127D 7 HIP,"$6,328.00",$0.00,"$6,328.00","$2,847.60","$4,516.29",$0.00,"$1,090.28",$0.00,$0.00,"$1,107.98","$6,328.00",$0.00,"$3,164.00","$5,011.78","$5,062.40",$0.00,$990.33,$0.00,"$1,007.42",$0.00
7850-5-008,SUP,HCPCS C1776,,7850-5-008  -  STEM FEM HIPSTAR 127D 8 HIP,"$6,328.00",$0.00,"$6,328.00","$2,847.60","$4,516.29",$0.00,"$1,090.28",$0.00,$0.00,"$1,107.98","$6,328.00",$0.00,"$3,164.00","$5,011.78","$5,062.40",$0.00,$990.33,$0.00,"$1,007.42",$0.00
7850-5-009,SUP,HCPCS C1776,,7850-5-009  -  STEM FEM HIPSTAR 127D 9 HIP,"$6,328.00",$0.00,"$6,328.00","$2,847.60","$4,516.29",$0.00,"$1,090.28",$0.00,$0.00,"$1,107.98","$6,328.00",$0.00,"$3,164.00","$5,011.78","$5,062.40",$0.00,$990.33,$0.00,"$1,007.42",$0.00
7850-5-010,SUP,HCPCS C1776,,7850-5-010  -  STEM FEM HIPSTAR 127D 10 HIP,"$6,328.00",$0.00,"$6,328.00","$2,847.60","$4,516.29",$0.00,"$1,090.28",$0.00,$0.00,"$1,107.98","$6,328.00",$0.00,"$3,164.00","$5,011.78","$5,062.40",$0.00,$990.33,$0.00,"$1,007.42",$0.00
7850-5-011,SUP,HCPCS C1776,,7850-5-011  -  STEM FEM HIPSTAR 127D 11 HIP,"$6,665.00",$0.00,"$6,665.00","$2,999.25","$4,756.81",$0.00,"$1,148.35",$0.00,$0.00,"$1,166.99","$6,665.00",$0.00,"$3,332.50","$5,278.68","$5,332.00",$0.00,"$1,043.07",$0.00,"$1,061.07",$0.00
7850-5-012,SUP,HCPCS C1776,,7850-5-012  -  STEM FEM HIPSTAR 127D 12 HIP,"$6,665.00",$0.00,"$6,665.00","$2,999.25","$4,756.81",$0.00,"$1,148.35",$0.00,$0.00,"$1,166.99","$6,665.00",$0.00,"$3,332.50","$5,278.68","$5,332.00",$0.00,"$1,043.07",$0.00,"$1,061.07",$0.00
7925011S,SUP,HCPCS C1713,,7925011S  -  CABLE SPINAL 2 LOOP 2 CRIMP TITANIUM STERILE,"$2,325.00",$0.00,"$2,325.00","$1,046.25","$1,659.35",$0.00,$400.59,$0.00,$0.00,$407.09,"$2,325.00",$0.00,"$1,162.50","$1,841.40","$1,860.00",$0.00,$363.86,$0.00,$370.14,$0.00
79-43903,SUP,HCPCS C1713,,79-43903  -  CEMENT BONE INJECTABLE BIOCOMPATIBLE OSTEOCONDUCTIVE,"$3,357.50",$0.00,"$3,357.50","$1,510.88","$2,396.25",$0.00,$578.48,$0.00,$0.00,$587.87,"$3,357.50",$0.00,"$1,678.75","$2,659.14","$2,686.00",$0.00,$525.45,$0.00,$534.51,$0.00
79-43905,SUP,HCPCS C1713,,79-43905  -  CEMENT BONE INJECTABLE BIOCOMPATIBLE OSTEOCONDUCTIVE,"$3,817.23",$0.00,"$3,817.23","$1,717.75","$2,724.36",$0.00,$657.69,$0.00,$0.00,$668.37,"$3,817.23",$0.00,"$1,908.62","$3,023.25","$3,053.79",$0.00,$597.40,$0.00,$607.70,$0.00
79-43910,SUP,HCPCS C1713,,79-43910  -  CEMENT BN 10CC STRL LF HYDROSET INJ OSTCNDC CA PHOS VOID FIL,"$7,335.12",$0.00,"$7,335.12","$3,300.80","$5,158.80",$0.00,"$1,263.80",$0.00,$0.00,"$1,284.32","$7,335.12",$0.00,"$3,667.56","$5,809.42","$5,868.10",$0.00,"$1,147.95",$0.00,"$1,167.75",$0.00
79-43915,SUP,HCPCS C1713,,79-43915  -  CEMENT BONE INJECTABLE OSTEOCONDUCTIVE HYDROSET CALCIUM,"$10,553.66",$0.00,"$10,553.66","$4,749.15","$5,158.80",$0.00,"$1,818.34",$0.00,$0.00,"$1,847.86","$10,553.66",$0.00,"$5,276.83","$8,358.50","$8,442.93",$0.00,"$1,651.65",$0.00,"$1,680.14",$0.00
79-45903,SUP,HCPCS C1713,,79-45903  -  DIRECT INJECT 3CC,"$3,840.00",$0.00,"$3,840.00","$1,728.00","$2,740.61",$0.00,$661.61,$0.00,$0.00,$672.35,"$3,840.00",$0.00,"$1,920.00","$3,041.28","$3,072.00",$0.00,$600.96,$0.00,$611.33,$0.00
79-45905,SUP,HCPCS C1713,,79-45905  -  DIRECT INJECT 5CC,"$6,010.00",$0.00,"$6,010.00","$2,704.50","$4,289.34",$0.00,"$1,035.49",$0.00,$0.00,"$1,052.30","$6,010.00",$0.00,"$3,005.00","$4,759.92","$4,808.00",$0.00,$940.57,$0.00,$956.79,$0.00
79-45910,SUP,HCPCS C1713,,79-45910  -  DIRECT INJECT 10CC,"$11,437.50",$0.00,"$11,437.50","$5,146.88","$5,158.80",$0.00,"$1,970.62",$0.00,$0.00,"$2,002.61","$11,437.50",$0.00,"$5,718.75","$9,058.50","$9,150.00",$0.00,"$1,789.97",$0.00,"$1,820.85",$0.00
794G,SUP,Custom 27203010,,794G  -  SUTURE ABSORBABLE 6-0 G-6 18IN 2 ARM MONOFILAMENT CHROMIC,$44.15,$0.00,$44.15,$0.00,$31.51,$0.00,$0.00,$0.00,$0.00,$0.00,$44.15,$0.00,$22.08,$34.97,$35.32,$0.00,$0.00,$0.00,$0.00,$0.00
79-80017,SUP,Custom 27203010,,SPLINT ORTH LG 16IN KNEE SUP,$31.53,$0.00,$31.53,$0.00,$22.50,$0.00,$0.00,$0.00,$0.00,$0.00,$31.53,$0.00,$15.76,$24.97,$25.22,$0.00,$0.00,$0.00,$0.00,$0.00
79-83203,SUP,HCPCS L0172,,79-83203  -  COLLAR CERV SMALL 10-20IN 2IN CHIN REST COMFORT PAD,$101.88,$0.00,$112.86,$45.85,$72.71,$18.13,$112.86,$0.00,$0.00,$17.84,$101.88,$0.00,$50.94,$80.69,$81.50,$61.13,$107.46,$0.00,$109.67,$0.00
79-83205,SUP,HCPCS L0172,,79-83205  -  COLLAR CERV MEDIUM 10-20IN 2.5IN CHIN REST PAD TRACHEAL OPEN,$101.88,$0.00,$112.86,$45.85,$72.71,$18.13,$112.86,$0.00,$0.00,$17.84,$101.88,$0.00,$50.94,$80.69,$81.50,$61.13,$107.46,$0.00,$109.67,$0.00
79-83207,SUP,HCPCS L0172,,79-83207  -  COLLAR CERV LARGE 10-20IN 3IN CHIN REST PAD TRACHEAL OPEN,$101.88,$0.00,$112.86,$45.85,$72.71,$18.13,$112.86,$0.00,$0.00,$17.84,$101.88,$0.00,$50.94,$80.69,$81.50,$61.13,$107.46,$0.00,$109.67,$0.00
79-83208,SUP,Custom 27203010,,COLLAR CERV ADLT STOUT 14-24INX1.75IN MI J CHIN REST TRCH,$108.68,$0.00,$108.68,$0.00,$77.56,$0.00,$0.00,$0.00,$0.00,$0.00,$108.68,$0.00,$54.34,$86.07,$86.94,$0.00,$0.00,$0.00,$0.00,$0.00
79-94000,SUP,Custom 27203010,,BRACE ORTH SM UNV PS FOAM KNEERANGER,$139.65,$0.00,$139.65,$0.00,$99.67,$0.00,$0.00,$0.00,$0.00,$0.00,$139.65,$0.00,$69.83,$110.60,$111.72,$0.00,$0.00,$0.00,$0.00,$0.00
79-94001,SUP,Custom 27203010,,BRACE ORTH LG UNV PS FOAM KNEERANGER,$139.65,$0.00,$139.65,$0.00,$99.67,$0.00,$0.00,$0.00,$0.00,$0.00,$139.65,$0.00,$69.83,$110.60,$111.72,$0.00,$0.00,$0.00,$0.00,$0.00
79-95413,SUP,Custom 27203010,,BRACE WLK SM AIR RCKR SOLE MAXTRAX BLK STD HT,$93.15,$0.00,$93.15,$0.00,$66.48,$0.00,$0.00,$0.00,$0.00,$0.00,$93.15,$0.00,$46.58,$73.77,$74.52,$0.00,$0.00,$0.00,$0.00,$0.00
79-96018,SUP,Custom 27203010,,IMMOBILIZER ORTH UNV 18IN 36IN KNEE BSC ELAST ML STAY CNTCT,$35.00,$0.00,$35.00,$0.00,$24.98,$0.00,$0.00,$0.00,$0.00,$0.00,$35.00,$0.00,$17.50,$27.72,$28.00,$0.00,$0.00,$0.00,$0.00,$0.00
79-97957,SUP,Custom 27203010,,BRACE HUMERAL FX LARGE,$137.50,$0.00,$137.50,$0.00,$98.13,$0.00,$0.00,$0.00,$0.00,$0.00,$137.50,$0.00,$68.75,$108.90,$110.00,$0.00,$0.00,$0.00,$0.00,$0.00
79-98600,SUP,Custom 27203010,,CORD TRC 100YD SPL NYL,$53.43,$0.00,$53.43,$0.00,$38.13,$0.00,$0.00,$0.00,$0.00,$0.00,$53.43,$0.00,$26.71,$42.32,$42.74,$0.00,$0.00,$0.00,$0.00,$0.00
7AC60-MN,SUP,Custom 27203010,,7AC60-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$312.38,$0.00,$312.38,$0.00,$222.94,$0.00,$0.00,$0.00,$0.00,$0.00,$312.38,$0.00,$156.19,$247.40,$249.90,$0.00,$0.00,$0.00,$0.00,$0.00
7BA05,SUP,Custom 27203010,,7BA05  -  PLATE 18MM TI BONE SPNL,$297.50,$0.00,$297.50,$0.00,$212.33,$0.00,$0.00,$0.00,$0.00,$0.00,$297.50,$0.00,$148.75,$235.62,$238.00,$0.00,$0.00,$0.00,$0.00,$0.00
7BA05L-MN,SUP,Custom 27203010,,7BA05L-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$297.50,$0.00,$297.50,$0.00,$212.33,$0.00,$0.00,$0.00,$0.00,$0.00,$297.50,$0.00,$148.75,$235.62,$238.00,$0.00,$0.00,$0.00,$0.00,$0.00
7BA05-MN,SUP,Custom 27203010,,7BA05-MN  -  PLATE 18MM TI BONE SPNL,$297.50,$0.00,$297.50,$0.00,$212.33,$0.00,$0.00,$0.00,$0.00,$0.00,$297.50,$0.00,$148.75,$235.62,$238.00,$0.00,$0.00,$0.00,$0.00,$0.00
7BA06DL-MN,SUP,Custom 27203010,,7BA06DL-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$323.00,$0.00,$323.00,$0.00,$230.53,$0.00,$0.00,$0.00,$0.00,$0.00,$323.00,$0.00,$161.50,$255.82,$258.40,$0.00,$0.00,$0.00,$0.00,$0.00
7BA06D-MN,SUP,Custom 27203010,,7BA06D-MN  -  PLATE 18MM TI BONE SPNL,$323.00,$0.00,$323.00,$0.00,$230.53,$0.00,$0.00,$0.00,$0.00,$0.00,$323.00,$0.00,$161.50,$255.82,$258.40,$0.00,$0.00,$0.00,$0.00,$0.00
7BA10,SUP,Custom 27203010,,7BA10  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$297.50,$0.00,$297.50,$0.00,$212.33,$0.00,$0.00,$0.00,$0.00,$0.00,$297.50,$0.00,$148.75,$235.62,$238.00,$0.00,$0.00,$0.00,$0.00,$0.00
7BA10C-MN,SUP,Custom 27203010,,7BA10C-MN  -  PLATE 18MM TI BONE SPNL,$306.00,$0.00,$306.00,$0.00,$218.39,$0.00,$0.00,$0.00,$0.00,$0.00,$306.00,$0.00,$153.00,$242.35,$244.80,$0.00,$0.00,$0.00,$0.00,$0.00
7BA10D,SUP,Custom 27203010,,7BA10D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$323.00,$0.00,$323.00,$0.00,$230.53,$0.00,$0.00,$0.00,$0.00,$0.00,$323.00,$0.00,$161.50,$255.82,$258.40,$0.00,$0.00,$0.00,$0.00,$0.00
7BA10-MN,SUP,Custom 27203010,,7BA10-MN  -  PLATE 18MM TI BONE SPNL,$297.50,$0.00,$297.50,$0.00,$212.33,$0.00,$0.00,$0.00,$0.00,$0.00,$297.50,$0.00,$148.75,$235.62,$238.00,$0.00,$0.00,$0.00,$0.00,$0.00
7BA15,SUP,Custom 27203010,,7BA15  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$297.50,$0.00,$297.50,$0.00,$212.33,$0.00,$0.00,$0.00,$0.00,$0.00,$297.50,$0.00,$148.75,$235.62,$238.00,$0.00,$0.00,$0.00,$0.00,$0.00
7BA15D,SUP,Custom 27203010,,7BA15D  -  PLATE 18MM TI BONE SPNL,$323.00,$0.00,$323.00,$0.00,$230.53,$0.00,$0.00,$0.00,$0.00,$0.00,$323.00,$0.00,$161.50,$255.82,$258.40,$0.00,$0.00,$0.00,$0.00,$0.00
7BA15DL-MN,SUP,Custom 27203010,,7BA15DL-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$323.00,$0.00,$323.00,$0.00,$230.53,$0.00,$0.00,$0.00,$0.00,$0.00,$323.00,$0.00,$161.50,$255.82,$258.40,$0.00,$0.00,$0.00,$0.00,$0.00
7BA15D-MN,SUP,Custom 27203010,,7BA15D-MN  -  PLATE 18MM TI BONE SPNL,$323.00,$0.00,$323.00,$0.00,$230.53,$0.00,$0.00,$0.00,$0.00,$0.00,$323.00,$0.00,$161.50,$255.82,$258.40,$0.00,$0.00,$0.00,$0.00,$0.00
7BA15-MN,SUP,Custom 27203010,,7BA15-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$297.50,$0.00,$297.50,$0.00,$212.33,$0.00,$0.00,$0.00,$0.00,$0.00,$297.50,$0.00,$148.75,$235.62,$238.00,$0.00,$0.00,$0.00,$0.00,$0.00
7BA20,SUP,Custom 27203010,,7BA20  -  PLATE 18MM TI BONE SPNL,$297.50,$0.00,$297.50,$0.00,$212.33,$0.00,$0.00,$0.00,$0.00,$0.00,$297.50,$0.00,$148.75,$235.62,$238.00,$0.00,$0.00,$0.00,$0.00,$0.00
7BA20C-MN,SUP,Custom 27203010,,7BA20C-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$306.00,$0.00,$306.00,$0.00,$218.39,$0.00,$0.00,$0.00,$0.00,$0.00,$306.00,$0.00,$153.00,$242.35,$244.80,$0.00,$0.00,$0.00,$0.00,$0.00
7BA20D,SUP,Custom 27203010,,7BA20D  -  PLATE 18MM TI BONE SPNL,$323.00,$0.00,$323.00,$0.00,$230.53,$0.00,$0.00,$0.00,$0.00,$0.00,$323.00,$0.00,$161.50,$255.82,$258.40,$0.00,$0.00,$0.00,$0.00,$0.00
7BA20DC-MN,SUP,Custom 27203010,,7BA20DC-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$325.13,$0.00,$325.13,$0.00,$232.04,$0.00,$0.00,$0.00,$0.00,$0.00,$325.13,$0.00,$162.56,$257.50,$260.10,$0.00,$0.00,$0.00,$0.00,$0.00
7BA20DL-MN,SUP,Custom 27203010,,7BA20DL-MN  -  PLATE 18MM TI BONE SPNL,$323.00,$0.00,$323.00,$0.00,$230.53,$0.00,$0.00,$0.00,$0.00,$0.00,$323.00,$0.00,$161.50,$255.82,$258.40,$0.00,$0.00,$0.00,$0.00,$0.00
7BA20-MN,SUP,Custom 27203010,,7BA20-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$297.50,$0.00,$297.50,$0.00,$212.33,$0.00,$0.00,$0.00,$0.00,$0.00,$297.50,$0.00,$148.75,$235.62,$238.00,$0.00,$0.00,$0.00,$0.00,$0.00
7BA25,SUP,Custom 27203010,,7BA25  -  PLATE 18MM TI BONE SPNL,$297.50,$0.00,$297.50,$0.00,$212.33,$0.00,$0.00,$0.00,$0.00,$0.00,$297.50,$0.00,$148.75,$235.62,$238.00,$0.00,$0.00,$0.00,$0.00,$0.00
7BA25D,SUP,Custom 27203010,,7BA25D  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$323.00,$0.00,$323.00,$0.00,$230.53,$0.00,$0.00,$0.00,$0.00,$0.00,$323.00,$0.00,$161.50,$255.82,$258.40,$0.00,$0.00,$0.00,$0.00,$0.00
7BA25D-MN,SUP,Custom 27203010,,7BA25D-MN  -  PLATE 18MM TI BONE SPNL,$323.00,$0.00,$323.00,$0.00,$230.53,$0.00,$0.00,$0.00,$0.00,$0.00,$323.00,$0.00,$161.50,$255.82,$258.40,$0.00,$0.00,$0.00,$0.00,$0.00
7BA25-MN,SUP,Custom 27203010,,7BA25-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$297.50,$0.00,$297.50,$0.00,$212.33,$0.00,$0.00,$0.00,$0.00,$0.00,$297.50,$0.00,$148.75,$235.62,$238.00,$0.00,$0.00,$0.00,$0.00,$0.00
7BA30,SUP,Custom 27203010,,7BA30  -  PLATE 18MM TI BONE SPNL,$299.63,$0.00,$299.63,$0.00,$213.84,$0.00,$0.00,$0.00,$0.00,$0.00,$299.63,$0.00,$149.81,$237.31,$239.70,$0.00,$0.00,$0.00,$0.00,$0.00
7BA30C-MN,SUP,Custom 27203010,,7BA30C-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$306.00,$0.00,$306.00,$0.00,$218.39,$0.00,$0.00,$0.00,$0.00,$0.00,$306.00,$0.00,$153.00,$242.35,$244.80,$0.00,$0.00,$0.00,$0.00,$0.00
7BA30D,SUP,Custom 27203010,,7BA30D  -  PLATE 18MM TI BONE SPNL,$323.00,$0.00,$323.00,$0.00,$230.53,$0.00,$0.00,$0.00,$0.00,$0.00,$323.00,$0.00,$161.50,$255.82,$258.40,$0.00,$0.00,$0.00,$0.00,$0.00
7BA30DC-MN,SUP,Custom 27203010,,7BA30DC-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$325.13,$0.00,$325.13,$0.00,$232.04,$0.00,$0.00,$0.00,$0.00,$0.00,$325.13,$0.00,$162.56,$257.50,$260.10,$0.00,$0.00,$0.00,$0.00,$0.00
7BA30DL-MN,SUP,Custom 27203010,,7BA30DL-MN  -  PLATE 18MM TI BONE SPNL,$323.00,$0.00,$323.00,$0.00,$230.53,$0.00,$0.00,$0.00,$0.00,$0.00,$323.00,$0.00,$161.50,$255.82,$258.40,$0.00,$0.00,$0.00,$0.00,$0.00
7BA30L-MN,SUP,Custom 27203010,,7BA30L-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$297.50,$0.00,$297.50,$0.00,$212.33,$0.00,$0.00,$0.00,$0.00,$0.00,$297.50,$0.00,$148.75,$235.62,$238.00,$0.00,$0.00,$0.00,$0.00,$0.00
7BA30-MN,SUP,Custom 27203010,,7BA30-MN  -  PLATE 18MM TI BONE SPNL,$297.50,$0.00,$297.50,$0.00,$212.33,$0.00,$0.00,$0.00,$0.00,$0.00,$297.50,$0.00,$148.75,$235.62,$238.00,$0.00,$0.00,$0.00,$0.00,$0.00
7BA40C-MN,SUP,Custom 27203010,,7BA40C-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$306.00,$0.00,$306.00,$0.00,$218.39,$0.00,$0.00,$0.00,$0.00,$0.00,$306.00,$0.00,$153.00,$242.35,$244.80,$0.00,$0.00,$0.00,$0.00,$0.00
7BA40D,SUP,Custom 27203010,,7BA40D  -  TOOL DISSECTING BALL 4MM 7CM DIAMOND MIDAS REX LEGEND,$325.13,$0.00,$325.13,$0.00,$232.04,$0.00,$0.00,$0.00,$0.00,$0.00,$325.13,$0.00,$162.56,$257.50,$260.10,$0.00,$0.00,$0.00,$0.00,$0.00
7BA40DC-MN,SUP,Custom 27203010,,7BA40DC-MN  -  PLATE 18MM TI BONE SPNL,$325.13,$0.00,$325.13,$0.00,$232.04,$0.00,$0.00,$0.00,$0.00,$0.00,$325.13,$0.00,$162.56,$257.50,$260.10,$0.00,$0.00,$0.00,$0.00,$0.00
7BA40F-MN,SUP,Custom 27203010,,7BA40F-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$297.50,$0.00,$297.50,$0.00,$212.33,$0.00,$0.00,$0.00,$0.00,$0.00,$297.50,$0.00,$148.75,$235.62,$238.00,$0.00,$0.00,$0.00,$0.00,$0.00
7BA40-MN,SUP,Custom 27203010,,7BA40-MN  -  PLATE 18MM TI BONE SPNL,$297.50,$0.00,$297.50,$0.00,$212.33,$0.00,$0.00,$0.00,$0.00,$0.00,$297.50,$0.00,$148.75,$235.62,$238.00,$0.00,$0.00,$0.00,$0.00,$0.00
7BA50C-MN,SUP,Custom 27203010,,7BA50C-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$306.00,$0.00,$306.00,$0.00,$218.39,$0.00,$0.00,$0.00,$0.00,$0.00,$306.00,$0.00,$153.00,$242.35,$244.80,$0.00,$0.00,$0.00,$0.00,$0.00
7BA50DC-MN,SUP,Custom 27203010,,7BA50DC-MN  -  PLATE 18MM TI BONE SPNL,$325.13,$0.00,$325.13,$0.00,$232.04,$0.00,$0.00,$0.00,$0.00,$0.00,$325.13,$0.00,$162.56,$257.50,$260.10,$0.00,$0.00,$0.00,$0.00,$0.00
7BA50F-MN,SUP,Custom 27203010,,7BA50F-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$297.50,$0.00,$297.50,$0.00,$212.33,$0.00,$0.00,$0.00,$0.00,$0.00,$297.50,$0.00,$148.75,$235.62,$238.00,$0.00,$0.00,$0.00,$0.00,$0.00
7BA50-MN,SUP,Custom 27203010,,7BA50-MN  -  PLATE 18MM TI BONE SPNL,$297.50,$0.00,$297.50,$0.00,$212.33,$0.00,$0.00,$0.00,$0.00,$0.00,$297.50,$0.00,$148.75,$235.62,$238.00,$0.00,$0.00,$0.00,$0.00,$0.00
7BA60C-MN,SUP,Custom 27203010,,7BA60C-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$306.00,$0.00,$306.00,$0.00,$218.39,$0.00,$0.00,$0.00,$0.00,$0.00,$306.00,$0.00,$153.00,$242.35,$244.80,$0.00,$0.00,$0.00,$0.00,$0.00
7BA60D,SUP,Custom 27203010,,7BA60D  -  PLATE 18MM TI BONE SPNL,$325.13,$0.00,$325.13,$0.00,$232.04,$0.00,$0.00,$0.00,$0.00,$0.00,$325.13,$0.00,$162.56,$257.50,$260.10,$0.00,$0.00,$0.00,$0.00,$0.00
7BA60DC-MN,SUP,Custom 27203010,,7BA60DC-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$325.13,$0.00,$325.13,$0.00,$232.04,$0.00,$0.00,$0.00,$0.00,$0.00,$325.13,$0.00,$162.56,$257.50,$260.10,$0.00,$0.00,$0.00,$0.00,$0.00
7BA60D-MN,SUP,Custom 27203010,,7BA60D-MN  -  PLATE 18MM TI BONE SPNL,$323.00,$0.00,$323.00,$0.00,$230.53,$0.00,$0.00,$0.00,$0.00,$0.00,$323.00,$0.00,$161.50,$255.82,$258.40,$0.00,$0.00,$0.00,$0.00,$0.00
7BA60F-MN,SUP,Custom 27203010,,7BA60F-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$297.50,$0.00,$297.50,$0.00,$212.33,$0.00,$0.00,$0.00,$0.00,$0.00,$297.50,$0.00,$148.75,$235.62,$238.00,$0.00,$0.00,$0.00,$0.00,$0.00
7BA60-MN,SUP,Custom 27203010,,7BA60-MN  -  PLATE 18MM TI BONE SPNL,$297.50,$0.00,$297.50,$0.00,$212.33,$0.00,$0.00,$0.00,$0.00,$0.00,$297.50,$0.00,$148.75,$235.62,$238.00,$0.00,$0.00,$0.00,$0.00,$0.00
7BA70C-MN,SUP,Custom 27203010,,7BA70C-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$306.00,$0.00,$306.00,$0.00,$218.39,$0.00,$0.00,$0.00,$0.00,$0.00,$306.00,$0.00,$153.00,$242.35,$244.80,$0.00,$0.00,$0.00,$0.00,$0.00
7BA70D-MN,SUP,Custom 27203010,,7BA70D-MN  -  TOOL DISS MIDAS REX LEGEND MEDNEXT BALL L7 CM OD7 MM STERILE,$323.00,$0.00,$323.00,$0.00,$230.53,$0.00,$0.00,$0.00,$0.00,$0.00,$323.00,$0.00,$161.50,$255.82,$258.40,$0.00,$0.00,$0.00,$0.00,$0.00
7BA70-MN,SUP,Custom 27203010,,7BA70-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$299.63,$0.00,$299.63,$0.00,$213.84,$0.00,$0.00,$0.00,$0.00,$0.00,$299.63,$0.00,$149.81,$237.31,$239.70,$0.00,$0.00,$0.00,$0.00,$0.00
7BA80C-MN,SUP,Custom 27203010,,7BA80C-MN  -  PLATE 18MM TI BONE SPNL,$306.00,$0.00,$306.00,$0.00,$218.39,$0.00,$0.00,$0.00,$0.00,$0.00,$306.00,$0.00,$153.00,$242.35,$244.80,$0.00,$0.00,$0.00,$0.00,$0.00
7BA80D-MN,SUP,Custom 27203010,,7BA80D-MN  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$323.00,$0.00,$323.00,$0.00,$230.53,$0.00,$0.00,$0.00,$0.00,$0.00,$323.00,$0.00,$161.50,$255.82,$258.40,$0.00,$0.00,$0.00,$0.00,$0.00
7BA80-MN,SUP,Custom 27203010,,7BA80-MN  -  PLATE 18MM TI BONE SPNL,$297.50,$0.00,$297.50,$0.00,$212.33,$0.00,$0.00,$0.00,$0.00,$0.00,$297.50,$0.00,$148.75,$235.62,$238.00,$0.00,$0.00,$0.00,$0.00,$0.00
7SCT,SUP,Custom 27203010,,7SCT  -  TUBE TRACHEOSTOMY 9.6MM 7MM 80MM 1 CANNU CUFF LOW PRESSURE,$72.45,$0.00,$72.45,$0.00,$51.70,$0.00,$0.00,$0.00,$0.00,$0.00,$72.45,$0.00,$36.22,$57.38,$57.96,$0.00,$0.00,$0.00,$0.00,$0.00
800.604.02S,SUP,HCPCS C1713,,800.604.02S  -  SCREW BONE 4MM 1.5MM CORT CRNMXF RESORB STRL,$373.50,$0.00,$373.50,$168.08,$266.57,$0.00,$64.35,$0.00,$0.00,$65.40,$373.50,$0.00,$186.75,$295.81,$298.80,$0.00,$58.45,$0.00,$59.46,$0.00
80-0055,SUP,Custom 27203010,,80-0055  -  DRILL SURG CANN,$730.00,$0.00,$730.00,$0.00,$521.00,$0.00,$0.00,$0.00,$0.00,$0.00,$730.00,$0.00,$365.00,$578.16,$584.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0056,SUP,Custom 27203010,,80-0056  -  BIT DRL 5.5MM ACTRK2,$730.00,$0.00,$730.00,$0.00,$521.00,$0.00,$0.00,$0.00,$0.00,$0.00,$730.00,$0.00,$365.00,$578.16,$584.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0100,SUP,Custom 27203010,,80-0100  -  DRILL SRG MIC LNG ACTRK2,$730.00,$0.00,$730.00,$0.00,$521.00,$0.00,$0.00,$0.00,$0.00,$0.00,$730.00,$0.00,$365.00,$578.16,$584.00,$0.00,$0.00,$0.00,$0.00,$0.00
800-1003A,SUP,Custom 27203010,,800-1003A  -  KIT CNTRF 30ML GPS III 1 PLTL CONC DISP,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
8001021-3,SUP,HCPCS C1781,,8001021-3  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,962.25",$0.00,"$2,962.25","$1,333.01","$2,114.16",$0.00,$510.38,$0.00,$0.00,$518.67,"$2,962.25",$0.00,"$1,481.13","$2,346.10","$2,369.80",$0.00,$463.59,$0.00,$471.59,$0.00
8001021-6,SUP,HCPCS C1781,,8001021-6  -  PLATE 18MM TI BONE SPNL,"$2,962.25",$0.00,"$2,962.25","$1,333.01","$2,114.16",$0.00,$510.38,$0.00,$0.00,$518.67,"$2,962.25",$0.00,"$1,481.13","$2,346.10","$2,369.80",$0.00,$463.59,$0.00,$471.59,$0.00
80-0148,SUP,HCPCS C1713,,80-0148  -  SCREW BN 3MM 2 TRK TAP DRL CLVCL,$427.50,$0.00,$427.50,$192.38,$305.11,$0.00,$73.66,$0.00,$0.00,$74.85,$427.50,$0.00,$213.75,$338.58,$342.00,$0.00,$66.90,$0.00,$68.06,$0.00
80-0149,SUP,Custom 27203010,,80-0149  -  SCREW BN 3.8MM 2 TRK TAP DRL CLVCL,$427.50,$0.00,$427.50,$0.00,$305.11,$0.00,$0.00,$0.00,$0.00,$0.00,$427.50,$0.00,$213.75,$338.58,$342.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0150,SUP,HCPCS C1769,,80-0150  -  GUIDE STD T ACLC SURG LEFT DORSAL,"$2,960.00",$0.00,"$2,960.00","$1,607.28","$2,112.55",$0.00,$509.99,$0.00,$0.00,$518.27,"$2,960.00",$0.00,"$1,480.00","$2,344.32","$2,368.00",$0.00,$463.24,$0.00,$471.23,$0.00
8001511-3,SUP,HCPCS C1781,,8001511-3  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,188.75",$0.00,"$2,188.75",$984.94,"$1,562.11",$0.00,$377.11,$0.00,$0.00,$383.23,"$2,188.75",$0.00,"$1,094.38","$1,733.49","$1,751.00",$0.00,$342.54,$0.00,$348.45,$0.00
8001511-6,SUP,HCPCS C1781,,8001511-6  -  PLATE 18MM TI BONE SPNL,"$2,188.75",$0.00,"$2,188.75",$984.94,"$1,562.11",$0.00,$377.11,$0.00,$0.00,$383.23,"$2,188.75",$0.00,"$1,094.38","$1,733.49","$1,751.00",$0.00,$342.54,$0.00,$348.45,$0.00
8001521-3,SUP,HCPCS C1781,,8001521-3  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,768.88",$0.00,"$2,768.88","$1,245.99","$1,976.15",$0.00,$477.06,$0.00,$0.00,$484.81,"$2,768.88",$0.00,"$1,384.44","$2,192.95","$2,215.10",$0.00,$433.33,$0.00,$440.80,$0.00
8001521-6,SUP,HCPCS C1781,,8001521-6  -  PLATE 18MM TI BONE SPNL,"$2,881.50",$0.00,"$2,881.50","$1,296.68","$2,056.53",$0.00,$496.47,$0.00,$0.00,$504.53,"$2,881.50",$0.00,"$1,440.75","$2,282.15","$2,305.20",$0.00,$450.95,$0.00,$458.73,$0.00
8001523-6,SUP,HCPCS C1781,,8001523-6  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,881.50",$0.00,"$2,881.50","$1,296.68","$2,056.53",$0.00,$496.47,$0.00,$0.00,$504.53,"$2,881.50",$0.00,"$1,440.75","$2,282.15","$2,305.20",$0.00,$450.95,$0.00,$458.73,$0.00
8001531-6,SUP,HCPCS C1781,,8001531-6  -  PLATE 18MM TI BONE SPNL,"$4,740.88",$0.00,"$4,740.88","$2,133.39","$3,383.56",$0.00,$816.83,$0.00,$0.00,$830.09,"$4,740.88",$0.00,"$2,370.44","$3,754.78","$3,792.70",$0.00,$741.95,$0.00,$754.75,$0.00
8001533-6,SUP,HCPCS C1781,,8001533-6  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$4,836.50",$0.00,"$4,836.50","$2,176.43","$3,451.81",$0.00,$833.30,$0.00,$0.00,$846.83,"$4,836.50",$0.00,"$2,418.25","$3,830.51","$3,869.20",$0.00,$756.91,$0.00,$769.97,$0.00
80-018,SUP,Custom 27203010,,80-018  -  BIT DRILL 2MM HEAD,$125.00,$0.00,$125.00,$0.00,$89.21,$0.00,$0.00,$0.00,$0.00,$0.00,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0180,SUP,Custom 27203010,,80-0180  -  TIP SCRDRVR 1.5MM SLD HEX AO CONNECT DRVR NONSTRL,$470.00,$0.00,$470.00,$0.00,$335.44,$0.00,$0.00,$0.00,$0.00,$0.00,$470.00,$0.00,$235.00,$372.24,$376.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0205,SUP,Custom 27203010,,80-0205  -  TRPHN ACTRK6/7 SURG,$842.50,$0.00,$842.50,$0.00,$601.29,$0.00,$0.00,$0.00,$0.00,$0.00,$842.50,$0.00,$421.25,$667.26,$674.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0206,SUP,Custom 27203010,,80-0206  -  TRPHN ACTRK+ SURG,$842.50,$0.00,$842.50,$0.00,$601.29,$0.00,$0.00,$0.00,$0.00,$0.00,$842.50,$0.00,$421.25,$667.26,$674.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0207,SUP,Custom 27203010,,80-0207  -  TRPHN ACTRK 4/5 SURG,$842.50,$0.00,$842.50,$0.00,$601.29,$0.00,$0.00,$0.00,$0.00,$0.00,$842.50,$0.00,$421.25,$667.26,$674.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0208,SUP,Custom 27203010,,80-0208  -  TRPHN 20+ MM STD ACTRK SURG,$842.50,$0.00,$842.50,$0.00,$601.29,$0.00,$0.00,$0.00,$0.00,$0.00,$842.50,$0.00,$421.25,$667.26,$674.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0209,SUP,Custom 27203010,,80-0209  -  TRPHN 0-20MM STD ACTRK SURG,$842.50,$0.00,$842.50,$0.00,$601.29,$0.00,$0.00,$0.00,$0.00,$0.00,$842.50,$0.00,$421.25,$667.26,$674.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0210,SUP,Custom 27203010,,80-0210  -  TRPHN MINI ACTRK SURG,$842.50,$0.00,$842.50,$0.00,$601.29,$0.00,$0.00,$0.00,$0.00,$0.00,$842.50,$0.00,$421.25,$667.26,$674.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0211,SUP,Custom 27203010,,80-0211  -  TRPHN STD ACTRK2 SURG,$842.50,$0.00,$842.50,$0.00,$601.29,$0.00,$0.00,$0.00,$0.00,$0.00,$842.50,$0.00,$421.25,$667.26,$674.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0212,SUP,Custom 27203010,,80-0212  -  TRPHN MINI ACTRK2 SURG,$842.50,$0.00,$842.50,$0.00,$601.29,$0.00,$0.00,$0.00,$0.00,$0.00,$842.50,$0.00,$421.25,$667.26,$674.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0213,SUP,Custom 27203010,,80-0213  -  TRPHN MIC ACTRK2 SURG,$842.50,$0.00,$842.50,$0.00,$601.29,$0.00,$0.00,$0.00,$0.00,$0.00,$842.50,$0.00,$421.25,$667.26,$674.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0214,SUP,Custom 27203010,,80-0214  -  TRPHN ACTRK2 SURG 5.5 MM SCR,$842.50,$0.00,$842.50,$0.00,$601.29,$0.00,$0.00,$0.00,$0.00,$0.00,$842.50,$0.00,$421.25,$667.26,$674.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0216,SUP,Custom 27203010,,80-0216  -  TRPHN ACTRK2 BRKN SURG 3.5 MM CMPR SCR,$842.50,$0.00,$842.50,$0.00,$601.29,$0.00,$0.00,$0.00,$0.00,$0.00,$842.50,$0.00,$421.25,$667.26,$674.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0217,SUP,Custom 27203010,,80-0217  -  TRPHN ACTRK2 BRKN SURG 2.7 MM CMPR SCR,$842.50,$0.00,$842.50,$0.00,$601.29,$0.00,$0.00,$0.00,$0.00,$0.00,$842.50,$0.00,$421.25,$667.26,$674.00,$0.00,$0.00,$0.00,$0.00,$0.00
8002221-6,SUP,HCPCS C1781,,8002221-6  -  PLATE 18MM TI BONE SPNL,"$2,828.38",$0.00,"$2,828.38","$1,272.77","$2,018.61",$0.00,$487.31,$0.00,$0.00,$495.23,"$2,828.38",$0.00,"$1,414.19","$2,240.08","$2,262.70",$0.00,$442.64,$0.00,$450.28,$0.00
8002231-6,SUP,HCPCS C1781,,8002231-6  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$4,798.25",$0.00,"$4,798.25","$2,159.21","$3,424.51",$0.00,$826.71,$0.00,$0.00,$840.14,"$4,798.25",$0.00,"$2,399.13","$3,800.21","$3,838.60",$0.00,$750.93,$0.00,$763.88,$0.00
8002233-6,SUP,HCPCS C1781,,8002233-6  -  PLATE 18MM TI BONE SPNL,"$4,798.25",$0.00,"$4,798.25","$2,159.21","$3,424.51",$0.00,$826.71,$0.00,$0.00,$840.14,"$4,798.25",$0.00,"$2,399.13","$3,800.21","$3,838.60",$0.00,$750.93,$0.00,$763.88,$0.00
80-0248,SUP,HCPCS C1713,,80-0248  -  PLATE SM TACK BONE,$137.50,$0.00,$137.50,$61.88,$98.13,$0.00,$23.69,$0.00,$0.00,$24.08,$137.50,$0.00,$68.75,$108.90,$110.00,$0.00,$21.52,$0.00,$21.89,$0.00
80-0297,SUP,Custom 27203010,,80-0297  -  BIT DRILL 4.6MM 3.1MM ACTRK DNS,$805.00,$0.00,$805.00,$0.00,$574.53,$0.00,$0.00,$0.00,$0.00,$0.00,$805.00,$0.00,$402.50,$637.56,$644.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0298,SUP,Custom 27203010,,80-0298  -  DRILL SURG ACTRK+ CANN DNS QRLSE,$805.00,$0.00,$805.00,$0.00,$574.53,$0.00,$0.00,$0.00,$0.00,$0.00,$805.00,$0.00,$402.50,$637.56,$644.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0302,SUP,Custom 27203010,,80-0302  -  BIT DRILL 2.5MM HEX TIP FLXB,"$1,152.50",$0.00,"$1,152.50",$0.00,$822.54,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,152.50",$0.00,$576.25,$912.78,$922.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0318,SUP,Custom 27203010,,80-0318  -  BIT DRL 2MM NS ACLC 2 SURGIBIT QRLSE 2.7MM SCR,$147.50,$0.00,$147.50,$0.00,$105.27,$0.00,$0.00,$0.00,$0.00,$0.00,$147.50,$0.00,$73.75,$116.82,$118.00,$0.00,$0.00,$0.00,$0.00,$0.00
800-3510,SUP,Custom 27203010,,STRIP UA ATNMX 9 PRMTR REAGENT,$86.13,$0.00,$86.13,$0.00,$61.47,$0.00,$0.00,$0.00,$0.00,$0.00,$86.13,$0.00,$43.06,$68.21,$68.90,$0.00,$0.00,$0.00,$0.00,$0.00
80-0362,SUP,Custom 27203010,,80-0362  -  TAP BN 2.3MM,$285.00,$0.00,$285.00,$0.00,$203.40,$0.00,$0.00,$0.00,$0.00,$0.00,$285.00,$0.00,$142.50,$225.72,$228.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0386,SUP,Custom 27203010,,80-0386  -  DRILL SURG QRLSE 2MM,$147.50,$0.00,$147.50,$0.00,$105.27,$0.00,$0.00,$0.00,$0.00,$0.00,$147.50,$0.00,$73.75,$116.82,$118.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0387,SUP,Custom 27203010,,80-0387  -  DRILL SRG 2.8MM QRLSE 3.5MM SCR,$147.50,$0.00,$147.50,$0.00,$105.27,$0.00,$0.00,$0.00,$0.00,$0.00,$147.50,$0.00,$73.75,$116.82,$118.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0399,SUP,Custom 27203010,,80-0399  -  DRILL SURG 1.5MM ACTRK LEFT HND,$460.00,$0.00,$460.00,$0.00,$328.30,$0.00,$0.00,$0.00,$0.00,$0.00,$460.00,$0.00,$230.00,$364.32,$368.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0400,SUP,Custom 27203010,,80-0400  -  DRILL SURG 2MM ACTRK LEFT HND SCR REM,$460.00,$0.00,$460.00,$0.00,$328.30,$0.00,$0.00,$0.00,$0.00,$0.00,$460.00,$0.00,$230.00,$364.32,$368.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0401,SUP,Custom 27203010,,80-0401  -  DRILL SURG 2.5MM ACTRK LEFT HND SCR REM,$460.00,$0.00,$460.00,$0.00,$328.30,$0.00,$0.00,$0.00,$0.00,$0.00,$460.00,$0.00,$230.00,$364.32,$368.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0402,SUP,Custom 27203010,,80-0402  -  DRILL SURG 3MM ACTRK LEFT HND SCR REM,$460.00,$0.00,$460.00,$0.00,$328.30,$0.00,$0.00,$0.00,$0.00,$0.00,$460.00,$0.00,$230.00,$364.32,$368.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0403,SUP,Custom 27203010,,80-0403  -  DRILL SURG 3.5MM ACTRK LEFT HND SCR REM,$460.00,$0.00,$460.00,$0.00,$328.30,$0.00,$0.00,$0.00,$0.00,$0.00,$460.00,$0.00,$230.00,$364.32,$368.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0404,SUP,Custom 27203010,,80-0404  -  DRILL SURG 4MM ACTRK LEFT HND SCR REM,$460.00,$0.00,$460.00,$0.00,$328.30,$0.00,$0.00,$0.00,$0.00,$0.00,$460.00,$0.00,$230.00,$364.32,$368.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0411,SUP,Custom 27803010,,80-0411  -  PIN TNSNBND SNAPPER,$212.50,$0.00,$212.50,$0.00,$151.66,$0.00,$0.00,$0.00,$0.00,$0.00,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0413,SUP,HCPCS C1769,,80-0413  -  WIRE FX .062IN KRSH,$37.50,$0.00,$37.50,$20.36,$26.76,$0.00,$6.46,$0.00,$0.00,$6.57,$37.50,$0.00,$18.75,$29.70,$30.00,$0.00,$5.87,$0.00,$5.97,$0.00
80-0465,SUP,Custom 27203010,,80-0465  -  DRILL SRG CNN OLCRN,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0477,SUP,Custom 27203010,,80-0477  -  DRILL SURG 40-65MM ACTRK6/7 CANN QRLSE DNS,$805.00,$0.00,$805.00,$0.00,$574.53,$0.00,$0.00,$0.00,$0.00,$0.00,$805.00,$0.00,$402.50,$637.56,$644.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0478,SUP,Custom 27203010,,80-0478  -  DRILL SURG 70-85MM ACTRK6/7 CANN QRLSE DNS,$902.50,$0.00,$902.50,$0.00,$644.11,$0.00,$0.00,$0.00,$0.00,$0.00,$902.50,$0.00,$451.25,$714.78,$722.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0479,SUP,Custom 27203010,,80-0479  -  DRILL SURG 90-120MM ACTRK6/7 CANN QRLSE DNS,"$1,127.50",$0.00,"$1,127.50",$0.00,$804.70,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,127.50",$0.00,$563.75,$892.98,$902.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0569,SUP,Custom 27203010,,80-0569  -  REAMER SURG 16MM CNCV MTP FRFT MIDFT PLT SYS NONSTRL,"$1,360.00",$0.00,"$1,360.00",$0.00,$970.63,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,360.00",$0.00,$680.00,"$1,077.12","$1,088.00",$0.00,$0.00,$0.00,$0.00,$0.00
80-0570,SUP,Custom 27203010,,80-0570  -  REAMER SURG 16MM CNVX MTP FRFT MIDFT PLT SYS NONSTRL,"$1,360.00",$0.00,"$1,360.00",$0.00,$970.63,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,360.00",$0.00,$680.00,"$1,077.12","$1,088.00",$0.00,$0.00,$0.00,$0.00,$0.00
80-0571,SUP,Custom 27203010,,80-0571  -  REAMER SURG 18MM MALE SET FT,"$1,360.00",$0.00,"$1,360.00",$0.00,$970.63,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,360.00",$0.00,$680.00,"$1,077.12","$1,088.00",$0.00,$0.00,$0.00,$0.00,$0.00
80-0572,SUP,Custom 27203010,,80-0572  -  REAMER SURG 18MM FMALE SET FT,"$1,360.00",$0.00,"$1,360.00",$0.00,$970.63,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,360.00",$0.00,$680.00,"$1,077.12","$1,088.00",$0.00,$0.00,$0.00,$0.00,$0.00
80-0573,SUP,Custom 27203010,,80-0573  -  REAMER SURG 20MM CNCV MTP FRFT MIDFT PLT SYS NONSTRL,"$1,360.00",$0.00,"$1,360.00",$0.00,$970.63,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,360.00",$0.00,$680.00,"$1,077.12","$1,088.00",$0.00,$0.00,$0.00,$0.00,$0.00
80-0574,SUP,Custom 27203010,,80-0574  -  REAMER SURG 74MM STNLS STELL CNCV SM BONE,"$1,360.00",$0.00,"$1,360.00",$0.00,$970.63,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,360.00",$0.00,$680.00,"$1,077.12","$1,088.00",$0.00,$0.00,$0.00,$0.00,$0.00
80-0575,SUP,Custom 27203010,,80-0575  -  REAMER SURG 76MM SS CNVX SM BONE,"$1,360.00",$0.00,"$1,360.00",$0.00,$970.63,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,360.00",$0.00,$680.00,"$1,077.12","$1,088.00",$0.00,$0.00,$0.00,$0.00,$0.00
80-0576,SUP,Custom 27203010,,80-0576  -  REAMER SURG 75MM SS CNCV SM BONE,"$1,360.00",$0.00,"$1,360.00",$0.00,$970.63,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,360.00",$0.00,$680.00,"$1,077.12","$1,088.00",$0.00,$0.00,$0.00,$0.00,$0.00
80-0583,SUP,Custom 27203010,,80-0583  -  DRIVER 1.5MM ACTRK QRLSE SLD HEX TIP SURG,$382.50,$0.00,$382.50,$0.00,$272.99,$0.00,$0.00,$0.00,$0.00,$0.00,$382.50,$0.00,$191.25,$302.94,$306.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0598,SUP,Custom 27203010,,80-0598  -  XTRT SURG EZOUT QRLSE 1.5MM,$307.50,$0.00,$307.50,$0.00,$219.46,$0.00,$0.00,$0.00,$0.00,$0.00,$307.50,$0.00,$153.75,$243.54,$246.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0599,SUP,Custom 27203010,,80-0599  -  XTRT SURG ACTRK QRLSE EZOUT 2MM,$307.50,$0.00,$307.50,$0.00,$219.46,$0.00,$0.00,$0.00,$0.00,$0.00,$307.50,$0.00,$153.75,$243.54,$246.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0600,SUP,Custom 27203010,,80-0600  -  XTRT SURG EZOUT QRLSE 2.5MM,$325.00,$0.00,$325.00,$0.00,$231.95,$0.00,$0.00,$0.00,$0.00,$0.00,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0601,SUP,Custom 27203010,,80-0601  -  TOOL REM 3MM ACTRK SCR EASYOUT,$400.00,$0.00,$400.00,$0.00,$285.48,$0.00,$0.00,$0.00,$0.00,$0.00,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0602,SUP,Custom 27203010,,80-0602  -  TOOL REM 3.5MM ACTRK SCR EASYOUT,$430.00,$0.00,$430.00,$0.00,$306.89,$0.00,$0.00,$0.00,$0.00,$0.00,$430.00,$0.00,$215.00,$340.56,$344.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0603,SUP,Custom 27203010,,80-0603  -  TOOL REM 4MM ACTRK SCR EASYOUT,$490.00,$0.00,$490.00,$0.00,$349.71,$0.00,$0.00,$0.00,$0.00,$0.00,$490.00,$0.00,$245.00,$388.08,$392.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0605,SUP,Custom 27203010,,80-0605  -  DRIVER ACTRK HEX TIP IMPCT XTRT 3MM SURG,$842.50,$0.00,$842.50,$0.00,$601.29,$0.00,$0.00,$0.00,$0.00,$0.00,$842.50,$0.00,$421.25,$667.26,$674.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0606,SUP,Custom 27203010,,80-0606  -  DRIVER ACTRK HEX TIP IMPCT SCR XTRT 4MM SURG,$842.50,$0.00,$842.50,$0.00,$601.29,$0.00,$0.00,$0.00,$0.00,$0.00,$842.50,$0.00,$421.25,$667.26,$674.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0610,SUP,Custom 27203010,,80-0610  -  TIP SCRDRVR ACTRK REM SHFT QRLSE,$612.50,$0.00,$612.50,$0.00,$437.14,$0.00,$0.00,$0.00,$0.00,$0.00,$612.50,$0.00,$306.25,$485.10,$490.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0611,SUP,Custom 27203010,,80-0611  -  WRENCH SURG SCR REM TIP ACTRK,"$1,837.50",$0.00,"$1,837.50",$0.00,"$1,311.42",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,837.50",$0.00,$918.75,"$1,455.30","$1,470.00",$0.00,$0.00,$0.00,$0.00,$0.00
80-0612,SUP,Custom 27203010,,80-0612  -  TIP SCRDRVR ACTRK MIC REM,"$1,225.00",$0.00,"$1,225.00",$0.00,$874.28,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,225.00",$0.00,$612.50,$970.20,$980.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0613,SUP,Custom 27203010,,80-0613  -  TOOL REM ACTRK MINI TIP,"$1,225.00",$0.00,"$1,225.00",$0.00,$874.28,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,225.00",$0.00,$612.50,$970.20,$980.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0614,SUP,Custom 27203010,,80-0614  -  TOOL REM ACTRK STD TIP,"$1,225.00",$0.00,"$1,225.00",$0.00,$874.28,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,225.00",$0.00,$612.50,$970.20,$980.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0615,SUP,Custom 27203010,,80-0615  -  TOOL REM ACTRK LG TIP,"$1,225.00",$0.00,"$1,225.00",$0.00,$874.28,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,225.00",$0.00,$612.50,$970.20,$980.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0616,SUP,Custom 27203010,,80-0616  -  TOOL REM ACTRK XL TIP,"$1,225.00",$0.00,"$1,225.00",$0.00,$874.28,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,225.00",$0.00,$612.50,$970.20,$980.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0625,SUP,Custom 27203010,,80-0625  -  TAP BONE 2.7MM HEXALOBE SCR,$307.50,$0.00,$307.50,$0.00,$219.46,$0.00,$0.00,$0.00,$0.00,$0.00,$307.50,$0.00,$153.75,$243.54,$246.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0626,SUP,Custom 27203010,,80-0626  -  TAP BN INS CORONOID DISP 3MM NLCKG SCR,$315.00,$0.00,$315.00,$0.00,$224.82,$0.00,$0.00,$0.00,$0.00,$0.00,$315.00,$0.00,$157.50,$249.48,$252.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0627,SUP,Custom 27203010,,80-0627  -  DRILL SURG QRLSE 2.3MM,$300.00,$0.00,$300.00,$0.00,$214.11,$0.00,$0.00,$0.00,$0.00,$0.00,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0628,SUP,Custom 27203010,,80-0628  -  GUIDE DRILL 2MM 2.3MM NAR,$730.00,$0.00,$730.00,$0.00,$521.00,$0.00,$0.00,$0.00,$0.00,$0.00,$730.00,$0.00,$365.00,$578.16,$584.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0632,SUP,Custom 27203010,,80-0632  -  DRIVER 2MM QRLSE SLD HEX TIP SURG,$460.00,$0.00,$460.00,$0.00,$328.30,$0.00,$0.00,$0.00,$0.00,$0.00,$460.00,$0.00,$230.00,$364.32,$368.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0633,SUP,Custom 27203010,,80-0633  -  DRIVER 3MM ACTRK QRLSE SLD HEX TIP SURG,$535.00,$0.00,$535.00,$0.00,$381.83,$0.00,$0.00,$0.00,$0.00,$0.00,$535.00,$0.00,$267.50,$423.72,$428.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0634,SUP,Custom 27203010,,80-0634  -  DRIVER 3.5MM ACTRK QRLSE SLD HEX TIP SURG,$597.50,$0.00,$597.50,$0.00,$426.44,$0.00,$0.00,$0.00,$0.00,$0.00,$597.50,$0.00,$298.75,$473.22,$478.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0635,SUP,Custom 27203010,,80-0635  -  DRIVER 4MM ACTRK QRLSE SLD HEX TIP SURG,$657.50,$0.00,$657.50,$0.00,$469.26,$0.00,$0.00,$0.00,$0.00,$0.00,$657.50,$0.00,$328.75,$520.74,$526.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0636,SUP,Custom 27203010,,80-0636  -  DRIVER ACTRK QRLSE CRCIFRM TIP SURG,$767.50,$0.00,$767.50,$0.00,$547.76,$0.00,$0.00,$0.00,$0.00,$0.00,$767.50,$0.00,$383.75,$607.86,$614.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0642,SUP,Custom 27203010,,80-0642  -  ROD XTRNFX 2.8IN DRL FIB,$302.50,$0.00,$302.50,$0.00,$215.89,$0.00,$0.00,$0.00,$0.00,$0.00,$302.50,$0.00,$151.25,$239.58,$242.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0659,SUP,Custom 27203010,,80-0659  -  TAP SRG DIST ELB 3 MM SCR,$730.00,$0.00,$730.00,$0.00,$521.00,$0.00,$0.00,$0.00,$0.00,$0.00,$730.00,$0.00,$365.00,$578.16,$584.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0661,SUP,Custom 27203010,,80-0661  -  TAP SRG NS HUM DIST 3.5 MM SCR,$730.00,$0.00,$730.00,$0.00,$521.00,$0.00,$0.00,$0.00,$0.00,$0.00,$730.00,$0.00,$365.00,$578.16,$584.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0663,SUP,Custom 27203010,,80-0663  -  HANDLE DRVR MED RCHT,"$2,275.00",$0.00,"$2,275.00",$0.00,"$1,623.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,275.00",$0.00,"$1,137.50","$1,801.80","$1,820.00",$0.00,$0.00,$0.00,$0.00,$0.00
80-0664,SUP,Custom 27203010,,80-0664  -  PROBE SURG 2.3MM DEPTH,$737.50,$0.00,$737.50,$0.00,$526.35,$0.00,$0.00,$0.00,$0.00,$0.00,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0688,SUP,Custom 27203010,,80-0688  -  WIRE FIX .054IN KWIRE GUIDE REUSE,$290.00,$0.00,$290.00,$0.00,$206.97,$0.00,$0.00,$0.00,$0.00,$0.00,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0724,SUP,Custom 27203010,,80-0724  -  BIT DRILL 2.5MM FRAG-LOC SURG,$535.00,$0.00,$535.00,$0.00,$381.83,$0.00,$0.00,$0.00,$0.00,$0.00,$535.00,$0.00,$267.50,$423.72,$428.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0728,SUP,Custom 27203010,,80-0728  -  DRIVER 1.5MM HEX TIP LCK GRV 2.3MM SURG,$535.00,$0.00,$535.00,$0.00,$381.83,$0.00,$0.00,$0.00,$0.00,$0.00,$535.00,$0.00,$267.50,$423.72,$428.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0758,SUP,Custom 27203010,,80-0758  -  GUIDEWIRE ORTHOPEDIC 24IN THREADED INSTR UCSS,$805.00,$0.00,$805.00,$0.00,$574.53,$0.00,$0.00,$0.00,$0.00,$0.00,$805.00,$0.00,$402.50,$637.56,$644.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0759,SUP,Custom 27203010,,80-0759  -  DRIVER SRG T8 MN STICKFIT HEXALOBE QC DRL REUSE,$707.50,$0.00,$707.50,$0.00,$504.94,$0.00,$0.00,$0.00,$0.00,$0.00,$707.50,$0.00,$353.75,$560.34,$566.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0760,SUP,Custom 27203010,,80-0760  -  DRIVER SRG T15 HEXALOBE SCR STK FIR,$707.50,$0.00,$707.50,$0.00,$504.94,$0.00,$0.00,$0.00,$0.00,$0.00,$707.50,$0.00,$353.75,$560.34,$566.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0772,SUP,HCPCS C1713,,80-0772  -  SCREW BN 3MM 2 TRK STP DRL CLVCL,$547.50,$0.00,$547.50,$246.38,$390.75,$0.00,$94.33,$0.00,$0.00,$95.86,$547.50,$0.00,$273.75,$433.62,$438.00,$0.00,$85.68,$0.00,$87.16,$0.00
80-0773,SUP,Custom 27203010,,80-0773  -  SCREW BN 3.8MM 2 TRK STP DRL CLVCL,$547.50,$0.00,$547.50,$0.00,$390.75,$0.00,$0.00,$0.00,$0.00,$0.00,$547.50,$0.00,$273.75,$433.62,$438.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0774,SUP,Custom 27203010,,80-0774  -  REAMER SURG 3MM THDL,"$1,287.50",$0.00,"$1,287.50",$0.00,$918.89,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,287.50",$0.00,$643.75,"$1,019.70","$1,030.00",$0.00,$0.00,$0.00,$0.00,$0.00
80-0775,SUP,Custom 27203010,,80-0775  -  REAMER SURG 3.8MM THDL DL TRK CLVCL SCR SYS,"$1,287.50",$0.00,"$1,287.50",$0.00,$918.89,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,287.50",$0.00,$643.75,"$1,019.70","$1,030.00",$0.00,$0.00,$0.00,$0.00,$0.00
80-0783,SUP,Custom 27203010,,80-0783  -  SCREW BN 3MM 2 TRK TAP CLVCL,$420.00,$0.00,$420.00,$0.00,$299.75,$0.00,$0.00,$0.00,$0.00,$0.00,$420.00,$0.00,$210.00,$332.64,$336.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-0838,SUP,HCPCS C1713,,80-0838  -  SCREW BONE .75IN 3/32IN BLNK,$15.00,$0.00,$15.00,$6.75,$10.71,$0.00,$2.58,$0.00,$0.00,$2.63,$15.00,$0.00,$7.50,$11.88,$12.00,$0.00,$2.35,$0.00,$2.39,$0.00
801 325 100,SUP,Custom 27203010,,SERACLONE ANTI-A 10X10ML,$894.38,$0.00,$894.38,$0.00,$638.32,$0.00,$0.00,$0.00,$0.00,$0.00,$894.38,$0.00,$447.19,$708.35,$715.50,$0.00,$0.00,$0.00,$0.00,$0.00
801 350 100,SUP,Custom 27203010,,SERACLONE ANTI-B 10X10ML,$894.38,$0.00,$894.38,$0.00,$638.32,$0.00,$0.00,$0.00,$0.00,$0.00,$894.38,$0.00,$447.19,$708.35,$715.50,$0.00,$0.00,$0.00,$0.00,$0.00
80129-201,SUP,HCPCS C1874,,80129-201  -  STENT ESPH 16FR 18MM 67CM 70MM ALIMAXX-ES FULL CVR PROX SUT,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,$0.00,$0.00,$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
80129-202,SUP,HCPCS C1874,,80129-202  -  STENT ESPH 18MM 22FR 100CM ALIMAXX-E REM COVERED RADOPQ MTL,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,$0.00,$0.00,$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
80129-203,SUP,HCPCS C1874,,80129-203  -  STENT ESPH 22FR 18MM 120CM ALIMAXX-E REM COVERED MTL,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,$0.00,$0.00,$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
80129-204,SUP,HCPCS C1874,,80129-204  -  STENT ESPH 22MM 22FR 70CM ALIMAXX-E REM COVERED RADOPQ MTL,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,$0.00,$0.00,$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
80129-205,SUP,HCPCS C1874,,80129-205  -  STENT ESPH 22FR 100CM ALIMAXX-E SYS MTL,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,$0.00,$0.00,$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
80129-206,SUP,HCPCS C1874,,80129-206  -  STENT ESPH 22FR 120CM ALIMAXX-E SLF XPD MTL DISP,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,$0.00,$0.00,$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
80129-207,SUP,HCPCS C1874,,80129-207  -  STENT ESPH 12MM 70CM ALIMAXX-ES FLLY COVERED,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,$0.00,$0.00,$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
80129-208,SUP,HCPCS C1874,,80129-208  -  STENT ESPH 22MM 100CM ALIMAXX-ES PU CVR ANTIMIGRATION STRUT,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,$0.00,$0.00,$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
80129-209,SUP,HCPCS C1874,,80129-209  -  STENT ESPH GMTR 12MM 16FR 120MM NS 62CM ALIMAXX-ES FLLY,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,$0.00,$0.00,$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
80129-210,SUP,HCPCS C1874,,80129-210  -  STENT ESPH 14MM 70CM ALIMAXX-ES FLLY COVERED,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,$0.00,$0.00,$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
80129-211,SUP,HCPCS C1874,,80129-211  -  STENT ESPH 14MM 16FR 100MM 64CM ALIMAXX-ES FLLY COVERED SMTH,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,$0.00,$0.00,$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
80129-212,SUP,HCPCS C1874,,80129-212  -  STENT ESPH 14MM 16FR 62CM 120MM ALIMAXX-ES FLLY COVERED GMTR,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,$0.00,$0.00,$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
80129-213,SUP,HCPCS C1874,,80129-213  -  STENT ESPH GMTR 16MM 70CM ALIMAXX-ES FLLY COVERED PU CVR,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,$0.00,$0.00,$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
80129-214,SUP,HCPCS C1874,,80129-214  -  STENT ESPH 16MM 16FR 100MM 64CM ALIMAXX-ES FLLY COVERED SMTH,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,$0.00,$0.00,$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
80129-215,SUP,HCPCS C1874,,80129-215  -  STENT ESPH 16MM 62CM 120MM ALIMAXX-ES FLLY COVERED GMTR PU,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,$0.00,$0.00,$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
80129-406,SUP,HCPCS C1769,,80129-406  -  GUIDEWIRE ENDSCP STR .035IN 260CM SUPER STIFF FLEXIBILITY,$500.00,$0.00,$500.00,$271.50,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
80-1759,SUP,HCPCS C1713,,80-1759  -  TACK FX .04IN PLT,$322.50,$0.00,$322.50,$145.13,$230.17,$0.00,$55.57,$0.00,$0.00,$56.47,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$50.47,$0.00,$51.34,$0.00
80-1794,SUP,Custom 27203010,,80-1794  -  DRILL SRG 1.1MM 3.5IN QRLSE STD AO 1.5MM SCR,$742.50,$0.00,$742.50,$0.00,$529.92,$0.00,$0.00,$0.00,$0.00,$0.00,$742.50,$0.00,$371.25,$588.06,$594.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-1796,SUP,Custom 27203010,,80-1796  -  DRILL SURG 2MM 3.5IN QUICK RELEASE STANDARD AO SURGIBIT,$742.50,$0.00,$742.50,$0.00,$529.92,$0.00,$0.00,$0.00,$0.00,$0.00,$742.50,$0.00,$371.25,$588.06,$594.00,$0.00,$0.00,$0.00,$0.00,$0.00
80-1797,SUP,Custom 27203010,,80-1797  -  DRILL SURG 3.5IN CUT INSERTION SURGIBIT MINI 2IN REUSABLE,$147.50,$0.00,$147.50,$0.00,$105.27,$0.00,$0.00,$0.00,$0.00,$0.00,$147.50,$0.00,$73.75,$116.82,$118.00,$0.00,$0.00,$0.00,$0.00,$0.00
802 042 100,SUP,Custom 27203010,,SERACLONE ANTI-D 10X10ML,$928.13,$0.00,$928.13,$0.00,$662.40,$0.00,$0.00,$0.00,$0.00,$0.00,$928.13,$0.00,$464.06,$735.08,$742.50,$0.00,$0.00,$0.00,$0.00,$0.00
802 336 100,SUP,Custom 27203010,,SERACLONE ANTI-E 1X5ML,$265.50,$0.00,$265.50,$0.00,$189.49,$0.00,$0.00,$0.00,$0.00,$0.00,$265.50,$0.00,$132.75,$210.28,$212.40,$0.00,$0.00,$0.00,$0.00,$0.00
8023 A,SUP,Custom 27803010,,8023 A  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$213.75,$0.00,$213.75,$0.00,$152.55,$0.00,$0.00,$0.00,$0.00,$0.00,$213.75,$0.00,$106.88,$169.29,$171.00,$0.00,$0.00,$0.00,$0.00,$0.00
8023 B,SUP,Custom 27803010,,8023 B  -  PLATE 18MM TI BONE SPNL,$213.75,$0.00,$213.75,$0.00,$152.55,$0.00,$0.00,$0.00,$0.00,$0.00,$213.75,$0.00,$106.88,$169.29,$171.00,$0.00,$0.00,$0.00,$0.00,$0.00
803.605.02S,SUP,HCPCS C1713,,803.605.02S  -  SCREW BONE 1.5MM 5MM CORT RESORB STRL,$361.03,$0.00,$361.03,$162.46,$257.66,$0.00,$62.20,$0.00,$0.00,$63.21,$361.03,$0.00,$180.51,$285.94,$288.82,$0.00,$56.50,$0.00,$57.48,$0.00
804 175 100,SUP,Custom 27203010,,AHG ANTI-LGG 10 X 10 ML,$463.50,$0.00,$463.50,$0.00,$330.80,$0.00,$0.00,$0.00,$0.00,$0.00,$463.50,$0.00,$231.75,$367.09,$370.80,$0.00,$0.00,$0.00,$0.00,$0.00
804.006.02S,SUP,HCPCS C1713,,804.006.02S  -  SCREW BONE 2MM 6MM CORT RESORB MESH STRL,$361.03,$0.00,$361.03,$162.46,$257.66,$0.00,$62.20,$0.00,$0.00,$63.21,$361.03,$0.00,$180.51,$285.94,$288.82,$0.00,$56.50,$0.00,$57.48,$0.00
80-4403L,SUP,HCPCS C1776,,80-4403L  -  COMPONENT FEMORAL 3 57X51MM CRUCIATE RETAIN POST PRIM LUG,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
80-4403R,SUP,HCPCS C1776,,80-4403R  -  COMPONENT FEMORAL 3 57X51MM CRUCIATE RETAIN PRIM LUG SCORPIO,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
80-4404L,SUP,HCPCS C1776,,80-4404L  -  COMPONENT FEMORAL 4 60X53MM CRUCIATE RETAIN PRIM LUG SCORPIO,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
80-4404R,SUP,HCPCS C1776,,80-4404R  -  COMPONENT FEMORAL 4 60X53MM CRUCIATE RETAIN PRIM LUG SCORPIO,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
80-4405L,SUP,HCPCS C1776,,80-4405L  -  COMPONENT FEMORAL 5 62X55MM CRUCIATE RETAIN PRIM LUG SCORPIO,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
80-4405R,SUP,HCPCS C1776,,80-4405R  -  COMPONENT FEMORAL 5 62X55MM CRUCIATE RETAIN PRIM LUG SCORPIO,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
80-4406L,SUP,HCPCS C1776,,80-4406L  -  COMPONENT FEMORAL 6 65X57MM CRUCIATE RETAIN PRIM LUG SCORPIO,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
80-4406R,SUP,HCPCS C1776,,80-4406R  -  COMPONENT FEMORAL 6 65X57MM CRUCIATE RETAIN PRIM LUG SCORPIO,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
80-4407L,SUP,HCPCS C1776,,80-4407L  -  COMPONENT FEMORAL 7 67X60MM CRUCIATE RETAIN PRIM LUG SCORPIO,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
80-4407R,SUP,HCPCS C1776,,80-4407R  -  COMPONENT FEMORAL 7 67X60MM CRUCIATE RETAIN PRIM LUG SCORPIO,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
80-4408L,SUP,HCPCS C1776,,80-4408L  -  COMPONENT FEMORAL 8 70X62MM CRUCIATE RETAIN PRIM LUG SCORPIO,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
80-4408R,SUP,HCPCS C1776,,80-4408R  -  COMPONENT FEMORAL 8 70X62MM CRUCIATE RETAIN PRIM LUG SCORPIO,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
80-4409L,SUP,HCPCS C1776,,80-4409L  -  COMPONENT FEMORAL 9 72X64MM CRUCIATE RETAIN PRIM LUG SCORPIO,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
80-4409R,SUP,HCPCS C1776,,80-4409R  -  COMPONENT FEMORAL 9 72X64MM CRUCIATE RETAIN PRIM LUG SCORPIO,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
80-4411L,SUP,HCPCS C1776,,80-4411L  -  COMPONENT FEMORAL 11 77X69MM CRUCIATE RETAIN PRIM LUG,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
80-4411R,SUP,HCPCS C1776,,80-4411R  -  COMPONENT FEMORAL 11 77X69MM CRUCIATE RETAIN PRIM LUG,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
80-4413L,SUP,HCPCS C1776,,80-4413L  -  COMPONENT FEMORAL 13 82X74MM CRUCIATE RETAIN PRIM LUG,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
80-4413R,SUP,HCPCS C1776,,80-4413R  -  COMPONENT FEMORAL 13 82X74MM CRUCIATE RETAIN PRIM LUG,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
805.603.02S,SUP,HCPCS C1713,,805.603.02S  -  SCREW BN 1.5MM 3MM STRL CRNMXF CORT 2 PK,$393.75,$0.00,$393.75,$177.19,$281.02,$0.00,$67.84,$0.00,$0.00,$68.94,$393.75,$0.00,$196.88,$311.85,$315.00,$0.00,$61.62,$0.00,$62.69,$0.00
805.604.02S,SUP,HCPCS C1713,,805.604.02S  -  SCREW BONE RPD RESORB 4MM 1.5MM CORT CRNMXF STRL,$393.75,$0.00,$393.75,$177.19,$281.02,$0.00,$67.84,$0.00,$0.00,$68.94,$393.75,$0.00,$196.88,$311.85,$315.00,$0.00,$61.62,$0.00,$62.69,$0.00
805.605.02S,SUP,HCPCS C1713,,805.605.02S  -  SCREW BN 1.5MM 5MM STRL CRNMXF CORT 2 PK,$393.75,$0.00,$393.75,$177.19,$281.02,$0.00,$67.84,$0.00,$0.00,$68.94,$393.75,$0.00,$196.88,$311.85,$315.00,$0.00,$61.62,$0.00,$62.69,$0.00
805.606.02S,SUP,HCPCS C1713,,805.606.02S  -  SCREW BN 1.5MM 6MM STRL CRNMXF CORT 2 PK,$393.75,$0.00,$393.75,$177.19,$281.02,$0.00,$67.84,$0.00,$0.00,$68.94,$393.75,$0.00,$196.88,$311.85,$315.00,$0.00,$61.62,$0.00,$62.69,$0.00
805.608.02S,SUP,HCPCS C1713,,805.608.02S  -  SCREW BONE 8MM 1.5MM CORT CRNMXF RPD RESORB STRL,$393.75,$0.00,$393.75,$177.19,$281.02,$0.00,$67.84,$0.00,$0.00,$68.94,$393.75,$0.00,$196.88,$311.85,$315.00,$0.00,$61.62,$0.00,$62.69,$0.00
805.614.02S,SUP,HCPCS C1713,,805.614.02S  -  TACK FX 1.5MM 4MM STRL RAPIDSORB RSRB CRNMXF,$373.50,$0.00,$373.50,$168.08,$266.57,$0.00,$64.35,$0.00,$0.00,$65.40,$373.50,$0.00,$186.75,$295.81,$298.80,$0.00,$58.45,$0.00,$59.46,$0.00
806.004.02S,SUP,HCPCS C1713,,806.004.02S  -  SCREW BONE 4MM 2MM CORT CRNMXF RPD RESORB STRL,$393.75,$0.00,$393.75,$177.19,$281.02,$0.00,$67.84,$0.00,$0.00,$68.94,$393.75,$0.00,$196.88,$311.85,$315.00,$0.00,$61.62,$0.00,$62.69,$0.00
806.006.02S,SUP,HCPCS C1713,,806.006.02S  -  SCREW BN 2MM 6MM STRL CRNMXF CORT 2 PK,$393.75,$0.00,$393.75,$177.19,$281.02,$0.00,$67.84,$0.00,$0.00,$68.94,$393.75,$0.00,$196.88,$311.85,$315.00,$0.00,$61.62,$0.00,$62.69,$0.00
806.008.02S,SUP,HCPCS C1713,,806.008.02S  -  SCREW BN 2MM 8MM STRL CRNMXF CORT 2 PK,$393.75,$0.00,$393.75,$177.19,$281.02,$0.00,$67.84,$0.00,$0.00,$68.94,$393.75,$0.00,$196.88,$311.85,$315.00,$0.00,$61.62,$0.00,$62.69,$0.00
806.044.02S,SUP,HCPCS C1713,,806.044.02S  -  SCREW BONE 4MM 2.5MM CORT CRNMXF RPD RESORB ER STRL,$393.75,$0.00,$393.75,$177.19,$281.02,$0.00,$67.84,$0.00,$0.00,$68.94,$393.75,$0.00,$196.88,$311.85,$315.00,$0.00,$61.62,$0.00,$62.69,$0.00
806.046.02S,SUP,HCPCS C1713,,806.046.02S  -  SCREW BONE 6MM 2.5MM CORT CRNMXF RPD RESORB ER STRL,$393.75,$0.00,$393.75,$177.19,$281.02,$0.00,$67.84,$0.00,$0.00,$68.94,$393.75,$0.00,$196.88,$311.85,$315.00,$0.00,$61.62,$0.00,$62.69,$0.00
806.048.02S,SUP,HCPCS C1713,,806.048.02S  -  SCREW BONE 8MM 2.5MM CORT CRNMXF RPD RESORB ER STRL,$393.75,$0.00,$393.75,$177.19,$281.02,$0.00,$67.84,$0.00,$0.00,$68.94,$393.75,$0.00,$196.88,$311.85,$315.00,$0.00,$61.62,$0.00,$62.69,$0.00
808 052 100,SUP,Custom 27203010,,SERACLONE ANTI-S 1 X 2 MLL,$787.50,$0.00,$787.50,$0.00,$562.04,$0.00,$0.00,$0.00,$0.00,$0.00,$787.50,$0.00,$393.75,$623.70,$630.00,$0.00,$0.00,$0.00,$0.00,$0.00
808 188 100,SUP,Custom 27203010,,SERACLONE ANTI-FYA 1 X 2 ML,$270.00,$0.00,$270.00,$0.00,$192.70,$0.00,$0.00,$0.00,$0.00,$0.00,$270.00,$0.00,$135.00,$213.84,$216.00,$0.00,$0.00,$0.00,$0.00,$0.00
808 403 100,SUP,Custom 27203010,,SERACLONE ANTI-LEA 1X2ML,$590.63,$0.00,$590.63,$0.00,$421.53,$0.00,$0.00,$0.00,$0.00,$0.00,$590.63,$0.00,$295.31,$467.78,$472.50,$0.00,$0.00,$0.00,$0.00,$0.00
808 410 100,SUP,Custom 27203010,,SERACLONE ANTI-M 1X 2 ML,$225.00,$0.00,$225.00,$0.00,$160.58,$0.00,$0.00,$0.00,$0.00,$0.00,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$0.00,$0.00,$0.00,$0.00
808 415 100,SUP,Custom 27203010,,SERACLONE ANTI-N 1 X 2 ML,$236.25,$0.00,$236.25,$0.00,$168.61,$0.00,$0.00,$0.00,$0.00,$0.00,$236.25,$0.00,$118.13,$187.11,$189.00,$0.00,$0.00,$0.00,$0.00,$0.00
808-002,SUP,HCPCS C1713,,808-002  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
808-083,SUP,HCPCS C1713,,808-083  -  PLATE 18MM TI BONE SPNL,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
808-105,SUP,HCPCS C1713,,808-105  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
808-190,SUP,HCPCS C1713,,808-190  -  PLATE 18MM TI BONE SPNL,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
808-524,SUP,HCPCS C1713,,808-524  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,670.00",$0.00,"$2,670.00","$1,201.50","$1,905.58",$0.00,$460.03,$0.00,$0.00,$467.50,"$2,670.00",$0.00,"$1,335.00","$2,114.64","$2,136.00",$0.00,$417.86,$0.00,$425.06,$0.00
809-DBL,SUP,HCPCS C1713,,809-DBL  -  PLATE 18MM TI BONE SPNL,$97.05,$0.00,$97.05,$43.67,$69.26,$0.00,$16.72,$0.00,$0.00,$16.99,$97.05,$0.00,$48.53,$76.86,$77.64,$0.00,$15.19,$0.00,$15.45,$0.00
80CR000022,SUP,Custom 27203010,,REAGENT TRIS BUFF SAL PH 8 COAG,$30.00,$0.00,$30.00,$0.00,$21.41,$0.00,$0.00,$0.00,$0.00,$0.00,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$0.00,$0.00,$0.00,$0.00
80XLTCD,SUP,Custom 27203010,,80XLTCD  -  TUBE TRCH 40MM 50MM 13.3MM 8MM 105MM STRL LF 15MM SHLY XLT,$162.05,$0.00,$162.05,$0.00,$115.65,$0.00,$0.00,$0.00,$0.00,$0.00,$162.05,$0.00,$81.02,$128.34,$129.64,$0.00,$0.00,$0.00,$0.00,$0.00
80XLTCP,SUP,Custom 27203010,,80XLTCP  -  TUBE TRCH 40MM 35MM 13.3MM 8MM 105MM STRL LF 30MM SHLY XLT,$162.05,$0.00,$162.05,$0.00,$115.65,$0.00,$0.00,$0.00,$0.00,$0.00,$162.05,$0.00,$81.02,$128.34,$129.64,$0.00,$0.00,$0.00,$0.00,$0.00
810041B,SUP,HCPCS C1781,,810041B  -  MESH TRANSVAGINAL 45X1.1CM TAPE TVT PROLENE BLUE,"$1,955.10",$0.00,"$1,955.10",$879.80,"$1,395.35",$0.00,$336.85,$0.00,$0.00,$342.32,"$1,955.10",$0.00,$977.55,"$1,548.44","$1,564.08",$0.00,$305.97,$0.00,$311.25,$0.00
810-200,SUP,HCPCS C1713,,810-200  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
810-201,SUP,HCPCS C1713,,810-201  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
810-202,SUP,HCPCS C1713,,810-202  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
810-203,SUP,HCPCS C1713,,810-203  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
810-205,SUP,HCPCS C1713,,810-205  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
810-206,SUP,HCPCS C1713,,810-206  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
810-207,SUP,HCPCS C1713,,810-207  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
810-208,SUP,HCPCS C1713,,810-208  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
810-221,SUP,HCPCS C1713,,810-221  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
810-222,SUP,HCPCS C1713,,810-222  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8103.0201S,SUP,HCPCS C1713,,8103.0201S  -  SUBSTITUTE BNGFT PLUS XEMPLIFI DEMINERALIZE BONE MATRIX 1ML,$570.00,$0.00,$570.00,$256.50,$406.81,$0.00,$98.21,$0.00,$0.00,$99.80,$570.00,$0.00,$285.00,$451.44,$456.00,$0.00,$89.21,$0.00,$90.74,$0.00
8103.0203S,SUP,HCPCS C1713,,8103.0203S  -  SUBSTITUTE BNGFT PLUS XEMPLIFI DEMINERALIZE BONE MATRIX 3ML,"$1,485.00",$0.00,"$1,485.00",$668.25,"$1,059.84",$0.00,$255.86,$0.00,$0.00,$260.01,"$1,485.00",$0.00,$742.50,"$1,176.12","$1,188.00",$0.00,$232.40,$0.00,$236.41,$0.00
810-300,SUP,HCPCS C1713,,810-300  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
810-301,SUP,HCPCS C1713,,810-301  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
810-302,SUP,HCPCS C1713,,810-302  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
810-303,SUP,HCPCS C1713,,810-303  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
810-304,SUP,HCPCS C1713,,810-304  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
810-305,SUP,HCPCS C1713,,810-305  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
810-306,SUP,HCPCS C1713,,810-306  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
810-307,SUP,HCPCS C1713,,810-307  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
810-308,SUP,HCPCS C1713,,810-308  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
810-321,SUP,HCPCS C1713,,810-321  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
810-322,SUP,HCPCS C1713,,810-322  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
810-323,SUP,HCPCS C1713,,810-323  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
810-400,SUP,HCPCS C1713,,810-400  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
810-401,SUP,HCPCS C1713,,810-401  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
810-402,SUP,HCPCS C1713,,810-402  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
810-403,SUP,HCPCS C1713,,810-403  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
810-404,SUP,HCPCS C1713,,810-404  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
810-405,SUP,HCPCS C1713,,810-405  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
810-406,SUP,HCPCS C1713,,810-406  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
810-407,SUP,HCPCS C1713,,810-407  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
810-408,SUP,HCPCS C1713,,810-408  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
810-421,SUP,HCPCS C1713,,810-421  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
810-422,SUP,HCPCS C1713,,810-422  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
810-423,SUP,HCPCS C1713,,810-423  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
810-450,SUP,HCPCS C1713,,810-450  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
810-451,SUP,HCPCS C1713,,810-451  -  PLATE 18MM TI BONE SPNL,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
8104528M,SUP,HCPCS C1713,,8104528M  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8104530M,SUP,HCPCS C1713,,8104530M  -  PLATE BN 30-34MM X10 XLNK TI SPNE 4.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8104534M,SUP,HCPCS C1713,,8104534M  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8104541M,SUP,HCPCS C1713,,8104541M  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8104555M,SUP,HCPCS C1713,,8104555M  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
810-A20-1350,SUP,Custom 27203010,,SCISSORS 4.75IN CRB EDG WIRE CTR SURG LTX,$105.33,$0.00,$105.33,$0.00,$75.17,$0.00,$0.00,$0.00,$0.00,$0.00,$105.33,$0.00,$52.66,$83.42,$84.26,$0.00,$0.00,$0.00,$0.00,$0.00
811-300,SUP,HCPCS C1713,,811-300  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
811-301,SUP,HCPCS C1713,,811-301  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
811-302,SUP,HCPCS C1713,,811-302  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
811-303,SUP,HCPCS C1713,,811-303  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
811-304,SUP,HCPCS C1713,,811-304  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
811-305,SUP,HCPCS C1713,,811-305  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
811-306,SUP,HCPCS C1713,,811-306  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
811-307,SUP,HCPCS C1713,,811-307  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
811-308,SUP,HCPCS C1713,,811-308  -  PLATE BN 1.5IN STRL XLNK CD HZN LOPRFL TI SPNE 5.5MM ROD,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
811-313,SUP,Custom 27803010,,811-313  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$0.00,"$1,427.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
811-321,SUP,HCPCS C1713,,811-321  -  PLATE BN 1.55-1.75IN STRL MLSPN XLNK CD HZN LOPRFL TI SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
811-322,SUP,HCPCS C1713,,811-322  -  PLATE BN 1.75-2.15IN STRL MLSPN XLNK CD HZN LOPRFL TI SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
811-323,SUP,HCPCS C1713,,811-323  -  PLATE BN 2.15-2.95IN STRL MLSPN XLNK CD HZN LOPRFL TI SPNE,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
811-324,SUP,HCPCS C1713,,811-324  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
811-400,SUP,HCPCS C1713,,811-400  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
811-401,SUP,HCPCS C1713,,811-401  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
811-402,SUP,HCPCS C1713,,811-402  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
811-403,SUP,HCPCS C1713,,811-403  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
811-404,SUP,HCPCS C1713,,811-404  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
811-405,SUP,HCPCS C1713,,811-405  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
811-406,SUP,HCPCS C1713,,811-406  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
811-407,SUP,HCPCS C1713,,811-407  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
811-408,SUP,HCPCS C1713,,811-408  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
811-421,SUP,HCPCS C1713,,811-421  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
811-422,SUP,HCPCS C1713,,811-422  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
811-423,SUP,HCPCS C1713,,811-423  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
811-450,SUP,HCPCS C1713,,811-450  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
811-451,SUP,HCPCS C1713,,811-451  -  PLATE 18MM TI BONE SPNL,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
8114528M,SUP,HCPCS C1713,,8114528M  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8114530M,SUP,HCPCS C1713,,8114530M  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8114534M,SUP,HCPCS C1713,,8114534M  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8114541M,SUP,HCPCS C1713,,8114541M  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
8114555M,SUP,HCPCS C1713,,8114555M  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
811-500,SUP,HCPCS C1713,,811-500  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
811-501,SUP,HCPCS C1713,,811-501  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
811-DBL,SUP,HCPCS C1713,,811-DBL  -  PLATE 18MM TI BONE SPNL,$97.75,$0.00,$97.75,$43.99,$69.76,$0.00,$16.84,$0.00,$0.00,$17.12,$97.75,$0.00,$48.88,$77.42,$78.20,$0.00,$15.30,$0.00,$15.56,$0.00
813-DBL,SUP,HCPCS C1713,,813-DBL  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$97.75,$0.00,$97.75,$43.99,$69.76,$0.00,$16.84,$0.00,$0.00,$17.12,$97.75,$0.00,$48.88,$77.42,$78.20,$0.00,$15.30,$0.00,$15.56,$0.00
81-4403L,SUP,HCPCS C1776,,81-4403L  -  COMPONENT FEMORAL 3 57X51MM POSTERIOR STABILIZE PRIM LUG,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
81-4403R,SUP,HCPCS C1776,,81-4403R  -  COMPONENT FEMORAL 3 57X51MM POSTERIOR STABILIZE PRIM LUG,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
81-4404L,SUP,HCPCS C1776,,81-4404L  -  COMPONENT FEMORAL 4 60X54MM POSTERIOR STABILIZE PRIM LUG,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
81-4404R,SUP,HCPCS C1776,,81-4404R  -  COMPONENT FEMORAL 4 60X54MM POSTERIOR STABILIZE PRIM LUG,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
81-4405L,SUP,HCPCS C1776,,81-4405L  -  COMPONENT FEMORAL 5 62X56MM POSTERIOR STABILIZE PRIM LUG,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
81-4405R,SUP,HCPCS C1776,,81-4405R  -  COMPONENT FEMORAL 5 62X56MM POSTERIOR STABILIZE PRIM LUG,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
81-4406L,SUP,HCPCS C1776,,81-4406L  -  COMPONENT FEMORAL 6 65X58MM POSTERIOR STABILIZE PRIM LUG,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
81-4406R,SUP,HCPCS C1776,,81-4406R  -  COMPONENT FEMORAL 6 65X58MM POSTERIOR STABILIZE PRIM LUG,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
81-4407L,SUP,HCPCS C1776,,81-4407L  -  COMPONENT FEMORAL 7 67X61MM POSTERIOR STABILIZE PRIM LUG,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
81-4407R,SUP,HCPCS C1776,,81-4407R  -  COMPONENT FEMORAL 7 67X61MM POSTERIOR STABILIZE PRIM LUG,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
81-4408L,SUP,HCPCS C1776,,81-4408L  -  COMPONENT FEMORAL 8 70X63MM POSTERIOR STABILIZE PRIM LUG,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
81-4408R,SUP,HCPCS C1776,,81-4408R  -  COMPONENT FEMORAL 8 70X63MM POSTERIOR STABILIZE PRIM LUG,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
81-4409L,SUP,HCPCS C1776,,81-4409L  -  COMPONENT FEMORAL 9 72X65MM POSTERIOR STABILIZE PRIM LUG,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
81-4409R,SUP,HCPCS C1776,,81-4409R  -  COMPONENT FEMORAL 9 72X65MM POSTERIOR STABILIZE PRIM LUG,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
81-4411L,SUP,HCPCS C1776,,81-4411L  -  COMPONENT FEMORAL 11 77X70MM POSTERIOR STABILIZE PRIM LUG,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
81-4411R,SUP,HCPCS C1776,,81-4411R  -  COMPONENT FEMORAL 11 77X70MM POSTERIOR STABILIZE PRIM LUG,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
81-4413L,SUP,HCPCS C1776,,81-4413L  -  COMPONENT FEMORAL 13 82X75MM POSTERIOR STABILIZE PRIM LUG,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
81-4413R,SUP,HCPCS C1776,,81-4413R  -  COMPONENT FEMORAL 13 82X75MM POSTERIOR STABILIZE PRIM LUG,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
81500V,SUP,Custom 27203010,,81500V  -  APPLIER ENDOSCOPIC MED LARGE  STRAIGHT 13INŸŸ,"$2,373.73",$0.00,"$2,373.73",$0.00,"$1,694.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,373.73",$0.00,"$1,186.86","$1,879.99","$1,898.98",$0.00,$0.00,$0.00,$0.00,$0.00
815-013,SUP,HCPCS C1713,,815-013  -  PLATE 18MM TI BONE SPNL,$475.50,$0.00,$475.50,$213.98,$339.36,$0.00,$81.93,$0.00,$0.00,$83.26,$475.50,$0.00,$237.75,$376.60,$380.40,$0.00,$74.42,$0.00,$75.70,$0.00
815-015,SUP,HCPCS C1713,,815-015  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$475.50,$0.00,$475.50,$213.98,$339.36,$0.00,$81.93,$0.00,$0.00,$83.26,$475.50,$0.00,$237.75,$376.60,$380.40,$0.00,$74.42,$0.00,$75.70,$0.00
815-017,SUP,HCPCS C1713,,815-017  -  PLATE 18MM TI BONE SPNL,$475.50,$0.00,$475.50,$213.98,$339.36,$0.00,$81.93,$0.00,$0.00,$83.26,$475.50,$0.00,$237.75,$376.60,$380.40,$0.00,$74.42,$0.00,$75.70,$0.00
81501V,SUP,Custom 27203010,,81501V  -  CLIP INTNL ENDO REMOVER MED LARGE - LARGE  STRAIGHT 13INŸŸ,"$2,164.98",$0.00,"$2,164.98",$0.00,"$1,545.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,164.98",$0.00,"$1,082.49","$1,714.66","$1,731.98",$0.00,$0.00,$0.00,$0.00,$0.00
816-013,SUP,HCPCS C1713,,816-013  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$549.00,$0.00,$549.00,$247.05,$391.82,$0.00,$94.59,$0.00,$0.00,$96.13,$549.00,$0.00,$274.50,$434.81,$439.20,$0.00,$85.92,$0.00,$87.40,$0.00
816-015,SUP,HCPCS C1713,,816-015  -  PLATE 18MM TI BONE SPNL,$549.00,$0.00,$549.00,$247.05,$391.82,$0.00,$94.59,$0.00,$0.00,$96.13,$549.00,$0.00,$274.50,$434.81,$439.20,$0.00,$85.92,$0.00,$87.40,$0.00
816-017,SUP,HCPCS C1713,,816-017  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$549.00,$0.00,$549.00,$247.05,$391.82,$0.00,$94.59,$0.00,$0.00,$96.13,$549.00,$0.00,$274.50,$434.81,$439.20,$0.00,$85.92,$0.00,$87.40,$0.00
81602V,SUP,Custom 27203010,,81602V  -  APPLIER ENDOSCOPIC LARGE  CURVED 13INŸŸ,"$2,373.73",$0.00,"$2,373.73",$0.00,"$1,694.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,373.73",$0.00,"$1,186.86","$1,879.99","$1,898.98",$0.00,$0.00,$0.00,$0.00,$0.00
8161-35-026,SUP,HCPCS C1713,,8161-35-026  -  SCREW 3.5X26MM CORTICAL LOCKING,$402.50,$0.00,$402.50,$181.13,$287.26,$0.00,$69.35,$0.00,$0.00,$70.47,$402.50,$0.00,$201.25,$318.78,$322.00,$0.00,$62.99,$0.00,$64.08,$0.00
8161-35-044,SUP,HCPCS C1713,,8161-35-044  -  SCREW BONE 3.5MM 44MM CORT LCK,$325.00,$0.00,$325.00,$146.25,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
81701V,SUP,Custom 27203010,,81701V  -  CLIP INTNL ENDO REMOVERŸLARGE - XLARGE  STRAIGHT 13INŸŸ,"$2,249.98",$0.00,"$2,249.98",$0.00,"$1,605.81",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,249.98",$0.00,"$1,124.99","$1,781.98","$1,799.98",$0.00,$0.00,$0.00,$0.00,$0.00
81702V,SUP,Custom 27203010,,81702V  -  APPLIER ENDOSCOPIC XLARGE  CURVED 13INŸŸ,"$2,548.73",$0.00,"$2,548.73",$0.00,"$1,819.03",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,548.73",$0.00,"$1,274.36","$2,018.59","$2,038.98",$0.00,$0.00,$0.00,$0.00,$0.00
81B001,SUP,HCPCS C1776,,81B001  -  GRAFT SFT TIS FRZDR ANT TIB TNDN,"$5,032.50",$0.00,"$5,032.50","$2,264.63","$3,591.70",$0.00,$867.07,$0.00,$0.00,$881.15,"$5,032.50",$0.00,"$2,516.25","$3,985.74","$4,026.00",$0.00,$787.59,$0.00,$801.17,$0.00
81B005,SUP,HCPCS C1776,,81B005  -  GRAFT BN GRCLS SEMITENDINOSUS,"$5,045.00",$0.00,"$5,045.00","$2,270.25","$3,600.62",$0.00,$869.23,$0.00,$0.00,$883.34,"$5,045.00",$0.00,"$2,522.50","$3,995.64","$4,036.00",$0.00,$789.54,$0.00,$803.16,$0.00
820-050,SUP,HCPCS C1713,,820-050  -  PLATE 18MM TI BONE SPNL,$553.50,$0.00,$553.50,$249.08,$395.03,$0.00,$95.37,$0.00,$0.00,$96.91,$553.50,$0.00,$276.75,$438.37,$442.80,$0.00,$86.62,$0.00,$88.12,$0.00
82091-01,SUP,HCPCS C1876,,82091-01  -  STENT VASCULAR TAPER 8-6MM 30MM SELF EXPANDABLE ERGONOMIC,"$4,125.00",$0.00,"$4,125.00","$1,856.25","$2,944.01",$0.00,$710.72,$0.00,$0.00,$722.25,"$4,125.00",$0.00,"$2,062.50","$3,267.00","$3,300.00",$0.00,$645.56,$0.00,$656.70,$0.00
82-1750,SUP,HCPCS C1729,,82-1750  -  BACTISEAL CLEAR EVD CATHETER ANTIBIOTIC IMPREGNATED CATHETER,$386.40,$0.00,$386.40,$209.82,$275.77,$0.00,$66.57,$0.00,$0.00,$67.66,$386.40,$0.00,$193.20,$306.03,$309.12,$0.00,$60.47,$0.00,$61.51,$0.00
82-2-0308,SUP,Custom 27803010,,82-2-0308  -  INSERT TIBIAL 3 8MM CRUC RET BEARING SCORPIO NRG KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-2-0310,SUP,Custom 27803010,,82-2-0310  -  INSERT TIBIAL 3 10MM CRUC RET BEARING SCORPIO NRG KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-2-0312,SUP,Custom 27803010,,82-2-0312  -  INSERT TIBIAL 3 12MM CRUC RET BEARING SCORPIO NRG KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-2-0315,SUP,Custom 27803010,,82-2-0315  -  INSERT TIBIAL 3 15MM CRUC RET BEARING SCORPIO NRG KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-2-0318,SUP,Custom 27803010,,82-2-0318  -  INSERT TIBIAL 3 18MM CRUC RET BEARING SCORPIO NRG KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-2-0321,SUP,Custom 27803010,,82-2-0321  -  INSERT TIBIAL 3 21MM CRUC RET BEARING SCORPIO NRG KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-2-0324,SUP,Custom 27803010,,82-2-0324  -  INSERT TIBIAL 3 24MM CRUC RET BEARING SCORPIO NRG KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-2-0508,SUP,Custom 27803010,,82-2-0508  -  INSERT TIBIAL 5 8MM CRUC RET BEARING SCORPIO NRG KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-2-0510,SUP,Custom 27803010,,82-2-0510  -  INSERT TIBIAL 5 10MM CRUC RET BEARING SCORPIO NRG KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-2-0512,SUP,Custom 27803010,,82-2-0512  -  INSERT TIBIAL 5 12MM CRUC RET BEARING SCORPIO NRG KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-2-0515,SUP,Custom 27803010,,82-2-0515  -  INSERT TIBIAL 5 15MM CRUC RET BEARING SCORPIO NRG KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-2-0518,SUP,Custom 27803010,,82-2-0518  -  INSERT TIBIAL 5 18MM CRUC RET BEARING SCORPIO NRG KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-2-0521,SUP,Custom 27803010,,82-2-0521  -  INSERT TIBIAL 5 21MM CRUC RET BEARING SCORPIO NRG KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-2-0524,SUP,Custom 27803010,,82-2-0524  -  INSERT TIBIAL 5 24MM CRUC RET BEARING SCORPIO NRG KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-2-0708,SUP,Custom 27803010,,82-2-0708  -  INSERT TIBIAL 7 BEARING NRG KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-2-0710,SUP,Custom 27803010,,82-2-0710  -  INSERT TIBIAL 7 10MM CRUC RET BEARING SCORPIO NRG KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-2-0712,SUP,Custom 27803010,,82-2-0712  -  INSERT TIBIAL 7 12MM CRUC RET BEARING SCORPIO NRG KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-2-0715,SUP,Custom 27803010,,82-2-0715  -  INSERT TIBIAL 7 15MM SCORPIO NRG CR ANKLE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-2-0718,SUP,Custom 27803010,,82-2-0718  -  INSERT TIBIAL 7 18MM CRUC RET BEARING SCORPIO NRG KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-2-0721,SUP,Custom 27803010,,82-2-0721  -  INSERT TIBIAL 7 21MM CRUC RET BEARING SCORPIO NRG KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-2-0724,SUP,Custom 27803010,,82-2-0724  -  INSERT TIBIAL 7 24MM CRUC RET BEARING SCORPIO NRG KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-2-0908,SUP,Custom 27803010,,82-2-0908  -  INSERT TIBIAL 9 8MM CRUC RET BEARING SCORPIO NRG KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-2-0910,SUP,Custom 27803010,,82-2-0910  -  INSERT TIBIAL 9 10MM CRUC RET BEARING SCORPIO NRG KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-2-0912,SUP,Custom 27803010,,82-2-0912  -  INSERT TIBIAL 9 12MM SCORPIO NRG CR ANKLE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-2-0915,SUP,Custom 27803010,,82-2-0915  -  INSERT TIBIAL 9 15MM CRUC RET BEARING SCORPIO NRG KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-2-0918,SUP,Custom 27803010,,82-2-0918  -  INSERT TIBIAL 9 18MM CRUC RET BEARING SCORPIO NRG KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-2-0921,SUP,Custom 27803010,,82-2-0921  -  INSERT TIBIAL 9 21MM CRUC RET BEARING SCORPIO NRG KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-2-0924,SUP,Custom 27803010,,82-2-0924  -  INSERT TIBIAL 9 24MM CRUC RET BEARING SCORPIO NRG KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-2-1108,SUP,Custom 27803010,,82-2-1108  -  INSERT TIBIAL 11 8MM CRUC RET BEARING SCORPIO NRG KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-2-1110,SUP,Custom 27803010,,82-2-1110  -  INSERT TIBIAL 11 10MM CRUC RET BEARING SCORPIO NRG KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-2-1112,SUP,Custom 27803010,,82-2-1112  -  INSERT TIBIAL 11 12MM CRUC RET BEARING SCORPIO NRG KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-2-1115,SUP,Custom 27803010,,82-2-1115  -  INSERT TIBIAL 11 15MM CRUC RET BEARING SCORPIO NRG KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-2-1118,SUP,Custom 27803010,,82-2-1118  -  INSERT TIBIAL 11 18MM CRUC RET BEARING SCORPIO NRG KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-2-1121,SUP,Custom 27803010,,82-2-1121  -  INSERT TIBIAL 11 21MM CRUC RET BEARING SCORPIO NRG KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-2-1124,SUP,Custom 27803010,,82-2-1124  -  INSERT TIBIAL 11 24MM CRUC RET BEARING SCORPIO NRG KNEE,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
822-230,SUP,HCPCS C1713,,822-230  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,209.00",$0.00,"$1,209.00",$544.05,$862.86,$0.00,$208.30,$0.00,$0.00,$211.69,"$1,209.00",$0.00,$604.50,$957.53,$967.20,$0.00,$189.21,$0.00,$192.47,$0.00
822-235,SUP,HCPCS C1713,,822-235  -  PLATE 18MM TI BONE SPNL,"$1,209.00",$0.00,"$1,209.00",$544.05,$862.86,$0.00,$208.30,$0.00,$0.00,$211.69,"$1,209.00",$0.00,$604.50,$957.53,$967.20,$0.00,$189.21,$0.00,$192.47,$0.00
82-3-0308,SUP,Custom 27803010,,82-3-0308  -  INSERT TIBIAL 3 8MM POSTERIOR STABILIZE BEARING SCORPIO NRG,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-3-0310,SUP,Custom 27803010,,82-3-0310  -  INSERT TIBIAL 3 10MM POSTERIOR STABILIZE BEARING SCORPIO NRG,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-3-0312,SUP,Custom 27803010,,82-3-0312  -  INSERT TIBIAL 3 12MM POSTERIOR STABILIZE BEARING SCORPIO NRG,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-3-0315,SUP,Custom 27803010,,82-3-0315  -  INSERT TIBIAL 3 15MM POSTERIOR STABILIZE BEARING SCORPIO NRG,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-3-0318,SUP,Custom 27803010,,82-3-0318  -  INSERT TIBIAL 3 18MM POSTERIOR STABILIZE BEARING SCORPIO NRG,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-3-0321,SUP,Custom 27803010,,82-3-0321  -  INSERT TIBIAL 3 21MM POSTERIOR STABILIZE BEARING SCORPIO NRG,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-3-0324,SUP,Custom 27803010,,82-3-0324  -  INSERT TIBIAL 3 24MM POSTERIOR STABILIZE BEARING SCORPIO NRG,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-3-0508,SUP,Custom 27803010,,82-3-0508  -  INSERT TIBIAL 5 8MM POSTERIOR STABILIZE BEARING SCORPIO NRG,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-3-0510,SUP,Custom 27803010,,82-3-0510  -  INSERT TIBIAL 5 10MM POSTERIOR STABILIZE BEARING SCORPIO NRG,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-3-0512,SUP,Custom 27803010,,82-3-0512  -  INSERT TIBIAL 5 12MM POSTERIOR STABILIZE BEARING SCORPIO NRG,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-3-0515,SUP,Custom 27803010,,82-3-0515  -  INSERT TIBIAL 5 15MM POSTERIOR STABILIZE BEARING SCORPIO NRG,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-3-0518,SUP,Custom 27803010,,82-3-0518  -  INSERT TIBIAL 5 18MM POSTERIOR STABILIZE BEARING SCORPIO NRG,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-3-0521,SUP,Custom 27803010,,82-3-0521  -  INSERT TIBIAL 5 21MM POSTERIOR STABILIZE BEARING SCORPIO NRG,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-3-0524,SUP,Custom 27803010,,82-3-0524  -  INSERT TIBIAL 5 24MM POSTERIOR STABILIZE BEARING SCORPIO NRG,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-3-0708,SUP,Custom 27803010,,82-3-0708  -  INSERT TIBIAL 7 8MM POSTERIOR STABILIZE BEARING SCORPIO NRG,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-3-0710,SUP,Custom 27803010,,82-3-0710  -  INSERT TIBIAL 7 10MM POSTERIOR STABILIZE BEARING SCORPIO NRG,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-3-0712,SUP,Custom 27803010,,82-3-0712  -  INSERT TIBIAL 7 12MM POSTERIOR STABILIZE BEARING SCORPIO NRG,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-3-0715,SUP,Custom 27803010,,82-3-0715  -  INSERT TIBIAL 7 15MM POSTERIOR STABILIZE BEARING SCORPIO NRG,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-3-0718,SUP,Custom 27803010,,82-3-0718  -  INSERT TIBIAL 7 18MM POSTERIOR STABILIZE BEARING SCORPIO NRG,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-3-0721,SUP,Custom 27803010,,82-3-0721  -  INSERT TIBIAL 7 21MM POSTERIOR STABILIZE BEARING SCORPIO NRG,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-3-0724,SUP,Custom 27803010,,82-3-0724  -  INSERT TIBIAL 7 24MM POSTERIOR STABILIZE BEARING SCORPIO NRG,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-3-0908,SUP,Custom 27803010,,82-3-0908  -  INSERT TIBIAL 9 8MM POSTERIOR STABILIZE BEARING SCORPIO NRG,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-3-0910,SUP,Custom 27803010,,82-3-0910  -  INSERT TIBIAL 9 10MM POSTERIOR STABILIZE BEARING SCORPIO NRG,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-3-0912,SUP,Custom 27803010,,82-3-0912  -  INSERT TIBIAL 9 12MM POSTERIOR STABILIZE BEARING SCORPIO NRG,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-3-0915,SUP,Custom 27803010,,82-3-0915  -  INSERT TIBIAL 9 15MM POSTERIOR STABILIZE BEARING SCORPIO NRG,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-3-0918,SUP,Custom 27803010,,82-3-0918  -  INSERT TIBIAL 9 18MM POSTERIOR STABILIZE BEARING SCORPIO NRG,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-3-0921,SUP,Custom 27803010,,82-3-0921  -  INSERT TIBIAL 9 21MM POSTERIOR STABILIZE BEARING SCORPIO NRG,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-3-0924,SUP,Custom 27803010,,82-3-0924  -  INSERT TIBIAL 9 24MM POSTERIOR STABILIZE BEARING SCORPIO NRG,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-3-1108,SUP,Custom 27803010,,82-3-1108  -  INSERT TIBIAL 11 8MM POSTERIOR STABILIZE BEARING SCORPIO NRG,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-3-1110,SUP,Custom 27803010,,82-3-1110  -  INSERT TIBIAL 11 10MM POSTERIOR STABILIZE BEARING SCORPIO,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-3-1112,SUP,Custom 27803010,,82-3-1112  -  INSERT TIBIAL 11 12MM POSTERIOR STABILIZE BEARING SCORPIO,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-3-1115,SUP,Custom 27803010,,82-3-1115  -  INSERT TIBIAL 11 15MM POSTERIOR STABILIZE BEARING SCORPIO,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-3-1118,SUP,Custom 27803010,,82-3-1118  -  INSERT TIBIAL 11 18MM POSTERIOR STABILIZE BEARING SCORPIO,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-3-1121,SUP,Custom 27803010,,82-3-1121  -  INSERT TIBIAL 11 21MM POSTERIOR STABILIZE BEARING SCORPIO,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-3-1124,SUP,Custom 27803010,,82-3-1124  -  INSERT TIBIAL 11 24MM POSTERIOR STABILIZE BEARING SCORPIO,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
82-3164,SUP,Custom 27803010,,82-3164  -  VALVE SHNT REG STRL STRT2 CSF PRGM FLW CNTRL BALL SPRG MECH,"$9,839.45",$0.00,"$9,839.45",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$9,839.45",$0.00,"$4,919.73","$7,792.84","$7,871.56",$0.00,$0.00,$0.00,$0.00,$0.00
824-005,SUP,HCPCS C1713,,824-005  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
824-007,SUP,Custom 27803010,,824-007  -  PLATE 18MM TI BONE SPNL,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
824-027,SUP,HCPCS C1713,,824-027  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
824-028,SUP,HCPCS C1713,,824-028  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
824-040,SUP,HCPCS C1713,,824-040  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
824-041,SUP,HCPCS C1713,,824-041  -  PLATE 18MM TI BONE SPNL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
824-042,SUP,HCPCS C1713,,824-042  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
82-50200,SUP,Custom 27203010,,ELECTRODE EMG NM RSPN PT SMLTR CBL 15FT 8250200,"$1,802.50",$0.00,"$1,802.50",$0.00,"$1,286.44",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,802.50",$0.00,$901.25,"$1,427.58","$1,442.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-50600,SUP,Custom 27203010,,ELECTRODE EMG NM RSPN PT SMLTR CBL 15FT 8250600,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-5472,SUP,Custom 27803010,,82-5472  -  VALVE SHNT REG STRL DLT CSF 1 LVL,"$3,617.13",$0.00,"$3,617.13",$0.00,"$2,581.54",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,617.13",$0.00,"$1,808.56","$2,864.77","$2,893.70",$0.00,$0.00,$0.00,$0.00,$0.00
82-5474,SUP,Custom 27803010,,82-5474  -  VALVE SHNT REG 40X16.5MM STRL LF 13MM DLT PS MDCL CSF PRFRM,"$3,617.13",$0.00,"$3,617.13",$0.00,"$2,581.54",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,617.13",$0.00,"$1,808.56","$2,864.77","$2,893.70",$0.00,$0.00,$0.00,$0.00,$0.00
826-011,SUP,Custom 27203010,,826-011  -  PLATE 18MM TI BONE SPNL,$828.50,$0.00,$828.50,$0.00,$591.30,$0.00,$0.00,$0.00,$0.00,$0.00,$828.50,$0.00,$414.25,$656.17,$662.80,$0.00,$0.00,$0.00,$0.00,$0.00
826-012,SUP,Custom 27203010,,826-012  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$828.50,$0.00,$828.50,$0.00,$591.30,$0.00,$0.00,$0.00,$0.00,$0.00,$828.50,$0.00,$414.25,$656.17,$662.80,$0.00,$0.00,$0.00,$0.00,$0.00
826-013,SUP,Custom 27203010,,826-013  -  PLATE 18MM TI BONE SPNL,$828.50,$0.00,$828.50,$0.00,$591.30,$0.00,$0.00,$0.00,$0.00,$0.00,$828.50,$0.00,$414.25,$656.17,$662.80,$0.00,$0.00,$0.00,$0.00,$0.00
826-016,SUP,Custom 27803010,,826-016  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$388.50,$0.00,$388.50,$0.00,$277.27,$0.00,$0.00,$0.00,$0.00,$0.00,$388.50,$0.00,$194.25,$307.69,$310.80,$0.00,$0.00,$0.00,$0.00,$0.00
82-6-0308,SUP,Custom 27803010,,82-6-0308  -  INSERT TIBIAL 3 8MM CRUC RET SCORPIO NRG X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-6-0310,SUP,Custom 27803010,,82-6-0310  -  INSERT TIBIAL 3 10MM CRUC RET SCORPIO NRG X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-6-0312,SUP,Custom 27803010,,82-6-0312  -  INSERT TIBIAL 3 12MM CRUC RET SCORPIO NRG X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-6-0314,SUP,Custom 27803010,,82-6-0314  -  INSERT TIBIAL 3 14MM CRUC RET SCORPIO NRG KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-6-0315,SUP,Custom 27803010,,82-6-0315  -  INSERT TIBIAL 3 15MM CRUC RET SCORPIO NRG X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-6-0318,SUP,Custom 27803010,,82-6-0318  -  INSERT TIBIAL 3 18MM CRUC RET SCORPIO NRG X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-6-0321,SUP,Custom 27803010,,82-6-0321  -  INSERT TIBIAL 3 21MM CRUC RET SCORPIO NRG X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-6-0324,SUP,Custom 27803010,,82-6-0324  -  INSERT TIBIAL 3 24MM CRUC RET SCORPIO NRG X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-6-0508,SUP,Custom 27803010,,82-6-0508  -  INSERT TIBIAL 5 8MM KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-6-0510,SUP,Custom 27803010,,82-6-0510  -  INSERT TIBIAL 5 10MM CRUC RET SCORPIO NRG X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-6-0512,SUP,Custom 27803010,,82-6-0512  -  INSERT TIBIAL 5 12MM CRUC RET SCORPIO NRG X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-6-0515,SUP,Custom 27803010,,82-6-0515  -  INSERT TIBIAL 5 15MM CRUC RET SCORPIO NRG X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-6-0518,SUP,Custom 27803010,,82-6-0518  -  INSERT TIBIAL 5 18MM CRUC RET SCORPIO NRG X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-6-0521,SUP,Custom 27803010,,82-6-0521  -  INSERT TIBIAL 5 21MM CRUC RET SCORPIO NRG X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-6-0524,SUP,Custom 27803010,,82-6-0524  -  INSERT TIBIAL 5 24MM CRUC RET SCORPIO NRG X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-6-0708,SUP,Custom 27803010,,82-6-0708  -  INSERT TIBIAL 7 8MM CRUC RET SCORPIO NRG X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-6-0710,SUP,Custom 27803010,,82-6-0710  -  INSERT TIBIAL 7 10MM CRUC RET SCORPIO NRG X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-6-0712,SUP,Custom 27803010,,82-6-0712  -  INSERT TIBIAL X3 POLYETHYLENE KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-6-0715,SUP,Custom 27803010,,82-6-0715  -  INSERT TIBIAL 7 15MM CRUC RET SCORPIO NRG X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-6-0718,SUP,Custom 27803010,,82-6-0718  -  INSERT TIBIAL 7 18MM CRUC RET SCORPIO NRG X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-6-0721,SUP,Custom 27803010,,82-6-0721  -  INSERT TIBIAL 7 21MM CRUC RET SCORPIO NRG X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-6-0724,SUP,Custom 27803010,,82-6-0724  -  INSERT TIBIAL 7 24MM CRUC RET SCORPIO NRG X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-6-0908,SUP,Custom 27803010,,82-6-0908  -  INSERT TIBIAL 9 8MM CRUC RET SCORPIO NRG X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-6-0910,SUP,Custom 27803010,,82-6-0910  -  INSERT TIBIAL 9 10MM CRUC RET SCORPIO NRG X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-6-0912,SUP,Custom 27803010,,82-6-0912  -  INSERT TIBIAL 9 12MM CRUC RET SCORPIO NRG X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-6-0914,SUP,Custom 27803010,,82-6-0914  -  INSERT TIBIAL 9 14MM CRUC RET SCORPIO NRG KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-6-0915,SUP,Custom 27803010,,82-6-0915  -  INSERT TIBIAL 9 15MM CRUC RET SCORPIO NRG X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-6-0916,SUP,Custom 27803010,,82-6-0916  -  INSERT TIBIAL 9 16MM CRUC RET SCORPIO NRG KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-6-0918,SUP,Custom 27803010,,82-6-0918  -  INSERT TIBIAL 9 18MM CRUC RET SCORPIO NRG X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-6-0921,SUP,Custom 27803010,,82-6-0921  -  INSERT TIBIAL 9 21MM CRUC RET SCORPIO NRG X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-6-0924,SUP,Custom 27803010,,82-6-0924  -  INSERT TIBIAL 9 24MM CRUC RET SCORPIO NRG X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-6-1108,SUP,Custom 27803010,,82-6-1108  -  INSERT TIBIAL 11 8MM CRUC RET SCORPIO NRG X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-6-1110,SUP,Custom 27803010,,82-6-1110  -  INSERT TIBIAL 11 10MM CRUC RET SCORPIO NRG X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-6-1112,SUP,Custom 27803010,,82-6-1112  -  INSERT TIBIAL 11 12MM CRUC RET SCORPIO NRG X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-6-1114,SUP,Custom 27803010,,82-6-1114  -  INSERT TIBIAL 11 14MM CRUC RET SCORPIO NRG KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-6-1115,SUP,Custom 27803010,,82-6-1115  -  INSERT TIBIAL 11 15MM CRUC RET SCORPIO NRG X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-6-1116,SUP,Custom 27803010,,82-6-1116  -  INSERT TIBIAL 11 16MM CRUC RET SCORPIO NRG KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-6-1118,SUP,Custom 27803010,,82-6-1118  -  INSERT TIBIAL CRUC RET SCORPIO X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-6-1121,SUP,Custom 27803010,,82-6-1121  -  INSERT TIBIAL 11 21MM CRUC RET SCORPIO NRG X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-6-1124,SUP,Custom 27803010,,82-6-1124  -  INSERT TIBIAL 11 24MM CRUC RET SCORPIO NRG X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
826-212,SUP,Custom 27203010,,826-212  -  PLATE 18MM TI BONE SPNL,"$1,004.75",$0.00,"$1,004.75",$0.00,$717.09,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,004.75",$0.00,$502.38,$795.76,$803.80,$0.00,$0.00,$0.00,$0.00,$0.00
826-213,SUP,Custom 27203010,,826-213  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,004.75",$0.00,"$1,004.75",$0.00,$717.09,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,004.75",$0.00,$502.38,$795.76,$803.80,$0.00,$0.00,$0.00,$0.00,$0.00
826-216,SUP,Custom 27803010,,826-216  -  PLATE 18MM TI BONE SPNL,$495.00,$0.00,$495.00,$0.00,$353.28,$0.00,$0.00,$0.00,$0.00,$0.00,$495.00,$0.00,$247.50,$392.04,$396.00,$0.00,$0.00,$0.00,$0.00,$0.00
826-217,SUP,HCPCS C1713,,826-217  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$178.50,$0.00,$178.50,$80.33,$127.40,$0.00,$30.75,$0.00,$0.00,$31.25,$178.50,$0.00,$89.25,$141.37,$142.80,$0.00,$27.94,$0.00,$28.42,$0.00
826-219,SUP,Custom 27203010,,826-219  -  PLATE 18MM TI BONE SPNL,"$1,004.75",$0.00,"$1,004.75",$0.00,$717.09,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,004.75",$0.00,$502.38,$795.76,$803.80,$0.00,$0.00,$0.00,$0.00,$0.00
826-320,SUP,Custom 27203010,,826-320  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,004.75",$0.00,"$1,004.75",$0.00,$717.09,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,004.75",$0.00,$502.38,$795.76,$803.80,$0.00,$0.00,$0.00,$0.00,$0.00
826614 - USE 19994800,SUP,Custom 27803010,,826614 - USE 19994800  -  KIT CRANIOTOMY CRANIAL ACCES CODMAN,$721.63,$0.00,$721.63,$0.00,$515.02,$0.00,$0.00,$0.00,$0.00,$0.00,$721.63,$0.00,$360.81,$571.53,$577.30,$0.00,$0.00,$0.00,$0.00,$0.00
82-6638,SUP,Custom 27803010,,82-6638  -  KIT PRSS MONITR MCSNSR .7MM SBDRL INPRENCH SKL BOLT,"$1,947.50",$0.00,"$1,947.50",$0.00,"$1,389.93",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,947.50",$0.00,$973.75,"$1,542.42","$1,558.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-6653,SUP,Custom 27803010,,82-6653  -  KIT PRESSURE MONITR 38CM TRANSDUCER CATHETER TUNNELING,"$2,027.50",$0.00,"$2,027.50",$0.00,"$1,447.03",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,027.50",$0.00,"$1,013.75","$1,605.78","$1,622.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-7-0308,SUP,Custom 27803010,,82-7-0308  -  INSERT TIBIAL 3 8MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-7-0310,SUP,Custom 27803010,,82-7-0310  -  INSERT TIBIAL 3 10MM,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-7-0312,SUP,Custom 27803010,,82-7-0312  -  INSERT TIBIAL 3 12MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-7-0314,SUP,Custom 27803010,,82-7-0314  -  INSERT TIBIAL 3 14MM POSTERIOR STABILIZING SCORPIO NRG KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-7-0315,SUP,Custom 27803010,,82-7-0315  -  INSERT TIBIAL 3 15MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-7-0316,SUP,Custom 27803010,,82-7-0316  -  INSERT TIBIAL 3 16MM POSTERIOR STABILIZE SCORPIO NRG KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-7-0318,SUP,Custom 27803010,,82-7-0318  -  INSERT TIBIAL 3 18MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-7-0321,SUP,Custom 27803010,,82-7-0321  -  INSERT TIBIAL 3 21MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-7-0324,SUP,Custom 27803010,,82-7-0324  -  INSERT TIBIAL 3 24MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-7-0508,SUP,Custom 27803010,,82-7-0508  -  INSERT TIBIAL 5 8MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-7-0510,SUP,Custom 27803010,,82-7-0510  -  INSERT TIBIAL 5 10MM,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-7-0512,SUP,Custom 27803010,,82-7-0512  -  INSERT TIBIAL 5 12MM,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-7-0514,SUP,Custom 27803010,,82-7-0514  -  INSERT TIBIAL 5 14MM POSTERIOR STABILIZE SCORPIO NRG KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-7-0515,SUP,Custom 27803010,,82-7-0515  -  INSERT TIBIAL 5 15MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-7-0516,SUP,Custom 27803010,,82-7-0516  -  INSERT TIBIAL 5 16MM POSTERIOR STABILIZE SCORPIO NRG KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-7-0518,SUP,Custom 27803010,,82-7-0518  -  INSERT TIBIAL 3 18MM,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-7-0521,SUP,Custom 27803010,,82-7-0521  -  INSERT TIBIAL 5 21MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-7-0524,SUP,Custom 27803010,,82-7-0524  -  INSERT TIBIAL 5 24MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-7-0708,SUP,Custom 27803010,,82-7-0708  -  INSERT TIBIAL 7 8MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-7-0710,SUP,Custom 27803010,,82-7-0710  -  INSERT TIBIAL 7 10MM,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-7-0712,SUP,Custom 27803010,,82-7-0712  -  INSERT TIBIAL 7 12MM SCORPIO KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-7-0714,SUP,Custom 27803010,,82-7-0714  -  INSERT TIBIAL 7 14MM POSTERIOR STABILIZE SCORPIO NRG KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-7-0715,SUP,Custom 27803010,,82-7-0715  -  INSERT TIBIAL 7 15MM SCORPIO KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-7-0716,SUP,Custom 27803010,,82-7-0716  -  INSERT TIBIAL 7 16MM POSTERIOR STABILIZE SCORPIO NRG KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-7-0718,SUP,Custom 27803010,,82-7-0718  -  INSERT TIBIAL 7 18MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-7-0721,SUP,Custom 27803010,,82-7-0721  -  INSERT TIBIAL 7 21MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-7-0724,SUP,Custom 27803010,,82-7-0724  -  INSERT TIBIAL 7 24MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-7-0908,SUP,Custom 27803010,,82-7-0908  -  INSERT TIBIAL 9 8MM KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-7-0910,SUP,Custom 27803010,,82-7-0910  -  INSERT TIBIAL 10MM KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-7-0912,SUP,Custom 27803010,,82-7-0912  -  INSERT TIBIAL 9 12MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-7-0914,SUP,Custom 27803010,,82-7-0914  -  INSERT TIBIAL 9 14MM POSTERIOR STABILIZE SCORPIO NRG KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-7-0915,SUP,Custom 27803010,,82-7-0915  -  INSERT TIBIAL 9 15MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-7-0916,SUP,Custom 27803010,,82-7-0916  -  INSERT TIBIAL 9 16MM POSTERIOR STABILIZE SCORPIO NRG KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-7-0918,SUP,Custom 27803010,,82-7-0918  -  INSERT TIBIAL 9 18MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-7-0921,SUP,Custom 27803010,,82-7-0921  -  INSERT TIBIAL 9 21MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-7-0924,SUP,Custom 27803010,,82-7-0924  -  INSERT TIBIAL 9 24MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-7-1108,SUP,Custom 27803010,,82-7-1108  -  INSERT TIBIAL 11 8MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-7-1110,SUP,Custom 27803010,,82-7-1110  -  INSERT TIBIAL 11 10MM POSTERIOR STABILIZE SCORPIO NRG X3,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-7-1112,SUP,Custom 27803010,,82-7-1112  -  INSERT TIBIAL 11 12MM POSTERIOR STABILIZE SCORPIO NRG X3,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-7-1114,SUP,Custom 27803010,,82-7-1114  -  INSERT TIBIAL 11 14MM POSTERIOR STABILIZE SCORPIO NRG KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-7-1115,SUP,Custom 27803010,,82-7-1115  -  INSERT TIBIAL 11 15MM POSTERIOR STABILIZE SCORPIO NRG X3,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-7-1116,SUP,Custom 27803010,,82-7-1116  -  INSERT TIBIAL 11 16MM POSTERIOR STABILIZE SCORPIO NRG KNEE,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-7-1118,SUP,Custom 27803010,,82-7-1118  -  INSERT TIBIAL 11 18MM POSTERIOR STABILIZE SCORPIO NRG X3,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-7-1121,SUP,Custom 27803010,,82-7-1121  -  INSERT TIBIAL 11 21MM POSTERIOR STABILIZE SCORPIO NRG X3,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
82-7-1124,SUP,Custom 27803010,,82-7-1124  -  INSERT TIBIAL 11 24MM POSTERIOR STABILIZE SCORPIO NRG X3,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
827-160,SUP,HCPCS C1713,,827-160  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$129.00,$0.00,$129.00,$58.05,$92.07,$0.00,$22.23,$0.00,$0.00,$22.59,$129.00,$0.00,$64.50,$102.17,$103.20,$0.00,$20.19,$0.00,$20.54,$0.00
828-083,SUP,HCPCS C1713,,828-083  -  PLATE 18MM TI BONE SPNL,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
828-090,SUP,HCPCS C1713,,828-090  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
828-105,SUP,HCPCS C1713,,828-105  -  PLATE 18MM TI BONE SPNL,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
828-107,SUP,HCPCS C1713,,828-107  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
828-135C,SUP,Custom 27803010,,828-135C  -  PLATE 18MM TI BONE SPNL,"$1,314.30",$0.00,"$1,314.30",$0.00,$938.02,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,314.30",$0.00,$657.15,"$1,040.93","$1,051.44",$0.00,$0.00,$0.00,$0.00,$0.00
828-136C,SUP,Custom 27803010,,828-136C  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,314.30",$0.00,"$1,314.30",$0.00,$938.02,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,314.30",$0.00,$657.15,"$1,040.93","$1,051.44",$0.00,$0.00,$0.00,$0.00,$0.00
828-137C,SUP,Custom 27803010,,828-137C  -  PLATE 18MM TI BONE SPNL,"$1,314.30",$0.00,"$1,314.30",$0.00,$938.02,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,314.30",$0.00,$657.15,"$1,040.93","$1,051.44",$0.00,$0.00,$0.00,$0.00,$0.00
828-145,SUP,HCPCS C1713,,828-145  -  SCREW BONE TSRH TI SPNL LCK FLSH BRK 6.35 MM ROD,$482.65,$0.00,$482.65,$217.19,$344.47,$0.00,$83.16,$0.00,$0.00,$84.51,$482.65,$0.00,$241.33,$382.26,$386.12,$0.00,$75.53,$0.00,$76.84,$0.00
828-190,SUP,HCPCS C1713,,828-190  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
828-191C,SUP,Custom 27803010,,828-191C  -  PLATE 18MM TI BONE SPNL,"$1,314.30",$0.00,"$1,314.30",$0.00,$938.02,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,314.30",$0.00,$657.15,"$1,040.93","$1,051.44",$0.00,$0.00,$0.00,$0.00,$0.00
828-193,SUP,Custom 27803010,,828-193  -  BOLT SPNL 6.35MM TSRH SM TI T TOP TGHT VA,"$2,361.80",$0.00,"$2,361.80",$0.00,"$1,685.62",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,361.80",$0.00,"$1,180.90","$1,870.55","$1,889.44",$0.00,$0.00,$0.00,$0.00,$0.00
828-193C,SUP,HCPCS C1713,,828-193C  -  BOLT SPNL 6.35MM TSRH SM TI T TOP TGHT CONNCTR,"$1,314.30",$0.00,"$1,314.30",$591.44,$938.02,$0.00,$226.45,$0.00,$0.00,$230.12,"$1,314.30",$0.00,$657.15,"$1,040.93","$1,051.44",$0.00,$205.69,$0.00,$209.24,$0.00
828-349C,SUP,Custom 27803010,,828-349C  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,314.30",$0.00,"$1,314.30",$0.00,$938.02,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,314.30",$0.00,$657.15,"$1,040.93","$1,051.44",$0.00,$0.00,$0.00,$0.00,$0.00
828-780,SUP,HCPCS C1713,,828-780  -  PLATE 18MM TI BONE SPNL,"$2,194.50",$0.00,"$2,194.50",$987.53,"$1,566.21",$0.00,$378.10,$0.00,$0.00,$384.24,"$2,194.50",$0.00,"$1,097.25","$1,738.04","$1,755.60",$0.00,$343.44,$0.00,$349.36,$0.00
828-785,SUP,HCPCS C1713,,828-785  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,194.50",$0.00,"$2,194.50",$987.53,"$1,566.21",$0.00,$378.10,$0.00,$0.00,$384.24,"$2,194.50",$0.00,"$1,097.25","$1,738.04","$1,755.60",$0.00,$343.44,$0.00,$349.36,$0.00
828-790,SUP,HCPCS C1713,,828-790  -  PLATE 18MM TI BONE SPNL,"$2,194.50",$0.00,"$2,194.50",$987.53,"$1,566.21",$0.00,$378.10,$0.00,$0.00,$384.24,"$2,194.50",$0.00,"$1,097.25","$1,738.04","$1,755.60",$0.00,$343.44,$0.00,$349.36,$0.00
828-795,SUP,HCPCS C1713,,828-795  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,194.50",$0.00,"$2,194.50",$987.53,"$1,566.21",$0.00,$378.10,$0.00,$0.00,$384.24,"$2,194.50",$0.00,"$1,097.25","$1,738.04","$1,755.60",$0.00,$343.44,$0.00,$349.36,$0.00
828800PL,SUP,Custom 27803010,,828800PL  -  VALVE SHUNT INLINE CERTAS,"$11,400.58",$0.00,"$11,400.58",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,400.58",$0.00,"$5,700.29","$9,029.26","$9,120.46",$0.00,$0.00,$0.00,$0.00,$0.00
828-830,SUP,HCPCS C1713,,828-830  -  PLATE 18MM TI BONE SPNL,"$2,194.50",$0.00,"$2,194.50",$987.53,"$1,566.21",$0.00,$378.10,$0.00,$0.00,$384.24,"$2,194.50",$0.00,"$1,097.25","$1,738.04","$1,755.60",$0.00,$343.44,$0.00,$349.36,$0.00
828-835,SUP,HCPCS C1713,,828-835  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,194.50",$0.00,"$2,194.50",$987.53,"$1,566.21",$0.00,$378.10,$0.00,$0.00,$384.24,"$2,194.50",$0.00,"$1,097.25","$1,738.04","$1,755.60",$0.00,$343.44,$0.00,$349.36,$0.00
828-840,SUP,HCPCS C1713,,828-840  -  PLATE 18MM TI BONE SPNL,"$2,194.50",$0.00,"$2,194.50",$987.53,"$1,566.21",$0.00,$378.10,$0.00,$0.00,$384.24,"$2,194.50",$0.00,"$1,097.25","$1,738.04","$1,755.60",$0.00,$343.44,$0.00,$349.36,$0.00
828-845,SUP,HCPCS C1713,,828-845  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,194.50",$0.00,"$2,194.50",$987.53,"$1,566.21",$0.00,$378.10,$0.00,$0.00,$384.24,"$2,194.50",$0.00,"$1,097.25","$1,738.04","$1,755.60",$0.00,$343.44,$0.00,$349.36,$0.00
828-850,SUP,HCPCS C1713,,828-850  -  PLATE 18MM TI BONE SPNL,"$2,194.50",$0.00,"$2,194.50",$987.53,"$1,566.21",$0.00,$378.10,$0.00,$0.00,$384.24,"$2,194.50",$0.00,"$1,097.25","$1,738.04","$1,755.60",$0.00,$343.44,$0.00,$349.36,$0.00
828-855,SUP,HCPCS C1713,,828-855  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,194.50",$0.00,"$2,194.50",$987.53,"$1,566.21",$0.00,$378.10,$0.00,$0.00,$384.24,"$2,194.50",$0.00,"$1,097.25","$1,738.04","$1,755.60",$0.00,$343.44,$0.00,$349.36,$0.00
828-860,SUP,HCPCS C1713,,828-860  -  PLATE 18MM TI BONE SPNL,"$2,194.50",$0.00,"$2,194.50",$987.53,"$1,566.21",$0.00,$378.10,$0.00,$0.00,$384.24,"$2,194.50",$0.00,"$1,097.25","$1,738.04","$1,755.60",$0.00,$343.44,$0.00,$349.36,$0.00
828-930,SUP,HCPCS C1713,,828-930  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,194.50",$0.00,"$2,194.50",$987.53,"$1,566.21",$0.00,$378.10,$0.00,$0.00,$384.24,"$2,194.50",$0.00,"$1,097.25","$1,738.04","$1,755.60",$0.00,$343.44,$0.00,$349.36,$0.00
828-935,SUP,HCPCS C1713,,828-935  -  PLATE 18MM TI BONE SPNL,"$2,194.50",$0.00,"$2,194.50",$987.53,"$1,566.21",$0.00,$378.10,$0.00,$0.00,$384.24,"$2,194.50",$0.00,"$1,097.25","$1,738.04","$1,755.60",$0.00,$343.44,$0.00,$349.36,$0.00
828-940,SUP,HCPCS C1713,,828-940  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,194.50",$0.00,"$2,194.50",$987.53,"$1,566.21",$0.00,$378.10,$0.00,$0.00,$384.24,"$2,194.50",$0.00,"$1,097.25","$1,738.04","$1,755.60",$0.00,$343.44,$0.00,$349.36,$0.00
828-945,SUP,HCPCS C1713,,828-945  -  PLATE 18MM TI BONE SPNL,"$2,194.50",$0.00,"$2,194.50",$987.53,"$1,566.21",$0.00,$378.10,$0.00,$0.00,$384.24,"$2,194.50",$0.00,"$1,097.25","$1,738.04","$1,755.60",$0.00,$343.44,$0.00,$349.36,$0.00
828-950,SUP,HCPCS C1713,,828-950  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,194.50",$0.00,"$2,194.50",$987.53,"$1,566.21",$0.00,$378.10,$0.00,$0.00,$384.24,"$2,194.50",$0.00,"$1,097.25","$1,738.04","$1,755.60",$0.00,$343.44,$0.00,$349.36,$0.00
830-031,SUP,HCPCS C1713,,830-031  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
830-033,SUP,HCPCS C1713,,830-033  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
830-035,SUP,HCPCS C1713,,830-035  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
830-037,SUP,HCPCS C1713,,830-037  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
830-039,SUP,HCPCS C1713,,830-039  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
830-041,SUP,HCPCS C1713,,830-041  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
830-043,SUP,HCPCS C1713,,830-043  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
830-045,SUP,HCPCS C1713,,830-045  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
830-050,SUP,HCPCS C1713,,830-050  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
830-051,SUP,HCPCS C1713,,830-051  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
8300KITB19A,SUP,Custom 27803010,,8300KITB19A  -  VALVE AOR 19MM STRL LF EDWRD INTUITY ELT,"$30,000.00",$0.00,"$30,000.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$30,000.00",$0.00,"$15,000.00","$23,760.00","$24,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
8300KITB21A,SUP,Custom 27803010,,8300KITB21A  -  VALVE AOR 21MM STRL LF EDWRD INTUITY ELT,"$30,000.00",$0.00,"$30,000.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$30,000.00",$0.00,"$15,000.00","$23,760.00","$24,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
8300KITB23A,SUP,Custom 27803010,,8300KITB23A  -  VALVE AOR 23MM STRL LF EDWRD INTUITY ELT,"$30,000.00",$0.00,"$30,000.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$30,000.00",$0.00,"$15,000.00","$23,760.00","$24,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
8300KITB25A,SUP,Custom 27803010,,8300KITB25A  -  VALVE AOR 25MM STRL LF EDWRD INTUITY ELT,"$30,000.00",$0.00,"$30,000.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$30,000.00",$0.00,"$15,000.00","$23,760.00","$24,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
8300KITB27A,SUP,Custom 27803010,,8300KITB27A  -  VALVE AOR 27MM STRL LF EDWRD INTUITY ELT,"$30,000.00",$0.00,"$30,000.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$30,000.00",$0.00,"$15,000.00","$23,760.00","$24,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
8304H,SUP,Custom 27203010,,8304H  -  SUTURE NABSB 7-0 BV-1 24IN BLU PR VSBLCK 2 ARM MFL,$47.46,$0.00,$47.46,$0.00,$33.88,$0.00,$0.00,$0.00,$0.00,$0.00,$47.46,$0.00,$23.73,$37.59,$37.97,$0.00,$0.00,$0.00,$0.00,$0.00
830-529,SUP,HCPCS C1713,,830-529  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
830-531,SUP,HCPCS C1713,,830-531  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
830-533,SUP,HCPCS C1713,,830-533  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
830-535,SUP,HCPCS C1713,,830-535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
830-537,SUP,HCPCS C1713,,830-537  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
830-539,SUP,HCPCS C1713,,830-539  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
830-541,SUP,HCPCS C1713,,830-541  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
830-550,SUP,HCPCS C1713,,830-550  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
830-551,SUP,HCPCS C1713,,830-551  -  PLATE 18MM TI BONE SPNL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
8305H,SUP,Custom 27203010,,8305H  -  SUTURE NONABSORBABLE 6-0 BV-1 24IN 2 ARM MONOFILAMENT FIRM,$47.36,$0.00,$47.36,$0.00,$33.80,$0.00,$0.00,$0.00,$0.00,$0.00,$47.36,$0.00,$23.68,$37.51,$37.89,$0.00,$0.00,$0.00,$0.00,$0.00
83545309H,SUP,HCPCS C1713,,83545309H  -  SCREW BN OSTEOGRIP TSRH HA SPNE,"$2,062.50",$0.00,"$2,062.50",$928.13,"$1,472.01",$0.00,$355.36,$0.00,$0.00,$361.13,"$2,062.50",$0.00,"$1,031.25","$1,633.50","$1,650.00",$0.00,$322.78,$0.00,$328.35,$0.00
83545359H,SUP,HCPCS C1713,,83545359H  -  SCREW BN OSTEOGRIP TSRH HA SPNE,"$2,062.50",$0.00,"$2,062.50",$928.13,"$1,472.01",$0.00,$355.36,$0.00,$0.00,$361.13,"$2,062.50",$0.00,"$1,031.25","$1,633.50","$1,650.00",$0.00,$322.78,$0.00,$328.35,$0.00
83545409H,SUP,HCPCS C1713,,83545409H  -  SCREW BN 4.5MM 40MM OSTEOGRIP TSRH HA SPNE,"$2,062.50",$0.00,"$2,062.50",$928.13,"$1,472.01",$0.00,$355.36,$0.00,$0.00,$361.13,"$2,062.50",$0.00,"$1,031.25","$1,633.50","$1,650.00",$0.00,$322.78,$0.00,$328.35,$0.00
83545459H,SUP,HCPCS C1713,,83545459H  -  SCREW BN 4.5MM 45MM OSTEOGRIP TSRH HA SPNE,"$2,062.50",$0.00,"$2,062.50",$928.13,"$1,472.01",$0.00,$355.36,$0.00,$0.00,$361.13,"$2,062.50",$0.00,"$1,031.25","$1,633.50","$1,650.00",$0.00,$322.78,$0.00,$328.35,$0.00
83545509H,SUP,HCPCS C1713,,83545509H  -  SCREW BN 4.5MM 50MM TSRH OSTEOGRIP THNLN TI SPNE,"$2,062.50",$0.00,"$2,062.50",$928.13,"$1,472.01",$0.00,$355.36,$0.00,$0.00,$361.13,"$2,062.50",$0.00,"$1,031.25","$1,633.50","$1,650.00",$0.00,$322.78,$0.00,$328.35,$0.00
83545559H,SUP,HCPCS C1713,,83545559H  -  SCREW BN 4.5MM 55MM OSTEOGRIP TSRH HA SPNE,"$2,062.50",$0.00,"$2,062.50",$928.13,"$1,472.01",$0.00,$355.36,$0.00,$0.00,$361.13,"$2,062.50",$0.00,"$1,031.25","$1,633.50","$1,650.00",$0.00,$322.78,$0.00,$328.35,$0.00
83545609H,SUP,HCPCS C1713,,83545609H  -  SCREW BN 4.5MM 60MM OSTEOGRIP TSRH HA SPNE,"$2,062.50",$0.00,"$2,062.50",$928.13,"$1,472.01",$0.00,$355.36,$0.00,$0.00,$361.13,"$2,062.50",$0.00,"$1,031.25","$1,633.50","$1,650.00",$0.00,$322.78,$0.00,$328.35,$0.00
83555309H,SUP,HCPCS C1713,,83555309H  -  SCREW BN 5.5MM 30MM OSTEOGRIP TSRH HA SPNE,"$2,062.50",$0.00,"$2,062.50",$928.13,"$1,472.01",$0.00,$355.36,$0.00,$0.00,$361.13,"$2,062.50",$0.00,"$1,031.25","$1,633.50","$1,650.00",$0.00,$322.78,$0.00,$328.35,$0.00
83555359H,SUP,HCPCS C1713,,83555359H  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,062.50",$0.00,"$2,062.50",$928.13,"$1,472.01",$0.00,$355.36,$0.00,$0.00,$361.13,"$2,062.50",$0.00,"$1,031.25","$1,633.50","$1,650.00",$0.00,$322.78,$0.00,$328.35,$0.00
83555409H,SUP,HCPCS C1713,,83555409H  -  SCREW BN 5.5MM 40MM OSTEOGRIP TSRH HA SPNE,"$2,062.50",$0.00,"$2,062.50",$928.13,"$1,472.01",$0.00,$355.36,$0.00,$0.00,$361.13,"$2,062.50",$0.00,"$1,031.25","$1,633.50","$1,650.00",$0.00,$322.78,$0.00,$328.35,$0.00
83555459H,SUP,HCPCS C1713,,83555459H  -  SCREW BN 5.5MM 45MM OSTEOGRIP TSRH HA SPNE,"$2,062.50",$0.00,"$2,062.50",$928.13,"$1,472.01",$0.00,$355.36,$0.00,$0.00,$361.13,"$2,062.50",$0.00,"$1,031.25","$1,633.50","$1,650.00",$0.00,$322.78,$0.00,$328.35,$0.00
83555509H,SUP,HCPCS C1713,,83555509H  -  SCREW BN 5.5MM 50MM OSTEOGRIP TSRH HA SPNE,"$2,062.50",$0.00,"$2,062.50",$928.13,"$1,472.01",$0.00,$355.36,$0.00,$0.00,$361.13,"$2,062.50",$0.00,"$1,031.25","$1,633.50","$1,650.00",$0.00,$322.78,$0.00,$328.35,$0.00
83555559H,SUP,HCPCS C1713,,83555559H  -  SCREW BN 5.5MM 55MM OSTEOGRIP TSRH HA SPNE,"$2,062.50",$0.00,"$2,062.50",$928.13,"$1,472.01",$0.00,$355.36,$0.00,$0.00,$361.13,"$2,062.50",$0.00,"$1,031.25","$1,633.50","$1,650.00",$0.00,$322.78,$0.00,$328.35,$0.00
83555609H,SUP,HCPCS C1713,,83555609H  -  SCREW BN 5.5MM 60MM OSTEOGRIP TSRH HA SPNE,"$2,062.50",$0.00,"$2,062.50",$928.13,"$1,472.01",$0.00,$355.36,$0.00,$0.00,$361.13,"$2,062.50",$0.00,"$1,031.25","$1,633.50","$1,650.00",$0.00,$322.78,$0.00,$328.35,$0.00
83565309H,SUP,HCPCS C1713,,83565309H  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,062.50",$0.00,"$2,062.50",$928.13,"$1,472.01",$0.00,$355.36,$0.00,$0.00,$361.13,"$2,062.50",$0.00,"$1,031.25","$1,633.50","$1,650.00",$0.00,$322.78,$0.00,$328.35,$0.00
83565359H,SUP,HCPCS C1713,,83565359H  -  PLATE 18MM TI BONE SPNL,"$2,062.50",$0.00,"$2,062.50",$928.13,"$1,472.01",$0.00,$355.36,$0.00,$0.00,$361.13,"$2,062.50",$0.00,"$1,031.25","$1,633.50","$1,650.00",$0.00,$322.78,$0.00,$328.35,$0.00
83565409H,SUP,HCPCS C1713,,83565409H  -  SCREW BN 5.5MM 40MM OSTEOGRIP TSRH HA SPNE,"$2,062.50",$0.00,"$2,062.50",$928.13,"$1,472.01",$0.00,$355.36,$0.00,$0.00,$361.13,"$2,062.50",$0.00,"$1,031.25","$1,633.50","$1,650.00",$0.00,$322.78,$0.00,$328.35,$0.00
83565459H,SUP,HCPCS C1713,,83565459H  -  SCREW BN 5.5MM 45MM OSTEOGRIP TSRH HA SPNE,"$2,062.50",$0.00,"$2,062.50",$928.13,"$1,472.01",$0.00,$355.36,$0.00,$0.00,$361.13,"$2,062.50",$0.00,"$1,031.25","$1,633.50","$1,650.00",$0.00,$322.78,$0.00,$328.35,$0.00
83565509H,SUP,HCPCS C1713,,83565509H  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,062.50",$0.00,"$2,062.50",$928.13,"$1,472.01",$0.00,$355.36,$0.00,$0.00,$361.13,"$2,062.50",$0.00,"$1,031.25","$1,633.50","$1,650.00",$0.00,$322.78,$0.00,$328.35,$0.00
83565559H,SUP,HCPCS C1713,,83565559H  -  PLATE 18MM TI BONE SPNL,"$2,062.50",$0.00,"$2,062.50",$928.13,"$1,472.01",$0.00,$355.36,$0.00,$0.00,$361.13,"$2,062.50",$0.00,"$1,031.25","$1,633.50","$1,650.00",$0.00,$322.78,$0.00,$328.35,$0.00
83565609H,SUP,HCPCS C1713,,83565609H  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,062.50",$0.00,"$2,062.50",$928.13,"$1,472.01",$0.00,$355.36,$0.00,$0.00,$361.13,"$2,062.50",$0.00,"$1,031.25","$1,633.50","$1,650.00",$0.00,$322.78,$0.00,$328.35,$0.00
83575309H,SUP,HCPCS C1713,,83575309H  -  SCREW BN 7.5MM 30MM OSTEOGRIP TSRH HA SPNE,"$2,062.50",$0.00,"$2,062.50",$928.13,"$1,472.01",$0.00,$355.36,$0.00,$0.00,$361.13,"$2,062.50",$0.00,"$1,031.25","$1,633.50","$1,650.00",$0.00,$322.78,$0.00,$328.35,$0.00
83575359H,SUP,HCPCS C1713,,83575359H  -  SCREW BN 7.5MM 35MM OSTEOGRIP TSRH HA SPNE,"$2,062.50",$0.00,"$2,062.50",$928.13,"$1,472.01",$0.00,$355.36,$0.00,$0.00,$361.13,"$2,062.50",$0.00,"$1,031.25","$1,633.50","$1,650.00",$0.00,$322.78,$0.00,$328.35,$0.00
83575409H,SUP,HCPCS C1713,,83575409H  -  SCREW BN 7.5MM 40MM OSTEOGRIP TSRH HA SPNE,"$2,062.50",$0.00,"$2,062.50",$928.13,"$1,472.01",$0.00,$355.36,$0.00,$0.00,$361.13,"$2,062.50",$0.00,"$1,031.25","$1,633.50","$1,650.00",$0.00,$322.78,$0.00,$328.35,$0.00
83575459H,SUP,HCPCS C1713,,83575459H  -  SCREW BN 7.5MM 45MM OSTEOGRIP TSRH HA SPNE,"$2,062.50",$0.00,"$2,062.50",$928.13,"$1,472.01",$0.00,$355.36,$0.00,$0.00,$361.13,"$2,062.50",$0.00,"$1,031.25","$1,633.50","$1,650.00",$0.00,$322.78,$0.00,$328.35,$0.00
83575509H,SUP,HCPCS C1713,,83575509H  -  SCREW BN 7.5MM 50MM OSTEOGRIP TSRH HA SPNE,"$2,062.50",$0.00,"$2,062.50",$928.13,"$1,472.01",$0.00,$355.36,$0.00,$0.00,$361.13,"$2,062.50",$0.00,"$1,031.25","$1,633.50","$1,650.00",$0.00,$322.78,$0.00,$328.35,$0.00
83575559H,SUP,HCPCS C1713,,83575559H  -  SCREW BN 7.5MM 55MM OSTEOGRIP TSRH HA SPNE,"$2,062.50",$0.00,"$2,062.50",$928.13,"$1,472.01",$0.00,$355.36,$0.00,$0.00,$361.13,"$2,062.50",$0.00,"$1,031.25","$1,633.50","$1,650.00",$0.00,$322.78,$0.00,$328.35,$0.00
83575609H,SUP,HCPCS C1713,,83575609H  -  SCREW BN 7.5MM 60MM OSTEOGRIP TSRH HA SPNE,"$2,062.50",$0.00,"$2,062.50",$928.13,"$1,472.01",$0.00,$355.36,$0.00,$0.00,$361.13,"$2,062.50",$0.00,"$1,031.25","$1,633.50","$1,650.00",$0.00,$322.78,$0.00,$328.35,$0.00
83585309H,SUP,HCPCS C1713,,83585309H  -  SCREW BN 8.5MM 30MM OSTEOGRIP TSRH HA SPNE,"$2,062.50",$0.00,"$2,062.50",$928.13,"$1,472.01",$0.00,$355.36,$0.00,$0.00,$361.13,"$2,062.50",$0.00,"$1,031.25","$1,633.50","$1,650.00",$0.00,$322.78,$0.00,$328.35,$0.00
83585359H,SUP,HCPCS C1713,,83585359H  -  SCREW BN 8.5MM 35MM OSTEOGRIP TSRH HA SPNE,"$2,062.50",$0.00,"$2,062.50",$928.13,"$1,472.01",$0.00,$355.36,$0.00,$0.00,$361.13,"$2,062.50",$0.00,"$1,031.25","$1,633.50","$1,650.00",$0.00,$322.78,$0.00,$328.35,$0.00
83585409H,SUP,HCPCS C1713,,83585409H  -  SCREW BN 8.5MM 40MM OSTEOGRIP TSRH HA SPNE,"$2,062.50",$0.00,"$2,062.50",$928.13,"$1,472.01",$0.00,$355.36,$0.00,$0.00,$361.13,"$2,062.50",$0.00,"$1,031.25","$1,633.50","$1,650.00",$0.00,$322.78,$0.00,$328.35,$0.00
83585459H,SUP,HCPCS C1713,,83585459H  -  SCREW BN 8.5MM 45MM OSTEOGRIP TSRH HA SPNE,"$2,062.50",$0.00,"$2,062.50",$928.13,"$1,472.01",$0.00,$355.36,$0.00,$0.00,$361.13,"$2,062.50",$0.00,"$1,031.25","$1,633.50","$1,650.00",$0.00,$322.78,$0.00,$328.35,$0.00
83585509H,SUP,HCPCS C1713,,83585509H  -  SCREW BN 8.5MM 50MM OSTEOGRIP TSRH HA SPNE,"$2,062.50",$0.00,"$2,062.50",$928.13,"$1,472.01",$0.00,$355.36,$0.00,$0.00,$361.13,"$2,062.50",$0.00,"$1,031.25","$1,633.50","$1,650.00",$0.00,$322.78,$0.00,$328.35,$0.00
83585559H,SUP,HCPCS C1713,,83585559H  -  SCREW BN 8.5MM 55MM OSTEOGRIP TSRH HA SPNE,"$2,062.50",$0.00,"$2,062.50",$928.13,"$1,472.01",$0.00,$355.36,$0.00,$0.00,$361.13,"$2,062.50",$0.00,"$1,031.25","$1,633.50","$1,650.00",$0.00,$322.78,$0.00,$328.35,$0.00
83585609H,SUP,HCPCS C1713,,83585609H  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,062.50",$0.00,"$2,062.50",$928.13,"$1,472.01",$0.00,$355.36,$0.00,$0.00,$361.13,"$2,062.50",$0.00,"$1,031.25","$1,633.50","$1,650.00",$0.00,$322.78,$0.00,$328.35,$0.00
837-125,SUP,HCPCS C1713,,837-125  -  PLATE 18MM TI BONE SPNL,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
837-135,SUP,HCPCS C1713,,837-135  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
837-230,SUP,HCPCS C1713,,837-230  -  PLATE 18MM TI BONE SPNL,"$1,087.50",$0.00,"$1,087.50",$489.38,$776.15,$0.00,$187.37,$0.00,$0.00,$190.41,"$1,087.50",$0.00,$543.75,$861.30,$870.00,$0.00,$170.19,$0.00,$173.13,$0.00
837-235,SUP,HCPCS C1713,,837-235  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,087.50",$0.00,"$1,087.50",$489.38,$776.15,$0.00,$187.37,$0.00,$0.00,$190.41,"$1,087.50",$0.00,$543.75,$861.30,$870.00,$0.00,$170.19,$0.00,$173.13,$0.00
837-240,SUP,HCPCS C1713,,837-240  -  PLATE 18MM TI BONE SPNL,"$1,087.50",$0.00,"$1,087.50",$489.38,$776.15,$0.00,$187.37,$0.00,$0.00,$190.41,"$1,087.50",$0.00,$543.75,$861.30,$870.00,$0.00,$170.19,$0.00,$173.13,$0.00
837-245,SUP,HCPCS C1713,,837-245  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,087.50",$0.00,"$1,087.50",$489.38,$776.15,$0.00,$187.37,$0.00,$0.00,$190.41,"$1,087.50",$0.00,$543.75,$861.30,$870.00,$0.00,$170.19,$0.00,$173.13,$0.00
837-250,SUP,HCPCS C1713,,837-250  -  PLATE 18MM TI BONE SPNL,"$1,087.50",$0.00,"$1,087.50",$489.38,$776.15,$0.00,$187.37,$0.00,$0.00,$190.41,"$1,087.50",$0.00,$543.75,$861.30,$870.00,$0.00,$170.19,$0.00,$173.13,$0.00
837-330,SUP,HCPCS C1713,,837-330  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,087.50",$0.00,"$1,087.50",$489.38,$776.15,$0.00,$187.37,$0.00,$0.00,$190.41,"$1,087.50",$0.00,$543.75,$861.30,$870.00,$0.00,$170.19,$0.00,$173.13,$0.00
837-335,SUP,HCPCS C1713,,837-335  -  PLATE 18MM TI BONE SPNL,"$1,087.50",$0.00,"$1,087.50",$489.38,$776.15,$0.00,$187.37,$0.00,$0.00,$190.41,"$1,087.50",$0.00,$543.75,$861.30,$870.00,$0.00,$170.19,$0.00,$173.13,$0.00
837-340,SUP,HCPCS C1713,,837-340  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,087.50",$0.00,"$1,087.50",$489.38,$776.15,$0.00,$187.37,$0.00,$0.00,$190.41,"$1,087.50",$0.00,$543.75,$861.30,$870.00,$0.00,$170.19,$0.00,$173.13,$0.00
837-345,SUP,HCPCS C1713,,837-345  -  PLATE 18MM TI BONE SPNL,"$1,087.50",$0.00,"$1,087.50",$489.38,$776.15,$0.00,$187.37,$0.00,$0.00,$190.41,"$1,087.50",$0.00,$543.75,$861.30,$870.00,$0.00,$170.19,$0.00,$173.13,$0.00
837-350,SUP,HCPCS C1713,,837-350  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,087.50",$0.00,"$1,087.50",$489.38,$776.15,$0.00,$187.37,$0.00,$0.00,$190.41,"$1,087.50",$0.00,$543.75,$861.30,$870.00,$0.00,$170.19,$0.00,$173.13,$0.00
837-355,SUP,HCPCS C1713,,837-355  -  PLATE 18MM TI BONE SPNL,"$1,087.50",$0.00,"$1,087.50",$489.38,$776.15,$0.00,$187.37,$0.00,$0.00,$190.41,"$1,087.50",$0.00,$543.75,$861.30,$870.00,$0.00,$170.19,$0.00,$173.13,$0.00
837-430,SUP,HCPCS C1713,,837-430  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,087.50",$0.00,"$1,087.50",$489.38,$776.15,$0.00,$187.37,$0.00,$0.00,$190.41,"$1,087.50",$0.00,$543.75,$861.30,$870.00,$0.00,$170.19,$0.00,$173.13,$0.00
837-435,SUP,HCPCS C1713,,837-435  -  PLATE 18MM TI BONE SPNL,"$1,087.50",$0.00,"$1,087.50",$489.38,$776.15,$0.00,$187.37,$0.00,$0.00,$190.41,"$1,087.50",$0.00,$543.75,$861.30,$870.00,$0.00,$170.19,$0.00,$173.13,$0.00
837-440,SUP,HCPCS C1713,,837-440  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,087.50",$0.00,"$1,087.50",$489.38,$776.15,$0.00,$187.37,$0.00,$0.00,$190.41,"$1,087.50",$0.00,$543.75,$861.30,$870.00,$0.00,$170.19,$0.00,$173.13,$0.00
837-445,SUP,HCPCS C1713,,837-445  -  PLATE 18MM TI BONE SPNL,"$1,087.50",$0.00,"$1,087.50",$489.38,$776.15,$0.00,$187.37,$0.00,$0.00,$190.41,"$1,087.50",$0.00,$543.75,$861.30,$870.00,$0.00,$170.19,$0.00,$173.13,$0.00
837-450,SUP,HCPCS C1713,,837-450  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,087.50",$0.00,"$1,087.50",$489.38,$776.15,$0.00,$187.37,$0.00,$0.00,$190.41,"$1,087.50",$0.00,$543.75,$861.30,$870.00,$0.00,$170.19,$0.00,$173.13,$0.00
837-455,SUP,HCPCS C1713,,837-455  -  PLATE 18MM TI BONE SPNL,"$1,087.50",$0.00,"$1,087.50",$489.38,$776.15,$0.00,$187.37,$0.00,$0.00,$190.41,"$1,087.50",$0.00,$543.75,$861.30,$870.00,$0.00,$170.19,$0.00,$173.13,$0.00
837-460,SUP,HCPCS C1713,,837-460  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,087.50",$0.00,"$1,087.50",$489.38,$776.15,$0.00,$187.37,$0.00,$0.00,$190.41,"$1,087.50",$0.00,$543.75,$861.30,$870.00,$0.00,$170.19,$0.00,$173.13,$0.00
837-530,SUP,HCPCS C1713,,837-530  -  PLATE 18MM TI BONE SPNL,$984.00,$0.00,$984.00,$442.80,$702.28,$0.00,$169.54,$0.00,$0.00,$172.29,$984.00,$0.00,$492.00,$779.33,$787.20,$0.00,$154.00,$0.00,$156.65,$0.00
837-535,SUP,HCPCS C1713,,837-535  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$984.00,$0.00,$984.00,$442.80,$702.28,$0.00,$169.54,$0.00,$0.00,$172.29,$984.00,$0.00,$492.00,$779.33,$787.20,$0.00,$154.00,$0.00,$156.65,$0.00
837-540,SUP,HCPCS C1713,,837-540  -  PLATE 18MM TI BONE SPNL,$984.00,$0.00,$984.00,$442.80,$702.28,$0.00,$169.54,$0.00,$0.00,$172.29,$984.00,$0.00,$492.00,$779.33,$787.20,$0.00,$154.00,$0.00,$156.65,$0.00
837-545,SUP,HCPCS C1713,,837-545  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$984.00,$0.00,$984.00,$442.80,$702.28,$0.00,$169.54,$0.00,$0.00,$172.29,$984.00,$0.00,$492.00,$779.33,$787.20,$0.00,$154.00,$0.00,$156.65,$0.00
837-550,SUP,HCPCS C1713,,837-550  -  PLATE 18MM TI BONE SPNL,$984.00,$0.00,$984.00,$442.80,$702.28,$0.00,$169.54,$0.00,$0.00,$172.29,$984.00,$0.00,$492.00,$779.33,$787.20,$0.00,$154.00,$0.00,$156.65,$0.00
837-630,SUP,HCPCS C1713,,837-630  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$984.00,$0.00,$984.00,$442.80,$702.28,$0.00,$169.54,$0.00,$0.00,$172.29,$984.00,$0.00,$492.00,$779.33,$787.20,$0.00,$154.00,$0.00,$156.65,$0.00
837-635,SUP,HCPCS C1713,,837-635  -  PLATE 18MM TI BONE SPNL,$984.00,$0.00,$984.00,$442.80,$702.28,$0.00,$169.54,$0.00,$0.00,$172.29,$984.00,$0.00,$492.00,$779.33,$787.20,$0.00,$154.00,$0.00,$156.65,$0.00
837-640,SUP,HCPCS C1713,,837-640  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$984.00,$0.00,$984.00,$442.80,$702.28,$0.00,$169.54,$0.00,$0.00,$172.29,$984.00,$0.00,$492.00,$779.33,$787.20,$0.00,$154.00,$0.00,$156.65,$0.00
837-645,SUP,HCPCS C1713,,837-645  -  PLATE 18MM TI BONE SPNL,$984.00,$0.00,$984.00,$442.80,$702.28,$0.00,$169.54,$0.00,$0.00,$172.29,$984.00,$0.00,$492.00,$779.33,$787.20,$0.00,$154.00,$0.00,$156.65,$0.00
837-650,SUP,HCPCS C1713,,837-650  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$984.00,$0.00,$984.00,$442.80,$702.28,$0.00,$169.54,$0.00,$0.00,$172.29,$984.00,$0.00,$492.00,$779.33,$787.20,$0.00,$154.00,$0.00,$156.65,$0.00
837-655,SUP,HCPCS C1713,,837-655  -  PLATE 18MM TI BONE SPNL,$984.00,$0.00,$984.00,$442.80,$702.28,$0.00,$169.54,$0.00,$0.00,$172.29,$984.00,$0.00,$492.00,$779.33,$787.20,$0.00,$154.00,$0.00,$156.65,$0.00
837-730,SUP,HCPCS C1713,,837-730  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$984.00,$0.00,$984.00,$442.80,$702.28,$0.00,$169.54,$0.00,$0.00,$172.29,$984.00,$0.00,$492.00,$779.33,$787.20,$0.00,$154.00,$0.00,$156.65,$0.00
837-735,SUP,HCPCS C1713,,837-735  -  PLATE 18MM TI BONE SPNL,$984.00,$0.00,$984.00,$442.80,$702.28,$0.00,$169.54,$0.00,$0.00,$172.29,$984.00,$0.00,$492.00,$779.33,$787.20,$0.00,$154.00,$0.00,$156.65,$0.00
837-740,SUP,HCPCS C1713,,837-740  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$984.00,$0.00,$984.00,$442.80,$702.28,$0.00,$169.54,$0.00,$0.00,$172.29,$984.00,$0.00,$492.00,$779.33,$787.20,$0.00,$154.00,$0.00,$156.65,$0.00
837-745,SUP,HCPCS C1713,,837-745  -  PLATE 18MM TI BONE SPNL,$984.00,$0.00,$984.00,$442.80,$702.28,$0.00,$169.54,$0.00,$0.00,$172.29,$984.00,$0.00,$492.00,$779.33,$787.20,$0.00,$154.00,$0.00,$156.65,$0.00
837-750,SUP,HCPCS C1713,,837-750  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$984.00,$0.00,$984.00,$442.80,$702.28,$0.00,$169.54,$0.00,$0.00,$172.29,$984.00,$0.00,$492.00,$779.33,$787.20,$0.00,$154.00,$0.00,$156.65,$0.00
837-755,SUP,HCPCS C1713,,837-755  -  PLATE 18MM TI BONE SPNL,$984.00,$0.00,$984.00,$442.80,$702.28,$0.00,$169.54,$0.00,$0.00,$172.29,$984.00,$0.00,$492.00,$779.33,$787.20,$0.00,$154.00,$0.00,$156.65,$0.00
837-760,SUP,HCPCS C1713,,837-760  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$984.00,$0.00,$984.00,$442.80,$702.28,$0.00,$169.54,$0.00,$0.00,$172.29,$984.00,$0.00,$492.00,$779.33,$787.20,$0.00,$154.00,$0.00,$156.65,$0.00
837-835,SUP,HCPCS C1713,,837-835  -  PLATE 18MM TI BONE SPNL,$984.00,$0.00,$984.00,$442.80,$702.28,$0.00,$169.54,$0.00,$0.00,$172.29,$984.00,$0.00,$492.00,$779.33,$787.20,$0.00,$154.00,$0.00,$156.65,$0.00
837-845,SUP,HCPCS C1713,,837-845  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$984.00,$0.00,$984.00,$442.80,$702.28,$0.00,$169.54,$0.00,$0.00,$172.29,$984.00,$0.00,$492.00,$779.33,$787.20,$0.00,$154.00,$0.00,$156.65,$0.00
8379120C,SUP,Custom 27803010,,8379120C  -  PLATE 18MM TI BONE SPNL,"$2,165.65",$0.00,"$2,165.65",$0.00,"$1,545.62",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,165.65",$0.00,"$1,082.83","$1,715.19","$1,732.52",$0.00,$0.00,$0.00,$0.00,$0.00
8379121C,SUP,Custom 27803010,,8379121C  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,165.65",$0.00,"$2,165.65",$0.00,"$1,545.62",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,165.65",$0.00,"$1,082.83","$1,715.19","$1,732.52",$0.00,$0.00,$0.00,$0.00,$0.00
838-012,SUP,HCPCS C1713,,838-012  -  PLATE 18MM TI BONE SPNL,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
838-855,SUP,HCPCS C1713,,838-855  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
8400-0611,SUP,HCPCS Q4107,,8400-0611  -  TISSUE SYNTH CALCIUM SLF 5ML OSTST RESORB MINI BEAD KIT FST,"$1,637.50",$0.00,"$1,637.50",$0.00,"$1,168.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,637.50",$0.00,$818.75,"$1,296.90","$1,310.00",$0.00,$0.00,$0.00,$0.00,$0.00
84133HT,SUP,HCPCS C1713,,84133HT  -  PLATE 18MM TI BONE SPNL,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
84154T,SUP,Custom 27803010,,84154T  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,200.50",$0.00,"$2,200.50",$0.00,"$1,570.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.50",$0.00,"$1,100.25","$1,742.80","$1,760.40",$0.00,$0.00,$0.00,$0.00,$0.00
84161HT,SUP,HCPCS C1713,,84161HT  -  PLATE 18MM TI BONE SPNL,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
84181H,SUP,Custom 27803010,,84181H  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,991.25",$0.00,"$1,991.25",$0.00,"$1,421.16",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,991.25",$0.00,$995.63,"$1,577.07","$1,593.00",$0.00,$0.00,$0.00,$0.00,$0.00
84193H,SUP,HCPCS C1713,,84193H  -  PLATE 18MM TI BONE SPNL,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
84193HT,SUP,HCPCS C1713,,84193HT  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
8450107030D,SUP,Custom 27203010,,8450107030D  -  BIT DRILL 3MM 13CM MATCH HEAD DIAMOND,$466.35,$0.00,$466.35,$0.00,$332.83,$0.00,$0.00,$0.00,$0.00,$0.00,$466.35,$0.00,$233.18,$369.35,$373.08,$0.00,$0.00,$0.00,$0.00,$0.00
845-011,SUP,HCPCS C1713,,845-011  -  PLATE 18MM TI BONE SPNL,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
84505H,SUP,Custom 27803010,,84505H  -  CONNECTOR ROD 5.5/5.5MM DMN SPNE,"$1,796.58",$0.00,"$1,796.58",$0.00,"$1,282.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,796.58",$0.00,$898.29,"$1,422.89","$1,437.26",$0.00,$0.00,$0.00,$0.00,$0.00
84505HT,SUP,Custom 27803010,,84505HT  -  PLATE 18MM TI BONE SPNL,"$1,831.18",$0.00,"$1,831.18",$0.00,"$1,306.91",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,831.18",$0.00,$915.59,"$1,450.29","$1,464.94",$0.00,$0.00,$0.00,$0.00,$0.00
84505LH,SUP,Custom 27803010,,84505LH  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,796.58",$0.00,"$1,796.58",$0.00,"$1,282.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,796.58",$0.00,$898.29,"$1,422.89","$1,437.26",$0.00,$0.00,$0.00,$0.00,$0.00
84505QH,SUP,Custom 27803010,,84505QH  -  PLATE 18MM TI BONE SPNL,"$1,831.18",$0.00,"$1,831.18",$0.00,"$1,306.91",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,831.18",$0.00,$915.59,"$1,450.29","$1,464.94",$0.00,$0.00,$0.00,$0.00,$0.00
84506H,SUP,Custom 27803010,,84506H  -  CONNECTOR ROD 5.5/6.35MM CD HZN DMN SS SPNE,"$1,796.58",$0.00,"$1,796.58",$0.00,"$1,282.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,796.58",$0.00,$898.29,"$1,422.89","$1,437.26",$0.00,$0.00,$0.00,$0.00,$0.00
84506HT,SUP,Custom 27803010,,84506HT  -  PLATE 18MM TI BONE SPNL,"$1,831.18",$0.00,"$1,831.18",$0.00,"$1,306.91",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,831.18",$0.00,$915.59,"$1,450.29","$1,464.94",$0.00,$0.00,$0.00,$0.00,$0.00
84507H,SUP,Custom 27803010,,84507H  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,052.75",$0.00,"$2,052.75",$0.00,"$1,465.05",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,052.75",$0.00,"$1,026.38","$1,625.78","$1,642.20",$0.00,$0.00,$0.00,$0.00,$0.00
84507HT,SUP,Custom 27803010,,84507HT  -  PLATE 18MM TI BONE SPNL,"$1,831.18",$0.00,"$1,831.18",$0.00,"$1,306.91",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,831.18",$0.00,$915.59,"$1,450.29","$1,464.94",$0.00,$0.00,$0.00,$0.00,$0.00
84509H,SUP,Custom 27803010,,84509H  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,118.45",$0.00,"$2,118.45",$0.00,"$1,511.94",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,118.45",$0.00,"$1,059.23","$1,677.81","$1,694.76",$0.00,$0.00,$0.00,$0.00,$0.00
84509HT,SUP,Custom 27803010,,84509HT  -  PLATE 18MM TI BONE SPNL,"$2,346.10",$0.00,"$2,346.10",$0.00,"$1,674.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,346.10",$0.00,"$1,173.05","$1,858.11","$1,876.88",$0.00,$0.00,$0.00,$0.00,$0.00
84510H,SUP,Custom 27803010,,84510H  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,118.45",$0.00,"$2,118.45",$0.00,"$1,511.94",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,118.45",$0.00,"$1,059.23","$1,677.81","$1,694.76",$0.00,$0.00,$0.00,$0.00,$0.00
84510HT,SUP,Custom 27803010,,84510HT  -  PLATE 18MM TI BONE SPNL,"$2,346.10",$0.00,"$2,346.10",$0.00,"$1,674.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,346.10",$0.00,"$1,173.05","$1,858.11","$1,876.88",$0.00,$0.00,$0.00,$0.00,$0.00
84511H,SUP,Custom 27803010,,84511H  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,118.45",$0.00,"$2,118.45",$0.00,"$1,511.94",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,118.45",$0.00,"$1,059.23","$1,677.81","$1,694.76",$0.00,$0.00,$0.00,$0.00,$0.00
848-011,SUP,HCPCS C1713,,848-011  -  PLATE 18MM TI BONE SPNL,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
848-012,SUP,HCPCS C1713,,848-012  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
848-520,SUP,HCPCS C1713,,848-520  -  PLATE 18MM TI BONE SPNL,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
848-523,SUP,HCPCS C1713,,848-523  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
848-525,SUP,HCPCS C1713,,848-525  -  PLATE 18MM TI BONE SPNL,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
848-528,SUP,HCPCS C1713,,848-528  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
848-530,SUP,HCPCS C1713,,848-530  -  PLATE 18MM TI BONE SPNL,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
848-533,SUP,HCPCS C1713,,848-533  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
848-535,SUP,HCPCS C1713,,848-535  -  PLATE 18MM TI BONE SPNL,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
848-538,SUP,HCPCS C1713,,848-538  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
848-540,SUP,HCPCS C1713,,848-540  -  PLATE 18MM TI BONE SPNL,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
848-543,SUP,HCPCS C1713,,848-543  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
848-545,SUP,HCPCS C1713,,848-545  -  PLATE 18MM TI BONE SPNL,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
848-548,SUP,HCPCS C1713,,848-548  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
848-550,SUP,HCPCS C1713,,848-550  -  PLATE 18MM TI BONE SPNL,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
848-553,SUP,HCPCS C1713,,848-553  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
848-555,SUP,HCPCS C1713,,848-555  -  PLATE 18MM TI BONE SPNL,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
848-625,SUP,HCPCS C1713,,848-625  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
848-630,SUP,HCPCS C1713,,848-630  -  PLATE 18MM TI BONE SPNL,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
848-635,SUP,HCPCS C1713,,848-635  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
848-640,SUP,HCPCS C1713,,848-640  -  PLATE 18MM TI BONE SPNL,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
848-645,SUP,HCPCS C1713,,848-645  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
848-725,SUP,HCPCS C1713,,848-725  -  PLATE 18MM TI BONE SPNL,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
848-730,SUP,HCPCS C1713,,848-730  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
848-735,SUP,HCPCS C1713,,848-735  -  PLATE 18MM TI BONE SPNL,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
848-740,SUP,HCPCS C1713,,848-740  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
848-745,SUP,HCPCS C1713,,848-745  -  PLATE 18MM TI BONE SPNL,"$2,352.00",$0.00,"$2,352.00","$1,058.40","$1,678.62",$0.00,$405.24,$0.00,$0.00,$411.82,"$2,352.00",$0.00,"$1,176.00","$1,862.78","$1,881.60",$0.00,$368.09,$0.00,$374.44,$0.00
848-855,SUP,HCPCS C1713,,848-855  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
851.002.01S,SUP,HCPCS C1713,,851.002.01S  -  PLATE BONE CRNMXF 2 HOLE STR RPD RESORB 1.5 MM SCR STRL,$315.00,$0.00,$315.00,$141.75,$224.82,$0.00,$54.27,$0.00,$0.00,$55.15,$315.00,$0.00,$157.50,$249.48,$252.00,$0.00,$49.30,$0.00,$50.15,$0.00
851.004.01S,SUP,HCPCS C1713,,851.004.01S  -  PLATE BONE CRNMXF 4 HOLE STR RPD RESORB 1.5 MM SCR STRL,$461.25,$0.00,$461.25,$207.56,$329.19,$0.00,$79.47,$0.00,$0.00,$80.76,$461.25,$0.00,$230.63,$365.31,$369.00,$0.00,$72.19,$0.00,$73.43,$0.00
851.008.01S,SUP,HCPCS C1713,,851.008.01S  -  PLATE BONE CRNMXF 8 HOLE ADP RPD RESORB 1.5 MM SCR STRL,$517.50,$0.00,$517.50,$232.88,$369.34,$0.00,$89.16,$0.00,$0.00,$90.61,$517.50,$0.00,$258.75,$409.86,$414.00,$0.00,$80.99,$0.00,$82.39,$0.00
851.009.01S,SUP,HCPCS C1713,,851.009.01S  -  PLATE 1.5 MM SCR 8 HOLE SCLP ADP SCLP RPD RESORB BONE STRL,$517.50,$0.00,$517.50,$232.88,$369.34,$0.00,$89.16,$0.00,$0.00,$90.61,$517.50,$0.00,$258.75,$409.86,$414.00,$0.00,$80.99,$0.00,$82.39,$0.00
851.020.01S,SUP,HCPCS C1713,,851.020.01S  -  PLATE BONE CRNMXF 20 HOLE ADP RPD RESORB 1.5 MM SCR STRL,$753.75,$0.00,$753.75,$339.19,$537.95,$0.00,$129.87,$0.00,$0.00,$131.98,$753.75,$0.00,$376.88,$596.97,$603.00,$0.00,$117.96,$0.00,$120.00,$0.00
851.021.01S,SUP,HCPCS C1713,,851.021.01S  -  PLATE 1.5 MM SCR 20 HOLE SCLP ADP SCLP RPD RESORB BONE STRL,$753.75,$0.00,$753.75,$339.19,$537.95,$0.00,$129.87,$0.00,$0.00,$131.98,$753.75,$0.00,$376.88,$596.97,$603.00,$0.00,$117.96,$0.00,$120.00,$0.00
851.110.01S,SUP,HCPCS C1713,,851.110.01S  -  PLATE BONE ORBTL RIM 10 HOLE RPD RESORB 1.5 MM SCR STRL,$697.50,$0.00,$697.50,$313.88,$497.81,$0.00,$120.18,$0.00,$0.00,$122.13,$697.50,$0.00,$348.75,$552.42,$558.00,$0.00,$109.16,$0.00,$111.04,$0.00
851.320.01S,SUP,HCPCS C1713,,851.320.01S  -  PLATE BONE CRNMXF 10 HOLE 2 Y RPD RESORB 1.5 MM SCR STRL,$697.50,$0.00,$697.50,$313.88,$497.81,$0.00,$120.18,$0.00,$0.00,$122.13,$697.50,$0.00,$348.75,$552.42,$558.00,$0.00,$109.16,$0.00,$111.04,$0.00
851.343.01S,SUP,HCPCS C1713,,851.343.01S  -  PLATE BONE CRNMXF 4X3X3 HOLE Y RPD RESORB 1.5 MM SCR STRL,$697.50,$0.00,$697.50,$313.88,$497.81,$0.00,$120.18,$0.00,$0.00,$122.13,$697.50,$0.00,$348.75,$552.42,$558.00,$0.00,$109.16,$0.00,$111.04,$0.00
851.344.01S,SUP,HCPCS C1713,,851.344.01S  -  1.5MM RAPID RESORB T-PLATE 2 X 3 HOLES-STERILE,$697.50,$0.00,$697.50,$313.88,$497.81,$0.00,$120.18,$0.00,$0.00,$122.13,$697.50,$0.00,$348.75,$552.42,$558.00,$0.00,$109.16,$0.00,$111.04,$0.00
851.420.01S,SUP,HCPCS C1713,,851.420.01S  -  PLATE BONE CRNMXF 2X10 HOLE STRUT RPD RESORB 1.5 MM SCR STRL,"$1,226.25",$0.00,"$1,226.25",$551.81,$875.17,$0.00,$211.28,$0.00,$0.00,$214.71,"$1,226.25",$0.00,$613.13,$971.19,$981.00,$0.00,$191.91,$0.00,$195.22,$0.00
851.421.01S,SUP,HCPCS C1713,,851.421.01S  -  PLATE BONE CRNMXF 2X18 HOLE STRUT RPD RESORB 1.5 MM SCR STRL,"$1,518.75",$0.00,"$1,518.75",$683.44,"$1,083.93",$0.00,$261.67,$0.00,$0.00,$265.92,"$1,518.75",$0.00,$759.38,"$1,202.85","$1,215.00",$0.00,$237.68,$0.00,$241.79,$0.00
851.424.01S,SUP,HCPCS C1713,,851.424.01S  -  PLATE BONE CRNMXF 2X10 HOLE STRUT SCLP RPD RESORB 1.5 MM SCR,"$1,228.50",$0.00,"$1,228.50",$552.83,$876.78,$0.00,$211.66,$0.00,$0.00,$215.10,"$1,228.50",$0.00,$614.25,$972.97,$982.80,$0.00,$192.26,$0.00,$195.58,$0.00
851.425.01S,SUP,HCPCS C1713,,851.425.01S  -  PLATE BONE CRNMXF 2X18 HOLE STRUT SCLP RPD RESORB 1.5 MM SCR,"$1,518.75",$0.00,"$1,518.75",$683.44,"$1,083.93",$0.00,$261.67,$0.00,$0.00,$265.92,"$1,518.75",$0.00,$759.38,"$1,202.85","$1,215.00",$0.00,$237.68,$0.00,$241.79,$0.00
851.436.01S,SUP,HCPCS C1713,,851.436.01S  -  PLATE 1.5 MM SCR 2X36 HOLE STRUT SCLP RPD RESORB BONE STRL,"$3,026.25",$0.00,"$3,026.25","$1,361.81","$2,159.83",$0.00,$521.41,$0.00,$0.00,$529.87,"$3,026.25",$0.00,"$1,513.13","$2,396.79","$2,421.00",$0.00,$473.61,$0.00,$481.78,$0.00
851.500.01S,SUP,HCPCS C1713,,851.500.01S  -  1.5MM RAPID RESORB BOX PLATE 4 HOLES-STERILE,$697.50,$0.00,$697.50,$313.88,$497.81,$0.00,$120.18,$0.00,$0.00,$122.13,$697.50,$0.00,$348.75,$552.42,$558.00,$0.00,$109.16,$0.00,$111.04,$0.00
851.506.01S,SUP,Custom 27803010,,851.506.01S  -  COVER BUR HOLE CRNMXF 8 HOLE RPD RESORB 1.5 MM SCR STRL,$641.25,$0.00,$641.25,$0.00,$457.66,$0.00,$0.00,$0.00,$0.00,$0.00,$641.25,$0.00,$320.63,$507.87,$513.00,$0.00,$0.00,$0.00,$0.00,$0.00
851.508.01S,SUP,Custom 27803010,,851.508.01S  -  COVER BUR HOLE CRNMXF 10 HOLE RPD RESORB 1.5 MM SCR STRL,$641.25,$0.00,$641.25,$0.00,$457.66,$0.00,$0.00,$0.00,$0.00,$0.00,$641.25,$0.00,$320.63,$507.87,$513.00,$0.00,$0.00,$0.00,$0.00,$0.00
851.510.01S,SUP,HCPCS C1713,,851.510.01S  -  PLATE BONE 50X50X.5MM CRNMXF MESH RPD RESORB 1.5MM SCR STRL,"$3,060.00",$0.00,"$3,060.00","$1,377.00","$2,183.92",$0.00,$527.22,$0.00,$0.00,$535.78,"$3,060.00",$0.00,"$1,530.00","$2,423.52","$2,448.00",$0.00,$478.89,$0.00,$487.15,$0.00
851.512.01S,SUP,HCPCS C1713,,851.512.01S  -  PLATE BONE 100X100X.5MM CRNMXF MESH RPD RESORB 1.5MM SCR,"$6,525.00",$0.00,"$6,525.00","$2,936.25","$4,656.89",$0.00,"$1,124.22",$0.00,$0.00,"$1,142.48","$6,525.00",$0.00,"$3,262.50","$5,167.80","$5,220.00",$0.00,"$1,021.16",$0.00,"$1,038.78",$0.00
851.520.01S,SUP,HCPCS C1713,,851.520.01S  -  PLATE BONE 50X50X.8MM CRNMXF MESH RPD RESORB 1.5MM SCR STRL,"$3,195.00",$0.00,"$3,195.00","$1,437.75","$2,280.27",$0.00,$550.48,$0.00,$0.00,$559.42,"$3,195.00",$0.00,"$1,597.50","$2,530.44","$2,556.00",$0.00,$500.02,$0.00,$508.64,$0.00
851.521.01S,SUP,HCPCS C1713,,851.521.01S  -  PLATE BONE 100X100X.8MM CRNMXF MESH RPD RESORB 1.5MM SCR,"$7,278.75",$0.00,"$7,278.75","$3,275.44","$5,158.80",$0.00,"$1,254.09",$0.00,$0.00,"$1,274.45","$7,278.75",$0.00,"$3,639.38","$5,764.77","$5,823.00",$0.00,"$1,139.12",$0.00,"$1,158.78",$0.00
851.532.01S,SUP,HCPCS C1713,,851.532.01S  -  PLATE BONE 50X50X.5MM CRNMXF SHT RPD RESORB 1.5MM SCR STRL,"$2,256.75",$0.00,"$2,256.75","$1,015.54","$1,610.64",$0.00,$388.83,$0.00,$0.00,$395.14,"$2,256.75",$0.00,"$1,128.38","$1,787.35","$1,805.40",$0.00,$353.18,$0.00,$359.27,$0.00
851.534.01S,SUP,HCPCS C1713,,851.534.01S  -  PLATE BONE 50X50X.8MM CRNMXF SHT RPD RESORB 1.5MM SCR STRL,"$2,351.25",$0.00,"$2,351.25","$1,058.06","$1,678.09",$0.00,$405.11,$0.00,$0.00,$411.69,"$2,351.25",$0.00,"$1,175.63","$1,862.19","$1,881.00",$0.00,$367.97,$0.00,$374.32,$0.00
851.540.01S,SUP,HCPCS C1713,,851.540.01S  -  PLATE BONE TRNS 24X24MM THK.5MM ORBTL FLR RPD REABSORBABLE,"$1,890.00",$0.00,"$1,890.00",$850.50,"$1,348.89",$0.00,$325.64,$0.00,$0.00,$330.92,"$1,890.00",$0.00,$945.00,"$1,496.88","$1,512.00",$0.00,$295.79,$0.00,$300.89,$0.00
851.541.01S,SUP,HCPCS C1713,,851.541.01S  -  PLATE BONE 30MM MED ORBTL FLR RPD RESORB 1.5MM SCR STRL,"$1,968.75",$0.00,"$1,968.75",$885.94,"$1,405.10",$0.00,$339.21,$0.00,$0.00,$344.71,"$1,968.75",$0.00,$984.38,"$1,559.25","$1,575.00",$0.00,$308.11,$0.00,$313.43,$0.00
851.542.01S,SUP,HCPCS C1713,,851.542.01S  -  PLATE BONE 35MM LG ORBTL FLR RPD RESORB 1.5MM SCR STRL,"$2,047.50",$0.00,"$2,047.50",$921.38,"$1,461.30",$0.00,$352.77,$0.00,$0.00,$358.50,"$2,047.50",$0.00,"$1,023.75","$1,621.62","$1,638.00",$0.00,$320.43,$0.00,$325.96,$0.00
851.604.01S,SUP,HCPCS C1713,,851.604.01S  -  PLATE BONE CRNMXF 4 HOLE X RPD RESORB 1.5 MM SCR STRL,$663.75,$0.00,$663.75,$298.69,$473.72,$0.00,$114.36,$0.00,$0.00,$116.22,$663.75,$0.00,$331.88,$525.69,$531.00,$0.00,$103.88,$0.00,$105.67,$0.00
851.605.01S,SUP,HCPCS C1713,,851.605.01S  -  1.5MM RAPID RESORB X-PLATE 8 HOLES-STERILE,$663.75,$0.00,$663.75,$298.69,$473.72,$0.00,$114.36,$0.00,$0.00,$116.22,$663.75,$0.00,$331.88,$525.69,$531.00,$0.00,$103.88,$0.00,$105.67,$0.00
851.611.01S,SUP,HCPCS C1713,,851.611.01S  -  1.5MM RAPID RESORB CONTOURABLE MESH/50X50X0.25MM THK-STERILE,"$3,352.50",$0.00,"$3,352.50","$1,508.63","$2,392.68",$0.00,$577.62,$0.00,$0.00,$587.00,"$3,352.50",$0.00,"$1,676.25","$2,655.18","$2,682.00",$0.00,$524.67,$0.00,$533.72,$0.00
851.612.01S,SUP,HCPCS C1713,,851.612.01S  -  MESH CRNL 100X100X.25MM STRL RAPIDSORB CNTR RSRB RPD 1.5MM,"$7,222.50",$0.00,"$7,222.50","$3,250.13","$5,154.70",$0.00,"$1,244.40",$0.00,$0.00,"$1,264.60","$7,222.50",$0.00,"$3,611.25","$5,720.22","$5,778.00",$0.00,"$1,130.32",$0.00,"$1,149.82",$0.00
851.621.01S,SUP,HCPCS C1713,,851.621.01S  -  1.5MM RAPID RESORB CONTOURABLE MESH/50X50X0.5MM THK-STERILE,"$3,352.50",$0.00,"$3,352.50","$1,508.63","$2,392.68",$0.00,$577.62,$0.00,$0.00,$587.00,"$3,352.50",$0.00,"$1,676.25","$2,655.18","$2,682.00",$0.00,$524.67,$0.00,$533.72,$0.00
851.622.01S,SUP,HCPCS C1713,,851.622.01S  -  PLATE 100X100X.50MM 1.5MM SCR CONTUR MESH RPD RESORB BONE,"$7,222.50",$0.00,"$7,222.50","$3,250.13","$5,154.70",$0.00,"$1,244.40",$0.00,$0.00,"$1,264.60","$7,222.50",$0.00,"$3,611.25","$5,720.22","$5,778.00",$0.00,"$1,130.32",$0.00,"$1,149.82",$0.00
851.623.01S,SUP,HCPCS C1713,,851.623.01S  -  PLATE 150X150X.5MM 1.5MM SCR CONTUR MESH RPD RESORB BONE,"$12,172.50",$0.00,"$12,172.50","$5,477.63","$5,158.80",$0.00,"$2,097.26",$0.00,$0.00,"$2,131.31","$12,172.50",$0.00,"$6,086.25","$9,640.62","$9,738.00",$0.00,"$1,905.00",$0.00,"$1,937.86",$0.00
851.633.01S,SUP,HCPCS C1713,,851.633.01S  -  1.5MM RAPID RESORB CONTOURABLE MESH/150X150X0.8MM THK-STERIL,"$12,375.00",$0.00,"$12,375.00","$5,568.75","$5,158.80",$0.00,"$2,132.15",$0.00,$0.00,"$2,166.76","$12,375.00",$0.00,"$6,187.50","$9,801.00","$9,900.00",$0.00,"$1,936.69",$0.00,"$1,970.10",$0.00
851.651.01S,SUP,HCPCS C1713,,851.651.01S  -  PLATE BONE .5MM CRNMXF CONTUR MESH RPD RESORB 1.5MM SCR STRL,"$3,352.50",$0.00,"$3,352.50","$1,508.63","$2,392.68",$0.00,$577.62,$0.00,$0.00,$587.00,"$3,352.50",$0.00,"$1,676.25","$2,655.18","$2,682.00",$0.00,$524.67,$0.00,$533.72,$0.00
851.652.01S,SUP,HCPCS C1713,,851.652.01S  -  PLATE BONE .5MM 100MM CRNMXF CONTUR MESH RPD RESORB 1.5MM,"$7,222.50",$0.00,"$7,222.50","$3,250.13","$5,154.70",$0.00,"$1,244.40",$0.00,$0.00,"$1,264.60","$7,222.50",$0.00,"$3,611.25","$5,720.22","$5,778.00",$0.00,"$1,130.32",$0.00,"$1,149.82",$0.00
851.661.01S,SUP,HCPCS C1713,,851.661.01S  -  PLATE BONE .8MM 50MM CRNMXF CONTUR MESH RPD RESORB 1.5MM SCR,"$3,487.50",$0.00,"$3,487.50","$1,569.38","$2,489.03",$0.00,$600.88,$0.00,$0.00,$610.63,"$3,487.50",$0.00,"$1,743.75","$2,762.10","$2,790.00",$0.00,$545.79,$0.00,$555.21,$0.00
851.662.01S,SUP,HCPCS C1713,,851.662.01S  -  PLATE .8MM 1.5MM SCR CONTUR MESH RESORB RGD BONE 100MM,"$7,605.00",$0.00,"$7,605.00","$3,422.25","$5,158.80",$0.00,"$1,310.30",$0.00,$0.00,"$1,331.57","$7,605.00",$0.00,"$3,802.50","$6,023.16","$6,084.00",$0.00,"$1,190.18",$0.00,"$1,210.72",$0.00
851.680.01S,SUP,HCPCS C1713,,851.680.01S  -  1.5MM RAPID RESORB SELLAR FLR PL 7MMX25MM/0.5MM THK-STERILE,$641.25,$0.00,$641.25,$288.56,$457.66,$0.00,$110.48,$0.00,$0.00,$112.28,$641.25,$0.00,$320.63,$507.87,$513.00,$0.00,$100.36,$0.00,$102.09,$0.00
851.681.01S,SUP,HCPCS C1713,,851.681.01S  -  1.5MM RAPID RESORB SELLAR FLR PL 7MMX25MM/0.8MM THK-STERILE,$641.25,$0.00,$641.25,$288.56,$457.66,$0.00,$110.48,$0.00,$0.00,$112.28,$641.25,$0.00,$320.63,$507.87,$513.00,$0.00,$100.36,$0.00,$102.09,$0.00
851.689.01S,SUP,HCPCS C1713,,851.689.01S  -  1.5MM RAPID RESORB ORBTL FL PL W/BENDING TEMPLATE/24MM-STER,"$1,901.25",$0.00,"$1,901.25",$855.56,"$1,356.92",$0.00,$327.58,$0.00,$0.00,$332.89,"$1,901.25",$0.00,$950.63,"$1,505.79","$1,521.00",$0.00,$297.55,$0.00,$302.68,$0.00
851.690.01S,SUP,HCPCS C1713,,851.690.01S  -  PLATE BONE 30X30MM ORBTL FLR RPD RESORB BNDRG TMPLT 1.5MM,"$1,980.00",$0.00,"$1,980.00",$891.00,"$1,413.13",$0.00,$341.14,$0.00,$0.00,$346.68,"$1,980.00",$0.00,$990.00,"$1,568.16","$1,584.00",$0.00,$309.87,$0.00,$315.22,$0.00
851.691.01S,SUP,HCPCS C1713,,851.691.01S  -  PLATE 35X35MM 1.5MM SCR BNDRG TMPLT RPD RESORB BONE ORBTL,"$2,047.50",$0.00,"$2,047.50",$921.38,"$1,461.30",$0.00,$352.77,$0.00,$0.00,$358.50,"$2,047.50",$0.00,"$1,023.75","$1,621.62","$1,638.00",$0.00,$320.43,$0.00,$325.96,$0.00
851.711.01S,SUP,HCPCS C1713,,851.711.01S  -  PLATE BONE 50X50X.5MM CRNMXF STR ROW MESH RPD RESORB 1.5MM,"$3,060.00",$0.00,"$3,060.00","$1,377.00","$2,183.92",$0.00,$527.22,$0.00,$0.00,$535.78,"$3,060.00",$0.00,"$1,530.00","$2,423.52","$2,448.00",$0.00,$478.89,$0.00,$487.15,$0.00
851.711.97S,SUP,HCPCS C1713,,851.711.97S  -  PLATE BONE 50X50X.5MM STR ROW MESH RAPID RESORB POLY,"$2,763.63",$0.00,"$2,763.63","$1,243.63","$1,972.40",$0.00,$462.29,$0.00,$0.00,$483.89,"$2,763.63",$0.00,"$1,381.81","$2,188.79","$2,210.90",$0.00,$419.91,$0.00,$439.97,$0.00
851.712.01S,SUP,HCPCS C1713,,851.712.01S  -  PLATE BONE 100X100X.5MM CRNMXF STR ROW MESH RPD RESORB 1.5MM,"$6,525.00",$0.00,"$6,525.00","$2,936.25","$4,656.89",$0.00,"$1,124.22",$0.00,$0.00,"$1,142.48","$6,525.00",$0.00,"$3,262.50","$5,167.80","$5,220.00",$0.00,"$1,021.16",$0.00,"$1,038.78",$0.00
851.712.97S,SUP,HCPCS C1713,,851.712.97S  -  PLATE BONE 100MM RESORB STR ROW MESH ORTHOPEDIC NONSTRL 1MM,"$5,894.18",$0.00,"$5,894.18","$2,652.38","$4,206.67",$0.00,$985.96,$0.00,$0.00,"$1,032.02","$5,894.18",$0.00,"$2,947.09","$4,668.19","$4,715.34",$0.00,$895.57,$0.00,$938.35,$0.00
851.721.01S,SUP,HCPCS C1713,,851.721.01S  -  PLATE BONE 50X50X.8MM CRNMXF STR ROW MESH RPD RESORB 1.5MM,"$3,240.00",$0.00,"$3,240.00","$1,458.00","$2,312.39",$0.00,$558.24,$0.00,$0.00,$567.30,"$3,240.00",$0.00,"$1,620.00","$2,566.08","$2,592.00",$0.00,$507.06,$0.00,$515.81,$0.00
851.722.01S,SUP,HCPCS C1713,,851.722.01S  -  PLATE BONE 100X100X.8MM CRNMXF STR ROW MESH RPD RESORB 1.5MM,"$7,200.00",$0.00,"$7,200.00","$3,240.00","$5,138.64",$0.00,"$1,240.52",$0.00,$0.00,"$1,260.66","$7,200.00",$0.00,"$3,600.00","$5,702.40","$5,760.00",$0.00,"$1,126.80",$0.00,"$1,146.24",$0.00
851.724.01S,SUP,HCPCS C1713,,851.724.01S  -  1.5MM RAPID RESORB STRAIGHT ROW MESH/75X75X0.8MM THK-STER,"$4,657.50",$0.00,"$4,657.50","$2,095.88","$3,324.06",$0.00,$802.46,$0.00,$0.00,$815.49,"$4,657.50",$0.00,"$2,328.75","$3,688.74","$3,726.00",$0.00,$728.90,$0.00,$741.47,$0.00
851.801.01S,SUP,Custom 27803010,,851.801.01S  -  CLAMP TUBE 18MM CRANIAL FLP RPD RESORB STRL,$787.50,$0.00,$787.50,$0.00,$562.04,$0.00,$0.00,$0.00,$0.00,$0.00,$787.50,$0.00,$393.75,$623.70,$630.00,$0.00,$0.00,$0.00,$0.00,$0.00
852.002.01S,SUP,HCPCS C1713,,852.002.01S  -  PLATE BONE CRNMXF 2 HOLE STR RPD RESORB 2 MM SCR STRL,$326.25,$0.00,$326.25,$146.81,$232.84,$0.00,$56.21,$0.00,$0.00,$57.12,$326.25,$0.00,$163.13,$258.39,$261.00,$0.00,$51.06,$0.00,$51.94,$0.00
852.004.01S,SUP,HCPCS C1713,,852.004.01S  -  PLATE BONE CRNMXF 4 HOLE STR RPD RESORB 2 MM SCR STRL,$483.75,$0.00,$483.75,$217.69,$345.25,$0.00,$83.35,$0.00,$0.00,$84.70,$483.75,$0.00,$241.88,$383.13,$387.00,$0.00,$75.71,$0.00,$77.01,$0.00
852.008.01S,SUP,HCPCS C1713,,852.008.01S  -  PLATE BONE CRNMXF 8 HOLE ADP RPD RESORB 2 MM SCR STRL,$540.00,$0.00,$540.00,$243.00,$385.40,$0.00,$93.04,$0.00,$0.00,$94.55,$540.00,$0.00,$270.00,$427.68,$432.00,$0.00,$84.51,$0.00,$85.97,$0.00
852.020.01S,SUP,HCPCS C1713,,852.020.01S  -  PLATE BONE 2MM 20 HOLE ADP RPD RESORB STRL,$787.50,$0.00,$787.50,$354.38,$562.04,$0.00,$135.68,$0.00,$0.00,$137.88,$787.50,$0.00,$393.75,$623.70,$630.00,$0.00,$123.24,$0.00,$125.37,$0.00
852.110.01S,SUP,HCPCS C1713,,852.110.01S  -  PLATE BONE ORBTL RIM 10 HOLE RPD RESORB 2 MM SCR STRL,$697.50,$0.00,$697.50,$313.88,$497.81,$0.00,$120.18,$0.00,$0.00,$122.13,$697.50,$0.00,$348.75,$552.42,$558.00,$0.00,$109.16,$0.00,$111.04,$0.00
852.263.01S,SUP,HCPCS C1713,,852.263.01S  -  PLATE BONE CRNMXF 6X4 HOLE L LEFT OBLQ RPD RESORB 2 MM SCR,$697.50,$0.00,$697.50,$313.88,$497.81,$0.00,$120.18,$0.00,$0.00,$122.13,$697.50,$0.00,$348.75,$552.42,$558.00,$0.00,$109.16,$0.00,$111.04,$0.00
852.264.01S,SUP,HCPCS C1713,,852.264.01S  -  PLATE BONE CRNMXF 6X4 HOLE L RIGHT OBLQ RPD RESORB 2 MM SCR,$697.50,$0.00,$697.50,$313.88,$497.81,$0.00,$120.18,$0.00,$0.00,$122.13,$697.50,$0.00,$348.75,$552.42,$558.00,$0.00,$109.16,$0.00,$111.04,$0.00
852.343.01S,SUP,HCPCS C1713,,852.343.01S  -  PLATE BONE CRNMXF 4X3X3 HOLE RPD RESORB 2 MM SCR STRL,$697.50,$0.00,$697.50,$313.88,$497.81,$0.00,$120.18,$0.00,$0.00,$122.13,$697.50,$0.00,$348.75,$552.42,$558.00,$0.00,$109.16,$0.00,$111.04,$0.00
852.420.01S,SUP,HCPCS C1713,,852.420.01S  -  PLATE BONE CRNMXF 2X10 HOLE STRUT RPD RESORB 2 MM SCR STRL,"$1,293.75",$0.00,"$1,293.75",$582.19,$923.35,$0.00,$222.91,$0.00,$0.00,$226.53,"$1,293.75",$0.00,$646.88,"$1,024.65","$1,035.00",$0.00,$202.47,$0.00,$205.97,$0.00
852.421.01S,SUP,HCPCS C1713,,852.421.01S  -  PLATE BONE CRNMXF 2X18 HOLE STRUT RPD RESORB 2 MM SCR STRL,"$1,597.50",$0.00,"$1,597.50",$718.88,"$1,140.14",$0.00,$275.24,$0.00,$0.00,$279.71,"$1,597.50",$0.00,$798.75,"$1,265.22","$1,278.00",$0.00,$250.01,$0.00,$254.32,$0.00
852.520.01S,SUP,HCPCS C1713,,852.520.01S  -  PLATE BONE 48X48X1.2MM CRNMXF MESH RPD RESORB 2MM SCR STRL,"$3,487.50",$0.00,"$3,487.50","$1,569.38","$2,489.03",$0.00,$600.88,$0.00,$0.00,$610.63,"$3,487.50",$0.00,"$1,743.75","$2,762.10","$2,790.00",$0.00,$545.79,$0.00,$555.21,$0.00
852.521.01S,SUP,HCPCS C1713,,852.521.01S  -  PLATE BONE 78X78X1.2MM CRNMXF MESH RPD RESORB 2MM SCR STRL,"$5,445.00",$0.00,"$5,445.00","$2,450.25","$3,886.10",$0.00,$938.15,$0.00,$0.00,$953.38,"$5,445.00",$0.00,"$2,722.50","$4,312.44","$4,356.00",$0.00,$852.14,$0.00,$866.84,$0.00
852.641.01S,SUP,HCPCS C1713,,852.641.01S  -  PLATE BONE 1.2MM 50MM CRNMXF CONTUR MESH RPD RESORB 2MM SCR,"$3,802.50",$0.00,"$3,802.50","$1,711.13","$2,713.84",$0.00,$655.15,$0.00,$0.00,$665.79,"$3,802.50",$0.00,"$1,901.25","$3,011.58","$3,042.00",$0.00,$595.09,$0.00,$605.36,$0.00
852-000,SUP,Custom 27203010,,KIT NOW LGNL URN AG MCBLTST 22 TST,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
853008LH,SUP,HCPCS C1713,,853008LH  -  PLATE 18MM TI BONE SPNL,"$1,093.50",$0.00,"$1,093.50",$492.08,$780.43,$0.00,$188.40,$0.00,$0.00,$191.46,"$1,093.50",$0.00,$546.75,$866.05,$874.80,$0.00,$171.13,$0.00,$174.09,$0.00
853008LW,SUP,HCPCS C1713,,853008LW  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,093.50",$0.00,"$1,093.50",$492.08,$780.43,$0.00,$188.40,$0.00,$0.00,$191.46,"$1,093.50",$0.00,$546.75,$866.05,$874.80,$0.00,$171.13,$0.00,$174.09,$0.00
853008WM,SUP,HCPCS C1713,,853008WM  -  PLATE 18MM TI BONE SPNL,"$1,093.50",$0.00,"$1,093.50",$492.08,$780.43,$0.00,$188.40,$0.00,$0.00,$191.46,"$1,093.50",$0.00,$546.75,$866.05,$874.80,$0.00,$171.13,$0.00,$174.09,$0.00
853-010,SUP,HCPCS C1713,,853-010  -  PLATE 10MM TI MLT HOLE OPN DOOR PCUT INTRINSIC STAB CLR CD,"$1,093.50",$0.00,"$1,093.50",$492.08,$780.43,$0.00,$188.40,$0.00,$0.00,$191.46,"$1,093.50",$0.00,$546.75,$866.05,$874.80,$0.00,$171.13,$0.00,$174.09,$0.00
853010LH,SUP,HCPCS C1713,,853010LH  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,093.50",$0.00,"$1,093.50",$492.08,$780.43,$0.00,$188.40,$0.00,$0.00,$191.46,"$1,093.50",$0.00,$546.75,$866.05,$874.80,$0.00,$171.13,$0.00,$174.09,$0.00
853010LW,SUP,HCPCS C1713,,853010LW  -  PLATE BN W MTH 10MM CENTERPIECE LAT HL OPN DOOR CLR CD TI,"$1,093.50",$0.00,"$1,093.50",$492.08,$780.43,$0.00,$188.40,$0.00,$0.00,$191.46,"$1,093.50",$0.00,$546.75,$866.05,$874.80,$0.00,$171.13,$0.00,$174.09,$0.00
853010WM,SUP,HCPCS C1713,,853010WM  -  PLATE 18MM TI BONE SPNL,"$1,093.50",$0.00,"$1,093.50",$492.08,$780.43,$0.00,$188.40,$0.00,$0.00,$191.46,"$1,093.50",$0.00,$546.75,$866.05,$874.80,$0.00,$171.13,$0.00,$174.09,$0.00
853-012,SUP,HCPCS C1713,,853-012  -  PLATE 12MM TI MLT HOLE OPN DOOR PCUT INTRINSIC STAB CLR CD,"$1,093.50",$0.00,"$1,093.50",$492.08,$780.43,$0.00,$188.40,$0.00,$0.00,$191.46,"$1,093.50",$0.00,$546.75,$866.05,$874.80,$0.00,$171.13,$0.00,$174.09,$0.00
853012LH,SUP,HCPCS C1713,,853012LH  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,093.50",$0.00,"$1,093.50",$492.08,$780.43,$0.00,$188.40,$0.00,$0.00,$191.46,"$1,093.50",$0.00,$546.75,$866.05,$874.80,$0.00,$171.13,$0.00,$174.09,$0.00
853012WM,SUP,HCPCS C1713,,853012WM  -  PLATE 18MM TI BONE SPNL,"$1,093.50",$0.00,"$1,093.50",$492.08,$780.43,$0.00,$188.40,$0.00,$0.00,$191.46,"$1,093.50",$0.00,$546.75,$866.05,$874.80,$0.00,$171.13,$0.00,$174.09,$0.00
853-014,SUP,HCPCS C1713,,853-014  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,093.50",$0.00,"$1,093.50",$492.08,$780.43,$0.00,$188.40,$0.00,$0.00,$191.46,"$1,093.50",$0.00,$546.75,$866.05,$874.80,$0.00,$171.13,$0.00,$174.09,$0.00
853014LH,SUP,HCPCS C1713,,853014LH  -  PLATE 18MM TI BONE SPNL,"$1,093.50",$0.00,"$1,093.50",$492.08,$780.43,$0.00,$188.40,$0.00,$0.00,$191.46,"$1,093.50",$0.00,$546.75,$866.05,$874.80,$0.00,$171.13,$0.00,$174.09,$0.00
853014LW,SUP,HCPCS C1713,,853014LW  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,093.50",$0.00,"$1,093.50",$492.08,$780.43,$0.00,$188.40,$0.00,$0.00,$191.46,"$1,093.50",$0.00,$546.75,$866.05,$874.80,$0.00,$171.13,$0.00,$174.09,$0.00
853014WM,SUP,HCPCS C1713,,853014WM  -  PLATE 18MM TI BONE SPNL,"$1,093.50",$0.00,"$1,093.50",$492.08,$780.43,$0.00,$188.40,$0.00,$0.00,$191.46,"$1,093.50",$0.00,$546.75,$866.05,$874.80,$0.00,$171.13,$0.00,$174.09,$0.00
853-016,SUP,HCPCS C1713,,853-016  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,093.50",$0.00,"$1,093.50",$492.08,$780.43,$0.00,$188.40,$0.00,$0.00,$191.46,"$1,093.50",$0.00,$546.75,$866.05,$874.80,$0.00,$171.13,$0.00,$174.09,$0.00
853016LH,SUP,HCPCS C1713,,853016LH  -  PLATE 18MM TI BONE SPNL,"$1,093.50",$0.00,"$1,093.50",$492.08,$780.43,$0.00,$188.40,$0.00,$0.00,$191.46,"$1,093.50",$0.00,$546.75,$866.05,$874.80,$0.00,$171.13,$0.00,$174.09,$0.00
853016LW,SUP,HCPCS C1713,,853016LW  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,093.50",$0.00,"$1,093.50",$492.08,$780.43,$0.00,$188.40,$0.00,$0.00,$191.46,"$1,093.50",$0.00,$546.75,$866.05,$874.80,$0.00,$171.13,$0.00,$174.09,$0.00
853016WM,SUP,HCPCS C1713,,853016WM  -  PLATE 18MM TI BONE SPNL,"$1,093.50",$0.00,"$1,093.50",$492.08,$780.43,$0.00,$188.40,$0.00,$0.00,$191.46,"$1,093.50",$0.00,$546.75,$866.05,$874.80,$0.00,$171.13,$0.00,$174.09,$0.00
853-018,SUP,HCPCS C1713,,853-018  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,093.50",$0.00,"$1,093.50",$492.08,$780.43,$0.00,$188.40,$0.00,$0.00,$191.46,"$1,093.50",$0.00,$546.75,$866.05,$874.80,$0.00,$171.13,$0.00,$174.09,$0.00
853018LH,SUP,HCPCS C1713,,853018LH  -  PLATE 18MM TI BONE SPNL,"$1,093.50",$0.00,"$1,093.50",$492.08,$780.43,$0.00,$188.40,$0.00,$0.00,$191.46,"$1,093.50",$0.00,$546.75,$866.05,$874.80,$0.00,$171.13,$0.00,$174.09,$0.00
853018LW,SUP,HCPCS C1713,,853018LW  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,093.50",$0.00,"$1,093.50",$492.08,$780.43,$0.00,$188.40,$0.00,$0.00,$191.46,"$1,093.50",$0.00,$546.75,$866.05,$874.80,$0.00,$171.13,$0.00,$174.09,$0.00
853018WM,SUP,HCPCS C1713,,853018WM  -  PLATE 18MM TI BONE SPNL,"$1,093.50",$0.00,"$1,093.50",$492.08,$780.43,$0.00,$188.40,$0.00,$0.00,$191.46,"$1,093.50",$0.00,$546.75,$866.05,$874.80,$0.00,$171.13,$0.00,$174.09,$0.00
853-107,SUP,HCPCS C1713,,853-107  -  PLATE 7MM TI BONE SPNL,"$1,657.50",$0.00,"$1,657.50",$745.88,"$1,182.96",$0.00,$285.58,$0.00,$0.00,$290.21,"$1,657.50",$0.00,$828.75,"$1,312.74","$1,326.00",$0.00,$259.40,$0.00,$263.87,$0.00
853408LH,SUP,HCPCS C1713,,853408LH  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,093.50",$0.00,"$1,093.50",$492.08,$780.43,$0.00,$188.40,$0.00,$0.00,$191.46,"$1,093.50",$0.00,$546.75,$866.05,$874.80,$0.00,$171.13,$0.00,$174.09,$0.00
853-410,SUP,HCPCS C1713,,853-410  -  PLATE BN 10MM NS CENTERPIECE GFT SPNE,"$1,093.50",$0.00,"$1,093.50",$492.08,$780.43,$0.00,$188.40,$0.00,$0.00,$191.46,"$1,093.50",$0.00,$546.75,$866.05,$874.80,$0.00,$171.13,$0.00,$174.09,$0.00
853410LH,SUP,HCPCS C1713,,853410LH  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,093.50",$0.00,"$1,093.50",$492.08,$780.43,$0.00,$188.40,$0.00,$0.00,$191.46,"$1,093.50",$0.00,$546.75,$866.05,$874.80,$0.00,$171.13,$0.00,$174.09,$0.00
853-412,SUP,HCPCS C1713,,853-412  -  PLATE BN 12MM NS CENTERPIECE GFT SPNE,"$1,093.50",$0.00,"$1,093.50",$492.08,$780.43,$0.00,$188.40,$0.00,$0.00,$191.46,"$1,093.50",$0.00,$546.75,$866.05,$874.80,$0.00,$171.13,$0.00,$174.09,$0.00
853412LH,SUP,HCPCS C1713,,853412LH  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,093.50",$0.00,"$1,093.50",$492.08,$780.43,$0.00,$188.40,$0.00,$0.00,$191.46,"$1,093.50",$0.00,$546.75,$866.05,$874.80,$0.00,$171.13,$0.00,$174.09,$0.00
853-414,SUP,HCPCS C1713,,853-414  -  PLATE 18MM TI BONE SPNL,"$1,093.50",$0.00,"$1,093.50",$492.08,$780.43,$0.00,$188.40,$0.00,$0.00,$191.46,"$1,093.50",$0.00,$546.75,$866.05,$874.80,$0.00,$171.13,$0.00,$174.09,$0.00
853414LH,SUP,HCPCS C1713,,853414LH  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,093.50",$0.00,"$1,093.50",$492.08,$780.43,$0.00,$188.40,$0.00,$0.00,$191.46,"$1,093.50",$0.00,$546.75,$866.05,$874.80,$0.00,$171.13,$0.00,$174.09,$0.00
853-416,SUP,HCPCS C1713,,853-416  -  PLATE 18MM TI BONE SPNL,"$1,093.50",$0.00,"$1,093.50",$492.08,$780.43,$0.00,$188.40,$0.00,$0.00,$191.46,"$1,093.50",$0.00,$546.75,$866.05,$874.80,$0.00,$171.13,$0.00,$174.09,$0.00
853416LH,SUP,HCPCS C1713,,853416LH  -  SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT,"$1,093.50",$0.00,"$1,093.50",$492.08,$780.43,$0.00,$188.40,$0.00,$0.00,$191.46,"$1,093.50",$0.00,$546.75,$866.05,$874.80,$0.00,$171.13,$0.00,$174.09,$0.00
853-418,SUP,Custom 27803010,,853-418  -  PLATE 18MM TI BONE SPNL,"$1,093.50",$0.00,"$1,093.50",$0.00,$780.43,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,093.50",$0.00,$546.75,$866.05,$874.80,$0.00,$0.00,$0.00,$0.00,$0.00
853-465,SUP,HCPCS C1713,,853-465  -  SCREW BONE 2.6MM 5MM CENTERPIECE TI SPNL SLFTAP CLR CD,$171.00,$0.00,$171.00,$76.95,$122.04,$0.00,$29.46,$0.00,$0.00,$29.94,$171.00,$0.00,$85.50,$135.43,$136.80,$0.00,$26.76,$0.00,$27.22,$0.00
853-467,SUP,HCPCS C1713,,853-467  -  BONE SCREW 853-467 2.6 X 7MM,$171.00,$0.00,$171.00,$76.95,$122.04,$0.00,$29.46,$0.00,$0.00,$29.94,$171.00,$0.00,$85.50,$135.43,$136.80,$0.00,$26.76,$0.00,$27.22,$0.00
853-469,SUP,HCPCS C1713,,853-469  -  BONE SCREW 853-469 2.6 X 9MM,$171.00,$0.00,$171.00,$76.95,$122.04,$0.00,$29.46,$0.00,$0.00,$29.94,$171.00,$0.00,$85.50,$135.43,$136.80,$0.00,$26.76,$0.00,$27.22,$0.00
853-471,SUP,HCPCS C1713,,853-471  -  BONE SCREW 853-471 2.6 X 11MM,$171.00,$0.00,$171.00,$76.95,$122.04,$0.00,$29.46,$0.00,$0.00,$29.94,$171.00,$0.00,$85.50,$135.43,$136.80,$0.00,$26.76,$0.00,$27.22,$0.00
853-505,SUP,HCPCS C1713,,853-505  -  SCREW BONE 3MM 5MM CENTERPIECE TI SPNL SLFTAP CLR CD,$171.00,$0.00,$171.00,$76.95,$122.04,$0.00,$29.46,$0.00,$0.00,$29.94,$171.00,$0.00,$85.50,$135.43,$136.80,$0.00,$26.76,$0.00,$27.22,$0.00
853-507,SUP,HCPCS C1713,,853-507  -  BONE SCREW 853-507 3.0 X 7MM,$171.00,$0.00,$171.00,$76.95,$122.04,$0.00,$29.46,$0.00,$0.00,$29.94,$171.00,$0.00,$85.50,$135.43,$136.80,$0.00,$26.76,$0.00,$27.22,$0.00
853-509,SUP,HCPCS C1713,,853-509  -  BONE SCREW 853-509 3.0 X 9MM,$171.00,$0.00,$171.00,$76.95,$122.04,$0.00,$29.46,$0.00,$0.00,$29.94,$171.00,$0.00,$85.50,$135.43,$136.80,$0.00,$26.76,$0.00,$27.22,$0.00
853-511,SUP,HCPCS C1713,,853-511  -  BONE SCREW 853-511 3.0 X 11MM,$171.00,$0.00,$171.00,$76.95,$122.04,$0.00,$29.46,$0.00,$0.00,$29.94,$171.00,$0.00,$85.50,$135.43,$136.80,$0.00,$26.76,$0.00,$27.22,$0.00
853-602,SUP,Custom 27203010,,853-602  -  INSTRUMENT 853-602 TRI FLAT DRILL BIT,$225.00,$0.00,$225.00,$0.00,$160.58,$0.00,$0.00,$0.00,$0.00,$0.00,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$0.00,$0.00,$0.00,$0.00
8550012L,SUP,HCPCS C1713,,8550012L  -  ROD 8550012L 5.5MM TI HEX END LINED ROD,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
855-011,SUP,HCPCS C1713,,855-011  -  ROD 855-011 5.5 MM HEX-END ROD L20 TI,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
855011L100,SUP,HCPCS C1713,,855011L100  -  ROD 855011L100 TSRH 5.5X100MM TI,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
855-012,SUP,HCPCS C1713,,855-012  -  ROD 855-012 TITANIUM ROD CP GRADE IV,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
85-62010,SUP,Custom 27203010,,85-62010  -  STM HNDHLD LCTR VRSTIM3 NRV STD SBDRM,$113.00,$0.00,$113.00,$0.00,$80.65,$0.00,$0.00,$0.00,$0.00,$0.00,$113.00,$0.00,$56.50,$89.50,$90.40,$0.00,$0.00,$0.00,$0.00,$0.00
858-002,SUP,HCPCS C1713,,858-002  -  HOOK 858-002 5.5 SMALL PEDICLE,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
858-010,SUP,HCPCS C1713,,858-010  -  HOOK 858-010 5.5 SMALL WIDE BLADE,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
858-020,SUP,HCPCS C1713,,858-020  -  HOOK 858-020 5.5 SMALL NARROW BLADE,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
858-024,SUP,HCPCS C1713,,858-024  -  HOOK 858-024 5.5 SMALL ANGLED BLADE,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
858-030,SUP,HCPCS C1713,,858-030  -  HOOK 858-030 5.5 SMALL EXTENDED BODY,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
858-052,SUP,HCPCS C1713,,858-052  -  HOOK 858-052 5.5 SMALL NARROW BLADE RMPD,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
858-102,SUP,HCPCS C1713,,858-102  -  HOOK 858-102 5.5 PEDICLE,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
858-110,SUP,HCPCS C1713,,858-110  -  HOOK 858-110 5.5 WIDE BLADE,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
858-112,SUP,HCPCS C1713,,858-112  -  HOOK 858-112 5.5 WIDE BLADE SMALL GRVE,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
858-120,SUP,HCPCS C1713,,858-120  -  HOOK 858-120 5.5 NARROW BLADE,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
858-122,SUP,HCPCS C1713,,858-122  -  HOOK 858-122 NARROW BLADE SMALL GROOVE,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
858-124,SUP,HCPCS C1713,,858-124  -  HOOK 858-124 5.5 ANGLED BLADE,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
858-130,SUP,HCPCS C1713,,858-130  -  HOOK 858-130 5.5 EXTENDED BODY,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
858-140,SUP,HCPCS C1713,,858-140  -  HOOK 858-140 5.5 RIGHT OFFSET,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
858-142,SUP,HCPCS C1713,,858-142  -  HOOK 858-142 5.5 LEFT OFFSET,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
858-150,SUP,HCPCS C1713,,858-150  -  HOOK 858-150 5.5 STANDARD BLADE RAMPED,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
858-152,SUP,HCPCS C1713,,858-152  -  HOOK 858-152 5.5 NARROW BLADE RAMPED,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
858-160,SUP,HCPCS C1713,,858-160  -  HOOK 858-160 5.5 RIGHT ANGLED,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
858-162,SUP,HCPCS C1713,,858-162  -  HOOK 858-162 5.5 LEFT ANGLED,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
858-202,SUP,HCPCS C1713,,858-202  -  HOOK 858-202 5.5 LARGE PEDICLE,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
858-218,SUP,HCPCS C1713,,858-218  -  HOOK 858-218 LARGE GROOVE WIDE BLADE,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
858-220,SUP,HCPCS C1713,,858-220  -  HOOK 858-220 5.5 LARGE GROOVE,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
858-230,SUP,HCPCS C1713,,858-230  -  HOOK 858-230 5.5 EXTD BODY LARGE GRVE,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
858-425,SUP,HCPCS C1713,,858-425  -  SCREW 858-425 CDH FIXED ANGLE 4.5 X 25,"$1,659.00",$0.00,"$1,659.00",$746.55,"$1,184.03",$0.00,$285.84,$0.00,$0.00,$290.48,"$1,659.00",$0.00,$829.50,"$1,313.93","$1,327.20",$0.00,$259.63,$0.00,$264.11,$0.00
858-430,SUP,HCPCS C1713,,858-430  -  SCREW 858-430 CDH FIXED ANGLE 4.5 X 30,"$1,659.00",$0.00,"$1,659.00",$746.55,"$1,184.03",$0.00,$285.84,$0.00,$0.00,$290.48,"$1,659.00",$0.00,$829.50,"$1,313.93","$1,327.20",$0.00,$259.63,$0.00,$264.11,$0.00
858-435,SUP,HCPCS C1713,,858-435  -  SCREW 858-435 CDH FIXED ANGLE 4.5 X 35,"$1,659.00",$0.00,"$1,659.00",$746.55,"$1,184.03",$0.00,$285.84,$0.00,$0.00,$290.48,"$1,659.00",$0.00,$829.50,"$1,313.93","$1,327.20",$0.00,$259.63,$0.00,$264.11,$0.00
858-440,SUP,HCPCS C1713,,858-440  -  SCREW 858-440 CDH FIXED ANGLE 4.5 X 40,"$1,659.00",$0.00,"$1,659.00",$746.55,"$1,184.03",$0.00,$285.84,$0.00,$0.00,$290.48,"$1,659.00",$0.00,$829.50,"$1,313.93","$1,327.20",$0.00,$259.63,$0.00,$264.11,$0.00
858-525,SUP,HCPCS C1713,,858-525  -  SCREW 858-525 CDH FIXED ANGLE 5.5 X 25,"$1,659.00",$0.00,"$1,659.00",$746.55,"$1,184.03",$0.00,$285.84,$0.00,$0.00,$290.48,"$1,659.00",$0.00,$829.50,"$1,313.93","$1,327.20",$0.00,$259.63,$0.00,$264.11,$0.00
858-530,SUP,HCPCS C1713,,858-530  -  SCREW 858-530 CDH FIXED ANGLE 5.5 X 30,"$1,659.00",$0.00,"$1,659.00",$746.55,"$1,184.03",$0.00,$285.84,$0.00,$0.00,$290.48,"$1,659.00",$0.00,$829.50,"$1,313.93","$1,327.20",$0.00,$259.63,$0.00,$264.11,$0.00
858-535,SUP,HCPCS C1713,,858-535  -  SCREW 858-535 CDH FIXED ANGLE 5.5 X 35,"$1,659.00",$0.00,"$1,659.00",$746.55,"$1,184.03",$0.00,$285.84,$0.00,$0.00,$290.48,"$1,659.00",$0.00,$829.50,"$1,313.93","$1,327.20",$0.00,$259.63,$0.00,$264.11,$0.00
858-540,SUP,HCPCS C1713,,858-540  -  SCREW 858-540 CDH FIXED ANGLE 5.5 X 40,"$1,659.00",$0.00,"$1,659.00",$746.55,"$1,184.03",$0.00,$285.84,$0.00,$0.00,$290.48,"$1,659.00",$0.00,$829.50,"$1,313.93","$1,327.20",$0.00,$259.63,$0.00,$264.11,$0.00
858-545,SUP,HCPCS C1713,,858-545  -  SCREW 858-545 CDH FIXED ANGLE 5.5 X 45,"$1,659.00",$0.00,"$1,659.00",$746.55,"$1,184.03",$0.00,$285.84,$0.00,$0.00,$290.48,"$1,659.00",$0.00,$829.50,"$1,313.93","$1,327.20",$0.00,$259.63,$0.00,$264.11,$0.00
858-550,SUP,HCPCS C1713,,858-550  -  SCREW 858-550 CDH FIXED ANGLE 5.5 X 50,"$1,659.00",$0.00,"$1,659.00",$746.55,"$1,184.03",$0.00,$285.84,$0.00,$0.00,$290.48,"$1,659.00",$0.00,$829.50,"$1,313.93","$1,327.20",$0.00,$259.63,$0.00,$264.11,$0.00
858-555,SUP,HCPCS C1713,,858-555  -  SCREW BONE 5.5MM 55MM TI SPNL FIXANG,"$1,659.00",$0.00,"$1,659.00",$746.55,"$1,184.03",$0.00,$285.84,$0.00,$0.00,$290.48,"$1,659.00",$0.00,$829.50,"$1,313.93","$1,327.20",$0.00,$259.63,$0.00,$264.11,$0.00
858-630,SUP,HCPCS C1713,,858-630  -  SCREW 858-630 CDH FIXED ANGLE 6.5 X 30,"$1,659.00",$0.00,"$1,659.00",$746.55,"$1,184.03",$0.00,$285.84,$0.00,$0.00,$290.48,"$1,659.00",$0.00,$829.50,"$1,313.93","$1,327.20",$0.00,$259.63,$0.00,$264.11,$0.00
858-635,SUP,HCPCS C1713,,858-635  -  SCREW 858-635 CDH FIXED ANGLE 6.5 X 35,"$1,659.00",$0.00,"$1,659.00",$746.55,"$1,184.03",$0.00,$285.84,$0.00,$0.00,$290.48,"$1,659.00",$0.00,$829.50,"$1,313.93","$1,327.20",$0.00,$259.63,$0.00,$264.11,$0.00
858-640,SUP,HCPCS C1713,,858-640  -  SCREW 858-640 CDH FIXED ANGLE 6.5 X 40,"$1,659.00",$0.00,"$1,659.00",$746.55,"$1,184.03",$0.00,$285.84,$0.00,$0.00,$290.48,"$1,659.00",$0.00,$829.50,"$1,313.93","$1,327.20",$0.00,$259.63,$0.00,$264.11,$0.00
858-645,SUP,HCPCS C1713,,858-645  -  SCREW 858-645 CDH FIXED ANGLE 6.5 X 45,"$1,659.00",$0.00,"$1,659.00",$746.55,"$1,184.03",$0.00,$285.84,$0.00,$0.00,$290.48,"$1,659.00",$0.00,$829.50,"$1,313.93","$1,327.20",$0.00,$259.63,$0.00,$264.11,$0.00
858-650,SUP,HCPCS C1713,,858-650  -  SCREW 858-650 CDH FIXED ANGLE 6.5 X 50,"$1,659.00",$0.00,"$1,659.00",$746.55,"$1,184.03",$0.00,$285.84,$0.00,$0.00,$290.48,"$1,659.00",$0.00,$829.50,"$1,313.93","$1,327.20",$0.00,$259.63,$0.00,$264.11,$0.00
858-655,SUP,HCPCS C1713,,858-655  -  SCREW 858-655 CDH FIXED ANGLE 6.5 X 55,"$1,659.00",$0.00,"$1,659.00",$746.55,"$1,184.03",$0.00,$285.84,$0.00,$0.00,$290.48,"$1,659.00",$0.00,$829.50,"$1,313.93","$1,327.20",$0.00,$259.63,$0.00,$264.11,$0.00
858-730,SUP,HCPCS C1713,,858-730  -  SCREW 858-730 CDH FIXED ANGLE 7.5 X 30,"$1,659.00",$0.00,"$1,659.00",$746.55,"$1,184.03",$0.00,$285.84,$0.00,$0.00,$290.48,"$1,659.00",$0.00,$829.50,"$1,313.93","$1,327.20",$0.00,$259.63,$0.00,$264.11,$0.00
858-735,SUP,HCPCS C1713,,858-735  -  SCREW 858-735 CDH FIXED ANGLE 7.5 X 35,"$1,659.00",$0.00,"$1,659.00",$746.55,"$1,184.03",$0.00,$285.84,$0.00,$0.00,$290.48,"$1,659.00",$0.00,$829.50,"$1,313.93","$1,327.20",$0.00,$259.63,$0.00,$264.11,$0.00
858-740,SUP,HCPCS C1713,,858-740  -  SCREW 858-740 CDH FIXED ANGLE 7.5 X 40,"$1,659.00",$0.00,"$1,659.00",$746.55,"$1,184.03",$0.00,$285.84,$0.00,$0.00,$290.48,"$1,659.00",$0.00,$829.50,"$1,313.93","$1,327.20",$0.00,$259.63,$0.00,$264.11,$0.00
858-745,SUP,HCPCS C1713,,858-745  -  SCREW 858-745 CDH FIXED ANGLE 7.5 X 45,"$1,659.00",$0.00,"$1,659.00",$746.55,"$1,184.03",$0.00,$285.84,$0.00,$0.00,$290.48,"$1,659.00",$0.00,$829.50,"$1,313.93","$1,327.20",$0.00,$259.63,$0.00,$264.11,$0.00
858-750,SUP,HCPCS C1713,,858-750  -  SCREW 858-750 CDH FIXED ANGLE 7.5 X 50,"$1,659.00",$0.00,"$1,659.00",$746.55,"$1,184.03",$0.00,$285.84,$0.00,$0.00,$290.48,"$1,659.00",$0.00,$829.50,"$1,313.93","$1,327.20",$0.00,$259.63,$0.00,$264.11,$0.00
858-755,SUP,HCPCS C1713,,858-755  -  SCREW 858-755 CDH FIXED ANGLE 7.5 X 55,"$1,659.00",$0.00,"$1,659.00",$746.55,"$1,184.03",$0.00,$285.84,$0.00,$0.00,$290.48,"$1,659.00",$0.00,$829.50,"$1,313.93","$1,327.20",$0.00,$259.63,$0.00,$264.11,$0.00
858-855,SUP,HCPCS C1713,,858-855  -  SCREW SET 8.5MM 55MM HZNM8 BRK OFF SS SPNE 5.5MM ROD,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
859-002,SUP,HCPCS C1713,,859-002  -  HOOK 859-002 5.5 SMALL PEDICLE TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
85900P,SUP,HCPCS C1725,,85900P  -  CATHETER ULTRASOUND 20MHZ STANDARD TAPER 5FR 20MM 150CM,"$1,812.50",$0.00,"$1,812.50",$984.19,"$1,293.58",$0.00,$312.28,$0.00,$0.00,$317.35,"$1,812.50",$0.00,$906.25,"$1,435.50","$1,450.00",$0.00,$283.66,$0.00,$288.55,$0.00
859-010,SUP,HCPCS C1713,,859-010  -  HOOK 859-010 5.5 SMALL WIDE BLADE TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
859-012,SUP,HCPCS C1713,,859-012  -  HOOK 859-012 SV WIDE BLADE SM GROOVE TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
859-020,SUP,HCPCS C1713,,859-020  -  HOOK 859-020 5.5 SM NARROW BLADE TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
859-024,SUP,HCPCS C1713,,859-024  -  HOOK 859-024 5.5 SM ANGLED BLADE TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
859-030,SUP,HCPCS C1713,,859-030  -  HOOK 859-030 5.5 SM EXTEND BODY TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
859-052,SUP,HCPCS C1713,,859-052  -  HOOK 859-052 5.5 SM NRW BLD RAMPED TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
859-102,SUP,HCPCS C1713,,859-102  -  HOOK 859-102 5.5 PEDICLE TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
859-110,SUP,HCPCS C1713,,859-110  -  HOOK 859-110 5.5 WIDE BLADE TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
859-112,SUP,HCPCS C1713,,859-112  -  HOOK 859-112 5.5 WIDE BLADE SM GROOVE TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
859-120,SUP,HCPCS C1713,,859-120  -  HOOK 859-120 5.5 NARROW BLADE TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
859-122,SUP,HCPCS C1713,,859-122  -  HOOK 859-122 NARROW BLADE SM GROOVE TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
859-124,SUP,HCPCS C1713,,859-124  -  HOOK 859-124 5.5 ANGLED BLADE TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
859-130,SUP,HCPCS C1713,,859-130  -  HOOK 859-130 5.5 EXTENDED BOBY TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
859-140,SUP,HCPCS C1713,,859-140  -  HOOK 859-140 5.5 RIGHT OFFSET TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
859-142,SUP,HCPCS C1713,,859-142  -  HOOK 859-142 5.5 LEFT OFFSET TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
859-150,SUP,HCPCS C1713,,859-150  -  HOOK 859-150 5.5 STNDRD BLADE RPD TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
859-152,SUP,HCPCS C1713,,859-152  -  HOOK 859-152 5.5 NARROW BLADE RPD TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
859-160,SUP,HCPCS C1713,,859-160  -  HOOK 859-160 5.5 RIGHT ANGLED TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
859-162,SUP,HCPCS C1713,,859-162  -  HOOK 859-162 5.5 LEFT ANGLED TI,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
859-425,SUP,HCPCS C1713,,859-425  -  SCREW 859-425 CDH FIXED ANGLE 4.5 X25 TI,"$1,893.00",$0.00,"$1,893.00",$851.85,"$1,351.03",$0.00,$326.15,$0.00,$0.00,$331.45,"$1,893.00",$0.00,$946.50,"$1,499.26","$1,514.40",$0.00,$296.25,$0.00,$301.37,$0.00
859-430,SUP,HCPCS C1713,,859-430  -  SCREW 859-430 CDH FIXED ANGLE 4.5 X30 TI,"$1,893.00",$0.00,"$1,893.00",$851.85,"$1,351.03",$0.00,$326.15,$0.00,$0.00,$331.45,"$1,893.00",$0.00,$946.50,"$1,499.26","$1,514.40",$0.00,$296.25,$0.00,$301.37,$0.00
859-435,SUP,HCPCS C1713,,859-435  -  SCREW 859-435 CDH FIXED ANGLE 4.5 X35 TI,"$1,893.00",$0.00,"$1,893.00",$851.85,"$1,351.03",$0.00,$326.15,$0.00,$0.00,$331.45,"$1,893.00",$0.00,$946.50,"$1,499.26","$1,514.40",$0.00,$296.25,$0.00,$301.37,$0.00
859-440,SUP,HCPCS C1713,,859-440  -  SCREW 859-440 CDH FIXED ANGLE 4.5 X40 TI,"$1,893.00",$0.00,"$1,893.00",$851.85,"$1,351.03",$0.00,$326.15,$0.00,$0.00,$331.45,"$1,893.00",$0.00,$946.50,"$1,499.26","$1,514.40",$0.00,$296.25,$0.00,$301.37,$0.00
859-445,SUP,HCPCS C1713,,859-445  -  SCREW 859-445 CDH FIXED ANGLE 4.5 X45 TI,"$1,893.00",$0.00,"$1,893.00",$851.85,"$1,351.03",$0.00,$326.15,$0.00,$0.00,$331.45,"$1,893.00",$0.00,$946.50,"$1,499.26","$1,514.40",$0.00,$296.25,$0.00,$301.37,$0.00
859-450,SUP,HCPCS C1713,,859-450  -  SCREW 859-450 CDH FIXED ANGLE 4.5 X50 TI,"$1,893.00",$0.00,"$1,893.00",$851.85,"$1,351.03",$0.00,$326.15,$0.00,$0.00,$331.45,"$1,893.00",$0.00,$946.50,"$1,499.26","$1,514.40",$0.00,$296.25,$0.00,$301.37,$0.00
859-525,SUP,HCPCS C1713,,859-525  -  SCREW 859-525  5.5 FIXED ANGLE 5.5X25 TI,"$1,893.00",$0.00,"$1,893.00",$851.85,"$1,351.03",$0.00,$326.15,$0.00,$0.00,$331.45,"$1,893.00",$0.00,$946.50,"$1,499.26","$1,514.40",$0.00,$296.25,$0.00,$301.37,$0.00
859-530,SUP,HCPCS C1713,,859-530  -  SCREW 859-530  5.5 FIXED ANGLE 5.5X30 TI,"$1,893.00",$0.00,"$1,893.00",$851.85,"$1,351.03",$0.00,$326.15,$0.00,$0.00,$331.45,"$1,893.00",$0.00,$946.50,"$1,499.26","$1,514.40",$0.00,$296.25,$0.00,$301.37,$0.00
859-535,SUP,HCPCS C1713,,859-535  -  SCREW 859-535  5.5 FIXED ANGLE 5.5X35 TI,"$1,893.00",$0.00,"$1,893.00",$851.85,"$1,351.03",$0.00,$326.15,$0.00,$0.00,$331.45,"$1,893.00",$0.00,$946.50,"$1,499.26","$1,514.40",$0.00,$296.25,$0.00,$301.37,$0.00
859-540,SUP,HCPCS C1713,,859-540  -  SCREW 859-540  5.5 FIXED ANGLE 5.5X40 TI,"$1,893.00",$0.00,"$1,893.00",$851.85,"$1,351.03",$0.00,$326.15,$0.00,$0.00,$331.45,"$1,893.00",$0.00,$946.50,"$1,499.26","$1,514.40",$0.00,$296.25,$0.00,$301.37,$0.00
859-545,SUP,HCPCS C1713,,859-545  -  SCREW 859-545  5.5 FIXED ANGLE 5.5X45 TI,"$1,893.00",$0.00,"$1,893.00",$851.85,"$1,351.03",$0.00,$326.15,$0.00,$0.00,$331.45,"$1,893.00",$0.00,$946.50,"$1,499.26","$1,514.40",$0.00,$296.25,$0.00,$301.37,$0.00
859-550,SUP,HCPCS C1713,,859-550  -  SCREW 859-550  5.5 FIXED ANGLE 5.5X50 TI,"$1,893.00",$0.00,"$1,893.00",$851.85,"$1,351.03",$0.00,$326.15,$0.00,$0.00,$331.45,"$1,893.00",$0.00,$946.50,"$1,499.26","$1,514.40",$0.00,$296.25,$0.00,$301.37,$0.00
859-555,SUP,HCPCS C1713,,859-555  -  SCREW 859-555  5.5 FIXED ANGLE 5.5X55 TI,"$1,893.00",$0.00,"$1,893.00",$851.85,"$1,351.03",$0.00,$326.15,$0.00,$0.00,$331.45,"$1,893.00",$0.00,$946.50,"$1,499.26","$1,514.40",$0.00,$296.25,$0.00,$301.37,$0.00
859-630,SUP,HCPCS C1713,,859-630  -  SCREW 859-630  5.5 FIXED ANGLE 6.5X30 TI,"$1,893.00",$0.00,"$1,893.00",$851.85,"$1,351.03",$0.00,$326.15,$0.00,$0.00,$331.45,"$1,893.00",$0.00,$946.50,"$1,499.26","$1,514.40",$0.00,$296.25,$0.00,$301.37,$0.00
859-635,SUP,HCPCS C1713,,859-635  -  SCREW 859-635  5.5 FIXED ANGLE 6.5X35 TI,"$1,893.00",$0.00,"$1,893.00",$851.85,"$1,351.03",$0.00,$326.15,$0.00,$0.00,$331.45,"$1,893.00",$0.00,$946.50,"$1,499.26","$1,514.40",$0.00,$296.25,$0.00,$301.37,$0.00
859-640,SUP,HCPCS C1713,,859-640  -  SCREW 859-640  5.5 FIXED ANGLE 6.5X40 TI,"$1,893.00",$0.00,"$1,893.00",$851.85,"$1,351.03",$0.00,$326.15,$0.00,$0.00,$331.45,"$1,893.00",$0.00,$946.50,"$1,499.26","$1,514.40",$0.00,$296.25,$0.00,$301.37,$0.00
859-645,SUP,HCPCS C1713,,859-645  -  SCREW 859-645  5.5 FIXED ANGLE 6.5X45 TI,"$1,893.00",$0.00,"$1,893.00",$851.85,"$1,351.03",$0.00,$326.15,$0.00,$0.00,$331.45,"$1,893.00",$0.00,$946.50,"$1,499.26","$1,514.40",$0.00,$296.25,$0.00,$301.37,$0.00
859-650,SUP,HCPCS C1713,,859-650  -  SCREW 859-650  5.5 FIXED ANGLE 6.5X50 TI,"$1,893.00",$0.00,"$1,893.00",$851.85,"$1,351.03",$0.00,$326.15,$0.00,$0.00,$331.45,"$1,893.00",$0.00,$946.50,"$1,499.26","$1,514.40",$0.00,$296.25,$0.00,$301.37,$0.00
859-655,SUP,HCPCS C1713,,859-655  -  SCREW 859-655  5.5 FIXED ANGLE 6.5X55 TI,"$1,893.00",$0.00,"$1,893.00",$851.85,"$1,351.03",$0.00,$326.15,$0.00,$0.00,$331.45,"$1,893.00",$0.00,$946.50,"$1,499.26","$1,514.40",$0.00,$296.25,$0.00,$301.37,$0.00
859-730,SUP,HCPCS C1713,,859-730  -  SCREW 859-730  5.5 FIXED ANGLE 7.5X30 TI,"$1,893.00",$0.00,"$1,893.00",$851.85,"$1,351.03",$0.00,$326.15,$0.00,$0.00,$331.45,"$1,893.00",$0.00,$946.50,"$1,499.26","$1,514.40",$0.00,$296.25,$0.00,$301.37,$0.00
859-735,SUP,HCPCS C1713,,859-735  -  SCREW 859-735  5.5 FIXED ANGLE 7.5X35 TI,"$1,893.00",$0.00,"$1,893.00",$851.85,"$1,351.03",$0.00,$326.15,$0.00,$0.00,$331.45,"$1,893.00",$0.00,$946.50,"$1,499.26","$1,514.40",$0.00,$296.25,$0.00,$301.37,$0.00
859-740,SUP,HCPCS C1713,,859-740  -  SCREW 859-740  5.5 FIXED ANGLE 7.5X40 TI,"$1,893.00",$0.00,"$1,893.00",$851.85,"$1,351.03",$0.00,$326.15,$0.00,$0.00,$331.45,"$1,893.00",$0.00,$946.50,"$1,499.26","$1,514.40",$0.00,$296.25,$0.00,$301.37,$0.00
859-745,SUP,HCPCS C1713,,859-745  -  SCREW 859-745  5.5 FIXED ANGLE 7.5X45 TI,"$1,893.00",$0.00,"$1,893.00",$851.85,"$1,351.03",$0.00,$326.15,$0.00,$0.00,$331.45,"$1,893.00",$0.00,$946.50,"$1,499.26","$1,514.40",$0.00,$296.25,$0.00,$301.37,$0.00
859-750,SUP,HCPCS C1713,,859-750  -  SCREW 859-750  5.5 FIXED ANGLE 7.5X50 TI,"$1,893.00",$0.00,"$1,893.00",$851.85,"$1,351.03",$0.00,$326.15,$0.00,$0.00,$331.45,"$1,893.00",$0.00,$946.50,"$1,499.26","$1,514.40",$0.00,$296.25,$0.00,$301.37,$0.00
859-755,SUP,HCPCS C1713,,859-755  -  SCREW 859-755  5.5 FIXED ANGLE 7.5X55 TI,"$1,893.00",$0.00,"$1,893.00",$851.85,"$1,351.03",$0.00,$326.15,$0.00,$0.00,$331.45,"$1,893.00",$0.00,$946.50,"$1,499.26","$1,514.40",$0.00,$296.25,$0.00,$301.37,$0.00
859-760,SUP,HCPCS C1713,,859-760  -  SCREW 859-760  5.5 FIXED ANGLE 7.5X60 TI,"$1,893.00",$0.00,"$1,893.00",$851.85,"$1,351.03",$0.00,$326.15,$0.00,$0.00,$331.45,"$1,893.00",$0.00,$946.50,"$1,499.26","$1,514.40",$0.00,$296.25,$0.00,$301.37,$0.00
86-100,SUP,HCPCS C1713,,86-100  -  PLATE BN V NS LF TRITIUM STRNL DISP,"$1,237.50",$0.00,"$1,237.50",$556.88,$883.20,$0.00,$213.22,$0.00,$0.00,$216.68,"$1,237.50",$0.00,$618.75,$980.10,$990.00,$0.00,$193.67,$0.00,$197.01,$0.00
86-200,SUP,HCPCS C1713,,86-200  -  PLATE BN TRITIUM 8 HL 1 CBL STRNL,"$1,737.50",$0.00,"$1,737.50",$781.88,"$1,240.05",$0.00,$299.36,$0.00,$0.00,$304.22,"$1,737.50",$0.00,$868.75,"$1,376.10","$1,390.00",$0.00,$271.92,$0.00,$276.61,$0.00
86-27-08,SUP,HCPCS C1713,,86-27-08  -  SCREW BN 2.7MM 8MM NS TRITIUM STRNL,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
86-27-10,SUP,HCPCS C1713,,86-27-10  -  SCREW BN 2.7MM 10MM NS TRITIUM STRNL,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
86-27-12,SUP,HCPCS C1713,,86-27-12  -  SCREW BN 12MM NS LF TRITIUM STRNL CBL PLT SYS,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
86-27-14,SUP,HCPCS C1713,,86-27-14  -  SCREW BN 14MM NS LF TRITIUM STRNL CBL PLT SYS,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
86-27-16,SUP,HCPCS C1713,,86-27-16  -  SCREW BN 16MM NS TRITIUM STRNL CBL PLT SYS,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
86-300,SUP,HCPCS C1713,,86-300  -  PLATE BN NS TRITIUM 2 CBL STRNL,"$1,845.00",$0.00,"$1,845.00",$830.25,"$1,316.78",$0.00,$317.88,$0.00,$0.00,$323.04,"$1,845.00",$0.00,$922.50,"$1,461.24","$1,476.00",$0.00,$288.74,$0.00,$293.72,$0.00
86-30-08,SUP,HCPCS C1713,,86-30-08  -  SCREW BN NS TRITIUM RSC STRNL CBL PLT SYS,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
86-30-10,SUP,HCPCS C1713,,86-30-10  -  SCREW BN 3MM 10MM NS LF RSC TRITIUM STRNL CBL PLT SYS,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
86-30-12,SUP,HCPCS C1713,,86-30-12  -  SCREW BN 3MM 12MM NS LF RSC TRITIUM STRNL CBL PLT SYS,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
86-30-14,SUP,HCPCS C1713,,86-30-14  -  SCREW BN 3MM 14MM NS LF RSC TRITIUM STRNL CBL PLT SYS,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
86-30-16,SUP,HCPCS C1713,,86-30-16  -  SCREW BN NS TRITIUM RSC STRNL,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
86-350-S,SUP,HCPCS C1713,,86-350-S  -  DEVICE FX STRL LF TRITIUM 4 HL 2 CBL PLT SHRP NDL STRNL,"$1,882.50",$0.00,"$1,882.50",$847.13,"$1,343.54",$0.00,$324.35,$0.00,$0.00,$329.61,"$1,882.50",$0.00,$941.25,"$1,490.94","$1,506.00",$0.00,$294.61,$0.00,$299.69,$0.00
86-400,SUP,HCPCS C1713,,86-400  -  PLATE BN TRITIUM 5 HL 1 CBL STRNL,"$1,487.50",$0.00,"$1,487.50",$669.38,"$1,061.63",$0.00,$256.29,$0.00,$0.00,$260.45,"$1,487.50",$0.00,$743.75,"$1,178.10","$1,190.00",$0.00,$232.79,$0.00,$236.81,$0.00
86-500,SUP,HCPCS C1713,,86-500  -  PLATE BN TRITIUM 4 HL 1 CBL STRNL,"$1,487.50",$0.00,"$1,487.50",$669.38,"$1,061.63",$0.00,$256.29,$0.00,$0.00,$260.45,"$1,487.50",$0.00,$743.75,"$1,178.10","$1,190.00",$0.00,$232.79,$0.00,$236.81,$0.00
86-600,SUP,HCPCS C1713,,86-600  -  PLATE BN NS TRITIUM CBL STRNL RB,"$1,790.00",$0.00,"$1,790.00",$805.50,"$1,277.52",$0.00,$308.41,$0.00,$0.00,$313.41,"$1,790.00",$0.00,$895.00,"$1,417.68","$1,432.00",$0.00,$280.14,$0.00,$284.97,$0.00
86-700,SUP,HCPCS C1713,,86-700  -  PLATE LADDER TRITIUM SCP 14 HL PRECONTOUR STRNM STRNL CBL,"$1,797.50",$0.00,"$1,797.50",$808.88,"$1,282.88",$0.00,$309.70,$0.00,$0.00,$314.73,"$1,797.50",$0.00,$898.75,"$1,423.62","$1,438.00",$0.00,$281.31,$0.00,$286.16,$0.00
868-011,SUP,HCPCS C1713,,868-011  -  ROD 868-011 LEG 5.5 DIA HEX END SS,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
868-021,SUP,HCPCS C1713,,868-021  -  ROD 868-021 LEG 5.5 DIA LINED HEX END SS,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
869-011,SUP,HCPCS C1713,,869-011  -  ROD 869-011 LEG 5.5 DIA HEX END TI,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
869-012,SUP,HCPCS C1713,,869-012  -  ROD 869-012 LEG 5.5 DIA HEX END TI,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
869-013,SUP,HCPCS C1713,,869-013  -  ROD SPNL 50MM 5.5MM CD HZN LGC STD TI HEX END IV CP GRAD,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
869-014,SUP,HCPCS C1713,,869-014  -  CP 2 ROD - 5.5MM DIA L=500MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
869-021,SUP,HCPCS C1713,,869-021  -  SCREW BONE 5.5MM 210MM CD HZN LGC TI PDCL MULTIAX STRL 5.5MM,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
869-022,SUP,HCPCS C1713,,869-022  -  ROD SPNL 50CM 5.5MM CD HZN LGC LNG TI IV HEX END LN CAP,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
8696G,SUP,Custom 27203010,,8696G  -  SUTURE NABSB 7-0 P1 18IN BLU PRLN MFL,$16.63,$0.00,$16.63,$0.00,$11.87,$0.00,$0.00,$0.00,$0.00,$0.00,$16.63,$0.00,$8.32,$13.17,$13.31,$0.00,$0.00,$0.00,$0.00,$0.00
8700-000865-01,SUP,Custom 27203010,,8700-000865-01  -  PACK SRG 6FT IVTM COOL LINE SRT UP DISP,"$6,725.10",$0.00,"$6,725.10",$0.00,"$4,799.70",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,725.10",$0.00,"$3,362.55","$5,326.28","$5,380.08",$0.00,$0.00,$0.00,$0.00,$0.00
8700-000866-01,SUP,Custom 27203010,,8700-000866-01  -  PACK SRG 6FT IVTM ICY SRT UP DISP,"$9,639.60",$0.00,"$9,639.60",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$9,639.60",$0.00,"$4,819.80","$7,634.56","$7,711.68",$0.00,$0.00,$0.00,$0.00,$0.00
8700-000867-01,SUP,Custom 27203010,,8700-000867-01  -  PACK SRG 6FT IVTM QUATTRO SRT UP DISP,"$10,579.20",$0.00,"$10,579.20",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$10,579.20",$0.00,"$5,289.60","$8,378.73","$8,463.36",$0.00,$0.00,$0.00,$0.00,$0.00
8700-0654-01,SUP,HCPCS C1751,,8700-0654-01  -  CATH CEN VEN 9.3FR 22CM 58MM ODS,"$1,226.70",$0.00,"$1,226.70",$552.02,$875.50,$0.00,$211.35,$0.00,$0.00,$214.79,"$1,226.70",$0.00,$613.35,$971.55,$981.36,$0.00,$191.98,$0.00,$195.29,$0.00
8700-0657-01,SUP,HCPCS C1751,,8700-0657-01  -  CATHETER CEN VEN .032IN 9.3FR 38CM 75CM 3 INFUS LUMEN EXTN,"$1,955.33",$0.00,"$1,955.33",$879.90,"$1,395.52",$0.00,$336.89,$0.00,$0.00,$342.36,"$1,955.33",$0.00,$977.66,"$1,548.62","$1,564.26",$0.00,$306.01,$0.00,$311.29,$0.00
8700-0660-01,SUP,HCPCS C1752,,8700-0660-01  -  KIT 45CM 9.3FR TRIP CATH QT,"$2,190.23",$0.00,"$2,190.23",$0.00,"$1,563.16",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,190.23",$0.00,"$1,095.11","$1,734.66","$1,752.18",$0.00,$0.00,$0.00,$0.00,$0.00
8700-0781-01,SUP,Custom 27203010,,8700-0781-01  -  CATHETER CV 9.3FR 22CM STRL LF CL LN HEAT EXCH KT,"$1,287.60",$0.00,"$1,287.60",$0.00,$918.96,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,287.60",$0.00,$643.80,"$1,019.78","$1,030.08",$0.00,$0.00,$0.00,$0.00,$0.00
8700-0782-01,SUP,Custom 27203010,,8700-0782-01  -  KIT CATH 9.3FR 38CM ICY CV,"$2,053.20",$0.00,"$2,053.20",$0.00,"$1,465.37",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,053.20",$0.00,"$1,026.60","$1,626.13","$1,642.56",$0.00,$0.00,$0.00,$0.00,$0.00
8700-0783-01,SUP,Custom 27203010,,8700-0783-01  -  KIT CATH 9.3FR 45CM QUATTRO HEAT EXCH 3 LUM LL APPLAUSE HEP,"$2,298.98",$0.00,"$2,298.98",$0.00,"$1,640.78",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,298.98",$0.00,"$1,149.49","$1,820.79","$1,839.18",$0.00,$0.00,$0.00,$0.00,$0.00
8700-0784-01,SUP,Custom 27203010,,8700-0784-01  -  KIT IV CLGRD 3K SRT,$454.58,$0.00,$454.58,$0.00,$324.43,$0.00,$0.00,$0.00,$0.00,$0.00,$454.58,$0.00,$227.29,$360.03,$363.66,$0.00,$0.00,$0.00,$0.00,$0.00
8700-0785-01,SUP,Custom 27203010,,8700-0785-01  -  TUBING XTN 9FT,$511.13,$0.00,$511.13,$0.00,$364.79,$0.00,$0.00,$0.00,$0.00,$0.00,$511.13,$0.00,$255.56,$404.81,$408.90,$0.00,$0.00,$0.00,$0.00,$0.00
8709H,SUP,Custom 27203010,,8709H  -  SUTURE NONABSORBABLE 6-0 BV-1 30IN 2 ARM MONOFILAMENT,$34.09,$0.00,$34.09,$0.00,$24.33,$0.00,$0.00,$0.00,$0.00,$0.00,$34.09,$0.00,$17.04,$27.00,$27.27,$0.00,$0.00,$0.00,$0.00,$0.00
873-004,SUP,HCPCS C1769,,873-004  -  GWIRE ORTH 24IN UCSS THRD INSTR,$225.00,$0.00,$225.00,$122.18,$160.58,$0.00,$38.77,$0.00,$0.00,$39.40,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$35.21,$0.00,$35.82,$0.00
873-011,SUP,HCPCS C1769,,873-011  -  GWIRE ORTH 24IN UCSS NTHRD INSTR DISP,$225.00,$0.00,$225.00,$122.18,$160.58,$0.00,$38.77,$0.00,$0.00,$39.40,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$35.21,$0.00,$35.82,$0.00
873-030,SUP,HCPCS C1713,,873-030  -  BONE SCREW 873-030 4.0 CANN CORT L 30MM,"$1,381.50",$0.00,"$1,381.50",$621.68,$985.98,$0.00,$238.03,$0.00,$0.00,$241.89,"$1,381.50",$0.00,$690.75,"$1,094.15","$1,105.20",$0.00,$216.20,$0.00,$219.93,$0.00
873-032,SUP,HCPCS C1713,,873-032  -  BONE SCREW 873-032 4.0 CANN CORT L 32MM,"$1,381.50",$0.00,"$1,381.50",$621.68,$985.98,$0.00,$238.03,$0.00,$0.00,$241.89,"$1,381.50",$0.00,$690.75,"$1,094.15","$1,105.20",$0.00,$216.20,$0.00,$219.93,$0.00
873-034,SUP,HCPCS C1713,,873-034  -  BONE SCREW 873-034 4.0 CANN CORT L 34MM,"$1,381.50",$0.00,"$1,381.50",$621.68,$985.98,$0.00,$238.03,$0.00,$0.00,$241.89,"$1,381.50",$0.00,$690.75,"$1,094.15","$1,105.20",$0.00,$216.20,$0.00,$219.93,$0.00
873-036,SUP,HCPCS C1713,,873-036  -  BONE SCREW 873-036 4.0 CANN CORT L 36MM,"$1,381.50",$0.00,"$1,381.50",$621.68,$985.98,$0.00,$238.03,$0.00,$0.00,$241.89,"$1,381.50",$0.00,$690.75,"$1,094.15","$1,105.20",$0.00,$216.20,$0.00,$219.93,$0.00
873-038,SUP,HCPCS C1713,,873-038  -  BONE SCREW 873-038 4.0 CANN CORT L 38MM,"$1,381.50",$0.00,"$1,381.50",$621.68,$985.98,$0.00,$238.03,$0.00,$0.00,$241.89,"$1,381.50",$0.00,$690.75,"$1,094.15","$1,105.20",$0.00,$216.20,$0.00,$219.93,$0.00
873-040,SUP,HCPCS C1713,,873-040  -  SCREW BONE 4MM 40MM UCSS TI CORT CANN,"$1,381.50",$0.00,"$1,381.50",$621.68,$985.98,$0.00,$238.03,$0.00,$0.00,$241.89,"$1,381.50",$0.00,$690.75,"$1,094.15","$1,105.20",$0.00,$216.20,$0.00,$219.93,$0.00
873-042,SUP,HCPCS C1713,,873-042  -  SCREW BONE 4MM 42MM UCSS TI CORT CANN,"$1,381.50",$0.00,"$1,381.50",$621.68,$985.98,$0.00,$238.03,$0.00,$0.00,$241.89,"$1,381.50",$0.00,$690.75,"$1,094.15","$1,105.20",$0.00,$216.20,$0.00,$219.93,$0.00
873-044,SUP,HCPCS C1713,,873-044  -  BONE SCREW 873-044 4.0 CANN CORT L 44MM,"$1,381.50",$0.00,"$1,381.50",$621.68,$985.98,$0.00,$238.03,$0.00,$0.00,$241.89,"$1,381.50",$0.00,$690.75,"$1,094.15","$1,105.20",$0.00,$216.20,$0.00,$219.93,$0.00
873-046,SUP,HCPCS C1713,,873-046  -  BONE SCREW 873-046 4.0 CANN CORT L 46MM,"$1,381.50",$0.00,"$1,381.50",$621.68,$985.98,$0.00,$238.03,$0.00,$0.00,$241.89,"$1,381.50",$0.00,$690.75,"$1,094.15","$1,105.20",$0.00,$216.20,$0.00,$219.93,$0.00
873-048,SUP,HCPCS C1713,,873-048  -  BONE SCREW 873-048 4.0 CANN CORT L 48MM,"$1,381.50",$0.00,"$1,381.50",$621.68,$985.98,$0.00,$238.03,$0.00,$0.00,$241.89,"$1,381.50",$0.00,$690.75,"$1,094.15","$1,105.20",$0.00,$216.20,$0.00,$219.93,$0.00
873-050,SUP,HCPCS C1713,,873-050  -  BONE SCREW 873-050 4.0 CANN CORT L 50MM,"$1,381.50",$0.00,"$1,381.50",$621.68,$985.98,$0.00,$238.03,$0.00,$0.00,$241.89,"$1,381.50",$0.00,$690.75,"$1,094.15","$1,105.20",$0.00,$216.20,$0.00,$219.93,$0.00
873-136,SUP,HCPCS C1713,,873-136  -  SCREW BN P/T 4MM 36MM UCSS LG CNN TI SPNE CORT,"$1,381.50",$0.00,"$1,381.50",$621.68,$985.98,$0.00,$238.03,$0.00,$0.00,$241.89,"$1,381.50",$0.00,$690.75,"$1,094.15","$1,105.20",$0.00,$216.20,$0.00,$219.93,$0.00
873-138,SUP,HCPCS C1713,,873-138  -  BONE SCREW 873-138 4.0 CAN CORT LAG L 38,"$1,381.50",$0.00,"$1,381.50",$621.68,$985.98,$0.00,$238.03,$0.00,$0.00,$241.89,"$1,381.50",$0.00,$690.75,"$1,094.15","$1,105.20",$0.00,$216.20,$0.00,$219.93,$0.00
873-140,SUP,HCPCS C1713,,873-140  -  BONE SCREW 873-140 4.0 CAN CORT LAG L 40,"$1,381.50",$0.00,"$1,381.50",$621.68,$985.98,$0.00,$238.03,$0.00,$0.00,$241.89,"$1,381.50",$0.00,$690.75,"$1,094.15","$1,105.20",$0.00,$216.20,$0.00,$219.93,$0.00
873-142,SUP,HCPCS C1713,,873-142  -  BONE SCREW 873-142 4.0 CAN CORT LAG L 42,"$1,381.50",$0.00,"$1,381.50",$621.68,$985.98,$0.00,$238.03,$0.00,$0.00,$241.89,"$1,381.50",$0.00,$690.75,"$1,094.15","$1,105.20",$0.00,$216.20,$0.00,$219.93,$0.00
873-144,SUP,HCPCS C1713,,873-144  -  BONE SCREW 873-144 4.0 CAN CORT LAG L 44,"$1,381.50",$0.00,"$1,381.50",$621.68,$985.98,$0.00,$238.03,$0.00,$0.00,$241.89,"$1,381.50",$0.00,$690.75,"$1,094.15","$1,105.20",$0.00,$216.20,$0.00,$219.93,$0.00
873-146,SUP,HCPCS C1713,,873-146  -  BONE SCREW 873-146 4.0 CAN CORT LAG L 46,"$1,381.50",$0.00,"$1,381.50",$621.68,$985.98,$0.00,$238.03,$0.00,$0.00,$241.89,"$1,381.50",$0.00,$690.75,"$1,094.15","$1,105.20",$0.00,$216.20,$0.00,$219.93,$0.00
873-148,SUP,HCPCS C1713,,873-148  -  BONE SCREW 873-148 4.0 CAN CORT LAG L 48,"$1,381.50",$0.00,"$1,381.50",$621.68,$985.98,$0.00,$238.03,$0.00,$0.00,$241.89,"$1,381.50",$0.00,$690.75,"$1,094.15","$1,105.20",$0.00,$216.20,$0.00,$219.93,$0.00
873-150,SUP,HCPCS C1713,,873-150  -  BONE SCREW 873-150 4.0 CAN CORT LAG L 50,"$1,381.50",$0.00,"$1,381.50",$621.68,$985.98,$0.00,$238.03,$0.00,$0.00,$241.89,"$1,381.50",$0.00,$690.75,"$1,094.15","$1,105.20",$0.00,$216.20,$0.00,$219.93,$0.00
8747H,SUP,Custom 27203010,,8747H  -  SUTURE NONABSORBABLE 7-0 BV175-8 24IN 2 ARM MONOFILAMENT,$72.38,$0.00,$72.38,$0.00,$51.66,$0.00,$0.00,$0.00,$0.00,$0.00,$72.38,$0.00,$36.19,$57.32,$57.91,$0.00,$0.00,$0.00,$0.00,$0.00
87525S,SUP,HCPCS C1713,,87525S  -  SCREW BN STD 8.75MM 25MM SPRL R90D LCK TI SPNE THORLMBR,"$1,233.33",$0.00,"$1,233.33",$555.00,$880.22,$0.00,$212.50,$0.00,$0.00,$215.95,"$1,233.33",$0.00,$616.66,$976.80,$986.66,$0.00,$193.02,$0.00,$196.35,$0.00
87530S,SUP,HCPCS C1713,,87530S  -  SCREW BN STD 8.75MM 30MM SPRL R90D LCK TI SPNE THORLMBR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
87535S,SUP,HCPCS C1713,,87535S  -  SCREW BN STD 8.75MM 35MM SPRL R90D LCK TI SPNE THORLMBR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
87540S,SUP,HCPCS C1713,,87540S  -  SCREW BN STD 8.75MM 40MM SPRL R90D LCK TI SPNE THORLMBR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
87545S,SUP,HCPCS C1713,,87545S  -  SCREW BN STD 8.75MM 45MM SPRL R90D LCK TI SPNE THORLMBR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
87550S,SUP,HCPCS C1713,,87550S  -  SCREW BN STD 8.75MM 50MM SPRL R90D LCK TI SPNE THORLMBR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
87555S,SUP,HCPCS C1713,,87555S  -  SCREW BN STD 8.75MM 55MM SPRL R90D LCK TI SPNE THORLMBR,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
876-010,SUP,HCPCS C1713,,876-010  -  SCREW 876-010 ATLANTIS CAN FAS 4.0X10MM,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
876-011,SUP,HCPCS C1713,,876-011  -  SCREW 876-011 ATLANTIS CAN FAS 4.0X11MM,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
876-012,SUP,HCPCS C1713,,876-012  -  SCREW BN 4MM 12MM GRY STRL ATLNTS FX ANG TI SPNE CRV CANC,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
876-013,SUP,HCPCS C1713,,876-013  -  SCREW BN 4MM 13MM GRY STRL ATLNTS FX ANG TI SPNE CRV CANC,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
876-014,SUP,HCPCS C1713,,876-014  -  SCREW BN 4MM 14MM GRY STRL ATLNTS FX ANG TI SPNE CANC CRV,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
876-015,SUP,HCPCS C1713,,876-015  -  SCREW BN 4MM 15MM GRY STRL ATLNTS FX ANG TI SPNE CRV CANC,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
876-016,SUP,HCPCS C1713,,876-016  -  SCREW BN 4MM 16MM GRY STRL ATLNTS FX ANG TI SPNE CRV CANC,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
876-017,SUP,HCPCS C1713,,876-017  -  SCREW BN 4MM 17MM GRY STRL ATLNTS FX ANG TI SPNE CRV CANC,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
876-018,SUP,HCPCS C1713,,876-018  -  SCREW BN 4MM 18MM GRY STRL ATLNTS FX ANG TI SPNE CRV CANC,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
876-019,SUP,HCPCS C1713,,876-019  -  SCREW 876-019 ATLANTIS CAN FAS 4.0X19MM,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
876-020,SUP,HCPCS C1713,,876-020  -  SCREW 876-020 ATLANTIS CAN FAS 4.0X20MM,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
876-021,SUP,HCPCS C1713,,876-021  -  SCREW 876-021 ATLANTIS CAN FAS 4.0X21MM,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
876-053,SUP,HCPCS C1713,,876-053  -  SCREW BN 4.5MM 13MM BLU STRL ATLNTS FX ANG TI SPNE CRV CANC,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
876-055,SUP,HCPCS C1713,,876-055  -  SCREW BN 4.5MM 15MM BLU STRL ATLNTS FX ANG TI SPNE CRV CANC,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
876-057,SUP,HCPCS C1713,,876-057  -  SCREW BN 4.5MM 17MM BLU STRL ATLNTS FX ANG TI SPNE CRV CANC,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
876-119,SUP,HCPCS C1713,,876-119  -  PLATE 876-119 19MM ANTERIOR CERVICAL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
876-121,SUP,HCPCS C1713,,876-121  -  PLATE 876-121 21MM ANTERIOR CERVICAL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
876-123,SUP,HCPCS C1713,,876-123  -  PLATE 876-123 23MM ANTERIOR CERVICAL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
876-125,SUP,HCPCS C1713,,876-125  -  PLATE 876-125 25MM ANTERIOR CERVICAL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
876-127,SUP,HCPCS C1713,,876-127  -  PLATE 876-127 27.5MM ANTERIOR CERVICAL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
876-130,SUP,HCPCS C1713,,876-130  -  PLATE 876-130 30MM ANTERIOR CERVICAL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
876-132,SUP,HCPCS C1713,,876-132  -  PLATE 876-132 32.5MM ANTERIOR CERVICAL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
876-135,SUP,HCPCS C1713,,876-135  -  PLATE 876-135 35MM ANTERIOR CERVICAL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
876-137,SUP,HCPCS C1713,,876-137  -  PLATE 876-137 37.5MM ANTERIOR CERVICAL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
876-140,SUP,HCPCS C1713,,876-140  -  PLATE 876-140 40MM ANTERIOR CERVICAL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
876-142,SUP,HCPCS C1713,,876-142  -  PLATE BN 42.5MM STRL ATLNTS LCK LOPRFL TI SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
876-145,SUP,HCPCS C1713,,876-145  -  PLATE 876-145 45MM ANTERIOR CERVICAL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
876-147,SUP,HCPCS C1713,,876-147  -  PLATE 876-147 47.5MM ANTERIOR CERVICAL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
876-150,SUP,HCPCS C1713,,876-150  -  PLATE 876-150 50MM ANTERIOR CERVICAL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
876-152,SUP,HCPCS C1713,,876-152  -  PLATE 876-152 52.5MM ANTERIOR CERVICAL,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
876-155,SUP,HCPCS C1713,,876-155  -  PLATE 876-155 55MM ANTERIOR CERVICAL,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
876-157,SUP,HCPCS C1713,,876-157  -  PLATE 876-157 57.5MM ANTERIOR CERVICAL,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
876-160,SUP,HCPCS C1713,,876-160  -  PLATE 876-160 60MM ANTERIOR CERVICAL,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
876-162,SUP,HCPCS C1713,,876-162  -  PLATE 876-162 62.5MM ANTERIOR CERVICAL,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
876-165,SUP,HCPCS C1713,,876-165  -  PLATE 876-165 65MM ANTERIOR CERVICAL,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
876-167,SUP,HCPCS C1713,,876-167  -  PLATE 876-167 67.5MM ANTERIOR CERVICAL,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
876-170,SUP,HCPCS C1713,,876-170  -  PLATE 876-170 70MM ANTERIOR CERVICAL,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
876-172,SUP,HCPCS C1713,,876-172  -  PLATE 876-172 72.5MM ANTERIOR CERVICAL,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
876-175,SUP,HCPCS C1713,,876-175  -  PLATE 876-175 75MM ANTERIOR CERVICAL,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
876-177,SUP,HCPCS C1713,,876-177  -  PLATE 876-177 77.5MM ANTERIOR CERVICAL,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
876-180,SUP,HCPCS C1713,,876-180  -  PLATE 876-180 80MM ANTERIOR CERVICAL,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
876-182,SUP,HCPCS C1713,,876-182  -  PLATE 876-182 82.5MM ANTERIOR CERVICAL,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
876-185,SUP,HCPCS C1713,,876-185  -  PLATE 876-185 85MM ANTERIOR CERVICAL,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
876-187,SUP,HCPCS C1713,,876-187  -  PLATE 876-187 87.5MM ANTERIOR CERVICAL,"$4,135.50",$0.00,"$4,135.50","$1,860.98","$2,951.51",$0.00,$712.53,$0.00,$0.00,$724.09,"$4,135.50",$0.00,"$2,067.75","$3,275.32","$3,308.40",$0.00,$647.21,$0.00,$658.37,$0.00
876-190,SUP,HCPCS C1713,,876-190  -  PLATE 876-190 90MM ANTERIOR CERVICAL,"$4,135.50",$0.00,"$4,135.50","$1,860.98","$2,951.51",$0.00,$712.53,$0.00,$0.00,$724.09,"$4,135.50",$0.00,"$2,067.75","$3,275.32","$3,308.40",$0.00,$647.21,$0.00,$658.37,$0.00
876-195,SUP,HCPCS C1713,,876-195  -  PLATE 876-195 95MM ANTERIOR CERVICAL,"$4,135.50",$0.00,"$4,135.50","$1,860.98","$2,951.51",$0.00,$712.53,$0.00,$0.00,$724.09,"$4,135.50",$0.00,"$2,067.75","$3,275.32","$3,308.40",$0.00,$647.21,$0.00,$658.37,$0.00
876-200,SUP,HCPCS C1713,,876-200  -  PLATE 876-200 100MM ANTERIOR CERVICAL,"$4,135.50",$0.00,"$4,135.50","$1,860.98","$2,951.51",$0.00,$712.53,$0.00,$0.00,$724.09,"$4,135.50",$0.00,"$2,067.75","$3,275.32","$3,308.40",$0.00,$647.21,$0.00,$658.37,$0.00
876-205,SUP,HCPCS C1713,,876-205  -  PLATE 876-205 105MM ANTERIOR CERVICAL,"$4,135.50",$0.00,"$4,135.50","$1,860.98","$2,951.51",$0.00,$712.53,$0.00,$0.00,$724.09,"$4,135.50",$0.00,"$2,067.75","$3,275.32","$3,308.40",$0.00,$647.21,$0.00,$658.37,$0.00
876-210,SUP,HCPCS C1713,,876-210  -  PLATE 876-210 110MM ANTERIOR CERVICAL,"$4,135.50",$0.00,"$4,135.50","$1,860.98","$2,951.51",$0.00,$712.53,$0.00,$0.00,$724.09,"$4,135.50",$0.00,"$2,067.75","$3,275.32","$3,308.40",$0.00,$647.21,$0.00,$658.37,$0.00
8762H,SUP,Custom 27203010,,8762H  -  SUTURE NABSB 3-0 SH-1 30IN BLU PRLN 2 ARM MFL,$554.42,$0.00,$554.42,$0.00,$395.69,$0.00,$0.00,$0.00,$0.00,$0.00,$554.42,$0.00,$277.21,$439.10,$443.53,$0.00,$0.00,$0.00,$0.00,$0.00
876-310,SUP,HCPCS C1713,,876-310  -  SCREW 876-310 VAS CANCELLOUS 4.0X10MM,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
876-311,SUP,HCPCS C1713,,876-311  -  SCREW 876-311 VAS CANCELLOUS 4.0X11MM,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
876-312,SUP,HCPCS C1713,,876-312  -  SCREW BN 4MM 12MM GRN STRL ATLNTS VA TI SPNE CRV CANC ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
876-313,SUP,HCPCS C1713,,876-313  -  SCREW BN 4MM 13MM GRN STRL ATLNTS VA TI SPNE CRV CANC ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
876-314,SUP,HCPCS C1713,,876-314  -  SCREW BN 4MM 14MM GRN STRL ATLNTS VA TI SPNE CRV CANC ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
876-315,SUP,HCPCS C1713,,876-315  -  SCREW BN 4MM 15MM GRN STRL ATLNTS VA TI SPNE CRV CANC ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
876-316,SUP,HCPCS C1713,,876-316  -  SCREW BN 4MM 16MM GRN STRL ATLNTS VA TI SPNE CRV CANC ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
876-317,SUP,HCPCS C1713,,876-317  -  SCREW BN 4MM 17MM GRN STRL ATLNTS VA TI SPNE CRV CANC ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
876-318,SUP,HCPCS C1713,,876-318  -  SCREW BN 4MM 18MM GRN STRL ATLNTS VA TI SPNE CRV CANC ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
876-319,SUP,HCPCS C1713,,876-319  -  SCREW 876-319 VAS CANCELLOUS 4.0X19MM,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
876-320,SUP,HCPCS C1713,,876-320  -  SCREW 876-320 VAS CANCELLOUS 4.0X20MM,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
876-321,SUP,HCPCS C1713,,876-321  -  SCREW 876-321 VAS CANCELLOUS 4.0X21MM,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
876-353,SUP,HCPCS C1713,,876-353  -  SCREW BN 4.5MM 13MM MAG STRL ATLNTS VA TI SPNE CRV CANC ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
876-355,SUP,HCPCS C1713,,876-355  -  SCREW BN 4.5MM 15MM MAG STRL ATLNTS VA TI SPNE CRV CANC ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
876-357,SUP,HCPCS C1713,,876-357  -  SCREW BN 4.5MM 17MM MAG STRL ATLNTS VA TI SPNE CRV CANC ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
876-404,SUP,HCPCS C1713,,876-404  -  PIN HLD ATLNTS ANT CERV SPN PLT INSTR TI STRL,$219.00,$0.00,$219.00,$98.55,$156.30,$0.00,$37.73,$0.00,$0.00,$38.35,$219.00,$0.00,$109.50,$173.45,$175.20,$0.00,$34.27,$0.00,$34.86,$0.00
876-443,SUP,Custom 27203010,,876-443  -  BIT DRILL 13MM ATLNTS SPNL 3 FLAT STRL DISP,$760.00,$0.00,$760.00,$0.00,$542.41,$0.00,$0.00,$0.00,$0.00,$0.00,$760.00,$0.00,$380.00,$601.92,$608.00,$0.00,$0.00,$0.00,$0.00,$0.00
876-455,SUP,Custom 27203010,,876-455  -  BIT DRILL 5MM ATLNTS 3 FLAT ADJ STRL DISP,$501.00,$0.00,$501.00,$0.00,$357.56,$0.00,$0.00,$0.00,$0.00,$0.00,$501.00,$0.00,$250.50,$396.79,$400.80,$0.00,$0.00,$0.00,$0.00,$0.00
876-612,SUP,HCPCS C1713,,876-612  -  SCREW BN 4MM 12MM STRL ATLNTS VA SLF DRL TI SPNE CRV ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
876-613,SUP,HCPCS C1713,,876-613  -  SCREW BN 4MM 13MM GRN STRL ATLNTS VA SLF DRL TI SPNE CRV,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
876-614,SUP,HCPCS C1713,,876-614  -  SCREW BN 4MM 14MM STRL ATLNTS VA SLF DRL NTNL SPNL CANC ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
876-615,SUP,HCPCS C1713,,876-615  -  SCREW BN 4MM 15MM GRN STRL ATLNTS VA SLF DRL TI SPNE CRV,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
876-643,SUP,HCPCS C1713,,876-643  -  SCREW BN 4.5MM 13MM MAG STRL ATLNTS VA SLF DRL TI SPNE CRV,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
876-644,SUP,HCPCS C1713,,876-644  -  SCREW BN 4.5MM 14MM STRL ATLNTS VA SLF DRL NTNL SPNL CANC,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
876-645,SUP,HCPCS C1713,,876-645  -  SCREW BN 4.5MM 15MM MAG STRL ATLNTS VA SLF DRL TI SPNE CRV,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
876-710,SUP,HCPCS C1713,,876-710  -  SCREW 876-710 FA SELF TAPPING 4.0X10MM,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
876-711,SUP,HCPCS C1713,,876-711  -  SCREW 876-711 FA SELF TAPPING 4.0X11MM,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
876-712,SUP,HCPCS C1713,,876-712  -  SCREW BN 4MM 12MM GRY STRL ATLNTS FX ANG ST TI SPNE CRV CANC,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
876-713,SUP,HCPCS C1713,,876-713  -  SCREW BN 4MM 13MM GRY STRL ATLNTS FX ANG ST TI SPNE CRV CANC,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
876-714,SUP,HCPCS C1713,,876-714  -  SCREW BONE 4MM 14MM ATLNTS TI CANC ANT CERV SPN FAVORED ANG,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
876-715,SUP,HCPCS C1713,,876-715  -  SCREW BN 4MM 15MM GRY STRL ATLNTS FX ANG ST TI SPNE CRV CANC,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
876-716,SUP,HCPCS C1713,,876-716  -  SCREW BONE 4MM 16MM ATLNTS TI CANC ANT CERV SPNE SLFTAP FIX,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
876-717,SUP,HCPCS C1713,,876-717  -  SCREW BONE 4MM 17MM ATLNTS TI CANC ANT CERV SPNE SLFTAP FIX,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
876-718,SUP,HCPCS C1713,,876-718  -  SCREW BN 4MM 18MM GRY STRL ATLNTS FX ANG ST TI SPNE CRV CANC,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
876-753,SUP,HCPCS C1713,,876-753  -  SCREW BN 4.5MM 13MM BLU STRL ATLNTS FX ANG ST TI SPNE CRV,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
876-755,SUP,HCPCS C1713,,876-755  -  SCREW BN 4.5MM 15MM BLU STRL ATLNTS FX ANG ST TI SPNE CRV,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
876-757,SUP,HCPCS C1713,,876-757  -  SCREW BONE 4.5MM 17MM ATLNTS TI CANC ANT CERV SPNE SLFTAP,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
876-810,SUP,HCPCS C1713,,876-810  -  SCREW 876-810 VA SELF TAPPING 4.0X10MM,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
876-811,SUP,HCPCS C1713,,876-811  -  SCREW 876-811 VA SELF TAPPING 4.0X11MM,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
876-812,SUP,HCPCS C1713,,876-812  -  SCREW BN 4MM 12MM GRN STRL ATLNTS VA ST TI SPNE CRV CANC ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
876-813,SUP,HCPCS C1713,,876-813  -  SCREW BN 4MM 13MM GRN STRL ATLNTS VA ST TI SPNE CRV CANC ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
876-814,SUP,HCPCS C1713,,876-814  -  SCREW BONE 4MM 14MM ATLNTS TI SPNL CANC VAR ANG SLFTAP STRL,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
876-815,SUP,HCPCS C1713,,876-815  -  SCREW BN 4MM 15MM GRN STRL ATLNTS VA ST TI SPNE CRV CANC ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
876-816,SUP,HCPCS C1713,,876-816  -  SCREW BONE 4MM 16MM ATLNTS TI SPNL CANC VAR ANG SLFTAP STRL,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
876-817,SUP,HCPCS C1713,,876-817  -  SCREW BONE 4MM 17MM ATLNTS TI CANC ANT CERV SPNE SLFTAP VA,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
876-818,SUP,HCPCS C1713,,876-818  -  SCREW BN 4MM 18MM GRN STRL ATLNTS VA ST TI SPNE CRV CANC ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
876-853,SUP,HCPCS C1713,,876-853  -  SCREW BONE 4.5MM 13MM ATLNTS TI ANT CERV SPN SLFTAP VAR ANG,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
876-855,SUP,HCPCS C1713,,876-855  -  SCREW BN 4.5MM 15MM MAG STRL ATLNTS VA ST TI SPNE CRV CANC,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
876-857,SUP,HCPCS C1713,,876-857  -  SCREW BONE 4.5MM 17MM ATLNTS TI CANC ANT CERV SPNE SLFTAP VA,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
876-943,SUP,Custom 27203010,,876-943  -  INSTRUMENT 876-943 ATL NONSTRL 3M DRLBIT,$501.00,$0.00,$501.00,$0.00,$357.56,$0.00,$0.00,$0.00,$0.00,$0.00,$501.00,$0.00,$250.50,$396.79,$400.80,$0.00,$0.00,$0.00,$0.00,$0.00
876-955,SUP,Custom 27203010,,876-955  -  INSTRUMENT 876-955 ATL NONSTRL ADJ DRLBT,$501.00,$0.00,$501.00,$0.00,$357.56,$0.00,$0.00,$0.00,$0.00,$0.00,$501.00,$0.00,$250.50,$396.79,$400.80,$0.00,$0.00,$0.00,$0.00,$0.00
8800500A,SUP,HCPCS C1713,,8800500A  -  SCREW BN 10.5MM 100MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8800510A,SUP,HCPCS C1713,,8800510A  -  SCREW BN 10.5MM 110MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8800520A,SUP,HCPCS C1713,,8800520A  -  SCREW BN 10.5MM 120MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8800525A,SUP,HCPCS C1713,,8800525A  -  SCREW BN 10.5MM 25MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8800530A,SUP,HCPCS C1713,,8800530A  -  SCREW BN 10.5MM 30MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8800535A,SUP,HCPCS C1713,,8800535A  -  SCREW BN 10.5MM 35MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8800540A,SUP,HCPCS C1713,,8800540A  -  SCREW BN 10.5MM 40MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8800545A,SUP,HCPCS C1713,,8800545A  -  SCREW BN 10.5MM 45MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8800550A,SUP,HCPCS C1713,,8800550A  -  SCREW BN 10.5MM 50MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8800555A,SUP,HCPCS C1713,,8800555A  -  SCREW BN 10.5MM 55MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8800560A,SUP,HCPCS C1713,,8800560A  -  SCREW BN 10.5MM 60MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8800570A,SUP,HCPCS C1713,,8800570A  -  SCREW BN 10.5MM 70MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8800580A,SUP,HCPCS C1713,,8800580A  -  SCREW BN 10.5MM 80MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8800590A,SUP,HCPCS C1713,,8800590A  -  SCREW BN 10.5MM 90MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8804525A,SUP,HCPCS C1713,,8804525A  -  SCREW BN 4.5MM 25MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8804530A,SUP,HCPCS C1713,,8804530A  -  SCREW BN 4.5MM 30MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8804535A,SUP,HCPCS C1713,,8804535A  -  SCREW BN 4.5MM 35MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8804540A,SUP,HCPCS C1713,,8804540A  -  SCREW BN 4.5MM 40MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8804545A,SUP,HCPCS C1713,,8804545A  -  SCREW BN 4.5MM 45MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8804550A,SUP,HCPCS C1713,,8804550A  -  SCREW BN 4.5MM 50MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8804555A,SUP,HCPCS C1713,,8804555A  -  SCREW BN 4.5MM 55MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8804560A,SUP,HCPCS C1713,,8804560A  -  SCREW BN 4.5MM 60MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8805025A,SUP,HCPCS C1713,,8805025A  -  SCREW BN 5MM 25MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8805030A,SUP,HCPCS C1713,,8805030A  -  SCREW BN 5MM 30MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8805035A,SUP,HCPCS C1713,,8805035A  -  SCREW BN 5MM 35MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8805040A,SUP,HCPCS C1713,,8805040A  -  SCREW BN 5MM 40MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8805045A,SUP,HCPCS C1713,,8805045A  -  SCREW BN 5MM 45MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8805050A,SUP,HCPCS C1713,,8805050A  -  SCREW BN 5MM 50MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8805055A,SUP,HCPCS C1713,,8805055A  -  SCREW BN 5MM 55MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8805060A,SUP,HCPCS C1713,,8805060A  -  SCREW BN 5MM 60MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8805525A,SUP,HCPCS C1713,,8805525A  -  SCREW BN 5.5MM 25MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8805530A,SUP,HCPCS C1713,,8805530A  -  SCREW BN 5.5MM 30MM NS PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8805535A,SUP,HCPCS C1713,,8805535A  -  SCREW BN 5.5MM 35MM NS PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8805540A,SUP,HCPCS C1713,,8805540A  -  SCREW BONE 40MM POLYAX PRECEPT 5.5MM SPN,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8805545A,SUP,HCPCS C1713,,8805545A  -  SCREW BONE 45MM POLYAX PRECEPT 5.5MM SPN,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8805550A,SUP,HCPCS C1713,,8805550A  -  SCREW BONE 50MM POLYAX PRECEPT 5.5MM SPN,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8805555A,SUP,HCPCS C1713,,8805555A  -  SCREW BN 5.5MM 55MM NS PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8805560A,SUP,HCPCS C1713,,8805560A  -  SCREW BN 5.5MM 60MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8806025A,SUP,HCPCS C1713,,8806025A  -  SCREW BN 6MM 25MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8806030A,SUP,HCPCS C1713,,8806030A  -  SCREW BN 6MM 30MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8806035A,SUP,HCPCS C1713,,8806035A  -  SCREW BN 6MM 35MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8806040A,SUP,HCPCS C1713,,8806040A  -  SCREW BN 6MM 40MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8806045A,SUP,HCPCS C1713,,8806045A  -  SCREW BN 6MM 45MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8806050A,SUP,HCPCS C1713,,8806050A  -  SCREW BN 6MM 50MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8806055A,SUP,HCPCS C1713,,8806055A  -  SCREW BN 6MM 55MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8806060A,SUP,HCPCS C1713,,8806060A  -  SCREW BN 6MM 60MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8806500A,SUP,HCPCS C1713,,8806500A  -  SCREW BN 6.5MM 100MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8806510A,SUP,HCPCS C1713,,8806510A  -  SCREW BN 6.5MM 110MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8806520A,SUP,HCPCS C1713,,8806520A  -  SCREW BN 6.5MM 120MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8806525A,SUP,HCPCS C1713,,8806525A  -  SCREW BN 6.5MM 25MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8806530A,SUP,HCPCS C1713,,8806530A  -  SCREW BN 6.5MM 30MM NS PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8806535A,SUP,HCPCS C1713,,8806535A  -  SCREW BN 6.5MM 35MM NS PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8806540A,SUP,HCPCS C1713,,8806540A  -  SCREW BN 6.5MM 40MM NS PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8806545A,SUP,HCPCS C1713,,8806545A  -  SCREW BONE 6.5MM 45MM POLYAX PRECEPT SPN,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8806550A,SUP,HCPCS C1713,,8806550A  -  SCREW BONE 50MM 6.5MM SPN MAS,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8806555A,SUP,HCPCS C1713,,8806555A  -  SCREW BN 6.5MM 55MM NS PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8806560A,SUP,HCPCS C1713,,8806560A  -  SCREW BN 6.5MM 60MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8806570A,SUP,HCPCS C1713,,8806570A  -  SCREW BN 6.5MM 70MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8806580A,SUP,HCPCS C1713,,8806580A  -  SCREW BN 6.5MM 80MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8806590A,SUP,HCPCS C1713,,8806590A  -  SCREW BN 6.5MM 90MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8807000A,SUP,HCPCS C1713,,8807000A  -  SCREW BN 7MM 100MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8807010A,SUP,HCPCS C1713,,8807010A  -  SCREW BN 7MM 110MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8807020A,SUP,HCPCS C1713,,8807020A  -  SCREW BN 7MM 120MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8807025A,SUP,HCPCS C1713,,8807025A  -  SCREW BN 7MM 25MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8807030A,SUP,HCPCS C1713,,8807030A  -  SCREW BN 7MM 30MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8807035A,SUP,HCPCS C1713,,8807035A  -  SCREW BN 7MM 35MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8807040A,SUP,HCPCS C1713,,8807040A  -  SCREW BN 7MM 40MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8807045A,SUP,HCPCS C1713,,8807045A  -  SCREW BN 7MM 45MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8807050A,SUP,HCPCS C1713,,8807050A  -  SCREW BN 7MM 50MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8807060A,SUP,HCPCS C1713,,8807060A  -  SCREW BN 7MM 60MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8807070A,SUP,HCPCS C1713,,8807070A  -  SCREW BN 7MM 70MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8807080A,SUP,HCPCS C1713,,8807080A  -  SCREW BN 7MM 80MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8807090A,SUP,HCPCS C1713,,8807090A  -  SCREW BN 7MM 90MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8807500A,SUP,HCPCS C1713,,8807500A  -  SCREW BN 7.5MM 100MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8807510A,SUP,HCPCS C1713,,8807510A  -  SCREW BN 7.5MM 110MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8807520A,SUP,HCPCS C1713,,8807520A  -  SCREW BN 7.5MM 120MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8807525A,SUP,HCPCS C1713,,8807525A  -  SCREW BN 7.5MM 25MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8807530A,SUP,HCPCS C1713,,8807530A  -  SCREW BN 7.5MM 30MM NS PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8807535A,SUP,HCPCS C1713,,8807535A  -  SCREW BN 7.5MM 35MM NS PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8807540A,SUP,HCPCS C1713,,8807540A  -  SCREW BN 7.5MM 40MM NS PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8807545A,SUP,HCPCS C1713,,8807545A  -  SCREW BN 7.5MM 45MM NS PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8807550A,SUP,HCPCS C1713,,8807550A  -  SCREW BN 7.5MM 50MM NS PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8807555A,SUP,HCPCS C1713,,8807555A  -  SCREW BN 7.5MM 55MM NS PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8807560A,SUP,HCPCS C1713,,8807560A  -  SCREW BN 7.5MM 60MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8807570A,SUP,HCPCS C1713,,8807570A  -  SCREW BN 7.5MM 70MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8807580A,SUP,HCPCS C1713,,8807580A  -  SCREW BN 7.5MM 80MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8807590A,SUP,HCPCS C1713,,8807590A  -  SCREW BN 7.5MM 90MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8808500A,SUP,HCPCS C1713,,8808500A  -  SCREW BN 8.5MM 100MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8808510A,SUP,HCPCS C1713,,8808510A  -  SCREW BN 8.5MM 110MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8808520A,SUP,HCPCS C1713,,8808520A  -  SCREW BN 8.5MM 120MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8808525A,SUP,HCPCS C1713,,8808525A  -  SCREW BN 8.5MM 25MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8808530A,SUP,HCPCS C1713,,8808530A  -  SCREW BN 8.5MM 30MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8808535A,SUP,HCPCS C1713,,8808535A  -  SCREW BN 8.5MM 35MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8808540A,SUP,HCPCS C1713,,8808540A  -  SCREW BN 8.5MM 40MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8808545A,SUP,HCPCS C1713,,8808545A  -  SCREW BN 8.5MM 45MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8808550A,SUP,HCPCS C1713,,8808550A  -  SCREW BN 8.5MM 50MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8808555A,SUP,HCPCS C1713,,8808555A  -  SCREW BN 8.5MM 55MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8808560A,SUP,HCPCS C1713,,8808560A  -  SCREW BN 8.5MM 60MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8808570A,SUP,HCPCS C1713,,8808570A  -  SCREW BN 8.5MM 70MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8808580A,SUP,HCPCS C1713,,8808580A  -  SCREW BN 8.5MM 80MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8808590A,SUP,HCPCS C1713,,8808590A  -  SCREW BN 8.5MM 90MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8809500A,SUP,HCPCS C1713,,8809500A  -  SCREW BN 9.5MM 100MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8809510A,SUP,HCPCS C1713,,8809510A  -  SCREW BN 9.5MM 110MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8809520A,SUP,HCPCS C1713,,8809520A  -  SCREW BN 9.5MM 120MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8809525A,SUP,HCPCS C1713,,8809525A  -  SCREW BN 9.5MM 25MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8809530A,SUP,HCPCS C1713,,8809530A  -  SCREW BN 9.5MM 30MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8809535A,SUP,HCPCS C1713,,8809535A  -  SCREW BN 9.5MM 35MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8809540A,SUP,HCPCS C1713,,8809540A  -  SCREW BN 9.5MM 40MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8809545A,SUP,HCPCS C1713,,8809545A  -  SCREW BN 9.5MM 45MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8809550A,SUP,HCPCS C1713,,8809550A  -  SCREW BN 9.5MM 50MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8809555A,SUP,HCPCS C1713,,8809555A  -  SCREW BN 9.5MM 55MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8809560A,SUP,HCPCS C1713,,8809560A  -  SCREW BN 9.5MM 60MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8809570A,SUP,HCPCS C1713,,8809570A  -  SCREW BN 9.5MM 70MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8809580A,SUP,HCPCS C1713,,8809580A  -  SCREW BN 9.5MM 80MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8809590A,SUP,HCPCS C1713,,8809590A  -  SCREW BN 9.5MM 90MM PRCPT PA SPNE,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
8829-01,SUP,Custom 27203010,,8829-01  -  PADDING CAST 36X21X.25IN ORTHOPEDIC LATEX FREE WHITE FELT,$17.71,$0.00,$17.71,$0.00,$12.64,$0.00,$0.00,$0.00,$0.00,$0.00,$17.71,$0.00,$8.86,$14.03,$14.17,$0.00,$0.00,$0.00,$0.00,$0.00
88-571042,SUP,HCPCS C1725,,88-571042  -  CATH DRAIN 28FR 20IN ARG 6 EYLT RIGHT ANG THRMSNS DEPTH MARK,$182.39,$0.00,$182.39,$99.04,$130.17,$0.00,$31.43,$0.00,$0.00,$31.94,$182.39,$0.00,$91.20,$144.45,$145.91,$0.00,$28.54,$0.00,$29.04,$0.00
8872H,SUP,Custom 27203010,,8872H  -  SUTURE NONABSORBABLE 3-0 RB-1 30IN MONOFILAMENT PROLENE BLUE,$342.72,$0.00,$342.72,$0.00,$244.60,$0.00,$0.00,$0.00,$0.00,$0.00,$342.72,$0.00,$171.36,$271.43,$274.17,$0.00,$0.00,$0.00,$0.00,$0.00
8888146044P,SUP,HCPCS C1750,,8888146044P  -  KIT CATHETER 61CM 44CM SYMMETRICAL TIP PALINDROME PRECISION,"$1,445.42",$0.00,"$1,144.77",$225.00,$356.85,$0.00,$249.04,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,"$1,144.77",$400.00,$0.00,$226.21,$0.00,$79.60,$0.00
8900-2065,SUP,Custom 27203010,,ELECTRODE DFBR PED MULFUNC PAD PDPDZ,$75.75,$0.00,$75.75,$0.00,$54.06,$0.00,$0.00,$0.00,$0.00,$0.00,$75.75,$0.00,$37.88,$59.99,$60.60,$0.00,$0.00,$0.00,$0.00,$0.00
8900-4003,SUP,Custom 27203010,,8900-4003  -  ELECTRODE DEFIBRILLATOR RECTANGULAR 24IN MULTIFUNCTION CLOSE,$72.85,$0.00,$72.85,$0.00,$51.99,$0.00,$0.00,$0.00,$0.00,$0.00,$72.85,$0.00,$36.42,$57.70,$58.28,$0.00,$0.00,$0.00,$0.00,$0.00
890-120,SUP,Custom 27803010,,890-120  -  CAGE SPNL 20MMX12MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
890-125,SUP,Custom 27803010,,890-125  -  CAGE SPNL 25MMX12MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
890-140,SUP,Custom 27803010,,890-140  -  CAGE SPNL 20MMX14MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
890-143,SUP,Custom 27803010,,890-143  -  CAGE SPNL 23MMX14MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
890-146,SUP,Custom 27803010,,890-146  -  CAGE SPNL 26MMX14MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
890-149,SUP,Custom 27803010,,890-149  -  CAGE SPNL 29MMX14MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
890-160,SUP,Custom 27803010,,890-160  -  CAGE SPNL 20MMX16MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
890-163,SUP,Custom 27803010,,890-163  -  CAGE SPNL 23MMX16MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
890-166,SUP,Custom 27803010,,890-166  -  CAGE SPNL 26MMX16MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
890-169,SUP,Custom 27803010,,890-169  -  CAGE SPNL 29MMX16MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
890-180,SUP,Custom 27803010,,890-180  -  CAGE SPNL 20MMX18MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
890-183,SUP,Custom 27803010,,890-183  -  CAGE SPNL 23MMX18MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
890-186,SUP,Custom 27803010,,890-186  -  CAGE SPNL 26MMX18MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
890-189,SUP,Custom 27803010,,890-189  -  CAGE SPNL 29MMX18MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
890-200,SUP,Custom 27803010,,890-200  -  CAGE SPNL 20MMX20MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
890-203,SUP,Custom 27803010,,890-203  -  CAGE SPNL 23MMX20MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
890-206,SUP,Custom 27803010,,890-206  -  CAGE SPNL 26MMX20MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
890-209,SUP,Custom 27803010,,890-209  -  CAGE SPNL 29MMX20MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
890-220,SUP,Custom 27803010,,890-220  -  CAGE SPNL 20MMX22MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
890-223,SUP,Custom 27803010,,890-223  -  CAGE SPNL 23MMX22MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
890-226,SUP,Custom 27803010,,890-226  -  CAGE SPNL 26MMX22MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
890-229,SUP,Custom 27803010,,890-229  -  CAGE SPNL 29MMX22MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
890-240,SUP,Custom 27803010,,890-240  -  CAGE SPNL 24MMX20MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
890-243,SUP,Custom 27803010,,890-243  -  CAGE SPNL 24MMX23MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
890-244,SUP,HCPCS C1713,,890-244  -  BONE 890-244 PRESS PLUG 12MM,$541.50,$0.00,$541.50,$243.68,$386.47,$0.00,$93.30,$0.00,$0.00,$94.81,$541.50,$0.00,$270.75,$428.87,$433.20,$0.00,$84.74,$0.00,$86.21,$0.00
890-246,SUP,Custom 27803010,,890-246  -  CAGE SPNL 26MMX24MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
890-249,SUP,Custom 27803010,,890-249  -  CAGE SPNL 29MMX24MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
890-444,SUP,HCPCS C1713,,890-444  -  BONE 890-444 PRESS PLUG 14MM,$541.50,$0.00,$541.50,$243.68,$386.47,$0.00,$93.30,$0.00,$0.00,$94.81,$541.50,$0.00,$270.75,$428.87,$433.20,$0.00,$84.74,$0.00,$86.21,$0.00
890-999,SUP,HCPCS C1713,,890-999  -  SCREW 890-999 LATERAL EXT. REPLACEMENT,$42.00,$0.00,$42.00,$18.90,$29.98,$0.00,$7.24,$0.00,$0.00,$7.35,$42.00,$0.00,$21.00,$33.26,$33.60,$0.00,$6.57,$0.00,$6.69,$0.00
89104EH,SUP,HCPCS C1713,,89104EH  -  SCREW 89104EH  BREAK OFF SET  T25,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
89104EHT,SUP,HCPCS C1713,,89104EHT  -  SET SCR CD HZN M10 BRKOF TI SPNE PDCL,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
89-2505,SUP,Custom 27203010,,89-2505  -  KIT SRG OB EMS,$19.18,$0.00,$19.18,$0.00,$13.69,$0.00,$0.00,$0.00,$0.00,$0.00,$19.18,$0.00,$9.59,$15.19,$15.34,$0.00,$0.00,$0.00,$0.00,$0.00
8941420P,SUP,Custom 27803010,,8941420P  -  CAGE SPNL 14MM 20X17MM LTCG TI LMBR TPR FSN DEV,"$7,865.00",$0.00,"$7,865.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,865.00",$0.00,"$3,932.50","$6,229.08","$6,292.00",$0.00,$0.00,$0.00,$0.00,$0.00
8941423P,SUP,Custom 27803010,,8941423P  -  CAGE SPNL 14MM 23X17.5MM LTCG PEEK-OPTM LMBR TPR FSN DEV,"$7,865.00",$0.00,"$7,865.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,865.00",$0.00,"$3,932.50","$6,229.08","$6,292.00",$0.00,$0.00,$0.00,$0.00,$0.00
8941620P,SUP,Custom 27803010,,8941620P  -  CAGE SPNL 16MM 20X19MM LTCG PEEK-OPTM LMBR TPR FSN DEV,"$7,865.00",$0.00,"$7,865.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,865.00",$0.00,"$3,932.50","$6,229.08","$6,292.00",$0.00,$0.00,$0.00,$0.00,$0.00
8941623P,SUP,Custom 27803010,,8941623P  -  CAGE SPNL 16MM 23X19MM LTCG TI LMBR TPR FSN DEV,"$7,865.00",$0.00,"$7,865.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,865.00",$0.00,"$3,932.50","$6,229.08","$6,292.00",$0.00,$0.00,$0.00,$0.00,$0.00
8941626P,SUP,Custom 27803010,,8941626P  -  CAGE SPNL 16MM 26X20MM LTCG PEEK-OPTM LMBR TPR FSN DEV,"$7,865.00",$0.00,"$7,865.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,865.00",$0.00,"$3,932.50","$6,229.08","$6,292.00",$0.00,$0.00,$0.00,$0.00,$0.00
8941823P,SUP,Custom 27803010,,8941823P  -  CAGE SPNL 18MM 23X21.5MM LTCG PEEK-OPTM LMBR TPR FSN DEV,"$7,865.00",$0.00,"$7,865.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,865.00",$0.00,"$3,932.50","$6,229.08","$6,292.00",$0.00,$0.00,$0.00,$0.00,$0.00
8941826P,SUP,Custom 27803010,,8941826P  -  CAGE SPNL 18MM 26X22MM LTCG PEEK-OPTM LMBR TPR FSN DEV,"$7,865.00",$0.00,"$7,865.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,865.00",$0.00,"$3,932.50","$6,229.08","$6,292.00",$0.00,$0.00,$0.00,$0.00,$0.00
89690E,SUP,Custom 27203010,,89690E  -  INSTRUMENT 89690E IMP HLDR CURVD REDUCD,"$2,295.00",$0.00,"$2,295.00",$0.00,"$1,637.94",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,295.00",$0.00,"$1,147.50","$1,817.64","$1,836.00",$0.00,$0.00,$0.00,$0.00,$0.00
8AC50,SUP,Custom 27203010,,8AC50  -  TOOL LEGEND 8CM 5MM AC,$320.88,$0.00,$320.88,$0.00,$229.01,$0.00,$0.00,$0.00,$0.00,$0.00,$320.88,$0.00,$160.44,$254.14,$256.70,$0.00,$0.00,$0.00,$0.00,$0.00
8AC60,SUP,Custom 27203010,,8AC60  -  TOOL LEGEND 8CM 6MM AC,$320.88,$0.00,$320.88,$0.00,$229.01,$0.00,$0.00,$0.00,$0.00,$0.00,$320.88,$0.00,$160.44,$254.14,$256.70,$0.00,$0.00,$0.00,$0.00,$0.00
8DCFN,SUP,Custom 27203010,,8DCFN  -  TUBE TRCH 8 12.2MM 7.6MM 79MM STRL LF SHLY CUFLS DISP INR,$83.74,$0.00,$83.74,$0.00,$59.76,$0.00,$0.00,$0.00,$0.00,$0.00,$83.74,$0.00,$41.87,$66.32,$66.99,$0.00,$0.00,$0.00,$0.00,$0.00
8DCFS,SUP,Custom 27203010,,8DCFS  -  TUBE TRCH 8 12.2MM 7.6MM 79MM STRL LF SHLY CUFLS DISP INR,$89.90,$0.00,$89.90,$0.00,$64.16,$0.00,$0.00,$0.00,$0.00,$0.00,$89.90,$0.00,$44.95,$71.20,$71.92,$0.00,$0.00,$0.00,$0.00,$0.00
8DCT,SUP,Custom 27203010,,8DCT  -  TUBE TRCH 8 12.2MM 7.6MM 79MM STRL LF SHLY CUF DISP INR CNN,$95.08,$0.00,$95.08,$0.00,$67.86,$0.00,$0.00,$0.00,$0.00,$0.00,$95.08,$0.00,$47.54,$75.30,$76.06,$0.00,$0.00,$0.00,$0.00,$0.00
8DFEN,SUP,Custom 27203010,,8DFEN  -  TUBE TRCH 8 12.2MM 7.6MM 79MM STRL LF SHLY CUF DISP INR CNN,$100.92,$0.00,$100.92,$0.00,$72.02,$0.00,$0.00,$0.00,$0.00,$0.00,$100.92,$0.00,$50.46,$79.93,$80.73,$0.00,$0.00,$0.00,$0.00,$0.00
8LGT,SUP,Custom 27203010,,8LGT  -  TUBE TRACHEOSTOMY 8 12.6MM 15MM 7.6MM 50MM CUFFLESS,$116.45,$0.00,$116.45,$0.00,$83.11,$0.00,$0.00,$0.00,$0.00,$0.00,$116.45,$0.00,$58.22,$92.23,$93.16,$0.00,$0.00,$0.00,$0.00,$0.00
8LGT,SUP,Custom 27203010,,TUBE 50MM 7.6MM UNCUF LRNTMY SHLY TRCH 8 STRL LF DISP,$119.98,$0.00,$116.45,$0.00,$83.11,$0.00,$0.00,$0.00,$0.00,$0.00,$116.45,$0.00,$58.22,$95.02,$93.16,$0.00,$0.00,$0.00,$0.00,$0.00
8MH22D,SUP,Custom 27203010,,8MH22D  -  TOOL LEGEND 8CM 1.7 MH DIAM,$295.38,$0.00,$295.38,$0.00,$210.81,$0.00,$0.00,$0.00,$0.00,$0.00,$295.38,$0.00,$147.69,$233.94,$236.30,$0.00,$0.00,$0.00,$0.00,$0.00
8SCT,SUP,Custom 27203010,,8SCT  -  TUBE TRACHEOSTOMY 8 10.9MM 8MM 89MM 1 CANNU CUFF SMOOTH,$72.45,$0.00,$72.45,$0.00,$51.70,$0.00,$0.00,$0.00,$0.00,$0.00,$72.45,$0.00,$36.22,$57.38,$57.96,$0.00,$0.00,$0.00,$0.00,$0.00
8TA17,SUP,Custom 27203010,,8TA17  -  TOOL LEGEND 8CM 1.7MM TA,$265.63,$0.00,$265.63,$0.00,$189.58,$0.00,$0.00,$0.00,$0.00,$0.00,$265.63,$0.00,$132.81,$210.38,$212.50,$0.00,$0.00,$0.00,$0.00,$0.00
8TD084,SUP,Custom 27203010,,8TD084  -  TOOL LEGND 8CM 8MM 4MM DEPTH TWST,$388.88,$0.00,$388.88,$0.00,$277.54,$0.00,$0.00,$0.00,$0.00,$0.00,$388.88,$0.00,$194.44,$307.99,$311.10,$0.00,$0.00,$0.00,$0.00,$0.00
8TD104,SUP,Custom 27203010,,8TD104  -  TOOL LEGEND 8CM 1MM 4MM DEPTH TD,$240.13,$0.00,$240.13,$0.00,$171.38,$0.00,$0.00,$0.00,$0.00,$0.00,$240.13,$0.00,$120.06,$190.18,$192.10,$0.00,$0.00,$0.00,$0.00,$0.00
8TD114,SUP,Custom 27203010,,8TD114  -  TOOL LEGEND 8CM 1.1MM 4MM TD,$240.13,$0.00,$240.13,$0.00,$171.38,$0.00,$0.00,$0.00,$0.00,$0.00,$240.13,$0.00,$120.06,$190.18,$192.10,$0.00,$0.00,$0.00,$0.00,$0.00
8TD116,SUP,Custom 27203010,,8TD116  -  TOOL LEGEND 8CM 1.1MM 6MM DEPTH,$240.13,$0.00,$240.13,$0.00,$171.38,$0.00,$0.00,$0.00,$0.00,$0.00,$240.13,$0.00,$120.06,$190.18,$192.10,$0.00,$0.00,$0.00,$0.00,$0.00
8TD124,SUP,Custom 27203010,,8TD124  -  TOOL LEGEND 8CM 1.2MM 4MM DEPTH,$240.13,$0.00,$240.13,$0.00,$171.38,$0.00,$0.00,$0.00,$0.00,$0.00,$240.13,$0.00,$120.06,$190.18,$192.10,$0.00,$0.00,$0.00,$0.00,$0.00
8TD126,SUP,Custom 27203010,,8TD126  -  TOOL LEGEND 8CM 1.2MM 6MM DEPTH,$240.13,$0.00,$240.13,$0.00,$171.38,$0.00,$0.00,$0.00,$0.00,$0.00,$240.13,$0.00,$120.06,$190.18,$192.10,$0.00,$0.00,$0.00,$0.00,$0.00
8TD134,SUP,Custom 27203010,,8TD134  -  TOOL LEGEND 8CM 1.3MM 4MM DEPTH,$240.13,$0.00,$240.13,$0.00,$171.38,$0.00,$0.00,$0.00,$0.00,$0.00,$240.13,$0.00,$120.06,$190.18,$192.10,$0.00,$0.00,$0.00,$0.00,$0.00
8TD136,SUP,Custom 27203010,,8TD136  -  TOOL LEGEND 8CM 1.3MM 6MM DEPTH,$240.13,$0.00,$240.13,$0.00,$171.38,$0.00,$0.00,$0.00,$0.00,$0.00,$240.13,$0.00,$120.06,$190.18,$192.10,$0.00,$0.00,$0.00,$0.00,$0.00
8TD154,SUP,Custom 27203010,,8TD154  -  TOOL LEGEND 8CM 1.5MM 4MM DEPTH,$240.13,$0.00,$240.13,$0.00,$171.38,$0.00,$0.00,$0.00,$0.00,$0.00,$240.13,$0.00,$120.06,$190.18,$192.10,$0.00,$0.00,$0.00,$0.00,$0.00
8TD156,SUP,Custom 27203010,,8TD156  -  TOOL LEGEND 8CM 1.5MM 6MM DEPTH,$240.13,$0.00,$240.13,$0.00,$171.38,$0.00,$0.00,$0.00,$0.00,$0.00,$240.13,$0.00,$120.06,$190.18,$192.10,$0.00,$0.00,$0.00,$0.00,$0.00
8TD158,SUP,Custom 27203010,,8TD158  -  TOOL LEGEND 8CM 1.5MM 8MM DEPTH,$240.13,$0.00,$240.13,$0.00,$171.38,$0.00,$0.00,$0.00,$0.00,$0.00,$240.13,$0.00,$120.06,$190.18,$192.10,$0.00,$0.00,$0.00,$0.00,$0.00
8TD174,SUP,Custom 27203010,,8TD174  -  TOOL LEGEND 8CM 1.7MM 4MM DEPTH,$240.13,$0.00,$240.13,$0.00,$171.38,$0.00,$0.00,$0.00,$0.00,$0.00,$240.13,$0.00,$120.06,$190.18,$192.10,$0.00,$0.00,$0.00,$0.00,$0.00
8TD176,SUP,Custom 27203010,,8TD176  -  TOOL LEGEND 8CM 1.7MM 6MM DEPTH,$240.13,$0.00,$240.13,$0.00,$171.38,$0.00,$0.00,$0.00,$0.00,$0.00,$240.13,$0.00,$120.06,$190.18,$192.10,$0.00,$0.00,$0.00,$0.00,$0.00
8TD178,SUP,Custom 27203010,,8TD178  -  TOOL LEGEND 8CM 1.7MM 8MM DEPTH,$240.13,$0.00,$240.13,$0.00,$171.38,$0.00,$0.00,$0.00,$0.00,$0.00,$240.13,$0.00,$120.06,$190.18,$192.10,$0.00,$0.00,$0.00,$0.00,$0.00
8TD204,SUP,Custom 27203010,,8TD204  -  TOOL LEGEND 8CM 2MM 4MM DEPTH TD,$240.13,$0.00,$240.13,$0.00,$171.38,$0.00,$0.00,$0.00,$0.00,$0.00,$240.13,$0.00,$120.06,$190.18,$192.10,$0.00,$0.00,$0.00,$0.00,$0.00
8TD206,SUP,Custom 27203010,,8TD206  -  TOOL LEGEND 8CM 2MM 6 MM DEPTH TD,$240.13,$0.00,$240.13,$0.00,$171.38,$0.00,$0.00,$0.00,$0.00,$0.00,$240.13,$0.00,$120.06,$190.18,$192.10,$0.00,$0.00,$0.00,$0.00,$0.00
8TD208,SUP,Custom 27203010,,8TD208  -  TOOL LEGEND 8CM 2MM 8MM DEPTH TD,$240.13,$0.00,$240.13,$0.00,$171.38,$0.00,$0.00,$0.00,$0.00,$0.00,$240.13,$0.00,$120.06,$190.18,$192.10,$0.00,$0.00,$0.00,$0.00,$0.00
9001G,SUP,Custom 27203010,,9001G  -  SUTURE NONABSORBABLE 10-0 CS160-6 6IN 2 ARM MONOFILAMENT,$48.64,$0.00,$48.64,$0.00,$34.71,$0.00,$0.00,$0.00,$0.00,$0.00,$48.64,$0.00,$24.32,$38.52,$38.91,$0.00,$0.00,$0.00,$0.00,$0.00
9001-VC-005,SUP,Custom 27203010,,9001-VC-005  -  NEEDLE BAND PRC WRST,$247.50,$0.00,$247.50,$0.00,$176.64,$0.00,$0.00,$0.00,$0.00,$0.00,$247.50,$0.00,$123.75,$196.02,$198.00,$0.00,$0.00,$0.00,$0.00,$0.00
9003 B,SUP,Custom 27803010,,9003 B  -  KIT 9003 B INTL ONLY SHUNT CONT SM ME,$859.75,$0.00,$859.75,$0.00,$613.60,$0.00,$0.00,$0.00,$0.00,$0.00,$859.75,$0.00,$429.88,$680.92,$687.80,$0.00,$0.00,$0.00,$0.00,$0.00
900-601,SUP,HCPCS C1769,,900-601  -  GWIRE ORTH 150MM 1.6MM DRILL TIP NONSTRL,$108.65,$0.00,$108.65,$59.00,$77.54,$0.00,$18.72,$0.00,$0.00,$19.02,$108.65,$0.00,$54.33,$86.05,$86.92,$0.00,$17.00,$0.00,$17.30,$0.00
9007 H,SUP,Custom 27803010,,9007 H  -  CATH 9007 H C/P STD W/CLOS PRESS-HIGH,$605.63,$0.00,$605.63,$0.00,$432.23,$0.00,$0.00,$0.00,$0.00,$0.00,$605.63,$0.00,$302.81,$479.66,$484.50,$0.00,$0.00,$0.00,$0.00,$0.00
9007 L,SUP,Custom 27803010,,9007 L  -  CATH 9007 L C/P STD W/CLOS PRESS-LOW,$605.63,$0.00,$605.63,$0.00,$432.23,$0.00,$0.00,$0.00,$0.00,$0.00,$605.63,$0.00,$302.81,$479.66,$484.50,$0.00,$0.00,$0.00,$0.00,$0.00
9007 M,SUP,Custom 27803010,,9007 M  -  CATH 9007 M C/P STD W/CLOS PRESS-MED,$605.63,$0.00,$605.63,$0.00,$432.23,$0.00,$0.00,$0.00,$0.00,$0.00,$605.63,$0.00,$302.81,$479.66,$484.50,$0.00,$0.00,$0.00,$0.00,$0.00
9009 B-H,SUP,Custom 27803010,,9009 B-H  -  SHUNT 9009 B-H ASSY SM HI W/PERT OPN-90,"$2,657.63",$0.00,"$2,657.63",$0.00,"$1,896.75",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,657.63",$0.00,"$1,328.81","$2,104.84","$2,126.10",$0.00,$0.00,$0.00,$0.00,$0.00
9009 B-L,SUP,Custom 27803010,,9009 B-L  -  SHUNT 9009 B-L ASSY SM LO W/PERT OPN-90,"$2,498.50",$0.00,"$2,498.50",$0.00,"$1,783.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,498.50",$0.00,"$1,249.25","$1,978.81","$1,998.80",$0.00,$0.00,$0.00,$0.00,$0.00
9009 B-M,SUP,Custom 27803010,,9009 B-M  -  SHNT 9009 B-M ASSY SM MED W/PERT OPN-90,"$2,498.50",$0.00,"$2,498.50",$0.00,"$1,783.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,498.50",$0.00,"$1,249.25","$1,978.81","$1,998.80",$0.00,$0.00,$0.00,$0.00,$0.00
900MR869,SUP,Custom 27203010,,PROBE DUAL ARWY THRMTR 90D 60IN MR850 HMDF,$334.38,$0.00,$334.38,$0.00,$238.64,$0.00,$0.00,$0.00,$0.00,$0.00,$334.38,$0.00,$167.19,$264.83,$267.50,$0.00,$0.00,$0.00,$0.00,$0.00
901-118,SUP,Custom 27803010,,901-118  -  SHUNT NS INTRO PRTNL,$127.00,$0.00,$127.00,$0.00,$90.64,$0.00,$0.00,$0.00,$0.00,$0.00,$127.00,$0.00,$63.50,$100.58,$101.60,$0.00,$0.00,$0.00,$0.00,$0.00
90129-203,SUP,HCPCS C1874,,90129-203  -  STENT TRCHBR LOPRFL 18MM 22FR 56MM NS AERO OTW FULL CVR FLXB,"$5,750.00",$0.00,"$5,750.00","$2,587.50","$4,103.78",$0.00,$990.70,$0.00,$0.00,"$1,006.78","$5,750.00",$0.00,"$2,875.00","$4,554.00","$4,600.00",$0.00,$899.88,$0.00,$915.40,$0.00
90129-204,SUP,HCPCS C1874,,90129-204  -  STENT TRCHBR GMTR 16MM 22FR 40MM NS 61CM AERO OTW FLLY CVR,"$5,750.00",$0.00,"$5,750.00","$2,587.50","$4,103.78",$0.00,$990.70,$0.00,$0.00,"$1,006.78","$5,750.00",$0.00,"$2,875.00","$4,554.00","$4,600.00",$0.00,$899.88,$0.00,$915.40,$0.00
90129-206,SUP,HCPCS C1874,,90129-206  -  STENT TRCHBR LOPRFL 16MM 22FR 56MM NS AERO OTW FULL CVR FLXB,"$5,750.00",$0.00,"$5,750.00","$2,587.50","$4,103.78",$0.00,$990.70,$0.00,$0.00,"$1,006.78","$5,750.00",$0.00,"$2,875.00","$4,554.00","$4,600.00",$0.00,$899.88,$0.00,$915.40,$0.00
90129-207,SUP,HCPCS C1874,,90129-207  -  STENT TRCHBR GMTR 10MM 16FR 20MM NS 63CM AERO OTW FLLY CVR,"$5,750.00",$0.00,"$5,750.00","$2,587.50","$4,103.78",$0.00,$990.70,$0.00,$0.00,"$1,006.78","$5,750.00",$0.00,"$2,875.00","$4,554.00","$4,600.00",$0.00,$899.88,$0.00,$915.40,$0.00
90129-209,SUP,HCPCS C1874,,90129-209  -  STENT TRCHBR GMTR 10MM 16FR 40MM NS 61CM AERO OTW FLLY CVR,"$5,750.00",$0.00,"$5,750.00","$2,587.50","$4,103.78",$0.00,$990.70,$0.00,$0.00,"$1,006.78","$5,750.00",$0.00,"$2,875.00","$4,554.00","$4,600.00",$0.00,$899.88,$0.00,$915.40,$0.00
90129-210,SUP,HCPCS C1874,,90129-210  -  STENT TRCHBR 12MM 16FR 20MM 63CM AERO FLLY CVR ANTIMIGRATION,"$5,750.00",$0.00,"$5,750.00","$2,587.50","$4,103.78",$0.00,$990.70,$0.00,$0.00,"$1,006.78","$5,750.00",$0.00,"$2,875.00","$4,554.00","$4,600.00",$0.00,$899.88,$0.00,$915.40,$0.00
90129-211,SUP,HCPCS C1874,,90129-211  -  STENT TRCHBR GMTR 12MM 16FR 30MM NS 62CM AERO OTW FLLY CVR,"$5,750.00",$0.00,"$5,750.00","$2,587.50","$4,103.78",$0.00,$990.70,$0.00,$0.00,"$1,006.78","$5,750.00",$0.00,"$2,875.00","$4,554.00","$4,600.00",$0.00,$899.88,$0.00,$915.40,$0.00
90129-213,SUP,HCPCS C1874,,90129-213  -  STENT TRCHBR GMTR 14MM 16FR 20MM NS 63CM AERO OTW FLLY CVR,"$5,750.00",$0.00,"$5,750.00","$2,587.50","$4,103.78",$0.00,$990.70,$0.00,$0.00,"$1,006.78","$5,750.00",$0.00,"$2,875.00","$4,554.00","$4,600.00",$0.00,$899.88,$0.00,$915.40,$0.00
90129-214,SUP,HCPCS C1874,,90129-214  -  STENT TRCHBR GMTR 14MM 16FR 30MM NS 62CM AERO OTW FLLY CVR,"$5,750.00",$0.00,"$5,750.00","$2,587.50","$4,103.78",$0.00,$990.70,$0.00,$0.00,"$1,006.78","$5,750.00",$0.00,"$2,875.00","$4,554.00","$4,600.00",$0.00,$899.88,$0.00,$915.40,$0.00
90129-215,SUP,HCPCS C1874,,90129-215  -  STENT TRCHBR GMTR 14MM 16FR 40MM NS 61CM AERO OTW FLLY CVR,"$5,750.00",$0.00,"$5,750.00","$2,587.50","$4,103.78",$0.00,$990.70,$0.00,$0.00,"$1,006.78","$5,750.00",$0.00,"$2,875.00","$4,554.00","$4,600.00",$0.00,$899.88,$0.00,$915.40,$0.00
90129-216,SUP,HCPCS C1874,,90129-216  -  STENT TRCHBR GMTR 20MM 22FR 40MM NS 61CM AERO OTW FLLY CVR,"$5,750.00",$0.00,"$5,750.00","$2,587.50","$4,103.78",$0.00,$990.70,$0.00,$0.00,"$1,006.78","$5,750.00",$0.00,"$2,875.00","$4,554.00","$4,600.00",$0.00,$899.88,$0.00,$915.40,$0.00
90129-217,SUP,HCPCS C1874,,90129-217  -  STENT TRCHBR 20MM 60MM AERO OTW FLLY COVERED,"$5,750.00",$0.00,"$5,750.00","$2,587.50","$4,103.78",$0.00,$990.70,$0.00,$0.00,"$1,006.78","$5,750.00",$0.00,"$2,875.00","$4,554.00","$4,600.00",$0.00,$899.88,$0.00,$915.40,$0.00
90129-218,SUP,HCPCS C1874,,90129-218  -  STENT TRCH 20MM 80MM AERO FLLY COVERED,"$5,750.00",$0.00,"$5,750.00","$2,587.50","$4,103.78",$0.00,$990.70,$0.00,$0.00,"$1,006.78","$5,750.00",$0.00,"$2,875.00","$4,554.00","$4,600.00",$0.00,$899.88,$0.00,$915.40,$0.00
90129-301,SUP,HCPCS C1874,,90129-301  -  STENT TRCHBR 18MM 40MM AERO DV FLLY COVERED DRCT VIS SYS,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,$0.00,$0.00,$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
90129-302,SUP,HCPCS C1874,,90129-302  -  STENT TRCHBR 18MM 60MM AERO DV FLLY COVERED DRCT VIS SYS,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,$0.00,$0.00,$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
90129-303,SUP,HCPCS C1874,,90129-303  -  STENT TRCHBR 18MM 80MM AERO DV FLLY COVERED DRCT VSN DLV SYS,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,$0.00,$0.00,$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
90129-304,SUP,HCPCS C1874,,90129-304  -  STENT TRCHBR 16MM 30MM 40MM 39MM AERO OTW DRCT VIS NOVEL,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,$0.00,$0.00,$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
90129-305,SUP,HCPCS C1874,,90129-305  -  STENT TRCHBR 16MM 60MM AERO FLLY COVERED PURSE STNG DRCT VIS,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,$0.00,$0.00,$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
90129-306,SUP,HCPCS C1874,,90129-306  -  STENT TRCHBR 16MM 80MM AERO DV FLLY COVERED DRCT VSN DLV SYS,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,$0.00,$0.00,$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
90129-310,SUP,HCPCS C1874,,90129-310  -  STENT TRCHBR 12MM 20MM AERO DV FLLY COVERED DRCT VSN DLV SYS,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,$0.00,$0.00,$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
90129-311,SUP,HCPCS C1874,,90129-311  -  STENT TRCHBR GMTR LOPRFL 12MM 28FR 30MM 40CM AERO FULL CVR,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,$0.00,$0.00,$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
90129-312,SUP,HCPCS C1874,,90129-312  -  STENT TRCHBR GMTR LOPRFL 28FR 12MM 40MM 39CM AERO FULL CVR,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,$0.00,$0.00,$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
90129-313,SUP,HCPCS C1874,,90129-313  -  STENT TRCHBR 14MM 20MM AERO DV FLLY COVERED DRCT VSN DLV SYS,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,$0.00,$0.00,$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
90129-314,SUP,HCPCS C1874,,90129-314  -  STENT TRCHBR 14MM 30MM AERO DV FLLY COVERED DRCT VIS SYS,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,$0.00,$0.00,$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
90129-315,SUP,HCPCS C1874,,90129-315  -  STENT TRCHBR 14MM 40MM AERO FLLY COVERED PURSE STNG DRCT VIS,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,$0.00,$0.00,$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
90129-316,SUP,HCPCS C1874,,90129-316  -  STENT TRCHBR 20MM 40MM AERO DV FLLY COVERED DRCT VIS SYS,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,$0.00,$0.00,$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
90129-317,SUP,HCPCS C1874,,90129-317  -  STENT TRCHBR 20MM 60MM AERO DV FLLY COVERED DRCT VIS SYS,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,$0.00,$0.00,$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
90129-318,SUP,HCPCS C1874,,90129-318  -  STENT TRCHBR 20MM 80MM AERO DV FLLY COVERED DRCT VIS SYS,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,$0.00,$0.00,$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
90129-501,SUP,HCPCS C1874,,90129-501  -  SIZER SRG AEROSIZER STNT MSR DEV,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
9013 A,SUP,Custom 27803010,,9013 A  -  RESERVOIR 9013 A VENT 12MM CONVT IC 50MM,"$1,047.38",$0.00,"$1,047.38",$0.00,$747.51,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,047.38",$0.00,$523.69,$829.52,$837.90,$0.00,$0.00,$0.00,$0.00,$0.00
9013 B,SUP,Custom 27803010,,9013 B  -  RESERVOIR 9013 B VENT 12MM CONVT IC 60MM,"$1,047.38",$0.00,"$1,047.38",$0.00,$747.51,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,047.38",$0.00,$523.69,$829.52,$837.90,$0.00,$0.00,$0.00,$0.00,$0.00
9013 F,SUP,Custom 27803010,,9013 F  -  RESERVOIR 9013 F VENT 12MM CONVT IC 7CM,"$1,047.38",$0.00,"$1,047.38",$0.00,$747.51,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,047.38",$0.00,$523.69,$829.52,$837.90,$0.00,$0.00,$0.00,$0.00,$0.00
9013 G,SUP,Custom 27803010,,9013 G  -  RESERVOIR 9013 G VENT 12MM CONVT IC 8CM,"$1,047.38",$0.00,"$1,047.38",$0.00,$747.51,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,047.38",$0.00,$523.69,$829.52,$837.90,$0.00,$0.00,$0.00,$0.00,$0.00
903016A,SUP,HCPCS C1729,,903016A  -  TRAY CATH BDX IC CMP CR 16FR 350ML FOLEY URMTR ANTIINFECTIVE,$24.95,$0.00,$24.95,$13.55,$17.81,$0.00,$4.30,$0.00,$0.00,$4.37,$24.95,$0.00,$12.48,$19.76,$19.96,$0.00,$3.91,$0.00,$3.97,$0.00
903018A,SUP,HCPCS C1729,,TRAY CATH LBRCTH 18FR 350ML FOLEY URMTR,$41.48,$0.00,$41.48,$22.52,$29.60,$0.00,$7.15,$0.00,$0.00,$7.26,$41.48,$0.00,$20.74,$32.85,$33.18,$0.00,$6.49,$0.00,$6.60,$0.00
9032G,SUP,Custom 27203010,,9032G  -  SUTURE NONABSORBABLE 10-0 CS175-8 12IN 2 ARM MONOFILAMENT,$43.61,$0.00,$43.61,$0.00,$31.13,$0.00,$0.00,$0.00,$0.00,$0.00,$43.61,$0.00,$21.81,$34.54,$34.89,$0.00,$0.00,$0.00,$0.00,$0.00
9040 R,SUP,Custom 27803010,,9040 R  -  KIT 9040 R SHUNT CSF BH MED SML CATHS,$859.75,$0.00,$859.75,$0.00,$613.60,$0.00,$0.00,$0.00,$0.00,$0.00,$859.75,$0.00,$429.88,$680.92,$687.80,$0.00,$0.00,$0.00,$0.00,$0.00
9042 A,SUP,HCPCS C1894,,9042 A  -  VAD 9042 A 12MM CONVT 50MM-INTRODUCER,"$1,223.13",$0.00,"$1,223.13",$664.16,$872.94,$0.00,$210.74,$0.00,$0.00,$214.16,"$1,223.13",$0.00,$611.56,$968.72,$978.50,$0.00,$191.42,$0.00,$194.72,$0.00
9042 B,SUP,HCPCS C1894,,9042 B  -  VAD 9042 B 12MM CONVT 60MM-INTRODUCER,"$1,223.13",$0.00,"$1,223.13",$664.16,$872.94,$0.00,$210.74,$0.00,$0.00,$214.16,"$1,223.13",$0.00,$611.56,$968.72,$978.50,$0.00,$191.42,$0.00,$194.72,$0.00
9042 D,SUP,HCPCS C1894,,9042 D  -  VAD 9042 D 12MM CONVT 40MM-INTRODUCER,"$1,047.38",$0.00,"$1,047.38",$568.72,$747.51,$0.00,$180.46,$0.00,$0.00,$183.39,"$1,047.38",$0.00,$523.69,$829.52,$837.90,$0.00,$163.91,$0.00,$166.74,$0.00
9042 G,SUP,HCPCS C1894,,9042 G  -  VAD 9042 G 12MM CONVT 35MM-INTRODUCER,"$1,047.38",$0.00,"$1,047.38",$568.72,$747.51,$0.00,$180.46,$0.00,$0.00,$183.39,"$1,047.38",$0.00,$523.69,$829.52,$837.90,$0.00,$163.91,$0.00,$166.74,$0.00
9046 B-H,SUP,Custom 27803010,,9046 B-H  -  SHUNT 9046 B-H ASSY REG HIGH PERIT 90CM,"$2,498.50",$0.00,"$2,498.50",$0.00,"$1,783.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,498.50",$0.00,"$1,249.25","$1,978.81","$1,998.80",$0.00,$0.00,$0.00,$0.00,$0.00
9046 B-L,SUP,Custom 27803010,,9046 B-L  -  SHUNT 9046 B-L ASSY REG LOW PERIT-90CM,"$2,498.50",$0.00,"$2,498.50",$0.00,"$1,783.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,498.50",$0.00,"$1,249.25","$1,978.81","$1,998.80",$0.00,$0.00,$0.00,$0.00,$0.00
9046 B-M,SUP,Custom 27803010,,9046 B-M  -  SHUNT 9046 B-M ASSY REG MED PERIT-90CM,"$2,498.50",$0.00,"$2,498.50",$0.00,"$1,783.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,498.50",$0.00,"$1,249.25","$1,978.81","$1,998.80",$0.00,$0.00,$0.00,$0.00,$0.00
905-101,SUP,HCPCS C1781,,905-101  -  MESH 905-101  PYRM 10MM X 100MM ROUND,"$12,604.58",$0.00,"$12,604.58","$5,672.06","$5,158.80",$0.00,"$2,171.71",$0.00,$0.00,"$2,206.96","$12,604.58",$0.00,"$6,302.29","$9,982.83","$10,083.66",$0.00,"$1,972.62",$0.00,"$2,006.65",$0.00
905-103,SUP,HCPCS C1781,,905-103  -  CAGE SPNL RND 10MM 30MM PRMSH MESH TI LMBR INTRBD FS,"$7,138.60",$0.00,"$7,138.60","$3,212.37","$5,094.82",$0.00,"$1,229.95",$0.00,$0.00,"$1,249.91","$7,138.60",$0.00,"$3,569.30","$5,653.77","$5,710.88",$0.00,"$1,117.19",$0.00,"$1,136.47",$0.00
905-107,SUP,HCPCS C1781,,905-107  -  MESH 905-107  PYRM 10MM X 70MM ROUND,"$12,604.58",$0.00,"$12,604.58","$5,672.06","$5,158.80",$0.00,"$2,171.71",$0.00,$0.00,"$2,206.96","$12,604.58",$0.00,"$6,302.29","$9,982.83","$10,083.66",$0.00,"$1,972.62",$0.00,"$2,006.65",$0.00
905-108,SUP,HCPCS C1781,,905-108  -  CAGE SPNL RND 10MM 8MM PRMSH MESH TI LMBR INTRBD FS,"$3,513.85",$0.00,"$3,513.85","$1,581.23","$2,507.83",$0.00,$605.42,$0.00,$0.00,$615.25,"$3,513.85",$0.00,"$1,756.93","$2,782.97","$2,811.08",$0.00,$549.92,$0.00,$559.40,$0.00
905-110,SUP,HCPCS C1781,,905-110  -  CAGE SPNL RND 10MM 10MM PRMSH MESH TI LMBR INTRBD FS,"$3,513.85",$0.00,"$3,513.85","$1,581.23","$2,507.83",$0.00,$605.42,$0.00,$0.00,$615.25,"$3,513.85",$0.00,"$1,756.93","$2,782.97","$2,811.08",$0.00,$549.92,$0.00,$559.40,$0.00
905-112,SUP,HCPCS C1781,,905-112  -  CAGE SPNL RND 10MM 12MM PRMSH MESH TI LMBR INTRBD FS,"$3,513.85",$0.00,"$3,513.85","$1,581.23","$2,507.83",$0.00,$605.42,$0.00,$0.00,$615.25,"$3,513.85",$0.00,"$1,756.93","$2,782.97","$2,811.08",$0.00,$549.92,$0.00,$559.40,$0.00
905-115,SUP,HCPCS C1781,,905-115  -  CAGE SPNL RND 10MM 15MM PRMSH MESH TI LMBR INTRBD FS,"$3,513.85",$0.00,"$3,513.85","$1,581.23","$2,507.83",$0.00,$605.42,$0.00,$0.00,$615.25,"$3,513.85",$0.00,"$1,756.93","$2,782.97","$2,811.08",$0.00,$549.92,$0.00,$559.40,$0.00
905-133,SUP,HCPCS C1781,,905-133  -  CAGE SPNL RND 13MM 30MM PRMSH MESH TI LMBR INTRBD FS,"$7,138.60",$0.00,"$7,138.60","$3,212.37","$5,094.82",$0.00,"$1,229.95",$0.00,$0.00,"$1,249.91","$7,138.60",$0.00,"$3,569.30","$5,653.77","$5,710.88",$0.00,"$1,117.19",$0.00,"$1,136.47",$0.00
905-137,SUP,HCPCS C1781,,905-137  -  MESH 905-137  PYRM 13MM X 70MM ROUND,"$12,604.58",$0.00,"$12,604.58","$5,672.06","$5,158.80",$0.00,"$2,171.71",$0.00,$0.00,"$2,206.96","$12,604.58",$0.00,"$6,302.29","$9,982.83","$10,083.66",$0.00,"$1,972.62",$0.00,"$2,006.65",$0.00
905-139,SUP,HCPCS C1781,,905-139  -  CAGE SPNL RND 13MM 9MM PRMSH MESH TI LMBR INTRBD FS,"$3,513.85",$0.00,"$3,513.85","$1,581.23","$2,507.83",$0.00,$605.42,$0.00,$0.00,$615.25,"$3,513.85",$0.00,"$1,756.93","$2,782.97","$2,811.08",$0.00,$549.92,$0.00,$559.40,$0.00
905-161,SUP,HCPCS C1781,,905-161  -  CAGE SPNL RND 16MM 10MM PRMSH MESH TI LMBR INTRBD FS,"$3,513.85",$0.00,"$3,513.85","$1,581.23","$2,507.83",$0.00,$605.42,$0.00,$0.00,$615.25,"$3,513.85",$0.00,"$1,756.93","$2,782.97","$2,811.08",$0.00,$549.92,$0.00,$559.40,$0.00
905-163,SUP,HCPCS C1781,,905-163  -  CAGE SPNL RND 16MM 30MM PRMSH MESH TI LMBR INTRBD FS,"$7,138.60",$0.00,"$7,138.60","$3,212.37","$5,094.82",$0.00,"$1,229.95",$0.00,$0.00,"$1,249.91","$7,138.60",$0.00,"$3,569.30","$5,653.77","$5,710.88",$0.00,"$1,117.19",$0.00,"$1,136.47",$0.00
905-166,SUP,HCPCS C1781,,905-166  -  MESH 905-166  PYRM 16MM X 60MM ROUND,"$12,604.58",$0.00,"$12,604.58","$5,672.06","$5,158.80",$0.00,"$2,171.71",$0.00,$0.00,"$2,206.96","$12,604.58",$0.00,"$6,302.29","$9,982.83","$10,083.66",$0.00,"$1,972.62",$0.00,"$2,006.65",$0.00
905-194,SUP,Custom 27803010,,905-194  -  CAGE SPNL RND 19MM 40MM PRMSH MESH TI LMBR INTRBD FS,"$12,604.58",$0.00,"$12,604.58",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$12,604.58",$0.00,"$6,302.29","$9,982.83","$10,083.66",$0.00,$0.00,$0.00,$0.00,$0.00
905-199,SUP,HCPCS C1781,,905-199  -  CAGE SPNL RND 19MM 90MM PRMSH MESH TI LMBR INTRBD FS,"$12,604.58",$0.00,"$12,604.58","$5,672.06","$5,158.80",$0.00,"$2,171.71",$0.00,$0.00,"$2,206.96","$12,604.58",$0.00,"$6,302.29","$9,982.83","$10,083.66",$0.00,"$1,972.62",$0.00,"$2,006.65",$0.00
905-251,SUP,HCPCS C1781,,905-251  -  MESH 905-251  PYRM 25MM X 100MM ROUND,"$12,604.58",$0.00,"$12,604.58","$5,672.06","$5,158.80",$0.00,"$2,171.71",$0.00,$0.00,"$2,206.96","$12,604.58",$0.00,"$6,302.29","$9,982.83","$10,083.66",$0.00,"$1,972.62",$0.00,"$2,006.65",$0.00
905-255,SUP,HCPCS C1781,,905-255  -  MESH 905-255  PYRM 25MM ROUND X 10X15HGT,"$7,138.60",$0.00,"$7,138.60","$3,212.37","$5,094.82",$0.00,"$1,229.95",$0.00,$0.00,"$1,249.91","$7,138.60",$0.00,"$3,569.30","$5,653.77","$5,710.88",$0.00,"$1,117.19",$0.00,"$1,136.47",$0.00
905-256,SUP,Custom 27803010,,905-256  -  CAGE SPNL 60MMX25MM PRMSH TI RND MESH,"$12,604.58",$0.00,"$12,604.58",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$12,604.58",$0.00,"$6,302.29","$9,982.83","$10,083.66",$0.00,$0.00,$0.00,$0.00,$0.00
905-299,SUP,HCPCS C1781,,905-299  -  MESH 905-299  PYRM 19MM X ROUND END CAP,$858.00,$0.00,$858.00,$386.10,$612.35,$0.00,$147.83,$0.00,$0.00,$150.23,$858.00,$0.00,$429.00,$679.54,$686.40,$0.00,$134.28,$0.00,$136.59,$0.00
905-308,SUP,HCPCS C1781,,905-308  -  CAGE SPNL RND 13MM 8MM PRMSH MESH TI LMBR INTRBD FS,"$3,513.85",$0.00,"$3,513.85","$1,581.23","$2,507.83",$0.00,$605.42,$0.00,$0.00,$615.25,"$3,513.85",$0.00,"$1,756.93","$2,782.97","$2,811.08",$0.00,$549.92,$0.00,$559.40,$0.00
905-309,SUP,HCPCS C1781,,905-309  -  MESH 905-309  PYRM 25MM X 100MM ROUND,"$12,604.58",$0.00,"$12,604.58","$5,672.06","$5,158.80",$0.00,"$2,171.71",$0.00,$0.00,"$2,206.96","$12,604.58",$0.00,"$6,302.29","$9,982.83","$10,083.66",$0.00,"$1,972.62",$0.00,"$2,006.65",$0.00
905-310,SUP,HCPCS C1781,,905-310  -  CAGE SPNL RND 13MM 10MM PRMSH MESH TI LMBR INTRBD FS,"$3,513.85",$0.00,"$3,513.85","$1,581.23","$2,507.83",$0.00,$605.42,$0.00,$0.00,$615.25,"$3,513.85",$0.00,"$1,756.93","$2,782.97","$2,811.08",$0.00,$549.92,$0.00,$559.40,$0.00
905-311,SUP,HCPCS C1781,,905-311  -  MESH 905-311  PYRM  13MM X 11MM ROUND,"$3,513.85",$0.00,"$3,513.85","$1,581.23","$2,507.83",$0.00,$605.42,$0.00,$0.00,$615.25,"$3,513.85",$0.00,"$1,756.93","$2,782.97","$2,811.08",$0.00,$549.92,$0.00,$559.40,$0.00
905-312,SUP,HCPCS C1781,,905-312  -  MESH 905-312  PYRM  13MM X 12MM ROUND,"$3,513.85",$0.00,"$3,513.85","$1,581.23","$2,507.83",$0.00,$605.42,$0.00,$0.00,$615.25,"$3,513.85",$0.00,"$1,756.93","$2,782.97","$2,811.08",$0.00,$549.92,$0.00,$559.40,$0.00
905-313,SUP,HCPCS C1781,,905-313  -  MESH 905-313  PYRM  13MM X 13MM ROUND,"$3,513.85",$0.00,"$3,513.85","$1,581.23","$2,507.83",$0.00,$605.42,$0.00,$0.00,$615.25,"$3,513.85",$0.00,"$1,756.93","$2,782.97","$2,811.08",$0.00,$549.92,$0.00,$559.40,$0.00
905-320,SUP,HCPCS C1781,,905-320  -  MESH 905-320  PYRM  13MM X 20MM ROUND,"$3,513.85",$0.00,"$3,513.85","$1,581.23","$2,507.83",$0.00,$605.42,$0.00,$0.00,$615.25,"$3,513.85",$0.00,"$1,756.93","$2,782.97","$2,811.08",$0.00,$549.92,$0.00,$559.40,$0.00
905-399,SUP,HCPCS C1781,,905-399  -  MESH 905-399  PYRM 25MM ROUND END CAP,$858.00,$0.00,$858.00,$386.10,$612.35,$0.00,$147.83,$0.00,$0.00,$150.23,$858.00,$0.00,$429.00,$679.54,$686.40,$0.00,$134.28,$0.00,$136.59,$0.00
905-401,SUP,HCPCS C1781,,905-401  -  MESH SRG OVOID 14X10X10MM PRMSH,"$7,138.60",$0.00,"$7,138.60","$3,212.37","$5,094.82",$0.00,"$1,229.95",$0.00,$0.00,"$1,249.91","$7,138.60",$0.00,"$3,569.30","$5,653.77","$5,710.88",$0.00,"$1,117.19",$0.00,"$1,136.47",$0.00
905-403,SUP,HCPCS C1781,,905-403  -  CAGE SPNL OVOID 14X10X30MM PRMSH MESH TI LMBR INTRBD FS,"$7,138.60",$0.00,"$7,138.60","$3,212.37","$5,094.82",$0.00,"$1,229.95",$0.00,$0.00,"$1,249.91","$7,138.60",$0.00,"$3,569.30","$5,653.77","$5,710.88",$0.00,"$1,117.19",$0.00,"$1,136.47",$0.00
905-407,SUP,HCPCS C1781,,905-407  -  MESH 905-407  PYRM 10X14X70 OVOID,"$12,604.58",$0.00,"$12,604.58","$5,672.06","$5,158.80",$0.00,"$2,171.71",$0.00,$0.00,"$2,206.96","$12,604.58",$0.00,"$6,302.29","$9,982.83","$10,083.66",$0.00,"$1,972.62",$0.00,"$2,006.65",$0.00
905-408,SUP,HCPCS C1781,,905-408  -  CAGE SPNL OVOID 14X10X8MM PRMSH MESH TI LMBR INTRBD FS,"$7,138.60",$0.00,"$7,138.60","$3,212.37","$5,094.82",$0.00,"$1,229.95",$0.00,$0.00,"$1,249.91","$7,138.60",$0.00,"$3,569.30","$5,653.77","$5,710.88",$0.00,"$1,117.19",$0.00,"$1,136.47",$0.00
905-409,SUP,HCPCS C1781,,905-409  -  MESH 905-409  PYRM  10 X 14 OVOID X 9MM,"$7,138.60",$0.00,"$7,138.60","$3,212.37","$5,094.82",$0.00,"$1,229.95",$0.00,$0.00,"$1,249.91","$7,138.60",$0.00,"$3,569.30","$5,653.77","$5,710.88",$0.00,"$1,117.19",$0.00,"$1,136.47",$0.00
905-411,SUP,HCPCS C1781,,905-411  -  MESH 905-411  PYRM  10 X 14 OVOID X 11MM,"$7,138.60",$0.00,"$7,138.60","$3,212.37","$5,094.82",$0.00,"$1,229.95",$0.00,$0.00,"$1,249.91","$7,138.60",$0.00,"$3,569.30","$5,653.77","$5,710.88",$0.00,"$1,117.19",$0.00,"$1,136.47",$0.00
905-412,SUP,HCPCS C1781,,905-412  -  MESH 905-412  PYRM  10 X 14 OVOID X 12MM,"$7,138.60",$0.00,"$7,138.60","$3,212.37","$5,094.82",$0.00,"$1,229.95",$0.00,$0.00,"$1,249.91","$7,138.60",$0.00,"$3,569.30","$5,653.77","$5,710.88",$0.00,"$1,117.19",$0.00,"$1,136.47",$0.00
905-415,SUP,HCPCS C1781,,905-415  -  MESH 905-415  PYRM  10 X 14 OVOID X 15MM,"$7,138.60",$0.00,"$7,138.60","$3,212.37","$5,094.82",$0.00,"$1,229.95",$0.00,$0.00,"$1,249.91","$7,138.60",$0.00,"$3,569.30","$5,653.77","$5,710.88",$0.00,"$1,117.19",$0.00,"$1,136.47",$0.00
905-501,SUP,HCPCS C1781,,905-501  -  MESH 905-501  PYRM 13 X17 X 10 OVOID,"$7,138.60",$0.00,"$7,138.60","$3,212.37","$5,094.82",$0.00,"$1,229.95",$0.00,$0.00,"$1,249.91","$7,138.60",$0.00,"$3,569.30","$5,653.77","$5,710.88",$0.00,"$1,117.19",$0.00,"$1,136.47",$0.00
905-508,SUP,HCPCS C1781,,905-508  -  MESH 905-508  PYRM  13 X 17 OVOID X 8MM,"$7,138.60",$0.00,"$7,138.60","$3,212.37","$5,094.82",$0.00,"$1,229.95",$0.00,$0.00,"$1,249.91","$7,138.60",$0.00,"$3,569.30","$5,653.77","$5,710.88",$0.00,"$1,117.19",$0.00,"$1,136.47",$0.00
905-509,SUP,HCPCS C1781,,905-509  -  MESH 905-509  PYRM  13 X 17 OVOID X 9MM,"$7,138.60",$0.00,"$7,138.60","$3,212.37","$5,094.82",$0.00,"$1,229.95",$0.00,$0.00,"$1,249.91","$7,138.60",$0.00,"$3,569.30","$5,653.77","$5,710.88",$0.00,"$1,117.19",$0.00,"$1,136.47",$0.00
905-511,SUP,HCPCS C1781,,905-511  -  MESH 905-511  PYRM  13 X 17 OVOID X 11MM,"$7,138.60",$0.00,"$7,138.60","$3,212.37","$5,094.82",$0.00,"$1,229.95",$0.00,$0.00,"$1,249.91","$7,138.60",$0.00,"$3,569.30","$5,653.77","$5,710.88",$0.00,"$1,117.19",$0.00,"$1,136.47",$0.00
905-512,SUP,HCPCS C1781,,905-512  -  MESH 905-512  PYRM  13 X 17 OVOID X 12MM,"$7,138.60",$0.00,"$7,138.60","$3,212.37","$5,094.82",$0.00,"$1,229.95",$0.00,$0.00,"$1,249.91","$7,138.60",$0.00,"$3,569.30","$5,653.77","$5,710.88",$0.00,"$1,117.19",$0.00,"$1,136.47",$0.00
905-515,SUP,HCPCS C1781,,905-515  -  MESH 905-515  PYRM  13 X 17 OVOID X 15MM,"$7,138.60",$0.00,"$7,138.60","$3,212.37","$5,094.82",$0.00,"$1,229.95",$0.00,$0.00,"$1,249.91","$7,138.60",$0.00,"$3,569.30","$5,653.77","$5,710.88",$0.00,"$1,117.19",$0.00,"$1,136.47",$0.00
905-520,SUP,HCPCS C1781,,905-520  -  MESH 905-520  PYRM  13 X 17 OVOID X 20MM,"$7,138.60",$0.00,"$7,138.60","$3,212.37","$5,094.82",$0.00,"$1,229.95",$0.00,$0.00,"$1,249.91","$7,138.60",$0.00,"$3,569.30","$5,653.77","$5,710.88",$0.00,"$1,117.19",$0.00,"$1,136.47",$0.00
905-608,SUP,HCPCS C1781,,905-608  -  MESH 905-608  PYRM  16MM X 8MM ROUND,"$3,513.85",$0.00,"$3,513.85","$1,581.23","$2,507.83",$0.00,$605.42,$0.00,$0.00,$615.25,"$3,513.85",$0.00,"$1,756.93","$2,782.97","$2,811.08",$0.00,$549.92,$0.00,$559.40,$0.00
905-609,SUP,HCPCS C1781,,905-609  -  MESH 905-609  PYRM  16MM X 9MM ROUND,"$3,513.85",$0.00,"$3,513.85","$1,581.23","$2,507.83",$0.00,$605.42,$0.00,$0.00,$615.25,"$3,513.85",$0.00,"$1,756.93","$2,782.97","$2,811.08",$0.00,$549.92,$0.00,$559.40,$0.00
905-611,SUP,HCPCS C1781,,905-611  -  MESH 905-611  PYRM  16MM X 11MM ROUND,"$3,513.85",$0.00,"$3,513.85","$1,581.23","$2,507.83",$0.00,$605.42,$0.00,$0.00,$615.25,"$3,513.85",$0.00,"$1,756.93","$2,782.97","$2,811.08",$0.00,$549.92,$0.00,$559.40,$0.00
905-612,SUP,HCPCS C1781,,905-612  -  MESH 905-612  PYRM  16MM X 12MM ROUND,"$3,513.85",$0.00,"$3,513.85","$1,581.23","$2,507.83",$0.00,$605.42,$0.00,$0.00,$615.25,"$3,513.85",$0.00,"$1,756.93","$2,782.97","$2,811.08",$0.00,$549.92,$0.00,$559.40,$0.00
905-615,SUP,HCPCS C1781,,905-615  -  MESH 905-615  PYRM  16MM X 15MM ROUND,"$3,513.85",$0.00,"$3,513.85","$1,581.23","$2,507.83",$0.00,$605.42,$0.00,$0.00,$615.25,"$3,513.85",$0.00,"$1,756.93","$2,782.97","$2,811.08",$0.00,$549.92,$0.00,$559.40,$0.00
905-800,SUP,HCPCS C1781,,905-800  -  MESH 905-800  PYRM END RING SET SCRW,$81.25,$0.00,$81.25,$36.56,$57.99,$0.00,$14.00,$0.00,$0.00,$14.23,$81.25,$0.00,$40.63,$64.35,$65.00,$0.00,$12.72,$0.00,$12.94,$0.00
905-810,SUP,Custom 27203010,,905-810  -  INSTRUMENT 905-810 MESH HOLDER STRAIGHT,"$1,486.50",$0.00,"$1,486.50",$0.00,"$1,060.92",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,486.50",$0.00,$743.25,"$1,177.31","$1,189.20",$0.00,$0.00,$0.00,$0.00,$0.00
905-815,SUP,Custom 27203010,,905-815  -  INSTRUMENT 905-815 MESH HOLDER SMALL,"$1,486.50",$0.00,"$1,486.50",$0.00,"$1,060.92",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,486.50",$0.00,$743.25,"$1,177.31","$1,189.20",$0.00,$0.00,$0.00,$0.00,$0.00
905-820,SUP,Custom 27203010,,905-820  -  INSTRUMENT 905-820 MESH ACTOR STRAIGHT,"$1,461.00",$0.00,"$1,461.00",$0.00,"$1,042.72",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,461.00",$0.00,$730.50,"$1,157.11","$1,168.80",$0.00,$0.00,$0.00,$0.00,$0.00
905-825,SUP,Custom 27203010,,905-825  -  INSTRUMENT 905-825 ANGLED MESH IMPACTOR,"$1,461.00",$0.00,"$1,461.00",$0.00,"$1,042.72",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,461.00",$0.00,$730.50,"$1,157.11","$1,168.80",$0.00,$0.00,$0.00,$0.00,$0.00
905-830,SUP,Custom 27203010,,905-830  -  INSTRUMENT 905-830 MESH TRIMMER,"$2,518.50",$0.00,"$2,518.50",$0.00,"$1,797.45",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,518.50",$0.00,"$1,259.25","$1,994.65","$2,014.80",$0.00,$0.00,$0.00,$0.00,$0.00
905-880,SUP,Custom 27203010,,905-880  -  INSTRUMENT 905-880 END RING DRVR,$937.50,$0.00,$937.50,$0.00,$669.09,$0.00,$0.00,$0.00,$0.00,$0.00,$937.50,$0.00,$468.75,$742.50,$750.00,$0.00,$0.00,$0.00,$0.00,$0.00
905-901,SUP,HCPCS C1781,,905-901  -  MESH 905-901  PYRM 13MM X 130MM CURVED,"$16,827.60",$0.00,"$16,827.60","$7,572.42","$5,158.80",$0.00,"$2,899.31",$0.00,$0.00,"$2,946.38","$16,827.60",$0.00,"$8,413.80","$13,327.46","$13,462.08",$0.00,"$2,633.52",$0.00,"$2,678.95",$0.00
905-902,SUP,HCPCS C1781,,905-902  -  MESH 905-902  PYRM 10X14 OVOIDX130MM CRV,"$16,827.60",$0.00,"$16,827.60","$7,572.42","$5,158.80",$0.00,"$2,899.31",$0.00,$0.00,"$2,946.38","$16,827.60",$0.00,"$8,413.80","$13,327.46","$13,462.08",$0.00,"$2,633.52",$0.00,"$2,678.95",$0.00
905-903,SUP,HCPCS C1781,,905-903  -  CAGE SPNL ANG 19MM 150MM PRMSH MESH TI LMBR INTRBD FS,"$16,827.60",$0.00,"$16,827.60","$7,572.42","$5,158.80",$0.00,"$2,899.31",$0.00,$0.00,"$2,946.38","$16,827.60",$0.00,"$8,413.80","$13,327.46","$13,462.08",$0.00,"$2,633.52",$0.00,"$2,678.95",$0.00
905-904,SUP,HCPCS C1781,,905-904  -  CAGE SPNL ANG 25MM 150MM PRMSH MESH TI LMBR INTRBD FS,"$16,827.60",$0.00,"$16,827.60","$7,572.42","$5,158.80",$0.00,"$2,899.31",$0.00,$0.00,"$2,946.38","$16,827.60",$0.00,"$8,413.80","$13,327.46","$13,462.08",$0.00,"$2,633.52",$0.00,"$2,678.95",$0.00
907-1080011,SUP,Custom 27203010,,BRACE ORTH BGE 10.5IN SM RT WRST SPRT 11425-55,$27.50,$0.00,$27.50,$0.00,$19.63,$0.00,$0.00,$0.00,$0.00,$0.00,$27.50,$0.00,$13.75,$21.78,$22.00,$0.00,$0.00,$0.00,$0.00,$0.00
909-145,SUP,Custom 27203010,,909-145  -  PIN 14MM DSTRCT,$90.00,$0.00,$90.00,$0.00,$64.23,$0.00,$0.00,$0.00,$0.00,$0.00,$90.00,$0.00,$45.00,$71.28,$72.00,$0.00,$0.00,$0.00,$0.00,$0.00
9091G,SUP,Custom 27203010,,9091G  -  SUTURE NABSB 10-0 CTC-6L 4IN BLU PRLN HMSL ULT 2 ARM MFL,$74.55,$0.00,$74.55,$0.00,$53.21,$0.00,$0.00,$0.00,$0.00,$0.00,$74.55,$0.00,$37.27,$59.04,$59.64,$0.00,$0.00,$0.00,$0.00,$0.00
91-1504,SUP,HCPCS C1713,,91-1504  -  SCREW BONE 1.5MM 4MM SLFTAP HIGH TORQUE CROSS DRIVE GOLD,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
91-1505,SUP,HCPCS C1713,,91-1505  -  SCREW BONE 1.5MM 5MM SLFTAP HIGH TORQUE CROSS DRIVE GOLD,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
91-1506,SUP,HCPCS C1713,,91-1506  -  SCREW BONE 1.5MM 6MM HIGH TORQUE CROSS DRIVE CENTRE DRIVE,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
91-1507,SUP,HCPCS C1713,,91-1507  -  SCREW BONE 1.5MM 7MM HIGH TORQUE CROSS DRIVE CENTRE DRIVE,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
91-1508,SUP,HCPCS C1713,,91-1508  -  SCREW TI 8MM 1.5MM MANDIB XDR HTORQ BONE CD,$140.00,$0.00,$140.00,$63.00,$99.92,$0.00,$24.12,$0.00,$0.00,$24.51,$140.00,$0.00,$70.00,$110.88,$112.00,$0.00,$21.91,$0.00,$22.29,$0.00
91-1509,SUP,HCPCS C1713,,91-1509  -  SCREW BONE 1.5MM 9MM HIGH TORQUE CROSS DRIVE CENTRE DRIVE,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
91-1511,SUP,HCPCS C1713,,91-1511  -  SCREW BONE 1.5MM 11MM HIGH TORQUE CROSS DRIVE TITANIUM,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
91-1513,SUP,HCPCS C1713,,91-1513  -  SCREW BONE 1.5MM 13MM HIGH TORQUE CROSS DRIVE CENTRE DRIVE,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
91-1515,SUP,HCPCS C1713,,91-1515  -  SCREW BONE 1.5MM 15MM HIGH TORQUE CROSS DRIVE TITANIUM,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
91-1805,SUP,HCPCS C1713,,91-1805  -  SCREW BONE 1.8MM 5MM EMERGENCY SELF TAP HIGH TORQUE CROSS,$245.00,$0.00,$245.00,$110.25,$174.86,$0.00,$42.21,$0.00,$0.00,$42.90,$245.00,$0.00,$122.50,$194.04,$196.00,$0.00,$38.34,$0.00,$39.00,$0.00
91-1807,SUP,HCPCS C1713,,91-1807  -  SCREW BONE 1.8MM 7MM EMERGENCY HIGH TORQUE CROSS DRIVE,$245.00,$0.00,$245.00,$110.25,$174.86,$0.00,$42.21,$0.00,$0.00,$42.90,$245.00,$0.00,$122.50,$194.04,$196.00,$0.00,$38.34,$0.00,$39.00,$0.00
91-1809,SUP,HCPCS C1713,,91-1809  -  SCREW TI 9MM 1.8MM MANDIB ER XDR HTORQ BONE CD,$140.00,$0.00,$140.00,$63.00,$99.92,$0.00,$24.12,$0.00,$0.00,$24.51,$140.00,$0.00,$70.00,$110.88,$112.00,$0.00,$21.91,$0.00,$22.29,$0.00
91500V,SUP,Custom 27203010,,91500V  -  APPLIER ENDOSCOPIC MED LARGE  STRAIGHT 18INŸŸ,"$2,773.73",$0.00,"$2,773.73",$0.00,"$1,979.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,773.73",$0.00,"$1,386.86","$2,196.79","$2,218.98",$0.00,$0.00,$0.00,$0.00,$0.00
91501V,SUP,Custom 27203010,,91501V  -  CLIP INTNL ENDO REMOVER MED LARGE - LARGE  STRAIGHT 18INŸŸ,"$2,249.98",$0.00,"$2,249.98",$0.00,"$1,605.81",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,249.98",$0.00,"$1,124.99","$1,781.98","$1,799.98",$0.00,$0.00,$0.00,$0.00,$0.00
915-3100,SUP,Custom 27803010,,915-3100  -  PIN FIX HEAT CONTOURING PEN LACTOSORB STERILE,$300.00,$0.00,$300.00,$0.00,$214.11,$0.00,$0.00,$0.00,$0.00,$0.00,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$0.00,$0.00,$0.00,$0.00
91-5607,SUP,HCPCS C1713,,91-5607  -  SCREW BONE 2MM 7MM SELF DRILL TRAUMAONE LORENZ BLUE MANDIB,$435.00,$0.00,$435.00,$195.75,$310.46,$0.00,$74.95,$0.00,$0.00,$76.17,$435.00,$0.00,$217.50,$344.52,$348.00,$0.00,$68.08,$0.00,$69.25,$0.00
91-5609,SUP,HCPCS C1713,,91-5609  -  SCREW BONE 2MM 9MM SLFDRILL LORENZ TRAUMAONE BLUE MANDIB,$435.00,$0.00,$435.00,$195.75,$310.46,$0.00,$74.95,$0.00,$0.00,$76.17,$435.00,$0.00,$217.50,$344.52,$348.00,$0.00,$68.08,$0.00,$69.25,$0.00
91-5611,SUP,HCPCS C1713,,91-5611  -  SCREW BONE 2MM 11MM SLFDRILL LORENZ TRAUMAONE BLUE MANDIB,$435.00,$0.00,$435.00,$195.75,$310.46,$0.00,$74.95,$0.00,$0.00,$76.17,$435.00,$0.00,$217.50,$344.52,$348.00,$0.00,$68.08,$0.00,$69.25,$0.00
91-5707,SUP,HCPCS C1713,,91-5707  -  SCREW BONE 2MM 7MM SELF DRILL TEMPORARY ANCHOR CROSS DRIVE,$487.50,$0.00,$487.50,$219.38,$347.93,$0.00,$83.99,$0.00,$0.00,$85.36,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$76.29,$0.00,$77.61,$0.00
91602V,SUP,Custom 27203010,,91602V  -  APPLIER ENDOSCOPIC LARGE  CURVED 18INŸŸ,"$2,773.73",$0.00,"$2,773.73",$0.00,"$1,979.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,773.73",$0.00,"$1,386.86","$2,196.79","$2,218.98",$0.00,$0.00,$0.00,$0.00,$0.00
91-6103,SUP,HCPCS C1713,,91-6103  -  SCREW BONE 1.5MM 3.5MM SELF DRILL HIGH TORQUE CROSS DRIVE,$245.00,$0.00,$245.00,$110.25,$174.86,$0.00,$42.21,$0.00,$0.00,$42.90,$245.00,$0.00,$122.50,$194.04,$196.00,$0.00,$38.34,$0.00,$39.00,$0.00
91-6104,SUP,HCPCS C1713,,91-6104  -  SCREW BONE 1.5MM 4MM SELF DRILL HIGH TORQUE CROSS DRIVE,$245.00,$0.00,$245.00,$110.25,$174.86,$0.00,$42.21,$0.00,$0.00,$42.90,$245.00,$0.00,$122.50,$194.04,$196.00,$0.00,$38.34,$0.00,$39.00,$0.00
91-6105,SUP,HCPCS C1713,,91-6105  -  SCREW BONE 1.5MM 5MM SELF DRILL HIGH TORQUE CROSS DRIVE,$245.00,$0.00,$245.00,$110.25,$174.86,$0.00,$42.21,$0.00,$0.00,$42.90,$245.00,$0.00,$122.50,$194.04,$196.00,$0.00,$38.34,$0.00,$39.00,$0.00
91-6106,SUP,HCPCS C1713,,91-6106  -  SCREW BN 1.5MM 6MM GRN SLF DRL XDR TI MDFC LORENZ TRAUMAONE,$152.50,$0.00,$152.50,$68.63,$108.84,$0.00,$26.27,$0.00,$0.00,$26.70,$152.50,$0.00,$76.25,$120.78,$122.00,$0.00,$23.87,$0.00,$24.28,$0.00
91-6107,SUP,HCPCS C1713,,91-6107  -  SCREW BN 1.5MM 7MM GRN SLF DRL XDR TI MDFC LORENZ TRAUMAONE,$152.50,$0.00,$152.50,$68.63,$108.84,$0.00,$26.27,$0.00,$0.00,$26.70,$152.50,$0.00,$76.25,$120.78,$122.00,$0.00,$23.87,$0.00,$24.28,$0.00
91-6703,SUP,HCPCS C1713,,91-6703  -  SCREW BONE 1.5MM 3.5MM SELF DRILL CROSS DRIVE THINFLAP,$260.00,$0.00,$260.00,$117.00,$185.56,$0.00,$44.80,$0.00,$0.00,$45.52,$260.00,$0.00,$130.00,$205.92,$208.00,$0.00,$40.69,$0.00,$41.39,$0.00
91-6704,SUP,HCPCS C1713,,91-6704  -  SCREW BONE 1.5MM 4MM SELF DRILL CROSS DRIVE THINFLAP,$260.00,$0.00,$260.00,$117.00,$185.56,$0.00,$44.80,$0.00,$0.00,$45.52,$260.00,$0.00,$130.00,$205.92,$208.00,$0.00,$40.69,$0.00,$41.39,$0.00
91701V,SUP,Custom 27203010,,91701V  -  CLIP INTNL ENDO REMOVER LARGE - XLARGE  STRAIGHT 18INŸŸ,"$2,364.98",$0.00,"$2,364.98",$0.00,"$1,687.88",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,364.98",$0.00,"$1,182.49","$1,873.06","$1,891.98",$0.00,$0.00,$0.00,$0.00,$0.00
91702V,SUP,Custom 27203010,,91702V  -  APPLIER ENDOSCOPIC XLARGE  CURVED 18INŸŸ,"$2,773.73",$0.00,"$2,773.73",$0.00,"$1,979.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,773.73",$0.00,"$1,386.86","$2,196.79","$2,218.98",$0.00,$0.00,$0.00,$0.00,$0.00
92-00646,SUP,HCPCS C1713,,92-00646  -  PLATE BONE 90X90MM MESH PREFORMED TITANIUM,"$24,750.00",$0.00,"$24,750.00","$11,137.50","$5,158.80",$0.00,"$4,264.30",$0.00,$0.00,"$4,333.53","$24,750.00",$0.00,"$12,375.00","$19,602.00","$19,800.00",$0.00,"$3,873.38",$0.00,"$3,940.20",$0.00
92-00647,SUP,HCPCS C1713,,92-00647  -  PLATE BONE 190X140MM MESH PREFORMED TITANIUM,"$68,617.50",$0.00,"$68,617.50","$30,877.88","$5,158.80",$0.00,"$8,138.89",$0.00,$0.00,"$8,138.89","$68,617.50",$0.00,"$34,308.75","$54,345.06","$54,894.00",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
92-03210,SUP,HCPCS C1713,,92-03210  -  PLATE BN NS UNV NEURO II 2 HL LOPRFL TAB,$540.00,$0.00,$540.00,$243.00,$385.40,$0.00,$93.04,$0.00,$0.00,$94.55,$540.00,$0.00,$270.00,$427.68,$432.00,$0.00,$84.51,$0.00,$85.97,$0.00
92-03510,SUP,Custom 27803010,,92-03510  -  COVER BURR HOLE 10MM LP CRANIUM 3MM SCREW,"$1,052.50",$0.00,"$1,052.50",$0.00,$751.17,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,052.50",$0.00,$526.25,$833.58,$842.00,$0.00,$0.00,$0.00,$0.00,$0.00
92-03514,SUP,Custom 27803010,,92-03514  -  COVER BURR HOLE LP 14MM CRANIUM 3MM SCREW,"$1,052.50",$0.00,"$1,052.50",$0.00,$751.17,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,052.50",$0.00,$526.25,$833.58,$842.00,$0.00,$0.00,$0.00,$0.00,$0.00
92-03608,SUP,HCPCS C1713,,92-03608  -  PLATE BONE 2Y MICRO LP 8MM 6 HOLE BAR CRANIUM,"$1,170.00",$0.00,"$1,170.00",$526.50,$835.03,$0.00,$201.59,$0.00,$0.00,$204.86,"$1,170.00",$0.00,$585.00,$926.64,$936.00,$0.00,$183.11,$0.00,$186.26,$0.00
92-05228,SUP,HCPCS C1713,,92-05228  -  PLATE BONE LARGE LP BOX TITANIUM CRANIOMAXILLOFACIAL,$945.00,$0.00,$945.00,$425.25,$674.45,$0.00,$162.82,$0.00,$0.00,$165.46,$945.00,$0.00,$472.50,$748.44,$756.00,$0.00,$147.89,$0.00,$150.44,$0.00
92-07211,SUP,Custom 27203010,,92-07211  -  SLEEVE LAPSCP TWN FX BLDE,$525.25,$0.00,$525.25,$0.00,$374.87,$0.00,$0.00,$0.00,$0.00,$0.00,$525.25,$0.00,$262.63,$416.00,$420.20,$0.00,$0.00,$0.00,$0.00,$0.00
92-07230,SUP,Custom 27203010,,92-07230  -  BIT DRILL 200MM 3.4MM CANN,$550.00,$0.00,$550.00,$0.00,$392.54,$0.00,$0.00,$0.00,$0.00,$0.00,$550.00,$0.00,$275.00,$435.60,$440.00,$0.00,$0.00,$0.00,$0.00,$0.00
92-10504,SUP,HCPCS C1713,,92-10504  -  PLATE BN MN 4 HL TI 1.25MM,"$1,857.50",$0.00,"$1,857.50",$835.88,"$1,325.70",$0.00,$320.04,$0.00,$0.00,$325.23,"$1,857.50",$0.00,$928.75,"$1,471.14","$1,486.00",$0.00,$290.70,$0.00,$295.71,$0.00
92-10505,SUP,HCPCS C1713,,92-10505  -  PLATE BONE MINI 1.5MM 4 HOLE BAR TITANIUM MAXFACL,"$2,100.00",$0.00,"$2,100.00",$945.00,"$1,498.77",$0.00,$361.82,$0.00,$0.00,$367.69,"$2,100.00",$0.00,"$1,050.00","$1,663.20","$1,680.00",$0.00,$328.65,$0.00,$334.32,$0.00
92-10506,SUP,HCPCS C1713,,92-10506  -  PLATE BONE MINI 6 HOLE CUSTOM MAXFACL,"$2,555.00",$0.00,"$2,555.00","$1,149.75","$1,823.50",$0.00,$440.21,$0.00,$0.00,$447.36,"$2,555.00",$0.00,"$1,277.50","$2,023.56","$2,044.00",$0.00,$399.86,$0.00,$406.76,$0.00
92-10507,SUP,HCPCS C1713,,92-10507  -  PLATE BONE 2MM 6 HOLE BARMAND LOCK CRANIOMAXILLOFACIAL,"$2,675.00",$0.00,"$2,675.00","$1,203.75","$1,909.15",$0.00,$460.89,$0.00,$0.00,$468.37,"$2,675.00",$0.00,"$1,337.50","$2,118.60","$2,140.00",$0.00,$418.64,$0.00,$425.86,$0.00
92-10516,SUP,HCPCS C1713,,92-10516  -  PLATE BN 1.5MM MN 16 HL MXLFCL,"$2,850.00",$0.00,"$2,850.00","$1,282.50","$2,034.05",$0.00,$491.04,$0.00,$0.00,$499.01,"$2,850.00",$0.00,"$1,425.00","$2,257.20","$2,280.00",$0.00,$446.03,$0.00,$453.72,$0.00
92-10562,SUP,HCPCS C1713,,92-10562  -  PLATE BN STRUT TROCH,"$2,850.00",$0.00,"$2,850.00","$1,282.50","$2,034.05",$0.00,$491.04,$0.00,$0.00,$499.01,"$2,850.00",$0.00,"$1,425.00","$2,257.20","$2,280.00",$0.00,$446.03,$0.00,$453.72,$0.00
92-15514,SUP,HCPCS C1713,,92-15514  -  PLATE BONE 2MM STR FRAC,"$3,907.50",$0.00,"$3,907.50","$1,758.38","$2,788.78",$0.00,$673.24,$0.00,$0.00,$684.17,"$3,907.50",$0.00,"$1,953.75","$3,094.74","$3,126.00",$0.00,$611.52,$0.00,$622.07,$0.00
92-15904,SUP,HCPCS C1713,,92-15904  -  SCREW BONE 1.5MM 4MM SELF DRILL TITANIUM CRANIOMAXILLOFACIAL,$100.95,$0.00,$100.95,$45.43,$72.05,$0.00,$17.39,$0.00,$0.00,$17.68,$100.95,$0.00,$50.48,$79.95,$80.76,$0.00,$15.80,$0.00,$16.07,$0.00
92-15905,SUP,HCPCS C1713,,92-15905  -  SCREW BONE 5MM 1.5MM MAXFACL TI SLFDRILL XPIN,$100.95,$0.00,$100.95,$45.43,$72.05,$0.00,$17.39,$0.00,$0.00,$17.68,$100.95,$0.00,$50.48,$79.95,$80.76,$0.00,$15.80,$0.00,$16.07,$0.00
92-15920,SUP,HCPCS C1713,,92-15920  -  PLATE BONE 20MM HEMI RECONSTRUCTION TITANIUM MANDIB,"$10,292.50",$0.00,"$10,292.50","$4,631.63","$5,158.80",$0.00,"$1,773.35",$0.00,$0.00,"$1,802.13","$10,292.50",$0.00,"$5,146.25","$8,151.66","$8,234.00",$0.00,"$1,610.78",$0.00,"$1,638.57",$0.00
92-15922,SUP,HCPCS C1713,,92-15922  -  PLATE BONE 22MM HEMI RECONSTRUCTION TITANIUM MANDIB,"$10,292.50",$0.00,"$10,292.50","$4,631.63","$5,158.80",$0.00,"$1,773.35",$0.00,$0.00,"$1,802.13","$10,292.50",$0.00,"$5,146.25","$8,151.66","$8,234.00",$0.00,"$1,610.78",$0.00,"$1,638.57",$0.00
92-16035,SUP,Custom 27100030,,92-16035  -  BIT DRILL 1.6MM 35MM 7MM TWIST STOP,$960.00,$0.00,$960.00,$0.00,$685.15,$0.00,$0.00,$0.00,$0.00,$0.00,$960.00,$0.00,$480.00,$760.32,$768.00,$0.00,$0.00,$0.00,$0.00,$0.00
92-16135,SUP,Custom 27203010,,92-16135  -  DRILL SRG 1.6MM 115MM NS LF 35MM CLR CD DISP,$990.00,$0.00,$990.00,$0.00,$706.56,$0.00,$0.00,$0.00,$0.00,$0.00,$990.00,$0.00,$495.00,$784.08,$792.00,$0.00,$0.00,$0.00,$0.00,$0.00
92-17126,SUP,Custom 27203010,,92-17126  -  BIT DRL TWST,$165.00,$0.00,$165.00,$0.00,$117.76,$0.00,$0.00,$0.00,$0.00,$0.00,$165.00,$0.00,$82.50,$130.68,$132.00,$0.00,$0.00,$0.00,$0.00,$0.00
92-19035,SUP,Custom 27100030,,92-19035  -  BIT DRILL 1.9MM 35MM TWIST,"$1,002.50",$0.00,"$1,002.50",$0.00,$715.48,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,002.50",$0.00,$501.25,$793.98,$802.00,$0.00,$0.00,$0.00,$0.00,$0.00
92-23126,SUP,Custom 27203010,,92-23126  -  BIT DRL 23MM,$165.00,$0.00,$165.00,$0.00,$117.76,$0.00,$0.00,$0.00,$0.00,$0.00,$165.00,$0.00,$82.50,$130.68,$132.00,$0.00,$0.00,$0.00,$0.00,$0.00
92-25290,SUP,HCPCS C1713,,92-25290  -  PLATE STD LNG BONE RIGHT DORSAL RADL,$893.75,$0.00,$893.75,$402.19,$637.87,$0.00,$153.99,$0.00,$0.00,$156.49,$893.75,$0.00,$446.88,$707.85,$715.00,$0.00,$139.87,$0.00,$142.29,$0.00
92-25291,SUP,HCPCS C1713,,92-25291  -  PLATE STD LNG BONE LEFT DORSAL RADL,$893.75,$0.00,$893.75,$402.19,$637.87,$0.00,$153.99,$0.00,$0.00,$156.49,$893.75,$0.00,$446.88,$707.85,$715.00,$0.00,$139.87,$0.00,$142.29,$0.00
92-25292,SUP,HCPCS C1713,,92-25292  -  PLATE LNG W BONE RIGHT DORSAL RADL,$893.75,$0.00,$893.75,$402.19,$637.87,$0.00,$153.99,$0.00,$0.00,$156.49,$893.75,$0.00,$446.88,$707.85,$715.00,$0.00,$139.87,$0.00,$142.29,$0.00
92-25293,SUP,HCPCS C1713,,92-25293  -  PLATE LNG W BONE LEFT DORSAL RADL,$893.75,$0.00,$893.75,$402.19,$637.87,$0.00,$153.99,$0.00,$0.00,$156.49,$893.75,$0.00,$446.88,$707.85,$715.00,$0.00,$139.87,$0.00,$142.29,$0.00
92-25395,SUP,HCPCS C1713,,92-25395  -  PLATE NAR XLNG BONE VOLR RADL,"$1,216.88",$0.00,"$1,216.88",$547.59,$868.48,$0.00,$209.66,$0.00,$0.00,$213.07,"$1,216.88",$0.00,$608.44,$963.77,$973.50,$0.00,$190.44,$0.00,$193.73,$0.00
92-25397,SUP,HCPCS C1713,,92-25397  -  PLATE STD XLNG BONE VOLR RADL,"$1,216.88",$0.00,"$1,216.88",$547.59,$868.48,$0.00,$209.66,$0.00,$0.00,$213.07,"$1,216.88",$0.00,$608.44,$963.77,$973.50,$0.00,$190.44,$0.00,$193.73,$0.00
92-25399,SUP,HCPCS C1713,,92-25399  -  PLATE W XLNG BONE VOLR RADL,"$1,216.88",$0.00,"$1,216.88",$547.59,$868.48,$0.00,$209.66,$0.00,$0.00,$213.07,"$1,216.88",$0.00,$608.44,$963.77,$973.50,$0.00,$190.44,$0.00,$193.73,$0.00
92-25403,SUP,HCPCS C1713,,92-25403  -  PLATE BN SHRT T,"$1,124.75",$0.00,"$1,124.75",$506.14,$802.73,$0.00,$193.79,$0.00,$0.00,$196.93,"$1,124.75",$0.00,$562.38,$890.80,$899.80,$0.00,$176.02,$0.00,$179.06,$0.00
92-25405,SUP,HCPCS C1713,,92-25405  -  PLATE LNG 7 HOLE T CLMN BONE ULN,"$1,124.75",$0.00,"$1,124.75",$506.14,$802.73,$0.00,$193.79,$0.00,$0.00,$196.93,"$1,124.75",$0.00,$562.38,$890.80,$899.80,$0.00,$176.02,$0.00,$179.06,$0.00
92-27007,SUP,Custom 27203010,,92-27007  -  HOLDER INSTR SHFT PLT,$434.50,$0.00,$434.50,$0.00,$310.10,$0.00,$0.00,$0.00,$0.00,$0.00,$434.50,$0.00,$217.25,$344.12,$347.60,$0.00,$0.00,$0.00,$0.00,$0.00
92-40281,SUP,HCPCS C1713,,92-40281  -  WIRE FX 1.4MM 160MM KRSH STP,$41.25,$0.00,$41.25,$18.56,$29.44,$0.00,$7.11,$0.00,$0.00,$7.22,$41.25,$0.00,$20.63,$32.67,$33.00,$0.00,$6.46,$0.00,$6.57,$0.00
92-40283,SUP,HCPCS C1713,,92-40283  -  WIRE FX .062IN 160MM KRSH,$48.13,$0.00,$48.13,$21.66,$34.35,$0.00,$8.29,$0.00,$0.00,$8.43,$48.13,$0.00,$24.06,$38.12,$38.50,$0.00,$7.53,$0.00,$7.66,$0.00
92-53514,SUP,Custom 27803010,,92-53514  -  COVER BURR HOLE 14MM LP,$950.00,$0.00,$950.00,$0.00,$678.02,$0.00,$0.00,$0.00,$0.00,$0.00,$950.00,$0.00,$475.00,$752.40,$760.00,$0.00,$0.00,$0.00,$0.00,$0.00
92-55005,SUP,HCPCS C1713,,92-55005  -  PLATE BONE SHORT 4 HOLE PREBENT CRANIOMAXILLOFACIAL LEFT,"$1,222.50",$0.00,"$1,222.50",$550.13,$872.50,$0.00,$210.63,$0.00,$0.00,$214.05,"$1,222.50",$0.00,$611.25,$968.22,$978.00,$0.00,$191.32,$0.00,$194.62,$0.00
92-55007,SUP,HCPCS C1713,,92-55007  -  PLATE BONE SHORT 4 HOLE PREBENT CRANIOMAXILLOFACIAL RIGHT,"$1,222.50",$0.00,"$1,222.50",$550.13,$872.50,$0.00,$210.63,$0.00,$0.00,$214.05,"$1,222.50",$0.00,$611.25,$968.22,$978.00,$0.00,$191.32,$0.00,$194.62,$0.00
92-55011,SUP,HCPCS C1713,,92-55011  -  PLATE BN 2.5MM 11 HL MNDB,"$7,835.00",$0.00,"$7,835.00","$3,525.75","$5,158.80",$0.00,"$1,349.93",$0.00,$0.00,"$1,371.85","$7,835.00",$0.00,"$3,917.50","$6,205.32","$6,268.00",$0.00,"$1,226.18",$0.00,"$1,247.33",$0.00
92-55066,SUP,HCPCS C1713,,92-55066  -  PLATE BONE 100D L BAR CRANIOMAXILLOFACIAL RIGHT,"$1,150.00",$0.00,"$1,150.00",$517.50,$820.76,$0.00,$198.14,$0.00,$0.00,$201.36,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$179.98,$0.00,$183.08,$0.00
92-55067,SUP,HCPCS C1713,,92-55067  -  PLATE BONE 100D L BAR CRANIOMAXILLOFACIAL LEFT,"$1,150.00",$0.00,"$1,150.00",$517.50,$820.76,$0.00,$198.14,$0.00,$0.00,$201.36,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$179.98,$0.00,$183.08,$0.00
92-55159,SUP,HCPCS C1713,,92-55159  -  PLATE BN 2MM 11 HL CRNMXF,"$6,960.00",$0.00,"$6,960.00","$3,132.00","$4,967.35",$0.00,"$1,199.17",$0.00,$0.00,"$1,218.64","$6,960.00",$0.00,"$3,480.00","$5,512.32","$5,568.00",$0.00,"$1,089.24",$0.00,"$1,108.03",$0.00
92-55161,SUP,HCPCS C1713,,92-55161  -  PLATE BONE 2MM 17 HOLE PRIM RECONSTRUCTION TEMPLATE MANDIB,"$8,477.50",$0.00,"$8,477.50","$3,814.88","$5,158.80",$0.00,"$1,460.63",$0.00,$0.00,"$1,484.34","$8,477.50",$0.00,"$4,238.75","$6,714.18","$6,782.00",$0.00,"$1,326.73",$0.00,"$1,349.62",$0.00
92-55506,SUP,HCPCS C1713,,92-55506  -  PLATE BONE 4 HOLE PREBENT TITANIUM LEFT MAXFACL,"$1,082.50",$0.00,"$1,082.50",$487.13,$772.58,$0.00,$186.51,$0.00,$0.00,$189.54,"$1,082.50",$0.00,$541.25,$857.34,$866.00,$0.00,$169.41,$0.00,$172.33,$0.00
92-55922,SUP,HCPCS C1713,,92-55922  -  PLATE BN 2MM HEMI PRM LT 2,"$6,475.00",$0.00,"$6,475.00","$2,913.75","$4,621.21",$0.00,"$1,115.61",$0.00,$0.00,"$1,133.72","$6,475.00",$0.00,"$3,237.50","$5,128.20","$5,180.00",$0.00,"$1,013.34",$0.00,"$1,030.82",$0.00
92-57262,SUP,HCPCS C1713,,92-57262  -  PLATE BN FX 1.7 MM SCR,$584.38,$0.00,$584.38,$262.97,$417.07,$0.00,$100.68,$0.00,$0.00,$102.32,$584.38,$0.00,$292.19,$462.83,$467.50,$0.00,$91.45,$0.00,$93.03,$0.00
92-60090,SUP,Custom 27203010,,92-60090  -  TWIST DRILL DIA.0.9X66MM TWIST LENGTH 22MM AO SHAFT,$165.00,$0.00,$165.00,$0.00,$117.76,$0.00,$0.00,$0.00,$0.00,$0.00,$165.00,$0.00,$82.50,$130.68,$132.00,$0.00,$0.00,$0.00,$0.00,$0.00
92-60130,SUP,Custom 27203010,,92-60130  -  TWIST DRILL DIA.1.3X66MM TWIST LENGTH 22MM AO SHAFT,$165.00,$0.00,$165.00,$0.00,$117.76,$0.00,$0.00,$0.00,$0.00,$0.00,$165.00,$0.00,$82.50,$130.68,$132.00,$0.00,$0.00,$0.00,$0.00,$0.00
92-60165,SUP,Custom 27100030,,92-60165  -  BIT DRILL 35MM COLOR CODED,$775.00,$0.00,$775.00,$0.00,$553.12,$0.00,$0.00,$0.00,$0.00,$0.00,$775.00,$0.00,$387.50,$613.80,$620.00,$0.00,$0.00,$0.00,$0.00,$0.00
92-60170,SUP,Custom 27203010,,92-60170  -  DRILL TWST 1.7MM 66MM,$165.00,$0.00,$165.00,$0.00,$117.76,$0.00,$0.00,$0.00,$0.00,$0.00,$165.00,$0.00,$82.50,$130.68,$132.00,$0.00,$0.00,$0.00,$0.00,$0.00
92-60190,SUP,Custom 27203010,,92-60190  -  TWIST DRILL DIA.1.9X82MM TWIST LENGTH 39MM AO SHAFT,$165.00,$0.00,$165.00,$0.00,$117.76,$0.00,$0.00,$0.00,$0.00,$0.00,$165.00,$0.00,$82.50,$130.68,$132.00,$0.00,$0.00,$0.00,$0.00,$0.00
92-60199,SUP,Custom 27100030,,92-60199  -  DRILL TWIST 1.9MM STOP 35MM 115MM,$877.50,$0.00,$877.50,$0.00,$626.27,$0.00,$0.00,$0.00,$0.00,$0.00,$877.50,$0.00,$438.75,$694.98,$702.00,$0.00,$0.00,$0.00,$0.00,$0.00
92-60230,SUP,Custom 27203010,,92-60230  -  DRILL TWST 2.3MM 82MM,$165.00,$0.00,$165.00,$0.00,$117.76,$0.00,$0.00,$0.00,$0.00,$0.00,$165.00,$0.00,$82.50,$130.68,$132.00,$0.00,$0.00,$0.00,$0.00,$0.00
92-62254,SUP,Custom 27203010,,92-62254  -  GUIDE DRL 1.2MM 1.7MM FUSED,"$1,175.63",$0.00,"$1,175.63",$0.00,$839.04,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,175.63",$0.00,$587.81,$931.10,$940.50,$0.00,$0.00,$0.00,$0.00,$0.00
92-62255,SUP,Custom 27203010,,92-62255  -  GUIDE DRL 2.3MM LG FUSED CMPR,"$1,117.88",$0.00,"$1,117.88",$0.00,$797.83,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,117.88",$0.00,$558.94,$885.36,$894.30,$0.00,$0.00,$0.00,$0.00,$0.00
92-62256,SUP,Custom 27203010,,92-62256  -  GUIDE DRL 2.3MM 2.5MM FUSED CENTRIC,"$1,227.88",$0.00,"$1,227.88",$0.00,$876.33,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,227.88",$0.00,$613.94,$972.48,$982.30,$0.00,$0.00,$0.00,$0.00,$0.00
92-62270,SUP,Custom 27803010,,92-62270  -  TAP FOR 2.7MM SCREW,$570.63,$0.00,$570.63,$0.00,$407.26,$0.00,$0.00,$0.00,$0.00,$0.00,$570.63,$0.00,$285.31,$451.94,$456.50,$0.00,$0.00,$0.00,$0.00,$0.00
931HF75,SUP,HCPCS C1887,,CATHETER ART 7.5FR 110CM 5 LUM TD SG HEP,$210.25,$0.00,$210.25,$114.17,$150.06,$0.00,$36.23,$0.00,$0.00,$36.81,$210.25,$0.00,$105.13,$166.52,$168.20,$0.00,$32.90,$0.00,$33.47,$0.00
93-9268,SUP,HCPCS C1762,,93-9268  -  GRAFT SKIN 8X6CM DEHYDRATED GAMA IRRADIATED AXIS TUTOPLAST,"$3,847.50",$0.00,"$3,847.50",$0.00,"$2,745.96",$0.00,$662.91,$0.00,$0.00,$0.00,"$3,847.50",$0.00,"$1,923.75","$3,047.22","$3,078.00",$0.00,$602.13,$0.00,$0.00,$0.00
94107CE,SUP,HCPCS C1713,,94107CE  -  CROSSLINK 94107CE DTT4 FOR COMPRESS L60,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
94107DE,SUP,HCPCS C1713,,94107DE  -  CROSSLINK 94107DE DTT4 FOR DISTRACT L60,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
94-202,SUP,Custom 27203010,,REAGENT LUPOTEK DETECTIN ANALY,$400.00,$0.00,$400.00,$0.00,$285.48,$0.00,$0.00,$0.00,$0.00,$0.00,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$0.00,$0.00,$0.00,$0.00
9450002E,SUP,Custom 27203010,,9450002E  -  DISPOSABLE 9450002E ELECTRO LOWIMPED22MM,$669.00,$0.00,$669.00,$0.00,$477.47,$0.00,$0.00,$0.00,$0.00,$0.00,$669.00,$0.00,$334.50,$529.85,$535.20,$0.00,$0.00,$0.00,$0.00,$0.00
945DMA1002,SUP,Custom 27203010,,945DMA1002  -  ELECTRODE 945DMA1002 AD GOLDFOIL EAR CAN,$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
945DMA1004,SUP,Custom 27203010,,945DMA1004  -  ELECTRODE 945DMA1004 PED GOLDFOIL EARCAN,$9.00,$0.00,$9.00,$0.00,$6.42,$0.00,$0.00,$0.00,$0.00,$0.00,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$0.00,$0.00,$0.00,$0.00
945DME1001,SUP,Custom 27203010,,945DME1001  -  ELECTRODE 945DME1001 1.2M CORKSCREW,$82.50,$0.00,$82.50,$0.00,$58.88,$0.00,$0.00,$0.00,$0.00,$0.00,$82.50,$0.00,$41.25,$65.34,$66.00,$0.00,$0.00,$0.00,$0.00,$0.00
945DME1004,SUP,Custom 27203010,,945DME1004  -  ELECTRODE 945DME1004 3.5X5CM 2M SING GR,$25.50,$0.00,$25.50,$0.00,$18.20,$0.00,$0.00,$0.00,$0.00,$0.00,$25.50,$0.00,$12.75,$20.20,$20.40,$0.00,$0.00,$0.00,$0.00,$0.00
945DME2002,SUP,Custom 27203010,,945DME2002  -  ELECTRODE 945DME2002 48IN 1.2M CORKSCREW,$165.00,$0.00,$165.00,$0.00,$117.76,$0.00,$0.00,$0.00,$0.00,$0.00,$165.00,$0.00,$82.50,$130.68,$132.00,$0.00,$0.00,$0.00,$0.00,$0.00
945DSE1115,SUP,Custom 27203010,,945DSE1115  -  ELECTRODE 945DSE1115 1.5X2CM 1.5M SINGLE,$12.00,$0.00,$12.00,$0.00,$8.56,$0.00,$0.00,$0.00,$0.00,$0.00,$12.00,$0.00,$6.00,$9.50,$9.60,$0.00,$0.00,$0.00,$0.00,$0.00
945DSE1125,SUP,Custom 27203010,,945DSE1125  -  ELECTRODE 945DSE1125 1.5X2CM 2.5M SINGLE,$18.00,$0.00,$18.00,$0.00,$12.85,$0.00,$0.00,$0.00,$0.00,$0.00,$18.00,$0.00,$9.00,$14.26,$14.40,$0.00,$0.00,$0.00,$0.00,$0.00
945DSE2115,SUP,Custom 27203010,,945DSE2115  -  ELECTRODE 945DSE2115 2X2.7CM 1.5M SINGLE,$12.00,$0.00,$12.00,$0.00,$8.56,$0.00,$0.00,$0.00,$0.00,$0.00,$12.00,$0.00,$6.00,$9.50,$9.60,$0.00,$0.00,$0.00,$0.00,$0.00
945DSE2125,SUP,Custom 27203010,,945DSE2125  -  ELECTRODE 945DSE2125 2X2.7CM 2.5M SINGLE,$15.00,$0.00,$15.00,$0.00,$10.71,$0.00,$0.00,$0.00,$0.00,$0.00,$15.00,$0.00,$7.50,$11.88,$12.00,$0.00,$0.00,$0.00,$0.00,$0.00
945DSE3115,SUP,Custom 27203010,,945DSE3115  -  ELECTRODE 945DSE3115 1.5X2CM 1.5M DUAL,$43.50,$0.00,$43.50,$0.00,$31.05,$0.00,$0.00,$0.00,$0.00,$0.00,$43.50,$0.00,$21.75,$34.45,$34.80,$0.00,$0.00,$0.00,$0.00,$0.00
945DSE3125,SUP,Custom 27203010,,945DSE3125  -  ELECTRODE 945DSE3125 1.5X2CM 2.5M DUAL,$63.00,$0.00,$63.00,$0.00,$44.96,$0.00,$0.00,$0.00,$0.00,$0.00,$63.00,$0.00,$31.50,$49.90,$50.40,$0.00,$0.00,$0.00,$0.00,$0.00
945DSE4115,SUP,Custom 27203010,,945DSE4115  -  ELECTRODE 945DSE4115 2X2.7CM 1.5M DUAL,$43.50,$0.00,$43.50,$0.00,$31.05,$0.00,$0.00,$0.00,$0.00,$0.00,$43.50,$0.00,$21.75,$34.45,$34.80,$0.00,$0.00,$0.00,$0.00,$0.00
945DSE4125,SUP,Custom 27203010,,945DSE4125  -  ELECTRODE 945DSE4125 2X2.7CM 2.5M DUAL,$63.00,$0.00,$63.00,$0.00,$44.96,$0.00,$0.00,$0.00,$0.00,$0.00,$63.00,$0.00,$31.50,$49.90,$50.40,$0.00,$0.00,$0.00,$0.00,$0.00
945DSN1260,SUP,Custom 27203010,,945DSN1260  -  ELECTRODE 945DSN1260 13MM 27G 1.5M SING,$22.50,$0.00,$22.50,$0.00,$16.06,$0.00,$0.00,$0.00,$0.00,$0.00,$22.50,$0.00,$11.25,$17.82,$18.00,$0.00,$0.00,$0.00,$0.00,$0.00
945DSN1299,SUP,Custom 27203010,,945DSN1299  -  ELECTRODE 945DSN1299 13MM 27G 2.5M SING,$22.50,$0.00,$22.50,$0.00,$16.06,$0.00,$0.00,$0.00,$0.00,$0.00,$22.50,$0.00,$11.25,$17.82,$18.00,$0.00,$0.00,$0.00,$0.00,$0.00
945DSN2260,SUP,Custom 27203010,,945DSN2260  -  ELECTRODE 945DSN2260 13MM 27G 1.5M DUAL,$52.50,$0.00,$52.50,$0.00,$37.47,$0.00,$0.00,$0.00,$0.00,$0.00,$52.50,$0.00,$26.25,$41.58,$42.00,$0.00,$0.00,$0.00,$0.00,$0.00
945DSN2280,SUP,Custom 27203010,,945DSN2280  -  ELECTRODE 945DSN2280 13MM 27G 2.0M DUAL,$52.50,$0.00,$52.50,$0.00,$37.47,$0.00,$0.00,$0.00,$0.00,$0.00,$52.50,$0.00,$26.25,$41.58,$42.00,$0.00,$0.00,$0.00,$0.00,$0.00
945DSN2299,SUP,Custom 27203010,,945DSN2299  -  ELECTRODE 945DSN2299 13MM 27G 2.5M DUAL,$61.50,$0.00,$61.50,$0.00,$43.89,$0.00,$0.00,$0.00,$0.00,$0.00,$61.50,$0.00,$30.75,$48.71,$49.20,$0.00,$0.00,$0.00,$0.00,$0.00
945DTE0001,SUP,HCPCS C1898,,945DTE0001  -  LEAD 945DTE0001 0.6M RED CLIP,$45.00,$0.00,$45.00,$20.25,$32.12,$0.00,$7.75,$0.00,$0.00,$7.88,$45.00,$0.00,$22.50,$35.64,$36.00,$0.00,$7.04,$0.00,$7.16,$0.00
945DTE0002,SUP,HCPCS C1898,,945DTE0002  -  LEAD 945DTE0002 0.6 GREEN CLIP,$45.00,$0.00,$45.00,$20.25,$32.12,$0.00,$7.75,$0.00,$0.00,$7.88,$45.00,$0.00,$22.50,$35.64,$36.00,$0.00,$7.04,$0.00,$7.16,$0.00
945DTE0003,SUP,HCPCS C1898,,945DTE0003  -  LEAD 945DTE0003 0.6M BLACK CLIP,$45.00,$0.00,$45.00,$20.25,$32.12,$0.00,$7.75,$0.00,$0.00,$7.88,$45.00,$0.00,$22.50,$35.64,$36.00,$0.00,$7.04,$0.00,$7.16,$0.00
945DTE1002,SUP,Custom 27203010,,945DTE1002  -  ELECTRODE 945DTE1002 1.27X1.9CMPREGELTAB,$33.00,$0.00,$33.00,$0.00,$23.55,$0.00,$0.00,$0.00,$0.00,$0.00,$33.00,$0.00,$16.50,$26.14,$26.40,$0.00,$0.00,$0.00,$0.00,$0.00
945DTE1003,SUP,Custom 27203010,,945DTE1003  -  ELECTRODE 945DTE1003 2.54X2.54CMPRETAB,$33.00,$0.00,$33.00,$0.00,$23.55,$0.00,$0.00,$0.00,$0.00,$0.00,$33.00,$0.00,$16.50,$26.14,$26.40,$0.00,$0.00,$0.00,$0.00,$0.00
945MEP1001,SUP,Custom 27203010,,945MEP1001  -  ELECTRODE 945MEP1001 KEYED CORKSCREW,$624.00,$0.00,$624.00,$0.00,$445.35,$0.00,$0.00,$0.00,$0.00,$0.00,$624.00,$0.00,$312.00,$494.21,$499.20,$0.00,$0.00,$0.00,$0.00,$0.00
945NRE1003,SUP,Custom 27203010,,945NRE1003  -  ELECTRODE 945NRE1003 SD NEEDLE RECORDING,$891.00,$0.00,$891.00,$0.00,$635.91,$0.00,$0.00,$0.00,$0.00,$0.00,$891.00,$0.00,$445.50,$705.67,$712.80,$0.00,$0.00,$0.00,$0.00,$0.00
945NRE1004,SUP,Custom 27203010,,945NRE1004  -  ELECTRODE 945NRE1004 NEEDLE WITH RING,"$1,320.00",$0.00,"$1,320.00",$0.00,$942.08,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,320.00",$0.00,$660.00,"$1,045.44","$1,056.00",$0.00,$0.00,$0.00,$0.00,$0.00
945POC1002,SUP,HCPCS C1713,,945POC1002  -  CLIP 945POC1002 SD PULSE OX,$223.50,$0.00,$223.50,$100.58,$159.51,$0.00,$38.51,$0.00,$0.00,$39.13,$223.50,$0.00,$111.75,$177.01,$178.80,$0.00,$34.98,$0.00,$35.58,$0.00
945PXC2002,SUP,HCPCS C1713,,945PXC2002  -  CLIP 945PXC2002 1MLEAD PULSEOX FING/TOE,$82.50,$0.00,$82.50,$37.13,$58.88,$0.00,$14.21,$0.00,$0.00,$14.45,$82.50,$0.00,$41.25,$65.34,$66.00,$0.00,$12.91,$0.00,$13.13,$0.00
945RMA1016,SUP,Custom 27203010,,945RMA1016  -  TUBE 945RMA1016 REPLACEMENT,$22.50,$0.00,$22.50,$0.00,$16.06,$0.00,$0.00,$0.00,$0.00,$0.00,$22.50,$0.00,$11.25,$17.82,$18.00,$0.00,$0.00,$0.00,$0.00,$0.00
945RMA1019,SUP,Custom 27203010,,945RMA1019  -  ELECTRODE 945RMA1019 10-7.5MMLARYNGEAL,$289.50,$0.00,$289.50,$0.00,$206.62,$0.00,$0.00,$0.00,$0.00,$0.00,$289.50,$0.00,$144.75,$229.28,$231.60,$0.00,$0.00,$0.00,$0.00,$0.00
945RMA1019S,SUP,Custom 27203010,,945RMA1019S  -  ELECTRODE 945RMA1019S 7-6MM LARYNGEAL,$289.50,$0.00,$289.50,$0.00,$206.62,$0.00,$0.00,$0.00,$0.00,$0.00,$289.50,$0.00,$144.75,$229.28,$231.60,$0.00,$0.00,$0.00,$0.00,$0.00
945RMA1019SP,SUP,Custom 27203010,,945RMA1019SP  -  ELECTRODE 945RMA1019SP 5.5-2MMLARYNGEAL,$289.50,$0.00,$289.50,$0.00,$206.62,$0.00,$0.00,$0.00,$0.00,$0.00,$289.50,$0.00,$144.75,$229.28,$231.60,$0.00,$0.00,$0.00,$0.00,$0.00
945RMA2029,SUP,Custom 27203010,,945RMA2029  -  ELECTRODE 945RMA2029 LARGE LARYNGEAL,$330.00,$0.00,$330.00,$0.00,$235.52,$0.00,$0.00,$0.00,$0.00,$0.00,$330.00,$0.00,$165.00,$261.36,$264.00,$0.00,$0.00,$0.00,$0.00,$0.00
945RMA2029SP,SUP,Custom 27203010,,945RMA2029SP  -  ELECTRODE 945RMA2029SP MEDIUM LARYNGEAL,$330.00,$0.00,$330.00,$0.00,$235.52,$0.00,$0.00,$0.00,$0.00,$0.00,$330.00,$0.00,$165.00,$261.36,$264.00,$0.00,$0.00,$0.00,$0.00,$0.00
945SRE1002,SUP,Custom 27203010,,945SRE1002  -  ELECTRODE 945SRE1002 SD SURFACERECORDING,$891.00,$0.00,$891.00,$0.00,$635.91,$0.00,$0.00,$0.00,$0.00,$0.00,$891.00,$0.00,$445.50,$705.67,$712.80,$0.00,$0.00,$0.00,$0.00,$0.00
9461-217,SUP,Custom 27203010,,TUBING BP RECT SCR CONNCTR LF 12FT PED ADLT GRY EGL 3K DASH,$150.00,$0.00,$150.00,$0.00,$107.06,$0.00,$0.00,$0.00,$0.00,$0.00,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$0.00,$0.00,$0.00,$0.00
95-1318BIO,SUP,Custom 27203010,,BAG 18X13IN BHZR LOGO SPGRD SPEC,$0.40,$0.00,$0.40,$0.00,$0.29,$0.00,$0.00,$0.00,$0.00,$0.00,$0.40,$0.00,$0.20,$0.32,$0.32,$0.00,$0.00,$0.00,$0.00,$0.00
95-201,SUP,Custom 27203010,,REAGENT LUPOTEK CORRECTIN ANALY,$425.00,$0.00,$425.00,$0.00,$303.32,$0.00,$0.00,$0.00,$0.00,$0.00,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$0.00,$0.00,$0.00,$0.00
9529-,SUP,Custom 27203010,,9529-  -  SLEEVE CMPR MED KN LGTH 21- IN NS LF KDL SCD EXP ADJ CRCMF,$34.45,$0.00,$27.28,$0.00,$23.54,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$16.49,$27.28,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
96004-N,SUP,Custom 27203010,,PACIFIER NBN SIL STH 1 PC DSGN LF NTR,$2.58,$0.00,$2.58,$0.00,$1.84,$0.00,$0.00,$0.00,$0.00,$0.00,$2.58,$0.00,$1.29,$2.04,$2.06,$0.00,$0.00,$0.00,$0.00,$0.00
96505H,SUP,Custom 27803010,,96505H  -  CONNECTOR ROD 6.35/6.35MM DMN SPNE,"$1,796.58",$0.00,"$1,796.58",$0.00,"$1,282.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,796.58",$0.00,$898.29,"$1,422.89","$1,437.26",$0.00,$0.00,$0.00,$0.00,$0.00
96505HT,SUP,Custom 27803010,,96505HT  -  CONNECTOR 96505HT DOM DIA 6.35-6.35 TI,"$1,831.18",$0.00,"$1,831.18",$0.00,"$1,306.91",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,831.18",$0.00,$915.59,"$1,450.29","$1,464.94",$0.00,$0.00,$0.00,$0.00,$0.00
96507H,SUP,Custom 27803010,,96507H  -  CONNECTOR 96507H CDH DOMINO 6.35-7MM,"$1,796.58",$0.00,"$1,796.58",$0.00,"$1,282.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,796.58",$0.00,$898.29,"$1,422.89","$1,437.26",$0.00,$0.00,$0.00,$0.00,$0.00
96509H,SUP,Custom 27803010,,96509H  -  CONNECTOR 96509H AXIAL 6.35- 6.35,"$2,118.45",$0.00,"$2,118.45",$0.00,"$1,511.94",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,118.45",$0.00,"$1,059.23","$1,677.81","$1,694.76",$0.00,$0.00,$0.00,$0.00,$0.00
96509HT,SUP,Custom 27803010,,96509HT  -  CONNECTOR 96509HT AXIAL 6.35- 6.35TI,"$2,346.10",$0.00,"$2,346.10",$0.00,"$1,674.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,346.10",$0.00,"$1,173.05","$1,858.11","$1,876.88",$0.00,$0.00,$0.00,$0.00,$0.00
968-021,SUP,HCPCS C1713,,968-021  -  ROD 968-021    WITH LINE SS,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
96880-021,SUP,Custom 27803010,,96880-021  -  CANNULA PRFSN 60CM 21FR FEM PERC VN ADLT 3/8IN 1,"$1,060.00",$0.00,"$1,060.00",$0.00,$756.52,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,060.00",$0.00,$530.00,$839.52,$848.00,$0.00,$0.00,$0.00,$0.00,$0.00
96880-025,SUP,Custom 27203010,,96880-025  -  CANNULA PERFUSION 3/8IN 25FR 60CM 1 PIECE KINK RESISTANT,"$1,000.00",$0.00,"$1,000.00",$0.00,$713.70,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,000.00",$0.00,$500.00,$792.00,$800.00,$0.00,$0.00,$0.00,$0.00,$0.00
969-012,SUP,HCPCS C1713,,969-012  -  ROD 969-012 SEA FOAM GREEN CP,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
969-022,SUP,HCPCS C1713,,969-022  -  ROD 969-022 SEA FOAM GREEN CP W/LINE,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
976-119,SUP,HCPCS C1713,,976-119  -  PLATE BN 19MM STRL ATL VS LCK TI SPNE CRV ANT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
976-121,SUP,HCPCS C1713,,976-121  -  PLATE 21MM TI LCK ATL VS BONE ANT CERV SPNE STRL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
976-123,SUP,HCPCS C1713,,976-123  -  PLATE 23MM TI LCK ATL VS BONE ANT CERV SPN STRL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
976-125,SUP,HCPCS C1713,,976-125  -  PLATE 25MM TI LCK ATL VS BONE ANT CERV SPN STRL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
976-127,SUP,HCPCS C1713,,976-127  -  PLATE 27.5MM TI ATLNTS BONE ANT CERV SPN,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
976-130,SUP,HCPCS C1713,,976-130  -  PLATE BN 30MM STRL ATL VS LCK TI SPNE CRV ANT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
976-132,SUP,HCPCS C1713,,976-132  -  PLATE BN 32.5MM STRL ATL VS LCK TI SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
976-135,SUP,HCPCS C1713,,976-135  -  PLATE BN 35MM STRL ATL VS LCK TI SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
976-137,SUP,HCPCS C1713,,976-137  -  PLATE BN 37.5MM STRL ATL VS LCK TI SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
976-140,SUP,HCPCS C1713,,976-140  -  PLATE BN 40MM STRL ATL VS LCK TI SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
976-142,SUP,HCPCS C1713,,976-142  -  PLATE 42.5MM TI ALLOY LCK ATL VS BONE ANT CERV SPN STRL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
976-145,SUP,HCPCS C1713,,976-145  -  PLATE 45MM TI ATLNTS BONE ANT CERV SPN,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
976-147,SUP,HCPCS C1713,,976-147  -  PLATE BN 47.5MM STRL ATL VS LCK TI SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
976-150,SUP,HCPCS C1713,,976-150  -  PLATE BN 50MM STRL ATL VS LCK TI SPNE CRV ANT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
976-152,SUP,HCPCS C1713,,976-152  -  PLATE BN 52.5MM STRL ATL VS LCK TI SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
976-155,SUP,HCPCS C1713,,976-155  -  PLATE BN 55MM STRL ATL VS LCK TI SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
976-157,SUP,HCPCS C1713,,976-157  -  PLATE BN 57.5MM STRL ATL VS LCK TI SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
976-160,SUP,HCPCS C1713,,976-160  -  PLATE BN 60MM STRL ATL VS LCK TI SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
976-162,SUP,HCPCS C1713,,976-162  -  PLATE BN 62.5MM STRL ATL VS LCK TI SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
976-165,SUP,HCPCS C1713,,976-165  -  PLATE BN 65MM STRL ATL VS LCK TI SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
976-167,SUP,HCPCS C1713,,976-167  -  PLATE BN 67.5MM STRL ATL VS LCK TI SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
976-170,SUP,HCPCS C1713,,976-170  -  PLATE BN 70MM STRL ATL VS LCK TI SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
976-172,SUP,HCPCS C1713,,976-172  -  PLATE BN 72.5MM STRL ATL VS LCK TI SPNE CRV ANT,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
976-175,SUP,HCPCS C1713,,976-175  -  PLATE BN 75MM STRL ATL VS LCK TI SPNE CRV ANT,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
976-177,SUP,HCPCS C1713,,976-177  -  PLATE BN 77.5MM STRL ATL VS LCK TI SPNE CRV ANT,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
976-180,SUP,HCPCS C1713,,976-180  -  PLATE BN 80MM STRL ATL VS LCK TI SPNE CRV ANT,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
976-182,SUP,HCPCS C1713,,976-182  -  PLATE BN 82.5MM STRL ATL VS LCK TI SPNE CRV ANT,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
976-185,SUP,HCPCS C1713,,976-185  -  PLATE BN 85MM STRL ATL VS LCK TI SPNE CRV ANT,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
976-187,SUP,HCPCS C1713,,976-187  -  PLATE 87.5MM TI LCK ATL VS BONE ANT CERV SPN STRL,"$4,278.00",$0.00,"$4,278.00","$1,925.10","$3,053.21",$0.00,$737.08,$0.00,$0.00,$749.04,"$4,278.00",$0.00,"$2,139.00","$3,388.18","$3,422.40",$0.00,$669.51,$0.00,$681.06,$0.00
976-190,SUP,HCPCS C1713,,976-190  -  PLATE 90MM TI ATL VS BONE ANT CERV SPN,"$4,278.00",$0.00,"$4,278.00","$1,925.10","$3,053.21",$0.00,$737.08,$0.00,$0.00,$749.04,"$4,278.00",$0.00,"$2,139.00","$3,388.18","$3,422.40",$0.00,$669.51,$0.00,$681.06,$0.00
976-195,SUP,HCPCS C1713,,976-195  -  PLATE 95MM TI LCK ATL VS BONE ANT CERV SPN STRL,"$4,278.00",$0.00,"$4,278.00","$1,925.10","$3,053.21",$0.00,$737.08,$0.00,$0.00,$749.04,"$4,278.00",$0.00,"$2,139.00","$3,388.18","$3,422.40",$0.00,$669.51,$0.00,$681.06,$0.00
976-200,SUP,HCPCS C1713,,976-200  -  PLATE 100MM TI LCK ATL VS BONE ANT CERV SPN STRL,"$4,278.00",$0.00,"$4,278.00","$1,925.10","$3,053.21",$0.00,$737.08,$0.00,$0.00,$749.04,"$4,278.00",$0.00,"$2,139.00","$3,388.18","$3,422.40",$0.00,$669.51,$0.00,$681.06,$0.00
976-205,SUP,HCPCS C1713,,976-205  -  PLATE 105MM TI LCK ATL VS BONE ANT CERV SPN STRL,"$4,278.00",$0.00,"$4,278.00","$1,925.10","$3,053.21",$0.00,$737.08,$0.00,$0.00,$749.04,"$4,278.00",$0.00,"$2,139.00","$3,388.18","$3,422.40",$0.00,$669.51,$0.00,$681.06,$0.00
976-210,SUP,HCPCS C1713,,976-210  -  PLATE 110MM TI LCK ATL VS BONE ANT CERV SPN STRL,"$4,278.00",$0.00,"$4,278.00","$1,925.10","$3,053.21",$0.00,$737.08,$0.00,$0.00,$749.04,"$4,278.00",$0.00,"$2,139.00","$3,388.18","$3,422.40",$0.00,$669.51,$0.00,$681.06,$0.00
976-612,SUP,HCPCS C1713,,976-612  -  SCREW BN 4MM 12MM STRL ATL VS FX ANG SLF DRL TI SPNE CRV ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
976-613,SUP,HCPCS C1713,,976-613  -  SCREW BN 4MM 13MM STRL ATL VS FX ANG SLF DRL TI SPNE CRV ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
976-614,SUP,HCPCS C1713,,976-614  -  SCREW BN 4MM 14MM STRL ATL VS FX ANG SLF DRL TI SPNE CRV ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
976-615,SUP,HCPCS C1713,,976-615  -  SCREW BN 4MM 15MM STRL ATL VS FX ANG SLF DRL TI SPNE CRV ANT,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
976-643,SUP,HCPCS C1713,,976-643  -  SCREW BN 4.5MM 13MM STRL ATL VS FX ANG SLF DRL TI SPNE CRV,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
976-644,SUP,HCPCS C1713,,976-644  -  SCREW BN 4.5MM 14MM STRL ATL VS FX ANG SLF DRL TI SPNE CRV,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
976-645,SUP,HCPCS C1713,,976-645  -  SCREW BN 4.5MM 15MM STRL ATL VS FX ANG SLF DRL TI SPNE CRV,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
9789-,SUP,Custom 27203010,,9789-  -  SLEEVE CMPR LG KN LGTH 26- IN NS LF KDL SCD EXP ADJ CRCMF,$45.05,$0.00,$35.68,$0.00,$30.79,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00,$21.57,$35.68,$0.00,$0.00,$0.00,$0.00,$0.00,$0.00
995FR19,SUP,Custom 27803010,,995FR19  -  FREESTYLE ROOT VALVE 19 MM,"$15,330.00",$0.00,"$15,330.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$15,330.00",$0.00,"$7,665.00","$12,141.36","$12,264.00",$0.00,$0.00,$0.00,$0.00,$0.00
995FR21,SUP,Custom 27803010,,995FR21  -  FREESTYLE ROOT VALVE 21 MM,"$15,330.00",$0.00,"$15,330.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$15,330.00",$0.00,"$7,665.00","$12,141.36","$12,264.00",$0.00,$0.00,$0.00,$0.00,$0.00
995FR23,SUP,Custom 27803010,,995FR23  -  FREESTYLE ROOT VALVE 23 MM,"$15,330.00",$0.00,"$15,330.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$15,330.00",$0.00,"$7,665.00","$12,141.36","$12,264.00",$0.00,$0.00,$0.00,$0.00,$0.00
995FR25,SUP,Custom 27803010,,995FR25  -  FREESTYLE ROOT VALVE 25 MM,"$15,330.00",$0.00,"$15,330.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$15,330.00",$0.00,"$7,665.00","$12,141.36","$12,264.00",$0.00,$0.00,$0.00,$0.00,$0.00
995FR29,SUP,Custom 27803010,,995FR29  -  FREESTYLE ROOT VALVE 29 MM,"$15,330.00",$0.00,"$15,330.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$15,330.00",$0.00,"$7,665.00","$12,141.36","$12,264.00",$0.00,$0.00,$0.00,$0.00,$0.00
99-7284,SUP,HCPCS C1713,,99-7284  -  SCREW BONE 1.5MM 4MM SELF DRILL CENTRE-DRIVE TITANIUM MANDIB,$140.00,$0.00,$140.00,$63.00,$99.92,$0.00,$24.12,$0.00,$0.00,$24.51,$140.00,$0.00,$70.00,$110.88,$112.00,$0.00,$21.91,$0.00,$22.29,$0.00
999-LG,SUP,HCPCS L3702,,999-LG  -  SPLINT ORTH LG BCKL VLCR CLSR PVC KODEL POST ELB,$66.03,$0.00,$208.54,$29.71,$47.12,$11.75,$208.54,$0.00,$0.00,$11.56,$66.03,$0.00,$33.01,$52.30,$52.82,$39.62,$198.56,$0.00,$202.65,$0.00
999-MED,SUP,HCPCS L3702,,999-MED  -  SPLINT ORTH MED BCKL VLCR CLSR PVC KODEL POST ELB,$66.03,$0.00,$208.54,$29.71,$47.12,$11.75,$208.54,$0.00,$0.00,$11.56,$66.03,$0.00,$33.01,$52.30,$52.82,$39.62,$198.56,$0.00,$202.65,$0.00
9AC50,SUP,Custom 27203010,,9AC50  -  TOOL LEGEND 9CM 5MM AC,$320.88,$0.00,$320.88,$0.00,$229.01,$0.00,$0.00,$0.00,$0.00,$0.00,$320.88,$0.00,$160.44,$254.14,$256.70,$0.00,$0.00,$0.00,$0.00,$0.00
9AC60,SUP,Custom 27203010,,9AC60  -  TOOL LEGEND 9CM 6MM AC,$320.88,$0.00,$320.88,$0.00,$229.01,$0.00,$0.00,$0.00,$0.00,$0.00,$320.88,$0.00,$160.44,$254.14,$256.70,$0.00,$0.00,$0.00,$0.00,$0.00
9AC75,SUP,Custom 27203010,,9AC75  -  TOOL LEGEND 9CM 7.5MM AC,$320.88,$0.00,$320.88,$0.00,$229.01,$0.00,$0.00,$0.00,$0.00,$0.00,$320.88,$0.00,$160.44,$254.14,$256.70,$0.00,$0.00,$0.00,$0.00,$0.00
9AC90,SUP,Custom 27203010,,9AC90  -  TOOL LEGEND 9CM 9MM AC,$320.88,$0.00,$320.88,$0.00,$229.01,$0.00,$0.00,$0.00,$0.00,$0.00,$320.88,$0.00,$160.44,$254.14,$256.70,$0.00,$0.00,$0.00,$0.00,$0.00
9BA30,SUP,Custom 27203010,,9BA30  -  TOOL LEGEND 9CM 3MM BA,$333.63,$0.00,$333.63,$0.00,$238.11,$0.00,$0.00,$0.00,$0.00,$0.00,$333.63,$0.00,$166.81,$264.23,$266.90,$0.00,$0.00,$0.00,$0.00,$0.00
9BA30D,SUP,Custom 27203010,,9BA30D  -  TOOL LEGEND 9CM 3MM BA DIAM,$380.38,$0.00,$380.38,$0.00,$271.47,$0.00,$0.00,$0.00,$0.00,$0.00,$380.38,$0.00,$190.19,$301.26,$304.30,$0.00,$0.00,$0.00,$0.00,$0.00
9BA30DC,SUP,Custom 27203010,,9BA30DC  -  TOOL LEGEND 9CM 3MM BA DIAM CRS,$382.50,$0.00,$382.50,$0.00,$272.99,$0.00,$0.00,$0.00,$0.00,$0.00,$382.50,$0.00,$191.25,$302.94,$306.00,$0.00,$0.00,$0.00,$0.00,$0.00
9BA40,SUP,Custom 27203010,,9BA40  -  TOOL LEGEND 9CM 4MM BA FLUTED,$333.63,$0.00,$333.63,$0.00,$238.11,$0.00,$0.00,$0.00,$0.00,$0.00,$333.63,$0.00,$166.81,$264.23,$266.90,$0.00,$0.00,$0.00,$0.00,$0.00
9BA40D,SUP,Custom 27203010,,9BA40D  -  TOOL LEGEND 9CM 4MM BA DIAM,$380.38,$0.00,$380.38,$0.00,$271.47,$0.00,$0.00,$0.00,$0.00,$0.00,$380.38,$0.00,$190.19,$301.26,$304.30,$0.00,$0.00,$0.00,$0.00,$0.00
9BA40DC,SUP,Custom 27203010,,9BA40DC  -  TOOL LEGEND 9CM 4MM BA DIAM CRS,$382.50,$0.00,$382.50,$0.00,$272.99,$0.00,$0.00,$0.00,$0.00,$0.00,$382.50,$0.00,$191.25,$302.94,$306.00,$0.00,$0.00,$0.00,$0.00,$0.00
9BA40DX,SUP,Custom 27203010,,9BA40DX  -  TOOL LEGEND 9CM 4MM DIAM X CRS,$378.25,$0.00,$378.25,$0.00,$269.96,$0.00,$0.00,$0.00,$0.00,$0.00,$378.25,$0.00,$189.13,$299.57,$302.60,$0.00,$0.00,$0.00,$0.00,$0.00
9BA50DC,SUP,Custom 27203010,,9BA50DC  -  TOOL LEGEND 9CM 5MM BA DIAM CRS,$382.50,$0.00,$382.50,$0.00,$272.99,$0.00,$0.00,$0.00,$0.00,$0.00,$382.50,$0.00,$191.25,$302.94,$306.00,$0.00,$0.00,$0.00,$0.00,$0.00
9BA50DX,SUP,Custom 27203010,,9BA50DX  -  TOOL LEGEND 9CM 5MM DIAM X CRS,$378.25,$0.00,$378.25,$0.00,$269.96,$0.00,$0.00,$0.00,$0.00,$0.00,$378.25,$0.00,$189.13,$299.57,$302.60,$0.00,$0.00,$0.00,$0.00,$0.00
9BA60DC,SUP,Custom 27203010,,9BA60DC  -  TOOL LEGEND 9CM 6MM BA DIAM CRS,$382.50,$0.00,$382.50,$0.00,$272.99,$0.00,$0.00,$0.00,$0.00,$0.00,$382.50,$0.00,$191.25,$302.94,$306.00,$0.00,$0.00,$0.00,$0.00,$0.00
9BA60DX,SUP,Custom 27203010,,9BA60DX  -  TOOL LEGEND 9CM 6MM DIAM X CRS,$378.25,$0.00,$378.25,$0.00,$269.96,$0.00,$0.00,$0.00,$0.00,$0.00,$378.25,$0.00,$189.13,$299.57,$302.60,$0.00,$0.00,$0.00,$0.00,$0.00
9BA75D,SUP,Custom 27203010,,9BA75D  -  TOOL LEGEND 9CM 7.5MM BA DIAM,$380.38,$0.00,$380.38,$0.00,$271.47,$0.00,$0.00,$0.00,$0.00,$0.00,$380.38,$0.00,$190.19,$301.26,$304.30,$0.00,$0.00,$0.00,$0.00,$0.00
9BA90,SUP,Custom 27203010,,9BA90  -  TOOL LEGEND 9CM 9MM BA,$333.63,$0.00,$333.63,$0.00,$238.11,$0.00,$0.00,$0.00,$0.00,$0.00,$333.63,$0.00,$166.81,$264.23,$266.90,$0.00,$0.00,$0.00,$0.00,$0.00
9CY50,SUP,Custom 27203010,,9CY50  -  TOOL LEGEND 9CM 5MM CY,$308.13,$0.00,$308.13,$0.00,$219.91,$0.00,$0.00,$0.00,$0.00,$0.00,$308.13,$0.00,$154.06,$244.04,$246.50,$0.00,$0.00,$0.00,$0.00,$0.00
9CY60,SUP,Custom 27203010,,9CY60  -  TOOL LEGEND 9CM 6MM CY,$308.13,$0.00,$308.13,$0.00,$219.91,$0.00,$0.00,$0.00,$0.00,$0.00,$308.13,$0.00,$154.06,$244.04,$246.50,$0.00,$0.00,$0.00,$0.00,$0.00
9CY75,SUP,Custom 27203010,,9CY75  -  TOOL LEGEND 9CM 7.5MM CY,$308.13,$0.00,$308.13,$0.00,$219.91,$0.00,$0.00,$0.00,$0.00,$0.00,$308.13,$0.00,$154.06,$244.04,$246.50,$0.00,$0.00,$0.00,$0.00,$0.00
9HM100,SUP,Custom 27203010,,9HM100  -  TOOL LEGEND 9CM 10MM HOLE MAKER,$412.25,$0.00,$412.25,$0.00,$294.22,$0.00,$0.00,$0.00,$0.00,$0.00,$412.25,$0.00,$206.13,$326.50,$329.80,$0.00,$0.00,$0.00,$0.00,$0.00
9HM126,SUP,Custom 27203010,,9HM126  -  TOOL LEGEND 9CM 12.6MM HOLE MAKER,$412.25,$0.00,$412.25,$0.00,$294.22,$0.00,$0.00,$0.00,$0.00,$0.00,$412.25,$0.00,$206.13,$326.50,$329.80,$0.00,$0.00,$0.00,$0.00,$0.00
9HM95,SUP,Custom 27203010,,9HM95  -  TOOL LEGEND 9CM 9.5MM HOLE MAKER,$412.25,$0.00,$412.25,$0.00,$294.22,$0.00,$0.00,$0.00,$0.00,$0.00,$412.25,$0.00,$206.13,$326.50,$329.80,$0.00,$0.00,$0.00,$0.00,$0.00
9HS108,SUP,Custom 27203010,,9HS108  -  TOOL LEGEND 9CM 10.8MM ID HS,$467.50,$0.00,$467.50,$0.00,$333.65,$0.00,$0.00,$0.00,$0.00,$0.00,$467.50,$0.00,$233.75,$370.26,$374.00,$0.00,$0.00,$0.00,$0.00,$0.00
9HS135,SUP,Custom 27203010,,9HS135  -  TOOL LEGEND 9CM 13.5MM ID HS,$467.50,$0.00,$467.50,$0.00,$333.65,$0.00,$0.00,$0.00,$0.00,$0.00,$467.50,$0.00,$233.75,$370.26,$374.00,$0.00,$0.00,$0.00,$0.00,$0.00
9MH30DC,SUP,Custom 27203010,,9MH30DC  -  TOOL LEGEND 9CM 3MM MH DIAM CRS,$367.63,$0.00,$367.63,$0.00,$262.37,$0.00,$0.00,$0.00,$0.00,$0.00,$367.63,$0.00,$183.81,$291.16,$294.10,$0.00,$0.00,$0.00,$0.00,$0.00
9OV55,SUP,Custom 27203010,,9OV55  -  TOOL LEGEND 9CM 5.5MM OVAL,$323.00,$0.00,$323.00,$0.00,$230.53,$0.00,$0.00,$0.00,$0.00,$0.00,$323.00,$0.00,$161.50,$255.82,$258.40,$0.00,$0.00,$0.00,$0.00,$0.00
9SCT,SUP,Custom 27203010,,9SCT  -  TUBE TRACHEOSTOMY 12.1MM 9MM 99MM 1 CANNU CUFF LATEX FREE,$72.45,$0.00,$72.45,$0.00,$51.70,$0.00,$0.00,$0.00,$0.00,$0.00,$72.45,$0.00,$36.22,$57.38,$57.96,$0.00,$0.00,$0.00,$0.00,$0.00
9TA30,SUP,Custom 27203010,,9TA30  -  TOOL LEGEND 9CM 3MM TA,$337.88,$0.00,$337.88,$0.00,$241.14,$0.00,$0.00,$0.00,$0.00,$0.00,$337.88,$0.00,$168.94,$267.60,$270.30,$0.00,$0.00,$0.00,$0.00,$0.00
A0082,SUP,Custom 25003010,,ANTIBODY VWF 8 RBT IGG ANHMN 2ML LAB,$708.10,$0.00,$708.10,$0.00,$505.37,$0.00,$0.00,$0.00,$0.00,$0.00,$708.10,$0.00,$354.05,$560.82,$566.48,$0.00,$0.00,$0.00,$0.00,$0.00
A1-0014,SUP,HCPCS C1713,,A1-0014  -  SCREW BONE 14MM ACUTWIST,$712.50,$0.00,$712.50,$320.63,$508.51,$0.00,$122.76,$0.00,$0.00,$124.75,$712.50,$0.00,$356.25,$564.30,$570.00,$0.00,$111.51,$0.00,$113.43,$0.00
A1-0016,SUP,HCPCS C1713,,A1-0016  -  SCREW BONE 16MM ACUTWIST,$712.50,$0.00,$712.50,$320.63,$508.51,$0.00,$122.76,$0.00,$0.00,$124.75,$712.50,$0.00,$356.25,$564.30,$570.00,$0.00,$111.51,$0.00,$113.43,$0.00
A1-0020,SUP,HCPCS C1713,,A1-0020  -  SCREW BONE 20MM ACUTWIST,$712.50,$0.00,$712.50,$320.63,$508.51,$0.00,$122.76,$0.00,$0.00,$124.75,$712.50,$0.00,$356.25,$564.30,$570.00,$0.00,$111.51,$0.00,$113.43,$0.00
A1-0022,SUP,HCPCS C1713,,A1-0022  -  SCREW BONE 22MM ACUTWIST,$712.50,$0.00,$712.50,$320.63,$508.51,$0.00,$122.76,$0.00,$0.00,$124.75,$712.50,$0.00,$356.25,$564.30,$570.00,$0.00,$111.51,$0.00,$113.43,$0.00
A10230592,SUP,Custom 27803010,,A10230592  -  VALVE AORTIC 21MM EP SUP THV,"$23,350.00",$0.00,"$23,350.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$23,350.00",$0.00,"$11,675.00","$18,493.20","$18,680.00",$0.00,$0.00,$0.00,$0.00,$0.00
A10235766,SUP,Custom 27803010,,A10235766  -  VALVE MTRL 25MM 23MM EP 3 PIG LEAFLETS STNT LINX AC TCH LP,"$23,350.00",$0.00,"$23,350.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$23,350.00",$0.00,"$11,675.00","$18,493.20","$18,680.00",$0.00,$0.00,$0.00,$0.00,$0.00
A1072,SUP,Custom 27203010,,A1072  -  PIN SKL STRL MYFLD WNG GRV PLS ADLT CRNM DISP,$27.27,$0.00,$27.27,$0.00,$19.47,$0.00,$0.00,$0.00,$0.00,$0.00,$27.27,$0.00,$13.64,$21.60,$21.82,$0.00,$0.00,$0.00,$0.00,$0.00
A-1083,SUP,HCPCS C1713,,A-1083  -  PIN SKULL 13MM RED O RING SECURE FIT RIGID FIX MAYFIELD,$102.50,$0.00,$102.50,$46.13,$73.15,$0.00,$17.66,$0.00,$0.00,$17.95,$102.50,$0.00,$51.25,$81.18,$82.00,$0.00,$16.04,$0.00,$16.32,$0.00
A14208,SUP,Custom 27203010,,REAGENT FOL ACCES SYN 100 TST ANALY,$175.00,$0.00,$175.00,$0.00,$124.90,$0.00,$0.00,$0.00,$0.00,$0.00,$175.00,$0.00,$87.50,$138.60,$140.00,$0.00,$0.00,$0.00,$0.00,$0.00
A16793,SUP,Custom 27203010,,REAGENT ANALY UNCL DSL WSH BUFF 10L 800 SER,$77.50,$0.00,$77.50,$0.00,$55.31,$0.00,$0.00,$0.00,$0.00,$0.00,$77.50,$0.00,$38.75,$61.38,$62.00,$0.00,$0.00,$0.00,$0.00,$0.00
A16953,SUP,Custom 27203010,,CALIBRATOR INTC PTH UNICEL IMMUN,$382.50,$0.00,$382.50,$0.00,$272.99,$0.00,$0.00,$0.00,$0.00,$0.00,$382.50,$0.00,$191.25,$302.94,$306.00,$0.00,$0.00,$0.00,$0.00,$0.00
A16972,SUP,Custom 27203010,,REAGENT INTC PTH ACCES 100 TST ANALY NEO,$690.00,$0.00,$690.00,$0.00,$492.45,$0.00,$0.00,$0.00,$0.00,$0.00,$690.00,$0.00,$345.00,$546.48,$552.00,$0.00,$0.00,$0.00,$0.00,$0.00
A16P4,SUP,Custom 27203010,,CHEMICAL LAB ACTN POLY BTL 4L HST GRAD,$196.40,$0.00,$196.40,$0.00,$140.17,$0.00,$0.00,$0.00,$0.00,$0.00,$196.40,$0.00,$98.20,$155.55,$157.12,$0.00,$0.00,$0.00,$0.00,$0.00
A16S-4,SUP,Custom 27203010,,CHEMICAL LAB ACTN SAFETIN 4L HST GRAD,$264.35,$0.00,$264.35,$0.00,$188.67,$0.00,$0.00,$0.00,$0.00,$0.00,$264.35,$0.00,$132.18,$209.37,$211.48,$0.00,$0.00,$0.00,$0.00,$0.00
A18/20,SUP,Custom 27203010,,NEEDLE BIOP 18GA 20CM ACHV COAX AUTO PRGM SFT TIS DISP,$123.00,$0.00,$123.00,$0.00,$87.79,$0.00,$0.00,$0.00,$0.00,$0.00,$123.00,$0.00,$61.50,$97.42,$98.40,$0.00,$0.00,$0.00,$0.00,$0.00
A1815,SUP,Custom 27203010,,NEEDLE BIOP 18GA 15CM ACHV COAX AUTO PRGM SFT TIS DISP,$108.00,$0.00,$108.00,$0.00,$77.08,$0.00,$0.00,$0.00,$0.00,$0.00,$108.00,$0.00,$54.00,$85.54,$86.40,$0.00,$0.00,$0.00,$0.00,$0.00
A189,SUP,Custom 27203010,,NEEDLE BIOP 18GA 9CM ACHV COAX AUTO PRGM SFT TIS DISP,$106.95,$0.00,$106.95,$0.00,$76.33,$0.00,$0.00,$0.00,$0.00,$0.00,$106.95,$0.00,$53.48,$84.70,$85.56,$0.00,$0.00,$0.00,$0.00,$0.00
A19611,SUP,Custom 27203010,,REAGENT LI SYN INFNT 18ML 130 TST ANALY,"$1,055.00",$0.00,"$1,055.00",$0.00,$752.95,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,055.00",$0.00,$527.50,$835.56,$844.00,$0.00,$0.00,$0.00,$0.00,$0.00
A200S,SUP,Custom 27203010,,REAGENT SHTH FLUID A MLTLY BTL ANALY,$107.53,$0.00,$107.53,$0.00,$76.74,$0.00,$0.00,$0.00,$0.00,$0.00,$107.53,$0.00,$53.76,$85.16,$86.02,$0.00,$0.00,$0.00,$0.00,$0.00
A2015-020,SUP,HCPCS C1725,,A2015-020  -  CATHETER BLNDIL 1.5MM 150CM 20MM ARMADA FLXB MRKR STREAMLINE,$212.50,$0.00,$212.50,$115.39,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
A2020,SUP,Custom 27203010,,NEEDLE BIOP 20GA 20CM ACHV COAX AUTO PRGM SFT TIS DISP,$116.03,$0.00,$116.03,$0.00,$82.81,$0.00,$0.00,$0.00,$0.00,$0.00,$116.03,$0.00,$58.01,$91.90,$92.82,$0.00,$0.00,$0.00,$0.00,$0.00
A2020-200,SUP,HCPCS C1725,,A2020-200  -  CATHETER BLNDIL 2MM 150CM 200MM ARMADA FLXB MRKR STREAMLINE,$212.50,$0.00,$212.50,$115.39,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
A2030-080,SUP,HCPCS C1725,,A2030-080  -  CATHETER BLNDIL 3MM 150CM 80MM ARMADA FLXB MRKR STREAMLINE,$212.50,$0.00,$212.50,$115.39,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
A21101,SUP,Custom 27203010,,REAGENT ANA 2 A MLTLY ANALY,"$3,008.98",$0.00,"$3,008.98",$0.00,"$2,147.51",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,008.98",$0.00,"$1,504.49","$2,383.11","$2,407.18",$0.00,$0.00,$0.00,$0.00,$0.00
A2552 25,SUP,Custom 27203010,,TRAY EPDRL NRV BLCK A2552 25,$37.33,$0.00,$37.33,$0.00,$26.64,$0.00,$0.00,$0.00,$0.00,$0.00,$37.33,$0.00,$18.66,$29.57,$29.86,$0.00,$0.00,$0.00,$0.00,$0.00
A-3434,SUP,Custom 27203010,,A-3434  -  BIT DRILL 86MM AO SHAFT TWIST STOP 30MM 1.6MM 2MM SCREW,$290.00,$0.00,$290.00,$0.00,$206.97,$0.00,$0.00,$0.00,$0.00,$0.00,$290.00,$0.00,$145.00,$229.68,$232.00,$0.00,$0.00,$0.00,$0.00,$0.00
A3524,SUP,Custom 25003010,,ANTIBODY TDT RBT PLYCLN .5ML LAB,"$3,400.00",$0.00,"$3,400.00",$0.00,"$2,426.58",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,400.00",$0.00,"$1,700.00","$2,692.80","$2,720.00",$0.00,$0.00,$0.00,$0.00,$0.00
A368LL,SUP,HCPCS L1930,,A368LL  -  SPLINT ORTHOPEDIC 9-10.5 LARGE 20.5IN 7.75IN POSTERIOR LEAF,$74.98,$0.00,$74.98,$0.00,$53.51,$0.00,$0.00,$0.00,$0.00,$0.00,$74.98,$0.00,$37.49,$59.38,$59.98,$0.00,$0.00,$0.00,$0.00,$0.00
A368LM,SUP,HCPCS L1930,,A368LM  -  SPLINT ORTHOPEDIC 7-9 MEDIUM 19.5IN 7IN POSTERIOR LEAF,$74.98,$0.00,$74.98,$0.00,$53.51,$0.00,$0.00,$0.00,$0.00,$0.00,$74.98,$0.00,$37.49,$59.38,$59.98,$0.00,$0.00,$0.00,$0.00,$0.00
A368LX,SUP,HCPCS L1930,,A368LX  -  SPLINT ORTHOPEDIC 11-12.5 XL 21.5IN 8.5IN POSTERIOR LEAF,$80.58,$0.00,$80.58,$0.00,$57.51,$0.00,$0.00,$0.00,$0.00,$0.00,$80.58,$0.00,$40.29,$63.82,$64.46,$0.00,$0.00,$0.00,$0.00,$0.00
A368RL,SUP,HCPCS L1930,,A368RL  -  SPLINT ORTHOPEDIC 9-11 LARGE 20.5IN 7.75IN POSTERIOR LEAF,$74.98,$0.00,$74.98,$0.00,$53.51,$0.00,$0.00,$0.00,$0.00,$0.00,$74.98,$0.00,$37.49,$59.38,$59.98,$0.00,$0.00,$0.00,$0.00,$0.00
A368RM,SUP,HCPCS L1930,,A368RM  -  SPLINT ORTHOPEDIC 7-9 MEDIUM 19.5IN 7IN POSTERIOR LEAF,$74.98,$0.00,$74.98,$0.00,$53.51,$0.00,$0.00,$0.00,$0.00,$0.00,$74.98,$0.00,$37.49,$59.38,$59.98,$0.00,$0.00,$0.00,$0.00,$0.00
A368RX,SUP,HCPCS L1930,,A368RX  -  SPLINT ORTHOPEDIC 11-12.5 XL 21.5IN 8.5IN POSTERIOR LEAF,$80.58,$0.00,$80.58,$0.00,$57.51,$0.00,$0.00,$0.00,$0.00,$0.00,$80.58,$0.00,$40.29,$63.82,$64.46,$0.00,$0.00,$0.00,$0.00,$0.00
A38-212,SUP,Custom 27203010,,CHEMICAL GLAC ACETCID 2.5L GLS BTL ACS GRAD LAB,$267.70,$0.00,$267.70,$0.00,$191.06,$0.00,$0.00,$0.00,$0.00,$0.00,$267.70,$0.00,$133.85,$212.02,$214.16,$0.00,$0.00,$0.00,$0.00,$0.00
A390014,SUP,HCPCS C1713,,A390014  -  WASHER ORTH 8MM 4MM,$35.70,$0.00,$35.70,$16.07,$25.48,$0.00,$6.15,$0.00,$0.00,$6.25,$35.70,$0.00,$17.85,$28.27,$28.56,$0.00,$5.59,$0.00,$5.68,$0.00
A3SR01,SUP,HCPCS C1786,,A3SR01  -  PACEMAKER CRD ADVISA SR MR SURESCAN 1 CHMBR UNPLR,"$7,750.00",$0.00,"$7,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,750.00",$0.00,"$3,875.00","$6,138.00","$6,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
A-4300.01,SUP,HCPCS C1713,,A-4300.01  -  PLATE BN STRG 18MMX.6MM APTUS 4 HL FX TI HND 1.2/1.5MM SCR,$580.13,$0.00,$580.13,$261.06,$414.04,$0.00,$99.95,$0.00,$0.00,$101.58,$580.13,$0.00,$290.06,$459.46,$464.10,$0.00,$90.79,$0.00,$92.36,$0.00
A-4300.03,SUP,HCPCS C1713,,A-4300.03  -  PLATE 6 HOLE BONE,$580.13,$0.00,$580.13,$261.06,$414.04,$0.00,$99.95,$0.00,$0.00,$101.58,$580.13,$0.00,$290.06,$459.46,$464.10,$0.00,$90.79,$0.00,$92.36,$0.00
A-4300.04,SUP,HCPCS C1713,,A-4300.04  -  PLATE 1.5MM 16 HOLE STR BONE 1.2MM,$784.88,$0.00,$784.88,$353.19,$560.17,$0.00,$135.23,$0.00,$0.00,$137.43,$784.88,$0.00,$392.44,$621.62,$627.90,$0.00,$122.83,$0.00,$124.95,$0.00
A-4300.05,SUP,HCPCS C1713,,A-4300.05  -  PLATE BN CRV 69MMX.6MM APTUS 16 HL FX TI HND 1.2/1.5MM SCR,$784.88,$0.00,$784.88,$353.19,$560.17,$0.00,$135.23,$0.00,$0.00,$137.43,$784.88,$0.00,$392.44,$621.62,$627.90,$0.00,$122.83,$0.00,$124.95,$0.00
A-4300.06,SUP,HCPCS C1713,,A-4300.06  -  PLATE BN OFST 51MMX.6MM APTUS 16 HL FX TI HND 1.2/1.5MM SCR,$784.88,$0.00,$784.88,$353.19,$560.17,$0.00,$135.23,$0.00,$0.00,$137.43,$784.88,$0.00,$392.44,$621.62,$627.90,$0.00,$122.83,$0.00,$124.95,$0.00
A-4300.10,SUP,HCPCS C1713,,A-4300.10  -  PLATE BN T 27MMX.6MM APTUS 2X5 HL FX TI HND 1.2/1.5MM SCR,$690.38,$0.00,$690.38,$310.67,$492.72,$0.00,$118.95,$0.00,$0.00,$120.88,$690.38,$0.00,$345.19,$546.78,$552.30,$0.00,$108.04,$0.00,$109.91,$0.00
A-4300.11,SUP,HCPCS C1713,,A-4300.11  -  PLATE T 27X10X.6MM TI 1.2-1.5MM SCR 3X5 HOLE FIX APTUS BONE,$690.38,$0.00,$690.38,$310.67,$492.72,$0.00,$118.95,$0.00,$0.00,$120.88,$690.38,$0.00,$345.19,$546.78,$552.30,$0.00,$108.04,$0.00,$109.91,$0.00
A-4300.13,SUP,HCPCS C1713,,A-4300.13  -  PLATE BN 1.2MM 1.5MM Y 2.4 HL,$690.38,$0.00,$690.38,$310.67,$492.72,$0.00,$118.95,$0.00,$0.00,$120.88,$690.38,$0.00,$345.19,$546.78,$552.30,$0.00,$108.04,$0.00,$109.91,$0.00
A-4300.20,SUP,HCPCS C1713,,A-4300.20  -  PLATE BN 1.2MM 1.5MM L 2-3 HL LT,$690.38,$0.00,$690.38,$310.67,$492.72,$0.00,$118.95,$0.00,$0.00,$120.88,$690.38,$0.00,$345.19,$546.78,$552.30,$0.00,$108.04,$0.00,$109.91,$0.00
A-4300.21,SUP,HCPCS C1713,,A-4300.21  -  PLATE BN L RT 18MMX.6MM APTUS 2X3 HL FX TI HND 1.2/1.5MM SCR,$690.38,$0.00,$690.38,$310.67,$492.72,$0.00,$118.95,$0.00,$0.00,$120.88,$690.38,$0.00,$345.19,$546.78,$552.30,$0.00,$108.04,$0.00,$109.91,$0.00
A-4300.50,SUP,HCPCS C1713,,A-4300.50  -  PLATE BN RECT 9MMX.6MM APTUS 2X2 HL GRID FX TI HND 1.2/1.5MM,$711.38,$0.00,$711.38,$320.12,$507.71,$0.00,$122.57,$0.00,$0.00,$124.56,$711.38,$0.00,$355.69,$563.41,$569.10,$0.00,$111.33,$0.00,$113.25,$0.00
A-4300.51,SUP,HCPCS C1713,,A-4300.51  -  PLATE 1.2 MM 1.5 MM SCR LEAN MESH BONE,$711.38,$0.00,$711.38,$320.12,$507.71,$0.00,$122.57,$0.00,$0.00,$124.56,$711.38,$0.00,$355.69,$563.41,$569.10,$0.00,$111.33,$0.00,$113.25,$0.00
A-4300.54,SUP,HCPCS C1713,,A-4300.54  -  PLATE 1.2-1.5 MM SCR MESH TRP 2X2 HOLE BONE,$711.38,$0.00,$711.38,$320.12,$507.71,$0.00,$122.57,$0.00,$0.00,$124.56,$711.38,$0.00,$355.69,$563.41,$569.10,$0.00,$111.33,$0.00,$113.25,$0.00
A-4300.55,SUP,HCPCS C1713,,A-4300.55  -  PLATE BN RECT 15MMX.6MM APTUS 3X2 HL GRID FX TI HND 1.2/1.5,$771.75,$0.00,$771.75,$347.29,$550.80,$0.00,$132.97,$0.00,$0.00,$135.13,$771.75,$0.00,$385.88,$611.23,$617.40,$0.00,$120.78,$0.00,$122.86,$0.00
A-4300.56,SUP,HCPCS C1713,,A-4300.56  -  PLATE BN TRPZD,$771.75,$0.00,$771.75,$347.29,$550.80,$0.00,$132.97,$0.00,$0.00,$135.13,$771.75,$0.00,$385.88,$611.23,$617.40,$0.00,$120.78,$0.00,$122.86,$0.00
A-4300.58,SUP,HCPCS C1713,,A-4300.58  -  PLATE 1.2-1.5 MM SCR MESH TRP 3X2 HOLE BONE LEFT,$771.75,$0.00,$771.75,$347.29,$550.80,$0.00,$132.97,$0.00,$0.00,$135.13,$771.75,$0.00,$385.88,$611.23,$617.40,$0.00,$120.78,$0.00,$122.86,$0.00
A-4300.59,SUP,HCPCS C1713,,A-4300.59  -  PLATE BN TRPZD RT 17MMX.6MM APTUS 3X2 HL GRID FX TI HND,$771.75,$0.00,$771.75,$347.29,$550.80,$0.00,$132.97,$0.00,$0.00,$135.13,$771.75,$0.00,$385.88,$611.23,$617.40,$0.00,$120.78,$0.00,$122.86,$0.00
A-4300.60,SUP,HCPCS C1713,,A-4300.60  -  PLATE BN ANG LT 17MMX.6MM APTUS 3X3 HL GRID FX TI HND,$800.63,$0.00,$800.63,$360.28,$571.41,$0.00,$137.94,$0.00,$0.00,$140.18,$800.63,$0.00,$400.31,$634.10,$640.50,$0.00,$125.30,$0.00,$127.46,$0.00
A-4300.61,SUP,HCPCS C1713,,A-4300.61  -  PLATE BN ANG RT 17MMX.6MM APTUS 3X3 HL GRID FX TI HND,$800.63,$0.00,$800.63,$360.28,$571.41,$0.00,$137.94,$0.00,$0.00,$140.18,$800.63,$0.00,$400.31,$634.10,$640.50,$0.00,$125.30,$0.00,$127.46,$0.00
A-4300.62,SUP,HCPCS C1713,,A-4300.62  -  PLATE BN TRPZD 21MMX.6MM APTUS 4X2 HL GRID FX TI HND 1.2/1.5,$808.50,$0.00,$808.50,$363.83,$577.03,$0.00,$139.30,$0.00,$0.00,$141.56,$808.50,$0.00,$404.25,$640.33,$646.80,$0.00,$126.53,$0.00,$128.71,$0.00
A-4300.64,SUP,HCPCS C1713,,A-4300.64  -  PLATE BN ANG LT 20MMX.6MM APTUS 4X2 HL GRID FX TI HND,$808.50,$0.00,$808.50,$363.83,$577.03,$0.00,$139.30,$0.00,$0.00,$141.56,$808.50,$0.00,$404.25,$640.33,$646.80,$0.00,$126.53,$0.00,$128.71,$0.00
A-4300.65,SUP,HCPCS C1713,,A-4300.65  -  PLATE BN ANG RT 20MMX.6MM APTUS 4X2 HL GRID FX TI HND,$808.50,$0.00,$808.50,$363.83,$577.03,$0.00,$139.30,$0.00,$0.00,$141.56,$808.50,$0.00,$404.25,$640.33,$646.80,$0.00,$126.53,$0.00,$128.71,$0.00
A-4300.66,SUP,HCPCS C1713,,A-4300.66  -  PLATE BN ANG LT 27MMX.6MM APTUS 5X2 HL GRID FX TI HND,$808.50,$0.00,$808.50,$363.83,$577.03,$0.00,$139.30,$0.00,$0.00,$141.56,$808.50,$0.00,$404.25,$640.33,$646.80,$0.00,$126.53,$0.00,$128.71,$0.00
A-4300.67,SUP,HCPCS C1713,,A-4300.67  -  PLATE BN TRPZD 33MMX.6MM APTUS 6X2 HL GRID FX TI HND 1.2/1.5,$808.50,$0.00,$808.50,$363.83,$577.03,$0.00,$139.30,$0.00,$0.00,$141.56,$808.50,$0.00,$404.25,$640.33,$646.80,$0.00,$126.53,$0.00,$128.71,$0.00
A43102,SUP,Custom 27804086,,A43102  -  FILLER BN VOID 1ML GRFTN ALGRF PTTY JR DBM,$540.00,$0.00,$540.00,$0.00,$385.40,$0.00,$0.00,$0.00,$0.00,$0.00,$540.00,$0.00,$270.00,$427.68,$432.00,$0.00,$0.00,$0.00,$0.00,$0.00
A43103,SUP,Custom 27804086,,A43103  -  GRAFT BN 2.5ML GRFTN PTTY JR DBM,"$1,190.00",$0.00,"$1,190.00",$0.00,$849.30,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,190.00",$0.00,$595.00,$942.48,$952.00,$0.00,$0.00,$0.00,$0.00,$0.00
A433F-1GAL,SUP,Custom 27203010,,CHEMICAL METHNL 1GL F STY POLY BTL HST GRAD LAB,$147.50,$0.00,$147.50,$0.00,$105.27,$0.00,$0.00,$0.00,$0.00,$0.00,$147.50,$0.00,$73.75,$116.82,$118.00,$0.00,$0.00,$0.00,$0.00,$0.00
A433P4,SUP,Custom 27203010,,CHEMICAL METHNL 4L POLY BTL HST GRAD LAB,$67.45,$0.00,$67.45,$0.00,$48.14,$0.00,$0.00,$0.00,$0.00,$0.00,$67.45,$0.00,$33.73,$53.42,$53.96,$0.00,$0.00,$0.00,$0.00,$0.00
A-4340.11,SUP,HCPCS C1713,,A-4340.11  -  PLATE BN T OFST 35X10X.6MM APTUS 3X8 HL 2 HK CMPR TI HND,$879.38,$0.00,$879.38,$395.72,$627.61,$0.00,$151.51,$0.00,$0.00,$153.97,$879.38,$0.00,$439.69,$696.47,$703.50,$0.00,$137.62,$0.00,$140.00,$0.00
A-4340.12,SUP,HCPCS C1713,,A-4340.12  -  PLATE BN T OFST 35X13X.6MM APTUS 4X8 HL CMPR TI HND 1.2/1.5,$879.38,$0.00,$879.38,$395.72,$627.61,$0.00,$151.51,$0.00,$0.00,$153.97,$879.38,$0.00,$439.69,$696.47,$703.50,$0.00,$137.62,$0.00,$140.00,$0.00
A-4340.30,SUP,HCPCS C1713,,A-4340.30  -  PLATE 30MM 1.5MM SCR 4X8 HOLE GRID ANG CMPR BONE TRPZD,$950.25,$0.00,$950.25,$427.61,$678.19,$0.00,$163.72,$0.00,$0.00,$166.38,$950.25,$0.00,$475.13,$752.60,$760.20,$0.00,$148.71,$0.00,$151.28,$0.00
A-4340.31,SUP,HCPCS C1713,,A-4340.31  -  PLATE 5 HOLE CMPR PIN BONE RIGHT,$950.25,$0.00,$950.25,$427.61,$678.19,$0.00,$163.72,$0.00,$0.00,$166.38,$950.25,$0.00,$475.13,$752.60,$760.20,$0.00,$148.71,$0.00,$151.28,$0.00
A-4340.32,SUP,HCPCS C1713,,A-4340.32  -  PLATE BN .6MM APTUS 1 HL 2 HK CMPR TI HND 1.2/1.5MM SCR,$879.38,$0.00,$879.38,$395.72,$627.61,$0.00,$151.51,$0.00,$0.00,$153.97,$879.38,$0.00,$439.69,$696.47,$703.50,$0.00,$137.62,$0.00,$140.00,$0.00
A-4350.01,SUP,HCPCS C1713,,A-4350.01  -  PLATE STR 19MMX.8MM TI 1.5MM SCR 4 HOLE APTUS TRLK BONE,"$1,141.88",$0.00,"$1,141.88",$513.84,$814.96,$0.00,$196.74,$0.00,$0.00,$199.93,"$1,141.88",$0.00,$570.94,$904.37,$913.50,$0.00,$178.70,$0.00,$181.79,$0.00
A-4350.14,SUP,HCPCS C1713,,A-4350.14  -  PLATE T 25X11X.8MM TI 1.5MM SCR 8 HOLE APTUS TRLK BONE,"$1,218.00",$0.00,"$1,218.00",$548.10,$869.29,$0.00,$209.86,$0.00,$0.00,$213.26,"$1,218.00",$0.00,$609.00,$964.66,$974.40,$0.00,$190.62,$0.00,$193.91,$0.00
A-4350.23,SUP,HCPCS C1713,,A-4350.23  -  PLATE 23X9X.8MM TI 1.5MM SCR 6 HOLE ROT APTUS TRLK BONE,"$1,241.63",$0.00,"$1,241.63",$558.73,$886.15,$0.00,$213.93,$0.00,$0.00,$217.40,"$1,241.63",$0.00,$620.81,$983.37,$993.30,$0.00,$194.31,$0.00,$197.67,$0.00
A-4350.41,SUP,HCPCS C1713,,A-4350.41  -  PLATE T 24X11X.8MM TI 1.5MM SCR 9 HOLE 2 ROW APTUS TRLK BONE,"$1,262.63",$0.00,"$1,262.63",$568.18,$901.14,$0.00,$217.54,$0.00,$0.00,$221.08,"$1,262.63",$0.00,$631.31,"$1,000.00","$1,010.10",$0.00,$197.60,$0.00,$201.01,$0.00
A-4350.50,SUP,HCPCS C1713,,A-4350.50  -  PLATE RECT 9MMX.8MM TI 1.5MM SCR 4 HOLE GRID APTUS TRLK BONE,"$1,372.88",$0.00,"$1,372.88",$617.79,$979.82,$0.00,$236.54,$0.00,$0.00,$240.38,"$1,372.88",$0.00,$686.44,"$1,087.32","$1,098.30",$0.00,$214.85,$0.00,$218.56,$0.00
A-4350.56,SUP,HCPCS C1713,,A-4350.56  -  PLATE TRPZD 15MMX.8MM TI 1.5MM SCR 6X2 HOLE GRID APTUS TRLK,"$1,420.13",$0.00,"$1,420.13",$639.06,"$1,013.54",$0.00,$244.68,$0.00,$0.00,$248.65,"$1,420.13",$0.00,$710.06,"$1,124.74","$1,136.10",$0.00,$222.25,$0.00,$226.08,$0.00
A-4350.62,SUP,HCPCS C1713,,A-4350.62  -  PLATE TRPZD 21MMX.8MM TI 1.5MM SCR 4X2 HOLE GRID APTUS TRLK,"$1,496.25",$0.00,"$1,496.25",$673.31,"$1,067.87",$0.00,$257.80,$0.00,$0.00,$261.98,"$1,496.25",$0.00,$748.13,"$1,185.03","$1,197.00",$0.00,$234.16,$0.00,$238.20,$0.00
A-4350.66,SUP,HCPCS C1713,,A-4350.66  -  PLATE TRPZD 27MMX.8MM TI 1.5MM SCR 5X2 HOLE GRID APTUS TRLK,"$1,530.38",$0.00,"$1,530.38",$688.67,"$1,092.23",$0.00,$263.68,$0.00,$0.00,$267.96,"$1,530.38",$0.00,$765.19,"$1,212.06","$1,224.30",$0.00,$239.50,$0.00,$243.64,$0.00
A-4350.80,SUP,HCPCS C1713,,A-4350.80  -  PLATE SCPHD 17MMX.8MM TI 1.5MM SCR 6 HOLE APTUS TRLK BONE,"$1,496.25",$0.00,"$1,496.25",$673.31,"$1,067.87",$0.00,$257.80,$0.00,$0.00,$261.98,"$1,496.25",$0.00,$748.13,"$1,185.03","$1,197.00",$0.00,$234.16,$0.00,$238.20,$0.00
A4502,SUP,Custom 25003010,,ANTIBODY CD117 PLYCLN RBT ANHMN .2 1ML LAB,"$1,399.23",$0.00,"$1,399.23",$0.00,$998.63,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,399.23",$0.00,$699.61,"$1,108.19","$1,119.38",$0.00,$0.00,$0.00,$0.00,$0.00
A45-10020,SUP,HCPCS C1713,,A45-10020  -  SCREW BONE 4.5/3.5MM 100MM 20MM DNFX SS CORT TPR,$335.00,$0.00,$335.00,$150.75,$239.09,$0.00,$57.72,$0.00,$0.00,$58.66,$335.00,$0.00,$167.50,$265.32,$268.00,$0.00,$52.43,$0.00,$53.33,$0.00
A-4645.01,SUP,HCPCS C1713,,A-4645.01  -  PLATE BN STRG 29MMX1.3MM APTUS 4 HL CMPR TI MTCRPL 2/2.3MM,$816.38,$0.00,$816.38,$367.37,$582.65,$0.00,$140.66,$0.00,$0.00,$142.94,$816.38,$0.00,$408.19,$646.57,$653.10,$0.00,$127.76,$0.00,$129.97,$0.00
A-4645.02,SUP,HCPCS C1713,,A-4645.02  -  PLATE BN STRG 36MMX1.3MM APTUS 5 HL CMPR TI MTCRPL 2/2.3MM,$816.38,$0.00,$816.38,$367.37,$582.65,$0.00,$140.66,$0.00,$0.00,$142.94,$816.38,$0.00,$408.19,$646.57,$653.10,$0.00,$127.76,$0.00,$129.97,$0.00
A-4645.03,SUP,HCPCS C1713,,A-4645.03  -  PLATE BN STRG 42MMX1.3MM APTUS 6 HL CMPR TI MTCRPL 2/2.3MM,$816.38,$0.00,$816.38,$367.37,$582.65,$0.00,$140.66,$0.00,$0.00,$142.94,$816.38,$0.00,$408.19,$646.57,$653.10,$0.00,$127.76,$0.00,$129.97,$0.00
A-4645.08,SUP,HCPCS C1713,,A-4645.08  -  PLATE STR 2-2.3MM SCR 8 HOLE 4 CRNR FSN CMPR APTUS BONE,$918.75,$0.00,$918.75,$413.44,$655.71,$0.00,$158.30,$0.00,$0.00,$160.87,$918.75,$0.00,$459.38,$727.65,$735.00,$0.00,$143.78,$0.00,$146.27,$0.00
A-4645.10,SUP,HCPCS C1713,,A-4645.10  -  PLATE BN T 35MMX1.3MM APTUS 2X4 HL CMPR TI MTCRPL 2/2.3MM,$737.63,$0.00,$737.63,$331.93,$526.44,$0.00,$127.09,$0.00,$0.00,$129.15,$737.63,$0.00,$368.81,$584.20,$590.10,$0.00,$115.44,$0.00,$117.43,$0.00
A-4645.16,SUP,HCPCS C1713,,A-4645.16  -  PLATE BN T 60MMX1.3MM APTUS 2X8 HL CMPR TI MTCRPL 2/2.3MM,$997.50,$0.00,$997.50,$448.88,$711.92,$0.00,$171.86,$0.00,$0.00,$174.65,$997.50,$0.00,$498.75,$790.02,$798.00,$0.00,$156.11,$0.00,$158.80,$0.00
A-4645.20,SUP,HCPCS C1713,,A-4645.20  -  PLATE BN L LT 37MMX1.3MM APTUS 2X4 HL CMPR TI MTCRPL 2/2.3MM,$737.63,$0.00,$737.63,$331.93,$526.44,$0.00,$127.09,$0.00,$0.00,$129.15,$737.63,$0.00,$368.81,$584.20,$590.10,$0.00,$115.44,$0.00,$117.43,$0.00
A-4645.21,SUP,HCPCS C1713,,A-4645.21  -  PLATE BN L RT 37MMX1.3MM APTUS 2X4 HL CMPR TI MTCRPL 2/2.3MM,$737.63,$0.00,$737.63,$331.93,$526.44,$0.00,$127.09,$0.00,$0.00,$129.15,$737.63,$0.00,$368.81,$584.20,$590.10,$0.00,$115.44,$0.00,$117.43,$0.00
A-4645.22,SUP,HCPCS C1713,,A-4645.22  -  PLATE BN L LT 63MMX1.3MM APTUS 2X8 HL CMPR TI MTCRPL 2/2.3MM,$997.50,$0.00,$997.50,$448.88,$711.92,$0.00,$171.86,$0.00,$0.00,$174.65,$997.50,$0.00,$498.75,$790.02,$798.00,$0.00,$156.11,$0.00,$158.80,$0.00
A-4645.23,SUP,HCPCS C1713,,A-4645.23  -  PLATE RIGHT ANG 63MMX1.3MM 2-2.3MM SCR 2X8 HOLE CMPR BAR,$997.50,$0.00,$997.50,$448.88,$711.92,$0.00,$171.86,$0.00,$0.00,$174.65,$997.50,$0.00,$498.75,$790.02,$798.00,$0.00,$156.11,$0.00,$158.80,$0.00
A-4650.03,SUP,HCPCS C1713,,A-4650.03  -  PLATE BN STRG 33MMX1MM APTUS TRLK 6 HL TI HND 2/2.3MM SCR,"$1,186.50",$0.00,"$1,186.50",$533.93,$846.81,$0.00,$204.43,$0.00,$0.00,$207.75,"$1,186.50",$0.00,$593.25,$939.71,$949.20,$0.00,$185.69,$0.00,$188.89,$0.00
A-4650.10,SUP,HCPCS C1713,,A-4650.10  -  PLATE BN T 29MMX1MM APTUS TRLK 2X4 HL TI HND 2/2.3MM SCR,"$1,228.50",$0.00,"$1,228.50",$552.83,$876.78,$0.00,$211.66,$0.00,$0.00,$215.10,"$1,228.50",$0.00,$614.25,$972.97,$982.80,$0.00,$192.26,$0.00,$195.58,$0.00
A-4650.11,SUP,HCPCS C1713,,A-4650.11  -  PLATE BN T 29X13X1MM APTUS TRLK 3X4 HL TI HND 2/2.3MM SCR,"$1,286.25",$0.00,"$1,286.25",$578.81,$918.00,$0.00,$221.61,$0.00,$0.00,$225.21,"$1,286.25",$0.00,$643.13,"$1,018.71","$1,029.00",$0.00,$201.30,$0.00,$204.77,$0.00
A-4650.13,SUP,HCPCS C1713,,A-4650.13  -  PLATE BN Y 35MMX1MM APTUS TRLK 2X5 HL TI HND 2/2.3MM SCR,"$1,265.25",$0.00,"$1,265.25",$569.36,$903.01,$0.00,$218.00,$0.00,$0.00,$221.54,"$1,265.25",$0.00,$632.63,"$1,002.08","$1,012.20",$0.00,$198.01,$0.00,$201.43,$0.00
A-4650.20,SUP,HCPCS C1713,,A-4650.20  -  PLATE 20MM 2MM SCR 4 HOLE L LCK GRID CMPR BONE TRPZD,"$1,218.00",$0.00,"$1,218.00",$548.10,$869.29,$0.00,$209.86,$0.00,$0.00,$213.26,"$1,218.00",$0.00,$609.00,$964.66,$974.40,$0.00,$190.62,$0.00,$193.91,$0.00
A-4650.21,SUP,HCPCS C1713,,A-4650.21  -  PLATE BN L RT 32MMX1MM APTUS TRLK 2X4 HL TI HND 2/2.3MM SCR,"$1,218.00",$0.00,"$1,218.00",$548.10,$869.29,$0.00,$209.86,$0.00,$0.00,$213.26,"$1,218.00",$0.00,$609.00,$964.66,$974.40,$0.00,$190.62,$0.00,$193.91,$0.00
A-4650.51,SUP,HCPCS C1713,,A-4650.51  -  PLATE BN RECT 13MMX1MM APTUS TRLK 2X2 HL GRID TI HND 2/2.3MM,"$1,428.00",$0.00,"$1,428.00",$642.60,"$1,019.16",$0.00,$246.04,$0.00,$0.00,$250.03,"$1,428.00",$0.00,$714.00,"$1,130.98","$1,142.40",$0.00,$223.48,$0.00,$227.34,$0.00
A-4650.56,SUP,HCPCS C1713,,A-4650.56  -  PLATE 56MM 2MM SCR 6 HOLE LCK GRID CMPR BONE TRPZD,"$1,475.25",$0.00,"$1,475.25",$663.86,"$1,052.89",$0.00,$254.18,$0.00,$0.00,$258.30,"$1,475.25",$0.00,$737.63,"$1,168.40","$1,180.20",$0.00,$230.88,$0.00,$234.86,$0.00
A-4650.58,SUP,HCPCS C1713,,A-4650.58  -  PLATE 2 MM 2.3 MM SCR 3X2 HOLE LCK GRID BONE TRPZD LEFT,"$1,556.63",$0.00,"$1,556.63",$700.48,"$1,110.96",$0.00,$268.20,$0.00,$0.00,$272.55,"$1,556.63",$0.00,$778.31,"$1,232.85","$1,245.30",$0.00,$243.61,$0.00,$247.81,$0.00
A-4650.59,SUP,HCPCS C1713,,A-4650.59  -  PLATE BN TRPZD RT 23MMX1MM APTUS TRLK 3X2 HL GRID TI HND,"$1,556.63",$0.00,"$1,556.63",$700.48,"$1,110.96",$0.00,$268.20,$0.00,$0.00,$272.55,"$1,556.63",$0.00,$778.31,"$1,232.85","$1,245.30",$0.00,$243.61,$0.00,$247.81,$0.00
A-4650.62,SUP,HCPCS C1713,,A-4650.62  -  PLATE BN TRPZD 29MMX1MM APTUS TRLK 4X2 HL GRID TI HND 2/2.3,"$1,556.63",$0.00,"$1,556.63",$700.48,"$1,110.96",$0.00,$268.20,$0.00,$0.00,$272.55,"$1,556.63",$0.00,$778.31,"$1,232.85","$1,245.30",$0.00,$243.61,$0.00,$247.81,$0.00
A-4650.67,SUP,HCPCS C1713,,A-4650.67  -  PLATE BN TRPZD 45MMX1MM APTUS TRLK 6X2 HL GRID TI HND 2/2.3,"$1,622.25",$0.00,"$1,622.25",$730.01,"$1,157.80",$0.00,$279.51,$0.00,$0.00,$284.04,"$1,622.25",$0.00,$811.13,"$1,284.82","$1,297.80",$0.00,$253.88,$0.00,$258.26,$0.00
A-4655.01,SUP,HCPCS C1713,,A-4655.01  -  PLATE STR 27MMX1.3MM TI 2-2.3MM SCR 4 HOLE LCK GRID APTUS,"$1,572.50",$0.00,"$1,572.50",$707.63,"$1,122.29",$0.00,$270.93,$0.00,$0.00,$275.33,"$1,572.50",$0.00,$786.25,"$1,245.42","$1,258.00",$0.00,$246.10,$0.00,$250.34,$0.00
A-4655.02,SUP,HCPCS C1713,,A-4655.02  -  PLATE STR 32MMX1.3MM TI 2-2.3MM SCR 5 HOLE LCK GRID APTUS,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
A-4655.03,SUP,HCPCS C1713,,A-4655.03  -  PLATE STR 38MMX1.3MM TI 2-2.3MM SCR 6 HOLE LCK GRID APTUS,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
A-4655.08,SUP,HCPCS C1713,,A-4655.08  -  PLATE 1.3MM 2MM 2.3MM SCR 8 HOLE LCK CVD BONE TRPZD,"$1,922.50",$0.00,"$1,922.50",$865.13,"$1,372.09",$0.00,$331.24,$0.00,$0.00,$336.61,"$1,922.50",$0.00,$961.25,"$1,522.62","$1,538.00",$0.00,$300.87,$0.00,$306.06,$0.00
A-4655.10,SUP,HCPCS C1713,,A-4655.10  -  PLATE 1.3MM 2MM 2.3MM SCR 2-4 HOLE T LCK BONE TRPZD,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
A-4655.16,SUP,HCPCS C1713,,A-4655.16  -  PLATE T 56MMX1.3MM TI 2-2.3MM SCR 2X8 HOLE LCK GRID APTUS,"$1,922.50",$0.00,"$1,922.50",$865.13,"$1,372.09",$0.00,$331.24,$0.00,$0.00,$336.61,"$1,922.50",$0.00,$961.25,"$1,522.62","$1,538.00",$0.00,$300.87,$0.00,$306.06,$0.00
A-4655.20,SUP,HCPCS C1713,,A-4655.20  -  PLATE L LEFT ANG 35MMX1.3MM TI 2-2.3MM SCR 2X6 HOLE LCK GRID,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
A-4655.21,SUP,HCPCS C1713,,A-4655.21  -  PLATE L RIGHT ANG 35MMX1.3MM TI 2-2.3MM SCR 4 HOLE LCK GRID,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
A-4655.22,SUP,HCPCS C1713,,A-4655.22  -  PLATE L LEFT ANG 58MMX1.3MM TI 2-2.3MM SCR 2X8 HOLE LCK GRID,"$1,922.50",$0.00,"$1,922.50",$865.13,"$1,372.09",$0.00,$331.24,$0.00,$0.00,$336.61,"$1,922.50",$0.00,$961.25,"$1,522.62","$1,538.00",$0.00,$300.87,$0.00,$306.06,$0.00
A-4655.23,SUP,HCPCS C1713,,A-4655.23  -  PLATE L RIGHT ANG 58MMX1.3MM TI 2-2.3MM SCR 10 HOLE LCK GRID,"$1,922.50",$0.00,"$1,922.50",$865.13,"$1,372.09",$0.00,$331.24,$0.00,$0.00,$336.61,"$1,922.50",$0.00,$961.25,"$1,522.62","$1,538.00",$0.00,$300.87,$0.00,$306.06,$0.00
A-4655.51,SUP,HCPCS C1713,,A-4655.51  -  PLATE 1.3MM 2MM 2.3MM SCR 2X2 HOLE LCK GRID SQ BONE TRPZD,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
A-4655.56,SUP,HCPCS C1713,,A-4655.56  -  PLATE 3X2 HOLE MESH LCK TRP BONE,"$1,875.00",$0.00,"$1,875.00",$843.75,"$1,338.19",$0.00,$323.05,$0.00,$0.00,$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
A-4655.62,SUP,HCPCS C1713,,A-4655.62  -  PLATE 1.3MM 2MM 2.3MM SCR 4X2 HOLE T LCK GRID BONE TRPZD,"$1,970.00",$0.00,"$1,970.00",$886.50,"$1,405.99",$0.00,$339.42,$0.00,$0.00,$344.93,"$1,970.00",$0.00,$985.00,"$1,560.24","$1,576.00",$0.00,$308.31,$0.00,$313.62,$0.00
A-4655.66,SUP,HCPCS C1713,,A-4655.66  -  PLATE TRPZD 42MMX1.3MM TI 2-2.3MM SCR 5X2 HOLE LCK GRID,"$2,057.50",$0.00,"$2,057.50",$925.88,"$1,468.44",$0.00,$354.50,$0.00,$0.00,$360.25,"$2,057.50",$0.00,"$1,028.75","$1,629.54","$1,646.00",$0.00,$322.00,$0.00,$327.55,$0.00
A-5040.21/1,SUP,Custom 27203010,,A-5040.21/1  -  WIRE FX 1.2MM 150MM NS KRSH APTUS TROC TIP SS,$75.00,$0.00,$75.00,$0.00,$53.53,$0.00,$0.00,$0.00,$0.00,$0.00,$75.00,$0.00,$37.50,$59.40,$60.00,$0.00,$0.00,$0.00,$0.00,$0.00
A-5100.04/1,SUP,HCPCS C1713,,A-5100.04/1  -  SCREW 4MM 1.2MM 4MM HEAD CORT BONE,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5100.05/1,SUP,HCPCS C1713,,A-5100.05/1  -  SCREW BONE 1.2MM 5MM CORT 4 HNDL,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5100.06/1,SUP,HCPCS C1713,,A-5100.06/1  -  SCREW BONE 1.2MM 6MM CORT 4 HNDL,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5100.07/1,SUP,HCPCS C1713,,A-5100.07/1  -  SCREW BONE 1.2MM 7MM APTUS TI 4MM HEAD CORTEX HAND HEXADRIVE,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5100.08/1,SUP,HCPCS C1713,,A-5100.08/1  -  SCREW BONE 1.2MM 08MM CORT HD4 1-PKG,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5100.09/1,SUP,HCPCS C1713,,A-5100.09/1  -  SCREW BONE 1.2MM 9MM CORT 4 HNDL,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5100.10/1,SUP,HCPCS C1713,,A-5100.10/1  -  SCREW BONE 10MM 1.2MM 4MM HEAD CORT,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5100.12/1,SUP,HCPCS C1713,,A-5100.12/1  -  SCREW BONE 1.2MM 12MM 4MM HEAD CORTEX HAND HEXADRIVE 4,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5100.14/1,SUP,HCPCS C1713,,A-5100.14/1  -  SCREW BONE 1.2MM 14MM CORT 4 HNDL,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5100.16/1,SUP,HCPCS C1713,,A-5100.16/1  -  SCREW BONE 1.2MM 16MM CORT 4 HNDL,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5200.04/1,SUP,HCPCS C1713,,A-5200.04/1  -  SCREW BONE 1.5MM 4MM CORT 4 HNDL,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5200.05/1,SUP,HCPCS C1713,,A-5200.05/1  -  SCREW BONE 1.5MM 5MM CORT 4 HNDL,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5200.06,SUP,HCPCS C1713,,A-5200.06  -  SCREW BONE 6MM 1.5MM CORTICAL,$218.50,$0.00,$218.50,$98.33,$155.94,$0.00,$37.65,$0.00,$0.00,$38.26,$218.50,$0.00,$109.25,$173.05,$174.80,$0.00,$34.20,$0.00,$34.79,$0.00
A-5200.06/1,SUP,HCPCS C1713,,A-5200.06/1  -  SCREW BONE 1.5MM 6MM APTUS TI HAND CORT HEXADRIVE 4,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5200.07/1,SUP,HCPCS C1713,,A-5200.07/1  -  SCREW BONE 1.5MM 7MM APTUS TI HAND CORT HEXADRIVE 4,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5200.08,SUP,HCPCS C1713,,A-5200.08  -  SCREW BONE 8MM HEXADRIVE 4 APTUS TITANIUM 1.5MM CORTICAL,$218.50,$0.00,$218.50,$98.33,$155.94,$0.00,$37.65,$0.00,$0.00,$38.26,$218.50,$0.00,$109.25,$173.05,$174.80,$0.00,$34.20,$0.00,$34.79,$0.00
A-5200.08/1,SUP,HCPCS C1713,,A-5200.08/1  -  SCREW BONE 1.5MM 8MM APTUS TI CORTEX HAND GRN,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5200.09/1,SUP,HCPCS C1713,,A-5200.09/1  -  SCREW BONE 1.5MM 9MM APTUS TI HAND CORT HEXADRIVE 4,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5200.10,SUP,HCPCS C1713,,A-5200.10  -  SCREW BONE 10MM WASHER TWIST DRILL HEXADRIVE 4 APTUS GREEN,$218.50,$0.00,$218.50,$98.33,$155.94,$0.00,$37.65,$0.00,$0.00,$38.26,$218.50,$0.00,$109.25,$173.05,$174.80,$0.00,$34.20,$0.00,$34.79,$0.00
A-5200.10/1,SUP,HCPCS C1713,,A-5200.10/1  -  SCREW BONE 1.5MM 10MM APTUS TI HAND CORT HEXADRIVE 4,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5200.11/1,SUP,HCPCS C1713,,A-5200.11/1  -  SCREW BONE 1.5MM 11MM APTUS TI 4MM HEAD CORTEX ELB HAND,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5200.12/1,SUP,HCPCS C1713,,A-5200.12/1  -  SCREW BONE 1.5MM 12MM APTUS TI 4MM HEAD CORTEX HAND 4,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5200.13/1,SUP,HCPCS C1713,,A-5200.13/1  -  SCREW BONE 1.5MM 13MM APTUS TI 4MM HEAD CORTEX ELB HAND,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5200.14/1,SUP,HCPCS C1713,,A-5200.14/1  -  SCREW BONE 1.5MM 14MM APTUS TI HAND CORT HEXADRIVE 4,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5200.15/1,SUP,HCPCS C1713,,A-5200.15/1  -  SCREW BONE 1.5MM 15MM APTUS TI CORTEX HAND HEXADRIVE 4,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5200.16/1,SUP,HCPCS C1713,,A-5200.16/1  -  SCREW BN 1.5MM 16MM 4 HNDL CORT,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5200.17/1,SUP,HCPCS C1713,,A-5200.17/1  -  SCREW BN 1.5MM 17MM 4 HNDL CORT,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5200.18/1,SUP,HCPCS C1713,,A-5200.18/1  -  SCREW BONE 1.5MM 18MM CORT 4 HNDL,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5200.19/1,SUP,HCPCS C1713,,A-5200.19/1  -  SCREW BONE 1.5MM 19MM APTUS CORT,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5200.20/1,SUP,HCPCS C1713,,A-5200.20/1  -  SCREW BONE 1.5MM 20MM CORT 4 HNDL,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5200.21/1,SUP,HCPCS C1713,,A-5200.21/1  -  SCREW BONE 1.5MM 21MM CORT 4 HNDL,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5200.22/1,SUP,HCPCS C1713,,A-5200.22/1  -  SCREW BONE 1.5MM 22MM APTUS CORT,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5200.23/1,SUP,HCPCS C1713,,A-5200.23/1  -  SCREW BN 1.5MM 23MM APTUS CORT,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5200.24/1,SUP,HCPCS C1713,,A-5200.24/1  -  SCREW BONE 1.5MM 24MM APTUS TI CORTEX HAND HEXADRIVE 4,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5250.04/1,SUP,HCPCS C1713,,A-5250.04/1  -  SCREW BONE 1.5MM 4MM APTUS TRLK TI PHLNG HAND HEXADRIVE 4,$337.50,$0.00,$337.50,$151.88,$240.87,$0.00,$58.15,$0.00,$0.00,$59.09,$337.50,$0.00,$168.75,$267.30,$270.00,$0.00,$52.82,$0.00,$53.73,$0.00
A-5250.05/1,SUP,HCPCS C1713,,A-5250.05/1  -  SCREW BONE 1.5MM 5MM APTUS TRLK TI PHLNG HAND HEXADRIVE 4,$337.50,$0.00,$337.50,$151.88,$240.87,$0.00,$58.15,$0.00,$0.00,$59.09,$337.50,$0.00,$168.75,$267.30,$270.00,$0.00,$52.82,$0.00,$53.73,$0.00
A-5250.06/1,SUP,HCPCS C1713,,A-5250.06/1  -  SCREW BONE 1.5MM 6MM APTUS TRLK TI PHLNG HAND HEXADRIVE 4,$337.50,$0.00,$337.50,$151.88,$240.87,$0.00,$58.15,$0.00,$0.00,$59.09,$337.50,$0.00,$168.75,$267.30,$270.00,$0.00,$52.82,$0.00,$53.73,$0.00
A-5250.07,SUP,HCPCS C1713,,A-5250.07  -  SCREW BONE 7MM 2 THREADED HEXADRIVE 4 OPTIMAL SELF RETAINING,$218.50,$0.00,$218.50,$98.33,$155.94,$0.00,$37.65,$0.00,$0.00,$38.26,$218.50,$0.00,$109.25,$173.05,$174.80,$0.00,$34.20,$0.00,$34.79,$0.00
A-5250.07/1,SUP,HCPCS C1713,,A-5250.07/1  -  SCREW BONE 1.5MM 7MM APTUS TRLK TI PHLNG HAND HEXADRIVE 4,$337.50,$0.00,$337.50,$151.88,$240.87,$0.00,$58.15,$0.00,$0.00,$59.09,$337.50,$0.00,$168.75,$267.30,$270.00,$0.00,$52.82,$0.00,$53.73,$0.00
A-5250.08,SUP,HCPCS C1713,,A-5250.08  -  SCREW BONE 8MM 2 THREAD HEXADRIVE 4 ATRAUMATIC TIP LOCKING,$305.00,$0.00,$305.00,$137.25,$217.68,$0.00,$52.55,$0.00,$0.00,$53.40,$305.00,$0.00,$152.50,$241.56,$244.00,$0.00,$47.73,$0.00,$48.56,$0.00
A-5250.08/1,SUP,HCPCS C1713,,A-5250.08/1  -  SCREW BONE 1.5MM 8MM APTUS TRLK TI PHLNG HAND HEXADRIVE 4,$337.50,$0.00,$337.50,$151.88,$240.87,$0.00,$58.15,$0.00,$0.00,$59.09,$337.50,$0.00,$168.75,$267.30,$270.00,$0.00,$52.82,$0.00,$53.73,$0.00
A-5250.09/1,SUP,HCPCS C1713,,A-5250.09/1  -  SCREW BONE 1.5MM 9MM APTUS TRLK TI PHLNG HAND HEXADRIVE 4,$337.50,$0.00,$337.50,$151.88,$240.87,$0.00,$58.15,$0.00,$0.00,$59.09,$337.50,$0.00,$168.75,$267.30,$270.00,$0.00,$52.82,$0.00,$53.73,$0.00
A-5250.10/1,SUP,HCPCS C1713,,A-5250.10/1  -  SCREW BONE 1.5MM 10MM APTUS TRLK TI PHLNG HAND HEXADRIVE 4,$337.50,$0.00,$337.50,$151.88,$240.87,$0.00,$58.15,$0.00,$0.00,$59.09,$337.50,$0.00,$168.75,$267.30,$270.00,$0.00,$52.82,$0.00,$53.73,$0.00
A-5250.11/1,SUP,HCPCS C1713,,A-5250.11/1  -  SCREW BONE 1.5MM 11MM APTUS TRLK TI PHLNG HAND HEXADRIVE 4,$337.50,$0.00,$337.50,$151.88,$240.87,$0.00,$58.15,$0.00,$0.00,$59.09,$337.50,$0.00,$168.75,$267.30,$270.00,$0.00,$52.82,$0.00,$53.73,$0.00
A-5250.12/1,SUP,HCPCS C1713,,A-5250.12/1  -  SCREW BONE 1.5MM 12MM APTUS TRLK TI PHLNG HAND HEXADRIVE 4,$337.50,$0.00,$337.50,$151.88,$240.87,$0.00,$58.15,$0.00,$0.00,$59.09,$337.50,$0.00,$168.75,$267.30,$270.00,$0.00,$52.82,$0.00,$53.73,$0.00
A-5250.13/1,SUP,HCPCS C1713,,A-5250.13/1  -  SCREW BONE 1.5MM 13MM APTUS TRLK TI PHLNG HAND HEXADRIVE 4,$337.50,$0.00,$337.50,$151.88,$240.87,$0.00,$58.15,$0.00,$0.00,$59.09,$337.50,$0.00,$168.75,$267.30,$270.00,$0.00,$52.82,$0.00,$53.73,$0.00
A-5250-11,SUP,HCPCS C1713,,A-5250-11  -  SCREW BONE 11MM LOCK 1.5MM CORTICAL,$355.00,$0.00,$355.00,$159.75,$253.36,$0.00,$61.16,$0.00,$0.00,$62.16,$355.00,$0.00,$177.50,$281.16,$284.00,$0.00,$55.56,$0.00,$56.52,$0.00
A-5300.06/1,SUP,HCPCS C1713,,A-5300.06/1  -  SCREW BONE 1.8MM 6MM CORT 4 HNDL,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5300.10/1,SUP,HCPCS C1713,,A-5300.10/1  -  SCREW BONE 1.8MM 10MM APTUS TI 4MM HEAD CORTEX HAND ER,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5400.04/1,SUP,HCPCS C1713,,A-5400.04/1  -  SCREW BONE 2MM 4MM APTUS TI CORTEX HAND HEXADRIVE 6,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5400.05,SUP,HCPCS C1713,,A-5400.05  -  SCREW BONE 5MM 6MM HEAD 2MM CORTICAL,$437.00,$0.00,$437.00,$196.65,$311.89,$0.00,$75.29,$0.00,$0.00,$76.52,$437.00,$0.00,$218.50,$346.10,$349.60,$0.00,$68.39,$0.00,$69.57,$0.00
A-5400.05/1,SUP,HCPCS C1713,,A-5400.05/1  -  SCREW BONE 2MM 5MM APTUS TI CORTEX HAND HEXADRIVE 6,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5400.06/1,SUP,HCPCS C1713,,A-5400.06/1  -  SCREW BONE 2MM 6MM APTUS TI CORTEX HAND HEXADRIVE 6,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5400.07/1,SUP,HCPCS C1713,,A-5400.07/1  -  SCREW BONE 2MM 7MM APTUS TI TPR HAND WRST CORT 2 THRD,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5400.08,SUP,HCPCS C1713,,A-5400.08  -  SCREW BONE 8MM SLFTAP SELF RETAINING ATRAUMATIC TIP,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5400.08/1,SUP,HCPCS C1713,,A-5400.08/1  -  SCREW BONE 2MM 8MM APTUS TI TPR HAND ELB WRST CORT 2 THRD,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5400.09/1,SUP,HCPCS C1713,,A-5400.09/1  -  SCREW BONE 2MM 9MM APTUS TI 6MM HEAD CORTEX HAND LCK BLUE,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5400.10/1,SUP,HCPCS C1713,,A-5400.10/1  -  SCREW BONE 2MM 10MM APTUS TI 6MM HEAD CORTEX WRST ELB HAND,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5400.11,SUP,HCPCS C1713,,A-5400.11  -  SCREW BONE 11MM SLFTAP SELF RETAINING ATRAUMATIC TIP,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5400.11/1,SUP,HCPCS C1713,,A-5400.11/1  -  SCREW BONE 2MM 11MM APTUS TI CORTEX WRST ELB HAND FT 2 THRD,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5400.12,SUP,HCPCS C1713,,A-5400.12  -  SCREW BONE 12MM 6MM HEAD 2MM CORTICAL,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5400.12/1,SUP,HCPCS C1713,,A-5400.12/1  -  SCREW BONE 2MM 12MM APTUS TI TPR HAND ELB WRST CORT 2 THRD,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5400.13,SUP,HCPCS C1713,,A-5400.13  -  SCREW BONE 13MM 2MM CORTICAL,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5400.13/1,SUP,HCPCS C1713,,A-5400.13/1  -  SCREW BONE 2MM 13MM APTUS TI TPR HAND WRST CORT 2 THRD,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5400.14,SUP,HCPCS C1713,,A-5400.14  -  SCREW BONE 14MM SLFTAP SELF RETAINING ATRAUMATIC TIP,$218.50,$0.00,$218.50,$98.33,$155.94,$0.00,$37.65,$0.00,$0.00,$38.26,$218.50,$0.00,$109.25,$173.05,$174.80,$0.00,$34.20,$0.00,$34.79,$0.00
A-5400.14/1,SUP,HCPCS C1713,,A-5400.14/1  -  SCREW BONE 2MM 14MM APTUS TI CORTEX HAND HEXADRIVE 6,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5400.15/1,SUP,HCPCS C1713,,A-5400.15/1  -  SCREW BONE 2MM 15MM APTUS TI CORTEX HAND BLUE,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5400.16/1,SUP,HCPCS C1713,,A-5400.16/1  -  SCREW BONE 2MM 16MM CORT 6 HNDL,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5400.17,SUP,HCPCS C1713,,A-5400.17  -  SCREW BONE 17MM APTUS BLUE TITANIUM 2MM HAND CORTICAL,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5400.17/1,SUP,HCPCS C1713,,A-5400.17/1  -  SCREW BONE 2MM 17MM APTUS TI CORTEX HAND BLUE,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5400.18/1,SUP,HCPCS C1713,,A-5400.18/1  -  SCREW BONE 2MM 18MM CORT 6 HNDL,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5400.19/1,SUP,HCPCS C1713,,A-5400.19/1  -  SCREW BONE 2MM 19MM CORT 6 HNDL,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5400.20,SUP,HCPCS C1713,,A-5400.20  -  SCREW BONE 20MM 6MM HEAD 2MM CORTICAL,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5400.20/1,SUP,HCPCS C1713,,A-5400.20/1  -  SCREW BONE 2MM 20MM APTUS TRLK TI MIDFT HEXADRIVE 6,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5400.21/1,SUP,HCPCS C1713,,A-5400.21/1  -  SCREW BONE 2MM 21MM APTUS TI CORTEX HEXADRIVE 6,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5400.22/1,SUP,HCPCS C1713,,A-5400.22/1  -  SCREW BONE 2MM 22MM APTUS TI CORTEX HEXADRIVE 6,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5400.23/1,SUP,HCPCS C1713,,A-5400.23/1  -  SCREW BONE 2MM 23MM CORT 6 HNDL,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5400.24/1,SUP,HCPCS C1713,,A-5400.24/1  -  SCREW BONE 2MM 24MM CORT 6 HNDL,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5450.06/1,SUP,HCPCS C1713,,A-5450.06/1  -  SCREW BONE 2MM 6MM APTUS TRLK TI FT HAND ELB WRST CORT,$337.50,$0.00,$337.50,$151.88,$240.87,$0.00,$58.15,$0.00,$0.00,$59.09,$337.50,$0.00,$168.75,$267.30,$270.00,$0.00,$52.82,$0.00,$53.73,$0.00
A-5450.07/1,SUP,HCPCS C1713,,A-5450.07/1  -  SCREW BONE 2MM 7MM APTUS TRLK TI FT HAND WRST CORT HEXADRIVE,$337.50,$0.00,$337.50,$151.88,$240.87,$0.00,$58.15,$0.00,$0.00,$59.09,$337.50,$0.00,$168.75,$267.30,$270.00,$0.00,$52.82,$0.00,$53.73,$0.00
A-5450.08/1,SUP,HCPCS C1713,,A-5450.08/1  -  SCREW BONE 2MM 8MM APTUS TRLK TI FT HAND ELB WRST CORT,$337.50,$0.00,$337.50,$151.88,$240.87,$0.00,$58.15,$0.00,$0.00,$59.09,$337.50,$0.00,$168.75,$267.30,$270.00,$0.00,$52.82,$0.00,$53.73,$0.00
A-5450.09,SUP,HCPCS C1713,,A-5450.09  -  SCREW BONE 9MM LOCK APTUS BLUE TITANIUM 2MM HAND CORTICAL,$337.50,$0.00,$337.50,$151.88,$240.87,$0.00,$58.15,$0.00,$0.00,$59.09,$337.50,$0.00,$168.75,$267.30,$270.00,$0.00,$52.82,$0.00,$53.73,$0.00
A-5450.09/1,SUP,HCPCS C1713,,A-5450.09/1  -  SCREW BONE 2MM 9MM APTUS TI 6MM CORTEX WRST 2 THRD TRLK,$337.50,$0.00,$337.50,$151.88,$240.87,$0.00,$58.15,$0.00,$0.00,$59.09,$337.50,$0.00,$168.75,$267.30,$270.00,$0.00,$52.82,$0.00,$53.73,$0.00
A-5450.10,SUP,HCPCS C1713,,A-5450.10  -  SCREW BONE 10MM TRILOCK LOCKING TECHNOLOGY SLFTAP VAR ANG,$337.50,$0.00,$337.50,$151.88,$240.87,$0.00,$58.15,$0.00,$0.00,$59.09,$337.50,$0.00,$168.75,$267.30,$270.00,$0.00,$52.82,$0.00,$53.73,$0.00
A-5450.10/1,SUP,HCPCS C1713,,A-5450.10/1  -  SCREW BONE 2MM 10MM APTUS TI 6MM HEAD WRST ELB HAND FT 2,$337.50,$0.00,$337.50,$151.88,$240.87,$0.00,$58.15,$0.00,$0.00,$59.09,$337.50,$0.00,$168.75,$267.30,$270.00,$0.00,$52.82,$0.00,$53.73,$0.00
A-5450.11,SUP,HCPCS C1713,,A-5450.11  -  SCREW BONE 11MM LOCKING HEXADRIVE 6 APTUS TRILOCK BLUE,$337.50,$0.00,$337.50,$151.88,$240.87,$0.00,$58.15,$0.00,$0.00,$59.09,$337.50,$0.00,$168.75,$267.30,$270.00,$0.00,$52.82,$0.00,$53.73,$0.00
A-5450.11/1,SUP,HCPCS C1713,,A-5450.11/1  -  SCREW BONE 2MM 11MM APTUS TRLK TI FT HAND WRST CORT,$337.50,$0.00,$337.50,$151.88,$240.87,$0.00,$58.15,$0.00,$0.00,$59.09,$337.50,$0.00,$168.75,$267.30,$270.00,$0.00,$52.82,$0.00,$53.73,$0.00
A-5450.12,SUP,HCPCS C1713,,A-5450.12  -  SCREW BONE 12MM TRILOCK LOCKING TECHNOLOGY SLFTAP VAR ANG,$337.50,$0.00,$337.50,$151.88,$240.87,$0.00,$58.15,$0.00,$0.00,$59.09,$337.50,$0.00,$168.75,$267.30,$270.00,$0.00,$52.82,$0.00,$53.73,$0.00
A-5450.12/1,SUP,HCPCS C1713,,A-5450.12/1  -  SCREW BONE 2MM 12MM APTUS TRLK TI CORTEX FRFT MIDFT LCK,$337.50,$0.00,$337.50,$151.88,$240.87,$0.00,$58.15,$0.00,$0.00,$59.09,$337.50,$0.00,$168.75,$267.30,$270.00,$0.00,$52.82,$0.00,$53.73,$0.00
A-5450.13/1,SUP,HCPCS C1713,,A-5450.13/1  -  SCREW BONE 2MM 13MM APTUS TI 6MM HEAD CORTEX WRST ELB HAND,$337.50,$0.00,$337.50,$151.88,$240.87,$0.00,$58.15,$0.00,$0.00,$59.09,$337.50,$0.00,$168.75,$267.30,$270.00,$0.00,$52.82,$0.00,$53.73,$0.00
A-5450.14/1,SUP,HCPCS C1713,,A-5450.14/1  -  SCREW BONE 2MM 14MM APTUS TI 6MM HEAD CORTEX HAND LCK BLUE,$337.50,$0.00,$337.50,$151.88,$240.87,$0.00,$58.15,$0.00,$0.00,$59.09,$337.50,$0.00,$168.75,$267.30,$270.00,$0.00,$52.82,$0.00,$53.73,$0.00
A-5450.16,SUP,HCPCS C1713,,A-5450.16  -  SCREW BONE 16MM LOCKING HEXAGONAL DRIVE 2MM,$355.00,$0.00,$355.00,$159.75,$253.36,$0.00,$61.16,$0.00,$0.00,$62.16,$355.00,$0.00,$177.50,$281.16,$284.00,$0.00,$55.56,$0.00,$56.52,$0.00
A-5450.16/1,SUP,HCPCS C1713,,A-5450.16/1  -  SCREW BONE 2MM 16MM APTUS TRLK TI MIDFT HEXADRIVE 6,$337.50,$0.00,$337.50,$151.88,$240.87,$0.00,$58.15,$0.00,$0.00,$59.09,$337.50,$0.00,$168.75,$267.30,$270.00,$0.00,$52.82,$0.00,$53.73,$0.00
A-5450.18/1,SUP,HCPCS C1713,,A-5450.18/1  -  SCREW BONE 2MM 18MM APTUS TRLK TI FT HAND ELB WRST CORT,$337.50,$0.00,$337.50,$151.88,$240.87,$0.00,$58.15,$0.00,$0.00,$59.09,$337.50,$0.00,$168.75,$267.30,$270.00,$0.00,$52.82,$0.00,$53.73,$0.00
A-5450.20/1,SUP,HCPCS C1713,,A-5450.20/1  -  SCREW BONE 2MM 20MM APTUS TI 6MM HEAD WRST ELB HAND FT 2,$337.50,$0.00,$337.50,$151.88,$240.87,$0.00,$58.15,$0.00,$0.00,$59.09,$337.50,$0.00,$168.75,$267.30,$270.00,$0.00,$52.82,$0.00,$53.73,$0.00
A-5500.05/1,SUP,HCPCS C1713,,A-5500.05/1  -  SCREW 5MM 2.3MM 6MM HEAD CORT BONE,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5500.06/1,SUP,HCPCS C1713,,A-5500.06/1  -  SCREW BONE 2.3MM 6MM CORT 6 HNDL,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5500.07/1,SUP,HCPCS C1713,,A-5500.07/1  -  SCREW BONE 2.3MM 7MM APTUS CORT,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5500.08/1,SUP,HCPCS C1713,,A-5500.08/1  -  SCREW BONE 2.3MM 8MM APTUS TI TPR ATRM CORTEX WRST ELB HAND,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5500.09/1,SUP,HCPCS C1713,,A-5500.09/1  -  SCREW BONE 2.3MM 9MM APTUS TI TPR FT HAND CORT 2 THRD,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5500.10/1,SUP,HCPCS C1713,,A-5500.10/1  -  SCREW BONE 2.3MM 10MM APTUS TI TPR FT HAND ELB WRST CORT 2,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5500.11/1,SUP,HCPCS C1713,,A-5500.11/1  -  SCREW BONE 2.3MM 11MM APTUS TI CORTEX HAND BROWN,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5500.12/1,SUP,HCPCS C1713,,A-5500.12/1  -  SCREW BONE 2.3MM 12MM APTUS TI TPR ATRM CORTEX WRST ELB HAND,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5500.13/1,SUP,HCPCS C1713,,A-5500.13/1  -  SCREW BONE 2.3MM 13MM APTUS TI TPR FT HAND CORT 2 THRD,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5500.14/1,SUP,HCPCS C1713,,A-5500.14/1  -  SCREW BONE 2.3MM 14MM APTUS TI TPR ATRM CORTEX WRST ELB HAND,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5500.15/1,SUP,HCPCS C1713,,A-5500.15/1  -  SCREW BONE 2.3MM 15MM APTUS TI TPR FT HAND CORT 2 THRD,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5500.16/1,SUP,HCPCS C1713,,A-5500.16/1  -  SCREW BONE 2.3MM 16MM APTUS TI TPR FT HAND ELB WRST CORT 2,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5500.17/1,SUP,HCPCS C1713,,A-5500.17/1  -  SCREW BONE 2.3MM 17MM CORT 6 HNDL,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5500.18/1,SUP,HCPCS C1713,,A-5500.18/1  -  SCREW BONE 2.3MM 18MM APTUS TI TPR FT HAND CORT 2 THRD,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5500.19/1,SUP,HCPCS C1713,,A-5500.19/1  -  SCREW BONE 2.3MM 19MM CORT 6 HNDL,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5500.20/1,SUP,HCPCS C1713,,A-5500.20/1  -  SCREW BONE 2.3MM 20MM APTUS TI TPR FT HAND CORT 2 THRD,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5500.21/1,SUP,HCPCS C1713,,A-5500.21/1  -  SCREW BONE 2.3MM 21MM CORT 6 HNDL,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5500.22/1,SUP,HCPCS C1713,,A-5500.22/1  -  SCREW BONE 2.3MM 22MM CORT 6 HNDL,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5500.23/1,SUP,HCPCS C1713,,A-5500.23/1  -  SCREW BONE 2.3MM 23MM APTUS TI CORT HAND BROWN,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A-5500.24/1,SUP,HCPCS C1713,,A-5500.24/1  -  SCREW BONE 2.3MM 24MM APTUS TI TPR FT HAND CORT 2 THRD,$210.00,$0.00,$210.00,$94.50,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
A60-15030,SUP,HCPCS C1713,,A60-15030  -  SCREW BONE 6/5MM 150MM 30MM VSN 6MM SHNK CORT ANKL THRD TPR,$335.00,$0.00,$335.00,$150.75,$239.09,$0.00,$57.72,$0.00,$0.00,$58.66,$335.00,$0.00,$167.50,$265.32,$268.00,$0.00,$52.43,$0.00,$53.33,$0.00
AAE21,SUP,Custom 27203010,,AAE21  -  DST SERIES EEA 21  BX /3,"$2,445.20",$0.00,"$2,445.20",$0.00,"$1,745.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,445.20",$0.00,"$1,222.60","$1,936.60","$1,956.16",$0.00,$0.00,$0.00,$0.00,$0.00
ABS-1000,SUP,Custom 27203010,,ABS-1000  -  SYSTEM BN CMNT 3ML DLV MX ABS,$472.50,$0.00,$472.50,$0.00,$337.22,$0.00,$0.00,$0.00,$0.00,$0.00,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$0.00,$0.00,$0.00,$0.00
ABS-1000-L,SUP,Custom 27203010,,ABS-1000-L  -  SYSTEM BN CMNT LG MX DLV APL,$612.50,$0.00,$612.50,$0.00,$437.14,$0.00,$0.00,$0.00,$0.00,$0.00,$612.50,$0.00,$306.25,$485.10,$490.00,$0.00,$0.00,$0.00,$0.00,$0.00
ABS-1000-S,SUP,Custom 27203010,,ABS-1000-S  -  SYSTEM BN CMNT STRL ARTHX DLV MX SM APL,$612.50,$0.00,$612.50,$0.00,$437.14,$0.00,$0.00,$0.00,$0.00,$0.00,$612.50,$0.00,$306.25,$485.10,$490.00,$0.00,$0.00,$0.00,$0.00,$0.00
ABS-1001,SUP,Custom 27203010,,ABS-1001  -  NEEDLE EPDRL TUO OBT,$140.00,$0.00,$140.00,$0.00,$99.92,$0.00,$0.00,$0.00,$0.00,$0.00,$140.00,$0.00,$70.00,$110.88,$112.00,$0.00,$0.00,$0.00,$0.00,$0.00
ABS-1002,SUP,Custom 27203010,,ABS-1002  -  NEEDLE EPDRL STRG TUO OBT,$140.00,$0.00,$140.00,$0.00,$99.92,$0.00,$0.00,$0.00,$0.00,$0.00,$140.00,$0.00,$70.00,$110.88,$112.00,$0.00,$0.00,$0.00,$0.00,$0.00
ABS-10020,SUP,Custom 27203010,,ABS-10020  -  CENTRIFUGE BNCHTP 110V ACP HETTICH ROTOFIX 32 SWNG OUT RTR,"$10,750.00",$0.00,"$10,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$10,750.00",$0.00,"$5,375.00","$8,514.00","$8,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
ABS-10023,SUP,HCPCS C1713,,ABS-10023  -  CAP CNTRF ACP HETTICH REPL BCKT ABS-10023,$125.00,$0.00,$125.00,$56.25,$89.21,$0.00,$21.54,$0.00,$0.00,$21.89,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$19.56,$0.00,$19.90,$0.00
ABS-1003,SUP,Custom 27203010,,ABS-1003  -  SYSTEM BN CMNT FNL,$70.00,$0.00,$70.00,$0.00,$49.96,$0.00,$0.00,$0.00,$0.00,$0.00,$70.00,$0.00,$35.00,$55.44,$56.00,$0.00,$0.00,$0.00,$0.00,$0.00
ABS-10050,SUP,Custom 27203010,,ABS-10050  -  APPLICATOR SRG XLNG BLNT BVL 10CM VISCOGEL EZ TO FIL HVISC,$687.50,$0.00,$687.50,$0.00,$490.67,$0.00,$0.00,$0.00,$0.00,$0.00,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$0.00,$0.00,$0.00,$0.00
ABS-10051,SUP,Custom 27203010,,ABS-10051  -  APPLICATOR SRG XLNG BLNT BVL 3CM VSC SPRY EZ TO FIL LVISC MX,$687.50,$0.00,$687.50,$0.00,$490.67,$0.00,$0.00,$0.00,$0.00,$0.00,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$0.00,$0.00,$0.00,$0.00
ABS10055,SUP,Custom 27203010,,ABS10055  -  KIT SRG STRL TULIP GEMS CELLFRIENDLY SUPERLUERLOK ADIPOSE,$375.00,$0.00,$375.00,$0.00,$267.64,$0.00,$0.00,$0.00,$0.00,$0.00,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$0.00,$0.00,$0.00,$0.00
ABS-1007-BC,SUP,HCPCS C1762,,ABS-1007-BC  -  MATRIX TISS .75CC BIOCARTILAGE,"$1,875.00",$0.00,"$1,875.00",$0.00,"$1,338.19",$0.00,$323.05,$0.00,$0.00,$0.00,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$0.00,$0.00
ABS-1010-BC,SUP,HCPCS C1762,,ABS-1010-BC  -  FILLER BN VOID 1CC BIOCARTILAGE,"$2,450.00",$0.00,"$2,450.00",$0.00,"$1,748.57",$0.00,$422.12,$0.00,$0.00,$0.00,"$2,450.00",$0.00,"$1,225.00","$1,940.40","$1,960.00",$0.00,$383.43,$0.00,$0.00,$0.00
ABS-1102-19,SUP,HCPCS L8699,,ABS-1102-19  -  GRAFT BN 19X12MM CARTIFORM,"$15,625.00",$0.00,"$15,625.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$15,625.00",$0.00,"$7,812.50","$12,375.00","$12,500.00",$0.00,$0.00,$0.00,$0.00,$0.00
ABS-1102-25,SUP,HCPCS L8699,,ABS-1102-25  -  GRAFT BN 25X20MM CARTIFORM,"$27,500.00",$0.00,"$27,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
ABS-20000,SUP,Custom 27203010,,ABS-20000  -  NEEDLE SPNL 17GA 14.63CM 1.27CM 8 HL FENESTRATE HUB,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
ABS-2001-01,SUP,HCPCS C1713,,ABS-2001-01  -  FILLER BN VOID 1CC STIMUBLAST PTTY,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
ABS-2001-02,SUP,HCPCS C1713,,ABS-2001-02  -  FILLER BN VOID 2.5CC STIMUBLAST PTTY,"$1,100.00",$0.00,"$1,100.00",$495.00,$785.07,$0.00,$189.52,$0.00,$0.00,$192.60,"$1,100.00",$0.00,$550.00,$871.20,$880.00,$0.00,$172.15,$0.00,$175.12,$0.00
ABS-2001-05,SUP,HCPCS C1713,,ABS-2001-05  -  FILLER BN VOID 5ML STIMUBLAST PTTY RVRS PHS MED DBM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
ABS-2002-05,SUP,HCPCS C1713,,ABS-2002-05  -  FILLER BN VOID 5CC NS STIMUBLAST ARTHX GEL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
ABS-2002-10,SUP,HCPCS C1713,,ABS-2002-10  -  FILLER BN VOID 10ML STIMUBLAST GEL RVRS PHS MED DBM,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,$0.00,$0.00,$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
ABS-2003-05,SUP,HCPCS C1713,,ABS-2003-05  -  FILLER BN VOID 5ML STIMUBLAST PTTY RVRS PHS MED CANC DBM,"$2,050.00",$0.00,"$2,050.00",$922.50,"$1,463.09",$0.00,$353.20,$0.00,$0.00,$358.94,"$2,050.00",$0.00,"$1,025.00","$1,623.60","$1,640.00",$0.00,$320.83,$0.00,$326.36,$0.00
ABS-2003-10,SUP,HCPCS C1713,,ABS-2003-10  -  FILLER BN VOID 10ML STIMUBLAST PTTY RVRS PHS MED CANC DBM,"$3,237.50",$0.00,"$3,237.50","$1,456.88","$2,310.60",$0.00,$557.81,$0.00,$0.00,$566.86,"$3,237.50",$0.00,"$1,618.75","$2,564.10","$2,590.00",$0.00,$506.67,$0.00,$515.41,$0.00
ABS-2004-01,SUP,HCPCS C1713,,ABS-2004-01  -  FILLER BN VOID 1ML STIMUBLAST PTTY RVRS PHS MED CANC DBM,$525.00,$0.00,$525.00,$236.25,$374.69,$0.00,$90.45,$0.00,$0.00,$91.92,$525.00,$0.00,$262.50,$415.80,$420.00,$0.00,$82.16,$0.00,$83.58,$0.00
ABS-2004-03,SUP,HCPCS C1713,,ABS-2004-03  -  FILLER BN VOID 3ML STIMUBLAST PST RVRS PHS MED CANC DBM,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
ABS-2004-08,SUP,HCPCS C1713,,ABS-2004-08  -  FILLER BN VOID 8ML STIMUBLAST PST RVRS PHS MED CANC DBM,"$2,487.50",$0.00,"$2,487.50","$1,119.38","$1,775.33",$0.00,$428.58,$0.00,$0.00,$435.54,"$2,487.50",$0.00,"$1,243.75","$1,970.10","$1,990.00",$0.00,$389.29,$0.00,$396.01,$0.00
ABS-2009-02,SUP,HCPCS L8699,,ABS-2009-02  -  GRAFT BN 2.5CC ARTHROCELL,"$4,750.00",$0.00,"$4,750.00",$0.00,"$3,390.08",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,750.00",$0.00,"$2,375.00","$3,762.00","$3,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
ABS-2009-05,SUP,HCPCS L8699,,ABS-2009-05  -  GRAFT BN 5CC ARTHROCELL,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
ABS-21000,SUP,Custom 27203010,,ABS-21000  -  NEEDLE EPDRL 17GA 6IN TUO DLV,$62.50,$0.00,$62.50,$0.00,$44.61,$0.00,$0.00,$0.00,$0.00,$0.00,$62.50,$0.00,$31.25,$49.50,$50.00,$0.00,$0.00,$0.00,$0.00,$0.00
ABS-30001S,SUP,HCPCS L8699,,ABS-30001S  -  GRAFT SFT TIS THK 5X5CM STRL HDRT RTU REINF DRML XCLR MTRX,"$4,125.00",$0.00,"$4,125.00",$0.00,"$2,944.01",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,125.00",$0.00,"$2,062.50","$3,267.00","$3,300.00",$0.00,$0.00,$0.00,$0.00,$0.00
ABS-30002S,SUP,HCPCS L8699,,ABS-30002S  -  GRAFT SFT TIS THK 8X6CM STRL HDRT RTU REINF DRML XCLR MTRX,"$4,500.00",$0.00,"$4,500.00",$0.00,"$3,211.65",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,500.00",$0.00,"$2,250.00","$3,564.00","$3,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
ABS-4003,SUP,Custom 27203010,,ABS-4003  -  DRESSING WND 3X3IN JUMPSTART ANMC,$35.00,$0.00,$35.00,$0.00,$24.98,$0.00,$0.00,$0.00,$0.00,$0.00,$35.00,$0.00,$17.50,$27.72,$28.00,$0.00,$0.00,$0.00,$0.00,$0.00
ABS-4004,SUP,Custom 27203010,,ABS-4004  -  DRESSING WND 4X4IN JUMPSTART ANMC,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
ABS-4005,SUP,Custom 27203010,,ABS-4005  -  DRESSING WND 1.5IN 8IN JUMPSTART ANMC,$475.00,$0.00,$475.00,$0.00,$339.01,$0.00,$0.00,$0.00,$0.00,$0.00,$475.00,$0.00,$237.50,$376.20,$380.00,$0.00,$0.00,$0.00,$0.00,$0.00
ABS-4008,SUP,Custom 27203010,,ABS-4008  -  DRESSING WND 8X8IN JUMPSTART ANMC,$300.00,$0.00,$300.00,$0.00,$214.11,$0.00,$0.00,$0.00,$0.00,$0.00,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$0.00,$0.00,$0.00,$0.00
ABS-4012,SUP,Custom 27203010,,ABS-4012  -  DRESSING WND 12X12IN JUMPSTART 1 LYR DOT MTRX PTRN ANMC LSR,$562.50,$0.00,$562.50,$0.00,$401.46,$0.00,$0.00,$0.00,$0.00,$0.00,$562.50,$0.00,$281.25,$445.50,$450.00,$0.00,$0.00,$0.00,$0.00,$0.00
ABS-4025,SUP,Custom 27203010,,ABS-4025  -  DRESSING WND 2X5IN JUMPSTART ANMC,$400.00,$0.00,$400.00,$0.00,$285.48,$0.00,$0.00,$0.00,$0.00,$0.00,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$0.00,$0.00,$0.00,$0.00
ABS-4053,SUP,Custom 27203010,,ABS-4053  -  DRESSING WND 4X4IN 2X2IN JUMPSTART COMP ADH BRDR PD ANMC,$82.50,$0.00,$82.50,$0.00,$58.88,$0.00,$0.00,$0.00,$0.00,$0.00,$82.50,$0.00,$41.25,$65.34,$66.00,$0.00,$0.00,$0.00,$0.00,$0.00
ABS-4054,SUP,Custom 27203010,,ABS-4054  -  DRESSING WND 2.5IN 1IN JUMPSTART COMP ADH BRDR PD ANMC,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
ABS-4056,SUP,Custom 27203010,,ABS-4056  -  DRESSING WND 4IN 2IN JUMPSTART COMP ADH BRDR PD ANMC,$32.50,$0.00,$32.50,$0.00,$23.20,$0.00,$0.00,$0.00,$0.00,$0.00,$32.50,$0.00,$16.25,$25.74,$26.00,$0.00,$0.00,$0.00,$0.00,$0.00
ABS-4100-022,SUP,HCPCS L8699,,ABS-4100-022  -  MATRIX TISS THN 2X2CM ARTHX AMNION,"$2,375.00",$0.00,"$2,375.00",$0.00,"$1,695.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,375.00",$0.00,"$1,187.50","$1,881.00","$1,900.00",$0.00,$0.00,$0.00,$0.00,$0.00
ABS-4100-023,SUP,HCPCS L8699,,ABS-4100-023  -  MATRIX TISS THN 3X2CM ARTHX AMNION,"$2,875.00",$0.00,"$2,875.00",$0.00,"$2,051.89",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,875.00",$0.00,"$1,437.50","$2,277.00","$2,300.00",$0.00,$0.00,$0.00,$0.00,$0.00
ABS-4100-033,SUP,HCPCS L8699,,ABS-4100-033  -  MATRIX TISS THN 3X3CM AMNION,"$3,937.50",$0.00,"$3,937.50",$0.00,"$2,810.19",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,937.50",$0.00,"$1,968.75","$3,118.50","$3,150.00",$0.00,$0.00,$0.00,$0.00,$0.00
ABS-4100-044,SUP,HCPCS L8699,,ABS-4100-044  -  MATRIX TISS THN 4X4CM ARTHX AMNION,"$5,562.50",$0.00,"$5,562.50",$0.00,"$3,969.96",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,562.50",$0.00,"$2,781.25","$4,405.50","$4,450.00",$0.00,$0.00,$0.00,$0.00,$0.00
ABS-4100-046,SUP,HCPCS L8699,,ABS-4100-046  -  MATRIX TISS THN 6X4CM ALGRF AMNION,"$7,562.50",$0.00,"$7,562.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,562.50",$0.00,"$3,781.25","$5,989.50","$6,050.00",$0.00,$0.00,$0.00,$0.00,$0.00
ABS-4100-048,SUP,HCPCS L8699,,ABS-4100-048  -  MATRIX TISS THN 8X4CM ARTHX AMNION,"$9,312.50",$0.00,"$9,312.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$9,312.50",$0.00,"$4,656.25","$7,375.50","$7,450.00",$0.00,$0.00,$0.00,$0.00,$0.00
ABS-4100-077,SUP,HCPCS L8699,,ABS-4100-077  -  MATRIX TISS THN 7X7CM ARTHX AMNION,"$12,312.50",$0.00,"$12,312.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$12,312.50",$0.00,"$6,156.25","$9,751.50","$9,850.00",$0.00,$0.00,$0.00,$0.00,$0.00
ABS-4100-212,SUP,HCPCS L8699,,ABS-4100-212  -  MATRIX TISS THN 12X2CM ARTHX AMNION,"$7,562.50",$0.00,"$7,562.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,562.50",$0.00,"$3,781.25","$5,989.50","$6,050.00",$0.00,$0.00,$0.00,$0.00,$0.00
ABS-4200-022,SUP,HCPCS L8699,,ABS-4200-022  -  MATRIX TISS THK 2X2CM ALGRF AMNION,"$2,956.25",$0.00,"$2,956.25",$0.00,"$2,109.88",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,956.25",$0.00,"$1,478.13","$2,341.35","$2,365.00",$0.00,$0.00,$0.00,$0.00,$0.00
ABS-4200-023,SUP,HCPCS L8699,,ABS-4200-023  -  MATRIX TISS THK 8X3CM ARTHX AMNION,"$4,250.00",$0.00,"$4,250.00",$0.00,"$3,033.23",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,250.00",$0.00,"$2,125.00","$3,366.00","$3,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
ABS-4200-033,SUP,HCPCS L8699,,ABS-4200-033  -  MATRIX TISS THK 3X3CM ALGRF AMNION,"$6,125.00",$0.00,"$6,125.00",$0.00,"$4,371.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,125.00",$0.00,"$3,062.50","$4,851.00","$4,900.00",$0.00,$0.00,$0.00,$0.00,$0.00
ABS-4200-034,SUP,HCPCS L8699,,ABS-4200-034  -  MATRIX TISS THK 4X3CM ARTHX AMNION,"$7,000.00",$0.00,"$7,000.00",$0.00,"$4,995.90",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,000.00",$0.00,"$3,500.00","$5,544.00","$5,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
ABS-4200-036,SUP,HCPCS L8699,,ABS-4200-036  -  MATRIX TISS THK 4X3CM AMNION,"$9,250.00",$0.00,"$9,250.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$9,250.00",$0.00,"$4,625.00","$7,326.00","$7,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
ABS-4200-038,SUP,HCPCS L8699,,ABS-4200-038  -  MATRIX TISS THK 8X3CM ARTHX AMNION,"$11,000.00",$0.00,"$11,000.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,000.00",$0.00,"$5,500.00","$8,712.00","$8,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
ABS-4300-050,SUP,HCPCS L8699,,ABS-4300-050  -  MATRIX TISS .5CC ARTHX ALGRF FLW AMNION,"$2,000.00",$0.00,"$2,000.00",$0.00,"$1,427.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
ABS-4300-100,SUP,HCPCS L8699,,ABS-4300-100  -  MATRIX TISS 1CC ARTHX AMNION FLW,"$2,750.00",$0.00,"$2,750.00",$0.00,"$1,962.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
ABS-4300-200,SUP,HCPCS L8699,,ABS-4300-200  -  MATRIX TISS 2CC ARTHX AMNION FLW,"$4,500.00",$0.00,"$4,500.00",$0.00,"$3,211.65",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,500.00",$0.00,"$2,250.00","$3,564.00","$3,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
ABSTACK15,SUP,Custom 27203010,,ABSTACK15  -  DEVICE FIX 5MM 15 TACK RATCHET HANDLE PISTOL GRIP NO SHARP,$627.03,$0.00,$627.03,$0.00,$447.51,$0.00,$0.00,$0.00,$0.00,$0.00,$627.03,$0.00,$313.51,$496.61,$501.62,$0.00,$0.00,$0.00,$0.00,$0.00
ABSTACK30,SUP,Custom 27203010,,ABSTACK30  -  DEVICE FIX 5MM 30 TACK RATCHET HANDLE PISTOL GRIP NO SHARP,"$1,160.00",$0.00,"$1,160.00",$0.00,$827.89,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,160.00",$0.00,$580.00,$918.72,$928.00,$0.00,$0.00,$0.00,$0.00,$0.00
AC003,SUP,Custom 27203010,,AC003  -  SET SPNL ADPR BRMR HL MYFLD,"$2,077.78",$0.00,"$2,077.78",$0.00,"$1,482.91",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,077.78",$0.00,"$1,038.89","$1,645.60","$1,662.22",$0.00,$0.00,$0.00,$0.00,$0.00
AC018,SUP,HCPCS C1713,,AC018  -  PIN BRMR HL SKL STRL,$116.25,$0.00,$116.25,$52.31,$82.97,$0.00,$20.03,$0.00,$0.00,$20.35,$116.25,$0.00,$58.13,$92.07,$93.00,$0.00,$18.19,$0.00,$18.51,$0.00
AC020,SUP,HCPCS C1713,,AC020  -  PIN BRMR HL SKL STRL,$100.50,$0.00,$100.50,$45.23,$71.73,$0.00,$17.32,$0.00,$0.00,$17.60,$100.50,$0.00,$50.25,$79.60,$80.40,$0.00,$15.73,$0.00,$16.00,$0.00
AC3930A,SUP,Custom 27203010,,AC3930A  -  CATHETER ANGEL,"$5,625.00",$0.00,"$5,625.00",$0.00,"$4,014.56",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,625.00",$0.00,"$2,812.50","$4,455.00","$4,500.00",$0.00,$0.00,$0.00,$0.00,$0.00
ACH140,SUP,HCPCS C1760,,ACH140  -  DEVICE CLOSURE STANDARD 40MM EXCLUSION SYSTEM ATRICLIP,"$2,487.50",$0.00,"$2,487.50","$1,119.38","$1,775.33",$0.00,$428.58,$0.00,$0.00,$435.54,"$2,487.50",$0.00,"$1,243.75","$1,970.10","$1,990.00",$0.00,$389.29,$0.00,$396.01,$0.00
ACTR10,SUP,Custom 27803010,,ACTR10  -  RING CPSLR TNSN THK.15MM 10-12.3MM STRL REFORM PMMA,$492.53,$0.00,$492.53,$0.00,$351.52,$0.00,$0.00,$0.00,$0.00,$0.00,$492.53,$0.00,$246.26,$390.08,$394.02,$0.00,$0.00,$0.00,$0.00,$0.00
ACTR11,SUP,Custom 27803010,,ACTR11  -  RING CPSLR FX THK.17MM 11-13MM STRL REFORM PMMA,$492.53,$0.00,$492.53,$0.00,$351.52,$0.00,$0.00,$0.00,$0.00,$0.00,$492.53,$0.00,$246.26,$390.08,$394.02,$0.00,$0.00,$0.00,$0.00,$0.00
ACTR12,SUP,Custom 27803010,,ACTR12  -  RING CPSLR TNSN THK.2MM 12-14.5MM STRL REFORM PMMA,$492.53,$0.00,$492.53,$0.00,$351.52,$0.00,$0.00,$0.00,$0.00,$0.00,$492.53,$0.00,$246.26,$390.08,$394.02,$0.00,$0.00,$0.00,$0.00,$0.00
ACU0T0.300,SUP,HCPCS V2632,,ACU0T0.300  -  LENS IOL +30 DIOP STRL LF ACRSF ULTRASERT 1 PC FLD UV BLU,$335.00,$0.00,$335.00,$150.75,$239.09,$0.00,$57.72,$0.00,$0.00,$58.66,$335.00,$0.00,$167.50,$265.32,$268.00,$0.00,$52.43,$0.00,$53.33,$0.00
ACX2200,SUP,Custom 27203010,,NEUTRALIZER SOL GLUTEX 2 GLUT AND OPA,$13.03,$0.00,$13.03,$0.00,$9.30,$0.00,$0.00,$0.00,$0.00,$0.00,$13.03,$0.00,$6.51,$10.32,$10.42,$0.00,$0.00,$0.00,$0.00,$0.00
AD03,SUP,Custom 27203010,,AD03  -  CHUCK DRL 1000 RPM MDSRX LGN JCB PRFR DRVR,"$7,528.10",$0.00,"$7,528.10",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,528.10",$0.00,"$3,764.05","$5,962.26","$6,022.48",$0.00,$0.00,$0.00,$0.00,$0.00
AD-5230,SUP,HCPCS V2790,,AD-5230  -  GRAFT HUM TIS 3X2CM AMBIODRY2 AMNIO MEMBR DHDR STRL DISP,"$1,487.50",$0.00,"$1,487.50",$669.38,"$1,061.63",$0.00,$256.29,$0.00,$0.00,$260.45,"$1,487.50",$0.00,$743.75,"$1,178.10","$1,190.00",$0.00,$232.79,$0.00,$236.81,$0.00
ADAPTADRK2,SUP,HCPCS C2619,,ADAPTADRK2  -  PACEMAKER CARDIAC THK7.5MM 47.9X44.7MM IMPLTABLE 2 CHAMBER,"$8,525.00",$0.00,"$8,525.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,525.00",$0.00,"$4,262.50","$6,751.80","$6,820.00",$0.00,$0.00,$0.00,$0.00,$0.00
ADAPTALGDRK2,SUP,HCPCS C2619,,ADAPTALGDRK2  -  KIT PCMKR LG ADAPTA 2 CHMBR 2 LD,"$8,525.00",$0.00,"$8,525.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,525.00",$0.00,"$4,262.50","$6,751.80","$6,820.00",$0.00,$0.00,$0.00,$0.00,$0.00
ADAPTASRK2,SUP,HCPCS C2619,,ADAPTASRK2  -  PACEMAKER CARDIAC IMPLTABLE 1 CHAMBER RATE RESPONSIVE,"$6,512.50",$0.00,"$6,512.50",$0.00,"$4,647.97",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,512.50",$0.00,"$3,256.25","$5,157.90","$5,210.00",$0.00,$0.00,$0.00,$0.00,$0.00
ADDR01,SUP,HCPCS C1785,,ADDR01  -  PACEMAKER CRD 12.1CC ADAPTA DR 2 CHMBR IS-1 CNCT GNTR 27.1GM,"$6,500.00",$0.00,"$6,500.00","$2,925.00","$4,639.05",$0.00,"$1,119.92",$0.00,$0.00,"$1,138.10","$6,500.00",$0.00,"$3,250.00","$5,148.00","$5,200.00",$0.00,"$1,017.25",$0.00,"$1,034.80",$0.00
ADDRL1,SUP,HCPCS C2619,,ADDRL1  -  PACEMAKER CARDIAC THK7.5MM 45.4X52.3MM 2 CHAMBER UNIPOLAR,"$6,500.00",$0.00,"$6,500.00",$0.00,"$4,639.05",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,500.00",$0.00,"$3,250.00","$5,148.00","$5,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
ADDRS1,SUP,Custom 27203010,,ADDRS1  -  PACEMAKER CARDIAC THK7.5MM 42.9X44.7MM 2 CHAMBER UNIPOLAR,"$6,500.00",$0.00,"$6,500.00",$0.00,"$4,639.05",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,500.00",$0.00,"$3,250.00","$5,148.00","$5,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
ADP215790C,SUP,Custom 27011340,,ADP215790C  -  KIT SURG PED,$29.73,$0.00,$29.73,$0.00,$21.21,$0.00,$0.00,$0.00,$0.00,$0.00,$29.73,$0.00,$14.86,$23.55,$23.78,$0.00,$0.00,$0.00,$0.00,$0.00
ADS201844,SUP,Custom 27203010,,ADS201844  -  SEALANT HEMOSTATIC NEEDLE FREE ADAPTER FLOSEAL MATRIX 10ML,$968.25,$0.00,$766.85,$0.00,$442.94,$0.00,$0.00,$0.00,$0.00,$0.00,$620.62,$0.00,$310.31,$766.85,$496.50,$0.00,$0.00,$0.00,$0.00,$0.00
ADS201845,SUP,Custom 27203010,,ADS201845  -  SEALANT HEMOSTATIC NEEDLE FREE ADAPTER FLOSEAL MATRIX 5ML,$620.62,$0.00,$968.25,$0.00,$691.04,$0.00,$0.00,$0.00,$0.00,$0.00,$968.25,$0.00,$484.13,$491.53,$774.60,$0.00,$0.00,$0.00,$0.00,$0.00
AF02,SUP,Custom 27203010,,AF02  -  ATTCH TL FT MDSRX LGN 2.4MM F2,"$2,133.10",$0.00,"$2,133.10",$0.00,"$1,522.39",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,133.10",$0.00,"$1,066.55","$1,689.42","$1,706.48",$0.00,$0.00,$0.00,$0.00,$0.00
AF101,SUP,Custom 27011340,,AF101  -  HALTER TRC 28-38IN HALO AIRFLO SHRT HDNK VST SYS EXFIX,"$2,812.50",$0.00,"$2,812.50",$0.00,"$2,007.28",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,812.50",$0.00,"$1,406.25","$2,227.50","$2,250.00",$0.00,$0.00,$0.00,$0.00,$0.00
AF-101,SUP,Custom 27203010,,AF-101  -  HALTER TRC 28-38IN HALO AIRFLO SHRT HDNK VST SYS EXFIX,"$3,002.13",$0.00,"$3,002.13",$0.00,"$2,142.62",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,002.13",$0.00,"$1,501.06","$2,377.69","$2,401.70",$0.00,$0.00,$0.00,$0.00,$0.00
AF102,SUP,Custom 27011340,,AF102  -  HALTER TRC 30-44IN BREMER AIRFLO LG HDNK VST HALO,"$2,812.50",$0.00,"$2,812.50",$0.00,"$2,007.28",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,812.50",$0.00,"$1,406.25","$2,227.50","$2,250.00",$0.00,$0.00,$0.00,$0.00,$0.00
AF-1230,SUP,HCPCS V2790,,AF-1230  -  GRAFT SFT TIS THN 3X2CM OPQ AMBIODRY5 LTWT AMNIO MEMBR,"$1,687.50",$0.00,"$1,687.50",$759.38,"$1,204.37",$0.00,$290.75,$0.00,$0.00,$295.47,"$1,687.50",$0.00,$843.75,"$1,336.50","$1,350.00",$0.00,$264.09,$0.00,$268.65,$0.00
AFLEX100,SUP,HCPCS Q4125,,AFLEX100  -  GRAFT SFT TIS THK1.5MM 35X35MM STRL ARTHROFLEX FLEXIGRAFT,"$5,682.50",$0.00,"$5,682.50",$0.00,"$4,055.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,682.50",$0.00,"$2,841.25","$4,500.54","$4,546.00",$0.00,$0.00,$0.00,$0.00,$0.00
AFLEX101,SUP,HCPCS Q4125,,AFLEX101  -  GRAFT SFT TIS THK1.5MM 40X70MM STRL MATRACELL ARTHROFLEX,"$6,755.00",$0.00,"$6,755.00",$0.00,"$4,821.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,755.00",$0.00,"$3,377.50","$5,349.96","$5,404.00",$0.00,$0.00,$0.00,$0.00,$0.00
AFLEX103,SUP,HCPCS Q4125,,AFLEX103  -  GRAFT SFT TIS THK1.5MM 90X50MM STRL MATRACELL ARTHROFLEX,"$9,177.50",$0.00,"$9,177.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$9,177.50",$0.00,"$4,588.75","$7,268.58","$7,342.00",$0.00,$0.00,$0.00,$0.00,$0.00
AFLEX150,SUP,HCPCS Q4125,,AFLEX150  -  GRAFT SFT TIS THK1.5MM 140X15MM STRL MATRACELL ARTHROFLEX,"$5,100.00",$0.00,"$5,100.00",$0.00,"$3,639.87",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,100.00",$0.00,"$2,550.00","$4,039.20","$4,080.00",$0.00,$0.00,$0.00,$0.00,$0.00
AFLEX200,SUP,HCPCS Q4125,,AFLEX200  -  GRAFT SFT TIS THK2MM 35X35MM STRL MATRACELL ARTHROFLEX,"$7,662.50",$0.00,"$7,662.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,662.50",$0.00,"$3,831.25","$6,068.70","$6,130.00",$0.00,$0.00,$0.00,$0.00,$0.00
AFLEX201,SUP,HCPCS Q4125,,AFLEX201  -  GRAFT SFT TIS THK2MM 70X40MM STRL MATRACELL ARTHROFLEX,"$9,270.00",$0.00,"$9,270.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,$0.00,$0.00,$0.00,$0.00
AFLEX301,SUP,HCPCS Q4125,,AFLEX301  -  GRAFT SFT TIS THK3MM 70X40MM DECELLULARIZE DERM,"$9,722.50",$0.00,"$9,722.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$9,722.50",$0.00,"$4,861.25","$7,700.22","$7,778.00",$0.00,$0.00,$0.00,$0.00,$0.00
AFLEX400,SUP,HCPCS Q4125,,AFLEX400  -  GRAFT SFT TIS 40X40X1MM DECELLUARIZE DERM,"$5,227.50",$0.00,"$5,227.50",$0.00,"$3,730.87",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,227.50",$0.00,"$2,613.75","$4,140.18","$4,182.00",$0.00,$0.00,$0.00,$0.00,$0.00
AFLEX401,SUP,HCPCS Q4125,,AFLEX401  -  GRAFT SFT TIS 70X40X1MM DECELLULARIZE DERM,"$6,375.00",$0.00,"$6,375.00",$0.00,"$4,549.84",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,375.00",$0.00,"$3,187.50","$5,049.00","$5,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
AFLEX500,SUP,HCPCS Q4125,,AFLEX500  -  GRAFT SFT TIS THK.5MM 40X30MM DECELLULARIZE DERM,"$2,942.50",$0.00,"$2,942.50",$0.00,"$2,100.06",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,942.50",$0.00,"$1,471.25","$2,330.46","$2,354.00",$0.00,$0.00,$0.00,$0.00,$0.00
AG0340,SUP,HCPCS C1763,,AG0340  -  PROTECTOR NERVE 3.5MM 40MM REINFORCED WRAP AXOGUARD PIG,"$5,350.00",$0.00,"$5,350.00","$2,407.50","$3,818.30",$0.00,$921.78,$0.00,$0.00,$936.74,"$5,350.00",$0.00,"$2,675.00","$4,237.20","$4,280.00",$0.00,$837.28,$0.00,$851.72,$0.00
AG0740,SUP,HCPCS C1763,,AG0740  -  PROTECTOR TISSUE 7MM 40MM AXOGUARD PIG EXTRACELLULAR MATRIX,"$5,375.00",$0.00,"$5,375.00","$2,418.75","$3,836.14",$0.00,$926.09,$0.00,$0.00,$941.12,"$5,375.00",$0.00,"$2,687.50","$4,257.00","$4,300.00",$0.00,$841.19,$0.00,$855.70,$0.00
AG1040,SUP,HCPCS C1763,,AG1040  -  PROTECTOR NERVE 10MM 40MM MULTILAMINAR AXOGUARD,"$5,487.50",$0.00,"$5,487.50","$2,469.38","$3,916.43",$0.00,$945.47,$0.00,$0.00,$960.82,"$5,487.50",$0.00,"$2,743.75","$4,346.10","$4,390.00",$0.00,$858.79,$0.00,$873.61,$0.00
AG-2015,SUP,HCPCS V2790,,AG-2015  -  GRAFT SOFT TISSUE B THK50-100UM 2X1.5IN ALLOGRAFT,"$1,675.00",$0.00,"$1,675.00",$753.75,"$1,195.45",$0.00,$288.59,$0.00,$0.00,$293.28,"$1,675.00",$0.00,$837.50,"$1,326.60","$1,340.00",$0.00,$262.14,$0.00,$266.66,$0.00
AGX215,SUP,HCPCS C1763,,AGX215  -  CONNECTOR NERVE 2MM 15MM COAPTATION AID AXOGUARD PIG,"$3,450.00",$0.00,"$3,450.00","$1,552.50","$2,560.40",$0.00,$594.42,$0.00,$0.00,$604.07,"$3,450.00",$0.00,"$1,725.00","$2,732.40","$2,760.00",$0.00,$539.93,$0.00,$571.13,$0.00
AGX310,SUP,HCPCS C1763,,AGX310  -  CONNECTOR NERVE 3MM 10MM COAPTATION AID AXOGUARD PIG,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
AGX415,SUP,HCPCS C1763,,AGX415  -  CONNECTOR NERVE 4MM 15MM COAPTATION AID AXOGUARD PIG,"$3,450.00",$0.00,"$3,450.00","$1,552.50","$2,560.40",$0.00,$594.42,$0.00,$0.00,$604.07,"$3,450.00",$0.00,"$1,725.00","$2,732.40","$2,760.00",$0.00,$539.93,$0.00,$571.13,$0.00
AGX515,SUP,HCPCS C1763,,AGX515  -  CONNECTOR NERVE 5MM 15MM COAPTATION AID AXOGUARD PIG,"$3,450.00",$0.00,"$3,450.00","$1,552.50","$2,560.40",$0.00,$594.42,$0.00,$0.00,$604.07,"$3,450.00",$0.00,"$1,725.00","$2,732.40","$2,760.00",$0.00,$539.93,$0.00,$571.13,$0.00
AI-0010-S,SUP,HCPCS C1713,,AI-0010-S  -  SCREW BONE 10MM ACUTWIST ACTRK CALC CMPR STRL,$712.50,$0.00,$712.50,$320.63,$508.51,$0.00,$122.76,$0.00,$0.00,$124.75,$712.50,$0.00,$356.25,$564.30,$570.00,$0.00,$111.51,$0.00,$113.43,$0.00
AI-0012-S,SUP,HCPCS C1713,,AI-0012-S  -  SCREW BONE 12MM ACUTWIST SS CALC CMPR STRL,$712.50,$0.00,$712.50,$320.63,$508.51,$0.00,$122.76,$0.00,$0.00,$124.75,$712.50,$0.00,$356.25,$564.30,$570.00,$0.00,$111.51,$0.00,$113.43,$0.00
AI-0014-S,SUP,HCPCS C1713,,AI-0014-S  -  SCREW BONE 14MM ACUTWIST SS FT HAND CMPR STRL,$712.50,$0.00,$712.50,$320.63,$508.51,$0.00,$122.76,$0.00,$0.00,$124.75,$712.50,$0.00,$356.25,$564.30,$570.00,$0.00,$111.51,$0.00,$113.43,$0.00
AI-0016,SUP,HCPCS C1713,,AI-0016  -  SCREW BONE 16MM ACUTWIST TI ORTH CMPR NONSTRL,$712.50,$0.00,$712.50,$320.63,$508.51,$0.00,$122.76,$0.00,$0.00,$124.75,$712.50,$0.00,$356.25,$564.30,$570.00,$0.00,$111.51,$0.00,$113.43,$0.00
AI-0016-S,SUP,HCPCS C1713,,AI-0016-S  -  SCREW BONE 16MM ACUTWIST ACTRK CMPR STRL,$712.50,$0.00,$712.50,$320.63,$508.51,$0.00,$122.76,$0.00,$0.00,$124.75,$712.50,$0.00,$356.25,$564.30,$570.00,$0.00,$111.51,$0.00,$113.43,$0.00
AI-0018-S,SUP,HCPCS C1713,,AI-0018-S  -  SCREW BONE 18MM ACUTWIST ACTRK CMPR STRL,$712.50,$0.00,$712.50,$320.63,$508.51,$0.00,$122.76,$0.00,$0.00,$124.75,$712.50,$0.00,$356.25,$564.30,$570.00,$0.00,$111.51,$0.00,$113.43,$0.00
AI-0020,SUP,HCPCS C1713,,AI-0020  -  SCREW BONE 20MM ACUTWIST,$712.50,$0.00,$712.50,$320.63,$508.51,$0.00,$122.76,$0.00,$0.00,$124.75,$712.50,$0.00,$356.25,$564.30,$570.00,$0.00,$111.51,$0.00,$113.43,$0.00
AI-0020-S,SUP,HCPCS C1713,,AI-0020-S  -  SCREW BONE 20MM ACUTWIST SS FT HAND CMPR STRL,$712.50,$0.00,$712.50,$320.63,$508.51,$0.00,$122.76,$0.00,$0.00,$124.75,$712.50,$0.00,$356.25,$564.30,$570.00,$0.00,$111.51,$0.00,$113.43,$0.00
AI-0022-S,SUP,HCPCS C1713,,AI-0022-S  -  SCREW BONE 22MM ACUTWIST ACTRK TI FULTHD HAND FT CMPR HDLS,$712.50,$0.00,$712.50,$320.63,$508.51,$0.00,$122.76,$0.00,$0.00,$124.75,$712.50,$0.00,$356.25,$564.30,$570.00,$0.00,$111.51,$0.00,$113.43,$0.00
AI-0024,SUP,HCPCS C1713,,AI-0024  -  SCREW BONE 24MM ACUTWIST TI ORTH NONSTRL,$712.50,$0.00,$712.50,$320.63,$508.51,$0.00,$122.76,$0.00,$0.00,$124.75,$712.50,$0.00,$356.25,$564.30,$570.00,$0.00,$111.51,$0.00,$113.43,$0.00
AI-0024-S,SUP,HCPCS C1713,,AI-0024-S  -  SCREW BONE 24MM ACUTWIST ACTRK TI ORTH CMPR STRL,$712.50,$0.00,$712.50,$320.63,$508.51,$0.00,$122.76,$0.00,$0.00,$124.75,$712.50,$0.00,$356.25,$564.30,$570.00,$0.00,$111.51,$0.00,$113.43,$0.00
AI-0026,SUP,HCPCS C1713,,AI-0026  -  SCREW BONE 26MM ACTRK ACUTWIST CMPR NONSTRL,$712.50,$0.00,$712.50,$320.63,$508.51,$0.00,$122.76,$0.00,$0.00,$124.75,$712.50,$0.00,$356.25,$564.30,$570.00,$0.00,$111.51,$0.00,$113.43,$0.00
AI-0026-S,SUP,HCPCS C1713,,AI-0026-S  -  SCREW BONE 26MM ACUTWIST ACTRK ORTH CMPR STRL,$712.50,$0.00,$712.50,$320.63,$508.51,$0.00,$122.76,$0.00,$0.00,$124.75,$712.50,$0.00,$356.25,$564.30,$570.00,$0.00,$111.51,$0.00,$113.43,$0.00
AI-0028-S,SUP,HCPCS C1713,,AI-0028-S  -  SCREW BONE 28MM ACUTWIST ACTRK FT HAND CMPR STRL,$712.50,$0.00,$712.50,$320.63,$508.51,$0.00,$122.76,$0.00,$0.00,$124.75,$712.50,$0.00,$356.25,$564.30,$570.00,$0.00,$111.51,$0.00,$113.43,$0.00
AI-0030-S,SUP,HCPCS C1713,,AI-0030-S  -  SCREW BONE 30MM ACUTWIST ACTRK PERIART WRST ANKL HAND FT,$712.50,$0.00,$712.50,$320.63,$508.51,$0.00,$122.76,$0.00,$0.00,$124.75,$712.50,$0.00,$356.25,$564.30,$570.00,$0.00,$111.51,$0.00,$113.43,$0.00
AI-07127,SUP,HCPCS C1725,,CATHETER ANGIO 7FR 110CM 2 LUM WDG PRSS PED,$113.68,$0.00,$113.68,$61.73,$81.13,$0.00,$19.59,$0.00,$0.00,$19.90,$113.68,$0.00,$56.84,$90.03,$90.94,$0.00,$17.79,$0.00,$18.10,$0.00
AI-EX20,SUP,HCPCS C1713,,AI-EX20  -  SCREW BONE ACTRK ACUTWIST CMPNT XTRT,$437.50,$0.00,$437.50,$196.88,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
AI-NG30,SUP,HCPCS C1713,,AI-NG30  -  SCREW BONE 30MM ACTRK ACUTWIST TI ORTH TAP NONSTRL,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
AK-01000,SUP,Custom 27203010,,AK-01000  -  KIT THORACENTESIS 8FR 22GA 7.5IN 1.5IN 3 WAY STOPCOCK,$275.40,$0.00,$218.12,$0.00,$95.62,$0.00,$0.00,$0.00,$0.00,$0.00,$133.98,$0.00,$66.99,$218.12,$107.18,$0.00,$0.00,$0.00,$0.00,$0.00
AK-04212,SUP,HCPCS C1751,,AK-04212  -  KIT CATHETER .032IN 16GA 18GA 20CM 2.5IN CATHETER GWIRE,$41.70,$0.00,$41.70,$22.65,$29.76,$0.00,$7.19,$0.00,$0.00,$7.30,$41.70,$0.00,$20.85,$33.03,$33.36,$0.00,$6.53,$0.00,$6.64,$0.00
AK-09000,SUP,HCPCS C1729,,AK-09000  -  KIT PERITONEAL LAVAGE .035IN 8FR 18GA 9.25IN 17.75IN,$85.17,$0.00,$85.17,$46.25,$60.78,$0.00,$14.67,$0.00,$0.00,$14.91,$85.17,$0.00,$42.58,$67.45,$68.13,$0.00,$13.33,$0.00,$13.56,$0.00
AK-09601,SUP,HCPCS C1894,,INTRODUCER SHTH 6FR 10CM INTGR HMSTS VLV SDPRT TISS DILAT,$78.75,$0.00,$78.75,$42.76,$56.20,$0.00,$13.57,$0.00,$0.00,$13.79,$78.75,$0.00,$39.38,$62.37,$63.00,$0.00,$12.32,$0.00,$12.54,$0.00
AK-15703-ASP,SUP,Custom 27203010,,TRAY CATH 7FR 8IN CEN VEN A-H BL FLX 3 LUM RADIOPQ SPRG,$131.08,$0.00,$131.08,$0.00,$93.55,$0.00,$0.00,$0.00,$0.00,$0.00,$131.08,$0.00,$65.54,$103.82,$104.86,$0.00,$0.00,$0.00,$0.00,$0.00
AK-16553,SUP,HCPCS C1769,,KIT PED 5 1/8IN 5.5FR .018IN 3 LUM RADIOPQ SPRG GUIDEWIRE,$126.85,$0.00,$126.85,$68.88,$90.53,$0.00,$21.86,$0.00,$0.00,$22.21,$126.85,$0.00,$63.43,$100.47,$101.48,$0.00,$19.85,$0.00,$20.19,$0.00
AK-16702,SUP,HCPCS C1769,,KIT 8IN 7FR .032IN 2 LUM RADIOPQ SPRG GUIDEWIRE INTROD NDL,$95.50,$0.00,$95.50,$51.86,$68.16,$0.00,$16.45,$0.00,$0.00,$16.72,$95.50,$0.00,$47.75,$75.64,$76.40,$0.00,$14.95,$0.00,$15.20,$0.00
AK-22702,SUP,HCPCS C1729,,KIT CATH 6 5/16IN 7FR BLUFLTP ARWG+A BL .025IN CEN VEN PU 2,$130.25,$0.00,$130.25,$70.73,$92.96,$0.00,$22.44,$0.00,$0.00,$22.81,$130.25,$0.00,$65.13,$103.16,$104.20,$0.00,$20.38,$0.00,$20.74,$0.00
AK-24703-A,SUP,HCPCS C1729,,CATHETER KIT  CENTRAL VENOUS ARROWGUARD 7FR X 12IN MULTI LUM,$960.00,$0.00,$960.00,$521.28,$685.15,$0.00,$165.40,$0.00,$0.00,$168.09,$960.00,$0.00,$480.00,$760.32,$768.00,$0.00,$150.24,$0.00,$152.83,$0.00
AK-42854-SK,SUP,HCPCS C1769,,KIT 6IN 8.5FR .032IN 4 LUM RADIOPQ SPRG GUIDEWIRE INTROD NDL,$194.61,$0.00,$194.61,$105.67,$138.89,$0.00,$33.53,$0.00,$0.00,$34.07,$194.61,$0.00,$97.31,$154.13,$155.69,$0.00,$30.46,$0.00,$30.98,$0.00
AM-0025S,SUP,HCPCS C1713,,AM-0025S  -  SCREW BONE 4/5MM 25MM ACTRK FIXAT STRL,$769.78,$0.00,$769.78,$346.40,$549.39,$0.00,$132.63,$0.00,$0.00,$134.78,$769.78,$0.00,$384.89,$609.67,$615.82,$0.00,$120.47,$0.00,$122.55,$0.00
AM-0025-S,SUP,HCPCS C1713,,AM-0025-S  -  SCREW BONE 4/5MM 25MM ACTRK TI FULTHD ORTH SLFTAP CANN CMPR,$940.00,$0.00,$940.00,$423.00,$670.88,$0.00,$161.96,$0.00,$0.00,$164.59,$940.00,$0.00,$470.00,$744.48,$752.00,$0.00,$147.11,$0.00,$149.65,$0.00
AM-0030S,SUP,HCPCS C1713,,AM-0030S  -  SCREW BONE 4/5MM 30MM ACTRK FIXAT STRL,$769.78,$0.00,$769.78,$346.40,$549.39,$0.00,$132.63,$0.00,$0.00,$134.78,$769.78,$0.00,$384.89,$609.67,$615.82,$0.00,$120.47,$0.00,$122.55,$0.00
AM-0030-S,SUP,HCPCS C1713,,AM-0030-S  -  SCREW BONE 4/5MM 30MM ACTRK TI FULTHD HINDFOOT ANKL FIX STRL,$940.00,$0.00,$940.00,$423.00,$670.88,$0.00,$161.96,$0.00,$0.00,$164.59,$940.00,$0.00,$470.00,$744.48,$752.00,$0.00,$147.11,$0.00,$149.65,$0.00
AM-0035S,SUP,HCPCS C1713,,AM-0035S  -  SCREW BONE 35MM ACTRK 4/5 ACUMED FIXAT STRL,$769.78,$0.00,$769.78,$346.40,$549.39,$0.00,$132.63,$0.00,$0.00,$134.78,$769.78,$0.00,$384.89,$609.67,$615.82,$0.00,$120.47,$0.00,$122.55,$0.00
AM-0035-S,SUP,HCPCS C1713,,AM-0035-S  -  SCREW BONE 4/5MM 35MM ACTRK TI FULTHD HINDFOOT ANKL SLFTAP,$940.00,$0.00,$940.00,$423.00,$670.88,$0.00,$161.96,$0.00,$0.00,$164.59,$940.00,$0.00,$470.00,$744.48,$752.00,$0.00,$147.11,$0.00,$149.65,$0.00
AM-0040S,SUP,HCPCS C1713,,AM-0040S  -  SCREW BONE 40MM ACTRK 4/5 ACUMED FIXAT STRL,$769.78,$0.00,$769.78,$346.40,$549.39,$0.00,$132.63,$0.00,$0.00,$134.78,$769.78,$0.00,$384.89,$609.67,$615.82,$0.00,$120.47,$0.00,$122.55,$0.00
AM-0040-S,SUP,HCPCS C1713,,AM-0040-S  -  SCREW BONE 4MM 5MM 40MM ACTRK TI FULTHD ORTH FIX STRL,$940.00,$0.00,$940.00,$423.00,$670.88,$0.00,$161.96,$0.00,$0.00,$164.59,$940.00,$0.00,$470.00,$744.48,$752.00,$0.00,$147.11,$0.00,$149.65,$0.00
AM-0045S,SUP,HCPCS C1713,,AM-0045S  -  SCREW BONE 4/5MM 45MM ACTRK FIXAT STRL,$769.78,$0.00,$769.78,$346.40,$549.39,$0.00,$132.63,$0.00,$0.00,$134.78,$769.78,$0.00,$384.89,$609.67,$615.82,$0.00,$120.47,$0.00,$122.55,$0.00
AM-0045-S,SUP,HCPCS C1713,,AM-0045-S  -  SCREW BN FT 4-5MM 45MM STRL ACTRK ST CNN CMPR HDLS TPR TI,$940.00,$0.00,$940.00,$423.00,$670.88,$0.00,$161.96,$0.00,$0.00,$164.59,$940.00,$0.00,$470.00,$744.48,$752.00,$0.00,$147.11,$0.00,$149.65,$0.00
AM-0050S,SUP,HCPCS C1713,,AM-0050S  -  SCREW BONE 4/5MM 50MM ACTRK FIXAT STRL,$769.78,$0.00,$769.78,$346.40,$549.39,$0.00,$132.63,$0.00,$0.00,$134.78,$769.78,$0.00,$384.89,$609.67,$615.82,$0.00,$120.47,$0.00,$122.55,$0.00
AM-0050-S,SUP,HCPCS C1713,,AM-0050-S  -  SCREW BONE 4/5MM 50MM ACTRK TI FULTHD HINDFOOT ANKL FIX STRL,$940.00,$0.00,$940.00,$423.00,$670.88,$0.00,$161.96,$0.00,$0.00,$164.59,$940.00,$0.00,$470.00,$744.48,$752.00,$0.00,$147.11,$0.00,$149.65,$0.00
AM2184,SUP,Custom 27203010,,STRIP UA URSTX GLUC PRTN REAGENT,$48.45,$0.00,$48.45,$0.00,$34.58,$0.00,$0.00,$0.00,$0.00,$0.00,$48.45,$0.00,$24.23,$38.37,$38.76,$0.00,$0.00,$0.00,$0.00,$0.00
AM2190,SUP,Custom 27203010,,STRIP UA HEMASTIX URN BLOOD REAGENT,$37.98,$0.00,$37.98,$0.00,$27.10,$0.00,$0.00,$0.00,$0.00,$0.00,$37.98,$0.00,$18.99,$30.08,$30.38,$0.00,$0.00,$0.00,$0.00,$0.00
AM-5010,SUP,Custom 27203010,,AM-5010  -  BIT DRILL 4MM 5MM ACTRK STD CANN NONSTRL,$180.00,$0.00,$180.00,$0.00,$128.47,$0.00,$0.00,$0.00,$0.00,$0.00,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$0.00,$0.00,$0.00,$0.00
AM-5014,SUP,Custom 27203010,,AM-5014  -  DRILL SRG 4/5MM ACTRK DNS CNN BN,$180.00,$0.00,$180.00,$0.00,$128.47,$0.00,$0.00,$0.00,$0.00,$0.00,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$0.00,$0.00,$0.00,$0.00
AMP 225 210 152,SUP,HCPCS C1725,,AMP 225 210 152  -  CATHETER BLNDIL 2-2.5MM 150CM 210MM AM DP OTW LOPRFL TPR BRD,$987.50,$0.00,$987.50,$536.21,$704.78,$0.00,$170.14,$0.00,$0.00,$172.90,$987.50,$0.00,$493.75,$782.10,$790.00,$0.00,$154.54,$0.00,$157.21,$0.00
AM-TA25,SUP,HCPCS C1713,,AM-TA25  -  SCREW BONE 25MM ACTRK 4/5 FT ANKL TPR NONSTRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
AN04318,SUP,HCPCS C1769,,INTRODUCER CATH 18GA 2.5IN SPRG GUIDEWIRE,$5.38,$0.00,$5.38,$2.92,$3.84,$0.00,$0.93,$0.00,$0.00,$0.94,$5.38,$0.00,$2.69,$4.26,$4.30,$0.00,$0.84,$0.00,$0.86,$0.00
AP-0035-S,SUP,HCPCS C1713,,AP-0035-S  -  SCREW BONE 5/6.5MM 35MM ACTRK+ TI ORTH FIX STRL,$940.00,$0.00,$940.00,$423.00,$670.88,$0.00,$161.96,$0.00,$0.00,$164.59,$940.00,$0.00,$470.00,$744.48,$752.00,$0.00,$147.11,$0.00,$149.65,$0.00
AP-0040-S,SUP,HCPCS C1713,,AP-0040-S  -  SCREW BONE 5/6.5MM 40MM ACTRK+ TI HINDFOOT ANKL FIX STRL,$940.00,$0.00,$940.00,$423.00,$670.88,$0.00,$161.96,$0.00,$0.00,$164.59,$940.00,$0.00,$470.00,$744.48,$752.00,$0.00,$147.11,$0.00,$149.65,$0.00
AP-0045-S,SUP,HCPCS C1713,,AP-0045-S  -  SCREW BONE 5/6.5MM 45MM ACTRK+ TI ORTH CANN STRL,$940.00,$0.00,$940.00,$423.00,$670.88,$0.00,$161.96,$0.00,$0.00,$164.59,$940.00,$0.00,$470.00,$744.48,$752.00,$0.00,$147.11,$0.00,$149.65,$0.00
AP-0050-S,SUP,HCPCS C1713,,AP-0050-S  -  SCREW BONE 5/6.5MM 50MM ACTRK+ TI HINDFOOT ANKL FIX STRL,$940.00,$0.00,$940.00,$423.00,$670.88,$0.00,$161.96,$0.00,$0.00,$164.59,$940.00,$0.00,$470.00,$744.48,$752.00,$0.00,$147.11,$0.00,$149.65,$0.00
AP-0055-S,SUP,HCPCS C1713,,AP-0055-S  -  SCREW BONE 5/6.5MM 55MM ACTRK+ TI ORTH FIX STRL,$940.00,$0.00,$940.00,$423.00,$670.88,$0.00,$161.96,$0.00,$0.00,$164.59,$940.00,$0.00,$470.00,$744.48,$752.00,$0.00,$147.11,$0.00,$149.65,$0.00
AP-0060-S,SUP,HCPCS C1713,,AP-0060-S  -  SCREW BONE 5/6.5MM 60MM ACTRK+ TI HINDFOOT ANKL FIX STRL,$940.00,$0.00,$940.00,$423.00,$670.88,$0.00,$161.96,$0.00,$0.00,$164.59,$940.00,$0.00,$470.00,$744.48,$752.00,$0.00,$147.11,$0.00,$149.65,$0.00
AP-0065-S,SUP,HCPCS C1713,,AP-0065-S  -  SCREW BONE 5/6.5MM 65MM ACTRK+ TI HINDFOOT ANKL FIX STRL,$940.00,$0.00,$940.00,$423.00,$670.88,$0.00,$161.96,$0.00,$0.00,$164.59,$940.00,$0.00,$470.00,$744.48,$752.00,$0.00,$147.11,$0.00,$149.65,$0.00
AP-0070-S,SUP,HCPCS C1713,,AP-0070-S  -  SCREW BONE 5/6.5MM 70MM ACMD/TRK PLUS TI ORTH FIX STRL,$940.00,$0.00,$940.00,$423.00,$670.88,$0.00,$161.96,$0.00,$0.00,$164.59,$940.00,$0.00,$470.00,$744.48,$752.00,$0.00,$147.11,$0.00,$149.65,$0.00
AP-0075-S,SUP,HCPCS C1713,,AP-0075-S  -  SCREW BONE 5/6.5MM 75MM ACMD/TRK PLUS TI ORTH FIX STRL,$940.00,$0.00,$940.00,$423.00,$670.88,$0.00,$161.96,$0.00,$0.00,$164.59,$940.00,$0.00,$470.00,$744.48,$752.00,$0.00,$147.11,$0.00,$149.65,$0.00
AP-0080-S,SUP,HCPCS C1713,,AP-0080-S  -  SCREW BONE 5/6.5MM 80MM ACTRK+ TI HINDFOOT ANKL FIX STRL,$940.00,$0.00,$940.00,$423.00,$670.88,$0.00,$161.96,$0.00,$0.00,$164.59,$940.00,$0.00,$470.00,$744.48,$752.00,$0.00,$147.11,$0.00,$149.65,$0.00
AP-010,SUP,Custom 27203010,,AP-010  -  BIT DRILL CANN,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
AP-0100,SUP,Custom 27203010,,AP-0100  -  DRILL SURG TAPER CANN ACUTRAK PLUS TITANIUM,$180.00,$0.00,$180.00,$0.00,$128.47,$0.00,$0.00,$0.00,$0.00,$0.00,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$0.00,$0.00,$0.00,$0.00
AP-0104,SUP,Custom 27203010,,AP-0104  -  DRILL SRG ACTRK+ DNS BN,$180.00,$0.00,$180.00,$0.00,$128.47,$0.00,$0.00,$0.00,$0.00,$0.00,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$0.00,$0.00,$0.00,$0.00
AP-0110,SUP,Custom 27203010,,AP-0110  -  BIT DRL NS ACTRK+ CNN GRV SPNE,$785.00,$0.00,$785.00,$0.00,$560.25,$0.00,$0.00,$0.00,$0.00,$0.00,$785.00,$0.00,$392.50,$621.72,$628.00,$0.00,$0.00,$0.00,$0.00,$0.00
AP-67008,SUP,Custom 27203010,,AP-67008  -  DEVICE REM 4MM SCR,$747.50,$0.00,$747.50,$0.00,$533.49,$0.00,$0.00,$0.00,$0.00,$0.00,$747.50,$0.00,$373.75,$592.02,$598.00,$0.00,$0.00,$0.00,$0.00,$0.00
AP-67011,SUP,Custom 27203010,,AP-67011  -  DRILL SURG SM 40-120MM CANN ACTRK 6-7MM STRL,$180.00,$0.00,$180.00,$0.00,$128.47,$0.00,$0.00,$0.00,$0.00,$0.00,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$0.00,$0.00,$0.00,$0.00
AP-67012,SUP,Custom 27203010,,AP-67012  -  DRILL SURG MED 70-85MM CANN DNS ACTRK 6-7MM STRL,$180.00,$0.00,$180.00,$0.00,$128.47,$0.00,$0.00,$0.00,$0.00,$0.00,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$0.00,$0.00,$0.00,$0.00
AP-67013,SUP,Custom 27203010,,AP-67013  -  DRILL SURG LG 90-120MM CANN ACTRK 6-7MM NONSTRL,$180.00,$0.00,$180.00,$0.00,$128.47,$0.00,$0.00,$0.00,$0.00,$0.00,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$0.00,$0.00,$0.00,$0.00
AP-67014,SUP,Custom 27203010,,AP-67014  -  BIT DRILL 40-65MM 6MM 7MM ACTRK SM CANN DNS STRL,$180.00,$0.00,$180.00,$0.00,$128.47,$0.00,$0.00,$0.00,$0.00,$0.00,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$0.00,$0.00,$0.00,$0.00
AP-67015,SUP,Custom 27203010,,AP-67015  -  DRILL HAND RED 70-85MM ACTRK MED CANN DNS 6/7 SCR SYS STRL,$180.00,$0.00,$180.00,$0.00,$128.47,$0.00,$0.00,$0.00,$0.00,$0.00,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$0.00,$0.00,$0.00,$0.00
AP-67016,SUP,Custom 27203010,,AP-67016  -  DRILL SURG REG 40-120MM CANN ACTRK 6-7MM STRL YLW ACUTRACK,$180.00,$0.00,$180.00,$0.00,$128.47,$0.00,$0.00,$0.00,$0.00,$0.00,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$0.00,$0.00,$0.00,$0.00
AP-67100-S,SUP,HCPCS C1713,,AP-67100-S  -  SCREW BONE 6-7MM 100MM ACTRK TI SM BONE NONSTRL,$940.00,$0.00,$940.00,$423.00,$670.88,$0.00,$161.96,$0.00,$0.00,$164.59,$940.00,$0.00,$470.00,$744.48,$752.00,$0.00,$147.11,$0.00,$149.65,$0.00
AP-67105-S,SUP,HCPCS C1713,,AP-67105-S  -  SCREW BONE 6-7MM 105MM ACTRK FIX STRL,$940.00,$0.00,$940.00,$423.00,$670.88,$0.00,$161.96,$0.00,$0.00,$164.59,$940.00,$0.00,$470.00,$744.48,$752.00,$0.00,$147.11,$0.00,$149.65,$0.00
AP-67110-S,SUP,HCPCS C1713,,AP-67110-S  -  SCREW BONE 6-7MM 110MM ACTRK FIX STRL,$940.00,$0.00,$940.00,$423.00,$670.88,$0.00,$161.96,$0.00,$0.00,$164.59,$940.00,$0.00,$470.00,$744.48,$752.00,$0.00,$147.11,$0.00,$149.65,$0.00
AP-67115-S,SUP,HCPCS C1713,,AP-67115-S  -  SCREW BONE 6/7MM 115MM ACTRK FIX,$940.00,$0.00,$940.00,$423.00,$670.88,$0.00,$161.96,$0.00,$0.00,$164.59,$940.00,$0.00,$470.00,$744.48,$752.00,$0.00,$147.11,$0.00,$149.65,$0.00
AP-67120-S,SUP,HCPCS C1713,,AP-67120-S  -  SCREW BONE 6/7MM 120MM ACTRK FIX,$940.00,$0.00,$940.00,$423.00,$670.88,$0.00,$161.96,$0.00,$0.00,$164.59,$940.00,$0.00,$470.00,$744.48,$752.00,$0.00,$147.11,$0.00,$149.65,$0.00
AP-6740-S,SUP,HCPCS C1713,,AP-6740-S  -  SCREW BONE 6/7MM 40MM ACTRK TI FULTHD ORTH SLFTAP CANN STRL,$940.00,$0.00,$940.00,$423.00,$670.88,$0.00,$161.96,$0.00,$0.00,$164.59,$940.00,$0.00,$470.00,$744.48,$752.00,$0.00,$147.11,$0.00,$149.65,$0.00
AP-6745-S,SUP,HCPCS C1713,,AP-6745-S  -  SCREW BONE 6/7MM 45MM ACTRK TI FULTHD ORTH SLFTAP CANN CMPR,$940.00,$0.00,$940.00,$423.00,$670.88,$0.00,$161.96,$0.00,$0.00,$164.59,$940.00,$0.00,$470.00,$744.48,$752.00,$0.00,$147.11,$0.00,$149.65,$0.00
AP-6750-S,SUP,HCPCS C1713,,AP-6750-S  -  SCREW BONE 6/7MM 50MM ACTRK TI UPR XTRMT FRFT FIX STRL,$940.00,$0.00,$940.00,$423.00,$670.88,$0.00,$161.96,$0.00,$0.00,$164.59,$940.00,$0.00,$470.00,$744.48,$752.00,$0.00,$147.11,$0.00,$149.65,$0.00
AP-6755-S,SUP,HCPCS C1713,,AP-6755-S  -  SCREW BONE 6/7MM 55MM ACTRK TI UPR XTRMT FRFT FIX STRL,$940.00,$0.00,$940.00,$423.00,$670.88,$0.00,$161.96,$0.00,$0.00,$164.59,$940.00,$0.00,$470.00,$744.48,$752.00,$0.00,$147.11,$0.00,$149.65,$0.00
AP-6760-S,SUP,HCPCS C1713,,AP-6760-S  -  SCREW BONE 6/7MM 60MM ACTRK TI FULTHD ORTH SLFTAP CANN CMPR,$940.00,$0.00,$940.00,$423.00,$670.88,$0.00,$161.96,$0.00,$0.00,$164.59,$940.00,$0.00,$470.00,$744.48,$752.00,$0.00,$147.11,$0.00,$149.65,$0.00
AP-6765-S,SUP,HCPCS C1713,,AP-6765-S  -  SCREW BONE 6/7MM 65MM ACTRK TI ORTH FIX STRL,$940.00,$0.00,$940.00,$423.00,$670.88,$0.00,$161.96,$0.00,$0.00,$164.59,$940.00,$0.00,$470.00,$744.48,$752.00,$0.00,$147.11,$0.00,$149.65,$0.00
AP-6770-S,SUP,HCPCS C1713,,AP-6770-S  -  SCREW BONE 6/7MM 70MM ACTRK TI ORTH FIX STRL 6 7 SCR,$940.00,$0.00,$940.00,$423.00,$670.88,$0.00,$161.96,$0.00,$0.00,$164.59,$940.00,$0.00,$470.00,$744.48,$752.00,$0.00,$147.11,$0.00,$149.65,$0.00
AP-6775-S,SUP,HCPCS C1713,,AP-6775-S  -  SCREW BONE 6/7MM 75MM ACTRK TI FULTHD ORTH SLFTAP CANN CMPR,$940.00,$0.00,$940.00,$423.00,$670.88,$0.00,$161.96,$0.00,$0.00,$164.59,$940.00,$0.00,$470.00,$744.48,$752.00,$0.00,$147.11,$0.00,$149.65,$0.00
AP-6780-S,SUP,HCPCS C1713,,AP-6780-S  -  SCREW BN .094IN 6/7MM 4MM 80MM STRL ACTRK FX TI,$940.00,$0.00,$940.00,$423.00,$670.88,$0.00,$161.96,$0.00,$0.00,$164.59,$940.00,$0.00,$470.00,$744.48,$752.00,$0.00,$147.11,$0.00,$149.65,$0.00
AP-6785-S,SUP,HCPCS C1713,,AP-6785-S  -  SCREW BONE 6/7MM 85MM ACTRK TI UPR XTRMT FRFT FIX STRL,$940.00,$0.00,$940.00,$423.00,$670.88,$0.00,$161.96,$0.00,$0.00,$164.59,$940.00,$0.00,$470.00,$744.48,$752.00,$0.00,$147.11,$0.00,$149.65,$0.00
AP-6790-S,SUP,HCPCS C1713,,AP-6790-S  -  SCREW BONE 6-7MM 90MM ACTRK TI SM BONE STRL,$940.00,$0.00,$940.00,$423.00,$670.88,$0.00,$161.96,$0.00,$0.00,$164.59,$940.00,$0.00,$470.00,$744.48,$752.00,$0.00,$147.11,$0.00,$149.65,$0.00
AP-6795-S,SUP,HCPCS C1713,,AP-6795-S  -  SCREW BONE 6/7MM 95MM ACTRK TI ORTH STRL,$940.00,$0.00,$940.00,$423.00,$670.88,$0.00,$161.96,$0.00,$0.00,$164.59,$940.00,$0.00,$470.00,$744.48,$752.00,$0.00,$147.11,$0.00,$149.65,$0.00
AQL-110,SUP,HCPCS C1713,,AQL-110  -  SET TBG AQUILEX FL CNTRL INFL,$912.50,$0.00,$912.50,$410.63,$651.25,$0.00,$157.22,$0.00,$0.00,$159.77,$912.50,$0.00,$456.25,$722.70,$730.00,$0.00,$142.81,$0.00,$145.27,$0.00
AQL-111,SUP,Custom 27203010,,AQL-111  -  SET TBG AQUILEX FL CNTRL OFLW,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-005-AC00,SUP,Custom 27203010,,AR-005-AC00  -  CLAMP XTRNFX IBALANCE ANKL UNCNDL KN ARTHOPLASTY,"$1,700.00",$0.00,"$1,700.00",$0.00,"$1,213.29",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,700.00",$0.00,$850.00,"$1,346.40","$1,360.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-1000,SUP,Custom 27203010,,AR-1000  -  PASSER SUT TRANSOSSEOUS,$162.50,$0.00,$162.50,$0.00,$115.98,$0.00,$0.00,$0.00,$0.00,$0.00,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1006,SUP,HCPCS C1713,,AR-1006  -  STAPLE BN SPK 20X6MM STRL COCR ACL PCL,$197.50,$0.00,$197.50,$88.88,$140.96,$0.00,$34.03,$0.00,$0.00,$34.58,$197.50,$0.00,$98.75,$156.42,$158.00,$0.00,$30.91,$0.00,$31.44,$0.00
AR-1006M,SUP,HCPCS C1713,,AR-1006M  -  STAPLE BN 20X6MM STRL COCR ACL PCL,$197.50,$0.00,$197.50,$88.88,$140.96,$0.00,$34.03,$0.00,$0.00,$34.58,$197.50,$0.00,$98.75,$156.42,$158.00,$0.00,$30.91,$0.00,$31.44,$0.00
AR-1006MNS,SUP,Custom 27803010,,AR-1006MNS  -  STAPLE BN 20X6MM NS COCR ACL PCL,$197.50,$0.00,$197.50,$0.00,$140.96,$0.00,$0.00,$0.00,$0.00,$0.00,$197.50,$0.00,$98.75,$156.42,$158.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1006NS,SUP,Custom 27803010,,AR-1006NS  -  STAPLE BN SPK 20X6MM NS COCR ACL PCL,$197.50,$0.00,$197.50,$0.00,$140.96,$0.00,$0.00,$0.00,$0.00,$0.00,$197.50,$0.00,$98.75,$156.42,$158.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1008,SUP,HCPCS C1713,,AR-1008  -  STAPLE BN SPK 20X8MM STRL LOPRFL LGMNT COCR ACL PCL,$197.50,$0.00,$197.50,$88.88,$140.96,$0.00,$34.03,$0.00,$0.00,$34.58,$197.50,$0.00,$98.75,$156.42,$158.00,$0.00,$30.91,$0.00,$31.44,$0.00
AR-1008NS,SUP,Custom 27803010,,AR-1008NS  -  STAPLE BN SPK 20X8MM NS COCR ACL PCL,$197.50,$0.00,$197.50,$0.00,$140.96,$0.00,$0.00,$0.00,$0.00,$0.00,$197.50,$0.00,$98.75,$156.42,$158.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1011,SUP,HCPCS C1713,,AR-1011  -  STAPLE BN SPK 20X11MM STRL COCR ACL PCL,$197.50,$0.00,$197.50,$88.88,$140.96,$0.00,$34.03,$0.00,$0.00,$34.58,$197.50,$0.00,$98.75,$156.42,$158.00,$0.00,$30.91,$0.00,$31.44,$0.00
AR-1011NS,SUP,Custom 27803010,,AR-1011NS  -  STAPLE BN SPK LOPRFL 20X11MM NS COCR ACL PCL,$197.50,$0.00,$197.50,$0.00,$140.96,$0.00,$0.00,$0.00,$0.00,$0.00,$197.50,$0.00,$98.75,$156.42,$158.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1016,SUP,HCPCS C1713,,AR-1016  -  STAPLE BN SPK 20X16MM STRL COCR ACL PCL,$197.50,$0.00,$197.50,$88.88,$140.96,$0.00,$34.03,$0.00,$0.00,$34.58,$197.50,$0.00,$98.75,$156.42,$158.00,$0.00,$30.91,$0.00,$31.44,$0.00
AR-1016NS,SUP,Custom 27803010,,AR-1016NS  -  STAPLE BN SPK LOPRFL 20X16MM NS COCR ACL PCL,$197.50,$0.00,$197.50,$0.00,$140.96,$0.00,$0.00,$0.00,$0.00,$0.00,$197.50,$0.00,$98.75,$156.42,$158.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1201.7D,SUP,Custom 27203010,,AR-1201.7D  -  BIT DRL SM LOPRFL 1.7MM 20X25IN AMERPAK FRM 100 AO CNCT PLT,$197.50,$0.00,$197.50,$0.00,$140.96,$0.00,$0.00,$0.00,$0.00,$0.00,$197.50,$0.00,$98.75,$156.42,$158.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1201-7DC,SUP,Custom 27203010,,AR-1201-7DC  -  BIT DRL 1.7MM CNN AO CNCT,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1202-3D,SUP,Custom 27203010,,AR-1202-3D  -  BIT DRL 2.3MM SM FRAG SCR,$187.50,$0.00,$187.50,$0.00,$133.82,$0.00,$0.00,$0.00,$0.00,$0.00,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-12040,SUP,Custom 27203010,,AR-12040  -  PUNCH ARTHRO 3.5MM STR SER 1 DSGN WIDEBITER 3.4MM,"$2,487.50",$0.00,"$2,487.50",$0.00,"$1,775.33",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,487.50",$0.00,"$1,243.75","$1,970.10","$1,990.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-1204AF-100,SUP,Custom 27203010,,AR-1204AF-100  -  CUTTER ASCP 10MM BLU STRL LF FLIPCUTTER II DRL PIN FEM SCKT,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1204AF-105,SUP,Custom 27203010,,AR-1204AF-105  -  CUTTER ARTHRO RTRGRD LP 10.5MM DRILL PIN FEMORAL SOCKET,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1204AF-110,SUP,Custom 27203010,,AR-1204AF-110  -  CUTTER ARTHRO RTRGRD LP 11MM DRILL PIN FEMORAL SOCKET,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1204AF-115,SUP,Custom 27203010,,AR-1204AF-115  -  CUTTER ASCP 11.5MM FLIPCUTTER II RETROCONSTRUCTION DRL PIN,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1204AF-120,SUP,Custom 27203010,,AR-1204AF-120  -  CUTTER ASCP 12MM FLIPCUTTER II RETROCONSTRUCTION DRL PIN RMR,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1204AF-125,SUP,Custom 27203010,,AR-1204AF-125  -  CUTTER ASCP RTRGD LOPRFL 12.5MM BLU STRL LF FLIPCUTTER II,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1204AF-130,SUP,Custom 27203010,,AR-1204AF-130  -  CUTTER ASCP RTRGD LOPRFL 13MM BLU STRL LF FLIPCUTTER II DRL,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1204AF-50,SUP,Custom 27203010,,AR-1204AF-50  -  CUTTER ASCP RTRGD LOPRFL 5MM BLU STRL LF FLIPCUTTER II DRL,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1204AF-55,SUP,Custom 27203010,,AR-1204AF-55  -  CUTTER ASCP 5MM FLIPCUTTER II,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1204AF-60,SUP,Custom 27203010,,AR-1204AF-60  -  CUTTER ASCP RTRGD LOPRFL 6MM BLU STRL LF FLIPCUTTER II DRL,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1204AF-65,SUP,Custom 27203010,,AR-1204AF-65  -  CUTTER ASCP RTRGD LOPRFL 6.5MM BLU STRL LF FLIPCUTTER II DRL,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1204AF-70,SUP,Custom 27203010,,AR-1204AF-70  -  CUTTER ASCP RTRGD LOPRFL 7MM BLU STRL LF FLIPCUTTER II DRL,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1204AF-75,SUP,Custom 27203010,,AR-1204AF-75  -  CUTTER ASCP RTRGD 7.5MM BLU STRL LF FLIPCUTTER II DRL PIN,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1204AF-80,SUP,Custom 27203010,,AR-1204AF-80  -  CUTTER ASCP 8MM BLU STRL LF FLIPCUTTER II DRL PIN FEM SCKT,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1204AF-85,SUP,Custom 27203010,,AR-1204AF-85  -  CUTTER ASCP 8.5MM BLU STRL LF FLIPCUTTER II DRL PIN FEM SCKT,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1204AF-90,SUP,Custom 27203010,,AR-1204AF-90  -  CUTTER ASCP RTRGD 9MM BLU STRL LF FLIPCUTTER II DRL PIN FEM,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1204AF-95,SUP,Custom 27203010,,AR-1204AF-95  -  CUTTER ASCP RTRGD LOPRFL 9.5MM BLU STRL LF FLIPCUTTER II DRL,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1204AS-105,SUP,Custom 27203010,,AR-1204AS-105  -  CUTTER ASCP SHRT 10.5MM FLIPCUTTER II ANTM SCKT KN 3.5MM,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1204AS-110,SUP,Custom 27203010,,AR-1204AS-110  -  CUTTER ASCP SHRT 11MM FLIPCUTTER II ANTM SCKT KN 3.5MM,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1204AS-120,SUP,Custom 27203010,,AR-1204AS-120  -  CUTTER ASCP SHRT 12MM FLIPCUTTER II ANTM SCKT KN 3.5MM,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1204AS-50,SUP,Custom 27203010,,AR-1204AS-50  -  CUTTER ASCP SHRT 5MM FLIPCUTTER II ANTM SCKT KN 3.5MM,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1204AS-55,SUP,Custom 27203010,,AR-1204AS-55  -  CUTTER ASCP SHRT 5.5MM FLIPCUTTER II ANTM SCKT KN 3.5MM,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1204AS-60,SUP,Custom 27203010,,AR-1204AS-60  -  CUTTER ASCP SHRT 6MM FLIPCUTTER II ANTM SCKT KN 3.5MM,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1204AS-65,SUP,Custom 27203010,,AR-1204AS-65  -  CUTTER ASCP SHRT 6.5MM FLIPCUTTER II ANTM SCKT KN 3.5MM,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1204AS-70,SUP,Custom 27203010,,AR-1204AS-70  -  CUTTER ASCP SHRT 7MM FLIPCUTTER II ANTM SCKT KN 3.5MM,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1204AS-75,SUP,Custom 27203010,,AR-1204AS-75  -  CUTTER ASCP SHRT 7.5MM FLIPCUTTER II ANTM SCKT KN 3.5MM,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1204AS-80,SUP,Custom 27203010,,AR-1204AS-80  -  CUTTER ASCP SHRT 8MM FLIPCUTTER II ANTM SCKT KN 3.5MM,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1204AS-85,SUP,Custom 27203010,,AR-1204AS-85  -  CUTTER ASCP SHRT 8.5MM FLIPCUTTER II ANTM SCKT KN 3.5MM,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1204AS-90,SUP,Custom 27203010,,AR-1204AS-90  -  CUTTER ARTHRO ANTM SCKT FLIPCUTTER II SHRT KNEE 9,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1204AS-95,SUP,Custom 27203010,,AR-1204AS-95  -  CUTTER ASCP SHRT 9.5MM FLIPCUTTER II ANTM SCKT KN 3.5MM,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1204D,SUP,Custom 27203010,,AR-1204D  -  DRILL SURG BIT SCREW BIO-TENODESIS 4MM,$287.50,$0.00,$287.50,$0.00,$205.19,$0.00,$0.00,$0.00,$0.00,$0.00,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1204R-055S,SUP,Custom 27203010,,AR-1204R-055S  -  CUTTER ASCP 5.5MM STRL RETROCUTTER ANTM SCKT FLXB TNL FEM,$487.50,$0.00,$487.50,$0.00,$347.93,$0.00,$0.00,$0.00,$0.00,$0.00,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1204R-05S,SUP,Custom 27203010,,AR-1204R-05S  -  CUTTER ASCP 5MM STRL RETROCUTTER ANTM SCKT FLXB TNL FEM TIB,$487.50,$0.00,$487.50,$0.00,$347.93,$0.00,$0.00,$0.00,$0.00,$0.00,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1204R-065S,SUP,Custom 27203010,,AR-1204R-065S  -  CUTTER ASCP 6.5MM STRL RETROCUTTER ANTM SCKT FLXB TNL FEM,$487.50,$0.00,$487.50,$0.00,$347.93,$0.00,$0.00,$0.00,$0.00,$0.00,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1204R-06S,SUP,Custom 27203010,,AR-1204R-06S  -  CUTTER ASCP 6MM STRL RETROCUTTER ANTM SCKT FLXB TNL FEM TIB,$487.50,$0.00,$487.50,$0.00,$347.93,$0.00,$0.00,$0.00,$0.00,$0.00,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1204R-075S,SUP,Custom 27203010,,AR-1204R-075S  -  CUTTER ASCP 7.5MM STRL RETROCUTTER ANTM SCKT FLXB TNL FEM,$487.50,$0.00,$487.50,$0.00,$347.93,$0.00,$0.00,$0.00,$0.00,$0.00,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1204R-07S,SUP,Custom 27203010,,AR-1204R-07S  -  CUTTER ASCP 7MM STRL RETROCUTTER ANTM SCKT FLXB TNL FEM TIB,$487.50,$0.00,$487.50,$0.00,$347.93,$0.00,$0.00,$0.00,$0.00,$0.00,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1204R-08S,SUP,Custom 27203010,,AR-1204R-08S  -  CUTTER ASCP 8MM STRL RETROCUTTER ANTM SCKT FLXB TNL FEM TIB,$487.50,$0.00,$487.50,$0.00,$347.93,$0.00,$0.00,$0.00,$0.00,$0.00,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1204R-095S,SUP,Custom 27203010,,AR-1204R-095S  -  CUTTER ASCP 9.5MM STRL RETROCUTTER ANTM SCKT FLXB TNL FEM,$487.50,$0.00,$487.50,$0.00,$347.93,$0.00,$0.00,$0.00,$0.00,$0.00,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1204R-09S,SUP,Custom 27203010,,AR-1204R-09S  -  CUTTER ASCP 9MM STRL RETROCUTTER ANTM SCKT FLXB TNL FEM TIB,$487.50,$0.00,$487.50,$0.00,$347.93,$0.00,$0.00,$0.00,$0.00,$0.00,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1204R-105S,SUP,Custom 27203010,,AR-1204R-105S  -  CUTTER ASCP 10.5MM STRL RETROCUTTER ANTM SCKT FLXB TNL FEM,$487.50,$0.00,$487.50,$0.00,$347.93,$0.00,$0.00,$0.00,$0.00,$0.00,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1204R-12S,SUP,Custom 27203010,,AR-1204R-12S  -  CUTTER ASCP 12MM STRL RETROCUTTER ANTM SCKT FLXB TNL FEM TIB,$487.50,$0.00,$487.50,$0.00,$347.93,$0.00,$0.00,$0.00,$0.00,$0.00,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1218-100,SUP,Custom 27203010,,AR-1218-100  -  DRILL SURG FULL THICK 10MM CALIBRATE DEPTH MARK CANN ACL,$487.50,$0.00,$487.50,$0.00,$347.93,$0.00,$0.00,$0.00,$0.00,$0.00,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1218-105,SUP,Custom 27203010,,AR-1218-105  -  DRILL SRG 10.5MM STRL CNN,$487.50,$0.00,$487.50,$0.00,$347.93,$0.00,$0.00,$0.00,$0.00,$0.00,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1218-115,SUP,Custom 27203010,,AR-1218-115  -  DRILL SRG 11.5MM STRL CNN,$487.50,$0.00,$487.50,$0.00,$347.93,$0.00,$0.00,$0.00,$0.00,$0.00,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1218-120,SUP,Custom 27203010,,AR-1218-120  -  DRILL SRG 12MM STRL CNN,$487.50,$0.00,$487.50,$0.00,$347.93,$0.00,$0.00,$0.00,$0.00,$0.00,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1218-150,SUP,Custom 27203010,,AR-1218-150  -  DRILL SRG 15MM STRL CNN,$487.50,$0.00,$487.50,$0.00,$347.93,$0.00,$0.00,$0.00,$0.00,$0.00,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1218-40,SUP,Custom 27203010,,AR-1218-40  -  DRILL SRG FULL THK 4MM STRL CLBRT D MRK CNN ACL DISP,$487.50,$0.00,$487.50,$0.00,$347.93,$0.00,$0.00,$0.00,$0.00,$0.00,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1218-50,SUP,Custom 27203010,,AR-1218-50  -  DRILL SRG FULL THK 5MM STRL CLBRT D MRK CNN ACL DISP,$487.50,$0.00,$487.50,$0.00,$347.93,$0.00,$0.00,$0.00,$0.00,$0.00,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1218-55,SUP,Custom 27203010,,AR-1218-55  -  DRILL SRG CNN 5.5 MM SCR,$487.50,$0.00,$487.50,$0.00,$347.93,$0.00,$0.00,$0.00,$0.00,$0.00,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1218-60,SUP,Custom 27203010,,AR-1218-60  -  DRILL SRG FULL THK 6MM STRL CLBRT D MRK CNN ACL HAZ,$487.50,$0.00,$487.50,$0.00,$347.93,$0.00,$0.00,$0.00,$0.00,$0.00,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1218-65,SUP,Custom 27203010,,AR-1218-65  -  DRILL SRG 6.5MM STRL CNN,$487.50,$0.00,$487.50,$0.00,$347.93,$0.00,$0.00,$0.00,$0.00,$0.00,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1218-70,SUP,Custom 27203010,,AR-1218-70  -  DRILL SRG 7MM STRL CNN,$487.50,$0.00,$487.50,$0.00,$347.93,$0.00,$0.00,$0.00,$0.00,$0.00,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1218-75,SUP,Custom 27203010,,AR-1218-75  -  DRILL SURG 7.5MM CANN STERILE,$487.50,$0.00,$487.50,$0.00,$347.93,$0.00,$0.00,$0.00,$0.00,$0.00,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1218-80,SUP,Custom 27203010,,AR-1218-80  -  DRILL SRG FULL THK 8MM STRL CLBRT D MRK CNN ACL DISP,$487.50,$0.00,$487.50,$0.00,$347.93,$0.00,$0.00,$0.00,$0.00,$0.00,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1218-90,SUP,Custom 27203010,,AR-1218-90  -  DRILL SURG FULL THICK 9MM CALIBRATE DEPTH MARK CANN ACL,$487.50,$0.00,$487.50,$0.00,$347.93,$0.00,$0.00,$0.00,$0.00,$0.00,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1218-95,SUP,Custom 27203010,,AR-1218-95  -  DRILL SURG FULL THK CLBRT DEPTH MARK CANN ACL 9.5,$487.50,$0.00,$487.50,$0.00,$347.93,$0.00,$0.00,$0.00,$0.00,$0.00,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1220S,SUP,Custom 27203010,,AR-1220S  -  REAMER SRG 7MM STRL CNN COLR PIN SET COR DISP,$512.50,$0.00,$512.50,$0.00,$365.77,$0.00,$0.00,$0.00,$0.00,$0.00,$512.50,$0.00,$256.25,$405.90,$410.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1222S,SUP,Custom 27203010,,AR-1222S  -  REAMER SRG 8MM STRL CNN COLR PIN SET COR DISP,$512.50,$0.00,$512.50,$0.00,$365.77,$0.00,$0.00,$0.00,$0.00,$0.00,$512.50,$0.00,$256.25,$405.90,$410.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1223S,SUP,Custom 27203010,,AR-1223S  -  REAMER SRG 9MM STRL CNN COLR PIN SET COR DISP,$512.50,$0.00,$512.50,$0.00,$365.77,$0.00,$0.00,$0.00,$0.00,$0.00,$512.50,$0.00,$256.25,$405.90,$410.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1224S,SUP,Custom 27203010,,AR-1224S  -  REAMER SRG 10MM STRL CNN COLR PIN SET COR DISP,$512.50,$0.00,$512.50,$0.00,$365.77,$0.00,$0.00,$0.00,$0.00,$0.00,$512.50,$0.00,$256.25,$405.90,$410.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1226S,SUP,Custom 27203010,,AR-1226S  -  REAMER SRG 11MM STRL CNN COLR PIN SET COR DISP,$512.50,$0.00,$512.50,$0.00,$365.77,$0.00,$0.00,$0.00,$0.00,$0.00,$512.50,$0.00,$256.25,$405.90,$410.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1227S,SUP,Custom 27203010,,AR-1227S  -  REAMER SRG 12MM STRL CNN COLR PIN SET COR DISP,$512.50,$0.00,$512.50,$0.00,$365.77,$0.00,$0.00,$0.00,$0.00,$0.00,$512.50,$0.00,$256.25,$405.90,$410.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1229S,SUP,Custom 27203010,,AR-1229S  -  REAMER SRG 13MM STRL CNN COLR PIN SET COR DISP,$512.50,$0.00,$512.50,$0.00,$365.77,$0.00,$0.00,$0.00,$0.00,$0.00,$512.50,$0.00,$256.25,$405.90,$410.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1231S,SUP,Custom 27203010,,AR-1231S  -  REAMER SRG 14MM STRL CNN COLR PIN SET COR DISP,$512.50,$0.00,$512.50,$0.00,$365.77,$0.00,$0.00,$0.00,$0.00,$0.00,$512.50,$0.00,$256.25,$405.90,$410.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1246-1,SUP,Custom 27203010,,AR-1246-1  -  GUIDE DRL OFST 3MM,$780.00,$0.00,$780.00,$0.00,$556.69,$0.00,$0.00,$0.00,$0.00,$0.00,$780.00,$0.00,$390.00,$617.76,$624.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1250,SUP,Custom 27203010,,AR-1250  -  DRILL SRG 25-30MM 2MM 12IN STRL SEMIFIX D MRK NTNL TIB DISP,$80.00,$0.00,$80.00,$0.00,$57.10,$0.00,$0.00,$0.00,$0.00,$0.00,$80.00,$0.00,$40.00,$63.36,$64.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1250F,SUP,Custom 27203010,,AR-1250F  -  GUIDE PIN ORTH 3.5MM 30CM STRL PREDRILL ACL DISP FLIPCUTTER,$110.00,$0.00,$110.00,$0.00,$78.51,$0.00,$0.00,$0.00,$0.00,$0.00,$110.00,$0.00,$55.00,$87.12,$88.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1250L,SUP,Custom 27203010,,AR-1250L  -  GUIDE PIN ORTH 2.4MM 30CM STRL PREDRILL ACL DISP,$80.00,$0.00,$80.00,$0.00,$57.10,$0.00,$0.00,$0.00,$0.00,$0.00,$80.00,$0.00,$40.00,$63.36,$64.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1250LT,SUP,Custom 27203010,,AR-1250LT  -  DRILL SRG 2.4MM STP 3MM SUT TK,$200.00,$0.00,$200.00,$0.00,$142.74,$0.00,$0.00,$0.00,$0.00,$0.00,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1250LTC,SUP,Custom 27203010,,AR-1250LTC  -  DRILL SRG 3MM STP 3MM SUT TK HRD BN,$200.00,$0.00,$200.00,$0.00,$142.74,$0.00,$0.00,$0.00,$0.00,$0.00,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1252,SUP,Custom 27203010,,AR-1252  -  DRILL SRG THK SPD 3MM SUT TK,$197.50,$0.00,$197.50,$0.00,$140.96,$0.00,$0.00,$0.00,$0.00,$0.00,$197.50,$0.00,$98.75,$156.42,$158.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1254,SUP,Custom 27203010,,AR-1254  -  GUIDE PIN ORTH 25/30MM 2MM STRL D MRK NTNL 6MM SCR,$52.50,$0.00,$52.50,$0.00,$37.47,$0.00,$0.00,$0.00,$0.00,$0.00,$52.50,$0.00,$26.25,$41.58,$42.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1256,SUP,Custom 27203010,,AR-1256  -  DRILL SRG SHRT SPD STRL BSUT TK NDL DISP SUT TK,$197.50,$0.00,$197.50,$0.00,$140.96,$0.00,$0.00,$0.00,$0.00,$0.00,$197.50,$0.00,$98.75,$156.42,$158.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1257,SUP,Custom 27203010,,AR-1257  -  DRILL SRG SPD STRL BSUT TK DISP 3MM SUT TK,$197.50,$0.00,$197.50,$0.00,$140.96,$0.00,$0.00,$0.00,$0.00,$0.00,$197.50,$0.00,$98.75,$156.42,$158.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1259,SUP,Custom 27203010,,AR-1259  -  PASSER SUT RETROPASSER NTNL ASCP,$310.00,$0.00,$310.00,$0.00,$221.25,$0.00,$0.00,$0.00,$0.00,$0.00,$310.00,$0.00,$155.00,$245.52,$248.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1267,SUP,HCPCS C1713,,AR-1267  -  CAP PCTV POPLITEUM PCL,$840.00,$0.00,$840.00,$378.00,$599.51,$0.00,$144.73,$0.00,$0.00,$147.08,$840.00,$0.00,$420.00,$665.28,$672.00,$0.00,$131.46,$0.00,$133.73,$0.00
AR-1270,SUP,Custom 27203010,,AR-1270  -  GUIDE DRL LNG NS RETROBUTTON D,$872.50,$0.00,$872.50,$0.00,$622.70,$0.00,$0.00,$0.00,$0.00,$0.00,$872.50,$0.00,$436.25,$691.02,$698.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1288-100,SUP,HCPCS C1713,,AR-1288-100  -  SYSTEM FX SHRT 10MM TGHTRP RT FLIPCUTTER II 2 LD,"$1,737.50",$0.00,"$1,737.50",$781.88,"$1,240.05",$0.00,$299.36,$0.00,$0.00,$304.22,"$1,737.50",$0.00,$868.75,"$1,376.10","$1,390.00",$0.00,$271.92,$0.00,$276.61,$0.00
AR-1288-105,SUP,HCPCS C1713,,AR-1288-105  -  SYSTEM FX SHRT 10.5MM TGHTRP RT FLIPCUTTER II 2 LD,"$1,737.50",$0.00,"$1,737.50",$781.88,"$1,240.05",$0.00,$299.36,$0.00,$0.00,$304.22,"$1,737.50",$0.00,$868.75,"$1,376.10","$1,390.00",$0.00,$271.92,$0.00,$276.61,$0.00
AR-1288-110,SUP,HCPCS C1713,,AR-1288-110  -  SYSTEM FX 11MM TGHTRP RT SHRT FLIPCUTTER II 2 LD,"$1,737.50",$0.00,"$1,737.50",$781.88,"$1,240.05",$0.00,$299.36,$0.00,$0.00,$304.22,"$1,737.50",$0.00,$868.75,"$1,376.10","$1,390.00",$0.00,$271.92,$0.00,$276.61,$0.00
AR-1288-70,SUP,HCPCS C1713,,AR-1288-70  -  SYSTEM FX SHRT 7MM TGHTRP RT FLIPCUTTER II 2 LD,"$1,737.50",$0.00,"$1,737.50",$781.88,"$1,240.05",$0.00,$299.36,$0.00,$0.00,$304.22,"$1,737.50",$0.00,$868.75,"$1,376.10","$1,390.00",$0.00,$271.92,$0.00,$276.61,$0.00
AR-1288-75,SUP,HCPCS C1713,,AR-1288-75  -  SYSTEM FX SHRT 7.5MM TGHTRP RT FLIPCUTTER II 2 LD,"$1,737.50",$0.00,"$1,737.50",$781.88,"$1,240.05",$0.00,$299.36,$0.00,$0.00,$304.22,"$1,737.50",$0.00,$868.75,"$1,376.10","$1,390.00",$0.00,$271.92,$0.00,$276.61,$0.00
AR-1288-80,SUP,HCPCS C1713,,AR-1288-80  -  SYSTEM FX SHRT 8MM TGHTRP RT FLIPCUTTER II 2 LD,"$1,737.50",$0.00,"$1,737.50",$781.88,"$1,240.05",$0.00,$299.36,$0.00,$0.00,$304.22,"$1,737.50",$0.00,$868.75,"$1,376.10","$1,390.00",$0.00,$271.92,$0.00,$276.61,$0.00
AR-1288-85,SUP,HCPCS C1713,,AR-1288-85  -  SYSTEM FX SHRT 8.5MM TGHTRP RT FLIPCUTTER II 2 LD,"$1,737.50",$0.00,"$1,737.50",$781.88,"$1,240.05",$0.00,$299.36,$0.00,$0.00,$304.22,"$1,737.50",$0.00,$868.75,"$1,376.10","$1,390.00",$0.00,$271.92,$0.00,$276.61,$0.00
AR-1288-90,SUP,HCPCS C1713,,AR-1288-90  -  SYSTEM FX SHRT 9MM TGHTRP RT FLIPCUTTER II 2 LD,"$1,737.50",$0.00,"$1,737.50",$781.88,"$1,240.05",$0.00,$299.36,$0.00,$0.00,$304.22,"$1,737.50",$0.00,$868.75,"$1,376.10","$1,390.00",$0.00,$271.92,$0.00,$276.61,$0.00
AR-1288-95,SUP,HCPCS C1713,,AR-1288-95  -  SYSTEM FX SHRT 9.5MM TGHTRP RT FLIPCUTTER II 2 LD,"$1,737.50",$0.00,"$1,737.50",$781.88,"$1,240.05",$0.00,$299.36,$0.00,$0.00,$304.22,"$1,737.50",$0.00,$868.75,"$1,376.10","$1,390.00",$0.00,$271.92,$0.00,$276.61,$0.00
AR-1288BTB-100,SUP,HCPCS C1713,,AR-1288BTB-100  -  KIT FX 10MM SHRT TGHTRP FLIPCUTTER 2 LD BN TNDN BN,"$1,925.00",$0.00,"$1,925.00",$866.25,"$1,373.87",$0.00,$331.67,$0.00,$0.00,$337.05,"$1,925.00",$0.00,$962.50,"$1,524.60","$1,540.00",$0.00,$301.26,$0.00,$306.46,$0.00
AR-1288BTB-110,SUP,HCPCS C1713,,AR-1288BTB-110  -  KIT FX 11MM SHRT TGHTRP FLIPCUTTER 2 LD BN TNDN BN,"$1,925.00",$0.00,"$1,925.00",$866.25,"$1,373.87",$0.00,$331.67,$0.00,$0.00,$337.05,"$1,925.00",$0.00,$962.50,"$1,524.60","$1,540.00",$0.00,$301.26,$0.00,$306.46,$0.00
AR-1288BTB-70,SUP,HCPCS C1713,,AR-1288BTB-70  -  KIT FX 7MM SHRT TGHTRP FLIPCUTTER 2 LD BN TNDN BN,"$1,925.00",$0.00,"$1,925.00",$866.25,"$1,373.87",$0.00,$331.67,$0.00,$0.00,$337.05,"$1,925.00",$0.00,$962.50,"$1,524.60","$1,540.00",$0.00,$301.26,$0.00,$306.46,$0.00
AR-1288BTB-75,SUP,HCPCS C1713,,AR-1288BTB-75  -  KIT FX 7.5MM SHRT TGHTRP FLIPCUTTER 2 LD BN TNDN BN,"$1,925.00",$0.00,"$1,925.00",$866.25,"$1,373.87",$0.00,$331.67,$0.00,$0.00,$337.05,"$1,925.00",$0.00,$962.50,"$1,524.60","$1,540.00",$0.00,$301.26,$0.00,$306.46,$0.00
AR-1288BTB-80,SUP,HCPCS C1713,,AR-1288BTB-80  -  KIT FX 8MM SHRT TGHTRP FLIPCUTTER 2 LD BN TNDN BN,"$1,925.00",$0.00,"$1,925.00",$866.25,"$1,373.87",$0.00,$331.67,$0.00,$0.00,$337.05,"$1,925.00",$0.00,$962.50,"$1,524.60","$1,540.00",$0.00,$301.26,$0.00,$306.46,$0.00
AR-1288BTB-85,SUP,HCPCS C1713,,AR-1288BTB-85  -  KIT FX 8.5MM SHRT TGHTRP FLIPCUTTER 2 LD BN TNDN BN,"$1,925.00",$0.00,"$1,925.00",$866.25,"$1,373.87",$0.00,$331.67,$0.00,$0.00,$337.05,"$1,925.00",$0.00,$962.50,"$1,524.60","$1,540.00",$0.00,$301.26,$0.00,$306.46,$0.00
AR-1288BTB-90,SUP,HCPCS C1713,,AR-1288BTB-90  -  SYSTEM FX 9MM STRL LF ARTHX TGHTRP BTB J DISP FLPCTR IIS,"$1,925.00",$0.00,"$1,925.00",$866.25,"$1,373.87",$0.00,$331.67,$0.00,$0.00,$337.05,"$1,925.00",$0.00,$962.50,"$1,524.60","$1,540.00",$0.00,$301.26,$0.00,$306.46,$0.00
AR-1288BTB-95,SUP,HCPCS C1713,,AR-1288BTB-95  -  SYSTEM FX 9.5MM STRL LF ARTHX TGHTRP BTB J DISP FLPCTR IIS,"$1,925.00",$0.00,"$1,925.00",$866.25,"$1,373.87",$0.00,$331.67,$0.00,$0.00,$337.05,"$1,925.00",$0.00,$962.50,"$1,524.60","$1,540.00",$0.00,$301.26,$0.00,$306.46,$0.00
AR-1291-4,SUP,Custom 27203010,,AR-1291-4  -  NEEDLE SUT STRL GFT PREP DISP,$925.00,$0.00,$925.00,$0.00,$660.17,$0.00,$0.00,$0.00,$0.00,$0.00,$925.00,$0.00,$462.50,$732.60,$740.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1297,SUP,Custom 27203010,,AR-1297  -  GUIDE PIN ORTH BALL 1.7MM ACL,$170.00,$0.00,$170.00,$0.00,$121.33,$0.00,$0.00,$0.00,$0.00,$0.00,$170.00,$0.00,$85.00,$134.64,$136.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1297L,SUP,Custom 27203010,,AR-1297L  -  GUIDE PIN ORTH 2.4MM 50CM STRL SUT EYE ACL DISP PCL REPR,$170.00,$0.00,$170.00,$0.00,$121.33,$0.00,$0.00,$0.00,$0.00,$0.00,$170.00,$0.00,$85.00,$134.64,$136.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-12990N,SUP,Custom 27203010,,AR-12990N  -  NEEDLE SUT SCRPN KN,$487.50,$0.00,$487.50,$0.00,$347.93,$0.00,$0.00,$0.00,$0.00,$0.00,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-13100-05.0,SUP,HCPCS C1713,,AR-13100-05.0  -  PLATE BN 5MM STRL SS KN FEM 6.5MM CANC 4.5MM CORT SCR OPN,"$1,825.00",$0.00,"$1,825.00",$821.25,"$1,302.50",$0.00,$314.44,$0.00,$0.00,$319.54,"$1,825.00",$0.00,$912.50,"$1,445.40","$1,460.00",$0.00,$285.61,$0.00,$290.54,$0.00
AR-13100-07.5,SUP,HCPCS C1713,,AR-13100-07.5  -  PLATE BN 7.5MM STRL SS KN FEM 6.5MM CANC 4.5MM CORT SCR OPN,"$1,825.00",$0.00,"$1,825.00",$821.25,"$1,302.50",$0.00,$314.44,$0.00,$0.00,$319.54,"$1,825.00",$0.00,$912.50,"$1,445.40","$1,460.00",$0.00,$285.61,$0.00,$290.54,$0.00
AR-13100-09.0,SUP,HCPCS C1713,,AR-13100-09.0  -  PLATE BN 9MM STRL SS KN FEM 6.5MM CANC 4.5MM CORT SCR OPN,"$1,825.00",$0.00,"$1,825.00",$821.25,"$1,302.50",$0.00,$314.44,$0.00,$0.00,$319.54,"$1,825.00",$0.00,$912.50,"$1,445.40","$1,460.00",$0.00,$285.61,$0.00,$290.54,$0.00
AR-13100-10.0,SUP,HCPCS C1713,,AR-13100-10.0  -  PLATE BN 10MM STRL SS KN FEM 6.5MM CANC 4.5MM CORT SCR OPN,"$1,825.00",$0.00,"$1,825.00",$821.25,"$1,302.50",$0.00,$314.44,$0.00,$0.00,$319.54,"$1,825.00",$0.00,$912.50,"$1,445.40","$1,460.00",$0.00,$285.61,$0.00,$290.54,$0.00
AR-13100-11.0,SUP,HCPCS C1713,,AR-13100-11.0  -  PLATE BN 11MM STRL SS KN FEM 6.5MM CANC 4.5MM CORT SCR OPN,"$1,825.00",$0.00,"$1,825.00",$821.25,"$1,302.50",$0.00,$314.44,$0.00,$0.00,$319.54,"$1,825.00",$0.00,$912.50,"$1,445.40","$1,460.00",$0.00,$285.61,$0.00,$290.54,$0.00
AR-13100-12.5,SUP,HCPCS C1713,,AR-13100-12.5  -  PLATE BN 12.5MM STRL SS KN FEM 6.5MM CANC 4.5MM CORT SCR OPN,"$1,825.00",$0.00,"$1,825.00",$821.25,"$1,302.50",$0.00,$314.44,$0.00,$0.00,$319.54,"$1,825.00",$0.00,$912.50,"$1,445.40","$1,460.00",$0.00,$285.61,$0.00,$290.54,$0.00
AR-13100-15.0,SUP,HCPCS C1713,,AR-13100-15.0  -  PLATE BN 15MM STRL SS KN FEM 6.5MM CANC 4.5MM CORT SCR OPN,"$1,825.00",$0.00,"$1,825.00",$821.25,"$1,302.50",$0.00,$314.44,$0.00,$0.00,$319.54,"$1,825.00",$0.00,$912.50,"$1,445.40","$1,460.00",$0.00,$285.61,$0.00,$290.54,$0.00
AR-13100-17.5,SUP,HCPCS C1713,,AR-13100-17.5  -  PLATE BN 17.5MM STRL SS KN FEM 6.5MM CANC 4.5MM CORT SCR OPN,"$1,825.00",$0.00,"$1,825.00",$821.25,"$1,302.50",$0.00,$314.44,$0.00,$0.00,$319.54,"$1,825.00",$0.00,$912.50,"$1,445.40","$1,460.00",$0.00,$285.61,$0.00,$290.54,$0.00
AR-13100T-05.0,SUP,HCPCS C1713,,AR-13100T-05.0  -  PLATE BN 5MM STRL TI KN FEM 6.5MM CANC 4.5MM CORT SCR OPN,"$2,237.50",$0.00,"$2,237.50","$1,006.88","$1,596.90",$0.00,$385.51,$0.00,$0.00,$391.77,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$350.17,$0.00,$356.21,$0.00
AR-13100T-07.5,SUP,HCPCS C1713,,AR-13100T-07.5  -  PLATE BN 7.5MM STRL TI KN FEM 6.5MM CANC 4.5MM CORT SCR OPN,"$2,237.50",$0.00,"$2,237.50","$1,006.88","$1,596.90",$0.00,$385.51,$0.00,$0.00,$391.77,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$350.17,$0.00,$356.21,$0.00
AR-13100T-09.0,SUP,HCPCS C1713,,AR-13100T-09.0  -  PLATE BN 9MM STRL TI KN FEM 6.5MM CANC 4.5MM CORT SCR OPN,"$2,237.50",$0.00,"$2,237.50","$1,006.88","$1,596.90",$0.00,$385.51,$0.00,$0.00,$391.77,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$350.17,$0.00,$356.21,$0.00
AR-13100T-10.0,SUP,HCPCS C1713,,AR-13100T-10.0  -  PLATE BN 10MM STRL TI KN FEM 6.5MM CANC 4.5MM CORT SCR OPN,"$2,237.50",$0.00,"$2,237.50","$1,006.88","$1,596.90",$0.00,$385.51,$0.00,$0.00,$391.77,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$350.17,$0.00,$356.21,$0.00
AR-13100T-11.0,SUP,HCPCS C1713,,AR-13100T-11.0  -  PLATE BN 11MM STRL TI KN FEM 6.5MM CANC 4.5MM CORT SCR OPN,"$2,237.50",$0.00,"$2,237.50","$1,006.88","$1,596.90",$0.00,$385.51,$0.00,$0.00,$391.77,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$350.17,$0.00,$356.21,$0.00
AR-13100T-12.5,SUP,HCPCS C1713,,AR-13100T-12.5  -  PLATE BN 12.5MM STRL TI KN FEM 6.5MM CANC 4.5MM CORT SCR OPN,"$2,237.50",$0.00,"$2,237.50","$1,006.88","$1,596.90",$0.00,$385.51,$0.00,$0.00,$391.77,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$350.17,$0.00,$356.21,$0.00
AR-13100T-15.0,SUP,HCPCS C1713,,AR-13100T-15.0  -  PLATE BN 15MM STRL TI KN FEM 6.5MM CANC 4.5MM CORT SCR OPN,"$2,237.50",$0.00,"$2,237.50","$1,006.88","$1,596.90",$0.00,$385.51,$0.00,$0.00,$391.77,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$350.17,$0.00,$356.21,$0.00
AR-13100T-17.5,SUP,HCPCS C1713,,AR-13100T-17.5  -  PLATE BN 17.5MM STRL TI KN FEM 6.5MM CANC 4.5MM CORT SCR OPN,"$2,237.50",$0.00,"$2,237.50","$1,006.88","$1,596.90",$0.00,$385.51,$0.00,$0.00,$391.77,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$350.17,$0.00,$356.21,$0.00
AR-13120G-2,SUP,Custom 27203010,,AR-13120G-2  -  GUIDE DRL MN LOPRFL D 2.4MM SCR,"$1,125.00",$0.00,"$1,125.00",$0.00,$802.91,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-13120T-10,SUP,HCPCS C1713,,AR-13120T-10  -  SCREW BN 1.5MM FT HEX 2.3MM 10MM STRL LOPRFL SCR SLF DRL ST,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-13120T-10C,SUP,HCPCS C1713,,AR-13120T-10C  -  SCREW BN 1.5MM P/T HEX 2.3MM 10MM STRL LOPRFL SCR LG CNN ST,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-13120T-10S,SUP,HCPCS C1713,,AR-13120T-10S  -  SCREW BN 2.3MM 10MM STRL ARTHX LOPRFL CORT,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-13120T-11,SUP,HCPCS C1713,,AR-13120T-11  -  SCREW BN 1.5MM HEX FT 2.3MM 11MM STRL LOPRFL SCR SLF DRL ST,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-13120T-11S,SUP,HCPCS C1713,,AR-13120T-11S  -  SCREW BN 2.3MM 11MM STRL ARTHX LOPRFL CORT,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-13120T-12,SUP,HCPCS C1713,,AR-13120T-12  -  SCREW BN 1.5MM FT HEX 2.3MM 12MM STRL LOPRFL SCR SLF DRL ST,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-13120T-12C,SUP,HCPCS C1713,,AR-13120T-12C  -  SCREW BN 1.5MM P/T HEX 2.3MM 12MM STRL LOPRFL SCR LG CNN ST,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-13120T-12S,SUP,HCPCS C1713,,AR-13120T-12S  -  SCREW BN 2.3MM 12MM STRL ARTHX LOPRFL CORT,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-13120T-13,SUP,HCPCS C1713,,AR-13120T-13  -  SCREW BN 1.5MM HEX FT 2.3MM 13MM STRL LOPRFL SCR SLF DRL ST,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-13120T-13S,SUP,HCPCS C1713,,AR-13120T-13S  -  SCREW BN 2.3MM 13MM STRL ARTHX LOPRFL CORT,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-13120T-14,SUP,HCPCS C1713,,AR-13120T-14  -  SCREW BN 1.5MM FT HEX 2.3MM 14MM STRL LOPRFL SCR SLF DRL ST,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-13120T-14C,SUP,HCPCS C1713,,AR-13120T-14C  -  SCREW BN 1.5MM P/T HEX 2.3MM 14MM STRL LOPRFL SCR LG CNN ST,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-13120T-14S,SUP,HCPCS C1713,,AR-13120T-14S  -  SCREW BN 2.3MM 14MM STRL ARTHX LOPRFL CORT,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-13120T-15,SUP,HCPCS C1713,,AR-13120T-15  -  SCREW BN 1.5MM HEX FT 2.3MM 15MM STRL LOPRFL SCR SLF DRL ST,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-13120T-15S,SUP,HCPCS C1713,,AR-13120T-15S  -  SCREW BN 2.3MM 15MM STRL ARTHX LOPRFL CORT,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-13120T-16,SUP,HCPCS C1713,,AR-13120T-16  -  SCREW BN 1.5MM FT HEX 2.3MM 16MM STRL LOPRFL SCR SLF DRL ST,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-13120T-16C,SUP,HCPCS C1713,,AR-13120T-16C  -  SCREW BN 1.5MM P/T HEX 2.3MM 16MM STRL LOPRFL SCR LG CNN ST,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-13120T-16S,SUP,HCPCS C1713,,AR-13120T-16S  -  SCREW BN 2.3MM 16MM STRL ARTHX LOPRFL CORT,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-13120T-17,SUP,HCPCS C1713,,AR-13120T-17  -  SCREW BN 1.5MM HEX FT 2.3MM 17MM STRL LOPRFL SCR SLF DRL ST,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-13120T-17S,SUP,HCPCS C1713,,AR-13120T-17S  -  SCREW BN 2.3MM 17MM STRL ARTHX LOPRFL CORT,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-13120T-18,SUP,HCPCS C1713,,AR-13120T-18  -  SCREW BN 1.5MM FT HEX 2.3MM 18MM STRL LOPRFL SCR SLF DRL ST,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-13120T-18C,SUP,HCPCS C1713,,AR-13120T-18C  -  SCREW BN 1.5MM P/T HEX 2.3MM 18MM STRL LOPRFL SCR LG CNN ST,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-13120T-18S,SUP,HCPCS C1713,,AR-13120T-18S  -  SCREW BN 2.3MM 18MM STRL ARTHX LOPRFL CORT,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-13120T-19,SUP,HCPCS C1713,,AR-13120T-19  -  SCREW BN 1.5MM HEX FT 2.3MM 19MM STRL LOPRFL SCR SLF DRL ST,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-13120T-19S,SUP,HCPCS C1713,,AR-13120T-19S  -  SCREW BN 2.3MM 19MM STRL ARTHX LOPRFL CORT,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-13120T-20,SUP,HCPCS C1713,,AR-13120T-20  -  SCREW BN 1.5MM FT HEX 2.3MM 20MM STRL LOPRFL SCR SLF DRL ST,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-13120T-20C,SUP,HCPCS C1713,,AR-13120T-20C  -  SCREW BN 1.5MM P/T HEX 2.3MM 20MM STRL LOPRFL SCR LG CNN ST,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-13120T-20S,SUP,HCPCS C1713,,AR-13120T-20S  -  SCREW BN 2.3MM 20MM STRL ARTHX LOPRFL CORT,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-13120T-21,SUP,HCPCS C1713,,AR-13120T-21  -  SCREW BN 1.5MM HEX FT 2.3MM 21MM STRL LOPRFL SCR SLF DRL ST,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-13120T-21S,SUP,HCPCS C1713,,AR-13120T-21S  -  SCREW BN 2.3MM 21MM STRL ARTHX LOPRFL CORT,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-13120T-22,SUP,HCPCS C1713,,AR-13120T-22  -  SCREW BN 1.5MM FT HEX 2.3MM 22MM STRL LOPRFL SCR SLF DRL ST,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-13120T-22C,SUP,HCPCS C1713,,AR-13120T-22C  -  SCREW BN 1.5MM P/T HEX 2.3MM 22MM STRL LOPRFL SCR LG CNN ST,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-13120T-22S,SUP,HCPCS C1713,,AR-13120T-22S  -  SCREW BN 2.3MM 22MM STRL ARTHX LOPRFL CORT,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-13120T-23,SUP,HCPCS C1713,,AR-13120T-23  -  SCREW BN 1.5MM HEX FT 2.3MM 23MM STRL LOPRFL SCR SLF DRL ST,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-13120T-23S,SUP,HCPCS C1713,,AR-13120T-23S  -  SCREW BN 2.3MM 23MM STRL ARTHX LOPRFL CORT,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-13120T-24,SUP,HCPCS C1713,,AR-13120T-24  -  SCREW BN 1.5MM FT HEX 2.3MM 24MM STRL LOPRFL SCR SLF DRL ST,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-13120T-24C,SUP,HCPCS C1713,,AR-13120T-24C  -  SCREW BN 1.5MM P/T HEX 2.3MM 24MM STRL LOPRFL SCR LG CNN ST,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-13120T-24S,SUP,HCPCS C1713,,AR-13120T-24S  -  SCREW BN 2.3MM 24MM STRL ARTHX LOPRFL CORT,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-13120T-25,SUP,HCPCS C1713,,AR-13120T-25  -  SCREW BN 1.5MM HEX FT 2.3MM 25MM STRL LOPRFL SCR SLF DRL ST,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-13120T-25S,SUP,HCPCS C1713,,AR-13120T-25S  -  SCREW BN 2.3MM 25MM STRL ARTHX LOPRFL CORT,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-13120T-26,SUP,HCPCS C1713,,AR-13120T-26  -  SCREW BN 1.5MM FT HEX 2.3MM 26MM STRL LOPRFL SCR SLF DRL ST,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-13120T-26C,SUP,HCPCS C1713,,AR-13120T-26C  -  SCREW BN 1.5MM P/T HEX 2.3MM 26MM STRL LOPRFL SCR LG CNN ST,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-13120T-26S,SUP,HCPCS C1713,,AR-13120T-26S  -  SCREW BN 2.3MM 26MM STRL ARTHX LOPRFL CORT,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-13120T-27,SUP,HCPCS C1713,,AR-13120T-27  -  SCREW BN 1.5MM HEX FT 2.3MM 27MM STRL LOPRFL SCR SLF DRL ST,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-13120T-27S,SUP,HCPCS C1713,,AR-13120T-27S  -  SCREW BN 2.3MM 27MM STRL ARTHX LOPRFL CORT,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-13120T-28,SUP,HCPCS C1713,,AR-13120T-28  -  SCREW BN 1.5MM FT HEX 2.3MM 28MM STRL LOPRFL SCR SLF DRL ST,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-13120T-28C,SUP,HCPCS C1713,,AR-13120T-28C  -  SCREW BN 1.5MM P/T HEX 2.3MM 28MM STRL LOPRFL SCR LG CNN ST,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-13120T-28S,SUP,HCPCS C1713,,AR-13120T-28S  -  SCREW BN 2.3MM 28MM STRL ARTHX LOPRFL CORT,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-13120T-29,SUP,HCPCS C1713,,AR-13120T-29  -  SCREW BN 1.5MM HEX FT 2.3MM 29MM STRL LOPRFL SCR SLF DRL ST,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-13120T-29S,SUP,HCPCS C1713,,AR-13120T-29S  -  SCREW BN 2.3MM 29MM STRL ARTHX LOPRFL CORT,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-13120T-30,SUP,HCPCS C1713,,AR-13120T-30  -  SCREW BN 1.5MM FT HEX 2.3MM 30MM STRL LOPRFL SCR SLF DRL ST,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-13120T-30C,SUP,HCPCS C1713,,AR-13120T-30C  -  SCREW BN 1.5MM P/T HEX 2.3MM 30MM STRL LOPRFL SCR LG CNN ST,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-13120T-30S,SUP,HCPCS C1713,,AR-13120T-30S  -  SCREW BN 2.3MM 30MM STRL ARTHX LOPRFL CORT,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-13123-08,SUP,HCPCS C1713,,AR-13123-08  -  SCREW BN 2.3MM 8MM SS CORT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
AR-13123-10,SUP,HCPCS C1713,,AR-13123-10  -  SCREW BN 2.3MM 10MM STRL LOPRFL SCR SLD SS SM BN CORT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
AR-13123-12,SUP,HCPCS C1713,,AR-13123-12  -  SCREW BN 2.3MM 12MM STRL LOPRFL SCR SLD SS SM BN CORT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
AR-13123-14,SUP,HCPCS C1713,,AR-13123-14  -  SCREW BN 2.3MM 14MM STRL LOPRFL SCR SLD SS SM BN CORT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
AR-13123-16,SUP,HCPCS C1713,,AR-13123-16  -  SCREW BN 2.3MM 16MM STRL LOPRFL SCR SLD SS SM BN CORT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
AR-13123-18,SUP,HCPCS C1713,,AR-13123-18  -  SCREW BN 2.3MM 18MM STRL LOPRFL SCR SLD SS SM BN CORT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
AR-13123-20,SUP,HCPCS C1713,,AR-13123-20  -  SCREW BN 2.3MM 20MM STRL LOPRFL SCR SLD SS SM BN CORT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
AR-13123-22,SUP,HCPCS C1713,,AR-13123-22  -  SCREW BN 2.3MM 22MM STRL LOPRFL SCR SLD SS SM BN CORT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
AR-13123-24,SUP,HCPCS C1713,,AR-13123-24  -  SCREW BN 2.3MM 24MM SS CORT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
AR-1318FT,SUP,HCPCS C1713,,AR-1318FT  -  ANCHOR SUTURE 2-0 3/8 CIR MICRO FULTHD TAPER 2.2MM 4MM 17.9,$712.50,$0.00,$712.50,$320.63,$508.51,$0.00,$122.76,$0.00,$0.00,$124.75,$712.50,$0.00,$356.25,$564.30,$570.00,$0.00,$111.51,$0.00,$113.43,$0.00
AR-1318FT-40,SUP,HCPCS C1713,,AR-1318FT-40  -  ANCHOR SUTURE 4-0 3/8 CIR MICRO FULTHD TAPER 2.2MM 4MM 12.3,"$1,020.00",$0.00,"$1,020.00",$459.00,$727.97,$0.00,$175.74,$0.00,$0.00,$178.59,"$1,020.00",$0.00,$510.00,$807.84,$816.00,$0.00,$159.63,$0.00,$162.38,$0.00
AR-1319FT,SUP,HCPCS C1713,,AR-1319FT  -  ANCHOR SUTURE 2-0 3/8 CIR MINI FULTHD TAPER 2.7MM 7MM 17.9MM,$712.50,$0.00,$712.50,$320.63,$508.51,$0.00,$122.76,$0.00,$0.00,$124.75,$712.50,$0.00,$356.25,$564.30,$570.00,$0.00,$111.51,$0.00,$113.43,$0.00
AR-13200-03.0,SUP,HCPCS C1713,,AR-13200-03.0  -  PLATE BN 3MM STRL SS TIB OPN WDG OSTM,"$1,300.00",$0.00,"$1,300.00",$585.00,$927.81,$0.00,$223.98,$0.00,$0.00,$227.62,"$1,300.00",$0.00,$650.00,"$1,029.60","$1,040.00",$0.00,$203.45,$0.00,$206.96,$0.00
AR-13200-03.0S,SUP,HCPCS C1713,,AR-13200-03.0S  -  PLATE BN 3MM STRL ARTHX TIB OPN WDG OSTM,$345.00,$0.00,$345.00,$155.25,$246.23,$0.00,$59.44,$0.00,$0.00,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
AR-13200-05.0,SUP,HCPCS C1713,,AR-13200-05.0  -  PLATE BN 5MM STRL SS TIB OPN WDG OSTM,"$1,300.00",$0.00,"$1,300.00",$585.00,$927.81,$0.00,$223.98,$0.00,$0.00,$227.62,"$1,300.00",$0.00,$650.00,"$1,029.60","$1,040.00",$0.00,$203.45,$0.00,$206.96,$0.00
AR-13200-05.0S,SUP,HCPCS C1713,,AR-13200-05.0S  -  PLATE BN 5MM STRL ARTHX TIB OPN WDG OSTM,$345.00,$0.00,$345.00,$155.25,$246.23,$0.00,$59.44,$0.00,$0.00,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
AR-13200-06.0,SUP,HCPCS C1713,,AR-13200-06.0  -  PLATE BN 6MM STRL SS TIB OPN WDG OSTM,"$1,300.00",$0.00,"$1,300.00",$585.00,$927.81,$0.00,$223.98,$0.00,$0.00,$227.62,"$1,300.00",$0.00,$650.00,"$1,029.60","$1,040.00",$0.00,$203.45,$0.00,$206.96,$0.00
AR-13200-06.0S,SUP,HCPCS C1713,,AR-13200-06.0S  -  PLATE BN 6MM STRL ARTHX TIB OPN WDG OSTM,$345.00,$0.00,$345.00,$155.25,$246.23,$0.00,$59.44,$0.00,$0.00,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
AR-13200-07.5,SUP,HCPCS C1713,,AR-13200-07.5  -  PLATE BN 7.5MM STRL SS TIB OPN WDG OSTM,"$1,300.00",$0.00,"$1,300.00",$585.00,$927.81,$0.00,$223.98,$0.00,$0.00,$227.62,"$1,300.00",$0.00,$650.00,"$1,029.60","$1,040.00",$0.00,$203.45,$0.00,$206.96,$0.00
AR-13200-07.5S,SUP,HCPCS C1713,,AR-13200-07.5S  -  PLATE BN 7.5MM STRL ARTHX TIB OPN WDG OSTM,$345.00,$0.00,$345.00,$155.25,$246.23,$0.00,$59.44,$0.00,$0.00,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
AR-13200-09.0,SUP,HCPCS C1713,,AR-13200-09.0  -  PLATE BN 9MM STRL SS TIB OPN WDG OSTM,"$1,300.00",$0.00,"$1,300.00",$585.00,$927.81,$0.00,$223.98,$0.00,$0.00,$227.62,"$1,300.00",$0.00,$650.00,"$1,029.60","$1,040.00",$0.00,$203.45,$0.00,$206.96,$0.00
AR-13200-09.0S,SUP,HCPCS C1713,,AR-13200-09.0S  -  PLATE BN 9MM STRL ARTHX TIB OPN WDG OSTM,$345.00,$0.00,$345.00,$155.25,$246.23,$0.00,$59.44,$0.00,$0.00,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
AR-13200-10.0,SUP,HCPCS C1713,,AR-13200-10.0  -  PLATE BN 10MM STRL SS TIB OPN WDG OSTM,"$1,300.00",$0.00,"$1,300.00",$585.00,$927.81,$0.00,$223.98,$0.00,$0.00,$227.62,"$1,300.00",$0.00,$650.00,"$1,029.60","$1,040.00",$0.00,$203.45,$0.00,$206.96,$0.00
AR-13200-10.0S,SUP,HCPCS C1713,,AR-13200-10.0S  -  PLATE BN 10MM STRL ARTHX TIB OPN WDG OSTM,$345.00,$0.00,$345.00,$155.25,$246.23,$0.00,$59.44,$0.00,$0.00,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
AR-13200-11.0,SUP,HCPCS C1713,,AR-13200-11.0  -  PLATE BN 11MM STRL SS TIB OPN WDG OSTM,"$1,300.00",$0.00,"$1,300.00",$585.00,$927.81,$0.00,$223.98,$0.00,$0.00,$227.62,"$1,300.00",$0.00,$650.00,"$1,029.60","$1,040.00",$0.00,$203.45,$0.00,$206.96,$0.00
AR-13200-11.0S,SUP,HCPCS C1713,,AR-13200-11.0S  -  PLATE BN 11MM STRL ARTHX TIB OPN WDG OSTM,$345.00,$0.00,$345.00,$155.25,$246.23,$0.00,$59.44,$0.00,$0.00,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
AR-13200-12.5,SUP,HCPCS C1713,,AR-13200-12.5  -  PLATE BN 12.5MM STRL SS TIB OPN WDG OSTM,"$1,300.00",$0.00,"$1,300.00",$585.00,$927.81,$0.00,$223.98,$0.00,$0.00,$227.62,"$1,300.00",$0.00,$650.00,"$1,029.60","$1,040.00",$0.00,$203.45,$0.00,$206.96,$0.00
AR-13200-12.5S,SUP,HCPCS C1713,,AR-13200-12.5S  -  PLATE BN 12.5MM STRL ARTHX TIB OPN WDG OSTM,$345.00,$0.00,$345.00,$155.25,$246.23,$0.00,$59.44,$0.00,$0.00,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
AR-13200-13.5,SUP,HCPCS C1713,,AR-13200-13.5  -  PLATE BN 13.5MM STRL SS TIB OPN WDG OSTM,"$1,300.00",$0.00,"$1,300.00",$585.00,$927.81,$0.00,$223.98,$0.00,$0.00,$227.62,"$1,300.00",$0.00,$650.00,"$1,029.60","$1,040.00",$0.00,$203.45,$0.00,$206.96,$0.00
AR-13200-13.5S,SUP,HCPCS C1713,,AR-13200-13.5S  -  PLATE BN 13.5MM STRL ARTHX TIB OPN WDG OSTM,$345.00,$0.00,$345.00,$155.25,$246.23,$0.00,$59.44,$0.00,$0.00,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
AR-13200-15.0,SUP,HCPCS C1713,,AR-13200-15.0  -  PLATE BN 15MM STRL SS TIB OPN WDG OSTM,"$1,300.00",$0.00,"$1,300.00",$585.00,$927.81,$0.00,$223.98,$0.00,$0.00,$227.62,"$1,300.00",$0.00,$650.00,"$1,029.60","$1,040.00",$0.00,$203.45,$0.00,$206.96,$0.00
AR-13200-15.0S,SUP,HCPCS C1713,,AR-13200-15.0S  -  PLATE BN 15MM STRL ARTHX TIB OPN WDG OSTM,$345.00,$0.00,$345.00,$155.25,$246.23,$0.00,$59.44,$0.00,$0.00,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
AR-13200-16.0,SUP,HCPCS C1713,,AR-13200-16.0  -  PLATE BN 16MM STRL SS TIB OPN WDG OSTM,"$1,300.00",$0.00,"$1,300.00",$585.00,$927.81,$0.00,$223.98,$0.00,$0.00,$227.62,"$1,300.00",$0.00,$650.00,"$1,029.60","$1,040.00",$0.00,$203.45,$0.00,$206.96,$0.00
AR-13200-16.0S,SUP,HCPCS C1713,,AR-13200-16.0S  -  PLATE BN 16MM STRL ARTHX TIB OPN WDG OSTM,$345.00,$0.00,$345.00,$155.25,$246.23,$0.00,$59.44,$0.00,$0.00,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
AR-13200-17.5,SUP,HCPCS C1713,,AR-13200-17.5  -  PLATE BN 17.5MM STRL SS TIB OPN WDG OSTM,"$1,300.00",$0.00,"$1,300.00",$585.00,$927.81,$0.00,$223.98,$0.00,$0.00,$227.62,"$1,300.00",$0.00,$650.00,"$1,029.60","$1,040.00",$0.00,$203.45,$0.00,$206.96,$0.00
AR-13200-17.5S,SUP,HCPCS C1713,,AR-13200-17.5S  -  PLATE BN 17.5MM STRL ARTHX TIB OPN WDG OSTM,$345.00,$0.00,$345.00,$155.25,$246.23,$0.00,$59.44,$0.00,$0.00,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
AR-13200D-05,SUP,HCPCS C1713,,AR-13200D-05  -  PLATE BN LOPRFL 5MM STRL SS TIB DIST 3.5-4MM SCR OPN WDG,"$1,300.00",$0.00,"$1,300.00",$585.00,$927.81,$0.00,$223.98,$0.00,$0.00,$227.62,"$1,300.00",$0.00,$650.00,"$1,029.60","$1,040.00",$0.00,$203.45,$0.00,$206.96,$0.00
AR-13200D-06,SUP,HCPCS C1713,,AR-13200D-06  -  PLATE BN LOPRFL 6MM STRL SS TIB DIST 3.5-4MM SCR OPN WDG,"$1,300.00",$0.00,"$1,300.00",$585.00,$927.81,$0.00,$223.98,$0.00,$0.00,$227.62,"$1,300.00",$0.00,$650.00,"$1,029.60","$1,040.00",$0.00,$203.45,$0.00,$206.96,$0.00
AR-13200D-07,SUP,HCPCS C1713,,AR-13200D-07  -  PLATE BN LOPRFL 7MM STRL SS TIB DIST 3.5-4MM SCR OPN WDG,"$1,300.00",$0.00,"$1,300.00",$585.00,$927.81,$0.00,$223.98,$0.00,$0.00,$227.62,"$1,300.00",$0.00,$650.00,"$1,029.60","$1,040.00",$0.00,$203.45,$0.00,$206.96,$0.00
AR-13200D-08,SUP,HCPCS C1713,,AR-13200D-08  -  PLATE BN LOPRFL 8MM STRL SS TIB DIST 3.5-4MM SCR OPN WDG,"$1,300.00",$0.00,"$1,300.00",$585.00,$927.81,$0.00,$223.98,$0.00,$0.00,$227.62,"$1,300.00",$0.00,$650.00,"$1,029.60","$1,040.00",$0.00,$203.45,$0.00,$206.96,$0.00
AR-13200D-09,SUP,HCPCS C1713,,AR-13200D-09  -  PLATE BN LOPRFL 9MM STRL SS TIB DIST 3.5-4MM SCR OPN WDG,"$1,300.00",$0.00,"$1,300.00",$585.00,$927.81,$0.00,$223.98,$0.00,$0.00,$227.62,"$1,300.00",$0.00,$650.00,"$1,029.60","$1,040.00",$0.00,$203.45,$0.00,$206.96,$0.00
AR-13200D-10,SUP,HCPCS C1713,,AR-13200D-10  -  PLATE BN LOPRFL 10MM STRL SS TIB DIST 3.5-4MM SCR OPN WDG,"$1,300.00",$0.00,"$1,300.00",$585.00,$927.81,$0.00,$223.98,$0.00,$0.00,$227.62,"$1,300.00",$0.00,$650.00,"$1,029.60","$1,040.00",$0.00,$203.45,$0.00,$206.96,$0.00
AR-13200DC,SUP,HCPCS C1713,,AR-13200DC  -  PLATE BN LOPRFL SS TIB DIST 3.5/4MM SCR CLS WDG OSTM,"$1,300.00",$0.00,"$1,300.00",$585.00,$927.81,$0.00,$223.98,$0.00,$0.00,$227.62,"$1,300.00",$0.00,$650.00,"$1,029.60","$1,040.00",$0.00,$203.45,$0.00,$206.96,$0.00
AR-13200M,SUP,HCPCS C1713,,AR-13200M  -  PLATE BN L FLT TI METATARSUS 2.4MM SCR,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-13200M-025L,SUP,HCPCS C1713,,AR-13200M-025L  -  PLATE BN L LOPRFL 2.5MM TI METATARSUS LT 2.4MM SCR OPN WDG,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-13200M-025R,SUP,HCPCS C1713,,AR-13200M-025R  -  PLATE BN L LOPRFL 2.5MM TI METATARSUS RT 2.4MM SCR OPN WDG,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-13200M-02L,SUP,HCPCS C1713,,AR-13200M-02L  -  PLATE BN L LOPRFL 2MM TI METATARSUS LT 2.4MM SCR OPN WDG,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-13200M-02R,SUP,HCPCS C1713,,AR-13200M-02R  -  PLATE BN L LOPRFL 2MM TI METATARSUS RT 2.4MM SCR OPN WDG,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-13200M-035L,SUP,HCPCS C1713,,AR-13200M-035L  -  PLATE BN L LOPRFL 3.5MM TI METATARSUS LT 2.4MM SCR OPN WDG,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-13200M-035R,SUP,HCPCS C1713,,AR-13200M-035R  -  PLATE BN L LOPRFL 3.5MM TI METATARSUS RT 2.4MM SCR OPN WDG,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-13200M-03L,SUP,HCPCS C1713,,AR-13200M-03L  -  PLATE BN L LOPRFL 3MM TI METATARSUS LT 2.4MM SCR OPN WDG,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-13200M-03R,SUP,HCPCS C1713,,AR-13200M-03R  -  PLATE BN L LOPRFL 3MM TI METATARSUS RT 2.4MM SCR OPN WDG,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-13200M-045L,SUP,HCPCS C1713,,AR-13200M-045L  -  PLATE BN L LOPRFL 4.5MM TI METATARSUS LT 2.4MM SCR OPN WDG,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-13200M-045R,SUP,HCPCS C1713,,AR-13200M-045R  -  PLATE BN L LOPRFL 4.5MM TI METATARSUS RT 2.4MM SCR OPN WDG,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-13200M-04L,SUP,HCPCS C1713,,AR-13200M-04L  -  PLATE BN L LOPRFL 4MM TI METATARSUS LT 2.4MM SCR OPN WDG,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-13200M-04R,SUP,HCPCS C1713,,AR-13200M-04R  -  PLATE BN L LOPRFL 4MM TI METATARSUS RT 2.4MM SCR OPN WDG,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-13200M-055L,SUP,HCPCS C1713,,AR-13200M-055L  -  PLATE BN L LOPRFL 5.5MM TI METATARSUS LT 2.4MM SCR OPN WDG,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-13200M-055R,SUP,HCPCS C1713,,AR-13200M-055R  -  PLATE BN L LOPRFL 5.5MM TI METATARSUS RT 2.4MM SCR OPN WDG,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-13200M-05L,SUP,HCPCS C1713,,AR-13200M-05L  -  PLATE BN L LOPRFL 5MM TI METATARSUS LT 2.4MM SCR OPN WDG,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-13200M-05R,SUP,HCPCS C1713,,AR-13200M-05R  -  PLATE BN L LOPRFL 5MM TI METATARSUS RT 2.4MM SCR OPN WDG,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-13200M-065L,SUP,HCPCS C1713,,AR-13200M-065L  -  PLATE BN L LOPRFL 6.5MM TI METATARSUS LT 2.4MM SCR OPN WDG,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-13200M-065R,SUP,HCPCS C1713,,AR-13200M-065R  -  PLATE BN L LOPRFL 6.5MM TI METATARSUS RT 2.4MM SCR OPN WDG,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-13200M-06L,SUP,HCPCS C1713,,AR-13200M-06L  -  PLATE BN L LOPRFL 6MM TI METATARSUS LT 2.4MM SCR OPN WDG,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-13200M-06R,SUP,HCPCS C1713,,AR-13200M-06R  -  PLATE BN L LOPRFL 6MM TI METATARSUS RT 2.4MM SCR OPN WDG,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-13200M-075L,SUP,HCPCS C1713,,AR-13200M-075L  -  PLATE BN 32219095 7.5MM NS ARTHX LOPRFL OPN WDG TI,"$1,237.50",$0.00,"$1,237.50",$556.88,$883.20,$0.00,$213.22,$0.00,$0.00,$216.68,"$1,237.50",$0.00,$618.75,$980.10,$990.00,$0.00,$193.67,$0.00,$197.01,$0.00
AR-13200M-075R,SUP,HCPCS C1713,,AR-13200M-075R  -  PLATE BN 7.5MM NS ARTHX LOPRFL OPN WDG TI METATARSUS RT,"$1,237.50",$0.00,"$1,237.50",$556.88,$883.20,$0.00,$213.22,$0.00,$0.00,$216.68,"$1,237.50",$0.00,$618.75,$980.10,$990.00,$0.00,$193.67,$0.00,$197.01,$0.00
AR-13200M-07L,SUP,HCPCS C1713,,AR-13200M-07L  -  PLATE BN L LOPRFL 7MM TI METATARSUS LT 2.4MM SCR OPN WDG,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-13200M-07R,SUP,HCPCS C1713,,AR-13200M-07R  -  PLATE BN L LOPRFL 7MM TI METATARSUS RT 2.4MM SCR OPN WDG,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-13200PA-05.0,SUP,HCPCS C1713,,AR-13200PA-05.0  -  PLATE BN 5MM ANTEROPOSTERIOR SLOP SS TIB 6.5MM CANC 4.5MM,"$1,300.00",$0.00,"$1,300.00",$585.00,$927.81,$0.00,$223.98,$0.00,$0.00,$227.62,"$1,300.00",$0.00,$650.00,"$1,029.60","$1,040.00",$0.00,$203.45,$0.00,$206.96,$0.00
AR-13200PA-06.0,SUP,HCPCS C1713,,AR-13200PA-06.0  -  PLATE BN 6MM ANTEROPOSTERIOR SLOP SS TIB 6.5MM CANC 4.5MM,"$1,300.00",$0.00,"$1,300.00",$585.00,$927.81,$0.00,$223.98,$0.00,$0.00,$227.62,"$1,300.00",$0.00,$650.00,"$1,029.60","$1,040.00",$0.00,$203.45,$0.00,$206.96,$0.00
AR-13200PA-07.5,SUP,HCPCS C1713,,AR-13200PA-07.5  -  PLATE BN 7.5MM ANTEROPOSTERIOR SLOP SS TIB 6.5MM CANC 4.5MM,"$1,300.00",$0.00,"$1,300.00",$585.00,$927.81,$0.00,$223.98,$0.00,$0.00,$227.62,"$1,300.00",$0.00,$650.00,"$1,029.60","$1,040.00",$0.00,$203.45,$0.00,$206.96,$0.00
AR-13200PA-09.0,SUP,HCPCS C1713,,AR-13200PA-09.0  -  PLATE BN 9MM ANTEROPOSTERIOR SLOP SS TIB 6.5MM CANC 4.5MM,"$1,300.00",$0.00,"$1,300.00",$585.00,$927.81,$0.00,$223.98,$0.00,$0.00,$227.62,"$1,300.00",$0.00,$650.00,"$1,029.60","$1,040.00",$0.00,$203.45,$0.00,$206.96,$0.00
AR-13200PA-10.0,SUP,HCPCS C1713,,AR-13200PA-10.0  -  PLATE BN 10MM ANTEROPOSTERIOR SLOP SS TIB 6.5MM CANC 4.5MM,"$1,300.00",$0.00,"$1,300.00",$585.00,$927.81,$0.00,$223.98,$0.00,$0.00,$227.62,"$1,300.00",$0.00,$650.00,"$1,029.60","$1,040.00",$0.00,$203.45,$0.00,$206.96,$0.00
AR-13200PA-11.0,SUP,HCPCS C1713,,AR-13200PA-11.0  -  PLATE BN 11MM ANTEROPOSTERIOR SLOP SS TIB 6.5MM CANC 4.5MM,"$1,300.00",$0.00,"$1,300.00",$585.00,$927.81,$0.00,$223.98,$0.00,$0.00,$227.62,"$1,300.00",$0.00,$650.00,"$1,029.60","$1,040.00",$0.00,$203.45,$0.00,$206.96,$0.00
AR-13200PA-12.5,SUP,HCPCS C1713,,AR-13200PA-12.5  -  PLATE BN 12.5MM ANTEROPOSTERIOR SLOP SS TIB 6.5MM CANC 4.5MM,"$1,300.00",$0.00,"$1,300.00",$585.00,$927.81,$0.00,$223.98,$0.00,$0.00,$227.62,"$1,300.00",$0.00,$650.00,"$1,029.60","$1,040.00",$0.00,$203.45,$0.00,$206.96,$0.00
AR-13200PA-13.5,SUP,HCPCS C1713,,AR-13200PA-13.5  -  PLATE BN 13.5MM ANTEROPOSTERIOR SLOP SS TIB 6.5MM CANC 4.5MM,"$1,300.00",$0.00,"$1,300.00",$585.00,$927.81,$0.00,$223.98,$0.00,$0.00,$227.62,"$1,300.00",$0.00,$650.00,"$1,029.60","$1,040.00",$0.00,$203.45,$0.00,$206.96,$0.00
AR-13200PA-15.0,SUP,HCPCS C1713,,AR-13200PA-15.0  -  PLATE BN 15MM ANTEROPOSTERIOR SLOP SS TIB 6.5MM CANC 4.5MM,"$1,300.00",$0.00,"$1,300.00",$585.00,$927.81,$0.00,$223.98,$0.00,$0.00,$227.62,"$1,300.00",$0.00,$650.00,"$1,029.60","$1,040.00",$0.00,$203.45,$0.00,$206.96,$0.00
AR-13200PA-16.0,SUP,HCPCS C1713,,AR-13200PA-16.0  -  PLATE BN 16MM ANTEROPOSTERIOR SLOP SS TIB 6.5MM CANC 4.5MM,"$1,300.00",$0.00,"$1,300.00",$585.00,$927.81,$0.00,$223.98,$0.00,$0.00,$227.62,"$1,300.00",$0.00,$650.00,"$1,029.60","$1,040.00",$0.00,$203.45,$0.00,$206.96,$0.00
AR-13200PA-17.5,SUP,HCPCS C1713,,AR-13200PA-17.5  -  PLATE BN 17.5MM ANTEROPOSTERIOR SLOP SS TIB 6.5MM CANC 4.5MM,"$1,300.00",$0.00,"$1,300.00",$585.00,$927.81,$0.00,$223.98,$0.00,$0.00,$227.62,"$1,300.00",$0.00,$650.00,"$1,029.60","$1,040.00",$0.00,$203.45,$0.00,$206.96,$0.00
AR-13200ST-05.0,SUP,HCPCS C1713,,AR-13200ST-05.0  -  PLATE BN LOPRFL 5MM ANTEROPOSTERIOR SLOP TI TIB 6.5MM CANC,"$1,825.00",$0.00,"$1,825.00",$821.25,"$1,302.50",$0.00,$314.44,$0.00,$0.00,$319.54,"$1,825.00",$0.00,$912.50,"$1,445.40","$1,460.00",$0.00,$285.61,$0.00,$290.54,$0.00
AR-13200ST-07.5,SUP,HCPCS C1713,,AR-13200ST-07.5  -  PLATE BN LOPRFL 7.5MM ANTEROPOSTERIOR SLOP TI TIB 6.5MM CANC,"$1,825.00",$0.00,"$1,825.00",$821.25,"$1,302.50",$0.00,$314.44,$0.00,$0.00,$319.54,"$1,825.00",$0.00,$912.50,"$1,445.40","$1,460.00",$0.00,$285.61,$0.00,$290.54,$0.00
AR-13200ST-09.0,SUP,HCPCS C1713,,AR-13200ST-09.0  -  PLATE BN LOPRFL 9MM ANTEROPOSTERIOR SLOP TI TIB 6.5MM CANC,"$1,825.00",$0.00,"$1,825.00",$821.25,"$1,302.50",$0.00,$314.44,$0.00,$0.00,$319.54,"$1,825.00",$0.00,$912.50,"$1,445.40","$1,460.00",$0.00,$285.61,$0.00,$290.54,$0.00
AR-13200ST-10.0,SUP,HCPCS C1713,,AR-13200ST-10.0  -  PLATE BN LOPRFL 10MM ANTEROPOSTERIOR SLOP TI TIB 6.5MM CANC,"$1,825.00",$0.00,"$1,825.00",$821.25,"$1,302.50",$0.00,$314.44,$0.00,$0.00,$319.54,"$1,825.00",$0.00,$912.50,"$1,445.40","$1,460.00",$0.00,$285.61,$0.00,$290.54,$0.00
AR-13200ST-11.0,SUP,HCPCS C1713,,AR-13200ST-11.0  -  PLATE BN LOPRFL 11MM ANTEROPOSTERIOR SLOP TI TIB 6.5MM CANC,"$1,825.00",$0.00,"$1,825.00",$821.25,"$1,302.50",$0.00,$314.44,$0.00,$0.00,$319.54,"$1,825.00",$0.00,$912.50,"$1,445.40","$1,460.00",$0.00,$285.61,$0.00,$290.54,$0.00
AR-13200ST-12.5,SUP,HCPCS C1713,,AR-13200ST-12.5  -  PLATE BN LOPRFL 12.5MM ANTEROPOSTERIOR SLOP TI TIB 6.5MM,"$1,825.00",$0.00,"$1,825.00",$821.25,"$1,302.50",$0.00,$314.44,$0.00,$0.00,$319.54,"$1,825.00",$0.00,$912.50,"$1,445.40","$1,460.00",$0.00,$285.61,$0.00,$290.54,$0.00
AR-13200ST-15.0,SUP,HCPCS C1713,,AR-13200ST-15.0  -  PLATE BN LOPRFL 15MM ANTEROPOSTERIOR SLOP TI TIB 6.5MM CANC,"$1,825.00",$0.00,"$1,825.00",$821.25,"$1,302.50",$0.00,$314.44,$0.00,$0.00,$319.54,"$1,825.00",$0.00,$912.50,"$1,445.40","$1,460.00",$0.00,$285.61,$0.00,$290.54,$0.00
AR-13200ST-17.5,SUP,HCPCS C1713,,AR-13200ST-17.5  -  PLATE BN LOPRFL 17.5MM ANTEROPOSTERIOR SLOP TI TIB 6.5MM,"$1,825.00",$0.00,"$1,825.00",$821.25,"$1,302.50",$0.00,$314.44,$0.00,$0.00,$319.54,"$1,825.00",$0.00,$912.50,"$1,445.40","$1,460.00",$0.00,$285.61,$0.00,$290.54,$0.00
AR-13200T-05.0,SUP,HCPCS C1713,,AR-13200T-05.0  -  PLATE BN LOPRFL 5MM TI TIB 6.5MM CANC 4.5MM CORT SCR OPN WDG,"$1,825.00",$0.00,"$1,825.00",$821.25,"$1,302.50",$0.00,$314.44,$0.00,$0.00,$319.54,"$1,825.00",$0.00,$912.50,"$1,445.40","$1,460.00",$0.00,$285.61,$0.00,$290.54,$0.00
AR-13200T-07.5,SUP,HCPCS C1713,,AR-13200T-07.5  -  PLATE BN LOPRFL 7.5MM TI TIB 6.5MM CANC 4.5MM CORT SCR OPN,"$1,825.00",$0.00,"$1,825.00",$821.25,"$1,302.50",$0.00,$314.44,$0.00,$0.00,$319.54,"$1,825.00",$0.00,$912.50,"$1,445.40","$1,460.00",$0.00,$285.61,$0.00,$290.54,$0.00
AR-13200T-09.0,SUP,HCPCS C1713,,AR-13200T-09.0  -  PLATE BN LOPRFL 9MM TI TIB 6.5MM CANC 4.5MM CORT SCR OPN WDG,"$1,825.00",$0.00,"$1,825.00",$821.25,"$1,302.50",$0.00,$314.44,$0.00,$0.00,$319.54,"$1,825.00",$0.00,$912.50,"$1,445.40","$1,460.00",$0.00,$285.61,$0.00,$290.54,$0.00
AR-13200T-10.0,SUP,HCPCS C1713,,AR-13200T-10.0  -  PLATE BN 10MM LOPRFL TI TIB 6.5MM CANC 4.5MM CORT SCR OPN,"$1,825.00",$0.00,"$1,825.00",$821.25,"$1,302.50",$0.00,$314.44,$0.00,$0.00,$319.54,"$1,825.00",$0.00,$912.50,"$1,445.40","$1,460.00",$0.00,$285.61,$0.00,$290.54,$0.00
AR-13200T-11.0,SUP,HCPCS C1713,,AR-13200T-11.0  -  PLATE BN LOPRFL 11MM TI TIB 6.5MM CANC 4.5MM CORT SCR OPN,"$1,825.00",$0.00,"$1,825.00",$821.25,"$1,302.50",$0.00,$314.44,$0.00,$0.00,$319.54,"$1,825.00",$0.00,$912.50,"$1,445.40","$1,460.00",$0.00,$285.61,$0.00,$290.54,$0.00
AR-13200T-12.5,SUP,HCPCS C1713,,AR-13200T-12.5  -  PLATE BN LOPRFL 12.5MM TI TIB 6.5MM CANC 4.5MM CORT SCR OPN,"$1,825.00",$0.00,"$1,825.00",$821.25,"$1,302.50",$0.00,$314.44,$0.00,$0.00,$319.54,"$1,825.00",$0.00,$912.50,"$1,445.40","$1,460.00",$0.00,$285.61,$0.00,$290.54,$0.00
AR-13200T-15.0,SUP,HCPCS C1713,,AR-13200T-15.0  -  PLATE BN LOPRFL 15MM TI TIB 6.5MM CANC 4.5MM CORT SCR OPN,"$1,825.00",$0.00,"$1,825.00",$821.25,"$1,302.50",$0.00,$314.44,$0.00,$0.00,$319.54,"$1,825.00",$0.00,$912.50,"$1,445.40","$1,460.00",$0.00,$285.61,$0.00,$290.54,$0.00
AR-13200T-17.5,SUP,HCPCS C1713,,AR-13200T-17.5  -  PLATE BN LOPRFL 17.5MM TI TIB 6.5MM CANC 4.5MM CORT SCR OPN,"$1,825.00",$0.00,"$1,825.00",$821.25,"$1,302.50",$0.00,$314.44,$0.00,$0.00,$319.54,"$1,825.00",$0.00,$912.50,"$1,445.40","$1,460.00",$0.00,$285.61,$0.00,$290.54,$0.00
AR-1320BCNF,SUP,HCPCS C1713,,AR-1320BCNF  -  ANCHOR SUT MIC NS DISP,$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
AR-1320BCNF-40,SUP,HCPCS C1713,,AR-1320BCNF-40  -  ANCHOR SUT 4-0 MIC 2 TPR 2.4MM 6.5MM NS SUT TK FBRWR BCMPS,$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
AR-1320DSC,SUP,Custom 27203010,,AR-1320DSC  -  KIT INST MIC 1.8MM 2MM STRL SUT TK BIT DRL GD PNCH SHLDR,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-13215,SUP,HCPCS C1713,,AR-13215  -  PLATE BN 30MM STRL 2 HL SPRT KN OSTM,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
AR-13217,SUP,Custom 27203010,,AR-13217  -  KIT INST CUT BLCK PIN DISP T3 AMZ,"$1,247.50",$0.00,"$1,247.50",$0.00,$890.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,247.50",$0.00,$623.75,$988.02,$998.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-13220,SUP,Custom 27203010,,AR-13220  -  DRILL BIT CNTRSNK 2.3MM AO CNCT,$125.00,$0.00,$125.00,$0.00,$89.21,$0.00,$0.00,$0.00,$0.00,$0.00,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-13220C,SUP,Custom 27203010,,AR-13220C  -  DRILL BIT CNTRSNK 2.3MM AO CNCT CNN,$375.00,$0.00,$375.00,$0.00,$267.64,$0.00,$0.00,$0.00,$0.00,$0.00,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-13220DG,SUP,Custom 27203010,,AR-13220DG  -  GUIDE DRL LOPRFL PLT,$525.00,$0.00,$525.00,$0.00,$374.69,$0.00,$0.00,$0.00,$0.00,$0.00,$525.00,$0.00,$262.50,$415.80,$420.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1322-752SF,SUP,HCPCS C1713,,AR-1322-752SF  -  ANCHOR SUT 2-0 SM 2.4MM 7.5MM STRL FSTK2 FWR BABSR HNDL,$462.50,$0.00,$462.50,$208.13,$330.09,$0.00,$79.69,$0.00,$0.00,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
AR-1322BCNF,SUP,HCPCS C1713,,AR-1322BCNF  -  ANCHOR SUT 2-0 MIC STRG FWD TPR 2.4MM 8.5MM LF BSUT TK FBRWR,$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
AR-1322D-18,SUP,Custom 27203010,,AR-1322D-18  -  DRILL SRG MN 1.8MM SUT TK,$237.50,$0.00,$237.50,$0.00,$169.50,$0.00,$0.00,$0.00,$0.00,$0.00,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1322D-20,SUP,Custom 27203010,,AR-1322D-20  -  DRILL SRG MN 2MM SUT TK,$237.50,$0.00,$237.50,$0.00,$169.50,$0.00,$0.00,$0.00,$0.00,$0.00,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1322DSC,SUP,Custom 27203010,,AR-1322DSC  -  KIT ESCP INST 2-0 MN 2.4MM 8.5MM STRL LF BSUT TK ANCH DRLBT,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1322SXF,SUP,HCPCS C1713,,AR-1322SXF  -  ANCHOR SUT 2 2.4MM 11.7MM STRL FSTK FWR BRD CNN INSRTR ST TI,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-1324B,SUP,HCPCS C1713,,AR-1324B  -  ANCHOR SUT 2 3MM 14MM STRL BFSTK TVDK BRD EYLT HNDL INSRTR,$562.50,$0.00,$562.50,$253.13,$401.46,$0.00,$96.92,$0.00,$0.00,$98.49,$562.50,$0.00,$281.25,$445.50,$450.00,$0.00,$88.03,$0.00,$89.55,$0.00
AR-1324BF,SUP,HCPCS C1713,,AR-1324BF  -  ANCHOR SUT 2 3MM 14MM STRL BFSTK FWR BRD EYLT HNDL INSRTR,$612.50,$0.00,$612.50,$275.63,$437.14,$0.00,$105.53,$0.00,$0.00,$107.24,$612.50,$0.00,$306.25,$485.10,$490.00,$0.00,$95.86,$0.00,$97.51,$0.00
AR-1324BF-2,SUP,HCPCS C1713,,AR-1324BF-2  -  ANCHOR SUT 2 3MM 11MM STRL BFSTK FWR BRD EYLT HNDL INSRTR,$650.00,$0.00,$650.00,$292.50,$463.91,$0.00,$111.99,$0.00,$0.00,$113.81,$650.00,$0.00,$325.00,$514.80,$520.00,$0.00,$101.73,$0.00,$103.48,$0.00
AR-1324D,SUP,Custom 27203010,,AR-1324D  -  DRILL SRG SPR 2.8MM FSTK II CNN TI SHLDR,$225.00,$0.00,$225.00,$0.00,$160.58,$0.00,$0.00,$0.00,$0.00,$0.00,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1324HF,SUP,HCPCS C1713,,AR-1324HF  -  ANCHOR SUT 2 2.8MM 11.7MM STRL FSTK2 FWR HNDL TI KN,$450.00,$0.00,$450.00,$202.50,$321.17,$0.00,$77.53,$0.00,$0.00,$78.79,$450.00,$0.00,$225.00,$356.40,$360.00,$0.00,$70.43,$0.00,$71.64,$0.00
AR-1324SF,SUP,HCPCS C1713,,AR-1324SF  -  ANCHOR SUT 2 2.8MM 11.7MM STRL FSTK2 FWR CNN INSRTR TI,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-13280-35,SUP,HCPCS C1713,,AR-13280-35  -  SCREW BN 6.5MM 35MM TI TIB CANC OPN WDG OSTM,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
AR-13280-40,SUP,HCPCS C1713,,AR-13280-40  -  SCREW BN 6.5MM 40MM TI TIB CANC OPN WDG OSTM,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
AR-13280-45,SUP,HCPCS C1713,,AR-13280-45  -  SCREW BN 6.5MM 45MM TI TIB CANC OPN WDG OSTM,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
AR-13280-50,SUP,HCPCS C1713,,AR-13280-50  -  SCREW BN 6.5MM 50MM TI TIB CANC OPN WDG OSTM,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
AR-13280-55,SUP,HCPCS C1713,,AR-13280-55  -  SCREW BN 6.5MM 55MM TI TIB CANC OPN WDG OSTM,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
AR-13280-60,SUP,HCPCS C1713,,AR-13280-60  -  SCREW BN 6.5MM 60MM TI TIB CANC OPN WDG OSTM,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
AR-13280-65,SUP,HCPCS C1713,,AR-13280-65  -  SCREW BN 6.5MM 65MM TI TIB CANC OPN WDG OSTM,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
AR-13280-70,SUP,HCPCS C1713,,AR-13280-70  -  SCREW BN 6.5MM 70MM TI TIB CANC OPN WDG OSTM,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
AR-13303-2.4,SUP,Custom 27203010,,AR-13303-2.4  -  GUIDE PIN ORTH 2.4MM BRKWY FEM OSTM,$92.50,$0.00,$92.50,$0.00,$66.02,$0.00,$0.00,$0.00,$0.00,$0.00,$92.50,$0.00,$46.25,$73.26,$74.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-13303-3.0,SUP,Custom 27203010,,AR-13303-3.0  -  GUIDE PIN ORTH 3MM BRKWY FEM OSTM,$80.00,$0.00,$80.00,$0.00,$57.10,$0.00,$0.00,$0.00,$0.00,$0.00,$80.00,$0.00,$40.00,$63.36,$64.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-13319,SUP,Custom 27203010,,AR-13319  -  DRILL SRG HTO TI SCR,$180.00,$0.00,$180.00,$0.00,$128.47,$0.00,$0.00,$0.00,$0.00,$0.00,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-13320,SUP,Custom 27203010,,AR-13320  -  GUIDE DRL OPN WDG OSTM HTO PLT,$512.50,$0.00,$512.50,$0.00,$365.77,$0.00,$0.00,$0.00,$0.00,$0.00,$512.50,$0.00,$256.25,$405.90,$410.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-13321,SUP,Custom 27203010,,AR-13321  -  GUIDE DRL OPN WDG OSTM HTO TI PLT,$180.00,$0.00,$180.00,$0.00,$128.47,$0.00,$0.00,$0.00,$0.00,$0.00,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-13370-2,SUP,HCPCS C1713,,AR-13370-2  -  FILLER BN VOID 30X10MM STRL OPTM PORE DIA RGD FX DEV TRM WDG,"$1,237.50",$0.00,"$1,237.50",$556.88,$883.20,$0.00,$213.22,$0.00,$0.00,$216.68,"$1,237.50",$0.00,$618.75,$980.10,$990.00,$0.00,$193.67,$0.00,$197.01,$0.00
AR-13370-3,SUP,HCPCS C1713,,AR-13370-3  -  FILLER BN VOID 35X12MM STRL OPTM PORE DIA RGD FX DEV TRM WDG,"$1,237.50",$0.00,"$1,237.50",$556.88,$883.20,$0.00,$213.22,$0.00,$0.00,$216.68,"$1,237.50",$0.00,$618.75,$980.10,$990.00,$0.00,$193.67,$0.00,$197.01,$0.00
AR-13370-4,SUP,HCPCS C1713,,AR-13370-4  -  FILLER BN VOID 35X15MM STRL OPTM PORE DIA RGD FX DEV TRM WDG,"$1,237.50",$0.00,"$1,237.50",$556.88,$883.20,$0.00,$213.22,$0.00,$0.00,$216.68,"$1,237.50",$0.00,$618.75,$980.10,$990.00,$0.00,$193.67,$0.00,$197.01,$0.00
AR-13372-1,SUP,HCPCS C1713,,AR-13372-1  -  FILLER BN VOID 75D THK7MM TRPZD 25X8MM OSFERION,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-13372-2,SUP,HCPCS C1713,,AR-13372-2  -  FILLER BN VOID 75D THK7MM TRPZD 25X9MM OSFERION,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-13372-3,SUP,HCPCS C1713,,AR-13372-3  -  FILLER BN VOID 75D THK7MM TRPZD 25X10MM OSFERION,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-13380-26,SUP,HCPCS C1713,,AR-13380-26  -  SCREW BN 4.5MM 26MM TI TIB CORT OPN WDG OSTM,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
AR-13380-28,SUP,HCPCS C1713,,AR-13380-28  -  SCREW BN 4.5MM 28MM TI TIB CORT OPN WDG OSTM,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
AR-13380-30,SUP,HCPCS C1713,,AR-13380-30  -  SCREW BN 4.5MM 30MM TI TIB CORT OPN WDG OSTM,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
AR-13380-32,SUP,HCPCS C1713,,AR-13380-32  -  SCREW BN 4.5MM 32MM TI TIB CORT OPN WDG OSTM,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
AR-13380-34,SUP,HCPCS C1713,,AR-13380-34  -  SCREW BN 4.5MM 34MM TI TIB CORT OPN WDG OSTM,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
AR-13380-36,SUP,HCPCS C1713,,AR-13380-36  -  SCREW BN 4.5MM 36MM TI TIB CORT OPN WDG OSTM,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
AR-13380-38,SUP,HCPCS C1713,,AR-13380-38  -  SCREW BN 4.5MM 38MM TI TIB CORT OPN WDG OSTM,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
AR-13380-40,SUP,HCPCS C1713,,AR-13380-40  -  SCREW BN 4.5MM 40MM TI TIB CORT OPN WDG OSTM,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
AR-13380-42,SUP,HCPCS C1713,,AR-13380-42  -  SCREW BN 4.5MM 42MM TI TIB CORT OPN WDG OSTM,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
AR-13380-44,SUP,HCPCS C1713,,AR-13380-44  -  SCREW BN 4.5MM 44MM TI TIB CORT OPN WDG OSTM,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
AR-13380-46,SUP,HCPCS C1713,,AR-13380-46  -  SCREW BN 4.5MM 46MM TI TIB CORT OPN WDG OSTM,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
AR-13380-48,SUP,HCPCS C1713,,AR-13380-48  -  SCREW BN 4.5MM 48MM TI TIB CORT OPN WDG OSTM,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
AR-13380-50,SUP,HCPCS C1713,,AR-13380-50  -  SCREW BN 4.5MM 50MM TI TIB CORT OPN WDG OSTM,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
AR-13380-52,SUP,HCPCS C1713,,AR-13380-52  -  SCREW BN 4.5MM 52MM TI TIB CORT OPN WDG OSTM,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
AR-13380-54,SUP,HCPCS C1713,,AR-13380-54  -  SCREW BN 4.5MM 54MM TI TIB CORT OPN WDG OSTM,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
AR-13380-56,SUP,HCPCS C1713,,AR-13380-56  -  SCREW BN 4.5MM 56MM TI TIB CORT OPN WDG OSTM,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
AR-13380-58,SUP,HCPCS C1713,,AR-13380-58  -  SCREW BN 4.5MM 58MM TI TIB CORT OPN WDG OSTM,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
AR-13380-60,SUP,HCPCS C1713,,AR-13380-60  -  SCREW BN 4.5MM 60MM TI TIB CORT OPN WDG OSTM,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
AR-13400L-05,SUP,Custom 27803010,,AR-13400L-05  -  WEDGE TIB 5D LG IBALANCE HTO,"$4,750.00",$0.00,"$4,750.00",$0.00,"$3,390.08",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,750.00",$0.00,"$2,375.00","$3,762.00","$3,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-13400L-06,SUP,Custom 27803010,,AR-13400L-06  -  WEDGE TIB 6D 7D LG XL IBALANCE HTO,"$4,750.00",$0.00,"$4,750.00",$0.00,"$3,390.08",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,750.00",$0.00,"$2,375.00","$3,762.00","$3,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-13400L-07,SUP,Custom 27803010,,AR-13400L-07  -  WEDGE TIB 6D 7D LG XL IBALANCE PEEK KN HTO,"$4,750.00",$0.00,"$4,750.00",$0.00,"$3,390.08",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,750.00",$0.00,"$2,375.00","$3,762.00","$3,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-13400L-08,SUP,Custom 27803010,,AR-13400L-08  -  WEDGE TIB 7D 8D LG XL IBALANCE KN HTO,"$4,750.00",$0.00,"$4,750.00",$0.00,"$3,390.08",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,750.00",$0.00,"$2,375.00","$3,762.00","$3,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-13400L-09,SUP,Custom 27803010,,AR-13400L-09  -  WEDGE TIB 8D 9D LG XL IBALANCE PEEK KN HTO PLT,"$4,750.00",$0.00,"$4,750.00",$0.00,"$3,390.08",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,750.00",$0.00,"$2,375.00","$3,762.00","$3,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-13400L-10,SUP,Custom 27803010,,AR-13400L-10  -  WEDGE TIB 9D 10D LG XL IBALANCE PEEK KN HTO PLT,"$4,750.00",$0.00,"$4,750.00",$0.00,"$3,390.08",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,750.00",$0.00,"$2,375.00","$3,762.00","$3,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-13400L-11,SUP,Custom 27803010,,AR-13400L-11  -  WEDGE TIB 10D 11D LG XL IBALANCE PEEK KN HTO PLT,"$4,750.00",$0.00,"$4,750.00",$0.00,"$3,390.08",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,750.00",$0.00,"$2,375.00","$3,762.00","$3,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-13400L-12,SUP,Custom 27803010,,AR-13400L-12  -  WEDGE TIB 11D 12D LG XL IBALANCE PEEK KN HTO PLT,"$4,750.00",$0.00,"$4,750.00",$0.00,"$3,390.08",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,750.00",$0.00,"$2,375.00","$3,762.00","$3,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-13400L-13,SUP,Custom 27803010,,AR-13400L-13  -  WEDGE TIB 12D 13D LG XL IBALANCE HTO,"$4,750.00",$0.00,"$4,750.00",$0.00,"$3,390.08",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,750.00",$0.00,"$2,375.00","$3,762.00","$3,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-13400L-14,SUP,Custom 27803010,,AR-13400L-14  -  WEDGE TIB 13D 14D LG XL IBALANCE PEEK HTO,"$4,750.00",$0.00,"$4,750.00",$0.00,"$3,390.08",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,750.00",$0.00,"$2,375.00","$3,762.00","$3,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-13400L-15,SUP,Custom 27803010,,AR-13400L-15  -  WEDGE TIB 15D LG IBALANCE HTO,"$4,750.00",$0.00,"$4,750.00",$0.00,"$3,390.08",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,750.00",$0.00,"$2,375.00","$3,762.00","$3,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-13400M-05,SUP,Custom 27803010,,AR-13400M-05  -  WEDGE TIB 5D 6D S/MED IBALANCE HTO,"$4,750.00",$0.00,"$4,750.00",$0.00,"$3,390.08",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,750.00",$0.00,"$2,375.00","$3,762.00","$3,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-13400M-06,SUP,Custom 27803010,,AR-13400M-06  -  WEDGE TIB 6D MED IBALANCE HTO,"$4,750.00",$0.00,"$4,750.00",$0.00,"$3,390.08",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,750.00",$0.00,"$2,375.00","$3,762.00","$3,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-13400M-07,SUP,Custom 27803010,,AR-13400M-07  -  WEDGE TIB 7D 8D S/MED IBALANCE PEEK KN HTO PLT,"$4,750.00",$0.00,"$4,750.00",$0.00,"$3,390.08",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,750.00",$0.00,"$2,375.00","$3,762.00","$3,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-13400M-08,SUP,Custom 27803010,,AR-13400M-08  -  WEDGE TIB 8D 9D S/MED IBALANCE PEEK KN HTO PLT,"$4,750.00",$0.00,"$4,750.00",$0.00,"$3,390.08",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,750.00",$0.00,"$2,375.00","$3,762.00","$3,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-13400M-09,SUP,Custom 27803010,,AR-13400M-09  -  WEDGE TIB 9D 10D S/MED IBALANCE PEEK KN HTO PLT,"$4,750.00",$0.00,"$4,750.00",$0.00,"$3,390.08",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,750.00",$0.00,"$2,375.00","$3,762.00","$3,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-13400M-10,SUP,Custom 27803010,,AR-13400M-10  -  WEDGE TIB 10D 11D S/MED IBALANCE PEEK KN HTO PLT,"$4,750.00",$0.00,"$4,750.00",$0.00,"$3,390.08",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,750.00",$0.00,"$2,375.00","$3,762.00","$3,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-13400M-11,SUP,Custom 27803010,,AR-13400M-11  -  WEDGE TIB 13D 11D S/MED IBALANCE HTO,"$4,750.00",$0.00,"$4,750.00",$0.00,"$3,390.08",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,750.00",$0.00,"$2,375.00","$3,762.00","$3,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-13400M-12,SUP,Custom 27803010,,AR-13400M-12  -  WEDGE TIB 12D 14D S/MED IBALANCE PEEK KN HTO PLT,"$4,750.00",$0.00,"$4,750.00",$0.00,"$3,390.08",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,750.00",$0.00,"$2,375.00","$3,762.00","$3,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-13400M-13,SUP,Custom 27803010,,AR-13400M-13  -  WEDGE TIB 15D 13D S/MED IBALANCE KN HTO,"$4,750.00",$0.00,"$4,750.00",$0.00,"$3,390.08",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,750.00",$0.00,"$2,375.00","$3,762.00","$3,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-13400M-14,SUP,Custom 27803010,,AR-13400M-14  -  WEDGE TIB 14D MED IBALANCE HTO,"$4,750.00",$0.00,"$4,750.00",$0.00,"$3,390.08",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,750.00",$0.00,"$2,375.00","$3,762.00","$3,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-13400M-15,SUP,Custom 27803010,,AR-13400M-15  -  WEDGE TIB 15D MED IBALANCE HTO,"$4,750.00",$0.00,"$4,750.00",$0.00,"$3,390.08",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,750.00",$0.00,"$2,375.00","$3,762.00","$3,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-13400S-12,SUP,Custom 27803010,,AR-13400S-12  -  WEDGE TIB 12D SM IBALANCE PEEK KN HTO PLT,"$4,750.00",$0.00,"$4,750.00",$0.00,"$3,390.08",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,750.00",$0.00,"$2,375.00","$3,762.00","$3,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-13401-20,SUP,HCPCS C1713,,AR-13401-20  -  ANCHOR SUT 6.5MM 20MM IBALANCE CANC HTO,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-13401-22,SUP,HCPCS C1713,,AR-13401-22  -  ANCHOR SUT 6.5MM 22MM IBALANCE CANC HTO,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-13401-24,SUP,HCPCS C1713,,AR-13401-24  -  ANCHOR SUT 6.5MM 24MM IBALANCE CANC HTO,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-13401-26,SUP,HCPCS C1713,,AR-13401-26  -  ANCHOR SUT 6.5MM 26MM IBALANCE CANC HTO,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-13401-28,SUP,HCPCS C1713,,AR-13401-28  -  ANCHOR SUT 6.5MM 28MM IBALANCE CANC HTO,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-13401-30,SUP,HCPCS C1713,,AR-13401-30  -  ANCHOR SUT 6.5MM 30MM IBALANCE CANC HTO,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-13401-32,SUP,HCPCS C1713,,AR-13401-32  -  ANCHOR SUT 6.5MM 32MM IBALANCE CANC HTO,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-13402-24,SUP,HCPCS C1713,,AR-13402-24  -  ANCHOR SUT 4.5MM 24MM IBALANCE CORT HTO,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-13402-26,SUP,HCPCS C1713,,AR-13402-26  -  ANCHOR SUT 4.5MM 26MM IBALANCE CORT HTO,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-13402-28,SUP,HCPCS C1713,,AR-13402-28  -  ANCHOR SUT 4.5MM 28MM IBALANCE CORT HTO,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-13402-30,SUP,HCPCS C1713,,AR-13402-30  -  ANCHOR SUT 4.5MM 30MM IBALANCE CORT HTO,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-13402-32,SUP,HCPCS C1713,,AR-13402-32  -  ANCHOR SUT 4.5MM 32MM IBALANCE CORT HTO,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-13402-34,SUP,HCPCS C1713,,AR-13402-34  -  ANCHOR SUT 4.5MM 34MM IBALANCE CORT HTO,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-13402-36,SUP,HCPCS C1713,,AR-13402-36  -  ANCHOR SUT 4.5MM 36MM IBALANCE CORT HTO,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-13402-38,SUP,HCPCS C1713,,AR-13402-38  -  ANCHOR SUT 4.5MM 38MM IBALANCE CORT HTO,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-13402-40,SUP,HCPCS C1713,,AR-13402-40  -  ANCHOR SUT 4.5MM 40MM IBALANCE CORT HTO,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-13402-42,SUP,HCPCS C1713,,AR-13402-42  -  ANCHOR SUT 4.5MM 42MM IBALANCE CORT HTO,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-13402-44,SUP,HCPCS C1713,,AR-13402-44  -  ANCHOR SUT 4.5MM 44MM IBALANCE CORT HTO,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-13402-46,SUP,HCPCS C1713,,AR-13402-46  -  ANCHOR SUT 4.5MM 46MM IBALANCE CORT HTO,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-13402-48,SUP,HCPCS C1713,,AR-13402-48  -  ANCHOR SUT 4.5MM 48MM IBALANCE CORT HTO,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-13402-50,SUP,HCPCS C1713,,AR-13402-50  -  ANCHOR SUT 4.5MM 50MM IBALANCE CORT HTO,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-13402-52,SUP,HCPCS C1713,,AR-13402-52  -  ANCHOR SUT 4.5MM 52MM IBALANCE HTO,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-13413,SUP,HCPCS C1713,,AR-13413  -  WASHER ORTH FSTN LCK,$177.45,$0.00,$177.45,$79.85,$126.65,$0.00,$30.57,$0.00,$0.00,$31.07,$177.45,$0.00,$88.73,$140.54,$141.96,$0.00,$27.77,$0.00,$28.25,$0.00
AR-13417L,SUP,Custom 27203010,,AR-13417L  -  GUIDE DRL LG FREECUT KYHL HTO IBALANCE,"$2,697.50",$0.00,"$2,697.50",$0.00,"$1,925.21",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,697.50",$0.00,"$1,348.75","$2,136.42","$2,158.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-13417M,SUP,Custom 27203010,,AR-13417M  -  GUIDE DRL MED FREECUT KYHL HTO IBALANCE,"$2,697.50",$0.00,"$2,697.50",$0.00,"$1,925.21",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,697.50",$0.00,"$1,348.75","$2,136.42","$2,158.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-13433,SUP,Custom 27203010,,AR-13433  -  GUIDE DRL IBALANCE ANCH HTO,$632.40,$0.00,$632.40,$0.00,$451.34,$0.00,$0.00,$0.00,$0.00,$0.00,$632.40,$0.00,$316.20,$500.86,$505.92,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1349,SUP,Custom 27803010,,AR-1349  -  WASHER 14MM SPK LP ORTH TI CANC SCR STRL,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1349L,SUP,Custom 27803010,,AR-1349L  -  WASHER ORTH 18MM STRL SPK LOPRFL TI CANC SCR,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1349LM,SUP,Custom 27803010,,AR-1349LM  -  WASHER ORTH 18MM STRL SUT TI ACL DISP CANC SCR,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1349LMNS,SUP,Custom 27803010,,AR-1349LMNS  -  WASHER ORTH LOPRFL 18MM NS SUT TI ACL PCL CANC SCR,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1349LNS,SUP,Custom 27803010,,AR-1349LNS  -  WASHER 18MM ACL PCL SPK LP ORTH TI CANC SCR,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1349M,SUP,Custom 27803010,,AR-1349M  -  WASHER ORTH 14MM STRL TI CANC SCR,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1349MNS,SUP,Custom 27803010,,AR-1349MNS  -  WASHER 14MM ACL PCL SUTURE LP ORTH TI CANC SCR,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1349NS,SUP,Custom 27803010,,AR-1349NS  -  WASHER ORTH SPK LOPRFL 14MM NS TI ACL PCL CANC SCR,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1351,SUP,HCPCS C1713,,AR-1351  -  PIN FX 3MM 40MM STRL TRNFX SLF CUT ST TI ACL,$395.00,$0.00,$395.00,$177.75,$281.91,$0.00,$68.06,$0.00,$0.00,$69.16,$395.00,$0.00,$197.50,$312.84,$316.00,$0.00,$61.82,$0.00,$62.88,$0.00
AR-1351B,SUP,HCPCS C1713,,AR-1351B  -  IMPLANT FX 5MM 40MM STRL BTRNSF 1 XPN AMRPH BABSR PUL OUT,$722.50,$0.00,$722.50,$325.13,$515.65,$0.00,$124.48,$0.00,$0.00,$126.50,$722.50,$0.00,$361.25,$572.22,$578.00,$0.00,$113.07,$0.00,$115.02,$0.00
AR-1351BK-CP,SUP,HCPCS C1713,,AR-1351BK-CP  -  SET IMPL 40MM BTRNSF PK ACL,"$1,102.50",$0.00,"$1,102.50",$496.13,$786.85,$0.00,$189.96,$0.00,$0.00,$193.04,"$1,102.50",$0.00,$551.25,$873.18,$882.00,$0.00,$172.54,$0.00,$175.52,$0.00
AR-1351BT,SUP,HCPCS C1713,,AR-1351BT  -  IMPLANT FX 3MM 40MM STRL BTRNSF 1 XPN AMRPH BABSR PUL OUT,$722.50,$0.00,$722.50,$325.13,$515.65,$0.00,$124.48,$0.00,$0.00,$126.50,$722.50,$0.00,$361.25,$572.22,$578.00,$0.00,$113.07,$0.00,$115.02,$0.00
AR-1351C-01,SUP,HCPCS C1713,,AR-1351C-01  -  SCREW INTFR 5MM 40MM STRL TRNFX STRNG BCMPS KN,$997.50,$0.00,$997.50,$448.88,$711.92,$0.00,$171.86,$0.00,$0.00,$174.65,$997.50,$0.00,$498.75,$790.02,$798.00,$0.00,$156.11,$0.00,$158.80,$0.00
AR-1351C-02,SUP,HCPCS C1713,,AR-1351C-02  -  SCREW INTFR 5MM 50MM STRL TRNFX STRNG BCMPS KN,$997.50,$0.00,$997.50,$448.88,$711.92,$0.00,$171.86,$0.00,$0.00,$174.65,$997.50,$0.00,$498.75,$790.02,$798.00,$0.00,$156.11,$0.00,$158.80,$0.00
AR-1351K-CP,SUP,HCPCS C1713,,AR-1351K-CP  -  SET IMPL 40MM TRNFX2 PK ACL,$775.00,$0.00,$775.00,$348.75,$553.12,$0.00,$133.53,$0.00,$0.00,$135.70,$775.00,$0.00,$387.50,$613.80,$620.00,$0.00,$121.29,$0.00,$123.38,$0.00
AR-1351L,SUP,HCPCS C1713,,AR-1351L  -  IMPLANT FX 3MM 50MM STRL TRNFX SLF CUT ST TI ACL,$395.00,$0.00,$395.00,$177.75,$281.91,$0.00,$68.06,$0.00,$0.00,$69.16,$395.00,$0.00,$197.50,$312.84,$316.00,$0.00,$61.82,$0.00,$62.88,$0.00
AR-1351LB,SUP,HCPCS C1713,,AR-1351LB  -  IMPLANT FX 5MM 50MM STRL BTRNSF 1 XPN AMRPH BABSR PUL OUT,$722.50,$0.00,$722.50,$325.13,$515.65,$0.00,$124.48,$0.00,$0.00,$126.50,$722.50,$0.00,$361.25,$572.22,$578.00,$0.00,$113.07,$0.00,$115.02,$0.00
AR-1351LBK-CP,SUP,HCPCS C1713,,AR-1351LBK-CP  -  SET IMPL 50MM BTRNSF PK ACL,"$1,102.50",$0.00,"$1,102.50",$496.13,$786.85,$0.00,$189.96,$0.00,$0.00,$193.04,"$1,102.50",$0.00,$551.25,$873.18,$882.00,$0.00,$172.54,$0.00,$175.52,$0.00
AR-1351LBT,SUP,HCPCS C1713,,AR-1351LBT  -  IMPLANT FX 3MM 50MM STRL BTRNSF 1 XPN AMRPH BABSR PUL OUT,$722.50,$0.00,$722.50,$325.13,$515.65,$0.00,$124.48,$0.00,$0.00,$126.50,$722.50,$0.00,$361.25,$572.22,$578.00,$0.00,$113.07,$0.00,$115.02,$0.00
AR-1351LK-CP,SUP,HCPCS C1713,,AR-1351LK-CP  -  SET IMPL 50MM TRNFX PK ACL,$775.00,$0.00,$775.00,$348.75,$553.12,$0.00,$133.53,$0.00,$0.00,$135.70,$775.00,$0.00,$387.50,$613.80,$620.00,$0.00,$121.29,$0.00,$123.38,$0.00
AR-1355,SUP,HCPCS C1713,,AR-1355  -  SCREW BONE GROOVE LP 6.5MM 25MM DEPTH MARK STEP DRILL,$222.50,$0.00,$222.50,$100.13,$158.80,$0.00,$38.34,$0.00,$0.00,$38.96,$222.50,$0.00,$111.25,$176.22,$178.00,$0.00,$34.82,$0.00,$35.42,$0.00
AR-1355D,SUP,Custom 27203010,,AR-1355D  -  DRILL SRG 25MM LSR D MRK STP KN LOPRFL CANC SCR,$205.00,$0.00,$205.00,$0.00,$146.31,$0.00,$0.00,$0.00,$0.00,$0.00,$205.00,$0.00,$102.50,$162.36,$164.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1355NS,SUP,HCPCS C1713,,AR-1355NS  -  SCREW BN LOPRFL 6.5MM 25MM NS SMTH SHNK TI ACL PCL CANC,$222.50,$0.00,$222.50,$100.13,$158.80,$0.00,$38.34,$0.00,$0.00,$38.96,$222.50,$0.00,$111.25,$176.22,$178.00,$0.00,$34.82,$0.00,$35.42,$0.00
AR-1356,SUP,HCPCS C1713,,AR-1356  -  SCREW BN GRV LOPRFL 6.5MM 30MM STRL D MRK STP DRL TI ACL/PCL,$222.50,$0.00,$222.50,$100.13,$158.80,$0.00,$38.34,$0.00,$0.00,$38.96,$222.50,$0.00,$111.25,$176.22,$178.00,$0.00,$34.82,$0.00,$35.42,$0.00
AR-1356NS,SUP,HCPCS C1713,,AR-1356NS  -  SCREW BN LOPRFL 6.5MM 30MM NS SMTH SHNK TI ACL PCL CANC,$222.50,$0.00,$222.50,$100.13,$158.80,$0.00,$38.34,$0.00,$0.00,$38.96,$222.50,$0.00,$111.25,$176.22,$178.00,$0.00,$34.82,$0.00,$35.42,$0.00
AR-1357,SUP,HCPCS C1713,,AR-1357  -  SCREW BN GRV LOPRFL 6.5MM 35MM STRL D MRK STP DRL TI ACL/PCL,$222.50,$0.00,$222.50,$100.13,$158.80,$0.00,$38.34,$0.00,$0.00,$38.96,$222.50,$0.00,$111.25,$176.22,$178.00,$0.00,$34.82,$0.00,$35.42,$0.00
AR-1357B,SUP,HCPCS C1713,,AR-1357B  -  POST FX 6.25MM 35MM STRL BPST WSHR POLY L LAC ACD ACL DISP,$675.00,$0.00,$675.00,$303.75,$481.75,$0.00,$116.30,$0.00,$0.00,$118.19,$675.00,$0.00,$337.50,$534.60,$540.00,$0.00,$105.64,$0.00,$107.46,$0.00
AR-1357NS,SUP,HCPCS C1713,,AR-1357NS  -  SCREW BN LOPRFL 6.5MM 35MM NS SMTH SHNK TI ACL PCL CANC,$222.50,$0.00,$222.50,$100.13,$158.80,$0.00,$38.34,$0.00,$0.00,$38.96,$222.50,$0.00,$111.25,$176.22,$178.00,$0.00,$34.82,$0.00,$35.42,$0.00
AR-1358,SUP,HCPCS C1713,,AR-1358  -  SCREW BN GRV LOPRFL 6.5MM 40MM STRL D MRK STP DRL TI ACL/PCL,$222.50,$0.00,$222.50,$100.13,$158.80,$0.00,$38.34,$0.00,$0.00,$38.96,$222.50,$0.00,$111.25,$176.22,$178.00,$0.00,$34.82,$0.00,$35.42,$0.00
AR-1358NS,SUP,HCPCS C1713,,AR-1358NS  -  SCREW BN LOPRFL 6.5MM 40MM NS SMTH SHNK TI ACL PCL CANC,$222.50,$0.00,$222.50,$100.13,$158.80,$0.00,$38.34,$0.00,$0.00,$38.96,$222.50,$0.00,$111.25,$176.22,$178.00,$0.00,$34.82,$0.00,$35.42,$0.00
AR-1360B,SUP,HCPCS C1713,,AR-1360B  -  SCREW INTFR 6MM 23MM STRL BIOINTF CNN SHTH POLY L LAC ACD,$355.00,$0.00,$355.00,$159.75,$253.36,$0.00,$61.16,$0.00,$0.00,$62.16,$355.00,$0.00,$177.50,$281.16,$284.00,$0.00,$55.56,$0.00,$56.52,$0.00
AR-1360C,SUP,HCPCS C1713,,AR-1360C  -  SCREW INTFR 6MM 23MM STRL CNN RDC HD BCMPS ACL PCL,$587.50,$0.00,$587.50,$264.38,$419.30,$0.00,$101.22,$0.00,$0.00,$102.87,$587.50,$0.00,$293.75,$465.30,$470.00,$0.00,$91.94,$0.00,$93.53,$0.00
AR-1360C-CP,SUP,HCPCS C1713,,AR-1360C-CP  -  SET IMPL 4.5MM 6MM CNN DRL GDPN INTFR SCR RMR TMPLT MPFL PK,"$3,717.50",$0.00,"$3,717.50","$1,672.88","$2,653.18",$0.00,$640.51,$0.00,$0.00,$650.90,"$3,717.50",$0.00,"$1,858.75","$2,944.26","$2,974.00",$0.00,$581.79,$0.00,$591.83,$0.00
AR-1360CST-CP,SUP,HCPCS C1713,,AR-1360CST-CP  -  SET IMPL 1.1MM 3.5IN CNN CLS EYLT DRL PIN RMR TMPLT MPFL PK,"$4,217.50",$0.00,"$4,217.50","$1,897.88","$3,010.03",$0.00,$726.65,$0.00,$0.00,$738.45,"$4,217.50",$0.00,"$2,108.75","$3,340.26","$3,374.00",$0.00,$660.04,$0.00,$671.43,$0.00
AR-1360E,SUP,HCPCS C1713,,AR-1360E  -  SCREW INTFR 6MM 20MM STRL CNN SHTH TI ACL PCL ACPT 2MM NTNL,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-1360P,SUP,HCPCS C1713,,AR-1360P  -  SCREW INTFR 6MM 23MM STRL THRD PTRN PEEK-OPTM ACL PCL,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-1363,SUP,HCPCS C1713,,AR-1363  -  SCREW INTFR 3MM 40MM STRL TRNFX SLF CUT ST TI ACL,$460.00,$0.00,$460.00,$207.00,$328.30,$0.00,$79.26,$0.00,$0.00,$80.54,$460.00,$0.00,$230.00,$364.32,$368.00,$0.00,$71.99,$0.00,$73.23,$0.00
AR-1363L,SUP,HCPCS C1713,,AR-1363L  -  SCREW INTFR 3MM 50MM STRL TRNFX SLF CUT ST TI ACL,$460.00,$0.00,$460.00,$207.00,$328.30,$0.00,$79.26,$0.00,$0.00,$80.54,$460.00,$0.00,$230.00,$364.32,$368.00,$0.00,$71.99,$0.00,$73.23,$0.00
AR-1365-25,SUP,HCPCS C1713,,AR-1365-25  -  POST FIX LP 4.5MM 25MM SELF TAP THREAD TITANIUM KNEE,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
AR-1365-275,SUP,Custom 27203010,,AR-1365-275  -  POST FX LOPRFL 4.5MM 27.5MM STRL ST THRD TI KN BCORT,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1365-30,SUP,Custom 27203010,,AR-1365-30  -  POST FX LOPRFL 4.5MM 30MM STRL ST THRD TI KN BCORT,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1365-325,SUP,Custom 27203010,,AR-1365-325  -  POST FX LOPRFL 4.5MM 32.5MM ST THRD TI KN BCORT,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1365-375,SUP,Custom 27203010,,AR-1365-375  -  POST FX LOPRFL 4.5MM 37.5MM STRL ST THRD TI KN BCORT,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1365-40,SUP,Custom 27203010,,AR-1365-40  -  POST FX LOPRFL 4.5MM 40MM STRL ST THRD TI KN BCORT,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1365-425,SUP,Custom 27203010,,AR-1365-425  -  POST FX LOPRFL 4.5MM 42.5MM STRL ST THRD TI KN BCORT,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1365-45,SUP,Custom 27203010,,AR-1365-45  -  POST FX LOPRFL 4.5MM 45MM STRL ST THRD TI KN BCORT,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1365-475,SUP,Custom 27203010,,AR-1365-475  -  POST FX LOPRFL 4.5MM 47.5MM STRL ST THRD TI KN BCORT,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1365-50,SUP,Custom 27203010,,AR-1365-50  -  POST FX LOPRFL 4.5MM 50MM STRL ST THRD TI KN BCORT,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1365-525,SUP,Custom 27203010,,AR-1365-525  -  POST FX LOPRFL 4.5MM 52.5MM STRL ST THRD TI KN BCORT,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1365-55,SUP,Custom 27203010,,AR-1365-55  -  POST FX LOPRFL 4.5MM 55MM STRL ST THRD TI KN BCORT,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1365-575,SUP,Custom 27203010,,AR-1365-575  -  POST FX LOPRFL 4.5MM 57.5MM STRL ST THRD TI KN BCORT,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1365-60,SUP,Custom 27203010,,AR-1365-60  -  POST FX LOPRFL 4.5MM 60MM STRL ST THRD TI KN BCORT,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1365NS-25,SUP,Custom 27203010,,AR-1365NS-25  -  POST FX LOPRFL 4.5MM 25MM NS TI ACL PCL BCORT,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1365NS-275,SUP,Custom 27203010,,AR-1365NS-275  -  POST FX LOPRFL 4.5MM 27.5MM NS TI ACL PCL BCORT,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1365NS-30,SUP,Custom 27203010,,AR-1365NS-30  -  POST FX LOPRFL 4.5MM 30MM NS TI ACL PCL BCORT,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1365NS-325,SUP,Custom 27203010,,AR-1365NS-325  -  POST FX LOPRFL 4.5MM 32.5MM NS TI ACL PCL BCORT,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1365NS-35,SUP,Custom 27203010,,AR-1365NS-35  -  POST FX LOPRFL 4.5MM 35MM NS TI ACL PCL BCORT,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1365NS-375,SUP,Custom 27203010,,AR-1365NS-375  -  POST FX LOPRFL 4.5MM 37.5MM NS TI ACL PCL BCORT,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1365NS-40,SUP,Custom 27203010,,AR-1365NS-40  -  POST FX LOPRFL 4.5MM 40MM NS TI ACL PCL BCORT,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1365NS-425,SUP,Custom 27203010,,AR-1365NS-425  -  POST FX LOPRFL 4.5MM 42.5MM NS TI ACL PCL BCORT,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1365NS-45,SUP,Custom 27203010,,AR-1365NS-45  -  POST FX LOPRFL 4.5MM 45MM NS TI ACL PCL BCORT,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1365NS-475,SUP,Custom 27203010,,AR-1365NS-475  -  POST FX LOPRFL 4.5MM 47.5MM NS TI ACL PCL BCORT,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1365NS-50,SUP,Custom 27203010,,AR-1365NS-50  -  POST FX LOPRFL 4.5MM 50MM NS TI ACL PCL BCORT,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1365NS-525,SUP,Custom 27203010,,AR-1365NS-525  -  POST FX LOPRFL 4.5MM 52.5MM NS TI ACL PCL BCORT,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1365NS-55,SUP,Custom 27203010,,AR-1365NS-55  -  POST FX LOPRFL 4.5MM 55MM NS TI ACL PCL BCORT,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1365NS-575,SUP,Custom 27203010,,AR-1365NS-575  -  POST FX LOPRFL 4.5MM 57.5MM NS TI ACL PCL BCORT,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1365NS-60,SUP,Custom 27203010,,AR-1365NS-60  -  POST FX LOPRFL 4.5MM 60MM NS TI ACL PCL BCORT,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1366-30,SUP,Custom 27203010,,AR-1366-30  -  POST FX LOPRFL 6.5MM 30MM STRL ST THRD TI KN BCORT,$525.00,$0.00,$525.00,$0.00,$374.69,$0.00,$0.00,$0.00,$0.00,$0.00,$525.00,$0.00,$262.50,$415.80,$420.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1366-32,SUP,Custom 27203010,,AR-1366-32  -  POST FX LOPRFL 6.5MM 32MM STRL ST THRD TI KN BCORT,$525.00,$0.00,$525.00,$0.00,$374.69,$0.00,$0.00,$0.00,$0.00,$0.00,$525.00,$0.00,$262.50,$415.80,$420.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1366-34,SUP,Custom 27203010,,AR-1366-34  -  POST FX LOPRFL 6.5MM 34MM STRL ST THRD TI KN BCORT,$525.00,$0.00,$525.00,$0.00,$374.69,$0.00,$0.00,$0.00,$0.00,$0.00,$525.00,$0.00,$262.50,$415.80,$420.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1366-36,SUP,Custom 27203010,,AR-1366-36  -  POST FX LOPRFL 6.5MM 36MM STRL ST THRD TI KN BCORT,$525.00,$0.00,$525.00,$0.00,$374.69,$0.00,$0.00,$0.00,$0.00,$0.00,$525.00,$0.00,$262.50,$415.80,$420.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1366-38,SUP,Custom 27203010,,AR-1366-38  -  POST FX LOPRFL 6.5MM 38MM STRL ST THRD TI KN BCORT,$525.00,$0.00,$525.00,$0.00,$374.69,$0.00,$0.00,$0.00,$0.00,$0.00,$525.00,$0.00,$262.50,$415.80,$420.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1366-40,SUP,Custom 27203010,,AR-1366-40  -  POST FX LOPRFL 6.5MM 40MM STRL ST THRD TI KN BCORT,$525.00,$0.00,$525.00,$0.00,$374.69,$0.00,$0.00,$0.00,$0.00,$0.00,$525.00,$0.00,$262.50,$415.80,$420.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1366-42,SUP,Custom 27203010,,AR-1366-42  -  POST FX LOPRFL 6.5MM 42MM STRL ST THRD TI KN BCORT,$525.00,$0.00,$525.00,$0.00,$374.69,$0.00,$0.00,$0.00,$0.00,$0.00,$525.00,$0.00,$262.50,$415.80,$420.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1366-44,SUP,Custom 27203010,,AR-1366-44  -  POST FX LOPRFL 6.5MM 44MM ST THRD TI KN BCORT,$525.00,$0.00,$525.00,$0.00,$374.69,$0.00,$0.00,$0.00,$0.00,$0.00,$525.00,$0.00,$262.50,$415.80,$420.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1366-46,SUP,Custom 27203010,,AR-1366-46  -  POST FX LOPRFL 6.5MM 46MM STRL ST THRD TI KN BCORT,$525.00,$0.00,$525.00,$0.00,$374.69,$0.00,$0.00,$0.00,$0.00,$0.00,$525.00,$0.00,$262.50,$415.80,$420.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1366-48,SUP,Custom 27203010,,AR-1366-48  -  POST FX LOPRFL 6.5MM 48MM STRL ST THRD TI KN BCORT,$525.00,$0.00,$525.00,$0.00,$374.69,$0.00,$0.00,$0.00,$0.00,$0.00,$525.00,$0.00,$262.50,$415.80,$420.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1366-50,SUP,Custom 27203010,,AR-1366-50  -  POST FX LOPRFL 6.5MM 50MM ST THRD TI KN BCORT,$525.00,$0.00,$525.00,$0.00,$374.69,$0.00,$0.00,$0.00,$0.00,$0.00,$525.00,$0.00,$262.50,$415.80,$420.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1366-52,SUP,Custom 27203010,,AR-1366-52  -  POST FX LOPRFL 6.5MM 52MM STRL ST THRD TI KN BCORT,$525.00,$0.00,$525.00,$0.00,$374.69,$0.00,$0.00,$0.00,$0.00,$0.00,$525.00,$0.00,$262.50,$415.80,$420.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1366NS-30,SUP,Custom 27203010,,AR-1366NS-30  -  POST FX LOPRFL 6.5MM 30MM NS TI ACL PCL BCORT,$525.00,$0.00,$525.00,$0.00,$374.69,$0.00,$0.00,$0.00,$0.00,$0.00,$525.00,$0.00,$262.50,$415.80,$420.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1366NS-32,SUP,Custom 27203010,,AR-1366NS-32  -  POST FX LOPRFL 6.5MM 32MM NS TI ACL PCL BCORT,$525.00,$0.00,$525.00,$0.00,$374.69,$0.00,$0.00,$0.00,$0.00,$0.00,$525.00,$0.00,$262.50,$415.80,$420.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1366NS-34,SUP,Custom 27203010,,AR-1366NS-34  -  POST FX LOPRFL 6.5MM 34MM NS TI ACL PCL BCORT,$525.00,$0.00,$525.00,$0.00,$374.69,$0.00,$0.00,$0.00,$0.00,$0.00,$525.00,$0.00,$262.50,$415.80,$420.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1366NS-36,SUP,Custom 27203010,,AR-1366NS-36  -  POST FX LOPRFL 6.5MM 36MM NS TI ACL PCL BCORT,$525.00,$0.00,$525.00,$0.00,$374.69,$0.00,$0.00,$0.00,$0.00,$0.00,$525.00,$0.00,$262.50,$415.80,$420.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1366NS-38,SUP,Custom 27203010,,AR-1366NS-38  -  POST FX LOPRFL 6.5MM 38MM NS TI ACL PCL BCORT,$525.00,$0.00,$525.00,$0.00,$374.69,$0.00,$0.00,$0.00,$0.00,$0.00,$525.00,$0.00,$262.50,$415.80,$420.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1366NS-40,SUP,Custom 27203010,,AR-1366NS-40  -  POST FX LOPRFL 6.5MM 40MM NS TI ACL PCL BCORT,$525.00,$0.00,$525.00,$0.00,$374.69,$0.00,$0.00,$0.00,$0.00,$0.00,$525.00,$0.00,$262.50,$415.80,$420.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1366NS-42,SUP,Custom 27203010,,AR-1366NS-42  -  POST FX LOPRFL 6.5MM 42MM NS TI ACL PCL BCORT,$525.00,$0.00,$525.00,$0.00,$374.69,$0.00,$0.00,$0.00,$0.00,$0.00,$525.00,$0.00,$262.50,$415.80,$420.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1366NS-44,SUP,Custom 27203010,,AR-1366NS-44  -  POST FX LOPRFL 6.5MM 44MM NS TI ACL PCL BCORT,$525.00,$0.00,$525.00,$0.00,$374.69,$0.00,$0.00,$0.00,$0.00,$0.00,$525.00,$0.00,$262.50,$415.80,$420.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1366NS-46,SUP,Custom 27203010,,AR-1366NS-46  -  POST FX LOPRFL 6.5MM 46MM NS TI ACL PCL BCORT,$525.00,$0.00,$525.00,$0.00,$374.69,$0.00,$0.00,$0.00,$0.00,$0.00,$525.00,$0.00,$262.50,$415.80,$420.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1366NS-48,SUP,Custom 27203010,,AR-1366NS-48  -  POST FX LOPRFL 6.5MM 48MM NS TI ACL PCL BCORT,$525.00,$0.00,$525.00,$0.00,$374.69,$0.00,$0.00,$0.00,$0.00,$0.00,$525.00,$0.00,$262.50,$415.80,$420.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1366NS-50,SUP,Custom 27203010,,AR-1366NS-50  -  POST FX LOPRFL 6.5MM 50MM NS TI ACL PCL BCORT,$525.00,$0.00,$525.00,$0.00,$374.69,$0.00,$0.00,$0.00,$0.00,$0.00,$525.00,$0.00,$262.50,$415.80,$420.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1367D,SUP,Custom 27203010,,AR-1367D  -  BIT DRL 4.8MM 6.5MM POST,$512.50,$0.00,$512.50,$0.00,$365.77,$0.00,$0.00,$0.00,$0.00,$0.00,$512.50,$0.00,$256.25,$405.90,$410.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1370,SUP,HCPCS C1713,,"AR-1370  -  SCREW, CANNULATED INTERFERENCE",$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-1370B,SUP,HCPCS C1713,,AR-1370B  -  SCREW INTFR 7MM 23MM STRL BIOINTF CNN SHTH POLY L LAC ACD,$355.00,$0.00,$355.00,$159.75,$253.36,$0.00,$61.16,$0.00,$0.00,$62.16,$355.00,$0.00,$177.50,$281.16,$284.00,$0.00,$55.56,$0.00,$56.52,$0.00
AR-1370C,SUP,HCPCS C1713,,AR-1370C  -  SCREW INTERFERENCE 7MM 23MM CANN REDUCE HEAD BIOCOMPOSITE,$587.50,$0.00,$587.50,$264.38,$419.30,$0.00,$101.22,$0.00,$0.00,$102.87,$587.50,$0.00,$293.75,$465.30,$470.00,$0.00,$91.94,$0.00,$93.53,$0.00
AR-1370E,SUP,HCPCS C1713,,AR-1370E  -  SCREW INTFR 7MM 20MM STRL CNN DISP SHTH TI ACL PCL ACPT 2MM,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-1370H-25,SUP,HCPCS C1713,,AR-1370H-25  -  SCREW INTFR BLNT RND 7MM 25MM STRL CNN SFT TI ACL PCL ACPT 2,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-1370H-30,SUP,HCPCS C1713,,AR-1370H-30  -  SCREW INTFR BLNT RND 7MM 30MM STRL CNN SFT TI ACL PCL ACPT 2,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-1370P,SUP,HCPCS C1713,,AR-1370P  -  SCREW INTFR 7MM 23MM STRL PEEK-OPTM,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-1370T,SUP,HCPCS C1713,,AR-1370T  -  SCREW INTFR FT RND 7MM 20MM STRL CNN RECON TI ACL PCL ACPT 2,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-1370TB,SUP,HCPCS C1713,,AR-1370TB  -  SCREW INTFR FT 7MM 28MM STRL BIOINTF CNN POLY L LAC ACD ACL,$355.00,$0.00,$355.00,$159.75,$253.36,$0.00,$61.16,$0.00,$0.00,$62.16,$355.00,$0.00,$177.50,$281.16,$284.00,$0.00,$55.56,$0.00,$56.52,$0.00
AR-1370TC,SUP,HCPCS C1713,,AR-1370TC  -  SCREW INTFR FT STP TPR 7MM 28MM STRL CNN FULL SEAT RDC HD,$587.50,$0.00,$587.50,$264.38,$419.30,$0.00,$101.22,$0.00,$0.00,$102.87,$587.50,$0.00,$293.75,$465.30,$470.00,$0.00,$91.94,$0.00,$93.53,$0.00
AR-1371,SUP,HCPCS C1713,,AR-1371  -  SCREW INTFR 7MM 25MM STRL CNN TI ACL PCL,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-13710-03.0,SUP,HCPCS C1713,,AR-13710-03.0  -  PLATE BN STRG 3MM STRL CONTOURLOCK HTO PLT TIB LT OPN WDG,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
AR-13710-05.0,SUP,HCPCS C1713,,AR-13710-05.0  -  PLATE BN STRG 5MM STRL CONTOURLOCK HTO PLT TIB LT OPN WDG,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
AR-13710-07.5,SUP,HCPCS C1713,,AR-13710-07.5  -  PLATE BN STRG 7.5MM STRL CONTOURLOCK HTO PLT TIB LT OPN WDG,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
AR-13710-09.0,SUP,HCPCS C1713,,AR-13710-09.0  -  PLATE BN STRG 9MM STRL CONTOURLOCK HTO PLT TIB LT OPN WDG,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
AR-13710-10.0,SUP,HCPCS C1713,,AR-13710-10.0  -  PLATE BN STRG 10MM STRL CONTOURLOCK HTO PLT TIB LT OPN WDG,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
AR-13710-11.0,SUP,HCPCS C1713,,AR-13710-11.0  -  PLATE BN STRG 11MM STRL CONTOURLOCK HTO PLT TIB LT OPN WDG,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
AR-13710-12.5,SUP,HCPCS C1713,,AR-13710-12.5  -  PLATE BN STRG 12.5MM STRL CONTOURLOCK HTO PLT TIB LT OPN WDG,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
AR-13710-15.0,SUP,HCPCS C1713,,AR-13710-15.0  -  PLATE BN STRG 15MM STRL CONTOURLOCK HTO PLT TIB LT OPN WDG,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
AR-13710-17.5,SUP,HCPCS C1713,,AR-13710-17.5  -  PLATE BN STRG 17.5MM STRL CONTOURLOCK HTO PLT TIB LT OPN WDG,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
AR-13715-03.0,SUP,HCPCS C1713,,AR-13715-03.0  -  PLATE BN STRG 3MM STRL CONTOURLOCK HTO PLT TIB RT OPN WDG,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
AR-13715-05.0,SUP,HCPCS C1713,,AR-13715-05.0  -  PLATE BN STRG 5MM STRL CONTOURLOCK HTO PLT TIB RT OPN WDG,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
AR-13715-07.5,SUP,HCPCS C1713,,AR-13715-07.5  -  PLATE BN STRG 7.5MM STRL CONTOURLOCK HTO PLT TIB RT OPN WDG,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
AR-13715-09.0,SUP,HCPCS C1713,,AR-13715-09.0  -  PLATE BN STRG 9MM STRL CONTOURLOCK HTO PLT TIB RT OPN WDG,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
AR-13715-10.0,SUP,HCPCS C1713,,AR-13715-10.0  -  PLATE BN STRG 10MM STRL CONTOURLOCK HTO PLT TIB RT OPN WDG,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
AR-13715-11.0,SUP,HCPCS C1713,,AR-13715-11.0  -  PLATE BN STRG 11MM STRL CONTOURLOCK HTO PLT TIB RT OPN WDG,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
AR-13715-12.5,SUP,HCPCS C1713,,AR-13715-12.5  -  PLATE BN STRG 12.5MM STRL CONTOURLOCK HTO PLT TIB RT OPN WDG,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
AR-13715-15.0,SUP,HCPCS C1713,,AR-13715-15.0  -  PLATE BN STRG 15MM STRL CONTOURLOCK HTO PLT TIB RT OPN WDG,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
AR-13715-17.5,SUP,HCPCS C1713,,AR-13715-17.5  -  PLATE BN STRG 17.5MM STRL CONTOURLOCK HTO PLT TIB RT OPN WDG,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
AR-1371E,SUP,HCPCS C1713,,AR-1371E  -  SCREW INTFR 7MM 25MM STRL CNN SHTH TI ACL PCL ACPT 2MM NTNL,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-1371T,SUP,HCPCS C1713,,AR-1371T  -  SCREW INTFR FT RND 7MM 25MM STRL CNN RECON TI ACL PCL ACPT 2,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-1372,SUP,HCPCS C1713,,AR-1372  -  SCREW INTFR 7MM 30MM STRL BIOINTF CNN TI ACL PCL,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-13720-05.0,SUP,HCPCS C1713,,AR-13720-05.0  -  PLATE BN 5MM STRL CONTOURLOCK HTO PLT ANTEROPOSTERIOR SLOP,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
AR-13720-07.5,SUP,HCPCS C1713,,AR-13720-07.5  -  PLATE BN 7.5MM STRL CONTOURLOCK HTO PLT ANTEROPOSTERIOR SLOP,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
AR-13720-09.0,SUP,HCPCS C1713,,AR-13720-09.0  -  PLATE BN 9MM STRL CONTOURLOCK HTO PLT ANTEROPOSTERIOR SLOP,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
AR-13720-10.0,SUP,HCPCS C1713,,AR-13720-10.0  -  PLATE BN 10MM STRL CONTOURLOCK HTO PLT ANTEROPOSTERIOR SLOP,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
AR-13720-11.0,SUP,HCPCS C1713,,AR-13720-11.0  -  PLATE BN 11MM STRL CONTOURLOCK HTO PLT ANTEROPOSTERIOR SLOP,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
AR-13720-12.5,SUP,HCPCS C1713,,AR-13720-12.5  -  PLATE BN 12.5MM STRL CONTOURLOCK HTO PLT ANTEROPOSTERIOR,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
AR-13720-15.0,SUP,HCPCS C1713,,AR-13720-15.0  -  PLATE BN 15MM STRL CONTOURLOCK HTO PLT ANTEROPOSTERIOR SLOP,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
AR-13720-17.5,SUP,HCPCS C1713,,AR-13720-17.5  -  PLATE BN 17.5MM STRL CONTOURLOCK HTO PLT ANTEROPOSTERIOR,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
AR-13725-05.0,SUP,HCPCS C1713,,AR-13725-05.0  -  PLATE BN 5MM STRL CONTOURLOCK HTO PLT ANTEROPOSTERIOR SLOP,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
AR-13725-07.5,SUP,HCPCS C1713,,AR-13725-07.5  -  PLATE BN 7.5MM STRL CONTOURLOCK HTO PLT ANTEROPOSTERIOR SLOP,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
AR-13725-09.0,SUP,HCPCS C1713,,AR-13725-09.0  -  PLATE BN 9MM STRL CONTOURLOCK HTO PLT ANTEROPOSTERIOR SLOP,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
AR-13725-10.0,SUP,HCPCS C1713,,AR-13725-10.0  -  PLATE BN 10MM STRL CONTOURLOCK HTO PLT ANTEROPOSTERIOR SLOP,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
AR-13725-11.0,SUP,HCPCS C1713,,AR-13725-11.0  -  PLATE BN 11MM STRL CONTOURLOCK HTO PLT ANTEROPOSTERIOR SLOP,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
AR-13725-12.5,SUP,HCPCS C1713,,AR-13725-12.5  -  PLATE BN 12.5MM STRL CONTOURLOCK HTO PLT ANTEROPOSTERIOR,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
AR-13725-15.0,SUP,HCPCS C1713,,AR-13725-15.0  -  PLATE BN 15MM STRL CONTOURLOCK HTO PLT ANTEROPOSTERIOR SLOP,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
AR-13725-17.5,SUP,HCPCS C1713,,AR-13725-17.5  -  PLATE BN 17.5MM STRL CONTOURLOCK HTO PLT ANTEROPOSTERIOR,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
AR-1372E,SUP,HCPCS C1713,,AR-1372E  -  SCREW INTFR 7MM 30MM STRL CNN SHTH TI ACL PCL ACPT 2MM NTNL,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-1372T,SUP,HCPCS C1713,,AR-1372T  -  SCREW INTFR FT RND 7MM 30MM STRL CNN RECON TI ACL PCL ACPT 2,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-13730-01,SUP,HCPCS C1713,,AR-13730-01  -  PLATE BN FLT 67MM STRL CONTOURLOCK HTO PLT TIB LT OPN WDG,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
AR-13730-02,SUP,HCPCS C1713,,AR-13730-02  -  PLATE BN FLT 71MM STRL CONTOURLOCK HTO PLT TIB LT OPN WDG,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
AR-13730-03,SUP,HCPCS C1713,,AR-13730-03  -  PLATE BN FLT 84MM STRL CONTOURLOCK HTO PLT TIB LT OPN WDG,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
AR-13735-01,SUP,HCPCS C1713,,AR-13735-01  -  PLATE BN FLT 67MM STRL CONTOURLOCK HTO PLT TIB RT OPN WDG,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
AR-13735-02,SUP,HCPCS C1713,,AR-13735-02  -  PLATE BN FLT 71MM STRL CONTOURLOCK HTO PLT TIB RT OPN WDG,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
AR-13735-03,SUP,HCPCS C1713,,AR-13735-03  -  PLATE BN FLT 84MM STRL CONTOURLOCK HTO PLT TIB RT OPN WDG,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
AR-1375E,SUP,HCPCS C1713,,AR-1375E  -  SCREW INTFR 7MM 15MM STRL CNN SHTH TI ACL PCL ACPT 2MM NTNL,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-1380,SUP,HCPCS C1713,,AR-1380  -  SCREW INTFR 8MM 20MM STRL BIOINTF CNN TI ACL PCL,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-1380B,SUP,HCPCS C1713,,AR-1380B  -  SCREW INTFR 8MM 23MM STRL BIOINTF CNN SHTH POLY L LAC ACD,$355.00,$0.00,$355.00,$159.75,$253.36,$0.00,$61.16,$0.00,$0.00,$62.16,$355.00,$0.00,$177.50,$281.16,$284.00,$0.00,$55.56,$0.00,$56.52,$0.00
AR-1380E,SUP,HCPCS C1713,,AR-1380E  -  SCREW INTERFERENCE 8MM 20MM CANN SHEATH TITANIUM ACL PCL,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-1380H-25,SUP,HCPCS C1713,,AR-1380H-25  -  SCREW INTFR BLNT RND 8MM 25MM STRL CNN SFT TI ACL PCL ACPT 2,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-1380H-30,SUP,HCPCS C1713,,AR-1380H-30  -  SCREW INTFR BLNT RND 8MM 30MM STRL CNN SFT TI ACL PCL ACPT 2,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-1380H-35,SUP,HCPCS C1713,,AR-1380H-35  -  SCREW INTFR BLNT RND 8MM 35MM STRL CNN SFT TI ACL PCL ACPT 2,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-1380HLU-25,SUP,HCPCS C1713,,AR-1380HLU-25  -  SCREW SOFT CANN LFT HAND THD 8X25MM TI,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-1380P,SUP,HCPCS C1713,,AR-1380P  -  SCREW INTFR 8MM 23MM STRL PEEK-OPTM,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-1380T,SUP,HCPCS C1713,,AR-1380T  -  SCREW INTFR FT RND 8MM 20MM STRL CNN RECON TI ACL PCL ACPT 2,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-1380TB,SUP,HCPCS C1713,,AR-1380TB  -  SCREW INTFR FT 8MM 28MM STRL BIOINTF CNN POLY L LAC ACD ACL,$355.00,$0.00,$355.00,$159.75,$253.36,$0.00,$61.16,$0.00,$0.00,$62.16,$355.00,$0.00,$177.50,$281.16,$284.00,$0.00,$55.56,$0.00,$56.52,$0.00
AR-1380TC,SUP,HCPCS C1713,,AR-1380TC  -  SCREW INTFR BLNT FT STP TPR 8MM 28MM STRL CNN FULL SEAT RDC,$587.50,$0.00,$587.50,$264.38,$419.30,$0.00,$101.22,$0.00,$0.00,$102.87,$587.50,$0.00,$293.75,$465.30,$470.00,$0.00,$91.94,$0.00,$93.53,$0.00
AR-1381,SUP,HCPCS C1713,,AR-1381  -  SCREW INTFR 8MM 25MM STRL BIOINTF CNN TI ACL PCL,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-1381T,SUP,HCPCS C1713,,AR-1381T  -  SCREW INTFR FT RND 8MM 25MM STRL CNN RECON TI ACL PCL ACPT 2,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-1382,SUP,HCPCS C1713,,AR-1382  -  SCREW INTFR 8MM 30MM STRL BIOINTF CNN TI ACL PCL,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-1382T,SUP,HCPCS C1713,,AR-1382T  -  SCREW INTFR FT RND 8MM 30MM STRL CNN RECON TI ACL PCL ACPT 2,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-1390,SUP,HCPCS C1713,,AR-1390  -  SCREW INTFR 9MM 20MM STRL BIOINTF CNN TI ACL PCL,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-1390B,SUP,HCPCS C1713,,AR-1390B  -  SCREW INTFR 9MM 23MM STRL BIOINTF CNN SHTH POLY L LAC ACD,$355.00,$0.00,$355.00,$159.75,$253.36,$0.00,$61.16,$0.00,$0.00,$62.16,$355.00,$0.00,$177.50,$281.16,$284.00,$0.00,$55.56,$0.00,$56.52,$0.00
AR-1390E,SUP,HCPCS C1713,,AR-1390E  -  SCREW INTFR 20MM 9MM KNEE CANN SHTH STRL DISP,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-1390H-35,SUP,HCPCS C1713,,AR-1390H-35  -  SCREW INTFR BLNT RND 9MM 35MM STRL CNN SFT TI ACL PCL ACPT 2,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-1390P,SUP,HCPCS C1713,,AR-1390P  -  SCREW INTFR 9MM 23MM STRL PEEK-OPTM,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-1390T,SUP,HCPCS C1713,,AR-1390T  -  SCREW INTFR FT RND 9MM 20MM STRL CNN RECON TI ACL PCL ACPT 2,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-1390TB,SUP,HCPCS C1713,,AR-1390TB  -  SCREW INTFR FT 9MM 28MM STRL BIOINTF CNN POLY L LAC ACD ACL,$355.00,$0.00,$355.00,$159.75,$253.36,$0.00,$61.16,$0.00,$0.00,$62.16,$355.00,$0.00,$177.50,$281.16,$284.00,$0.00,$55.56,$0.00,$56.52,$0.00
AR-1390TC,SUP,HCPCS C1713,,AR-1390TC  -  SCREW INTERFERENCE BLUNT FULTHD STEP TAPER 9MM 28MM CANN,$587.50,$0.00,$587.50,$264.38,$419.30,$0.00,$101.22,$0.00,$0.00,$102.87,$587.50,$0.00,$293.75,$465.30,$470.00,$0.00,$91.94,$0.00,$93.53,$0.00
AR-1391,SUP,HCPCS C1713,,AR-1391  -  SCREW INTFR 9MM 25MM STRL BIOINTF CNN TI ACL PCL,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-1391E,SUP,HCPCS C1713,,AR-1391E  -  SCREW INTFR 9MM 25MM STRL CNN DISP SHTH TI ACL PCL ACPT 2MM,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-1391T,SUP,HCPCS C1713,,AR-1391T  -  SCREW INTFR FT RND 9MM 25MM STRL CNN RECON TI ACL PCL ACPT 2,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-1392,SUP,HCPCS C1713,,AR-1392  -  SCREW INTFR RND 9MM 30MM STRL CNN TI ACL PCL,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-1392E,SUP,HCPCS C1713,,AR-1392E  -  SCREW INTFR 9MM 30MM STRL CNN SHTH TI ACL PCL ACPT 2MM NTNL,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-1392T,SUP,HCPCS C1713,,AR-1392T  -  SCREW INTFR FT RND 9MM 30MM STRL CNN RECON TI ACL PCL ACPT 2,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-13991N,SUP,Custom 27203010,,AR-13991N  -  NEEDLE SUTURE SCORPION SUREFIRE ROTATOR CUFF,$350.00,$0.00,$350.00,$0.00,$249.80,$0.00,$0.00,$0.00,$0.00,$0.00,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-13995N,SUP,Custom 27203010,,AR-13995N  -  NEEDLE SUT MF SCRPN,$425.00,$0.00,$425.00,$0.00,$303.32,$0.00,$0.00,$0.00,$0.00,$0.00,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1400,SUP,HCPCS C1713,,AR-1400  -  SCREW INTFR 10MM 20MM STRL BIOINTF CNN TI ACL PCL,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-14003,SUP,HCPCS C1713,,AR-14003  -  PLATE BN STRL SUTUREPLATE 3 HL HUM,"$3,737.50",$0.00,"$3,737.50","$1,681.88","$2,667.45",$0.00,$643.95,$0.00,$0.00,$654.41,"$3,737.50",$0.00,"$1,868.75","$2,960.10","$2,990.00",$0.00,$584.92,$0.00,$595.01,$0.00
AR-14005,SUP,HCPCS C1713,,AR-14005  -  PLATE BN STRL SUTUREPLATE 5 HL HUM,"$3,987.50",$0.00,"$3,987.50","$1,794.38","$2,845.88",$0.00,$687.03,$0.00,$0.00,$698.18,"$3,987.50",$0.00,"$1,993.75","$3,158.10","$3,190.00",$0.00,$624.04,$0.00,$634.81,$0.00
AR-1400B,SUP,HCPCS C1713,,AR-1400B  -  SCREW INTFR 10MM 23MM STRL BIOINTF CNN SHTH POLY L LAC ACD,$355.00,$0.00,$355.00,$159.75,$253.36,$0.00,$61.16,$0.00,$0.00,$62.16,$355.00,$0.00,$177.50,$281.16,$284.00,$0.00,$55.56,$0.00,$56.52,$0.00
AR-1400H-25,SUP,HCPCS C1713,,AR-1400H-25  -  SCREW INTFR BLNT RND 10MM 25MM STRL CNN SFT TI ACL PCL ACPT,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-1400H-30,SUP,HCPCS C1713,,AR-1400H-30  -  SCREW INTFR BLNT RND 10MM 30MM STRL CNN SFT TI ACL PCL ACPT,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-1400H-35,SUP,HCPCS C1713,,AR-1400H-35  -  SCREW INTFR BLNT RND 10MM 35MM STRL CNN SFT TI ACL PCL ACPT,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-1400P,SUP,HCPCS C1713,,AR-1400P  -  SCREW INTFR 10MM 23MM STRL PEEK-OPTM,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-1400T,SUP,HCPCS C1713,,AR-1400T  -  SCREW INTFR FT RND 10MM 28MM STRL CNN RECON TI ACL PCL ACPT,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-1400TB,SUP,HCPCS C1713,,AR-1400TB  -  SCREW INTFR FT 10MM 28MM STRL BIOINTF CNN POLY L LAC ACD ACL,$355.00,$0.00,$355.00,$159.75,$253.36,$0.00,$61.16,$0.00,$0.00,$62.16,$355.00,$0.00,$177.50,$281.16,$284.00,$0.00,$55.56,$0.00,$56.52,$0.00
AR-1400TC,SUP,HCPCS C1713,,AR-1400TC  -  SCREW INTFR BLNT FT STP TPR 10MM 28MM STRL CNN FULL SEAT RDC,$587.50,$0.00,$587.50,$264.38,$419.30,$0.00,$101.22,$0.00,$0.00,$102.87,$587.50,$0.00,$293.75,$465.30,$470.00,$0.00,$91.94,$0.00,$93.53,$0.00
AR-1401,SUP,HCPCS C1713,,AR-1401  -  SCREW INTFR 10MM 25MM STRL CNN TI ACL PCL DISP,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-14012,SUP,Custom 27203010,,AR-14012  -  GUIDE DRL 2.5MM SUTUREPLATE THRD,"$1,062.50",$0.00,"$1,062.50",$0.00,$758.31,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,062.50",$0.00,$531.25,$841.50,$850.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1401T,SUP,HCPCS C1713,,AR-1401T  -  SCREW INTFR FT RND 10MM 25MM STRL CNN RECON TI ACL PCL ACPT,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-1402,SUP,HCPCS C1713,,AR-1402  -  SCREW INTFR 10MM 30MM STRL BIOINTF CNN TI ACL PCL,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-14029,SUP,Custom 27203010,,AR-14029  -  GUIDE DRL 2.5MM,$662.50,$0.00,$662.50,$0.00,$472.83,$0.00,$0.00,$0.00,$0.00,$0.00,$662.50,$0.00,$331.25,$524.70,$530.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1402T,SUP,HCPCS C1713,,AR-1402T  -  SCREW INTFR FT RND 10MM 30MM STRL CNN RECON TI ACL PCL ACPT,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-1403TB,SUP,HCPCS C1713,,AR-1403TB  -  SCREW INTFR FT 11MM 28MM STRL BIOINTF CNN BLNT POLY L LAC,$355.00,$0.00,$355.00,$159.75,$253.36,$0.00,$61.16,$0.00,$0.00,$62.16,$355.00,$0.00,$177.50,$281.16,$284.00,$0.00,$55.56,$0.00,$56.52,$0.00
AR-1403TC,SUP,HCPCS C1713,,AR-1403TC  -  SCREW INTFR FT STP TPR 11MM 28MM STRL CNN SEAT RDC HD BLNT,$587.50,$0.00,$587.50,$264.38,$419.30,$0.00,$101.22,$0.00,$0.00,$102.87,$587.50,$0.00,$293.75,$465.30,$470.00,$0.00,$91.94,$0.00,$93.53,$0.00
AR-1404TB,SUP,HCPCS C1713,,AR-1404TB  -  SCREW INTFR FT 12MM 28MM STRL BIOINTF CNN BLNT POLY L LAC,$355.00,$0.00,$355.00,$159.75,$253.36,$0.00,$61.16,$0.00,$0.00,$62.16,$355.00,$0.00,$177.50,$281.16,$284.00,$0.00,$55.56,$0.00,$56.52,$0.00
AR-1405LP,SUP,Custom 27203010,,AR-1405LP  -  REAMER SRG LOPRFL 5MM STRL CNN ACL DISP,$487.50,$0.00,$487.50,$0.00,$347.93,$0.00,$0.00,$0.00,$0.00,$0.00,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1405LP-50,SUP,Custom 27203010,,AR-1405LP-50  -  REAMER SURG LP 5.5MM CANN ACL STERILE DISPOSABLE,$487.50,$0.00,$487.50,$0.00,$347.93,$0.00,$0.00,$0.00,$0.00,$0.00,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1406LP,SUP,Custom 27203010,,AR-1406LP  -  REAMER SRG LOPRFL 6MM STRL CNN ACL DISP,$487.50,$0.00,$487.50,$0.00,$347.93,$0.00,$0.00,$0.00,$0.00,$0.00,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1406LP-50,SUP,Custom 27203010,,AR-1406LP-50  -  REAMER SRG LOPRFL 6.5MM STRL CNN ACL DISP,$487.50,$0.00,$487.50,$0.00,$347.93,$0.00,$0.00,$0.00,$0.00,$0.00,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1407LP,SUP,Custom 27203010,,AR-1407LP  -  REAMER SURG LP 7MM CANN ACL STERILE DISPOSABLE,$487.50,$0.00,$487.50,$0.00,$347.93,$0.00,$0.00,$0.00,$0.00,$0.00,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1407LP-50,SUP,Custom 27203010,,AR-1407LP-50  -  REAMER SURG LP 7.5MM CANN ACL STERILE DISPOSABLE,$487.50,$0.00,$487.50,$0.00,$347.93,$0.00,$0.00,$0.00,$0.00,$0.00,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1408LP,SUP,Custom 27203010,,AR-1408LP  -  REAMER SURG LP 8MM CANN ACL STERILE DISPOSABLE,$487.50,$0.00,$487.50,$0.00,$347.93,$0.00,$0.00,$0.00,$0.00,$0.00,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1408LP-50,SUP,Custom 27203010,,AR-1408LP-50  -  REAMER SURG LP 8.5MM CANN ACL STERILE DISPOSABLE,$487.50,$0.00,$487.50,$0.00,$347.93,$0.00,$0.00,$0.00,$0.00,$0.00,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1408LPF,SUP,Custom 27203010,,AR-1408LPF  -  REAMER SRG LOPRFL 8MM LOW PROFILE,$712.50,$0.00,$712.50,$0.00,$508.51,$0.00,$0.00,$0.00,$0.00,$0.00,$712.50,$0.00,$356.25,$564.30,$570.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1408LPF-50,SUP,Custom 27203010,,AR-1408LPF-50  -  REAMER SRG LOPRFL 8.5MM LOW PROFILE,$712.50,$0.00,$712.50,$0.00,$508.51,$0.00,$0.00,$0.00,$0.00,$0.00,$712.50,$0.00,$356.25,$564.30,$570.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1409LP,SUP,Custom 27203010,,AR-1409LP  -  REAMER SURG LP 9MM CANN ACL STERILE DISPOSABLE,$487.50,$0.00,$487.50,$0.00,$347.93,$0.00,$0.00,$0.00,$0.00,$0.00,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1409LP-50,SUP,Custom 27203010,,AR-1409LP-50  -  REAMER SURG LP 9.5MM CANN ACL STERILE DISPOSABLE,$487.50,$0.00,$487.50,$0.00,$347.93,$0.00,$0.00,$0.00,$0.00,$0.00,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1409LPF,SUP,Custom 27203010,,AR-1409LPF  -  REAMER SRG LOPRFL 9MM LOW PROFILE,$712.50,$0.00,$712.50,$0.00,$508.51,$0.00,$0.00,$0.00,$0.00,$0.00,$712.50,$0.00,$356.25,$564.30,$570.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1409LPF-50,SUP,Custom 27203010,,AR-1409LPF-50  -  REAMER SRG LOPRFL 9.5MM LOW PROFILE,$712.50,$0.00,$712.50,$0.00,$508.51,$0.00,$0.00,$0.00,$0.00,$0.00,$712.50,$0.00,$356.25,$564.30,$570.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1410LP,SUP,Custom 27203010,,AR-1410LP  -  REAMER SURG LP 10MM CANN ACL STERILE DISPOSABLE,$487.50,$0.00,$487.50,$0.00,$347.93,$0.00,$0.00,$0.00,$0.00,$0.00,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1410LP-50,SUP,Custom 27203010,,AR-1410LP-50  -  REAMER SURG LP 10.5MM CANN ACL STERILE DISPOSABLE,$487.50,$0.00,$487.50,$0.00,$347.93,$0.00,$0.00,$0.00,$0.00,$0.00,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1410LPF,SUP,Custom 27203010,,AR-1410LPF  -  REAMER SRG LOPRFL 10MM LOW PROFILE,$712.50,$0.00,$712.50,$0.00,$508.51,$0.00,$0.00,$0.00,$0.00,$0.00,$712.50,$0.00,$356.25,$564.30,$570.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1410LPF-50,SUP,Custom 27203010,,AR-1410LPF-50  -  REAMER SRG LOPRFL 10.5MM LOW PROFILE,$712.50,$0.00,$712.50,$0.00,$508.51,$0.00,$0.00,$0.00,$0.00,$0.00,$712.50,$0.00,$356.25,$564.30,$570.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-14116,SUP,HCPCS C1713,,AR-14116  -  SCREW BN LOPRFL 3.5MM 16MM SUTUREPLATE LCK TI SHLDR CORT,$280.00,$0.00,$280.00,$126.00,$199.84,$0.00,$48.24,$0.00,$0.00,$49.03,$280.00,$0.00,$140.00,$221.76,$224.00,$0.00,$43.82,$0.00,$44.58,$0.00
AR-14116NL,SUP,HCPCS C1713,,AR-14116NL  -  SCREW BN LOPRFL 3.5MM 16MM SUTUREPLATE TI SHLDR CORT ARTHPL,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
AR-14118,SUP,HCPCS C1713,,AR-14118  -  SCREW BN LOPRFL 3.5MM 18MM SUTUREPLATE LCK TI SHLDR CORT,$280.00,$0.00,$280.00,$126.00,$199.84,$0.00,$48.24,$0.00,$0.00,$49.03,$280.00,$0.00,$140.00,$221.76,$224.00,$0.00,$43.82,$0.00,$44.58,$0.00
AR-14118NL,SUP,HCPCS C1713,,AR-14118NL  -  SCREW BN LOPRFL 3.5MM 18MM SUTUREPLATE TI SHLDR CORT ARTHPL,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
AR-1411LP,SUP,Custom 27203010,,AR-1411LP  -  REAMER SURG LP 11MM CANN ACL STERILE DISPOSABLE,$487.50,$0.00,$487.50,$0.00,$347.93,$0.00,$0.00,$0.00,$0.00,$0.00,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1411LP-50,SUP,Custom 27203010,,AR-1411LP-50  -  REAMER SRG LOPRFL 11.5MM STRL CNN ACL DISP,$487.50,$0.00,$487.50,$0.00,$347.93,$0.00,$0.00,$0.00,$0.00,$0.00,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1411LPF,SUP,Custom 27203010,,AR-1411LPF  -  REAMER SRG LOPRFL 11MM LOW PROFILE,$712.50,$0.00,$712.50,$0.00,$508.51,$0.00,$0.00,$0.00,$0.00,$0.00,$712.50,$0.00,$356.25,$564.30,$570.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-14120,SUP,HCPCS C1713,,AR-14120  -  SCREW BN LOPRFL 3.5MM 20MM SUTUREPLATE LCK TI SHLDR CORT,$280.00,$0.00,$280.00,$126.00,$199.84,$0.00,$48.24,$0.00,$0.00,$49.03,$280.00,$0.00,$140.00,$221.76,$224.00,$0.00,$43.82,$0.00,$44.58,$0.00
AR-14120NL,SUP,HCPCS C1713,,AR-14120NL  -  SCREW BN LOPRFL 3.5MM 20MM SUTUREPLATE TI SHLDR CORT ARTHPL,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
AR-14122,SUP,HCPCS C1713,,AR-14122  -  SCREW BN LOPRFL 3.5MM 22MM SUTUREPLATE LCK TI SHLDR CORT,$280.00,$0.00,$280.00,$126.00,$199.84,$0.00,$48.24,$0.00,$0.00,$49.03,$280.00,$0.00,$140.00,$221.76,$224.00,$0.00,$43.82,$0.00,$44.58,$0.00
AR-14122NL,SUP,HCPCS C1713,,AR-14122NL  -  SCREW BN LOPRFL 3.5MM 22MM SUTUREPLATE TI SHLDR CORT ARTHPL,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
AR-14124,SUP,HCPCS C1713,,AR-14124  -  SCREW BN LOPRFL 3.5MM 24MM SUTUREPLATE LCK TI SHLDR CORT,$280.00,$0.00,$280.00,$126.00,$199.84,$0.00,$48.24,$0.00,$0.00,$49.03,$280.00,$0.00,$140.00,$221.76,$224.00,$0.00,$43.82,$0.00,$44.58,$0.00
AR-14124NL,SUP,HCPCS C1713,,AR-14124NL  -  SCREW BN LOPRFL 3.5MM 24MM SUTUREPLATE TI SHLDR CORT ARTHPL,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
AR-14126,SUP,HCPCS C1713,,AR-14126  -  SCREW BN LOPRFL 3.5MM 26MM SUTUREPLATE LCK TI SHLDR CORT,$280.00,$0.00,$280.00,$126.00,$199.84,$0.00,$48.24,$0.00,$0.00,$49.03,$280.00,$0.00,$140.00,$221.76,$224.00,$0.00,$43.82,$0.00,$44.58,$0.00
AR-14126NL,SUP,HCPCS C1713,,AR-14126NL  -  SCREW BN LOPRFL 3.5MM 26MM SUTUREPLATE TI SHLDR CORT ARTHPL,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
AR-14128,SUP,HCPCS C1713,,AR-14128  -  SCREW BN LOPRFL 3.5MM 28MM SUTUREPLATE LCK TI SHLDR CORT,$280.00,$0.00,$280.00,$126.00,$199.84,$0.00,$48.24,$0.00,$0.00,$49.03,$280.00,$0.00,$140.00,$221.76,$224.00,$0.00,$43.82,$0.00,$44.58,$0.00
AR-14128NL,SUP,HCPCS C1713,,AR-14128NL  -  SCREW BN LOPRFL 3.5MM 28MM SUTUREPLATE TI SHLDR CORT ARTHPL,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
AR-1412LP,SUP,Custom 27203010,,AR-1412LP  -  REAMER SRG LOPRFL 12MM STRL CNN ACL DISP,$487.50,$0.00,$487.50,$0.00,$347.93,$0.00,$0.00,$0.00,$0.00,$0.00,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1412LP-50,SUP,Custom 27203010,,AR-1412LP-50  -  REAMER SRG LOPRFL 12.5MM STRL CNN ACL DISP,$487.50,$0.00,$487.50,$0.00,$347.93,$0.00,$0.00,$0.00,$0.00,$0.00,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-14130,SUP,HCPCS C1713,,AR-14130  -  SCREW BN LOPRFL 3.5MM 30MM SUTUREPLATE LCK TI SHLDR CORT,$280.00,$0.00,$280.00,$126.00,$199.84,$0.00,$48.24,$0.00,$0.00,$49.03,$280.00,$0.00,$140.00,$221.76,$224.00,$0.00,$43.82,$0.00,$44.58,$0.00
AR-14130NL,SUP,HCPCS C1713,,AR-14130NL  -  SCREW BN LOPRFL 3.5MM 30MM SUTUREPLATE TI SHLDR CORT ARTHPL,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
AR-14132,SUP,HCPCS C1713,,AR-14132  -  SCREW BN LOPRFL 3.5MM 32MM SUTUREPLATE LCK TI SHLDR CORT,$280.00,$0.00,$280.00,$126.00,$199.84,$0.00,$48.24,$0.00,$0.00,$49.03,$280.00,$0.00,$140.00,$221.76,$224.00,$0.00,$43.82,$0.00,$44.58,$0.00
AR-14132NL,SUP,HCPCS C1713,,AR-14132NL  -  SCREW BN LOPRFL 3.5MM 32MM SUTUREPLATE TI SHLDR CORT ARTHPL,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
AR-14134,SUP,HCPCS C1713,,AR-14134  -  SCREW BN LOPRFL 3.5MM 34MM SUTUREPLATE LCK TI SHLDR CORT,$280.00,$0.00,$280.00,$126.00,$199.84,$0.00,$48.24,$0.00,$0.00,$49.03,$280.00,$0.00,$140.00,$221.76,$224.00,$0.00,$43.82,$0.00,$44.58,$0.00
AR-14134NL,SUP,HCPCS C1713,,AR-14134NL  -  SCREW BN LOPRFL 3.5MM 34MM SUTUREPLATE TI SHLDR CORT ARTHPL,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
AR-14136,SUP,HCPCS C1713,,AR-14136  -  SCREW BN LOPRFL 3.5MM 36MM SUTUREPLATE LCK TI SHLDR CORT,$280.00,$0.00,$280.00,$126.00,$199.84,$0.00,$48.24,$0.00,$0.00,$49.03,$280.00,$0.00,$140.00,$221.76,$224.00,$0.00,$43.82,$0.00,$44.58,$0.00
AR-14136NL,SUP,HCPCS C1713,,AR-14136NL  -  SCREW BN LOPRFL 3.5MM 36MM SUTUREPLATE TI SHLDR CORT ARTHPL,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
AR-14138,SUP,HCPCS C1713,,AR-14138  -  SCREW BN LOPRFL 3.5MM 38MM SUTUREPLATE LCK TI SHLDR CORT,$280.00,$0.00,$280.00,$126.00,$199.84,$0.00,$48.24,$0.00,$0.00,$49.03,$280.00,$0.00,$140.00,$221.76,$224.00,$0.00,$43.82,$0.00,$44.58,$0.00
AR-14138NL,SUP,HCPCS C1713,,AR-14138NL  -  SCREW BN LOPRFL 3.5MM 38MM SUTUREPLATE TI SHLDR CORT ARTHPL,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
AR-1413LP,SUP,Custom 27203010,,AR-1413LP  -  REAMER SRG LOPRFL 13MM STRL CNN ACL DISP,$487.50,$0.00,$487.50,$0.00,$347.93,$0.00,$0.00,$0.00,$0.00,$0.00,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-14140,SUP,HCPCS C1713,,AR-14140  -  SCREW BN LOPRFL 3.5MM 40MM SUTUREPLATE LCK TI SHLDR CORT,$280.00,$0.00,$280.00,$126.00,$199.84,$0.00,$48.24,$0.00,$0.00,$49.03,$280.00,$0.00,$140.00,$221.76,$224.00,$0.00,$43.82,$0.00,$44.58,$0.00
AR-14140NL,SUP,HCPCS C1713,,AR-14140NL  -  SCREW BN LOPRFL 3.5MM 40MM SUTUREPLATE TI SHLDR CORT ARTHPL,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
AR-14145,SUP,HCPCS C1713,,AR-14145  -  SCREW BN LOPRFL 3.5MM 45MM SUTUREPLATE LCK TI SHLDR CORT,$280.00,$0.00,$280.00,$126.00,$199.84,$0.00,$48.24,$0.00,$0.00,$49.03,$280.00,$0.00,$140.00,$221.76,$224.00,$0.00,$43.82,$0.00,$44.58,$0.00
AR-14145NL,SUP,HCPCS C1713,,AR-14145NL  -  SCREW BN LOPRFL 3.5MM 45MM SUTUREPLATE TI SHLDR CORT ARTHPL,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
AR-14150,SUP,HCPCS C1713,,AR-14150  -  SCREW BN LOPRFL 3.5MM 50MM SUTUREPLATE LCK TI SHLDR CORT,$280.00,$0.00,$280.00,$126.00,$199.84,$0.00,$48.24,$0.00,$0.00,$49.03,$280.00,$0.00,$140.00,$221.76,$224.00,$0.00,$43.82,$0.00,$44.58,$0.00
AR-14150NL,SUP,HCPCS C1713,,AR-14150NL  -  SCREW BN LOPRFL 3.5MM 50MM SUTUREPLATE TI SHLDR CORT ARTHPL,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
AR-14224,SUP,HCPCS C1713,,AR-14224  -  SCREW BN LOPRFL 4MM 24MM SUTUREPLATE LCK TI SHLDR CANC,$280.00,$0.00,$280.00,$126.00,$199.84,$0.00,$48.24,$0.00,$0.00,$49.03,$280.00,$0.00,$140.00,$221.76,$224.00,$0.00,$43.82,$0.00,$44.58,$0.00
AR-14226,SUP,HCPCS C1713,,AR-14226  -  SCREW BN LOPRFL 4MM 26MM SUTUREPLATE LCK TI SHLDR CANC,$280.00,$0.00,$280.00,$126.00,$199.84,$0.00,$48.24,$0.00,$0.00,$49.03,$280.00,$0.00,$140.00,$221.76,$224.00,$0.00,$43.82,$0.00,$44.58,$0.00
AR-14228,SUP,HCPCS C1713,,AR-14228  -  SCREW BN LOPRFL 4MM 28MM SUTUREPLATE LCK TI SHLDR CANC,$280.00,$0.00,$280.00,$126.00,$199.84,$0.00,$48.24,$0.00,$0.00,$49.03,$280.00,$0.00,$140.00,$221.76,$224.00,$0.00,$43.82,$0.00,$44.58,$0.00
AR-14230,SUP,HCPCS C1713,,AR-14230  -  SCREW BN LOPRFL 4MM 30MM SUTUREPLATE LCK TI SHLDR CANC,$280.00,$0.00,$280.00,$126.00,$199.84,$0.00,$48.24,$0.00,$0.00,$49.03,$280.00,$0.00,$140.00,$221.76,$224.00,$0.00,$43.82,$0.00,$44.58,$0.00
AR-14232,SUP,HCPCS C1713,,AR-14232  -  SCREW BN LOPRFL 4MM 32MM SUTUREPLATE LCK TI SHLDR CANC,$280.00,$0.00,$280.00,$126.00,$199.84,$0.00,$48.24,$0.00,$0.00,$49.03,$280.00,$0.00,$140.00,$221.76,$224.00,$0.00,$43.82,$0.00,$44.58,$0.00
AR-14234,SUP,HCPCS C1713,,AR-14234  -  SCREW BN LOPRFL 4MM 34MM SUTUREPLATE LCK TI SHLDR CANC,$280.00,$0.00,$280.00,$126.00,$199.84,$0.00,$48.24,$0.00,$0.00,$49.03,$280.00,$0.00,$140.00,$221.76,$224.00,$0.00,$43.82,$0.00,$44.58,$0.00
AR-14236,SUP,HCPCS C1713,,AR-14236  -  SCREW BN LOPRFL 4MM 36MM SUTUREPLATE LCK TI SHLDR CANC,$280.00,$0.00,$280.00,$126.00,$199.84,$0.00,$48.24,$0.00,$0.00,$49.03,$280.00,$0.00,$140.00,$221.76,$224.00,$0.00,$43.82,$0.00,$44.58,$0.00
AR-14238,SUP,HCPCS C1713,,AR-14238  -  SCREW BN LOPRFL 4MM 38MM SUTUREPLATE LCK TI SHLDR CANC,$280.00,$0.00,$280.00,$126.00,$199.84,$0.00,$48.24,$0.00,$0.00,$49.03,$280.00,$0.00,$140.00,$221.76,$224.00,$0.00,$43.82,$0.00,$44.58,$0.00
AR-14240,SUP,HCPCS C1713,,AR-14240  -  SCREW BN LOPRFL 4MM 40MM SUTUREPLATE LCK TI SHLDR CANC,$280.00,$0.00,$280.00,$126.00,$199.84,$0.00,$48.24,$0.00,$0.00,$49.03,$280.00,$0.00,$140.00,$221.76,$224.00,$0.00,$43.82,$0.00,$44.58,$0.00
AR-14242,SUP,HCPCS C1713,,AR-14242  -  SCREW BN LOPRFL 4MM 42MM SUTUREPLATE LCK TI SHLDR CANC,$280.00,$0.00,$280.00,$126.00,$199.84,$0.00,$48.24,$0.00,$0.00,$49.03,$280.00,$0.00,$140.00,$221.76,$224.00,$0.00,$43.82,$0.00,$44.58,$0.00
AR-14244,SUP,HCPCS C1713,,AR-14244  -  SCREW BN LOPRFL 4MM 44MM SUTUREPLATE LCK TI SHLDR CANC,$280.00,$0.00,$280.00,$126.00,$199.84,$0.00,$48.24,$0.00,$0.00,$49.03,$280.00,$0.00,$140.00,$221.76,$224.00,$0.00,$43.82,$0.00,$44.58,$0.00
AR-14246,SUP,HCPCS C1713,,AR-14246  -  SCREW BN LOPRFL 4MM 46MM SUTUREPLATE LCK TI SHLDR CANC,$280.00,$0.00,$280.00,$126.00,$199.84,$0.00,$48.24,$0.00,$0.00,$49.03,$280.00,$0.00,$140.00,$221.76,$224.00,$0.00,$43.82,$0.00,$44.58,$0.00
AR-14248,SUP,HCPCS C1713,,AR-14248  -  SCREW BN LOPRFL 4MM 48MM SUTUREPLATE LCK TI SHLDR CANC,$280.00,$0.00,$280.00,$126.00,$199.84,$0.00,$48.24,$0.00,$0.00,$49.03,$280.00,$0.00,$140.00,$221.76,$224.00,$0.00,$43.82,$0.00,$44.58,$0.00
AR-14250,SUP,HCPCS C1713,,AR-14250  -  SCREW BN 4MM 50MM SUTUREPLATE LCK HUM CANC,$280.00,$0.00,$280.00,$126.00,$199.84,$0.00,$48.24,$0.00,$0.00,$49.03,$280.00,$0.00,$140.00,$221.76,$224.00,$0.00,$43.82,$0.00,$44.58,$0.00
AR-14252,SUP,HCPCS C1713,,AR-14252  -  SCREW BN LOPRFL 4MM 52MM SUTUREPLATE LCK TI SHLDR CANC,$280.00,$0.00,$280.00,$126.00,$199.84,$0.00,$48.24,$0.00,$0.00,$49.03,$280.00,$0.00,$140.00,$221.76,$224.00,$0.00,$43.82,$0.00,$44.58,$0.00
AR-14254,SUP,HCPCS C1713,,AR-14254  -  SCREW BN LOPRFL 4MM 54MM SUTUREPLATE LCK TI SHLDR CANC,$280.00,$0.00,$280.00,$126.00,$199.84,$0.00,$48.24,$0.00,$0.00,$49.03,$280.00,$0.00,$140.00,$221.76,$224.00,$0.00,$43.82,$0.00,$44.58,$0.00
AR-14256,SUP,HCPCS C1713,,AR-14256  -  SCREW BN LOPRFL 4MM 56MM SUTUREPLATE LCK TI SHLDR CANC,$280.00,$0.00,$280.00,$126.00,$199.84,$0.00,$48.24,$0.00,$0.00,$49.03,$280.00,$0.00,$140.00,$221.76,$224.00,$0.00,$43.82,$0.00,$44.58,$0.00
AR-1450,SUP,Custom 27203010,,AR-1450  -  REAMER SRG 6MM STRL PILT HD,$512.50,$0.00,$512.50,$0.00,$365.77,$0.00,$0.00,$0.00,$0.00,$0.00,$512.50,$0.00,$256.25,$405.90,$410.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1451,SUP,Custom 27203010,,AR-1451  -  REAMER SURG 6.5MM PILOT HEAD STERILE,$512.50,$0.00,$512.50,$0.00,$365.77,$0.00,$0.00,$0.00,$0.00,$0.00,$512.50,$0.00,$256.25,$405.90,$410.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1452,SUP,Custom 27203010,,AR-1452  -  REAMER SRG 7MM STRL PILT HD,$512.50,$0.00,$512.50,$0.00,$365.77,$0.00,$0.00,$0.00,$0.00,$0.00,$512.50,$0.00,$256.25,$405.90,$410.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1453,SUP,Custom 27203010,,AR-1453  -  REAMER SRG 7.5MM STRL PILT HD,$512.50,$0.00,$512.50,$0.00,$365.77,$0.00,$0.00,$0.00,$0.00,$0.00,$512.50,$0.00,$256.25,$405.90,$410.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1454,SUP,Custom 27203010,,AR-1454  -  REAMER SRG 8MM STRL PILT HD,$512.50,$0.00,$512.50,$0.00,$365.77,$0.00,$0.00,$0.00,$0.00,$0.00,$512.50,$0.00,$256.25,$405.90,$410.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1455,SUP,Custom 27203010,,AR-1455  -  REAMER SRG 8.5MM STRL PILT HD,$512.50,$0.00,$512.50,$0.00,$365.77,$0.00,$0.00,$0.00,$0.00,$0.00,$512.50,$0.00,$256.25,$405.90,$410.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1456,SUP,Custom 27203010,,AR-1456  -  REAMER SRG 9MM STRL PILT HD,$512.50,$0.00,$512.50,$0.00,$365.77,$0.00,$0.00,$0.00,$0.00,$0.00,$512.50,$0.00,$256.25,$405.90,$410.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1457,SUP,Custom 27203010,,AR-1457  -  REAMER SRG 9.5MM STRL PILT HD,$512.50,$0.00,$512.50,$0.00,$365.77,$0.00,$0.00,$0.00,$0.00,$0.00,$512.50,$0.00,$256.25,$405.90,$410.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1458,SUP,Custom 27203010,,AR-1458  -  REAMER SRG 10MM STRL PILT HD,$512.50,$0.00,$512.50,$0.00,$365.77,$0.00,$0.00,$0.00,$0.00,$0.00,$512.50,$0.00,$256.25,$405.90,$410.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1502,SUP,Custom 27203010,,AR-1502  -  INSERT PSTN CSHN FM LG HLDR,$662.50,$0.00,$662.50,$0.00,$472.83,$0.00,$0.00,$0.00,$0.00,$0.00,$662.50,$0.00,$331.25,$524.70,$530.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1510FL,SUP,Custom 27203010,,AR-1510FL  -  GUIDE DRL RETROCONSTRUCTION SET ADJ C RING FTPRNT SLV FEM LT,"$1,365.00",$0.00,"$1,365.00",$0.00,$974.20,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,365.00",$0.00,$682.50,"$1,081.08","$1,092.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-1510FLS,SUP,Custom 27203010,,AR-1510FLS  -  GUIDE DRL ANG SM RETROCONSTRUCTION FTPRNT FEM LT ACL,"$2,433.75",$0.00,"$2,433.75",$0.00,"$1,736.97",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,433.75",$0.00,"$1,216.88","$1,927.53","$1,947.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-1510FPL,SUP,Custom 27203010,,AR-1510FPL  -  GUIDE DRL 7MM OFST RETROCONSTRUCTION FTPRNT FEM LT ACL,"$1,365.00",$0.00,"$1,365.00",$0.00,$974.20,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,365.00",$0.00,$682.50,"$1,081.08","$1,092.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-1510FPR,SUP,Custom 27203010,,AR-1510FPR  -  GUIDE DRL 7MM OFST RETROCONSTRUCTION FTPRNT FEM RT ACL,"$1,365.00",$0.00,"$1,365.00",$0.00,$974.20,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,365.00",$0.00,$682.50,"$1,081.08","$1,092.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-1510FR,SUP,Custom 27203010,,AR-1510FR  -  GUIDE DRL RETROCONSTRUCTION SET ADJ C RING FTPRNT SLV FEM RT,"$1,365.00",$0.00,"$1,365.00",$0.00,$974.20,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,365.00",$0.00,$682.50,"$1,081.08","$1,092.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-1510FRS,SUP,Custom 27203010,,AR-1510FRS  -  GUIDE DRL ANG SM RETROCONSTRUCTION FTPRNT FEM RT ACL,"$2,433.75",$0.00,"$2,433.75",$0.00,"$1,736.97",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,433.75",$0.00,"$1,216.88","$1,927.53","$1,947.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-1530BC,SUP,HCPCS C1713,,AR-1530BC  -  SCREW INTFR 3MM 8MM STRL TENODESIS HNDL INSRTR BCMPS SFT TIS,$937.50,$0.00,$937.50,$421.88,$669.09,$0.00,$161.53,$0.00,$0.00,$164.15,$937.50,$0.00,$468.75,$742.50,$750.00,$0.00,$146.72,$0.00,$149.25,$0.00
AR-1530C-25,SUP,Custom 27203010,,AR-1530C-25  -  BIT DRL 2.5MM CNN,$412.50,$0.00,$412.50,$0.00,$294.40,$0.00,$0.00,$0.00,$0.00,$0.00,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1530DS,SUP,Custom 27203010,,AR-1530DS  -  KIT INST 2-0 .041IN 2.5MM BTNDS FWR NDL CNN DRL SUT PASS WRE,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1530P-CP,SUP,HCPCS C1713,,AR-1530P-CP  -  SYSTEM IMPL STRL INTERNALBRACE PEEK FOREFOOT,"$3,487.50",$0.00,"$3,487.50","$1,569.38","$2,489.03",$0.00,$600.88,$0.00,$0.00,$610.63,"$3,487.50",$0.00,"$1,743.75","$2,762.10","$2,790.00",$0.00,$545.79,$0.00,$555.21,$0.00
AR-1530PS,SUP,HCPCS C1713,,AR-1530PS  -  SCREW INTFR 3MM 8MM STRL TENODESIS HNDL INSRTR VNT PEEK-OPTM,$912.50,$0.00,$912.50,$410.63,$651.25,$0.00,$157.22,$0.00,$0.00,$159.77,$912.50,$0.00,$456.25,$722.70,$730.00,$0.00,$142.81,$0.00,$145.27,$0.00
AR-1540B,SUP,HCPCS C1713,,AR-1540B  -  SCREW INTFR 4MM 10MM STRL BTNDS RECON POLY L LAC ACD ACL PCL,$787.50,$0.00,$787.50,$354.38,$562.04,$0.00,$135.68,$0.00,$0.00,$137.88,$787.50,$0.00,$393.75,$623.70,$630.00,$0.00,$123.24,$0.00,$125.37,$0.00
AR-1540BC,SUP,HCPCS C1713,,AR-1540BC  -  SCREW INTFR 4MM 10MM STRL TENODESIS BCMPS ACL,$862.50,$0.00,$862.50,$388.13,$615.57,$0.00,$148.60,$0.00,$0.00,$151.02,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$134.98,$0.00,$137.31,$0.00
AR-1540CDS,SUP,HCPCS C1713,,AR-1540CDS  -  SCREW INTFR 4MM 10MM TENODESIS SCR DISP DRVR PK BCMPS,"$4,812.50",$0.00,"$4,812.50","$2,165.63","$3,434.68",$0.00,$829.17,$0.00,$0.00,$842.63,"$4,812.50",$0.00,"$2,406.25","$3,811.50","$3,850.00",$0.00,$753.16,$0.00,$766.15,$0.00
AR-1540PS,SUP,HCPCS C1713,,AR-1540PS  -  SCREW INTFR 4MM 10MM STRL TENODESIS VNT PEEK-OPTM FT/ANKL,$787.50,$0.00,$787.50,$354.38,$562.04,$0.00,$135.68,$0.00,$0.00,$137.88,$787.50,$0.00,$393.75,$623.70,$630.00,$0.00,$123.24,$0.00,$125.37,$0.00
AR-1547BC,SUP,HCPCS C1713,,AR-1547BC  -  SCREW INTFR 4.75MM 15MM STRL TENODESIS BCMPS ACL,$862.50,$0.00,$862.50,$388.13,$615.57,$0.00,$148.60,$0.00,$0.00,$151.02,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$134.98,$0.00,$137.31,$0.00
AR-1547CDS,SUP,HCPCS C1713,,AR-1547CDS  -  SCREW INTFR 4.75MM 15MM TENODESIS SCR DISP DRVR PK BCMPS,"$4,812.50",$0.00,"$4,812.50","$2,165.63","$3,434.68",$0.00,$829.17,$0.00,$0.00,$842.63,"$4,812.50",$0.00,"$2,406.25","$3,811.50","$3,850.00",$0.00,$753.16,$0.00,$766.15,$0.00
AR-1547PS,SUP,HCPCS C1713,,AR-1547PS  -  SCREW INTFR 4.75MM 15MM STRL TENODESIS VNT PEEK-OPTM FT/ANKL,$787.50,$0.00,$787.50,$354.38,$562.04,$0.00,$135.68,$0.00,$0.00,$137.88,$787.50,$0.00,$393.75,$623.70,$630.00,$0.00,$123.24,$0.00,$125.37,$0.00
AR-1555BC,SUP,HCPCS C1713,,AR-1555BC  -  SCREW INTFR 5.5MM 15MM STRL TENODESIS BCMPS ACL,$862.50,$0.00,$862.50,$388.13,$615.57,$0.00,$148.60,$0.00,$0.00,$151.02,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$134.98,$0.00,$137.31,$0.00
AR-1555CDS-1,SUP,HCPCS C1713,,AR-1555CDS-1  -  SCREW BN 5.5MM 15MM STRL ARTHX DISP DRVR BCMPS TENODESIS,$962.50,$0.00,$962.50,$433.13,$686.94,$0.00,$165.83,$0.00,$0.00,$168.53,$962.50,$0.00,$481.25,$762.30,$770.00,$0.00,$150.63,$0.00,$153.23,$0.00
AR-1555PS,SUP,HCPCS C1713,,AR-1555PS  -  SCREW INTFR 5.5MM 15MM STRL TENODESIS VNT PEEK-OPTM FT/ANKL,$787.50,$0.00,$787.50,$354.38,$562.04,$0.00,$135.68,$0.00,$0.00,$137.88,$787.50,$0.00,$393.75,$623.70,$630.00,$0.00,$123.24,$0.00,$125.37,$0.00
AR-1562BC,SUP,HCPCS C1713,,AR-1562BC  -  SCREW INTFR 6.25MM 15MM STRL TENODESIS BCMPS ACL,$862.50,$0.00,$862.50,$388.13,$615.57,$0.00,$148.60,$0.00,$0.00,$151.02,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$134.98,$0.00,$137.31,$0.00
AR-1562CDS,SUP,HCPCS C1713,,AR-1562CDS  -  SCREW INTFR 6.25MM 15MM TENODESIS SCR DISP DRVR PK BCMPS,"$4,812.50",$0.00,"$4,812.50","$2,165.63","$3,434.68",$0.00,$829.17,$0.00,$0.00,$842.63,"$4,812.50",$0.00,"$2,406.25","$3,811.50","$3,850.00",$0.00,$753.16,$0.00,$766.15,$0.00
AR-1562PS,SUP,HCPCS C1713,,AR-1562PS  -  SCREW INTFR 6.25MM 15MM STRL TENODESIS VNT PEEK-OPTM FT/ANKL,$787.50,$0.00,$787.50,$354.38,$562.04,$0.00,$135.68,$0.00,$0.00,$137.88,$787.50,$0.00,$393.75,$623.70,$630.00,$0.00,$123.24,$0.00,$125.37,$0.00
AR-1570BC,SUP,HCPCS C1713,,AR-1570BC  -  SCREW INTFR 7MM 23MM STRL TENODESIS BCMPS ACL,$862.50,$0.00,$862.50,$388.13,$615.57,$0.00,$148.60,$0.00,$0.00,$151.02,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$134.98,$0.00,$137.31,$0.00
AR-1570PS,SUP,HCPCS C1713,,AR-1570PS  -  SCREW INTFR 7MM 23MM STRL TENODESIS VNT PEEK-OPTM FT/ANKL,$787.50,$0.00,$787.50,$354.38,$562.04,$0.00,$135.68,$0.00,$0.00,$137.88,$787.50,$0.00,$393.75,$623.70,$630.00,$0.00,$123.24,$0.00,$125.37,$0.00
AR-1580BC,SUP,HCPCS C1713,,AR-1580BC  -  SCREW INTFR 8MM 23MM STRL TENODESIS BCMPS ACL,$862.50,$0.00,$862.50,$388.13,$615.57,$0.00,$148.60,$0.00,$0.00,$151.02,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$134.98,$0.00,$137.31,$0.00
AR-1580PS,SUP,HCPCS C1713,,AR-1580PS  -  SCREW INTFR 8MM 23MM STRL TENODESIS VNT PEEK-OPTM FT/ANKL,$787.50,$0.00,$787.50,$354.38,$562.04,$0.00,$135.68,$0.00,$0.00,$137.88,$787.50,$0.00,$393.75,$623.70,$630.00,$0.00,$123.24,$0.00,$125.37,$0.00
AR-1586FR-07,SUP,HCPCS C1713,,AR-1586FR-07  -  SCREW INTFR 7MM 20MM STRL RETROSCREW 2 BNDL RECON RVRS THRD,$312.50,$0.00,$312.50,$140.63,$223.03,$0.00,$53.84,$0.00,$0.00,$54.72,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$48.91,$0.00,$49.75,$0.00
AR-1586FR-08,SUP,HCPCS C1713,,AR-1586FR-08  -  SCREW INTFR 8MM 20MM STRL RETROSCREW 2 BNDL RECON RVRS THRD,$312.50,$0.00,$312.50,$140.63,$223.03,$0.00,$53.84,$0.00,$0.00,$54.72,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$48.91,$0.00,$49.75,$0.00
AR-1586FR-09,SUP,HCPCS C1713,,AR-1586FR-09  -  SCREW INTFR 9MM 20MM STRL RETROSCREW 2 BNDL RECON RVRS THRD,$312.50,$0.00,$312.50,$140.63,$223.03,$0.00,$53.84,$0.00,$0.00,$54.72,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$48.91,$0.00,$49.75,$0.00
AR-1586FR-10,SUP,HCPCS C1713,,AR-1586FR-10  -  SCREW INTFR 10MM 20MM STRL RETROSCREW 2 BNDL RECON RVRS THRD,$312.50,$0.00,$312.50,$140.63,$223.03,$0.00,$53.84,$0.00,$0.00,$54.72,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$48.91,$0.00,$49.75,$0.00
AR-1586FRB-07,SUP,HCPCS C1713,,AR-1586FRB-07  -  SCREW INTFR 7MM 20MM STRL RETROSCREW RECON RVRS THRD DSGN,$485.00,$0.00,$485.00,$218.25,$346.14,$0.00,$83.56,$0.00,$0.00,$84.92,$485.00,$0.00,$242.50,$384.12,$388.00,$0.00,$75.90,$0.00,$77.21,$0.00
AR-1586FRB-08,SUP,HCPCS C1713,,AR-1586FRB-08  -  SCREW INTFR 8MM 20MM STRL RETROSCREW RECON RVRS THRD DSGN,$485.00,$0.00,$485.00,$218.25,$346.14,$0.00,$83.56,$0.00,$0.00,$84.92,$485.00,$0.00,$242.50,$384.12,$388.00,$0.00,$75.90,$0.00,$77.21,$0.00
AR-1586FRB-09,SUP,HCPCS C1713,,AR-1586FRB-09  -  SCREW INTFR 9MM 20MM STRL RETROSCREW RECON RVRS THRD DSGN,$485.00,$0.00,$485.00,$218.25,$346.14,$0.00,$83.56,$0.00,$0.00,$84.92,$485.00,$0.00,$242.50,$384.12,$388.00,$0.00,$75.90,$0.00,$77.21,$0.00
AR-1586FRB-10,SUP,HCPCS C1713,,AR-1586FRB-10  -  SCREW INTFR 10MM 20MM STRL RETROSCREW RECON RVRS THRD DSGN,$485.00,$0.00,$485.00,$218.25,$346.14,$0.00,$83.56,$0.00,$0.00,$84.92,$485.00,$0.00,$242.50,$384.12,$388.00,$0.00,$75.90,$0.00,$77.21,$0.00
AR-1586LB-08,SUP,HCPCS C1713,,AR-1586LB-08  -  SCREW INTFR 8MM 20MM STRL RETROSCREW RECON RVRS THRD DSGN,$485.00,$0.00,$485.00,$218.25,$346.14,$0.00,$83.56,$0.00,$0.00,$84.92,$485.00,$0.00,$242.50,$384.12,$388.00,$0.00,$75.90,$0.00,$77.21,$0.00
AR-1586LB-09,SUP,HCPCS C1713,,AR-1586LB-09  -  SCREW INTFR 9MM 20MM STRL RETROSCREW RECON RVRS THRD DSGN,$485.00,$0.00,$485.00,$218.25,$346.14,$0.00,$83.56,$0.00,$0.00,$84.92,$485.00,$0.00,$242.50,$384.12,$388.00,$0.00,$75.90,$0.00,$77.21,$0.00
AR-1586LB-10,SUP,HCPCS C1713,,AR-1586LB-10  -  SCREW INTFR 10MM 20MM STRL RETROSCREW RECON RVRS THRD DSGN,$485.00,$0.00,$485.00,$218.25,$346.14,$0.00,$83.56,$0.00,$0.00,$84.92,$485.00,$0.00,$242.50,$384.12,$388.00,$0.00,$75.90,$0.00,$77.21,$0.00
AR-1586R-08,SUP,HCPCS C1713,,AR-1586R-08  -  SCREW INTFR 8MM 20MM STRL RETROSCREW RECON RVRS THRD DSGN TI,$312.50,$0.00,$312.50,$140.63,$223.03,$0.00,$53.84,$0.00,$0.00,$54.72,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$48.91,$0.00,$49.75,$0.00
AR-1586R-09,SUP,HCPCS C1713,,AR-1586R-09  -  SCREW INTFR 9MM 20MM STRL RETROSCREW RECON RVRS THRD DSGN TI,$312.50,$0.00,$312.50,$140.63,$223.03,$0.00,$53.84,$0.00,$0.00,$54.72,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$48.91,$0.00,$49.75,$0.00
AR-1586R-10,SUP,HCPCS C1713,,AR-1586R-10  -  SCREW INTFR 10MM 20MM STRL RETROSCREW RECON RVRS THRD DSGN,$312.50,$0.00,$312.50,$140.63,$223.03,$0.00,$53.84,$0.00,$0.00,$54.72,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$48.91,$0.00,$49.75,$0.00
AR-1586RB-06,SUP,HCPCS C1713,,AR-1586RB-06  -  SCREW INTFR 6MM 20MM STRL RETROSCREW RECON RVRS THRD DSGN,$485.00,$0.00,$485.00,$218.25,$346.14,$0.00,$83.56,$0.00,$0.00,$84.92,$485.00,$0.00,$242.50,$384.12,$388.00,$0.00,$75.90,$0.00,$77.21,$0.00
AR-1586RB-07,SUP,HCPCS C1713,,AR-1586RB-07  -  SCREW INTFR 7MM 20MM STRL RETROSCREW RECON RVRS THRD DSGN,$485.00,$0.00,$485.00,$218.25,$346.14,$0.00,$83.56,$0.00,$0.00,$84.92,$485.00,$0.00,$242.50,$384.12,$388.00,$0.00,$75.90,$0.00,$77.21,$0.00
AR-1586RB-08,SUP,HCPCS C1713,,AR-1586RB-08  -  SCREW INTFR 8MM 20MM STRL RETROSCREW RECON RVRS THRD POLY L,$485.00,$0.00,$485.00,$218.25,$346.14,$0.00,$83.56,$0.00,$0.00,$84.92,$485.00,$0.00,$242.50,$384.12,$388.00,$0.00,$75.90,$0.00,$77.21,$0.00
AR-1586RB-09,SUP,HCPCS C1713,,AR-1586RB-09  -  SCREW INTFR 9MM 20MM STRL RETROSCREW RECON RVRS THRD DSGN,$485.00,$0.00,$485.00,$218.25,$346.14,$0.00,$83.56,$0.00,$0.00,$84.92,$485.00,$0.00,$242.50,$384.12,$388.00,$0.00,$75.90,$0.00,$77.21,$0.00
AR-1586RB-10,SUP,HCPCS C1713,,AR-1586RB-10  -  SCREW INTFR 10MM 20MM STRL RETROSCREW RECON RVRS THRD DSGN,$485.00,$0.00,$485.00,$218.25,$346.14,$0.00,$83.56,$0.00,$0.00,$84.92,$485.00,$0.00,$242.50,$384.12,$388.00,$0.00,$75.90,$0.00,$77.21,$0.00
AR-1586RC-07,SUP,HCPCS C1713,,AR-1586RC-07  -  SCREW INTFR 20MM 7MM STRL RETROSCREW RVRS THRD DSGN BCMPS,$587.50,$0.00,$587.50,$264.38,$419.30,$0.00,$101.22,$0.00,$0.00,$102.87,$587.50,$0.00,$293.75,$465.30,$470.00,$0.00,$91.94,$0.00,$93.53,$0.00
AR-1586RC-08,SUP,HCPCS C1713,,AR-1586RC-08  -  SCREW INTFR 20MM 8MM STRL RETROSCREW RVRS THRD DSGN BCMPS,$587.50,$0.00,$587.50,$264.38,$419.30,$0.00,$101.22,$0.00,$0.00,$102.87,$587.50,$0.00,$293.75,$465.30,$470.00,$0.00,$91.94,$0.00,$93.53,$0.00
AR-1586RC-09,SUP,HCPCS C1713,,AR-1586RC-09  -  SCREW INTFR 20MM 9MM STRL RETROSCREW RVRS THRD DSGN BCMPS,$587.50,$0.00,$587.50,$264.38,$419.30,$0.00,$101.22,$0.00,$0.00,$102.87,$587.50,$0.00,$293.75,$465.30,$470.00,$0.00,$91.94,$0.00,$93.53,$0.00
AR-1586RC-10,SUP,HCPCS C1713,,AR-1586RC-10  -  SCREW INTFR 10MM 20MM STRL RETROSCREW ACL RVRS THRD DSGN,$587.50,$0.00,$587.50,$264.38,$419.30,$0.00,$101.22,$0.00,$0.00,$102.87,$587.50,$0.00,$293.75,$465.30,$470.00,$0.00,$91.94,$0.00,$93.53,$0.00
AR-1587S,SUP,Custom 27203010,,AR-1587S  -  KIT INST STRL ALL INSD ACL DISP,"$1,182.50",$0.00,"$1,182.50",$0.00,$843.95,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,182.50",$0.00,$591.25,$936.54,$946.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1588-15,SUP,HCPCS C1763,,AR-1588-15  -  BUTTON FX 12MM STRL 15MM RETROBUTTON LOOP SLF FLP TI UHMWPE,$587.50,$0.00,$587.50,$264.38,$419.30,$0.00,$101.22,$0.00,$0.00,$102.87,$587.50,$0.00,$293.75,$465.30,$470.00,$0.00,$91.94,$0.00,$93.53,$0.00
AR-1588-25,SUP,HCPCS C1763,,AR-1588-25  -  BUTTON FX 12MM STRL 25MM RETROBUTTON LOOP SLF FLP TI UHMWPE,$587.50,$0.00,$587.50,$264.38,$419.30,$0.00,$101.22,$0.00,$0.00,$102.87,$587.50,$0.00,$293.75,$465.30,$470.00,$0.00,$91.94,$0.00,$93.53,$0.00
AR-1588-25BT,SUP,HCPCS C1763,,AR-1588-25BT  -  BUTTON FX 12MM STRL 25MM RETROBUTTON LOOP SLF FLP TI UHMWPE,$762.50,$0.00,$762.50,$343.13,$544.20,$0.00,$131.37,$0.00,$0.00,$133.51,$762.50,$0.00,$381.25,$603.90,$610.00,$0.00,$119.33,$0.00,$121.39,$0.00
AR-1588-30BT,SUP,HCPCS C1763,,AR-1588-30BT  -  BUTTON FX 12MM STRL 30MM RETROBUTTON LOOP SLF FLP TI UHMWPE,$762.50,$0.00,$762.50,$343.13,$544.20,$0.00,$131.37,$0.00,$0.00,$133.51,$762.50,$0.00,$381.25,$603.90,$610.00,$0.00,$119.33,$0.00,$121.39,$0.00
AR-1588-35,SUP,HCPCS C1763,,AR-1588-35  -  BUTTON FX 12MM STRL 35MM RETROBUTTON LOOP SLF FLP TI UHMWPE,$587.50,$0.00,$587.50,$264.38,$419.30,$0.00,$101.22,$0.00,$0.00,$102.87,$587.50,$0.00,$293.75,$465.30,$470.00,$0.00,$91.94,$0.00,$93.53,$0.00
AR-1588-35BT,SUP,HCPCS C1763,,AR-1588-35BT  -  BUTTON FX 12MM STRL 35MM RETROBUTTON LOOP SLF FLP TI UHMWPE,$762.50,$0.00,$762.50,$343.13,$544.20,$0.00,$131.37,$0.00,$0.00,$133.51,$762.50,$0.00,$381.25,$603.90,$610.00,$0.00,$119.33,$0.00,$121.39,$0.00
AR-1588-40,SUP,HCPCS C1763,,AR-1588-40  -  BUTTON FX 12MM STRL 40MM RETROBUTTON LOOP SLF FLP TI UHMWPE,$587.50,$0.00,$587.50,$264.38,$419.30,$0.00,$101.22,$0.00,$0.00,$102.87,$587.50,$0.00,$293.75,$465.30,$470.00,$0.00,$91.94,$0.00,$93.53,$0.00
AR-1588-45,SUP,HCPCS C1763,,AR-1588-45  -  BUTTON FX 12MM STRL 45MM RETROBUTTON LOOP SLF FLP TI UHMWPE,$587.50,$0.00,$587.50,$264.38,$419.30,$0.00,$101.22,$0.00,$0.00,$102.87,$587.50,$0.00,$293.75,$465.30,$470.00,$0.00,$91.94,$0.00,$93.53,$0.00
AR-1588-50,SUP,HCPCS C1763,,AR-1588-50  -  BUTTON FX 12MM STRL 50MM RETROBUTTON LOOP SLF FLP TI UHMWPE,$587.50,$0.00,$587.50,$264.38,$419.30,$0.00,$101.22,$0.00,$0.00,$102.87,$587.50,$0.00,$293.75,$465.30,$470.00,$0.00,$91.94,$0.00,$93.53,$0.00
AR-1588-55,SUP,HCPCS C1763,,AR-1588-55  -  BUTTON FX 12MM STRL 55MM RETROBUTTON LOOP SLF FLP TI UHMWPE,$587.50,$0.00,$587.50,$264.38,$419.30,$0.00,$101.22,$0.00,$0.00,$102.87,$587.50,$0.00,$293.75,$465.30,$470.00,$0.00,$91.94,$0.00,$93.53,$0.00
AR-1588-55BT,SUP,HCPCS C1763,,"AR-1588-55BT  -  BUTTON BTB RETROBUTTON, 12MM X 55MM LOOP",$762.50,$0.00,$762.50,$343.13,$544.20,$0.00,$131.37,$0.00,$0.00,$133.51,$762.50,$0.00,$381.25,$603.90,$610.00,$0.00,$119.33,$0.00,$121.39,$0.00
AR-1588-60,SUP,HCPCS C1763,,AR-1588-60  -  BUTTON FX 12MM STRL 60MM RETROBUTTON LOOP SLF FLP TI UHMWPE,$587.50,$0.00,$587.50,$264.38,$419.30,$0.00,$101.22,$0.00,$0.00,$102.87,$587.50,$0.00,$293.75,$465.30,$470.00,$0.00,$91.94,$0.00,$93.53,$0.00
AR-1588-60BT,SUP,HCPCS C1763,,"AR-1588-60BT  -  BUTTON BTB 12MM RETROBUTTON, 60MM LOOP",$762.50,$0.00,$762.50,$343.13,$544.20,$0.00,$131.37,$0.00,$0.00,$133.51,$762.50,$0.00,$381.25,$603.90,$610.00,$0.00,$119.33,$0.00,$121.39,$0.00
AR-1588BTB,SUP,HCPCS C1713,,AR-1588BTB  -  DEVICE FIX SMALL 10MM 4 POINT LOCK ADJUSTABLE LOOP DRILL,"$1,062.50",$0.00,"$1,062.50",$478.13,$758.31,$0.00,$183.06,$0.00,$0.00,$186.04,"$1,062.50",$0.00,$531.25,$841.50,$850.00,$0.00,$166.28,$0.00,$169.15,$0.00
AR-1588BTB-J,SUP,HCPCS C1713,,AR-1588BTB-J  -  DEVICE FX TGHTRP DEPLOYING SUT,"$1,112.50",$0.00,"$1,112.50",$500.63,$793.99,$0.00,$191.68,$0.00,$0.00,$194.79,"$1,112.50",$0.00,$556.25,$881.10,$890.00,$0.00,$174.11,$0.00,$177.11,$0.00
AR-1588RT,SUP,HCPCS C1713,,AR-1588RT  -  KIT ENDSCP INSTR LATEX FREE TIGHTROPE TITANIUM UHMWPE ACL,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
AR-1588RT-07,SUP,Custom 27203010,,AR-1588RT-07  -  KIT ASCP FX 8MM LF TGHTRP FLIPCUTTER II TIB RT ACL,"$1,687.50",$0.00,"$1,687.50",$0.00,"$1,204.37",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,687.50",$0.00,$843.75,"$1,336.50","$1,350.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-1588RT-13,SUP,Custom 27203010,,AR-1588RT-13  -  KIT ASCP FX 11MM LF TGHTRP FLIPCUTTER II TIB RT ACL,"$1,687.50",$0.00,"$1,687.50",$0.00,"$1,204.37",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,687.50",$0.00,$843.75,"$1,336.50","$1,350.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-1588RT-18,SUP,Custom 27203010,,AR-1588RT-18  -  KIT ASCP FX 9MM LF TGHTRP FLIPCUTTER II TIB RT ACL,"$1,687.50",$0.00,"$1,687.50",$0.00,"$1,204.37",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,687.50",$0.00,$843.75,"$1,336.50","$1,350.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-1588RT-J,SUP,HCPCS C1713,,AR-1588RT-J  -  DEVICE FX TGHTRP 2 LD PASS SUT ACL RT,$925.00,$0.00,$925.00,$416.25,$660.17,$0.00,$159.37,$0.00,$0.00,$161.96,$925.00,$0.00,$462.50,$732.60,$740.00,$0.00,$144.76,$0.00,$147.26,$0.00
AR-1588RTS,SUP,HCPCS C1713,,AR-1588RTS  -  KIT ARTHRO FIX DELIVERY SYSTEM DRILL PIN TIGHTROPE ACL RIGHT,"$1,125.00",$0.00,"$1,125.00",$506.25,$802.91,$0.00,$193.83,$0.00,$0.00,$196.98,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$176.06,$0.00,$179.10,$0.00
AR-1588T,SUP,Custom 27203010,,AR-1588T  -  KIT ASCP FX STRL TGHTRP REPR ACL,$875.00,$0.00,$875.00,$0.00,$624.49,$0.00,$0.00,$0.00,$0.00,$0.00,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1588TB,SUP,HCPCS C1763,,AR-1588TB  -  BUTTON FX 12MM 8MM TGHTRP ATCH SLOT ACL,$357.50,$0.00,$357.50,$160.88,$255.15,$0.00,$61.60,$0.00,$0.00,$62.60,$357.50,$0.00,$178.75,$283.14,$286.00,$0.00,$55.95,$0.00,$56.91,$0.00
AR-1588TB-1,SUP,HCPCS C1763,,AR-1588TB-1  -  BUTTON FIXATION TIGHTROPE ROUND OD14 MM ACL ATTACHABLE,$535.00,$0.00,$535.00,$240.75,$381.83,$0.00,$92.18,$0.00,$0.00,$93.67,$535.00,$0.00,$267.50,$423.72,$428.00,$0.00,$83.73,$0.00,$85.17,$0.00
AR-1588TB-2,SUP,HCPCS C1763,,AR-1588TB-2  -  BUTTON FX OBLNG 13MMXW 3.4MM TGHTRP ATCH SLOT ACL,$502.50,$0.00,$502.50,$226.13,$358.63,$0.00,$86.58,$0.00,$0.00,$87.98,$502.50,$0.00,$251.25,$397.98,$402.00,$0.00,$78.64,$0.00,$80.00,$0.00
AR-1588TB-3,SUP,HCPCS C1763,,AR-1588TB-3  -  BUTTON FX RND CNCV 11MM TGHTRP ATCH,$560.00,$0.00,$560.00,$252.00,$399.67,$0.00,$96.49,$0.00,$0.00,$98.05,$560.00,$0.00,$280.00,$443.52,$448.00,$0.00,$87.64,$0.00,$89.15,$0.00
AR-1588TB-4,SUP,HCPCS C1763,,AR-1588TB-4  -  BUTTON FX RND CNCV 14MM TGHTRP ATCH,$560.00,$0.00,$560.00,$252.00,$399.67,$0.00,$96.49,$0.00,$0.00,$98.05,$560.00,$0.00,$280.00,$443.52,$448.00,$0.00,$87.64,$0.00,$89.15,$0.00
AR-1588TB-5,SUP,HCPCS C1763,,AR-1588TB-5  -  BUTTON FX RND 20MM 9MM TGHTRP COLR ABS,$560.00,$0.00,$560.00,$252.00,$399.67,$0.00,$96.49,$0.00,$0.00,$98.05,$560.00,$0.00,$280.00,$443.52,$448.00,$0.00,$87.64,$0.00,$89.15,$0.00
AR-1588TDB-7,SUP,HCPCS C1713,,AR-1588TDB-7  -  DEVICE FX 7MM TGHTRP DLV SYS ACL DISP,"$1,162.50",$0.00,"$1,162.50",$523.13,$829.68,$0.00,$200.29,$0.00,$0.00,$203.54,"$1,162.50",$0.00,$581.25,$920.70,$930.00,$0.00,$181.93,$0.00,$185.07,$0.00
AR-1588TDB-7S,SUP,HCPCS C1713,,AR-1588TDB-7S  -  DEVICE FX TGHTRP DLV SYS ACL,"$1,475.00",$0.00,"$1,475.00",$663.75,"$1,052.71",$0.00,$254.14,$0.00,$0.00,$258.26,"$1,475.00",$0.00,$737.50,"$1,168.20","$1,180.00",$0.00,$230.84,$0.00,$234.82,$0.00
AR-1588TN,SUP,HCPCS C1713,,AR-1588TN  -  DEVICE TGHTRP ACL UHMWPE ATCH,$460.00,$0.00,$460.00,$207.00,$328.30,$0.00,$79.26,$0.00,$0.00,$80.54,$460.00,$0.00,$230.00,$364.32,$368.00,$0.00,$71.99,$0.00,$73.23,$0.00
AR-1588TN-1,SUP,HCPCS C1713,,AR-1588TN-1  -  DEVICE FX TGHTRP ATCH OPN UHMWPE ACL,$485.00,$0.00,$485.00,$218.25,$346.14,$0.00,$83.56,$0.00,$0.00,$84.92,$485.00,$0.00,$242.50,$384.12,$388.00,$0.00,$75.90,$0.00,$77.21,$0.00
AR-1588TP,SUP,Custom 27203010,,AR-1588TP  -  KIT ASCP FX TGHTRP PCL,$872.50,$0.00,$872.50,$0.00,$622.70,$0.00,$0.00,$0.00,$0.00,$0.00,$872.50,$0.00,$436.25,$691.02,$698.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1589-15,SUP,HCPCS C1763,,AR-1589-15  -  BUTTON FX LNG 15MM STRL 15MM RETROBUTTON LOOP SLF FLP TI,$587.50,$0.00,$587.50,$264.38,$419.30,$0.00,$101.22,$0.00,$0.00,$102.87,$587.50,$0.00,$293.75,$465.30,$470.00,$0.00,$91.94,$0.00,$93.53,$0.00
AR-1589-20,SUP,HCPCS C1763,,AR-1589-20  -  BUTTON FX LNG 15MM STRL 20MM RETROBUTTON LOOP SLF FLP TI,$587.50,$0.00,$587.50,$264.38,$419.30,$0.00,$101.22,$0.00,$0.00,$102.87,$587.50,$0.00,$293.75,$465.30,$470.00,$0.00,$91.94,$0.00,$93.53,$0.00
AR-1589-25,SUP,HCPCS C1763,,AR-1589-25  -  BUTTON FX LNG 15MM STRL 25MM RETROBUTTON LOOP SLF FLP TI,$587.50,$0.00,$587.50,$264.38,$419.30,$0.00,$101.22,$0.00,$0.00,$102.87,$587.50,$0.00,$293.75,$465.30,$470.00,$0.00,$91.94,$0.00,$93.53,$0.00
AR-1589-30,SUP,HCPCS C1763,,AR-1589-30  -  BUTTON FX LNG 15MM STRL 30MM RETROBUTTON LOOP SLF FLP TI,$587.50,$0.00,$587.50,$264.38,$419.30,$0.00,$101.22,$0.00,$0.00,$102.87,$587.50,$0.00,$293.75,$465.30,$470.00,$0.00,$91.94,$0.00,$93.53,$0.00
AR-1589-35,SUP,HCPCS C1763,,AR-1589-35  -  BUTTON FX LNG 15MM STRL 35MM RETROBUTTON LOOP SLF FLP TI,$587.50,$0.00,$587.50,$264.38,$419.30,$0.00,$101.22,$0.00,$0.00,$102.87,$587.50,$0.00,$293.75,$465.30,$470.00,$0.00,$91.94,$0.00,$93.53,$0.00
AR-1589-40,SUP,HCPCS C1763,,AR-1589-40  -  BUTTON FX LNG 15MM STRL 40MM RETROBUTTON LOOP SLF FLP TI,$587.50,$0.00,$587.50,$264.38,$419.30,$0.00,$101.22,$0.00,$0.00,$102.87,$587.50,$0.00,$293.75,$465.30,$470.00,$0.00,$91.94,$0.00,$93.53,$0.00
AR-1589RT,SUP,HCPCS C1763,,AR-1589RT  -  BUTTON SUT LG 20X5MM TGHTRP XTD FTPRNT,$562.50,$0.00,$562.50,$253.13,$401.46,$0.00,$96.92,$0.00,$0.00,$98.49,$562.50,$0.00,$281.25,$445.50,$450.00,$0.00,$88.03,$0.00,$89.55,$0.00
AR-1590BC,SUP,HCPCS C1713,,AR-1590BC  -  SCREW INTFR 9MM 23MM STRL TENODESIS BCMPS ACL,$862.50,$0.00,$862.50,$388.13,$615.57,$0.00,$148.60,$0.00,$0.00,$151.02,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$134.98,$0.00,$137.31,$0.00
AR-1590PS,SUP,HCPCS C1713,,AR-1590PS  -  SCREW INTFR 9MM 23MM STRL TENODESIS VNT PEEK-OPTM FT/ANKL,$787.50,$0.00,$787.50,$354.38,$562.04,$0.00,$135.68,$0.00,$0.00,$137.88,$787.50,$0.00,$393.75,$623.70,$630.00,$0.00,$123.24,$0.00,$125.37,$0.00
AR-1592,SUP,HCPCS C1763,,AR-1592  -  BUTTON FX XL 11MM 20MM STRL RETROBUTTON ASYM LOOP RECON STF,$662.50,$0.00,$662.50,$298.13,$472.83,$0.00,$114.15,$0.00,$0.00,$116.00,$662.50,$0.00,$331.25,$524.70,$530.00,$0.00,$103.68,$0.00,$105.47,$0.00
AR-1593,SUP,Custom 27203010,,AR-1593  -  SYSTEM FX ACL,"$1,500.00",$0.00,"$1,500.00",$0.00,"$1,070.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-1595,SUP,HCPCS C1763,,AR-1595  -  PIN DRILL RETROBUTTON KNEE ACL STERILE DISPOSABLE,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-1595TC,SUP,HCPCS C1763,,AR-1595TC  -  PIN DRL 4MM STRL RETROBUTTON TGHTRP CLS EYLT KN ACL DISP,$312.50,$0.00,$312.50,$140.63,$223.03,$0.00,$53.84,$0.00,$0.00,$54.72,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$48.91,$0.00,$49.75,$0.00
AR-1605S,SUP,HCPCS C1713,,AR-1605S  -  HOOK SCR STOR WLMNT 2 HK 2 BOLT DRL,$47.50,$0.00,$47.50,$21.38,$33.90,$0.00,$8.18,$0.00,$0.00,$8.32,$47.50,$0.00,$23.75,$37.62,$38.00,$0.00,$7.43,$0.00,$7.56,$0.00
AR-1606,SUP,Custom 27203010,,AR-1606  -  DEVICE PSTN STRL CBN STAR SLV LAT TRC ROT STRAP FM FRARM,$175.00,$0.00,$175.00,$0.00,$124.90,$0.00,$0.00,$0.00,$0.00,$0.00,$175.00,$0.00,$87.50,$138.60,$140.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1606C,SUP,Custom 27203010,,AR-1606C  -  DEVICE PSTN STRL CBN STAR SLV CMPCT LAT TRC ROT STRAP SFT FM,$150.00,$0.00,$150.00,$0.00,$107.06,$0.00,$0.00,$0.00,$0.00,$0.00,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1606LV,SUP,Custom 27203010,,AR-1606LV  -  DEVICE PSTN XLNG STRL STAR SLV VLCR FM ARM DISP,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1606SV,SUP,Custom 27203010,,AR-1606SV  -  DEVICE PSTN SM STRL STAR SLV VLCR LMB DISP,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1606V,SUP,Custom 27203010,,AR-1606V  -  DEVICE POSITIONING TRACTION SLING STAR SLEEVE VELCRO FOAM,"$1,500.00",$0.00,"$1,500.00",$0.00,"$1,070.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-1627-06,SUP,Custom 27203010,,AR-1627-06  -  KIT PSTN UNV HD STRL DISP,$49.75,$0.00,$49.75,$0.00,$35.51,$0.00,$0.00,$0.00,$0.00,$0.00,$49.75,$0.00,$24.88,$39.40,$39.80,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1627-11,SUP,Custom 27203010,,AR-1627-11  -  CLAMP OP TBL CLRK RAIL,$937.50,$0.00,$937.50,$0.00,$669.09,$0.00,$0.00,$0.00,$0.00,$0.00,$937.50,$0.00,$468.75,$742.50,$750.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1644,SUP,Custom 27203010,,AR-1644  -  KIT POSITIONING BEACH CHAIR DRAPE HOLDER LIGHTWEIGHT TRIMANO,$187.50,$0.00,$187.50,$0.00,$133.82,$0.00,$0.00,$0.00,$0.00,$0.00,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1648,SUP,Custom 27203010,,AR-1648  -  COVER PSTN STRL TRIMANO DRP,$45.00,$0.00,$45.00,$0.00,$32.12,$0.00,$0.00,$0.00,$0.00,$0.00,$45.00,$0.00,$22.50,$35.64,$36.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1650-07,SUP,Custom 27203010,,AR-1650-07  -  CLAMP OP TBL CLRK RAIL SHLDR SPNS SYS,"$2,000.00",$0.00,"$2,000.00",$0.00,"$1,427.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-1655PS,SUP,HCPCS C1713,,AR-1655PS  -  SCREW INTFR 5.5MM 8MM STRL BTNDS RECON PEEK-OPTM ACL,$712.50,$0.00,$712.50,$320.63,$508.51,$0.00,$122.76,$0.00,$0.00,$124.75,$712.50,$0.00,$356.25,$564.30,$570.00,$0.00,$111.51,$0.00,$113.43,$0.00
AR-1655PS-10,SUP,HCPCS C1713,,AR-1655PS-10  -  SCREW INTFR 5.5MM 10MM STRL BTNDS RECON PEEK-OPTM ACL,$712.50,$0.00,$712.50,$320.63,$508.51,$0.00,$122.76,$0.00,$0.00,$124.75,$712.50,$0.00,$356.25,$564.30,$570.00,$0.00,$111.51,$0.00,$113.43,$0.00
AR-1655PS-12,SUP,HCPCS C1713,,AR-1655PS-12  -  SCREW INTFR 5.5MM 12MM STRL BTNDS RECON PEEK-OPTM ACL,$712.50,$0.00,$712.50,$320.63,$508.51,$0.00,$122.76,$0.00,$0.00,$124.75,$712.50,$0.00,$356.25,$564.30,$570.00,$0.00,$111.51,$0.00,$113.43,$0.00
AR-1662B,SUP,HCPCS C1713,,AR-1662B  -  ANCHOR SUT 6.25MM 19.1MM SWIVELOCK BICEPS TENODESIS SYS,$950.00,$0.00,$950.00,$427.50,$678.02,$0.00,$163.68,$0.00,$0.00,$166.34,$950.00,$0.00,$475.00,$752.40,$760.00,$0.00,$148.68,$0.00,$151.24,$0.00
AR-1662BC,SUP,HCPCS C1713,,AR-1662BC  -  ANCHOR SUT 6.25MM 19.1MM STRL SWIVELOCK TENODESIS CLS EYLT,"$1,025.00",$0.00,"$1,025.00",$461.25,$731.54,$0.00,$176.60,$0.00,$0.00,$179.47,"$1,025.00",$0.00,$512.50,$811.80,$820.00,$0.00,$160.41,$0.00,$163.18,$0.00
AR-1662BC-7,SUP,HCPCS C1713,,AR-1662BC-7  -  ANCHOR SUT SWVLK TENO BIO-COMP 7X 19.5MM,"$1,087.50",$0.00,"$1,087.50",$489.38,$776.15,$0.00,$187.37,$0.00,$0.00,$190.41,"$1,087.50",$0.00,$543.75,$861.30,$870.00,$0.00,$170.19,$0.00,$173.13,$0.00
AR-1662BC-8,SUP,HCPCS C1713,,AR-1662BC-8  -  ANCHOR SUTURE 8MM 19.5MM FORK EYELET SWIVELOCK TENODESIS,"$1,555.00",$0.00,"$1,555.00",$699.75,"$1,109.80",$0.00,$267.92,$0.00,$0.00,$272.27,"$1,555.00",$0.00,$777.50,"$1,231.56","$1,244.00",$0.00,$243.36,$0.00,$247.56,$0.00
AR-1662BC-9,SUP,HCPCS C1713,,AR-1662BC-9  -  ANCHOR SUT 9MM 19.5MM STRL SWIVELOCK TENODESIS FRK EYLT,"$1,087.50",$0.00,"$1,087.50",$489.38,$776.15,$0.00,$187.37,$0.00,$0.00,$190.41,"$1,087.50",$0.00,$543.75,$861.30,$870.00,$0.00,$170.19,$0.00,$173.13,$0.00
AR-1662BCC-7,SUP,HCPCS C1713,,AR-1662BCC-7  -  ANCHOR SUT 7MM 19.1MM STRL SWIVELOCK TENODESIS CLS EYLT,"$1,087.50",$0.00,"$1,087.50",$489.38,$776.15,$0.00,$187.37,$0.00,$0.00,$190.41,"$1,087.50",$0.00,$543.75,$861.30,$870.00,$0.00,$170.19,$0.00,$173.13,$0.00
AR-1662BCC-8,SUP,HCPCS C1713,,AR-1662BCC-8  -  ANCHOR SUT 8MM 19.1MM STRL SWIVELOCK TENODESIS CLS EYLT,"$1,087.50",$0.00,"$1,087.50",$489.38,$776.15,$0.00,$187.37,$0.00,$0.00,$190.41,"$1,087.50",$0.00,$543.75,$861.30,$870.00,$0.00,$170.19,$0.00,$173.13,$0.00
AR-1662BCC-9,SUP,HCPCS C1713,,AR-1662BCC-9  -  ANCHOR SUT 9MM 19.1MM STRL SWIVELOCK TENODESIS CLS EYLT,"$1,087.50",$0.00,"$1,087.50",$489.38,$776.15,$0.00,$187.37,$0.00,$0.00,$190.41,"$1,087.50",$0.00,$543.75,$861.30,$870.00,$0.00,$170.19,$0.00,$173.13,$0.00
AR-1662PSL-7,SUP,HCPCS C1713,,AR-1662PSL-7  -  ANCHOR SUT 7MM 19.5MM STRL SWIVELOCK TENODESIS FRK EYLT PEEK,"$1,012.50",$0.00,"$1,012.50",$455.63,$722.62,$0.00,$174.45,$0.00,$0.00,$177.28,"$1,012.50",$0.00,$506.25,$801.90,$810.00,$0.00,$158.46,$0.00,$161.19,$0.00
AR-1662PSL-8,SUP,HCPCS C1713,,AR-1662PSL-8  -  ANCHOR SUT 8MM 19.5MM STRL SWIVELOCK TENODESIS FRK EYLT PEEK,"$1,447.50",$0.00,"$1,447.50",$651.38,"$1,033.08",$0.00,$249.40,$0.00,$0.00,$253.45,"$1,447.50",$0.00,$723.75,"$1,146.42","$1,158.00",$0.00,$226.53,$0.00,$230.44,$0.00
AR-1662PSL-9,SUP,HCPCS C1713,,AR-1662PSL-9  -  ANCHOR SUT 9MM 19.5MM STRL SWIVELOCK TENODESIS FRK EYLT PEEK,"$1,012.50",$0.00,"$1,012.50",$455.63,$722.62,$0.00,$174.45,$0.00,$0.00,$177.28,"$1,012.50",$0.00,$506.25,$801.90,$810.00,$0.00,$158.46,$0.00,$161.19,$0.00
AR-1670BC,SUP,HCPCS C1713,,AR-1670BC  -  SCREW INTFR 7MM 10MM STRL TENODESIS BCMPS ACL,$862.50,$0.00,$862.50,$388.13,$615.57,$0.00,$148.60,$0.00,$0.00,$151.02,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$134.98,$0.00,$137.31,$0.00
AR-1670PS,SUP,HCPCS C1713,,AR-1670PS  -  SCREW INTFR 7MM 10MM STRL TENODESIS PEEK-OPTM ACL,$787.50,$0.00,$787.50,$354.38,$562.04,$0.00,$135.68,$0.00,$0.00,$137.88,$787.50,$0.00,$393.75,$623.70,$630.00,$0.00,$123.24,$0.00,$125.37,$0.00
AR-1675BC-CP,SUP,HCPCS C1713,,AR-1675BC-CP  -  SET IMPL BCMPS SCRDRVR RECON SYS,"$4,375.00",$0.00,"$4,375.00","$1,968.75","$3,122.44",$0.00,$753.79,$0.00,$0.00,$766.03,"$4,375.00",$0.00,"$2,187.50","$3,465.00","$3,500.00",$0.00,$684.69,$0.00,$696.50,$0.00
AR-1676DS,SUP,Custom 27203010,,AR-1676DS  -  KIT INSTR BIOABSORBABLE BIO-TENODESIS STERILE DISPOSABLE,$487.50,$0.00,$487.50,$0.00,$347.93,$0.00,$0.00,$0.00,$0.00,$0.00,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1676-DS,SUP,HCPCS C1713,,KIT ARTHRO FIXAT BTNDS BABSR STRL DISP,$437.50,$0.00,$437.50,$196.88,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
AR-1677BC-CP,SUP,HCPCS C1713,,AR-1677BC-CP  -  SET IMPL 4MM CNN DRL GDPN RLR SCR TNDN SHTL CMC LGMNT RECON,"$1,487.50",$0.00,"$1,487.50",$669.38,"$1,061.63",$0.00,$256.29,$0.00,$0.00,$260.45,"$1,487.50",$0.00,$743.75,"$1,178.10","$1,190.00",$0.00,$232.79,$0.00,$236.81,$0.00
AR-1678-01,SUP,Custom 27203010,,AR-1678-01  -  GUIDE DRL LF TTH FT,"$1,737.50",$0.00,"$1,737.50",$0.00,"$1,240.05",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,737.50",$0.00,$868.75,"$1,376.10","$1,390.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-1678-02,SUP,Custom 27203010,,AR-1678-02  -  BIT DRL 3.5MM SWIVELOCK,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1678-05,SUP,Custom 27203010,,AR-1678-05  -  BIT DRL 3.5MM SWIVELOCK,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1678-CP,SUP,HCPCS C1713,,AR-1678-CP  -  SET IMPL 3.5MM INTERNALBRACE SWIVELOCK FIBERTAPE 2 2 NDL,"$2,437.50",$0.00,"$2,437.50","$1,096.88","$1,739.64",$0.00,$419.97,$0.00,$0.00,$426.79,"$2,437.50",$0.00,"$1,218.75","$1,930.50","$1,950.00",$0.00,$381.47,$0.00,$388.05,$0.00
AR-1680B,SUP,HCPCS C1713,,AR-1680B  -  SCREW BABSR 12MM 8MM BTNDS ACL PLLA RECON STRL DISP,$712.50,$0.00,$712.50,$320.63,$508.51,$0.00,$122.76,$0.00,$0.00,$124.75,$712.50,$0.00,$356.25,$564.30,$570.00,$0.00,$111.51,$0.00,$113.43,$0.00
AR-1680PS,SUP,HCPCS C1713,,AR-1680PS  -  TENODESIS SCREW 8X12MM,$787.50,$0.00,$787.50,$354.38,$562.04,$0.00,$135.68,$0.00,$0.00,$137.88,$787.50,$0.00,$393.75,$623.70,$630.00,$0.00,$123.24,$0.00,$125.37,$0.00
AR-1688-CP,SUP,Custom 27203010,,AR-1688-CP  -  KIT ASCP FX INTERNALBRACE FIBERTAPE CLGN LGMNT AUG REPR,"$2,687.50",$0.00,"$2,687.50",$0.00,"$1,918.07",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,687.50",$0.00,"$1,343.75","$2,128.50","$2,150.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-16991N,SUP,Custom 27203010,,AR-16991N  -  NEEDLE SUT RND GRV LOPRFL SCRPN FBRWR 1 PRTL SMTH JAW MN,$487.50,$0.00,$487.50,$0.00,$347.93,$0.00,$0.00,$0.00,$0.00,$0.00,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-16992N,SUP,Custom 27203010,,AR-16992N  -  NEEDLE SUT SCRPN CAPSULECLOSE,$612.50,$0.00,$612.50,$0.00,$437.14,$0.00,$0.00,$0.00,$0.00,$0.00,$612.50,$0.00,$306.25,$485.10,$490.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1713-03,SUP,Custom 27203010,,AR-1713-03  -  CLAMP BDRL DSTRCT SET STRL ANKL,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-1801,SUP,Custom 27203010,,AR-1801  -  GUIDE DRL OFST 7MM AU FEM ACL TRNTB DISP 7-8MM HL,"$2,087.50",$0.00,"$2,087.50",$0.00,"$1,489.85",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,087.50",$0.00,"$1,043.75","$1,653.30","$1,670.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-1802D,SUP,Custom 27203010,,AR-1802D  -  CANNULA ASCP 9-12MM STRL TNL SIL TIB DISP,$475.00,$0.00,$475.00,$0.00,$339.01,$0.00,$0.00,$0.00,$0.00,$0.00,$475.00,$0.00,$237.50,$376.20,$380.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1803,SUP,Custom 27203010,,AR-1803  -  GUIDE DRL OFST 5MM RD FEM ACL TRNTB DISP 7-8MM HL,"$2,087.50",$0.00,"$2,087.50",$0.00,"$1,489.85",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,087.50",$0.00,"$1,043.75","$1,653.30","$1,670.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-1804,SUP,Custom 27203010,,AR-1804  -  GUIDE DRL OFST 6MM GRN FEM ACL TRNTB DISP 8-9MM HL,"$2,087.50",$0.00,"$2,087.50",$0.00,"$1,489.85",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,087.50",$0.00,"$1,043.75","$1,653.30","$1,670.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-1805,SUP,Custom 27203010,,AR-1805  -  GUIDE DRL OFST 8MM BLU FEM ACL TRNTB DISP 12-13MM HL,"$2,087.50",$0.00,"$2,087.50",$0.00,"$1,489.85",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,087.50",$0.00,"$1,043.75","$1,653.30","$1,670.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-1806,SUP,Custom 27203010,,AR-1806  -  GUIDE DRL OFST 4MM PUR FEM ACL TRNTB DISP 6-7MM HL,"$2,087.50",$0.00,"$2,087.50",$0.00,"$1,489.85",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,087.50",$0.00,"$1,043.75","$1,653.30","$1,670.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-1822,SUP,Custom 27203010,,AR-1822  -  BIT DRL LNG 2MM STRL D STP GFT HRVT,$62.50,$0.00,$62.50,$0.00,$44.61,$0.00,$0.00,$0.00,$0.00,$0.00,$62.50,$0.00,$31.25,$49.50,$50.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1861,SUP,Custom 27203010,,AR-1861  -  CANNULA ASCP 11MM GFT PASS,$732.50,$0.00,$732.50,$0.00,$522.79,$0.00,$0.00,$0.00,$0.00,$0.00,$732.50,$0.00,$366.25,$580.14,$586.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1875,SUP,Custom 27203010,,AR-1875  -  GUIDE DRL ADAPTEUR C RING ACL,"$3,545.00",$0.00,"$3,545.00",$0.00,"$2,530.07",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,545.00",$0.00,"$1,772.50","$2,807.64","$2,836.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-1897S,SUP,Custom 27203010,,AR-1897S  -  KIT INST HALL SW BLDE ACL DISP TRNTB,$562.50,$0.00,$562.50,$0.00,$401.46,$0.00,$0.00,$0.00,$0.00,$0.00,$562.50,$0.00,$281.25,$445.50,$450.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-18985,SUP,HCPCS C1713,,AR-18985  -  KIT INST ACL TRNTB DISP,$520.00,$0.00,$520.00,$234.00,$371.12,$0.00,$89.59,$0.00,$0.00,$91.05,$520.00,$0.00,$260.00,$411.84,$416.00,$0.00,$81.38,$0.00,$82.78,$0.00
AR-1902SF,SUP,HCPCS C1713,,AR-1902SF  -  ANCHOR SUT 2 5MM 15.5MM STRL CSCR2 FWR 2 EYLT ST TI ROTR CUF,$537.50,$0.00,$537.50,$241.88,$383.61,$0.00,$92.61,$0.00,$0.00,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
AR-1907H-3.5,SUP,Custom 27203010,,AR-1907H-3.5  -  GUIDE DRL 3.5MM ANCH CNN TROC SDL HIP,"$1,247.50",$0.00,"$1,247.50",$0.00,$890.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,247.50",$0.00,$623.75,$988.02,$998.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1911,SUP,Custom 27203010,,AR-1911  -  DRILL SRG SPD 1 STP 3.5MM PUSHLOCK,$237.50,$0.00,$237.50,$0.00,$169.50,$0.00,$0.00,$0.00,$0.00,$0.00,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1912,SUP,Custom 27203010,,AR-1912  -  DRILL SRG LG 1 STP 3.5MM PUSHLOCK,$237.50,$0.00,$237.50,$0.00,$169.50,$0.00,$0.00,$0.00,$0.00,$0.00,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1913,SUP,Custom 27203010,,AR-1913  -  BIT DRL 3.5MM BCMPS PUSHLOCK,$237.50,$0.00,$237.50,$0.00,$169.50,$0.00,$0.00,$0.00,$0.00,$0.00,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1915FT-2,SUP,HCPCS C1713,,AR-1915FT-2  -  ANCHOR SUT 1 2.3MM .5 CRC 2 DMD PT FT 3.5MM 2.5MM 26.5MM,$712.50,$0.00,$712.50,$320.63,$508.51,$0.00,$122.76,$0.00,$0.00,$124.75,$712.50,$0.00,$356.25,$564.30,$570.00,$0.00,$111.51,$0.00,$113.43,$0.00
AR-1915S,SUP,HCPCS C1713,,AR-1915S  -  ANCHOR SUT 2 3.5MM 12MM STRL CRKSCR BABSR ST TI ROTR CUF,$450.00,$0.00,$450.00,$202.50,$321.17,$0.00,$77.53,$0.00,$0.00,$78.79,$450.00,$0.00,$225.00,$356.40,$360.00,$0.00,$70.43,$0.00,$71.64,$0.00
AR-1915SF,SUP,HCPCS C1713,,AR-1915SF  -  ANCHOR SUT 2 3.5MM 12MM STRL CSCR FWR ST SUT EYLT TI ROTR,$487.50,$0.00,$487.50,$219.38,$347.93,$0.00,$83.99,$0.00,$0.00,$85.36,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$76.29,$0.00,$77.61,$0.00
AR-1915SNF,SUP,HCPCS C1713,,AR-1915SNF  -  ANCHOR SUTURE 2.3MM 0 SHORT .5 CIR 2 DIAMOND POINT 3.5MM,$525.00,$0.00,$525.00,$236.25,$374.69,$0.00,$90.45,$0.00,$0.00,$91.92,$525.00,$0.00,$262.50,$415.80,$420.00,$0.00,$82.16,$0.00,$83.58,$0.00
AR-1920BF,SUP,HCPCS C1713,,AR-1920BF  -  BIOCRKSCRW SUTR ANCH 5MM W/2 #2 FW,$650.00,$0.00,$650.00,$292.50,$463.91,$0.00,$111.99,$0.00,$0.00,$113.81,$650.00,$0.00,$325.00,$514.80,$520.00,$0.00,$101.73,$0.00,$103.48,$0.00
AR-1920BFT,SUP,HCPCS C1713,,AR-1920BFT  -  ANCHOR SUT 2 5MM 17.9MM STRL BCSCR TGRL BABSR BRD HNDL,$700.00,$0.00,$700.00,$315.00,$499.59,$0.00,$120.61,$0.00,$0.00,$122.56,$700.00,$0.00,$350.00,$554.40,$560.00,$0.00,$109.55,$0.00,$111.44,$0.00
AR-1920BNF,SUP,HCPCS C1713,,AR-1920BNF  -  ANCHOR SUT 2 3/8 CRC 5MM 26MM STRL 17.9MM BCSCR FWR BABSR,$675.00,$0.00,$675.00,$303.75,$481.75,$0.00,$116.30,$0.00,$0.00,$118.19,$675.00,$0.00,$337.50,$534.60,$540.00,$0.00,$105.64,$0.00,$107.46,$0.00
AR-1920NSF,SUP,HCPCS C1713,,AR-1920NSF  -  ANCHOR SUT 2 5MM 15.5MM STRL CSCR FWR BRD NDL ROTR CUF DISP,$537.50,$0.00,$537.50,$241.88,$383.61,$0.00,$92.61,$0.00,$0.00,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
AR-1920S,SUP,HCPCS C1713,,AR-1920S  -  ANCHOR SUT 2 5MM 15.5MM STRL CRKSCR BRD HNDL INSRTR TI ROTR,$450.00,$0.00,$450.00,$202.50,$321.17,$0.00,$77.53,$0.00,$0.00,$78.79,$450.00,$0.00,$225.00,$356.40,$360.00,$0.00,$70.43,$0.00,$71.64,$0.00
AR-1920SF,SUP,HCPCS C1713,,AR-1920SF  -  ANCHOR SUT 2 5MM 15.5MM STRL CSCR FWR HNDL INSRTR TI ROTR,$487.50,$0.00,$487.50,$219.38,$347.93,$0.00,$83.99,$0.00,$0.00,$85.36,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$76.29,$0.00,$77.61,$0.00
AR-1920SNF,SUP,HCPCS C1713,,AR-1920SNF  -  ANCHOR SUT 2 5MM 15MM STRL CSCR FWR BABSR HNDL INSRTR NDL,$525.00,$0.00,$525.00,$236.25,$374.69,$0.00,$90.45,$0.00,$0.00,$91.92,$525.00,$0.00,$262.50,$415.80,$420.00,$0.00,$82.16,$0.00,$83.58,$0.00
AR-1922BC,SUP,HCPCS C1713,,AR-1922BC  -  ANCHOR SUT 4.5MM 24MM STRL PUSHLOCK BCMPS DISP,"$1,000.00",$0.00,"$1,000.00",$450.00,$713.70,$0.00,$172.30,$0.00,$0.00,$175.09,"$1,000.00",$0.00,$500.00,$792.00,$800.00,$0.00,$156.50,$0.00,$159.20,$0.00
AR-1922BCM,SUP,HCPCS C1713,,AR-1922BCM  -  ANCHOR SUT 4.5MM 28MM STRL PUSHLOCK SLF PNCH BCMPS DISP,"$1,037.50",$0.00,"$1,037.50",$466.88,$740.46,$0.00,$178.76,$0.00,$0.00,$181.66,"$1,037.50",$0.00,$518.75,$821.70,$830.00,$0.00,$162.37,$0.00,$165.17,$0.00
AR-1922BM,SUP,HCPCS C1713,,AR-1922BM  -  ANCHOR SUT 4.5MM 28MM STRL BIO-PUSHLOCK SLF PNCH DISP,$975.00,$0.00,$975.00,$438.75,$695.86,$0.00,$167.99,$0.00,$0.00,$170.71,$975.00,$0.00,$487.50,$772.20,$780.00,$0.00,$152.59,$0.00,$155.22,$0.00
AR-1922PS,SUP,HCPCS C1713,,AR-1922PS  -  ANCHOR SUT 4.5MM 24MM STRL PUSHLOCK PEEK SHLDR DISP,$900.00,$0.00,$900.00,$405.00,$642.33,$0.00,$155.07,$0.00,$0.00,$157.58,$900.00,$0.00,$450.00,$712.80,$720.00,$0.00,$140.85,$0.00,$143.28,$0.00
AR-1922PSM,SUP,HCPCS C1713,,AR-1922PSM  -  ANCHOR SUT 4.5MM 28MM STRL PUSHLOCK SLF PNCH PEEK DISP,$975.00,$0.00,$975.00,$438.75,$695.86,$0.00,$167.99,$0.00,$0.00,$170.71,$975.00,$0.00,$487.50,$772.20,$780.00,$0.00,$152.59,$0.00,$155.22,$0.00
AR-1923BC,SUP,HCPCS C1713,,AR-1923BC  -  ANCHOR SUTURE 2.9MM 15.5MM PUSHLOCK BIOCOMPOSITE STERILE,"$1,000.00",$0.00,"$1,000.00",$450.00,$713.70,$0.00,$172.30,$0.00,$0.00,$175.09,"$1,000.00",$0.00,$500.00,$792.00,$800.00,$0.00,$156.50,$0.00,$159.20,$0.00
AR-1923BCH,SUP,HCPCS C1713,,AR-1923BCH  -  ANCHOR SUT PUSHLOCK BCMPS HIP,"$1,000.00",$0.00,"$1,000.00",$450.00,$713.70,$0.00,$172.30,$0.00,$0.00,$175.09,"$1,000.00",$0.00,$500.00,$792.00,$800.00,$0.00,$156.50,$0.00,$159.20,$0.00
AR-1923BNF,SUP,HCPCS C1713,,AR-1923BNF  -  ANCHOR SUT 3/8 CRC DMD 3.7MM 17.9MM STRL 22.2MM BCSCR FWR,$650.00,$0.00,$650.00,$292.50,$463.91,$0.00,$111.99,$0.00,$0.00,$113.81,$650.00,$0.00,$325.00,$514.80,$520.00,$0.00,$101.73,$0.00,$103.48,$0.00
AR-1923D,SUP,Custom 27203010,,AR-1923D  -  DRILL SRG 2.9 MM PUSHLOCK HRD BN,$237.50,$0.00,$237.50,$0.00,$169.50,$0.00,$0.00,$0.00,$0.00,$0.00,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1923DH,SUP,Custom 27203010,,AR-1923DH  -  DRILL SRG HIP 2.9 MM PUSHLOCK,$362.50,$0.00,$362.50,$0.00,$258.72,$0.00,$0.00,$0.00,$0.00,$0.00,$362.50,$0.00,$181.25,$287.10,$290.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1923DHS,SUP,Custom 27203010,,AR-1923DHS  -  KIT INST 2.9MM DISP 2.9MM PUSHLOCK,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1923DHT,SUP,Custom 27203010,,AR-1923DHT  -  DRILL SRG HIP HRD BN 2.9 MM PUSHLOCK,$362.50,$0.00,$362.50,$0.00,$258.72,$0.00,$0.00,$0.00,$0.00,$0.00,$362.50,$0.00,$181.25,$287.10,$290.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1923DS,SUP,HCPCS C1713,,AR-1923DS  -  KIT INSTR 2.9MM DRILL SPEAR METAL STERILE DISPOSABLE 2.9MM,$437.50,$0.00,$437.50,$196.88,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
AR-1923D-ST,SUP,Custom 27203010,,AR-1923D-ST  -  DRILL SRG STRL 2.9 MM PUSHLOCK,$262.50,$0.00,$262.50,$0.00,$187.35,$0.00,$0.00,$0.00,$0.00,$0.00,$262.50,$0.00,$131.25,$207.90,$210.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1923DT,SUP,Custom 27203010,,AR-1923DT  -  DRILL SRG 2.9 MM SHRT PUSHLOCK HRD BN,$237.50,$0.00,$237.50,$0.00,$169.50,$0.00,$0.00,$0.00,$0.00,$0.00,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1923DT-ST,SUP,Custom 27203010,,AR-1923DT-ST  -  DRILL SRG STRL 2.9 MM PUSHLOCK,$262.50,$0.00,$262.50,$0.00,$187.35,$0.00,$0.00,$0.00,$0.00,$0.00,$262.50,$0.00,$131.25,$207.90,$210.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1923MC,SUP,Custom 27203010,,AR-1923MC  -  CANNULA ASCP FT 2.9MM 4.5MM PUSHLOCK CRKSCR MTL REUSE,$850.00,$0.00,$850.00,$0.00,$606.65,$0.00,$0.00,$0.00,$0.00,$0.00,$850.00,$0.00,$425.00,$673.20,$680.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1923MCS,SUP,Custom 27203010,,AR-1923MCS  -  CANNULA ASCP 2.9MM 4.5MM PUSHLOCK CRKSCR SET MTL REUSE,"$1,412.50",$0.00,"$1,412.50",$0.00,"$1,008.10",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,412.50",$0.00,$706.25,"$1,118.70","$1,130.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-1923PHS,SUP,HCPCS C1713,,AR-1923PHS  -  ANCHOR SUT 2.9MM 15.5MM STRL PUSHLOCK PEEK HIP DISP,$900.00,$0.00,$900.00,$405.00,$642.33,$0.00,$155.07,$0.00,$0.00,$157.58,$900.00,$0.00,$450.00,$712.80,$720.00,$0.00,$140.85,$0.00,$143.28,$0.00
AR-1923PK,SUP,Custom 27203010,,AR-1923PK  -  KIT ENDSCP INSTR 1.1MM 17GA 2.9MM CANNU DRILL NEEDLE PORTAL,$550.00,$0.00,$550.00,$0.00,$392.54,$0.00,$0.00,$0.00,$0.00,$0.00,$550.00,$0.00,$275.00,$435.60,$440.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1923SD,SUP,Custom 27203010,,AR-1923SD  -  DRILL SRG SPD STRL 2.9MM PUSHLOCK,$275.00,$0.00,$275.00,$0.00,$196.27,$0.00,$0.00,$0.00,$0.00,$0.00,$275.00,$0.00,$137.50,$217.80,$220.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1925BF,SUP,HCPCS C1713,,AR-1925BF  -  ANCHOR SUT 2 FT 6.5MM 17.9MM STRL BCSCR 2 BABSR ROTR CUF,$650.00,$0.00,$650.00,$292.50,$463.91,$0.00,$111.99,$0.00,$0.00,$113.81,$650.00,$0.00,$325.00,$514.80,$520.00,$0.00,$101.73,$0.00,$103.48,$0.00
AR-1925BNF,SUP,HCPCS C1713,,AR-1925BNF  -  ANCHOR SUT 2 6.5MM 17.9MM STRL BCSCR FWR 2 BRD BABSR MLD,$675.00,$0.00,$675.00,$303.75,$481.75,$0.00,$116.30,$0.00,$0.00,$118.19,$675.00,$0.00,$337.50,$534.60,$540.00,$0.00,$105.64,$0.00,$107.46,$0.00
AR-1925SF,SUP,HCPCS C1713,,AR-1925SF  -  ANCHOR SUT 2 6.5MM 15.5MM STRL CSCR FWR 2 BABSR HNDL INSRTR,$487.50,$0.00,$487.50,$219.38,$347.93,$0.00,$83.99,$0.00,$0.00,$85.36,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$76.29,$0.00,$77.61,$0.00
AR-1926BC,SUP,HCPCS C1713,,AR-1926BC  -  ANCHOR SUT 3.5MM 19.5MM STRL PUSHLOCK BCMPS DISP,"$1,000.00",$0.00,"$1,000.00",$450.00,$713.70,$0.00,$172.30,$0.00,$0.00,$175.09,"$1,000.00",$0.00,$500.00,$792.00,$800.00,$0.00,$156.50,$0.00,$159.20,$0.00
AR-1926BH,SUP,HCPCS C1713,,AR-1926BH  -  ANCHOR SUT 3.5MM 19.5MM STRL BIO-PUSHLOCK HIP DISP,$900.00,$0.00,$900.00,$405.00,$642.33,$0.00,$155.07,$0.00,$0.00,$157.58,$900.00,$0.00,$450.00,$712.80,$720.00,$0.00,$140.85,$0.00,$143.28,$0.00
AR-1926DHS,SUP,Custom 27203010,,AR-1926DHS  -  KIT INST DISP 3.5MM PUSHLOCK,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1926DS-2,SUP,Custom 27203010,,AR-1926DS-2  -  KIT INST OFST DRL GD 3.5MM PUSHLOCK,$525.00,$0.00,$525.00,$0.00,$374.69,$0.00,$0.00,$0.00,$0.00,$0.00,$525.00,$0.00,$262.50,$415.80,$420.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1926MC,SUP,Custom 27203010,,AR-1926MC  -  CANNULA ASCP PUSHLOCK MTL,$650.00,$0.00,$650.00,$0.00,$463.91,$0.00,$0.00,$0.00,$0.00,$0.00,$650.00,$0.00,$325.00,$514.80,$520.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1926PHS,SUP,HCPCS C1713,,AR-1926PHS  -  ANCHOR SUT 3.5MM 19.5MM STRL BIO-PUSHLOCK HIP DISP,$900.00,$0.00,$900.00,$405.00,$642.33,$0.00,$155.07,$0.00,$0.00,$157.58,$900.00,$0.00,$450.00,$712.80,$720.00,$0.00,$140.85,$0.00,$143.28,$0.00
AR-1926PS,SUP,HCPCS C1713,,AR-1926PS  -  ANCHOR SUT 3.5MM 19.5MM STRL PUSHLOCK PEEK ROTR CUF DISP,$900.00,$0.00,$900.00,$405.00,$642.33,$0.00,$155.07,$0.00,$0.00,$157.58,$900.00,$0.00,$450.00,$712.80,$720.00,$0.00,$140.85,$0.00,$143.28,$0.00
AR-1927BCF,SUP,HCPCS C1713,,AR-1927BCF  -  ANCHOR SUT 2 FT 5.5MM 14.7MM STRL CSCR FWR TIGERWIRE 2 DRV,"$4,062.50",$0.00,"$4,062.50","$1,828.13","$2,899.41",$0.00,$699.95,$0.00,$0.00,$711.31,"$4,062.50",$0.00,"$2,031.25","$3,217.50","$3,250.00",$0.00,$635.78,$0.00,$646.75,$0.00
AR-1927BCF-3,SUP,HCPCS C1713,,AR-1927BCF-3  -  ANCHOR SUT 2 FT 5.5MM 14.7MM STRL CSCR FWR 3 BCMPS DISP,$850.00,$0.00,$850.00,$382.50,$606.65,$0.00,$146.45,$0.00,$0.00,$148.83,$850.00,$0.00,$425.00,$673.20,$680.00,$0.00,$133.03,$0.00,$135.32,$0.00
AR-1927BCF-45,SUP,HCPCS C1713,,AR-1927BCF-45  -  ANCHOR SUT 2 FT 4.5MM 14MM STRL CSCR FWR 2 BCMPS DISP,$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
AR-1927BCF-65,SUP,HCPCS C1713,,AR-1927BCF-65  -  ANCHOR SUT 2 FT 6.5MM 14.7MM STRL CSCR FWR 2 VNT BCMPS DISP,$837.50,$0.00,$837.50,$376.88,$597.72,$0.00,$144.30,$0.00,$0.00,$146.64,$837.50,$0.00,$418.75,$663.30,$670.00,$0.00,$131.07,$0.00,$133.33,$0.00
AR-1927BCFT,SUP,HCPCS C1713,,AR-1927BCFT  -  ANCHOR SUTURE 2 SQUARE FULTHD 5.5MM 14.7MM DRIVE MECHANISM,$862.50,$0.00,$862.50,$388.13,$615.57,$0.00,$148.60,$0.00,$0.00,$151.02,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$134.98,$0.00,$137.31,$0.00
AR-1927BCFT-45,SUP,HCPCS C1713,,AR-1927BCFT-45  -  ANCHOR SUT 2 SQ FT 4.5MM 14.7MM STRL CRKSCR TGTL DRV MECH,$862.50,$0.00,$862.50,$388.13,$615.57,$0.00,$148.60,$0.00,$0.00,$151.02,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$134.98,$0.00,$137.31,$0.00
AR-1927BCNF,SUP,HCPCS C1713,,AR-1927BCNF  -  ANCHOR SUTURE 2 FULTHD 5.5MM 14.7MM 2 4 NEEDLE CORKSCREW,"$1,197.50",$0.00,"$1,197.50",$538.88,$854.66,$0.00,$206.32,$0.00,$0.00,$209.67,"$1,197.50",$0.00,$598.75,$948.42,$958.00,$0.00,$187.41,$0.00,$190.64,$0.00
AR-1927BCNF-45,SUP,HCPCS C1713,,AR-1927BCNF-45  -  ANCHOR SUT 4.5MM BCMPS CRKSCR FT NDL,$837.50,$0.00,$837.50,$376.88,$597.72,$0.00,$144.30,$0.00,$0.00,$146.64,$837.50,$0.00,$418.75,$663.30,$670.00,$0.00,$131.07,$0.00,$133.33,$0.00
AR-1927BCT,SUP,HCPCS C1713,,AR-1927BCT  -  ANCHOR SUT FT 1.3MM 5.5MM 14.7MM BLK BLU WHT CRKSCR,"$4,437.50",$0.00,"$4,437.50","$1,996.88","$3,167.04",$0.00,$764.56,$0.00,$0.00,$776.97,"$4,437.50",$0.00,"$2,218.75","$3,514.50","$3,550.00",$0.00,$694.47,$0.00,$706.45,$0.00
AR-1927BF,SUP,HCPCS C1713,,AR-1927BF  -  ANCHOR SUT 2 FT 5.5MM 14.7MM STRL BCSCR FWR 2 POLY L LACTD,$712.50,$0.00,$712.50,$320.63,$508.51,$0.00,$122.76,$0.00,$0.00,$124.75,$712.50,$0.00,$356.25,$564.30,$570.00,$0.00,$111.51,$0.00,$113.43,$0.00
AR-1927BF-3,SUP,HCPCS C1713,,AR-1927BF-3  -  ANCHOR SUT 2 FT 5.5MM 14.7MM STRL BCSCR FWR 3 PLAY BABSR VNT,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
AR-1927BF-45,SUP,HCPCS C1713,,AR-1927BF-45  -  ANCHOR SUT 2 FT 4.5MM 14MM STRL BCSCR FWR 2 POLY L LACTD CO,$712.50,$0.00,$712.50,$320.63,$508.51,$0.00,$122.76,$0.00,$0.00,$124.75,$712.50,$0.00,$356.25,$564.30,$570.00,$0.00,$111.51,$0.00,$113.43,$0.00
AR-1927BF-65,SUP,HCPCS C1713,,AR-1927BF-65  -  ANCHOR SUT 2 FT 6.5MM 14.7MM STRL BCSCR FWR 2 POLY L LACTD,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
AR-1927BFC,SUP,HCPCS C1713,,AR-1927BFC  -  ANCHOR SUT 2 FT 5.5MM 14.7MM STRL BCSCR FWR FIBERCHAIN BABSR,$787.50,$0.00,$787.50,$354.38,$562.04,$0.00,$135.68,$0.00,$0.00,$137.88,$787.50,$0.00,$393.75,$623.70,$630.00,$0.00,$123.24,$0.00,$125.37,$0.00
AR-1927BFS,SUP,HCPCS C1713,,AR-1927BFS  -  ANCHOR SUT 2 FT 5.5MM 14.7MM STRL BCSCR SCRPN BABSR NDL DISP,"$1,062.50",$0.00,"$1,062.50",$478.13,$758.31,$0.00,$183.06,$0.00,$0.00,$186.04,"$1,062.50",$0.00,$531.25,$841.50,$850.00,$0.00,$166.28,$0.00,$169.15,$0.00
AR-1927BFT-45,SUP,HCPCS C1713,,AR-1927BFT-45  -  ANCHOR SUT 2 FT 4.5MM 14MM STRL BCSCR TGRL POLY L LACTD CO D,$762.50,$0.00,$762.50,$343.13,$544.20,$0.00,$131.37,$0.00,$0.00,$133.51,$762.50,$0.00,$381.25,$603.90,$610.00,$0.00,$119.33,$0.00,$121.39,$0.00
AR-1927BNF,SUP,HCPCS C1713,,AR-1927BNF  -  ANCHOR SUT 2 .5 CRC FT 5.5MM 14.7MM STRL 26MM BCSCR FWR 2 4,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
AR-1927BNF-45,SUP,HCPCS C1713,,AR-1927BNF-45  -  ANCHOR SUT 2 .5 CRC FT 4.5MM 14MM STRL 26MM BCSCR FWR 2 4,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
AR-1927PBS,SUP,HCPCS C1713,,AR-1927PBS  -  PUNCH ARTHRO STERILE DISPOSABLE 5.5 CORKSCREW FULTHD,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
AR-1927PNF,SUP,HCPCS C1713,,AR-1927PNF  -  ANCHOR SUT 2 FT 5.5MM 14.7MM STRL CSCR FWR 2 BRD 4 NDL PEEK,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
AR-1927PNF-45,SUP,HCPCS C1713,,AR-1927PNF-45  -  ANCHOR SUT 2 FT 4.5MM 14MM BLU W/B STRL CSCR FWR 2 BRD 4 NDL,$502.50,$0.00,$502.50,$226.13,$358.63,$0.00,$86.58,$0.00,$0.00,$87.98,$502.50,$0.00,$251.25,$397.98,$402.00,$0.00,$78.64,$0.00,$80.00,$0.00
AR-1927PSF,SUP,HCPCS C1713,,AR-1927PSF  -  ANCHOR SUT 2 FT 5.5MM 14.7MM STRL CSCR FWR 2 PEEK DISP,$712.50,$0.00,$712.50,$320.63,$508.51,$0.00,$122.76,$0.00,$0.00,$124.75,$712.50,$0.00,$356.25,$564.30,$570.00,$0.00,$111.51,$0.00,$113.43,$0.00
AR-1927PSF-3,SUP,HCPCS C1713,,AR-1927PSF-3  -  ANCHOR SUT 2 FT 5.5MM 14.7MM STRL CSCR FWR 3 PEEK SHLDR DISP,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
AR-1927PSF-45,SUP,HCPCS C1713,,AR-1927PSF-45  -  ANCHOR SUT 2 FT 4.5MM 14MM BLK BLU WHT STRL CSCR FWR 2 PEEK,$820.00,$0.00,$820.00,$369.00,$585.23,$0.00,$141.28,$0.00,$0.00,$143.58,$820.00,$0.00,$410.00,$649.44,$656.00,$0.00,$128.33,$0.00,$130.54,$0.00
AR-1927PSF-65,SUP,HCPCS C1713,,AR-1927PSF-65  -  ANCHOR SUT 2 FT 6.5MM STRL CSCR FWR 2 PEEK DISP,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
AR-1928SF,SUP,HCPCS C1713,,AR-1928SF  -  ANCHOR SUT 2 FT 5.5MM 15MM STRL CSCR2 FWR,$575.00,$0.00,$575.00,$258.75,$410.38,$0.00,$99.07,$0.00,$0.00,$100.68,$575.00,$0.00,$287.50,$455.40,$460.00,$0.00,$89.99,$0.00,$91.54,$0.00
AR-1928SF-2,SUP,HCPCS C1713,,AR-1928SF-2  -  ANCHOR SUT 2 FT 5.5MM 16.3MM STRL CSCR2 FWR TI DISP,$575.00,$0.00,$575.00,$258.75,$410.38,$0.00,$99.07,$0.00,$0.00,$100.68,$575.00,$0.00,$287.50,$455.40,$460.00,$0.00,$89.99,$0.00,$91.54,$0.00
AR-1928SF-3,SUP,HCPCS C1713,,AR-1928SF-3  -  ANCHOR SUT 2 FT 5.5MM 16.3MM STRL CSCR2 FWR 3 TI DISP,$612.50,$0.00,$612.50,$275.63,$437.14,$0.00,$105.53,$0.00,$0.00,$107.24,$612.50,$0.00,$306.25,$485.10,$490.00,$0.00,$95.86,$0.00,$97.51,$0.00
AR-1928SF-45,SUP,HCPCS C1713,,AR-1928SF-45  -  ANCHOR SUT 2 FT 4.5MM 14MM STRL CSCR2 FWR 2 TI DISP,$575.00,$0.00,$575.00,$258.75,$410.38,$0.00,$99.07,$0.00,$0.00,$100.68,$575.00,$0.00,$287.50,$455.40,$460.00,$0.00,$89.99,$0.00,$91.54,$0.00
AR-1928SFT-2,SUP,HCPCS C1713,,AR-1928SFT-2  -  ANCHOR SUT 2 FT 5.5MM 16.3MM STRL CRKSCR II TGTL TI,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-1928SNF,SUP,HCPCS C1713,,AR-1928SNF  -  ANCHOR SUT 2 5.5MM 26MM STRL CSCR FWR TI ROTR CUF DISP,$637.50,$0.00,$637.50,$286.88,$454.98,$0.00,$109.84,$0.00,$0.00,$111.62,$637.50,$0.00,$318.75,$504.90,$510.00,$0.00,$99.77,$0.00,$101.49,$0.00
AR1928SNF-2,SUP,HCPCS C1713,,AR1928SNF-2  -  ANCHOR SUT 5.5MM 2 .5 CRC FT DMD CSCR2 FWR ROTR CUF 2 KNT,$637.50,$0.00,$637.50,$286.88,$454.98,$0.00,$109.84,$0.00,$0.00,$111.62,$637.50,$0.00,$318.75,$504.90,$510.00,$0.00,$99.77,$0.00,$101.49,$0.00
AR-1928SNF-2,SUP,HCPCS C1713,,AR-1928SNF-2  -  ANCHOR SUTURE 2 .5 CIR FULTHD DIAMOND 5.5MM 16MM 26MM 2 KNOT,$637.50,$0.00,$637.50,$286.88,$454.98,$0.00,$109.84,$0.00,$0.00,$111.62,$637.50,$0.00,$318.75,$504.90,$510.00,$0.00,$99.77,$0.00,$101.49,$0.00
AR-1929SF-3,SUP,HCPCS C1713,,"AR-1929SF-3  -  SUTURE ANCHOR, CORKSCREW FT III",$612.50,$0.00,$612.50,$275.63,$437.14,$0.00,$105.53,$0.00,$0.00,$107.24,$612.50,$0.00,$306.25,$485.10,$490.00,$0.00,$95.86,$0.00,$97.51,$0.00
AR-1931S,SUP,Custom 27203010,,AR-1931S  -  REAMER SRG 14MM STRL CNN COLR PIN SET COR DISP,$200.00,$0.00,$200.00,$0.00,$142.74,$0.00,$0.00,$0.00,$0.00,$0.00,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1934-20DS,SUP,Custom 27203010,,AR-1934-20DS  -  KIT INST 2MM SUT TK ANCH DRL SPR TROC DISP,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1934-24DS,SUP,Custom 27203010,,AR-1934-24DS  -  KIT ESCP INST 2.4MM BSUT TK ANCH SPR STP DRL DISP ASCP,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1934BCF,SUP,HCPCS C1713,,AR-1934BCF  -  ANCHOR SUT 2 3MM 14.5MM STRL SUT TK FBRWR BCMPS DISP,$762.50,$0.00,$762.50,$343.13,$544.20,$0.00,$131.37,$0.00,$0.00,$133.51,$762.50,$0.00,$381.25,$603.90,$610.00,$0.00,$119.33,$0.00,$121.39,$0.00
AR-1934BCF-2,SUP,HCPCS C1713,,AR-1934BCF-2  -  ANCHOR SUT 2 3MM 14.5MM STRL SUT TK TIGERWIRE FBRWR BCMPS,$800.00,$0.00,$800.00,$360.00,$570.96,$0.00,$137.84,$0.00,$0.00,$140.07,$800.00,$0.00,$400.00,$633.60,$640.00,$0.00,$125.20,$0.00,$127.36,$0.00
AR-1934BCF-20,SUP,HCPCS C1713,,AR-1934BCF-20  -  ANCHOR SUT 1 MN 2MM 12MM STRL SUT TK FBRWR BCMPS,$762.50,$0.00,$762.50,$343.13,$544.20,$0.00,$131.37,$0.00,$0.00,$133.51,$762.50,$0.00,$381.25,$603.90,$610.00,$0.00,$119.33,$0.00,$121.39,$0.00
AR-1934BCF-24,SUP,HCPCS C1713,,AR-1934BCF-24  -  ANCHOR SUT 2 2.4MM 12MM STRL SUT TK FBRWR BCMPS DISP,$762.50,$0.00,$762.50,$343.13,$544.20,$0.00,$131.37,$0.00,$0.00,$133.51,$762.50,$0.00,$381.25,$603.90,$610.00,$0.00,$119.33,$0.00,$121.39,$0.00
AR-1934BCF-24-2,SUP,HCPCS C1713,,AR-1934BCF-24-2  -  ANCHOR SUT 2 2.4MM 12MM STRL SUT TK FBRWR BCMPS DISP,$800.00,$0.00,$800.00,$360.00,$570.96,$0.00,$137.84,$0.00,$0.00,$140.07,$800.00,$0.00,$400.00,$633.60,$640.00,$0.00,$125.20,$0.00,$127.36,$0.00
AR-1934BCFT,SUP,HCPCS C1713,,AR-1934BCFT  -  ANCHOR SUTURE 2 3MM 14.5MM SUTURETAK TIGERTAIL BIOCOMPOSITE,$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
AR-1934BCFT-2,SUP,HCPCS C1713,,AR-1934BCFT-2  -  ANCHOR SUT 2 3MM 14.5MM STRL SUT TK TGTL BCMPS DISP,$850.00,$0.00,$850.00,$382.50,$606.65,$0.00,$146.45,$0.00,$0.00,$148.83,$850.00,$0.00,$425.00,$673.20,$680.00,$0.00,$133.03,$0.00,$135.32,$0.00
AR-1934BF,SUP,HCPCS C1713,,AR-1934BF  -  ANCHOR SUT 2 3MM 14.5MM STRL BSUT TK FBRWR BABSR PUSH IN,$612.50,$0.00,$612.50,$275.63,$437.14,$0.00,$105.53,$0.00,$0.00,$107.24,$612.50,$0.00,$306.25,$485.10,$490.00,$0.00,$95.86,$0.00,$97.51,$0.00
AR-1934BFT,SUP,HCPCS C1713,,AR-1934BFT  -  ANCHOR SUTURE 3MM 2 BSUT TK TGTL ROTR CUF BABSR ARTHRO 14MM,$662.50,$0.00,$662.50,$298.13,$472.83,$0.00,$114.15,$0.00,$0.00,$116.00,$662.50,$0.00,$331.25,$524.70,$530.00,$0.00,$103.68,$0.00,$105.47,$0.00
AR-1934D-20,SUP,Custom 27203010,,AR-1934D-20  -  DRILL SRG 2 MM SUT TK,$200.00,$0.00,$200.00,$0.00,$142.74,$0.00,$0.00,$0.00,$0.00,$0.00,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1934D-20-1,SUP,Custom 27203010,,AR-1934D-20-1  -  DRILL SRG 2 MM SUT TK HRD BN,$200.00,$0.00,$200.00,$0.00,$142.74,$0.00,$0.00,$0.00,$0.00,$0.00,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1934D-24,SUP,Custom 27203010,,AR-1934D-24  -  DRILL SRG STP DISP 2.4MM SUT TK,$200.00,$0.00,$200.00,$0.00,$142.74,$0.00,$0.00,$0.00,$0.00,$0.00,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1934D-24-1,SUP,Custom 27203010,,AR-1934D-24-1  -  DRILL SRG 2.6MM 2.4MM SUT TK,$200.00,$0.00,$200.00,$0.00,$142.74,$0.00,$0.00,$0.00,$0.00,$0.00,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1934D-24-2,SUP,Custom 27203010,,AR-1934D-24-2  -  DRILL SRG 2.6MM 2.4MM SUT TK,$200.00,$0.00,$200.00,$0.00,$142.74,$0.00,$0.00,$0.00,$0.00,$0.00,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1934DHS-2,SUP,Custom 27203010,,AR-1934DHS-2  -  KIT INST HIP DISP 3MM SUT TK,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1934DS-2,SUP,Custom 27203010,,AR-1934DS-2  -  KIT INST STRL GD SPR STP DRL TROC DISP 3MM SUT TK,$400.00,$0.00,$400.00,$0.00,$285.48,$0.00,$0.00,$0.00,$0.00,$0.00,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1934PF-20,SUP,HCPCS C1713,,AR-1934PF-20  -  ANCHOR SUT 1 2MM 12MM STRL SUT TK FBRWR PEEK,$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
AR-1934PF-24,SUP,HCPCS C1713,,AR-1934PF-24  -  ANCHOR SUT 2 2.4MM 12MM STRL SUT TK FBRWR PEEK,$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
AR-1934PI,SUP,Custom 27203010,,AR-1934PI  -  KIT INS 1.1MM 17GA 2.4MM BSUT TK DRL NDL PERC INS PRTL DIL,$487.50,$0.00,$487.50,$0.00,$347.93,$0.00,$0.00,$0.00,$0.00,$0.00,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1934PI-20,SUP,Custom 27203010,,AR-1934PI-20  -  KIT INS 1.1MM 17GA 2MM SUT TK DRL PRTL DIL SPR SPNL NDL WRE,$487.50,$0.00,$487.50,$0.00,$347.93,$0.00,$0.00,$0.00,$0.00,$0.00,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1934PI-30,SUP,Custom 27203010,,AR-1934PI-30  -  KIT INSERTION 1.1MM 17GA 3MM STEP DRILL PORTAL DILAT SPEAR,$487.50,$0.00,$487.50,$0.00,$347.93,$0.00,$0.00,$0.00,$0.00,$0.00,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1934PRK,SUP,Custom 27203010,,AR-1934PRK  -  KIT ASCP FX 2.4MM 4.5MM SUT TK SWIVELOCK SPR NDL GW DIL,"$2,962.50",$0.00,"$2,962.50",$0.00,"$2,114.34",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,962.50",$0.00,"$1,481.25","$2,346.30","$2,370.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-1934PS,SUP,HCPCS C1713,,AR-1934PS  -  ANCHOR SUT 2 3MM 12.4MM BSUT TK FBRWR PEEK,$600.00,$0.00,$600.00,$270.00,$428.22,$0.00,$103.38,$0.00,$0.00,$105.06,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$93.90,$0.00,$95.52,$0.00
AR-1934PS-2,SUP,HCPCS C1713,,AR-1934PS-2  -  ANCHOR SUT 2 3MM 12.2MM SUT TK FBRWR PEEK ROTR CUF,$637.50,$0.00,$637.50,$286.88,$454.98,$0.00,$109.84,$0.00,$0.00,$111.62,$637.50,$0.00,$318.75,$504.90,$510.00,$0.00,$99.77,$0.00,$101.49,$0.00
AR-1938BC,SUP,HCPCS C1713,,AR-1938BC  -  ANCHOR SUT 2 3MM 12.7MM SUT TK FBRWR KNTLS BCMPS,"$1,062.50",$0.00,"$1,062.50",$478.13,$758.31,$0.00,$183.06,$0.00,$0.00,$186.04,"$1,062.50",$0.00,$531.25,$841.50,$850.00,$0.00,$166.28,$0.00,$169.15,$0.00
AR-1938D,SUP,Custom 27203010,,AR-1938D  -  DRILL SRG 2.6MM 3MM SUT TK,$262.50,$0.00,$262.50,$0.00,$187.35,$0.00,$0.00,$0.00,$0.00,$0.00,$262.50,$0.00,$131.25,$207.90,$210.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1938PS,SUP,HCPCS C1713,,AR-1938PS  -  ANCHOR SUT 2 3MM 12.7MM KNTLS SUT TK FBRWR PEEK,$962.50,$0.00,$962.50,$433.13,$686.94,$0.00,$165.83,$0.00,$0.00,$168.53,$962.50,$0.00,$481.25,$762.30,$770.00,$0.00,$150.63,$0.00,$153.23,$0.00
AR-1938PS-PL,SUP,HCPCS C1713,,AR-1938PS-PL  -  SUTRE ANCH PEEK S-TAK KNOTLESS 3X12.7M,$962.50,$0.00,$962.50,$433.13,$686.94,$0.00,$165.83,$0.00,$0.00,$168.53,$962.50,$0.00,$481.25,$762.30,$770.00,$0.00,$150.63,$0.00,$153.23,$0.00
AR-1949H-2.4,SUP,Custom 27203010,,AR-1949H-2.4  -  GUIDE DRL 2.4MM ANCH CNN SDL TROC HIP,"$1,247.50",$0.00,"$1,247.50",$0.00,$890.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,247.50",$0.00,$623.75,$988.02,$998.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1949H-3.0,SUP,Custom 27203010,,AR-1949H-3.0  -  GUIDE DRL 3MM ANCH CNN SDL TROC HIP,"$1,247.50",$0.00,"$1,247.50",$0.00,$890.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,247.50",$0.00,$623.75,$988.02,$998.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1965,SUP,Custom 27203010,,AR-1965  -  GUIDE DRL ALGTR MNSCL ALGRF,"$5,120.00",$0.00,"$5,120.00",$0.00,"$3,654.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,120.00",$0.00,"$2,560.00","$4,055.04","$4,096.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-1965G,SUP,Custom 27203010,,AR-1965G  -  GUIDE DRL DVTL TIB,"$7,250.00",$0.00,"$7,250.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,250.00",$0.00,"$3,625.00","$5,742.00","$5,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-1966DS,SUP,Custom 27203010,,AR-1966DS  -  KIT INST ALGRF DISP,"$1,825.00",$0.00,"$1,825.00",$0.00,"$1,302.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,825.00",$0.00,$912.50,"$1,445.40","$1,460.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-1967A,SUP,Custom 27203010,,AR-1967A  -  CLAMP SRG ADJ SFT TIS,"$1,510.00",$0.00,"$1,510.00",$0.00,"$1,077.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,510.00",$0.00,$755.00,"$1,195.92","$1,208.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-1967F,SUP,Custom 27203010,,AR-1967F  -  CLAMP SRG FX SFT TIS,"$1,510.00",$0.00,"$1,510.00",$0.00,"$1,077.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,510.00",$0.00,$755.00,"$1,195.92","$1,208.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-1974,SUP,Custom 27203010,,AR-1974  -  DRILL SRG 5MM ACL 3MM PIN TRNFX,$512.50,$0.00,$512.50,$0.00,$365.77,$0.00,$0.00,$0.00,$0.00,$0.00,$512.50,$0.00,$256.25,$405.90,$410.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1974L,SUP,Custom 27203010,,AR-1974L  -  DRILL SRG LNG 5MM STRL 2MM GDPN TRNFX2,$737.50,$0.00,$737.50,$0.00,$526.35,$0.00,$0.00,$0.00,$0.00,$0.00,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1975,SUP,Custom 27203010,,AR-1975  -  GUIDE DRL ACL RECON TIB TRNFX2,"$2,350.00",$0.00,"$2,350.00",$0.00,"$1,677.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,350.00",$0.00,"$1,175.00","$1,861.20","$1,880.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-1980-05S,SUP,Custom 27203010,,AR-1980-05S  -  SET GFT HRVT 6MM 5MM STRL OATS COLR PIN TUBE ACL DISP,"$1,247.50",$0.00,"$1,247.50",$0.00,$890.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,247.50",$0.00,$623.75,$988.02,$998.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1980-06S,SUP,Custom 27203010,,AR-1980-06S  -  SET GFT HRVT 7MM 6MM STRL OATS COLR PIN TUBE ACL DISP,"$1,247.50",$0.00,"$1,247.50",$0.00,$890.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,247.50",$0.00,$623.75,$988.02,$998.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1980-07S,SUP,Custom 27203010,,AR-1980-07S  -  SET GFT HRVT 8MM 7MM STRL OATS COLR PIN TUBE ACL DISP,"$1,247.50",$0.00,"$1,247.50",$0.00,$890.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,247.50",$0.00,$623.75,$988.02,$998.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1980-08S,SUP,Custom 27203010,,AR-1980-08S  -  SET GFT HRVT 9MM 8MM STRL OATS COLR PIN TUBE ACL DISP,"$1,247.50",$0.00,"$1,247.50",$0.00,$890.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,247.50",$0.00,$623.75,$988.02,$998.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1980-09S,SUP,Custom 27203010,,AR-1980-09S  -  SET GFT HRVT 10MM 9MM STRL OATS COLR PIN TUBE ACL DISP,"$1,247.50",$0.00,"$1,247.50",$0.00,$890.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,247.50",$0.00,$623.75,$988.02,$998.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1980-10S,SUP,Custom 27203010,,AR-1980-10S  -  SET GFT HRVT 11MM 10MM STRL OATS COLR PIN TUBE ACL DISP,"$1,247.50",$0.00,"$1,247.50",$0.00,$890.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,247.50",$0.00,$623.75,$988.02,$998.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1980-12SU,SUP,Custom 27203010,,AR-1980-12SU  -  SET GFT HRVT 12MM 11MM STRL OATS COLR PIN TUBE ACL DISP,"$1,247.50",$0.00,"$1,247.50",$0.00,$890.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,247.50",$0.00,$623.75,$988.02,$998.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1981-04S,SUP,Custom 27203010,,AR-1981-04S  -  SET GFT HRVT 4.75MM STRL OATS ALGN ROD COR XTRDR DLV TUBE,"$1,300.00",$0.00,"$1,300.00",$0.00,$927.81,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,300.00",$0.00,$650.00,"$1,029.60","$1,040.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-1981-06H,SUP,Custom 27203010,,AR-1981-06H  -  SET GFT HRVT 6MM STRL OATS ALGN ROD COR XTRDR DLV TUBE TAMP,$737.50,$0.00,$737.50,$0.00,$526.35,$0.00,$0.00,$0.00,$0.00,$0.00,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1981-06S,SUP,Custom 27203010,,AR-1981-06S  -  SET GFT HRVT 7MM 6MM STRL OATS ALGN ROD COR XTRDR DLV TUBE,"$1,300.00",$0.00,"$1,300.00",$0.00,$927.81,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,300.00",$0.00,$650.00,"$1,029.60","$1,040.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-1981-08H,SUP,Custom 27203010,,AR-1981-08H  -  SET GFT HRVT 8MM STRL OATS ALGN ROD COR XTRDR DLV TUBE TAMP,$737.50,$0.00,$737.50,$0.00,$526.35,$0.00,$0.00,$0.00,$0.00,$0.00,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1981-08S,SUP,Custom 27203010,,AR-1981-08S  -  SET GFT HRVT 9MM 8MM STRL OATS ALGN ROD COR XTRDR DLV TUBE,"$1,300.00",$0.00,"$1,300.00",$0.00,$927.81,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,300.00",$0.00,$650.00,"$1,029.60","$1,040.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-1981-10H,SUP,Custom 27203010,,AR-1981-10H  -  SET GFT HRVT 10MM STRL OATS ALGN ROD COR XTRDR DLV TUBE TAMP,$737.50,$0.00,$737.50,$0.00,$526.35,$0.00,$0.00,$0.00,$0.00,$0.00,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-1982-08S,SUP,Custom 27203010,,AR-1982-08S  -  SET GFT HRVT RTRGD 8MM STRL OATS DISP,"$1,825.00",$0.00,"$1,825.00",$0.00,"$1,302.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,825.00",$0.00,$912.50,"$1,445.40","$1,460.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-1982-10S,SUP,Custom 27203010,,AR-1982-10S  -  SET GFT HRVT RTRGD 10MM STRL OATS DISP,"$1,825.00",$0.00,"$1,825.00",$0.00,"$1,302.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,825.00",$0.00,$912.50,"$1,445.40","$1,460.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-1983,SUP,HCPCS C1713,,AR-1983  -  CAP PCTV OATS CRTLG ACL,$775.00,$0.00,$775.00,$348.75,$553.12,$0.00,$133.53,$0.00,$0.00,$135.70,$775.00,$0.00,$387.50,$613.80,$620.00,$0.00,$121.29,$0.00,$123.38,$0.00
AR-1991,SUP,HCPCS C1713,,AR-1991  -  CALIBRATOR PIN OATS,$327.50,$0.00,$327.50,$147.38,$233.74,$0.00,$56.43,$0.00,$0.00,$57.34,$327.50,$0.00,$163.75,$259.38,$262.00,$0.00,$51.25,$0.00,$52.14,$0.00
AR-2236B,SUP,HCPCS C1763,,AR-2236B  -  BUTTON FX 6.5MM 1MM TISSUEBUTTON HNDL INSRTR PRELD POLY L,$175.00,$0.00,$175.00,$78.75,$124.90,$0.00,$30.15,$0.00,$0.00,$30.64,$175.00,$0.00,$87.50,$138.60,$140.00,$0.00,$27.39,$0.00,$27.86,$0.00
AR-2238B,SUP,HCPCS C1763,,AR-2238B  -  BUTTON FX 8MM 1MM STRL TISSUEBUTTON BABSR POLY L LAC ACD SFT,$175.00,$0.00,$175.00,$78.75,$124.90,$0.00,$30.15,$0.00,$0.00,$30.64,$175.00,$0.00,$87.50,$138.60,$140.00,$0.00,$27.39,$0.00,$27.86,$0.00
AR-2240B,SUP,HCPCS C1763,,AR-2240B  -  BUTTON FX 5MM 10MM STRL TISSUEBUTTON POLY L LAC ACD ROTR CUF,$175.00,$0.00,$175.00,$78.75,$124.90,$0.00,$30.15,$0.00,$0.00,$30.64,$175.00,$0.00,$87.50,$138.60,$140.00,$0.00,$27.39,$0.00,$27.86,$0.00
AR-2253L,SUP,Custom 27203010,,AR-2253L  -  GUIDE DRL ARM LT ACJT ACJT RECON SYS,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-2253R,SUP,Custom 27203010,,AR-2253R  -  GUIDE DRL ARM RT ACJT ACJT RECON SYS,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-2255CG,SUP,Custom 27203010,,AR-2255CG  -  GUIDE DRL CNST ACJT,"$4,912.50",$0.00,"$4,912.50",$0.00,"$3,506.05",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,912.50",$0.00,"$2,456.25","$3,890.70","$3,930.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-2257-01,SUP,HCPCS C1763,,AR-2257-01  -  BUTTON FX CLVCL,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
AR-2257-02,SUP,HCPCS C1763,,AR-2257-02  -  BUTTON FX CORACOID,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
AR-2257D-24,SUP,Custom 27203010,,AR-2257D-24  -  DRILL SRG 2.4MM CNN ACML REPR,$687.50,$0.00,$687.50,$0.00,$490.67,$0.00,$0.00,$0.00,$0.00,$0.00,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-2257D-30,SUP,Custom 27203010,,AR-2257D-30  -  DRILL SRG 3MM CNN AC REPR,$687.50,$0.00,$687.50,$0.00,$490.67,$0.00,$0.00,$0.00,$0.00,$0.00,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-2258-03,SUP,Custom 27803010,,AR-2258-03  -  WASHER ORTH CLVCL,$875.00,$0.00,$875.00,$0.00,$624.49,$0.00,$0.00,$0.00,$0.00,$0.00,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-2260,SUP,Custom 27203010,,AR-2260  -  KIT ASCP FX STRL BTN DRL PIN INSRTR SCR,"$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-2261,SUP,HCPCS C1763,,AR-2261  -  BUTTON SUT 12MM STRL BICEPS,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
AR-2263,SUP,HCPCS C1763,,AR-2263  -  PIN DRL 3.2MM STRL BISCEPSBUTTON DIST DISP,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-2264,SUP,HCPCS C1713,,AR-2264  -  DEVICE FX STRL TGHTRP TWN TAIL ACJT,"$1,437.50",$0.00,"$1,437.50",$646.88,"$1,025.94",$0.00,$247.67,$0.00,$0.00,$251.69,"$1,437.50",$0.00,$718.75,"$1,138.50","$1,150.00",$0.00,$224.97,$0.00,$228.85,$0.00
AR-2266,SUP,HCPCS C1763,,AR-2266  -  BUTTON FX 2.6MM 10.9MM TI SHLDR PECTORALIS MN OPN REPR,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
AR-2267,SUP,HCPCS C1763,,AR-2267  -  BUTTON FX LF INSRTR LG EYLT PECTORALIS,"$1,087.50",$0.00,"$1,087.50",$489.38,$776.15,$0.00,$187.37,$0.00,$0.00,$190.41,"$1,087.50",$0.00,$543.75,$861.30,$870.00,$0.00,$170.19,$0.00,$173.13,$0.00
AR-2270,SUP,HCPCS C1763,,AR-2270  -  BUTTON FX DOG BN,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
AR-2271,SUP,Custom 27203010,,AR-2271  -  KIT ASCP FX 2MM 3MM TIGERTAPE SUTLSO 2 DOG BN BTN CNN DRL,"$2,812.50",$0.00,"$2,812.50",$0.00,"$2,007.28",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,812.50",$0.00,"$1,406.25","$2,227.50","$2,250.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-2273,SUP,Custom 27203010,,AR-2273  -  GUIDE DRL ACJT ACJT RECON SYS,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-2274,SUP,Custom 27203010,,AR-2274  -  CANNULA ESCP 4.7MM SLOT,$987.50,$0.00,$987.50,$0.00,$704.78,$0.00,$0.00,$0.00,$0.00,$0.00,$987.50,$0.00,$493.75,$782.10,$790.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-2280,SUP,HCPCS C1763,,AR-2280  -  BUTTON INSERTER/SUTURE KIT,"$1,975.00",$0.00,"$1,975.00",$888.75,"$1,409.56",$0.00,$340.28,$0.00,$0.00,$345.81,"$1,975.00",$0.00,$987.50,"$1,564.20","$1,580.00",$0.00,$309.09,$0.00,$314.42,$0.00
AR-2281,SUP,HCPCS C1763,,AR-2281  -  12MM BUTTON/SUTURE CONSTRUCT,$987.50,$0.00,$987.50,$444.38,$704.78,$0.00,$170.14,$0.00,$0.00,$172.90,$987.50,$0.00,$493.75,$782.10,$790.00,$0.00,$154.54,$0.00,$157.21,$0.00
AR-2290,SUP,HCPCS C1713,,AR-2290  -  SET IMPLANT PROXIMAL TENODESIS BUTTON FIBERLOOP DRILL PIN,"$1,687.50",$0.00,"$1,687.50",$759.38,"$1,204.37",$0.00,$290.75,$0.00,$0.00,$295.47,"$1,687.50",$0.00,$843.75,"$1,336.50","$1,350.00",$0.00,$264.09,$0.00,$268.65,$0.00
AR-2291,SUP,HCPCS C1763,,AR-2291  -  BUTTON FX 0 BICEPS PROX TENODESIS,"$1,087.50",$0.00,"$1,087.50",$489.38,$776.15,$0.00,$187.37,$0.00,$0.00,$190.41,"$1,087.50",$0.00,$543.75,$861.30,$870.00,$0.00,$170.19,$0.00,$173.13,$0.00
AR-2323BCC,SUP,HCPCS C1713,,AR-2323BCC  -  ANCHOR SUTURE 5.5MM 19.1MM CLOSE EYELET VENT SWIVELOCK C,"$1,000.00",$0.00,"$1,000.00",$450.00,$713.70,$0.00,$172.30,$0.00,$0.00,$175.09,"$1,000.00",$0.00,$500.00,$792.00,$800.00,$0.00,$156.50,$0.00,$159.20,$0.00
AR-2323BCM,SUP,HCPCS C1713,,AR-2323BCM  -  ANCHOR SUT 5.5MM 24.5MM STRL SWIVELOCK SP SLF PNCH VNT BCMPS,"$1,050.00",$0.00,"$1,050.00",$472.50,$749.39,$0.00,$180.91,$0.00,$0.00,$183.85,"$1,050.00",$0.00,$525.00,$831.60,$840.00,$0.00,$164.33,$0.00,$167.16,$0.00
AR-2323BCT-2,SUP,HCPCS C1713,,AR-2323BCT-2  -  ANCHOR SUT 2 5.5MM 22MM BLK BLU WHT FIBERTAK SWIVELOCK C,"$5,312.50",$0.00,"$5,312.50","$2,390.63","$3,791.53",$0.00,$915.32,$0.00,$0.00,$930.18,"$5,312.50",$0.00,"$2,656.25","$4,207.50","$4,250.00",$0.00,$831.41,$0.00,$845.75,$0.00
AR-2323BSL,SUP,HCPCS C1713,,AR-2323BSL  -  ANCHOR SUT 5.5MM 20MM STRL BIO-SWIVELOCK SLF PNCH VNT DISP,$937.50,$0.00,$937.50,$421.88,$669.09,$0.00,$161.53,$0.00,$0.00,$164.15,$937.50,$0.00,$468.75,$742.50,$750.00,$0.00,$146.72,$0.00,$149.25,$0.00
AR-2323BSLC,SUP,HCPCS C1713,,AR-2323BSLC  -  ANCHOR SUT 5.5MM 19.1MM STRL BIO-SWIVELOCK C CLS EYLT VNT,$937.50,$0.00,$937.50,$421.88,$669.09,$0.00,$161.53,$0.00,$0.00,$164.15,$937.50,$0.00,$468.75,$742.50,$750.00,$0.00,$146.72,$0.00,$149.25,$0.00
AR-2323BSLM,SUP,HCPCS C1713,,AR-2323BSLM  -  ANCHOR SUT 5.5MM 24.5MM STRL BIO-SWIVELOCK SLF PNCH VNT DISP,"$1,000.00",$0.00,"$1,000.00",$450.00,$713.70,$0.00,$172.30,$0.00,$0.00,$175.09,"$1,000.00",$0.00,$500.00,$792.00,$800.00,$0.00,$156.50,$0.00,$159.20,$0.00
AR-2323PSL,SUP,HCPCS C1713,,AR-2323PSL  -  ANCHOR SUT 5.5MM 20MM SWIVELOCK PEEK,$937.50,$0.00,$937.50,$421.88,$669.09,$0.00,$161.53,$0.00,$0.00,$164.15,$937.50,$0.00,$468.75,$742.50,$750.00,$0.00,$146.72,$0.00,$149.25,$0.00
AR-2323PSLC,SUP,HCPCS C1713,,AR-2323PSLC  -  ANCHOR SUTURE 5.5MM 19.1MM CLOSE EYELET SWIVELOCK C,"$1,340.00",$0.00,"$1,340.00",$603.00,$956.36,$0.00,$230.88,$0.00,$0.00,$234.62,"$1,340.00",$0.00,$670.00,"$1,061.28","$1,072.00",$0.00,$209.71,$0.00,$213.33,$0.00
AR-2323PSLC-2,SUP,HCPCS C1713,,AR-2323PSLC-2  -  ANCHOR SUT 5.5MM STRL LF ARTHX SWIVELOCK 2 LD PEEK,$987.50,$0.00,$987.50,$444.38,$704.78,$0.00,$170.14,$0.00,$0.00,$172.90,$987.50,$0.00,$493.75,$782.10,$790.00,$0.00,$154.54,$0.00,$157.21,$0.00
AR-2323PSLM,SUP,HCPCS C1713,,AR-2323PSLM  -  ANCHOR SUT 5.5MM 24.5MM STRL BIO-SWIVELOCK SLF PNCH DISP,"$1,000.00",$0.00,"$1,000.00",$450.00,$713.70,$0.00,$172.30,$0.00,$0.00,$175.09,"$1,000.00",$0.00,$500.00,$792.00,$800.00,$0.00,$156.50,$0.00,$159.20,$0.00
AR-2323SLM,SUP,HCPCS C1713,,AR-2323SLM  -  ANCHOR SUT 5.5MM 24.5MM STRL SWIVELOCK SLF PNCH DISP,$800.00,$0.00,$800.00,$360.00,$570.96,$0.00,$137.84,$0.00,$0.00,$140.07,$800.00,$0.00,$400.00,$633.60,$640.00,$0.00,$125.20,$0.00,$127.36,$0.00
AR-2324BCC,SUP,HCPCS C1713,,AR-2324BCC  -  ANCHOR SUTURE 4.75MM 19.1MM CLOSE EYELET VENT SWIVELOCK C,"$1,000.00",$0.00,"$1,000.00",$450.00,$713.70,$0.00,$172.30,$0.00,$0.00,$175.09,"$1,000.00",$0.00,$500.00,$792.00,$800.00,$0.00,$156.50,$0.00,$159.20,$0.00
AR-2324BCC-2,SUP,HCPCS C1713,,AR-2324BCC-2  -  ANCHOR SUT 4.75MM STRL SWIVELOCK TIGERWIRE ARTHX 2 LD 2 TIP,"$1,042.50",$0.00,"$1,042.50",$469.13,$744.03,$0.00,$179.62,$0.00,$0.00,$182.53,"$1,042.50",$0.00,$521.25,$825.66,$834.00,$0.00,$163.15,$0.00,$165.97,$0.00
AR-2324BCC-CP,SUP,HCPCS C1713,,AR-2324BCC-CP  -  SET IMPL FULL 4.75MM 19.1MM SWIVELOCK C CLS EYLT VNT KN,"$2,562.50",$0.00,"$2,562.50","$1,153.13","$1,828.86",$0.00,$441.51,$0.00,$0.00,$448.67,"$2,562.50",$0.00,"$1,281.25","$2,029.50","$2,050.00",$0.00,$401.03,$0.00,$407.95,$0.00
AR-2324BCCS,SUP,HCPCS C1713,,AR-2324BCCS  -  SYSTEM ENDSCP FIX 4.75MM NEEDLE MULTIFIRE SCORPION SWIVELOCK,"$1,600.00",$0.00,"$1,600.00",$720.00,"$1,141.92",$0.00,$275.67,$0.00,$0.00,$280.15,"$1,600.00",$0.00,$800.00,"$1,267.20","$1,280.00",$0.00,$250.40,$0.00,$254.72,$0.00
AR-2324BCCT,SUP,HCPCS C1713,,AR-2324BCCT  -  ANCHOR SUTURE 4.75MM 19.1MM CLOSE EYELET TAPE LOOP VENT,"$1,607.50",$0.00,"$1,607.50",$723.38,"$1,147.27",$0.00,$276.96,$0.00,$0.00,$281.46,"$1,607.50",$0.00,$803.75,"$1,273.14","$1,286.00",$0.00,$251.57,$0.00,$255.91,$0.00
AR-2324BCCTT,SUP,HCPCS C1713,,AR-2324BCCTT  -  ANCHOR SUTURE 4.75MM 19.1MM CLOSE EYELET VENT SWIVELOCK C,"$1,350.00",$0.00,"$1,350.00",$607.50,$963.50,$0.00,$232.60,$0.00,$0.00,$236.37,"$1,350.00",$0.00,$675.00,"$1,069.20","$1,080.00",$0.00,$211.28,$0.00,$214.92,$0.00
AR-2324BCM,SUP,HCPCS C1713,,AR-2324BCM  -  ANCHOR SUTURE 4.75MM 24.5MM SELF PUNCH VENT SWIVELOCK,"$1,430.00",$0.00,"$1,430.00",$643.50,"$1,020.59",$0.00,$246.38,$0.00,$0.00,$250.38,"$1,430.00",$0.00,$715.00,"$1,132.56","$1,144.00",$0.00,$223.80,$0.00,$227.66,$0.00
AR-2324BCT-2,SUP,HCPCS C1713,,AR-2324BCT-2  -  ANCHOR SUT 2 4.75MM 22MM BLK BLU WHT SWIVELOCK C FIBERTAK,"$5,312.50",$0.00,"$5,312.50","$2,390.63","$3,791.53",$0.00,$915.32,$0.00,$0.00,$930.18,"$5,312.50",$0.00,"$2,656.25","$4,207.50","$4,250.00",$0.00,$831.41,$0.00,$845.75,$0.00
AR-2324BSL,SUP,HCPCS C1713,,AR-2324BSL  -  ANCHOR SUT 4.75MM 20MM STRL BIO-SWIVELOCK DISP,$937.50,$0.00,$937.50,$421.88,$669.09,$0.00,$161.53,$0.00,$0.00,$164.15,$937.50,$0.00,$468.75,$742.50,$750.00,$0.00,$146.72,$0.00,$149.25,$0.00
AR-2324BSLC,SUP,HCPCS C1713,,AR-2324BSLC  -  ANCHOR SUT 4.75MM 19.1MM STRL BIO-SWIVELOCK C CLS EYLT VNT,$937.50,$0.00,$937.50,$421.88,$669.09,$0.00,$161.53,$0.00,$0.00,$164.15,$937.50,$0.00,$468.75,$742.50,$750.00,$0.00,$146.72,$0.00,$149.25,$0.00
AR-2324PCT,SUP,HCPCS C1713,,AR-2324PCT  -  ANCHOR SUT 4.75MM 19.1MM BLU STRL SWIVELOCK C FIBERTAPE CLS,"$1,062.50",$0.00,"$1,062.50",$478.13,$758.31,$0.00,$183.06,$0.00,$0.00,$186.04,"$1,062.50",$0.00,$531.25,$841.50,$850.00,$0.00,$166.28,$0.00,$169.15,$0.00
AR-2324PCTT,SUP,HCPCS C1713,,AR-2324PCTT  -  ANCHOR SUT 4.75MM 19.1MM B/W STRL SWIVELOCK C TIGERTAPE CLS,"$1,062.50",$0.00,"$1,062.50",$478.13,$758.31,$0.00,$183.06,$0.00,$0.00,$186.04,"$1,062.50",$0.00,$531.25,$841.50,$850.00,$0.00,$166.28,$0.00,$169.15,$0.00
AR-2324PSLC,SUP,HCPCS C1713,,AR-2324PSLC  -  ANCHOR SUTURE 4.75MM 19.1MM CLOSE EYELET VENT SWIVELOCK PEEK,"$1,340.00",$0.00,"$1,340.00",$603.00,$956.36,$0.00,$230.88,$0.00,$0.00,$234.62,"$1,340.00",$0.00,$670.00,"$1,061.28","$1,072.00",$0.00,$209.71,$0.00,$213.33,$0.00
AR-2324PSLC-2,SUP,HCPCS C1713,,AR-2324PSLC-2  -  ANCHOR SUT 4.75MM STRL LF ARTHX SWIVELOCK 2 LD PEEK,$987.50,$0.00,$987.50,$444.38,$704.78,$0.00,$170.14,$0.00,$0.00,$172.90,$987.50,$0.00,$493.75,$782.10,$790.00,$0.00,$154.54,$0.00,$157.21,$0.00
AR-2324PSLM,SUP,HCPCS C1713,,AR-2324PSLM  -  ANCHOR SUT 4.75MM 24.5MM STRL SWIVELOCK SLF PNCH VNT PEEK,"$1,000.00",$0.00,"$1,000.00",$450.00,$713.70,$0.00,$172.30,$0.00,$0.00,$175.09,"$1,000.00",$0.00,$500.00,$792.00,$800.00,$0.00,$156.50,$0.00,$159.20,$0.00
AR-2324SLM,SUP,HCPCS C1713,,AR-2324SLM  -  ANCHOR SUT 4.75MM 24.5MM STRL SWIVELOCK SLF PNCH VNT TI DISP,$800.00,$0.00,$800.00,$360.00,$570.96,$0.00,$137.84,$0.00,$0.00,$140.07,$800.00,$0.00,$400.00,$633.60,$640.00,$0.00,$125.20,$0.00,$127.36,$0.00
AR-2325BCC,SUP,HCPCS C1713,,AR-2325BCC  -  BIO-COMP SWVLK 3.5X 15.8MM,"$1,000.00",$0.00,"$1,000.00",$450.00,$713.70,$0.00,$172.30,$0.00,$0.00,$175.09,"$1,000.00",$0.00,$500.00,$792.00,$800.00,$0.00,$156.50,$0.00,$159.20,$0.00
AR-2325D,SUP,Custom 27203010,,AR-2325D  -  DRILL SRG 3.5 MM SWIVELLOCK,$237.50,$0.00,$237.50,$0.00,$169.50,$0.00,$0.00,$0.00,$0.00,$0.00,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-2325D-ST,SUP,Custom 27203010,,AR-2325D-ST  -  DRILL SRG STRL 3.5 MM LABRAL SWIVELOCK,$262.50,$0.00,$262.50,$0.00,$187.35,$0.00,$0.00,$0.00,$0.00,$0.00,$262.50,$0.00,$131.25,$207.90,$210.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-2325PSLC,SUP,HCPCS C1713,,AR-2325PSLC  -  ANCHOR SUT 3.5MM 14.8MM SWIVELOCK VNT PEEK-OPTM,$937.50,$0.00,$937.50,$421.88,$669.09,$0.00,$161.53,$0.00,$0.00,$164.15,$937.50,$0.00,$468.75,$742.50,$750.00,$0.00,$146.72,$0.00,$149.25,$0.00
AR-2374,SUP,Custom 27203010,,AR-2374  -  5.1MM CANNULATED REAMER WITH STOP,$512.50,$0.00,$512.50,$0.00,$365.77,$0.00,$0.00,$0.00,$0.00,$0.00,$512.50,$0.00,$256.25,$405.90,$410.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-2511,SUP,Custom 27203010,,AR-2511  -  GUIDE DRL SHLDR PERC REUSE PNG SYS,"$1,937.50",$0.00,"$1,937.50",$0.00,"$1,382.79",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,937.50",$0.00,$968.75,"$1,534.50","$1,550.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-2512,SUP,Custom 27203010,,AR-2512  -  GUIDE DRL PRLL SHLDR PERC REUSE PNG SYS,"$2,487.50",$0.00,"$2,487.50",$0.00,"$1,775.33",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,487.50",$0.00,"$1,243.75","$1,970.10","$1,990.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-2528,SUP,Custom 27203010,,AR-2528  -  DRILL SRG 3.2MM CNN SHLDR PERC DISP PNG SYS,$712.50,$0.00,$712.50,$0.00,$508.51,$0.00,$0.00,$0.00,$0.00,$0.00,$712.50,$0.00,$356.25,$564.30,$570.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-2600SBS-6,SUP,HCPCS C1713,,AR-2600SBS-6  -  SYSTEM FX 4.75MM BLK BLU WHT SPEEDBRIDGE SWIVELOCK FIBERTAPE,"$4,000.00",$0.00,"$4,000.00","$1,800.00","$2,854.80",$0.00,$689.18,$0.00,$0.00,$700.37,"$4,000.00",$0.00,"$2,000.00","$3,168.00","$3,200.00",$0.00,$626.00,$0.00,$636.80,$0.00
AR-2622DL,SUP,HCPCS C1713,,AR-2622DL  -  PLATE BN 22MM CLVCL LT DIST,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
AR-2622DR,SUP,HCPCS C1713,,AR-2622DR  -  PLATE BN 22D STRL ARTHX CLVCL RT DIST,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
AR-2650CL,SUP,HCPCS C1713,,AR-2650CL  -  PLATE BN PRECONTOUR STRL CNTR 3RD CMPR SLOT LCK HL SS CLVCL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
AR-2650CR,SUP,HCPCS C1713,,AR-2650CR  -  PLATE BN PRECONTOUR STRL CNTR 3RD CMPR SLOT LCK HL SS CLVCL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
AR-2651CL,SUP,HCPCS C1713,,AR-2651CL  -  PLATE BN PRECONTOUR STRL CNTR 3RD CMPR SLOT LCK HL SS CLVCL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
AR-2651CR,SUP,HCPCS C1713,,AR-2651CR  -  PLATE BN PRECONTOUR STRL CNTR 3RD CMPR SLOT LCK HL SS CLVCL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
AR-2652CL,SUP,HCPCS C1713,,AR-2652CL  -  PLATE BN PRECONTOUR STRL CNTR 3RD CMPR SLOT LCK HL SS CLVCL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
AR-2652CR,SUP,HCPCS C1713,,AR-2652CR  -  PLATE BN PRECONTOUR STRL CNTR 3RD CMPR SLOT LCK HL SS CLVCL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
AR-2653CL,SUP,HCPCS C1713,,AR-2653CL  -  PLATE BN PRECONTOUR STRL CNTR 3RD CMPR SLOT LCK HL SS CLVCL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
AR-2653CR,SUP,HCPCS C1713,,AR-2653CR  -  PLATE BN PRECONTOUR STRL CNTR 3RD CMPR SLOT LCK HL SS CLVCL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
AR-2654CL,SUP,HCPCS C1713,,AR-2654CL  -  PLATE BN PRECONTOUR STRL CNTR 3RD CMPR SLOT LCK HL SS CLVCL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
AR-2654CR,SUP,HCPCS C1713,,AR-2654CR  -  PLATE BN PRECONTOUR STRL CNTR 3RD CMPR SLOT LCK HL SS CLVCL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
AR-2655CL,SUP,HCPCS C1713,,AR-2655CL  -  PLATE BN PRECONTOUR STRL CNTR 3RD CMPR SLOT LCK HL SS CLVCL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
AR-2655CR,SUP,HCPCS C1713,,AR-2655CR  -  PLATE BN PRECONTOUR STRL CNTR 3RD CMPR SLOT LCK HL SS CLVCL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
AR-2656DL,SUP,HCPCS C1713,,AR-2656DL  -  PLATE BN SHRT PRECONTOUR STRL CHMFR SUT EYLT CMPR SLOT THRD,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
AR-2656DR,SUP,HCPCS C1713,,AR-2656DR  -  PLATE BN SHRT PRECONTOUR LOPRFL LCK CMPR HL SS CLVCL RT DIST,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
AR-2657DL,SUP,HCPCS C1713,,AR-2657DL  -  PLATE BN SHRT PRECONTOUR STRL CHMFR SUT EYLT CMPR SLOT THRD,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
AR-2657DR,SUP,HCPCS C1713,,AR-2657DR  -  PLATE BN SHRT PRECONTOUR STRL CHMFR SUT EYLT CMPR SLOT THRD,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
AR-2658,SUP,HCPCS C1713,,AR-2658  -  BUTTON FX CMPR SLOT PLT SEAT FLSH SS CLVCL DIST,$875.00,$0.00,$875.00,$393.75,$624.49,$0.00,$150.76,$0.00,$0.00,$153.21,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$136.94,$0.00,$139.30,$0.00
AR-2664L,SUP,Custom 27203010,,AR-2664L  -  GUIDE DRL PLT SCR CLVCL LT DIST,"$1,187.50",$0.00,"$1,187.50",$0.00,$847.52,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,187.50",$0.00,$593.75,$940.50,$950.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-2664R,SUP,Custom 27203010,,AR-2664R  -  GUIDE DRL PLT SCR CLVCL RT DIST,"$1,187.50",$0.00,"$1,187.50",$0.00,$847.52,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,187.50",$0.00,$593.75,$940.50,$950.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-2665-10H,SUP,HCPCS C1713,,AR-2665-10H  -  SCREW BN HEXALOBE 2.5MM 10MM HRBRT 2 PTCH SS ELB SHLDR SM,$562.50,$0.00,$562.50,$253.13,$401.46,$0.00,$96.92,$0.00,$0.00,$98.49,$562.50,$0.00,$281.25,$445.50,$450.00,$0.00,$88.03,$0.00,$89.55,$0.00
AR-2665-12H,SUP,HCPCS C1713,,AR-2665-12H  -  SCREW BN HEXALOBE 2.5MM 12MM HRBRT 2 PTCH SS ELB SHLDR SM,$562.50,$0.00,$562.50,$253.13,$401.46,$0.00,$96.92,$0.00,$0.00,$98.49,$562.50,$0.00,$281.25,$445.50,$450.00,$0.00,$88.03,$0.00,$89.55,$0.00
AR-2665-14H,SUP,HCPCS C1713,,AR-2665-14H  -  SCREW BN HEXALOBE 2.5MM 14MM HRBRT 2 PTCH SS ELB SHLDR SM,$562.50,$0.00,$562.50,$253.13,$401.46,$0.00,$96.92,$0.00,$0.00,$98.49,$562.50,$0.00,$281.25,$445.50,$450.00,$0.00,$88.03,$0.00,$89.55,$0.00
AR-2665-16H,SUP,HCPCS C1713,,AR-2665-16H  -  SCREW BN HEXALOBE 2.5MM 16MM HRBRT 2 PTCH SS ELB SHLDR SM,$562.50,$0.00,$562.50,$253.13,$401.46,$0.00,$96.92,$0.00,$0.00,$98.49,$562.50,$0.00,$281.25,$445.50,$450.00,$0.00,$88.03,$0.00,$89.55,$0.00
AR-2665-18H,SUP,HCPCS C1713,,AR-2665-18H  -  SCREW BN HEXALOBE 2.5MM 18MM HRBRT 2 PTCH SS ELB SHLDR SM,$562.50,$0.00,$562.50,$253.13,$401.46,$0.00,$96.92,$0.00,$0.00,$98.49,$562.50,$0.00,$281.25,$445.50,$450.00,$0.00,$88.03,$0.00,$89.55,$0.00
AR-2665-20H,SUP,HCPCS C1713,,AR-2665-20H  -  SCREW BN HEXALOBE 2.5MM 20MM HRBRT 2 PTCH SS ELB SHLDR SM,$562.50,$0.00,$562.50,$253.13,$401.46,$0.00,$96.92,$0.00,$0.00,$98.49,$562.50,$0.00,$281.25,$445.50,$450.00,$0.00,$88.03,$0.00,$89.55,$0.00
AR-2665-22H,SUP,HCPCS C1713,,AR-2665-22H  -  SCREW BN HEXALOBE 2.5MM 22MM HRBRT 2 PTCH SS ELB SHLDR SM,$562.50,$0.00,$562.50,$253.13,$401.46,$0.00,$96.92,$0.00,$0.00,$98.49,$562.50,$0.00,$281.25,$445.50,$450.00,$0.00,$88.03,$0.00,$89.55,$0.00
AR-2665-24H,SUP,HCPCS C1713,,AR-2665-24H  -  SCREW BN HEXALOBE 2.5MM 24MM HRBRT 2 PTCH SS ELB SHLDR SM,$562.50,$0.00,$562.50,$253.13,$401.46,$0.00,$96.92,$0.00,$0.00,$98.49,$562.50,$0.00,$281.25,$445.50,$450.00,$0.00,$88.03,$0.00,$89.55,$0.00
AR-2668,SUP,Custom 27203010,,AR-2668  -  GUIDE DRL LCK SLV 2.7 MM SCR,$187.50,$0.00,$187.50,$0.00,$133.82,$0.00,$0.00,$0.00,$0.00,$0.00,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-2669,SUP,Custom 27203010,,AR-2669  -  GUIDE DRL LCK DIST 2.7 MM SCR,$262.50,$0.00,$262.50,$0.00,$187.35,$0.00,$0.00,$0.00,$0.00,$0.00,$262.50,$0.00,$131.25,$207.90,$210.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-2680ST,SUP,HCPCS C1713,,AR-2680ST  -  PLATE BN PRECONTOUR FX 7 HL SS CLVCL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
AR-2685DR-10,SUP,HCPCS C1713,,AR-2685DR-10  -  PLATE BN 10 HL LOPRFL PRECONTOUR CMPR SLOT SS CLVCL RT DIST,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
AR-2810-20,SUP,Custom 27203010,,AR-2810-20  -  PARTIAL ECLIPSE HUMERAL REAMER,"$1,375.00",$0.00,"$1,375.00",$0.00,$981.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-2810-25,SUP,Custom 27203010,,AR-2810-25  -  PARTIAL ECLIPSE HUMERAL REAMER,"$1,375.00",$0.00,"$1,375.00",$0.00,$981.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-2810F-18-5,SUP,Custom 27203010,,AR-2810F-18-5  -  PARTIAL ECLIPSE GLENOID REAMER,"$1,625.00",$0.00,"$1,625.00",$0.00,"$1,159.76",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,625.00",$0.00,$812.50,"$1,287.00","$1,300.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-2810F-20-5,SUP,Custom 27203010,,AR-2810F-20-5  -  PARTIAL ECLIPSE GLENOID REAMER,"$1,500.00",$0.00,"$1,500.00",$0.00,"$1,070.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-2810F-22-5,SUP,Custom 27203010,,AR-2810F-22-5  -  PARTIAL ECLIPSE GLENOID REAMER,"$1,500.00",$0.00,"$1,500.00",$0.00,"$1,070.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-2810R-20-5,SUP,Custom 27203010,,AR-2810R-20-5  -  ALLOGRAFT PARTIAL ECLIPSE HUMERAL REAMER,"$1,625.00",$0.00,"$1,625.00",$0.00,"$1,159.76",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,625.00",$0.00,$812.50,"$1,287.00","$1,300.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-2810R-25-5,SUP,Custom 27203010,,AR-2810R-25-5  -  ALLOGRAFT PARTIAL ECLIPSE HUMERAL REAMER,"$1,625.00",$0.00,"$1,625.00",$0.00,"$1,159.76",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,625.00",$0.00,$812.50,"$1,287.00","$1,300.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-2810R-30-5,SUP,Custom 27203010,,AR-2810R-30-5  -  ALLOGRAFT PARTIAL ECLIPSE HUMERAL REAMER,"$1,625.00",$0.00,"$1,625.00",$0.00,"$1,159.76",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,625.00",$0.00,$812.50,"$1,287.00","$1,300.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-2820,SUP,Custom 27203010,,AR-2820  -  GUIDE DRL PRT ECLPS STEMLESS SHLDR ARTHPL,"$3,500.00",$0.00,"$3,500.00",$0.00,"$2,497.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-2922BC,SUP,HCPCS C1713,,AR-2922BC  -  ANCHOR SUT 2.4MM 11.3MM PUSHLOCK BCMPS 1 FBRWR 2 FIBERLINK,"$1,000.00",$0.00,"$1,000.00",$450.00,$713.70,$0.00,$172.30,$0.00,$0.00,$175.09,"$1,000.00",$0.00,$500.00,$792.00,$800.00,$0.00,$156.50,$0.00,$159.20,$0.00
AR-2922D-24-1,SUP,Custom 27203010,,AR-2922D-24-1  -  DRILL SRG 2.4 MM PUSHLOCK,$237.50,$0.00,$237.50,$0.00,$169.50,$0.00,$0.00,$0.00,$0.00,$0.00,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-2922PS,SUP,HCPCS C1713,,AR-2922PS  -  ANCHOR SUT 2.4MM 14MM STRL PUSHLOCK CNN EYLT HNDL INSRTR,$900.00,$0.00,$900.00,$405.00,$642.33,$0.00,$155.07,$0.00,$0.00,$157.58,$900.00,$0.00,$450.00,$712.80,$720.00,$0.00,$140.85,$0.00,$143.28,$0.00
AR-2923BC,SUP,HCPCS C1713,,AR-2923BC  -  ANCHOR SUTURE SHORT 2.9MM 12.5MM CANN EYELET HANDLE INSERTER,"$1,430.00",$0.00,"$1,430.00",$643.50,"$1,020.59",$0.00,$246.38,$0.00,$0.00,$250.38,"$1,430.00",$0.00,$715.00,"$1,132.56","$1,144.00",$0.00,$223.80,$0.00,$227.66,$0.00
AR-2923BCH,SUP,HCPCS C1713,,AR-2923BCH  -  SUTR ANCH HIP BIO-COMP P-LCK 2.9X12.5MM,"$1,050.00",$0.00,"$1,050.00",$472.50,$749.39,$0.00,$180.91,$0.00,$0.00,$183.85,"$1,050.00",$0.00,$525.00,$831.60,$840.00,$0.00,$164.33,$0.00,$167.16,$0.00
AR-2923D,SUP,Custom 27203010,,AR-2923D  -  DRILL SRG BCMPS 2.9 MM SHRT PUSHLOCK,$237.50,$0.00,$237.50,$0.00,$169.50,$0.00,$0.00,$0.00,$0.00,$0.00,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-2923DHT,SUP,Custom 27203010,,AR-2923DHT  -  DRILL SRG HIP SHRT 2.9 MM PUSHLOCK HRD BN,$362.50,$0.00,$362.50,$0.00,$258.72,$0.00,$0.00,$0.00,$0.00,$0.00,$362.50,$0.00,$181.25,$287.10,$290.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-2923D-ST,SUP,Custom 27203010,,AR-2923D-ST  -  DRILL SRG STRL ELB SHLDR 2.9 MM SHRT PUSHLOCK,$262.50,$0.00,$262.50,$0.00,$187.35,$0.00,$0.00,$0.00,$0.00,$0.00,$262.50,$0.00,$131.25,$207.90,$210.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-2923DT,SUP,Custom 27203010,,AR-2923DT  -  DRILL SRG 2.9 MM SHRT PUSHLOCK HRD BN,$237.50,$0.00,$237.50,$0.00,$169.50,$0.00,$0.00,$0.00,$0.00,$0.00,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-2923DT-ST,SUP,Custom 27203010,,AR-2923DT-ST  -  DRILL SRG STRL 2.9 MM SHRT PUSHLOCK HRD BN,$262.50,$0.00,$262.50,$0.00,$187.35,$0.00,$0.00,$0.00,$0.00,$0.00,$262.50,$0.00,$131.25,$207.90,$210.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-2923PHS,SUP,HCPCS C1713,,AR-2923PHS  -  ANCHOR SUT SHRT 2.9MM 12.5MM PUSHLOCK PEEK HIP,$950.00,$0.00,$950.00,$427.50,$678.02,$0.00,$163.68,$0.00,$0.00,$166.34,$950.00,$0.00,$475.00,$752.40,$760.00,$0.00,$148.68,$0.00,$151.24,$0.00
AR-2923PS,SUP,HCPCS C1713,,AR-2923PS  -  ANCHOR SUT SHRT 2.9MM 12.5MM STRL PUSHLOCK CNN PEEK,$900.00,$0.00,$900.00,$405.00,$642.33,$0.00,$155.07,$0.00,$0.00,$157.58,$900.00,$0.00,$450.00,$712.80,$720.00,$0.00,$140.85,$0.00,$143.28,$0.00
AR-2950SC,SUP,Custom 27203010,,AR-2950SC  -  CLAMP SRG GRAFTPRO SFT TIS,"$1,492.50",$0.00,"$1,492.50",$0.00,"$1,065.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,492.50",$0.00,$746.25,"$1,182.06","$1,194.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-2962,SUP,Custom 27203010,,AR-2962  -  GUIDE DRL DVTL ALGRF MNSCS,"$1,825.00",$0.00,"$1,825.00",$0.00,"$1,302.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,825.00",$0.00,$912.50,"$1,445.40","$1,460.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-3400H-4.5,SUP,Custom 27203010,,AR-3400H-4.5  -  CANNULA ASCP HIP LGTH TPR 4.5MM BLNT FENESTRATE QCK CNCT LCK,$869.55,$0.00,$869.55,$0.00,$620.60,$0.00,$0.00,$0.00,$0.00,$0.00,$869.55,$0.00,$434.78,$688.68,$695.64,$0.00,$0.00,$0.00,$0.00,$0.00
AR-3400H-5.0,SUP,Custom 27203010,,AR-3400H-5.0  -  CANNULA ASCP HIP LGTH TPR 5MM BLNT FENESTRATE QCK CNCT LCK,$869.55,$0.00,$869.55,$0.00,$620.60,$0.00,$0.00,$0.00,$0.00,$0.00,$869.55,$0.00,$434.78,$688.68,$695.64,$0.00,$0.00,$0.00,$0.00,$0.00
AR-3400H-5.5,SUP,Custom 27203010,,AR-3400H-5.5  -  CANNULA ASCP HIP LGTH TPR 5.5MM BLNT FENESTRATE QCK CNCT LCK,$869.55,$0.00,$869.55,$0.00,$620.60,$0.00,$0.00,$0.00,$0.00,$0.00,$869.55,$0.00,$434.78,$688.68,$695.64,$0.00,$0.00,$0.00,$0.00,$0.00
AR-3400H-6.5,SUP,Custom 27203010,,AR-3400H-6.5  -  CANNULA ASCP HIP LGTH TPR 6.5MM BLNT FENESTRATE QCK CNCT LCK,$869.55,$0.00,$869.55,$0.00,$620.60,$0.00,$0.00,$0.00,$0.00,$0.00,$869.55,$0.00,$434.78,$688.68,$695.64,$0.00,$0.00,$0.00,$0.00,$0.00
AR-3490HQC,SUP,Custom 27203010,,AR-3490HQC  -  CANNULA ASCP STD HIP LGTH HUB QCK CNCT,$670.73,$0.00,$670.73,$0.00,$478.70,$0.00,$0.00,$0.00,$0.00,$0.00,$670.73,$0.00,$335.36,$531.22,$536.58,$0.00,$0.00,$0.00,$0.00,$0.00
AR-3600-2,SUP,HCPCS C1713,,AR-3600-2  -  ANCHOR SUT 2 FIBERTAK FBRWR CLS EYLT,$850.00,$0.00,$850.00,$382.50,$606.65,$0.00,$146.45,$0.00,$0.00,$148.83,$850.00,$0.00,$425.00,$673.20,$680.00,$0.00,$133.03,$0.00,$135.32,$0.00
AR-3600D-1,SUP,Custom 27203010,,AR-3600D-1  -  DRILL SRG 1.6MM FIBERTAK,$262.50,$0.00,$262.50,$0.00,$187.35,$0.00,$0.00,$0.00,$0.00,$0.00,$262.50,$0.00,$131.25,$207.90,$210.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-3600DS,SUP,HCPCS C1713,,AR-3600DS  -  ANCHOR SUT STRL LF ARTHX FIBERTAK DRL SPR OBT DISP,"$1,300.00",$0.00,"$1,300.00",$585.00,$927.81,$0.00,$223.98,$0.00,$0.00,$227.62,"$1,300.00",$0.00,$650.00,"$1,029.60","$1,040.00",$0.00,$203.45,$0.00,$206.96,$0.00
AR-3600ND-3,SUP,Custom 27203010,,AR-3600ND-3  -  DRILL SRG 1.7MM FLXB FIBERTAK,$262.50,$0.00,$262.50,$0.00,$187.35,$0.00,$0.00,$0.00,$0.00,$0.00,$262.50,$0.00,$131.25,$207.90,$210.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-3601,SUP,HCPCS C1713,,"AR-3601  -  KNOTLESS FIBERTAK SUTURE ANCHOR, 1.5MM",$987.50,$0.00,$987.50,$444.38,$704.78,$0.00,$170.14,$0.00,$0.00,$172.90,$987.50,$0.00,$493.75,$782.10,$790.00,$0.00,$154.54,$0.00,$157.21,$0.00
AR-3602-2,SUP,HCPCS C1713,,AR-3602-2  -  ANCHOR SUT 1.3MM BLU WHT FIBERTAK SUTURETAPE 2 LD,$925.00,$0.00,$925.00,$416.25,$660.17,$0.00,$159.37,$0.00,$0.00,$161.96,$925.00,$0.00,$462.50,$732.60,$740.00,$0.00,$144.76,$0.00,$147.26,$0.00
AR-3603-2,SUP,HCPCS C1713,,AR-3603-2  -  ANCHOR SUT 2 FIBERTAK TGTL 2 LD,$850.00,$0.00,$850.00,$382.50,$606.65,$0.00,$146.45,$0.00,$0.00,$148.83,$850.00,$0.00,$425.00,$673.20,$680.00,$0.00,$133.03,$0.00,$135.32,$0.00
AR-3651T,SUP,HCPCS C1713,,AR-3651T  -  ANCHOR SUT 2 BLK GRN/WHT FIBERTAK TGTL LABRALTAPE 2 ROW,"$1,125.00",$0.00,"$1,125.00",$506.25,$802.91,$0.00,$193.83,$0.00,$0.00,$196.98,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$176.06,$0.00,$179.10,$0.00
AR-3651TT,SUP,HCPCS C1713,,AR-3651TT  -  ANCHOR SUT 2 BLK BLU WHT FIBERTAK TGTL LABRALTAPE 2 ROW,"$1,125.00",$0.00,"$1,125.00",$506.25,$802.91,$0.00,$193.83,$0.00,$0.00,$196.98,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$176.06,$0.00,$179.10,$0.00
AR-4007JS,SUP,Custom 27203010,,AR-4007JS  -  SET GFT PREP MNS DRT JSTK,"$1,300.00",$0.00,"$1,300.00",$0.00,$927.81,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,300.00",$0.00,$650.00,"$1,029.60","$1,040.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-4008,SUP,Custom 27203010,,AR-4008  -  PROBE ASCP STRL MNS DRT MSR DISP,$117.50,$0.00,$117.50,$0.00,$83.86,$0.00,$0.00,$0.00,$0.00,$0.00,$117.50,$0.00,$58.75,$93.06,$94.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-4045,SUP,Custom 27203010,,AR-4045  -  CANNULA ASCP STRL MNS DRT OBT DISP,$60.00,$0.00,$60.00,$0.00,$42.82,$0.00,$0.00,$0.00,$0.00,$0.00,$60.00,$0.00,$30.00,$47.52,$48.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-4065-45L,SUP,Custom 27203010,,AR-4065-45L  -  PASSER SUT 45D CRV LT STRL CRKSCR SUTLSO DISP ASCP,$325.00,$0.00,$325.00,$0.00,$231.95,$0.00,$0.00,$0.00,$0.00,$0.00,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-4065-45R,SUP,Custom 27203010,,AR-4065-45R  -  PASSER SUT 45D RT CRV STRL CRKSCR SUTLSO DISP ASCP,$325.00,$0.00,$325.00,$0.00,$231.95,$0.00,$0.00,$0.00,$0.00,$0.00,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-4065-90S,SUP,Custom 27203010,,AR-4065-90S  -  PASSER SUT 90D 2.3MM STRL SUTLSO NTNL ELB SHLDR DISP ASCP,$287.50,$0.00,$287.50,$0.00,$205.19,$0.00,$0.00,$0.00,$0.00,$0.00,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-4065-90W,SUP,Custom 27203010,,AR-4065-90W  -  PASSER SUT 90D 2.3MM STRL SUTLSO WRE LOOP NTNL ELB SHLDR,$325.00,$0.00,$325.00,$0.00,$231.95,$0.00,$0.00,$0.00,$0.00,$0.00,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-4065B,SUP,Custom 27203010,,AR-4065B  -  PASSER SUT UNV BNA 2.3MM STRL SUTLSO ROTR CUF NTNL DISP ASCP,$325.00,$0.00,$325.00,$0.00,$231.95,$0.00,$0.00,$0.00,$0.00,$0.00,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-4065H,SUP,HCPCS C1713,,AR-4065H  -  ANCHOR SUT 45D LASSO HIP,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-4065S,SUP,Custom 27203010,,AR-4065S  -  PASSER SUT 45D CRV STRL SUTLSO NTNL DISP ASCP,$287.50,$0.00,$287.50,$0.00,$205.19,$0.00,$0.00,$0.00,$0.00,$0.00,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-4065W,SUP,Custom 27203010,,AR-4065W  -  PASSER SUT 45D 2.3MM STRL SUTLSO WRE LOOP NTNL DISP ASCP,$325.00,$0.00,$325.00,$0.00,$231.95,$0.00,$0.00,$0.00,$0.00,$0.00,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-4068-05SD,SUP,Custom 27203010,,AR-4068-05SD  -  PASSER SUT 1.8MM 3.8MM STRL SUTLSO SD WIRELOOP NTNL ASCP,$70.00,$0.00,$70.00,$0.00,$49.96,$0.00,$0.00,$0.00,$0.00,$0.00,$70.00,$0.00,$35.00,$55.44,$56.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-4068-25TL,SUP,Custom 27203010,,AR-4068-25TL  -  PASSER SUTURE 25D TIGHT LEFT CURVE 1.8MM 3.8MM SUTURELASSO,$350.00,$0.00,$350.00,$0.00,$249.80,$0.00,$0.00,$0.00,$0.00,$0.00,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-4068-25TLF,SUP,Custom 27203010,,AR-4068-25TLF  -  PASSER SUT 25D TIGHT LT CRV 1.8MM 3.8MM STRL SUTLSO SD,$445.00,$0.00,$445.00,$0.00,$317.60,$0.00,$0.00,$0.00,$0.00,$0.00,$445.00,$0.00,$222.50,$352.44,$356.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-4068-25TR,SUP,Custom 27203010,,AR-4068-25TR  -  PASSER SUT 25D TIGHT RT CRV 1.8MM 3.8MM STRL SUTLSO SD THB,$350.00,$0.00,$350.00,$0.00,$249.80,$0.00,$0.00,$0.00,$0.00,$0.00,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-4068-25TRF,SUP,Custom 27203010,,AR-4068-25TRF  -  PASSER SUT 25D TIGHT RT CRV 1.8MM 3.8MM STRL SUTLSO SD,$445.00,$0.00,$445.00,$0.00,$317.60,$0.00,$0.00,$0.00,$0.00,$0.00,$445.00,$0.00,$222.50,$352.44,$356.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-4068-30,SUP,Custom 27203010,,AR-4068-30  -  PASSER SUT 30D STRG 1.8MM 3.8MM STRL SUTLSO SD THB PD NTNL,$350.00,$0.00,$350.00,$0.00,$249.80,$0.00,$0.00,$0.00,$0.00,$0.00,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-4068-45L,SUP,Custom 27203010,,AR-4068-45L  -  PASSER SUTURE 45D LEFT CURVE 1.8MM 3.8MM THUMB PAD,$350.00,$0.00,$350.00,$0.00,$249.80,$0.00,$0.00,$0.00,$0.00,$0.00,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-4068-45LH,SUP,Custom 27203010,,AR-4068-45LH  -  PASSER SUT 45D LT CRV STRL SUTLSO DISP HIP ASCP,$412.50,$0.00,$412.50,$0.00,$294.40,$0.00,$0.00,$0.00,$0.00,$0.00,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-4068-45R,SUP,Custom 27203010,,AR-4068-45R  -  PASSER SUTURE 45D RIGHT CURVE 1.8MM 3.8MM THUMB PAD,$350.00,$0.00,$350.00,$0.00,$249.80,$0.00,$0.00,$0.00,$0.00,$0.00,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-4068-45RH,SUP,Custom 27203010,,AR-4068-45RH  -  PASSER SUT 45D RT CRV STRL SUTLSO DISP HIP ASCP,$412.50,$0.00,$412.50,$0.00,$294.40,$0.00,$0.00,$0.00,$0.00,$0.00,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-4068-90,SUP,Custom 27203010,,AR-4068-90  -  PASSER SUTURE 90D UP STR 1.8MM 3.8MM THUMB PAD SUTURELASSO,$350.00,$0.00,$350.00,$0.00,$249.80,$0.00,$0.00,$0.00,$0.00,$0.00,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-4068-90H,SUP,Custom 27203010,,AR-4068-90H  -  PASSER SUT 90D STRG STRL SUTLSO DISP HIP ASCP,$412.50,$0.00,$412.50,$0.00,$294.40,$0.00,$0.00,$0.00,$0.00,$0.00,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-4068-90L,SUP,Custom 27203010,,AR-4068-90L  -  PASSER SUTURE 90D LEFT CURVE 1.8MM 3.8MM THUMB PAD,$350.00,$0.00,$350.00,$0.00,$249.80,$0.00,$0.00,$0.00,$0.00,$0.00,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-4068-90R,SUP,Custom 27203010,,AR-4068-90R  -  PASSER SUTURE 90D RIGHT CURVE 1.8MM 3.8MM THUMB PAD,$350.00,$0.00,$350.00,$0.00,$249.80,$0.00,$0.00,$0.00,$0.00,$0.00,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-4068C,SUP,Custom 27203010,,AR-4068C  -  PASSER SUTURE SMALL CRESCENT 1.8MM 3.8MM THUMB PAD,$350.00,$0.00,$350.00,$0.00,$249.80,$0.00,$0.00,$0.00,$0.00,$0.00,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-4068CH,SUP,Custom 27203010,,AR-4068CH  -  PASSER SUT CRSNT STRL SUTLSO DISP HIP ASCP,$412.50,$0.00,$412.50,$0.00,$294.40,$0.00,$0.00,$0.00,$0.00,$0.00,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-4070-01,SUP,Custom 27203010,,AR-4070-01  -  PROBE ASCP 60D 220MM MSR,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-4070-70S,SUP,Custom 27203010,,AR-4070-70S  -  PROBE ASCP 70D STRL MSR MP KN DISP,$395.00,$0.00,$395.00,$0.00,$281.91,$0.00,$0.00,$0.00,$0.00,$0.00,$395.00,$0.00,$197.50,$312.84,$316.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-4151B,SUP,HCPCS C1713,,AR-4151B  -  PIN DRL 1.5MM 100MM STRL TRMIT DISP,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
AR-4151DS,SUP,HCPCS C1713,,AR-4151DS  -  KIT INST 1.5MM 100MM STRL TRMIT DRL PIN KRSH BN TAMP GD SLV,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,$0.00,$0.00,$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
AR-4152B,SUP,HCPCS C1713,,AR-4152B  -  PIN DRL 2MM 100MM STRL TRMIT DISP,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
AR-4152DS,SUP,HCPCS C1713,,AR-4152DS  -  KIT INST 2MM 100MM STRL TRMIT DRL PIN KRSH BN TAMP GD SLV,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,$0.00,$0.00,$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
AR-4152MS,SUP,HCPCS C1713,,AR-4152MS  -  PIN DRL 2MM 100MM STRL TRMIT,"$1,875.00",$0.00,"$1,875.00",$843.75,"$1,338.19",$0.00,$323.05,$0.00,$0.00,$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
AR-4154P-3010,SUP,HCPCS C1713,,AR-4154P-3010  -  KIT TRMA FX 10D 2.5MM 30MM STRL PIP DART RDLCNT INSRTR DRL,"$1,487.50",$0.00,"$1,487.50",$669.38,"$1,061.63",$0.00,$256.29,$0.00,$0.00,$260.45,"$1,487.50",$0.00,$743.75,"$1,178.10","$1,190.00",$0.00,$232.79,$0.00,$236.81,$0.00
AR-4154PS-3000,SUP,HCPCS C1713,,AR-4154PS-3000  -  KIT TRMA FX STRG 2.5MM 30MM STRL PIP DART INSRTR DRL GW TROC,"$1,487.50",$0.00,"$1,487.50",$669.38,"$1,061.63",$0.00,$256.29,$0.00,$0.00,$260.45,"$1,487.50",$0.00,$743.75,"$1,178.10","$1,190.00",$0.00,$232.79,$0.00,$236.81,$0.00
AR-4154PS-3010,SUP,HCPCS C1713,,AR-4154PS-3010  -  KIT TRMA FX 10D 2.5MM 30MM STRL PIP DART INSRTR DRL GW BRB,"$1,487.50",$0.00,"$1,487.50",$669.38,"$1,061.63",$0.00,$256.29,$0.00,$0.00,$260.45,"$1,487.50",$0.00,$743.75,"$1,178.10","$1,190.00",$0.00,$232.79,$0.00,$236.81,$0.00
AR-4155P-3010,SUP,HCPCS C1713,,AR-4155P-3010  -  KIT TRMA FX 10D 3MM 30MM STRL PIP DART RDLCNT INSRTR DRL GW,"$1,487.50",$0.00,"$1,487.50",$669.38,"$1,061.63",$0.00,$256.29,$0.00,$0.00,$260.45,"$1,487.50",$0.00,$743.75,"$1,178.10","$1,190.00",$0.00,$232.79,$0.00,$236.81,$0.00
AR-4155PS-3010,SUP,HCPCS C1713,,AR-4155PS-3010  -  KIT TRMA FX 10D 3MM 30MM STRL PIP DART INSRTR DRL GW TROC,"$1,487.50",$0.00,"$1,487.50",$669.38,"$1,061.63",$0.00,$256.29,$0.00,$0.00,$260.45,"$1,487.50",$0.00,$743.75,"$1,178.10","$1,190.00",$0.00,$232.79,$0.00,$236.81,$0.00
AR-4156DS,SUP,HCPCS C1713,,AR-4156DS  -  KIT INST 2MM 100MM STRL TRMIT DRL PIN KRSH BN TAMP GD SLV,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,$0.00,$0.00,$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
AR-4160-20,SUP,Custom 27203010,,AR-4160-20  -  BIT DRL 2MM TRMIT,$197.50,$0.00,$197.50,$0.00,$140.96,$0.00,$0.00,$0.00,$0.00,$0.00,$197.50,$0.00,$98.75,$156.42,$158.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-4160-24,SUP,Custom 27203010,,AR-4160-24  -  BIT DRL 2.4MM TRMIT,$197.50,$0.00,$197.50,$0.00,$140.96,$0.00,$0.00,$0.00,$0.00,$0.00,$197.50,$0.00,$98.75,$156.42,$158.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-4160-25,SUP,Custom 27203010,,AR-4160-25  -  BIT DRL 2.5MM TRMIT,$197.50,$0.00,$197.50,$0.00,$140.96,$0.00,$0.00,$0.00,$0.00,$0.00,$197.50,$0.00,$98.75,$156.42,$158.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-4160-26,SUP,Custom 27203010,,AR-4160-26  -  BIT DRL 2.6MM TRMIT,$197.50,$0.00,$197.50,$0.00,$140.96,$0.00,$0.00,$0.00,$0.00,$0.00,$197.50,$0.00,$98.75,$156.42,$158.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-4160-27,SUP,Custom 27203010,,AR-4160-27  -  BIT DRL 2.7MM TRMIT,$197.50,$0.00,$197.50,$0.00,$140.96,$0.00,$0.00,$0.00,$0.00,$0.00,$197.50,$0.00,$98.75,$156.42,$158.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-4160-34,SUP,Custom 27203010,,AR-4160-34  -  BIT DRL 3.4MM TRMIT,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-4160-35,SUP,Custom 27203010,,AR-4160-35  -  BIT DRL 3.5MM TRMIT,$197.50,$0.00,$197.50,$0.00,$140.96,$0.00,$0.00,$0.00,$0.00,$0.00,$197.50,$0.00,$98.75,$156.42,$158.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-4160-40,SUP,Custom 27203010,,AR-4160-40  -  BIT DRL 4MM TRMIT,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-4160-45,SUP,Custom 27203010,,AR-4160-45  -  BIT DRL 4.5MM TRMIT,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-4161,SUP,Custom 27203010,,AR-4161  -  DRILL BIT CNTRSNK 2.7MM TRMIT,$362.50,$0.00,$362.50,$0.00,$258.72,$0.00,$0.00,$0.00,$0.00,$0.00,$362.50,$0.00,$181.25,$287.10,$290.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-4161B,SUP,HCPCS C1713,,AR-4161B  -  SCREW INTFR HEX 2.7MM 30MM STRL TRMIT CNN POLY L LAC ACD ACL,$482.50,$0.00,$482.50,$217.13,$344.36,$0.00,$83.13,$0.00,$0.00,$84.48,$482.50,$0.00,$241.25,$382.14,$386.00,$0.00,$75.51,$0.00,$76.81,$0.00
AR-4161G,SUP,Custom 27203010,,AR-4161G  -  GUIDE DRL 2MM 2.7MM TRMIT,$400.00,$0.00,$400.00,$0.00,$285.48,$0.00,$0.00,$0.00,$0.00,$0.00,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-4162B,SUP,HCPCS C1713,,AR-4162B  -  SCREW INTFR HEX 3.5MM 40MM STRL TRMIT CNN POLY L LAC ACD ACL,$525.00,$0.00,$525.00,$236.25,$374.69,$0.00,$90.45,$0.00,$0.00,$91.92,$525.00,$0.00,$262.50,$415.80,$420.00,$0.00,$82.16,$0.00,$83.58,$0.00
AR-4163,SUP,Custom 27203010,,AR-4163  -  DRILL BIT CNTRSNK 4MM,$362.50,$0.00,$362.50,$0.00,$258.72,$0.00,$0.00,$0.00,$0.00,$0.00,$362.50,$0.00,$181.25,$287.10,$290.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-4163B,SUP,HCPCS C1713,,AR-4163B  -  SCREW INTFR HEX 4MM 50MM STRL TRMIT CNN POLY L LAC ACD ACL,$525.00,$0.00,$525.00,$236.25,$374.69,$0.00,$90.45,$0.00,$0.00,$91.92,$525.00,$0.00,$262.50,$415.80,$420.00,$0.00,$82.16,$0.00,$83.58,$0.00
AR-4163G,SUP,Custom 27203010,,AR-4163G  -  GUIDE DRL 2.4MM 4MM TRMIT,$400.00,$0.00,$400.00,$0.00,$285.48,$0.00,$0.00,$0.00,$0.00,$0.00,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-4164,SUP,Custom 27203010,,AR-4164  -  DRILL BIT CNTRSNK 4.5MM,$362.50,$0.00,$362.50,$0.00,$258.72,$0.00,$0.00,$0.00,$0.00,$0.00,$362.50,$0.00,$181.25,$287.10,$290.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-4164B,SUP,HCPCS C1713,,AR-4164B  -  SCREW INTFR FT HEX 4.5MM 60MM STRL TRMIT CNN POLY L LAC ACD,$775.00,$0.00,$775.00,$348.75,$553.12,$0.00,$133.53,$0.00,$0.00,$135.70,$775.00,$0.00,$387.50,$613.80,$620.00,$0.00,$121.29,$0.00,$123.38,$0.00
AR-4164G,SUP,Custom 27203010,,AR-4164G  -  GUIDE DRL 3.4MM 4.5MM TRMIT,"$1,000.00",$0.00,"$1,000.00",$0.00,$713.70,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,000.00",$0.00,$500.00,$792.00,$800.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-4207-12,SUP,Custom 27203010,,AR-4207-12  -  COMPONENT SUBTALAR CNCV 7MM 12MM STRL PROSTOP BABSR TI POLY,"$2,737.50",$0.00,"$2,737.50",$0.00,"$1,953.75",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,737.50",$0.00,"$1,368.75","$2,168.10","$2,190.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-4208-14,SUP,Custom 27203010,,AR-4208-14  -  COMPONENT SUBTALAR CNCV 8MM 14MM STRL PROSTOP BABSR TI POLY,"$2,737.50",$0.00,"$2,737.50",$0.00,"$1,953.75",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,737.50",$0.00,"$1,368.75","$2,168.10","$2,190.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-4208B-14,SUP,Custom 27203010,,AR-4208B-14  -  COMPONENT SUBTALAR CNCV 8MM 14MM STRL PROSTOP + BABSR TI,"$3,237.50",$0.00,"$3,237.50",$0.00,"$2,310.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,237.50",$0.00,"$1,618.75","$2,564.10","$2,590.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-4209-14,SUP,Custom 27203010,,AR-4209-14  -  COMPONENT SUBTALAR CNCV 9MM 14MM STRL PROSTOP BABSR TI POLY,"$2,737.50",$0.00,"$2,737.50",$0.00,"$1,953.75",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,737.50",$0.00,"$1,368.75","$2,168.10","$2,190.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-4209B-14,SUP,Custom 27203010,,AR-4209B-14  -  COMPONENT SUBTALAR CNCV 9MM 14MM STRL PROSTOP + BABSR TI,"$3,237.50",$0.00,"$3,237.50",$0.00,"$2,310.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,237.50",$0.00,"$1,618.75","$2,564.10","$2,590.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-4210-14,SUP,Custom 27203010,,AR-4210-14  -  COMPONENT SUBTALAR CNCV 10MM 14MM STRL PROSTOP BABSR TI POLY,"$2,737.50",$0.00,"$2,737.50",$0.00,"$1,953.75",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,737.50",$0.00,"$1,368.75","$2,168.10","$2,190.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-4210B-14,SUP,Custom 27203010,,AR-4210B-14  -  COMPONENT SUBTALAR CNCV 10MM 14MM STRL PROSTOP + BABSR TI,"$3,237.50",$0.00,"$3,237.50",$0.00,"$2,310.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,237.50",$0.00,"$1,618.75","$2,564.10","$2,590.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-4211-16,SUP,Custom 27203010,,AR-4211-16  -  COMPONENT SUBTALAR CNCV 11MM 16MM STRL PROSTOP BABSR TI POLY,"$2,737.50",$0.00,"$2,737.50",$0.00,"$1,953.75",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,737.50",$0.00,"$1,368.75","$2,168.10","$2,190.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-4211B-16,SUP,Custom 27203010,,AR-4211B-16  -  COMPONENT SUBTALAR CNCV 11MM 16MM STRL PROSTOP + BABSR TI,"$3,237.50",$0.00,"$3,237.50",$0.00,"$2,310.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,237.50",$0.00,"$1,618.75","$2,564.10","$2,590.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-4212-16,SUP,Custom 27203010,,AR-4212-16  -  COMPONENT SUBTALAR CNCV 12MM 16MM STRL PROSTOP BABSR TI POLY,"$2,737.50",$0.00,"$2,737.50",$0.00,"$1,953.75",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,737.50",$0.00,"$1,368.75","$2,168.10","$2,190.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-4212B-16,SUP,Custom 27203010,,AR-4212B-16  -  COMPONENT SUBTALAR CNCV 12MM 16MM STRL PROSTOP + BABSR TI,"$3,237.50",$0.00,"$3,237.50",$0.00,"$2,310.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,237.50",$0.00,"$1,618.75","$2,564.10","$2,590.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-4502,SUP,HCPCS C1713,,AR-4502  -  NEEDLE SUT 2-0 CRV SPEEDCINCH FBRWR PEEK,$987.50,$0.00,$987.50,$444.38,$704.78,$0.00,$170.14,$0.00,$0.00,$172.90,$987.50,$0.00,$493.75,$782.10,$790.00,$0.00,$154.54,$0.00,$157.21,$0.00
AR-4515,SUP,Custom 27203010,,AR-4515  -  CUTTER SUTURE REMOVAL KNOT PUSHER MENISCAL CINCH STERILE,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-4520,SUP,Custom 27203010,,AR-4520  -  CUTTER SUT REM TGHTRP RECON SUT ACL ASCP,$395.00,$0.00,$395.00,$0.00,$281.91,$0.00,$0.00,$0.00,$0.00,$0.00,$395.00,$0.00,$197.50,$312.84,$316.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-5010AB,SUP,HCPCS C1713,,AR-5010AB  -  SCREW INTFR 50D 10MM 17MM STRL BCRTCL BCK END FLSH POLY L,$355.00,$0.00,$355.00,$159.75,$253.36,$0.00,$61.16,$0.00,$0.00,$62.16,$355.00,$0.00,$177.50,$281.16,$284.00,$0.00,$55.56,$0.00,$56.52,$0.00
AR-5010BB,SUP,HCPCS C1713,,AR-5010BB  -  SCREW INTFR 10MM 20MM STRL BCRTCL BCK END FLSH POLY L LAC,$355.00,$0.00,$355.00,$159.75,$253.36,$0.00,$61.16,$0.00,$0.00,$62.16,$355.00,$0.00,$177.50,$281.16,$284.00,$0.00,$55.56,$0.00,$56.52,$0.00
AR-5011AB,SUP,HCPCS C1713,,AR-5011AB  -  SCREW INTFR 50D 11MM 17MM STRL BCRTCL BCK END FLSH POLY L,$355.00,$0.00,$355.00,$159.75,$253.36,$0.00,$61.16,$0.00,$0.00,$62.16,$355.00,$0.00,$177.50,$281.16,$284.00,$0.00,$55.56,$0.00,$56.52,$0.00
AR-501-TBA0,SUP,HCPCS C1713,,AR-501-TBA0  -  BEARING TIB 1 10MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
AR-501-TBA1,SUP,HCPCS C1713,,AR-501-TBA1  -  BEARING TIB 1 11MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
AR-501-TBA2,SUP,HCPCS C1713,,AR-501-TBA2  -  BEARING TIB 1 12MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
AR-501-TBA4,SUP,HCPCS C1713,,AR-501-TBA4  -  BEARING TIB 1 14MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
AR-501-TBA8,SUP,HCPCS C1713,,AR-501-TBA8  -  BEARING TIB 1 8MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
AR-501-TBA9,SUP,HCPCS C1713,,AR-501-TBA9  -  BEARING TIB 1 9MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
AR-501-TBB0,SUP,HCPCS C1713,,AR-501-TBB0  -  BEARING TIB 2 10MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
AR-501-TBB1,SUP,HCPCS C1713,,AR-501-TBB1  -  BEARING TIB 2 11MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
AR-501-TBB2,SUP,HCPCS C1713,,AR-501-TBB2  -  BEARING TIB 2 12MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
AR-501-TBB4,SUP,HCPCS C1713,,AR-501-TBB4  -  BEARING TIB 2 14MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
AR-501-TBB8,SUP,HCPCS C1713,,AR-501-TBB8  -  BEARING TIB 2 8MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
AR-501-TBB9,SUP,HCPCS C1713,,AR-501-TBB9  -  BEARING TIB 2 9MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
AR-501-TBC0,SUP,HCPCS C1713,,AR-501-TBC0  -  BEARING TIB 3 10MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
AR-501-TBC1,SUP,HCPCS C1713,,AR-501-TBC1  -  BEARING TIB 3 11MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
AR-501-TBC2,SUP,HCPCS C1713,,AR-501-TBC2  -  BEARING TIB 3 12MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
AR-501-TBC4,SUP,HCPCS C1713,,AR-501-TBC4  -  BEARING TIB 3 14MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
AR-501-TBC8,SUP,HCPCS C1713,,AR-501-TBC8  -  BEARING TIB 3 8MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
AR-501-TBC9,SUP,HCPCS C1713,,AR-501-TBC9  -  BEARING TIB 3 9MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
AR-501-TBD0,SUP,HCPCS C1713,,AR-501-TBD0  -  BEARING TIB 4 10MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
AR-501-TBD1,SUP,HCPCS C1713,,AR-501-TBD1  -  BEARING TIB 4 11MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
AR-501-TBD2,SUP,HCPCS C1713,,AR-501-TBD2  -  BEARING TIB 4 12MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
AR-501-TBD4,SUP,HCPCS C1713,,AR-501-TBD4  -  BEARING TIB 4 14MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
AR-501-TBD8,SUP,HCPCS C1713,,AR-501-TBD8  -  BEARING TIB 4 8MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
AR-501-TBD9,SUP,HCPCS C1713,,AR-501-TBD9  -  BEARING TIB D 9MM UNCMP,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
AR-501-TBE0,SUP,HCPCS C1713,,AR-501-TBE0  -  BEARING TIB 5 10MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
AR-501-TBE1,SUP,HCPCS C1713,,AR-501-TBE1  -  BEARING TIB 5 11MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
AR-501-TBE2,SUP,HCPCS C1713,,AR-501-TBE2  -  BEARING TIB 5 12MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
AR-501-TBE4,SUP,HCPCS C1713,,AR-501-TBE4  -  BEARING TIB 5 14MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
AR-501-TBE8,SUP,HCPCS C1713,,AR-501-TBE8  -  BEARING TIB 5 8MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
AR-501-TBE9,SUP,HCPCS C1713,,AR-501-TBE9  -  BEARING TIB 5 9MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
AR-501-TBF0,SUP,HCPCS C1713,,AR-501-TBF0  -  BEARING TIB 6 10MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
AR-501-TBF1,SUP,HCPCS C1713,,AR-501-TBF1  -  BEARING TIB 6 11MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
AR-501-TBF2,SUP,HCPCS C1713,,AR-501-TBF2  -  BEARING TIB 6 12MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
AR-501-TBF4,SUP,HCPCS C1713,,AR-501-TBF4  -  BEARING TIB 6 14MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
AR-501-TBF8,SUP,HCPCS C1713,,AR-501-TBF8  -  BEARING TIB 6 8MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
AR-501-TBF9,SUP,HCPCS C1713,,AR-501-TBF9  -  BEARING TIB 6 9MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
AR-501-TTLA,SUP,Custom 27203010,,AR-501-TTLA  -  TRAY TIB 1 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL LT MDL,"$4,500.00",$0.00,"$4,500.00",$0.00,"$3,211.65",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,500.00",$0.00,"$2,250.00","$3,564.00","$3,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-501-TTLB,SUP,Custom 27203010,,AR-501-TTLB  -  TRAY TIB 2 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL LT MDL,"$4,500.00",$0.00,"$4,500.00",$0.00,"$3,211.65",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,500.00",$0.00,"$2,250.00","$3,564.00","$3,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-501-TTLC,SUP,Custom 27203010,,AR-501-TTLC  -  TRAY TIB 3 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL LT MDL,"$4,500.00",$0.00,"$4,500.00",$0.00,"$3,211.65",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,500.00",$0.00,"$2,250.00","$3,564.00","$3,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-501-TTLD,SUP,HCPCS C1776,,AR-501-TTLD  -  COMPONENT TIBTRY D UNCMP LT,"$4,500.00",$0.00,"$4,500.00","$2,025.00","$3,211.65",$0.00,$775.33,$0.00,$0.00,$787.91,"$4,500.00",$0.00,"$2,250.00","$3,564.00","$3,600.00",$0.00,$704.25,$0.00,$716.40,$0.00
AR-501-TTLE,SUP,Custom 27203010,,AR-501-TTLE  -  TRAY TIB 5 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL LT MDL,"$4,500.00",$0.00,"$4,500.00",$0.00,"$3,211.65",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,500.00",$0.00,"$2,250.00","$3,564.00","$3,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-501-TTLF,SUP,Custom 27203010,,AR-501-TTLF  -  TRAY TIB 6 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL LT MDL,"$4,500.00",$0.00,"$4,500.00",$0.00,"$3,211.65",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,500.00",$0.00,"$2,250.00","$3,564.00","$3,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-501-TTRA,SUP,Custom 27203010,,AR-501-TTRA  -  TRAY TIB 1 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL RT MDL,"$4,500.00",$0.00,"$4,500.00",$0.00,"$3,211.65",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,500.00",$0.00,"$2,250.00","$3,564.00","$3,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-501-TTRB,SUP,Custom 27203010,,AR-501-TTRB  -  TRAY TIB 2 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL RT MDL,"$4,500.00",$0.00,"$4,500.00",$0.00,"$3,211.65",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,500.00",$0.00,"$2,250.00","$3,564.00","$3,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-501-TTRC,SUP,Custom 27203010,,AR-501-TTRC  -  TRAY TIB 3 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL RT MDL,"$4,500.00",$0.00,"$4,500.00",$0.00,"$3,211.65",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,500.00",$0.00,"$2,250.00","$3,564.00","$3,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-501-TTRD,SUP,Custom 27203010,,AR-501-TTRD  -  TRAY TIB 4 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL RT MDL,"$4,500.00",$0.00,"$4,500.00",$0.00,"$3,211.65",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,500.00",$0.00,"$2,250.00","$3,564.00","$3,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-501-TTRE,SUP,Custom 27203010,,AR-501-TTRE  -  TRAY TIB 5 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL RT MDL,"$4,500.00",$0.00,"$4,500.00",$0.00,"$3,211.65",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,500.00",$0.00,"$2,250.00","$3,564.00","$3,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-501-TTRF,SUP,Custom 27203010,,AR-501-TTRF  -  TRAY TIB 6 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL RT MDL,"$4,500.00",$0.00,"$4,500.00",$0.00,"$3,211.65",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,500.00",$0.00,"$2,250.00","$3,564.00","$3,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-501-UFLA,SUP,HCPCS C1776,,AR-501-UFLA  -  COMPONENT FEM 1 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL LT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
AR-501-UFLB,SUP,HCPCS C1776,,AR-501-UFLB  -  COMPONENT FEM 2 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL LT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
AR-501-UFLC,SUP,HCPCS C1776,,AR-501-UFLC  -  COMPONENT FEM 3 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL LT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
AR-501-UFLD,SUP,HCPCS C1776,,AR-501-UFLD  -  COMPONENT FEM 4 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL LT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
AR-501-UFLE,SUP,HCPCS C1776,,AR-501-UFLE  -  COMPONENT FEM E KN LT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
AR-501-UFLF,SUP,HCPCS C1776,,AR-501-UFLF  -  COMPONENT FEM 6 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL LT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
AR-501-UFRA,SUP,HCPCS C1776,,AR-501-UFRA  -  COMPONENT FEM 1 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL RT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
AR-501-UFRB,SUP,HCPCS C1776,,AR-501-UFRB  -  COMPONENT FEM 2 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL RT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
AR-501-UFRC,SUP,HCPCS C1776,,AR-501-UFRC  -  COMPONENT FEM 3 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL RT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
AR-501-UFRD,SUP,HCPCS C1776,,AR-501-UFRD  -  COMPONENT FEM 4 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL RT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
AR-501-UFRE,SUP,HCPCS C1776,,AR-501-UFRE  -  COMPONENT FEM 5 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL RT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
AR-501-UFRF,SUP,HCPCS C1776,,AR-501-UFRF  -  COMPONENT FEM 6 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL RT,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
AR-502-1L,SUP,HCPCS C1776,,AR-502-1L  -  COMPONENT FEM 1 IBALANCE PTLFEM LT,"$11,900.00",$0.00,"$11,900.00","$5,355.00","$5,158.80",$0.00,"$2,050.31",$0.00,$0.00,"$2,083.59","$11,900.00",$0.00,"$5,950.00","$9,424.80","$9,520.00",$0.00,"$1,862.35",$0.00,"$1,894.48",$0.00
AR-502-1R,SUP,HCPCS C1776,,AR-502-1R  -  COMPONENT FEM 1 IBALANCE PTLFEM RT,"$11,900.00",$0.00,"$11,900.00","$5,355.00","$5,158.80",$0.00,"$2,050.31",$0.00,$0.00,"$2,083.59","$11,900.00",$0.00,"$5,950.00","$9,424.80","$9,520.00",$0.00,"$1,862.35",$0.00,"$1,894.48",$0.00
AR-502-2L,SUP,HCPCS C1776,,AR-502-2L  -  COMPONENT FEM 2 IBALANCE PTLFEM LT,"$11,900.00",$0.00,"$11,900.00","$5,355.00","$5,158.80",$0.00,"$2,050.31",$0.00,$0.00,"$2,083.59","$11,900.00",$0.00,"$5,950.00","$9,424.80","$9,520.00",$0.00,"$1,862.35",$0.00,"$1,894.48",$0.00
AR-502-2R,SUP,HCPCS C1776,,AR-502-2R  -  COMPONENT FEM 2 IBALANCE PTLFEM RT,"$11,900.00",$0.00,"$11,900.00","$5,355.00","$5,158.80",$0.00,"$2,050.31",$0.00,$0.00,"$2,083.59","$11,900.00",$0.00,"$5,950.00","$9,424.80","$9,520.00",$0.00,"$1,862.35",$0.00,"$1,894.48",$0.00
AR-502-3L,SUP,HCPCS C1776,,AR-502-3L  -  COMPONENT FEM 3 IBALANCE PTLFEM LT,"$11,900.00",$0.00,"$11,900.00","$5,355.00","$5,158.80",$0.00,"$2,050.31",$0.00,$0.00,"$2,083.59","$11,900.00",$0.00,"$5,950.00","$9,424.80","$9,520.00",$0.00,"$1,862.35",$0.00,"$1,894.48",$0.00
AR-502-3R,SUP,HCPCS C1776,,AR-502-3R  -  COMPONENT FEM 3 IBALANCE PTLFEM RT,"$11,900.00",$0.00,"$11,900.00","$5,355.00","$5,158.80",$0.00,"$2,050.31",$0.00,$0.00,"$2,083.59","$11,900.00",$0.00,"$5,950.00","$9,424.80","$9,520.00",$0.00,"$1,862.35",$0.00,"$1,894.48",$0.00
AR-502-4L,SUP,HCPCS C1776,,AR-502-4L  -  COMPONENT FEM 4 IBALANCE PTLFEM LT,"$11,900.00",$0.00,"$11,900.00","$5,355.00","$5,158.80",$0.00,"$2,050.31",$0.00,$0.00,"$2,083.59","$11,900.00",$0.00,"$5,950.00","$9,424.80","$9,520.00",$0.00,"$1,862.35",$0.00,"$1,894.48",$0.00
AR-502-4R,SUP,HCPCS C1776,,AR-502-4R  -  COMPONENT FEM 4 IBALANCE PTLFEM RT,"$11,900.00",$0.00,"$11,900.00","$5,355.00","$5,158.80",$0.00,"$2,050.31",$0.00,$0.00,"$2,083.59","$11,900.00",$0.00,"$5,950.00","$9,424.80","$9,520.00",$0.00,"$1,862.35",$0.00,"$1,894.48",$0.00
AR-5024TDA,SUP,Custom 27203010,,AR-5024TDA  -  BIT DRL CMPR SCR TPR ASCP,$875.00,$0.00,$875.00,$0.00,$624.49,$0.00,$0.00,$0.00,$0.00,$0.00,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-5024TDP,SUP,Custom 27203010,,AR-5024TDP  -  BIT DRL CMPR SCR TPR PERC,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-5025B-16,SUP,HCPCS C1713,,AR-5025B-16  -  SCREW INTFR TPR 3-3.7MM 16MM STRL BIO-CMPR SCR CNN SLF CMPR,$987.50,$0.00,$987.50,$444.38,$704.78,$0.00,$170.14,$0.00,$0.00,$172.90,$987.50,$0.00,$493.75,$782.10,$790.00,$0.00,$154.54,$0.00,$157.21,$0.00
AR-5025B-18,SUP,HCPCS C1713,,AR-5025B-18  -  SCREW INTFR TPR 3-3.7MM 18MM STRL BIO-CMPR SCR CNN SLF CMPR,$987.50,$0.00,$987.50,$444.38,$704.78,$0.00,$170.14,$0.00,$0.00,$172.90,$987.50,$0.00,$493.75,$782.10,$790.00,$0.00,$154.54,$0.00,$157.21,$0.00
AR-5025B-20,SUP,HCPCS C1713,,AR-5025B-20  -  SCREW INTFR TPR 2.7-3.7MM 20MM STRL BIO-CMPR SCR CNN SLF,$987.50,$0.00,$987.50,$444.38,$704.78,$0.00,$170.14,$0.00,$0.00,$172.90,$987.50,$0.00,$493.75,$782.10,$790.00,$0.00,$154.54,$0.00,$157.21,$0.00
AR-5025B-22,SUP,HCPCS C1713,,AR-5025B-22  -  SCREW INTFR TPR 3-3.7MM 22MM STRL BIO-CMPR SCR CNN SLF CMPR,$987.50,$0.00,$987.50,$444.38,$704.78,$0.00,$170.14,$0.00,$0.00,$172.90,$987.50,$0.00,$493.75,$782.10,$790.00,$0.00,$154.54,$0.00,$157.21,$0.00
AR-5025B-24,SUP,HCPCS C1713,,AR-5025B-24  -  SCREW INTFR TPR 3-3.7MM 24MM STRL BIO-CMPR SCR CNN SLF CMPR,$987.50,$0.00,$987.50,$444.38,$704.78,$0.00,$170.14,$0.00,$0.00,$172.90,$987.50,$0.00,$493.75,$782.10,$790.00,$0.00,$154.54,$0.00,$157.21,$0.00
AR-5025B-26,SUP,HCPCS C1713,,AR-5025B-26  -  SCREW INTFR TPR 3-3.7MM 26MM STRL BIO-CMPR SCR CNN SLF CMPR,$987.50,$0.00,$987.50,$444.38,$704.78,$0.00,$170.14,$0.00,$0.00,$172.90,$987.50,$0.00,$493.75,$782.10,$790.00,$0.00,$154.54,$0.00,$157.21,$0.00
AR-5025ETDC-26,SUP,Custom 27203010,,AR-5025ETDC-26  -  BIT DRL 26MM CNN BIO-CMPR SCR,$450.00,$0.00,$450.00,$0.00,$321.17,$0.00,$0.00,$0.00,$0.00,$0.00,$450.00,$0.00,$225.00,$356.40,$360.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-5025TD,SUP,Custom 27203010,,AR-5025TD  -  BIT DRL 2.7MM 20MM CNN BIO-CMPR SCR,$237.50,$0.00,$237.50,$0.00,$169.50,$0.00,$0.00,$0.00,$0.00,$0.00,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-5025TDC,SUP,Custom 27203010,,AR-5025TDC  -  BIT DRL CNN BIO-CMPR SCR,$350.00,$0.00,$350.00,$0.00,$249.80,$0.00,$0.00,$0.00,$0.00,$0.00,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-5025TDC-16,SUP,Custom 27203010,,AR-5025TDC-16  -  BIT DRL 16MM CNN BIO-CMPR SCR,$350.00,$0.00,$350.00,$0.00,$249.80,$0.00,$0.00,$0.00,$0.00,$0.00,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-5025TDC-18,SUP,Custom 27203010,,AR-5025TDC-18  -  BIT DRL 18MM CNN BIO-CMPR SCR,$350.00,$0.00,$350.00,$0.00,$249.80,$0.00,$0.00,$0.00,$0.00,$0.00,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-5025TDC-22,SUP,Custom 27203010,,AR-5025TDC-22  -  BIT DRL 22MM CNN BIO-CMPR SCR,$350.00,$0.00,$350.00,$0.00,$249.80,$0.00,$0.00,$0.00,$0.00,$0.00,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-5025TDC-24,SUP,Custom 27203010,,AR-5025TDC-24  -  BIT DRL 24MM CNN BIO-CMPR SCR,$350.00,$0.00,$350.00,$0.00,$249.80,$0.00,$0.00,$0.00,$0.00,$0.00,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-5025TDC-26,SUP,Custom 27203010,,AR-5025TDC-26  -  BIT DRL 26MM CNN BIO-CMPR SCR,$350.00,$0.00,$350.00,$0.00,$249.80,$0.00,$0.00,$0.00,$0.00,$0.00,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-5026B-16,SUP,HCPCS C1713,,AR-5026B-16  -  SCREW INTFR TPR 3.5-4.4MM 16MM BIO-CMPR SCR CNN SLF CMPR STP,$987.50,$0.00,$987.50,$444.38,$704.78,$0.00,$170.14,$0.00,$0.00,$172.90,$987.50,$0.00,$493.75,$782.10,$790.00,$0.00,$154.54,$0.00,$157.21,$0.00
AR-5026B-18,SUP,HCPCS C1713,,AR-5026B-18  -  SCREW INTFR TPR 3.5-4.5MM 18MM BIO-CMPR SCR CNN SLF CMPR STP,$987.50,$0.00,$987.50,$444.38,$704.78,$0.00,$170.14,$0.00,$0.00,$172.90,$987.50,$0.00,$493.75,$782.10,$790.00,$0.00,$154.54,$0.00,$157.21,$0.00
AR-5026B-20,SUP,HCPCS C1713,,AR-5026B-20  -  SCREW INTFR TPR 3.5-4.6MM 20MM BIO-CMPR SCR CNN SLF CMPR STP,$987.50,$0.00,$987.50,$444.38,$704.78,$0.00,$170.14,$0.00,$0.00,$172.90,$987.50,$0.00,$493.75,$782.10,$790.00,$0.00,$154.54,$0.00,$157.21,$0.00
AR-5026B-22,SUP,HCPCS C1713,,AR-5026B-22  -  SCREW INTFR TPR 3.5-4.7MM 22MM BIO-CMPR SCR CNN SLF CMPR STP,$987.50,$0.00,$987.50,$444.38,$704.78,$0.00,$170.14,$0.00,$0.00,$172.90,$987.50,$0.00,$493.75,$782.10,$790.00,$0.00,$154.54,$0.00,$157.21,$0.00
AR-5026B-24,SUP,HCPCS C1713,,AR-5026B-24  -  SCREW INTFR TPR 3.5-4.8MM 24MM BIO-CMPR SCR CNN SLF CMPR STP,$987.50,$0.00,$987.50,$444.38,$704.78,$0.00,$170.14,$0.00,$0.00,$172.90,$987.50,$0.00,$493.75,$782.10,$790.00,$0.00,$154.54,$0.00,$157.21,$0.00
AR-5026B-26,SUP,HCPCS C1713,,AR-5026B-26  -  SCREW INTFR TPR 3.5-4.9MM 26MM BIO-CMPR SCR CNN SLF CMPR STP,$987.50,$0.00,$987.50,$444.38,$704.78,$0.00,$170.14,$0.00,$0.00,$172.90,$987.50,$0.00,$493.75,$782.10,$790.00,$0.00,$154.54,$0.00,$157.21,$0.00
AR-5026B-28,SUP,HCPCS C1713,,AR-5026B-28  -  SCREW INTFR TPR 3.5-5-5MM 28MM BIO-CMPR SCR CNN SLF CMPR STP,$987.50,$0.00,$987.50,$444.38,$704.78,$0.00,$170.14,$0.00,$0.00,$172.90,$987.50,$0.00,$493.75,$782.10,$790.00,$0.00,$154.54,$0.00,$157.21,$0.00
AR-5026B-30,SUP,HCPCS C1713,,AR-5026B-30  -  SCREW INTFR TPR 3.5-5.1MM 30MM BIO-CMPR SCR CNN SLF CMPR STP,$987.50,$0.00,$987.50,$444.38,$704.78,$0.00,$170.14,$0.00,$0.00,$172.90,$987.50,$0.00,$493.75,$782.10,$790.00,$0.00,$154.54,$0.00,$157.21,$0.00
AR-5026B-32,SUP,HCPCS C1713,,AR-5026B-32  -  SCREW INTFR TPR 3.5-3.5MM 32MM BIO-CMPR SCR CNN SLF CMPR STP,$987.50,$0.00,$987.50,$444.38,$704.78,$0.00,$170.14,$0.00,$0.00,$172.90,$987.50,$0.00,$493.75,$782.10,$790.00,$0.00,$154.54,$0.00,$157.21,$0.00
AR-5026G,SUP,Custom 27203010,,AR-5026G  -  GUIDE DRL 20MM C RING DRVR BIO-CMPR SCR,"$1,900.00",$0.00,"$1,900.00",$0.00,"$1,356.03",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,900.00",$0.00,$950.00,"$1,504.80","$1,520.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-5026TDC-16,SUP,Custom 27203010,,AR-5026TDC-16  -  BIT DRL TPR 3.5MM 16MM BIO-CMPR SCR,$350.00,$0.00,$350.00,$0.00,$249.80,$0.00,$0.00,$0.00,$0.00,$0.00,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-5026TDC-18,SUP,Custom 27203010,,AR-5026TDC-18  -  BIT DRL TPR 3.5MM 18MM BIO-CMPR SCR,$350.00,$0.00,$350.00,$0.00,$249.80,$0.00,$0.00,$0.00,$0.00,$0.00,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-5026TDC-20,SUP,Custom 27203010,,AR-5026TDC-20  -  BIT DRL TPR 3.5MM 20MM BIO-CMPR SCR,$350.00,$0.00,$350.00,$0.00,$249.80,$0.00,$0.00,$0.00,$0.00,$0.00,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-5026TDC-22,SUP,Custom 27203010,,AR-5026TDC-22  -  BIT DRL TPR 3.5MM 22MM BIO-CMPR SCR,$350.00,$0.00,$350.00,$0.00,$249.80,$0.00,$0.00,$0.00,$0.00,$0.00,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-5026TDC-24,SUP,Custom 27203010,,AR-5026TDC-24  -  BIT DRL TPR 3.5MM 24MM BIO-CMPR SCR,$350.00,$0.00,$350.00,$0.00,$249.80,$0.00,$0.00,$0.00,$0.00,$0.00,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-5026TDC-26,SUP,Custom 27203010,,AR-5026TDC-26  -  BIT DRL TPR 3.5MM 26MM BIO-CMPR SCR,$350.00,$0.00,$350.00,$0.00,$249.80,$0.00,$0.00,$0.00,$0.00,$0.00,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-5026TDC-28,SUP,Custom 27203010,,AR-5026TDC-28  -  BIT DRL TPR 3.5MM 28MM BIO-CMPR SCR,$350.00,$0.00,$350.00,$0.00,$249.80,$0.00,$0.00,$0.00,$0.00,$0.00,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-5026TDC-30,SUP,Custom 27203010,,AR-5026TDC-30  -  BIT DRL TPR 3.5MM 30MM BIO-CMPR SCR,$350.00,$0.00,$350.00,$0.00,$249.80,$0.00,$0.00,$0.00,$0.00,$0.00,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-5026TDC-32,SUP,Custom 27203010,,AR-5026TDC-32  -  BIT DRL TPR 3.5MM 32MM BIO-CMPR SCR,$350.00,$0.00,$350.00,$0.00,$249.80,$0.00,$0.00,$0.00,$0.00,$0.00,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-5028B-08,SUP,HCPCS C1713,,AR-5028B-08  -  SCREW INTFR DLT TPR 8MM 28MM STRL 6.5MM BIOINTF POLY L LAC,$485.00,$0.00,$485.00,$218.25,$346.14,$0.00,$83.56,$0.00,$0.00,$84.92,$485.00,$0.00,$242.50,$384.12,$388.00,$0.00,$75.90,$0.00,$77.21,$0.00
AR-5028B-09,SUP,HCPCS C1713,,AR-5028B-09  -  SCREW INTFR DLT TPR 9MM 28MM STRL 7.5MM BIOINTF POLY L LAC,$485.00,$0.00,$485.00,$218.25,$346.14,$0.00,$83.56,$0.00,$0.00,$84.92,$485.00,$0.00,$242.50,$384.12,$388.00,$0.00,$75.90,$0.00,$77.21,$0.00
AR-5028B-10,SUP,HCPCS C1713,,AR-5028B-10  -  SCREW INTFR DLT TPR 10MM 28MM STRL 8.5MM BIOINTF POLY L LAC,$485.00,$0.00,$485.00,$218.25,$346.14,$0.00,$83.56,$0.00,$0.00,$84.92,$485.00,$0.00,$242.50,$384.12,$388.00,$0.00,$75.90,$0.00,$77.21,$0.00
AR-5028B-11,SUP,HCPCS C1713,,AR-5028B-11  -  SCREW INTFR DLT TPR 11MM 28MM STRL 9.5MM BIOINTF POLY L LAC,$485.00,$0.00,$485.00,$218.25,$346.14,$0.00,$83.56,$0.00,$0.00,$84.92,$485.00,$0.00,$242.50,$384.12,$388.00,$0.00,$75.90,$0.00,$77.21,$0.00
AR-5028C-08,SUP,HCPCS C1713,,AR-5028C-08  -  SCREW INTFR DLT TPR 8MM 28MM STRL BCMPS SHLDR,$587.50,$0.00,$587.50,$264.38,$419.30,$0.00,$101.22,$0.00,$0.00,$102.87,$587.50,$0.00,$293.75,$465.30,$470.00,$0.00,$91.94,$0.00,$93.53,$0.00
AR-5028C-10,SUP,HCPCS C1713,,AR-5028C-10  -  SCREW INTERFERENCE DELTA TAPER 10MM 28MM BIOCOMPOSITE,$587.50,$0.00,$587.50,$264.38,$419.30,$0.00,$101.22,$0.00,$0.00,$102.87,$587.50,$0.00,$293.75,$465.30,$470.00,$0.00,$91.94,$0.00,$93.53,$0.00
AR-5028C-11,SUP,HCPCS C1713,,AR-5028C-11  -  SCREW INTERFERENCE DELTA TAPER 11MM 28MM BIOCOMPOSITE,$587.50,$0.00,$587.50,$264.38,$419.30,$0.00,$101.22,$0.00,$0.00,$102.87,$587.50,$0.00,$293.75,$465.30,$470.00,$0.00,$91.94,$0.00,$93.53,$0.00
AR-5028P-07,SUP,HCPCS C1713,,AR-5028P-07  -  SCREW INTFR DLT TPR 7MM 28MM STRL RECON SHTH THRD PTRN,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-5028P-08,SUP,HCPCS C1713,,AR-5028P-08  -  ROUND DELTA TAPERED INTERFERENCE SCREW,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-5028P-09,SUP,HCPCS C1713,,AR-5028P-09  -  SCREW INTFR DLT TPR 9MM 28MM STRL RECON SHTH THRD PTRN,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-5028P-10,SUP,HCPCS C1713,,AR-5028P-10  -  SCREW INTFR DLT TPR 10MM 28MM STRL RECON SHTH THRD PTRN,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-5028P-11,SUP,HCPCS C1713,,AR-5028P-11  -  SCREW INTFR DLT TPR 11MM 28MM STRL RECON SHTH THRD PTRN,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-5028P-12,SUP,HCPCS C1713,,AR-5028P-12  -  SCREW INTFR DLT TPR 12MM 28MM STRL RECON SHTH THRD PTRN,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-5035P-09,SUP,HCPCS C1713,,AR-5035P-09  -  SCREW INTFR DLT TPR 9MM 35MM STRL CNN DRVR RECON PEEK-OPTM,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-5035P-10,SUP,HCPCS C1713,,AR-5035P-10  -  SCREW INTFR DLT TPR 10MM 35MM STRL CNN DRVR RECON PEEK-OPTM,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-5035P-11,SUP,HCPCS C1713,,AR-5035P-11  -  SCREW INTFR DLT TPR 11MM 35MM STRL CNN DRVR RECON PEEK-OPTM,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-5035P-12,SUP,HCPCS C1713,,AR-5035P-12  -  SCREW INTFR DLT TPR 12MM 35MM STRL CNN DRVR RECON PEEK-OPTM,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-5035TB-09,SUP,HCPCS C1713,,AR-5035TB-09  -  SCREW INTFR DLT TPR 7.5-9MM 35MM STRL BIOINTF CNN POLY L LAC,$485.00,$0.00,$485.00,$218.25,$346.14,$0.00,$83.56,$0.00,$0.00,$84.92,$485.00,$0.00,$242.50,$384.12,$388.00,$0.00,$75.90,$0.00,$77.21,$0.00
AR-5035TB-10,SUP,HCPCS C1713,,AR-5035TB-10  -  SCREW INTFR DLT TPR 8.5-10MM 35MM STRL BIOINTF CNN POLY L,$485.00,$0.00,$485.00,$218.25,$346.14,$0.00,$83.56,$0.00,$0.00,$84.92,$485.00,$0.00,$242.50,$384.12,$388.00,$0.00,$75.90,$0.00,$77.21,$0.00
AR-5035TB-11,SUP,HCPCS C1713,,AR-5035TB-11  -  SCREW INTFR DLT TPR 9.5-11MM 35MM STRL BIOINTF CNN POLY L,$485.00,$0.00,$485.00,$218.25,$346.14,$0.00,$83.56,$0.00,$0.00,$84.92,$485.00,$0.00,$242.50,$384.12,$388.00,$0.00,$75.90,$0.00,$77.21,$0.00
AR-5035TB-12,SUP,HCPCS C1713,,AR-5035TB-12  -  SCREW INTFR DLT TPR 10.5-12MM 35MM STRL BIOINTF CNN POLY L,$485.00,$0.00,$485.00,$218.25,$346.14,$0.00,$83.56,$0.00,$0.00,$84.92,$485.00,$0.00,$242.50,$384.12,$388.00,$0.00,$75.90,$0.00,$77.21,$0.00
AR-5035TC-09,SUP,HCPCS C1713,,AR-5035TC-09  -  SCREW INTFR DLT 9MM 35MM STRL CNN BCMPS ACL,$587.50,$0.00,$587.50,$264.38,$419.30,$0.00,$101.22,$0.00,$0.00,$102.87,$587.50,$0.00,$293.75,$465.30,$470.00,$0.00,$91.94,$0.00,$93.53,$0.00
AR-5035TC-10,SUP,HCPCS C1713,,AR-5035TC-10  -  SCREW INTFR DLT 10MM 35MM STRL CNN BCMPS ACL,$587.50,$0.00,$587.50,$264.38,$419.30,$0.00,$101.22,$0.00,$0.00,$102.87,$587.50,$0.00,$293.75,$465.30,$470.00,$0.00,$91.94,$0.00,$93.53,$0.00
AR-5035TC-12,SUP,HCPCS C1713,,AR-5035TC-12  -  SCREW INTFR BCMPS 35MM 12MM DLT ACL CANN STRL,$587.50,$0.00,$587.50,$264.38,$419.30,$0.00,$101.22,$0.00,$0.00,$102.87,$587.50,$0.00,$293.75,$465.30,$470.00,$0.00,$91.94,$0.00,$93.53,$0.00
AR-503-A1008,SUP,HCPCS C1776,,"AR-503-A1008  -  CR PLUS TIBIAL BEARING, SIZE 10, 8MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
AR-503-A1009,SUP,HCPCS C1776,,"AR-503-A1009  -  CR PLUS TIBIAL BEARING, SIZE 10, 9MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
AR-503-A1010,SUP,HCPCS C1776,,"AR-503-A1010  -  CR PLUS TIBIAL BEARING, SIZE 10, 10MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
AR-503-A1011,SUP,HCPCS C1776,,"AR-503-A1011  -  CR PLUS TIBIAL BEARING, SIZE 10, 11MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
AR-503-A1012,SUP,HCPCS C1776,,"AR-503-A1012  -  CR PLUS TIBIAL BEARING, SIZE 10, 12MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
AR-503-A1013,SUP,HCPCS C1776,,"AR-503-A1013  -  CR PLUS TIBIAL BEARING, SIZE 10, 13MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
AR-503-A1014,SUP,HCPCS C1776,,"AR-503-A1014  -  CR PLUS TIBIAL BEARING, SIZE 10, 14MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
AR-503-A1016,SUP,HCPCS C1776,,"AR-503-A1016  -  CR PLUS TIBIAL BEARING, SIZE 10, 16MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
AR-503-A1018,SUP,HCPCS C1776,,"AR-503-A1018  -  CR PLUS TIBIAL BEARING, SIZE 10, 18MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
AR-503-A908,SUP,HCPCS C1776,,"AR-503-A908  -  CR PLUS TIBIAL BEARING, SIZE 9, 8MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
AR-503-A909,SUP,HCPCS C1776,,"AR-503-A909  -  CR PLUS TIBIAL BEARING, SIZE 9, 9MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
AR-503-A910,SUP,HCPCS C1776,,"AR-503-A910  -  CR PLUS TIBIAL BEARING, SIZE 9, 10MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
AR-503-A911,SUP,HCPCS C1776,,"AR-503-A911  -  CR PLUS TIBIAL BEARING, SIZE 9, 11MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
AR-503-A912,SUP,HCPCS C1776,,"AR-503-A912  -  CR PLUS TIBIAL BEARING, SIZE 9, 12MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
AR-503-A913,SUP,HCPCS C1776,,"AR-503-A913  -  CR PLUS TIBIAL BEARING, SIZE 9, 13MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
AR-503-A914,SUP,HCPCS C1776,,"AR-503-A914  -  CR PLUS TIBIAL BEARING, SIZE 9, 14MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
AR-503-A916,SUP,HCPCS C1776,,"AR-503-A916  -  CR PLUS TIBIAL BEARING, SIZE 9, 16MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
AR-503-A918,SUP,HCPCS C1776,,"AR-503-A918  -  CR PLUS TIBIAL BEARING, SIZE 9, 18MM","$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
AR-503-PSRA,SUP,HCPCS C1776,,AR-503-PSRA  -  COMPONENT FEM IBALANCE CMNT POST STAB KN RT,"$7,750.00",$0.00,"$7,750.00","$3,487.50","$5,158.80",$0.00,"$1,335.29",$0.00,$0.00,"$1,356.96","$7,750.00",$0.00,"$3,875.00","$6,138.00","$6,200.00",$0.00,"$1,212.88",$0.00,"$1,233.80",$0.00
AR-504-PSA8,SUP,HCPCS C1776,,AR-504-PSA8  -  COMPONENT PTLR DOME 27MM 8MM IBALANCE,"$2,187.50",$0.00,"$2,187.50",$984.38,"$1,561.22",$0.00,$376.90,$0.00,$0.00,$383.01,"$2,187.50",$0.00,"$1,093.75","$1,732.50","$1,750.00",$0.00,$342.34,$0.00,$348.25,$0.00
AR-504-PSB8,SUP,HCPCS C1776,,AR-504-PSB8  -  COMPONENT PTLR DOME 30MM 8MM IBALANCE,"$2,187.50",$0.00,"$2,187.50",$984.38,"$1,561.22",$0.00,$376.90,$0.00,$0.00,$383.01,"$2,187.50",$0.00,"$1,093.75","$1,732.50","$1,750.00",$0.00,$342.34,$0.00,$348.25,$0.00
AR-504-PSE0,SUP,HCPCS C1776,,AR-504-PSE0  -  COMPONENT PTLR THK10MM 3 DOME 40MM IBALANCE 3 PG,"$2,187.50",$0.00,"$2,187.50",$984.38,"$1,561.22",$0.00,$376.90,$0.00,$0.00,$383.01,"$2,187.50",$0.00,"$1,093.75","$1,732.50","$1,750.00",$0.00,$342.34,$0.00,$348.25,$0.00
AR-5050-05,SUP,Custom 27203010,,AR-5050-05  -  CLAMP SRG 2X SM WEBER LNG THROW PTLR FX SYS,$442.50,$0.00,$442.50,$0.00,$315.81,$0.00,$0.00,$0.00,$0.00,$0.00,$442.50,$0.00,$221.25,$350.46,$354.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-5050-07,SUP,Custom 27203010,,AR-5050-07  -  GUIDE DRL 2MM 1.6MM,"$1,117.50",$0.00,"$1,117.50",$0.00,$797.56,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,117.50",$0.00,$558.75,$885.06,$894.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-5050-11,SUP,Custom 27203010,,AR-5050-11  -  GUIDE DRL PRLL PTLR FX,"$1,402.50",$0.00,"$1,402.50",$0.00,"$1,000.96",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,402.50",$0.00,$701.25,"$1,110.78","$1,122.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-5050K-2,SUP,Custom 27203010,,AR-5050K-2  -  CANNULA ASCP 7MM 7CM STRL OBT THRD SHLDR DISP,$97.50,$0.00,$97.50,$0.00,$69.59,$0.00,$0.00,$0.00,$0.00,$0.00,$97.50,$0.00,$48.75,$77.22,$78.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-5051-24,SUP,HCPCS C1713,,AR-5051-24  -  SCREW BN 4MM 24MM CNN BLNT TIP LOPRFL,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-5051-26,SUP,HCPCS C1713,,AR-5051-26  -  SCREW BN 4MM 26MM CNN BLNT TIP LOPRFL,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-5051-28,SUP,HCPCS C1713,,AR-5051-28  -  SCREW BN 4MM 28MM CNN BLNT TIP LOPRFL,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-5051-30,SUP,HCPCS C1713,,AR-5051-30  -  SCREW BN 4MM 30MM CNN BLNT TIP LOPRFL,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-5051-32,SUP,HCPCS C1713,,AR-5051-32  -  SCREW BN 4MM 32MM BLNT TIP CNN LG,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-5051-34,SUP,HCPCS C1713,,AR-5051-34  -  SCREW BN 4MM 34MM BLNT TIP CNN LG,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-5051-36,SUP,HCPCS C1713,,AR-5051-36  -  SCREW BN 4MM 36MM CNN BLNT TIP LOPRFL,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-5051-38,SUP,HCPCS C1713,,AR-5051-38  -  SCREW BN 4MM 38MM CNN BLNT TIP LOPRFL,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-5051-40,SUP,HCPCS C1713,,AR-5051-40  -  SCREW BN 4MM 40MM BLNT TIP CNN LG,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-5051-42,SUP,HCPCS C1713,,AR-5051-42  -  SCREW BN 4MM 42MM BLNT TIP CNN LG,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-5051-44,SUP,HCPCS C1713,,AR-5051-44  -  SCREW BN 4MM 44MM CNN BLNT LOPRFL,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-5051-46,SUP,HCPCS C1713,,AR-5051-46  -  SCREW BN 4MM 46MM CNN BLNT LOPRFL,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-5051-48,SUP,HCPCS C1713,,AR-5051-48  -  SCREW BN 4MM 48MM CNN BLNT TIP LOPRFL,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-5051-50,SUP,HCPCS C1713,,AR-5051-50  -  SCREW BN 4MM 50MM CNN LOPRFL BLNT TIP,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-5051-55,SUP,HCPCS C1713,,AR-5051-55  -  SCREW BN 4MM 55MM CNN BLNT LOPRFL,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-5051-60,SUP,HCPCS C1713,,AR-5051-60  -  SCREW BN 4MM 60MM CNN BLNT LOPRFL,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-5068-25TL,SUP,Custom 27203010,,AR-5068-25TL  -  PASSER SUT 25D SUTLSO SD CRV LT SHFT TIGHT,$737.50,$0.00,$737.50,$0.00,$526.35,$0.00,$0.00,$0.00,$0.00,$0.00,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-5068-25TR,SUP,Custom 27203010,,AR-5068-25TR  -  PASSER SUT 25D SUTLSO SD CRV RT SHFT TIGHT,$737.50,$0.00,$737.50,$0.00,$526.35,$0.00,$0.00,$0.00,$0.00,$0.00,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-5068-30,SUP,Custom 27203010,,AR-5068-30  -  PASSER SUT 30D SUTLSO SD STRG SHFT,$737.50,$0.00,$737.50,$0.00,$526.35,$0.00,$0.00,$0.00,$0.00,$0.00,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-5068-45L,SUP,Custom 27203010,,AR-5068-45L  -  PASSER SUT 45D SUTLSO SD CRV LT SHFT,$737.50,$0.00,$737.50,$0.00,$526.35,$0.00,$0.00,$0.00,$0.00,$0.00,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-5068-45R,SUP,Custom 27203010,,AR-5068-45R  -  PASSER SUT 45D SUTLSO SD CRV RT SHFT,$737.50,$0.00,$737.50,$0.00,$526.35,$0.00,$0.00,$0.00,$0.00,$0.00,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-5068-90,SUP,Custom 27203010,,AR-5068-90  -  PASSER SUT 90D SUTLSO SD STRG SHFT,$737.50,$0.00,$737.50,$0.00,$526.35,$0.00,$0.00,$0.00,$0.00,$0.00,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-5068-90L,SUP,Custom 27203010,,AR-5068-90L  -  PASSER SUT 90D SUTLSO SD CRV LT SHFT,$737.50,$0.00,$737.50,$0.00,$526.35,$0.00,$0.00,$0.00,$0.00,$0.00,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-5068-90R,SUP,Custom 27203010,,AR-5068-90R  -  PASSER SUT 90D SUTLSO SD CRV RT SHFT,$737.50,$0.00,$737.50,$0.00,$526.35,$0.00,$0.00,$0.00,$0.00,$0.00,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-5068-90T,SUP,Custom 27203010,,AR-5068-90T  -  PASSER SUT 90D 2 SUTLSO SD SHFT STRG RT,$737.50,$0.00,$737.50,$0.00,$526.35,$0.00,$0.00,$0.00,$0.00,$0.00,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-5068C,SUP,Custom 27203010,,AR-5068C  -  PASSER SUT SUTLSO SD CRSNT SHFT,$737.50,$0.00,$737.50,$0.00,$526.35,$0.00,$0.00,$0.00,$0.00,$0.00,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-5068H,SUP,Custom 27203010,,AR-5068H  -  PASSER SUT SUTLSO HNDL,"$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-5080AB,SUP,HCPCS C1713,,AR-5080AB  -  SCREW INTFR 50D 8MM 17MM STRL BCRTCL BCK END FLSH POLY L LAC,$355.00,$0.00,$355.00,$159.75,$253.36,$0.00,$61.16,$0.00,$0.00,$62.16,$355.00,$0.00,$177.50,$281.16,$284.00,$0.00,$55.56,$0.00,$56.52,$0.00
AR-5080BB,SUP,HCPCS C1713,,AR-5080BB  -  SCREW INTFR 8MM 20MM STRL BCRTCL BCK END FLSH POLY L LAC ACD,$355.00,$0.00,$355.00,$159.75,$253.36,$0.00,$61.16,$0.00,$0.00,$62.16,$355.00,$0.00,$177.50,$281.16,$284.00,$0.00,$55.56,$0.00,$56.52,$0.00
AR-5090AB,SUP,HCPCS C1713,,AR-5090AB  -  SCREW INTFR 50D 9MM 17MM STRL BCRTCL BCK END FLSH POLY L LAC,$355.00,$0.00,$355.00,$159.75,$253.36,$0.00,$61.16,$0.00,$0.00,$62.16,$355.00,$0.00,$177.50,$281.16,$284.00,$0.00,$55.56,$0.00,$56.52,$0.00
AR-5090BB,SUP,HCPCS C1713,,AR-5090BB  -  SCREW INTFR 9MM 20MM STRL BCRTCL BCK END FLSH POLY L LAC ACD,$355.00,$0.00,$355.00,$159.75,$253.36,$0.00,$61.16,$0.00,$0.00,$62.16,$355.00,$0.00,$177.50,$281.16,$284.00,$0.00,$55.56,$0.00,$56.52,$0.00
AR-513-10100,SUP,HCPCS C1776,,AR-513-10100  -  EXTENSION STM 10MM 100MM IBALANCE SCR TIB,"$2,875.00",$0.00,"$2,875.00","$1,293.75","$2,051.89",$0.00,$495.35,$0.00,$0.00,$503.39,"$2,875.00",$0.00,"$1,437.50","$2,277.00","$2,300.00",$0.00,$449.94,$0.00,$457.70,$0.00
AR-513-1050,SUP,HCPCS C1776,,AR-513-1050  -  STEM XTN 10MM 50MM IBALANCE TKA SCR TIB,"$2,875.00",$0.00,"$2,875.00","$1,293.75","$2,051.89",$0.00,$495.35,$0.00,$0.00,$503.39,"$2,875.00",$0.00,"$1,437.50","$2,277.00","$2,300.00",$0.00,$449.94,$0.00,$457.70,$0.00
AR-513-12100,SUP,HCPCS C1776,,AR-513-12100  -  EXTENSION STM 12MM 100MM IBALANCE SCR TIB,"$2,875.00",$0.00,"$2,875.00","$1,293.75","$2,051.89",$0.00,$495.35,$0.00,$0.00,$503.39,"$2,875.00",$0.00,"$1,437.50","$2,277.00","$2,300.00",$0.00,$449.94,$0.00,$457.70,$0.00
AR-513-1250,SUP,HCPCS C1776,,AR-513-1250  -  COMPONENT FEM 12MM 50MM STRL IBALANCE ARTHX STM XTN CMNT T/K,"$2,875.00",$0.00,"$2,875.00","$1,293.75","$2,051.89",$0.00,$495.35,$0.00,$0.00,$503.39,"$2,875.00",$0.00,"$1,437.50","$2,277.00","$2,300.00",$0.00,$449.94,$0.00,$457.70,$0.00
AR-513-14100,SUP,HCPCS C1776,,AR-513-14100  -  EXTENSION STM 14MM 100MM IBALANCE SCR TIB,"$2,875.00",$0.00,"$2,875.00","$1,293.75","$2,051.89",$0.00,$495.35,$0.00,$0.00,$503.39,"$2,875.00",$0.00,"$1,437.50","$2,277.00","$2,300.00",$0.00,$449.94,$0.00,$457.70,$0.00
AR-513-1450,SUP,HCPCS C1776,,AR-513-1450  -  COMPONENT FEM 14MM 50MM STRL IBALANCE ARTHX STM XTN CMNT T/K,"$2,875.00",$0.00,"$2,875.00","$1,293.75","$2,051.89",$0.00,$495.35,$0.00,$0.00,$503.39,"$2,875.00",$0.00,"$1,437.50","$2,277.00","$2,300.00",$0.00,$449.94,$0.00,$457.70,$0.00
AR-513-RL1010,SUP,HCPCS C1713,,AR-513-RL1010  -  AUGMENT TIB 10 10MM IBALANCE SCR RL/LM TKA,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,$0.00,$0.00,$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
AR-513-RL105,SUP,HCPCS C1713,,AR-513-RL105  -  AUGMENT TIB 10 5MM IBALANCE SCR RL/LM TKA,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,$0.00,$0.00,$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
AR-513-RL110,SUP,HCPCS C1713,,AR-513-RL110  -  AUGMENT TIB 1 10MM IBALANCE SCR RL/LM TKA,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,$0.00,$0.00,$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
AR-513-RL15,SUP,HCPCS C1713,,AR-513-RL15  -  AUGMENT TIB 1 5MM IBALANCE SCR RL/LM TKA,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,$0.00,$0.00,$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
AR-513-RL210,SUP,HCPCS C1713,,AR-513-RL210  -  AUGMENT TIB 2 10MM IBALANCE SCR LT MDL RL TKA,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,$0.00,$0.00,$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
AR-513-RL25,SUP,HCPCS C1713,,AR-513-RL25  -  AUGMENT TIB 2 5MM IBALANCE SCR RL/LM TKA,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,$0.00,$0.00,$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
AR-513-RL310,SUP,HCPCS C1713,,AR-513-RL310  -  AUGMENT TIB 3 10MM IBALANCE SCR RL/LM TKA,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,$0.00,$0.00,$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
AR-513-RL35,SUP,HCPCS C1713,,AR-513-RL35  -  AUGMENT TIB 3 5MM IBALANCE SCR RL/LM TKA,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,$0.00,$0.00,$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
AR-513-RL410,SUP,HCPCS C1713,,AR-513-RL410  -  AUGMENT TIB 4 10MM IBALANCE SCR LT MDL RL TKA,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,$0.00,$0.00,$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
AR-513-RL45,SUP,HCPCS C1713,,AR-513-RL45  -  AUGMENT TIB 4 5MM IBALANCE SCR RL/LM TKA,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,$0.00,$0.00,$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
AR-513-RL510,SUP,HCPCS C1713,,AR-513-RL510  -  AUGMENT TIB 5 10MM IBALANCE SCR RL/LM TKA,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,$0.00,$0.00,$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
AR-513-RL55,SUP,HCPCS C1713,,AR-513-RL55  -  AUGMENT TIB 5 5MM IBALANCE SCR LT MDL RL TKA,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,$0.00,$0.00,$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
AR-513-RL610,SUP,HCPCS C1713,,AR-513-RL610  -  AUGMENT TIB 6 10MM IBALANCE SCR RL/LM TKA,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,$0.00,$0.00,$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
AR-513-RL65,SUP,HCPCS C1713,,AR-513-RL65  -  AUGMENT TIB 5 5MM IBALANCE SCR RL/LM TKA,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,$0.00,$0.00,$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
AR-513-RL710,SUP,HCPCS C1713,,AR-513-RL710  -  AUGMENT TIB 7 10MM IBALANCE SCR RL/LM TKA,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,$0.00,$0.00,$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
AR-513-RL75,SUP,HCPCS C1713,,AR-513-RL75  -  AUGMENT TIB 7 5MM IBALANCE SCR RL/LM TKA,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,$0.00,$0.00,$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
AR-513-RL810,SUP,HCPCS C1713,,AR-513-RL810  -  AUGMENT TIB 8 10MM IBALANCE SCR RL/LM TKA,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,$0.00,$0.00,$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
AR-513-RL85,SUP,HCPCS C1713,,AR-513-RL85  -  AUGMENT TIB 8 5MM IBALANCE SCR LT MDL RL TKA,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,$0.00,$0.00,$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
AR-513-RL910,SUP,HCPCS C1713,,AR-513-RL910  -  AUGMENT TIB 9 10MM IBALANCE SCR LT MDL RL TKA,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,$0.00,$0.00,$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
AR-513-RL95,SUP,HCPCS C1713,,AR-513-RL95  -  AUGMENT TIB 9 5MM IBALANCE SCR RL/LM TKA,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,$0.00,$0.00,$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
AR-513-RM1010,SUP,HCPCS C1713,,AR-513-RM1010  -  AUGMENT TIB 10 10MM IBALANCE SCR LT MDL RL TKA,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,$0.00,$0.00,$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
AR-513-RM105,SUP,HCPCS C1713,,AR-513-RM105  -  AUGMENT TIB 10 5MM IBALANCE SCR RMLL TKA,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,$0.00,$0.00,$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
AR-513-RM110,SUP,HCPCS C1713,,AR-513-RM110  -  AUGMENT TIB 1 10MM IBALANCE SCR RMLL TKA,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,$0.00,$0.00,$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
AR-513-RM15,SUP,HCPCS C1713,,AR-513-RM15  -  AUGMENT TIB 1 5MM IBALANCE SCR RMLL TKA,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,$0.00,$0.00,$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
AR-513-RM210,SUP,HCPCS C1713,,AR-513-RM210  -  AUGMENT TIB 2 10MM IBALANCE SCR RMLL TKA,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,$0.00,$0.00,$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
AR-513-RM25,SUP,HCPCS C1713,,AR-513-RM25  -  AUGMENT TIB 2 5MM IBALANCE SCR RMLL TKA,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,$0.00,$0.00,$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
AR-513-RM310,SUP,HCPCS C1713,,AR-513-RM310  -  AUGMENT TIB 3 10MM IBALANCE SCR RMLL TKA,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,$0.00,$0.00,$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
AR-513-RM35,SUP,HCPCS C1713,,AR-513-RM35  -  AUGMENT TIB 3 5MM IBALANCE SCR RMLL TKA,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,$0.00,$0.00,$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
AR-513-RM410,SUP,HCPCS C1713,,AR-513-RM410  -  AUGMENT TIB 4 10MM IBALANCE SCR RMLL TKA,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,$0.00,$0.00,$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
AR-513-RM45,SUP,HCPCS C1713,,AR-513-RM45  -  AUGMENT TIB 4 5MM IBALANCE SCR RMLL TKA,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,$0.00,$0.00,$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
AR-513-RM510,SUP,HCPCS C1713,,AR-513-RM510  -  AUGMENT TIB 5 10MM IBALANCE SCR RMLL TKA,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,$0.00,$0.00,$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
AR-513-RM55,SUP,HCPCS C1713,,AR-513-RM55  -  AUGMENT TIB 5 5MM IBALANCE SCR RMLL TKA,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,$0.00,$0.00,$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
AR-513-RM610,SUP,HCPCS C1713,,AR-513-RM610  -  AUGMENT TIB 6 10MM IBALANCE SCR RMLL TKA,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,$0.00,$0.00,$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
AR-513-RM65,SUP,HCPCS C1713,,AR-513-RM65  -  AUGMENT TIB 6 5MM IBALANCE SCR RMLL TKA,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,$0.00,$0.00,$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
AR-513-RM710,SUP,HCPCS C1713,,AR-513-RM710  -  AUGMENT TIB 7 10MM IBALANCE SCR RMLL TKA,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,$0.00,$0.00,$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
AR-513-RM75,SUP,HCPCS C1713,,AR-513-RM75  -  AUGMENT TIB 7 5MM IBALANCE SCR RMLL TKA,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,$0.00,$0.00,$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
AR-513-RM810,SUP,HCPCS C1713,,AR-513-RM810  -  AUGMENT TIB 8 10MM IBALANCE SCR LT MDL RL TKA,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,$0.00,$0.00,$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
AR-513-RM85,SUP,HCPCS C1713,,AR-513-RM85  -  AUGMENT TIB 8 5MM IBALANCE SCR RMLL TKA,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,$0.00,$0.00,$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
AR-513-RM910,SUP,HCPCS C1713,,AR-513-RM910  -  AUGMENT TIB 9 10MM IBALANCE SCR RMLL TKA,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,$0.00,$0.00,$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
AR-513-RM95,SUP,HCPCS C1713,,AR-513-RM95  -  AUGMENT TIB 9 5MM IBALANCE SCR RMLL TKA,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,$0.00,$0.00,$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
AR-513-T1,SUP,HCPCS C1713,,AR-513-T1  -  COMPONENT TIBTRY 1 STRL IBALANCE ARTHX MDLR T/K ARTHPL,"$6,175.00",$0.00,"$6,175.00","$2,778.75","$4,407.10",$0.00,"$1,063.92",$0.00,$0.00,"$1,081.19","$6,175.00",$0.00,"$3,087.50","$4,890.60","$4,940.00",$0.00,$966.39,$0.00,$983.06,$0.00
AR-513-T2,SUP,HCPCS C1713,,AR-513-T2  -  COMPONENT TIBTRY 2 STRL IBALANCE ARTHX MDLR T/K ARTHPL,"$6,175.00",$0.00,"$6,175.00","$2,778.75","$4,407.10",$0.00,"$1,063.92",$0.00,$0.00,"$1,081.19","$6,175.00",$0.00,"$3,087.50","$4,890.60","$4,940.00",$0.00,$966.39,$0.00,$983.06,$0.00
AR-513-T5,SUP,HCPCS C1713,,AR-513-T5  -  COMPONENT TIBTRY 5 STRL IBALANCE ARTHX MDLR T/K ARTHPL,"$6,175.00",$0.00,"$6,175.00","$2,778.75","$4,407.10",$0.00,"$1,063.92",$0.00,$0.00,"$1,081.19","$6,175.00",$0.00,"$3,087.50","$4,890.60","$4,940.00",$0.00,$966.39,$0.00,$983.06,$0.00
AR-513-T7,SUP,HCPCS C1713,,AR-513-T7  -  COMPONENT TIBTRY 7 STRL IBALANCE ARTHX MDLR T/K ARTHPL,"$6,175.00",$0.00,"$6,175.00","$2,778.75","$4,407.10",$0.00,"$1,063.92",$0.00,$0.00,"$1,081.19","$6,175.00",$0.00,"$3,087.50","$4,890.60","$4,940.00",$0.00,$966.39,$0.00,$983.06,$0.00
AR-513-T8,SUP,HCPCS C1713,,AR-513-T8  -  COMPONENT TIBTRY 8 STRL IBALANCE ARTHX MDLR T/K ARTHPL,"$6,175.00",$0.00,"$6,175.00","$2,778.75","$4,407.10",$0.00,"$1,063.92",$0.00,$0.00,"$1,081.19","$6,175.00",$0.00,"$3,087.50","$4,890.60","$4,940.00",$0.00,$966.39,$0.00,$983.06,$0.00
AR-513-T9,SUP,HCPCS C1713,,AR-513-T9  -  COMPONENT TIBTRY 9 STRL IBALANCE ARTHX MDLR T/K ARTHPL,"$6,175.00",$0.00,"$6,175.00","$2,778.75","$4,407.10",$0.00,"$1,063.92",$0.00,$0.00,"$1,081.19","$6,175.00",$0.00,"$3,087.50","$4,890.60","$4,940.00",$0.00,$966.39,$0.00,$983.06,$0.00
AR-513-TL10,SUP,HCPCS C1713,,AR-513-TL10  -  AUGMENT TIB 10MM LCK SCR,$167.50,$0.00,$167.50,$75.38,$119.54,$0.00,$28.86,$0.00,$0.00,$29.33,$167.50,$0.00,$83.75,$132.66,$134.00,$0.00,$26.21,$0.00,$26.67,$0.00
AR-513-TL5,SUP,HCPCS C1713,,AR-513-TL5  -  AUGMENT TIB 5MM LCK SCR KN,$167.50,$0.00,$167.50,$75.38,$119.54,$0.00,$28.86,$0.00,$0.00,$29.33,$167.50,$0.00,$83.75,$132.66,$134.00,$0.00,$26.21,$0.00,$26.67,$0.00
AR-516-5R,SUP,HCPCS C1776,,AR-516-5R  -  COMPONENT FEM 5 IBALANCE CMNT POST STAB KN RT T/K ARTHPL,"$7,750.00",$0.00,"$7,750.00","$3,487.50","$5,158.80",$0.00,"$1,335.29",$0.00,$0.00,"$1,356.96","$7,750.00",$0.00,"$3,875.00","$6,138.00","$6,200.00",$0.00,"$1,212.88",$0.00,"$1,233.80",$0.00
AR-523-B1008,SUP,HCPCS C1776,,"AR-523-B1008  -  PS TIBIAL BEARING, SIZE 10, 8MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B1009,SUP,HCPCS C1776,,"AR-523-B1009  -  PS TIBIAL BEARING, SIZE 10, 9MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B1010,SUP,HCPCS C1776,,"AR-523-B1010  -  PS TIBIAL BEARING, SIZE 10, 10MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B1011,SUP,HCPCS C1776,,"AR-523-B1011  -  PS TIBIAL BEARING, SIZE 10, 11MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B1012,SUP,HCPCS C1776,,"AR-523-B1012  -  PS TIBIAL BEARING, SIZE 10, 12MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B1013,SUP,HCPCS C1776,,"AR-523-B1013  -  PS TIBIAL BEARING, SIZE 10, 13MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B1014,SUP,HCPCS C1776,,"AR-523-B1014  -  PS TIBIAL BEARING, SIZE 10, 14MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B1016,SUP,HCPCS C1776,,"AR-523-B1016  -  PS TIBIAL BEARING, SIZE 10, 16MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B1018,SUP,HCPCS C1776,,"AR-523-B1018  -  PS TIBIAL BEARING, SIZE 10, 18MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B1020,SUP,HCPCS C1776,,"AR-523-B1020  -  PS TIBIAL BEARING, SIZE 10, 20MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B108,SUP,HCPCS C1776,,"AR-523-B108  -  PS TIBIAL BEARING, SIZE 1, 8MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B109,SUP,HCPCS C1776,,"AR-523-B109  -  PS TIBIAL BEARING, SIZE 1, 9MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B110,SUP,HCPCS C1776,,"AR-523-B110  -  PS TIBIAL BEARING, SIZE 1, 10MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B111,SUP,HCPCS C1776,,"AR-523-B111  -  PS TIBIAL BEARING, SIZE 1, 11MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B112,SUP,HCPCS C1776,,"AR-523-B112  -  PS TIBIAL BEARING, SIZE 1, 12MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B113,SUP,HCPCS C1776,,"AR-523-B113  -  PS TIBIAL BEARING, SIZE 1, 13MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B114,SUP,HCPCS C1776,,"AR-523-B114  -  PS TIBIAL BEARING, SIZE 1, 14MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B116,SUP,HCPCS C1776,,"AR-523-B116  -  PS TIBIAL BEARING, SIZE 1, 16MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B118,SUP,HCPCS C1776,,"AR-523-B118  -  PS TIBIAL BEARING, SIZE 1, 18MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B120,SUP,HCPCS C1776,,"AR-523-B120  -  PS TIBIAL BEARING, SIZE 1, 20MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B208,SUP,HCPCS C1776,,"AR-523-B208  -  PS TIBIAL BEARING, SIZE 2, 8MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B209,SUP,HCPCS C1776,,"AR-523-B209  -  PS TIBIAL BEARING, SIZE 2, 9MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B210,SUP,HCPCS C1776,,"AR-523-B210  -  PS TIBIAL BEARING, SIZE 2, 10MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B211,SUP,HCPCS C1776,,"AR-523-B211  -  PS TIBIAL BEARING, SIZE 2, 11MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B212,SUP,HCPCS C1776,,"AR-523-B212  -  PS TIBIAL BEARING, SIZE 2, 12MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B213,SUP,HCPCS C1776,,"AR-523-B213  -  PS TIBIAL BEARING, SIZE 2, 13MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B214,SUP,HCPCS C1776,,"AR-523-B214  -  PS TIBIAL BEARING, SIZE 2, 14MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B216,SUP,HCPCS C1776,,"AR-523-B216  -  PS TIBIAL BEARING, SIZE 2, 16MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B218,SUP,HCPCS C1776,,"AR-523-B218  -  PS TIBIAL BEARING, SIZE 2, 18MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B220,SUP,HCPCS C1776,,"AR-523-B220  -  PS TIBIAL BEARING, SIZE 2, 20MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B308,SUP,HCPCS C1776,,"AR-523-B308  -  PS TIBIAL BEARING, SIZE 3, 8MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B309,SUP,HCPCS C1776,,"AR-523-B309  -  PS TIBIAL BEARING, SIZE 3, 9MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B310,SUP,HCPCS C1776,,"AR-523-B310  -  PS TIBIAL BEARING, SIZE 3, 10MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B311,SUP,HCPCS C1776,,"AR-523-B311  -  PS TIBIAL BEARING, SIZE 3, 11MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B312,SUP,HCPCS C1776,,"AR-523-B312  -  PS TIBIAL BEARING, SIZE 3, 12MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B313,SUP,HCPCS C1776,,"AR-523-B313  -  PS TIBIAL BEARING, SIZE 3, 13MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B314,SUP,HCPCS C1776,,"AR-523-B314  -  PS TIBIAL BEARING, SIZE 3, 14MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B316,SUP,HCPCS C1776,,"AR-523-B316  -  PS TIBIAL BEARING, SIZE 3, 16MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B318,SUP,HCPCS C1776,,"AR-523-B318  -  PS TIBIAL BEARING, SIZE 3, 18MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B320,SUP,HCPCS C1776,,"AR-523-B320  -  PS TIBIAL BEARING, SIZE 3, 20MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B408,SUP,HCPCS C1776,,"AR-523-B408  -  PS TIBIAL BEARING, SIZE 4, 8MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B409,SUP,HCPCS C1776,,"AR-523-B409  -  PS TIBIAL BEARING, SIZE 4, 9MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B410,SUP,HCPCS C1776,,"AR-523-B410  -  PS TIBIAL BEARING, SIZE 4, 10MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B411,SUP,HCPCS C1776,,"AR-523-B411  -  PS TIBIAL BEARING, SIZE 4, 11MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B412,SUP,HCPCS C1776,,"AR-523-B412  -  PS TIBIAL BEARING, SIZE 4, 12MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B413,SUP,HCPCS C1776,,"AR-523-B413  -  PS TIBIAL BEARING, SIZE 4, 13MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B414,SUP,HCPCS C1776,,"AR-523-B414  -  PS TIBIAL BEARING, SIZE 4, 14MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B416,SUP,HCPCS C1776,,"AR-523-B416  -  PS TIBIAL BEARING, SIZE 4, 16MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B418,SUP,HCPCS C1776,,"AR-523-B418  -  PS TIBIAL BEARING, SIZE 4, 18MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B420,SUP,HCPCS C1776,,"AR-523-B420  -  PS TIBIAL BEARING, SIZE 4, 20MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B508,SUP,HCPCS C1776,,"AR-523-B508  -  PS TIBIAL BEARING, SIZE 5, 8MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B509,SUP,HCPCS C1776,,"AR-523-B509  -  PS TIBIAL BEARING, SIZE 5, 9MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B510,SUP,HCPCS C1776,,"AR-523-B510  -  PS TIBIAL BEARING, SIZE 5, 10MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B511,SUP,HCPCS C1776,,"AR-523-B511  -  PS TIBIAL BEARING, SIZE 5, 11MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B512,SUP,HCPCS C1776,,"AR-523-B512  -  PS TIBIAL BEARING, SIZE 5, 12MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B513,SUP,HCPCS C1776,,"AR-523-B513  -  PS TIBIAL BEARING, SIZE 5, 13MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B514,SUP,HCPCS C1776,,"AR-523-B514  -  PS TIBIAL BEARING, SIZE 5, 14MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B516,SUP,HCPCS C1776,,"AR-523-B516  -  PS TIBIAL BEARING, SIZE 5, 16MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B518,SUP,HCPCS C1776,,"AR-523-B518  -  PS TIBIAL BEARING, SIZE 5, 18MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B520,SUP,HCPCS C1776,,"AR-523-B520  -  PS TIBIAL BEARING, SIZE 5, 20MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B608,SUP,HCPCS C1776,,"AR-523-B608  -  PS TIBIAL BEARING, SIZE 6, 8MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B609,SUP,HCPCS C1776,,"AR-523-B609  -  PS TIBIAL BEARING, SIZE 6, 9MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B610,SUP,HCPCS C1776,,"AR-523-B610  -  PS TIBIAL BEARING, SIZE 6, 10MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B611,SUP,HCPCS C1776,,"AR-523-B611  -  PS TIBIAL BEARING, SIZE 6, 11MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B612,SUP,HCPCS C1776,,"AR-523-B612  -  PS TIBIAL BEARING, SIZE 6, 12MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B613,SUP,HCPCS C1776,,"AR-523-B613  -  PS TIBIAL BEARING, SIZE 6, 13MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B614,SUP,HCPCS C1776,,"AR-523-B614  -  PS TIBIAL BEARING, SIZE 6, 14MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B616,SUP,HCPCS C1776,,"AR-523-B616  -  PS TIBIAL BEARING, SIZE 6, 16MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B618,SUP,HCPCS C1776,,"AR-523-B618  -  PS TIBIAL BEARING, SIZE 6, 18MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B620,SUP,HCPCS C1776,,"AR-523-B620  -  PS TIBIAL BEARING, SIZE 6, 20MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B708,SUP,HCPCS C1776,,"AR-523-B708  -  PS TIBIAL BEARING, SIZE 7, 8MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B709,SUP,HCPCS C1776,,"AR-523-B709  -  PS TIBIAL BEARING, SIZE 7, 9MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B710,SUP,HCPCS C1776,,"AR-523-B710  -  PS TIBIAL BEARING, SIZE 7, 10MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B711,SUP,HCPCS C1776,,"AR-523-B711  -  PS TIBIAL BEARING, SIZE 7, 11MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B712,SUP,HCPCS C1776,,"AR-523-B712  -  PS TIBIAL BEARING, SIZE 7, 12MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B713,SUP,HCPCS C1776,,"AR-523-B713  -  PS TIBIAL BEARING, SIZE 7, 13MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B714,SUP,HCPCS C1776,,"AR-523-B714  -  PS TIBIAL BEARING, SIZE 7, 14MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B716,SUP,HCPCS C1776,,"AR-523-B716  -  PS TIBIAL BEARING, SIZE 7, 16MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B718,SUP,HCPCS C1776,,"AR-523-B718  -  PS TIBIAL BEARING, SIZE 7, 18MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B720,SUP,HCPCS C1776,,"AR-523-B720  -  PS TIBIAL BEARING, SIZE 7, 20MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B808,SUP,HCPCS C1776,,"AR-523-B808  -  PS TIBIAL BEARING, SIZE 8, 8MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B809,SUP,HCPCS C1776,,"AR-523-B809  -  PS TIBIAL BEARING, SIZE 8, 9MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B810,SUP,HCPCS C1776,,"AR-523-B810  -  PS TIBIAL BEARING, SIZE 8, 10MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B811,SUP,HCPCS C1776,,"AR-523-B811  -  PS TIBIAL BEARING, SIZE 8, 11MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B812,SUP,HCPCS C1776,,"AR-523-B812  -  PS TIBIAL BEARING, SIZE 8, 12MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B813,SUP,HCPCS C1776,,"AR-523-B813  -  PS TIBIAL BEARING, SIZE 8, 13MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B814,SUP,HCPCS C1776,,"AR-523-B814  -  PS TIBIAL BEARING, SIZE 8, 14MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B816,SUP,HCPCS C1776,,"AR-523-B816  -  PS TIBIAL BEARING, SIZE 8, 16MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B818,SUP,HCPCS C1776,,"AR-523-B818  -  PS TIBIAL BEARING, SIZE 8, 18MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B820,SUP,HCPCS C1776,,"AR-523-B820  -  PS TIBIAL BEARING, SIZE 8, 20MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B908,SUP,HCPCS C1776,,"AR-523-B908  -  PS TIBIAL BEARING, SIZE 9, 8MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B909,SUP,HCPCS C1776,,"AR-523-B909  -  PS TIBIAL BEARING, SIZE 9, 9MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B910,SUP,HCPCS C1776,,"AR-523-B910  -  PS TIBIAL BEARING, SIZE 9, 10MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B911,SUP,HCPCS C1776,,"AR-523-B911  -  PS TIBIAL BEARING, SIZE 9, 11MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B912,SUP,HCPCS C1776,,"AR-523-B912  -  PS TIBIAL BEARING, SIZE 9, 12MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B913,SUP,HCPCS C1776,,"AR-523-B913  -  PS TIBIAL BEARING, SIZE 9, 13MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B914,SUP,HCPCS C1776,,"AR-523-B914  -  PS TIBIAL BEARING, SIZE 9, 14MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B916,SUP,HCPCS C1776,,"AR-523-B916  -  PS TIBIAL BEARING, SIZE 9, 16MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B918,SUP,HCPCS C1776,,"AR-523-B918  -  PS TIBIAL BEARING, SIZE 9, 18MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-523-B920,SUP,HCPCS C1776,,"AR-523-B920  -  PS TIBIAL BEARING, SIZE 9, 20MM, VIT E","$5,085.00",$0.00,"$5,085.00","$2,288.25","$3,629.16",$0.00,$876.12,$0.00,$0.00,$890.34,"$5,085.00",$0.00,"$2,542.50","$4,027.32","$4,068.00",$0.00,$795.80,$0.00,$809.53,$0.00
AR-524-PS328,SUP,HCPCS C1713,,AR-524-PS328  -  DOME PTLR 32MM 8MM STRL LF ARTHX VIT E KN,"$2,967.50",$0.00,"$2,967.50","$1,335.38","$2,117.90",$0.00,$511.29,$0.00,$0.00,$519.59,"$2,967.50",$0.00,"$1,483.75","$2,350.26","$2,374.00",$0.00,$464.41,$0.00,$472.43,$0.00
AR-524-PSA8,SUP,HCPCS C1713,,AR-524-PSA8  -  DOME PTLR 27MM 8MM STRL LF ARTHX VIT E KN,"$2,967.50",$0.00,"$2,967.50","$1,335.38","$2,117.90",$0.00,$511.29,$0.00,$0.00,$519.59,"$2,967.50",$0.00,"$1,483.75","$2,350.26","$2,374.00",$0.00,$464.41,$0.00,$472.43,$0.00
AR-524-PSB8,SUP,HCPCS C1713,,AR-524-PSB8  -  DOME PTLR 30MM 8MM STRL LF ARTHX VIT E KN,"$2,967.50",$0.00,"$2,967.50","$1,335.38","$2,117.90",$0.00,$511.29,$0.00,$0.00,$519.59,"$2,967.50",$0.00,"$1,483.75","$2,350.26","$2,374.00",$0.00,$464.41,$0.00,$472.43,$0.00
AR-524-PSC9,SUP,HCPCS C1713,,AR-524-PSC9  -  DOME PTLR 34MM 9MM STRL LF ARTHX VIT E,"$2,967.50",$0.00,"$2,967.50","$1,335.38","$2,117.90",$0.00,$511.29,$0.00,$0.00,$519.59,"$2,967.50",$0.00,"$1,483.75","$2,350.26","$2,374.00",$0.00,$464.41,$0.00,$472.43,$0.00
AR-524-PSD0,SUP,HCPCS C1713,,AR-524-PSD0  -  DOME PTLR 37MM 10MM STRL LF ARTHX VIT E,"$2,967.50",$0.00,"$2,967.50","$1,335.38","$2,117.90",$0.00,$511.29,$0.00,$0.00,$519.59,"$2,967.50",$0.00,"$1,483.75","$2,350.26","$2,374.00",$0.00,$464.41,$0.00,$472.43,$0.00
AR-524-PSE0,SUP,HCPCS C1713,,AR-524-PSE0  -  DOME PTLR 40MM 10MM STRL LF ARTHX VIT E KN,"$2,967.50",$0.00,"$2,967.50","$1,335.38","$2,117.90",$0.00,$511.29,$0.00,$0.00,$519.59,"$2,967.50",$0.00,"$1,483.75","$2,350.26","$2,374.00",$0.00,$464.41,$0.00,$472.43,$0.00
AR-5503,SUP,Custom 27203010,,AR-5503  -  GUIDE DRL PIN PRLL,"$1,390.30",$0.00,"$1,390.30",$0.00,$992.26,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,390.30",$0.00,$695.15,"$1,101.12","$1,112.24",$0.00,$0.00,$0.00,$0.00,$0.00
AR-5511-CP,SUP,HCPCS C1713,,AR-5511-CP  -  KIT ARTHRO FIX INTERNALBRACE FIBERTAPE SWIVELOCK,"$2,987.50",$0.00,"$2,987.50","$1,344.38","$2,132.18",$0.00,$514.73,$0.00,$0.00,$523.09,"$2,987.50",$0.00,"$1,493.75","$2,366.10","$2,390.00",$0.00,$467.54,$0.00,$475.61,$0.00
AR-5600-01,SUP,Custom 27203010,,AR-5600-01  -  GUIDE DRL OFST CRDL FISH MTH 4MM CHONDROGUARD NOVEL TIP XTN,"$1,497.50",$0.00,"$1,497.50",$0.00,"$1,068.77",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,497.50",$0.00,$748.75,"$1,186.02","$1,198.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-5600-02,SUP,Custom 27203010,,AR-5600-02  -  GUIDE DRL OFST CRDL FISH MTH 6MM CHONDROGUARD NOVEL TIP XTN,"$1,497.50",$0.00,"$1,497.50",$0.00,"$1,068.77",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,497.50",$0.00,$748.75,"$1,186.02","$1,198.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-601-BBS0,SUP,Custom 27203010,,AR-601-BBS0  -  BIT DRL 2.7MM TRMIT CNN SLF CMPR THRD PTCH,$850.00,$0.00,$850.00,$0.00,$606.65,$0.00,$0.00,$0.00,$0.00,$0.00,$850.00,$0.00,$425.00,$673.20,$680.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-601-SB06,SUP,Custom 27203010,,AR-601-SB06  -  INSERT TIB 6MM IBALANCE SPCR BLCK KN UNCNDL,$160.00,$0.00,$160.00,$0.00,$114.19,$0.00,$0.00,$0.00,$0.00,$0.00,$160.00,$0.00,$80.00,$126.72,$128.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-601-SB07,SUP,Custom 27203010,,AR-601-SB07  -  INSERT TIB 7MM IBALANCE SPCR BLCK KN UNCNDL,$160.00,$0.00,$160.00,$0.00,$114.19,$0.00,$0.00,$0.00,$0.00,$0.00,$160.00,$0.00,$80.00,$126.72,$128.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-601-SB08,SUP,Custom 27203010,,AR-601-SB08  -  INSERT TIB 8MM IBALANCE SPCR BLCK KN UNCNDL,$160.00,$0.00,$160.00,$0.00,$114.19,$0.00,$0.00,$0.00,$0.00,$0.00,$160.00,$0.00,$80.00,$126.72,$128.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-601-SB09,SUP,Custom 27203010,,AR-601-SB09  -  INSERT TIB 9MM IBALANCE SPCR BLCK KN UNCNDL,$160.00,$0.00,$160.00,$0.00,$114.19,$0.00,$0.00,$0.00,$0.00,$0.00,$160.00,$0.00,$80.00,$126.72,$128.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-601-SB10,SUP,Custom 27203010,,AR-601-SB10  -  INSERT TIB 10MM IBALANCE SPCR BLCK KN UNCNDL,$160.00,$0.00,$160.00,$0.00,$114.19,$0.00,$0.00,$0.00,$0.00,$0.00,$160.00,$0.00,$80.00,$126.72,$128.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-602-44,SUP,Custom 27203010,,AR-602-44  -  GUIDE DRL 27MM IBALANCE PTLR,$617.50,$0.00,$617.50,$0.00,$440.71,$0.00,$0.00,$0.00,$0.00,$0.00,$617.50,$0.00,$308.75,$489.06,$494.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-602-45,SUP,Custom 27203010,,AR-602-45  -  GUIDE DRL 30MM IBALANCE PTLR,$617.50,$0.00,$617.50,$0.00,$440.71,$0.00,$0.00,$0.00,$0.00,$0.00,$617.50,$0.00,$308.75,$489.06,$494.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-602-46,SUP,Custom 27203010,,AR-602-46  -  GUIDE DRL 34MM IBALANCE PTLR,$617.50,$0.00,$617.50,$0.00,$440.71,$0.00,$0.00,$0.00,$0.00,$0.00,$617.50,$0.00,$308.75,$489.06,$494.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-602-47,SUP,Custom 27203010,,AR-602-47  -  GUIDE DRL 37MM IBALANCE PTLR,$617.50,$0.00,$617.50,$0.00,$440.71,$0.00,$0.00,$0.00,$0.00,$0.00,$617.50,$0.00,$308.75,$489.06,$494.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-602-49,SUP,Custom 27203010,,AR-602-49  -  GUIDE DRL IBALANCE CMBN PTLR,$915.00,$0.00,$915.00,$0.00,$653.04,$0.00,$0.00,$0.00,$0.00,$0.00,$915.00,$0.00,$457.50,$724.68,$732.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-603-85,SUP,Custom 27203010,,AR-603-85  -  CLAMP SRG IBALANCE CMNT TMPLT PTLR,"$3,712.50",$0.00,"$3,712.50",$0.00,"$2,649.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,712.50",$0.00,"$1,856.25","$2,940.30","$2,970.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-6068-25TL,SUP,Custom 27203010,,AR-6068-25TL  -  PASSER SUTURE 25D SMALL TIGHT LEFT CURVE 8.25MM CANNU,$400.00,$0.00,$400.00,$0.00,$285.48,$0.00,$0.00,$0.00,$0.00,$0.00,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6068-25TR,SUP,Custom 27203010,,AR-6068-25TR  -  PASSER SUT 25D SM TIGHT RT CRV 8.25MM STRL QUICKPASS SUTLSO,$400.00,$0.00,$400.00,$0.00,$285.48,$0.00,$0.00,$0.00,$0.00,$0.00,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6068-30,SUP,Custom 27203010,,AR-6068-30  -  PASSER SUT 30D SM STRG 7MM STRL QUICKPASS SUTLSO CNN ERG,$400.00,$0.00,$400.00,$0.00,$285.48,$0.00,$0.00,$0.00,$0.00,$0.00,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6068-45L,SUP,Custom 27203010,,AR-6068-45L  -  PASSER SUT 45D SM LT CRV 7MM STRL QUICKPASS SUTLSO CNN ERG,$400.00,$0.00,$400.00,$0.00,$285.48,$0.00,$0.00,$0.00,$0.00,$0.00,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6068-45R,SUP,Custom 27203010,,AR-6068-45R  -  PASSER SUT 45D CRV QUICKPASS SUTLSO RT,$400.00,$0.00,$400.00,$0.00,$285.48,$0.00,$0.00,$0.00,$0.00,$0.00,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6068-90,SUP,Custom 27203010,,AR-6068-90  -  PASSER SUTURE 90D SMALL STR 7MM CANNU ERGONOMIC HANDLE,$400.00,$0.00,$400.00,$0.00,$285.48,$0.00,$0.00,$0.00,$0.00,$0.00,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6068-90L,SUP,Custom 27203010,,AR-6068-90L  -  PASSER SUT 90D SM LT CRV 8.25MM STRL QUICKPASS SUTLSO CNN,$400.00,$0.00,$400.00,$0.00,$285.48,$0.00,$0.00,$0.00,$0.00,$0.00,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6068-90R,SUP,Custom 27203010,,AR-6068-90R  -  PASSER SUT 90D SM RT CRV 8.25MM STRL QUICKPASS SUTLSO CNN,$400.00,$0.00,$400.00,$0.00,$285.48,$0.00,$0.00,$0.00,$0.00,$0.00,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6068-90T,SUP,Custom 27203010,,AR-6068-90T  -  PASSER SUT 90D SM TC 7MM STRL QUICKPASS SUTLSO CNN ERG HNDL,$400.00,$0.00,$400.00,$0.00,$285.48,$0.00,$0.00,$0.00,$0.00,$0.00,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6069-45L,SUP,Custom 27203010,,AR-6069-45L  -  PASSER SUT 45D 1 LT CRV 1.5MM 10YD BLU SUTLSO ERG HNDL,$400.00,$0.00,$400.00,$0.00,$285.48,$0.00,$0.00,$0.00,$0.00,$0.00,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6069-45R,SUP,Custom 27203010,,AR-6069-45R  -  PASSER SUT 45D 1 RT CRV 1.5MM 10YD BLU SUTLSO ERG HNDL,$400.00,$0.00,$400.00,$0.00,$285.48,$0.00,$0.00,$0.00,$0.00,$0.00,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6069-90,SUP,Custom 27203010,,AR-6069-90  -  PASSER SUT 90D STRG CRV SUTLSO REELPASS,$400.00,$0.00,$400.00,$0.00,$285.48,$0.00,$0.00,$0.00,$0.00,$0.00,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6506,SUP,Custom 27203010,,AR-6506  -  CANNULA ASCP OPN,$987.50,$0.00,$987.50,$0.00,$704.78,$0.00,$0.00,$0.00,$0.00,$0.00,$987.50,$0.00,$493.75,$782.10,$790.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6507,SUP,Custom 27203010,,AR-6507  -  CANNULA ASCP BLNT OPN,$987.50,$0.00,$987.50,$0.00,$704.78,$0.00,$0.00,$0.00,$0.00,$0.00,$987.50,$0.00,$493.75,$782.10,$790.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6507-01,SUP,Custom 27203010,,AR-6507-01  -  CANNULA ASCP TPR OPN SHRP PLYCRB,$150.00,$0.00,$150.00,$0.00,$107.06,$0.00,$0.00,$0.00,$0.00,$0.00,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6507-02,SUP,Custom 27203010,,AR-6507-02  -  CANNULA ASCP BLNT OPN SHRP PLYCRB,$150.00,$0.00,$150.00,$0.00,$107.06,$0.00,$0.00,$0.00,$0.00,$0.00,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6507-03,SUP,Custom 27203010,,AR-6507-03  -  CANNULA ASCP TPR DTCH HNDL OPN MTL,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6507-04,SUP,Custom 27203010,,AR-6507-04  -  CANNULA ASCP BLNT DTCH HNDL OPN MTL,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6520-15,SUP,Custom 27203010,,AR-6520-15  -  STICK SWH LNG ACR CNN DTCH HNDL HIP,$475.00,$0.00,$475.00,$0.00,$339.01,$0.00,$0.00,$0.00,$0.00,$0.00,$475.00,$0.00,$237.50,$376.20,$380.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6520-16,SUP,Custom 27203010,,AR-6520-16  -  STICK SWH LNG 3.5MM 15IN CNN,$662.50,$0.00,$662.50,$0.00,$472.83,$0.00,$0.00,$0.00,$0.00,$0.00,$662.50,$0.00,$331.25,$524.70,$530.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6521,SUP,Custom 27203010,,AR-6521  -  NEEDLE ESCP STRL PIN REPL DISP PRTL DILATION SET ASCP,$162.50,$0.00,$162.50,$0.00,$115.98,$0.00,$0.00,$0.00,$0.00,$0.00,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6523,SUP,Custom 27203010,,AR-6523  -  NEEDLE ESCP BLNT STRL DISP PRTL DILATION SET ASCP,$162.50,$0.00,$162.50,$0.00,$115.98,$0.00,$0.00,$0.00,$0.00,$0.00,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6526S,SUP,Custom 27203010,,AR-6526S  -  KIT ENDSCP INSTR MSTR 1.5MM 14GA GWIRE KNF BLADE,"$1,125.00",$0.00,"$1,125.00",$0.00,$802.91,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6527S,SUP,Custom 27203010,,AR-6527S  -  KIT ESCP INST CRV BNA 14GA 1.5MM 35ML BLDE KNF PIN SYR NTNL,$937.50,$0.00,$937.50,$0.00,$669.09,$0.00,$0.00,$0.00,$0.00,$0.00,$937.50,$0.00,$468.75,$742.50,$750.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6528-07,SUP,Custom 27203010,,AR-6528-07  -  PROBE ASCP 220MM NAV-X RND ABLT MNPLR STRBL COAG HIP,"$1,237.50",$0.00,"$1,237.50",$0.00,$883.20,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,237.50",$0.00,$618.75,$980.10,$990.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6529-07,SUP,Custom 27203010,,AR-6529-07  -  POST OP TBL PERI HDS,"$1,125.00",$0.00,"$1,125.00",$0.00,$802.91,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6530,SUP,Custom 27203010,,AR-6530  -  CANNU ARTHRO 7CM THRD TWST IN STRL DISP 8.25MM,$90.00,$0.00,$90.00,$0.00,$64.23,$0.00,$0.00,$0.00,$0.00,$0.00,$90.00,$0.00,$45.00,$71.28,$72.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6530N,SUP,Custom 27203010,,AR-6530N  -  CANNU ARTHRO 7CM NTCH TWST IN STRL DISP 8.25MM,$90.00,$0.00,$90.00,$0.00,$64.23,$0.00,$0.00,$0.00,$0.00,$0.00,$90.00,$0.00,$45.00,$71.28,$72.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6532,SUP,Custom 27203010,,AR-6532  -  CANNULA ASCP 5.5MM 9CM STRL OBT THRD SHLDR DISP,$62.50,$0.00,$62.50,$0.00,$44.61,$0.00,$0.00,$0.00,$0.00,$0.00,$62.50,$0.00,$31.25,$49.50,$50.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6535,SUP,Custom 27203010,,AR-6535  -  CANNULA ARTHRO 6MM 7CM OBTURATOR THREAD TWIST-IN TRANSLUCENT,$62.50,$0.00,$62.50,$0.00,$44.61,$0.00,$0.00,$0.00,$0.00,$0.00,$62.50,$0.00,$31.25,$49.50,$50.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6535TD,SUP,Custom 27203010,,AR-6535TD  -  CANNULA ASCP 6MM 7CM TWST-IN 3 DAM SDPRT LL CNCT VLV SWH,$400.00,$0.00,$400.00,$0.00,$285.48,$0.00,$0.00,$0.00,$0.00,$0.00,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6545,SUP,Custom 27203010,,AR-6545  -  CANNULA ASCP 6MM 9CM TRNLU STRL TWST-IN OBT THRD SHLDR DISP,$62.50,$0.00,$62.50,$0.00,$44.61,$0.00,$0.00,$0.00,$0.00,$0.00,$62.50,$0.00,$31.25,$49.50,$50.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6548,SUP,Custom 27203010,,AR-6548  -  CANNULA ARTHRO LP OBTURATOR THREAD PUSHLOCK SHOULDER STERILE,$90.00,$0.00,$90.00,$0.00,$64.23,$0.00,$0.00,$0.00,$0.00,$0.00,$90.00,$0.00,$45.00,$71.28,$72.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6550TD,SUP,Custom 27203010,,AR-6550TD  -  CANNULA ASCP 7MM 7CM TWST-IN 3 DAM SDPRT LL CNCT VLV SWH,$400.00,$0.00,$400.00,$0.00,$285.48,$0.00,$0.00,$0.00,$0.00,$0.00,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6551L,SUP,Custom 27203010,,AR-6551L  -  CANNULA ASCP SM 6MM 7.75CM,$325.00,$0.00,$325.00,$0.00,$231.95,$0.00,$0.00,$0.00,$0.00,$0.00,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6560,SUP,Custom 27203010,,AR-6560  -  CANNULA ASCP BRL 5.75MM 7CM TRNLU STRL CRYS DIST RING RTNT,$62.50,$0.00,$62.50,$0.00,$44.61,$0.00,$0.00,$0.00,$0.00,$0.00,$62.50,$0.00,$31.25,$49.50,$50.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6560F,SUP,Custom 27203010,,AR-6560F  -  CANNULA ASCP BRL 5.75MM 7CM TRNLU STRL CRYS DIST RING FLXB,$70.00,$0.00,$70.00,$0.00,$49.96,$0.00,$0.00,$0.00,$0.00,$0.00,$70.00,$0.00,$35.00,$55.44,$56.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6562,SUP,Custom 27203010,,AR-6562  -  CANNULA ASCP BRL 5.75MM 7CM TRNLU STRL CRYS RTNT BWL SMTH,$62.50,$0.00,$62.50,$0.00,$44.61,$0.00,$0.00,$0.00,$0.00,$0.00,$62.50,$0.00,$31.25,$49.50,$50.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6564,SUP,Custom 27203010,,AR-6564  -  CANNULA ASCP P/T BRL 5.75MM 7CM TRNLU STRL CRYS RTNT BWL,$62.50,$0.00,$62.50,$0.00,$44.61,$0.00,$0.00,$0.00,$0.00,$0.00,$62.50,$0.00,$31.25,$49.50,$50.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6565,SUP,Custom 27203010,,AR-6565  -  CANNULA ASCP 6MM 9CM STRL SHOHN LNGTDNL SLOT OBT SHLDR DISP,$62.50,$0.00,$62.50,$0.00,$44.61,$0.00,$0.00,$0.00,$0.00,$0.00,$62.50,$0.00,$31.25,$49.50,$50.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6566,SUP,Custom 27203010,,AR-6566  -  CANNULA ASCP P/T 8.25MM 7CM TRNLU STRL FLXB OBT THRD ROTR,$62.50,$0.00,$62.50,$0.00,$44.61,$0.00,$0.00,$0.00,$0.00,$0.00,$62.50,$0.00,$31.25,$49.50,$50.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6568,SUP,Custom 27203010,,AR-6568  -  CANNULA ASCP SHRT P/T 5.75MM 5CM TRNLU CRYS,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6570,SUP,Custom 27203010,,AR-6570  -  CANNULA ARTHRO 7MM 7CM OBTURATOR TWIST-IN TRANSLUCENT,$62.50,$0.00,$62.50,$0.00,$44.61,$0.00,$0.00,$0.00,$0.00,$0.00,$62.50,$0.00,$31.25,$49.50,$50.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6570F,SUP,Custom 27203010,,AR-6570F  -  CANNULA ASCP 7MM 7CM TRNLU STRL TWST-IN FLXB OBT SHLDR DISP,$70.00,$0.00,$70.00,$0.00,$49.96,$0.00,$0.00,$0.00,$0.00,$0.00,$70.00,$0.00,$35.00,$55.44,$56.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6570TD,SUP,Custom 27203010,,AR-6570TD  -  CANNULA ASCP 7MM 7CM TWST-IN 3 DAM SDPRT LL CNCT VLV SWH,$400.00,$0.00,$400.00,$0.00,$285.48,$0.00,$0.00,$0.00,$0.00,$0.00,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6570TDNV,SUP,Custom 27203010,,AR-6570TDNV  -  CANNULA ASCP 6MM 7CM TWST-IN 3 DAM SDPRT LL CNCT NO VLV,$400.00,$0.00,$400.00,$0.00,$285.48,$0.00,$0.00,$0.00,$0.00,$0.00,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6572,SUP,Custom 27203010,,AR-6572  -  CANNULA ARTHRO LP 8.25MM 9CM SELF RETAINING SYSTEM GEMINI SR,$80.00,$0.00,$80.00,$0.00,$57.10,$0.00,$0.00,$0.00,$0.00,$0.00,$80.00,$0.00,$40.00,$63.36,$64.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6575-09,SUP,Custom 27203010,,AR-6575-09  -  CANNULA ASCP P/T 8.25MM 9CM TRNLU STRL OBT DISP,$62.50,$0.00,$62.50,$0.00,$44.61,$0.00,$0.00,$0.00,$0.00,$0.00,$62.50,$0.00,$31.25,$49.50,$50.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6575-11,SUP,Custom 27203010,,AR-6575-11  -  CANNULA ASCP P/T 8.25MM 11CM TRNLU STRL OBT DISP,$62.50,$0.00,$62.50,$0.00,$44.61,$0.00,$0.00,$0.00,$0.00,$0.00,$62.50,$0.00,$31.25,$49.50,$50.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6576S-C,SUP,Custom 27203010,,AR-6576S-C  -  SYSTEM ESCP XL ASCP C MNT HIP,"$68,530.00",$0.00,"$68,530.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$68,530.00",$0.00,"$34,265.00","$54,275.76","$54,824.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-6576S-E,SUP,Custom 27203010,,AR-6576S-E  -  SYSTEM ESCP XL ASCP EYE PC HIP,"$61,055.00",$0.00,"$61,055.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$61,055.00",$0.00,"$30,527.50","$48,355.56","$48,844.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-6577-09,SUP,Custom 27203010,,AR-6577-09  -  CANNULA ARTHRO PTHRD 7MM 9CM HIP STERILE,$90.00,$0.00,$90.00,$0.00,$64.23,$0.00,$0.00,$0.00,$0.00,$0.00,$90.00,$0.00,$45.00,$71.28,$72.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6577-11,SUP,Custom 27203010,,AR-6577-11  -  CANNULA ASCP P/T 7MM 11CM STRL HIP,$62.50,$0.00,$62.50,$0.00,$44.61,$0.00,$0.00,$0.00,$0.00,$0.00,$62.50,$0.00,$31.25,$49.50,$50.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6580,SUP,Custom 27203010,,AR-6580  -  CANNULA ASCP 3.75MM 3 DAM,$343.75,$0.00,$343.75,$0.00,$245.33,$0.00,$0.00,$0.00,$0.00,$0.00,$343.75,$0.00,$171.88,$272.25,$275.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6590,SUP,Custom 27203010,,AR-6590  -  CANNULA ASCP TRMIT CSTM HIP,$162.50,$0.00,$162.50,$0.00,$115.98,$0.00,$0.00,$0.00,$0.00,$0.00,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6590DT,SUP,Custom 27203010,,AR-6590DT  -  CANNULA ASCP TRMIT DTCH OBT,$650.00,$0.00,$650.00,$0.00,$463.91,$0.00,$0.00,$0.00,$0.00,$0.00,$650.00,$0.00,$325.00,$514.80,$520.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6590ST,SUP,Custom 27203010,,AR-6590ST  -  STICK SWH 4MM TRMIT CNN CNN,$687.50,$0.00,$687.50,$0.00,$490.67,$0.00,$0.00,$0.00,$0.00,$0.00,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6592,SUP,Custom 27203010,,AR-6592  -  CANNULA BTN CRV LOPRFL STRL LF PSPRT 1 PC MLD 2 DAM DSGN 2,$362.50,$0.00,$362.50,$0.00,$258.72,$0.00,$0.00,$0.00,$0.00,$0.00,$362.50,$0.00,$181.25,$287.10,$290.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6592-06-20,SUP,Custom 27203010,,AR-6592-06-20  -  CANNULA BTN CRV LOPRFL 6MM 2CM STRL LF PSPRT 1 PC MLD 2 DAM,$80.00,$0.00,$80.00,$0.00,$57.10,$0.00,$0.00,$0.00,$0.00,$0.00,$80.00,$0.00,$40.00,$63.36,$64.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6592-06-30,SUP,Custom 27203010,,AR-6592-06-30  -  CANNULA BTN CRV LOPRFL 6MM 3CM STRL LF PSPRT 1 PC MLD 2 DAM,$80.00,$0.00,$80.00,$0.00,$57.10,$0.00,$0.00,$0.00,$0.00,$0.00,$80.00,$0.00,$40.00,$63.36,$64.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6592-06-40,SUP,Custom 27203010,,AR-6592-06-40  -  CANNULA BTN CRV LOPRFL 6MM 4CM STRL LF PSPRT 1 PC MLD 2 DAM,$80.00,$0.00,$80.00,$0.00,$57.10,$0.00,$0.00,$0.00,$0.00,$0.00,$80.00,$0.00,$40.00,$63.36,$64.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6592-06-50,SUP,Custom 27203010,,AR-6592-06-50  -  CANNULA BTN CRV LOPRFL 6MM 5CM STRL LF PSPRT 1 PC MLD 2 DAM,$80.00,$0.00,$80.00,$0.00,$57.10,$0.00,$0.00,$0.00,$0.00,$0.00,$80.00,$0.00,$40.00,$63.36,$64.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6592-08-20,SUP,Custom 27203010,,AR-6592-08-20  -  CANNULA BTN CRV LOPRFL 8MM 2CM STRL LF PSPRT 1 PC MLD 2 DAM,$80.00,$0.00,$80.00,$0.00,$57.10,$0.00,$0.00,$0.00,$0.00,$0.00,$80.00,$0.00,$40.00,$63.36,$64.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6592-08-40,SUP,Custom 27203010,,AR-6592-08-40  -  CANNULA BTN CRV LOPRFL 8MM 4CM STRL LF PSPRT 1 PC MLD 2 DAM,$80.00,$0.00,$80.00,$0.00,$57.10,$0.00,$0.00,$0.00,$0.00,$0.00,$80.00,$0.00,$40.00,$63.36,$64.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6592-08-50,SUP,Custom 27203010,,AR-6592-08-50  -  CANNULA BTN CRV LOPRFL 8MM 5CM STRL LF PSPRT 1 PC MLD 2 DAM,$80.00,$0.00,$80.00,$0.00,$57.10,$0.00,$0.00,$0.00,$0.00,$0.00,$80.00,$0.00,$40.00,$63.36,$64.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6592-08-60,SUP,Custom 27203010,,AR-6592-08-60  -  CANNULA BTN CRV LOPRFL 8MM 6CM STRL LF PSPRT 1 PC MLD 2 DAM,$80.00,$0.00,$80.00,$0.00,$57.10,$0.00,$0.00,$0.00,$0.00,$0.00,$80.00,$0.00,$40.00,$63.36,$64.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6592-08-90,SUP,Custom 27203010,,AR-6592-08-90  -  CANNULA BTN CRV LOPRFL 9MM 9CM STRL LF PSPRT 1 PC MLD 2 DAM,$150.00,$0.00,$150.00,$0.00,$107.06,$0.00,$0.00,$0.00,$0.00,$0.00,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6592-10-20,SUP,Custom 27203010,,AR-6592-10-20  -  CANNULA BTN CRV LOPRFL 10MM 2CM STRL LF PSPRT 1 PC MLD 2 DAM,$80.00,$0.00,$80.00,$0.00,$57.10,$0.00,$0.00,$0.00,$0.00,$0.00,$80.00,$0.00,$40.00,$63.36,$64.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6592-10-30,SUP,Custom 27203010,,AR-6592-10-30  -  CANNU 3CM 10MM CANNU BTN PSPRT DISP STRL,$115.00,$0.00,$115.00,$0.00,$82.08,$0.00,$0.00,$0.00,$0.00,$0.00,$115.00,$0.00,$57.50,$91.08,$92.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6592-10-40,SUP,Custom 27203010,,AR-6592-10-40  -  CANNULA BUTTON CURVE LP 10MM 4CM 1 PIECE MOLD 2 DAM DESIGN 2,$115.00,$0.00,$115.00,$0.00,$82.08,$0.00,$0.00,$0.00,$0.00,$0.00,$115.00,$0.00,$57.50,$91.08,$92.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6592-10-50,SUP,Custom 27203010,,AR-6592-10-50  -  CANNULA BUTTON CURVE LP 10MM 5CM 1 PIECE MOLD 2 DAM DESIGN 2,$115.00,$0.00,$115.00,$0.00,$82.08,$0.00,$0.00,$0.00,$0.00,$0.00,$115.00,$0.00,$57.50,$91.08,$92.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-6955,SUP,HCPCS C1713,,AR-6955  -  SET IMPL 2.7MM TRMIT TNL INSTRUMENTATION SET,"$4,917.50",$0.00,"$4,917.50","$2,212.88","$3,509.62",$0.00,$847.26,$0.00,$0.00,$861.01,"$4,917.50",$0.00,"$2,458.75","$3,894.66","$3,934.00",$0.00,$769.59,$0.00,$782.87,$0.00
AR-7000-03,SUP,Custom 27203010,,AR-7000-03  -  GUIDE DRL 4MM PRLL,"$1,125.00",$0.00,"$1,125.00",$0.00,$802.91,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7000-04,SUP,Custom 27203010,,AR-7000-04  -  GUIDE DRL 6MM PRLL,"$1,125.00",$0.00,"$1,125.00",$0.00,$802.91,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7000-05,SUP,Custom 27203010,,AR-7000-05  -  GUIDE DRL 8MM PRLL,"$1,125.00",$0.00,"$1,125.00",$0.00,$802.91,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7000-07,SUP,Custom 27203010,,AR-7000-07  -  GUIDE DRL CORACOID,"$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-7000-14,SUP,Custom 27203010,,AR-7000-14  -  DRILL SURG MINI .066IN 2.75MM CANN OPEN REPAIR,$875.00,$0.00,$875.00,$0.00,$624.49,$0.00,$0.00,$0.00,$0.00,$0.00,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7000-15,SUP,Custom 27803010,,AR-7000-15  -  WASHER ORTHOPEDIC CANN SELF COMPRESS THREAD PITCH TITANIUM,$125.00,$0.00,$125.00,$0.00,$89.21,$0.00,$0.00,$0.00,$0.00,$0.00,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7000-16,SUP,Custom 27203010,,AR-7000-16  -  GUIDE DRL PRLL,"$1,062.50",$0.00,"$1,062.50",$0.00,$758.31,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,062.50",$0.00,$531.25,$841.50,$850.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7000-17,SUP,Custom 27203010,,AR-7000-17  -  GUIDE DRL SHLW CORACOID,"$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-7000-18T,SUP,Custom 27803010,,AR-7000-18T  -  WASHER ESCP 2 CRV FBRWR NDL SUT TI ASCP,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7000-26,SUP,HCPCS C1713,,AR-7000-26  -  SCREW BN P/T 3.75MM 26MM SLF DRL ST CNN TI SHLDR GLND,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
AR-7000-26FT,SUP,HCPCS C1713,,AR-7000-26FT  -  SCREW BN FT 3.75MM 26MM SLF DRL ST CNN TI SHLDR GLND,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
AR-7000-28,SUP,HCPCS C1713,,AR-7000-28  -  SCREW BN P/T 3.75MM 28MM SLF DRL ST CNN TI SHLDR GLND,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
AR-7000-28FT,SUP,HCPCS C1713,,AR-7000-28FT  -  SCREW BN FT 3.75MM 28MM SLF DRL ST CNN TI SHLDR GLND,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
AR-7000-30,SUP,HCPCS C1713,,AR-7000-30  -  SCREW BN P/T 3.75MM 30MM SLF DRL ST CNN TI SHLDR GLND,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
AR-7000-30FT,SUP,HCPCS C1713,,AR-7000-30FT  -  SCREW BN FT 3.75MM 30MM SLF DRL ST CNN TI SHLDR GLND,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
AR-7000-32,SUP,HCPCS C1713,,AR-7000-32  -  SCREW BONE PTHRD 3.75MM 32MM SELF DRILL SELF TAP CANN,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
AR-7000-32FT,SUP,HCPCS C1713,,AR-7000-32FT  -  SCREW BN FT 3.75MM 32MM SLF DRL ST CNN TI SHLDR GLND,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
AR-7000-34,SUP,HCPCS C1713,,AR-7000-34  -  SCREW BN P/T 3.75MM 34MM SLF DRL ST CNN TI SHLDR GLND,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
AR-7000-34FT,SUP,HCPCS C1713,,AR-7000-34FT  -  SCREW BONE 3.75MM 34MM TI FULTHD SHLDR GLND SLF,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
AR-7000-36,SUP,HCPCS C1713,,AR-7000-36  -  SCREW BONE PTHRD 3.75MM 36MM SELF DRILL SELF TAP CANN,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
AR-7000-36FT,SUP,HCPCS C1713,,AR-7000-36FT  -  SCREW BN FT 3.75MM 36MM SLF DRL ST CNN TI SHLDR GLND,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
AR-7000-38,SUP,HCPCS C1713,,AR-7000-38  -  SCREW BN P/T 3.75MM 38MM SLF DRL ST CNN TI SHLDR GLND,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
AR-7000-38FT,SUP,HCPCS C1713,,AR-7000-38FT  -  SCREW BN FT 3.75MM 38MM SLF DRL ST CNN TI SHLDR GLND,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
AR-7000-40,SUP,HCPCS C1713,,AR-7000-40  -  SCREW BONE PTHRD 3.75MM 40MM SELF DRILL SELF TAP CANN,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
AR-7000-40FT,SUP,HCPCS C1713,,AR-7000-40FT  -  SCREW BN FT 3.75MM 40MM SLF DRL ST CNN TI SHLDR GLND,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
AR-7000-42,SUP,HCPCS C1713,,AR-7000-42  -  SCREW BONE PTHRD 3.75MM 42MM SELF DRILL SELF TAP CANN,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
AR-7000-42FT,SUP,HCPCS C1713,,AR-7000-42FT  -  SCREW BN FT 3.75MM 42MM SLF DRL ST CNN TI SHLDR GLND,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
AR-7199,SUP,Custom 27203010,,AR-7199  -  DEVICE PSTN BLU WHT FINGERSHIELD LT OPN TIP MRKR PCTV RADOPQ,$87.50,$0.00,$87.50,$0.00,$62.45,$0.00,$0.00,$0.00,$0.00,$0.00,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7200,SUP,Custom 27803010,,AR-7200  -  SUTURE NABSB 2 T-5 38IN BLU FBRWR MS LWR KNT PRFL,$55.00,$0.00,$55.00,$0.00,$39.25,$0.00,$0.00,$0.00,$0.00,$0.00,$55.00,$0.00,$27.50,$43.56,$44.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7200B,SUP,Custom 27803010,,AR-7200B  -  SUTURE NABSB 2 TPR 38IN FBRWR BRD TIE MS LWR KNT PRFL NDL,$97.50,$0.00,$97.50,$0.00,$69.59,$0.00,$0.00,$0.00,$0.00,$0.00,$97.50,$0.00,$48.75,$77.22,$78.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7201,SUP,Custom 27803010,,AR-7201  -  SUTURE NABSB 2 .5 CRC STRG DMD PT RVRS CUT 38IN BLK BLU WHT,$87.50,$0.00,$87.50,$0.00,$62.45,$0.00,$0.00,$0.00,$0.00,$0.00,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7202,SUP,Custom 27803010,,AR-7202  -  SUTURE NABSB 2 C-13 38IN BLU FBRWR BRD TIE MS LWR KNT PRFL,$55.00,$0.00,$55.00,$0.00,$39.25,$0.00,$0.00,$0.00,$0.00,$0.00,$55.00,$0.00,$27.50,$43.56,$44.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7203,SUP,Custom 27203010,,AR-7203  -  SUTURE NABSB 2 38IN B/W TIGERWIRE BRD,$57.50,$0.00,$57.50,$0.00,$41.04,$0.00,$0.00,$0.00,$0.00,$0.00,$57.50,$0.00,$28.75,$45.54,$46.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7204,SUP,Custom 27803010,,AR-7204  -  SUTURE NABSB 2 STRG 26IN GRN 10MM FBRWR BRD MS CLS LOOP LWR,$150.00,$0.00,$150.00,$0.00,$107.06,$0.00,$0.00,$0.00,$0.00,$0.00,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7205,SUP,Custom 27803010,,AR-7205  -  SUTURE NABSB 2 T-5 38IN BLU FBRWR BRD TIE MS LWR KNT PRFL,$112.50,$0.00,$112.50,$0.00,$80.29,$0.00,$0.00,$0.00,$0.00,$0.00,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7205T,SUP,Custom 27203010,,AR-7205T  -  SUTURE NABSB 2 T-5 38IN B/W FVR TGRWR 2 ARM BRD TIE MS LWR,$112.50,$0.00,$112.50,$0.00,$80.29,$0.00,$0.00,$0.00,$0.00,$0.00,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7206,SUP,Custom 27803010,,AR-7206  -  SUTURE NABSB 2 T-8 38IN BLU FBRWR 2 ARM BRD MS LWR KNT PRFL,$55.00,$0.00,$55.00,$0.00,$39.25,$0.00,$0.00,$0.00,$0.00,$0.00,$55.00,$0.00,$27.50,$43.56,$44.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7207,SUP,Custom 27803010,,AR-7207  -  SUTURE NABSB 2 38IN BLU 10MM FBRWR BRD TIE MS LWR KNT PRFL,$100.00,$0.00,$100.00,$0.00,$71.37,$0.00,$0.00,$0.00,$0.00,$0.00,$100.00,$0.00,$50.00,$79.20,$80.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7208,SUP,Custom 27803010,,AR-7208  -  SUTURE NABSB 2 T-5 38IN BLK BLU WHT FBRWR BRD TIE MS LWR KNT,$120.00,$0.00,$120.00,$0.00,$85.64,$0.00,$0.00,$0.00,$0.00,$0.00,$120.00,$0.00,$60.00,$95.04,$96.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7209,SUP,Custom 27803010,,AR-7209  -  SUTURE NABSB 2 50IN 12IN FBSTK FBRWR 1 END STIFFEN,$125.00,$0.00,$125.00,$0.00,$89.21,$0.00,$0.00,$0.00,$0.00,$0.00,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7209T,SUP,HCPCS C1713,,AR-7209T  -  SUTURE NONABSORBABLE 2 50IN 12IN 1 END STIFFEN MONOFILAMENT,$125.00,$0.00,$125.00,$56.25,$89.21,$0.00,$21.54,$0.00,$0.00,$21.89,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$19.56,$0.00,$19.90,$0.00
AR-7210,SUP,Custom 27803010,,AR-7210  -  SUTURE NABSB 5 38IN BLU FBRWR BRD TIE MS LWR KNT PRFL,$95.00,$0.00,$95.00,$0.00,$67.80,$0.00,$0.00,$0.00,$0.00,$0.00,$95.00,$0.00,$47.50,$75.24,$76.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7211,SUP,Custom 27203010,,AR-7211  -  SUTURE NABSB 5 CCS-1 38IN BLU FBRWR MS LWR KNT PRFL,$100.00,$0.00,$100.00,$0.00,$71.37,$0.00,$0.00,$0.00,$0.00,$0.00,$100.00,$0.00,$50.00,$79.20,$80.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7212,SUP,Custom 27803010,,AR-7212  -  SUTURE NABSB 5 .5 CRC 38IN BLK BLU WHT 48MM FBRWR CNV CUT,$262.50,$0.00,$262.50,$0.00,$187.35,$0.00,$0.00,$0.00,$0.00,$0.00,$262.50,$0.00,$131.25,$207.90,$210.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7213,SUP,Custom 27803010,,AR-7213  -  SUTURE NONABSORBABLE 5 T-5 CCS-1 38IN 48MM BRAID TIES,$100.00,$0.00,$100.00,$0.00,$71.37,$0.00,$0.00,$0.00,$0.00,$0.00,$100.00,$0.00,$50.00,$79.20,$80.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7216,SUP,Custom 27803010,,AR-7216  -  SUTURE NABSB 1 38IN BLU FBRWR BRD TIE MS LWR KNT PRFL,$52.50,$0.00,$52.50,$0.00,$37.47,$0.00,$0.00,$0.00,$0.00,$0.00,$52.50,$0.00,$26.25,$41.58,$42.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7217,SUP,Custom 27803010,,AR-7217  -  SUTURE NABSB 2 .5 CRC RVRS CUT 38IN BLK BLU WHT 36.6MM FBRWR,$120.00,$0.00,$120.00,$0.00,$85.64,$0.00,$0.00,$0.00,$0.00,$0.00,$120.00,$0.00,$60.00,$95.04,$96.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7220,SUP,Custom 27203010,,AR-7220  -  SUTURE NABSB 2-0 T-13 18IN BLU FBRWR MS LWR KNT PRFL,$48.75,$0.00,$48.75,$0.00,$34.79,$0.00,$0.00,$0.00,$0.00,$0.00,$48.75,$0.00,$24.38,$38.61,$39.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7221,SUP,Custom 27803010,,"AR-7221  -  FIBERWIRE, BRAIDED PB 2-0 SUTURE, BLUE",$52.50,$0.00,$52.50,$0.00,$37.47,$0.00,$0.00,$0.00,$0.00,$0.00,$52.50,$0.00,$26.25,$41.58,$42.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7222,SUP,Custom 27803010,,AR-7222  -  SUTURE NABSB 2-0 50IN BLU 12IN FBRWR FBSTK 1 END STIFFEN BRD,$105.00,$0.00,$105.00,$0.00,$74.94,$0.00,$0.00,$0.00,$0.00,$0.00,$105.00,$0.00,$52.50,$83.16,$84.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7223SM,SUP,Custom 27803010,,AR-7223SM  -  SUTURE NABSB 2-0 SM STRL FBRWR BRD SWEDGE LO KNT PRFL MNSCS,$206.25,$0.00,$206.25,$0.00,$147.20,$0.00,$0.00,$0.00,$0.00,$0.00,$206.25,$0.00,$103.13,$163.35,$165.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7227-01,SUP,Custom 27803010,,AR-7227-01  -  SUTURE NABSB 3-0 T-43 18IN BLU FBRWR BRD TIE MS LWR KNT PRFL,$55.00,$0.00,$55.00,$0.00,$39.25,$0.00,$0.00,$0.00,$0.00,$0.00,$55.00,$0.00,$27.50,$43.56,$44.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7227-02,SUP,Custom 27803010,,AR-7227-02  -  SUTURE NABSB 3-0 C-22 18IN BLU FBRWR BRD TIE MS LWR KNT PRFL,$55.00,$0.00,$55.00,$0.00,$39.25,$0.00,$0.00,$0.00,$0.00,$0.00,$55.00,$0.00,$27.50,$43.56,$44.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7228,SUP,Custom 27803010,,AR-7228  -  SUTURE NABSB 4-0 DE-10 18IN BLU FBRWR BRD TIE MS LWR KNT,$55.00,$0.00,$55.00,$0.00,$39.25,$0.00,$0.00,$0.00,$0.00,$0.00,$55.00,$0.00,$27.50,$43.56,$44.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7229-12,SUP,Custom 27203010,,AR-7229-12  -  SUTURE NABSB 4-0 T-13 12IN BLU FIBERLOOP MS,$125.00,$0.00,$125.00,$0.00,$89.21,$0.00,$0.00,$0.00,$0.00,$0.00,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7229-20,SUP,Custom 27203010,,AR-7229-20  -  SUTURE NABSB 4-0 3/8 CRC 10IN BLU 17.9MM FIBERLOOP TPR NDL,$125.00,$0.00,$125.00,$0.00,$89.21,$0.00,$0.00,$0.00,$0.00,$0.00,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7230-01,SUP,Custom 27803010,,AR-7230-01  -  SUTURE NABSB 4-0 T-12 18IN BLU FBRWR MS LWR KNT PRFL,$55.00,$0.00,$55.00,$0.00,$39.25,$0.00,$0.00,$0.00,$0.00,$0.00,$55.00,$0.00,$27.50,$43.56,$44.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7230-02,SUP,Custom 27803010,,AR-7230-02  -  SUTURE NABSB 4-0 C-17 18IN BLU FBRWR BRD TIE MS LWR KNT PRFL,$55.00,$0.00,$55.00,$0.00,$39.25,$0.00,$0.00,$0.00,$0.00,$0.00,$55.00,$0.00,$27.50,$43.56,$44.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7232-01,SUP,Custom 27203010,,AR-7232-01  -  SUTURE NABSB 2-0 D-17 60IN BLU FIBERLOOP 2 ARM MS,$125.00,$0.00,$125.00,$0.00,$89.21,$0.00,$0.00,$0.00,$0.00,$0.00,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7232-02,SUP,Custom 27203010,,AR-7232-02  -  SUTURE NABSB 2-0 D-14 24IN BLU FIBERLOOP 2 ARM MS,$125.00,$0.00,$125.00,$0.00,$89.21,$0.00,$0.00,$0.00,$0.00,$0.00,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7232-03,SUP,Custom 27203010,,AR-7232-03  -  SUTURE NABSB 2-0 SD-2 13IN BLU FIBERLOOP 2 ARM MS,$125.00,$0.00,$125.00,$0.00,$89.21,$0.00,$0.00,$0.00,$0.00,$0.00,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7232-05,SUP,Custom 27203010,,AR-7232-05  -  SUTURE NABSB 2-0 3/8 CRC TPR PNT 14IN 17.9MM FIBERLOOP LOOP,"$1,500.00",$0.00,"$1,500.00",$0.00,"$1,070.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-7233,SUP,Custom 27803010,,AR-7233  -  SUTURE NABSB 2 38IN BLU FBRWR BRD TIE MS LWR KNT PRFL,$52.50,$0.00,$52.50,$0.00,$37.47,$0.00,$0.00,$0.00,$0.00,$0.00,$52.50,$0.00,$26.25,$41.58,$42.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7234,SUP,Custom 27203010,,AR-7234  -  SUTURE NONABSORBABLE 2 7MM STR 20IN 76MM BRAID MULTISTRAND,$125.00,$0.00,$125.00,$0.00,$89.21,$0.00,$0.00,$0.00,$0.00,$0.00,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7234-01,SUP,Custom 27203010,,AR-7234-01  -  SUTURE NABSB 2 7MM STRG 20IN WHT 76MM FIBERLOOP BRD MS NDL,$125.00,$0.00,$125.00,$0.00,$89.21,$0.00,$0.00,$0.00,$0.00,$0.00,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7234B,SUP,Custom 27203010,,AR-7234B  -  SUTURE NABSB 2 STRG 20IN BLU 76MM FIBERLOOP BRD MS NDL,$187.50,$0.00,$187.50,$0.00,$133.82,$0.00,$0.00,$0.00,$0.00,$0.00,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7234C,SUP,Custom 27203010,,AR-7234C  -  SUTURE NONABSORBABLE 2 .5 CIR CURVE 20IN BRAID MULTISTRAND,$161.25,$0.00,$161.25,$0.00,$115.08,$0.00,$0.00,$0.00,$0.00,$0.00,$161.25,$0.00,$80.63,$127.71,$129.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7234T,SUP,Custom 27203010,,AR-7234T  -  SUTURE NONABSORBABLE 2 STR 20IN 3IN BRAID MULTISTRAND NEEDLE,$161.25,$0.00,$161.25,$0.00,$115.08,$0.00,$0.00,$0.00,$0.00,$0.00,$161.25,$0.00,$80.63,$127.71,$129.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7235,SUP,Custom 27203010,,AR-7235  -  SUTURE NONABSORBABLE 2 26IN 1.5IN BRAID TIES MULTISTRAND,$137.50,$0.00,$137.50,$0.00,$98.13,$0.00,$0.00,$0.00,$0.00,$0.00,$137.50,$0.00,$68.75,$108.90,$110.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7235T,SUP,Custom 27203010,,AR-7235T  -  SUTURE NABSB 2 26IN B/W TIGERLINK FBRWR CLS LOOP,$137.50,$0.00,$137.50,$0.00,$98.13,$0.00,$0.00,$0.00,$0.00,$0.00,$137.50,$0.00,$68.75,$108.90,$110.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7237,SUP,Custom 27803010,,AR-7237  -  SUTURE NABSB 2 TPR 54IN BLU 36INX2MM FIBERTAPE FBRWR BRD,$262.50,$0.00,$262.50,$0.00,$187.35,$0.00,$0.00,$0.00,$0.00,$0.00,$262.50,$0.00,$131.25,$207.90,$210.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7237-17LN,SUP,Custom 27803010,,AR-7237-17LN  -  SUTURE NABSB 2MM STRG 17IN BLU FIBERTAPE BRD,$125.00,$0.00,$125.00,$0.00,$89.21,$0.00,$0.00,$0.00,$0.00,$0.00,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7237-17N,SUP,Custom 27803010,,AR-7237-17N  -  SUTURE NABSB 2 .5 CRC TPR 17IN BLU 26.5MM FIBERTAPE FBRWR,$190.00,$0.00,$190.00,$0.00,$135.60,$0.00,$0.00,$0.00,$0.00,$0.00,$190.00,$0.00,$95.00,$150.48,$152.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7237-7,SUP,Custom 27803010,,AR-7237-7  -  SUTURE NONABSORBABLE 2 TAPER 7INX2MM BRAID FIBERTAPE,$125.00,$0.00,$125.00,$0.00,$89.21,$0.00,$0.00,$0.00,$0.00,$0.00,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7237-7T,SUP,Custom 27203010,,AR-7237-7T  -  SUTURE NABSB 2 TPR 7INX2MM B/W TIGERTAPE TIGERWIRE BRD,$125.00,$0.00,$125.00,$0.00,$89.21,$0.00,$0.00,$0.00,$0.00,$0.00,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7240,SUP,Custom 27803010,,AR-7240  -  SUTURE NONABSORBABLE 2 38IN BRAID 2 STRAND LOWER KNOT,$87.50,$0.00,$87.50,$0.00,$62.45,$0.00,$0.00,$0.00,$0.00,$0.00,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7242,SUP,Custom 27203010,,AR-7242  -  SUTURE NABSB 2-0 T-5 18IN BLU TIGERTAPE FBRWR BRD TIE MS,$55.00,$0.00,$55.00,$0.00,$39.25,$0.00,$0.00,$0.00,$0.00,$0.00,$55.00,$0.00,$27.50,$43.56,$44.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7246,SUP,Custom 27803010,,AR-7246  -  SUTURE NABSB 2 STRG DMD 38IN BLU 26.5MM FBRWR 1 END NDL,$80.00,$0.00,$80.00,$0.00,$57.10,$0.00,$0.00,$0.00,$0.00,$0.00,$80.00,$0.00,$40.00,$63.36,$64.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7246-02,SUP,Custom 27803010,,AR-7246-02  -  SUTURE NABSB 2 STRG DMD 38IN BLU 64MM FBRWR 1 END 2 NDL,$110.00,$0.00,$110.00,$0.00,$78.51,$0.00,$0.00,$0.00,$0.00,$0.00,$110.00,$0.00,$55.00,$87.12,$88.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7248,SUP,Custom 27803010,,AR-7248  -  SUTURE NABSB 4-0 T-22 18IN WHT FBRWR BRD TIE MS LWR KNT PRFL,$55.00,$0.00,$55.00,$0.00,$39.25,$0.00,$0.00,$0.00,$0.00,$0.00,$55.00,$0.00,$27.50,$43.56,$44.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7249-12,SUP,Custom 27203010,,AR-7249-12  -  SUTURE NABSB 4-0 T-22 6IN WHT FIBERLOOP MS,$125.00,$0.00,$125.00,$0.00,$89.21,$0.00,$0.00,$0.00,$0.00,$0.00,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7249-20,SUP,Custom 27203010,,AR-7249-20  -  SUTURE NABSB 4-0 T-22 10IN WHT FIBERLOOP MS,$125.00,$0.00,$125.00,$0.00,$89.21,$0.00,$0.00,$0.00,$0.00,$0.00,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7250,SUP,Custom 27803010,,AR-7250  -  SUTURE NABSB 0 T-4 38IN BLU FBRWR BRD TIE MS LWR KNT PRFL,$55.00,$0.00,$55.00,$0.00,$39.25,$0.00,$0.00,$0.00,$0.00,$0.00,$55.00,$0.00,$27.50,$43.56,$44.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7251,SUP,Custom 27803010,,AR-7251  -  SUTURE NABSB 0 D-10 38IN BLU FBRWR BRD TIE MS LWR KNT PRFL,$55.00,$0.00,$55.00,$0.00,$39.25,$0.00,$0.00,$0.00,$0.00,$0.00,$55.00,$0.00,$27.50,$43.56,$44.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7253,SUP,Custom 27203010,,AR-7253  -  SUTURE NABSB 0 7MM STRG 13IN BLU 76MM FIBERLOOP BRD MS,$125.00,$0.00,$125.00,$0.00,$89.21,$0.00,$0.00,$0.00,$0.00,$0.00,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7253T,SUP,Custom 27203010,,AR-7253T  -  SUTURE NABSB 0 7MM STRG 13IN B/W 76MM FIBERLOOP TIGERLOOP,$125.00,$0.00,$125.00,$0.00,$89.21,$0.00,$0.00,$0.00,$0.00,$0.00,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7254,SUP,Custom 27803010,,AR-7254  -  SUTURE NABSB 0 FBRWR,$52.50,$0.00,$52.50,$0.00,$37.47,$0.00,$0.00,$0.00,$0.00,$0.00,$52.50,$0.00,$26.25,$41.58,$42.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7255,SUP,Custom 27803010,,AR-7255  -  SUTURE NABSB 0 38IN WHT FBRWR LWR KNT PRFL SMTH TIE ABL SUP,$62.50,$0.00,$62.50,$0.00,$44.61,$0.00,$0.00,$0.00,$0.00,$0.00,$62.50,$0.00,$31.25,$49.50,$50.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7258,SUP,Custom 27203010,,AR-7258  -  SUTURE NABSB 0 36IN BLU 1.5IN FIBERLINK LOOP,"$1,950.00",$0.00,"$1,950.00",$0.00,"$1,391.72",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,950.00",$0.00,$975.00,"$1,544.40","$1,560.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-7258T,SUP,Custom 27203010,,AR-7258T  -  SUTURE NABSB 0 36IN 1.5IN TIGERLINK LOOP,"$1,950.00",$0.00,"$1,950.00",$0.00,"$1,391.72",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,950.00",$0.00,$975.00,"$1,544.40","$1,560.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-7264,SUP,Custom 27803010,,AR-7264  -  SUTURE NABSB 2 FIBERTAG SPEEDWHIP FIBERLOOP,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7270,SUP,Custom 27803010,,AR-7270  -  SUTURE NABSB 2 10 LNG LOOP 7MM FBRWR FIBERCHAIN BRD,$187.50,$0.00,$187.50,$0.00,$133.82,$0.00,$0.00,$0.00,$0.00,$0.00,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7272,SUP,Custom 27803010,,AR-7272  -  FIBERWIRE CL WHITE BLUE 38IN,$52.50,$0.00,$52.50,$0.00,$37.47,$0.00,$0.00,$0.00,$0.00,$0.00,$52.50,$0.00,$26.25,$41.58,$42.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7272T,SUP,Custom 27203010,,AR-7272T  -  TIGERWIRE CL WHITE BLACK 38IN W  NDL,$55.00,$0.00,$55.00,$0.00,$39.25,$0.00,$0.00,$0.00,$0.00,$0.00,$55.00,$0.00,$27.50,$43.56,$44.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7275,SUP,Custom 27803010,,AR-7275  -  SUTURE NONABSORBABLE 2 2MM 8IN 24IN FIBERTAPE FIBERWIRE BLUE,$197.50,$0.00,$197.50,$0.00,$140.96,$0.00,$0.00,$0.00,$0.00,$0.00,$197.50,$0.00,$98.75,$156.42,$158.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7275T,SUP,Custom 27203010,,AR-7275T  -  SUTURE NONABSORBABLE 2 2MM 8IN 24IN TIGERTAPE TIGERWIRE BLUE,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7276,SUP,Custom 27203010,,AR-7276  -  SUTURE NABSB 1.5MM 36IN WHT LABRALTAPE,$175.00,$0.00,$175.00,$0.00,$124.90,$0.00,$0.00,$0.00,$0.00,$0.00,$175.00,$0.00,$87.50,$138.60,$140.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7276T,SUP,Custom 27203010,,AR-7276T  -  SUTURE NONABSORBABLE 1.5MM 36IN LABRALTAPE BLACK WHITE,$175.00,$0.00,$175.00,$0.00,$124.90,$0.00,$0.00,$0.00,$0.00,$0.00,$175.00,$0.00,$87.50,$138.60,$140.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7280,SUP,Custom 27203010,,AR-7280  -  NEEDLE SUT C-13 .5 CRC RVRS CUT 36.6MM LOOP NTNL,$47.50,$0.00,$47.50,$0.00,$33.90,$0.00,$0.00,$0.00,$0.00,$0.00,$47.50,$0.00,$23.75,$37.62,$38.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7281,SUP,Custom 27203010,,AR-7281  -  NEEDLE SUT T-5 .5 CRC TPR 26.5MM BTNDS LOOP NTNL DISP,$47.50,$0.00,$47.50,$0.00,$33.90,$0.00,$0.00,$0.00,$0.00,$0.00,$47.50,$0.00,$23.75,$37.62,$38.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7282,SUP,Custom 27203010,,AR-7282  -  PASSER SUT 1 FBRWR LOOP,$112.50,$0.00,$112.50,$0.00,$80.29,$0.00,$0.00,$0.00,$0.00,$0.00,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7284,SUP,Custom 27203010,,AR-7284  -  SUTURE NABSB 2 FIBERLOOP SWAGE STRG NDL,"$1,950.00",$0.00,"$1,950.00",$0.00,"$1,391.72",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,950.00",$0.00,$975.00,"$1,544.40","$1,560.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-7300DS,SUP,Custom 27203010,,AR-7300DS  -  BLADE SHVR 3MM 7CM STRL COOLCUT ASCP DSCT S JNT DISP,$165.00,$0.00,$165.00,$0.00,$117.76,$0.00,$0.00,$0.00,$0.00,$0.00,$165.00,$0.00,$82.50,$130.68,$132.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7300OBT,SUP,Custom 27203010,,AR-7300OBT  -  BURR SHVR 10 FLUT OVL3MM S JNT,$165.00,$0.00,$165.00,$0.00,$117.76,$0.00,$0.00,$0.00,$0.00,$0.00,$165.00,$0.00,$82.50,$130.68,$132.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7324PSL,SUP,HCPCS C1713,,AR-7324PSL  -  ANCHOR SUT SWIVELOCK TENODESIS PEEK,"$1,087.50",$0.00,"$1,087.50",$489.38,$776.15,$0.00,$187.37,$0.00,$0.00,$190.41,"$1,087.50",$0.00,$543.75,$861.30,$870.00,$0.00,$170.19,$0.00,$173.13,$0.00
AR-7400TD,SUP,Custom 27203010,,AR-7400TD  -  BLADE SHVR 4MM 7CM TORPEDO COOLCUT OVIOD OUTR WDW SMTH CUT,$252.50,$0.00,$252.50,$0.00,$180.21,$0.00,$0.00,$0.00,$0.00,$0.00,$252.50,$0.00,$126.25,$199.98,$202.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7500,SUP,Custom 27203010,,AR-7500  -  SUTURE NABSB 1.3MM 36IN WHT BLU STRL SUTURETAPE .5 CRC TPR,$87.50,$0.00,$87.50,$0.00,$62.45,$0.00,$0.00,$0.00,$0.00,$0.00,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7710,SUP,Custom 27203010,,AR-7710  -  BIT DRL 5MM 15MM SCKT HUM TNL ULN COLLATERAL LGMNT,$987.50,$0.00,$987.50,$0.00,$704.78,$0.00,$0.00,$0.00,$0.00,$0.00,$987.50,$0.00,$493.75,$782.10,$790.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7710-4.5,SUP,Custom 27203010,,AR-7710-4.5  -  BIT DRL 4.5MM HUM TNL ULN COLLATERAL LGMNT,$337.50,$0.00,$337.50,$0.00,$240.87,$0.00,$0.00,$0.00,$0.00,$0.00,$337.50,$0.00,$168.75,$267.30,$270.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7710-5.0,SUP,Custom 27203010,,AR-7710-5.0  -  BIT DRL 5MM HUM TNL ULN COLLATERAL LGMNT,$337.50,$0.00,$337.50,$0.00,$240.87,$0.00,$0.00,$0.00,$0.00,$0.00,$337.50,$0.00,$168.75,$267.30,$270.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7711,SUP,Custom 27203010,,AR-7711  -  BIT DRL 4.5MM 15MM SCKT HUM TNL ULN COLLATERAL LGMNT,$987.50,$0.00,$987.50,$0.00,$704.78,$0.00,$0.00,$0.00,$0.00,$0.00,$987.50,$0.00,$493.75,$782.10,$790.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7715-4.5,SUP,Custom 27203010,,AR-7715-4.5  -  KIT INST 2 MIC CRV 6IN STRL TIGERLOOP FIBERLOOP SUTLSO NDL,"$1,737.50",$0.00,"$1,737.50",$0.00,"$1,240.05",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,737.50",$0.00,$868.75,"$1,376.10","$1,390.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-7720-2.0,SUP,Custom 27203010,,AR-7720-2.0  -  DRILL SRG 2MM RECON ELB HUM ULN COLLATERAL LGMNT,$337.50,$0.00,$337.50,$0.00,$240.87,$0.00,$0.00,$0.00,$0.00,$0.00,$337.50,$0.00,$168.75,$267.30,$270.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7720-2.7,SUP,Custom 27203010,,AR-7720-2.7  -  DRILL SRG 2.7MM HUM,$337.50,$0.00,$337.50,$0.00,$240.87,$0.00,$0.00,$0.00,$0.00,$0.00,$337.50,$0.00,$168.75,$267.30,$270.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7720-3.2,SUP,Custom 27203010,,AR-7720-3.2  -  DRILL SRG 3.2MM HUM,$337.50,$0.00,$337.50,$0.00,$240.87,$0.00,$0.00,$0.00,$0.00,$0.00,$337.50,$0.00,$168.75,$267.30,$270.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7720-3.5,SUP,Custom 27203010,,AR-7720-3.5  -  DRILL SRG 3.5MM RECON ELB HUM ULN COLLATERAL LGMNT,$337.50,$0.00,$337.50,$0.00,$240.87,$0.00,$0.00,$0.00,$0.00,$0.00,$337.50,$0.00,$168.75,$267.30,$270.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7720-4.0,SUP,Custom 27203010,,AR-7720-4.0  -  DRILL SRG 4MM RECON ELB HUM ULN COLLATERAL LGMNT,$337.50,$0.00,$337.50,$0.00,$240.87,$0.00,$0.00,$0.00,$0.00,$0.00,$337.50,$0.00,$168.75,$267.30,$270.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7750-3.5,SUP,Custom 27203010,,AR-7750-3.5  -  GUIDE DRL V 3.5MM,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7750-55,SUP,Custom 27203010,,AR-7750-55  -  GUIDE DRL 55D V ULNA,"$1,487.50",$0.00,"$1,487.50",$0.00,"$1,061.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,487.50",$0.00,$743.75,"$1,178.10","$1,190.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-7750-55M,SUP,Custom 27203010,,AR-7750-55M  -  GUIDE DRL 55D V PRT ULNA,"$1,487.50",$0.00,"$1,487.50",$0.00,"$1,061.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,487.50",$0.00,$743.75,"$1,178.10","$1,190.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-7752,SUP,Custom 27203010,,AR-7752  -  GUIDE DRL 3.5MM,$987.50,$0.00,$987.50,$0.00,$704.78,$0.00,$0.00,$0.00,$0.00,$0.00,$987.50,$0.00,$493.75,$782.10,$790.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-7755,SUP,Custom 27203010,,AR-7755  -  GUIDE DRL OFST 7MM ULNA,"$1,487.50",$0.00,"$1,487.50",$0.00,"$1,061.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,487.50",$0.00,$743.75,"$1,178.10","$1,190.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-8003-10,SUP,HCPCS C1713,,AR-8003-10  -  STAPLE BN 10X10MM CMPR SS,"$1,062.50",$0.00,"$1,062.50",$478.13,$758.31,$0.00,$183.06,$0.00,$0.00,$186.04,"$1,062.50",$0.00,$531.25,$841.50,$850.00,$0.00,$166.28,$0.00,$169.15,$0.00
AR-8003-15,SUP,HCPCS C1713,,AR-8003-15  -  STAPLE BN 15X10MM CMPR SS,"$1,062.50",$0.00,"$1,062.50",$478.13,$758.31,$0.00,$183.06,$0.00,$0.00,$186.04,"$1,062.50",$0.00,$531.25,$841.50,$850.00,$0.00,$166.28,$0.00,$169.15,$0.00
AR-8004-10,SUP,HCPCS C1713,,AR-8004-10  -  STAPLE BN 10X15MM CMPR SS,"$1,062.50",$0.00,"$1,062.50",$478.13,$758.31,$0.00,$183.06,$0.00,$0.00,$186.04,"$1,062.50",$0.00,$531.25,$841.50,$850.00,$0.00,$166.28,$0.00,$169.15,$0.00
AR-8004-15,SUP,HCPCS C1713,,AR-8004-15  -  STAPLE BN 15X15MM CMPR SS DISP,"$1,062.50",$0.00,"$1,062.50",$478.13,$758.31,$0.00,$183.06,$0.00,$0.00,$186.04,"$1,062.50",$0.00,$531.25,$841.50,$850.00,$0.00,$166.28,$0.00,$169.15,$0.00
AR-8005-20,SUP,HCPCS C1713,,AR-8005-20  -  STAPLE BN 20X20MM CMPR SS DISP,"$1,062.50",$0.00,"$1,062.50",$478.13,$758.31,$0.00,$183.06,$0.00,$0.00,$186.04,"$1,062.50",$0.00,$531.25,$841.50,$850.00,$0.00,$166.28,$0.00,$169.15,$0.00
AR-8005D-20,SUP,Custom 27203010,,AR-8005D-20  -  BIT DRL 2MM 120MM CNN,$347.50,$0.00,$347.50,$0.00,$248.01,$0.00,$0.00,$0.00,$0.00,$0.00,$347.50,$0.00,$173.75,$275.22,$278.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8005D-30,SUP,Custom 27203010,,AR-8005D-30  -  BIT DRL 3MM 120MM CNN,$347.50,$0.00,$347.50,$0.00,$248.01,$0.00,$0.00,$0.00,$0.00,$0.00,$347.50,$0.00,$173.75,$275.22,$278.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8006-20,SUP,HCPCS C1713,,AR-8006-20  -  PLATE BN 20MM 2 CMPR 2 HL SS FT/ANKL,"$2,237.50",$0.00,"$2,237.50","$1,006.88","$1,596.90",$0.00,$385.51,$0.00,$0.00,$391.77,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$350.17,$0.00,$356.21,$0.00
AR-8006-25,SUP,HCPCS C1713,,AR-8006-25  -  PLATE BN 25MM 2 CMPR 2 HL SS FT/ANKL,"$2,237.50",$0.00,"$2,237.50","$1,006.88","$1,596.90",$0.00,$385.51,$0.00,$0.00,$391.77,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$350.17,$0.00,$356.21,$0.00
AR-8006-30,SUP,HCPCS C1713,,AR-8006-30  -  PLATE BN 30MM 2 CMPR 2 HL SS FT/ANKL,"$2,237.50",$0.00,"$2,237.50","$1,006.88","$1,596.90",$0.00,$385.51,$0.00,$0.00,$391.77,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$350.17,$0.00,$356.21,$0.00
AR-8006C,SUP,Custom 27203010,,AR-8006C  -  BIT DRL 2.4MM TRMIT CNN SLF CMPR THRD PTCH,"$3,625.00",$0.00,"$3,625.00",$0.00,"$2,587.16",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,625.00",$0.00,"$1,812.50","$2,871.00","$2,900.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-8006S,SUP,Custom 27203010,,AR-8006S  -  BIT DRL 2.5MM LAPIDUS CNN SLF CMPR THRD PTCH MIDFOOT,"$10,000.00",$0.00,"$10,000.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-8006T,SUP,HCPCS C1713,,AR-8006T  -  PLATE BN TRL 2 HL 2 CMPR,"$1,237.50",$0.00,"$1,237.50",$556.88,$883.20,$0.00,$213.22,$0.00,$0.00,$216.68,"$1,237.50",$0.00,$618.75,$980.10,$990.00,$0.00,$193.67,$0.00,$197.01,$0.00
AR-8007-20,SUP,HCPCS C1713,,AR-8007-20  -  PLATE BN 20MM 2 CMPR 3 HL SS FT/ANKL,"$2,487.50",$0.00,"$2,487.50","$1,119.38","$1,775.33",$0.00,$428.58,$0.00,$0.00,$435.54,"$2,487.50",$0.00,"$1,243.75","$1,970.10","$1,990.00",$0.00,$389.29,$0.00,$396.01,$0.00
AR-8007-25,SUP,HCPCS C1713,,AR-8007-25  -  PLATE BN 25MM 2 CMPR 3 HL SS FT/ANKL,"$2,487.50",$0.00,"$2,487.50","$1,119.38","$1,775.33",$0.00,$428.58,$0.00,$0.00,$435.54,"$2,487.50",$0.00,"$1,243.75","$1,970.10","$1,990.00",$0.00,$389.29,$0.00,$396.01,$0.00
AR-8007-30,SUP,HCPCS C1713,,AR-8007-30  -  PLATE BN 30MM 2 CMPR 3 HL SS FT/ANKL,"$2,487.50",$0.00,"$2,487.50","$1,119.38","$1,775.33",$0.00,$428.58,$0.00,$0.00,$435.54,"$2,487.50",$0.00,"$1,243.75","$1,970.10","$1,990.00",$0.00,$389.29,$0.00,$396.01,$0.00
AR-8007C-1,SUP,HCPCS C1713,,AR-8007C-1  -  CASE INST 2 CMPR,"$4,737.50",$0.00,"$4,737.50","$2,131.88","$3,381.15",$0.00,$816.25,$0.00,$0.00,$829.50,"$4,737.50",$0.00,"$2,368.75","$3,752.10","$3,790.00",$0.00,$741.42,$0.00,$754.21,$0.00
AR-8007T,SUP,HCPCS C1713,,AR-8007T  -  TRIAL TRMA 3 HL 2 CMPR PLT,"$1,237.50",$0.00,"$1,237.50",$556.88,$883.20,$0.00,$213.22,$0.00,$0.00,$216.68,"$1,237.50",$0.00,$618.75,$980.10,$990.00,$0.00,$193.67,$0.00,$197.01,$0.00
AR-8008-20,SUP,HCPCS C1713,,AR-8008-20  -  PLATE BN STRG 20MM 2 CMPR 4 HL SS FT/ANKL,"$2,987.50",$0.00,"$2,987.50","$1,344.38","$2,132.18",$0.00,$514.73,$0.00,$0.00,$523.09,"$2,987.50",$0.00,"$1,493.75","$2,366.10","$2,390.00",$0.00,$467.54,$0.00,$475.61,$0.00
AR-8008-25,SUP,HCPCS C1713,,AR-8008-25  -  PLATE BN STRG 25MM 2 CMPR 4 HL SS FT/ANKL,"$2,987.50",$0.00,"$2,987.50","$1,344.38","$2,132.18",$0.00,$514.73,$0.00,$0.00,$523.09,"$2,987.50",$0.00,"$1,493.75","$2,366.10","$2,390.00",$0.00,$467.54,$0.00,$475.61,$0.00
AR-8008-30,SUP,HCPCS C1713,,AR-8008-30  -  PLATE BN STRG 30MM 2 CMPR 4 HL SS FT/ANKL,"$2,987.50",$0.00,"$2,987.50","$1,344.38","$2,132.18",$0.00,$514.73,$0.00,$0.00,$523.09,"$2,987.50",$0.00,"$1,493.75","$2,366.10","$2,390.00",$0.00,$467.54,$0.00,$475.61,$0.00
AR-8009-20,SUP,HCPCS C1713,,AR-8009-20  -  PLATE BN SQ 20MM 2 CMPR 4 HL SS FT/ANKL,"$2,987.50",$0.00,"$2,987.50","$1,344.38","$2,132.18",$0.00,$514.73,$0.00,$0.00,$523.09,"$2,987.50",$0.00,"$1,493.75","$2,366.10","$2,390.00",$0.00,$467.54,$0.00,$475.61,$0.00
AR-8009-25,SUP,HCPCS C1713,,AR-8009-25  -  PLATE BN SQ 25MM 2 CMPR 4 HL SS FT/ANKL,"$2,987.50",$0.00,"$2,987.50","$1,344.38","$2,132.18",$0.00,$514.73,$0.00,$0.00,$523.09,"$2,987.50",$0.00,"$1,493.75","$2,366.10","$2,390.00",$0.00,$467.54,$0.00,$475.61,$0.00
AR-8009-30,SUP,HCPCS C1713,,AR-8009-30  -  PLATE BN SQ 30MM 2 CMPR 4 HL SS FT/ANKL,"$2,987.50",$0.00,"$2,987.50","$1,344.38","$2,132.18",$0.00,$514.73,$0.00,$0.00,$523.09,"$2,987.50",$0.00,"$1,493.75","$2,366.10","$2,390.00",$0.00,$467.54,$0.00,$475.61,$0.00
AR-8400CSS,SUP,Custom 27203010,,AR-8400CSS  -  BURR SHVR 6 FLUT 4MM 13CM STRL CLRCT COOLCUT SLAP,$165.00,$0.00,$165.00,$0.00,$117.76,$0.00,$0.00,$0.00,$0.00,$0.00,$165.00,$0.00,$82.50,$130.68,$132.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8400EX,SUP,Custom 27203010,,AR-8400EX  -  BLADE SHVR 4MM 13CM STRL EXCLBR COOLCUT DISP,$147.50,$0.00,$147.50,$0.00,$105.27,$0.00,$0.00,$0.00,$0.00,$0.00,$147.50,$0.00,$73.75,$116.82,$118.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8400OBE,SUP,Custom 27203010,,AR-8400OBE  -  BURR SHVR 8 FLUT OVL 4MM 13CM STRL COOLCUT DISP,$147.50,$0.00,$147.50,$0.00,$105.27,$0.00,$0.00,$0.00,$0.00,$0.00,$147.50,$0.00,$73.75,$116.82,$118.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8500BC,SUP,Custom 27203010,,AR-8500BC  -  CUTTER BN CUT 5MM 13CM STRL COOLCUT DISP,$165.00,$0.00,$165.00,$0.00,$117.76,$0.00,$0.00,$0.00,$0.00,$0.00,$165.00,$0.00,$82.50,$130.68,$132.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8500EX,SUP,Custom 27203010,,AR-8500EX  -  BLADE SHVR 5MM 13CM STRL EXCLBR COOLCUT DISP,$147.50,$0.00,$147.50,$0.00,$105.27,$0.00,$0.00,$0.00,$0.00,$0.00,$147.50,$0.00,$73.75,$116.82,$118.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8500OBE,SUP,Custom 27203010,,AR-8500OBE  -  BURR SHVR 8 FLUT OVL 5MM 13CM STRL COOLCUT DISP,$147.50,$0.00,$147.50,$0.00,$105.27,$0.00,$0.00,$0.00,$0.00,$0.00,$147.50,$0.00,$73.75,$116.82,$118.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8545-16,SUP,HCPCS C1713,,AR-8545-16  -  SCREW BN LOPRFL 4.5MM 16MM ANKL,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
AR-8545-18,SUP,HCPCS C1713,,AR-8545-18  -  SCREW BN LOPRFL 4.5MM 18MM ANKL,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
AR-8545-20,SUP,HCPCS C1713,,AR-8545-20  -  SCREW BN LOPRFL 4.5MM 20MM ANKL,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
AR-8545-22,SUP,HCPCS C1713,,AR-8545-22  -  SCREW BN LOPRFL 4.5MM 22MM ANKL,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
AR-8545-24,SUP,HCPCS C1713,,AR-8545-24  -  SCREW BN LOPRFL 4.5MM 24MM ANKL,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
AR-8545-26,SUP,HCPCS C1713,,AR-8545-26  -  SCREW BN LOPRFL 4.5MM 26MM ANKL,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
AR-8545-28,SUP,HCPCS C1713,,AR-8545-28  -  SCREW BN LOPRFL 4.5MM 28MM ANKL,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
AR-8545-30,SUP,HCPCS C1713,,AR-8545-30  -  SCREW BN LOPRFL 4.5MM 30MM ANKL,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
AR-8545-32,SUP,HCPCS C1713,,AR-8545-32  -  SCREW BN LOPRFL 4.5MM 32MM ANKL,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
AR-8545-34,SUP,HCPCS C1713,,AR-8545-34  -  SCREW BN LOPRFL 4.5MM 34MM ANKL,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
AR-8545-36,SUP,HCPCS C1713,,AR-8545-36  -  SCREW BN LOPRFL 4.5MM 36MM ANKL,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
AR-8545-38,SUP,HCPCS C1713,,AR-8545-38  -  SCREW BN LOPRFL 4.5MM 38MM ANKL,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
AR-8545-40,SUP,HCPCS C1713,,AR-8545-40  -  SCREW BN LOPRFL 4.5MM 40MM ANKL,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
AR-8545-42,SUP,HCPCS C1713,,AR-8545-42  -  SCREW BN 4.5MM 42MM NS ARTHX LOPRFL TI,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
AR-8545-45,SUP,HCPCS C1713,,AR-8545-45  -  SCREW BN LOPRFL 4.5MM 45MM ANKL,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
AR-8545-48,SUP,HCPCS C1713,,AR-8545-48  -  SCREW BN 4.5MM 48MM LOPRFL TI,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
AR-8545-50,SUP,HCPCS C1713,,AR-8545-50  -  SCREW BN LOPRFL 4.5MM 50MM ANKL,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
AR-8545-55,SUP,HCPCS C1713,,AR-8545-55  -  SCREW BN LOPRFL 4.5MM 55MM ANKL,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
AR-8545-60,SUP,HCPCS C1713,,AR-8545-60  -  SCREW BN LOPRFL 4.5MM 60MM ANKL,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
AR-8545-65,SUP,HCPCS C1713,,AR-8545-65  -  SCREW BN LOPRFL 4.5MM 65MM ANKL,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
AR-8545L-16,SUP,HCPCS C1713,,AR-8545L-16  -  SCREW BN LOPRFL 4.5MM 16MM LCK ANKL,$487.50,$0.00,$487.50,$219.38,$347.93,$0.00,$83.99,$0.00,$0.00,$85.36,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$76.29,$0.00,$77.61,$0.00
AR-8545L-18,SUP,HCPCS C1713,,AR-8545L-18  -  SCREW BN LOPRFL 4.5MM 18MM LCK ANKL,$487.50,$0.00,$487.50,$219.38,$347.93,$0.00,$83.99,$0.00,$0.00,$85.36,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$76.29,$0.00,$77.61,$0.00
AR-8545L-20,SUP,HCPCS C1713,,AR-8545L-20  -  SCREW BN LOPRFL 4.5MM 20MM LCK ANKL,$487.50,$0.00,$487.50,$219.38,$347.93,$0.00,$83.99,$0.00,$0.00,$85.36,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$76.29,$0.00,$77.61,$0.00
AR-8545L-22,SUP,HCPCS C1713,,AR-8545L-22  -  SCREW BN LOPRFL 4.5MM 22MM LCK ANKL,$487.50,$0.00,$487.50,$219.38,$347.93,$0.00,$83.99,$0.00,$0.00,$85.36,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$76.29,$0.00,$77.61,$0.00
AR-8545L-24,SUP,HCPCS C1713,,AR-8545L-24  -  SCREW BN LOPRFL 4.5MM 24MM LCK ANKL,$487.50,$0.00,$487.50,$219.38,$347.93,$0.00,$83.99,$0.00,$0.00,$85.36,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$76.29,$0.00,$77.61,$0.00
AR-8545L-26,SUP,HCPCS C1713,,AR-8545L-26  -  SCREW BN LOPRFL 4.5MM 26MM LCK ANKL,$487.50,$0.00,$487.50,$219.38,$347.93,$0.00,$83.99,$0.00,$0.00,$85.36,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$76.29,$0.00,$77.61,$0.00
AR-8545L-28,SUP,HCPCS C1713,,AR-8545L-28  -  SCREW BN LOPRFL 4.5MM 28MM LCK ANKL,$487.50,$0.00,$487.50,$219.38,$347.93,$0.00,$83.99,$0.00,$0.00,$85.36,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$76.29,$0.00,$77.61,$0.00
AR-8545L-30,SUP,HCPCS C1713,,AR-8545L-30  -  SCREW BN LOPRFL 4.5MM 30MM LCK ANKL,$487.50,$0.00,$487.50,$219.38,$347.93,$0.00,$83.99,$0.00,$0.00,$85.36,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$76.29,$0.00,$77.61,$0.00
AR-8545L-32,SUP,HCPCS C1713,,AR-8545L-32  -  SCREW BN LOPRFL 4.5MM 32MM LCK ANKL,$487.50,$0.00,$487.50,$219.38,$347.93,$0.00,$83.99,$0.00,$0.00,$85.36,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$76.29,$0.00,$77.61,$0.00
AR-8545L-34,SUP,HCPCS C1713,,AR-8545L-34  -  SCREW BN LOPRFL 4.5MM 34MM LCK ANKL,$487.50,$0.00,$487.50,$219.38,$347.93,$0.00,$83.99,$0.00,$0.00,$85.36,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$76.29,$0.00,$77.61,$0.00
AR-8545L-36,SUP,HCPCS C1713,,AR-8545L-36  -  SCREW BN LOPRFL 4.5MM 36MM LCK ANKL,$487.50,$0.00,$487.50,$219.38,$347.93,$0.00,$83.99,$0.00,$0.00,$85.36,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$76.29,$0.00,$77.61,$0.00
AR-8545L-38,SUP,HCPCS C1713,,AR-8545L-38  -  SCREW BN LOPRFL 4.5MM 38MM LCK ANKL,$487.50,$0.00,$487.50,$219.38,$347.93,$0.00,$83.99,$0.00,$0.00,$85.36,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$76.29,$0.00,$77.61,$0.00
AR-8545L-40,SUP,HCPCS C1713,,AR-8545L-40  -  SCREW BN LOPRFL 4.5MM 40MM LCK ANKL,$487.50,$0.00,$487.50,$219.38,$347.93,$0.00,$83.99,$0.00,$0.00,$85.36,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$76.29,$0.00,$77.61,$0.00
AR-8545L-44,SUP,HCPCS C1713,,AR-8545L-44  -  SCREW BN 4.5MM 44MM NS ARTHX LCK LOPRFL TI,$487.50,$0.00,$487.50,$219.38,$347.93,$0.00,$83.99,$0.00,$0.00,$85.36,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$76.29,$0.00,$77.61,$0.00
AR-8545L-50,SUP,HCPCS C1713,,AR-8545L-50  -  SCREW BN LOPRFL 4.5MM 50MM LCK ANKL,$487.50,$0.00,$487.50,$219.38,$347.93,$0.00,$83.99,$0.00,$0.00,$85.36,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$76.29,$0.00,$77.61,$0.00
AR-8545L-50S,SUP,HCPCS C1713,,AR-8545L-50S  -  SCREW BN 4.5MM 50MM STRL ARTHX LOPRFL LCK,$487.50,$0.00,$487.50,$219.38,$347.93,$0.00,$83.99,$0.00,$0.00,$85.36,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$76.29,$0.00,$77.61,$0.00
AR-8545L-52,SUP,HCPCS C1713,,AR-8545L-52  -  SCREW BN 4.5MM 52MM LOPRFL LCK,$487.50,$0.00,$487.50,$219.38,$347.93,$0.00,$83.99,$0.00,$0.00,$85.36,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$76.29,$0.00,$77.61,$0.00
AR-8545L-54,SUP,HCPCS C1713,,AR-8545L-54  -  SCREW BN 4.5MM 54MM LOPRFL LCK,$487.50,$0.00,$487.50,$219.38,$347.93,$0.00,$83.99,$0.00,$0.00,$85.36,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$76.29,$0.00,$77.61,$0.00
AR-8545L-55,SUP,HCPCS C1713,,AR-8545L-55  -  SCREW BN LOPRFL 4.5MM 55MM LCK ANKL,$487.50,$0.00,$487.50,$219.38,$347.93,$0.00,$83.99,$0.00,$0.00,$85.36,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$76.29,$0.00,$77.61,$0.00
AR-8545L-56,SUP,HCPCS C1713,,AR-8545L-56  -  SCREW BN 4.5MM 56MM LOPRFL LCK,$487.50,$0.00,$487.50,$219.38,$347.93,$0.00,$83.99,$0.00,$0.00,$85.36,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$76.29,$0.00,$77.61,$0.00
AR-8545L-58,SUP,HCPCS C1713,,AR-8545L-58  -  SCREW BN 4.5MM 58MM LOPRFL LCK,$487.50,$0.00,$487.50,$219.38,$347.93,$0.00,$83.99,$0.00,$0.00,$85.36,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$76.29,$0.00,$77.61,$0.00
AR-8545L-60,SUP,HCPCS C1713,,AR-8545L-60  -  SCREW BN LOPRFL 4.5MM 60MM LCK ANKL,$487.50,$0.00,$487.50,$219.38,$347.93,$0.00,$83.99,$0.00,$0.00,$85.36,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$76.29,$0.00,$77.61,$0.00
AR-8545L-65,SUP,HCPCS C1713,,AR-8545L-65  -  SCREW BN LOPRFL 4.5MM 65MM LCK ANKL,$487.50,$0.00,$487.50,$219.38,$347.93,$0.00,$83.99,$0.00,$0.00,$85.36,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$76.29,$0.00,$77.61,$0.00
AR-8555-20,SUP,HCPCS C1713,,AR-8555-20  -  SCREW BN LOPRFL 5.5MM 20MM ANKL CANC,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
AR-8555-25,SUP,HCPCS C1713,,AR-8555-25  -  SCREW BN LOPRFL 5.5MM 25MM ANKL CANC,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
AR-8555-30,SUP,HCPCS C1713,,AR-8555-30  -  SCREW BN LOPRFL 5.5MM 30MM ANKL CANC,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
AR-8555-35,SUP,HCPCS C1713,,AR-8555-35  -  SCREW BN LOPRFL 5.5MM 35MM ANKL CANC,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
AR-8555-40,SUP,HCPCS C1713,,AR-8555-40  -  SCREW BN LOPRFL 5.5MM 40MM ANKL CANC,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
AR-8555-45,SUP,HCPCS C1713,,AR-8555-45  -  SCREW BN LOPRFL 5.5MM 45MM ANKL CANC,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
AR-8555-50,SUP,HCPCS C1713,,AR-8555-50  -  SCREW BN LOPRFL 5.5MM 50MM ANKL CANC,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
AR-8555-55,SUP,HCPCS C1713,,AR-8555-55  -  SCREW BN LOPRFL 5.5MM 55MM ANKL CANC,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
AR-8555-60,SUP,HCPCS C1713,,AR-8555-60  -  SCREW BN LOPRFL 5.5MM 60MM ANKL CANC,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
AR-8555-65,SUP,HCPCS C1713,,AR-8555-65  -  SCREW BN LOPRFL 5.5MM 65MM ANKL CANC,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
AR-8555-70,SUP,HCPCS C1713,,AR-8555-70  -  SCREW BN LOPRFL 5.5MM 70MM ANKL CANC,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
AR-8555-75,SUP,HCPCS C1713,,AR-8555-75  -  SCREW BN LOPRFL 5.5MM 75MM ANKL CANC,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
AR-8610DB-25,SUP,Custom 27203010,,"AR-8610DB-25  -  DRILL BIT, CANNULATED, 1.7MM",$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8610DB-25C,SUP,Custom 27203010,,AR-8610DB-25C  -  BIT DRL 1.7MM CNN,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8610DB-30,SUP,Custom 27203010,,"AR-8610DB-30  -  DRILL BIT, CANNULATED, 2.0MM",$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8610DB-30C,SUP,Custom 27203010,,AR-8610DB-30C  -  BIT DRL 2MM CNN VTRN,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8610DB-43,SUP,Custom 27203010,,"AR-8610DB-43  -  DRILL BIT, CANNULATED, 3.0MM",$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8610DB-43C,SUP,Custom 27203010,,AR-8610DB-43C  -  BIT DRL 3MM CNN DISP 4.3MM HDLS CMPR SCR,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8610DB-65,SUP,Custom 27203010,,"AR-8610DB-65  -  DRILL BIT, CANNULATED, 4.3MM",$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8610DB-65C,SUP,Custom 27203010,,AR-8610DB-65C  -  BIT DRL 4.3MM CNN DISP 6.5MM HDLS CMPR P/T SCR,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8610S-01,SUP,HCPCS C1713,,AR-8610S-01  -  HEADLESS COMPRESSION SCREW SYSTEM2.5/3.0,"$34,412.50",$0.00,"$34,412.50","$15,485.63","$5,158.80",$0.00,"$5,929.10",$0.00,$0.00,"$6,025.35","$34,412.50",$0.00,"$17,206.25","$27,254.70","$27,530.00",$0.00,"$5,385.56",$0.00,"$5,478.47",$0.00
AR-8610S-02,SUP,HCPCS C1713,,AR-8610S-02  -  HEADLESS COMPRESSION SCREW SYSTEM4.3/6.5,"$29,750.00",$0.00,"$29,750.00","$13,387.50","$5,158.80",$0.00,"$5,125.78",$0.00,$0.00,"$5,208.99","$29,750.00",$0.00,"$14,875.00","$23,562.00","$23,800.00",$0.00,"$4,655.88",$0.00,"$4,736.20",$0.00
AR-8625-08,SUP,HCPCS C1713,,AR-8625-08  -  HEADLESS COMPR SCRW 2.5X 8 MMCANN,$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
AR-8625-10,SUP,HCPCS C1713,,AR-8625-10  -  HEADLESS COMPR SCRW 2.5X 10 MMCANN,$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
AR-8625-12,SUP,HCPCS C1713,,AR-8625-12  -  HEADLESS COMPR SCRW 2.5X 12 MMCANN,$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
AR-8625-14,SUP,HCPCS C1713,,AR-8625-14  -  HEADLESS COMPR SCRW 2.5X 14 MMCANN,$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
AR-8625-16,SUP,HCPCS C1713,,AR-8625-16  -  HEADLESS COMPR SCRW 2.5X 16 MMCANN,$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
AR-8625-18,SUP,HCPCS C1713,,AR-8625-18  -  HEADLESS COMPR SCRW 2.5X 18 MMCANN,$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
AR-8625-20,SUP,HCPCS C1713,,AR-8625-20  -  SCREW BN T15 FT HEXALOBE 3.5MM 20MM LOPRFL SCR SLF DRL SLD,$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
AR-8625-22,SUP,HCPCS C1713,,AR-8625-22  -  HEADLESS COMPR SCRW 2.5X 22 MMCANN,$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
AR-8625-24,SUP,HCPCS C1713,,AR-8625-24  -  HEADLESS COMPR SCRW 2.5X 24 MMCANN,$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
AR-8625-26,SUP,HCPCS C1713,,AR-8625-26  -  HEADLESS COMPR SCRW 2.5X 26 MMCANN,$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
AR-8625-28,SUP,HCPCS C1713,,AR-8625-28  -  HEADLESS COMPR SCRW 2.5X 28 MMCANN,$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
AR-8625-30,SUP,HCPCS C1713,,AR-8625-30  -  HEADLESS COMPR SCRW 2.5X 30 MMCANN,$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
AR-8625-32,SUP,HCPCS C1713,,AR-8625-32  -  HEADLESS COMPR SCRW 2.5X 32 MMCANN,$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
AR-8625-34,SUP,HCPCS C1713,,AR-8625-34  -  HEADLESS COMPR SCRW 2.5X 34 MMCANN,$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
AR-8630-10,SUP,HCPCS C1713,,"AR-8630-10  -  HEDLESS COMPR SCRW,3.0X 10 MMCANN",$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
AR-8630-12,SUP,HCPCS C1713,,"AR-8630-12  -  HEDLESS COMPR SCRW,3.0X 12 MMCANN",$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
AR-8630-14,SUP,HCPCS C1713,,"AR-8630-14  -  HEDLESS COMPR SCRW,3.0X 14 MMCANN",$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
AR-8630-16,SUP,HCPCS C1713,,"AR-8630-16  -  HEDLESS COMPR SCRW,3.0X 16 MMCANN",$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
AR-8630-18,SUP,HCPCS C1713,,"AR-8630-18  -  HEDLESS COMPR SCRW,3.0X 18 MMCANN",$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
AR-8630-20,SUP,HCPCS C1713,,"AR-8630-20  -  HEDLESS COMPR SCRW,3.0X 20 MMCANN",$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
AR-8630-22,SUP,HCPCS C1713,,"AR-8630-22  -  HEDLESS COMPR SCRW,3.0X 22 MMCANN",$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
AR-8630-24,SUP,HCPCS C1713,,AR-8630-24  -  SCREW BN 3MM 24MM NS ARTHX CMPR CNN HDLS,$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
AR-8630-26,SUP,HCPCS C1713,,"AR-8630-26  -  HEDLESS COMPR SCRW,3.0X 26 MMCANN",$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
AR-8630-28,SUP,HCPCS C1713,,"AR-8630-28  -  HEDLESS COMPR SCRW,3.0X 28 MMCANN",$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
AR-8630-30,SUP,HCPCS C1713,,"AR-8630-30  -  HEDLESS COMPR SCRW,3.0X 30 MMCANN",$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
AR-8630-32,SUP,HCPCS C1713,,"AR-8630-32  -  HEDLESS COMPR SCRW,3.0X 32 MMCANN",$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
AR-8630-34,SUP,HCPCS C1713,,"AR-8630-34  -  HEDLESS COMPR SCRW,3.0X 34 MMCANN",$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
AR-8630-36,SUP,HCPCS C1713,,"AR-8630-36  -  HEDLESS COMPR SCRW,3.0X 36 MMCANN",$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
AR-8643-14,SUP,HCPCS C1713,,"AR-8643-14  -  HEDLESS COMPR SCRW,4.3X 14 MMCANN",$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
AR-8643-16,SUP,HCPCS C1713,,"AR-8643-16  -  HEDLESS COMPR SCRW,4.3X 16 MMCANN",$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
AR-8643-18,SUP,HCPCS C1713,,"AR-8643-18  -  HEDLESS COMPR SCRW,4.3X 18 MMCANN",$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
AR-8643-20,SUP,HCPCS C1713,,"AR-8643-20  -  HEDLESS COMPR SCRW,4.3X 20 MMCANN",$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
AR-8643-22,SUP,HCPCS C1713,,"AR-8643-22  -  HEDLESS COMPR SCRW,4.3X 22 MMCANN",$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
AR-8643-24,SUP,HCPCS C1713,,"AR-8643-24  -  HEDLESS COMPR SCRW,4.3X 24 MMCANN",$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
AR-8643-26,SUP,HCPCS C1713,,"AR-8643-26  -  HEDLESS COMPR SCRW,4.3X 26 MMCANN",$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
AR-8643-28,SUP,HCPCS C1713,,"AR-8643-28  -  HEDLESS COMPR SCRW,4.3X 28 MMCANN",$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
AR-8643-30,SUP,HCPCS C1713,,"AR-8643-30  -  HEDLESS COMPR SCRW,4.3X 30 MMCANN",$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
AR-8643-32,SUP,HCPCS C1713,,"AR-8643-32  -  HEDLESS COMPR SCRW,4.3X 32 MMCANN",$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
AR-8643-34,SUP,HCPCS C1713,,"AR-8643-34  -  HEDLESS COMPR SCRW,4.3X 34 MMCANN",$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
AR-8643-36,SUP,HCPCS C1713,,"AR-8643-36  -  HEDLESS COMPR SCRW,4.3X 36 MMCANN",$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
AR-8643-38,SUP,HCPCS C1713,,"AR-8643-38  -  HEDLESS COMPR SCRW,4.3X 38 MMCANN",$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
AR-8643-40,SUP,HCPCS C1713,,"AR-8643-40  -  HEDLESS COMPR SCRW,4.3X 40 MMCANN",$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
AR-8643-42,SUP,HCPCS C1713,,"AR-8643-42  -  HEDLESS COMPR SCRW,4.3X 42 MMCANN",$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
AR-8643-44,SUP,HCPCS C1713,,"AR-8643-44  -  HEDLESS COMPR SCRW,4.3X 44 MMCANN",$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
AR-8643-46,SUP,HCPCS C1713,,"AR-8643-46  -  HEDLESS COMPR SCRW,4.3X 46 MMCANN",$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
AR-8643-48,SUP,HCPCS C1713,,"AR-8643-48  -  HEDLESS COMPR SCRW,4.3X 48 MMCANN",$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
AR-8643-50,SUP,HCPCS C1713,,"AR-8643-50  -  HEDLESS COMPR SCRW,4.3X 50 MMCANN",$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
AR-8643-55,SUP,HCPCS C1713,,"AR-8643-55  -  HEDLESS COMPR SCRW,4.3X 55 MMCANN",$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
AR-8643-60,SUP,HCPCS C1713,,"AR-8643-60  -  HEDLESS COMPR SCRW,4.3X 60 MMCANN",$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
AR-8643-65,SUP,HCPCS C1713,,"AR-8643-65  -  HEDLESS COMPR SCRW,4.3X 65 MMCANN",$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
AR-8643-70,SUP,HCPCS C1713,,"AR-8643-70  -  HEDLESS COMPR SCRW,4.3X 70 MMCANN",$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
AR-8643-75,SUP,HCPCS C1713,,"AR-8643-75  -  HEDLESS COMPR SCRW,4.3X 75 MMCANN",$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
AR-8643-80,SUP,HCPCS C1713,,"AR-8643-80  -  HEDLESS COMPR SCRW,4.3X 80 MMCANN",$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
AR-8655-13,SUP,Custom 27203010,,AR-8655-13  -  GUIDE DRL ANKL,$875.00,$0.00,$875.00,$0.00,$624.49,$0.00,$0.00,$0.00,$0.00,$0.00,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8656G,SUP,Custom 27203010,,AR-8656G  -  GUIDE DRL GPS TRGT,"$4,987.50",$0.00,"$4,987.50",$0.00,"$3,559.58",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,987.50",$0.00,"$2,493.75","$3,950.10","$3,990.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-8656G-04,SUP,Custom 27203010,,AR-8656G-04  -  CANNULA ASCP GPS 1.1/1.6/2.4 MM,"$1,125.00",$0.00,"$1,125.00",$0.00,$802.91,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8665-100,SUP,HCPCS C1713,,AR-8665-100  -  HEDLESS COMPR SCRW 6.5X 100 MMCANN,"$1,312.50",$0.00,"$1,312.50",$590.63,$936.73,$0.00,$226.14,$0.00,$0.00,$229.81,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$205.41,$0.00,$208.95,$0.00
AR-8665-105,SUP,HCPCS C1713,,AR-8665-105  -  HEDLESS COMPR SCRW 6.5X 105 MMCANN,"$1,312.50",$0.00,"$1,312.50",$590.63,$936.73,$0.00,$226.14,$0.00,$0.00,$229.81,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$205.41,$0.00,$208.95,$0.00
AR-8665-110,SUP,HCPCS C1713,,AR-8665-110  -  HEDLESS COMPR SCRW 6.5X 110MMCANN,"$1,312.50",$0.00,"$1,312.50",$590.63,$936.73,$0.00,$226.14,$0.00,$0.00,$229.81,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$205.41,$0.00,$208.95,$0.00
AR-8665-115,SUP,HCPCS C1713,,AR-8665-115  -  HEDLESS COMPR SCRW 6.5X 115 MMCANN,"$1,312.50",$0.00,"$1,312.50",$590.63,$936.73,$0.00,$226.14,$0.00,$0.00,$229.81,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$205.41,$0.00,$208.95,$0.00
AR-8665-120,SUP,HCPCS C1713,,AR-8665-120  -  HEDLESS COMPR SCRW 6.5X 120 MMCANN,"$1,312.50",$0.00,"$1,312.50",$590.63,$936.73,$0.00,$226.14,$0.00,$0.00,$229.81,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$205.41,$0.00,$208.95,$0.00
AR-8665-18100,SUP,HCPCS C1713,,AR-8665-18100  -  SCREW BN ST 6.5MM 100MM CMPR CNN HDLS VTRN,"$1,437.50",$0.00,"$1,437.50",$646.88,"$1,025.94",$0.00,$247.67,$0.00,$0.00,$251.69,"$1,437.50",$0.00,$718.75,"$1,138.50","$1,150.00",$0.00,$224.97,$0.00,$228.85,$0.00
AR-8665-18105,SUP,HCPCS C1713,,AR-8665-18105  -  SCREW BN ST 6.5MM 105MM CMPR CNN HDLS VTRN,"$1,437.50",$0.00,"$1,437.50",$646.88,"$1,025.94",$0.00,$247.67,$0.00,$0.00,$251.69,"$1,437.50",$0.00,$718.75,"$1,138.50","$1,150.00",$0.00,$224.97,$0.00,$228.85,$0.00
AR-8665-18110,SUP,HCPCS C1713,,AR-8665-18110  -  SCREW BN ST 6.5MM 110MM CMPR CNN HDLS VTRN,"$1,437.50",$0.00,"$1,437.50",$646.88,"$1,025.94",$0.00,$247.67,$0.00,$0.00,$251.69,"$1,437.50",$0.00,$718.75,"$1,138.50","$1,150.00",$0.00,$224.97,$0.00,$228.85,$0.00
AR-8665-18115,SUP,HCPCS C1713,,AR-8665-18115  -  SCREW BN ST 6.5MM 115MM CMPR CNN HDLS VTRN,"$1,437.50",$0.00,"$1,437.50",$646.88,"$1,025.94",$0.00,$247.67,$0.00,$0.00,$251.69,"$1,437.50",$0.00,$718.75,"$1,138.50","$1,150.00",$0.00,$224.97,$0.00,$228.85,$0.00
AR-8665-18120,SUP,HCPCS C1713,,AR-8665-18120  -  SCREW BN ST 6.5MM 120MM CMPR CNN HDLS VTRN,"$1,437.50",$0.00,"$1,437.50",$646.88,"$1,025.94",$0.00,$247.67,$0.00,$0.00,$251.69,"$1,437.50",$0.00,$718.75,"$1,138.50","$1,150.00",$0.00,$224.97,$0.00,$228.85,$0.00
AR-8665-1830,SUP,HCPCS C1713,,AR-8665-1830  -  SCREW BN ST 6.5MM 30MM CMPR CNN HDLS VTRN,"$1,437.50",$0.00,"$1,437.50",$646.88,"$1,025.94",$0.00,$247.67,$0.00,$0.00,$251.69,"$1,437.50",$0.00,$718.75,"$1,138.50","$1,150.00",$0.00,$224.97,$0.00,$228.85,$0.00
AR-8665-1835,SUP,HCPCS C1713,,AR-8665-1835  -  SCREW BN ST 6.5MM 35MM CMPR CNN HDLS VTRN,"$1,437.50",$0.00,"$1,437.50",$646.88,"$1,025.94",$0.00,$247.67,$0.00,$0.00,$251.69,"$1,437.50",$0.00,$718.75,"$1,138.50","$1,150.00",$0.00,$224.97,$0.00,$228.85,$0.00
AR-8665-1850,SUP,HCPCS C1713,,AR-8665-1850  -  SCREW BN P/T 6.5MM 50MM CMPR HDLS,"$1,437.50",$0.00,"$1,437.50",$646.88,"$1,025.94",$0.00,$247.67,$0.00,$0.00,$251.69,"$1,437.50",$0.00,$718.75,"$1,138.50","$1,150.00",$0.00,$224.97,$0.00,$228.85,$0.00
AR-8665-1855,SUP,HCPCS C1713,,AR-8665-1855  -  SCREW BN ST 6.5MM 55MM CNN HDLS VTRN,"$1,437.50",$0.00,"$1,437.50",$646.88,"$1,025.94",$0.00,$247.67,$0.00,$0.00,$251.69,"$1,437.50",$0.00,$718.75,"$1,138.50","$1,150.00",$0.00,$224.97,$0.00,$228.85,$0.00
AR-8665-1860,SUP,HCPCS C1713,,AR-8665-1860  -  SCREW BN ST 6.5MM 60MM CMPR CNN HDLS VTRN,"$1,437.50",$0.00,"$1,437.50",$646.88,"$1,025.94",$0.00,$247.67,$0.00,$0.00,$251.69,"$1,437.50",$0.00,$718.75,"$1,138.50","$1,150.00",$0.00,$224.97,$0.00,$228.85,$0.00
AR-8665-1865,SUP,HCPCS C1713,,AR-8665-1865  -  SCREW BN ST 6.5MM 65MM CMPR CNN HDLS VTRN,"$1,437.50",$0.00,"$1,437.50",$646.88,"$1,025.94",$0.00,$247.67,$0.00,$0.00,$251.69,"$1,437.50",$0.00,$718.75,"$1,138.50","$1,150.00",$0.00,$224.97,$0.00,$228.85,$0.00
AR-8665-1880,SUP,HCPCS C1713,,AR-8665-1880  -  SCREW BN P/T 6.5MM 80MM CMPR HDLS,"$1,437.50",$0.00,"$1,437.50",$646.88,"$1,025.94",$0.00,$247.67,$0.00,$0.00,$251.69,"$1,437.50",$0.00,$718.75,"$1,138.50","$1,150.00",$0.00,$224.97,$0.00,$228.85,$0.00
AR-8665-1885,SUP,HCPCS C1713,,AR-8665-1885  -  SCREW BN P/T 6.5MM 85MM CMPR HDLS,"$1,437.50",$0.00,"$1,437.50",$646.88,"$1,025.94",$0.00,$247.67,$0.00,$0.00,$251.69,"$1,437.50",$0.00,$718.75,"$1,138.50","$1,150.00",$0.00,$224.97,$0.00,$228.85,$0.00
AR-8665-1890,SUP,HCPCS C1713,,AR-8665-1890  -  SCREW BN ST 6.5MM 90MM CMPR CNN HDLS VTRN,"$1,437.50",$0.00,"$1,437.50",$646.88,"$1,025.94",$0.00,$247.67,$0.00,$0.00,$251.69,"$1,437.50",$0.00,$718.75,"$1,138.50","$1,150.00",$0.00,$224.97,$0.00,$228.85,$0.00
AR-8665-1895,SUP,HCPCS C1713,,AR-8665-1895  -  SCREW BN ST 6.5MM 95MM CMPR CNN HDLS VTRN,"$1,437.50",$0.00,"$1,437.50",$646.88,"$1,025.94",$0.00,$247.67,$0.00,$0.00,$251.69,"$1,437.50",$0.00,$718.75,"$1,138.50","$1,150.00",$0.00,$224.97,$0.00,$228.85,$0.00
AR-8665-28100,SUP,HCPCS C1713,,AR-8665-28100  -  SCREW BN L/T 6.5MM 100MM CMPR CNN HDLS VTRN,"$1,437.50",$0.00,"$1,437.50",$646.88,"$1,025.94",$0.00,$247.67,$0.00,$0.00,$251.69,"$1,437.50",$0.00,$718.75,"$1,138.50","$1,150.00",$0.00,$224.97,$0.00,$228.85,$0.00
AR-8665-28105,SUP,HCPCS C1713,,AR-8665-28105  -  SCREW BN L/T 6.5MM 105MM CMPR CNN HDLS VTRN,"$1,437.50",$0.00,"$1,437.50",$646.88,"$1,025.94",$0.00,$247.67,$0.00,$0.00,$251.69,"$1,437.50",$0.00,$718.75,"$1,138.50","$1,150.00",$0.00,$224.97,$0.00,$228.85,$0.00
AR-8665-28110,SUP,HCPCS C1713,,AR-8665-28110  -  SCREW BN L/T 6.5MM 110MM CMPR CNN HDLS VTRN,"$1,437.50",$0.00,"$1,437.50",$646.88,"$1,025.94",$0.00,$247.67,$0.00,$0.00,$251.69,"$1,437.50",$0.00,$718.75,"$1,138.50","$1,150.00",$0.00,$224.97,$0.00,$228.85,$0.00
AR-8665-28115,SUP,HCPCS C1713,,AR-8665-28115  -  SCREW BN L/T 6.5MM 115MM CMPR CNN HDLS VTRN,"$1,437.50",$0.00,"$1,437.50",$646.88,"$1,025.94",$0.00,$247.67,$0.00,$0.00,$251.69,"$1,437.50",$0.00,$718.75,"$1,138.50","$1,150.00",$0.00,$224.97,$0.00,$228.85,$0.00
AR-8665-28120,SUP,HCPCS C1713,,AR-8665-28120  -  SCREW BN L/T 6.5MM 120MM CMPR CNN HDLS VTRN,"$1,437.50",$0.00,"$1,437.50",$646.88,"$1,025.94",$0.00,$247.67,$0.00,$0.00,$251.69,"$1,437.50",$0.00,$718.75,"$1,138.50","$1,150.00",$0.00,$224.97,$0.00,$228.85,$0.00
AR-8665-2860,SUP,HCPCS C1713,,AR-8665-2860  -  SCREW BN L/T 6.5MM 60MM CMPR CNN HDLS VTRN,"$1,437.50",$0.00,"$1,437.50",$646.88,"$1,025.94",$0.00,$247.67,$0.00,$0.00,$251.69,"$1,437.50",$0.00,$718.75,"$1,138.50","$1,150.00",$0.00,$224.97,$0.00,$228.85,$0.00
AR-8665-2865,SUP,HCPCS C1713,,AR-8665-2865  -  SCREW BN L/T 6.5MM 65MM CMPR CNN HDLS VTRN,"$1,437.50",$0.00,"$1,437.50",$646.88,"$1,025.94",$0.00,$247.67,$0.00,$0.00,$251.69,"$1,437.50",$0.00,$718.75,"$1,138.50","$1,150.00",$0.00,$224.97,$0.00,$228.85,$0.00
AR-8665-2870,SUP,HCPCS C1713,,AR-8665-2870  -  SCREW BN L/T 6.5MM 70MM CMPR CNN HDLS VTRN,"$1,437.50",$0.00,"$1,437.50",$646.88,"$1,025.94",$0.00,$247.67,$0.00,$0.00,$251.69,"$1,437.50",$0.00,$718.75,"$1,138.50","$1,150.00",$0.00,$224.97,$0.00,$228.85,$0.00
AR-8665-2875,SUP,HCPCS C1713,,AR-8665-2875  -  SCREW BN L/T 6.5MM 75MM CMPR CNN HDLS VTRN,"$1,437.50",$0.00,"$1,437.50",$646.88,"$1,025.94",$0.00,$247.67,$0.00,$0.00,$251.69,"$1,437.50",$0.00,$718.75,"$1,138.50","$1,150.00",$0.00,$224.97,$0.00,$228.85,$0.00
AR-8665-2880,SUP,HCPCS C1713,,AR-8665-2880  -  SCREW BN L/T 6.5MM 80MM CMPR CNN HDLS VTRN,"$1,437.50",$0.00,"$1,437.50",$646.88,"$1,025.94",$0.00,$247.67,$0.00,$0.00,$251.69,"$1,437.50",$0.00,$718.75,"$1,138.50","$1,150.00",$0.00,$224.97,$0.00,$228.85,$0.00
AR-8665-2885,SUP,HCPCS C1713,,AR-8665-2885  -  SCREW BN L/T 6.5MM 85MM NS ARTHX CMPR HDLS,"$1,437.50",$0.00,"$1,437.50",$646.88,"$1,025.94",$0.00,$247.67,$0.00,$0.00,$251.69,"$1,437.50",$0.00,$718.75,"$1,138.50","$1,150.00",$0.00,$224.97,$0.00,$228.85,$0.00
AR-8665-2890,SUP,HCPCS C1713,,AR-8665-2890  -  SCREW BN L/T 6.5MM 90MM CMPR CNN HDLS VTRN,"$1,437.50",$0.00,"$1,437.50",$646.88,"$1,025.94",$0.00,$247.67,$0.00,$0.00,$251.69,"$1,437.50",$0.00,$718.75,"$1,138.50","$1,150.00",$0.00,$224.97,$0.00,$228.85,$0.00
AR-8665-2895,SUP,HCPCS C1713,,AR-8665-2895  -  SCREW BN L/T 6.5MM 95MM NS ARTHX CMPR HDLS,"$1,437.50",$0.00,"$1,437.50",$646.88,"$1,025.94",$0.00,$247.67,$0.00,$0.00,$251.69,"$1,437.50",$0.00,$718.75,"$1,138.50","$1,150.00",$0.00,$224.97,$0.00,$228.85,$0.00
AR-8665-30,SUP,HCPCS C1713,,AR-8665-30  -  HEDLESS COMPR SCRW 6.5X 30 MMCANN,"$1,312.50",$0.00,"$1,312.50",$590.63,$936.73,$0.00,$226.14,$0.00,$0.00,$229.81,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$205.41,$0.00,$208.95,$0.00
AR-8665-35,SUP,HCPCS C1713,,AR-8665-35  -  HEDLESS COMPR SCRW 6.5X 35 MMCANN,"$1,312.50",$0.00,"$1,312.50",$590.63,$936.73,$0.00,$226.14,$0.00,$0.00,$229.81,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$205.41,$0.00,$208.95,$0.00
AR-8665-40,SUP,HCPCS C1713,,AR-8665-40  -  HEDLESS COMPR SCRW 6.5X 40 MMCANN,"$1,312.50",$0.00,"$1,312.50",$590.63,$936.73,$0.00,$226.14,$0.00,$0.00,$229.81,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$205.41,$0.00,$208.95,$0.00
AR-8665-45,SUP,HCPCS C1713,,AR-8665-45  -  HEDLESS COMPR SCRW 6.5X 45 MMCANN,"$1,312.50",$0.00,"$1,312.50",$590.63,$936.73,$0.00,$226.14,$0.00,$0.00,$229.81,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$205.41,$0.00,$208.95,$0.00
AR-8665-50,SUP,HCPCS C1713,,AR-8665-50  -  HEDLESS COMPR SCRW 6.5X 50 MMCANN,"$1,312.50",$0.00,"$1,312.50",$590.63,$936.73,$0.00,$226.14,$0.00,$0.00,$229.81,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$205.41,$0.00,$208.95,$0.00
AR-8665-55,SUP,HCPCS C1713,,AR-8665-55  -  HEDLESS COMPR SCRW 6.5X 55 MMCANN,"$1,312.50",$0.00,"$1,312.50",$590.63,$936.73,$0.00,$226.14,$0.00,$0.00,$229.81,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$205.41,$0.00,$208.95,$0.00
AR-8665-60,SUP,HCPCS C1713,,AR-8665-60  -  HEDLESS COMPR SCRW 6.5X 60 MMCANN,"$1,312.50",$0.00,"$1,312.50",$590.63,$936.73,$0.00,$226.14,$0.00,$0.00,$229.81,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$205.41,$0.00,$208.95,$0.00
AR-8665-65,SUP,HCPCS C1713,,AR-8665-65  -  HEDLESS COMPR SCRW 6.5X 65 MMCANN,"$1,312.50",$0.00,"$1,312.50",$590.63,$936.73,$0.00,$226.14,$0.00,$0.00,$229.81,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$205.41,$0.00,$208.95,$0.00
AR-8665-70,SUP,HCPCS C1713,,AR-8665-70  -  HEDLESS COMPR SCRW 6.5X 70 MMCANN,"$1,312.50",$0.00,"$1,312.50",$590.63,$936.73,$0.00,$226.14,$0.00,$0.00,$229.81,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$205.41,$0.00,$208.95,$0.00
AR-8665-75,SUP,HCPCS C1713,,AR-8665-75  -  HEDLESS COMPR SCRW 6.5X 75 MMCANN,"$1,312.50",$0.00,"$1,312.50",$590.63,$936.73,$0.00,$226.14,$0.00,$0.00,$229.81,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$205.41,$0.00,$208.95,$0.00
AR-8665-80,SUP,HCPCS C1713,,AR-8665-80  -  SCREW BN 6.5MM 80MM NS ARTHX CMPR CNN HDLS,"$1,312.50",$0.00,"$1,312.50",$590.63,$936.73,$0.00,$226.14,$0.00,$0.00,$229.81,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$205.41,$0.00,$208.95,$0.00
AR-8665-85,SUP,HCPCS C1713,,AR-8665-85  -  HEDLESS COMPR SCRW 6.5X 85 MMCANN,"$1,312.50",$0.00,"$1,312.50",$590.63,$936.73,$0.00,$226.14,$0.00,$0.00,$229.81,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$205.41,$0.00,$208.95,$0.00
AR-8665-90,SUP,HCPCS C1713,,AR-8665-90  -  SCREW BN 6.5MM 90MM NS ARTHX CMPR CNN HDLS,"$1,312.50",$0.00,"$1,312.50",$590.63,$936.73,$0.00,$226.14,$0.00,$0.00,$229.81,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$205.41,$0.00,$208.95,$0.00
AR-8665-95,SUP,HCPCS C1713,,AR-8665-95  -  HEDLESS COMPR SCRW 6.5X 95 MMCANN,"$1,312.50",$0.00,"$1,312.50",$590.63,$936.73,$0.00,$226.14,$0.00,$0.00,$229.81,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$205.41,$0.00,$208.95,$0.00
AR-8690DS,SUP,HCPCS C1713,,AR-8690DS  -  SYSTEM FX CPR MN SCRPN DX,"$2,375.00",$0.00,"$2,375.00","$1,068.75","$1,695.04",$0.00,$409.20,$0.00,$0.00,$415.84,"$2,375.00",$0.00,"$1,187.50","$1,881.00","$1,900.00",$0.00,$371.69,$0.00,$378.10,$0.00
AR-8692DS,SUP,Custom 27203010,,AR-8692DS  -  SYSTEM FX CPR VPR,"$2,375.00",$0.00,"$2,375.00",$0.00,"$1,695.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,375.00",$0.00,"$1,187.50","$1,881.00","$1,900.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-8701,SUP,Custom 27203010,,AR-8701  -  PASSER SUTURE MICRO SMALL CURVE BENT 1.25MM 6IN BRAID EASIER,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8703,SUP,Custom 27203010,,AR-8703  -  PASSER SUTLSO MIC STR SUTURE STRL DISP,$562.50,$0.00,$562.50,$0.00,$401.46,$0.00,$0.00,$0.00,$0.00,$0.00,$562.50,$0.00,$281.25,$445.50,$450.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8704,SUP,Custom 27203010,,AR-8704  -  PASSER SUT 70D MIC SHRT BNT 3ANG STRL SUTLSO FIBROCARTILAGE,$350.00,$0.00,$350.00,$0.00,$249.80,$0.00,$0.00,$0.00,$0.00,$0.00,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8708,SUP,HCPCS C1713,,AR-8708  -  STAPLE BN SM 8MM SUT SS,$275.00,$0.00,$275.00,$123.75,$196.27,$0.00,$47.38,$0.00,$0.00,$48.15,$275.00,$0.00,$137.50,$217.80,$220.00,$0.00,$43.04,$0.00,$43.78,$0.00
AR-8708S,SUP,HCPCS C1713,,AR-8708S  -  STAPLE BN SM QFIX,"$5,625.00",$0.00,"$5,625.00","$2,531.25","$4,014.56",$0.00,$969.16,$0.00,$0.00,$984.89,"$5,625.00",$0.00,"$2,812.50","$4,455.00","$4,500.00",$0.00,$880.31,$0.00,$895.50,$0.00
AR-8710,SUP,HCPCS C1713,,AR-8710  -  STAPLE BN SM 10MM QFIX SS,$275.00,$0.00,$275.00,$123.75,$196.27,$0.00,$47.38,$0.00,$0.00,$48.15,$275.00,$0.00,$137.50,$217.80,$220.00,$0.00,$43.04,$0.00,$43.78,$0.00
AR-8714,SUP,HCPCS C1713,,AR-8714  -  PLATE BN LOPRFL 12MM PLAPLE SS DIAPHYSIS,$962.50,$0.00,$962.50,$433.13,$686.94,$0.00,$165.83,$0.00,$0.00,$168.53,$962.50,$0.00,$481.25,$762.30,$770.00,$0.00,$150.63,$0.00,$153.23,$0.00
AR-8715,SUP,HCPCS C1713,,AR-8715  -  PLATE BN LOPRFL 15MM PLAPLE SS SM BN 2.3MM CORT SCR,$962.50,$0.00,$962.50,$433.13,$686.94,$0.00,$165.83,$0.00,$0.00,$168.53,$962.50,$0.00,$481.25,$762.30,$770.00,$0.00,$150.63,$0.00,$153.23,$0.00
AR-8716,SUP,HCPCS C1713,,AR-8716  -  PLATE BN LOPRFL 20MM PLAPLE SS SM BN 2.3MM CORT SCR,$962.50,$0.00,$962.50,$433.13,$686.94,$0.00,$165.83,$0.00,$0.00,$168.53,$962.50,$0.00,$481.25,$762.30,$770.00,$0.00,$150.63,$0.00,$153.23,$0.00
AR-8720-08PT,SUP,HCPCS C1713,,AR-8720-08PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2MM 8MM QFIX SLF DRL ST CNN,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
AR-8720-10PT,SUP,HCPCS C1713,,AR-8720-10PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2MM 10MM QFIX SLF DRL ST CNN,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
AR-8720-12PT,SUP,HCPCS C1713,,AR-8720-12PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2MM 12MM QFIX SLF DRL ST CNN,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
AR-8720-14PT,SUP,HCPCS C1713,,AR-8720-14PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2MM 14MM QFIX SLF DRL ST CNN,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
AR-8720-16PT,SUP,HCPCS C1713,,AR-8720-16PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2MM 16MM QFIX SLF DRL ST CNN,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
AR-8720-18PT,SUP,HCPCS C1713,,AR-8720-18PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2MM 18MM QFIX SLF DRL ST CNN,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
AR-8720-20PT,SUP,HCPCS C1713,,AR-8720-20PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2MM 20MM QFIX SLF DRL ST CNN,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
AR-8720-22PT,SUP,HCPCS C1713,,AR-8720-22PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2MM 22MM QFIX SLF DRL ST CNN,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
AR-8720-24PT,SUP,HCPCS C1713,,AR-8720-24PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2MM 24MM QFIX SLF DRL ST CNN,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
AR-8720-26PT,SUP,HCPCS C1713,,AR-8720-26PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2MM 26MM QFIX SLF DRL ST CNN,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
AR-8720-28PT,SUP,HCPCS C1713,,AR-8720-28PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2MM 28MM QFIX SLF DRL ST CNN,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
AR-8720-30PT,SUP,HCPCS C1713,,AR-8720-30PT  -  SCREW BN P/T 2MM 30MM QFIX CNN TI,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
AR-8724-08,SUP,HCPCS C1713,,AR-8724-08  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 8MM QFIX SLF DRL ST,$275.00,$0.00,$275.00,$123.75,$196.27,$0.00,$47.38,$0.00,$0.00,$48.15,$275.00,$0.00,$137.50,$217.80,$220.00,$0.00,$43.04,$0.00,$43.78,$0.00
AR-8724-08PT,SUP,HCPCS C1713,,AR-8724-08PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 8MM QFIX SLF DRL ST,$362.50,$0.00,$362.50,$163.13,$258.72,$0.00,$62.46,$0.00,$0.00,$63.47,$362.50,$0.00,$181.25,$287.10,$290.00,$0.00,$56.73,$0.00,$57.71,$0.00
AR-8724-10,SUP,HCPCS C1713,,AR-8724-10  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 10MM QFIX SLF DRL ST,$275.00,$0.00,$275.00,$123.75,$196.27,$0.00,$47.38,$0.00,$0.00,$48.15,$275.00,$0.00,$137.50,$217.80,$220.00,$0.00,$43.04,$0.00,$43.78,$0.00
AR-8724-10PT,SUP,HCPCS C1713,,AR-8724-10PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 10MM QFIX SLF DRL ST,$362.50,$0.00,$362.50,$163.13,$258.72,$0.00,$62.46,$0.00,$0.00,$63.47,$362.50,$0.00,$181.25,$287.10,$290.00,$0.00,$56.73,$0.00,$57.71,$0.00
AR-8724-12,SUP,HCPCS C1713,,AR-8724-12  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 12MM QFIX SLF DRL ST,$275.00,$0.00,$275.00,$123.75,$196.27,$0.00,$47.38,$0.00,$0.00,$48.15,$275.00,$0.00,$137.50,$217.80,$220.00,$0.00,$43.04,$0.00,$43.78,$0.00
AR-8724-12PT,SUP,HCPCS C1713,,AR-8724-12PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 12MM QFIX SLF DRL ST,$362.50,$0.00,$362.50,$163.13,$258.72,$0.00,$62.46,$0.00,$0.00,$63.47,$362.50,$0.00,$181.25,$287.10,$290.00,$0.00,$56.73,$0.00,$57.71,$0.00
AR-8724-14,SUP,HCPCS C1713,,AR-8724-14  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 14MM QFIX SLF DRL ST,$275.00,$0.00,$275.00,$123.75,$196.27,$0.00,$47.38,$0.00,$0.00,$48.15,$275.00,$0.00,$137.50,$217.80,$220.00,$0.00,$43.04,$0.00,$43.78,$0.00
AR-8724-14PT,SUP,HCPCS C1713,,AR-8724-14PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 14MM QFIX SLF DRL ST,$362.50,$0.00,$362.50,$163.13,$258.72,$0.00,$62.46,$0.00,$0.00,$63.47,$362.50,$0.00,$181.25,$287.10,$290.00,$0.00,$56.73,$0.00,$57.71,$0.00
AR-8724-16,SUP,HCPCS C1713,,AR-8724-16  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 16MM QFIX SLF DRL ST,$275.00,$0.00,$275.00,$123.75,$196.27,$0.00,$47.38,$0.00,$0.00,$48.15,$275.00,$0.00,$137.50,$217.80,$220.00,$0.00,$43.04,$0.00,$43.78,$0.00
AR-8724-16PT,SUP,HCPCS C1713,,AR-8724-16PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 16MM QFIX SLF DRL ST,$362.50,$0.00,$362.50,$163.13,$258.72,$0.00,$62.46,$0.00,$0.00,$63.47,$362.50,$0.00,$181.25,$287.10,$290.00,$0.00,$56.73,$0.00,$57.71,$0.00
AR-8724-18PT,SUP,HCPCS C1713,,AR-8724-18PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 18MM QFIX SLF DRL ST,$362.50,$0.00,$362.50,$163.13,$258.72,$0.00,$62.46,$0.00,$0.00,$63.47,$362.50,$0.00,$181.25,$287.10,$290.00,$0.00,$56.73,$0.00,$57.71,$0.00
AR-8724-20,SUP,HCPCS C1713,,AR-8724-20  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 20MM QFIX SLF DRL ST,$275.00,$0.00,$275.00,$123.75,$196.27,$0.00,$47.38,$0.00,$0.00,$48.15,$275.00,$0.00,$137.50,$217.80,$220.00,$0.00,$43.04,$0.00,$43.78,$0.00
AR-8724-20PT,SUP,HCPCS C1713,,AR-8724-20PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 20MM QFIX SLF DRL ST,$362.50,$0.00,$362.50,$163.13,$258.72,$0.00,$62.46,$0.00,$0.00,$63.47,$362.50,$0.00,$181.25,$287.10,$290.00,$0.00,$56.73,$0.00,$57.71,$0.00
AR-8724-22,SUP,HCPCS C1713,,AR-8724-22  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 22MM QFIX SLF DRL ST,$275.00,$0.00,$275.00,$123.75,$196.27,$0.00,$47.38,$0.00,$0.00,$48.15,$275.00,$0.00,$137.50,$217.80,$220.00,$0.00,$43.04,$0.00,$43.78,$0.00
AR-8724-22PT,SUP,HCPCS C1713,,AR-8724-22PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 22MM QFIX SLF DRL ST,$362.50,$0.00,$362.50,$163.13,$258.72,$0.00,$62.46,$0.00,$0.00,$63.47,$362.50,$0.00,$181.25,$287.10,$290.00,$0.00,$56.73,$0.00,$57.71,$0.00
AR-8724-24PT,SUP,HCPCS C1713,,AR-8724-24PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 24MM QFIX SLF DRL ST,$362.50,$0.00,$362.50,$163.13,$258.72,$0.00,$62.46,$0.00,$0.00,$63.47,$362.50,$0.00,$181.25,$287.10,$290.00,$0.00,$56.73,$0.00,$57.71,$0.00
AR-8724-26PT,SUP,HCPCS C1713,,AR-8724-26PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 26MM QFIX SLF DRL ST,$362.50,$0.00,$362.50,$163.13,$258.72,$0.00,$62.46,$0.00,$0.00,$63.47,$362.50,$0.00,$181.25,$287.10,$290.00,$0.00,$56.73,$0.00,$57.71,$0.00
AR-8724-28,SUP,HCPCS C1713,,AR-8724-28  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 28MM QFIX SLF DRL ST,$275.00,$0.00,$275.00,$123.75,$196.27,$0.00,$47.38,$0.00,$0.00,$48.15,$275.00,$0.00,$137.50,$217.80,$220.00,$0.00,$43.04,$0.00,$43.78,$0.00
AR-8724-28PT,SUP,HCPCS C1713,,AR-8724-28PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 28MM QFIX SLF DRL ST,$362.50,$0.00,$362.50,$163.13,$258.72,$0.00,$62.46,$0.00,$0.00,$63.47,$362.50,$0.00,$181.25,$287.10,$290.00,$0.00,$56.73,$0.00,$57.71,$0.00
AR-8724-30,SUP,HCPCS C1713,,AR-8724-30  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 30MM QFIX SLF DRL ST,$275.00,$0.00,$275.00,$123.75,$196.27,$0.00,$47.38,$0.00,$0.00,$48.15,$275.00,$0.00,$137.50,$217.80,$220.00,$0.00,$43.04,$0.00,$43.78,$0.00
AR-8724-30PT,SUP,HCPCS C1713,,AR-8724-30PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 30MM QFIX SLF DRL ST,$362.50,$0.00,$362.50,$163.13,$258.72,$0.00,$62.46,$0.00,$0.00,$63.47,$362.50,$0.00,$181.25,$287.10,$290.00,$0.00,$56.73,$0.00,$57.71,$0.00
AR-8724-32,SUP,HCPCS C1713,,AR-8724-32  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 32MM QFIX SLF DRL ST,$275.00,$0.00,$275.00,$123.75,$196.27,$0.00,$47.38,$0.00,$0.00,$48.15,$275.00,$0.00,$137.50,$217.80,$220.00,$0.00,$43.04,$0.00,$43.78,$0.00
AR-8724-32PT,SUP,HCPCS C1713,,AR-8724-32PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 32MM QFIX SLF DRL ST,$362.50,$0.00,$362.50,$163.13,$258.72,$0.00,$62.46,$0.00,$0.00,$63.47,$362.50,$0.00,$181.25,$287.10,$290.00,$0.00,$56.73,$0.00,$57.71,$0.00
AR-8724-34,SUP,HCPCS C1713,,AR-8724-34  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 34MM QFIX SLF DRL ST,$275.00,$0.00,$275.00,$123.75,$196.27,$0.00,$47.38,$0.00,$0.00,$48.15,$275.00,$0.00,$137.50,$217.80,$220.00,$0.00,$43.04,$0.00,$43.78,$0.00
AR-8724-34PT,SUP,HCPCS C1713,,AR-8724-34PT  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 34MM QFIX SLF DRL ST,$362.50,$0.00,$362.50,$163.13,$258.72,$0.00,$62.46,$0.00,$0.00,$63.47,$362.50,$0.00,$181.25,$287.10,$290.00,$0.00,$56.73,$0.00,$57.71,$0.00
AR-8724-36,SUP,HCPCS C1713,,AR-8724-36  -  SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 36MM QFIX SLF DRL ST,$275.00,$0.00,$275.00,$123.75,$196.27,$0.00,$47.38,$0.00,$0.00,$48.15,$275.00,$0.00,$137.50,$217.80,$220.00,$0.00,$43.04,$0.00,$43.78,$0.00
AR-8724-36PT,SUP,HCPCS C1713,,AR-8724-36PT  -  SCREW BN P/T 2.4MM 36MM QFIX CNN TI,$362.50,$0.00,$362.50,$163.13,$258.72,$0.00,$62.46,$0.00,$0.00,$63.47,$362.50,$0.00,$181.25,$287.10,$290.00,$0.00,$56.73,$0.00,$57.71,$0.00
AR-8724-38,SUP,HCPCS C1713,,AR-8724-38  -  SCREW BN 2.4MM 38MM LOPRFL TI FT/ANKL CORT,$275.00,$0.00,$275.00,$123.75,$196.27,$0.00,$47.38,$0.00,$0.00,$48.15,$275.00,$0.00,$137.50,$217.80,$220.00,$0.00,$43.04,$0.00,$43.78,$0.00
AR-8724-40,SUP,HCPCS C1713,,AR-8724-40  -  SCREW BN 2.4MM 40MM LOPRFL TI FT/ANKL CORT,$275.00,$0.00,$275.00,$123.75,$196.27,$0.00,$47.38,$0.00,$0.00,$48.15,$275.00,$0.00,$137.50,$217.80,$220.00,$0.00,$43.04,$0.00,$43.78,$0.00
AR-8724GV,SUP,Custom 27203010,,AR-8724GV  -  GUIDE DRL 2.4MM VA,"$1,037.50",$0.00,"$1,037.50",$0.00,$740.46,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,037.50",$0.00,$518.75,$821.70,$830.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8724L-08,SUP,HCPCS C1713,,AR-8724L-08  -  SCREW BN 2.4MM 8MM LCK LOPRFL,$312.50,$0.00,$312.50,$140.63,$223.03,$0.00,$53.84,$0.00,$0.00,$54.72,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$48.91,$0.00,$49.75,$0.00
AR-8724L-10,SUP,HCPCS C1713,,AR-8724L-10  -  SCREW BN T8 FT HEXALOBE 2.4MM 10MM SLF DRL SLD LCK TI SM BN,$312.50,$0.00,$312.50,$140.63,$223.03,$0.00,$53.84,$0.00,$0.00,$54.72,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$48.91,$0.00,$49.75,$0.00
AR-8724L-12,SUP,HCPCS C1713,,AR-8724L-12  -  SCREW BN T8 FT HEXALOBE 2.4MM 12MM SLF DRL SLD LCK TI SM BN,$312.50,$0.00,$312.50,$140.63,$223.03,$0.00,$53.84,$0.00,$0.00,$54.72,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$48.91,$0.00,$49.75,$0.00
AR-8724L-14,SUP,HCPCS C1713,,AR-8724L-14  -  SCREW BN T8 FT HEXALOBE 2.4MM 14MM SLF DRL SLD LCK TI SM BN,$312.50,$0.00,$312.50,$140.63,$223.03,$0.00,$53.84,$0.00,$0.00,$54.72,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$48.91,$0.00,$49.75,$0.00
AR-8724L-16,SUP,HCPCS C1713,,AR-8724L-16  -  SCREW BN T8 FT HEXALOBE 2.4MM 16MM SLF DRL SLD LCK TI SM BN,$312.50,$0.00,$312.50,$140.63,$223.03,$0.00,$53.84,$0.00,$0.00,$54.72,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$48.91,$0.00,$49.75,$0.00
AR-8724L-18,SUP,HCPCS C1713,,AR-8724L-18  -  SCREW BN T8 FT HEXALOBE 2.4MM 18MM SLF DRL SLD LCK TI SM BN,$312.50,$0.00,$312.50,$140.63,$223.03,$0.00,$53.84,$0.00,$0.00,$54.72,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$48.91,$0.00,$49.75,$0.00
AR-8724L-20,SUP,HCPCS C1713,,AR-8724L-20  -  SCREW BN T8 FT HEXALOBE 2.4MM 20MM SLF DRL SLD LCK TI SM BN,$312.50,$0.00,$312.50,$140.63,$223.03,$0.00,$53.84,$0.00,$0.00,$54.72,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$48.91,$0.00,$49.75,$0.00
AR-8724L-22,SUP,HCPCS C1713,,AR-8724L-22  -  SCREW BN LOPRFL 2.4MM 22MM LCK ST SLD TI FT,$312.50,$0.00,$312.50,$140.63,$223.03,$0.00,$53.84,$0.00,$0.00,$54.72,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$48.91,$0.00,$49.75,$0.00
AR-8724L-24,SUP,HCPCS C1713,,AR-8724L-24  -  SCREW BN LOPRFL 2.4MM 24MM LCK ST SLD TI FT,$312.50,$0.00,$312.50,$140.63,$223.03,$0.00,$53.84,$0.00,$0.00,$54.72,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$48.91,$0.00,$49.75,$0.00
AR-8724L-26,SUP,HCPCS C1713,,AR-8724L-26  -  SCREW BN 2.4MM 26MM LCK LOPRFL TI FT/ANKL,$312.50,$0.00,$312.50,$140.63,$223.03,$0.00,$53.84,$0.00,$0.00,$54.72,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$48.91,$0.00,$49.75,$0.00
AR-8724L-28,SUP,HCPCS C1713,,AR-8724L-28  -  SCREW BN 2.4MM 28MM LOPRFL LCK TI,$312.50,$0.00,$312.50,$140.63,$223.03,$0.00,$53.84,$0.00,$0.00,$54.72,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$48.91,$0.00,$49.75,$0.00
AR-8724L-30,SUP,HCPCS C1713,,AR-8724L-30  -  SCREW BN 2.4MM 30MM LCK LOPRFL TI FT/ANKL,$312.50,$0.00,$312.50,$140.63,$223.03,$0.00,$53.84,$0.00,$0.00,$54.72,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$48.91,$0.00,$49.75,$0.00
AR-8724L-32,SUP,HCPCS C1713,,AR-8724L-32  -  SCREW BN 2.4MM 32MM LCK LOPRFL TI FT/ANKL,$312.50,$0.00,$312.50,$140.63,$223.03,$0.00,$53.84,$0.00,$0.00,$54.72,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$48.91,$0.00,$49.75,$0.00
AR-8724L-34,SUP,HCPCS C1713,,AR-8724L-34  -  SCREW BN T8 FT HEXALOBE 2.4MM 34MM LCK SLF DRL SLD TI SM BN,$312.50,$0.00,$312.50,$140.63,$223.03,$0.00,$53.84,$0.00,$0.00,$54.72,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$48.91,$0.00,$49.75,$0.00
AR-8724L-36,SUP,HCPCS C1713,,AR-8724L-36  -  SCREW BN T8 FT HEXALOBE 2.4MM 36MM LCK SLF DRL SLD TI SM BN,$312.50,$0.00,$312.50,$140.63,$223.03,$0.00,$53.84,$0.00,$0.00,$54.72,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$48.91,$0.00,$49.75,$0.00
AR-8724L-38,SUP,HCPCS C1713,,AR-8724L-38  -  SCREW BN 2.4MM 38MM LCK LOPRFL TI FT/ANKL,$312.50,$0.00,$312.50,$140.63,$223.03,$0.00,$53.84,$0.00,$0.00,$54.72,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$48.91,$0.00,$49.75,$0.00
AR-8724L-40,SUP,HCPCS C1713,,AR-8724L-40  -  SCREW BN 2.4MM 40MM LCK LOPRFL TI FT/ANKL,$312.50,$0.00,$312.50,$140.63,$223.03,$0.00,$53.84,$0.00,$0.00,$54.72,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$48.91,$0.00,$49.75,$0.00
AR-8724V-08,SUP,HCPCS C1713,,AR-8724V-08  -  SCREW BN LOPRFL 2.4MM 8MM VA ST SLD LCK TI FT HND ANKL WRST,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
AR-8724V-10,SUP,HCPCS C1713,,AR-8724V-10  -  SCREW BN LOPRFL 2.4MM 10MM VA ST SLD LCK TI FT HND ANKL WRST,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
AR-8724V-12,SUP,HCPCS C1713,,AR-8724V-12  -  SCREW BN LOPRFL 2.4MM 12MM VA ST SLD LCK TI FT HND ANKL WRST,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
AR-8724V-14,SUP,HCPCS C1713,,AR-8724V-14  -  SCREW BN LOPRFL 2.4MM 14MM VA ST SLD LCK TI FT HND ANKL WRST,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
AR-8724V-16,SUP,HCPCS C1713,,AR-8724V-16  -  SCREW BN LOPRFL 2.4MM 16MM VA ST SLD LCK TI FT HND ANKL WRST,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
AR-8724V-18,SUP,HCPCS C1713,,AR-8724V-18  -  SCREW BN LOPRFL 2.4MM 18MM VA ST SLD LCK TI FT HND ANKL WRST,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
AR-8724V-20,SUP,HCPCS C1713,,AR-8724V-20  -  SCREW BN LOPRFL 2.4MM 20MM VA ST SLD LCK TI FT HND ANKL WRST,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
AR-8724V-22,SUP,HCPCS C1713,,AR-8724V-22  -  SCREW BN LOPRFL 2.4MM 22MM VA ST SLD LCK TI FT HND ANKL WRST,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
AR-8724V-24,SUP,HCPCS C1713,,AR-8724V-24  -  SCREW BN LOPRFL 2.4MM 24MM VA ST SLD LCK TI FT HND ANKL WRST,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
AR-8724V-26,SUP,HCPCS C1713,,AR-8724V-26  -  SCREW BN LOPRFL 2.4MM 26MM VA ST SLD LCK TI FT HND ANKL WRST,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
AR-8724V-28,SUP,HCPCS C1713,,AR-8724V-28  -  SCREW BN LOPRFL 2.4MM 28MM VA ST SLD LCK TI FT HND ANKL WRST,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
AR-8724V-30,SUP,HCPCS C1713,,AR-8724V-30  -  SCREW BN LOPRFL 2.4MM 30MM VA ST SLD LCK TI FT HND ANKL WRST,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
AR-8724V-32,SUP,HCPCS C1713,,AR-8724V-32  -  SCREW BN LOPRFL 2.4MM 32MM LCK ST SLD VA TI FT HND ANKL WRST,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
AR-8724V-34,SUP,HCPCS C1713,,AR-8724V-34  -  SCREW BN LOPRFL 2.4MM 34MM LCK ST SLD VA TI FT HND ANKL WRST,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
AR-8724V-36,SUP,HCPCS C1713,,AR-8724V-36  -  SCREW BN LOPRFL 2.4MM 32MM LCK ST SLD VA TI FT HND ANKL WRST,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
AR-8724V-38,SUP,HCPCS C1713,,AR-8724V-38  -  SCREW BN LOPRFL 2.4MM 38MM LCK ST SLD VA TI FT HND ANKL WRST,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
AR-8724V-40,SUP,HCPCS C1713,,AR-8724V-40  -  SCREW BN LOPRFL 2.4MM 40MM LCK ST SLD VA TI FT HND ANKL WRST,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
AR-8724W,SUP,HCPCS C1713,,AR-8724W  -  WASHER ORTH 6MM TI 2/2.4MM QFIX SCR,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8725-08H,SUP,HCPCS C1713,,AR-8725-08H  -  SCREW BN 1.5MM MIC FT HEX 2.5MM 8MM QFIX SLF DRL ST CNN CMPR,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
AR-8725-09H,SUP,HCPCS C1713,,AR-8725-09H  -  SCREW BN 1.5MM MIC FT HEX 2.5MM 9MM QFIX SLF DRL ST CNN CMPR,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
AR-8725-10H,SUP,HCPCS C1713,,AR-8725-10H  -  SCREW BN 1.5MM MIC FT HEX 2.5MM 10MM QFIX SLF DRL ST CNN,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
AR-8725-11H,SUP,HCPCS C1713,,AR-8725-11H  -  SCREW BN 1.5MM MIC FT HEX 2.5MM 11MM QFIX SLF DRL ST CNN,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
AR-8725-12H,SUP,HCPCS C1713,,AR-8725-12H  -  SCREW BN 1.5MM MIC FT HEX 2.5MM 12MM QFIX SLF DRL ST CNN,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
AR-8725-13H,SUP,HCPCS C1713,,AR-8725-13H  -  SCREW BN 1.5MM MIC FT HEX 2.5MM 13MM QFIX SLF DRL ST CNN,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
AR-8725-14H,SUP,HCPCS C1713,,AR-8725-14H  -  SCREW BN 1.5MM MIC FT 2.5MM 14MM QFIX SLF DRL ST CNN CMPR TI,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
AR-8725-16H,SUP,HCPCS C1713,,AR-8725-16H  -  SCREW BN 1.5MM MIC FT HEX 2.5MM 16MM QFIX SLF DRL ST CNN,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
AR-8725-18H,SUP,HCPCS C1713,,AR-8725-18H  -  SCREW BN 1.5MM MIC FT HEX 2.5MM 18MM QFIX SLF DRL ST CNN,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
AR-8725-20H,SUP,HCPCS C1713,,AR-8725-20H  -  SCREW BN 1.5MM MIC FT HEX 2.5MM 20MM QFIX SLF DRL ST CNN,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
AR-8725-22H,SUP,HCPCS C1713,,AR-8725-22H  -  SCREW BN 1.5MM MIC FT HEX 2.5MM 22MM QFIX SLF DRL ST CNN,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
AR-8725-24H,SUP,HCPCS C1713,,AR-8725-24H  -  SCREW BN 1.5MM MIC FT HEX 2.5MM 24MM QFIX SLF DRL ST CNN,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
AR-8725-26H,SUP,HCPCS C1713,,AR-8725-26H  -  SCREW BN 1.5MM MIC FT HEX 2.5MM 26MM QFIX SLF DRL ST CNN,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
AR-8725-28H,SUP,HCPCS C1713,,AR-8725-28H  -  SCREW BN 1.5MM MIC FT HEX 2.5MM 28MM QFIX SLF DRL ST CNN,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
AR-8725-30H,SUP,HCPCS C1713,,AR-8725-30H  -  SCREW BN 1.5MM MIC FT HEX 2.5MM 30MM QFIX SLF DRL ST CNN,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
AR-8730-10PT,SUP,HCPCS C1713,,AR-8730-10PT  -  SCREW BN T10 P/T HEXALOBE LOPRFL 3MM 10MM QFIX SLF DRL ST,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
AR-8730-12H,SUP,HCPCS C1713,,AR-8730-12H  -  SCREW BN MN FT 3.6MM 12MM QFIX CNN CMPR TI FT/ANKL,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
AR-8730-12PT,SUP,HCPCS C1713,,AR-8730-12PT  -  SCREW BN T10 P/T HEXALOBE LOPRFL 3MM 12MM QFIX SLF DRL ST,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
AR-8730-14H,SUP,HCPCS C1713,,AR-8730-14H  -  SCREW BN MN FT 3.6MM 14MM QFIX CNN CMPR TI FT/ANKL,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
AR-8730-14PT,SUP,HCPCS C1713,,AR-8730-14PT  -  SCREW BN T10 P/T HEXALOBE LOPRFL 3MM 14MM QFIX SLF DRL ST,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
AR-8730-16H,SUP,HCPCS C1713,,AR-8730-16H  -  SCREW BN MN FT 3.6MM 16MM QFIX CNN CMPR TI FT/ANKL,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
AR-8730-16PT,SUP,HCPCS C1713,,AR-8730-16PT  -  SCREW BN T10 P/T HEXALOBE LOPRFL 3MM 16MM QFIX SLF DRL ST,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
AR-8730-18H,SUP,HCPCS C1713,,AR-8730-18H  -  SCREW BN MN FT 3.6MM 18MM QFIX CNN CMPR TI FT/ANKL,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
AR-8730-18PT,SUP,HCPCS C1713,,AR-8730-18PT  -  SCREW BN T10 P/T HEXALOBE LOPRFL 3MM 18MM QFIX SLF DRL ST,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
AR-8730-20H,SUP,HCPCS C1713,,AR-8730-20H  -  SCREW BN MN FT 3.6MM 20MM QFIX CNN CMPR TI FT/ANKL,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
AR-8730-20PT,SUP,HCPCS C1713,,AR-8730-20PT  -  SCREW BN T10 P/T HEXALOBE LOPRFL 3MM 20MM QFIX SLF DRL ST,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
AR-8730-22H,SUP,HCPCS C1713,,AR-8730-22H  -  SCREW BN MN FT 3.5MM 22MM QFIX CMPR TI FT/ANKL,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
AR-8730-22PT,SUP,HCPCS C1713,,AR-8730-22PT  -  SCREW BN T10 P/T HEXALOBE LOPRFL 3MM 22MM QFIX SLF DRL ST,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
AR-8730-24H,SUP,HCPCS C1713,,AR-8730-24H  -  SCREW BN MN FT 3.6MM 24MM QFIX CNN CMPR TI FT/ANKL,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
AR-8730-24PT,SUP,HCPCS C1713,,AR-8730-24PT  -  SCREW BN T10 P/T HEXALOBE LOPRFL 3MM 24MM QFIX SLF DRL ST,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
AR-8730-26H,SUP,HCPCS C1713,,AR-8730-26H  -  SCREW BN MN FT 3.6MM 26MM QFIX CNN CMPR TI FT/ANKL,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
AR-8730-26PT,SUP,HCPCS C1713,,AR-8730-26PT  -  SCREW BN T10 P/T HEXALOBE LOPRFL 3MM 26MM QFIX SLF DRL ST,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
AR-8730-28H,SUP,HCPCS C1713,,AR-8730-28H  -  SCREW BN MN FT 3.6MM 28MM QFIX CNN CMPR TI FT/ANKL,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
AR-8730-28PT,SUP,HCPCS C1713,,AR-8730-28PT  -  SCREW BN P/T 3MM 28MM QFIX TI CANC,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
AR-8730-30H,SUP,HCPCS C1713,,AR-8730-30H  -  SCREW BN MN FT 3.6MM 30MM QFIX CNN CMPR TI FT/ANKL,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
AR-8730-30PT,SUP,HCPCS C1713,,AR-8730-30PT  -  SCREW BN T10 P/T HEXALOBE LOPRFL 3MM 30MM QFIX SLF DRL ST,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
AR-8730-32H,SUP,HCPCS C1713,,AR-8730-32H  -  SCREW BN MN FT 3.6MM 32MM QFIX CNN CMPR TI FT/ANKL,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
AR-8730-32PT,SUP,HCPCS C1713,,AR-8730-32PT  -  SCREW BN T10 P/T HEXALOBE LOPRFL 3MM 32MM QFIX SLF DRL ST,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
AR-8730-34H,SUP,HCPCS C1713,,AR-8730-34H  -  SCREW BN MN FT 3.6MM 34MM QFIX CNN CMPR TI FT/ANKL,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
AR-8730-34PT,SUP,HCPCS C1713,,AR-8730-34PT  -  SCREW BN T10 P/T HEXALOBE LOPRFL 3MM 34MM QFIX SLF DRL ST,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
AR-8730-36PT,SUP,HCPCS C1713,,AR-8730-36PT  -  SCREW BN T10 P/T HEXALOBE LOPRFL 3MM 36MM QFIX SLF DRL ST,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
AR-8730-38PT,SUP,HCPCS C1713,,AR-8730-38PT  -  SCREW BN P/T 3MM 38MM QFIX TI CANC,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
AR-8730-40PT,SUP,HCPCS C1713,,AR-8730-40PT  -  SCREW BN T10 P/T HEXALOBE LOPRFL 3MM 40MM QFIX SLF DRL ST,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
AR-8730-42PT,SUP,HCPCS C1713,,AR-8730-42PT  -  SCREW BN T10 P/T HEXALOBE LOPRFL 3MM 42MM QFIX SLF DRL ST,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
AR-8730-44PT,SUP,HCPCS C1713,,AR-8730-44PT  -  SCREW BN T10 P/T HEXALOBE LOPRFL 3MM 44MM QFIX SLF DRL ST,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
AR-8730-46PT,SUP,HCPCS C1713,,AR-8730-46PT  -  SCREW BN T10 P/T HEXALOBE LOPRFL 3MM 46MM QFIX SLF DRL ST,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
AR-8730-48PT,SUP,HCPCS C1713,,AR-8730-48PT  -  SCREW BN T10 P/T HEXALOBE LOPRFL 3MM 48MM QFIX SLF DRL ST,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
AR-8730-50PT,SUP,HCPCS C1713,,AR-8730-50PT  -  SCREW BN T10 P/T HEXALOBE LOPRFL 3MM 50MM QFIX SLF DRL ST,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
AR-8730W,SUP,HCPCS C1713,,AR-8730W  -  WASHER ORTH 6.5MM TI 3MM QFIX SCR,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8737-03,SUP,Custom 27203010,,AR-8737-03  -  GUIDE DRL .86MM 1.7MM,$850.00,$0.00,$850.00,$0.00,$606.65,$0.00,$0.00,$0.00,$0.00,$0.00,$850.00,$0.00,$425.00,$673.20,$680.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8737-06,SUP,Custom 27203010,,AR-8737-06  -  GUIDE DRL 3MM 4MM,$850.00,$0.00,$850.00,$0.00,$606.65,$0.00,$0.00,$0.00,$0.00,$0.00,$850.00,$0.00,$425.00,$673.20,$680.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8737-09,SUP,Custom 27203010,,AR-8737-09  -  BIT DRL 2.5MM QFIX CNN,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8737-11,SUP,Custom 27203010,,AR-8737-11  -  BIT DRL 4MM QFIX CNN,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8737-17,SUP,Custom 27203010,,AR-8737-17  -  BIT DRL 1.7MM QFIX CNN,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8737-23,SUP,Custom 27203010,,AR-8737-23  -  DRILL BIT CNTRSNK 2-2.4MM QFIX CNN,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8737-24,SUP,Custom 27203010,,AR-8737-24  -  DRILL BIT CNTRSNK 3MM QFIX CNN,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8737-34,SUP,Custom 27203010,,AR-8737-34  -  BIT DRL STRG 2MM CNN DISP MIC CMPR FT SCR,$487.50,$0.00,$487.50,$0.00,$347.93,$0.00,$0.00,$0.00,$0.00,$0.00,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8737-35,SUP,Custom 27203010,,AR-8737-35  -  BIT DRL STRG 2.7MM CNN 3.5MM MN CMPR FT SCR,$487.50,$0.00,$487.50,$0.00,$347.93,$0.00,$0.00,$0.00,$0.00,$0.00,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8737-43,SUP,Custom 27203010,,AR-8737-43  -  GUIDE DRL PERC CMPR FT SCR SYS SET,"$1,737.50",$0.00,"$1,737.50",$0.00,"$1,240.05",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,737.50",$0.00,$868.75,"$1,376.10","$1,390.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-8737-48,SUP,Custom 27203010,,AR-8737-48  -  GUIDE DRL PRLL MIC CMPR FT SCR,"$1,375.00",$0.00,"$1,375.00",$0.00,$981.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-8737-49,SUP,Custom 27203010,,AR-8737-49  -  GUIDE DRL PRLL MN CMPR FT SCR,"$1,375.00",$0.00,"$1,375.00",$0.00,$981.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-8737-50,SUP,Custom 27203010,,AR-8737-50  -  BIT DRL STRG 2.7MM CLBRT CNN STD CMPR FT 4MM SCR,$487.50,$0.00,$487.50,$0.00,$347.93,$0.00,$0.00,$0.00,$0.00,$0.00,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8737-55,SUP,Custom 27203010,,AR-8737-55  -  GUIDE DRL PRLL 4 MM STD CMPR FT SCR,"$1,375.00",$0.00,"$1,375.00",$0.00,$981.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-8737-57,SUP,Custom 27203010,,AR-8737-57  -  CLAMP XTRNFX PIN PERC CMPR FT SCR SYS SET,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-8737-58,SUP,Custom 27203010,,AR-8737-58  -  BIT DRL STRG 2.2MM CNN 2.5MM CMPR FT SCR,$487.50,$0.00,$487.50,$0.00,$347.93,$0.00,$0.00,$0.00,$0.00,$0.00,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8737C-SC-01,SUP,HCPCS C1713,,AR-8737C-SC-01  -  PLATE STRL QFIX CADDY TOP CNN SCR SYS,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
AR-8737H-2,SUP,HCPCS C1713,,AR-8737H-2  -  SET TRMA FX UPGRD CMPR FT SCR,"$15,587.50",$0.00,"$15,587.50","$7,014.38","$5,158.80",$0.00,"$2,685.65",$0.00,$0.00,"$2,729.25","$15,587.50",$0.00,"$7,793.75","$12,345.30","$12,470.00",$0.00,"$2,439.44",$0.00,"$2,481.53",$0.00
AR-8740-14PTS,SUP,HCPCS C1713,,AR-8740-14PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 14MM QFIX BCMPT,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-8740-16H,SUP,HCPCS C1713,,AR-8740-16H  -  SCREW BN STD FT 4.6MM 16MM CNN CMPR VAR STP PTCH TI FT HND,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
AR-8740-16PTS,SUP,HCPCS C1713,,AR-8740-16PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 16MM QFIX BCMPT,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-8740-18H,SUP,HCPCS C1713,,AR-8740-18H  -  SCREW BN STD FT 4.6MM 18MM QFIX CNN CMPR TI ANKL/FT,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
AR-8740-18PTS,SUP,HCPCS C1713,,AR-8740-18PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 18MM QFIX BCMPT,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-8740-20H,SUP,HCPCS C1713,,AR-8740-20H  -  SCREW BN STD FT 4.6MM 20MM CNN CMPR VAR STP PTCH TI FT HND,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
AR-8740-20PTS,SUP,HCPCS C1713,,AR-8740-20PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 20MM QFIX BCMPT,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-8740-22H,SUP,HCPCS C1713,,AR-8740-22H  -  SCREW BN STD FT 4MM 22MM CNN CMPR VAR STP PTCH TI FT HND,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
AR-8740-22PTS,SUP,HCPCS C1713,,AR-8740-22PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 22MM QFIX BCMPT,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-8740-24H,SUP,HCPCS C1713,,AR-8740-24H  -  SCREW BN STD FT 4.6MM 24MM CNN CMPR VAR STP PTCH TI FT HND,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
AR-8740-24PTS,SUP,HCPCS C1713,,AR-8740-24PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 24MM QFIX BCMPT,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-8740-26H,SUP,HCPCS C1713,,AR-8740-26H  -  SCREW BN STD FT 4.6MM 26MM CNN CMPR VAR STP PTCH TI FT HND,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
AR-8740-26PTS,SUP,HCPCS C1713,,AR-8740-26PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 26MM QFIX BCMPT,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-8740-28H,SUP,HCPCS C1713,,AR-8740-28H  -  SCREW BN STD FT 4.6MM 28MM QFIX CNN CMPR TI ANKL/FT,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
AR-8740-28PTS,SUP,HCPCS C1713,,AR-8740-28PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 28MM QFIX BCMPT,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-8740-30H,SUP,HCPCS C1713,,AR-8740-30H  -  SCREW BN STD FT 4MM 30MM CNN CMPR VAR STP PTCH TI FT HND,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
AR-8740-30PTL,SUP,HCPCS C1713,,AR-8740-30PTL  -  SCREW BN LNG P/T LOPRFL 4MM 30MM SLF DRL ST CNN TI SHLDR,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-8740-30PTS,SUP,HCPCS C1713,,AR-8740-30PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 30MM QFIX BCMPT,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-8740-32H,SUP,HCPCS C1713,,AR-8740-32H  -  SCREW BN STD FT 4.6MM 32MM QFIX CNN CMPR TI ANKL/FT,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
AR-8740-32PTL,SUP,HCPCS C1713,,AR-8740-32PTL  -  SCREW BN LNG P/T LOPRFL 4MM 32MM SLF DRL ST CNN TI SHLDR,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-8740-32PTS,SUP,HCPCS C1713,,AR-8740-32PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 32MM QFIX BCMPT,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-8740-34H,SUP,HCPCS C1713,,AR-8740-34H  -  SCREW BN STD FT 4MM 34MM CNN CMPR VAR STP PTCH TI FT HND,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
AR-8740-34PTL,SUP,HCPCS C1713,,AR-8740-34PTL  -  SCREW BN LNG P/T LOPRFL 4MM 34MM SLF DRL ST CNN TI SHLDR,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-8740-34PTS,SUP,HCPCS C1713,,AR-8740-34PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 34MM QFIX BCMPT,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-8740-36H,SUP,HCPCS C1713,,AR-8740-36H  -  SCREW BN STD FT 4MM 36MM CNN CMPR VAR STP PTCH TI FT/ANKL,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
AR-8740-36PTL,SUP,HCPCS C1713,,AR-8740-36PTL  -  SCREW BN LNG P/T LOPRFL 4MM 36MM SLF DRL ST CNN TI SHLDR,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-8740-36PTS,SUP,HCPCS C1713,,AR-8740-36PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 36MM QFIX BCMPT,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-8740-38H,SUP,HCPCS C1713,,AR-8740-38H  -  SCREW BN STD FT 4MM 38MM CNN CMPR VAR STP PTCH TI FT HND,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
AR-8740-38PTL,SUP,HCPCS C1713,,AR-8740-38PTL  -  SCREW BN LNG P/T LOPRFL 4MM 38MM SLF DRL ST CNN TI SHLDR,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-8740-38PTS,SUP,HCPCS C1713,,AR-8740-38PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 38MM QFIX BCMPT,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-8740-40H,SUP,HCPCS C1713,,AR-8740-40H  -  SCREW BN STD FT 4MM 40MM CNN CMPR VAR STP PTCH TI FT HND,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
AR-8740-40PTS,SUP,HCPCS C1713,,AR-8740-40PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 40MM QFIX BCMPT,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-8740-42H,SUP,HCPCS C1713,,AR-8740-42H  -  SCREW BN STD FT 4.6MM 42MM CNN CMPR VAR STP PTCH TI FT HND,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
AR-8740-42PTS,SUP,HCPCS C1713,,AR-8740-42PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 42MM QFIX BCMPT,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-8740-44H,SUP,HCPCS C1713,,AR-8740-44H  -  SCREW BN STD FT 4.6MM 44MM CNN CMPR VAR STP PTCH TI FT HND,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
AR-8740-44PTS,SUP,HCPCS C1713,,AR-8740-44PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 44MM QFIX BCMPT,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-8740-46H,SUP,HCPCS C1713,,AR-8740-46H  -  SCREW BN STD FT 4.6MM 46MM CNN CMPR VAR STP PTCH TI FT HND,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
AR-8740-46PTS,SUP,HCPCS C1713,,AR-8740-46PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 46MM QFIX BCMPT,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-8740-48H,SUP,HCPCS C1713,,AR-8740-48H  -  SCREW BN STD FT 4.6MM 48MM CNN CMPR VAR STP PTCH TI FT HND,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
AR-8740-48PTS,SUP,HCPCS C1713,,AR-8740-48PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 48MM QFIX BCMPT,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-8740-50H,SUP,HCPCS C1713,,AR-8740-50H  -  SCREW BN STD FT 4.6MM 50MM CNN CMPR VAR STP PTCH TI FT HND,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
AR-8740-50PTS,SUP,HCPCS C1713,,AR-8740-50PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 50MM QFIX BCMPT,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-8740-52PTLS,SUP,HCPCS C1713,,AR-8740-52PTLS  -  SCREW BN P/T 4MM 52MM STRL ARTHX LOPRFL,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-8740-52PTS,SUP,HCPCS C1713,,AR-8740-52PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 52MM QFIX BCMPT,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-8740-54PTS,SUP,HCPCS C1713,,AR-8740-54PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 54MM QFIX BCMPT,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-8740-56PTS,SUP,HCPCS C1713,,AR-8740-56PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 56MM QFIX BCMPT,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-8740-58PTS,SUP,HCPCS C1713,,AR-8740-58PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 58MM QFIX BCMPT,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-8740-60PTS,SUP,HCPCS C1713,,AR-8740-60PTS  -  SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 60MM QFIX BCMPT,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-8740W,SUP,HCPCS C1713,,AR-8740W  -  WASHER ORTH 7MM TI 4MM QFIX SCR,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8801,SUP,Custom 27203010,,AR-8801  -  SHEATH ASCP GD SLOT,"$1,500.00",$0.00,"$1,500.00",$0.00,"$1,070.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-8825B,SUP,HCPCS C1713,,AR-8825B  -  ANCHOR SUT MN 2.5MM 8MM STRL BIO-PUSHLOCK,$900.00,$0.00,$900.00,$405.00,$642.33,$0.00,$155.07,$0.00,$0.00,$157.58,$900.00,$0.00,$450.00,$712.80,$720.00,$0.00,$140.85,$0.00,$143.28,$0.00
AR-8825CP,SUP,Custom 27203010,,AR-8825CP  -  KIT INST 3ANG FIBROCARTILAGE CMPLX DISP,$875.00,$0.00,$875.00,$0.00,$624.49,$0.00,$0.00,$0.00,$0.00,$0.00,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8825P,SUP,HCPCS C1713,,AR-8825P  -  ANCHOR SUT MN 2.5MM 8MM STRL PUSHLOCK PEEK,$900.00,$0.00,$900.00,$405.00,$642.33,$0.00,$155.07,$0.00,$0.00,$157.58,$900.00,$0.00,$450.00,$712.80,$720.00,$0.00,$140.85,$0.00,$143.28,$0.00
AR-8826G,SUP,Custom 27203010,,AR-8826G  -  GUIDE DRL C RING GFT ANCH,"$7,187.50",$0.00,"$7,187.50",$0.00,"$5,129.72",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,187.50",$0.00,"$3,593.75","$5,692.50","$5,750.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-8827-10,SUP,HCPCS C1713,,AR-8827-10  -  SCREW BN 2.7MM 10MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
AR-8827-12,SUP,HCPCS C1713,,AR-8827-12  -  SCREW BN 2.7MM 12MM LOPRFL SCR NONLOCK SS CORT ANKL FX MGMT,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
AR-8827-14,SUP,HCPCS C1713,,AR-8827-14  -  SCREW BN 2.7MM 14MM LOPRFL SCR NONLOCK SS CORT ANKL FX MGMT,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
AR-8827-16,SUP,HCPCS C1713,,AR-8827-16  -  SCREW BN 2.7MM 16MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
AR-8827-18,SUP,HCPCS C1713,,AR-8827-18  -  SCREW BN 2.7MM 18MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
AR-8827-20,SUP,HCPCS C1713,,AR-8827-20  -  SCREW BN 2.7MM 20MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
AR-8827-22,SUP,HCPCS C1713,,AR-8827-22  -  SCREW BN 2.7MM 22MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
AR-8827-24,SUP,HCPCS C1713,,AR-8827-24  -  SCREW BN 2.7MM 24MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
AR-8827-26,SUP,HCPCS C1713,,AR-8827-26  -  SCREW BN 2.7MM 26MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
AR-8827-28,SUP,HCPCS C1713,,AR-8827-28  -  SCREW BN 2.7MM 28MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
AR-8827-30,SUP,HCPCS C1713,,AR-8827-30  -  SCREW BN 2.7MM 30MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
AR-8827-32,SUP,HCPCS C1713,,AR-8827-32  -  SCREW BN 2.7MM 32MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
AR-8827-34,SUP,HCPCS C1713,,AR-8827-34  -  SCREW BN 2.7MM 34MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
AR-8827-36,SUP,HCPCS C1713,,AR-8827-36  -  SCREW BN 2.7MM 36MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
AR-8827-38,SUP,HCPCS C1713,,AR-8827-38  -  SCREW BN 2.7MM 38MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
AR-8827-40,SUP,HCPCS C1713,,AR-8827-40  -  SCREW BN 2.7MM 40MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
AR-8827-42,SUP,HCPCS C1713,,AR-8827-42  -  SCREW BN 2.7MM 42MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
AR-8827-44,SUP,HCPCS C1713,,AR-8827-44  -  SCREW BN 2.7MM 44MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
AR-8827-46,SUP,HCPCS C1713,,AR-8827-46  -  SCREW BN 2.7MM 46MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
AR-8827-48,SUP,HCPCS C1713,,AR-8827-48  -  SCREW BN 2.7MM 48MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
AR-8827-50,SUP,HCPCS C1713,,AR-8827-50  -  SCREW BN 2.7MM 50MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
AR-8827-52,SUP,HCPCS C1713,,AR-8827-52  -  SCREW BN 2.7MM 52MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
AR-8827-54,SUP,HCPCS C1713,,AR-8827-54  -  SCREW BN 2.7MM 54MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
AR-8827-56,SUP,HCPCS C1713,,AR-8827-56  -  SCREW BN 2.7MM 56MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
AR-8827-58,SUP,HCPCS C1713,,AR-8827-58  -  SCREW BN 2.7MM 56MM NONLOCK LOPRFL ANKL CORT FX MGMT SYS,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
AR-8827-60,SUP,HCPCS C1713,,AR-8827-60  -  SCREW BN 2.7MM 60MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
AR-8827D-01,SUP,Custom 27203010,,AR-8827D-01  -  BIT DRL 2.7MM 2.7/3MM SCR ANKL FX MGMT SYS,$212.50,$0.00,$212.50,$0.00,$151.66,$0.00,$0.00,$0.00,$0.00,$0.00,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8827D-02,SUP,Custom 27203010,,AR-8827D-02  -  GUIDE DRL 2.7MM 2MM,"$1,000.00",$0.00,"$1,000.00",$0.00,$713.70,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,000.00",$0.00,$500.00,$792.00,$800.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8827L-08,SUP,HCPCS C1713,,AR-8827L-08  -  SCREW BN T10 HEXALOBE FT 2.7MM 8MM LOPRFL SCR LCK MDLR SLF,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-8827L-10,SUP,HCPCS C1713,,AR-8827L-10  -  SCREW BN FT T10 HEXALOBE 2.7MM 10MM LOPRFL SCR SLF DRL SLD,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-8827L-12,SUP,HCPCS C1713,,AR-8827L-12  -  SCREW BN FT T10 HEXALOBE 2.7MM 12MM LOPRFL SCR SLF DRL SLD,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-8827L-14,SUP,HCPCS C1713,,AR-8827L-14  -  SCREW BN FT T10 HEXALOBE 2.7MM 14MM LOPRFL SCR SLF DRL SLD,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-8827L-16,SUP,HCPCS C1713,,AR-8827L-16  -  SCREW BN FT T10 HEXALOBE 2.7MM 16MM LOPRFL SCR SLF DRL SLD,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-8827L-18,SUP,HCPCS C1713,,AR-8827L-18  -  SCREW BN FT T10 HEXALOBE 2.7MM 18MM LOPRFL SCR SLF DRL SLD,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-8827L-20,SUP,HCPCS C1713,,AR-8827L-20  -  SCREW BN FT T10 HEXALOBE 2.7MM 20MM LOPRFL SCR SLF DRL SLD,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-8827L-22,SUP,HCPCS C1713,,AR-8827L-22  -  SCREW BN FT T10 HEXALOBE 2.7MM 22MM LOPRFL SCR SLF DRL SLD,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-8827L-24,SUP,HCPCS C1713,,AR-8827L-24  -  SCREW BN FT T10 HEXALOBE 2.7MM 24MM LOPRFL SCR SLF DRL SLD,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-8827L-26,SUP,HCPCS C1713,,AR-8827L-26  -  SCREW BN FT T10 HEXALOBE 2.7MM 26MM LOPRFL SCR SLF DRL SLD,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-8827L-28,SUP,HCPCS C1713,,AR-8827L-28  -  SCREW BN T10 HEXALOBE FT 2.7MM 28MM LOPRFL SCR LCK MDLR SLF,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-8827L-30,SUP,HCPCS C1713,,AR-8827L-30  -  SCREW BN 2.7MM 30MM LOPRFL LCK ANKL,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-8827L-34,SUP,HCPCS C1713,,AR-8827L-34  -  SCREW BN 2.7MM 34MM NS LF LPR ARTHX LCK SS,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-8827L-36,SUP,HCPCS C1713,,AR-8827L-36  -  SCREW BN 2.7MM 36MM NS LF LPR ARTHX LCK SS,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-8827L-38,SUP,HCPCS C1713,,AR-8827L-38  -  SCREW BN 2.7MM 38MM NS LF LPR ARTHX LCK SS,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-8827L-40,SUP,HCPCS C1713,,AR-8827L-40  -  SCREW BN 2.7MM 40MM NS LF LPR ARTHX LCK SS,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-8827L-42,SUP,HCPCS C1713,,AR-8827L-42  -  SCREW BN 2.7MM 42MM STRL LOPRFL SCR LCK ANKL,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-8827L-44,SUP,HCPCS C1713,,AR-8827L-44  -  SCREW BN 2.7MM 44MM LOPRFL SCR LCK,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-8827L-46,SUP,HCPCS C1713,,AR-8827L-46  -  SCREW BN 2.7MM 46MM STRL LOPRFL SCR LCK ANKL,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-8827L-48,SUP,HCPCS C1713,,AR-8827L-48  -  SCREW BN 2.7MM 48MM STRL LOPRFL SCR LCK,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-8827L-50,SUP,HCPCS C1713,,AR-8827L-50  -  SCREW BN 2.7MM 50MM LOPRFL SCR LCK ANKL,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-8827L-52,SUP,HCPCS C1713,,AR-8827L-52  -  SCREW BN 2.7MM 52MM LOPRFL SCR LCK ANKL,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-8827L-54,SUP,HCPCS C1713,,AR-8827L-54  -  SCREW BN 2.7MM 54MM ARTHX LOPRFL SCR LCK,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-8827L-56,SUP,HCPCS C1713,,AR-8827L-56  -  SCREW BN 2.7MM 56MM LOPRFL SCR LCK ANKL,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-8827L-58,SUP,HCPCS C1713,,AR-8827L-58  -  SCREW BN 2.7MM 58MM ARTHX LOPRFL SCR LCK,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-8827L-60,SUP,HCPCS C1713,,AR-8827L-60  -  SCREW BN 2.7MM 60MM LOPRFL SCR LCK ANKL,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-8830-10,SUP,HCPCS C1713,,AR-8830-10  -  SCREW BN FT T10 HEXALOBE 3MM 10MM LOPRFL SCR SLF DRL SLD,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8830-12,SUP,HCPCS C1713,,AR-8830-12  -  SCREW BN FT T10 HEXALOBE 3MM 12MM LOPRFL SCR SLF DRL SLD,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8830-14,SUP,HCPCS C1713,,AR-8830-14  -  SCREW BN FT T10 HEXALOBE 3MM 14MM LOPRFL SCR SLF DRL SLD,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8830-16,SUP,HCPCS C1713,,AR-8830-16  -  SCREW BN FT T10 HEXALOBE 3MM 16MM LOPRFL SCR SLF DRL SLD,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8830-18,SUP,HCPCS C1713,,AR-8830-18  -  SCREW BN FT T10 HEXALOBE 3MM 18MM LOPRFL SCR SLF DRL SLD,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8830-20,SUP,HCPCS C1713,,AR-8830-20  -  SCREW BN FT T10 HEXALOBE 3MM 20MM LOPRFL SCR SLF DRL SLD,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8830-22,SUP,HCPCS C1713,,AR-8830-22  -  SCREW BN FT T10 HEXALOBE 3MM 22MM LOPRFL SCR SLF DRL SLD,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8830-24,SUP,HCPCS C1713,,AR-8830-24  -  SCREW BN FT T10 HEXALOBE 3MM 24MM LOPRFL SCR SLF DRL SLD,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8830-26,SUP,HCPCS C1713,,AR-8830-26  -  SCREW BN FT T10 HEXALOBE 3MM 26MM LOPRFL SCR SLF DRL SLD,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8830-28,SUP,HCPCS C1713,,AR-8830-28  -  SCREW BN FT T10 HEXALOBE 3MM 28MM LOPRFL SCR SLF DRL SLD,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8830-30,SUP,HCPCS C1713,,AR-8830-30  -  SCREW BN FT T10 HEXALOBE 3MM 30MM LOPRFL SCR SLF DRL SLD,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8835-08,SUP,HCPCS C1713,,AR-8835-08  -  SCREW BN T15 HEXALOBE FT 3.5MM 8MM LOPRFL SCR MDLR SLF DRL,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8835-08S,SUP,HCPCS C1713,,AR-8835-08S  -  SCREW BN 3.5MM 8MM STRL ARTHX LOPRFL CORT,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8835-10,SUP,HCPCS C1713,,AR-8835-10  -  SCREW BN T15 FT HEXALOBE 3.5MM 10MM LOPRFL SCR SLF DRL SLD,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8835-12,SUP,HCPCS C1713,,AR-8835-12  -  SCREW BN T15 FT HEXALOBE 3.5MM 12MM LOPRFL SCR SLF DRL SLD,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8835-14,SUP,HCPCS C1713,,AR-8835-14  -  SCREW BN T15 FT HEXALOBE 3.5MM 14MM LOPRFL SCR SLF DRL SLD,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8835-16,SUP,HCPCS C1713,,AR-8835-16  -  SCREW BN T15 FT HEXALOBE 3.5MM 16MM LOPRFL SCR SLF DRL SLD,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8835-18,SUP,HCPCS C1713,,AR-8835-18  -  SCREW BN T15 FT HEXALOBE 3.5MM 18MM LOPRFL SCR SLF DRL SLD,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8835-20,SUP,HCPCS C1713,,AR-8835-20  -  SCREW BN T15 FT HEXALOBE 3.5MM 20MM LOPRFL SCR SLF DRL SLD,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8835-22,SUP,HCPCS C1713,,AR-8835-22  -  SCREW BN T15 FT HEXALOBE 3.5MM 22MM LOPRFL SCR SLF DRL SLD,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8835-24,SUP,HCPCS C1713,,AR-8835-24  -  SCREW BN T15 FT HEXALOBE 3.5MM 24MM LOPRFL SCR SLF DRL SLD,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8835-26,SUP,HCPCS C1713,,AR-8835-26  -  SCREW BN T15 FT HEXALOBE 3.5MM 26MM LOPRFL SCR SLF DRL SLD,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8835-28,SUP,HCPCS C1713,,AR-8835-28  -  SCREW BN T15 FT HEXALOBE 3.5MM 28MM LOPRFL SCR SLF DRL SLD,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8835-30,SUP,HCPCS C1713,,AR-8835-30  -  SCREW BN T15 HEXALOBE FT 3.5MM 30MM LOPRFL SCR MDLR SLF DRL,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8835-32,SUP,HCPCS C1713,,AR-8835-32  -  SCREW BN T15 HEXALOBE FT 3.5MM 32MM LOPRFL SCR MDLR SLF DRL,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8835-34,SUP,HCPCS C1713,,AR-8835-34  -  SCREW BN T15 HEXALOBE FT 3.5MM 34MM LOPRFL SCR MDLR SLF DRL,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8835-35,SUP,HCPCS C1713,,AR-8835-35  -  SCREW BN T15 FT HEXALOBE 3.5MM 35MM LOPRFL SCR SLF DRL SLD,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8835-36,SUP,HCPCS C1713,,AR-8835-36  -  SCREW BN T15 HEXALOBE FT 3.5MM 36MM LOPRFL SCR MDLR SLF DRL,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8835-38,SUP,HCPCS C1713,,AR-8835-38  -  SCREW BN T15 HEXALOBE FT 3.5MM 38MM LOPRFL SCR MDLR SLF DRL,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8835-40,SUP,HCPCS C1713,,AR-8835-40  -  SCREW BN T15 FT HEXALOBE 3.5MM 40MM LOPRFL SCR SLF DRL SLD,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8835-42,SUP,HCPCS C1713,,AR-8835-42  -  SCREW BN T15 HEXALOBE FT 3.5MM 42MM LOPRFL SCR MDLR SLF DRL,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8835-44,SUP,HCPCS C1713,,AR-8835-44  -  SCREW BN T15 FT HEXALOBE 3.5MM 44MM LOPRFL SCR SLF DRL SLD,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8835-45,SUP,HCPCS C1713,,AR-8835-45  -  SCREW BN T15 FT HEXALOBE 3.5MM 45MM LOPRFL SCR SLF DRL SLD,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8835-46,SUP,HCPCS C1713,,AR-8835-46  -  SCREW BN T15 HEXALOBE FT 3.5MM 46MM LOPRFL SCR MDLR SLF DRL,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8835-48,SUP,HCPCS C1713,,AR-8835-48  -  SCREW BN T15 HEXALOBE FT 3.5MM 48MM LOPRFL SCR MDLR SLF DRL,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8835-50,SUP,HCPCS C1713,,AR-8835-50  -  SCREW BN T15 FT HEXALOBE 3.5MM 50MM LOPRFL SCR SLF DRL SLD,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8835-55,SUP,HCPCS C1713,,AR-8835-55  -  SCREW BN T15 FT HEXALOBE 3.5MM 55MM LOPRFL SCR SLF DRL SLD,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8835-60,SUP,HCPCS C1713,,AR-8835-60  -  SCREW BN T15 FT HEXALOBE 3.5MM 60MM LOPRFL SCR SLF DRL SLD,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8835-65,SUP,HCPCS C1713,,AR-8835-65  -  SCREW BN HEXALOBE FT 3.5MM 65MM LOPRFL SCR T15 SLF DRL SLD,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8835-70,SUP,HCPCS C1713,,AR-8835-70  -  SCREW BN HEXALOBE FT 3.5MM 70MM LOPRFL SCR T15 SLF DRL SLD,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8835-75,SUP,HCPCS C1713,,AR-8835-75  -  SCREW BN HEXALOBE FT 3.5MM 75MM LOPRFL SCR T15 SLF DRL SLD,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8835-80,SUP,HCPCS C1713,,AR-8835-80  -  SCREW BN 3.5MM 80MM ARTHX LOPRFL SCR CORT,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8835L-08,SUP,HCPCS C1713,,AR-8835L-08  -  SCREW BN T15 HEXALOBE FT 3.5MM 8MM LOPRFL SCR LCK MDLR SLF,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-8835L-10,SUP,HCPCS C1713,,AR-8835L-10  -  SCREW BN T15 FT HEXALOBE 3.5MM 10MM LOPRFL SCR SLF DRL SLD,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-8835L-12,SUP,HCPCS C1713,,AR-8835L-12  -  SCREW BN T15 FT HEXALOBE 3.5MM 12MM LOPRFL SCR SLF DRL SLD,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-8835L-14,SUP,HCPCS C1713,,AR-8835L-14  -  SCREW BN T15 FT HEXALOBE 3.5MM 14MM LOPRFL SCR SLF DRL SLD,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-8835L-16,SUP,HCPCS C1713,,AR-8835L-16  -  SCREW BN T15 FT HEXALOBE 3.5MM 16MM LOPRFL SCR SLF DRL SLD,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-8835L-18,SUP,HCPCS C1713,,AR-8835L-18  -  SCREW BN T15 FT HEXALOBE 3.5MM 18MM LOPRFL SCR SLF DRL SLD,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-8835L-20,SUP,HCPCS C1713,,AR-8835L-20  -  SCREW BN T15 FT HEXALOBE 3.5MM 20MM LOPRFL SCR SLF DRL SLD,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-8835L-22,SUP,HCPCS C1713,,AR-8835L-22  -  SCREW BN T15 FT HEXALOBE 3.5MM 22MM LOPRFL SCR SLF DRL SLD,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-8835L-24,SUP,HCPCS C1713,,AR-8835L-24  -  SCREW BN T15 HEXALOBE FT 3.5MM 24MM LOPRFL SCR LCK MDLR SLF,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-8835L-26,SUP,HCPCS C1713,,AR-8835L-26  -  SCREW BN T15 HEXALOBE FT 3.5MM 26MM LOPRFL SCR LCK MDLR SLF,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-8835L-28,SUP,HCPCS C1713,,AR-8835L-28  -  SCREW BN T15 HEXALOBE FT 3.5MM 28MM LOPRFL SCR LCK MDLR SLF,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-8835L-30,SUP,HCPCS C1713,,AR-8835L-30  -  SCREW BN T15 FT HEXALOBE 3.5MM 30MM LOPRFL SCR SLF DRL SLD,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-8835L-32,SUP,HCPCS C1713,,AR-8835L-32  -  SCREW BN T15 HEXALOBE FT 3.5MM 32MM LOPRFL SCR LCK MDLR SLF,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-8835L-34,SUP,HCPCS C1713,,AR-8835L-34  -  SCREW BN T15 HEXALOBE FT 3.5MM 34MM LOPRFL SCR LCK MDLR SLF,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-8835L-36,SUP,HCPCS C1713,,AR-8835L-36  -  SCREW BN T15 HEXALOBE FT 3.5MM 36MM LOPRFL SCR LCK MDLR SLF,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-8835L-38,SUP,HCPCS C1713,,AR-8835L-38  -  SCREW BN T15 HEXALOBE FT 3.5MM 38MM LOPRFL SCR LCK MDLR SLF,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-8835L-40,SUP,HCPCS C1713,,AR-8835L-40  -  SCREW BN T15 FT HEXALOBE 3.5MM 40MM LOPRFL SCR SLF DRL SLD,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-8835L-42,SUP,HCPCS C1713,,AR-8835L-42  -  SCREW BN T15 FT HEXALOBE 3.5MM 42MM LOPRFL SCR SLF DRL SLD,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-8835L-44,SUP,HCPCS C1713,,AR-8835L-44  -  SCREW BN T15 FT HEXALOBE 3.5MM 44MM LOPRFL SCR SLF DRL SLD,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-8835L-45,SUP,HCPCS C1713,,AR-8835L-45  -  SCREW BN T15 FT HEXALOBE 3.5MM 45MM LOPRFL SCR SLF DRL SLD,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-8835L-46,SUP,HCPCS C1713,,AR-8835L-46  -  SCREW BN T15 FT HEXALOBE 3.5MM 46MM LOPRFL SCR SLF DRL SLD,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-8835L-48,SUP,HCPCS C1713,,AR-8835L-48  -  SCREW BN T15 FT HEXALOBE 3.5MM 48MM LOPRFL SCR SLF DRL SLD,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-8835L-50,SUP,HCPCS C1713,,AR-8835L-50  -  SCREW BN T15 HEXALOBE FT 3.5MM 50MM LOPRFL SCR LCK MDLR SLF,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-8840-10,SUP,HCPCS C1713,,AR-8840-10  -  SCREW BN T15 FT HEXALOBE 4MM 10MM LOPRFL SCR SLF DRL SLD,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8840-10S,SUP,HCPCS C1713,,AR-8840-10S  -  SCREW BN 4MM 10MM STRL ARTHX LOPRFL CANC,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8840-12,SUP,HCPCS C1713,,AR-8840-12  -  SCREW BN T15 FT HEXALOBE 4MM 12MM LOPRFL SCR SLF DRL SLD,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8840-12S,SUP,HCPCS C1713,,AR-8840-12S  -  SCREW BN 4MM 12MM STRL ARTHX LOPRFL CANC,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8840-14,SUP,HCPCS C1713,,AR-8840-14  -  SCREW BN T15 FT HEXALOBE 4MM 14MM LOPRFL SCR SLF DRL SLD,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8840-16,SUP,HCPCS C1713,,AR-8840-16  -  SCREW BN T15 FT HEXALOBE 4MM 16MM LOPRFL SCR SLF DRL SLD,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8840-16S,SUP,HCPCS C1713,,AR-8840-16S  -  SCREW BN 4MM 16MM STRL ARTHX LOPRFL CANC,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8840-18,SUP,HCPCS C1713,,AR-8840-18  -  SCREW BN T15 FT HEXALOBE 4MM 18MM LOPRFL SCR SLF DRL SLD,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8840-18S,SUP,HCPCS C1713,,AR-8840-18S  -  SCREW BN 4MM 18MM STRL ARTHX LOPRFL CANC,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8840-20,SUP,HCPCS C1713,,AR-8840-20  -  SCREW BN T15 FT HEXALOBE 4MM 20MM LOPRFL SCR SLF DRL SLD,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8840-20S,SUP,HCPCS C1713,,AR-8840-20S  -  SCREW BN 4MM 20MM STRL ARTHX LOPRFL CANC,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8840-22,SUP,HCPCS C1713,,AR-8840-22  -  SCREW BN T15 FT HEXALOBE 4MM 22MM LOPRFL SCR SLF DRL SLD,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8840-22S,SUP,HCPCS C1713,,AR-8840-22S  -  SCREW BN 4MM 22MM STRL ARTHX LOPRFL CANC,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8840-24,SUP,HCPCS C1713,,AR-8840-24  -  SCREW BN T15 FT HEXALOBE 4MM 24MM LOPRFL SCR SLF DRL SLD,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8840-26,SUP,HCPCS C1713,,AR-8840-26  -  SCREW BN T15 FT HEXALOBE 4MM 26MM LOPRFL SCR SLF DRL SLD,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8840-26S,SUP,HCPCS C1713,,AR-8840-26S  -  SCREW BN 4MM 26MM STRL ARTHX LOPRFL CANC,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8840-28,SUP,HCPCS C1713,,AR-8840-28  -  SCREW BN T15 FT HEXALOBE 4MM 28MM LOPRFL SCR SLF DRL SLD,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8840-28S,SUP,HCPCS C1713,,AR-8840-28S  -  SCREW BN 4MM 28MM STRL ARTHX LOPRFL CANC,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8840-30,SUP,HCPCS C1713,,AR-8840-30  -  SCREW BN T15 FT HEXALOBE 4MM 30MM LOPRFL SCR SLF DRL SLD,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8840-32,SUP,HCPCS C1713,,AR-8840-32  -  SCREW BN T15 FT HEXALOBE 4MM 32MM LOPRFL SCR SLF DRL SLD,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8840-32S,SUP,HCPCS C1713,,AR-8840-32S  -  SCREW BN 4MM 32MM STRL ARTHX LOPRFL CANC,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8840-34,SUP,HCPCS C1713,,AR-8840-34  -  SCREW BN T15 FT HEXALOBE 4MM 34MM LOPRFL SCR SLF DRL SLD,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8840-34S,SUP,HCPCS C1713,,AR-8840-34S  -  SCREW BN 4MM 34MM STRL ARTHX LOPRFL CANC,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8840-36,SUP,HCPCS C1713,,AR-8840-36  -  SCREW BN T15 HEXALOBE FT 4MM 36MM LOPRFL SCR MDLR SLF DRL,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8840-36S,SUP,HCPCS C1713,,AR-8840-36S  -  SCREW BN 4MM 36MM STRL ARTHX LOPRFL CANC,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8840-38,SUP,HCPCS C1713,,AR-8840-38  -  SCREW BN T15 FT HEXALOBE 4MM 38MM LOPRFL SCR SLF DRL SLD,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8840-38S,SUP,HCPCS C1713,,AR-8840-38S  -  SCREW BN 4MM 38MM STRL ARTHX LOPRFL CANC,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8840-40,SUP,HCPCS C1713,,AR-8840-40  -  SCREW BN T15 FT HEXALOBE 4MM 40MM LOPRFL SCR SLF DRL SLD,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8840-40S,SUP,HCPCS C1713,,AR-8840-40S  -  SCREW BN 4MM 40MM STRL ARTHX LOPRFL CANC,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8840-42,SUP,HCPCS C1713,,AR-8840-42  -  SCREW BN T15 FT HEXALOBE 4MM 42MM LOPRFL SCR SLF DRL SLD,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8840-44,SUP,HCPCS C1713,,AR-8840-44  -  SCREW BN T15 HEXALOBE FT 4MM 44MM LOPRFL SCR MDLR SLF DRL,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8840-45,SUP,HCPCS C1713,,AR-8840-45  -  SCREW BN T15 FT HEXALOBE 4MM 45MM LOPRFL SCR SLF DRL SLD,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8840-46,SUP,HCPCS C1713,,AR-8840-46  -  SCREW BN T15 HEXALOBE FT 4MM 46MM LOPRFL SCR MDLR SLF DRL,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8840-48,SUP,HCPCS C1713,,AR-8840-48  -  SCREW BN T15 HEXALOBE FT 4MM 48MM LOPRFL SCR MDLR SLF DRL,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8840-50,SUP,HCPCS C1713,,AR-8840-50  -  SCREW BN T15 HEXALOBE FT 4MM 50MM LOPRFL SCR MDLR SLF DRL,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8840-50S,SUP,HCPCS C1713,,AR-8840-50S  -  SCREW BN 4MM 50MM STRL ARTHX LOPRFL CANC,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8840-55,SUP,HCPCS C1713,,AR-8840-55  -  SCREW BN T15 FT HEXALOBE 4MM 55MM LOPRFL SCR SLF DRL SLD,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8840-55S,SUP,HCPCS C1713,,AR-8840-55S  -  SCREW BN 4MM 55MM STRL ARTHX LOPRFL CANC,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8840-60,SUP,HCPCS C1713,,AR-8840-60  -  SCREW BN T15 HEXALOBE FT 4MM 60MM LOPRFL SCR MDLR SLF DRL,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8840C-30,SUP,HCPCS C1713,,AR-8840C-30  -  SCREW BN SHRT 1/3 LGTH T15 HEXALOBE 4MM 30MM LOPRFL SCR SLF,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-8840C-32,SUP,HCPCS C1713,,AR-8840C-32  -  SCREW BN ST 4MM 32MM LOPRFL SCR CNN SS ANKL FX MGMT SYS,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-8840C-34,SUP,HCPCS C1713,,AR-8840C-34  -  SCREW BN ST 4MM 34MM LOPRFL SCR CNN SS ANKL FX MGMT SYS,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-8840C-35,SUP,HCPCS C1713,,AR-8840C-35  -  SCREW BN SHRT 1/3 LGTH T15 HEXALOBE 4MM 35MM LOPRFL SCR MDLR,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-8840C-36,SUP,HCPCS C1713,,AR-8840C-36  -  SCREW BN ST 4MM 36MM LOPRFL SCR CNN SS ANKL FX MGMT SYS,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-8840C-38,SUP,HCPCS C1713,,AR-8840C-38  -  SCREW BN ST 4MM 38MM LOPRFL SCR CNN SS ANKL FX MGMT SYS,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-8840C-40,SUP,HCPCS C1713,,AR-8840C-40  -  SCREW BN SHRT 1/3 LGTH T15 HEXALOBE 4MM 40MM LOPRFL SCR SLF,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-8840C-42,SUP,HCPCS C1713,,AR-8840C-42  -  SCREW BN SHRT 1/3 LGTH T15 HEXALOBE 4MM 42MM LOPRFL SCR SLF,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-8840C-44,SUP,HCPCS C1713,,AR-8840C-44  -  SCREW BN ST 4MM 44MM LOPRFL SCR CNN SS ANKL FX MGMT SYS,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-8840C-45,SUP,HCPCS C1713,,AR-8840C-45  -  SCREW BN SHRT 1/3 LGTH T15 HEXALOBE 4MM 45MM LOPRFL SCR MDLR,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-8840C-46,SUP,HCPCS C1713,,AR-8840C-46  -  SCREW BN SHRT 1/3 LGTH T15 HEXALOBE 4MM 46MM LOPRFL SCR SLF,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-8840C-48,SUP,HCPCS C1713,,AR-8840C-48  -  SCREW BN ST 4MM 48MM LOPRFL SCR CNN SS ANKL FX MGMT SYS,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-8840C-50,SUP,HCPCS C1713,,AR-8840C-50  -  SCREW BN SHRT 1/3 LGTH T15 HEXALOBE 4MM 50MM LOPRFL SCR SLF,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-8840C-55,SUP,HCPCS C1713,,AR-8840C-55  -  SCREW BN SHRT 1/3 LGTH T15 HEXALOBE 4MM 55MM LOPRFL SCR MDLR,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-8840C-60,SUP,HCPCS C1713,,AR-8840C-60  -  SCREW BN SHRT 1/3 LGTH T15 HEXALOBE 4MM 60MM LOPRFL SCR MDLR,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-8840CL-30,SUP,HCPCS C1713,,AR-8840CL-30  -  SCREW BN LNG .5 LGTH T15 HEXALOBE 4MM 30MM LOPRFL SCR SLF,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-8840CL-32,SUP,HCPCS C1713,,AR-8840CL-32  -  SCREW BN LNG .5 LGTH T15 HEXALOBE 4MM 32MM LOPRFL SCR SLF,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-8840CL-34,SUP,HCPCS C1713,,AR-8840CL-34  -  SCREW BN L/T 4MM 34MM LOPRFL SCR CNN SS ANKL FX MGMT SYS,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-8840CL-35,SUP,HCPCS C1713,,AR-8840CL-35  -  SCREW BN LNG .5 LGTH T15 HEXALOBE 4MM 35MM LOPRFL SCR SLF,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-8840CL-36,SUP,HCPCS C1713,,AR-8840CL-36  -  SCREW BN L/T 4MM 36MM LOPRFL SCR CNN SS ANKL FX MGMT SYS,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-8840CL-38,SUP,HCPCS C1713,,AR-8840CL-38  -  SCREW BN LNG .5 LGTH T15 HEXALOBE 4MM 38MM LOPRFL SCR SLF,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-8840CL-40,SUP,HCPCS C1713,,AR-8840CL-40  -  SCREW BN LNG .5 LGTH T15 HEXALOBE 4MM 40MM LOPRFL SCR SLF,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-8840CL-42,SUP,HCPCS C1713,,AR-8840CL-42  -  SCREW BN LNG .5 LGTH T15 HEXALOBE 4MM 42MM LOPRFL SCR MDLR,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-8840CL-44,SUP,HCPCS C1713,,AR-8840CL-44  -  SCREW BN LNG .5 LGTH T15 HEXALOBE 4MM 44MM LOPRFL SCR SLF,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-8840CL-45,SUP,HCPCS C1713,,AR-8840CL-45  -  SCREW BN LNG .5 LGTH T15 HEXALOBE 4MM 45MM LOPRFL SCR SLF,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-8840CL-46,SUP,HCPCS C1713,,AR-8840CL-46  -  SCREW BN L/T 4MM 46MM LOPRFL SCR CNN SS ANKL FX MGMT SYS,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-8840CL-48,SUP,HCPCS C1713,,AR-8840CL-48  -  SCREW BN LNG .5 LGTH T15 HEXALOBE 4MM 48MM LOPRFL SCR SLF,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-8840CL-50,SUP,HCPCS C1713,,AR-8840CL-50  -  SCREW BN LNG .5 LGTH T15 HEXALOBE 4MM 50MM LOPRFL SCR SLF,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-8840CL-55,SUP,HCPCS C1713,,AR-8840CL-55  -  SCREW BN LNG .5 LGTH T15 HEXALOBE 4MM 55MM LOPRFL SCR SLF,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-8840CL-60,SUP,HCPCS C1713,,AR-8840CL-60  -  SCREW BN LNG .5 LGTH T15 HEXALOBE 4MM 60MM LOPRFL SCR SLF,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
AR-8840P-30,SUP,HCPCS C1713,,AR-8840P-30  -  SCREW BN ST 4MM 30MM LOPRFL SCR SS ANKL FX MGMT SYS,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8840P-32,SUP,HCPCS C1713,,AR-8840P-32  -  SCREW BN ST 4MM 32MM LOPRFL SCR SS ANKL FX MGMT SYS,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8840P-34,SUP,HCPCS C1713,,AR-8840P-34  -  SCREW BN ST 4MM 34MM LOPRFL SCR SS ANKL FX MGMT SYS,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8840P-36,SUP,HCPCS C1713,,AR-8840P-36  -  SCREW BN ST 4MM 36MM LOPRFL SCR SS ANKL FX MGMT SYS,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8840P-38,SUP,HCPCS C1713,,AR-8840P-38  -  SCREW BN ST 4MM 38MM LOPRFL SCR SS ANKL FX MGMT SYS,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8840P-40,SUP,HCPCS C1713,,AR-8840P-40  -  SCREW BN SHRT 1/3 LGTH T15 HEXALOBE 4MM 40MM LOPRFL SCR SLF,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8840P-42,SUP,HCPCS C1713,,AR-8840P-42  -  SCREW BN ST 4MM 42MM LOPRFL SCR SS ANKL FX MGMT SYS,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8840P-44,SUP,HCPCS C1713,,AR-8840P-44  -  SCREW BN ST 4MM 44MM LOPRFL SCR SS ANKL FX MGMT SYS,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8840P-46,SUP,HCPCS C1713,,AR-8840P-46  -  SCREW BN ST 4MM 46MM LOPRFL SS,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8840P-48,SUP,HCPCS C1713,,AR-8840P-48  -  SCREW BN ST 4MM 48MM LOPRFL SCR SS ANKL FX MGMT SYS,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8840P-50,SUP,HCPCS C1713,,AR-8840P-50  -  SCREW BN ST 4MM 50MM LOPRFL SS,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8840P-55,SUP,HCPCS C1713,,AR-8840P-55  -  SCREW BN ST 4MM 55MM LOPRFL SCR SS ANKL FX MGMT SYS,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8840P-60,SUP,HCPCS C1713,,AR-8840P-60  -  SCREW BN ST 4MM 60MM LOPRFL SS,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8840PL-30,SUP,HCPCS C1713,,AR-8840PL-30  -  SCREW BN L/T 4MM 30MM LOPRFL SS,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8840PL-32,SUP,HCPCS C1713,,AR-8840PL-32  -  SCREW BN L/T 4MM 32MM LOPRFL SS,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8840PL-34,SUP,HCPCS C1713,,AR-8840PL-34  -  SCREW BN L/T 4MM 34MM LOPRFL SS,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8840PL-36,SUP,HCPCS C1713,,AR-8840PL-36  -  SCREW BN L/T 4MM 36MM LOPRFL SS,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8840PL-38,SUP,HCPCS C1713,,AR-8840PL-38  -  SCREW BN LNG 1/3 LGTH T15 HEXALOBE 4MM 38MM LOPRFL SCR MDLR,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8840PL-40,SUP,HCPCS C1713,,AR-8840PL-40  -  SCREW BN L/T 4MM 40MM LOPRFL SS,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8840PL-42,SUP,HCPCS C1713,,AR-8840PL-42  -  SCREW BN L/T 4MM 42MM LOPRFL SS,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8840PL-44,SUP,HCPCS C1713,,AR-8840PL-44  -  SCREW BN L/T 4MM 44MM LOPRFL SS,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8840PL-46,SUP,HCPCS C1713,,AR-8840PL-46  -  SCREW BN LNG 1/3 LGTH T15 HEXALOBE 4MM 46MM LOPRFL SCR MDLR,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8840PL-48,SUP,HCPCS C1713,,AR-8840PL-48  -  SCREW BN LNG 1/3 LGTH T15 HEXALOBE 4MM 48MM LOPRFL SCR MDLR,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8840PL-50,SUP,HCPCS C1713,,AR-8840PL-50  -  SCREW BN L/T 4MM 50MM LOPRFL SS,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8840PL-55,SUP,HCPCS C1713,,AR-8840PL-55  -  SCREW BN L/T 4MM 55MM LOPRFL SCR SS ANKL FX MGMT SYS,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8840PL-60,SUP,HCPCS C1713,,AR-8840PL-60  -  SCREW BN L/T 4MM 60MM LOPRFL SCR SS ANKL FX MGMT SYS,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8870W,SUP,HCPCS C1713,,AR-8870W  -  WASHER ORTH 7MM,$80.25,$0.00,$80.25,$36.11,$57.27,$0.00,$13.83,$0.00,$0.00,$14.05,$80.25,$0.00,$40.13,$63.56,$64.20,$0.00,$12.56,$0.00,$12.78,$0.00
AR-8911DC,SUP,Custom 27203010,,AR-8911DC  -  BIT DRL CNN MN TGHTRP,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8911DS,SUP,HCPCS C1713,,AR-8911DS  -  KIT ESCP INST .45IN MN RND 2.7MM 1.6MM STRL TGHTRP BTN CNN,"$1,312.50",$0.00,"$1,312.50",$590.63,$936.73,$0.00,$226.14,$0.00,$0.00,$229.81,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$205.41,$0.00,$208.95,$0.00
AR-8911G-05,SUP,Custom 27203010,,AR-8911G-05  -  GUIDE DRL KRSH WRE MN TGHTRP,"$1,000.00",$0.00,"$1,000.00",$0.00,$713.70,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,000.00",$0.00,$500.00,$792.00,$800.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8912DS,SUP,HCPCS C1713,,AR-8912DS  -  KIT ESCP INST MN FT STRL TGHTRP BCSCR CNN DRLBT CUP BTN DRVR,"$1,700.00",$0.00,"$1,700.00",$765.00,"$1,213.29",$0.00,$292.90,$0.00,$0.00,$297.66,"$1,700.00",$0.00,$850.00,"$1,346.40","$1,360.00",$0.00,$266.05,$0.00,$270.64,$0.00
AR-8913DS,SUP,HCPCS C1713,,AR-8913DS  -  BUTTON FX MN TGHTRP INSRTR,"$1,512.50",$0.00,"$1,512.50",$680.63,"$1,079.47",$0.00,$260.60,$0.00,$0.00,$264.83,"$1,512.50",$0.00,$756.25,"$1,197.90","$1,210.00",$0.00,$236.71,$0.00,$240.79,$0.00
AR-8914P,SUP,HCPCS C1713,,AR-8914P  -  PLATE BN MN TGHTRP BTRS,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
AR-8916-05,SUP,Custom 27203010,,AR-8916-05  -  GUIDE DRL 1.7MM 2.5MM,$712.50,$0.00,$712.50,$0.00,$508.51,$0.00,$0.00,$0.00,$0.00,$0.00,$712.50,$0.00,$356.25,$564.30,$570.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8916-06,SUP,Custom 27203010,,AR-8916-06  -  BIT DRL 2.5MM CLBRT GRAD 3.5MM LCK CORT SCR,$170.00,$0.00,$170.00,$0.00,$121.33,$0.00,$0.00,$0.00,$0.00,$0.00,$170.00,$0.00,$85.00,$134.64,$136.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8916-07,SUP,Custom 27203010,,AR-8916-07  -  GUIDE DRL 3.5MM 30MM THRD WRST PLT SYS,$720.00,$0.00,$720.00,$0.00,$513.86,$0.00,$0.00,$0.00,$0.00,$0.00,$720.00,$0.00,$360.00,$570.24,$576.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8916-09,SUP,Custom 27203010,,AR-8916-09  -  GUIDE DRL 2.4MM AIM WRST PLT SYS,$790.00,$0.00,$790.00,$0.00,$563.82,$0.00,$0.00,$0.00,$0.00,$0.00,$790.00,$0.00,$395.00,$625.68,$632.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8916-16,SUP,HCPCS C1713,,AR-8916-16  -  SCREW BN ATCH RDS RT DIST VOLR,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-8916-17,SUP,HCPCS C1713,,AR-8916-17  -  SCREW BN ATCH RDS LT DIST VOLR,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-8916-21,SUP,Custom 27203010,,AR-8916-21  -  GUIDE DRL 2.4MM VAL DRP WRST PLT SYS,$610.00,$0.00,$610.00,$0.00,$435.36,$0.00,$0.00,$0.00,$0.00,$0.00,$610.00,$0.00,$305.00,$483.12,$488.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8916-23,SUP,Custom 27203010,,AR-8916-23  -  GUIDE DRL 2.5MM 1.7MM,"$1,035.00",$0.00,"$1,035.00",$0.00,$738.68,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,035.00",$0.00,$517.50,$819.72,$828.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8916-26,SUP,Custom 27203010,,AR-8916-26  -  GUIDE DRL PRLL Y 1.7MM PLT PERIPROSTHETIC,$950.00,$0.00,$950.00,$0.00,$678.02,$0.00,$0.00,$0.00,$0.00,$0.00,$950.00,$0.00,$475.00,$752.40,$760.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8916-28,SUP,Custom 27203010,,AR-8916-28  -  BIT DRL SHRT 1.7MM GRAD 2.4MM VA LCK CORT SCR,$197.50,$0.00,$197.50,$0.00,$140.96,$0.00,$0.00,$0.00,$0.00,$0.00,$197.50,$0.00,$98.75,$156.42,$158.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8916CX24-18,SUP,HCPCS C1713,,AR-8916CX24-18  -  SCREW BN 2.4MM CORT,$275.00,$0.00,$275.00,$123.75,$196.27,$0.00,$47.38,$0.00,$0.00,$48.15,$275.00,$0.00,$137.50,$217.80,$220.00,$0.00,$43.04,$0.00,$43.78,$0.00
AR-8916DNL-04,SUP,HCPCS C1713,,AR-8916DNL-04  -  PLATE BN NAR 4 HL RDS LT DIST DRSL,"$3,237.50",$0.00,"$3,237.50","$1,456.88","$2,310.60",$0.00,$557.81,$0.00,$0.00,$566.86,"$3,237.50",$0.00,"$1,618.75","$2,564.10","$2,590.00",$0.00,$506.67,$0.00,$515.41,$0.00
AR-8916DNR-04,SUP,HCPCS C1713,,AR-8916DNR-04  -  PLATE BN NAR 4 HL RDS RT DIST DRSL,"$3,237.50",$0.00,"$3,237.50","$1,456.88","$2,310.60",$0.00,$557.81,$0.00,$0.00,$566.86,"$3,237.50",$0.00,"$1,618.75","$2,564.10","$2,590.00",$0.00,$506.67,$0.00,$515.41,$0.00
AR-8916DSL-04,SUP,HCPCS C1713,,AR-8916DSL-04  -  PLATE BN 4 HL RDS LT DIST DRSL,"$3,237.50",$0.00,"$3,237.50","$1,456.88","$2,310.60",$0.00,$557.81,$0.00,$0.00,$566.86,"$3,237.50",$0.00,"$1,618.75","$2,564.10","$2,590.00",$0.00,$506.67,$0.00,$515.41,$0.00
AR-8916DSR-04,SUP,HCPCS C1713,,AR-8916DSR-04  -  PLATE BN STD 4 HL RDS RT DRSL DIST,"$3,237.50",$0.00,"$3,237.50","$1,456.88","$2,310.60",$0.00,$557.81,$0.00,$0.00,$566.86,"$3,237.50",$0.00,"$1,618.75","$2,564.10","$2,590.00",$0.00,$506.67,$0.00,$515.41,$0.00
AR-8916FS,SUP,HCPCS C1713,,AR-8916FS  -  MODULE INST FRAG SPC SYS,"$5,662.50",$0.00,"$5,662.50","$2,548.13","$4,041.33",$0.00,$975.62,$0.00,$0.00,$991.46,"$5,662.50",$0.00,"$2,831.25","$4,484.70","$4,530.00",$0.00,$886.18,$0.00,$901.47,$0.00
AR-8916RSTY-05,SUP,HCPCS C1713,,AR-8916RSTY-05  -  PLATE BN 5 HL WRST RDS 2.4 MM SCR STYLOID,"$2,237.50",$0.00,"$2,237.50","$1,006.88","$1,596.90",$0.00,$385.51,$0.00,$0.00,$391.77,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$350.17,$0.00,$356.21,$0.00
AR-8916SPN,SUP,HCPCS C1713,,AR-8916SPN  -  PLATE BN 9 HL SPAN TI WRST,"$4,487.50",$0.00,"$4,487.50","$2,019.38","$3,202.73",$0.00,$773.17,$0.00,$0.00,$785.73,"$4,487.50",$0.00,"$2,243.75","$3,554.10","$3,590.00",$0.00,$702.29,$0.00,$714.41,$0.00
AR-8916VH-04,SUP,HCPCS C1713,,AR-8916VH-04  -  PLATE BN 4 HL HK RDS VOLR,"$2,237.50",$0.00,"$2,237.50","$1,006.88","$1,596.90",$0.00,$385.51,$0.00,$0.00,$391.77,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$350.17,$0.00,$356.21,$0.00
AR-8916VH-06,SUP,HCPCS C1713,,AR-8916VH-06  -  PLATE BN 6 HL HK TI WRST VOLR,"$2,237.50",$0.00,"$2,237.50","$1,006.88","$1,596.90",$0.00,$385.51,$0.00,$0.00,$391.77,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$350.17,$0.00,$356.21,$0.00
AR-8916VNC-08,SUP,HCPCS C1713,,AR-8916VNC-08  -  SCREW BN P/T LOPRFL 2.4MM 8MM AU LCK SMTH VA TI RDS CORT,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
AR-8916VNC-10,SUP,HCPCS C1713,,AR-8916VNC-10  -  SCREW BN P/T LOPRFL 2.4MM 10MM AU LCK SMTH VA TI RDS CORT,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
AR-8916VNC-12,SUP,HCPCS C1713,,AR-8916VNC-12  -  SCREW BN P/T LOPRFL 2.4MM 12MM AU LCK SMTH VA TI RDS CORT,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
AR-8916VNC-14,SUP,HCPCS C1713,,AR-8916VNC-14  -  SCREW BN P/T LOPRFL 2.4MM 14MM AU VA LCK SMTH TI RDS CORT,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
AR-8916VNC-16,SUP,HCPCS C1713,,AR-8916VNC-16  -  SCREW BN P/T LOPRFL 2.4MM 16MM AU VA LCK SMTH TI RDS CORT,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
AR-8916VNC-18,SUP,HCPCS C1713,,AR-8916VNC-18  -  SCREW BN P/T LOPRFL 2.4MM 18MM AU VA LCK SMTH TI RDS CORT,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
AR-8916VNC-20,SUP,HCPCS C1713,,AR-8916VNC-20  -  SCREW BN P/T LOPRFL 2.4MM 20MM AU VA LCK SMTH TI RDS CORT,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
AR-8916VNC-22,SUP,HCPCS C1713,,AR-8916VNC-22  -  SCREW BN P/T LOPRFL 2.4MM 22MM AU VA LCK SMTH TI RDS CORT,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
AR-8916VNC-24,SUP,HCPCS C1713,,AR-8916VNC-24  -  SCREW BN P/T LOPRFL 2.4MM 24MM AU VA LCK SMTH TI RDS CORT,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
AR-8916VNC-26,SUP,HCPCS C1713,,AR-8916VNC-26  -  SCREW BN P/T LOPRFL 2.4MM 26MM AU LCK SMTH VA TI RDS CORT,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
AR-8916VNC-28,SUP,HCPCS C1713,,AR-8916VNC-28  -  SCREW BN P/T LOPRFL 2.4MM 28MM AU LCK SMTH VA TI RDS CORT,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
AR-8916VNC-30,SUP,HCPCS C1713,,AR-8916VNC-30  -  SCREW BN P/T LOPRFL 2.4MM 30MM AU LCK SMTH VA TI RDS CORT,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
AR-8916VNC-32,SUP,HCPCS C1713,,AR-8916VNC-32  -  SCREW BN P/T LOPRFL 2.4MM 32MM AU LCK SMTH VA TI RDS CORT,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
AR-8916VNC-34,SUP,HCPCS C1713,,AR-8916VNC-34  -  SCREW BN P/T LOPRFL 2.4MM 34MM AU LCK SMTH VA TI RDS CORT,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
AR-8916VNL-03,SUP,HCPCS C1713,,AR-8916VNL-03  -  PLATE BN NAR CNTR 3 HL ANTM GFT WDW TI RDS LT WRST VOLR,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-8916VNL-05,SUP,HCPCS C1713,,AR-8916VNL-05  -  PLATE BN NAR CNTR 5 HL ANTM GFT WDW TI RDS LT WRST VOLR,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-8916VNL-07,SUP,HCPCS C1713,,AR-8916VNL-07  -  PLATE BN NAR CNTR 7 HL ANTM GFT WDW TI RDS LT WRST VOLR,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-8916VNR-03,SUP,HCPCS C1713,,AR-8916VNR-03  -  PLATE BN NAR CNTR 3 HL ANTM GFT WDW TI RDS RT WRST VOLR,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-8916VNR-05,SUP,HCPCS C1713,,AR-8916VNR-05  -  PLATE BN NAR CNTR 5 HL ANTM GFT WDW TI RDS RT WRST VOLR,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-8916VNR-07,SUP,HCPCS C1713,,AR-8916VNR-07  -  PLATE BN NAR CNTR 7 HL ANTM GFT WDW TI RDS RT WRST VOLR,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-8916VSL-03,SUP,HCPCS C1713,,AR-8916VSL-03  -  PLATE BN STD CNTR 3 HL ANTM GFT WDW TI RDS LT WRST VOLR,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-8916VSL-05,SUP,HCPCS C1713,,AR-8916VSL-05  -  PLATE BN STD CNTR 5 HL ANTM GFT WDW TI RDS LT WRST VOLR,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-8916VSL-07,SUP,HCPCS C1713,,AR-8916VSL-07  -  PLATE BN STD CNTR 7 HL ANTM GFT WDW TI RDS LT WRST VOLR,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-8916VSL-09,SUP,HCPCS C1713,,AR-8916VSL-09  -  PLATE BN STD CNTR 9 HL ANTM GFT WDW TI RDS LT WRST VOLR,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-8916VSR-03,SUP,HCPCS C1713,,AR-8916VSR-03  -  PLATE BN STD CNTR 3 HL ANTM GFT WDW TI RDS RT WRST VOLR,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-8916VSR-05,SUP,HCPCS C1713,,AR-8916VSR-05  -  PLATE BN STD CNTR 5 HL ANTM GFT WDW TI RDS RT WRST VOLR,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-8916VSR-07,SUP,HCPCS C1713,,AR-8916VSR-07  -  PLATE BN STD CNTR 7 HL ANTM GFT WDW TI RDS RT WRST VOLR,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-8916VSR-09,SUP,HCPCS C1713,,AR-8916VSR-09  -  PLATE BN STD CNTR 9 HL ANTM GFT WDW TI RDS RT WRST VOLR,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-8916VWL-03,SUP,HCPCS C1713,,AR-8916VWL-03  -  PLATE BN W CNTR 3 HL ANTM GFT WDW TI RDS LT WRST VOLR,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-8916VWL-05,SUP,HCPCS C1713,,AR-8916VWL-05  -  PLATE BN W CNTR 5 HL ANTM GFT WDW TI RDS LT WRST VOLR,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-8916VWL-07,SUP,HCPCS C1713,,AR-8916VWL-07  -  PLATE BN W CNTR 7 HL ANTM GFT WDW TI RDS LT WRST VOLR,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-8916VWL-09,SUP,HCPCS C1713,,AR-8916VWL-09  -  PLATE BN W CNTR 9 HL ANTM GFT WDW TI RDS LT WRST VOLR,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-8916VWR-03,SUP,HCPCS C1713,,AR-8916VWR-03  -  PLATE BN W CNTR 3 HL ANTM GFT WDW TI RDS RT WRST VOLR,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-8916VWR-05,SUP,HCPCS C1713,,AR-8916VWR-05  -  PLATE BN W CNTR 5 HL ANTM GFT WDW TI RDS RT WRST VOLR,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-8916VWR-07,SUP,HCPCS C1713,,AR-8916VWR-07  -  PLATE BN W CNTR 7 HL ANTM GFT WDW TI RDS RT WRST VOLR,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-8916VWR-09,SUP,HCPCS C1713,,AR-8916VWR-09  -  PLATE BN W CNTR 9 HL ANTM GFT WDW TI RDS RT WRST VOLR,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-8917DS,SUP,HCPCS C1713,,AR-8917DS  -  KIT ESCP INST MN FT 3.5MM STRL TGHTRP DRL GW HNDL INSRTR,"$1,575.00",$0.00,"$1,575.00",$708.75,"$1,124.08",$0.00,$271.36,$0.00,$0.00,$275.77,"$1,575.00",$0.00,$787.50,"$1,247.40","$1,260.00",$0.00,$246.49,$0.00,$250.74,$0.00
AR-8919DS,SUP,Custom 27203010,,AR-8919DS  -  KIT ASCP FX MN 1.1MM TGHTRP KRSH BTN ANCH SUT CMC,"$2,237.50",$0.00,"$2,237.50",$0.00,"$1,596.90",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-8920,SUP,HCPCS C1763,,AR-8920  -  BUTTON SUT 3.5MM STRL,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
AR-8920CDS,SUP,Custom 27203010,,AR-8920CDS  -  KIT ESCP INST STRL TGHTRP CNN FLXB TI DISP SYNDESMOSIS REPR,"$1,312.50",$0.00,"$1,312.50",$0.00,$936.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-8920DC,SUP,Custom 27203010,,AR-8920DC  -  BIT DRL 3.5MM CNN,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8921CDS,SUP,HCPCS C1769,,AR-8921CDS  -  TIGHTROPE AR-8921CDS,"$1,312.50",$0.00,"$1,312.50",$712.69,$936.73,$0.00,$226.14,$0.00,$0.00,$229.81,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$205.41,$0.00,$208.95,$0.00
AR-8922,SUP,HCPCS C1763,,AR-8922  -  BUTTON SUT 12MM STRL,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
AR-8923BC,SUP,HCPCS C1713,,AR-8923BC  -  ANCHOR SUT SHRT MED 2.9MM 2.3MM 12.5MM STRL PUSHLOCK BCMPS,"$1,000.00",$0.00,"$1,000.00",$450.00,$713.70,$0.00,$172.30,$0.00,$0.00,$175.09,"$1,000.00",$0.00,$500.00,$792.00,$800.00,$0.00,$156.50,$0.00,$159.20,$0.00
AR-8923DSC,SUP,Custom 27203010,,AR-8923DSC  -  KIT INST SHRT DRLBT DRL GD DISP 2.9/12.5MM BCMPS PUSHLOCK,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8926SS,SUP,Custom 27203010,,AR-8926SS  -  KIT ESCP INST STRL TGHTRP CNN SS SYNDESMOSIS REPR ASCP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-8926T,SUP,Custom 27203010,,AR-8926T  -  KIT ESCP INST STRL TGHTRP SUT TI DESMOSIS REPR ASCP,"$2,200.00",$0.00,"$2,200.00",$0.00,"$1,570.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-8927BC,SUP,HCPCS C1713,,AR-8927BC  -  ANCHOR SUT 1 LG FT TPR 3.4MM 15MM CSCR FWR TIGERWIRE BRD NDL,$812.50,$0.00,$812.50,$365.63,$579.88,$0.00,$139.99,$0.00,$0.00,$142.26,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$127.16,$0.00,$129.35,$0.00
AR-8927BCNF-CP,SUP,HCPCS C1713,,AR-8927BCNF-CP  -  SET IMPL STRL LF ARTHX SUTUREBRIDGE BCMPS DISP AHLS PK,"$3,987.50",$0.00,"$3,987.50","$1,794.38","$2,845.88",$0.00,$687.03,$0.00,$0.00,$698.18,"$3,987.50",$0.00,"$1,993.75","$3,158.10","$3,190.00",$0.00,$624.04,$0.00,$634.81,$0.00
AR-8927BNF,SUP,HCPCS C1713,,AR-8927BNF  -  ANCHOR SUT 1 LG FT TPR 5.5MM 15MM BCSCR FWR BRD NDL POLY L,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
AR-8927BNF-CP,SUP,HCPCS C1713,,AR-8927BNF-CP  -  SET IMPL LG TPR SUTUREBRIDGE ANCH DRL GD NDL PNCH TAP AHLS,"$3,100.00",$0.00,"$3,100.00","$1,395.00","$2,212.47",$0.00,$534.11,$0.00,$0.00,$542.79,"$3,100.00",$0.00,"$1,550.00","$2,455.20","$2,480.00",$0.00,$485.15,$0.00,$493.52,$0.00
AR-8927DSC,SUP,Custom 27203010,,AR-8927DSC  -  KIT INST DISP 4.5/14MM BCMPS CRKSCR,$502.50,$0.00,$502.50,$0.00,$358.63,$0.00,$0.00,$0.00,$0.00,$0.00,$502.50,$0.00,$251.25,$397.98,$402.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8927P-CP,SUP,HCPCS C1713,,AR-8927P-CP  -  SET IMPL SUTUREBRIDGE DRL GD PNCH PUSHLOCK TAP PEEK AHLS PK,"$3,100.00",$0.00,"$3,100.00","$1,395.00","$2,212.47",$0.00,$534.11,$0.00,$0.00,$542.79,"$3,100.00",$0.00,"$1,550.00","$2,455.20","$2,480.00",$0.00,$485.15,$0.00,$493.52,$0.00
AR-8928BC-CP,SUP,HCPCS C1713,,AR-8928BC-CP  -  SET IMPL SUTUREBRIDGE ANCH DRILL GUIDE PNCH TAP,"$4,350.00",$0.00,"$4,350.00","$1,957.50","$3,104.60",$0.00,$749.48,$0.00,$0.00,$761.65,"$4,350.00",$0.00,"$2,175.00","$3,445.20","$3,480.00",$0.00,$680.78,$0.00,$692.52,$0.00
AR-8928BCJ-CP,SUP,HCPCS C1713,,AR-8928BCJ-CP  -  SYSTEM FX STRL SPEEDBRIDGE JUMPSTART BCMPS AHLS,"$4,987.50",$0.00,"$4,987.50","$2,244.38","$3,559.58",$0.00,$859.32,$0.00,$0.00,$873.27,"$4,987.50",$0.00,"$2,493.75","$3,950.10","$3,990.00",$0.00,$780.54,$0.00,$794.01,$0.00
AR-8928P-CP,SUP,HCPCS C1713,,AR-8928P-CP  -  SET IMPL SUTUREBRIDGE ANCH DRL GD PNCH TAP PEEK AHLS PK,"$4,350.00",$0.00,"$4,350.00","$1,957.50","$3,104.60",$0.00,$749.48,$0.00,$0.00,$761.65,"$4,350.00",$0.00,"$2,175.00","$3,445.20","$3,480.00",$0.00,$680.78,$0.00,$692.52,$0.00
AR-8928PJ-CP,SUP,HCPCS C1713,,AR-8928PJ-CP  -  SYSTEM IMPL STRL ARTHX SPEEDBRIDGE JUMPSTART AHLS,"$4,987.50",$0.00,"$4,987.50","$2,244.38","$3,559.58",$0.00,$859.32,$0.00,$0.00,$873.27,"$4,987.50",$0.00,"$2,493.75","$3,950.10","$3,990.00",$0.00,$780.54,$0.00,$794.01,$0.00
AR-8930-10,SUP,HCPCS C1713,,AR-8930-10  -  SCREW BN FT 2MM 10MM SLVR QFIX 3 PR SLF DRL ST SNPOF SLD TI,$600.00,$0.00,$600.00,$270.00,$428.22,$0.00,$103.38,$0.00,$0.00,$105.06,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$93.90,$0.00,$95.52,$0.00
AR-8930-11,SUP,HCPCS C1713,,AR-8930-11  -  SCREW BN FT 2MM 11MM MAG QFIX 3 PR SLF DRL ST SNPOF SLD TI,$600.00,$0.00,$600.00,$270.00,$428.22,$0.00,$103.38,$0.00,$0.00,$105.06,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$93.90,$0.00,$95.52,$0.00
AR-8930-12,SUP,HCPCS C1713,,AR-8930-12  -  SCREW BN FT 2MM 12MM BLU QFIX 3 PR SLF DRL ST SNPOF SLD TI,$600.00,$0.00,$600.00,$270.00,$428.22,$0.00,$103.38,$0.00,$0.00,$105.06,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$93.90,$0.00,$95.52,$0.00
AR-8930-13,SUP,HCPCS C1713,,AR-8930-13  -  SCREW BN FT 2MM 13MM GRN QFIX 3 PR SLF DRL ST SNPOF SLD TI,$600.00,$0.00,$600.00,$270.00,$428.22,$0.00,$103.38,$0.00,$0.00,$105.06,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$93.90,$0.00,$95.52,$0.00
AR-8930-14,SUP,HCPCS C1713,,AR-8930-14  -  SCREW BN FT 2MM 14MM PUR QFIX 3 PR SLF DRL ST SNPOF SLD TI,$600.00,$0.00,$600.00,$270.00,$428.22,$0.00,$103.38,$0.00,$0.00,$105.06,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$93.90,$0.00,$95.52,$0.00
AR-8930D-13,SUP,Custom 27203010,,AR-8930D-13  -  BIT DRL 1.3MM 2MM QFIX SCR,$287.50,$0.00,$287.50,$0.00,$205.19,$0.00,$0.00,$0.00,$0.00,$0.00,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8930MC,SUP,Custom 27203010,,AR-8930MC  -  CLAMP SRG QFIX WEIL OSTM,"$3,737.50",$0.00,"$3,737.50",$0.00,"$2,667.45",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,737.50",$0.00,"$1,868.75","$2,960.10","$2,990.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-8930MCS,SUP,Custom 27203010,,AR-8930MCS  -  CLAMP SRG QFIX INST SET,"$4,737.50",$0.00,"$4,737.50",$0.00,"$3,381.15",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,737.50",$0.00,"$2,368.75","$3,752.10","$3,790.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-8931-13,SUP,HCPCS C1713,,AR-8931-13  -  SCREW BN FT 3MM 13MM YLW QFIX 3 PR SLF DRL SNPOF TI FT HND,$600.00,$0.00,$600.00,$270.00,$428.22,$0.00,$103.38,$0.00,$0.00,$105.06,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$93.90,$0.00,$95.52,$0.00
AR-8931-15,SUP,HCPCS C1713,,AR-8931-15  -  SCREW BN FT 3MM 15MM LGHT BLU QFIX 3 PR SLF DRL SNPOF TI FT,$600.00,$0.00,$600.00,$270.00,$428.22,$0.00,$103.38,$0.00,$0.00,$105.06,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$93.90,$0.00,$95.52,$0.00
AR-8931-17,SUP,HCPCS C1713,,AR-8931-17  -  SCREW BN FT 3MM 17MM AQ QFIX 3 PR SLF DRL SNPOF TI FT HND,$600.00,$0.00,$600.00,$270.00,$428.22,$0.00,$103.38,$0.00,$0.00,$105.06,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$93.90,$0.00,$95.52,$0.00
AR-8931-17S,SUP,HCPCS C1713,,AR-8931-17S  -  SCREW BN 3MM 17MM STRL ARTHX QFIX,$600.00,$0.00,$600.00,$270.00,$428.22,$0.00,$103.38,$0.00,$0.00,$105.06,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$93.90,$0.00,$95.52,$0.00
AR-8931-19,SUP,HCPCS C1713,,AR-8931-19  -  SCREW BN FT 3MM 19MM BRNZ QFIX 3 PR SLF DRL SNPOF TI FT HND,$600.00,$0.00,$600.00,$270.00,$428.22,$0.00,$103.38,$0.00,$0.00,$105.06,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$93.90,$0.00,$95.52,$0.00
AR-8933-10,SUP,HCPCS C1713,,AR-8933-10  -  SCREW BN FT T10 HEXALOBE 3MM 10MM LOPRFL SCR SLF DRL SLD TI,$275.00,$0.00,$275.00,$123.75,$196.27,$0.00,$47.38,$0.00,$0.00,$48.15,$275.00,$0.00,$137.50,$217.80,$220.00,$0.00,$43.04,$0.00,$43.78,$0.00
AR-8933-10PT,SUP,HCPCS C1713,,AR-8933-10PT  -  SCREW BN 2.5MM HEX P/T 3MM 10MM LOPRFL SCR SLF DRL ST CNN TI,$300.00,$0.00,$300.00,$135.00,$214.11,$0.00,$51.69,$0.00,$0.00,$52.53,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$46.95,$0.00,$47.76,$0.00
AR-8933-12,SUP,HCPCS C1713,,AR-8933-12  -  SCREW BN FT T10 HEXALOBE 3MM 12MM LOPRFL SCR SLF DRL SLD TI,$275.00,$0.00,$275.00,$123.75,$196.27,$0.00,$47.38,$0.00,$0.00,$48.15,$275.00,$0.00,$137.50,$217.80,$220.00,$0.00,$43.04,$0.00,$43.78,$0.00
AR-8933-12PT,SUP,HCPCS C1713,,AR-8933-12PT  -  SCREW BN 2.5MM P/T HEX 3MM 12MM LOPRFL SCR SLF DRL ST CNN TI,$300.00,$0.00,$300.00,$135.00,$214.11,$0.00,$51.69,$0.00,$0.00,$52.53,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$46.95,$0.00,$47.76,$0.00
AR-8933-14,SUP,HCPCS C1713,,AR-8933-14  -  SCREW BN FT T10 HEXALOBE 3MM 14MM LOPRFL SCR SLF DRL SLD TI,$275.00,$0.00,$275.00,$123.75,$196.27,$0.00,$47.38,$0.00,$0.00,$48.15,$275.00,$0.00,$137.50,$217.80,$220.00,$0.00,$43.04,$0.00,$43.78,$0.00
AR-8933-14PT,SUP,HCPCS C1713,,AR-8933-14PT  -  SCREW BN 2.5MM P/T HEX 3MM 14MM LOPRFL SCR SLF DRL ST CNN TI,$300.00,$0.00,$300.00,$135.00,$214.11,$0.00,$51.69,$0.00,$0.00,$52.53,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$46.95,$0.00,$47.76,$0.00
AR-8933-16,SUP,HCPCS C1713,,AR-8933-16  -  SCREW BN FT T10 HEXALOBE 3MM 16MM LOPRFL SCR SLF DRL SLD TI,$275.00,$0.00,$275.00,$123.75,$196.27,$0.00,$47.38,$0.00,$0.00,$48.15,$275.00,$0.00,$137.50,$217.80,$220.00,$0.00,$43.04,$0.00,$43.78,$0.00
AR-8933-16PT,SUP,HCPCS C1713,,AR-8933-16PT  -  SCREW BN 2.5MM P/T HEX 3MM 16MM LOPRFL SCR SLF DRL ST CNN TI,$300.00,$0.00,$300.00,$135.00,$214.11,$0.00,$51.69,$0.00,$0.00,$52.53,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$46.95,$0.00,$47.76,$0.00
AR-8933-18,SUP,HCPCS C1713,,AR-8933-18  -  SCREW BN T10 HEXALOBE FT 3MM 18MM LOPRFL SCR SLF DRL SLD TI,$275.00,$0.00,$275.00,$123.75,$196.27,$0.00,$47.38,$0.00,$0.00,$48.15,$275.00,$0.00,$137.50,$217.80,$220.00,$0.00,$43.04,$0.00,$43.78,$0.00
AR-8933-18PT,SUP,HCPCS C1713,,AR-8933-18PT  -  SCREW BN 2.5MM P/T HEX 3MM 18MM LOPRFL SCR SLF DRL ST CNN TI,$300.00,$0.00,$300.00,$135.00,$214.11,$0.00,$51.69,$0.00,$0.00,$52.53,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$46.95,$0.00,$47.76,$0.00
AR-8933-18PTS,SUP,HCPCS C1713,,AR-8933-18PTS  -  SCREW BN P/T 3MM 18MM STRL ARTHX LOPRFL SCR CNN TI,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8933-20,SUP,HCPCS C1713,,AR-8933-20  -  SCREW BN FT T10 HEXALOBE 3MM 20MM LOPRFL SCR SLF DRL SLD TI,$275.00,$0.00,$275.00,$123.75,$196.27,$0.00,$47.38,$0.00,$0.00,$48.15,$275.00,$0.00,$137.50,$217.80,$220.00,$0.00,$43.04,$0.00,$43.78,$0.00
AR-8933-20C,SUP,Custom 27203010,,AR-8933-20C  -  BIT DRL 2MM CNN AO,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8933-20PT,SUP,HCPCS C1713,,AR-8933-20PT  -  SCREW BN 2.5MM P/T HEX 3MM 20MM LOPRFL SCR SLF DRL ST CNN TI,$300.00,$0.00,$300.00,$135.00,$214.11,$0.00,$51.69,$0.00,$0.00,$52.53,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$46.95,$0.00,$47.76,$0.00
AR-8933-20PTS,SUP,HCPCS C1713,,AR-8933-20PTS  -  SCREW BN P/T 3MM 20MM STRL ARTHX LOPRFL SCR CNN TI,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8933-22,SUP,HCPCS C1713,,AR-8933-22  -  SCREW BN FT T10 HEXALOBE 3MM 22MM LOPRFL SCR SLF DRL SLD TI,$275.00,$0.00,$275.00,$123.75,$196.27,$0.00,$47.38,$0.00,$0.00,$48.15,$275.00,$0.00,$137.50,$217.80,$220.00,$0.00,$43.04,$0.00,$43.78,$0.00
AR-8933-22PT,SUP,HCPCS C1713,,AR-8933-22PT  -  SCREW BN 2.5MM P/T HEX 3MM 22MM LOPRFL SCR SLF DRL ST CNN TI,$300.00,$0.00,$300.00,$135.00,$214.11,$0.00,$51.69,$0.00,$0.00,$52.53,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$46.95,$0.00,$47.76,$0.00
AR-8933-24,SUP,HCPCS C1713,,AR-8933-24  -  SCREW BN FT T10 HEXALOBE 3MM 24MM LOPRFL SCR SLF DRL SLD TI,$275.00,$0.00,$275.00,$123.75,$196.27,$0.00,$47.38,$0.00,$0.00,$48.15,$275.00,$0.00,$137.50,$217.80,$220.00,$0.00,$43.04,$0.00,$43.78,$0.00
AR-8933-24PT,SUP,HCPCS C1713,,AR-8933-24PT  -  SCREW BN 2.5MM P/T HEX 3MM 24MM LOPRFL SCR SLF DRL ST CNN TI,$300.00,$0.00,$300.00,$135.00,$214.11,$0.00,$51.69,$0.00,$0.00,$52.53,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$46.95,$0.00,$47.76,$0.00
AR-8933-26,SUP,HCPCS C1713,,AR-8933-26  -  SCREW BN T10 HEXALOBE FT 3MM 26MM LOPRFL SCR SLF DRL SLD TI,$275.00,$0.00,$275.00,$123.75,$196.27,$0.00,$47.38,$0.00,$0.00,$48.15,$275.00,$0.00,$137.50,$217.80,$220.00,$0.00,$43.04,$0.00,$43.78,$0.00
AR-8933-26PT,SUP,HCPCS C1713,,AR-8933-26PT  -  SCREW BN 2.5MM P/T HEX 3MM 26MM LOPRFL SCR SLF DRL ST CNN TI,$300.00,$0.00,$300.00,$135.00,$214.11,$0.00,$51.69,$0.00,$0.00,$52.53,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$46.95,$0.00,$47.76,$0.00
AR-8933-28,SUP,HCPCS C1713,,AR-8933-28  -  SCREW BN FT T10 HEXALOBE 3MM 28MM LOPRFL SCR SLF DRL SLD TI,$275.00,$0.00,$275.00,$123.75,$196.27,$0.00,$47.38,$0.00,$0.00,$48.15,$275.00,$0.00,$137.50,$217.80,$220.00,$0.00,$43.04,$0.00,$43.78,$0.00
AR-8933-28PT,SUP,HCPCS C1713,,AR-8933-28PT  -  SCREW BN 2.5MM P/T HEX 3MM 28MM LOPRFL SCR SLF DRL ST CNN TI,$300.00,$0.00,$300.00,$135.00,$214.11,$0.00,$51.69,$0.00,$0.00,$52.53,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$46.95,$0.00,$47.76,$0.00
AR-8933-30,SUP,HCPCS C1713,,AR-8933-30  -  SCREW BN T10 HEXALOBE FT 3MM 30MM LOPRFL SCR SLF DRL SLD TI,$275.00,$0.00,$275.00,$123.75,$196.27,$0.00,$47.38,$0.00,$0.00,$48.15,$275.00,$0.00,$137.50,$217.80,$220.00,$0.00,$43.04,$0.00,$43.78,$0.00
AR-8933-30C,SUP,Custom 27203010,,AR-8933-30C  -  BIT DRL 3MM CNN,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8933-30PT,SUP,HCPCS C1713,,AR-8933-30PT  -  SCREW BN 2.5MM P/T HEX 3MM 30MM LOPRFL SCR SLF DRL ST CNN TI,$300.00,$0.00,$300.00,$135.00,$214.11,$0.00,$51.69,$0.00,$0.00,$52.53,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$46.95,$0.00,$47.76,$0.00
AR-8933-30PTS,SUP,HCPCS C1713,,AR-8933-30PTS  -  SCREW BN P/T 3MM 30MM STRL ARTHX LOPRFL SCR CNN TI,$87.50,$0.00,$87.50,$39.38,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
AR-8933-32PT,SUP,HCPCS C1713,,AR-8933-32PT  -  SCREW BN 2.5MM P/T HEX 3MM 32MM LOPRFL SCR SLF DRL ST CNN TI,$300.00,$0.00,$300.00,$135.00,$214.11,$0.00,$51.69,$0.00,$0.00,$52.53,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$46.95,$0.00,$47.76,$0.00
AR-8933-34,SUP,HCPCS C1713,,AR-8933-34  -  SCREW BN T10 HEXALOBE FT 3MM 34MM LOPRFL SCR SLF DRL SLD TI,$275.00,$0.00,$275.00,$123.75,$196.27,$0.00,$47.38,$0.00,$0.00,$48.15,$275.00,$0.00,$137.50,$217.80,$220.00,$0.00,$43.04,$0.00,$43.78,$0.00
AR-8933-34PT,SUP,HCPCS C1713,,AR-8933-34PT  -  SCREW BN 2.5MM HEX P/T 3MM 34MM LOPRFL SCR SLF DRL ST CNN TI,$300.00,$0.00,$300.00,$135.00,$214.11,$0.00,$51.69,$0.00,$0.00,$52.53,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$46.95,$0.00,$47.76,$0.00
AR-8933-36,SUP,HCPCS C1713,,AR-8933-36  -  SCREW BN T10 HEXALOBE FT 3MM 36MM LOPRFL SCR SLF DRL SLD TI,$275.00,$0.00,$275.00,$123.75,$196.27,$0.00,$47.38,$0.00,$0.00,$48.15,$275.00,$0.00,$137.50,$217.80,$220.00,$0.00,$43.04,$0.00,$43.78,$0.00
AR-8933-36PT,SUP,HCPCS C1713,,AR-8933-36PT  -  SCREW BN 2.5MM P/T HEX 3MM 36MM LOPRFL SCR SLF DRL ST CNN TI,$300.00,$0.00,$300.00,$135.00,$214.11,$0.00,$51.69,$0.00,$0.00,$52.53,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$46.95,$0.00,$47.76,$0.00
AR-8933-38,SUP,HCPCS C1713,,AR-8933-38  -  SCREW BN T10 HEXALOBE FT 3MM 38MM LOPRFL SCR SLF DRL SLD TI,$275.00,$0.00,$275.00,$123.75,$196.27,$0.00,$47.38,$0.00,$0.00,$48.15,$275.00,$0.00,$137.50,$217.80,$220.00,$0.00,$43.04,$0.00,$43.78,$0.00
AR-8933-38PT,SUP,HCPCS C1713,,AR-8933-38PT  -  SCREW BN 2.5MM P/T HEX 3MM 38MM LOPRFL SCR SLF DRL ST CNN TI,$300.00,$0.00,$300.00,$135.00,$214.11,$0.00,$51.69,$0.00,$0.00,$52.53,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$46.95,$0.00,$47.76,$0.00
AR-8933-40,SUP,HCPCS C1713,,AR-8933-40  -  SCREW BN T10 HEXALOBE FT 3MM 40MM LOPRFL SCR SLF DRL SLD TI,$275.00,$0.00,$275.00,$123.75,$196.27,$0.00,$47.38,$0.00,$0.00,$48.15,$275.00,$0.00,$137.50,$217.80,$220.00,$0.00,$43.04,$0.00,$43.78,$0.00
AR-8933-40PT,SUP,HCPCS C1713,,AR-8933-40PT  -  SCREW BN 2.5MM P/T HEX 3MM 40MM LOPRFL SCR SLF DRL ST CNN TI,$300.00,$0.00,$300.00,$135.00,$214.11,$0.00,$51.69,$0.00,$0.00,$52.53,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$46.95,$0.00,$47.76,$0.00
AR-8933G,SUP,Custom 27203010,,AR-8933G  -  GUIDE DRL LOPRFL 1.1-2MM,$712.50,$0.00,$712.50,$0.00,$508.51,$0.00,$0.00,$0.00,$0.00,$0.00,$712.50,$0.00,$356.25,$564.30,$570.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8933GV,SUP,Custom 27203010,,AR-8933GV  -  GUIDE DRL 3MM VA,"$1,037.50",$0.00,"$1,037.50",$0.00,$740.46,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,037.50",$0.00,$518.75,$821.70,$830.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8933L-10,SUP,HCPCS C1713,,AR-8933L-10  -  SCREW BN FT T10 HEXALOBE 3MM 10MM SLF DRL SLD LCK TI,$275.00,$0.00,$275.00,$123.75,$196.27,$0.00,$47.38,$0.00,$0.00,$48.15,$275.00,$0.00,$137.50,$217.80,$220.00,$0.00,$43.04,$0.00,$43.78,$0.00
AR-8933L-12,SUP,HCPCS C1713,,AR-8933L-12  -  SCREW BN FT T10 HEXALOBE 3MM 12MM SLF DRL SLD LCK TI,$275.00,$0.00,$275.00,$123.75,$196.27,$0.00,$47.38,$0.00,$0.00,$48.15,$275.00,$0.00,$137.50,$217.80,$220.00,$0.00,$43.04,$0.00,$43.78,$0.00
AR-8933L-14,SUP,HCPCS C1713,,AR-8933L-14  -  SCREW BN FT T10 HEXALOBE 3MM 14MM SLF DRL SLD LCK TI,$275.00,$0.00,$275.00,$123.75,$196.27,$0.00,$47.38,$0.00,$0.00,$48.15,$275.00,$0.00,$137.50,$217.80,$220.00,$0.00,$43.04,$0.00,$43.78,$0.00
AR-8933L-16,SUP,HCPCS C1713,,AR-8933L-16  -  SCREW BN FT T10 HEXALOBE 3MM 16MM SLF DRL SLD LCK TI,$275.00,$0.00,$275.00,$123.75,$196.27,$0.00,$47.38,$0.00,$0.00,$48.15,$275.00,$0.00,$137.50,$217.80,$220.00,$0.00,$43.04,$0.00,$43.78,$0.00
AR-8933L-18,SUP,HCPCS C1713,,AR-8933L-18  -  SCREW BN T10 HEXALOBE FT 3MM 18MM SLF DRL SLD LCK LOPRFL TI,$275.00,$0.00,$275.00,$123.75,$196.27,$0.00,$47.38,$0.00,$0.00,$48.15,$275.00,$0.00,$137.50,$217.80,$220.00,$0.00,$43.04,$0.00,$43.78,$0.00
AR-8933L-20,SUP,HCPCS C1713,,AR-8933L-20  -  SCREW BN FT T10 3MM 20MM SLF DRL SLD LCK LOPRFL TI FOREFOOT,$275.00,$0.00,$275.00,$123.75,$196.27,$0.00,$47.38,$0.00,$0.00,$48.15,$275.00,$0.00,$137.50,$217.80,$220.00,$0.00,$43.04,$0.00,$43.78,$0.00
AR-8933L-22,SUP,HCPCS C1713,,AR-8933L-22  -  SCREW BN FT T10 HEXALOBE 3MM 22MM SLF DRL SLD LCK TI,$275.00,$0.00,$275.00,$123.75,$196.27,$0.00,$47.38,$0.00,$0.00,$48.15,$275.00,$0.00,$137.50,$217.80,$220.00,$0.00,$43.04,$0.00,$43.78,$0.00
AR-8933L-24,SUP,HCPCS C1713,,AR-8933L-24  -  SCREW BN FT T10 HEXALOBE 3MM 24MM SLF DRL SLD LCK TI,$275.00,$0.00,$275.00,$123.75,$196.27,$0.00,$47.38,$0.00,$0.00,$48.15,$275.00,$0.00,$137.50,$217.80,$220.00,$0.00,$43.04,$0.00,$43.78,$0.00
AR-8933L-26,SUP,HCPCS C1713,,AR-8933L-26  -  SCREW BN T10 HEXALOBE FT 3MM 26MM LCK SLF DRL SLD TI,$275.00,$0.00,$275.00,$123.75,$196.27,$0.00,$47.38,$0.00,$0.00,$48.15,$275.00,$0.00,$137.50,$217.80,$220.00,$0.00,$43.04,$0.00,$43.78,$0.00
AR-8933L-28,SUP,HCPCS C1713,,AR-8933L-28  -  SCREW BN 3MM 28MM LCK LOPRFL TI FT HND ANKL WRST,$275.00,$0.00,$275.00,$123.75,$196.27,$0.00,$47.38,$0.00,$0.00,$48.15,$275.00,$0.00,$137.50,$217.80,$220.00,$0.00,$43.04,$0.00,$43.78,$0.00
AR-8933L-30,SUP,HCPCS C1713,,AR-8933L-30  -  SCREW BN 3MM 30MM LCK LOPRFL TI FT HND ANKL WRST,$275.00,$0.00,$275.00,$123.75,$196.27,$0.00,$47.38,$0.00,$0.00,$48.15,$275.00,$0.00,$137.50,$217.80,$220.00,$0.00,$43.04,$0.00,$43.78,$0.00
AR-8933L-32,SUP,HCPCS C1713,,AR-8933L-32  -  SCREW BN 3MM 32MM LCK TI FT/ANKL,$275.00,$0.00,$275.00,$123.75,$196.27,$0.00,$47.38,$0.00,$0.00,$48.15,$275.00,$0.00,$137.50,$217.80,$220.00,$0.00,$43.04,$0.00,$43.78,$0.00
AR-8933L-36,SUP,HCPCS C1713,,AR-8933L-36  -  SCREW BN 3MM 36MM LOPRFL LCK TI,$275.00,$0.00,$275.00,$123.75,$196.27,$0.00,$47.38,$0.00,$0.00,$48.15,$275.00,$0.00,$137.50,$217.80,$220.00,$0.00,$43.04,$0.00,$43.78,$0.00
AR-8933L-38,SUP,HCPCS C1713,,AR-8933L-38  -  SCREW BN 3MM 38MM LCK TI FT/ANKL,$275.00,$0.00,$275.00,$123.75,$196.27,$0.00,$47.38,$0.00,$0.00,$48.15,$275.00,$0.00,$137.50,$217.80,$220.00,$0.00,$43.04,$0.00,$43.78,$0.00
AR-8933L-40,SUP,HCPCS C1713,,AR-8933L-40  -  SCREW BN 3MM 40MM LCK TI FT/ANKL,$275.00,$0.00,$275.00,$123.75,$196.27,$0.00,$47.38,$0.00,$0.00,$48.15,$275.00,$0.00,$137.50,$217.80,$220.00,$0.00,$43.04,$0.00,$43.78,$0.00
AR-8933V-10,SUP,HCPCS C1713,,AR-8933V-10  -  SCREW BN 3MM 10MM LCK VA TI FT,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
AR-8933V-12,SUP,HCPCS C1713,,AR-8933V-12  -  SCREW BN 3MM 12MM LCK VA TI FT,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
AR-8933V-14,SUP,HCPCS C1713,,AR-8933V-14  -  SCREW BN 3MM 14MM LCK VA TI FT,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
AR-8933V-16,SUP,HCPCS C1713,,AR-8933V-16  -  SCREW BN 3MM 16MM VA LCK TI FT,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
AR-8933V-18,SUP,HCPCS C1713,,AR-8933V-18  -  SCREW BN 3MM 18MM LCK VA TI FT,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
AR-8933V-20,SUP,HCPCS C1713,,AR-8933V-20  -  SCREW BN 3MM 20MM VA LCK TI FT,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
AR-8933V-22,SUP,HCPCS C1713,,AR-8933V-22  -  SCREW BN 3MM 22MM VA LCK TI FT,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
AR-8933V-24,SUP,HCPCS C1713,,AR-8933V-24  -  SCREW BN 3MM 24MM LCK VA TI FT,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
AR-8933V-26,SUP,HCPCS C1713,,AR-8933V-26  -  SCREW BN 3MM 26MM LCK VA TI FT,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
AR-8933V-28,SUP,HCPCS C1713,,AR-8933V-28  -  SCREW BN 3MM 28MM LCK VA TI FT,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
AR-8933V-30,SUP,HCPCS C1713,,AR-8933V-30  -  SCREW BN 3MM 30MM LCK VA TI FT,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
AR-8933V-32,SUP,HCPCS C1713,,AR-8933V-32  -  SCREW BN 3MM 32MM LCK VA TI FT,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
AR-8933V-34,SUP,HCPCS C1713,,AR-8933V-34  -  SCREW BN 3MM 34MM LCK VA TI FT,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
AR-8933V-36,SUP,HCPCS C1713,,AR-8933V-36  -  SCREW BN 3MM 36MM LCK VA TI FT,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
AR-8933V-38,SUP,HCPCS C1713,,AR-8933V-38  -  SCREW BN 3MM 38MM LCK VA TI FT,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
AR-8933V-40,SUP,HCPCS C1713,,AR-8933V-40  -  SCREW BN 3MM 40MM LCK VA TI FT,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
AR-8934BCNF,SUP,HCPCS C1713,,AR-8934BCNF  -  ANCHOR SUTURE 1 .5 CIR 2 DIAMOND 26.2MM NEEDLE SUTURETAK,"$1,162.50",$0.00,"$1,162.50",$523.13,$829.68,$0.00,$200.29,$0.00,$0.00,$203.54,"$1,162.50",$0.00,$581.25,$920.70,$930.00,$0.00,$181.93,$0.00,$185.07,$0.00
AR-8934BCNF-00,SUP,HCPCS C1713,,AR-8934BCNF-00  -  ANCHOR SUT 0 .5 CRC 4 DMD 22.2MM SUT TK FBRWR NDL BCMPS S,"$4,062.50",$0.00,"$4,062.50","$1,828.13","$2,899.41",$0.00,$699.95,$0.00,$0.00,$711.31,"$4,062.50",$0.00,"$2,031.25","$3,217.50","$3,250.00",$0.00,$635.78,$0.00,$646.75,$0.00
AR-8934DSC,SUP,Custom 27203010,,AR-8934DSC  -  KIT INSTR 2.4MM DRILL GUIDE STEP DRILL DISPOSABLE SMALL,$362.50,$0.00,$362.50,$0.00,$258.72,$0.00,$0.00,$0.00,$0.00,$0.00,$362.50,$0.00,$181.25,$287.10,$290.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8935-10,SUP,HCPCS C1713,,AR-8935-10  -  SCREW BN T15 HEXALOBE FT 3.5MM 10MM LOPRFL SCR SLF DRL SLD,$150.00,$0.00,$150.00,$67.50,$107.06,$0.00,$25.84,$0.00,$0.00,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
AR-8935-11,SUP,HCPCS C1713,,AR-8935-11  -  SCREW BN T15 HEXALOBE FT 3.5MM 11MM LOPRFL SCR SLF DRL SLD,$150.00,$0.00,$150.00,$67.50,$107.06,$0.00,$25.84,$0.00,$0.00,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
AR-8935-12,SUP,HCPCS C1713,,AR-8935-12  -  SCREW BN T15 FT HEXALOBE 3.5MM 12MM LOPRFL SCR SLF DRL SLD,$150.00,$0.00,$150.00,$67.50,$107.06,$0.00,$25.84,$0.00,$0.00,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
AR-8935-13,SUP,HCPCS C1713,,AR-8935-13  -  SCREW BN T15 FT HEXALOBE 3.5MM 13MM LOPRFL SCR SLF DRL SLD,$150.00,$0.00,$150.00,$67.50,$107.06,$0.00,$25.84,$0.00,$0.00,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
AR-8935-14,SUP,HCPCS C1713,,AR-8935-14  -  SCREW BN T15 FT HEXALOBE 3.5MM 14MM LOPRFL SCR SLF DRL SLD,$150.00,$0.00,$150.00,$67.50,$107.06,$0.00,$25.84,$0.00,$0.00,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
AR-8935-16,SUP,HCPCS C1713,,AR-8935-16  -  SCREW BN T15 FT HEXALOBE 3.5MM 16MM LOPRFL SCR SLF DRL SLD,$150.00,$0.00,$150.00,$67.50,$107.06,$0.00,$25.84,$0.00,$0.00,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
AR-8935-18,SUP,HCPCS C1713,,AR-8935-18  -  SCREW BN T15 FT HEXALOBE 3.5MM 18MM LOPRFL SCR SLF DRL SLD,$150.00,$0.00,$150.00,$67.50,$107.06,$0.00,$25.84,$0.00,$0.00,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
AR-8935-20,SUP,HCPCS C1713,,AR-8935-20  -  SCREW BN T15 FT HEXALOBE 3.5MM 20MM LOPRFL SCR SLF DRL SLD,$150.00,$0.00,$150.00,$67.50,$107.06,$0.00,$25.84,$0.00,$0.00,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
AR-8935-22,SUP,HCPCS C1713,,AR-8935-22  -  SCREW BN T15 FT HEXALOBE 3.5MM 22MM LOPRFL SCR SLF DRL SLD,$150.00,$0.00,$150.00,$67.50,$107.06,$0.00,$25.84,$0.00,$0.00,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
AR-8935-28,SUP,HCPCS C1713,,AR-8935-28  -  SCREW BN T15 FT HEXALOBE 3.5MM 28MM LOPRFL SCR SLF DRL SLD,$150.00,$0.00,$150.00,$67.50,$107.06,$0.00,$25.84,$0.00,$0.00,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
AR-8935-30,SUP,HCPCS C1713,,AR-8935-30  -  SCREW BN T15 FT HEXALOBE 3.5MM 30MM LOPRFL SCR SLF DRL SLD,$150.00,$0.00,$150.00,$67.50,$107.06,$0.00,$25.84,$0.00,$0.00,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
AR-8935-34,SUP,HCPCS C1713,,AR-8935-34  -  SCREW BN T15 FT HEXALOBE 3.5MM 34MM LOPRFL SCR SLF DRL SLD,$150.00,$0.00,$150.00,$67.50,$107.06,$0.00,$25.84,$0.00,$0.00,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
AR-8935-36,SUP,HCPCS C1713,,AR-8935-36  -  SCREW BN T15 FT HEXALOBE 3.5MM 36MM LOPRFL SCR SLF DRL SLD,$150.00,$0.00,$150.00,$67.50,$107.06,$0.00,$25.84,$0.00,$0.00,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
AR-8935-38,SUP,HCPCS C1713,,AR-8935-38  -  SCREW BN T15 FT HEXALOBE 3.5MM 38MM LOPRFL SCR SLF DRL SLD,$150.00,$0.00,$150.00,$67.50,$107.06,$0.00,$25.84,$0.00,$0.00,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
AR-8935-40,SUP,HCPCS C1713,,AR-8935-40  -  SCREW BN T15 FT HEXALOBE 3.5MM 40MM LOPRFL SCR SLF DRL SLD,$150.00,$0.00,$150.00,$67.50,$107.06,$0.00,$25.84,$0.00,$0.00,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
AR-8935-42,SUP,HCPCS C1713,,AR-8935-42  -  SCREW BN T15 FT HEXALOBE 3.5MM 42MM LOPRFL SCR SLF DRL SLD,$150.00,$0.00,$150.00,$67.50,$107.06,$0.00,$25.84,$0.00,$0.00,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
AR-8935-44,SUP,HCPCS C1713,,AR-8935-44  -  SCREW BN T15 FT HEXALOBE 3.5MM 44MM LOPRFL SCR SLF DRL SLD,$150.00,$0.00,$150.00,$67.50,$107.06,$0.00,$25.84,$0.00,$0.00,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
AR-8935-46,SUP,HCPCS C1713,,AR-8935-46  -  SCREW BN 3.5MM 46MM LOPRFL TI FT/ANKL CORT,$150.00,$0.00,$150.00,$67.50,$107.06,$0.00,$25.84,$0.00,$0.00,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
AR-8935-48,SUP,HCPCS C1713,,AR-8935-48  -  SCREW BN 3.5MM 48MM LOPRFL TI CORT,$150.00,$0.00,$150.00,$67.50,$107.06,$0.00,$25.84,$0.00,$0.00,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
AR-8935-50,SUP,HCPCS C1713,,AR-8935-50  -  SCREW BN 3.5MM 50MM LOPRFL TI FT/ANKL CORT,$150.00,$0.00,$150.00,$67.50,$107.06,$0.00,$25.84,$0.00,$0.00,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
AR-8935-52,SUP,HCPCS C1713,,AR-8935-52  -  SCREW BN 3.5MM 52MM LOPRFL TI CORT,$150.00,$0.00,$150.00,$67.50,$107.06,$0.00,$25.84,$0.00,$0.00,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
AR-8935-54,SUP,HCPCS C1713,,AR-8935-54  -  SCREW BN 3.5MM 54MM LOPRFL TI FT/ANKL CORT,$150.00,$0.00,$150.00,$67.50,$107.06,$0.00,$25.84,$0.00,$0.00,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
AR-8935-56,SUP,HCPCS C1713,,AR-8935-56  -  SCREW BN 3.5MM 56MM LOPRFL TI FT/ANKL CORT,$150.00,$0.00,$150.00,$67.50,$107.06,$0.00,$25.84,$0.00,$0.00,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
AR-8935-58,SUP,HCPCS C1713,,AR-8935-58  -  SCREW BN 3.5MM 58MM LOPRFL TI FT/ANKL CORT,$150.00,$0.00,$150.00,$67.50,$107.06,$0.00,$25.84,$0.00,$0.00,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
AR-8935-60,SUP,HCPCS C1713,,AR-8935-60  -  SCREW BN 3.5MM 60MM LOPRFL TI FT/ANKL CORT,$150.00,$0.00,$150.00,$67.50,$107.06,$0.00,$25.84,$0.00,$0.00,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
AR-8935G,SUP,Custom 27203010,,AR-8935G  -  GUIDE DRL 3.5MM 4MM,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8935GV,SUP,Custom 27203010,,AR-8935GV  -  GUIDE DRL 3.5MM VA,"$1,037.50",$0.00,"$1,037.50",$0.00,$740.46,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,037.50",$0.00,$518.75,$821.70,$830.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8935GVN,SUP,Custom 27203010,,AR-8935GVN  -  GUIDE DRL 3.5MM LCK VA,$337.50,$0.00,$337.50,$0.00,$240.87,$0.00,$0.00,$0.00,$0.00,$0.00,$337.50,$0.00,$168.75,$267.30,$270.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8935L-10,SUP,HCPCS C1713,,AR-8935L-10  -  SCREW BN 3.5MM 10MM LOPRFL LCK TI,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
AR-8935L-12,SUP,HCPCS C1713,,AR-8935L-12  -  SCREW BN 3.5MM 12MM LCK LOPRFL TI,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
AR-8935L-14,SUP,HCPCS C1713,,AR-8935L-14  -  SCREW BN T15 FT HEXALOBE 3.5MM 14MM SLF DRL SLD LCK TI,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
AR-8935L-16,SUP,HCPCS C1713,,AR-8935L-16  -  SCREW BN 3.5MM 16MM LCK TI MIDFOOT CORT,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
AR-8935L-20,SUP,HCPCS C1713,,AR-8935L-20  -  SCREW BN T15 FT HEXALOBE 3.5MM 20MM SLF DRL SLD LCK TI,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
AR-8935L-22,SUP,HCPCS C1713,,AR-8935L-22  -  SCREW BN T15 FT HEXALOBE 3.5MM 22MM SLF DRL SLD LCK TI,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
AR-8935L-24,SUP,HCPCS C1713,,AR-8935L-24  -  SCREW BN T15 FT HEXALOBE 3.5MM 24MM SLF DRL SLD LCK TI,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
AR-8935L-26,SUP,HCPCS C1713,,AR-8935L-26  -  SCREW BN T15 FT HEXALOBE 3.5MM 26MM SLF DRL SLD LCK TI,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
AR-8935L-28,SUP,HCPCS C1713,,AR-8935L-28  -  SCREW BN T15 FT HEXALOBE 3.5MM 28MM SLF DRL SLD LCK TI,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
AR-8935L-30,SUP,HCPCS C1713,,AR-8935L-30  -  SCREW BN T15 FT HEXALOBE 3.5MM 30MM SLF DRL SLD LCK TI,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
AR-8935L-32,SUP,HCPCS C1713,,AR-8935L-32  -  SCREW BN T15 FT HEXALOBE 3.5MM 32MM SLF DRL SLD LCK TI,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
AR-8935L-34,SUP,HCPCS C1713,,AR-8935L-34  -  SCREW BN T15 FT HEXALOBE 3.5MM 34MM SLF DRL SLD LCK TI,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
AR-8935L-36,SUP,HCPCS C1713,,AR-8935L-36  -  SCREW BN T15 FT HEXALOBE 3.5MM 36MM SLF DRL SLD LCK TI,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
AR-8935L-38,SUP,HCPCS C1713,,AR-8935L-38  -  SCREW BN T15 FT HEXALOBE 3.5MM 38MM SLF DRL SLD LCK TI,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
AR-8935L-40,SUP,HCPCS C1713,,AR-8935L-40  -  SCREW BN T15 FT HEXALOBE 3.5MM 40MM SLF DRL SLD LCK TI,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
AR-8935L-42,SUP,HCPCS C1713,,AR-8935L-42  -  SCREW BN T15 FT HEXALOBE 3.5MM 42MM SLF DRL SLD LCK TI,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
AR-8935L-44,SUP,HCPCS C1713,,AR-8935L-44  -  SCREW BN T15 FT HEXALOBE 3.5MM 44MM SLF DRL SLD LCK TI,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
AR-8935L-46,SUP,HCPCS C1713,,AR-8935L-46  -  SCREW BN 3.5MM 46MM LCK LOPRFL TI HND ANKL LNG BN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
AR-8935L-48,SUP,HCPCS C1713,,AR-8935L-48  -  SCREW BN 3.5MM 48MM LCK LOPRFL TI FT/ANKL,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
AR-8935L-50,SUP,HCPCS C1713,,AR-8935L-50  -  SCREW BN 3.5MM 50MM LCK LOPRFL TI FT/ANKL,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
AR-8935L-52,SUP,HCPCS C1713,,AR-8935L-52  -  SCREW BN 3.5MM 52MM LCK LOPRFL TI FT/ANKL,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
AR-8935L-54,SUP,HCPCS C1713,,AR-8935L-54  -  SCREW BN 3.5MM 54MM LCK LOPRFL TI FT/ANKL,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
AR-8935L-56,SUP,HCPCS C1713,,AR-8935L-56  -  SCREW BN 3.5MM 56MM LCK LOPRFL TI FT/ANKL,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
AR-8935L-58,SUP,HCPCS C1713,,AR-8935L-58  -  SCREW BN 3.5MM 58MM LCK LOPRFL TI FT/ANKL,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
AR-8935L-60,SUP,HCPCS C1713,,AR-8935L-60  -  SCREW BN 3.5MM 60MM LCK LOPRFL TI FT/ANKL,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
AR-8936BC-CP,SUP,HCPCS C1713,,AR-8936BC-CP  -  KIT ESCP INST CNN STP DRL DRL GD OBT BROSTROM ASCP,"$3,625.00",$0.00,"$3,625.00","$1,631.25","$2,587.16",$0.00,$624.57,$0.00,$0.00,$634.71,"$3,625.00",$0.00,"$1,812.50","$2,871.00","$2,900.00",$0.00,$567.31,$0.00,$577.10,$0.00
AR-8938P,SUP,HCPCS C1713,,AR-8938P  -  KIT INST RD YLW 2 EYLT CNVR LCK DRVR SMPL SNP SUT LDR PEEK,$487.50,$0.00,$487.50,$219.38,$347.93,$0.00,$83.99,$0.00,$0.00,$85.36,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$76.29,$0.00,$77.61,$0.00
AR-8940-14,SUP,HCPCS C1713,,AR-8940-14  -  SCREW BN T15 FT HEXALOBE 4MM 14MM LOPRFL SCR SLF DRL SLD TI,$150.00,$0.00,$150.00,$67.50,$107.06,$0.00,$25.84,$0.00,$0.00,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
AR-8940-16,SUP,HCPCS C1713,,AR-8940-16  -  SCREW BN T15 FT HEXALOBE 4MM 16MM LOPRFL SCR SLF DRL SLD TI,$150.00,$0.00,$150.00,$67.50,$107.06,$0.00,$25.84,$0.00,$0.00,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
AR-8940-16S,SUP,HCPCS C1713,,AR-8940-16S  -  SCREW BN 4MM 16MM STRL ARTHX LOPRFL SCR TI,$300.00,$0.00,$300.00,$135.00,$214.11,$0.00,$51.69,$0.00,$0.00,$52.53,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$46.95,$0.00,$47.76,$0.00
AR-8940-18,SUP,HCPCS C1713,,AR-8940-18  -  SCREW BN T15 FT HEXALOBE 4MM 18MM LOPRFL SCR SLF DRL SLD TI,$150.00,$0.00,$150.00,$67.50,$107.06,$0.00,$25.84,$0.00,$0.00,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
AR-8940-18S,SUP,HCPCS C1713,,AR-8940-18S  -  SCREW BN 4MM 18MM STRL ARTHX LOPRFL SCR TI,$300.00,$0.00,$300.00,$135.00,$214.11,$0.00,$51.69,$0.00,$0.00,$52.53,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$46.95,$0.00,$47.76,$0.00
AR-8940-20,SUP,HCPCS C1713,,AR-8940-20  -  SCREW BN T15 FT HEXALOBE 4MM 20MM LOPRFL SCR SLF DRL SLD TI,$150.00,$0.00,$150.00,$67.50,$107.06,$0.00,$25.84,$0.00,$0.00,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
AR-8940-20S,SUP,HCPCS C1713,,AR-8940-20S  -  SCREW BN 4MM 20MM STRL ARTHX LOPRFL SCR TI,$300.00,$0.00,$300.00,$135.00,$214.11,$0.00,$51.69,$0.00,$0.00,$52.53,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$46.95,$0.00,$47.76,$0.00
AR-8940-22,SUP,HCPCS C1713,,AR-8940-22  -  SCREW BN T15 FT HEXALOBE 4MM 22MM LOPRFL SCR SLF DRL SLD TI,$150.00,$0.00,$150.00,$67.50,$107.06,$0.00,$25.84,$0.00,$0.00,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
AR-8940-22S,SUP,HCPCS C1713,,AR-8940-22S  -  SCREW BN 4MM 22MM STRL ARTHX LOPRFL SCR TI,$300.00,$0.00,$300.00,$135.00,$214.11,$0.00,$51.69,$0.00,$0.00,$52.53,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$46.95,$0.00,$47.76,$0.00
AR-8940-24,SUP,HCPCS C1713,,AR-8940-24  -  SCREW BN T15 FT HEXALOBE 4MM 24MM LOPRFL SCR SLF DRL SLD TI,$150.00,$0.00,$150.00,$67.50,$107.06,$0.00,$25.84,$0.00,$0.00,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
AR-8940-26,SUP,HCPCS C1713,,AR-8940-26  -  SCREW BN T15 FT HEXALOBE 4MM 26MM LOPRFL SCR SLF DRL SLD TI,$150.00,$0.00,$150.00,$67.50,$107.06,$0.00,$25.84,$0.00,$0.00,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
AR-8940-28,SUP,HCPCS C1713,,AR-8940-28  -  SCREW BN T15 FT HEXALOBE 4MM 28MM LOPRFL SCR SLF DRL SLD TI,$150.00,$0.00,$150.00,$67.50,$107.06,$0.00,$25.84,$0.00,$0.00,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
AR-8940-28S,SUP,HCPCS C1713,,AR-8940-28S  -  SCREW BN 4MM 28MM STRL ARTHX LOPRFL SCR TI,$300.00,$0.00,$300.00,$135.00,$214.11,$0.00,$51.69,$0.00,$0.00,$52.53,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$46.95,$0.00,$47.76,$0.00
AR-8940-30,SUP,HCPCS C1713,,AR-8940-30  -  SCREW BN T15 FT HEXALOBE 4MM 30MM LOPRFL SCR SLF DRL SLD TI,$150.00,$0.00,$150.00,$67.50,$107.06,$0.00,$25.84,$0.00,$0.00,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
AR-8940-30S,SUP,HCPCS C1713,,AR-8940-30S  -  SCREW BN 4MM 30MM STRL ARTHX LOPRFL SCR TI,$300.00,$0.00,$300.00,$135.00,$214.11,$0.00,$51.69,$0.00,$0.00,$52.53,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$46.95,$0.00,$47.76,$0.00
AR-8940-32,SUP,HCPCS C1713,,AR-8940-32  -  SCREW BN T15 FT HEXALOBE 4MM 32MM LOPRFL SCR SLF DRL SLD TI,$150.00,$0.00,$150.00,$67.50,$107.06,$0.00,$25.84,$0.00,$0.00,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
AR-8940-32S,SUP,HCPCS C1713,,AR-8940-32S  -  SCREW BN 4MM 32MM STRL ARTHX LOPRFL SCR TI,$300.00,$0.00,$300.00,$135.00,$214.11,$0.00,$51.69,$0.00,$0.00,$52.53,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$46.95,$0.00,$47.76,$0.00
AR-8940-34,SUP,HCPCS C1713,,AR-8940-34  -  SCREW BN T15 FT HEXALOBE 4MM 34MM LOPRFL SCR SLF DRL SLD TI,$150.00,$0.00,$150.00,$67.50,$107.06,$0.00,$25.84,$0.00,$0.00,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
AR-8940-36,SUP,HCPCS C1713,,AR-8940-36  -  SCREW BN T15 FT HEXALOBE 4MM 36MM LOPRFL SCR SLF DRL SLD TI,$150.00,$0.00,$150.00,$67.50,$107.06,$0.00,$25.84,$0.00,$0.00,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
AR-8940-38,SUP,HCPCS C1713,,AR-8940-38  -  SCREW BN T15 FT HEXALOBE 4MM 38MM LOPRFL SCR SLF DRL SLD TI,$150.00,$0.00,$150.00,$67.50,$107.06,$0.00,$25.84,$0.00,$0.00,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
AR-8940-40,SUP,HCPCS C1713,,AR-8940-40  -  SCREW BN T15 FT HEXALOBE 4MM 40MM LOPRFL SCR SLF DRL SLD TI,$150.00,$0.00,$150.00,$67.50,$107.06,$0.00,$25.84,$0.00,$0.00,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
AR-8940-40S,SUP,HCPCS C1713,,AR-8940-40S  -  SCREW BN 4MM 40MM STRL ARTHX LOPRFL SCR TI,$300.00,$0.00,$300.00,$135.00,$214.11,$0.00,$51.69,$0.00,$0.00,$52.53,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$46.95,$0.00,$47.76,$0.00
AR-8940-42,SUP,HCPCS C1713,,AR-8940-42  -  SCREW BN T15 FT HEXALOBE 4MM 42MM LOPRFL SCR SLF DRL SLD TI,$150.00,$0.00,$150.00,$67.50,$107.06,$0.00,$25.84,$0.00,$0.00,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
AR-8940-42S,SUP,HCPCS C1713,,AR-8940-42S  -  SCREW BN 4MM 42MM STRL ARTHX LOPRFL SCR TI,$300.00,$0.00,$300.00,$135.00,$214.11,$0.00,$51.69,$0.00,$0.00,$52.53,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$46.95,$0.00,$47.76,$0.00
AR-8940-44,SUP,HCPCS C1713,,AR-8940-44  -  SCREW BN T15 FT HEXALOBE 4MM 44MM LOPRFL SCR SLF DRL SLD TI,$150.00,$0.00,$150.00,$67.50,$107.06,$0.00,$25.84,$0.00,$0.00,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
AR-8940-46,SUP,HCPCS C1713,,AR-8940-46  -  SCREW BN 4MM 46MM LOPRFL TI FT/ANKL CANC,$150.00,$0.00,$150.00,$67.50,$107.06,$0.00,$25.84,$0.00,$0.00,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
AR-8940-48,SUP,HCPCS C1713,,AR-8940-48  -  SCREW BN 4MM 48MM LOPRFL TI FT/ANKL CANC,$150.00,$0.00,$150.00,$67.50,$107.06,$0.00,$25.84,$0.00,$0.00,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
AR-8940-50,SUP,HCPCS C1713,,AR-8940-50  -  SCREW BN 4MM 50MM LOPRFL TI HND ANKL LNG BN,$150.00,$0.00,$150.00,$67.50,$107.06,$0.00,$25.84,$0.00,$0.00,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
AR-8940-52,SUP,HCPCS C1713,,AR-8940-52  -  SCREW BN 4MM 52MM LOPRFL TI FT/ANKL CANC,$150.00,$0.00,$150.00,$67.50,$107.06,$0.00,$25.84,$0.00,$0.00,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
AR-8940-54,SUP,HCPCS C1713,,AR-8940-54  -  SCREW BN 4MM 54MM LOPRFL TI FT/ANKL CANC,$150.00,$0.00,$150.00,$67.50,$107.06,$0.00,$25.84,$0.00,$0.00,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
AR-8940-56,SUP,HCPCS C1713,,AR-8940-56  -  SCREW BN 4MM 56MM LOPRFL TI FT/ANKL CANC,$150.00,$0.00,$150.00,$67.50,$107.06,$0.00,$25.84,$0.00,$0.00,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
AR-8940-58,SUP,HCPCS C1713,,AR-8940-58  -  SCREW BN 4MM 58MM LOPRFL TI FT/ANKL CANC,$150.00,$0.00,$150.00,$67.50,$107.06,$0.00,$25.84,$0.00,$0.00,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
AR-8940-60,SUP,HCPCS C1713,,AR-8940-60  -  SCREW BN 4MM 60MM LOPRFL TI FT/ANKL CANC,$150.00,$0.00,$150.00,$67.50,$107.06,$0.00,$25.84,$0.00,$0.00,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
AR-8941-6,SUP,HCPCS C1769,,AR-8941-6  -  WIRE FIX .062IN .062IN 6IN KWIRE,$100.00,$0.00,$100.00,$54.30,$71.37,$0.00,$17.23,$0.00,$0.00,$17.51,$100.00,$0.00,$50.00,$79.20,$80.00,$0.00,$15.65,$0.00,$15.92,$0.00
AR-8941-7,SUP,HCPCS C1769,,AR-8941-7  -  WIRE FIX .062IN .062IN 7IN KWIRE,$100.00,$0.00,$100.00,$54.30,$71.37,$0.00,$17.23,$0.00,$0.00,$17.51,$100.00,$0.00,$50.00,$79.20,$80.00,$0.00,$15.65,$0.00,$15.92,$0.00
AR-8941G,SUP,Custom 27203010,,AR-8941G  -  GUIDE DRL 3.5/4 MM MTL SCR,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8941GL,SUP,Custom 27203010,,AR-8941GL  -  GUIDE DRL D LCK,$562.50,$0.00,$562.50,$0.00,$401.46,$0.00,$0.00,$0.00,$0.00,$0.00,$562.50,$0.00,$281.25,$445.50,$450.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8941L,SUP,HCPCS C1713,,AR-8941L  -  PLATE BN LNG LOPRFL FT/ANKL LAPIDUS LISFRANC,"$1,625.00",$0.00,"$1,625.00",$731.25,"$1,159.76",$0.00,$279.98,$0.00,$0.00,$284.52,"$1,625.00",$0.00,$812.50,"$1,287.00","$1,300.00",$0.00,$254.31,$0.00,$258.70,$0.00
AR-8941PLS,SUP,HCPCS C1713,,AR-8941PLS  -  PLATE BN SHRT LOPRFL PRECONTOUR TI PLNTR LT LAPIDUS,"$3,737.50",$0.00,"$3,737.50","$1,681.88","$2,667.45",$0.00,$643.95,$0.00,$0.00,$654.41,"$3,737.50",$0.00,"$1,868.75","$2,960.10","$2,990.00",$0.00,$584.92,$0.00,$595.01,$0.00
AR-8941PR,SUP,HCPCS C1713,,AR-8941PR  -  PLATE BN PLNTR RT LAPIDUS,"$3,737.50",$0.00,"$3,737.50","$1,681.88","$2,667.45",$0.00,$643.95,$0.00,$0.00,$654.41,"$3,737.50",$0.00,"$1,868.75","$2,960.10","$2,990.00",$0.00,$584.92,$0.00,$595.01,$0.00
AR-8941PRS,SUP,HCPCS C1713,,AR-8941PRS  -  PLATE BN SHRT PLNTR RT LAPIDUS,"$3,737.50",$0.00,"$3,737.50","$1,681.88","$2,667.45",$0.00,$643.95,$0.00,$0.00,$654.41,"$3,737.50",$0.00,"$1,868.75","$2,960.10","$2,990.00",$0.00,$584.92,$0.00,$595.01,$0.00
AR-8942-02,SUP,Custom 27203010,,AR-8942-02  -  BIT DRL WDG 1.7MM EVANS DISP,$300.00,$0.00,$300.00,$0.00,$214.11,$0.00,$0.00,$0.00,$0.00,$0.00,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8942-03,SUP,Custom 27203010,,AR-8942-03  -  GUIDE DRL 1.7MM EVANS WDG,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8942L-06,SUP,HCPCS C1713,,AR-8942L-06  -  PLATE BN H WDG LOPRFL 34X16X6MM TI MIDFOOT LT,"$1,625.00",$0.00,"$1,625.00",$731.25,"$1,159.76",$0.00,$279.98,$0.00,$0.00,$284.52,"$1,625.00",$0.00,$812.50,"$1,287.00","$1,300.00",$0.00,$254.31,$0.00,$258.70,$0.00
AR-8942L-08,SUP,HCPCS C1713,,AR-8942L-08  -  PLATE BN H WDG LOPRFL 36X16X8MM TI MIDFOOT LT,"$1,625.00",$0.00,"$1,625.00",$731.25,"$1,159.76",$0.00,$279.98,$0.00,$0.00,$284.52,"$1,625.00",$0.00,$812.50,"$1,287.00","$1,300.00",$0.00,$254.31,$0.00,$258.70,$0.00
AR-8942L-10,SUP,HCPCS C1713,,AR-8942L-10  -  PLATE BN H WDG LOPRFL 36X16X10MM TI MIDFOOT LT,"$1,625.00",$0.00,"$1,625.00",$731.25,"$1,159.76",$0.00,$279.98,$0.00,$0.00,$284.52,"$1,625.00",$0.00,$812.50,"$1,287.00","$1,300.00",$0.00,$254.31,$0.00,$258.70,$0.00
AR-8942L-L,SUP,HCPCS C1713,,AR-8942L-L  -  PLATE BN LG H FLT LOPRFL 38X16MM TI MIDFOOT LT,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
AR-8942L-M,SUP,HCPCS C1713,,AR-8942L-M  -  PLATE BN MED H FLT LOPRFL 34X16MM TI MIDFOOT LT,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
AR-8942L-S,SUP,HCPCS C1713,,AR-8942L-S  -  PLATE BN SM H FLT LOPRFL 28X16MM TI MIDFOOT LT,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
AR-8942R-06,SUP,HCPCS C1713,,AR-8942R-06  -  PLATE BN H WDG LOPRFL 34X16X6MM TI MIDFOOT RT,"$1,625.00",$0.00,"$1,625.00",$731.25,"$1,159.76",$0.00,$279.98,$0.00,$0.00,$284.52,"$1,625.00",$0.00,$812.50,"$1,287.00","$1,300.00",$0.00,$254.31,$0.00,$258.70,$0.00
AR-8942R-08,SUP,HCPCS C1713,,AR-8942R-08  -  PLATE BN H WDG LOPRFL 34X16X8MM TI MIDFOOT RT,"$1,625.00",$0.00,"$1,625.00",$731.25,"$1,159.76",$0.00,$279.98,$0.00,$0.00,$284.52,"$1,625.00",$0.00,$812.50,"$1,287.00","$1,300.00",$0.00,$254.31,$0.00,$258.70,$0.00
AR-8942R-10,SUP,HCPCS C1713,,AR-8942R-10  -  PLATE BN H WDG LOPRFL 36X16X10MM TI MIDFOOT RT,"$1,625.00",$0.00,"$1,625.00",$731.25,"$1,159.76",$0.00,$279.98,$0.00,$0.00,$284.52,"$1,625.00",$0.00,$812.50,"$1,287.00","$1,300.00",$0.00,$254.31,$0.00,$258.70,$0.00
AR-8942R-L,SUP,HCPCS C1713,,AR-8942R-L  -  PLATE BN LG H FLT LOPRFL 38X16MM TI MIDFOOT RT,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
AR-8942R-M,SUP,HCPCS C1713,,AR-8942R-M  -  PLATE BN MED H FLT LOPRFL 34X16MM TI MIDFOOT RT,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
AR-8942R-S,SUP,HCPCS C1713,,AR-8942R-S  -  PLATE BN SM H FLT LOPRFL 28X16MM TI MIDFOOT RT,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
AR-8943-02,SUP,Custom 27203010,,AR-8943-02  -  BIT DRL 2.6MM 160MM CNN 4MM LPS P/T SCR,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8943-03,SUP,Custom 27203010,,AR-8943-03  -  GUIDE DRL 1.35-2.6MM 4MM LPS P/T SCR,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8943-05,SUP,Custom 27203010,,AR-8943-05  -  DRILL BIT CNTRSNK 4MM QFIX CNN 4MM LPS P/T SCR,$375.00,$0.00,$375.00,$0.00,$267.64,$0.00,$0.00,$0.00,$0.00,$0.00,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8943-13,SUP,Custom 27203010,,AR-8943-13  -  BIT DRL 2.5MM CLBRT GRAD,$212.50,$0.00,$212.50,$0.00,$151.66,$0.00,$0.00,$0.00,$0.00,$0.00,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8943-14,SUP,Custom 27203010,,AR-8943-14  -  GUIDE DRL 3.5MM 2.5MM 3.5MM CORT 4MM CANC SCR LCK,"$1,000.00",$0.00,"$1,000.00",$0.00,$713.70,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,000.00",$0.00,$500.00,$792.00,$800.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8943-16,SUP,Custom 27203010,,AR-8943-16  -  BIT DRL 2MM CLBRT GRAD 2.7/3MM SCR,$237.50,$0.00,$237.50,$0.00,$169.50,$0.00,$0.00,$0.00,$0.00,$0.00,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8943-17,SUP,Custom 27203010,,AR-8943-17  -  GUIDE DRL LOPRFL 2.7MM THRD 2.7/3MM SCR,"$1,000.00",$0.00,"$1,000.00",$0.00,$713.70,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,000.00",$0.00,$500.00,$792.00,$800.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8943-24,SUP,Custom 27203010,,AR-8943-24  -  CLAMP SRG WEBER,$562.50,$0.00,$562.50,$0.00,$401.46,$0.00,$0.00,$0.00,$0.00,$0.00,$562.50,$0.00,$281.25,$445.50,$450.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8943-26,SUP,Custom 27203010,,AR-8943-26  -  GUIDE DRL LOPRFL 3.5MM THRD,"$1,000.00",$0.00,"$1,000.00",$0.00,$713.70,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,000.00",$0.00,$500.00,$792.00,$800.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8943-30,SUP,Custom 27203010,,AR-8943-30  -  BIT DRL 2.5MM 110MM ANKL 3.5MM CORT 4MM CANC SCR LCK,$212.50,$0.00,$212.50,$0.00,$151.66,$0.00,$0.00,$0.00,$0.00,$0.00,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8943-31,SUP,Custom 27203010,,AR-8943-31  -  GUIDE DRL 3MM 2MM ANKL 2.7/3MM SCR,$687.50,$0.00,$687.50,$0.00,$490.67,$0.00,$0.00,$0.00,$0.00,$0.00,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8943-36,SUP,Custom 27203010,,AR-8943-36  -  BIT DRL 3MM ANKL 2.7/3MM SCR,$287.50,$0.00,$287.50,$0.00,$205.19,$0.00,$0.00,$0.00,$0.00,$0.00,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8943-37,SUP,HCPCS C1713,,AR-8943-37  -  SCREW BN REPL ATCH ANKL FX MGMT,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
AR-8943-40,SUP,Custom 27203010,,AR-8943-40  -  BIT DRL 2MM CNN,$687.50,$0.00,$687.50,$0.00,$490.67,$0.00,$0.00,$0.00,$0.00,$0.00,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8943-41,SUP,Custom 27203010,,AR-8943-41  -  GUIDE DRL 2.6MM 1.35MM PRLL 4MM LPS P/T SCR,"$1,000.00",$0.00,"$1,000.00",$0.00,$713.70,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,000.00",$0.00,$500.00,$792.00,$800.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8943-43,SUP,Custom 27203010,,AR-8943-43  -  GUIDE DRL 3.5MM BIT FX LCK VA FT/ANKL 3.5MM CORT 4MM CANC,"$1,000.00",$0.00,"$1,000.00",$0.00,$713.70,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,000.00",$0.00,$500.00,$792.00,$800.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8943-44,SUP,Custom 27203010,,AR-8943-44  -  CLAMP SRG SYNDESMOSIS,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-8943BL-04,SUP,HCPCS C1713,,AR-8943BL-04  -  PLATE BN LOPRFL 4 HL LCK MDLR SS FIB LT DIST,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
AR-8943BL-05,SUP,HCPCS C1713,,AR-8943BL-05  -  PLATE BN LOPRFL 5 HL LCK MDLR SS FIB LT DIST,"$1,625.00",$0.00,"$1,625.00",$731.25,"$1,159.76",$0.00,$279.98,$0.00,$0.00,$284.52,"$1,625.00",$0.00,$812.50,"$1,287.00","$1,300.00",$0.00,$254.31,$0.00,$258.70,$0.00
AR-8943BL-06,SUP,HCPCS C1713,,AR-8943BL-06  -  PLATE BN LOPRFL 6 HL LCK MDLR SS FIB LT DIST,"$1,812.50",$0.00,"$1,812.50",$815.63,"$1,293.58",$0.00,$312.28,$0.00,$0.00,$317.35,"$1,812.50",$0.00,$906.25,"$1,435.50","$1,450.00",$0.00,$283.66,$0.00,$288.55,$0.00
AR-8943BL-08,SUP,HCPCS C1713,,AR-8943BL-08  -  PLATE BN LOPRFL 8 HL LCK MDLR SS FIB LT DIST,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-8943BLS-10,SUP,HCPCS C1713,,AR-8943BLS-10  -  PLATE BN STRL 10 HL LCK FIB LT DIST,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
AR-8943BLS-12,SUP,HCPCS C1713,,AR-8943BLS-12  -  PLATE BN STRL 12 HL LCK FIB LT DIST,"$2,150.00",$0.00,"$2,150.00",$967.50,"$1,534.46",$0.00,$370.43,$0.00,$0.00,$376.45,"$2,150.00",$0.00,"$1,075.00","$1,702.80","$1,720.00",$0.00,$336.48,$0.00,$342.28,$0.00
AR-8943BLS-14,SUP,HCPCS C1713,,AR-8943BLS-14  -  PLATE BN STRL 14 HL LCK FIB LT DIST,"$2,175.00",$0.00,"$2,175.00",$978.75,"$1,552.30",$0.00,$374.74,$0.00,$0.00,$380.83,"$2,175.00",$0.00,"$1,087.50","$1,722.60","$1,740.00",$0.00,$340.39,$0.00,$346.26,$0.00
AR-8943BR-04,SUP,HCPCS C1713,,AR-8943BR-04  -  PLATE BN LOPRFL 4 HL LCK MDLR SS ANKL RT FIB,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
AR-8943BR-05,SUP,HCPCS C1713,,AR-8943BR-05  -  PLATE BN LOPRFL 5 HL LCK MDLR SS ANKL RT FIB,"$1,625.00",$0.00,"$1,625.00",$731.25,"$1,159.76",$0.00,$279.98,$0.00,$0.00,$284.52,"$1,625.00",$0.00,$812.50,"$1,287.00","$1,300.00",$0.00,$254.31,$0.00,$258.70,$0.00
AR-8943BR-06,SUP,HCPCS C1713,,AR-8943BR-06  -  PLATE BN LOPRFL 6 HL LCK MDLR SS ANKL RT FIB,"$1,812.50",$0.00,"$1,812.50",$815.63,"$1,293.58",$0.00,$312.28,$0.00,$0.00,$317.35,"$1,812.50",$0.00,$906.25,"$1,435.50","$1,450.00",$0.00,$283.66,$0.00,$288.55,$0.00
AR-8943BR-08,SUP,HCPCS C1713,,AR-8943BR-08  -  PLATE BN LOPRFL 8 HL LCK MDLR SS ANKL RT FIB,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-8943BRS-10,SUP,HCPCS C1713,,AR-8943BRS-10  -  PLATE BN STRL 10 HL LCK FIB RT DIST,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
AR-8943BRS-12,SUP,HCPCS C1713,,AR-8943BRS-12  -  PLATE BN STRL 12 HL LCK FIB RT DIST,"$2,150.00",$0.00,"$2,150.00",$967.50,"$1,534.46",$0.00,$370.43,$0.00,$0.00,$376.45,"$2,150.00",$0.00,"$1,075.00","$1,702.80","$1,720.00",$0.00,$336.48,$0.00,$342.28,$0.00
AR-8943BRS-14,SUP,HCPCS C1713,,AR-8943BRS-14  -  PLATE BN STRL 12 HL LCK FIB RT DIST,"$2,175.00",$0.00,"$2,175.00",$978.75,"$1,552.30",$0.00,$374.74,$0.00,$0.00,$380.83,"$2,175.00",$0.00,"$1,087.50","$1,722.60","$1,740.00",$0.00,$340.39,$0.00,$346.26,$0.00
AR-8943C-04,SUP,HCPCS C1713,,AR-8943C-04  -  PLATE BN STRG 55MM 4 HL LCK SS ANKL,"$1,125.00",$0.00,"$1,125.00",$506.25,$802.91,$0.00,$193.83,$0.00,$0.00,$196.98,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$176.06,$0.00,$179.10,$0.00
AR-8943C-06,SUP,HCPCS C1713,,AR-8943C-06  -  PLATE BN STRG 80MM 6 HL LCK SS ANKL,"$1,187.50",$0.00,"$1,187.50",$534.38,$847.52,$0.00,$204.60,$0.00,$0.00,$207.92,"$1,187.50",$0.00,$593.75,$940.50,$950.00,$0.00,$185.84,$0.00,$189.05,$0.00
AR-8943C-07,SUP,HCPCS C1713,,AR-8943C-07  -  PLATE BN STRG 93MM 7 HL LCK SS ANKL,"$1,312.50",$0.00,"$1,312.50",$590.63,$936.73,$0.00,$226.14,$0.00,$0.00,$229.81,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$205.41,$0.00,$208.95,$0.00
AR-8943C-08,SUP,HCPCS C1713,,AR-8943C-08  -  PLATE BN STRG 106MM 8 HL LCK SS ANKL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
AR-8943C-10,SUP,HCPCS C1713,,AR-8943C-10  -  PLATE BN STRG 131MM 10 HL LCK SS ANKL,"$1,487.50",$0.00,"$1,487.50",$669.38,"$1,061.63",$0.00,$256.29,$0.00,$0.00,$260.45,"$1,487.50",$0.00,$743.75,"$1,178.10","$1,190.00",$0.00,$232.79,$0.00,$236.81,$0.00
AR-8943C-12,SUP,HCPCS C1713,,AR-8943C-12  -  PLATE BN STRG 156MM 12 HL LCK SS ANKL,"$1,737.50",$0.00,"$1,737.50",$781.88,"$1,240.05",$0.00,$299.36,$0.00,$0.00,$304.22,"$1,737.50",$0.00,$868.75,"$1,376.10","$1,390.00",$0.00,$271.92,$0.00,$276.61,$0.00
AR-8943H-03,SUP,HCPCS C1713,,AR-8943H-03  -  PLATE BN 61MM 3 HL HK LCK SS ANKL MLLE MDL,"$2,062.50",$0.00,"$2,062.50",$928.13,"$1,472.01",$0.00,$355.36,$0.00,$0.00,$361.13,"$2,062.50",$0.00,"$1,031.25","$1,633.50","$1,650.00",$0.00,$322.78,$0.00,$328.35,$0.00
AR-8943H-05,SUP,HCPCS C1713,,AR-8943H-05  -  PLATE BN 79MM 5 HL HK LCK SS FT/ANKL MDL,"$2,062.50",$0.00,"$2,062.50",$928.13,"$1,472.01",$0.00,$355.36,$0.00,$0.00,$361.13,"$2,062.50",$0.00,"$1,031.25","$1,633.50","$1,650.00",$0.00,$322.78,$0.00,$328.35,$0.00
AR-8943H-07,SUP,HCPCS C1713,,AR-8943H-07  -  PLATE BN 97MM 7 HL HK LCK SS FT/ANKL MDL,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
AR-8943I,SUP,HCPCS C1713,,AR-8943I  -  SET IMPL ANKL FX SYS,"$112,500.00",$0.00,"$112,500.00","$50,625.00","$5,158.80",$0.00,"$8,138.89",$0.00,$0.00,"$8,138.89","$112,500.00",$0.00,"$56,250.00","$89,100.00","$90,000.00",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
AR-8943T-04,SUP,HCPCS C1713,,AR-8943T-04  -  PLATE BN 1/3 TUBE 47MM 4 HL LCK SS ANKL,$562.50,$0.00,$562.50,$253.13,$401.46,$0.00,$96.92,$0.00,$0.00,$98.49,$562.50,$0.00,$281.25,$445.50,$450.00,$0.00,$88.03,$0.00,$89.55,$0.00
AR-8943T-05,SUP,HCPCS C1713,,AR-8943T-05  -  PLATE BN 1/3 TUBE 59MM 5 HL LCK SS ANKL,$587.50,$0.00,$587.50,$264.38,$419.30,$0.00,$101.22,$0.00,$0.00,$102.87,$587.50,$0.00,$293.75,$465.30,$470.00,$0.00,$91.94,$0.00,$93.53,$0.00
AR-8943T-06,SUP,HCPCS C1713,,AR-8943T-06  -  PLATE BN 1/3 TUBE 72MM 6 HL LCK SS ANKL,$600.00,$0.00,$600.00,$270.00,$428.22,$0.00,$103.38,$0.00,$0.00,$105.06,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$93.90,$0.00,$95.52,$0.00
AR-8943T-07,SUP,HCPCS C1713,,AR-8943T-07  -  PLATE BN 1/3 TUBE 85MM 7 HL LCK SS ANKL,$637.50,$0.00,$637.50,$286.88,$454.98,$0.00,$109.84,$0.00,$0.00,$111.62,$637.50,$0.00,$318.75,$504.90,$510.00,$0.00,$99.77,$0.00,$101.49,$0.00
AR-8943T-08,SUP,HCPCS C1713,,AR-8943T-08  -  PLATE BN 1/3 TUBE 98MM 8 HL LCK SS ANKL,$662.50,$0.00,$662.50,$298.13,$472.83,$0.00,$114.15,$0.00,$0.00,$116.00,$662.50,$0.00,$331.25,$524.70,$530.00,$0.00,$103.68,$0.00,$105.47,$0.00
AR-8943T-10,SUP,HCPCS C1713,,AR-8943T-10  -  PLATE BN 1/3 TUBE 123MM 10 HL LCK SS ANKL,$700.00,$0.00,$700.00,$315.00,$499.59,$0.00,$120.61,$0.00,$0.00,$122.56,$700.00,$0.00,$350.00,$554.40,$560.00,$0.00,$109.55,$0.00,$111.44,$0.00
AR-8943T-12,SUP,HCPCS C1713,,AR-8943T-12  -  PLATE BN 1/3 TUBE 148MM 12 HL LCK SS ANKL,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
AR-8943TH-03,SUP,HCPCS C1713,,AR-8943TH-03  -  PLATE BN 72MM 3 HL AVULSION HK LCK SS ANKL LAT,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
AR-8943TH-05,SUP,HCPCS C1713,,AR-8943TH-05  -  PLATE BN 98MM 5 HL AVULSION HK LCK SS ANKL LAT,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
AR-8943TH-07,SUP,HCPCS C1713,,AR-8943TH-07  -  PLATE BN 123MM 7 HL AVULSION HK LCK SS ANKL LAT,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
AR-8944-10S,SUP,HCPCS C1713,,AR-8944-10S  -  PLATE BN 10D STD LOPRFL MTP VLGS,"$2,737.50",$0.00,"$2,737.50","$1,231.88","$1,953.75",$0.00,$471.66,$0.00,$0.00,$479.31,"$2,737.50",$0.00,"$1,368.75","$2,168.10","$2,190.00",$0.00,$428.42,$0.00,$435.81,$0.00
AR-8944-22,SUP,Custom 27203010,,AR-8944-22  -  BIT DRL 2MM AO CNCT LCK 3MM SCR,$212.50,$0.00,$212.50,$0.00,$151.66,$0.00,$0.00,$0.00,$0.00,$0.00,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8944C-10S,SUP,HCPCS C1713,,AR-8944C-10S  -  PLATE BN 10D STD DFLXN MTP VLGS,"$2,737.50",$0.00,"$2,737.50","$1,231.88","$1,953.75",$0.00,$471.66,$0.00,$0.00,$479.31,"$2,737.50",$0.00,"$1,368.75","$2,168.10","$2,190.00",$0.00,$428.42,$0.00,$435.81,$0.00
AR-8944CL-L,SUP,HCPCS C1713,,AR-8944CL-L  -  PLATE BN LNG CNTR LOPRFL MTP PLT FSN MOD TI FOREFOOT LT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
AR-8944CL-P,SUP,HCPCS C1713,,AR-8944CL-P  -  PLATE BN SHRT CNTR FSN MOD TI FOREFOOT 1ST MTP LT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
AR-8944CL-S,SUP,HCPCS C1713,,AR-8944CL-S  -  PLATE BN STD CNTR LOPRFL MTP PLT FSN MOD TI FOREFOOT LT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
AR-8944CR-L,SUP,HCPCS C1713,,AR-8944CR-L  -  PLATE BN LNG CNTR LOPRFL MTP PLT FSN MOD TI FOREFOOT RT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
AR-8944CR-P,SUP,HCPCS C1713,,AR-8944CR-P  -  PLATE BN SHRT CNTR LOPRFL MTP PLT FSN MOD TI FOREFOOT RT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
AR-8944CR-S,SUP,HCPCS C1713,,AR-8944CR-S  -  PLATE BN STD CNTR LOPRFL MTP PLT FSN MOD TI FOREFOOT RT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
AR-8944-L,SUP,HCPCS C1713,,AR-8944-L  -  PLATE BN LNG STRG LOPRFL MTP PLT FSN MOD TI FOREFOOT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
AR-8944-P,SUP,HCPCS C1713,,AR-8944-P  -  PLATE BN SHRT STRG LOPRFL MTP PLT FSN MOD TI FOREFOOT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
AR-8945-20FT,SUP,HCPCS C1713,,AR-8945-20FT  -  SCREW BN .062IN 3.5MM FT HEX LOPRFL 4.5MM 20MM SLF DRL ST,$437.50,$0.00,$437.50,$196.88,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
AR-8945-20PT,SUP,HCPCS C1713,,AR-8945-20PT  -  SCREW BN .062IN 3.5MM 1/3 FT HEX LOPRFL 4.5MM 20MM SLF DRL,$437.50,$0.00,$437.50,$196.88,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
AR-8945-22FT,SUP,HCPCS C1713,,AR-8945-22FT  -  SCREW BN FT HEX 4.5MM 22MM LOPRFL SCR SLF DRL ST CNN LG TI,$437.50,$0.00,$437.50,$196.88,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
AR-8945-22PT,SUP,HCPCS C1713,,AR-8945-22PT  -  SCREW BN P/T LOPRFL 4.5MM 22MM CNN TI MLR CORT,$437.50,$0.00,$437.50,$196.88,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
AR-8945-24FT,SUP,HCPCS C1713,,AR-8945-24FT  -  SCREW BN FT HEX 4.5MM 24MM LOPRFL SCR SLF DRL ST CNN LG TI,$437.50,$0.00,$437.50,$196.88,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
AR-8945-24PT,SUP,HCPCS C1713,,AR-8945-24PT  -  SCREW BN P/T HEX 4.5MM 24MM LOPRFL SCR SLF DRL ST CNN LG TI,$437.50,$0.00,$437.50,$196.88,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
AR-8945-26FT,SUP,HCPCS C1713,,AR-8945-26FT  -  SCREW BN FT HEX 4.5MM 26MM LOPRFL SCR SLF DRL ST CNN LG TI,$437.50,$0.00,$437.50,$196.88,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
AR-8945-26PT,SUP,HCPCS C1713,,AR-8945-26PT  -  SCREW BN P/T LOPRFL 4.5MM 26MM CNN TI MLR CORT,$437.50,$0.00,$437.50,$196.88,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
AR-8945-28FT,SUP,HCPCS C1713,,AR-8945-28FT  -  SCREW BN FT HEX 4.5MM 28MM LOPRFL SCR SLF DRL ST CNN LG TI,$437.50,$0.00,$437.50,$196.88,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
AR-8945-28PT,SUP,HCPCS C1713,,AR-8945-28PT  -  SCREW BN P/T HEX 4.5MM 28MM LOPRFL SCR SLF DRL ST CNN LG TI,$437.50,$0.00,$437.50,$196.88,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
AR-8945-30C,SUP,Custom 27203010,,AR-8945-30C  -  BIT DRL MN 3MM 120MM CNN 4.5MM SCR,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8945-30FT,SUP,HCPCS C1713,,AR-8945-30FT  -  SCREW BN FT HEX 4.5MM 30MM LOPRFL SCR SLF DRL ST CNN LG TI,$437.50,$0.00,$437.50,$196.88,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
AR-8945-30PT,SUP,HCPCS C1713,,AR-8945-30PT  -  SCREW BN P/T HEX 4.5MM 30MM LOPRFL SCR SLF DRL ST CNN LG TI,$437.50,$0.00,$437.50,$196.88,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
AR-8945-32FT,SUP,HCPCS C1713,,AR-8945-32FT  -  SCREW BN FT HEX 4.5MM 32MM LOPRFL SCR SLF DRL ST CNN LG TI,$437.50,$0.00,$437.50,$196.88,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
AR-8945-32PT,SUP,HCPCS C1713,,AR-8945-32PT  -  SCREW BN P/T HEX 4.5MM 32MM LOPRFL SCR SLF DRL ST CNN LG TI,$437.50,$0.00,$437.50,$196.88,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
AR-8945-34FT,SUP,HCPCS C1713,,AR-8945-34FT  -  SCREW BN FT HEX 4.5MM 34MM LOPRFL SCR SLF DRL ST CNN LG TI,$437.50,$0.00,$437.50,$196.88,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
AR-8945-34PT,SUP,HCPCS C1713,,AR-8945-34PT  -  SCREW BN P/T HEX 4.5MM 34MM LOPRFL SCR SLF DRL ST CNN LG TI,$437.50,$0.00,$437.50,$196.88,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
AR-8945-35FT,SUP,HCPCS C1713,,AR-8945-35FT  -  SCREW BN FT HEX 4.5MM 35MM LOPRFL SCR SLF DRL ST CNN LG TI,$437.50,$0.00,$437.50,$196.88,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
AR-8945-35PT,SUP,HCPCS C1713,,AR-8945-35PT  -  SCREW BN P/T HEX 4.5MM 35MM LOPRFL SCR SLF DRL ST CNN LG TI,$437.50,$0.00,$437.50,$196.88,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
AR-8945-36FT,SUP,HCPCS C1713,,AR-8945-36FT  -  SCREW BN FT HEX 4.5MM 36MM LOPRFL SCR SLF DRL ST CNN LG TI,$437.50,$0.00,$437.50,$196.88,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
AR-8945-36PT,SUP,HCPCS C1713,,AR-8945-36PT  -  SCREW BN P/T HEX 4.5MM 36MM LOPRFL SCR SLF DRL ST CNN LG TI,$437.50,$0.00,$437.50,$196.88,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
AR-8945-38FT,SUP,HCPCS C1713,,AR-8945-38FT  -  SCREW BN FT HEX 4.5MM 38MM LOPRFL SCR SLF DRL ST CNN LG TI,$437.50,$0.00,$437.50,$196.88,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
AR-8945-38PT,SUP,HCPCS C1713,,AR-8945-38PT  -  SCREW BN P/T HEX 4.5MM 38MM LOPRFL SCR SLF DRL ST CNN LG TI,$437.50,$0.00,$437.50,$196.88,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
AR-8945-40FT,SUP,HCPCS C1713,,AR-8945-40FT  -  SCREW BN FT HEX 4.5MM 40MM LOPRFL SCR SLF DRL ST CNN LG TI,$437.50,$0.00,$437.50,$196.88,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
AR-8945-40PT,SUP,HCPCS C1713,,AR-8945-40PT  -  SCREW BN P/T HEX 4.5MM 40MM LOPRFL SCR SLF DRL ST CNN LG TI,$437.50,$0.00,$437.50,$196.88,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
AR-8945-45C,SUP,Custom 27203010,,AR-8945-45C  -  BIT DRL 4.5MM HDSN CNN,$487.50,$0.00,$487.50,$0.00,$347.93,$0.00,$0.00,$0.00,$0.00,$0.00,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8945-45FT,SUP,HCPCS C1713,,AR-8945-45FT  -  SCREW BN FT HEX 4.5MM 45MM LOPRFL SCR SLF DRL ST CNN LG TI,$437.50,$0.00,$437.50,$196.88,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
AR-8945-45PT,SUP,HCPCS C1713,,AR-8945-45PT  -  SCREW BN P/T HEX 4.5MM 45MM LOPRFL SCR SLF DRL ST CNN LG TI,$437.50,$0.00,$437.50,$196.88,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
AR-8945-50FT,SUP,HCPCS C1713,,AR-8945-50FT  -  SCREW BN FT HEX 4.5MM 50MM LOPRFL SCR SLF DRL ST CNN LG TI,$437.50,$0.00,$437.50,$196.88,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
AR-8945-50PT,SUP,HCPCS C1713,,AR-8945-50PT  -  SCREW BN P/T HEX 4.5MM 50MM LOPRFL SCR SLF DRL ST CNN LG TI,$437.50,$0.00,$437.50,$196.88,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
AR-8945-55FT,SUP,HCPCS C1713,,AR-8945-55FT  -  SCREW BN FT HEX 4.5MM 55MM LOPRFL SCR SLF DRL ST CNN LG TI,$437.50,$0.00,$437.50,$196.88,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
AR-8945-55PT,SUP,HCPCS C1713,,AR-8945-55PT  -  SCREW BN P/T HEX 4.5MM 55MM LOPRFL SCR SLF DRL ST CNN LG TI,$437.50,$0.00,$437.50,$196.88,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
AR-8945-60FT,SUP,HCPCS C1713,,AR-8945-60FT  -  SCREW BN FT HEX 4.5MM 60MM LOPRFL SCR SLF DRL ST CNN LG TI,$437.50,$0.00,$437.50,$196.88,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
AR-8945-60PT,SUP,HCPCS C1713,,AR-8945-60PT  -  SCREW BN P/T HEX 4.5MM 60MM LOPRFL SCR SLF DRL ST CNN LG TI,$437.50,$0.00,$437.50,$196.88,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
AR-8945-65FT,SUP,HCPCS C1713,,AR-8945-65FT  -  SCREW BN FT HEX 4.5MM 65MM LOPRFL SCR SLF DRL ST CNN LG TI,$437.50,$0.00,$437.50,$196.88,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
AR-8945-65PT,SUP,HCPCS C1713,,AR-8945-65PT  -  SCREW BN P/T HEX 4.5MM 65MM LOPRFL SCR SLF DRL ST CNN LG TI,$437.50,$0.00,$437.50,$196.88,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
AR-8945-70FT,SUP,HCPCS C1713,,AR-8945-70FT  -  SCREW BN FT HEX 4.5MM 70MM LOPRFL SCR SLF DRL ST CNN LG TI,$437.50,$0.00,$437.50,$196.88,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
AR-8945-70PT,SUP,HCPCS C1713,,AR-8945-70PT  -  SCREW BN P/T HEX 4.5MM 70MM LOPRFL SCR SLF DRL ST CNN LG TI,$437.50,$0.00,$437.50,$196.88,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
AR-8945-75FT,SUP,HCPCS C1713,,AR-8945-75FT  -  SCREW BN FT HEX 4.5MM 75MM LOPRFL SCR SLF DRL ST CNN LG TI,$437.50,$0.00,$437.50,$196.88,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
AR-8945-75PT,SUP,HCPCS C1713,,AR-8945-75PT  -  SCREW BN P/T HEX 4.5MM 75MM LOPRFL SCR SLF DRL ST CNN LG TI,$437.50,$0.00,$437.50,$196.88,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
AR-8945-80FT,SUP,HCPCS C1713,,AR-8945-80FT  -  SCREW BN FT HEX 4.5MM 80MM LOPRFL SCR SLF DRL ST CNN LG TI,$437.50,$0.00,$437.50,$196.88,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
AR-8945-80PT,SUP,HCPCS C1713,,AR-8945-80PT  -  SCREW BN P/T HEX 4.5MM 80MM LOPRFL SCR SLF DRL ST CNN LG TI,$437.50,$0.00,$437.50,$196.88,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
AR-8945CS,SUP,Custom 27203010,,AR-8945CS  -  DRILL BIT CNTRSNK CNN FX HNDL 4.5/6 MM,$550.00,$0.00,$550.00,$0.00,$392.54,$0.00,$0.00,$0.00,$0.00,$0.00,$550.00,$0.00,$275.00,$435.60,$440.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8945CSF,SUP,Custom 27203010,,AR-8945CSF  -  COUNTERSINK DRL CNN 4.5 MM SCR,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8945W,SUP,HCPCS C1713,,AR-8945W  -  WASHER ORTH 10MM CNN TI,$200.00,$0.00,$200.00,$90.00,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
AR-8947DS,SUP,HCPCS C1713,,AR-8947DS  -  PLATE BN BTRS TGHTRP IMPL DLV ANKL SYNDESMOSIS,"$2,562.50",$0.00,"$2,562.50","$1,153.13","$1,828.86",$0.00,$441.51,$0.00,$0.00,$448.67,"$2,562.50",$0.00,"$1,281.25","$2,029.50","$2,050.00",$0.00,$401.03,$0.00,$407.95,$0.00
AR-8948-00,SUP,HCPCS C1713,,AR-8948-00  -  PLATE BN FLT LOPRFL TI CTTN FT/ANKL 2.4MM SCR,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-8948-02,SUP,HCPCS C1713,,AR-8948-02  -  PLATE BN LOPRFL 2MM TI CTTN FT/ANKL 2.4MM SCR,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-8948-06,SUP,HCPCS C1713,,AR-8948-06  -  PLATE BN LOPRFL 6MM TI CTTN FT/ANKL 2.4MM SCR,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-8948-08,SUP,HCPCS C1713,,AR-8948-08  -  PLATE BN LOPRFL 8MM TI CTTN FT/ANKL 2.4MM SCR,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-8949-050,SUP,HCPCS C1713,,AR-8949-050  -  PLATE BN 5MM STP CALCANEUS,"$2,450.00",$0.00,"$2,450.00","$1,102.50","$1,748.57",$0.00,$422.12,$0.00,$0.00,$428.98,"$2,450.00",$0.00,"$1,225.00","$1,940.40","$1,960.00",$0.00,$383.43,$0.00,$390.04,$0.00
AR-8949-075,SUP,HCPCS C1713,,AR-8949-075  -  PLATE BN 7.5MM STP CALCANEUS,"$2,450.00",$0.00,"$2,450.00","$1,102.50","$1,748.57",$0.00,$422.12,$0.00,$0.00,$428.98,"$2,450.00",$0.00,"$1,225.00","$1,940.40","$1,960.00",$0.00,$383.43,$0.00,$390.04,$0.00
AR-8949-100,SUP,HCPCS C1713,,AR-8949-100  -  PLATE BN 10MM STP CALCANEUS,"$2,450.00",$0.00,"$2,450.00","$1,102.50","$1,748.57",$0.00,$422.12,$0.00,$0.00,$428.98,"$2,450.00",$0.00,"$1,225.00","$1,940.40","$1,960.00",$0.00,$383.43,$0.00,$390.04,$0.00
AR-8949DG,SUP,Custom 27203010,,AR-8949DG  -  GUIDE DRL CMPR HL,"$1,200.00",$0.00,"$1,200.00",$0.00,$856.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,200.00",$0.00,$600.00,$950.40,$960.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8949S,SUP,HCPCS C1713,,AR-8949S  -  PLATE BN 5MM 7.5MM 10MM STP CALCANEUS,"$5,625.00",$0.00,"$5,625.00","$2,531.25","$4,014.56",$0.00,$969.16,$0.00,$0.00,$984.89,"$5,625.00",$0.00,"$2,812.50","$4,455.00","$4,500.00",$0.00,$880.31,$0.00,$895.50,$0.00
AR-8950-01,SUP,Custom 27203010,,AR-8950-01  -  COUNTERSINK DRL 2.4MM,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8950-02,SUP,Custom 27203010,,AR-8950-02  -  COUNTERSINK DRL 3MM,$375.00,$0.00,$375.00,$0.00,$267.64,$0.00,$0.00,$0.00,$0.00,$0.00,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8950-03,SUP,Custom 27203010,,AR-8950-03  -  COUNTERSINK DRL 3.5 4 MM SCR,$375.00,$0.00,$375.00,$0.00,$267.64,$0.00,$0.00,$0.00,$0.00,$0.00,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8950-05,SUP,Custom 27203010,,AR-8950-05  -  BIT DRL 3MM,$197.50,$0.00,$197.50,$0.00,$140.96,$0.00,$0.00,$0.00,$0.00,$0.00,$197.50,$0.00,$98.75,$156.42,$158.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8950-08,SUP,Custom 27203010,,AR-8950-08  -  GUIDE DRL BNT 2.4MM LCK,$300.00,$0.00,$300.00,$0.00,$214.11,$0.00,$0.00,$0.00,$0.00,$0.00,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8950-09,SUP,Custom 27203010,,AR-8950-09  -  GUIDE DRL BNT 3MM LCK,$300.00,$0.00,$300.00,$0.00,$214.11,$0.00,$0.00,$0.00,$0.00,$0.00,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8950C-14,SUP,Custom 27203010,,AR-8950C-14  -  INSERT TRY CMPRH FT SYS,"$3,737.50",$0.00,"$3,737.50",$0.00,"$2,667.45",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,737.50",$0.00,"$1,868.75","$2,960.10","$2,990.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-8950JD-1,SUP,HCPCS C1713,,AR-8950JD-1  -  DISTRACTOR SRG MN 16MM TRC SCR,$437.50,$0.00,$437.50,$196.88,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
AR-8950JD-2,SUP,HCPCS C1713,,AR-8950JD-2  -  SCREW DSTRCT 20MM MN JNT,$437.50,$0.00,$437.50,$196.88,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
AR-8950S-V1,SUP,HCPCS C1713,,AR-8950S-V1  -  SET SCR VA CMPRH FT SYS,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
AR-8951LL,SUP,HCPCS C1713,,AR-8951LL  -  PLATE BN LG CNTR LOPRFL 1.4MM TI LISFRANC LT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
AR-8951LR,SUP,HCPCS C1713,,AR-8951LR  -  PLATE BN LG CNTR LOPRFL 1.4MM TI LISFRANC RT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
AR-8951ML,SUP,HCPCS C1713,,AR-8951ML  -  PLATE BN MED CNTR LOPRFL 1.4MM TI LISFRANC LT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
AR-8951MR,SUP,HCPCS C1713,,AR-8951MR  -  PLATE BN MED CNTR LOPRFL 1.4MM TI LISFRANC RT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
AR-8951SL,SUP,HCPCS C1713,,AR-8951SL  -  PLATE BN SM CNTR LOPRFL 1.4MM TI LISFRANC LT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
AR-8951SR,SUP,HCPCS C1713,,AR-8951SR  -  PLATE BN SM CNTR LOPRFL 1.4MM TI LISFRANC RT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
AR-8952MC-LL,SUP,HCPCS C1713,,AR-8952MC-LL  -  PLATE BN LG LOPRFL CLMN FT LT MDL 3.5MM SCR,"$3,737.50",$0.00,"$3,737.50","$1,681.88","$2,667.45",$0.00,$643.95,$0.00,$0.00,$654.41,"$3,737.50",$0.00,"$1,868.75","$2,960.10","$2,990.00",$0.00,$584.92,$0.00,$595.01,$0.00
AR-8952MC-LR,SUP,HCPCS C1713,,AR-8952MC-LR  -  PLATE BN LG LOPRFL CLMN FT RT MDL 3.5MM SCR,"$3,737.50",$0.00,"$3,737.50","$1,681.88","$2,667.45",$0.00,$643.95,$0.00,$0.00,$654.41,"$3,737.50",$0.00,"$1,868.75","$2,960.10","$2,990.00",$0.00,$584.92,$0.00,$595.01,$0.00
AR-8952MC-ML,SUP,HCPCS C1713,,AR-8952MC-ML  -  PLATE BN MED LOPRFL CLMN FT LT MDL 3.5MM SCR,"$3,737.50",$0.00,"$3,737.50","$1,681.88","$2,667.45",$0.00,$643.95,$0.00,$0.00,$654.41,"$3,737.50",$0.00,"$1,868.75","$2,960.10","$2,990.00",$0.00,$584.92,$0.00,$595.01,$0.00
AR-8952MC-MR,SUP,HCPCS C1713,,AR-8952MC-MR  -  PLATE BN MED LOPRFL CLMN FT RT MDL 3.5MM SCR,"$3,737.50",$0.00,"$3,737.50","$1,681.88","$2,667.45",$0.00,$643.95,$0.00,$0.00,$654.41,"$3,737.50",$0.00,"$1,868.75","$2,960.10","$2,990.00",$0.00,$584.92,$0.00,$595.01,$0.00
AR-8952MC-SL,SUP,HCPCS C1713,,AR-8952MC-SL  -  PLATE BN SM LOPRFL CLMN FT LT MDL 3.5MM SCR,"$3,737.50",$0.00,"$3,737.50","$1,681.88","$2,667.45",$0.00,$643.95,$0.00,$0.00,$654.41,"$3,737.50",$0.00,"$1,868.75","$2,960.10","$2,990.00",$0.00,$584.92,$0.00,$595.01,$0.00
AR-8952MC-SR,SUP,HCPCS C1713,,AR-8952MC-SR  -  PLATE BN SM LOPRFL CLMN FT RT MDL 3.5MM SCR,"$3,737.50",$0.00,"$3,737.50","$1,681.88","$2,667.45",$0.00,$643.95,$0.00,$0.00,$654.41,"$3,737.50",$0.00,"$1,868.75","$2,960.10","$2,990.00",$0.00,$584.92,$0.00,$595.01,$0.00
AR-8952ML-05L,SUP,HCPCS C1713,,AR-8952ML-05L  -  PLATE BN 5 HL TI WRST LT 2.4 MM SCR,"$2,237.50",$0.00,"$2,237.50","$1,006.88","$1,596.90",$0.00,$385.51,$0.00,$0.00,$391.77,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$350.17,$0.00,$356.21,$0.00
AR-8952ML-05R,SUP,HCPCS C1713,,AR-8952ML-05R  -  PLATE BN L 2 HLE/HD 5 HL SHFT TI RT 2.4MM SCR,"$2,237.50",$0.00,"$2,237.50","$1,006.88","$1,596.90",$0.00,$385.51,$0.00,$0.00,$391.77,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$350.17,$0.00,$356.21,$0.00
AR-8952MS-04,SUP,HCPCS C1713,,AR-8952MS-04  -  PLATE BN STRG LOPRFL 2.4MM 4 HL FT,"$1,737.50",$0.00,"$1,737.50",$781.88,"$1,240.05",$0.00,$299.36,$0.00,$0.00,$304.22,"$1,737.50",$0.00,$868.75,"$1,376.10","$1,390.00",$0.00,$271.92,$0.00,$276.61,$0.00
AR-8952MS-05,SUP,HCPCS C1713,,AR-8952MS-05  -  PLATE BN STRG LOPRFL 2.4MM 5 HL FT,"$1,737.50",$0.00,"$1,737.50",$781.88,"$1,240.05",$0.00,$299.36,$0.00,$0.00,$304.22,"$1,737.50",$0.00,$868.75,"$1,376.10","$1,390.00",$0.00,$271.92,$0.00,$276.61,$0.00
AR-8952MS-06,SUP,HCPCS C1713,,AR-8952MS-06  -  PLATE BN STRG LOPRFL 2.4MM 6 HL FT,"$1,737.50",$0.00,"$1,737.50",$781.88,"$1,240.05",$0.00,$299.36,$0.00,$0.00,$304.22,"$1,737.50",$0.00,$868.75,"$1,376.10","$1,390.00",$0.00,$271.92,$0.00,$276.61,$0.00
AR-8952MS-07,SUP,HCPCS C1713,,AR-8952MS-07  -  PLATE BN STRG LOPRFL 2.4MM 7 HL FT,"$1,737.50",$0.00,"$1,737.50",$781.88,"$1,240.05",$0.00,$299.36,$0.00,$0.00,$304.22,"$1,737.50",$0.00,$868.75,"$1,376.10","$1,390.00",$0.00,$271.92,$0.00,$276.61,$0.00
AR-8952MS-08,SUP,HCPCS C1713,,AR-8952MS-08  -  PLATE BN STRG 8 HL LOPRFL 2.4MM SCR,"$1,737.50",$0.00,"$1,737.50",$781.88,"$1,240.05",$0.00,$299.36,$0.00,$0.00,$304.22,"$1,737.50",$0.00,$868.75,"$1,376.10","$1,390.00",$0.00,$271.92,$0.00,$276.61,$0.00
AR-8952MT-03,SUP,HCPCS C1713,,AR-8952MT-03  -  PLATE BN T 3 HL LOPRFL 2.4MM SCR,"$1,737.50",$0.00,"$1,737.50",$781.88,"$1,240.05",$0.00,$299.36,$0.00,$0.00,$304.22,"$1,737.50",$0.00,$868.75,"$1,376.10","$1,390.00",$0.00,$271.92,$0.00,$276.61,$0.00
AR-8952MT-04,SUP,HCPCS C1713,,AR-8952MT-04  -  PLATE BN T LOPRFL 4 HL FT 2.4MM SCR,"$1,737.50",$0.00,"$1,737.50",$781.88,"$1,240.05",$0.00,$299.36,$0.00,$0.00,$304.22,"$1,737.50",$0.00,$868.75,"$1,376.10","$1,390.00",$0.00,$271.92,$0.00,$276.61,$0.00
AR-8952MT-05,SUP,HCPCS C1713,,AR-8952MT-05  -  PLATE BN T LOPRFL 2.4MM 5 HL FT,"$1,737.50",$0.00,"$1,737.50",$781.88,"$1,240.05",$0.00,$299.36,$0.00,$0.00,$304.22,"$1,737.50",$0.00,$868.75,"$1,376.10","$1,390.00",$0.00,$271.92,$0.00,$276.61,$0.00
AR-8952MT-06,SUP,HCPCS C1713,,AR-8952MT-06  -  PLATE BN T LOPRFL 2.4MM 6 HL FT,"$1,737.50",$0.00,"$1,737.50",$781.88,"$1,240.05",$0.00,$299.36,$0.00,$0.00,$304.22,"$1,737.50",$0.00,$868.75,"$1,376.10","$1,390.00",$0.00,$271.92,$0.00,$276.61,$0.00
AR-8952MT-07,SUP,HCPCS C1713,,AR-8952MT-07  -  PLATE BN T 2.4MM 7 HL LOPRFL,"$1,737.50",$0.00,"$1,737.50",$781.88,"$1,240.05",$0.00,$299.36,$0.00,$0.00,$304.22,"$1,737.50",$0.00,$868.75,"$1,376.10","$1,390.00",$0.00,$271.92,$0.00,$276.61,$0.00
AR-8952MT-08,SUP,HCPCS C1713,,AR-8952MT-08  -  PLATE BN T 8 HL LOPRFL 2.4MM SCR,"$1,737.50",$0.00,"$1,737.50",$781.88,"$1,240.05",$0.00,$299.36,$0.00,$0.00,$304.22,"$1,737.50",$0.00,$868.75,"$1,376.10","$1,390.00",$0.00,$271.92,$0.00,$276.61,$0.00
AR-8952MT-09,SUP,HCPCS C1713,,AR-8952MT-09  -  PLATE BN T LOPRFL 9 HL 2.4MM SCR,"$1,737.50",$0.00,"$1,737.50",$781.88,"$1,240.05",$0.00,$299.36,$0.00,$0.00,$304.22,"$1,737.50",$0.00,$868.75,"$1,376.10","$1,390.00",$0.00,$271.92,$0.00,$276.61,$0.00
AR-8952TS-02,SUP,HCPCS C1713,,AR-8952TS-02  -  PLATE BN STRG LOPRFL 2 HL TI FT 3MM SCR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
AR-8952TS-04,SUP,HCPCS C1713,,AR-8952TS-04  -  PLATE BN STRG 3MM LOPRFL 4 HL TI,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
AR-8952TS-05,SUP,HCPCS C1713,,AR-8952TS-05  -  PLATE BN STRG 5 HL LOPRFL TI 3MM SCR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
AR-8952TT-03,SUP,HCPCS C1713,,AR-8952TT-03  -  PLATE BN T LOPRFL 3MM 3 HL TI FT,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
AR-8952TT-04,SUP,HCPCS C1713,,AR-8952TT-04  -  PLATE BN T 4 HL LOPRFL TI 3MM SCR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
AR-8952XL,SUP,HCPCS C1713,,AR-8952XL  -  PLATE BN LG X 2 HL TI FT 3MM SCR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
AR-8952XM,SUP,HCPCS C1713,,AR-8952XM  -  PLATE BN MED X TI 3MM SCR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
AR-8952XP,SUP,HCPCS C1713,,AR-8952XP  -  PLATE BN SM X TI 2.4MM SCR,"$1,737.50",$0.00,"$1,737.50",$781.88,"$1,240.05",$0.00,$299.36,$0.00,$0.00,$304.22,"$1,737.50",$0.00,$868.75,"$1,376.10","$1,390.00",$0.00,$271.92,$0.00,$276.61,$0.00
AR-8953-00,SUP,HCPCS C1713,,AR-8953-00  -  PLATE BN FLT LCK POW TI FT/ANKL PROX 3MM SCR OPN WDG OSTM,"$2,237.50",$0.00,"$2,237.50","$1,006.88","$1,596.90",$0.00,$385.51,$0.00,$0.00,$391.77,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$350.17,$0.00,$356.21,$0.00
AR-8953-02,SUP,HCPCS C1713,,AR-8953-02  -  PLATE BN LOPRFL 2MM LCK POW TI FT/ANKL PROX 3MM SCR OPN WDG,"$2,237.50",$0.00,"$2,237.50","$1,006.88","$1,596.90",$0.00,$385.51,$0.00,$0.00,$391.77,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$350.17,$0.00,$356.21,$0.00
AR-8953-025,SUP,HCPCS C1713,,AR-8953-025  -  PLATE BN LOPRFL 2.5MM LCK POW TI FT/ANKL PROX 3MM SCR OPN,"$2,237.50",$0.00,"$2,237.50","$1,006.88","$1,596.90",$0.00,$385.51,$0.00,$0.00,$391.77,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$350.17,$0.00,$356.21,$0.00
AR-8953-03,SUP,HCPCS C1713,,AR-8953-03  -  PLATE BN LOPRFL 3MM LCK POW TI FT/ANKL PROX 3MM SCR OPN WDG,"$2,237.50",$0.00,"$2,237.50","$1,006.88","$1,596.90",$0.00,$385.51,$0.00,$0.00,$391.77,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$350.17,$0.00,$356.21,$0.00
AR-8953-035,SUP,HCPCS C1713,,AR-8953-035  -  PLATE BN LOPRFL 3.5MM LCK POW TI FT/ANKL PROX 3MM SCR OPN,"$2,237.50",$0.00,"$2,237.50","$1,006.88","$1,596.90",$0.00,$385.51,$0.00,$0.00,$391.77,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$350.17,$0.00,$356.21,$0.00
AR-8953-04,SUP,HCPCS C1713,,AR-8953-04  -  PLATE BN 4MM LCK POW LOPRFL TI FT/ANKL PROX 3MM SCR OPN WDG,"$2,237.50",$0.00,"$2,237.50","$1,006.88","$1,596.90",$0.00,$385.51,$0.00,$0.00,$391.77,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$350.17,$0.00,$356.21,$0.00
AR-8953-045,SUP,HCPCS C1713,,AR-8953-045  -  PLATE BN LOPRFL 4.5MM LCK POW TI FT/ANKL PROX 3MM SCR OPN,"$2,237.50",$0.00,"$2,237.50","$1,006.88","$1,596.90",$0.00,$385.51,$0.00,$0.00,$391.77,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$350.17,$0.00,$356.21,$0.00
AR-8953-05,SUP,HCPCS C1713,,AR-8953-05  -  PLATE BN LOPRFL 5MM LCK POW TI FT/ANKL PROX 3MM SCR OPN WDG,"$2,237.50",$0.00,"$2,237.50","$1,006.88","$1,596.90",$0.00,$385.51,$0.00,$0.00,$391.77,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$350.17,$0.00,$356.21,$0.00
AR-8953-055,SUP,HCPCS C1713,,AR-8953-055  -  PLATE BN LOPRFL 5.5MM LCK POW TI FT/ANKL PROX 3MM SCR OPN,"$2,237.50",$0.00,"$2,237.50","$1,006.88","$1,596.90",$0.00,$385.51,$0.00,$0.00,$391.77,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$350.17,$0.00,$356.21,$0.00
AR-8953-06,SUP,HCPCS C1713,,AR-8953-06  -  PLATE BN LOPRFL 6MM LCK POW TI FT/ANKL PROX 3MM SCR OPN WDG,"$2,237.50",$0.00,"$2,237.50","$1,006.88","$1,596.90",$0.00,$385.51,$0.00,$0.00,$391.77,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$350.17,$0.00,$356.21,$0.00
AR-8953-065,SUP,HCPCS C1713,,AR-8953-065  -  PLATE BN LOPRFL 6.5MM LCK POW TI FT/ANKL PROX 3MM SCR OPN,"$2,237.50",$0.00,"$2,237.50","$1,006.88","$1,596.90",$0.00,$385.51,$0.00,$0.00,$391.77,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$350.17,$0.00,$356.21,$0.00
AR-8953-07,SUP,HCPCS C1713,,AR-8953-07  -  PLATE BN LOPRFL 7MM LCK POW TI FT/ANKL PROX 3MM SCR OPN WDG,"$2,237.50",$0.00,"$2,237.50","$1,006.88","$1,596.90",$0.00,$385.51,$0.00,$0.00,$391.77,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$350.17,$0.00,$356.21,$0.00
AR-8954-07,SUP,Custom 27203010,,AR-8954-07  -  GUIDE DRL BNT 3.5MM LCK,$300.00,$0.00,$300.00,$0.00,$214.11,$0.00,$0.00,$0.00,$0.00,$0.00,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8954ML-L,SUP,HCPCS C1713,,AR-8954ML-L  -  PLATE BN LNG LOPRFL TPR LCK CALCANEUS LT ANT ATCH GD PERC,"$2,737.50",$0.00,"$2,737.50","$1,231.88","$1,953.75",$0.00,$471.66,$0.00,$0.00,$479.31,"$2,737.50",$0.00,"$1,368.75","$2,168.10","$2,190.00",$0.00,$428.42,$0.00,$435.81,$0.00
AR-8954ML-S,SUP,HCPCS C1713,,AR-8954ML-S  -  PLATE BN STD LOPRFL TPR LCK CALCANEUS LT ANT ATCH GD PERC,"$2,737.50",$0.00,"$2,737.50","$1,231.88","$1,953.75",$0.00,$471.66,$0.00,$0.00,$479.31,"$2,737.50",$0.00,"$1,368.75","$2,168.10","$2,190.00",$0.00,$428.42,$0.00,$435.81,$0.00
AR-8954MR-L,SUP,HCPCS C1713,,AR-8954MR-L  -  PLATE BN LNG LOPRFL TPR LCK CALCANEUS RT ANT ATCH GD PERC,"$2,737.50",$0.00,"$2,737.50","$1,231.88","$1,953.75",$0.00,$471.66,$0.00,$0.00,$479.31,"$2,737.50",$0.00,"$1,368.75","$2,168.10","$2,190.00",$0.00,$428.42,$0.00,$435.81,$0.00
AR-8954MR-S,SUP,HCPCS C1713,,AR-8954MR-S  -  PLATE BN STD LOPRFL TPR LCK CALCANEUS RT ANT ATCH GD PERC,"$2,737.50",$0.00,"$2,737.50","$1,231.88","$1,953.75",$0.00,$471.66,$0.00,$0.00,$479.31,"$2,737.50",$0.00,"$1,368.75","$2,168.10","$2,190.00",$0.00,$428.42,$0.00,$435.81,$0.00
AR-8954MT,SUP,HCPCS C1713,,AR-8954MT  -  PLATE BN T LOPRFL 4 HL FT 3.5MM SCR,"$2,737.50",$0.00,"$2,737.50","$1,231.88","$1,953.75",$0.00,$471.66,$0.00,$0.00,$479.31,"$2,737.50",$0.00,"$1,368.75","$2,168.10","$2,190.00",$0.00,$428.42,$0.00,$435.81,$0.00
AR-8954PL-L,SUP,HCPCS C1713,,AR-8954PL-L  -  PLATE BN LG PRIMTR CALC FX LT,"$2,737.50",$0.00,"$2,737.50","$1,231.88","$1,953.75",$0.00,$471.66,$0.00,$0.00,$479.31,"$2,737.50",$0.00,"$1,368.75","$2,168.10","$2,190.00",$0.00,$428.42,$0.00,$435.81,$0.00
AR-8954PL-M,SUP,HCPCS C1713,,AR-8954PL-M  -  PLATE BN MED LOPRFL LCK PRIMTR TI CALCANEUS LT 3.5/4MM SCR,"$2,737.50",$0.00,"$2,737.50","$1,231.88","$1,953.75",$0.00,$471.66,$0.00,$0.00,$479.31,"$2,737.50",$0.00,"$1,368.75","$2,168.10","$2,190.00",$0.00,$428.42,$0.00,$435.81,$0.00
AR-8954PL-S,SUP,HCPCS C1713,,AR-8954PL-S  -  PLATE BN SM LOPRFL LCK PRIMTR TI CALCANEUS LT 3.5/4MM SCR,"$2,737.50",$0.00,"$2,737.50","$1,231.88","$1,953.75",$0.00,$471.66,$0.00,$0.00,$479.31,"$2,737.50",$0.00,"$1,368.75","$2,168.10","$2,190.00",$0.00,$428.42,$0.00,$435.81,$0.00
AR-8954PL-XS,SUP,HCPCS C1713,,AR-8954PL-XS  -  PLATE BN XS LOPRFL LCK PRIMTR TI CALCANEUS LT 3.5/4MM SCR,"$2,737.50",$0.00,"$2,737.50","$1,231.88","$1,953.75",$0.00,$471.66,$0.00,$0.00,$479.31,"$2,737.50",$0.00,"$1,368.75","$2,168.10","$2,190.00",$0.00,$428.42,$0.00,$435.81,$0.00
AR-8954PR-L,SUP,HCPCS C1713,,AR-8954PR-L  -  PLATE BN LG LOPRFL LCK PRIMTR TI CALCANEUS RT 3.5/4MM SCR,"$2,737.50",$0.00,"$2,737.50","$1,231.88","$1,953.75",$0.00,$471.66,$0.00,$0.00,$479.31,"$2,737.50",$0.00,"$1,368.75","$2,168.10","$2,190.00",$0.00,$428.42,$0.00,$435.81,$0.00
AR-8954PR-M,SUP,HCPCS C1713,,AR-8954PR-M  -  PLATE BN MED LOPRFL LCK PRIMTR TI CALCANEUS RT 3.5/4MM SCR,"$2,737.50",$0.00,"$2,737.50","$1,231.88","$1,953.75",$0.00,$471.66,$0.00,$0.00,$479.31,"$2,737.50",$0.00,"$1,368.75","$2,168.10","$2,190.00",$0.00,$428.42,$0.00,$435.81,$0.00
AR-8954PR-S,SUP,HCPCS C1713,,AR-8954PR-S  -  PLATE BN SM LOPRFL LCK PRIMTR TI CALCANEUS RT 3.5/4MM SCR,"$2,737.50",$0.00,"$2,737.50","$1,231.88","$1,953.75",$0.00,$471.66,$0.00,$0.00,$479.31,"$2,737.50",$0.00,"$1,368.75","$2,168.10","$2,190.00",$0.00,$428.42,$0.00,$435.81,$0.00
AR-8954PR-XS,SUP,HCPCS C1713,,AR-8954PR-XS  -  PLATE BN XS LOPRFL LCK PRIMTR TI CALCANEUS RT 3.5/4MM SCR,"$2,737.50",$0.00,"$2,737.50","$1,231.88","$1,953.75",$0.00,$471.66,$0.00,$0.00,$479.31,"$2,737.50",$0.00,"$1,368.75","$2,168.10","$2,190.00",$0.00,$428.42,$0.00,$435.81,$0.00
AR-8954YL-L,SUP,HCPCS C1713,,AR-8954YL-L  -  PLATE BN LNG LOPRFL TPR LCK CALCANEUS LT ANT POST ATCH GD,"$2,737.50",$0.00,"$2,737.50","$1,231.88","$1,953.75",$0.00,$471.66,$0.00,$0.00,$479.31,"$2,737.50",$0.00,"$1,368.75","$2,168.10","$2,190.00",$0.00,$428.42,$0.00,$435.81,$0.00
AR-8954YL-S,SUP,HCPCS C1713,,AR-8954YL-S  -  PLATE BN STD LOPRFL TPR LCK CALCANEUS LT ANT POST ATCH GD,"$2,737.50",$0.00,"$2,737.50","$1,231.88","$1,953.75",$0.00,$471.66,$0.00,$0.00,$479.31,"$2,737.50",$0.00,"$1,368.75","$2,168.10","$2,190.00",$0.00,$428.42,$0.00,$435.81,$0.00
AR-8954YR-L,SUP,HCPCS C1713,,AR-8954YR-L  -  PLATE BN LNG LOPRFL TPR LCK CALCANEUS RT ANT POST ATCH GD,"$2,737.50",$0.00,"$2,737.50","$1,231.88","$1,953.75",$0.00,$471.66,$0.00,$0.00,$479.31,"$2,737.50",$0.00,"$1,368.75","$2,168.10","$2,190.00",$0.00,$428.42,$0.00,$435.81,$0.00
AR-8954YR-S,SUP,HCPCS C1713,,AR-8954YR-S  -  PLATE BN STD LOPRFL TPR LCK CALCANEUS RT ANT POST ATCH GD,"$2,737.50",$0.00,"$2,737.50","$1,231.88","$1,953.75",$0.00,$471.66,$0.00,$0.00,$479.31,"$2,737.50",$0.00,"$1,368.75","$2,168.10","$2,190.00",$0.00,$428.42,$0.00,$435.81,$0.00
AR-8955-60PT,SUP,HCPCS C1713,,AR-8955-60PT  -  SCREW BN 3.5MM P/T HEX 5.5MM 60MM LOPRFL SCR SLF DRL SLD LG,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
AR-8955-65PT,SUP,HCPCS C1713,,AR-8955-65PT  -  SCREW BN 3.5MM P/T HEX 5.5MM 65MM LOPRFL SCR SLF DRL SLD LG,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
AR-8955G,SUP,Custom 27203010,,AR-8955G  -  GUIDE DRL LOPRFL 4MM 1.6MM 4.5MM SCR,"$1,000.00",$0.00,"$1,000.00",$0.00,$713.70,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,000.00",$0.00,$500.00,$792.00,$800.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8955T,SUP,HCPCS C1713,,AR-8955T  -  SCREW BN LOPRFL 5.5MM TAP JNS FX,$437.50,$0.00,$437.50,$196.88,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
AR-8956-01,SUP,HCPCS C1713,,AR-8956-01  -  PLATE BN UNV HK METATARSUS FIFTH MTRSL FX SYS,"$2,312.50",$0.00,"$2,312.50","$1,040.63","$1,650.43",$0.00,$398.43,$0.00,$0.00,$404.90,"$2,312.50",$0.00,"$1,156.25","$1,831.50","$1,850.00",$0.00,$361.91,$0.00,$368.15,$0.00
AR-8956-08,SUP,HCPCS C1713,,AR-8956-08  -  PLATE BN HK TAMP METATARSUS FIFTH MTRSL FX SYS,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
AR-8956L-02,SUP,HCPCS C1713,,AR-8956L-02  -  PLATE BN LNG HK METATARSUS LT FIFTH MTRSL FX SYS,"$3,187.50",$0.00,"$3,187.50","$1,434.38","$2,274.92",$0.00,$549.19,$0.00,$0.00,$558.11,"$3,187.50",$0.00,"$1,593.75","$2,524.50","$2,550.00",$0.00,$498.84,$0.00,$507.45,$0.00
AR-8956R-03,SUP,HCPCS C1713,,AR-8956R-03  -  PLATE BN LNG 7 HL HK LOPRFL 5TH MTRSL RT 2.4MM SCR,"$3,187.50",$0.00,"$3,187.50","$1,434.38","$2,274.92",$0.00,$549.19,$0.00,$0.00,$558.11,"$3,187.50",$0.00,"$1,593.75","$2,524.50","$2,550.00",$0.00,$498.84,$0.00,$507.45,$0.00
AR-8958-01,SUP,HCPCS C1713,,AR-8958-01  -  PLATE BN TGHTRP 2 HL SS SYNDESMOSIS,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
AR-8958-01S,SUP,HCPCS C1713,,AR-8958-01S  -  PLATE BN STRL TGHTRP 2 HL SS SYNDESMOSIS,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
AR-8958-02,SUP,HCPCS C1713,,AR-8958-02  -  PLATE BN TGHTRP 2 HL TI SYNDESMOSIS,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
AR-8958-02S,SUP,HCPCS C1713,,AR-8958-02S  -  PLATE BN STRL TGHTRP 2 HL TI SYNDESMOSIS,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
AR-8958TDS,SUP,HCPCS C1713,,AR-8958TDS  -  SYSTEM FX TGHTRP BB-TAK 2,"$5,875.00",$0.00,"$5,875.00","$2,643.75","$4,192.99",$0.00,"$1,012.23",$0.00,$0.00,"$1,028.67","$5,875.00",$0.00,"$2,937.50","$4,653.00","$4,700.00",$0.00,$919.44,$0.00,$935.30,$0.00
AR-8963-05,SUP,Custom 27203010,,AR-8963-05  -  BIT DRL LNG 2MM CLBRT TIB DIST,$237.50,$0.00,$237.50,$0.00,$169.50,$0.00,$0.00,$0.00,$0.00,$0.00,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8963-08,SUP,Custom 27203010,,AR-8963-08  -  GUIDE DRL 2.7MM 10-60MM THRD,"$1,000.00",$0.00,"$1,000.00",$0.00,$713.70,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,000.00",$0.00,$500.00,$792.00,$800.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8963A-03,SUP,HCPCS C1713,,AR-8963A-03  -  PLATE BN 62MM 3 HL 2 ROW CONSTRUCT TPR TIP TIB DIST ANT 2.7,"$2,312.50",$0.00,"$2,312.50","$1,040.63","$1,650.43",$0.00,$398.43,$0.00,$0.00,$404.90,"$2,312.50",$0.00,"$1,156.25","$1,831.50","$1,850.00",$0.00,$361.91,$0.00,$368.15,$0.00
AR-8963A-05,SUP,HCPCS C1713,,AR-8963A-05  -  PLATE BN 84MM 5 HL TIB DIST ANT,"$2,375.00",$0.00,"$2,375.00","$1,068.75","$1,695.04",$0.00,$409.20,$0.00,$0.00,$415.84,"$2,375.00",$0.00,"$1,187.50","$1,881.00","$1,900.00",$0.00,$371.69,$0.00,$378.10,$0.00
AR-8963A-07,SUP,HCPCS C1713,,AR-8963A-07  -  PLATE BN 107MM 7 HL 2 ROW CONSTRUCT TPR TIP TIB DIST ANT 2.7,"$2,450.00",$0.00,"$2,450.00","$1,102.50","$1,748.57",$0.00,$422.12,$0.00,$0.00,$428.98,"$2,450.00",$0.00,"$1,225.00","$1,940.40","$1,960.00",$0.00,$383.43,$0.00,$390.04,$0.00
AR-8963A-09,SUP,HCPCS C1713,,AR-8963A-09  -  PLATE BN 130MM 9 HL 2 ROW CONSTRUCT TPR TIP TIB DIST ANT 2.7,"$3,125.00",$0.00,"$3,125.00","$1,406.25","$2,230.31",$0.00,$538.42,$0.00,$0.00,$547.16,"$3,125.00",$0.00,"$1,562.50","$2,475.00","$2,500.00",$0.00,$489.06,$0.00,$497.50,$0.00
AR-8963AL-04,SUP,HCPCS C1713,,AR-8963AL-04  -  PLATE BN CNTR 66MM 4 HL TPR TIP LOPRFL TIB LT DIST ALAT 2.7,"$4,550.00",$0.00,"$4,550.00","$2,047.50","$3,247.34",$0.00,$783.94,$0.00,$0.00,$796.67,"$4,550.00",$0.00,"$2,275.00","$3,603.60","$3,640.00",$0.00,$712.08,$0.00,$724.36,$0.00
AR-8963AL-06,SUP,HCPCS C1713,,AR-8963AL-06  -  PLATE BN OBLNG 91MM 6 HL TPR TIP LOPRFL TIB LT DIST ALAT,"$4,600.00",$0.00,"$4,600.00","$2,070.00","$3,283.02",$0.00,$792.56,$0.00,$0.00,$805.42,"$4,600.00",$0.00,"$2,300.00","$3,643.20","$3,680.00",$0.00,$719.90,$0.00,$732.32,$0.00
AR-8963AL-08,SUP,HCPCS C1713,,AR-8963AL-08  -  PLATE BN 117MM 8 HL TIB LT DIST ALAT,"$4,650.00",$0.00,"$4,650.00","$2,092.50","$3,318.71",$0.00,$801.17,$0.00,$0.00,$814.18,"$4,650.00",$0.00,"$2,325.00","$3,682.80","$3,720.00",$0.00,$727.73,$0.00,$740.28,$0.00
AR-8963AL-10,SUP,HCPCS C1713,,AR-8963AL-10  -  PLATE BN 142MM 10 HL TIB LT DIST ALAT,"$4,700.00",$0.00,"$4,700.00","$2,115.00","$3,354.39",$0.00,$809.79,$0.00,$0.00,$822.93,"$4,700.00",$0.00,"$2,350.00","$3,722.40","$3,760.00",$0.00,$735.55,$0.00,$748.24,$0.00
AR-8963AL-12,SUP,HCPCS C1713,,AR-8963AL-12  -  PLATE BN 168MM 12 HL TIB LT DIST ALAT,"$4,750.00",$0.00,"$4,750.00","$2,137.50","$3,390.08",$0.00,$818.40,$0.00,$0.00,$831.69,"$4,750.00",$0.00,"$2,375.00","$3,762.00","$3,800.00",$0.00,$743.38,$0.00,$756.20,$0.00
AR-8963AL-14,SUP,HCPCS C1713,,AR-8963AL-14  -  PLATE BN 193MM 14 HL TPR TIP OBLNG HL LOPRFL TIB LT DIST,"$4,800.00",$0.00,"$4,800.00","$2,160.00","$3,425.76",$0.00,$827.02,$0.00,$0.00,$840.44,"$4,800.00",$0.00,"$2,400.00","$3,801.60","$3,840.00",$0.00,$751.20,$0.00,$764.16,$0.00
AR-8963AL-16,SUP,HCPCS C1713,,AR-8963AL-16  -  PLATE BN 218MM 16 HL TPR TIP OBLNG HL LOPRFL TIB LT DIST,"$4,850.00",$0.00,"$4,850.00","$2,182.50","$3,461.45",$0.00,$835.63,$0.00,$0.00,$849.20,"$4,850.00",$0.00,"$2,425.00","$3,841.20","$3,880.00",$0.00,$759.03,$0.00,$772.12,$0.00
AR-8963AL-18,SUP,HCPCS C1713,,AR-8963AL-18  -  PLATE BN BTRS 244MM 18 HL OBLNG HL TPR TIP LOPRFL TIB LT,"$4,900.00",$0.00,"$4,900.00","$2,205.00","$3,497.13",$0.00,$844.25,$0.00,$0.00,$857.95,"$4,900.00",$0.00,"$2,450.00","$3,880.80","$3,920.00",$0.00,$766.85,$0.00,$780.08,$0.00
AR-8963APLL-04,SUP,HCPCS C1713,,AR-8963APLL-04  -  PLATE BN 75MM 4 HL TPR TIP LOPRFL FIB LT DIST P/L 2.7MM LCK,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
AR-8963APLL-06,SUP,HCPCS C1713,,AR-8963APLL-06  -  PLATE BN 126MM ANTM 6 HL SS FIB LT DIST P/L,"$2,875.00",$0.00,"$2,875.00","$1,293.75","$2,051.89",$0.00,$495.35,$0.00,$0.00,$503.39,"$2,875.00",$0.00,"$1,437.50","$2,277.00","$2,300.00",$0.00,$449.94,$0.00,$457.70,$0.00
AR-8963APLL-08,SUP,HCPCS C1713,,AR-8963APLL-08  -  PLATE BN 151MM 8 HL ANTM TPR TIP CUT OUT FIB LT DIST P/L,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,$0.00,$0.00,$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
AR-8963APLL-10,SUP,HCPCS C1713,,AR-8963APLL-10  -  PLATE BN 10 HL ANTM TPR TIP CUT OUT FIB LT DIST P/L,"$3,125.00",$0.00,"$3,125.00","$1,406.25","$2,230.31",$0.00,$538.42,$0.00,$0.00,$547.16,"$3,125.00",$0.00,"$1,562.50","$2,475.00","$2,500.00",$0.00,$489.06,$0.00,$497.50,$0.00
AR-8963APLR-04,SUP,HCPCS C1713,,AR-8963APLR-04  -  PLATE BN 75MM JUMPSTART 4 HL FIB RT DIST P/L,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
AR-8963APLR-06,SUP,HCPCS C1713,,AR-8963APLR-06  -  PLATE BN LOPRFL SS FIB RT P/L DIST,"$2,875.00",$0.00,"$2,875.00","$1,293.75","$2,051.89",$0.00,$495.35,$0.00,$0.00,$503.39,"$2,875.00",$0.00,"$1,437.50","$2,277.00","$2,300.00",$0.00,$449.94,$0.00,$457.70,$0.00
AR-8963APLR-08,SUP,HCPCS C1713,,AR-8963APLR-08  -  PLATE BN 151MM 8 HL FIB RT DIST P/L,"$3,000.00",$0.00,"$3,000.00","$1,350.00","$2,141.10",$0.00,$516.89,$0.00,$0.00,$525.28,"$3,000.00",$0.00,"$1,500.00","$2,376.00","$2,400.00",$0.00,$469.50,$0.00,$477.60,$0.00
AR-8963APLR-10,SUP,HCPCS C1713,,AR-8963APLR-10  -  PLATE BN 10 HL FIB RT DIST P/L,"$3,125.00",$0.00,"$3,125.00","$1,406.25","$2,230.31",$0.00,$538.42,$0.00,$0.00,$547.16,"$3,125.00",$0.00,"$1,562.50","$2,475.00","$2,500.00",$0.00,$489.06,$0.00,$497.50,$0.00
AR-8963AR-04,SUP,HCPCS C1713,,AR-8963AR-04  -  PLATE BN BTRS 66MM 4 HL OBLNG HL TPR TIP LOPRFL TIB RT DIST,"$4,550.00",$0.00,"$4,550.00","$2,047.50","$3,247.34",$0.00,$783.94,$0.00,$0.00,$796.67,"$4,550.00",$0.00,"$2,275.00","$3,603.60","$3,640.00",$0.00,$712.08,$0.00,$724.36,$0.00
AR-8963AR-06,SUP,HCPCS C1713,,AR-8963AR-06  -  PLATE BN BTRS 91MM 6 HL OBLNG HL TPR TIP LOPRFL TIB RT DIST,"$4,600.00",$0.00,"$4,600.00","$2,070.00","$3,283.02",$0.00,$792.56,$0.00,$0.00,$805.42,"$4,600.00",$0.00,"$2,300.00","$3,643.20","$3,680.00",$0.00,$719.90,$0.00,$732.32,$0.00
AR-8963AR-08,SUP,HCPCS C1713,,AR-8963AR-08  -  PLATE BN 117MM 8 HL TIB RT DIST ALAT,"$4,650.00",$0.00,"$4,650.00","$2,092.50","$3,318.71",$0.00,$801.17,$0.00,$0.00,$814.18,"$4,650.00",$0.00,"$2,325.00","$3,682.80","$3,720.00",$0.00,$727.73,$0.00,$740.28,$0.00
AR-8963AR-10,SUP,HCPCS C1713,,AR-8963AR-10  -  PLATE BN 142MM 10 HL TIB RT DIST ALAT,"$4,700.00",$0.00,"$4,700.00","$2,115.00","$3,354.39",$0.00,$809.79,$0.00,$0.00,$822.93,"$4,700.00",$0.00,"$2,350.00","$3,722.40","$3,760.00",$0.00,$735.55,$0.00,$748.24,$0.00
AR-8963AR-14,SUP,HCPCS C1713,,AR-8963AR-14  -  PLATE BN 193MM 14 HL TIB RT DIST ALAT,"$4,800.00",$0.00,"$4,800.00","$2,160.00","$3,425.76",$0.00,$827.02,$0.00,$0.00,$840.44,"$4,800.00",$0.00,"$2,400.00","$3,801.60","$3,840.00",$0.00,$751.20,$0.00,$764.16,$0.00
AR-8963AR-16,SUP,HCPCS C1713,,AR-8963AR-16  -  PLATE BN 218MM 16 HL TPR TIP OBLNG HL LOPRFL TIB RT DIST,"$4,850.00",$0.00,"$4,850.00","$2,182.50","$3,461.45",$0.00,$835.63,$0.00,$0.00,$849.20,"$4,850.00",$0.00,"$2,425.00","$3,841.20","$3,880.00",$0.00,$759.03,$0.00,$772.12,$0.00
AR-8963AR-18,SUP,HCPCS C1713,,AR-8963AR-18  -  PLATE BN BTRS 244MM 18 HL OBLNG HL TPR TIP LOPRFL TIB RT,"$4,900.00",$0.00,"$4,900.00","$2,205.00","$3,497.13",$0.00,$844.25,$0.00,$0.00,$857.95,"$4,900.00",$0.00,"$2,450.00","$3,880.80","$3,920.00",$0.00,$766.85,$0.00,$780.08,$0.00
AR-8963ML-04,SUP,HCPCS C1713,,AR-8963ML-04  -  PLATE BN 103MM 4 HL TIB LT DIST MDL,"$4,300.00",$0.00,"$4,300.00","$1,935.00","$3,068.91",$0.00,$740.87,$0.00,$0.00,$752.90,"$4,300.00",$0.00,"$2,150.00","$3,405.60","$3,440.00",$0.00,$672.95,$0.00,$684.56,$0.00
AR-8963ML-06,SUP,HCPCS C1713,,AR-8963ML-06  -  PLATE BN 128MM 6 HL TIB LT DIST MDL,"$4,350.00",$0.00,"$4,350.00","$1,957.50","$3,104.60",$0.00,$749.48,$0.00,$0.00,$761.65,"$4,350.00",$0.00,"$2,175.00","$3,445.20","$3,480.00",$0.00,$680.78,$0.00,$692.52,$0.00
AR-8963ML-10,SUP,HCPCS C1713,,AR-8963ML-10  -  PLATE BN 179MM 10 HL TPR TIP OBLNG HL LOPRFL TIB LT DIST MDL,"$4,450.00",$0.00,"$4,450.00","$2,002.50","$3,175.97",$0.00,$766.71,$0.00,$0.00,$779.16,"$4,450.00",$0.00,"$2,225.00","$3,524.40","$3,560.00",$0.00,$696.43,$0.00,$708.44,$0.00
AR-8963ML-14,SUP,HCPCS C1713,,AR-8963ML-14  -  PLATE BN 230MM 14 HL TIB LT DIST MDL,"$4,550.00",$0.00,"$4,550.00","$2,047.50","$3,247.34",$0.00,$783.94,$0.00,$0.00,$796.67,"$4,550.00",$0.00,"$2,275.00","$3,603.60","$3,640.00",$0.00,$712.08,$0.00,$724.36,$0.00
AR-8963ML-16,SUP,HCPCS C1713,,AR-8963ML-16  -  PLATE BN 278MM 16 HL TPR TIP OBLNG HL LOPRFL TIB LT DIST MDL,"$4,600.00",$0.00,"$4,600.00","$2,070.00","$3,283.02",$0.00,$792.56,$0.00,$0.00,$805.42,"$4,600.00",$0.00,"$2,300.00","$3,643.20","$3,680.00",$0.00,$719.90,$0.00,$732.32,$0.00
AR-8963MR-04,SUP,HCPCS C1713,,AR-8963MR-04  -  PLATE BN 4 HL LOPRFL SS TIB RT DIST MDL 2.7 MM SCR,"$4,300.00",$0.00,"$4,300.00","$1,935.00","$3,068.91",$0.00,$740.87,$0.00,$0.00,$752.90,"$4,300.00",$0.00,"$2,150.00","$3,405.60","$3,440.00",$0.00,$672.95,$0.00,$684.56,$0.00
AR-8963MR-06,SUP,HCPCS C1713,,AR-8963MR-06  -  PLATE BN CNTR 128MM 6 HL TPR TIP LOPRFL TIB RT DIST MDL 2.7,"$4,350.00",$0.00,"$4,350.00","$1,957.50","$3,104.60",$0.00,$749.48,$0.00,$0.00,$761.65,"$4,350.00",$0.00,"$2,175.00","$3,445.20","$3,480.00",$0.00,$680.78,$0.00,$692.52,$0.00
AR-8963MR-08,SUP,HCPCS C1713,,AR-8963MR-08  -  PLATE BN 154MM 8 HL TPR TIP OBLNG HL LOPRFL TIB RT DIST MDL,"$4,400.00",$0.00,"$4,400.00","$1,980.00","$3,140.28",$0.00,$758.10,$0.00,$0.00,$770.40,"$4,400.00",$0.00,"$2,200.00","$3,484.80","$3,520.00",$0.00,$688.60,$0.00,$700.48,$0.00
AR-8963MR-10,SUP,HCPCS C1713,,AR-8963MR-10  -  PLATE BN CNTR 179MM 10 HL LOPRFL TPR TIP TIB RT DIST MDL,"$4,450.00",$0.00,"$4,450.00","$2,002.50","$3,175.97",$0.00,$766.71,$0.00,$0.00,$779.16,"$4,450.00",$0.00,"$2,225.00","$3,524.40","$3,560.00",$0.00,$696.43,$0.00,$708.44,$0.00
AR-8963MR-12,SUP,HCPCS C1713,,AR-8963MR-12  -  PLATE BN 204MM 12 HL TPR TIP OBLNG HL LOPRFL TIB RT DIST MDL,"$4,500.00",$0.00,"$4,500.00","$2,025.00","$3,211.65",$0.00,$775.33,$0.00,$0.00,$787.91,"$4,500.00",$0.00,"$2,250.00","$3,564.00","$3,600.00",$0.00,$704.25,$0.00,$716.40,$0.00
AR-8963MR-14,SUP,HCPCS C1713,,AR-8963MR-14  -  PLATE BN 230MM 14 HL TPR TIP OBLNG HL LOPRFL TIB RT DIST MDL,"$4,550.00",$0.00,"$4,550.00","$2,047.50","$3,247.34",$0.00,$783.94,$0.00,$0.00,$796.67,"$4,550.00",$0.00,"$2,275.00","$3,603.60","$3,640.00",$0.00,$712.08,$0.00,$724.36,$0.00
AR-8963MR-16,SUP,HCPCS C1713,,AR-8963MR-16  -  PLATE BN 278MM 16 HL TPR TIP OBLNG HL LOPRFL TIB RT DIST MDL,"$4,600.00",$0.00,"$4,600.00","$2,070.00","$3,283.02",$0.00,$792.56,$0.00,$0.00,$805.42,"$4,600.00",$0.00,"$2,300.00","$3,643.20","$3,680.00",$0.00,$719.90,$0.00,$732.32,$0.00
AR-8963P-03,SUP,HCPCS C1713,,AR-8963P-03  -  PLATE BN 57MM ARTHX 3 HL TIB DP,"$2,487.50",$0.00,"$2,487.50","$1,119.38","$1,775.33",$0.00,$428.58,$0.00,$0.00,$435.54,"$2,487.50",$0.00,"$1,243.75","$1,970.10","$1,990.00",$0.00,$389.29,$0.00,$396.01,$0.00
AR-8963P-05,SUP,HCPCS C1713,,AR-8963P-05  -  PLATE BN 77MM 5 HL TIB DP,"$2,487.50",$0.00,"$2,487.50","$1,119.38","$1,775.33",$0.00,$428.58,$0.00,$0.00,$435.54,"$2,487.50",$0.00,"$1,243.75","$1,970.10","$1,990.00",$0.00,$389.29,$0.00,$396.01,$0.00
AR-8963P-07,SUP,HCPCS C1713,,AR-8963P-07  -  PLATE BN 7 HL TIB DP,"$2,437.50",$0.00,"$2,437.50","$1,096.88","$1,739.64",$0.00,$419.97,$0.00,$0.00,$426.79,"$2,437.50",$0.00,"$1,218.75","$1,930.50","$1,950.00",$0.00,$381.47,$0.00,$388.05,$0.00
AR-8963P-09,SUP,HCPCS C1713,,AR-8963P-09  -  PLATE BN 118MM 9 HL TIB DP,"$3,125.00",$0.00,"$3,125.00","$1,406.25","$2,230.31",$0.00,$538.42,$0.00,$0.00,$547.16,"$3,125.00",$0.00,"$1,562.50","$2,475.00","$2,500.00",$0.00,$489.06,$0.00,$497.50,$0.00
AR-8963PLL-04,SUP,HCPCS C1713,,AR-8963PLL-04  -  PLATE BN 75MM 4 HL FIB DIST P/L,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
AR-8963PLL-05,SUP,HCPCS C1713,,AR-8963PLL-05  -  PLATE BN STD 88MM 5 HL TPR TIP FIB DIST P/L 2.7MM LCK,"$2,050.00",$0.00,"$2,050.00",$922.50,"$1,463.09",$0.00,$353.20,$0.00,$0.00,$358.94,"$2,050.00",$0.00,"$1,025.00","$1,623.60","$1,640.00",$0.00,$320.83,$0.00,$326.36,$0.00
AR-8963PLL-06,SUP,HCPCS C1713,,AR-8963PLL-06  -  PLATE BN 100MM 6 HL TPR TIP CUT OUT SCLP FIB DIST P/L,"$2,100.00",$0.00,"$2,100.00",$945.00,"$1,498.77",$0.00,$361.82,$0.00,$0.00,$367.69,"$2,100.00",$0.00,"$1,050.00","$1,663.20","$1,680.00",$0.00,$328.65,$0.00,$334.32,$0.00
AR-8963PLL-08,SUP,HCPCS C1713,,AR-8963PLL-08  -  PLATE BN STD 126MM 8 HL TPR TIP FIB DIST P/L 2.7MM LCK,"$2,150.00",$0.00,"$2,150.00",$967.50,"$1,534.46",$0.00,$370.43,$0.00,$0.00,$376.45,"$2,150.00",$0.00,"$1,075.00","$1,702.80","$1,720.00",$0.00,$336.48,$0.00,$342.28,$0.00
AR-8963RM-02,SUP,HCPCS C1713,,AR-8963RM-02  -  PLATE BN STRG 16MM 2 HL OBLNG HL TPR TIP LOPRFL 2.7MM SCR,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-8963RM-03,SUP,HCPCS C1713,,AR-8963RM-03  -  PLATE BN STRG 16MM 3 HL OBLNG HL TPR TIP LOPRFL 2.7MM SCR,$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
AR-8963RM-04,SUP,HCPCS C1713,,AR-8963RM-04  -  PLATE BN STRG 16MM 4 HL OBLNG HL TPR TIP LOPRFL 2.7MM SCR,$712.50,$0.00,$712.50,$320.63,$508.51,$0.00,$122.76,$0.00,$0.00,$124.75,$712.50,$0.00,$356.25,$564.30,$570.00,$0.00,$111.51,$0.00,$113.43,$0.00
AR-8963RM-05,SUP,HCPCS C1713,,AR-8963RM-05  -  PLATE BN STRG 40MM 5 HL 2.7MM SCR,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
AR-8964-01,SUP,HCPCS C1713,,AR-8964-01  -  SCREW BN 4MM 125MM SCHNZ,$312.50,$0.00,$312.50,$140.63,$223.03,$0.00,$53.84,$0.00,$0.00,$54.72,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$48.91,$0.00,$49.75,$0.00
AR-8964-02,SUP,HCPCS C1713,,AR-8964-02  -  SCREW BN 4MM 125MM SCHNZ,$312.50,$0.00,$312.50,$140.63,$223.03,$0.00,$53.84,$0.00,$0.00,$54.72,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$48.91,$0.00,$49.75,$0.00
AR-8964-03,SUP,HCPCS C1713,,AR-8964-03  -  SCREW BN 5MM 175MM SCHNZ,$312.50,$0.00,$312.50,$140.63,$223.03,$0.00,$53.84,$0.00,$0.00,$54.72,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$48.91,$0.00,$49.75,$0.00
AR-8964-04,SUP,HCPCS C1713,,AR-8964-04  -  SCREW BN 5MM 200MM SCHNZ,$312.50,$0.00,$312.50,$140.63,$223.03,$0.00,$53.84,$0.00,$0.00,$54.72,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$48.91,$0.00,$49.75,$0.00
AR-8964-05,SUP,HCPCS C1713,,AR-8964-05  -  PIN FX 6MM 225MM TRNFX,$225.00,$0.00,$225.00,$101.25,$160.58,$0.00,$38.77,$0.00,$0.00,$39.40,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$35.21,$0.00,$35.82,$0.00
AR-8964-06,SUP,HCPCS C1713,,AR-8964-06  -  PIN FX 6MM 300MM TRNFX,$225.00,$0.00,$225.00,$101.25,$160.58,$0.00,$38.77,$0.00,$0.00,$39.40,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$35.21,$0.00,$35.82,$0.00
AR-8964-07,SUP,Custom 27203010,,AR-8964-07  -  CLAMP XTRNFX LG CMBN,"$1,240.00",$0.00,"$1,240.00",$0.00,$884.99,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,240.00",$0.00,$620.00,$982.08,$992.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8964-08,SUP,Custom 27203010,,AR-8964-08  -  CLAMP XTRNFX LG MLPN,"$1,000.00",$0.00,"$1,000.00",$0.00,$713.70,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,000.00",$0.00,$500.00,$792.00,$800.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8964-09,SUP,Custom 27203010,,AR-8964-09  -  CLAMP XTRNFX LG MLPN ROD ATCH,$937.50,$0.00,$937.50,$0.00,$669.09,$0.00,$0.00,$0.00,$0.00,$0.00,$937.50,$0.00,$468.75,$742.50,$750.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8964-10,SUP,Custom 27203010,,AR-8964-10  -  BIT DRL 3.5MM 195MM,$237.50,$0.00,$237.50,$0.00,$169.50,$0.00,$0.00,$0.00,$0.00,$0.00,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8964-22,SUP,HCPCS C1713,,AR-8964-22  -  CAP END NS LF ARTHX SCR,"$1,250.00",$0.00,"$1,250.00",$562.50,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
AR-8964-24,SUP,HCPCS C1713,,AR-8964-24  -  SCREW BN 5MM 250MM SCHNZ,$312.50,$0.00,$312.50,$140.63,$223.03,$0.00,$53.84,$0.00,$0.00,$54.72,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$48.91,$0.00,$49.75,$0.00
AR-8964R-100,SUP,HCPCS C1713,,AR-8964R-100  -  ROD XTRNFX 11MM 100MM ARTHROFX RDLCNT LTWT CFBR,$422.50,$0.00,$422.50,$190.13,$301.54,$0.00,$72.79,$0.00,$0.00,$73.98,$422.50,$0.00,$211.25,$334.62,$338.00,$0.00,$66.12,$0.00,$67.26,$0.00
AR-8964R-150,SUP,HCPCS C1713,,AR-8964R-150  -  ROD XTRNFX 11MM 150MM CFBR,$422.50,$0.00,$422.50,$190.13,$301.54,$0.00,$72.79,$0.00,$0.00,$73.98,$422.50,$0.00,$211.25,$334.62,$338.00,$0.00,$66.12,$0.00,$67.26,$0.00
AR-8964R-200,SUP,HCPCS C1713,,AR-8964R-200  -  ROD XTRNFX 11MM 200MM ARTHROFX CFBR,$422.50,$0.00,$422.50,$190.13,$301.54,$0.00,$72.79,$0.00,$0.00,$73.98,$422.50,$0.00,$211.25,$334.62,$338.00,$0.00,$66.12,$0.00,$67.26,$0.00
AR-8964R-250,SUP,HCPCS C1713,,AR-8964R-250  -  ROD XTRNFX 11MM 250MM CFBR,$422.50,$0.00,$422.50,$190.13,$301.54,$0.00,$72.79,$0.00,$0.00,$73.98,$422.50,$0.00,$211.25,$334.62,$338.00,$0.00,$66.12,$0.00,$67.26,$0.00
AR-8964R-300,SUP,HCPCS C1713,,AR-8964R-300  -  ROD XTRNFX 11MM 300MM CFBR,$475.00,$0.00,$475.00,$213.75,$339.01,$0.00,$81.84,$0.00,$0.00,$83.17,$475.00,$0.00,$237.50,$376.20,$380.00,$0.00,$74.34,$0.00,$75.62,$0.00
AR-8964R-350,SUP,HCPCS C1713,,AR-8964R-350  -  ROD XTRNFX 11MM 350MM CFBR,$475.00,$0.00,$475.00,$213.75,$339.01,$0.00,$81.84,$0.00,$0.00,$83.17,$475.00,$0.00,$237.50,$376.20,$380.00,$0.00,$74.34,$0.00,$75.62,$0.00
AR-8964R-400,SUP,HCPCS C1713,,AR-8964R-400  -  ROD XTRNFX 11MM 400MM CFBR,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
AR-8964R-450,SUP,HCPCS C1713,,AR-8964R-450  -  ROD XTRNFX 11MM 450MM CFBR,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
AR-8964R-500,SUP,HCPCS C1713,,AR-8964R-500  -  ROD XTRNFX 11MM 500MM ARTHROFX RDLCNT LTWT CFBR,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-8964S,SUP,Custom 27203010,,AR-8964S  -  SYSTEM XTRNFX ARTHROFX,"$35,000.00",$0.00,"$35,000.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$35,000.00",$0.00,"$17,500.00","$27,720.00","$28,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-8967-100FT,SUP,HCPCS C1713,,AR-8967-100FT  -  SCREW BN FT 6.7MM 100MM LOPRFL SCR SLF DRL ST CNN MTL,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-8967-105FT,SUP,HCPCS C1713,,AR-8967-105FT  -  SCREW BN FT 6.7MM 105MM LOPRFL SCR SLF DRL ST CNN MTL,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-8967-110FT,SUP,HCPCS C1713,,AR-8967-110FT  -  SCREW BN FT 6.7MM 110MM LOPRFL SCR SLF DRL ST CNN MTL,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-8967-115FT,SUP,HCPCS C1713,,AR-8967-115FT  -  SCREW BN FT 6.7MM 115MM LOPRFL SCR SLF DRL ST CNN MTL,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-8967-120FT,SUP,HCPCS C1713,,AR-8967-120FT  -  SCREW BN FT 6.7MM 120MM LOPRFL SCR SLF DRL ST CNN MTL,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-8967-18100,SUP,HCPCS C1713,,AR-8967-18100  -  SCREW BN LOPRFL 6.7MM 100MM 18MM CNN TI FT/ANKL,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-8967-18105,SUP,HCPCS C1713,,AR-8967-18105  -  SCREW BN LOPRFL 6.7MM 105MM 18MM CNN TI FT/ANKL,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-8967-18110,SUP,HCPCS C1713,,AR-8967-18110  -  SCREW BN LOPRFL 6.7MM 110MM 18MM CNN TI FT/ANKL,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-8967-18115,SUP,HCPCS C1713,,AR-8967-18115  -  SCREW BN LOPRFL 6.7MM 115MM 18MM CNN TI FT/ANKL,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-8967-18120,SUP,HCPCS C1713,,AR-8967-18120  -  SCREW BN LOPRFL 6.7MM 120MM 18MM CNN TI FT/ANKL,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-8967-1840,SUP,HCPCS C1713,,AR-8967-1840  -  SCREW BN 3.5MM HEX 6.7MM 40MM 18MM LOPRFL SCR SLF DRL ST CNN,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-8967-1845,SUP,HCPCS C1713,,AR-8967-1845  -  SCREW BN 3.5MM HEX 6.7MM 45MM 18MM LOPRFL SCR SLF DRL ST CNN,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-8967-1850,SUP,HCPCS C1713,,AR-8967-1850  -  SCREW BN 3.5MM HEX 6.7MM 50MM 18MM LOPRFL SCR SLF DRL ST CNN,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-8967-1855,SUP,HCPCS C1713,,AR-8967-1855  -  SCREW BN 3.5MM HEX 6.7MM 55MM 18MM LOPRFL SCR SLF DRL ST CNN,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-8967-1860,SUP,HCPCS C1713,,AR-8967-1860  -  SCREW BN 3.5MM HEX 6.7MM 60MM 18MM LOPRFL SCR SLF DRL ST CNN,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-8967-1865,SUP,HCPCS C1713,,AR-8967-1865  -  SCREW BN 3.5MM HEX 6.7MM 65MM 18MM LOPRFL SCR SLF DRL ST CNN,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-8967-1865S,SUP,HCPCS C1713,,AR-8967-1865S  -  SCREW BN P/T 6.7MM 65MM STRL ARTHX LOPRFL SCR CNN TI,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-8967-1870,SUP,HCPCS C1713,,AR-8967-1870  -  SCREW BN 3.5MM HEX 6.7MM 70MM 18MM LOPRFL SCR SLF DRL ST CNN,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-8967-1875,SUP,HCPCS C1713,,AR-8967-1875  -  SCREW BN 3.5MM HEX 6.7MM 75MM 18MM LOPRFL SCR SLF DRL ST CNN,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-8967-1880,SUP,HCPCS C1713,,AR-8967-1880  -  SCREW BN 3.5MM HEX 6.7MM 80MM 18MM LOPRFL SCR SLF DRL ST CNN,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-8967-1880S,SUP,HCPCS C1713,,AR-8967-1880S  -  SCREW BN P/T 6.7MM 80MM STRL ARTHX LOPRFL SCR CNN TI,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-8967-1885,SUP,HCPCS C1713,,AR-8967-1885  -  SCREW BN 3.5MM HEX 6.7MM 85MM 18MM LOPRFL SCR SLF DRL ST CNN,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-8967-1890,SUP,HCPCS C1713,,AR-8967-1890  -  SCREW BN 3.5MM HEX 6.7MM 90MM 18MM LOPRFL SCR SLF DRL ST CNN,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-8967-1890S,SUP,HCPCS C1713,,AR-8967-1890S  -  SCREW BN P/T 6.7MM 90MM STRL ARTHX LOPRFL SCR CNN TI,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-8967-1895,SUP,HCPCS C1713,,AR-8967-1895  -  SCREW BN 3.5MM HEX 6.7MM 95MM 18MM LOPRFL SCR SLF DRL ST CNN,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-8967-28100,SUP,HCPCS C1713,,AR-8967-28100  -  SCREW BN 3.5MM HEX 6.7MM 100MM 18MM LOPRFL SCR SLF DRL ST,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-8967-28105,SUP,HCPCS C1713,,AR-8967-28105  -  SCREW BN 3.5MM HEX 6.7MM 105MM 18MM LOPRFL SCR SLF DRL ST,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-8967-28110,SUP,HCPCS C1713,,AR-8967-28110  -  SCREW BN 3.5MM HEX 6.7MM 110MM 18MM LOPRFL SCR SLF DRL ST,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-8967-28115,SUP,HCPCS C1713,,AR-8967-28115  -  SCREW BN 3.5MM HEX 6.7MM 115MM 18MM LOPRFL SCR SLF DRL ST,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-8967-28120,SUP,HCPCS C1713,,AR-8967-28120  -  SCREW BN 3.5MM HEX 6.7MM 120MM 18MM LOPRFL SCR SLF DRL ST,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-8967-2840,SUP,HCPCS C1713,,AR-8967-2840  -  SCREW BN 3.5MM HEX 6.7MM 40MM 28MM LOPRFL SCR SLF DRL ST CNN,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-8967-2845,SUP,HCPCS C1713,,AR-8967-2845  -  SCREW BN 3.5MM HEX 6.7MM 45MM 28MM LOPRFL SCR SLF DRL ST CNN,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-8967-2850,SUP,HCPCS C1713,,AR-8967-2850  -  SCREW BN 3.5MM HEX 6.7MM 50MM 28MM LOPRFL SCR SLF DRL ST CNN,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-8967-2855,SUP,HCPCS C1713,,AR-8967-2855  -  SCREW BN 3.5MM HEX 6.7MM 55MM 28MM LOPRFL SCR SLF DRL ST CNN,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-8967-2860,SUP,HCPCS C1713,,AR-8967-2860  -  SCREW BN 3.5MM HEX 6.7MM 60MM 28MM LOPRFL SCR SLF DRL ST CNN,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-8967-2865,SUP,HCPCS C1713,,AR-8967-2865  -  SCREW BN 3.5MM HEX 6.7MM 65MM 28MM LOPRFL SCR SLF DRL ST CNN,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-8967-2870,SUP,HCPCS C1713,,AR-8967-2870  -  SCREW BN 3.5MM HEX 6.7MM 70MM 28MM LOPRFL SCR SLF DRL ST CNN,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-8967-2875,SUP,HCPCS C1713,,AR-8967-2875  -  SCREW BN 3.5MM HEX 6.7MM 75MM 28MM LOPRFL SCR SLF DRL ST CNN,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-8967-2880,SUP,HCPCS C1713,,AR-8967-2880  -  SCREW BN 3.5MM HEX 6.7MM 80MM 28MM LOPRFL SCR SLF DRL ST CNN,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-8967-2885,SUP,HCPCS C1713,,AR-8967-2885  -  SCREW BN 3.5MM HEX 6.7MM 85MM 28MM LOPRFL SCR SLF DRL ST CNN,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-8967-2890,SUP,HCPCS C1713,,AR-8967-2890  -  SCREW BN 3.5MM HEX 6.7MM 90MM 28MM LOPRFL SCR SLF DRL ST CNN,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-8967-2895,SUP,HCPCS C1713,,AR-8967-2895  -  SCREW BN 3.5MM HEX 6.7MM 95MM 28MM LOPRFL SCR SLF DRL ST CNN,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-8967-40C,SUP,Custom 27203010,,AR-8967-40C  -  BIT DRL 4MM 120MM CNN 6.7MM SCR,$487.50,$0.00,$487.50,$0.00,$347.93,$0.00,$0.00,$0.00,$0.00,$0.00,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8967-40FT,SUP,HCPCS C1713,,AR-8967-40FT  -  SCREW BN FT 6.7MM 40MM LOPRFL SCR CNN MTL FT/ANKL,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-8967-45FT,SUP,HCPCS C1713,,AR-8967-45FT  -  SCREW BN FT 6.7MM 45MM LOPRFL SCR SLF DRL ST CNN MTL FT/ANKL,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-8967-50FT,SUP,HCPCS C1713,,AR-8967-50FT  -  SCREW BN FT 6.7MM 50MM LOPRFL SCR SLF DRL ST CNN MTL FT/ANKL,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-8967-55FT,SUP,HCPCS C1713,,AR-8967-55FT  -  SCREW BN FT 6.7MM 55MM LOPRFL SCR SLF DRL ST CNN MTL FT/ANKL,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-8967-60FT,SUP,HCPCS C1713,,AR-8967-60FT  -  SCREW BN FT 6.7MM 60MM LOPRFL SCR SLF DRL ST CNN MTL FT/ANKL,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-8967-65FT,SUP,HCPCS C1713,,AR-8967-65FT  -  SCREW BN FT 6.7MM 65MM LOPRFL SCR SLF DRL ST CNN MTL FT/ANKL,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-8967-67C,SUP,Custom 27203010,,AR-8967-67C  -  BIT DRL MN 6.7MM HDSN CNN,$487.50,$0.00,$487.50,$0.00,$347.93,$0.00,$0.00,$0.00,$0.00,$0.00,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8967-70FT,SUP,HCPCS C1713,,AR-8967-70FT  -  SCREW BN FT 6.7MM 70MM LOPRFL SCR SLF DRL ST CNN MTL FT/ANKL,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-8967-75FT,SUP,HCPCS C1713,,AR-8967-75FT  -  SCREW BN FT 6.7MM 75MM LOPRFL SCR SLF DRL ST CNN MTL FT/ANKL,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-8967-80FT,SUP,HCPCS C1713,,AR-8967-80FT  -  SCREW BN FT 6.7MM 80MM LOPRFL SCR SLF DRL ST CNN MTL FT/ANKL,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-8967-85FT,SUP,HCPCS C1713,,AR-8967-85FT  -  SCREW BN FT 6.7MM 85MM LOPRFL SCR SLF DRL ST CNN MTL FT/ANKL,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-8967-90FT,SUP,HCPCS C1713,,AR-8967-90FT  -  SCREW BN FT 6.7MM 90MM LOPRFL SCR SLF DRL ST CNN MTL FT/ANKL,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-8967-95FT,SUP,HCPCS C1713,,AR-8967-95FT  -  SCREW BN FT 6.7MM 95MM LOPRFL SCR SLF DRL ST CNN MTL FT/ANKL,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-8967C,SUP,HCPCS C1713,,AR-8967C  -  SCREW BN LOPRFL 7MM PLT INS SM BN,"$1,000.00",$0.00,"$1,000.00",$450.00,$713.70,$0.00,$172.30,$0.00,$0.00,$175.09,"$1,000.00",$0.00,$500.00,$792.00,$800.00,$0.00,$156.50,$0.00,$159.20,$0.00
AR-8967CSF,SUP,Custom 27203010,,AR-8967CSF  -  COUNTERSINK DRL CNN 6.7 MM SCR,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8967G,SUP,Custom 27203010,,AR-8967G  -  GUIDE DRL 6.7MM 4MM CNN,"$1,000.00",$0.00,"$1,000.00",$0.00,$713.70,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,000.00",$0.00,$500.00,$792.00,$800.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8967S,SUP,HCPCS C1713,,AR-8967S  -  MODULE INST 6.7 MM TENODESIS LOPRFL SCR,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
AR-8967W,SUP,HCPCS C1713,,AR-8967W  -  WASHER ORTH 13MM TI,$200.00,$0.00,$200.00,$90.00,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
AR-8970-01,SUP,Custom 27203010,,AR-8970-01  -  GUIDE DRL 4.5 MM LCK SCR,"$1,000.00",$0.00,"$1,000.00",$0.00,$713.70,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,000.00",$0.00,$500.00,$792.00,$800.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8970-02,SUP,Custom 27203010,,AR-8970-02  -  GUIDE DRL 3 4.5 MM SCR,"$1,000.00",$0.00,"$1,000.00",$0.00,$713.70,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,000.00",$0.00,$500.00,$792.00,$800.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8970-30,SUP,Custom 27203010,,AR-8970-30  -  BIT DRL 3MM CLBRT,$487.50,$0.00,$487.50,$0.00,$347.93,$0.00,$0.00,$0.00,$0.00,$0.00,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8970-30C,SUP,Custom 27203010,,AR-8970-30C  -  BIT DRL 3MM CNN,$487.50,$0.00,$487.50,$0.00,$347.93,$0.00,$0.00,$0.00,$0.00,$0.00,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8970-40C,SUP,Custom 27203010,,AR-8970-40C  -  BIT DRL 4MM CNN,$487.50,$0.00,$487.50,$0.00,$347.93,$0.00,$0.00,$0.00,$0.00,$0.00,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8970-45,SUP,Custom 27203010,,AR-8970-45  -  BIT DRL 4.5MM,$197.50,$0.00,$197.50,$0.00,$140.96,$0.00,$0.00,$0.00,$0.00,$0.00,$197.50,$0.00,$98.75,$156.42,$158.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8970-55,SUP,Custom 27203010,,AR-8970-55  -  BIT DRL 5.5MM,$197.50,$0.00,$197.50,$0.00,$140.96,$0.00,$0.00,$0.00,$0.00,$0.00,$197.50,$0.00,$98.75,$156.42,$158.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8970AL,SUP,HCPCS C1713,,AR-8970AL  -  PLATE BN ANKL LT ANT,"$5,187.50",$0.00,"$5,187.50","$2,334.38","$3,702.32",$0.00,$893.78,$0.00,$0.00,$908.29,"$5,187.50",$0.00,"$2,593.75","$4,108.50","$4,150.00",$0.00,$811.84,$0.00,$825.85,$0.00
AR-8970AR,SUP,HCPCS C1713,,AR-8970AR  -  PLATE BN ANKL RT ANT,"$5,187.50",$0.00,"$5,187.50","$2,334.38","$3,702.32",$0.00,$893.78,$0.00,$0.00,$908.29,"$5,187.50",$0.00,"$2,593.75","$4,108.50","$4,150.00",$0.00,$811.84,$0.00,$825.85,$0.00
AR-8970PL,SUP,HCPCS C1713,,AR-8970PL  -  PLATE BN ANKL LT TIBIOTALOCALCANEAL POST,"$5,687.50",$0.00,"$5,687.50","$2,559.38","$4,059.17",$0.00,$979.93,$0.00,$0.00,$995.84,"$5,687.50",$0.00,"$2,843.75","$4,504.50","$4,550.00",$0.00,$890.09,$0.00,$905.45,$0.00
AR-8970PR,SUP,HCPCS C1713,,AR-8970PR  -  PLATE BN ANKL RT POST TIBIOTALOCALCANEAL,"$5,687.50",$0.00,"$5,687.50","$2,559.38","$4,059.17",$0.00,$979.93,$0.00,$0.00,$995.84,"$5,687.50",$0.00,"$2,843.75","$4,504.50","$4,550.00",$0.00,$890.09,$0.00,$905.45,$0.00
AR-8970S,SUP,HCPCS C1713,,AR-8970S  -  SCREW BN ANKL FSN PLT SYS,"$36,250.00",$0.00,"$36,250.00","$16,312.50","$5,158.80",$0.00,"$6,245.69",$0.00,$0.00,"$6,347.09","$36,250.00",$0.00,"$18,125.00","$28,710.00","$29,000.00",$0.00,"$5,673.13",$0.00,"$5,771.00",$0.00
AR-8970TT,SUP,HCPCS C1713,,AR-8970TT  -  PLATE BN FSN ANKL TIBIOTALAR LAT,"$5,187.50",$0.00,"$5,187.50","$2,334.38","$3,702.32",$0.00,$893.78,$0.00,$0.00,$908.29,"$5,187.50",$0.00,"$2,593.75","$4,108.50","$4,150.00",$0.00,$811.84,$0.00,$825.85,$0.00
AR-8970TTC,SUP,HCPCS C1713,,AR-8970TTC  -  PLATE BN FSN ANKL LAT TIBIOTALOCALCANEAL,"$5,437.50",$0.00,"$5,437.50","$2,446.88","$3,880.74",$0.00,$936.85,$0.00,$0.00,$952.06,"$5,437.50",$0.00,"$2,718.75","$4,306.50","$4,350.00",$0.00,$850.97,$0.00,$865.65,$0.00
AR-8978DS,SUP,Custom 27203010,,AR-8978DS  -  KIT ASCP FX 3.5MM 8.5MM STRL ARTHX DX SWIVELOCK SL,$687.50,$0.00,$687.50,$0.00,$490.67,$0.00,$0.00,$0.00,$0.00,$0.00,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8978P,SUP,HCPCS C1713,,AR-8978P  -  ANCHOR SUT 3.5MM STRL DX SWIVELOCK SL8.5MM FRK EYLT,"$1,062.50",$0.00,"$1,062.50",$478.13,$758.31,$0.00,$183.06,$0.00,$0.00,$186.04,"$1,062.50",$0.00,$531.25,$841.50,$850.00,$0.00,$166.28,$0.00,$169.15,$0.00
AR-8981-06S,SUP,Custom 27203010,,AR-8981-06S  -  SET GFT HRVT 6MM STRL OATS DISP S JNT,"$1,237.50",$0.00,"$1,237.50",$0.00,$883.20,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,237.50",$0.00,$618.75,$980.10,$990.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8981-08S,SUP,Custom 27203010,,AR-8981-08S  -  SET GFT HRVT 8MM STRL OATS DISP S JNT,"$1,237.50",$0.00,"$1,237.50",$0.00,$883.20,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,237.50",$0.00,$618.75,$980.10,$990.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8981-10S,SUP,Custom 27203010,,AR-8981-10S  -  SET GFT HRVT 10MM STRL OATS DISP S JNT,"$1,237.50",$0.00,"$1,237.50",$0.00,$883.20,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,237.50",$0.00,$618.75,$980.10,$990.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-8999N,SUP,Custom 27203010,,AR-8999N  -  NEEDLE SUT MN SCRPN DX,"$4,937.50",$0.00,"$4,937.50",$0.00,"$3,523.89",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,937.50",$0.00,"$2,468.75","$3,910.50","$3,950.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-9045-40PT,SUP,HCPCS C1713,,AR-9045-40PT  -  SCREW BN P/T LOPRFL 4.5MM 40MM SLD TI METATARSUS JNS FX,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-9045-45PT,SUP,HCPCS C1713,,AR-9045-45PT  -  SCREW BN P/T 4.5MM 45MM LOPRFL HD ST TI METATARSUS,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-9045-50PT,SUP,HCPCS C1713,,AR-9045-50PT  -  SCREW BN P/T LOPRFL 4.5MM 50MM SLD TI METATARSUS JNS FX,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-9045-55PT,SUP,HCPCS C1713,,AR-9045-55PT  -  SCREW BN P/T LOPRFL 4.5MM 55MM SLD TI METATARSUS JNS FX,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-9045-60PT,SUP,HCPCS C1713,,AR-9045-60PT  -  SCREW BN P/T LOPRFL 4.5MM 60MM SLD TI METATARSUS JNS FX,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-9045-65PT,SUP,HCPCS C1713,,AR-9045-65PT  -  SCREW BN P/T LOPRFL 4.5MM 65MM SLD TI METATARSUS JNS FX,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-9055-40PT,SUP,HCPCS C1713,,AR-9055-40PT  -  SCREW BN P/T LOPRFL 5.5MM 40MM SLD TI METATARSUS JNS FX,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-9055-45PT,SUP,HCPCS C1713,,AR-9055-45PT  -  SCREW BN P/T 5.5MM 45MM SOLINULLD LOPRFL ST TI METATARSUS,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-9055-50PT,SUP,HCPCS C1713,,AR-9055-50PT  -  SCREW BN P/T LOPRFL 5.5MM 50MM SLD TI METATARSUS JNS FX,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-9055-55PT,SUP,HCPCS C1713,,AR-9055-55PT  -  SCREW BN P/T 5.5MM 55MM LOPRFL HD ST TI METATARSUS,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-9055-60PT,SUP,HCPCS C1713,,AR-9055-60PT  -  SCREW BN P/T LOPRFL 5.5MM 60MM SLD TI METATARSUS JNS FX,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-9055-65PT,SUP,HCPCS C1713,,AR-9055-65PT  -  SCREW BN P/T LOPRFL 5.5MM 65MM SLD TI METATARSUS JNS FX,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-9060-40PT,SUP,HCPCS C1713,,AR-9060-40PT  -  SCREW BN P/T LOPRFL 6MM 40MM SLD TI METATARSUS JNS FX,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-9060-45PT,SUP,HCPCS C1713,,AR-9060-45PT  -  SCREW BN P/T LOPRFL 6MM 45MM SLD TI METATARSUS JNS FX,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-9060-50PT,SUP,HCPCS C1713,,AR-9060-50PT  -  SCREW BN P/T LOPRFL 6MM 50MM SLD TI METATARSUS JNS FX,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-9060-55PT,SUP,HCPCS C1713,,AR-9060-55PT  -  SCREW BN P/T LOPRFL 6MM 55MM SLD TI METATARSUS JNS FX,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-9060-60PT,SUP,HCPCS C1713,,AR-9060-60PT  -  SCREW BN P/T LOPRFL 6MM 60MM SLD TI METATARSUS JNS FX,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-9060-65PT,SUP,HCPCS C1713,,AR-9060-65PT  -  SCREW BN P/T LOPRFL 6MM 65MM SLD TI METATARSUS JNS FX,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
AR-9100-05P,SUP,HCPCS C1776,,AR-9100-05P  -  STEM HUM 5MM 105MM STRL,"$9,187.50",$0.00,"$9,187.50","$4,134.38","$5,158.80",$0.00,"$1,582.96",$0.00,$0.00,"$1,608.66","$9,187.50",$0.00,"$4,593.75","$7,276.50","$7,350.00",$0.00,"$1,437.84",$0.00,"$1,462.65",$0.00
AR-9100-05S,SUP,HCPCS C1776,,AR-9100-05S  -  STEM HUM 132.5D 5MM 60MM UNIVERS APX,"$10,437.50",$0.00,"$10,437.50","$4,696.88","$5,158.80",$0.00,"$1,798.33",$0.00,$0.00,"$1,827.52","$10,437.50",$0.00,"$5,218.75","$8,266.50","$8,350.00",$0.00,"$1,633.47",$0.00,"$1,661.65",$0.00
AR-9100-06P,SUP,HCPCS C1776,,AR-9100-06P  -  STEM HUM 6MM 115MM STRL UNIVERS II SHLDR,"$9,187.50",$0.00,"$9,187.50","$4,134.38","$5,158.80",$0.00,"$1,582.96",$0.00,$0.00,"$1,608.66","$9,187.50",$0.00,"$4,593.75","$7,276.50","$7,350.00",$0.00,"$1,437.84",$0.00,"$1,462.65",$0.00
AR-9100-06S,SUP,HCPCS C1776,,AR-9100-06S  -  STEM HUM RECT 6MM 60MM UNIVERS APX PRFT REM TRUNION SUT HL,"$10,437.50",$0.00,"$10,437.50","$4,696.88","$5,158.80",$0.00,"$1,798.33",$0.00,$0.00,"$1,827.52","$10,437.50",$0.00,"$5,218.75","$8,266.50","$8,350.00",$0.00,"$1,633.47",$0.00,"$1,661.65",$0.00
AR-9100-07,SUP,HCPCS C1776,,AR-9100-07  -  STEM HUM 7MM UNIVERS SHLDR,"$5,987.50",$0.00,"$5,987.50","$2,694.38","$4,273.28",$0.00,"$1,031.62",$0.00,$0.00,"$1,048.36","$5,987.50",$0.00,"$2,993.75","$4,742.10","$4,790.00",$0.00,$937.04,$0.00,$953.21,$0.00
AR-9100-07P,SUP,HCPCS C1776,,AR-9100-07P  -  STEM HUM 7MM 140MM STRL UNIVERS II SHLDR,"$9,187.50",$0.00,"$9,187.50","$4,134.38","$5,158.80",$0.00,"$1,582.96",$0.00,$0.00,"$1,608.66","$9,187.50",$0.00,"$4,593.75","$7,276.50","$7,350.00",$0.00,"$1,437.84",$0.00,"$1,462.65",$0.00
AR-9100-07S,SUP,HCPCS C1776,,AR-9100-07S  -  STEM HUM RECT 7MM 60MM UNIVERS APX PRFT REM TRUNION SUT HL,"$10,437.50",$0.00,"$10,437.50","$4,696.88","$5,158.80",$0.00,"$1,798.33",$0.00,$0.00,"$1,827.52","$10,437.50",$0.00,"$5,218.75","$8,266.50","$8,350.00",$0.00,"$1,633.47",$0.00,"$1,661.65",$0.00
AR-9100-08,SUP,HCPCS C1776,,AR-9100-08  -  STEM HUM 8MM UNIVERS SHLDR,"$5,987.50",$0.00,"$5,987.50","$2,694.38","$4,273.28",$0.00,"$1,031.62",$0.00,$0.00,"$1,048.36","$5,987.50",$0.00,"$2,993.75","$4,742.10","$4,790.00",$0.00,$937.04,$0.00,$953.21,$0.00
AR-9100-08F,SUP,HCPCS C1776,,AR-9100-08F  -  STEM HUM 8MM 158MM STRL UNIVERS ADJ HT SHLDR,"$6,812.50",$0.00,"$6,812.50","$3,065.63","$4,862.08",$0.00,"$1,173.76",$0.00,$0.00,"$1,192.81","$6,812.50",$0.00,"$3,406.25","$5,395.50","$5,450.00",$0.00,"$1,066.16",$0.00,"$1,084.55",$0.00
AR-9100-08P,SUP,HCPCS C1776,,AR-9100-08P  -  STEM HUM 8MM 143MM STRL UNIVERS II SHLDR,"$9,187.50",$0.00,"$9,187.50","$4,134.38","$5,158.80",$0.00,"$1,582.96",$0.00,$0.00,"$1,608.66","$9,187.50",$0.00,"$4,593.75","$7,276.50","$7,350.00",$0.00,"$1,437.84",$0.00,"$1,462.65",$0.00
AR-9100-08S,SUP,HCPCS C1776,,AR-9100-08S  -  STEM HUM RECT 8MM 60MM UNIVERS APX PRFT REM TRUNION SUT HL,"$10,437.50",$0.00,"$10,437.50","$4,696.88","$5,158.80",$0.00,"$1,798.33",$0.00,$0.00,"$1,827.52","$10,437.50",$0.00,"$5,218.75","$8,266.50","$8,350.00",$0.00,"$1,633.47",$0.00,"$1,661.65",$0.00
AR-9100-09,SUP,HCPCS C1776,,AR-9100-09  -  STEM HUM 9MM UNIVERS SHLDR,"$5,987.50",$0.00,"$5,987.50","$2,694.38","$4,273.28",$0.00,"$1,031.62",$0.00,$0.00,"$1,048.36","$5,987.50",$0.00,"$2,993.75","$4,742.10","$4,790.00",$0.00,$937.04,$0.00,$953.21,$0.00
AR-9100-09F,SUP,HCPCS C1776,,AR-9100-09F  -  STEM HUM 9MM 173MM STRL UNIVERS ADJ HT SHLDR,"$6,812.50",$0.00,"$6,812.50","$3,065.63","$4,862.08",$0.00,"$1,173.76",$0.00,$0.00,"$1,192.81","$6,812.50",$0.00,"$3,406.25","$5,395.50","$5,450.00",$0.00,"$1,066.16",$0.00,"$1,084.55",$0.00
AR-9100-09P,SUP,HCPCS C1776,,AR-9100-09P  -  STEM HUM 9MM 146MM STRL UNIVERS II SHLDR,"$9,187.50",$0.00,"$9,187.50","$4,134.38","$5,158.80",$0.00,"$1,582.96",$0.00,$0.00,"$1,608.66","$9,187.50",$0.00,"$4,593.75","$7,276.50","$7,350.00",$0.00,"$1,437.84",$0.00,"$1,462.65",$0.00
AR-9100-09S,SUP,HCPCS C1776,,AR-9100-09S  -  STEM HUM RECT 9MM 60MM UNIVERS APX PRFT REM TRUNION SUT HL,"$10,437.50",$0.00,"$10,437.50","$4,696.88","$5,158.80",$0.00,"$1,798.33",$0.00,$0.00,"$1,827.52","$10,437.50",$0.00,"$5,218.75","$8,266.50","$8,350.00",$0.00,"$1,633.47",$0.00,"$1,661.65",$0.00
AR-9100-10F,SUP,HCPCS C1776,,AR-9100-10F  -  STEM HUM 10MM 180MM STRL UNIVERS ADJ HT FX SHLDR,"$6,812.50",$0.00,"$6,812.50","$3,065.63","$4,862.08",$0.00,"$1,173.76",$0.00,$0.00,"$1,192.81","$6,812.50",$0.00,"$3,406.25","$5,395.50","$5,450.00",$0.00,"$1,066.16",$0.00,"$1,084.55",$0.00
AR-9100-10P,SUP,HCPCS C1776,,AR-9100-10P  -  STEM HUM 10MM 148MM STRL UNIVERS II SHLDR,"$9,187.50",$0.00,"$9,187.50","$4,134.38","$5,158.80",$0.00,"$1,582.96",$0.00,$0.00,"$1,608.66","$9,187.50",$0.00,"$4,593.75","$7,276.50","$7,350.00",$0.00,"$1,437.84",$0.00,"$1,462.65",$0.00
AR-9100-10S,SUP,HCPCS C1776,,AR-9100-10S  -  STEM HUM RECT 10MM 60MM UNIVERS APX PRFT REM TRUNION SUT HL,"$10,437.50",$0.00,"$10,437.50","$4,696.88","$5,158.80",$0.00,"$1,798.33",$0.00,$0.00,"$1,827.52","$10,437.50",$0.00,"$5,218.75","$8,266.50","$8,350.00",$0.00,"$1,633.47",$0.00,"$1,661.65",$0.00
AR-9100-11,SUP,HCPCS C1776,,AR-9100-11  -  STEM HUM 11MM UNIVERS SHLDR,"$5,987.50",$0.00,"$5,987.50","$2,694.38","$4,273.28",$0.00,"$1,031.62",$0.00,$0.00,"$1,048.36","$5,987.50",$0.00,"$2,993.75","$4,742.10","$4,790.00",$0.00,$937.04,$0.00,$953.21,$0.00
AR-9100-11F,SUP,HCPCS C1776,,AR-9100-11F  -  STEM HUM 11MM 187MM STRL UNIVERS ADJ HT SHLDR,"$6,812.50",$0.00,"$6,812.50","$3,065.63","$4,862.08",$0.00,"$1,173.76",$0.00,$0.00,"$1,192.81","$6,812.50",$0.00,"$3,406.25","$5,395.50","$5,450.00",$0.00,"$1,066.16",$0.00,"$1,084.55",$0.00
AR-9100-11P,SUP,HCPCS C1776,,AR-9100-11P  -  STEM HUM 11MM 151MM STRL UNIVERS II SHLDR,"$9,187.50",$0.00,"$9,187.50","$4,134.38","$5,158.80",$0.00,"$1,582.96",$0.00,$0.00,"$1,608.66","$9,187.50",$0.00,"$4,593.75","$7,276.50","$7,350.00",$0.00,"$1,437.84",$0.00,"$1,462.65",$0.00
AR-9100-11S,SUP,HCPCS C1776,,AR-9100-11S  -  STEM HUM RECT 11MM 60MM UNIVERS APX PRFT REM TRUNION SUT HL,"$10,437.50",$0.00,"$10,437.50","$4,696.88","$5,158.80",$0.00,"$1,798.33",$0.00,$0.00,"$1,827.52","$10,437.50",$0.00,"$5,218.75","$8,266.50","$8,350.00",$0.00,"$1,633.47",$0.00,"$1,661.65",$0.00
AR-9100-12,SUP,HCPCS C1776,,AR-9100-12  -  STEM HUM 12MM UNIVERS SHLDR,"$5,987.50",$0.00,"$5,987.50","$2,694.38","$4,273.28",$0.00,"$1,031.62",$0.00,$0.00,"$1,048.36","$5,987.50",$0.00,"$2,993.75","$4,742.10","$4,790.00",$0.00,$937.04,$0.00,$953.21,$0.00
AR-9100-12F,SUP,HCPCS C1776,,AR-9100-12F  -  STEM HUM 12MM 195MM STRL UNIVERS ADJ HT SHLDR,"$6,812.50",$0.00,"$6,812.50","$3,065.63","$4,862.08",$0.00,"$1,173.76",$0.00,$0.00,"$1,192.81","$6,812.50",$0.00,"$3,406.25","$5,395.50","$5,450.00",$0.00,"$1,066.16",$0.00,"$1,084.55",$0.00
AR-9100-12P,SUP,HCPCS C1776,,AR-9100-12P  -  STEM HUM 12MM 151MM STRL UNIVERS II SHLDR,"$9,187.50",$0.00,"$9,187.50","$4,134.38","$5,158.80",$0.00,"$1,582.96",$0.00,$0.00,"$1,608.66","$9,187.50",$0.00,"$4,593.75","$7,276.50","$7,350.00",$0.00,"$1,437.84",$0.00,"$1,462.65",$0.00
AR-9100-12S,SUP,HCPCS C1776,,AR-9100-12S  -  STEM HUM RECT 12MM 60MM UNIVERS APX PRFT REM TRUNION SUT HL,"$10,437.50",$0.00,"$10,437.50","$4,696.88","$5,158.80",$0.00,"$1,798.33",$0.00,$0.00,"$1,827.52","$10,437.50",$0.00,"$5,218.75","$8,266.50","$8,350.00",$0.00,"$1,633.47",$0.00,"$1,661.65",$0.00
AR-9100-13F,SUP,HCPCS C1776,,AR-9100-13F  -  STEM HUM 13MM 204MM STRL UNIVERS ADJ HT SHLDR FX,"$6,812.50",$0.00,"$6,812.50","$3,065.63","$4,862.08",$0.00,"$1,173.76",$0.00,$0.00,"$1,192.81","$6,812.50",$0.00,"$3,406.25","$5,395.50","$5,450.00",$0.00,"$1,066.16",$0.00,"$1,084.55",$0.00
AR-9100-13P,SUP,HCPCS C1776,,AR-9100-13P  -  STEM HUM 13MM UNIVERS SHLDR,"$9,187.50",$0.00,"$9,187.50","$4,134.38","$5,158.80",$0.00,"$1,582.96",$0.00,$0.00,"$1,608.66","$9,187.50",$0.00,"$4,593.75","$7,276.50","$7,350.00",$0.00,"$1,437.84",$0.00,"$1,462.65",$0.00
AR-9100-13S,SUP,HCPCS C1776,,AR-9100-13S  -  STEM HUM RECT 13MM 65MM UNIVERS APX PRFT REM TRUNION SUT HL,"$10,437.50",$0.00,"$10,437.50","$4,696.88","$5,158.80",$0.00,"$1,798.33",$0.00,$0.00,"$1,827.52","$10,437.50",$0.00,"$5,218.75","$8,266.50","$8,350.00",$0.00,"$1,633.47",$0.00,"$1,661.65",$0.00
AR-9100-14P,SUP,HCPCS C1776,,AR-9100-14P  -  STEM HUM 14MM 151MM STRL UNIVERS II SHLDR,"$9,187.50",$0.00,"$9,187.50","$4,134.38","$5,158.80",$0.00,"$1,582.96",$0.00,$0.00,"$1,608.66","$9,187.50",$0.00,"$4,593.75","$7,276.50","$7,350.00",$0.00,"$1,437.84",$0.00,"$1,462.65",$0.00
AR-9100-14S,SUP,HCPCS C1776,,AR-9100-14S  -  STEM HUM RECT 14MM 65MM UNIVERS APX PRFT REM TRUNION SUT HL,"$10,437.50",$0.00,"$10,437.50","$4,696.88","$5,158.80",$0.00,"$1,798.33",$0.00,$0.00,"$1,827.52","$10,437.50",$0.00,"$5,218.75","$8,266.50","$8,350.00",$0.00,"$1,633.47",$0.00,"$1,661.65",$0.00
AR-9100-15P,SUP,HCPCS C1776,,AR-9100-15P  -  STEM HUM 15MM 151MM STRL UNIVERS II SHLDR,"$9,187.50",$0.00,"$9,187.50","$4,134.38","$5,158.80",$0.00,"$1,582.96",$0.00,$0.00,"$1,608.66","$9,187.50",$0.00,"$4,593.75","$7,276.50","$7,350.00",$0.00,"$1,437.84",$0.00,"$1,462.65",$0.00
AR-9100-15S,SUP,HCPCS C1776,,AR-9100-15S  -  STEM HUM RECT 15MM 65MM UNIVERS APX PRFT REM TRUNION SUT HL,"$10,437.50",$0.00,"$10,437.50","$4,696.88","$5,158.80",$0.00,"$1,798.33",$0.00,$0.00,"$1,827.52","$10,437.50",$0.00,"$5,218.75","$8,266.50","$8,350.00",$0.00,"$1,633.47",$0.00,"$1,661.65",$0.00
AR-9100-21,SUP,Custom 27203010,,AR-9100-21  -  KIT ASCP FX UNV TRUNNION,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-9100-22,SUP,HCPCS C1776,,AR-9100-22  -  COMPONENT GLND 3 USP UNIVERS REPL TRUNION KT,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-9100-24,SUP,HCPCS C1776,,AR-9100-24  -  COMPONENT GLND 5 USP UNIVERS REPL TRUNION KT,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
AR-9104-01,SUP,HCPCS C1776,,AR-9104-01  -  COMPONENT GLND SM STRL UNIVERS II CMNT KEEL PE SHLDR,"$3,937.50",$0.00,"$3,937.50","$1,771.88","$2,810.19",$0.00,$678.41,$0.00,$0.00,$689.42,"$3,937.50",$0.00,"$1,968.75","$3,118.50","$3,150.00",$0.00,$616.22,$0.00,$626.85,$0.00
AR-9104-02,SUP,HCPCS C1776,,AR-9104-02  -  COMPONENT GLND MED STRL UNIVERS II CMNT KEEL PE SHLDR,"$3,937.50",$0.00,"$3,937.50","$1,771.88","$2,810.19",$0.00,$678.41,$0.00,$0.00,$689.42,"$3,937.50",$0.00,"$1,968.75","$3,118.50","$3,150.00",$0.00,$616.22,$0.00,$626.85,$0.00
AR-9104-03,SUP,HCPCS C1776,,AR-9104-03  -  COMPONENT GLND LG STRL UNIVERS II CMNT KEEL PE SHLDR,"$3,937.50",$0.00,"$3,937.50","$1,771.88","$2,810.19",$0.00,$678.41,$0.00,$0.00,$689.42,"$3,937.50",$0.00,"$1,968.75","$3,118.50","$3,150.00",$0.00,$616.22,$0.00,$626.85,$0.00
AR-9104-04,SUP,HCPCS C1776,,AR-9104-04  -  COMPONENT GLND XL STRL UNIVERS II CMNT KEEL PE SHLDR,"$3,937.50",$0.00,"$3,937.50","$1,771.88","$2,810.19",$0.00,$678.41,$0.00,$0.00,$689.42,"$3,937.50",$0.00,"$1,968.75","$3,118.50","$3,150.00",$0.00,$616.22,$0.00,$626.85,$0.00
AR-9105-01,SUP,HCPCS C1776,,AR-9105-01  -  COMPONENT GLND SM STRL UNIVERS II CMNT PG PE SHLDR,"$3,937.50",$0.00,"$3,937.50","$1,771.88","$2,810.19",$0.00,$678.41,$0.00,$0.00,$689.42,"$3,937.50",$0.00,"$1,968.75","$3,118.50","$3,150.00",$0.00,$616.22,$0.00,$626.85,$0.00
AR-9105-02,SUP,HCPCS C1776,,AR-9105-02  -  COMPONENT GLND MED STRL UNIVERS II CMNT PG PE SHLDR,"$3,937.50",$0.00,"$3,937.50","$1,771.88","$2,810.19",$0.00,$678.41,$0.00,$0.00,$689.42,"$3,937.50",$0.00,"$1,968.75","$3,118.50","$3,150.00",$0.00,$616.22,$0.00,$626.85,$0.00
AR-9105-03,SUP,HCPCS C1776,,AR-9105-03  -  COMPONENT GLND LG STRL UNIVERS II CMNT PG PE SHLDR,"$3,937.50",$0.00,"$3,937.50","$1,771.88","$2,810.19",$0.00,$678.41,$0.00,$0.00,$689.42,"$3,937.50",$0.00,"$1,968.75","$3,118.50","$3,150.00",$0.00,$616.22,$0.00,$626.85,$0.00
AR-9105-04,SUP,HCPCS C1776,,AR-9105-04  -  COMPONENT GLND XL STRL UNIVERS II CMNT PG PE SHLDR,"$3,937.50",$0.00,"$3,937.50","$1,771.88","$2,810.19",$0.00,$678.41,$0.00,$0.00,$689.42,"$3,937.50",$0.00,"$1,968.75","$3,118.50","$3,150.00",$0.00,$616.22,$0.00,$626.85,$0.00
AR-9106-01,SUP,HCPCS C1713,,AR-9106-01  -  COMPONENT GLND SM STRL LF UNIVERS VAULTLOCK DISP,"$3,937.50",$0.00,"$3,937.50","$1,771.88","$2,810.19",$0.00,$678.41,$0.00,$0.00,$689.42,"$3,937.50",$0.00,"$1,968.75","$3,118.50","$3,150.00",$0.00,$616.22,$0.00,$626.85,$0.00
AR-9106-02,SUP,HCPCS C1776,,AR-9106-02  -  COMPONENT GLND MED STRL ARTHX UNIVERS VAULTLOCK,"$3,937.50",$0.00,"$3,937.50","$1,771.88","$2,810.19",$0.00,$678.41,$0.00,$0.00,$689.42,"$3,937.50",$0.00,"$1,968.75","$3,118.50","$3,150.00",$0.00,$616.22,$0.00,$626.85,$0.00
AR-9106-04,SUP,HCPCS C1776,,AR-9106-04  -  COMPONENT GLND XL STRL ARTHX UNIVERS VAULTLOCK,"$3,937.50",$0.00,"$3,937.50","$1,771.88","$2,810.19",$0.00,$678.41,$0.00,$0.00,$689.42,"$3,937.50",$0.00,"$1,968.75","$3,118.50","$3,150.00",$0.00,$616.22,$0.00,$626.85,$0.00
AR-9120-01,SUP,HCPCS C1713,,AR-9120-01  -  BASEPLATE GLND SM UNV SHLDR,"$4,287.50",$0.00,"$4,287.50","$1,929.38","$3,059.99",$0.00,$738.71,$0.00,$0.00,$750.71,"$4,287.50",$0.00,"$2,143.75","$3,395.70","$3,430.00",$0.00,$670.99,$0.00,$682.57,$0.00
AR-9125-1,SUP,Custom 27203010,,AR-9125-1  -  GUIDE DRL -10D 5D SM GLND,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-9125-10,SUP,Custom 27203010,,AR-9125-10  -  GUIDE DRL -20D 15D 0D SM GLND,"$1,787.50",$0.00,"$1,787.50",$0.00,"$1,275.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,787.50",$0.00,$893.75,"$1,415.70","$1,430.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-9125-2,SUP,Custom 27203010,,AR-9125-2  -  GUIDE DRL -10D 5D MED GLND,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-9125-20,SUP,Custom 27203010,,AR-9125-20  -  GUIDE DRL -20D 15D 0D MED GLND,"$1,787.50",$0.00,"$1,787.50",$0.00,"$1,275.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,787.50",$0.00,$893.75,"$1,415.70","$1,430.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-9125-3,SUP,Custom 27203010,,AR-9125-3  -  GUIDE DRL -10D 5D LG GLND,"$1,750.00",$0.00,"$1,750.00",$0.00,"$1,248.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-9125-30,SUP,Custom 27203010,,AR-9125-30  -  GUIDE DRL -20D 15D 0D LG GLND,"$1,787.50",$0.00,"$1,787.50",$0.00,"$1,275.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,787.50",$0.00,$893.75,"$1,415.70","$1,430.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-9140-14,SUP,HCPCS C1776,,AR-9140-14  -  HEAD HUM 40MM 14MM UNIVERS 3D MTL SHLDR,"$4,375.00",$0.00,"$4,375.00","$1,968.75","$3,122.44",$0.00,$753.79,$0.00,$0.00,$766.03,"$4,375.00",$0.00,"$2,187.50","$3,465.00","$3,500.00",$0.00,$684.69,$0.00,$696.50,$0.00
AR-9140-17P,SUP,HCPCS C1776,,AR-9140-17P  -  HEAD HUM 40MM 17MM STRL UNIVERS II ANTM RSTR VAR ADJ SHLDR,"$4,375.00",$0.00,"$4,375.00","$1,968.75","$3,122.44",$0.00,$753.79,$0.00,$0.00,$766.03,"$4,375.00",$0.00,"$2,187.50","$3,465.00","$3,500.00",$0.00,$684.69,$0.00,$696.50,$0.00
AR-9142-17CA,SUP,HCPCS C1776,,"AR-9142-17CA  -  UNIVERS CA HUMERAL HEAD,  42/17","$5,875.00",$0.00,"$5,875.00","$2,643.75","$4,192.99",$0.00,"$1,012.23",$0.00,$0.00,"$1,028.67","$5,875.00",$0.00,"$2,937.50","$4,653.00","$4,700.00",$0.00,$919.44,$0.00,$935.30,$0.00
AR-9142-17P,SUP,HCPCS C1776,,AR-9142-17P  -  HEAD HUM 42MM 17MM STRL UNIVERS II ANTM RSTR VAR ADJ SHLDR,"$4,375.00",$0.00,"$4,375.00","$1,968.75","$3,122.44",$0.00,$753.79,$0.00,$0.00,$766.03,"$4,375.00",$0.00,"$2,187.50","$3,465.00","$3,500.00",$0.00,$684.69,$0.00,$696.50,$0.00
AR-9143-15,SUP,HCPCS C1776,,AR-9143-15  -  HEAD HUM 43MM 15MM SHLDR,"$4,375.00",$0.00,"$4,375.00","$1,968.75","$3,122.44",$0.00,$753.79,$0.00,$0.00,$766.03,"$4,375.00",$0.00,"$2,187.50","$3,465.00","$3,500.00",$0.00,$684.69,$0.00,$696.50,$0.00
AR-9143-15F,SUP,HCPCS C1776,,AR-9143-15F  -  HEAD HUM 43MM 15MM SHLDR,"$3,125.00",$0.00,"$3,125.00","$1,406.25","$2,230.31",$0.00,$538.42,$0.00,$0.00,$547.16,"$3,125.00",$0.00,"$1,562.50","$2,475.00","$2,500.00",$0.00,$489.06,$0.00,$497.50,$0.00
AR-9144-17CA,SUP,HCPCS C1776,,"AR-9144-17CA  -  UNIVERS CA HUMERAL HEAD, 44/17","$5,875.00",$0.00,"$5,875.00","$2,643.75","$4,192.99",$0.00,"$1,012.23",$0.00,$0.00,"$1,028.67","$5,875.00",$0.00,"$2,937.50","$4,653.00","$4,700.00",$0.00,$919.44,$0.00,$935.30,$0.00
AR-9144-17P,SUP,HCPCS C1776,,AR-9144-17P  -  HEAD HUM 44MM 17MM STRL UNIVERS II ANTM RSTR VAR ADJ SHLDR,"$4,375.00",$0.00,"$4,375.00","$1,968.75","$3,122.44",$0.00,$753.79,$0.00,$0.00,$766.03,"$4,375.00",$0.00,"$2,187.50","$3,465.00","$3,500.00",$0.00,$684.69,$0.00,$696.50,$0.00
AR-9144-19CA,SUP,HCPCS C1776,,"AR-9144-19CA  -  UNIVERS CA HUMERAL HEAD, 44/19","$5,875.00",$0.00,"$5,875.00","$2,643.75","$4,192.99",$0.00,"$1,012.23",$0.00,$0.00,"$1,028.67","$5,875.00",$0.00,"$2,937.50","$4,653.00","$4,700.00",$0.00,$919.44,$0.00,$935.30,$0.00
AR-9144-19P,SUP,HCPCS C1776,,AR-9144-19P  -  HEAD HUM 44MM 19MM STRL UNIVERS II ANTM RSTR VAR ADJ SHLDR,"$4,375.00",$0.00,"$4,375.00","$1,968.75","$3,122.44",$0.00,$753.79,$0.00,$0.00,$766.03,"$4,375.00",$0.00,"$2,187.50","$3,465.00","$3,500.00",$0.00,$684.69,$0.00,$696.50,$0.00
AR-9145-15,SUP,HCPCS C1776,,AR-9145-15  -  HEAD HUM 45MM 15MM MTL SHLDR,"$4,375.00",$0.00,"$4,375.00","$1,968.75","$3,122.44",$0.00,$753.79,$0.00,$0.00,$766.03,"$4,375.00",$0.00,"$2,187.50","$3,465.00","$3,500.00",$0.00,$684.69,$0.00,$696.50,$0.00
AR-9145-24,SUP,HCPCS C1713,,AR-9145-24  -  SCREW BN 18D 4.5MM 24MM UNIVERS REVERS LCK VA SHLDR GLND,$300.00,$0.00,$300.00,$135.00,$214.11,$0.00,$51.69,$0.00,$0.00,$52.53,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$46.95,$0.00,$47.76,$0.00
AR-9145-24NL,SUP,HCPCS C1713,,AR-9145-24NL  -  SCREW BN 4.5MM 24MM UNIVERS REVERS NONLOCK PERI,$300.00,$0.00,$300.00,$135.00,$214.11,$0.00,$51.69,$0.00,$0.00,$52.53,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$46.95,$0.00,$47.76,$0.00
AR-9145-30,SUP,HCPCS C1713,,AR-9145-30  -  SCREW BONE 4.5MM 30MM UNIVERS REVERS 18D SHLDR,$300.00,$0.00,$300.00,$135.00,$214.11,$0.00,$51.69,$0.00,$0.00,$52.53,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$46.95,$0.00,$47.76,$0.00
AR-9145-30NL,SUP,HCPCS C1713,,"AR-9145-30NL  -  PERIPHERAL SCREW,  NL, UNI REV, 4.5X30MM",$300.00,$0.00,$300.00,$135.00,$214.11,$0.00,$51.69,$0.00,$0.00,$52.53,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$46.95,$0.00,$47.76,$0.00
AR-9145-36,SUP,HCPCS C1713,,AR-9145-36  -  SCREW BONE 4.5MM 36MM UNIVERS REVERS 18D SHLDR,$300.00,$0.00,$300.00,$135.00,$214.11,$0.00,$51.69,$0.00,$0.00,$52.53,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$46.95,$0.00,$47.76,$0.00
AR-9145-36NL,SUP,HCPCS C1713,,AR-9145-36NL  -  SCREW BN 4.5MM 36MM UNIVERS REVERS NONLOCK PERI,$300.00,$0.00,$300.00,$135.00,$214.11,$0.00,$51.69,$0.00,$0.00,$52.53,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$46.95,$0.00,$47.76,$0.00
AR-9145-42,SUP,HCPCS C1713,,AR-9145-42  -  SCREW BN 18D 4.5MM 42MM UNIVERS REVERS LCK VA SHLDR GLND,$300.00,$0.00,$300.00,$135.00,$214.11,$0.00,$51.69,$0.00,$0.00,$52.53,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$46.95,$0.00,$47.76,$0.00
AR-9145-42NL,SUP,HCPCS C1713,,AR-9145-42NL  -  SCREW BN 4.5MM 42MM UNIVERS REVERS NONLOCK PERI,$300.00,$0.00,$300.00,$135.00,$214.11,$0.00,$51.69,$0.00,$0.00,$52.53,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$46.95,$0.00,$47.76,$0.00
AR-9145-48,SUP,HCPCS C1713,,AR-9145-48  -  SCREW BN 18D 4.5MM 48MM UNIVERS REVERS LCK VA SHLDR GLND,$300.00,$0.00,$300.00,$135.00,$214.11,$0.00,$51.69,$0.00,$0.00,$52.53,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$46.95,$0.00,$47.76,$0.00
AR-9145-48NL,SUP,HCPCS C1713,,AR-9145-48NL  -  SCREW BN 4.5MM 48MM UNIVERS REVERS NONLOCK PERI,$300.00,$0.00,$300.00,$135.00,$214.11,$0.00,$51.69,$0.00,$0.00,$52.53,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$46.95,$0.00,$47.76,$0.00
AR-9145DG,SUP,Custom 27203010,,AR-9145DG  -  GUIDE DRL 45MM UNIVERS REVERS GLND,"$1,825.00",$0.00,"$1,825.00",$0.00,"$1,302.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,825.00",$0.00,$912.50,"$1,445.40","$1,460.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-9146-17,SUP,HCPCS C1776,,AR-9146-17  -  HEAD HUM 46MM 17MM STRL UNIVERS ADJ HT ANTM REFIXATION,"$4,375.00",$0.00,"$4,375.00","$1,968.75","$3,122.44",$0.00,$753.79,$0.00,$0.00,$766.03,"$4,375.00",$0.00,"$2,187.50","$3,465.00","$3,500.00",$0.00,$684.69,$0.00,$696.50,$0.00
AR-9146-17F,SUP,HCPCS C1776,,AR-9146-17F  -  HEAD HUM 46MM 17MM STRL UNIVERS ADJ HT ANTM REFIXATION,"$3,125.00",$0.00,"$3,125.00","$1,406.25","$2,230.31",$0.00,$538.42,$0.00,$0.00,$547.16,"$3,125.00",$0.00,"$1,562.50","$2,475.00","$2,500.00",$0.00,$489.06,$0.00,$497.50,$0.00
AR-9146-18CA,SUP,HCPCS C1776,,"AR-9146-18CA  -  UNIVERS CA HUMERAL HEAD, 46/18","$5,875.00",$0.00,"$5,875.00","$2,643.75","$4,192.99",$0.00,"$1,012.23",$0.00,$0.00,"$1,028.67","$5,875.00",$0.00,"$2,937.50","$4,653.00","$4,700.00",$0.00,$919.44,$0.00,$935.30,$0.00
AR-9146-18P,SUP,HCPCS C1776,,AR-9146-18P  -  HEAD HUM 46MM 18MM STRL UNIVERS II ANTM RSTR VAR ADJ SHLDR,"$4,375.00",$0.00,"$4,375.00","$1,968.75","$3,122.44",$0.00,$753.79,$0.00,$0.00,$766.03,"$4,375.00",$0.00,"$2,187.50","$3,465.00","$3,500.00",$0.00,$684.69,$0.00,$696.50,$0.00
AR-9146-20CA,SUP,HCPCS C1776,,"AR-9146-20CA  -  UNIVERS CA HUMERAL HEAD, 46/20","$5,875.00",$0.00,"$5,875.00","$2,643.75","$4,192.99",$0.00,"$1,012.23",$0.00,$0.00,"$1,028.67","$5,875.00",$0.00,"$2,937.50","$4,653.00","$4,700.00",$0.00,$919.44,$0.00,$935.30,$0.00
AR-9146-20P,SUP,HCPCS C1776,,AR-9146-20P  -  HEAD HUM 46MM 20MM STRL UNIVERS II ANTM RSTR VAR ADJ SHLDR,"$4,375.00",$0.00,"$4,375.00","$1,968.75","$3,122.44",$0.00,$753.79,$0.00,$0.00,$766.03,"$4,375.00",$0.00,"$2,187.50","$3,465.00","$3,500.00",$0.00,$684.69,$0.00,$696.50,$0.00
AR-9148-17,SUP,HCPCS C1776,,AR-9148-17  -  HEAD HUM 48MM 17MM STRL UNIVERS ADJ HT ECNTRC SET MTL SHLDR,"$4,375.00",$0.00,"$4,375.00","$1,968.75","$3,122.44",$0.00,$753.79,$0.00,$0.00,$766.03,"$4,375.00",$0.00,"$2,187.50","$3,465.00","$3,500.00",$0.00,$684.69,$0.00,$696.50,$0.00
AR-9148-17F,SUP,HCPCS C1776,,AR-9148-17F  -  HEAD HUM 48MM 17MM STRL UNIVERS ADJ HT ECNTRC SET MTL SHLDR,"$3,125.00",$0.00,"$3,125.00","$1,406.25","$2,230.31",$0.00,$538.42,$0.00,$0.00,$547.16,"$3,125.00",$0.00,"$1,562.50","$2,475.00","$2,500.00",$0.00,$489.06,$0.00,$497.50,$0.00
AR-9148-18,SUP,HCPCS C1776,,AR-9148-18  -  HEAD HUM 3D,"$2,987.50",$0.00,"$2,987.50","$1,344.38","$2,132.18",$0.00,$514.73,$0.00,$0.00,$523.09,"$2,987.50",$0.00,"$1,493.75","$2,366.10","$2,390.00",$0.00,$467.54,$0.00,$475.61,$0.00
AR-9148-19CA,SUP,HCPCS C1776,,"AR-9148-19CA  -  UNIVERS CA HUMERAL HEAD, 48/19","$5,875.00",$0.00,"$5,875.00","$2,643.75","$4,192.99",$0.00,"$1,012.23",$0.00,$0.00,"$1,028.67","$5,875.00",$0.00,"$2,937.50","$4,653.00","$4,700.00",$0.00,$919.44,$0.00,$935.30,$0.00
AR-9148-19P,SUP,HCPCS C1776,,AR-9148-19P  -  HEAD HUM 48MM 19MM STRL UNIVERS II ANTM RSTR VAR ADJ SHLDR,"$4,375.00",$0.00,"$4,375.00","$1,968.75","$3,122.44",$0.00,$753.79,$0.00,$0.00,$766.03,"$4,375.00",$0.00,"$2,187.50","$3,465.00","$3,500.00",$0.00,$684.69,$0.00,$696.50,$0.00
AR-9148-21CA,SUP,HCPCS C1776,,"AR-9148-21CA  -  UNIVERS CA HUMERAL HEAD, 48/21","$5,875.00",$0.00,"$5,875.00","$2,643.75","$4,192.99",$0.00,"$1,012.23",$0.00,$0.00,"$1,028.67","$5,875.00",$0.00,"$2,937.50","$4,653.00","$4,700.00",$0.00,$919.44,$0.00,$935.30,$0.00
AR-9148-21P,SUP,HCPCS C1776,,AR-9148-21P  -  HEAD HUM 48MM 21MM STRL UNIVERS II ANTM RSTR VAR ADJ SHLDR,"$4,375.00",$0.00,"$4,375.00","$1,968.75","$3,122.44",$0.00,$753.79,$0.00,$0.00,$766.03,"$4,375.00",$0.00,"$2,187.50","$3,465.00","$3,500.00",$0.00,$684.69,$0.00,$696.50,$0.00
AR-9150-19,SUP,HCPCS C1776,,AR-9150-19  -  HEAD HUM 50MM 19MM STRL UNIVERS ADJ HT ECNTRC SET MTL SHLDR,"$4,375.00",$0.00,"$4,375.00","$1,968.75","$3,122.44",$0.00,$753.79,$0.00,$0.00,$766.03,"$4,375.00",$0.00,"$2,187.50","$3,465.00","$3,500.00",$0.00,$684.69,$0.00,$696.50,$0.00
AR-9150-19CA,SUP,HCPCS C1776,,"AR-9150-19CA  -  UNIVERS CA HUMERAL HEAD, 50/19","$5,875.00",$0.00,"$5,875.00","$2,643.75","$4,192.99",$0.00,"$1,012.23",$0.00,$0.00,"$1,028.67","$5,875.00",$0.00,"$2,937.50","$4,653.00","$4,700.00",$0.00,$919.44,$0.00,$935.30,$0.00
AR-9150-19F,SUP,HCPCS C1776,,AR-9150-19F  -  HEAD HUM 50MM 19MM STRL UNIVERS ADJ HT ANTM REFIXATION,"$3,125.00",$0.00,"$3,125.00","$1,406.25","$2,230.31",$0.00,$538.42,$0.00,$0.00,$547.16,"$3,125.00",$0.00,"$1,562.50","$2,475.00","$2,500.00",$0.00,$489.06,$0.00,$497.50,$0.00
AR-9150-19P,SUP,HCPCS C1776,,AR-9150-19P  -  HEAD HUM 50MM 19MM STRL UNIVERS II ANTM RSTR VAR ADJ SHLDR,"$4,375.00",$0.00,"$4,375.00","$1,968.75","$3,122.44",$0.00,$753.79,$0.00,$0.00,$766.03,"$4,375.00",$0.00,"$2,187.50","$3,465.00","$3,500.00",$0.00,$684.69,$0.00,$696.50,$0.00
AR-9150-21CA,SUP,HCPCS C1776,,"AR-9150-21CA  -  UNIVERS CA HUMERAL HEAD, 50/21","$5,875.00",$0.00,"$5,875.00","$2,643.75","$4,192.99",$0.00,"$1,012.23",$0.00,$0.00,"$1,028.67","$5,875.00",$0.00,"$2,937.50","$4,653.00","$4,700.00",$0.00,$919.44,$0.00,$935.30,$0.00
AR-9150-21P,SUP,HCPCS C1776,,AR-9150-21P  -  HEAD HUM 50MM 21MM STRL UNIVERS II ANTM RSTR VAR ADJ SHLDR,"$4,375.00",$0.00,"$4,375.00","$1,968.75","$3,122.44",$0.00,$753.79,$0.00,$0.00,$766.03,"$4,375.00",$0.00,"$2,187.50","$3,465.00","$3,500.00",$0.00,$684.69,$0.00,$696.50,$0.00
AR-9151-22,SUP,HCPCS C1776,,AR-9151-22  -  HEAD HUM 51MM 22MM STRL UNIVERS ADJ HT ECNTRC SET MTL SHLDR,"$4,375.00",$0.00,"$4,375.00","$1,968.75","$3,122.44",$0.00,$753.79,$0.00,$0.00,$766.03,"$4,375.00",$0.00,"$2,187.50","$3,465.00","$3,500.00",$0.00,$684.69,$0.00,$696.50,$0.00
AR-9151-22F,SUP,HCPCS C1776,,AR-9151-22F  -  HEAD HUM 51MM 22MM STRL UNIVERS ADJ HT ANTM REFIXATION,"$3,125.00",$0.00,"$3,125.00","$1,406.25","$2,230.31",$0.00,$538.42,$0.00,$0.00,$547.16,"$3,125.00",$0.00,"$1,562.50","$2,475.00","$2,500.00",$0.00,$489.06,$0.00,$497.50,$0.00
AR-9152-20CA,SUP,HCPCS C1776,,"AR-9152-20CA  -  UNIVERS CA HUMERAL HEAD, 52/20","$5,875.00",$0.00,"$5,875.00","$2,643.75","$4,192.99",$0.00,"$1,012.23",$0.00,$0.00,"$1,028.67","$5,875.00",$0.00,"$2,937.50","$4,653.00","$4,700.00",$0.00,$919.44,$0.00,$935.30,$0.00
AR-9152-20P,SUP,HCPCS C1776,,AR-9152-20P  -  HEAD HUM 52MM 20MM STRL UNIVERS II ANTM RSTR VAR ADJ SHLDR,"$4,375.00",$0.00,"$4,375.00","$1,968.75","$3,122.44",$0.00,$753.79,$0.00,$0.00,$766.03,"$4,375.00",$0.00,"$2,187.50","$3,465.00","$3,500.00",$0.00,$684.69,$0.00,$696.50,$0.00
AR-9152-22CA,SUP,HCPCS C1776,,"AR-9152-22CA  -  UNIVERS CA HUMERAL HEAD, 52/22","$5,875.00",$0.00,"$5,875.00","$2,643.75","$4,192.99",$0.00,"$1,012.23",$0.00,$0.00,"$1,028.67","$5,875.00",$0.00,"$2,937.50","$4,653.00","$4,700.00",$0.00,$919.44,$0.00,$935.30,$0.00
AR-9152-22P,SUP,HCPCS C1776,,AR-9152-22P  -  HEAD HUM 52MM 22MM STRL UNIVERS II ANTM RSTR VAR ADJ SHLDR,"$4,375.00",$0.00,"$4,375.00","$1,968.75","$3,122.44",$0.00,$753.79,$0.00,$0.00,$766.03,"$4,375.00",$0.00,"$2,187.50","$3,465.00","$3,500.00",$0.00,$684.69,$0.00,$696.50,$0.00
AR-9153-19,SUP,HCPCS C1776,,AR-9153-19  -  HEAD HUM 53MM 19MM UNIVERS 3D SHLDR,"$4,375.00",$0.00,"$4,375.00","$1,968.75","$3,122.44",$0.00,$753.79,$0.00,$0.00,$766.03,"$4,375.00",$0.00,"$2,187.50","$3,465.00","$3,500.00",$0.00,$684.69,$0.00,$696.50,$0.00
AR-9153-19F,SUP,HCPCS C1776,,AR-9153-19F  -  HEAD HUM 53MM 19MM STRL UNIVERS ADJ HT ANTM REFIXATION,"$3,125.00",$0.00,"$3,125.00","$1,406.25","$2,230.31",$0.00,$538.42,$0.00,$0.00,$547.16,"$3,125.00",$0.00,"$1,562.50","$2,475.00","$2,500.00",$0.00,$489.06,$0.00,$497.50,$0.00
AR-9153-23,SUP,HCPCS C1776,,AR-9153-23  -  HEAD HUM 53MM 23MM UNIVERS 3D SHLDR,"$4,375.00",$0.00,"$4,375.00","$1,968.75","$3,122.44",$0.00,$753.79,$0.00,$0.00,$766.03,"$4,375.00",$0.00,"$2,187.50","$3,465.00","$3,500.00",$0.00,$684.69,$0.00,$696.50,$0.00
AR-9154-21CA,SUP,HCPCS C1776,,"AR-9154-21CA  -  UNIVERS CA HUMERAL HEAD, 54/21","$5,875.00",$0.00,"$5,875.00","$2,643.75","$4,192.99",$0.00,"$1,012.23",$0.00,$0.00,"$1,028.67","$5,875.00",$0.00,"$2,937.50","$4,653.00","$4,700.00",$0.00,$919.44,$0.00,$935.30,$0.00
AR-9154-21P,SUP,HCPCS C1776,,AR-9154-21P  -  HEAD HUM 54MM 21MM STRL UNIVERS II ANTM RSTR VAR ADJ SHLDR,"$4,375.00",$0.00,"$4,375.00","$1,968.75","$3,122.44",$0.00,$753.79,$0.00,$0.00,$766.03,"$4,375.00",$0.00,"$2,187.50","$3,465.00","$3,500.00",$0.00,$684.69,$0.00,$696.50,$0.00
AR-9154-23CA,SUP,HCPCS C1776,,"AR-9154-23CA  -  UNIVERS CA HUMERAL HEAD, 54/23","$5,875.00",$0.00,"$5,875.00","$2,643.75","$4,192.99",$0.00,"$1,012.23",$0.00,$0.00,"$1,028.67","$5,875.00",$0.00,"$2,937.50","$4,653.00","$4,700.00",$0.00,$919.44,$0.00,$935.30,$0.00
AR-9154-23P,SUP,HCPCS C1776,,AR-9154-23P  -  HEAD HUM 54MM 23MM STRL UNIVERS II ANTM RSTR VAR ADJ SHLDR,"$4,375.00",$0.00,"$4,375.00","$1,968.75","$3,122.44",$0.00,$753.79,$0.00,$0.00,$766.03,"$4,375.00",$0.00,"$2,187.50","$3,465.00","$3,500.00",$0.00,$684.69,$0.00,$696.50,$0.00
AR-9156-22CA,SUP,HCPCS C1776,,AR-9156-22CA  -  HEAD HUM 56MM 22MM UNIVERS CA,"$5,875.00",$0.00,"$5,875.00","$2,643.75","$4,192.99",$0.00,"$1,012.23",$0.00,$0.00,"$1,028.67","$5,875.00",$0.00,"$2,937.50","$4,653.00","$4,700.00",$0.00,$919.44,$0.00,$935.30,$0.00
AR-9156-22P,SUP,HCPCS C1776,,AR-9156-22P  -  HEAD HUM 56MM 22MM STRL UNIVERS II ANTM RSTR VAR ADJ SHLDR,"$4,375.00",$0.00,"$4,375.00","$1,968.75","$3,122.44",$0.00,$753.79,$0.00,$0.00,$766.03,"$4,375.00",$0.00,"$2,187.50","$3,465.00","$3,500.00",$0.00,$684.69,$0.00,$696.50,$0.00
AR-9156-24CA,SUP,HCPCS C1776,,AR-9156-24CA  -  HEAD HUM 56MM 24MM UNIVERS CA,"$5,875.00",$0.00,"$5,875.00","$2,643.75","$4,192.99",$0.00,"$1,012.23",$0.00,$0.00,"$1,028.67","$5,875.00",$0.00,"$2,937.50","$4,653.00","$4,700.00",$0.00,$919.44,$0.00,$935.30,$0.00
AR-9156-24P,SUP,HCPCS C1776,,AR-9156-24P  -  HEAD HUM 56MM 24MM STRL UNIVERS II ANTM RSTR VAR ADJ SHLDR,"$4,375.00",$0.00,"$4,375.00","$1,968.75","$3,122.44",$0.00,$753.79,$0.00,$0.00,$766.03,"$4,375.00",$0.00,"$2,187.50","$3,465.00","$3,500.00",$0.00,$684.69,$0.00,$696.50,$0.00
AR-9165-15,SUP,HCPCS C1713,,AR-9165-15  -  SCREW BN 6.5MM 15MM UNIVERS REVERS VA SHLDR GLND CNTR,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
AR-9165-15NL,SUP,HCPCS C1713,,AR-9165-15NL  -  SCREW BN 6.5MM 15MM UNIVERS REVERS VA SHLDR GLND CNTR NONLOC,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
AR-9165-20,SUP,HCPCS C1713,,AR-9165-20  -  SCREW BN 6.5MM 20MM UNIVERS REVERS VA SHLDR GLND CNTR,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
AR-9165-20NL,SUP,HCPCS C1713,,AR-9165-20NL  -  SCREW BONE 6.5MM 20MM UNIVERS REVERS,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
AR-9165-25,SUP,HCPCS C1713,,AR-9165-25  -  SCREW BN 6.5MM 25MM UNIVERS REVERS VA SHLDR GLND CNTR,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
AR-9165-25NL,SUP,HCPCS C1713,,AR-9165-25NL  -  SCREW BN 6.5MM 25MM UNIVERS REVERS CNTR NONLOCK,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
AR-9165-30NL,SUP,HCPCS C1713,,AR-9165-30NL  -  SCREW BN 6.5MM 30MM UNIVERS REVERS CNTR NONLOCK,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
AR-9165-35NL,SUP,HCPCS C1713,,AR-9165-35NL  -  SCREW BN 6.5MM 35MM UNIVERS REVERS CNTR NONLOCK,$425.00,$0.00,$425.00,$191.25,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
AR-9165DDG,SUP,HCPCS C1713,,AR-9165DDG  -  SCREW BN UNIVERS REVERS CNTR UNV BSPLT IMPCTR,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
AR-9202-16,SUP,HCPCS C1776,,AR-9202-16  -  CONNECTOR XTRNFX UNIVERS 3D TRL HD,$575.00,$0.00,$575.00,$258.75,$410.38,$0.00,$99.07,$0.00,$0.00,$100.68,$575.00,$0.00,$287.50,$455.40,$460.00,$0.00,$89.99,$0.00,$91.54,$0.00
AR-9204-02,SUP,HCPCS C1776,,AR-9204-02  -  STEM HUM UNIVERS XTRT SHLDR SHLDR FX,"$2,100.00",$0.00,"$2,100.00",$945.00,"$1,498.77",$0.00,$361.82,$0.00,$0.00,$367.69,"$2,100.00",$0.00,"$1,050.00","$1,663.20","$1,680.00",$0.00,$328.65,$0.00,$334.32,$0.00
AR-9207S,SUP,HCPCS C1776,,AR-9207S  -  SET SPNL UNIVERS II STRL,$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
AR-9215-1-01,SUP,Custom 27203010,,AR-9215-1-01  -  GUIDE DRL 6.5IN HNDL,$625.00,$0.00,$625.00,$0.00,$446.06,$0.00,$0.00,$0.00,$0.00,$0.00,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-9215-1-02,SUP,Custom 27203010,,AR-9215-1-02  -  GUIDE DRL LNG UNIVERS II HNDL GLND,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-9215-2,SUP,Custom 27203010,,AR-9215-2  -  GUIDE DRL 1 SM GLND,$875.00,$0.00,$875.00,$0.00,$624.49,$0.00,$0.00,$0.00,$0.00,$0.00,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-9215-3,SUP,Custom 27203010,,AR-9215-3  -  GUIDE DRL 2 SM KEEL GLND,$875.00,$0.00,$875.00,$0.00,$624.49,$0.00,$0.00,$0.00,$0.00,$0.00,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-9215-4,SUP,Custom 27203010,,AR-9215-4  -  GUIDE DRL 1 MED KEEL GLND,$875.00,$0.00,$875.00,$0.00,$624.49,$0.00,$0.00,$0.00,$0.00,$0.00,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-9215-5,SUP,Custom 27203010,,AR-9215-5  -  GUIDE DRL 2 MED KEEL GLND,$875.00,$0.00,$875.00,$0.00,$624.49,$0.00,$0.00,$0.00,$0.00,$0.00,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-9215-6,SUP,Custom 27203010,,AR-9215-6  -  GUIDE DRL 1 LG KEEL GLND,$875.00,$0.00,$875.00,$0.00,$624.49,$0.00,$0.00,$0.00,$0.00,$0.00,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-9215-7,SUP,Custom 27203010,,AR-9215-7  -  GUIDE DRL 2 LG KEEL GLND,$875.00,$0.00,$875.00,$0.00,$624.49,$0.00,$0.00,$0.00,$0.00,$0.00,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-9215-8,SUP,Custom 27203010,,AR-9215-8  -  GUIDE DRL 1 XL GLND,$875.00,$0.00,$875.00,$0.00,$624.49,$0.00,$0.00,$0.00,$0.00,$0.00,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-9215-9,SUP,Custom 27203010,,AR-9215-9  -  GUIDE DRL 2 XL KEEL GLND,$875.00,$0.00,$875.00,$0.00,$624.49,$0.00,$0.00,$0.00,$0.00,$0.00,$875.00,$0.00,$437.50,$693.00,$700.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-9216-1,SUP,Custom 27203010,,AR-9216-1  -  GUIDE DRL 6MM UNIVERS II GLND,$812.50,$0.00,$812.50,$0.00,$579.88,$0.00,$0.00,$0.00,$0.00,$0.00,$812.50,$0.00,$406.25,$643.50,$650.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-9216-2,SUP,Custom 27203010,,AR-9216-2  -  GUIDE DRL UNIVERS II GLV PRTC GLND,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-9216-4,SUP,Custom 27203010,,AR-9216-4  -  GUIDE DRL UNIVERS II GLV PRTC GLND,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-9231-01,SUP,Custom 27203010,,AR-9231-01  -  GUIDE DRL 2 SM UNIVERS II PG GLND,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-9231-01PP,SUP,Custom 27203010,,AR-9231-01PP  -  GUIDE DRL SM UNIVERS VAULTLOCK GLND,"$1,625.00",$0.00,"$1,625.00",$0.00,"$1,159.76",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,625.00",$0.00,$812.50,"$1,287.00","$1,300.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-9231-02,SUP,Custom 27203010,,AR-9231-02  -  GUIDE DRL 2 MED UNIVERS II PG GLND,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-9231-02PP,SUP,Custom 27203010,,AR-9231-02PP  -  GUIDE DRL MED UNIVERS VAULTLOCK GLND,"$1,625.00",$0.00,"$1,625.00",$0.00,"$1,159.76",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,625.00",$0.00,$812.50,"$1,287.00","$1,300.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-9231-03,SUP,Custom 27203010,,AR-9231-03  -  GUIDE DRL 2 LG UNIVERS II PG GLND,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-9231-03PP,SUP,Custom 27203010,,AR-9231-03PP  -  GUIDE DRL LG UNIVERS VAULTLOCK GLND,"$1,625.00",$0.00,"$1,625.00",$0.00,"$1,159.76",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,625.00",$0.00,$812.50,"$1,287.00","$1,300.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-9231-04,SUP,Custom 27203010,,AR-9231-04  -  GUIDE DRL 2 XL UNIVERS II PG GLND,"$1,250.00",$0.00,"$1,250.00",$0.00,$892.13,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-9231-04PP,SUP,Custom 27203010,,AR-9231-04PP  -  GUIDE DRL XL UNIVERS VAULTLOCK GLND,"$1,625.00",$0.00,"$1,625.00",$0.00,"$1,159.76",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,625.00",$0.00,$812.50,"$1,287.00","$1,300.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-9500-170,SUP,HCPCS C1776,,AR-9500-170  -  JOINT TOE 17MM STRL ANATOEMIC PILT PNCH COCR PHALANX,"$1,737.50",$0.00,"$1,737.50",$781.88,"$1,240.05",$0.00,$299.36,$0.00,$0.00,$304.22,"$1,737.50",$0.00,$868.75,"$1,376.10","$1,390.00",$0.00,$271.92,$0.00,$276.61,$0.00
AR-9500-185,SUP,HCPCS C1776,,AR-9500-185  -  JOINT TOE 18.5MM STRL ANATOEMIC PILT PNCH COCR PHALANX,"$1,737.50",$0.00,"$1,737.50",$781.88,"$1,240.05",$0.00,$299.36,$0.00,$0.00,$304.22,"$1,737.50",$0.00,$868.75,"$1,376.10","$1,390.00",$0.00,$271.92,$0.00,$276.61,$0.00
AR-9500-200,SUP,HCPCS C1776,,AR-9500-200  -  JOINT TOE 20MM STRL ANATOEMIC PILT PNCH COCR PHALANX,"$1,737.50",$0.00,"$1,737.50",$781.88,"$1,240.05",$0.00,$299.36,$0.00,$0.00,$304.22,"$1,737.50",$0.00,$868.75,"$1,376.10","$1,390.00",$0.00,$271.92,$0.00,$276.61,$0.00
AR-9500-215,SUP,HCPCS C1776,,AR-9500-215  -  JOINT TOE 21.5MM STRL ANATOEMIC PILT PNCH COCR PHALANX,"$1,737.50",$0.00,"$1,737.50",$781.88,"$1,240.05",$0.00,$299.36,$0.00,$0.00,$304.22,"$1,737.50",$0.00,$868.75,"$1,376.10","$1,390.00",$0.00,$271.92,$0.00,$276.61,$0.00
AR-9500-230,SUP,HCPCS C1776,,AR-9500-230  -  JOINT TOE 23MM STRL ANATOEMIC PILT PNCH COCR PHALANX,"$1,737.50",$0.00,"$1,737.50",$781.88,"$1,240.05",$0.00,$299.36,$0.00,$0.00,$304.22,"$1,737.50",$0.00,$868.75,"$1,376.10","$1,390.00",$0.00,$271.92,$0.00,$276.61,$0.00
AR-9500T-170,SUP,HCPCS C1776,,AR-9500T-170  -  TRIAL ANKL 17MM ANATOEMIC PHALANX,$150.00,$0.00,$150.00,$67.50,$107.06,$0.00,$25.84,$0.00,$0.00,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
AR-9500T-185,SUP,HCPCS C1776,,AR-9500T-185  -  TRIAL ANKL 18.5MM ANATOEMIC PHALANX,$150.00,$0.00,$150.00,$67.50,$107.06,$0.00,$25.84,$0.00,$0.00,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
AR-9500T-200,SUP,HCPCS C1776,,AR-9500T-200  -  TRIAL ANKL 20MM ANATOEMIC PHALANX,$150.00,$0.00,$150.00,$67.50,$107.06,$0.00,$25.84,$0.00,$0.00,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
AR-9500T-215,SUP,HCPCS C1776,,AR-9500T-215  -  TRIAL ANKL 21.5MM ANATOEMIC PHALANX,$150.00,$0.00,$150.00,$67.50,$107.06,$0.00,$25.84,$0.00,$0.00,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
AR-9500T-230,SUP,HCPCS C1776,,AR-9500T-230  -  TRIAL ANKL 23MM ANATOEMIC PHALANX,$150.00,$0.00,$150.00,$67.50,$107.06,$0.00,$25.84,$0.00,$0.00,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
AR-9501-05-135CPC,SUP,HCPCS C1776,,AR-9501-05-135CPC  -  STEM HUM 135D 5 95MM STRL UNIVERS REVERS SET SPL MNBLCK PROX,"$9,187.50",$0.00,"$9,187.50","$4,134.38","$5,158.80",$0.00,"$1,582.96",$0.00,$0.00,"$1,608.66","$9,187.50",$0.00,"$4,593.75","$7,276.50","$7,350.00",$0.00,"$1,437.84",$0.00,"$1,462.65",$0.00
AR-9501-05-155CPC,SUP,HCPCS C1776,,AR-9501-05-155CPC  -  STEM HUM 155D 5 95MM STRL UNIVERS REVERS SET SPL MNBLCK PROX,"$9,187.50",$0.00,"$9,187.50","$4,134.38","$5,158.80",$0.00,"$1,582.96",$0.00,$0.00,"$1,608.66","$9,187.50",$0.00,"$4,593.75","$7,276.50","$7,350.00",$0.00,"$1,437.84",$0.00,"$1,462.65",$0.00
AR-9501-06CPC,SUP,HCPCS C1776,,AR-9501-06CPC  -  STEM HUM 6 111MM STRL UNIVERS REVERS COR SET PROX FIL CA,"$6,212.50",$0.00,"$6,212.50","$2,795.63","$4,433.86",$0.00,"$1,070.38",$0.00,$0.00,"$1,087.76","$6,212.50",$0.00,"$3,106.25","$4,920.30","$4,970.00",$0.00,$972.26,$0.00,$989.03,$0.00
AR-9501-06RCPC,SUP,HCPCS C1776,,AR-9501-06RCPC  -  STEM HUM 6 LNG 150MM STRL UNIVERS REVERS PROX FIL REV CA,"$7,437.50",$0.00,"$7,437.50","$3,346.88","$5,158.80",$0.00,"$1,281.44",$0.00,$0.00,"$1,302.25","$7,437.50",$0.00,"$3,718.75","$5,890.50","$5,950.00",$0.00,"$1,163.97",$0.00,"$1,184.05",$0.00
AR-9501-07CPC,SUP,HCPCS C1776,,AR-9501-07CPC  -  STEM HUM 115MM CORE SET PROX FIL UNIVERS REVERS,"$6,212.50",$0.00,"$6,212.50","$2,795.63","$4,433.86",$0.00,"$1,070.38",$0.00,$0.00,"$1,087.76","$6,212.50",$0.00,"$3,106.25","$4,920.30","$4,970.00",$0.00,$972.26,$0.00,$989.03,$0.00
AR-9501-08CPC,SUP,HCPCS C1776,,AR-9501-08CPC  -  STEM HUM 8 119MM STRL UNIVERS REVERS COR SET PROX FIL CA,"$6,212.50",$0.00,"$6,212.50","$2,795.63","$4,433.86",$0.00,"$1,070.38",$0.00,$0.00,"$1,087.76","$6,212.50",$0.00,"$3,106.25","$4,920.30","$4,970.00",$0.00,$972.26,$0.00,$989.03,$0.00
AR-9501-09CPC,SUP,HCPCS C1776,,AR-9501-09CPC  -  STEM HUM 9 123MM STRL UNIVERS REVERS COR SET PROX FIL CA,"$6,212.50",$0.00,"$6,212.50","$2,795.63","$4,433.86",$0.00,"$1,070.38",$0.00,$0.00,"$1,087.76","$6,212.50",$0.00,"$3,106.25","$4,920.30","$4,970.00",$0.00,$972.26,$0.00,$989.03,$0.00
AR-9501-09RCPC,SUP,HCPCS C1776,,AR-9501-09RCPC  -  STEM HUM 9 LNG 180MM STRL UNIVERS REVERS PROX FIL REV CA,"$7,437.50",$0.00,"$7,437.50","$3,346.88","$5,158.80",$0.00,"$1,281.44",$0.00,$0.00,"$1,302.25","$7,437.50",$0.00,"$3,718.75","$5,890.50","$5,950.00",$0.00,"$1,163.97",$0.00,"$1,184.05",$0.00
AR-9501-10CPC,SUP,HCPCS C1776,,AR-9501-10CPC  -  STEM HUM 10 127MM STRL UNIVERS REVERS COR SET PROX FIL CA,"$6,212.50",$0.00,"$6,212.50","$2,795.63","$4,433.86",$0.00,"$1,070.38",$0.00,$0.00,"$1,087.76","$6,212.50",$0.00,"$3,106.25","$4,920.30","$4,970.00",$0.00,$972.26,$0.00,$989.03,$0.00
AR-9501-11CPC,SUP,HCPCS C1776,,AR-9501-11CPC  -  STEM HUM 11 131MM STRL UNIVERS REVERS COR SET PROX FIL CA,"$6,212.50",$0.00,"$6,212.50","$2,795.63","$4,433.86",$0.00,"$1,070.38",$0.00,$0.00,"$1,087.76","$6,212.50",$0.00,"$3,106.25","$4,920.30","$4,970.00",$0.00,$972.26,$0.00,$989.03,$0.00
AR-9501-12CPC,SUP,HCPCS C1776,,AR-9501-12CPC  -  STEM HUM 12 135MM STRL UNIVERS REVERS COR SET PROX FIL CA,"$6,212.50",$0.00,"$6,212.50","$2,795.63","$4,433.86",$0.00,"$1,070.38",$0.00,$0.00,"$1,087.76","$6,212.50",$0.00,"$3,106.25","$4,920.30","$4,970.00",$0.00,$972.26,$0.00,$989.03,$0.00
AR-9501-12RCPC,SUP,HCPCS C1776,,AR-9501-12RCPC  -  STEM HUM 12 LNG 180MM STRL UNIVERS REVERS PROX FIL REV CA,"$7,437.50",$0.00,"$7,437.50","$3,346.88","$5,158.80",$0.00,"$1,281.44",$0.00,$0.00,"$1,302.25","$7,437.50",$0.00,"$3,718.75","$5,890.50","$5,950.00",$0.00,"$1,163.97",$0.00,"$1,184.05",$0.00
AR-9501-13CPC,SUP,HCPCS C1776,,AR-9501-13CPC  -  STEM HUM 13 139MM STRL UNIVERS REVERS SET SPL PROX FIL CA,"$6,212.50",$0.00,"$6,212.50","$2,795.63","$4,433.86",$0.00,"$1,070.38",$0.00,$0.00,"$1,087.76","$6,212.50",$0.00,"$3,106.25","$4,920.30","$4,970.00",$0.00,$972.26,$0.00,$989.03,$0.00
AR-9501-14CPC,SUP,HCPCS C1776,,AR-9501-14CPC  -  STEM HUM 14 143MM STRL UNIVERS REVERS SET SPL PROX FIL CA,"$6,212.50",$0.00,"$6,212.50","$2,795.63","$4,433.86",$0.00,"$1,070.38",$0.00,$0.00,"$1,087.76","$6,212.50",$0.00,"$3,106.25","$4,920.30","$4,970.00",$0.00,$972.26,$0.00,$989.03,$0.00
AR-9501-15CPC,SUP,HCPCS C1776,,AR-9501-15CPC  -  STEM HUM 15 146MM STRL UNIVERS REVERS SET SPL PROX FIL CA,"$6,212.50",$0.00,"$6,212.50","$2,795.63","$4,433.86",$0.00,"$1,070.38",$0.00,$0.00,"$1,087.76","$6,212.50",$0.00,"$3,106.25","$4,920.30","$4,970.00",$0.00,$972.26,$0.00,$989.03,$0.00
AR-9502-36ARCA,SUP,HCPCS C1776,,AR-9502-36ARCA  -  ADAPTER HD 36MM STRL ARTHX RVRS CUF ARTHROPATHY,"$5,375.00",$0.00,"$5,375.00","$2,418.75","$3,836.14",$0.00,$926.09,$0.00,$0.00,$941.12,"$5,375.00",$0.00,"$2,687.50","$4,257.00","$4,300.00",$0.00,$841.19,$0.00,$855.70,$0.00
AR-9502-36CPC,SUP,Custom 27803010,,AR-9502-36CPC  -  CUP HUM NTRL 36MM STRL UNIVERS REVERS CA PHOS SHLDR ARTHPL,"$4,462.50",$0.00,"$4,462.50",$0.00,"$3,184.89",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,462.50",$0.00,"$2,231.25","$3,534.30","$3,570.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-9502-36LCPC,SUP,Custom 27803010,,AR-9502-36LCPC  -  CUP HUM +2MM OFST 36MM STRL UNIVERS REVERS CA PHOS SHLDR LT,"$4,462.50",$0.00,"$4,462.50",$0.00,"$3,184.89",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,462.50",$0.00,"$2,231.25","$3,534.30","$3,570.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-9502-36RCPC,SUP,Custom 27803010,,AR-9502-36RCPC  -  CUP HUM +2MM OFST 36MM STRL UNIVERS REVERS CA PHOS SHLDR RT,"$4,462.50",$0.00,"$4,462.50",$0.00,"$3,184.89",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,462.50",$0.00,"$2,231.25","$3,534.30","$3,570.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-9502-39ARCA,SUP,HCPCS C1776,,AR-9502-39ARCA  -  ADAPTER HD 39MM STRL ARTHX RVRS,"$5,375.00",$0.00,"$5,375.00","$2,418.75","$3,836.14",$0.00,$926.09,$0.00,$0.00,$941.12,"$5,375.00",$0.00,"$2,687.50","$4,257.00","$4,300.00",$0.00,$841.19,$0.00,$855.70,$0.00
AR-9502-39CPC,SUP,Custom 27803010,,AR-9502-39CPC  -  CUP HUM NTRL 39MM STRL UNIVERS REVERS CA PHOS SHLDR ARTHPL,"$4,462.50",$0.00,"$4,462.50",$0.00,"$3,184.89",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,462.50",$0.00,"$2,231.25","$3,534.30","$3,570.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-9502-39LCPC,SUP,Custom 27803010,,AR-9502-39LCPC  -  CUP HUM +2MM OFST 39MM STRL UNIVERS REVERS CA PHOS SHLDR LT,"$4,462.50",$0.00,"$4,462.50",$0.00,"$3,184.89",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,462.50",$0.00,"$2,231.25","$3,534.30","$3,570.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-9502-39RCPC,SUP,Custom 27803010,,AR-9502-39RCPC  -  CUP HUM +2MM OFST 39MM STRL UNIVERS REVERS CA PHOS SHLDR RT,"$4,462.50",$0.00,"$4,462.50",$0.00,"$3,184.89",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,462.50",$0.00,"$2,231.25","$3,534.30","$3,570.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-9502-42ARCA,SUP,HCPCS C1776,,AR-9502-42ARCA  -  ADAPTER HD 42MM STRL ARTHX RVRS,"$5,375.00",$0.00,"$5,375.00","$2,418.75","$3,836.14",$0.00,$926.09,$0.00,$0.00,$941.12,"$5,375.00",$0.00,"$2,687.50","$4,257.00","$4,300.00",$0.00,$841.19,$0.00,$855.70,$0.00
AR-9502-42CPC,SUP,Custom 27803010,,AR-9502-42CPC  -  CUP HUM NTRL 42MM STRL UNIVERS REVERS CA PHOS SHLDR ARTHPL,"$4,462.50",$0.00,"$4,462.50",$0.00,"$3,184.89",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,462.50",$0.00,"$2,231.25","$3,534.30","$3,570.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-9502-42LCPC,SUP,Custom 27803010,,AR-9502-42LCPC  -  CUP HUM +2MM OFST 42MM STRL UNIVERS REVERS CA PHOS SHLDR LT,"$4,462.50",$0.00,"$4,462.50",$0.00,"$3,184.89",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,462.50",$0.00,"$2,231.25","$3,534.30","$3,570.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-9502-42RCPC,SUP,Custom 27803010,,AR-9502-42RCPC  -  CUP HUM +2MM OFST 42MM STRL UNIVERS REVERS CA PHOS SHLDR RT,"$4,462.50",$0.00,"$4,462.50",$0.00,"$3,184.89",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,462.50",$0.00,"$2,231.25","$3,534.30","$3,570.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-9502F-36CPC,SUP,HCPCS C1776,,AR-9502F-36CPC  -  CUP HUM 36MM STRL LF ARTHX UNIVERS REVERS SUT,"$4,462.50",$0.00,"$4,462.50","$2,008.13","$3,184.89",$0.00,$768.87,$0.00,$0.00,$781.35,"$4,462.50",$0.00,"$2,231.25","$3,534.30","$3,570.00",$0.00,$698.38,$0.00,$710.43,$0.00
AR-9502F-36LCPC,SUP,Custom 27803010,,AR-9502F-36LCPC  -  CUP HUM +2 36MM UNIVERS REVERS SUT SHLDR LT,"$4,462.50",$0.00,"$4,462.50",$0.00,"$3,184.89",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,462.50",$0.00,"$2,231.25","$3,534.30","$3,570.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-9502F-36RCPC,SUP,Custom 27803010,,AR-9502F-36RCPC  -  CUP HUM +2 36MM UNIVERS REVERS SUT SHLDR RT,"$4,462.50",$0.00,"$4,462.50",$0.00,"$3,184.89",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,462.50",$0.00,"$2,231.25","$3,534.30","$3,570.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-9502F-39LCPC,SUP,Custom 27803010,,AR-9502F-39LCPC  -  CUP HUM +2 39MM UNIVERS REVERS SUT SHLDR LT,"$4,462.50",$0.00,"$4,462.50",$0.00,"$3,184.89",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,462.50",$0.00,"$2,231.25","$3,534.30","$3,570.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-9502F-39RCPC,SUP,Custom 27803010,,AR-9502F-39RCPC  -  CUP HUM +2 39MM UNIVERS REVERS SUT SHLDR RT,"$4,462.50",$0.00,"$4,462.50",$0.00,"$3,184.89",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,462.50",$0.00,"$2,231.25","$3,534.30","$3,570.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-9502F-42RCPC,SUP,Custom 27803010,,AR-9502F-42RCPC  -  CUP HUM +2 42MM UNIVERS REVERS SUT SHLDR RT,"$4,462.50",$0.00,"$4,462.50",$0.00,"$3,184.89",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,462.50",$0.00,"$2,231.25","$3,534.30","$3,570.00",$0.00,$0.00,$0.00,$0.00,$0.00
AR-9503L-03,SUP,HCPCS C1776,,AR-9503L-03  -  INSERT HUM +3MM LG 42MM STRL UNIVERS REVERS SHLDR ARTHPL,"$2,537.50",$0.00,"$2,537.50","$1,141.88","$1,811.01",$0.00,$437.20,$0.00,$0.00,$444.30,"$2,537.50",$0.00,"$1,268.75","$2,009.70","$2,030.00",$0.00,$397.12,$0.00,$403.97,$0.00
AR-9503L-03C,SUP,HCPCS C1776,,AR-9503L-03C  -  INSERT HUM +3MM LG 42MM STRL UNIVERS REVERS CNSTRN SHLDR,"$2,537.50",$0.00,"$2,537.50","$1,141.88","$1,811.01",$0.00,$437.20,$0.00,$0.00,$444.30,"$2,537.50",$0.00,"$1,268.75","$2,009.70","$2,030.00",$0.00,$397.12,$0.00,$403.97,$0.00
AR-9503L-06,SUP,HCPCS C1776,,AR-9503L-06  -  INSERT HUM +6MM LG 42MM STRL UNIVERS REVERS SHLDR ARTHPL,"$2,537.50",$0.00,"$2,537.50","$1,141.88","$1,811.01",$0.00,$437.20,$0.00,$0.00,$444.30,"$2,537.50",$0.00,"$1,268.75","$2,009.70","$2,030.00",$0.00,$397.12,$0.00,$403.97,$0.00
AR-9503L-06C,SUP,HCPCS C1776,,AR-9503L-06C  -  INSERT HUM +6MM LG 42MM STRL UNIVERS REVERS CNSTRN SHLDR,"$2,537.50",$0.00,"$2,537.50","$1,141.88","$1,811.01",$0.00,$437.20,$0.00,$0.00,$444.30,"$2,537.50",$0.00,"$1,268.75","$2,009.70","$2,030.00",$0.00,$397.12,$0.00,$403.97,$0.00
AR-9503M-03,SUP,HCPCS C1776,,AR-9503M-03  -  INSERT HUM +3MM MED 39MM STRL UNIVERS REVERS SHLDR ARTHPL,"$2,537.50",$0.00,"$2,537.50","$1,141.88","$1,811.01",$0.00,$437.20,$0.00,$0.00,$444.30,"$2,537.50",$0.00,"$1,268.75","$2,009.70","$2,030.00",$0.00,$397.12,$0.00,$403.97,$0.00
AR-9503M-03C,SUP,HCPCS C1776,,AR-9503M-03C  -  INSERT HUM +3MM MED 39MM STRL UNIVERS REVERS CNSTRN SHLDR,"$2,537.50",$0.00,"$2,537.50","$1,141.88","$1,811.01",$0.00,$437.20,$0.00,$0.00,$444.30,"$2,537.50",$0.00,"$1,268.75","$2,009.70","$2,030.00",$0.00,$397.12,$0.00,$403.97,$0.00
AR-9503M-06,SUP,HCPCS C1776,,AR-9503M-06  -  INSERT HUM +6MM MED 39MM STRL UNIVERS REVERS SHLDR ARTHPL,"$2,537.50",$0.00,"$2,537.50","$1,141.88","$1,811.01",$0.00,$437.20,$0.00,$0.00,$444.30,"$2,537.50",$0.00,"$1,268.75","$2,009.70","$2,030.00",$0.00,$397.12,$0.00,$403.97,$0.00
AR-9503M-06C,SUP,HCPCS C1776,,AR-9503M-06C  -  INSERT HUM +6MM MED 39MM STRL UNIVERS REVERS CNSTRN SHLDR,"$2,537.50",$0.00,"$2,537.50","$1,141.88","$1,811.01",$0.00,$437.20,$0.00,$0.00,$444.30,"$2,537.50",$0.00,"$1,268.75","$2,009.70","$2,030.00",$0.00,$397.12,$0.00,$403.97,$0.00
AR-9503S-03,SUP,HCPCS C1776,,AR-9503S-03  -  INSERT HUM 36MM UNIVERS REVERS +3MM SM SHLDR,"$2,537.50",$0.00,"$2,537.50","$1,141.88","$1,811.01",$0.00,$437.20,$0.00,$0.00,$444.30,"$2,537.50",$0.00,"$1,268.75","$2,009.70","$2,030.00",$0.00,$397.12,$0.00,$403.97,$0.00
AR-9503S-03C,SUP,HCPCS C1776,,AR-9503S-03C  -  INSERT HUM +3MM SM 36MM STRL UNIVERS REVERS CNSTRN SHLDR,"$2,537.50",$0.00,"$2,537.50","$1,141.88","$1,811.01",$0.00,$437.20,$0.00,$0.00,$444.30,"$2,537.50",$0.00,"$1,268.75","$2,009.70","$2,030.00",$0.00,$397.12,$0.00,$403.97,$0.00
AR-9503S-06,SUP,HCPCS C1776,,AR-9503S-06  -  INSERT HUM +6MM SM 36MM STRL UNIVERS REVERS SHLDR ARTHPL,"$2,537.50",$0.00,"$2,537.50","$1,141.88","$1,811.01",$0.00,$437.20,$0.00,$0.00,$444.30,"$2,537.50",$0.00,"$1,268.75","$2,009.70","$2,030.00",$0.00,$397.12,$0.00,$403.97,$0.00
AR-9503S-06C,SUP,HCPCS C1776,,AR-9503S-06C  -  INSERT HUM +6MM SM 36MM STRL UNIVERS REVERS CNSTRN SHLDR,"$2,537.50",$0.00,"$2,537.50","$1,141.88","$1,811.01",$0.00,$437.20,$0.00,$0.00,$444.30,"$2,537.50",$0.00,"$1,268.75","$2,009.70","$2,030.00",$0.00,$397.12,$0.00,$403.97,$0.00
AR-9504L,SUP,HCPCS C1776,,AR-9504L  -  HEAD GLND LG UNV 42MM STRL UNIVERS REVERS GLENOSPHERE VA CA,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,$0.00,$0.00,$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
AR-9504L-04,SUP,HCPCS C1776,,AR-9504L-04  -  HEAD GLND +4MM LG UNV LAT OFST 42MM STRL UNIVERS REVERS,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,$0.00,$0.00,$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
AR-9504M,SUP,HCPCS C1776,,AR-9504M  -  HEAD GLND MED UNV 39MM STRL UNIVERS REVERS GLENOSPHERE VA CA,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,$0.00,$0.00,$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
AR-9504M-02,SUP,HCPCS C1776,,AR-9504M-02  -  HEAD GLND +2.5MM MED UNV INFR OFST 42MM STRL UNIVERS REVERS,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,$0.00,$0.00,$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
AR-9504M-04,SUP,HCPCS C1776,,AR-9504M-04  -  HEAD GLND +4MM MED UNV LAT OFST 39MM STRL UNIVERS REVERS,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,$0.00,$0.00,$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
AR-9504S,SUP,HCPCS C1776,,AR-9504S  -  HEAD GLND SM UNV 36MM STRL UNIVERS REVERS GLENOSPHERE VA CA,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,$0.00,$0.00,$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
AR-9504S-02,SUP,HCPCS C1776,,AR-9504S-02  -  HEAD GLND +2.5MM SM UNV INFR OFST 36MM STRL UNIVERS REVERS,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,$0.00,$0.00,$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
AR-9504S-04,SUP,HCPCS C1776,,AR-9504S-04  -  HEAD GLND 36MM UNIVERS REVERS +4MM SM UNV LAT,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,$0.00,$0.00,$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
AR-9504S-INF,SUP,HCPCS C1776,,AR-9504S-INF  -  HEAD GLND +2.5MM INFR OFST 36MM STRL UNIVERS REVERS,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,$0.00,$0.00,$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
AR-9505-06,SUP,HCPCS C1776,,AR-9505-06  -  SPACER HUM +6MM 39MM STRL UNIVERS REVERS TI SHLDR ARTHPL,"$1,225.00",$0.00,"$1,225.00",$551.25,$874.28,$0.00,$211.06,$0.00,$0.00,$214.49,"$1,225.00",$0.00,$612.50,$970.20,$980.00,$0.00,$191.71,$0.00,$195.02,$0.00
AR-9505-09,SUP,HCPCS C1776,,AR-9505-09  -  SPACER HUM +9MM 36MM STRL UNIVERS REVERS TI SHLDR ARTHPL,"$1,225.00",$0.00,"$1,225.00",$551.25,$874.28,$0.00,$211.06,$0.00,$0.00,$214.49,"$1,225.00",$0.00,$612.50,$970.20,$980.00,$0.00,$191.71,$0.00,$195.02,$0.00
AR-9505-12,SUP,HCPCS C1776,,AR-9505-12  -  SPACER HUM +12MM 39MM STRL UNIVERS REVERS TI SHLDR ARTHPL,"$1,225.00",$0.00,"$1,225.00",$551.25,$874.28,$0.00,$211.06,$0.00,$0.00,$214.49,"$1,225.00",$0.00,$612.50,$970.20,$980.00,$0.00,$191.71,$0.00,$195.02,$0.00
AR-9505-15,SUP,HCPCS C1776,,AR-9505-15  -  SPACER HUM +15MM 39MM STRL UNIVERS REVERS TI SHLDR ARTHPL,"$1,225.00",$0.00,"$1,225.00",$551.25,$874.28,$0.00,$211.06,$0.00,$0.00,$214.49,"$1,225.00",$0.00,$612.50,$970.20,$980.00,$0.00,$191.71,$0.00,$195.02,$0.00
AR-9510-06,SUP,HCPCS C1776,,AR-9510-06  -  RASP SRG 6 UNIVERS REVERS STM TRL SHLDR ARTHPL,"$3,262.50",$0.00,"$3,262.50","$1,468.13","$2,328.45",$0.00,$562.11,$0.00,$0.00,$571.24,"$3,262.50",$0.00,"$1,631.25","$2,583.90","$2,610.00",$0.00,$510.58,$0.00,$519.39,$0.00
AR-9510-07,SUP,HCPCS C1776,,AR-9510-07  -  RASP SRG 7 UNIVERS REVERS STM TRL SHLDR ARTHPL,"$3,262.50",$0.00,"$3,262.50","$1,468.13","$2,328.45",$0.00,$562.11,$0.00,$0.00,$571.24,"$3,262.50",$0.00,"$1,631.25","$2,583.90","$2,610.00",$0.00,$510.58,$0.00,$519.39,$0.00
AR-9510-08,SUP,HCPCS C1776,,AR-9510-08  -  RASP SRG 8 UNIVERS REVERS STM TRL SHLDR ARTHPL,"$3,262.50",$0.00,"$3,262.50","$1,468.13","$2,328.45",$0.00,$562.11,$0.00,$0.00,$571.24,"$3,262.50",$0.00,"$1,631.25","$2,583.90","$2,610.00",$0.00,$510.58,$0.00,$519.39,$0.00
AR-9510-09,SUP,HCPCS C1776,,AR-9510-09  -  RASP SRG 9 UNIVERS REVERS STM TRL SHLDR ARTHPL,"$3,262.50",$0.00,"$3,262.50","$1,468.13","$2,328.45",$0.00,$562.11,$0.00,$0.00,$571.24,"$3,262.50",$0.00,"$1,631.25","$2,583.90","$2,610.00",$0.00,$510.58,$0.00,$519.39,$0.00
AR-9510-09R,SUP,HCPCS C1776,,AR-9510-09R  -  RASP SRG 9 LNG 180MM UNIVERS REVERS REV STM TRL SHLDR ARTHPL,"$3,612.50",$0.00,"$3,612.50","$1,625.63","$2,578.24",$0.00,$622.42,$0.00,$0.00,$632.52,"$3,612.50",$0.00,"$1,806.25","$2,861.10","$2,890.00",$0.00,$565.36,$0.00,$575.11,$0.00
AR-9510-10,SUP,HCPCS C1776,,AR-9510-10  -  RASP SRG 10 UNIVERS REVERS STM TRL SHLDR ARTHPL,"$3,262.50",$0.00,"$3,262.50","$1,468.13","$2,328.45",$0.00,$562.11,$0.00,$0.00,$571.24,"$3,262.50",$0.00,"$1,631.25","$2,583.90","$2,610.00",$0.00,$510.58,$0.00,$519.39,$0.00
AR-9510-11,SUP,HCPCS C1776,,AR-9510-11  -  RASP SRG 11 UNIVERS REVERS STM TRL SHLDR ARTHPL,"$3,262.50",$0.00,"$3,262.50","$1,468.13","$2,328.45",$0.00,$562.11,$0.00,$0.00,$571.24,"$3,262.50",$0.00,"$1,631.25","$2,583.90","$2,610.00",$0.00,$510.58,$0.00,$519.39,$0.00
AR-9510-12,SUP,HCPCS C1776,,AR-9510-12  -  RASP SRG 12 UNIVERS REVERS STM TRL SHLDR ARTHPL,"$3,262.50",$0.00,"$3,262.50","$1,468.13","$2,328.45",$0.00,$562.11,$0.00,$0.00,$571.24,"$3,262.50",$0.00,"$1,631.25","$2,583.90","$2,610.00",$0.00,$510.58,$0.00,$519.39,$0.00
AR-9510-12R,SUP,HCPCS C1776,,AR-9510-12R  -  RASP SRG 12 LNG 180MM UNIVERS REVERS REV STM TRL SHLDR,"$3,612.50",$0.00,"$3,612.50","$1,625.63","$2,578.24",$0.00,$622.42,$0.00,$0.00,$632.52,"$3,612.50",$0.00,"$1,806.25","$2,861.10","$2,890.00",$0.00,$565.36,$0.00,$575.11,$0.00
AR-9510-13,SUP,HCPCS C1776,,AR-9510-13  -  RASP SRG 13 UNIVERS REVERS STM TRL SHLDR ARTHPL,"$3,262.50",$0.00,"$3,262.50","$1,468.13","$2,328.45",$0.00,$562.11,$0.00,$0.00,$571.24,"$3,262.50",$0.00,"$1,631.25","$2,583.90","$2,610.00",$0.00,$510.58,$0.00,$519.39,$0.00
AR-9510-14,SUP,HCPCS C1776,,AR-9510-14  -  RASP SRG 14 UNIVERS REVERS STM TRL SHLDR ARTHPL,"$3,412.50",$0.00,"$3,412.50","$1,535.63","$2,435.50",$0.00,$587.96,$0.00,$0.00,$597.50,"$3,412.50",$0.00,"$1,706.25","$2,702.70","$2,730.00",$0.00,$534.06,$0.00,$543.27,$0.00
AR-9510-15,SUP,HCPCS C1776,,AR-9510-15  -  RASP SRG 15 UNIVERS REVERS STM TRL SHLDR ARTHPL,"$3,412.50",$0.00,"$3,412.50","$1,535.63","$2,435.50",$0.00,$587.96,$0.00,$0.00,$597.50,"$3,412.50",$0.00,"$1,706.25","$2,702.70","$2,730.00",$0.00,$534.06,$0.00,$543.27,$0.00
AR-9550-06,SUP,HCPCS C1776,,AR-9550-06  -  SPACER HUM +6MM 42MM STRL UNIVERS REVERS TI SHLDR ARTHPL,"$1,225.00",$0.00,"$1,225.00",$551.25,$874.28,$0.00,$211.06,$0.00,$0.00,$214.49,"$1,225.00",$0.00,$612.50,$970.20,$980.00,$0.00,$191.71,$0.00,$195.02,$0.00
AR-9550-09,SUP,HCPCS C1776,,AR-9550-09  -  SPACER HUM +9MM 42MM STRL UNIVERS REVERS TI SHLDR ARTHPL,"$1,225.00",$0.00,"$1,225.00",$551.25,$874.28,$0.00,$211.06,$0.00,$0.00,$214.49,"$1,225.00",$0.00,$612.50,$970.20,$980.00,$0.00,$191.71,$0.00,$195.02,$0.00
AR-9550-12,SUP,HCPCS C1776,,AR-9550-12  -  SPACER HUM +12MM 42MM STRL UNIVERS REVERS TI SHLDR ARTHPL,"$1,225.00",$0.00,"$1,225.00",$551.25,$874.28,$0.00,$211.06,$0.00,$0.00,$214.49,"$1,225.00",$0.00,$612.50,$970.20,$980.00,$0.00,$191.71,$0.00,$195.02,$0.00
AR-9550-15,SUP,HCPCS C1776,,AR-9550-15  -  SPACER HUM +15MM 42MM STRL UNIVERS REVERS TI SHLDR ARTHPL,"$1,225.00",$0.00,"$1,225.00",$551.25,$874.28,$0.00,$211.06,$0.00,$0.00,$214.49,"$1,225.00",$0.00,$612.50,$970.20,$980.00,$0.00,$191.71,$0.00,$195.02,$0.00
AR-9555-06,SUP,HCPCS C1776,,AR-9555-06  -  SPACER HUM 36MM UNIVERS REVERS +6MM SHLDR TI,"$1,225.00",$0.00,"$1,225.00",$551.25,$874.28,$0.00,$211.06,$0.00,$0.00,$214.49,"$1,225.00",$0.00,$612.50,$970.20,$980.00,$0.00,$191.71,$0.00,$195.02,$0.00
AR-9555-09,SUP,HCPCS C1776,,AR-9555-09  -  SPACER HUM +9MM 36MM STRL UNIVERS REVERS TI SHLDR ARTHPL,"$1,225.00",$0.00,"$1,225.00",$551.25,$874.28,$0.00,$211.06,$0.00,$0.00,$214.49,"$1,225.00",$0.00,$612.50,$970.20,$980.00,$0.00,$191.71,$0.00,$195.02,$0.00
AR-9555-12,SUP,HCPCS C1776,,AR-9555-12  -  SPACER HUM +12MM 36MM STRL UNIVERS REVERS TI SHLDR ARTHPL,"$1,225.00",$0.00,"$1,225.00",$551.25,$874.28,$0.00,$211.06,$0.00,$0.00,$214.49,"$1,225.00",$0.00,$612.50,$970.20,$980.00,$0.00,$191.71,$0.00,$195.02,$0.00
AR-9555-15,SUP,HCPCS C1776,,AR-9555-15  -  SPACER HUM +15MM 36MM STRL UNIVERS REVERS TI SHLDR ARTHPL,"$1,225.00",$0.00,"$1,225.00",$551.25,$874.28,$0.00,$211.06,$0.00,$0.00,$214.49,"$1,225.00",$0.00,$612.50,$970.20,$980.00,$0.00,$191.71,$0.00,$195.02,$0.00
AR-9703A-90,SUP,Custom 27203010,,AR-9703A-90  -  PROBE ESURG 90D LOPRFL 3MM STRL OPES ASPIRATE ABLT DISP,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-9704A-90,SUP,Custom 27203010,,AR-9704A-90  -  PROBE ESURG 90D LOPRFL 4MM STRL OPES ASPIRATE ABLT DISP,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-9705-90,SUP,Custom 27203010,,AR-9705-90  -  PROBE ESURG 90D LOPRFL STRL OPES ABLT TTHBRSH DISP,$337.50,$0.00,$337.50,$0.00,$240.87,$0.00,$0.00,$0.00,$0.00,$0.00,$337.50,$0.00,$168.75,$267.30,$270.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-9705A-90,SUP,Custom 27203010,,AR-9705A-90  -  PROBE ESURG 90D LOPRFL STRL OPES ASPIRATE ABLT TTHBRSH DISP,$462.50,$0.00,$462.50,$0.00,$330.09,$0.00,$0.00,$0.00,$0.00,$0.00,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-9802M-45,SUP,Custom 27203010,,AR-9802M-45  -  ELECTRODE ESURG 45D STRL COOLCUT ABLATOR MNSCTM,$287.50,$0.00,$287.50,$0.00,$205.19,$0.00,$0.00,$0.00,$0.00,$0.00,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-9802M-90,SUP,Custom 27203010,,AR-9802M-90  -  ELECTRODE ESURG 90D COOLCUT ABLATOR MNSCTM,$287.50,$0.00,$287.50,$0.00,$205.19,$0.00,$0.00,$0.00,$0.00,$0.00,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-9803-30,SUP,Custom 27203010,,AR-9803-30  -  PROBE ESURG 30D 3MM STRL COOLCUT ABLT RF WND,$325.00,$0.00,$325.00,$0.00,$231.95,$0.00,$0.00,$0.00,$0.00,$0.00,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-9803-50,SUP,Custom 27203010,,AR-9803-50  -  ELECTRODE ESURG 50D 3MM COOLCUT 50 ABLATOR 50NA,$325.00,$0.00,$325.00,$0.00,$231.95,$0.00,$0.00,$0.00,$0.00,$0.00,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-9803-90,SUP,Custom 27203010,,AR-9803-90  -  PROBE ESURG 90D 3MM STRL COOLCUT ABLT RF WND,$325.00,$0.00,$325.00,$0.00,$231.95,$0.00,$0.00,$0.00,$0.00,$0.00,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-9803A-30,SUP,Custom 27203010,,AR-9803A-30  -  PROBE ESURG 30D 3MM STRL COOLCUT ASPIRATE ABLT RF WND,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-9803A-50,SUP,Custom 27203010,,AR-9803A-50  -  PROBE ESURG 50D 3MM STRL COOLCUT ASPIRATE ABLT RF WND,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-9803A-90,SUP,Custom 27203010,,AR-9803A-90  -  PROBE ESURG 3MM COOLCUT 90D ASPIRATE ABLT RF WND,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-9808,SUP,Custom 27203010,,AR-9808  -  ELECTRODE ESURG BALL STRL COOLCUT ABLT RF WND S JNT,$287.50,$0.00,$287.50,$0.00,$205.19,$0.00,$0.00,$0.00,$0.00,$0.00,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-9808-45,SUP,Custom 27203010,,AR-9808-45  -  ELECTRODE ESURG 45D COOLCUT BALL ASCP,$287.50,$0.00,$287.50,$0.00,$205.19,$0.00,$0.00,$0.00,$0.00,$0.00,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-9808SJ,SUP,Custom 27203010,,AR-9808SJ  -  ELECTRODE ESURG BALL STRL COOLCUT ABLT RF WND S JNT,$287.50,$0.00,$287.50,$0.00,$205.19,$0.00,$0.00,$0.00,$0.00,$0.00,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-9808SJ-45,SUP,Custom 27203010,,AR-9808SJ-45  -  ELECTRODE ESURG 45D BALL STRL COOLCUT ABLT RF WND S JNT,$287.50,$0.00,$287.50,$0.00,$205.19,$0.00,$0.00,$0.00,$0.00,$0.00,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-9809SJ-45,SUP,Custom 27203010,,AR-9809SJ-45  -  ELECTRODE ESURG 45D BALL STRL COOLCUT ABLT RF WND S JNT,$287.50,$0.00,$287.50,$0.00,$205.19,$0.00,$0.00,$0.00,$0.00,$0.00,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-9809SJ-90,SUP,Custom 27203010,,AR-9809SJ-90  -  ELECTRODE ESURG 90D BALL STRL COOLCUT ABLT RF WND S JNT,$287.50,$0.00,$287.50,$0.00,$205.19,$0.00,$0.00,$0.00,$0.00,$0.00,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-9811,SUP,Custom 27203010,,AR-9811  -  PROBE ESURG 90D APLO RF ML PRT,$475.00,$0.00,$475.00,$0.00,$339.01,$0.00,$0.00,$0.00,$0.00,$0.00,$475.00,$0.00,$237.50,$376.20,$380.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-992,SUP,Custom 27203010,,AR-992  -  KIT ARTHRO FIX TRNFX2 SCR CANN DILAT ROTR CUF STRL DISP,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
AR-9943BL-04,SUP,HCPCS C1713,,AR-9943BL-04  -  PLATE BN 4 HL LCK TI FIB LT DIST,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
AR-9943BL-05,SUP,HCPCS C1713,,AR-9943BL-05  -  PLATE BN 5 HL LCK TI FIB LT DIST,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
AR-9943BL-06,SUP,HCPCS C1713,,AR-9943BL-06  -  PLATE BN 6 HL LCK TI FIB LT DIST,"$1,937.50",$0.00,"$1,937.50",$871.88,"$1,382.79",$0.00,$333.82,$0.00,$0.00,$339.24,"$1,937.50",$0.00,$968.75,"$1,534.50","$1,550.00",$0.00,$303.22,$0.00,$308.45,$0.00
AR-9943BL-08,SUP,HCPCS C1713,,AR-9943BL-08  -  PLATE BN ARTHX 8 HL LCK TI FIB LT DIST,"$2,112.50",$0.00,"$2,112.50",$950.63,"$1,507.69",$0.00,$363.97,$0.00,$0.00,$369.88,"$2,112.50",$0.00,"$1,056.25","$1,673.10","$1,690.00",$0.00,$330.61,$0.00,$336.31,$0.00
AR-9943BL-10,SUP,HCPCS C1713,,AR-9943BL-10  -  PLATE BN ARTHX 10 HL LCK TI FIB LT DIST,"$2,325.00",$0.00,"$2,325.00","$1,046.25","$1,659.35",$0.00,$400.59,$0.00,$0.00,$407.09,"$2,325.00",$0.00,"$1,162.50","$1,841.40","$1,860.00",$0.00,$363.86,$0.00,$370.14,$0.00
AR-9943BL-12,SUP,HCPCS C1713,,AR-9943BL-12  -  PLATE BN ARTHX 12 HL LCK TI FIB LT DIST,"$2,350.00",$0.00,"$2,350.00","$1,057.50","$1,677.20",$0.00,$404.89,$0.00,$0.00,$411.47,"$2,350.00",$0.00,"$1,175.00","$1,861.20","$1,880.00",$0.00,$367.78,$0.00,$374.12,$0.00
AR-9943BL-14,SUP,HCPCS C1713,,AR-9943BL-14  -  PLATE BN ARTHX 14 HL LCK TI FIB LT DIST,"$2,375.00",$0.00,"$2,375.00","$1,068.75","$1,695.04",$0.00,$409.20,$0.00,$0.00,$415.84,"$2,375.00",$0.00,"$1,187.50","$1,881.00","$1,900.00",$0.00,$371.69,$0.00,$378.10,$0.00
AR-9943BR-04,SUP,HCPCS C1713,,AR-9943BR-04  -  PLATE BN 4 HL LCK TI FIB DIST,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
AR-9943BR-06,SUP,HCPCS C1713,,AR-9943BR-06  -  PLATE BN 6 HL LCK TI FIB RT DIST,"$1,937.50",$0.00,"$1,937.50",$871.88,"$1,382.79",$0.00,$333.82,$0.00,$0.00,$339.24,"$1,937.50",$0.00,$968.75,"$1,534.50","$1,550.00",$0.00,$303.22,$0.00,$308.45,$0.00
AR-9943BR-08,SUP,HCPCS C1713,,AR-9943BR-08  -  PLATE BN ARTHX 8 HL LCK TI FIB RT DIST,"$2,112.50",$0.00,"$2,112.50",$950.63,"$1,507.69",$0.00,$363.97,$0.00,$0.00,$369.88,"$2,112.50",$0.00,"$1,056.25","$1,673.10","$1,690.00",$0.00,$330.61,$0.00,$336.31,$0.00
AR-9943BR-10,SUP,HCPCS C1713,,AR-9943BR-10  -  PLATE BN ARTHX 10 HL LCK TI FIB RT DIST,"$2,325.00",$0.00,"$2,325.00","$1,046.25","$1,659.35",$0.00,$400.59,$0.00,$0.00,$407.09,"$2,325.00",$0.00,"$1,162.50","$1,841.40","$1,860.00",$0.00,$363.86,$0.00,$370.14,$0.00
AR-9943BR-12,SUP,HCPCS C1713,,AR-9943BR-12  -  PLATE BN NS ARTHX 12 HL LCK TI FIB RT DIST,"$2,350.00",$0.00,"$2,350.00","$1,057.50","$1,677.20",$0.00,$404.89,$0.00,$0.00,$411.47,"$2,350.00",$0.00,"$1,175.00","$1,861.20","$1,880.00",$0.00,$367.78,$0.00,$374.12,$0.00
AR-9943BR-14,SUP,HCPCS C1713,,AR-9943BR-14  -  PLATE BN ARTHX 14 HL LCK TI FIB RT DIST,"$2,375.00",$0.00,"$2,375.00","$1,068.75","$1,695.04",$0.00,$409.20,$0.00,$0.00,$415.84,"$2,375.00",$0.00,"$1,187.50","$1,881.00","$1,900.00",$0.00,$371.69,$0.00,$378.10,$0.00
AR-9943C-04,SUP,HCPCS C1713,,AR-9943C-04  -  PLATE BN STRG 4 HL LCK TI,"$1,125.00",$0.00,"$1,125.00",$506.25,$802.91,$0.00,$193.83,$0.00,$0.00,$196.98,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$176.06,$0.00,$179.10,$0.00
AR-9943C-06,SUP,HCPCS C1713,,AR-9943C-06  -  PLATE BN STRG 6 HL LCK TI,"$1,187.50",$0.00,"$1,187.50",$534.38,$847.52,$0.00,$204.60,$0.00,$0.00,$207.92,"$1,187.50",$0.00,$593.75,$940.50,$950.00,$0.00,$185.84,$0.00,$189.05,$0.00
AR-9943C-07,SUP,HCPCS C1713,,AR-9943C-07  -  PLATE BN STRG 7 HL LCK TI,"$1,312.50",$0.00,"$1,312.50",$590.63,$936.73,$0.00,$226.14,$0.00,$0.00,$229.81,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$205.41,$0.00,$208.95,$0.00
AR-9943C-08,SUP,HCPCS C1713,,AR-9943C-08  -  PLATE BN STRG 8 HL LCK TI ANKL,"$1,375.00",$0.00,"$1,375.00",$618.75,$981.34,$0.00,$236.91,$0.00,$0.00,$240.75,"$1,375.00",$0.00,$687.50,"$1,089.00","$1,100.00",$0.00,$215.19,$0.00,$218.90,$0.00
AR-9943C-10,SUP,HCPCS C1713,,AR-9943C-10  -  PLATE BN STRG 10 HL LCK TI,"$1,487.50",$0.00,"$1,487.50",$669.38,"$1,061.63",$0.00,$256.29,$0.00,$0.00,$260.45,"$1,487.50",$0.00,$743.75,"$1,178.10","$1,190.00",$0.00,$232.79,$0.00,$236.81,$0.00
AR-9943C-12,SUP,HCPCS C1713,,AR-9943C-12  -  PLATE BN STRG 12 HL LCK TI,"$1,737.50",$0.00,"$1,737.50",$781.88,"$1,240.05",$0.00,$299.36,$0.00,$0.00,$304.22,"$1,737.50",$0.00,$868.75,"$1,376.10","$1,390.00",$0.00,$271.92,$0.00,$276.61,$0.00
AR-9943T-04,SUP,HCPCS C1713,,AR-9943T-04  -  PLATE BN 1/3 TBLR 4 HL LCK TI,$562.50,$0.00,$562.50,$253.13,$401.46,$0.00,$96.92,$0.00,$0.00,$98.49,$562.50,$0.00,$281.25,$445.50,$450.00,$0.00,$88.03,$0.00,$89.55,$0.00
AR-9943T-05,SUP,HCPCS C1713,,AR-9943T-05  -  PLATE BN 1/3 TBLR 5 HL LCK TI,$587.50,$0.00,$587.50,$264.38,$419.30,$0.00,$101.22,$0.00,$0.00,$102.87,$587.50,$0.00,$293.75,$465.30,$470.00,$0.00,$91.94,$0.00,$93.53,$0.00
AR-9943T-06,SUP,HCPCS C1713,,AR-9943T-06  -  PLATE BN 1/3 TUBE 6 HL LCK TI,$600.00,$0.00,$600.00,$270.00,$428.22,$0.00,$103.38,$0.00,$0.00,$105.06,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$93.90,$0.00,$95.52,$0.00
AR-9943T-07,SUP,HCPCS C1713,,AR-9943T-07  -  PLATE BN 3 TBLR 7 HL LCK TI,$637.50,$0.00,$637.50,$286.88,$454.98,$0.00,$109.84,$0.00,$0.00,$111.62,$637.50,$0.00,$318.75,$504.90,$510.00,$0.00,$99.77,$0.00,$101.49,$0.00
AR-9943T-08,SUP,HCPCS C1713,,AR-9943T-08  -  PLATE BN 1/3 TBLR 8 HL LCK TI,$662.50,$0.00,$662.50,$298.13,$472.83,$0.00,$114.15,$0.00,$0.00,$116.00,$662.50,$0.00,$331.25,$524.70,$530.00,$0.00,$103.68,$0.00,$105.47,$0.00
AR-9943T-10,SUP,HCPCS C1713,,AR-9943T-10  -  PLATE BN 1/3 TBLR 10 HL LCK TI ANKL,$700.00,$0.00,$700.00,$315.00,$499.59,$0.00,$120.61,$0.00,$0.00,$122.56,$700.00,$0.00,$350.00,$554.40,$560.00,$0.00,$109.55,$0.00,$111.44,$0.00
AR-9943T-12,SUP,HCPCS C1713,,AR-9943T-12  -  PLATE BN 1/3 TBLR 12 HL LCK TI,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
AS09,SUP,Custom 27203010,,AS09  -  ATTACHMENT TL STRG 3.2MM 9CM MDSRX LGN LG BORE,"$2,133.10",$0.00,"$2,133.10",$0.00,"$1,522.39",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,133.10",$0.00,"$1,066.55","$1,689.42","$1,706.48",$0.00,$0.00,$0.00,$0.00,$0.00
AS10,SUP,Custom 27203010,,AS10  -  ATTCH TL 10CM STR SM BORE MDSRX LGN 2.4MM,"$1,823.93",$0.00,"$1,823.93",$0.00,"$1,301.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,823.93",$0.00,$911.96,"$1,444.55","$1,459.14",$0.00,$0.00,$0.00,$0.00,$0.00
AS74180-06,SUP,Custom 27203010,,AS74180-06  -  PACK VITRECTOMY 23GA,$150.00,$0.00,$150.00,$0.00,$107.06,$0.00,$0.00,$0.00,$0.00,$0.00,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$0.00,$0.00,$0.00,$0.00
AT-0225-S,SUP,HCPCS C1713,,AT-0225-S  -  SCREW BONE 22.5MM ACTRK STD,$775.00,$0.00,$775.00,$348.75,$553.12,$0.00,$133.53,$0.00,$0.00,$135.70,$775.00,$0.00,$387.50,$613.80,$620.00,$0.00,$121.29,$0.00,$123.38,$0.00
AT-1032,SUP,Custom 27203010,,AT-1032  -  BIT DRILL ACTRK CANN,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
AT-1125-S,SUP,HCPCS C1713,,AT-1125-S  -  SCREW BONE 3.3-4.6MM 12.5MM ACTRK TI STD FULTHD ORTH SLFTAP,$940.00,$0.00,$940.00,$423.00,$670.88,$0.00,$161.96,$0.00,$0.00,$164.59,$940.00,$0.00,$470.00,$744.48,$752.00,$0.00,$147.11,$0.00,$149.65,$0.00
AT-1150-S,SUP,HCPCS C1713,,AT-1150-S  -  SCREW BN STD 15MM,$940.00,$0.00,$940.00,$423.00,$670.88,$0.00,$161.96,$0.00,$0.00,$164.59,$940.00,$0.00,$470.00,$744.48,$752.00,$0.00,$147.11,$0.00,$149.65,$0.00
AT-1175-S,SUP,HCPCS C1713,,AT-1175-S  -  SCREW BN STD 3.3-4.6MM 17.5MM STRL ACTRK SLF CUT CNN VAR,$940.00,$0.00,$940.00,$423.00,$670.88,$0.00,$161.96,$0.00,$0.00,$164.59,$940.00,$0.00,$470.00,$744.48,$752.00,$0.00,$147.11,$0.00,$149.65,$0.00
AT-1200-S,SUP,HCPCS C1713,,AT-1200-S  -  SCREW BN STD 3.3-4.6MM 20MM STRL ACTRK SLF CUT CNN VAR PTCH,$940.00,$0.00,$940.00,$423.00,$670.88,$0.00,$161.96,$0.00,$0.00,$164.59,$940.00,$0.00,$470.00,$744.48,$752.00,$0.00,$147.11,$0.00,$149.65,$0.00
AT-1225-S,SUP,HCPCS C1713,,AT-1225-S  -  SCREW BN STD 3.3-4.6MM 22.5MM STRL ACTRK SLF CUT CNN VAR,$940.00,$0.00,$940.00,$423.00,$670.88,$0.00,$161.96,$0.00,$0.00,$164.59,$940.00,$0.00,$470.00,$744.48,$752.00,$0.00,$147.11,$0.00,$149.65,$0.00
AT-1250-S,SUP,HCPCS C1713,,AT-1250-S  -  SCREW BN STD 3.3-4.6MM 25MM STRL ACTRK SLF CUT CNN VAR PTCH,$940.00,$0.00,$940.00,$423.00,$670.88,$0.00,$161.96,$0.00,$0.00,$164.59,$940.00,$0.00,$470.00,$744.48,$752.00,$0.00,$147.11,$0.00,$149.65,$0.00
AT-1275-S,SUP,HCPCS C1713,,AT-1275-S  -  SCREW BN STD 3.3-4.6MM 27.5MM STRL ACTRK SLF CUT CNN VAR,$940.00,$0.00,$940.00,$423.00,$670.88,$0.00,$161.96,$0.00,$0.00,$164.59,$940.00,$0.00,$470.00,$744.48,$752.00,$0.00,$147.11,$0.00,$149.65,$0.00
AT-1300-S,SUP,HCPCS C1713,,AT-1300-S  -  SCREW BN STD 3.3-4.6MM 30MM STRL ACTRK SLF CUT CNN VAR PTCH,$940.00,$0.00,$940.00,$423.00,$670.88,$0.00,$161.96,$0.00,$0.00,$164.59,$940.00,$0.00,$470.00,$744.48,$752.00,$0.00,$147.11,$0.00,$149.65,$0.00
AT2-1509,SUP,Custom 27203010,,AT2-1509  -  BIT DRL 2 MIC ACUTRAL,$567.50,$0.00,$567.50,$0.00,$405.02,$0.00,$0.00,$0.00,$0.00,$0.00,$567.50,$0.00,$283.75,$449.46,$454.00,$0.00,$0.00,$0.00,$0.00,$0.00
AT2-2515,SUP,Custom 27203010,,AT2-2515  -  BIT DRL STD ACTRK2,$567.50,$0.00,$567.50,$0.00,$405.02,$0.00,$0.00,$0.00,$0.00,$0.00,$567.50,$0.00,$283.75,$449.46,$454.00,$0.00,$0.00,$0.00,$0.00,$0.00
AT2-3500,SUP,HCPCS C1769,,AT2-3500  -  GUIDEWIRE ORTH .035IN PRLL,$600.00,$0.00,$600.00,$325.80,$428.22,$0.00,$103.38,$0.00,$0.00,$105.06,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$93.90,$0.00,$95.52,$0.00
AT2-4500,SUP,HCPCS C1769,,AT2-4500  -  GWIRE ORTH .045IN PRLL,$560.00,$0.00,$560.00,$304.08,$399.67,$0.00,$96.49,$0.00,$0.00,$98.05,$560.00,$0.00,$280.00,$443.52,$448.00,$0.00,$87.64,$0.00,$89.15,$0.00
AT2-520-S,SUP,HCPCS C1713,,AT2-520-S  -  SCREW BONE 20MM ACTRK2 STD STRL,"$1,062.50",$0.00,"$1,062.50",$478.13,$758.31,$0.00,$183.06,$0.00,$0.00,$186.04,"$1,062.50",$0.00,$531.25,$841.50,$850.00,$0.00,$166.28,$0.00,$169.15,$0.00
AT2-5400,SUP,HCPCS C1769,,AT2-5400  -  GWIRE ORTH .054IN PRLL,$560.00,$0.00,$560.00,$304.08,$399.67,$0.00,$96.49,$0.00,$0.00,$98.05,$560.00,$0.00,$280.00,$443.52,$448.00,$0.00,$87.64,$0.00,$89.15,$0.00
AT2-C08-S,SUP,HCPCS C1713,,AT2-C08-S  -  SCREW BN MIC 8MM FUSHIA,"$1,160.00",$0.00,"$1,160.00",$522.00,$827.89,$0.00,$199.86,$0.00,$0.00,$203.11,"$1,160.00",$0.00,$580.00,$918.72,$928.00,$0.00,$181.54,$0.00,$184.67,$0.00
AT2-C09-S,SUP,HCPCS C1713,,AT2-C09-S  -  SCREW BN MIC 9MM FUSHIA,"$1,160.00",$0.00,"$1,160.00",$522.00,$827.89,$0.00,$199.86,$0.00,$0.00,$203.11,"$1,160.00",$0.00,$580.00,$918.72,$928.00,$0.00,$181.54,$0.00,$184.67,$0.00
AT2-C10-S,SUP,HCPCS C1713,,AT2-C10-S  -  SCREW BN MIC 10MM FUSHIA,"$1,160.00",$0.00,"$1,160.00",$522.00,$827.89,$0.00,$199.86,$0.00,$0.00,$203.11,"$1,160.00",$0.00,$580.00,$918.72,$928.00,$0.00,$181.54,$0.00,$184.67,$0.00
AT2-C11-S,SUP,HCPCS C1713,,AT2-C11-S  -  SCREW BONE 2MM 11MM ACTRK TI MIC FULTHD ORTH SLFTAP CANN,"$1,160.00",$0.00,"$1,160.00",$522.00,$827.89,$0.00,$199.86,$0.00,$0.00,$203.11,"$1,160.00",$0.00,$580.00,$918.72,$928.00,$0.00,$181.54,$0.00,$184.67,$0.00
AT2-C12-S,SUP,HCPCS C1713,,AT2-C12-S  -  SCREW BN MIC 12MM FUSHIA,"$1,160.00",$0.00,"$1,160.00",$522.00,$827.89,$0.00,$199.86,$0.00,$0.00,$203.11,"$1,160.00",$0.00,$580.00,$918.72,$928.00,$0.00,$181.54,$0.00,$184.67,$0.00
AT2-C13-S,SUP,HCPCS C1713,,AT2-C13-S  -  SCREW BONE 2MM 13MM ACTRK2 TI MIC FULTHD ORTH SLFTAP CANN,"$1,160.00",$0.00,"$1,160.00",$522.00,$827.89,$0.00,$199.86,$0.00,$0.00,$203.11,"$1,160.00",$0.00,$580.00,$918.72,$928.00,$0.00,$181.54,$0.00,$184.67,$0.00
AT2-C14-S,SUP,HCPCS C1713,,AT2-C14-S  -  SCREW BN MIC 14MM FUSHIA,"$1,160.00",$0.00,"$1,160.00",$522.00,$827.89,$0.00,$199.86,$0.00,$0.00,$203.11,"$1,160.00",$0.00,$580.00,$918.72,$928.00,$0.00,$181.54,$0.00,$184.67,$0.00
AT2-C16-S,SUP,HCPCS C1713,,AT2-C16-S  -  SCREW BN MIC 16MM FUSHIA,"$1,160.00",$0.00,"$1,160.00",$522.00,$827.89,$0.00,$199.86,$0.00,$0.00,$203.11,"$1,160.00",$0.00,$580.00,$918.72,$928.00,$0.00,$181.54,$0.00,$184.67,$0.00
AT2-C18-S,SUP,HCPCS C1713,,AT2-C18-S  -  SCREW BN MIC 18MM FUSHIA,"$1,160.00",$0.00,"$1,160.00",$522.00,$827.89,$0.00,$199.86,$0.00,$0.00,$203.11,"$1,160.00",$0.00,$580.00,$918.72,$928.00,$0.00,$181.54,$0.00,$184.67,$0.00
AT2-C20-S,SUP,HCPCS C1713,,AT2-C20-S  -  SCREW BN MIC FT 2.5-2.8MM 20MM STRL ACTRK2 SLF CUT CNN VAR,"$1,160.00",$0.00,"$1,160.00",$522.00,$827.89,$0.00,$199.86,$0.00,$0.00,$203.11,"$1,160.00",$0.00,$580.00,$918.72,$928.00,$0.00,$181.54,$0.00,$184.67,$0.00
AT2L1813,SUP,Custom 27203010,,AT2L1813  -  BIT DRILL ACTRK2 MINI,$567.50,$0.00,$567.50,$0.00,$405.02,$0.00,$0.00,$0.00,$0.00,$0.00,$567.50,$0.00,$283.75,$449.46,$454.00,$0.00,$0.00,$0.00,$0.00,$0.00
AT2-L2515,SUP,HCPCS C1713,,AT2-L2515  -  BIT DRL LNG ACTRK2,$567.50,$0.00,$567.50,$255.38,$405.02,$0.00,$97.78,$0.00,$0.00,$99.36,$567.50,$0.00,$283.75,$449.46,$454.00,$0.00,$88.81,$0.00,$90.35,$0.00
AT2-M16-S,SUP,HCPCS C1713,,AT2-M16-S  -  SCREW BN MN FT 3.5-3.6MM 16MM STRL ACTRK2 SLF CUT CNN VAR,"$1,160.00",$0.00,"$1,160.00",$522.00,$827.89,$0.00,$199.86,$0.00,$0.00,$203.11,"$1,160.00",$0.00,$580.00,$918.72,$928.00,$0.00,$181.54,$0.00,$184.67,$0.00
AT2M-1813,SUP,Custom 27203010,,AT2M-1813  -  BIT DRILL 2MM ACTRK2 MINI PRFL 3.5-4MM SCR NONSTRL,$567.50,$0.00,$567.50,$0.00,$405.02,$0.00,$0.00,$0.00,$0.00,$0.00,$567.50,$0.00,$283.75,$449.46,$454.00,$0.00,$0.00,$0.00,$0.00,$0.00
AT2-M18-S,SUP,HCPCS C1713,,AT2-M18-S  -  SCREW BN MN 18MM STRL ACTRK2 TI ORTH,"$1,160.00",$0.00,"$1,160.00",$522.00,$827.89,$0.00,$199.86,$0.00,$0.00,$203.11,"$1,160.00",$0.00,$580.00,$918.72,$928.00,$0.00,$181.54,$0.00,$184.67,$0.00
AT2-M20-S,SUP,HCPCS C1713,,AT2-M20-S  -  SCREW BN MN 20MM STRL ACTRK2 TI ORTH,"$1,160.00",$0.00,"$1,160.00",$522.00,$827.89,$0.00,$199.86,$0.00,$0.00,$203.11,"$1,160.00",$0.00,$580.00,$918.72,$928.00,$0.00,$181.54,$0.00,$184.67,$0.00
AT2-M22-S,SUP,HCPCS C1713,,AT2-M22-S  -  SCREW BN MN FT 3.5-3.6MM 22MM STRL ACTRK2 SLF CUT CNN VAR,"$1,160.00",$0.00,"$1,160.00",$522.00,$827.89,$0.00,$199.86,$0.00,$0.00,$203.11,"$1,160.00",$0.00,$580.00,$918.72,$928.00,$0.00,$181.54,$0.00,$184.67,$0.00
AT2-M24-S,SUP,HCPCS C1713,,AT2-M24-S  -  SCREW BN MN 24MM STRL ACTRK2 TI ORTH,"$1,160.00",$0.00,"$1,160.00",$522.00,$827.89,$0.00,$199.86,$0.00,$0.00,$203.11,"$1,160.00",$0.00,$580.00,$918.72,$928.00,$0.00,$181.54,$0.00,$184.67,$0.00
AT2M-26S,SUP,HCPCS C1713,,AT2M-26S  -  SCREW BONE 26MM ACTRK2 MINI STRL,"$1,062.50",$0.00,"$1,062.50",$478.13,$758.31,$0.00,$183.06,$0.00,$0.00,$186.04,"$1,062.50",$0.00,$531.25,$841.50,$850.00,$0.00,$166.28,$0.00,$169.15,$0.00
AT2-M26-S,SUP,HCPCS C1713,,AT2-M26-S  -  SCREW BN MN FT 3.5-3.6MM 26MM STRL ACTRK2 SLF CUT CNN VAR,"$1,160.00",$0.00,"$1,160.00",$522.00,$827.89,$0.00,$199.86,$0.00,$0.00,$203.11,"$1,160.00",$0.00,$580.00,$918.72,$928.00,$0.00,$181.54,$0.00,$184.67,$0.00
AT2M-28S,SUP,HCPCS C1713,,AT2M-28S  -  SCREW BONE 28MM ACTRK2 MINI STRL,"$1,062.50",$0.00,"$1,062.50",$478.13,$758.31,$0.00,$183.06,$0.00,$0.00,$186.04,"$1,062.50",$0.00,$531.25,$841.50,$850.00,$0.00,$166.28,$0.00,$169.15,$0.00
AT2-M28-S,SUP,HCPCS C1713,,AT2-M28-S  -  SCREW BN MN FT 3.5-3.6MM 28MM STRL ACTRK2 SLF CUT CNN VAR,"$1,160.00",$0.00,"$1,160.00",$522.00,$827.89,$0.00,$199.86,$0.00,$0.00,$203.11,"$1,160.00",$0.00,$580.00,$918.72,$928.00,$0.00,$181.54,$0.00,$184.67,$0.00
AT2-M30-S,SUP,HCPCS C1713,,AT2-M30-S  -  SCREW 30.0MM MINI ACUTRAK 2 BONE,"$1,160.00",$0.00,"$1,160.00",$522.00,$827.89,$0.00,$199.86,$0.00,$0.00,$203.11,"$1,160.00",$0.00,$580.00,$918.72,$928.00,$0.00,$181.54,$0.00,$184.67,$0.00
AT2M-L1813,SUP,Custom 27203010,,AT2M-L1813  -  BIT DRL MN,$567.50,$0.00,$567.50,$0.00,$405.02,$0.00,$0.00,$0.00,$0.00,$0.00,$567.50,$0.00,$283.75,$449.46,$454.00,$0.00,$0.00,$0.00,$0.00,$0.00
AT2-ML1813,SUP,Custom 27203010,,BIT DRILL ACTRK2 MINI LNG INSTR,$467.50,$0.00,$467.50,$0.00,$333.65,$0.00,$0.00,$0.00,$0.00,$0.00,$467.50,$0.00,$233.75,$370.26,$374.00,$0.00,$0.00,$0.00,$0.00,$0.00
AT2ML1816,SUP,Custom 27203010,,AT2ML1816  -  BIT DRILL,$567.50,$0.00,$567.50,$0.00,$405.02,$0.00,$0.00,$0.00,$0.00,$0.00,$567.50,$0.00,$283.75,$449.46,$454.00,$0.00,$0.00,$0.00,$0.00,$0.00
AT2-S16-S,SUP,HCPCS C1713,,AT2-S16-S  -  SCREW BN STD 2MM 16MM ACTRK2,"$1,160.00",$0.00,"$1,160.00",$522.00,$827.89,$0.00,$199.86,$0.00,$0.00,$203.11,"$1,160.00",$0.00,$580.00,$918.72,$928.00,$0.00,$181.54,$0.00,$184.67,$0.00
AT2-S18-S,SUP,HCPCS C1713,,AT2-S18-S  -  SCREW BN STD FT 4-4.1MM 18MM STRL ACTRK2 SLF CUT CNN VAR,"$1,160.00",$0.00,"$1,160.00",$522.00,$827.89,$0.00,$199.86,$0.00,$0.00,$203.11,"$1,160.00",$0.00,$580.00,$918.72,$928.00,$0.00,$181.54,$0.00,$184.67,$0.00
AT2-S20-S,SUP,HCPCS C1713,,AT2-S20-S  -  SCREW BN STD FT 4-4.1MM 20MM STRL ACTRK2 SLF CUT CNN VAR,"$1,160.00",$0.00,"$1,160.00",$522.00,$827.89,$0.00,$199.86,$0.00,$0.00,$203.11,"$1,160.00",$0.00,$580.00,$918.72,$928.00,$0.00,$181.54,$0.00,$184.67,$0.00
AT2-S22-S,SUP,HCPCS C1713,,AT2-S22-S  -  SCREW BN STD FT 4-4.1MM 22MM STRL ACTRK2 SLF CUT CNN VAR,"$1,160.00",$0.00,"$1,160.00",$522.00,$827.89,$0.00,$199.86,$0.00,$0.00,$203.11,"$1,160.00",$0.00,$580.00,$918.72,$928.00,$0.00,$181.54,$0.00,$184.67,$0.00
AT2-S24-S,SUP,HCPCS C1713,,AT2-S24-S  -  SCREW BN 24MM STRL,"$1,160.00",$0.00,"$1,160.00",$522.00,$827.89,$0.00,$199.86,$0.00,$0.00,$203.11,"$1,160.00",$0.00,$580.00,$918.72,$928.00,$0.00,$181.54,$0.00,$184.67,$0.00
AT2-S26-S,SUP,HCPCS C1713,,AT2-S26-S  -  SCREW BN STD FT 4-4.1MM 26MM STRL ACTRK2 SLFCT CNN CMPR HEX,"$1,160.00",$0.00,"$1,160.00",$522.00,$827.89,$0.00,$199.86,$0.00,$0.00,$203.11,"$1,160.00",$0.00,$580.00,$918.72,$928.00,$0.00,$181.54,$0.00,$184.67,$0.00
AT2-S28-S,SUP,HCPCS C1713,,AT2-S28-S  -  SCREW BN STD 2MM 28MM ACTRK2,"$1,160.00",$0.00,"$1,160.00",$522.00,$827.89,$0.00,$199.86,$0.00,$0.00,$203.11,"$1,160.00",$0.00,$580.00,$918.72,$928.00,$0.00,$181.54,$0.00,$184.67,$0.00
AT2-S30-S,SUP,HCPCS C1713,,AT2-S30-S  -  SCREW BONE 2MM 30MM ACTRK2 TI STD HINDFOOT ANKL SLFTAP CANN,"$1,160.00",$0.00,"$1,160.00",$522.00,$827.89,$0.00,$199.86,$0.00,$0.00,$203.11,"$1,160.00",$0.00,$580.00,$918.72,$928.00,$0.00,$181.54,$0.00,$184.67,$0.00
AT2-S32-S,SUP,HCPCS C1713,,AT2-S32-S  -  SCREW BONE 2MM 32MM ACTRK2 TI STD FT HAND SLFTAP CANN CMPR,"$1,160.00",$0.00,"$1,160.00",$522.00,$827.89,$0.00,$199.86,$0.00,$0.00,$203.11,"$1,160.00",$0.00,$580.00,$918.72,$928.00,$0.00,$181.54,$0.00,$184.67,$0.00
AT2-S34-S,SUP,HCPCS C1713,,AT2-S34-S  -  SCREW BONE 2MM 34MM ACTRK2 TI STD FT HAND SLFTAP CANN CMPR,"$1,160.00",$0.00,"$1,160.00",$522.00,$827.89,$0.00,$199.86,$0.00,$0.00,$203.11,"$1,160.00",$0.00,$580.00,$918.72,$928.00,$0.00,$181.54,$0.00,$184.67,$0.00
AT-7032,SUP,Custom 27203010,,AT-7032  -  BIT DRL STD TPR 2.5MM 4.7MM STRL ACTRK CNN TI,$180.00,$0.00,$180.00,$0.00,$128.47,$0.00,$0.00,$0.00,$0.00,$0.00,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$0.00,$0.00,$0.00,$0.00
AT-7044,SUP,Custom 27203010,,AT-7044  -  BIT DRILL ACTRK STD BONE CANN DNS STRL,$180.00,$0.00,$180.00,$0.00,$128.47,$0.00,$0.00,$0.00,$0.00,$0.00,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$0.00,$0.00,$0.00,$0.00
ATF-024,SUP,Custom 27203010,,ATF-024  -  DRILL SRG 24MM ACTRK FSN,$180.00,$0.00,$180.00,$0.00,$128.47,$0.00,$0.00,$0.00,$0.00,$0.00,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$0.00,$0.00,$0.00,$0.00
ATF-032,SUP,Custom 27203010,,ATF-032  -  BIT DRILL 32MM ACTRK FSN STRL,$180.00,$0.00,$180.00,$0.00,$128.47,$0.00,$0.00,$0.00,$0.00,$0.00,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$0.00,$0.00,$0.00,$0.00
ATF-037,SUP,Custom 27203010,,ATF-037  -  BIT DRILL 37MM ACTRK FSN STRL,$180.00,$0.00,$180.00,$0.00,$128.47,$0.00,$0.00,$0.00,$0.00,$0.00,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$0.00,$0.00,$0.00,$0.00
ATF-140-S,SUP,HCPCS C1713,,ATF-140-S  -  SCREW BN 14MM ACTRK FSN,$810.00,$0.00,$810.00,$364.50,$578.10,$0.00,$139.56,$0.00,$0.00,$141.82,$810.00,$0.00,$405.00,$641.52,$648.00,$0.00,$126.77,$0.00,$128.95,$0.00
ATF-160-S,SUP,HCPCS C1713,,ATF-160-S  -  SCREW BN 16MM ACTRK FSN,$810.00,$0.00,$810.00,$364.50,$578.10,$0.00,$139.56,$0.00,$0.00,$141.82,$810.00,$0.00,$405.00,$641.52,$648.00,$0.00,$126.77,$0.00,$128.95,$0.00
ATF-180-S,SUP,HCPCS C1713,,ATF-180-S  -  SCREW BN 18MM ACTRK FSN,$810.00,$0.00,$810.00,$364.50,$578.10,$0.00,$139.56,$0.00,$0.00,$141.82,$810.00,$0.00,$405.00,$641.52,$648.00,$0.00,$126.77,$0.00,$128.95,$0.00
ATF-200-S,SUP,HCPCS C1713,,ATF-200-S  -  SCREW BN 20MM ACTRK FSN,$810.00,$0.00,$810.00,$364.50,$578.10,$0.00,$139.56,$0.00,$0.00,$141.82,$810.00,$0.00,$405.00,$641.52,$648.00,$0.00,$126.77,$0.00,$128.95,$0.00
ATF-220-S,SUP,HCPCS C1713,,ATF-220-S  -  SCREW BN 22MM ACTRK FSN,$810.00,$0.00,$810.00,$364.50,$578.10,$0.00,$139.56,$0.00,$0.00,$141.82,$810.00,$0.00,$405.00,$641.52,$648.00,$0.00,$126.77,$0.00,$128.95,$0.00
ATF-240-S,SUP,HCPCS C1713,,ATF-240-S  -  SCREW BN FT 2-2.5MM 24MM STRL ACTRK SLF CUT CNN FSN HDLS TI,$810.00,$0.00,$810.00,$364.50,$578.10,$0.00,$139.56,$0.00,$0.00,$141.82,$810.00,$0.00,$405.00,$641.52,$648.00,$0.00,$126.77,$0.00,$128.95,$0.00
ATF-270-S,SUP,HCPCS C1713,,ATF-270-S  -  SCREW BN FT 2.8-3.5MM 27MM STRL ACTRK SLF CUT CNN FSN HDLS,$810.00,$0.00,$810.00,$364.50,$578.10,$0.00,$139.56,$0.00,$0.00,$141.82,$810.00,$0.00,$405.00,$641.52,$648.00,$0.00,$126.77,$0.00,$128.95,$0.00
ATF-320-S,SUP,HCPCS C1713,,ATF-320-S  -  SCREW BONE 32MM ACTRK TI HAND FT STRL,$810.00,$0.00,$810.00,$364.50,$578.10,$0.00,$139.56,$0.00,$0.00,$141.82,$810.00,$0.00,$405.00,$641.52,$648.00,$0.00,$126.77,$0.00,$128.95,$0.00
ATF-370-S,SUP,Custom 27803010,,ATF-370-S  -  FUSION DEVICE 37.0MM ACUTRAK,$810.00,$0.00,$810.00,$0.00,$578.10,$0.00,$0.00,$0.00,$0.00,$0.00,$810.00,$0.00,$405.00,$641.52,$648.00,$0.00,$0.00,$0.00,$0.00,$0.00
ATM-008-S,SUP,HCPCS C1713,,ATM-008-S  -  SCREW BN 8MM ACTRK,$940.00,$0.00,$940.00,$423.00,$670.88,$0.00,$161.96,$0.00,$0.00,$164.59,$940.00,$0.00,$470.00,$744.48,$752.00,$0.00,$147.11,$0.00,$149.65,$0.00
ATM-078,SUP,Custom 27203010,,ATM-078  -  BIT DRILL MN ACTRK SHRT CANN STRL,$180.00,$0.00,$180.00,$0.00,$128.47,$0.00,$0.00,$0.00,$0.00,$0.00,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$0.00,$0.00,$0.00,$0.00
ATM-099,SUP,Custom 27203010,,ATM-099  -  BIT DRILL ACTRK LNG CANN TIP TPR STRL,$180.00,$0.00,$180.00,$0.00,$128.47,$0.00,$0.00,$0.00,$0.00,$0.00,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$0.00,$0.00,$0.00,$0.00
ATM-100-S,SUP,HCPCS C1713,,ATM-100-S  -  SCREW BN MN 10MM ACTRK FX,$940.00,$0.00,$940.00,$423.00,$670.88,$0.00,$161.96,$0.00,$0.00,$164.59,$940.00,$0.00,$470.00,$744.48,$752.00,$0.00,$147.11,$0.00,$149.65,$0.00
ATM-120-S,SUP,HCPCS C1713,,ATM-120-S  -  SCREW BN MN FT 2.8-3.6MM 12MM STRL ACTRK SLF CUT CNN VAR,$940.00,$0.00,$940.00,$423.00,$670.88,$0.00,$161.96,$0.00,$0.00,$164.59,$940.00,$0.00,$470.00,$744.48,$752.00,$0.00,$147.11,$0.00,$149.65,$0.00
ATM-140-S,SUP,HCPCS C1713,,ATM-140-S  -  SCREW BN MN FT 2.8-3.6MM 14MM STRL ACTRK SLF CUT CNN VAR,$940.00,$0.00,$940.00,$423.00,$670.88,$0.00,$161.96,$0.00,$0.00,$164.59,$940.00,$0.00,$470.00,$744.48,$752.00,$0.00,$147.11,$0.00,$149.65,$0.00
ATM-160-S,SUP,HCPCS C1713,,ATM-160-S  -  SCREW BN MN FT 2.8-3.6MM 16MM STRL ACTRK SLF CUT CNN VAR,$940.00,$0.00,$940.00,$423.00,$670.88,$0.00,$161.96,$0.00,$0.00,$164.59,$940.00,$0.00,$470.00,$744.48,$752.00,$0.00,$147.11,$0.00,$149.65,$0.00
ATM-180-S,SUP,HCPCS C1713,,ATM-180-S  -  SCREW BN MN FT 2.8-3.6MM 18MM STRL ACTRK SLF CUT CNN VAR,$940.00,$0.00,$940.00,$423.00,$670.88,$0.00,$161.96,$0.00,$0.00,$164.59,$940.00,$0.00,$470.00,$744.48,$752.00,$0.00,$147.11,$0.00,$149.65,$0.00
ATM-200-S,SUP,HCPCS C1713,,ATM-200-S  -  SCREW BN MN FT 2.8-3.6MM 20MM STRL ACTRK SLF CUT CNN VAR,$940.00,$0.00,$940.00,$423.00,$670.88,$0.00,$161.96,$0.00,$0.00,$164.59,$940.00,$0.00,$470.00,$744.48,$752.00,$0.00,$147.11,$0.00,$149.65,$0.00
ATM-220-S,SUP,HCPCS C1713,,ATM-220-S  -  SCREW BN MN FT 2.8-3.6MM 22MM STRL ACTRK SLF CUT CNN VAR,$940.00,$0.00,$940.00,$423.00,$670.88,$0.00,$161.96,$0.00,$0.00,$164.59,$940.00,$0.00,$470.00,$744.48,$752.00,$0.00,$147.11,$0.00,$149.65,$0.00
ATM-240-S,SUP,HCPCS C1713,,ATM-240-S  -  SCREW BN MN 24MM ACTRK FX,$940.00,$0.00,$940.00,$423.00,$670.88,$0.00,$161.96,$0.00,$0.00,$164.59,$940.00,$0.00,$470.00,$744.48,$752.00,$0.00,$147.11,$0.00,$149.65,$0.00
ATM-260-S,SUP,HCPCS C1713,,ATM-260-S  -  SCREW BN MN FT 2.8-3.6MM 26MM STRL ACTRK SLF CUT CNN VAR,$940.00,$0.00,$940.00,$423.00,$670.88,$0.00,$161.96,$0.00,$0.00,$164.59,$940.00,$0.00,$470.00,$744.48,$752.00,$0.00,$147.11,$0.00,$149.65,$0.00
AU00T0,SUP,HCPCS V2632,,AU00T0  -  LENS IOL 0D PLANAR 6MM 30MM ACRSF IQ STABLEFORCE ULTRASERT,$537.50,$0.00,$537.50,$241.88,$383.61,$0.00,$92.61,$0.00,$0.00,$94.11,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$84.12,$0.00,$85.57,$0.00
AVM851,SUP,Custom 27803010,,AVM851  -  CLIP INTNL SM STRL LF FLSH SFLN UPR JAW SIL TI FLLPN TUBE,$223.95,$0.00,$223.95,$0.00,$159.84,$0.00,$0.00,$0.00,$0.00,$0.00,$223.95,$0.00,$111.98,$177.37,$179.16,$0.00,$0.00,$0.00,$0.00,$0.00
AVSM10060,SUP,HCPCS C2625,,AVSM10060  -  STENT VASCULAR COVERA COVERED 10MM X 60MM 80CM DELIVERY STR,"$6,750.00",$0.00,"$6,750.00","$3,037.50","$4,817.48",$0.00,"$1,162.99",$0.00,$0.00,"$1,181.87","$6,750.00",$0.00,"$3,375.00","$5,346.00","$5,400.00",$0.00,"$1,056.38",$0.00,"$1,074.60",$0.00
AW-04018,SUP,HCPCS C1769,,GUIDEWIRE VASC .018IN 25CM STRG SFTP SPRG,$15.50,$0.00,$15.50,$8.42,$11.06,$0.00,$2.67,$0.00,$0.00,$2.71,$15.50,$0.00,$7.75,$12.28,$12.40,$0.00,$2.43,$0.00,$2.47,$0.00
AW04432,SUP,HCPCS C1769,,GUIDEWIRE VASC .032IN 60CM JTP STRG SFTP DUAL END SPRG ARW,$23.50,$0.00,$23.50,$12.76,$16.77,$0.00,$4.05,$0.00,$0.00,$4.11,$23.50,$0.00,$11.75,$18.61,$18.80,$0.00,$3.68,$0.00,$3.74,$0.00
AW-04432,SUP,HCPCS C1769,,GUIDEWIRE VASC .032IN 60CM JTP STRG SFTP DUAL END SPRG ARW,$58.75,$0.00,$58.75,$31.90,$41.93,$0.00,$10.12,$0.00,$0.00,$10.29,$58.75,$0.00,$29.38,$46.53,$47.00,$0.00,$9.19,$0.00,$9.35,$0.00
AW-14735,SUP,HCPCS C1769,,GUIDEWIRE VASC .35IN 65CM SPRG JTP 2 END STRG ARW ADV SS,$23.60,$0.00,$23.60,$12.81,$16.84,$0.00,$4.07,$0.00,$0.00,$4.13,$23.60,$0.00,$11.80,$18.69,$18.88,$0.00,$3.69,$0.00,$3.76,$0.00
AX100,SUP,Custom 27203010,,CALIBRATOR A MLTLY 5ML IMMUN,"$1,452.78",$0.00,"$1,452.78",$0.00,"$1,036.85",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,452.78",$0.00,$726.39,"$1,150.60","$1,162.22",$0.00,$0.00,$0.00,$0.00,$0.00
AX9001,SUP,Custom 27203010,,REAGENT A MLTLY DLY MNTN ANALY,$460.95,$0.00,$460.95,$0.00,$328.98,$0.00,$0.00,$0.00,$0.00,$0.00,$460.95,$0.00,$230.48,$365.07,$368.76,$0.00,$0.00,$0.00,$0.00,$0.00
B000-0185,SUP,HCPCS C1713,,B000-0185  -  RESTRICTOR CEMENT SMALL UNIVERSAL 18.5MM REVISION PLUG HIP,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
B000-0200,SUP,HCPCS C1713,,B000-0200  -  PLUG BONE CMNT MED UNV 20MM,$188.00,$0.00,$188.00,$84.60,$134.18,$0.00,$32.39,$0.00,$0.00,$32.92,$188.00,$0.00,$94.00,$148.90,$150.40,$0.00,$29.42,$0.00,$29.93,$0.00
B000-0240,SUP,HCPCS C1713,,B000-0240  -  RSTRC CMNT MED UNV 24MM HIP REV,$183.00,$0.00,$183.00,$82.35,$130.61,$0.00,$31.53,$0.00,$0.00,$32.04,$183.00,$0.00,$91.50,$144.94,$146.40,$0.00,$28.64,$0.00,$29.13,$0.00
B000-0300,SUP,HCPCS C1713,,B000-0300  -  RESTRICTOR CEMENT XL UNIVERSAL 30MM REVISION HIP,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
B000-1185,SUP,HCPCS C1713,,B000-1185  -  RESTRICTOR CEMENT SMALL UNIVERSAL DISPOSABLE INSERTER DISTAL,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
B000-1240,SUP,HCPCS C1713,,B000-1240  -  RESTRICTOR CEMENT MEDIUM UNIVERSAL DISPOSABLE INSERTER,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
B000-1300,SUP,HCPCS C1713,,B000-1300  -  RESTRICTOR CEMENT UNIVERSAL DISPOSABLE INSERTER,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
B001-0110,SUP,HCPCS C1713,,B001-0110  -  PLUG BONE CEMENT 1 11MM UHMWPE HIP,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
B002-0125,SUP,HCPCS C1713,,B002-0125  -  PLUG BONE CEMENT 2 12.5MM UHMWPE HIP,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
B003-0140,SUP,HCPCS C1713,,B003-0140  -  PLUG BONE CEMENT 3 17.5MM UHMWPE HIP,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
B004-0155,SUP,HCPCS C1713,,B004-0155  -  PLUG BONE CEMENT 4 23MM UHMWPE HIP,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
B005-0170,SUP,HCPCS C1713,,B005-0170  -  PLUG BONE CEMENT 5 17MM UHMWPE HIP,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
B006-0185,SUP,HCPCS C1713,,B006-0185  -  PLUG BONE CEMENT 6 18MM UHMWPE HIP,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
B007-0200,SUP,HCPCS C1713,,B007-0200  -  PLUG BONE CEMENT 7 20MM UHMWPE HIP,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
B008-0215,SUP,HCPCS C1713,,B008-0215  -  PLUG BONE CEMENT 8 21.5MM  UHMWPE,$112.50,$0.00,$112.50,$50.63,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
B1000729BL,SUP,Custom 27203010,,CASSETTE TISS BLUE SHDN EMBD DISP,$288.18,$0.00,$288.18,$0.00,$205.67,$0.00,$0.00,$0.00,$0.00,$0.00,$288.18,$0.00,$144.09,$228.24,$230.54,$0.00,$0.00,$0.00,$0.00,$0.00
B1000729DRD,SUP,Custom 27203010,,CASSETTE TISS ANTM PTH 2,$328.35,$0.00,$328.35,$0.00,$234.34,$0.00,$0.00,$0.00,$0.00,$0.00,$328.35,$0.00,$164.18,$260.05,$262.68,$0.00,$0.00,$0.00,$0.00,$0.00
B1000729OR,SUP,Custom 27203010,,CASSETTE TISS ORNG SHDN EMBD 2 DISP,$262.25,$0.00,$262.25,$0.00,$187.17,$0.00,$0.00,$0.00,$0.00,$0.00,$262.25,$0.00,$131.13,$207.70,$209.80,$0.00,$0.00,$0.00,$0.00,$0.00
B1000729PK,SUP,Custom 27203010,,CASSETTE TISS PNK SHDN EMBD DISP,$326.50,$0.00,$326.50,$0.00,$233.02,$0.00,$0.00,$0.00,$0.00,$0.00,$326.50,$0.00,$163.25,$258.59,$261.20,$0.00,$0.00,$0.00,$0.00,$0.00
B1000729WH,SUP,Custom 27203010,,CASSETTE TISS/BIOP WHT EMBD SM SLOT ACTL PLMR,$262.25,$0.00,$262.25,$0.00,$187.17,$0.00,$0.00,$0.00,$0.00,$0.00,$262.25,$0.00,$131.13,$207.70,$209.80,$0.00,$0.00,$0.00,$0.00,$0.00
B10-27A-00,SUP,Custom 27803010,,B10-27A-00  -  VALVE AORTIC 17MM 27MM BIOCOR PIG STNT LP FLEXFIT STENT,"$19,200.00",$0.00,"$19,200.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$19,200.00",$0.00,"$9,600.00","$15,206.40","$15,360.00",$0.00,$0.00,$0.00,$0.00,$0.00
B1036-1,SUP,Custom 27203010,,KIT PR RTCLN RVIR EIA DIR AG DTCT MICROTITRATION VIR TST 48,$789.23,$0.00,$789.23,$0.00,$563.27,$0.00,$0.00,$0.00,$0.00,$0.00,$789.23,$0.00,$394.61,$625.07,$631.38,$0.00,$0.00,$0.00,$0.00,$0.00
B1046-23,SUP,Custom 27203010,,KIT IMMUN TST GNGN 2 N GC 24 TST,$181.90,$0.00,$181.90,$0.00,$129.82,$0.00,$0.00,$0.00,$0.00,$0.00,$181.90,$0.00,$90.95,$144.06,$145.52,$0.00,$0.00,$0.00,$0.00,$0.00
B1055-16A,SUP,Custom 27203010,,REAGENT MYCL CALCOFLUOR WHT DRPR .5ML,$135.93,$0.00,$135.93,$0.00,$97.01,$0.00,$0.00,$0.00,$0.00,$0.00,$135.93,$0.00,$67.96,$107.66,$108.74,$0.00,$0.00,$0.00,$0.00,$0.00
B1055-4,SUP,Custom 27203010,,REAGENT MCBL INDOPHENOL OXDS DRPR CRUSHABLE AMPULE BBL .5ML,$1.28,$0.00,$1.28,$0.00,$0.91,$0.00,$0.00,$0.00,$0.00,$0.00,$1.28,$0.00,$0.64,$1.01,$1.02,$0.00,$0.00,$0.00,$0.00,$0.00
B1076-1B,SUP,Custom 25003010,,DISK NITROCEFIN B LCTMS DTCT BBL ID,$125.60,$0.00,$125.60,$0.00,$89.64,$0.00,$0.00,$0.00,$0.00,$0.00,$125.60,$0.00,$62.80,$99.48,$100.48,$0.00,$0.00,$0.00,$0.00,$0.00
B12LT,SUP,Custom 27203010,,B12LT  -  TROCAR LAPSCOP 12MM 100MM STABILITY SLEEVE OPTICAL TIP,$475.45,$0.00,$475.45,$0.00,$339.33,$0.00,$0.00,$0.00,$0.00,$0.00,$475.45,$0.00,$237.73,$376.56,$380.36,$0.00,$0.00,$0.00,$0.00,$0.00
B12XT,SUP,Custom 27203010,,B12XT  -  TROCAR LAPSCOP 12MM 150MM STABILITY SLEEVE OPTICAL OBTURATOR,$536.91,$0.00,$536.91,$0.00,$383.19,$0.00,$0.00,$0.00,$0.00,$0.00,$536.91,$0.00,$268.45,$425.23,$429.53,$0.00,$0.00,$0.00,$0.00,$0.00
B2996-60,SUP,HCPCS C1760,,CLOSURE TUBE UNV NTR WHT XTRN SL CLR CD VRSSCLSR 10-16MM,$0.10,$0.00,$0.10,$0.05,$0.07,$0.00,$0.02,$0.00,$0.00,$0.02,$0.10,$0.00,$0.05,$0.08,$0.08,$0.00,$0.02,$0.00,$0.02,$0.00
B40826,SUP,Custom 27203010,,REAGENT MCBL COAG PLSM EDTA RBT LYPH BBL 15ML,$581.23,$0.00,$581.23,$0.00,$414.82,$0.00,$0.00,$0.00,$0.00,$0.00,$581.23,$0.00,$290.61,$460.33,$464.98,$0.00,$0.00,$0.00,$0.00,$0.00
B4340863,SUP,Custom 27203010,,KIT MYCTST MYCOPREP NAOH NA CHLOR PHOS BUFF DCNT DGST 150ML,$447.88,$0.00,$447.88,$0.00,$319.65,$0.00,$0.00,$0.00,$0.00,$0.00,$447.88,$0.00,$223.94,$354.72,$358.30,$0.00,$0.00,$0.00,$0.00,$0.00
B500-5016,SUP,HCPCS C1713,,B500-5016  -  SCREW BONE 5MM 16MM CORT,$89.38,$0.00,$89.38,$40.22,$63.79,$0.00,$15.40,$0.00,$0.00,$15.65,$89.38,$0.00,$44.69,$70.79,$71.50,$0.00,$13.99,$0.00,$14.23,$0.00
B500-5020,SUP,HCPCS C1713,,B500-5020  -  SCREW BONE 5MM 20MM CORT,$89.38,$0.00,$89.38,$40.22,$63.79,$0.00,$15.40,$0.00,$0.00,$15.65,$89.38,$0.00,$44.69,$70.79,$71.50,$0.00,$13.99,$0.00,$14.23,$0.00
B500-5024,SUP,HCPCS C1713,,B500-5024  -  SCREW BONE 5MM 24MM CORT,$89.38,$0.00,$89.38,$40.22,$63.79,$0.00,$15.40,$0.00,$0.00,$15.65,$89.38,$0.00,$44.69,$70.79,$71.50,$0.00,$13.99,$0.00,$14.23,$0.00
B500-5028,SUP,HCPCS C1713,,B500-5028  -  SCREW BONE 5MM 28MM CORT,$89.38,$0.00,$89.38,$40.22,$63.79,$0.00,$15.40,$0.00,$0.00,$15.65,$89.38,$0.00,$44.69,$70.79,$71.50,$0.00,$13.99,$0.00,$14.23,$0.00
B500-5032,SUP,HCPCS C1713,,B500-5032  -  SCREW BONE 5MM 32MM CORT,$89.38,$0.00,$89.38,$40.22,$63.79,$0.00,$15.40,$0.00,$0.00,$15.65,$89.38,$0.00,$44.69,$70.79,$71.50,$0.00,$13.99,$0.00,$14.23,$0.00
B500-5034,SUP,HCPCS C1713,,B500-5034  -  SCREW BONE 5MM 34MM CORT,$89.38,$0.00,$89.38,$40.22,$63.79,$0.00,$15.40,$0.00,$0.00,$15.65,$89.38,$0.00,$44.69,$70.79,$71.50,$0.00,$13.99,$0.00,$14.23,$0.00
B500-5036,SUP,HCPCS C1713,,B500-5036  -  SCREW BONE 5MM 36MM CORT,$89.38,$0.00,$89.38,$40.22,$63.79,$0.00,$15.40,$0.00,$0.00,$15.65,$89.38,$0.00,$44.69,$70.79,$71.50,$0.00,$13.99,$0.00,$14.23,$0.00
B500-5038,SUP,HCPCS C1713,,B500-5038  -  SCREW BONE 5MM 38MM CORT,$89.38,$0.00,$89.38,$40.22,$63.79,$0.00,$15.40,$0.00,$0.00,$15.65,$89.38,$0.00,$44.69,$70.79,$71.50,$0.00,$13.99,$0.00,$14.23,$0.00
B500-5040,SUP,HCPCS C1713,,B500-5040  -  SCREW BONE 5MM 40MM CORT,$89.38,$0.00,$89.38,$40.22,$63.79,$0.00,$15.40,$0.00,$0.00,$15.65,$89.38,$0.00,$44.69,$70.79,$71.50,$0.00,$13.99,$0.00,$14.23,$0.00
B500-5042,SUP,HCPCS C1713,,B500-5042  -  SCREW BONE 5MM 42MM CORT,$89.38,$0.00,$89.38,$40.22,$63.79,$0.00,$15.40,$0.00,$0.00,$15.65,$89.38,$0.00,$44.69,$70.79,$71.50,$0.00,$13.99,$0.00,$14.23,$0.00
B500-5044,SUP,HCPCS C1713,,B500-5044  -  SCREW BONE 5MM 44MM CORT,$89.38,$0.00,$89.38,$40.22,$63.79,$0.00,$15.40,$0.00,$0.00,$15.65,$89.38,$0.00,$44.69,$70.79,$71.50,$0.00,$13.99,$0.00,$14.23,$0.00
B500-5046,SUP,HCPCS C1713,,B500-5046  -  SCREW BONE 5MM 46MM CORT,$89.38,$0.00,$89.38,$40.22,$63.79,$0.00,$15.40,$0.00,$0.00,$15.65,$89.38,$0.00,$44.69,$70.79,$71.50,$0.00,$13.99,$0.00,$14.23,$0.00
B500-5048,SUP,HCPCS C1713,,B500-5048  -  SCREW BONE 5MM 48MM CORT,$89.38,$0.00,$89.38,$40.22,$63.79,$0.00,$15.40,$0.00,$0.00,$15.65,$89.38,$0.00,$44.69,$70.79,$71.50,$0.00,$13.99,$0.00,$14.23,$0.00
B500-5050,SUP,HCPCS C1713,,B500-5050  -  SCREW BONE 5MM 50MM CORT,$89.38,$0.00,$89.38,$40.22,$63.79,$0.00,$15.40,$0.00,$0.00,$15.65,$89.38,$0.00,$44.69,$70.79,$71.50,$0.00,$13.99,$0.00,$14.23,$0.00
B500-5052,SUP,HCPCS C1713,,B500-5052  -  SCREW BONE 5MM 52MM CORT,$89.38,$0.00,$89.38,$40.22,$63.79,$0.00,$15.40,$0.00,$0.00,$15.65,$89.38,$0.00,$44.69,$70.79,$71.50,$0.00,$13.99,$0.00,$14.23,$0.00
B500-5054,SUP,HCPCS C1713,,B500-5054  -  SCREW BONE 5MM 54MM CORT,$89.38,$0.00,$89.38,$40.22,$63.79,$0.00,$15.40,$0.00,$0.00,$15.65,$89.38,$0.00,$44.69,$70.79,$71.50,$0.00,$13.99,$0.00,$14.23,$0.00
B500-5056,SUP,HCPCS C1713,,B500-5056  -  SCREW BONE 5MM 56MM CORT,$89.38,$0.00,$89.38,$40.22,$63.79,$0.00,$15.40,$0.00,$0.00,$15.65,$89.38,$0.00,$44.69,$70.79,$71.50,$0.00,$13.99,$0.00,$14.23,$0.00
B56030,SUP,Custom 27203010,,KIT DRCGN EZ RSV CNTRL REAGENT TUBE TIP VIR TST 30 TST,$355.50,$0.00,$355.50,$0.00,$253.72,$0.00,$0.00,$0.00,$0.00,$0.00,$355.50,$0.00,$177.75,$281.56,$284.40,$0.00,$0.00,$0.00,$0.00,$0.00
B5LT,SUP,Custom 27203010,,B5LT  -  TROCAR LAPSCOP 5MM 100MM STABILITY SLEEVE CANNU XCEL,$349.76,$0.00,$349.76,$0.00,$249.63,$0.00,$0.00,$0.00,$0.00,$0.00,$349.76,$0.00,$174.88,$277.01,$279.81,$0.00,$0.00,$0.00,$0.00,$0.00
B5STF,SUP,Custom 27203010,,B5STF  -  TROCAR LAPSCP STD 5MM STRL LF VERSAONE FX CNN BLDE DISP,$73.97,$0.00,$73.97,$0.00,$52.79,$0.00,$0.00,$0.00,$0.00,$0.00,$73.97,$0.00,$36.98,$58.58,$59.17,$0.00,$0.00,$0.00,$0.00,$0.00
B5XT,SUP,Custom 27203010,,B5XT  -  TROCAR LAPSCOP 5MM 100MM STABILITY SLEEVE XCEL ENDOPATH,$405.73,$0.00,$405.73,$0.00,$289.57,$0.00,$0.00,$0.00,$0.00,$0.00,$405.73,$0.00,$202.86,$321.34,$324.58,$0.00,$0.00,$0.00,$0.00,$0.00
B6940-20,SUP,Custom 27203010,,CONTROL RPR BBL MACV CRD 1.5ML IMMUN,$46.10,$0.00,$46.10,$0.00,$32.90,$0.00,$0.00,$0.00,$0.00,$0.00,$46.10,$0.00,$23.05,$36.51,$36.88,$0.00,$0.00,$0.00,$0.00,$0.00
B6940-21,SUP,Custom 27203010,,DEVICE DISPENSTIRS RPR CRD IMMUN TST,$79.23,$0.00,$79.23,$0.00,$56.54,$0.00,$0.00,$0.00,$0.00,$0.00,$79.23,$0.00,$39.61,$62.75,$63.38,$0.00,$0.00,$0.00,$0.00,$0.00
B6940-4,SUP,Custom 27203010,,KIT MACV RPR QUAL SPOT CRD SERTST 10 TST,$243.75,$0.00,$243.75,$0.00,$173.96,$0.00,$0.00,$0.00,$0.00,$0.00,$243.75,$0.00,$121.88,$193.05,$195.00,$0.00,$0.00,$0.00,$0.00,$0.00
B6944-19,SUP,Custom 27203010,,KIT DRCGN RSV LAT FLW CLIA WVD VIR TST 30 TST,$994.50,$0.00,$994.50,$0.00,$709.77,$0.00,$0.00,$0.00,$0.00,$0.00,$994.50,$0.00,$497.25,$787.64,$795.60,$0.00,$0.00,$0.00,$0.00,$0.00
B9990800,SUP,Custom 27203010,,REAGENT CYTO RD CYRCH COLLECT FLUID ALC BS 3.8L,$278.58,$0.00,$278.58,$0.00,$198.82,$0.00,$0.00,$0.00,$0.00,$0.00,$278.58,$0.00,$139.29,$220.64,$222.86,$0.00,$0.00,$0.00,$0.00,$0.00
BA22-40/I13-40,SUP,Custom 27803010,,BA22-40/I13-40  -  GRAFT STNT 2 BRCH 22MM 13MM 40MM STRL LF 40MM AFX STRATA,"$28,950.00",$0.00,"$28,950.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$28,950.00",$0.00,"$14,475.00","$22,928.40","$23,160.00",$0.00,$0.00,$0.00,$0.00,$0.00
BA22-60/I13-40,SUP,Custom 27803010,,BA22-60/I13-40  -  GRAFT STNT BFUR 22-13MM 17FR 60MM 40MM AFX ACTIVESEAL STRATA,"$28,025.00",$0.00,"$28,025.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$28,025.00",$0.00,"$14,012.50","$22,195.80","$22,420.00",$0.00,$0.00,$0.00,$0.00,$0.00
BA22-70/I16-30,SUP,Custom 27803010,,BA22-70/I16-30  -  GRAFT STNT 2 BRCH 22MM 16MM 70MM STRL 30MM AFX LMB XTN PTFE,"$28,950.00",$0.00,"$28,950.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$28,950.00",$0.00,"$14,475.00","$22,928.40","$23,160.00",$0.00,$0.00,$0.00,$0.00,$0.00
BA25-70/I16-30,SUP,Custom 27803010,,BA25-70/I16-30  -  GRAFT STENT 70MM SELF EXPANDABLE MAIN BODY POLYPRO SUTURE,"$28,025.00",$0.00,"$28,025.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$28,025.00",$0.00,"$14,012.50","$22,195.80","$22,420.00",$0.00,$0.00,$0.00,$0.00,$0.00
BA25-80/I16-40,SUP,Custom 27803010,,BA25-80/I16-40  -  GRAFT STENT 80MM SELF EXPAND MAIN BODY AFX ACTIVESEAL STRATA,"$28,025.00",$0.00,"$28,025.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$28,025.00",$0.00,"$14,012.50","$22,195.80","$22,420.00",$0.00,$0.00,$0.00,$0.00,$0.00
BA28-70/I16-30,SUP,Custom 27803010,,BA28-70/I16-30  -  GRAFT STNT BFUR 28-16MM 17FR 70MM 30MM AFX ACTIVESEAL STRATA,"$28,237.50",$0.00,"$28,237.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$28,237.50",$0.00,"$14,118.75","$22,364.10","$22,590.00",$0.00,$0.00,$0.00,$0.00,$0.00
BC585049,SUP,Custom 27203010,,BC585049  -  CYSTOTOME IRR 50MM 45D ANG TIP,$95.65,$0.00,$95.65,$0.00,$68.27,$0.00,$0.00,$0.00,$0.00,$0.00,$95.65,$0.00,$47.83,$75.75,$76.52,$0.00,$0.00,$0.00,$0.00,$0.00
BCK9015,SUP,Custom 27804086,,BCK9015  -  SYSTEM BONE CMNT 15CM DLV NDL HNDL KT 11GA STRL AVTX,$537.50,$0.00,$537.50,$0.00,$383.61,$0.00,$0.00,$0.00,$0.00,$0.00,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$0.00,$0.00,$0.00,$0.00
BE1234,SUP,HCPCS C1713,,"BE1234  -  ROD, PEEK, 200MM",$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$129.22,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
BE6055,SUP,HCPCS L8613,,BE6055  -  SET ET 14GA 26IN STRL 24IN BLM-SNG INTRO NDL SHTH CATH PNCT,$589.50,$0.00,$589.50,$0.00,$420.73,$0.00,$0.00,$0.00,$0.00,$0.00,$589.50,$0.00,$294.75,$466.88,$471.60,$0.00,$0.00,$0.00,$0.00,$0.00
BEA22-70/I16-30,SUP,Custom 27803010,,BEA22-70/I16-30  -  GRAFT STNT 2 BRCH 22MM 16MM 70MM STRL LF 30MM AFX2 MAIN BD,"$34,997.50",$0.00,"$34,997.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$34,997.50",$0.00,"$17,498.75","$27,718.02","$27,998.00",$0.00,$0.00,$0.00,$0.00,$0.00
BG101-350,SUP,HCPCS C1783,,BG101-350  -  DRAIN GLAUCOMA IMNPLANT BAERVELDT SILICONE ANTER CHAM,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
BG3510-5-US,SUP,HCPCS A4364,,BG3510-5-US  -  ADH SURG BIOGL SFT TIS BSA GLUT PREFL SYR 10ML STRL LATEX,"$1,725.00",$0.00,"$1,725.00",$936.68,"$1,231.13",$0.00,$2.34,$0.00,$0.00,$302.03,"$1,725.00",$0.00,$862.50,"$1,366.20","$1,380.00",$0.00,$269.96,$0.00,$274.62,$0.00
BG-8006-S,SUP,Custom 27203010,,BG-8006-S  -  BIT DRILL 6MM BNGFT BNGFT SYS STRL,$965.00,$0.00,$965.00,$0.00,$688.72,$0.00,$0.00,$0.00,$0.00,$0.00,$965.00,$0.00,$482.50,$764.28,$772.00,$0.00,$0.00,$0.00,$0.00,$0.00
BG-8010-S,SUP,Custom 27203010,,BG-8010-S  -  BIT DRILL 8MM BNGFT BNGFT SYS STRL,$965.00,$0.00,$965.00,$0.00,$688.72,$0.00,$0.00,$0.00,$0.00,$0.00,$965.00,$0.00,$482.50,$764.28,$772.00,$0.00,$0.00,$0.00,$0.00,$0.00
BG-8020-S,SUP,Custom 27203010,,BG-8020-S  -  BIT DRILL 10MM BNGFT BNGFT SYS STRL,$965.00,$0.00,$965.00,$0.00,$688.72,$0.00,$0.00,$0.00,$0.00,$0.00,$965.00,$0.00,$482.50,$764.28,$772.00,$0.00,$0.00,$0.00,$0.00,$0.00
BG-8030-S,SUP,Custom 27203010,,BG-8030-S  -  BIT DRILL 12MM BNGFT BNGFT SYS STRL,$965.00,$0.00,$965.00,$0.00,$688.72,$0.00,$0.00,$0.00,$0.00,$0.00,$965.00,$0.00,$482.50,$764.28,$772.00,$0.00,$0.00,$0.00,$0.00,$0.00
BG-8040,SUP,Custom 27203010,,BG-8040  -  ADPR TBG HDSN FIT,$510.00,$0.00,$510.00,$0.00,$363.99,$0.00,$0.00,$0.00,$0.00,$0.00,$510.00,$0.00,$255.00,$403.92,$408.00,$0.00,$0.00,$0.00,$0.00,$0.00
BG-8043,SUP,Custom 27203010,,BG-8043  -  HANDLE RCHT T BNGFT,"$2,287.50",$0.00,"$2,287.50",$0.00,"$1,632.59",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,287.50",$0.00,"$1,143.75","$1,811.70","$1,830.00",$0.00,$0.00,$0.00,$0.00,$0.00
BG-8044,SUP,Custom 27203010,,BG-8044  -  ADPR CHK JCB,$572.50,$0.00,$572.50,$0.00,$408.59,$0.00,$0.00,$0.00,$0.00,$0.00,$572.50,$0.00,$286.25,$453.42,$458.00,$0.00,$0.00,$0.00,$0.00,$0.00
BG-8060,SUP,Custom 27203010,,BG-8060  -  EXTRACTOR SRG G S GFT,$162.50,$0.00,$162.50,$0.00,$115.98,$0.00,$0.00,$0.00,$0.00,$0.00,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$0.00,$0.00,$0.00,$0.00
BG-8064,SUP,Custom 27203010,,BG-8064  -  EXTRACTOR SRG 6MM G S,$162.50,$0.00,$162.50,$0.00,$115.98,$0.00,$0.00,$0.00,$0.00,$0.00,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$0.00,$0.00,$0.00,$0.00
BG-8080,SUP,Custom 27203010,,BG-8080  -  PUNCH SRG GFT TROC,$205.00,$0.00,$205.00,$0.00,$146.31,$0.00,$0.00,$0.00,$0.00,$0.00,$205.00,$0.00,$102.50,$162.36,$164.00,$0.00,$0.00,$0.00,$0.00,$0.00
BI-2030,SUP,Custom 27203010,,BI-2030  -  CIRCUIT BREATHING 9X8X3IN TRANSPORT TEST CAP PORTABLE,$73.61,$0.00,$73.61,$0.00,$52.53,$0.00,$0.00,$0.00,$0.00,$0.00,$73.61,$0.00,$36.80,$58.30,$58.89,$0.00,$0.00,$0.00,$0.00,$0.00
BK406,SUP,Custom 27203010,,BK406  -  PROTECTOR STUMP ROOKE BKA,$622.50,$0.00,$622.50,$0.00,$444.28,$0.00,$0.00,$0.00,$0.00,$0.00,$622.50,$0.00,$311.25,$493.02,$498.00,$0.00,$0.00,$0.00,$0.00,$0.00
BL5115-2,SUP,Custom 27203010,,BL5115-2  -  PACK SRG STD NS LF ADP FLUIDICS DISP,$160.00,$0.00,$160.00,$0.00,$114.19,$0.00,$0.00,$0.00,$0.00,$0.00,$160.00,$0.00,$80.00,$126.72,$128.00,$0.00,$0.00,$0.00,$0.00,$0.00
BM200,SUP,Custom 27203010,,BM200  -  BONE MILL BM200 LEGEND PNEU DISPOSABLE,$627.75,$0.00,$627.75,$0.00,$448.03,$0.00,$0.00,$0.00,$0.00,$0.00,$627.75,$0.00,$313.88,$497.18,$502.20,$0.00,$0.00,$0.00,$0.00,$0.00
BMW2021,SUP,HCPCS Q4108,,BMW2021  -  DRESSING BIO 2X2IN STRL LF INTGR BL MX BVN CLGN GAG,"$5,877.25",$0.00,"$5,877.25",$0.00,"$4,194.59",$0.00,"$1,012.62",$0.00,$0.00,$0.00,"$5,877.25",$0.00,"$2,938.63","$4,654.78","$4,701.80",$0.00,$39.86,$0.00,$0.00,$0.00
BMW8101,SUP,HCPCS Q4104,,BMW8101  -  DRESSING BIOLOGICAL 10X8IN ADHERENT BILAYER MATRIX FLEXIBLE,"$27,151.33",$0.00,"$27,151.33","$12,218.10","$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$27,151.33",$0.00,"$13,575.66","$21,503.85","$21,721.06",$0.00,$0.00,$0.00,"$4,322.49",$0.00
BP10405,SUP,Custom 27803010,,BP10405  -  BP SUTURABLE GRAFT 4CM X 5CM,$978.25,$0.00,$978.25,$0.00,$698.18,$0.00,$0.00,$0.00,$0.00,$0.00,$978.25,$0.00,$489.13,$774.77,$782.60,$0.00,$0.00,$0.00,$0.00,$0.00
BP10608,SUP,Custom 27803010,,BP10608  -  BP SUTURABLE GRAFT 6CM X 8CM,"$1,264.90",$0.00,"$1,264.90",$0.00,$902.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,264.90",$0.00,$632.45,"$1,001.80","$1,011.92",$0.00,$0.00,$0.00,$0.00,$0.00
BP10812,SUP,Custom 27803010,,BP10812  -  BP SUTURABLE GRAFT 8CM X 12CM,"$2,083.90",$0.00,"$2,083.90",$0.00,"$1,487.28",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,083.90",$0.00,"$1,041.95","$1,650.45","$1,667.12",$0.00,$0.00,$0.00,$0.00,$0.00
BP11216,SUP,Custom 27803010,,BP11216  -  GRAFT SFT TIS 12X16CM STRL TTPLST RSRB SUTURABLE,"$3,884.80",$0.00,"$3,884.80",$0.00,"$2,772.58",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,884.80",$0.00,"$1,942.40","$3,076.76","$3,107.84",$0.00,$0.00,$0.00,$0.00,$0.00
BRC000410-00,SUP,HCPCS C1725,,BRC000410-00  -  CATHETER BLNOCC 4MM 10MM ASCNT CMPT SYS MCIOL NRVSC ANRSM,"$2,915.00",$0.00,"$2,915.00","$1,582.85","$2,080.44",$0.00,$502.24,$0.00,$0.00,$510.39,"$2,915.00",$0.00,"$1,457.50","$2,308.68","$2,332.00",$0.00,$456.20,$0.00,$464.07,$0.00
BRC000415-00,SUP,HCPCS C1725,,BRC000415-00  -  CATHETER BLNOCC 4MM 15MM ASCNT REMODEL,"$2,915.00",$0.00,"$2,915.00","$1,582.85","$2,080.44",$0.00,$502.24,$0.00,$0.00,$510.39,"$2,915.00",$0.00,"$1,457.50","$2,308.68","$2,332.00",$0.00,$456.20,$0.00,$464.07,$0.00
BRS000609-00,SUP,HCPCS C1725,,BRS000609-00  -  CATHETER BLNOCC 6MM 9MM ASCNT REMODEL,"$2,915.00",$0.00,"$2,915.00","$1,582.85","$2,080.44",$0.00,$502.24,$0.00,$0.00,$510.39,"$2,915.00",$0.00,"$1,457.50","$2,308.68","$2,332.00",$0.00,$456.20,$0.00,$464.07,$0.00
BSCLX351304100,SUP,Custom 27203010,,BSCLX351304100  -  CATHETER BLNDIL 4MM 130CM LF 100MM LUTONIX 035 PCLTXL ACPT,"$3,500.00",$0.00,"$3,500.00",$0.00,"$2,497.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
BSCLX351304120,SUP,Custom 27203010,,BSCLX351304120  -  CATHETER BLNDIL 4MM 130CM LF 120MM LUTONIX 035 PCLTXL ACPT,"$3,500.00",$0.00,"$3,500.00",$0.00,"$2,497.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
BSCLX351304150,SUP,Custom 27203010,,BSCLX351304150  -  CATHETER BLNDIL 4MM 130CM LF 150MM LUTONIX 035 PCLTXL ACPT,"$3,500.00",$0.00,"$3,500.00",$0.00,"$2,497.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
BSCLX35130440,SUP,Custom 27203010,,BSCLX35130440  -  CATHETER BLNDIL 4MM 130CM LF 40MM LUTONIX 035 PCLTXL ACPT,"$3,500.00",$0.00,"$3,500.00",$0.00,"$2,497.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
BSCLX35130460,SUP,Custom 27203010,,BSCLX35130460  -  CATHETER BLNDIL 4MM 130CM LF 60MM LUTONIX 035 PCLTXL ACPT,"$3,500.00",$0.00,"$3,500.00",$0.00,"$2,497.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
BSCLX35130480,SUP,Custom 27203010,,BSCLX35130480  -  CATHETER BLNDIL 4MM 130CM LF 80MM LUTONIX 035 PCLTXL ACPT,"$3,500.00",$0.00,"$3,500.00",$0.00,"$2,497.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
BSCLX351305100,SUP,Custom 27203010,,BSCLX351305100  -  CATHETER BLNDIL 5MM 130CM LF 100MM LUTONIX 035 PCLTXL ACPT,"$3,500.00",$0.00,"$3,500.00",$0.00,"$2,497.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
BSCLX351305120,SUP,Custom 27203010,,BSCLX351305120  -  CATHETER BLNDIL 5MM 130CM LF 120MM LUTONIX 035 PCLTXL ACPT,"$3,500.00",$0.00,"$3,500.00",$0.00,"$2,497.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
BSCLX351305150,SUP,Custom 27203010,,BSCLX351305150  -  CATHETER BLNDIL 5MM 130CM LF 150MM LUTONIX 035 PCLTXL ACPT,"$3,500.00",$0.00,"$3,500.00",$0.00,"$2,497.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
BSCLX35130540,SUP,Custom 27203010,,BSCLX35130540  -  CATHETER BLNDIL 5MM 130CM LF 40MM LUTONIX 035 PCLTXL ACPT,"$3,500.00",$0.00,"$3,500.00",$0.00,"$2,497.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
BSCLX35130560,SUP,Custom 27203010,,BSCLX35130560  -  CATHETER BLNDIL 5MM 130CM LF 60MM LUTONIX 035 PCLTXL ACPT,"$3,500.00",$0.00,"$3,500.00",$0.00,"$2,497.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
BSCLX35130580,SUP,Custom 27203010,,BSCLX35130580  -  CATHETER BLNDIL 5MM 130CM LF 80MM LUTONIX 035 PCLTXL ACPT,"$3,500.00",$0.00,"$3,500.00",$0.00,"$2,497.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
BSCLX351306100,SUP,Custom 27203010,,BSCLX351306100  -  CATHETER BLNDIL 6MM 130CM LF 100MM LUTONIX 035 PCLTXL ACPT,"$3,500.00",$0.00,"$3,500.00",$0.00,"$2,497.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
BSCLX351306120,SUP,Custom 27203010,,BSCLX351306120  -  CATHETER BALDILAT 6FR 6MM 130CM 120MM PCLTXL,"$3,500.00",$0.00,"$3,500.00",$0.00,"$2,497.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
BSCLX351306150,SUP,Custom 27203010,,BSCLX351306150  -  CATHETER BLNDIL 6MM 130CM LF 150MM LUTONIX 035 PCLTXL ACPT,"$3,500.00",$0.00,"$3,500.00",$0.00,"$2,497.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
BSCLX35130640,SUP,Custom 27203010,,BSCLX35130640  -  CATHETER BLNDIL 6MM 130CM LF 40MM LUTONIX 035 PCLTXL ACPT,"$3,500.00",$0.00,"$3,500.00",$0.00,"$2,497.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
BSCLX35130660,SUP,Custom 27203010,,BSCLX35130660  -  CATHETER BLNDIL 6MM 130CM LF 60MM LUTONIX 035 PCLTXL ACPT,"$3,500.00",$0.00,"$3,500.00",$0.00,"$2,497.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
BSCLX35130680,SUP,Custom 27203010,,BSCLX35130680  -  CATHETER BLNDIL 6MM 130CM LF 80MM LUTONIX 035 PCLTXL ACPT,"$3,500.00",$0.00,"$3,500.00",$0.00,"$2,497.95",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
BTC-100,SUP,HCPCS C1758,,CATHETER URET BT-CATH TEMPONADE,$266.75,$0.00,$266.75,$144.85,$190.38,$0.00,$45.96,$0.00,$0.00,$46.71,$266.75,$0.00,$133.38,$211.27,$213.40,$0.00,$41.75,$0.00,$42.47,$0.00
BTE1000,SUP,Custom 27803010,,BTE1000  -  EXPANDER TISSUE P8-10.2CM RECTANGLE 17X8CM REMOTE PORT,"$1,337.50",$0.00,"$1,337.50",$0.00,$954.57,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,337.50",$0.00,$668.75,"$1,059.30","$1,070.00",$0.00,$0.00,$0.00,$0.00,$0.00
BTE750,SUP,Custom 27803010,,BTE750  -  EXPANDER TISSUE P7-9CM RECTANGLE 15X7.5CM REMOTE PORT SMOOTH,"$1,337.50",$0.00,"$1,337.50",$0.00,$954.57,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,337.50",$0.00,$668.75,"$1,059.30","$1,070.00",$0.00,$0.00,$0.00,$0.00,$0.00
BW012,SUP,Custom 27803010,,BW012  -  WAX BN STRL LF OSTENE HMST AGNT ALK OXD 2.5GM DISP,$192.05,$0.00,$192.05,$0.00,$137.07,$0.00,$0.00,$0.00,$0.00,$0.00,$192.05,$0.00,$96.03,$152.10,$153.64,$0.00,$0.00,$0.00,$0.00,$0.00
BW-012,SUP,Custom 27203010,,OSTENE-A WATER-SOLUBLE BONE HEMOSTASIS MATERIALS,$165.63,$0.00,$165.63,$0.00,$118.21,$0.00,$0.00,$0.00,$0.00,$0.00,$165.63,$0.00,$82.81,$131.18,$132.50,$0.00,$0.00,$0.00,$0.00,$0.00
BX00711052,SUP,Custom 27203010,,BX00711052  -  NET SPEC RTRVL 230CM 2.5MM RTHNT STD STRNG REINF NT X SCR,$222.50,$0.00,$222.50,$0.00,$158.80,$0.00,$0.00,$0.00,$0.00,$0.00,$222.50,$0.00,$111.25,$176.22,$178.00,$0.00,$0.00,$0.00,$0.00,$0.00
BX-1000,SUP,Custom 27203010,,BX-1000  -  KIT ASCP ARTHROBOX,$987.50,$0.00,$987.50,$0.00,$704.78,$0.00,$0.00,$0.00,$0.00,$0.00,$987.50,$0.00,$493.75,$782.10,$790.00,$0.00,$0.00,$0.00,$0.00,$0.00
BXA073901A,SUP,HCPCS C1874,,BXA073901A  -  STENT EPRSTH .035IN 7MM 11MM 7FR 39MM 80CM GORE VBHN BLN,"$8,760.00",$0.00,"$8,760.00","$3,942.00","$5,158.80",$0.00,"$1,509.30",$0.00,$0.00,"$1,533.81","$8,760.00",$0.00,"$4,380.00","$6,937.92","$7,008.00",$0.00,"$1,370.94",$0.00,"$1,394.59",$0.00
BXA075901A,SUP,HCPCS C1874,,BXA075901A  -  STENT EPRSTH .035IN 7MM 11MM 7FR 59MM 80CM GORE VBHN BLN,"$8,760.00",$0.00,"$8,760.00","$3,942.00","$5,158.80",$0.00,"$1,509.30",$0.00,$0.00,"$1,533.81","$8,760.00",$0.00,"$4,380.00","$6,937.92","$7,008.00",$0.00,"$1,370.94",$0.00,"$1,394.59",$0.00
BXA082901A,SUP,HCPCS C1874,,BXA082901A  -  STENT EPRSTH .035IN 8MM 11MM 7FR 29MM 80CM GORE VBHN BLN,"$8,760.00",$0.00,"$8,760.00","$3,942.00","$5,158.80",$0.00,"$1,509.30",$0.00,$0.00,"$1,533.81","$8,760.00",$0.00,"$4,380.00","$6,937.92","$7,008.00",$0.00,"$1,370.94",$0.00,"$1,394.59",$0.00
BXA083901A,SUP,HCPCS C1874,,BXA083901A  -  STENT EPRSTH .035IN 8MM 11MM 7FR 39MM 80CM GORE VBHN BLN,"$8,760.00",$0.00,"$8,760.00","$3,942.00","$5,158.80",$0.00,"$1,509.30",$0.00,$0.00,"$1,533.81","$8,760.00",$0.00,"$4,380.00","$6,937.92","$7,008.00",$0.00,"$1,370.94",$0.00,"$1,394.59",$0.00
BXA085901A,SUP,HCPCS C1874,,BXA085901A  -  STENT EPRSTH .035IN 8MM 11MM 7FR 59MM 80CM GORE VBHN BLN,"$8,760.00",$0.00,"$8,760.00","$3,942.00","$5,158.80",$0.00,"$1,509.30",$0.00,$0.00,"$1,533.81","$8,760.00",$0.00,"$4,380.00","$6,937.92","$7,008.00",$0.00,"$1,370.94",$0.00,"$1,394.59",$0.00
C021D,SUP,Custom 27203010,,C021D  -  SUTURE NONABSORBABLE 0 CT-1 18IN CONTROL RELEASE BRAID 8,$289.78,$0.00,$289.78,$0.00,$206.82,$0.00,$0.00,$0.00,$0.00,$0.00,$289.78,$0.00,$144.89,$229.51,$231.83,$0.00,$0.00,$0.00,$0.00,$0.00
C-028,SUP,HCPCS C1713,,C-028  -  GUARD PIN YLW .028IN PINCAP .028IN POST SURG KWR STNM PIN,$4.58,$0.00,$4.58,$2.06,$3.27,$0.00,$0.79,$0.00,$0.00,$0.80,$4.58,$0.00,$2.29,$3.63,$3.67,$0.00,$0.72,$0.00,$0.73,$0.00
C-045,SUP,HCPCS C1713,,C-045  -  CAP PCTV PINCAP STRL WHT .045IN 1.1MM .045IN,$4.58,$0.00,$4.58,$2.06,$3.27,$0.00,$0.79,$0.00,$0.00,$0.80,$4.58,$0.00,$2.29,$3.63,$3.67,$0.00,$0.72,$0.00,$0.73,$0.00
C-062,SUP,HCPCS C1713,,C-062  -  CAP PCTV .062IN KWR PINCAP STRL POST SURG KWR STNM PIN GRN,$2.75,$0.00,$2.75,$1.24,$1.96,$0.00,$0.47,$0.00,$0.00,$0.48,$2.75,$0.00,$1.38,$2.18,$2.20,$0.00,$0.43,$0.00,$0.44,$0.00
C-078,SUP,HCPCS C1713,,C-078  -  GUARD PIN PNK .078IN .035IN KWR STNM STRL,$5.00,$0.00,$5.00,$2.25,$3.57,$0.00,$0.86,$0.00,$0.00,$0.88,$5.00,$0.00,$2.50,$3.96,$4.00,$0.00,$0.78,$0.00,$0.80,$0.00
C0L-3140,SUP,HCPCS C1713,,C0L-3140  -  SCREW BONE 3.5MM 14MM ACUMED ACLC CORT ORTH LCK STRL,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
C0L-3160,SUP,HCPCS C1713,,C0L-3160  -  SCREW BONE 3.5MM 16MM TI DISTAL RADL CORT CLVCL WR HND LCK,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
C141,SUP,HCPCS C1713,,C141  -  COVER PIN .141IN KWR,$5.00,$0.00,$5.00,$2.25,$3.57,$0.00,$0.86,$0.00,$0.00,$0.88,$5.00,$0.00,$2.50,$3.96,$4.00,$0.00,$0.78,$0.00,$0.80,$0.00
C156,SUP,HCPCS C1713,,C156  -  COVER PIN .156IN KWR,$5.00,$0.00,$5.00,$2.25,$3.57,$0.00,$0.86,$0.00,$0.00,$0.88,$5.00,$0.00,$2.50,$3.96,$4.00,$0.00,$0.78,$0.00,$0.80,$0.00
C1712,SUP,HCPCS C1713,,C1712  -  SCREW BONE 1.7MM 12MM CANN LBLU,$787.50,$0.00,$787.50,$354.38,$562.04,$0.00,$135.68,$0.00,$0.00,$137.88,$787.50,$0.00,$393.75,$623.70,$630.00,$0.00,$123.24,$0.00,$125.37,$0.00
C1713,SUP,HCPCS C1713,,C1713  -  SCREW BONE 13MM CANN LIGHT BLUE 1.7MM,$787.50,$0.00,$787.50,$354.38,$562.04,$0.00,$135.68,$0.00,$0.00,$137.88,$787.50,$0.00,$393.75,$623.70,$630.00,$0.00,$123.24,$0.00,$125.37,$0.00
C1714,SUP,HCPCS C1713,,C1714  -  SCREW BONE 9MM CANN COMPRESSION LIGHT BLUE 1.7MM ORTHOPEDIC,$787.50,$0.00,$787.50,$354.38,$562.04,$0.00,$135.68,$0.00,$0.00,$137.88,$787.50,$0.00,$393.75,$623.70,$630.00,$0.00,$123.24,$0.00,$125.37,$0.00
C2314,SUP,HCPCS C1713,,C2314  -  SCREW BONE L14 MM OD2.3 MM ORTHOPEDIC LOCK BLUE,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
C2316,SUP,HCPCS C1713,,C2316  -  SCREW BN 2.3MM 16MM BLU CNN CMPR,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
C2318,SUP,HCPCS C1713,,"C2318  -  CANNULATED SCREW 2.3MM, 18MM",$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
C2320,SUP,HCPCS C1713,,C2320  -  SCREW BONE 20MM LOCK BLUE 2.3MM ORTHOPEDIC,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
C2322,SUP,HCPCS C1713,,C2322  -  SCREW BONE 22MM CANN COMPRESSION BLUE 2.3MM,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
C2324,SUP,HCPCS C1713,,C2324  -  SCREW BN 2.3MM 24MM BLU CNN CMPR,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
C2326,SUP,HCPCS C1713,,C2326  -  SCREW BONE 26MM CANN COMPRESSION BLUE 2.3MM,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
C2328,SUP,HCPCS C1713,,C2328  -  SCREW BONE 28MM CANN COMPRESSION BLUE 2.3MM,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
C2TR01,SUP,HCPCS C2621,,C2TR01  -  PACEMAKER CARDIAC THK6MM 57X59MM 2 CHAMBER RATE RESPONSIVE,"$15,000.00",$0.00,"$15,000.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$15,000.00",$0.00,"$7,500.00","$11,880.00","$12,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
C3.5-20,SUP,HCPCS C1713,,C3.5-20  -  SCREW BONE 20MM CANN ORANGE 3.5MM ORTHOPEDIC,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
C3018,SUP,HCPCS C1713,,C3018  -  SCREW BONE 18MM CANN COMPRESSION YELLOW 3MM,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
C3020,SUP,HCPCS C1713,,C3020  -  SCREW BONE 20MM CANN COMPRESSION YELLOW 3MM,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
C3022,SUP,HCPCS C1713,,C3022  -  SCREW BONE 22MM CANN YELLOW 3MM,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
C3024,SUP,HCPCS C1713,,C3024  -  SCREW BONE 24MM COMPRESSION 3MM,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
C3026,SUP,HCPCS C1713,,C3026  -  SCREW BONE 26MM CANN COMPRESSION YELLOW 3MM,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
C3524,SUP,HCPCS C1713,,C3524  -  SCREW BONE 24MM CANN COMPRESSION ORANGE 3.5MM ORTHOPEDIC,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
C3RL01-B:US,SUP,HCPCS Q4100,,C3RL01-B:US  -  DEVICE CELL HRVT RECELL ATLGS,"$16,250.00",$0.00,"$16,250.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
C4120,SUP,Custom 27203010,,C4120  -  CARTRIDGE GRSPR 5MM 38CM STRL 20MM D DR ATRM DISP,$175.00,$0.00,$175.00,$0.00,$124.90,$0.00,$0.00,$0.00,$0.00,$0.00,$175.00,$0.00,$87.50,$138.60,$140.00,$0.00,$0.00,$0.00,$0.00,$0.00
C4319-5B,SUP,Custom 27203010,,C4319-5B  -  ADPR SCT 15MM 15MM BLUE SWVL TRCHCR CLOSE SCT SYS TRCHCR,$86.68,$0.00,$86.68,$0.00,$61.87,$0.00,$0.00,$0.00,$0.00,$0.00,$86.68,$0.00,$43.34,$68.65,$69.35,$0.00,$0.00,$0.00,$0.00,$0.00
C4330,SUP,Custom 27203010,,CHEMICAL LAB XYLN CLR AGNT POLY BTL 1GL HST GRAD,$35.93,$0.00,$35.93,$0.00,$25.64,$0.00,$0.00,$0.00,$0.00,$0.00,$35.93,$0.00,$17.96,$28.46,$28.74,$0.00,$0.00,$0.00,$0.00,$0.00
C46145,SUP,Custom 27203010,,C46145  -  CUSA CURVED EXTENDED STD TIPS 8/BX,"$1,219.38",$0.00,"$1,219.38",$0.00,$870.27,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,219.38",$0.00,$609.69,$965.75,$975.50,$0.00,$0.00,$0.00,$0.00,$0.00
C514D,SUP,Custom 27203010,,C514D  -  SUTURE NONABSORBABLE 4-0 SH 18IN CONTROL RELEASE BRAID 8,$30.13,$0.00,$30.13,$0.00,$21.50,$0.00,$0.00,$0.00,$0.00,$0.00,$30.13,$0.00,$15.07,$23.86,$24.10,$0.00,$0.00,$0.00,$0.00,$0.00
C554D,SUP,Custom 27203010,,C554D  -  SUTURE NRLN 4-0 RB1 18IN BRAID CR MPK BLK NABSB,$35.34,$0.00,$35.34,$0.00,$25.22,$0.00,$0.00,$0.00,$0.00,$0.00,$35.34,$0.00,$17.67,$27.99,$28.27,$0.00,$0.00,$0.00,$0.00,$0.00
C584D,SUP,Custom 27203010,,C584D  -  SUTURE NABSB 4-0 TF 18IN BLK NRLN CR BRD 8 STRN NYL 6 6,$40.46,$0.00,$40.46,$0.00,$28.88,$0.00,$0.00,$0.00,$0.00,$0.00,$40.46,$0.00,$20.23,$32.04,$32.37,$0.00,$0.00,$0.00,$0.00,$0.00
C8402,SUP,Custom 27203010,,C8402  -  RETRACTOR SURG MEDIUM RING ATRAUMATIC SELF RETAIN WOUND,$135.00,$0.00,$135.00,$0.00,$96.35,$0.00,$0.00,$0.00,$0.00,$0.00,$135.00,$0.00,$67.50,$106.92,$108.00,$0.00,$0.00,$0.00,$0.00,$0.00
C8403,SUP,Custom 27203010,,C8403  -  RETRACTOR SURG LARGE RIGID RETRACTION RING ALEXIS O 9-14CM,$187.50,$0.00,$187.50,$0.00,$133.82,$0.00,$0.00,$0.00,$0.00,$0.00,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$0.00,$0.00,$0.00,$0.00
C8404,SUP,Custom 27203010,,C8404  -  RETRACTOR SURG XL 11-17CM WOUND LATEX FREE ALEXIS 11-17CM,$237.50,$0.00,$237.50,$0.00,$169.50,$0.00,$0.00,$0.00,$0.00,$0.00,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$0.00,$0.00,$0.00,$0.00
C8584,SUP,Custom 27203010,,C8584  -  BIT DRILL 9IN TAPERED HEAD TUNNEL DEPTH ECCENTRIC MONOFLUTED,"$1,751.00",$0.00,"$1,751.00",$0.00,"$1,249.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,751.00",$0.00,$875.50,"$1,386.79","$1,400.80",$0.00,$0.00,$0.00,$0.00,$0.00
C8XX2,SUP,Custom 27203010,,C8XX2  -  PORT HND ACC 120MM LF ALEXIS GLPRT WND RTRCTR LAPSCP MRK PEN,"$1,625.00",$0.00,"$1,625.00",$0.00,"$1,159.76",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,625.00",$0.00,$812.50,"$1,287.00","$1,300.00",$0.00,$0.00,$0.00,$0.00,$0.00
C8XX2NONCE,SUP,Custom 27203010,,PORT HND ACCES GLPRT ALEXIS O RTRCTR LAPSCOP,"$1,264.65",$0.00,"$1,264.65",$0.00,$902.58,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,264.65",$0.00,$632.33,"$1,001.60","$1,011.72",$0.00,$0.00,$0.00,$0.00,$0.00
C8XXX2N,SUP,Custom 27203010,,C8XXX2N  -  GELPORT,"$1,264.65",$0.00,"$1,264.65",$0.00,$902.58,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,264.65",$0.00,$632.33,"$1,001.60","$1,011.72",$0.00,$0.00,$0.00,$0.00,$0.00
C-99999-13,SUP,Custom 27203010,,CAP TUBE BLK PHNL SCR ON RBR LINR DISP,$0.25,$0.00,$0.25,$0.00,$0.18,$0.00,$0.00,$0.00,$0.00,$0.00,$0.25,$0.00,$0.13,$0.20,$0.20,$0.00,$0.00,$0.00,$0.00,$0.00
CA0304,SUP,Custom 27803010,,CA0304  -  GRAFT SFT TISSUE AVIVE HUMAN UMBILICAL CORD MEMBRANE 3CMX4CM,"$6,000.00",$0.00,"$6,000.00",$0.00,"$4,282.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,000.00",$0.00,"$3,000.00","$4,752.00","$4,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
CA2011,SUP,HCPCS C1894,,DEVICE BIOP 11CM 20GA ACHV SFT TIS COAX AUTO INTROD THNWL,$149.10,$0.00,$149.10,$80.96,$106.41,$0.00,$25.69,$0.00,$0.00,$26.11,$149.10,$0.00,$74.55,$118.09,$119.28,$0.00,$23.33,$0.00,$23.74,$0.00
CA-4120,SUP,HCPCS C1713,,CA-4120  -  SCREW BN 4MM 12MM NS HEX TI CANC,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CA-4140,SUP,HCPCS C1713,,CA-4140  -  SCREW BN 4MM 14MM NS HEX TI CANC,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CA-4160,SUP,HCPCS C1713,,CA-4160  -  SCREW BN 4MM 16MM NS HEX TI CANC,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CA-4180,SUP,HCPCS C1713,,CA-4180  -  SCREW BN 4MM 18MM NS HEX TI CANC,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CA-4200,SUP,HCPCS C1713,,CA-4200  -  SCREW BN 4MM 20MM NS HEX TI CANC,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CA-4220,SUP,HCPCS C1713,,CA-4220  -  SCREW BN 4MM 22MM NS HEX TI CANC,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CA-4225,SUP,HCPCS C1713,,CA-4225  -  SCREW BONE 4MM 22.5MM TI CANC NONSTRL,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CA-4240,SUP,HCPCS C1713,,CA-4240  -  SCREW BN 4MM 24MM NS HEX TI CANC,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CA-4250,SUP,HCPCS C1713,,CA-4250  -  SCREW BONE 4MM 25MM TI CANC NONSTRL,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CA-4260,SUP,HCPCS C1713,,CA-4260  -  SCREW BN 4MM 26MM NS HEX TI CANC,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CA-4275,SUP,HCPCS C1713,,CA-4275  -  SCREW BONE 4MM 27.5MM CANC NONSTRL,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CA-4280,SUP,HCPCS C1713,,CA-4280  -  SCREW BN 4MM 28MM CNN,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CA-4300,SUP,HCPCS C1713,,CA-4300  -  SCREW BN 4MM 30MM NS HEX TI CANC,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CA-4340,SUP,HCPCS C1713,,CA-4340  -  SCREW BONE 4MM 34MM TI CANC NONSTRL,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CA-4350,SUP,HCPCS C1713,,CA-4350  -  SCREW BONE 4MM 35MM TI CANC NONSTRL,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CA-4400,SUP,HCPCS C1713,,CA-4400  -  SCREW BONE 4MM 40MM TI CANC NONSTRL,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CA-4450,SUP,HCPCS C1713,,CA-4450  -  SCREW BONE 4MM 45MM TI CANC NONSTRL,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CA-4500,SUP,HCPCS C1713,,CA-4500  -  SCREW BONE 4MM 50MM TI CANC NONSTRL,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CA-4550,SUP,HCPCS C1713,,CA-4550  -  SCREW BN 4MM 55MM CNN,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CA-4600,SUP,HCPCS C1713,,CA-4600  -  SCREW BN 4MM 60MM NS HEX TI CANC,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CAB3.8-12,SUP,HCPCS C1713,,CAB3.8-12  -  SCREW BONE 3.8MM 12MM CANCELLOUS,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
CAB3.8-16,SUP,HCPCS C1713,,CAB3.8-16  -  SCREW BONE 3.8MM 16MM CANCELLOUS,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
CAB3.8-20,SUP,HCPCS C1713,,CAB3.8-20  -  SCREW BONE 3.8MM 20MM CANCELLOUS ANKLE FIX SYSTEM,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
CAB3.8-24,SUP,HCPCS C1713,,CAB3.8-24  -  SCREW BN 3.8MM 24MM CANC ANKL FX SYS,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
CAB3.8-26,SUP,HCPCS C1713,,CAB3.8-26  -  SCREW BONE 3.8MM 26MM CANCELLOUS ANKLE FIX SYSTEM,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
CA-PHB25,SUP,HCPCS C1713,,CA-PHB25  -  SCREW BONE 4.5MM 25MM TI ORTH LCK BTRS NONSTRL,$400.00,$0.00,$400.00,$180.00,$285.48,$0.00,$68.92,$0.00,$0.00,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
CA-PHB275,SUP,HCPCS C1713,,CA-PHB275  -  SCREW BONE 27.5MM CANC PROX HUM BTRS,$400.00,$0.00,$400.00,$180.00,$285.48,$0.00,$68.92,$0.00,$0.00,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
CA-PHB30,SUP,HCPCS C1713,,CA-PHB30  -  SCREW BONE 4.5MM 30MM TI ORTH LCK BTRS NONSTRL,$400.00,$0.00,$400.00,$180.00,$285.48,$0.00,$68.92,$0.00,$0.00,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
CA-PHB325,SUP,HCPCS C1713,,CA-PHB325  -  SCREW BONE 4.5MM 32.5MM TI ORTH LCK BTRS NONSTRL,$400.00,$0.00,$400.00,$180.00,$285.48,$0.00,$68.92,$0.00,$0.00,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
CA-PHB35,SUP,HCPCS C1713,,CA-PHB35  -  SCREW BONE 4.5MM 35MM TI ORTH LCK BTRS NONSTRL,$400.00,$0.00,$400.00,$180.00,$285.48,$0.00,$68.92,$0.00,$0.00,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
CA-PHB375,SUP,HCPCS C1713,,CA-PHB375  -  SCREW BONE 4.5MM 37.5MM TI CANC LCK BTRS NONSTRL,$400.00,$0.00,$400.00,$180.00,$285.48,$0.00,$68.92,$0.00,$0.00,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
CA-PHB40,SUP,HCPCS C1713,,CA-PHB40  -  SCREW BN 4.5MM 40MM NS CORT,$400.00,$0.00,$400.00,$180.00,$285.48,$0.00,$68.92,$0.00,$0.00,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
CA-PHB45,SUP,HCPCS C1713,,CA-PHB45  -  SCREW BN 4.5MM 45MM LCK,$400.00,$0.00,$400.00,$180.00,$285.48,$0.00,$68.92,$0.00,$0.00,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
CA-PHB50,SUP,HCPCS C1713,,CA-PHB50  -  SCREW BONE 4.5MM 50MM TI PROX HUM BTRS NONSTRL,$400.00,$0.00,$400.00,$180.00,$285.48,$0.00,$68.92,$0.00,$0.00,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
CA-PHB55,SUP,HCPCS C1713,,CA-PHB55  -  SCREW BONE 4.5MM 55MM TI PROX HUM PLT BTRS NONSTRL,$400.00,$0.00,$400.00,$180.00,$285.48,$0.00,$68.92,$0.00,$0.00,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
CAR500,SUP,Custom 27203010,,CARTRIDGE HMDIAL DISP CAR-500,"$3,225.00",$0.00,"$3,225.00",$0.00,"$2,301.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,225.00",$0.00,"$1,612.50","$2,554.20","$2,580.00",$0.00,$0.00,$0.00,$0.00,$0.00
CAT00241,SUP,Custom 27203010,,CAT00241  -  KIT ARTHRO 17GA HIP NTNL PRTL ENTRY 2 SPNL NDL SYR,$822.50,$0.00,$822.50,$0.00,$587.02,$0.00,$0.00,$0.00,$0.00,$0.00,$822.50,$0.00,$411.25,$651.42,$658.00,$0.00,$0.00,$0.00,$0.00,$0.00
CB09BA10,SUP,Custom 27203010,,CB09BA10  -  CURVEDBUR CB09BA10 09CMX1MM BALL,$711.00,$0.00,$711.00,$0.00,$507.44,$0.00,$0.00,$0.00,$0.00,$0.00,$711.00,$0.00,$355.50,$563.11,$568.80,$0.00,$0.00,$0.00,$0.00,$0.00
CB09BA10D,SUP,Custom 27203010,,CB09BA10D  -  CURVEDBUR CB09BA10D 09CMX1MM BALL DIAMND,$711.00,$0.00,$711.00,$0.00,$507.44,$0.00,$0.00,$0.00,$0.00,$0.00,$711.00,$0.00,$355.50,$563.11,$568.80,$0.00,$0.00,$0.00,$0.00,$0.00
CB09BA20,SUP,Custom 27203010,,CB09BA20  -  CURVEDBUR CB09BA20 09CMX2MM BALL,$711.00,$0.00,$711.00,$0.00,$507.44,$0.00,$0.00,$0.00,$0.00,$0.00,$711.00,$0.00,$355.50,$563.11,$568.80,$0.00,$0.00,$0.00,$0.00,$0.00
CB09BA20D,SUP,Custom 27203010,,CB09BA20D  -  CURVEDBUR CB09BA20D 09CMX2MM BALL DIAMND,$711.00,$0.00,$711.00,$0.00,$507.44,$0.00,$0.00,$0.00,$0.00,$0.00,$711.00,$0.00,$355.50,$563.11,$568.80,$0.00,$0.00,$0.00,$0.00,$0.00
CB09BA30,SUP,Custom 27203010,,CB09BA30  -  CURVEDBUR CB09BA30 09CMX3MM BALL,$711.00,$0.00,$711.00,$0.00,$507.44,$0.00,$0.00,$0.00,$0.00,$0.00,$711.00,$0.00,$355.50,$563.11,$568.80,$0.00,$0.00,$0.00,$0.00,$0.00
CB09BA30D,SUP,Custom 27203010,,CB09BA30D  -  CURVEDBUR CB09BA30D 09CMX1MM BALL DIAMND,$711.00,$0.00,$711.00,$0.00,$507.44,$0.00,$0.00,$0.00,$0.00,$0.00,$711.00,$0.00,$355.50,$563.11,$568.80,$0.00,$0.00,$0.00,$0.00,$0.00
CB09BA40,SUP,Custom 27203010,,CB09BA40  -  CURVEDBUR CB09BA40 09CMX4MM BALL,$711.00,$0.00,$711.00,$0.00,$507.44,$0.00,$0.00,$0.00,$0.00,$0.00,$711.00,$0.00,$355.50,$563.11,$568.80,$0.00,$0.00,$0.00,$0.00,$0.00
CB09BA40D,SUP,Custom 27203010,,CB09BA40D  -  CURVEDBUR CB09BA40D 09CMX4MM BALL DIAMND,$711.00,$0.00,$711.00,$0.00,$507.44,$0.00,$0.00,$0.00,$0.00,$0.00,$711.00,$0.00,$355.50,$563.11,$568.80,$0.00,$0.00,$0.00,$0.00,$0.00
CB11BA10,SUP,Custom 27203010,,CB11BA10  -  CURVEDBUR CB11BA10 11CMX1MM BALL,$711.00,$0.00,$711.00,$0.00,$507.44,$0.00,$0.00,$0.00,$0.00,$0.00,$711.00,$0.00,$355.50,$563.11,$568.80,$0.00,$0.00,$0.00,$0.00,$0.00
CB11BA10D,SUP,Custom 27203010,,CB11BA10D  -  CURVEDBUR CB11BA10D 11CMX1MM BALL DIAMND,$711.00,$0.00,$711.00,$0.00,$507.44,$0.00,$0.00,$0.00,$0.00,$0.00,$711.00,$0.00,$355.50,$563.11,$568.80,$0.00,$0.00,$0.00,$0.00,$0.00
CB11BA20,SUP,Custom 27203010,,CB11BA20  -  CURVEDBUR CB11BA20 11CMX2MM BALL,$711.00,$0.00,$711.00,$0.00,$507.44,$0.00,$0.00,$0.00,$0.00,$0.00,$711.00,$0.00,$355.50,$563.11,$568.80,$0.00,$0.00,$0.00,$0.00,$0.00
CB11BA20D,SUP,Custom 27203010,,CB11BA20D  -  CURVEDBUR CB11BA20D 11CMX2MM BALL DIAMND,$711.00,$0.00,$711.00,$0.00,$507.44,$0.00,$0.00,$0.00,$0.00,$0.00,$711.00,$0.00,$355.50,$563.11,$568.80,$0.00,$0.00,$0.00,$0.00,$0.00
CB11BA30,SUP,Custom 27203010,,CB11BA30  -  CURVEDBUR CB11BA30 11CMX3MM BALL,$711.00,$0.00,$711.00,$0.00,$507.44,$0.00,$0.00,$0.00,$0.00,$0.00,$711.00,$0.00,$355.50,$563.11,$568.80,$0.00,$0.00,$0.00,$0.00,$0.00
CB11BA30D,SUP,Custom 27203010,,CB11BA30D  -  CURVEDBUR CB11BA30D 11CMX1MM BALL DIAMND,$711.00,$0.00,$711.00,$0.00,$507.44,$0.00,$0.00,$0.00,$0.00,$0.00,$711.00,$0.00,$355.50,$563.11,$568.80,$0.00,$0.00,$0.00,$0.00,$0.00
CB11BA40,SUP,Custom 27203010,,CB11BA40  -  CURVEDBUR CB11BA40 11CMX4MM BALL,$711.00,$0.00,$711.00,$0.00,$507.44,$0.00,$0.00,$0.00,$0.00,$0.00,$711.00,$0.00,$355.50,$563.11,$568.80,$0.00,$0.00,$0.00,$0.00,$0.00
CB11BA40D,SUP,Custom 27203010,,CB11BA40D  -  CURVEDBUR CB11BA40D 11CMX4MM BALL DIAMND,$711.00,$0.00,$711.00,$0.00,$507.44,$0.00,$0.00,$0.00,$0.00,$0.00,$711.00,$0.00,$355.50,$563.11,$568.80,$0.00,$0.00,$0.00,$0.00,$0.00
CBO33010,SUP,HCPCS C1726,,CBO33010  -  CATHETER BLNDIL 3MM 10MM ANGPLSTY,$687.50,$0.00,$687.50,$373.31,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
CC-2300,SUP,Custom 27203010,,CC-2300  -  CONNECTOR DIALYSIS TITANIUM 2 PART FLEX-NECK CATHETER STERIL,$377.50,$0.00,$377.50,$0.00,$269.42,$0.00,$0.00,$0.00,$0.00,$0.00,$377.50,$0.00,$188.75,$298.98,$302.00,$0.00,$0.00,$0.00,$0.00,$0.00
C-CAE-14.0-100-DLT-EF,SUP,HCPCS C1729,,CATHETER ARWYEX 14FR 100CM 2 LUM ENDOTRAC TUBE XFRM RPFT,$114.05,$0.00,$114.05,$61.93,$81.40,$0.00,$19.65,$0.00,$0.00,$19.97,$114.05,$0.00,$57.03,$90.33,$91.24,$0.00,$17.85,$0.00,$18.16,$0.00
CCH1910,SUP,Custom 27203010,,COAXIAL INTRODUCER NEEDLE 19GA 10CM,$33.75,$0.00,$33.75,$0.00,$24.09,$0.00,$0.00,$0.00,$0.00,$0.00,$33.75,$0.00,$16.88,$26.73,$27.00,$0.00,$0.00,$0.00,$0.00,$0.00
CD1231-40,SUP,HCPCS C1722,,CD1231-40  -  DEFIBRILLATOR CARDIAC THK14MM 40J 40X73MM 1 CHAMBER IS-1,"$32,250.00",$0.00,"$32,250.00","$14,512.50","$5,158.80",$0.00,"$5,556.51",$0.00,$0.00,"$5,646.72","$32,250.00",$0.00,"$16,125.00","$25,542.00","$25,800.00",$0.00,"$5,047.13",$0.00,"$5,134.20",$0.00
CD1231-40Q,SUP,HCPCS C1722,,CD1231-40Q  -  DEFIBRILLATOR CARDIAC THK14MM 40J 40X71MM 1 CHAMBER DF-4 RF,"$32,250.00",$0.00,"$32,250.00","$14,512.50","$5,158.80",$0.00,"$5,556.51",$0.00,$0.00,"$5,646.72","$32,250.00",$0.00,"$16,125.00","$25,542.00","$25,800.00",$0.00,"$5,047.13",$0.00,"$5,134.20",$0.00
CD2231-40,SUP,HCPCS C1721,,CD2231-40  -  DEFIBRILLATOR CARDIAC THK14MM 40J 40X74MM 2 CHAMBER 2DF-1,"$33,075.00",$0.00,"$33,075.00","$14,883.75","$5,158.80",$0.00,"$5,698.66",$0.00,$0.00,"$5,791.17","$33,075.00",$0.00,"$16,537.50","$26,195.40","$26,460.00",$0.00,"$5,176.24",$0.00,"$5,265.54",$0.00
CD2231-40Q,SUP,HCPCS C1721,,CD2231-40Q  -  DEFIBRILLATOR CARDIAC THK14MM 40J 40X71MM 2 CHAMBER 2DF-4,"$33,075.00",$0.00,"$33,075.00","$14,883.75","$5,158.80",$0.00,"$5,698.66",$0.00,$0.00,"$5,791.17","$33,075.00",$0.00,"$16,537.50","$26,195.40","$26,460.00",$0.00,"$5,176.24",$0.00,"$5,265.54",$0.00
CD2257-40,SUP,HCPCS C1721,,CD2257-40  -  DEFIBRILLATOR CARDIAC THK14MM 40J 40X74MM 2 CHAMBER 2DF-1,"$33,075.00",$0.00,"$33,075.00","$14,883.75","$5,158.80",$0.00,"$5,698.66",$0.00,$0.00,"$5,791.17","$33,075.00",$0.00,"$16,537.50","$26,195.40","$26,460.00",$0.00,"$5,176.24",$0.00,"$5,265.54",$0.00
CD2257-40Q,SUP,HCPCS C1721,,CD2257-40Q  -  DEFIBRILLATOR CRD THK14MM 40J 40X71MM 35CC STRL LF FORTIFY,"$33,075.00",$0.00,"$33,075.00","$14,883.75","$5,158.80",$0.00,"$5,698.66",$0.00,$0.00,"$5,791.17","$33,075.00",$0.00,"$16,537.50","$26,195.40","$26,460.00",$0.00,"$5,176.24",$0.00,"$5,265.54",$0.00
CD2311-36,SUP,HCPCS C1721,,CD2311-36  -  DEFIBRILLATOR CARDIAC THK12MM 36J 51X69MM 1 CHAMBER 1IS-1 1,"$33,075.00",$0.00,"$33,075.00","$14,883.75","$5,158.80",$0.00,"$5,698.66",$0.00,$0.00,"$5,791.17","$33,075.00",$0.00,"$16,537.50","$26,195.40","$26,460.00",$0.00,"$5,176.24",$0.00,"$5,265.54",$0.00
CD2311-36Q,SUP,HCPCS C1721,,CD2311-36Q  -  DEFIBRILLATOR CRD THK12MM 36J 51X70MM 31ML ELLIPSE 2 CHMBR 1,"$33,075.00",$0.00,"$33,075.00","$14,883.75","$5,158.80",$0.00,"$5,698.66",$0.00,$0.00,"$5,791.17","$33,075.00",$0.00,"$16,537.50","$26,195.40","$26,460.00",$0.00,"$5,176.24",$0.00,"$5,265.54",$0.00
CD3231-40,SUP,HCPCS C1721,,CD3231-40  -  DEFIBRILLATOR CRD THK14MM 2.5V 40X79MM 36ML UNIFY CRT-D QHR,"$45,500.00",$0.00,"$45,500.00","$20,475.00","$5,158.80",$0.00,"$7,839.42",$0.00,$0.00,"$7,966.69","$45,500.00",$0.00,"$22,750.00","$36,036.00","$36,400.00",$0.00,"$7,120.75",$0.00,"$7,243.60",$0.00
CD3231-40Q,SUP,HCPCS C1721,,CD3231-40Q  -  DEFIBRILLATOR CARDIAC THK14MM 2.5V 500OHM 60 PPM 40X73MM 2,"$39,825.00",$0.00,"$39,825.00","$17,921.25","$5,158.80",$0.00,"$6,861.65",$0.00,$0.00,"$6,973.04","$39,825.00",$0.00,"$19,912.50","$31,541.40","$31,860.00",$0.00,"$6,232.61",$0.00,"$6,340.14",$0.00
CD3257-40,SUP,HCPCS C1882,,CD3257-40  -  DEFIBRILLATOR CRD THK14MM 40J 40X79MM 36CC UNIFY ASR CRT-D 2,"$39,825.00",$0.00,"$39,825.00","$17,921.25","$5,158.80",$0.00,"$6,861.65",$0.00,$0.00,"$6,973.04","$39,825.00",$0.00,"$19,912.50","$31,541.40","$31,860.00",$0.00,"$6,232.61",$0.00,"$6,340.14",$0.00
CD3257-40Q,SUP,HCPCS C1882,,CD3257-40Q  -  DEFIBRILLATOR CRD THK14MM 40J 40X73MM 36CC UNIFY ASR,"$39,825.00",$0.00,"$39,825.00","$17,921.25","$5,158.80",$0.00,"$6,861.65",$0.00,$0.00,"$6,973.04","$39,825.00",$0.00,"$19,912.50","$31,541.40","$31,860.00",$0.00,"$6,232.61",$0.00,"$6,340.14",$0.00
CD3265-40,SUP,HCPCS C1882,,CD3265-40  -  DEFIBRILLATOR CARDIAC THK14MM 40J 41X83MM 2 CHAMBER 1IS-1 1,"$42,750.00",$0.00,"$42,750.00","$19,237.50","$5,158.80",$0.00,"$7,365.61",$0.00,$0.00,"$7,485.18","$42,750.00",$0.00,"$21,375.00","$33,858.00","$34,200.00",$0.00,"$6,690.38",$0.00,"$6,805.80",$0.00
CD3265-40Q,SUP,HCPCS C1882,,CD3265-40Q  -  DEFIBRILLATOR CRD THK14MM 40J 41X76MM 38CC QD ASR,"$42,750.00",$0.00,"$42,750.00","$19,237.50","$5,158.80",$0.00,"$7,365.61",$0.00,$0.00,"$7,485.18","$42,750.00",$0.00,"$21,375.00","$33,858.00","$34,200.00",$0.00,"$6,690.38",$0.00,"$6,805.80",$0.00
CDSLM57,SUP,Custom 27803010,,CDSLM57  -  PATCH DURAL 7X5IN LATEX FREE DURAMATRIX-ONLAY,"$6,065.00",$0.00,"$6,065.00",$0.00,"$4,328.59",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,065.00",$0.00,"$3,032.50","$4,803.48","$4,852.00",$0.00,$0.00,$0.00,$0.00,$0.00
CDSM33,SUP,Custom 27803010,,CDSM33  -  PATCH DURA 3X3IN DRMTRX IMPL FLXB STRNG CLGN MTRX,"$3,105.00",$0.00,"$3,105.00",$0.00,"$2,216.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,105.00",$0.00,"$1,552.50","$2,459.16","$2,484.00",$0.00,$0.00,$0.00,$0.00,$0.00
CF7-3-60,SUP,HCPCS C1888,,CF7-3-60  -  CATHETER INTERVENTIONAL .025IN 7FR 60CM 3CM RADIOFREQUENCY,"$5,250.00",$0.00,"$5,250.00",$0.00,"$3,746.93",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
CFF03,SUP,Custom 27203010,,CFF03  -  TROCAR LAPSCP 5MM 100MM LF KII FIOS ADV FX SLV RPD INSFL 1ST,"$1,350.00",$0.00,"$1,350.00",$0.00,$963.50,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,350.00",$0.00,$675.00,"$1,069.20","$1,080.00",$0.00,$0.00,$0.00,$0.00,$0.00
CFF71,SUP,Custom 27203010,,CFF71  -  TROCAR LAPSCP 12MM 150MM LF KII FIOS 1ST ENTRY ADV FX SLV,$175.00,$0.00,$175.00,$0.00,$124.90,$0.00,$0.00,$0.00,$0.00,$0.00,$175.00,$0.00,$87.50,$138.60,$140.00,$0.00,$0.00,$0.00,$0.00,$0.00
CG409,SUP,HCPCS C1725,,CG409  -  CATHETER ANGIO CBR 2 CRV 4FR .041IN 65CM 15CM GLDCATH GLD,$121.38,$0.00,$121.38,$65.91,$86.63,$0.00,$20.91,$0.00,$0.00,$21.25,$121.38,$0.00,$60.69,$96.13,$97.10,$0.00,$19.00,$0.00,$19.32,$0.00
CG415,SUP,HCPCS C1725,,CG415  -  CATHETER ANGIOGRAPHIC ANGLE 4FR .041IN 65CM 15CM 2 BRAID,$121.38,$0.00,$121.38,$65.91,$86.63,$0.00,$20.91,$0.00,$0.00,$21.25,$121.38,$0.00,$60.69,$96.13,$97.10,$0.00,$19.00,$0.00,$19.32,$0.00
CG416,SUP,HCPCS C1887,,CG416  -  CATHETER ANGIOGRAPHIC ANGLE 4FR .041IN 100CM 15CM 2 BRAID,$121.38,$0.00,$121.38,$65.91,$86.63,$0.00,$20.91,$0.00,$0.00,$21.25,$121.38,$0.00,$60.69,$96.13,$97.10,$0.00,$19.00,$0.00,$19.32,$0.00
CG502,SUP,HCPCS C1725,,CG502  -  CATHETER ANGIO CBR 2 CRV 5FR .047IN 65CM 25CM GLDCATH GLD,$121.38,$0.00,$121.38,$65.91,$86.63,$0.00,$20.91,$0.00,$0.00,$21.25,$121.38,$0.00,$60.69,$96.13,$97.10,$0.00,$19.00,$0.00,$19.32,$0.00
CG506,SUP,HCPCS C1725,,CG506  -  CATHETER ANGIO STRG TPR 5FR .047IN 100CM GLDCATH GLD TCH BRD,$121.38,$0.00,$121.38,$65.91,$86.63,$0.00,$20.91,$0.00,$0.00,$21.25,$121.38,$0.00,$60.69,$96.13,$97.10,$0.00,$19.00,$0.00,$19.32,$0.00
CG507,SUP,HCPCS C1725,,CG507  -  CATHETER ANGIOGRAPHIC ANGLE 5FR .047IN 65CM 25CM 1 BRAID,$121.38,$0.00,$121.38,$65.91,$86.63,$0.00,$20.91,$0.00,$0.00,$21.25,$121.38,$0.00,$60.69,$96.13,$97.10,$0.00,$19.00,$0.00,$19.32,$0.00
CG508,SUP,HCPCS C1725,,CG508  -  CATHETER ANGIOGRAPHIC ANGLE 5FR .047IN 100CM 25CM 1 BRAID,$121.38,$0.00,$121.38,$65.91,$86.63,$0.00,$20.91,$0.00,$0.00,$21.25,$121.38,$0.00,$60.69,$96.13,$97.10,$0.00,$19.00,$0.00,$19.32,$0.00
CG511,SUP,HCPCS C1725,,CG511  -  CATHETER ANGIOGRAPHIC SIMMONS 2 CURVE 5FR .047IN 100CM 1,$121.38,$0.00,$121.38,$65.91,$86.63,$0.00,$20.91,$0.00,$0.00,$21.25,$121.38,$0.00,$60.69,$96.13,$97.10,$0.00,$19.00,$0.00,$19.32,$0.00
CG513,SUP,HCPCS C1725,,CG513  -  CATHETER ANGIO HDHNTR 1 CRV 5FR .047IN 100CM 25CM GLDCATH,$121.38,$0.00,$121.38,$65.91,$86.63,$0.00,$20.91,$0.00,$0.00,$21.25,$121.38,$0.00,$60.69,$96.13,$97.10,$0.00,$19.00,$0.00,$19.32,$0.00
CG514,SUP,HCPCS C1725,,CG514  -  CATHETER ANGIO BNTSN 1 CRV 5FR .047IN 100CM 25CM GLDCATH GLD,$121.38,$0.00,$121.38,$65.91,$86.63,$0.00,$20.91,$0.00,$0.00,$21.25,$121.38,$0.00,$60.69,$96.13,$97.10,$0.00,$19.00,$0.00,$19.32,$0.00
CL-07735,SUP,HCPCS C1894,,INTRODUCER SHTH 7FR 8FR 13.75IN INTGR HMSTS VLV SDPRT,$149.00,$0.00,$149.00,$80.91,$106.34,$0.00,$25.67,$0.00,$0.00,$26.09,$149.00,$0.00,$74.50,$118.01,$119.20,$0.00,$23.32,$0.00,$23.72,$0.00
CL-07765,SUP,HCPCS C1894,,INTRODUCER SHTH 7FR 65CM INTGR HMSTS VLV SDPRT TISS DILAT 3W,$233.45,$0.00,$233.45,$126.76,$166.61,$0.00,$40.22,$0.00,$0.00,$40.88,$233.45,$0.00,$116.73,$184.89,$186.76,$0.00,$36.53,$0.00,$37.17,$0.00
CM105C,SUP,Custom 25003010,,ANTIBODY CK 5 CK 6 CLONE CK5/6.007 MS IGG1 1ML LAB,"$1,257.50",$0.00,"$1,257.50",$0.00,$897.48,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,257.50",$0.00,$628.75,$995.94,"$1,006.00",$0.00,$0.00,$0.00,$0.00,$0.00
CM1520,SUP,HCPCS Q4116,,CM1520  -  MATRIX TISS THK.4-1.6MM MED CNTR 19.3X9.6CM ALDRM SLCT ALGRF,"$13,972.50",$0.00,"$13,972.50","$6,287.63","$5,158.80",$0.00,"$2,407.39",$0.00,$0.00,"$2,446.47","$13,972.50",$0.00,"$6,986.25","$11,066.22","$11,178.00",$0.00,"$2,186.70",$0.00,"$2,224.42",$0.00
CM630147S,SUP,HCPCS C1713,,CM630147S  -  NAIL 11MM 32CM HIP RIGHT GAMMA3 IM 130D LNG STRL,"$1,947.00",$0.00,"$1,947.00",$876.15,"$1,389.57",$0.00,$335.46,$0.00,$0.00,$340.90,"$1,947.00",$0.00,$973.50,"$1,542.02","$1,557.60",$0.00,$304.71,$0.00,$309.96,$0.00
CM640047S,SUP,HCPCS C1713,,CM640047S  -  NAIL 11MM 32CM LEFT HIP GAMA IM 130D LNG STRL,"$1,947.00",$0.00,"$1,947.00",$876.15,"$1,389.57",$0.00,$335.46,$0.00,$0.00,$340.90,"$1,947.00",$0.00,$973.50,"$1,542.02","$1,557.60",$0.00,$304.71,$0.00,$309.96,$0.00
CM640048S,SUP,HCPCS C1713,,CM640048S  -  NAIL 11MM 28CM LEFT HIP GAMA IM 130D LNG,"$1,947.00",$0.00,"$1,947.00",$876.15,"$1,389.57",$0.00,$335.46,$0.00,$0.00,$340.90,"$1,947.00",$0.00,$973.50,"$1,542.02","$1,557.60",$0.00,$304.71,$0.00,$309.96,$0.00
CM640060S,SUP,HCPCS C1713,,CM640060S  -  NAIL 11MM 300MM HIP LEFT GAMMA3 IM 135D LNG,"$1,947.00",$0.00,"$1,947.00",$876.15,"$1,389.57",$0.00,$335.46,$0.00,$0.00,$340.90,"$1,947.00",$0.00,$973.50,"$1,542.02","$1,557.60",$0.00,$304.71,$0.00,$309.96,$0.00
CM640106S,SUP,HCPCS C1713,,CM640106S  -  NAIL 11MM 32CM LEFT ORTH GAMA IM 135D LNG STRL,"$1,947.00",$0.00,"$1,947.00",$876.15,"$1,389.57",$0.00,$335.46,$0.00,$0.00,$340.90,"$1,947.00",$0.00,$973.50,"$1,542.02","$1,557.60",$0.00,$304.71,$0.00,$309.96,$0.00
CM640113S,SUP,HCPCS C1713,,CM640113S  -  NAIL 11MM 30CM HIP LEFT FEM GAMMA3 IM 130D LNG TI STRL,"$1,947.00",$0.00,"$1,947.00",$876.15,"$1,389.57",$0.00,$335.46,$0.00,$0.00,$340.90,"$1,947.00",$0.00,$973.50,"$1,542.02","$1,557.60",$0.00,$304.71,$0.00,$309.96,$0.00
CM644004S,SUP,HCPCS C1713,,CM644004S  -  NAIL 11MM 28CM LEFT HIP GAMA IM 135D LNG,"$1,947.00",$0.00,"$1,947.00",$876.15,"$1,389.57",$0.00,$335.46,$0.00,$0.00,$340.90,"$1,947.00",$0.00,$973.50,"$1,542.02","$1,557.60",$0.00,$304.71,$0.00,$309.96,$0.00
CM645050S,SUP,HCPCS C1713,,CM645050S  -  NAIL RIGHT GAMA IM LNG,"$1,947.00",$0.00,"$1,947.00",$876.15,"$1,389.57",$0.00,$335.46,$0.00,$0.00,$340.90,"$1,947.00",$0.00,$973.50,"$1,542.02","$1,557.60",$0.00,$304.71,$0.00,$309.96,$0.00
CM645051S,SUP,HCPCS C1713,,CM645051S  -  NAIL 11MM 280MM HIP RIGHT GAMMA3 IM 135D LNG,"$1,947.00",$0.00,"$1,947.00",$876.15,"$1,389.57",$0.00,$335.46,$0.00,$0.00,$340.90,"$1,947.00",$0.00,$973.50,"$1,542.02","$1,557.60",$0.00,$304.71,$0.00,$309.96,$0.00
CM645059S,SUP,HCPCS C1713,,CM645059S  -  NAIL 11MM 30CM RIGHT ORTH GAMA IM 135D LNG STRL,"$1,947.00",$0.00,"$1,947.00",$876.15,"$1,389.57",$0.00,$335.46,$0.00,$0.00,$340.90,"$1,947.00",$0.00,$973.50,"$1,542.02","$1,557.60",$0.00,$304.71,$0.00,$309.96,$0.00
CM645092S,SUP,HCPCS C1713,,CM645092S  -  NAIL RIGHT GAMA IM LNG,"$1,947.00",$0.00,"$1,947.00",$876.15,"$1,389.57",$0.00,$335.46,$0.00,$0.00,$340.90,"$1,947.00",$0.00,$973.50,"$1,542.02","$1,557.60",$0.00,$304.71,$0.00,$309.96,$0.00
CM645107S,SUP,HCPCS C1713,,CM645107S  -  NAIL 11MM 30CM HIP RIGHT FEM GAMMA3 IM 130D LNG TI STRL,"$1,947.00",$0.00,"$1,947.00",$876.15,"$1,389.57",$0.00,$335.46,$0.00,$0.00,$340.90,"$1,947.00",$0.00,$973.50,"$1,542.02","$1,557.60",$0.00,$304.71,$0.00,$309.96,$0.00
CMRM6122,SUP,Custom 27503206,,CMRM6122  -  ENVELOPE DFBR MED 2.5X2.75IN AIGISRX PCMKR ANBCTRL KNTD DISP,"$1,737.50",$0.00,"$1,737.50",$0.00,"$1,240.05",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,737.50",$0.00,$868.75,"$1,376.10","$1,390.00",$0.00,$0.00,$0.00,$0.00,$0.00
CMRM6133,SUP,Custom 27503206,,CMRM6133  -  ENVELOPE DFBR 3.35X3IN AIGISRX RSRB MINOCYCLINE RFMPN PP,"$2,237.50",$0.00,"$2,237.50",$0.00,"$1,596.90",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$0.00,$0.00,$0.00,$0.00
CMW-18-190,SUP,HCPCS C1769,,CMW-18-190  -  GUIDEWIRE VASCULAR MICRO .018IN 190CM SHAPEABLE TIP APPROACH,$167.03,$0.00,$167.03,$90.69,$119.21,$0.00,$28.78,$0.00,$0.00,$29.24,$167.03,$0.00,$83.51,$132.29,$133.62,$0.00,$26.14,$0.00,$26.59,$0.00
CO201037,SUP,HCPCS C1760,,CO201037  -  CLIP SURG HEMOSTATIC TEMPORARY NEUROLOGICAL RANEY PLST SCALP,$42.14,$0.00,$42.14,$18.96,$30.08,$0.00,$7.26,$0.00,$0.00,$7.38,$42.14,$0.00,$21.07,$33.37,$33.72,$0.00,$6.60,$0.00,$6.71,$0.00
CO-2324,SUP,HCPCS C1713,,CO-2324  -  SCREW BONE 2.3MM 24MM TI CORT NONSTRL,$165.00,$0.00,$165.00,$74.25,$117.76,$0.00,$28.43,$0.00,$0.00,$28.89,$165.00,$0.00,$82.50,$130.68,$132.00,$0.00,$25.82,$0.00,$26.27,$0.00
CO-2326,SUP,HCPCS C1713,,CO-2326  -  SCREW BONE 2.3MM 26MM TI CORT NONSTRL,$165.00,$0.00,$165.00,$74.25,$117.76,$0.00,$28.43,$0.00,$0.00,$28.89,$165.00,$0.00,$82.50,$130.68,$132.00,$0.00,$25.82,$0.00,$26.27,$0.00
CO261230,SUP,Custom 27203010,,CO261230  -  KIT CRANIOTOMY,"$1,025.00",$0.00,"$1,025.00",$0.00,$731.54,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,025.00",$0.00,$512.50,$811.80,$820.00,$0.00,$0.00,$0.00,$0.00,$0.00
CO-2706,SUP,HCPCS C1713,,CO-2706  -  SCREW BONE 2MM 7MM 6MM CORT DORSAL,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-2708,SUP,HCPCS C1713,,CO-2708  -  SCREW BN 2.7MM 8MM CORT,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-2710,SUP,HCPCS C1713,,CO-2710  -  SCREW BN 2.7MM 10MM NS TI CORT,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-2712,SUP,HCPCS C1713,,CO-2712  -  SCREW BN 2.7MM 12MM NS CORT,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-2714,SUP,HCPCS C1713,,CO-2714  -  SCREW BN 2.7MM 14MM NS TI CORT,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-2716,SUP,HCPCS C1713,,CO-2716  -  SCREW BN 2.7MM 16MM NS TI CORT,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-2718,SUP,HCPCS C1713,,CO-2718  -  SCREW BN 2.7MM 18MM NS CORT,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-2720,SUP,HCPCS C1713,,CO-2720  -  SCREW BN 2.7MM 20MM NS TI CORT,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-2722,SUP,HCPCS C1713,,CO-2722  -  SCREW BN 2.7MM 22MM NS TI CORT,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-27225,SUP,HCPCS C1713,,CO-27225  -  SCREW BONE 2.7MM 22.5MM TI CORT ELB NONSTRL,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-2724,SUP,HCPCS C1713,,CO-2724  -  SCREW BN 2.7MM 24MM NS TI CORT,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-2725,SUP,HCPCS C1713,,CO-2725  -  SCREW BN 2.7MM 25MM NS TI CORT,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-2726,SUP,HCPCS C1713,,CO-2726  -  SCREW BN 2.7MM 26MM CORT,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-27275,SUP,HCPCS C1713,,CO-27275  -  SCREW BONE 2.7MM 27.5MM TI CORT ELB NONSTRL,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-2728,SUP,HCPCS C1713,,CO-2728  -  SCREW BN 2.7MM 28MM NS TI CORT,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-2730,SUP,HCPCS C1713,,CO-2730  -  SCREW BN 2.7MM 30MM NS TI CORT,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-2732,SUP,HCPCS C1713,,CO-2732  -  SCREW BN 2.7MM 32MM CORT,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-2734,SUP,HCPCS C1713,,CO-2734  -  SCREW BN 2.7MM 34MM CORT,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-2735,SUP,HCPCS C1713,,CO-2735  -  SCREW BONE 2.7MM 35MM TI CORT ELB NONSTRL,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-2736,SUP,HCPCS C1713,,CO-2736  -  SCREW BN 2.7MM 36MM NS TI CORT,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-27375,SUP,HCPCS C1713,,CO-27375  -  SCREW BONE 2.7MM 37.5MM CORT NONSTRL,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-2738,SUP,HCPCS C1713,,CO-2738  -  SCREW BN 2.7MM 38MM NS TI CORT,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-2740,SUP,HCPCS C1713,,CO-2740  -  SCREW BN 2.7MM 40MM NS TI CORT,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-2745,SUP,HCPCS C1713,,CO-2745  -  SCREW BONE 2.7MM 45MM TI CORT NONSTRL,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-2750,SUP,HCPCS C1713,,CO-2750  -  SCREW BN 2.7MM 50MM NS TI CORT,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-2755,SUP,HCPCS C1713,,CO-2755  -  SCREW BN 2.7MM 55MM NS TI CORT,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-2760,SUP,HCPCS C1713,,CO-2760  -  SCREW BN 2.7MM 60MM NS TI CORT,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-2765,SUP,HCPCS C1713,,CO-2765  -  SCREW BONE 2.7MM 65MM TI CORT ORTH LCK NONSTRL,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-3060,SUP,HCPCS C1713,,CO-3060  -  SCREW BONE 3.5MM 6MM CORT NONSTRL,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-3080,SUP,HCPCS C1713,,CO-3080  -  SCREW BN 3.5MM 8MM NS TI CORT,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-3100,SUP,HCPCS C1713,,CO-3100  -  SCREW BN 3.5MM 10MM NS TI CORT,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-3110,SUP,HCPCS C1713,,CO-3110  -  SCREW BN 3.5MM 10MM NS NLCKG CORT,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-3120,SUP,HCPCS C1713,,CO-3120  -  SCREW BN 3.5MM 12MM NS TI CORT,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-3140,SUP,HCPCS C1713,,CO-3140  -  SCREW BN 3.5MM 14MM NS TI CORT,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-3150-S,SUP,HCPCS C1713,,CO-3150-S  -  SCREW BONE 3.5MM 15MM ACUMED TI CORT WR HND STRL,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
CO-3160,SUP,HCPCS C1713,,CO-3160  -  SCREW BN 3.5MM 16MM NS TI CORT,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-3175-S,SUP,HCPCS C1713,,CO-3175-S  -  SCREW BONE 3.5MM 17.5MM ACUMED TI CORT WR HND STRL,$380.00,$0.00,$380.00,$171.00,$271.21,$0.00,$65.47,$0.00,$0.00,$66.53,$380.00,$0.00,$190.00,$300.96,$304.00,$0.00,$59.47,$0.00,$60.50,$0.00
CO-3180,SUP,HCPCS C1713,,CO-3180  -  SCREW BN 3.5MM 18MM NS TI CORT,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-3200,SUP,HCPCS C1713,,CO-3200  -  SCREW BN 3.5MM 20MM NS TI CORT,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-3200-S,SUP,HCPCS C1713,,CO-3200-S  -  SCREW BONE 3.5MM 20MM CORT STRL,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
CO-3220,SUP,HCPCS C1713,,CO-3220  -  SCREW BN 3.5MM 22MM NS TI CORT,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-3225,SUP,HCPCS C1713,,CO-3225  -  SCREW BN 3.5MM 22.5MM CORT,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-3240,SUP,HCPCS C1713,,CO-3240  -  SCREW BN 3.5MM 24MM CORT,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-3250,SUP,HCPCS C1713,,CO-3250  -  SCREW BONE 3.5MM 25MM TI CORT NONSTRL,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-3250-S,SUP,HCPCS C1713,,CO-3250-S  -  SCREW BONE L25 MM OD3.5 MM CORTICAL,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-3260,SUP,HCPCS C1713,,CO-3260  -  SCREW BN 3.5MM 26MM NS TI CORT,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-3275,SUP,HCPCS C1713,,CO-3275  -  SCREW BONE 3.5MM 27.5MM TI CORT ELB NONSTRL,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-3280,SUP,HCPCS C1713,,CO-3280  -  SCREW BN 3.5MM 28MM NS TI CORT,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO3300,SUP,HCPCS C1713,,CO3300  -  SCREW BONE 3.5MM 30MM TI CORT ORTH STRL,$135.85,$0.00,$135.85,$61.13,$96.96,$0.00,$23.41,$0.00,$0.00,$23.79,$135.85,$0.00,$67.93,$107.59,$108.68,$0.00,$21.26,$0.00,$21.63,$0.00
CO-3300,SUP,HCPCS C1713,,CO-3300  -  SCREW BN 3.5MM 30MM NS TI CORT,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-3300-S,SUP,HCPCS C1713,,CO-3300-S  -  SCREW BONE 3.5MM 30MM ACUMED TI CORT WR HND STRL,$165.00,$0.00,$165.00,$74.25,$117.76,$0.00,$28.43,$0.00,$0.00,$28.89,$165.00,$0.00,$82.50,$130.68,$132.00,$0.00,$25.82,$0.00,$26.27,$0.00
CO-3320,SUP,HCPCS C1713,,CO-3320  -  SCREW BN 3.5MM 32MM NS TI CORT,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-3325,SUP,HCPCS C1713,,CO-3325  -  SCREW BN 3.5MM 32.5MM NS TI CORT,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-3340,SUP,HCPCS C1713,,CO-3340  -  SCREW BONE 3.5MM 34MM TI CORT CLVCL SHLDR ANKL FT LCK,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-3350,SUP,HCPCS C1713,,CO-3350  -  SCREW BONE 3.5MM 35MM TI CORT ELB NONSTRL,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-3360,SUP,HCPCS C1713,,CO-3360  -  SCREW BN 3.5MM 36MM NS TI CORT,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-3375,SUP,HCPCS C1713,,CO-3375  -  SCREW BONE 3.5MM 37.5MM TI CORT NONSTRL,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-3380,SUP,HCPCS C1713,,CO-3380  -  SCREW BN 3.5MM 38MM NS TI CORT,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-3400,SUP,HCPCS C1713,,CO-3400  -  SCREW BN 3.5MM 40MM NS TI CORT,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-3450,SUP,HCPCS C1713,,CO-3450  -  SCREW BN 3.5MM 45MM NS TI CORT,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-3500,SUP,HCPCS C1713,,CO-3500  -  SCREW BONE 3.5MM 50MM TI CORT FIB NONSTRL,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-3550,SUP,HCPCS C1713,,CO-3550  -  SCREW BN 3.5MM 55MM NS TI CORT,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-3600,SUP,HCPCS C1713,,CO-3600  -  SCREW BN 3.5MM 60MM NS TI CORT,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-3650,SUP,HCPCS C1713,,CO-3650  -  SCREW BN 3.5MM 65MM NS TI CORT,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO431022,SUP,HCPCS C1713,,CO431022  -  PLATE BONE 150X150MM MESH TITANIUM CRANFCL,"$2,950.00",$0.00,"$2,950.00","$1,327.50","$2,105.42",$0.00,$508.27,$0.00,$0.00,$516.52,"$2,950.00",$0.00,"$1,475.00","$2,336.40","$2,360.00",$0.00,$461.68,$0.00,$469.64,$0.00
CO431050,SUP,HCPCS C1713,,KIT CRANIOPLASTY 2 BAG POWDER 2 VIAL LIQUID 2 MATRIX BAG,"$2,879.26",$0.00,"$2,879.26","$1,295.67","$2,054.93",$0.00,$496.08,$0.00,$0.00,$504.13,"$2,879.26",$0.00,"$1,439.63","$2,280.37","$2,303.41",$0.00,$450.60,$0.00,$458.38,$0.00
CODA-2-10.0-35-120-32,SUP,HCPCS C2628,,CODA-2-10.0-35-120-32  -  CATH BALDILAT .035IN 10FR OD 32MM 120CM BALLON VASC PROS,"$1,042.50",$0.00,"$1,042.50",$0.00,$744.03,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,042.50",$0.00,$521.25,$825.66,$834.00,$0.00,$0.00,$0.00,$0.00,$0.00
CODA-2-10.0-35-120-40,SUP,HCPCS C2628,,CODA-2-10.0-35-120-40  -  CATH BALDILAT .035IN 10FR 40MM 120CM CODA 40ML,"$1,042.50",$0.00,"$1,042.50",$0.00,$744.03,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,042.50",$0.00,$521.25,$825.66,$834.00,$0.00,$0.00,$0.00,$0.00,$0.00
CO-F2106,SUP,HCPCS C1713,,CO-F2106  -  SCREW BONE 2.1MM 6MM TI CORT WR HND CRCIFRM RECESS NONSTRL,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-F2108,SUP,HCPCS C1713,,CO-F2108  -  SCREW BN 2.1MM 8MM NLCKG TI,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-F2110,SUP,HCPCS C1713,,CO-F2110  -  SCREW BN 2.1MM 10MM NLCKG TI,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-F2112,SUP,HCPCS C1713,,CO-F2112  -  SCREW BN 2.1MM 12MM NLCKG TI,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-F2114,SUP,HCPCS C1713,,CO-F2114  -  SCREW BONE 2.1MM 14MM TI WR HND CRCIFRM NONSTRL,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-F2116,SUP,HCPCS C1713,,CO-F2116  -  SCREW BN 2.1MM 16MM NLCKG TI,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-F2118,SUP,HCPCS C1713,,CO-F2118  -  SCREW BONE 2.1MM 18MM TI CORT LCK NONSTRL MDLR HAND SYS,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-F2120,SUP,HCPCS C1713,,CO-F2120  -  SCREW BONE 2.1MM 20MM CORT NONSTRL,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-F2122,SUP,HCPCS C1713,,CO-F2122  -  SCREW BONE 2.1MM 22MM TI ORTH NONSTRL,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-F2124,SUP,HCPCS C1713,,CO-F2124  -  SCREW BONE 2.1MM 24MM TI CORT CRCIFRM RECESS NONSTRL,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-F2126,SUP,HCPCS C1713,,CO-F2126  -  SCREW BONE 2.1MM 26MM TI CORT CRCIFRM RECESS NONSTRL,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-F2128,SUP,HCPCS C1713,,CO-F2128  -  SCREW BONE 2.1MM 28MM TI CORT CRCIFRM RECESS NONSTRL,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-F2706,SUP,HCPCS C1713,,CO-F2706  -  SCREW BN 2.7MM 6MM NS CRFRM TI CORT MDLR HND SYS,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-F2708,SUP,HCPCS C1713,,CO-F2708  -  SCREW BN 2.7MM 8MM NS CRFRM TI CORT MDLR HND SYS,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-F2710,SUP,HCPCS C1713,,CO-F2710  -  SCREW BN 2.7MM 10MM NS CRFRM TI CORT MDLR HND SYS,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-F2712,SUP,HCPCS C1713,,CO-F2712  -  SCREW BN 2.7MM 12MM NS CRFRM TI CORT MDLR HND SYS,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-F2714,SUP,HCPCS C1713,,CO-F2714  -  SCREW BN 2.7MM 14MM CRFRM CORT,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-F2716,SUP,HCPCS C1713,,CO-F2716  -  SCREW BONE 2.7MM 16MM TI ORTH CRCIFRM NONSTRL,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-F2718,SUP,HCPCS C1713,,CO-F2718  -  SCREW BONE 2.7MM 18MM TI CORT LCK NONSTRL,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-F2720,SUP,HCPCS C1713,,CO-F2720  -  SCREW BONE 2.7MM 20MM TI CORT LCK NSTRL,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-F2722,SUP,HCPCS C1713,,CO-F2722  -  SCREW BONE 2.7MM 22MM TI CORT LCK NONSTRL,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-F2724,SUP,HCPCS C1713,,CO-F2724  -  SCREW BONE 2.7MM 24MM TI CORT LCK NONSTRL,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-F2726,SUP,HCPCS C1713,,CO-F2726  -  SCREW BONE 2.7MM 26MM ACUMED TI RADL ELB CRCIFRM STRL,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-F2728,SUP,HCPCS C1713,,CO-F2728  -  SCREW BONE 2.7MM 28MM TI CORT CRCIFRM NONSTRL,$180.00,$0.00,$180.00,$81.00,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
CO-FA2736,SUP,HCPCS C1713,,CO-FA2736  -  SCREW BONE 2.7MM 36MM TAP-LOC ACUMED CORT ELB STRL,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
CO-FA3545,SUP,HCPCS C1713,,CO-FA3545  -  SCREW BONE 3.5MM 45MM TAP-LOC ACUMED ELB STRL,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
CO-FA3555,SUP,HCPCS C1713,,CO-FA3555  -  SCREW BONE 3.5MM 55MM TAP-LOC ACUMED ELB STRL,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
COL-2080,SUP,HCPCS C1713,,COL-2080  -  SCREW BN 2.7MM 8MM LCK CORT,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
COL-2100,SUP,HCPCS C1713,,COL-2100  -  SCREW BONE 2.7MM 10MM TI CORT ELB LCK NONSTRL,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
COL-2120,SUP,HCPCS C1713,,COL-2120  -  SCREW BN 2.7MM 12MM LCK CORT,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
COL-2140,SUP,HCPCS C1713,,COL-2140  -  SCREW BN 2.7MM 14MM NS LCK HEX TI CORT,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
COL-2160,SUP,HCPCS C1713,,COL-2160  -  SCREW BN 2.7MM 16MM NS LCK HEX TI CORT,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
COL-2180,SUP,HCPCS C1713,,COL-2180  -  SCREW BN 2.7MM 18MM NS LCK HEX TI CORT,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
COL-2200,SUP,HCPCS C1713,,COL-2200  -  SCREW BN 2.7MM 20MM LCK CORT,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
COL-2220,SUP,HCPCS C1713,,COL-2220  -  SCREW BN 2.7MM 22MM NS LCK HEX TI CORT,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
COL-2240,SUP,HCPCS C1713,,COL-2240  -  SCREW BONE 2.7MM 24MM TI CORT ELB LCK NONSTRL,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
COL-2250,SUP,HCPCS C1713,,COL-2250  -  SCREW BONE 2.7MM 25MM CORT SCAPULAR LCK NONSTRL,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
COL-2260,SUP,HCPCS C1713,,COL-2260  -  SCREW BONE 2.7MM 26MM TI CORT ELB LCK NONSTRL,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
COL-2280,SUP,HCPCS C1713,,COL-2280  -  SCREW BONE 2.7MM 28MM TI CORT LCK NONSTRL,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
COL-2300,SUP,HCPCS C1713,,COL-2300  -  SCREW BONE 2.7MM 30MM CORT LCK,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
COL-2320,SUP,HCPCS C1713,,COL-2320  -  SCREW BONE 2.7MM 32MM CORT LCK,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
COL-2340,SUP,HCPCS C1713,,COL-2340  -  SCREW BONE 2.7MM 34MM TI CORT LCK NONSTRL,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
COL-2360,SUP,HCPCS C1713,,COL-2360  -  SCREW BONE 2.7MM 36MM CORT LCK,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
COL-2380,SUP,HCPCS C1713,,COL-2380  -  SCREW BONE 2.7MM 38MM TI FULTHD CORT LCK,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
COL-2400,SUP,HCPCS C1713,,COL-2400  -  SCREW BONE 2.7MM 40MM TI CORT LCK NONSTRL,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
COL-2450,SUP,HCPCS C1713,,COL-2450  -  SCREW BONE 2.7MM 45MM CORT SCAPULAR LCK NONSTRL,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
COL-2500,SUP,HCPCS C1713,,COL-2500  -  SCREW BONE 2.7MM 50MM CORT SCAPULAR LCK NONSTRL,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
COL-2550,SUP,HCPCS C1713,,COL-2550  -  SCREW BONE 2.7MM 55MM CORT SCAPULAR LCK NONSTRL,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
COL-2600,SUP,HCPCS C1713,,COL-2600  -  SCREW BN 2.7MM 60MM NS LCK HEX TI CORT,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
COL-2650,SUP,HCPCS C1713,,COL-2650  -  SCREW BONE 2.7MM 65MM CORT SCAPULAR LCK NONSTRL,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
COL-2718,SUP,HCPCS C1713,,COL-2718  -  SCREW BONE 2.7MM 18MM CORT LCK NONSTRL,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
COL-2720,SUP,HCPCS C1713,,COL-2720  -  SCREW BONE 2.7MM 20MM CORT,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
COL-2722,SUP,HCPCS C1713,,COL-2722  -  SCREW BONE 2.7MM 22MM TI CORT LCK NONSTRL,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
COL-3060,SUP,HCPCS C1713,,COL-3060  -  SCREW BONE 3.5MM 6MM CORT LCK NONSTRL,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
COL-3080,SUP,HCPCS C1713,,COL-3080  -  SCREW BONE 3.5MM 8MM TI DISTAL RADL CORT CLVCL WR HND LCK,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
COL-3100,SUP,HCPCS C1713,,COL-3100  -  SCREW BONE 3.5MM 10MM TI DISTAL RADL CORT CLVCL WR HND LCK,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
COL-3120,SUP,HCPCS C1713,,COL-3120  -  SCREW BONE 3.5MM 12MM TI CORT LCK NONSTRL,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
CO-L3120,SUP,HCPCS C1713,,CO-L3120  -  SCREW BONE 3.5MM 12MM CORT LCK NSTRL,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
COL-3140,SUP,HCPCS C1713,,COL-3140  -  SCREW BONE 3.5MM 14MM TI DISTAL RADL CORT CLVCL WR HND LCK,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
CO-L3140,SUP,HCPCS C1713,,CO-L3140  -  SCREW BONE 3.5MM 14MM ACUMED ACLC CORT ORTH LCK STRL,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
COL-3160,SUP,HCPCS C1713,,COL-3160  -  SCREW BONE 3.5MM 16MM TI DISTAL RADL CORT CLVCL WR HND LCK,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
COL-3180,SUP,HCPCS C1713,,COL-3180  -  SCREW BONE 3.5MM 18MM TI CORT LCK NONSTRL,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
CO-L3180,SUP,HCPCS C1713,,CO-L3180  -  SCREW BONE 3.5MM 18MM ACLC ACUMED CORT ORTH LCK STRL,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
COL-3200,SUP,HCPCS C1713,,COL-3200  -  SCREW BONE 3.5MM 20MM TI DISTAL RADL CORT CLVCL WR HND LCK,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
COL-3220,SUP,HCPCS C1713,,COL-3220  -  SCREW BONE 3.5MM 22MM TI DISTAL RADL CORT CLVCL WR HND LCK,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
COL-3225,SUP,HCPCS C1713,,COL-3225  -  SCREW BONE 3.5MM 22.5MM CORT LCK NONSTRL,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
COL-3240,SUP,HCPCS C1713,,COL-3240  -  SCREW BONE 3.5MM 24MM ACUMED TI CORT LCK NONSTRL,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
COL-3250,SUP,HCPCS C1713,,COL-3250  -  SCREW BONE 3.5MM 25MM TI CORT LCK NONSTRL,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
COL-3260,SUP,HCPCS C1713,,COL-3260  -  SCREW BONE 3.5MM 26MM ACUMED TI DISTAL RADL CORT CLVCL WR,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
COL-3275,SUP,HCPCS C1713,,COL-3275  -  SCREW BONE 3.5MM 27.5MM TI CORT LCK NONSTRL,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
COL-3280,SUP,HCPCS C1713,,COL-3280  -  SCREW BONE 3.5MM 28MM TI DISTAL RADL CORT CLVCL WR HND LCK,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
COL-3300,SUP,HCPCS C1713,,COL-3300  -  SCREW BN 3.5MM 30MM NS TI CORT,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
COL-3320,SUP,HCPCS C1713,,COL-3320  -  SCREW BN 3.5MM 32MM NS LCK TI CORT,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
COL-3340,SUP,HCPCS C1713,,COL-3340  -  SCREW BONE 3.5MM 34MM TI CORT LCK NONSTRL,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
COL-3360,SUP,HCPCS C1713,,COL-3360  -  SCREW BN 3.5MM 36MM NS LCK TI CORT,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
COL-3380,SUP,HCPCS C1713,,COL-3380  -  SCREW BN 3.5MM 38MM LCK CORT,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
COL-3400,SUP,HCPCS C1713,,COL-3400  -  SCREW BN 3.5MM 40MM NS LCK TI CORT,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
COL-3450,SUP,HCPCS C1713,,COL-3450  -  SCREW BN 3.5MM 45MM NS LCK TI CORT,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
COL-3500,SUP,HCPCS C1713,,COL-3500  -  SCREW BN 3.5MM 50MM NS LCK TI CORT,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
COL-3550,SUP,HCPCS C1713,,COL-3550  -  SCREW BN 3.5MM 55MM LCK CORT,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
COL-3600,SUP,HCPCS C1713,,COL-3600  -  SCREW BN 3.5MM 60MM LCK CORT,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
COL-3650,SUP,HCPCS C1713,,COL-3650  -  SCREW BN 3.5MM 65MM LCK CORT,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
COLS-35080-TS,SUP,HCPCS C1713,,COLS-35080-TS  -  SCREW BN 3.5MM 8MM LCK TI RDS CORT DIST,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
COLS-35090-TS,SUP,HCPCS C1713,,COLS-35090-TS  -  SCREW BN 3.5MM 9MM LCK TI RDS CORT DIST,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
COLS-35100-TS,SUP,HCPCS C1713,,COLS-35100-TS  -  SCREW BN 3.5MM 10MM NS GEMINUS LCK TI DIST CORT VOLR RDS,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
COLS-35110-TS,SUP,HCPCS C1713,,COLS-35110-TS  -  SCREW BN 3.5MM 11MM BRNZ NS GEMINUS LCK TI CORT VOLR DIST,$247.50,$0.00,$247.50,$111.38,$176.64,$0.00,$42.64,$0.00,$0.00,$43.34,$247.50,$0.00,$123.75,$196.02,$198.00,$0.00,$38.73,$0.00,$39.40,$0.00
COLS-35120-TS,SUP,HCPCS C1713,,COLS-35120-TS  -  SCREW BN 3.5MM 12MM NS GEMINUS LCK TI DIST CORT VOLR RDS,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
COLS-35130-TS,SUP,HCPCS C1713,,COLS-35130-TS  -  SCREW BN 3.5MM 13MM NS GEMINUS LCK TI DIST CORT VOLR RDS,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
COLS-35140-TS,SUP,HCPCS C1713,,COLS-35140-TS  -  SCREW BN 3.5MM 14MM NS GEMINUS LCK TI DIST CORT VOLR RDS,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
COLS-35150-TS,SUP,HCPCS C1713,,COLS-35150-TS  -  SCREW BN 3.5MM 15MM NS GEMINUS LCK TI DIST CORT VOLR RDS,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
COLS-35160-TS,SUP,HCPCS C1713,,COLS-35160-TS  -  SCREW BN 3.5MM 16MM NS GEMINUS LCK TI DIST CORT VOLR RDS,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
COLS-35180-TS,SUP,HCPCS C1713,,COLS-35180-TS  -  SCREW BN 3.5MM 18MM NS GEMINUS LCK TI DIST CORT VOLR RDS,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
CO-N2308,SUP,HCPCS C1713,,CO-N2308  -  SCREW BN 2.3MM 8MM NONTOGGLING,$220.00,$0.00,$220.00,$99.00,$157.01,$0.00,$37.90,$0.00,$0.00,$38.52,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$34.43,$0.00,$35.02,$0.00
CO-N2310,SUP,HCPCS C1713,,CO-N2310  -  SCREW BN 2.3MM 10MM NONTOGGLING CORT,$220.00,$0.00,$220.00,$99.00,$157.01,$0.00,$37.90,$0.00,$0.00,$38.52,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$34.43,$0.00,$35.02,$0.00
CO-N2312,SUP,HCPCS C1713,,CO-N2312  -  SCREW BN 2.3MM 12MM NLCKG,$220.00,$0.00,$220.00,$99.00,$157.01,$0.00,$37.90,$0.00,$0.00,$38.52,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$34.43,$0.00,$35.02,$0.00
CO-N2314,SUP,HCPCS C1713,,CO-N2314  -  SCREW BN 2.3MM 14MM SLVR NS NONTOGGLE HEX TI CORT,$220.00,$0.00,$220.00,$99.00,$157.01,$0.00,$37.90,$0.00,$0.00,$38.52,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$34.43,$0.00,$35.02,$0.00
CO-N2316,SUP,HCPCS C1713,,CO-N2316  -  SCREW BN 2.3MM 16MM SLVR NS NONTOGGLE HEX TI CORT,$220.00,$0.00,$220.00,$99.00,$157.01,$0.00,$37.90,$0.00,$0.00,$38.52,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$34.43,$0.00,$35.02,$0.00
CO-N2318,SUP,HCPCS C1713,,CO-N2318  -  SCREW BN 2.3MM 18MM SLVR NS NONTOGGLE HEX TI CORT,$220.00,$0.00,$220.00,$99.00,$157.01,$0.00,$37.90,$0.00,$0.00,$38.52,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$34.43,$0.00,$35.02,$0.00
CO-N2320,SUP,HCPCS C1713,,CO-N2320  -  SCREW BN 2.3MM 20MM SLVR NS NONTOGGLE HEX TI CORT,$220.00,$0.00,$220.00,$99.00,$157.01,$0.00,$37.90,$0.00,$0.00,$38.52,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$34.43,$0.00,$35.02,$0.00
CO-N2322,SUP,HCPCS C1713,,CO-N2322  -  SCREW BN 2.3MM 22MM SLVR NS NONTOGGLE HEX TI CORT,$220.00,$0.00,$220.00,$99.00,$157.01,$0.00,$37.90,$0.00,$0.00,$38.52,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$34.43,$0.00,$35.02,$0.00
CO-N2324,SUP,HCPCS C1713,,CO-N2324  -  SCREW BONE 2.3MM 24MM ACLC ACUMED TI DISTAL RADL WR HND,$220.00,$0.00,$220.00,$99.00,$157.01,$0.00,$37.90,$0.00,$0.00,$38.52,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$34.43,$0.00,$35.02,$0.00
CON-2326,SUP,HCPCS C1713,,CON-2326  -  SCREW BONE 2.3MM 26MM ACLC ACUMED DISTAL RADL WR HND,$150.00,$0.00,$150.00,$67.50,$107.06,$0.00,$25.84,$0.00,$0.00,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
CO-N2326,SUP,HCPCS C1713,,CO-N2326  -  SCREW BONE 2.3MM 26MM ACLC ACUMED TI THRD DISTAL RADL WR HND,$220.00,$0.00,$220.00,$99.00,$157.01,$0.00,$37.90,$0.00,$0.00,$38.52,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$34.43,$0.00,$35.02,$0.00
CO-N2328,SUP,HCPCS C1713,,CO-N2328  -  SCREW 2.3MM X 28MM NON-TOGGLING CORTICAL,$220.00,$0.00,$220.00,$99.00,$157.01,$0.00,$37.90,$0.00,$0.00,$38.52,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$34.43,$0.00,$35.02,$0.00
CO-N2330,SUP,HCPCS C1713,,CO-N2330  -  SCREW BONE 2.3MM 30MM ACLC ACUMED TI THRD DISTAL RADL WR HND,$220.00,$0.00,$220.00,$99.00,$157.01,$0.00,$37.90,$0.00,$0.00,$38.52,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$34.43,$0.00,$35.02,$0.00
CO-N2332,SUP,HCPCS C1713,,CO-N2332  -  SCREW BN 2.3MM 32MM STRL NONTOGGLING CORT,$220.00,$0.00,$220.00,$99.00,$157.01,$0.00,$37.90,$0.00,$0.00,$38.52,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$34.43,$0.00,$35.02,$0.00
CO-N2334,SUP,HCPCS C1713,,CO-N2334  -  SCREW BONE 2.3MM 34MM ACLC 2 DISTAL VOLR CORT RADL,$220.00,$0.00,$220.00,$99.00,$157.01,$0.00,$37.90,$0.00,$0.00,$38.52,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$34.43,$0.00,$35.02,$0.00
CO-N2336,SUP,HCPCS C1713,,CO-N2336  -  SCREW BONE 2.3MM 36MM ACLC 2 DISTAL VOLR CORT RADL,$220.00,$0.00,$220.00,$99.00,$157.01,$0.00,$37.90,$0.00,$0.00,$38.52,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$34.43,$0.00,$35.02,$0.00
CO-N2338,SUP,HCPCS C1713,,CO-N2338  -  SCREW BONE 2.3MM 38MM ACLC 2 DISTAL VOLR CORT RADL,$220.00,$0.00,$220.00,$99.00,$157.01,$0.00,$37.90,$0.00,$0.00,$38.52,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$34.43,$0.00,$35.02,$0.00
CO-N2340,SUP,HCPCS C1713,,CO-N2340  -  SCREW BONE 2.3MM 40MM ACLC 2 DISTAL VOLR CORT RADL,$220.00,$0.00,$220.00,$99.00,$157.01,$0.00,$37.90,$0.00,$0.00,$38.52,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$34.43,$0.00,$35.02,$0.00
CO-N2342,SUP,HCPCS C1713,,CO-N2342  -  SCREW BONE 2.3MM 42MM ACLC 2 DISTAL VOLR CORT RADL,$220.00,$0.00,$220.00,$99.00,$157.01,$0.00,$37.90,$0.00,$0.00,$38.52,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$34.43,$0.00,$35.02,$0.00
CO-N2344,SUP,HCPCS C1713,,CO-N2344  -  SCREW BONE 2.3MM 44MM ACLC 2 DISTAL VOLR CORT RADL,$220.00,$0.00,$220.00,$99.00,$157.01,$0.00,$37.90,$0.00,$0.00,$38.52,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$34.43,$0.00,$35.02,$0.00
CO-N2346,SUP,HCPCS C1713,,CO-N2346  -  SCREW BONE 2.3MM 46MM ACLC 2 DISTAL VOLR CORT RADL,$220.00,$0.00,$220.00,$99.00,$157.01,$0.00,$37.90,$0.00,$0.00,$38.52,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$34.43,$0.00,$35.02,$0.00
CONSULTAMMAM,SUP,HCPCS C2621,,CONSULTAMMAM  -  CONSULTA CRT-D ADVANCED SYSTEM,"$60,500.00",$0.00,"$60,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$60,500.00",$0.00,"$30,250.00","$47,916.00","$48,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
CO-S2112,SUP,HCPCS C1713,,CO-S2112  -  SCREW BONE 2.1MM 12MM CORT LP STRL,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
CO-S2114,SUP,HCPCS C1713,,CO-S2114  -  SCREW BONE 2.1MM 14MM CORT LP STRL,$145.00,$0.00,$145.00,$65.25,$103.49,$0.00,$24.98,$0.00,$0.00,$25.39,$145.00,$0.00,$72.50,$114.84,$116.00,$0.00,$22.69,$0.00,$23.08,$0.00
CO-S2308,SUP,Custom 27803010,,CO-S2308  -  PEG FIX 2.3MM 8MM CORT LCK ACUMED STRL,$220.00,$0.00,$220.00,$0.00,$157.01,$0.00,$0.00,$0.00,$0.00,$0.00,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$0.00,$0.00,$0.00,$0.00
CO-S2310,SUP,HCPCS C1713,,CO-S2310  -  PEG FX 2.3MM 10MM LCK SMTH,$220.00,$0.00,$220.00,$99.00,$157.01,$0.00,$37.90,$0.00,$0.00,$38.52,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$34.43,$0.00,$35.02,$0.00
CO-S2312,SUP,Custom 27203010,,CO-S2312  -  PEG FIX 2.3MM 12MM CORT LCK STRL,$220.00,$0.00,$220.00,$0.00,$157.01,$0.00,$0.00,$0.00,$0.00,$0.00,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$0.00,$0.00,$0.00,$0.00
CO-S2314,SUP,Custom 27803010,,CO-S2314  -  PEG 2.3MM 14MM CORT LCK TI NONSTRL,$220.00,$0.00,$220.00,$0.00,$157.01,$0.00,$0.00,$0.00,$0.00,$0.00,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$0.00,$0.00,$0.00,$0.00
CO-S2316,SUP,Custom 27803010,,CO-S2316  -  PEG FX 2.3MM 16MM SMTH LCK CORT,$220.00,$0.00,$220.00,$0.00,$157.01,$0.00,$0.00,$0.00,$0.00,$0.00,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$0.00,$0.00,$0.00,$0.00
CO-S2318,SUP,Custom 27803010,,CO-S2318  -  PEG 2.3MM 18MM DISTAL RADL WR HND LCK SMTH TI NONSTRL,$220.00,$0.00,$220.00,$0.00,$157.01,$0.00,$0.00,$0.00,$0.00,$0.00,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$0.00,$0.00,$0.00,$0.00
CO-S2320,SUP,Custom 27803010,,CO-S2320  -  PEG BONE 20MM 2.3MM CORT SMTH LCK STRL,$220.00,$0.00,$220.00,$0.00,$157.01,$0.00,$0.00,$0.00,$0.00,$0.00,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$0.00,$0.00,$0.00,$0.00
CO-S2322,SUP,Custom 27803010,,CO-S2322  -  PEG BONE 22MM 2.3MM ACLC CORT SMTH LCK,$220.00,$0.00,$220.00,$0.00,$157.01,$0.00,$0.00,$0.00,$0.00,$0.00,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$0.00,$0.00,$0.00,$0.00
CO-S2324,SUP,Custom 27803010,,CO-S2324  -  PEG 2.3MM 24MM DISTAL RADL WR HND LCK SMTH TI ACUMED STRL,$220.00,$0.00,$220.00,$0.00,$157.01,$0.00,$0.00,$0.00,$0.00,$0.00,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$0.00,$0.00,$0.00,$0.00
CO-S2326,SUP,Custom 27803010,,CO-S2326  -  PEG 2.3MM 26MM WR HND LCK SMTH TI ACUMED STRL,$220.00,$0.00,$220.00,$0.00,$157.01,$0.00,$0.00,$0.00,$0.00,$0.00,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$0.00,$0.00,$0.00,$0.00
CO-S2328,SUP,HCPCS C1713,,CO-S2328  -  PEG FX 2.3MM 28MM SMTH LCK CORT,$220.00,$0.00,$220.00,$99.00,$157.01,$0.00,$37.90,$0.00,$0.00,$38.52,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$34.43,$0.00,$35.02,$0.00
CO-S2714,SUP,HCPCS C1713,,CO-S2714  -  SCREW BONE 2.7MM 14MM CORT LP STRL,$145.00,$0.00,$145.00,$65.25,$103.49,$0.00,$24.98,$0.00,$0.00,$25.39,$145.00,$0.00,$72.50,$114.84,$116.00,$0.00,$22.69,$0.00,$23.08,$0.00
CO-T2308,SUP,HCPCS C1713,,CO-T2308  -  SCREW BN FT 2.3MM 8MM AU NS LCK HEX TI CORT,$220.00,$0.00,$220.00,$99.00,$157.01,$0.00,$37.90,$0.00,$0.00,$38.52,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$34.43,$0.00,$35.02,$0.00
CO-T2310,SUP,HCPCS C1713,,CO-T2310  -  SCREW BN FT 2.3MM 10MM AU NS LCK HEX TI CORT,$220.00,$0.00,$220.00,$99.00,$157.01,$0.00,$37.90,$0.00,$0.00,$38.52,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$34.43,$0.00,$35.02,$0.00
CO-T2312,SUP,HCPCS C1713,,CO-T2312  -  SCREW BN FT 2.3MM 12MM AU NS LCK HEX TI CORT,$220.00,$0.00,$220.00,$99.00,$157.01,$0.00,$37.90,$0.00,$0.00,$38.52,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$34.43,$0.00,$35.02,$0.00
COT-2314,SUP,HCPCS C1713,,COT-2314  -  SCREW BONE 2.3MM 14MM CORT LCK NSTRL,$175.00,$0.00,$175.00,$78.75,$124.90,$0.00,$30.15,$0.00,$0.00,$30.64,$175.00,$0.00,$87.50,$138.60,$140.00,$0.00,$27.39,$0.00,$27.86,$0.00
CO-T2314,SUP,HCPCS C1713,,CO-T2314  -  SCREW BN FT 2.3MM 14MM AU NS LCK HEX TI CORT,$220.00,$0.00,$220.00,$99.00,$157.01,$0.00,$37.90,$0.00,$0.00,$38.52,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$34.43,$0.00,$35.02,$0.00
CO-T2316,SUP,HCPCS C1713,,CO-T2316  -  SCREW BN FT 2.3MM 16MM AU NS LCK HEX TI CORT,$220.00,$0.00,$220.00,$99.00,$157.01,$0.00,$37.90,$0.00,$0.00,$38.52,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$34.43,$0.00,$35.02,$0.00
CO-T2318,SUP,HCPCS C1713,,CO-T2318  -  SCREW BN FT 2.3MM 18MM AU NS LCK HEX TI CORT,$220.00,$0.00,$220.00,$99.00,$157.01,$0.00,$37.90,$0.00,$0.00,$38.52,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$34.43,$0.00,$35.02,$0.00
CO-T2320,SUP,HCPCS C1713,,CO-T2320  -  SCREW BN FT 2.3MM 20MM AU NS LCK HEX TI CORT,$220.00,$0.00,$220.00,$99.00,$157.01,$0.00,$37.90,$0.00,$0.00,$38.52,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$34.43,$0.00,$35.02,$0.00
CO-T2322,SUP,HCPCS C1713,,CO-T2322  -  SCREW BN FT 2.3MM 22MM AU NS LCK HEX TI CORT,$220.00,$0.00,$220.00,$99.00,$157.01,$0.00,$37.90,$0.00,$0.00,$38.52,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$34.43,$0.00,$35.02,$0.00
CO-T2324,SUP,HCPCS C1713,,CO-T2324  -  SCREW BN FT 2.3MM 24MM AU NS LCK HEX TI CORT,$220.00,$0.00,$220.00,$99.00,$157.01,$0.00,$37.90,$0.00,$0.00,$38.52,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$34.43,$0.00,$35.02,$0.00
CO-T2326,SUP,HCPCS C1713,,CO-T2326  -  SCREW BN FT 2.3MM 26MM AU NS LCK HEX TI CORT,$220.00,$0.00,$220.00,$99.00,$157.01,$0.00,$37.90,$0.00,$0.00,$38.52,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$34.43,$0.00,$35.02,$0.00
CO-T2328,SUP,HCPCS C1713,,CO-T2328  -  SCREW BONE 2.3MM 28MM ACUMED TI THRD DISTAL RADL CORT WR HND,$220.00,$0.00,$220.00,$99.00,$157.01,$0.00,$37.90,$0.00,$0.00,$38.52,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$34.43,$0.00,$35.02,$0.00
CO-T2330,SUP,HCPCS C1713,,CO-T2330  -  SCREW CORTICAL LOCK 2.3MM X 30MM,$220.00,$0.00,$220.00,$99.00,$157.01,$0.00,$37.90,$0.00,$0.00,$38.52,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$34.43,$0.00,$35.02,$0.00
CO-T2332,SUP,HCPCS C1713,,CO-T2332  -  SCREW BONE 2.3MM 32MM ACLC 2 FULTHD DISTAL VOLR CORT RADL,$220.00,$0.00,$220.00,$99.00,$157.01,$0.00,$37.90,$0.00,$0.00,$38.52,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$34.43,$0.00,$35.02,$0.00
CO-T2334,SUP,HCPCS C1713,,CO-T2334  -  SCREW BONE 2.3MM 34MM CORT LCK,$220.00,$0.00,$220.00,$99.00,$157.01,$0.00,$37.90,$0.00,$0.00,$38.52,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$34.43,$0.00,$35.02,$0.00
CO-T2336,SUP,HCPCS C1713,,CO-T2336  -  SCREW BONE 2.3MM 36MM CORT LCK,$220.00,$0.00,$220.00,$99.00,$157.01,$0.00,$37.90,$0.00,$0.00,$38.52,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$34.43,$0.00,$35.02,$0.00
CO-T2338,SUP,HCPCS C1713,,CO-T2338  -  SCREW BONE 2.3MM 38MM ACLC 2 FULTHD DISTAL VOLR CORT RADL,$220.00,$0.00,$220.00,$99.00,$157.01,$0.00,$37.90,$0.00,$0.00,$38.52,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$34.43,$0.00,$35.02,$0.00
CO-T2340,SUP,HCPCS C1713,,CO-T2340  -  SCREW BONE 2.3MM 24MM TI CORT ELB LCK NONSTRL,$220.00,$0.00,$220.00,$99.00,$157.01,$0.00,$37.90,$0.00,$0.00,$38.52,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$34.43,$0.00,$35.02,$0.00
CO-T2342,SUP,HCPCS C1713,,CO-T2342  -  SCREW BONE 2.3MM 42MM ACLC 2 FULTHD DISTAL VOLR CORT RADL,$220.00,$0.00,$220.00,$99.00,$157.01,$0.00,$37.90,$0.00,$0.00,$38.52,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$34.43,$0.00,$35.02,$0.00
CO-T2344,SUP,HCPCS C1713,,CO-T2344  -  SCREW BONE 2.3MM 44MM ACLC 2 FULTHD DISTAL VOLR CORT RADL,$220.00,$0.00,$220.00,$99.00,$157.01,$0.00,$37.90,$0.00,$0.00,$38.52,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$34.43,$0.00,$35.02,$0.00
CO-T2346,SUP,HCPCS C1713,,CO-T2346  -  SCREW BONE 2.3MM 46MM ACLC 2 FULTHD DISTAL VOLR CORT RADL,$220.00,$0.00,$220.00,$99.00,$157.01,$0.00,$37.90,$0.00,$0.00,$38.52,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$34.43,$0.00,$35.02,$0.00
CP320340,SUP,HCPCS C1713,,CP320340  -  CUSTOM KNEE ARTHRODESIS NAIL 11.5X880MM,"$16,225.00",$0.00,"$16,225.00","$7,301.25","$5,158.80",$0.00,"$2,795.49",$0.00,$0.00,"$2,840.87","$16,225.00",$0.00,"$8,112.50","$12,850.20","$12,980.00",$0.00,"$2,539.21",$0.00,"$2,583.02",$0.00
CP326963,SUP,HCPCS C1713,,CP326963  -  ASNIS SCREW 8.0 X 160MM,"$1,097.25",$0.00,"$1,097.25",$493.76,$783.11,$0.00,$189.05,$0.00,$0.00,$192.12,"$1,097.25",$0.00,$548.63,$869.02,$877.80,$0.00,$171.72,$0.00,$174.68,$0.00
CP326981,SUP,HCPCS C1713,,CP326981  -  ASNIS SCREW 8.0 X 180MM,"$1,097.25",$0.00,"$1,097.25",$493.76,$783.11,$0.00,$189.05,$0.00,$0.00,$192.12,"$1,097.25",$0.00,$548.63,$869.02,$877.80,$0.00,$171.72,$0.00,$174.68,$0.00
CP390009,SUP,HCPCS C1713,,CP390009  -  WASHER 26MM,$140.25,$0.00,$140.25,$63.11,$100.10,$0.00,$24.16,$0.00,$0.00,$24.56,$140.25,$0.00,$70.13,$111.08,$112.20,$0.00,$21.95,$0.00,$22.33,$0.00
CP425737,SUP,HCPCS C1713,,CP425737  -  CUSTOM CLAVICLE PLATE,"$4,400.00",$0.00,"$4,400.00","$1,980.00","$3,140.28",$0.00,$758.10,$0.00,$0.00,$770.40,"$4,400.00",$0.00,"$2,200.00","$3,484.80","$3,520.00",$0.00,$688.60,$0.00,$700.48,$0.00
CP427181,SUP,HCPCS C1713,,CP427181  -  AXSOS CUSTOM-MADE DEVICE_ HUMERUS PLATE 8-HOLES,"$4,812.50",$0.00,"$4,812.50","$2,165.63","$3,434.68",$0.00,$829.17,$0.00,$0.00,$842.63,"$4,812.50",$0.00,"$2,406.25","$3,811.50","$3,850.00",$0.00,$753.16,$0.00,$766.15,$0.00
CP427182,SUP,HCPCS C1713,,CP427182  -  AXSOS CUSTOM-MADE DEVICE - HUMERUS PLATE 6 HOLES,"$9,625.00",$0.00,"$9,625.00","$4,331.25","$5,158.80",$0.00,"$1,658.34",$0.00,$0.00,"$1,685.26","$9,625.00",$0.00,"$4,812.50","$7,623.00","$7,700.00",$0.00,"$1,506.31",$0.00,"$1,532.30",$0.00
CP461006,SUP,Custom 27803010,,CP461006  -  TRIAL SURG 4CM OSS DPHSL IMPL,"$2,500,000.00",$0.00,"$2,500,000.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,500,000.00",$0.00,"$1,250,000.00","$1,980,000.00","$2,000,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
CP5080-2-112,SUP,Custom 27203010,,CP5080-2-112  -  APEX PIN DIA 2MM_ LENGTH 100MM_ THREAD LENGTH 12MM,$220.00,$0.00,$220.00,$0.00,$157.01,$0.00,$0.00,$0.00,$0.00,$0.00,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$0.00,$0.00,$0.00,$0.00
CP5080-2-120,SUP,Custom 27203010,,CP5080-2-120  -  APEX PIN DIA 2MM_ LENGTH 100MM_ THREAD LENGTH 20MM,$220.00,$0.00,$220.00,$0.00,$157.01,$0.00,$0.00,$0.00,$0.00,$0.00,$220.00,$0.00,$110.00,$174.24,$176.00,$0.00,$0.00,$0.00,$0.00,$0.00
CP5080-2-212,SUP,Custom 27203010,,CP5080-2-212  -  CUSTOM-MADE DEVICE APEX DIA 2MM 100 X 12MM,$364.38,$0.00,$364.38,$0.00,$260.05,$0.00,$0.00,$0.00,$0.00,$0.00,$364.38,$0.00,$182.19,$288.59,$291.50,$0.00,$0.00,$0.00,$0.00,$0.00
CP5080-2-220,SUP,Custom 27203010,,CP5080-2-220  -  CUSTOM-MADE DEVICE APEX DIA 2MM 100 X 20MM,$364.38,$0.00,$364.38,$0.00,$260.05,$0.00,$0.00,$0.00,$0.00,$0.00,$364.38,$0.00,$182.19,$288.59,$291.50,$0.00,$0.00,$0.00,$0.00,$0.00
CP5150-2-864,SUP,Custom 27803010,,CP5150-2-864  -  MONOTUBE TRIAX DIA 20 X 640MM,"$3,118.50",$0.00,"$3,118.50",$0.00,"$2,225.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,118.50",$0.00,"$1,559.25","$2,469.85","$2,494.80",$0.00,$0.00,$0.00,$0.00,$0.00
CP606155,SUP,Custom 27803010,,CP606155  -  ASNIS III DIA 6.5 X 155MM - CUSTOM MADE DEVICE,"$1,080.75",$0.00,"$1,080.75",$0.00,$771.33,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,080.75",$0.00,$540.38,$855.95,$864.60,$0.00,$0.00,$0.00,$0.00,$0.00
CP606160,SUP,Custom 27803010,,CP606160  -  ASNIS III DIA 6.5 X 160MM - CUSTOM MADE DEVICE,"$1,080.75",$0.00,"$1,080.75",$0.00,$771.33,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,080.75",$0.00,$540.38,$855.95,$864.60,$0.00,$0.00,$0.00,$0.00,$0.00
CP910,SUP,HCPCS L8614,,CP910  -  PROCESSOR SOUND EARHOOK INDICATOR LIGHT RECHARGABLE BATTERY,"$23,250.00",$0.00,"$23,250.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$23,250.00",$0.00,"$11,625.00","$18,414.00","$18,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
CPO-6,SUP,Custom 27011340,,CPO-6  -  CATHETER SURG 6FR PNEUMO COLPOTOMY LATEX FREE COLPO-PNEUMO,$109.68,$0.00,$109.68,$0.00,$78.28,$0.00,$0.00,$0.00,$0.00,$0.00,$109.68,$0.00,$54.84,$86.87,$87.74,$0.00,$0.00,$0.00,$0.00,$0.00
C-PTISY-100-HC-PERC8,SUP,HCPCS C1769,,C-PTISY-100-HC-PERC8  -  INTROD TUBE 24-28FR CGL BRHN 8 PERC HYDPHI INTROD SHLY DILAT,$905.05,$0.00,$905.05,$491.44,$645.93,$0.00,$155.94,$0.00,$0.00,$158.47,$905.05,$0.00,$452.53,$716.80,$724.04,$0.00,$141.64,$0.00,$144.08,$0.00
CQ75102,SUP,HCPCS C1725,,CQ75102  -  CATHETER BLNDIL 10MM 75CM 2CM CONQ RADOPQ RPD INFL SHTHLS,$662.50,$0.00,$662.50,$359.74,$472.83,$0.00,$114.15,$0.00,$0.00,$116.00,$662.50,$0.00,$331.25,$524.70,$530.00,$0.00,$103.68,$0.00,$105.47,$0.00
CQ75104,SUP,HCPCS C1725,,CQ75104  -  CATHETER BLNDIL 10MM 75CM 4CM CONQ RADOPQ RPD INFL SHTHLS,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$0.00,$0.00,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
CQ75122,SUP,HCPCS C1725,,CQ75122  -  CATHETER BLNDIL 12MM 75CM LF 2CM CONQ RPD INFL SHTHLS ENTRY,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$0.00,$0.00,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
CQ75124,SUP,HCPCS C1725,,CQ75124  -  CATHETER BLNDIL 12MM 75CM 4CM CONQ RADOPQ RPD INFL SHTHLS,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$0.00,$0.00,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
CQ7552,SUP,HCPCS C1725,,CQ7552  -  CATHETER BLNDIL 5MM 75CM 2CM CONQ RADOPQ RPD INFL SHTHLS,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$0.00,$0.00,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
CQ7554,SUP,HCPCS C1725,,CQ7554  -  CATHETER BLNDIL 5MM 75CM 4CM CONQ RADOPQ RPD INFL SHTHLS,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$0.00,$0.00,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
CQ7562,SUP,HCPCS C1725,,CQ7562  -  CATHETER BLNDIL 6MM 75CM 2CM CONQ RADOPQ RPD INFL SHTHLS,$662.50,$0.00,$662.50,$359.74,$472.83,$0.00,$114.15,$0.00,$0.00,$116.00,$662.50,$0.00,$331.25,$524.70,$530.00,$0.00,$103.68,$0.00,$105.47,$0.00
CQ7564,SUP,HCPCS C1725,,CQ7564  -  CATHETER BLNDIL 6MM 75CM 4CM CONQ RADOPQ RPD INFL SHTHLS,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$0.00,$0.00,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
CQ7572,SUP,HCPCS C1725,,CQ7572  -  CATHETER BLNDIL 7MM 75CM 2CM CONQ RADOPQ RPD INFL SHTHLS,$662.50,$0.00,$662.50,$359.74,$472.83,$0.00,$114.15,$0.00,$0.00,$116.00,$662.50,$0.00,$331.25,$524.70,$530.00,$0.00,$103.68,$0.00,$105.47,$0.00
CQ7574,SUP,HCPCS C1725,,CQ7574  -  CATHETER BLNDIL 7MM 75CM 4CM CONQ RADOPQ RPD INFL SHTHLS,$662.50,$0.00,$662.50,$359.74,$472.83,$0.00,$114.15,$0.00,$0.00,$116.00,$662.50,$0.00,$331.25,$524.70,$530.00,$0.00,$103.68,$0.00,$105.47,$0.00
CQ7582,SUP,HCPCS C1725,,CQ7582  -  CATHETER BLNDIL 8MM 75CM LF 2CM CONQ RPD INFL SHTHLS ENTRY,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$0.00,$0.00,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
CQ7584,SUP,HCPCS C1725,,CQ7584  -  CATHETER BLNDIL 8MM 75CM 4CM CONQ RADOPQ RPD INFL SHTHLS,$462.50,$0.00,$462.50,$251.14,$330.09,$0.00,$79.69,$0.00,$0.00,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
CR5BU0.100,SUP,HCPCS V2632,,CR5BU0.100  -  LENS IOL +10 DIOP 13.5MM 7MM PSTCHBR BICNVX 1 PC PMMA,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR5BU0.105,SUP,HCPCS V2632,,CR5BU0.105  -  LENS IOL +10.5 DIOP 13.5MM 7MM PSTCHBR BICNVX 1 PC PMMA,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR5BU0.110,SUP,HCPCS V2632,,CR5BU0.110  -  LENS INTRAOCULAR PMMA 11.0 DIOPTER L13.5 MM OD7 MM,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR5BU0.115,SUP,HCPCS V2632,,CR5BU0.115  -  LENS INTRAOCULAR PMMA 11.5 DIOPTER L13.5 MM OD7 MM,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR5BU0.120,SUP,HCPCS V2632,,CR5BU0.120  -  LENS INTRAOCULAR PMMA 12.0 DIOPTER L13.5 MM OD7 MM,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR5BU0.125,SUP,HCPCS V2632,,CR5BU0.125  -  LENS INTRAOCULAR PMMA 12.5 DIOPTER L13.5 MM OD7 MM,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR5BU0.130,SUP,HCPCS V2632,,CR5BU0.130  -  LENS INTRAOCULAR PMMA 13.0 DIOPTER L13.5 MM OD7 MM,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR5BU0.135,SUP,HCPCS V2632,,CR5BU0.135  -  LENS INTRAOCULAR PMMA 13.5 DIOPTER L13.5 MM OD7 MM,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR5BU0.140,SUP,HCPCS V2632,,CR5BU0.140  -  LENS INTRAOCULAR PMMA 14.0 DIOPTER L13.5 MM OD7 MM,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR5BU0.145,SUP,HCPCS V2632,,CR5BU0.145  -  LENS INTRAOCULAR PMMA 14.5 DIOPTER L13.5 MM OD7 MM,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR5BU0.150,SUP,HCPCS V2632,,CR5BU0.150  -  LENS INTRAOCULAR PMMA 15.0 DIOPTER L13.5 MM OD7 MM,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR5BU0.155,SUP,HCPCS V2632,,CR5BU0.155  -  LENS INTRAOCULAR PMMA 15.5 DIOPTER L13.5 MM OD7 MM,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR5BU0.160,SUP,HCPCS V2632,,CR5BU0.160  -  LENS INTRAOCULAR PMMA 16.0 DIOPTER L13.5 MM OD7 MM,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR5BU0.165,SUP,HCPCS V2632,,CR5BU0.165  -  LENS INTRAOCULAR PMMA 16.5 DIOPTER L13.5 MM OD7 MM,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR5BU0.170,SUP,HCPCS V2632,,CR5BU0.170  -  LENS INTRAOCULAR PMMA 17.0 DIOPTER L13.5 MM OD7 MM,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR5BU0.175,SUP,HCPCS V2632,,CR5BU0.175  -  LENS INTRAOCULAR PMMA 17.5 DIOPTER L13.5 MM OD7 MM,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR5BU0.180,SUP,HCPCS V2632,,CR5BU0.180  -  LENS INTRAOCULAR PMMA 18.0 DIOPTER L13.5 MM OD7 MM,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR5BU0.185,SUP,HCPCS V2632,,CR5BU0.185  -  LENS INTRAOCULAR PMMA 18.5 DIOPTER L13.5 MM OD7 MM,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR5BU0.190,SUP,HCPCS V2632,,CR5BU0.190  -  LENS INTRAOCULAR PMMA 19.0 DIOPTER L13.5 MM OD7 MM,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR5BU0.195,SUP,HCPCS V2632,,CR5BU0.195  -  LENS INTRAOCULAR PMMA 19.5 DIOPTER L13.5 MM OD7 MM,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR5BU0.200,SUP,HCPCS V2632,,CR5BU0.200  -  LENS INTRAOCULAR PMMA 20.0 DIOPTER L13.5 MM OD7 MM,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR5BU0.205,SUP,HCPCS V2632,,CR5BU0.205  -  LENS INTRAOCULAR PMMA 20.5 DIOPTER L13.5 MM OD7 MM,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR5BU0.210,SUP,HCPCS V2632,,CR5BU0.210  -  LENS INTRAOCULAR PMMA 21.0 DIOPTER L13.5 MM OD7 MM,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR5BU0.215,SUP,HCPCS V2632,,CR5BU0.215  -  LENS INTRAOCULAR PMMA 21.5 DIOPTER L13.5 MM OD7 MM,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR5BU0.220,SUP,HCPCS V2632,,CR5BU0.220  -  LENS INTRAOCULAR PMMA 22.0 DIOPTER L13.5 MM OD7 MM,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR5BU0.225,SUP,HCPCS V2632,,CR5BU0.225  -  LENS INTRAOCULAR PMMA 22.5 DIOPTER L13.5 MM OD7 MM,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR5BU0.230,SUP,HCPCS V2632,,CR5BU0.230  -  LENS INTRAOCULAR PMMA 23.0 DIOPTER L13.5 MM OD7 MM,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR5BU0.235,SUP,HCPCS V2632,,CR5BU0.235  -  LENS INTRAOCULAR PMMA 23.5 DIOPTER L13.5 MM OD7 MM,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR5BU0.240,SUP,HCPCS V2632,,CR5BU0.240  -  LENS INTRAOCULAR PMMA 24.0 DIOPTER L13.5 MM OD7 MM,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR5BU0.245,SUP,HCPCS V2632,,CR5BU0.245  -  LENS INTRAOCULAR PMMA 24.5 DIOPTER L13.5 MM OD7 MM,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR5BU0.250,SUP,HCPCS V2632,,CR5BU0.250  -  LENS INTRAOCULAR PMMA 25.0 DIOPTER L13.5 MM OD7 MM,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR5BU0.255,SUP,HCPCS V2632,,CR5BU0.255  -  LENS INTRAOCULAR PMMA 25.5 DIOPTER L13.5 MM OD7 MM,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR5BU0.260,SUP,HCPCS V2632,,CR5BU0.260  -  LENS INTRAOCULAR PMMA 26.0 DIOPTER L13.5 MM OD7 MM,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR5BU0.265,SUP,HCPCS V2632,,CR5BU0.265  -  LENS INTRAOCULAR PMMA 26.5 DIOPTER L13.5 MM OD7 MM,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR5BU0.270,SUP,HCPCS V2632,,CR5BU0.270  -  LENS INTRAOCULAR PMMA 27.0 DIOPTER L13.5 MM OD7 MM,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR5BU0.275,SUP,HCPCS V2632,,CR5BU0.275  -  LENS INTRAOCULAR PMMA 27.5 DIOPTER L13.5 MM OD7 MM,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR5BU0.280,SUP,HCPCS V2632,,CR5BU0.280  -  LENS INTRAOCULAR PMMA 28.0 DIOPTER L13.5 MM OD7 MM,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR5BU0.285,SUP,HCPCS V2632,,CR5BU0.285  -  LENS INTRAOCULAR PMMA 28.5 DIOPTER L13.5 MM OD7 MM,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR5BU0.290,SUP,HCPCS V2632,,CR5BU0.290  -  LENS INTRAOCULAR PMMA 29.0 DIOPTER L13.5 MM OD7 MM,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR5BU0.295,SUP,HCPCS V2632,,CR5BU0.295  -  LENS INTRAOCULAR PMMA 29.5 DIOPTER L13.5 MM OD7 MM,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR5BU0.300,SUP,HCPCS V2632,,CR5BU0.300  -  LENS INTRAOCULAR PMMA 30.0 DIOPTER L13.5 MM OD7 MM,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR70BU.040,SUP,HCPCS V2632,,CR70BU.040  -  LENS IOL 10 D +4 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV ABS,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR70BU.045,SUP,HCPCS V2632,,CR70BU.045  -  LENS IOL 10 D +4.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR70BU.050,SUP,HCPCS V2632,,CR70BU.050  -  LENS IOL 10 D +5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV ABS,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR70BU.055,SUP,HCPCS V2632,,CR70BU.055  -  LENS IOL 10 D +5.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR70BU.060,SUP,HCPCS V2632,,CR70BU.060  -  LENS IOL 10 D +6 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV ABS,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR70BU.065,SUP,HCPCS V2632,,CR70BU.065  -  LENS IOL 10 D +6.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR70BU.070,SUP,HCPCS V2632,,CR70BU.070  -  LENS IOL 10 D +7 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV ABS,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR70BU.075,SUP,HCPCS V2632,,CR70BU.075  -  LENS IOL 10 D +7.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR70BU.080,SUP,HCPCS V2632,,CR70BU.080  -  LENS IOL 10 D +8 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV ABS,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR70BU.085,SUP,HCPCS V2632,,CR70BU.085  -  LENS IOL 10 D +8.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR70BU.090,SUP,HCPCS V2632,,CR70BU.090  -  LENS IOL 10 D +9 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV ABS,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR70BU.095,SUP,HCPCS V2632,,CR70BU.095  -  LENS IOL 10 D +9.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR70BU.100,SUP,HCPCS V2632,,CR70BU.100  -  LENS IOL 10 D +10 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR70BU.105,SUP,HCPCS V2632,,CR70BU.105  -  LENS IOL 10 D +10.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR70BU.110,SUP,HCPCS V2632,,CR70BU.110  -  LENS IOL 10 D +11 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR70BU.115,SUP,HCPCS V2632,,CR70BU.115  -  LENS IOL 10 D +11.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR70BU.120,SUP,HCPCS V2632,,CR70BU.120  -  LENS IOL 10 D +12 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR70BU.125,SUP,HCPCS V2632,,CR70BU.125  -  LENS IOL 10 D +12.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR70BU.130,SUP,HCPCS V2632,,CR70BU.130  -  LENS IOL 10 D +13 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR70BU.135,SUP,HCPCS V2632,,CR70BU.135  -  LENS IOL 10 D +13.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR70BU.140,SUP,HCPCS V2632,,CR70BU.140  -  LENS IOL 10 D +14 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR70BU.145,SUP,HCPCS V2632,,CR70BU.145  -  LENS IOL 10 D +14.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR70BU.150,SUP,HCPCS V2632,,CR70BU.150  -  LENS IOL 10 D +15 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR70BU.155,SUP,HCPCS V2632,,CR70BU.155  -  LENS IOL 10 D +15.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR70BU.160,SUP,HCPCS V2632,,CR70BU.160  -  LENS IOL 10 D +16 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR70BU.165,SUP,HCPCS V2632,,CR70BU.165  -  LENS IOL 10 D +16.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR70BU.170,SUP,HCPCS V2632,,CR70BU.170  -  LENS IOL 10 D +17 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR70BU.175,SUP,HCPCS V2632,,CR70BU.175  -  LENS IOL 10 D +17.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR70BU.180,SUP,HCPCS V2632,,CR70BU.180  -  LENS IOL 10 D +18 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR70BU.185,SUP,HCPCS V2632,,CR70BU.185  -  LENS IOL 10 D +18.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR70BU.190,SUP,HCPCS V2632,,CR70BU.190  -  LENS IOL 10 D +19 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR70BU.195,SUP,HCPCS V2632,,CR70BU.195  -  LENS IOL 10 D +19.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR70BU.200,SUP,HCPCS V2632,,CR70BU.200  -  LENS IOL 10 D +20 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR70BU.205,SUP,HCPCS V2632,,CR70BU.205  -  LENS IOL 10 D +20.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR70BU.210,SUP,HCPCS V2632,,CR70BU.210  -  LENS IOL 10 D +21 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR70BU.215,SUP,HCPCS V2632,,CR70BU.215  -  LENS IOL 10 D +21.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR70BU.220,SUP,HCPCS V2632,,CR70BU.220  -  LENS IOL 10 D +22 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR70BU.225,SUP,HCPCS V2632,,CR70BU.225  -  LENS IOL 10 D +22.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR70BU.230,SUP,HCPCS V2632,,CR70BU.230  -  LENS IOL 10 D +23 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR70BU.235,SUP,HCPCS V2632,,CR70BU.235  -  LENS IOL 10 D +23.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR70BU.240,SUP,HCPCS V2632,,CR70BU.240  -  LENS IOL 10 D +24 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR70BU.245,SUP,HCPCS V2632,,CR70BU.245  -  LENS IOL 10 D +24.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR70BU.250,SUP,HCPCS V2632,,CR70BU.250  -  LENS IOL 10 D +25 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR70BU.255,SUP,HCPCS V2632,,CR70BU.255  -  LENS IOL 10 D +25.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR70BU.260,SUP,HCPCS V2632,,CR70BU.260  -  LENS IOL 10 D +26 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR70BU.265,SUP,HCPCS V2632,,CR70BU.265  -  LENS IOL 10 D +26.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR70BU.270,SUP,HCPCS V2632,,CR70BU.270  -  LENS IOL 10 D +27 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR70BU.275,SUP,HCPCS V2632,,CR70BU.275  -  LENS IOL 10 D +27.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR70BU.280,SUP,HCPCS V2632,,CR70BU.280  -  LENS IOL 10 D +28 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR70BU.285,SUP,HCPCS V2632,,CR70BU.285  -  LENS IOL 10 D +28.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR70BU.290,SUP,HCPCS V2632,,CR70BU.290  -  LENS IOL 10 D +29 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR70BU.295,SUP,HCPCS V2632,,CR70BU.295  -  LENS IOL 10 D +29.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CR70BU.300,SUP,HCPCS V2632,,CR70BU.300  -  LENS IOL 10 D +30 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CS-01701,SUP,HCPCS C1726,,CS-01701  -  KIT CHLGM 4FR 10FR 60CM 1.25ML 21.4CM 2 LUM 3W STPCK CATH,$325.00,$0.00,$325.00,$176.48,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
CS-12,SUP,HCPCS C1713,,CS-12  -  SCREW BONE 3.5MM 12MM DVR TI DISTAL RADL VOLR CORT,$175.00,$0.00,$175.00,$78.75,$124.90,$0.00,$30.15,$0.00,$0.00,$30.64,$175.00,$0.00,$87.50,$138.60,$140.00,$0.00,$27.39,$0.00,$27.86,$0.00
CS-16,SUP,HCPCS C1713,,CS-16  -  SCREW BONE 3.5MM 16MM DVR TI DISTAL RADL VOLR CORT,$175.00,$0.00,$175.00,$78.75,$124.90,$0.00,$30.15,$0.00,$0.00,$30.64,$175.00,$0.00,$87.50,$138.60,$140.00,$0.00,$27.39,$0.00,$27.86,$0.00
CS-18,SUP,HCPCS C1713,,CS-18  -  SCREW BONE 3.5MM 18MM DVR TI DISTAL RADL VOLR CORT,$175.00,$0.00,$175.00,$78.75,$124.90,$0.00,$30.15,$0.00,$0.00,$30.64,$175.00,$0.00,$87.50,$138.60,$140.00,$0.00,$27.39,$0.00,$27.86,$0.00
CS220-ICC,SUP,Custom 27203010,,DRESSING NADH VAC GFM FOAM ABD,$801.14,$0.00,$801.14,$0.00,$571.77,$0.00,$0.00,$0.00,$0.00,$0.00,$801.14,$0.00,$400.57,$634.50,$640.91,$0.00,$0.00,$0.00,$0.00,$0.00
CS-362,SUP,Custom 27203010,,CS-362  -  CATHETER DIALYSIS FLEX-NECK ADULT SMALL L62 CM W6-14 CM OD5.,$222.50,$0.00,$222.50,$0.00,$158.80,$0.00,$0.00,$0.00,$0.00,$0.00,$222.50,$0.00,$111.25,$176.22,$178.00,$0.00,$0.00,$0.00,$0.00,$0.00
CS40G,SUP,Custom 27203010,,CS40G  -  STAPLER INTERNAL CURVE 40MMX4.7MM 2MM 6 FIRING 4 ROW LINEAR,"$1,625.51",$0.00,"$1,625.51",$0.00,"$1,160.13",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,625.51",$0.00,$812.75,"$1,287.40","$1,300.41",$0.00,$0.00,$0.00,$0.00,$0.00
CSOFT6,SUP,Custom 27203010,,CSOFT6  -  CLIP SURG FGRTY SFJW 6MM SPRG ATRM OCL STRL,$322.50,$0.00,$322.50,$0.00,$230.17,$0.00,$0.00,$0.00,$0.00,$0.00,$322.50,$0.00,$161.25,$255.42,$258.00,$0.00,$0.00,$0.00,$0.00,$0.00
CSP243,SUP,Custom 27203010,,PACK HAEMONETICS BASIC HI,$170.00,$0.00,$170.00,$0.00,$121.33,$0.00,$0.00,$0.00,$0.00,$0.00,$170.00,$0.00,$85.00,$134.64,$136.00,$0.00,$0.00,$0.00,$0.00,$0.00
CTI-512N,SUP,Custom 27203010,,CTI-512N  -  DEVICE CLOSURE 5MM 10/12MM SUTURE PASSER CARTER-THOMASON,$278.10,$0.00,$278.10,$0.00,$198.48,$0.00,$0.00,$0.00,$0.00,$0.00,$278.10,$0.00,$139.05,$220.26,$222.48,$0.00,$0.00,$0.00,$0.00,$0.00
C-TP-1507,SUP,Custom 27803010,,C-TP-1507  -  DEVICE CLSR ANG TIGERPAW SYS II 7 CNCT UNQ FSTNR ZERO BLD,"$3,375.00",$0.00,"$3,375.00",$0.00,"$2,408.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,375.00",$0.00,"$1,687.50","$2,673.00","$2,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
C-TP-1509,SUP,Custom 27803010,,C-TP-1509  -  DEVICE CLSR ANG TIGERPAW SYS II 9 CNCT UNQ FSTNR ZERO BLD,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
CTP200-FLS,SUP,Custom 27203010,,SYRINGE INJEC 60IN VSTRN CT LP TBG QKFL TUBE FRN LD 200ML,$865.00,$0.00,$865.00,$0.00,$617.35,$0.00,$0.00,$0.00,$0.00,$0.00,$865.00,$0.00,$432.50,$685.08,$692.00,$0.00,$0.00,$0.00,$0.00,$0.00
CTR11R,SUP,Custom 27803010,,CTR11R  -  RING TENSION FORTIFEYE PMMA 13 MM 11 MM CAPSULAR RIGHT PRELO,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
CUSTOM IMPLANT,SUP,HCPCS C1763,,CUSTOM IMPLANT  -  TISSUE SYNTH PE POR MEDPOR IMPL CSTM CRANIAL,"$12,000.00",$0.00,"$12,000.00","$5,400.00","$5,158.80",$0.00,"$2,067.54",$0.00,$0.00,"$2,101.10","$12,000.00",$0.00,"$6,000.00","$9,504.00","$9,600.00",$0.00,"$1,878.00",$0.00,"$1,910.40",$0.00
CX30D,SUP,Custom 27203010,,CX30D  -  SUTURE NABSB 1 CTX 18IN GRN EBND CR BRD 8 STRN,$360.61,$0.00,$360.61,$0.00,$257.36,$0.00,$0.00,$0.00,$0.00,$0.00,$360.61,$0.00,$180.30,$285.60,$288.48,$0.00,$0.00,$0.00,$0.00,$0.00
CX41D,SUP,Custom 27203010,,CX41D  -  SUTURE NONABSORBABLE 0 MO-7 18IN CONTROL RELEASE BRAID 8,$35.82,$0.00,$35.82,$0.00,$25.56,$0.00,$0.00,$0.00,$0.00,$0.00,$35.82,$0.00,$17.91,$28.37,$28.66,$0.00,$0.00,$0.00,$0.00,$0.00
CXI-4.0-35-150-P-NS-0,SUP,HCPCS C1887,,CXI-4.0-35-150-P-NS-0  -  CATH GUID .035IN 4FR 150CM SPRT STR TIP LP RADIOPQ BRAID SS,$422.50,$0.00,$422.50,$229.42,$301.54,$0.00,$72.79,$0.00,$0.00,$73.98,$422.50,$0.00,$211.25,$334.62,$338.00,$0.00,$66.12,$0.00,$67.26,$0.00
CXS08300,SUP,HCPCS C1874,,CXS08300  -  STENT CORON 3MM 8MM 137CM .014IN OTW SLF XPD RAPEX RAPTORAIL,"$6,500.00",$0.00,"$6,500.00","$2,925.00","$4,639.05",$0.00,"$1,119.92",$0.00,$0.00,"$1,138.10","$6,500.00",$0.00,"$3,250.00","$5,148.00","$5,200.00",$0.00,"$1,017.25",$0.00,"$1,034.80",$0.00
CZ70BD.100,SUP,HCPCS V2632,,CZ70BD.100  -  LENS IOL +10 DIOP 12.5MM 7MM PSTCHBR BICNVX 1 PC EYLT PMMA,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CZ70BD.105,SUP,HCPCS V2632,,CZ70BD.105  -  LENS IOL +10.5 DIOP 12.5MM 7MM PSTCHBR BICNVX 1 PC EYLT PMMA,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CZ70BD.110,SUP,HCPCS V2632,,CZ70BD.110  -  LENS IOL +11 DIOP 5 D 12.5MM 7MM PSTCHBR 1 PC BICNVX EYLT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CZ70BD.115,SUP,HCPCS V2632,,CZ70BD.115  -  LENS IOL +11.5 DIOP 5 D 12.5MM 7MM PSTCHBR 1 PC BICNVX EYLT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CZ70BD.120,SUP,HCPCS V2632,,CZ70BD.120  -  LENS IOL +12 DIOP 12.5MM 7MM PSTCHBR BICNVX 1 PC EYLT PMMA,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CZ70BD.125,SUP,HCPCS V2632,,CZ70BD.125  -  LENS IOL +12.5 DIOP 12.5MM 7MM PSTCHBR BICNVX 1 PC EYLT PMMA,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CZ70BD.130,SUP,HCPCS V2632,,CZ70BD.130  -  LENS IOL +13 DIOP 12.5MM 7MM PSTCHBR BICNVX 1 PC EYLT PMMA,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CZ70BD.135,SUP,HCPCS V2632,,CZ70BD.135  -  LENS IOL +13.5 DIOP 5 D 12.5MM 7MM PSTCHBR 1 PC BICNVX EYLT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CZ70BD.140,SUP,HCPCS V2632,,CZ70BD.140  -  LENS IOL +14 DIOP 12.5MM 7MM PSTCHBR BICNVX EYLT 1 PC PMMA,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CZ70BD.145,SUP,HCPCS V2632,,CZ70BD.145  -  LENS IOL +14.5 DIOP 12.5MM 7MM PSTCHBR BICNVX 1 PC EYLT PMMA,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CZ70BD.150,SUP,HCPCS V2632,,CZ70BD.150  -  LENS IOL +15 DIOP 5 D 12.5MM 7MM PSTCHBR 1 PC BICNVX EYLT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CZ70BD.155,SUP,HCPCS V2632,,CZ70BD.155  -  LENS IOL +15.5 DIOP 5 D 12.5MM 7MM PSTCHBR 1 PC BICNVX EYLT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CZ70BD.160,SUP,HCPCS V2632,,CZ70BD.160  -  LENS IOL +16 DIOP 12.5MM 7MM PSTCHBR BICNVX 1 PC EYLT PMMA,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CZ70BD.165,SUP,HCPCS V2632,,CZ70BD.165  -  LENS IOL +16.5 DIOP 5 D 12.5MM 7MM PSTCHBR 1 PC BICNVX EYLT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CZ70BD.170,SUP,HCPCS V2632,,CZ70BD.170  -  LENS IOL +17 DIOP 12.5MM 7MM PSTCHBR BICNVX 1 PC EYLT PMMA,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CZ70BD.175,SUP,HCPCS V2632,,CZ70BD.175  -  LENS IOL +17.5 DIOP 12.5MM 7MM PSTCHBR BICNVX 1 PC EYLT PMMA,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CZ70BD.180,SUP,HCPCS V2632,,CZ70BD.180  -  LENS IOL 5 D +18 DIOP 12.5MM 7MM PSTCHBR 1 PC BICNVX EYLT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CZ70BD.185,SUP,HCPCS V2632,,CZ70BD.185  -  LENS IOL +18.5 DIOP 5 D 12.5MM 7MM PSTCHBR 1 PC BICNVX EYLT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CZ70BD.190,SUP,HCPCS V2632,,CZ70BD.190  -  LENS IOL +19 DIOP 5 D 12.5MM 7MM PSTCHBR 1 PC BICNVX EYLT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CZ70BD.195,SUP,HCPCS V2632,,CZ70BD.195  -  LENS IOL +19.5 DIOP 5 D 12.5MM 7MM PSTCHBR 1 PC BICNVX EYLT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CZ70BD.200,SUP,HCPCS V2632,,CZ70BD.200  -  LENS IOL 5 D +20 DIOPTER BICNVX 7MM 12.5MM 1 PIECE UV,$125.00,$0.00,$125.00,$56.25,$89.21,$0.00,$21.54,$0.00,$0.00,$21.89,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$19.56,$0.00,$19.90,$0.00
CZ70BD.205,SUP,HCPCS V2632,,CZ70BD.205  -  LENS IOL +20.5 DIOP 5 D 12.5MM 7MM PSTCHBR 1 PC BICNVX EYLT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CZ70BD.210,SUP,HCPCS V2632,,CZ70BD.210  -  LENS IOL +21 DIOP 5 D 12.5MM 7MM PSTCHBR 1 PC BICNVX EYLT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CZ70BD.215,SUP,HCPCS V2632,,CZ70BD.215  -  LENS IOL +21.5 DIOP 5 D 12.5MM 7MM PSTCHBR 1 PC BICNVX EYLT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CZ70BD.220,SUP,HCPCS V2632,,CZ70BD.220  -  LENS IOL 5 D +22 DIOP 12.5MM 7MM PSTCHBR 1 PC BICNVX EYLT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CZ70BD.225,SUP,HCPCS V2632,,CZ70BD.225  -  LENS IOL +22.5 DIOP 12.5MM 7MM PSTCHBR BICNVX 1 PC EYLT PMMA,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CZ70BD.230,SUP,HCPCS V2632,,CZ70BD.230  -  LEN INTRAOCULAR CZ70BD 23.0D,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CZ70BD.235,SUP,HCPCS V2632,,CZ70BD.235  -  LENS IOL 5 D +23.5 DIOP 12.5MM 7MM PSTCHBR 1 PC BICNVX EYLT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CZ70BD.240,SUP,HCPCS V2632,,CZ70BD.240  -  LENS IOL +24 DIOP 5 D 12.5MM 7MM PSTCHBR 1 PC BICNVX EYLT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CZ70BD.245,SUP,HCPCS V2632,,CZ70BD.245  -  LENS IOL +24.5 DIOP 12.5MM 7MM PSTCHBR BICNVX 1 PC EYLT PMMA,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CZ70BD.250,SUP,HCPCS V2632,,CZ70BD.250  -  LENS IOL 5 D +25 DIOP 12.5MM 7MM PSTCHBR 1 PC BICNVX EYLT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CZ70BD.255,SUP,HCPCS V2632,,CZ70BD.255  -  LENS IOL +25.5 DIOP 12.5MM 7MM PSTCHBR BICNVX 1 PC EYLT PMMA,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CZ70BD.260,SUP,HCPCS V2632,,CZ70BD.260  -  LENS IOL +26 DIOP 12.5MM 7MM PSTCHBR BICNVX 1 PC EYLT PMMA,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CZ70BD.265,SUP,HCPCS V2632,,CZ70BD.265  -  LENS IOL +26.5 DIOP 12.5MM 7MM PSTCHBR BICNVX 1 PC EYLT PMMA,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CZ70BD.270,SUP,HCPCS V2632,,CZ70BD.270  -  LENS IOL +27 DIOP 12.5MM 7MM PSTCHBR BICNVX 1 PC EYLT PMMA,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CZ70BD.275,SUP,HCPCS V2632,,CZ70BD.275  -  LENS IOL 5 D +27.5 DIOP MOD C BCNVX 7MM 12.5MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CZ70BD.280,SUP,HCPCS V2632,,CZ70BD.280  -  LENS IOL 5 D +28 DIOP MOD C BCNVX 7MM 12.5MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CZ70BD.285,SUP,HCPCS V2632,,CZ70BD.285  -  LENS IOL 5 D +28.5 DIOP MOD C BCNVX 7MM 12.5MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CZ70BD.290,SUP,HCPCS V2632,,CZ70BD.290  -  LENS IOL 5 D +29 DIOP MOD C BCNVX 7MM 12.5MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CZ70BD.295,SUP,HCPCS V2632,,CZ70BD.295  -  LENS IOL 5 D +29.5 DIOP MOD C BCNVX 7MM 12.5MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
CZ70BD.300,SUP,HCPCS V2632,,CZ70BD.300  -  LENS IOL 5 D +30 DIOP MOD C BCNVX 7MM 12.5MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
D204DRM,SUP,HCPCS C1721,,D204DRM  -  ICD D204DRM SECURA DR DF4 US,"$38,750.00",$0.00,"$38,750.00","$17,437.50","$5,158.80",$0.00,"$6,676.43",$0.00,$0.00,"$6,784.82","$38,750.00",$0.00,"$19,375.00","$30,690.00","$31,000.00",$0.00,"$6,064.38",$0.00,"$6,169.00",$0.00
D204TRM,SUP,HCPCS C2621,,D204TRM  -  DEFIBRILLATOR CARDIAC THK15MM 51X66MM 2 CHAMBER 2IS-1 1DF-4,"$69,920.00",$0.00,"$69,920.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$69,920.00",$0.00,"$34,960.00","$55,376.64","$55,936.00",$0.00,$0.00,$0.00,$0.00,$0.00
D204VRM,SUP,HCPCS C1721,,D204VRM  -  ICD D204VRM SECURA VR DF4 US,"$33,750.00",$0.00,"$33,750.00","$15,187.50","$5,158.80",$0.00,"$5,814.96",$0.00,$0.00,"$5,909.36","$33,750.00",$0.00,"$16,875.00","$26,730.00","$27,000.00",$0.00,"$5,281.88",$0.00,"$5,373.00",$0.00
D224DRG,SUP,HCPCS C1721,,D224DRG  -  ICD D224DRG SECURA DR,"$38,750.00",$0.00,"$38,750.00","$17,437.50","$5,158.80",$0.00,"$6,676.43",$0.00,$0.00,"$6,784.82","$38,750.00",$0.00,"$19,375.00","$30,690.00","$31,000.00",$0.00,"$6,064.38",$0.00,"$6,169.00",$0.00
D224TRK,SUP,HCPCS C1882,,D224TRK  -  DEFIBRILLATOR CARDIAC THK.59IN 2.01X2.72IN IMPLTABLE,"$69,920.00",$0.00,"$69,920.00","$31,464.00","$5,158.80",$0.00,"$8,138.89",$0.00,$0.00,"$8,138.89","$69,920.00",$0.00,"$34,960.00","$55,376.64","$55,936.00",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
D25L,SUP,Custom 27203010,,SENSOR ADLT NC OXSNSR 2 36IN OXM PLS ADH STRAP CBL DISP,$38.43,$0.00,$38.43,$0.00,$27.42,$0.00,$0.00,$0.00,$0.00,$0.00,$38.43,$0.00,$19.21,$30.44,$30.74,$0.00,$0.00,$0.00,$0.00,$0.00
D284DRG,SUP,HCPCS C1721,,D284DRG  -  DEFIBRILLATOR CARD MXMO 2 IMPLTABLE 2 CHMBR DR MODL,"$38,750.00",$0.00,"$38,750.00","$17,437.50","$5,158.80",$0.00,"$6,676.43",$0.00,$0.00,"$6,784.82","$38,750.00",$0.00,"$19,375.00","$30,690.00","$31,000.00",$0.00,"$6,064.38",$0.00,"$6,169.00",$0.00
D284VRC,SUP,HCPCS C1721,,D284VRC  -  DEFIBRILLATOR CARD MXMO 2 IMPLTABLE 1 CHMBR VR MODL,"$32,500.00",$0.00,"$32,500.00","$14,625.00","$5,158.80",$0.00,"$5,599.59",$0.00,$0.00,"$5,690.49","$32,500.00",$0.00,"$16,250.00","$25,740.00","$26,000.00",$0.00,"$5,086.25",$0.00,"$5,174.00",$0.00
D-2871-600,SUP,Custom 27203010,,FILTER INCBTR OHMD,$27.68,$0.00,$27.68,$0.00,$19.75,$0.00,$0.00,$0.00,$0.00,$0.00,$27.68,$0.00,$13.84,$21.92,$22.14,$0.00,$0.00,$0.00,$0.00,$0.00
D300,SUP,Custom 27203010,,SYSTEM BLOOD WRM ADM SET NRMTH LVL 1 DISP 1000ML/MIN STRL LF,$269.20,$0.00,$269.20,$0.00,$192.13,$0.00,$0.00,$0.00,$0.00,$0.00,$269.20,$0.00,$134.60,$213.21,$215.36,$0.00,$0.00,$0.00,$0.00,$0.00
D334DRG,SUP,HCPCS C1721,,D334DRG  -  ICD D334DRG PROTECTA DR IS-1/DF-1 US,"$38,750.00",$0.00,"$38,750.00","$17,437.50","$5,158.80",$0.00,"$6,676.43",$0.00,$0.00,"$6,784.82","$38,750.00",$0.00,"$19,375.00","$30,690.00","$31,000.00",$0.00,"$6,064.38",$0.00,"$6,169.00",$0.00
D334DRM,SUP,HCPCS C1721,,D334DRM  -  ICD D334DRM PROTECTA DR DF4 US,"$38,750.00",$0.00,"$38,750.00","$17,437.50","$5,158.80",$0.00,"$6,676.43",$0.00,$0.00,"$6,784.82","$38,750.00",$0.00,"$19,375.00","$30,690.00","$31,000.00",$0.00,"$6,064.38",$0.00,"$6,169.00",$0.00
D334TRG,SUP,HCPCS C1721,,D334TRG  -  CRT-D D334TRG PROTECTA IS-1/DF-1 US,"$45,500.00",$0.00,"$45,500.00","$20,475.00","$5,158.80",$0.00,"$7,839.42",$0.00,$0.00,"$7,966.69","$45,500.00",$0.00,"$22,750.00","$36,036.00","$36,400.00",$0.00,"$7,120.75",$0.00,"$7,243.60",$0.00
D334TRM,SUP,HCPCS C1721,,D334TRM  -  CRT-D D334TRM PROTECTA DF4 US,"$45,500.00",$0.00,"$45,500.00","$20,475.00","$5,158.80",$0.00,"$7,839.42",$0.00,$0.00,"$7,966.69","$45,500.00",$0.00,"$22,750.00","$36,036.00","$36,400.00",$0.00,"$7,120.75",$0.00,"$7,243.60",$0.00
D4295,SUP,Custom 27203010,,D4295  -  SUTURE PRLN 4-0 TF 36IN MFL CSTM BLUE NABSB,$120.03,$0.00,$120.03,$0.00,$85.66,$0.00,$0.00,$0.00,$0.00,$0.00,$120.03,$0.00,$60.01,$95.06,$96.02,$0.00,$0.00,$0.00,$0.00,$0.00
D5961,SUP,Custom 27203010,,D5961  -  SUTURE ABSORBABLE 2 BP-1 27IN BRAID COATED CUSTOM VICRYL,$357.60,$0.00,$357.60,$0.00,$255.22,$0.00,$0.00,$0.00,$0.00,$0.00,$357.60,$0.00,$178.80,$283.22,$286.08,$0.00,$0.00,$0.00,$0.00,$0.00
D7933,SUP,Custom 27203010,,D7933  -  SUTURE ABS 4-0 SH 36IN VIOL PDS2 2 ARM MFL,$97.96,$0.00,$97.96,$0.00,$69.92,$0.00,$0.00,$0.00,$0.00,$0.00,$97.96,$0.00,$48.98,$77.58,$78.37,$0.00,$0.00,$0.00,$0.00,$0.00
D900VP8HS,SUP,Custom 27203010,,PROBE DPLR 2.9X5.5IN MN DPL 8 MHZ MINI,"$1,280.83",$0.00,"$1,280.83",$0.00,$914.12,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,280.83",$0.00,$640.41,"$1,014.42","$1,024.66",$0.00,$0.00,$0.00,$0.00,$0.00
D9311,SUP,Custom 27203010,,D9311  -  KIT SUTURE 3-0 EBND EXC CSTM D SPCL,$94.58,$0.00,$94.58,$0.00,$67.50,$0.00,$0.00,$0.00,$0.00,$0.00,$94.58,$0.00,$47.29,$74.91,$75.67,$0.00,$0.00,$0.00,$0.00,$0.00
D98100H,SUP,Custom 27203010,,D98100H  -  PROBE PCNG 135CM 2.4FR CHND TRNLMN 5 PCNG PCPRT CATH,$481.83,$0.00,$481.83,$0.00,$343.88,$0.00,$0.00,$0.00,$0.00,$0.00,$481.83,$0.00,$240.91,$381.61,$385.46,$0.00,$0.00,$0.00,$0.00,$0.00
DB2.5,SUP,Custom 27203010,,BIT DRILL 2.5MM FAST STRL DISP,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
DB-2.5,SUP,Custom 27203010,,DB-2.5  -  BIT DRILL 2.5MM STRL DISP,$200.00,$0.00,$200.00,$0.00,$142.74,$0.00,$0.00,$0.00,$0.00,$0.00,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$0.00,$0.00,$0.00,$0.00
DCE-110,SUP,Custom 27203010,,ELECTRODE ESURG 23MM 15MM CLTZ LG CNZTN DISP,$52.25,$0.00,$52.25,$0.00,$37.29,$0.00,$0.00,$0.00,$0.00,$0.00,$52.25,$0.00,$26.13,$41.38,$41.80,$0.00,$0.00,$0.00,$0.00,$0.00
DCE-115,SUP,Custom 27203010,,ELECTRODE ESURG 18X11MM CLTZ MED CNZTN CNTOUR,$52.25,$0.00,$52.25,$0.00,$37.29,$0.00,$0.00,$0.00,$0.00,$0.00,$52.25,$0.00,$26.13,$41.38,$41.80,$0.00,$0.00,$0.00,$0.00,$0.00
DFS100210-20,SUP,Custom 27803010,,DFS100210-20  -  COIL EMBL 2MM 10CM DELTAPAQ DELTAWIND 10 MCIOL STRCH RS DTCH,"$2,294.25",$0.00,"$2,294.25",$0.00,"$1,637.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,294.25",$0.00,"$1,147.13","$1,817.05","$1,835.40",$0.00,$0.00,$0.00,$0.00,$0.00
DFS100250-20,SUP,Custom 27803010,,DFS100250-20  -  COIL EMBL 2.5MM 10CM DELTAPAQ DELTAWIND 10 MCIOL STRCH RS,"$2,294.25",$0.00,"$2,294.25",$0.00,"$1,637.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,294.25",$0.00,"$1,147.13","$1,817.05","$1,835.40",$0.00,$0.00,$0.00,$0.00,$0.00
DFS100310-20,SUP,Custom 27803010,,DFS100310-20  -  MICROCOIL PLATINUM DELTAPAQ 3MMX10CM,"$2,294.25",$0.00,"$2,294.25",$0.00,"$1,637.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,294.25",$0.00,"$1,147.13","$1,817.05","$1,835.40",$0.00,$0.00,$0.00,$0.00,$0.00
DFS100406-20,SUP,Custom 27803010,,DFS100406-20  -  COIL EMBL 4MM 6CM DELTAPAQ DELTAWIND 10 MCIOL STRCH RS DTCH,"$2,294.25",$0.00,"$2,294.25",$0.00,"$1,637.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,294.25",$0.00,"$1,147.13","$1,817.05","$1,835.40",$0.00,$0.00,$0.00,$0.00,$0.00
DFS100408-20,SUP,Custom 27803010,,DFS100408-20  -  COIL EMBL 4MM 8CM DELTAPAQ DELTAWIND 10 MCIOL STRCH RS DTCH,"$2,294.25",$0.00,"$2,294.25",$0.00,"$1,637.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,294.25",$0.00,"$1,147.13","$1,817.05","$1,835.40",$0.00,$0.00,$0.00,$0.00,$0.00
DFS100410-20,SUP,Custom 27803010,,DFS100410-20  -  COIL EMBL 4MM 10CM DELTAPAQ DELTAWIND 10 MCIOL STRCH RS DTCH,"$2,294.25",$0.00,"$2,294.25",$0.00,"$1,637.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,294.25",$0.00,"$1,147.13","$1,817.05","$1,835.40",$0.00,$0.00,$0.00,$0.00,$0.00
DFS100510-20,SUP,Custom 27803010,,DFS100510-20  -  COIL EMBL 5MM 10CM DELTAPAQ DELTAWIND 10 MCIOL STRCH RS DTCH,"$2,294.25",$0.00,"$2,294.25",$0.00,"$1,637.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,294.25",$0.00,"$1,147.13","$1,817.05","$1,835.40",$0.00,$0.00,$0.00,$0.00,$0.00
DFS100515-20,SUP,Custom 27803010,,DFS100515-20  -  COIL EMBL 5MM 15CM DELTAPAQ DELTAWIND 10 MCIOL STRCH RS DTCH,"$2,294.25",$0.00,"$2,294.25",$0.00,"$1,637.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,294.25",$0.00,"$1,147.13","$1,817.05","$1,835.40",$0.00,$0.00,$0.00,$0.00,$0.00
DIN1515X,SUP,Custom 27203010,,NEEDLE IO 3/8-1 7/8IN 15GA BN MRW LNCT PNT ADJ FLNG STY,$31.73,$0.00,$31.73,$0.00,$22.64,$0.00,$0.00,$0.00,$0.00,$0.00,$31.73,$0.00,$15.86,$25.13,$25.38,$0.00,$0.00,$0.00,$0.00,$0.00
DJ4008X,SUP,Custom 27203010,,DJ4008X  -  NEEDLE BIOP STANDARD TAPER 8GA 4IN LIGHTWEIGHT HANDLE DISTAL,$43.82,$0.00,$55.96,$0.00,$39.94,$0.00,$0.00,$0.00,$0.00,$0.00,$55.96,$0.00,$27.98,$34.71,$44.77,$0.00,$0.00,$0.00,$0.00,$0.00
DJ4011X,SUP,Custom 27203010,,NEEDLE BIOP 11GA 4IN JMSHD STD HNDL TPR DISTAL TIP BN MRW,$53.85,$0.00,$53.85,$0.00,$38.43,$0.00,$0.00,$0.00,$0.00,$0.00,$53.85,$0.00,$26.93,$42.65,$43.08,$0.00,$0.00,$0.00,$0.00,$0.00
DJ6011X,SUP,Custom 27203010,,DJ6011X  -  NEEDLE BIOP 11GA 6IN TAPER DISTAL SHARP BEVEL TIP ADAPTER,$39.36,$0.00,$39.36,$0.00,$28.09,$0.00,$0.00,$0.00,$0.00,$0.00,$39.36,$0.00,$19.68,$31.17,$31.49,$0.00,$0.00,$0.00,$0.00,$0.00
DL900F,SUP,HCPCS C1880,,DL900F  -  FILTER EMBOLIZATION DELIVERY KIT DENALI NITINOL FEMORAL VENA,"$3,750.00",$0.00,"$3,750.00","$1,687.50","$2,676.38",$0.00,$646.11,$0.00,$0.00,$656.60,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$586.88,$0.00,$597.00,$0.00
DLP-B11,SUP,Custom 27203010,,ELECTRODE ESURG TN 11CM LETZ SF-T-GA UTAHLOOP RND LOOP SHAFT,$35.63,$0.00,$35.63,$0.00,$25.43,$0.00,$0.00,$0.00,$0.00,$0.00,$35.63,$0.00,$17.81,$28.22,$28.50,$0.00,$0.00,$0.00,$0.00,$0.00
DLS-7083-01S,SUP,Custom 27203010,,DLS-7083-01S  -  NEEDLE BN CMNT 8GA 10CM STRL DLV,$146.78,$0.00,$146.78,$0.00,$104.75,$0.00,$0.00,$0.00,$0.00,$0.00,$146.78,$0.00,$73.39,$116.25,$117.42,$0.00,$0.00,$0.00,$0.00,$0.00
DLS-7083-05S,SUP,Custom 27203010,,DLS-7083-05S  -  NEEDLE BONE CEMENT 8GA 10CM DELIVERY NORIAN SRS STERILE,$114.38,$0.00,$114.38,$0.00,$81.63,$0.00,$0.00,$0.00,$0.00,$0.00,$114.38,$0.00,$57.19,$90.59,$91.50,$0.00,$0.00,$0.00,$0.00,$0.00
DLS-7103-01S,SUP,Custom 27804086,,DLS-7103-01S  -  SYSTEM BONE CEMENT 10GA 10CM DELIVERY NEEDLE NORIAN SRS,$146.78,$0.00,$146.78,$0.00,$104.75,$0.00,$0.00,$0.00,$0.00,$0.00,$146.78,$0.00,$73.39,$116.25,$117.42,$0.00,$0.00,$0.00,$0.00,$0.00
DLS-7103-05S,SUP,Custom 27203010,,DLS-7103-05S  -  NEEDLE BONE CEMENT 10GA 10CM NORIAN SRS STERILE DISPOSABLE,$589.03,$0.00,$589.03,$0.00,$420.39,$0.00,$0.00,$0.00,$0.00,$0.00,$589.03,$0.00,$294.51,$466.51,$471.22,$0.00,$0.00,$0.00,$0.00,$0.00
DNX12,SUP,HCPCS A4364,,DNX12  -  ADH SKNCLS 2 OCTYL CYNCRLT DRMBND ADV EZ TO USE APL TOP .7ML,$49.98,$0.00,$49.98,$27.14,$35.67,$0.00,$2.34,$0.00,$0.00,$8.75,$49.98,$0.00,$24.99,$39.58,$39.98,$0.00,$7.82,$0.00,$7.96,$0.00
DPL 100151-20,SUP,Custom 27803010,,DPL 100151-20  -  COIL EMBL 1MM 1.5CM DELTAPLUSH PLTN,"$2,544.60",$0.00,"$2,544.60",$0.00,"$1,816.08",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,544.60",$0.00,"$1,272.30","$2,015.32","$2,035.68",$0.00,$0.00,$0.00,$0.00,$0.00
DPL 100152-20,SUP,Custom 27803010,,DPL 100152-20  -  COIL EMBL 1.5MM 2CM DELTAPLUSH PLTN,"$2,544.60",$0.00,"$2,544.60",$0.00,"$1,816.08",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,544.60",$0.00,"$1,272.30","$2,015.32","$2,035.68",$0.00,$0.00,$0.00,$0.00,$0.00
DPL 100153-20,SUP,Custom 27803010,,DPL 100153-20  -  COIL EMBL MIC 1.5MM 3CM DELTAPLUSH,"$2,544.60",$0.00,"$2,544.60",$0.00,"$1,816.08",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,544.60",$0.00,"$1,272.30","$2,015.32","$2,035.68",$0.00,$0.00,$0.00,$0.00,$0.00
DPL 100202-20,SUP,Custom 27803010,,DPL 100202-20  -  COIL EMBL 2MM 2CM DELTAPLUSH PLTN,"$2,544.60",$0.00,"$2,544.60",$0.00,"$1,816.08",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,544.60",$0.00,"$1,272.30","$2,015.32","$2,035.68",$0.00,$0.00,$0.00,$0.00,$0.00
DPL 100203-20,SUP,Custom 27803010,,DPL 100203-20  -  COIL EMBL 2MM 3CM DELTAPLUSH PLTN,"$2,544.60",$0.00,"$2,544.60",$0.00,"$1,816.08",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,544.60",$0.00,"$1,272.30","$2,015.32","$2,035.68",$0.00,$0.00,$0.00,$0.00,$0.00
DPL 100204-20,SUP,Custom 27803010,,DPL 100204-20  -  COIL EMBL 2MM 4CM DELTAPLUSH PLTN,"$2,544.60",$0.00,"$2,544.60",$0.00,"$1,816.08",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,544.60",$0.00,"$1,272.30","$2,015.32","$2,035.68",$0.00,$0.00,$0.00,$0.00,$0.00
DPL 100206-20,SUP,Custom 27803010,,DPL 100206-20  -  COIL EMBL 2MM 6CM DELTAPLUSH PLTN,"$2,544.60",$0.00,"$2,544.60",$0.00,"$1,816.08",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,544.60",$0.00,"$1,272.30","$2,015.32","$2,035.68",$0.00,$0.00,$0.00,$0.00,$0.00
DPL10020120,SUP,Custom 27803010,,DPL10020120  -  COIL EMBL 2MM 1CM DELTAPLUSH PLTN,"$2,544.60",$0.00,"$2,544.60",$0.00,"$1,816.08",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,544.60",$0.00,"$1,272.30","$2,015.32","$2,035.68",$0.00,$0.00,$0.00,$0.00,$0.00
DRB1015,SUP,Custom 27203010,,DRB1015  -  BIT DRILL 10MM BUD NONSTRL,$757.50,$0.00,$757.50,$0.00,$540.63,$0.00,$0.00,$0.00,$0.00,$0.00,$757.50,$0.00,$378.75,$599.94,$606.00,$0.00,$0.00,$0.00,$0.00,$0.00
DRB1115,SUP,Custom 27203010,,DRB1115  -  DRILL SURG 11MM IMPL FIX BUD STRL,$757.50,$0.00,$757.50,$0.00,$540.63,$0.00,$0.00,$0.00,$0.00,$0.00,$757.50,$0.00,$378.75,$599.94,$606.00,$0.00,$0.00,$0.00,$0.00,$0.00
DRILL BIT,SUP,HCPCS C1713,,DRILL BIT  -  DRILL BIT 2.4MM QUICK COUPLING W/65MM STOP,$462.50,$0.00,$462.50,$208.13,$330.09,$0.00,$79.69,$0.00,$0.00,$80.98,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$72.38,$0.00,$73.63,$0.00
DRILL-1.6CL,SUP,Custom 27203010,,DRILL-1.6CL  -  BIT DRILL TWISTED 1.6MM,$387.50,$0.00,$387.50,$0.00,$276.56,$0.00,$0.00,$0.00,$0.00,$0.00,$387.50,$0.00,$193.75,$306.90,$310.00,$0.00,$0.00,$0.00,$0.00,$0.00
DRILL-1.75L,SUP,Custom 27203010,,DRILL-1.75L  -  BIT DRL 1.75IN TWST,$300.00,$0.00,$300.00,$0.00,$214.11,$0.00,$0.00,$0.00,$0.00,$0.00,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$0.00,$0.00,$0.00,$0.00
DRILL-2.00,SUP,Custom 27203010,,DRILL-2.00  -  DRILL TWIST REGULAR 2MM,$300.00,$0.00,$300.00,$0.00,$214.11,$0.00,$0.00,$0.00,$0.00,$0.00,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$0.00,$0.00,$0.00,$0.00
DRILL-2.00CL,SUP,Custom 27203010,,DRILL-2.00CL  -  BIT DRILL CANN TWIST LONG 3.2MM 2MM,$387.50,$0.00,$387.50,$0.00,$276.56,$0.00,$0.00,$0.00,$0.00,$0.00,$387.50,$0.00,$193.75,$306.90,$310.00,$0.00,$0.00,$0.00,$0.00,$0.00
DRILL-2.00L,SUP,Custom 27203010,,DRILL-2.00L  -  DRILL TWIST LONG 2MM,$300.00,$0.00,$300.00,$0.00,$214.11,$0.00,$0.00,$0.00,$0.00,$0.00,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$0.00,$0.00,$0.00,$0.00
DRILL-2.1/110C,SUP,Custom 27203010,,DRILL-2.1/110C  -  DRILL SRG 2.1MM 110MM CNN TI,$412.50,$0.00,$412.50,$0.00,$294.40,$0.00,$0.00,$0.00,$0.00,$0.00,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$0.00,$0.00,$0.00,$0.00
DRILL-2.1CL,SUP,Custom 27203010,,DRILL-2.1CL  -  BIT DRILL SMALL HEADLESS SCREWS 2.1MM,$387.50,$0.00,$387.50,$0.00,$276.56,$0.00,$0.00,$0.00,$0.00,$0.00,$387.50,$0.00,$193.75,$306.90,$310.00,$0.00,$0.00,$0.00,$0.00,$0.00
DRILL-2.3,SUP,Custom 27203010,,DRILL-2.3  -  BIT DRL 2.3MM STRL,$300.00,$0.00,$300.00,$0.00,$214.11,$0.00,$0.00,$0.00,$0.00,$0.00,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$0.00,$0.00,$0.00,$0.00
DRILL-2.3/080,SUP,Custom 27203010,,DRILL-2.3/080  -  DRILL SRG 2.3MM 80MM NS LF REUSE,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
DRILL-2.30,SUP,Custom 27203010,,DRILL-2.30  -  BIT DRILL TWIST 2.3MM,$300.00,$0.00,$300.00,$0.00,$214.11,$0.00,$0.00,$0.00,$0.00,$0.00,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$0.00,$0.00,$0.00,$0.00
DRILL-2.30L,SUP,Custom 27203010,,DRILL-2.30L  -  BIT DRILL LONG TWIST 2.3MM,$300.00,$0.00,$300.00,$0.00,$214.11,$0.00,$0.00,$0.00,$0.00,$0.00,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$0.00,$0.00,$0.00,$0.00
DRILL-2.4CL,SUP,Custom 27203010,,DRILL-2.4CL  -  BIT DRILL 2.4MM GS,$387.50,$0.00,$387.50,$0.00,$276.56,$0.00,$0.00,$0.00,$0.00,$0.00,$387.50,$0.00,$193.75,$306.90,$310.00,$0.00,$0.00,$0.00,$0.00,$0.00
DRILL-3.20L,SUP,Custom 27203010,,DRILL-3.20L  -  DRILL TWIST NONCANNULATED 3.2MM,$300.00,$0.00,$300.00,$0.00,$214.11,$0.00,$0.00,$0.00,$0.00,$0.00,$300.00,$0.00,$150.00,$237.60,$240.00,$0.00,$0.00,$0.00,$0.00,$0.00
DRLL-PLS-20,SUP,HCPCS C1713,,DRLL-PLS-20  -  DRILL SRG 2MM 40MM GEMINUS CNN PA LCK SCR,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
DRLL-SSC-20040,SUP,Custom 27203010,,DRLL-SSC-20040  -  DRILL SURG 2MM 40MM SOLID SIDE CUT GEMINUS NONSTRL,$275.00,$0.00,$275.00,$0.00,$196.27,$0.00,$0.00,$0.00,$0.00,$0.00,$275.00,$0.00,$137.50,$217.80,$220.00,$0.00,$0.00,$0.00,$0.00,$0.00
DRLL-SSC-23040,SUP,Custom 27203010,,"DRLL-SSC-23040  -  DRILL, 2.3MM X 40MM","$2,755.00",$0.00,"$2,755.00",$0.00,"$1,966.24",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,755.00",$0.00,"$1,377.50","$2,181.96","$2,204.00",$0.00,$0.00,$0.00,$0.00,$0.00
DRLL-SSC-25040,SUP,Custom 27203010,,DRLL-SSC-25040  -  DRILL SURG 2.5MM 40MM SOLID SIDE CUT GEMINUS NONSTRL,$275.00,$0.00,$275.00,$0.00,$196.27,$0.00,$0.00,$0.00,$0.00,$0.00,$275.00,$0.00,$137.50,$217.80,$220.00,$0.00,$0.00,$0.00,$0.00,$0.00
DRM600,SUP,Custom 27203010,,HEMOCYTOMETER SPERM CNT 2 CHMBR SLD COVERLIP GRID ETCH CLVU,$399.20,$0.00,$399.20,$0.00,$284.91,$0.00,$0.00,$0.00,$0.00,$0.00,$399.20,$0.00,$199.60,$316.17,$319.36,$0.00,$0.00,$0.00,$0.00,$0.00
DRV22508UX,SUP,HCPCS C1874,,STENT CORON 2.25MM 8MM RAPEX MDRVR DRV22508UX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
DRV22512UX,SUP,HCPCS C1874,,STENT CORON 2.25MM 12MM RAPEX MDRVR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
DRV22514UX,SUP,HCPCS C1874,,STENT CORON 2.25MM 14MM RAPEX MDRVR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
DRV22518UX,SUP,HCPCS C1874,,STENT CORON 2.25MM 18MM RAPEX MDRVR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
DRV22524UX,SUP,HCPCS C1874,,STENT CORON 2.25MM 24MM RAPEX MDRVR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
DRV25008UX,SUP,HCPCS C1874,,STENT CORON 2.5MM 8MM RAPEX MDRVR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
DRV25012UX,SUP,HCPCS C1874,,STENT CORON 2.25MM 8MM RAPEX MDRVR DRV25012UX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
DRV25014UX,SUP,HCPCS C1874,,STENT CORON 2.5MM 14MM RAPEX MDRVR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
DRV25018UX,SUP,HCPCS C1874,,STENT CORON 2.5MM 18MM RAPEX MDRVR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
DRV25024UX,SUP,HCPCS C1874,,STENT CORON 2.5MM 24MM RAPEX MDRVR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
DRV27508UX,SUP,HCPCS C1874,,STENT CORON 2.75MM 8MM RAPEX DRVR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
DRV27512UX,SUP,HCPCS C1874,,STENT CORON 2.75MM 12MM RAPEX DRVR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
DRV27514UX,SUP,HCPCS C1874,,STENT CORON 2.75MM 14MM RAPEX MDRVR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
DRV27518UX,SUP,HCPCS C1874,,STENT CORON 2.75MM 18MM RAPEX MDRVR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
DRV27524UX,SUP,HCPCS C1874,,STENT CORON 2.75MM 24MM RAPEX MDRVR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
DRV30012UX,SUP,HCPCS C1874,,STENT CORON 3MM 12MM RAPEX DRVR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
DRV30015UX,SUP,HCPCS C1874,,STENT CORON 3MM 15MM RAPEX DRVR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
DRV30018UX,SUP,HCPCS C1874,,STENT CORON 3MM 18MM RAPEX DRVR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
DRV30024UX,SUP,HCPCS C1874,,STENT CORON 3MM 24MM RAPEX DRVR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
DRV30030UX,SUP,HCPCS C1874,,STENT CORON 3MM 30MM RAPEX DRVR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
DRV35009UX,SUP,HCPCS C1874,,STENT CORON 3.5MM 9MM RAPEX DRVR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
DRV35012UX,SUP,HCPCS C1874,,STENT CORON 3.5MM 12MM RAPEX DRVR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
DRV35015UX,SUP,HCPCS C1874,,STENT CORON 3.5MM 15MM RAPEX DRVR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
DRV35018UX,SUP,HCPCS C1874,,STENT CORON 3.5MM 18MM RAPEX DRVR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
DRV35024UX,SUP,HCPCS C1874,,STENT CORON 3.5MM 24MM RAPEX DRVR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
DRV35030UX,SUP,HCPCS C1874,,STENT CORON 3.5MM 30MM RAPEX DRVR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
DRV40009UX,SUP,HCPCS C1874,,STENT CORON 4MM 9MM RAPEX DRVR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
DRV40012UX,SUP,HCPCS C1874,,STENT CORON 4MM 12MM RAPEX DRVR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
DRV40015UX,SUP,HCPCS C1874,,STENT CORON 4MM 15MM RAPEX DRVR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
DRV40018UX,SUP,HCPCS C1874,,STENT CORON 4MM 18MM RAPEX DRVR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
DRV40024UX,SUP,HCPCS C1874,,STENT CORON 4MM 24MM RAPEX DRVR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
DRV40030UX,SUP,HCPCS C1874,,STENT CORON 4MM 30MM RAPEX DRVR,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
DRVR-AOS-PLS,SUP,Custom 27203010,,DRVR-AOS-PLS  -  DRIVER SRG GEMINUS PA LCK SCR AO CNCT DISP,$255.00,$0.00,$255.00,$0.00,$181.99,$0.00,$0.00,$0.00,$0.00,$0.00,$255.00,$0.00,$127.50,$201.96,$204.00,$0.00,$0.00,$0.00,$0.00,$0.00
DRVR-AOS-S20,SUP,Custom 27203010,,DRVR-AOS-S20  -  DRIVER SRG 2MM NS GEMINUS SQ TIP AO CNCT DISP,$207.50,$0.00,$207.50,$0.00,$148.09,$0.00,$0.00,$0.00,$0.00,$0.00,$207.50,$0.00,$103.75,$164.34,$166.00,$0.00,$0.00,$0.00,$0.00,$0.00
DRVR-UQC-T10,SUP,Custom 27203010,,DRVR-UQC-T10  -  DRIVER SRG 2MM NS GEMINUS T10 UNV QCK CNCT DISP,$237.50,$0.00,$237.50,$0.00,$169.50,$0.00,$0.00,$0.00,$0.00,$0.00,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$0.00,$0.00,$0.00,$0.00
DS100A-1,SUP,Custom 27203010,,SENSOR ADLT DRSNSR 24IN FNGR OXM CLIP DGT MEM CHP NSTRL,$210.63,$0.00,$210.63,$0.00,$150.32,$0.00,$0.00,$0.00,$0.00,$0.00,$210.63,$0.00,$105.31,$166.82,$168.50,$0.00,$0.00,$0.00,$0.00,$0.00
DS2A003,SUP,Custom 27203010,,DS2A003  -  SLITTER CATH UNV CPS ERG DSGN ACPT 4-6FR LD,$112.50,$0.00,$112.50,$0.00,$80.29,$0.00,$0.00,$0.00,$0.00,$0.00,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$0.00,$0.00,$0.00,$0.00
DS2C002,SUP,HCPCS C1893,,DS2C002  -  CATHETER GD 115D 9FR 47CM CPS DRCT SL II DRCT-TO-TRGT BRD,"$1,250.00",$0.00,"$1,250.00",$678.75,$892.13,$0.00,$215.37,$0.00,$0.00,$218.87,"$1,250.00",$0.00,$625.00,$990.00,"$1,000.00",$0.00,$195.63,$0.00,$199.00,$0.00
DS2N021/59,SUP,HCPCS C1893,,DS2N021/59  -  CATHETER GD ACUTE CRV 7FR 59CM CPS AIM SL DRCT-TO-TRGT,$500.00,$0.00,$500.00,$271.50,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
DS2N021/65,SUP,HCPCS C1887,,DS2N021/65  -  CATHETER GD ACUTE CRV 7FR 65CM CPS AIM SL DRCT-TO-TRGT,$500.00,$0.00,$500.00,$271.50,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
DS2N022/59,SUP,HCPCS C1887,,DS2N022/59  -  CPS AIM SL,$500.00,$0.00,$500.00,$271.50,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
DS2N022/65,SUP,HCPCS C1887,,DS2N022/65  -  CATHETER GD 90D 7FR 65CM CPS AIM SL DRCT-TO-TRGT SLITTABLE,$500.00,$0.00,$500.00,$271.50,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
DS2N023/59,SUP,HCPCS C1887,,DS2N023/59  -  CATHETER GD OBTUSE CRV 7FR 59CM CPS AIM SL DRCT-TO-TRGT,$500.00,$0.00,$500.00,$271.50,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
DS2N023/65,SUP,HCPCS C1887,,DS2N023/65  -  CPS AIM SL,$500.00,$0.00,$500.00,$271.50,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
DS2N024/65,SUP,HCPCS C1887,,DS2N024/65  -  CATHETER GD CSL CRV 7FR 65CM CPS AIM SL DRCT-TO-TRGT,$500.00,$0.00,$500.00,$271.50,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
DS2N025/65,SUP,HCPCS C1887,,DS2N025/65  -  CATHETER GD ASII CRV 7FR 65CM CPS AIM SL DRCT-TO-TRGT,$500.00,$0.00,$500.00,$271.50,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
DSF1833,SUP,HCPCS C1894,,DSF1833  -  SHEATH INTRO 18FR 6.7MM 6MM 33CM GORE DRYSEAL FLX HDRPH,"$1,510.00",$0.00,"$1,510.00",$819.93,"$1,077.69",$0.00,$260.17,$0.00,$0.00,$264.39,"$1,510.00",$0.00,$755.00,"$1,195.92","$1,208.00",$0.00,$236.32,$0.00,$240.39,$0.00
DSL1228,SUP,HCPCS C1894,,DSL1228  -  SHEATH INTRO 12FR 5MM 4.1MM 28CM DRYSEAL DIL VLV INFL SYR,$687.50,$0.00,$687.50,$373.31,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
DSL1628,SUP,HCPCS C1894,,DSL1628  -  SHEATH INTRO 16FR 6.2MM 5.3MM 28CM DRYSEAL DIL VLV INFL SYR,$687.50,$0.00,$687.50,$373.31,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
DSL2628,SUP,HCPCS C1894,,DSL2628  -  SHEATH INTROD 28CM DRYSEAL DILAT VALVE INFLAT SYRINGE,$862.50,$0.00,$862.50,$468.34,$615.57,$0.00,$148.60,$0.00,$0.00,$151.02,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$134.98,$0.00,$137.31,$0.00
DUET4535A,SUP,Custom 27203010,,DUET4535A  -  RELOAD STPLR 45MMX3.5MM STRL LF 1.5MM DUET TRS ARTC TISS,"$1,718.23",$0.00,"$1,718.23",$0.00,"$1,226.30",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,718.23",$0.00,$859.11,"$1,360.84","$1,374.58",$0.00,$0.00,$0.00,$0.00,$0.00
DUET4548A,SUP,Custom 27203010,,DUET4548A  -  RELOAD STPLR 45MMX4.8MM STRL LF 2MM DUET TRS ARTC TISS DISP,"$1,909.14",$0.00,"$1,909.14",$0.00,"$1,362.56",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,909.14",$0.00,$954.57,"$1,512.04","$1,527.31",$0.00,$0.00,$0.00,$0.00,$0.00
DUET6035A,SUP,Custom 27203010,,DUET6035A  -  RELOAD STPLR 60MMX3.5MM STRL LF 1.5MM DUET TRS ARTC TISS,"$1,867.59",$0.00,"$1,867.59",$0.00,"$1,332.90",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,867.59",$0.00,$933.80,"$1,479.13","$1,494.07",$0.00,$0.00,$0.00,$0.00,$0.00
DUET6048A,SUP,Custom 27203010,,DUET6048A  -  RELOAD STPLR 60MMX4.8MM STRL LF 2MM DUET TRS ARTC TISS DISP,"$11,205.54",$0.00,"$11,205.54",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,205.54",$0.00,"$5,602.77","$8,874.79","$8,964.43",$0.00,$0.00,$0.00,$0.00,$0.00
DUR1000D,SUP,Custom 27011340,,DUR1000D  -  LASER FIBER_ 1000 MICRON,"$2,794.28",$0.00,"$2,794.28",$0.00,"$1,994.28",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,794.28",$0.00,"$1,397.14","$2,213.07","$2,235.43",$0.00,$0.00,$0.00,$0.00,$0.00
DUR270D,SUP,Custom 27011340,,DUR270D  -  LASER FIBER_ 270 MICRON,"$1,266.67",$0.00,"$1,266.67",$0.00,$904.02,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,266.67",$0.00,$633.33,"$1,003.20","$1,013.33",$0.00,$0.00,$0.00,$0.00,$0.00
DUR400D,SUP,Custom 27011340,,DUR400D  -  LASER FIBER_ 400 MICRON,"$1,266.67",$0.00,"$1,266.67",$0.00,$904.02,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,266.67",$0.00,$633.33,"$1,003.20","$1,013.33",$0.00,$0.00,$0.00,$0.00,$0.00
DUR400DBX,SUP,Custom 27011340,,DUR400DBX  -  FIBER LSR 400UM STRL DUR HO DISP LTHTRP,"$1,074.28",$0.00,"$1,074.28",$0.00,$766.72,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,074.28",$0.00,$537.14,$850.83,$859.43,$0.00,$0.00,$0.00,$0.00,$0.00
DUR600D,SUP,Custom 27011340,,DUR600D  -  LASER FIBER_ 600 MICRON,"$1,475.00",$0.00,"$1,475.00",$0.00,"$1,052.71",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,475.00",$0.00,$737.50,"$1,168.20","$1,180.00",$0.00,$0.00,$0.00,$0.00,$0.00
DUR600DBX,SUP,Custom 27011340,,DUR600DBX  -  FIBER LSR 600UM STRL DUR HO DISP LTHTRP,"$1,254.17",$0.00,"$1,254.17",$0.00,$895.10,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,254.17",$0.00,$627.08,$993.30,"$1,003.33",$0.00,$0.00,$0.00,$0.00,$0.00
DVR-AXXL,SUP,HCPCS C1713,,DVR-AXXL  -  PLATE X XTD DVR BONE LEFT DISTAL VOLR RADL STRL,"$3,865.00",$0.00,"$3,865.00","$1,739.25","$2,758.45",$0.00,$665.92,$0.00,$0.00,$676.73,"$3,865.00",$0.00,"$1,932.50","$3,061.08","$3,092.00",$0.00,$604.87,$0.00,$615.31,$0.00
DWB172,SUP,HCPCS C1776,,DWB172  -  STEM HUM 130MM 9MM BONE GRW AQLS CMNT 25IN NECK FRAC,"$10,685.00",$0.00,"$10,685.00","$4,808.25","$5,158.80",$0.00,"$1,840.97",$0.00,$0.00,"$1,870.86","$10,685.00",$0.00,"$5,342.50","$8,462.52","$8,548.00",$0.00,"$1,672.20",$0.00,"$1,701.05",$0.00
DWB173,SUP,HCPCS C1776,,DWB173  -  HEAD HUM 130MM 12MM SHLDR FRAC AQLS COCR 130D,"$4,215.00",$0.00,"$4,215.00","$1,896.75","$3,008.25",$0.00,$726.22,$0.00,$0.00,$738.01,"$4,215.00",$0.00,"$2,107.50","$3,338.28","$3,372.00",$0.00,$659.65,$0.00,$671.03,$0.00
DWB243,SUP,HCPCS C1776,,DWB243  -  HEAD HUM CALOTTE HUMERALE,"$4,215.00",$0.00,"$4,215.00","$1,896.75","$3,008.25",$0.00,$726.22,$0.00,$0.00,$738.01,"$4,215.00",$0.00,"$2,107.50","$3,338.28","$3,372.00",$0.00,$659.65,$0.00,$671.03,$0.00
DWB252,SUP,HCPCS C1776,,DWB252  -  HEAD HUM 52MM 19MM AQLS CMNT PVRS TI SHLDR,"$17,125.00",$0.00,"$17,125.00","$7,706.25","$5,158.80",$0.00,"$2,950.55",$0.00,$0.00,"$2,998.45","$17,125.00",$0.00,"$8,562.50","$13,563.00","$13,700.00",$0.00,"$2,680.06",$0.00,"$2,726.30",$0.00
DWB253,SUP,HCPCS C1776,,DWB253  -  HEAD HUM 23MM 52MM SHLDR CMNT PVRS AQLS TI,"$10,685.00",$0.00,"$10,685.00","$4,808.25","$5,158.80",$0.00,"$1,840.97",$0.00,$0.00,"$1,870.86","$10,685.00",$0.00,"$5,342.50","$8,462.52","$8,548.00",$0.00,"$1,672.20",$0.00,"$1,701.05",$0.00
DWD020,SUP,HCPCS C1713,,DWD020  -  SCREW BSPLT 20MM 4.5MM AQLS GLND TI LOCK MLDIR ST,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
DWD023,SUP,HCPCS C1713,,DWD023  -  SCREW BSPLT 23MM 4.5MM AQLS GLND TI LOCK MLDIR ST,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
DWD029,SUP,HCPCS C1713,,DWD029  -  SCREW BSPLT 29MM 4.5MM AQLS GLND TI LOCK MLDIR ST,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
DWD055,SUP,Custom 27203010,,DWD055  -  BIT DRL 3MM STRL DISP,$342.50,$0.00,$342.50,$0.00,$244.44,$0.00,$0.00,$0.00,$0.00,$0.00,$342.50,$0.00,$171.25,$271.26,$274.00,$0.00,$0.00,$0.00,$0.00,$0.00
DWD180,SUP,HCPCS C1776,,DWD180  -  SPHERE GLND 36MM AQLS CRCO RVRS CNTR 25MM BSPLT,"$8,312.50",$0.00,"$8,312.50","$3,740.63","$5,158.80",$0.00,"$1,432.20",$0.00,$0.00,"$1,455.45","$8,312.50",$0.00,"$4,156.25","$6,583.50","$6,650.00",$0.00,"$1,300.91",$0.00,"$1,323.35",$0.00
DWD860,SUP,HCPCS C1776,,DWD860  -  INSERT HUM 36MM AQLS 6MM SHLDR LAT PVRS ADPR FRAC,"$4,507.50",$0.00,"$4,507.50","$2,028.38","$3,217.00",$0.00,$776.62,$0.00,$0.00,$789.23,"$4,507.50",$0.00,"$2,253.75","$3,569.94","$3,606.00",$0.00,$705.42,$0.00,$717.59,$0.00
DWD861,SUP,HCPCS C1776,,DWD861  -  INSERT HUM 36MM AQLS +9MM LAT RVRS ADPR FRAC PRIM,"$4,507.50",$0.00,"$4,507.50","$2,028.38","$3,217.00",$0.00,$776.62,$0.00,$0.00,$789.23,"$4,507.50",$0.00,"$2,253.75","$3,569.94","$3,606.00",$0.00,$705.42,$0.00,$717.59,$0.00
DWD901,SUP,HCPCS C1776,,DWD901  -  STEM HUM 130MM 7MM PVRS FRAC AQLS SHLDR,"$13,975.00",$0.00,"$13,975.00","$6,288.75","$5,158.80",$0.00,"$2,407.82",$0.00,$0.00,"$2,446.91","$13,975.00",$0.00,"$6,987.50","$11,068.20","$11,180.00",$0.00,"$2,187.09",$0.00,"$2,224.82",$0.00
DX-22-100,SUP,Custom 27203010,,DX-22-100  -  SYSTEM SPNL FX DTRAX,"$2,125.00",$0.00,"$2,125.00",$0.00,"$1,516.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
DYND13522,SUP,HCPCS A4351,,DYND13522  -  CATHETER URTH RBNSN 22FR 16IN SMTH TIP 2 OVL EYE RADIOPQ FNL,$2.07,$0.00,$2.07,$0.00,$1.48,$0.00,$0.00,$0.00,$0.00,$0.00,$2.07,$0.00,$1.03,$1.64,$1.66,$0.00,$0.00,$0.00,$0.00,$0.00
E05021,SUP,Custom 27203010,,E05021  -  ADAPTER ESURG UNV STRL VLAB MNPLR FTSWTCH DISP ACPT 3.2- MM,$97.83,$0.00,$97.83,$0.00,$69.82,$0.00,$0.00,$0.00,$0.00,$0.00,$97.83,$0.00,$48.91,$77.48,$78.26,$0.00,$0.00,$0.00,$0.00,$0.00
E0570,SUP,Custom 27203010,,RETRACTOR STRG NRV ROOT SURG,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
E100-21A-00,SUP,Custom 27803010,,E100-21A-00  -  VALVE AORTIC 21MM EP,"$15,000.00",$0.00,"$15,000.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$15,000.00",$0.00,"$7,500.00","$11,880.00","$12,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
E100-23A-00,SUP,Custom 27803010,,E100-23A-00  -  VALVE AOR 23MM 21MM 15MM EP LINX BPRTH STNT SW CUF PLSTR SUP,"$15,000.00",$0.00,"$15,000.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$15,000.00",$0.00,"$7,500.00","$11,880.00","$12,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
E100-25A-00,SUP,Custom 27803010,,E100-25A-00  -  VALVE AORTIC 25MM EP,"$15,000.00",$0.00,"$15,000.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$15,000.00",$0.00,"$7,500.00","$11,880.00","$12,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
E100-25M-00,SUP,Custom 27803010,,E100-25M-00  -  VALVE MTRL 25MM 23MM 16MM EP FLEXFIT BPRTH STNT HLDR LOPRFL,"$23,350.00",$0.00,"$23,350.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$23,350.00",$0.00,"$11,675.00","$18,493.20","$18,680.00",$0.00,$0.00,$0.00,$0.00,$0.00
E100-27A-00,SUP,Custom 27803010,,E100-27A-00  -  VALVE AOR 27MM 25MM 17MM EP LINX BPRTH STNT SW CUF PLSTR SUP,"$15,000.00",$0.00,"$15,000.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$15,000.00",$0.00,"$7,500.00","$11,880.00","$12,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
E100-27M-00,SUP,Custom 27803010,,E100-27M-00  -  VALVE MTRL LOPRFL 25MM 23MM 16MM EP FLEXFIT BPRTH STNT HLDR,"$15,500.00",$0.00,"$15,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$15,500.00",$0.00,"$7,750.00","$12,276.00","$12,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
E100-29A-00,SUP,Custom 27803010,,E100-29A-00  -  VALVE AORTIC 29MM EP THV,"$15,000.00",$0.00,"$15,000.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$15,000.00",$0.00,"$7,500.00","$11,880.00","$12,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
E100-29M-00,SUP,Custom 27803010,,E100-29M-00  -  VALVE MTRL 29MM 27MM 19MM LF 10MM EP LINX BIOCOR FLEXFIT,"$15,500.00",$0.00,"$15,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$15,500.00",$0.00,"$7,750.00","$12,276.00","$12,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
E100-31M-00,SUP,Custom 27803010,,E100-31M-00  -  VALVE MTRL 31MM 29MM 20MM STRL LF EP FLEXFIT BPRTH STNT HLDR,"$15,500.00",$0.00,"$15,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$15,500.00",$0.00,"$7,750.00","$12,276.00","$12,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
E100-33M-00,SUP,Custom 27803010,,E100-33M-00  -  VALVE MTRL 33MM 41MM 31MM 20MM STRL EP FLEXFIT BPRTH STNT,"$15,500.00",$0.00,"$15,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$15,500.00",$0.00,"$7,750.00","$12,276.00","$12,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
E1457,SUP,Custom 27203010,,E1457  -  ELECTRODE ELECTROSURGICAL 45D 178MM NEEDLE SLEEVE,$282.50,$0.00,$282.50,$0.00,$201.62,$0.00,$0.00,$0.00,$0.00,$0.00,$282.50,$0.00,$141.25,$223.74,$226.00,$0.00,$0.00,$0.00,$0.00,$0.00
E2505-10FR,SUP,Custom 27203010,,E2505-10FR  -  COAG SCT 6IN 10FR LECTROVAC FTSWTCH ACT SHFT STRL DISP,$19.33,$0.00,$19.33,$0.00,$13.79,$0.00,$0.00,$0.00,$0.00,$0.00,$19.33,$0.00,$9.66,$15.31,$15.46,$0.00,$0.00,$0.00,$0.00,$0.00
E2530-6,SUP,Custom 27203010,,E2530-6  -  ELECTRODE ELECTROSURGICAL 6IN HANDSET COAGULATION FLEXIBLE,$649.00,$0.00,$649.00,$0.00,$463.19,$0.00,$0.00,$0.00,$0.00,$0.00,$649.00,$0.00,$324.50,$514.01,$519.20,$0.00,$0.00,$0.00,$0.00,$0.00
E-3F,SUP,Custom 27203010,,PROBE LTHTRP 120CM 3FR ELHDR STRL AEH2 3,$446.68,$0.00,$446.68,$0.00,$318.79,$0.00,$0.00,$0.00,$0.00,$0.00,$446.68,$0.00,$223.34,$353.77,$357.34,$0.00,$0.00,$0.00,$0.00,$0.00
E5211-6K,SUP,Custom 27203010,,E5211-6K  -  BIT DRILL 7.4MM 150MM,$291.50,$0.00,$291.50,$0.00,$208.04,$0.00,$0.00,$0.00,$0.00,$0.00,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$0.00,$0.00,$0.00,$0.00
E5211-6L,SUP,Custom 27203010,,E5211-6L  -  BIT DRILL 7.4MM 200MM,$291.50,$0.00,$291.50,$0.00,$208.04,$0.00,$0.00,$0.00,$0.00,$0.00,$291.50,$0.00,$145.75,$230.87,$233.20,$0.00,$0.00,$0.00,$0.00,$0.00
E-70-0045,SUP,HCPCS C1713,,E-70-0045  -  PLATE ACUMED BONE LEFT DISTAL ULN,"$2,237.50",$0.00,"$2,237.50","$1,006.88","$1,596.90",$0.00,$385.51,$0.00,$0.00,$391.77,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$350.17,$0.00,$356.21,$0.00
EA100,SUP,Custom 27203010,,EA100  -  INSTRUMENT TRAY EA100 LEGEND EHS STYLUS,"$1,258.00",$0.00,"$1,258.00",$0.00,$897.83,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,258.00",$0.00,$629.00,$996.34,"$1,006.40",$0.00,$0.00,$0.00,$0.00,$0.00
EAW2827,SUP,Custom 27203010,,REGULATOR FLOW 1 DISS OXYGEN CYLINDER,$240.00,$0.00,$240.00,$0.00,$171.29,$0.00,$0.00,$0.00,$0.00,$0.00,$240.00,$0.00,$120.00,$190.08,$192.00,$0.00,$0.00,$0.00,$0.00,$0.00
EB0101,SUP,Custom 27203010,,EB0101  -  RSTRC CMNT LTD 8-15MM ELB,$420.00,$0.00,$420.00,$0.00,$299.75,$0.00,$0.00,$0.00,$0.00,$0.00,$420.00,$0.00,$210.00,$332.64,$336.00,$0.00,$0.00,$0.00,$0.00,$0.00
EB2S103,SUP,HCPCS C1884,,EB2S103  -  PARTICLES EMBL 100-300UM 2ML YLW BDBL MCSPH CMPR PVA,$437.50,$0.00,$437.50,$196.88,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
EB2S305,SUP,Custom 27803010,,EB2S305  -  PARTICLES EMBL 300-500UM 2ML BLU BDBL CMPR MCSPH PVA,$460.00,$0.00,$460.00,$0.00,$328.30,$0.00,$0.00,$0.00,$0.00,$0.00,$460.00,$0.00,$230.00,$364.32,$368.00,$0.00,$0.00,$0.00,$0.00,$0.00
EB2S507,SUP,HCPCS C1884,,EB2S507  -  PARTICLES EMBL 500-700UM 2ML RD BDBL CMPR PRECISELY CLBRT,$460.00,$0.00,$460.00,$207.00,$328.30,$0.00,$79.26,$0.00,$0.00,$80.54,$460.00,$0.00,$230.00,$364.32,$368.00,$0.00,$71.99,$0.00,$73.23,$0.00
EB2S709,SUP,HCPCS C1884,,EB2S709  -  PARTICLES EMBL 700-900UM 2ML GRN BDBL CMPR PRECISELY CLBRT,$437.50,$0.00,$437.50,$196.88,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
EB2S912,SUP,HCPCS C1884,,EB2S912  -  PARTICLES EMBL 900-1200UM 2ML PUR BDBL CMPR PRECISELY CLBRT,$437.50,$0.00,$437.50,$196.88,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
ECATCH15,SUP,Custom 27203010,,ECATCH15  -  POUCH SPEC RTRVL 15MM 34.5CM LF 29.5CM E-CTCH II FLXB ERG,$283.90,$0.00,$283.90,$0.00,$202.62,$0.00,$0.00,$0.00,$0.00,$0.00,$283.90,$0.00,$141.95,$224.85,$227.12,$0.00,$0.00,$0.00,$0.00,$0.00
ECH060040A,SUP,HCPCS C1768,,ECH060040A  -  GRAFT VASCULAR 6CM 40CM 3 LAYER ACUSEAL PTFE,"$3,225.00",$0.00,"$3,225.00","$1,451.25","$2,301.68",$0.00,$555.65,$0.00,$0.00,$564.67,"$3,225.00",$0.00,"$1,612.50","$2,554.20","$2,580.00",$0.00,$504.71,$0.00,$513.42,$0.00
ECH470045A,SUP,HCPCS C1768,,ECH470045A  -  GRAFT VASCULAR 4-7MM 45CM TAPER GORE ACUSEAL STERILE,"$3,700.00",$0.00,"$3,700.00","$1,665.00","$2,640.69",$0.00,$637.49,$0.00,$0.00,$647.84,"$3,700.00",$0.00,"$1,850.00","$2,930.40","$2,960.00",$0.00,$579.05,$0.00,$589.04,$0.00
ECHO-1-22,SUP,Custom 27203102,,SHEATH BLUE 22G (STIFFER),$669.30,$0.00,$669.30,$0.00,$477.68,$0.00,$0.00,$0.00,$0.00,$0.00,$669.30,$0.00,$334.65,$530.09,$535.44,$0.00,$0.00,$0.00,$0.00,$0.00
ECHO--19,SUP,Custom 27203105,,NEEDLE 19G,$225.00,$0.00,$225.00,$0.00,$160.58,$0.00,$0.00,$0.00,$0.00,$0.00,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$0.00,$0.00,$0.00,$0.00
ECHO-19-CB,SUP,Custom 27203106,,CYTOLOGY BRUSH (ECHO-19),$20.13,$0.00,$20.13,$0.00,$14.36,$0.00,$0.00,$0.00,$0.00,$0.00,$20.13,$0.00,$10.06,$15.94,$16.10,$0.00,$0.00,$0.00,$0.00,$0.00
ECHO-20-CPN,SUP,Custom 27203104,,CELIAC PLEXUS NEUROLYSIS NEEDLE 20G,$272.58,$0.00,$272.58,$0.00,$194.54,$0.00,$0.00,$0.00,$0.00,$0.00,$272.58,$0.00,$136.29,$215.88,$218.06,$0.00,$0.00,$0.00,$0.00,$0.00
ECHO-25,SUP,Custom 27203590,,NEEDLE BX 25G,$225.00,$0.00,$225.00,$0.00,$160.58,$0.00,$0.00,$0.00,$0.00,$0.00,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$0.00,$0.00,$0.00,$0.00
ECHO-3-22,SUP,Custom 27203103,,GREEN SPRING COIL SHEATH 22G,$669.30,$0.00,$669.30,$0.00,$477.68,$0.00,$0.00,$0.00,$0.00,$0.00,$669.30,$0.00,$334.65,$530.09,$535.44,$0.00,$0.00,$0.00,$0.00,$0.00
EDI-3180,SUP,Custom 27203010,,PAD DFBR PADPRO RDTRNS ADLT 2516 LF,$32.50,$0.00,$32.50,$0.00,$23.20,$0.00,$0.00,$0.00,$0.00,$0.00,$32.50,$0.00,$16.25,$25.74,$26.00,$0.00,$0.00,$0.00,$0.00,$0.00
EDI-3183,SUP,Custom 27203010,,PAD DFBR PADPRO RDTRNS INF 2603 LF,$32.50,$0.00,$32.50,$0.00,$23.20,$0.00,$0.00,$0.00,$0.00,$0.00,$32.50,$0.00,$16.25,$25.74,$26.00,$0.00,$0.00,$0.00,$0.00,$0.00
EEA2835,SUP,Custom 27203010,,EEA2835  -  STAPLER INTERNAL 3.5MM CIRCULAR 28MM 22CM SHAFT LARGE,$746.73,$0.00,$746.73,$0.00,$532.94,$0.00,$0.00,$0.00,$0.00,$0.00,$746.73,$0.00,$373.36,$591.41,$597.38,$0.00,$0.00,$0.00,$0.00,$0.00
EGIA60CTAMT,SUP,Custom 27203010,,EGIA60CTAMT  -  RELOAD STPLR 60MM PUR STRL LF ARTC CRV TIP INTRO MED THKTIS,"$4,321.80",$0.00,"$4,321.80",$0.00,"$3,084.47",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,321.80",$0.00,"$2,160.90","$3,422.87","$3,457.44",$0.00,$0.00,$0.00,$0.00,$0.00
EGIARADXT,SUP,Custom 27203010,,EGIARADXT  -  RELOAD STPLR 15MM BLK STRL LF EGIA RADL TI X THKTIS DISP,"$6,411.75",$0.00,"$6,411.75",$0.00,"$4,576.07",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,411.75",$0.00,"$3,205.88","$5,078.11","$5,129.40",$0.00,$0.00,$0.00,$0.00,$0.00
EL21L,SUP,Custom 27203010,,EL21L  -  SUTURE ABSORBABLE 0 3.9MM 21IN BRAID COATED LIGATE LOOP,$55.06,$0.00,$55.06,$0.00,$39.30,$0.00,$0.00,$0.00,$0.00,$0.00,$55.06,$0.00,$27.53,$43.61,$44.05,$0.00,$0.00,$0.00,$0.00,$0.00
ELAFIXP2P744,SUP,HCPCS C1893,,ELAFIXP2P744  -  LEAD PCNG ELAPASS PSV FX ART VNTRC,"$1,125.00",$0.00,"$1,125.00",$610.88,$802.91,$0.00,$193.83,$0.00,$0.00,$196.98,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$176.06,$0.00,$179.10,$0.00
ELAFIXP2P752,SUP,HCPCS C1893,,ELAFIXP2P752  -  LEAD PCNG 52CM SCR IN BP ATRERY,"$1,125.00",$0.00,"$1,125.00",$610.88,$802.91,$0.00,$193.83,$0.00,$0.00,$196.98,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$176.06,$0.00,$179.10,$0.00
ELAFIXP2P758,SUP,HCPCS C1893,,ELAFIXP2P758  -  LEAD SRG 10MM 7FR 58CM SCR IN IS 1,"$1,125.00",$0.00,"$1,125.00",$610.88,$802.91,$0.00,$193.83,$0.00,$0.00,$196.98,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$176.06,$0.00,$179.10,$0.00
ELAFIXS2J748,SUP,HCPCS C1898,,ELAFIXS2J748  -  LEAD PCNG JTP ATR,"$1,125.00",$0.00,"$1,125.00",$506.25,$802.91,$0.00,$193.83,$0.00,$0.00,$196.98,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$176.06,$0.00,$179.10,$0.00
ELAFIXS2J752,SUP,HCPCS C1898,,ELAFIXS2J752  -  LEAD PCNG JTP ATR,"$1,125.00",$0.00,"$1,125.00",$506.25,$802.91,$0.00,$193.83,$0.00,$0.00,$196.98,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$176.06,$0.00,$179.10,$0.00
ELAPASSP752,SUP,HCPCS C1898,,ELAPASSP752  -  LEAD PCNG ELAPASS TN VNTRC,"$1,125.00",$0.00,"$1,125.00",$506.25,$802.91,$0.00,$193.83,$0.00,$0.00,$196.98,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$176.06,$0.00,$179.10,$0.00
ELAPASSP758,SUP,HCPCS C1898,,ELAPASSP758  -  LEAD PCNG 58CM BP STRG VNTRC,"$1,125.00",$0.00,"$1,125.00",$506.25,$802.91,$0.00,$193.83,$0.00,$0.00,$196.98,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$176.06,$0.00,$179.10,$0.00
ELAPASSPJ744,SUP,HCPCS C1898,,ELAPASSPJ744  -  LEAD PCNG 7FR 44CM ELAPASS P BP ATR,"$1,125.00",$0.00,"$1,125.00",$506.25,$802.91,$0.00,$193.83,$0.00,$0.00,$196.98,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$176.06,$0.00,$179.10,$0.00
ELAPASSPJ752,SUP,HCPCS C1898,,ELAPASSPJ752  -  LEAD PACING J 52CM BIPOL PREFORMED TINED LOW VOLTAGE ELAPASS,"$1,125.00",$0.00,"$1,125.00",$506.25,$802.91,$0.00,$193.83,$0.00,$0.00,$196.98,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$176.06,$0.00,$179.10,$0.00
EMP-FBX1000HS,SUP,Custom 27203010,,EMP-FBX1000HS  -  LASER SURGICAL 1000 MH FIBER SINGLE USE,"$2,026.14",$0.00,"$2,026.14",$0.00,"$1,446.06",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,026.14",$0.00,"$1,013.07","$1,604.70","$1,620.91",$0.00,$0.00,$0.00,$0.00,$0.00
EMP-FBX272HS-C,SUP,Custom 27203010,,"EMP-FBX272HS-C  -  LASER SURGICAL 272 MH FIBER SINGLE USE, COMPATIBLE",$640.62,$0.00,$640.62,$0.00,$457.21,$0.00,$0.00,$0.00,$0.00,$0.00,$640.62,$0.00,$320.31,$507.37,$512.50,$0.00,$0.00,$0.00,$0.00,$0.00
EMP-FBX365HS,SUP,Custom 27203010,,EMP-FBX365HS  -  LASER SURGICAL 365 MH FIBER SINGLE USE,$640.62,$0.00,$640.62,$0.00,$457.21,$0.00,$0.00,$0.00,$0.00,$0.00,$640.62,$0.00,$320.31,$507.37,$512.50,$0.00,$0.00,$0.00,$0.00,$0.00
EMP-FBX550HS,SUP,Custom 27203010,,EMP-FBX550HS  -  LASER SURGICAL 550 MH FIBER SINGLE USE,"$1,084.68",$0.00,"$1,084.68",$0.00,$774.14,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,084.68",$0.00,$542.34,$859.07,$867.74,$0.00,$0.00,$0.00,$0.00,$0.00
EN2006015-C,SUP,HCPCS C1757,,EN2006015-C  -  SNARE VASC STD 9-15MM 6FR 120CM 100CM ENSNR 3 PREFRM LOOP,$827.50,$0.00,$827.50,$0.00,$590.59,$0.00,$0.00,$0.00,$0.00,$0.00,$827.50,$0.00,$413.75,$655.38,$662.00,$0.00,$0.00,$0.00,$0.00,$0.00
EN2007030,SUP,Custom 27203010,,EN2007030  -  SNARE VASC STD 18-30MM 7FR 120CM 100CM ENSNR 3 INTERLACE,$827.50,$0.00,$827.50,$0.00,$590.59,$0.00,$0.00,$0.00,$0.00,$0.00,$827.50,$0.00,$413.75,$655.38,$662.00,$0.00,$0.00,$0.00,$0.00,$0.00
EN2007045,SUP,Custom 27203010,,EN2007045  -  SNARE VASCULAR 120CM 3 PREFORM LOOP WIRE KINK RESISTANT,"$1,100.00",$0.00,"$1,100.00",$0.00,$785.07,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,100.00",$0.00,$550.00,$871.20,$880.00,$0.00,$0.00,$0.00,$0.00,$0.00
ENBD-7,SUP,HCPCS C1725,,CATHETER DRAIN 7FR 250CM 5 SDPRT LCK PGTL ENDSCP BIL NSL,$286.15,$0.00,$286.15,$155.38,$204.23,$0.00,$49.30,$0.00,$0.00,$50.10,$286.15,$0.00,$143.08,$226.63,$228.92,$0.00,$44.78,$0.00,$45.56,$0.00
ENDO-014,SUP,HCPCS C1769,,ENDO-014  -  GUIDEWIRE ENDOVASCULAR L260 CM OD.014 IN ANCILLARY,$450.00,$0.00,$450.00,$244.35,$321.17,$0.00,$77.53,$0.00,$0.00,$78.79,$450.00,$0.00,$225.00,$356.40,$360.00,$0.00,$70.43,$0.00,$71.64,$0.00
ENF402300,SUP,HCPCS C1874,,ENF402300  -  STENT VASCULAR 4.5MM 22MM W/O DISTAL TIP ENTERPRISE NITINOL,"$14,899.20",$0.00,"$14,899.20","$6,704.64","$5,158.80",$0.00,"$2,567.06",$0.00,$0.00,"$2,608.73","$14,899.20",$0.00,"$7,449.60","$11,800.17","$11,919.36",$0.00,"$2,331.72",$0.00,"$2,371.95",$0.00
ENF402312,SUP,HCPCS C1874,,ENF402312  -  STENT VASC 4.5MM 22MM ENTRP RECON DEV SLF EXPANDABLE DLV SYS,"$14,899.20",$0.00,"$14,899.20","$6,704.64","$5,158.80",$0.00,"$2,567.06",$0.00,$0.00,"$2,608.73","$14,899.20",$0.00,"$7,449.60","$11,800.17","$11,919.36",$0.00,"$2,331.72",$0.00,"$2,371.95",$0.00
ENF403000,SUP,HCPCS C1874,,ENF403000  -  STENT VASCULAR 4.5MM 28MM W/O DISTAL TIP ENTERPRISE NITINOL,"$14,899.20",$0.00,"$14,899.20","$6,704.64","$5,158.80",$0.00,"$2,567.06",$0.00,$0.00,"$2,608.73","$14,899.20",$0.00,"$7,449.60","$11,800.17","$11,919.36",$0.00,"$2,331.72",$0.00,"$2,371.95",$0.00
ENF403012,SUP,HCPCS C1874,,ENF403012  -  STENT VASC 4.5MM 28MM ENTRP RECON DEV SLF EXPANDABLE DLV SYS,"$14,899.20",$0.00,"$14,899.20","$6,704.64","$5,158.80",$0.00,"$2,567.06",$0.00,$0.00,"$2,608.73","$14,899.20",$0.00,"$7,449.60","$11,800.17","$11,919.36",$0.00,"$2,331.72",$0.00,"$2,371.95",$0.00
ENF403900,SUP,HCPCS C1874,,ENF403900  -  STENT VASCULAR 4.5MM 37MM W/O DISTAL TIP ENTERPRISE NITINOL,"$14,899.20",$0.00,"$14,899.20","$6,704.64","$5,158.80",$0.00,"$2,567.06",$0.00,$0.00,"$2,608.73","$14,899.20",$0.00,"$7,449.60","$11,800.17","$11,919.36",$0.00,"$2,331.72",$0.00,"$2,371.95",$0.00
ENF403912,SUP,HCPCS C1874,,ENF403912  -  STENT VASC 4.5MM 37MM ENTRP RECON DEV SLF EXPANDABLE DLV SYS,"$14,899.20",$0.00,"$14,899.20","$6,704.64","$5,158.80",$0.00,"$2,567.06",$0.00,$0.00,"$2,608.73","$14,899.20",$0.00,"$7,449.60","$11,800.17","$11,919.36",$0.00,"$2,331.72",$0.00,"$2,371.95",$0.00
ENSP25008UX,SUP,HCPCS C1874,,STENT CORON 8MM 25MM DRUG ELUDING ENDVR,"$4,312.50",$0.00,"$4,312.50","$1,940.63","$3,077.83",$0.00,$743.02,$0.00,$0.00,$755.08,"$4,312.50",$0.00,"$2,156.25","$3,415.50","$3,450.00",$0.00,$674.91,$0.00,$686.55,$0.00
ENSP25012UX,SUP,HCPCS C1874,,STENT CORON 2.5MM 12MM DRUG ELUDING ENDVR SPRNT,"$4,312.50",$0.00,"$4,312.50","$1,940.63","$3,077.83",$0.00,$743.02,$0.00,$0.00,$755.08,"$4,312.50",$0.00,"$2,156.25","$3,415.50","$3,450.00",$0.00,$674.91,$0.00,$686.55,$0.00
ENSP25014UX,SUP,HCPCS C1874,,STENT CORON 2.5MM 14MM DRUG ELUDING ENDVR,"$4,312.50",$0.00,"$4,312.50","$1,940.63","$3,077.83",$0.00,$743.02,$0.00,$0.00,$755.08,"$4,312.50",$0.00,"$2,156.25","$3,415.50","$3,450.00",$0.00,$674.91,$0.00,$686.55,$0.00
ENSP25018UX,SUP,HCPCS C1874,,STENT CORON 2.5MM 18MM DRUG ELUDING ENDVR SPRNT,"$4,312.50",$0.00,"$4,312.50","$1,940.63","$3,077.83",$0.00,$743.02,$0.00,$0.00,$755.08,"$4,312.50",$0.00,"$2,156.25","$3,415.50","$3,450.00",$0.00,$674.91,$0.00,$686.55,$0.00
ENSP25024UX,SUP,HCPCS C1874,,STENT CORON 2.5MM 24MM DRUG ELUDING ENDVR,"$4,312.50",$0.00,"$4,312.50","$1,940.63","$3,077.83",$0.00,$743.02,$0.00,$0.00,$755.08,"$4,312.50",$0.00,"$2,156.25","$3,415.50","$3,450.00",$0.00,$674.91,$0.00,$686.55,$0.00
ENSP25030UX,SUP,HCPCS C1874,,STENT CORON 2.5MM 30MM DRUG ELUDING ENDVR,"$4,312.50",$0.00,"$4,312.50","$1,940.63","$3,077.83",$0.00,$743.02,$0.00,$0.00,$755.08,"$4,312.50",$0.00,"$2,156.25","$3,415.50","$3,450.00",$0.00,$674.91,$0.00,$686.55,$0.00
ENSP30009UX,SUP,HCPCS C1874,,STENT CORON 3MM 9MM DRUG ELUDING ENDVR,"$4,312.50",$0.00,"$4,312.50","$1,940.63","$3,077.83",$0.00,$743.02,$0.00,$0.00,$755.08,"$4,312.50",$0.00,"$2,156.25","$3,415.50","$3,450.00",$0.00,$674.91,$0.00,$686.55,$0.00
ENSP30012UX,SUP,HCPCS C1874,,STENT CORON 3MM 12MM DRUG ELUDING ENDVR,"$4,312.50",$0.00,"$4,312.50","$1,940.63","$3,077.83",$0.00,$743.02,$0.00,$0.00,$755.08,"$4,312.50",$0.00,"$2,156.25","$3,415.50","$3,450.00",$0.00,$674.91,$0.00,$686.55,$0.00
ENSP30015UX,SUP,HCPCS C1874,,STENT CORON 3MM 15MM DRUG ELUDING ENDVR,"$4,312.50",$0.00,"$4,312.50","$1,940.63","$3,077.83",$0.00,$743.02,$0.00,$0.00,$755.08,"$4,312.50",$0.00,"$2,156.25","$3,415.50","$3,450.00",$0.00,$674.91,$0.00,$686.55,$0.00
ENSP30018UX,SUP,HCPCS C1874,,STENT CORON 3MM 18MM DRUG ELUDING ENDVR,"$4,312.50",$0.00,"$4,312.50","$1,940.63","$3,077.83",$0.00,$743.02,$0.00,$0.00,$755.08,"$4,312.50",$0.00,"$2,156.25","$3,415.50","$3,450.00",$0.00,$674.91,$0.00,$686.55,$0.00
ENSP30024UX,SUP,HCPCS C1874,,STENT CORON 3MM 24MM DRUG ELUDING ENDVR,"$4,312.50",$0.00,"$4,312.50","$1,940.63","$3,077.83",$0.00,$743.02,$0.00,$0.00,$755.08,"$4,312.50",$0.00,"$2,156.25","$3,415.50","$3,450.00",$0.00,$674.91,$0.00,$686.55,$0.00
ENSP30030UX,SUP,HCPCS C1874,,STENT CORON 3MM 30MM DRUG ELUDING ENDVR,"$4,312.50",$0.00,"$4,312.50","$1,940.63","$3,077.83",$0.00,$743.02,$0.00,$0.00,$755.08,"$4,312.50",$0.00,"$2,156.25","$3,415.50","$3,450.00",$0.00,$674.91,$0.00,$686.55,$0.00
ENSP35009UX,SUP,HCPCS C1874,,STENT CORON 3.5MM 9MM DRUG ELUDING ENDVR,"$4,312.50",$0.00,"$4,312.50","$1,940.63","$3,077.83",$0.00,$743.02,$0.00,$0.00,$755.08,"$4,312.50",$0.00,"$2,156.25","$3,415.50","$3,450.00",$0.00,$674.91,$0.00,$686.55,$0.00
ENSP35012UX,SUP,HCPCS C1874,,STENT CORON 3.5MM 12MM DRUG ELUDING ENDVR,"$4,312.50",$0.00,"$4,312.50","$1,940.63","$3,077.83",$0.00,$743.02,$0.00,$0.00,$755.08,"$4,312.50",$0.00,"$2,156.25","$3,415.50","$3,450.00",$0.00,$674.91,$0.00,$686.55,$0.00
ENSP35015UX,SUP,HCPCS C1874,,STENT CORON 3.5MM 15MM DRUG ELUDING ENDVR,"$4,312.50",$0.00,"$4,312.50","$1,940.63","$3,077.83",$0.00,$743.02,$0.00,$0.00,$755.08,"$4,312.50",$0.00,"$2,156.25","$3,415.50","$3,450.00",$0.00,$674.91,$0.00,$686.55,$0.00
ENSP35018UX,SUP,HCPCS C1874,,STENT CORON 3.5MM 18MM DRUG ELUDING ENDVR SPRNT,"$4,312.50",$0.00,"$4,312.50","$1,940.63","$3,077.83",$0.00,$743.02,$0.00,$0.00,$755.08,"$4,312.50",$0.00,"$2,156.25","$3,415.50","$3,450.00",$0.00,$674.91,$0.00,$686.55,$0.00
ENSP35024UX,SUP,HCPCS C1874,,STENT CORON 3.5MM 24MM DRUG ELUDING ENDVR,"$4,312.50",$0.00,"$4,312.50","$1,940.63","$3,077.83",$0.00,$743.02,$0.00,$0.00,$755.08,"$4,312.50",$0.00,"$2,156.25","$3,415.50","$3,450.00",$0.00,$674.91,$0.00,$686.55,$0.00
ENSP35030UX,SUP,HCPCS C1874,,STENT CORON 3.5MM 30MM DRUG ELUDING ENDVR,"$4,312.50",$0.00,"$4,312.50","$1,940.63","$3,077.83",$0.00,$743.02,$0.00,$0.00,$755.08,"$4,312.50",$0.00,"$2,156.25","$3,415.50","$3,450.00",$0.00,$674.91,$0.00,$686.55,$0.00
ER7232A,SUP,HCPCS C2628,,ER7232A  -  ER-REBOA CATHETER,"$5,437.50",$0.00,"$5,437.50",$0.00,"$3,880.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,437.50",$0.00,"$2,718.75","$4,306.50","$4,350.00",$0.00,$0.00,$0.00,$0.00,$0.00
ES3352,SUP,HCPCS C1729,,CATHETER INTRAVENOUS PROTECTIV ACUVANCE 16G X 2IN SAFETY STR,$4.10,$0.00,$4.10,$2.23,$2.93,$0.00,$0.71,$0.00,$0.00,$0.72,$4.10,$0.00,$2.05,$3.25,$3.28,$0.00,$0.64,$0.00,$0.65,$0.00
ESCDH33,SUP,Custom 27203010,,ESCDH33  -  STAPLER INTNL CRV CRC 33MM 5.5MM STRL LF 1-2.5MM PRX LNR CTR,"$3,588.47",$0.00,"$3,588.47",$0.00,"$2,561.09",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,588.47",$0.00,"$1,794.24","$2,842.07","$2,870.78",$0.00,$0.00,$0.00,$0.00,$0.00
ESEJ10G,SUP,Custom 27203010,,ESEJ10G  -  SUTURE ABSORBABLE 0 18IN BRAID TIES COATED VICRYL ENDOLOOP,$376.17,$0.00,$376.17,$0.00,$268.47,$0.00,$0.00,$0.00,$0.00,$0.00,$376.17,$0.00,$188.09,$297.93,$300.94,$0.00,$0.00,$0.00,$0.00,$0.00
ESP100-21-00,SUP,Custom 27803010,,ESP100-21-00  -  VALVE AORTIC 21MM EP SUP THV,"$15,000.00",$0.00,"$15,000.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$15,000.00",$0.00,"$7,500.00","$11,880.00","$12,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
ESP100-23-00,SUP,Custom 27803010,,ESP100-23-00  -  VALVE AOR 23MM 16MM EP FLEXFIT BPRTH STNT SCLP INFL EDG HLDR,"$15,000.00",$0.00,"$15,000.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$15,000.00",$0.00,"$7,500.00","$11,880.00","$12,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
ESP100-25-00,SUP,Custom 27803010,,ESP100-25-00  -  VALVE AORTIC 25MM EP SUP THV,"$19,700.00",$0.00,"$19,700.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$19,700.00",$0.00,"$9,850.00","$15,602.40","$15,760.00",$0.00,$0.00,$0.00,$0.00,$0.00
ESP100-27-00,SUP,Custom 27803010,,ESP100-27-00  -  VALVE AORTIC 27MM EP SUP THV,"$15,000.00",$0.00,"$15,000.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$15,000.00",$0.00,"$7,500.00","$11,880.00","$12,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
ESP1955,SUP,Custom 27011340,,ESP1955  -  SPLINTS YELLOW JACKET,$65.63,$0.00,$65.63,$0.00,$46.84,$0.00,$0.00,$0.00,$0.00,$0.00,$65.63,$0.00,$32.81,$51.98,$52.50,$0.00,$0.00,$0.00,$0.00,$0.00
ESP3075,SUP,Custom 27203010,,ESP3075  -  KIT SPLINT NEOPRENE DURABLE NONABSORBENT EASY FRACTURE MANAG,$437.38,$0.00,$437.38,$0.00,$312.15,$0.00,$0.00,$0.00,$0.00,$0.00,$437.38,$0.00,$218.69,$346.40,$349.90,$0.00,$0.00,$0.00,$0.00,$0.00
ESP-3100,SUP,Custom 27203010,,SPLINT TRACTION 4 LEG ADULT,$412.38,$0.00,$412.38,$0.00,$294.31,$0.00,$0.00,$0.00,$0.00,$0.00,$412.38,$0.00,$206.19,$326.60,$329.90,$0.00,$0.00,$0.00,$0.00,$0.00
ESP3101,SUP,Custom 27203010,,SPLINT TRACTION 3 LEG PEDIATRIC,$412.38,$0.00,$412.38,$0.00,$294.31,$0.00,$0.00,$0.00,$0.00,$0.00,$412.38,$0.00,$206.19,$326.60,$329.90,$0.00,$0.00,$0.00,$0.00,$0.00
ESP-3119,SUP,Custom 27203010,,SPLINT TRACTION SINGLE SAGER FORM III,$686.25,$0.00,$686.25,$0.00,$489.78,$0.00,$0.00,$0.00,$0.00,$0.00,$686.25,$0.00,$343.13,$543.51,$549.00,$0.00,$0.00,$0.00,$0.00,$0.00
ESU-501,SUP,Custom 27203010,,FILTER SMKEVC PK FINESSE,$83.13,$0.00,$83.13,$0.00,$59.33,$0.00,$0.00,$0.00,$0.00,$0.00,$83.13,$0.00,$41.56,$65.84,$66.50,$0.00,$0.00,$0.00,$0.00,$0.00
ETBF3216C166E,SUP,Custom 27803010,,ETBF3216C166E  -  GRAFT STNT 2 BRCH 32-16MM 20FR 166MM ENDURANT II DLV SYS C,"$24,937.50",$0.00,"$24,937.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$24,937.50",$0.00,"$12,468.75","$19,750.50","$19,950.00",$0.00,$0.00,$0.00,$0.00,$0.00
ETDPP6,SUP,Custom 27203010,,ETDPP6  -  ADHESIVE SKNCLS 2 OCTYL CYNCRLT DRMBND VL TOP LQ HVISC PRPN,$64.42,$0.00,$64.42,$0.00,$45.98,$0.00,$0.00,$0.00,$0.00,$0.00,$64.42,$0.00,$32.21,$51.02,$51.54,$0.00,$0.00,$0.00,$0.00,$0.00
ETLW1616C82E,SUP,Custom 27803010,,ETLW1616C82E  -  GRAFT STNT 16-16MM 14FR 82MM ENDURANT II DLV SYS C DIST,"$11,187.50",$0.00,"$11,187.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,187.50",$0.00,"$5,593.75","$8,860.50","$8,950.00",$0.00,$0.00,$0.00,$0.00,$0.00
ETLW1620C156E,SUP,Custom 27803010,,ETLW1620C156E  -  GRAFT STNT 16-20MM 16FR 156MM ENDURANT II DLV SYS C DIST,"$16,000.00",$0.00,"$16,000.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$16,000.00",$0.00,"$8,000.00","$12,672.00","$12,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
ETLW1628C93E,SUP,HCPCS C2625,,ETLW1628C93E  -  GRAFT STNT 16-28MM 16FR 93MM ENDURANT II DLV SYS C DIST,"$12,312.50",$0.00,"$12,312.50","$5,540.63","$5,158.80",$0.00,"$2,121.38",$0.00,$0.00,"$2,155.82","$12,312.50",$0.00,"$6,156.25","$9,751.50","$9,850.00",$0.00,"$1,926.91",$0.00,"$1,960.15",$0.00
ETVKMM,SUP,HCPCS C1781,,ETVKMM  -  MESH SURG 6X6IN ABS KNTD WVN VCL PLGC 910,$791.30,$0.00,$791.30,$356.09,$564.75,$0.00,$136.34,$0.00,$0.00,$138.55,$791.30,$0.00,$395.65,$626.71,$633.04,$0.00,$123.84,$0.00,$125.97,$0.00
EUSCFS-070026-14-13,SUP,HCPCS C1768,,EUSCFS-070026-14-13  -  SET STENT 26CM 7-14FR CFLX URET EURTM RELS SLV PSTNR 13CM,$297.06,$0.00,$297.06,$133.68,$212.01,$0.00,$51.18,$0.00,$0.00,$52.01,$297.06,$0.00,$148.53,$235.27,$237.65,$0.00,$46.49,$0.00,$47.29,$0.00
EUSN-19-QC,SUP,Custom 27203105,,NEEDLE BX 19G,$359.88,$0.00,$359.88,$0.00,$256.84,$0.00,$0.00,$0.00,$0.00,$0.00,$359.88,$0.00,$179.94,$285.02,$287.90,$0.00,$0.00,$0.00,$0.00,$0.00
EX70410,SUP,HCPCS A4364,,EX70410  -  ADHESIVE SKNCLS 1ML EXOFIN,$2.50,$0.00,$2.50,$1.36,$1.78,$0.00,$2.34,$0.00,$0.00,$0.44,$2.50,$0.00,$1.25,$1.98,$2.00,$0.00,$0.39,$0.00,$0.40,$0.00
EXPORTAP,SUP,HCPCS C1757,,EXPORTAP  -  CATHETER THROMBECTOMY FULL WALL 6FR .07IN 140CM BRAID,"$1,425.00",$0.00,"$1,425.00",$0.00,"$1,017.02",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,425.00",$0.00,$712.50,"$1,128.60","$1,140.00",$0.00,$0.00,$0.00,$0.00,$0.00
EZ15-15-15,SUP,HCPCS C1713,,EZ15-15-15  -  STAPLE BONE 2MM 15X15X1.8-1.3MM MONOCORTICAL SUPERELASTIC LP,"$3,092.70",$0.00,"$3,092.70","$1,391.72","$2,207.26",$0.00,$532.86,$0.00,$0.00,$541.51,"$3,092.70",$0.00,"$1,546.35","$2,449.42","$2,474.16",$0.00,$484.01,$0.00,$492.36,$0.00
EZF21TA,SUP,Custom 27203010,,EZF21TA  -  CANNULA PERFUSION 3/8IN 21FR 14.8IN CURVE TIP SUTURE FLANGE,$110.68,$0.00,$110.68,$0.00,$78.99,$0.00,$0.00,$0.00,$0.00,$0.00,$110.68,$0.00,$55.34,$87.66,$88.54,$0.00,$0.00,$0.00,$0.00,$0.00
EZS24TA,SUP,Custom 27203010,,EZS24TA  -  CANNULA PERFUSION 3/8IN STR 24FR 14IN AUTO DILATE TIP SUTURE,$93.30,$0.00,$93.30,$0.00,$66.59,$0.00,$0.00,$0.00,$0.00,$0.00,$93.30,$0.00,$46.65,$73.89,$74.64,$0.00,$0.00,$0.00,$0.00,$0.00
F1/8TA15S,SUP,Custom 27203010,,F1/8TA15S  -  TOOL LEGEND 8 CM 1.5MM SPIRAL,$269.88,$0.00,$269.88,$0.00,$192.61,$0.00,$0.00,$0.00,$0.00,$0.00,$269.88,$0.00,$134.94,$213.74,$215.90,$0.00,$0.00,$0.00,$0.00,$0.00
F1006,SUP,HCPCS C1768,,F1006  -  GRAFT VASC 10CM 6MM IMPR CBFL PTFE PERI BYPS FLX,$891.48,$0.00,$891.48,$401.16,$636.25,$0.00,$153.60,$0.00,$0.00,$156.09,$891.48,$0.00,$445.74,$706.05,$713.18,$0.00,$139.52,$0.00,$141.92,$0.00
F1010,SUP,HCPCS C1768,,F1010  -  GRAFT VASC 10CM 10MM IMPR CBFL PTFE PERI BYPS FLX,$891.48,$0.00,$891.48,$401.16,$636.25,$0.00,$153.60,$0.00,$0.00,$156.09,$891.48,$0.00,$445.74,$706.05,$713.18,$0.00,$139.52,$0.00,$141.92,$0.00
F2/8TA23S,SUP,Custom 27203010,,F2/8TA23S  -  TOOL LEGEND 8CM 2.3MM SPIRAL,$269.88,$0.00,$269.88,$0.00,$192.61,$0.00,$0.00,$0.00,$0.00,$0.00,$269.88,$0.00,$134.94,$213.74,$215.90,$0.00,$0.00,$0.00,$0.00,$0.00
F-30,SUP,Custom 27203010,,FILTER TRNSF GAS VNT REPL LKCYT RBC 40UM,$51.75,$0.00,$51.75,$0.00,$36.93,$0.00,$0.00,$0.00,$0.00,$0.00,$51.75,$0.00,$25.88,$40.99,$41.40,$0.00,$0.00,$0.00,$0.00,$0.00
F6008,SUP,HCPCS C1768,,F6008  -  GRAFT VASC 60CM 8MM IMPR CBFL PTFE PERI BYPS FLX,"$2,160.88",$0.00,"$2,160.88",$972.39,"$1,542.22",$0.00,$372.31,$0.00,$0.00,$378.35,"$2,160.88",$0.00,"$1,080.44","$1,711.42","$1,728.70",$0.00,$338.18,$0.00,$344.01,$0.00
F7006,SUP,HCPCS C1768,,F7006  -  GRAFT VASC 70CM 6MM IMPR CBFL PTFE PERI BYPS FLX,"$2,570.28",$0.00,"$2,570.28","$1,156.62","$1,834.41",$0.00,$442.85,$0.00,$0.00,$450.03,"$2,570.28",$0.00,"$1,285.14","$2,035.66","$2,056.22",$0.00,$402.25,$0.00,$409.19,$0.00
F7008,SUP,HCPCS C1768,,F7008  -  GRAFT VASC STRG 8MM 70CM IMPRA FLX SM BEAD EPTFE,"$2,570.28",$0.00,"$2,570.28","$1,156.62","$1,834.41",$0.00,$442.85,$0.00,$0.00,$450.03,"$2,570.28",$0.00,"$1,285.14","$2,035.66","$2,056.22",$0.00,$402.25,$0.00,$409.19,$0.00
FA-0140,SUP,HCPCS C1713,,FA-0140  -  SCREW BN 3.5MM 14MM CNN XTRMT,$562.50,$0.00,$562.50,$253.13,$401.46,$0.00,$96.92,$0.00,$0.00,$98.49,$562.50,$0.00,$281.25,$445.50,$450.00,$0.00,$88.03,$0.00,$89.55,$0.00
FA-0160,SUP,HCPCS C1713,,FA-0160  -  SCREW BN 3.5MM 16MM CNN XTRMT,$492.50,$0.00,$492.50,$221.63,$351.50,$0.00,$84.86,$0.00,$0.00,$86.23,$492.50,$0.00,$246.25,$390.06,$394.00,$0.00,$77.08,$0.00,$78.41,$0.00
FA-0180,SUP,HCPCS C1713,,FA-0180  -  SCREW BN 3.5MM 18MM CNN XTRMT,$492.50,$0.00,$492.50,$221.63,$351.50,$0.00,$84.86,$0.00,$0.00,$86.23,$492.50,$0.00,$246.25,$390.06,$394.00,$0.00,$77.08,$0.00,$78.41,$0.00
FA-0200,SUP,HCPCS C1713,,FA-0200  -  SCREW BN 3.5MM 20MM CNN XTRMT,$492.50,$0.00,$492.50,$221.63,$351.50,$0.00,$84.86,$0.00,$0.00,$86.23,$492.50,$0.00,$246.25,$390.06,$394.00,$0.00,$77.08,$0.00,$78.41,$0.00
FA-0220,SUP,HCPCS C1713,,FA-0220  -  SCREW BN 3.5MM 22MM CNN XTRMT,$492.50,$0.00,$492.50,$221.63,$351.50,$0.00,$84.86,$0.00,$0.00,$86.23,$492.50,$0.00,$246.25,$390.06,$394.00,$0.00,$77.08,$0.00,$78.41,$0.00
FA-0240,SUP,HCPCS C1713,,FA-0240  -  SCREW BN 3.5MM 24MM CNN XTRMT,$492.50,$0.00,$492.50,$221.63,$351.50,$0.00,$84.86,$0.00,$0.00,$86.23,$492.50,$0.00,$246.25,$390.06,$394.00,$0.00,$77.08,$0.00,$78.41,$0.00
FA-0260,SUP,HCPCS C1713,,FA-0260  -  SCREW BN 3.5MM 26MM CNN XTRMT,$492.50,$0.00,$492.50,$221.63,$351.50,$0.00,$84.86,$0.00,$0.00,$86.23,$492.50,$0.00,$246.25,$390.06,$394.00,$0.00,$77.08,$0.00,$78.41,$0.00
FA-0280,SUP,HCPCS C1713,,FA-0280  -  SCREW BN 3.5MM 28MM CNN XTRMT,$492.50,$0.00,$492.50,$221.63,$351.50,$0.00,$84.86,$0.00,$0.00,$86.23,$492.50,$0.00,$246.25,$390.06,$394.00,$0.00,$77.08,$0.00,$78.41,$0.00
FA-0300,SUP,HCPCS C1713,,FA-0300  -  SCREW BN 3.5MM 30MM CNN XTRMT,$492.50,$0.00,$492.50,$221.63,$351.50,$0.00,$84.86,$0.00,$0.00,$86.23,$492.50,$0.00,$246.25,$390.06,$394.00,$0.00,$77.08,$0.00,$78.41,$0.00
FA-0320,SUP,HCPCS C1713,,FA-0320  -  SCREW BN 3.5MM 32MM CNN XTRMT,$492.50,$0.00,$492.50,$221.63,$351.50,$0.00,$84.86,$0.00,$0.00,$86.23,$492.50,$0.00,$246.25,$390.06,$394.00,$0.00,$77.08,$0.00,$78.41,$0.00
FA-0340,SUP,HCPCS C1713,,FA-0340  -  SCREW BN 3.5MM 34MM CNN XTRMT,$492.50,$0.00,$492.50,$221.63,$351.50,$0.00,$84.86,$0.00,$0.00,$86.23,$492.50,$0.00,$246.25,$390.06,$394.00,$0.00,$77.08,$0.00,$78.41,$0.00
FA-0360,SUP,HCPCS C1713,,FA-0360  -  SCREW BN 3.5MM 36MM CNN XTRMT,$492.50,$0.00,$492.50,$221.63,$351.50,$0.00,$84.86,$0.00,$0.00,$86.23,$492.50,$0.00,$246.25,$390.06,$394.00,$0.00,$77.08,$0.00,$78.41,$0.00
FA-0380,SUP,HCPCS C1713,,FA-0380  -  SCREW BN 3.5MM 38MM CNN XTRMT,$492.50,$0.00,$492.50,$221.63,$351.50,$0.00,$84.86,$0.00,$0.00,$86.23,$492.50,$0.00,$246.25,$390.06,$394.00,$0.00,$77.08,$0.00,$78.41,$0.00
FA-0400,SUP,HCPCS C1713,,FA-0400  -  SCREW BN 3.5MM 40MM CNN XTRMT,$492.50,$0.00,$492.50,$221.63,$351.50,$0.00,$84.86,$0.00,$0.00,$86.23,$492.50,$0.00,$246.25,$390.06,$394.00,$0.00,$77.08,$0.00,$78.41,$0.00
FA-04020,SUP,Custom 27203010,,FA-04020  -  KIT ARTERIAL LINE .018IN 20GA 22GA 1.75IN CATHETER RADIOPQ,$57.04,$0.00,$57.04,$0.00,$40.71,$0.00,$0.00,$0.00,$0.00,$0.00,$57.04,$0.00,$28.52,$45.18,$45.63,$0.00,$0.00,$0.00,$0.00,$0.00
FA-0420,SUP,HCPCS C1713,,FA-0420  -  SCREW BN 3.5MM 42MM CNN XTRMT,$492.50,$0.00,$492.50,$221.63,$351.50,$0.00,$84.86,$0.00,$0.00,$86.23,$492.50,$0.00,$246.25,$390.06,$394.00,$0.00,$77.08,$0.00,$78.41,$0.00
FA-4014,SUP,HCPCS C1713,,FA-4014  -  SCREW BN 4MM 14MM CNN XTRMT,$492.50,$0.00,$492.50,$221.63,$351.50,$0.00,$84.86,$0.00,$0.00,$86.23,$492.50,$0.00,$246.25,$390.06,$394.00,$0.00,$77.08,$0.00,$78.41,$0.00
FA-4016,SUP,HCPCS C1713,,FA-4016  -  SCREW BN 4MM 16MM CNN XTRMT,$492.50,$0.00,$492.50,$221.63,$351.50,$0.00,$84.86,$0.00,$0.00,$86.23,$492.50,$0.00,$246.25,$390.06,$394.00,$0.00,$77.08,$0.00,$78.41,$0.00
FA-4018,SUP,HCPCS C1713,,FA-4018  -  SCREW BN 4MM 18MM CNN XTRMT,$492.50,$0.00,$492.50,$221.63,$351.50,$0.00,$84.86,$0.00,$0.00,$86.23,$492.50,$0.00,$246.25,$390.06,$394.00,$0.00,$77.08,$0.00,$78.41,$0.00
FA-4020,SUP,HCPCS C1713,,FA-4020  -  SCREW BN 4MM 20MM CNN XTRMT,$492.50,$0.00,$492.50,$221.63,$351.50,$0.00,$84.86,$0.00,$0.00,$86.23,$492.50,$0.00,$246.25,$390.06,$394.00,$0.00,$77.08,$0.00,$78.41,$0.00
FA-4022,SUP,HCPCS C1713,,FA-4022  -  SCREW BN 4MM 22MM CNN XTRMT,$492.50,$0.00,$492.50,$221.63,$351.50,$0.00,$84.86,$0.00,$0.00,$86.23,$492.50,$0.00,$246.25,$390.06,$394.00,$0.00,$77.08,$0.00,$78.41,$0.00
FA-4024,SUP,HCPCS C1713,,FA-4024  -  SCREW BN 4MM 24MM CNN XTRMT,$492.50,$0.00,$492.50,$221.63,$351.50,$0.00,$84.86,$0.00,$0.00,$86.23,$492.50,$0.00,$246.25,$390.06,$394.00,$0.00,$77.08,$0.00,$78.41,$0.00
FA-4026,SUP,HCPCS C1713,,FA-4026  -  SCREW BN 4MM 26MM CNN XTRMT,$492.50,$0.00,$492.50,$221.63,$351.50,$0.00,$84.86,$0.00,$0.00,$86.23,$492.50,$0.00,$246.25,$390.06,$394.00,$0.00,$77.08,$0.00,$78.41,$0.00
FA-4028,SUP,HCPCS C1713,,FA-4028  -  SCREW BN 4MM 28MM CNN XTRMT,$492.50,$0.00,$492.50,$221.63,$351.50,$0.00,$84.86,$0.00,$0.00,$86.23,$492.50,$0.00,$246.25,$390.06,$394.00,$0.00,$77.08,$0.00,$78.41,$0.00
FA-4030,SUP,HCPCS C1713,,FA-4030  -  SCREW BN 4MM 30MM CNN XTRMT,$492.50,$0.00,$492.50,$221.63,$351.50,$0.00,$84.86,$0.00,$0.00,$86.23,$492.50,$0.00,$246.25,$390.06,$394.00,$0.00,$77.08,$0.00,$78.41,$0.00
FA-4032,SUP,HCPCS C1713,,FA-4032  -  SCREW BN 4MM 32MM CNN XTRMT,$492.50,$0.00,$492.50,$221.63,$351.50,$0.00,$84.86,$0.00,$0.00,$86.23,$492.50,$0.00,$246.25,$390.06,$394.00,$0.00,$77.08,$0.00,$78.41,$0.00
FA-4034,SUP,HCPCS C1713,,FA-4034  -  SCREW BN 4MM 34MM CNN XTRMT,$492.50,$0.00,$492.50,$221.63,$351.50,$0.00,$84.86,$0.00,$0.00,$86.23,$492.50,$0.00,$246.25,$390.06,$394.00,$0.00,$77.08,$0.00,$78.41,$0.00
FA-4036,SUP,HCPCS C1713,,FA-4036  -  SCREW BN 4MM 36MM CNN XTRMT,$492.50,$0.00,$492.50,$221.63,$351.50,$0.00,$84.86,$0.00,$0.00,$86.23,$492.50,$0.00,$246.25,$390.06,$394.00,$0.00,$77.08,$0.00,$78.41,$0.00
FA-4038,SUP,HCPCS C1713,,FA-4038  -  SCREW BN 4MM 38MM CNN XTRMT,$492.50,$0.00,$492.50,$221.63,$351.50,$0.00,$84.86,$0.00,$0.00,$86.23,$492.50,$0.00,$246.25,$390.06,$394.00,$0.00,$77.08,$0.00,$78.41,$0.00
FA-4040,SUP,HCPCS C1713,,FA-4040  -  SCREW BN 4MM 40MM CNN XTRMT,$492.50,$0.00,$492.50,$221.63,$351.50,$0.00,$84.86,$0.00,$0.00,$86.23,$492.50,$0.00,$246.25,$390.06,$394.00,$0.00,$77.08,$0.00,$78.41,$0.00
FA-4042,SUP,HCPCS C1713,,FA-4042  -  SCREW BN 4MM 42MM CNN XTRMT,$492.50,$0.00,$492.50,$221.63,$351.50,$0.00,$84.86,$0.00,$0.00,$86.23,$492.50,$0.00,$246.25,$390.06,$394.00,$0.00,$77.08,$0.00,$78.41,$0.00
FA-55150-1030,SUP,HCPCS C2628,,FA-55150-1030  -  CATH INFUS MIC 2.8FR 3.2FR .027IN 150CM 10CM MARKSMAN,"$2,625.00",$0.00,"$2,625.00",$0.00,"$1,873.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
FA-88810-20,SUP,Custom 27203010,,FA-88810-20  -  DEVICE RTRVL 2MM ALGTR NRVSC FB ATRM DSGN SF RELS,"$6,562.50",$0.00,"$6,562.50",$0.00,"$4,683.66",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,562.50",$0.00,"$3,281.25","$5,197.50","$5,250.00",$0.00,$0.00,$0.00,$0.00,$0.00
FA-88810-30,SUP,Custom 27203010,,FA-88810-30  -  ALLIGATOR RETRIEVAL-30,"$6,562.50",$0.00,"$6,562.50",$0.00,"$4,683.66",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,562.50",$0.00,"$3,281.25","$5,197.50","$5,250.00",$0.00,$0.00,$0.00,$0.00,$0.00
FA-88810-40,SUP,Custom 27203010,,FA-88810-40  -  DEVICE RTRVL ALGTR 4MM FB ATRM DSGN SF RELS,"$6,562.50",$0.00,"$6,562.50",$0.00,"$4,683.66",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,562.50",$0.00,"$3,281.25","$5,197.50","$5,250.00",$0.00,$0.00,$0.00,$0.00,$0.00
FA-88810-50,SUP,HCPCS C1773,,FA-88810-50  -  DEVICE SPEC RTRVL ALGTR 5MM NRVSC 4 INTLCK PLTN JAW,"$6,562.50",$0.00,"$6,562.50","$3,563.44","$4,683.66",$0.00,"$1,130.69",$0.00,$0.00,"$1,149.04","$6,562.50",$0.00,"$3,281.25","$5,197.50","$5,250.00",$0.00,"$1,027.03",$0.00,"$1,044.75",$0.00
FA-9020,SUP,HCPCS C1713,,FA-9020  -  DRILL SRG XTRMT 3.5 MM SCR,$355.00,$0.00,$355.00,$159.75,$253.36,$0.00,$61.16,$0.00,$0.00,$62.16,$355.00,$0.00,$177.50,$281.16,$284.00,$0.00,$55.56,$0.00,$56.52,$0.00
FA-CO2736,SUP,HCPCS C1713,,FA-CO2736  -  SCREW BONE 2.7MM 36MM TAP-LOC ACUMED TI ELB TAP STRL,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
FA-CO2738,SUP,HCPCS C1713,,FA-CO2738  -  SCREW BONE 2.7MM 38MM TI CORT TAP NONSTRL,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
FA-CO2740,SUP,HCPCS C1713,,FA-CO2740  -  SCREW BONE 2.7MM 40MM ACUMED TI CORT TAP NONSTRL,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
FA-CO2745,SUP,HCPCS C1713,,FA-CO2745  -  SCREW BONE 2.7MM 45MM TI ELB LCK TAP STRL,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
FA-CO2750,SUP,HCPCS C1713,,FA-CO2750  -  SCREW BONE 2.7MM 50MM TAP-LOC TI CORT ELB LCK NONSTRL,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
FA-CO2755,SUP,HCPCS C1713,,FA-CO2755  -  SCREW BONE 2.7MM 55MM TAP-LOC ACUMED TI ELB TAP STRL,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
FA-CO2760,SUP,HCPCS C1713,,FA-CO2760  -  SCREW BONE 2.7MM 60MM TAP-LOC ACUMED TI ELB TPR STRL,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
FA-CO3536,SUP,HCPCS C1713,,FA-CO3536  -  SCREW BONE 3.5MM 36MM TAP-LOC TI CORT LCK TAP NONSTRL,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
FA-CO3538,SUP,HCPCS C1713,,FA-CO3538  -  SCREW BN 3.5MM 38MM TAP LCK,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
FA-CO3540,SUP,HCPCS C1713,,FA-CO3540  -  SCREW BONE 3.5MM 40MM TAP-LOC TI ELB LCK TAP NONSTRL,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
FA-CO3545,SUP,HCPCS C1713,,FA-CO3545  -  SCREW BONE 3.5MM 45MM TI CORT LCK TAP NONSTRL,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
FA-CO3550,SUP,HCPCS C1713,,FA-CO3550  -  SCREW BN 3.5MM 50MM NS TPRLK CORT,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
FA-CO3555,SUP,HCPCS C1713,,FA-CO3555  -  SCREW BN 3.5MM 55MM NS LCK TAP TI ELB PLT SYS,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
FA-CO3560,SUP,HCPCS C1713,,FA-CO3560  -  SCREW BN 3.5MM 60MM NS LCK TAP TI ELB PLT SYS,$232.50,$0.00,$232.50,$104.63,$165.94,$0.00,$40.06,$0.00,$0.00,$40.71,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$36.39,$0.00,$37.01,$0.00
FBRC,SUP,HCPCS C1884,,FBRC  -  SYSTEM REM .035IN 10FR 75CM RCVR CN WRE BSKT RADOPQ PEBAX,"$1,593.45",$0.00,"$1,593.45",$717.05,"$1,137.24",$0.00,$274.54,$0.00,$0.00,$279.00,"$1,593.45",$0.00,$796.72,"$1,262.01","$1,274.76",$0.00,$249.37,$0.00,$253.68,$0.00
FCROF2005,SUP,Custom 27203010,,FILTER 20.5UM,$31.58,$0.00,$31.58,$0.00,$22.54,$0.00,$0.00,$0.00,$0.00,$0.00,$31.58,$0.00,$15.79,$25.01,$25.26,$0.00,$0.00,$0.00,$0.00,$0.00
FD-410LR,SUP,Custom 27203010,,FD-410LR  -  FORCEPS MNPLR 2.75MM 2.8MM 165X5MM STRL COAGRASPER HMSTS,$463.53,$0.00,$463.53,$0.00,$330.82,$0.00,$0.00,$0.00,$0.00,$0.00,$463.53,$0.00,$231.76,$367.12,$370.82,$0.00,$0.00,$0.00,$0.00,$0.00
FD-411UR,SUP,Custom 27203010,,FD-411UR  -  FORCEPS MNPLR 2.75MM 3.2MM 230X4MM STRL COAGRASPER HMSTS,$588.85,$0.00,$588.85,$0.00,$420.26,$0.00,$0.00,$0.00,$0.00,$0.00,$588.85,$0.00,$294.43,$466.37,$471.08,$0.00,$0.00,$0.00,$0.00,$0.00
FD-412LR,SUP,Custom 27203010,,FD-412LR  -  FORCEPS ESCP 2.8MM 2.75MM 165CM COAGRASPER HMST GRSPR MNPLR,$463.53,$0.00,$463.53,$0.00,$330.82,$0.00,$0.00,$0.00,$0.00,$0.00,$463.53,$0.00,$231.76,$367.12,$370.82,$0.00,$0.00,$0.00,$0.00,$0.00
FDB2.0,SUP,Custom 27203010,,BIT DRILL 2MM STRL DISP DB20,$250.00,$0.00,$250.00,$0.00,$178.43,$0.00,$0.00,$0.00,$0.00,$0.00,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$0.00,$0.00,$0.00,$0.00
FE660K,SUP,Custom 27803010,,FE660K  -  CLIP ANEURYSM STANDARD 10.3MM OPENING 5MM 12MM STR FENST,$920.95,$0.00,$920.95,$0.00,$657.28,$0.00,$0.00,$0.00,$0.00,$0.00,$920.95,$0.00,$460.48,$729.39,$736.76,$0.00,$0.00,$0.00,$0.00,$0.00
FE664K,SUP,Custom 27803010,,FE664K  -  CLIP ANEURYSM 5.5MM OPEN STANDARD 5MM 10/6.4MM PERMANENT,$920.95,$0.00,$920.95,$0.00,$657.28,$0.00,$0.00,$0.00,$0.00,$0.00,$920.95,$0.00,$460.48,$729.39,$736.76,$0.00,$0.00,$0.00,$0.00,$0.00
FE776K,SUP,Custom 27803010,,FE776K  -  CLIP ANEURYSM STANDARD 5MM OPENING 5MM 10MM CVD DOWN FENST,$920.95,$0.00,$920.95,$0.00,$657.28,$0.00,$0.00,$0.00,$0.00,$0.00,$920.95,$0.00,$460.48,$729.39,$736.76,$0.00,$0.00,$0.00,$0.00,$0.00
FE779K,SUP,Custom 27803010,,FE779K  -  CLIP ANEURYSM STANDARD 5MM OPENING 5MM 10MM CVD UP FENST,$920.95,$0.00,$920.95,$0.00,$657.28,$0.00,$0.00,$0.00,$0.00,$0.00,$920.95,$0.00,$460.48,$729.39,$736.76,$0.00,$0.00,$0.00,$0.00,$0.00
FEM08040,SUP,HCPCS C1876,,FEM08040  -  GRAFT STNT 8MM 9FR 40MM 80CM FLN + 2 LYR KINK RST INR CATH,"$7,857.50",$0.00,"$7,857.50","$3,535.88","$5,158.80",$0.00,"$1,353.81",$0.00,$0.00,"$1,375.79","$7,857.50",$0.00,"$3,928.75","$6,223.14","$6,286.00",$0.00,"$1,229.70",$0.00,"$1,250.91",$0.00
FEMII016AS,SUP,Custom 27203010,,FEMII016AS  -  FEM-FLEX II CANNULA 16 FR,$592.30,$0.00,$592.30,$0.00,$422.72,$0.00,$0.00,$0.00,$0.00,$0.00,$592.30,$0.00,$296.15,$469.10,$473.84,$0.00,$0.00,$0.00,$0.00,$0.00
FEMII018AS,SUP,Custom 27203010,,FEMII018AS  -  FEM-FLEX II CANNULA 18 FR,$592.30,$0.00,$592.30,$0.00,$422.72,$0.00,$0.00,$0.00,$0.00,$0.00,$592.30,$0.00,$296.15,$469.10,$473.84,$0.00,$0.00,$0.00,$0.00,$0.00
FEMII020AS,SUP,Custom 27203010,,FEMII020AS  -  FEM-FLEX II CANNULA 20 FR,$592.30,$0.00,$592.30,$0.00,$422.72,$0.00,$0.00,$0.00,$0.00,$0.00,$592.30,$0.00,$296.15,$469.10,$473.84,$0.00,$0.00,$0.00,$0.00,$0.00
FG-0201,SUP,Custom 27203010,,FG-0201  -  DEVICE TISS REM 3.6MM SYMPHION RESCT,"$4,120.00",$0.00,"$4,120.00",$0.00,"$2,940.44",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,120.00",$0.00,"$2,060.00","$3,263.04","$3,296.00",$0.00,$0.00,$0.00,$0.00,$0.00
FG-0202,SUP,Custom 27203010,,FG-0202  -  TISSUE REMOVAL SYSTEM FLUID MANAGEMENT ACCESSORIES,"$1,284.93",$0.00,"$1,284.93",$0.00,$917.05,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,284.93",$0.00,$642.46,"$1,017.66","$1,027.94",$0.00,$0.00,$0.00,$0.00,$0.00
FG-44NR-1,SUP,Custom 27203010,,FG-44NR-1  -  FORCEP SPEC RTRVL 180CM 2.8MM BRNCHL FB ROT ALGTR JAW RAT,"$1,163.58",$0.00,"$1,163.58",$0.00,$830.44,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,163.58",$0.00,$581.79,$921.56,$930.86,$0.00,$0.00,$0.00,$0.00,$0.00
FGL07560,SUP,HCPCS L8699,,FGL07560  -  GRAFT SFT TIS 7.5MM 60MM FLEXIGRAFT GRAFTLINK ALGRF FRZN,"$6,040.00",$0.00,"$6,040.00",$0.00,"$4,310.75",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,040.00",$0.00,"$3,020.00","$4,783.68","$4,832.00",$0.00,$0.00,$0.00,$0.00,$0.00
FLT08040,SUP,HCPCS C1768,,STENT TRACHEOBRONCHIAL FLUENCY 8MM X 40MM SELF EXPANDING COV,"$5,737.50",$0.00,"$5,737.50","$2,581.88","$4,094.85",$0.00,$988.54,$0.00,$0.00,"$1,004.59","$5,737.50",$0.00,"$2,868.75","$4,544.10","$4,590.00",$0.00,$897.92,$0.00,$913.41,$0.00
FP-07.24.0,SUP,HCPCS C1713,,FP-07.24.0  -  CAGE SPNL 24MMX7MM FUSE 0D PLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
FP-08.24.0,SUP,HCPCS C1713,,FP-08.24.0  -  CAGE SPNL 24MMX8MM FUSE 0D PLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
FP-09.24.4,SUP,HCPCS C1713,,FP-09.24.4  -  CAGE SPNL 24MMX9MM FUSE 4D PLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
FP-09.24.8,SUP,HCPCS C1713,,FP-09.24.8  -  CAGE SPNL 24MMX9MM FUSE 8D PLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
FP-10.24.4,SUP,HCPCS C1713,,FP-10.24.4  -  CAGE SPNL 24MMX10MM FUSE 4D PLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
FP-10.24.8,SUP,HCPCS C1713,,FP-10.24.8  -  CAGE SPNL 24MMX10MM FUSE 8D PLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
FP-11.24.4,SUP,HCPCS C1713,,FP-11.24.4  -  CAGE SPNL 24MMX11MM FUSE 4D PLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
FP-11.24.8,SUP,HCPCS C1713,,FP-11.24.8  -  CAGE SPNL 24MMX11MM FUSE 8D PLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
FP-12.24.4,SUP,HCPCS C1713,,FP-12.24.4  -  CAGE SPNL 24MMX12MM FUSE 4D PLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
FP-12.24.8,SUP,HCPCS C1713,,FP-12.24.8  -  CAGE SPNL 24MMX12MM FUSE 8D PLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
FP-13.24.4,SUP,HCPCS C1713,,FP-13.24.4  -  CAGE SPNL 24MMX13MM FUSE 4D PLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
FP-13.24.8,SUP,HCPCS C1713,,FP-13.24.8  -  CAGE SPNL 24MMX13MM FUSE 8D PLIF,"$7,500.00",$0.00,"$7,500.00","$3,375.00","$5,158.80",$0.00,"$1,292.21",$0.00,$0.00,"$1,313.19","$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,"$1,173.75",$0.00,"$1,194.00",$0.00
FP-14,SUP,HCPCS C1713,,FP-14  -  PEG FIX 2.5MM 14MM FULTHD,$175.00,$0.00,$175.00,$78.75,$124.90,$0.00,$30.15,$0.00,$0.00,$30.64,$175.00,$0.00,$87.50,$138.60,$140.00,$0.00,$27.39,$0.00,$27.86,$0.00
FP-16,SUP,HCPCS C1713,,FP-16  -  PEG FIX 2.5MM 16MM FULTHD,$175.00,$0.00,$175.00,$78.75,$124.90,$0.00,$30.15,$0.00,$0.00,$30.64,$175.00,$0.00,$87.50,$138.60,$140.00,$0.00,$27.39,$0.00,$27.86,$0.00
FP-20,SUP,HCPCS C1713,,FP-20  -  PEG FIX 2.5MM 20MM FULTHD,$175.00,$0.00,$175.00,$78.75,$124.90,$0.00,$30.15,$0.00,$0.00,$30.64,$175.00,$0.00,$87.50,$138.60,$140.00,$0.00,$27.39,$0.00,$27.86,$0.00
FP-26,SUP,HCPCS C1713,,FP-26  -  PEG FIX 2.5MM 26MM FULTHD,$175.00,$0.00,$175.00,$78.75,$124.90,$0.00,$30.15,$0.00,$0.00,$30.64,$175.00,$0.00,$87.50,$138.60,$140.00,$0.00,$27.39,$0.00,$27.86,$0.00
FP-7,SUP,HCPCS C1783,,FP-7  -  DRAIN GLAUCOMA THK.9MM BLUNT TAPER .635MM .305MM 16X13MM 25,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
FR995-27,SUP,Custom 27803010,,FR995-27  -  VALVE AOR 27MM 34MM STRL 3MM FRSTL BPRTH PRCN ROOT,"$23,125.00",$0.00,"$23,125.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$23,125.00",$0.00,"$11,562.50","$18,315.00","$18,500.00",$0.00,$0.00,$0.00,$0.00,$0.00
FR995-29,SUP,Custom 27803010,,FR995-29  -  FREESTYLE ROOT VALVE 29 MM,"$15,330.00",$0.00,"$15,330.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$15,330.00",$0.00,"$7,665.00","$12,141.36","$12,264.00",$0.00,$0.00,$0.00,$0.00,$0.00
FS0808,SUP,HCPCS C1781,,FS0808  -  GRAFT SNTH TISS 8X8CM BIO-A BABSR REINF SCFLD TISS,"$1,022.50",$0.00,"$1,022.50",$460.13,$729.76,$0.00,$176.17,$0.00,$0.00,$179.03,"$1,022.50",$0.00,$511.25,$809.82,$818.00,$0.00,$160.02,$0.00,$162.78,$0.00
FS0915,SUP,HCPCS C1781,,FS0915  -  GRAFT SNTH TISS 15X9CM GORE BIO-A BABSR SCFLD,"$1,825.00",$0.00,"$1,825.00",$821.25,"$1,302.50",$0.00,$314.44,$0.00,$0.00,$319.54,"$1,825.00",$0.00,$912.50,"$1,445.40","$1,460.00",$0.00,$285.61,$0.00,$290.54,$0.00
FS1030,SUP,HCPCS C1781,,FS1030  -  MESH SRG 30X10CM BIO-ASNTH BABSR REINF SCFLD TRM TISS,"$5,027.50",$0.00,"$5,027.50","$2,262.38","$3,588.13",$0.00,$866.21,$0.00,$0.00,$880.28,"$5,027.50",$0.00,"$2,513.75","$3,981.78","$4,022.00",$0.00,$786.80,$0.00,$800.38,$0.00
FS2020,SUP,HCPCS C1781,,FS2020  -  GRAFT SNTH TISS 20X20CM BIO-A BABSR REINF SCFLD TISS,"$6,712.50",$0.00,"$6,712.50","$3,020.63","$4,790.71",$0.00,"$1,156.53",$0.00,$0.00,"$1,175.31","$6,712.50",$0.00,"$3,356.25","$5,316.30","$5,370.00",$0.00,"$1,050.51",$0.00,"$1,068.63",$0.00
FS2030,SUP,HCPCS C1781,,FS2030  -  MESH SRG 30X20CM BIO-A BABSR REINF SCFLD TISS,"$10,080.00",$0.00,"$10,080.00","$4,536.00","$5,158.80",$0.00,"$1,736.73",$0.00,$0.00,"$1,764.93","$10,080.00",$0.00,"$5,040.00","$7,983.36","$8,064.00",$0.00,"$1,577.52",$0.00,"$1,604.74",$0.00
FSR100201-20,SUP,Custom 27803010,,FSR100201-20  -  COIL EMBL HLCL 2MM 1CM ULTIPAQ 10 MCIOL STRCH RS LOOP DTCH,"$2,165.95",$0.00,"$2,165.95",$0.00,"$1,545.84",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,165.95",$0.00,"$1,082.98","$1,715.43","$1,732.76",$0.00,$0.00,$0.00,$0.00,$0.00
FSR100202-20,SUP,Custom 27803010,,FSR100202-20  -  COIL EMBL HLCL 2MM 2CM ULTIPAQ 10 MCIOL STRCH RS LOOP DTCH,"$2,195.23",$0.00,"$2,195.23",$0.00,"$1,566.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,195.23",$0.00,"$1,097.61","$1,738.62","$1,756.18",$0.00,$0.00,$0.00,$0.00,$0.00
FSR100203-20,SUP,Custom 27803010,,FSR100203-20  -  COIL EMBL HLCL 2MM 3CM ULTIPAQ 10 MCIOL STRCH RS LOOP DTCH,"$2,224.50",$0.00,"$2,224.50",$0.00,"$1,587.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,224.50",$0.00,"$1,112.25","$1,761.80","$1,779.60",$0.00,$0.00,$0.00,$0.00,$0.00
FSR100204-20,SUP,Custom 27803010,,FSR100204-20  -  COIL EMBL HLCL 2MM 4CM ULTIPAQ 10 MCIOL STRCH RS LOOP DTCH,"$2,224.50",$0.00,"$2,224.50",$0.00,"$1,587.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,224.50",$0.00,"$1,112.25","$1,761.80","$1,779.60",$0.00,$0.00,$0.00,$0.00,$0.00
FSR100206-20,SUP,Custom 27803010,,FSR100206-20  -  COIL EMBL HLCL 2MM 6CM ULTIPAQ 10 MCIOL STRCH RS LOOP DTCH,"$2,253.78",$0.00,"$2,253.78",$0.00,"$1,608.52",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,253.78",$0.00,"$1,126.89","$1,784.99","$1,803.02",$0.00,$0.00,$0.00,$0.00,$0.00
FSR100208-20,SUP,Custom 27803010,,FSR100208-20  -  COIL EMBL HLX 2MM 8CM ULTIPAQ 10 MCIOL STRCH RS HLCL LOOP,"$2,283.05",$0.00,"$2,283.05",$0.00,"$1,629.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,283.05",$0.00,"$1,141.53","$1,808.18","$1,826.44",$0.00,$0.00,$0.00,$0.00,$0.00
FSR100252-20,SUP,Custom 27803010,,FSR100252-20  -  COIL EMBL HLX 2.5MM 2CM ULTIPAQ 10 MCIOL STRCH RS HLCL LOOP,"$2,195.23",$0.00,"$2,195.23",$0.00,"$1,566.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,195.23",$0.00,"$1,097.61","$1,738.62","$1,756.18",$0.00,$0.00,$0.00,$0.00,$0.00
FSR100254-20,SUP,Custom 27803010,,FSR100254-20  -  COIL EMBL HLCL 2.5MM 4CM ULTIPAQ 10 MCIOL STRCH RS LOOP DTCH,"$2,224.50",$0.00,"$2,224.50",$0.00,"$1,587.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,224.50",$0.00,"$1,112.25","$1,761.80","$1,779.60",$0.00,$0.00,$0.00,$0.00,$0.00
FSR100256-20,SUP,Custom 27803010,,FSR100256-20  -  COIL EMBL HLCL 2.5MM 6CM ULTIPAQ 10 MCIOL STRCH RS LOOP DTCH,"$2,253.78",$0.00,"$2,253.78",$0.00,"$1,608.52",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,253.78",$0.00,"$1,126.89","$1,784.99","$1,803.02",$0.00,$0.00,$0.00,$0.00,$0.00
FSR100258-20,SUP,Custom 27803010,,FSR100258-20  -  COIL EMBL 2.5MM 8CM ULTIPAQ 10 MCIOL STRCH RS HLCL LOOP DTCH,"$2,283.05",$0.00,"$2,283.05",$0.00,"$1,629.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,283.05",$0.00,"$1,141.53","$1,808.18","$1,826.44",$0.00,$0.00,$0.00,$0.00,$0.00
FSR100306-20,SUP,Custom 27803010,,FSR100306-20  -  COIL EMBL HLCL 3MM 6CM ULTIPAQ 10 MCIOL STRCH RS LOOP DTCH,"$2,253.78",$0.00,"$2,253.78",$0.00,"$1,608.52",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,253.78",$0.00,"$1,126.89","$1,784.99","$1,803.02",$0.00,$0.00,$0.00,$0.00,$0.00
FSR100308-20,SUP,Custom 27803010,,FSR100308-20  -  COIL EMBL 3MM 8CM ULTIPAQ 10 MCIOL HLCL LOOP DTCH SFT STRCH,"$2,283.05",$0.00,"$2,283.05",$0.00,"$1,629.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,283.05",$0.00,"$1,141.53","$1,808.18","$1,826.44",$0.00,$0.00,$0.00,$0.00,$0.00
FSR100406-20,SUP,Custom 27803010,,FSR100406-20  -  COIL EMBL HLCL 4MM 6CM ULTIPAQ 10 MCIOL STRCH RS LOOP DTCH,"$2,253.78",$0.00,"$2,253.78",$0.00,"$1,608.52",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,253.78",$0.00,"$1,126.89","$1,784.99","$1,803.02",$0.00,$0.00,$0.00,$0.00,$0.00
FSR100408-20,SUP,Custom 27803010,,FSR100408-20  -  COIL EMBL HLCL 4MM 8CM ULTIPAQ 10 MCIOL STRCH RS LOOP DTCH,"$2,283.05",$0.00,"$2,283.05",$0.00,"$1,629.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,283.05",$0.00,"$1,141.53","$1,808.18","$1,826.44",$0.00,$0.00,$0.00,$0.00,$0.00
FT-1100,SUP,Custom 27203010,,FT-1100  -  TROCAR SURGICAL FALLER DIALYSIS CATHETER,$187.50,$0.00,$187.50,$0.00,$133.82,$0.00,$0.00,$0.00,$0.00,$0.00,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$0.00,$0.00,$0.00,$0.00
FT-12100,SUP,Custom 27803010,,FT-12100  -  CORONARY SHUNT 1.00 MM,$174.00,$0.00,$174.00,$0.00,$124.18,$0.00,$0.00,$0.00,$0.00,$0.00,$174.00,$0.00,$87.00,$137.81,$139.20,$0.00,$0.00,$0.00,$0.00,$0.00
FT12125,SUP,Custom 27803010,,FT12125  -  SHUNT CARDIO BULB TAPER 1.25MM 18MM RADIOPQ FLEXIBLE,$174.00,$0.00,$174.00,$0.00,$124.18,$0.00,$0.00,$0.00,$0.00,$0.00,$174.00,$0.00,$87.00,$137.81,$139.20,$0.00,$0.00,$0.00,$0.00,$0.00
FT-12125,SUP,Custom 27803010,,FT-12125  -  CORONARY SHUNT 1.25 MM,$174.00,$0.00,$174.00,$0.00,$124.18,$0.00,$0.00,$0.00,$0.00,$0.00,$174.00,$0.00,$87.00,$137.81,$139.20,$0.00,$0.00,$0.00,$0.00,$0.00
FT-12150,SUP,Custom 27803010,,FT-12150  -  CORONARY SHUNT 1.50 MM,$174.00,$0.00,$174.00,$0.00,$124.18,$0.00,$0.00,$0.00,$0.00,$0.00,$174.00,$0.00,$87.00,$137.81,$139.20,$0.00,$0.00,$0.00,$0.00,$0.00
FT-12175,SUP,Custom 27803010,,FT-12175  -  CORONARY SHUNT 1.75 MM,$174.00,$0.00,$174.00,$0.00,$124.18,$0.00,$0.00,$0.00,$0.00,$0.00,$174.00,$0.00,$87.00,$137.81,$139.20,$0.00,$0.00,$0.00,$0.00,$0.00
FT-12200,SUP,Custom 27803010,,FT-12200  -  CORONARY SHUNT 2.00 MM,$184.60,$0.00,$184.60,$0.00,$131.75,$0.00,$0.00,$0.00,$0.00,$0.00,$184.60,$0.00,$92.30,$146.20,$147.68,$0.00,$0.00,$0.00,$0.00,$0.00
FT-12225,SUP,Custom 27803010,,FT-12225  -  CORONARY SHUNT 2.25 MM,$174.00,$0.00,$174.00,$0.00,$124.18,$0.00,$0.00,$0.00,$0.00,$0.00,$174.00,$0.00,$87.00,$137.81,$139.20,$0.00,$0.00,$0.00,$0.00,$0.00
FT12250,SUP,Custom 27803010,,FT12250  -  SHUNT CARDIO 2.5MM 18MM FLO-THRU INTRALUMINAL,$174.00,$0.00,$174.00,$0.00,$124.18,$0.00,$0.00,$0.00,$0.00,$0.00,$174.00,$0.00,$87.00,$137.81,$139.20,$0.00,$0.00,$0.00,$0.00,$0.00
FT-12250,SUP,Custom 27803010,,FT-12250  -  CORONARY SHUNT 2.20 MM,$174.00,$0.00,$174.00,$0.00,$124.18,$0.00,$0.00,$0.00,$0.00,$0.00,$174.00,$0.00,$87.00,$137.81,$139.20,$0.00,$0.00,$0.00,$0.00,$0.00
FT180T,SUP,Custom 27803010,,FT180T  -  CLIP ANEURYSM MINI 3.3MM OPENING 3MM STR TEMPORARY NARROW,$975.25,$0.00,$975.25,$0.00,$696.04,$0.00,$0.00,$0.00,$0.00,$0.00,$975.25,$0.00,$487.63,$772.40,$780.20,$0.00,$0.00,$0.00,$0.00,$0.00
FT190T,SUP,Custom 27803010,,FT190T  -  CLIP ANEURYSM MINI 4MM OPENING 5MM STR NARROW TEMPORARY,$975.25,$0.00,$975.25,$0.00,$696.04,$0.00,$0.00,$0.00,$0.00,$0.00,$975.25,$0.00,$487.63,$772.40,$780.20,$0.00,$0.00,$0.00,$0.00,$0.00
FT220T,SUP,Custom 27803010,,FT220T  -  CLIP ANEURYSM MINI 4.6MM OPENING 7MM STR TEMPORARY LATEX,$975.25,$0.00,$975.25,$0.00,$696.04,$0.00,$0.00,$0.00,$0.00,$0.00,$975.25,$0.00,$487.63,$772.40,$780.20,$0.00,$0.00,$0.00,$0.00,$0.00
FT222T,SUP,Custom 27803010,,FT222T  -  CLIP ANEURYSM MINI 4.4MM OPENING 6.6MM CVD SLIGHTLY,$975.25,$0.00,$975.25,$0.00,$696.04,$0.00,$0.00,$0.00,$0.00,$0.00,$975.25,$0.00,$487.63,$772.40,$780.20,$0.00,$0.00,$0.00,$0.00,$0.00
FT224T,SUP,Custom 27803010,,FT224T  -  CLIP ANEURYSM MINI 4MM OPENING 5MM CVD TEMPORARY LATEX FREE,$975.25,$0.00,$975.25,$0.00,$696.04,$0.00,$0.00,$0.00,$0.00,$0.00,$975.25,$0.00,$487.63,$772.40,$780.20,$0.00,$0.00,$0.00,$0.00,$0.00
FT250T,SUP,Custom 27803010,,FT250T  -  CLIP ANEURYSM 7MM OPEN STANDARD 9MM TEMPORARY SPRING,$975.25,$0.00,$975.25,$0.00,$696.04,$0.00,$0.00,$0.00,$0.00,$0.00,$975.25,$0.00,$487.63,$772.40,$780.20,$0.00,$0.00,$0.00,$0.00,$0.00
FT252T,SUP,Custom 27803010,,FT252T  -  CLIP ANEURYSM STANDARD 6.8MM OPENING 8.3MM CVD SLIGHTLY,$975.25,$0.00,$975.25,$0.00,$696.04,$0.00,$0.00,$0.00,$0.00,$0.00,$975.25,$0.00,$487.63,$772.40,$780.20,$0.00,$0.00,$0.00,$0.00,$0.00
FT254T,SUP,Custom 27803010,,FT254T  -  CLIP ANEURYSM STANDARD 6.1MM OPENING 6.4MM CVD TEMPORARY,$975.25,$0.00,$975.25,$0.00,$696.04,$0.00,$0.00,$0.00,$0.00,$0.00,$975.25,$0.00,$487.63,$772.40,$780.20,$0.00,$0.00,$0.00,$0.00,$0.00
FT280T,SUP,Custom 27803010,,FT280T  -  CLIP ANEURYSM 9.2MM OPENING STANDARD 15MM TEMPORARY MRI,$975.25,$0.00,$975.25,$0.00,$696.04,$0.00,$0.00,$0.00,$0.00,$0.00,$975.25,$0.00,$487.63,$772.40,$780.20,$0.00,$0.00,$0.00,$0.00,$0.00
FT290T,SUP,Custom 27803010,,FT290T  -  CLIP ANEURYSM STANDARD 11.4MM OPENING 20MM STR TEMPORARY,$975.25,$0.00,$975.25,$0.00,$696.04,$0.00,$0.00,$0.00,$0.00,$0.00,$975.25,$0.00,$487.63,$772.40,$780.20,$0.00,$0.00,$0.00,$0.00,$0.00
FT620T,SUP,Custom 27803010,,FT620T  -  CLIP ANEURYSM STANDARD 9.6MM OPENING 3.5MM 12MM STR FENST,$975.25,$0.00,$975.25,$0.00,$696.04,$0.00,$0.00,$0.00,$0.00,$0.00,$975.25,$0.00,$487.63,$772.40,$780.20,$0.00,$0.00,$0.00,$0.00,$0.00
FT623T,SUP,Custom 27803010,,FT623T  -  CLIP ANEURYSM 7.8MM OPENING STANDARD 10.6MM PERMANENT MRI,$975.25,$0.00,$975.25,$0.00,$696.04,$0.00,$0.00,$0.00,$0.00,$0.00,$975.25,$0.00,$487.63,$772.40,$780.20,$0.00,$0.00,$0.00,$0.00,$0.00
FT640T,SUP,Custom 27803010,,FT640T  -  CLIP ANEURYSM STANDARD 7.9MM OPENING 5MM 6MM STR FENST,$975.25,$0.00,$975.25,$0.00,$696.04,$0.00,$0.00,$0.00,$0.00,$0.00,$975.25,$0.00,$487.63,$772.40,$780.20,$0.00,$0.00,$0.00,$0.00,$0.00
FT680T,SUP,Custom 27803010,,FT680T  -  CLIP ANEURYSM MINI 3.3MM OPENING 3MM STR NARROW PERMANENT,$975.25,$0.00,$975.25,$0.00,$696.04,$0.00,$0.00,$0.00,$0.00,$0.00,$975.25,$0.00,$487.63,$772.40,$780.20,$0.00,$0.00,$0.00,$0.00,$0.00
FT690T,SUP,Custom 27803010,,FT690T  -  CLIP ANEURYSM MINI 4MM OPENING 5MM STR NARROW PERMANENT,$975.25,$0.00,$975.25,$0.00,$696.04,$0.00,$0.00,$0.00,$0.00,$0.00,$975.25,$0.00,$487.63,$772.40,$780.20,$0.00,$0.00,$0.00,$0.00,$0.00
FT700T,SUP,Custom 27803010,,FT700T  -  CLIP ANEURYSM MINI 3.5MM OPENING 3MM SLIGHTLY CVD PERMANENT,$975.25,$0.00,$975.25,$0.00,$696.04,$0.00,$0.00,$0.00,$0.00,$0.00,$975.25,$0.00,$487.63,$772.40,$780.20,$0.00,$0.00,$0.00,$0.00,$0.00
FT710T,SUP,Custom 27803010,,FT710T  -  CLIP ANEURYSM MINI 4MM OPENING 5MM STR PERMANENT LATEX FREE,$975.25,$0.00,$975.25,$0.00,$696.04,$0.00,$0.00,$0.00,$0.00,$0.00,$975.25,$0.00,$487.63,$772.40,$780.20,$0.00,$0.00,$0.00,$0.00,$0.00
FT712T,SUP,Custom 27803010,,FT712T  -  CLIP ANEURYSM MINI 3.8MM OPENING 4.7MM CVD SLIGHTLY,$975.25,$0.00,$975.25,$0.00,$696.04,$0.00,$0.00,$0.00,$0.00,$0.00,$975.25,$0.00,$487.63,$772.40,$780.20,$0.00,$0.00,$0.00,$0.00,$0.00
FT714T,SUP,Custom 27803010,,FT714T  -  CLIP ANEURYSM MINI 3.5MM OPENING 3.9MM SLIGHTLY CVD,$975.25,$0.00,$975.25,$0.00,$696.04,$0.00,$0.00,$0.00,$0.00,$0.00,$975.25,$0.00,$487.63,$772.40,$780.20,$0.00,$0.00,$0.00,$0.00,$0.00
FT720T,SUP,Custom 27803010,,FT720T  -  CLIP ANEURYSM MINI 4.6MM OPENING 7MM STR PERMANENT LATEX,$975.25,$0.00,$975.25,$0.00,$696.04,$0.00,$0.00,$0.00,$0.00,$0.00,$975.25,$0.00,$487.63,$772.40,$780.20,$0.00,$0.00,$0.00,$0.00,$0.00
FT722T,SUP,Custom 27803010,,FT722T  -  CLIP ANEURYSM MINI 4.4MM OPENING 6.6MM CVD SLIGHTLY,$975.25,$0.00,$975.25,$0.00,$696.04,$0.00,$0.00,$0.00,$0.00,$0.00,$975.25,$0.00,$487.63,$772.40,$780.20,$0.00,$0.00,$0.00,$0.00,$0.00
FT724T,SUP,Custom 27803010,,FT724T  -  CLIP ANEURYSM MINI 4MM OPENING 5MM CVD PERMANENT LATEX FREE,$975.25,$0.00,$975.25,$0.00,$696.04,$0.00,$0.00,$0.00,$0.00,$0.00,$975.25,$0.00,$487.63,$772.40,$780.20,$0.00,$0.00,$0.00,$0.00,$0.00
FT726T,SUP,Custom 27803010,,FT726T  -  CLIP ANEURYSM MINI 4MM OPENING 5.2MM SLIGHTLY CVD PERMANENT,$975.25,$0.00,$975.25,$0.00,$696.04,$0.00,$0.00,$0.00,$0.00,$0.00,$975.25,$0.00,$487.63,$772.40,$780.20,$0.00,$0.00,$0.00,$0.00,$0.00
FT727T,SUP,Custom 27803010,,FT727T  -  CLIP ANEURYSM MINI 7MM OPENING 4MM BAYONET PERMANENT LATEX,$975.25,$0.00,$975.25,$0.00,$696.04,$0.00,$0.00,$0.00,$0.00,$0.00,$975.25,$0.00,$487.63,$772.40,$780.20,$0.00,$0.00,$0.00,$0.00,$0.00
FT728D,SUP,Custom 27803010,,FT728D  -  CLIP ANEURYSM MINI 5.7MM OPENING 7MM BAYONET PERMANENT LATEX,$975.25,$0.00,$975.25,$0.00,$696.04,$0.00,$0.00,$0.00,$0.00,$0.00,$975.25,$0.00,$487.63,$772.40,$780.20,$0.00,$0.00,$0.00,$0.00,$0.00
FT740T,SUP,Custom 27803010,,FT740T  -  CLIP ANEURYSM 6.2MM OPENING STANDARD 7MM PERMANENT MRI,$975.25,$0.00,$975.25,$0.00,$696.04,$0.00,$0.00,$0.00,$0.00,$0.00,$975.25,$0.00,$487.63,$772.40,$780.20,$0.00,$0.00,$0.00,$0.00,$0.00
FT742T,SUP,Custom 27803010,,FT742T  -  CLIP ANEURYSM STANDARD 6MM OPENING 6.5MM SLIGHTLY CVD,$975.25,$0.00,$975.25,$0.00,$696.04,$0.00,$0.00,$0.00,$0.00,$0.00,$975.25,$0.00,$487.63,$772.40,$780.20,$0.00,$0.00,$0.00,$0.00,$0.00
FT744T,SUP,Custom 27803010,,FT744T  -  CLIP ANEURYSM STANDARD 5.5MM OPENING 5.4MM CVD PERMANENT,$975.25,$0.00,$975.25,$0.00,$696.04,$0.00,$0.00,$0.00,$0.00,$0.00,$975.25,$0.00,$487.63,$772.40,$780.20,$0.00,$0.00,$0.00,$0.00,$0.00
FT746T,SUP,Custom 27803010,,FT746T  -  CLIP ANEURYSM STANDARD 5.7MM OPENING 7MM LATERAL ANGLED,$975.25,$0.00,$975.25,$0.00,$696.04,$0.00,$0.00,$0.00,$0.00,$0.00,$975.25,$0.00,$487.63,$772.40,$780.20,$0.00,$0.00,$0.00,$0.00,$0.00
FT747T,SUP,Custom 27803010,,FT747T  -  CLIP ANEURYSM 7MM OPENING STANDARD 8.6MM PERMANENT MRI,$975.25,$0.00,$975.25,$0.00,$696.04,$0.00,$0.00,$0.00,$0.00,$0.00,$975.25,$0.00,$487.63,$772.40,$780.20,$0.00,$0.00,$0.00,$0.00,$0.00
FT750T,SUP,Custom 27803010,,FT750T  -  CLIP ANEURYSM STANDARD 7MM OPENING 9MM STR PERMANENT LATEX,$975.25,$0.00,$975.25,$0.00,$696.04,$0.00,$0.00,$0.00,$0.00,$0.00,$975.25,$0.00,$487.63,$772.40,$780.20,$0.00,$0.00,$0.00,$0.00,$0.00
FT752T,SUP,Custom 27803010,,FT752T  -  CLIP ANEURYSM STANDARD 6.8MM OPENING 8.3MM SLIGHTLY CVD,$975.25,$0.00,$975.25,$0.00,$696.04,$0.00,$0.00,$0.00,$0.00,$0.00,$975.25,$0.00,$487.63,$772.40,$780.20,$0.00,$0.00,$0.00,$0.00,$0.00
FT754T,SUP,Custom 27803010,,FT754T  -  CLIP ANEURYSM STANDARD 6.1MM OPENING 6.4MM CVD PERMANENT,$975.25,$0.00,$975.25,$0.00,$696.04,$0.00,$0.00,$0.00,$0.00,$0.00,$975.25,$0.00,$487.63,$772.40,$780.20,$0.00,$0.00,$0.00,$0.00,$0.00
FT760T,SUP,Custom 27803010,,FT760T  -  CLIP ANEURYSM STANDARD 7.8MM OPENING 11MM STR PERMANENT,$975.25,$0.00,$975.25,$0.00,$696.04,$0.00,$0.00,$0.00,$0.00,$0.00,$975.25,$0.00,$487.63,$772.40,$780.20,$0.00,$0.00,$0.00,$0.00,$0.00
FT762T,SUP,Custom 27803010,,FT762T  -  CLIP ANEURYSM 7.5MM OPENING STANDARD 10.2MM PERMANENT MRI,$975.25,$0.00,$975.25,$0.00,$696.04,$0.00,$0.00,$0.00,$0.00,$0.00,$975.25,$0.00,$487.63,$772.40,$780.20,$0.00,$0.00,$0.00,$0.00,$0.00
FT780D,SUP,Custom 27803010,,FT780D  -  CLIP ANEURYSM 9.2MM OPENING STANDARD 15MM PERMANENT MRI,$975.25,$0.00,$975.25,$0.00,$696.04,$0.00,$0.00,$0.00,$0.00,$0.00,$975.25,$0.00,$487.63,$772.40,$780.20,$0.00,$0.00,$0.00,$0.00,$0.00
FT782T,SUP,Custom 27803010,,FT782T  -  CLIP ANEURYSM STANDARD 8.7MM OPENING 13.7MM PERMANENT CVD,$975.25,$0.00,$975.25,$0.00,$696.04,$0.00,$0.00,$0.00,$0.00,$0.00,$975.25,$0.00,$487.63,$772.40,$780.20,$0.00,$0.00,$0.00,$0.00,$0.00
FT786T,SUP,Custom 27803010,,FT786T  -  CLIP ANEURYSM STANDARD 9.8MM OPENING 15.3MM CVD SLIGHTLY,$975.25,$0.00,$975.25,$0.00,$696.04,$0.00,$0.00,$0.00,$0.00,$0.00,$975.25,$0.00,$487.63,$772.40,$780.20,$0.00,$0.00,$0.00,$0.00,$0.00
FT790D,SUP,Custom 27803010,,FT790D  -  CLIP ANEURYSM STANDARD 11.4MM OPENING 20MM STR PERMANENT,$975.25,$0.00,$975.25,$0.00,$696.04,$0.00,$0.00,$0.00,$0.00,$0.00,$975.25,$0.00,$487.63,$772.40,$780.20,$0.00,$0.00,$0.00,$0.00,$0.00
FT806T,SUP,Custom 27803010,,FT806T  -  CLIP ANEURYSM MINI 4.5MM OPENING 7MM ANGLED FORWARD,$975.25,$0.00,$975.25,$0.00,$696.04,$0.00,$0.00,$0.00,$0.00,$0.00,$975.25,$0.00,$487.63,$772.40,$780.20,$0.00,$0.00,$0.00,$0.00,$0.00
FT810T,SUP,Custom 27803010,,FT810T  -  CLIP ANEURYSM STANDARD 6.5MM OPENING 9MM ANGLED FORWARD,$975.25,$0.00,$975.25,$0.00,$696.04,$0.00,$0.00,$0.00,$0.00,$0.00,$975.25,$0.00,$487.63,$772.40,$780.20,$0.00,$0.00,$0.00,$0.00,$0.00
FT820T,SUP,Custom 27803010,,FT820T  -  CLIP ANEURYSM STANDARD 4.5MM OPENING 7MM ANGLED RIGHT,$975.25,$0.00,$975.25,$0.00,$696.04,$0.00,$0.00,$0.00,$0.00,$0.00,$975.25,$0.00,$487.63,$772.40,$780.20,$0.00,$0.00,$0.00,$0.00,$0.00
FTL10040,SUP,HCPCS C1876,,FTL10040  -  STENT TRCHBR 10MM 9FR 40MM STRL 117CM FLN + PUZZLE GFT,"$7,482.50",$0.00,"$7,482.50","$3,367.13","$5,158.80",$0.00,"$1,289.20",$0.00,$0.00,"$1,310.13","$7,482.50",$0.00,"$3,741.25","$5,926.14","$5,986.00",$0.00,"$1,171.01",$0.00,"$1,191.21",$0.00
FTM06040,SUP,HCPCS C1876,,FTM06040  -  STENT TRCHBR 6MM 40MM 80CM .035IN SLF XPD DLV SYS FLN PLUS,"$7,482.50",$0.00,"$7,482.50","$3,367.13","$5,158.80",$0.00,"$1,289.20",$0.00,$0.00,"$1,310.13","$7,482.50",$0.00,"$3,741.25","$5,926.14","$5,986.00",$0.00,"$1,171.01",$0.00,"$1,191.21",$0.00
FX-4001-S,SUP,Custom 27203010,,FX-4001-S  -  KIT XTRNFX STRL STABLELOC LTWT RDLCNT WRST,"$3,462.50",$0.00,"$3,462.50",$0.00,"$2,471.19",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,462.50",$0.00,"$1,731.25","$2,742.30","$2,770.00",$0.00,$0.00,$0.00,$0.00,$0.00
FX-4004-S,SUP,Custom 27203010,,FX-4004-S  -  PIN FIX 3.2MM SLFDRILL 30MM ORTH STABLELOC STRL,$707.50,$0.00,$707.50,$0.00,$504.94,$0.00,$0.00,$0.00,$0.00,$0.00,$707.50,$0.00,$353.75,$560.34,$566.00,$0.00,$0.00,$0.00,$0.00,$0.00
FX-4054-S,SUP,Custom 27203010,,FX-4054-S  -  PIN FIX 2.7MM SLFDRILL 25MM,$707.50,$0.00,$707.50,$0.00,$504.94,$0.00,$0.00,$0.00,$0.00,$0.00,$707.50,$0.00,$353.75,$560.34,$566.00,$0.00,$0.00,$0.00,$0.00,$0.00
G00130,SUP,HCPCS C1725,,G00130  -  CATH ANGIO .035IN 5FR 65CM STR FLXB PE,$32.50,$0.00,$32.50,$17.65,$23.20,$0.00,$5.60,$0.00,$0.00,$5.69,$32.50,$0.00,$16.25,$25.74,$26.00,$0.00,$5.09,$0.00,$5.17,$0.00
G00164,SUP,Custom 27203010,,G00164  -  STOPCOCK IV .95IN CLR STRL 1 WY F TO M LL ROT ADPR LP PLS,$14.38,$0.00,$14.38,$0.00,$10.26,$0.00,$0.00,$0.00,$0.00,$0.00,$14.38,$0.00,$7.19,$11.39,$11.50,$0.00,$0.00,$0.00,$0.00,$0.00
G00165,SUP,HCPCS C1770,,G00165  -  COIL EMBL 5CM 5MM 3.2 LOOP FBR OCL SPRG .035IN SS A/V STRL,$65.89,$0.00,$65.89,$0.00,$47.02,$0.00,$0.00,$0.00,$0.00,$0.00,$65.89,$0.00,$32.94,$52.18,$52.71,$0.00,$0.00,$0.00,$0.00,$0.00
G00314,SUP,HCPCS C1769,,G00314  -  GUIDEWIRE VASC 3MM .038IN 100CM STRL SFTJ JTP HVYDTY CRV,$25.50,$0.00,$25.50,$13.85,$18.20,$0.00,$4.39,$0.00,$0.00,$4.46,$25.50,$0.00,$12.75,$20.20,$20.40,$0.00,$3.99,$0.00,$4.06,$0.00
G00321,SUP,HCPCS C1769,,G00321  -  GUIDEWIRE VASC STRG .038IN 145CM LNDRQS RING TRQ SS PTFE,$27.63,$0.00,$27.63,$15.00,$19.72,$0.00,$4.76,$0.00,$0.00,$4.84,$27.63,$0.00,$13.81,$21.88,$22.10,$0.00,$4.32,$0.00,$4.40,$0.00
G00331,SUP,HCPCS C1769,,G00331  -  SET STNT .035IN 2 PGTL CRV 4.7FR 28CM STRL PSTNR GW SFLX,$27.63,$0.00,$27.63,$15.00,$19.72,$0.00,$4.76,$0.00,$0.00,$4.84,$27.63,$0.00,$13.81,$21.88,$22.10,$0.00,$4.32,$0.00,$4.40,$0.00
G00511,SUP,HCPCS C1769,,G00511  -  GUIDEWIRE VASCULAR CURVE TAPER .035IN 145CM 3CM FLEXIBLE TIP,$35.63,$0.00,$35.63,$19.34,$25.43,$0.00,$6.14,$0.00,$0.00,$6.24,$35.63,$0.00,$17.81,$28.22,$28.50,$0.00,$5.58,$0.00,$5.67,$0.00
G00529,SUP,HCPCS C1769,,G00529  -  GUIDEWIRE VASCULAR CURVE TAPER .035IN 80CM 3CM FLEXIBLE TIP,$31.98,$0.00,$31.98,$17.36,$22.82,$0.00,$5.51,$0.00,$0.00,$5.60,$31.98,$0.00,$15.99,$25.33,$25.58,$0.00,$5.00,$0.00,$5.09,$0.00
G00593,SUP,HCPCS C1769,,G00593  -  GUIDEWIRE VASCULAR STR TAPER .018IN 50CM FLEXIBLE TIP FIX,$30.95,$0.00,$30.95,$16.81,$22.09,$0.00,$5.33,$0.00,$0.00,$5.42,$30.95,$0.00,$15.48,$24.51,$24.76,$0.00,$4.84,$0.00,$4.93,$0.00
G00631,SUP,HCPCS C1769,,G00631  -  GUIDEWIRE VASC STRG .038IN 145CM FX COR SS,$45.70,$0.00,$45.70,$24.82,$32.62,$0.00,$7.87,$0.00,$0.00,$8.00,$45.70,$0.00,$22.85,$36.19,$36.56,$0.00,$7.15,$0.00,$7.28,$0.00
G00666,SUP,HCPCS C1769,,G00666  -  GUIDEWIRE VASC .035IN 145CM 8CM AMPTZ 2 FLX TP XSTIF SS,$52.55,$0.00,$52.55,$28.53,$37.50,$0.00,$9.05,$0.00,$0.00,$9.20,$52.55,$0.00,$26.28,$41.62,$42.04,$0.00,$8.22,$0.00,$8.37,$0.00
G00683,SUP,HCPCS C1769,,G00683  -  GUIDEWIRE VASC STRG TPR .028IN 145CM STRL FX COR SS PTFE,$43.38,$0.00,$43.38,$23.55,$30.96,$0.00,$7.47,$0.00,$0.00,$7.59,$43.38,$0.00,$21.69,$34.36,$34.70,$0.00,$6.79,$0.00,$6.91,$0.00
G00691,SUP,HCPCS C1769,,G00691  -  GWIRE VASC .035IN 145CM 20CM STR FLEXIBILE TIP FLPY BNTSN LG,$48.75,$0.00,$48.75,$26.47,$34.79,$0.00,$8.40,$0.00,$0.00,$8.54,$48.75,$0.00,$24.38,$38.61,$39.00,$0.00,$7.63,$0.00,$7.76,$0.00
G00693,SUP,HCPCS C1769,,G00693  -  GUIDEWIRE VASCULAR STR BENTSON CURVE .038IN 145CM 20CM,$61.88,$0.00,$61.88,$33.60,$44.16,$0.00,$10.66,$0.00,$0.00,$10.83,$61.88,$0.00,$30.94,$49.01,$49.50,$0.00,$9.68,$0.00,$9.85,$0.00
G00785,SUP,HCPCS C1769,,G00785  -  GUIDEWIRE VASC .045IN 145CM STRL STRG TPR FXCR SS PTFE DISP,$44.10,$0.00,$44.10,$23.95,$31.47,$0.00,$7.60,$0.00,$0.00,$7.72,$44.10,$0.00,$22.05,$34.93,$35.28,$0.00,$6.90,$0.00,$7.02,$0.00
G00852,SUP,Custom 27203010,,G00852  -  NEEDLE BIOP 22GA 10CM CHIBA STERILE DISPOSABLE ASPIRAT,$26.58,$0.00,$26.58,$0.00,$18.97,$0.00,$0.00,$0.00,$0.00,$0.00,$26.58,$0.00,$13.29,$21.05,$21.26,$0.00,$0.00,$0.00,$0.00,$0.00
G01035,SUP,Custom 27203010,,COIL 38-2-3 EMBOLIZATION  MWCE,$145.00,$0.00,$145.00,$0.00,$103.49,$0.00,$0.00,$0.00,$0.00,$0.00,$145.00,$0.00,$72.50,$114.84,$116.00,$0.00,$0.00,$0.00,$0.00,$0.00
G01095,SUP,HCPCS C1769,,G01095  -  GWIRE VASC 6CM .035IN 200CM 20CM BNTSN STR ATRM TIP LG DIA,$51.25,$0.00,$51.25,$27.83,$36.58,$0.00,$8.83,$0.00,$0.00,$8.97,$51.25,$0.00,$25.63,$40.59,$41.00,$0.00,$8.02,$0.00,$8.16,$0.00
G01184,SUP,HCPCS C1770,,G01184  -  COIL EMBL 4CM 3MM 4.3 LOOP .038IN SS VASC STRL DISP,$210.00,$0.00,$210.00,$0.00,$149.88,$0.00,$0.00,$0.00,$0.00,$0.00,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$0.00,$0.00,$0.00,$0.00
G01185,SUP,HCPCS C1770,,G01185  -  COIL EMBL .038IN 5MM 5CM STRL 3.2 LOOP SS VASC,$65.89,$0.00,$65.89,$0.00,$47.02,$0.00,$0.00,$0.00,$0.00,$0.00,$65.89,$0.00,$32.94,$52.18,$52.71,$0.00,$0.00,$0.00,$0.00,$0.00
G011LF,SUP,Custom 27203010,,GUIDE PRB 11GA MAMTM BRST BIOP LORAD FSCHR STRL DISP,$18.38,$0.00,$18.38,$0.00,$13.11,$0.00,$0.00,$0.00,$0.00,$0.00,$18.38,$0.00,$9.19,$14.56,$14.70,$0.00,$0.00,$0.00,$0.00,$0.00
G01212,SUP,HCPCS C1892,,G01212  -  DILATOR SURG STANDARD 16FR 20CM RADIOPQ VESSEL STERILE,$18.35,$0.00,$18.35,$9.96,$13.10,$0.00,$3.16,$0.00,$0.00,$3.21,$18.35,$0.00,$9.18,$14.53,$14.68,$0.00,$2.87,$0.00,$2.92,$0.00
G01232,SUP,HCPCS C1770,,G01232  -  COIL EMBOLIZATION 15MM 8CM 1.7 LOOP LOAD CARTRIDGE STAINLESS,$65.89,$0.00,$65.89,$0.00,$47.02,$0.00,$0.00,$0.00,$0.00,$0.00,$65.89,$0.00,$32.94,$52.18,$52.71,$0.00,$0.00,$0.00,$0.00,$0.00
G01261,SUP,HCPCS C1769,,G01261  -  GUIDEWIRE VASCULAR J ROSEN CURVE .035IN 145CM 1.5CM HEAVY,$35.00,$0.00,$35.00,$19.01,$24.98,$0.00,$6.03,$0.00,$0.00,$6.13,$35.00,$0.00,$17.50,$27.72,$28.00,$0.00,$5.48,$0.00,$5.57,$0.00
G01292,SUP,HCPCS C1770,,G01292  -  COIL EMBL .038IN 10MM 5CM STRL 1.6 LOOP SS VASC,$65.89,$0.00,$65.89,$0.00,$47.02,$0.00,$0.00,$0.00,$0.00,$0.00,$65.89,$0.00,$32.94,$52.18,$52.71,$0.00,$0.00,$0.00,$0.00,$0.00
G01371,SUP,HCPCS C1769,,G01371  -  GUIDEWIRE VASC .038IN 145CM AMPTZ MOV COR TPR STRG PTFE,$45.70,$0.00,$45.70,$24.82,$32.62,$0.00,$7.87,$0.00,$0.00,$8.00,$45.70,$0.00,$22.85,$36.19,$36.56,$0.00,$7.15,$0.00,$7.28,$0.00
G01384,SUP,HCPCS C1725,,G01384  -  CATHETER BLNDIL 80CM 4.5CM V ANDL TPR TIP ILC FEM POPLT ART,$60.00,$0.00,$60.00,$32.58,$42.82,$0.00,$10.34,$0.00,$0.00,$10.51,$60.00,$0.00,$30.00,$47.52,$48.00,$0.00,$9.39,$0.00,$9.55,$0.00
G01471,SUP,Custom 27203010,,G01471  -  DILATOR VASCULAR STANDARD 20FR 20CM RADIOPQ STERILE,$34.05,$0.00,$34.05,$0.00,$24.30,$0.00,$0.00,$0.00,$0.00,$0.00,$34.05,$0.00,$17.03,$26.97,$27.24,$0.00,$0.00,$0.00,$0.00,$0.00
G01472,SUP,Custom 27203010,,G01472  -  DILATOR VASCULAR .038IN 22FR 20CM RADIOPQ GWIRE STERILE,$34.05,$0.00,$34.05,$0.00,$24.30,$0.00,$0.00,$0.00,$0.00,$0.00,$34.05,$0.00,$17.03,$26.97,$27.24,$0.00,$0.00,$0.00,$0.00,$0.00
G01616,SUP,HCPCS C1769,,G01616  -  GUIDEWIRE VASC .038IN 260CM BNTSN STRG FXCR SS PTFE CRBRL,$121.25,$0.00,$121.25,$65.84,$86.54,$0.00,$20.89,$0.00,$0.00,$21.23,$121.25,$0.00,$60.63,$96.03,$97.00,$0.00,$18.98,$0.00,$19.30,$0.00
G01618,SUP,Custom 27203010,,G01618  -  NEEDLE PROCEDURE 21GA 7CM 1 PART ENTRY THIN WALL,$8.23,$0.00,$8.23,$0.00,$5.87,$0.00,$0.00,$0.00,$0.00,$0.00,$8.23,$0.00,$4.11,$6.52,$6.58,$0.00,$0.00,$0.00,$0.00,$0.00
G01729,SUP,HCPCS C1769,,G01729  -  GUIDEWIRE VASC STD STRG .035IN 145CM 3CM 2 FLXB SS PTFE,$39.33,$0.00,$39.33,$21.35,$28.07,$0.00,$6.78,$0.00,$0.00,$6.89,$39.33,$0.00,$19.66,$31.15,$31.46,$0.00,$6.15,$0.00,$6.26,$0.00
G01884,SUP,Custom 27203010,,G01884  -  DILATOR VASCULAR .038IN STANDARD 24FR 20CM STANDARD RADIOPQ,$34.05,$0.00,$34.05,$0.00,$24.30,$0.00,$0.00,$0.00,$0.00,$0.00,$34.05,$0.00,$17.03,$26.97,$27.24,$0.00,$0.00,$0.00,$0.00,$0.00
G02295,SUP,HCPCS C1769,,G02295  -  CATHETER URET UNV 4FR 70CM RTNR WDG,$4.30,$0.00,$4.30,$2.34,$3.07,$0.00,$0.74,$0.00,$0.00,$0.75,$4.30,$0.00,$2.15,$3.41,$3.44,$0.00,$0.67,$0.00,$0.68,$0.00
G02760,SUP,HCPCS C1770,,G02760  -  COIL EMBL 4CM 3MM 4.3 LOOP .035IN SS STRL DISP,$65.89,$0.00,$65.89,$0.00,$47.02,$0.00,$0.00,$0.00,$0.00,$0.00,$65.89,$0.00,$32.94,$52.18,$52.71,$0.00,$0.00,$0.00,$0.00,$0.00
G03031,SUP,HCPCS C1769,,G03031  -  GUIDEWIRE VASCULAR STR FLOPPY TAPER .038IN 145CM FLEXIBLE,$64.58,$0.00,$64.58,$35.06,$46.09,$0.00,$11.13,$0.00,$0.00,$11.31,$64.58,$0.00,$32.29,$51.15,$51.66,$0.00,$10.11,$0.00,$10.28,$0.00
G03037,SUP,HCPCS C1769,,G03037  -  GUIDEWIRE VASC .038IN 100CM STRL STRG TPR FXCR SS PTFE DISP,$55.00,$0.00,$55.00,$29.87,$39.25,$0.00,$9.48,$0.00,$0.00,$9.63,$55.00,$0.00,$27.50,$43.56,$44.00,$0.00,$8.61,$0.00,$8.76,$0.00
G03095,SUP,HCPCS C1769,,G03095  -  GUIDEWIRE VASCULAR 3CM STR TAPER .035IN 145CM 7CM FLEXIBLE,$64.58,$0.00,$64.58,$35.06,$46.09,$0.00,$11.13,$0.00,$0.00,$11.31,$64.58,$0.00,$32.29,$51.15,$51.66,$0.00,$10.11,$0.00,$10.28,$0.00
G03211,SUP,HCPCS C1769,,G03211  -  GUIDEWIRE VASC .038IN 145CM STRL STRG MOV COR SS PTFE DISP,$51.93,$0.00,$51.93,$28.20,$37.06,$0.00,$8.95,$0.00,$0.00,$9.09,$51.93,$0.00,$25.96,$41.13,$41.54,$0.00,$8.13,$0.00,$8.27,$0.00
G03301,SUP,HCPCS C1729,,G03301  -  SET DRAIN 29CM 9FR PTFE THOR 20 SDPRT 1 WY STPCK CATH NDL,$383.65,$0.00,$383.65,$208.32,$273.81,$0.00,$66.10,$0.00,$0.00,$67.17,$383.65,$0.00,$191.83,$303.85,$306.92,$0.00,$60.04,$0.00,$61.08,$0.00
G03445,SUP,HCPCS C1769,,G03445  -  GUIDEWIRE URO STD STRG .038IN 145CM STRL 3CM 2 FLX TP FXCR,$55.00,$0.00,$55.00,$29.87,$39.25,$0.00,$9.48,$0.00,$0.00,$9.63,$55.00,$0.00,$27.50,$43.56,$44.00,$0.00,$8.61,$0.00,$8.76,$0.00
G03522,SUP,HCPCS C1769,,G03522  -  GUIDEWIRE VASC STRG TPR .035IN 145CM STRL AMPTZ MOV COR SS,$50.10,$0.00,$50.10,$27.20,$35.76,$0.00,$8.63,$0.00,$0.00,$8.77,$50.10,$0.00,$25.05,$39.68,$40.08,$0.00,$7.84,$0.00,$7.98,$0.00
G03562,SUP,HCPCS C1769,,G03562  -  GUIDEWIRE VASCULAR STR .035IN 260CM EXTRA STIFF SHAFT COIL,$67.50,$0.00,$67.50,$36.65,$48.17,$0.00,$11.63,$0.00,$0.00,$11.82,$67.50,$0.00,$33.75,$53.46,$54.00,$0.00,$10.56,$0.00,$10.75,$0.00
G03579,SUP,HCPCS C1769,,G03579  -  GUIDEWIRE VASCULAR STR .038IN 300CM EXTRA STIFF SHAFT,$67.50,$0.00,$67.50,$36.65,$48.17,$0.00,$11.63,$0.00,$0.00,$11.82,$67.50,$0.00,$33.75,$53.46,$54.00,$0.00,$10.56,$0.00,$10.75,$0.00
G03831,SUP,HCPCS C2628,,G03831  -  CATHETER BLNDIL 32MM 120CM CODA PU ACPT .035IN GW 12FR INTRO,"$1,042.50",$0.00,"$1,042.50",$0.00,$744.03,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,042.50",$0.00,$521.25,$825.66,$834.00,$0.00,$0.00,$0.00,$0.00,$0.00
G04001,SUP,HCPCS C1769,,G04001  -  GUIDEWIRE VASCULAR STR .035IN 300CM FLEXIBLE TIP EXTRA STIFF,$101.25,$0.00,$101.25,$54.98,$72.26,$0.00,$17.44,$0.00,$0.00,$17.73,$101.25,$0.00,$50.63,$80.19,$81.00,$0.00,$15.85,$0.00,$16.12,$0.00
G04044,SUP,HCPCS C1770,,G04044  -  COIL EMBL 2CM 3MM 2.1 LOOP .035IN SS STRL DISP,$65.89,$0.00,$65.89,$0.00,$47.02,$0.00,$0.00,$0.00,$0.00,$0.00,$65.89,$0.00,$32.94,$52.18,$52.71,$0.00,$0.00,$0.00,$0.00,$0.00
G04096,SUP,HCPCS C1892,,G04096  -  INTRODUCER SHEATH LARGE 22FR 13CM 20CM GWIRE DILAT PEEL-AWAY,$113.15,$0.00,$113.15,$61.44,$80.76,$0.00,$19.50,$0.00,$0.00,$19.81,$113.15,$0.00,$56.58,$89.61,$90.52,$0.00,$17.71,$0.00,$18.01,$0.00
G04267,SUP,HCPCS C1894,,G04267  -  SET ACC NEFF PERC,$204.80,$0.00,$204.80,$111.21,$146.17,$0.00,$35.29,$0.00,$0.00,$35.86,$204.80,$0.00,$102.40,$162.20,$163.84,$0.00,$32.05,$0.00,$32.60,$0.00
G04636,SUP,HCPCS C1894,,G04636  -  INTROD SHTH 4FR 10CM 40CM COAX CATH MPNCH SS .018IN,$69.00,$0.00,$69.00,$37.47,$49.25,$0.00,$11.89,$0.00,$0.00,$12.08,$69.00,$0.00,$34.50,$54.65,$55.20,$0.00,$10.80,$0.00,$10.98,$0.00
G05021,SUP,Custom 27203010,,G05021  -  COIL EMBOLIZATION .035IN X 10MM X 5CM SPRING METAL,$400.00,$0.00,$400.00,$0.00,$285.48,$0.00,$0.00,$0.00,$0.00,$0.00,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$0.00,$0.00,$0.00,$0.00
G05060,SUP,HCPCS C1725,,G05060  -  CATH ANGIO .035IN STD PGTL CURVE 4FR 70CM 10 SDPRT HFLO NYL,$32.50,$0.00,$32.50,$17.65,$23.20,$0.00,$5.60,$0.00,$0.00,$5.69,$32.50,$0.00,$16.25,$25.74,$26.00,$0.00,$5.09,$0.00,$5.17,$0.00
G05183,SUP,HCPCS C1769,,G05183  -  GUIDEWIRE VASCULAR ANGLED .018IN 60CM 7CM SOFT COPE MANDRIL,$94.53,$0.00,$94.53,$51.33,$67.46,$0.00,$16.29,$0.00,$0.00,$16.55,$94.53,$0.00,$47.26,$74.87,$75.62,$0.00,$14.79,$0.00,$15.05,$0.00
G05189,SUP,HCPCS C1725,,G05189  -  CATHETER ANGIOGRAPHIC PIGTAIL CURVE 5FR 70CM SIZING 10,$55.00,$0.00,$55.00,$29.87,$39.25,$0.00,$9.48,$0.00,$0.00,$9.63,$55.00,$0.00,$27.50,$43.56,$44.00,$0.00,$8.61,$0.00,$8.76,$0.00
G05641,SUP,Custom 27203010,,G05641  -  ADAPTER TUBING MALE LUER LOCK LOCK TO TUOHY BORST STOPCOCK,$25.20,$0.00,$25.20,$0.00,$17.99,$0.00,$0.00,$0.00,$0.00,$0.00,$25.20,$0.00,$12.60,$19.96,$20.16,$0.00,$0.00,$0.00,$0.00,$0.00
G05839,SUP,Custom 27203010,,G05839  -  SET JJNSTM 80CM 16.5FR 24FR CR-ALZT-CNS 2 LUM 2 CATH SDPRT,$825.80,$0.00,$825.80,$0.00,$589.37,$0.00,$0.00,$0.00,$0.00,$0.00,$825.80,$0.00,$412.90,$654.03,$660.64,$0.00,$0.00,$0.00,$0.00,$0.00
G06299,SUP,Custom 27203010,,G06299  -  ADAPTER CATHETER 9FR LARGE BORE SIDE ARM ROTATING MALE INFUS,$50.00,$0.00,$50.00,$0.00,$35.69,$0.00,$0.00,$0.00,$0.00,$0.00,$50.00,$0.00,$25.00,$39.60,$40.00,$0.00,$0.00,$0.00,$0.00,$0.00
G06444,SUP,HCPCS C1892,,G06444  -  SET INTROD 18FR 15.5CM PEEL-AWAY PERCUTANEOUS STERILE,$113.15,$0.00,$113.15,$61.44,$80.76,$0.00,$19.50,$0.00,$0.00,$19.81,$113.15,$0.00,$56.58,$89.61,$90.52,$0.00,$17.71,$0.00,$18.01,$0.00
G06445,SUP,HCPCS C1892,,G06445  -  INTRODUCER SHEATH LARGE 20FR 13CM 20CM PEEL-AWAY,$113.15,$0.00,$113.15,$61.44,$80.76,$0.00,$19.50,$0.00,$0.00,$19.81,$113.15,$0.00,$56.58,$89.61,$90.52,$0.00,$17.71,$0.00,$18.01,$0.00
G06446,SUP,HCPCS C1892,,G06446  -  INTRODUCER SHEATH .038IN LARGE 24FR 13CM 20CM PEEL-AWAY,$113.15,$0.00,$113.15,$61.44,$80.76,$0.00,$19.50,$0.00,$0.00,$19.81,$113.15,$0.00,$56.58,$89.61,$90.52,$0.00,$17.71,$0.00,$18.01,$0.00
G06447,SUP,HCPCS C1892,,G06447  -  INTRODUCER SHEATH .038IN LARGE 26FR 13CM 20CM W/O GWIRE,$113.15,$0.00,$113.15,$61.44,$80.76,$0.00,$19.50,$0.00,$0.00,$19.81,$113.15,$0.00,$56.58,$89.61,$90.52,$0.00,$17.71,$0.00,$18.01,$0.00
G06451,SUP,HCPCS C1880,,G06451  -  SYSTEM EMBOLIZATION .038IN 11FR 12FR 40CM EMERGENCY CHRONIC,"$3,487.50",$0.00,"$3,487.50","$1,569.38","$2,489.03",$0.00,$600.88,$0.00,$0.00,$610.63,"$3,487.50",$0.00,"$1,743.75","$2,762.10","$2,790.00",$0.00,$545.79,$0.00,$555.21,$0.00
G06452,SUP,HCPCS C1880,,G06452  -  FILTER EMBOLIZATION .038IN 40MM 11FR 75CM CATHETER GWIRE,"$3,487.50",$0.00,"$3,487.50","$1,569.38","$2,489.03",$0.00,$600.88,$0.00,$0.00,$610.63,"$3,487.50",$0.00,"$1,743.75","$2,762.10","$2,790.00",$0.00,$545.79,$0.00,$555.21,$0.00
G06491,SUP,HCPCS C1892,,G06491  -  SET INTROD .038IN 11FR 15.5CM PEEL-AWAY PERCUTANEOUS STERILE,$113.15,$0.00,$113.15,$61.44,$80.76,$0.00,$19.50,$0.00,$0.00,$19.81,$113.15,$0.00,$56.58,$89.61,$90.52,$0.00,$17.71,$0.00,$18.01,$0.00
G06492,SUP,HCPCS C1892,,G06492  -  SET INTROD .038IN 12FR 15.5CM PEEL-AWAY PERCUTANEOUS STERILE,$113.15,$0.00,$113.15,$61.44,$80.76,$0.00,$19.50,$0.00,$0.00,$19.81,$113.15,$0.00,$56.58,$89.61,$90.52,$0.00,$17.71,$0.00,$18.01,$0.00
G06541,SUP,HCPCS C1894,,G06541  -  SET INTERVENTIONAL 9FR 16GA 38.5CM 50.5CM INTROD SHEATH,"$1,215.25",$0.00,"$1,215.25",$659.88,$867.32,$0.00,$209.38,$0.00,$0.00,$212.78,"$1,215.25",$0.00,$607.63,$962.48,$972.20,$0.00,$190.19,$0.00,$193.47,$0.00
G06929,SUP,Custom 27203010,,G06929  -  SET INTERVENTIONAL .038IN 10FR 40CM 62.5CM CATHETER CANNU,"$1,101.30",$0.00,"$1,101.30",$0.00,$786.00,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,101.30",$0.00,$550.65,$872.23,$881.04,$0.00,$0.00,$0.00,$0.00,$0.00
G07090,SUP,HCPCS C1729,,G07090  -  TRAY DRAIN 14FR 41CM 4 SIDEPORT RADIOPQ ENTRY NEEDLE SCALPEL,$377.98,$0.00,$377.98,$205.24,$269.76,$0.00,$65.12,$0.00,$0.00,$66.18,$377.98,$0.00,$188.99,$299.36,$302.38,$0.00,$59.15,$0.00,$60.17,$0.00
G07429,SUP,HCPCS C1894,,G07429  -  SET INTROD 6FR 13CM 20CM SIDEARM FITTING SIDE CONNECT LINE,$50.00,$0.00,$50.00,$27.15,$35.69,$0.00,$8.61,$0.00,$0.00,$8.75,$50.00,$0.00,$25.00,$39.60,$40.00,$0.00,$7.83,$0.00,$7.96,$0.00
G07465,SUP,HCPCS C1894,,G07465  -  INTRODUCER SHEATH 9FR 30CM SMALL VALVE ASMBLY RADIOPQ BAND,$175.00,$0.00,$175.00,$95.03,$124.90,$0.00,$30.15,$0.00,$0.00,$30.64,$175.00,$0.00,$87.50,$138.60,$140.00,$0.00,$27.39,$0.00,$27.86,$0.00
G07914,SUP,HCPCS C1769,,G07914  -  GUIDEWIRE VASCULAR TAPER .035IN 145CM RADIOPQ FLOPPY TIP,$93.75,$0.00,$93.75,$50.91,$66.91,$0.00,$16.15,$0.00,$0.00,$16.41,$93.75,$0.00,$46.88,$74.25,$75.00,$0.00,$14.67,$0.00,$14.93,$0.00
G07937,SUP,HCPCS C1769,,G07937  -  GUIDEWIRE VASCULAR ANGLE TAPER .035IN 180CM 9CM RADIOPQ,$93.75,$0.00,$93.75,$50.91,$66.91,$0.00,$16.15,$0.00,$0.00,$16.41,$93.75,$0.00,$46.88,$74.25,$75.00,$0.00,$14.67,$0.00,$14.93,$0.00
G08113,SUP,Custom 27203010,,G08113  -  CATHETER ANGIOGRAPHIC SLIP-CATH BEACON TIP HYDROPHILIC OD18,$313.20,$0.00,$313.20,$0.00,$223.53,$0.00,$0.00,$0.00,$0.00,$0.00,$313.20,$0.00,$156.60,$248.05,$250.56,$0.00,$0.00,$0.00,$0.00,$0.00
G08259,SUP,Custom 27203010,,G08259  -  COIL EMBOLIZATION .018IN 6-2MM 7CM SOFT MICROCOIL TORNADO,$275.33,$0.00,$275.33,$0.00,$196.50,$0.00,$0.00,$0.00,$0.00,$0.00,$275.33,$0.00,$137.66,$218.06,$220.26,$0.00,$0.00,$0.00,$0.00,$0.00
G08261,SUP,HCPCS C1770,,G08261  -  COIL EMBL 2CM 3-2MM TRND MCIOL MLFRM SFT .018IN PLTN,$270.00,$0.00,$270.00,$0.00,$192.70,$0.00,$0.00,$0.00,$0.00,$0.00,$270.00,$0.00,$135.00,$213.84,$216.00,$0.00,$0.00,$0.00,$0.00,$0.00
G08283,SUP,Custom 27203010,,G08283  -  SET BIOP 60CM 18GA 7FR Q COR CHK FLO VLV ADPR HVDTY FRNG,"$1,075.00",$0.00,"$1,075.00",$0.00,$767.23,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,075.00",$0.00,$537.50,$851.40,$860.00,$0.00,$0.00,$0.00,$0.00,$0.00
G08417,SUP,HCPCS C1729,,G08417  -  SET GSTRM 14FR 1 LUM 6 SDPRT CATH GWIRE NDL LOOP W-O 30CM,$301.63,$0.00,$301.63,$163.78,$215.27,$0.00,$51.97,$0.00,$0.00,$52.81,$301.63,$0.00,$150.81,$238.89,$241.30,$0.00,$47.20,$0.00,$48.02,$0.00
G08421,SUP,HCPCS C1725,,G08421  -  CATHETER ANGIOGRAPHIC HEADHUNTER 1 CURVE 5FR 100CM TORCON NB,$62.50,$0.00,$62.50,$33.94,$44.61,$0.00,$10.77,$0.00,$0.00,$10.94,$62.50,$0.00,$31.25,$49.50,$50.00,$0.00,$9.78,$0.00,$9.95,$0.00
G08422,SUP,HCPCS C1725,,G08422  -  CATHETER ANGIOGRAPHIC ANGLE SIMMONS 2 CURVE 5FR 100CM,$62.50,$0.00,$62.50,$33.94,$44.61,$0.00,$10.77,$0.00,$0.00,$10.94,$62.50,$0.00,$31.25,$49.50,$50.00,$0.00,$9.78,$0.00,$9.95,$0.00
G08427,SUP,HCPCS C1769,,G08427  -  GUIDEWIRE VASCULAR ANGLE TAPER .018IN 60CM SOFT TIP COPE,$115.30,$0.00,$115.30,$62.61,$82.29,$0.00,$19.87,$0.00,$0.00,$20.19,$115.30,$0.00,$57.65,$91.32,$92.24,$0.00,$18.04,$0.00,$18.36,$0.00
G08441,SUP,HCPCS C1725,,G08441  -  CATHETER ANGIOGRAPHIC C1 CURVE ANGLE 5FR 65CM MULTPUR TORCON,$62.50,$0.00,$62.50,$33.94,$44.61,$0.00,$10.77,$0.00,$0.00,$10.94,$62.50,$0.00,$31.25,$49.50,$50.00,$0.00,$9.78,$0.00,$9.95,$0.00
G08442,SUP,HCPCS C1725,,G08442  -  CATH ANGIO .035IN C2 CURVE 5FR 65CM VSCR ANG MULTPUR NYL SS,$32.50,$0.00,$32.50,$17.65,$23.20,$0.00,$5.60,$0.00,$0.00,$5.69,$32.50,$0.00,$16.25,$25.74,$26.00,$0.00,$5.09,$0.00,$5.17,$0.00
G08471,SUP,HCPCS C1725,,G08471  -  CATHETER ANGIOGRAPHIC SIMMONS 1 CURVE 5FR 100CM TORCON NB,$62.50,$0.00,$62.50,$33.94,$44.61,$0.00,$10.77,$0.00,$0.00,$10.94,$62.50,$0.00,$31.25,$49.50,$50.00,$0.00,$9.78,$0.00,$9.95,$0.00
G08515,SUP,HCPCS C1725,,G08515  -  CATH ANGIO .035IN NEFF CURVE 5FR 80CM 8 SDPRT NYL SS TRNB AD,$40.55,$0.00,$40.55,$22.02,$28.94,$0.00,$6.99,$0.00,$0.00,$7.10,$40.55,$0.00,$20.28,$32.12,$32.44,$0.00,$6.35,$0.00,$6.46,$0.00
G08581,SUP,HCPCS C1884,,G08581  -  CATHETER ANGIOGRAPHIC DAV CURVE ANGLE 5FR 100CM MULTPUR,$62.50,$0.00,$62.50,$28.13,$44.61,$0.00,$10.77,$0.00,$0.00,$10.94,$62.50,$0.00,$31.25,$49.50,$50.00,$0.00,$9.78,$0.00,$9.95,$0.00
G08597,SUP,HCPCS C1725,,G08597  -  CATHETER ANGIOGRAPHIC SIMMONS 3 CURVE 5FR 100CM TORCON NB,$62.50,$0.00,$62.50,$33.94,$44.61,$0.00,$10.77,$0.00,$0.00,$10.94,$62.50,$0.00,$31.25,$49.50,$50.00,$0.00,$9.78,$0.00,$9.95,$0.00
G08686,SUP,HCPCS C1894,,G08686  -  SET INTRO 10FR 3.3MM 30CM STRL 41CM CKFL DISP ACPT .038IN GW,$107.50,$0.00,$107.50,$58.37,$76.72,$0.00,$18.52,$0.00,$0.00,$18.82,$107.50,$0.00,$53.75,$85.14,$86.00,$0.00,$16.82,$0.00,$17.11,$0.00
G08699,SUP,Custom 27203010,,G08699  -  CATHETER ANGIOGRAPHIC DAV CURVE ANGLE 5FR 100CM MULTPUR,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
G08777,SUP,HCPCS C1769,,G08777  -  GUIDEWIRE VASCULAR ANGLE SPRING COIL .014IN 180CM HEAVY DUTY,$278.13,$0.00,$278.13,$151.02,$198.50,$0.00,$47.92,$0.00,$0.00,$48.70,$278.13,$0.00,$139.06,$220.28,$222.50,$0.00,$43.53,$0.00,$44.28,$0.00
G08801,SUP,HCPCS C1769,,G08801  -  GUIDEWIRE VASCULAR TAPER FLOPPY ANGLE SPRING COIL .014IN 300,$306.25,$0.00,$306.25,$166.29,$218.57,$0.00,$52.77,$0.00,$0.00,$53.62,$306.25,$0.00,$153.13,$242.55,$245.00,$0.00,$47.93,$0.00,$48.76,$0.00
G08943,SUP,HCPCS C1725,,G08943  -  CATH ANGIO .038IN 7FR 100CM PULM 4 SDPRT MONT1 TIP GW FLXB,$32.50,$0.00,$32.50,$17.65,$23.20,$0.00,$5.60,$0.00,$0.00,$5.69,$32.50,$0.00,$16.25,$25.74,$26.00,$0.00,$5.09,$0.00,$5.17,$0.00
G08957,SUP,HCPCS C1894,,G08957  -  SET INTROD .038IN 14FR 30CM 41CM RADIOPQ DILAT SIDEARM FIT,$317.50,$0.00,$317.50,$172.40,$226.60,$0.00,$54.70,$0.00,$0.00,$55.59,$317.50,$0.00,$158.75,$251.46,$254.00,$0.00,$49.69,$0.00,$50.55,$0.00
G09215,SUP,HCPCS C1770,,G09215  -  COIL EMBOLIZATION .018IN 8-4MM 9.5CM MICROCOIL SOFT SPACED,$275.33,$0.00,$275.33,$0.00,$196.50,$0.00,$0.00,$0.00,$0.00,$0.00,$275.33,$0.00,$137.66,$218.06,$220.26,$0.00,$0.00,$0.00,$0.00,$0.00
G09409,SUP,HCPCS C1725,,G09409  -  CATH ANGIO .035IN 4FR 70CM 10 SDPRT STR HFLO ATRM TIP DSGN,$46.88,$0.00,$46.88,$25.45,$33.45,$0.00,$8.08,$0.00,$0.00,$8.21,$46.88,$0.00,$23.44,$37.13,$37.50,$0.00,$7.34,$0.00,$7.46,$0.00
G09411,SUP,HCPCS C1725,,G09411  -  CATH ANGIO .035IN 5FR 70CM 10 SDPRT STR HFLO ATRM TIP DSGN,$32.50,$0.00,$32.50,$17.65,$23.20,$0.00,$5.60,$0.00,$0.00,$5.69,$32.50,$0.00,$16.25,$25.74,$26.00,$0.00,$5.09,$0.00,$5.17,$0.00
G09469,SUP,HCPCS C1725,,G09469  -  CATHETER ANGIOGRAPHIC ANGLE KMP CURVE TAPER 5FR 65CM LP,$62.50,$0.00,$62.50,$33.94,$44.61,$0.00,$10.77,$0.00,$0.00,$10.94,$62.50,$0.00,$31.25,$49.50,$50.00,$0.00,$9.78,$0.00,$9.95,$0.00
G09479,SUP,HCPCS C1894,,G09479  -  INTRODUCER CATHETER .038IN 7FR 40CM BALKIN UP AND OVER,"$1,750.00",$0.00,"$1,750.00",$950.25,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
G09497,SUP,HCPCS C1729,,G09497  -  CATHETER DRAIN 8.5FR 40CM 32 SIDEPORT RADIOPQ BAND MAC-LOC,$249.90,$0.00,$249.90,$135.70,$178.35,$0.00,$43.06,$0.00,$0.00,$43.76,$249.90,$0.00,$124.95,$197.92,$199.92,$0.00,$39.11,$0.00,$39.78,$0.00
G09498,SUP,HCPCS C1729,,G09498  -  CATHETER DRAIN 10.2FR 40CM 32 SIDEPORT RADIOPQ BAND MAC-LOC,$249.90,$0.00,$249.90,$135.70,$178.35,$0.00,$43.06,$0.00,$0.00,$43.76,$249.90,$0.00,$124.95,$197.92,$199.92,$0.00,$39.11,$0.00,$39.78,$0.00
G09499,SUP,HCPCS C1729,,G09499  -  CATHETER DRAIN 12FR 40CM 32 SIDEPORT RADIOPQ BAND MAC-LOC,$249.90,$0.00,$249.90,$135.70,$178.35,$0.00,$43.06,$0.00,$0.00,$43.76,$249.90,$0.00,$124.95,$197.92,$199.92,$0.00,$39.11,$0.00,$39.78,$0.00
G09500,SUP,HCPCS C1729,,G09500  -  CATHETER DRAIN 14FR 40CM 8CM 32 SIDEPORT LOCK MECHANISM,$249.90,$0.00,$249.90,$135.70,$178.35,$0.00,$43.06,$0.00,$0.00,$43.76,$249.90,$0.00,$124.95,$197.92,$199.92,$0.00,$39.11,$0.00,$39.78,$0.00
G09501,SUP,HCPCS C1729,,G09501  -  CATHETER DRAIN 8.5FR 25CM 6 SIDEPORT TROCAR MULTPUR RADIOPQ,$249.90,$0.00,$249.90,$135.70,$178.35,$0.00,$43.06,$0.00,$0.00,$43.76,$249.90,$0.00,$124.95,$197.92,$199.92,$0.00,$39.11,$0.00,$39.78,$0.00
G09502,SUP,HCPCS C1729,,G09502  -  CATHETER DRAIN 10.2FR 25CM 6 SIDEPORT LOCK LOOP RADIOPQ BAND,$249.90,$0.00,$249.90,$135.70,$178.35,$0.00,$43.06,$0.00,$0.00,$43.76,$249.90,$0.00,$124.95,$197.92,$199.92,$0.00,$39.11,$0.00,$39.78,$0.00
G09503,SUP,HCPCS C1729,,G09503  -  CATHETER DRAIN .038IN 12FR 25CM 6 SIDEPORT MAC LOC LOCKING,$249.90,$0.00,$249.90,$135.70,$178.35,$0.00,$43.06,$0.00,$0.00,$43.76,$249.90,$0.00,$124.95,$197.92,$199.92,$0.00,$39.11,$0.00,$39.78,$0.00
G09504,SUP,HCPCS C1729,,G09504  -  CATHETER DRAIN .038IN 14FR 25CM 6 SIDEPORT MAC-LOC LOCKING,$249.90,$0.00,$249.90,$135.70,$178.35,$0.00,$43.06,$0.00,$0.00,$43.76,$249.90,$0.00,$124.95,$197.92,$199.92,$0.00,$39.11,$0.00,$39.78,$0.00
G09607,SUP,HCPCS C1769,,G09607  -  GUIDEWIRE VASCULAR .035IN 145CM ANGLE SHORT TAPER FLEXIBLE,$93.75,$0.00,$93.75,$50.91,$66.91,$0.00,$16.15,$0.00,$0.00,$16.41,$93.75,$0.00,$46.88,$74.25,$75.00,$0.00,$14.67,$0.00,$14.93,$0.00
G09691,SUP,HCPCS C1892,,G09691  -  INTRODUCER SHEATH .038IN LARGE 16FR 30CM 42CM RADIOPQ BAND,$317.50,$0.00,$317.50,$172.40,$226.60,$0.00,$54.70,$0.00,$0.00,$55.59,$317.50,$0.00,$158.75,$251.46,$254.00,$0.00,$49.69,$0.00,$50.55,$0.00
G09751,SUP,HCPCS C1725,,G09751  -  CATHETER ANGIOGRAPHIC KMP CURVE 5FR 40CM TORCON NB ADVANTAGE,$62.50,$0.00,$62.50,$33.94,$44.61,$0.00,$10.77,$0.00,$0.00,$10.94,$62.50,$0.00,$31.25,$49.50,$50.00,$0.00,$9.78,$0.00,$9.95,$0.00
G09954,SUP,HCPCS C1769,,G09954  -  GUIDEWIRE VASCULAR STR .035IN 145CM FLEXIBLE TIP ULTRA-STIFF,$64.58,$0.00,$64.58,$35.06,$46.09,$0.00,$11.13,$0.00,$0.00,$11.31,$64.58,$0.00,$32.29,$51.15,$51.66,$0.00,$10.11,$0.00,$10.28,$0.00
G09956,SUP,HCPCS C1769,,G09956  -  GUIDEWIRE VASCULAR STR .035IN 180CM FLEXIBLE TIP ULTRA-STIFF,$86.25,$0.00,$86.25,$46.83,$61.56,$0.00,$14.86,$0.00,$0.00,$15.10,$86.25,$0.00,$43.13,$68.31,$69.00,$0.00,$13.50,$0.00,$13.73,$0.00
G10205,SUP,Custom 27203010,,G10205  -  DILATOR VASCULAR .025IN 4FR 20CM DECREASED FRICTION RADIOPQ,$26.75,$0.00,$26.75,$0.00,$19.09,$0.00,$0.00,$0.00,$0.00,$0.00,$26.75,$0.00,$13.38,$21.19,$21.40,$0.00,$0.00,$0.00,$0.00,$0.00
G10210,SUP,Custom 27203010,,G10210  -  TRAY PERICARDIOCENTESIS PIGTAIL CURVE 8.3FR 18GA 40CM 15CM 6,$473.75,$0.00,$473.75,$0.00,$338.12,$0.00,$0.00,$0.00,$0.00,$0.00,$473.75,$0.00,$236.88,$375.21,$379.00,$0.00,$0.00,$0.00,$0.00,$0.00
G10292,SUP,HCPCS C1758,,G10292  -  DILATOR VASCULAR 12FR 20CM RADIOPQ HYDPHI STERILE DISPOSABLE,$26.75,$0.00,$26.75,$14.53,$19.09,$0.00,$4.61,$0.00,$0.00,$4.68,$26.75,$0.00,$13.38,$21.19,$21.40,$0.00,$4.19,$0.00,$4.26,$0.00
G10383,SUP,HCPCS C1894,,G10383  -  INTRODUCER SHEATH 6FR 40CM OVER CONTRALATERAL RADIOPQ BAND,$187.50,$0.00,$187.50,$101.81,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G10405,SUP,HCPCS C1894,,G10405  -  INTROD SHTH 7FR 40CM BLK U-O CNTRLT DSGN RADIOPQ BAND W/O,$154.70,$0.00,$154.70,$84.00,$110.41,$0.00,$26.65,$0.00,$0.00,$27.09,$154.70,$0.00,$77.35,$122.52,$123.76,$0.00,$24.21,$0.00,$24.63,$0.00
G10414,SUP,HCPCS C1770,,G10414  -  COIL EMBOLIZATION .035IN STANDARD SMALL 4-3MM 2.6CM TORNADO,$275.33,$0.00,$275.33,$0.00,$196.50,$0.00,$0.00,$0.00,$0.00,$0.00,$275.33,$0.00,$137.66,$218.06,$220.26,$0.00,$0.00,$0.00,$0.00,$0.00
G10415,SUP,HCPCS C1770,,G10415  -  COIL EMBOLIZATION .035IN STANDARD SMALL 5-3MM 4.1CM SOFT,$275.33,$0.00,$275.33,$0.00,$196.50,$0.00,$0.00,$0.00,$0.00,$0.00,$275.33,$0.00,$137.66,$218.06,$220.26,$0.00,$0.00,$0.00,$0.00,$0.00
G10417,SUP,HCPCS C1770,,G10417  -  COIL EMBOLIZATION 7-3MM 8CM TORNADO PLATINUM ARTERIOVENOUS,$275.33,$0.00,$275.33,$0.00,$196.50,$0.00,$0.00,$0.00,$0.00,$0.00,$275.33,$0.00,$137.66,$218.06,$220.26,$0.00,$0.00,$0.00,$0.00,$0.00
G10455,SUP,HCPCS C1725,,G10455  -  CATHETER ANGIOGRAPHIC MPA CURVE 5FR 65CM TORCON NB ADVANTAGE,$55.00,$0.00,$55.00,$29.87,$39.25,$0.00,$9.48,$0.00,$0.00,$9.63,$55.00,$0.00,$27.50,$43.56,$44.00,$0.00,$8.61,$0.00,$8.76,$0.00
G10460,SUP,HCPCS C1894,,G10460  -  SET ACCES 15CM 6FR 22GA 4FR NEFF .018IN PERC HYDPHI CHBA NDL,$249.38,$0.00,$249.38,$135.41,$177.98,$0.00,$42.97,$0.00,$0.00,$43.66,$249.38,$0.00,$124.69,$197.51,$199.50,$0.00,$39.03,$0.00,$39.70,$0.00
G10554,SUP,Custom 27203010,,G10554  -  SET INTUBATION .038IN 3MM 14FR 70CM 110CM RTRGRD RADIOPQ,$316.25,$0.00,$316.25,$0.00,$225.71,$0.00,$0.00,$0.00,$0.00,$0.00,$316.25,$0.00,$158.13,$250.47,$253.00,$0.00,$0.00,$0.00,$0.00,$0.00
G10722,SUP,Custom 27203010,,G10722  -  NEEDLE INTRAOSSEOUS 15.5GA 3CM 2 OPPOSE SIDEPORT INFUS,$111.25,$0.00,$111.25,$0.00,$79.40,$0.00,$0.00,$0.00,$0.00,$0.00,$111.25,$0.00,$55.63,$88.11,$89.00,$0.00,$0.00,$0.00,$0.00,$0.00
G10992,SUP,Custom 27203010,,G10992  -  CATH IU DISP HSG,$299.49,$0.00,$299.49,$0.00,$213.74,$0.00,$0.00,$0.00,$0.00,$0.00,$299.49,$0.00,$149.74,$237.20,$239.59,$0.00,$0.00,$0.00,$0.00,$0.00
G11017,SUP,HCPCS C1894,,G11017  -  INTROD CATH 40CM 8FR .038IN CHK-FLO PRFRMR BLK U-O CNTRLT,$337.50,$0.00,$337.50,$183.26,$240.87,$0.00,$58.15,$0.00,$0.00,$59.09,$337.50,$0.00,$168.75,$267.30,$270.00,$0.00,$52.82,$0.00,$53.73,$0.00
G11189,SUP,HCPCS C1892,,G11189 - CATHETER ANGIOGRAPHIC VISCERAL 1 CURVE 5FR 80CM TORCON NB,$46.88,$0.00,$46.88,$25.45,$33.45,$0.00,$8.08,$0.00,$0.00,$8.21,$46.88,$0.00,$23.44,$37.13,$37.50,$0.00,$7.34,$0.00,$7.46,$0.00
G11240,SUP,HCPCS C1894,,G11240  -  SET INTROD .038IN 11FR 70CM RADIOPQ BAND CHK-FLO PERFORMER,$237.50,$0.00,$237.50,$128.96,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
G11667,SUP,HCPCS C1769,,G11667  -  GUIDEWIRE VASC CRV .035IN 260CM STRL 2MM RDRR PC THE FIRM,$93.75,$0.00,$93.75,$50.91,$66.91,$0.00,$16.15,$0.00,$0.00,$16.41,$93.75,$0.00,$46.88,$74.25,$75.00,$0.00,$14.67,$0.00,$14.93,$0.00
G11672,SUP,HCPCS C1894,,G11672  -  INTRODUCER SHEATH .038IN LARGE 18FR 30CM 42CM RADIOPQ BAND,$317.50,$0.00,$317.50,$172.40,$226.60,$0.00,$54.70,$0.00,$0.00,$55.59,$317.50,$0.00,$158.75,$251.46,$254.00,$0.00,$49.69,$0.00,$50.55,$0.00
G11916,SUP,HCPCS C1884,,G11916  -  CATHETER ANGIO PGTL CRV 5FR 100CM AUROUS 10 SDPRT RADOPQ SZ,$343.13,$0.00,$343.13,$154.41,$244.89,$0.00,$59.12,$0.00,$0.00,$60.08,$343.13,$0.00,$171.56,$271.76,$274.50,$0.00,$53.70,$0.00,$54.63,$0.00
G12016,SUP,HCPCS C1769,,G12016  -  GUIDEWIRE VASC .018IN 8FR 6.5FR 20CM STRL 15CM JEFFREY SET,$317.95,$0.00,$317.95,$172.65,$226.92,$0.00,$54.78,$0.00,$0.00,$55.67,$317.95,$0.00,$158.98,$251.82,$254.36,$0.00,$49.76,$0.00,$50.62,$0.00
G12082,SUP,HCPCS C1884,,G12082  -  CATHETER ANGIO VTK CRBRL CRV 5FR 125CM SCTH BTP BRD RADOPQ,$122.50,$0.00,$122.50,$55.13,$87.43,$0.00,$21.11,$0.00,$0.00,$21.45,$122.50,$0.00,$61.25,$97.02,$98.00,$0.00,$19.17,$0.00,$19.50,$0.00
G12168,SUP,HCPCS C1884,,G12168  -  CATH ANGIO .038IN VERT CURVE 5FR 125CM RADIOPQ LUB SRFC,$122.50,$0.00,$122.50,$55.13,$87.43,$0.00,$21.11,$0.00,$0.00,$21.45,$122.50,$0.00,$61.25,$97.02,$98.00,$0.00,$19.17,$0.00,$19.50,$0.00
G12170,SUP,HCPCS C1725,,G12170  -  CATHETER ANGIOGRAPHIC .038IN VERT CURVE 5FR 125CM LP RADIOPQ,$62.50,$0.00,$62.50,$33.94,$44.61,$0.00,$10.77,$0.00,$0.00,$10.94,$62.50,$0.00,$31.25,$49.50,$50.00,$0.00,$9.78,$0.00,$9.95,$0.00
G12179,SUP,Custom 27203010,,G12179  -  CATH ANGIO .038IN TEGT CURVE 5FR 65CM HYDPHI SCTH BTP,$122.50,$0.00,$122.50,$0.00,$87.43,$0.00,$0.00,$0.00,$0.00,$0.00,$122.50,$0.00,$61.25,$97.02,$98.00,$0.00,$0.00,$0.00,$0.00,$0.00
G12266,SUP,HCPCS C1894,,G12266  -  SHEATH GUID 6FR 2.2MM 90CM CHK-FLO VALVE SOFT TIP RADIOPQ,$187.50,$0.00,$187.50,$101.81,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G12423,SUP,HCPCS C1894,,G12423  -  SET INTROD .018IN 6FR 20CM 13CM ACCES NEEDLE PLATINUM TIP,$95.00,$0.00,$95.00,$51.59,$67.80,$0.00,$16.37,$0.00,$0.00,$16.63,$95.00,$0.00,$47.50,$75.24,$76.00,$0.00,$14.87,$0.00,$15.12,$0.00
G12513,SUP,Custom 27203010,,G12513  -  TRAY TRCH 24-28FR CGL BRHN STD HYDPHI SHLY PERC TUBE DILAT,$838.43,$0.00,$838.43,$0.00,$598.38,$0.00,$0.00,$0.00,$0.00,$0.00,$838.43,$0.00,$419.21,$664.04,$670.74,$0.00,$0.00,$0.00,$0.00,$0.00
G12560,SUP,HCPCS C1894,,G12560  -  SET INTROD 10CM 4FR MPNCH PSH+ .018IN GWIRE PLTN TIP CATH 40,$122.93,$0.00,$122.93,$66.75,$87.73,$0.00,$21.18,$0.00,$0.00,$21.52,$122.93,$0.00,$61.46,$97.36,$98.34,$0.00,$19.24,$0.00,$19.57,$0.00
G12565,SUP,HCPCS C1894,,G12565  -  TRAY TRCH 8FR STRL SHLY CGL BLU RHINO JTP NDL GD CATH RADOPQ,"$1,631.40",$0.00,"$1,631.40",$885.85,"$1,164.33",$0.00,$281.08,$0.00,$0.00,$285.65,"$1,631.40",$0.00,$815.70,"$1,292.07","$1,305.12",$0.00,$255.31,$0.00,$259.72,$0.00
G12580,SUP,HCPCS C1763,,G12580  -  GRAFT SFT TIS 10X7CM 4 SHT FRZDR SIS ES PIG ACLR CLGN MTRX,"$2,262.50",$0.00,"$2,262.50","$1,018.13","$1,614.75",$0.00,$389.82,$0.00,$0.00,$396.15,"$2,262.50",$0.00,"$1,131.25","$1,791.90","$1,810.00",$0.00,$354.08,$0.00,$360.19,$0.00
G12831,SUP,HCPCS C1894,,G12831  -  INTRODUCER SHEATH 25CM DILAT NONTAPER CLOSE CHK-FLO XL AQ 41,$847.50,$0.00,$847.50,$460.19,$604.86,$0.00,$146.02,$0.00,$0.00,$148.39,$847.50,$0.00,$423.75,$671.22,$678.00,$0.00,$132.63,$0.00,$134.92,$0.00
G12835,SUP,HCPCS C1894,,G12835  -  INTRODUCER CATHETER 7FR 2.5MM 90CM TUOHY BORST SIDEARM DILAT,$377.50,$0.00,$377.50,$204.98,$269.42,$0.00,$65.04,$0.00,$0.00,$66.10,$377.50,$0.00,$188.75,$298.98,$302.00,$0.00,$59.08,$0.00,$60.10,$0.00
G12847,SUP,HCPCS C1763,,G12847  -  GUIDEWIRE ESCP STRG .038IN 145CM 2 FLX TP,$872.83,$0.00,$872.83,$392.77,$622.94,$0.00,$150.38,$0.00,$0.00,$152.82,$872.83,$0.00,$436.41,$691.28,$698.26,$0.00,$136.60,$0.00,$138.95,$0.00
G12848,SUP,HCPCS C1763,,G12848  -  GRAFT SFT TIS 10X7CM SURGISIS 1 LYR SHT PEEL OPN DRY PRCN,"$2,391.50",$0.00,"$2,391.50","$1,076.18","$1,706.81",$0.00,$412.04,$0.00,$0.00,$418.73,"$2,391.50",$0.00,"$1,195.75","$1,894.07","$1,913.20",$0.00,$374.27,$0.00,$380.73,$0.00
G13032,SUP,HCPCS C1894,,G13032  -  INTRODUCER CATHETER .038IN 10IN 30CM LARGE VALVE ASMBLY,$190.00,$0.00,$190.00,$103.17,$135.60,$0.00,$32.74,$0.00,$0.00,$33.27,$190.00,$0.00,$95.00,$150.48,$152.00,$0.00,$29.74,$0.00,$30.25,$0.00
G13033,SUP,HCPCS C1894,,G13033  -  INTRODUCER SHEATH .038IN 10FR 80CM LARGE VALVE ASMBLY,$265.00,$0.00,$265.00,$143.90,$189.13,$0.00,$45.66,$0.00,$0.00,$46.40,$265.00,$0.00,$132.50,$209.88,$212.00,$0.00,$41.47,$0.00,$42.19,$0.00
G13081,SUP,HCPCS C1894,,G13081  -  INTRODUCER CATHETER .035IN 10FR 38.5CM CHK FLO VALVE RADIOPQ,$214.23,$0.00,$214.23,$116.32,$152.89,$0.00,$36.91,$0.00,$0.00,$37.51,$214.23,$0.00,$107.11,$169.67,$171.38,$0.00,$33.53,$0.00,$34.10,$0.00
G13116,SUP,HCPCS C1763,,G13116  -  GRAFT SFT TIS 20X7CM SURGISIS BIODESIGN 4 PLY SHT PRCN ACLR,"$1,309.23",$0.00,"$1,309.23",$589.15,$934.39,$0.00,$225.57,$0.00,$0.00,$229.23,"$1,309.23",$0.00,$654.61,"$1,036.91","$1,047.38",$0.00,$204.89,$0.00,$208.43,$0.00
G13166,SUP,HCPCS C1769,,G13166  -  TRAY TRCH STRL SHLY CGL BLU RHINO PERC DISP,"$1,757.72",$0.00,"$1,757.72",$954.44,"$1,254.49",$0.00,$302.85,$0.00,$0.00,$307.76,"$1,757.72",$0.00,$878.86,"$1,392.11","$1,406.18",$0.00,$275.08,$0.00,$279.83,$0.00
G13287,SUP,HCPCS C1773,,G13287  -  SET RETRIEVAL 6.3FR 11FR 80CM 60CM LOOP CATHETER GUNTHER,$625.00,$0.00,$625.00,$339.38,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
G13338,SUP,HCPCS C1894,,G13338  -  INTRODUCER SHEATH 7FR .1IN 80CM TUOHY BORST SIDEARM RADIOPQ,$377.50,$0.00,$377.50,$204.98,$269.42,$0.00,$65.04,$0.00,$0.00,$66.10,$377.50,$0.00,$188.75,$298.98,$302.00,$0.00,$59.08,$0.00,$60.10,$0.00
G13389,SUP,HCPCS C1876,,G13389  -  STENT VASC 6MM 40MM 80CM .035IN SLF XPD DLV SYS ZL NTNL,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
G13398,SUP,HCPCS C1876,,G13398  -  STENT VASC 8MM 30MM 80CM SLF XPD DLV SYS ZL,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
G13399,SUP,HCPCS C1876,,G13399  -  STENT BIL 9MM 7FR 40MM 80CM .035IN SLF XPD PRELD DLV SYS ZL,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
G13400,SUP,HCPCS C1876,,G13400  -  STENT BIL 8MM 6CM 80CM .035IN SLF XPD PRELD DLV SYS ZL NTNL,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
G13404,SUP,HCPCS C1876,,G13404  -  STENT VASC 9MM 40MM 80CM SLF XPD DLV SYS ZL,$2.50,$0.00,$2.50,$1.13,$1.78,$0.00,$0.43,$0.00,$0.00,$0.44,$2.50,$0.00,$1.25,$1.98,$2.00,$0.00,$0.39,$0.00,$0.40,$0.00
G13539,SUP,HCPCS C1894,,G13539  -  INTRODUCER SHEATH .038IN 6FR .087IN 80CM GWIRE FLEXOR,$377.50,$0.00,$377.50,$204.98,$269.42,$0.00,$65.04,$0.00,$0.00,$66.10,$377.50,$0.00,$188.75,$298.98,$302.00,$0.00,$59.08,$0.00,$60.10,$0.00
G13559,SUP,HCPCS C1725,,G13559  -  CATH ANGIO .038IN CHG-A CURVE 5FR 80CM VSCR NYL SS TRNB AD,$87.50,$0.00,$87.50,$47.51,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
G13561,SUP,HCPCS C1725,,G13561  -  CATHETER ANGIOGRAPHIC CHUANG C CURVE 5FR 80CM TORCON NB,$62.50,$0.00,$62.50,$33.94,$44.61,$0.00,$10.77,$0.00,$0.00,$10.94,$62.50,$0.00,$31.25,$49.50,$50.00,$0.00,$9.78,$0.00,$9.95,$0.00
G13793,SUP,Custom 27203010,,G13793  -  CATHETER ANGIOGRAPHIC 65CM MULTPUR TORCON NB ADVANTAGE,$65.00,$0.00,$65.00,$0.00,$46.39,$0.00,$0.00,$0.00,$0.00,$0.00,$65.00,$0.00,$32.50,$51.48,$52.00,$0.00,$0.00,$0.00,$0.00,$0.00
G13806,SUP,HCPCS C1763,,G13806  -  GRAFT SFT TIS 7X4CM SURGISIS BIODESIGN 4 PLY PRCN ACLR CLGN,"$1,870.33",$0.00,"$1,870.33",$841.65,"$1,334.85",$0.00,$322.25,$0.00,$0.00,$327.48,"$1,870.33",$0.00,$935.16,"$1,481.30","$1,496.26",$0.00,$292.71,$0.00,$297.76,$0.00
G13807,SUP,HCPCS C1763,,G13807  -  GRAFT SFT TIS 10X7CM SURGISIS BIODESIGN 4 PLY PRCN ACLR CLGN,$897.75,$0.00,$897.75,$403.99,$640.72,$0.00,$154.68,$0.00,$0.00,$157.19,$897.75,$0.00,$448.88,$711.02,$718.20,$0.00,$140.50,$0.00,$142.92,$0.00
G13808,SUP,HCPCS C1763,,G13808  -  GRAFT SFT TIS 3.5X5CM SURGISIS BIODESIGN 4 PLY PRCN ACLR,$993.60,$0.00,$993.60,$447.12,$709.13,$0.00,$171.19,$0.00,$0.00,$173.97,$993.60,$0.00,$496.80,$786.93,$794.88,$0.00,$155.50,$0.00,$158.18,$0.00
G13816,SUP,HCPCS C1769,,G13816  -  GUIDEWIRE ENDSCP STR STANDARD .035IN 480CM PURPLE STERILE,$192.50,$0.00,$192.50,$104.53,$137.39,$0.00,$33.17,$0.00,$0.00,$33.71,$192.50,$0.00,$96.25,$152.46,$154.00,$0.00,$30.13,$0.00,$30.65,$0.00
G14014,SUP,HCPCS C1758,,G14014  -  GRAFT SFT TIS 2X3CM SURGISIS BIODESIGN FRZDR PRCN ACLR CLGN,$276.25,$0.00,$276.25,$150.00,$197.16,$0.00,$47.60,$0.00,$0.00,$48.37,$276.25,$0.00,$138.13,$218.79,$221.00,$0.00,$43.23,$0.00,$43.98,$0.00
G14015,SUP,HCPCS C1758,,G14015  -  CATHETER URET 3FR 70CM FLXTP CLS END RT,$27.63,$0.00,$27.63,$15.00,$19.72,$0.00,$4.76,$0.00,$0.00,$4.84,$27.63,$0.00,$13.81,$21.88,$22.10,$0.00,$4.32,$0.00,$4.40,$0.00
G14016,SUP,HCPCS C1758,,G14016  -  CATHETER URET 4FR 70CM LF FLXTP CLS END FLX TP RT,$27.63,$0.00,$27.63,$15.00,$19.72,$0.00,$4.76,$0.00,$0.00,$4.84,$27.63,$0.00,$13.81,$21.88,$22.10,$0.00,$4.32,$0.00,$4.40,$0.00
G14017,SUP,HCPCS C1758,,G14017  -  CATHETER URET 5FR 70CM LF FLXTP CLS END RT,$27.63,$0.00,$27.63,$15.00,$19.72,$0.00,$4.76,$0.00,$0.00,$4.84,$27.63,$0.00,$13.81,$21.88,$22.10,$0.00,$4.32,$0.00,$4.40,$0.00
G14018,SUP,HCPCS C1758,,G14018  -  CATHETER URET 6FR 70CM LF FLXTP CLS END FLX TP RT,$27.63,$0.00,$27.63,$15.00,$19.72,$0.00,$4.76,$0.00,$0.00,$4.84,$27.63,$0.00,$13.81,$21.88,$22.10,$0.00,$4.32,$0.00,$4.40,$0.00
G14019,SUP,HCPCS C1758,,G14019  -  CATHETER URET 7FR 70CM FLXTP CLS END RT,$31.77,$0.00,$31.77,$17.25,$22.67,$0.00,$5.47,$0.00,$0.00,$5.56,$31.77,$0.00,$15.89,$25.16,$25.42,$0.00,$4.97,$0.00,$5.06,$0.00
G14022,SUP,HCPCS C1758,,G14022  -  CATHETER URET 8FR 70CM LF FLXTP CLS END FLX TP RT,$31.77,$0.00,$31.77,$17.25,$22.67,$0.00,$5.47,$0.00,$0.00,$5.56,$31.77,$0.00,$15.89,$25.16,$25.42,$0.00,$4.97,$0.00,$5.06,$0.00
G14023,SUP,HCPCS C1758,,G14023  -  CATHETER URET 3FR 70CM FLXTP CLS END FLX TP LT,$27.63,$0.00,$27.63,$15.00,$19.72,$0.00,$4.76,$0.00,$0.00,$4.84,$27.63,$0.00,$13.81,$21.88,$22.10,$0.00,$4.32,$0.00,$4.40,$0.00
G14024,SUP,HCPCS C1758,,G14024  -  CATHETER URET 4FR 70CM FLXTP CLS END FLX TP LT,$27.63,$0.00,$27.63,$15.00,$19.72,$0.00,$4.76,$0.00,$0.00,$4.84,$27.63,$0.00,$13.81,$21.88,$22.10,$0.00,$4.32,$0.00,$4.40,$0.00
G14025,SUP,HCPCS C1758,,G14025  -  CATHETER URET 5FR 70CM LF FLXTP CLS END FLX TP LT,$27.63,$0.00,$27.63,$15.00,$19.72,$0.00,$4.76,$0.00,$0.00,$4.84,$27.63,$0.00,$13.81,$21.88,$22.10,$0.00,$4.32,$0.00,$4.40,$0.00
G14026,SUP,HCPCS C1758,,G14026  -  CATHETER URET 6FR 70CM FLXTP CLS END LT,$31.77,$0.00,$31.77,$17.25,$22.67,$0.00,$5.47,$0.00,$0.00,$5.56,$31.77,$0.00,$15.89,$25.16,$25.42,$0.00,$4.97,$0.00,$5.06,$0.00
G14027,SUP,HCPCS C1758,,G14027  -  CATHETER URET 7FR 70CM FLXTP CLS END LT,$31.77,$0.00,$31.77,$17.25,$22.67,$0.00,$5.47,$0.00,$0.00,$5.56,$31.77,$0.00,$15.89,$25.16,$25.42,$0.00,$4.97,$0.00,$5.06,$0.00
G14034,SUP,HCPCS C1758,,G14034  -  CATHETER URET 8FR 70CM WHSTLTP RT,$2.78,$0.00,$2.78,$1.51,$1.99,$0.00,$0.48,$0.00,$0.00,$0.49,$2.78,$0.00,$1.39,$2.20,$2.23,$0.00,$0.44,$0.00,$0.44,$0.00
G14035,SUP,HCPCS C1758,,G14035  -  CATHETER URET 9FR 70CM WHSTLTP RT,$27.83,$0.00,$27.83,$15.11,$19.86,$0.00,$4.79,$0.00,$0.00,$4.87,$27.83,$0.00,$13.91,$22.04,$22.26,$0.00,$4.35,$0.00,$4.43,$0.00
G14040,SUP,HCPCS C1758,,G14040  -  CATHETER URET 6FR 70CM WHSTLTP LT,$26.88,$0.00,$26.88,$14.60,$19.19,$0.00,$4.63,$0.00,$0.00,$4.71,$26.88,$0.00,$13.44,$21.29,$21.51,$0.00,$4.21,$0.00,$4.28,$0.00
G14041,SUP,HCPCS C1758,,G14041  -  CATHETER URET WHSTL 7FR 70CM LT,$26.88,$0.00,$26.88,$14.60,$19.19,$0.00,$4.63,$0.00,$0.00,$4.71,$26.88,$0.00,$13.44,$21.29,$21.51,$0.00,$4.21,$0.00,$4.28,$0.00
G14046,SUP,HCPCS C1758,,G14046  -  CATHETER URET 6FR 70CM RND TIP LT,$26.88,$0.00,$26.88,$14.60,$19.19,$0.00,$4.63,$0.00,$0.00,$4.71,$26.88,$0.00,$13.44,$21.29,$21.51,$0.00,$4.21,$0.00,$4.28,$0.00
G14047,SUP,HCPCS C1758,,G14047  -  CATHETER URET 7FR 70CM RND TIP LT,$26.88,$0.00,$26.88,$14.60,$19.19,$0.00,$4.63,$0.00,$0.00,$4.71,$26.88,$0.00,$13.44,$21.29,$21.51,$0.00,$4.21,$0.00,$4.28,$0.00
G14048,SUP,HCPCS C1758,,G14048  -  CATHETER URET 8FR 70CM RND TIP LT,$2.78,$0.00,$2.78,$1.51,$1.99,$0.00,$0.48,$0.00,$0.00,$0.49,$2.78,$0.00,$1.39,$2.20,$2.23,$0.00,$0.44,$0.00,$0.44,$0.00
G14049,SUP,HCPCS C1758,,G14049  -  CATHETER URET 9FR 70CM RND TIP LT,$27.83,$0.00,$27.83,$15.11,$19.86,$0.00,$4.79,$0.00,$0.00,$4.87,$27.83,$0.00,$13.91,$22.04,$22.26,$0.00,$4.35,$0.00,$4.43,$0.00
G14050,SUP,HCPCS C1758,,G14050  -  CATHETER URET 10FR 70CM RND TIP LT,$26.88,$0.00,$26.88,$14.60,$19.19,$0.00,$4.63,$0.00,$0.00,$4.71,$26.88,$0.00,$13.44,$21.29,$21.51,$0.00,$4.21,$0.00,$4.28,$0.00
G14053,SUP,HCPCS C1758,,G14053  -  CATHETER URET RND 5FR 70CM STY NTCH PORT LT,$26.88,$0.00,$26.88,$14.60,$19.19,$0.00,$4.63,$0.00,$0.00,$4.71,$26.88,$0.00,$13.44,$21.29,$21.51,$0.00,$4.21,$0.00,$4.28,$0.00
G14054,SUP,HCPCS C1758,,G14054  -  CATHETER URET RND 6FR 70CM STY NTCH PORT LT,$2.78,$0.00,$2.78,$1.51,$1.99,$0.00,$0.48,$0.00,$0.00,$0.49,$2.78,$0.00,$1.39,$2.20,$2.23,$0.00,$0.44,$0.00,$0.44,$0.00
G14055,SUP,HCPCS C1758,,G14055  -  CATHETER URET 7FR 70CM RND TIP RT,$27.83,$0.00,$27.83,$15.11,$19.86,$0.00,$4.79,$0.00,$0.00,$4.87,$27.83,$0.00,$13.91,$22.04,$22.26,$0.00,$4.35,$0.00,$4.43,$0.00
G14056,SUP,HCPCS C1758,,G14056  -  CATHETER URET PGTL CRV 4.7FR 45CM DRETLER MTLNTH,$276.25,$0.00,$276.25,$150.00,$197.16,$0.00,$47.60,$0.00,$0.00,$48.37,$276.25,$0.00,$138.13,$218.79,$221.00,$0.00,$43.23,$0.00,$43.98,$0.00
G14057,SUP,HCPCS C1758,,G14057  -  CATHETER URET RND 8FR 70CM STY NTCH PORT RT,$27.63,$0.00,$27.63,$15.00,$19.72,$0.00,$4.76,$0.00,$0.00,$4.84,$27.63,$0.00,$13.81,$21.88,$22.10,$0.00,$4.32,$0.00,$4.40,$0.00
G14099,SUP,HCPCS C2627,,G14099  -  CATH SPBC STAMEY 14FR 25CM OBT CONNCTNG TUBE STPCK PERC STRL,$95.63,$0.00,$95.63,$51.92,$68.25,$0.00,$16.48,$0.00,$0.00,$16.74,$95.63,$0.00,$47.81,$75.74,$76.50,$0.00,$14.97,$0.00,$15.22,$0.00
G14120,SUP,HCPCS C1729,,G14120  -  TUBE CONNCTNG STANDARD 14FR 50CM MALE LUER LOCK LOCK LOCK,$40.70,$0.00,$40.70,$22.10,$29.05,$0.00,$7.01,$0.00,$0.00,$7.13,$40.70,$0.00,$20.35,$32.23,$32.56,$0.00,$6.37,$0.00,$6.48,$0.00
G14121,SUP,HCPCS C1729,,G14121  -  TUBE CNCT 14FR 30CM T-B 2 F LL Y 1 DRN BG CNCT ADPR,$40.70,$0.00,$40.70,$22.10,$29.05,$0.00,$7.01,$0.00,$0.00,$7.13,$40.70,$0.00,$20.35,$32.23,$32.56,$0.00,$6.37,$0.00,$6.48,$0.00
G14127,SUP,HCPCS C1773,,G14127  -  STOPCOCK IV 3W 2 F TO 1 M LL PLS PERC,$398.45,$0.00,$398.45,$216.36,$284.37,$0.00,$68.65,$0.00,$0.00,$69.77,$398.45,$0.00,$199.23,$315.57,$318.76,$0.00,$62.36,$0.00,$63.43,$0.00
G14133,SUP,HCPCS C2627,,G14133  -  DISK RTNT 14FR PERC,$31.90,$0.00,$31.90,$17.32,$22.77,$0.00,$5.50,$0.00,$0.00,$5.59,$31.90,$0.00,$15.95,$25.26,$25.52,$0.00,$4.99,$0.00,$5.08,$0.00
G14134,SUP,HCPCS C2627,,G14134  -  DILATOR URTH 6FR 20CM PE FSCA,$31.90,$0.00,$31.90,$17.32,$22.77,$0.00,$5.50,$0.00,$0.00,$5.59,$31.90,$0.00,$15.95,$25.26,$25.52,$0.00,$4.99,$0.00,$5.08,$0.00
G14135,SUP,HCPCS C2627,,G14135  -  DILATOR URTH 7FR 20CM STRL PE FSCA,$31.90,$0.00,$31.90,$17.32,$22.77,$0.00,$5.50,$0.00,$0.00,$5.59,$31.90,$0.00,$15.95,$25.26,$25.52,$0.00,$4.99,$0.00,$5.08,$0.00
G14136,SUP,HCPCS C2627,,G14136  -  DILATOR URTH 7FR 20CM STRL PE FSCA,$31.90,$0.00,$31.90,$17.32,$22.77,$0.00,$5.50,$0.00,$0.00,$5.59,$31.90,$0.00,$15.95,$25.26,$25.52,$0.00,$4.99,$0.00,$5.08,$0.00
G14137,SUP,HCPCS C2627,,G14137  -  DILATOR URTH 9FR 20CM PE FSCA,$31.90,$0.00,$31.90,$17.32,$22.77,$0.00,$5.50,$0.00,$0.00,$5.59,$31.90,$0.00,$15.95,$25.26,$25.52,$0.00,$4.99,$0.00,$5.08,$0.00
G14138,SUP,HCPCS C2627,,G14138  -  DILATOR URTH 10FR 20CM PE FSCA,$31.90,$0.00,$31.90,$17.32,$22.77,$0.00,$5.50,$0.00,$0.00,$5.59,$31.90,$0.00,$15.95,$25.26,$25.52,$0.00,$4.99,$0.00,$5.08,$0.00
G14139,SUP,HCPCS C2627,,G14139  -  DILATOR URTH 12FR 20CM PE FSCA,$31.90,$0.00,$31.90,$17.32,$22.77,$0.00,$5.50,$0.00,$0.00,$5.59,$31.90,$0.00,$15.95,$25.26,$25.52,$0.00,$4.99,$0.00,$5.08,$0.00
G14140,SUP,HCPCS C2627,,G14140  -  DILATOR URTH 14FR 20CM PE FSCA,$31.90,$0.00,$31.90,$17.32,$22.77,$0.00,$5.50,$0.00,$0.00,$5.59,$31.90,$0.00,$15.95,$25.26,$25.52,$0.00,$4.99,$0.00,$5.08,$0.00
G14141,SUP,HCPCS C2627,,G14141  -  DILATOR URTH 16FR 20CM PE FSCA,$31.90,$0.00,$31.90,$17.32,$22.77,$0.00,$5.50,$0.00,$0.00,$5.59,$31.90,$0.00,$15.95,$25.26,$25.52,$0.00,$4.99,$0.00,$5.08,$0.00
G14143,SUP,HCPCS C1758,,G14143  -  DILATOR URTH 18FR 20CM STRL PE FSCA,$123.83,$0.00,$123.83,$67.24,$88.37,$0.00,$21.33,$0.00,$0.00,$21.68,$123.83,$0.00,$61.91,$98.07,$99.06,$0.00,$19.38,$0.00,$19.71,$0.00
G14144,SUP,HCPCS C1758,,G14144  -  SET CATH .025IN PGTL CRV 4FR 70CM STRL 145CM SDPRT GW PU RT,$108.45,$0.00,$108.45,$58.89,$77.40,$0.00,$18.69,$0.00,$0.00,$18.99,$108.45,$0.00,$54.23,$85.89,$86.76,$0.00,$16.97,$0.00,$17.27,$0.00
G14145,SUP,HCPCS C1758,,G14145  -  SET CATH PGTL CRV 5FR .38IN 70CM STRL 145CM SDPRT GW RT,$108.45,$0.00,$108.45,$58.89,$77.40,$0.00,$18.69,$0.00,$0.00,$18.99,$108.45,$0.00,$54.23,$85.89,$86.76,$0.00,$16.97,$0.00,$17.27,$0.00
G14146,SUP,HCPCS C1758,,G14146  -  SET CATH .038IN PGTL CRV 5FR 70CM 145CM SDPRT GW LFRIC SRFC,$108.45,$0.00,$108.45,$58.89,$77.40,$0.00,$18.69,$0.00,$0.00,$18.99,$108.45,$0.00,$54.23,$85.89,$86.76,$0.00,$16.97,$0.00,$17.27,$0.00
G14147,SUP,HCPCS C1758,,G14147  -  SET CATH PGTL CRV 7FR .045IN 70CM STRL 145CM SDPRT GW RT,$123.83,$0.00,$123.83,$67.24,$88.37,$0.00,$21.33,$0.00,$0.00,$21.68,$123.83,$0.00,$61.91,$98.07,$99.06,$0.00,$19.38,$0.00,$19.71,$0.00
G14148,SUP,HCPCS C1758,,G14148  -  SET CATH .025IN PGTL CRV 4FR 70CM 145CM SDPRT GW LFRIC SRFC,$108.45,$0.00,$108.45,$58.89,$77.40,$0.00,$18.69,$0.00,$0.00,$18.99,$108.45,$0.00,$54.23,$85.89,$86.76,$0.00,$16.97,$0.00,$17.27,$0.00
G14149,SUP,HCPCS C1758,,G14149  -  SET CATH .038IN PGTL CRV 5FR 70CM 145CM SDPRT GW LFRIC SRFC,$108.45,$0.00,$108.45,$58.89,$77.40,$0.00,$18.69,$0.00,$0.00,$18.99,$108.45,$0.00,$54.23,$85.89,$86.76,$0.00,$16.97,$0.00,$17.27,$0.00
G14150,SUP,HCPCS C1758,,G14150  -  SET CATH .038IN PGTL CRV 6FR 70CM 145CM SDPRT GW LFRIC SRFC,$108.45,$0.00,$108.45,$58.89,$77.40,$0.00,$18.69,$0.00,$0.00,$18.99,$108.45,$0.00,$54.23,$85.89,$86.76,$0.00,$16.97,$0.00,$17.27,$0.00
G14151,SUP,HCPCS C1758,,G14151  -  SET CATH .045IN PGTL CRV 7FR 70CM 145CM SDPRT GW LFRIC SRFC,$123.83,$0.00,$123.83,$67.24,$88.37,$0.00,$21.33,$0.00,$0.00,$21.68,$123.83,$0.00,$61.91,$98.07,$99.06,$0.00,$19.38,$0.00,$19.71,$0.00
G14152,SUP,HCPCS C1758,,G14152  -  SET CATH .025IN PGTL CRV 4FR 70CM STRL 145CM SDPRT GW ALONG,$108.45,$0.00,$108.45,$58.89,$77.40,$0.00,$18.69,$0.00,$0.00,$18.99,$108.45,$0.00,$54.23,$85.89,$86.76,$0.00,$16.97,$0.00,$17.27,$0.00
G14153,SUP,HCPCS C1758,,G14153  -  SET CATH .038IN PGTL CRV 6FR 70CM STRL 145CM SDPRT GW ALONG,$123.83,$0.00,$123.83,$67.24,$88.37,$0.00,$21.33,$0.00,$0.00,$21.68,$123.83,$0.00,$61.91,$98.07,$99.06,$0.00,$19.38,$0.00,$19.71,$0.00
G14155,SUP,HCPCS C1758,,G14155  -  SET CATH .045IN PGTL CRV 7FR 70CM 145CM SDPRT GW ALONG SHFT,$123.83,$0.00,$123.83,$67.24,$88.37,$0.00,$21.33,$0.00,$0.00,$21.68,$123.83,$0.00,$61.91,$98.07,$99.06,$0.00,$19.38,$0.00,$19.71,$0.00
G14156,SUP,HCPCS C1758,,G14156  -  SET CATH .038IN PGTL CRV 5FR 70CM STRL 145CM SDPRT GW ALONG,$108.45,$0.00,$108.45,$58.89,$77.40,$0.00,$18.69,$0.00,$0.00,$18.99,$108.45,$0.00,$54.23,$85.89,$86.76,$0.00,$16.97,$0.00,$17.27,$0.00
G14157,SUP,HCPCS C1758,,G14157  -  SET CATH .038IN PGTL CRV 6FR 70CM 145CM SDPRT GW ALONG SHFT,$123.83,$0.00,$123.83,$67.24,$88.37,$0.00,$21.33,$0.00,$0.00,$21.68,$123.83,$0.00,$61.91,$98.07,$99.06,$0.00,$19.38,$0.00,$19.71,$0.00
G14158,SUP,HCPCS C1758,,G14158  -  SET CATH .045IN PGTL CRV 7FR 70CM 145CM SDPRT GW ALONG SHFT,$108.45,$0.00,$108.45,$58.89,$77.40,$0.00,$18.69,$0.00,$0.00,$18.99,$108.45,$0.00,$54.23,$85.89,$86.76,$0.00,$16.97,$0.00,$17.27,$0.00
G14173,SUP,HCPCS C2627,,G14173  -  SET CATH .038IN PGTL CRV 5FR 70CM 145CM SDPRT GW ALONG SHFT,$31.90,$0.00,$31.90,$17.32,$22.77,$0.00,$5.50,$0.00,$0.00,$5.59,$31.90,$0.00,$15.95,$25.26,$25.52,$0.00,$4.99,$0.00,$5.08,$0.00
G14174,SUP,HCPCS C2627,,G14174  -  DILATOR URTH 24FR 20CM PE FSCA,$31.90,$0.00,$31.90,$17.32,$22.77,$0.00,$5.50,$0.00,$0.00,$5.59,$31.90,$0.00,$15.95,$25.26,$25.52,$0.00,$4.99,$0.00,$5.08,$0.00
G14175,SUP,HCPCS C2627,,G14175  -  DILATOR URTH 20FR 20CM STRL PE FSCA DISP,$31.90,$0.00,$31.90,$17.32,$22.77,$0.00,$5.50,$0.00,$0.00,$5.59,$31.90,$0.00,$15.95,$25.26,$25.52,$0.00,$4.99,$0.00,$5.08,$0.00
G14177,SUP,HCPCS C2627,,G14177  -  DILATOR URTH 22FR 20CM STRL PE FSCA DISP,$31.90,$0.00,$31.90,$17.32,$22.77,$0.00,$5.50,$0.00,$0.00,$5.59,$31.90,$0.00,$15.95,$25.26,$25.52,$0.00,$4.99,$0.00,$5.08,$0.00
G14178,SUP,Custom 27203010,,G14178  -  DILATOR URTH 5FR 20CM STRL PE FSCA DISP,$200.00,$0.00,$200.00,$0.00,$142.74,$0.00,$0.00,$0.00,$0.00,$0.00,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$0.00,$0.00,$0.00,$0.00
G14185,SUP,HCPCS C1769,,G14185  -  SHEATH ACC 12FR 13CM LF FLXR PRLL RPD RELS WKG CHNL LFRIC,$510.95,$0.00,$510.95,$277.45,$364.67,$0.00,$88.03,$0.00,$0.00,$89.46,$510.95,$0.00,$255.48,$404.67,$408.76,$0.00,$79.96,$0.00,$81.34,$0.00
G14186,SUP,HCPCS C2627,,G14186  -  STYLET NPHSTM 14FR FLXB,$63.25,$0.00,$63.25,$34.34,$45.14,$0.00,$10.90,$0.00,$0.00,$11.07,$63.25,$0.00,$31.63,$50.09,$50.60,$0.00,$9.90,$0.00,$10.07,$0.00
G14187,SUP,HCPCS C2627,,G14187  -  DILATOR URTH 8FR 37CM STRL PE FSCA DISP,$63.25,$0.00,$63.25,$34.34,$45.14,$0.00,$10.90,$0.00,$0.00,$11.07,$63.25,$0.00,$31.63,$50.09,$50.60,$0.00,$9.90,$0.00,$10.07,$0.00
G14188,SUP,HCPCS C2627,,G14188  -  DILATOR URTH 10FR 37CM STRL PE FSCA DISP,$63.25,$0.00,$63.25,$34.34,$45.14,$0.00,$10.90,$0.00,$0.00,$11.07,$63.25,$0.00,$31.63,$50.09,$50.60,$0.00,$9.90,$0.00,$10.07,$0.00
G14189,SUP,HCPCS C2627,,G14189  -  DILATOR URTH 12FR 37CM STRL PE FSCA DISP,$63.25,$0.00,$63.25,$34.34,$45.14,$0.00,$10.90,$0.00,$0.00,$11.07,$63.25,$0.00,$31.63,$50.09,$50.60,$0.00,$9.90,$0.00,$10.07,$0.00
G14190,SUP,HCPCS C2627,,G14190  -  DILATOR URTH 14FR 37CM STRL PE FSCA DISP,$63.25,$0.00,$63.25,$34.34,$45.14,$0.00,$10.90,$0.00,$0.00,$11.07,$63.25,$0.00,$31.63,$50.09,$50.60,$0.00,$9.90,$0.00,$10.07,$0.00
G14191,SUP,HCPCS C2627,,G14191  -  DILATOR URTH 16FR 37CM PE FSCA,$63.25,$0.00,$63.25,$34.34,$45.14,$0.00,$10.90,$0.00,$0.00,$11.07,$63.25,$0.00,$31.63,$50.09,$50.60,$0.00,$9.90,$0.00,$10.07,$0.00
G14192,SUP,HCPCS C2627,,G14192  -  DILATOR URTH 20FR 37CM PE FSCA,$63.25,$0.00,$63.25,$34.34,$45.14,$0.00,$10.90,$0.00,$0.00,$11.07,$63.25,$0.00,$31.63,$50.09,$50.60,$0.00,$9.90,$0.00,$10.07,$0.00
G14193,SUP,HCPCS C2627,,G14193  -  DILATOR URTH 22FR 37CM STRL DISP,$72.73,$0.00,$72.73,$39.49,$51.90,$0.00,$12.53,$0.00,$0.00,$12.73,$72.73,$0.00,$36.36,$57.60,$58.18,$0.00,$11.38,$0.00,$11.58,$0.00
G14194,SUP,HCPCS C2627,,G14194  -  DILATOR URTH 24FR 37CM STRL DISP,$75.28,$0.00,$75.28,$40.87,$53.72,$0.00,$12.97,$0.00,$0.00,$13.18,$75.28,$0.00,$37.64,$59.62,$60.22,$0.00,$11.78,$0.00,$11.98,$0.00
G14195,SUP,HCPCS C2627,,G14195  -  DILATOR URTH 8FR 37CM SDPRT PE FSCA,$65.45,$0.00,$65.45,$35.54,$46.71,$0.00,$11.28,$0.00,$0.00,$11.46,$65.45,$0.00,$32.73,$51.84,$52.36,$0.00,$10.24,$0.00,$10.42,$0.00
G14196,SUP,HCPCS C2627,,G14196  -  DILATOR URTH 10FR 37CM STRL SDPRT DISP,$65.45,$0.00,$65.45,$35.54,$46.71,$0.00,$11.28,$0.00,$0.00,$11.46,$65.45,$0.00,$32.73,$51.84,$52.36,$0.00,$10.24,$0.00,$10.42,$0.00
G14197,SUP,HCPCS C2627,,G14197  -  DILATOR URTH 12FR 37CM SDPRT PE FSCA,$65.45,$0.00,$65.45,$35.54,$46.71,$0.00,$11.28,$0.00,$0.00,$11.46,$65.45,$0.00,$32.73,$51.84,$52.36,$0.00,$10.24,$0.00,$10.42,$0.00
G14198,SUP,HCPCS C2627,,G14198  -  DILATOR URTH 14FR 37CM STRL SDPRT DISP,$65.45,$0.00,$65.45,$35.54,$46.71,$0.00,$11.28,$0.00,$0.00,$11.46,$65.45,$0.00,$32.73,$51.84,$52.36,$0.00,$10.24,$0.00,$10.42,$0.00
G14199,SUP,HCPCS C2627,,G14199  -  DILATOR URTH 16FR 37CM SDPRT PE FSCA,$65.45,$0.00,$65.45,$35.54,$46.71,$0.00,$11.28,$0.00,$0.00,$11.46,$65.45,$0.00,$32.73,$51.84,$52.36,$0.00,$10.24,$0.00,$10.42,$0.00
G14200,SUP,HCPCS C2627,,G14200  -  DILATOR URTH 18FR 37CM STRL SDPRT DISP,$65.45,$0.00,$65.45,$35.54,$46.71,$0.00,$11.28,$0.00,$0.00,$11.46,$65.45,$0.00,$32.73,$51.84,$52.36,$0.00,$10.24,$0.00,$10.42,$0.00
G14201,SUP,HCPCS C2627,,G14201  -  DILATOR URTH 20FR 37CM STRL SDPRT DISP,$65.45,$0.00,$65.45,$35.54,$46.71,$0.00,$11.28,$0.00,$0.00,$11.46,$65.45,$0.00,$32.73,$51.84,$52.36,$0.00,$10.24,$0.00,$10.42,$0.00
G14202,SUP,HCPCS C2627,,G14202  -  DILATOR URTH 22FR 37CM STRL SDPRT DISP,$65.45,$0.00,$65.45,$35.54,$46.71,$0.00,$11.28,$0.00,$0.00,$11.46,$65.45,$0.00,$32.73,$51.84,$52.36,$0.00,$10.24,$0.00,$10.42,$0.00
G14211,SUP,HCPCS C1773,,G14211  -  DILATOR URTH 24FR 37CM STRL SDPRT DISP,$398.45,$0.00,$398.45,$216.36,$284.37,$0.00,$68.65,$0.00,$0.00,$69.77,$398.45,$0.00,$199.23,$315.57,$318.76,$0.00,$62.36,$0.00,$63.43,$0.00
G14214,SUP,HCPCS C2627,,G14214  -  FORCEPS GRSP 5FR 20MM 60CM 3 PR,$510.95,$0.00,$510.95,$277.45,$364.67,$0.00,$88.03,$0.00,$0.00,$89.46,$510.95,$0.00,$255.48,$404.67,$408.76,$0.00,$79.96,$0.00,$81.34,$0.00
G14220,SUP,Custom 27203010,,G14220  -  NEEDLE ENDSCP 35CM 23GA 8MM URTH CSCP INJEC PRC WMS,$47.30,$0.00,$47.30,$0.00,$33.76,$0.00,$0.00,$0.00,$0.00,$0.00,$47.30,$0.00,$23.65,$37.46,$37.84,$0.00,$0.00,$0.00,$0.00,$0.00
G14231,SUP,HCPCS C1769,,G14231  -  TUBE DRN STD 14FR 30CM STRL LF 1 WY STPCK CNCT DISP,$33.80,$0.00,$33.80,$18.35,$24.12,$0.00,$5.82,$0.00,$0.00,$5.92,$33.80,$0.00,$16.90,$26.77,$27.04,$0.00,$5.29,$0.00,$5.38,$0.00
G14254,SUP,Custom 27203010,,G14254  -  PUNCH SRG 14FR 3MM NS FL CATH TIP REUSE CUT .118IN RND HL,$33.00,$0.00,$33.00,$0.00,$23.55,$0.00,$0.00,$0.00,$0.00,$0.00,$33.00,$0.00,$16.50,$26.14,$26.40,$0.00,$0.00,$0.00,$0.00,$0.00
G14255,SUP,Custom 27203010,,G14255  -  NEEDLE PRC 22GA 20CM SKNY CHBA TIP PERC NPHSTM,$35.75,$0.00,$35.75,$0.00,$25.51,$0.00,$0.00,$0.00,$0.00,$0.00,$35.75,$0.00,$17.88,$28.31,$28.60,$0.00,$0.00,$0.00,$0.00,$0.00
G14256,SUP,Custom 27203010,,G14256  -  NEEDLE PRC STD 18GA 20CM ECHTP 2 PRT TROC DISP NPHSTM,$35.75,$0.00,$35.75,$0.00,$25.51,$0.00,$0.00,$0.00,$0.00,$0.00,$35.75,$0.00,$17.88,$28.31,$28.60,$0.00,$0.00,$0.00,$0.00,$0.00
G14257,SUP,Custom 27203010,,G14257  -  NEEDLE PRC 18GA 11CM MTPLK PERC,$74.65,$0.00,$74.65,$0.00,$53.28,$0.00,$0.00,$0.00,$0.00,$0.00,$74.65,$0.00,$37.33,$59.12,$59.72,$0.00,$0.00,$0.00,$0.00,$0.00
G14259,SUP,Custom 27203010,,G14259  -  NEEDLE PRC STD 18GA 25CM 2 PRT TROC DISP,$95.70,$0.00,$95.70,$0.00,$68.30,$0.00,$0.00,$0.00,$0.00,$0.00,$95.70,$0.00,$47.85,$75.79,$76.56,$0.00,$0.00,$0.00,$0.00,$0.00
G14260,SUP,HCPCS C1769,,G14260  -  NEEDLE BX STD 18GA 25CM TFE SHTH TROC STY RNL,$91.25,$0.00,$91.25,$49.55,$65.13,$0.00,$15.72,$0.00,$0.00,$15.98,$91.25,$0.00,$45.63,$72.27,$73.00,$0.00,$14.28,$0.00,$14.53,$0.00
G14261,SUP,HCPCS C1726,,G14261  -  GUIDEWIRE URO STD .038IN 80CM STRL LF 3MM SFTJ FX COR STRG,$330.00,$0.00,$330.00,$179.19,$235.52,$0.00,$56.86,$0.00,$0.00,$57.78,$330.00,$0.00,$165.00,$261.36,$264.00,$0.00,$51.65,$0.00,$52.54,$0.00
G14263,SUP,Custom 27203010,,G14263  -  DILATOR URTH 18FR 37CM STRL DISP,$525.20,$0.00,$525.20,$0.00,$374.84,$0.00,$0.00,$0.00,$0.00,$0.00,$525.20,$0.00,$262.60,$415.96,$420.16,$0.00,$0.00,$0.00,$0.00,$0.00
G14270,SUP,HCPCS C1894,,G14270  -  SET NDL 18-22GA 14-22CM MTPLK COAX PERC,$128.70,$0.00,$128.70,$69.88,$91.85,$0.00,$22.17,$0.00,$0.00,$22.53,$128.70,$0.00,$64.35,$101.93,$102.96,$0.00,$20.14,$0.00,$20.49,$0.00
G14275,SUP,HCPCS C2627,,G14275  -  TUBE CNCT STD 14FR 135CM M LL DRN BG,$578.13,$0.00,$578.13,$313.92,$412.61,$0.00,$99.61,$0.00,$0.00,$101.23,$578.13,$0.00,$289.06,$457.88,$462.50,$0.00,$90.48,$0.00,$92.04,$0.00
G14276,SUP,Custom 27203010,,G14276  -  SET DIL 26-36FR 37CM STRL PE FSCA DISP,$103.73,$0.00,$103.73,$0.00,$74.03,$0.00,$0.00,$0.00,$0.00,$0.00,$103.73,$0.00,$51.86,$82.15,$82.98,$0.00,$0.00,$0.00,$0.00,$0.00
G14277,SUP,Custom 27203010,,G14277  -  DILATOR URTH 26FR 37CM PE FSCA,$90.20,$0.00,$90.20,$0.00,$64.38,$0.00,$0.00,$0.00,$0.00,$0.00,$90.20,$0.00,$45.10,$71.44,$72.16,$0.00,$0.00,$0.00,$0.00,$0.00
G14278,SUP,Custom 27203010,,G14278  -  DILATOR URTH 28FR 37CM STRL PE FSCA DISP,$103.73,$0.00,$103.73,$0.00,$74.03,$0.00,$0.00,$0.00,$0.00,$0.00,$103.73,$0.00,$51.86,$82.15,$82.98,$0.00,$0.00,$0.00,$0.00,$0.00
G14279,SUP,Custom 27203010,,G14279  -  DILATOR URTH 30FR 37CM STRL DISP,$103.73,$0.00,$103.73,$0.00,$74.03,$0.00,$0.00,$0.00,$0.00,$0.00,$103.73,$0.00,$51.86,$82.15,$82.98,$0.00,$0.00,$0.00,$0.00,$0.00
G14280,SUP,Custom 27203010,,G14280  -  DILATOR URTH 32FR 37CM PE FSCA,$103.73,$0.00,$103.73,$0.00,$74.03,$0.00,$0.00,$0.00,$0.00,$0.00,$103.73,$0.00,$51.86,$82.15,$82.98,$0.00,$0.00,$0.00,$0.00,$0.00
G14281,SUP,Custom 27203010,,G14281  -  DILATOR URTH 34FR 37CM PE FSCA,$103.73,$0.00,$103.73,$0.00,$74.03,$0.00,$0.00,$0.00,$0.00,$0.00,$103.73,$0.00,$51.86,$82.15,$82.98,$0.00,$0.00,$0.00,$0.00,$0.00
G14282,SUP,HCPCS C1729,,G14282  -  DILATOR URTH 36FR 37CM PE FSCA,$404.80,$0.00,$404.80,$219.81,$288.91,$0.00,$69.75,$0.00,$0.00,$70.88,$404.80,$0.00,$202.40,$320.60,$323.84,$0.00,$63.35,$0.00,$64.44,$0.00
G14283,SUP,HCPCS C1729,,G14283  -  SET NPHSTM STD 10FR 19.5CM LTX COPE LOOP NDL GW CATH CNN DIL,$188.10,$0.00,$188.10,$102.14,$134.25,$0.00,$32.41,$0.00,$0.00,$32.93,$188.10,$0.00,$94.05,$148.98,$150.48,$0.00,$29.44,$0.00,$29.95,$0.00
G14284,SUP,HCPCS C1894,,G14284  -  SET NPHSTM 10FR 18GA 19.5CM STRL LTX 35CM CK RADOPQ CATH CNN,$216.70,$0.00,$216.70,$117.67,$154.66,$0.00,$37.34,$0.00,$0.00,$37.94,$216.70,$0.00,$108.35,$171.63,$173.36,$0.00,$33.91,$0.00,$34.50,$0.00
G14285,SUP,HCPCS C1769,,G14285  -  SET NPHSTM 6-16FR 20CM COPE LOOP NDL GW CATH CNN DIL PERC,$33.80,$0.00,$33.80,$18.35,$24.12,$0.00,$5.82,$0.00,$0.00,$5.92,$33.80,$0.00,$16.90,$26.77,$27.04,$0.00,$5.29,$0.00,$5.38,$0.00
G14287,SUP,Custom 27203010,,G14287  -  GUIDEWIRE VASC 39CM STD STRG .038IN 80CM STRL 1CM FXCR FLX,$50.60,$0.00,$50.60,$0.00,$36.11,$0.00,$0.00,$0.00,$0.00,$0.00,$50.60,$0.00,$25.30,$40.08,$40.48,$0.00,$0.00,$0.00,$0.00,$0.00
G14297,SUP,HCPCS C1769,,G14297  -  ADAPTER INST 3-6FR 1 WY STPCK SDARM Y FIT M LL,$330.00,$0.00,$330.00,$179.19,$235.52,$0.00,$56.86,$0.00,$0.00,$57.78,$330.00,$0.00,$165.00,$261.36,$264.00,$0.00,$51.65,$0.00,$52.54,$0.00
G14298,SUP,HCPCS C2627,,G14298  -  SET DIL 6-18FR 60CM PE URETER,$41.80,$0.00,$41.80,$22.70,$29.83,$0.00,$7.20,$0.00,$0.00,$7.32,$41.80,$0.00,$20.90,$33.11,$33.44,$0.00,$6.54,$0.00,$6.65,$0.00
G14299,SUP,HCPCS C2627,,G14299  -  DILATOR URET 8FR 60CM STRL PE DISP,$41.80,$0.00,$41.80,$22.70,$29.83,$0.00,$7.20,$0.00,$0.00,$7.32,$41.80,$0.00,$20.90,$33.11,$33.44,$0.00,$6.54,$0.00,$6.65,$0.00
G14300,SUP,HCPCS C2627,,G14300  -  DILATOR URET 9FR 60CM STRL PE DISP,$41.80,$0.00,$41.80,$22.70,$29.83,$0.00,$7.20,$0.00,$0.00,$7.32,$41.80,$0.00,$20.90,$33.11,$33.44,$0.00,$6.54,$0.00,$6.65,$0.00
G14301,SUP,HCPCS C2627,,G14301  -  DILATOR URET 10FR 60CM STRL PE,$41.80,$0.00,$41.80,$22.70,$29.83,$0.00,$7.20,$0.00,$0.00,$7.32,$41.80,$0.00,$20.90,$33.11,$33.44,$0.00,$6.54,$0.00,$6.65,$0.00
G14302,SUP,HCPCS C2627,,G14302  -  DILATOR URET 12FR 60CM STRL PE,$41.80,$0.00,$41.80,$22.70,$29.83,$0.00,$7.20,$0.00,$0.00,$7.32,$41.80,$0.00,$20.90,$33.11,$33.44,$0.00,$6.54,$0.00,$6.65,$0.00
G14303,SUP,HCPCS C2627,,G14303  -  DILATOR URET 14FR 60CM STRL PE,$41.80,$0.00,$41.80,$22.70,$29.83,$0.00,$7.20,$0.00,$0.00,$7.32,$41.80,$0.00,$20.90,$33.11,$33.44,$0.00,$6.54,$0.00,$6.65,$0.00
G14304,SUP,HCPCS C2627,,G14304  -  DILATOR URET 16FR 60CM STRL PE,$41.80,$0.00,$41.80,$22.70,$29.83,$0.00,$7.20,$0.00,$0.00,$7.32,$41.80,$0.00,$20.90,$33.11,$33.44,$0.00,$6.54,$0.00,$6.65,$0.00
G14305,SUP,HCPCS C1726,,G14305  -  DILATOR URET 16FR 60CM PE FSCA,$51.15,$0.00,$51.15,$27.77,$36.51,$0.00,$8.81,$0.00,$0.00,$8.96,$51.15,$0.00,$25.58,$40.51,$40.92,$0.00,$8.00,$0.00,$8.14,$0.00
G14306,SUP,HCPCS C1894,,G14306  -  CATHETER BLNDIL 8FR 84CM STRL AMPTZ GD RNL,$86.90,$0.00,$86.90,$47.19,$62.02,$0.00,$14.97,$0.00,$0.00,$15.22,$86.90,$0.00,$43.45,$68.82,$69.52,$0.00,$13.60,$0.00,$13.83,$0.00
G14307,SUP,HCPCS C1769,,G14307  -  SET INTRO .038IN 50CM 12FR 5FR 100CM STRL 22CM GW RADOPQ,$38.88,$0.00,$38.88,$21.11,$27.75,$0.00,$6.70,$0.00,$0.00,$6.81,$38.88,$0.00,$19.44,$30.79,$31.10,$0.00,$6.08,$0.00,$6.19,$0.00
G14309,SUP,HCPCS C1769,,G14309  -  GUIDEWIRE ESCP STD CDE .038IN 145CM FXCR,$33.80,$0.00,$33.80,$18.35,$24.12,$0.00,$5.82,$0.00,$0.00,$5.92,$33.80,$0.00,$16.90,$26.77,$27.04,$0.00,$5.29,$0.00,$5.38,$0.00
G14311,SUP,HCPCS C1892,,G14311  -  GUIDEWIRE VASC STD STRG .038IN 145CM STRL 3CM FLX TP FXCR SS,$143.00,$0.00,$143.00,$77.65,$102.06,$0.00,$24.64,$0.00,$0.00,$25.04,$143.00,$0.00,$71.50,$113.26,$114.40,$0.00,$22.38,$0.00,$22.77,$0.00
G14320,SUP,HCPCS C1758,,G14320  -  SET INTRO STD 9FR 65CM 60CM PLWY SHTH GW URET,$352.00,$0.00,$352.00,$191.14,$251.22,$0.00,$60.65,$0.00,$0.00,$61.63,$352.00,$0.00,$176.00,$278.78,$281.60,$0.00,$55.09,$0.00,$56.04,$0.00
G14323,SUP,HCPCS C1769,,G14323  -  DILATOR URET 7FR 6MM 65CM 4CM BLN CATH,$37.40,$0.00,$37.40,$20.31,$26.69,$0.00,$6.44,$0.00,$0.00,$6.55,$37.40,$0.00,$18.70,$29.62,$29.92,$0.00,$5.85,$0.00,$5.95,$0.00
G14326,SUP,HCPCS C1769,,G14326  -  GUIDEWIRE URO .038IN 145CM 3CM FX COR STRG FLX TP HVDTY SS,$38.88,$0.00,$38.88,$21.11,$27.75,$0.00,$6.70,$0.00,$0.00,$6.81,$38.88,$0.00,$19.44,$30.79,$31.10,$0.00,$6.08,$0.00,$6.19,$0.00
G14328,SUP,Custom 27203010,,G14328  -  GUIDEWIRE VASC STD .038IN 100CM FXCR SS,$572.00,$0.00,$572.00,$0.00,$408.24,$0.00,$0.00,$0.00,$0.00,$0.00,$572.00,$0.00,$286.00,$453.02,$457.60,$0.00,$0.00,$0.00,$0.00,$0.00
G14335,SUP,HCPCS C1773,,G14335  -  SET NPHSTM 7FR 82CM STRL LAWSON RTRGD GW PNCT PERC DISP,$398.45,$0.00,$398.45,$216.36,$284.37,$0.00,$68.65,$0.00,$0.00,$69.77,$398.45,$0.00,$199.23,$315.57,$318.76,$0.00,$62.36,$0.00,$63.43,$0.00
G14337,SUP,HCPCS C2628,,G14337  -  FORCEPS GRSP 4.5FR 65CM 15MM 3WR COAX SHTH,$319.00,$0.00,$319.00,$0.00,$227.67,$0.00,$0.00,$0.00,$0.00,$0.00,$319.00,$0.00,$159.50,$252.65,$255.20,$0.00,$0.00,$0.00,$0.00,$0.00
G14343,SUP,HCPCS C1729,,G14343  -  CATHETER BLNOCC 6FR 75CM STRL REM ADPR RADOPQ SIL UPJ DISP,$363.00,$0.00,$363.00,$197.11,$259.07,$0.00,$62.54,$0.00,$0.00,$63.56,$363.00,$0.00,$181.50,$287.50,$290.40,$0.00,$56.81,$0.00,$57.79,$0.00
G14344,SUP,HCPCS C1758,,G14344  -  CATHETER NPHSTM 17FR 12MM 25CM 15CM KAYE TMPND BLN RADOPQ,$330.00,$0.00,$330.00,$179.19,$235.52,$0.00,$56.86,$0.00,$0.00,$57.78,$330.00,$0.00,$165.00,$261.36,$264.00,$0.00,$51.65,$0.00,$52.54,$0.00
G14363,SUP,HCPCS C2617,,G14363  -  DILATOR SRG 7FR 6MM 65CM STRL 10CM BLN CATH RADOPQ PINVISE,$300.60,$0.00,$300.60,$135.27,$214.54,$0.00,$51.79,$0.00,$0.00,$52.63,$300.60,$0.00,$150.30,$238.08,$240.48,$0.00,$47.04,$0.00,$47.86,$0.00
G14364,SUP,HCPCS C2617,,G14364  -  SET STNT .035IN 50CM SM 2 PGTL CRV STRG 5FR 8CM GRN STRL 70,$300.60,$0.00,$300.60,$135.27,$214.54,$0.00,$51.79,$0.00,$0.00,$52.63,$300.60,$0.00,$150.30,$238.08,$240.48,$0.00,$47.04,$0.00,$47.86,$0.00
G14365,SUP,HCPCS C2617,,G14365  -  SET STNT .035IN 50CM SM 2 PGTL CRV STRG 5FR 10CM GRN STRL 70,$300.60,$0.00,$300.60,$135.27,$214.54,$0.00,$51.79,$0.00,$0.00,$52.63,$300.60,$0.00,$150.30,$238.08,$240.48,$0.00,$47.04,$0.00,$47.86,$0.00
G14366,SUP,HCPCS C2617,,G14366  -  SET STNT .035IN 50CM SM 2 PGTL CRV STRG 5FR 12CM GRN STRL 70,$300.60,$0.00,$300.60,$135.27,$214.54,$0.00,$51.79,$0.00,$0.00,$52.63,$300.60,$0.00,$150.30,$238.08,$240.48,$0.00,$47.04,$0.00,$47.86,$0.00
G14367,SUP,HCPCS C2617,,G14367  -  SET STNT .035IN 50CM SM 2 PGTL CRV STRG 5FR 14CM GRN STRL 70,$300.60,$0.00,$300.60,$135.27,$214.54,$0.00,$51.79,$0.00,$0.00,$52.63,$300.60,$0.00,$150.30,$238.08,$240.48,$0.00,$47.04,$0.00,$47.86,$0.00
G14405,SUP,HCPCS C1892,,G14405  -  SET STNT .035IN 50CM SM 2 PGTL CRV 5FR 16CM GRN STRL 70CM,$143.00,$0.00,$143.00,$77.65,$102.06,$0.00,$24.64,$0.00,$0.00,$25.04,$143.00,$0.00,$71.50,$113.26,$114.40,$0.00,$22.38,$0.00,$22.77,$0.00
G14408,SUP,HCPCS C1758,,G14408  -  SET INTRO 14FR 60CM 65CM PLWY CATH 2 KNOB GW SHTH URET,$60.38,$0.00,$60.38,$32.78,$43.09,$0.00,$10.40,$0.00,$0.00,$10.57,$60.38,$0.00,$30.19,$47.82,$48.30,$0.00,$9.45,$0.00,$9.61,$0.00
G14420,SUP,HCPCS C2627,,G14420  -  TUBE CNCT LG 24FR 30CM LF M LL TO BG DRN,$41.80,$0.00,$41.80,$22.70,$29.83,$0.00,$7.20,$0.00,$0.00,$7.32,$41.80,$0.00,$20.90,$33.11,$33.44,$0.00,$6.54,$0.00,$6.65,$0.00
G14421,SUP,HCPCS C2627,,G14421  -  DILATOR URET 6FR 60CM STRL LFRIC SRFC PE DISP,$165.73,$0.00,$165.73,$89.99,$118.28,$0.00,$28.55,$0.00,$0.00,$29.02,$165.73,$0.00,$82.86,$131.26,$132.58,$0.00,$25.94,$0.00,$26.38,$0.00
G14422,SUP,HCPCS C1758,,G14422  -  SET NPHSTM 5FR 75CM 15CM KAYE TMPND BLN CATH STY STNT PERC,$352.00,$0.00,$352.00,$191.14,$251.22,$0.00,$60.65,$0.00,$0.00,$61.63,$352.00,$0.00,$176.00,$278.78,$281.60,$0.00,$55.09,$0.00,$56.04,$0.00
G14423,SUP,HCPCS C1729,,G14423  -  DILATOR URET .038IN 5FR 5MM 65CM STRL 4CM INFL BLN RADOPQ,$466.40,$0.00,$466.40,$253.26,$332.87,$0.00,$80.36,$0.00,$0.00,$81.66,$466.40,$0.00,$233.20,$369.39,$373.12,$0.00,$72.99,$0.00,$74.25,$0.00
G14426,SUP,HCPCS C1892,,G14426  -  SET NPHSTM 17FR 12MM 25CM 10ML STRL LF 15CM KAYE TMPND BLN,$143.00,$0.00,$143.00,$77.65,$102.06,$0.00,$24.64,$0.00,$0.00,$25.04,$143.00,$0.00,$71.50,$113.26,$114.40,$0.00,$22.38,$0.00,$22.77,$0.00
G14427,SUP,HCPCS C1892,,G14427  -  SET INTRO STD 12FR 65CM 60CM PLWY GW 2 KNOB URET,$143.00,$0.00,$143.00,$77.65,$102.06,$0.00,$24.64,$0.00,$0.00,$25.04,$143.00,$0.00,$71.50,$113.26,$114.40,$0.00,$22.38,$0.00,$22.77,$0.00
G14428,SUP,HCPCS C1892,,G14428  -  SET INTRO STD 11FR 65CM 60CM PLWY GW 2 KNOB URET,$143.00,$0.00,$143.00,$77.65,$102.06,$0.00,$24.64,$0.00,$0.00,$25.04,$143.00,$0.00,$71.50,$113.26,$114.40,$0.00,$22.38,$0.00,$22.77,$0.00
G14431,SUP,HCPCS C1729,,G14431  -  CATHETER URET .025IN 4FR 70CM STRL OP-EN PVC DISP,$18.59,$0.00,$18.59,$10.09,$13.27,$0.00,$3.20,$0.00,$0.00,$3.25,$18.59,$0.00,$9.30,$14.72,$14.87,$0.00,$2.91,$0.00,$2.96,$0.00
G14432,SUP,HCPCS C1892,,G14432  -  SET NPHSTM 7-18FR 20-30CM STRL MLCT CATH STNT STY RTNT DISK,$164.45,$0.00,$164.45,$89.30,$117.37,$0.00,$28.33,$0.00,$0.00,$28.79,$164.45,$0.00,$82.23,$130.24,$131.56,$0.00,$25.74,$0.00,$26.18,$0.00
G14433,SUP,HCPCS C1892,,G14433  -  SET INTRO .038IN STD STRG 16FR 65CM 60CM PLWY 2 KNOB GW SHTH,$164.45,$0.00,$164.45,$89.30,$117.37,$0.00,$28.33,$0.00,$0.00,$28.79,$164.45,$0.00,$82.23,$130.24,$131.56,$0.00,$25.74,$0.00,$26.18,$0.00
G14434,SUP,HCPCS C2627,,G14434  -  SET INTRO STD 18FR 65CM 60CM PLWY GW SHTH 2 KNOB URET,$41.80,$0.00,$41.80,$22.70,$29.83,$0.00,$7.20,$0.00,$0.00,$7.32,$41.80,$0.00,$20.90,$33.11,$33.44,$0.00,$6.54,$0.00,$6.65,$0.00
G14437,SUP,HCPCS C1729,,G14437  -  DILATOR URET 11FR 60CM SET PE,$185.90,$0.00,$185.90,$100.94,$132.68,$0.00,$32.03,$0.00,$0.00,$32.55,$185.90,$0.00,$92.95,$147.23,$148.72,$0.00,$29.09,$0.00,$29.60,$0.00
G14440,SUP,HCPCS C1892,,G14440  -  SET NPHSTM 22FR 35CM MLCT CATH STY RTNT DISK CNCT TUBE PU,$118.80,$0.00,$118.80,$64.51,$84.79,$0.00,$20.47,$0.00,$0.00,$20.80,$118.80,$0.00,$59.40,$94.09,$95.04,$0.00,$18.59,$0.00,$18.91,$0.00
G14441,SUP,HCPCS C1892,,G14441  -  SET INTRO STD 9FR 37CM 32CM PLWY 2 KNOB SHTH GW,$118.80,$0.00,$118.80,$64.51,$84.79,$0.00,$20.47,$0.00,$0.00,$20.80,$118.80,$0.00,$59.40,$94.09,$95.04,$0.00,$18.59,$0.00,$18.91,$0.00
G14442,SUP,HCPCS C1892,,G14442  -  SET INTRO STD 10FR 37CM 32CM PLWY GW 2 KNOB SHTH URET,$118.80,$0.00,$118.80,$64.51,$84.79,$0.00,$20.47,$0.00,$0.00,$20.80,$118.80,$0.00,$59.40,$94.09,$95.04,$0.00,$18.59,$0.00,$18.91,$0.00
G14443,SUP,HCPCS C1892,,G14443  -  SET INTRO STD 12FR 37CM 32CM PLWY 2 KNOB SHTH GW URETER,$118.80,$0.00,$118.80,$64.51,$84.79,$0.00,$20.47,$0.00,$0.00,$20.80,$118.80,$0.00,$59.40,$94.09,$95.04,$0.00,$18.59,$0.00,$18.91,$0.00
G14444,SUP,HCPCS C1892,,G14444  -  SET INTRO STD 14FR 37CM 32CM PLWY 2 KNOB SHTH GW,$118.80,$0.00,$118.80,$64.51,$84.79,$0.00,$20.47,$0.00,$0.00,$20.80,$118.80,$0.00,$59.40,$94.09,$95.04,$0.00,$18.59,$0.00,$18.91,$0.00
G14445,SUP,HCPCS C1892,,G14445  -  SET INTRO STD 16FR 37CM 32CM PLWY GW 2 KNOB SHTH URET,$118.80,$0.00,$118.80,$64.51,$84.79,$0.00,$20.47,$0.00,$0.00,$20.80,$118.80,$0.00,$59.40,$94.09,$95.04,$0.00,$18.59,$0.00,$18.91,$0.00
G14454,SUP,HCPCS C1729,,G14454  -  LINE INJ 7FR 30CM CNRST STD FIT,$185.90,$0.00,$185.90,$100.94,$132.68,$0.00,$32.03,$0.00,$0.00,$32.55,$185.90,$0.00,$92.95,$147.23,$148.72,$0.00,$29.09,$0.00,$29.60,$0.00
G14457,SUP,Custom 27203010,,G14457  -  CATHETER URET .038IN 8FR 70CM STRL OP-EN DISP,$11.01,$0.00,$11.01,$0.00,$7.86,$0.00,$0.00,$0.00,$0.00,$0.00,$11.01,$0.00,$5.50,$8.72,$8.81,$0.00,$0.00,$0.00,$0.00,$0.00
G14461,SUP,Custom 27203010,,G14461  -  NEEDLE PRC STD 18GA 15CM ECHTP TROC STY SHTH PTFE RNL,$35.75,$0.00,$35.75,$0.00,$25.51,$0.00,$0.00,$0.00,$0.00,$0.00,$35.75,$0.00,$17.88,$28.31,$28.60,$0.00,$0.00,$0.00,$0.00,$0.00
G14463,SUP,HCPCS C1758,,G14463  -  NEEDLE PRC 18GA 15CM STRL ECHTP 2 PRT TROC DISP NPHSTM,$404.80,$0.00,$404.80,$219.81,$288.91,$0.00,$69.75,$0.00,$0.00,$70.88,$404.80,$0.00,$202.40,$320.60,$323.84,$0.00,$63.35,$0.00,$64.44,$0.00
G14485,SUP,HCPCS C1726,,G14485  -  ADAPTER CATH F LL TO LG FIT,$510.95,$0.00,$510.95,$277.45,$364.67,$0.00,$88.03,$0.00,$0.00,$89.46,$510.95,$0.00,$255.48,$404.67,$408.76,$0.00,$79.96,$0.00,$81.34,$0.00
G14500,SUP,Custom 27203010,,G14500  -  STYLET NPHSTM 8.5FR FLXB MLCT CATH REM,$147.40,$0.00,$147.40,$0.00,$105.20,$0.00,$0.00,$0.00,$0.00,$0.00,$147.40,$0.00,$73.70,$116.74,$117.92,$0.00,$0.00,$0.00,$0.00,$0.00
G14501,SUP,HCPCS C1729,,G14501  -  APPROXIMATOR SRG WILLSCHER SET VASC,$185.90,$0.00,$185.90,$100.94,$132.68,$0.00,$32.03,$0.00,$0.00,$32.55,$185.90,$0.00,$92.95,$147.23,$148.72,$0.00,$29.09,$0.00,$29.60,$0.00
G14504,SUP,HCPCS C1726,,G14504  -  SET NPHSTM 5FR 20CM MLCT CATH LL STY RTNT DISK CNCT TUBE PU,$587.60,$0.00,$587.60,$319.07,$419.37,$0.00,$101.24,$0.00,$0.00,$102.88,$587.60,$0.00,$293.80,$465.38,$470.08,$0.00,$91.96,$0.00,$93.55,$0.00
G14508,SUP,HCPCS C1729,,G14508  -  SET DIL 6-30FR 30CM 19CM AMPTZ MOD RADOPQ SHTH RNL,$363.00,$0.00,$363.00,$197.11,$259.07,$0.00,$62.54,$0.00,$0.00,$63.56,$363.00,$0.00,$181.50,$287.50,$290.40,$0.00,$56.81,$0.00,$57.79,$0.00
G14510,SUP,HCPCS C1729,,G14510  -  SET NPHSTM PGTL CRV 6FR 7CM STRL 3 DIL 2 NDL CATH CNCT TUBE,$185.90,$0.00,$185.90,$100.94,$132.68,$0.00,$32.03,$0.00,$0.00,$32.55,$185.90,$0.00,$92.95,$147.23,$148.72,$0.00,$29.09,$0.00,$29.60,$0.00
G14511,SUP,HCPCS C1758,,G14511  -  SET NPHSTM 7FR 20CM MLCT CATH STNT LL RTNT DISK PU,$27.83,$0.00,$27.83,$15.11,$19.86,$0.00,$4.79,$0.00,$0.00,$4.87,$27.83,$0.00,$13.91,$22.04,$22.26,$0.00,$4.35,$0.00,$4.43,$0.00
G14513,SUP,HCPCS C2625,,G14513  -  CATHETER URET 10FR 70CM OP-EN ACPT .038IN GW,$123.00,$0.00,$123.00,$55.35,$87.79,$0.00,$21.19,$0.00,$0.00,$21.54,$123.00,$0.00,$61.50,$97.42,$98.40,$0.00,$19.25,$0.00,$19.58,$0.00
G14514,SUP,HCPCS C2625,,G14514  -  SET STNT .025IN PGTL CRV STRG 3.7FR 125CM BLU STRL 145CM,$141.45,$0.00,$141.45,$63.65,$100.95,$0.00,$24.37,$0.00,$0.00,$24.77,$141.45,$0.00,$70.73,$112.03,$113.16,$0.00,$22.14,$0.00,$22.52,$0.00
G14515,SUP,HCPCS C2628,,G14515  -  SET STNT .035IN PGTL CRV STRG 4.7FR 125CM BLU STRL 145CM,$319.00,$0.00,$319.00,$0.00,$227.67,$0.00,$0.00,$0.00,$0.00,$0.00,$319.00,$0.00,$159.50,$252.65,$255.20,$0.00,$0.00,$0.00,$0.00,$0.00
G14519,SUP,Custom 27203010,,G14519  -  PROBE LTHTRP 1MM 605MM LMA STONEBREAKER PNEUM KT DISP,$15.62,$0.00,$15.62,$0.00,$11.15,$0.00,$0.00,$0.00,$0.00,$0.00,$15.62,$0.00,$7.81,$12.37,$12.50,$0.00,$0.00,$0.00,$0.00,$0.00
G14521,SUP,HCPCS C1758,,G14521  -  SET DRN 300ML NS PCH 1 CNCT,$276.25,$0.00,$276.25,$150.00,$197.16,$0.00,$47.60,$0.00,$0.00,$48.37,$276.25,$0.00,$138.13,$218.79,$221.00,$0.00,$43.23,$0.00,$43.98,$0.00
G14526,SUP,HCPCS C1729,,G14526  -  STYLET NPHSTM 5FR FLXB 10FR MLCT CATH REM,$185.90,$0.00,$185.90,$100.94,$132.68,$0.00,$32.03,$0.00,$0.00,$32.55,$185.90,$0.00,$92.95,$147.23,$148.72,$0.00,$29.09,$0.00,$29.60,$0.00
G14544,SUP,HCPCS C1769,,G14544  -  DEVICE SPEC RTRVL 5FR 5MM 65CM 4CM RTNR 4WR OCL STON BLN,$33.80,$0.00,$33.80,$18.35,$24.12,$0.00,$5.82,$0.00,$0.00,$5.92,$33.80,$0.00,$16.90,$26.77,$27.04,$0.00,$5.29,$0.00,$5.38,$0.00
G14547,SUP,Custom 27203010,,G14547  -  GUIDEWIRE URO STD STRG .035IN 145CM STRL 3CM FLX TP FX COR,$604.00,$0.00,$604.00,$0.00,$431.07,$0.00,$0.00,$0.00,$0.00,$0.00,$604.00,$0.00,$302.00,$478.37,$483.20,$0.00,$0.00,$0.00,$0.00,$0.00
G14551,SUP,HCPCS C1769,,G14551  -  EXTRACTOR STON 5FR 6MM 65CM 4CM RTNR 4WR HLCL BLNDIL FLFRM,$38.88,$0.00,$38.88,$21.11,$27.75,$0.00,$6.70,$0.00,$0.00,$6.81,$38.88,$0.00,$19.44,$30.79,$31.10,$0.00,$6.08,$0.00,$6.19,$0.00
G14554,SUP,HCPCS C1769,,G14554  -  GUIDEWIRE ESCP STD .028IN 145CM LD EXTR RDRR PC FXCR DFLC,$33.80,$0.00,$33.80,$18.35,$24.12,$0.00,$5.82,$0.00,$0.00,$5.92,$33.80,$0.00,$16.90,$26.77,$27.04,$0.00,$5.29,$0.00,$5.38,$0.00
G14565,SUP,HCPCS C2627,,G14565  -  GUIDEWIRE ESCP STD STRG .038IN 145CM STRL 1CM FXCR FLX TP SS,$103.73,$0.00,$103.73,$56.32,$74.03,$0.00,$17.87,$0.00,$0.00,$18.16,$103.73,$0.00,$51.86,$82.15,$82.98,$0.00,$16.23,$0.00,$16.51,$0.00
G14566,SUP,HCPCS C2627,,G14566  -  DILATOR URTH 6FR 37CM SET PTFE FSCA,$90.20,$0.00,$90.20,$48.98,$64.38,$0.00,$15.54,$0.00,$0.00,$15.79,$90.20,$0.00,$45.10,$71.44,$72.16,$0.00,$14.12,$0.00,$14.36,$0.00
G14567,SUP,HCPCS C2627,,G14567  -  DILATOR URTH 8FR 37CM SET PTFE FSCA,$90.20,$0.00,$90.20,$48.98,$64.38,$0.00,$15.54,$0.00,$0.00,$15.79,$90.20,$0.00,$45.10,$71.44,$72.16,$0.00,$14.12,$0.00,$14.36,$0.00
G14568,SUP,HCPCS C2627,,G14568  -  DILATOR URTH 10FR 37CM SET TFE FSCA,$90.20,$0.00,$90.20,$48.98,$64.38,$0.00,$15.54,$0.00,$0.00,$15.79,$90.20,$0.00,$45.10,$71.44,$72.16,$0.00,$14.12,$0.00,$14.36,$0.00
G14569,SUP,HCPCS C2627,,G14569  -  DILATOR URTH 12FR 37CM PTFE FSCA,$103.73,$0.00,$103.73,$56.32,$74.03,$0.00,$17.87,$0.00,$0.00,$18.16,$103.73,$0.00,$51.86,$82.15,$82.98,$0.00,$16.23,$0.00,$16.51,$0.00
G14570,SUP,HCPCS C2627,,G14570  -  DILATOR URTH 14FR 37CM SET TFE FSCA,$103.73,$0.00,$103.73,$56.32,$74.03,$0.00,$17.87,$0.00,$0.00,$18.16,$103.73,$0.00,$51.86,$82.15,$82.98,$0.00,$16.23,$0.00,$16.51,$0.00
G14571,SUP,HCPCS C2627,,G14571  -  DILATOR URTH 16FR 37CM SET PTFE FSCA,$103.73,$0.00,$103.73,$56.32,$74.03,$0.00,$17.87,$0.00,$0.00,$18.16,$103.73,$0.00,$51.86,$82.15,$82.98,$0.00,$16.23,$0.00,$16.51,$0.00
G14572,SUP,HCPCS C2627,,G14572  -  DILATOR URTH 18FR 37CM SET PTFE FSCA,$721.05,$0.00,$721.05,$391.53,$514.61,$0.00,$124.23,$0.00,$0.00,$126.25,$721.05,$0.00,$360.53,$571.07,$576.84,$0.00,$112.84,$0.00,$114.79,$0.00
G14574,SUP,HCPCS C1769,,G14574  -  DILATOR URET 6-18FR 37CM SET PTFE FSCA,$638.00,$0.00,$638.00,$346.43,$455.34,$0.00,$109.92,$0.00,$0.00,$111.71,$638.00,$0.00,$319.00,$505.30,$510.40,$0.00,$99.85,$0.00,$101.57,$0.00
G14575,SUP,HCPCS C2627,,G14575  -  DILATOR URET 6-18FR 60CM SET GW LFRIC SRFC PTFE FSCA,$99.00,$0.00,$99.00,$53.76,$70.66,$0.00,$17.06,$0.00,$0.00,$17.33,$99.00,$0.00,$49.50,$78.41,$79.20,$0.00,$15.49,$0.00,$15.76,$0.00
G14576,SUP,HCPCS C2627,,G14576  -  DILATOR URET 6FR 60CM SET PTFE DISP,$99.00,$0.00,$99.00,$53.76,$70.66,$0.00,$17.06,$0.00,$0.00,$17.33,$99.00,$0.00,$49.50,$78.41,$79.20,$0.00,$15.49,$0.00,$15.76,$0.00
G14577,SUP,HCPCS C2627,,G14577  -  DILATOR URET 8FR 60CM SET PTFE FSCA,$99.00,$0.00,$99.00,$53.76,$70.66,$0.00,$17.06,$0.00,$0.00,$17.33,$99.00,$0.00,$49.50,$78.41,$79.20,$0.00,$15.49,$0.00,$15.76,$0.00
G14578,SUP,HCPCS C2627,,G14578  -  DILATOR URET 10FR 60CM SET PTFE DISP,$99.00,$0.00,$99.00,$53.76,$70.66,$0.00,$17.06,$0.00,$0.00,$17.33,$99.00,$0.00,$49.50,$78.41,$79.20,$0.00,$15.49,$0.00,$15.76,$0.00
G14579,SUP,HCPCS C2627,,G14579  -  DILATOR URET 12FR 60CM SET PTFE DISP,$113.85,$0.00,$113.85,$61.82,$81.25,$0.00,$19.62,$0.00,$0.00,$19.93,$113.85,$0.00,$56.93,$90.17,$91.08,$0.00,$17.82,$0.00,$18.12,$0.00
G14580,SUP,HCPCS C2627,,G14580  -  DILATOR URET 14FR 60CM SET PTFE FSCA,$113.85,$0.00,$113.85,$61.82,$81.25,$0.00,$19.62,$0.00,$0.00,$19.93,$113.85,$0.00,$56.93,$90.17,$91.08,$0.00,$17.82,$0.00,$18.12,$0.00
G14581,SUP,HCPCS C2627,,G14581  -  DILATOR URET 16FR 60CM SET TFE FSCA,$113.85,$0.00,$113.85,$61.82,$81.25,$0.00,$19.62,$0.00,$0.00,$19.93,$113.85,$0.00,$56.93,$90.17,$91.08,$0.00,$17.82,$0.00,$18.12,$0.00
G14587,SUP,HCPCS C1758,,G14587  -  DILATOR URET 18FR 60CM SET PTFE FSCA,$72.60,$0.00,$72.60,$39.42,$51.81,$0.00,$12.51,$0.00,$0.00,$12.71,$72.60,$0.00,$36.30,$57.50,$58.08,$0.00,$11.36,$0.00,$11.56,$0.00
G14589,SUP,HCPCS C1769,,G14589  -  CATHETER URET 20D .035IN TPR STRG 6FR 70CM 145CM GW,$52.08,$0.00,$52.08,$28.28,$37.17,$0.00,$8.97,$0.00,$0.00,$9.12,$52.08,$0.00,$26.04,$41.25,$41.66,$0.00,$8.15,$0.00,$8.29,$0.00
G14590,SUP,HCPCS C1769,,G14590  -  GUIDEWIRE VASC STRG .038IN 145CM STRL 15CM BNTSN FLX TP FX,$52.08,$0.00,$52.08,$28.28,$37.17,$0.00,$8.97,$0.00,$0.00,$9.12,$52.08,$0.00,$26.04,$41.25,$41.66,$0.00,$8.15,$0.00,$8.29,$0.00
G14592,SUP,HCPCS C1758,,G14592  -  GUIDEWIRE VASC .035IN 145CM STRL 15CM BNTSN BNTSN FLX TP,$27.50,$0.00,$27.50,$14.93,$19.63,$0.00,$4.74,$0.00,$0.00,$4.82,$27.50,$0.00,$13.75,$21.78,$22.00,$0.00,$4.30,$0.00,$4.38,$0.00
G14593,SUP,HCPCS C1758,,G14593  -  CATHETER URET 4FR 70CM RND TIP STY LT,$27.50,$0.00,$27.50,$14.93,$19.63,$0.00,$4.74,$0.00,$0.00,$4.82,$27.50,$0.00,$13.75,$21.78,$22.00,$0.00,$4.30,$0.00,$4.38,$0.00
G14595,SUP,HCPCS C1773,,G14595  -  CATHETER URET 5FR 70CM RND TIP STY LT,$398.45,$0.00,$398.45,$216.36,$284.37,$0.00,$68.65,$0.00,$0.00,$69.77,$398.45,$0.00,$199.23,$315.57,$318.76,$0.00,$62.36,$0.00,$63.43,$0.00
G14596,SUP,HCPCS C1773,,G14596  -  FORCEPS SPEC RTRVL 3.2FR 10MM 65CM STRL 3WR GRSP COAX SHTH,$398.45,$0.00,$398.45,$216.36,$284.37,$0.00,$68.65,$0.00,$0.00,$69.77,$398.45,$0.00,$199.23,$315.57,$318.76,$0.00,$62.36,$0.00,$63.43,$0.00
G14597,SUP,HCPCS C1758,,G14597  -  FORCEPS ESCP 14MM 3.5FR 65CM STRL GRSP,$83.50,$0.00,$83.50,$45.34,$59.59,$0.00,$14.39,$0.00,$0.00,$14.62,$83.50,$0.00,$41.75,$66.13,$66.80,$0.00,$13.07,$0.00,$13.29,$0.00
G14598,SUP,HCPCS C1758,,G14598  -  CATHETER URET 20D .028IN TPR STRG 4FR 70CM 145CM GW,$72.60,$0.00,$72.60,$39.42,$51.81,$0.00,$12.51,$0.00,$0.00,$12.71,$72.60,$0.00,$36.30,$57.50,$58.08,$0.00,$11.36,$0.00,$11.56,$0.00
G14599,SUP,HCPCS C1758,,G14599  -  CATHETER URET 20D .035IN 5FR 70CM FLXB ANG TIP TPR END GW,$83.50,$0.00,$83.50,$45.34,$59.59,$0.00,$14.39,$0.00,$0.00,$14.62,$83.50,$0.00,$41.75,$66.13,$66.80,$0.00,$13.07,$0.00,$13.29,$0.00
G14600,SUP,HCPCS C1758,,G14600  -  CATHETER URET 20D .028IN BVL STRG 4FR 70CM 145CM GW,$72.60,$0.00,$72.60,$39.42,$51.81,$0.00,$12.51,$0.00,$0.00,$12.71,$72.60,$0.00,$36.30,$57.50,$58.08,$0.00,$11.36,$0.00,$11.56,$0.00
G14606,SUP,HCPCS C2617,,G14606  -  CATHETER URET 20D .035IN 5FR 70CM 145CM ANG TIP BVL END GW,$261.38,$0.00,$261.38,$117.62,$186.54,$0.00,$45.03,$0.00,$0.00,$45.76,$261.38,$0.00,$130.69,$207.01,$209.10,$0.00,$40.91,$0.00,$41.61,$0.00
G14608,SUP,HCPCS C1758,,G14608  -  SET STNT .025IN 50CM SM 2 PGTL CRV STRG 3.7FR 26CM GRN STRL,$330.00,$0.00,$330.00,$179.19,$235.52,$0.00,$56.86,$0.00,$0.00,$57.78,$330.00,$0.00,$165.00,$261.36,$264.00,$0.00,$51.65,$0.00,$52.54,$0.00
G14619,SUP,HCPCS C1769,,G14619  -  TROCAR SRG STD 18GA 11CM DISP,$52.08,$0.00,$52.08,$28.28,$37.17,$0.00,$8.97,$0.00,$0.00,$9.12,$52.08,$0.00,$26.04,$41.25,$41.66,$0.00,$8.15,$0.00,$8.29,$0.00
G14631,SUP,HCPCS C1769,,G14631  -  GUIDEWIRE ESCP .038IN 145CM STRL CNS BNTSN MOV COR SS PTFE,$71.38,$0.00,$71.38,$38.76,$50.94,$0.00,$12.30,$0.00,$0.00,$12.50,$71.38,$0.00,$35.69,$56.53,$57.10,$0.00,$11.17,$0.00,$11.36,$0.00
G14639,SUP,HCPCS C2617,,G14639  -  GUIDEWIRE VASC STRG .038IN 145CM AMPTZ FLXB FXCR,$261.38,$0.00,$261.38,$117.62,$186.54,$0.00,$45.03,$0.00,$0.00,$45.76,$261.38,$0.00,$130.69,$207.01,$209.10,$0.00,$40.91,$0.00,$41.61,$0.00
G14650,SUP,HCPCS C2627,,G14650  -  SET NPHSTM .038IN 22GA 18GA 80CM 20CM SFTJ 2 NDL ENTRY GW,$306.13,$0.00,$306.13,$166.23,$218.48,$0.00,$52.74,$0.00,$0.00,$53.60,$306.13,$0.00,$153.06,$242.45,$244.90,$0.00,$47.91,$0.00,$48.74,$0.00
G14658,SUP,HCPCS C1769,,G14658  -  SET NPHSTM 300ML STRL 2 CNCT DRN PCH SFT ELC BELT REED VLV,$465.53,$0.00,$465.53,$252.78,$332.25,$0.00,$80.21,$0.00,$0.00,$81.51,$465.53,$0.00,$232.76,$368.70,$372.42,$0.00,$72.85,$0.00,$74.11,$0.00
G14659,SUP,HCPCS C1758,,G14659  -  SET NPHSTM 8.2FR 19.5CM LTX COPE LOOP CATH NDL GW STPCK,$32.90,$0.00,$32.90,$17.86,$23.48,$0.00,$5.67,$0.00,$0.00,$5.76,$32.90,$0.00,$16.45,$26.06,$26.32,$0.00,$5.15,$0.00,$5.24,$0.00
G14663,SUP,HCPCS C1758,,G14663  -  CATHETER URETERAL 4.8FR 8FR 70CM CONE TIP,$27.63,$0.00,$27.63,$15.00,$19.72,$0.00,$4.76,$0.00,$0.00,$4.84,$27.63,$0.00,$13.81,$21.88,$22.10,$0.00,$4.32,$0.00,$4.40,$0.00
G14665,SUP,HCPCS C1758,,G14665  -  CATHETER URET .038IN 5FR 70CM FLXTP OP-EN GW MOD,$276.25,$0.00,$276.25,$150.00,$197.16,$0.00,$47.60,$0.00,$0.00,$48.37,$276.25,$0.00,$138.13,$218.79,$221.00,$0.00,$43.23,$0.00,$43.98,$0.00
G14667,SUP,HCPCS C1758,,G14667  -  CATHETER URETERAL CONE 7FR 12FR 70CM,$27.63,$0.00,$27.63,$15.00,$19.72,$0.00,$4.76,$0.00,$0.00,$4.84,$27.63,$0.00,$13.81,$21.88,$22.10,$0.00,$4.32,$0.00,$4.40,$0.00
G14669,SUP,HCPCS C1758,,G14669  -  CATHETER URET 6FR 10FR 70CM CONE TIP,$27.63,$0.00,$27.63,$15.00,$19.72,$0.00,$4.76,$0.00,$0.00,$4.84,$27.63,$0.00,$13.81,$21.88,$22.10,$0.00,$4.32,$0.00,$4.40,$0.00
G14671,SUP,HCPCS C1758,,G14671  -  CATHETER URET 8FR 14FR 70CM CONE TIP,$3.29,$0.00,$3.29,$1.79,$2.35,$0.00,$0.57,$0.00,$0.00,$0.58,$3.29,$0.00,$1.65,$2.61,$2.63,$0.00,$0.51,$0.00,$0.52,$0.00
G14674,SUP,HCPCS C1773,,G14674  -  CATHETER URET 5FR 70CM ANG TIP TPR END MOD,$313.45,$0.00,$313.45,$170.20,$223.71,$0.00,$54.01,$0.00,$0.00,$54.88,$313.45,$0.00,$156.73,$248.25,$250.76,$0.00,$49.05,$0.00,$49.90,$0.00
G14676,SUP,Custom 27203010,,G14676  -  FORCEPS GRASPING 10MM 3.2FR 115MM COAXIAL SHEATH HANDLE,$398.45,$0.00,$398.45,$0.00,$284.37,$0.00,$0.00,$0.00,$0.00,$0.00,$398.45,$0.00,$199.23,$315.57,$318.76,$0.00,$0.00,$0.00,$0.00,$0.00
G14677,SUP,HCPCS C1773,,G14677  -  RETRIEVER SRG 3FR 115CM STRL FLTWR LOOP URET,$398.45,$0.00,$398.45,$216.36,$284.37,$0.00,$68.65,$0.00,$0.00,$69.77,$398.45,$0.00,$199.23,$315.57,$318.76,$0.00,$62.36,$0.00,$63.43,$0.00
G14681,SUP,Custom 27203010,,G14681  -  SYRINGE ASP 5ML VAC,$604.00,$0.00,$604.00,$0.00,$431.07,$0.00,$0.00,$0.00,$0.00,$0.00,$604.00,$0.00,$302.00,$478.37,$483.20,$0.00,$0.00,$0.00,$0.00,$0.00
G14685,SUP,HCPCS C1769,,G14685  -  DEVICE SPEC RTRVL 5CM 5MM 5FR 4CM 65CM RTNR 3WR STON HLCL,$52.08,$0.00,$52.08,$28.28,$37.17,$0.00,$8.97,$0.00,$0.00,$9.12,$52.08,$0.00,$26.04,$41.25,$41.66,$0.00,$8.15,$0.00,$8.29,$0.00
G14686,SUP,HCPCS C1758,,G14686  -  GUIDEWIRE VASC .035IN 145CM CNS BNTSN MOV COR DSGN FLXB,$27.50,$0.00,$27.50,$14.93,$19.63,$0.00,$4.74,$0.00,$0.00,$4.82,$27.50,$0.00,$13.75,$21.78,$22.00,$0.00,$4.30,$0.00,$4.38,$0.00
G14687,SUP,HCPCS C1758,,G14687  -  CATHETER URET 4FR 70CM RND TIP STY RT,$27.50,$0.00,$27.50,$14.93,$19.63,$0.00,$4.74,$0.00,$0.00,$4.82,$27.50,$0.00,$13.75,$21.78,$22.00,$0.00,$4.30,$0.00,$4.38,$0.00
G14688,SUP,HCPCS C1894,,G14688  -  CATHETER URET 5FR 70CM RND TIP STY LT,$86.90,$0.00,$86.90,$47.19,$62.02,$0.00,$14.97,$0.00,$0.00,$15.22,$86.90,$0.00,$43.45,$68.82,$69.52,$0.00,$13.60,$0.00,$13.83,$0.00
G14693,SUP,HCPCS C1769,,G14693  -  STRAINER SPEC NS STON DISP,$1.40,$0.00,$1.40,$0.76,$1.00,$0.00,$0.24,$0.00,$0.00,$0.25,$1.40,$0.00,$0.70,$1.11,$1.12,$0.00,$0.22,$0.00,$0.22,$0.00
G14694,SUP,HCPCS C1729,,G14694  -  GUIDEWIRE VASC .035IN 145CM 8CM AMPTZ FLX TP XSTIF SS,$188.10,$0.00,$188.10,$102.14,$134.25,$0.00,$32.41,$0.00,$0.00,$32.93,$188.10,$0.00,$94.05,$148.98,$150.48,$0.00,$29.44,$0.00,$29.95,$0.00
G14700,SUP,HCPCS C2617,,G14700  -  CATHETER NPHSTM 8.2FR 19.5CM STRL LTX COPE LOOP CNN PERC,$261.38,$0.00,$261.38,$117.62,$186.54,$0.00,$45.03,$0.00,$0.00,$45.76,$261.38,$0.00,$130.69,$207.01,$209.10,$0.00,$40.91,$0.00,$41.61,$0.00
G14705,SUP,HCPCS C1729,,G14705  -  SET STNT .025IN SM 2 PGTL CRV STRG 3.7FR 14CM GRN STRL 70CM,$188.10,$0.00,$188.10,$102.14,$134.25,$0.00,$32.41,$0.00,$0.00,$32.93,$188.10,$0.00,$94.05,$148.98,$150.48,$0.00,$29.44,$0.00,$29.95,$0.00
G14706,SUP,HCPCS C1758,,G14706  -  SET NPHSTM 12FR 19.5CM CK CNN GW COPE TY LOOP,$32.90,$0.00,$32.90,$17.86,$23.48,$0.00,$5.67,$0.00,$0.00,$5.76,$32.90,$0.00,$16.45,$26.06,$26.32,$0.00,$5.15,$0.00,$5.24,$0.00
G14714,SUP,HCPCS C1729,,G14714  -  CATHETER URET 6FR 70CM ANG TIP TPR END,$404.80,$0.00,$404.80,$219.81,$288.91,$0.00,$69.75,$0.00,$0.00,$70.88,$404.80,$0.00,$202.40,$320.60,$323.84,$0.00,$63.35,$0.00,$64.44,$0.00
G14717,SUP,HCPCS C1758,,G14717  -  SET NPHSTM THNWL 12FR 21GA 19.5CM STRL 15CM COPE LOOP 1 WY,$28.60,$0.00,$28.60,$15.53,$20.41,$0.00,$4.93,$0.00,$0.00,$5.01,$28.60,$0.00,$14.30,$22.65,$22.88,$0.00,$4.48,$0.00,$4.55,$0.00
G14731,SUP,HCPCS C1769,,G14731  -  CATHETER URET 4.8FR 8FR 70CM CONE TIP OP-EN,$3.38,$0.00,$3.38,$1.84,$2.41,$0.00,$0.58,$0.00,$0.00,$0.59,$3.38,$0.00,$1.69,$2.68,$2.70,$0.00,$0.53,$0.00,$0.54,$0.00
G14732,SUP,Custom 27203010,,G14732  -  GUIDEWIRE URO STD STRG .038IN 145CM STRL LF 3CM FX COR FLX,$61.25,$0.00,$61.25,$0.00,$43.71,$0.00,$0.00,$0.00,$0.00,$0.00,$61.25,$0.00,$30.63,$48.51,$49.00,$0.00,$0.00,$0.00,$0.00,$0.00
G14738,SUP,HCPCS C1758,,G14738  -  ADAPTER CATH Y 3-6FR M LL SDARM T-B,$27.83,$0.00,$27.83,$15.11,$19.86,$0.00,$4.79,$0.00,$0.00,$4.87,$27.83,$0.00,$13.91,$22.04,$22.26,$0.00,$4.35,$0.00,$4.43,$0.00
G14742,SUP,HCPCS C2617,,G14742  -  FILIFORM URTH 7FR 10IN MLBL TIP THRD,$261.38,$0.00,$261.38,$117.62,$186.54,$0.00,$45.03,$0.00,$0.00,$45.76,$261.38,$0.00,$130.69,$207.01,$209.10,$0.00,$40.91,$0.00,$41.61,$0.00
G14744,SUP,Custom 27203010,,G14744  -  SET STNT .035IN 70CM SM 2 PGTL CRV STRG 3.7FR 24CM GRN STRL,$366.85,$0.00,$366.85,$0.00,$261.82,$0.00,$0.00,$0.00,$0.00,$0.00,$366.85,$0.00,$183.43,$290.55,$293.48,$0.00,$0.00,$0.00,$0.00,$0.00
G14748,SUP,Custom 27203010,,G14748  -  ADAPTER CATHETER 3-6FR FOLEY SIDEARM TUOHY-BORST STERILE,$50.60,$0.00,$50.60,$0.00,$36.11,$0.00,$0.00,$0.00,$0.00,$0.00,$50.60,$0.00,$25.30,$40.08,$40.48,$0.00,$0.00,$0.00,$0.00,$0.00
G14772,SUP,HCPCS C1729,,G14772  -  DISK RTNT 12FR STAB INDWL PERC CATH TIE,$185.90,$0.00,$185.90,$100.94,$132.68,$0.00,$32.03,$0.00,$0.00,$32.55,$185.90,$0.00,$92.95,$147.23,$148.72,$0.00,$29.09,$0.00,$29.60,$0.00
G14779,SUP,HCPCS C2625,,G14779  -  SET NPHSTM 7-12FR 30CM 20CM MLCT CATH STNT LL CNCT TUBE STY,$139.40,$0.00,$139.40,$62.73,$99.49,$0.00,$24.02,$0.00,$0.00,$24.41,$139.40,$0.00,$69.70,$110.40,$111.52,$0.00,$21.82,$0.00,$22.19,$0.00
G14780,SUP,HCPCS C2617,,G14780  -  SET STNT .038IN 5MM PGTL CRV 7FR 75CM STRL 100CM BNDR CATH,$139.40,$0.00,$139.40,$62.73,$99.49,$0.00,$24.02,$0.00,$0.00,$24.41,$139.40,$0.00,$69.70,$110.40,$111.52,$0.00,$21.82,$0.00,$22.19,$0.00
G14782,SUP,HCPCS C1769,,G14782  -  SET STNT .038IN 5MM PGTL CRV 7FR 75CM STRL 100CM BNDR CATH,$404.80,$0.00,$404.80,$219.81,$288.91,$0.00,$69.75,$0.00,$0.00,$70.88,$404.80,$0.00,$202.40,$320.60,$323.84,$0.00,$63.35,$0.00,$64.44,$0.00
G14787,SUP,HCPCS C2617,,G14787  -  DILATOR URET 7FR 6MM 65CM 4CM SET BLN RADOPQ GW,$261.38,$0.00,$261.38,$117.62,$186.54,$0.00,$45.03,$0.00,$0.00,$45.76,$261.38,$0.00,$130.69,$207.01,$209.10,$0.00,$40.91,$0.00,$41.61,$0.00
G14788,SUP,HCPCS C2617,,G14788  -  SET STNT 50CM 70CM SM 2 PGTL CRV STRG 3.7FR 16CM STRL 145CM,$251.13,$0.00,$251.13,$113.01,$179.23,$0.00,$43.27,$0.00,$0.00,$43.97,$251.13,$0.00,$125.56,$198.89,$200.90,$0.00,$39.30,$0.00,$39.98,$0.00
G14789,SUP,HCPCS C2617,,G14789  -  SET STNT .038IN 40CM J 2 PGTL CRV STRG 10FR 10FR 26CM STRL,$288.80,$0.00,$288.80,$129.96,$206.12,$0.00,$49.76,$0.00,$0.00,$50.57,$288.80,$0.00,$144.40,$228.73,$231.04,$0.00,$45.20,$0.00,$45.98,$0.00
G14790,SUP,HCPCS C2617,,G14790  -  SET STNT .038IN 40CM J 2 PGTL CRV STRG 10FR 10FR 24CM STRL,$288.80,$0.00,$288.80,$129.96,$206.12,$0.00,$49.76,$0.00,$0.00,$50.57,$288.80,$0.00,$144.40,$228.73,$231.04,$0.00,$45.20,$0.00,$45.98,$0.00
G14791,SUP,HCPCS C2628,,G14791  -  CATHETER BLNOCC 5.3FR 75CM STRL REM ADPR RADOPQ SIL UPJ DISP,$319.00,$0.00,$319.00,$0.00,$227.67,$0.00,$0.00,$0.00,$0.00,$0.00,$319.00,$0.00,$159.50,$252.65,$255.20,$0.00,$0.00,$0.00,$0.00,$0.00
G14794,SUP,HCPCS C2617,,G14794  -  SET STNT .038IN 40CM J 2 PGTL CRV STRG 10FR 10FR 22CM STRL,$261.38,$0.00,$261.38,$117.62,$186.54,$0.00,$45.03,$0.00,$0.00,$45.76,$261.38,$0.00,$130.69,$207.01,$209.10,$0.00,$40.91,$0.00,$41.61,$0.00
G14796,SUP,HCPCS C2627,,G14796  -  SET STNT 50CM 70CM SM 2 PGTL CRV STRG 3.7FR 8CM STRL 145CM,$36.70,$0.00,$36.70,$19.93,$26.19,$0.00,$6.32,$0.00,$0.00,$6.43,$36.70,$0.00,$18.35,$29.07,$29.36,$0.00,$5.74,$0.00,$5.84,$0.00
G14798,SUP,HCPCS C1758,,G14798  -  DILATOR URTH 11FR 20CM PE FSCA,$28.60,$0.00,$28.60,$15.53,$20.41,$0.00,$4.93,$0.00,$0.00,$5.01,$28.60,$0.00,$14.30,$22.65,$22.88,$0.00,$4.48,$0.00,$4.55,$0.00
G14799,SUP,HCPCS C2617,,G14799  -  CATHETER URET 5FR 110CM FLXTP CLS END RT,$261.38,$0.00,$261.38,$117.62,$186.54,$0.00,$45.03,$0.00,$0.00,$45.76,$261.38,$0.00,$130.69,$207.01,$209.10,$0.00,$40.91,$0.00,$41.61,$0.00
G14803,SUP,HCPCS C1758,,G14803  -  SET STNT 50CM 70CM SM 2 PGTL CRV STRG 3.7FR 18CM STRL 145CM,$123.83,$0.00,$123.83,$67.24,$88.37,$0.00,$21.33,$0.00,$0.00,$21.68,$123.83,$0.00,$61.91,$98.07,$99.06,$0.00,$19.38,$0.00,$19.71,$0.00
G14804,SUP,HCPCS C1758,,G14804  -  CATHETER URET .045IN PGTL CRV 8FR 70CM SDPRT GW RT,$27.83,$0.00,$27.83,$15.11,$19.86,$0.00,$4.79,$0.00,$0.00,$4.87,$27.83,$0.00,$13.91,$22.04,$22.26,$0.00,$4.35,$0.00,$4.43,$0.00
G14808,SUP,HCPCS C1758,,G14808  -  CATHETER URET .038IN 5FR 115CM OP-EN GW MOD,$276.25,$0.00,$276.25,$150.00,$197.16,$0.00,$47.60,$0.00,$0.00,$48.37,$276.25,$0.00,$138.13,$218.79,$221.00,$0.00,$43.23,$0.00,$43.98,$0.00
G14809,SUP,HCPCS C1758,,G14809  -  CATHETER URET STD 6FR 70CM FLXTP OP-EN FLX TP ACPT .038IN GW,$27.63,$0.00,$27.63,$15.00,$19.72,$0.00,$4.76,$0.00,$0.00,$4.84,$27.63,$0.00,$13.81,$21.88,$22.10,$0.00,$4.32,$0.00,$4.40,$0.00
G14822,SUP,HCPCS C2625,,G14822  -  CATHETER URET 3FR 70CM OP-EN ACPT .018IN GW,$139.40,$0.00,$139.40,$62.73,$99.49,$0.00,$24.02,$0.00,$0.00,$24.41,$139.40,$0.00,$69.70,$110.40,$111.52,$0.00,$21.82,$0.00,$22.19,$0.00
G14823,SUP,HCPCS C2625,,G14823  -  SET STNT .038IN 5MM PGTL CRV 7FR 70CM WHT STRL 145CM BNDR,$139.40,$0.00,$139.40,$62.73,$99.49,$0.00,$24.02,$0.00,$0.00,$24.41,$139.40,$0.00,$69.70,$110.40,$111.52,$0.00,$21.82,$0.00,$22.19,$0.00
G14832,SUP,HCPCS C2617,,G14832  -  SET STNT .018IN SM 2 PGTL CRV CDE 4.7FR 4FR 12CM STRL CP,$253.25,$0.00,$253.25,$113.96,$180.74,$0.00,$43.63,$0.00,$0.00,$44.34,$253.25,$0.00,$126.63,$200.57,$202.60,$0.00,$39.63,$0.00,$40.32,$0.00
G14834,SUP,HCPCS C2617,,G14834  -  SET STNT .038IN 5MM PGTL CRV 7FR 70CM WHT STRL 145CM BNDR,$261.38,$0.00,$261.38,$117.62,$186.54,$0.00,$45.03,$0.00,$0.00,$45.76,$261.38,$0.00,$130.69,$207.01,$209.10,$0.00,$40.91,$0.00,$41.61,$0.00
G14836,SUP,HCPCS C2625,,G14836  -  SET STNT SM 2 PGTL CRV 3.7FR AST LGTH STRL CATH RADOPQ PSTNR,$261.38,$0.00,$261.38,$117.62,$186.54,$0.00,$45.03,$0.00,$0.00,$45.76,$261.38,$0.00,$130.69,$207.01,$209.10,$0.00,$40.91,$0.00,$41.61,$0.00
G14837,SUP,HCPCS C2625,,G14837  -  SET STNT .038IN 3CM 40CM 70CM 6FR 22-32CM STRL 145CM KWART,$261.38,$0.00,$261.38,$117.62,$186.54,$0.00,$45.03,$0.00,$0.00,$45.76,$261.38,$0.00,$130.69,$207.01,$209.10,$0.00,$40.91,$0.00,$41.61,$0.00
G14840,SUP,HCPCS C2617,,G14840  -  SET STNT .038IN 3CM 40CM 70CM .038IN 7FR 22-32CM STRL 145CM,$251.13,$0.00,$251.13,$113.01,$179.23,$0.00,$43.27,$0.00,$0.00,$43.97,$251.13,$0.00,$125.56,$198.89,$200.90,$0.00,$39.30,$0.00,$39.98,$0.00
G14843,SUP,HCPCS C2617,,G14843  -  SET STNT .018IN SM 2 PGTL CRV 4.7FR 4FR 16CM STRL CP MDRL,$288.80,$0.00,$288.80,$129.96,$206.12,$0.00,$49.76,$0.00,$0.00,$50.57,$288.80,$0.00,$144.40,$228.73,$231.04,$0.00,$45.20,$0.00,$45.98,$0.00
G14844,SUP,HCPCS C2625,,G14844  -  SET STNT .038IN 40CM 2 PGTL CRV STRG 12FR 12FR 26CM STRL 145,$261.38,$0.00,$261.38,$117.62,$186.54,$0.00,$45.03,$0.00,$0.00,$45.76,$261.38,$0.00,$130.69,$207.01,$209.10,$0.00,$40.91,$0.00,$41.61,$0.00
G14854,SUP,HCPCS C2617,,G14854  -  SET STNT .038IN 8.2FR 22-32CM STRL KWART RETRO-INJ STNT,$288.80,$0.00,$288.80,$129.96,$206.12,$0.00,$49.76,$0.00,$0.00,$50.57,$288.80,$0.00,$144.40,$228.73,$231.04,$0.00,$45.20,$0.00,$45.98,$0.00
G14857,SUP,HCPCS C1758,,G14857  -  SET STNT .038IN 40CM 2 PGTL CRV STRG 12FR 12FR 24CM STRL 145,$27.83,$0.00,$27.83,$15.11,$19.86,$0.00,$4.79,$0.00,$0.00,$4.87,$27.83,$0.00,$13.91,$22.04,$22.26,$0.00,$4.35,$0.00,$4.43,$0.00
G14859,SUP,HCPCS C2627,,G14859  -  CATHETER URET .038IN 5FR 95CM OP-EN GW MOD,$66.43,$0.00,$66.43,$36.07,$47.41,$0.00,$11.44,$0.00,$0.00,$11.63,$66.43,$0.00,$33.21,$52.61,$53.14,$0.00,$10.40,$0.00,$10.57,$0.00
G14861,SUP,HCPCS C2627,,G14861  -  DILATOR URTH 26FR 20CM PE FSCA,$66.43,$0.00,$66.43,$36.07,$47.41,$0.00,$11.44,$0.00,$0.00,$11.63,$66.43,$0.00,$33.21,$52.61,$53.14,$0.00,$10.40,$0.00,$10.57,$0.00
G14865,SUP,HCPCS C2617,,G14865  -  DILATOR URTH 30FR 20CM PE FSCA,$251.13,$0.00,$251.13,$113.01,$179.23,$0.00,$43.27,$0.00,$0.00,$43.97,$251.13,$0.00,$125.56,$198.89,$200.90,$0.00,$39.30,$0.00,$39.98,$0.00
G14866,SUP,HCPCS C2617,,G14866  -  SET STNT .018IN SM 2 PGTL CRV CDE 6FR 4FR 16CM STRL CP MDRL,$288.80,$0.00,$288.80,$129.96,$206.12,$0.00,$49.76,$0.00,$0.00,$50.57,$288.80,$0.00,$144.40,$228.73,$231.04,$0.00,$45.20,$0.00,$45.98,$0.00
G14867,SUP,HCPCS C2617,,G14867  -  SET STNT .018IN SM 2 PGTL CRV CDE 6FR 4FR 14CM STRL CP MDRL,$251.13,$0.00,$251.13,$113.01,$179.23,$0.00,$43.27,$0.00,$0.00,$43.97,$251.13,$0.00,$125.56,$198.89,$200.90,$0.00,$39.30,$0.00,$39.98,$0.00
G14870,SUP,HCPCS C1758,,G14870  -  SET STNT .018IN SM 2 PGTL CRV 6FR 4FR 12CM STRL CP MDRL,$36.70,$0.00,$36.70,$19.93,$26.19,$0.00,$6.32,$0.00,$0.00,$6.43,$36.70,$0.00,$18.35,$29.07,$29.36,$0.00,$5.74,$0.00,$5.84,$0.00
G14873,SUP,HCPCS C1758,,G14873  -  CATHETER URET 3.8FR 70CM LSR,$276.25,$0.00,$276.25,$150.00,$197.16,$0.00,$47.60,$0.00,$0.00,$48.37,$276.25,$0.00,$138.13,$218.79,$221.00,$0.00,$43.23,$0.00,$43.98,$0.00
G14885,SUP,HCPCS C2625,,G14885  -  SET STNT 3CM 6FR 22CM STRL 145CM KWART RETRO-INJ RADOPQ,$300.60,$0.00,$300.60,$135.27,$214.54,$0.00,$51.79,$0.00,$0.00,$52.63,$300.60,$0.00,$150.30,$238.08,$240.48,$0.00,$47.04,$0.00,$47.86,$0.00
G14886,SUP,HCPCS C2625,,G14886  -  CATHETER URET 5FR 70CM SPRL TIP SDPRT ACC ACPT .038IN GW,$26.14,$0.00,$26.14,$11.76,$18.65,$0.00,$4.50,$0.00,$0.00,$4.58,$26.14,$0.00,$13.07,$20.70,$20.91,$0.00,$4.09,$0.00,$4.16,$0.00
G14887,SUP,HCPCS C2625,,G14887  -  SET STNT .038IN 2 PGTL CRV 6FR 26CM STRL KWART RETRO-INJ,$261.38,$0.00,$261.38,$117.62,$186.54,$0.00,$45.03,$0.00,$0.00,$45.76,$261.38,$0.00,$130.69,$207.01,$209.10,$0.00,$40.91,$0.00,$41.61,$0.00
G14890,SUP,HCPCS C1758,,G14890  -  SET STNT .038IN 40CM 70CM 2 PGTL CRV STRG 6FR 24CM STRL 145,$36.70,$0.00,$36.70,$19.93,$26.19,$0.00,$6.32,$0.00,$0.00,$6.43,$36.70,$0.00,$18.35,$29.07,$29.36,$0.00,$5.74,$0.00,$5.84,$0.00
G14891,SUP,HCPCS C2627,,G14891  -  SET CATH 16FR 25CM SET SPBC STM MLCT,$95.63,$0.00,$95.63,$51.92,$68.25,$0.00,$16.48,$0.00,$0.00,$16.74,$95.63,$0.00,$47.81,$75.74,$76.50,$0.00,$14.97,$0.00,$15.22,$0.00
G14893,SUP,HCPCS C1894,,G14893  -  CATHETER URET 3FR 70CM LSR ACPT .010IN GW,$451.00,$0.00,$451.00,$244.89,$321.88,$0.00,$77.71,$0.00,$0.00,$78.97,$451.00,$0.00,$225.50,$357.19,$360.80,$0.00,$70.58,$0.00,$71.80,$0.00
G14897,SUP,HCPCS C2617,,G14897  -  DILATOR URTH RING 8-26FR 50CM LTX RADOPQ PTFE TRQ GW RADOPQ,$261.38,$0.00,$261.38,$117.62,$186.54,$0.00,$45.03,$0.00,$0.00,$45.76,$261.38,$0.00,$130.69,$207.01,$209.10,$0.00,$40.91,$0.00,$41.61,$0.00
G14898,SUP,HCPCS C2617,,G14898  -  SET STNT 50CM 70CM SM 2 PGTL CRV STRG 3.7FR 22CM STRL 145CM,$251.13,$0.00,$251.13,$113.01,$179.23,$0.00,$43.27,$0.00,$0.00,$43.97,$251.13,$0.00,$125.56,$198.89,$200.90,$0.00,$39.30,$0.00,$39.98,$0.00
G14900,SUP,Custom 27203010,,G14900  -  SET STNT .018IN SM 2 PGTL CRV CDE 4.7FR 4FR 14CM STRL CP,$26.58,$0.00,$26.58,$0.00,$18.97,$0.00,$0.00,$0.00,$0.00,$0.00,$26.58,$0.00,$13.29,$21.05,$21.26,$0.00,$0.00,$0.00,$0.00,$0.00
G14905,SUP,HCPCS C2625,,G14905  -  DEVICE SCR 16FR STRL RTNT DISK SIL DISP ACPT 16FR,$261.38,$0.00,$261.38,$117.62,$186.54,$0.00,$45.03,$0.00,$0.00,$45.76,$261.38,$0.00,$130.69,$207.01,$209.10,$0.00,$40.91,$0.00,$41.61,$0.00
G14906,SUP,HCPCS C2617,,G14906  -  SET STNT .018IN SM 2 PGTL CRV CDE 4.7FR 10CM STRL RADOPQ,$251.13,$0.00,$251.13,$113.01,$179.23,$0.00,$43.27,$0.00,$0.00,$43.97,$251.13,$0.00,$125.56,$198.89,$200.90,$0.00,$39.30,$0.00,$39.98,$0.00
G14910,SUP,HCPCS C2625,,G14910  -  SET STNT .038IN 2 PGTL CRV 6FR 28CM STRL KWART RETRO-INJ,$261.38,$0.00,$261.38,$117.62,$186.54,$0.00,$45.03,$0.00,$0.00,$45.76,$261.38,$0.00,$130.69,$207.01,$209.10,$0.00,$40.91,$0.00,$41.61,$0.00
G14911,SUP,HCPCS C2625,,G14911  -  SET STNT .038IN 40CM 70CM 2 PGTL CRV STRG 7FR 26CM STRL 145,$261.38,$0.00,$261.38,$117.62,$186.54,$0.00,$45.03,$0.00,$0.00,$45.76,$261.38,$0.00,$130.69,$207.01,$209.10,$0.00,$40.91,$0.00,$41.61,$0.00
G14912,SUP,HCPCS C2625,,G14912  -  SET STNT .038IN 40CM 70CM 2 PGTL CRV 7FR 24CM STRL 145CM,$261.38,$0.00,$261.38,$117.62,$186.54,$0.00,$45.03,$0.00,$0.00,$45.76,$261.38,$0.00,$130.69,$207.01,$209.10,$0.00,$40.91,$0.00,$41.61,$0.00
G14916,SUP,HCPCS C2625,,G14916  -  SET STNT .038IN 40CM 70CM 2 PGTL CRV STRG 7FR 28CM STRL 145,$261.38,$0.00,$261.38,$117.62,$186.54,$0.00,$45.03,$0.00,$0.00,$45.76,$261.38,$0.00,$130.69,$207.01,$209.10,$0.00,$40.91,$0.00,$41.61,$0.00
G14917,SUP,HCPCS C1729,,G14917  -  SET STNT .038IN 3CM 40CM 70CM STRG 4.7FR 22-32CM STRL 145CM,$404.80,$0.00,$404.80,$219.81,$288.91,$0.00,$69.75,$0.00,$0.00,$70.88,$404.80,$0.00,$202.40,$320.60,$323.84,$0.00,$63.35,$0.00,$64.44,$0.00
G14919,SUP,Custom 27203010,,G14919  -  SET NPHSTM .038IN THNWL CRV 14FR 19.5CM STRL 30CM COPE LOOP,$185.60,$0.00,$185.60,$0.00,$132.46,$0.00,$0.00,$0.00,$0.00,$0.00,$185.60,$0.00,$92.80,$147.00,$148.48,$0.00,$0.00,$0.00,$0.00,$0.00
G14920,SUP,HCPCS C2627,,G14920  -  BRUSH CYTO 3.2FR 115CM BX SET STRG TIP OCL URET,$144.10,$0.00,$144.10,$78.25,$102.84,$0.00,$24.83,$0.00,$0.00,$25.23,$144.10,$0.00,$72.05,$114.13,$115.28,$0.00,$22.55,$0.00,$22.94,$0.00
G14921,SUP,HCPCS C1773,,G14921  -  GUIDEWIRE ESCP .035IN 145CM 3CM FLX TP STD BD SS URET,$664.55,$0.00,$664.55,$360.85,$474.29,$0.00,$114.50,$0.00,$0.00,$116.36,$664.55,$0.00,$332.28,$526.32,$531.64,$0.00,$104.00,$0.00,$105.80,$0.00
G14922,SUP,HCPCS C1773,,G14922  -  SET CATH 16FR 14FR 22CM 3CC LTX 30CM RTNR BLN NDL OBT CNCT,$664.55,$0.00,$664.55,$360.85,$474.29,$0.00,$114.50,$0.00,$0.00,$116.36,$664.55,$0.00,$332.28,$526.32,$531.64,$0.00,$104.00,$0.00,$105.80,$0.00
G14925,SUP,HCPCS C1758,,G14925  -  FORCEPS SPEC RTRVL 3.3FR 115CM STRL 1 JAW STON FLXB SHFT,$32.90,$0.00,$32.90,$17.86,$23.48,$0.00,$5.67,$0.00,$0.00,$5.76,$32.90,$0.00,$16.45,$26.06,$26.32,$0.00,$5.15,$0.00,$5.24,$0.00
G14935,SUP,HCPCS C1773,,G14935  -  CATHETER URET STD 8FR 70CM PLLK OP-EN FLX TP ACPT .038IN GW,$664.55,$0.00,$664.55,$360.85,$474.29,$0.00,$114.50,$0.00,$0.00,$116.36,$664.55,$0.00,$332.28,$526.32,$531.64,$0.00,$104.00,$0.00,$105.80,$0.00
G14936,SUP,HCPCS C1773,,G14936  -  FORCEPS SPEC RTRVL 3.3FR 65CM STRL LF ALGTR TTH FLXB SHFT,$764.25,$0.00,$764.25,$414.99,$545.45,$0.00,$131.68,$0.00,$0.00,$133.81,$764.25,$0.00,$382.13,$605.29,$611.40,$0.00,$119.61,$0.00,$121.67,$0.00
G14938,SUP,HCPCS C1758,,G14938  -  FORCEPS SPEC RTRVL 3.3FR 65CM 1 JAW RAT TTH URO,$28.60,$0.00,$28.60,$15.53,$20.41,$0.00,$4.93,$0.00,$0.00,$5.01,$28.60,$0.00,$14.30,$22.65,$22.88,$0.00,$4.48,$0.00,$4.55,$0.00
G14941,SUP,HCPCS C1758,,G14941  -  CATHETER URET .038IN 5FR 70CM PLLK OP-EN GW MOD FLX TP,$28.60,$0.00,$28.60,$15.53,$20.41,$0.00,$4.93,$0.00,$0.00,$5.01,$28.60,$0.00,$14.30,$22.65,$22.88,$0.00,$4.48,$0.00,$4.55,$0.00
G14943,SUP,HCPCS C2617,,G14943  -  CATHETER URET SPRL 6FR 70CM LG SDPRT ACPT .038IN GW,$288.80,$0.00,$288.80,$129.96,$206.12,$0.00,$49.76,$0.00,$0.00,$50.57,$288.80,$0.00,$144.40,$228.73,$231.04,$0.00,$45.20,$0.00,$45.98,$0.00
G14951,SUP,HCPCS C2617,,G14951  -  SET STNT .038IN 40CM 2 PGTL CRV STRG 12FR 22CM STRL 145CM,$251.13,$0.00,$251.13,$113.01,$179.23,$0.00,$43.27,$0.00,$0.00,$43.97,$251.13,$0.00,$125.56,$198.89,$200.90,$0.00,$39.30,$0.00,$39.98,$0.00
G14952,SUP,HCPCS C1758,,G14952  -  SET STNT .018IN SM 2 PGTL CRV CDE 7FR 4FR 12CM STRL CP MDRL,$27.83,$0.00,$27.83,$15.11,$19.86,$0.00,$4.79,$0.00,$0.00,$4.87,$27.83,$0.00,$13.91,$22.04,$22.26,$0.00,$4.35,$0.00,$4.43,$0.00
G14955,SUP,HCPCS C2625,,G14955  -  CATHETER URET 5FR 70CM WHSTLTP MOD,$261.38,$0.00,$261.38,$117.62,$186.54,$0.00,$45.03,$0.00,$0.00,$45.76,$261.38,$0.00,$130.69,$207.01,$209.10,$0.00,$40.91,$0.00,$41.61,$0.00
G14975,SUP,HCPCS C1769,,G14975  -  SET STNT .038IN 40CM 70CM 2 PGTL CRV STRG 4.7FR 24CM STRL,$69.98,$0.00,$69.98,$38.00,$49.94,$0.00,$12.06,$0.00,$0.00,$12.25,$69.98,$0.00,$34.99,$55.42,$55.98,$0.00,$10.95,$0.00,$11.14,$0.00
G14980,SUP,HCPCS C1758,,G14980  -  GUIDEWIRE URO .035IN 145CM 8CM AMPTZ STRG FLX TP SS,$109.48,$0.00,$109.48,$59.44,$78.13,$0.00,$18.86,$0.00,$0.00,$19.17,$109.48,$0.00,$54.74,$86.71,$87.58,$0.00,$17.13,$0.00,$17.43,$0.00
G14991,SUP,HCPCS C2617,,G14991  -  SET CATH .038IN PGTL CRV 7FR 90CM STRL 145CM PSTNR SDPRT GW,$288.80,$0.00,$288.80,$129.96,$206.12,$0.00,$49.76,$0.00,$0.00,$50.57,$288.80,$0.00,$144.40,$228.73,$231.04,$0.00,$45.20,$0.00,$45.98,$0.00
G14992,SUP,HCPCS C2617,,G14992  -  SET STNT .038IN 40CM 2 PGTL CRV STRG 10FR 28CM STRL 145CM,$288.80,$0.00,$288.80,$129.96,$206.12,$0.00,$49.76,$0.00,$0.00,$50.57,$288.80,$0.00,$144.40,$228.73,$231.04,$0.00,$45.20,$0.00,$45.98,$0.00
G15000,SUP,HCPCS C2617,,G15000  -  SET STNT .038IN 40CM 2 PGTL CRV STRG 10FR 20CM STRL 145CM,$288.80,$0.00,$288.80,$129.96,$206.12,$0.00,$49.76,$0.00,$0.00,$50.57,$288.80,$0.00,$144.40,$228.73,$231.04,$0.00,$45.20,$0.00,$45.98,$0.00
G15003,SUP,HCPCS C2617,,G15003  -  SET STNT .018IN SM 2 PGTL CRV CDE 6FR 4FR 8CM STRL CP MDRL,$251.13,$0.00,$251.13,$113.01,$179.23,$0.00,$43.27,$0.00,$0.00,$43.97,$251.13,$0.00,$125.56,$198.89,$200.90,$0.00,$39.30,$0.00,$39.98,$0.00
G15015,SUP,HCPCS C2625,,G15015  -  SET STNT .018IN SM 2 PGTL CRV CDE 6FR 4FR 10CM STRL CP MDRL,$261.38,$0.00,$261.38,$117.62,$186.54,$0.00,$45.03,$0.00,$0.00,$45.76,$261.38,$0.00,$130.69,$207.01,$209.10,$0.00,$40.91,$0.00,$41.61,$0.00
G15016,SUP,HCPCS C2625,,G15016  -  SET STNT .038IN 40CM 70CM 2 PGTL CRV STRG 8.2FR 24CM STRL,$261.38,$0.00,$261.38,$117.62,$186.54,$0.00,$45.03,$0.00,$0.00,$45.76,$261.38,$0.00,$130.69,$207.01,$209.10,$0.00,$40.91,$0.00,$41.61,$0.00
G15020,SUP,HCPCS C1758,,G15020  -  SET STNT .038IN 40CM 70CM 2 PGTL CRV STRG 4.7FR 26CM STRL,$31.90,$0.00,$31.90,$17.32,$22.77,$0.00,$5.50,$0.00,$0.00,$5.59,$31.90,$0.00,$15.95,$25.26,$25.52,$0.00,$4.99,$0.00,$5.08,$0.00
G15030,SUP,Custom 27203010,,G15030  -  CATHETER URET 3FR 115CM LSR FBR HNDL,$59.40,$0.00,$59.40,$0.00,$42.39,$0.00,$0.00,$0.00,$0.00,$0.00,$59.40,$0.00,$29.70,$47.04,$47.52,$0.00,$0.00,$0.00,$0.00,$0.00
G15034,SUP,HCPCS C1729,,G15034  -  ADAPTER CATH 14FR 15CM GOLDBERG FL DRN BG URET,$155.60,$0.00,$155.60,$84.49,$111.05,$0.00,$26.81,$0.00,$0.00,$27.24,$155.60,$0.00,$77.80,$123.24,$124.48,$0.00,$24.35,$0.00,$24.77,$0.00
G15035,SUP,HCPCS C1729,,G15035  -  SET NPHSTM PGTL CRV 8.2FR 15CM 5CM MOD CATH STNT CNCT TUBE,$155.60,$0.00,$155.60,$84.49,$111.05,$0.00,$26.81,$0.00,$0.00,$27.24,$155.60,$0.00,$77.80,$123.24,$124.48,$0.00,$24.35,$0.00,$24.77,$0.00
G15037,SUP,HCPCS C1758,,G15037  -  SET NPHSTM PGTL CRV 8.2FR 15CM 7CM MOD CATH STNT CNCT TUBE,$32.90,$0.00,$32.90,$17.86,$23.48,$0.00,$5.67,$0.00,$0.00,$5.76,$32.90,$0.00,$16.45,$26.06,$26.32,$0.00,$5.15,$0.00,$5.24,$0.00
G15038,SUP,HCPCS C2617,,G15038  -  CATHETER URET .038IN 5FR 115CM PLLK OP-EN GW MOD FLX TP,$288.80,$0.00,$288.80,$129.96,$206.12,$0.00,$49.76,$0.00,$0.00,$50.57,$288.80,$0.00,$144.40,$228.73,$231.04,$0.00,$45.20,$0.00,$45.98,$0.00
G15040,SUP,HCPCS C1758,,G15040  -  SET STNT .038IN 2 PGTL CRV CDE 7FR 10CM STRL RADOPQ GW SFLX,$276.25,$0.00,$276.25,$150.00,$197.16,$0.00,$47.60,$0.00,$0.00,$48.37,$276.25,$0.00,$138.13,$218.79,$221.00,$0.00,$43.23,$0.00,$43.98,$0.00
G15042,SUP,HCPCS C2617,,G15042  -  CATHETER URET STD 4FR 70CM LF FLXTP PLCK OP-EN ACPT .028IN,$6.66,$0.00,$6.66,$3.00,$4.76,$0.00,$1.15,$0.00,$0.00,$1.17,$6.66,$0.00,$3.33,$5.27,$5.33,$0.00,$1.04,$0.00,$1.06,$0.00
G15045,SUP,Custom 27203010,,G15045  -  STENT URTH 10FR 30CM STRL FRLT KLG SUT BLB SIL DISP,$200.00,$0.00,$200.00,$0.00,$142.74,$0.00,$0.00,$0.00,$0.00,$0.00,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$0.00,$0.00,$0.00,$0.00
G15047,SUP,HCPCS C2617,,G15047  -  SET BX 3.2FR 115CM BRSH DFLC RADOPQ URET,$66.63,$0.00,$66.63,$29.98,$47.55,$0.00,$11.48,$0.00,$0.00,$11.67,$66.63,$0.00,$33.31,$52.77,$53.30,$0.00,$10.43,$0.00,$10.61,$0.00
G15049,SUP,HCPCS C2617,,G15049  -  STENT URTH 8FR 30CM STRL FRLT KLG SIL DISP HYPOSPADIAS,$66.63,$0.00,$66.63,$29.98,$47.55,$0.00,$11.48,$0.00,$0.00,$11.67,$66.63,$0.00,$33.31,$52.77,$53.30,$0.00,$10.43,$0.00,$10.61,$0.00
G15050,SUP,HCPCS C2617,,G15050  -  STENT URTH 8FR 12CM STRL ZAONTZ DISP HYPOSPADIAS EPISPADIAS,$66.63,$0.00,$66.63,$29.98,$47.55,$0.00,$11.48,$0.00,$0.00,$11.67,$66.63,$0.00,$33.31,$52.77,$53.30,$0.00,$10.43,$0.00,$10.61,$0.00
G15054,SUP,Custom 27203010,,G15054  -  FORCEPS ENDSCP 3.3FR 115CM FLEXIBLE OVAL BIOP CUP TISSUE,$781.00,$0.00,$781.00,$0.00,$557.40,$0.00,$0.00,$0.00,$0.00,$0.00,$781.00,$0.00,$390.50,$618.55,$624.80,$0.00,$0.00,$0.00,$0.00,$0.00
G15056,SUP,Custom 27203010,,G15056  -  STENT URTH 10FR 12CM STRL ZAONTZ DISP HYPOSPADIAS OR,$45.55,$0.00,$45.55,$0.00,$32.51,$0.00,$0.00,$0.00,$0.00,$0.00,$45.55,$0.00,$22.78,$36.08,$36.44,$0.00,$0.00,$0.00,$0.00,$0.00
G15061,SUP,HCPCS C1726,,G15061  -  CARRIER SUT 30D 16CM PEREYRA RAZ LGT REUSE,$385.00,$0.00,$385.00,$209.06,$274.77,$0.00,$66.33,$0.00,$0.00,$67.41,$385.00,$0.00,$192.50,$304.92,$308.00,$0.00,$60.25,$0.00,$61.29,$0.00
G15062,SUP,HCPCS C1726,,G15062  -  CATHETER URTH 7FR 30CM STRL M DISP,$442.75,$0.00,$442.75,$240.41,$315.99,$0.00,$76.28,$0.00,$0.00,$77.52,$442.75,$0.00,$221.38,$350.66,$354.20,$0.00,$69.29,$0.00,$70.49,$0.00
G15067,SUP,HCPCS C1769,,G15067  -  CATHETER BLNDIL SET F URET,$37.40,$0.00,$37.40,$20.31,$26.69,$0.00,$6.44,$0.00,$0.00,$6.55,$37.40,$0.00,$18.70,$29.62,$29.92,$0.00,$5.85,$0.00,$5.95,$0.00
G15070,SUP,HCPCS C2627,,G15070  -  GUIDEWIRE ESCP STRG STD .038IN 80CM STRL 3CM FLX TP FXCR SS,$144.10,$0.00,$144.10,$78.25,$102.84,$0.00,$24.83,$0.00,$0.00,$25.23,$144.10,$0.00,$72.05,$114.13,$115.28,$0.00,$22.55,$0.00,$22.94,$0.00
G15076,SUP,HCPCS C2617,,G15076  -  SET CATH 10FR 22CM 3ML STRL LTX 30CM RTNR BLN SS NDL OBT,$288.80,$0.00,$288.80,$129.96,$206.12,$0.00,$49.76,$0.00,$0.00,$50.57,$288.80,$0.00,$144.40,$228.73,$231.04,$0.00,$45.20,$0.00,$45.98,$0.00
G15077,SUP,HCPCS C2617,,G15077  -  SET DRN 8FR 6-10FR 30CM 20CM CATH DIL LOOP,$251.13,$0.00,$251.13,$113.01,$179.23,$0.00,$43.27,$0.00,$0.00,$43.97,$251.13,$0.00,$125.56,$198.89,$200.90,$0.00,$39.30,$0.00,$39.98,$0.00
G15079,SUP,HCPCS C1892,,G15079  -  SET STNT .018IN SM 2 PGTL CRV CDE 4.7FR 8CM STRL RADOPQ,$103.53,$0.00,$103.53,$56.21,$73.89,$0.00,$17.84,$0.00,$0.00,$18.13,$103.53,$0.00,$51.76,$82.00,$82.82,$0.00,$16.20,$0.00,$16.48,$0.00
G15088,SUP,HCPCS C2627,,G15088  -  CATHETER URO 8FR 8.5FR 88CM 30CM CK SET GW 810 STNT PLC,$41.80,$0.00,$41.80,$22.70,$29.83,$0.00,$7.20,$0.00,$0.00,$7.32,$41.80,$0.00,$20.90,$33.11,$33.44,$0.00,$6.54,$0.00,$6.65,$0.00
G15089,SUP,HCPCS C2627,,G15089  -  DILATOR URET 7FR 60CM SET PE,$187.00,$0.00,$187.00,$101.54,$133.46,$0.00,$32.22,$0.00,$0.00,$32.74,$187.00,$0.00,$93.50,$148.10,$149.60,$0.00,$29.27,$0.00,$29.77,$0.00
G15093,SUP,HCPCS C2617,,G15093  -  CATHETER SPBC 16FR 12CM OB PLWY ACC INTRO SET GW TROC NDL,$288.80,$0.00,$288.80,$129.96,$206.12,$0.00,$49.76,$0.00,$0.00,$50.57,$288.80,$0.00,$144.40,$228.73,$231.04,$0.00,$45.20,$0.00,$45.98,$0.00
G15108,SUP,Custom 27203010,,G15108  -  SET STNT .018IN 2 PGTL CRV CDE 7FR 16CM STRL RADOPQ PSTNR GW,$75.90,$0.00,$75.90,$0.00,$54.17,$0.00,$0.00,$0.00,$0.00,$0.00,$75.90,$0.00,$37.95,$60.11,$60.72,$0.00,$0.00,$0.00,$0.00,$0.00
G15109,SUP,Custom 27203010,,G15109  -  DILATOR URTH 8FR 35.5CM DIST TIP,$75.90,$0.00,$75.90,$0.00,$54.17,$0.00,$0.00,$0.00,$0.00,$0.00,$75.90,$0.00,$37.95,$60.11,$60.72,$0.00,$0.00,$0.00,$0.00,$0.00
G15116,SUP,HCPCS C1758,,G15116  -  CATHETER URET 4FR 70CM WHSTLTP MOD,$32.90,$0.00,$32.90,$17.86,$23.48,$0.00,$5.67,$0.00,$0.00,$5.76,$32.90,$0.00,$16.45,$26.06,$26.32,$0.00,$5.15,$0.00,$5.24,$0.00
G15120,SUP,HCPCS C2617,,G15120  -  CATHETER URET 4FR 115CM FLXTP CLS END RT,$287.00,$0.00,$287.00,$129.15,$204.83,$0.00,$49.45,$0.00,$0.00,$50.25,$287.00,$0.00,$143.50,$227.30,$229.60,$0.00,$44.92,$0.00,$45.69,$0.00
G15121,SUP,HCPCS C1758,,G15121  -  SET STNT .038IN 2 PGTL CRV 7FR 24CM BLK STRL 145CM RADOPQ,$83.50,$0.00,$83.50,$45.34,$59.59,$0.00,$14.39,$0.00,$0.00,$14.62,$83.50,$0.00,$41.75,$66.13,$66.80,$0.00,$13.07,$0.00,$13.29,$0.00
G15123,SUP,HCPCS C2617,,G15123  -  CATHETER URET 20D .035IN 7FR 70CM 145CM ANG TIP TPR END GW,$287.00,$0.00,$287.00,$129.15,$204.83,$0.00,$49.45,$0.00,$0.00,$50.25,$287.00,$0.00,$143.50,$227.30,$229.60,$0.00,$44.92,$0.00,$45.69,$0.00
G15124,SUP,HCPCS C2617,,G15124  -  SET STNT .038IN 2 PGTL CRV FLFRM 7FR 22CM BLK STRL 145CM,$287.00,$0.00,$287.00,$129.15,$204.83,$0.00,$49.45,$0.00,$0.00,$50.25,$287.00,$0.00,$143.50,$227.30,$229.60,$0.00,$44.92,$0.00,$45.69,$0.00
G15125,SUP,HCPCS C2617,,G15125  -  SET STNT .038IN 2 PGTL CRV 7FR 26CM BLK STRL 145CM RADOPQ,$287.00,$0.00,$287.00,$129.15,$204.83,$0.00,$49.45,$0.00,$0.00,$50.25,$287.00,$0.00,$143.50,$227.30,$229.60,$0.00,$44.92,$0.00,$45.69,$0.00
G15126,SUP,HCPCS C2617,,G15126  -  SET STNT .038IN 2 PGTL CRV 7FR 28CM BLK STRL 145CM RADOPQ,$287.00,$0.00,$287.00,$129.15,$204.83,$0.00,$49.45,$0.00,$0.00,$50.25,$287.00,$0.00,$143.50,$227.30,$229.60,$0.00,$44.92,$0.00,$45.69,$0.00
G15127,SUP,HCPCS C2617,,G15127  -  SET STNT .038IN 2 PGTL CRV STRG FLFRM 7FR 30CM BLK STRL 145,$287.00,$0.00,$287.00,$129.15,$204.83,$0.00,$49.45,$0.00,$0.00,$50.25,$287.00,$0.00,$143.50,$227.30,$229.60,$0.00,$44.92,$0.00,$45.69,$0.00
G15128,SUP,HCPCS C2617,,G15128  -  SET STNT .038IN 2 PGTL CRV STRG FLFRM 8.5FR 22CM BLK STRL,$287.00,$0.00,$287.00,$129.15,$204.83,$0.00,$49.45,$0.00,$0.00,$50.25,$287.00,$0.00,$143.50,$227.30,$229.60,$0.00,$44.92,$0.00,$45.69,$0.00
G15129,SUP,HCPCS C2617,,G15129  -  SET STNT .038IN 2 PGTL CRV 8.5FR 24CM BLK STRL 145CM RADOPQ,$287.00,$0.00,$287.00,$129.15,$204.83,$0.00,$49.45,$0.00,$0.00,$50.25,$287.00,$0.00,$143.50,$227.30,$229.60,$0.00,$44.92,$0.00,$45.69,$0.00
G15130,SUP,HCPCS C2617,,G15130  -  SET STNT .038IN 2 PGTL CRV 8.5FR 28CM BLK STRL 145CM RADOPQ,$287.00,$0.00,$287.00,$129.15,$204.83,$0.00,$49.45,$0.00,$0.00,$50.25,$287.00,$0.00,$143.50,$227.30,$229.60,$0.00,$44.92,$0.00,$45.69,$0.00
G15133,SUP,Custom 27203010,,G15133  -  SET NPHSTM 500ML STRL 1 CNCT DRN PCH SFT ELC BELT REED VLV,$71.25,$0.00,$71.25,$0.00,$50.85,$0.00,$0.00,$0.00,$0.00,$0.00,$71.25,$0.00,$35.63,$56.43,$57.00,$0.00,$0.00,$0.00,$0.00,$0.00
G15134,SUP,Custom 27203010,,G15134  -  SET STNT .038IN 2 PGTL CRV STRG FLFRM 8.5FR 26CM BLK STRL,$71.25,$0.00,$71.25,$0.00,$50.85,$0.00,$0.00,$0.00,$0.00,$0.00,$71.25,$0.00,$35.63,$56.43,$57.00,$0.00,$0.00,$0.00,$0.00,$0.00
G15136,SUP,Custom 27203010,,G15136  -  SET NPHSTM 500ML STRL DRN PCH SFT ELC BELT REED VLV MECH,$71.25,$0.00,$71.25,$0.00,$50.85,$0.00,$0.00,$0.00,$0.00,$0.00,$71.25,$0.00,$35.63,$56.43,$57.00,$0.00,$0.00,$0.00,$0.00,$0.00
G15137,SUP,Custom 27203010,,G15137  -  SET NPHSTM 500ML NS CK 1 CNCT DRN PCH SFT ELC BELT DISP,$71.25,$0.00,$71.25,$0.00,$50.85,$0.00,$0.00,$0.00,$0.00,$0.00,$71.25,$0.00,$35.63,$56.43,$57.00,$0.00,$0.00,$0.00,$0.00,$0.00
G15138,SUP,HCPCS C2617,,G15138  -  SET NPHSTM 500ML NS 2 CNCT DRN PCH SFT ELC BELT REED VLV,$288.80,$0.00,$288.80,$129.96,$206.12,$0.00,$49.76,$0.00,$0.00,$50.57,$288.80,$0.00,$144.40,$228.73,$231.04,$0.00,$45.20,$0.00,$45.98,$0.00
G15144,SUP,HCPCS C2617,,G15144  -  SET STNT .018IN SM 2 PGTL CRV 7FR 14CM STRL RADOPQ PSTNR GW,$287.00,$0.00,$287.00,$129.15,$204.83,$0.00,$49.45,$0.00,$0.00,$50.25,$287.00,$0.00,$143.50,$227.30,$229.60,$0.00,$44.92,$0.00,$45.69,$0.00
G15145,SUP,HCPCS C2617,,G15145  -  SET STNT .038IN 2 PGTL CRV FLFRM 6FR 22CM BLK STRL 145CM,$287.00,$0.00,$287.00,$129.15,$204.83,$0.00,$49.45,$0.00,$0.00,$50.25,$287.00,$0.00,$143.50,$227.30,$229.60,$0.00,$44.92,$0.00,$45.69,$0.00
G15146,SUP,HCPCS C2617,,G15146  -  SET STNT .038IN 2 PGTL CRV FLFRM 6FR 24CM BLK STRL 145CM,$287.00,$0.00,$287.00,$129.15,$204.83,$0.00,$49.45,$0.00,$0.00,$50.25,$287.00,$0.00,$143.50,$227.30,$229.60,$0.00,$44.92,$0.00,$45.69,$0.00
G15147,SUP,HCPCS C2617,,G15147  -  SET STNT .038IN 2 PGTL CRV FLFRM 6FR 26CM BLK STRL 145CM,$287.00,$0.00,$287.00,$129.15,$204.83,$0.00,$49.45,$0.00,$0.00,$50.25,$287.00,$0.00,$143.50,$227.30,$229.60,$0.00,$44.92,$0.00,$45.69,$0.00
G15148,SUP,HCPCS C2617,,G15148  -  SET STNT .038IN 2 PGTL CRV 6FR 28CM BLK STRL 145CM RADOPQ,$287.00,$0.00,$287.00,$129.15,$204.83,$0.00,$49.45,$0.00,$0.00,$50.25,$287.00,$0.00,$143.50,$227.30,$229.60,$0.00,$44.92,$0.00,$45.69,$0.00
G15149,SUP,HCPCS C2627,,G15149  -  SET STNT .038IN 2 PGTL CRV STRG FLFRM 6FR 30CM BLK STRL 145,$137.90,$0.00,$137.90,$74.88,$98.42,$0.00,$23.76,$0.00,$0.00,$24.15,$137.90,$0.00,$68.95,$109.22,$110.32,$0.00,$21.58,$0.00,$21.95,$0.00
G15150,SUP,HCPCS C2617,,G15150  -  SET CATH LOOP 14FR 23CM BLU SFLX 1 WY STPCK NDL OBT CNCT,$251.13,$0.00,$251.13,$113.01,$179.23,$0.00,$43.27,$0.00,$0.00,$43.97,$251.13,$0.00,$125.56,$198.89,$200.90,$0.00,$39.30,$0.00,$39.98,$0.00
G15167,SUP,Custom 27203010,,G15167  -  DILATOR URTH 6-10FR MEATUS,$35.43,$0.00,$35.43,$0.00,$25.28,$0.00,$0.00,$0.00,$0.00,$0.00,$35.43,$0.00,$17.71,$28.06,$28.34,$0.00,$0.00,$0.00,$0.00,$0.00
G15168,SUP,HCPCS C2625,,G15168  -  CATHETER URO 8-14FR SPRT SFT LOPRFL NKNK CRV PERC,$141.45,$0.00,$141.45,$63.65,$100.95,$0.00,$24.37,$0.00,$0.00,$24.77,$141.45,$0.00,$70.73,$112.03,$113.16,$0.00,$22.14,$0.00,$22.52,$0.00
G15170,SUP,Custom 27203010,,G15170  -  SET NPHSTM PGTL CRV 8.2FR 125CM DRETLER STNT GW,$59.40,$0.00,$59.40,$0.00,$42.39,$0.00,$0.00,$0.00,$0.00,$0.00,$59.40,$0.00,$29.70,$47.04,$47.52,$0.00,$0.00,$0.00,$0.00,$0.00
G15172,SUP,HCPCS C1758,,G15172  -  CATHETER URTH 22-24FR RTNR FL TRC TEMP TRC,$31.63,$0.00,$31.63,$17.17,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
G15193,SUP,HCPCS C2617,,G15193  -  CATHETER URET 3FR 70CM RND TIP STY RT,$287.00,$0.00,$287.00,$129.15,$204.83,$0.00,$49.45,$0.00,$0.00,$50.25,$287.00,$0.00,$143.50,$227.30,$229.60,$0.00,$44.92,$0.00,$45.69,$0.00
G15195,SUP,HCPCS C1758,,G15195  -  SET STNT .038IN 2 PGTL CRV STRG FLFRM 6FR 20CM BLK STRL 145,$31.90,$0.00,$31.90,$17.32,$22.77,$0.00,$5.50,$0.00,$0.00,$5.59,$31.90,$0.00,$15.95,$25.26,$25.52,$0.00,$4.99,$0.00,$5.08,$0.00
G15196,SUP,HCPCS C2627,,G15196  -  CATHETER URET 2FR 115CM LSR ADPR,$256.80,$0.00,$256.80,$139.44,$183.28,$0.00,$44.25,$0.00,$0.00,$44.96,$256.80,$0.00,$128.40,$203.39,$205.44,$0.00,$40.19,$0.00,$40.88,$0.00
G15211,SUP,HCPCS C1773,,G15211  -  FOLLOWER URTH 10FR 35.5CM PHLPS DIL DIST TIP THRD WO SDPRT,$664.55,$0.00,$664.55,$360.85,$474.29,$0.00,$114.50,$0.00,$0.00,$116.36,$664.55,$0.00,$332.28,$526.32,$531.64,$0.00,$104.00,$0.00,$105.80,$0.00
G15214,SUP,HCPCS C1729,,G15214  -  FORCEPS SPEC RTRVL 3.3FR 115CM MS TTH FLXB SHFT,$188.10,$0.00,$188.10,$102.14,$134.25,$0.00,$32.41,$0.00,$0.00,$32.93,$188.10,$0.00,$94.05,$148.98,$150.48,$0.00,$29.44,$0.00,$29.95,$0.00
G15216,SUP,HCPCS C1758,,G15216  -  SET NPHSTM 14FR 19.5CM STRL LTX CK CATH CNN COPE LOOP NTR,$27.83,$0.00,$27.83,$15.11,$19.86,$0.00,$4.79,$0.00,$0.00,$4.87,$27.83,$0.00,$13.91,$22.04,$22.26,$0.00,$4.35,$0.00,$4.43,$0.00
G15219,SUP,Custom 27203010,,G15219  -  CATHETER URET .038IN 5FR 70CM OP-EN MOD,$25.30,$0.00,$25.30,$0.00,$18.06,$0.00,$0.00,$0.00,$0.00,$0.00,$25.30,$0.00,$12.65,$20.04,$20.24,$0.00,$0.00,$0.00,$0.00,$0.00
G15221,SUP,HCPCS C1892,,G15221  -  ADAPTER CATH 7-10FR T-B M LL LD TM,$136.63,$0.00,$136.63,$74.19,$97.51,$0.00,$23.54,$0.00,$0.00,$23.92,$136.63,$0.00,$68.31,$108.21,$109.30,$0.00,$21.38,$0.00,$21.75,$0.00
G15223,SUP,HCPCS C2625,,G15223  -  SET INTRO STD 20FR 37CM 32CM PLWY 2 KNOB SHTH GW,$160.30,$0.00,$160.30,$72.14,$114.41,$0.00,$27.62,$0.00,$0.00,$28.07,$160.30,$0.00,$80.15,$126.96,$128.24,$0.00,$25.09,$0.00,$25.52,$0.00
G15224,SUP,HCPCS C2625,,G15224  -  SET STNT .038IN 5MM PGTL CRV 6FR 75CM BLK STRL 100CM BNDR,$160.30,$0.00,$160.30,$72.14,$114.41,$0.00,$27.62,$0.00,$0.00,$28.07,$160.30,$0.00,$80.15,$126.96,$128.24,$0.00,$25.09,$0.00,$25.52,$0.00
G15225,SUP,HCPCS C1769,,G15225  -  SET STNT .038IN 5MM PGTL CRV 6FR 75CM BLK STRL 100CM BNDR,$38.88,$0.00,$38.88,$21.11,$27.75,$0.00,$6.70,$0.00,$0.00,$6.81,$38.88,$0.00,$19.44,$30.79,$31.10,$0.00,$6.08,$0.00,$6.19,$0.00
G15227,SUP,HCPCS C2625,,G15227  -  SET STNT 3CM 2 PGTL CRV 7FR 22CM STRL 145CM KWART RETRO-INJ,$300.60,$0.00,$300.60,$135.27,$214.54,$0.00,$51.79,$0.00,$0.00,$52.63,$300.60,$0.00,$150.30,$238.08,$240.48,$0.00,$47.04,$0.00,$47.86,$0.00
G15230,SUP,Custom 27203010,,G15230  -  FORCEP SPEC RTRVL 65CM 5.2FR 1 JAW ALGTR TOOTH FLXB SHFT,$646.00,$0.00,$646.00,$0.00,$461.05,$0.00,$0.00,$0.00,$0.00,$0.00,$646.00,$0.00,$323.00,$511.63,$516.80,$0.00,$0.00,$0.00,$0.00,$0.00
G15233,SUP,HCPCS C2617,,G15233  -  GUIDEWIRE ESCP STD .035IN 145CM FXCR SS,$66.63,$0.00,$66.63,$29.98,$47.55,$0.00,$11.48,$0.00,$0.00,$11.67,$66.63,$0.00,$33.31,$52.77,$53.30,$0.00,$10.43,$0.00,$10.61,$0.00
G15240,SUP,HCPCS C1729,,G15240  -  TUBE CNCT 10FR 30CM M LL DRN BG,$150.55,$0.00,$150.55,$81.75,$107.45,$0.00,$25.94,$0.00,$0.00,$26.36,$150.55,$0.00,$75.28,$119.24,$120.44,$0.00,$23.56,$0.00,$23.97,$0.00
G15248,SUP,HCPCS C1769,,G15248  -  SET NPHSTM 10FR 19.5CM COPE LOOP CATH CNN GW,$51.00,$0.00,$51.00,$27.69,$36.40,$0.00,$8.79,$0.00,$0.00,$8.93,$51.00,$0.00,$25.50,$40.39,$40.80,$0.00,$7.98,$0.00,$8.12,$0.00
G15252,SUP,HCPCS C1769,,G15252  -  GUIDEWIRE VASC STD STRG .028IN 145CM STRL 3CM FXCR FLX TP SS,$51.00,$0.00,$51.00,$27.69,$36.40,$0.00,$8.79,$0.00,$0.00,$8.93,$51.00,$0.00,$25.50,$40.39,$40.80,$0.00,$7.98,$0.00,$8.12,$0.00
G15256,SUP,HCPCS C1769,,G15256  -  GUIDEWIRE VASC STD STRG .035IN 145CM STRL 3CM FX COR FLX TP,$51.00,$0.00,$51.00,$27.69,$36.40,$0.00,$8.79,$0.00,$0.00,$8.93,$51.00,$0.00,$25.50,$40.39,$40.80,$0.00,$7.98,$0.00,$8.12,$0.00
G15261,SUP,HCPCS C2627,,G15261  -  CUFF CONTINENCE 10ML NS TEMP INTOP CAP SYR SIL M REUSE,$144.10,$0.00,$144.10,$78.25,$102.84,$0.00,$24.83,$0.00,$0.00,$25.23,$144.10,$0.00,$72.05,$114.13,$115.28,$0.00,$22.55,$0.00,$22.94,$0.00
G15262,SUP,Custom 27203010,,G15262  -  GUIDEWIRE URO STD STRG .038IN 145CM STRL 3CM FLX TP FXCR SS,$177.10,$0.00,$177.10,$0.00,$126.40,$0.00,$0.00,$0.00,$0.00,$0.00,$177.10,$0.00,$88.55,$140.26,$141.68,$0.00,$0.00,$0.00,$0.00,$0.00
G15276,SUP,Custom 27203010,,G15276  -  ADAPTER CATH 2 M LL,$60.50,$0.00,$60.50,$0.00,$43.18,$0.00,$0.00,$0.00,$0.00,$0.00,$60.50,$0.00,$30.25,$47.92,$48.40,$0.00,$0.00,$0.00,$0.00,$0.00
G15279,SUP,Custom 27203010,,G15279  -  NEEDLE ESCP 25GA 5FR 35CM 8MM WMS CSCP,$46.83,$0.00,$46.83,$0.00,$33.42,$0.00,$0.00,$0.00,$0.00,$0.00,$46.83,$0.00,$23.41,$37.09,$37.46,$0.00,$0.00,$0.00,$0.00,$0.00
G15280,SUP,HCPCS C1769,,G15280  -  NEEDLE ESCP 14FR 20CM HATTER ASP CSCP FLXB,$51.00,$0.00,$51.00,$27.69,$36.40,$0.00,$8.79,$0.00,$0.00,$8.93,$51.00,$0.00,$25.50,$40.39,$40.80,$0.00,$7.98,$0.00,$8.12,$0.00
G15284,SUP,HCPCS C1758,,G15284  -  GUIDEWIRE VASC STD .035IN 145CM STRL MOV COR SS SLIP-COAT,$40.70,$0.00,$40.70,$22.10,$29.05,$0.00,$7.01,$0.00,$0.00,$7.13,$40.70,$0.00,$20.35,$32.23,$32.56,$0.00,$6.37,$0.00,$6.48,$0.00
G15290,SUP,Custom 27203010,,G15290  -  CATHETER ESCP 2FR 3CM SILBER ASP,$37.40,$0.00,$37.40,$0.00,$26.69,$0.00,$0.00,$0.00,$0.00,$0.00,$37.40,$0.00,$18.70,$29.62,$29.92,$0.00,$0.00,$0.00,$0.00,$0.00
G15291,SUP,Custom 27203010,,G15291  -  NEEDLE PRC 22GA 20CM STRL SKNY ECHTP CHBA TIP PERC US IMG,$41.80,$0.00,$41.80,$0.00,$29.83,$0.00,$0.00,$0.00,$0.00,$0.00,$41.80,$0.00,$20.90,$33.11,$33.44,$0.00,$0.00,$0.00,$0.00,$0.00
G15292,SUP,Custom 27203010,,G15292  -  NEEDLE PRC TROC 18GA 20CM STRL ECHTP 2 PRT DISP US IMG,$93.50,$0.00,$93.50,$0.00,$66.73,$0.00,$0.00,$0.00,$0.00,$0.00,$93.50,$0.00,$46.75,$74.05,$74.80,$0.00,$0.00,$0.00,$0.00,$0.00
G15293,SUP,Custom 27203010,,G15293  -  NEEDLE PRC 18GA 22GA 14-22CM MTPLK ECHTP COAX PERC,$79.70,$0.00,$79.70,$0.00,$56.88,$0.00,$0.00,$0.00,$0.00,$0.00,$79.70,$0.00,$39.85,$63.12,$63.76,$0.00,$0.00,$0.00,$0.00,$0.00
G15296,SUP,Custom 27203010,,G15296  -  NEEDLE TROC STD 18GA 25CM ECHTP 2 PRT DISP,$60.50,$0.00,$60.50,$0.00,$43.18,$0.00,$0.00,$0.00,$0.00,$0.00,$60.50,$0.00,$30.25,$47.92,$48.40,$0.00,$0.00,$0.00,$0.00,$0.00
G15299,SUP,HCPCS C1758,,G15299  -  NEEDLE ESCP 23GA 3.7FR 35CM WMS CSCP,$29.70,$0.00,$29.70,$16.13,$21.20,$0.00,$5.12,$0.00,$0.00,$5.20,$29.70,$0.00,$14.85,$23.52,$23.76,$0.00,$4.65,$0.00,$4.73,$0.00
G15300,SUP,HCPCS C1758,,G15300  -  ADAPTER ESCP ANG STRL LF SCHOBORG LSR FBR CATH URET DISP,$83.50,$0.00,$83.50,$45.34,$59.59,$0.00,$14.39,$0.00,$0.00,$14.62,$83.50,$0.00,$41.75,$66.13,$66.80,$0.00,$13.07,$0.00,$13.29,$0.00
G15301,SUP,HCPCS C1758,,G15301  -  CATHETER URET 40D .035IN TPR STRG 5FR 70CM 145CM SF GW NYL,$72.60,$0.00,$72.60,$39.42,$51.81,$0.00,$12.51,$0.00,$0.00,$12.71,$72.60,$0.00,$36.30,$57.50,$58.08,$0.00,$11.36,$0.00,$11.56,$0.00
G15302,SUP,HCPCS C1758,,G15302  -  CATHETER URET 40D .035IN TPR 6FR 70CM 145CM GW,$72.60,$0.00,$72.60,$39.42,$51.81,$0.00,$12.51,$0.00,$0.00,$12.71,$72.60,$0.00,$36.30,$57.50,$58.08,$0.00,$11.36,$0.00,$11.56,$0.00
G15397,SUP,HCPCS C2617,,G15397  -  CATHETER URET 40D .035IN 5FR 70CM 145CM FLXB ANG TIP BVL END,$215.55,$0.00,$215.55,$97.00,$153.84,$0.00,$37.14,$0.00,$0.00,$37.74,$215.55,$0.00,$107.78,$170.72,$172.44,$0.00,$33.73,$0.00,$34.32,$0.00
G15422,SUP,Custom 27203010,,G15422  -  FORCEP SPEC RTRVL 65CM 5.2FR 2 JAW ALGTR TOOTH,$656.00,$0.00,$656.00,$0.00,$468.19,$0.00,$0.00,$0.00,$0.00,$0.00,$656.00,$0.00,$328.00,$519.55,$524.80,$0.00,$0.00,$0.00,$0.00,$0.00
G15424,SUP,HCPCS C1758,,G15424  -  STENT URET 2 PGTL CRV 4.7FR 8CM STRL SFLX PED DISP ACPT .035,$31.63,$0.00,$31.63,$17.17,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
G15425,SUP,HCPCS C1758,,G15425  -  CATHETER URET .018IN 3FR 70CM OP-EN GW MOD,$31.63,$0.00,$31.63,$17.17,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
G15429,SUP,HCPCS C1726,,G15429  -  CATHETER URET .025IN 4FR 70CM OP-EN GW MOD,$45.00,$0.00,$45.00,$24.44,$32.12,$0.00,$7.75,$0.00,$0.00,$7.88,$45.00,$0.00,$22.50,$35.64,$36.00,$0.00,$7.04,$0.00,$7.16,$0.00
G15434,SUP,HCPCS C1726,,G15434  -  DEVICE SUT 10D 17CM PEREYRA LGT CR REUSE,$45.00,$0.00,$45.00,$24.44,$32.12,$0.00,$7.75,$0.00,$0.00,$7.88,$45.00,$0.00,$22.50,$35.64,$36.00,$0.00,$7.04,$0.00,$7.16,$0.00
G15435,SUP,HCPCS C1726,,G15435  -  CATHETER URDY 7FR 38CM STRL 2 LUM URETER DISP,$54.23,$0.00,$54.23,$29.44,$38.70,$0.00,$9.34,$0.00,$0.00,$9.49,$54.23,$0.00,$27.11,$42.95,$43.38,$0.00,$8.49,$0.00,$8.63,$0.00
G15443,SUP,HCPCS C2617,,G15443  -  CATHETER URDY 7.4FR 30CM 3 LUM,$287.00,$0.00,$287.00,$129.15,$204.83,$0.00,$49.45,$0.00,$0.00,$50.25,$287.00,$0.00,$143.50,$227.30,$229.60,$0.00,$44.92,$0.00,$45.69,$0.00
G15444,SUP,HCPCS C2617,,G15444  -  SET STNT .038IN 2 PGTL CRV STRG FLFRM 8.5FR 20CM BLK STRL,$287.00,$0.00,$287.00,$129.15,$204.83,$0.00,$49.45,$0.00,$0.00,$50.25,$287.00,$0.00,$143.50,$227.30,$229.60,$0.00,$44.92,$0.00,$45.69,$0.00
G15469,SUP,HCPCS C1769,,G15469  -  SET STNT .038IN 2 PGTL CRV STRG FLFRM 7FR 20CM BLK STRL 145,$207.90,$0.00,$207.90,$112.89,$148.38,$0.00,$35.82,$0.00,$0.00,$36.40,$207.90,$0.00,$103.95,$164.66,$166.32,$0.00,$32.54,$0.00,$33.10,$0.00
G15473,SUP,HCPCS C2625,,G15473  -  SET INTRO .035IN STRG 8-14FR 18GA 14CM STRL 10CM SP TUBE NDL,$160.30,$0.00,$160.30,$72.14,$114.41,$0.00,$27.62,$0.00,$0.00,$28.07,$160.30,$0.00,$80.15,$126.96,$128.24,$0.00,$25.09,$0.00,$25.52,$0.00
G15475,SUP,Custom 27203010,,G15475  -  SET STNT .038IN 5MM PGTL CRV 8.2FR 75CM STRL 100CM BNDR CATH,$29.70,$0.00,$29.70,$0.00,$21.20,$0.00,$0.00,$0.00,$0.00,$0.00,$29.70,$0.00,$14.85,$23.52,$23.76,$0.00,$0.00,$0.00,$0.00,$0.00
G15476,SUP,Custom 27203010,,G15476  -  ADAPTER CATH 9FR STRL CKFL SDARM STPCK F LL PEEL OPN DISP,$27.50,$0.00,$27.50,$0.00,$19.63,$0.00,$0.00,$0.00,$0.00,$0.00,$27.50,$0.00,$13.75,$21.78,$22.00,$0.00,$0.00,$0.00,$0.00,$0.00
G15495,SUP,HCPCS C2625,,G15495  -  SET STNT 3CM 145CM STRL KWART RETRO-INJ INSRTR TETH RELS SLV,$300.60,$0.00,$300.60,$135.27,$214.54,$0.00,$51.79,$0.00,$0.00,$52.63,$300.60,$0.00,$150.30,$238.08,$240.48,$0.00,$47.04,$0.00,$47.86,$0.00
G15500,SUP,HCPCS C1758,,G15500  -  ADAPTER CATH 9FR STRL CKFL SLF SL F LL DISP,$32.90,$0.00,$32.90,$17.86,$23.48,$0.00,$5.67,$0.00,$0.00,$5.76,$32.90,$0.00,$16.45,$26.06,$26.32,$0.00,$5.15,$0.00,$5.24,$0.00
G15513,SUP,Custom 27203010,,G15513  -  CATHETER URET 4FR 70CM SPRL TIP ACC LG SDPRT ACPT .028IN GW,$115.13,$0.00,$115.13,$0.00,$82.16,$0.00,$0.00,$0.00,$0.00,$0.00,$115.13,$0.00,$57.56,$91.18,$92.10,$0.00,$0.00,$0.00,$0.00,$0.00
G15514,SUP,HCPCS C2617,,G15514  -  NEEDLE PRC 18GA 25CM ECHTP TROC STY SHTH TFE RNL,$215.55,$0.00,$215.55,$97.00,$153.84,$0.00,$37.14,$0.00,$0.00,$37.74,$215.55,$0.00,$107.78,$170.72,$172.44,$0.00,$33.73,$0.00,$34.32,$0.00
G15530,SUP,HCPCS C1769,,G15530  -  STENT URET 2 PGTL CRV 7FR 20CM STRL SFLX DISP ACPT .038IN GW,$58.65,$0.00,$58.65,$31.85,$41.86,$0.00,$10.11,$0.00,$0.00,$10.27,$58.65,$0.00,$29.33,$46.45,$46.92,$0.00,$9.18,$0.00,$9.34,$0.00
G15532,SUP,HCPCS C2617,,G15532  -  GUIDEWIRE ESCP STD .028IN 145CM FXCR HDRPH,$261.38,$0.00,$261.38,$117.62,$186.54,$0.00,$45.03,$0.00,$0.00,$45.76,$261.38,$0.00,$130.69,$207.01,$209.10,$0.00,$40.91,$0.00,$41.61,$0.00
G15540,SUP,HCPCS C1726,,G15540  -  SET STNT .025IN 3.7FR 21-32CM STRL CATH RADOPQ MTLNTH PSTNR,$97.18,$0.00,$97.18,$52.77,$69.35,$0.00,$16.74,$0.00,$0.00,$17.01,$97.18,$0.00,$48.59,$76.97,$77.74,$0.00,$15.21,$0.00,$15.47,$0.00
G15579,SUP,HCPCS C1758,,G15579  -  CATHETER URDY 7.4FR 30CM 3 LUM BLN,$32.90,$0.00,$32.90,$17.86,$23.48,$0.00,$5.67,$0.00,$0.00,$5.76,$32.90,$0.00,$16.45,$26.06,$26.32,$0.00,$5.15,$0.00,$5.24,$0.00
G15600,SUP,HCPCS C1769,,G15600  -  CATHETER URET .028IN 4FR 115CM FLXTP OP-EN GW MOD FLX TP,$58.65,$0.00,$58.65,$31.85,$41.86,$0.00,$10.11,$0.00,$0.00,$10.27,$58.65,$0.00,$29.33,$46.45,$46.92,$0.00,$9.18,$0.00,$9.34,$0.00
G15602,SUP,HCPCS C1769,,G15602  -  GUIDEWIRE ESCP STD .035IN 145CM FXCR HDRPH,$58.65,$0.00,$58.65,$31.85,$41.86,$0.00,$10.11,$0.00,$0.00,$10.27,$58.65,$0.00,$29.33,$46.45,$46.92,$0.00,$9.18,$0.00,$9.34,$0.00
G15603,SUP,HCPCS C1726,,G15603  -  GUIDEWIRE URO BNTSN CRV STRG .035IN 145CM STRL 15CM FXCR FLX,$45.00,$0.00,$45.00,$24.44,$32.12,$0.00,$7.75,$0.00,$0.00,$7.88,$45.00,$0.00,$22.50,$35.64,$36.00,$0.00,$7.04,$0.00,$7.16,$0.00
G15606,SUP,HCPCS C2617,,G15606  -  CATHETER URDY 10FR 39CM 2 LUM,$251.13,$0.00,$251.13,$113.01,$179.23,$0.00,$43.27,$0.00,$0.00,$43.97,$251.13,$0.00,$125.56,$198.89,$200.90,$0.00,$39.30,$0.00,$39.98,$0.00
G15607,SUP,HCPCS C2617,,G15607  -  SET STNT .018IN 2 PGTL CRV CDE 3FR 4FR 8CM GRY STRL CATH,$251.13,$0.00,$251.13,$113.01,$179.23,$0.00,$43.27,$0.00,$0.00,$43.97,$251.13,$0.00,$125.56,$198.89,$200.90,$0.00,$39.30,$0.00,$39.98,$0.00
G15608,SUP,HCPCS C2617,,G15608  -  SET STNT .018IN 2 PGTL CRV CDE 3FR 4FR 10CM GRY STRL CATH,$251.13,$0.00,$251.13,$113.01,$179.23,$0.00,$43.27,$0.00,$0.00,$43.97,$251.13,$0.00,$125.56,$198.89,$200.90,$0.00,$39.30,$0.00,$39.98,$0.00
G15610,SUP,HCPCS C2617,,G15610  -  SET STNT .018IN 2 PGTL CRV CDE 3FR 4FR 12CM GRY STRL CATH,$215.55,$0.00,$215.55,$97.00,$153.84,$0.00,$37.14,$0.00,$0.00,$37.74,$215.55,$0.00,$107.78,$170.72,$172.44,$0.00,$33.73,$0.00,$34.32,$0.00
G15621,SUP,Custom 27203010,,G15621  -  STENT URET 2 PGTL CRV 4.7FR 10CM STRL SFLX PED DISP ACPT,$48.08,$0.00,$48.08,$0.00,$34.31,$0.00,$0.00,$0.00,$0.00,$0.00,$48.08,$0.00,$24.04,$38.08,$38.46,$0.00,$0.00,$0.00,$0.00,$0.00
G15624,SUP,HCPCS C2617,,G15624  -  NEEDLE PRC STD 18GA 11CM ECHTP 2 PRT TROC DISP,$288.80,$0.00,$288.80,$129.96,$206.12,$0.00,$49.76,$0.00,$0.00,$50.57,$288.80,$0.00,$144.40,$228.73,$231.04,$0.00,$45.20,$0.00,$45.98,$0.00
G15632,SUP,HCPCS C2627,,G15632  -  SET STNT .018IN SM 2 PGTL CRV CDE 3FR 7FR 6CM STRL RADOPQ GW,$258.05,$0.00,$258.05,$140.12,$184.17,$0.00,$44.46,$0.00,$0.00,$45.18,$258.05,$0.00,$129.03,$204.38,$206.44,$0.00,$40.38,$0.00,$41.08,$0.00
G15636,SUP,HCPCS C1758,,G15636  -  SET DIL 6-12FR 60CM WO GW PE HDRPH URET,$47.30,$0.00,$47.30,$25.68,$33.76,$0.00,$8.15,$0.00,$0.00,$8.28,$47.30,$0.00,$23.65,$37.46,$37.84,$0.00,$7.40,$0.00,$7.53,$0.00
G15637,SUP,HCPCS C1758,,G15637  -  CATHETER URET 5FR 70CM ECHTP OP-EN ACPT .038IN GW,$54.40,$0.00,$54.40,$29.54,$38.83,$0.00,$9.37,$0.00,$0.00,$9.53,$54.40,$0.00,$27.20,$43.08,$43.52,$0.00,$8.51,$0.00,$8.66,$0.00
G15638,SUP,HCPCS C1758,,G15638  -  CATHETER URET .038IN 6FR 70CM ECHTP OP-EN GW,$54.40,$0.00,$54.40,$29.54,$38.83,$0.00,$9.37,$0.00,$0.00,$9.53,$54.40,$0.00,$27.20,$43.08,$43.52,$0.00,$8.51,$0.00,$8.66,$0.00
G15639,SUP,HCPCS C1758,,G15639  -  CATHETER URET .038IN 7FR 70CM ECHTP OP-EN GW,$54.40,$0.00,$54.40,$29.54,$38.83,$0.00,$9.37,$0.00,$0.00,$9.53,$54.40,$0.00,$27.20,$43.08,$43.52,$0.00,$8.51,$0.00,$8.66,$0.00
G15650,SUP,Custom 27203010,,G15650  -  CATHETER URET .038IN 8FR 70CM ECHTP OP-EN GW,$29.70,$0.00,$29.70,$0.00,$21.20,$0.00,$0.00,$0.00,$0.00,$0.00,$29.70,$0.00,$14.85,$23.52,$23.76,$0.00,$0.00,$0.00,$0.00,$0.00
G15670,SUP,HCPCS C1758,,G15670  -  ADAPTER CATH UNV 9FR STRL CKFL F LL DISP,$150.68,$0.00,$150.68,$81.82,$107.54,$0.00,$25.96,$0.00,$0.00,$26.38,$150.68,$0.00,$75.34,$119.34,$120.54,$0.00,$23.58,$0.00,$23.99,$0.00
G15731,SUP,HCPCS C1769,,G15731  -  GUIDEWIRE VASC .032IN 145CM AMPTZ MOV COR STRG TPR,$69.98,$0.00,$69.98,$38.00,$49.94,$0.00,$12.06,$0.00,$0.00,$12.25,$69.98,$0.00,$34.99,$55.42,$55.98,$0.00,$10.95,$0.00,$11.14,$0.00
G15732,SUP,HCPCS C1769,,G15732  -  CATHETER URET .045IN PGTL CRV 8FR 70CM 145CM SDPRT SHFT GW,$69.98,$0.00,$69.98,$38.00,$49.94,$0.00,$12.06,$0.00,$0.00,$12.25,$69.98,$0.00,$34.99,$55.42,$55.98,$0.00,$10.95,$0.00,$11.14,$0.00
G15733,SUP,HCPCS C1892,,G15733  -  GUIDEWIRE VASC .038IN 145CM LF 3CM AMPTZ 2 FLXB STF SS,$136.63,$0.00,$136.63,$74.19,$97.51,$0.00,$23.54,$0.00,$0.00,$23.92,$136.63,$0.00,$68.31,$108.21,$109.30,$0.00,$21.38,$0.00,$21.75,$0.00
G15739,SUP,HCPCS C1726,,G15739  -  POUCH SPEC RTRVL 5X2IN YLW LAPSAC SRG REM MORCELLATION INTGR,$54.23,$0.00,$54.23,$29.44,$38.70,$0.00,$9.34,$0.00,$0.00,$9.49,$54.23,$0.00,$27.11,$42.95,$43.38,$0.00,$8.49,$0.00,$8.63,$0.00
G15753,SUP,HCPCS C2627,,G15753  -  TUBE CNCT 14FR 11CM M LL DRN BG T-B ADPR,$72.73,$0.00,$72.73,$39.49,$51.90,$0.00,$12.53,$0.00,$0.00,$12.73,$72.73,$0.00,$36.36,$57.60,$58.18,$0.00,$11.38,$0.00,$11.58,$0.00
G15764,SUP,HCPCS C2627,,G15764  -  DILATOR URTH 6FR 37CM PE FSCA,$29.70,$0.00,$29.70,$16.13,$21.20,$0.00,$5.12,$0.00,$0.00,$5.20,$29.70,$0.00,$14.85,$23.52,$23.76,$0.00,$4.65,$0.00,$4.73,$0.00
G15766,SUP,Custom 27203010,,G15766  -  CATHETER URDY 4FR 60CM PRSS BLDR,$70.40,$0.00,$70.40,$0.00,$50.24,$0.00,$0.00,$0.00,$0.00,$0.00,$70.40,$0.00,$35.20,$55.76,$56.32,$0.00,$0.00,$0.00,$0.00,$0.00
G15771,SUP,Custom 27203010,,G15771  -  CATHETER URDY 12FR 36CM STRL LTX 5CM PRSS BLN SIL RCTL DISP,$626.88,$0.00,$626.88,$0.00,$447.40,$0.00,$0.00,$0.00,$0.00,$0.00,$626.88,$0.00,$313.44,$496.49,$501.50,$0.00,$0.00,$0.00,$0.00,$0.00
G15789,SUP,HCPCS C1729,,G15789  -  INTRODUCER ESCP 25.5CM 5X8IN LAPSAC LGR ACC PORT HNDL SS AL,$465.53,$0.00,$465.53,$252.78,$332.25,$0.00,$80.21,$0.00,$0.00,$81.51,$465.53,$0.00,$232.76,$368.70,$372.42,$0.00,$72.85,$0.00,$74.11,$0.00
G15792,SUP,HCPCS C1758,,G15792  -  SET NPHSTM 12FR 30CM STRL LTX 20CM COPE LOOP NDL GW DIL CNCT,$32.90,$0.00,$32.90,$17.86,$23.48,$0.00,$5.67,$0.00,$0.00,$5.76,$32.90,$0.00,$16.45,$26.06,$26.32,$0.00,$5.15,$0.00,$5.24,$0.00
G15803,SUP,HCPCS C1758,,G15803  -  CATHETER URET .038IN 5FR 120CM FLXTP OP-EN GW MOD,$27.83,$0.00,$27.83,$15.11,$19.86,$0.00,$4.79,$0.00,$0.00,$4.87,$27.83,$0.00,$13.91,$22.04,$22.26,$0.00,$4.35,$0.00,$4.43,$0.00
G15821,SUP,HCPCS C1758,,G15821  -  CATHETER URET 9FR 15CM WHSTLTP MOD LT,$31.63,$0.00,$31.63,$17.17,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
G15859,SUP,HCPCS C1758,,G15859  -  CATHETER URET 3FR 125CM RND TIP STY LT,$27.83,$0.00,$27.83,$15.11,$19.86,$0.00,$4.79,$0.00,$0.00,$4.87,$27.83,$0.00,$13.91,$22.04,$22.26,$0.00,$4.35,$0.00,$4.43,$0.00
G15864,SUP,Custom 27203010,,G15864  -  CATHETER URET 4FR 90CM WHSTLTP MOD RT,$69.58,$0.00,$69.58,$0.00,$49.66,$0.00,$0.00,$0.00,$0.00,$0.00,$69.58,$0.00,$34.79,$55.11,$55.66,$0.00,$0.00,$0.00,$0.00,$0.00
G15871,SUP,HCPCS C1758,,G15871  -  NEEDLE INJ 20GA 5FR 35CM 7MM WMS CSCP,$100.25,$0.00,$100.25,$54.44,$71.55,$0.00,$17.27,$0.00,$0.00,$17.55,$100.25,$0.00,$50.13,$79.40,$80.20,$0.00,$15.69,$0.00,$15.96,$0.00
G15873,SUP,HCPCS C1726,,G15873  -  CATHETER URET PGTL CRV 8.2FR 56CM SFLX,$49.10,$0.00,$49.10,$26.66,$35.04,$0.00,$8.46,$0.00,$0.00,$8.60,$49.10,$0.00,$24.55,$38.89,$39.28,$0.00,$7.68,$0.00,$7.82,$0.00
G15875,SUP,HCPCS C2625,,G15875  -  CATHETER URDY 7.4FR 30CM 3 LUM,$259.33,$0.00,$259.33,$116.70,$185.08,$0.00,$44.68,$0.00,$0.00,$45.41,$259.33,$0.00,$129.66,$205.39,$207.46,$0.00,$40.58,$0.00,$41.28,$0.00
G15876,SUP,HCPCS C2625,,G15876  -  SET STNT .038IN 5MM PGTL CRV 8.4FR 90CM STRL 125CM BNDR CATH,$225.50,$0.00,$225.50,$101.48,$160.94,$0.00,$38.85,$0.00,$0.00,$39.48,$225.50,$0.00,$112.75,$178.60,$180.40,$0.00,$35.29,$0.00,$35.90,$0.00
G15877,SUP,HCPCS C2625,,G15877  -  SET STNT .038IN 5MM PGTL CRV 7.2FR 90CM STRL 125CM BNDR CATH,$259.33,$0.00,$259.33,$116.70,$185.08,$0.00,$44.68,$0.00,$0.00,$45.41,$259.33,$0.00,$129.66,$205.39,$207.46,$0.00,$40.58,$0.00,$41.28,$0.00
G15878,SUP,HCPCS C2625,,G15878  -  SET STNT .038IN 5MM PGTL CRV 8.4FR 90CM STRL 125CM BNDR CATH,$225.50,$0.00,$225.50,$101.48,$160.94,$0.00,$38.85,$0.00,$0.00,$39.48,$225.50,$0.00,$112.75,$178.60,$180.40,$0.00,$35.29,$0.00,$35.90,$0.00
G15885,SUP,HCPCS C1758,,G15885  -  SET STNT .038IN 5MM PGTL CRV 7.2FR 90CM STRL 125CM BNDR CATH,$36.30,$0.00,$36.30,$19.71,$25.91,$0.00,$6.25,$0.00,$0.00,$6.36,$36.30,$0.00,$18.15,$28.75,$29.04,$0.00,$5.68,$0.00,$5.78,$0.00
G15889,SUP,HCPCS C1758,,G15889  -  CATHETER URET 3FR 70CM STF STY PED,$39.95,$0.00,$39.95,$21.69,$28.51,$0.00,$6.88,$0.00,$0.00,$6.99,$39.95,$0.00,$19.98,$31.64,$31.96,$0.00,$6.25,$0.00,$6.36,$0.00
G15899,SUP,HCPCS C1726,,G15899  -  CATHETER URET .038IN 5FR 70CM FLXTP OP-EN GW MOD,$45.00,$0.00,$45.00,$24.44,$32.12,$0.00,$7.75,$0.00,$0.00,$7.88,$45.00,$0.00,$22.50,$35.64,$36.00,$0.00,$7.04,$0.00,$7.16,$0.00
G15924,SUP,HCPCS C2617,,G15924  -  POUCH DRN 300ML STRL SFT ELC BELT REED VLV MECH REUSE,$76.63,$0.00,$76.63,$34.48,$54.69,$0.00,$13.20,$0.00,$0.00,$13.42,$76.63,$0.00,$38.31,$60.69,$61.30,$0.00,$11.99,$0.00,$12.20,$0.00
G15925,SUP,HCPCS C1729,,G15925  -  STENT URTH 8FR 40CM STRL FRLT KLG CNTR BLB SIL DISP,$404.80,$0.00,$404.80,$219.81,$288.91,$0.00,$69.75,$0.00,$0.00,$70.88,$404.80,$0.00,$202.40,$320.60,$323.84,$0.00,$63.35,$0.00,$64.44,$0.00
G15929,SUP,HCPCS C2617,,G15929  -  SET NPHSTM 10FR 19.5CM LTX COPE LOOP MOD CATH GW RTNT DISK,$251.13,$0.00,$251.13,$113.01,$179.23,$0.00,$43.27,$0.00,$0.00,$43.97,$251.13,$0.00,$125.56,$198.89,$200.90,$0.00,$39.30,$0.00,$39.98,$0.00
G15934,SUP,HCPCS C1769,,G15934  -  SET STNT .018IN 2 PGTL CRV CDE 3FR 4FR 14CM STRL CP MDRL,$58.65,$0.00,$58.65,$31.85,$41.86,$0.00,$10.11,$0.00,$0.00,$10.27,$58.65,$0.00,$29.33,$46.45,$46.92,$0.00,$9.18,$0.00,$9.34,$0.00
G15935,SUP,HCPCS C1769,,G15935  -  GUIDEWIRE ESCP STD STRG .025IN 145CM 3CM FLX TP FXCR SS,$52.08,$0.00,$52.08,$28.28,$37.17,$0.00,$8.97,$0.00,$0.00,$9.12,$52.08,$0.00,$26.04,$41.25,$41.66,$0.00,$8.15,$0.00,$8.29,$0.00
G16019,SUP,HCPCS C2617,,G16019  -  TUBE CNCT 14FR 30CM STRL 2 DRN PCH,$253.45,$0.00,$253.45,$114.05,$180.89,$0.00,$43.67,$0.00,$0.00,$44.38,$253.45,$0.00,$126.73,$200.73,$202.76,$0.00,$39.66,$0.00,$40.35,$0.00
G16020,SUP,HCPCS C2617,,G16020  -  SET STNT .035IN SM 2 PGTL CRV 4.7FR 4FR 10CM STRL CATH,$253.45,$0.00,$253.45,$114.05,$180.89,$0.00,$43.67,$0.00,$0.00,$44.38,$253.45,$0.00,$126.73,$200.73,$202.76,$0.00,$39.66,$0.00,$40.35,$0.00
G16021,SUP,HCPCS C2617,,G16021  -  SET STNT .035IN SM 2 PGTL CRV 4.7FR 4FR 14CM STRL CATH,$253.45,$0.00,$253.45,$114.05,$180.89,$0.00,$43.67,$0.00,$0.00,$44.38,$253.45,$0.00,$126.73,$200.73,$202.76,$0.00,$39.66,$0.00,$40.35,$0.00
G16035,SUP,HCPCS C2617,,G16035  -  SET STNT .035IN SM 2 PGTL CRV 4.7FR 4FR 16CM STRL CATH,$253.45,$0.00,$253.45,$114.05,$180.89,$0.00,$43.67,$0.00,$0.00,$44.38,$253.45,$0.00,$126.73,$200.73,$202.76,$0.00,$39.66,$0.00,$40.35,$0.00
G16040,SUP,HCPCS C2617,,G16040  -  SET STNT .038IN SM 2 PGTL CRV 7FR 4FR 12CM STRL CATH RADOPQ,$253.45,$0.00,$253.45,$114.05,$180.89,$0.00,$43.67,$0.00,$0.00,$44.38,$253.45,$0.00,$126.73,$200.73,$202.76,$0.00,$39.66,$0.00,$40.35,$0.00
G16112,SUP,Custom 27203010,,G16112  -  SET STNT .038IN SM 2 PGTL CRV 6FR 4FR 14CM STRL CATH RADOPQ,$69.58,$0.00,$69.58,$0.00,$49.66,$0.00,$0.00,$0.00,$0.00,$0.00,$69.58,$0.00,$34.79,$55.11,$55.66,$0.00,$0.00,$0.00,$0.00,$0.00
G16116,SUP,HCPCS C1726,,G16116  -  NEEDLE INJ 23GA 5FR 45CM 8MM WMS CSCP,$587.60,$0.00,$587.60,$319.07,$419.37,$0.00,$101.24,$0.00,$0.00,$102.88,$587.60,$0.00,$293.80,$465.38,$470.08,$0.00,$91.96,$0.00,$93.55,$0.00
G16120,SUP,HCPCS C2627,,G16120  -  SET DIL 6-30FR 30CM 16CM AMPTZ MOD RADOPQ SHTH RNL,$215.05,$0.00,$215.05,$116.77,$153.48,$0.00,$37.05,$0.00,$0.00,$37.65,$215.05,$0.00,$107.53,$170.32,$172.04,$0.00,$33.66,$0.00,$34.24,$0.00
G16121,SUP,HCPCS C1769,,G16121  -  INTRODUCER NPHSTM 18FR 12CM OB PLWY ACC SET GW TROC NDL SPBC,$215.05,$0.00,$215.05,$116.77,$153.48,$0.00,$37.05,$0.00,$0.00,$37.65,$215.05,$0.00,$107.53,$170.32,$172.04,$0.00,$33.66,$0.00,$34.24,$0.00
G16122,SUP,HCPCS C1769,,G16122  -  SET CATH TROC 20FR 12CM OB PLWY INTRO NDL GW SPBC,$215.05,$0.00,$215.05,$116.77,$153.48,$0.00,$37.05,$0.00,$0.00,$37.65,$215.05,$0.00,$107.53,$170.32,$172.04,$0.00,$33.66,$0.00,$34.24,$0.00
G16123,SUP,HCPCS C1769,,G16123  -  INTRODUCER NPHSTM 22FR 12CM PLWY ACC SET GW TROC NDL,$215.05,$0.00,$215.05,$116.77,$153.48,$0.00,$37.05,$0.00,$0.00,$37.65,$215.05,$0.00,$107.53,$170.32,$172.04,$0.00,$33.66,$0.00,$34.24,$0.00
G16187,SUP,HCPCS C2625,,G16187  -  POUCH DRN STRL BELT PLS ADJ REUSE,$160.30,$0.00,$160.30,$72.14,$114.41,$0.00,$27.62,$0.00,$0.00,$28.07,$160.30,$0.00,$80.15,$126.96,$128.24,$0.00,$25.09,$0.00,$25.52,$0.00
G16198,SUP,HCPCS C2627,,G16198  -  CATHETER URET .038IN 5FR 120CM OP-EN GW MOD,$165.73,$0.00,$165.73,$89.99,$118.28,$0.00,$28.55,$0.00,$0.00,$29.02,$165.73,$0.00,$82.86,$131.26,$132.58,$0.00,$25.94,$0.00,$26.38,$0.00
G16226,SUP,HCPCS C2617,,G16226  -  SET CATH 10FR 22CM RTNR BLN SPBC,$317.75,$0.00,$317.75,$142.99,$226.78,$0.00,$54.75,$0.00,$0.00,$55.64,$317.75,$0.00,$158.88,$251.66,$254.20,$0.00,$49.73,$0.00,$50.59,$0.00
G16227,SUP,HCPCS C2617,,G16227  -  SET STNT 5FR 8-20CM GRN GW CATH PSTNR RNL TRNSPLNT,$317.75,$0.00,$317.75,$142.99,$226.78,$0.00,$54.75,$0.00,$0.00,$55.64,$317.75,$0.00,$158.88,$251.66,$254.20,$0.00,$49.73,$0.00,$50.59,$0.00
G16228,SUP,HCPCS C2617,,G16228  -  SET STNT .028IN 6FR 8-20CM GRN STRL 145CM GRN CATH MTLNTH,$365.43,$0.00,$365.43,$164.44,$260.80,$0.00,$62.96,$0.00,$0.00,$63.98,$365.43,$0.00,$182.71,$289.42,$292.34,$0.00,$57.19,$0.00,$58.18,$0.00
G16229,SUP,HCPCS C2617,,G16229  -  SET STNT 6FR 22-32CM GRN GW CATH PSTNR RNL TRNSPLNT,$317.75,$0.00,$317.75,$142.99,$226.78,$0.00,$54.75,$0.00,$0.00,$55.64,$317.75,$0.00,$158.88,$251.66,$254.20,$0.00,$49.73,$0.00,$50.59,$0.00
G16230,SUP,HCPCS C2617,,G16230  -  SET STNT 7FR 8-20CM GRN GW CATH PSTNR RNL TRNSPLNT,$317.75,$0.00,$317.75,$142.99,$226.78,$0.00,$54.75,$0.00,$0.00,$55.64,$317.75,$0.00,$158.88,$251.66,$254.20,$0.00,$49.73,$0.00,$50.59,$0.00
G16658,SUP,HCPCS C1769,,G16658  -  SET STNT 8.5FR 8-20CM GRN GW CATH PSTNR RNL TRNSPLNT,$465.53,$0.00,$465.53,$252.78,$332.25,$0.00,$80.21,$0.00,$0.00,$81.51,$465.53,$0.00,$232.76,$368.70,$372.42,$0.00,$72.85,$0.00,$74.11,$0.00
G16672,SUP,Custom 27203010,,G16672  -  SET NPHSTM 12FR 19.5CM LTX COPE LOOP MOD CATH GW RTNT DISK,$482.33,$0.00,$482.33,$0.00,$344.24,$0.00,$0.00,$0.00,$0.00,$0.00,$482.33,$0.00,$241.16,$382.01,$385.86,$0.00,$0.00,$0.00,$0.00,$0.00
G16684,SUP,Custom 27203010,,G16684  -  EXTRACTOR STON FLT 3FR 115CM 4WR BSKT LSR PLMD,$60.50,$0.00,$60.50,$0.00,$43.18,$0.00,$0.00,$0.00,$0.00,$0.00,$60.50,$0.00,$30.25,$47.92,$48.40,$0.00,$0.00,$0.00,$0.00,$0.00
G16695,SUP,Custom 27203010,,G16695  -  NEEDLE INJ 23GA 3.7FR 35CM 8MM WMS CSCP,$73.15,$0.00,$73.15,$0.00,$52.21,$0.00,$0.00,$0.00,$0.00,$0.00,$73.15,$0.00,$36.58,$57.93,$58.52,$0.00,$0.00,$0.00,$0.00,$0.00
G16696,SUP,HCPCS C2627,,G16696  -  CATHETER PRSS 12FR 36CM 2CM BLN SIL RCTL,$166.10,$0.00,$166.10,$90.19,$118.55,$0.00,$28.62,$0.00,$0.00,$29.08,$166.10,$0.00,$83.05,$131.55,$132.88,$0.00,$25.99,$0.00,$26.44,$0.00
G16699,SUP,HCPCS C2627,,G16699  -  SET CATH TROC 8FR 54CM STRL DRN ADPR SPBC CYSTOSTOMY,$166.10,$0.00,$166.10,$90.19,$118.55,$0.00,$28.62,$0.00,$0.00,$29.08,$166.10,$0.00,$83.05,$131.55,$132.88,$0.00,$25.99,$0.00,$26.44,$0.00
G16702,SUP,HCPCS C1773,,G16702  -  SET CATH LOPRFL STD 10FR 54CM STRL TROC STY PLS DRN ADPR,$397.80,$0.00,$397.80,$216.01,$283.91,$0.00,$68.54,$0.00,$0.00,$69.65,$397.80,$0.00,$198.90,$315.06,$318.24,$0.00,$62.26,$0.00,$63.33,$0.00
G16705,SUP,HCPCS C1726,,G16705  -  FORCEPS SPEC RTRVL 2.5FR 10MM 115CM COAX SHTH GRSP,$98.20,$0.00,$98.20,$53.32,$70.09,$0.00,$16.92,$0.00,$0.00,$17.19,$98.20,$0.00,$49.10,$77.77,$78.56,$0.00,$15.37,$0.00,$15.63,$0.00
G16708,SUP,HCPCS C1758,,G16708  -  CATHETER URDY 7FR 43CM STRL 2 LUM LOOP URETHRA DISP,$28.60,$0.00,$28.60,$15.53,$20.41,$0.00,$4.93,$0.00,$0.00,$5.01,$28.60,$0.00,$14.30,$22.65,$22.88,$0.00,$4.48,$0.00,$4.55,$0.00
G16731,SUP,HCPCS C2617,,G16731  -  CATHETER URET .038IN 6FR 10CM FLXTP OP-EN GW MOD,$288.80,$0.00,$288.80,$129.96,$206.12,$0.00,$49.76,$0.00,$0.00,$50.57,$288.80,$0.00,$144.40,$228.73,$231.04,$0.00,$45.20,$0.00,$45.98,$0.00
G16740,SUP,HCPCS C2627,,G16740  -  SET CATH 12FR 16GA 30CM UNIVERSA MLCT 1 WY STPCK CNCT TUBE,$166.10,$0.00,$166.10,$90.19,$118.55,$0.00,$28.62,$0.00,$0.00,$29.08,$166.10,$0.00,$83.05,$131.55,$132.88,$0.00,$25.99,$0.00,$26.44,$0.00
G16758,SUP,HCPCS C2617,,G16758  -  SET STNT .038IN CDE 3FR 4FR 8-12CM STRL CATH RADOPQ MTLNTH,$66.63,$0.00,$66.63,$29.98,$47.55,$0.00,$11.48,$0.00,$0.00,$11.67,$66.63,$0.00,$33.31,$52.77,$53.30,$0.00,$10.43,$0.00,$10.61,$0.00
G16775,SUP,Custom 27203010,,G16775  -  STENT URTH 6FR 12CM STRL ZAONTZ PS DRN DISP HYPOSPADIAS,$78.10,$0.00,$78.10,$0.00,$55.74,$0.00,$0.00,$0.00,$0.00,$0.00,$78.10,$0.00,$39.05,$61.86,$62.48,$0.00,$0.00,$0.00,$0.00,$0.00
G16780,SUP,HCPCS C1726,,G16780  -  NEEDLE ESCP 4.5MM 18GA 10CM INCISING RNL FSCA,$49.10,$0.00,$49.10,$26.66,$35.04,$0.00,$8.46,$0.00,$0.00,$8.60,$49.10,$0.00,$24.55,$38.89,$39.28,$0.00,$7.68,$0.00,$7.82,$0.00
G16783,SUP,HCPCS C1758,,G16783  -  CATHETER URDY 7FR 30CM 2 LUM,$31.63,$0.00,$31.63,$17.17,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
G16784,SUP,HCPCS C1758,,G16784  -  CATHETER URET 4FR 110CM RND TIP RT,$31.63,$0.00,$31.63,$17.17,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
G16791,SUP,HCPCS C2627,,G16791  -  CATHETER URET 3FR 70CM RND TIP STY PORT LT,$50.60,$0.00,$50.60,$27.48,$36.11,$0.00,$8.72,$0.00,$0.00,$8.86,$50.60,$0.00,$25.30,$40.08,$40.48,$0.00,$7.92,$0.00,$8.06,$0.00
G16792,SUP,HCPCS C1758,,G16792  -  CATHETER SPBC 8FR 54CM CYSTOSTOMY SFT LOPRFL,$35.43,$0.00,$35.43,$19.24,$25.28,$0.00,$6.10,$0.00,$0.00,$6.20,$35.43,$0.00,$17.71,$28.06,$28.34,$0.00,$5.54,$0.00,$5.64,$0.00
G16816,SUP,HCPCS C1729,,G16816  -  CATHETER URET .038IN 5FR 70CM FLXTP OP-EN GW MOD,$216.33,$0.00,$216.33,$117.46,$154.39,$0.00,$37.27,$0.00,$0.00,$37.88,$216.33,$0.00,$108.16,$171.33,$173.06,$0.00,$33.85,$0.00,$34.44,$0.00
G16817,SUP,HCPCS C2625,,G16817  -  SET NPHSTM 12FR 40CM COPE LOOP MOD NDL GW CNN DIL,$139.40,$0.00,$139.40,$62.73,$99.49,$0.00,$24.02,$0.00,$0.00,$24.41,$139.40,$0.00,$69.70,$110.40,$111.52,$0.00,$21.82,$0.00,$22.19,$0.00
G16818,SUP,HCPCS C2625,,G16818  -  SET STNT .038IN 5MM 6FR 75CM STRL 100CM BNDR CATH RADOPQ,$139.40,$0.00,$139.40,$62.73,$99.49,$0.00,$24.02,$0.00,$0.00,$24.41,$139.40,$0.00,$69.70,$110.40,$111.52,$0.00,$21.82,$0.00,$22.19,$0.00
G16820,SUP,HCPCS C2617,,G16820  -  SET STNT .038IN 5MM 6FR 75CM STRL 100CM BNDR CATH RADOPQ,$288.80,$0.00,$288.80,$129.96,$206.12,$0.00,$49.76,$0.00,$0.00,$50.57,$288.80,$0.00,$144.40,$228.73,$231.04,$0.00,$45.20,$0.00,$45.98,$0.00
G16821,SUP,HCPCS C2617,,G16821  -  SET STNT .018IN SM 2 PGTL CRV CDE 3FR 16CM STRL CP MDRL CATH,$288.80,$0.00,$288.80,$129.96,$206.12,$0.00,$49.76,$0.00,$0.00,$50.57,$288.80,$0.00,$144.40,$228.73,$231.04,$0.00,$45.20,$0.00,$45.98,$0.00
G16876,SUP,HCPCS C1769,,G16876  -  SET STNT .018IN SM 2 PGTL CRV CDE 3FR 20CM STRL CP MDRL CATH,$39.33,$0.00,$39.33,$21.35,$28.07,$0.00,$6.78,$0.00,$0.00,$6.89,$39.33,$0.00,$19.66,$31.15,$31.46,$0.00,$6.15,$0.00,$6.26,$0.00
G16880,SUP,HCPCS C2617,,G16880  -  GUIDEWIRE ESCP 70CM STD STRG .038IN 145CM STRL 3CM FXCR FLX,$288.80,$0.00,$288.80,$129.96,$206.12,$0.00,$49.76,$0.00,$0.00,$50.57,$288.80,$0.00,$144.40,$228.73,$231.04,$0.00,$45.20,$0.00,$45.98,$0.00
G16881,SUP,HCPCS C2617,,G16881  -  SET STNT .018IN SM 2 PGTL CRV CDE 3FR 22CM STRL CP MDRL CATH,$288.80,$0.00,$288.80,$129.96,$206.12,$0.00,$49.76,$0.00,$0.00,$50.57,$288.80,$0.00,$144.40,$228.73,$231.04,$0.00,$45.20,$0.00,$45.98,$0.00
G16890,SUP,HCPCS C1758,,G16890  -  SET STNT .018IN SM 2 PGTL CRV CDE 3FR 24CM STRL CP MDRL CATH,$182.45,$0.00,$182.45,$99.07,$130.21,$0.00,$31.44,$0.00,$0.00,$31.95,$182.45,$0.00,$91.23,$144.50,$145.96,$0.00,$28.55,$0.00,$29.05,$0.00
G16893,SUP,HCPCS C1726,,G16893  -  SET CATH 7.5FR 25CM DEWAN URDY NDL SF WRE PLWY SHTH DIL SPBC,$510.95,$0.00,$510.95,$277.45,$364.67,$0.00,$88.03,$0.00,$0.00,$89.46,$510.95,$0.00,$255.48,$404.67,$408.76,$0.00,$79.96,$0.00,$81.34,$0.00
G16919,SUP,HCPCS C2627,,G16919  -  SYSTEM IRR URTSCP,$205.38,$0.00,$205.38,$111.52,$146.58,$0.00,$35.39,$0.00,$0.00,$35.96,$205.38,$0.00,$102.69,$162.66,$164.30,$0.00,$32.14,$0.00,$32.70,$0.00
G16920,SUP,HCPCS C2627,,G16920  -  CATHETER SPBC 8FR 20CM STRL MLCT SIL DISP,$205.38,$0.00,$205.38,$111.52,$146.58,$0.00,$35.39,$0.00,$0.00,$35.96,$205.38,$0.00,$102.69,$162.66,$164.30,$0.00,$32.14,$0.00,$32.70,$0.00
G16921,SUP,HCPCS C2627,,G16921  -  CATHETER SPBC 10FR 20CM MLCT WNG SFT SIL,$205.38,$0.00,$205.38,$111.52,$146.58,$0.00,$35.39,$0.00,$0.00,$35.96,$205.38,$0.00,$102.69,$162.66,$164.30,$0.00,$32.14,$0.00,$32.70,$0.00
G16922,SUP,HCPCS C2627,,G16922  -  CATHETER SPBC 12FR 20CM STRL MLCT SIL DISP,$205.38,$0.00,$205.38,$111.52,$146.58,$0.00,$35.39,$0.00,$0.00,$35.96,$205.38,$0.00,$102.69,$162.66,$164.30,$0.00,$32.14,$0.00,$32.70,$0.00
G16923,SUP,HCPCS C2627,,G16923  -  CATHETER SPBC 14FR 25CM STRL MLCT WNG SIL DISP,$205.38,$0.00,$205.38,$111.52,$146.58,$0.00,$35.39,$0.00,$0.00,$35.96,$205.38,$0.00,$102.69,$162.66,$164.30,$0.00,$32.14,$0.00,$32.70,$0.00
G16924,SUP,HCPCS C2627,,G16924  -  CATHETER SPBC 16FR 25CM STRL MLCT WNG SIL DISP,$205.38,$0.00,$205.38,$111.52,$146.58,$0.00,$35.39,$0.00,$0.00,$35.96,$205.38,$0.00,$102.69,$162.66,$164.30,$0.00,$32.14,$0.00,$32.70,$0.00
G16925,SUP,HCPCS C2627,,G16925  -  CATHETER SPBC 18FR 25CM MLCT WNG SFT SIL,$205.38,$0.00,$205.38,$111.52,$146.58,$0.00,$35.39,$0.00,$0.00,$35.96,$205.38,$0.00,$102.69,$162.66,$164.30,$0.00,$32.14,$0.00,$32.70,$0.00
G16926,SUP,HCPCS C2627,,G16926  -  CATHETER SPBC 20FR 25CM STRL MLCT WNG SIL DISP,$205.38,$0.00,$205.38,$111.52,$146.58,$0.00,$35.39,$0.00,$0.00,$35.96,$205.38,$0.00,$102.69,$162.66,$164.30,$0.00,$32.14,$0.00,$32.70,$0.00
G16927,SUP,HCPCS C2627,,G16927  -  CATHETER SPBC 22FR 25CM STRL MLCT WNG SIL DISP,$205.38,$0.00,$205.38,$111.52,$146.58,$0.00,$35.39,$0.00,$0.00,$35.96,$205.38,$0.00,$102.69,$162.66,$164.30,$0.00,$32.14,$0.00,$32.70,$0.00
G16938,SUP,HCPCS C2625,,G16938  -  CATHETER SPBC 24FR 25CM STRL MLCT WNG SFT SIL,$160.30,$0.00,$160.30,$72.14,$114.41,$0.00,$27.62,$0.00,$0.00,$28.07,$160.30,$0.00,$80.15,$126.96,$128.24,$0.00,$25.09,$0.00,$25.52,$0.00
G16939,SUP,Custom 27203010,,G16939  -  SET STNT .038IN 5MM PGTL CRV TPR 7FR 75CM STRL 100CM BNDR,$266.20,$0.00,$266.20,$0.00,$189.99,$0.00,$0.00,$0.00,$0.00,$0.00,$266.20,$0.00,$133.10,$210.83,$212.96,$0.00,$0.00,$0.00,$0.00,$0.00
G16940,SUP,Custom 27203010,,G16940  -  SET NPHSTM 16.8CM NDL GW PERC,$306.13,$0.00,$306.13,$0.00,$218.48,$0.00,$0.00,$0.00,$0.00,$0.00,$306.13,$0.00,$153.06,$242.45,$244.90,$0.00,$0.00,$0.00,$0.00,$0.00
G16987,SUP,HCPCS C1726,,G16987  -  SET NPHSTM NDL SHTH PERC,$111.00,$0.00,$111.00,$60.27,$79.22,$0.00,$19.12,$0.00,$0.00,$19.44,$111.00,$0.00,$55.50,$87.91,$88.80,$0.00,$17.37,$0.00,$17.67,$0.00
G16989,SUP,HCPCS C1758,,G16989  -  CATHETER URDY 7.4FR 30CM 3 LUM CDE OVL PORT BLN,$31.63,$0.00,$31.63,$17.17,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
G16992,SUP,HCPCS C2625,,G16992  -  CATHETER URET .038IN 5FR 70CM OP-EN GW,$235.75,$0.00,$235.75,$106.09,$168.25,$0.00,$40.62,$0.00,$0.00,$41.28,$235.75,$0.00,$117.88,$186.71,$188.60,$0.00,$36.89,$0.00,$37.53,$0.00
G16993,SUP,HCPCS C2625,,G16993  -  SET STNT .038IN 5MM PGTL CRV 4.7FR 75CM STRL 100CM BNDR CATH,$379.25,$0.00,$379.25,$170.66,$270.67,$0.00,$65.34,$0.00,$0.00,$66.40,$379.25,$0.00,$189.63,$300.37,$303.40,$0.00,$59.35,$0.00,$60.38,$0.00
G16994,SUP,HCPCS C2625,,G16994  -  SET STNT .038IN 5MM PGTL CRV 8.4FR 90CM STRL 125CM BNDR CATH,$379.25,$0.00,$379.25,$170.66,$270.67,$0.00,$65.34,$0.00,$0.00,$66.40,$379.25,$0.00,$189.63,$300.37,$303.40,$0.00,$59.35,$0.00,$60.38,$0.00
G16995,SUP,HCPCS C2625,,G16995  -  SET STENT .038IN 5MM PIGTAIL CURVE 8.2FR 75CM 100CM CATHETER,$235.75,$0.00,$235.75,$106.09,$168.25,$0.00,$40.62,$0.00,$0.00,$41.28,$235.75,$0.00,$117.88,$186.71,$188.60,$0.00,$36.89,$0.00,$37.53,$0.00
G16996,SUP,HCPCS C2625,,G16996  -  SET STNT .038IN 5MM PGTL CRV 7.2FR 90CM STRL 125CM BNDR CATH,$235.75,$0.00,$235.75,$106.09,$168.25,$0.00,$40.62,$0.00,$0.00,$41.28,$235.75,$0.00,$117.88,$186.71,$188.60,$0.00,$36.89,$0.00,$37.53,$0.00
G16997,SUP,HCPCS C2625,,G16997  -  SET STNT .038IN 5MM PGTL CRV 7FR 75CM STRL 100CM BNDR CATH,$235.75,$0.00,$235.75,$106.09,$168.25,$0.00,$40.62,$0.00,$0.00,$41.28,$235.75,$0.00,$117.88,$186.71,$188.60,$0.00,$36.89,$0.00,$37.53,$0.00
G17013,SUP,HCPCS C1758,,G17013  -  CATHETER URET .05IN 10FR 50CM STRL LF 2 INJ LUM TPR TIP,$79.20,$0.00,$79.20,$43.01,$56.53,$0.00,$13.65,$0.00,$0.00,$13.87,$79.20,$0.00,$39.60,$62.73,$63.36,$0.00,$12.39,$0.00,$12.61,$0.00
G17018,SUP,Custom 27203010,,G17018  -  SET STNT .038IN 5MM PGTL CRV 6FR 75CM STRL 100CM BNDR CATH,$89.10,$0.00,$89.10,$0.00,$63.59,$0.00,$0.00,$0.00,$0.00,$0.00,$89.10,$0.00,$44.55,$70.57,$71.28,$0.00,$0.00,$0.00,$0.00,$0.00
G17043,SUP,HCPCS C1726,,G17043  -  TUBE CNCT 5FR 10CM M TO F LL MOD,$73.60,$0.00,$73.60,$39.96,$52.53,$0.00,$12.68,$0.00,$0.00,$12.89,$73.60,$0.00,$36.80,$58.29,$58.88,$0.00,$11.52,$0.00,$11.72,$0.00
G17051,SUP,HCPCS C1758,,G17051  -  CATHETER URDY 7FR 38CM CLR JSPH 2 LUM NRDOP,$28.60,$0.00,$28.60,$15.53,$20.41,$0.00,$4.93,$0.00,$0.00,$5.01,$28.60,$0.00,$14.30,$22.65,$22.88,$0.00,$4.48,$0.00,$4.55,$0.00
G17083,SUP,HCPCS C1758,,G17083  -  ADAPTER CATH STD TLR LL SYR,$56.10,$0.00,$56.10,$30.46,$40.04,$0.00,$9.67,$0.00,$0.00,$9.82,$56.10,$0.00,$28.05,$44.43,$44.88,$0.00,$8.78,$0.00,$8.93,$0.00
G17104,SUP,Custom 27203010,,G17104  -  CATHETER URET .028IN 4FR 70CM FLXTP OP-EN GW MOD,$306.13,$0.00,$306.13,$0.00,$218.48,$0.00,$0.00,$0.00,$0.00,$0.00,$306.13,$0.00,$153.06,$242.45,$244.90,$0.00,$0.00,$0.00,$0.00,$0.00
G17111,SUP,Custom 27203010,,G17111  -  CATH URTH 6FR 25CM 2W FOLEY CLOSE END RND SIL 1.5ML,$48.76,$0.00,$48.76,$0.00,$34.80,$0.00,$0.00,$0.00,$0.00,$0.00,$48.76,$0.00,$24.38,$38.62,$39.01,$0.00,$0.00,$0.00,$0.00,$0.00
G17128,SUP,HCPCS C1769,,G17128  -  SET NPHSTM 6-12FR NDL GW DIL PERC,$248.30,$0.00,$248.30,$134.83,$177.21,$0.00,$42.78,$0.00,$0.00,$43.48,$248.30,$0.00,$124.15,$196.65,$198.64,$0.00,$38.86,$0.00,$39.53,$0.00
G17130,SUP,HCPCS C2617,,G17130  -  SET STNT .038IN 2 PGTL CRV 6FR 10CM STRL CATH RADOPQ PSTNR,$312.38,$0.00,$312.38,$140.57,$222.94,$0.00,$53.82,$0.00,$0.00,$54.69,$312.38,$0.00,$156.19,$247.40,$249.90,$0.00,$48.89,$0.00,$49.73,$0.00
G17131,SUP,HCPCS C2617,,G17131  -  SET STNT 2 PGTL CRV 7-14FR 30CM 13CM RELS SLV PSTNR ULTHNE,$312.38,$0.00,$312.38,$140.57,$222.94,$0.00,$53.82,$0.00,$0.00,$54.69,$312.38,$0.00,$156.19,$247.40,$249.90,$0.00,$48.89,$0.00,$49.73,$0.00
G17132,SUP,HCPCS C2617,,G17132  -  SET STNT .038IN 2 PGTL CRV 7-14FR 13CM STRL 28CM RADOPQ,$312.38,$0.00,$312.38,$140.57,$222.94,$0.00,$53.82,$0.00,$0.00,$54.69,$312.38,$0.00,$156.19,$247.40,$249.90,$0.00,$48.89,$0.00,$49.73,$0.00
G17133,SUP,HCPCS C2617,,G17133  -  SET STNT BCNTP 7-14FR 26CM STRL 13CM RELS SLV PSTNR ULTHNE,$312.38,$0.00,$312.38,$140.57,$222.94,$0.00,$53.82,$0.00,$0.00,$54.69,$312.38,$0.00,$156.19,$247.40,$249.90,$0.00,$48.89,$0.00,$49.73,$0.00
G17135,SUP,HCPCS C2617,,G17135  -  SET STNT 2 PGTL CRV 7-14FR 24CM 13CM RELS SLV PSTNR ULTHNE,$312.38,$0.00,$312.38,$140.57,$222.94,$0.00,$53.82,$0.00,$0.00,$54.69,$312.38,$0.00,$156.19,$247.40,$249.90,$0.00,$48.89,$0.00,$49.73,$0.00
G17136,SUP,HCPCS C2617,,G17136  -  SET STNT 2 PGTL CRV 7-14FR 22CM 13CM RELS SLV PSTNR ULTHNE,$312.38,$0.00,$312.38,$140.57,$222.94,$0.00,$53.82,$0.00,$0.00,$54.69,$312.38,$0.00,$156.19,$247.40,$249.90,$0.00,$48.89,$0.00,$49.73,$0.00
G17138,SUP,HCPCS C2617,,G17138  -  SET STNT .038IN 2 PGTL CRV 7-14FR 13CM STRL 20CM RADOPQ,$312.38,$0.00,$312.38,$140.57,$222.94,$0.00,$53.82,$0.00,$0.00,$54.69,$312.38,$0.00,$156.19,$247.40,$249.90,$0.00,$48.89,$0.00,$49.73,$0.00
G17139,SUP,HCPCS C2617,,G17139  -  SET STNT .038IN 2 PGTL CRV 6-9.5FR 13CM STRL 30CM RADOPQ,$271.63,$0.00,$271.63,$122.23,$193.86,$0.00,$46.80,$0.00,$0.00,$47.56,$271.63,$0.00,$135.81,$215.13,$217.30,$0.00,$42.51,$0.00,$43.24,$0.00
G17140,SUP,HCPCS C2617,,G17140  -  STENT URET THNWL PGTL CRV 7-14FR 26CM STRL LF RTRMX+ PSTNR,$312.38,$0.00,$312.38,$140.57,$222.94,$0.00,$53.82,$0.00,$0.00,$54.69,$312.38,$0.00,$156.19,$247.40,$249.90,$0.00,$48.89,$0.00,$49.73,$0.00
G17141,SUP,HCPCS C2617,,G17141  -  SET STNT .038IN 2 PGTL CRV 6-9.5FR 13CM STRL 28CM RADOPQ,$312.38,$0.00,$312.38,$140.57,$222.94,$0.00,$53.82,$0.00,$0.00,$54.69,$312.38,$0.00,$156.19,$247.40,$249.90,$0.00,$48.89,$0.00,$49.73,$0.00
G17142,SUP,HCPCS C2617,,G17142  -  SET STNT .038IN 2 PGTL CRV 6-9.5FR 13CM STRL 24CM RADOPQ,$312.38,$0.00,$312.38,$140.57,$222.94,$0.00,$53.82,$0.00,$0.00,$54.69,$312.38,$0.00,$156.19,$247.40,$249.90,$0.00,$48.89,$0.00,$49.73,$0.00
G17143,SUP,HCPCS C2617,,G17143  -  SET STNT 2 PGTL CRV 6-9.5FR 22CM 13CM RELS SLV PSTNR ULTHNE,$312.38,$0.00,$312.38,$140.57,$222.94,$0.00,$53.82,$0.00,$0.00,$54.69,$312.38,$0.00,$156.19,$247.40,$249.90,$0.00,$48.89,$0.00,$49.73,$0.00
G17144,SUP,HCPCS C2617,,G17144  -  SET STNT .038IN 2 PGTL CRV 6-9.5FR 13CM STRL 20CM RADOPQ,$312.38,$0.00,$312.38,$140.57,$222.94,$0.00,$53.82,$0.00,$0.00,$54.69,$312.38,$0.00,$156.19,$247.40,$249.90,$0.00,$48.89,$0.00,$49.73,$0.00
G17145,SUP,HCPCS C1758,,G17145  -  SET STNT .038IN 2 PGTL CRV 6-9.5FR 13CM STRL 18CM RADOPQ,$85.80,$0.00,$85.80,$46.59,$61.24,$0.00,$14.78,$0.00,$0.00,$15.02,$85.80,$0.00,$42.90,$67.95,$68.64,$0.00,$13.43,$0.00,$13.66,$0.00
G17150,SUP,HCPCS C2625,,G17150  -  CATHETER URET .04IN 6/10FR 50CM LF FLXTP 2 LUM GW AQ,$292.13,$0.00,$292.13,$131.46,$208.49,$0.00,$50.33,$0.00,$0.00,$51.15,$292.13,$0.00,$146.06,$231.37,$233.70,$0.00,$45.72,$0.00,$46.51,$0.00
G17151,SUP,HCPCS C2625,,G17151  -  SET STNT .038IN 3CM STRG 4.7FR 22-32CM STRL 145CM KWART,$292.13,$0.00,$292.13,$131.46,$208.49,$0.00,$50.33,$0.00,$0.00,$51.15,$292.13,$0.00,$146.06,$231.37,$233.70,$0.00,$45.72,$0.00,$46.51,$0.00
G17152,SUP,HCPCS C2625,,G17152  -  SET STNT .038IN 3CM STRG 6FR 22-32CM STRL 145CM KWART,$292.13,$0.00,$292.13,$131.46,$208.49,$0.00,$50.33,$0.00,$0.00,$51.15,$292.13,$0.00,$146.06,$231.37,$233.70,$0.00,$45.72,$0.00,$46.51,$0.00
G17153,SUP,HCPCS C2625,,G17153  -  SET STNT 7FR 22-32CM KWART RETRO-INJ SFLX MTLNTH RELS SLV GW,$292.13,$0.00,$292.13,$131.46,$208.49,$0.00,$50.33,$0.00,$0.00,$51.15,$292.13,$0.00,$146.06,$231.37,$233.70,$0.00,$45.72,$0.00,$46.51,$0.00
G17155,SUP,HCPCS C2627,,G17155  -  SET STNT .038IN 3CM STRG 8.2FR 22-32CM STRL 145CM KWART,$444.40,$0.00,$444.40,$241.31,$317.17,$0.00,$76.57,$0.00,$0.00,$77.81,$444.40,$0.00,$222.20,$351.96,$355.52,$0.00,$69.55,$0.00,$70.75,$0.00
G17156,SUP,HCPCS C1769,,G17156  -  SET NPHSTM 8.5FR 25CM STRL 2 GW CNN DIL MCLC CATH ULTHNE,$444.40,$0.00,$444.40,$241.31,$317.17,$0.00,$76.57,$0.00,$0.00,$77.81,$444.40,$0.00,$222.20,$351.96,$355.52,$0.00,$69.55,$0.00,$70.75,$0.00
G17157,SUP,HCPCS C2627,,G17157  -  SET NPHSTM 10.2FR 25CM STRL MCLC 2 GW CNN DIL CNCT TUBE,$511.05,$0.00,$511.05,$277.50,$364.74,$0.00,$88.05,$0.00,$0.00,$89.48,$511.05,$0.00,$255.53,$404.75,$408.84,$0.00,$79.98,$0.00,$81.36,$0.00
G17158,SUP,HCPCS C2627,,G17158  -  SET NPHSTM 12FR 25CM 2 GW CNN DIL CNCT TUBE MC LC LCK LOOP,$511.05,$0.00,$511.05,$277.50,$364.74,$0.00,$88.05,$0.00,$0.00,$89.48,$511.05,$0.00,$255.53,$404.75,$408.84,$0.00,$79.98,$0.00,$81.36,$0.00
G17160,SUP,HCPCS C1758,,G17160  -  SET NPHSTM 14FR 25CM 2 GW CNN DIL CNCT TUBE MC LC LCK LOOP,$27.83,$0.00,$27.83,$15.11,$19.86,$0.00,$4.79,$0.00,$0.00,$4.87,$27.83,$0.00,$13.91,$22.04,$22.26,$0.00,$4.35,$0.00,$4.43,$0.00
G17185,SUP,HCPCS C2625,,G17185  -  DRAIN INCS .25IN 12IN STRL LF PNRS SIL DISP OPN WND,$235.75,$0.00,$235.75,$106.09,$168.25,$0.00,$40.62,$0.00,$0.00,$41.28,$235.75,$0.00,$117.88,$186.71,$188.60,$0.00,$36.89,$0.00,$37.53,$0.00
G17186,SUP,HCPCS C2625,,G17186  -  SET STNT 8.2FR 75CM BNDR SFLX OP-EN DVRSN URETER,$235.75,$0.00,$235.75,$106.09,$168.25,$0.00,$40.62,$0.00,$0.00,$41.28,$235.75,$0.00,$117.88,$186.71,$188.60,$0.00,$36.89,$0.00,$37.53,$0.00
G17214,SUP,HCPCS C1769,,G17214  -  CATHETER URTH 18FR 34CM 5ML UNIVERSA 2W FL CLS END RND TIP,$8.59,$0.00,$8.59,$4.67,$6.13,$0.00,$1.48,$0.00,$0.00,$1.50,$8.59,$0.00,$4.30,$6.80,$6.88,$0.00,$1.34,$0.00,$1.37,$0.00
G17230,SUP,HCPCS C1726,,G17230  -  SET CATH .021IN 6FR 25CM 1ML UNIVERSA 2W FL OP-EN GW SIL PED,$45.00,$0.00,$45.00,$24.44,$32.12,$0.00,$7.75,$0.00,$0.00,$7.88,$45.00,$0.00,$22.50,$35.64,$36.00,$0.00,$7.04,$0.00,$7.16,$0.00
G17237,SUP,HCPCS C1758,,G17237  -  CATHETER URDY 7FR 38CM 2 LUM CDE,$27.83,$0.00,$27.83,$15.11,$19.86,$0.00,$4.79,$0.00,$0.00,$4.87,$27.83,$0.00,$13.91,$22.04,$22.26,$0.00,$4.35,$0.00,$4.43,$0.00
G17239,SUP,HCPCS C1729,,G17239  -  CATHETER URET 5FR 110CM RND TIP RT,$311.20,$0.00,$311.20,$168.98,$222.10,$0.00,$53.62,$0.00,$0.00,$54.49,$311.20,$0.00,$155.60,$246.47,$248.96,$0.00,$48.70,$0.00,$49.54,$0.00
G17252,SUP,HCPCS C1726,,G17252  -  CATHETER XTRN 1.3IN NS NADH CNDM SIL M REUSE,$51.15,$0.00,$51.15,$27.77,$36.51,$0.00,$8.81,$0.00,$0.00,$8.96,$51.15,$0.00,$25.58,$40.51,$40.92,$0.00,$8.00,$0.00,$8.14,$0.00
G17262,SUP,HCPCS C1758,,G17262  -  TUBING URDY INF ST VNT,$27.83,$0.00,$27.83,$15.11,$19.86,$0.00,$4.79,$0.00,$0.00,$4.87,$27.83,$0.00,$13.91,$22.04,$22.26,$0.00,$4.35,$0.00,$4.43,$0.00
G17306,SUP,HCPCS C2617,,G17306  -  ADAPTER CATH TLR LL SYR PED,$261.38,$0.00,$261.38,$117.62,$186.54,$0.00,$45.03,$0.00,$0.00,$45.76,$261.38,$0.00,$130.69,$207.01,$209.10,$0.00,$40.91,$0.00,$41.61,$0.00
G17310,SUP,HCPCS C1769,,G17310  -  SET STNT .025IN 3.7FR 8-30CM STRL CATH RADOPQ MTLNTH PSTNR,$396.00,$0.00,$396.00,$215.03,$282.63,$0.00,$68.23,$0.00,$0.00,$69.34,$396.00,$0.00,$198.00,$313.63,$316.80,$0.00,$61.97,$0.00,$63.04,$0.00
G17318,SUP,HCPCS C1726,,G17318  -  SET DIL 6-18FR 60CM AQ PE URET,$48.08,$0.00,$48.08,$26.10,$34.31,$0.00,$8.28,$0.00,$0.00,$8.42,$48.08,$0.00,$24.04,$38.08,$38.46,$0.00,$7.52,$0.00,$7.65,$0.00
G17320,SUP,HCPCS C1726,,G17320  -  CATHETER SUPRAPUBIC 14FR 22CM 30CM SET NEEDLE OBTURATOR,$144.10,$0.00,$144.10,$78.25,$102.84,$0.00,$24.83,$0.00,$0.00,$25.23,$144.10,$0.00,$72.05,$114.13,$115.28,$0.00,$22.55,$0.00,$22.94,$0.00
G17322,SUP,HCPCS C1726,,G17322  -  CATHETER URDY 5FR 30CM 2 LUM,$657.80,$0.00,$657.80,$357.19,$469.47,$0.00,$113.34,$0.00,$0.00,$115.18,$657.80,$0.00,$328.90,$520.98,$526.24,$0.00,$102.95,$0.00,$104.72,$0.00
G17323,SUP,HCPCS C1758,,G17323  -  SET DIL 6-30FR 30CM 16CM AMPTZ RADOPQ SHTH HDRPH RNL,$97.18,$0.00,$97.18,$52.77,$69.35,$0.00,$16.74,$0.00,$0.00,$17.01,$97.18,$0.00,$48.59,$76.97,$77.74,$0.00,$15.21,$0.00,$15.47,$0.00
G17330,SUP,HCPCS C1758,,G17330  -  CATHETER URET .05IN 6/10FR .04IN 50CM STRL LF FLXTP 2 LUM AQ,$103.33,$0.00,$103.33,$56.11,$73.74,$0.00,$17.80,$0.00,$0.00,$18.09,$103.33,$0.00,$51.66,$81.84,$82.66,$0.00,$16.17,$0.00,$16.45,$0.00
G17354,SUP,HCPCS C2627,,G17354  -  CATHETER URTH 16FR 34CM 5ML UNIVERSA 2W FL OP-EN SIL,$4.85,$0.00,$4.85,$2.63,$3.46,$0.00,$0.84,$0.00,$0.00,$0.85,$4.85,$0.00,$2.43,$3.84,$3.88,$0.00,$0.76,$0.00,$0.77,$0.00
G17355,SUP,HCPCS C2627,,G17355  -  DILATOR URET 8FR 60CM PE HDRPH,$58.20,$0.00,$58.20,$31.60,$41.54,$0.00,$10.03,$0.00,$0.00,$10.19,$58.20,$0.00,$29.10,$46.09,$46.56,$0.00,$9.11,$0.00,$9.27,$0.00
G17477,SUP,HCPCS C2627,,G17477  -  STOPCOCK CSCP SAN ANTONIO MOD FIT,$58.20,$0.00,$58.20,$31.60,$41.54,$0.00,$10.03,$0.00,$0.00,$10.19,$58.20,$0.00,$29.10,$46.09,$46.56,$0.00,$9.11,$0.00,$9.27,$0.00
G17515,SUP,HCPCS C2627,,G17515  -  CATHETER URTH 18FR 34CM 5ML UNIVERSA 2W OP-EN BLN FL SIL DOD,$15.92,$0.00,$15.92,$8.64,$11.36,$0.00,$2.74,$0.00,$0.00,$2.79,$15.92,$0.00,$7.96,$12.61,$12.74,$0.00,$2.49,$0.00,$2.53,$0.00
G17520,SUP,Custom 27203010,,G17520  -  CATHETER SPBC 8FR 54CM CYSTOSTOMY MOD TROC STY DRN ADPR PUL,$302.83,$0.00,$302.83,$0.00,$216.13,$0.00,$0.00,$0.00,$0.00,$0.00,$302.83,$0.00,$151.41,$239.84,$242.26,$0.00,$0.00,$0.00,$0.00,$0.00
G17521,SUP,HCPCS C1758,,G17521  -  EXTRACTOR STON 4.5FR 2CM 65CM STRL NCRCL TPLS UNDX HNDL WRE,$100.25,$0.00,$100.25,$54.44,$71.55,$0.00,$17.27,$0.00,$0.00,$17.55,$100.25,$0.00,$50.13,$79.40,$80.20,$0.00,$15.69,$0.00,$15.96,$0.00
G17539,SUP,HCPCS C1769,,G17539  -  CATHETER URET .038IN PGTL CRV 6FR 70CM SDPRT GW,$94.58,$0.00,$94.58,$51.35,$67.50,$0.00,$16.29,$0.00,$0.00,$16.56,$94.58,$0.00,$47.29,$74.91,$75.66,$0.00,$14.80,$0.00,$15.06,$0.00
G17540,SUP,HCPCS C1769,,G17540  -  GUIDEWIRE VASC STRG .038IN 145CM STRL 3CM RDRR PC STD BD,$94.58,$0.00,$94.58,$51.35,$67.50,$0.00,$16.29,$0.00,$0.00,$16.56,$94.58,$0.00,$47.29,$74.91,$75.66,$0.00,$14.80,$0.00,$15.06,$0.00
G17541,SUP,HCPCS C1769,,G17541  -  GUIDEWIRE VASC ANG STD .035IN 145CM 3CM RDRR PC TRQ CNTRL,$94.58,$0.00,$94.58,$51.35,$67.50,$0.00,$16.29,$0.00,$0.00,$16.56,$94.58,$0.00,$47.29,$74.91,$75.66,$0.00,$14.80,$0.00,$15.06,$0.00
G17542,SUP,HCPCS C1769,,G17542  -  GUIDEWIRE VASC ANG .038IN 145CM STRL 3CM RDRR PC STD BD NTNL,$94.58,$0.00,$94.58,$51.35,$67.50,$0.00,$16.29,$0.00,$0.00,$16.56,$94.58,$0.00,$47.29,$74.91,$75.66,$0.00,$14.80,$0.00,$15.06,$0.00
G17558,SUP,Custom 27203010,,G17558  -  CATH IU NOVY 5FR 40CM SET CVD CANNULATION 55CM DISP,$246.02,$0.00,$246.02,$0.00,$175.58,$0.00,$0.00,$0.00,$0.00,$0.00,$246.02,$0.00,$123.01,$194.85,$196.81,$0.00,$0.00,$0.00,$0.00,$0.00
G17560,SUP,HCPCS C1758,,G17560  -  POSITIONER STNT 6FR 50CM RADOPQ URET,$111.00,$0.00,$111.00,$60.27,$79.22,$0.00,$19.12,$0.00,$0.00,$19.44,$111.00,$0.00,$55.50,$87.91,$88.80,$0.00,$17.37,$0.00,$17.67,$0.00
G17571,SUP,HCPCS C2625,,G17571  -  CATHETER URET .03IN 4FR 70CM SFLX OP-EN GW,$141.45,$0.00,$141.45,$63.65,$100.95,$0.00,$24.37,$0.00,$0.00,$24.77,$141.45,$0.00,$70.73,$112.03,$113.16,$0.00,$22.14,$0.00,$22.52,$0.00
G17578,SUP,HCPCS C2627,,G17578  -  CATHETER URET .05IN 5/10FR .04IN 50CM FLXTP 2 LUM AQ,$58.20,$0.00,$58.20,$31.60,$41.54,$0.00,$10.03,$0.00,$0.00,$10.19,$58.20,$0.00,$29.10,$46.09,$46.56,$0.00,$9.11,$0.00,$9.27,$0.00
G17601,SUP,HCPCS C1892,,G17601  -  DILATOR URET 14FR 60CM PE HDRPH,$164.45,$0.00,$164.45,$89.30,$117.37,$0.00,$28.33,$0.00,$0.00,$28.79,$164.45,$0.00,$82.23,$130.24,$131.56,$0.00,$25.74,$0.00,$26.18,$0.00
G17618,SUP,Custom 27203010,,G17618  -  INTRODUCER NPHSTM 14FR 65CM 60CM PLWY PERC,$390.50,$0.00,$390.50,$0.00,$278.70,$0.00,$0.00,$0.00,$0.00,$0.00,$390.50,$0.00,$195.25,$309.28,$312.40,$0.00,$0.00,$0.00,$0.00,$0.00
G17627,SUP,Custom 27203010,,G17627  -  NEEDLE BRCHTX 18GA 20CM ECHTP SET,$462.20,$0.00,$462.20,$0.00,$329.87,$0.00,$0.00,$0.00,$0.00,$0.00,$462.20,$0.00,$231.10,$366.06,$369.76,$0.00,$0.00,$0.00,$0.00,$0.00
G17639,SUP,HCPCS C2625,,G17639  -  DILATOR URET LNG TPR 6-12FR 60CM STRL LFRIC SRFC AQ,$141.45,$0.00,$141.45,$63.65,$100.95,$0.00,$24.37,$0.00,$0.00,$24.77,$141.45,$0.00,$70.73,$112.03,$113.16,$0.00,$22.14,$0.00,$22.52,$0.00
G17648,SUP,HCPCS C2617,,G17648  -  POSITIONER STNT 4FR 25CM,$76.63,$0.00,$76.63,$34.48,$54.69,$0.00,$13.20,$0.00,$0.00,$13.42,$76.63,$0.00,$38.31,$60.69,$61.30,$0.00,$11.99,$0.00,$12.20,$0.00
G17666,SUP,HCPCS C2617,,G17666  -  STENT URTH 8FR 24FR 30CM STRL FRLT KLG SDPRT SUT BLB DISP,$117.88,$0.00,$117.88,$53.04,$84.13,$0.00,$20.31,$0.00,$0.00,$20.64,$117.88,$0.00,$58.94,$93.36,$94.30,$0.00,$18.45,$0.00,$18.77,$0.00
G17667,SUP,HCPCS C2617,,G17667  -  SET STNT 6FR 50CM STRL KL DPR URETHRA DISP,$92.25,$0.00,$92.25,$41.51,$65.84,$0.00,$15.89,$0.00,$0.00,$16.15,$92.25,$0.00,$46.13,$73.06,$73.80,$0.00,$14.44,$0.00,$14.69,$0.00
G17668,SUP,HCPCS C2617,,G17668  -  STENT URTH 6FR 50CM KL DPR,$102.50,$0.00,$102.50,$46.13,$73.15,$0.00,$17.66,$0.00,$0.00,$17.95,$102.50,$0.00,$51.25,$81.18,$82.00,$0.00,$16.04,$0.00,$16.32,$0.00
G17669,SUP,HCPCS C2617,,G17669  -  SET STNT 8FR 50CM STRL KL DPR URETHRA DISP,$92.25,$0.00,$92.25,$41.51,$65.84,$0.00,$15.89,$0.00,$0.00,$16.15,$92.25,$0.00,$46.13,$73.06,$73.80,$0.00,$14.44,$0.00,$14.69,$0.00
G17671,SUP,HCPCS C2617,,G17671  -  STENT URTH 8FR 50CM STRL KL DPR DISP,$300.60,$0.00,$300.60,$135.27,$214.54,$0.00,$51.79,$0.00,$0.00,$52.63,$300.60,$0.00,$150.30,$238.08,$240.48,$0.00,$47.04,$0.00,$47.86,$0.00
G17676,SUP,HCPCS C2617,,G17676  -  SET STNT .025IN SM 2 PGTL CRV STRG 3.7FR 6CM STRL RADOPQ,$253.45,$0.00,$253.45,$114.05,$180.89,$0.00,$43.67,$0.00,$0.00,$44.38,$253.45,$0.00,$126.73,$200.73,$202.76,$0.00,$39.66,$0.00,$40.35,$0.00
G17793,SUP,HCPCS C2617,,G17793  -  POSITIONER STNT 5FR 50CM,$288.80,$0.00,$288.80,$129.96,$206.12,$0.00,$49.76,$0.00,$0.00,$50.57,$288.80,$0.00,$144.40,$228.73,$231.04,$0.00,$45.20,$0.00,$45.98,$0.00
G17794,SUP,HCPCS C2627,,G17794  -  SET STNT .018IN 2 PGTL CRV CDE 3FR 4FR 4CM STRL CP MDRL CATH,$72.60,$0.00,$72.60,$39.42,$51.81,$0.00,$12.51,$0.00,$0.00,$12.71,$72.60,$0.00,$36.30,$57.50,$58.08,$0.00,$11.36,$0.00,$11.56,$0.00
G17795,SUP,HCPCS C1726,,G17795  -  DILATOR URTH 6-12FR 30CM LNG TPR FSCA,$72.60,$0.00,$72.60,$39.42,$51.81,$0.00,$12.51,$0.00,$0.00,$12.71,$72.60,$0.00,$36.30,$57.50,$58.08,$0.00,$11.36,$0.00,$11.56,$0.00
G17797,SUP,HCPCS C1758,,G17797  -  DILATOR URTH LNG TPR 18FR 30CM AQ,$42.90,$0.00,$42.90,$23.29,$30.62,$0.00,$7.39,$0.00,$0.00,$7.51,$42.90,$0.00,$21.45,$33.98,$34.32,$0.00,$6.71,$0.00,$6.83,$0.00
G17819,SUP,HCPCS C1758,,G17819  -  DEVICE TRQ STRL OLCOTT DISP ACPT .014-.045IN GW RDRR,$27.83,$0.00,$27.83,$15.11,$19.86,$0.00,$4.79,$0.00,$0.00,$4.87,$27.83,$0.00,$13.91,$22.04,$22.26,$0.00,$4.35,$0.00,$4.43,$0.00
G17842,SUP,HCPCS C1726,,G17842  -  CATHETER URET .040IN 7FR 70CM SFLX OP-EN GW,$264.00,$0.00,$264.00,$143.35,$188.42,$0.00,$45.49,$0.00,$0.00,$46.22,$264.00,$0.00,$132.00,$209.09,$211.20,$0.00,$41.32,$0.00,$42.03,$0.00
G17843,SUP,HCPCS C1726,,G17843  -  CATHETER URTH 9FR 8.7MM 29CM 18CM CDE BLN,$264.00,$0.00,$264.00,$143.35,$188.42,$0.00,$45.49,$0.00,$0.00,$46.22,$264.00,$0.00,$132.00,$209.09,$211.20,$0.00,$41.32,$0.00,$42.03,$0.00
G17844,SUP,HCPCS C1726,,G17844  -  CATHETER URTH FLFRM 9FR 8.7MM 29CM 18CM BLN,$264.00,$0.00,$264.00,$143.35,$188.42,$0.00,$45.49,$0.00,$0.00,$46.22,$264.00,$0.00,$132.00,$209.09,$211.20,$0.00,$41.32,$0.00,$42.03,$0.00
G17852,SUP,HCPCS C2617,,G17852  -  CATHETER URTH 7FR 8.7MM 29CM 18CM OPN TIP BLN,$251.13,$0.00,$251.13,$113.01,$179.23,$0.00,$43.27,$0.00,$0.00,$43.97,$251.13,$0.00,$125.56,$198.89,$200.90,$0.00,$39.30,$0.00,$39.98,$0.00
G17866,SUP,HCPCS C1769,,G17866  -  SET STNT .035IN 4.7FR 21-32CM STRL CATH RADOPQ MTLNTH PSTNR,$107.85,$0.00,$107.85,$58.56,$76.97,$0.00,$18.58,$0.00,$0.00,$18.88,$107.85,$0.00,$53.93,$85.42,$86.28,$0.00,$16.88,$0.00,$17.17,$0.00
G17898,SUP,HCPCS C1769,,G17898  -  KIT PRC 11FR MNPRC ENTRY PED PERC,$108.75,$0.00,$108.75,$59.05,$77.61,$0.00,$18.74,$0.00,$0.00,$19.04,$108.75,$0.00,$54.38,$86.13,$87.00,$0.00,$17.02,$0.00,$17.31,$0.00
G17913,SUP,HCPCS C1758,,G17913  -  FILIFORM URTH 18FR 12.5IN INTGR,$27.50,$0.00,$27.50,$14.93,$19.63,$0.00,$4.74,$0.00,$0.00,$4.82,$27.50,$0.00,$13.75,$21.78,$22.00,$0.00,$4.30,$0.00,$4.38,$0.00
G17915,SUP,HCPCS C1758,,G17915  -  CATHETER URET .038IN 7FR 15CM FLXTP OP-EN GW MOD,$32.90,$0.00,$32.90,$17.86,$23.48,$0.00,$5.67,$0.00,$0.00,$5.76,$32.90,$0.00,$16.45,$26.06,$26.32,$0.00,$5.15,$0.00,$5.24,$0.00
G17940,SUP,Custom 27203010,,G17940  -  SET DRN 200ML NS BG PED DISP,$478.13,$0.00,$478.13,$0.00,$341.24,$0.00,$0.00,$0.00,$0.00,$0.00,$478.13,$0.00,$239.06,$378.68,$382.50,$0.00,$0.00,$0.00,$0.00,$0.00
G17941,SUP,Custom 27203010,,G17941  -  EXTRACTOR STON 3.2FR 115CM 5CM NFORCE DWR 3WR BSKT HLCL OCL,$478.13,$0.00,$478.13,$0.00,$341.24,$0.00,$0.00,$0.00,$0.00,$0.00,$478.13,$0.00,$239.06,$378.68,$382.50,$0.00,$0.00,$0.00,$0.00,$0.00
G17948,SUP,HCPCS C1726,,G17948  -  EXTRACTOR SRG 3.2FR 115CM 7CM NFORCE HLCL STON SET NTNL URO,$59.40,$0.00,$59.40,$32.25,$42.39,$0.00,$10.23,$0.00,$0.00,$10.40,$59.40,$0.00,$29.70,$47.04,$47.52,$0.00,$9.30,$0.00,$9.46,$0.00
G17949,SUP,HCPCS C1726,,G17949  -  DILATOR URTH 12FR 30CM AMPTZ RNL,$59.40,$0.00,$59.40,$32.25,$42.39,$0.00,$10.23,$0.00,$0.00,$10.40,$59.40,$0.00,$29.70,$47.04,$47.52,$0.00,$9.30,$0.00,$9.46,$0.00
G17950,SUP,HCPCS C1726,,G17950  -  DILATOR URTH 14FR 30CM AMPTZ RNL,$59.40,$0.00,$59.40,$32.25,$42.39,$0.00,$10.23,$0.00,$0.00,$10.40,$59.40,$0.00,$29.70,$47.04,$47.52,$0.00,$9.30,$0.00,$9.46,$0.00
G17951,SUP,HCPCS C1892,,G17951  -  DILATOR URET 16FR 30CM AMPTZ RNL,$59.40,$0.00,$59.40,$32.25,$42.39,$0.00,$10.23,$0.00,$0.00,$10.40,$59.40,$0.00,$29.70,$47.04,$47.52,$0.00,$9.30,$0.00,$9.46,$0.00
G17952,SUP,HCPCS C1892,,G17952  -  DILATOR URTH 18FR 30CM AMPTZ RNL,$59.40,$0.00,$59.40,$32.25,$42.39,$0.00,$10.23,$0.00,$0.00,$10.40,$59.40,$0.00,$29.70,$47.04,$47.52,$0.00,$9.30,$0.00,$9.46,$0.00
G17953,SUP,HCPCS C1726,,G17953  -  DILATOR URET 20FR 30CM AMPTZ RNL,$59.40,$0.00,$59.40,$32.25,$42.39,$0.00,$10.23,$0.00,$0.00,$10.40,$59.40,$0.00,$29.70,$47.04,$47.52,$0.00,$9.30,$0.00,$9.46,$0.00
G17954,SUP,HCPCS C1726,,G17954  -  DILATOR URET 22FR 30CM AMPTZ RNL,$59.40,$0.00,$59.40,$32.25,$42.39,$0.00,$10.23,$0.00,$0.00,$10.40,$59.40,$0.00,$29.70,$47.04,$47.52,$0.00,$9.30,$0.00,$9.46,$0.00
G17955,SUP,HCPCS C1726,,G17955  -  DILATOR SRG 24FR 30CM AMPTZ NPHSTM TRACT DILATION,$59.40,$0.00,$59.40,$32.25,$42.39,$0.00,$10.23,$0.00,$0.00,$10.40,$59.40,$0.00,$29.70,$47.04,$47.52,$0.00,$9.30,$0.00,$9.46,$0.00
G17956,SUP,HCPCS C1726,,G17956  -  DILATOR URET 26FR 30CM AMPTZ RNL,$59.40,$0.00,$59.40,$32.25,$42.39,$0.00,$10.23,$0.00,$0.00,$10.40,$59.40,$0.00,$29.70,$47.04,$47.52,$0.00,$9.30,$0.00,$9.46,$0.00
G17957,SUP,HCPCS C1726,,G17957  -  DILATOR URET 28FR 30CM AMPTZ RNL,$59.40,$0.00,$59.40,$32.25,$42.39,$0.00,$10.23,$0.00,$0.00,$10.40,$59.40,$0.00,$29.70,$47.04,$47.52,$0.00,$9.30,$0.00,$9.46,$0.00
G17963,SUP,HCPCS C1894,,G17963  -  DILATOR URTH 30FR 30CM AMPTZ RNL,$70.85,$0.00,$70.85,$38.47,$50.57,$0.00,$12.21,$0.00,$0.00,$12.41,$70.85,$0.00,$35.43,$56.11,$56.68,$0.00,$11.09,$0.00,$11.28,$0.00
G17964,SUP,HCPCS C1892,,G17964  -  SHEATH DIL 22FR 16CM AMPTZ OPQ RNL,$61.60,$0.00,$61.60,$33.45,$43.96,$0.00,$10.61,$0.00,$0.00,$10.79,$61.60,$0.00,$30.80,$48.79,$49.28,$0.00,$9.64,$0.00,$9.81,$0.00
G17965,SUP,HCPCS C1894,,G17965  -  SHEATH ACC 24FR 16CM AMPTZ OPQ RNL,$61.60,$0.00,$61.60,$33.45,$43.96,$0.00,$10.61,$0.00,$0.00,$10.79,$61.60,$0.00,$30.80,$48.79,$49.28,$0.00,$9.64,$0.00,$9.81,$0.00
G17966,SUP,HCPCS C1894,,G17966  -  SHEATH DIL 26FR 16CM AMPTZ OPQ RNL,$61.60,$0.00,$61.60,$33.45,$43.96,$0.00,$10.61,$0.00,$0.00,$10.79,$61.60,$0.00,$30.80,$48.79,$49.28,$0.00,$9.64,$0.00,$9.81,$0.00
G17967,SUP,HCPCS C1894,,G17967  -  SHEATH DIL 28FR 16CM AMPTZ OPQ RNL,$61.60,$0.00,$61.60,$33.45,$43.96,$0.00,$10.61,$0.00,$0.00,$10.79,$61.60,$0.00,$30.80,$48.79,$49.28,$0.00,$9.64,$0.00,$9.81,$0.00
G17968,SUP,HCPCS C1894,,G17968  -  SHEATH DIL 30FR 16CM AMPTZ OPQ RNL,$70.85,$0.00,$70.85,$38.47,$50.57,$0.00,$12.21,$0.00,$0.00,$12.41,$70.85,$0.00,$35.43,$56.11,$56.68,$0.00,$11.09,$0.00,$11.28,$0.00
G17969,SUP,HCPCS C1894,,G17969  -  SHEATH DIL 24FR 20CM AMPTZ OPQ RNL,$70.85,$0.00,$70.85,$38.47,$50.57,$0.00,$12.21,$0.00,$0.00,$12.41,$70.85,$0.00,$35.43,$56.11,$56.68,$0.00,$11.09,$0.00,$11.28,$0.00
G17970,SUP,HCPCS C1894,,G17970  -  SHEATH DIL 26FR 20CM AMPTZ OPQ RNL,$70.85,$0.00,$70.85,$38.47,$50.57,$0.00,$12.21,$0.00,$0.00,$12.41,$70.85,$0.00,$35.43,$56.11,$56.68,$0.00,$11.09,$0.00,$11.28,$0.00
G17971,SUP,HCPCS C1894,,G17971  -  SHEATH DIL 28FR 20CM AMPTZ OPQ RNL,$70.85,$0.00,$70.85,$38.47,$50.57,$0.00,$12.21,$0.00,$0.00,$12.41,$70.85,$0.00,$35.43,$56.11,$56.68,$0.00,$11.09,$0.00,$11.28,$0.00
G17973,SUP,HCPCS C1894,,G17973  -  SHEATH DIL 30FR 20CM AMPTZ OPQ RNL,$70.85,$0.00,$70.85,$38.47,$50.57,$0.00,$12.21,$0.00,$0.00,$12.41,$70.85,$0.00,$35.43,$56.11,$56.68,$0.00,$11.09,$0.00,$11.28,$0.00
G17975,SUP,HCPCS C1894,,G17975  -  SHEATH DIL 30FR 19CM AMPTZ OPQ RNL,$61.60,$0.00,$61.60,$33.45,$43.96,$0.00,$10.61,$0.00,$0.00,$10.79,$61.60,$0.00,$30.80,$48.79,$49.28,$0.00,$9.64,$0.00,$9.81,$0.00
G17976,SUP,HCPCS C1894,,G17976  -  SHEATH DIL 28FR 30CM OPQ AMPTZ RNL,$61.60,$0.00,$61.60,$33.45,$43.96,$0.00,$10.61,$0.00,$0.00,$10.79,$61.60,$0.00,$30.80,$48.79,$49.28,$0.00,$9.64,$0.00,$9.81,$0.00
G17980,SUP,HCPCS C1894,,G17980  -  SHEATH DIL 30FR 30CM AMPTZ OPQ,$70.85,$0.00,$70.85,$38.47,$50.57,$0.00,$12.21,$0.00,$0.00,$12.41,$70.85,$0.00,$35.43,$56.11,$56.68,$0.00,$11.09,$0.00,$11.28,$0.00
G17981,SUP,HCPCS C1894,,G17981  -  SHEATH DIL 30FR 24CM AMPTZ OPQ RNL,$70.85,$0.00,$70.85,$38.47,$50.57,$0.00,$12.21,$0.00,$0.00,$12.41,$70.85,$0.00,$35.43,$56.11,$56.68,$0.00,$11.09,$0.00,$11.28,$0.00
G17982,SUP,HCPCS C1894,,G17982  -  SHEATH DIL 12FR 16CM AMPTZ OPQ RNL,$70.85,$0.00,$70.85,$38.47,$50.57,$0.00,$12.21,$0.00,$0.00,$12.41,$70.85,$0.00,$35.43,$56.11,$56.68,$0.00,$11.09,$0.00,$11.28,$0.00
G17983,SUP,HCPCS C1894,,G17983  -  SHEATH DIL 14FR 16CM AMPTZ OPQ RNL,$70.85,$0.00,$70.85,$38.47,$50.57,$0.00,$12.21,$0.00,$0.00,$12.41,$70.85,$0.00,$35.43,$56.11,$56.68,$0.00,$11.09,$0.00,$11.28,$0.00
G17984,SUP,HCPCS C1894,,G17984  -  SHEATH DIL 16FR 16CM AMPTZ OPQ RNL,$70.85,$0.00,$70.85,$38.47,$50.57,$0.00,$12.21,$0.00,$0.00,$12.41,$70.85,$0.00,$35.43,$56.11,$56.68,$0.00,$11.09,$0.00,$11.28,$0.00
G17985,SUP,HCPCS C1894,,G17985  -  SHEATH DIL 18FR 16CM AMPTZ OPQ RNL,$70.85,$0.00,$70.85,$38.47,$50.57,$0.00,$12.21,$0.00,$0.00,$12.41,$70.85,$0.00,$35.43,$56.11,$56.68,$0.00,$11.09,$0.00,$11.28,$0.00
G17986,SUP,HCPCS C1894,,G17986  -  SHEATH DIL 20FR 16CM AMPTZ OPQ RNL,$70.85,$0.00,$70.85,$38.47,$50.57,$0.00,$12.21,$0.00,$0.00,$12.41,$70.85,$0.00,$35.43,$56.11,$56.68,$0.00,$11.09,$0.00,$11.28,$0.00
G17997,SUP,HCPCS C1894,,G17997  -  SHEATH DIL 30FR 25CM AMPTZ OPQ RNL,$70.85,$0.00,$70.85,$38.47,$50.57,$0.00,$12.21,$0.00,$0.00,$12.41,$70.85,$0.00,$35.43,$56.11,$56.68,$0.00,$11.09,$0.00,$11.28,$0.00
G17998,SUP,HCPCS C1894,,G17998  -  SHEATH DIL 30FR 22CM AMPTZ OPQ RNL,$70.85,$0.00,$70.85,$38.47,$50.57,$0.00,$12.21,$0.00,$0.00,$12.41,$70.85,$0.00,$35.43,$56.11,$56.68,$0.00,$11.09,$0.00,$11.28,$0.00
G17999,SUP,HCPCS C1894,,G17999  -  SHEATH DIL 32FR 16CM AMPTZ OPQ RNL,$70.85,$0.00,$70.85,$38.47,$50.57,$0.00,$12.21,$0.00,$0.00,$12.41,$70.85,$0.00,$35.43,$56.11,$56.68,$0.00,$11.09,$0.00,$11.28,$0.00
G18001,SUP,HCPCS C1892,,G18001  -  SHEATH DIL 34FR 16CM AMPTZ OPQ RNL,$80.85,$0.00,$80.85,$43.90,$57.70,$0.00,$13.93,$0.00,$0.00,$14.16,$80.85,$0.00,$40.43,$64.03,$64.68,$0.00,$12.65,$0.00,$12.87,$0.00
G18002,SUP,HCPCS C1894,,G18002  -  INTRODUCER NPHSTM 24FR 16CM 30CM AMPTZ DIL RNL,$80.85,$0.00,$80.85,$43.90,$57.70,$0.00,$13.93,$0.00,$0.00,$14.16,$80.85,$0.00,$40.43,$64.03,$64.68,$0.00,$12.65,$0.00,$12.87,$0.00
G18003,SUP,HCPCS C1892,,G18003  -  INTRODUCER NPHSTM 26FR 16CM 30CM AMPTZ DIL RNL,$80.85,$0.00,$80.85,$43.90,$57.70,$0.00,$13.93,$0.00,$0.00,$14.16,$80.85,$0.00,$40.43,$64.03,$64.68,$0.00,$12.65,$0.00,$12.87,$0.00
G18004,SUP,HCPCS C1894,,G18004  -  INTRODUCER NPHSTM 28FR 16CM 30CM AMPTZ DIL RNL,$80.85,$0.00,$80.85,$43.90,$57.70,$0.00,$13.93,$0.00,$0.00,$14.16,$80.85,$0.00,$40.43,$64.03,$64.68,$0.00,$12.65,$0.00,$12.87,$0.00
G18005,SUP,HCPCS C1892,,G18005  -  INTRODUCER NPHSTM 30FR 16CM 30CM AMPTZ DIL SHTH RNL,$92.98,$0.00,$92.98,$50.49,$66.36,$0.00,$16.02,$0.00,$0.00,$16.28,$92.98,$0.00,$46.49,$73.64,$74.38,$0.00,$14.55,$0.00,$14.80,$0.00
G18006,SUP,HCPCS C1892,,G18006  -  INTRODUCER NPHSTM 28FR 20CM 30CM AMPTZ DIL RNL,$92.98,$0.00,$92.98,$50.49,$66.36,$0.00,$16.02,$0.00,$0.00,$16.28,$92.98,$0.00,$46.49,$73.64,$74.38,$0.00,$14.55,$0.00,$14.80,$0.00
G18007,SUP,HCPCS C1892,,G18007  -  INTRODUCER NPHSTM 30FR 20CM 30CM AMPTZ DIL RNL,$92.98,$0.00,$92.98,$50.49,$66.36,$0.00,$16.02,$0.00,$0.00,$16.28,$92.98,$0.00,$46.49,$73.64,$74.38,$0.00,$14.55,$0.00,$14.80,$0.00
G18008,SUP,HCPCS C1892,,G18008  -  INTRODUCER NPHSTM 22FR 16CM 30CM AMPTZ DIL RNL,$92.98,$0.00,$92.98,$50.49,$66.36,$0.00,$16.02,$0.00,$0.00,$16.28,$92.98,$0.00,$46.49,$73.64,$74.38,$0.00,$14.55,$0.00,$14.80,$0.00
G18009,SUP,HCPCS C1892,,G18009  -  INTRODUCER NPHSTM 24FR 24CM 30CM AMPTZ DIL RNL,$92.98,$0.00,$92.98,$50.49,$66.36,$0.00,$16.02,$0.00,$0.00,$16.28,$92.98,$0.00,$46.49,$73.64,$74.38,$0.00,$14.55,$0.00,$14.80,$0.00
G18010,SUP,HCPCS C1892,,G18010  -  INTRODUCER NPHSTM 26FR 24CM 30CM AMPTZ DIL RNL,$92.98,$0.00,$92.98,$50.49,$66.36,$0.00,$16.02,$0.00,$0.00,$16.28,$92.98,$0.00,$46.49,$73.64,$74.38,$0.00,$14.55,$0.00,$14.80,$0.00
G18011,SUP,HCPCS C1892,,G18011  -  INTRODUCER NPHSTM 28FR 24CM 30CM AMPTZ DIL RNL,$92.98,$0.00,$92.98,$50.49,$66.36,$0.00,$16.02,$0.00,$0.00,$16.28,$92.98,$0.00,$46.49,$73.64,$74.38,$0.00,$14.55,$0.00,$14.80,$0.00
G18012,SUP,HCPCS C1892,,G18012  -  INTRODUCER NPHSTM 30FR 24CM 30CM AMPTZ DIL SHTH RNL,$92.98,$0.00,$92.98,$50.49,$66.36,$0.00,$16.02,$0.00,$0.00,$16.28,$92.98,$0.00,$46.49,$73.64,$74.38,$0.00,$14.55,$0.00,$14.80,$0.00
G18013,SUP,HCPCS C1892,,G18013  -  INTRODUCER NPHSTM 16FR 16CM 30CM AMPTZ DIL RNL,$92.98,$0.00,$92.98,$50.49,$66.36,$0.00,$16.02,$0.00,$0.00,$16.28,$92.98,$0.00,$46.49,$73.64,$74.38,$0.00,$14.55,$0.00,$14.80,$0.00
G18014,SUP,HCPCS C1892,,G18014  -  INTRODUCER NPHSTM 18FR 16CM 30CM AMPTZ DIL RNL,$92.98,$0.00,$92.98,$50.49,$66.36,$0.00,$16.02,$0.00,$0.00,$16.28,$92.98,$0.00,$46.49,$73.64,$74.38,$0.00,$14.55,$0.00,$14.80,$0.00
G18015,SUP,HCPCS C1892,,G18015  -  INTRODUCER NPHSTM 20FR 16CM 30CM AMPTZ DIL RNL,$92.98,$0.00,$92.98,$50.49,$66.36,$0.00,$16.02,$0.00,$0.00,$16.28,$92.98,$0.00,$46.49,$73.64,$74.38,$0.00,$14.55,$0.00,$14.80,$0.00
G18016,SUP,HCPCS C1892,,G18016  -  INTRODUCER NPHSTM 28FR 30CM 40CM AMPTZ DIL RNL,$92.98,$0.00,$92.98,$50.49,$66.36,$0.00,$16.02,$0.00,$0.00,$16.28,$92.98,$0.00,$46.49,$73.64,$74.38,$0.00,$14.55,$0.00,$14.80,$0.00
G18017,SUP,HCPCS C1892,,G18017  -  INTRODUCER NPHSTM 30FR 25CM 30CM AMPTZ DIL RNL,$92.98,$0.00,$92.98,$50.49,$66.36,$0.00,$16.02,$0.00,$0.00,$16.28,$92.98,$0.00,$46.49,$73.64,$74.38,$0.00,$14.55,$0.00,$14.80,$0.00
G18018,SUP,HCPCS C1892,,G18018  -  INTRODUCER NPHSTM 30FR 28CM 32CM AMPTZ DIL RNL,$92.98,$0.00,$92.98,$50.49,$66.36,$0.00,$16.02,$0.00,$0.00,$16.28,$92.98,$0.00,$46.49,$73.64,$74.38,$0.00,$14.55,$0.00,$14.80,$0.00
G18019,SUP,HCPCS C1892,,G18019  -  INTRODUCER NPHSTM 30FR 30CM 40CM AMPTZ DIL RNL,$80.85,$0.00,$80.85,$43.90,$57.70,$0.00,$13.93,$0.00,$0.00,$14.16,$80.85,$0.00,$40.43,$64.03,$64.68,$0.00,$12.65,$0.00,$12.87,$0.00
G18020,SUP,HCPCS C1892,,G18020  -  INTRODUCER NPHSTM 32FR 16CM 30CM AMPTZ DIL RNL,$80.85,$0.00,$80.85,$43.90,$57.70,$0.00,$13.93,$0.00,$0.00,$14.16,$80.85,$0.00,$40.43,$64.03,$64.68,$0.00,$12.65,$0.00,$12.87,$0.00
G18021,SUP,HCPCS C1892,,G18021  -  INTRODUCER NPHSTM 34FR 16CM 30CM AMPTZ DIL RNL,$92.98,$0.00,$92.98,$50.49,$66.36,$0.00,$16.02,$0.00,$0.00,$16.28,$92.98,$0.00,$46.49,$73.64,$74.38,$0.00,$14.55,$0.00,$14.80,$0.00
G18063,SUP,HCPCS C1892,,G18063  -  INTRODUCER NPHSTM 36FR 16CM 30CM AMPTZ DIL RNL,$103.53,$0.00,$103.53,$56.21,$73.89,$0.00,$17.84,$0.00,$0.00,$18.13,$103.53,$0.00,$51.76,$82.00,$82.82,$0.00,$16.20,$0.00,$16.48,$0.00
G18067,SUP,HCPCS C1726,,G18067  -  SET INTRO 8FR 10FR 70CM 30CM DSLT HFMN SHTH CATH RADOPQ BAND,$58.83,$0.00,$58.83,$31.94,$41.98,$0.00,$10.14,$0.00,$0.00,$10.30,$58.83,$0.00,$29.41,$46.59,$47.06,$0.00,$9.21,$0.00,$9.36,$0.00
G18070,SUP,HCPCS C2625,,G18070  -  CATHETER GD .038IN 5FR 100CM AMPTZ RADOPQ TFE SHTH RNL,$235.75,$0.00,$235.75,$106.09,$168.25,$0.00,$40.62,$0.00,$0.00,$41.28,$235.75,$0.00,$117.88,$186.71,$188.60,$0.00,$36.89,$0.00,$37.53,$0.00
G18127,SUP,HCPCS C2617,,G18127  -  SET STENT 26CM 7-14FR CFLX URET EURTM RELS SLV PSTNR 13CM,$261.38,$0.00,$261.38,$117.62,$186.54,$0.00,$45.03,$0.00,$0.00,$45.76,$261.38,$0.00,$130.69,$207.01,$209.10,$0.00,$40.91,$0.00,$41.61,$0.00
G18131,SUP,HCPCS C2617,,G18131  -  SET STNT .038IN 5MM PGTL CRV 7FR 75CM STRL 100MM BNDR 2 CATH,$235.75,$0.00,$235.75,$106.09,$168.25,$0.00,$40.62,$0.00,$0.00,$41.28,$235.75,$0.00,$117.88,$186.71,$188.60,$0.00,$36.89,$0.00,$37.53,$0.00
G18140,SUP,HCPCS C2617,,G18140  -  SET STNT .038IN 2 PGTL CRV 6-10FR 13CM STRL 26CM RADOPQ,$155.40,$0.00,$155.40,$69.93,$110.91,$0.00,$26.77,$0.00,$0.00,$27.21,$155.40,$0.00,$77.70,$123.08,$124.32,$0.00,$24.32,$0.00,$24.74,$0.00
G18142,SUP,HCPCS C1769,,G18142  -  SET CATH .038IN PGTL CRV 6FR 70CM 145CM SDPRT SHFT GW MOD,$94.58,$0.00,$94.58,$51.35,$67.50,$0.00,$16.29,$0.00,$0.00,$16.56,$94.58,$0.00,$47.29,$74.91,$75.66,$0.00,$14.80,$0.00,$15.06,$0.00
G18143,SUP,HCPCS C1769,,G18143  -  GUIDEWIRE VASC STRG .035IN 145CM STRL 7CM RDRR PC STD BD,$94.58,$0.00,$94.58,$51.35,$67.50,$0.00,$16.29,$0.00,$0.00,$16.56,$94.58,$0.00,$47.29,$74.91,$75.66,$0.00,$14.80,$0.00,$15.06,$0.00
G18144,SUP,HCPCS C1769,,G18144  -  GUIDEWIRE VASC ANG STD .035IN 145CM STRL 7CM RDRR PC STF BD,$94.58,$0.00,$94.58,$51.35,$67.50,$0.00,$16.29,$0.00,$0.00,$16.56,$94.58,$0.00,$47.29,$74.91,$75.66,$0.00,$14.80,$0.00,$15.06,$0.00
G18145,SUP,HCPCS C1769,,G18145  -  GUIDEWIRE VASC STRG STD .038IN 145CM STRL 7CM RDRR PC STF BD,$94.58,$0.00,$94.58,$51.35,$67.50,$0.00,$16.29,$0.00,$0.00,$16.56,$94.58,$0.00,$47.29,$74.91,$75.66,$0.00,$14.80,$0.00,$15.06,$0.00
G18153,SUP,HCPCS C1769,,G18153  -  GUIDEWIRE VASC STD ANG .038IN 145CM STRL 7CM RDRR PC NTNL,$94.58,$0.00,$94.58,$51.35,$67.50,$0.00,$16.29,$0.00,$0.00,$16.56,$94.58,$0.00,$47.29,$74.91,$75.66,$0.00,$14.80,$0.00,$15.06,$0.00
G18154,SUP,HCPCS C1769,,G18154  -  GUIDEWIRE VASC STRG .035IN 145CM 8CM RDRR PC STF BD LFRIC,$94.58,$0.00,$94.58,$51.35,$67.50,$0.00,$16.29,$0.00,$0.00,$16.56,$94.58,$0.00,$47.29,$74.91,$75.66,$0.00,$14.80,$0.00,$15.06,$0.00
G18155,SUP,HCPCS C1769,,G18155  -  GUIDEWIRE VASC .035IN 145CM STRL 8CM RDRR PC STF BD ANG TIP,$94.58,$0.00,$94.58,$51.35,$67.50,$0.00,$16.29,$0.00,$0.00,$16.56,$94.58,$0.00,$47.29,$74.91,$75.66,$0.00,$14.80,$0.00,$15.06,$0.00
G18156,SUP,HCPCS C1769,,G18156  -  GUIDEWIRE VASC STRG .038IN 145CM 8CM RDRR PC 1 TO 1 TRQ,$94.58,$0.00,$94.58,$51.35,$67.50,$0.00,$16.29,$0.00,$0.00,$16.56,$94.58,$0.00,$47.29,$74.91,$75.66,$0.00,$14.80,$0.00,$15.06,$0.00
G18162,SUP,HCPCS C2617,,G18162  -  GUIDEWIRE URO STRG .038IN 145CM STRL 5CM AMPTZ FLX TP FX COR,$32.90,$0.00,$32.90,$14.81,$23.48,$0.00,$5.67,$0.00,$0.00,$5.76,$32.90,$0.00,$16.45,$26.06,$26.32,$0.00,$5.15,$0.00,$5.24,$0.00
G18189,SUP,HCPCS C2627,,G18189  -  SET STNT 4FR 12-18CM STRL SALLE CATH MTLNTH PSTNR CNCT GW,$198.63,$0.00,$198.63,$107.85,$141.76,$0.00,$34.22,$0.00,$0.00,$34.78,$198.63,$0.00,$99.31,$157.31,$158.90,$0.00,$31.08,$0.00,$31.62,$0.00
G18191,SUP,Custom 27203010,,G18191  -  SET CATH 8FR 54CM CYSTOSTOMY MOD TROC STY DRN ADPR SPBC,$462.20,$0.00,$462.20,$0.00,$329.87,$0.00,$0.00,$0.00,$0.00,$0.00,$462.20,$0.00,$231.10,$366.06,$369.76,$0.00,$0.00,$0.00,$0.00,$0.00
G18193,SUP,Custom 27203010,,G18193  -  EXTRACTOR STON HLX 3FR 1CM 115CM NCRCL FLXB SHTH NTNL MEM,$302.83,$0.00,$302.83,$0.00,$216.13,$0.00,$0.00,$0.00,$0.00,$0.00,$302.83,$0.00,$151.41,$239.84,$242.26,$0.00,$0.00,$0.00,$0.00,$0.00
G18201,SUP,HCPCS C1892,,G18201  -  CATHETER XTRN 1.53IN NS NADH CNDM SIL M DISP,$92.98,$0.00,$92.98,$50.49,$66.36,$0.00,$16.02,$0.00,$0.00,$16.28,$92.98,$0.00,$46.49,$73.64,$74.38,$0.00,$14.55,$0.00,$14.80,$0.00
G18622,SUP,HCPCS C2617,,G18622  -  INTRODUCER NPHSTM 30FR 22CM 30CM AMPTZ DIL RNL,$285.83,$0.00,$285.83,$128.62,$203.99,$0.00,$49.25,$0.00,$0.00,$50.05,$285.83,$0.00,$142.91,$226.38,$228.66,$0.00,$44.73,$0.00,$45.50,$0.00
G18624,SUP,HCPCS C2625,,G18624  -  SET STNT .038IN 2 PGTL CRV 7FR 20CM BLU STRL CATH RADOPQ,$271.13,$0.00,$271.13,$122.01,$193.50,$0.00,$46.71,$0.00,$0.00,$47.47,$271.13,$0.00,$135.56,$214.73,$216.90,$0.00,$42.43,$0.00,$43.16,$0.00
G18629,SUP,HCPCS C1769,,G18629  -  SET STNT .038IN 5MM PGTL CRV 4.7FR 75CM STRL 100MM BNDR 2,$107.85,$0.00,$107.85,$58.56,$76.97,$0.00,$18.58,$0.00,$0.00,$18.88,$107.85,$0.00,$53.93,$85.42,$86.28,$0.00,$16.88,$0.00,$17.17,$0.00
G18639,SUP,HCPCS C2617,,G18639  -  GUIDEWIRE ESCP STRG .035IN 145CM STRL 3CM RDRR PC 1-1 TRQ,$285.83,$0.00,$285.83,$128.62,$203.99,$0.00,$49.25,$0.00,$0.00,$50.05,$285.83,$0.00,$142.91,$226.38,$228.66,$0.00,$44.73,$0.00,$45.50,$0.00
G18671,SUP,Custom 27203010,,G18671  -  SET STNT .038IN 2 PGTL CRV 7FR 24CM BLU STRL CATH RADOPQ,$84.70,$0.00,$84.70,$0.00,$60.45,$0.00,$0.00,$0.00,$0.00,$0.00,$84.70,$0.00,$42.35,$67.08,$67.76,$0.00,$0.00,$0.00,$0.00,$0.00
G18702,SUP,Custom 27203010,,G18702  -  NEEDLE BRCHTX 18GA 20CM ECHTP LOC,$94.60,$0.00,$94.60,$0.00,$67.52,$0.00,$0.00,$0.00,$0.00,$0.00,$94.60,$0.00,$47.30,$74.92,$75.68,$0.00,$0.00,$0.00,$0.00,$0.00
G18705,SUP,Custom 27203010,,G18705  -  NEEDLE BX 14GA 15CM STRL Q COR 1 HNDCNTL LTWT SFT TIS DISP,$94.60,$0.00,$94.60,$0.00,$67.52,$0.00,$0.00,$0.00,$0.00,$0.00,$94.60,$0.00,$47.30,$74.92,$75.68,$0.00,$0.00,$0.00,$0.00,$0.00
G18707,SUP,Custom 27203010,,G18707  -  NEEDLE BX 18GA 15CM STRL Q COR 1 HND CNTRL LTWT SFT TIS DISP,$94.60,$0.00,$94.60,$0.00,$67.52,$0.00,$0.00,$0.00,$0.00,$0.00,$94.60,$0.00,$47.30,$74.92,$75.68,$0.00,$0.00,$0.00,$0.00,$0.00
G18725,SUP,HCPCS C1892,,G18725  -  NEEDLE BX 18GA 20CM STRL Q COR 1 HND CNTRL LTWT SFT TIS DISP,$92.98,$0.00,$92.98,$50.49,$66.36,$0.00,$16.02,$0.00,$0.00,$16.28,$92.98,$0.00,$46.49,$73.64,$74.38,$0.00,$14.55,$0.00,$14.80,$0.00
G18758,SUP,HCPCS C1758,,G18758  -  INTRODUCER NPHSTM 26FR 20CM 32CM AMPTZ DIL RNL,$39.95,$0.00,$39.95,$21.69,$28.51,$0.00,$6.88,$0.00,$0.00,$6.99,$39.95,$0.00,$19.98,$31.64,$31.96,$0.00,$6.25,$0.00,$6.36,$0.00
G18777,SUP,Custom 27203010,,G18777  -  CATHETER URET .038IN 5FR 85CM FLXTP OP-EN GW MOD,$462.20,$0.00,$462.20,$0.00,$329.87,$0.00,$0.00,$0.00,$0.00,$0.00,$462.20,$0.00,$231.10,$366.06,$369.76,$0.00,$0.00,$0.00,$0.00,$0.00
G18778,SUP,Custom 27203010,,G18778  -  EXTRACTOR STON 2.2FR 2CM 115CM NCRCL TPLS MOD BSKT NTNL,$462.20,$0.00,$462.20,$0.00,$329.87,$0.00,$0.00,$0.00,$0.00,$0.00,$462.20,$0.00,$231.10,$366.06,$369.76,$0.00,$0.00,$0.00,$0.00,$0.00
G18790,SUP,HCPCS C1758,,G18790  -  EXTRACTOR STON 2.2FR 1CM 115CM STRL NCRCL NTNL URO DISP,$32.90,$0.00,$32.90,$17.86,$23.48,$0.00,$5.67,$0.00,$0.00,$5.76,$32.90,$0.00,$16.45,$26.06,$26.32,$0.00,$5.15,$0.00,$5.24,$0.00
G18792,SUP,HCPCS C1769,,G18792  -  CATHETER URET .038IN 5FR 110CM FLXTP OP-EN GW MOD,$108.38,$0.00,$108.38,$58.85,$77.35,$0.00,$18.67,$0.00,$0.00,$18.98,$108.38,$0.00,$54.19,$85.84,$86.70,$0.00,$16.96,$0.00,$17.25,$0.00
G18803,SUP,HCPCS C1892,,G18803  -  GUIDEWIRE URO .035IN 145CM STRL RDRR PC 2 FLX TP AQ DISP,$164.45,$0.00,$164.45,$89.30,$117.37,$0.00,$28.33,$0.00,$0.00,$28.79,$164.45,$0.00,$82.23,$130.24,$131.56,$0.00,$25.74,$0.00,$26.18,$0.00
G18813,SUP,Custom 27203010,,G18813  -  INTRODUCER NPHSTM 12FR 65CM 60CM PLWY 2 KNOB,$59.40,$0.00,$59.40,$0.00,$42.39,$0.00,$0.00,$0.00,$0.00,$0.00,$59.40,$0.00,$29.70,$47.04,$47.52,$0.00,$0.00,$0.00,$0.00,$0.00
G18827,SUP,HCPCS C2627,,G18827  -  ADAPTER CATH 6FR STRL T-B SDARM URET DISP,$102.50,$0.00,$102.50,$55.66,$73.15,$0.00,$17.66,$0.00,$0.00,$17.95,$102.50,$0.00,$51.25,$81.18,$82.00,$0.00,$16.04,$0.00,$16.32,$0.00
G18845,SUP,HCPCS C1758,,G18845  -  STENT URTH 6FR 50CM STRL 26CM KL DPR INK MRK DISP,$85.80,$0.00,$85.80,$46.59,$61.24,$0.00,$14.78,$0.00,$0.00,$15.02,$85.80,$0.00,$42.90,$67.95,$68.64,$0.00,$13.43,$0.00,$13.66,$0.00
G18876,SUP,HCPCS C1758,,G18876  -  CATHETER URET STD 6/10FR 24CM FLXTP 2 LUM ACC HDRPH,$27.83,$0.00,$27.83,$15.11,$19.86,$0.00,$4.79,$0.00,$0.00,$4.87,$27.83,$0.00,$13.91,$22.04,$22.26,$0.00,$4.35,$0.00,$4.43,$0.00
G18882,SUP,Custom 27203010,,G18882  -  GRASPER ENDSCP 3.2FR 10MM 115CM 3 PRONG DELTA WIRE STAINLESS,$472.83,$0.00,$472.83,$0.00,$337.46,$0.00,$0.00,$0.00,$0.00,$0.00,$472.83,$0.00,$236.41,$374.48,$378.26,$0.00,$0.00,$0.00,$0.00,$0.00
G18883,SUP,HCPCS C1758,,G18883  -  CATHETER URET 5FR 100CM RND TIP LT,$49.35,$0.00,$49.35,$26.80,$35.22,$0.00,$8.50,$0.00,$0.00,$8.64,$49.35,$0.00,$24.68,$39.09,$39.48,$0.00,$7.72,$0.00,$7.86,$0.00
G18884,SUP,HCPCS C1758,,G18884  -  CATHETER URET .05IN 7.1FR 40CM SFLX NTPR TIP LSR,$104.35,$0.00,$104.35,$56.66,$74.47,$0.00,$17.98,$0.00,$0.00,$18.27,$104.35,$0.00,$52.18,$82.65,$83.48,$0.00,$16.33,$0.00,$16.61,$0.00
G18909,SUP,HCPCS C1758,,G18909  -  CATHETER URET PGTL CRV 8.2FR 56CM SFLX HDRPH,$31.63,$0.00,$31.63,$17.17,$22.57,$0.00,$5.45,$0.00,$0.00,$5.54,$31.63,$0.00,$15.81,$25.05,$25.30,$0.00,$4.95,$0.00,$5.03,$0.00
G18996,SUP,HCPCS C1758,,G18996  -  CATHETER URET 3FR 100CM RND TIP STY LT,$104.35,$0.00,$104.35,$56.66,$74.47,$0.00,$17.98,$0.00,$0.00,$18.27,$104.35,$0.00,$52.18,$82.65,$83.48,$0.00,$16.33,$0.00,$16.61,$0.00
G18997,SUP,HCPCS C1758,,G18997  -  CATHETER URET PGTL CRV 10FR 56CM SFLX HDRPH,$119.20,$0.00,$119.20,$64.73,$85.07,$0.00,$20.54,$0.00,$0.00,$20.87,$119.20,$0.00,$59.60,$94.41,$95.36,$0.00,$18.65,$0.00,$18.98,$0.00
G19002,SUP,HCPCS C1758,,G19002  -  CATHETER URET PGTL CRV 7FR 56CM SFLX HDRPH,$53.13,$0.00,$53.13,$28.85,$37.92,$0.00,$9.15,$0.00,$0.00,$9.30,$53.13,$0.00,$26.56,$42.08,$42.50,$0.00,$8.31,$0.00,$8.46,$0.00
G19030,SUP,Custom 27203010,,G19030  -  CATHETER URET .038IN 7FR 70CM OP-EN GW MOD,$43.00,$0.00,$43.00,$0.00,$30.69,$0.00,$0.00,$0.00,$0.00,$0.00,$43.00,$0.00,$21.50,$34.06,$34.40,$0.00,$0.00,$0.00,$0.00,$0.00
G19032,SUP,Custom 27203010,,G19032  -  NEEDLE ESCP 18GA 20CM SKNY ECHTP CHBA TIP,$29.70,$0.00,$29.70,$0.00,$21.20,$0.00,$0.00,$0.00,$0.00,$0.00,$29.70,$0.00,$14.85,$23.52,$23.76,$0.00,$0.00,$0.00,$0.00,$0.00
G19055,SUP,HCPCS C1758,,G19055  -  ADAPTER CATH 9FR CKFL 3W STPCK SDARM SLF SL,$53.13,$0.00,$53.13,$28.85,$37.92,$0.00,$9.15,$0.00,$0.00,$9.30,$53.13,$0.00,$26.56,$42.08,$42.50,$0.00,$8.31,$0.00,$8.46,$0.00
G19069,SUP,HCPCS C2617,,G19069  -  CATHETER URET .038IN 7FR 70CM OP-EN GW MOD,$261.38,$0.00,$261.38,$117.62,$186.54,$0.00,$45.03,$0.00,$0.00,$45.76,$261.38,$0.00,$130.69,$207.01,$209.10,$0.00,$40.91,$0.00,$41.61,$0.00
G19072,SUP,Custom 27203010,,G19072  -  SET STNT 5FR 8-20CM STRL GRN CATH RADOPQ MTLNTH PSTNR,$478.13,$0.00,$478.13,$0.00,$341.24,$0.00,$0.00,$0.00,$0.00,$0.00,$478.13,$0.00,$239.06,$378.68,$382.50,$0.00,$0.00,$0.00,$0.00,$0.00
G19073,SUP,Custom 27203010,,G19073  -  EXTRACTOR STON 2.2FR 115CM 5CM NFORCE 3WR HLCL OCL NTNL,$549.85,$0.00,$549.85,$0.00,$392.43,$0.00,$0.00,$0.00,$0.00,$0.00,$549.85,$0.00,$274.93,$435.48,$439.88,$0.00,$0.00,$0.00,$0.00,$0.00
G19089,SUP,HCPCS C1729,,G19089  -  SET NPHSTM ECHTP NDL GW DIL PERC,$417.45,$0.00,$417.45,$226.68,$297.93,$0.00,$71.92,$0.00,$0.00,$73.09,$417.45,$0.00,$208.73,$330.62,$333.96,$0.00,$65.33,$0.00,$66.46,$0.00
G19097,SUP,HCPCS C1894,,G19097  -  SET NPHSTM PGTL CRV 6FR 7CM ECHTP NDL GW CATH DIL CNCT TUBE,$254.28,$0.00,$254.28,$138.07,$181.48,$0.00,$43.81,$0.00,$0.00,$44.52,$254.28,$0.00,$127.14,$201.39,$203.42,$0.00,$39.79,$0.00,$40.48,$0.00
G19098,SUP,HCPCS C1769,,G19098  -  SET NPHSTM COPE LOOP ECHTP NDL GW CATH CNN PERC,$465.53,$0.00,$465.53,$252.78,$332.25,$0.00,$80.21,$0.00,$0.00,$81.51,$465.53,$0.00,$232.76,$368.70,$372.42,$0.00,$72.85,$0.00,$74.11,$0.00
G19110,SUP,Custom 27203010,,G19110  -  SET NPHSTM 10FR 19.5CM LTX COPE LOOP ECHTP NDL STPCK CNN,$515.33,$0.00,$515.33,$0.00,$367.79,$0.00,$0.00,$0.00,$0.00,$0.00,$515.33,$0.00,$257.66,$408.14,$412.26,$0.00,$0.00,$0.00,$0.00,$0.00
G19111,SUP,Custom 27203010,,G19111  -  EXTRACTOR STON 3ANG 2.4FR 1CM 115CM STRL NCR DWR TPLS BSKT,$515.33,$0.00,$515.33,$0.00,$367.79,$0.00,$0.00,$0.00,$0.00,$0.00,$515.33,$0.00,$257.66,$408.14,$412.26,$0.00,$0.00,$0.00,$0.00,$0.00
G19119,SUP,HCPCS C1758,,G19119  -  EXTRACTOR STON 2.4FR 2CM 115CM NCR DWR TPLS MOD BSKT NTNL,$225.50,$0.00,$225.50,$122.45,$160.94,$0.00,$38.85,$0.00,$0.00,$39.48,$225.50,$0.00,$112.75,$178.60,$180.40,$0.00,$35.29,$0.00,$35.90,$0.00
G19168,SUP,HCPCS C1894,,G19168  -  SHEATH ACCES 12FR 35CM DILATION CONTIN WORKING CHANNEL,$308.00,$0.00,$308.00,$167.24,$219.82,$0.00,$53.07,$0.00,$0.00,$53.93,$308.00,$0.00,$154.00,$243.94,$246.40,$0.00,$48.20,$0.00,$49.03,$0.00
G19169,SUP,HCPCS C1894,,G19169  -  SET STNT ANTGRD 2 PGTL CRV 6FR 50CM GRN STRL 32CM SEIDMON,$308.00,$0.00,$308.00,$167.24,$219.82,$0.00,$53.07,$0.00,$0.00,$53.93,$308.00,$0.00,$154.00,$243.94,$246.40,$0.00,$48.20,$0.00,$49.03,$0.00
G19172,SUP,HCPCS C1894,,G19172  -  SHEATH ACCES 12FR DILATION CONTIN WKG CHNL FLXR,$308.00,$0.00,$308.00,$167.24,$219.82,$0.00,$53.07,$0.00,$0.00,$53.93,$308.00,$0.00,$154.00,$243.94,$246.40,$0.00,$48.20,$0.00,$49.03,$0.00
G19173,SUP,HCPCS C1894,,G19173  -  SHEATH ACC 12FR 55CM STRL LTX FLXR DILATION CNT WRK CHNL,$308.00,$0.00,$308.00,$167.24,$219.82,$0.00,$53.07,$0.00,$0.00,$53.93,$308.00,$0.00,$154.00,$243.94,$246.40,$0.00,$48.20,$0.00,$49.03,$0.00
G19174,SUP,HCPCS C1894,,G19174  -  SHEATH ACCES 9.5FR TPR DILAT CONTIN WRK CHNL LOCK,$308.00,$0.00,$308.00,$167.24,$219.82,$0.00,$53.07,$0.00,$0.00,$53.93,$308.00,$0.00,$154.00,$243.94,$246.40,$0.00,$48.20,$0.00,$49.03,$0.00
G19175,SUP,HCPCS C1894,,G19175  -  SHEATH ACC 12FR 20CM STRL LTX FLXR DILATION CNT WRK CHNL,$308.00,$0.00,$308.00,$167.24,$219.82,$0.00,$53.07,$0.00,$0.00,$53.93,$308.00,$0.00,$154.00,$243.94,$246.40,$0.00,$48.20,$0.00,$49.03,$0.00
G19176,SUP,HCPCS C1894,,G19176  -  SHEATH ACCES 9.5FR TPR DILAT CONTIN WRK CHNL LOCK,$308.00,$0.00,$308.00,$167.24,$219.82,$0.00,$53.07,$0.00,$0.00,$53.93,$308.00,$0.00,$154.00,$243.94,$246.40,$0.00,$48.20,$0.00,$49.03,$0.00
G19177,SUP,HCPCS C1894,,G19177  -  SHEATH ACC FNL 9.5FR 55CM STRL FLXR WKG CHNL LFRIC SRFC DIL,$308.00,$0.00,$308.00,$167.24,$219.82,$0.00,$53.07,$0.00,$0.00,$53.93,$308.00,$0.00,$154.00,$243.94,$246.40,$0.00,$48.20,$0.00,$49.03,$0.00
G19191,SUP,Custom 27203010,,G19191  -  NEEDLE ENDSCP 22GA 25CM SKINNY NEEDLE CHIBA ECHOTIP,$28.60,$0.00,$28.60,$0.00,$20.41,$0.00,$0.00,$0.00,$0.00,$0.00,$28.60,$0.00,$14.30,$22.65,$22.88,$0.00,$0.00,$0.00,$0.00,$0.00
G21363,SUP,Custom 27203010,,G21363  -  PROBE DPLR IMPLTABLE FLW 20MHZ STRL CKSWTZ,"$1,006.38",$0.00,"$1,006.38",$0.00,$718.25,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,006.38",$0.00,$503.19,$797.05,$805.10,$0.00,$0.00,$0.00,$0.00,$0.00
G21421,SUP,HCPCS C1729,,G21421  -  CATHETER ENDSCP 7FR 250CM 5 SIDEPORT LATEX FREE BILIARY,$207.50,$0.00,$207.50,$112.67,$148.09,$0.00,$35.75,$0.00,$0.00,$36.33,$207.50,$0.00,$103.75,$164.34,$166.00,$0.00,$32.47,$0.00,$33.03,$0.00
G21509,SUP,HCPCS C2617,,G21509  -  STENT PANCREATIC 7FR 15CM DRAIN OBSTRUCTED POSITIONING,$177.50,$0.00,$177.50,$79.88,$126.68,$0.00,$30.58,$0.00,$0.00,$31.08,$177.50,$0.00,$88.75,$140.58,$142.00,$0.00,$27.78,$0.00,$28.26,$0.00
G21586,SUP,HCPCS C1729,,G21586  -  SET DRAIN PUR 250CM 7FR .035IN PGTL CURVE NSBIL 5 SDPRT CATH,$350.00,$0.00,$350.00,$190.05,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
G21962,SUP,HCPCS C1769,,G21962  -  GUIDEWIRE ENDSCP 250CM PROGRESSIVELY FLEXIBLE TIP,$415.00,$0.00,$415.00,$225.35,$296.19,$0.00,$71.50,$0.00,$0.00,$72.66,$415.00,$0.00,$207.50,$328.68,$332.00,$0.00,$64.95,$0.00,$66.07,$0.00
G21978,SUP,HCPCS C1769,,G21978  -  GUIDEWIRE ENDSCP 360CM SAVARY-GILLIARD NONSTRL REUSABLE,$480.00,$0.00,$480.00,$260.64,$342.58,$0.00,$82.70,$0.00,$0.00,$84.04,$480.00,$0.00,$240.00,$380.16,$384.00,$0.00,$75.12,$0.00,$76.42,$0.00
G22102,SUP,HCPCS C2617,,G22102  -  STENT PANCREATIC 5FR 153CM DRAIN OBSTRUCTED POSITIONING,$177.50,$0.00,$177.50,$79.88,$126.68,$0.00,$30.58,$0.00,$0.00,$31.08,$177.50,$0.00,$88.75,$140.58,$142.00,$0.00,$27.78,$0.00,$28.26,$0.00
G22139,SUP,HCPCS C1769,,G22139  -  GUIDEWIRE ENDSCP 200CM FLEXIBLE TIP SAVARY-GILLIARD,$345.00,$0.00,$345.00,$187.34,$246.23,$0.00,$59.44,$0.00,$0.00,$60.41,$345.00,$0.00,$172.50,$273.24,$276.00,$0.00,$53.99,$0.00,$54.92,$0.00
G22409,SUP,Custom 27203010,,G22409  -  BRUSH CYTOLOGY 5FR 2MM 180CM GASTROSCOPE GREEN,$46.25,$0.00,$46.25,$0.00,$33.01,$0.00,$0.00,$0.00,$0.00,$0.00,$46.25,$0.00,$23.13,$36.63,$37.00,$0.00,$0.00,$0.00,$0.00,$0.00
G23239,SUP,HCPCS C2617,,G23239  -  LASER SRG 115V 20AMP RHPSD H-30,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23240,SUP,HCPCS C2617,,G23240  -  SET STNT .038IN 3CM PGTL CRV 7FR 30CM STRL 145CM UNIVERSA,$137.05,$0.00,$137.05,$61.67,$97.81,$0.00,$23.61,$0.00,$0.00,$24.00,$137.05,$0.00,$68.53,$108.54,$109.64,$0.00,$21.45,$0.00,$21.82,$0.00
G23241,SUP,HCPCS C2617,,G23241  -  STENT URET 2 PGTL CRV 5FR 18CM STRL UNIVERSA RADOPQ GRAD MRK,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23242,SUP,HCPCS C2617,,G23242  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 22-32CM STRL 145CM,$137.05,$0.00,$137.05,$61.67,$97.81,$0.00,$23.61,$0.00,$0.00,$24.00,$137.05,$0.00,$68.53,$108.54,$109.64,$0.00,$21.45,$0.00,$21.82,$0.00
G23243,SUP,HCPCS C2617,,G23243  -  STENT URET 2 PGTL CRV 5FR 18CM STRL UNIVERSA RADOPQ GRAD MRK,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23244,SUP,HCPCS C2617,,G23244  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 30CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23312,SUP,HCPCS C2617,,G23312  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 22-32CM STRL 145CM,$137.05,$0.00,$137.05,$61.67,$97.81,$0.00,$23.61,$0.00,$0.00,$24.00,$137.05,$0.00,$68.53,$108.54,$109.64,$0.00,$21.45,$0.00,$21.82,$0.00
G23313,SUP,HCPCS C2617,,G23313  -  SET STNT 2 PGTL CRV 5FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23314,SUP,HCPCS C2617,,G23314  -  SET STNT 2 PGTL CRV 6FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23315,SUP,HCPCS C2617,,G23315  -  SET STNT 2 PGTL CRV 7FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23316,SUP,HCPCS C2617,,G23316  -  SET STNT 2 PGTL CRV 8FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23317,SUP,HCPCS C2617,,G23317  -  SET STNT 2 PGTL CRV 6FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23318,SUP,HCPCS C2617,,G23318  -  SET STNT 2 PGTL CRV 7FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23319,SUP,HCPCS C2617,,G23319  -  SET STNT 2 PGTL CRV 8FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23320,SUP,HCPCS C2617,,G23320  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 22-32CM STRL 145CM,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23326,SUP,HCPCS C2617,,G23326  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 22-32CM STRL 145CM,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23327,SUP,HCPCS C2617,,G23327  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 22-32CM STRL 145CM,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23328,SUP,HCPCS C2617,,G23328  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 22-32CM STRL 145CM,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23329,SUP,HCPCS C2617,,G23329  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 22-32CM STRL 145CM,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23330,SUP,HCPCS C2617,,G23330  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 22-32CM STRL 145CM,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23331,SUP,HCPCS C2617,,G23331  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 22-32CM STRL 145CM,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23332,SUP,HCPCS C2617,,G23332  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 22-32CM STRL 145CM,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23333,SUP,HCPCS C2617,,G23333  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 22-32CM STRL 145CM,$137.05,$0.00,$137.05,$61.67,$97.81,$0.00,$23.61,$0.00,$0.00,$24.00,$137.05,$0.00,$68.53,$108.54,$109.64,$0.00,$21.45,$0.00,$21.82,$0.00
G23334,SUP,HCPCS C2617,,G23334  -  SET STNT 2 PGTL CRV 5FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23335,SUP,HCPCS C2617,,G23335  -  SET STNT 2 PGTL CRV 6FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23336,SUP,HCPCS C2617,,G23336  -  SET STNT 2 PGTL CRV 7FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23337,SUP,HCPCS C2617,,G23337  -  SET STNT 2 PGTL CRV 8FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23338,SUP,HCPCS C2617,,G23338  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 18CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23339,SUP,HCPCS C2617,,G23339  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 20CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23340,SUP,HCPCS C2617,,G23340  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 22CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23341,SUP,HCPCS C2617,,G23341  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 24CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23342,SUP,HCPCS C2617,,G23342  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 26CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23343,SUP,HCPCS C2617,,G23343  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 28CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23344,SUP,HCPCS C2617,,G23344  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 30CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23345,SUP,HCPCS C2617,,G23345  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 18CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23346,SUP,HCPCS C2617,,G23346  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 20CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23347,SUP,HCPCS C2617,,G23347  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 22CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23348,SUP,HCPCS C2617,,G23348  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 24CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23349,SUP,HCPCS C2617,,G23349  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 26CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23350,SUP,HCPCS C2617,,G23350  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 28CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23351,SUP,HCPCS C2617,,G23351  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 30CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23352,SUP,HCPCS C2617,,G23352  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 18CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23353,SUP,HCPCS C2617,,G23353  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 20CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23354,SUP,HCPCS C2617,,G23354  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 22CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23355,SUP,HCPCS C2617,,G23355  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 24CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23356,SUP,HCPCS C2617,,G23356  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 26CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23357,SUP,HCPCS C2617,,G23357  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 28CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23358,SUP,HCPCS C2617,,G23358  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 18CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23359,SUP,HCPCS C2617,,G23359  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 20CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23360,SUP,HCPCS C2617,,G23360  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 22CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23361,SUP,HCPCS C2617,,G23361  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 24CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23362,SUP,HCPCS C2617,,G23362  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 26CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23363,SUP,HCPCS C2617,,G23363  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 28CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23365,SUP,HCPCS C2617,,G23365  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 30CM STRL 145CM UNIVERSA,$137.05,$0.00,$137.05,$61.67,$97.81,$0.00,$23.61,$0.00,$0.00,$24.00,$137.05,$0.00,$68.53,$108.54,$109.64,$0.00,$21.45,$0.00,$21.82,$0.00
G23366,SUP,HCPCS C2617,,G23366  -  SET STNT 2 PGTL CRV 5FR 20CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23367,SUP,HCPCS C2617,,G23367  -  SET STNT 2 PGTL CRV 5FR 22CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23368,SUP,HCPCS C2617,,G23368  -  SET STNT 2 PGTL CRV 5FR 24CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23369,SUP,HCPCS C2617,,G23369  -  SET STNT 2 PGTL CRV 5FR 26CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23370,SUP,HCPCS C2617,,G23370  -  SET STNT 2 PGTL CRV 5FR 28CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23371,SUP,HCPCS C2617,,G23371  -  SET STNT 2 PGTL CRV 5FR 30CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23372,SUP,HCPCS C2617,,G23372  -  SET STNT 2 PGTL CRV 6FR 18CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23373,SUP,HCPCS C2617,,G23373  -  SET STNT 2 PGTL CRV 6FR 20CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23374,SUP,HCPCS C2617,,G23374  -  SET STNT 2 PGTL CRV 6FR 22CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23376,SUP,HCPCS C2617,,G23376  -  SET STNT 2 PGTL CRV 6FR 24CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23377,SUP,HCPCS C2617,,G23377  -  SET STNT 2 PGTL CRV 6FR 26CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23378,SUP,HCPCS C2617,,G23378  -  SET STNT 2 PGTL CRV 6FR 28CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23379,SUP,HCPCS C2617,,G23379  -  SET STNT 2 PGTL CRV 6FR 30CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23380,SUP,HCPCS C2617,,G23380  -  SET STNT 2 PGTL CRV 7FR 18CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23381,SUP,HCPCS C2617,,G23381  -  SET STNT 2 PGTL CRV 7FR 20CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23382,SUP,HCPCS C2617,,G23382  -  SET STNT 2 PGTL CRV 7FR 22CM STRL UNIVERSA RADOPQ GRAD PSTNR,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23383,SUP,HCPCS C2617,,G23383  -  STENT URET 2 PGTL CRV 7FR 24CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23384,SUP,HCPCS C2617,,G23384  -  STENT URET 2 PGTL CRV 7FR 26CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23385,SUP,HCPCS C2617,,G23385  -  SET STNT 2 PGTL CRV 7FR 28CM STRL UNIVERSA RADOPQ GRAD PSTNR,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23386,SUP,HCPCS C2617,,G23386  -  SET STNT 2 PGTL CRV 7FR 30CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23387,SUP,HCPCS C2617,,G23387  -  SET STNT 2 PGTL CRV 8FR 18CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23388,SUP,HCPCS C2617,,G23388  -  SET STNT 2 PGTL CRV 8FR 20CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23389,SUP,HCPCS C2617,,G23389  -  SET STNT 2 PGTL CRV 8FR 22CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23390,SUP,HCPCS C2617,,G23390  -  SET STNT 2 PGTL CRV 8FR 24CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23391,SUP,HCPCS C2617,,G23391  -  SET STNT 2 PGTL CRV 8FR 26CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23392,SUP,HCPCS C2617,,G23392  -  SET STNT 2 PGTL CRV 8FR 28CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23395,SUP,HCPCS C2617,,G23395  -  SET STNT 2 PGTL CRV 8FR 30CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23396,SUP,HCPCS C2617,,G23396  -  STENT URET 5FR 20CM STRL UNIVERSA FIRM PSTNR NO GW MFL TETH,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23397,SUP,HCPCS C2617,,G23397  -  SET STNT 2 PGTL CRV 5FR 22CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23398,SUP,HCPCS C2617,,G23398  -  SET STNT 2 PGTL CRV 5FR 24CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23399,SUP,HCPCS C2617,,G23399  -  STENT URET 5FR 26CM STRL UNIVERSA FIRM PSTNR NO GW MFL TETH,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23400,SUP,HCPCS C2617,,G23400  -  STENT URET 5FR 28CM STRL UNIVERSA FIRM PSTNR NO GW MFL TETH,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23401,SUP,HCPCS C2617,,G23401  -  SET STNT 2 PGTL CRV 5FR 30CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23402,SUP,HCPCS C2617,,G23402  -  SET STNT 2 PGTL CRV 6FR 18CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23404,SUP,HCPCS C2617,,G23404  -  SET STNT 2 PGTL CRV 6FR 20CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23405,SUP,HCPCS C2617,,G23405  -  STENT URET 6FR 22CM STRL UNIVERSA FIRM PSTNR NO GW MFL TETH,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23406,SUP,HCPCS C2617,,G23406  -  SET STNT 2 PGTL CRV 6FR 24CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23407,SUP,HCPCS C2617,,G23407  -  STENT URET 6FR 26CM STRL UNIVERSA FIRM PSTNR NO GW MFL TETH,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23408,SUP,HCPCS C2617,,G23408  -  STENT URET 6FR 28CM STRL UNIVERSA FIRM PSTNR NO GW MFL TETH,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23411,SUP,HCPCS C2617,,G23411  -  STENT URET 6FR 30CM STRL UNIVERSA FIRM PSTNR NO GW MFL TETH,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23412,SUP,HCPCS C2617,,G23412  -  SET STNT 2 PGTL CRV 7FR 18CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23413,SUP,HCPCS C2617,,G23413  -  SET STNT 2 PGTL CRV 7FR 20CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23415,SUP,HCPCS C2617,,G23415  -  SET STNT 2 PGTL CRV 7FR 22CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23416,SUP,HCPCS C2617,,G23416  -  STENT URET 7FR 24CM STRL UNIVERSA FIRM PSTNR NO GW MFL TETH,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23417,SUP,HCPCS C2617,,G23417  -  STENT URET 7FR 26CM STRL UNIVERSA FIRM PSTNR NO GW MFL TETH,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23418,SUP,HCPCS C2617,,G23418  -  STENT URET 7FR 28CM STRL UNIVERSA FIRM PSTNR NO GW MFL TETH,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23419,SUP,HCPCS C2617,,G23419  -  SET STNT 2 PGTL CRV 7FR 30CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23420,SUP,HCPCS C2617,,G23420  -  SET STNT 2 PGTL CRV 8FR 18CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23421,SUP,HCPCS C2617,,G23421  -  SET STNT 2 PGTL CRV 8FR 20CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23422,SUP,HCPCS C2617,,G23422  -  SET STNT 2 PGTL CRV 8FR 22CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23423,SUP,HCPCS C2617,,G23423  -  STENT URET 8FR 24CM STRL UNIVERSA FIRM PSTNR NO GW MFL TETH,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23424,SUP,HCPCS C2617,,G23424  -  SET STNT 2 PGTL CRV 8FR 26CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23425,SUP,HCPCS C2617,,G23425  -  SET STNT 2 PGTL CRV 8FR 28CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23428,SUP,HCPCS C2617,,G23428  -  SET STNT 2 PGTL CRV 8FR 30CM STRL UNIVERSA RADOPQ GRAD MRK,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23429,SUP,HCPCS C2617,,G23429  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 18CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23430,SUP,HCPCS C2617,,G23430  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 20CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23431,SUP,HCPCS C2617,,G23431  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 22CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23432,SUP,HCPCS C2617,,G23432  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 24CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23433,SUP,HCPCS C2617,,G23433  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 26CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23434,SUP,HCPCS C2617,,G23434  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 28CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23435,SUP,HCPCS C2617,,G23435  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 30CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23436,SUP,HCPCS C2617,,G23436  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 18CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23437,SUP,HCPCS C2617,,G23437  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 20CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23438,SUP,HCPCS C2617,,G23438  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 22CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23439,SUP,HCPCS C2617,,G23439  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 24CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23440,SUP,HCPCS C2617,,G23440  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 26CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23441,SUP,HCPCS C2617,,G23441  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 28CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23442,SUP,HCPCS C2617,,G23442  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 30CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23443,SUP,HCPCS C2617,,G23443  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 18CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23444,SUP,HCPCS C2617,,G23444  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 20CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23445,SUP,HCPCS C2617,,G23445  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 22CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23446,SUP,HCPCS C2617,,G23446  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 24CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23447,SUP,HCPCS C2617,,G23447  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 26CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23448,SUP,HCPCS C2617,,G23448  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 28CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23449,SUP,HCPCS C2617,,G23449  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 18CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23450,SUP,HCPCS C2617,,G23450  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 20CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23451,SUP,HCPCS C2617,,G23451  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 22CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23452,SUP,HCPCS C2617,,G23452  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 24CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23453,SUP,HCPCS C2617,,G23453  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 26CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23454,SUP,HCPCS C2617,,G23454  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 28CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23455,SUP,HCPCS C2617,,G23455  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 30CM STRL 145CM UNIVERSA,$137.05,$0.00,$137.05,$61.67,$97.81,$0.00,$23.61,$0.00,$0.00,$24.00,$137.05,$0.00,$68.53,$108.54,$109.64,$0.00,$21.45,$0.00,$21.82,$0.00
G23456,SUP,HCPCS C2617,,G23456  -  SET STNT 2 PGTL CRV 5FR 18CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23457,SUP,HCPCS C2617,,G23457  -  SET STNT 2 PGTL CRV 5FR 20CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23458,SUP,HCPCS C2617,,G23458  -  SET STNT 2 PGTL CRV 5FR 22CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23459,SUP,HCPCS C2617,,G23459  -  SET STNT 2 PGTL CRV 5FR 24CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23460,SUP,HCPCS C2617,,G23460  -  SET STNT 2 PGTL CRV 5FR 26CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23461,SUP,HCPCS C2617,,G23461  -  SET STNT 2 PGTL CRV 5FR 28CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23462,SUP,HCPCS C2617,,G23462  -  SET STNT 2 PGTL CRV 5FR 30CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23463,SUP,HCPCS C2617,,G23463  -  SET STNT 2 PGTL CRV 6FR 18CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23464,SUP,HCPCS C2617,,G23464  -  SET STNT 2 PGTL CRV 6FR 20CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23465,SUP,HCPCS C2617,,G23465  -  SET STNT 2 PGTL CRV 6FR 22CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23466,SUP,HCPCS C2617,,G23466  -  SET STNT 2 PGTL CRV 6FR 24CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23467,SUP,HCPCS C2617,,G23467  -  SET STNT 2 PGTL CRV 6FR 26CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23468,SUP,HCPCS C2617,,G23468  -  SET STNT 2 PGTL CRV 6FR 28CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23469,SUP,HCPCS C2617,,G23469  -  SET STNT 2 PGTL CRV 6FR 30CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23470,SUP,HCPCS C2617,,G23470  -  SET STNT 2 PGTL CRV 7FR 18CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23471,SUP,HCPCS C2617,,G23471  -  SET STNT 2 PGTL CRV 7FR 20CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23472,SUP,HCPCS C2617,,G23472  -  SET STNT 2 PGTL CRV 7FR 22CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23473,SUP,HCPCS C2617,,G23473  -  SET STNT 2 PGTL CRV 7FR 24CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23474,SUP,HCPCS C2617,,G23474  -  SET STNT 2 PGTL CRV 7FR 26CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23475,SUP,HCPCS C2617,,G23475  -  SET STNT 2 PGTL CRV 7FR 28CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23476,SUP,HCPCS C2617,,G23476  -  SET STNT 2 PGTL CRV 7FR 30CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23477,SUP,HCPCS C2617,,G23477  -  SET STNT 2 PGTL CRV 8FR 18CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23478,SUP,HCPCS C2617,,G23478  -  SET STNT 2 PGTL CRV 8FR 20CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23479,SUP,HCPCS C2617,,G23479  -  SET STNT 2 PGTL CRV 8FR 22CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23480,SUP,HCPCS C2617,,G23480  -  SET STNT 2 PGTL CRV 8FR 24CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23481,SUP,HCPCS C2617,,G23481  -  SET STNT 2 PGTL CRV 8FR 26CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23482,SUP,HCPCS C2617,,G23482  -  SET STNT 2 PGTL CRV 8FR 28CM STRL UNIVERSA RADOPQ GRAD MRK,$148.75,$0.00,$148.75,$66.94,$106.16,$0.00,$25.63,$0.00,$0.00,$26.04,$148.75,$0.00,$74.38,$117.81,$119.00,$0.00,$23.28,$0.00,$23.68,$0.00
G23483,SUP,HCPCS C2617,,G23483  -  SET STNT .038IN 2 PGTL CRV 8FR 30CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23484,SUP,HCPCS C2617,,G23484  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 18CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23485,SUP,HCPCS C2617,,G23485  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 20CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23486,SUP,HCPCS C2617,,G23486  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 22CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23487,SUP,HCPCS C2617,,G23487  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 24CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23488,SUP,HCPCS C2617,,G23488  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 26CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23489,SUP,HCPCS C2617,,G23489  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 28CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23490,SUP,HCPCS C2617,,G23490  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 30CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23491,SUP,HCPCS C2617,,G23491  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 18CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23492,SUP,HCPCS C2617,,G23492  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 20CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23493,SUP,HCPCS C2617,,G23493  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 22CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23494,SUP,HCPCS C2617,,G23494  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 24CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23495,SUP,HCPCS C2617,,G23495  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 26CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23496,SUP,HCPCS C2617,,G23496  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 28CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23497,SUP,HCPCS C2617,,G23497  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 30CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23498,SUP,HCPCS C2617,,G23498  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 18CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23499,SUP,HCPCS C2617,,G23499  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 20CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23500,SUP,HCPCS C2617,,G23500  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 22CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23501,SUP,HCPCS C2617,,G23501  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 24CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23502,SUP,HCPCS C2617,,G23502  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 26CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23503,SUP,HCPCS C2617,,G23503  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 24CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23504,SUP,HCPCS C2617,,G23504  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 30CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23505,SUP,HCPCS C2617,,G23505  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 18CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23506,SUP,HCPCS C2617,,G23506  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 20CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23507,SUP,HCPCS C2617,,G23507  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 22CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23508,SUP,HCPCS C2617,,G23508  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 24CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23509,SUP,HCPCS C2617,,G23509  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 26CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23510,SUP,HCPCS C2617,,G23510  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 28CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23511,SUP,HCPCS C2617,,G23511  -  SET STNT .038IN 2 PGTL CRV 8FR 30CM STRL 145CM UNIVERSA,$137.05,$0.00,$137.05,$61.67,$97.81,$0.00,$23.61,$0.00,$0.00,$24.00,$137.05,$0.00,$68.53,$108.54,$109.64,$0.00,$21.45,$0.00,$21.82,$0.00
G23512,SUP,HCPCS C2617,,G23512  -  SET STNT 2 PGTL CRV 5FR 22-32CM STRL 145CM UNIVERSA RADOPQ,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G23523,SUP,Custom 27803010,,G23523  -  COIL EMBOLIZATION 3MM 7CM 7.4 LOOP NESTER PLATINUM SYNTH,$264.20,$0.00,$264.20,$0.00,$188.56,$0.00,$0.00,$0.00,$0.00,$0.00,$264.20,$0.00,$132.10,$209.25,$211.36,$0.00,$0.00,$0.00,$0.00,$0.00
G23552,SUP,Custom 27203010,,G23552  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 22-32CM STRL 145CM,"$2,152.50",$0.00,"$2,152.50",$0.00,"$1,536.24",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,152.50",$0.00,"$1,076.25","$1,704.78","$1,722.00",$0.00,$0.00,$0.00,$0.00,$0.00
G23553,SUP,Custom 27203010,,G23553  -  FIBER LSR 20W 365UM RD STRL SMARTSYNC CNCT HO DISP RHPSD,"$2,367.30",$0.00,"$2,367.30",$0.00,"$1,689.54",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,367.30",$0.00,"$1,183.65","$1,874.90","$1,893.84",$0.00,$0.00,$0.00,$0.00,$0.00
G23665,SUP,Custom 27203010,,G23665  -  LASER SRG 230V 10AMP RHPSD H-30 HL-30B,"$2,231.25",$0.00,"$2,231.25",$0.00,"$1,592.44",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,231.25",$0.00,"$1,115.63","$1,767.15","$1,785.00",$0.00,$0.00,$0.00,$0.00,$0.00
G23666,SUP,Custom 27203010,,G23666  -  FIBER LSR 940UM CK HO,"$1,168.75",$0.00,"$1,168.75",$0.00,$834.14,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,168.75",$0.00,$584.38,$925.65,$935.00,$0.00,$0.00,$0.00,$0.00,$0.00
G23667,SUP,Custom 27203010,,G23667  -  FIBER LSR 550UM CK HO,"$1,009.38",$0.00,"$1,009.38",$0.00,$720.39,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,009.38",$0.00,$504.69,$799.43,$807.50,$0.00,$0.00,$0.00,$0.00,$0.00
G23668,SUP,Custom 27203010,,G23668  -  FIBER LSR 365UM CK HO,"$1,593.75",$0.00,"$1,593.75",$0.00,"$1,137.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,593.75",$0.00,$796.88,"$1,262.25","$1,275.00",$0.00,$0.00,$0.00,$0.00,$0.00
G23731,SUP,Custom 27203010,,G23731  -  FIBER LSR 273UM CK HO,"$2,921.25",$0.00,"$2,921.25",$0.00,"$2,084.90",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,921.25",$0.00,"$1,460.63","$2,313.63","$2,337.00",$0.00,$0.00,$0.00,$0.00,$0.00
G23733,SUP,Custom 27203010,,G23733  -  FIBER LSR 150UM CK HO,$849.10,$0.00,$849.10,$0.00,$606.00,$0.00,$0.00,$0.00,$0.00,$0.00,$849.10,$0.00,$424.55,$672.49,$679.28,$0.00,$0.00,$0.00,$0.00,$0.00
G23734,SUP,Custom 27203010,,G23734  -  FIBER LSR 200UM RD STRL SMARTSYNC CNCT HO DISP RHPSD H-30,$953.25,$0.00,$953.25,$0.00,$680.33,$0.00,$0.00,$0.00,$0.00,$0.00,$953.25,$0.00,$476.63,$754.97,$762.60,$0.00,$0.00,$0.00,$0.00,$0.00
G23735,SUP,Custom 27203010,,G23735  -  FIBER LSR 550UM RD STRL SMARTSYNC CNCT HO DISP RHPSD H-30,"$1,578.50",$0.00,"$1,578.50",$0.00,"$1,126.58",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,578.50",$0.00,$789.25,"$1,250.17","$1,262.80",$0.00,$0.00,$0.00,$0.00,$0.00
G24129,SUP,HCPCS C1769,,G24129  -  SET INTRO .018IN .087IN 5.5CM GW SUBMANDIBULAR SLVA DCT,$387.50,$0.00,$387.50,$210.41,$276.56,$0.00,$66.76,$0.00,$0.00,$67.85,$387.50,$0.00,$193.75,$306.90,$310.00,$0.00,$60.64,$0.00,$61.69,$0.00
G24132,SUP,HCPCS C1769,,G24132  -  SET INTRO .018IN .074IN 5.5CM GW SUBMANDIBULAR SLVA DCT,$387.50,$0.00,$387.50,$210.41,$276.56,$0.00,$66.76,$0.00,$0.00,$67.85,$387.50,$0.00,$193.75,$306.90,$310.00,$0.00,$60.64,$0.00,$61.69,$0.00
G24889,SUP,HCPCS C1874,,G24889  -  STENT VASCULAR 60MM DRUG ELUTING OTW DELIVERY SYSTEM ZILVER,"$3,737.50",$0.00,"$3,737.50","$1,681.88","$2,667.45",$0.00,$643.95,$0.00,$0.00,$654.41,"$3,737.50",$0.00,"$1,868.75","$2,960.10","$2,990.00",$0.00,$584.92,$0.00,$595.01,$0.00
G24890,SUP,HCPCS C1874,,G24890  -  STENT VASCULAR 80MM DRUG ELUTING SELF EXPANDING GWIRE ZILVER,"$4,487.50",$0.00,"$4,487.50","$2,019.38","$3,202.73",$0.00,$773.17,$0.00,$0.00,$785.73,"$4,487.50",$0.00,"$2,243.75","$3,554.10","$3,590.00",$0.00,$702.29,$0.00,$714.41,$0.00
G24894,SUP,HCPCS C1874,,G24894  -  STENT VASCULAR 60MM DRUG ELUTING OTW DELIVERY SYSTEM ZILVER,"$3,737.50",$0.00,"$3,737.50","$1,681.88","$2,667.45",$0.00,$643.95,$0.00,$0.00,$654.41,"$3,737.50",$0.00,"$1,868.75","$2,960.10","$2,990.00",$0.00,$584.92,$0.00,$595.01,$0.00
G24895,SUP,HCPCS C1874,,G24895  -  STENT VASC .035IN 7MM 6FR 80MM 125CM ZL PTX DRG ELUT SLF XPD,"$4,487.50",$0.00,"$4,487.50","$2,019.38","$3,202.73",$0.00,$773.17,$0.00,$0.00,$785.73,"$4,487.50",$0.00,"$2,243.75","$3,554.10","$3,590.00",$0.00,$702.29,$0.00,$714.41,$0.00
G24935,SUP,HCPCS C1874,,G24935  -  STENT VASCULAR 100MM DRUG ELUTING OTW SELF EXPAND ZILVER PTX,"$4,487.50",$0.00,"$4,487.50","$2,019.38","$3,202.73",$0.00,$773.17,$0.00,$0.00,$785.73,"$4,487.50",$0.00,"$2,243.75","$3,554.10","$3,590.00",$0.00,$702.29,$0.00,$714.41,$0.00
G24937,SUP,HCPCS C1874,,G24937  -  STENT VASCULAR 100MM DRUG ELUTING OTW DELIVERY SYSTEM ZILVER,"$4,487.50",$0.00,"$4,487.50","$2,019.38","$3,202.73",$0.00,$773.17,$0.00,$0.00,$785.73,"$4,487.50",$0.00,"$2,243.75","$3,554.10","$3,590.00",$0.00,$702.29,$0.00,$714.41,$0.00
G25292,SUP,Custom 27203010,,G25292  -  SYSTEM LTHTRP UNV 11.6FR 5FR 38CM STRL LITHASSIST TUO 2 LUM,"$2,666.15",$0.00,"$2,666.15",$0.00,"$1,902.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,666.15",$0.00,"$1,333.08","$2,111.59","$2,132.92",$0.00,$0.00,$0.00,$0.00,$0.00
G25293,SUP,Custom 27203010,,G25293  -  FIBER LSR CK HO DISP,$802.58,$0.00,$802.58,$0.00,$572.80,$0.00,$0.00,$0.00,$0.00,$0.00,$802.58,$0.00,$401.29,$635.64,$642.06,$0.00,$0.00,$0.00,$0.00,$0.00
G25294,SUP,Custom 27203010,,G25294  -  FIBER LSR 200UM CK HO DISP,$659.25,$0.00,$659.25,$0.00,$470.51,$0.00,$0.00,$0.00,$0.00,$0.00,$659.25,$0.00,$329.63,$522.13,$527.40,$0.00,$0.00,$0.00,$0.00,$0.00
G25295,SUP,Custom 27203010,,G25295  -  FIBER LSR HO HO DISP,$659.25,$0.00,$659.25,$0.00,$470.51,$0.00,$0.00,$0.00,$0.00,$0.00,$659.25,$0.00,$329.63,$522.13,$527.40,$0.00,$0.00,$0.00,$0.00,$0.00
G25296,SUP,Custom 27203010,,G25296  -  FIBER LSR 365UM RD SMARTSYNC HO DISP STD SMA CNCT,$857.93,$0.00,$857.93,$0.00,$612.30,$0.00,$0.00,$0.00,$0.00,$0.00,$857.93,$0.00,$428.96,$679.48,$686.34,$0.00,$0.00,$0.00,$0.00,$0.00
G25297,SUP,Custom 27203010,,G25297  -  FIBER LSR 550UM CK HO DISP,"$1,420.65",$0.00,"$1,420.65",$0.00,"$1,013.92",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,420.65",$0.00,$710.33,"$1,125.15","$1,136.52",$0.00,$0.00,$0.00,$0.00,$0.00
G25298,SUP,Custom 27203010,,G25298  -  FIBER LSR 940UM RD SMARTSYNC HO DISP STD SMA CNCT,$531.25,$0.00,$531.25,$0.00,$379.15,$0.00,$0.00,$0.00,$0.00,$0.00,$531.25,$0.00,$265.63,$420.75,$425.00,$0.00,$0.00,$0.00,$0.00,$0.00
G25299,SUP,Custom 27203010,,G25299  -  FIBER LSR 273UM CK MU HO,"$1,009.38",$0.00,"$1,009.38",$0.00,$720.39,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,009.38",$0.00,$504.69,$799.43,$807.50,$0.00,$0.00,$0.00,$0.00,$0.00
G25300,SUP,Custom 27203010,,G25300  -  FIBER LSR 365UM CK MU HO,"$1,168.75",$0.00,"$1,168.75",$0.00,$834.14,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,168.75",$0.00,$584.38,$925.65,$935.00,$0.00,$0.00,$0.00,$0.00,$0.00
G25301,SUP,Custom 27203010,,G25301  -  FIBER LSR 550UM CK MU HO,"$2,231.25",$0.00,"$2,231.25",$0.00,"$1,592.44",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,231.25",$0.00,"$1,115.63","$1,767.15","$1,785.00",$0.00,$0.00,$0.00,$0.00,$0.00
G25507,SUP,Custom 27203010,,G25507  -  NEEDLE ENDSCP 0-8CM 19GA 5.2FR 138-140CM SFT TIS US SHTH Q,$650.00,$0.00,$650.00,$0.00,$463.91,$0.00,$0.00,$0.00,$0.00,$0.00,$650.00,$0.00,$325.00,$514.80,$520.00,$0.00,$0.00,$0.00,$0.00,$0.00
G25668,SUP,Custom 27203010,,G25668  -  LGTR 15MM SHORTSHOT SA HMRHD 4 BAND NONSTRL DISP ENDSCP,$112.50,$0.00,$112.50,$0.00,$80.29,$0.00,$0.00,$0.00,$0.00,$0.00,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$0.00,$0.00,$0.00,$0.00
G25981,SUP,HCPCS C1894,,G25981  -  BUNDLE FO 150CM VUEOPTIC,$176.00,$0.00,$176.00,$95.57,$125.61,$0.00,$30.32,$0.00,$0.00,$30.82,$176.00,$0.00,$88.00,$139.39,$140.80,$0.00,$27.54,$0.00,$28.02,$0.00
G26124,SUP,Custom 27203010,,G26124  -  INTRODUCER SPBC 10FR 14FR 17CM 20CM 1STP DRN CATH DIL TROC,$536.58,$0.00,$536.58,$0.00,$382.95,$0.00,$0.00,$0.00,$0.00,$0.00,$536.58,$0.00,$268.29,$424.97,$429.26,$0.00,$0.00,$0.00,$0.00,$0.00
G26574,SUP,HCPCS C1726,,G26574  -  SET SPINAL MICROCOMPRESSION BROWN 4FR TRIGEMINAL GANGLION,"$1,027.00",$0.00,"$1,027.00",$557.66,$732.97,$0.00,$176.95,$0.00,$0.00,$179.82,"$1,027.00",$0.00,$513.50,$813.38,$821.60,$0.00,$160.73,$0.00,$163.50,$0.00
G26642,SUP,HCPCS C1894,,G26642  -  EXTRACTOR STON 5CM 7FR 6MM 65CM 4CM RTNR 3WR HLCL BLN,$176.00,$0.00,$176.00,$95.57,$125.61,$0.00,$30.32,$0.00,$0.00,$30.82,$176.00,$0.00,$88.00,$139.39,$140.80,$0.00,$27.54,$0.00,$28.02,$0.00
G26648,SUP,HCPCS C1894,,G26648  -  INTRODUCER SPBC 10FR 16FR 17CM 20CM 1STP DRN CATH DIL TROC,$176.00,$0.00,$176.00,$95.57,$125.61,$0.00,$30.32,$0.00,$0.00,$30.82,$176.00,$0.00,$88.00,$139.39,$140.80,$0.00,$27.54,$0.00,$28.02,$0.00
G26655,SUP,HCPCS C1894,,G26655  -  INTRODUCER SPBC 12FR 18FR 17CM 20CM 1STP DRN CATH DIL TROC,$176.00,$0.00,$176.00,$95.57,$125.61,$0.00,$30.32,$0.00,$0.00,$30.82,$176.00,$0.00,$88.00,$139.39,$140.80,$0.00,$27.54,$0.00,$28.02,$0.00
G26666,SUP,HCPCS C1894,,G26666  -  INTRODUCER SPBC 16FR 20- FR 17CM 20CM PLWY 1 STP DIL TROC,$176.00,$0.00,$176.00,$95.57,$125.61,$0.00,$30.32,$0.00,$0.00,$30.82,$176.00,$0.00,$88.00,$139.39,$140.80,$0.00,$27.54,$0.00,$28.02,$0.00
G26891,SUP,HCPCS C1725,,G26891  -  CATHETER BLNDIL 4MM 80CM STRL 2CM ATB ADV 2 LUM XPD RADOPQ,$275.00,$0.00,$275.00,$149.33,$196.27,$0.00,$47.38,$0.00,$0.00,$48.15,$275.00,$0.00,$137.50,$217.80,$220.00,$0.00,$43.04,$0.00,$43.78,$0.00
G26908,SUP,HCPCS C1726,,G26908  -  SET ENDSCP INSTR BILE DUCT ADPR CATH STON XTRT XPLR STRL,"$1,980.00",$0.00,"$1,980.00","$1,075.14","$1,413.13",$0.00,$341.14,$0.00,$0.00,$346.68,"$1,980.00",$0.00,$990.00,"$1,568.16","$1,584.00",$0.00,$309.87,$0.00,$315.22,$0.00
G26957,SUP,HCPCS C1769,,G26957  -  GUIDEWIRE VASCULAR 10MM RAD .035IN 110CM REUTER TIP,$187.50,$0.00,$187.50,$101.81,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G26973,SUP,HCPCS C1725,,G26973  -  CATH ANGIO 5FR .35IN 90CM VSCR SUP VIS GRADUAL TRNS OF,$32.50,$0.00,$32.50,$17.65,$23.20,$0.00,$5.60,$0.00,$0.00,$5.69,$32.50,$0.00,$16.25,$25.74,$26.00,$0.00,$5.09,$0.00,$5.17,$0.00
G26986,SUP,HCPCS C1770,,G26986  -  COIL EMBOLIZATION .018IN 10MM 14CM 4.5 LOOP SOFT RADIOPACITY,$264.20,$0.00,$264.20,$0.00,$188.56,$0.00,$0.00,$0.00,$0.00,$0.00,$264.20,$0.00,$132.10,$209.25,$211.36,$0.00,$0.00,$0.00,$0.00,$0.00
G26989,SUP,HCPCS C1770,,G26989  -  COIL EMBOLIZATION .018IN 6MM 14CM 7.4 LOOP SOFT RADIOPACITY,$264.20,$0.00,$264.20,$0.00,$188.56,$0.00,$0.00,$0.00,$0.00,$0.00,$264.20,$0.00,$132.10,$209.25,$211.36,$0.00,$0.00,$0.00,$0.00,$0.00
G26990,SUP,HCPCS C1770,,G26990  -  COIL EMBOLIZATION .018IN 8MM 14CM 5.6 LOOP SOFT RADIOPACITY,$264.20,$0.00,$264.20,$0.00,$188.56,$0.00,$0.00,$0.00,$0.00,$0.00,$264.20,$0.00,$132.10,$209.25,$211.36,$0.00,$0.00,$0.00,$0.00,$0.00
G26991,SUP,Custom 27203010,,G26991  -  COIL EMBOLIZATION .035IN 10MM 14CM 4.5 LOOP SOFT NESTER,$264.20,$0.00,$264.20,$0.00,$188.56,$0.00,$0.00,$0.00,$0.00,$0.00,$264.20,$0.00,$132.10,$209.25,$211.36,$0.00,$0.00,$0.00,$0.00,$0.00
G26994,SUP,Custom 27803010,,G26994  -  COIL EMBOLIZATION .035IN 7.4 LOOP 6MM 14CM SOFT CATHETER,$264.20,$0.00,$264.20,$0.00,$188.56,$0.00,$0.00,$0.00,$0.00,$0.00,$264.20,$0.00,$132.10,$209.25,$211.36,$0.00,$0.00,$0.00,$0.00,$0.00
G26995,SUP,HCPCS C1770,,G26995  -  COIL EMBOLIZATION .035IN 5.6 LOOPS 8MM 14CM SOFT CATHETER,$264.20,$0.00,$264.20,$0.00,$188.56,$0.00,$0.00,$0.00,$0.00,$0.00,$264.20,$0.00,$132.10,$209.25,$211.36,$0.00,$0.00,$0.00,$0.00,$0.00
G27035,SUP,HCPCS C1769,,G27035  -  GUIDEWIRE VASCULAR STR .035IN 260CM FLEXIBLE TIP STIFF SHAFT,$86.25,$0.00,$86.25,$46.83,$61.56,$0.00,$14.86,$0.00,$0.00,$15.10,$86.25,$0.00,$43.13,$68.31,$69.00,$0.00,$13.50,$0.00,$13.73,$0.00
G27047,SUP,Custom 27203010,,G27047  -  CATH JJNSTM 80CM 16.5FR CR-ALZT-CNS 2 LUM REPL STRL DISP,$180.35,$0.00,$180.35,$0.00,$128.72,$0.00,$0.00,$0.00,$0.00,$0.00,$180.35,$0.00,$90.18,$142.84,$144.28,$0.00,$0.00,$0.00,$0.00,$0.00
G27059,SUP,HCPCS C2617,,G27059  -  INTRODUCER SPBC 18FR 22FR 17CM 20CM 1STP DRN CATH DIL TROC,$253.45,$0.00,$253.45,$114.05,$180.89,$0.00,$43.67,$0.00,$0.00,$44.38,$253.45,$0.00,$126.73,$200.73,$202.76,$0.00,$39.66,$0.00,$40.35,$0.00
G27061,SUP,HCPCS C1729,,G27061  -  SET STNT 2 PGTL CRV 8.2FR 40CM RADOPQ PSTNR SFLX URETER,$150.55,$0.00,$150.55,$81.75,$107.45,$0.00,$25.94,$0.00,$0.00,$26.36,$150.55,$0.00,$75.28,$119.24,$120.44,$0.00,$23.56,$0.00,$23.97,$0.00
G27063,SUP,HCPCS C2617,,G27063  -  SET NPHSTM 12FR 30CM COPE LOOP MOD NDL GW CNN DIL,$365.43,$0.00,$365.43,$164.44,$260.80,$0.00,$62.96,$0.00,$0.00,$63.98,$365.43,$0.00,$182.71,$289.42,$292.34,$0.00,$57.19,$0.00,$58.18,$0.00
G27161,SUP,HCPCS C2617,,G27161  -  STENT PANCREATIC 5FR 14CM DRAIN OBSTRUCTED POSITIONING,$177.50,$0.00,$177.50,$79.88,$126.68,$0.00,$30.58,$0.00,$0.00,$31.08,$177.50,$0.00,$88.75,$140.58,$142.00,$0.00,$27.78,$0.00,$28.26,$0.00
G27234,SUP,Custom 27203010,,G27234  -  DEVICE STNT RTRVL 4.5FR 65CM NSNARE FLXB NTNL WRE CNSTRCT,$289.10,$0.00,$289.10,$0.00,$206.33,$0.00,$0.00,$0.00,$0.00,$0.00,$289.10,$0.00,$144.55,$228.97,$231.28,$0.00,$0.00,$0.00,$0.00,$0.00
G27887,SUP,HCPCS C1769,,G27887  -  GUIDEWIRE VASC STRG .028IN 145CM FX COR SS,$64.83,$0.00,$64.83,$35.20,$46.27,$0.00,$11.17,$0.00,$0.00,$11.35,$64.83,$0.00,$32.41,$51.35,$51.86,$0.00,$10.15,$0.00,$10.32,$0.00
G28999,SUP,HCPCS C1894,,G28999  -  INTRODUCER CATHETER 25CM SET CHK-FLO 20FR,$847.50,$0.00,$847.50,$460.19,$604.86,$0.00,$146.02,$0.00,$0.00,$148.39,$847.50,$0.00,$423.75,$671.22,$678.00,$0.00,$132.63,$0.00,$134.92,$0.00
G29965,SUP,HCPCS C1769,,GUIDE WIRE .035IN X 80CM X 10CM REFLECTOR REUTER TIP DEFLECT,$161.00,$0.00,$161.00,$87.42,$114.91,$0.00,$27.74,$0.00,$0.00,$28.19,$161.00,$0.00,$80.50,$127.51,$128.80,$0.00,$25.20,$0.00,$25.63,$0.00
G29982,SUP,HCPCS C1894,,G29982  -  SHEATH GUID .018/.038IN ANL1 CURVE 6FR .087IN 45CM RADIOPQ,$187.50,$0.00,$187.50,$101.81,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G29983,SUP,HCPCS C1894,,G29983  -  SHEATH GUID .018/.038IN ANL2 CURVE 6FR .087IN 45CM RADIOPQ,$187.50,$0.00,$187.50,$101.81,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G29985,SUP,HCPCS C1894,,G29985  -  SHEATH GUID ANL1 CURVE 7FR .100IN 45CM UNIQUELY FABRICATED,$187.50,$0.00,$187.50,$101.81,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G29986,SUP,HCPCS C1894,,G29986  -  SHEATH GUID .018/.038IN ANL2 CURVE 7FR .1IN 45CM RADIOPQ,$187.50,$0.00,$187.50,$101.81,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G29989,SUP,HCPCS C1894,,G29989  -  SHEATH GUID .018-.038IN ANL2 CURVE 6FR .087IN 90CM RADIOPQ,$377.50,$0.00,$377.50,$204.98,$269.42,$0.00,$65.04,$0.00,$0.00,$66.10,$377.50,$0.00,$188.75,$298.98,$302.00,$0.00,$59.08,$0.00,$60.10,$0.00
G30117,SUP,HCPCS C1894,,G30117  -  INTRODUCER SHEATH .018 .038IN ANL2 CURVE 5FR .074IN 45CM,$187.50,$0.00,$187.50,$101.81,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G30357,SUP,HCPCS C1726,,G30357  -  POUCH DRN 300ML NS ELC BELT ADJ 1 CNCT 2 TUBE REED VLV MECH,$618.80,$0.00,$618.80,$336.01,$441.64,$0.00,$106.62,$0.00,$0.00,$108.35,$618.80,$0.00,$309.40,$490.09,$495.04,$0.00,$96.84,$0.00,$98.51,$0.00
G30358,SUP,HCPCS C1726,,G30358  -  EXTRACTOR SRG 12FR 38CM STRL PRC NC STON TPLS ATRM NTNL DISP,$519.35,$0.00,$519.35,$282.01,$370.66,$0.00,$89.48,$0.00,$0.00,$90.93,$519.35,$0.00,$259.68,$411.33,$415.48,$0.00,$81.28,$0.00,$82.68,$0.00
G30360,SUP,HCPCS C1773,,G30360  -  CATHETER NPHSTM 10MM 15CM CLR ULTRX TRNS TPR BLN RADOPQ STRP,$419.70,$0.00,$419.70,$227.90,$299.54,$0.00,$72.31,$0.00,$0.00,$73.49,$419.70,$0.00,$209.85,$332.40,$335.76,$0.00,$65.68,$0.00,$66.82,$0.00
G30361,SUP,HCPCS C1773,,G30361  -  FORCEPS SPEC RTRVL 15MM 3.2FR 115CM STRL CPTR 3 PR STON FB,$419.70,$0.00,$419.70,$227.90,$299.54,$0.00,$72.31,$0.00,$0.00,$73.49,$419.70,$0.00,$209.85,$332.40,$335.76,$0.00,$65.68,$0.00,$66.82,$0.00
G30362,SUP,HCPCS C1773,,G30362  -  GRASPER ESCP 2.8FR 15MM 115CM CPTR 3 PR OPN WD MICROTHROW,$419.70,$0.00,$419.70,$227.90,$299.54,$0.00,$72.31,$0.00,$0.00,$73.49,$419.70,$0.00,$209.85,$332.40,$335.76,$0.00,$65.68,$0.00,$66.82,$0.00
G30364,SUP,HCPCS C1726,,G30364  -  CATHETER NEPHROSTOMY 20 ATM 10MM 15CM INFLATE BALLOON SHEATH,$519.35,$0.00,$519.35,$282.01,$370.66,$0.00,$89.48,$0.00,$0.00,$90.93,$519.35,$0.00,$259.68,$411.33,$415.48,$0.00,$81.28,$0.00,$82.68,$0.00
G30365,SUP,HCPCS C1726,,G30365  -  SET NEPHROSTOMY 10MM 15CM CATHETER RADIOPQ BALLOON SHEATH,$618.80,$0.00,$618.80,$336.01,$441.64,$0.00,$106.62,$0.00,$0.00,$108.35,$618.80,$0.00,$309.40,$490.09,$495.04,$0.00,$96.84,$0.00,$98.51,$0.00
G30375,SUP,HCPCS C1773,,G30375  -  FORCEPS SPEC RTRVL 15MM 3.2FR 90CM STRL CPTR 3 PR STON FB,$482.65,$0.00,$482.65,$262.08,$344.47,$0.00,$83.16,$0.00,$0.00,$84.51,$482.65,$0.00,$241.33,$382.26,$386.12,$0.00,$75.53,$0.00,$76.84,$0.00
G30389,SUP,HCPCS C1894,,G30389  -  SHEATH ACCES 14FR 35CM DILATION CONTIN WORKING CHANNEL,$308.00,$0.00,$308.00,$167.24,$219.82,$0.00,$53.07,$0.00,$0.00,$53.93,$308.00,$0.00,$154.00,$243.94,$246.40,$0.00,$48.20,$0.00,$49.03,$0.00
G30390,SUP,HCPCS C1894,,G30390  -  FORCEPS SPEC RTRVL 15MM 2.8FR 115CM STRL CPTR 3 PR STON FB,$308.00,$0.00,$308.00,$167.24,$219.82,$0.00,$53.07,$0.00,$0.00,$53.93,$308.00,$0.00,$154.00,$243.94,$246.40,$0.00,$48.20,$0.00,$49.03,$0.00
G30391,SUP,HCPCS C1894,,G30391  -  SHEATH ACC 14FR 55CM STRL FLXR DILATION CNT WRK CHNL AQ URET,$308.00,$0.00,$308.00,$167.24,$219.82,$0.00,$53.07,$0.00,$0.00,$53.93,$308.00,$0.00,$154.00,$243.94,$246.40,$0.00,$48.20,$0.00,$49.03,$0.00
G30393,SUP,HCPCS C1894,,G30393  -  SHEATH ACC 14FR 20CM FLXR DILATION CNT WKG CHNL URET,$308.00,$0.00,$308.00,$167.24,$219.82,$0.00,$53.07,$0.00,$0.00,$53.93,$308.00,$0.00,$154.00,$243.94,$246.40,$0.00,$48.20,$0.00,$49.03,$0.00
G30403,SUP,HCPCS C2627,,G30403  -  SHEATH ACC 14FR 28CM FLXR DILATION CNT WKG CHNL LFRIC SM,$166.10,$0.00,$166.10,$90.19,$118.55,$0.00,$28.62,$0.00,$0.00,$29.08,$166.10,$0.00,$83.05,$131.55,$132.88,$0.00,$25.99,$0.00,$26.44,$0.00
G30404,SUP,HCPCS C2627,,G30404  -  SET CATH 8.5FR 25CM MCLC NDL OBT CNN CNCT TUBE ULTHNE SPBC,$166.10,$0.00,$166.10,$90.19,$118.55,$0.00,$28.62,$0.00,$0.00,$29.08,$166.10,$0.00,$83.05,$131.55,$132.88,$0.00,$25.99,$0.00,$26.44,$0.00
G30405,SUP,HCPCS C2627,,G30405  -  SET CATH 12FR 25CM MCLC NDL OBT CNN CNCT TUBE ULTHNE SPBC,$166.10,$0.00,$166.10,$90.19,$118.55,$0.00,$28.62,$0.00,$0.00,$29.08,$166.10,$0.00,$83.05,$131.55,$132.88,$0.00,$25.99,$0.00,$26.44,$0.00
G30470,SUP,HCPCS C1769,,G30470  -  SET CATH 14FR 25CM MCLC NDL OBT CNN CNCT TUBE LCK LOOP,$595.83,$0.00,$595.83,$323.53,$425.24,$0.00,$102.66,$0.00,$0.00,$104.32,$595.83,$0.00,$297.91,$471.90,$476.66,$0.00,$93.25,$0.00,$94.86,$0.00
G30471,SUP,HCPCS C1769,,G30471  -  GUIDEWIRE VASCULAR .038IN 150CM 3CM STIFF ANGLED TIP CORE,$119.17,$0.00,$119.17,$64.71,$85.05,$0.00,$20.53,$0.00,$0.00,$20.86,$119.17,$0.00,$59.58,$94.38,$95.33,$0.00,$18.65,$0.00,$18.97,$0.00
G30472,SUP,HCPCS C1769,,G30472  -  GUIDEWIRE VASC STRG TPR .038IN 150CM STRL 3CM HIWIRE 1-1 TRQ,$75.84,$0.00,$75.84,$41.18,$54.12,$0.00,$13.07,$0.00,$0.00,$13.28,$75.84,$0.00,$37.92,$60.07,$60.67,$0.00,$11.87,$0.00,$12.07,$0.00
G30473,SUP,HCPCS C1769,,G30473  -  GUIDEWIRE VASCULAR STANDARD STR TAPER .038IN 150CM 3CM ONE,$74.80,$0.00,$74.80,$40.61,$53.38,$0.00,$12.89,$0.00,$0.00,$13.10,$74.80,$0.00,$37.40,$59.24,$59.84,$0.00,$11.71,$0.00,$11.91,$0.00
G30474,SUP,HCPCS C1769,,G30474  -  GUIDEWIRE VASC STRG TPR .038IN 150CM STRL 3CM HIWIRE 1-1 TRQ,$119.17,$0.00,$119.17,$64.71,$85.05,$0.00,$20.53,$0.00,$0.00,$20.86,$119.17,$0.00,$59.58,$94.38,$95.33,$0.00,$18.65,$0.00,$18.97,$0.00
G30475,SUP,HCPCS C1769,,G30475  -  GUIDEWIRE VASCULAR ANGLE TAPER .035IN 150CM 3CM 1TO 1 TORQUE,$119.17,$0.00,$119.17,$64.71,$85.05,$0.00,$20.53,$0.00,$0.00,$20.86,$119.17,$0.00,$59.58,$94.38,$95.33,$0.00,$18.65,$0.00,$18.97,$0.00
G30476,SUP,HCPCS C1769,,G30476  -  GUIDEWIRE VASCULAR STANDARD STR TAPER .035IN 150CM 3CM 1TO 1,$74.80,$0.00,$74.80,$40.61,$53.38,$0.00,$12.89,$0.00,$0.00,$13.10,$74.80,$0.00,$37.40,$59.24,$59.84,$0.00,$11.71,$0.00,$11.91,$0.00
G30477,SUP,HCPCS C1769,,G30477  -  GUIDEWIRE VASC STRG TPR .035IN 150CM 3CM HIWIRE STF BD 1 TO,$119.17,$0.00,$119.17,$64.71,$85.05,$0.00,$20.53,$0.00,$0.00,$20.86,$119.17,$0.00,$59.58,$94.38,$95.33,$0.00,$18.65,$0.00,$18.97,$0.00
G30478,SUP,HCPCS C1769,,G30478  -  GUIDEWIRE VASC TPR .025IN 150CM STRL 3MM HIWIRE STF BD STRG,$119.17,$0.00,$119.17,$64.71,$85.05,$0.00,$20.53,$0.00,$0.00,$20.86,$119.17,$0.00,$59.58,$94.38,$95.33,$0.00,$18.65,$0.00,$18.97,$0.00
G30479,SUP,HCPCS C1769,,G30479  -  GUIDEWIRE VASC TPR .025IN 150CM STRL 3MM HIWIRE STF BD ANG,$75.84,$0.00,$75.84,$41.18,$54.12,$0.00,$13.07,$0.00,$0.00,$13.28,$75.84,$0.00,$37.92,$60.07,$60.67,$0.00,$11.87,$0.00,$12.07,$0.00
G30480,SUP,HCPCS C1769,,G30480  -  GUIDEWIRE VASC ANG TPR .025IN 150CM STRL 3CM HIWIRE STD BD,$75.84,$0.00,$75.84,$41.18,$54.12,$0.00,$13.07,$0.00,$0.00,$13.28,$75.84,$0.00,$37.92,$60.07,$60.67,$0.00,$11.87,$0.00,$12.07,$0.00
G30481,SUP,HCPCS C1769,,G30481  -  GUIDEWIRE VASCULAR STANDARD ANGLE TAPER .035IN 150CM 3CM 1TO,$379.18,$0.00,$379.18,$205.89,$270.62,$0.00,$65.33,$0.00,$0.00,$66.39,$379.18,$0.00,$189.59,$300.31,$303.34,$0.00,$59.34,$0.00,$60.36,$0.00
G31027,SUP,Custom 27203010,,G31027  -  DEVICE SPHR 20ML EZTRD ERGONOMICAL QRLSE LOCK LVR INFLAT 30,$150.00,$0.00,$150.00,$0.00,$107.06,$0.00,$0.00,$0.00,$0.00,$0.00,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$0.00,$0.00,$0.00,$0.00
G31138,SUP,HCPCS C1894,,G31138  -  INTRODUCER SHEATH .038IN 6FR .087IN 90CM TUOHY BORST SIDEARM,$387.50,$0.00,$387.50,$210.41,$276.56,$0.00,$66.76,$0.00,$0.00,$67.85,$387.50,$0.00,$193.75,$306.90,$310.00,$0.00,$60.64,$0.00,$61.69,$0.00
G31215,SUP,Custom 27203010,,G31215  -  CATH ANGIO .035IN PGTL 5FR 70CM SZ 10 SDPRT RADIOPQ MRKR NYL,$287.50,$0.00,$287.50,$0.00,$205.19,$0.00,$0.00,$0.00,$0.00,$0.00,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$0.00,$0.00,$0.00,$0.00
G31216,SUP,HCPCS C1884,,G31216  -  CATH ANGIO .035IN PGTL 5FR 100CM SZ 10 SDPRT RADIOPQ MRKR,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
G31221,SUP,HCPCS C1884,,G31221  -  CATH ANGIO .035IN VCF CURVE 5FR 100CM 10 SDPRT RADIOPQ MRKR,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
G31518,SUP,Custom 27203010,,G31518  -  NEEDLE ENDSCP 22GA 5.2FR 8- CM ULTRASOUND BALL TIP ADJUST,$730.00,$0.00,$730.00,$0.00,$521.00,$0.00,$0.00,$0.00,$0.00,$0.00,$730.00,$0.00,$365.00,$578.16,$584.00,$0.00,$0.00,$0.00,$0.00,$0.00
G31519,SUP,Custom 27203010,,G31519  -  NEEDLE ENDSCP 25GA 5.2FR 0-8CM ULTRASOUND CNTOUR HANDLE,$730.00,$0.00,$730.00,$0.00,$521.00,$0.00,$0.00,$0.00,$0.00,$0.00,$730.00,$0.00,$365.00,$578.16,$584.00,$0.00,$0.00,$0.00,$0.00,$0.00
G31520,SUP,Custom 27203010,,G31520  -  NEEDLE ENDSCP 19GA 5.2-4.2FR 0-8CM ULTRASOUND CNTOUR HANDLE,$730.00,$0.00,$730.00,$0.00,$521.00,$0.00,$0.00,$0.00,$0.00,$0.00,$730.00,$0.00,$365.00,$578.16,$584.00,$0.00,$0.00,$0.00,$0.00,$0.00
G31550,SUP,HCPCS C1894,,G31550  -  CATHETER PSH .035IN 5FR STRL LF FSN GW BIL DCT DISP ESCP,$180.00,$0.00,$180.00,$97.74,$128.47,$0.00,$31.01,$0.00,$0.00,$31.52,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$28.17,$0.00,$28.66,$0.00
G31551,SUP,Custom 27203010,,G31551  -  CATHETER ENDSCP 7FR 3.2MM 170CM DOME TIP FUSION PURPLE,$180.00,$0.00,$180.00,$0.00,$128.47,$0.00,$0.00,$0.00,$0.00,$0.00,$180.00,$0.00,$90.00,$142.56,$144.00,$0.00,$0.00,$0.00,$0.00,$0.00
G32011,SUP,HCPCS C1876,,G32011  -  STENT BIL 6MM 6FR 30MM 80CM SLF XPD FLXB FLXR INTROD GOLD,"$3,125.00",$0.00,"$3,125.00","$1,406.25","$2,230.31",$0.00,$538.42,$0.00,$0.00,$547.16,"$3,125.00",$0.00,"$1,562.50","$2,475.00","$2,500.00",$0.00,$489.06,$0.00,$497.50,$0.00
G32233,SUP,HCPCS C1894,,G32233  -  INTRODUCER SHEATH .038IN LONG 10FR 40CM LARGE VALVE ASMBLY,$190.00,$0.00,$190.00,$103.17,$135.60,$0.00,$32.74,$0.00,$0.00,$33.27,$190.00,$0.00,$95.00,$150.48,$152.00,$0.00,$29.74,$0.00,$30.25,$0.00
G32500,SUP,HCPCS C1874,,G32500  -  GRAFT EVAS 2 BRCH 12MM 106MM STRL 28MM H&L-B 1-SHOT ZNTH,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17",$0.00,$0.00,"$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
G32501,SUP,HCPCS C1874,,G32501  -  GRAFT EVAS 2 BRCH 12MM 7.7MM 20FR 121MM 28MM ZNTH H&L-B,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17",$0.00,$0.00,"$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
G32502,SUP,HCPCS C1874,,G32502  -  GRAFT EVAS 24MM 7.7MM 20FR 76MM ZNTH H&L-B 1-SHOT 1 PROX,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17",$0.00,$0.00,"$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
G32503,SUP,HCPCS C1874,,G32503  -  GRAFT EVAS 26MM 7.7MM 20FR 76MM ZNTH H&L-B 1-SHOT 1 PROX,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11",$0.00,$0.00,"$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
G32504,SUP,HCPCS C1874,,G32504  -  GRAFT EVAS 28MM 7.7MM 20FR 76MM ZNTH H&L-B 1-SHOT 1 PROX,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11",$0.00,$0.00,"$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
G32505,SUP,HCPCS C1874,,G32505  -  GRAFT EVAS 30MM 7.7MM 20FR 76MM ZNTH H&L-B 1-SHOT 1 PROX,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11",$0.00,$0.00,"$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
G32506,SUP,HCPCS C1874,,G32506  -  GRAFT EVAS 32MM 7.7MM 20FR 76MM ZNTH H&L-B 1-SHOT 1 PROX,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11",$0.00,$0.00,"$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
G32507,SUP,HCPCS C1874,,G32507  -  GRAFT EVAS 24MM 7.7MM 20FR 91MM ZNTH H&L-B 1-SHOT 1 PROX,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11",$0.00,$0.00,"$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
G32508,SUP,HCPCS C1874,,G32508  -  GRAFT EVAS 26MM 7.7MM 20FR 91MM ZNTH H&L-B 1-SHOT 1 PROX,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11",$0.00,$0.00,"$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
G32509,SUP,HCPCS C1874,,G32509  -  GRAFT EVAS 28MM 7.7MM 20FR 91MM ZNTH H&L-B 1-SHOT 1 PROX,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11",$0.00,$0.00,"$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
G32510,SUP,HCPCS C1874,,G32510  -  GRAFT EVAS 30MM 7.7MM 20FR 91MM ZNTH H&L-B 1-SHOT 1 PROX,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11",$0.00,$0.00,"$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
G32511,SUP,HCPCS C1874,,G32511  -  GRAFT EVAS 32MM 7.7MM 20FR 91MM ZNTH H&L-B 1-SHOT 1 PROX,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11",$0.00,$0.00,"$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
G32512,SUP,HCPCS C1874,,G32512  -  GRAFT EVAS 24MM 7.7MM 20FR 106MM ZNTH H&L-B 1-SHOT 1 PROX,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11",$0.00,$0.00,"$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
G32513,SUP,HCPCS C1874,,G32513  -  GRAFT EVAS 26MM 7.7MM 20FR 106MM ZNTH H&L-B 1-SHOT 1 PROX,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11",$0.00,$0.00,"$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
G32514,SUP,HCPCS C1874,,G32514  -  GRAFT EVAS 28MM 7.7MM 20FR 106MM ZNTH H&L-B 1-SHOT 1 PROX,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11",$0.00,$0.00,"$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
G32515,SUP,HCPCS C1874,,G32515  -  GRAFT EVAS 30MM 7.7MM 20FR 106MM ZNTH H&L-B 1-SHOT 1 PROX,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11",$0.00,$0.00,"$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
G32516,SUP,HCPCS C1874,,G32516  -  GRAFT EVAS 32MM 7.7MM 20FR 106MM ZNTH H&L-B 1-SHOT 1 PROX,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11",$0.00,$0.00,"$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
G32517,SUP,HCPCS C1874,,G32517  -  GRAFT EVAS 24MM 7.7MM 20FR 121MM ZNTH H&L-B 1-SHOT 1 PROX,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11",$0.00,$0.00,"$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
G32518,SUP,HCPCS C1874,,G32518  -  GRAFT EVAS 26MM 7.7MM 20FR 121MM ZNTH H&L-B 1-SHOT 1 PROX,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11",$0.00,$0.00,"$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
G32519,SUP,HCPCS C1874,,G32519  -  GRAFT EVAS 28MM 7.7MM 20FR 121MM ZNTH H&L-B 1-SHOT 1 PROX,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11",$0.00,$0.00,"$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
G32520,SUP,HCPCS C1874,,G32520  -  GRAFT EVAS 30MM 7.7MM 20FR 121MM ZNTH H&L-B 1-SHOT 1 PROX,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11",$0.00,$0.00,"$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
G32521,SUP,HCPCS C1874,,G32521  -  GRAFT EVAS 32MM 7.7MM 20FR 121MM ZNTH H&L-B 1-SHOT 1 PROX,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11",$0.00,$0.00,"$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
G32522,SUP,HCPCS C1874,,G32522  -  GRAFT EVAS 34MM 7.7MM 20FR 84MM ZNTH H&L-B 1-SHOT 1 PROX,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11",$0.00,$0.00,"$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
G32523,SUP,HCPCS C1874,,G32523  -  GRAFT EVAS 36MM 8.5MM 20FR 84MM ZNTH H&L-B 1-SHOT 1 PROX,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11",$0.00,$0.00,"$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
G32524,SUP,HCPCS C1874,,G32524  -  GRAFT EVAS 34MM 7.7MM 20FR 99MM ZNTH H&L-B 1-SHOT 1 PROX,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11",$0.00,$0.00,"$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
G32525,SUP,HCPCS C1874,,G32525  -  GRAFT EVAS 36MM 8.5MM 20FR 99MM ZNTH H&L-B 1-SHOT 1 PROX,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11",$0.00,$0.00,"$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
G32526,SUP,HCPCS C1874,,G32526  -  GRAFT EVAS 34MM 7.7MM 20FR 114MM ZNTH H&L-B 1-SHOT 1 PROX,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11",$0.00,$0.00,"$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
G32527,SUP,HCPCS C1874,,G32527  -  GRAFT EVAS 36MM 8.5MM 20FR 114MM ZNTH H&L-B 1-SHOT 1 PROX,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11",$0.00,$0.00,"$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
G32528,SUP,HCPCS C1874,,G32528  -  GRAFT EVAS 34MM 7.7MM 20FR 129MM ZNTH H&L-B 1-SHOT 1 PROX,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11",$0.00,$0.00,"$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
G32529,SUP,HCPCS C1874,,G32529  -  GRAFT EVAS 36MM 8.5MM 20FR 129MM ZNTH H&L-B 1-SHOT 1 PROX,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11",$0.00,$0.00,"$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
G32530,SUP,HCPCS C1874,,G32530  -  GRAFT EVAS 24MM 7.7MM 20FR 94MM ZNTH H&L-B 1-SHOT 2 PROX,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11",$0.00,$0.00,"$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
G32531,SUP,HCPCS C1874,,G32531  -  GRAFT EVAS 26MM 7.7MM 20FR 94MM ZNTH H&L-B 1-SHOT 2 PROX,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11",$0.00,$0.00,"$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
G32532,SUP,HCPCS C1874,,G32532  -  GRAFT EVAS 20FR 94MM 28MM ZNTH VSCR FEN PROX BFUR BD AAA,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11",$0.00,$0.00,"$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
G32533,SUP,HCPCS C1874,,G32533  -  GRAFT EVAS 30MM 7.7MM 20FR 94MM ZNTH H&L-B 1-SHOT 2 PROX,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11",$0.00,$0.00,"$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
G32534,SUP,HCPCS C1874,,G32534  -  GRAFT EVAS 32MM 7.7MM 20FR 94MM ZNTH H&L-B 1-SHOT 2 PROX,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11",$0.00,$0.00,"$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
G32535,SUP,HCPCS C1874,,G32535  -  GRAFT EVAS 24MM 7.7MM 20FR 109MM ZNTH H&L-B 1-SHOT 2 PROX,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11",$0.00,$0.00,"$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
G32536,SUP,HCPCS C1874,,G32536  -  GRAFT EVAS 26MM 109MM STRL H&L-B 1-SHOT ZNTH 2 PROX INTNL,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11",$0.00,$0.00,"$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
G32537,SUP,HCPCS C1874,,G32537  -  GRAFT EVAS 28MM 109MM STRL H&L-B 1-SHOT ZNTH 2 PROX INTNL,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11",$0.00,$0.00,"$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
G32538,SUP,HCPCS C1874,,G32538  -  GRAFT EVAS 30MM 109MM STRL H&L-B 1-SHOT ZNTH 2 PROX INTNL,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11",$0.00,$0.00,"$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
G32539,SUP,HCPCS C1874,,G32539  -  GRAFT EVAS 32MM 109MM STRL H&L-B 1-SHOT ZNTH 2 PROX INTNL,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11",$0.00,$0.00,"$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
G32540,SUP,HCPCS C1874,,G32540  -  GRAFT EVAS 24MM 7.7MM 20FR 124MM ZNTH H&L-B 1-SHOT 2 PROX,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11",$0.00,$0.00,"$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
G32541,SUP,HCPCS C1874,,G32541  -  GRAFT EVAS 12FR 124MM 91MM ZNTH VSCR FEN DIST BFUR BD AAA,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11",$0.00,$0.00,"$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
G32542,SUP,HCPCS C1874,,G32542  -  GRAFT EVAS 2FR 124MM 28MM ZNTH FEN PROX BD AAA,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11",$0.00,$0.00,"$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
G32543,SUP,HCPCS C1874,,G32543  -  GRAFT EVAS 30MM 124MM STRL H&L-B 1-SHOT ZNTH 2 PROX INTNL,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11",$0.00,$0.00,"$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
G32544,SUP,HCPCS C1874,,G32544  -  GRAFT EVAS 32MM 124MM STRL H&L-B 1-SHOT ZNTH 2 PROX INTNL,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11",$0.00,$0.00,"$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
G32545,SUP,HCPCS C1874,,G32545  -  GRAFT EVAS 34MM 107MM STRL H&L-B 1-SHOT ZNTH 2 PROX INTNL,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11",$0.00,$0.00,"$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
G32546,SUP,HCPCS C1874,,G32546  -  GRAFT EVAS 36MM 107MM STRL H&L-B 1-SHOT ZNTH 2 PROX INTNL,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11",$0.00,$0.00,"$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
G32547,SUP,HCPCS C1874,,G32547  -  GRAFT EVAS 34MM 20FR 122MM STRL H L-B 1-SHOT ZNTH 2 PROX,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11",$0.00,$0.00,"$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
G32548,SUP,HCPCS C1874,,G32548  -  GRAFT EVAS 36MM 8.5MM 22FR 122MM ZNTH H&L-B 1-SHOT 2 PROX,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11",$0.00,$0.00,"$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
G32549,SUP,HCPCS C1874,,G32549  -  GRAFT EVAS 34MM 137MM STRL H&L-B 1-SHOT ZNTH 2 PROX INTNL,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11",$0.00,$0.00,"$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
G32550,SUP,HCPCS C1874,,G32550  -  GRAFT EVAS 36MM 137MM STRL ZNTH H&L-B 1-SHOT 2 PROX INTNL,"$27,500.00",$0.00,"$27,500.00","$12,375.00","$5,158.80",$0.00,"$4,738.11",$0.00,$0.00,"$4,815.03","$27,500.00",$0.00,"$13,750.00","$21,780.00","$22,000.00",$0.00,"$4,303.75",$0.00,"$4,378.00",$0.00
G32551,SUP,HCPCS C1874,,G32551  -  GRAFT EVAS 12FR 76MM 28MM ZNTH VSCR FEN DIST BFUR BD AAA,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17",$0.00,$0.00,"$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
G32552,SUP,HCPCS C1874,,G32552  -  GRAFT EVAS 16FR 76MM 28MM ZNTH VSCR FEN DIST BFUR BD AAA,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17",$0.00,$0.00,"$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
G32553,SUP,HCPCS C1874,,G32553  -  GRAFT EVAS 20FR 76MM 28MM ZNTH VSCR FEN DIST BFUR BD AAA,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17",$0.00,$0.00,"$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
G32554,SUP,HCPCS C1874,,G32554  -  GRAFT EVAS 12FR 91MM 28MM ZNTH VSCR FEN DIST BFUR BD AAA,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17",$0.00,$0.00,"$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
G32555,SUP,HCPCS C1874,,G32555  -  GRAFT EVAS 16FR 91MM 28MM ZNTH VSCR FEN DIST BFUR BD AAA,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17",$0.00,$0.00,"$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
G32556,SUP,HCPCS C1874,,G32556  -  GRAFT EVAS 20FR 91MM 28MM ZNTH VSCR FEN DIST BFUR BD AAA,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17",$0.00,$0.00,"$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
G32557,SUP,HCPCS C1874,,G32557  -  GRAFT EVAS 16FR 106MM 28MM ZNTH VSCR FEN DIST BFUR BD AAA,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17",$0.00,$0.00,"$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
G32558,SUP,HCPCS C1874,,G32558  -  GRAFT EVAS 20FR 106MM 28MM ZNTH VSCR FEN DIST BFUR BD AAA,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17",$0.00,$0.00,"$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
G32559,SUP,HCPCS C1874,,G32559  -  GRAFT EVAS 16FR 121MM 28MM ZNTH VSCR FEN DIST BFUR BD AAA,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17",$0.00,$0.00,"$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
G32560,SUP,HCPCS C1874,,G32560  -  GRAFT EVAS 20FR 121MM 28MM ZNTH VSCR FEN DIST BFUR BD AAA,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17",$0.00,$0.00,"$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
G32561,SUP,HCPCS C1874,,G32561  -  GRAFT EVAS 12FR 76MM 45MM ZNTH VSCR FEN DIST BFUR BD AAA,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17",$0.00,$0.00,"$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
G32562,SUP,HCPCS C1874,,G32562  -  GRAFT EVAS 16FR 76MM 45MM ZNTH VSCR FEN DIST BFUR BD AAA,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17",$0.00,$0.00,"$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
G32563,SUP,HCPCS C1874,,G32563  -  GRAFT EVAS 20FR 76MM 45MM ZNTH VSCR FEN DIST BFUR BD AAA,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17",$0.00,$0.00,"$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
G32564,SUP,HCPCS C1874,,G32564  -  GRAFT EVAS 24FR 76MM 45MM ZNTH VSCR FEN DIST BFUR BD AAA,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17",$0.00,$0.00,"$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
G32565,SUP,HCPCS C1874,,G32565  -  GRAFT EVAS 12FR 91MM 45MM ZNTH VSCR FEN DIST BFUR BD AAA,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17",$0.00,$0.00,"$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
G32566,SUP,HCPCS C1874,,G32566  -  GRAFT EVAS 16FR 91MM 45MM ZNTH VSCR FEN DIST BFUR BD AAA,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17",$0.00,$0.00,"$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
G32567,SUP,HCPCS C1874,,G32567  -  GRAFT EVAS 20FR 91MM 45MM ZNTH VSCR FEN DIST BFUR BD AAA,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17",$0.00,$0.00,"$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
G32568,SUP,HCPCS C1874,,G32568  -  GRAFT EVAS 24FR 91MM 45MM ZNTH VSCR FEN DIST BFUR BD AAA,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17",$0.00,$0.00,"$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
G32569,SUP,HCPCS C1874,,G32569  -  GRAFT EVAS 12FR 106MM 45MM ZNTH VSCR FEN DIST BFUR BD AAA,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17",$0.00,$0.00,"$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
G32570,SUP,HCPCS C1874,,G32570  -  GRAFT EVAS 16FR 106MM 45MM ZNTH VSCR FEN DIST BFUR BD AAA,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17",$0.00,$0.00,"$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
G32571,SUP,HCPCS C1874,,G32571  -  GRAFT EVAS 2 BRCH 20FR 106MM 45MM ZNTH H&L-B 1-SHOT VSCR FEN,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17",$0.00,$0.00,"$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
G32572,SUP,HCPCS C1874,,G32572  -  GRAFT EVAS 24FR 106MM 45MM ZNTH VSCR FEN DIST BFUR BD AAA,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17",$0.00,$0.00,"$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
G32573,SUP,HCPCS C1874,,G32573  -  GRAFT EVAS 12FR 121MM 45MM ZNTH VSCR FEN DIST BFUR BD AAA,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17",$0.00,$0.00,"$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
G32574,SUP,HCPCS C1874,,G32574  -  GRAFT EVAS 16FR 121MM 45MM ZNTH VSCR FEN DIST BFUR BD AAA,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17",$0.00,$0.00,"$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
G32575,SUP,HCPCS C1874,,G32575  -  GRAFT EVAS 20FR 121MM 45MM ZNTH VSCR FEN DIST BFUR BD AAA,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17",$0.00,$0.00,"$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
G32576,SUP,HCPCS C1874,,G32576  -  GRAFT EVAS 24FR 121MM 45MM ZNTH VSCR FEN DIST BFUR BD AAA,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17",$0.00,$0.00,"$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
G32577,SUP,HCPCS C1874,,G32577  -  GRAFT EVAS 12FR 76MM 62MM ZNTH VSCR FEN DIST BFUR BD AAA,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17",$0.00,$0.00,"$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
G32578,SUP,HCPCS C1874,,G32578  -  GRAFT EVAS 2 BRCH 20MM 8.1MM 20FR 76MM STRL 62MM ZNTH DIST,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17",$0.00,$0.00,"$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
G32579,SUP,HCPCS C1874,,G32579  -  GRAFT EVAS 24FR 76MM 62MM ZNTH 1-SHOT 2 BRCH VSCR FENESTRATE,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17",$0.00,$0.00,"$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
G32580,SUP,HCPCS C1874,,G32580  -  GRAFT EVAS 12FR 91MM 62MM ZNTH VSCR FEN DIST BFUR BD AAA,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17",$0.00,$0.00,"$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
G32581,SUP,HCPCS C1874,,G32581  -  GRAFT EVAS 16FR 91MM 62MM ZNTH FEN DIST BFUR BD AAA,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17",$0.00,$0.00,"$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
G32582,SUP,HCPCS C1874,,G32582  -  GRAFT EVAS 20FR 91MM 62MM ZNTH VSCR FEN DIST BFUR BD AAA,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17",$0.00,$0.00,"$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
G32583,SUP,HCPCS C1874,,G32583  -  GRAFT EVAS 24FR 91MM 62MM ZNTH VSCR FEN DIST BFUR BD AAA,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17",$0.00,$0.00,"$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
G32584,SUP,HCPCS C1874,,G32584  -  GRAFT EVAS 12FR 106MM 62MM ZNTH VSCR FEN DIST BFUR BD AAA,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17",$0.00,$0.00,"$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
G32585,SUP,HCPCS C1874,,G32585  -  GRAFT EVAS 16FR 106MM 62MM ZNTH VSCR FEN DIST BFUR BD AAA,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17",$0.00,$0.00,"$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
G32586,SUP,HCPCS C1874,,G32586  -  GRAFT EVAS 20FR 106MM 62MM ZNTH VSCR FEN DIST BFUR BD AAA,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17",$0.00,$0.00,"$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
G32587,SUP,HCPCS C1874,,G32587  -  GRAFT EVAS 24FR 106MM 62MM ZNTH VSCR FEN DIST BFUR BD AAA,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17",$0.00,$0.00,"$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
G32588,SUP,HCPCS C1874,,G32588  -  GRAFT EVAS 12FR 121MM 62MM ZNTH VSCR FEN DIST BFUR BD AAA,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17",$0.00,$0.00,"$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
G32589,SUP,HCPCS C1874,,G32589  -  GRAFT EVAS 16FR 121MM 62MM ZNTH VSCR FEN DIST BFUR BD AAA,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17",$0.00,$0.00,"$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
G32590,SUP,HCPCS C1874,,G32590  -  GRAFT EVAS 20FR 121MM 62MM ZNTH VSCR FEN DIST BFUR BD AAA,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17",$0.00,$0.00,"$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
G32591,SUP,HCPCS C1874,,G32591  -  GRAFT EVAS 24FR 121MM 62MM ZNTH VSCR FEN DIST BFUR BD AAA,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17",$0.00,$0.00,"$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
G32592,SUP,HCPCS C1874,,G32592  -  GRAFT EVAS 16FR 76MM 62MM ZNTH VSCR FEN DIST BFUR BD AAA,"$9,270.00",$0.00,"$9,270.00","$4,171.50","$5,158.80",$0.00,"$1,597.17",$0.00,$0.00,"$1,623.10","$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,"$1,450.76",$0.00,"$1,475.78",$0.00
G32701,SUP,Custom 27203010,,G32701  -  GUIDEWIRE VASC TPR STRG .025IN 150CM 3CM HIWIRE 1 TO 1 TRQ,$103.07,$0.00,$103.07,$0.00,$73.56,$0.00,$0.00,$0.00,$0.00,$0.00,$103.07,$0.00,$51.53,$81.63,$82.45,$0.00,$0.00,$0.00,$0.00,$0.00
G32702,SUP,Custom 27203010,,G32702  -  EXTRACTOR STON 2.4FR 1CM 115CM STRL NCOMPASS NCRCL 16 4WR,$515.33,$0.00,$515.33,$0.00,$367.79,$0.00,$0.00,$0.00,$0.00,$0.00,$515.33,$0.00,$257.66,$408.14,$412.26,$0.00,$0.00,$0.00,$0.00,$0.00
G32724,SUP,Custom 27203010,,G32724  -  EXTRACTOR STON 7MM 2.8FR 145MM NTRAP UMRL DSGN ENTRAPMENT,$515.33,$0.00,$515.33,$0.00,$367.79,$0.00,$0.00,$0.00,$0.00,$0.00,$515.33,$0.00,$257.66,$408.14,$412.26,$0.00,$0.00,$0.00,$0.00,$0.00
G32727,SUP,Custom 27203010,,G32727  -  CATHETER URTH 26FR 34CM UNIVERSA 2W FL CLS END RND TIP SIL,$33.94,$0.00,$33.94,$0.00,$24.22,$0.00,$0.00,$0.00,$0.00,$0.00,$33.94,$0.00,$16.97,$26.88,$27.15,$0.00,$0.00,$0.00,$0.00,$0.00
G32730,SUP,Custom 27203010,,G32730  -  EXTRACTOR STON HLX 3FR 3.2FR 115CM STRL CPTR 4WR OCL BSKT,$473.25,$0.00,$473.25,$0.00,$337.76,$0.00,$0.00,$0.00,$0.00,$0.00,$473.25,$0.00,$236.63,$374.81,$378.60,$0.00,$0.00,$0.00,$0.00,$0.00
G32733,SUP,Custom 27203010,,G32733  -  EXTRACTOR STONE 3FR 3.2FR 115CM 3 WIRE HELICAL OCCLUSIVE,$407.30,$0.00,$407.30,$0.00,$290.69,$0.00,$0.00,$0.00,$0.00,$0.00,$407.30,$0.00,$203.65,$322.58,$325.84,$0.00,$0.00,$0.00,$0.00,$0.00
G32734,SUP,Custom 27203010,,G32734  -  EXTRACTOR STON 3FR 3.2FR 115CM 5CM ATLS WR 4WR FLFRM BSKT,$407.30,$0.00,$407.30,$0.00,$290.69,$0.00,$0.00,$0.00,$0.00,$0.00,$407.30,$0.00,$203.65,$322.58,$325.84,$0.00,$0.00,$0.00,$0.00,$0.00
G32739,SUP,Custom 27203010,,G32739  -  EXTRACTOR STON 1.1FR 1.7FR 115CM STRL ATLS WR 4WR OCL BSKT,$281.55,$0.00,$281.55,$0.00,$200.94,$0.00,$0.00,$0.00,$0.00,$0.00,$281.55,$0.00,$140.78,$222.99,$225.24,$0.00,$0.00,$0.00,$0.00,$0.00
G32740,SUP,Custom 27203010,,G32740  -  EXTRACTOR STON 4.5FR 65CM CPTR 4WR OCL BSKT SHTH SS,$281.55,$0.00,$281.55,$0.00,$200.94,$0.00,$0.00,$0.00,$0.00,$0.00,$281.55,$0.00,$140.78,$222.99,$225.24,$0.00,$0.00,$0.00,$0.00,$0.00
G32742,SUP,Custom 27203010,,G32742  -  EXTRACTOR STON 4.5FR 65CM 5CM CPTR 4WR HLCL FLFRM BSKT SHTH,$281.55,$0.00,$281.55,$0.00,$200.94,$0.00,$0.00,$0.00,$0.00,$0.00,$281.55,$0.00,$140.78,$222.99,$225.24,$0.00,$0.00,$0.00,$0.00,$0.00
G32746,SUP,Custom 27203010,,G32746  -  EXTRACTOR STON 4.5FR 65CM 5CM CPTR 5WR HLCL FLFRM BSKT SHTH,$281.55,$0.00,$281.55,$0.00,$200.94,$0.00,$0.00,$0.00,$0.00,$0.00,$281.55,$0.00,$140.78,$222.99,$225.24,$0.00,$0.00,$0.00,$0.00,$0.00
G32749,SUP,Custom 27203010,,G32749  -  EXTRACTOR STON HLX 4.5FR 65CM CPTR 4WR HLCL OCL BSKT SHTH SS,$407.30,$0.00,$407.30,$0.00,$290.69,$0.00,$0.00,$0.00,$0.00,$0.00,$407.30,$0.00,$203.65,$322.58,$325.84,$0.00,$0.00,$0.00,$0.00,$0.00
G32750,SUP,Custom 27203010,,G32750  -  EXTRACTOR STON HLCL 3FR 3.2FR 115CM STRL CPTR 5WR OCL SHTH,$407.30,$0.00,$407.30,$0.00,$290.69,$0.00,$0.00,$0.00,$0.00,$0.00,$407.30,$0.00,$203.65,$322.58,$325.84,$0.00,$0.00,$0.00,$0.00,$0.00
G32756,SUP,Custom 27203010,,G32756  -  EXTRACTOR STON 3FR 3.2FR 115CM 5CM CPTR 4WR HLCL FLFRM BSKT,$407.30,$0.00,$407.30,$0.00,$290.69,$0.00,$0.00,$0.00,$0.00,$0.00,$407.30,$0.00,$203.65,$322.58,$325.84,$0.00,$0.00,$0.00,$0.00,$0.00
G32757,SUP,Custom 27203010,,G32757  -  EXTRACTOR STON 2.5FR 115CM CPTR 4WR HLCL OCL URO SS,$407.30,$0.00,$407.30,$0.00,$290.69,$0.00,$0.00,$0.00,$0.00,$0.00,$407.30,$0.00,$203.65,$322.58,$325.84,$0.00,$0.00,$0.00,$0.00,$0.00
G32773,SUP,HCPCS C2625,,G32773  -  CATHETER URTH 26FR 34CM UNIVERSA 2W FL OP-EN OPN TIP SIL,$17.08,$0.00,$17.08,$7.69,$12.19,$0.00,$2.94,$0.00,$0.00,$2.99,$17.08,$0.00,$8.54,$13.53,$13.67,$0.00,$2.67,$0.00,$2.72,$0.00
G32774,SUP,HCPCS C2625,,G32774  -  SET NPHSTM 4FR .025IN 12-18CM 145CM SALLE SFLX GW STY SS PU,$205.00,$0.00,$205.00,$92.25,$146.31,$0.00,$35.32,$0.00,$0.00,$35.89,$205.00,$0.00,$102.50,$162.36,$164.00,$0.00,$32.08,$0.00,$32.64,$0.00
G32779,SUP,Custom 27203010,,G32779  -  EXTRACTOR STONE 1.7FR 115CM 3 WIRE HELICAL OCCLUSIVE BASKET,$407.30,$0.00,$407.30,$0.00,$290.69,$0.00,$0.00,$0.00,$0.00,$0.00,$407.30,$0.00,$203.65,$322.58,$325.84,$0.00,$0.00,$0.00,$0.00,$0.00
G32781,SUP,Custom 27203010,,G32781  -  SET STNT .038IN 4.7FR 12-18CM STRL 145CM SALLE INTOP GW STY,$281.55,$0.00,$281.55,$0.00,$200.94,$0.00,$0.00,$0.00,$0.00,$0.00,$281.55,$0.00,$140.78,$222.99,$225.24,$0.00,$0.00,$0.00,$0.00,$0.00
G32784,SUP,Custom 27203010,,G32784  -  EXTRACTOR STON 4.5FR 65CM 5CM CPTR 6WR HLCL OCL BSKT SHTH SS,$407.30,$0.00,$407.30,$0.00,$290.69,$0.00,$0.00,$0.00,$0.00,$0.00,$407.30,$0.00,$203.65,$322.58,$325.84,$0.00,$0.00,$0.00,$0.00,$0.00
G32786,SUP,Custom 27203010,,G32786  -  EXTRACTOR STON 5CM 3.2FR 3FR 115CM CPTR 3WR HLCL FLFRM SS,$281.55,$0.00,$281.55,$0.00,$200.94,$0.00,$0.00,$0.00,$0.00,$0.00,$281.55,$0.00,$140.78,$222.99,$225.24,$0.00,$0.00,$0.00,$0.00,$0.00
G32788,SUP,Custom 27203010,,G32788  -  EXTRACTOR STON HLX 4.5FR 65CM 5CM CPTR 4WR HLCL FLFRM BSKT,$407.30,$0.00,$407.30,$0.00,$290.69,$0.00,$0.00,$0.00,$0.00,$0.00,$407.30,$0.00,$203.65,$322.58,$325.84,$0.00,$0.00,$0.00,$0.00,$0.00
G32789,SUP,HCPCS C1726,,G32789  -  SET DILAT 8-20FR 37CM SIDEPORT LOW FRICTION SLIPPERY SURFACE,$451.00,$0.00,$451.00,$244.89,$321.88,$0.00,$77.71,$0.00,$0.00,$78.97,$451.00,$0.00,$225.50,$357.19,$360.80,$0.00,$70.58,$0.00,$71.80,$0.00
G32824,SUP,Custom 27203010,,G32824  -  EXTRACTOR STONE 3.2FR 3FR 115CM 4 WIRE SHEATH TIP OCCLUSIVE,$407.30,$0.00,$407.30,$0.00,$290.69,$0.00,$0.00,$0.00,$0.00,$0.00,$407.30,$0.00,$203.65,$322.58,$325.84,$0.00,$0.00,$0.00,$0.00,$0.00
G32831,SUP,HCPCS C1758,,G32831  -  CATH URET .038IN 5FR 6MM 4CM TPR TIP PLTN BAND GWIRE,$433.88,$0.00,$433.88,$235.59,$309.66,$0.00,$74.75,$0.00,$0.00,$75.97,$433.88,$0.00,$216.94,$343.63,$347.10,$0.00,$67.90,$0.00,$69.07,$0.00
G32833,SUP,HCPCS C1758,,G32833  -  CATH URET .038IN 5FR 6MM 10CM TPR TIP PLTN BAND GWIRE,$433.88,$0.00,$433.88,$235.59,$309.66,$0.00,$74.75,$0.00,$0.00,$75.97,$433.88,$0.00,$216.94,$343.63,$347.10,$0.00,$67.90,$0.00,$69.07,$0.00
G32840,SUP,HCPCS C1758,,G32840  -  SET CATH ASCND BALDILAT INFLAT DEV TPR TIP PLTN BAND GWIRE 5,$511.88,$0.00,$511.88,$277.95,$365.33,$0.00,$88.19,$0.00,$0.00,$89.63,$511.88,$0.00,$255.94,$405.41,$409.50,$0.00,$80.11,$0.00,$81.49,$0.00
G32842,SUP,HCPCS C1758,,G32842  -  SET CATH ASCND BALDILAT INFLAT DEV TPR TIP PLTN BAND GWIRE 5,$511.88,$0.00,$511.88,$277.95,$365.33,$0.00,$88.19,$0.00,$0.00,$89.63,$511.88,$0.00,$255.94,$405.41,$409.50,$0.00,$80.11,$0.00,$81.49,$0.00
G32852,SUP,HCPCS C1894,,G32852  -  EXTRACTOR STON 2.5FR 2.8FR 115CM CPTR 4WR OCL BSKT SHTH SS,$308.00,$0.00,$308.00,$167.24,$219.82,$0.00,$53.07,$0.00,$0.00,$53.93,$308.00,$0.00,$154.00,$243.94,$246.40,$0.00,$48.20,$0.00,$49.03,$0.00
G32853,SUP,HCPCS C1894,,G32853  -  SHEATH ACC 12FR 13CM FLXR DILATION CNT WRK CHNL PRTC PED,$308.00,$0.00,$308.00,$167.24,$219.82,$0.00,$53.07,$0.00,$0.00,$53.93,$308.00,$0.00,$154.00,$243.94,$246.40,$0.00,$48.20,$0.00,$49.03,$0.00
G32855,SUP,HCPCS C2627,,G32855  -  SHEATH ACC 9.5FR 13CM FLXR DILATION CNT WKG CHNL PRTC PED,$223.98,$0.00,$223.98,$121.62,$159.85,$0.00,$38.59,$0.00,$0.00,$39.22,$223.98,$0.00,$111.99,$177.39,$179.18,$0.00,$35.05,$0.00,$35.66,$0.00
G32862,SUP,Custom 27203010,,G32862  -  STENT URET 8.5FR 65CM WHT STRL PATERSON-FORRESTER DISP URN,$289.10,$0.00,$289.10,$0.00,$206.33,$0.00,$0.00,$0.00,$0.00,$0.00,$289.10,$0.00,$144.55,$228.97,$231.28,$0.00,$0.00,$0.00,$0.00,$0.00
G32863,SUP,Custom 27203010,,G32863  -  EXTRACTOR STON 10FR 2CM 38CM PRC NC BSKT RPD ATRM TPLS NTNL,$515.33,$0.00,$515.33,$0.00,$367.79,$0.00,$0.00,$0.00,$0.00,$0.00,$515.33,$0.00,$257.66,$408.14,$412.26,$0.00,$0.00,$0.00,$0.00,$0.00
G33016,SUP,HCPCS C1880,,G33016  -  SYSTEM EMBOLIC PROTECTION 30MM 8.5FR 50MM 65CM DILAT COAXIAL,"$3,050.00",$0.00,"$3,050.00","$1,372.50","$2,176.79",$0.00,$525.50,$0.00,$0.00,$534.03,"$3,050.00",$0.00,"$1,525.00","$2,415.60","$2,440.00",$0.00,$477.33,$0.00,$485.56,$0.00
G33017,SUP,HCPCS C1880,,G33017  -  FILTER EMBOLIZATION 30MM 8.5FR 50MM 65CM 3 WAY STOPCOCK,"$3,050.00",$0.00,"$3,050.00","$1,372.50","$2,176.79",$0.00,$525.50,$0.00,$0.00,$534.03,"$3,050.00",$0.00,"$1,525.00","$2,415.60","$2,440.00",$0.00,$477.33,$0.00,$485.56,$0.00
G34038,SUP,Custom 27203010,,G34038  -  BRUSH CYTO 1MM 5MM SHFT US CYSTIC ECHOBRUSH ECHTP STRL DISP,$380.00,$0.00,$380.00,$0.00,$271.21,$0.00,$0.00,$0.00,$0.00,$0.00,$380.00,$0.00,$190.00,$300.96,$304.00,$0.00,$0.00,$0.00,$0.00,$0.00
G34176,SUP,HCPCS C2625,,G34176  -  EXTRACTOR STON 1.5CM 2.4FR 115CM 1.5CM NCOMPASS 4/16 WRE MOD,"$2,245.75",$0.00,"$2,245.75","$1,010.59","$1,602.79",$0.00,$386.93,$0.00,$0.00,$393.21,"$2,245.75",$0.00,"$1,122.88","$1,778.63","$1,796.60",$0.00,$351.46,$0.00,$357.52,$0.00
G34309,SUP,HCPCS C1880,,G34309  -  FILTER EMBL 65CM 30MM 7FR 49MM STRL 71CM CELECT NAVALIGN,"$2,312.50",$0.00,"$2,312.50","$1,040.63","$1,650.43",$0.00,$398.43,$0.00,$0.00,$404.90,"$2,312.50",$0.00,"$1,156.25","$1,831.50","$1,850.00",$0.00,$361.91,$0.00,$368.15,$0.00
G34311,SUP,Custom 27203010,,G34311  -  STENT URET 6FR 30CM RSNCE PSTN MTL ADLT URETER,$45.00,$0.00,$45.00,$0.00,$32.12,$0.00,$0.00,$0.00,$0.00,$0.00,$45.00,$0.00,$22.50,$35.64,$36.00,$0.00,$0.00,$0.00,$0.00,$0.00
G34502,SUP,HCPCS C1880,,G34502  -  FILTER EMBOLIZATION 65CM 30MM 7FR 49MM 79CM RADIOPQ PRELOAD,"$2,312.50",$0.00,"$2,312.50","$1,040.63","$1,650.43",$0.00,$398.43,$0.00,$0.00,$404.90,"$2,312.50",$0.00,"$1,156.25","$1,831.50","$1,850.00",$0.00,$361.91,$0.00,$368.15,$0.00
G34870,SUP,HCPCS C1894,,G34870  -  ADAPTER L/S NS VUELITE ACMI SCP,$325.00,$0.00,$325.00,$176.48,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
G34871,SUP,HCPCS C1894,,G34871  -  SHEATH ACC 10.7FR 13CM RPD RELS PRLL FLXR CNT CHNL URETER,$325.00,$0.00,$325.00,$176.48,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
G34872,SUP,HCPCS C1894,,G34872  -  SHEATH ACC 10.7FR 20CM RPD RELS PRLL FLXR CNT CHNL URETER,$325.00,$0.00,$325.00,$176.48,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
G34873,SUP,HCPCS C1894,,G34873  -  SHEATH ACC 10.7FR 28CM RPD RELS PRLL FLXR CNT CHNL URETER,$325.00,$0.00,$325.00,$176.48,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
G34874,SUP,HCPCS C1894,,G34874  -  SHEATH ACC 10.7FR 35CM RPD RELS PRLL FLXR CNT CHNL URETER,$325.00,$0.00,$325.00,$176.48,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
G34875,SUP,HCPCS C1894,,G34875  -  SHEATH ACC 10.7FR 45CM RPD RELS PRLL FLXR CNT CHNL URETER,$325.00,$0.00,$325.00,$176.48,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
G34876,SUP,HCPCS C1894,,G34876  -  SHEATH ACC 10.7FR 55CM RPD RELS PRLL FLXR CNT CHNL URETER,$308.00,$0.00,$308.00,$167.24,$219.82,$0.00,$53.07,$0.00,$0.00,$53.93,$308.00,$0.00,$154.00,$243.94,$246.40,$0.00,$48.20,$0.00,$49.03,$0.00
G34877,SUP,HCPCS C1894,,G34877  -  SHEATH ACC 10.7FR 13CM FLXR DILATION CNT WRK CHNL URETER,$308.00,$0.00,$308.00,$167.24,$219.82,$0.00,$53.07,$0.00,$0.00,$53.93,$308.00,$0.00,$154.00,$243.94,$246.40,$0.00,$48.20,$0.00,$49.03,$0.00
G34878,SUP,HCPCS C1894,,G34878  -  SHEATH ACCES SM TPR FNL 10.7FR DILAT LOCK HUB FLXB,$308.00,$0.00,$308.00,$167.24,$219.82,$0.00,$53.07,$0.00,$0.00,$53.93,$308.00,$0.00,$154.00,$243.94,$246.40,$0.00,$48.20,$0.00,$49.03,$0.00
G34879,SUP,HCPCS C1894,,G34879  -  SHEATH ACCES 10.7FR DILATION CONTIN WRK CHNL FLXR,$308.00,$0.00,$308.00,$167.24,$219.82,$0.00,$53.07,$0.00,$0.00,$53.93,$308.00,$0.00,$154.00,$243.94,$246.40,$0.00,$48.20,$0.00,$49.03,$0.00
G34880,SUP,HCPCS C1894,,G34880  -  SHEATH ACCES 10.7FR DILATION CONTIN WRK CHNL FLXR,$308.00,$0.00,$308.00,$167.24,$219.82,$0.00,$53.07,$0.00,$0.00,$53.93,$308.00,$0.00,$154.00,$243.94,$246.40,$0.00,$48.20,$0.00,$49.03,$0.00
G34881,SUP,HCPCS C1894,,G34881  -  SHEATH ACC 10.7FR 20CM FLXR DILATION CNT WRK CHNL URETER,$308.00,$0.00,$308.00,$167.24,$219.82,$0.00,$53.07,$0.00,$0.00,$53.93,$308.00,$0.00,$154.00,$243.94,$246.40,$0.00,$48.20,$0.00,$49.03,$0.00
G34931,SUP,Custom 27203010,,G34931  -  SHEATH ACC 10.7FR 55CM FLXR DILATION CNT WRK CHNL URETER,$462.50,$0.00,$462.50,$0.00,$330.09,$0.00,$0.00,$0.00,$0.00,$0.00,$462.50,$0.00,$231.25,$366.30,$370.00,$0.00,$0.00,$0.00,$0.00,$0.00
G35129,SUP,Custom 27203010,,G35129  -  LIGATOR ENDSCP MINI HEXAGON 9.5-13MM 5FR 2.8MM 6 BAND SNARE,$795.00,$0.00,$795.00,$0.00,$567.39,$0.00,$0.00,$0.00,$0.00,$0.00,$795.00,$0.00,$397.50,$629.64,$636.00,$0.00,$0.00,$0.00,$0.00,$0.00
G36022,SUP,HCPCS C1876,,G36022  -  STENT BILIARY .035IN 5MM 6FR 80MM 125CM SELF EXPANDING,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
G36226,SUP,HCPCS C1763,,G36226  -  GRAFT SFT TIS 9.5X.6CM ANAL FSTL PLUS SIS AFP PIG STRL DISP,"$2,237.50",$0.00,"$2,237.50","$1,006.88","$1,596.90",$0.00,$385.51,$0.00,$0.00,$391.77,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$350.17,$0.00,$356.21,$0.00
G36229,SUP,HCPCS C1876,,G36229  -  STENT BIL 12MM 6FR 40MM 80CM .035IN SLF XPD FLXB FLXR INTROD,"$2,612.50",$0.00,"$2,612.50","$1,175.63","$1,864.54",$0.00,$450.12,$0.00,$0.00,$457.43,"$2,612.50",$0.00,"$1,306.25","$2,069.10","$2,090.00",$0.00,$408.86,$0.00,$415.91,$0.00
G36231,SUP,HCPCS C1876,,G36231  -  STENT BIL 12MM 6FR 80MM 80CM .035IN SLF XPD FLXB FLXR INTROD,"$2,612.50",$0.00,"$2,612.50","$1,175.63","$1,864.54",$0.00,$450.12,$0.00,$0.00,$457.43,"$2,612.50",$0.00,"$1,306.25","$2,069.10","$2,090.00",$0.00,$408.86,$0.00,$415.91,$0.00
G36239,SUP,HCPCS C1876,,G36239  -  STENT BIL 12MM 40MM STRL 125CM ZL 635 FLXR SLF XPD RADOPQ,"$2,612.50",$0.00,"$2,612.50","$1,175.63","$1,864.54",$0.00,$450.12,$0.00,$0.00,$457.43,"$2,612.50",$0.00,"$1,306.25","$2,069.10","$2,090.00",$0.00,$408.86,$0.00,$415.91,$0.00
G36240,SUP,HCPCS C1876,,G36240  -  STENT BIL .035IN 12MM 6FR 60MM STRL 125CM ZL 635 SLF XPD,"$2,612.50",$0.00,"$2,612.50","$1,175.63","$1,864.54",$0.00,$450.12,$0.00,$0.00,$457.43,"$2,612.50",$0.00,"$1,306.25","$2,069.10","$2,090.00",$0.00,$408.86,$0.00,$415.91,$0.00
G36245,SUP,HCPCS C1876,,G36245  -  STENT BIL 14MM 6FR 60MM 125CM .035IN SLF XPD FLXB FLXR,"$2,612.50",$0.00,"$2,612.50","$1,175.63","$1,864.54",$0.00,$450.12,$0.00,$0.00,$457.43,"$2,612.50",$0.00,"$1,306.25","$2,069.10","$2,090.00",$0.00,$408.86,$0.00,$415.91,$0.00
G36321,SUP,Custom 27803010,,G36321  -  CATH ANGIO SLIP-CATH HYDROPHILIC .038 IN 160 D TIGHT CURVE,$122.50,$0.00,$122.50,$0.00,$87.43,$0.00,$0.00,$0.00,$0.00,$0.00,$122.50,$0.00,$61.25,$97.02,$98.00,$0.00,$0.00,$0.00,$0.00,$0.00
G36333,SUP,HCPCS C1894,,G36333  -  SET INTROD .018IN 5FR 21GA 10CM 40CM COAXIAL CATHETER GWIRE,$100.00,$0.00,$100.00,$54.30,$71.37,$0.00,$17.23,$0.00,$0.00,$17.51,$100.00,$0.00,$50.00,$79.20,$80.00,$0.00,$15.65,$0.00,$15.92,$0.00
G36359,SUP,HCPCS C1725,,G36359  -  CATH ANGIO .035IN VTK CURVE 5.5FR 125CM SHTH GWIRE RADIOPQ,$195.00,$0.00,$195.00,$105.89,$139.17,$0.00,$33.60,$0.00,$0.00,$34.14,$195.00,$0.00,$97.50,$154.44,$156.00,$0.00,$30.52,$0.00,$31.04,$0.00
G36360,SUP,HCPCS C1725,,G36360  -  CATH ANGIO .035IN SIM2 CURVE 5.5FR 125CM SHTH GWIRE RADIOPQ,$195.00,$0.00,$195.00,$105.89,$139.17,$0.00,$33.60,$0.00,$0.00,$34.14,$195.00,$0.00,$97.50,$154.44,$156.00,$0.00,$30.52,$0.00,$31.04,$0.00
G36405,SUP,HCPCS C1770,,G36405  -  COIL EMBOLIZATION .035IN 5MM 5CM 3.1 LOOP MREYE PLATINUM,$250.30,$0.00,$250.30,$0.00,$178.64,$0.00,$0.00,$0.00,$0.00,$0.00,$250.30,$0.00,$125.15,$198.24,$200.24,$0.00,$0.00,$0.00,$0.00,$0.00
G38463,SUP,HCPCS C1874,,G38463  -  STENT VASCULAR 6MM 40MM 125CM DRUG ELUTE OTW DELIVERY SYSTEM,"$2,937.50",$0.00,"$2,937.50","$1,321.88","$2,096.49",$0.00,$506.12,$0.00,$0.00,$514.33,"$2,937.50",$0.00,"$1,468.75","$2,326.50","$2,350.00",$0.00,$459.72,$0.00,$467.65,$0.00
G38479,SUP,HCPCS C1874,,G38479  -  STENT VASCULAR 6MM 60MM 125CM DRUG ELUTE OTW DELIVERY SYSTEM,"$3,737.50",$0.00,"$3,737.50","$1,681.88","$2,667.45",$0.00,$643.95,$0.00,$0.00,$654.41,"$3,737.50",$0.00,"$1,868.75","$2,960.10","$2,990.00",$0.00,$584.92,$0.00,$595.01,$0.00
G38480,SUP,HCPCS C1874,,G38480  -  STENT VASCULAR 6MM 80MM 125CM DRUG ELUTE OTW DELIVERY SYSTEM,"$4,487.50",$0.00,"$4,487.50","$2,019.38","$3,202.73",$0.00,$773.17,$0.00,$0.00,$785.73,"$4,487.50",$0.00,"$2,243.75","$3,554.10","$3,590.00",$0.00,$702.29,$0.00,$714.41,$0.00
G38481,SUP,HCPCS C1874,,G38481  -  STENT VASCULAR 125CM 6FR 80MM 100MM OTW ZILVER PTX,"$4,487.50",$0.00,"$4,487.50","$2,019.38","$3,202.73",$0.00,$773.17,$0.00,$0.00,$785.73,"$4,487.50",$0.00,"$2,243.75","$3,554.10","$3,590.00",$0.00,$702.29,$0.00,$714.41,$0.00
G38482,SUP,HCPCS C1874,,G38482  -  STENT VASCULAR 6MM 120MM 125CM DRUG ELUTE OTW DELIVERY,"$4,987.50",$0.00,"$4,987.50","$2,244.38","$3,559.58",$0.00,$859.32,$0.00,$0.00,$873.27,"$4,987.50",$0.00,"$2,493.75","$3,950.10","$3,990.00",$0.00,$780.54,$0.00,$794.01,$0.00
G38486,SUP,HCPCS C1874,,G38486  -  STENT VASCULAR 7MM 40MM 125CM DRUG ELUTE OTW DELIVERY SYSTEM,"$2,937.50",$0.00,"$2,937.50","$1,321.88","$2,096.49",$0.00,$506.12,$0.00,$0.00,$514.33,"$2,937.50",$0.00,"$1,468.75","$2,326.50","$2,350.00",$0.00,$459.72,$0.00,$467.65,$0.00
G38487,SUP,HCPCS C1874,,G38487  -  STENT VASCULAR 7MM 60MM 125CM DRUG ELUTE OTW DELIVERY SYSTEM,"$3,737.50",$0.00,"$3,737.50","$1,681.88","$2,667.45",$0.00,$643.95,$0.00,$0.00,$654.41,"$3,737.50",$0.00,"$1,868.75","$2,960.10","$2,990.00",$0.00,$584.92,$0.00,$595.01,$0.00
G38488,SUP,HCPCS C1874,,G38488  -  STENT VASCULAR 7MM 80MM 125CM DRUG ELUTE OTW DELIVERY SYSTEM,"$4,487.50",$0.00,"$4,487.50","$2,019.38","$3,202.73",$0.00,$773.17,$0.00,$0.00,$785.73,"$4,487.50",$0.00,"$2,243.75","$3,554.10","$3,590.00",$0.00,$702.29,$0.00,$714.41,$0.00
G38489,SUP,HCPCS C1874,,G38489  -  STENT VASCULAR 7MM 100MM 125CM DRUG ELUTE OTW DELIVERY,"$4,487.50",$0.00,"$4,487.50","$2,019.38","$3,202.73",$0.00,$773.17,$0.00,$0.00,$785.73,"$4,487.50",$0.00,"$2,243.75","$3,554.10","$3,590.00",$0.00,$702.29,$0.00,$714.41,$0.00
G38490,SUP,HCPCS C1874,,G38490  -  STENT VASCULAR 7MM 120MM 125CM DRUG ELUTE OTW DELIVERY,"$4,987.50",$0.00,"$4,987.50","$2,244.38","$3,559.58",$0.00,$859.32,$0.00,$0.00,$873.27,"$4,987.50",$0.00,"$2,493.75","$3,950.10","$3,990.00",$0.00,$780.54,$0.00,$794.01,$0.00
G38532,SUP,HCPCS C1874,,G38532  -  STENT VASCULAR 8MM 120MM 125CM OTW DRUG ELUTE DELIVERY,"$4,987.50",$0.00,"$4,987.50","$2,244.38","$3,559.58",$0.00,$859.32,$0.00,$0.00,$873.27,"$4,987.50",$0.00,"$2,493.75","$3,950.10","$3,990.00",$0.00,$780.54,$0.00,$794.01,$0.00
G38589,SUP,Custom 27803010,,G38589  -  GRAFT EVAS 2 BRCH 20MM 7.7MM 20FR 109MM 45MM ZNTH FENESTRATE,"$9,270.00",$0.00,"$9,270.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$9,270.00",$0.00,"$4,635.00","$7,341.84","$7,416.00",$0.00,$0.00,$0.00,$0.00,$0.00
G42409,SUP,Custom 27803010,,G42409  -  COIL EMBOLIZATION .035IN 4MM 3CM 2.4 LOOP MREYE PLATINUM,$250.30,$0.00,$250.30,$0.00,$178.64,$0.00,$0.00,$0.00,$0.00,$0.00,$250.30,$0.00,$125.15,$198.24,$200.24,$0.00,$0.00,$0.00,$0.00,$0.00
G42410,SUP,HCPCS C1770,,G42410  -  COIL EMBOLIZATION 5MM 3CM 1.9 LOOP STAINLESS STEEL SYNTH,$250.30,$0.00,$250.30,$0.00,$178.64,$0.00,$0.00,$0.00,$0.00,$0.00,$250.30,$0.00,$125.15,$198.24,$200.24,$0.00,$0.00,$0.00,$0.00,$0.00
G42419,SUP,HCPCS C1770,,G42419  -  COIL EMBOLIZATION .035IN 3MM 5CM 5.3 LOOP STAINLESS STEEL,$250.30,$0.00,$250.30,$0.00,$178.64,$0.00,$0.00,$0.00,$0.00,$0.00,$250.30,$0.00,$125.15,$198.24,$200.24,$0.00,$0.00,$0.00,$0.00,$0.00
G42423,SUP,HCPCS C1770,,G42423  -  COIL EMBOLIZATION .035IN 8MM 5CM 2 LOOP MREYE PLATINUM,$250.30,$0.00,$250.30,$0.00,$178.64,$0.00,$0.00,$0.00,$0.00,$0.00,$250.30,$0.00,$125.15,$198.24,$200.24,$0.00,$0.00,$0.00,$0.00,$0.00
G43821,SUP,HCPCS C1876,,G43821  -  STENT VASCULAR .035IN 6MM 6FR 40MM 125CM SELF EXPANDING,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
G43823,SUP,HCPCS C1876,,G43823  -  STENT VASCULAR 6MM 6FR 80MM 125CM SELF EXPAND INTROD OTW,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
G43831,SUP,HCPCS C1876,,G43831  -  STENT VASC 8MM 6FR 40MM 125CM .035IN SLF EXPANDABLE DLV SYS,"$2,612.50",$0.00,"$2,612.50","$1,175.63","$1,864.54",$0.00,$450.12,$0.00,$0.00,$457.43,"$2,612.50",$0.00,"$1,306.25","$2,069.10","$2,090.00",$0.00,$408.86,$0.00,$415.91,$0.00
G43833,SUP,HCPCS C1876,,G43833  -  STENT VASC 8MM 6FR 80MM 125CM .035IN SLF XPD FLXB FLXR,"$2,612.50",$0.00,"$2,612.50","$1,175.63","$1,864.54",$0.00,$450.12,$0.00,$0.00,$457.43,"$2,612.50",$0.00,"$1,306.25","$2,069.10","$2,090.00",$0.00,$408.86,$0.00,$415.91,$0.00
G43845,SUP,HCPCS C1877,,G43845  -  STENT VASC 6MM 6FR 30MM 80CM .035IN SLF XPD FLXB FLXR INTROD,"$2,612.50",$0.00,"$2,612.50","$1,175.63","$1,864.54",$0.00,$450.12,$0.00,$0.00,$457.43,"$2,612.50",$0.00,"$1,306.25","$2,069.10","$2,090.00",$0.00,$408.86,$0.00,$415.91,$0.00
G43846,SUP,HCPCS C1876,,G43846  -  STENT VASCULAR 6MM 40MM 80CM SELF EXPAND OTW INTROD RADIOPQ,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
G43850,SUP,HCPCS C1876,,G43850  -  STENT VASC 7MM 6FR 30MM 80CM .035IN SLF XPD FLXB FLXR INTROD,"$2,612.50",$0.00,"$2,612.50","$1,175.63","$1,864.54",$0.00,$450.12,$0.00,$0.00,$457.43,"$2,612.50",$0.00,"$1,306.25","$2,069.10","$2,090.00",$0.00,$408.86,$0.00,$415.91,$0.00
G43851,SUP,HCPCS C1876,,G43851  -  STENT VASCULAR 7MM 6FR 40MM 80CM SELF EXPAND FLEXIBLE SLOT,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
G43855,SUP,HCPCS C1876,,G43855  -  STENT VASCULAR .035IN 8MM 6FR 30MM 80CM SELF EXPANDING,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
G43856,SUP,HCPCS C1876,,G43856  -  STENT VASCULAR .035IN 8MM 6FR 40MM 80CM SELF EXPANDING,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
G43857,SUP,HCPCS C1876,,G43857  -  STENT VASCULAR .035IN 8MM 6FR 60MM 80CM SELF EXPANDING,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
G43861,SUP,HCPCS C1876,,G43861  -  STENT VASCULAR 9MM 6FR 40MM 80CM SELF EXPAND INTROD OTW,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
G43863,SUP,HCPCS C1876,,G43863  -  STENT VASC 9MM 6FR 80MM 80CM .035IN SLF XPD FLXB FLXR INTROD,"$2,612.50",$0.00,"$2,612.50","$1,175.63","$1,864.54",$0.00,$450.12,$0.00,$0.00,$457.43,"$2,612.50",$0.00,"$1,306.25","$2,069.10","$2,090.00",$0.00,$408.86,$0.00,$415.91,$0.00
G43865,SUP,HCPCS C1876,,G43865  -  STENT VASCULAR .035IN 10MM 6FR 30MM 80CM SELF EXPANDING,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
G43866,SUP,HCPCS C1876,,G43866  -  STENT VASCULAR .035IN 10MM 6FR 40MM 80CM SELF EXPANDING,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
G43868,SUP,HCPCS C1876,,G43868  -  STENT VASC 10MM 6FR 80MM 80CM .035IN SLF EXPANDABLE DLV SYS,"$2,612.50",$0.00,"$2,612.50","$1,175.63","$1,864.54",$0.00,$450.12,$0.00,$0.00,$457.43,"$2,612.50",$0.00,"$1,306.25","$2,069.10","$2,090.00",$0.00,$408.86,$0.00,$415.91,$0.00
G43870,SUP,HCPCS C1894,,G43870  -  SET INTROD 40CM 5FR MPNCH .018IN NTNL GWIRE 10CM VLNK STRL,$69.00,$0.00,$69.00,$37.47,$49.25,$0.00,$11.89,$0.00,$0.00,$12.08,$69.00,$0.00,$34.50,$54.65,$55.20,$0.00,$10.80,$0.00,$10.98,$0.00
G44153,SUP,HCPCS C1894,,G44153  -  SHEATH GUID .018-.038IN ANL0 CURVE 5FR .074IN 45CM INTROD,$187.50,$0.00,$187.50,$101.81,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G44154,SUP,HCPCS C1894,,G44154  -  SHEATH GUID .018-.038IN ANL0 CURVE 6FR .087IN 45CM INTROD,$187.50,$0.00,$187.50,$101.81,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G44155,SUP,HCPCS C1894,,G44155  -  SHEATH GUID .018/.038IN ANL0 CURVE 7FR .1IN 45CM INTROD,$187.50,$0.00,$187.50,$101.81,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G44846,SUP,HCPCS C1769,,G44846  -  GUIDEWIRE URO STRG .035IN 150CM 3CM MTN HBRD FLXB,$120.00,$0.00,$120.00,$65.16,$85.64,$0.00,$20.68,$0.00,$0.00,$21.01,$120.00,$0.00,$60.00,$95.04,$96.00,$0.00,$18.78,$0.00,$19.10,$0.00
G44848,SUP,HCPCS C1769,,G44848  -  GUIDEWIRE URO .035IN 150CM 3CM MTN HBRD FLXB STRG TIP,$120.00,$0.00,$120.00,$65.16,$85.64,$0.00,$20.68,$0.00,$0.00,$21.01,$120.00,$0.00,$60.00,$95.04,$96.00,$0.00,$18.78,$0.00,$19.10,$0.00
G44849,SUP,HCPCS C1769,,G44849  -  GUIDEWIRE URO .038IN 150CM 3CM MTN HBRD FLXB STRG TIP,$120.00,$0.00,$120.00,$65.16,$85.64,$0.00,$20.68,$0.00,$0.00,$21.01,$120.00,$0.00,$60.00,$95.04,$96.00,$0.00,$18.78,$0.00,$19.10,$0.00
G44855,SUP,HCPCS C1769,,G44855  -  GUIDEWIRE URO .038IN 150CM 3CM MTN HBRD FLXB ANG TIP,$120.00,$0.00,$120.00,$65.16,$85.64,$0.00,$20.68,$0.00,$0.00,$21.01,$120.00,$0.00,$60.00,$95.04,$96.00,$0.00,$18.78,$0.00,$19.10,$0.00
G45208,SUP,HCPCS C1769,,G45208  -  GUIDEWIRE VASCULAR CURVE .035IN 260CM 2 END FLEXIBLE TIP,"$1,432.50",$0.00,"$1,432.50",$777.85,"$1,022.38",$0.00,$246.81,$0.00,$0.00,$250.82,"$1,432.50",$0.00,$716.25,"$1,134.54","$1,146.00",$0.00,$224.19,$0.00,$228.05,$0.00
G45352,SUP,HCPCS C1769,,G45352  -  GUIDEWIRE VASC STRG .035IN 300CM 4CM LNDRQS XSTF FLX TP PTFE,"$1,169.05",$0.00,"$1,169.05",$634.79,$834.35,$0.00,$201.42,$0.00,$0.00,$204.69,"$1,169.05",$0.00,$584.53,$925.89,$935.24,$0.00,$182.96,$0.00,$186.11,$0.00
G46023,SUP,HCPCS C1726,,G46023  -  GUIDEWIRE URO .035IN 150CM 3CM MTN HBRD FLXB ANG TIP,$103.87,$0.00,$103.87,$56.40,$74.13,$0.00,$17.90,$0.00,$0.00,$18.19,$103.87,$0.00,$51.94,$82.27,$83.10,$0.00,$16.26,$0.00,$16.54,$0.00
G46024,SUP,HCPCS C1726,,G46024  -  CATHETER NPHSTM 6MM 15CM CLR ULTRX INFL BLN SHRT TRNS TPR,$618.80,$0.00,$618.80,$336.01,$441.64,$0.00,$106.62,$0.00,$0.00,$108.35,$618.80,$0.00,$309.40,$490.09,$495.04,$0.00,$96.84,$0.00,$98.51,$0.00
G46027,SUP,Custom 27203010,,G46027  -  SET NPHSTM 8MM 15CM CLR ULTRX INFL BLN SHRT TRNS TPR RADOPQ,$515.33,$0.00,$515.33,$0.00,$367.79,$0.00,$0.00,$0.00,$0.00,$0.00,$515.33,$0.00,$257.66,$408.14,$412.26,$0.00,$0.00,$0.00,$0.00,$0.00
G46028,SUP,HCPCS C1894,,G46028  -  EXTRACTOR STON 1.7FR 1CM 115CM NCOMPASS 4/16 WRE BSKT MOD,$407.00,$0.00,$407.00,$221.00,$290.48,$0.00,$70.12,$0.00,$0.00,$71.26,$407.00,$0.00,$203.50,$322.34,$325.60,$0.00,$63.70,$0.00,$64.79,$0.00
G46029,SUP,HCPCS C1894,,G46029  -  SHEATH ACC 3FR 9.5FR 55CM FLXR 2 CNT WRK CHNL 2 LUM DILATION,$407.00,$0.00,$407.00,$221.00,$290.48,$0.00,$70.12,$0.00,$0.00,$71.26,$407.00,$0.00,$203.50,$322.34,$325.60,$0.00,$63.70,$0.00,$64.79,$0.00
G46030,SUP,HCPCS C2627,,G46030  -  SHEATH ACC 3FR 12FR 13CM FLXR 2 CNT WRK CHNL 2 LUM DILATION,$117.15,$0.00,$117.15,$63.61,$83.61,$0.00,$20.18,$0.00,$0.00,$20.51,$117.15,$0.00,$58.58,$92.78,$93.72,$0.00,$18.33,$0.00,$18.65,$0.00
G46031,SUP,HCPCS C2627,,G46031  -  SHEATH ACC 18FR 17CM CLR AMPTZ RADOPQ STRP RNL,$117.15,$0.00,$117.15,$63.61,$83.61,$0.00,$20.18,$0.00,$0.00,$20.51,$117.15,$0.00,$58.58,$92.78,$93.72,$0.00,$18.33,$0.00,$18.65,$0.00
G46032,SUP,HCPCS C2627,,G46032  -  SHEATH ACC 24FR 17CM CLR AMPTZ RADOPQ STRP RNL,$117.15,$0.00,$117.15,$63.61,$83.61,$0.00,$20.18,$0.00,$0.00,$20.51,$117.15,$0.00,$58.58,$92.78,$93.72,$0.00,$18.33,$0.00,$18.65,$0.00
G46033,SUP,HCPCS C1726,,G46033  -  SHEATH ACC 30FR 17CM CLR AMPTZ RADOPQ STRP RNL,$519.35,$0.00,$519.35,$282.01,$370.66,$0.00,$89.48,$0.00,$0.00,$90.93,$519.35,$0.00,$259.68,$411.33,$415.48,$0.00,$81.28,$0.00,$82.68,$0.00
G46034,SUP,HCPCS C1726,,G46034  -  CATHETER NPHSTM 6MM 15CM ULTRX INFL BLN SHRT TRNS TPR RADOPQ,$519.35,$0.00,$519.35,$282.01,$370.66,$0.00,$89.48,$0.00,$0.00,$90.93,$519.35,$0.00,$259.68,$411.33,$415.48,$0.00,$81.28,$0.00,$82.68,$0.00
G46035,SUP,HCPCS C1726,,G46035  -  CATHETER NPHSTM 8MM 15CM ULTRX INFL BLN SHRT TRNS TPR RADOPQ,$519.35,$0.00,$519.35,$282.01,$370.66,$0.00,$89.48,$0.00,$0.00,$90.93,$519.35,$0.00,$259.68,$411.33,$415.48,$0.00,$81.28,$0.00,$82.68,$0.00
G46036,SUP,HCPCS C1726,,G46036  -  CATHETER NPHSTM 8MM 15CM CLR ULTRX INFL BLN SHRT TRNS TPR,$618.80,$0.00,$618.80,$336.01,$441.64,$0.00,$106.62,$0.00,$0.00,$108.35,$618.80,$0.00,$309.40,$490.09,$495.04,$0.00,$96.84,$0.00,$98.51,$0.00
G46037,SUP,HCPCS C1726,,G46037  -  SET NPHSTM 6MM 15CM ULTRX INFL BLN SHRT TRNS TPR RADOPQ STRP,$618.80,$0.00,$618.80,$336.01,$441.64,$0.00,$106.62,$0.00,$0.00,$108.35,$618.80,$0.00,$309.40,$490.09,$495.04,$0.00,$96.84,$0.00,$98.51,$0.00
G46038,SUP,HCPCS C1726,,G46038  -  SET NPHSTM 6MM 15CM CLR ULTRX INFL BLN SHRT TRNS TPR RADOPQ,$618.80,$0.00,$618.80,$336.01,$441.64,$0.00,$106.62,$0.00,$0.00,$108.35,$618.80,$0.00,$309.40,$490.09,$495.04,$0.00,$96.84,$0.00,$98.51,$0.00
G46041,SUP,HCPCS C1726,,G46041  -  CATHETER NPHSTM 10MM 15CM ULTRX,$519.35,$0.00,$519.35,$282.01,$370.66,$0.00,$89.48,$0.00,$0.00,$90.93,$519.35,$0.00,$259.68,$411.33,$415.48,$0.00,$81.28,$0.00,$82.68,$0.00
G46042,SUP,HCPCS C1726,,G46042  -  CATHETER NPHSTM 6MM 15CM ULTRX,$519.35,$0.00,$519.35,$282.01,$370.66,$0.00,$89.48,$0.00,$0.00,$90.93,$519.35,$0.00,$259.68,$411.33,$415.48,$0.00,$81.28,$0.00,$82.68,$0.00
G46043,SUP,HCPCS C1726,,G46043  -  EXTRACTOR STON 2.2FR 11MM 115CM STRL NGAGE NTNL URETER,$519.35,$0.00,$519.35,$282.01,$370.66,$0.00,$89.48,$0.00,$0.00,$90.93,$519.35,$0.00,$259.68,$411.33,$415.48,$0.00,$81.28,$0.00,$82.68,$0.00
G46044,SUP,Custom 27203010,,G46044  -  SET NPHSTM 8MM 15CM CLR ULTRX INFL BLN SHRT TRNS TPR RADOPQ,$814.00,$0.00,$814.00,$0.00,$580.95,$0.00,$0.00,$0.00,$0.00,$0.00,$814.00,$0.00,$407.00,$644.69,$651.20,$0.00,$0.00,$0.00,$0.00,$0.00
G46071,SUP,Custom 27203010,,G46071  -  DEVICE BX BX KNDY REUSE,$814.00,$0.00,$814.00,$0.00,$580.95,$0.00,$0.00,$0.00,$0.00,$0.00,$814.00,$0.00,$407.00,$644.69,$651.20,$0.00,$0.00,$0.00,$0.00,$0.00
G46072,SUP,HCPCS C1894,,G46072  -  NEEDLE BX 18GA 25CM STRL HUB ECHGN TIP SMPL NTCH DISP,$20.35,$0.00,$20.35,$11.05,$14.52,$0.00,$3.51,$0.00,$0.00,$3.56,$20.35,$0.00,$10.18,$16.12,$16.28,$0.00,$3.18,$0.00,$3.24,$0.00
G46073,SUP,HCPCS C1894,,G46073  -  SHEATH ACC 3FR 9.5FR 13CM FLXR DL 2 CNT WRK CHNL 2 LUM,$407.00,$0.00,$407.00,$221.00,$290.48,$0.00,$70.12,$0.00,$0.00,$71.26,$407.00,$0.00,$203.50,$322.34,$325.60,$0.00,$63.70,$0.00,$64.79,$0.00
G46074,SUP,HCPCS C1894,,G46074  -  SHEATH ACC 3FR 9.5FR 20CM FLXR DL 2 CNT WRK CHNL 2 LUM,$407.00,$0.00,$407.00,$221.00,$290.48,$0.00,$70.12,$0.00,$0.00,$71.26,$407.00,$0.00,$203.50,$322.34,$325.60,$0.00,$63.70,$0.00,$64.79,$0.00
G46075,SUP,HCPCS C1894,,G46075  -  SHEATH ACC 3FR 9.5FR 28CM FLXR DL 2 CNT WRK CHNL 2 LUM,$407.00,$0.00,$407.00,$221.00,$290.48,$0.00,$70.12,$0.00,$0.00,$71.26,$407.00,$0.00,$203.50,$322.34,$325.60,$0.00,$63.70,$0.00,$64.79,$0.00
G46076,SUP,HCPCS C1894,,G46076  -  SHEATH ACC 3FR 9.5FR 35CM FLXR DL 2 CNT WRK CHNL 2 LUM,$407.00,$0.00,$407.00,$221.00,$290.48,$0.00,$70.12,$0.00,$0.00,$71.26,$407.00,$0.00,$203.50,$322.34,$325.60,$0.00,$63.70,$0.00,$64.79,$0.00
G46077,SUP,HCPCS C1894,,G46077  -  SHEATH ACC 3FR 9.5FR 45CM FLXR DL 2 CNT WRK CHNL 2 LUM,$407.00,$0.00,$407.00,$221.00,$290.48,$0.00,$70.12,$0.00,$0.00,$71.26,$407.00,$0.00,$203.50,$322.34,$325.60,$0.00,$63.70,$0.00,$64.79,$0.00
G46078,SUP,HCPCS C1894,,G46078  -  SHEATH ACC 3FR 12FR 20CM FLXR 2 CNT WRK CHNL 2 LUM DILATION,$407.00,$0.00,$407.00,$221.00,$290.48,$0.00,$70.12,$0.00,$0.00,$71.26,$407.00,$0.00,$203.50,$322.34,$325.60,$0.00,$63.70,$0.00,$64.79,$0.00
G46079,SUP,HCPCS C1894,,G46079  -  SHEATH ACC 3FR 12FR 28CM FLXR 2 CNT WRK CHNL 2 LUM DILATION,$407.00,$0.00,$407.00,$221.00,$290.48,$0.00,$70.12,$0.00,$0.00,$71.26,$407.00,$0.00,$203.50,$322.34,$325.60,$0.00,$63.70,$0.00,$64.79,$0.00
G46080,SUP,HCPCS C1894,,G46080  -  SHEATH ACC 3FR 12FR 35CM FLXR DL 2 CNT WRK CHNL 2 LUM,$407.00,$0.00,$407.00,$221.00,$290.48,$0.00,$70.12,$0.00,$0.00,$71.26,$407.00,$0.00,$203.50,$322.34,$325.60,$0.00,$63.70,$0.00,$64.79,$0.00
G46081,SUP,HCPCS C1894,,G46081  -  SHEATH ACC 3FR 12FR 45CM FLXR DL 2 CNT WRK CHNL 2 LUM,$407.00,$0.00,$407.00,$221.00,$290.48,$0.00,$70.12,$0.00,$0.00,$71.26,$407.00,$0.00,$203.50,$322.34,$325.60,$0.00,$63.70,$0.00,$64.79,$0.00
G46137,SUP,HCPCS C1769,,G46137  -  SHEATH ACC 3FR 12FR 55CM FLXR 2 CNT WRK CHNL 2 LUM DILATION,$669.38,$0.00,$669.38,$363.47,$477.73,$0.00,$115.33,$0.00,$0.00,$117.20,$669.38,$0.00,$334.69,$530.15,$535.50,$0.00,$104.76,$0.00,$106.56,$0.00
G46138,SUP,HCPCS C1769,,G46138  -  GUIDEWIRE ESCP ANG STRG TPR .038IN 150CM STRL 3CM BIWIRE 1-1,$133.88,$0.00,$133.88,$72.69,$95.55,$0.00,$23.07,$0.00,$0.00,$23.44,$133.88,$0.00,$66.94,$106.03,$107.10,$0.00,$20.95,$0.00,$21.31,$0.00
G46139,SUP,HCPCS C1769,,G46139  -  GUIDEWIRE ESCP ANG .035IN 150CM STRL 3CM BIWIRE 1TO 1 TRQ,$133.88,$0.00,$133.88,$72.69,$95.55,$0.00,$23.07,$0.00,$0.00,$23.44,$133.88,$0.00,$66.94,$106.03,$107.10,$0.00,$20.95,$0.00,$21.31,$0.00
G46140,SUP,HCPCS C1769,,G46140  -  GUIDEWIRE VASC STRG ANG TPR .025IN 150CM 3CM BIWIRE 1TO 1,$111.38,$0.00,$111.38,$60.48,$79.49,$0.00,$19.19,$0.00,$0.00,$19.50,$111.38,$0.00,$55.69,$88.21,$89.10,$0.00,$17.43,$0.00,$17.73,$0.00
G46141,SUP,HCPCS C1769,,G46141  -  GUIDEWIRE URO ANG STRG TPR .038IN 150CM STRL 3CM BIWIRE 1-1,$111.38,$0.00,$111.38,$60.48,$79.49,$0.00,$19.19,$0.00,$0.00,$19.50,$111.38,$0.00,$55.69,$88.21,$89.10,$0.00,$17.43,$0.00,$17.73,$0.00
G46142,SUP,HCPCS C1769,,G46142  -  GUIDEWIRE VASC STD STRG .035IN 150CM 3CM BIWIRE 1TO 1 TRQ,$111.38,$0.00,$111.38,$60.48,$79.49,$0.00,$19.19,$0.00,$0.00,$19.50,$111.38,$0.00,$55.69,$88.21,$89.10,$0.00,$17.43,$0.00,$17.73,$0.00
G46167,SUP,HCPCS C1894,,G46167  -  SHEATH ACCES 9.5FR CONTIN WKG CHNL FLXB SCP,$308.00,$0.00,$308.00,$167.24,$219.82,$0.00,$53.07,$0.00,$0.00,$53.93,$308.00,$0.00,$154.00,$243.94,$246.40,$0.00,$48.20,$0.00,$49.03,$0.00
G46168,SUP,HCPCS C1894,,G46168  -  SHEATH ACCES 12FR CONTIN WOR CHNL TPR DILAT LOCK,$308.00,$0.00,$308.00,$167.24,$219.82,$0.00,$53.07,$0.00,$0.00,$53.93,$308.00,$0.00,$154.00,$243.94,$246.40,$0.00,$48.20,$0.00,$49.03,$0.00
G46169,SUP,HCPCS C1894,,G46169  -  GUIDEWIRE URO ANG STRG TPR .025IN 150CM 3CM BIWIRE STD BD,$308.00,$0.00,$308.00,$167.24,$219.82,$0.00,$53.07,$0.00,$0.00,$53.93,$308.00,$0.00,$154.00,$243.94,$246.40,$0.00,$48.20,$0.00,$49.03,$0.00
G46199,SUP,Custom 27203010,,G46199  -  RETRIEVER STNT 2.4FR 115CM NSNARE FLXB NTNL,$796.88,$0.00,$796.88,$0.00,$568.73,$0.00,$0.00,$0.00,$0.00,$0.00,$796.88,$0.00,$398.44,$631.13,$637.50,$0.00,$0.00,$0.00,$0.00,$0.00
G46200,SUP,Custom 27203010,,G46200  -  ELECTRODE ESURG .014IN 27FR CUT LOOP FIT 27FR STRZ 1 STM,$159.38,$0.00,$159.38,$0.00,$113.75,$0.00,$0.00,$0.00,$0.00,$0.00,$159.38,$0.00,$79.69,$126.23,$127.50,$0.00,$0.00,$0.00,$0.00,$0.00
G46202,SUP,Custom 27203010,,G46202  -  KNIFE ESCP STRL COLLINGS DISP FIT 24/27FR 1 STM RSSCP,$159.38,$0.00,$159.38,$0.00,$113.75,$0.00,$0.00,$0.00,$0.00,$0.00,$159.38,$0.00,$79.69,$126.23,$127.50,$0.00,$0.00,$0.00,$0.00,$0.00
G46203,SUP,Custom 27203010,,G46203  -  ELECTRODE ESURG 3MM RLLR BRL FIT 24/26/28FR ACMI USA/ELT,$159.38,$0.00,$159.38,$0.00,$113.75,$0.00,$0.00,$0.00,$0.00,$0.00,$159.38,$0.00,$79.69,$126.23,$127.50,$0.00,$0.00,$0.00,$0.00,$0.00
G46204,SUP,Custom 27203010,,G46204  -  ELECTRODE ESURG .014IN CUT LOOP GW FIT 24FR STRZ 2 STM RSSCP,$350.63,$0.00,$350.63,$0.00,$250.24,$0.00,$0.00,$0.00,$0.00,$0.00,$350.63,$0.00,$175.31,$277.70,$280.50,$0.00,$0.00,$0.00,$0.00,$0.00
G46205,SUP,Custom 27203010,,G46205  -  ELECTRODE ESURG PRFR RESCT COAG FIT 24 FR ACMI USA/ELT RSSCP,$308.13,$0.00,$308.13,$0.00,$219.91,$0.00,$0.00,$0.00,$0.00,$0.00,$308.13,$0.00,$154.06,$244.04,$246.50,$0.00,$0.00,$0.00,$0.00,$0.00
G46206,SUP,Custom 27203010,,G46206  -  EXTRACTOR STONE 1.5FR 1CM 115CM 4 WIRE TIPLESS BASKET,$515.33,$0.00,$515.33,$0.00,$367.79,$0.00,$0.00,$0.00,$0.00,$0.00,$515.33,$0.00,$257.66,$408.14,$412.26,$0.00,$0.00,$0.00,$0.00,$0.00
G46209,SUP,Custom 27203010,,G46209  -  KNIFE ESCP COLLINGS FIT 24/26/28 FR ACMI USA/ELT RSSCP,$159.38,$0.00,$159.38,$0.00,$113.75,$0.00,$0.00,$0.00,$0.00,$0.00,$159.38,$0.00,$79.69,$126.23,$127.50,$0.00,$0.00,$0.00,$0.00,$0.00
G46210,SUP,Custom 27203010,,G46210  -  ELECTRODE ESURG .012IN CUT LOOP GW FIT 24FR ACMI USA/ELT,$159.38,$0.00,$159.38,$0.00,$113.75,$0.00,$0.00,$0.00,$0.00,$0.00,$159.38,$0.00,$79.69,$126.23,$127.50,$0.00,$0.00,$0.00,$0.00,$0.00
G46211,SUP,Custom 27203010,,G46211  -  ELECTRODE ESURG .015IN CUT LOOP GW FIT 24FR ACMI USA/ELT,$159.38,$0.00,$159.38,$0.00,$113.75,$0.00,$0.00,$0.00,$0.00,$0.00,$159.38,$0.00,$79.69,$126.23,$127.50,$0.00,$0.00,$0.00,$0.00,$0.00
G46212,SUP,Custom 27203010,,G46212  -  ELECTRODE ESURG .012IN CUT LOOP GW FIT 26FR ACMI USA/ELT,$159.38,$0.00,$159.38,$0.00,$113.75,$0.00,$0.00,$0.00,$0.00,$0.00,$159.38,$0.00,$79.69,$126.23,$127.50,$0.00,$0.00,$0.00,$0.00,$0.00
G46213,SUP,Custom 27203010,,G46213  -  ELECTRODE ESURG .015IN CUT LOOP GW FIT 26FR ACMI USA/ELT,$159.38,$0.00,$159.38,$0.00,$113.75,$0.00,$0.00,$0.00,$0.00,$0.00,$159.38,$0.00,$79.69,$126.23,$127.50,$0.00,$0.00,$0.00,$0.00,$0.00
G46214,SUP,Custom 27203010,,G46214  -  ELECTRODE ESURG .012IN CUT LOOP GW FIT 28FR ACMI USA/ELT,$159.38,$0.00,$159.38,$0.00,$113.75,$0.00,$0.00,$0.00,$0.00,$0.00,$159.38,$0.00,$79.69,$126.23,$127.50,$0.00,$0.00,$0.00,$0.00,$0.00
G46215,SUP,Custom 27203010,,G46215  -  ELECTRODE ESURG .015IN LOOP GW URO FIT 28FR ACMI USA/ELT,$350.63,$0.00,$350.63,$0.00,$250.24,$0.00,$0.00,$0.00,$0.00,$0.00,$350.63,$0.00,$175.31,$277.70,$280.50,$0.00,$0.00,$0.00,$0.00,$0.00
G46216,SUP,Custom 27203010,,G46216  -  ELECTRODE ESURG PRFR RESCT COAG FIT 28 FR ACMI USA/ELT RSSCP,$159.38,$0.00,$159.38,$0.00,$113.75,$0.00,$0.00,$0.00,$0.00,$0.00,$159.38,$0.00,$79.69,$126.23,$127.50,$0.00,$0.00,$0.00,$0.00,$0.00
G46217,SUP,Custom 27203010,,G46217  -  ELECTRODE ESURG 3MM RLLR BALL FIT 24/26/28FR ACMI USA/ELT,$159.38,$0.00,$159.38,$0.00,$113.75,$0.00,$0.00,$0.00,$0.00,$0.00,$159.38,$0.00,$79.69,$126.23,$127.50,$0.00,$0.00,$0.00,$0.00,$0.00
G46218,SUP,Custom 27203010,,G46218  -  ELECTRODE ESURG 5MM RLLR BALL FIT 24/26/28FR ACMI USA/ELT,$159.38,$0.00,$159.38,$0.00,$113.75,$0.00,$0.00,$0.00,$0.00,$0.00,$159.38,$0.00,$79.69,$126.23,$127.50,$0.00,$0.00,$0.00,$0.00,$0.00
G46219,SUP,Custom 27203010,,G46219  -  ELECTRODE ESURG .012IN CUT LOOP GW FIT 24FR STRZ 1 STM RSSCP,$159.38,$0.00,$159.38,$0.00,$113.75,$0.00,$0.00,$0.00,$0.00,$0.00,$159.38,$0.00,$79.69,$126.23,$127.50,$0.00,$0.00,$0.00,$0.00,$0.00
G46220,SUP,Custom 27203010,,G46220  -  ELECTRODE MNPLR .014IN CUT LOOP GW FIT 24FR STRZ 1 STM RSSCP,$159.38,$0.00,$159.38,$0.00,$113.75,$0.00,$0.00,$0.00,$0.00,$0.00,$159.38,$0.00,$79.69,$126.23,$127.50,$0.00,$0.00,$0.00,$0.00,$0.00
G46221,SUP,Custom 27203010,,G46221  -  ELECTRODE ESURG .012IN LOOP GW URO FIT 27FR STRZ SGL STM,$350.63,$0.00,$350.63,$0.00,$250.24,$0.00,$0.00,$0.00,$0.00,$0.00,$350.63,$0.00,$175.31,$277.70,$280.50,$0.00,$0.00,$0.00,$0.00,$0.00
G46222,SUP,Custom 27203010,,G46222  -  ELECTRODE ESURG PRFR RESCT COAG FIT 24 FR STRZ 1 STM RSSCP,$350.63,$0.00,$350.63,$0.00,$250.24,$0.00,$0.00,$0.00,$0.00,$0.00,$350.63,$0.00,$175.31,$277.70,$280.50,$0.00,$0.00,$0.00,$0.00,$0.00
G46223,SUP,Custom 27203010,,G46223  -  ELECTRODE ESURG PRFR RESCT COAG FIT 27 FR STRZ 1 STM RSSCP,$159.38,$0.00,$159.38,$0.00,$113.75,$0.00,$0.00,$0.00,$0.00,$0.00,$159.38,$0.00,$79.69,$126.23,$127.50,$0.00,$0.00,$0.00,$0.00,$0.00
G46224,SUP,Custom 27203010,,G46224  -  ELECTRODE MNPLR 3MM CK RLLR BALL DISP FIT 24/27FR STRZ 1 STM,$159.38,$0.00,$159.38,$0.00,$113.75,$0.00,$0.00,$0.00,$0.00,$0.00,$159.38,$0.00,$79.69,$126.23,$127.50,$0.00,$0.00,$0.00,$0.00,$0.00
G46225,SUP,Custom 27203010,,G46225  -  ELECTRODE ESURG 5MM RLLR BALL FIT 24/27FR STRZ 1 STM RSSCP,$159.38,$0.00,$159.38,$0.00,$113.75,$0.00,$0.00,$0.00,$0.00,$0.00,$159.38,$0.00,$79.69,$126.23,$127.50,$0.00,$0.00,$0.00,$0.00,$0.00
G46226,SUP,Custom 27203010,,G46226  -  ELECTRODE ESURG 3MM RLLR BRL FIT 24/27FR STRZ 1 STM RSSCP,$308.13,$0.00,$308.13,$0.00,$219.91,$0.00,$0.00,$0.00,$0.00,$0.00,$308.13,$0.00,$154.06,$244.04,$246.50,$0.00,$0.00,$0.00,$0.00,$0.00
G46228,SUP,Custom 27203010,,G46228  -  KNIFE ESCP COLLINGS 24/26/28 FR RSSCP,$159.38,$0.00,$159.38,$0.00,$113.75,$0.00,$0.00,$0.00,$0.00,$0.00,$159.38,$0.00,$79.69,$126.23,$127.50,$0.00,$0.00,$0.00,$0.00,$0.00
G46229,SUP,Custom 27203010,,G46229  -  ELECTRODE ESURG 12D .012IN CUT LOOP GW FIT 24FR OL OES RSSCP,$159.38,$0.00,$159.38,$0.00,$113.75,$0.00,$0.00,$0.00,$0.00,$0.00,$159.38,$0.00,$79.69,$126.23,$127.50,$0.00,$0.00,$0.00,$0.00,$0.00
G46230,SUP,Custom 27203010,,G46230  -  ELECTRODE ESURG 30D 24FR .012IN CUT LOOP WRE OL OES RSSCP,$159.38,$0.00,$159.38,$0.00,$113.75,$0.00,$0.00,$0.00,$0.00,$0.00,$159.38,$0.00,$79.69,$126.23,$127.50,$0.00,$0.00,$0.00,$0.00,$0.00
G46231,SUP,Custom 27203010,,G46231  -  ELECTRODE ESURG 12D .012IN CUT LOOP GW FIT 26FR OL OES RSSCP,$159.38,$0.00,$159.38,$0.00,$113.75,$0.00,$0.00,$0.00,$0.00,$0.00,$159.38,$0.00,$79.69,$126.23,$127.50,$0.00,$0.00,$0.00,$0.00,$0.00
G46232,SUP,Custom 27203010,,G46232  -  ELECTRODE ESURG 30D .012IN 26FR LOOP CUT WRE FIT 26FR OL OES,$159.38,$0.00,$159.38,$0.00,$113.75,$0.00,$0.00,$0.00,$0.00,$0.00,$159.38,$0.00,$79.69,$126.23,$127.50,$0.00,$0.00,$0.00,$0.00,$0.00
G46233,SUP,Custom 27203010,,G46233  -  ELECTRODE ESURG 12D .012IN CUT LOOP GW FIT 28FR OL OES RSSCP,$159.38,$0.00,$159.38,$0.00,$113.75,$0.00,$0.00,$0.00,$0.00,$0.00,$159.38,$0.00,$79.69,$126.23,$127.50,$0.00,$0.00,$0.00,$0.00,$0.00
G46234,SUP,Custom 27203010,,G46234  -  ELECTRODE ESURG 30D .012IN CUT LOOP GW FIT 28FR OL OES RSSCP,$350.63,$0.00,$350.63,$0.00,$250.24,$0.00,$0.00,$0.00,$0.00,$0.00,$350.63,$0.00,$175.31,$277.70,$280.50,$0.00,$0.00,$0.00,$0.00,$0.00
G46235,SUP,Custom 27203010,,G46235  -  ELECTRODE ESURG PRFR RESCT COAG FIT 24 FR OL OES RSSCP,$350.63,$0.00,$350.63,$0.00,$250.24,$0.00,$0.00,$0.00,$0.00,$0.00,$350.63,$0.00,$175.31,$277.70,$280.50,$0.00,$0.00,$0.00,$0.00,$0.00
G46236,SUP,Custom 27203010,,G46236  -  ELECTRODE ESURG PRFR RESCT COAG FIT 26 FR OL OES RSSCP,$350.63,$0.00,$350.63,$0.00,$250.24,$0.00,$0.00,$0.00,$0.00,$0.00,$350.63,$0.00,$175.31,$277.70,$280.50,$0.00,$0.00,$0.00,$0.00,$0.00
G46237,SUP,Custom 27203010,,G46237  -  ELECTRODE ESURG PRFR RESCT COAG FIT 28 FR OL OES RSSCP,$159.38,$0.00,$159.38,$0.00,$113.75,$0.00,$0.00,$0.00,$0.00,$0.00,$159.38,$0.00,$79.69,$126.23,$127.50,$0.00,$0.00,$0.00,$0.00,$0.00
G46238,SUP,Custom 27203010,,G46238  -  ELECTRODE ESURG 5MM RLLR BALL FIT 24/26/28FR OL OES RSSCP,$159.38,$0.00,$159.38,$0.00,$113.75,$0.00,$0.00,$0.00,$0.00,$0.00,$159.38,$0.00,$79.69,$126.23,$127.50,$0.00,$0.00,$0.00,$0.00,$0.00
G46239,SUP,Custom 27203010,,G46239  -  ELECTRODE ESURG 3MM RLLR BALL FIT 24/26/28FR OL OES RSSCP,$308.13,$0.00,$308.13,$0.00,$219.91,$0.00,$0.00,$0.00,$0.00,$0.00,$308.13,$0.00,$154.06,$244.04,$246.50,$0.00,$0.00,$0.00,$0.00,$0.00
G46240,SUP,Custom 27203010,,G46240  -  ELECTRODE ESURG 3MM DIMPLED TIP VPR RLLR BALL FIT 24/26/28FR,$159.38,$0.00,$159.38,$0.00,$113.75,$0.00,$0.00,$0.00,$0.00,$0.00,$159.38,$0.00,$79.69,$126.23,$127.50,$0.00,$0.00,$0.00,$0.00,$0.00
G46241,SUP,Custom 27203010,,G46241  -  ELECTRODE ESURG .014IN CUT LOOP GW FIT 27FR STRZ 2 STM,$350.63,$0.00,$350.63,$0.00,$250.24,$0.00,$0.00,$0.00,$0.00,$0.00,$350.63,$0.00,$175.31,$277.70,$280.50,$0.00,$0.00,$0.00,$0.00,$0.00
G46242,SUP,Custom 27203010,,G46242  -  ELECTRODE ESURG PRFR RESCT COAG FIT 24 FR STRZ 2 STM RSSCP,$350.63,$0.00,$350.63,$0.00,$250.24,$0.00,$0.00,$0.00,$0.00,$0.00,$350.63,$0.00,$175.31,$277.70,$280.50,$0.00,$0.00,$0.00,$0.00,$0.00
G46243,SUP,Custom 27203010,,G46243  -  ELECTRODE ESURG PRFR RESCT COAG FIT 27 FR STRZ 2 STM RSSCP,$159.38,$0.00,$159.38,$0.00,$113.75,$0.00,$0.00,$0.00,$0.00,$0.00,$159.38,$0.00,$79.69,$126.23,$127.50,$0.00,$0.00,$0.00,$0.00,$0.00
G46244,SUP,Custom 27203010,,G46244  -  ELECTRODE ESURG 3MM RLLR BALL FIT 24/27FR STRZ 2 STM RSSCP,$159.38,$0.00,$159.38,$0.00,$113.75,$0.00,$0.00,$0.00,$0.00,$0.00,$159.38,$0.00,$79.69,$126.23,$127.50,$0.00,$0.00,$0.00,$0.00,$0.00
G46245,SUP,Custom 27203010,,G46245  -  ELECTRODE ESURG 5MM RLLR BALL FIT 24/27FR STRZ 2 STM RSSCP,$159.38,$0.00,$159.38,$0.00,$113.75,$0.00,$0.00,$0.00,$0.00,$0.00,$159.38,$0.00,$79.69,$126.23,$127.50,$0.00,$0.00,$0.00,$0.00,$0.00
G46246,SUP,Custom 27203010,,G46246  -  ELECTRODE ESURG 3MM RLLR BALL FIT 24/27FR STRZ 2 STM RSSCP,$308.13,$0.00,$308.13,$0.00,$219.91,$0.00,$0.00,$0.00,$0.00,$0.00,$308.13,$0.00,$154.06,$244.04,$246.50,$0.00,$0.00,$0.00,$0.00,$0.00
G46247,SUP,Custom 27203010,,G46247  -  ELECTRODE ESURG 3MM DIMPLED TIP VPR RLLR BALL FIT 24/27FR,$350.63,$0.00,$350.63,$0.00,$250.24,$0.00,$0.00,$0.00,$0.00,$0.00,$350.63,$0.00,$175.31,$277.70,$280.50,$0.00,$0.00,$0.00,$0.00,$0.00
G46612,SUP,HCPCS C1763,,G46612  -  GRAFT SFT TIS 13X8CM PLVC FLR INS SIS ES PIG ACLR CLGN MTRX,"$2,487.50",$0.00,"$2,487.50","$1,119.38","$1,775.33",$0.00,$428.58,$0.00,$0.00,$435.54,"$2,487.50",$0.00,"$1,243.75","$1,970.10","$1,990.00",$0.00,$389.29,$0.00,$396.01,$0.00
G47325,SUP,HCPCS C1770,,G47325  -  COIL EMBL 10MM 14CM NST MCIOL PLTN .018IN CATH,$264.20,$0.00,$264.20,$0.00,$188.56,$0.00,$0.00,$0.00,$0.00,$0.00,$264.20,$0.00,$132.10,$209.25,$211.36,$0.00,$0.00,$0.00,$0.00,$0.00
G47329,SUP,HCPCS C1770,,G47329  -  COIL EMBL 6MM 14CM NST MCIOL PLTN .018IN CATH,$264.20,$0.00,$264.20,$0.00,$188.56,$0.00,$0.00,$0.00,$0.00,$0.00,$264.20,$0.00,$132.10,$209.25,$211.36,$0.00,$0.00,$0.00,$0.00,$0.00
G47330,SUP,HCPCS C1770,,G47330  -  COIL EMBL 8MM 14CM NST MCIOL PLTN .018IN CATH,$264.20,$0.00,$264.20,$0.00,$188.56,$0.00,$0.00,$0.00,$0.00,$0.00,$264.20,$0.00,$132.10,$209.25,$211.36,$0.00,$0.00,$0.00,$0.00,$0.00
G47338,SUP,HCPCS Q4107,,G47338  -  COIL EMBL 3MM 7CM NST MCIOL PLTN .018IN CATH,$264.20,$0.00,$264.20,$0.00,$188.56,$0.00,$0.00,$0.00,$0.00,$0.00,$264.20,$0.00,$132.10,$209.25,$211.36,$0.00,$0.00,$0.00,$0.00,$0.00
G47339,SUP,Custom 27805113,,G47339  -  COIL EMBL 4MM 7CM NST MCIOL PLTN .018IN CATH,$264.20,$0.00,$264.20,$0.00,$188.56,$0.00,$0.00,$0.00,$0.00,$0.00,$264.20,$0.00,$132.10,$209.25,$211.36,$0.00,$0.00,$0.00,$0.00,$0.00
G47345,SUP,HCPCS C1770,,G47345  -  COIL EMBL 10MM 14CM NST MCIOL PLTN .035IN CATH,$264.20,$0.00,$264.20,$0.00,$188.56,$0.00,$0.00,$0.00,$0.00,$0.00,$264.20,$0.00,$132.10,$209.25,$211.36,$0.00,$0.00,$0.00,$0.00,$0.00
G47354,SUP,Custom 27803010,,G47354  -  COIL EMBL 6MM 14CM NST MCIOL PLTN .035IN CATH,$264.20,$0.00,$264.20,$0.00,$188.56,$0.00,$0.00,$0.00,$0.00,$0.00,$264.20,$0.00,$132.10,$209.25,$211.36,$0.00,$0.00,$0.00,$0.00,$0.00
G47355,SUP,HCPCS C1770,,G47355  -  COIL EMBL 8MM 14CM NST MCIOL PLTN .035IN CATH,$264.20,$0.00,$264.20,$0.00,$188.56,$0.00,$0.00,$0.00,$0.00,$0.00,$264.20,$0.00,$132.10,$209.25,$211.36,$0.00,$0.00,$0.00,$0.00,$0.00
G47365,SUP,Custom 27803010,,G47365  -  COIL EMBL 10MM 7CM NST MCIOL PLTN .035IN CATH,$264.20,$0.00,$264.20,$0.00,$188.56,$0.00,$0.00,$0.00,$0.00,$0.00,$264.20,$0.00,$132.10,$209.25,$211.36,$0.00,$0.00,$0.00,$0.00,$0.00
G47371,SUP,Custom 27803010,,G47371  -  COIL EMBL 3MM 7IN NST PLTN ACPT .035IN CATH,$264.20,$0.00,$264.20,$0.00,$188.56,$0.00,$0.00,$0.00,$0.00,$0.00,$264.20,$0.00,$132.10,$209.25,$211.36,$0.00,$0.00,$0.00,$0.00,$0.00
G47372,SUP,Custom 27803010,,G47372  -  COIL EMBL 4MM 7CM NST MCIOL PLTN .035IN CATH,$264.20,$0.00,$264.20,$0.00,$188.56,$0.00,$0.00,$0.00,$0.00,$0.00,$264.20,$0.00,$132.10,$209.25,$211.36,$0.00,$0.00,$0.00,$0.00,$0.00
G47416,SUP,HCPCS C1770,,G47416  -  COIL EMBL 3-2MM TRND MCIOL PLTN .018IN CATH,$275.33,$0.00,$275.33,$0.00,$196.50,$0.00,$0.00,$0.00,$0.00,$0.00,$275.33,$0.00,$137.66,$218.06,$220.26,$0.00,$0.00,$0.00,$0.00,$0.00
G47419,SUP,HCPCS C1770,,G47419  -  COIL EMBL 6-2MM TRND MCIOL PLTN .018IN CATH,$275.33,$0.00,$275.33,$0.00,$196.50,$0.00,$0.00,$0.00,$0.00,$0.00,$275.33,$0.00,$137.66,$218.06,$220.26,$0.00,$0.00,$0.00,$0.00,$0.00
G47421,SUP,HCPCS C1770,,G47421  -  COIL EMBL 8-4MM 9.5CM TRND MCL PRELD CRTDG PLTN SNTH FBR,$275.33,$0.00,$275.33,$0.00,$196.50,$0.00,$0.00,$0.00,$0.00,$0.00,$275.33,$0.00,$137.66,$218.06,$220.26,$0.00,$0.00,$0.00,$0.00,$0.00
G47519,SUP,HCPCS C1770,,G47519  -  COIL EMBL 4-3MM TRND PLTN .035IN CATH,$275.33,$0.00,$275.33,$0.00,$196.50,$0.00,$0.00,$0.00,$0.00,$0.00,$275.33,$0.00,$137.66,$218.06,$220.26,$0.00,$0.00,$0.00,$0.00,$0.00
G47520,SUP,HCPCS C1770,,G47520  -  COIL EMBL 5-3MM TRND PLTN .035IN CATH,$275.33,$0.00,$275.33,$0.00,$196.50,$0.00,$0.00,$0.00,$0.00,$0.00,$275.33,$0.00,$137.66,$218.06,$220.26,$0.00,$0.00,$0.00,$0.00,$0.00
G47522,SUP,HCPCS C1770,,G47522  -  COIL EMBL 7-3MM TRND PLTN .035IN CATH,$275.33,$0.00,$275.33,$0.00,$196.50,$0.00,$0.00,$0.00,$0.00,$0.00,$275.33,$0.00,$137.66,$218.06,$220.26,$0.00,$0.00,$0.00,$0.00,$0.00
G47654,SUP,HCPCS C1763,,G47654  -  DILATOR URTH 26FR 37CM S-CRV SDPRT HDRPH,$985.03,$0.00,$985.03,$443.26,$703.01,$0.00,$169.71,$0.00,$0.00,$172.47,$985.03,$0.00,$492.51,$780.14,$788.02,$0.00,$154.16,$0.00,$156.82,$0.00
G47655,SUP,HCPCS C1763,,G47655  -  GRAFT SFT TIS STD SURGISIS BIODESIGN STRTH FLXB RST TO INFCT,"$1,457.50",$0.00,"$1,457.50",$655.88,"$1,040.22",$0.00,$251.12,$0.00,$0.00,$255.20,"$1,457.50",$0.00,$728.75,"$1,154.34","$1,166.00",$0.00,$228.10,$0.00,$232.03,$0.00
G47700,SUP,HCPCS C1892,,G47700  -  INTRODUCER SHEATH .035IN ANL1 CURVE 11.4FR 10FR 45CM HIGH,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
G47701,SUP,HCPCS C1892,,G47701  -  INTRODUCER SHEATH .035IN ANL1 CURVE 13.4FR 12FR 45CM HIGH,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
G47732,SUP,HCPCS C1769,,G47732  -  GUIDEWIRE VASCULAR .014IN 135CM SHAPEABLE TIP KINK,$167.03,$0.00,$167.03,$90.69,$119.21,$0.00,$28.78,$0.00,$0.00,$29.24,$167.03,$0.00,$83.51,$132.29,$133.62,$0.00,$26.14,$0.00,$26.59,$0.00
G47733,SUP,HCPCS C1769,,G47733  -  GUIDEWIRE VASC .014IN 190CM APRCH SHP TIP KINK RST MNVBL LNR,$204.00,$0.00,$204.00,$110.77,$145.59,$0.00,$35.15,$0.00,$0.00,$35.72,$204.00,$0.00,$102.00,$161.57,$163.20,$0.00,$31.93,$0.00,$32.48,$0.00
G47734,SUP,HCPCS C1769,,G47734  -  GUIDEWIRE VASC .014IN 300CM APRCH SHP TIP KINK RST MNVBL LNR,$204.00,$0.00,$204.00,$110.77,$145.59,$0.00,$35.15,$0.00,$0.00,$35.72,$204.00,$0.00,$102.00,$161.57,$163.20,$0.00,$31.93,$0.00,$32.48,$0.00
G47804,SUP,HCPCS C1729,,G47804  -  GRAFT SFT TIS LG SURGISIS BIODESIGN STRTH FLXB RST TO INFCT,$244.20,$0.00,$244.20,$132.60,$174.29,$0.00,$42.07,$0.00,$0.00,$42.76,$244.20,$0.00,$122.10,$193.41,$195.36,$0.00,$38.22,$0.00,$38.88,$0.00
G47805,SUP,HCPCS C1729,,G47805  -  SET CATH CRC NPHSTM SPBC,$244.20,$0.00,$244.20,$132.60,$174.29,$0.00,$42.07,$0.00,$0.00,$42.76,$244.20,$0.00,$122.10,$193.41,$195.36,$0.00,$38.22,$0.00,$38.88,$0.00
G47806,SUP,HCPCS C1729,,G47806  -  SET CATH CRC NPHSTM SPBC,$244.20,$0.00,$244.20,$132.60,$174.29,$0.00,$42.07,$0.00,$0.00,$42.76,$244.20,$0.00,$122.10,$193.41,$195.36,$0.00,$38.22,$0.00,$38.88,$0.00
G47833,SUP,HCPCS C1769,,G47833  -  TRAY CENTRAL LINE INSERTION WITH BIOPATCH,$697.50,$0.00,$697.50,$378.74,$497.81,$0.00,$120.18,$0.00,$0.00,$122.13,$697.50,$0.00,$348.75,$552.42,$558.00,$0.00,$109.16,$0.00,$111.04,$0.00
G47858,SUP,Custom 27203010,,G47858  -  SET CATH CRC NPHSTM SPBC,"$1,034.00",$0.00,"$1,034.00",$0.00,$737.97,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,034.00",$0.00,$517.00,$818.93,$827.20,$0.00,$0.00,$0.00,$0.00,$0.00
G47859,SUP,Custom 27203010,,G47859  -  NEEDLE BX 18GA 20CM PAT HUB ECHGN TIP SMPL NTCH PRCS PSTN,$51.70,$0.00,$51.70,$0.00,$36.90,$0.00,$0.00,$0.00,$0.00,$0.00,$51.70,$0.00,$25.85,$40.95,$41.36,$0.00,$0.00,$0.00,$0.00,$0.00
G47868,SUP,HCPCS C1770,,G47868  -  COIL EMBL MREYE STRT KIT VRSTL MCIOL PLTN STRL DISP,"$8,750.00",$0.00,"$8,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,750.00",$0.00,"$4,375.00","$6,930.00","$7,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
G47942,SUP,HCPCS C1894,,G47942  -  SET INTROD .018IN 4FR 21GA 40CM 10CM SILHOUETTE,$105.00,$0.00,$105.00,$57.02,$74.94,$0.00,$18.09,$0.00,$0.00,$18.38,$105.00,$0.00,$52.50,$83.16,$84.00,$0.00,$16.43,$0.00,$16.72,$0.00
G48003,SUP,HCPCS C1894,,G48003  -  SET INTROD .018IN 4FR 40CM 10CM TRANSITIONLESS STIFFENED,$170.00,$0.00,$170.00,$92.31,$121.33,$0.00,$29.29,$0.00,$0.00,$29.77,$170.00,$0.00,$85.00,$134.64,$136.00,$0.00,$26.61,$0.00,$27.06,$0.00
G48007,SUP,HCPCS C1894,,G48007  -  INTRODUCER SHTH 5FR 10CM 40CM TRNSTLS STF MPNCH NTNL .018IN,$87.50,$0.00,$87.50,$47.51,$62.45,$0.00,$15.08,$0.00,$0.00,$15.32,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$13.69,$0.00,$13.93,$0.00
G48008,SUP,HCPCS C1894,,G48008  -  SET INTROD .018IN 5FR 21GA 40CM 10CM COAXIAL CATHETER GWIRE,$172.50,$0.00,$172.50,$93.67,$123.11,$0.00,$29.72,$0.00,$0.00,$30.20,$172.50,$0.00,$86.25,$136.62,$138.00,$0.00,$27.00,$0.00,$27.46,$0.00
G48031,SUP,HCPCS C1876,,G48031  -  STENT ESOPHAGEAL 20MM 25MM 10CM 8MM PARTIALLY COVERED,"$4,705.00",$0.00,"$4,705.00","$2,117.25","$3,357.96",$0.00,$810.65,$0.00,$0.00,$823.81,"$4,705.00",$0.00,"$2,352.50","$3,726.36","$3,764.00",$0.00,$736.33,$0.00,$749.04,$0.00
G48186,SUP,HCPCS C1894,,G48186  -  SHEATH GUID .018-.035IN ANL0 CURVE 4FR 1.5IN 45CM RADIOPQ,$195.00,$0.00,$195.00,$105.89,$139.17,$0.00,$33.60,$0.00,$0.00,$34.14,$195.00,$0.00,$97.50,$154.44,$156.00,$0.00,$30.52,$0.00,$31.04,$0.00
G48188,SUP,HCPCS C1894,,G48188  -  SHEATH GUID .018/.035IN ANL0 CURVE 4FR .059IN 90CM RADIOPQ,$377.50,$0.00,$377.50,$204.98,$269.42,$0.00,$65.04,$0.00,$0.00,$66.10,$377.50,$0.00,$188.75,$298.98,$302.00,$0.00,$59.08,$0.00,$60.10,$0.00
G48189,SUP,HCPCS C1894,,G48189  -  SHEATH GUID ANL0 CURVE STR 5FR .074IN 90CM CHK-FLO VALVE,$377.50,$0.00,$377.50,$204.98,$269.42,$0.00,$65.04,$0.00,$0.00,$66.10,$377.50,$0.00,$188.75,$298.98,$302.00,$0.00,$59.08,$0.00,$60.10,$0.00
G48240,SUP,Custom 27203010,,G48240  -  FORCEPS BIOP 2.4FR 115CM 1 BITE COLLECT BACKLOAD BIGOPSY,$880.00,$0.00,$880.00,$0.00,$628.06,$0.00,$0.00,$0.00,$0.00,$0.00,$880.00,$0.00,$440.00,$696.96,$704.00,$0.00,$0.00,$0.00,$0.00,$0.00
G48294,SUP,Custom 27203010,,G48294  -  EXTRACTOR STONE 1.7FR 8MM 115CM PATENTED NGAGE NITINOL,$515.33,$0.00,$515.33,$0.00,$367.79,$0.00,$0.00,$0.00,$0.00,$0.00,$515.33,$0.00,$257.66,$408.14,$412.26,$0.00,$0.00,$0.00,$0.00,$0.00
G48295,SUP,Custom 27203010,,G48295  -  NEEDLE BX 20GA 20CM PAT HUB ECHGN TIP SMPL NTCH PRCS PSTN,$25.77,$0.00,$25.77,$0.00,$18.39,$0.00,$0.00,$0.00,$0.00,$0.00,$25.77,$0.00,$12.88,$20.41,$20.61,$0.00,$0.00,$0.00,$0.00,$0.00
G48296,SUP,Custom 27203010,,G48296  -  SET NPHSTM 10MM 30FR 15CM CLR 17CM ULTRX RADOPQ STRP BLN,$515.33,$0.00,$515.33,$0.00,$367.79,$0.00,$0.00,$0.00,$0.00,$0.00,$515.33,$0.00,$257.66,$408.14,$412.26,$0.00,$0.00,$0.00,$0.00,$0.00
G48297,SUP,Custom 27203010,,G48297  -  EXTRACTOR STONE 2.2FR 8MM 115CM NGAGE NITINOL KIDNEY URETER,$515.33,$0.00,$515.33,$0.00,$367.79,$0.00,$0.00,$0.00,$0.00,$0.00,$515.33,$0.00,$257.66,$408.14,$412.26,$0.00,$0.00,$0.00,$0.00,$0.00
G48373,SUP,HCPCS C1880,,G48373  -  FILTER EMBOLIZATION 30MM 8.5FR 48MM 65CM 3 WAY STOPCOCK,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
G48402,SUP,HCPCS C1874,,G48402  -  GRAFT EVAS 2 BRCH 22MM 18FR 82MM STRL Z-TRK ZNTH FLX SLF,"$21,145.00",$0.00,"$21,145.00","$9,515.25","$5,158.80",$0.00,"$3,643.18",$0.00,$0.00,"$3,702.32","$21,145.00",$0.00,"$10,572.50","$16,746.84","$16,916.00",$0.00,"$3,309.19",$0.00,"$3,366.28",$0.00
G48422,SUP,HCPCS C1874,,G48422  -  GRAFT EVAS BFUR 30MM 7.7MM 20FR 82MM ZNTH FLX Z-TRK SLF XPD,"$21,145.00",$0.00,"$21,145.00","$9,515.25","$5,158.80",$0.00,"$3,643.18",$0.00,$0.00,"$3,702.32","$21,145.00",$0.00,"$10,572.50","$16,746.84","$16,916.00",$0.00,"$3,309.19",$0.00,"$3,366.28",$0.00
G48424,SUP,Custom 27803010,,G48424  -  GRAFT EVAS 2 BRCH 30MM 20FR 111MM ZNTH FLX Z-TRK SLF,"$21,145.00",$0.00,"$21,145.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,145.00",$0.00,"$10,572.50","$16,746.84","$16,916.00",$0.00,$0.00,$0.00,$0.00,$0.00
G48429,SUP,HCPCS C1874,,G48429  -  GRAFT EVAS 2 BRCH 32MM 20FR 111MM ZNTH FLX Z-TRK SLF,"$21,145.00",$0.00,"$21,145.00","$9,515.25","$5,158.80",$0.00,"$3,643.18",$0.00,$0.00,"$3,702.32","$21,145.00",$0.00,"$10,572.50","$16,746.84","$16,916.00",$0.00,"$3,309.19",$0.00,"$3,366.28",$0.00
G48431,SUP,HCPCS C1874,,G48431  -  GRAFT EVAS BFUR 32MM 20FR 140MM ZNTH FLX Z-TRK SLF XPD WVN,"$21,145.00",$0.00,"$21,145.00","$9,515.25","$5,158.80",$0.00,"$3,643.18",$0.00,$0.00,"$3,702.32","$21,145.00",$0.00,"$10,572.50","$16,746.84","$16,916.00",$0.00,"$3,309.19",$0.00,"$3,366.28",$0.00
G48522,SUP,Custom 27203010,,G48522  -  EXTRACTOR STON 1.7FR 11MM 115CM NGAGE NTNL KNDY URETER,"$1,615.00",$0.00,"$1,615.00",$0.00,"$1,152.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,615.00",$0.00,$807.50,"$1,279.08","$1,292.00",$0.00,$0.00,$0.00,$0.00,$0.00
G48526,SUP,Custom 27203010,,G48526  -  FIBER LSR 273UM GRN OPTILITE FLT TIP CNCT HO REUSE STD SMA,"$2,329.80",$0.00,"$2,329.80",$0.00,"$1,662.78",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,329.80",$0.00,"$1,164.90","$1,845.20","$1,863.84",$0.00,$0.00,$0.00,$0.00,$0.00
G48611,SUP,Custom 27203010,,G48611  -  FIBER LSR 273UM FLT BLK OPTILITE CNCT HO DISP STD SMA CNCT,$538.33,$0.00,$538.33,$0.00,$384.21,$0.00,$0.00,$0.00,$0.00,$0.00,$538.33,$0.00,$269.17,$426.36,$430.67,$0.00,$0.00,$0.00,$0.00,$0.00
G48612,SUP,Custom 27203010,,G48612  -  FIBER LSR 273UM GRN OPTILITE FLT TIP CNCT HO REUSE CNVGNT,"$4,735.50",$0.00,"$4,735.50",$0.00,"$3,379.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,735.50",$0.00,"$2,367.75","$3,750.52","$3,788.40",$0.00,$0.00,$0.00,$0.00,$0.00
G48613,SUP,Custom 27203010,,G48613  -  FIBER LSR 940UM BLK OPTILITE FLT TIP CNCT HO DISP STD SMA,$336.46,$0.00,$336.46,$0.00,$240.13,$0.00,$0.00,$0.00,$0.00,$0.00,$336.46,$0.00,$168.23,$266.48,$269.17,$0.00,$0.00,$0.00,$0.00,$0.00
G48614,SUP,Custom 27203010,,G48614  -  FIBER LSR 365UM BLU OPTILITE FLT TIP CNCT HO REUSE CNVGNT,"$2,367.30",$0.00,"$2,367.30",$0.00,"$1,689.54",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,367.30",$0.00,"$1,183.65","$1,874.90","$1,893.84",$0.00,$0.00,$0.00,$0.00,$0.00
G48615,SUP,Custom 27203010,,G48615  -  FIBER LSR 273UM RD OPTILITE FLT TIP CNCT HO DISP CNVGNT LSR,$389.58,$0.00,$389.58,$0.00,$278.05,$0.00,$0.00,$0.00,$0.00,$0.00,$389.58,$0.00,$194.79,$308.55,$311.67,$0.00,$0.00,$0.00,$0.00,$0.00
G48616,SUP,Custom 27203010,,G48616  -  FIBER LSR 550UM VIOL OPTILITE FLT TIP CNCT HO REUSE CNVGNT,"$2,152.50",$0.00,"$2,152.50",$0.00,"$1,536.24",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,152.50",$0.00,"$1,076.25","$1,704.78","$1,722.00",$0.00,$0.00,$0.00,$0.00,$0.00
G48617,SUP,Custom 27203010,,G48617  -  FIBER LSR 365UM FLT RD OPTILITE CNCT HO DISP CNVGNT LSR SYS,$743.75,$0.00,$743.75,$0.00,$530.81,$0.00,$0.00,$0.00,$0.00,$0.00,$743.75,$0.00,$371.88,$589.05,$595.00,$0.00,$0.00,$0.00,$0.00,$0.00
G48618,SUP,Custom 27203010,,G48618  -  FIBER LSR 940UM ORNG OPTILITE FLT TIP CNCT HO REUSE CNVGNT,"$1,009.38",$0.00,"$1,009.38",$0.00,$720.39,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,009.38",$0.00,$504.69,$799.43,$807.50,$0.00,$0.00,$0.00,$0.00,$0.00
G48619,SUP,Custom 27203010,,G48619  -  FIBER LSR 365UM FLT BLU OPTILITE FLXB CNCT HO REUSE STD SMA,"$1,168.75",$0.00,"$1,168.75",$0.00,$834.14,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,168.75",$0.00,$584.38,$925.65,$935.00,$0.00,$0.00,$0.00,$0.00,$0.00
G48620,SUP,Custom 27203010,,G48620  -  FIBER LSR 550UM RD OPTILITE FLT TIP CNCT HO REUSE STD SMA,"$2,859.75",$0.00,"$2,859.75",$0.00,"$2,041.00",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,859.75",$0.00,"$1,429.88","$2,264.92","$2,287.80",$0.00,$0.00,$0.00,$0.00,$0.00
G48621,SUP,Custom 27203010,,G48621  -  FIBER LSR 550UM FLT RD OPTILITE CNCT HO DISP CNVGNT LSR SYS,$743.75,$0.00,$743.75,$0.00,$530.81,$0.00,$0.00,$0.00,$0.00,$0.00,$743.75,$0.00,$371.88,$589.05,$595.00,$0.00,$0.00,$0.00,$0.00,$0.00
G48622,SUP,Custom 27203010,,G48622  -  FIBER LSR 940UM ORNG OPTILITE FLT TIP CNCT HO REUSE STD SMA,"$4,735.50",$0.00,"$4,735.50",$0.00,"$3,379.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,735.50",$0.00,"$2,367.75","$3,750.52","$3,788.40",$0.00,$0.00,$0.00,$0.00,$0.00
G48623,SUP,Custom 27203010,,G48623  -  FIBER LSR 940UM FLT 940UM RD OPTILITE RD CNCT HO DISP CNVGNT,$891.75,$0.00,$891.75,$0.00,$636.44,$0.00,$0.00,$0.00,$0.00,$0.00,$891.75,$0.00,$445.88,$706.27,$713.40,$0.00,$0.00,$0.00,$0.00,$0.00
G48624,SUP,Custom 27203010,,G48624  -  FIBER LSR 273UM BLK OPTILITE FLT TIP CNCT HO DISP TRMDN LSR,$973.75,$0.00,$973.75,$0.00,$694.97,$0.00,$0.00,$0.00,$0.00,$0.00,$973.75,$0.00,$486.88,$771.21,$779.00,$0.00,$0.00,$0.00,$0.00,$0.00
G48625,SUP,Custom 27203010,,G48625  -  FIBER LSR 150UM BLK OPTILITE FLT TIP CNCT HO DISP STD SMA,$891.75,$0.00,$891.75,$0.00,$636.44,$0.00,$0.00,$0.00,$0.00,$0.00,$891.75,$0.00,$445.88,$706.27,$713.40,$0.00,$0.00,$0.00,$0.00,$0.00
G48626,SUP,Custom 27203010,,G48626  -  FIBER LSR 200UM BLK OPTILITE FLT TIP CNCT HO DISP STD SMA,$717.50,$0.00,$717.50,$0.00,$512.08,$0.00,$0.00,$0.00,$0.00,$0.00,$717.50,$0.00,$358.75,$568.26,$574.00,$0.00,$0.00,$0.00,$0.00,$0.00
G48627,SUP,Custom 27203010,,G48627  -  FIBER LSR FLT 365UM BLK OPTILITE CNCT EXTREMELY FLXB HO DISP,$953.25,$0.00,$953.25,$0.00,$680.33,$0.00,$0.00,$0.00,$0.00,$0.00,$953.25,$0.00,$476.63,$754.97,$762.60,$0.00,$0.00,$0.00,$0.00,$0.00
G49044,SUP,HCPCS C1894,,G49044  -  INTRODUCER SHEATH .035IN ANL1 CURVE 8.8FR 7FR 110CM GUIDE,$502.50,$0.00,$502.50,$272.86,$358.63,$0.00,$86.58,$0.00,$0.00,$87.98,$502.50,$0.00,$251.25,$397.98,$402.00,$0.00,$78.64,$0.00,$80.00,$0.00
G49099,SUP,HCPCS C1894,,G49099  -  SHEATH GUID .018/.038IN ANL0 CURVE 8FR .113IN 45CM RADIOPQ,$187.50,$0.00,$187.50,$101.81,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G49100,SUP,HCPCS C1894,,G49100  -  INTRODUCER CATHETER .018/.038IN ANL1 CURVE 8FR .113IN 45CM,$187.50,$0.00,$187.50,$101.81,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G49257,SUP,Custom 27203010,,G49257  -  NEEDLE ESCP 20GA 6FR 8- CM STRL ECHTP ULT US CONE TIP SH CLC,$697.50,$0.00,$697.50,$0.00,$497.81,$0.00,$0.00,$0.00,$0.00,$0.00,$697.50,$0.00,$348.75,$552.42,$558.00,$0.00,$0.00,$0.00,$0.00,$0.00
G49333,SUP,HCPCS C1877,,G49333  -  STENT VASC 10MM 5FR 80MM 125CM .018IN SLF XPD FLXB FLXR,"$3,062.50",$0.00,"$3,062.50","$1,378.13","$2,185.71",$0.00,$527.65,$0.00,$0.00,$536.22,"$3,062.50",$0.00,"$1,531.25","$2,425.50","$2,450.00",$0.00,$479.28,$0.00,$487.55,$0.00
G49472,SUP,HCPCS C1892,,G49472  -  SET INTROD .018IN LONG 5FR 70CM 30CM COAXIAL CATHETER PEEL,$147.50,$0.00,$147.50,$80.09,$105.27,$0.00,$25.41,$0.00,$0.00,$25.83,$147.50,$0.00,$73.75,$116.82,$118.00,$0.00,$23.08,$0.00,$23.48,$0.00
G49473,SUP,HCPCS C1894,,G49473  -  SET INTROD .018IN LONG 5FR 21GA 100CM 45CM NEEDLE WIRE GUIDE,$147.50,$0.00,$147.50,$80.09,$105.27,$0.00,$25.41,$0.00,$0.00,$25.83,$147.50,$0.00,$73.75,$116.82,$118.00,$0.00,$23.08,$0.00,$23.48,$0.00
G49620,SUP,Custom 27203010,,G49620  -  FIBER LSR 550UM FLT BLK OPTILITE CNCT HO DISP STD SMA CNCT,$154.07,$0.00,$154.07,$0.00,$109.96,$0.00,$0.00,$0.00,$0.00,$0.00,$154.07,$0.00,$77.03,$122.02,$123.25,$0.00,$0.00,$0.00,$0.00,$0.00
G49762,SUP,HCPCS C2617,,G49762  -  MICROSCOPE SRG NS INSP FO SAFE EFCT CMPLT,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G49862,SUP,HCPCS C2617,,G49862  -  SET STNT .038IN 2 PGTL CRV 5FR 18CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G49863,SUP,HCPCS C2617,,G49863  -  SET STNT .038IN 2 PGTL CRV 5FR 18CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G49864,SUP,HCPCS C2617,,G49864  -  SET STNT .038IN 2 PGTL CRV 5FR 20CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G49865,SUP,HCPCS C2617,,G49865  -  SET STNT .038IN 2 PGTL CRV 5FR 22CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G49866,SUP,HCPCS C2617,,G49866  -  SET STNT .038IN 2 PGTL CRV 5FR 24CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G49867,SUP,HCPCS C2617,,G49867  -  SET STNT .038IN 2 PGTL CRV 5FR 26CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G49868,SUP,HCPCS C2617,,G49868  -  SET STNT .038IN 2 PGTL CRV 5FR 28CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G49869,SUP,HCPCS C2617,,G49869  -  SET STNT .038IN 2 PGTL CRV 5FR 30CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G49870,SUP,HCPCS C2617,,G49870  -  SET STNT .038IN 2 PGTL CRV 5FR 22-32CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G49871,SUP,HCPCS C2617,,G49871  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 18CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G49872,SUP,HCPCS C2617,,G49872  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 20CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G49873,SUP,HCPCS C2617,,G49873  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 22CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G49874,SUP,HCPCS C2617,,G49874  -  SET STENT .038IN 3CM 2 PIGTAIL CURVE 6FR 26CM 145CM,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G49875,SUP,HCPCS C2617,,G49875  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 24CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G49876,SUP,HCPCS C2617,,G49876  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 28CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G49877,SUP,HCPCS C2617,,G49877  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 30CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G49878,SUP,HCPCS C2617,,G49878  -  SET STNT 3CM 2 PGTL CRV 6FR 22-32CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G49879,SUP,HCPCS C2617,,G49879  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 18CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G49880,SUP,HCPCS C2617,,G49880  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 20CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G49881,SUP,HCPCS C2617,,G49881  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 22CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G49882,SUP,HCPCS C2617,,G49882  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 24CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G49883,SUP,HCPCS C2617,,G49883  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 26CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G49884,SUP,HCPCS C2617,,G49884  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 28CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G49885,SUP,HCPCS C2617,,G49885  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 30CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G49886,SUP,HCPCS C2617,,G49886  -  SET STNT 3CM 2 PGTL CRV 7FR 22-32CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G49887,SUP,HCPCS C2617,,G49887  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 18CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G49888,SUP,HCPCS C2617,,G49888  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 20CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G49889,SUP,HCPCS C2617,,G49889  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 22CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G49890,SUP,HCPCS C2617,,G49890  -  SET STNT 3CM 2 PGTL CRV 8FR 24CM STRL 145CM UNIVERSA FIRM,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G49891,SUP,HCPCS C2617,,G49891  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 26CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G49892,SUP,HCPCS C2617,,G49892  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 28CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G49893,SUP,HCPCS C2617,,G49893  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 30CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G49894,SUP,HCPCS C2617,,G49894  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 22-32CM STRL 145CM,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G49895,SUP,HCPCS C2625,,G49895  -  SET STENT 2 PIGTAIL CURVE 5FR 20CM RADIOPQ GRADUATE MARK,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G49896,SUP,HCPCS C2625,,G49896  -  SET STENT 2 PIGTAIL CURVE 5FR 22CM RADIOPQ GRADUATE MARK,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G49897,SUP,HCPCS C2625,,G49897  -  SET STENT 2 PIGTAIL CURVE 5FR 24CM RADIOPQ GRADUATE MARK,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G49898,SUP,HCPCS C2625,,G49898  -  SET STENT 2 PIGTAIL CURVE 5FR 26CM RADIOPQ GRADUATE MARK,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G49899,SUP,HCPCS C2625,,G49899  -  SET STENT 2 PIGTAIL CURVE 5FR 28CM RADIOPQ GRADUATE MARK,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G49900,SUP,HCPCS C2617,,G49900  -  SET STNT 2 PGTL CRV 5FR 18CM STRL UNIVERSA RADOPQ GRAD MRK,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G49901,SUP,HCPCS C2617,,G49901  -  SET STNT 2 PGTL CRV 5FR 30CM STRL UNIVERSA RADOPQ GRAD MRK,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G49902,SUP,HCPCS C2617,,G49902  -  SET STNT 2 PGTL CRV 5FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G49903,SUP,HCPCS C2625,,G49903  -  SET STENT 2 PIGTAIL CURVE 6FR 20CM RADIOPQ GRADUATE MARK,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G49904,SUP,HCPCS C2625,,G49904  -  SET STENT 2 PIGTAIL CURVE 6FR 22CM RADIOPQ GRADUATE MARK,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G49906,SUP,HCPCS C2625,,G49906  -  STENT URETERAL 6FR 26CM POSITIONER BRAID TETHER STRAIGHTENER,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G49907,SUP,HCPCS C2625,,G49907  -  STENT URETERAL 6FR 28CM POSITIONER SET BRAID TETHER RADIOPQ,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G49908,SUP,HCPCS C2617,,G49908  -  SET STNT 2 PGTL CRV 6FR 18CM STRL UNIVERSA RADOPQ GRAD MRK,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G49909,SUP,HCPCS C2617,,G49909  -  SET STNT 2 PGTL CRV 6FR 30CM STRL UNIVERSA RADOPQ GRAD MRK,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G49910,SUP,HCPCS C2617,,G49910  -  STENT URET 6FR 22-32CM UNIVERSA PSTNR SET BRD TETH RADOPQ,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G49911,SUP,HCPCS C2617,,G49911  -  SET STNT 2 PGTL CRV 7FR 18CM STRL UNIVERSA RADOPQ GRAD MRK,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G49912,SUP,HCPCS C2625,,G49912  -  SET STENT 2 PIGTAIL CURVE 7FR 22CM RADIOPQ GRADUATE MARK,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G49913,SUP,HCPCS C2625,,G49913  -  SET STENT PIGTAIL 7FR 24CM RADIOPQ TIP STRAIGHTENER,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G49914,SUP,HCPCS C2625,,G49914  -  SET STENT PIGTAIL 7FR 26CM RADIOPQ TIP STRAIGHTENER,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G49915,SUP,HCPCS C2625,,G49915  -  SET STENT 2 PIGTAIL CURVE 7FR 28CM RADIOPQ GRADUATE MARK,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G49916,SUP,HCPCS C2617,,G49916  -  SET STNT 2 PGTL CRV 7FR 20CM STRL UNIVERSA RADOPQ GRAD MRK,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G49917,SUP,HCPCS C2617,,G49917  -  STENT URET 2 PGTL CRV 7FR 30CM UNIVERSA FIRM GRAD MRK RADOPQ,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G49918,SUP,HCPCS C2617,,G49918  -  SET STNT PGTL 7FR 22-32CM STRL UNIVERSA RADOPQ TIP,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G49919,SUP,HCPCS C2617,,G49919  -  SET STNT 2 PGTL CRV 8FR 18CM STRL UNIVERSA RADOPQ GRAD MRK,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G49920,SUP,HCPCS C2625,,G49920  -  SET STENT 2 PIGTAIL CURVE 8FR 22CM RADIOPQ GRADUATE MARK,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G49921,SUP,HCPCS C2625,,G49921  -  SET STENT 2 PIGTAIL CURVE 8FR 24CM RADIOPQ GRADUATE MARK,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G49922,SUP,HCPCS C2625,,G49922  -  SET STENT 2 PIGTAIL CURVE 8FR 26CM RADIOPQ GRADUATE MARK,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G49923,SUP,HCPCS C2625,,G49923  -  SET STENT 2 PIGTAIL CURVE 8FR 28CM RADIOPQ GRADUATE MARK,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G49924,SUP,HCPCS C2617,,G49924  -  SET STNT 2 PGTL CRV 8FR 20CM STRL UNIVERSA RADOPQ GRAD MRK,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G49925,SUP,HCPCS C2617,,G49925  -  SET STNT 2 PGTL CRV 8FR 30CM STRL UNIVERSA RADOPQ GRAD MRK,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G49931,SUP,HCPCS C2617,,G49931  -  SET STNT 2 PGTL CRV 8FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G49932,SUP,HCPCS C2617,,G49932  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 20CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G49933,SUP,HCPCS C2617,,G49933  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 22CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G49934,SUP,HCPCS C2617,,G49934  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 24CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G49935,SUP,HCPCS C2617,,G49935  -  SET STNT .038IN 2 PGTL CRV 3CM 5FR 28CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G49936,SUP,HCPCS C2617,,G49936  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 26CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G49937,SUP,HCPCS C2617,,G49937  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 30CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G49938,SUP,HCPCS C2617,,G49938  -  SET STNT .038IN 3CM 2 PGTL CRV 5FR 22-32CM STRL 145CM,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G49939,SUP,HCPCS C2617,,G49939  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 18CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G49940,SUP,HCPCS C2617,,G49940  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 20CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G49941,SUP,HCPCS C2617,,G49941  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 22CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G49942,SUP,HCPCS C2617,,G49942  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 24CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G49943,SUP,HCPCS C2617,,G49943  -  SET STNT .038IN 3CM PGTL CRV 5FR 22-32CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G49944,SUP,HCPCS C2617,,G49944  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 28CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G49945,SUP,HCPCS C2617,,G49945  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 30CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G49946,SUP,HCPCS C2617,,G49946  -  SET STNT .038IN 3CM 2 PGTL CRV 6FR 22-32CM STRL 145CM,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G49947,SUP,HCPCS C2617,,G49947  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 18CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G49948,SUP,HCPCS C2617,,G49948  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 20CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G49949,SUP,HCPCS C2617,,G49949  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 22CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G49950,SUP,HCPCS C2617,,G49950  -  SET STNT 3CM 2 PGTL CRV 7FR 24CM STRL 145CM UNIVERSA SFT,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G49951,SUP,HCPCS C2617,,G49951  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 26CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G49952,SUP,HCPCS C2617,,G49952  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 28CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G49953,SUP,HCPCS C2617,,G49953  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 30CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G49954,SUP,HCPCS C2617,,G49954  -  SET STNT .038IN 3CM 2 PGTL CRV 7FR 22-32CM STRL 145CM,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G49955,SUP,HCPCS C2617,,G49955  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 18CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G49956,SUP,HCPCS C2617,,G49956  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 20CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G49957,SUP,HCPCS C2617,,G49957  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 22CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G49958,SUP,HCPCS C2617,,G49958  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 24CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G49959,SUP,HCPCS C2617,,G49959  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 26CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G49960,SUP,HCPCS C2617,,G49960  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 28CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G49961,SUP,HCPCS C2617,,G49961  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 30CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G49962,SUP,HCPCS C2617,,G49962  -  SET STNT .038IN 3CM 2 PGTL CRV 8FR 22-32CM STRL 145CM,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G49963,SUP,HCPCS C2617,,G49963  -  SET STNT 2 PGTL CRV 5FR 18CM STRL UNIVERSA RADOPQ GRAD MRK,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G49964,SUP,HCPCS C2617,,G49964  -  SET STNT 2 PGTL CRV 5FR 20CM STRL UNIVERSA RADOPQ GRAD MRK,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G49965,SUP,HCPCS C2617,,G49965  -  SET STNT 2 PGTL CRV 5FR 22CM STRL UNIVERSA RADOPQ GRAD MRK,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G49966,SUP,HCPCS C2617,,G49966  -  SET STNT 2 PGTL CRV 5FR 24CM STRL UNIVERSA RADOPQ GRAD MRK,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G49967,SUP,HCPCS C2617,,G49967  -  SET STNT 2 PGTL CRV 5FR 26CM UNIVERSA SFT GRAD MRK RADOPQ,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G49968,SUP,HCPCS C2617,,G49968  -  SET STNT 2 PGTL CRV 5FR 28CM STRL UNIVERSA RADOPQ SFT PSTNR,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G49969,SUP,HCPCS C2617,,G49969  -  SET STNT 2 PGTL CRV 5FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G49970,SUP,HCPCS C2617,,G49970  -  STENT URET 2 PGTL CRV 5FR 30CM UNIVERSA SFT GRAD MRK RADOPQ,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G49971,SUP,HCPCS C2617,,G49971  -  SET STNT 2 PGTL CRV 6FR 18CM STRL UNIVERSA RADOPQ GRAD MRK,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G49972,SUP,HCPCS C2617,,G49972  -  SET STNT PGTL 6FR 20CM STRL UNIVERSA RADOPQ TIP PSTNR,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G49973,SUP,HCPCS C2617,,G49973  -  SET STNT PGTL 6FR 22CM STRL UNIVERSA RADOPQ TIP PSTNR,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G49974,SUP,HCPCS C2617,,G49974  -  SET STNT 2 PGTL CRV 6FR 24CM STRL UNIVERSA RADOPQ PSTNR,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G49975,SUP,HCPCS C2617,,G49975  -  SET STNT 2 PGTL CRV 6FR 26CM STRL UNIVERSA RADOPQ PSTNR BRD,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G49976,SUP,HCPCS C2617,,G49976  -  SET STNT 2 PGTL CRV 6FR 28CM STRL UNIVERSA RADOPQ SFT PSTNR,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G49977,SUP,HCPCS C2617,,G49977  -  STENT URET 2 PGTL CRV 6FR 30CM UNIVERSA SFT GRAD MRK RADOPQ,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G49978,SUP,HCPCS C2617,,G49978  -  SET STNT 2 PGTL CRV 6FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G49979,SUP,HCPCS C2617,,G49979  -  SET STNT 2 PGTL CRV 7FR 18CM STRL UNIVERSA RADOPQ SFT PSTNR,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G49980,SUP,HCPCS C2617,,G49980  -  SET STNT 2 PGTL CRV 7FR 20CM STRL UNIVERSA RADOPQ SFT PSTNR,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G49981,SUP,HCPCS C2617,,G49981  -  SET STNT 2 PGTL CRV 7FR 22CM STRL UNIVERSA RADOPQ SFT PSTNR,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G49982,SUP,HCPCS C2617,,G49982  -  SET STNT 2 PGTL CRV 7FR 24CM STRL UNIVERSA RADOPQ SFT PSTNR,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G49983,SUP,HCPCS C2617,,G49983  -  SET STNT 2 PGTL CRV 7FR 26CM STRL UNIVERSA RADOPQ SFT PSTNR,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G49984,SUP,HCPCS C2617,,G49984  -  SET STNT 2 PGTL CRV 7FR 28CM STRL UNIVERSA RADOPQ SFT PSTNR,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G49985,SUP,HCPCS C2617,,G49985  -  SET STNT 2 PGTL CRV 7FR 30CM STRL UNIVERSA RADOPQ SFT PSTNR,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G49986,SUP,HCPCS C2617,,G49986  -  SET STNT 2 PGTL CRV 7FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G49987,SUP,HCPCS C2617,,G49987  -  SET STNT 2 PGTL CRV 8FR 18CM STRL UNIVERSA RADOPQ SFT PSTNR,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G49988,SUP,HCPCS C2617,,G49988  -  SET STNT 2 PGTL CRV 8FR 20CM STRL UNIVERSA RADOPQ SFT PSTNR,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G49989,SUP,HCPCS C2617,,G49989  -  SET STNT 2 PGTL CRV 8FR 22CM STRL UNIVERSA RADOPQ SFT PSTNR,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G49990,SUP,HCPCS C2617,,G49990  -  SET STNT 2 PGTL CRV 8FR 24CM STRL UNIVERSA RADOPQ SFT PSTNR,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G49991,SUP,HCPCS C2617,,G49991  -  SET STNT 2 PGTL CRV 8FR 26CM STRL UNIVERSA RADOPQ SFT PSTNR,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G49992,SUP,HCPCS C2617,,G49992  -  SET STNT 2 PGTL CRV 8FR 28CM STRL UNIVERSA RADOPQ SFT PSTNR,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G49993,SUP,HCPCS C2617,,G49993  -  SET STNT 2 PGTL CRV 8FR 30CM STRL UNIVERSA RADOPQ SFT PSTNR,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G50001,SUP,HCPCS C1887,,G50001  -  CATHETER GUID .018IN 2.6FR 150CM DEPTH MARKER RADIOPQ,$487.50,$0.00,$487.50,$264.71,$347.93,$0.00,$83.99,$0.00,$0.00,$85.36,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$76.29,$0.00,$77.61,$0.00
G50003,SUP,HCPCS C1887,,G50003  -  CATHETER GUID 2.6FR 150CM BRAID KINK RESISTANT RADIOPQ,$487.50,$0.00,$487.50,$264.71,$347.93,$0.00,$83.99,$0.00,$0.00,$85.36,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$76.29,$0.00,$77.61,$0.00
G50010,SUP,Custom 27203010,,G50010  -  FIBER LSR 550UM NS STRP TL,$275.00,$0.00,$275.00,$0.00,$196.27,$0.00,$0.00,$0.00,$0.00,$0.00,$275.00,$0.00,$137.50,$217.80,$220.00,$0.00,$0.00,$0.00,$0.00,$0.00
G50122,SUP,HCPCS C1876,,G50122  -  STENT BIL 6MM 6FR 140MM 80CM .035IN SLF EXPANDABLE DLV SYS,"$3,237.50",$0.00,"$3,237.50","$1,456.88","$2,310.60",$0.00,$557.81,$0.00,$0.00,$566.86,"$3,237.50",$0.00,"$1,618.75","$2,564.10","$2,590.00",$0.00,$506.67,$0.00,$515.41,$0.00
G50131,SUP,HCPCS C1876,,G50131  -  STENT BIL 7MM 6FR 140MM 80CM .035IN SLF EXPANDABLE DLV SYS,"$3,237.50",$0.00,"$3,237.50","$1,456.88","$2,310.60",$0.00,$557.81,$0.00,$0.00,$566.86,"$3,237.50",$0.00,"$1,618.75","$2,564.10","$2,590.00",$0.00,$506.67,$0.00,$515.41,$0.00
G50168,SUP,HCPCS C1876,,G50168  -  STENT BIL 7MM 6FR 100MM 125CM .035IN SLF EXPANDABLE DLV SYS,"$3,237.50",$0.00,"$3,237.50","$1,456.88","$2,310.60",$0.00,$557.81,$0.00,$0.00,$566.86,"$3,237.50",$0.00,"$1,618.75","$2,564.10","$2,590.00",$0.00,$506.67,$0.00,$515.41,$0.00
G50171,SUP,HCPCS C1876,,G50171  -  STENT BIL 8MM 6FR 100MM 125CM .035IN SLF EXPANDABLE DLV SYS,"$3,237.50",$0.00,"$3,237.50","$1,456.88","$2,310.60",$0.00,$557.81,$0.00,$0.00,$566.86,"$3,237.50",$0.00,"$1,618.75","$2,564.10","$2,590.00",$0.00,$506.67,$0.00,$515.41,$0.00
G50214,SUP,Custom 27203010,,G50214  -  GLASSES SF NS HO LSR,$95.70,$0.00,$95.70,$0.00,$68.30,$0.00,$0.00,$0.00,$0.00,$0.00,$95.70,$0.00,$47.85,$75.79,$76.56,$0.00,$0.00,$0.00,$0.00,$0.00
G50319,SUP,HCPCS C1725,,G50319  -  CATHETER BLNDIL 2MM 170CM STRL LF 20CM ADV LOPRFL KINK RST,"$1,351.50",$0.00,"$1,351.50",$733.86,$964.57,$0.00,$232.86,$0.00,$0.00,$236.64,"$1,351.50",$0.00,$675.75,"$1,070.39","$1,081.20",$0.00,$211.51,$0.00,$215.16,$0.00
G50333,SUP,HCPCS C1725,,G50333  -  CATHETER BLNDIL 3MM 170CM STRL LF 20CM ADV LOPRFL KINK RST,"$1,351.50",$0.00,"$1,351.50",$733.86,$964.57,$0.00,$232.86,$0.00,$0.00,$236.64,"$1,351.50",$0.00,$675.75,"$1,070.39","$1,081.20",$0.00,$211.51,$0.00,$215.16,$0.00
G50337,SUP,HCPCS C1725,,G50337  -  CATHETER BLNDIL 4MM 170CM STRL LF 8CM ADV LOPRFL KINK RST,"$1,351.50",$0.00,"$1,351.50",$733.86,$964.57,$0.00,$232.86,$0.00,$0.00,$236.64,"$1,351.50",$0.00,$675.75,"$1,070.39","$1,081.20",$0.00,$211.51,$0.00,$215.16,$0.00
G50686,SUP,HCPCS C1880,,G50686  -  SYSTEM EMBOLIC PROTECTION .038IN 12FR 40MM 11FR 75CM GWIRE,"$3,437.50",$0.00,"$3,437.50","$1,546.88","$2,453.34",$0.00,$592.26,$0.00,$0.00,$601.88,"$3,437.50",$0.00,"$1,718.75","$2,722.50","$2,750.00",$0.00,$537.97,$0.00,$547.25,$0.00
G50687,SUP,HCPCS C1880,,G50687  -  SYSTEM EMBOLIC PROTECTION .038IN 12FR 40MM 11FR 45CM GWIRE,"$3,437.50",$0.00,"$3,437.50","$1,546.88","$2,453.34",$0.00,$592.26,$0.00,$0.00,$601.88,"$3,437.50",$0.00,"$1,718.75","$2,722.50","$2,750.00",$0.00,$537.97,$0.00,$547.25,$0.00
G50784,SUP,HCPCS C1769,,G50784  -  GUIDEWIRE VASCULAR TAPER .014IN 135CM APPROACH STAINLESS,$416.88,$0.00,$416.88,$226.36,$297.52,$0.00,$71.83,$0.00,$0.00,$72.99,$416.88,$0.00,$208.44,$330.17,$333.50,$0.00,$65.24,$0.00,$66.37,$0.00
G50785,SUP,HCPCS C1769,,G50785  -  GUIDEWIRE VASCULAR TAPER .014IN 135CM APPROACH STAINLESS,$416.88,$0.00,$416.88,$226.36,$297.52,$0.00,$71.83,$0.00,$0.00,$72.99,$416.88,$0.00,$208.44,$330.17,$333.50,$0.00,$65.24,$0.00,$66.37,$0.00
G50788,SUP,HCPCS C1769,,G50788  -  GUIDEWIRE VASCULAR TAPER .014IN 190CM APPROACH STAINLESS,$416.88,$0.00,$416.88,$226.36,$297.52,$0.00,$71.83,$0.00,$0.00,$72.99,$416.88,$0.00,$208.44,$330.17,$333.50,$0.00,$65.24,$0.00,$66.37,$0.00
G50789,SUP,HCPCS C1769,,G50789  -  GUIDEWIRE VASCULAR TAPER .014IN 190CM APPROACH STAINLESS,$416.88,$0.00,$416.88,$226.36,$297.52,$0.00,$71.83,$0.00,$0.00,$72.99,$416.88,$0.00,$208.44,$330.17,$333.50,$0.00,$65.24,$0.00,$66.37,$0.00
G50791,SUP,HCPCS C1769,,G50791  -  GUIDEWIRE VASCULAR TAPER .014IN 300CM 12GM TIP LOAD APPROACH,$416.88,$0.00,$416.88,$226.36,$297.52,$0.00,$71.83,$0.00,$0.00,$72.99,$416.88,$0.00,$208.44,$330.17,$333.50,$0.00,$65.24,$0.00,$66.37,$0.00
G50792,SUP,HCPCS C1769,,G50792  -  GUIDEWIRE VASCULAR TAPER .014IN 300CM 18GM TIP LOAD APPROACH,$416.88,$0.00,$416.88,$226.36,$297.52,$0.00,$71.83,$0.00,$0.00,$72.99,$416.88,$0.00,$208.44,$330.17,$333.50,$0.00,$65.24,$0.00,$66.37,$0.00
G50793,SUP,HCPCS C1769,,G50793  -  GUIDEWIRE VASCULAR TAPER .014IN 300CM 25GM TIP LOAD APPROACH,$416.88,$0.00,$416.88,$226.36,$297.52,$0.00,$71.83,$0.00,$0.00,$72.99,$416.88,$0.00,$208.44,$330.17,$333.50,$0.00,$65.24,$0.00,$66.37,$0.00
G50972,SUP,HCPCS C1894,,G50972  -  NEEDLE PRC SHTH TFE,"$5,118.75",$0.00,"$5,118.75","$2,779.48","$3,653.25",$0.00,$881.94,$0.00,$0.00,$896.25,"$5,118.75",$0.00,"$2,559.38","$4,054.05","$4,095.00",$0.00,$801.08,$0.00,$814.91,$0.00
G50973,SUP,HCPCS C1894,,G50973  -  SHEATH ACC FLXR DFLC VSN URETER,"$1,023.75",$0.00,"$1,023.75",$555.90,$730.65,$0.00,$176.39,$0.00,$0.00,$179.25,"$1,023.75",$0.00,$511.88,$810.81,$819.00,$0.00,$160.22,$0.00,$162.98,$0.00
G50974,SUP,HCPCS C1894,,G50974  -  SHEATH ACC 180D FLXR DFLC VSN URETER,"$1,023.75",$0.00,"$1,023.75",$555.90,$730.65,$0.00,$176.39,$0.00,$0.00,$179.25,"$1,023.75",$0.00,$511.88,$810.81,$819.00,$0.00,$160.22,$0.00,$162.98,$0.00
G51183,SUP,HCPCS C1874,,G51183  -  STENT ESOPHAGEAL 23MM 18MM 12CM 2 LASSO LOOP CONTROL RELEASE,"$4,705.00",$0.00,"$4,705.00","$2,117.25","$3,357.96",$0.00,$810.65,$0.00,$0.00,$823.81,"$4,705.00",$0.00,"$2,352.50","$3,726.36","$3,764.00",$0.00,$736.33,$0.00,$749.04,$0.00
G51574,SUP,HCPCS C1887,,G51574  -  CATHETER GUID .014IN 3-1.9FR 150CM SUPPORT CORSSCATH,$362.50,$0.00,$362.50,$196.84,$258.72,$0.00,$62.46,$0.00,$0.00,$63.47,$362.50,$0.00,$181.25,$287.10,$290.00,$0.00,$56.73,$0.00,$57.71,$0.00
G51954,SUP,HCPCS C1769,,G51954  -  GUIDEWIRE VASCULAR MICRO .018IN 190CM SHAPEABLE TIP APPROACH,$167.03,$0.00,$167.03,$90.69,$119.21,$0.00,$28.78,$0.00,$0.00,$29.24,$167.03,$0.00,$83.51,$132.29,$133.62,$0.00,$26.14,$0.00,$26.59,$0.00
G51956,SUP,HCPCS C1769,,G51956  -  GUIDEWIRE VASCULAR MICRO .018IN 300CM SHAPEABLE TIP APPROACH,$218.68,$0.00,$218.68,$118.74,$156.07,$0.00,$37.68,$0.00,$0.00,$38.29,$218.68,$0.00,$109.34,$173.19,$174.94,$0.00,$34.22,$0.00,$34.81,$0.00
G52226,SUP,HCPCS C1874,,G52226  -  STENT ESOPHAGEAL 25MM 20MM 12CM CONTROLLED RELEASE FULLY,"$4,705.00",$0.00,"$4,705.00","$2,117.25","$3,357.96",$0.00,$810.65,$0.00,$0.00,$823.81,"$4,705.00",$0.00,"$2,352.50","$3,726.36","$3,764.00",$0.00,$736.33,$0.00,$749.04,$0.00
G52247,SUP,HCPCS C1725,,G52247  -  CATHETER BLNDIL 3MM 135CM STRL LF 8CM ADV 2 LUM LOPRFL,$612.00,$0.00,$612.00,$332.32,$436.78,$0.00,$105.44,$0.00,$0.00,$107.16,$612.00,$0.00,$306.00,$484.70,$489.60,$0.00,$95.78,$0.00,$97.43,$0.00
G52249,SUP,HCPCS C1725,,G52249  -  CATHETER BLNDIL 3MM 135CM STRL LF 12CM ADV 2 LUM LOPRFL,$612.00,$0.00,$612.00,$332.32,$436.78,$0.00,$105.44,$0.00,$0.00,$107.16,$612.00,$0.00,$306.00,$484.70,$489.60,$0.00,$95.78,$0.00,$97.43,$0.00
G52253,SUP,HCPCS C1725,,G52253  -  CATHETER BLNDIL 4MM 135CM STRL LF 8CM ADV 2 LUM LOPRFL,$612.00,$0.00,$612.00,$332.32,$436.78,$0.00,$105.44,$0.00,$0.00,$107.16,$612.00,$0.00,$306.00,$484.70,$489.60,$0.00,$95.78,$0.00,$97.43,$0.00
G52260,SUP,HCPCS C1725,,G52260  -  CATHETER BLNDIL 5MM 135CM STRL LF 8CM ADV 2 LUM LOPRFL,$612.00,$0.00,$612.00,$332.32,$436.78,$0.00,$105.44,$0.00,$0.00,$107.16,$612.00,$0.00,$306.00,$484.70,$489.60,$0.00,$95.78,$0.00,$97.43,$0.00
G52263,SUP,HCPCS C1725,,G52263  -  CATHETER BLNDIL 5MM 135CM STRL LF 14CM ADV 2 LUM LOPRFL,$612.00,$0.00,$612.00,$332.32,$436.78,$0.00,$105.44,$0.00,$0.00,$107.16,$612.00,$0.00,$306.00,$484.70,$489.60,$0.00,$95.78,$0.00,$97.43,$0.00
G52267,SUP,HCPCS C1725,,G52267  -  CATHETER BLNDIL 6MM 135CM STRL LF 8CM ADV 2 LUM LOPRFL,$612.00,$0.00,$612.00,$332.32,$436.78,$0.00,$105.44,$0.00,$0.00,$107.16,$612.00,$0.00,$306.00,$484.70,$489.60,$0.00,$95.78,$0.00,$97.43,$0.00
G52270,SUP,HCPCS C1725,,G52270  -  CATHETER BLNDIL 6MM 135CM STRL LF 14CM ADV 2 LUM LOPRFL,$612.00,$0.00,$612.00,$332.32,$436.78,$0.00,$105.44,$0.00,$0.00,$107.16,$612.00,$0.00,$306.00,$484.70,$489.60,$0.00,$95.78,$0.00,$97.43,$0.00
G52274,SUP,HCPCS C1725,,G52274  -  CATHETER BLNDIL 7MM 135CM STRL LF 8CM ADV 2 LUM LOPRFL,$612.00,$0.00,$612.00,$332.32,$436.78,$0.00,$105.44,$0.00,$0.00,$107.16,$612.00,$0.00,$306.00,$484.70,$489.60,$0.00,$95.78,$0.00,$97.43,$0.00
G52277,SUP,HCPCS C1725,,G52277  -  CATHETER BLNDIL 7MM 135CM STRL LF 14CM ADV 2 LUM LOPRFL,$600.00,$0.00,$600.00,$325.80,$428.22,$0.00,$103.38,$0.00,$0.00,$105.06,$600.00,$0.00,$300.00,$475.20,$480.00,$0.00,$93.90,$0.00,$95.52,$0.00
G52349,SUP,HCPCS C1725,,G52349  -  CATHETER BLNDIL 6MM 80CM STRL LF 12CM ADV 2 LUM LOPRFL,$612.00,$0.00,$612.00,$332.32,$436.78,$0.00,$105.44,$0.00,$0.00,$107.16,$612.00,$0.00,$306.00,$484.70,$489.60,$0.00,$95.78,$0.00,$97.43,$0.00
G52542,SUP,HCPCS C1887,,G52542  -  CATHETER GUID .035IN 4FR 135CM SUPPORT STR TIP LP RADIOPQ,$487.50,$0.00,$487.50,$264.71,$347.93,$0.00,$83.99,$0.00,$0.00,$85.36,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$76.29,$0.00,$77.61,$0.00
G52543,SUP,HCPCS C1887,,G52543  -  CATHETER SPRT DAV CRV 4FR 135CM STRL CXI RADOPQ BRD LOPRFL,$487.50,$0.00,$487.50,$264.71,$347.93,$0.00,$83.99,$0.00,$0.00,$85.36,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$76.29,$0.00,$77.61,$0.00
G52545,SUP,HCPCS C1887,,G52545  -  CATHETER GUID .035IN 4FR 150CM SUPPORT ANGLED TIP LP RADIOPQ,$487.50,$0.00,$487.50,$264.71,$347.93,$0.00,$83.99,$0.00,$0.00,$85.36,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$76.29,$0.00,$77.61,$0.00
G52599,SUP,Custom 27203010,,G52599  -  SHEATH ACC VUE FLXR DFLC UT ESCP SYS,$64.13,$0.00,$64.13,$0.00,$45.77,$0.00,$0.00,$0.00,$0.00,$0.00,$64.13,$0.00,$32.06,$50.79,$51.30,$0.00,$0.00,$0.00,$0.00,$0.00
G52603,SUP,Custom 27203010,,G52603  -  CARTRIDGE CO2 LITHOTRIPTER PNEUMATIC KIT LMA STONEBREAKER,$35.63,$0.00,$35.63,$0.00,$25.43,$0.00,$0.00,$0.00,$0.00,$0.00,$35.63,$0.00,$17.81,$28.22,$28.50,$0.00,$0.00,$0.00,$0.00,$0.00
G52605,SUP,Custom 27203010,,G52605  -  CATHETER URTH 10FR 25CM 3ML UNIVERSA 2W OP-EN BLN FL SIL DOD,$192.19,$0.00,$192.19,$0.00,$137.16,$0.00,$0.00,$0.00,$0.00,$0.00,$192.19,$0.00,$96.09,$152.21,$153.75,$0.00,$0.00,$0.00,$0.00,$0.00
G52606,SUP,Custom 27203010,,G52606  -  PROBE LITHOTRIPTER 1.6MM 500MM PNEUMATIC KIT LMA,$461.25,$0.00,$461.25,$0.00,$329.19,$0.00,$0.00,$0.00,$0.00,$0.00,$461.25,$0.00,$230.63,$365.31,$369.00,$0.00,$0.00,$0.00,$0.00,$0.00
G52607,SUP,Custom 27203010,,G52607  -  PROBE LITHOTRIPTER 1MM 500MM PNEUMATIC KIT LMA STONEBREAKER,$461.25,$0.00,$461.25,$0.00,$329.19,$0.00,$0.00,$0.00,$0.00,$0.00,$461.25,$0.00,$230.63,$365.31,$369.00,$0.00,$0.00,$0.00,$0.00,$0.00
G52608,SUP,Custom 27203010,,G52608  -  PROBE LITHOTRIPTER 2MM 425MM PNEUMATIC KIT STONEBREAKER,$461.25,$0.00,$461.25,$0.00,$329.19,$0.00,$0.00,$0.00,$0.00,$0.00,$461.25,$0.00,$230.63,$365.31,$369.00,$0.00,$0.00,$0.00,$0.00,$0.00
G52609,SUP,Custom 27203010,,G52609  -  LITHOTRIPTER SRG LMA STONEBREAKER XHST LN STRL PRB CAP PORT,"$2,306.25",$0.00,"$2,306.25",$0.00,"$1,645.97",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,306.25",$0.00,"$1,153.13","$1,826.55","$1,845.00",$0.00,$0.00,$0.00,$0.00,$0.00
G52736,SUP,HCPCS Q4107,,G52736  -  COIL EMBOLIZATION 7CM 3MM NESTER 7.4 LOOP SOFT ENHANCED RADI,$249.30,$0.00,$249.30,$0.00,$177.93,$0.00,$0.00,$0.00,$0.00,$0.00,$249.30,$0.00,$124.65,$197.45,$199.44,$0.00,$0.00,$0.00,$0.00,$0.00
G52737,SUP,Custom 27805113,,G52737  -  COIL EMBOLIZATION .018IN 4MM 7CM 5.6 LOOP SOFT ENHANCED,$264.20,$0.00,$264.20,$0.00,$188.56,$0.00,$0.00,$0.00,$0.00,$0.00,$264.20,$0.00,$132.10,$209.25,$211.36,$0.00,$0.00,$0.00,$0.00,$0.00
G52742,SUP,Custom 27803010,,G52742  -  COIL EMBOLIZATION .035IN 4MM 7CM 5.6 LOOP SOFT ENHANCED,$264.20,$0.00,$264.20,$0.00,$188.56,$0.00,$0.00,$0.00,$0.00,$0.00,$264.20,$0.00,$132.10,$209.25,$211.36,$0.00,$0.00,$0.00,$0.00,$0.00
G52745,SUP,Custom 27803010,,G52745  -  COIL EMBOLIZATION .035IN 10MM 7CM 2.2 LOOP SOFT ENHANCED,$264.20,$0.00,$264.20,$0.00,$188.56,$0.00,$0.00,$0.00,$0.00,$0.00,$264.20,$0.00,$132.10,$209.25,$211.36,$0.00,$0.00,$0.00,$0.00,$0.00
G52753,SUP,Custom 27803010,,G52753  -  COIL EMBOLIZATION .035IN 18MM 14CM 2.5 LOOP SOFT ENHANCED,$303.83,$0.00,$303.83,$0.00,$216.84,$0.00,$0.00,$0.00,$0.00,$0.00,$303.83,$0.00,$151.91,$240.63,$243.06,$0.00,$0.00,$0.00,$0.00,$0.00
G52754,SUP,Custom 27803010,,G52754  -  COIL EMBOLIZATION .035IN 20MM 14CM 2.2 LOOP SOFT ENHANCED,$303.83,$0.00,$303.83,$0.00,$216.84,$0.00,$0.00,$0.00,$0.00,$0.00,$303.83,$0.00,$151.91,$240.63,$243.06,$0.00,$0.00,$0.00,$0.00,$0.00
G52756,SUP,Custom 27803010,,G52756  -  COIL EMBOLIZATION .035IN 20MM 20CM 3.2 LOOP SOFT ENHANCED,$325.28,$0.00,$325.28,$0.00,$232.15,$0.00,$0.00,$0.00,$0.00,$0.00,$325.28,$0.00,$162.64,$257.62,$260.22,$0.00,$0.00,$0.00,$0.00,$0.00
G52909,SUP,HCPCS C1880,,G52909  -  FILTER EMBOLIZATION 30MM 7FR 48MM 65CM NAVALIGN DELIVERY,"$3,487.50",$0.00,"$3,487.50","$1,569.38","$2,489.03",$0.00,$600.88,$0.00,$0.00,$610.63,"$3,487.50",$0.00,"$1,743.75","$2,762.10","$2,790.00",$0.00,$545.79,$0.00,$555.21,$0.00
G52914,SUP,HCPCS C1880,,G52914  -  SYSTEM EMBL PRTC 30MM 7FR 48MM 65CM CELECT NAVALIGN DLV,"$3,487.50",$0.00,"$3,487.50","$1,569.38","$2,489.03",$0.00,$600.88,$0.00,$0.00,$610.63,"$3,487.50",$0.00,"$1,743.75","$2,762.10","$2,790.00",$0.00,$545.79,$0.00,$555.21,$0.00
G53030,SUP,HCPCS C1758,,G53030  -  PROBE LTHTRP 1.6MM 605MM LMA STONEBREAKER PNEUM KT DISP,$63.75,$0.00,$63.75,$34.62,$45.50,$0.00,$10.98,$0.00,$0.00,$11.16,$63.75,$0.00,$31.88,$50.49,$51.00,$0.00,$9.98,$0.00,$10.15,$0.00
G53145,SUP,HCPCS C2617,,G53145  -  CATHETER URTH 16FR 34CM 30ML UNIVERSA 3W FL RND BLDR SIL,$20.25,$0.00,$20.25,$9.11,$14.45,$0.00,$3.49,$0.00,$0.00,$3.55,$20.25,$0.00,$10.13,$16.04,$16.20,$0.00,$3.17,$0.00,$3.22,$0.00
G53146,SUP,HCPCS C2617,,G53146  -  SET STNT .038IN 3CM PGTL CRV 5FR 18CM STRL 145CM UNIVERSA,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G53179,SUP,HCPCS C1769,,G53179  -  TRAY TRACHEOSTOMY 2 CANNU TUBE SHILEY CUFFED PLIANT TIP,"$1,218.95",$0.00,"$1,218.95",$661.89,$869.96,$0.00,$210.02,$0.00,$0.00,$213.43,"$1,218.95",$0.00,$609.48,$965.41,$975.16,$0.00,$190.77,$0.00,$194.06,$0.00
G53211,SUP,HCPCS C1769,,G53211  -  SET STNT 2 PGTL CRV 8FR 22-32CM STRL UNIVERSA RADOPQ SFT,$67.58,$0.00,$67.58,$36.69,$48.23,$0.00,$11.64,$0.00,$0.00,$11.83,$67.58,$0.00,$33.79,$53.52,$54.06,$0.00,$10.58,$0.00,$10.76,$0.00
G53235,SUP,HCPCS C1758,,G53235  -  CATHETER URTH 26FR 34CM 30ML UNIVERSA 2W FL RND TIP CLS END,$26.56,$0.00,$26.56,$14.42,$18.96,$0.00,$4.58,$0.00,$0.00,$4.65,$26.56,$0.00,$13.28,$21.04,$21.25,$0.00,$4.16,$0.00,$4.23,$0.00
G53236,SUP,HCPCS C1758,,G53236  -  CATHETER URTH 18FR 34CM 30ML UNIVERSA 3W FL RND TIP CLS END,$31.88,$0.00,$31.88,$17.31,$22.75,$0.00,$5.49,$0.00,$0.00,$5.58,$31.88,$0.00,$15.94,$25.25,$25.50,$0.00,$4.99,$0.00,$5.07,$0.00
G53237,SUP,HCPCS C1758,,G53237  -  CATHETER URTH 20FR 34CM 30ML UNIVERSA 3W FL RND TIP CLS END,$31.88,$0.00,$31.88,$17.31,$22.75,$0.00,$5.49,$0.00,$0.00,$5.58,$31.88,$0.00,$15.94,$25.25,$25.50,$0.00,$4.99,$0.00,$5.07,$0.00
G53238,SUP,HCPCS C1758,,G53238  -  CATHETER URTH 22FR 34CM 30ML UNIVERSA 3W FL RND TIP CLS END,$31.88,$0.00,$31.88,$17.31,$22.75,$0.00,$5.49,$0.00,$0.00,$5.58,$31.88,$0.00,$15.94,$25.25,$25.50,$0.00,$4.99,$0.00,$5.07,$0.00
G53240,SUP,HCPCS C1758,,G53240  -  CATHETER URTH 24FR 34CM 30ML UNIVERSA 3W FL RND TIP CLS END,$31.88,$0.00,$31.88,$17.31,$22.75,$0.00,$5.49,$0.00,$0.00,$5.58,$31.88,$0.00,$15.94,$25.25,$25.50,$0.00,$4.99,$0.00,$5.07,$0.00
G53241,SUP,HCPCS C1758,,G53241  -  CATHETER URTH 26FR 34CM 30ML UNIVERSA 3W FL RND TIP CLS END,$31.88,$0.00,$31.88,$17.31,$22.75,$0.00,$5.49,$0.00,$0.00,$5.58,$31.88,$0.00,$15.94,$25.25,$25.50,$0.00,$4.99,$0.00,$5.07,$0.00
G53242,SUP,HCPCS C1758,,G53242  -  CATHETER URTH 16FR 34CM 30ML UNIVERSA 3W FL OP-EN SIL,$31.88,$0.00,$31.88,$17.31,$22.75,$0.00,$5.49,$0.00,$0.00,$5.58,$31.88,$0.00,$15.94,$25.25,$25.50,$0.00,$4.99,$0.00,$5.07,$0.00
G53243,SUP,HCPCS C1758,,G53243  -  CATHETER URTH 18FR 34CM 30ML UNIVERSA 3W FL OP-EN SIL,$31.88,$0.00,$31.88,$17.31,$22.75,$0.00,$5.49,$0.00,$0.00,$5.58,$31.88,$0.00,$15.94,$25.25,$25.50,$0.00,$4.99,$0.00,$5.07,$0.00
G53244,SUP,HCPCS C1758,,G53244  -  CATHETER URTH 20FR 34CM 30ML UNIVERSA 3W FL OP-EN SIL,$31.88,$0.00,$31.88,$17.31,$22.75,$0.00,$5.49,$0.00,$0.00,$5.58,$31.88,$0.00,$15.94,$25.25,$25.50,$0.00,$4.99,$0.00,$5.07,$0.00
G53245,SUP,HCPCS C1758,,G53245  -  CATHETER URTH 22FR 34CM 30ML UNIVERSA 3W FL OP-EN SIL,$31.88,$0.00,$31.88,$17.31,$22.75,$0.00,$5.49,$0.00,$0.00,$5.58,$31.88,$0.00,$15.94,$25.25,$25.50,$0.00,$4.99,$0.00,$5.07,$0.00
G53246,SUP,HCPCS C1758,,G53246  -  CATHETER URTH 24FR 34CM 30ML UNIVERSA 3W FL OP-EN SIL,$31.88,$0.00,$31.88,$17.31,$22.75,$0.00,$5.49,$0.00,$0.00,$5.58,$31.88,$0.00,$15.94,$25.25,$25.50,$0.00,$4.99,$0.00,$5.07,$0.00
G53421,SUP,HCPCS C1874,,G53421  -  GRAFT EVAS BFUR 30MM 20FR 120MM ZNTH TX2 PRFRM Z-TRK + SLF,"$30,235.00",$0.00,"$30,235.00","$13,605.75","$5,158.80",$0.00,"$5,209.34",$0.00,$0.00,"$5,293.91","$30,235.00",$0.00,"$15,117.50","$23,946.12","$24,188.00",$0.00,"$4,731.78",$0.00,"$4,813.41",$0.00
G53422,SUP,Custom 27803010,,G53422  -  GRAFT EVAS BFUR 30MM 20FR 140MM ZNTH TX2 PRFRM Z-TRK + SLF,"$30,235.00",$0.00,"$30,235.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$30,235.00",$0.00,"$15,117.50","$23,946.12","$24,188.00",$0.00,$0.00,$0.00,$0.00,$0.00
G53423,SUP,Custom 27803010,,G53423  -  GRAFT EVAS 30MM 20FR 200MM ZNTH TX2 DIST CMPNT PRFRM Z TRK +,"$30,235.00",$0.00,"$30,235.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$30,235.00",$0.00,"$15,117.50","$23,946.12","$24,188.00",$0.00,$0.00,$0.00,$0.00,$0.00
G53424,SUP,Custom 27803010,,G53424  -  GRAFT EVAS BFUR 32MM 20FR 120MM ZNTH TX2 PRFRM Z-TRK + PROX,"$30,235.00",$0.00,"$30,235.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$30,235.00",$0.00,"$15,117.50","$23,946.12","$24,188.00",$0.00,$0.00,$0.00,$0.00,$0.00
G53426,SUP,HCPCS C1874,,G53426  -  GRAFT EVAS 2 BRCH 32MM 20FR 200MM ZNTH TX2 PROX PRFRM Z-TRK,"$30,235.00",$0.00,"$30,235.00","$13,605.75","$5,158.80",$0.00,"$5,209.34",$0.00,$0.00,"$5,293.91","$30,235.00",$0.00,"$15,117.50","$23,946.12","$24,188.00",$0.00,"$4,731.78",$0.00,"$4,813.41",$0.00
G53427,SUP,HCPCS C1874,,G53427  -  GRAFT EVAS 2 BRCH CYL 34MM 20FR 127MM STRL PRFRM Z-TRK +,"$30,235.00",$0.00,"$30,235.00","$13,605.75","$5,158.80",$0.00,"$5,209.34",$0.00,$0.00,"$5,293.91","$30,235.00",$0.00,"$15,117.50","$23,946.12","$24,188.00",$0.00,"$4,731.78",$0.00,"$4,813.41",$0.00
G53428,SUP,Custom 27803010,,G53428  -  GRAFT EVAS BFUR 34MM 20FR 152MM ZNTH TX2 PRFRM Z-TRK + SLF,"$30,235.00",$0.00,"$30,235.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$30,235.00",$0.00,"$15,117.50","$23,946.12","$24,188.00",$0.00,$0.00,$0.00,$0.00,$0.00
G53429,SUP,Custom 27803010,,G53429  -  GRAFT EVAS BFUR 34MM 20FR 202MM ZNTH TX2 PRFRM Z-TRK + PROX,"$30,235.00",$0.00,"$30,235.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$30,235.00",$0.00,"$15,117.50","$23,946.12","$24,188.00",$0.00,$0.00,$0.00,$0.00,$0.00
G53430,SUP,Custom 27803010,,G53430  -  GRAFT EVAS BFUR 36MM 22FR 127MM ZNTH TX2 PRFRM Z-TRK + SLF,"$30,235.00",$0.00,"$30,235.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$30,235.00",$0.00,"$15,117.50","$23,946.12","$24,188.00",$0.00,$0.00,$0.00,$0.00,$0.00
G53433,SUP,HCPCS C1874,,G53433  -  GRAFT EVAS 2 BRCH 38MM 22FR 127MM ZNTH TX2 PRFRM Z-TRK + SLF,"$30,235.00",$0.00,"$30,235.00","$13,605.75","$5,158.80",$0.00,"$5,209.34",$0.00,$0.00,"$5,293.91","$30,235.00",$0.00,"$15,117.50","$23,946.12","$24,188.00",$0.00,"$4,731.78",$0.00,"$4,813.41",$0.00
G53434,SUP,Custom 27803010,,G53434  -  GRAFT EVAS BFUR 38MM 22FR 152MM ZNTH TX2 PRFRM Z-TRK + SLF,"$30,235.00",$0.00,"$30,235.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$30,235.00",$0.00,"$15,117.50","$23,946.12","$24,188.00",$0.00,$0.00,$0.00,$0.00,$0.00
G53435,SUP,Custom 27803010,,G53435  -  GRAFT EVAS BFUR 38MM 22FR 202MM ZNTH TX2 PRFRM Z-TRK + SLF,"$30,235.00",$0.00,"$30,235.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$30,235.00",$0.00,"$15,117.50","$23,946.12","$24,188.00",$0.00,$0.00,$0.00,$0.00,$0.00
G53436,SUP,Custom 27803010,,G53436  -  GRAFT EVAS BFUR 40MM 22FR 135MM ZNTH TX2 PRFRM Z-TRK + SLF,"$30,235.00",$0.00,"$30,235.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$30,235.00",$0.00,"$15,117.50","$23,946.12","$24,188.00",$0.00,$0.00,$0.00,$0.00,$0.00
G53440,SUP,Custom 27803010,,G53440  -  GRAFT EVAS BFUR 42MM 22FR 162MM ZNTH TX2 PRFRM Z-TRK + SLF,"$30,235.00",$0.00,"$30,235.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$30,235.00",$0.00,"$15,117.50","$23,946.12","$24,188.00",$0.00,$0.00,$0.00,$0.00,$0.00
G53441,SUP,Custom 27803010,,G53441  -  GRAFT EVAS BFUR 42MM 22FR 216MM ZNTH TX2 PRFRM Z-TRK + SLF,"$30,235.00",$0.00,"$30,235.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$30,235.00",$0.00,"$15,117.50","$23,946.12","$24,188.00",$0.00,$0.00,$0.00,$0.00,$0.00
G53442,SUP,Custom 27803010,,G53442  -  GRAFT EVAS BFUR 32MM 20FR 160MM ZNTH TX2 PRFRM Z-TRK + SLF,"$30,235.00",$0.00,"$30,235.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$30,235.00",$0.00,"$15,117.50","$23,946.12","$24,188.00",$0.00,$0.00,$0.00,$0.00,$0.00
G53446,SUP,Custom 27803010,,G53446  -  GRAFT EVAS BFUR 36MM 22FR 157MM ZNTH TX2 PRFRM Z-TRK + SLF,"$30,235.00",$0.00,"$30,235.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$30,235.00",$0.00,"$15,117.50","$23,946.12","$24,188.00",$0.00,$0.00,$0.00,$0.00,$0.00
G53449,SUP,HCPCS C1874,,G53449  -  GRAFT EVAS CYL TPR 38-34MM 8.5MM 22FR 202MM STRL PRFRM Z-TRK,"$30,235.00",$0.00,"$30,235.00","$13,605.75","$5,158.80",$0.00,"$5,209.34",$0.00,$0.00,"$5,293.91","$30,235.00",$0.00,"$15,117.50","$23,946.12","$24,188.00",$0.00,"$4,731.78",$0.00,"$4,813.41",$0.00
G53450,SUP,Custom 27803010,,G53450  -  GRAFT EVAS 40MM 22FR 158MM ZNTH TX2 PROX TPR CMPNT PRFRM,"$30,235.00",$0.00,"$30,235.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$30,235.00",$0.00,"$15,117.50","$23,946.12","$24,188.00",$0.00,$0.00,$0.00,$0.00,$0.00
G53454,SUP,Custom 27803010,,G53454  -  GRAFT EVAS 28MM 20FR 80MM ZNTH TX2 TBE CMPNT PROX XTN PRFRM,"$12,996.03",$0.00,"$12,996.03",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$12,996.03",$0.00,"$6,498.01","$10,292.86","$10,396.82",$0.00,$0.00,$0.00,$0.00,$0.00
G53455,SUP,Custom 27803010,,G53455  -  GRAFT EVAS BFUR 30MM 20FR 80MM ZNTH TX2 PRFRM Z-TRK + PROX,"$12,995.00",$0.00,"$12,995.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$12,995.00",$0.00,"$6,497.50","$10,292.04","$10,396.00",$0.00,$0.00,$0.00,$0.00,$0.00
G53456,SUP,Custom 27803010,,G53456  -  GRAFT EVAS BFUR 32MM 20FR 80MM ZNTH TX2 PRFRM Z-TRK + SLF,"$12,995.00",$0.00,"$12,995.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$12,995.00",$0.00,"$6,497.50","$10,292.04","$10,396.00",$0.00,$0.00,$0.00,$0.00,$0.00
G53457,SUP,Custom 27803010,,G53457  -  GRAFT EVAS 34MM 20FR 77MM ZNTH TX2 DIST XTN TBE CMPNT PRFRM,"$12,995.00",$0.00,"$12,995.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$12,995.00",$0.00,"$6,497.50","$10,292.04","$10,396.00",$0.00,$0.00,$0.00,$0.00,$0.00
G53458,SUP,Custom 27803010,,G53458  -  GRAFT EVAS 36MM 22FR 77MM ZNTH TX2 PROX XTN Z-TRK + TAA,"$12,995.00",$0.00,"$12,995.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$12,995.00",$0.00,"$6,497.50","$10,292.04","$10,396.00",$0.00,$0.00,$0.00,$0.00,$0.00
G53459,SUP,Custom 27803010,,G53459  -  GRAFT EVAS 38MM 22FR 77MM ZNTH TX2 PROX XTN PRFRM Z TRK +,"$12,995.00",$0.00,"$12,995.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$12,995.00",$0.00,"$6,497.50","$10,292.04","$10,396.00",$0.00,$0.00,$0.00,$0.00,$0.00
G53460,SUP,Custom 27803010,,G53460  -  GRAFT EVAS BFUR 40MM 22FR 81MM ZNTH TX2 PRFRM Z-TRK + SLF,"$12,995.00",$0.00,"$12,995.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$12,995.00",$0.00,"$6,497.50","$10,292.04","$10,396.00",$0.00,$0.00,$0.00,$0.00,$0.00
G53461,SUP,Custom 27803010,,G53461  -  GRAFT EVAS 42MM 22FR 81MM ZNTH TX2 PROX XTN PRFRM Z-TRK +,"$12,995.00",$0.00,"$12,995.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$12,995.00",$0.00,"$6,497.50","$10,292.04","$10,396.00",$0.00,$0.00,$0.00,$0.00,$0.00
G53463,SUP,HCPCS C1874,,G53463  -  GRAFT EVAS 30MM 7.7MM 20FR 80MM STRL ZNTH TX2 PRFRM ESBE,"$12,995.00",$0.00,"$12,995.00","$5,847.75","$5,158.80",$0.00,"$2,238.97",$0.00,$0.00,"$2,275.32","$12,995.00",$0.00,"$6,497.50","$10,292.04","$10,396.00",$0.00,"$2,033.72",$0.00,"$2,068.80",$0.00
G53486,SUP,Custom 27803010,,G53486  -  GRAFT EVAS 42MM 22FR 144MM ZNTH TX2 PRFRM Z TRK + INTRO SYS,"$16,442.50",$0.00,"$16,442.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$16,442.50",$0.00,"$8,221.25","$13,022.46","$13,154.00",$0.00,$0.00,$0.00,$0.00,$0.00
G53556,SUP,HCPCS C1769,,G53556  -  CATHETER URTH 26FR 34CM 30ML UNIVERSA 3W FL OP-EN SIL,$6.76,$0.00,$6.76,$3.67,$4.82,$0.00,$1.16,$0.00,$0.00,$1.18,$6.76,$0.00,$3.38,$5.35,$5.41,$0.00,$1.06,$0.00,$1.08,$0.00
G53557,SUP,HCPCS C1769,,G53557  -  GUIDEWIRE VASC STRG .038IN 145CM STRL 5CM AMPTZ FLXB STF,$67.58,$0.00,$67.58,$36.69,$48.23,$0.00,$11.64,$0.00,$0.00,$11.83,$67.58,$0.00,$33.79,$53.52,$54.06,$0.00,$10.58,$0.00,$10.76,$0.00
G53558,SUP,HCPCS C1769,,G53558  -  GUIDEWIRE VASC STRG .038IN 145CM STRL 5CM AMPTZ 2 FLXB STF,$67.58,$0.00,$67.58,$36.69,$48.23,$0.00,$11.64,$0.00,$0.00,$11.83,$67.58,$0.00,$33.79,$53.52,$54.06,$0.00,$10.58,$0.00,$10.76,$0.00
G53559,SUP,HCPCS C1769,,G53559  -  GUIDEWIRE ESCP STRG .025IN 145CM STRL 5CM AMPTZ XSTF FXCR,$67.58,$0.00,$67.58,$36.69,$48.23,$0.00,$11.64,$0.00,$0.00,$11.83,$67.58,$0.00,$33.79,$53.52,$54.06,$0.00,$10.58,$0.00,$10.76,$0.00
G53560,SUP,HCPCS C1769,,G53560  -  CATHETER NPHSTM 8MM 15CM ULTRX,$67.58,$0.00,$67.58,$36.69,$48.23,$0.00,$11.64,$0.00,$0.00,$11.83,$67.58,$0.00,$33.79,$53.52,$54.06,$0.00,$10.58,$0.00,$10.76,$0.00
G53561,SUP,HCPCS C1769,,G53561  -  GUIDEWIRE ESCP .035IN STRG 145CM 5CM AMPTZ FLX TP FXCR XSTF,$88.13,$0.00,$88.13,$47.85,$62.89,$0.00,$15.18,$0.00,$0.00,$15.43,$88.13,$0.00,$44.06,$69.80,$70.50,$0.00,$13.79,$0.00,$14.03,$0.00
G53562,SUP,HCPCS C1769,,G53562  -  GUIDEWIRE ESCP STRG .035IN 260CM STRL 5CM AMPTZ XSTF FXCR,$88.13,$0.00,$88.13,$47.85,$62.89,$0.00,$15.18,$0.00,$0.00,$15.43,$88.13,$0.00,$44.06,$69.80,$70.50,$0.00,$13.79,$0.00,$14.03,$0.00
G53563,SUP,HCPCS C1769,,G53563  -  GUIDEWIRE ESCP STRG .038IN 260CM STRL 5CM AMPTZ XSTF FXCR,$67.58,$0.00,$67.58,$36.69,$48.23,$0.00,$11.64,$0.00,$0.00,$11.83,$67.58,$0.00,$33.79,$53.52,$54.06,$0.00,$10.58,$0.00,$10.76,$0.00
G53564,SUP,HCPCS C1769,,G53564  -  GUIDEWIRE VASC STRG .035IN 145CM STRL 5CM AMPTZ 2 FLX TP,$67.58,$0.00,$67.58,$36.69,$48.23,$0.00,$11.64,$0.00,$0.00,$11.83,$67.58,$0.00,$33.79,$53.52,$54.06,$0.00,$10.58,$0.00,$10.76,$0.00
G53566,SUP,HCPCS C1769,,G53566  -  GUIDEWIRE URO STRG .038IN 145CM 5CM AMPTZ 2 FLX TP FX COR,$67.58,$0.00,$67.58,$36.69,$48.23,$0.00,$11.64,$0.00,$0.00,$11.83,$67.58,$0.00,$33.79,$53.52,$54.06,$0.00,$10.58,$0.00,$10.76,$0.00
G53567,SUP,HCPCS C1769,,G53567  -  GUIDEWIRE VASC STRG .035IN 145CM 5CM AMPTZ 2 FLX TP FXCR ULT,$67.58,$0.00,$67.58,$36.69,$48.23,$0.00,$11.64,$0.00,$0.00,$11.83,$67.58,$0.00,$33.79,$53.52,$54.06,$0.00,$10.58,$0.00,$10.76,$0.00
G53568,SUP,HCPCS C1769,,G53568  -  GUIDEWIRE VASC STRG .038IN 145CM STRL 5CM AMPTZ FLXB ULT STF,$67.58,$0.00,$67.58,$36.69,$48.23,$0.00,$11.64,$0.00,$0.00,$11.83,$67.58,$0.00,$33.79,$53.52,$54.06,$0.00,$10.58,$0.00,$10.76,$0.00
G53569,SUP,HCPCS C1769,,G53569  -  GUIDEWIRE VASC STRG .035IN 145CM STRL 5CM AMPTZ 2 FLXB ULT,$67.58,$0.00,$67.58,$36.69,$48.23,$0.00,$11.64,$0.00,$0.00,$11.83,$67.58,$0.00,$33.79,$53.52,$54.06,$0.00,$10.58,$0.00,$10.76,$0.00
G53672,SUP,HCPCS C2617,,G53672  -  GUIDEWIRE VASC STRG .038IN 145CM STRL 5CM AMPTZ 2 FLXB ULT,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G53674,SUP,HCPCS C2617,,G53674  -  SET STNT .038IN 3CM PGTL CRV 5FR 20CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G53675,SUP,HCPCS C2617,,G53675  -  SET STNT .038IN 3CM PGTL CRV 5FR 24CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G53676,SUP,HCPCS C2617,,G53676  -  SET STNT 3CM PGTL CRV 5FR 22CM STRL 145CM UNIVERSA RADOPQ,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G53677,SUP,HCPCS C2617,,G53677  -  SET STNT .038IN 3CM PGTL CRV 5FR 26CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G53678,SUP,HCPCS C2617,,G53678  -  SET STNT .038IN 3CM PGTL CRV 5FR 28CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G53680,SUP,HCPCS C2617,,G53680  -  SET STNT .038IN 3CM PGTL CRV 5FR 30CM STRL 145CM UNIVERSA,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G53681,SUP,HCPCS C2617,,G53681  -  SET STNT 2 PGTL CRV 5FR 18CM STRL UNIVERSA RADOPQ SFT PSTNR,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G53682,SUP,HCPCS C2617,,G53682  -  SET STNT 2 PGTL CRV 5FR 20CM STRL UNIVERSA RADOPQ SFT PSTNR,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G53683,SUP,HCPCS C2617,,G53683  -  SET STNT 2 PGTL CRV 5FR 22CM STRL UNIVERSA RADOPQ SFT PSTNR,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G53684,SUP,HCPCS C2617,,G53684  -  SET STNT 2 PGTL CRV 5FR 24CM STRL UNIVERSA RADOPQ SFT PSTNR,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G53685,SUP,HCPCS C2617,,G53685  -  SET STNT 2 PGTL CRV 5FR 26CM STRL UNIVERSA RADOPQ SFT PSTNR,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G53686,SUP,HCPCS C2617,,G53686  -  SET STNT 2 PGTL CRV 5FR 28CM STRL UNIVERSA RADOPQ SFT PSTNR,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G53687,SUP,HCPCS C2617,,G53687  -  SET STNT 2 PGTL CRV 5FR 30CM STRL UNIVERSA RADOPQ SFT PSTNR,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G53688,SUP,HCPCS C2617,,G53688  -  SET STNT .038IN 3CM PGTL CRV 5FR 22-32CM STRL 145CM UNIVERSA,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G53689,SUP,HCPCS C2617,,G53689  -  SET STNT 2 PGTL CRV 5FR 22-32CM STRL UNIVERSA PSTNR,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G53690,SUP,HCPCS C2617,,G53690  -  SET STNT 2 PGTL CRV 6FR 18CM UNIVERSA SFT GRAD MRK,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G53691,SUP,HCPCS C2617,,G53691  -  SET STNT PGTL CRV 6FR 20CM UNIVERSA SFT GRAD MRK,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G53692,SUP,HCPCS C2617,,G53692  -  SET STNT 2 PGTL CRV 6FR 22CM UNIVERSA SFT GRAD MRK,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G53693,SUP,HCPCS C2617,,G53693  -  SET STNT .038IN 3CM PGTL CRV 6FR 24CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G53694,SUP,HCPCS C2617,,G53694  -  SET STNT .038IN 3CM PGTL CRV 6FR 26CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G53695,SUP,HCPCS C2617,,G53695  -  SET STNT PGTL CRV 6FR 28CM UNIVERSA GW SFT GRAD MRK,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G53696,SUP,HCPCS C2617,,G53696  -  SET STNT .038IN 3CM PGTL CRV 6FR 30CM STRL 145CM UNIVERSA,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G53697,SUP,HCPCS C2617,,G53697  -  SET STNT 2 PGTL CRV 6FR 18CM STRL UNIVERSA RADOPQ SFT PSTNR,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G53698,SUP,HCPCS C2617,,G53698  -  SET STNT 6FR 22CM STRL LF UNIVERSA PSTNR GW BRD TETH RADOPQ,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G53699,SUP,HCPCS C2617,,G53699  -  SET STNT 2 PGTL CRV 6FR 20CM STRL UNIVERSA RADOPQ SFT PSTNR,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G53700,SUP,HCPCS C2617,,G53700  -  SET STNT 6FR 26CM STRL LF UNIVERSA PSTNR GW BRD TETH RADOPQ,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G53701,SUP,HCPCS C2617,,G53701  -  SET STNT 6FR 24CM STRL LF UNIVERSA PSTNR GW BRD TETH RADOPQ,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G53702,SUP,HCPCS C2617,,G53702  -  SET STNT 2 PGTL CRV 6FR 28CM STRL UNIVERSA RADOPQ SFT PSTNR,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G53703,SUP,HCPCS C2617,,G53703  -  SET STNT 2 PGTL CRV 6FR 30CM STRL UNIVERSA RADOPQ SFT PSTNR,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G53704,SUP,HCPCS C2617,,G53704  -  SET STNT .038IN 3CM PGTL CRV 6FR 22-32CM STRL 145CM UNIVERSA,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G53706,SUP,HCPCS C2617,,G53706  -  SET STNT 2 PGTL CRV 6FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G53707,SUP,HCPCS C2617,,G53707  -  SET STNT 3CM PGTL CRV 7FR 22-32CM STRL LF 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G53708,SUP,HCPCS C2617,,G53708  -  SET STNT .038IN 3CM PGTL CRV 7FR 18CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G53709,SUP,HCPCS C2617,,G53709  -  SET STNT .038IN 3CM PGTL CRV 7FR 20CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G53710,SUP,HCPCS C2617,,G53710  -  SET STNT .038IN 3CM PGTL CRV 7FR 22CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G53711,SUP,HCPCS C2617,,G53711  -  SET STNT .038IN 3CM PGTL CRV 7FR 24CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G53712,SUP,HCPCS C2617,,G53712  -  SET STNT .038IN 3CM PGTL CRV 7FR 26CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G53713,SUP,HCPCS C2617,,G53713  -  SET STNT .038IN 3CM PGTL CRV 7FR 28CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G53714,SUP,HCPCS C2617,,G53714  -  SET STNT .038IN 3CM PGTL CRV 7FR 30CM STRL 145CM UNIVERSA,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G53715,SUP,HCPCS C2617,,G53715  -  SET STNT 2 PGTL CRV 7FR 18CM STRL UNIVERSA RADOPQ SFT PSTNR,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G53716,SUP,HCPCS C2617,,G53716  -  SET STNT 2 PGTL CRV 7FR 20CM STRL UNIVERSA RADOPQ SFT PSTNR,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G53717,SUP,HCPCS C2617,,G53717  -  SET STNT 2 PGTL CRV 7FR 22CM STRL UNIVERSA RADOPQ SFT PSTNR,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G53718,SUP,HCPCS C2617,,G53718  -  SET STNT 2 PGTL CRV 7FR 24CM STRL UNIVERSA RADOPQ SFT PSTNR,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G53719,SUP,HCPCS C2617,,G53719  -  SET STNT 2 PGTL CRV 7FR 26CM STRL LF UNIVERSA RADOPQ SFT,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G53720,SUP,HCPCS C2617,,G53720  -  SET STNT 2 PGTL CRV 7FR 28CM STRL UNIVERSA RADOPQ SFT PSTNR,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G53721,SUP,HCPCS C2617,,G53721  -  SET STNT 2 PGTL CRV 7FR 30CM STRL UNIVERSA RADOPQ SFT PSTNR,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G53722,SUP,HCPCS C2617,,G53722  -  SET STNT .038IN 3CM PGTL CRV 8FR 22-32CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G53723,SUP,HCPCS C2617,,G53723  -  SET STNT .038IN 3CM PGTL CRV 8FR 18CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G53724,SUP,HCPCS C2617,,G53724  -  SET STNT .038IN 3CM PGTL CRV 8FR 20CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G53725,SUP,HCPCS C2617,,G53725  -  SET STNT .038IN 3CM PGTL CRV 8FR 22CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G53726,SUP,HCPCS C2617,,G53726  -  SET STNT .038IN 3CM PGTL CRV 8FR 24CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G53727,SUP,HCPCS C2617,,G53727  -  SET STNT .038IN 3CM PGTL CRV 8FR 26CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G53728,SUP,HCPCS C2617,,G53728  -  SET STNT .038IN 3CM PGTL CRV 8FR 28CM STRL 145CM UNIVERSA,$202.50,$0.00,$202.50,$91.13,$144.52,$0.00,$34.89,$0.00,$0.00,$35.46,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$31.69,$0.00,$32.24,$0.00
G53729,SUP,HCPCS C2617,,G53729  -  SET STNT .038IN 3CM PGTL CRV 8FR 30CM STRL 145CM UNIVERSA,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G53731,SUP,HCPCS C2617,,G53731  -  SET STNT 2 PGTL CRV 8FR 18CM STRL UNIVERSA RADOPQ SFT PSTNR,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G53732,SUP,HCPCS C2617,,G53732  -  SET STNT 2 PGTL CRV 8FR 20CM STRL UNIVERSA RADOPQ SFT PSTNR,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G53734,SUP,HCPCS C2617,,G53734  -  SET STNT 2 PGTL CRV 8FR 22CM STRL UNIVERSA RADOPQ SFT PSTNR,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G53735,SUP,HCPCS C2617,,G53735  -  SET STNT 2 PGTL CRV 8FR 24CM STRL UNIVERSA RADOPQ SFT PSTNR,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G53736,SUP,HCPCS C2617,,G53736  -  SET STNT 2 PGTL CRV 8FR 26CM STRL UNIVERSA RADOPQ SFT PSTNR,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G53737,SUP,HCPCS C2617,,G53737  -  SET STNT 2 PGTL CRV 8FR 28CM STRL UNIVERSA RADOPQ SFT PSTNR,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G54613,SUP,HCPCS C1763,,G54613  -  GRAFT SOFT TISSUE .4CM SET PLUG BUTTON BIODESIGN SURGISIS,"$2,612.50",$0.00,"$2,612.50","$1,175.63","$1,864.54",$0.00,$450.12,$0.00,$0.00,$457.43,"$2,612.50",$0.00,"$1,306.25","$2,069.10","$2,090.00",$0.00,$408.86,$0.00,$415.91,$0.00
G54614,SUP,HCPCS C1763,,G54614  -  GRAFT ENDOVASCULAR .7CM SET PLUG BUTTON BIODESIGN SURGISIS,"$2,612.50",$0.00,"$2,612.50","$1,175.63","$1,864.54",$0.00,$450.12,$0.00,$0.00,$457.43,"$2,612.50",$0.00,"$1,306.25","$2,069.10","$2,090.00",$0.00,$408.86,$0.00,$415.91,$0.00
G55230,SUP,HCPCS C1874,,G55230  -  GRAFT EVAS 2 BRCH 13MM 5.4MM 14FR 39MM STRL ZNTH SPRLZ Z-TRK,"$7,712.50",$0.00,"$7,712.50","$3,470.63","$5,158.80",$0.00,"$1,328.83",$0.00,$0.00,"$1,350.40","$7,712.50",$0.00,"$3,856.25","$6,108.30","$6,170.00",$0.00,"$1,207.01",$0.00,"$1,227.83",$0.00
G55231,SUP,HCPCS C1874,,G55231  -  GRAFT EVAS 2 BRCH 13MM 5.4MM 14FR 56MM STRL ZNTH SPRLZ Z-TRK,"$7,712.50",$0.00,"$7,712.50","$3,470.63","$5,158.80",$0.00,"$1,328.83",$0.00,$0.00,"$1,350.40","$7,712.50",$0.00,"$3,856.25","$6,108.30","$6,170.00",$0.00,"$1,207.01",$0.00,"$1,227.83",$0.00
G55236,SUP,HCPCS C1874,,G55236  -  GRAFT EVAS 2 BRCH 16MM 14FR 39MM SPRLZ ZNTH Z-TRK SLF XPD LG,"$7,712.50",$0.00,"$7,712.50","$3,470.63","$5,158.80",$0.00,"$1,328.83",$0.00,$0.00,"$1,350.40","$7,712.50",$0.00,"$3,856.25","$6,108.30","$6,170.00",$0.00,"$1,207.01",$0.00,"$1,227.83",$0.00
G55237,SUP,HCPCS C1874,,G55237  -  GRAFT EVAS BFUR 16MM 5.4MM 14FR 56MM ZNTH SPRLZ ANCLRY,"$7,712.50",$0.00,"$7,712.50","$3,470.63","$5,158.80",$0.00,"$1,328.83",$0.00,$0.00,"$1,350.40","$7,712.50",$0.00,"$3,856.25","$6,108.30","$6,170.00",$0.00,"$1,207.01",$0.00,"$1,227.83",$0.00
G55242,SUP,HCPCS C1874,,G55242  -  GRAFT EVAS 2 BRCH 20MM 6MM 16FR 74MM ZNTH SPRLZ ILC LG,"$7,712.50",$0.00,"$7,712.50","$3,470.63","$5,158.80",$0.00,"$1,328.83",$0.00,$0.00,"$1,350.40","$7,712.50",$0.00,"$3,856.25","$6,108.30","$6,170.00",$0.00,"$1,207.01",$0.00,"$1,227.83",$0.00
G55243,SUP,Custom 27803010,,G55243  -  GRAFT EVAS 2 BRCH 20MM 16FR 90MM SPRLZ ZNTH Z-TRK SLF XPD LG,"$7,712.50",$0.00,"$7,712.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,712.50",$0.00,"$3,856.25","$6,108.30","$6,170.00",$0.00,$0.00,$0.00,$0.00,$0.00
G55245,SUP,Custom 27803010,,G55245  -  GRAFT EVAS 24MM 6MM 5.3MM 56MM 71CM ZNTH SPRLZ ILC LG CAPTOR,"$9,412.50",$0.00,"$9,412.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$9,412.50",$0.00,"$4,706.25","$7,454.70","$7,530.00",$0.00,$0.00,$0.00,$0.00,$0.00
G55246,SUP,Custom 27803010,,G55246  -  GRAFT EVAS BFUR 24MM 16FR 74MM ZNTH SPRLZ Z-TRK SLF XPD WVN,"$7,712.50",$0.00,"$7,712.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,712.50",$0.00,"$3,856.25","$6,108.30","$6,170.00",$0.00,$0.00,$0.00,$0.00,$0.00
G55247,SUP,HCPCS C1874,,G55247  -  GRAFT EVAS 24MM 6MM 16FR 90MM ZNTH SPRLZ ANCLRY CNTRLT/IPSL,$385.63,$0.00,$385.63,$173.53,$275.22,$0.00,$66.44,$0.00,$0.00,$67.52,$385.63,$0.00,$192.81,$305.42,$308.50,$0.00,$60.35,$0.00,$61.39,$0.00
G55800,SUP,HCPCS C1729,,G55800  -  SET DRN 14FR 6-16FR 30CM 20CM UNIVERSA ECHTP SFTJ LOOP CATH,$350.68,$0.00,$350.68,$190.42,$250.28,$0.00,$60.42,$0.00,$0.00,$61.40,$350.68,$0.00,$175.34,$277.74,$280.54,$0.00,$54.88,$0.00,$55.83,$0.00
G55801,SUP,HCPCS C1729,,G55801  -  SET DRN 6FR 5-8FR 15CM 20CM CATH DIL LOOP,$350.68,$0.00,$350.68,$190.42,$250.28,$0.00,$60.42,$0.00,$0.00,$61.40,$350.68,$0.00,$175.34,$277.74,$280.54,$0.00,$54.88,$0.00,$55.83,$0.00
G55802,SUP,HCPCS C1729,,G55802  -  SHIELD SPLSH ELLIPSE 9X12IN LTX BRR RBR,$350.68,$0.00,$350.68,$190.42,$250.28,$0.00,$60.42,$0.00,$0.00,$61.40,$350.68,$0.00,$175.34,$277.74,$280.54,$0.00,$54.88,$0.00,$55.83,$0.00
G55803,SUP,HCPCS C1729,,G55803  -  SET DRN 12FR 6-14FR 30CM 20CM UNIVERSA DIL LOOP CATH INTRO,$350.68,$0.00,$350.68,$190.42,$250.28,$0.00,$60.42,$0.00,$0.00,$61.40,$350.68,$0.00,$175.34,$277.74,$280.54,$0.00,$54.88,$0.00,$55.83,$0.00
G55804,SUP,HCPCS C1729,,G55804  -  SET DRN 10FR 6-12FR 30CM 20CM CATH DIL LOOP,$350.68,$0.00,$350.68,$190.42,$250.28,$0.00,$60.42,$0.00,$0.00,$61.40,$350.68,$0.00,$175.34,$277.74,$280.54,$0.00,$54.88,$0.00,$55.83,$0.00
G55821,SUP,HCPCS C2627,,G55821  -  SET CATH 14FR 15GA 30CM UNIVERSA MLCT 1 WY STPCK CNCT TUBE,$99.00,$0.00,$99.00,$53.76,$70.66,$0.00,$17.06,$0.00,$0.00,$17.33,$99.00,$0.00,$49.50,$78.41,$79.20,$0.00,$15.49,$0.00,$15.76,$0.00
G55822,SUP,HCPCS C2627,,G55822  -  CATHETER SPBC 12FR 14FR 22CM 3CC STRL LTX 30CM RTNR SET NDL,$99.00,$0.00,$99.00,$53.76,$70.66,$0.00,$17.06,$0.00,$0.00,$17.33,$99.00,$0.00,$49.50,$78.41,$79.20,$0.00,$15.49,$0.00,$15.76,$0.00
G55823,SUP,HCPCS C2627,,G55823  -  SET CATH 10FR 18GA 30CM UNIVERSA MLCT DRN SPBC,$99.00,$0.00,$99.00,$53.76,$70.66,$0.00,$17.06,$0.00,$0.00,$17.33,$99.00,$0.00,$49.50,$78.41,$79.20,$0.00,$15.49,$0.00,$15.76,$0.00
G55824,SUP,HCPCS C2627,,G55824  -  SET CATH 12FR 54CM TROC STY DRN ADPR SPBC CYSTOSTOMY,$99.00,$0.00,$99.00,$53.76,$70.66,$0.00,$17.06,$0.00,$0.00,$17.33,$99.00,$0.00,$49.50,$78.41,$79.20,$0.00,$15.49,$0.00,$15.76,$0.00
G55825,SUP,HCPCS C1729,,G55825  -  INSERTER SRG 1.91IN STRL DISP ACPT 3.1FR,$3.96,$0.00,$3.96,$2.15,$2.83,$0.00,$0.68,$0.00,$0.00,$0.69,$3.96,$0.00,$1.98,$3.14,$3.17,$0.00,$0.62,$0.00,$0.63,$0.00
G56219,SUP,HCPCS C1894,,G56219  -  INTRODUCER SHEATH .035IN 4FR .059IN 70CM ANL0 CURVE STR TIP,$225.00,$0.00,$225.00,$122.18,$160.58,$0.00,$38.77,$0.00,$0.00,$39.40,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$35.21,$0.00,$35.82,$0.00
G56220,SUP,HCPCS C1894,,G56220  -  INTRODUCER SHEATH .035IN 5FR .074IN 70CM ANL0 CURVE STR TIP,$225.00,$0.00,$225.00,$122.18,$160.58,$0.00,$38.77,$0.00,$0.00,$39.40,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$35.21,$0.00,$35.82,$0.00
G56221,SUP,HCPCS C1894,,G56221  -  INTRODUCER SHEATH .035IN 6FR .087IN 70CM ANL0 CURVE STR TIP,$225.00,$0.00,$225.00,$122.18,$160.58,$0.00,$38.77,$0.00,$0.00,$39.40,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$35.21,$0.00,$35.82,$0.00
G56222,SUP,HCPCS C1894,,G56222  -  INTRODUCER SHEATH .035IN 7FR .1IN 70CM ANL0 CURVE STR TIP,$225.00,$0.00,$225.00,$122.18,$160.58,$0.00,$38.77,$0.00,$0.00,$39.40,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$35.21,$0.00,$35.82,$0.00
G56224,SUP,HCPCS C1894,,G56224  -  INTRODUCER SHEATH .035IN 4FR .059IN 70CM ANL1 CURVE MULTPUR,$225.00,$0.00,$225.00,$122.18,$160.58,$0.00,$38.77,$0.00,$0.00,$39.40,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$35.21,$0.00,$35.82,$0.00
G56225,SUP,HCPCS C1894,,G56225  -  INTRODUCER SHEATH .035IN 5FR .074IN 70CM ANL1 CURVE MULTPUR,$225.00,$0.00,$225.00,$122.18,$160.58,$0.00,$38.77,$0.00,$0.00,$39.40,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$35.21,$0.00,$35.82,$0.00
G56226,SUP,HCPCS C1894,,G56226  -  INTRODUCER SHEATH .035IN 6FR .087IN 70CM ANL1 CURVE MULTPUR,$225.00,$0.00,$225.00,$122.18,$160.58,$0.00,$38.77,$0.00,$0.00,$39.40,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$35.21,$0.00,$35.82,$0.00
G56227,SUP,HCPCS C1894,,G56227  -  INTRODUCER SHEATH .035IN 7FR .1IN 70CM ANL1 CURVE MULTPUR,$225.00,$0.00,$225.00,$122.18,$160.58,$0.00,$38.77,$0.00,$0.00,$39.40,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$35.21,$0.00,$35.82,$0.00
G56228,SUP,HCPCS C1894,,G56228  -  INTRODUCER SHEATH .035IN 8FR .113IN 70CM ANL1 CURVE MULTPUR,$225.00,$0.00,$225.00,$122.18,$160.58,$0.00,$38.77,$0.00,$0.00,$39.40,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$35.21,$0.00,$35.82,$0.00
G56277,SUP,HCPCS C1751,,G56277  -  TRAY CATHETER CEN VEN STERILE,$462.99,$0.00,$462.99,$251.40,$330.44,$0.00,$79.77,$0.00,$0.00,$81.07,$462.99,$0.00,$231.50,$366.69,$370.39,$0.00,$72.46,$0.00,$73.71,$0.00
G56278,SUP,HCPCS C1892,,G56278  -  INTRODUCER SHEATH .035IN 10FR .134IN 45CM ANL0 CURVE STR TIP,$187.50,$0.00,$187.50,$101.81,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
G56279,SUP,HCPCS C1892,,G56279  -  INTRODUCER SHEATH .035IN 12FR .162IN 45CM ANL0 CURVE STR TIP,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
G56334,SUP,HCPCS C1729,,G56334  -  CATHETER DRN 16FR 15GA 30CM UNIVERSA MLCT NDL,$99.00,$0.00,$99.00,$53.76,$70.66,$0.00,$17.06,$0.00,$0.00,$17.33,$99.00,$0.00,$49.50,$78.41,$79.20,$0.00,$15.49,$0.00,$15.76,$0.00
G56335,SUP,HCPCS C1729,,G56335  -  CATHETER DRN 8FR 19GA 15CM UNIVERSA MLCT NDL,$99.00,$0.00,$99.00,$53.76,$70.66,$0.00,$17.06,$0.00,$0.00,$17.33,$99.00,$0.00,$49.50,$78.41,$79.20,$0.00,$15.49,$0.00,$15.76,$0.00
G56401,SUP,Custom 27203010,,G56401  -  CATHETER DRN 10FR 18GA 15CM UNIVERSA MLCT NDL,$412.50,$0.00,$412.50,$0.00,$294.40,$0.00,$0.00,$0.00,$0.00,$0.00,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$0.00,$0.00,$0.00,$0.00
G56428,SUP,HCPCS C1894,,G56428  -  EXTRACTOR STON STD 10FR 1.5CM 38CM PERC NGAGE BSKT NTNL SS,$325.00,$0.00,$325.00,$176.48,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
G56429,SUP,HCPCS C1894,,G56429  -  SHEATH ESCP 9.5FR 20CM STRL PRLL FLXR DIL HDRPH URETER DISP,$325.00,$0.00,$325.00,$176.48,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
G56430,SUP,HCPCS C1894,,G56430  -  SHEATH ESCP 9.5FR 28CM STRL PRLL FLXR DIL HDRPH URETER DISP,$325.00,$0.00,$325.00,$176.48,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
G56431,SUP,HCPCS C1894,,G56431  -  SHEATH ESCP 9.5FR 35CM STRL PRLL FLXR DIL HDRPH URETER DISP,$325.00,$0.00,$325.00,$176.48,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
G56432,SUP,HCPCS C1894,,G56432  -  SHEATH ESCP 9.5FR 45CM STRL PRLL FLXR DIL HDRPH URETER DISP,$325.00,$0.00,$325.00,$176.48,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
G56433,SUP,HCPCS C1894,,G56433  -  SHEATH ESCP 9.5FR 55CM STRL PRLL FLXR DIL HDRPH URETER DISP,$325.00,$0.00,$325.00,$176.48,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
G56434,SUP,HCPCS C1894,,G56434  -  SHEATH ESCP 12FR 20CM STRL PRLL FLXR DIL HDRPH URETER DISP,$325.00,$0.00,$325.00,$176.48,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
G56435,SUP,HCPCS C1894,,G56435  -  SHEATH ACC 12FR 28CM RPD RELS PRLL FLXR CNT CHNL HDRPH URET,$325.00,$0.00,$325.00,$176.48,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
G56436,SUP,HCPCS C1894,,G56436  -  SHEATH ACC 12FR 35CM RPD RELS PRLL FLXR CNT CHNL HDRPH URET,$325.00,$0.00,$325.00,$176.48,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
G56438,SUP,HCPCS C1894,,G56438  -  SHEATH ESCP 12FR 45CM STRL PRLL FLXR DIL HDRPH URETER DISP,$325.00,$0.00,$325.00,$176.48,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
G56439,SUP,HCPCS C1894,,G56439  -  SHEATH ESCP 12FR 55CM STRL PRLL FLXR DIL HDRPH URETER DISP,$325.00,$0.00,$325.00,$176.48,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
G56440,SUP,HCPCS C1894,,G56440  -  SHEATH ESCP 14FR 20CM STRL PRLL FLXR DIL HDRPH URETER DISP,$325.00,$0.00,$325.00,$176.48,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
G56441,SUP,HCPCS C1894,,G56441  -  SHEATH ACC 14FR 28CM RPD RELS PRLL FLXR CNT CHNL HDRPH URET,$325.00,$0.00,$325.00,$176.48,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
G56442,SUP,HCPCS C1894,,G56442  -  SHEATH ACC 14FR 35CM RPD RELS PRLL FLXR CNT CHNL HDRPH URET,$325.00,$0.00,$325.00,$176.48,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
G56443,SUP,HCPCS C1894,,G56443  -  SHEATH ESCP 14FR 45CM STRL PRLL FLXR DIL HDRPH URETER DISP,$325.00,$0.00,$325.00,$176.48,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
G56445,SUP,HCPCS C1894,,G56445  -  SHEATH ESCP 14FR 55CM STRL PRLL FLXR DIL HDRPH URETER DISP,$325.00,$0.00,$325.00,$176.48,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
G56446,SUP,HCPCS C1894,,G56446  -  SHEATH ESCP 9.5FR 13CM STRL PRLL FLXR DIL HDRPH URETER DISP,$325.00,$0.00,$325.00,$176.48,$231.95,$0.00,$56.00,$0.00,$0.00,$56.90,$325.00,$0.00,$162.50,$257.40,$260.00,$0.00,$50.86,$0.00,$51.74,$0.00
G56537,SUP,Custom 27203010,,G56537  -  TRAY SURG 14FR 18GA 29CM 5CM 19 SIDEPORT CATHETER ECHOGENIC,$829.98,$0.00,$829.98,$0.00,$592.36,$0.00,$0.00,$0.00,$0.00,$0.00,$829.98,$0.00,$414.99,$657.34,$663.98,$0.00,$0.00,$0.00,$0.00,$0.00
GA3501,SUP,HCPCS C1769,,GA3501  -  GUIDEWIRE VASC ANG .035IN 180CM 25CM GLDWR ADV PTFE NTNL,$400.00,$0.00,$400.00,$217.20,$285.48,$0.00,$68.92,$0.00,$0.00,$70.04,$400.00,$0.00,$200.00,$316.80,$320.00,$0.00,$62.60,$0.00,$63.68,$0.00
GA3502,SUP,HCPCS C1769,,GA3502  -  GUIDEWIRE VASCULAR ANGLED .035IN 260CM 25CM GLIDEWIRE,$450.00,$0.00,$450.00,$244.35,$321.17,$0.00,$77.53,$0.00,$0.00,$78.79,$450.00,$0.00,$225.00,$356.40,$360.00,$0.00,$70.43,$0.00,$71.64,$0.00
GD-1115-100,SUP,Custom 27203010,,GD-1115-100  -  CANNULA ASCP 10CM OSTEOPRECISION VNT,"$1,875.00",$0.00,"$1,875.00",$0.00,"$1,338.19",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$0.00,$0.00,$0.00,$0.00
GEM1521,SUP,Custom 27203010,,GEM1521  -  CLIP HEMOSTATIC 30 CARTRIDGE SUPERFINE GEM BLUE TITANIUM,$29.17,$0.00,$29.17,$0.00,$20.82,$0.00,$0.00,$0.00,$0.00,$0.00,$29.17,$0.00,$14.58,$23.10,$23.33,$0.00,$0.00,$0.00,$0.00,$0.00
GEM2431,SUP,Custom 27203010,,GEM2431  -  CLIP INTNL MIC GM CRTDG TI HMST,$25.83,$0.00,$25.83,$0.00,$18.44,$0.00,$0.00,$0.00,$0.00,$0.00,$25.83,$0.00,$12.92,$20.46,$20.67,$0.00,$0.00,$0.00,$0.00,$0.00
GEM2751,SUP,Custom 27803010,,GEM2751  -  COUPLER ANSTM 1.5MM STRL GM MCVSC ANSTM DISP,$645.83,$0.00,$645.83,$0.00,$460.93,$0.00,$0.00,$0.00,$0.00,$0.00,$645.83,$0.00,$322.92,$511.50,$516.67,$0.00,$0.00,$0.00,$0.00,$0.00
GEM2752,SUP,Custom 27803010,,GEM2752  -  COUPLER ANSTM 20MHZ 2MM STRL LF GM RING PIN US DPLR SS DISP,$747.92,$0.00,$747.92,$0.00,$533.79,$0.00,$0.00,$0.00,$0.00,$0.00,$747.92,$0.00,$373.96,$592.35,$598.33,$0.00,$0.00,$0.00,$0.00,$0.00
GEM2753,SUP,Custom 27803010,,GEM2753  -  COUPLER ANSTM 20MHZ 2.5MM STRL LF GM RING PIN US DPLR SS,$747.92,$0.00,$747.92,$0.00,$533.79,$0.00,$0.00,$0.00,$0.00,$0.00,$747.92,$0.00,$373.96,$592.35,$598.33,$0.00,$0.00,$0.00,$0.00,$0.00
GEM2754,SUP,Custom 27803010,,GEM2754  -  COUPLER ANSTM 3MM STRL GM MCVSC DISP,$747.92,$0.00,$747.92,$0.00,$533.79,$0.00,$0.00,$0.00,$0.00,$0.00,$747.92,$0.00,$373.96,$592.35,$598.33,$0.00,$0.00,$0.00,$0.00,$0.00
GEM2756,SUP,Custom 27803010,,GEM2756  -  COUPLER ANSTM 4MM STRL GM MCVSC ANSTM DISP,$747.92,$0.00,$747.92,$0.00,$533.79,$0.00,$0.00,$0.00,$0.00,$0.00,$747.92,$0.00,$373.96,$592.35,$598.33,$0.00,$0.00,$0.00,$0.00,$0.00
GEZ6200US7B,SUP,HCPCS C1757,,GEZ6200US7B  -  CATHETER THROMBECTOMY 7FR .08IN 145CM ASPIRAT FULL-WALL,"$1,425.00",$0.00,"$1,425.00",$0.00,"$1,017.02",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,425.00",$0.00,$712.50,"$1,128.60","$1,140.00",$0.00,$0.00,$0.00,$0.00,$0.00
GFS-10A,SUP,Custom 27203010,,GFS-10A  -  PASSER SUT STRL LF GAB/FRAT GD ORG VLV IMPL,$950.18,$0.00,$950.18,$0.00,$678.14,$0.00,$0.00,$0.00,$0.00,$0.00,$950.18,$0.00,$475.09,$752.54,$760.14,$0.00,$0.00,$0.00,$0.00,$0.00
GFS-1A,SUP,Custom 27203010,,GFS-1A  -  PASSER SUTURE GUIDE ORGANIZER LATEX FREE GABBAY-FRATER VALVE,$403.53,$0.00,$403.53,$0.00,$288.00,$0.00,$0.00,$0.00,$0.00,$0.00,$403.53,$0.00,$201.76,$319.60,$322.82,$0.00,$0.00,$0.00,$0.00,$0.00
GH-05501,SUP,HCPCS C1729,,KIT EPDRL 9.84CM 17GA CATH,$90.80,$0.00,$90.80,$49.30,$64.80,$0.00,$15.64,$0.00,$0.00,$15.90,$90.80,$0.00,$45.40,$71.91,$72.64,$0.00,$14.21,$0.00,$14.46,$0.00
GIA10038L,SUP,Custom 27203010,,GIA10038L  -  RELOAD STPLR 100MMX3.8MM BLU STRL LF 1.5MM DST GIA 4 ROW LNR,$272.12,$0.00,$272.12,$0.00,$194.21,$0.00,$0.00,$0.00,$0.00,$0.00,$272.12,$0.00,$136.06,$215.52,$217.70,$0.00,$0.00,$0.00,$0.00,$0.00
GIA10038S,SUP,Custom 27203010,,GIA10038S  -  STAPLER INTERNAL 100MMX3.8MM 1.5MM 2 STAGGER ROW STAPLE LOAD,$522.24,$0.00,$522.24,$0.00,$372.72,$0.00,$0.00,$0.00,$0.00,$0.00,$522.24,$0.00,$261.12,$413.61,$417.79,$0.00,$0.00,$0.00,$0.00,$0.00
GIA10048L,SUP,Custom 27203010,,GIA10048L  -  RELOAD STPLR 100MMX4.8MM GRN STRL LF 2MM DST GIA 4 ROW LNR,$275.04,$0.00,$275.04,$0.00,$196.30,$0.00,$0.00,$0.00,$0.00,$0.00,$275.04,$0.00,$137.52,$217.83,$220.03,$0.00,$0.00,$0.00,$0.00,$0.00
GIA10048S,SUP,Custom 27203010,,GIA10048S  -  STAPLER INTERNAL 104MMX4.8MM 2MM 2 STAGGER ROW STAPLE LOAD,$564.67,$0.00,$564.67,$0.00,$403.00,$0.00,$0.00,$0.00,$0.00,$0.00,$564.67,$0.00,$282.34,$447.22,$451.74,$0.00,$0.00,$0.00,$0.00,$0.00
GIA6025L,SUP,Custom 27203010,,GIA6025L  -  RELOAD STPLR 60MMX2.5MM WHT STRL LF 1MM DST GIA 4 ROW LNR,$128.02,$0.00,$128.02,$0.00,$91.37,$0.00,$0.00,$0.00,$0.00,$0.00,$128.02,$0.00,$64.01,$101.39,$102.41,$0.00,$0.00,$0.00,$0.00,$0.00
GIA6038L,SUP,Custom 27203010,,GIA6038L  -  RELOAD STPLR 60MMX3.8MM BLU STRL LF 1.5MM DST GIA 4 ROW LNR,$118.86,$0.00,$118.86,$0.00,$84.83,$0.00,$0.00,$0.00,$0.00,$0.00,$118.86,$0.00,$59.43,$94.14,$95.09,$0.00,$0.00,$0.00,$0.00,$0.00
GIA6038S,SUP,Custom 27203010,,GIA6038S  -  STAPLER INTERNAL TEARDROP 60MMX3.8MM 1.5MM 4 ROW 2 STAGGER,$226.14,$0.00,$226.14,$0.00,$161.40,$0.00,$0.00,$0.00,$0.00,$0.00,$226.14,$0.00,$113.07,$179.10,$180.91,$0.00,$0.00,$0.00,$0.00,$0.00
GIA6048L,SUP,Custom 27203010,,GIA6048L  -  RELOAD STPLR 60MMX4.8MM GRN STRL LF 2MM DST GIA 4 ROW LNR,$117.13,$0.00,$117.13,$0.00,$83.60,$0.00,$0.00,$0.00,$0.00,$0.00,$117.13,$0.00,$58.57,$92.77,$93.70,$0.00,$0.00,$0.00,$0.00,$0.00
GIA6048S,SUP,Custom 27203010,,GIA6048S  -  STAPLER INTERNAL TEARDROP 60MMX4.8MM 2MM 4 ROW 2 STAGGER,$228.58,$0.00,$228.58,$0.00,$163.14,$0.00,$0.00,$0.00,$0.00,$0.00,$228.58,$0.00,$114.29,$181.04,$182.86,$0.00,$0.00,$0.00,$0.00,$0.00
GIA8038L,SUP,Custom 27203010,,GIA8038L  -  RELOAD STPLR 80MMX3.8MM BLU STRL LF 1.5MM DST GIA 4 ROW LNR,$173.77,$0.00,$173.77,$0.00,$124.02,$0.00,$0.00,$0.00,$0.00,$0.00,$173.77,$0.00,$86.88,$137.63,$139.01,$0.00,$0.00,$0.00,$0.00,$0.00
GIA8038S,SUP,Custom 27203010,,GIA8038S  -  STAPLER INTERNAL TEARDROP 80MMX3.8MM 1.5MM 4 ROW 2 STAGGER,$333.25,$0.00,$333.25,$0.00,$237.84,$0.00,$0.00,$0.00,$0.00,$0.00,$333.25,$0.00,$166.63,$263.93,$266.60,$0.00,$0.00,$0.00,$0.00,$0.00
GIA8048L,SUP,Custom 27203010,,GIA8048L  -  RELOAD STPLR 80MMX4.8MM GRN STRL LF 2MM DST GIA 4 ROW LNR,$173.77,$0.00,$173.77,$0.00,$124.02,$0.00,$0.00,$0.00,$0.00,$0.00,$173.77,$0.00,$86.88,$137.63,$139.01,$0.00,$0.00,$0.00,$0.00,$0.00
GIA8048S,SUP,Custom 27203010,,GIA8048S  -  STAPLER INTERNAL TEARDROP 80MMX4.8MM 2MM 4 ROW 2 STAGGER,$336.83,$0.00,$336.83,$0.00,$240.39,$0.00,$0.00,$0.00,$0.00,$0.00,$336.83,$0.00,$168.41,$266.77,$269.46,$0.00,$0.00,$0.00,$0.00,$0.00
GJ44,SUP,HCPCS Q4107,,GJ44  -  GRAFT SKIN 4CMX4CMX.38-1.02MM GRAFTJACKET THK.4-.8MM REGENER,"$4,302.50",$0.00,"$4,302.50",$0.00,"$3,070.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,302.50",$0.00,"$2,151.25","$3,407.58","$3,442.00",$0.00,$0.00,$0.00,$0.00,$0.00
GJ48,SUP,HCPCS Q4107,,GJ48  -  GRAFT SKIN 8CMX4CMX.38-1.02MM GRAFTJACKET THK.4-.8MM REGENER,"$7,570.20",$0.00,"$7,570.20",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,570.20",$0.00,"$3,785.10","$5,995.60","$6,056.16",$0.00,$0.00,$0.00,$0.00,$0.00
GJX,SUP,HCPCS Q4113,,GJX  -  GRAFT SKN 2ML GTJKT XPRESS SFT TIS SCFLD FLW ACLR DRML MTRX,"$4,840.00",$0.00,"$4,840.00",$0.00,"$3,454.31",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,840.00",$0.00,"$2,420.00","$3,833.28","$3,872.00",$0.00,$0.00,$0.00,$0.00,$0.00
GLU-50122,SUP,HCPCS A6196,,GLU-50122  -  DRESSING WND 12X5IN STRL LF GLUCAN II B GLUCAN CLGN DISP,$170.71,$0.00,$170.71,$92.69,$121.83,$0.00,$6.91,$0.00,$0.00,$29.89,$170.71,$0.00,$85.35,$135.20,$136.57,$0.00,$26.72,$0.00,$27.18,$0.00
GM1253-1720,SUP,Custom 27203010,,GM1253-1720  -  SET 3 NEEDLES W/MARKER 1.2X5MM,$225.00,$0.00,$225.00,$0.00,$160.58,$0.00,$0.00,$0.00,$0.00,$0.00,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$0.00,$0.00,$0.00,$0.00
GM1601,SUP,HCPCS C1769,,GM1601  -  GWIRE VASC 45D .016IN 180CM 2MM ANG FLX TP TRQ DEV GLDWR GL,$725.00,$0.00,$725.00,$393.68,$517.43,$0.00,$124.91,$0.00,$0.00,$126.94,$725.00,$0.00,$362.50,$574.20,$580.00,$0.00,$113.46,$0.00,$115.42,$0.00
GMN-DSP-160,SUP,HCPCS C1713,,"GMN-DSP-160  -  PLATE DORSAL SPANNING, SHORT","$2,990.00",$0.00,"$2,990.00","$1,345.50","$2,133.96",$0.00,$515.16,$0.00,$0.00,$523.53,"$2,990.00",$0.00,"$1,495.00","$2,368.08","$2,392.00",$0.00,$467.94,$0.00,$476.01,$0.00
GMN-DSP-210,SUP,HCPCS C1713,,GMN-DSP-210  -  PLATE DORSAL SPANNING,"$2,990.00",$0.00,"$2,990.00","$1,345.50","$2,133.96",$0.00,$515.16,$0.00,$0.00,$523.53,"$2,990.00",$0.00,"$1,495.00","$2,368.08","$2,392.00",$0.00,$467.94,$0.00,$476.01,$0.00
GMN-HP,SUP,HCPCS C1713,,GMN-HP  -  PLATE BN GEMINUS HK VOLR,$990.00,$0.00,$990.00,$445.50,$706.56,$0.00,$170.57,$0.00,$0.00,$173.34,$990.00,$0.00,$495.00,$784.08,$792.00,$0.00,$154.94,$0.00,$157.61,$0.00
GMN-HP-SCRW,SUP,HCPCS C1713,,GMN-HP-SCRW  -  PLATE BN GEMINUS HK SCR VOLR,$175.00,$0.00,$175.00,$78.75,$124.90,$0.00,$30.15,$0.00,$0.00,$30.64,$175.00,$0.00,$87.50,$138.60,$140.00,$0.00,$27.39,$0.00,$27.86,$0.00
GMN-LTN-3HL,SUP,HCPCS C1713,,GMN-LTN-3HL  -  PLATE BN NAR NS GEMINUS 3 HL TI LT DIST VOLR RDS FOSSA,"$1,990.00",$0.00,"$1,990.00",$895.50,"$1,420.26",$0.00,$342.87,$0.00,$0.00,$348.43,"$1,990.00",$0.00,$995.00,"$1,576.08","$1,592.00",$0.00,$311.44,$0.00,$316.81,$0.00
GMN-LTN-4HL,SUP,HCPCS C1713,,GMN-LTN-4HL  -  PLATE BN NAR NS GEMINUS 4 HL TI LT DIST VOLR RDS FOSSA,"$1,990.00",$0.00,"$1,990.00",$895.50,"$1,420.26",$0.00,$342.87,$0.00,$0.00,$348.43,"$1,990.00",$0.00,$995.00,"$1,576.08","$1,592.00",$0.00,$311.44,$0.00,$316.81,$0.00
GMN-LTS-3HL,SUP,HCPCS C1713,,GMN-LTS-3HL  -  PLATE BN STD NS GEMINUS 3 HL TI RDS LT VOLR DIST,"$2,237.50",$0.00,"$2,237.50","$1,006.88","$1,596.90",$0.00,$385.51,$0.00,$0.00,$391.77,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$350.17,$0.00,$356.21,$0.00
GMN-LTS-4HL,SUP,HCPCS C1713,,GMN-LTS-4HL  -  PLATE BN STD NS GEMINUS 4 HL TI LT DIST VOLR RDS FOSSA,"$1,990.00",$0.00,"$1,990.00",$895.50,"$1,420.26",$0.00,$342.87,$0.00,$0.00,$348.43,"$1,990.00",$0.00,$995.00,"$1,576.08","$1,592.00",$0.00,$311.44,$0.00,$316.81,$0.00
GMN-LTS-7HL,SUP,HCPCS C1713,,GMN-LTS-7HL  -  PLATE BN STD NS GEMINUS 7 HL TI LT DIST VOLR RDS FOSSA,"$2,190.00",$0.00,"$2,190.00",$985.50,"$1,563.00",$0.00,$377.33,$0.00,$0.00,$383.45,"$2,190.00",$0.00,"$1,095.00","$1,734.48","$1,752.00",$0.00,$342.74,$0.00,$348.65,$0.00
GMN-LTW-4HL,SUP,HCPCS C1713,,GMN-LTW-4HL  -  PLATE BN W NS GEMINUS 4 HL TI LT DIST VOLR RDS FOSSA,"$1,990.00",$0.00,"$1,990.00",$895.50,"$1,420.26",$0.00,$342.87,$0.00,$0.00,$348.43,"$1,990.00",$0.00,$995.00,"$1,576.08","$1,592.00",$0.00,$311.44,$0.00,$316.81,$0.00
GMN-RTN-3HL,SUP,HCPCS C1713,,GMN-RTN-3HL  -  PLATE BN NAR NS GEMINUS 3 HL TI RT DIST VOLR RDS FOSSA,"$1,990.00",$0.00,"$1,990.00",$895.50,"$1,420.26",$0.00,$342.87,$0.00,$0.00,$348.43,"$1,990.00",$0.00,$995.00,"$1,576.08","$1,592.00",$0.00,$311.44,$0.00,$316.81,$0.00
GMN-RTN-4HL,SUP,HCPCS C1713,,GMN-RTN-4HL  -  PLATE BN NAR NS GEMINUS 4 HL TI RT DIST VOLR RDS FOSSA,"$1,990.00",$0.00,"$1,990.00",$895.50,"$1,420.26",$0.00,$342.87,$0.00,$0.00,$348.43,"$1,990.00",$0.00,$995.00,"$1,576.08","$1,592.00",$0.00,$311.44,$0.00,$316.81,$0.00
GMN-RTS-3HL,SUP,HCPCS C1713,,GMN-RTS-3HL  -  PLATE BN STD NS GEMINUS 3 HL TI RT DIST VOLR RDS,"$1,990.00",$0.00,"$1,990.00",$895.50,"$1,420.26",$0.00,$342.87,$0.00,$0.00,$348.43,"$1,990.00",$0.00,$995.00,"$1,576.08","$1,592.00",$0.00,$311.44,$0.00,$316.81,$0.00
GMN-RTS-4HL,SUP,HCPCS C1713,,GMN-RTS-4HL  -  PLATE BN STD NS GEMINUS 4 HL TI RT DIST VOLR RDS FOSSA,"$1,990.00",$0.00,"$1,990.00",$895.50,"$1,420.26",$0.00,$342.87,$0.00,$0.00,$348.43,"$1,990.00",$0.00,$995.00,"$1,576.08","$1,592.00",$0.00,$311.44,$0.00,$316.81,$0.00
GMN-RTS-7HL,SUP,HCPCS C1713,,GMN-RTS-7HL  -  PLATE BN STD NS GEMINUS 7 HL TI RDS RT FOSSA DIST,"$2,190.00",$0.00,"$2,190.00",$985.50,"$1,563.00",$0.00,$377.33,$0.00,$0.00,$383.45,"$2,190.00",$0.00,"$1,095.00","$1,734.48","$1,752.00",$0.00,$342.74,$0.00,$348.65,$0.00
GMN-RTW-4HL,SUP,HCPCS C1713,,GMN-RTW-4HL  -  PLATE BN W NS GEMINUS 4 HL TI RDS RT DIST FOSSA,"$1,990.00",$0.00,"$1,990.00",$895.50,"$1,420.26",$0.00,$342.87,$0.00,$0.00,$348.43,"$1,990.00",$0.00,$995.00,"$1,576.08","$1,592.00",$0.00,$311.44,$0.00,$316.81,$0.00
GN1000,SUP,Custom 27803010,,GN1000  -  KIT SNR 10MM 4FR 120CM 102CM AGN CATH PREFORM LOOP RADOPQ,$825.00,$0.00,$825.00,$0.00,$588.80,$0.00,$0.00,$0.00,$0.00,$0.00,$825.00,$0.00,$412.50,$653.40,$660.00,$0.00,$0.00,$0.00,$0.00,$0.00
GN1500,SUP,Custom 27203010,,GN1500  -  KIT VASC 120CM 15MM 6FR AGN NTNL GOLD TUNG LOOP CATH NTNL,$675.00,$0.00,$675.00,$0.00,$481.75,$0.00,$0.00,$0.00,$0.00,$0.00,$675.00,$0.00,$337.50,$534.60,$540.00,$0.00,$0.00,$0.00,$0.00,$0.00
GN2500,SUP,Custom 27803010,,GN2500  -  KIT SNR 25MM 6FR 120CM 102CM AGN CATH PREFORM LOOP RADOPQ,$800.00,$0.00,$800.00,$0.00,$570.96,$0.00,$0.00,$0.00,$0.00,$0.00,$800.00,$0.00,$400.00,$633.60,$640.00,$0.00,$0.00,$0.00,$0.00,$0.00
GN500,SUP,Custom 27803010,,GN500  -  KIT SNR 5MM 4FR 120CM 102CM AGN CATH PREFORM LOOP RADOPQ,$675.00,$0.00,$675.00,$0.00,$481.75,$0.00,$0.00,$0.00,$0.00,$0.00,$675.00,$0.00,$337.50,$534.60,$540.00,$0.00,$0.00,$0.00,$0.00,$0.00
GOLD-18,SUP,HCPCS L8610,,GOLD-18  -  WEIGHT EYELID 3 SUTURE HOLE SUTUREGROOVE GOLD 1.8GM STERILE,$800.00,$0.00,$800.00,$360.00,$570.96,$0.00,$482.85,$0.00,$0.00,$140.07,$800.00,$0.00,$400.00,$633.60,$640.00,$0.00,$125.20,$0.00,$127.36,$0.00
GPSL,SUP,HCPCS C1781,,GPSL  -  MESH SURG GYNMSH 6X4IN PLVC NABSB SFT KNTD LTWT STRL POLYPRO,$847.00,$0.00,$847.00,$381.15,$604.50,$0.00,$145.93,$0.00,$0.00,$148.30,$847.00,$0.00,$423.50,$670.82,$677.60,$0.00,$132.56,$0.00,$134.84,$0.00
GPSXL3,SUP,HCPCS C1781,,GPSXL3  -  MESH SURG 25X25CM SOFT KNIT NONABSORBABLE GYNECARE GYNEMESH,"$4,367.00",$0.00,"$4,367.00","$1,965.15","$3,116.73",$0.00,$752.41,$0.00,$0.00,$764.63,"$4,367.00",$0.00,"$2,183.50","$3,458.66","$3,493.60",$0.00,$683.44,$0.00,$695.23,$0.00
GR1807,SUP,HCPCS C1769,,GR1807  -  GUIDEWIRE VASCULAR ANGLE .018IN 260CM 3CM GLIDEWIRE HYDPHI,$975.00,$0.00,$975.00,$529.43,$695.86,$0.00,$167.99,$0.00,$0.00,$170.71,$975.00,$0.00,$487.50,$772.20,$780.00,$0.00,$152.59,$0.00,$155.22,$0.00
GR3501,SUP,HCPCS C1769,,GR3501  -  GUIDEWIRE VASC STRG .035IN 150CM 3CM GLDWR STF SHFT HDRPH,$72.50,$0.00,$72.50,$39.37,$51.74,$0.00,$12.49,$0.00,$0.00,$12.69,$72.50,$0.00,$36.25,$57.42,$58.00,$0.00,$11.35,$0.00,$11.54,$0.00
GR3503,SUP,HCPCS C1769,,GR3503  -  GUIDEWIRE VASCULAR STANDARD STR .035IN 180CM 3CM JACKET CORE,$99.25,$0.00,$99.25,$53.89,$70.83,$0.00,$17.10,$0.00,$0.00,$17.38,$99.25,$0.00,$49.63,$78.61,$79.40,$0.00,$15.53,$0.00,$15.80,$0.00
GR3504,SUP,HCPCS C1769,,GR3504  -  GUIDEWIRE VASCULAR STANDARD STR .035IN 260CM 3CM JACKET CORE,$111.00,$0.00,$111.00,$60.27,$79.22,$0.00,$19.12,$0.00,$0.00,$19.44,$111.00,$0.00,$55.50,$87.91,$88.80,$0.00,$17.37,$0.00,$17.67,$0.00
GR3508,SUP,HCPCS C1769,,GR3508  -  GUIDEWIRE VASCULAR ANGLE STANDARD .035IN 180CM 3CM JACKET,$99.25,$0.00,$99.25,$53.89,$70.83,$0.00,$17.10,$0.00,$0.00,$17.38,$99.25,$0.00,$49.63,$78.61,$79.40,$0.00,$15.53,$0.00,$15.80,$0.00
GR3509,SUP,HCPCS C1769,,GUIDEWIRE VASC .035IN 260CM 3CM ANG FLX TP STD GLDWR GR3509,$118.60,$0.00,$118.60,$64.40,$84.64,$0.00,$20.43,$0.00,$0.00,$20.77,$118.60,$0.00,$59.30,$93.93,$94.88,$0.00,$18.56,$0.00,$18.88,$0.00
GR3807,SUP,HCPCS C1769,,GR3807  -  GUIDEWIRE VASCULAR ANGLED .038IN 150CM 8CM GLIDEWIRE HYDPHI,$81.75,$0.00,$81.75,$44.39,$58.34,$0.00,$14.09,$0.00,$0.00,$14.31,$81.75,$0.00,$40.88,$64.75,$65.40,$0.00,$12.79,$0.00,$13.01,$0.00
GR3808,SUP,HCPCS C1769,,GR3808  -  GUIDEWIRE VASCULAR ANGLED .038IN 180CM 3CM GLIDEWIRE HYDPHI,$99.25,$0.00,$99.25,$53.89,$70.83,$0.00,$17.10,$0.00,$0.00,$17.38,$99.25,$0.00,$49.63,$78.61,$79.40,$0.00,$15.53,$0.00,$15.80,$0.00
GR3809,SUP,HCPCS C1769,,GR3809  -  GUIDEWIRE VASCULAR ANGLED .038IN 260CM 3CM GLIDEWIRE HYDPHI,$111.00,$0.00,$111.00,$60.27,$79.22,$0.00,$19.12,$0.00,$0.00,$19.44,$111.00,$0.00,$55.50,$87.91,$88.80,$0.00,$17.37,$0.00,$17.67,$0.00
GR74089-02,SUP,Custom 27203010,,GR74089-02  -  BAG TISS CLSR 7.5CM DRAIN WL DFCT 7.5CM SILO STRL DISP SIL,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
GRAD0026-06,SUP,HCPCS C1751,,GRAD0026-06  -  TRAY SRG STRL PICC CTH LB RAD,$88.91,$0.00,$88.91,$48.28,$63.46,$0.00,$15.32,$0.00,$0.00,$15.57,$88.91,$0.00,$44.46,$70.42,$71.13,$0.00,$13.92,$0.00,$14.16,$0.00
GRAD0027-05,SUP,Custom 27203010,,GRAD0027-05  -  TRAY SRG STRL VNS ACC CTH LB RAD,$117.73,$0.00,$117.73,$0.00,$84.03,$0.00,$0.00,$0.00,$0.00,$0.00,$117.73,$0.00,$58.87,$93.24,$94.19,$0.00,$0.00,$0.00,$0.00,$0.00
GRAD0058-03,SUP,Custom 27203010,,GRAD0058-03  -  TRAY NEURO ANGIO,$131.43,$0.00,$131.43,$0.00,$93.80,$0.00,$0.00,$0.00,$0.00,$0.00,$131.43,$0.00,$65.71,$104.09,$105.14,$0.00,$0.00,$0.00,$0.00,$0.00
GRAD0059-03,SUP,Custom 27203010,,GRAD0059-03  -  TRAY BX STRL LF AVID TRUCUSTOM DISP,$52.27,$0.00,$52.27,$0.00,$37.31,$0.00,$0.00,$0.00,$0.00,$0.00,$52.27,$0.00,$26.14,$41.40,$41.82,$0.00,$0.00,$0.00,$0.00,$0.00
GS3503,SUP,HCPCS C1769,,GS3503  -  GUIDEWIRE VASCULAR STR .035IN 180CM 3CM STIFF SHAFT,$116.75,$0.00,$116.75,$63.40,$83.32,$0.00,$20.12,$0.00,$0.00,$20.44,$116.75,$0.00,$58.38,$92.47,$93.40,$0.00,$18.27,$0.00,$18.59,$0.00
GS3504,SUP,HCPCS C1769,,GS3504  -  GUIDEWIRE VASCULAR STR .035IN 260CM 3CM STIFF SHAFT FLEXIBLE,$124.63,$0.00,$124.63,$67.67,$88.94,$0.00,$21.47,$0.00,$0.00,$21.82,$124.63,$0.00,$62.31,$98.71,$99.70,$0.00,$19.50,$0.00,$19.84,$0.00
GS3506,SUP,HCPCS C1769,,GS3506  -  GUIDEWIRE VASCULAR ANGLE .035IN 150CM 3CM FLEXIBLE TIP STIFF,$112.88,$0.00,$112.88,$61.29,$80.56,$0.00,$19.45,$0.00,$0.00,$19.76,$112.88,$0.00,$56.44,$89.40,$90.30,$0.00,$17.66,$0.00,$17.97,$0.00
GS3508,SUP,HCPCS C1769,,GS3508  -  GUIDEWIRE VASCULAR ANGLE .035IN 180CM 3CM STIFF SHAFT,$116.75,$0.00,$116.75,$63.40,$83.32,$0.00,$20.12,$0.00,$0.00,$20.44,$116.75,$0.00,$58.38,$92.47,$93.40,$0.00,$18.27,$0.00,$18.59,$0.00
GS3509,SUP,HCPCS C1769,,GS3509  -  GUIDEWIRE VASCULAR ANGLE .035IN 260CM 3CM STIFF SHAFT,$124.63,$0.00,$124.63,$67.67,$88.94,$0.00,$21.47,$0.00,$0.00,$21.82,$124.63,$0.00,$62.31,$98.71,$99.70,$0.00,$19.50,$0.00,$19.84,$0.00
GS3807,SUP,HCPCS C1769,,GS3807  -  GUIDEWIRE VASCULAR ANGLE .038IN 180CM 3CM STIFF SHAFT,$116.75,$0.00,$116.75,$63.40,$83.32,$0.00,$20.12,$0.00,$0.00,$20.44,$116.75,$0.00,$58.38,$92.47,$93.40,$0.00,$18.27,$0.00,$18.59,$0.00
GSLM-14,SUP,HCPCS L8610,,GSLM-14  -  WEIGHT EYELID SLIM SUTUREGROOVE THK.75MM GOLD 1.4GM STERILE,$700.00,$0.00,$700.00,$315.00,$499.59,$0.00,$482.85,$0.00,$0.00,$122.56,$700.00,$0.00,$350.00,$554.40,$560.00,$0.00,$109.55,$0.00,$111.44,$0.00
GSLM-16,SUP,HCPCS L8610,,GSLM-16  -  WEIGHT EYELID SLIM SUTUREGROOVE THK.75MM GOLD 1.6GM STERILE,$750.00,$0.00,$750.00,$337.50,$535.28,$0.00,$482.85,$0.00,$0.00,$131.32,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$117.38,$0.00,$119.40,$0.00
GST45B,SUP,Custom 27203010,,GST45B  -  RELOAD STPLR 45MMX3.6MM BLU STRL LF 1.5MM ECHLN EPTH ECHLN,$891.00,$0.00,$891.00,$0.00,$635.91,$0.00,$0.00,$0.00,$0.00,$0.00,$891.00,$0.00,$445.50,$705.67,$712.80,$0.00,$0.00,$0.00,$0.00,$0.00
GST45G,SUP,Custom 27203010,,GST45G  -  RELOAD STPLR 45MMX4.1MM GRN STRL LF 2MM ECHLN EPTH ECHLN FLX,"$10,534.03",$0.00,"$10,534.03",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$10,534.03",$0.00,"$5,267.01","$8,342.95","$8,427.22",$0.00,$0.00,$0.00,$0.00,$0.00
GST45W,SUP,Custom 27203010,,GST45W  -  RELOAD STPLR 45MMX2.6MM WHT STRL LF 1MM ECHLN EPTH ECHLN FLX,$877.84,$0.00,$877.84,$0.00,$626.51,$0.00,$0.00,$0.00,$0.00,$0.00,$877.84,$0.00,$438.92,$695.25,$702.27,$0.00,$0.00,$0.00,$0.00,$0.00
GST60G,SUP,Custom 27203010,,GST60G  -  RELOAD STPLR 60MMX4.1MM GRN STRL LF 2MM ECHLN EPTH ECHLN FLX,$949.21,$0.00,$949.21,$0.00,$677.45,$0.00,$0.00,$0.00,$0.00,$0.00,$949.21,$0.00,$474.60,$751.77,$759.37,$0.00,$0.00,$0.00,$0.00,$0.00
GST60W,SUP,Custom 27203010,,GST60W  -  RELOAD STPLR 60MMX2.6MM WHT STRL LF 1MM ECHLN EPTH ECHLN FLX,$949.21,$0.00,$949.21,$0.00,$677.45,$0.00,$0.00,$0.00,$0.00,$0.00,$949.21,$0.00,$474.60,$751.77,$759.37,$0.00,$0.00,$0.00,$0.00,$0.00
GTK14,SUP,Custom 27203010,,GTK14  -  SYSTEM XTRT 14CM ALEXIS KII SPEC CNTN BG BLN BLNT TPGRD,$487.50,$0.00,$487.50,$0.00,$347.93,$0.00,$0.00,$0.00,$0.00,$0.00,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$0.00,$0.00,$0.00,$0.00
GTK17,SUP,Custom 27203010,,GTK17  -  SYSTEM XTRT 12X100MM 6500ML ALEXIS BLN BLNT TIP CNTN,$487.50,$0.00,$487.50,$0.00,$347.93,$0.00,$0.00,$0.00,$0.00,$0.00,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$0.00,$0.00,$0.00,$0.00
GYN-0480,SUP,Custom 27203010,,KIT SRPTH PK LAB CYTO 480 TST,"$7,380.00",$0.00,"$7,380.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,380.00",$0.00,"$3,690.00","$5,844.96","$5,904.00",$0.00,$0.00,$0.00,$0.00,$0.00
GYN-0500-B,SUP,Custom 27203010,,BRUSH CYTO BLUE BRM HNDL,$10.90,$0.00,$10.90,$0.00,$7.78,$0.00,$0.00,$0.00,$0.00,$0.00,$10.90,$0.00,$5.45,$8.63,$8.72,$0.00,$0.00,$0.00,$0.00,$0.00
H1058,SUP,Custom 27203010,,MASK O2 PED NREB,$8.00,$0.00,$8.00,$0.00,$5.71,$0.00,$0.00,$0.00,$0.00,$0.00,$8.00,$0.00,$4.00,$6.34,$6.40,$0.00,$0.00,$0.00,$0.00,$0.00
H312-4,SUP,Custom 27203010,,CHEMICAL LAB 3% H2O2 AMBR GLS BTL 4L,$460.25,$0.00,$460.25,$0.00,$328.48,$0.00,$0.00,$0.00,$0.00,$0.00,$460.25,$0.00,$230.13,$364.52,$368.20,$0.00,$0.00,$0.00,$0.00,$0.00
H470045A,SUP,HCPCS C1768,,H470045A  -  GRAFT VASCULAR STANDARD WALL TAPER 4-7MM 45CM STRETCH COATED,"$3,147.50",$0.00,"$3,147.50","$1,416.38","$2,246.37",$0.00,$542.30,$0.00,$0.00,$551.10,"$3,147.50",$0.00,"$1,573.75","$2,492.82","$2,518.00",$0.00,$492.58,$0.00,$501.08,$0.00
H74912100012,SUP,HCPCS C1769,,H74912100012  -  GUIDEWIRE VASCULAR STR FLOPPY SPRING COIL .014IN 300CM,$159.25,$0.00,$159.25,$86.47,$113.66,$0.00,$27.44,$0.00,$0.00,$27.88,$159.25,$0.00,$79.63,$126.13,$127.40,$0.00,$24.92,$0.00,$25.35,$0.00
H74912118012,SUP,HCPCS C1769,,H74912118012  -  GUIDEWIRE VASCULAR STR SPRING COIL .014IN 300CM 3CM MODERATE,$796.25,$0.00,$796.25,$432.36,$568.28,$0.00,$137.19,$0.00,$0.00,$139.42,$796.25,$0.00,$398.13,$630.63,$637.00,$0.00,$124.61,$0.00,$126.76,$0.00
H74912119012,SUP,HCPCS C1769,,H74912119012  -  GUIDEWIRE VASCULAR STR SPRING COIL .014IN 300CM EXTRA,$159.25,$0.00,$159.25,$86.47,$113.66,$0.00,$27.44,$0.00,$0.00,$27.88,$159.25,$0.00,$79.63,$126.13,$127.40,$0.00,$24.92,$0.00,$25.35,$0.00
H74912154012,SUP,HCPCS C1769,,H74912154012  -  GUIDEWIRE VASCULAR STR FLOPPY INTERMEDIATE .014IN 300CM 35CM,$159.25,$0.00,$159.25,$86.47,$113.66,$0.00,$27.44,$0.00,$0.00,$27.88,$159.25,$0.00,$79.63,$126.13,$127.40,$0.00,$24.92,$0.00,$25.35,$0.00
H74912155012,SUP,HCPCS C1769,,H74912155012  -  GUIDEWIRE VASCULAR STR .014IN 300CM EXTRA SUPPORT,$159.25,$0.00,$159.25,$86.47,$113.66,$0.00,$27.44,$0.00,$0.00,$27.88,$159.25,$0.00,$79.63,$126.13,$127.40,$0.00,$24.92,$0.00,$25.35,$0.00
H74914090100,SUP,HCPCS C1876,,H74914090100  -  STENT EPRSTH 14MM 90MM 100MM VICI VNS STNT CATH NTNL ACPT,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,$0.00,$0.00,$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
H74916060100,SUP,HCPCS C1876,,H74916060100  -  STENT EPRSTH 16MM 60MM 100MM VICI VNS STNT CATH NTNL ACPT,"$5,000.00",$0.00,"$5,000.00","$2,250.00","$3,568.50",$0.00,$861.48,$0.00,$0.00,$875.46,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$782.50,$0.00,$796.00,$0.00
H74916090100,SUP,HCPCS C1876,,H74916090100  -  STENT EPRSTH 16MM 90MM 100MM VICI VNS STNT CATH NTNL ACPT,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,$0.00,$0.00,$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
H74917521,SUP,HCPCS C1769,,H74917521  -  GUIDEWIRE VASCULAR STR SPRING COIL .014IN 300CM 5CM SUPER,$477.75,$0.00,$477.75,$259.42,$340.97,$0.00,$82.31,$0.00,$0.00,$83.65,$477.75,$0.00,$238.88,$378.38,$382.20,$0.00,$74.77,$0.00,$76.06,$0.00
H749201001900,SUP,HCPCS C1884,,H749201001900  -  SYSTEM EMBOLIC PROTECTION .014IN 110UM 3.2FR 6FR 3.5-5.5MM,"$3,001.25",$0.00,"$3,001.25","$1,350.56","$2,141.99",$0.00,$517.10,$0.00,$0.00,$525.49,"$3,001.25",$0.00,"$1,500.63","$2,376.99","$2,401.00",$0.00,$469.70,$0.00,$477.80,$0.00
H749201003000,SUP,HCPCS C1884,,H749201003000  -  SYSTEM EMBOLIC PROTECTION .014IN 110UM 3.2FR 6FR 3.5-5.5MM,"$3,001.25",$0.00,"$3,001.25","$1,350.56","$2,141.99",$0.00,$517.10,$0.00,$0.00,$525.49,"$3,001.25",$0.00,"$1,500.63","$2,376.99","$2,401.00",$0.00,$469.70,$0.00,$477.80,$0.00
H7492062009150,SUP,HCPCS C1726,,H7492062009150  -  CATH BALDILAT .014IN 3.2-2.3FR 1.5MM 135CM 9MM PTCA OTW TRK,$612.50,$0.00,$612.50,$332.59,$437.14,$0.00,$105.53,$0.00,$0.00,$107.24,$612.50,$0.00,$306.25,$485.10,$490.00,$0.00,$95.86,$0.00,$97.51,$0.00
H7492062009200,SUP,HCPCS C1726,,H7492062009200  -  CATH BALDILAT .014IN 3.2-2.3FR 2MM 135CM 9MM PTCA OTW TRK,$612.50,$0.00,$612.50,$332.59,$437.14,$0.00,$105.53,$0.00,$0.00,$107.24,$612.50,$0.00,$306.25,$485.10,$490.00,$0.00,$95.86,$0.00,$97.51,$0.00
H7492062009250,SUP,HCPCS C1726,,H7492062009250  -  CATH BALDILAT .014IN 3.2-2.4FR 2.5MM 135CM 9MM PTCA OTW TRK,$612.50,$0.00,$612.50,$332.59,$437.14,$0.00,$105.53,$0.00,$0.00,$107.24,$612.50,$0.00,$306.25,$485.10,$490.00,$0.00,$95.86,$0.00,$97.51,$0.00
H7492062009300,SUP,HCPCS C1726,,H7492062009300  -  CATH BALDILAT .014IN 3.2-2.4FR 3MM 135CM 9MM PTCA OTW TRK,$612.50,$0.00,$612.50,$332.59,$437.14,$0.00,$105.53,$0.00,$0.00,$107.24,$612.50,$0.00,$306.25,$485.10,$490.00,$0.00,$95.86,$0.00,$97.51,$0.00
H7492062009350,SUP,HCPCS C1726,,H7492062009350  -  CATH BALDILAT .014IN 3.5MM 135CM 9MM CORON OTW TRK TIP MAV,$612.50,$0.00,$612.50,$332.59,$437.14,$0.00,$105.53,$0.00,$0.00,$107.24,$612.50,$0.00,$306.25,$485.10,$490.00,$0.00,$95.86,$0.00,$97.51,$0.00
H7492062015150,SUP,HCPCS C1726,,H7492062015150  -  CATH BALDILAT .014IN 3.2-2.3FR 1.5MM 135CM 15MM PTCA OTW TRK,$612.50,$0.00,$612.50,$332.59,$437.14,$0.00,$105.53,$0.00,$0.00,$107.24,$612.50,$0.00,$306.25,$485.10,$490.00,$0.00,$95.86,$0.00,$97.51,$0.00
H7492062015200,SUP,HCPCS C1726,,H7492062015200  -  CATH BALDILAT .014IN 3.2-2.3FR 2MM 135CM 15MM PTCA OTW TRK,$612.50,$0.00,$612.50,$332.59,$437.14,$0.00,$105.53,$0.00,$0.00,$107.24,$612.50,$0.00,$306.25,$485.10,$490.00,$0.00,$95.86,$0.00,$97.51,$0.00
H7492062015250,SUP,HCPCS C1726,,H7492062015250  -  CATH BALDILAT .014IN 3.2-2.4FR 2.5MM 135CM 15MM PTCA OTW TRK,$612.50,$0.00,$612.50,$332.59,$437.14,$0.00,$105.53,$0.00,$0.00,$107.24,$612.50,$0.00,$306.25,$485.10,$490.00,$0.00,$95.86,$0.00,$97.51,$0.00
H7492062015270,SUP,HCPCS C1726,,H7492062015270  -  CATH BALDILAT .014IN 2.75MM 135CM 15MM CORON OTW TRK TIP MAV,$612.50,$0.00,$612.50,$332.59,$437.14,$0.00,$105.53,$0.00,$0.00,$107.24,$612.50,$0.00,$306.25,$485.10,$490.00,$0.00,$95.86,$0.00,$97.51,$0.00
H7492062015300,SUP,HCPCS C1726,,H7492062015300  -  CATH BALDILAT .014IN 3.2-2.4FR 3MM 135CM 15MM PTCA OTW TRK,$612.50,$0.00,$612.50,$332.59,$437.14,$0.00,$105.53,$0.00,$0.00,$107.24,$612.50,$0.00,$306.25,$485.10,$490.00,$0.00,$95.86,$0.00,$97.51,$0.00
H7492062015350,SUP,HCPCS C1726,,H7492062015350  -  CATH BALDILAT .014IN 3.2-2.7FR 3.5MM 135CM 15MM PTCA OTW TRK,$612.50,$0.00,$612.50,$332.59,$437.14,$0.00,$105.53,$0.00,$0.00,$107.24,$612.50,$0.00,$306.25,$485.10,$490.00,$0.00,$95.86,$0.00,$97.51,$0.00
H7492062020150,SUP,HCPCS C1726,,H7492062020150  -  CATH BALDILAT .014IN 3.2-2.3FR 1.5MM 135CM 20MM PTCA OTW TRK,$612.50,$0.00,$612.50,$332.59,$437.14,$0.00,$105.53,$0.00,$0.00,$107.24,$612.50,$0.00,$306.25,$485.10,$490.00,$0.00,$95.86,$0.00,$97.51,$0.00
H7492062020200,SUP,HCPCS C1726,,H7492062020200  -  CATH BALDILAT .014IN 3.2-2.3FR 2MM 135CM 20MM PTCA OTW TRK,$612.50,$0.00,$612.50,$332.59,$437.14,$0.00,$105.53,$0.00,$0.00,$107.24,$612.50,$0.00,$306.25,$485.10,$490.00,$0.00,$95.86,$0.00,$97.51,$0.00
H7492062020250,SUP,HCPCS C1726,,H7492062020250  -  CATH BALDILAT .014IN 3.2-2.4FR 2.5MM 135CM 20MM PTCA OTW TRK,$612.50,$0.00,$612.50,$332.59,$437.14,$0.00,$105.53,$0.00,$0.00,$107.24,$612.50,$0.00,$306.25,$485.10,$490.00,$0.00,$95.86,$0.00,$97.51,$0.00
H7492062020300,SUP,HCPCS C1726,,H7492062020300  -  CATH BALDILAT .014IN 3MM 135CM 20MM CORON OTW TRK TIP MAV,$612.50,$0.00,$612.50,$332.59,$437.14,$0.00,$105.53,$0.00,$0.00,$107.24,$612.50,$0.00,$306.25,$485.10,$490.00,$0.00,$95.86,$0.00,$97.51,$0.00
H749364560,SUP,HCPCS C1753,,H749364560  -  CATHETER ULTRASOUND 95CM OTW ATLANTIS PV 15MHZ 8FR,"$1,925.00",$0.00,"$1,925.00","$1,045.28","$1,373.87",$0.00,$331.67,$0.00,$0.00,$337.05,"$1,925.00",$0.00,$962.50,"$1,524.60","$1,540.00",$0.00,$301.26,$0.00,$306.46,$0.00
H74937911415150,SUP,HCPCS C1877,,H74937911415150  -  STENT BILIARY 4MM 15MM 150CM PREMOUNT BALLOON EXPAND,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74937911415900,SUP,HCPCS C1877,,H74937911415900  -  STENT BILIARY 4MM 15MM 90CM PREMOUNT BALLOON EXPAND CATHETER,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74937911515150,SUP,HCPCS C1877,,H74937911515150  -  STENT BILIARY 5MM 15MM 150CM PREMOUNT BALLOON EXPAND,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74937911515900,SUP,HCPCS C2617,,H74937911515900  -  STENT BILIARY SMALL 5MM 15MM 90CM PREMOUNT BALLOON EXPAND,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74937911614150,SUP,HCPCS C1877,,H74937911614150  -  STENT BILIARY 6MM 14MM 150CM PREMOUNT BALLOON EXPAND,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74937911614900,SUP,HCPCS C2617,,H74937911614900  -  STENT BILIARY SMALL 6MM 16MM 90CM PREMOUNT BALLOON EXPAND,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74937911715150,SUP,HCPCS C1877,,H74937911715150  -  STENT BILIARY 7MM 15MM 150CM PREMOUNT BALLOON EXPAND,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74937911715900,SUP,HCPCS C1877,,H74937911715900  -  STENT BILIARY SMALL 7MM 15MM 90CM PREMOUNT BALLOON EXPAND,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74937912419150,SUP,HCPCS C1877,,H74937912419150  -  STENT BILIARY 4MM 19MM 150CM PREMOUNT BALLOON EXPAND,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74937912419900,SUP,HCPCS C1877,,H74937912419900  -  STENT BILIARY 4MM 19MM 90CM PREMOUNTED BALLOON EXPANDING,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74937912519150,SUP,HCPCS C1877,,H74937912519150  -  STENT BILIARY 5MM 19MM 150CM PREMOUNT BALLOON EXPAND,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74937912519900,SUP,HCPCS C2617,,H74937912519900  -  STENT BILIARY SMALL 5MM 19MM 90CM PREMOUNT BALLOON EXPAND,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74937912618150,SUP,HCPCS C1877,,H74937912618150  -  STENT BILIARY 6MM 18MM 150CM PREMOUNT BALLOON EXPAND,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74937912618900,SUP,HCPCS C2617,,H74937912618900  -  STENT BILIARY SMALL 6MM 18MM 90CM PREMOUNT BALLOON EXPAND,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74937912719150,SUP,HCPCS C1877,,H74937912719150  -  STENT BILIARY 7MM 19MM 150CM PREMOUNT BALLOON EXPAND,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74937912719900,SUP,HCPCS C1877,,H74937912719900  -  STENT BILIARY SMALL 7MM 19MM 90CM PREMOUNT BALLOON EXPAND,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H7493791540200,SUP,HCPCS C1725,,H7493791540200  -  CATHETER BALDILAT 4MM 90CM 2CM SV RAPEX ULSF SV ANGIOPLST,"$1,162.50",$0.00,"$1,162.50",$631.24,$829.68,$0.00,$200.29,$0.00,$0.00,$203.54,"$1,162.50",$0.00,$581.25,$920.70,$930.00,$0.00,$181.93,$0.00,$185.07,$0.00
H7493791550200,SUP,HCPCS C1726,,H7493791550200  -  CATHETER BLNDIL 3.1FR 5MM 90CM 2CM ULSF SV PTA RX NONLASER,"$1,055.00",$0.00,"$1,055.00",$572.87,$752.95,$0.00,$181.77,$0.00,$0.00,$184.72,"$1,055.00",$0.00,$527.50,$835.56,$844.00,$0.00,$165.11,$0.00,$167.96,$0.00
H74938046102070,SUP,HCPCS C1877,,H74938046102070  -  STENT BILIARY 30MM 10MM 25MM 75CM OTW PREMOUNT BALLOON,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74938046104070,SUP,HCPCS C1877,,H74938046104070  -  STENT BILIARY 40MM 10MM 37MM 75CM OTW PREMOUNT CATHETER,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74938046106070,SUP,HCPCS C1877,,H74938046106070  -  STENT BILIARY 60MM 10MM 57MM 75CM OTW PREMOUNT CATHETER,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74938046520750,SUP,HCPCS C1877,,H74938046520750  -  STENT BILIARY 5MM 17MM 75CM OTW PREMOUNT BALLOON EXPAND,$150.00,$0.00,$150.00,$67.50,$107.06,$0.00,$25.84,$0.00,$0.00,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
H74938046530750,SUP,HCPCS C1877,,H74938046530750  -  STENT BILIARY 30MM 5MM 27MM 75CM OTW PREMOUNT BALLOON EXPAND,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74938046540750,SUP,HCPCS C1877,,H74938046540750  -  STENT BILIARY 5MM 37MM 75CM OTW PREMOUNT BALLOON EXPAND,$150.00,$0.00,$150.00,$67.50,$107.06,$0.00,$25.84,$0.00,$0.00,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
H74938046560750,SUP,HCPCS C1877,,H74938046560750  -  STENT BILIARY 5MM 57MM 75CM OTW PREMOUNT BALLOON EXPAND,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74938046620750,SUP,HCPCS C1877,,H74938046620750  -  STENT BILIARY 6MM 17MM 75CM OTW PREMOUNT BALLOON EXPAND,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74938046630750,SUP,HCPCS C1877,,H74938046630750  -  STENT BILIARY 6MM 30MM 75CM OTW PREMOUNT BALLOON EXPAND,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74938046640750,SUP,HCPCS C1877,,H74938046640750  -  STENT BILIARY 40MM 6MM 37MM 75CM OTW PREMOUNT BALLOON EXPAND,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74938046660750,SUP,HCPCS C1877,,H74938046660750  -  STENT BILIARY 60MM 6MM 57MM 75CM OTW PREMOUNT BALLOON EXPAND,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74938046720750,SUP,HCPCS C1877,,H74938046720750  -  STENT BILIARY 7MM 17MM 75CM OTW PREMOUNT BALLOON EXPAND,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74938046730750,SUP,HCPCS C1877,,H74938046730750  -  STENT BILIARY 30MM 7MM 27MM 75CM OTW PREMOUNT BALLOON EXPAND,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74938046740750,SUP,HCPCS C1877,,H74938046740750  -  STENT BILIARY 40MM 7MM 37MM 75CM OTW PREMOUNT BALLOON EXPAND,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74938046760750,SUP,HCPCS C1877,,H74938046760750  -  STENT BILIARY 60MM 7MM 57MM 75CM OTW PREMOUNT BALLOON EXPAND,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74938046820750,SUP,HCPCS C1877,,H74938046820750  -  STENT BILIARY 8MM 17MM 75CM OTW PREMOUNT BALLOON EXPAND,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74938046830750,SUP,HCPCS C1877,,H74938046830750  -  STENT BILIARY 8MM 27MM 75CM OTW PREMOUNT BALLOON EXPAND,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74938046840750,SUP,HCPCS C1877,,H74938046840750  -  STENT BILIARY 40MM 8MM 37MM 75CM OTW PREMOUNT BALLOON EXPAND,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74938046860750,SUP,HCPCS C1877,,H74938046860750  -  STENT BILIARY 60MM 8MM 57MM 75CM OTW PREMOUNT BALLOON EXPAND,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74938046920750,SUP,HCPCS C1877,,H74938046920750  -  STENT BILIARY 30MM 9MM 25MM 75CM OTW PREMOUNT BALLOON EXPAND,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74938046940750,SUP,HCPCS C1877,,H74938046940750  -  STENT BILIARY 40MM 9MM 37MM 75CM OTW PREMOUNT BALLOON EXPAND,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74938046960750,SUP,HCPCS C1877,,H74938046960750  -  STENT BILIARY 60MM 9MM 57MM 75CM OTW PREMOUNT BALLOON EXPAND,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74938047120130,SUP,HCPCS C1877,,H74938047120130  -  STENT BILIARY 30MM 10MM 25MM 135CM OTW PREMOUNT BALLOON,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74938047140130,SUP,HCPCS C1877,,H74938047140130  -  STENT BILIARY 10MM 7FR 37MM 135CM BALLOON EXPANDABLE,$150.00,$0.00,$150.00,$67.50,$107.06,$0.00,$25.84,$0.00,$0.00,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
H74938047160130,SUP,HCPCS C1877,,H74938047160130  -  STENT BILIARY 10MM 7FR 57MM 135CM BALLOON EXPANDABLE,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74938047520130,SUP,HCPCS C1877,,H74938047520130  -  STENT BILIARY .035IN 5MM 17MM 75CM CATHETER BALLOON INFLAT,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74938047530130,SUP,HCPCS C1877,,H74938047530130  -  STENT BILIARY 5MM 27MM 135CM OTW BALLOON EXPAND PREMOUNT,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74938047540130,SUP,HCPCS C1877,,H74938047540130  -  STENT BILIARY 5MM 40MM 135CM OTW BALLOON EXPAND PREMOUNT,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74938047560130,SUP,HCPCS C1877,,H74938047560130  -  STENT BILIARY 5MM 6FR 60MM 135CM BALLOON EXPANDING,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74938047620130,SUP,HCPCS C1877,,H74938047620130  -  STENT BILIARY 6MM 6FR 17MM 135CM PREMOUNTED BALLOON EXPRESS,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74938047630130,SUP,HCPCS C1877,,H74938047630130  -  STENT BILIARY 30MM 6MM 27MM 135CM OTW PREMOUNT BALLOON,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74938047640130,SUP,HCPCS C1877,,H74938047640130  -  STENT BILIARY 40MM 6MM 37MM 135CM OTW PREMOUNT BALLOON,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74938047660130,SUP,HCPCS C1877,,H74938047660130  -  STENT BILIARY 9MM 6MM 57MM 135CM PREMOUNT BALLOON EXPAND,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74938047720130,SUP,HCPCS C1877,,H74938047720130  -  STENT BILIARY 20MM 7MM 17MM 135CM OTW BALLOON EXPAND,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74938047730130,SUP,HCPCS C1877,,H74938047730130  -  STENT BILIARY 30MM 7MM 27MM 135CM OTW PREMOUNT BALLOON,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74938047740130,SUP,HCPCS C1877,,H74938047740130  -  STENT BILIARY 9MM 7MM 6FR 37MM 135CM BALLOON EXPANDABLE,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74938047760130,SUP,HCPCS C1877,,H74938047760130  -  STENT BILIARY 9MM 7MM 6FR 57MM 135CM BALLOON EXPANDABLE,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74938047820130,SUP,HCPCS C1877,,H74938047820130  -  STENT BILIARY 8MM 6FR 17MM 135CM BALLOON EXPANDABLE,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74938047830130,SUP,HCPCS C1877,,H74938047830130  -  STENT BILIARY 30MM 8MM 27MM 135CM OTW PREMOUNT BALLOON,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74938047840130,SUP,HCPCS C1877,,H74938047840130  -  STENT BILIARY 8MM 37MM 135CM BALLOON EXPAND PREMOUNT EXPRESS,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74938047860130,SUP,HCPCS C1877,,H74938047860130  -  STENT BILIARY 8MM 7IN 57MM 135CM OTW PREMOUNT BALLOON,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74938047920130,SUP,HCPCS C1877,,H74938047920130  -  STENT BILIARY 30MM 9MM 25MM 135CM OTW PREMOUNT BALLOON,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74938047940130,SUP,HCPCS C1877,,H74938047940130  -  STENT BILIARY 9MM 7FR 37MM 135CM BALLOON EXPANDABLE,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74938047960130,SUP,HCPCS C1877,,H74938047960130  -  STENT BILIARY 11MM 9MM 7FR 57MM 135CM PREMOUNT BALLOON,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H7493808012200,SUP,HCPCS C1726,,H7493808012200  -  CATH BALDILAT .014IN 2MM 12MM PCTA RAPEX LP TPR TIP Q M,$612.50,$0.00,$612.50,$332.59,$437.14,$0.00,$105.53,$0.00,$0.00,$107.24,$612.50,$0.00,$306.25,$485.10,$490.00,$0.00,$95.86,$0.00,$97.51,$0.00
H7493808012250,SUP,HCPCS C1726,,H7493808012250  -  CATH BALDILAT 1.8-2.7FR 2.5MM 135CM 12MM PTCA RAPEX LP TPR,$612.50,$0.00,$612.50,$332.59,$437.14,$0.00,$105.53,$0.00,$0.00,$107.24,$612.50,$0.00,$306.25,$485.10,$490.00,$0.00,$95.86,$0.00,$97.51,$0.00
H7493808012300,SUP,HCPCS C1726,,H7493808012300  -  CATH BALDILAT 3MM 135CM 12MM PCTA RAPEX LP TPR TIP Q M,$612.50,$0.00,$612.50,$332.59,$437.14,$0.00,$105.53,$0.00,$0.00,$107.24,$612.50,$0.00,$306.25,$485.10,$490.00,$0.00,$95.86,$0.00,$97.51,$0.00
H7493808012350,SUP,HCPCS C1726,,H7493808012350  -  CATH BALDILAT .014IN 1.8-2.7FR 3.5MM 135CM 12MM PTCA RAPEX,$612.50,$0.00,$612.50,$332.59,$437.14,$0.00,$105.53,$0.00,$0.00,$107.24,$612.50,$0.00,$306.25,$485.10,$490.00,$0.00,$95.86,$0.00,$97.51,$0.00
H7493808012400,SUP,HCPCS C1726,,H7493808012400  -  CATH BALDILAT .014IN 1.8-2.7FR 4MM 135CM 12MM PTCA RAPEX LP,$612.50,$0.00,$612.50,$332.59,$437.14,$0.00,$105.53,$0.00,$0.00,$107.24,$612.50,$0.00,$306.25,$485.10,$490.00,$0.00,$95.86,$0.00,$97.51,$0.00
H7493808012450,SUP,HCPCS C1726,,H7493808012450  -  CATH BALDILAT .014IN 2-2.7FR 4.5MM 135CM 12MM PTCA RAPEX LP,$612.50,$0.00,$612.50,$332.59,$437.14,$0.00,$105.53,$0.00,$0.00,$107.24,$612.50,$0.00,$306.25,$485.10,$490.00,$0.00,$95.86,$0.00,$97.51,$0.00
H749380801250,SUP,HCPCS C1726,,H749380801250  -  CATH BALDILAT .014IN 2-2.7FR 5MM 135CM 12MM PTCA RAPEX LP,$612.50,$0.00,$612.50,$332.59,$437.14,$0.00,$105.53,$0.00,$0.00,$107.24,$612.50,$0.00,$306.25,$485.10,$490.00,$0.00,$95.86,$0.00,$97.51,$0.00
H7493808015250,SUP,HCPCS C1726,,H7493808015250  -  CATH BALDILAT .014IN 2.5MM 15MM PTCA RAPEX Q M,$612.50,$0.00,$612.50,$332.59,$437.14,$0.00,$105.53,$0.00,$0.00,$107.24,$612.50,$0.00,$306.25,$485.10,$490.00,$0.00,$95.86,$0.00,$97.51,$0.00
H7493808015300,SUP,HCPCS C1726,,H7493808015300  -  CATH BALDILAT 3MM 135CM 15MM CORON PCTA RAPEX LP TPR TIP Q M,$612.50,$0.00,$612.50,$332.59,$437.14,$0.00,$105.53,$0.00,$0.00,$107.24,$612.50,$0.00,$306.25,$485.10,$490.00,$0.00,$95.86,$0.00,$97.51,$0.00
H7493808015350,SUP,HCPCS C1726,,H7493808015350  -  CATH BALDILAT .014IN 3.5MM 15MM PTCA RAPEX Q M,$612.50,$0.00,$612.50,$332.59,$437.14,$0.00,$105.53,$0.00,$0.00,$107.24,$612.50,$0.00,$306.25,$485.10,$490.00,$0.00,$95.86,$0.00,$97.51,$0.00
H7493808015400,SUP,HCPCS C1726,,H7493808015400  -  CATH BALDILAT .014IN 1.8-2.7FR 4MM 135CM 15MM PTCA RAPEX LP,$612.50,$0.00,$612.50,$332.59,$437.14,$0.00,$105.53,$0.00,$0.00,$107.24,$612.50,$0.00,$306.25,$485.10,$490.00,$0.00,$95.86,$0.00,$97.51,$0.00
H7493808015450,SUP,HCPCS C1726,,H7493808015450  -  CATH BALDILAT .014IN 2-2.7FR 4.5MM 135CM 15MM PTCA RAPEX LP,$612.50,$0.00,$612.50,$332.59,$437.14,$0.00,$105.53,$0.00,$0.00,$107.24,$612.50,$0.00,$306.25,$485.10,$490.00,$0.00,$95.86,$0.00,$97.51,$0.00
H7493808015500,SUP,HCPCS C1726,,H7493808015500  -  CATH BALDILAT .014IN 2-2.7FR 5MM 135CM 15MM PTCA RAPEX LP,$612.50,$0.00,$612.50,$332.59,$437.14,$0.00,$105.53,$0.00,$0.00,$107.24,$612.50,$0.00,$306.25,$485.10,$490.00,$0.00,$95.86,$0.00,$97.51,$0.00
H7493808020250,SUP,HCPCS C1726,,H7493808020250  -  CATH BALDILAT .014IN 1.8-2.7FR 2.5MM 135CM 20MM PTCA RAPEX,$612.50,$0.00,$612.50,$332.59,$437.14,$0.00,$105.53,$0.00,$0.00,$107.24,$612.50,$0.00,$306.25,$485.10,$490.00,$0.00,$95.86,$0.00,$97.51,$0.00
H7493808020300,SUP,HCPCS C1726,,H7493808020300  -  CATH BALDILAT .014IN 1.8-2.7FR 3MM 135CM 20MM PTCA RAPEX LP,$612.50,$0.00,$612.50,$332.59,$437.14,$0.00,$105.53,$0.00,$0.00,$107.24,$612.50,$0.00,$306.25,$485.10,$490.00,$0.00,$95.86,$0.00,$97.51,$0.00
H7493808020350,SUP,HCPCS C1726,,H7493808020350  -  CATH BALDILAT .014IN 1.8-2.7FR 3.5MM 135CM 20MM PTCA RAPEX,$612.50,$0.00,$612.50,$332.59,$437.14,$0.00,$105.53,$0.00,$0.00,$107.24,$612.50,$0.00,$306.25,$485.10,$490.00,$0.00,$95.86,$0.00,$97.51,$0.00
H7493808020400,SUP,HCPCS C1726,,H7493808020400  -  CATH BALDILAT .014IN 2-2.7FR 4MM 135CM 20MM PTCA RAPEX LP,$612.50,$0.00,$612.50,$332.59,$437.14,$0.00,$105.53,$0.00,$0.00,$107.24,$612.50,$0.00,$306.25,$485.10,$490.00,$0.00,$95.86,$0.00,$97.51,$0.00
H7493892809200,SUP,HCPCS C1726,,H7493892809200  -  CATHETER BLNDIL 2MM 142CM 9MM MAVERICK2 MNRL TRAKTIP TPR,$269.50,$0.00,$269.50,$146.34,$192.34,$0.00,$46.43,$0.00,$0.00,$47.19,$269.50,$0.00,$134.75,$213.44,$215.60,$0.00,$42.18,$0.00,$42.90,$0.00
H7493892809250,SUP,HCPCS C1725,,H7493892809250  -  CATHETER BLNDIL 2.5MM 142CM 9MM MAVERICK2 MNRL TRAKTIP TPR,$269.50,$0.00,$269.50,$146.34,$192.34,$0.00,$46.43,$0.00,$0.00,$47.19,$269.50,$0.00,$134.75,$213.44,$215.60,$0.00,$42.18,$0.00,$42.90,$0.00
H7493892809300,SUP,HCPCS C1725,,H7493892809300  -  CATHETER BLNDIL 3MM 142CM 9MM MAVERICK2 MNRL TRAKTIP TPR,$269.50,$0.00,$269.50,$146.34,$192.34,$0.00,$46.43,$0.00,$0.00,$47.19,$269.50,$0.00,$134.75,$213.44,$215.60,$0.00,$42.18,$0.00,$42.90,$0.00
H7493892809350,SUP,HCPCS C1726,,H7493892809350  -  CATH BALDILAT .014IN 1.8-2.7FR 3.5MM 135CM 9MM PTCA RAPEX LP,$612.50,$0.00,$612.50,$332.59,$437.14,$0.00,$105.53,$0.00,$0.00,$107.24,$612.50,$0.00,$306.25,$485.10,$490.00,$0.00,$95.86,$0.00,$97.51,$0.00
H7493892815150,SUP,HCPCS C1726,,H7493892815150  -  CATH BALDILAT .014IN 1.8-2.6-2.3FR 1.5MM 135CM 15MM PTCA,$612.50,$0.00,$612.50,$332.59,$437.14,$0.00,$105.53,$0.00,$0.00,$107.24,$612.50,$0.00,$306.25,$485.10,$490.00,$0.00,$95.86,$0.00,$97.51,$0.00
H7493892815200,SUP,HCPCS C1726,,H7493892815200  -  CATHETER BLNDIL 2MM 142CM 15MM MAVERICK2 MNRL TRAKTIP TPR,$269.50,$0.00,$269.50,$146.34,$192.34,$0.00,$46.43,$0.00,$0.00,$47.19,$269.50,$0.00,$134.75,$213.44,$215.60,$0.00,$42.18,$0.00,$42.90,$0.00
H7493892815250,SUP,HCPCS C1726,,H7493892815250  -  CATH BALDILAT .014IN 1.8-2.6-2.4FR 2.5MM 135CM 15MM PTCA,$612.50,$0.00,$612.50,$332.59,$437.14,$0.00,$105.53,$0.00,$0.00,$107.24,$612.50,$0.00,$306.25,$485.10,$490.00,$0.00,$95.86,$0.00,$97.51,$0.00
H7493892815300,SUP,HCPCS C1726,,H7493892815300  -  CATH BALDILAT .014IN 1.8-2.6-2.4FR 3MM 135CM 15MM PTCA RAPEX,$612.50,$0.00,$612.50,$332.59,$437.14,$0.00,$105.53,$0.00,$0.00,$107.24,$612.50,$0.00,$306.25,$485.10,$490.00,$0.00,$95.86,$0.00,$97.51,$0.00
H7493892815350,SUP,HCPCS C1726,,H7493892815350  -  CATH BALDILAT .014IN 1.8-2.7FR 3.5MM 135CM 15MM PTCA RAPEX,$612.50,$0.00,$612.50,$332.59,$437.14,$0.00,$105.53,$0.00,$0.00,$107.24,$612.50,$0.00,$306.25,$485.10,$490.00,$0.00,$95.86,$0.00,$97.51,$0.00
H7493892820200,SUP,HCPCS C1726,,H7493892820200  -  CATH BALDILAT .014IN 1.8-2.6-2.3FR 2MM 135CM 20MM PTCA RAPEX,$612.50,$0.00,$612.50,$332.59,$437.14,$0.00,$105.53,$0.00,$0.00,$107.24,$612.50,$0.00,$306.25,$485.10,$490.00,$0.00,$95.86,$0.00,$97.51,$0.00
H7493892820250,SUP,HCPCS C1726,,H7493892820250  -  CATH BALDILAT .014IN 1.8-2.6-2.4FR 2.5MM 135CM 20MM PTCA,$612.50,$0.00,$612.50,$332.59,$437.14,$0.00,$105.53,$0.00,$0.00,$107.24,$612.50,$0.00,$306.25,$485.10,$490.00,$0.00,$95.86,$0.00,$97.51,$0.00
H7493892820300,SUP,HCPCS C1726,,H7493892820300  -  CATH BALDILAT .014IN 1.8-2.6-2.4FR 3MM 135CM 20MM PTCA RAPEX,$612.50,$0.00,$612.50,$332.59,$437.14,$0.00,$105.53,$0.00,$0.00,$107.24,$612.50,$0.00,$306.25,$485.10,$490.00,$0.00,$95.86,$0.00,$97.51,$0.00
H7493894812010,SUP,HCPCS C1876,,H7493894812010  -  STENT BILIARY 21MM SELF EXPANDING SENTINOL NITINOL 135CM 10,"$2,437.50",$0.00,"$2,437.50","$1,096.88","$1,739.64",$0.00,$419.97,$0.00,$0.00,$426.79,"$2,437.50",$0.00,"$1,218.75","$1,930.50","$1,950.00",$0.00,$381.47,$0.00,$388.05,$0.00
H7493894812070,SUP,HCPCS C1876,,H7493894812070  -  STENT BILIARY 21MM SELF EXPANDING NONCOATED NONCOVERED,"$2,437.50",$0.00,"$2,437.50","$1,096.88","$1,739.64",$0.00,$419.97,$0.00,$0.00,$426.79,"$2,437.50",$0.00,"$1,218.75","$1,930.50","$1,950.00",$0.00,$381.47,$0.00,$388.05,$0.00
H7493894814010,SUP,HCPCS C1876,,H7493894814010  -  STENT BILIARY 40MM SELF EXPANDING SENTINOL NITINOL 135CM 10,"$2,437.50",$0.00,"$2,437.50","$1,096.88","$1,739.64",$0.00,$419.97,$0.00,$0.00,$426.79,"$2,437.50",$0.00,"$1,218.75","$1,930.50","$1,950.00",$0.00,$381.47,$0.00,$388.05,$0.00
H7493894814070,SUP,HCPCS C1876,,H7493894814070  -  STENT BILIARY 41MM SELF EXPANDING SHEATH CATHETER SENTINOL,"$2,437.50",$0.00,"$2,437.50","$1,096.88","$1,739.64",$0.00,$419.97,$0.00,$0.00,$426.79,"$2,437.50",$0.00,"$1,218.75","$1,930.50","$1,950.00",$0.00,$381.47,$0.00,$388.05,$0.00
H7493894816010,SUP,HCPCS C1876,,H7493894816010  -  STENT BILIARY 59MM SELF EXPANDABLE SENTINOL NITINOL 135CM 10,"$2,437.50",$0.00,"$2,437.50","$1,096.88","$1,739.64",$0.00,$419.97,$0.00,$0.00,$426.79,"$2,437.50",$0.00,"$1,218.75","$1,930.50","$1,950.00",$0.00,$381.47,$0.00,$388.05,$0.00
H7493894818010,SUP,HCPCS C1876,,H7493894818010  -  STENT BILIARY 80MM SELF EXPANDING SENTINOL NITINOL 135CM 10,"$2,437.50",$0.00,"$2,437.50","$1,096.88","$1,739.64",$0.00,$419.97,$0.00,$0.00,$426.79,"$2,437.50",$0.00,"$1,218.75","$1,930.50","$1,950.00",$0.00,$381.47,$0.00,$388.05,$0.00
H7493894852010,SUP,HCPCS C1876,,H7493894852010  -  STENT BILIARY 21MM SELF EXPANDING SENTINOL NITINOL 135CM 5MM,"$2,437.50",$0.00,"$2,437.50","$1,096.88","$1,739.64",$0.00,$419.97,$0.00,$0.00,$426.79,"$2,437.50",$0.00,"$1,218.75","$1,930.50","$1,950.00",$0.00,$381.47,$0.00,$388.05,$0.00
H7493894852070,SUP,HCPCS C1876,,H7493894852070  -  STENT BILIARY 21MM SELF EXPANDING SENTINOL NITINOL 75CM 5MM,"$2,437.50",$0.00,"$2,437.50","$1,096.88","$1,739.64",$0.00,$419.97,$0.00,$0.00,$426.79,"$2,437.50",$0.00,"$1,218.75","$1,930.50","$1,950.00",$0.00,$381.47,$0.00,$388.05,$0.00
H7493894854010,SUP,HCPCS C1876,,H7493894854010  -  STENT BILIARY 40MM SELF EXPAND DELIVERY SYSTEM SENTINOL,"$2,437.50",$0.00,"$2,437.50","$1,096.88","$1,739.64",$0.00,$419.97,$0.00,$0.00,$426.79,"$2,437.50",$0.00,"$1,218.75","$1,930.50","$1,950.00",$0.00,$381.47,$0.00,$388.05,$0.00
H7493894854070,SUP,HCPCS C1876,,H7493894854070  -  STENT BILIARY 40MM SELF EXPANDING NONCOATED NONCOVERED,"$2,437.50",$0.00,"$2,437.50","$1,096.88","$1,739.64",$0.00,$419.97,$0.00,$0.00,$426.79,"$2,437.50",$0.00,"$1,218.75","$1,930.50","$1,950.00",$0.00,$381.47,$0.00,$388.05,$0.00
H7493894856010,SUP,HCPCS C1876,,H7493894856010  -  STENT BILIARY 60MM SELF EXPAND DELIVERY SYSTEM SENTINOL,"$2,437.50",$0.00,"$2,437.50","$1,096.88","$1,739.64",$0.00,$419.97,$0.00,$0.00,$426.79,"$2,437.50",$0.00,"$1,218.75","$1,930.50","$1,950.00",$0.00,$381.47,$0.00,$388.05,$0.00
H7493894856070,SUP,HCPCS C1876,,H7493894856070  -  STENT BILIARY 60MM SELF EXPANDING NONCOATED NONCOVERED,"$2,437.50",$0.00,"$2,437.50","$1,096.88","$1,739.64",$0.00,$419.97,$0.00,$0.00,$426.79,"$2,437.50",$0.00,"$1,218.75","$1,930.50","$1,950.00",$0.00,$381.47,$0.00,$388.05,$0.00
H7493894862010,SUP,HCPCS C1876,,H7493894862010  -  STENT BILIARY 20MM SELF EXPANDING SENTINOL NITINOL 135CM 6MM,"$2,437.50",$0.00,"$2,437.50","$1,096.88","$1,739.64",$0.00,$419.97,$0.00,$0.00,$426.79,"$2,437.50",$0.00,"$1,218.75","$1,930.50","$1,950.00",$0.00,$381.47,$0.00,$388.05,$0.00
H7493894862070,SUP,HCPCS C1876,,H7493894862070  -  STENT BILIARY 20MM SELF EXPANDING SENTINOL NITINOL 75CM 6MM,"$2,437.50",$0.00,"$2,437.50","$1,096.88","$1,739.64",$0.00,$419.97,$0.00,$0.00,$426.79,"$2,437.50",$0.00,"$1,218.75","$1,930.50","$1,950.00",$0.00,$381.47,$0.00,$388.05,$0.00
H7493894864010,SUP,HCPCS C1876,,H7493894864010  -  STENT BILIARY 40MM SELF EXPAND DELIVERY SYSTEM SENTINOL,"$2,437.50",$0.00,"$2,437.50","$1,096.88","$1,739.64",$0.00,$419.97,$0.00,$0.00,$426.79,"$2,437.50",$0.00,"$1,218.75","$1,930.50","$1,950.00",$0.00,$381.47,$0.00,$388.05,$0.00
H7493894864070,SUP,HCPCS C1876,,H7493894864070  -  STENT BILIARY 40MM SELF EXPAND DELIVERY SYSTEM SENTINOL,"$2,437.50",$0.00,"$2,437.50","$1,096.88","$1,739.64",$0.00,$419.97,$0.00,$0.00,$426.79,"$2,437.50",$0.00,"$1,218.75","$1,930.50","$1,950.00",$0.00,$381.47,$0.00,$388.05,$0.00
H7493894866010,SUP,HCPCS C1876,,H7493894866010  -  STENT BILIARY 59MM SELF EXPAND DELIVERY SYSTEM SENTINOL,"$2,437.50",$0.00,"$2,437.50","$1,096.88","$1,739.64",$0.00,$419.97,$0.00,$0.00,$426.79,"$2,437.50",$0.00,"$1,218.75","$1,930.50","$1,950.00",$0.00,$381.47,$0.00,$388.05,$0.00
H7493894866070,SUP,HCPCS C1876,,H7493894866070  -  STENT BILIARY 59MM SELF EXPANDING SENTINOL NITINOL 75CM 6MM,"$2,437.50",$0.00,"$2,437.50","$1,096.88","$1,739.64",$0.00,$419.97,$0.00,$0.00,$426.79,"$2,437.50",$0.00,"$1,218.75","$1,930.50","$1,950.00",$0.00,$381.47,$0.00,$388.05,$0.00
H7493894868010,SUP,HCPCS C1876,,H7493894868010  -  STENT BILIARY 79MM SELF EXPAND DELIVERY SYSTEM SENTINOL,"$2,437.50",$0.00,"$2,437.50","$1,096.88","$1,739.64",$0.00,$419.97,$0.00,$0.00,$426.79,"$2,437.50",$0.00,"$1,218.75","$1,930.50","$1,950.00",$0.00,$381.47,$0.00,$388.05,$0.00
H7493894868070,SUP,HCPCS C1876,,H7493894868070  -  STENT BILIARY 79MM SELF EXPANDING SENTINOL NITINOL 75CM 6MM,"$2,437.50",$0.00,"$2,437.50","$1,096.88","$1,739.64",$0.00,$419.97,$0.00,$0.00,$426.79,"$2,437.50",$0.00,"$1,218.75","$1,930.50","$1,950.00",$0.00,$381.47,$0.00,$388.05,$0.00
H7493894872010,SUP,HCPCS C1876,,H7493894872010  -  STENT BILIARY 1350MM SELF EXPANDING CATHETER DELIVERY SYSTEM,"$2,437.50",$0.00,"$2,437.50","$1,096.88","$1,739.64",$0.00,$419.97,$0.00,$0.00,$426.79,"$2,437.50",$0.00,"$1,218.75","$1,930.50","$1,950.00",$0.00,$381.47,$0.00,$388.05,$0.00
H7493894872070,SUP,HCPCS C1876,,H7493894872070  -  STENT BILIARY 20MM SELF EXPANDING SENTINOL NITINOL 75CM 7MM,"$2,437.50",$0.00,"$2,437.50","$1,096.88","$1,739.64",$0.00,$419.97,$0.00,$0.00,$426.79,"$2,437.50",$0.00,"$1,218.75","$1,930.50","$1,950.00",$0.00,$381.47,$0.00,$388.05,$0.00
H7493894874010,SUP,HCPCS C1876,,H7493894874010  -  STENT BILIARY 39MM SELF EXPAND DELIVERY SYSTEM SENTINOL,"$2,437.50",$0.00,"$2,437.50","$1,096.88","$1,739.64",$0.00,$419.97,$0.00,$0.00,$426.79,"$2,437.50",$0.00,"$1,218.75","$1,930.50","$1,950.00",$0.00,$381.47,$0.00,$388.05,$0.00
H7493894874070,SUP,HCPCS C1876,,H7493894874070  -  STENT BILIARY 39MM SELF EXPANDABLE SENTINOL NITINOL 75CM 7MM,"$2,437.50",$0.00,"$2,437.50","$1,096.88","$1,739.64",$0.00,$419.97,$0.00,$0.00,$426.79,"$2,437.50",$0.00,"$1,218.75","$1,930.50","$1,950.00",$0.00,$381.47,$0.00,$388.05,$0.00
H7493894876010,SUP,HCPCS C1876,,H7493894876010  -  STENT BILIARY 59MM SELF EXPAND DELIVERY SYSTEM SENTINOL,"$2,437.50",$0.00,"$2,437.50","$1,096.88","$1,739.64",$0.00,$419.97,$0.00,$0.00,$426.79,"$2,437.50",$0.00,"$1,218.75","$1,930.50","$1,950.00",$0.00,$381.47,$0.00,$388.05,$0.00
H7493894876070,SUP,HCPCS C1876,,H7493894876070  -  STENT BILIARY 59MM SELF EXPANDING SENTINOL NITINOL 75CM 7MM,"$2,437.50",$0.00,"$2,437.50","$1,096.88","$1,739.64",$0.00,$419.97,$0.00,$0.00,$426.79,"$2,437.50",$0.00,"$1,218.75","$1,930.50","$1,950.00",$0.00,$381.47,$0.00,$388.05,$0.00
H7493894878010,SUP,HCPCS C1876,,H7493894878010  -  STENT BILIARY 78MM SELF EXPAND DELIVERY SYSTEM SENTINOL,"$2,437.50",$0.00,"$2,437.50","$1,096.88","$1,739.64",$0.00,$419.97,$0.00,$0.00,$426.79,"$2,437.50",$0.00,"$1,218.75","$1,930.50","$1,950.00",$0.00,$381.47,$0.00,$388.05,$0.00
H7493894878070,SUP,HCPCS C1876,,H7493894878070  -  STENT BILIARY 78MM SELF EXPANDING SENTINOL NITINOL 75CM 7MM,"$2,437.50",$0.00,"$2,437.50","$1,096.88","$1,739.64",$0.00,$419.97,$0.00,$0.00,$426.79,"$2,437.50",$0.00,"$1,218.75","$1,930.50","$1,950.00",$0.00,$381.47,$0.00,$388.05,$0.00
H7493894882010,SUP,HCPCS C1876,,H7493894882010  -  STENT BILIARY 21MM SELF EXPANDING SENTINOL NITINOL 135CM 8MM,"$2,437.50",$0.00,"$2,437.50","$1,096.88","$1,739.64",$0.00,$419.97,$0.00,$0.00,$426.79,"$2,437.50",$0.00,"$1,218.75","$1,930.50","$1,950.00",$0.00,$381.47,$0.00,$388.05,$0.00
H7493894882070,SUP,HCPCS C1876,,H7493894882070  -  STENT BILIARY 21MM SELF EXPANDING SENTINOL NITINOL 75CM 8MM,"$2,437.50",$0.00,"$2,437.50","$1,096.88","$1,739.64",$0.00,$419.97,$0.00,$0.00,$426.79,"$2,437.50",$0.00,"$1,218.75","$1,930.50","$1,950.00",$0.00,$381.47,$0.00,$388.05,$0.00
H7493894884010,SUP,HCPCS C1876,,H7493894884010  -  STENT BILIARY 42MM SELF EXPAND DELIVERY SYSTEM SENTINOL,"$2,437.50",$0.00,"$2,437.50","$1,096.88","$1,739.64",$0.00,$419.97,$0.00,$0.00,$426.79,"$2,437.50",$0.00,"$1,218.75","$1,930.50","$1,950.00",$0.00,$381.47,$0.00,$388.05,$0.00
H7493894884070,SUP,HCPCS C1876,,H7493894884070  -  STENT BILIARY 42MM SELF EXPAND DELIVERY SYSTEM SENTINOL,"$2,437.50",$0.00,"$2,437.50","$1,096.88","$1,739.64",$0.00,$419.97,$0.00,$0.00,$426.79,"$2,437.50",$0.00,"$1,218.75","$1,930.50","$1,950.00",$0.00,$381.47,$0.00,$388.05,$0.00
H7493894886010,SUP,HCPCS C1876,,H7493894886010  -  STENT BILIARY 60MM SELF EXPAND DELIVERY SYSTEM SENTINOL,"$2,437.50",$0.00,"$2,437.50","$1,096.88","$1,739.64",$0.00,$419.97,$0.00,$0.00,$426.79,"$2,437.50",$0.00,"$1,218.75","$1,930.50","$1,950.00",$0.00,$381.47,$0.00,$388.05,$0.00
H7493894886070,SUP,HCPCS C1876,,H7493894886070  -  STENT BILIARY 60MM SELF EXPAND DELIVERY SYSTEM SENTINOL,"$2,437.50",$0.00,"$2,437.50","$1,096.88","$1,739.64",$0.00,$419.97,$0.00,$0.00,$426.79,"$2,437.50",$0.00,"$1,218.75","$1,930.50","$1,950.00",$0.00,$381.47,$0.00,$388.05,$0.00
H7493894888010,SUP,HCPCS C1876,,H7493894888010  -  STENT BILIARY 81MM SELF EXPANDING DELIVERY SYSTEM SENTINOL,"$2,437.50",$0.00,"$2,437.50","$1,096.88","$1,739.64",$0.00,$419.97,$0.00,$0.00,$426.79,"$2,437.50",$0.00,"$1,218.75","$1,930.50","$1,950.00",$0.00,$381.47,$0.00,$388.05,$0.00
H7493894892010,SUP,HCPCS C1876,,H7493894892010  -  STENT BILIARY 21MM SELF EXPANDING SENTINOL NITINOL 135CM 9MM,"$2,437.50",$0.00,"$2,437.50","$1,096.88","$1,739.64",$0.00,$419.97,$0.00,$0.00,$426.79,"$2,437.50",$0.00,"$1,218.75","$1,930.50","$1,950.00",$0.00,$381.47,$0.00,$388.05,$0.00
H7493894892070,SUP,HCPCS C1876,,H7493894892070  -  STENT BILIARY 21MM SELF EXPANDING SENTINOL NITINOL 75CM 9MM,"$2,437.50",$0.00,"$2,437.50","$1,096.88","$1,739.64",$0.00,$419.97,$0.00,$0.00,$426.79,"$2,437.50",$0.00,"$1,218.75","$1,930.50","$1,950.00",$0.00,$381.47,$0.00,$388.05,$0.00
H7493894894010,SUP,HCPCS C1876,,H7493894894010  -  STENT BILIARY 42MM SELF EXPANDING SENTINOL NITINOL 135CM 9MM,"$2,437.50",$0.00,"$2,437.50","$1,096.88","$1,739.64",$0.00,$419.97,$0.00,$0.00,$426.79,"$2,437.50",$0.00,"$1,218.75","$1,930.50","$1,950.00",$0.00,$381.47,$0.00,$388.05,$0.00
H7493894894070,SUP,HCPCS C1876,,H7493894894070  -  STENT BILIARY 750MM SELF EXPANDING CATHETER DELIVERY SYSTEM,"$2,437.50",$0.00,"$2,437.50","$1,096.88","$1,739.64",$0.00,$419.97,$0.00,$0.00,$426.79,"$2,437.50",$0.00,"$1,218.75","$1,930.50","$1,950.00",$0.00,$381.47,$0.00,$388.05,$0.00
H7493894896010,SUP,HCPCS C1876,,H7493894896010  -  STENT BILIARY 60MM SELF EXPANDING SENTINOL NITINOL 135CM 9MM,"$2,437.50",$0.00,"$2,437.50","$1,096.88","$1,739.64",$0.00,$419.97,$0.00,$0.00,$426.79,"$2,437.50",$0.00,"$1,218.75","$1,930.50","$1,950.00",$0.00,$381.47,$0.00,$388.05,$0.00
H7493894896070,SUP,HCPCS C1876,,H7493894896070  -  STENT BILIARY 60MM SELF EXPANDING SENTINOL NITINOL 75CM 9MM,"$2,437.50",$0.00,"$2,437.50","$1,096.88","$1,739.64",$0.00,$419.97,$0.00,$0.00,$426.79,"$2,437.50",$0.00,"$1,218.75","$1,930.50","$1,950.00",$0.00,$381.47,$0.00,$388.05,$0.00
H7493894898010,SUP,HCPCS C1876,,H7493894898010  -  STENT BILIARY 80MM SELF EXPANDING SENTINOL NITINOL 135CM 9MM,"$2,437.50",$0.00,"$2,437.50","$1,096.88","$1,739.64",$0.00,$419.97,$0.00,$0.00,$426.79,"$2,437.50",$0.00,"$1,218.75","$1,930.50","$1,950.00",$0.00,$381.47,$0.00,$388.05,$0.00
H7493894898070,SUP,HCPCS C1876,,H7493894898070  -  STENT BILIARY 80MM SELF EXPANDING SENTINOL NITINOL 75CM 9MM,"$2,437.50",$0.00,"$2,437.50","$1,096.88","$1,739.64",$0.00,$419.97,$0.00,$0.00,$426.79,"$2,437.50",$0.00,"$1,218.75","$1,930.50","$1,950.00",$0.00,$381.47,$0.00,$388.05,$0.00
H7493897008250,SUP,HCPCS C2617,,H7493897008250  -  STENT CORON 2.5MM 8MM RAPEX BLN XPD TAXUS XPR2 MNRL 8.8%,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
H7493897008300,SUP,HCPCS C2617,,H7493897008300  -  STENT CORON 3MM 8MM RAPEX BLN EXPANDABLE TAXUS XPR2 MNRL,"$6,500.00",$0.00,"$6,500.00","$2,925.00","$4,639.05",$0.00,"$1,119.92",$0.00,$0.00,"$1,138.10","$6,500.00",$0.00,"$3,250.00","$5,148.00","$5,200.00",$0.00,"$1,017.25",$0.00,"$1,034.80",$0.00
H7493897008350,SUP,HCPCS C2617,,H7493897008350  -  STENT CORON 3.5MM 8MM RAPEX BLN XPD TAXUS XPR2 MNRL PCLTXL,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
H7493897012250,SUP,HCPCS C2617,,H7493897012250  -  STENT CORON 2.50MM 12MM XPR TAXUS XPR2 MNRL PCLTXL ELUT RX,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
H7493897012300,SUP,HCPCS C2617,,H7493897012300  -  STENT CORON 3MM 12MM RAPEX BLN XPD TAXUS XPR2 MNRL 8.8%,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
H7493897012350,SUP,HCPCS C2617,,H7493897012350  -  STENT CORON 3.5MM 12MM RAPEX BLN XPD TAXUS XPR2 MNRL PCLTXL,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
H7493897016250,SUP,HCPCS C2617,,H7493897016250  -  STENT CORON 2.5MM 16MM SYS ART TAXUS XPR2 MNRL 8.8% PCLTXL,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
H7493897016300,SUP,HCPCS C2617,,H7493897016300  -  STENT CORONARY ARTERY EXPRESS 2 TAXUS 3 X 16MM 8.8% PACLITAX,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
H7493897016350,SUP,HCPCS C2617,,H7493897016350  -  STENT CORON 3.5MM 16MM RAPEX BLN EXPANDABLE TAXUS XPR2 MNRL,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
H7493897020250,SUP,HCPCS C2617,,H7493897020250  -  STENT CORON 2.5MM 20MM TAXUS XPR2 MNRL 8.8% PCLTXL ELUT,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
H7493897020300,SUP,HCPCS C2617,,H7493897020300  -  STENT CORON 3MM 20MM RAPEX BLN EXPANDABLE TAXUS XPR2 MNRL,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
H7493897020350,SUP,HCPCS C2617,,H7493897020350  -  STENT CORON 3.5MM 20MM RAPEX BLN XPD XPR RX PCLTXL ELUT,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
H7493897028300,SUP,HCPCS C2617,,H7493897028300  -  STENT CORON 3MM 28MM RAPEX BLN XPD TAXUS XPR2 MNRL 8.8%,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
H7493897028350,SUP,HCPCS C2617,,H7493897028350  -  STENT CORON 3.5MM 28MM RAPEX BLN XPD TAXUS XPR2 MNRL 8.8%,"$6,500.00",$0.00,"$6,500.00","$2,925.00","$4,639.05",$0.00,"$1,119.92",$0.00,$0.00,"$1,138.10","$6,500.00",$0.00,"$3,250.00","$5,148.00","$5,200.00",$0.00,"$1,017.25",$0.00,"$1,034.80",$0.00
H7493897032300,SUP,HCPCS C2617,,H7493897032300  -  STENT CORON 3MM 32MM RAPEX BLN XPD TAXUS XPR2 MNRL PCLTXL,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
H7493897032350,SUP,HCPCS C2617,,H7493897032350  -  STENT CORON 3.5MM 32MM RAPEX BLN XPD XPR RX PCLTXL ELUT,"$6,250.00",$0.00,"$6,250.00","$2,812.50","$4,460.63",$0.00,"$1,076.84",$0.00,$0.00,"$1,094.33","$6,250.00",$0.00,"$3,125.00","$4,950.00","$5,000.00",$0.00,$978.13,$0.00,$995.00,$0.00
H74939031302010,SUP,HCPCS C1725,,H74939031302010  -  CATHETER BLNDIL 3MM 135CM 20MM STRLG MNRL TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031303010,SUP,HCPCS C1725,,H74939031303010  -  CATHETER BLNDIL 3MM 135CM 30MM STRLG MNRL TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031304010,SUP,HCPCS C1725,,H74939031304010  -  CATHETER BLNDIL 3MM 135CM 40MM STRLG MNRL TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031306010,SUP,HCPCS C1725,,H74939031306010  -  CATHETER BLNDIL 3MM 135CM 60MM STRLG MNRL TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031352010,SUP,HCPCS C1725,,H74939031352010  -  CATHETER BLNDIL 3.5MM 135CM 20MM STRLG MNRL TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031353010,SUP,HCPCS C1725,,H74939031353010  -  CATHETER BLNDIL 3.5MM 135CM 30MM STRLG MNRL RX INFL PORT,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031354010,SUP,HCPCS C1725,,H74939031354010  -  CATHETER BLNDIL 3.5MM 135CM 40MM STRLG MNRL TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031401080,SUP,HCPCS C1725,,H74939031401080  -  CATHETER BLNDIL 4MM 80CM 10MM STRLG MNRL TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031401580,SUP,HCPCS C1725,,H74939031401580  -  CATHETER BLNDIL 4MM 80CM 15MM STRLG MNRL TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031402010,SUP,HCPCS C1725,,H74939031402010  -  CATHETER BLNDIL 4MM 135CM 20MM STRLG MNRL TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031402080,SUP,HCPCS C1725,,H74939031402080  -  CATHETER BLNDIL 4MM 80CM 20MM STRLG MNRL TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031403010,SUP,HCPCS C1725,,H74939031403010  -  CATHETER BLNDIL 4MM 135CM 30MM STRLG MNRL TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031403080,SUP,HCPCS C1725,,H74939031403080  -  CATHETER BLNDIL 4MM 80CM 30MM STRLG MNRL TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031404010,SUP,HCPCS C1725,,H74939031404010  -  CATHETER BLNDIL 4MM 135CM 40MM STRLG MNRL TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031404080,SUP,HCPCS C1725,,H74939031404080  -  CATHETER BLNDIL 4MM 80CM 40MM STRLG MNRL TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031406010,SUP,HCPCS C1725,,H74939031406010  -  CATHETER BLNDIL 4MM 135CM 60MM STRLG MNRL TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031451580,SUP,HCPCS C1725,,H74939031451580  -  CATHETER BLNDIL 4.5MM 80CM 15MM STRLG MNRL TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031452010,SUP,HCPCS C1725,,H74939031452010  -  CATHETER BLNDIL 4.5MM 135CM 20MM STRLG MNRL TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031452080,SUP,HCPCS C1725,,H74939031452080  -  CATHETER BLNDIL 4.5MM 80CM 20MM STRLG MNRL TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031453010,SUP,HCPCS C1725,,H74939031453010  -  CATHETER BLNDIL 4.5MM 135CM 30MM STRLG MNRL RX INFL PORT,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031453080,SUP,HCPCS C1725,,H74939031453080  -  CATHETER BLNDIL 4.5MM 80CM 30MM STRLG MNRL TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031454010,SUP,HCPCS C1725,,H74939031454010  -  CATHETER BLNDIL 4.5MM 135CM 40MM STRLG MNRL TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031454080,SUP,HCPCS C1725,,H74939031454080  -  CATHETER BLNDIL 4.5MM 80CM 40MM STRLG MNRL TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031501080,SUP,HCPCS C1725,,H74939031501080  -  CATHETER BLNDIL 5MM 80CM 10MM STRLG MNRL TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031501580,SUP,HCPCS C1725,,H74939031501580  -  CATHETER BLNDIL 5MM 80CM 15MM STRLG MNRL TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031502010,SUP,HCPCS C1725,,H74939031502010  -  CATHETER BLNDIL 5MM 135CM 20MM STRLG MNRL TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031502080,SUP,HCPCS C1725,,H74939031502080  -  CATHETER BLNDIL 5MM 80CM 20MM STRLG MNRL TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031503010,SUP,HCPCS C1725,,H74939031503010  -  CATHETER BLNDIL 5MM 135CM 30MM STRLG MNRL TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031503080,SUP,HCPCS C1725,,H74939031503080  -  CATHETER BLNDIL 5MM 80CM 30MM STRLG MNRL TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031504010,SUP,HCPCS C1725,,H74939031504010  -  CATHETER BLNDIL 5MM 135CM 40MM STRLG MNRL TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031504080,SUP,HCPCS C1725,,H74939031504080  -  CATHETER BLNDIL 5MM 80CM 40MM STRLG MNRL TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031506010,SUP,HCPCS C1725,,H74939031506010  -  CATHETER BLNDIL 5MM 135CM 60MM STRLG MNRL TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031551580,SUP,HCPCS C1725,,H74939031551580  -  CATHETER BLNDIL 5.5MM 80CM 15MM STRLG MNRL TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031552010,SUP,HCPCS C1725,,H74939031552010  -  CATHETER BLNDIL 5.5MM 135CM 20MM STRLG MNRL TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031552080,SUP,HCPCS C1725,,H74939031552080  -  CATHETER BLNDIL 5.5MM 80CM 20MM STRLG MNRL TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031553010,SUP,HCPCS C1725,,H74939031553010  -  CATHETER BLNDIL 5.5MM 135CM 30MM STRLG MNRL TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031553080,SUP,HCPCS C1725,,H74939031553080  -  CATHETER BLNDIL 5.5MM 80CM 30MM STRLG MNRL TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031554010,SUP,HCPCS C1725,,H74939031554010  -  CATHETER BLNDIL 5.5MM 135CM 40MM STRLG MNRL TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031554080,SUP,HCPCS C1725,,H74939031554080  -  CATHETER BLNDIL 5.5MM 80CM 40MM STRLG MNRL TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031601080,SUP,HCPCS C1725,,H74939031601080  -  CATHETER BLNDIL 6MM 80CM 10MM STRLG MNRL TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031601580,SUP,HCPCS C1725,,H74939031601580  -  CATHETER BLNDIL 6MM 80CM 15MM STRLG MNRL TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031602010,SUP,HCPCS C1725,,H74939031602010  -  CATHETER BLNDIL 6MM 135CM 20MM STRLG MNRL TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031602080,SUP,HCPCS C1725,,H74939031602080  -  CATHETER BLNDIL 6MM 80CM 20MM STRLG MNRL TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031603010,SUP,HCPCS C1725,,H74939031603010  -  CATHETER BLNDIL 6MM 135CM 30MM STRLG MNRL TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031603080,SUP,HCPCS C1725,,H74939031603080  -  CATHETER BLNDIL 6MM 80CM 30MM STRLG MNRL TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031604010,SUP,HCPCS C1725,,H74939031604010  -  CATHETER BLNDIL 6MM 135CM 40MM STRLG MNRL TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031604080,SUP,HCPCS C1725,,H74939031604080  -  CATHETER BLNDIL 6MM 80CM 40MM STRLG MNRL TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031606010,SUP,HCPCS C1725,,H74939031606010  -  CATHETER BLNDIL 6MM 135CM 60MM STRLG MNRL TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031651580,SUP,HCPCS C1725,,H74939031651580  -  CATHETER BLNDIL 6.5MM 80CM 15MM STRLG MNRL TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031652010,SUP,HCPCS C1725,,H74939031652010  -  CATHETER BLNDIL 6.5MM 135CM 20MM STRLG MNRL TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031652080,SUP,HCPCS C1725,,H74939031652080  -  CATHETER BLNDIL 6.5MM 80CM 20MM STRLG MNRL TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031653010,SUP,HCPCS C1725,,H74939031653010  -  CATHETER BLNDIL 6.5MM 135CM 30MM STRLG MNRL TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031653080,SUP,HCPCS C1725,,H74939031653080  -  CATHETER BLNDIL 6.5MM 80CM 30MM STRLG MNRL TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031654010,SUP,HCPCS C1725,,H74939031654010  -  CATHETER BLNDIL 6.5MM 135CM 40MM STRLG MNRL TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031654080,SUP,HCPCS C1725,,H74939031654080  -  CATHETER BLNDIL 6.5MM 80CM 40MM STRLG MNRL TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031701080,SUP,HCPCS C1725,,H74939031701080  -  CATHETER BLNDIL 7MM 80CM 10MM STRLG MNRL TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031701580,SUP,HCPCS C1725,,H74939031701580  -  CATHETER BLNDIL 7MM 80CM 15MM STRLG MNRL TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031702010,SUP,HCPCS C1725,,H74939031702010  -  CATHETER BLNDIL 7MM 135CM 20MM STRLG MNRL TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031702080,SUP,HCPCS C1725,,H74939031702080  -  CATHETER BLNDIL 7MM 80CM 20MM STRLG MNRL RX INFL PORT LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031703010,SUP,HCPCS C1725,,H74939031703010  -  CATHETER BLNDIL 7MM 135CM 30MM STRLG MNRL TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031703080,SUP,HCPCS C1725,,H74939031703080  -  CATHETER BLNDIL 7MM 80CM 30MM STRLG MNRL TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031704010,SUP,HCPCS C1725,,H74939031704010  -  CATHETER BLNDIL 7MM 135CM 40MM STRLG MNRL TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031704080,SUP,HCPCS C1725,,H74939031704080  -  CATHETER BLNDIL 7MM 80CM 40MM STRLG MNRL TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031706010,SUP,HCPCS C1725,,H74939031706010  -  CATHETER BLNDIL 7MM 135CM 60MM STRLG MNRL TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031801080,SUP,HCPCS C1725,,H74939031801080  -  CATHETER BLNDIL 8MM 80CM 10MM STRLG MNRL TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031801580,SUP,HCPCS C1725,,H74939031801580  -  CATHETER BLNDIL 8MM 80CM 15MM STRLG MNRL TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031802010,SUP,HCPCS C1725,,H74939031802010  -  CATHETER BLNDIL 8MM 135CM 20MM STRLG MNRL TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031802080,SUP,HCPCS C1725,,H74939031802080  -  CATHETER BLNDIL 8MM 80CM 20MM STRLG MNRL TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031803010,SUP,HCPCS C1725,,H74939031803010  -  CATHETER BLNDIL 8MM 135CM 30MM STRLG MNRL TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031803080,SUP,HCPCS C1725,,H74939031803080  -  CATHETER BLNDIL 8MM 80CM 30MM STRLG MNRL TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031804010,SUP,HCPCS C1725,,H74939031804010  -  CATHETER BLNDIL 8MM 135CM 40MM STRLG MNRL TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031804080,SUP,HCPCS C1725,,H74939031804080  -  CATHETER BLNDIL 8MM 80CM 40MM STRLG MNRL TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939031806010,SUP,HCPCS C1725,,H74939031806010  -  CATHETER BLNDIL 8MM 135CM 60MM STRLG MNRL TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032102010,SUP,HCPCS C1753,,H74939032102010  -  CATHETER BLNDIL 10MM 135CM 20MM STRLG OTW TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032102080,SUP,HCPCS C1753,,H74939032102080  -  CATHETER BLNDIL 10MM 80CM 20MM STRLG OTW TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032103010,SUP,HCPCS C1753,,H74939032103010  -  CATHETER BLNDIL 10MM 135CM 30MM STRLG OTW TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032103080,SUP,HCPCS C1753,,H74939032103080  -  CATHETER BLNDIL 10MM 80CM 30MM STRLG OTW TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032104010,SUP,HCPCS C1753,,H74939032104010  -  CATHETER BLNDIL 10MM 135CM 40MM STRLG OTW TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032104080,SUP,HCPCS C1753,,H74939032104080  -  CATHETER BLNDIL 10MM 80CM 40MM STRLG OTW TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032106010,SUP,HCPCS C1753,,H74939032106010  -  CATHETER BLNDIL 10MM 135CM 60MM STRLG OTW TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032106080,SUP,HCPCS C1753,,H74939032106080  -  CATHETER BLNDIL 10MM 80CM 60MM STRLG OTW TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032108010,SUP,HCPCS C1753,,H74939032108010  -  CATHETER BLNDIL 10MM 135CM 80MM STRLG OTW TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032108080,SUP,HCPCS C1753,,H74939032108080  -  CATHETER BLNDIL 10MM 80CM 80MM STRLG OTW TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032401010,SUP,HCPCS C1753,,H74939032401010  -  CATHETER BLNDIL 4MM 135CM 100MM STRLG OTW INFL PORT LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032401080,SUP,HCPCS C1753,,H74939032401080  -  CATHETER BLNDIL 4MM 80CM 100MM STRLG OTW TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032402010,SUP,HCPCS C1726,,H74939032402010  -  CATHETER BLNDIL 4MM 135CM 20MM STRLG OTW INFL PORT LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032402040,SUP,HCPCS C1753,,H74939032402040  -  CATHETER BLNDIL 4MM 40CM 20MM STRLG OTW TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032402080,SUP,HCPCS C1753,,H74939032402080  -  CATHETER BLNDIL 4MM 80CM 20MM STRLG OTW INFL PORT LOPRFL TPR,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032403010,SUP,HCPCS C1753,,H74939032403010  -  CATHETER BLNDIL 4MM 135CM 30MM STRLG OTW TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032403080,SUP,HCPCS C1753,,H74939032403080  -  CATHETER BLNDIL 4MM 80CM 30MM STRLG OTW TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032404010,SUP,HCPCS C1726,,H74939032404010  -  CATHETER BLNDIL 4MM 135CM 40MM STRLG OTW TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032404040,SUP,HCPCS C1753,,H74939032404040  -  CATHETER BLNDIL 4MM 40CM 40MM STRLG OTW INFL PORT LOPRFL TPR,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032404080,SUP,HCPCS C1753,,H74939032404080  -  CATHETER BLNDIL 4MM 80CM 40MM STRLG OTW TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032406010,SUP,HCPCS C1753,,H74939032406010  -  CATHETER BLNDIL 4MM 135CM 60MM STRLG OTW INFL PORT LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032406080,SUP,HCPCS C1753,,H74939032406080  -  CATHETER BLNDIL 4MM 80CM 60MM STRLG OTW TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032408010,SUP,HCPCS C1753,,H74939032408010  -  CATHETER BLNDIL 4MM 135CM 80MM STRLG OTW TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032408080,SUP,HCPCS C1753,,H74939032408080  -  CATHETER BLNDIL 4MM 80CM 80MM STRLG OTW TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032501010,SUP,HCPCS C1753,,H74939032501010  -  CATHETER BLNDIL 5MM 135CM 100MM STRLG OTW TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032501080,SUP,HCPCS C1726,,H74939032501080  -  CATHETER BLNDIL 5MM 80CM 100MM STRLG OTW TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032501510,SUP,HCPCS C1725,,H74939032501510  -  CATHETER BLNDIL 5MM 150CM 150MM STRLG OTW TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032502010,SUP,HCPCS C1753,,H74939032502010  -  CATHETER BLNDIL 5MM 135CM 20MM STRLG OTW INFL PORT LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032502040,SUP,HCPCS C1753,,H74939032502040  -  CATHETER BLNDIL 5MM 40CM 20MM STRLG OTW TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032502080,SUP,HCPCS C1726,,H74939032502080  -  CATHETER BLNDIL 5MM 80CM 20MM STRLG OTW TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032502110,SUP,HCPCS C1725,,H74939032502110  -  CATHETER BLNDIL 5MM 150CM 200MM STRLG OTW TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032503010,SUP,HCPCS C1753,,H74939032503010  -  CATHETER BLNDIL 5MM 135CM 30MM STRLG OTW TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032503080,SUP,HCPCS C1753,,H74939032503080  -  CATHETER BLNDIL 5MM 80CM 30MM STRLG OTW TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032504010,SUP,HCPCS C1726,,H74939032504010  -  CATHETER BLNDIL 5MM 135CM 40MM STRLG OTW TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032504040,SUP,HCPCS C1753,,H74939032504040  -  CATHETER BLNDIL 5MM 40CM 40MM STRLG OTW INFL PORT LOPRFL TPR,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032504080,SUP,HCPCS C1726,,H74939032504080  -  CATHETER BLNDIL 5MM 80CM 40MM STRLG OTW TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032506010,SUP,HCPCS C1753,,H74939032506010  -  CATHETER BLNDIL 5MM 135CM 60MM STRLG OTW INFL PORT LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032506080,SUP,HCPCS C1726,,H74939032506080  -  CATHETER BLNDIL 5MM 80CM 60MM STRLG OTW TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032508010,SUP,HCPCS C1753,,H74939032508010  -  CATHETER BLNDIL 5MM 135CM 80MM STRLG OTW TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032508080,SUP,HCPCS C1726,,H74939032508080  -  CATHETER BLNDIL 5MM 80CM 80MM STRLG OTW TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032601010,SUP,HCPCS C1753,,H74939032601010  -  CATHETER BLNDIL 6MM 135CM 100MM STRLG OTW TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032601080,SUP,HCPCS C1753,,H74939032601080  -  CATHETER BLNDIL 6MM 80CM 100MM STRLG OTW TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032601510,SUP,HCPCS C1725,,H74939032601510  -  CATHETER BLNDIL 6MM 150CM 150MM STRLG OTW TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032602010,SUP,HCPCS C1726,,H74939032602010  -  CATHETER BLNDIL 6MM 135CM 20MM STRLG OTW INFL PORT LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032602040,SUP,HCPCS C1753,,H74939032602040  -  CATHETER BLNDIL 6MM 40CM 20MM STRLG OTW INFL PORT LOPRFL TPR,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032602080,SUP,HCPCS C1726,,H74939032602080  -  CATHETER BLNDIL 6MM 80CM 20MM STRLG OTW TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032602210,SUP,HCPCS C1725,,H74939032602210  -  CATHETER BLNDIL 6MM 150CM 220MM STRLG OTW TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032603010,SUP,HCPCS C1753,,H74939032603010  -  CATHETER BLNDIL 6MM 135CM 30MM STRLG OTW TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032603080,SUP,HCPCS C1753,,H74939032603080  -  CATHETER BLNDIL 6MM 80CM 30MM STRLG OTW TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032604010,SUP,HCPCS C1726,,H74939032604010  -  CATHETER BLNDIL 6MM 135CM 40MM STRLG OTW TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032604040,SUP,HCPCS C1753,,H74939032604040  -  CATHETER BLNDIL 6MM 40CM 40MM STRLG OTW INFL PORT LOPRFL TPR,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032604080,SUP,HCPCS C1726,,H74939032604080  -  CATHETER BLNDIL 6MM 80CM 40MM STRLG OTW TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032606010,SUP,HCPCS C1726,,H74939032606010  -  CATHETER BLNDIL 6MM 135CM 60MM STRLG OTW INFL PORT LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032606080,SUP,HCPCS C1726,,H74939032606080  -  CATHETER BLNDIL 6MM 80CM 60MM STRLG OTW TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032608010,SUP,HCPCS C1726,,H74939032608010  -  CATHETER BLNDIL 6MM 135CM 80MM STRLG OTW TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032608080,SUP,HCPCS C1753,,H74939032608080  -  CATHETER BLNDIL 6MM 80CM 80MM STRLG OTW TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032701010,SUP,HCPCS C1753,,H74939032701010  -  CATHETER BLNDIL 7MM 135CM 100MM STRLG OTW TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032701080,SUP,HCPCS C1753,,H74939032701080  -  CATHETER BLNDIL 7MM 80CM 100MM STRLG OTW INFL PORT LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032701210,SUP,HCPCS C1725,,H74939032701210  -  CATHETER BLNDIL 7MM 150CM 120MM STRLG OTW INFL PORT LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032701510,SUP,HCPCS C1725,,H74939032701510  -  CATHETER BLNDIL 7MM 150CM 150MM STRLG OTW TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032702010,SUP,HCPCS C1726,,H74939032702010  -  CATHETER BLNDIL 7MM 135CM 20MM STRLG OTW TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032702040,SUP,HCPCS C1753,,H74939032702040  -  CATHETER BLNDIL 7MM 40CM 20MM STRLG OTW TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032702080,SUP,HCPCS C1726,,H74939032702080  -  CATHETER BLNDIL 7MM 80CM 20MM STRLG OTW TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032702110,SUP,HCPCS C1725,,H74939032702110  -  CATHETER BLNDIL 7MM 150CM 200MM STRLG OTW INFL PORT LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032702210,SUP,HCPCS C1725,,H74939032702210  -  CATHETER BLNDIL 7MM 150CM 220MM STRLG OTW INFL PORT LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032703010,SUP,HCPCS C1753,,H74939032703010  -  CATHETER BLNDIL 7MM 135CM 30MM STRLG OTW TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032703080,SUP,HCPCS C1753,,H74939032703080  -  CATHETER BLNDIL 7MM 80CM 30MM STRLG OTW TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032704010,SUP,HCPCS C1726,,H74939032704010  -  CATHETER BLNDIL 7MM 135CM 40MM STRLG OTW TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032704040,SUP,HCPCS C1753,,H74939032704040  -  CATHETER BLNDIL 7MM 40CM 40MM STRLG OTW TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032704080,SUP,HCPCS C1726,,H74939032704080  -  CATHETER BLNDIL 7MM 80CM 40MM STRLG OTW TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032706010,SUP,HCPCS C1726,,H74939032706010  -  CATHETER BLNDIL 7MM 135CM 60MM STRLG OTW INFL PORT LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032706080,SUP,HCPCS C1726,,H74939032706080  -  CATHETER BLNDIL 7MM 80CM 60MM STRLG OTW TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032708010,SUP,HCPCS C1753,,H74939032708010  -  CATHETER BLNDIL 7MM 135CM 80MM STRLG OTW INFL PORT LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032708080,SUP,HCPCS C1726,,H74939032708080  -  CATHETER BLNDIL 7MM 80CM 80MM STRLG OTW TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032802010,SUP,HCPCS C1726,,H74939032802010  -  CATHETER BLNDIL 8MM 135CM 20MM STRLG OTW TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032802040,SUP,HCPCS C1753,,H74939032802040  -  CATHETER BLNDIL 8MM 40CM 20MM STRLG OTW TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032802080,SUP,HCPCS C1726,,H74939032802080  -  CATHETER BLNDIL 8MM 80CM 20MM STRLG OTW TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032803010,SUP,HCPCS C1753,,H74939032803010  -  CATHETER BLNDIL 8MM 135CM 30MM STRLG OTW TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032803080,SUP,HCPCS C1753,,H74939032803080  -  CATHETER BLNDIL 8MM 80CM 30MM STRLG OTW TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032804010,SUP,HCPCS C1726,,H74939032804010  -  CATHETER BLNDIL 8MM 135CM 40MM STRLG OTW TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032804040,SUP,HCPCS C1753,,H74939032804040  -  CATHETER BLNDIL 8MM 40CM 40MM STRLG OTW TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032804080,SUP,HCPCS C1726,,H74939032804080  -  CATHETER BLNDIL 8MM 80CM 40MM STRLG OTW TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032806010,SUP,HCPCS C1726,,H74939032806010  -  CATHETER BLNDIL 8MM 135CM 40MM STRLG OTW INFL PORT LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032806080,SUP,HCPCS C1726,,H74939032806080  -  CATHETER BLNDIL 8MM 80CM 60MM STRLG OTW TPR TIP LOPRFL INFL,$150.00,$0.00,$150.00,$81.45,$107.06,$0.00,$25.84,$0.00,$0.00,$26.26,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$23.48,$0.00,$23.88,$0.00
H74939032808010,SUP,HCPCS C1726,,H74939032808010  -  CATHETER BLNDIL 8MM 135CM 80MM STRLG OTW INFL PORT LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032808080,SUP,HCPCS C1753,,H74939032808080  -  CATHETER BLNDIL 8MM 80CM 80MM STRLG OTW TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032902010,SUP,HCPCS C1753,,H74939032902010  -  CATHETER BLNDIL 9MM 135CM 20MM STRLG OTW TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032902080,SUP,HCPCS C1753,,H74939032902080  -  CATHETER BLNDIL 9MM 80CM 20MM STRLG OTW TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032903010,SUP,HCPCS C1753,,H74939032903010  -  CATHETER BLNDIL 9MM 135CM 30MM STRLG OTW TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032903080,SUP,HCPCS C1753,,H74939032903080  -  CATHETER BLNDIL 9MM 80CM 30MM STRLG OTW TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032904010,SUP,HCPCS C1726,,H74939032904010  -  CATHETER BLNDIL 9MM 135CM 40MM STRLG OTW TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032904080,SUP,HCPCS C1726,,H74939032904080  -  CATHETER BLNDIL 9MM 80CM 40MM STRLG OTW TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032906010,SUP,HCPCS C1753,,H74939032906010  -  CATHETER BLNDIL 9MM 135CM 60MM STRLG OTW TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032906080,SUP,HCPCS C1753,,H74939032906080  -  CATHETER BLNDIL 9MM 80CM 60MM STRLG OTW TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032908010,SUP,HCPCS C1753,,H74939032908010  -  CATHETER BLNDIL 9MM 135CM 80MM STRLG OTW TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939032908080,SUP,HCPCS C1753,,H74939032908080  -  CATHETER BLNDIL 9MM 80CM 80MM STRLG OTW TPR TIP LOPRFL INFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939134152010,SUP,HCPCS C1726,,H74939134152010  -  CATHETER BLNDIL 1.5MM 142CM 20MM CYTE ES OTW ULT LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939134202010,SUP,HCPCS C1726,,H74939134202010  -  CATHETER BLNDIL 2MM 142CM 20MM CYTE ES OTW ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939134203010,SUP,HCPCS C1753,,H74939134203010  -  CATHETER BLNDIL 2MM 143CM 30MM CYTE ES OTW ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939134204010,SUP,HCPCS C1726,,H74939134204010  -  CATHETER BLNDIL 2MM 144CM 40MM CYTE ES OTW ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939134252010,SUP,HCPCS C1753,,H74939134252010  -  CATHETER BLNDIL 2.5MM 143CM 20MM CYTE ES OTW ULT LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939134253010,SUP,HCPCS C1753,,H74939134253010  -  CATHETER BLNDIL 2.5MM 144CM 30MM CYTE ES OTW ULT LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939134254010,SUP,HCPCS C1726,,H74939134254010  -  CATHETER BLNDIL 2.5MM 145CM 40MM CYTE ES OTW ULT LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939134302010,SUP,HCPCS C1726,,H74939134302010  -  CATHETER BLNDIL 3MM 143CM 20MM CYTE ES OTW ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939134303010,SUP,HCPCS C1753,,H74939134303010  -  CATHETER BLNDIL 3MM 144CM 30MM CYTE ES OTW ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939134304010,SUP,HCPCS C1726,,H74939134304010  -  CATHETER BLNDIL 3MM 145CM 40MM CYTE ES OTW ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939134352010,SUP,HCPCS C1753,,H74939134352010  -  CATHETER BLNDIL 3.5MM 143CM 20MM CYTE ES OTW ULT LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939134353010,SUP,HCPCS C1753,,H74939134353010  -  CATHETER BLNDIL 3.5MM 144CM 30MM CYTE ES OTW ULT LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939134354010,SUP,HCPCS C1753,,H74939134354010  -  CATHETER BLNDIL 3.5MM 145CM 40MM CYTE ES OTW ULT LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939134402010,SUP,HCPCS C1726,,H74939134402010  -  CATHETER BLNDIL 4MM 143CM 20MM CYTE ES OTW ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939134403010,SUP,HCPCS C1753,,H74939134403010  -  CATHETER BLNDIL 4MM 144CM 30MM CYTE ES OTW ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939134404010,SUP,HCPCS C1726,,H74939134404010  -  CATHETER BLNDIL 4MM 145CM 40MM CYTE ES OTW ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939135152010,SUP,HCPCS C1753,,H74939135152010  -  CATHETER BLNDIL 1.5MM 143CM 20MM CYTE ES MNRL RX ULT LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939135202010,SUP,HCPCS C1753,,H74939135202010  -  CATHETER BLNDIL 2MM 143CM 20MM CYTE ES MNRL RX ULT LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939135203010,SUP,HCPCS C1753,,H74939135203010  -  CATHETER BLNDIL 2MM 144CM 30MM CYTE ES MNRL ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939135204010,SUP,HCPCS C1753,,H74939135204010  -  CATHETER BLNDIL 2MM 145CM 40MM CYTE ES MNRL RX ULT LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939135252010,SUP,HCPCS C1753,,H74939135252010  -  CATHETER BLNDIL 2.5MM 144CM 20MM CYTE ES MNRL RX ULT LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939135253010,SUP,HCPCS C1753,,H74939135253010  -  CATHETER BLNDIL 2.5MM 145CM 30MM CYTE ES MNRL RX ULT LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939135254010,SUP,HCPCS C1753,,H74939135254010  -  CATHETER BLNDIL 2.5MM 145CM 40MM CYTE ES MNRL RX ULT LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939135302010,SUP,HCPCS C1753,,H74939135302010  -  CATHETER BLNDIL 3MM 144CM 20MM CYTE ES MNRL RX ULT LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939135303010,SUP,HCPCS C1753,,H74939135303010  -  CATHETER BLNDIL 3MM 145CM 30MM CYTE ES MNRL RX ULT LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939135304010,SUP,HCPCS C1753,,H74939135304010  -  CATHETER BLNDIL 3MM 146CM 40MM CYTE ES MNRL ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939135352010,SUP,HCPCS C1753,,H74939135352010  -  CATHETER BLNDIL 3.5MM 144CM 20MM CYTE ES MNRL RX ULT LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939135353010,SUP,HCPCS C1753,,H74939135353010  -  CATHETER BLNDIL 3.5MM 145CM 30MM CYTE ES MNRL RX ULT LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939135354010,SUP,HCPCS C1753,,H74939135354010  -  CATHETER BLNDIL 3.5MM 145CM 40MM CYTE ES MNRL RX ULT LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939135402010,SUP,HCPCS C1753,,H74939135402010  -  CATHETER BLNDIL 4MM 144CM 20MM CYTE ES MNRL RX ULT LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939135403010,SUP,HCPCS C1753,,H74939135403010  -  CATHETER BLNDIL 4MM 145CM 30MM CYTE ES MNRL RX ULT LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939135404010,SUP,HCPCS C1753,,H74939135404010  -  CATHETER BLNDIL 4MM 145CM 40MM CYTE ES MNRL RX ULT LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939147201010,SUP,HCPCS C1725,,H74939147201010  -  CATHETER BLNDIL 2MM 150CM 100MM STRLG SL OTW TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939147201090,SUP,HCPCS C1725,,H74939147201090  -  CATHETER BLNDIL 2MM 90CM 100MM STRLG SL MNRL RX INFL PORT,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939147201210,SUP,HCPCS C1725,,H74939147201210  -  CATHETER BLNDIL 2MM 150CM 120MM STRLG SL OTW TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939147201290,SUP,HCPCS C1725,,H74939147201290  -  CATHETER BLNDIL 2MM 90CM 120MM STRLG SL MNRL RX INFL PORT,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939147201510,SUP,HCPCS C1725,,H74939147201510  -  CATHETER BLNDIL 2MM 150CM 150MM STRLG SL OTW TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939147201590,SUP,HCPCS C1725,,H74939147201590  -  CATHETER BLNDIL 2MM 90CM 150MM STRLG SL MNRL RX INFL PORT,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939147208010,SUP,HCPCS C1725,,H74939147208010  -  CATHETER BLNDIL 2MM 150CM 80MM STRLG SL OTW TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939147208090,SUP,HCPCS C1725,,H74939147208090  -  CATHETER BLNDIL 2MM 90CM 80MM STRLG SL MNRL RX INFL PORT,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939147251010,SUP,HCPCS C1725,,H74939147251010  -  CATHETER BLNDIL 2.5MM 150CM 100MM STRLG SL OTW TPR TIP,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939147251090,SUP,HCPCS C1725,,H74939147251090  -  CATHETER BLNDIL 2.5MM 90CM 100MM STRLG SL MNRL RX INFL PORT,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939147251210,SUP,HCPCS C1725,,H74939147251210  -  CATHETER BLNDIL 2.5MM 150CM 120MM STRLG SL MNRL TPR TIP,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939147251290,SUP,HCPCS C1725,,H74939147251290  -  CATHETER BLNDIL 2.5MM 90CM 120MM STRLG SL MNRL RX INFL PORT,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939147251510,SUP,HCPCS C1725,,H74939147251510  -  CATHETER BLNDIL 2.5MM 150CM 150MM STRLG SL MNRL TPR TIP,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939147251590,SUP,HCPCS C1725,,H74939147251590  -  CATHETER BLNDIL 2.5MM 90CM 150MM STRLG SL MNRL RX INFL PORT,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939147258010,SUP,HCPCS C1725,,H74939147258010  -  CATHETER BLNDIL 2.5MM 150CM 80MM STRLG SL MNRL TPR TIP,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939147258090,SUP,HCPCS C1725,,H74939147258090  -  CATHETER BLNDIL 2.5MM 90CM 80MM STRLG SL MNRL RX INFL PORT,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939147301010,SUP,HCPCS C1725,,H74939147301010  -  CATHETER BLNDIL 3MM 150CM 100MM STRLG SL MNRL TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939147301090,SUP,HCPCS C1725,,H74939147301090  -  CATHETER BLNDIL 3MM 90CM 100MM STRLG SL MNRL RX INFL PORT,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939147301210,SUP,HCPCS C1725,,H74939147301210  -  CATHETER BLNDIL 3MM 150CM 120MM STRLG SL MNRL TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939147301290,SUP,HCPCS C1725,,H74939147301290  -  CATHETER BLNDIL 3MM 90CM 120MM STRLG SL MNRL RX INFL PORT,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939147301510,SUP,HCPCS C1725,,H74939147301510  -  CATHETER BLNDIL 3MM 150CM 150MM STRLG SL MNRL TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939147301590,SUP,HCPCS C1725,,H74939147301590  -  CATHETER BLNDIL 3MM 90CM 150MM STRLG SL MNRL RX INFL PORT,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939147308010,SUP,HCPCS C1725,,H74939147308010  -  CATHETER BLNDIL 3MM 150CM 80MM STRLG SL MNRL TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939147308090,SUP,HCPCS C1725,,H74939147308090  -  CATHETER BLNDIL 3MM 90CM 80MM STRLG SL MNRL RX INFL PORT,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939147351010,SUP,HCPCS C1725,,H74939147351010  -  CATHETER BLNDIL 3.5MM 150CM 100MM STRLG SL MNRL RX INFL PORT,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939147351090,SUP,HCPCS C1725,,H74939147351090  -  CATHETER BLNDIL 3.5MM 90CM 100MM STRLG SL MNRL RX INFL PORT,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939147351210,SUP,HCPCS C1725,,H74939147351210  -  CATHETER BLNDIL 3.5MM 150CM 120MM STRLG SL MNRL RX INFL PORT,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939147351290,SUP,HCPCS C1725,,H74939147351290  -  CATHETER BLNDIL 3.5MM 90CM 120MM STRLG SL MNRL RX INFL PORT,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939147351510,SUP,HCPCS C1725,,H74939147351510  -  CATHETER BLNDIL 3.5MM 150CM 150MM STRLG SL MNRL RX INFL PORT,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939147351590,SUP,HCPCS C1725,,H74939147351590  -  CATHETER BLNDIL 3.5MM 90CM 150MM STRLG SL MNRL RX INFL PORT,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939147358010,SUP,HCPCS C1725,,H74939147358010  -  CATHETER BLNDIL 3.5MM 150CM 80MM STRLG SL MNRL RX INFL PORT,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939147358090,SUP,HCPCS C1725,,H74939147358090  -  CATHETER BLNDIL 3.5MM 90CM 80MM STRLG SL MNRL RX INFL PORT,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939147401010,SUP,HCPCS C1725,,H74939147401010  -  CATHETER BLNDIL 4MM 150CM 100MM STRLG SL MNRL RX INFL PORT,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939147401090,SUP,HCPCS C1725,,H74939147401090  -  CATHETER BLNDIL 4MM 90CM 100MM STRLG SL MNRL RX INFL PORT,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939147401210,SUP,HCPCS C1725,,H74939147401210  -  CATHETER BLNDIL 4MM 150CM 120MM STRLG SL MNRL TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939147401290,SUP,HCPCS C1725,,H74939147401290  -  CATHETER BLNDIL 4MM 90CM 120MM STRLG SL MNRL RX INFL PORT,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939147401510,SUP,HCPCS C1725,,H74939147401510  -  CATHETER BLNDIL 4MM 150CM 150MM STRLG SL MNRL RX INFL PORT,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939147401590,SUP,HCPCS C1725,,H74939147401590  -  CATHETER BLNDIL 4MM 90CM 150MM STRLG SL MNRL RX INFL PORT,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939147408010,SUP,HCPCS C1725,,H74939147408010  -  CATHETER BLNDIL 4MM 150CM 80MM STRLG SL MNRL TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939147408090,SUP,HCPCS C1725,,H74939147408090  -  CATHETER BLNDIL 4MM 90CM 80MM STRLG SL MNRL RX INFL PORT,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939148201010,SUP,HCPCS C1726,,H74939148201010  -  CATHETER BLNDIL 2MM 150CM 100MM STRLG SL OTW INFL PORT,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939148201090,SUP,HCPCS C1753,,H74939148201090  -  CATHETER BLNDIL 2MM 100CM 90MM STRLG SL OTW TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939148201210,SUP,HCPCS C1726,,H74939148201210  -  CATHETER BLNDIL 2MM 150CM 120MM STRLG SL OTW INFL PORT,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939148201290,SUP,HCPCS C1725,,H74939148201290  -  CATHETER BLNDIL 2MM 90CM 120MM STRLG SL OTW INFL PORT LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939148201510,SUP,HCPCS C1726,,H74939148201510  -  CATHETER BLNDIL 2MM 150CM 150MM STRLG SL OTW INFL PORT,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939148201590,SUP,HCPCS C1725,,H74939148201590  -  CATHETER BLNDIL 2MM 90CM 150MM STRLG SL OTW INFL PORT LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939148208010,SUP,HCPCS C1726,,H74939148208010  -  CATHETER BLNDIL 2MM 150CM 80MM STRLG SL OTW TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939148208090,SUP,HCPCS C1753,,H74939148208090  -  CATHETER BLNDIL 2MM 90CM 80MM STRLG SL OTW TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939148251010,SUP,HCPCS C1753,,H74939148251010  -  CATHETER BLNDIL 2.5MM 150CM 100MM STRLG SL OTW INFL PORT,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939148251090,SUP,HCPCS C1753,,H74939148251090  -  CATHETER BLNDIL 2.5MM 90CM 100MM STRLG SL OTW INFL PORT,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939148251210,SUP,HCPCS C1725,,H74939148251210  -  CATHETER BLNDIL 2.5MM 150CM 120MM STRLG SL OTW INFL PORT,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939148251290,SUP,HCPCS C1725,,H74939148251290  -  CATHETER BLNDIL 2.5MM 90CM 120MM STRLG SL OTW INFL PORT,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939148251510,SUP,HCPCS C1725,,H74939148251510  -  CATHETER BLNDIL 2.5MM 150CM 150MM STRLG SL OTW INFL PORT,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939148251590,SUP,HCPCS C1725,,H74939148251590  -  CATHETER BLNDIL 2.5MM 90CM 150MM STRLG SL OTW INFL PORT,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939148258010,SUP,HCPCS C1753,,H74939148258010  -  CATHETER BLNDIL 2.5MM 150CM 80MM STRLG SL OTW INFL PORT,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939148258090,SUP,HCPCS C1753,,H74939148258090  -  CATHETER BLNDIL 2.5MM 90CM 80MM STRLG SL OTW INFL PORT,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939148301010,SUP,HCPCS C1726,,H74939148301010  -  CATHETER BLNDIL 3MM 150CM 100MM STRLG SL OTW INFL PORT,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939148301090,SUP,HCPCS C1753,,H74939148301090  -  CATHETER BLNDIL 3MM 90CM 100MM STRLG SL OTW INFL PORT LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939148301210,SUP,HCPCS C1726,,H74939148301210  -  CATHETER BLNDIL 3MM 150CM 120MM STRLG SL OTW TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939148301290,SUP,HCPCS C1725,,H74939148301290  -  CATHETER BLNDIL 3MM 90CM 120MM STRLG SL OTW TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939148301510,SUP,HCPCS C1726,,H74939148301510  -  CATHETER BLNDIL 3MM 150CM 150MM STRLG SL OTW INFL PORT,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939148301590,SUP,HCPCS C1725,,H74939148301590  -  CATHETER BLNDIL 3MM 90CM 150MM STRLG SL OTW TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939148308010,SUP,HCPCS C1726,,H74939148308010  -  CATHETER BLNDIL 3MM 150CM 80MM STRLG SL OTW TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939148308090,SUP,HCPCS C1753,,H74939148308090  -  CATHETER BLNDIL 3MM 90CM 80MM STRLG SL OTW TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939148351010,SUP,HCPCS C1753,,H74939148351010  -  CATHETER BLNDIL 3.5MM 150CM 100MM STRLG SL OTW INFL PORT,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939148351090,SUP,HCPCS C1753,,H74939148351090  -  CATHETER BLNDIL 3.5MM 90CM 100MM STRLG SL OTW INFL PORT,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939148351210,SUP,HCPCS C1725,,H74939148351210  -  CATHETER BLNDIL 3.5MM 150CM 120MM STRLG SL OTW INFL PORT,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939148351290,SUP,HCPCS C1725,,H74939148351290  -  CATHETER BLNDIL 3.5MM 90CM 120MM STRLG SL OTW INFL PORT,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939148351510,SUP,HCPCS C1725,,H74939148351510  -  CATHETER BLNDIL 3.5MM 150CM 150MM STRLG SL OTW INFL PORT,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939148351590,SUP,HCPCS C1725,,H74939148351590  -  CATHETER BLNDIL 3.5MM 90CM 150MM STRLG SL OTW INFL PORT,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939148358010,SUP,HCPCS C1753,,H74939148358010  -  CATHETER BLNDIL 3.5MM 150CM 80MM STRLG SL OTW INFL PORT,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939148358090,SUP,HCPCS C1753,,H74939148358090  -  CATHETER BLNDIL 3.5MM 90CM 80MM STRLG SL OTW INFL PORT,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939148401010,SUP,HCPCS C1753,,H74939148401010  -  CATHETER BLNDIL 4MM 150CM 100MM STRLG SL OTW INFL PORT,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939148401210,SUP,HCPCS C1725,,H74939148401210  -  CATHETER BLNDIL 4MM 150CM 120MM STRLG SL OTW TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939148401290,SUP,HCPCS C1725,,H74939148401290  -  CATHETER BLNDIL 4MM 90CM 120MM STRLG SL OTW TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939148401510,SUP,HCPCS C1726,,H74939148401510  -  CATHETER BLNDIL 4MM 150CM 150MM STRLG SL OTW TPR TIP LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939148401590,SUP,HCPCS C1725,,H74939148401590  -  CATHETER BLNDIL 4MM 90CM 150MM STRLG SL OTW INFL PORT LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939148408010,SUP,HCPCS C1726,,H74939148408010  -  CATHETER BLNDIL 4MM 150CM 80MM STRLG SL OTW INFL PORT LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939171030210,SUP,HCPCS C1753,,H74939171030210  -  CATHETER BALDILAT LP 5.3FR 3MM 135CM 20MM HIGH PRESSURE,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171030240,SUP,HCPCS C1753,,H74939171030240  -  CATHETER BLNDIL 3MM 40CM 20MM MUSTANG HI-PRS NYBAX ACPT .035,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171030270,SUP,HCPCS C1753,,H74939171030270  -  CATHETER BALDILAT LP 5.3FR 3MM 75CM 20MM HIGH PRESSURE,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171030310,SUP,HCPCS C1753,,H74939171030310  -  CATHETER BALDILAT .035IN 5FR 3MM 135CM 30MM PTA LP,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171030340,SUP,HCPCS C1753,,H74939171030340  -  CATHETER BLNDIL 3MM 40CM 30MM MUSTANG HI-PRS NYBAX ACPT .035,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171030370,SUP,HCPCS C1753,,H74939171030370  -  CATHETER BLNDIL 3MM 75CM 30MM MUSTANG HI-PRS NYBAX ACPT .035,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171030410,SUP,HCPCS C1753,,H74939171030410  -  CATHETER BALDILAT LP 5.3FR 3MM 135CM 40MM HIGH PRESSURE,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171030440,SUP,HCPCS C1753,,H74939171030440  -  CATHETER BLNDIL 3MM 40CM 40MM MUSTANG HI-PRS NYBAX ACPT .035,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171030470,SUP,HCPCS C1753,,H74939171030470  -  CATHETER BALDILAT LP 5.3FR 3MM 75CM 40MM HIGH PRESSURE,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171030610,SUP,HCPCS C1753,,H74939171030610  -  CATHETER BALDILAT LP 5.3FR 3MM 135CM 60MM HIGH PRESSURE,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171030640,SUP,HCPCS C1753,,H74939171030640  -  CATHETER BLNDIL 3MM 40CM 60MM MUSTANG HI-PRS NYBAX ACPT .035,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171030670,SUP,HCPCS C1753,,H74939171030670  -  CATHETER BALDILAT LP 5.3FR 3MM 75CM 60MM HIGH PRESSURE,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171030810,SUP,HCPCS C1753,,H74939171030810  -  CATHETER BLNDIL 3MM 135CM 80MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171030840,SUP,HCPCS C1753,,H74939171030840  -  CATHETER BLNDIL 3MM 40CM 80MM MUSTANG HI-PRS NYBAX ACPT .035,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171030870,SUP,HCPCS C1753,,H74939171030870  -  CATHETER BLNDIL 3MM 75CM 80MM MUSTANG HI-PRS NYBAX ACPT .035,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171031010,SUP,HCPCS C1753,,H74939171031010  -  CATHETER BALDILAT .035IN 3MM 135CM 100MM HIGH PRESSURE LP,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171031040,SUP,HCPCS C1753,,H74939171031040  -  CATHETER BLNDIL 3MM 40CM 100MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171031070,SUP,HCPCS C1753,,H74939171031070  -  CATHETER BLNDIL 3MM 75CM 100MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171031210,SUP,HCPCS C1753,,H74939171031210  -  CATHETER BLNDIL 3MM 135CM 120MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171031270,SUP,HCPCS C1753,,H74939171031270  -  CATHETER BLNDIL 3MM 75CM 120MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171031510,SUP,HCPCS C1753,,H74939171031510  -  CATHETER BALDILAT LP 5.3FR 3MM 135CM 150MM HIGH PRESSURE,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171031570,SUP,HCPCS C1753,,H74939171031570  -  CATHETER BLNDIL 3MM 75CM 150MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171031810,SUP,HCPCS C1753,,H74939171031810  -  CATHETER BALDILAT .035IN 5FR 3MM 135CM 180MM PTA LP,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171031870,SUP,HCPCS C1753,,H74939171031870  -  CATHETER BLNDIL 3MM 75CM 180MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171032010,SUP,HCPCS C1753,,H74939171032010  -  CATHETER BALDILAT LP 5.3FR 3MM 135CM 200MM HIGH PRESSURE,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171032070,SUP,HCPCS C1753,,H74939171032070  -  CATHETER BLNDIL 3MM 75CM 200MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171040210,SUP,HCPCS C1725,,H74939171040210  -  CATHETER BALDILAT .035IN 4MM 135CM 20MM HIGH PRESSURE LP,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171040240,SUP,HCPCS C1753,,H74939171040240  -  CATHETER BLNDIL 4MM 40CM 20MM MUSTANG HI-PRS NYBAX ACPT .035,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171040270,SUP,HCPCS C1726,,H74939171040270  -  CATHETER BALDILAT LP 5.3FR 4MM 75CM 20MM HIGH PRESSURE,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171040310,SUP,HCPCS C1753,,H74939171040310  -  CATHETER BALDILAT 4MM 135CM 30MM HIGH PRESSURE LP INFLAT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171040340,SUP,HCPCS C1753,,H74939171040340  -  CATHETER BLNDIL 4MM 40CM 30MM MUSTANG HI-PRS NYBAX ACPT .035,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171040370,SUP,HCPCS C1753,,H74939171040370  -  CATHETER BLNDIL 4MM 75CM 30MM MUSTANG HI-PRS NYBAX ACPT .035,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171040410,SUP,HCPCS C1726,,H74939171040410  -  CATHETER BALDILAT LP 5.3FR 4MM 135CM 40MM HIGH PRESSURE,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171040440,SUP,HCPCS C1753,,H74939171040440  -  CATHETER BLNDIL 4MM 40CM 40MM MUSTANG HI-PRS NYBAX ACPT .035,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171040470,SUP,HCPCS C1726,,H74939171040470  -  CATHETER BALDILAT LP 5.3FR 4MM 75CM 40MM HIGH PRESSURE,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171040610,SUP,HCPCS C1753,,H74939171040610  -  CATHETER BALDILAT LP 5.3FR 4MM 135CM 60MM HIGH PRESSURE,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171040640,SUP,HCPCS C1753,,H74939171040640  -  CATHETER BLNDIL 4MM 40CM 60MM MUSTANG HI-PRS NYBAX ACPT .035,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171040670,SUP,HCPCS C1753,,H74939171040670  -  CATHETER BALDILAT LP 5.3FR 4MM 75CM 60MM HIGH PRESSURE,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171040810,SUP,HCPCS C1753,,H74939171040810  -  CATHETER BALDILAT LP 5.3FR 4MM 135CM 80MM HIGH PRESSURE,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171040840,SUP,HCPCS C1753,,H74939171040840  -  CATHETER BLNDIL 4MM 40CM 80MM MUSTANG HI-PRS NYBAX ACPT .035,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171040870,SUP,HCPCS C1753,,H74939171040870  -  CATHETER BLNDIL 4MM 75CM 80MM MUSTANG HI-PRS NYBAX ACPT .035,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171041010,SUP,HCPCS C1753,,H74939171041010  -  CATHETER BALDILAT .035IN 4MM 135CM 100MM HIGH PRESSURE LP,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171041040,SUP,HCPCS C1753,,H74939171041040  -  CATHETER BLNDIL 4MM 40CM 100MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171041070,SUP,HCPCS C1753,,H74939171041070  -  CATHETER BLNDIL 4MM 75CM 100MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171041210,SUP,HCPCS C1726,,H74939171041210  -  CATHETER BLNDIL 4MM 135CM 120MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171041270,SUP,HCPCS C1753,,H74939171041270  -  CATHETER BLNDIL 4MM 75CM 120MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171041510,SUP,HCPCS C1753,,H74939171041510  -  CATHETER BALDILAT LP 5.3FR 4MM 135CM 150MM HIGH PRESSURE,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171041570,SUP,HCPCS C1753,,H74939171041570  -  CATHETER BLNDIL 4MM 75CM 150MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171041810,SUP,HCPCS C1753,,H74939171041810  -  CATHETER BLNDIL 4MM 135CM 180MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171041870,SUP,HCPCS C1753,,H74939171041870  -  CATHETER BLNDIL 4MM 75CM 180MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171042010,SUP,HCPCS C1725,,H74939171042010  -  CATHETER BALDILAT .035IN 4MM 135CM 200MM HIGH PRESSURE LP,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171042070,SUP,HCPCS C1753,,H74939171042070  -  CATHETER BLNDIL 4MM 75CM 200MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171050210,SUP,HCPCS C1726,,H74939171050210  -  CATHETER BALDILAT .035IN 5MM 135CM 20MM HIGH PRESSURE LP,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171050240,SUP,HCPCS C1753,,H74939171050240  -  CATHETER BLNDIL 5MM 40CM 20MM MUSTANG HI-PRS NYBAX ACPT .035,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171050270,SUP,HCPCS C1725,,H74939171050270  -  CATHETER BALDILAT LP 5.3FR 5MM 75CM 20MM HIGH PRESSURE,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171050310,SUP,HCPCS C1753,,H74939171050310  -  CATHETER BALDILAT LP 5FR 5MM 135CM 30MM HIGH PRESSURE,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171050340,SUP,HCPCS C1753,,H74939171050340  -  CATHETER BLNDIL 5MM 40CM 30MM MUSTANG HI-PRS NYBAX ACPT .035,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171050370,SUP,HCPCS C1753,,H74939171050370  -  CATHETER BLNDIL 5MM 75CM 30MM MUSTANG HI-PRS NYBAX ACPT .035,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171050410,SUP,HCPCS C1726,,H74939171050410  -  CATHETER BALDILAT 5FR 5MM 135CM 40MM HIGH PRESSURE LP INFLAT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171050440,SUP,HCPCS C1726,,H74939171050440  -  CATHETER BLNDIL 5MM 40CM 40MM MUSTANG HI-PRS NYBAX ACPT .035,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171050470,SUP,HCPCS C1726,,H74939171050470  -  CATHETER BALDILAT .035IN 5MM 75CM 40MM HIGH PRESSURE LP,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171050610,SUP,HCPCS C1753,,H74939171050610  -  CATHETER BALDILAT .035IN 5MM 135CM 60MM HIGH PRESSURE LP,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171050640,SUP,HCPCS C1753,,H74939171050640  -  CATHETER BLNDIL 5MM 40CM 60MM MUSTANG HI-PRS NYBAX ACPT .035,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171050670,SUP,HCPCS C1753,,H74939171050670  -  CATHETER BALDILAT .035IN 5MM 75CM 60MM HIGH PRESSURE LP,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171050810,SUP,HCPCS C1753,,H74939171050810  -  CATHETER BALDILAT LP 5.3FR 5MM 135CM 80MM HIGH PRESSURE,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171050840,SUP,HCPCS C1753,,H74939171050840  -  CATHETER BLNDIL 5MM 40CM 80MM MUSTANG HI-PRS NYBAX ACPT .035,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171050870,SUP,HCPCS C1753,,H74939171050870  -  CATHETER BLNDIL 5MM 75CM 80MM MUSTANG HI-PRS NYBAX ACPT .035,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171051010,SUP,HCPCS C1725,,H74939171051010  -  CATHETER BALDILAT LP 5.3FR 5MM 135CM 100MM HIGH PRESSURE,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171051040,SUP,HCPCS C1753,,H74939171051040  -  CATHETER BLNDIL 5MM 40CM 100MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171051070,SUP,HCPCS C1753,,H74939171051070  -  CATHETER BLNDIL 5MM 75CM 100MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171051210,SUP,HCPCS C1753,,H74939171051210  -  CATHETER BALDILAT LP 5.3FR 5MM 135CM 120MM HIGH PRESSURE,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171051240,SUP,HCPCS C1753,,H74939171051240  -  CATHETER BLNDIL 5MM 40CM 120MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171051270,SUP,HCPCS C1753,,H74939171051270  -  CATHETER BLNDIL 5MM 75CM 120MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171051510,SUP,HCPCS C1726,,H74939171051510  -  CATHETER BALDILAT LP 5.3FR 5MM 135CM 150MM HIGH PRESSURE,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171051570,SUP,HCPCS C1753,,H74939171051570  -  CATHETER BLNDIL 5MM 75CM 150MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171051810,SUP,HCPCS C1753,,H74939171051810  -  CATHETER BLNDIL 5MM 135CM 180MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171051870,SUP,HCPCS C1753,,H74939171051870  -  CATHETER BLNDIL 5MM 75CM 180MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171052010,SUP,HCPCS C1726,,H74939171052010  -  CATHETER BALDILAT LP 5.3FR 5MM 135CM 200MM HIGH PRESSURE,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171052070,SUP,HCPCS C1753,,H74939171052070  -  CATHETER BLNDIL 5MM 75CM 200MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171060210,SUP,HCPCS C1726,,H74939171060210  -  CATHETER BALDILAT .035IN 6MM 135CM 20MM HIGH PRESSURE LP,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171060240,SUP,HCPCS C1753,,H74939171060240  -  CATHETER BLNDIL 6MM 40CM 20MM MUSTANG HI-PRS NYBAX ACPT .035,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171060270,SUP,HCPCS C1726,,H74939171060270  -  CATHETER BALDILAT .035IN 6MM 75CM 20MM HIGH PRESSURE LP,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171060310,SUP,HCPCS C1753,,H74939171060310  -  CATHETER BLNDIL 6MM 135CM 30MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171060340,SUP,HCPCS C1753,,H74939171060340  -  CATHETER BLNDIL 6MM 40CM 30MM MUSTANG HI-PRS NYBAX ACPT .035,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171060370,SUP,HCPCS C1753,,H74939171060370  -  CATHETER BLNDIL 6MM 75CM 30MM MUSTANG HI-PRS NYBAX ACPT .035,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171060410,SUP,HCPCS C1726,,H74939171060410  -  CATHETER BALDILAT LP 5.3FR 6MM 135CM 40MM HIGH PRESSURE,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171060440,SUP,HCPCS C1726,,H74939171060440  -  CATHETER BLNDIL 6MM 40CM 40MM MUSTANG HI-PRS NYBAX ACPT .035,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171060470,SUP,HCPCS C1726,,H74939171060470  -  CATHETER BALDILAT 6MM 75CM 40MM HIGH PRESSURE LP INFLAT PORT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171060610,SUP,HCPCS C1753,,H74939171060610  -  CATHETER BALDILAT LP 5.3FR 6MM 135CM 60MM HIGH PRESSURE,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171060640,SUP,HCPCS C1753,,H74939171060640  -  CATHETER BLNDIL 6MM 40CM 60MM MUSTANG HI-PRS NYBAX ACPT .035,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171060670,SUP,HCPCS C1753,,H74939171060670  -  CATHETER BALDILAT .035IN 6MM 75CM 60MM HIGH PRESSURE LP,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171060810,SUP,HCPCS C1753,,H74939171060810  -  CATHETER BALDILAT LP 5.3FR 6MM 135CM 80MM HIGH PRESSURE,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171060840,SUP,HCPCS C1753,,H74939171060840  -  CATHETER BLNDIL 6MM 40CM 80MM MUSTANG HI-PRS NYBAX ACPT .035,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171060870,SUP,HCPCS C1753,,H74939171060870  -  CATHETER BALDILAT .035IN 6MM 75CM 80MM HIGH PRESSURE LP,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171061010,SUP,HCPCS C1726,,H74939171061010  -  CATHETER BALDILAT LP 5.3FR 6MM 135CM 100MM HIGH PRESSURE,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171061040,SUP,HCPCS C1753,,H74939171061040  -  CATHETER BLNDIL 6MM 40CM 100MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171061070,SUP,HCPCS C1726,,H74939171061070  -  CATHETER BALDILAT LP 5.3FR 6MM 75CM 100MM HIGH PRESSURE,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171061210,SUP,HCPCS C1753,,H74939171061210  -  CATHETER BALDILAT LP 5.3FR 6MM 135CM 120MM HIGH PRESSURE,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171061240,SUP,HCPCS C1753,,H74939171061240  -  CATHETER BLNDIL 6MM 40CM 120MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171061270,SUP,HCPCS C1753,,H74939171061270  -  CATHETER BLNDIL 6MM 75CM 120MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171061510,SUP,HCPCS C1726,,H74939171061510  -  CATHETER BALDILAT LP 5.3FR 6MM 135CM 150MM HIGH PRESSURE,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171061570,SUP,HCPCS C1753,,H74939171061570  -  CATHETER BLNDIL 6MM 75CM 150MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171061810,SUP,HCPCS C1753,,H74939171061810  -  CATHETER BLNDIL 6MM 135CM 180MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171061870,SUP,HCPCS C1753,,H74939171061870  -  CATHETER BLNDIL 6MM 75CM 180MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171062010,SUP,HCPCS C1726,,H74939171062010  -  CATHETER BALDILAT 6MM 135CM 200MM HIGH PRESSURE LP INFLAT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171062070,SUP,HCPCS C1753,,H74939171062070  -  CATHETER BLNDIL 6MM 75CM 200MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171070210,SUP,HCPCS C1753,,H74939171070210  -  CATHETER BALDILAT .035IN 7MM 135CM 20MM HIGH PRESSURE LP,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171070240,SUP,HCPCS C1753,,H74939171070240  -  CATHETER BLNDIL 7MM 40CM 20MM MUSTANG HI-PRS NYBAX ACPT .035,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171070270,SUP,HCPCS C1726,,H74939171070270  -  CATHETER BALDILAT LP 5.3FR 7MM 75CM 20MM HIGH PRESSURE,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171070310,SUP,HCPCS C1753,,H74939171070310  -  CATHETER BALDILAT LP 5.3FR 7MM 135CM 30MM HIGH PRESSURE,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171070340,SUP,HCPCS C1753,,H74939171070340  -  CATHETER BLNDIL 7MM 40CM 30MM MUSTANG HI-PRS NYBAX ACPT .035,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171070370,SUP,HCPCS C1753,,H74939171070370  -  CATHETER BLNDIL 7MM 75CM 30MM MUSTANG HI-PRS NYBAX ACPT .035,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171070410,SUP,HCPCS C1726,,H74939171070410  -  CATHETER BALDILAT .035IN 7MM 135CM 40MM HIGH PRESSURE LP,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171070440,SUP,HCPCS C1726,,H74939171070440  -  CATHETER BLNDIL 7MM 40CM 40MM MUSTANG HI-PRS NYBAX ACPT .035,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171070470,SUP,HCPCS C1726,,H74939171070470  -  CATHETER BALDILAT .035IN 7MM 75CM 40MM HIGH PRESSURE LP,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171070610,SUP,HCPCS C1753,,H74939171070610  -  CATHETER BALDILAT LP 5.3FR 7MM 135CM 60MM HIGH PRESSURE,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171070640,SUP,HCPCS C1753,,H74939171070640  -  CATHETER BLNDIL 7MM 40CM 60MM MUSTANG HI-PRS NYBAX ACPT .035,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171070670,SUP,HCPCS C1753,,H74939171070670  -  CATHETER BALDILAT .035IN 7MM 75CM 60MM HIGH PRESSURE LP,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171070810,SUP,HCPCS C1753,,H74939171070810  -  CATHETER BALDILAT LP 5.3FR 7MM 135CM 80MM HIGH PRESSURE,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171070840,SUP,HCPCS C1753,,H74939171070840  -  CATHETER BLNDIL 7MM 40CM 80MM MUSTANG HI-PRS NYBAX ACPT .035,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171070870,SUP,HCPCS C1753,,H74939171070870  -  CATHETER BLNDIL 7MM 75CM 80MM MUSTANG HI-PRS NYBAX ACPT .035,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171071010,SUP,HCPCS C1725,,H74939171071010  -  CATHETER BALDILAT LP 5.3FR 7MM 135CM 100MM HIGH PRESSURE,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171071040,SUP,HCPCS C1753,,H74939171071040  -  CATHETER BLNDIL 7MM 40CM 100MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171071070,SUP,HCPCS C1753,,H74939171071070  -  CATHETER BLNDIL 7MM 75CM 100MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171071210,SUP,HCPCS C1753,,H74939171071210  -  CATHETER BALDILAT LP 5.3FR 7MM 135CM 120MM HIGH PRESSURE,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171071270,SUP,HCPCS C1753,,H74939171071270  -  CATHETER BLNDIL 7MM 75CM 120MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171071510,SUP,HCPCS C1753,,H74939171071510  -  CATHETER BALDILAT LP 5.3FR 7MM 135CM 150MM HIGH PRESSURE,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171071570,SUP,HCPCS C1753,,H74939171071570  -  CATHETER BLNDIL 7MM 75CM 150MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171071810,SUP,HCPCS C1753,,H74939171071810  -  CATHETER BLNDIL 7MM 135CM 180MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171071870,SUP,HCPCS C1753,,H74939171071870  -  CATHETER BLNDIL 7MM 75CM 180MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171072010,SUP,HCPCS C1753,,H74939171072010  -  CATHETER BALDILAT LP 5.3FR 7MM 135CM 200MM HIGH PRESSURE,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171072070,SUP,HCPCS C1753,,H74939171072070  -  CATHETER BLNDIL 7MM 75CM 200MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171080210,SUP,HCPCS C1753,,H74939171080210  -  CATHETER BALDILAT LP 5.3FR 8MM 135CM 20MM HIGH PRESSURE,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171080240,SUP,HCPCS C1753,,H74939171080240  -  CATHETER BLNDIL 8MM 40CM 20MM MUSTANG HI-PRS NYBAX ACPT .035,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171080270,SUP,HCPCS C1725,,H74939171080270  -  CATHETER BALDILAT LP 5.3FR 8MM 75CM 20MM HIGH PRESSURE,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171080310,SUP,HCPCS C1753,,H74939171080310  -  CATHETER BALDILAT LP 5.3FR 8MM 135CM 30MM HIGH PRESSURE,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171080340,SUP,HCPCS C1753,,H74939171080340  -  CATHETER BLNDIL 8MM 40CM 30MM MUSTANG HI-PRS NYBAX ACPT .035,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171080370,SUP,HCPCS C1753,,H74939171080370  -  CATHETER BALDILAT LP 5.3FR 8MM 75CM 30MM HIGH PRESSURE,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171080410,SUP,HCPCS C1726,,H74939171080410  -  CATHETER BALDILAT 8MM 135CM 40MM HIGH PRESSURE LP INFLAT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171080440,SUP,HCPCS C1726,,H74939171080440  -  CATHETER BLNDIL 8MM 40CM 40MM MUSTANG HI-PRS NYBAX ACPT .035,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171080470,SUP,HCPCS C1726,,H74939171080470  -  CATHETER BALDILAT .035IN 8MM 75CM 40MM HIGH PRESSURE LP,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171080610,SUP,HCPCS C1753,,H74939171080610  -  CATHETER BALDILAT LP 5.3FR 8MM 135CM 60MM HIGH PRESSURE,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171080640,SUP,HCPCS C1753,,H74939171080640  -  CATHETER BLNDIL 8MM 40CM 60MM MUSTANG HI-PRS NYBAX ACPT .035,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171080670,SUP,HCPCS C1753,,H74939171080670  -  CATHETER BALDILAT .035IN 8MM 75CM 60MM HIGH PRESSURE LP,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171080810,SUP,HCPCS C1753,,H74939171080810  -  CATHETER BALDILAT LP 5.3FR 8MM 135CM 80MM HIGH PRESSURE,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171080840,SUP,HCPCS C1753,,H74939171080840  -  CATHETER BLNDIL 8MM 40CM 80MM MUSTANG HI-PRS NYBAX ACPT .035,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171080870,SUP,HCPCS C1725,,H74939171080870  -  CATHETER BALDILAT .035IN 8MM 75CM 80MM HIGH PRESSURE LP,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171081010,SUP,HCPCS C1726,,H74939171081010  -  CATHETER BALDILAT LP 5.3FR 8MM 135CM 100MM HIGH PRESSURE,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171081040,SUP,HCPCS C1753,,H74939171081040  -  CATHETER BLNDIL 8MM 40CM 100MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171081070,SUP,HCPCS C1726,,H74939171081070  -  CATHETER BLNDIL 8MM 75CM 100MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171081210,SUP,HCPCS C1753,,H74939171081210  -  CATHETER BLNDIL 8MM 135CM 120MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171081270,SUP,HCPCS C1753,,H74939171081270  -  CATHETER BLNDIL 8MM 75CM 120MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171081510,SUP,HCPCS C1753,,H74939171081510  -  CATHETER BLNDIL 8MM 135CM 150MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171081570,SUP,HCPCS C1753,,H74939171081570  -  CATHETER BLNDIL 8MM 75CM 150MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171081810,SUP,HCPCS C1753,,H74939171081810  -  CATHETER BALDILAT .035IN 5FR 8MM 135CM 180MM PTA LP,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171081870,SUP,HCPCS C1753,,H74939171081870  -  CATHETER BLNDIL 8MM 75CM 180MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171082010,SUP,HCPCS C1753,,H74939171082010  -  CATHETER BALDILAT .035IN 5FR 8MM 135CM 200MM PTA LP,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171082070,SUP,HCPCS C1753,,H74939171082070  -  CATHETER BALDILAT LP 5.3FR 8MM 75CM 200MM HIGH PRESSURE,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171086070,SUP,HCPCS C1725,,"H74939171086070  -  MUSTANG 8X 60, 75",$500.00,$0.00,$500.00,$271.50,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
H74939171090210,SUP,HCPCS C1753,,H74939171090210  -  CATHETER BALDILAT 18 ATM LP TAPER 5.8FR 9MM 135CM 20MM 2,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171090240,SUP,HCPCS C1753,,H74939171090240  -  CATHETER BLNDIL 9MM 40CM 20MM MUSTANG HI-PRS NYBAX ACPT .035,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171090270,SUP,HCPCS C1753,,H74939171090270  -  CATHETER BALDILAT LP 5.3FR 9MM 75CM 20MM HIGH PRESSURE,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171090310,SUP,HCPCS C1753,,H74939171090310  -  CATHETER BLNDIL 9MM 135CM 30MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171090340,SUP,HCPCS C1753,,H74939171090340  -  CATHETER BLNDIL 9MM 40CM 30MM MUSTANG HI-PRS NYBAX ACPT .035,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171090370,SUP,HCPCS C1753,,H74939171090370  -  CATHETER BLNDIL 9MM 75CM 30MM MUSTANG HI-PRS NYBAX ACPT .035,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171090410,SUP,HCPCS C1753,,H74939171090410  -  CATHETER BALDILAT LP 5.8FR 9MM 135CM 40MM HIGH PRESSURE,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171090440,SUP,HCPCS C1753,,H74939171090440  -  CATHETER BLNDIL 9MM 40CM 40MM MUSTANG HI-PRS NYBAX ACPT .035,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171090470,SUP,HCPCS C1725,,H74939171090470  -  CATHETER BALDILAT .035IN 9MM 75CM 40MM HIGH PRESSURE LP,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171090610,SUP,HCPCS C1753,,H74939171090610  -  CATHETER BLNDIL 9MM 135CM 60MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171090640,SUP,HCPCS C1753,,H74939171090640  -  CATHETER BLNDIL 9MM 40CM 60MM MUSTANG HI-PRS NYBAX ACPT .035,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171090670,SUP,HCPCS C1726,,H74939171090670  -  CATHETER BLNDIL 9MM 75CM 60MM MUSTANG HI-PRS NYBAX ACPT .035,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171090810,SUP,HCPCS C1753,,H74939171090810  -  CATHETER BLNDIL 9MM 135CM 80MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171090840,SUP,HCPCS C1753,,H74939171090840  -  CATHETER BLNDIL 9MM 40CM 80MM MUSTANG HI-PRS NYBAX ACPT .035,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171090870,SUP,HCPCS C1753,,H74939171090870  -  CATHETER BLNDIL 9MM 75CM 80MM MUSTANG HI-PRS NYBAX ACPT .035,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171100210,SUP,HCPCS C1753,,H74939171100210  -  CATHETER BALDILAT LP 5.8FR 10MM 135CM 20MM HIGH PRESSURE,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171100240,SUP,HCPCS C1753,,H74939171100240  -  CATHETER BLNDIL 10MM 40CM 20MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171100270,SUP,HCPCS C1726,,H74939171100270  -  CATHETER BALDILAT 10MM 75CM 20MM HIGH PRESSURE LP INFLAT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171100310,SUP,HCPCS C1753,,H74939171100310  -  CATHETER BLNDIL 10MM 135CM 30MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171100340,SUP,HCPCS C1753,,H74939171100340  -  CATHETER BLNDIL 10MM 40CM 30MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171100370,SUP,HCPCS C1753,,H74939171100370  -  CATHETER BALDILAT LP 5.8FR 10MM 75CM 30MM HIGH PRESSURE,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171100410,SUP,HCPCS C1753,,H74939171100410  -  CATHETER BALDILAT LP 5.8FR 10MM 135CM 40MM HIGH PRESSURE,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171100440,SUP,HCPCS C1753,,H74939171100440  -  CATHETER BLNDIL 10MM 40CM 40MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171100470,SUP,HCPCS C1726,,H74939171100470  -  CATHETER BALDILAT 10MM 75CM 40MM HIGH PRESSURE LP MUSTANG,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171100610,SUP,HCPCS C1753,,H74939171100610  -  CATHETER BLNDIL 10MM 135CM 60MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171100640,SUP,HCPCS C1753,,H74939171100640  -  CATHETER BLNDIL 10MM 40CM 60MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171100670,SUP,HCPCS C1725,,H74939171100670  -  CATHETER BALDILAT 5.8FR 10MM 75CM 60MM HIGH PRESSURE LP,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171100810,SUP,HCPCS C1753,,H74939171100810  -  CATHETER BLNDIL 10MM 135CM 80MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171100840,SUP,HCPCS C1753,,H74939171100840  -  CATHETER BLNDIL 10MM 40CM 80MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171100870,SUP,HCPCS C1753,,H74939171100870  -  CATHETER BALDILAT LP 5.8FR 10MM 75CM 80MM HIGH PRESSURE,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171120210,SUP,HCPCS C1753,,H74939171120210  -  CATHETER BALDILAT LP 5.8FR 12MM 135CM 20MM HIGH PRESSURE,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171120240,SUP,HCPCS C1753,,H74939171120240  -  CATHETER BLNDIL 12MM 40CM 20MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171120270,SUP,HCPCS C1753,,H74939171120270  -  CATHETER BALDILAT LP 5.8FR 12MM 75CM 20MM HIGH PRESSURE,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171120310,SUP,HCPCS C1753,,H74939171120310  -  CATHETER BLNDIL 12MM 135CM 30MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171120340,SUP,HCPCS C1753,,H74939171120340  -  CATHETER BLNDIL 12MM 40CM 30MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171120370,SUP,HCPCS C1753,,H74939171120370  -  CATHETER BALDILAT LP 5.8FR 12MM 75CM 30MM HIGH PRESSURE,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171120410,SUP,HCPCS C1753,,H74939171120410  -  CATHETER BLNDIL 12MM 135CM 40MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171120440,SUP,HCPCS C1753,,H74939171120440  -  CATHETER BLNDIL 12MM 40CM 40MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171120470,SUP,HCPCS C1726,,H74939171120470  -  CATHETER BALDILAT 12MM 75CM 40MM HIGH PRESSURE LP MUSTANG,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171120610,SUP,HCPCS C1753,,H74939171120610  -  CATHETER BLNDIL 12MM 135CM 60MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171120640,SUP,HCPCS C1753,,H74939171120640  -  CATHETER BLNDIL 12MM 40CM 60MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171120670,SUP,HCPCS C1753,,H74939171120670  -  CATHETER BLNDIL 12MM 75CM 60MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171120810,SUP,HCPCS C1753,,H74939171120810  -  CATHETER BLNDIL 12MM 135CM 80MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171120840,SUP,HCPCS C1753,,H74939171120840  -  CATHETER BLNDIL 12MM 40CM 80MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939171120870,SUP,HCPCS C1753,,H74939171120870  -  CATHETER BLNDIL 12MM 75CM 80MM MUSTANG HI-PRS NYBAX ACPT,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
H74939185150410,SUP,HCPCS C1725,,H74939185150410  -  CATHETER BLNDIL 1.5MM 150CM 40MM CYTE MNRL RX ULT LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939185201210,SUP,HCPCS C1725,,H74939185201210  -  CATHETER BLNDIL 2MM 150CM 120MM CYTE MNRL RX ULT LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939185201290,SUP,HCPCS C1725,,H74939185201290  -  CATHETER BLNDIL 2MM 90CM 120MM CYTE MNRL RX ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939185201510,SUP,HCPCS C1725,,H74939185201510  -  CATHETER BLNDIL 2MM 150CM 150MM CYTE MNRL ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939185201590,SUP,HCPCS C1725,,H74939185201590  -  CATHETER BLNDIL 2MM 90CM 150MM CYTE MNRL RX ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939185251210,SUP,HCPCS C1725,,H74939185251210  -  CATHETER BLNDIL 2.5MM 150CM 120MM CYTE MNRL RX ULT LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939185251290,SUP,HCPCS C1725,,H74939185251290  -  CATHETER BLNDIL 2.5MM 90CM 120MM CYTE MNRL RX ULT LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939185251510,SUP,HCPCS C1725,,H74939185251510  -  CATHETER BLNDIL 2.5MM 150CM 150MM CYTE MNRL ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939185251590,SUP,HCPCS C1725,,H74939185251590  -  CATHETER BLNDIL 2.5MM 90CM 150MM CYTE MNRL RX ULT LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939185301210,SUP,HCPCS C1725,,H74939185301210  -  CATHETER BLNDIL 3MM 150CM 120MM CYTE MNRL RX ULT LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939185301290,SUP,HCPCS C1725,,H74939185301290  -  CATHETER BLNDIL 3MM 90CM 120MM CYTE MNRL RX ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939185301510,SUP,HCPCS C1725,,H74939185301510  -  CATHETER BLNDIL 3MM 150CM 150MM CYTE MNRL ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939185301590,SUP,HCPCS C1725,,H74939185301590  -  CATHETER BLNDIL 3MM 90CM 150MM CYTE MNRL RX ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939185351210,SUP,HCPCS C1725,,H74939185351210  -  CATHETER BLNDIL 3.5MM 150CM 120MM CYTE MNRL RX ULT LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939185351290,SUP,HCPCS C1725,,H74939185351290  -  CATHETER BLNDIL 3.5MM 90CM 120MM CYTE MNRL RX ULT LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939185351510,SUP,HCPCS C1725,,H74939185351510  -  CATHETER BLNDIL 3.5MM 150CM 150MM CYTE MNRL ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939185351590,SUP,HCPCS C1725,,H74939185351590  -  CATHETER BLNDIL 3.5MM 90CM 150MM CYTE MNRL RX ULT LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939185401210,SUP,HCPCS C1725,,H74939185401210  -  CATHETER BLNDIL 4MM 150CM 120MM CYTE MNRL RX ULT LOPRFL,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939185401290,SUP,HCPCS C1725,,H74939185401290  -  CATHETER BLNDIL 4MM 90CM 120MM CYTE MNRL RX ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939185401510,SUP,HCPCS C1725,,H74939185401510  -  CATHETER BLNDIL 4MM 150CM 150MM CYTE MNRL ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939185401590,SUP,HCPCS C1725,,H74939185401590  -  CATHETER BLNDIL 4MM 90CM 150MM CYTE MNRL RX ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939186150410,SUP,HCPCS C1726,,H74939186150410  -  CATHETER BLNDIL 1.5MM 150CM 40MM CYTE OTW ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939186150490,SUP,HCPCS C1753,,H74939186150490  -  CATHETER BLNDIL 1.5MM 90CM 40MM CYTE OTW ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939186200610,SUP,HCPCS C1753,,H74939186200610  -  CATHETER BLNDIL 2MM 150CM 60MM CYTE OTW ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939186200690,SUP,HCPCS C1753,,H74939186200690  -  CATHETER BLNDIL 2MM 90CM 60MM CYTE OTW ULT LOPRFL NYBAX BSLD,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939186200810,SUP,HCPCS C1753,,H74939186200810  -  CATHETER BLNDIL 2MM 150CM 80MM CYTE OTW ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939186200890,SUP,HCPCS C1753,,H74939186200890  -  CATHETER BLNDIL 2MM 90CM 80MM CYTE OTW ULT LOPRFL NYBAX BSLD,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939186201010,SUP,HCPCS C1726,,H74939186201010  -  CATHETER BLNDIL 2MM 150CM 100MM CYTE OTW ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939186201090,SUP,HCPCS C1753,,H74939186201090  -  CATHETER BLNDIL 2MM 90CM 100MM CYTE OTW ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939186201210,SUP,HCPCS C1726,,H74939186201210  -  CATHETER BLNDIL 2MM 150CM 120MM CYTE OTW ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939186201290,SUP,HCPCS C1753,,H74939186201290  -  CATHETER BLNDIL 2MM 90CM 120MM CYTE OTW ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939186201510,SUP,HCPCS C1726,,H74939186201510  -  CATHETER BLNDIL 2MM 150CM 150MM CYTE OTW ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939186201590,SUP,HCPCS C1753,,H74939186201590  -  CATHETER BLNDIL 2MM 90CM 150MM CYTE OTW ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939186202210,SUP,HCPCS C1726,,H74939186202210  -  CATHETER BLNDIL 2MM 150CM 220MM CYTE OTW ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939186202290,SUP,HCPCS C1753,,H74939186202290  -  CATHETER BLNDIL 2MM 90CM 220MM CYTE OTW ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939186250610,SUP,HCPCS C1725,,H74939186250610  -  CATHETER BLNDIL 2.5MM 150CM 60MM CYTE OTW ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939186250690,SUP,HCPCS C1753,,H74939186250690  -  CATHETER BLNDIL 2.5MM 90CM 60MM CYTE OTW ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939186250810,SUP,HCPCS C1753,,H74939186250810  -  CATHETER BLNDIL 2.5MM 150CM 80MM CYTE OTW ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939186250890,SUP,HCPCS C1753,,H74939186250890  -  CATHETER BLNDIL 2.5MM 90CM 80MM CYTE OTW ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939186251010,SUP,HCPCS C1753,,H74939186251010  -  CATHETER BLNDIL 2.5MM 150CM 100MM CYTE OTW ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939186251090,SUP,HCPCS C1753,,H74939186251090  -  CATHETER BLNDIL 2.5MM 90CM 100MM CYTE OTW ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939186251210,SUP,HCPCS C1726,,H74939186251210  -  CATHETER BLNDIL 2.5MM 150CM 120MM CYTE OTW ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939186251290,SUP,HCPCS C1753,,H74939186251290  -  CATHETER BLNDIL 2.5MM 90CM 120MM CYTE OTW ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939186251510,SUP,HCPCS C1753,,H74939186251510  -  CATHETER BLNDIL 2.5MM 150CM 150MM CYTE OTW ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939186251590,SUP,HCPCS C1753,,H74939186251590  -  CATHETER BLNDIL 2.5MM 90CM 150MM CYTE OTW ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939186252210,SUP,HCPCS C1726,,H74939186252210  -  CATHETER BLNDIL 2.5MM 150CM 220MM CYTE OTW ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939186252290,SUP,HCPCS C1753,,H74939186252290  -  CATHETER BLNDIL 2.5MM 90CM 220MM CYTE OTW ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939186300610,SUP,HCPCS C1753,,H74939186300610  -  CATHETER BLNDIL 3MM 150CM 60MM CYTE OTW ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939186300690,SUP,HCPCS C1753,,H74939186300690  -  CATHETER BLNDIL 3MM 90CM 60MM CYTE OTW ULT LOPRFL NYBAX BSLD,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939186300810,SUP,HCPCS C1753,,H74939186300810  -  CATHETER BLNDIL 3MM 150CM 80MM CYTE OTW ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939186300890,SUP,HCPCS C1753,,H74939186300890  -  CATHETER BLNDIL 3MM 90CM 80MM CYTE OTW ULT LOPRFL NYBAX BSLD,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939186301010,SUP,HCPCS C1726,,H74939186301010  -  CATHETER BLNDIL 3MM 150CM 100MM CYTE OTW ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939186301090,SUP,HCPCS C1753,,H74939186301090  -  CATHETER BLNDIL 3MM 90CM 100MM CYTE OTW ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939186301210,SUP,HCPCS C1726,,H74939186301210  -  CATHETER BLNDIL 3MM 150CM 120MM CYTE OTW ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939186301290,SUP,HCPCS C1753,,H74939186301290  -  CATHETER BLNDIL 3MM 90CM 120MM CYTE OTW ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939186301510,SUP,HCPCS C1726,,H74939186301510  -  CATHETER BLNDIL 3MM 150CM 150MM CYTE OTW ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939186301590,SUP,HCPCS C1753,,H74939186301590  -  CATHETER BLNDIL 3MM 90CM 150MM CYTE OTW ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939186302210,SUP,HCPCS C1726,,H74939186302210  -  CATHETER BLNDIL 3MM 150CM 220MM CYTE OTW ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939186302290,SUP,HCPCS C1753,,H74939186302290  -  CATHETER BLNDIL 3MM 90CM 220MM CYTE OTW ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939186350610,SUP,HCPCS C1753,,H74939186350610  -  CATHETER BLNDIL 3.5MM 150CM 60MM CYTE OTW ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939186350690,SUP,HCPCS C1753,,H74939186350690  -  CATHETER BLNDIL 3.5MM 90CM 60MM CYTE OTW ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939186350810,SUP,HCPCS C1753,,H74939186350810  -  CATHETER BLNDIL 3.5MM 150CM 80MM CYTE OTW ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939186350890,SUP,HCPCS C1753,,H74939186350890  -  CATHETER BLNDIL 3.5MM 90CM 80MM CYTE OTW ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939186351010,SUP,HCPCS C1753,,H74939186351010  -  CATHETER BLNDIL 3.5MM 150CM 100MM CYTE OTW ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939186351090,SUP,HCPCS C1753,,H74939186351090  -  CATHETER BLNDIL 3.5MM 90CM 100MM CYTE OTW ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939186351210,SUP,HCPCS C1753,,H74939186351210  -  CATHETER BLNDIL 3.5MM 150CM 120MM CYTE OTW ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939186351290,SUP,HCPCS C1753,,H74939186351290  -  CATHETER BLNDIL 3.5MM 90CM 120MM CYTE OTW ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939186351510,SUP,HCPCS C1753,,H74939186351510  -  CATHETER BLNDIL 3.5MM 150CM 150MM CYTE OTW ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939186351590,SUP,HCPCS C1753,,H74939186351590  -  CATHETER BLNDIL 3.5MM 90CM 150MM CYTE OTW ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939186352210,SUP,HCPCS C1753,,H74939186352210  -  CATHETER BLNDIL 3.5MM 150CM 220MM CYTE OTW ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939186352290,SUP,HCPCS C1753,,H74939186352290  -  CATHETER BLNDIL 3.5MM 90CM 220MM CYTE OTW ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939186400610,SUP,HCPCS C1753,,H74939186400610  -  CATHETER BLNDIL 4MM 150CM 60MM CYTE OTW ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939186400690,SUP,HCPCS C1753,,H74939186400690  -  CATHETER BLNDIL 4MM 90CM 60MM CYTE OTW ULT LOPRFL NYBAX BSLD,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939186400810,SUP,HCPCS C1753,,H74939186400810  -  CATHETER BLNDIL 4MM 150CM 80MM CYTE OTW ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939186400890,SUP,HCPCS C1753,,H74939186400890  -  CATHETER BLNDIL 4MM 90CM 80MM CYTE OTW ULT LOPRFL NYBAX BSLD,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939186401010,SUP,HCPCS C1726,,H74939186401010  -  CATHETER BLNDIL 4MM 150CM 100MM CYTE OTW ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939186401090,SUP,HCPCS C1753,,H74939186401090  -  CATHETER BLNDIL 4MM 90CM 100MM CYTE OTW ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939186401210,SUP,HCPCS C1726,,H74939186401210  -  CATHETER BLNDIL 4MM 150CM 120MM CYTE OTW ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939186401290,SUP,HCPCS C1753,,H74939186401290  -  CATHETER BLNDIL 4MM 90CM 120MM CYTE OTW ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939186401510,SUP,HCPCS C1753,,H74939186401510  -  CATHETER BLNDIL 4MM 150CM 150MM CYTE OTW ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939186401590,SUP,HCPCS C1753,,H74939186401590  -  CATHETER BLNDIL 4MM 90CM 150MM CYTE OTW ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939186402210,SUP,HCPCS C1726,,H74939186402210  -  CATHETER BLNDIL 4MM 150CM 220MM CYTE OTW ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939186402290,SUP,HCPCS C1753,,H74939186402290  -  CATHETER BLNDIL 4MM 90CM 220MM CYTE OTW ULT LOPRFL NYBAX,$417.50,$0.00,$417.50,$226.70,$297.97,$0.00,$71.93,$0.00,$0.00,$73.10,$417.50,$0.00,$208.75,$330.66,$334.00,$0.00,$65.34,$0.00,$66.47,$0.00
H74939200061020,SUP,HCPCS C1876,,H74939200061020  -  STENT VASCULAR .035IN 6MM 100MM 120CM SELF EXPAND OTW GWIRE,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200061070,SUP,HCPCS C1876,,H74939200061070  -  STENT VASCULAR 6MM 100MM 75CM SELF EXPAND EPIC NITINOL ILIAC,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200061220,SUP,HCPCS C1876,,H74939200061220  -  STENT VASCULAR 6MM 120MM 120CM SELF EXPAND EPIC NITINOL,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200061270,SUP,HCPCS C1876,,H74939200061270  -  STENT VASCULAR .035IN 6MM 120MM 75CM SELF EXPAND OTW GWIRE,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200062020,SUP,HCPCS C1876,,H74939200062020  -  STENT VASCULAR 6MM 20MM 120CM SELF EXPAND EPIC NITINOL ILIAC,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200062070,SUP,HCPCS C1876,,H74939200062070  -  STENT VASCULAR 6MM 20MM 75CM SELF EXPAND EPIC NITINOL ILIAC,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200063020,SUP,HCPCS C1876,,H74939200063020  -  STENT VASCULAR 6MM 30MM 120CM SELF EXPAND EPIC NITINOL ILIAC,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200063070,SUP,HCPCS C1876,,H74939200063070  -  STENT VASCULAR 6MM 30MM 75CM SELF EXPAND EPIC NITINOL ILIAC,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200064020,SUP,HCPCS C1876,,H74939200064020  -  STENT VASCULAR 6MM 40MM 120CM SELF EXPAND EPIC NITINOL ILIAC,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200064070,SUP,HCPCS C1876,,H74939200064070  -  STENT VASCULAR .035IN 6MM 40MM 75CM SELF EXPAND OTW GWIRE,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200065020,SUP,HCPCS C1876,,H74939200065020  -  STENT VASCULAR 50MM SELF EXPAND EPIC NITINOL 120CM 6MM ILIAC,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
H74939200065070,SUP,HCPCS C1876,,H74939200065070  -  STENT VASCULAR 50MM SELF EXPAND EPIC NITINOL 75CM 6MM ILIAC,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
H74939200066020,SUP,HCPCS C1876,,H74939200066020  -  STENT VASCULAR .035IN 6MM 60MM 120CM SELF EXPAND OTW GWIRE,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200066070,SUP,HCPCS C1876,,H74939200066070  -  STENT VASCULAR 6MM 60MM 75CM SELF EXPAND EPIC NITINOL ILIAC,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200067020,SUP,HCPCS C1876,,H74939200067020  -  STENT VASCULAR 70MM SELF EXPAND EPIC NITINOL 120CM 6MM ILIAC,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
H74939200067070,SUP,HCPCS C1876,,H74939200067070  -  STENT VASCULAR 70MM SELF EXPAND EPIC NITINOL 75CM 6MM ILIAC,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
H74939200068020,SUP,HCPCS C1876,,H74939200068020  -  STENT VASCULAR 6MM 80MM 120CM SELF EXPAND EPIC NITINOL ILIAC,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200068070,SUP,HCPCS C1876,,H74939200068070  -  STENT VASCULAR 6MM 80MM 75CM SELF EXPAND EPIC NITINOL ILIAC,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200071020,SUP,HCPCS C1876,,H74939200071020  -  STENT VASCULAR .035IN 7MM 100MM 120CM SELF EXPAND OTW GWIRE,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200071070,SUP,HCPCS C1876,,H74939200071070  -  STENT VASCULAR 7MM 100MM 75CM SELF EXPAND EPIC NITINOL ILIAC,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200071220,SUP,HCPCS C1876,,H74939200071220  -  STENT VASCULAR 7MM 120MM 120CM SELF EXPAND EPIC NITINOL,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200071270,SUP,HCPCS C1876,,H74939200071270  -  STENT VASCULAR 7MM 120MM 75CM SELF EXPAND EPIC NITINOL ILIAC,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200072020,SUP,HCPCS C1876,,H74939200072020  -  STENT VASCULAR 7MM 20MM 120CM SELF EXPAND EPIC NITINOL ILIAC,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200072070,SUP,HCPCS C1876,,H74939200072070  -  STENT VASCULAR 7MM 20MM 75CM SELF EXPAND EPIC NITINOL ILIAC,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200073020,SUP,HCPCS C1876,,H74939200073020  -  STENT VASCULAR 7MM 30MM 120CM SELF EXPAND EPIC NITINOL ILIAC,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200073070,SUP,HCPCS C1876,,H74939200073070  -  STENT VASCULAR .035IN 7MM 30MM 75CM SELF EXPAND OTW GWIRE,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200074020,SUP,HCPCS C1876,,H74939200074020  -  STENT VASCULAR .035IN 7MM 40MM 120CM SELF EXPAND OTW GWIRE,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200074070,SUP,HCPCS C1876,,H74939200074070  -  STENT VASCULAR .035IN 7MM 40MM 75CM SELF EXPAND OTW GWIRE,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200075020,SUP,HCPCS C1876,,H74939200075020  -  STENT VASCULAR 50MM SELF EXPAND EPIC NITINOL 120CM 7MM ILIAC,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
H74939200075070,SUP,HCPCS C1876,,H74939200075070  -  STENT VASCULAR 50MM SELF EXPAND EPIC NITINOL 75CM 7MM ILIAC,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
H74939200076020,SUP,HCPCS C1876,,H74939200076020  -  STENT VASCULAR 7MM 60MM 120CM SELF EXPAND EPIC NITINOL ILIAC,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200076070,SUP,HCPCS C1876,,H74939200076070  -  STENT VASCULAR 7MM 60MM 75CM SELF EXPAND EPIC NITINOL ILIAC,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200077020,SUP,HCPCS C1876,,H74939200077020  -  STENT VASCULAR 70MM SELF EXPAND EPIC NITINOL 120CM 7MM ILIAC,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
H74939200077070,SUP,HCPCS C1876,,H74939200077070  -  STENT VASCULAR 70MM SELF EXPAND EPIC NITINOL 75CM 7MM ILIAC,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
H74939200078020,SUP,HCPCS C1876,,H74939200078020  -  STENT VASCULAR 7MM 80MM 120CM SELF EXPAND EPIC NITINOL ILIAC,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200078070,SUP,HCPCS C1876,,H74939200078070  -  STENT VASCULAR 7MM 80MM 75CM SELF EXPAND EPIC NITINOL ILIUM,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200081020,SUP,HCPCS C1876,,H74939200081020  -  STENT VASCULAR 8MM 100MM 120CM SELF EXPAND EPIC NITINOL,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200081070,SUP,HCPCS C1876,,H74939200081070  -  STENT VASCULAR 8MM 100MM 75CM SELF EXPAND EPIC NITINOL ILIAC,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200081220,SUP,HCPCS C1876,,H74939200081220  -  STENT VASCULAR .035IN 8MM 120MM 120CM SELF EXPAND OTW GWIRE,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200081270,SUP,HCPCS C1876,,H74939200081270  -  STENT VASCULAR 8MM 120MM 75CM SELF EXPAND EPIC NITINOL ILIAC,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200082020,SUP,HCPCS C1876,,H74939200082020  -  STENT VASCULAR 8MM 20MM 120CM SELF EXPAND EPIC NITINOL ILIAC,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200082070,SUP,HCPCS C1876,,H74939200082070  -  STENT VASCULAR 8MM 20MM 75CM SELF EXPAND EPIC NITINOL ILIUM,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200083020,SUP,HCPCS C1876,,H74939200083020  -  STENT VASCULAR 8MM 30MM 120CM SELF EXPAND EPIC NITINOL ILIAC,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200083070,SUP,HCPCS C1876,,H74939200083070  -  STENT VASCULAR .035IN 8MM 30MM 75CM SELF EXPAND OTW GWIRE,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200084020,SUP,HCPCS C1876,,H74939200084020  -  STENT VASCULAR 8MM 40MM 120CM SELF EXPAND EPIC NITINOL ILIAC,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200085020,SUP,HCPCS C1876,,H74939200085020  -  STENT VASCULAR 50MM SELF EXPAND EPIC NITINOL 120CM 8MM ILIAC,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
H74939200085070,SUP,HCPCS C1876,,H74939200085070  -  STENT VASCULAR 50MM SELF EXPAND EPIC NITINOL 75CM 8MM ILIAC,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
H74939200086020,SUP,HCPCS C1876,,H74939200086020  -  STENT VASCULAR 8MM 60MM 120CM SELF EXPAND EPIC NITINOL ILIAC,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200086070,SUP,HCPCS C1876,,H74939200086070  -  STENT VASCULAR 8MM 6FR 60MM 75CM SELF EXPAND SHEATH EPIC,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200087020,SUP,HCPCS C1876,,H74939200087020  -  STENT VASCULAR 70MM SELF EXPAND EPIC NITINOL 120CM 8MM ILIAC,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
H74939200087070,SUP,HCPCS C1876,,H74939200087070  -  STENT VASCULAR 70MM SELF EXPAND EPIC NITINOL 75CM 8MM ILIAC,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
H74939200088020,SUP,HCPCS C1876,,H74939200088020  -  STENT VASCULAR 8MM 80MM 120CM SELF EXPAND EPIC NITINOL ILIAC,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200088070,SUP,HCPCS C1876,,H74939200088070  -  STENT VASCULAR 8MM 80MM 75CM SELF EXPAND EPIC NITINOL ILIAC,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200091020,SUP,HCPCS C1876,,H74939200091020  -  STENT VASCULAR .035IN 8MM 100MM 120CM SELF EXPAND OTW GWIRE,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200091070,SUP,HCPCS C1876,,H74939200091070  -  STENT VASCULAR 9MM 100MM 75CM SELF EXPAND EPIC NITINOL ILIAC,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200092020,SUP,HCPCS C1876,,H74939200092020  -  STENT VASCULAR 9MM 20MM 120CM SELF EXPAND EPIC NITINOL ILIAC,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200092070,SUP,HCPCS C1876,,H74939200092070  -  STENT VASCULAR 9MM 20MM 75CM SELF EXPAND EPIC NITINOL ILIAC,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200093020,SUP,HCPCS C1876,,H74939200093020  -  STENT VASCULAR 9MM 30MM 120CM SELF EXPAND EPIC NITINOL ILIAC,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200093070,SUP,HCPCS C1876,,H74939200093070  -  STENT VASCULAR 9MM 30MM 75CM SELF EXPAND EPIC NITINOL ILIAC,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200094020,SUP,HCPCS C1876,,H74939200094020  -  STENT VASCULAR 9MM 40MM 120CM SELF EXPAND EPIC METAL ILIAC,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200094070,SUP,HCPCS C1876,,H74939200094070  -  STENT VASCULAR 9MM 40MM 75CM SELF EXPAND EPIC NITINOL ILIUM,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200095020,SUP,HCPCS C1876,,H74939200095020  -  STENT VASCULAR 50MM SELF EXPAND EPIC NITINOL 120CM 9MM ILIAC,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
H74939200095070,SUP,HCPCS C1876,,H74939200095070  -  STENT VASCULAR 50MM SELF EXPAND EPIC NITINOL 75CM 9MM ILIAC,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
H74939200096020,SUP,HCPCS C1876,,H74939200096020  -  STENT VASCULAR 9MM 60MM 120CM SELF EXPAND EPIC NITINOL ILIAC,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200096070,SUP,HCPCS C1876,,H74939200096070  -  STENT VASCULAR 9MM 60MM 75CM SELF EXPAND EPIC NITINOL ILIUM,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200097020,SUP,HCPCS C1876,,H74939200097020  -  STENT VASCULAR 70MM SELF EXPAND EPIC NITINOL 120CM 9MM ILIAC,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
H74939200097070,SUP,HCPCS C1876,,H74939200097070  -  STENT VASCULAR 70MM SELF EXPAND EPIC NITINOL 75CM 9MM ILIAC,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
H74939200098020,SUP,HCPCS C1876,,H74939200098020  -  STENT VASCULAR 9MM 80MM 120CM SELF EXPAND EPIC NITINOL ILIAC,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200098070,SUP,HCPCS C1876,,H74939200098070  -  STENT VASCULAR 9MM 80MM 75CM SELF EXPAND EPIC NITINOL ILIUM,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200101020,SUP,HCPCS C1876,,H74939200101020  -  STENT VASCULAR 9MM 100MM 120CM SELF EXPAND EPIC NITINOL,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200101070,SUP,HCPCS C1876,,H74939200101070  -  STENT VASCULAR 10MM 100MM 75CM SELF EXPAND EPIC NITINOL,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200102020,SUP,HCPCS C1876,,H74939200102020  -  STENT VASCULAR 10MM 20MM 120CM SELF EXPAND EPIC NITINOL,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200102070,SUP,HCPCS C1876,,H74939200102070  -  STENT VASCULAR 10MM 20MM 75CM SELF EXPAND EPIC NITINOL ILIAC,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200103020,SUP,HCPCS C1876,,H74939200103020  -  STENT VASCULAR 10MM 30MM 120CM SELF EXPAND EPIC NITINOL,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200103070,SUP,HCPCS C1876,,H74939200103070  -  STENT VASCULAR 10MM 30MM 75CM SELF EXPAND EPIC NITINOL ILIAC,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200104020,SUP,HCPCS C1876,,H74939200104020  -  STENT VASCULAR 10MM 40MM 120CM SELF EXPAND EPIC NITINOL,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200104070,SUP,HCPCS C1876,,H74939200104070  -  STENT VASCULAR 10MM 40MM 75CM SELF EXPAND EPIC NITINOL ILIAC,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200105020,SUP,HCPCS C1876,,H74939200105020  -  STENT VASCULAR 50MM SELF EXPAND EPIC NITINOL 120CM 10MM,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
H74939200105070,SUP,HCPCS C1876,,H74939200105070  -  STENT VASCULAR 50MM SELF EXPAND EPIC NITINOL 75CM 10MM ILIAC,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
H74939200106020,SUP,HCPCS C1876,,H74939200106020  -  STENT VASCULAR 10MM 60MM 120CM SELF EXPAND EPIC NITINOL,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200106070,SUP,HCPCS C1876,,H74939200106070  -  STENT VASCULAR 10MM 60MM 75CM SELF EXPAND EPIC NITINOL ILIAC,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200107020,SUP,HCPCS C1876,,H74939200107020  -  STENT VASCULAR 70MM SELF EXPAND EPIC NITINOL 120CM 10MM,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
H74939200107070,SUP,HCPCS C1876,,H74939200107070  -  STENT VASCULAR 70MM SELF EXPAND EPIC NITINOL 75CM 10MM ILIUM,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
H74939200108020,SUP,HCPCS C1876,,H74939200108020  -  STENT VASCULAR 10MM 80MM 120CM SELF EXPAND EPIC NITINOL,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200108070,SUP,HCPCS C1876,,H74939200108070  -  STENT VASCULAR 10MM 80MM 75CM SELF EXPAND EPIC NITINOL,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200123020,SUP,HCPCS C1876,,H74939200123020  -  STENT VASCULAR 12MM 30MM 120CM SELF EXPAND EPIC NITINOL,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200123070,SUP,HCPCS C1876,,H74939200123070  -  STENT VASCULAR 12MM 30MM 75CM SELF EXPAND EPIC NITINOL ILIAC,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200124020,SUP,HCPCS C1876,,H74939200124020  -  STENT VASCULAR 12MM 40MM 120CM SELF EXPAND EPIC NITINOL,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200124070,SUP,HCPCS C1876,,H74939200124070  -  STENT VASCULAR 12MM 40MM 75CM SELF EXPAND EPIC NITINOL ILIAC,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200125020,SUP,HCPCS C1876,,H74939200125020  -  STENT VASCULAR 50MM SELF EXPAND EPIC NITINOL 120CM 12MM,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
H74939200125070,SUP,HCPCS C1876,,H74939200125070  -  STENT VASCULAR 50MM SELF EXPAND EPIC NITINOL 75CM 12MM ILIUM,"$2,500.00",$0.00,"$2,500.00","$1,125.00","$1,784.25",$0.00,$430.74,$0.00,$0.00,$437.73,"$2,500.00",$0.00,"$1,250.00","$1,980.00","$2,000.00",$0.00,$391.25,$0.00,$398.00,$0.00
H74939200126020,SUP,HCPCS C1876,,H74939200126020  -  STENT VASCULAR 12MM 60MM 120CM SELF EXPAND EPIC NITINOL,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939200126070,SUP,HCPCS C1876,,H74939200126070  -  STENT VASCULAR 12MM 60MM 75CM SELF EXPAND EPIC NITINOL ILIAC,"$1,462.50",$0.00,"$1,462.50",$658.13,"$1,043.79",$0.00,$251.98,$0.00,$0.00,$256.07,"$1,462.50",$0.00,$731.25,"$1,158.30","$1,170.00",$0.00,$228.88,$0.00,$232.83,$0.00
H74939206030210,SUP,HCPCS C1753,,H74939206030210  -  CATHETER BLNDIL 3MM 135CM 20MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206030270,SUP,HCPCS C1753,,H74939206030270  -  CATHETER BLNDIL 3MM 75CM 20MM CHRGR OTW NC 2 LUM SHFT LOPRFL,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206030370,SUP,HCPCS C1753,,H74939206030370  -  CATHETER BLNDIL 3MM 75CM 30MM CHRGR OTW NC 2 LUM SHFT LOPRFL,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206030410,SUP,HCPCS C1753,,H74939206030410  -  CATHETER BLNDIL 3MM 135CM 40MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206030470,SUP,HCPCS C1753,,H74939206030470  -  CATHETER BLNDIL 3MM 75CM 40MM CHRGR OTW NC 2 LUM SHFT LOPRFL,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206030670,SUP,HCPCS C1753,,H74939206030670  -  CATHETER BLNDIL 3MM 75CM 60MM CHRGR OTW NC 2 LUM SHFT LOPRFL,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206030810,SUP,HCPCS C1753,,H74939206030810  -  CATHETER BLNDIL 3MM 135CM 80MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206031010,SUP,HCPCS C1753,,H74939206031010  -  CATHETER BLNDIL 3MM 135CM 100MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206031210,SUP,HCPCS C1753,,H74939206031210  -  CATHETER BLNDIL 3MM 135CM 120MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206031510,SUP,HCPCS C1753,,H74939206031510  -  CATHETER BLNDIL 3MM 135CM 150MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206031810,SUP,HCPCS C1753,,H74939206031810  -  CATHETER BLNDIL 3MM 135CM 180MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206032010,SUP,HCPCS C1753,,H74939206032010  -  CATHETER BLNDIL 3MM 135CM 200MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206040210,SUP,HCPCS C1753,,H74939206040210  -  CATHETER BLNDIL 4MM 135CM 20MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206040270,SUP,HCPCS C1753,,H74939206040270  -  CATHETER BLNDIL 4MM 75CM 20MM CHRGR OTW NC 2 LUM SHFT LOPRFL,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206040370,SUP,HCPCS C1753,,H74939206040370  -  CATHETER BLNDIL 4MM 75CM 30MM CHRGR OTW NC 2 LUM SHFT LOPRFL,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206040410,SUP,HCPCS C1753,,H74939206040410  -  CATHETER BLNDIL 4MM 135CM 40MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206040470,SUP,HCPCS C1753,,H74939206040470  -  CATHETER BLNDIL 4MM 75CM 40MM CHRGR OTW NC 2 LUM SHFT LOPRFL,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206040610,SUP,HCPCS C1753,,H74939206040610  -  CATHETER BLNDIL 4MM 135CM 60MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206040670,SUP,HCPCS C1753,,H74939206040670  -  CATHETER BLNDIL 4MM 75CM 60MM CHRGR OTW NC 2 LUM SHFT LOPRFL,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206040810,SUP,HCPCS C1753,,H74939206040810  -  CATHETER BLNDIL 4MM 135CM 80MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206040870,SUP,HCPCS C1753,,H74939206040870  -  CATHETER BLNDIL 4MM 75CM 80MM CHRGR OTW NC 2 LUM SHFT LOPRFL,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206041010,SUP,HCPCS C1753,,H74939206041010  -  CATHETER BLNDIL 4MM 135CM 100MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206041070,SUP,HCPCS C1753,,H74939206041070  -  CATHETER BLNDIL 4MM 75CM 100MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206041210,SUP,HCPCS C1753,,H74939206041210  -  CATHETER BLNDIL 4MM 135CM 120MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206041510,SUP,HCPCS C1753,,H74939206041510  -  CATHETER BLNDIL 4MM 135CM 150MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206041810,SUP,HCPCS C1753,,H74939206041810  -  CATHETER BLNDIL 4MM 135CM 180MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206042010,SUP,HCPCS C1753,,H74939206042010  -  CATHETER BLNDIL 4MM 135CM 200MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206050210,SUP,HCPCS C1753,,H74939206050210  -  CATHETER BLNDIL 5MM 135CM 20MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206050270,SUP,HCPCS C1753,,H74939206050270  -  CATHETER BLNDIL 5MM 75CM 20MM CHRGR OTW NC 2 LUM SHFT LOPRFL,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206050370,SUP,HCPCS C1753,,H74939206050370  -  CATHETER BLNDIL 5MM 75CM 30MM CHRGR OTW NC 2 LUM SHFT LOPRFL,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206050410,SUP,HCPCS C1753,,H74939206050410  -  CATHETER BLNDIL 5MM 135CM 40MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206050470,SUP,HCPCS C1753,,H74939206050470  -  CATHETER BLNDIL 5MM 75CM 40MM CHRGR OTW NC 2 LUM SHFT LOPRFL,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206050610,SUP,HCPCS C1753,,H74939206050610  -  CATHETER BLNDIL 5MM 135CM 60MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206050670,SUP,HCPCS C1753,,H74939206050670  -  CATHETER BLNDIL 5MM 75CM 60MM CHRGR OTW NC 2 LUM SHFT LOPRFL,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206050810,SUP,HCPCS C1753,,H74939206050810  -  CATHETER BLNDIL 5MM 135CM 80MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206050870,SUP,HCPCS C1753,,H74939206050870  -  CATHETER BLNDIL 5MM 75CM 80MM CHRGR OTW NC 2 LUM SHFT LOPRFL,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206051010,SUP,HCPCS C1753,,H74939206051010  -  CATHETER BLNDIL 5MM 135CM 100MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206051070,SUP,HCPCS C1753,,H74939206051070  -  CATHETER BLNDIL 5MM 75CM 100MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206051210,SUP,HCPCS C1753,,H74939206051210  -  CATHETER BLNDIL 5MM 135CM 120MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206051510,SUP,HCPCS C1753,,H74939206051510  -  CATHETER BLNDIL 5MM 135CM 150MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206051810,SUP,HCPCS C1753,,H74939206051810  -  CATHETER BLNDIL 5MM 135CM 180MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206052010,SUP,HCPCS C1753,,H74939206052010  -  CATHETER BLNDIL 5MM 135CM 200MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206060210,SUP,HCPCS C1753,,H74939206060210  -  CATHETER BLNDIL 6MM 135CM 20MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206060270,SUP,HCPCS C1753,,H74939206060270  -  CATHETER BLNDIL 6MM 75CM 20MM CHRGR OTW NC 2 LUM SHFT LOPRFL,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206060370,SUP,HCPCS C1753,,H74939206060370  -  CATHETER BLNDIL 6MM 75CM 30MM CHRGR OTW NC 2 LUM SHFT LOPRFL,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206060410,SUP,HCPCS C1753,,H74939206060410  -  CATHETER BLNDIL 6MM 135CM 40MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206060470,SUP,HCPCS C1753,,H74939206060470  -  CATHETER BLNDIL 6MM 75CM 40MM CHRGR OTW NC 2 LUM SHFT LOPRFL,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206060610,SUP,HCPCS C1753,,H74939206060610  -  CATHETER BLNDIL 6MM 135CM 60MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206060670,SUP,HCPCS C1753,,H74939206060670  -  CATHETER BLNDIL 6MM 75CM 60MM CHRGR OTW NC 2 LUM SHFT LOPRFL,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206060810,SUP,HCPCS C1753,,H74939206060810  -  CATHETER BLNDIL 6MM 135CM 80MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206060870,SUP,HCPCS C1753,,H74939206060870  -  CATHETER BLNDIL 6MM 75CM 80MM CHRGR OTW NC 2 LUM SHFT LOPRFL,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206061010,SUP,HCPCS C1753,,H74939206061010  -  CATHETER BLNDIL 6MM 135CM 100MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206061070,SUP,HCPCS C1753,,H74939206061070  -  CATHETER BLNDIL 6MM 75CM 100MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206061210,SUP,HCPCS C1753,,H74939206061210  -  CATHETER BLNDIL 6MM 135CM 120MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206061510,SUP,HCPCS C1753,,H74939206061510  -  CATHETER BLNDIL 6MM 135CM 150MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206061810,SUP,HCPCS C1753,,H74939206061810  -  CATHETER BLNDIL 6MM 135CM 180MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206062010,SUP,HCPCS C1753,,H74939206062010  -  CATHETER BLNDIL 6MM 135CM 200MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206070210,SUP,HCPCS C1753,,H74939206070210  -  CATHETER BLNDIL 7MM 135CM 20MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206070270,SUP,HCPCS C1753,,H74939206070270  -  CATHETER BLNDIL 7MM 75CM 20MM CHRGR OTW NC 2 LUM SHFT LOPRFL,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206070370,SUP,HCPCS C1753,,H74939206070370  -  CATHETER BLNDIL 7MM 75CM 30MM CHRGR OTW NC 2 LUM SHFT LOPRFL,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206070410,SUP,HCPCS C1753,,H74939206070410  -  CATHETER BLNDIL 7MM 135CM 40MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206070470,SUP,HCPCS C1753,,H74939206070470  -  CATHETER BLNDIL 7MM 75CM 40MM CHRGR OTW NC 2 LUM SHFT LOPRFL,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206070610,SUP,HCPCS C1753,,"H74939206070610  -  BALLOON CATHETER CHARGER 7.0 x60, 135cm",$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206070670,SUP,HCPCS C1753,,H74939206070670  -  CATHETER BLNDIL 7MM 75CM 60MM CHRGR OTW 2 LUM TPR TIP LOPRFL,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206070810,SUP,HCPCS C1753,,H74939206070810  -  CATHETER BLNDIL 7MM 135CM 80MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206070870,SUP,HCPCS C1753,,H74939206070870  -  CATHETER BLNDIL 7MM 75CM 80MM CHRGR OTW NC 2 LUM SHFT LOPRFL,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206071010,SUP,HCPCS C1753,,H74939206071010  -  CATHETER BLNDIL 7MM 135CM 100MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206071070,SUP,HCPCS C1753,,H74939206071070  -  CATHETER BLNDIL 7MM 75CM 100MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206071210,SUP,HCPCS C1753,,H74939206071210  -  CATHETER BLNDIL 7MM 135CM 120MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206071510,SUP,HCPCS C1753,,H74939206071510  -  CATHETER BLNDIL 7MM 135CM 150MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206071810,SUP,HCPCS C1753,,H74939206071810  -  CATHETER BLNDIL 7MM 135CM 180MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206072010,SUP,HCPCS C1753,,H74939206072010  -  CATHETER BLNDIL 7MM 135CM 200MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206080210,SUP,HCPCS C1753,,H74939206080210  -  CATHETER BLNDIL 8MM 135CM 20MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206080270,SUP,HCPCS C1753,,H74939206080270  -  CATHETER BLNDIL 8MM 75CM 20MM CHRGR OTW NC 2 LUM SHFT LOPRFL,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206080370,SUP,HCPCS C1753,,H74939206080370  -  CATHETER BLNDIL 8MM 75CM 30MM CHRGR OTW NC 2 LUM SHFT LOPRFL,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206080410,SUP,HCPCS C1753,,H74939206080410  -  CATHETER BLNDIL 8MM 135CM 40MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206080470,SUP,HCPCS C1753,,H74939206080470  -  CATHETER BLNDIL 8MM 75CM 40MM CHRGR OTW NC 2 LUM SHFT LOPRFL,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206080670,SUP,HCPCS C1753,,H74939206080670  -  CATHETER BLNDIL 8MM 75CM 60MM CHRGR OTW NC 2 LUM SHFT LOPRFL,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206080810,SUP,HCPCS C1753,,H74939206080810  -  CATHETER BLNDIL 8MM 135CM 80MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206080870,SUP,HCPCS C1753,,H74939206080870  -  CATHETER BLNDIL 8MM 75CM 80MM CHRGR OTW NC 2 LUM SHFT LOPRFL,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206081010,SUP,HCPCS C1753,,H74939206081010  -  CATHETER BLNDIL 8MM 135CM 100MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206081070,SUP,HCPCS C1753,,H74939206081070  -  CATHETER BLNDIL 8MM 75CM 100MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206081210,SUP,HCPCS C1753,,H74939206081210  -  CATHETER BLNDIL 8MM 135CM 120MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206081510,SUP,HCPCS C1753,,H74939206081510  -  CATHETER BLNDIL 8MM 135CM 150MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206081810,SUP,HCPCS C1753,,H74939206081810  -  CATHETER BLNDIL 8MM 135CM 180MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206082010,SUP,HCPCS C1753,,H74939206082010  -  CATHETER BLNDIL 8MM 135CM 200MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206090210,SUP,HCPCS C1753,,H74939206090210  -  CATHETER BLNDIL 9MM 135CM 20MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206090270,SUP,HCPCS C1753,,H74939206090270  -  CATHETER BLNDIL 9MM 75CM 20MM CHRGR OTW NC 2 LUM SHFT LOPRFL,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206090370,SUP,HCPCS C1753,,H74939206090370  -  CATHETER BLNDIL 9MM 75CM 30MM CHRGR OTW NC 2 LUM SHFT LOPRFL,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206090410,SUP,HCPCS C1753,,H74939206090410  -  CATHETER BLNDIL 9MM 135CM 40MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206090470,SUP,HCPCS C1753,,H74939206090470  -  CATHETER BLNDIL 9MM 75CM 40MM CHRGR OTW NC 2 LUM SHFT LOPRFL,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206090670,SUP,HCPCS C1753,,H74939206090670  -  CATHETER BLNDIL 9MM 75CM 60MM CHRGR OTW NC 2 LUM SHFT LOPRFL,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206090870,SUP,HCPCS C1753,,H74939206090870  -  CATHETER BLNDIL 9MM 75CM 80MM CHRGR OTW NC 2 LUM SHFT LOPRFL,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206100210,SUP,HCPCS C1753,,H74939206100210  -  CATHETER BLNDIL 10MM 135CM 20MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206100270,SUP,HCPCS C1753,,H74939206100270  -  CATHETER BLNDIL 10MM 75CM 20MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206100370,SUP,HCPCS C1753,,H74939206100370  -  CATHETER BLNDIL 10MM 75CM 30MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206100410,SUP,HCPCS C1753,,H74939206100410  -  CATHETER BLNDIL 10MM 135CM 40MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206100470,SUP,HCPCS C1753,,H74939206100470  -  CATHETER BLNDIL 10MM 75CM 40MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206100670,SUP,HCPCS C1753,,H74939206100670  -  CATHETER BLNDIL 10MM 75CM 60MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206100870,SUP,HCPCS C1753,,H74939206100870  -  CATHETER BLNDIL 10MM 75CM 80MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206120210,SUP,HCPCS C1753,,H74939206120210  -  CATHETER BLNDIL 12MM 135CM 20MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206120270,SUP,HCPCS C1753,,H74939206120270  -  CATHETER BLNDIL 12MM 75CM 20MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206120370,SUP,HCPCS C1753,,H74939206120370  -  CATHETER BLNDIL 12MM 75CM 30MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206120410,SUP,HCPCS C1753,,H74939206120410  -  CATHETER BLNDIL 12MM 135CM 40MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206120470,SUP,HCPCS C1753,,H74939206120470  -  CATHETER BLNDIL 12MM 75CM 40MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206120670,SUP,HCPCS C1753,,H74939206120670  -  CATHETER BLNDIL 12MM 75CM 60MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939206120870,SUP,HCPCS C1753,,H74939206120870  -  CATHETER BLNDIL 12MM 75CM 80MM CHRGR OTW NC 2 LUM SHFT,$200.00,$0.00,$200.00,$108.60,$142.74,$0.00,$34.46,$0.00,$0.00,$35.02,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$31.30,$0.00,$31.84,$0.00
H74939208001601,SUP,HCPCS C1769,,H74939208001601  -  WIRE CATHETER .017IN .018IN 165CM 300CM SHAPABLE DISTAL TIP,$205.80,$0.00,$205.80,$111.75,$146.88,$0.00,$35.46,$0.00,$0.00,$36.03,$205.80,$0.00,$102.90,$162.99,$164.64,$0.00,$32.21,$0.00,$32.76,$0.00
H74939208181650,SUP,HCPCS C2628,,H74939208181650  -  CATHETER ATHERECTOMY .017IN .018IN 165CM SHAPABLE DISTAL TIP,"$3,920.00",$0.00,"$3,920.00",$0.00,"$2,797.70",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,920.00",$0.00,"$1,960.00","$3,104.64","$3,136.00",$0.00,$0.00,$0.00,$0.00,$0.00
H74939212014131,SUP,HCPCS C1887,,H74939212014131  -  CATHETER SPRT 15MM SPC 3.4FR 135CM CLR PUR RUBICON 14 RADOPQ,"$1,470.00",$0.00,"$1,470.00",$798.21,"$1,049.14",$0.00,$253.27,$0.00,$0.00,$257.39,"$1,470.00",$0.00,$735.00,"$1,164.24","$1,176.00",$0.00,$230.06,$0.00,$234.02,$0.00
H74939212014151,SUP,HCPCS C1887,,H74939212014151  -  CATHETER GUID .018IN 150CM RADIOPQ ULTRA LP ROBUST BALLOON,"$1,470.00",$0.00,"$1,470.00",$798.21,"$1,049.14",$0.00,$253.27,$0.00,$0.00,$257.39,"$1,470.00",$0.00,$735.00,"$1,164.24","$1,176.00",$0.00,$230.06,$0.00,$234.02,$0.00
H74939216718210,SUP,HCPCS C1769,,H74939216718210  -  GUIDEWIRE VASCULAR STR SHORT TAPER .014IN 182CM 8CM ROBUST,$318.50,$0.00,$318.50,$172.95,$227.31,$0.00,$54.88,$0.00,$0.00,$55.77,$318.50,$0.00,$159.25,$252.25,$254.80,$0.00,$49.85,$0.00,$50.71,$0.00
H74939216718220,SUP,HCPCS C1769,,H74939216718220  -  GUIDEWIRE VASCULAR ANGLE SHORT TAPER .014IN 182CM 8CM ROBUST,$318.50,$0.00,$318.50,$172.95,$227.31,$0.00,$54.88,$0.00,$0.00,$55.77,$318.50,$0.00,$159.25,$252.25,$254.80,$0.00,$49.85,$0.00,$50.71,$0.00
H74939216730010,SUP,HCPCS C1769,,H74939216730010  -  GUIDEWIRE VASCULAR STR SHORT TAPER .014IN 300CM 8CM ROBUST,$318.50,$0.00,$318.50,$172.95,$227.31,$0.00,$54.88,$0.00,$0.00,$55.77,$318.50,$0.00,$159.25,$252.25,$254.80,$0.00,$49.85,$0.00,$50.71,$0.00
H74939216730020,SUP,HCPCS C1769,,H74939216730020  -  GUIDEWIRE VASCULAR ANGLE SHORT TAPER .014IN 300CM 8CM ROBUST,$318.50,$0.00,$318.50,$172.95,$227.31,$0.00,$54.88,$0.00,$0.00,$55.77,$318.50,$0.00,$159.25,$252.25,$254.80,$0.00,$49.85,$0.00,$50.71,$0.00
H74939216918210,SUP,HCPCS C1769,,H74939216918210  -  GUIDEWIRE VASCULAR STR LONG TAPER .014IN 182CM 11CM ROBUST,$318.50,$0.00,$318.50,$172.95,$227.31,$0.00,$54.88,$0.00,$0.00,$55.77,$318.50,$0.00,$159.25,$252.25,$254.80,$0.00,$49.85,$0.00,$50.71,$0.00
H74939216918220,SUP,HCPCS C1769,,H74939216918220  -  GUIDEWIRE VASCULAR ANGLE LONG TAPER .014IN 182CM 11CM ROBUST,$318.50,$0.00,$318.50,$172.95,$227.31,$0.00,$54.88,$0.00,$0.00,$55.77,$318.50,$0.00,$159.25,$252.25,$254.80,$0.00,$49.85,$0.00,$50.71,$0.00
H74939216930010,SUP,HCPCS C1769,,H74939216930010  -  GUIDEWIRE VASCULAR STR LONG TAPER .014IN 300CM 11CM ROBUST,$318.50,$0.00,$318.50,$172.95,$227.31,$0.00,$54.88,$0.00,$0.00,$55.77,$318.50,$0.00,$159.25,$252.25,$254.80,$0.00,$49.85,$0.00,$50.71,$0.00
H74939216930020,SUP,HCPCS C1769,,H74939216930020  -  GUIDEWIRE VASCULAR ANGLE LONG TAPER .014IN 300CM 11CM ROBUST,$318.50,$0.00,$318.50,$172.95,$227.31,$0.00,$54.88,$0.00,$0.00,$55.77,$318.50,$0.00,$159.25,$252.25,$254.80,$0.00,$49.85,$0.00,$50.71,$0.00
H74939239018091,SUP,HCPCS C1887,,H74939239018091  -  CATHETER SPRT 15MM SPC 4FR 90CM CLR PUR RUBICON 18 RADOPQ,"$1,470.00",$0.00,"$1,470.00",$798.21,"$1,049.14",$0.00,$253.27,$0.00,$0.00,$257.39,"$1,470.00",$0.00,$735.00,"$1,164.24","$1,176.00",$0.00,$230.06,$0.00,$234.02,$0.00
H74939239018131,SUP,HCPCS C1887,,H74939239018131  -  CATHETER SPRT 15MM SPC 4FR 135CM CLR PUR RUBICON 18 RADOPQ,"$1,470.00",$0.00,"$1,470.00",$798.21,"$1,049.14",$0.00,$253.27,$0.00,$0.00,$257.39,"$1,470.00",$0.00,$735.00,"$1,164.24","$1,176.00",$0.00,$230.06,$0.00,$234.02,$0.00
H74939239018151,SUP,HCPCS C1887,,H74939239018151  -  CATHETER SPRT 15MM SPC 4FR 150CM CLR PUR RUBICON 18 RADOPQ,"$1,470.00",$0.00,"$1,470.00",$798.21,"$1,049.14",$0.00,$253.27,$0.00,$0.00,$257.39,"$1,470.00",$0.00,$735.00,"$1,164.24","$1,176.00",$0.00,$230.06,$0.00,$234.02,$0.00
H74939240035061,SUP,HCPCS C1887,,H74939240035061  -  CATHETER SPRT 50MM SPC 5.1FR 65CM CLR PUR RUBICON 35 RADOPQ,"$1,470.00",$0.00,"$1,470.00",$798.21,"$1,049.14",$0.00,$253.27,$0.00,$0.00,$257.39,"$1,470.00",$0.00,$735.00,"$1,164.24","$1,176.00",$0.00,$230.06,$0.00,$234.02,$0.00
H74939240035091,SUP,HCPCS C1887,,H74939240035091  -  CATHETER SPRT 50MM SPC 5.1FR 90CM CLR PUR RUBICON 35 RADOPQ,"$1,470.00",$0.00,"$1,470.00",$798.21,"$1,049.14",$0.00,$253.27,$0.00,$0.00,$257.39,"$1,470.00",$0.00,$735.00,"$1,164.24","$1,176.00",$0.00,$230.06,$0.00,$234.02,$0.00
H74939240035131,SUP,HCPCS C1887,,H74939240035131  -  CATHETER SPRT 50MM SPC 5.1FR 135CM CLR PUR RUBICON 35 RADOPQ,"$1,470.00",$0.00,"$1,470.00",$798.21,"$1,049.14",$0.00,$253.27,$0.00,$0.00,$257.39,"$1,470.00",$0.00,$735.00,"$1,164.24","$1,176.00",$0.00,$230.06,$0.00,$234.02,$0.00
H74939240035151,SUP,HCPCS C1887,,H74939240035151  -  CATHETER SPRT 50MM SPC 5.1FR 150CM CLR PUR RUBICON 35 RADOPQ,"$1,470.00",$0.00,"$1,470.00",$798.21,"$1,049.14",$0.00,$253.27,$0.00,$0.00,$257.39,"$1,470.00",$0.00,$735.00,"$1,164.24","$1,176.00",$0.00,$230.06,$0.00,$234.02,$0.00
H749501001500,SUP,Custom 27203010,,H749501001500  -  SHEATH RTRVL 150CM 4FR F EZ .014IN BNTP,$187.50,$0.00,$187.50,$0.00,$133.82,$0.00,$0.00,$0.00,$0.00,$0.00,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$0.00,$0.00,$0.00,$0.00
H749CBO3200100,SUP,HCPCS C1726,,H749CBO3200100  -  CATHETER BLNDIL 2MM 137CM 10MM F CBLN OTW INFL PORT GW PORT,"$2,000.00",$0.00,"$2,000.00","$1,086.00","$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
H749CBO3200150,SUP,HCPCS C1726,,H749CBO3200150  -  CATHETER BLNDIL 2MM 137CM 15MM F CBLN OTW INFL PORT GW PORT,"$1,715.00",$0.00,"$1,715.00",$931.25,"$1,224.00",$0.00,$295.49,$0.00,$0.00,$300.28,"$1,715.00",$0.00,$857.50,"$1,358.28","$1,372.00",$0.00,$268.40,$0.00,$273.03,$0.00
H749CBO3250100,SUP,HCPCS C1726,,H749CBO3250100  -  CATHETER BLNDIL 2.5MM 137CM 10MM F CBLN OTW INFL PORT GW,"$1,715.00",$0.00,"$1,715.00",$931.25,"$1,224.00",$0.00,$295.49,$0.00,$0.00,$300.28,"$1,715.00",$0.00,$857.50,"$1,358.28","$1,372.00",$0.00,$268.40,$0.00,$273.03,$0.00
H749CBO3250150,SUP,HCPCS C1726,,H749CBO3250150  -  CATHETER BLNDIL 2.5MM 137CM 15MM F CBLN OTW INFL PORT GW,"$1,715.00",$0.00,"$1,715.00",$931.25,"$1,224.00",$0.00,$295.49,$0.00,$0.00,$300.28,"$1,715.00",$0.00,$857.50,"$1,358.28","$1,372.00",$0.00,$268.40,$0.00,$273.03,$0.00
H7587-58,SUP,Custom 27203010,,REAGENT B-OHB R1 R2 50ML ANALY,$854.13,$0.00,$854.13,$0.00,$609.59,$0.00,$0.00,$0.00,$0.00,$0.00,$854.13,$0.00,$427.06,$676.47,$683.30,$0.00,$0.00,$0.00,$0.00,$0.00
H7587-CTL,SUP,Custom 27203010,,CONTROL CHM 5ML SET B-OHB,$723.00,$0.00,$723.00,$0.00,$516.01,$0.00,$0.00,$0.00,$0.00,$0.00,$723.00,$0.00,$361.50,$572.62,$578.40,$0.00,$0.00,$0.00,$0.00,$0.00
H787107140145,SUP,HCPCS C1713,,H787107140145  -  CATHETER ANGIO ANG KMP CRV 4FR 65CM SFVU RADOPQ SLCT HTORQ,$35.00,$0.00,$35.00,$15.75,$24.98,$0.00,$6.03,$0.00,$0.00,$6.13,$35.00,$0.00,$17.50,$27.72,$28.00,$0.00,$5.48,$0.00,$5.57,$0.00
H787107322055,SUP,HCPCS C1887,,H787107322055  -  CATHETER ANGIO OM CRV 5FR 100CM SFVU RADOPQ FLSH HTORQ SHFT,$35.00,$0.00,$35.00,$19.01,$24.98,$0.00,$6.03,$0.00,$0.00,$6.13,$35.00,$0.00,$17.50,$27.72,$28.00,$0.00,$5.48,$0.00,$5.57,$0.00
H965100510,SUP,HCPCS C1887,,H965100510  -  CATHETER GD STRG 7FR 90CM STRL GDR SFTP XF 2X2 RND BRD X,$500.00,$0.00,$500.00,$271.50,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
H965251850,SUP,Custom 27203010,,H965251850  -  CANNULA PRFSN ANGIOVAC DIL FNL TIP RADOPQ COIL REINF DISP,"$28,750.00",$0.00,"$28,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$28,750.00",$0.00,"$14,375.00","$22,770.00","$23,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
H965251860,SUP,Custom 27203010,,H965251860  -  CANNULA PRFSN 20D ANGIOVAC DIL FNL TIP RADOPQ COIL REINF,"$28,750.00",$0.00,"$28,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$28,750.00",$0.00,"$14,375.00","$22,770.00","$23,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
H965251870,SUP,Custom 27203010,,H965251870  -  SYSTEM PRFSN ANGIOVAC CRCT PMP HD BBL TRP,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
H965251880,SUP,Custom 27203010,,H965251880  -  SYSTEM PRFSN ANGIOVAC CRCT BBL TRP,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
H965251900,SUP,Custom 27203010,,H965251900  -  CANNULA PRFSN ANGIOVAC STRG DIL CRCT BBL TRP COIL REINF DISP,"$32,500.00",$0.00,"$32,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$32,500.00",$0.00,"$16,250.00","$25,740.00","$26,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
H965251910,SUP,Custom 27203010,,H965251910  -  CANNULA PRFSN 20D ANGIOVAC DIL CRCT PMP HD BBL TRP DISP,"$32,500.00",$0.00,"$32,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$32,500.00",$0.00,"$16,250.00","$25,740.00","$26,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
H965251990,SUP,Custom 27203010,,H965251990  -  SYSTEM PRFSN ANGIOVAC CRCT,"$3,750.00",$0.00,"$3,750.00",$0.00,"$2,676.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,750.00",$0.00,"$1,875.00","$2,970.00","$3,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
H965402100,SUP,HCPCS C1877,,H965402100  -  STENT ENDOPRSTH 100CM 12MM 20MM 75CM UNCONSTRAIN FLEXIBLE,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
H965402110,SUP,HCPCS C1877,,H965402110  -  STENT ENDOPRSTH 12MM 8FR 40MM 100CM FLEXIBLE RECONSTRAINABLE,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
H965402120,SUP,HCPCS C2617,,H965402120  -  STENT ENDOPRSTH 100CM 12MM 8FR 60MM 75CM FLEXIBLE DELIVERY,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
H965402130,SUP,HCPCS C2617,,H965402130  -  STENT ENDOPRSTH 100CM 12MM 8FR 90MM 75CM FLEXIBLE DELIVERY,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
H965403100,SUP,HCPCS C1877,,H965403100  -  STENT ENDOPRSTH 100CM 14MM 20MM 75CM FLEXIBLE DELIVERY,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
H965403110,SUP,HCPCS C1877,,H965403110  -  STENT ENDOPRSTH 100CM 14MM 40MM 75CM UNCONSTRAIN FLEXIBLE,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
H965403120,SUP,HCPCS C1877,,H965403120  -  STENT ENDOPRSTH 100CM 14MM 9FR 60MM 75CM CATHETER,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
H965403130,SUP,HCPCS C1877,,H965403130  -  STENT ENDOPRSTH 100CM 14MM 9FR 90MM 75CM CATHETER,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
H965403300,SUP,HCPCS C1877,,H965403300  -  STENT ENDOPRSTH 160CM 16MM 9FR 20MM 75CM FLEXIBLE DELIVERY,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
H965403310,SUP,HCPCS C1877,,H965403310  -  STENT ENDOPRSTH 100CM 16MM 9FR 40MM 75CM FLEXIBLE DELIVERY,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
H965403320,SUP,HCPCS C1877,,H965403320  -  STENT ENDOPRSTH 100CM 16MM 9FR 60MM 75CM CATHETER,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
H965403330,SUP,HCPCS C2617,,H965403330  -  STENT ENDOPRSTH 100CM 16MM 9FR 90MM 75CM CATHETER,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
H965404110,SUP,HCPCS C1877,,H965404110  -  STENT ENDOPRSTH 100CM 18MM 10FR 40MM 75CM FLEXIBLE DELIVERY,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
H965404120,SUP,HCPCS C1877,,H965404120  -  STENT ENDOPRSTH 100CM 18MM 10FR 60MM 75CM CATHETER,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
H965404130,SUP,HCPCS C1877,,H965404130  -  STENT ENDOPRSTH 100CM 18MM 10FR 90MM 75CM FLEXIBLE DELIVERY,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
H965404300,SUP,HCPCS C1877,,H965404300  -  STENT ENDOPRSTH 100CM 20MM 10FR 40MM 75CM CATHETER,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
H965404310,SUP,HCPCS C1877,,H965404310  -  STENT ENDOPRSTH 100CM 20MM 10FR 55MM 75CM FLEXIBLE DELIVERY,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
H965404320,SUP,HCPCS C1877,,H965404320  -  STENT ENDOPRSTH 100CM 20MM 10FR 80MM 75CM FLEXIBLE DELIVERY,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
H965404500,SUP,HCPCS C1877,,H965404500  -  STENT ENDOPRSTH 100CM 22MM 10FR 35MM 75CM FLEXIBLE DELIVERY,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
H965404510,SUP,HCPCS C1877,,H965404510  -  STENT ENDOPRSTH 100CM 22MM 10FR 45MM 75CM FLEXIBLE DELIVERY,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
H965404520,SUP,HCPCS C1877,,H965404520  -  STENT ENDOPRSTH 100CM 22MM 10FR 70MM 75CM FLEXIBLE DELIVERY,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
H965405100,SUP,HCPCS C1877,,H965405100  -  STENT ENDOPRSTH 100CM 24MM 11FR 35MM 75CM FLEXIBLE DELIVERY,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
H965405110,SUP,HCPCS C1877,,H965405110  -  STENT ENDOPRSTH 100CM 24MM 12FR 45MM 75CM FLEXIBLE DELIVERY,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
H965405120,SUP,HCPCS C1877,,H965405120  -  STENT ENDOPRSTH 100CM 24MM 11FR 70MM 75CM FLEXIBLE DELIVERY,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
H965412000,SUP,HCPCS C1877,,H965412000  -  STENT ENDOPRSTH 160CM 12MM 9FR 20MM 135CM FLEXIBLE DELIVERY,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
H965412010,SUP,HCPCS C1877,,H965412010  -  STENT ENDOPRSTH 160CM 12MM 8FR 40MM 135CM DELIVERY SYSTEM,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
H965412020,SUP,HCPCS C1877,,H965412020  -  STENT ENDOPRSTH 160CM 12MM 8FR 60MM 135CM DELIVERY SYSTEM,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
H965412030,SUP,HCPCS C1877,,H965412030  -  STENT ENDOPRSTH 160CM 12MM 8FR 90MM 135CM DELIVERY SYSTEM,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
H965700150021,SUP,Custom 27203010,,H965700150021  -  STOPCOCK ANGIO 200 PSI NAMIC 3W ROT M COLR RT PORT PRTC,$2.32,$0.00,$2.32,$0.00,$1.65,$0.00,$0.00,$0.00,$0.00,$0.00,$2.32,$0.00,$1.16,$1.84,$1.85,$0.00,$0.00,$0.00,$0.00,$0.00
H965700150151,SUP,Custom 27203010,,H965700150151  -  STOPCOCK ANGIO 200 PSI NAMIC 1 WY ROT M COLR PORT PRTC,$2.00,$0.00,$2.16,$0.00,$1.54,$0.00,$0.00,$0.00,$0.00,$0.00,$2.16,$0.00,$1.08,$1.58,$1.73,$0.00,$0.00,$0.00,$0.00,$0.00
H965914000211,SUP,Custom 27203010,,H965914000211  -  ADAPTER ANGIO 200 PSI 5/16IN 28 THRD ORG Y .1IN STRL NAMIC,$16.05,$0.00,$16.05,$0.00,$11.45,$0.00,$0.00,$0.00,$0.00,$0.00,$16.05,$0.00,$8.03,$12.71,$12.84,$0.00,$0.00,$0.00,$0.00,$0.00
H965SCH306011,SUP,HCPCS C1769,,H965SCH306011  -  GUIDEWIRE VASCULAR C .035IN 300CM 10CM FLEXIBLE MEIER WIRE,$391.15,$0.00,$391.15,$212.39,$279.16,$0.00,$67.39,$0.00,$0.00,$68.49,$391.15,$0.00,$195.58,$309.79,$312.92,$0.00,$61.21,$0.00,$62.27,$0.00
HARH36,SUP,Custom 27203010,,HARH36  -  SHEARS ESURG CRV 5MM 36CM STRL LF HRMN A +7 ADV HMSTS 3,"$9,211.20",$0.00,"$9,211.20",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$9,211.20",$0.00,"$4,605.60","$7,295.27","$7,368.96",$0.00,$0.00,$0.00,$0.00,$0.00
HC0002,SUP,Custom 27203010,,HEMOSTASE MPH 5G 5-PACK,$669.50,$0.00,$669.50,$0.00,$477.82,$0.00,$0.00,$0.00,$0.00,$0.00,$669.50,$0.00,$334.75,$530.24,$535.60,$0.00,$0.00,$0.00,$0.00,$0.00
HC7001GAL,SUP,Custom 27203010,,REAGENT XYLN HSTPRP 1GL SLVT HISTOLGY,$58.70,$0.00,$58.70,$0.00,$41.89,$0.00,$0.00,$0.00,$0.00,$0.00,$58.70,$0.00,$29.35,$46.49,$46.96,$0.00,$0.00,$0.00,$0.00,$0.00
HCA-5125,SUP,HCPCS C1713,,HCA-5125  -  SCREW BONE 5MM 25MM TI CANC LCK NONSTRL,$380.00,$0.00,$380.00,$171.00,$271.21,$0.00,$65.47,$0.00,$0.00,$66.53,$380.00,$0.00,$190.00,$300.96,$304.00,$0.00,$59.47,$0.00,$60.50,$0.00
HCA-5127,SUP,HCPCS C1713,,HCA-5127  -  SCREW BONE 5MM 27.5MM CANC,$380.00,$0.00,$380.00,$171.00,$271.21,$0.00,$65.47,$0.00,$0.00,$66.53,$380.00,$0.00,$190.00,$300.96,$304.00,$0.00,$59.47,$0.00,$60.50,$0.00
HCA-5130,SUP,HCPCS C1713,,HCA-5130  -  SCREW BONE 5MM 30MM TI CANC NONSTRL,$380.00,$0.00,$380.00,$171.00,$271.21,$0.00,$65.47,$0.00,$0.00,$66.53,$380.00,$0.00,$190.00,$300.96,$304.00,$0.00,$59.47,$0.00,$60.50,$0.00
HCA-5132,SUP,HCPCS C1713,,HCA-5132  -  SCREW BONE 5MM 32.5MM TI CANC NONSTRL,$380.00,$0.00,$380.00,$171.00,$271.21,$0.00,$65.47,$0.00,$0.00,$66.53,$380.00,$0.00,$190.00,$300.96,$304.00,$0.00,$59.47,$0.00,$60.50,$0.00
HCA-5135,SUP,HCPCS C1713,,HCA-5135  -  SCREW BN 5MM 35MM NLCKG ORTH,$380.00,$0.00,$380.00,$171.00,$271.21,$0.00,$65.47,$0.00,$0.00,$66.53,$380.00,$0.00,$190.00,$300.96,$304.00,$0.00,$59.47,$0.00,$60.50,$0.00
HCA-5137,SUP,HCPCS C1713,,HCA-5137  -  SCREW BONE 5MM 37.5MM PLRS TI CANC HUM LCK NONSTRL,$380.00,$0.00,$380.00,$171.00,$271.21,$0.00,$65.47,$0.00,$0.00,$66.53,$380.00,$0.00,$190.00,$300.96,$304.00,$0.00,$59.47,$0.00,$60.50,$0.00
HCA-5140,SUP,HCPCS C1713,,HCA-5140  -  SCREW BN 5MM 40MM CANC,$380.00,$0.00,$380.00,$171.00,$271.21,$0.00,$65.47,$0.00,$0.00,$66.53,$380.00,$0.00,$190.00,$300.96,$304.00,$0.00,$59.47,$0.00,$60.50,$0.00
HCA-5145,SUP,HCPCS C1713,,HCA-5145  -  SCREW BONE 5MM 45MM CANC,$380.00,$0.00,$380.00,$171.00,$271.21,$0.00,$65.47,$0.00,$0.00,$66.53,$380.00,$0.00,$190.00,$300.96,$304.00,$0.00,$59.47,$0.00,$60.50,$0.00
HCA-5150,SUP,HCPCS C1713,,HCA-5150  -  SCREW BONE 5MM 50MM TI CANC NONSTRL,$380.00,$0.00,$380.00,$171.00,$271.21,$0.00,$65.47,$0.00,$0.00,$66.53,$380.00,$0.00,$190.00,$300.96,$304.00,$0.00,$59.47,$0.00,$60.50,$0.00
HCA-5155,SUP,HCPCS C1713,,HCA-5155  -  SCREW BN 5MM 55MM CANC,$380.00,$0.00,$380.00,$171.00,$271.21,$0.00,$65.47,$0.00,$0.00,$66.53,$380.00,$0.00,$190.00,$300.96,$304.00,$0.00,$59.47,$0.00,$60.50,$0.00
HCA5200-S,SUP,HCPCS C1713,,HCA5200-S  -  SCREW BONE 5MM 20MM PLRS TI CANC HUM STRL,$380.00,$0.00,$380.00,$171.00,$271.21,$0.00,$65.47,$0.00,$0.00,$66.53,$380.00,$0.00,$190.00,$300.96,$304.00,$0.00,$59.47,$0.00,$60.50,$0.00
HCA5250-S,SUP,HCPCS C1713,,HCA5250-S  -  SCREW BONE 5MM 25MM PLRS TI CANC STRL,$380.00,$0.00,$380.00,$171.00,$271.21,$0.00,$65.47,$0.00,$0.00,$66.53,$380.00,$0.00,$190.00,$300.96,$304.00,$0.00,$59.47,$0.00,$60.50,$0.00
HCA5275-S,SUP,HCPCS C1713,,HCA5275-S  -  SCREW BONE 5MM 27.5MM PLRS RADL ULN HUM FIB CANC STRL,$380.00,$0.00,$380.00,$171.00,$271.21,$0.00,$65.47,$0.00,$0.00,$66.53,$380.00,$0.00,$190.00,$300.96,$304.00,$0.00,$59.47,$0.00,$60.50,$0.00
HCA5300-S,SUP,HCPCS C1713,,HCA5300-S  -  SCREW BONE 5MM 30MM PLRS TI CANC HUM STRL,$380.00,$0.00,$380.00,$171.00,$271.21,$0.00,$65.47,$0.00,$0.00,$66.53,$380.00,$0.00,$190.00,$300.96,$304.00,$0.00,$59.47,$0.00,$60.50,$0.00
HCA5325-S,SUP,HCPCS C1713,,HCA5325-S  -  SCREW BONE 5MM 32.5MM CANC STRL,$380.00,$0.00,$380.00,$171.00,$271.21,$0.00,$65.47,$0.00,$0.00,$66.53,$380.00,$0.00,$190.00,$300.96,$304.00,$0.00,$59.47,$0.00,$60.50,$0.00
HCA5350-S,SUP,HCPCS C1713,,HCA5350-S  -  SCREW BONE 5MM 35MM PLRS TI CANC HUM LCK STRL,$380.00,$0.00,$380.00,$171.00,$271.21,$0.00,$65.47,$0.00,$0.00,$66.53,$380.00,$0.00,$190.00,$300.96,$304.00,$0.00,$59.47,$0.00,$60.50,$0.00
HCA5375-S,SUP,HCPCS C1713,,HCA5375-S  -  SCREW BONE 5MM 37.5MM PLRS RADL ULN HUM FIB CANC STRL,$380.00,$0.00,$380.00,$171.00,$271.21,$0.00,$65.47,$0.00,$0.00,$66.53,$380.00,$0.00,$190.00,$300.96,$304.00,$0.00,$59.47,$0.00,$60.50,$0.00
HCA5400-S,SUP,HCPCS C1713,,HCA5400-S  -  SCREW BONE 5MM 40MM PLRS TI CANC STRL,$380.00,$0.00,$380.00,$171.00,$271.21,$0.00,$65.47,$0.00,$0.00,$66.53,$380.00,$0.00,$190.00,$300.96,$304.00,$0.00,$59.47,$0.00,$60.50,$0.00
HCA5425-S,SUP,HCPCS C1713,,HCA5425-S  -  SCREW BONE 5MM 42.5MM PLRS RADL ULN HUM FIB CANC STRL,$380.00,$0.00,$380.00,$171.00,$271.21,$0.00,$65.47,$0.00,$0.00,$66.53,$380.00,$0.00,$190.00,$300.96,$304.00,$0.00,$59.47,$0.00,$60.50,$0.00
HCA5450-S,SUP,HCPCS C1713,,HCA5450-S  -  SCREW BONE 5MM 45MM PLRS TI CANC STRL,$380.00,$0.00,$380.00,$171.00,$271.21,$0.00,$65.47,$0.00,$0.00,$66.53,$380.00,$0.00,$190.00,$300.96,$304.00,$0.00,$59.47,$0.00,$60.50,$0.00
HCA5500-S,SUP,HCPCS C1713,,HCA5500-S  -  SCREW BONE 5MM 50MM PLRS TI CANC STRL,$380.00,$0.00,$380.00,$171.00,$271.21,$0.00,$65.47,$0.00,$0.00,$66.53,$380.00,$0.00,$190.00,$300.96,$304.00,$0.00,$59.47,$0.00,$60.50,$0.00
HCA5550-S,SUP,HCPCS C1713,,HCA5550-S  -  SCREW BONE 5MM 50MM PLRS TI CANC HUM LCK STRL,$380.00,$0.00,$380.00,$171.00,$271.21,$0.00,$65.47,$0.00,$0.00,$66.53,$380.00,$0.00,$190.00,$300.96,$304.00,$0.00,$59.47,$0.00,$60.50,$0.00
HCA-L5325-S,SUP,HCPCS C1713,,HCA-L5325-S  -  SCREW BN 5.3MM 25MM STRL PLRS LCK TI CANC HUM,$380.00,$0.00,$380.00,$171.00,$271.21,$0.00,$65.47,$0.00,$0.00,$66.53,$380.00,$0.00,$190.00,$300.96,$304.00,$0.00,$59.47,$0.00,$60.50,$0.00
HCA-L5330-S,SUP,HCPCS C1713,,HCA-L5330-S  -  SCREW BONE 5.3MM 30MM PLRS TI ORTH LCK STRL,$380.00,$0.00,$380.00,$171.00,$271.21,$0.00,$65.47,$0.00,$0.00,$66.53,$380.00,$0.00,$190.00,$300.96,$304.00,$0.00,$59.47,$0.00,$60.50,$0.00
HCA-L5335-S,SUP,HCPCS C1713,,HCA-L5335-S  -  SCREW BONE 5.3MM 35MM TI CANC LCK STRL,$380.00,$0.00,$380.00,$171.00,$271.21,$0.00,$65.47,$0.00,$0.00,$66.53,$380.00,$0.00,$190.00,$300.96,$304.00,$0.00,$59.47,$0.00,$60.50,$0.00
HCA-L5340-S,SUP,HCPCS C1713,,HCA-L5340-S  -  SCREW BONE 5.3MM 40MM PLRS TI ORTH LCK STRL,$380.00,$0.00,$380.00,$171.00,$271.21,$0.00,$65.47,$0.00,$0.00,$66.53,$380.00,$0.00,$190.00,$300.96,$304.00,$0.00,$59.47,$0.00,$60.50,$0.00
HCA-L5345-S,SUP,HCPCS C1713,,HCA-L5345-S  -  SCREW BN 5.3MM 45MM STRL LCK TI CANC,$380.00,$0.00,$380.00,$171.00,$271.21,$0.00,$65.47,$0.00,$0.00,$66.53,$380.00,$0.00,$190.00,$300.96,$304.00,$0.00,$59.47,$0.00,$60.50,$0.00
HCLP-27100-TS,SUP,HCPCS C1713,,HCLP-27100-TS  -  PEG FX 2.7MM 10MM NS GEMINUS HI CMPR LCK TI DIST VOLR RDS,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
HCLP-27120-TS,SUP,HCPCS C1713,,HCLP-27120-TS  -  PEG FX 2.7MM 12MM NS GEMINUS HI CMPR LCK TI DIST VOLR RDS,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
HCLP-27140-TS,SUP,HCPCS C1713,,HCLP-27140-TS  -  PEG FX 2.7MM 14MM NS GEMINUS HI CMPR LCK TI RDS DIST VOLR,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
HCLP-27160-TS,SUP,HCPCS C1713,,HCLP-27160-TS  -  PEG FIX 2.7MM 16MM HIGH COMPRESSION LOCKING GEMINUS TITANIUM,$247.50,$0.00,$247.50,$111.38,$176.64,$0.00,$42.64,$0.00,$0.00,$43.34,$247.50,$0.00,$123.75,$196.02,$198.00,$0.00,$38.73,$0.00,$39.40,$0.00
HCLP-27180-TS,SUP,HCPCS C1713,,HCLP-27180-TS  -  PEG FX 2.7MM 18MM NS GEMINUS HI CMPR LCK TI DIST VOLR RDS,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
HCLP-27190-TS,SUP,HCPCS C1713,,HCLP-27190-TS  -  PEG FX 2.7MM 19MM NS GEMINUS HI CMPR LCK TI DIST VOLR RDS,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
HCLP-27200-TS,SUP,HCPCS C1713,,HCLP-27200-TS  -  PEG FIX 2.7MM 20MM HIGH COMPRESSION LOCKING GEMINUS TITANIUM,$247.50,$0.00,$247.50,$111.38,$176.64,$0.00,$42.64,$0.00,$0.00,$43.34,$247.50,$0.00,$123.75,$196.02,$198.00,$0.00,$38.73,$0.00,$39.40,$0.00
HCLP-27210-TS,SUP,HCPCS C1713,,HCLP-27210-TS  -  PEG FX 2.7MM 21MM NS GEMINUS HI CMPR LCK TI RDS DIST VOLR,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
HCLP-27220-TS,SUP,HCPCS C1713,,HCLP-27220-TS  -  PEG FX 2.7MM 22MM NS GEMINUS HI CMPR LCK TI DIST VOLR RDS,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
HCLP-27230-TS,SUP,HCPCS C1713,,HCLP-27230-TS  -  PEG FX 2.7MM 23MM NS GEMINUS HI CMPR LCK TI DIST VOLR RDS,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
HCLP-27240-TS,SUP,HCPCS C1713,,HCLP-27240-TS  -  PEG FX 2.7MM 24MM NS GEMINUS HI CMPR LCK TI DIST VOLR RDS,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
HCLP-27260-TS,SUP,HCPCS C1713,,HCLP-27260-TS  -  PEG FX 2.7MM 26MM NS GEMINUS HI CMPR LCK TI DIST VOLR RDS,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
HCLP-27280-TS,SUP,HCPCS C1713,,HCLP-27280-TS  -  PEG FX 2.7MM 28MM NS GEMINUS HI CMPR LCK TI DIST VOLR RDS,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
HCLP-27300-TS,SUP,HCPCS C1713,,HCLP-27300-TS  -  PEG FX 2.7MM 30MM NS GEMINUS HI CMPR LCK TI DIST VOLR RDS,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
HCLP-27320-TS,SUP,HCPCS C1713,,HCLP-27320-TS  -  PEG FX 2.7MM 32MM NS GEMINUS HI CMPR LCK TI DIST VOLR RDS,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
HCO-3150-S,SUP,HCPCS C1713,,HCO-3150-S  -  SCREW BONE 3.5MM 15MM CORT,$380.00,$0.00,$380.00,$171.00,$271.21,$0.00,$65.47,$0.00,$0.00,$66.53,$380.00,$0.00,$190.00,$300.96,$304.00,$0.00,$59.47,$0.00,$60.50,$0.00
HCO3175-S,SUP,HCPCS C1713,,HCO3175-S  -  SCREW BONE 3.5MM 17.5MM PLRS TI CORT SHLDR STRL,$380.00,$0.00,$380.00,$171.00,$271.21,$0.00,$65.47,$0.00,$0.00,$66.53,$380.00,$0.00,$190.00,$300.96,$304.00,$0.00,$59.47,$0.00,$60.50,$0.00
HCO3200-S,SUP,HCPCS C1713,,HCO3200-S  -  SCREW BONE 3.5MM 20MM PLRS TI CORT HUM INTLCK STRL,$380.00,$0.00,$380.00,$171.00,$271.21,$0.00,$65.47,$0.00,$0.00,$66.53,$380.00,$0.00,$190.00,$300.96,$304.00,$0.00,$59.47,$0.00,$60.50,$0.00
HCO3225-S,SUP,HCPCS C1713,,HCO3225-S  -  SCREW BN 3.5MM 22.5MM STRL CORT,$380.00,$0.00,$380.00,$171.00,$271.21,$0.00,$65.47,$0.00,$0.00,$66.53,$380.00,$0.00,$190.00,$300.96,$304.00,$0.00,$59.47,$0.00,$60.50,$0.00
HCO3250-S,SUP,HCPCS C1713,,HCO3250-S  -  SCREW BONE 3.5MM 25MM PLRS TI CORT HUM SHLDR STRL,$380.00,$0.00,$380.00,$171.00,$271.21,$0.00,$65.47,$0.00,$0.00,$66.53,$380.00,$0.00,$190.00,$300.96,$304.00,$0.00,$59.47,$0.00,$60.50,$0.00
HCO3275-S,SUP,HCPCS C1713,,HCO3275-S  -  SCREW BONE 3.5MM 27.5MM PLRS CORT HUM SHLDR STRL,$380.00,$0.00,$380.00,$171.00,$271.21,$0.00,$65.47,$0.00,$0.00,$66.53,$380.00,$0.00,$190.00,$300.96,$304.00,$0.00,$59.47,$0.00,$60.50,$0.00
HCO3300-S,SUP,HCPCS C1713,,HCO3300-S  -  SCREW BONE 3.5MM 30MM PLRS TI CORT HUM INTLCK STRL,$380.00,$0.00,$380.00,$171.00,$271.21,$0.00,$65.47,$0.00,$0.00,$66.53,$380.00,$0.00,$190.00,$300.96,$304.00,$0.00,$59.47,$0.00,$60.50,$0.00
HCO3325-S,SUP,HCPCS C1713,,HCO3325-S  -  SCREW BONE 3.5MM 32.5MM PLRS TI CORT HUM STRL,$380.00,$0.00,$380.00,$171.00,$271.21,$0.00,$65.47,$0.00,$0.00,$66.53,$380.00,$0.00,$190.00,$300.96,$304.00,$0.00,$59.47,$0.00,$60.50,$0.00
HCO3350-S,SUP,HCPCS C1713,,HCO3350-S  -  SCREW BONE 3.5MM 35MM ACUMED TI CORT SHLDR STRL,$380.00,$0.00,$380.00,$171.00,$271.21,$0.00,$65.47,$0.00,$0.00,$66.53,$380.00,$0.00,$190.00,$300.96,$304.00,$0.00,$59.47,$0.00,$60.50,$0.00
HCO3375-S,SUP,HCPCS C1713,,HCO3375-S  -  SCREW BONE 3.5MM 37.5MM TI CORT STRL,$380.00,$0.00,$380.00,$171.00,$271.21,$0.00,$65.47,$0.00,$0.00,$66.53,$380.00,$0.00,$190.00,$300.96,$304.00,$0.00,$59.47,$0.00,$60.50,$0.00
HCO3400-S,SUP,HCPCS C1713,,HCO3400-S  -  SCREW BONE 3.5MM 40MM PLRS TI CORT HUM STRL,$380.00,$0.00,$380.00,$171.00,$271.21,$0.00,$65.47,$0.00,$0.00,$66.53,$380.00,$0.00,$190.00,$300.96,$304.00,$0.00,$59.47,$0.00,$60.50,$0.00
HCO3450-S,SUP,HCPCS C1713,,HCO3450-S  -  SCREW BONE 3.5MM 45MM PLRS TI CORT STRL,$380.00,$0.00,$380.00,$171.00,$271.21,$0.00,$65.47,$0.00,$0.00,$66.53,$380.00,$0.00,$190.00,$300.96,$304.00,$0.00,$59.47,$0.00,$60.50,$0.00
HCO3500-S,SUP,HCPCS C1713,,HCO3500-S  -  SCREW BONE 3.5MM 50MM PLRS TI CORT HUM SHLDR STRL,$380.00,$0.00,$380.00,$171.00,$271.21,$0.00,$65.47,$0.00,$0.00,$66.53,$380.00,$0.00,$190.00,$300.96,$304.00,$0.00,$59.47,$0.00,$60.50,$0.00
HCO3550-S,SUP,HCPCS C1713,,HCO3550-S  -  SCREW BONE 3.5MM 55MM PLRS TI CORT HUM STRL,$380.00,$0.00,$380.00,$171.00,$271.21,$0.00,$65.47,$0.00,$0.00,$66.53,$380.00,$0.00,$190.00,$300.96,$304.00,$0.00,$59.47,$0.00,$60.50,$0.00
HCO35WA,SUP,Custom 27803010,,HCO35WA  -  WASHER ORTH 3.5MM NS PLRS TI CORT SCR,$92.50,$0.00,$92.50,$0.00,$66.02,$0.00,$0.00,$0.00,$0.00,$0.00,$92.50,$0.00,$46.25,$73.26,$74.00,$0.00,$0.00,$0.00,$0.00,$0.00
HCO3600-S,SUP,HCPCS C1713,,HCO3600-S  -  SCREW BONE 3.5MM 60MM PLRS TI CORT NONSTRL,$380.00,$0.00,$380.00,$171.00,$271.21,$0.00,$65.47,$0.00,$0.00,$66.53,$380.00,$0.00,$190.00,$300.96,$304.00,$0.00,$59.47,$0.00,$60.50,$0.00
HD-1500,SUP,Custom 27203010,,HD-1500  -  DRIVER HEX SLD 1.5MM SURG,$301.88,$0.00,$301.88,$0.00,$215.45,$0.00,$0.00,$0.00,$0.00,$0.00,$301.88,$0.00,$150.94,$239.09,$241.50,$0.00,$0.00,$0.00,$0.00,$0.00
HD-1509,SUP,Custom 27203010,,HD-1509  -  DRIVER CANN HEX ASMBLY 1.5MM SURG,$682.50,$0.00,$682.50,$0.00,$487.10,$0.00,$0.00,$0.00,$0.00,$0.00,$682.50,$0.00,$341.25,$540.54,$546.00,$0.00,$0.00,$0.00,$0.00,$0.00
HD-2000,SUP,Custom 27203010,,HD-2000  -  DRIVER 2MM SLD SURG,$682.50,$0.00,$682.50,$0.00,$487.10,$0.00,$0.00,$0.00,$0.00,$0.00,$682.50,$0.00,$341.25,$540.54,$546.00,$0.00,$0.00,$0.00,$0.00,$0.00
HD-2011,SUP,Custom 27203010,,HD-2011  -  DRIVER SRG 2MM HEX CNN,$682.50,$0.00,$682.50,$0.00,$487.10,$0.00,$0.00,$0.00,$0.00,$0.00,$682.50,$0.00,$341.25,$540.54,$546.00,$0.00,$0.00,$0.00,$0.00,$0.00
HD-2500,SUP,Custom 27203010,,HD-2500  -  DRIVER SURG 2.5MM HEX SLD ASMBLY 2.5MM,$682.50,$0.00,$682.50,$0.00,$487.10,$0.00,$0.00,$0.00,$0.00,$0.00,$682.50,$0.00,$341.25,$540.54,$546.00,$0.00,$0.00,$0.00,$0.00,$0.00
HD-2515,SUP,Custom 27203010,,HD-2515  -  SCRDRVR 2.5MM CANN HEX 2.5MM SURG,$682.50,$0.00,$682.50,$0.00,$487.10,$0.00,$0.00,$0.00,$0.00,$0.00,$682.50,$0.00,$341.25,$540.54,$546.00,$0.00,$0.00,$0.00,$0.00,$0.00
HD-2516,SUP,Custom 27203010,,HD-2516  -  DRIVER CANN HEX ASMBLY 2.5MM SURG,$682.50,$0.00,$682.50,$0.00,$487.10,$0.00,$0.00,$0.00,$0.00,$0.00,$682.50,$0.00,$341.25,$540.54,$546.00,$0.00,$0.00,$0.00,$0.00,$0.00
HD-3016,SUP,Custom 27203010,,HD-3016  -  DRIVER CANN ASMBLY 3MM SURG,$682.50,$0.00,$682.50,$0.00,$487.10,$0.00,$0.00,$0.00,$0.00,$0.00,$682.50,$0.00,$341.25,$540.54,$546.00,$0.00,$0.00,$0.00,$0.00,$0.00
HD-3500,SUP,Custom 27203010,,HD-3500  -  SCRDRVR SLD ASMBLY 3.5MM SURG,$682.50,$0.00,$682.50,$0.00,$487.10,$0.00,$0.00,$0.00,$0.00,$0.00,$682.50,$0.00,$341.25,$540.54,$546.00,$0.00,$0.00,$0.00,$0.00,$0.00
HD-3725,SUP,Custom 27203010,,HD-3725  -  DRIVER PLRS CANN HDSN FIT 3MM SURG NONSTRL,$682.50,$0.00,$682.50,$0.00,$487.10,$0.00,$0.00,$0.00,$0.00,$0.00,$682.50,$0.00,$341.25,$540.54,$546.00,$0.00,$0.00,$0.00,$0.00,$0.00
HDF-1500,SUP,Custom 27203010,,HDF-1500  -  DRIVER 1.5MM ACTRK FSN SLD 1.5MM SURG MINI SCR,$682.50,$0.00,$682.50,$0.00,$487.10,$0.00,$0.00,$0.00,$0.00,$0.00,$682.50,$0.00,$341.25,$540.54,$546.00,$0.00,$0.00,$0.00,$0.00,$0.00
HDL-2000,SUP,Custom 27203010,,HDL-2000  -  SCREWDRIVER SRG 2MM SLD,$682.50,$0.00,$682.50,$0.00,$487.10,$0.00,$0.00,$0.00,$0.00,$0.00,$682.50,$0.00,$341.25,$540.54,$546.00,$0.00,$0.00,$0.00,$0.00,$0.00
HDL-2500,SUP,Custom 27203010,,HDL-2500  -  SCRDRVR 2.5MM HEX SLD SURG,$682.50,$0.00,$682.50,$0.00,$487.10,$0.00,$0.00,$0.00,$0.00,$0.00,$682.50,$0.00,$341.25,$540.54,$546.00,$0.00,$0.00,$0.00,$0.00,$0.00
HDM-1500,SUP,Custom 27203010,,HDM-1500  -  DRIVER 1.5MM SLD SURG,$682.50,$0.00,$682.50,$0.00,$487.10,$0.00,$0.00,$0.00,$0.00,$0.00,$682.50,$0.00,$341.25,$540.54,$546.00,$0.00,$0.00,$0.00,$0.00,$0.00
HEL180620-20,SUP,Custom 27803010,,HEL180620-20  -  COIL EMBL HLCL 6MM 20CM HELIPAQ 18 MCIOL LOOP DTCH STRCH RS,"$1,268.93",$0.00,"$1,268.93",$0.00,$905.63,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,268.93",$0.00,$634.46,"$1,004.99","$1,015.14",$0.00,$0.00,$0.00,$0.00,$0.00
HEL180730-20,SUP,Custom 27803010,,HEL180730-20  -  COIL EMBL HLCL 7MM 30CM HELIPAQ 18 MCIOL LOOP DTCH STRCH RS,"$1,358.30",$0.00,"$1,358.30",$0.00,$969.42,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,358.30",$0.00,$679.15,"$1,075.77","$1,086.64",$0.00,$0.00,$0.00,$0.00,$0.00
HEL180830-20,SUP,Custom 27803010,,HEL180830-20  -  COIL EMBL HLCL 8MM 30CM HELIPAQ 18 MCIOL LOOP DTCH STRCH RS,"$1,358.30",$0.00,"$1,358.30",$0.00,$969.42,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,358.30",$0.00,$679.15,"$1,075.77","$1,086.64",$0.00,$0.00,$0.00,$0.00,$0.00
HEL18093020,SUP,Custom 27803010,,HEL18093020  -  COIL EMBL HLCL 9MM 30CM HELIPAQ 18 MCIOL LOOP DTCH STRCH RS,"$1,358.30",$0.00,"$1,358.30",$0.00,$969.42,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,358.30",$0.00,$679.15,"$1,075.77","$1,086.64",$0.00,$0.00,$0.00,$0.00,$0.00
HEL181030-20,SUP,Custom 27803010,,HEL181030-20  -  COIL EMBL HLCL 10MM 30CM HELIPAQ 18 MCIOL LOOP DTCH STRCH RS,"$1,358.30",$0.00,"$1,358.30",$0.00,$969.42,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,358.30",$0.00,$679.15,"$1,075.77","$1,086.64",$0.00,$0.00,$0.00,$0.00,$0.00
HEL181230-20,SUP,Custom 27803010,,HEL181230-20  -  COIL EMBL 12MM 30CM HELIPAQ 18 MCIOL HLCL LOOP DTCH STRCH RS,"$1,429.78",$0.00,"$1,429.78",$0.00,"$1,020.43",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,429.78",$0.00,$714.89,"$1,132.39","$1,143.82",$0.00,$0.00,$0.00,$0.00,$0.00
HEL181430-20,SUP,Custom 27803010,,HEL181430-20  -  COIL EMBL 14MM 30CM HELIPAQ 18 MCIOL HLCL LOOP DTCH STRCH RS,"$1,429.78",$0.00,"$1,429.78",$0.00,"$1,020.43",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,429.78",$0.00,$714.89,"$1,132.39","$1,143.82",$0.00,$0.00,$0.00,$0.00,$0.00
HEL181630-20,SUP,Custom 27803010,,HEL181630-20  -  COIL EMBL 16MM 30CM HELIPAQ 18 MCIOL HLCL LOOP DTCH STRCH RS,"$1,268.93",$0.00,"$1,268.93",$0.00,$905.63,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,268.93",$0.00,$634.46,"$1,004.99","$1,015.14",$0.00,$0.00,$0.00,$0.00,$0.00
HEL181830-20,SUP,Custom 27803010,,HEL181830-20  -  COIL EMBL 18MM 30CM HELIPAQ 18 MCIOL HLCL LOOP DTCH STRCH RS,"$1,501.28",$0.00,"$1,501.28",$0.00,"$1,071.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,501.28",$0.00,$750.64,"$1,189.01","$1,201.02",$0.00,$0.00,$0.00,$0.00,$0.00
HEL182030-20,SUP,Custom 27803010,,HEL182030-20  -  COIL EMBL 20MM 30CM HELIPAQ 18 MCIOL HLCL LOOP DTCH STRCH RS,"$1,501.28",$0.00,"$1,501.28",$0.00,"$1,071.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,501.28",$0.00,$750.64,"$1,189.01","$1,201.02",$0.00,$0.00,$0.00,$0.00,$0.00
HERO 1003,SUP,Custom 27203010,,HERO 1003  -  KIT HEMODIALYSIS 16FR Y 10FR 12FR DELIVERY STYLET DILAT,"$1,275.00",$0.00,"$1,275.00",$0.00,$909.97,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,275.00",$0.00,$637.50,"$1,009.80","$1,020.00",$0.00,$0.00,$0.00,$0.00,$0.00
HEX2.7-12,SUP,HCPCS C1713,,HEX2.7-12  -  SCREW BN 2.7MM 12MM SS CORT TRIMED CLVCL FX SYS,$225.00,$0.00,$225.00,$101.25,$160.58,$0.00,$38.77,$0.00,$0.00,$39.40,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$35.21,$0.00,$35.82,$0.00
HEX2.7-14,SUP,HCPCS C1713,,HEX2.7-14  -  SCREW BN 2.7MM 14MM SS CORT TRIMED CLVCL FX SYS,$225.00,$0.00,$225.00,$101.25,$160.58,$0.00,$38.77,$0.00,$0.00,$39.40,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$35.21,$0.00,$35.82,$0.00
HEX3.2-08,SUP,HCPCS C1713,,HEX3.2-08  -  SCREW BONE 3.2MM 8MM HEXAGONAL HEAD CORTICAL,$225.00,$0.00,$225.00,$101.25,$160.58,$0.00,$38.77,$0.00,$0.00,$39.40,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$35.21,$0.00,$35.82,$0.00
HEX3.2-10,SUP,HCPCS C1713,,HEX3.2-10  -  SCREW BN 3.2MM 10MM HEX CORT ANKL FX SYS,$225.00,$0.00,$225.00,$101.25,$160.58,$0.00,$38.77,$0.00,$0.00,$39.40,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$35.21,$0.00,$35.82,$0.00
HEX3.2-11,SUP,HCPCS C1713,,HEX3.2-11  -  SCREW BONE 3.2MM 11MM HEXAGONAL HEAD CORTICAL,$225.00,$0.00,$225.00,$101.25,$160.58,$0.00,$38.77,$0.00,$0.00,$39.40,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$35.21,$0.00,$35.82,$0.00
HEX3.2-12,SUP,HCPCS C1713,,HEX3.2-12  -  SCREW BN 3.2MM 12MM HEX CORT ANKL FX SYS,$225.00,$0.00,$225.00,$101.25,$160.58,$0.00,$38.77,$0.00,$0.00,$39.40,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$35.21,$0.00,$35.82,$0.00
HEX3.2-13,SUP,HCPCS C1713,,HEX3.2-13  -  SCREW BN 3.2MM 13MM HEX CORT ANKL FX SYS,$225.00,$0.00,$225.00,$101.25,$160.58,$0.00,$38.77,$0.00,$0.00,$39.40,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$35.21,$0.00,$35.82,$0.00
HEX3.2-14,SUP,HCPCS C1713,,HEX3.2-14  -  SCREW BN 3.2MM 14MM HEX CORT ANKL FX SYS,$225.00,$0.00,$225.00,$101.25,$160.58,$0.00,$38.77,$0.00,$0.00,$39.40,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$35.21,$0.00,$35.82,$0.00
HEX3.2-15,SUP,HCPCS C1713,,HEX3.2-15  -  SCREW BONE 3.2MM 15MM HEXAGONAL HEAD CORTICAL,$225.00,$0.00,$225.00,$101.25,$160.58,$0.00,$38.77,$0.00,$0.00,$39.40,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$35.21,$0.00,$35.82,$0.00
HEX3.2-16,SUP,HCPCS C1713,,HEX3.2-16  -  SCREW BN 3.2MM 16MM HEX CORT ANKL FX SYS,$225.00,$0.00,$225.00,$101.25,$160.58,$0.00,$38.77,$0.00,$0.00,$39.40,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$35.21,$0.00,$35.82,$0.00
HEX3.2-18,SUP,HCPCS C1713,,HEX3.2-18  -  SCREW BN 3.2MM 18MM HEX CORT ANKL FX SYS,$225.00,$0.00,$225.00,$101.25,$160.58,$0.00,$38.77,$0.00,$0.00,$39.40,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$35.21,$0.00,$35.82,$0.00
HEX3.2-20,SUP,HCPCS C1713,,HEX3.2-20  -  SCREW BONE 3.2MM 20MM HEXAGONAL HEAD CORTICAL,$225.00,$0.00,$225.00,$101.25,$160.58,$0.00,$38.77,$0.00,$0.00,$39.40,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$35.21,$0.00,$35.82,$0.00
HEX3.2-22,SUP,HCPCS C1713,,HEX3.2-22  -  SCREW BONE 3.2MM 22MM HEXAGONAL HEAD CORTICAL,$225.00,$0.00,$225.00,$101.25,$160.58,$0.00,$38.77,$0.00,$0.00,$39.40,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$35.21,$0.00,$35.82,$0.00
HEX3.2-24,SUP,HCPCS C1713,,HEX3.2-24  -  SCREW BONE 3.2MM 24MM HEXAGONAL HEAD CORTICAL,$225.00,$0.00,$225.00,$101.25,$160.58,$0.00,$38.77,$0.00,$0.00,$39.40,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$35.21,$0.00,$35.82,$0.00
HEX3.2-26,SUP,HCPCS C1713,,HEX3.2-26  -  SCREW BONE 3.2MM 26MM HEXAGONAL HEAD CORTICAL,$225.00,$0.00,$225.00,$101.25,$160.58,$0.00,$38.77,$0.00,$0.00,$39.40,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$35.21,$0.00,$35.82,$0.00
HEX3.2-28,SUP,HCPCS C1713,,HEX3.2-28  -  SCREW BONE 3.2MM 28MM HEXAGON CORTICAL,$225.00,$0.00,$225.00,$101.25,$160.58,$0.00,$38.77,$0.00,$0.00,$39.40,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$35.21,$0.00,$35.82,$0.00
HEX3.2-30,SUP,HCPCS C1713,,HEX3.2-30  -  SCREW BN 3.2MM 30MM HEX CORT,$225.00,$0.00,$225.00,$101.25,$160.58,$0.00,$38.77,$0.00,$0.00,$39.40,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$35.21,$0.00,$35.82,$0.00
HF0200DSSM,SUP,Custom 27011340,,HF0200DSSM  -  FIBER LSR 270UM HO 1 WL STRL DISP,"$1,074.28",$0.00,"$1,074.28",$0.00,$766.72,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,074.28",$0.00,$537.14,$850.83,$859.43,$0.00,$0.00,$0.00,$0.00,$0.00
HH0710,SUP,HCPCS C1781,,HH0710  -  MESH SRG 10X7CM GORE BIO-ASNTH REINF TISS HIATAL HRN REPR,"$1,275.00",$0.00,"$1,275.00",$573.75,$909.97,$0.00,$219.68,$0.00,$0.00,$223.24,"$1,275.00",$0.00,$637.50,"$1,009.80","$1,020.00",$0.00,$199.54,$0.00,$202.98,$0.00
HIC135,SUP,HCPCS C1729,,EMBOCATHETER INFUSION SEGWAY,$625.00,$0.00,$625.00,$339.38,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
HLFDBX0270C,SUP,Custom 27203010,,HLFDBX0270C  -  LASER SRG 270MH DISP,$710.67,$0.00,$710.67,$0.00,$507.20,$0.00,$0.00,$0.00,$0.00,$0.00,$710.67,$0.00,$355.33,$562.85,$568.53,$0.00,$0.00,$0.00,$0.00,$0.00
HLFDBX0400C,SUP,Custom 27203010,,HLFDBX0400C  -  LASER SRG 400MH DISP,$848.67,$0.00,$848.67,$0.00,$605.69,$0.00,$0.00,$0.00,$0.00,$0.00,$848.67,$0.00,$424.33,$672.15,$678.93,$0.00,$0.00,$0.00,$0.00,$0.00
HLFDBX0600C,SUP,Custom 27011340,,HLFDBX0600C  -  FIBER LSR 600UM STRL DUR HO DISP LTHTRP,$848.67,$0.00,$848.67,$0.00,$605.69,$0.00,$0.00,$0.00,$0.00,$0.00,$848.67,$0.00,$424.33,$672.15,$678.93,$0.00,$0.00,$0.00,$0.00,$0.00
HLFDBX1000C,SUP,Custom 27203010,,HLFDBX1000C  -  LASER SURGICAL 1000 MH DISPOSABLE,"$1,911.60",$0.00,"$1,911.60",$0.00,"$1,364.31",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,911.60",$0.00,$955.80,"$1,513.99","$1,529.28",$0.00,$0.00,$0.00,$0.00,$0.00
HLS1007M,SUP,HCPCS C1894,,HLS1007M  -  INTRODUCER SHTH 7FR 13CM 20CM SFSHTH HMSTS VLV TRAW SDPRT,$130.00,$0.00,$130.00,$70.59,$92.78,$0.00,$22.40,$0.00,$0.00,$22.76,$130.00,$0.00,$65.00,$102.96,$104.00,$0.00,$20.35,$0.00,$20.70,$0.00
HLS10095M,SUP,HCPCS C1894,,HLS10095M  -  INTRODUCER SHEATH 9.5FR 13CM 20CM HEMOSTASIS VALVE TEAR AWAY,$146.25,$0.00,$146.25,$79.41,$104.38,$0.00,$25.20,$0.00,$0.00,$25.61,$146.25,$0.00,$73.13,$115.83,$117.00,$0.00,$22.89,$0.00,$23.28,$0.00
HLS1009M,SUP,HCPCS C1894,,HLS1009M  -  INTRODUCER LEAD 13CM 9FR SFSHTH HMSTS VLV TRAW SDPRT 20CM,$650.00,$0.00,$650.00,$352.95,$463.91,$0.00,$111.99,$0.00,$0.00,$113.81,$650.00,$0.00,$325.00,$514.80,$520.00,$0.00,$101.73,$0.00,$103.48,$0.00
HLS10105M,SUP,HCPCS C1894,,HLS10105M  -  INTRODUCER SHEATH 10.5FR 13CM 20CM HEMOSTASIS VALVE TEAR,$130.00,$0.00,$130.00,$70.59,$92.78,$0.00,$22.40,$0.00,$0.00,$22.76,$130.00,$0.00,$65.00,$102.96,$104.00,$0.00,$20.35,$0.00,$20.70,$0.00
HLS2509M,SUP,HCPCS C1894,,HLS2509M  -  INTRODUCER LEAD LONG 9FR 25CM 31.5CM HEMOSTASIS VALVE TEAR,$146.00,$0.00,$146.00,$79.28,$104.20,$0.00,$25.16,$0.00,$0.00,$25.56,$146.00,$0.00,$73.00,$115.63,$116.80,$0.00,$22.85,$0.00,$23.24,$0.00
HN1200,SUP,HCPCS C1776,,HN1200  -  SLEEVE CENTERING 38.1IN 9MM 12.7IN IMHS CP SET SCR IM HIP,$831.25,$0.00,$831.25,$374.06,$593.26,$0.00,$143.22,$0.00,$0.00,$145.55,$831.25,$0.00,$415.63,$658.35,$665.00,$0.00,$130.09,$0.00,$132.34,$0.00
HN1202,SUP,HCPCS C1713,,HN1202  -  SCREW SET IMHS CENTERING SLV HIP,$533.75,$0.00,$533.75,$240.19,$380.94,$0.00,$91.96,$0.00,$0.00,$93.46,$533.75,$0.00,$266.88,$422.73,$427.00,$0.00,$83.53,$0.00,$84.97,$0.00
HNR4.0-35-70-P-10S-0,SUP,HCPCS C1725,,HNR4.0-35-70-P-10S-0  -  CATH ANGIO .035IN 4FR 70CM 10 SDPRT STR HFLO ATRM TIP DSGN,$46.88,$0.00,$46.88,$25.45,$33.45,$0.00,$8.08,$0.00,$0.00,$8.21,$46.88,$0.00,$23.44,$37.13,$37.50,$0.00,$7.34,$0.00,$7.46,$0.00
HOOK-L4,SUP,HCPCS C1713,,HOOK-L4  -  PLATE BONE 4 HOLE HOOK LEFT ELBOW,"$1,875.00",$0.00,"$1,875.00",$843.75,"$1,338.19",$0.00,$323.05,$0.00,$0.00,$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
HOOK-R6,SUP,HCPCS C1713,,HOOK-R6  -  PLATE BONE 6 HOLE HOOK ORTHOPEDIC,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
HP01,SUP,HCPCS C1781,,HP01  -  PLUG SURG BIOABSORBABLE BIO-A HERN REPAIR,"$1,260.00",$0.00,"$1,260.00",$567.00,$899.26,$0.00,$217.09,$0.00,$0.00,$220.62,"$1,260.00",$0.00,$630.00,$997.92,"$1,008.00",$0.00,$197.19,$0.00,$200.59,$0.00
HP-2515,SUP,Custom 27203010,,HP-2515  -  DRIVER 2.5MM PWR TIP CANN SURG,$387.50,$0.00,$387.50,$0.00,$276.56,$0.00,$0.00,$0.00,$0.00,$0.00,$387.50,$0.00,$193.75,$306.90,$310.00,$0.00,$0.00,$0.00,$0.00,$0.00
HP3000,SUP,Custom 27203010,,HP3000  -  POSITIONER SRG STRFSH EVO MULTIAPPENDAGE SIL SCT CUP LOPRFL,"$1,987.50",$0.00,"$1,987.50",$0.00,"$1,418.48",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$0.00,$0.00,$0.00,$0.00
HP-3016,SUP,Custom 27203010,,HP-3016  -  DRIVER CANN PWR TIP 3MM SURG OPTN INST,$387.50,$0.00,$387.50,$0.00,$276.56,$0.00,$0.00,$0.00,$0.00,$0.00,$387.50,$0.00,$193.75,$306.90,$310.00,$0.00,$0.00,$0.00,$0.00,$0.00
HPC-0015,SUP,Custom 27203010,,HPC-0015  -  DRIVER 1.5MM SM HEX TIP SHFT 1.5MM SURG STRL DISP,$147.50,$0.00,$147.50,$0.00,$105.27,$0.00,$0.00,$0.00,$0.00,$0.00,$147.50,$0.00,$73.75,$116.82,$118.00,$0.00,$0.00,$0.00,$0.00,$0.00
HPC-0025,SUP,Custom 27203010,,HPC-0025  -  DRIVER 2.5MM QRLSE 2.5MM SURG,$147.50,$0.00,$147.50,$0.00,$105.27,$0.00,$0.00,$0.00,$0.00,$0.00,$147.50,$0.00,$73.75,$116.82,$118.00,$0.00,$0.00,$0.00,$0.00,$0.00
HPC-0035,SUP,Custom 27203010,,HPC-0035  -  DRIVER HEX QRLSE 3.5MM SURG,$147.50,$0.00,$147.50,$0.00,$105.27,$0.00,$0.00,$0.00,$0.00,$0.00,$147.50,$0.00,$73.75,$116.82,$118.00,$0.00,$0.00,$0.00,$0.00,$0.00
HR-0001-S,SUP,HCPCS C1713,,HR-0001-S  -  CAP END ORTH SCR ASMBLY IM NAIL STRL PLRS,$380.00,$0.00,$380.00,$171.00,$271.21,$0.00,$65.47,$0.00,$0.00,$66.53,$380.00,$0.00,$190.00,$300.96,$304.00,$0.00,$59.47,$0.00,$60.50,$0.00
HR-0024-S,SUP,HCPCS C1713,,HR-0024-S  -  CAP END 4MM STRL PLRS SCR ASMB,$757.50,$0.00,$757.50,$340.88,$540.63,$0.00,$130.51,$0.00,$0.00,$132.63,$757.50,$0.00,$378.75,$599.94,$606.00,$0.00,$118.55,$0.00,$120.59,$0.00
HR-0028-S,SUP,HCPCS C1713,,HR-0028-S  -  CAP END 8MM STRL PLRS SCR ASMB,$757.50,$0.00,$757.50,$340.88,$540.63,$0.00,$130.51,$0.00,$0.00,$132.63,$757.50,$0.00,$378.75,$599.94,$606.00,$0.00,$118.55,$0.00,$120.59,$0.00
HR-0050-S,SUP,HCPCS C1713,,HR-0050-S  -  CAP END PLRS SCR ASMB INS DEV,$757.50,$0.00,$757.50,$340.88,$540.63,$0.00,$130.51,$0.00,$0.00,$132.63,$757.50,$0.00,$378.75,$599.94,$606.00,$0.00,$118.55,$0.00,$120.59,$0.00
HR-0054-S,SUP,HCPCS C1713,,HR-0054-S  -  CAP END 4MM STRL PLRS SCR ASMB,$757.50,$0.00,$757.50,$340.88,$540.63,$0.00,$130.51,$0.00,$0.00,$132.63,$757.50,$0.00,$378.75,$599.94,$606.00,$0.00,$118.55,$0.00,$120.59,$0.00
HR-0058-S,SUP,HCPCS C1713,,HR-0058-S  -  CAP END 8MM STRL PLRS SCR ASMB,$757.50,$0.00,$757.50,$340.88,$540.63,$0.00,$130.51,$0.00,$0.00,$132.63,$757.50,$0.00,$378.75,$599.94,$606.00,$0.00,$118.55,$0.00,$120.59,$0.00
HR-0105,SUP,Custom 27203010,,HR-0105  -  BIT DRILL 2.7MM PLRS TAP,$75.00,$0.00,$75.00,$0.00,$53.53,$0.00,$0.00,$0.00,$0.00,$0.00,$75.00,$0.00,$37.50,$59.40,$60.00,$0.00,$0.00,$0.00,$0.00,$0.00
HR-0820-S,SUP,HCPCS C1713,,HR-0820-S  -  ROD ORTH 200MM 8MM PLRS PLUS HUM SHLDR TI HUM IM IMPL STRL,"$4,107.50",$0.00,"$4,107.50","$1,848.38","$2,931.52",$0.00,$707.70,$0.00,$0.00,$719.19,"$4,107.50",$0.00,"$2,053.75","$3,253.14","$3,286.00",$0.00,$642.82,$0.00,$653.91,$0.00
HR-0822-S,SUP,HCPCS C1713,,HR-0822-S  -  ROD ORTH 220MM 8MM PLRS PLUS HUM SHLDR TI HUM IM IMPL STRL,"$4,107.50",$0.00,"$4,107.50","$1,848.38","$2,931.52",$0.00,$707.70,$0.00,$0.00,$719.19,"$4,107.50",$0.00,"$2,053.75","$3,253.14","$3,286.00",$0.00,$642.82,$0.00,$653.91,$0.00
HR-0824-S,SUP,HCPCS C1713,,HR-0824-S  -  ROD ORTH 240MM 8MM PLRS PLUS HUM TI IM IMPL STRL,"$4,107.50",$0.00,"$4,107.50","$1,848.38","$2,931.52",$0.00,$707.70,$0.00,$0.00,$719.19,"$4,107.50",$0.00,"$2,053.75","$3,253.14","$3,286.00",$0.00,$642.82,$0.00,$653.91,$0.00
HR-0826-S,SUP,HCPCS C1713,,HR-0826-S  -  ROD ORTH 260MM 8MM PLRS PLUS HUM SHLDR TI HUM IM IMPL STRL,"$4,107.50",$0.00,"$4,107.50","$1,848.38","$2,931.52",$0.00,$707.70,$0.00,$0.00,$719.19,"$4,107.50",$0.00,"$2,053.75","$3,253.14","$3,286.00",$0.00,$642.82,$0.00,$653.91,$0.00
HR-0828-S,SUP,HCPCS C1713,,HR-0828-S  -  ROD ORTH 280MM 8MM PLRS PLUS HUM SHLDR TI HUM IM IMPL STRL,"$4,107.50",$0.00,"$4,107.50","$1,848.38","$2,931.52",$0.00,$707.70,$0.00,$0.00,$719.19,"$4,107.50",$0.00,"$2,053.75","$3,253.14","$3,286.00",$0.00,$642.82,$0.00,$653.91,$0.00
HR-3106,SUP,Custom 27203010,,HR-3106  -  DRILL SRG WITNESS HL CLRNC,$147.50,$0.00,$147.50,$0.00,$105.27,$0.00,$0.00,$0.00,$0.00,$0.00,$147.50,$0.00,$73.75,$116.82,$118.00,$0.00,$0.00,$0.00,$0.00,$0.00
HR-3107,SUP,Custom 27203010,,HR-3107  -  TAP SRG 3.5 MM SCR,$930.00,$0.00,$930.00,$0.00,$663.74,$0.00,$0.00,$0.00,$0.00,$0.00,$930.00,$0.00,$465.00,$736.56,$744.00,$0.00,$0.00,$0.00,$0.00,$0.00
HR-4D1055-S,SUP,HCPCS C1713,,HR-4D1055-S  -  ROD XTRNFX 2-4D 5.5MM 150MM STRL 10MM ANT POST,"$3,817.50",$0.00,"$3,817.50","$1,717.88","$2,724.55",$0.00,$657.74,$0.00,$0.00,$668.41,"$3,817.50",$0.00,"$1,908.75","$3,023.46","$3,054.00",$0.00,$597.44,$0.00,$607.75,$0.00
HRA-1055-S,SUP,HCPCS C1713,,HRA-1055-S  -  ROD XTRNFX 2-4D STD 5.5MM 150MM STRL 10MM,"$5,422.50",$0.00,"$5,422.50","$2,440.13","$3,870.04",$0.00,$934.27,$0.00,$0.00,$949.44,"$5,422.50",$0.00,"$2,711.25","$4,294.62","$4,338.00",$0.00,$848.62,$0.00,$863.26,$0.00
HR-D105,SUP,Custom 27203010,,HR-D105  -  BIT DRILL 35MM .109MM PLRS LNG TAP STRL,$147.50,$0.00,$147.50,$0.00,$105.27,$0.00,$0.00,$0.00,$0.00,$0.00,$147.50,$0.00,$73.75,$116.82,$118.00,$0.00,$0.00,$0.00,$0.00,$0.00
HRH-0820-S,SUP,HCPCS C1713,,HRH-0820-S  -  ROD XTRNFX 8MM 200MM STRL PLRS + SPCL,"$4,107.50",$0.00,"$4,107.50","$1,848.38","$2,931.52",$0.00,$707.70,$0.00,$0.00,$719.19,"$4,107.50",$0.00,"$2,053.75","$3,253.14","$3,286.00",$0.00,$642.82,$0.00,$653.91,$0.00
HRH-0822-S,SUP,HCPCS C1713,,HRH-0822-S  -  ROD XTRNFX 8MM 220MM PLRS + HUM PROX,"$4,107.50",$0.00,"$4,107.50","$1,848.38","$2,931.52",$0.00,$707.70,$0.00,$0.00,$719.19,"$4,107.50",$0.00,"$2,053.75","$3,253.14","$3,286.00",$0.00,$642.82,$0.00,$653.91,$0.00
HRH-0824-S,SUP,HCPCS C1713,,HRH-0824-S  -  ROD XTRNFX 8MM 240MM PLRS + SPCL,"$4,107.50",$0.00,"$4,107.50","$1,848.38","$2,931.52",$0.00,$707.70,$0.00,$0.00,$719.19,"$4,107.50",$0.00,"$2,053.75","$3,253.14","$3,286.00",$0.00,$642.82,$0.00,$653.91,$0.00
HRH-0826-S,SUP,HCPCS C1713,,HRH-0826-S  -  ROD XTRNFX 8MM 260MM STRL PLRS + SPCL,"$4,107.50",$0.00,"$4,107.50","$1,848.38","$2,931.52",$0.00,$707.70,$0.00,$0.00,$719.19,"$4,107.50",$0.00,"$2,053.75","$3,253.14","$3,286.00",$0.00,$642.82,$0.00,$653.91,$0.00
HRH-0828-S,SUP,HCPCS C1713,,HRH-0828-S  -  ROD XTRNFX 8MM 280MM NS PLRS + SPCL,"$4,107.50",$0.00,"$4,107.50","$1,848.38","$2,931.52",$0.00,$707.70,$0.00,$0.00,$719.19,"$4,107.50",$0.00,"$2,053.75","$3,253.14","$3,286.00",$0.00,$642.82,$0.00,$653.91,$0.00
HR-L1115-S,SUP,HCPCS C1713,,HR-L1115-S  -  NAIL 11MM 15CM HUM PLRS IM LCK TI STRL,"$4,107.50",$0.00,"$4,107.50","$1,848.38","$2,931.52",$0.00,$707.70,$0.00,$0.00,$719.19,"$4,107.50",$0.00,"$2,053.75","$3,253.14","$3,286.00",$0.00,$642.82,$0.00,$653.91,$0.00
HRSD105,SUP,Custom 27203010,,HRSD105  -  BIT DRILL 2.8MM PLRS SHRT TAP STRL,$95.00,$0.00,$95.00,$0.00,$67.80,$0.00,$0.00,$0.00,$0.00,$0.00,$95.00,$0.00,$47.50,$75.24,$76.00,$0.00,$0.00,$0.00,$0.00,$0.00
HR-WC50-S,SUP,Custom 27203010,,HR-WC50-S  -  WASHER XTRNFX 5MM STRL CIRC CLEATED FIB,$132.50,$0.00,$132.50,$0.00,$94.57,$0.00,$0.00,$0.00,$0.00,$0.00,$132.50,$0.00,$66.25,$104.94,$106.00,$0.00,$0.00,$0.00,$0.00,$0.00
HS007,SUP,Custom 27011340,,HS007  -  SPRT ORTH HALO SSTRC TLSO 14,"$1,860.55",$0.00,"$1,860.55",$0.00,"$1,327.87",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,860.55",$0.00,$930.28,"$1,473.56","$1,488.44",$0.00,$0.00,$0.00,$0.00,$0.00
HS765-010,SUP,HCPCS C1713,,SPACER MDI OPTHLR HLD CHMBR HNDHLD,$13.30,$0.00,$13.30,$5.99,$9.49,$0.00,$2.29,$0.00,$0.00,$2.33,$13.30,$0.00,$6.65,$10.53,$10.64,$0.00,$2.08,$0.00,$2.12,$0.00
HS80010-010,SUP,HCPCS C1713,,SPACER MDI OPTCH ADV VLV HLD CHMBR HNDHLD RPD BRTHG ALRM WO,$8.55,$0.00,$8.55,$3.85,$6.10,$0.00,$1.47,$0.00,$0.00,$1.50,$8.55,$0.00,$4.28,$6.77,$6.84,$0.00,$1.34,$0.00,$1.36,$0.00
HSK-3038,SUP,Custom 27203010,,HSK-3038  -  SYSTEM PROX SL 3.8MM HRTSTR III DLV DEV LDR AOR CTR,"$1,650.00",$0.00,"$1,650.00",$0.00,"$1,177.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,650.00",$0.00,$825.00,"$1,306.80","$1,320.00",$0.00,$0.00,$0.00,$0.00,$0.00
HT036,SUP,Custom 27011340,,HT036  -  HALTER TRC LG HLCRWN VST XTRNFXTR ADLT HDNK,"$1,492.50",$0.00,"$1,492.50",$0.00,"$1,065.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,492.50",$0.00,$746.25,"$1,182.06","$1,194.00",$0.00,$0.00,$0.00,$0.00,$0.00
HT036HI,SUP,Custom 27011340,,HT036HI  -  SET HLCRWN PIN LG SKL TRC,"$1,492.50",$0.00,"$1,492.50",$0.00,"$1,065.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,492.50",$0.00,$746.25,"$1,182.06","$1,194.00",$0.00,$0.00,$0.00,$0.00,$0.00
HT064050A,SUP,HCPCS C1768,,HT064050A  -  GRAFT VASCULAR THIN WALL 6MM 50CM 40CM REMOVABLE RING,"$4,527.50",$0.00,"$4,527.50","$2,037.38","$3,231.28",$0.00,$780.07,$0.00,$0.00,$792.73,"$4,527.50",$0.00,"$2,263.75","$3,585.78","$3,622.00",$0.00,$708.55,$0.00,$720.78,$0.00
HT067090A,SUP,HCPCS C1768,,HT067090A  -  GRAFT VASCULAR THIN WALL 6MM 90CM 70CM REMOVABLE RING,"$7,437.50",$0.00,"$7,437.50","$3,346.88","$5,158.80",$0.00,"$1,281.44",$0.00,$0.00,"$1,302.25","$7,437.50",$0.00,"$3,718.75","$5,890.50","$5,950.00",$0.00,"$1,163.97",$0.00,"$1,184.05",$0.00
HT084050A,SUP,HCPCS C1768,,HT084050A  -  GRAFT VASCULAR THIN WALL 8MM 50CM 40CM REMOVABLE RING,"$4,527.50",$0.00,"$4,527.50","$2,037.38","$3,231.28",$0.00,$780.07,$0.00,$0.00,$792.73,"$4,527.50",$0.00,"$2,263.75","$3,585.78","$3,622.00",$0.00,$708.55,$0.00,$720.78,$0.00
HT087090A,SUP,HCPCS C1768,,HT087090A  -  GRAFT VASCULAR THINWALL 8MM 90CM 70CM REMOVABLE RING STRETCH,"$7,437.50",$0.00,"$7,437.50","$3,346.88","$5,158.80",$0.00,"$1,281.44",$0.00,$0.00,"$1,302.25","$7,437.50",$0.00,"$3,718.75","$5,890.50","$5,950.00",$0.00,"$1,163.97",$0.00,"$1,184.05",$0.00
HT-0915,SUP,Custom 27203010,,HT-0915  -  DRIVER SRG 1.5MM HEX,$470.00,$0.00,$470.00,$0.00,$335.44,$0.00,$0.00,$0.00,$0.00,$0.00,$470.00,$0.00,$235.00,$372.24,$376.00,$0.00,$0.00,$0.00,$0.00,$0.00
HT-1120,SUP,Custom 27203010,,HT-1120  -  DRIVER SRG 2MM HEX,$470.00,$0.00,$470.00,$0.00,$335.44,$0.00,$0.00,$0.00,$0.00,$0.00,$470.00,$0.00,$235.00,$372.24,$376.00,$0.00,$0.00,$0.00,$0.00,$0.00
HT-1725,SUP,Custom 27203010,,HT-1725  -  DRIVER SRG 2.5MM HEX,$470.00,$0.00,$470.00,$0.00,$335.44,$0.00,$0.00,$0.00,$0.00,$0.00,$470.00,$0.00,$235.00,$372.24,$376.00,$0.00,$0.00,$0.00,$0.00,$0.00
HT-2502,SUP,Custom 27203010,,HT-2502  -  TIP SCRDRVR 6IN 2.5MM QRLSE SLD,$277.50,$0.00,$277.50,$0.00,$198.05,$0.00,$0.00,$0.00,$0.00,$0.00,$277.50,$0.00,$138.75,$219.78,$222.00,$0.00,$0.00,$0.00,$0.00,$0.00
HT-3010,SUP,HCPCS C1713,,HT-3010  -  SCREW BN ACUTRAC DRVR CNN TIP,$470.00,$0.00,$470.00,$211.50,$335.44,$0.00,$80.98,$0.00,$0.00,$82.29,$470.00,$0.00,$235.00,$372.24,$376.00,$0.00,$73.56,$0.00,$74.82,$0.00
HT-3012,SUP,Custom 27203010,,HT-3012  -  TIP SCRDRVR 3MM QRLSE SLD HEX,$277.50,$0.00,$277.50,$0.00,$198.05,$0.00,$0.00,$0.00,$0.00,$0.00,$277.50,$0.00,$138.75,$219.78,$222.00,$0.00,$0.00,$0.00,$0.00,$0.00
HT-4000,SUP,Custom 27203010,,HT-4000  -  DRIVER SRG 4MM CNN,$487.50,$0.00,$487.50,$0.00,$347.93,$0.00,$0.00,$0.00,$0.00,$0.00,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$0.00,$0.00,$0.00,$0.00
HT-4001,SUP,Custom 27203010,,HT-4001  -  TIP SCRDRVR 4MM SLD HEX,$277.50,$0.00,$277.50,$0.00,$198.05,$0.00,$0.00,$0.00,$0.00,$0.00,$277.50,$0.00,$138.75,$219.78,$222.00,$0.00,$0.00,$0.00,$0.00,$0.00
HW-0034,SUP,HCPCS C1713,,HW-0034  -  SCREW BN .25IN 8-32IN DRL HNDL SET,$2.50,$0.00,$2.50,$1.13,$1.78,$0.00,$0.43,$0.00,$0.00,$0.44,$2.50,$0.00,$1.25,$1.98,$2.00,$0.00,$0.39,$0.00,$0.40,$0.00
I20,SUP,Custom 27203010,,SENSOR INF OXSNR 2 OXM ADH,$30.80,$0.00,$30.80,$0.00,$21.98,$0.00,$0.00,$0.00,$0.00,$0.00,$30.80,$0.00,$15.40,$24.39,$24.64,$0.00,$0.00,$0.00,$0.00,$0.00
I20-13/C70F,SUP,Custom 27803010,,I20-13/C70F  -  GRAFT STNT STRG 20-13MM 17FR 70MM AFX ACTIVESEAL STRATA SLF,"$8,237.50",$0.00,"$8,237.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,237.50",$0.00,"$4,118.75","$6,524.10","$6,590.00",$0.00,$0.00,$0.00,$0.00,$0.00
I20-13/C88F,SUP,Custom 27803010,,I20-13/C88F  -  GRAFT STNT STRG 20-13MM 17FR 88MM AFX ACTIVESEAL STRATA SLF,"$8,187.50",$0.00,"$8,187.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,187.50",$0.00,"$4,093.75","$6,484.50","$6,550.00",$0.00,$0.00,$0.00,$0.00,$0.00
I20-13/C88F SA,SUP,Custom 27803010,,I20-13/C88F SA  -  GRAFT STNT 20-13MM 88MM STRL LF AFX STRATA ILC LMB AAA,"$8,187.50",$0.00,"$8,187.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,187.50",$0.00,"$4,093.75","$6,484.50","$6,550.00",$0.00,$0.00,$0.00,$0.00,$0.00
I20-20/C55F,SUP,Custom 27803010,,I20-20/C55F  -  GRAFT STNT STRG 20MM 17FR 55MM AFX ACTIVESEAL STRATA SLF,"$6,700.00",$0.00,"$6,700.00",$0.00,"$4,781.79",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,700.00",$0.00,"$3,350.00","$5,306.40","$5,360.00",$0.00,$0.00,$0.00,$0.00,$0.00
IAB05830-LWS,SUP,HCPCS C1714,,IAB05830-LWS  -  CATH IAB .025IN 8FR 25.3IN 6IN GWIRE NYL PU CARDIOTHANE 2,"$3,451.70",$0.00,"$3,451.70","$1,874.27","$2,463.48",$0.00,$594.71,$0.00,$0.00,$604.37,"$3,451.70",$0.00,"$1,725.85","$2,733.75","$2,761.36",$0.00,$540.19,$0.00,$549.51,$0.00
IAB-05830-LWS,SUP,Custom 27203010,,CATHETER IAB 8FR FIBEROPTIX 30ML LF,"$2,560.00",$0.00,"$2,560.00",$0.00,"$1,827.07",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,560.00",$0.00,"$1,280.00","$2,027.52","$2,048.00",$0.00,$0.00,$0.00,$0.00,$0.00
IAB-05840-LWS,SUP,HCPCS C1714,,IAB-05840-LWS  -  CATH IAB .025IN 8FR 27.3IN 6IN GWIRE NYL PU CARDIOTHANE 2,"$3,451.70",$0.00,"$3,451.70","$1,874.27","$2,463.48",$0.00,$594.71,$0.00,$0.00,$604.37,"$3,451.70",$0.00,"$1,725.85","$2,733.75","$2,761.36",$0.00,$540.19,$0.00,$549.51,$0.00
IAB-06830-LWS,SUP,HCPCS C1725,,CATHETER IAB 7.5FR FIBEROPTIX FLXB 30ML LF,"$2,087.50",$0.00,"$2,087.50","$1,133.51","$1,489.85",$0.00,$359.67,$0.00,$0.00,$365.50,"$2,087.50",$0.00,"$1,043.75","$1,653.30","$1,670.00",$0.00,$326.69,$0.00,$332.33,$0.00
IAS5-120LP,SUP,Custom 27203010,,IAS5-120LP  -  PORT ACC 5MM 120MM AIRSEAL 2 WL CNN LOPRFL OBT BLDLS OPTC,$291.67,$0.00,$291.67,$0.00,$208.16,$0.00,$0.00,$0.00,$0.00,$0.00,$291.67,$0.00,$145.83,$231.00,$233.33,$0.00,$0.00,$0.00,$0.00,$0.00
IBI-85641,SUP,Custom 27203010,,IBI-85641  -  CABLE CATH 8FT STRL LF REUSE,$350.00,$0.00,$350.00,$0.00,$249.80,$0.00,$0.00,$0.00,$0.00,$0.00,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$0.00,$0.00,$0.00,$0.00
IBI-85931,SUP,Custom 27203010,,IBI-85931  -  CABLE CATH 150CM INQ 24 PIN CNCT DX,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
IBI-87008,SUP,HCPCS C1731,,IBI-87008  -  CATHETER EP 4MM SPC 7FR 20MM 110CM INQ AFOCUS II 20 ELTRD MP,"$3,800.00",$0.00,"$3,800.00","$2,063.40","$2,712.06",$0.00,$654.72,$0.00,$0.00,$665.35,"$3,800.00",$0.00,"$1,900.00","$3,009.60","$3,040.00",$0.00,$594.70,$0.00,$604.96,$0.00
ICV1102,SUP,HCPCS C1785,,ICV1102  -  PACEMAKER CRD REPLY 2 CHMBR,"$10,500.00",$0.00,"$10,500.00","$4,725.00","$5,158.80",$0.00,"$1,809.10",$0.00,$0.00,"$1,838.47","$10,500.00",$0.00,"$5,250.00","$8,316.00","$8,400.00",$0.00,"$1,643.25",$0.00,"$1,671.60",$0.00
ICV1102 SYSTEM,SUP,HCPCS C1785,,ICV1102 SYSTEM  -  REPLY DR V2  SYSTEM,"$12,500.00",$0.00,"$12,500.00","$5,625.00","$5,158.80",$0.00,"$2,153.69",$0.00,$0.00,"$2,188.65","$12,500.00",$0.00,"$6,250.00","$9,900.00","$10,000.00",$0.00,"$1,956.25",$0.00,"$1,990.00",$0.00
ICV1116,SUP,HCPCS C1786,,ICV1116  -  PACEMAKER CRD ESPRT DR,"$9,125.00",$0.00,"$9,125.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$9,125.00",$0.00,"$4,562.50","$7,227.00","$7,300.00",$0.00,$0.00,$0.00,$0.00,$0.00
ICV1116 SYSTEM,SUP,HCPCS C1785,,ICV1116 SYSTEM  -  ESPRIT DR SYSTEM,"$11,610.00",$0.00,"$11,610.00","$5,224.50","$5,158.80",$0.00,"$2,000.34",$0.00,$0.00,"$2,032.82","$11,610.00",$0.00,"$5,805.00","$9,195.12","$9,288.00",$0.00,"$1,816.97",$0.00,"$1,848.31",$0.00
ICV1122,SUP,HCPCS C1786,,ICV1122  -  PACEMAKER CRD REPLY 1 CHMBR,"$8,250.00",$0.00,"$8,250.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,250.00",$0.00,"$4,125.00","$6,534.00","$6,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
ICV1122 SYSTEM,SUP,HCPCS C1786,,ICV1122 SYSTEM  -  REPLY SR V2 SYSTEM,"$9,500.00",$0.00,"$9,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$9,500.00",$0.00,"$4,750.00","$7,524.00","$7,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
ICV1127,SUP,HCPCS C1786,,ICV1127  -  PACEMAKER CRD ESPRT SR,"$6,962.50",$0.00,"$6,962.50",$0.00,"$4,969.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,962.50",$0.00,"$3,481.25","$5,514.30","$5,570.00",$0.00,$0.00,$0.00,$0.00,$0.00
ICV1127 SYSTEM,SUP,HCPCS C1786,,ICV1127 SYSTEM  -  ESPRIT SR SYSTEM,"$8,205.00",$0.00,"$8,205.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,205.00",$0.00,"$4,102.50","$6,498.36","$6,564.00",$0.00,$0.00,$0.00,$0.00,$0.00
ICV1179,SUP,HCPCS C1882,,ICV1179  -  DEFIBRILLATOR CRD PARADYM CRT ICD,"$44,412.50",$0.00,"$44,412.50","$19,985.63","$5,158.80",$0.00,"$7,652.05",$0.00,$0.00,"$7,776.27","$44,412.50",$0.00,"$22,206.25","$35,174.70","$35,530.00",$0.00,"$6,950.56",$0.00,"$7,070.47",$0.00
ICV1179 SYSTEM,SUP,HCPCS C1882,,ICV1179 SYSTEM  -  PARADYM CRT-D 8750 SYSTEM,"$58,187.50",$0.00,"$58,187.50","$26,184.38","$5,158.80",$0.00,"$8,138.89",$0.00,$0.00,"$8,138.89","$58,187.50",$0.00,"$29,093.75","$46,084.50","$46,550.00",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
ICV1199,SUP,HCPCS C1722,,ICV1199  -  DEFIBRILLATOR CRD PARADYM VR ICD,"$36,575.00",$0.00,"$36,575.00","$16,458.75","$5,158.80",$0.00,"$6,301.69",$0.00,$0.00,"$6,403.99","$36,575.00",$0.00,"$18,287.50","$28,967.40","$29,260.00",$0.00,"$5,723.99",$0.00,"$5,822.74",$0.00
ICV1200,SUP,HCPCS C1721,,ICV1200  -  DEFIBRILLATOR CRD PARADYM DR ICD,"$42,512.50",$0.00,"$42,512.50","$19,130.63","$5,158.80",$0.00,"$7,324.69",$0.00,$0.00,"$7,443.60","$42,512.50",$0.00,"$21,256.25","$33,669.90","$34,010.00",$0.00,"$6,653.21",$0.00,"$6,767.99",$0.00
ICV1258,SUP,HCPCS C1785,,ICV1258  -  REPLY DR,"$9,125.00",$0.00,"$9,125.00","$4,106.25","$5,158.80",$0.00,"$1,572.19",$0.00,$0.00,"$1,597.71","$9,125.00",$0.00,"$4,562.50","$7,227.00","$7,300.00",$0.00,"$1,428.06",$0.00,"$1,452.70",$0.00
ICV1258 SYSTEM,SUP,HCPCS C1785,,ICV1258 SYSTEM  -  REPLY DR SYSTEM,"$11,610.00",$0.00,"$11,610.00","$5,224.50","$5,158.80",$0.00,"$2,000.34",$0.00,$0.00,"$2,032.82","$11,610.00",$0.00,"$5,805.00","$9,195.12","$9,288.00",$0.00,"$1,816.97",$0.00,"$1,848.31",$0.00
ID-1-5,SUP,Custom 27203010,,ID-1-5  -  ACTU PNEUM LRS AXIUM 3D DTCH HLCL,$134.50,$0.00,$134.50,$0.00,$95.99,$0.00,$0.00,$0.00,$0.00,$0.00,$134.50,$0.00,$67.25,$106.52,$107.60,$0.00,$0.00,$0.00,$0.00,$0.00
ID3305,SUP,Custom 27803010,,ID3305  -  GRAFT SOFT TISSUE 3X3IN PATCH RESORB SUTURABLE DURAGEN,"$2,255.70",$0.00,"$2,255.70",$0.00,"$1,609.89",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,255.70",$0.00,"$1,127.85","$1,786.51","$1,804.56",$0.00,$0.00,$0.00,$0.00,$0.00
IJ27U,SUP,HCPCS C1898,,IJ27U  -  LEAD PACING 58CM ACTIVE FIX ISOLINE,"$10,000.00",$0.00,"$10,000.00","$4,500.00","$5,158.80",$0.00,"$1,722.95",$0.00,$0.00,"$1,750.92","$10,000.00",$0.00,"$5,000.00","$7,920.00","$8,000.00",$0.00,"$1,565.00",$0.00,"$1,592.00",$0.00
IM3ST,SUP,Custom 27803010,,IM3ST  -  BRAIN TISSUE MONITERING KIT,"$3,115.00",$0.00,"$3,115.00",$0.00,"$2,223.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,115.00",$0.00,"$1,557.50","$2,467.08","$2,492.00",$0.00,$0.00,$0.00,$0.00,$0.00
INS5010,SUP,HCPCS C1729,,INS5010  -  CATHETER DRN 1.5MM .7MM 80CM STRL LF HRMTC TUO CLS TIP LL,$568.05,$0.00,$568.05,$308.45,$405.42,$0.00,$97.87,$0.00,$0.00,$99.46,$568.05,$0.00,$284.03,$449.90,$454.44,$0.00,$88.90,$0.00,$90.43,$0.00
INS8401,SUP,Custom 27803010,,INS8401  -  SYSTEM DRN 35CM 700ML BLU STRL LF BE2 MNTR TRNDCR ATCH VNTRC,$980.00,$0.00,$980.00,$0.00,$699.43,$0.00,$0.00,$0.00,$0.00,$0.00,$980.00,$0.00,$490.00,$776.16,$784.00,$0.00,$0.00,$0.00,$0.00,$0.00
INS-8420,SUP,Custom 27803010,,INS-8420  -  KIT XTRN DRN 1.9MM VNTRC,$361.25,$0.00,$361.25,$0.00,$257.82,$0.00,$0.00,$0.00,$0.00,$0.00,$361.25,$0.00,$180.63,$286.11,$289.00,$0.00,$0.00,$0.00,$0.00,$0.00
INS8700,SUP,Custom 27011340,,INS8700  -  BAG XTRN DRN 700ML EDS 3 CSF CLT,$787.50,$0.00,$787.50,$0.00,$562.04,$0.00,$0.00,$0.00,$0.00,$0.00,$787.50,$0.00,$393.75,$623.70,$630.00,$0.00,$0.00,$0.00,$0.00,$0.00
INSHITHRZN,SUP,Custom 27803010,,INSHITHRZN  -  KIT CRNTMY 25GA 5/8IN STRL RZR NDL DRP,$700.60,$0.00,$700.60,$0.00,$500.02,$0.00,$0.00,$0.00,$0.00,$0.00,$700.60,$0.00,$350.30,$554.88,$560.48,$0.00,$0.00,$0.00,$0.00,$0.00
INT-105-19,SUP,HCPCS C1894,,INT-105-19  -  INTRODUCER SHTH 16FR 15CM PTFE,$52.50,$0.00,$52.50,$28.51,$37.47,$0.00,$9.05,$0.00,$0.00,$9.19,$52.50,$0.00,$26.25,$41.58,$42.00,$0.00,$8.22,$0.00,$8.36,$0.00
INT-105-45,SUP,HCPCS C1894,,INT-105-45  -  INTRODUCER TEAR AWAY 120F X 30CM,$125.00,$0.00,$125.00,$67.88,$89.21,$0.00,$21.54,$0.00,$0.00,$21.89,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$19.56,$0.00,$19.90,$0.00
INT22508UX,SUP,HCPCS C1876,,STENT METAL BARE INT22508UX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
INT22512UX,SUP,HCPCS C1876,,INT22512UX  -  SYSTEM COR STNT 2.25MM 12MM INTGR MICROTRAC RX 1 STRN INTGR,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
INT22514UX,SUP,HCPCS C1876,,STENT METAL BARE INT22514UX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
INT22518UX,SUP,HCPCS C1876,,STENT METAL BARE INT22518UX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
INT22522UX,SUP,HCPCS C1874,,INT22522UX  -  SYSTEM COR STNT 2.25MM 22MM INTGR MICROTRAC RX 1 STRN INTGR,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
INT22526UX,SUP,HCPCS C1874,,INT22526UX  -  SYSTEM COR STNT 2.25MM 26MM INTGR MICROTRAC RX 1 STRN INTGR,"$1,625.00",$0.00,"$1,625.00",$731.25,"$1,159.76",$0.00,$279.98,$0.00,$0.00,$284.52,"$1,625.00",$0.00,$812.50,"$1,287.00","$1,300.00",$0.00,$254.31,$0.00,$258.70,$0.00
INT25008UX,SUP,HCPCS C1877,,INT25008UX  -  SYSTEM COR STNT 2.5MM 8MM INTGR MICROTRAC RX 1 STRN INTGR,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
INT25012UX,SUP,HCPCS C1874,,INT25012UX  -  SYSTEM COR STNT 2.5MM 12MM INTGR MICROTRAC RX 1 STRN INTGR,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
INT25014UX,SUP,HCPCS C1874,,INT25014UX  -  SYSTEM COR STNT 2.5MM 14MM INTGR MICROTRAC RX 1 STRN INTGR,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
INT25018UX,SUP,HCPCS C1876,,STENT METAL BARE INT25018UX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
INT25022UX,SUP,HCPCS C1874,,INT25022UX  -  SYSTEM COR STNT 2.5MM 22MM INTGR MICROTRAC RX 1 STRN INTGR,"$1,625.00",$0.00,"$1,625.00",$731.25,"$1,159.76",$0.00,$279.98,$0.00,$0.00,$284.52,"$1,625.00",$0.00,$812.50,"$1,287.00","$1,300.00",$0.00,$254.31,$0.00,$258.70,$0.00
INT25026UX,SUP,HCPCS C1874,,INT25026UX  -  SYSTEM COR STNT 2.5MM 26MM INTGR MICROTRAC RX 1 STRN INTGR,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
INT27508UX,SUP,HCPCS C1874,,INT27508UX  -  SYSTEM COR STNT 2.75MM 8MM INTGR MICROTRAC RX 1 STRN INTGR,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
INT27512UX,SUP,HCPCS C1874,,INT27512UX  -  SYSTEM COR STNT 2.75MM 12MM INTGR MICROTRAC RX 1 STRN INTGR,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
INT27514UX,SUP,HCPCS C1874,,INT27514UX  -  SYSTEM COR STNT 2.75MM 14MM INTGR MICROTRAC RX 1 STRN INTGR,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
INT27518UX,SUP,HCPCS C1874,,INT27518UX  -  SYSTEM COR STNT 2.75MM 18MM INTGR MICROTRAC RX 1 STRN INTGR,"$1,625.00",$0.00,"$1,625.00",$731.25,"$1,159.76",$0.00,$279.98,$0.00,$0.00,$284.52,"$1,625.00",$0.00,$812.50,"$1,287.00","$1,300.00",$0.00,$254.31,$0.00,$258.70,$0.00
INT27526UX,SUP,HCPCS C1876,,INT27526UX  -  STENT CORON 2.75MM 26MM 1 STRN RAPEX SINUSOID OPTM,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
INT30009UX,SUP,HCPCS C1876,,INT30009UX  -  SYSTEM COR STNT 3MM 9MM INTGR MICROTRAC RX 1 STRN INTGR TIP,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
INT30012UX,SUP,HCPCS C1874,,INT30012UX  -  SYSTEM COR STNT 3MM 12MM INTGR MICROTRAC RX 1 STRN INTGR TIP,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
INT30018UX,SUP,HCPCS C1874,,INT30018UX  -  SYSTEM COR STNT 3MM 18MM INTGR MICROTRAC RX 1 STRN INTGR TIP,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
INT30022UX,SUP,HCPCS C1874,,INT30022UX  -  SYSTEM COR STNT 3MM 22MM INTGR MICROTRAC RX 1 STRN INTGR TIP,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
INT30026UX,SUP,HCPCS C1874,,INT30026UX  -  SYSTEM COR STNT 3MM 26MM INTGR MICROTRAC RX 1 STRN INTGR TIP,"$1,625.00",$0.00,"$1,625.00",$731.25,"$1,159.76",$0.00,$279.98,$0.00,$0.00,$284.52,"$1,625.00",$0.00,$812.50,"$1,287.00","$1,300.00",$0.00,$254.31,$0.00,$258.70,$0.00
INT30030UX,SUP,HCPCS C1876,,STENT METAL BARE INT30030UX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
INT35009UX,SUP,HCPCS C1876,,STENT METAL BARE INT35009UX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
INT35012UX,SUP,HCPCS C1876,,STENT METAL BARE INT35012UX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
INT35015UX,SUP,HCPCS C1876,,STENT METAL BARE INT35015UX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
INT35018UX,SUP,HCPCS C1876,,STENT METAL BARE INT35018UX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
INT35022UX,SUP,HCPCS C1876,,STENT METAL BARE INT35022UX,"$2,000.00",$0.00,"$2,000.00",$900.00,"$1,427.40",$0.00,$344.59,$0.00,$0.00,$350.18,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$313.00,$0.00,$318.40,$0.00
INT35026UX,SUP,HCPCS C1874,,INT35026UX  -  SYSTEM COR STNT 3.5MM 26MM INTGR MICROTRAC RX 1 STRN INTGR,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
INT35030UX,SUP,HCPCS C1874,,INT35030UX  -  SYSTEM COR STNT 3.5MM 30MM INTGR MICROTRAC RX 1 STRN INTGR,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
INT40009UX,SUP,HCPCS C1874,,INT40009UX  -  SYSTEM COR STNT 4MM 9MM INTGR MICROTRAC RX 1 STRN INTGR TIP,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
INT40012UX,SUP,HCPCS C1876,,INT40012UX  -  SYSTEM COR STNT 4MM 12MM INTGR MICROTRAC RX 1 STRN INTGR TIP,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
INT40015UX,SUP,HCPCS C1874,,INT40015UX  -  SYSTEM COR STNT 4MM 15MM INTGR MICROTRAC RX 1 STRN INTGR TIP,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
INT40018UX,SUP,HCPCS C1874,,INT40018UX  -  SYSTEM COR STNT 4MM 18MM INTGR MICROTRAC RX 1 STRN INTGR TIP,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
INT40022UX,SUP,HCPCS C1874,,INT40022UX  -  SYSTEM COR STNT 4MM 22MM INTGR MICROTRAC RX 1 STRN INTGR TIP,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
INT40026UX,SUP,HCPCS C1874,,INT40026UX  -  SYSTEM COR STNT 4MM 26MM INTGR MICROTRAC RX 1 STRN INTGR TIP,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
INT40030UX,SUP,HCPCS C1874,,INT40030UX  -  SYSTEM COR STNT 4MM 30MM INTGR MICROTRAC RX 1 STRN INTGR TIP,"$1,750.00",$0.00,"$1,750.00",$787.50,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
IPC-5000E,SUP,Custom 27203010,,IPC-5000E  -  CATHETER PRESSURE 3.5MM 5MM 82CM 2CM SENSOR TIP EXTERNAL,$57.73,$0.00,$57.73,$0.00,$41.20,$0.00,$0.00,$0.00,$0.00,$0.00,$57.73,$0.00,$28.86,$45.72,$46.18,$0.00,$0.00,$0.00,$0.00,$0.00
IRC115,SUP,Custom 27203010,,IRC115  -  CONSOLE LEGEND EHS IRRIGATION,"$4,710.00",$0.00,"$4,710.00",$0.00,"$3,361.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,710.00",$0.00,"$2,355.00","$3,730.32","$3,768.00",$0.00,$0.00,$0.00,$0.00,$0.00
IRC230,SUP,Custom 27203010,,IRC230  -  CONSOLE LEGEND IRRIGATION EHS EU,"$4,710.00",$0.00,"$4,710.00",$0.00,"$3,361.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,710.00",$0.00,"$2,355.00","$3,730.32","$3,768.00",$0.00,$0.00,$0.00,$0.00,$0.00
IRC400,SUP,Custom 27203010,,IRC400  -  CABLE SIGNAL IRRIGATION SYSTEM,$254.00,$0.00,$254.00,$0.00,$181.28,$0.00,$0.00,$0.00,$0.00,$0.00,$254.00,$0.00,$127.00,$201.17,$203.20,$0.00,$0.00,$0.00,$0.00,$0.00
IRC500,SUP,Custom 27203010,,IRC500  -  IV POLE IRC500  EHS IRRIGATION SYSTEM,$218.00,$0.00,$218.00,$0.00,$155.59,$0.00,$0.00,$0.00,$0.00,$0.00,$218.00,$0.00,$109.00,$172.66,$174.40,$0.00,$0.00,$0.00,$0.00,$0.00
IRD200,SUP,Custom 27203010,,IRD200  -  DISPOSABLE IRD200 IRRIGATION CONTROL,$162.00,$0.00,$162.00,$0.00,$115.62,$0.00,$0.00,$0.00,$0.00,$0.00,$162.00,$0.00,$81.00,$128.30,$129.60,$0.00,$0.00,$0.00,$0.00,$0.00
IRD250,SUP,Custom 27203010,,IRD250  -  DISPOSABLE IRD250 IRRIGATION TUBING SET,$200.00,$0.00,$200.00,$0.00,$142.74,$0.00,$0.00,$0.00,$0.00,$0.00,$200.00,$0.00,$100.00,$158.40,$160.00,$0.00,$0.00,$0.00,$0.00,$0.00
IRD300,SUP,Custom 27203010,,IRD300  -  TUBING IRRIGATION MIDAS REX LEGEND EHS DISPOSABLE,$196.40,$0.00,$196.40,$0.00,$140.17,$0.00,$0.00,$0.00,$0.00,$0.00,$196.40,$0.00,$98.20,$155.55,$157.12,$0.00,$0.00,$0.00,$0.00,$0.00
IRD350,SUP,Custom 27203010,,IRD350  -  TUBING IRRIGATION BURR TRANSNASAL,$322.00,$0.00,$322.00,$0.00,$229.81,$0.00,$0.00,$0.00,$0.00,$0.00,$322.00,$0.00,$161.00,$255.02,$257.60,$0.00,$0.00,$0.00,$0.00,$0.00
IST2,SUP,Custom 27203010,,"IST2  -  INDIGO SYSTEM, ASPIRATION TUBING",$912.50,$0.00,$912.50,$0.00,$651.25,$0.00,$0.00,$0.00,$0.00,$0.00,$912.50,$0.00,$456.25,$722.70,$730.00,$0.00,$0.00,$0.00,$0.00,$0.00
J3053-20,SUP,Custom 27203010,,INDICATOR ANAER GSPK DISP,$90.98,$0.00,$90.98,$0.00,$64.93,$0.00,$0.00,$0.00,$0.00,$0.00,$90.98,$0.00,$45.49,$72.06,$72.78,$0.00,$0.00,$0.00,$0.00,$0.00
J3053-21,SUP,Custom 27203010,,INDICATOR ANAER DRY STRP GSPK,$107.10,$0.00,$107.10,$0.00,$76.44,$0.00,$0.00,$0.00,$0.00,$0.00,$107.10,$0.00,$53.55,$84.82,$85.68,$0.00,$0.00,$0.00,$0.00,$0.00
J408G,SUP,Custom 27203010,,J408G  -  SUTURE VCL 8-0 5-130-4 9IN BRAID COAT VIOL ABS,$48.93,$0.00,$48.93,$0.00,$34.92,$0.00,$0.00,$0.00,$0.00,$0.00,$48.93,$0.00,$24.47,$38.75,$39.15,$0.00,$0.00,$0.00,$0.00,$0.00
J494H,SUP,Custom 27203010,,J494H  -  SUTURE ABSORBABLE 4-0 P-3 18IN BRAID COATED VICRYL MULTIPASS,$417.55,$0.00,$417.55,$0.00,$298.00,$0.00,$0.00,$0.00,$0.00,$0.00,$417.55,$0.00,$208.77,$330.70,$334.04,$0.00,$0.00,$0.00,$0.00,$0.00
J546G,SUP,Custom 27203010,,J546G  -  SUTURE ABS 7-0 TG140-8 18IN VIOL VC MCRPT 2 ARM BRD COAT,$36.09,$0.00,$36.09,$0.00,$25.76,$0.00,$0.00,$0.00,$0.00,$0.00,$36.09,$0.00,$18.05,$28.58,$28.87,$0.00,$0.00,$0.00,$0.00,$0.00
J548G,SUP,Custom 27203010,,J548G  -  SUTURE ABSORBABLE 8-0 TG140-8 12IN 2 ARM BRAID COATED VICRYL,$36.59,$0.00,$36.59,$0.00,$26.12,$0.00,$0.00,$0.00,$0.00,$0.00,$36.59,$0.00,$18.30,$28.98,$29.27,$0.00,$0.00,$0.00,$0.00,$0.00
J555G,SUP,Custom 27203010,,J555G  -  SUTURE ABS 6-0 S-29 18IN VIOL VC SBRLC 2 ARM BRD COAT,$37.76,$0.00,$37.76,$0.00,$26.95,$0.00,$0.00,$0.00,$0.00,$0.00,$37.76,$0.00,$18.88,$29.91,$30.21,$0.00,$0.00,$0.00,$0.00,$0.00
J570G,SUP,Custom 27203010,,J570G  -  SUTURE ABSORBABLE 6-0 S-14 18IN 2 ARM BRAID COATED VICRYL,$37.85,$0.00,$37.85,$0.00,$27.01,$0.00,$0.00,$0.00,$0.00,$0.00,$37.85,$0.00,$18.92,$29.98,$30.28,$0.00,$0.00,$0.00,$0.00,$0.00
J6054-0610,SUP,HCPCS C1776,,J6054-0610  -  SYSTEM THR SCRFT+ 6-10,"$7,204.00",$0.00,"$7,204.00","$3,241.80","$5,141.49",$0.00,"$1,241.21",$0.00,$0.00,"$1,261.36","$7,204.00",$0.00,"$3,602.00","$5,705.57","$5,763.20",$0.00,"$1,127.43",$0.00,"$1,146.88",$0.00
J6054-0711,SUP,HCPCS C1776,,J6054-0711  -  STEM FEM 130MM 11MM PRIM SECFIT PLUS HYDRXAPT 7 HIP,"$6,865.00",$0.00,"$6,865.00","$3,089.25","$4,899.55",$0.00,"$1,182.81",$0.00,$0.00,"$1,202.01","$6,865.00",$0.00,"$3,432.50","$5,437.08","$5,492.00",$0.00,"$1,074.37",$0.00,"$1,092.91",$0.00
J6054-0713,SUP,HCPCS C1776,,J6054-0713  -  STEM FEM 130MM 13MM PRIM SECFIT PLUS HYDRXAPT 7 HIP,"$6,865.00",$0.00,"$6,865.00","$3,089.25","$4,899.55",$0.00,"$1,182.81",$0.00,$0.00,"$1,202.01","$6,865.00",$0.00,"$3,432.50","$5,437.08","$5,492.00",$0.00,"$1,074.37",$0.00,"$1,092.91",$0.00
J6054-0812,SUP,HCPCS C1776,,J6054-0812  -  STEM FEM 130MM 12MM PRIM SECFIT PLUS HYDRXAPT 8 HIP,"$6,865.00",$0.00,"$6,865.00","$3,089.25","$4,899.55",$0.00,"$1,182.81",$0.00,$0.00,"$1,202.01","$6,865.00",$0.00,"$3,432.50","$5,437.08","$5,492.00",$0.00,"$1,074.37",$0.00,"$1,092.91",$0.00
J6054-0814,SUP,HCPCS C1776,,J6054-0814  -  STEM FEM 130MM 14MM PRIM SECFIT PLUS HYDRXAPT 8 HIP,"$6,865.00",$0.00,"$6,865.00","$3,089.25","$4,899.55",$0.00,"$1,182.81",$0.00,$0.00,"$1,202.01","$6,865.00",$0.00,"$3,432.50","$5,437.08","$5,492.00",$0.00,"$1,074.37",$0.00,"$1,092.91",$0.00
J6054-0913,SUP,HCPCS C1776,,J6054-0913  -  STEM FEM 130MM 13MM PRIM SECFIT PLUS HYDRXAPT 9 HIP,"$6,865.00",$0.00,"$6,865.00","$3,089.25","$4,899.55",$0.00,"$1,182.81",$0.00,$0.00,"$1,202.01","$6,865.00",$0.00,"$3,432.50","$5,437.08","$5,492.00",$0.00,"$1,074.37",$0.00,"$1,092.91",$0.00
J6054-0915,SUP,HCPCS C1776,,J6054-0915  -  STEM FEM 130MM 15MM PRIM SECFIT PLUS HYDRXAPT 9 HIP,"$6,865.00",$0.00,"$6,865.00","$3,089.25","$4,899.55",$0.00,"$1,182.81",$0.00,$0.00,"$1,202.01","$6,865.00",$0.00,"$3,432.50","$5,437.08","$5,492.00",$0.00,"$1,074.37",$0.00,"$1,092.91",$0.00
J6054-1014,SUP,HCPCS C1776,,J6054-1014  -  STEM FEM 130MM 14MM PRIM SECFIT PLUS HYDRXAPT 10 HIP,"$6,865.00",$0.00,"$6,865.00","$3,089.25","$4,899.55",$0.00,"$1,182.81",$0.00,$0.00,"$1,202.01","$6,865.00",$0.00,"$3,432.50","$5,437.08","$5,492.00",$0.00,"$1,074.37",$0.00,"$1,092.91",$0.00
J6054-1016,SUP,HCPCS C1776,,J6054-1016  -  STEM FEM 130MM 16MM PRIM SECFIT PLUS HYDRXAPT 10 HIP,"$6,865.00",$0.00,"$6,865.00","$3,089.25","$4,899.55",$0.00,"$1,182.81",$0.00,$0.00,"$1,202.01","$6,865.00",$0.00,"$3,432.50","$5,437.08","$5,492.00",$0.00,"$1,074.37",$0.00,"$1,092.91",$0.00
J6054-1115,SUP,HCPCS C1776,,J6054-1115  -  STEM FEM 170MM 15MM PRIM SECFIT PLUS HYDRXAPT 11 HIP,"$6,865.00",$0.00,"$6,865.00","$3,089.25","$4,899.55",$0.00,"$1,182.81",$0.00,$0.00,"$1,202.01","$6,865.00",$0.00,"$3,432.50","$5,437.08","$5,492.00",$0.00,"$1,074.37",$0.00,"$1,092.91",$0.00
J6054-1117,SUP,HCPCS C1776,,J6054-1117  -  STEM FEM 170MM 17MM PRIM SECFIT PLUS HYDRXAPT 11 HIP,"$6,865.00",$0.00,"$6,865.00","$3,089.25","$4,899.55",$0.00,"$1,182.81",$0.00,$0.00,"$1,202.01","$6,865.00",$0.00,"$3,432.50","$5,437.08","$5,492.00",$0.00,"$1,074.37",$0.00,"$1,092.91",$0.00
J6054-1216,SUP,HCPCS C1776,,J6054-1216  -  STEM FEM 170MM 16MM PRIM SECFIT PLUS HYDRXAPT 12 HIP,"$6,865.00",$0.00,"$6,865.00","$3,089.25","$4,899.55",$0.00,"$1,182.81",$0.00,$0.00,"$1,202.01","$6,865.00",$0.00,"$3,432.50","$5,437.08","$5,492.00",$0.00,"$1,074.37",$0.00,"$1,092.91",$0.00
J634H,SUP,Custom 27203010,,J634H  -  SUTURE ABS VIOL 18IN VCL 3-0 TIE BRAID COAT,$5.29,$0.00,$5.29,$0.00,$3.78,$0.00,$0.00,$0.00,$0.00,$0.00,$5.29,$0.00,$2.65,$4.19,$4.23,$0.00,$0.00,$0.00,$0.00,$0.00
J671G,SUP,Custom 27203010,,J671G  -  SUTURE ABSORBABLE 5-0 S-14 18IN 2 ARM BRAID COATED VICRYL,$31.41,$0.00,$31.41,$0.00,$22.42,$0.00,$0.00,$0.00,$0.00,$0.00,$31.41,$0.00,$15.71,$24.88,$25.13,$0.00,$0.00,$0.00,$0.00,$0.00
J726D,SUP,Custom 27203010,,J726D  -  SUTURE VCL 2-0 CT2 8-18IN CR BRAID COAT VIOL ABS,$47.20,$0.00,$47.20,$0.00,$33.69,$0.00,$0.00,$0.00,$0.00,$0.00,$47.20,$0.00,$23.60,$37.38,$37.76,$0.00,$0.00,$0.00,$0.00,$0.00
J727D,SUP,Custom 27203010,,J727D  -  SUTURE ABSORBABLE 0 CT-2 8-18IN TAPER POINT BRAID 8 STRAND,$30.34,$0.00,$30.34,$0.00,$21.65,$0.00,$0.00,$0.00,$0.00,$0.00,$30.34,$0.00,$15.17,$24.03,$24.27,$0.00,$0.00,$0.00,$0.00,$0.00
J739D,SUP,Custom 27203010,,J739D  -  SUTURE ABSORBABLE 2-0 CT-1 18IN CONTROL RELEASE BRAIDED 8,$30.30,$0.00,$30.30,$0.00,$21.63,$0.00,$0.00,$0.00,$0.00,$0.00,$30.30,$0.00,$15.15,$24.00,$24.24,$0.00,$0.00,$0.00,$0.00,$0.00
J740D,SUP,Custom 27203010,,J740D  -  SUTURE ABSORBABLE 0 CT-1 18IN CONTROL RELEASE BRAID 8 STRAND,$30.41,$0.00,$30.41,$0.00,$21.70,$0.00,$0.00,$0.00,$0.00,$0.00,$30.41,$0.00,$15.20,$24.08,$24.33,$0.00,$0.00,$0.00,$0.00,$0.00
J741D,SUP,Custom 27203010,,J741D  -  SUTURE ABSORBABLE 1 CT-1 18IN CONTROL RELEASE BRAID 8 STRAND,$361.24,$0.00,$361.24,$0.00,$257.82,$0.00,$0.00,$0.00,$0.00,$0.00,$361.24,$0.00,$180.62,$286.10,$288.99,$0.00,$0.00,$0.00,$0.00,$0.00
J754T CR,SUP,Custom 27203010,,J754T CR  -  NEEDLE 0 VICRYL 18 OS-6,$465.23,$0.00,$465.23,$0.00,$332.03,$0.00,$0.00,$0.00,$0.00,$0.00,$465.23,$0.00,$232.61,$368.46,$372.18,$0.00,$0.00,$0.00,$0.00,$0.00
J761D,SUP,Custom 27203010,,J761D  -  SUTURE ABSORBABLE 3-0 CP-2 18IN CONTROL RELEASE BRAID 8,$37.86,$0.00,$37.86,$0.00,$27.02,$0.00,$0.00,$0.00,$0.00,$0.00,$37.86,$0.00,$18.93,$29.99,$30.29,$0.00,$0.00,$0.00,$0.00,$0.00
J762D,SUP,Custom 27203010,,J762D  -  SUTURE ABSORBABLE 2-0 CP-2 18IN CONTROL RELEASE BRAID 8,$36.98,$0.00,$36.98,$0.00,$26.39,$0.00,$0.00,$0.00,$0.00,$0.00,$36.98,$0.00,$18.49,$29.29,$29.58,$0.00,$0.00,$0.00,$0.00,$0.00
J764D,SUP,Custom 27203010,,J764D  -  SUTURE ABSORBABLE 0 CTX 18IN CONTROL RELEASE BRAID 8 STRAND,$30.27,$0.00,$30.27,$0.00,$21.60,$0.00,$0.00,$0.00,$0.00,$0.00,$30.27,$0.00,$15.14,$23.97,$24.22,$0.00,$0.00,$0.00,$0.00,$0.00
J765D,SUP,Custom 27203010,,J765D  -  SUTURE ABSORBABLE 1 CTX 18IN CONTROL RELEASE BRAID 8 STRAND,$30.27,$0.00,$30.27,$0.00,$21.60,$0.00,$0.00,$0.00,$0.00,$0.00,$30.27,$0.00,$15.14,$23.97,$24.22,$0.00,$0.00,$0.00,$0.00,$0.00
J774D,SUP,Custom 27203010,,J774D  -  SUTURE ABS 3-0 SH 18IN VIOL VCL CR BRD 8 STRN COAT,$29.89,$0.00,$29.89,$0.00,$21.33,$0.00,$0.00,$0.00,$0.00,$0.00,$29.89,$0.00,$14.94,$23.67,$23.91,$0.00,$0.00,$0.00,$0.00,$0.00
J775D,SUP,Custom 27203010,,J775D  -  SUTURE ABS 2-0 SH 18IN VIOL VCL CR BRD 8 STRN COAT,$29.26,$0.00,$29.26,$0.00,$20.88,$0.00,$0.00,$0.00,$0.00,$0.00,$29.26,$0.00,$14.63,$23.17,$23.40,$0.00,$0.00,$0.00,$0.00,$0.00
J790D,SUP,Custom 27203010,,J790D  -  SUTURE ABSORBABLE 3-0 X-1 18IN CONTROL RELEASE BRAID 8,$44.34,$0.00,$44.34,$0.00,$31.64,$0.00,$0.00,$0.00,$0.00,$0.00,$44.34,$0.00,$22.17,$35.12,$35.47,$0.00,$0.00,$0.00,$0.00,$0.00
J840D,SUP,Custom 27203010,,J840D  -  SUTURE ABSORBABLE 0 CT-1 18IN CONTROL RELEASE BRAID 8 STRAND,$30.47,$0.00,$30.47,$0.00,$21.75,$0.00,$0.00,$0.00,$0.00,$0.00,$30.47,$0.00,$15.24,$24.13,$24.38,$0.00,$0.00,$0.00,$0.00,$0.00
J841D,SUP,Custom 27203010,,J841D  -  SUTURE ABSORBABLE 1 CT-1 18IN CONTROL RELEASE BRAID 8 STRAND,$30.24,$0.00,$30.24,$0.00,$21.58,$0.00,$0.00,$0.00,$0.00,$0.00,$30.24,$0.00,$15.12,$23.95,$24.19,$0.00,$0.00,$0.00,$0.00,$0.00
J841D CR,SUP,Custom 27203010,,J841D CR  -  NEEDLE 1VICRYL 18 CT1,$355.23,$0.00,$355.23,$0.00,$253.52,$0.00,$0.00,$0.00,$0.00,$0.00,$355.23,$0.00,$177.61,$281.34,$284.18,$0.00,$0.00,$0.00,$0.00,$0.00
J864D,SUP,Custom 27203010,,J864D  -  SUTURE ABS 3-0 SH 18IN UD VCL CR BRD 8 STRN COAT,$366.49,$0.00,$366.49,$0.00,$261.56,$0.00,$0.00,$0.00,$0.00,$0.00,$366.49,$0.00,$183.25,$290.26,$293.19,$0.00,$0.00,$0.00,$0.00,$0.00
JA-DLVT35L,SUP,Custom 27203010,,JA-DLVT35L  -  TUBE VIVASIGHT DL DOUBLE LUMEN ENDOTRACHEAL 35 FR LEFT SIDED,$442.50,$0.00,$442.50,$0.00,$315.81,$0.00,$0.00,$0.00,$0.00,$0.00,$442.50,$0.00,$221.25,$350.46,$354.00,$0.00,$0.00,$0.00,$0.00,$0.00
JA-DLVT37L,SUP,Custom 27203010,,JA-DLVT37L  -  TUBE VIVASIGHT DL DOUBLE LUMEN ENDOTRACHEAL 37 FR LEFT SIDED,$442.50,$0.00,$442.50,$0.00,$315.81,$0.00,$0.00,$0.00,$0.00,$0.00,$442.50,$0.00,$221.25,$350.46,$354.00,$0.00,$0.00,$0.00,$0.00,$0.00
JA-DLVT39L,SUP,Custom 27203010,,JA-DLVT39L  -  TUBE VIVASIGHT DL DOUBLE LUMEN ENDOTRACHEAL 39 FR LEFT SIDED,$442.50,$0.00,$442.50,$0.00,$315.81,$0.00,$0.00,$0.00,$0.00,$0.00,$442.50,$0.00,$221.25,$350.46,$354.00,$0.00,$0.00,$0.00,$0.00,$0.00
JA-DLVT41L,SUP,Custom 27203010,,JA-DLVT41L  -  TUBE VIVASIGHT DL DOUBLE LUMEN ENDOTRACHEAL 41 FR LEFT SIDED,$442.50,$0.00,$442.50,$0.00,$315.81,$0.00,$0.00,$0.00,$0.00,$0.00,$442.50,$0.00,$221.25,$350.46,$354.00,$0.00,$0.00,$0.00,$0.00,$0.00
JA-TVT70100,SUP,Custom 27203010,,JA-TVT70100  -  TUBE ENDOTRACHEAL VIVASIGHT SL SINGLE LUMEN 7.0MM,$302.50,$0.00,$302.50,$0.00,$215.89,$0.00,$0.00,$0.00,$0.00,$0.00,$302.50,$0.00,$151.25,$239.58,$242.00,$0.00,$0.00,$0.00,$0.00,$0.00
JA-TVT75105,SUP,Custom 27203010,,JA-TVT75105  -  TUBE ENDOTRACHEAL VIVASIGHT SL SINGLE LUMEN 7.5MM,$302.50,$0.00,$302.50,$0.00,$215.89,$0.00,$0.00,$0.00,$0.00,$0.00,$302.50,$0.00,$151.25,$239.58,$242.00,$0.00,$0.00,$0.00,$0.00,$0.00
JA-TVT80110,SUP,Custom 27203010,,JA-TVT80110  -  TUBE ENDOTRACHEAL VIVASIGHT SL SINGLE LUMEN 8.0MM,$302.50,$0.00,$302.50,$0.00,$215.89,$0.00,$0.00,$0.00,$0.00,$0.00,$302.50,$0.00,$151.25,$239.58,$242.00,$0.00,$0.00,$0.00,$0.00,$0.00
JB840,SUP,Custom 27203010,,JB840  -  SUTURE ABS 0 CTB-1 18IN UD VCL ETHGRD CR BRD 8 STRN COAT,$38.09,$0.00,$38.09,$0.00,$27.18,$0.00,$0.00,$0.00,$0.00,$0.00,$38.09,$0.00,$19.04,$30.17,$30.47,$0.00,$0.00,$0.00,$0.00,$0.00
JCDS-1618-EDS-HC,SUP,Custom 27203010,,SET DILATOR 16 AND 18 FR,$427.50,$0.00,$427.50,$0.00,$305.11,$0.00,$0.00,$0.00,$0.00,$0.00,$427.50,$0.00,$213.75,$338.58,$342.00,$0.00,$0.00,$0.00,$0.00,$0.00
JCDS-2022-EDS-HC,SUP,Custom 27203010,,SET DILATOR 20 AND 22 FR,$427.50,$0.00,$427.50,$0.00,$305.11,$0.00,$0.00,$0.00,$0.00,$0.00,$427.50,$0.00,$213.75,$338.58,$342.00,$0.00,$0.00,$0.00,$0.00,$0.00
JEM 330,SUP,HCPCS A7521,,JEM 330  -  TUBE ENDOTRAC 3MM CHGR SMTH RND TIP PE LATEX FREE DISP 3MM,$23.75,$0.00,$23.75,$0.00,$16.95,$0.00,$0.00,$0.00,$0.00,$0.00,$23.75,$0.00,$11.88,$18.81,$19.00,$0.00,$0.00,$0.00,$0.00,$0.00
JEM 365,SUP,HCPCS A7520,,JEM 365  -  CATHETER AIRWAY EXCHANGE SMOOTH ROUNDED TIP LATEX FREE JEM,$26.15,$0.00,$26.15,$0.00,$18.66,$0.00,$0.00,$0.00,$0.00,$0.00,$26.15,$0.00,$13.08,$20.71,$20.92,$0.00,$0.00,$0.00,$0.00,$0.00
JEM 400,SUP,Custom 27203010,,JEM 400  -  CATHETER AIRWAY EXCHANGE SMOOTH ROUNDED TIP LATEX FREE JEM,$26.15,$0.00,$26.15,$0.00,$18.66,$0.00,$0.00,$0.00,$0.00,$0.00,$26.15,$0.00,$13.08,$20.71,$20.92,$0.00,$0.00,$0.00,$0.00,$0.00
JEM370,SUP,Custom 27203010,,JEM370  -  CATHETER ARWYEX SMPL RPD TCHQ PE DISP 7MM,$22.55,$0.00,$22.55,$0.00,$16.09,$0.00,$0.00,$0.00,$0.00,$0.00,$22.55,$0.00,$11.28,$17.86,$18.04,$0.00,$0.00,$0.00,$0.00,$0.00
JJ1952,SUP,Custom 27203010,,JJ1952  -  HEMOSTAT ABSORBABLE 8X4IN ORIGINAL FLEXIBLE SHEER WEAVE,$147.91,$0.00,$147.91,$0.00,$105.56,$0.00,$0.00,$0.00,$0.00,$0.00,$147.91,$0.00,$73.95,$117.14,$118.32,$0.00,$0.00,$0.00,$0.00,$0.00
JJ4055,SUP,HCPCS C1729,,CATHETER IV 18GA 1.25IN RADIOPQ GRN JELCO TFLN STRL LF,$327.60,$0.00,$327.60,$177.89,$233.81,$0.00,$56.44,$0.00,$0.00,$57.36,$327.60,$0.00,$163.80,$259.46,$262.08,$0.00,$51.27,$0.00,$52.15,$0.00
J-NCS-504070,SUP,HCPCS C1887,,J-NCS-504070  -  CATH IU NOVY 5FR 40CM SET CVD CANNULATION 55CM DISP,$246.25,$0.00,$246.25,$133.71,$175.75,$0.00,$42.43,$0.00,$0.00,$43.12,$246.25,$0.00,$123.13,$195.03,$197.00,$0.00,$38.54,$0.00,$39.20,$0.00
JP-2230,SUP,Custom 27203010,,JP-2230  -  DRAIN INCS 19FR JP SIL RND HBLS CHNL STRL LATEX,$43.06,$0.00,$40.63,$0.00,$28.99,$0.00,$0.00,$0.00,$0.00,$0.00,$40.63,$0.00,$20.31,$34.10,$32.50,$0.00,$0.00,$0.00,$0.00,$0.00
JP-HUF071,SUP,Custom 27203010,,JP-HUF071  -  DRAIN INCISION 20CMX7MM 10FR FULL DUCT TROCAR LATEX FREE,$55.14,$0.00,$55.14,$0.00,$39.35,$0.00,$0.00,$0.00,$0.00,$0.00,$55.14,$0.00,$27.57,$43.67,$44.11,$0.00,$0.00,$0.00,$0.00,$0.00
JW31U,SUP,HCPCS C1898,,JW31U  -  LEAD PCNG OTW LT VNTRC SIN,"$4,750.00",$0.00,"$4,750.00","$2,137.50","$3,390.08",$0.00,$818.40,$0.00,$0.00,$831.69,"$4,750.00",$0.00,"$2,375.00","$3,762.00","$3,800.00",$0.00,$743.38,$0.00,$756.20,$0.00
K0675,SUP,Custom 27203010,,REAGENT RBT MS AB LSAB 2 110ML UNV SYS HRP CNJG IMMUN,"$1,382.93",$0.00,"$1,382.93",$0.00,$986.99,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,382.93",$0.00,$691.46,"$1,095.28","$1,106.34",$0.00,$0.00,$0.00,$0.00,$0.00
K20-2154,SUP,Custom 27203010,,K20-2154  -  BLADE OPTH 7MM CRNL SS TRPHN HNDL STRL DISP,$92.50,$0.00,$92.50,$0.00,$66.02,$0.00,$0.00,$0.00,$0.00,$0.00,$92.50,$0.00,$46.25,$73.26,$74.00,$0.00,$0.00,$0.00,$0.00,$0.00
K3468,SUP,Custom 27203010,,REAGENT DAB PLUS 110ML LQ CHRMGN 1100 TST IMMUN,$366.93,$0.00,$366.93,$0.00,$261.87,$0.00,$0.00,$0.00,$0.00,$0.00,$366.93,$0.00,$183.46,$290.61,$293.54,$0.00,$0.00,$0.00,$0.00,$0.00
K4061,SUP,Custom 27203010,,REAGENT HRP ENVSN PLUS 11ML RBT MS DUAL LNK 1100 TST IMMUN,"$4,024.85",$0.00,"$4,024.85",$0.00,"$2,872.54",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,024.85",$0.00,"$2,012.43","$3,187.68","$3,219.88",$0.00,$0.00,$0.00,$0.00,$0.00
K5204,SUP,Custom 27203010,,KIT IMMUN TST HERCEPTEST SLD REAGENT HER 2 35 TST,"$3,781.18",$0.00,"$3,781.18",$0.00,"$2,698.62",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,781.18",$0.00,"$1,890.59","$2,994.69","$3,024.94",$0.00,$0.00,$0.00,$0.00,$0.00
K581H,SUP,Custom 27203010,,K581H  -  SUTURE NONABSORBABLE 4-0 BB 24IN 2 ARM BRAID PERMA-HAND,$397.45,$0.00,$397.45,$0.00,$283.66,$0.00,$0.00,$0.00,$0.00,$0.00,$397.45,$0.00,$198.72,$314.78,$317.96,$0.00,$0.00,$0.00,$0.00,$0.00
K8-6180,SUP,Custom 27203010,,K8-6180  -  SPHERE EYE 18MM PLST SLD CLR,$35.00,$0.00,$35.00,$0.00,$24.98,$0.00,$0.00,$0.00,$0.00,$0.00,$35.00,$0.00,$17.50,$27.72,$28.00,$0.00,$0.00,$0.00,$0.00,$0.00
K8-6200,SUP,HCPCS L8610,,K8-6200  -  SPHERE EYE 20MM PLST SLD CLR,$62.78,$0.00,$482.85,$28.25,$44.80,$0.00,$482.85,$0.00,$0.00,$10.99,$62.78,$0.00,$31.39,$49.72,$50.22,$0.00,$9.82,$0.00,$9.99,$0.00
K8-6220,SUP,HCPCS L8610,,K8-6220  -  SPHERE EYE 22MM PLST SLD CLR,$67.50,$0.00,$482.85,$30.38,$48.17,$0.00,$482.85,$0.00,$0.00,$11.82,$67.50,$0.00,$33.75,$53.46,$54.00,$0.00,$10.56,$0.00,$10.75,$0.00
K8-6330,SUP,HCPCS L8610,,K8-6330  -  CNFRMR OPTH LG UNV PLST CLR,$35.00,$0.00,$482.85,$15.75,$24.98,$0.00,$482.85,$0.00,$0.00,$6.13,$35.00,$0.00,$17.50,$27.72,$28.00,$0.00,$5.48,$0.00,$5.57,$0.00
KC9529,SUP,Custom 27203010,,KC9529  -  SLEEVES KNEE MEDIUM LENGTH,$73.60,$0.00,$73.60,$0.00,$52.53,$0.00,$0.00,$0.00,$0.00,$0.00,$73.60,$0.00,$36.80,$58.29,$58.88,$0.00,$0.00,$0.00,$0.00,$0.00
KCFW-6.0-35-70-RB-HFANL1-HC,SUP,HCPCS C1894,,KCFW-6.0-35-70-RB-HFANL1-HC  -  INTROD SHTH 6FR .087IN 70CM ANL1 CURVE MULTPUR TIP ANSEL,$210.00,$0.00,$210.00,$114.03,$149.88,$0.00,$36.18,$0.00,$0.00,$36.77,$210.00,$0.00,$105.00,$166.32,$168.00,$0.00,$32.87,$0.00,$33.43,$0.00
KC-RUMI-35,SUP,HCPCS C1713,,KC-RUMI-35  -  MANIPULATOR ESCP 3.5CM STRL LF KOH-EFCT RUMI II K CP EZ LD,$223.26,$0.00,$223.26,$100.47,$159.34,$0.00,$38.47,$0.00,$0.00,$39.09,$223.26,$0.00,$111.63,$176.82,$178.61,$0.00,$34.94,$0.00,$35.54,$0.00
KLIPPEN,SUP,HCPCS C1879,,KLIPPEN  -  MARKER,$87.50,$0.00,$87.50,$0.00,$62.45,$0.00,$0.00,$0.00,$0.00,$0.00,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$0.00,$0.00,$0.00,$0.00
KLTSD403,SUP,Custom 27203010,,AIRWAY ESPH 3 KLT-D SCT MGMT PORT,$80.58,$0.00,$80.58,$0.00,$57.51,$0.00,$0.00,$0.00,$0.00,$0.00,$80.58,$0.00,$40.29,$63.82,$64.46,$0.00,$0.00,$0.00,$0.00,$0.00
KLTSD424,SUP,Custom 27203010,,KLTSD424 - AIRWAY ESPH 4 KLT-D SCT MGMT PORT,$80.58,$0.00,$80.58,$0.00,$57.51,$0.00,$0.00,$0.00,$0.00,$0.00,$80.58,$0.00,$40.29,$63.82,$64.46,$0.00,$0.00,$0.00,$0.00,$0.00
KLTSD425,SUP,Custom 27203010,,KLTSD425 - AIRWAY ESPH 5 KLT-D SCT MGMT PORT,$77.85,$0.00,$77.85,$0.00,$55.56,$0.00,$0.00,$0.00,$0.00,$0.00,$77.85,$0.00,$38.93,$61.66,$62.28,$0.00,$0.00,$0.00,$0.00,$0.00
KM172-14-54,SUP,Custom 27203010,,KM172-14-54  -  WIRE .054IN 4IN KWIRE SS SMTH TROCAR PNT 1 END ORTH NONSTRL,$5.70,$0.00,$5.70,$0.00,$4.07,$0.00,$0.00,$0.00,$0.00,$0.00,$5.70,$0.00,$2.85,$4.51,$4.56,$0.00,$0.00,$0.00,$0.00,$0.00
KT1835C,SUP,HCPCS C1753,,KT1835C  -  KIT CATH ER-REBOA,$375.00,$0.00,$375.00,$203.63,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
KW-062,SUP,HCPCS C1769,,KW-062  -  WIRE FIX .062IN KWIRE SS,$181.25,$0.00,$181.25,$98.42,$129.36,$0.00,$31.23,$0.00,$0.00,$31.74,$181.25,$0.00,$90.63,$143.55,$145.00,$0.00,$28.37,$0.00,$28.86,$0.00
KW062SS,SUP,HCPCS C1769,,KW062SS  -  WIRE FIX 1.6MM KWIRE SS,$62.50,$0.00,$62.50,$33.94,$44.61,$0.00,$10.77,$0.00,$0.00,$10.94,$62.50,$0.00,$31.25,$49.50,$50.00,$0.00,$9.78,$0.00,$9.95,$0.00
KWIR-STD-09152,SUP,Custom 27203010,,KWIR-STD-09152  -  WIRE FX STD .9MM 152MM KRSH TIP SS,$60.00,$0.00,$60.00,$0.00,$42.82,$0.00,$0.00,$0.00,$0.00,$0.00,$60.00,$0.00,$30.00,$47.52,$48.00,$0.00,$0.00,$0.00,$0.00,$0.00
KWIR-STD-15127,SUP,HCPCS C1713,,KWIR-STD-15127  -  WIRE FX 1.5MM 127MM KRSH STD TIP SS,$70.00,$0.00,$70.00,$31.50,$49.96,$0.00,$12.06,$0.00,$0.00,$12.26,$70.00,$0.00,$35.00,$55.44,$56.00,$0.00,$10.96,$0.00,$11.14,$0.00
L270309B,SUP,Custom 27203010,,KIT BBL RPR CRD SERTST 3ML,$131.50,$0.00,$131.50,$0.00,$93.85,$0.00,$0.00,$0.00,$0.00,$0.00,$131.50,$0.00,$65.75,$104.15,$105.20,$0.00,$0.00,$0.00,$0.00,$0.00
L3030,SUP,HCPCS C1713,,L3030  -  PIN SKL STRL MYFLD WNG GRV PLS ADLT CRNM DISP,$900.00,$0.00,$900.00,$405.00,$642.33,$0.00,$155.07,$0.00,$0.00,$157.58,$900.00,$0.00,$450.00,$712.80,$720.00,$0.00,$140.85,$0.00,$143.28,$0.00
L-70,SUP,Custom 27203010,,SYSTEM BLOOD WRM ADM SET INJEC PORT LVL 1 HTLN DISP STRL LF,$31.10,$0.00,$31.10,$0.00,$22.19,$0.00,$0.00,$0.00,$0.00,$0.00,$31.10,$0.00,$15.55,$24.63,$24.88,$0.00,$0.00,$0.00,$0.00,$0.00
LA6EBU30,SUP,HCPCS C1887,,CATHETER GUID EBU3 CURVE 6FR 100CM CORON LNCHR,$125.00,$0.00,$125.00,$67.88,$89.21,$0.00,$21.54,$0.00,$0.00,$21.89,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$19.56,$0.00,$19.90,$0.00
LA6EBU40,SUP,HCPCS C1887,,CATHETER GUID EBU4 CURVE 6FR 100CM LNCHR,$112.50,$0.00,$112.50,$61.09,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
LAG3.2-24,SUP,HCPCS C1713,,LAG3.2-24  -  SCREW BN 3.2MM 24MM LG CORT,$262.50,$0.00,$262.50,$118.13,$187.35,$0.00,$45.23,$0.00,$0.00,$45.96,$262.50,$0.00,$131.25,$207.90,$210.00,$0.00,$41.08,$0.00,$41.79,$0.00
LAG3.2-26,SUP,HCPCS C1713,,LAG3.2-26  -  SCREW BN 3.2MM 26MM LG CORT,$262.50,$0.00,$262.50,$118.13,$187.35,$0.00,$45.23,$0.00,$0.00,$45.96,$262.50,$0.00,$131.25,$207.90,$210.00,$0.00,$41.08,$0.00,$41.79,$0.00
LAG-4300,SUP,HCPCS C1713,,LAG-4300  -  SCREW BONE 30MM MLR LAG,$460.00,$0.00,$460.00,$207.00,$328.30,$0.00,$79.26,$0.00,$0.00,$80.54,$460.00,$0.00,$230.00,$364.32,$368.00,$0.00,$71.99,$0.00,$73.23,$0.00
LAG-4350,SUP,HCPCS C1713,,LAG-4350  -  SCREW BONE 35MM MLR LAG NONSTRL,$460.00,$0.00,$460.00,$207.00,$328.30,$0.00,$79.26,$0.00,$0.00,$80.54,$460.00,$0.00,$230.00,$364.32,$368.00,$0.00,$71.99,$0.00,$73.23,$0.00
LAG-4400,SUP,HCPCS C1713,,LAG-4400  -  SCREW BONE 40MM MLR LAG STRL,$460.00,$0.00,$460.00,$207.00,$328.30,$0.00,$79.26,$0.00,$0.00,$80.54,$460.00,$0.00,$230.00,$364.32,$368.00,$0.00,$71.99,$0.00,$73.23,$0.00
LAG-4450,SUP,HCPCS C1713,,LAG-4450  -  SCREW BONE 45MM MLR LAG NONSTRL,$460.00,$0.00,$460.00,$207.00,$328.30,$0.00,$79.26,$0.00,$0.00,$80.54,$460.00,$0.00,$230.00,$364.32,$368.00,$0.00,$71.99,$0.00,$73.23,$0.00
LAG-4500,SUP,HCPCS C1713,,LAG-4500  -  SCREW BONE 4MM 50MM TI MLR LAG NONSTRL,$460.00,$0.00,$460.00,$207.00,$328.30,$0.00,$79.26,$0.00,$0.00,$80.54,$460.00,$0.00,$230.00,$364.32,$368.00,$0.00,$71.99,$0.00,$73.23,$0.00
LAG-5036,SUP,HCPCS C1713,,LAG-5036  -  SCREW BONE 36MM UPR/LWR XTRMT SYNDESMOSIS LAG,$460.00,$0.00,$460.00,$207.00,$328.30,$0.00,$79.26,$0.00,$0.00,$80.54,$460.00,$0.00,$230.00,$364.32,$368.00,$0.00,$71.99,$0.00,$73.23,$0.00
LAG-5038,SUP,HCPCS C1713,,LAG-5038  -  SCREW BONE 38MM UPR/LWR XTRMT SYNDESMOSIS LAG,$460.00,$0.00,$460.00,$207.00,$328.30,$0.00,$79.26,$0.00,$0.00,$80.54,$460.00,$0.00,$230.00,$364.32,$368.00,$0.00,$71.99,$0.00,$73.23,$0.00
LAG-5040,SUP,HCPCS C1713,,LAG-5040  -  SCREW BONE 40MM UPR/LWR XTRMT SYNDESMOSIS LAG,$460.00,$0.00,$460.00,$207.00,$328.30,$0.00,$79.26,$0.00,$0.00,$80.54,$460.00,$0.00,$230.00,$364.32,$368.00,$0.00,$71.99,$0.00,$73.23,$0.00
LAG-5042,SUP,HCPCS C1713,,LAG-5042  -  SCREW BONE 42MM UPR/LWR XTRMT SYNDESMOSIS LAG,$460.00,$0.00,$460.00,$207.00,$328.30,$0.00,$79.26,$0.00,$0.00,$80.54,$460.00,$0.00,$230.00,$364.32,$368.00,$0.00,$71.99,$0.00,$73.23,$0.00
LAG-5044,SUP,HCPCS C1713,,LAG-5044  -  SCREW BONE 44MM UPR/LWR XTRMT SYNDESMOSIS LAG,$460.00,$0.00,$460.00,$207.00,$328.30,$0.00,$79.26,$0.00,$0.00,$80.54,$460.00,$0.00,$230.00,$364.32,$368.00,$0.00,$71.99,$0.00,$73.23,$0.00
LAG-5046,SUP,HCPCS C1713,,LAG-5046  -  SCREW BONE 46MM UPR/LWR XTRMT SYNDESMOSIS LAG,$460.00,$0.00,$460.00,$207.00,$328.30,$0.00,$79.26,$0.00,$0.00,$80.54,$460.00,$0.00,$230.00,$364.32,$368.00,$0.00,$71.99,$0.00,$73.23,$0.00
LAG-5048,SUP,HCPCS C1713,,LAG-5048  -  SCREW BONE 48MM UPR/LWR XTRMT SYNDESMOSIS LAG,$460.00,$0.00,$460.00,$207.00,$328.30,$0.00,$79.26,$0.00,$0.00,$80.54,$460.00,$0.00,$230.00,$364.32,$368.00,$0.00,$71.99,$0.00,$73.23,$0.00
LAG-5050,SUP,HCPCS C1713,,LAG-5050  -  SCREW BONE 50MM UPR/LWR XTRMT SYNDESMOSIS LAG,$460.00,$0.00,$460.00,$207.00,$328.30,$0.00,$79.26,$0.00,$0.00,$80.54,$460.00,$0.00,$230.00,$364.32,$368.00,$0.00,$71.99,$0.00,$73.23,$0.00
LAG-5052,SUP,HCPCS C1713,,LAG-5052  -  SCREW BONE 52MM UPR/LWR XTRMT SYNDESMOSIS LAG,$460.00,$0.00,$460.00,$207.00,$328.30,$0.00,$79.26,$0.00,$0.00,$80.54,$460.00,$0.00,$230.00,$364.32,$368.00,$0.00,$71.99,$0.00,$73.23,$0.00
LAG-5054,SUP,HCPCS C1713,,LAG-5054  -  SCREW BONE 54MM UPR/LWR XTRMT SYNDESMOSIS LAG,$460.00,$0.00,$460.00,$207.00,$328.30,$0.00,$79.26,$0.00,$0.00,$80.54,$460.00,$0.00,$230.00,$364.32,$368.00,$0.00,$71.99,$0.00,$73.23,$0.00
LAG-5056,SUP,HCPCS C1713,,LAG-5056  -  SCREW BONE 56MM UPR/LWR XTRMT SYNDESMOSIS LAG,$460.00,$0.00,$460.00,$207.00,$328.30,$0.00,$79.26,$0.00,$0.00,$80.54,$460.00,$0.00,$230.00,$364.32,$368.00,$0.00,$71.99,$0.00,$73.23,$0.00
LAG-5058,SUP,HCPCS C1713,,LAG-5058  -  SCREW BONE 58MM UPR/LWR XTRMT SYNDESMOSIS LAG,$460.00,$0.00,$460.00,$207.00,$328.30,$0.00,$79.26,$0.00,$0.00,$80.54,$460.00,$0.00,$230.00,$364.32,$368.00,$0.00,$71.99,$0.00,$73.23,$0.00
LAG-5060,SUP,HCPCS C1713,,LAG-5060  -  SCREW BONE 60MM UPR/LWR XTRMT SYNDESMOSIS LAG,$460.00,$0.00,$460.00,$207.00,$328.30,$0.00,$79.26,$0.00,$0.00,$80.54,$460.00,$0.00,$230.00,$364.32,$368.00,$0.00,$71.99,$0.00,$73.23,$0.00
LAG-5062,SUP,HCPCS C1713,,LAG-5062  -  SCREW BONE 62MM UPR/LWR XTRMT SYNDESMOSIS LAG,$460.00,$0.00,$460.00,$207.00,$328.30,$0.00,$79.26,$0.00,$0.00,$80.54,$460.00,$0.00,$230.00,$364.32,$368.00,$0.00,$71.99,$0.00,$73.23,$0.00
LAG-5064,SUP,HCPCS C1713,,LAG-5064  -  SCREW BONE 64MM UPR/LWR XTRMT SYNDESMOSIS LAG,$460.00,$0.00,$460.00,$207.00,$328.30,$0.00,$79.26,$0.00,$0.00,$80.54,$460.00,$0.00,$230.00,$364.32,$368.00,$0.00,$71.99,$0.00,$73.23,$0.00
LAG-5066,SUP,HCPCS C1713,,LAG-5066  -  SCREW BONE 66MM ANKL SYNDESMOSIS LAG NONSTRL,$460.00,$0.00,$460.00,$207.00,$328.30,$0.00,$79.26,$0.00,$0.00,$80.54,$460.00,$0.00,$230.00,$364.32,$368.00,$0.00,$71.99,$0.00,$73.23,$0.00
LAG-5068,SUP,HCPCS C1713,,LAG-5068  -  SCREW BONE 68MM UPR/LWR XTRMT SYNDESMOSIS LAG,$460.00,$0.00,$460.00,$207.00,$328.30,$0.00,$79.26,$0.00,$0.00,$80.54,$460.00,$0.00,$230.00,$364.32,$368.00,$0.00,$71.99,$0.00,$73.23,$0.00
LAG-5070,SUP,HCPCS C1713,,LAG-5070  -  SCREW BONE 70MM UPR/LWR XTRMT SYNDESMOSIS LAG,$460.00,$0.00,$460.00,$207.00,$328.30,$0.00,$79.26,$0.00,$0.00,$80.54,$460.00,$0.00,$230.00,$364.32,$368.00,$0.00,$71.99,$0.00,$73.23,$0.00
LAG-5072,SUP,HCPCS C1713,,LAG-5072  -  SCREW BONE 72MM UPR/LWR XTRMT SYNDESMOSIS LAG,$460.00,$0.00,$460.00,$207.00,$328.30,$0.00,$79.26,$0.00,$0.00,$80.54,$460.00,$0.00,$230.00,$364.32,$368.00,$0.00,$71.99,$0.00,$73.23,$0.00
LAG-5074,SUP,HCPCS C1713,,LAG-5074  -  SCREW BONE 74MM UPR/LWR XTRMT SYNDESMOSIS LAG,$460.00,$0.00,$460.00,$207.00,$328.30,$0.00,$79.26,$0.00,$0.00,$80.54,$460.00,$0.00,$230.00,$364.32,$368.00,$0.00,$71.99,$0.00,$73.23,$0.00
LC3006,SUP,Custom 27203010,,LC3006  -  KIT SRG STRL LF SPY PAQ DISP,"$1,374.25",$0.00,"$1,374.25",$0.00,$980.80,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,374.25",$0.00,$687.13,"$1,088.41","$1,099.40",$0.00,$0.00,$0.00,$0.00,$0.00
LCB002,SUP,Custom 27203010,,KIT INDCTR VRF MONITR STRP MEDIA VL LF,$6.83,$0.00,$6.83,$0.00,$4.87,$0.00,$0.00,$0.00,$0.00,$0.00,$6.83,$0.00,$3.41,$5.41,$5.46,$0.00,$0.00,$0.00,$0.00,$0.00
LCBS2.7-10,SUP,HCPCS C1713,,LCBS2.7-10  -  SCREW BN 2.7MM 10MM LCK SS CORT TRIMED CLVCL FX SYS,$262.50,$0.00,$262.50,$118.13,$187.35,$0.00,$45.23,$0.00,$0.00,$45.96,$262.50,$0.00,$131.25,$207.90,$210.00,$0.00,$41.08,$0.00,$41.79,$0.00
LCBS2.7-16,SUP,HCPCS C1713,,LCBS2.7-16  -  SCREW BN 2.7MM 16MM LCK SS CORT TRIMED CLVCL FX SYS,$262.50,$0.00,$262.50,$118.13,$187.35,$0.00,$45.23,$0.00,$0.00,$45.96,$262.50,$0.00,$131.25,$207.90,$210.00,$0.00,$41.08,$0.00,$41.79,$0.00
LCBS3.2-08,SUP,HCPCS C1713,,LCBS3.2-08  -  SCREW BONE 3.2MM 8MM FRARM ELB CORT LOCK,$262.50,$0.00,$262.50,$118.13,$187.35,$0.00,$45.23,$0.00,$0.00,$45.96,$262.50,$0.00,$131.25,$207.90,$210.00,$0.00,$41.08,$0.00,$41.79,$0.00
LCBS3.2-12,SUP,HCPCS C1713,,LCBS3.2-12  -  SCREW BONE 3.2MM 12MM LOCK FOREARM ELBOW CORTICAL,$262.50,$0.00,$262.50,$118.13,$187.35,$0.00,$45.23,$0.00,$0.00,$45.96,$262.50,$0.00,$131.25,$207.90,$210.00,$0.00,$41.08,$0.00,$41.79,$0.00
LCBS3.2-14,SUP,HCPCS C1713,,LCBS3.2-14  -  SCREW BONE 3.2MM 14MM LOCK OLECRANON HOOK PLATE FOREARM,$262.50,$0.00,$262.50,$118.13,$187.35,$0.00,$45.23,$0.00,$0.00,$45.96,$262.50,$0.00,$131.25,$207.90,$210.00,$0.00,$41.08,$0.00,$41.79,$0.00
LCBS3.2-16,SUP,HCPCS C1713,,LCBS3.2-16  -  SCREW BONE 3.2MM 16MM LOCK FOREARM ELBOW CORTICAL,$262.50,$0.00,$262.50,$118.13,$187.35,$0.00,$45.23,$0.00,$0.00,$45.96,$262.50,$0.00,$131.25,$207.90,$210.00,$0.00,$41.08,$0.00,$41.79,$0.00
LCBS3.2-18,SUP,HCPCS C1713,,LCBS3.2-18  -  SCREW BONE 3.2MM 18MM LOCK FOREARM ELBOW CORTICAL,$262.50,$0.00,$262.50,$118.13,$187.35,$0.00,$45.23,$0.00,$0.00,$45.96,$262.50,$0.00,$131.25,$207.90,$210.00,$0.00,$41.08,$0.00,$41.79,$0.00
LCBS3.2-22,SUP,HCPCS C1713,,LCBS3.2-22  -  SCREW BONE 3.2MM 22MM LOCK FOREARM ELBOW CORTICAL,$262.50,$0.00,$262.50,$118.13,$187.35,$0.00,$45.23,$0.00,$0.00,$45.96,$262.50,$0.00,$131.25,$207.90,$210.00,$0.00,$41.08,$0.00,$41.79,$0.00
LCBS32-24,SUP,HCPCS C1713,,LCBS32-24  -  SCREW BONE 24MM LOCK 3.2MM FOREARM ELBOW CORTICAL,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
LCC008,SUP,Custom 27203010,,STRIP INDCTR CHM MONITR VRF S1 PRC,$4.40,$0.00,$4.40,$0.00,$3.14,$0.00,$0.00,$0.00,$0.00,$0.00,$4.40,$0.00,$2.20,$3.48,$3.52,$0.00,$0.00,$0.00,$0.00,$0.00
LF1737,SUP,Custom 27203010,,LF1737  -  SEALER/DIVIDER LAPSCP 350D 5MM 37CM LGSR MD 1 STP SL MLFNC,"$1,318.35",$0.00,"$1,318.35",$0.00,$940.91,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,318.35",$0.00,$659.18,"$1,044.13","$1,054.68",$0.00,$0.00,$0.00,$0.00,$0.00
LF4318,SUP,Custom 27203010,,LF4318  -  SEALER/DIVIDER BP 180D 34MM LG 13.5MM 7.1IN STRL LF 36MM,"$8,795.55",$0.00,"$8,795.55",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,795.55",$0.00,"$4,397.78","$6,966.08","$7,036.44",$0.00,$0.00,$0.00,$0.00,$0.00
LF4418,SUP,Custom 27203010,,LF4418  -  SEALER/DIVIDER BP 14D 180D 34MM 13.5MM 18CM STRL LF 36MM,"$1,465.93",$0.00,"$1,465.93",$0.00,"$1,046.23",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,465.93",$0.00,$732.96,"$1,161.02","$1,172.74",$0.00,$0.00,$0.00,$0.00,$0.00
LFC002,SUP,Custom 27203010,,LFC002  -  TIP APL LIQUIBAND ADH TISS FLW CNTRL,$92.98,$0.00,$92.98,$0.00,$66.36,$0.00,$0.00,$0.00,$0.00,$0.00,$92.98,$0.00,$46.49,$73.64,$74.38,$0.00,$0.00,$0.00,$0.00,$0.00
LHEX3.2-12,SUP,HCPCS C1713,,LHEX3.2-12  -  SCREW BN 3.2MM 12MM LCK SS CORT TRIMED CLVCL FX SYS,$262.50,$0.00,$262.50,$118.13,$187.35,$0.00,$45.23,$0.00,$0.00,$45.96,$262.50,$0.00,$131.25,$207.90,$210.00,$0.00,$41.08,$0.00,$41.79,$0.00
LIG101,SUP,Custom 27203010,,LIQUIMMUNE IMMUNOASSAY LV 1 6X5ML,$150.00,$0.00,$150.00,$0.00,$107.06,$0.00,$0.00,$0.00,$0.00,$0.00,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$0.00,$0.00,$0.00,$0.00
LIG-101,SUP,Custom 27203010,,CONTROL IMAS MAS LIQUIMMUNE LVL 1 LQ 5ML IMMUN,$150.00,$0.00,$150.00,$0.00,$107.06,$0.00,$0.00,$0.00,$0.00,$0.00,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$0.00,$0.00,$0.00,$0.00
LIG202,SUP,Custom 27203010,,LIQUIMMUNE IMMUNOASSAY LV 2 6X5ML,$150.00,$0.00,$150.00,$0.00,$107.06,$0.00,$0.00,$0.00,$0.00,$0.00,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$0.00,$0.00,$0.00,$0.00
LIG-202,SUP,Custom 27203010,,CONTROL MLANLT 3-PNT LIQUIMMUNE LVL 2 ASY 5ML IMMUN,$150.00,$0.00,$150.00,$0.00,$107.06,$0.00,$0.00,$0.00,$0.00,$0.00,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$0.00,$0.00,$0.00,$0.00
LIG303,SUP,Custom 27203010,,LIQUIMMUNE IMMUNOASSAY LV 3 6X5ML,$150.00,$0.00,$150.00,$0.00,$107.06,$0.00,$0.00,$0.00,$0.00,$0.00,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$0.00,$0.00,$0.00,$0.00
LIG-303,SUP,Custom 27203010,,CONTROL IMAS MAS LIQUIMMUNE LVL 3 LQ 5ML IMMUN,$150.00,$0.00,$150.00,$0.00,$107.06,$0.00,$0.00,$0.00,$0.00,$0.00,$150.00,$0.00,$75.00,$118.80,$120.00,$0.00,$0.00,$0.00,$0.00,$0.00
LL0004,SUP,Custom 27203010,,LL0004  -  SET TBG 250 MILLIBAR STRL LTX 1 LUM INFL 2 OFLW DISP,$362.50,$0.00,$362.50,$0.00,$258.72,$0.00,$0.00,$0.00,$0.00,$0.00,$362.50,$0.00,$181.25,$287.10,$290.00,$0.00,$0.00,$0.00,$0.00,$0.00
LN205,SUP,Custom 27203010,,LN205  -  RESERVOIR CARDIOTOMY 3L UNFILTERED,$77.00,$0.00,$77.00,$0.00,$54.95,$0.00,$0.00,$0.00,$0.00,$0.00,$77.00,$0.00,$38.50,$60.98,$61.60,$0.00,$0.00,$0.00,$0.00,$0.00
LPG1510,SUP,HCPCS C1781,,LPG1510  -  MESH SURG 15X10CM SELF FIXATE FLAT SHEET LATEX FREE PROGRIP,"$1,048.25",$0.00,"$1,048.25",$471.71,$748.14,$0.00,$180.61,$0.00,$0.00,$183.54,"$1,048.25",$0.00,$524.13,$830.21,$838.60,$0.00,$164.05,$0.00,$166.88,$0.00
LPP11,SUP,Custom 27803010,,LPP11  -  EXPANDER TISSUE P5CM 11X9CM TEXTURED LP PLUS LATERAL EXTN,"$2,625.00",$0.00,"$2,625.00",$0.00,"$1,873.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$0.00,$0.00,$0.00,$0.00
LPP12,SUP,HCPCS C1789,,LPP12  -  EXPANDER TISSUE P5.2CM 9.8X12CM TEXTURED LOW POLE PLUS,"$3,025.00",$0.00,"$3,025.00","$1,361.25","$2,158.94",$0.00,$521.19,$0.00,$0.00,$529.65,"$3,025.00",$0.00,"$1,512.50","$2,395.80","$2,420.00",$0.00,$473.41,$0.00,$481.58,$0.00
LPP13,SUP,HCPCS C1789,,LPP13  -  XPD TISS 380-450ML TXTR LP PLUS LAT EXTN MID HT DERMASPAN,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,$0.00,$0.00,$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
LPP14,SUP,HCPCS C1789,,LPP14  -  EXPANDER TISSUE P6CM 14X11.2CM TEXTURED LP PLUS LATERAL EXTN,"$3,025.00",$0.00,"$3,025.00","$1,361.25","$2,158.94",$0.00,$521.19,$0.00,$0.00,$529.65,"$3,025.00",$0.00,"$1,512.50","$2,395.80","$2,420.00",$0.00,$473.41,$0.00,$481.58,$0.00
LPP15,SUP,HCPCS C1789,,LPP15  -  EXPANDER TISS P6.4-7.9CM MID HT 15X11.5CM 500-600CC,"$3,025.00",$0.00,"$3,025.00","$1,361.25","$2,158.94",$0.00,$521.19,$0.00,$0.00,$529.65,"$3,025.00",$0.00,"$1,512.50","$2,395.80","$2,420.00",$0.00,$473.41,$0.00,$481.58,$0.00
LPP16,SUP,HCPCS C1789,,LPP16  -  EXPANDER TISS P6.6-8.2CM MID HT 16X12CM 580-690CC DERMASPAN,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,$0.00,$0.00,$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
LQB001,SUP,Custom 27203010,,LQB001  -  LIQUIBAND SKIN ADHESIVE DOME TIP,$127.22,$0.00,$127.22,$0.00,$90.80,$0.00,$0.00,$0.00,$0.00,$0.00,$127.22,$0.00,$63.61,$100.76,$101.78,$0.00,$0.00,$0.00,$0.00,$0.00
LS1500,SUP,Custom 27203010,,LS1500  -  SEALER/DIVIDER LAPSCP 179D 12MM 5MM 37CM STRL 18X2.6MM LGSR,"$1,215.66",$0.00,"$1,215.66",$0.00,$867.62,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,215.66",$0.00,$607.83,$962.80,$972.53,$0.00,$0.00,$0.00,$0.00,$0.00
LS3111,SUP,Custom 27203010,,ELECTRODE ESURG LG XTD SNP IN RDG GR SRFC CORD,$102.05,$0.00,$102.05,$0.00,$72.83,$0.00,$0.00,$0.00,$0.00,$0.00,$102.05,$0.00,$51.03,$80.82,$81.64,$0.00,$0.00,$0.00,$0.00,$0.00
LT200,SUP,HCPCS C1760,,LT200  -  CLIP MED 3.2MM INTNL LGCLP EX TI ENDSCP LIGAT STRL DISP LF,$30.60,$0.00,$30.60,$13.77,$21.84,$0.00,$5.27,$0.00,$0.00,$5.36,$30.60,$0.00,$15.30,$24.24,$24.48,$0.00,$4.79,$0.00,$4.87,$0.00
LT400,SUP,HCPCS C1760,,LT400  -  CLIP LG 6.2MM INTNL LGCLP EX TI ENDSCP LIGAT STRL DISP LF,$56.10,$0.00,$56.10,$25.25,$40.04,$0.00,$9.67,$0.00,$0.00,$9.82,$56.10,$0.00,$28.05,$44.43,$44.88,$0.00,$8.78,$0.00,$8.93,$0.00
LUB07030,SUP,HCPCS C2625,,LUB07030  -  STENT BIL 7MM 6FR 30MM 80CM .035IN CATH GWIRE E-LMNX,"$3,883.20",$0.00,"$3,883.20","$1,747.44","$2,771.44",$0.00,$669.06,$0.00,$0.00,$679.92,"$3,883.20",$0.00,"$1,941.60","$3,075.49","$3,106.56",$0.00,$607.72,$0.00,$618.21,$0.00
LUB07040,SUP,HCPCS C2625,,LUB07040  -  STENT BIL .035IN 7MM 6FR 40MM 80CM LMNX SLF XPD DLV SYS NTNL,"$3,883.19",$0.00,"$3,883.19","$1,747.44","$2,771.43",$0.00,$669.05,$0.00,$0.00,$679.92,"$3,883.19",$0.00,"$1,941.60","$3,075.49","$3,106.55",$0.00,$607.72,$0.00,$618.20,$0.00
LUB08030,SUP,HCPCS C2625,,LUB08030  -  STENT BIL .035IN 8MM 6FR 30MM 80CM LMNX SLF XPD DLV SYS NTNL,"$3,883.19",$0.00,"$3,883.19","$1,747.44","$2,771.43",$0.00,$669.05,$0.00,$0.00,$679.92,"$3,883.19",$0.00,"$1,941.60","$3,075.49","$3,106.55",$0.00,$607.72,$0.00,$618.20,$0.00
LUB08060,SUP,HCPCS C2625,,LUB08060  -  STENT BIL .035IN 8MM 6FR 60MM 80CM LMNX SLF XPD DLV SYS NTNL,"$3,883.19",$0.00,"$3,883.19","$1,747.44","$2,771.43",$0.00,$669.05,$0.00,$0.00,$679.92,"$3,883.19",$0.00,"$1,941.60","$3,075.49","$3,106.55",$0.00,$607.72,$0.00,$618.20,$0.00
LUB10040,SUP,HCPCS C2625,,LUB10040  -  STENT VASC .035IN 10MM 6FR 40MM 80CM E-LMNX SAFE PERFORMAXX,"$2,250.00",$0.00,"$2,250.00","$1,012.50","$1,605.83",$0.00,$387.66,$0.00,$0.00,$393.96,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$352.13,$0.00,$358.20,$0.00
LUB10060,SUP,HCPCS C2625,,LUB10060  -  STENT BIL 10MM 60MM 80CM PERFORMAXX GRP E-LMNX,"$3,883.20",$0.00,"$3,883.20","$1,747.44","$2,771.44",$0.00,$669.06,$0.00,$0.00,$679.92,"$3,883.20",$0.00,"$1,941.60","$3,075.49","$3,106.56",$0.00,$607.72,$0.00,$618.21,$0.00
LUB12080,SUP,HCPCS C2625,,LUB12080  -  STENT BIL 12MM 6FR 80MM 80CM .035IN SLF XPD DLV SYS LMNX,"$4,686.61",$0.00,"$4,686.61","$2,108.97","$3,344.83",$0.00,$807.48,$0.00,$0.00,$820.59,"$4,686.61",$0.00,"$2,343.30","$3,711.80","$3,749.29",$0.00,$733.45,$0.00,$746.11,$0.00
LX10BD.100,SUP,HCPCS V2632,,LX10BD.100  -  LENS IOL 5 D +10 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX10BD.105,SUP,HCPCS V2632,,LX10BD.105  -  LENS IOL 5 D +10.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX10BD.110,SUP,HCPCS V2632,,LX10BD.110  -  LENS IOL 5 D +11 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX10BD.115,SUP,HCPCS V2632,,LX10BD.115  -  LENS IOL 5 D +11.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX10BD.120,SUP,HCPCS V2632,,LX10BD.120  -  LENS IOL 5 D +12 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX10BD.125,SUP,HCPCS V2632,,LX10BD.125  -  LENS IOL 5 D +12.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX10BD.130,SUP,HCPCS V2632,,LX10BD.130  -  LENS IOL 5 D +13 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX10BD.135,SUP,HCPCS V2632,,LX10BD.135  -  LENS IOL 5 D +13.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX10BD.140,SUP,HCPCS V2632,,LX10BD.140  -  LENS IOL 5 D +14 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX10BD.145,SUP,HCPCS V2632,,LX10BD.145  -  LENS IOL 5 D +14.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX10BD.150,SUP,HCPCS V2632,,LX10BD.150  -  LENS IOL 5 D +15 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX10BD.155,SUP,HCPCS V2632,,LX10BD.155  -  LENS IOL 5 D +15.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX10BD.160,SUP,HCPCS V2632,,LX10BD.160  -  LENS IOL 5 D +16 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX10BD.165,SUP,HCPCS V2632,,LX10BD.165  -  LENS IOL 5 D +16.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX10BD.170,SUP,HCPCS V2632,,LX10BD.170  -  LENS IOL 5 D +17 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX10BD.175,SUP,HCPCS V2632,,LX10BD.175  -  LENS IOL 5 D +17.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX10BD.180,SUP,HCPCS V2632,,LX10BD.180  -  LENS IOL 5 D +18 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX10BD.185,SUP,HCPCS V2632,,LX10BD.185  -  LENS IOL 5 D +18.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX10BD.190,SUP,HCPCS V2632,,LX10BD.190  -  LENS IOL 5 D +19 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX10BD.195,SUP,HCPCS V2632,,LX10BD.195  -  LENS IOL 5 D +19.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX10BD.200,SUP,HCPCS V2632,,LX10BD.200  -  LENS IOL 5 D +20 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX10BD.205,SUP,HCPCS V2632,,LX10BD.205  -  LENS IOL 5 D +20.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX10BD.210,SUP,HCPCS V2632,,LX10BD.210  -  LENS IOL 5 D +21 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX10BD.215,SUP,HCPCS V2632,,LX10BD.215  -  LENS IOL 5 D +21.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX10BD.220,SUP,HCPCS V2632,,LX10BD.220  -  LENS IOL 5 D +22 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX10BD.225,SUP,HCPCS V2632,,LX10BD.225  -  LENS IOL 5 D +22.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX10BD.230,SUP,HCPCS V2632,,LX10BD.230  -  LENS IOL 5 D +23 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX10BD.235,SUP,HCPCS V2632,,LX10BD.235  -  LENS IOL 5 D +23.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX10BD.240,SUP,HCPCS V2632,,LX10BD.240  -  LENS IOL 5 D +24 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX10BD.245,SUP,HCPCS V2632,,LX10BD.245  -  LENS IOL 5 D +24.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX10BD.250,SUP,HCPCS V2632,,LX10BD.250  -  LENS IOL 5 D +25 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX10BD.255,SUP,HCPCS V2632,,LX10BD.255  -  LENS IOL 5 D +25.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX10BD.260,SUP,HCPCS V2632,,LX10BD.260  -  LENS IOL 5 D +26 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX10BD.265,SUP,HCPCS V2632,,LX10BD.265  -  LENS IOL 5 D +26.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX10BD.270,SUP,HCPCS V2632,,LX10BD.270  -  LENS IOL 5 D +27 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX10BD.275,SUP,HCPCS V2632,,LX10BD.275  -  LENS IOL 5 D +27.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX10BD.280,SUP,HCPCS V2632,,LX10BD.280  -  LENS IOL 5 D +28 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX10BD.285,SUP,HCPCS V2632,,LX10BD.285  -  LENS IOL 5 D +28.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX10BD.290,SUP,HCPCS V2632,,LX10BD.290  -  LENS IOL 5 D +29 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX10BD.295,SUP,HCPCS V2632,,LX10BD.295  -  LENS IOL 5 D +29.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX10BD.300,SUP,HCPCS V2632,,LX10BD.300  -  LENS IOL 5 D +30 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX90BD.100,SUP,HCPCS V2632,,LX90BD.100  -  LENS IOL 5 D +10 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX90BD.105,SUP,HCPCS V2632,,LX90BD.105  -  LENS IOL 5 D +10.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX90BD.110,SUP,HCPCS V2632,,LX90BD.110  -  LENS IOL 5 D +11 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX90BD.115,SUP,HCPCS V2632,,LX90BD.115  -  LENS IOL 5 D +11.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX90BD.120,SUP,HCPCS V2632,,LX90BD.120  -  LENS IOL 5 D +12 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX90BD.125,SUP,HCPCS V2632,,LX90BD.125  -  LENS IOL 5 D +12.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX90BD.130,SUP,HCPCS V2632,,LX90BD.130  -  LENS IOL 5 D +13 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX90BD.135,SUP,HCPCS V2632,,LX90BD.135  -  LENS IOL 5 D +13.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX90BD.140,SUP,HCPCS V2632,,LX90BD.140  -  LENS IOL 5 D +14 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX90BD.145,SUP,HCPCS V2632,,LX90BD.145  -  LENS IOL 5 D +14.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX90BD.150,SUP,HCPCS V2632,,LX90BD.150  -  LENS IOL 5 D +15 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX90BD.155,SUP,HCPCS V2632,,LX90BD.155  -  LENS IOL 5 D +15.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX90BD.160,SUP,HCPCS V2632,,LX90BD.160  -  LENS IOL 5 D +16 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX90BD.165,SUP,HCPCS V2632,,LX90BD.165  -  LENS IOL 5 D +16.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX90BD.170,SUP,HCPCS V2632,,LX90BD.170  -  LENS IOL 5 D +17 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX90BD.175,SUP,HCPCS V2632,,LX90BD.175  -  LENS IOL 5 D +17.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX90BD.180,SUP,HCPCS V2632,,LX90BD.180  -  LENS IOL 5 D +18 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX90BD.185,SUP,HCPCS V2632,,LX90BD.185  -  LENS IOL 5 D +18.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX90BD.190,SUP,HCPCS V2632,,LX90BD.190  -  LENS IOL 5 D +19 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX90BD.195,SUP,HCPCS V2632,,LX90BD.195  -  LENS IOL 5 D +19.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX90BD.200,SUP,HCPCS V2632,,LX90BD.200  -  LENS IOL 5 D +20 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX90BD.205,SUP,HCPCS V2632,,LX90BD.205  -  LENS IOL 5 D +20.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX90BD.210,SUP,HCPCS V2632,,LX90BD.210  -  LENS IOL 5 D +21 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX90BD.215,SUP,HCPCS V2632,,LX90BD.215  -  LENS IOL 5 D +21.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX90BD.220,SUP,HCPCS V2632,,LX90BD.220  -  LENS IOL 5 D +22 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX90BD.225,SUP,HCPCS V2632,,LX90BD.225  -  LENS IOL 5 D +22.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX90BD.230,SUP,HCPCS V2632,,LX90BD.230  -  LENS IOL 5 D +23 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX90BD.235,SUP,HCPCS V2632,,LX90BD.235  -  LENS IOL 5 D +23.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX90BD.240,SUP,HCPCS V2632,,LX90BD.240  -  LENS IOL 5 D +24 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX90BD.245,SUP,HCPCS V2632,,LX90BD.245  -  LENS IOL 5 D +24.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX90BD.250,SUP,HCPCS V2632,,LX90BD.250  -  LENS IOL 5 D +25 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX90BD.255,SUP,HCPCS V2632,,LX90BD.255  -  LENS IOL 5 D +25.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX90BD.260,SUP,HCPCS V2632,,LX90BD.260  -  LENS IOL 5 D +26 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX90BD.265,SUP,HCPCS V2632,,LX90BD.265  -  LENS IOL 5 D +26.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX90BD.270,SUP,HCPCS V2632,,LX90BD.270  -  LENS IOL 5 D +27 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX90BD.275,SUP,HCPCS V2632,,LX90BD.275  -  LENS IOL 5 D +27.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX90BD.280,SUP,HCPCS V2632,,LX90BD.280  -  LENS IOL 5 D +28 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX90BD.285,SUP,HCPCS V2632,,LX90BD.285  -  LENS IOL 5 D +28.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX90BD.290,SUP,HCPCS V2632,,LX90BD.290  -  LENS IOL 5 D +29 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX90BD.295,SUP,HCPCS V2632,,LX90BD.295  -  LENS IOL 5 D +29.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LX90BD.300,SUP,HCPCS V2632,,LX90BD.300  -  LENS IOL 5 D +30 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
LXA19,SUP,Custom 27803010,,LXA19  -  VALVE AORTIC 19MM MITROFLOW BVN PRICRD,"$12,500.00",$0.00,"$12,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$12,500.00",$0.00,"$6,250.00","$9,900.00","$10,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
LXA21,SUP,Custom 27803010,,LXA21  -  VALVE AORTIC 21MM MITROFLOW BVN PRICRD,"$12,500.00",$0.00,"$12,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$12,500.00",$0.00,"$6,250.00","$9,900.00","$10,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
M001102200,SUP,HCPCS C1726,,M001102200  -  CATHETER BLNDIL 9FR 15MM 100CM 3CM LV ANGPLSTY,$998.00,$0.00,$998.00,$541.91,$712.27,$0.00,$171.95,$0.00,$0.00,$174.74,$998.00,$0.00,$499.00,$790.42,$798.40,$0.00,$156.19,$0.00,$158.88,$0.00
M001102240,SUP,HCPCS C1726,,M001102240  -  CATHETER BLNDIL 9FR 20MM 100CM 3CM BLU MAX 20 OTW NC HI-PRS,$687.50,$0.00,$687.50,$373.31,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
M0011031020,SUP,HCPCS C1751,,M0011031020  -  CATHETER INFS .014-.016IN 3-2.7FR .021-.022IN 150CM 12CM,"$1,225.00",$0.00,"$1,225.00",$665.18,$874.28,$0.00,$211.06,$0.00,$0.00,$214.49,"$1,225.00",$0.00,$612.50,$970.20,$980.00,$0.00,$191.71,$0.00,$195.02,$0.00
M001125000,SUP,HCPCS C1753,,M001125000  -  CATHETER BLNDIL 4MM 40CM 20MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125010,SUP,HCPCS C1753,,M001125010  -  CATHETER BLNDIL 4MM 75CM 20MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125020,SUP,HCPCS C1753,,M001125020  -  CATHETER BLNDIL 4MM 120CM 20MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125030,SUP,HCPCS C1753,,M001125030  -  CATHETER BLNDIL 4MM 40CM 30MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125040,SUP,HCPCS C1753,,M001125040  -  CATHETER BLNDIL 4MM 75CM 30MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125050,SUP,HCPCS C1753,,M001125050  -  CATHETER BLNDIL 4MM 120CM 30MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125060,SUP,HCPCS C1753,,M001125060  -  CATHETER BLNDIL 4MM 40CM 40MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125070,SUP,HCPCS C1753,,M001125070  -  CATHETER BLNDIL 4MM 75CM 40MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125080,SUP,HCPCS C1753,,M001125080  -  CATHETER BLNDIL 4MM 120CM 40MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125090,SUP,HCPCS C1753,,M001125090  -  CATHETER BLNDIL 4MM 40CM 100MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125100,SUP,HCPCS C1753,,M001125100  -  CATHETER BLNDIL 4MM 75CM 100MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125110,SUP,HCPCS C1753,,M001125110  -  CATHETER BLNDIL 4MM 120CM 100MM BLU MAX 20 OTW HI-PRS PERI,$825.00,$0.00,$825.00,$447.98,$588.80,$0.00,$142.14,$0.00,$0.00,$144.45,$825.00,$0.00,$412.50,$653.40,$660.00,$0.00,$129.11,$0.00,$131.34,$0.00
M001125120,SUP,HCPCS C1753,,M001125120  -  CATHETER BLNDIL 5MM 40CM 20MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125130,SUP,HCPCS C1753,,M001125130  -  CATHETER BLNDIL 5MM 75CM 20MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125140,SUP,HCPCS C1753,,M001125140  -  CATHETER BLNDIL 5MM 120CM 20MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125150,SUP,HCPCS C1753,,M001125150  -  CATHETER BLNDIL 5MM 40CM 30MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125160,SUP,HCPCS C1753,,M001125160  -  CATHETER BLNDIL 5MM 75CM 30MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125170,SUP,HCPCS C1753,,M001125170  -  CATHETER BLNDIL 5MM 120CM 30MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125180,SUP,HCPCS C1753,,M001125180  -  CATHETER BLNDIL 5MM 40CM 40MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125190,SUP,HCPCS C1753,,M001125190  -  CATHETER BLNDIL 5MM 75CM 40MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125200,SUP,HCPCS C1753,,M001125200  -  CATHETER BLNDIL 5MM 120CM 40MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125210,SUP,HCPCS C1753,,M001125210  -  CATHETER BLNDIL 5MM 40CM 100MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125220,SUP,HCPCS C1753,,M001125220  -  CATHETER BLNDIL 5MM 75CM 100MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125230,SUP,HCPCS C1753,,M001125230  -  CATHETER BLNDIL 5MM 120CM 100MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125240,SUP,HCPCS C1753,,M001125240  -  CATHETER BLNDIL 6MM 40CM 20MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125250,SUP,HCPCS C1753,,M001125250  -  CATHETER BLNDIL 6MM 75CM 20MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125260,SUP,HCPCS C1753,,M001125260  -  CATHETER BLNDIL 6MM 120CM 20MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125270,SUP,HCPCS C1753,,M001125270  -  CATHETER BLNDIL 6MM 40CM 30MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125280,SUP,HCPCS C1753,,M001125280  -  CATHETER BLNDIL 6MM 75CM 30MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125290,SUP,HCPCS C1753,,M001125290  -  CATHETER BLNDIL 6MM 120CM 30MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125300,SUP,HCPCS C1753,,M001125300  -  CATHETER BLNDIL 6MM 40CM 40MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125310,SUP,HCPCS C1753,,M001125310  -  CATHETER BLNDIL 6MM 75CM 40MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125320,SUP,HCPCS C1753,,M001125320  -  CATHETER BLNDIL 6MM 120CM 40MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125330,SUP,HCPCS C1753,,M001125330  -  CATHETER BLNDIL 6MM 40CM 100MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125340,SUP,HCPCS C1753,,M001125340  -  CATHETER BLNDIL 6MM 75CM 100MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125350,SUP,HCPCS C1753,,M001125350  -  CATHETER BLNDIL 6MM 120CM 100MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125360,SUP,HCPCS C1753,,M001125360  -  CATHETER BLNDIL 7MM 40CM 20MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125370,SUP,HCPCS C1753,,M001125370  -  CATHETER BLNDIL 7MM 75CM 20MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125380,SUP,HCPCS C1753,,M001125380  -  CATHETER BLNDIL 7MM 120CM 20MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125390,SUP,HCPCS C1753,,M001125390  -  CATHETER BLNDIL 7MM 40CM 30MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125400,SUP,HCPCS C1753,,M001125400  -  CATHETER BLNDIL 7MM 75CM 30MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125410,SUP,HCPCS C1753,,M001125410  -  CATHETER BLNDIL 7MM 120CM 30MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125420,SUP,HCPCS C1753,,M001125420  -  CATHETER BLNDIL 7MM 40CM 40MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125430,SUP,HCPCS C1753,,M001125430  -  CATHETER BLNDIL 7MM 75CM 40MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125440,SUP,HCPCS C1753,,M001125440  -  CATHETER BLNDIL 7MM 120CM 40MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125450,SUP,HCPCS C1753,,M001125450  -  CATHETER BLNDIL 7MM 40CM 100MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125460,SUP,HCPCS C1753,,M001125460  -  CATHETER BLNDIL 7MM 75CM 100MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125470,SUP,HCPCS C1753,,M001125470  -  CATHETER BLNDIL 7MM 120CM 100MM BLU MAX 20 OTW HI-PRS PERI,$825.00,$0.00,$825.00,$447.98,$588.80,$0.00,$142.14,$0.00,$0.00,$144.45,$825.00,$0.00,$412.50,$653.40,$660.00,$0.00,$129.11,$0.00,$131.34,$0.00
M001125480,SUP,HCPCS C1753,,M001125480  -  CATHETER BLNDIL 8MM 40CM 30MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125490,SUP,HCPCS C1726,,M001125490  -  CATHETER BLNDIL 8MM 75CM 30MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125500,SUP,HCPCS C1753,,M001125500  -  CATHETER BLNDIL 8MM 120CM 30MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125510,SUP,HCPCS C1753,,M001125510  -  CATHETER BLNDIL 8MM 40CM 40MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125520,SUP,HCPCS C1753,,M001125520  -  CATHETER BLNDIL 8MM 75CM 40MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125530,SUP,HCPCS C1753,,M001125530  -  CATHETER BLNDIL 8MM 120CM 40MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125540,SUP,HCPCS C1753,,M001125540  -  CATHETER BLNDIL 8MM 40CM 80MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125550,SUP,HCPCS C1753,,M001125550  -  CATHETER BLNDIL 8MM 75CM 80MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125560,SUP,HCPCS C1753,,M001125560  -  CATHETER BLNDIL 8MM 120CM 80MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125580,SUP,HCPCS C1753,,M001125580  -  CATHETER BLNDIL 9MM 75CM 30MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125590,SUP,HCPCS C1753,,M001125590  -  CATHETER BLNDIL 9MM 120CM 30MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125600,SUP,HCPCS C1753,,M001125600  -  CATHETER BLNDIL 9MM 40CM 40MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125610,SUP,HCPCS C1753,,M001125610  -  CATHETER BLNDIL 9MM 75CM 40MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125620,SUP,HCPCS C1753,,M001125620  -  CATHETER BLNDIL 9MM 120CM 40MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125630,SUP,HCPCS C1753,,M001125630  -  CATHETER BLNDIL 9MM 40CM 80MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125640,SUP,HCPCS C1753,,M001125640  -  CATHETER BLNDIL 9MM 75CM 80MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125650,SUP,HCPCS C1753,,M001125650  -  CATHETER BLNDIL 9MM 120CM 80MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125660,SUP,HCPCS C1753,,M001125660  -  CATHETER BLNDIL 10MM 40CM 30MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125670,SUP,HCPCS C1753,,M001125670  -  CATHETER BLNDIL 10MM 75CM 30MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125680,SUP,HCPCS C1753,,M001125680  -  CATHETER BLNDIL 10MM 120CM 30MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125690,SUP,HCPCS C1753,,M001125690  -  CATHETER BLNDIL 10MM 40CM 40MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125700,SUP,HCPCS C1726,,M001125700  -  CATHETER BLNDIL 10MM 75CM 40MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125710,SUP,HCPCS C1753,,M001125710  -  CATHETER BLNDIL 10MM 120CM 40MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125720,SUP,HCPCS C1753,,M001125720  -  CATHETER BLNDIL 10MM 40CM 80MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125730,SUP,HCPCS C1753,,M001125730  -  CATHETER BLNDIL 10MM 75CM 80MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M001125740,SUP,HCPCS C1753,,M001125740  -  CATHETER BLNDIL 10MM 120CM 80MM BLU MAX 20 OTW HI-PRS PERI,$463.05,$0.00,$463.05,$251.44,$330.48,$0.00,$79.78,$0.00,$0.00,$81.08,$463.05,$0.00,$231.53,$366.74,$370.44,$0.00,$72.47,$0.00,$73.72,$0.00
M0011341080,SUP,HCPCS C1751,,M0011341080  -  CATH INFUS .014-.016IN 3-2.5FR .022-.021IN 150CM 20CM MCTH 1,"$1,437.50",$0.00,"$1,437.50",$780.56,"$1,025.94",$0.00,$247.67,$0.00,$0.00,$251.69,"$1,437.50",$0.00,$718.75,"$1,138.50","$1,150.00",$0.00,$224.97,$0.00,$228.85,$0.00
M001145080,SUP,HCPCS C1753,,M001145080  -  CATHETER BLNDIL 12MM 75CM 20MM XXL QD-FOLD SCRCH RST HI,$512.50,$0.00,$512.50,$278.29,$365.77,$0.00,$88.30,$0.00,$0.00,$89.73,$512.50,$0.00,$256.25,$405.90,$410.00,$0.00,$80.21,$0.00,$81.59,$0.00
M001145090,SUP,HCPCS C1753,,M001145090  -  CATHETER BLNDIL 12MM 120CM 20MM XXL SCRCH RST HI STRTH SHFT,$512.50,$0.00,$512.50,$278.29,$365.77,$0.00,$88.30,$0.00,$0.00,$89.73,$512.50,$0.00,$256.25,$405.90,$410.00,$0.00,$80.21,$0.00,$81.59,$0.00
M001145100,SUP,HCPCS C1726,,M001145100  -  CATHETER BLNDIL 12MM 75CM 40MM XXL SCRCH RST HI STRTH SHFT,$512.50,$0.00,$512.50,$278.29,$365.77,$0.00,$88.30,$0.00,$0.00,$89.73,$512.50,$0.00,$256.25,$405.90,$410.00,$0.00,$80.21,$0.00,$81.59,$0.00
M001145110,SUP,HCPCS C1726,,M001145110  -  CATHETER BLNDIL 12MM 120CM 40MM XXL QD-FOLD SCRCH RST HI,$512.50,$0.00,$512.50,$278.29,$365.77,$0.00,$88.30,$0.00,$0.00,$89.73,$512.50,$0.00,$256.25,$405.90,$410.00,$0.00,$80.21,$0.00,$81.59,$0.00
M001145120,SUP,HCPCS C1753,,M001145120  -  CATHETER BLNDIL 14MM 75CM 20MM XXL QD-FOLD SCRCH RST HI,$512.50,$0.00,$512.50,$278.29,$365.77,$0.00,$88.30,$0.00,$0.00,$89.73,$512.50,$0.00,$256.25,$405.90,$410.00,$0.00,$80.21,$0.00,$81.59,$0.00
M001145130,SUP,HCPCS C1753,,M001145130  -  CATHETER BLNDIL 14MM 120CM 20MM XXL SCRCH RST HI STRTH SHFT,$512.50,$0.00,$512.50,$278.29,$365.77,$0.00,$88.30,$0.00,$0.00,$89.73,$512.50,$0.00,$256.25,$405.90,$410.00,$0.00,$80.21,$0.00,$81.59,$0.00
M001145140,SUP,HCPCS C1753,,M001145140  -  CATHETER BLNDIL 14MM 75CM 40MM XXL SCRCH RST HI STRTH SHFT,$512.50,$0.00,$512.50,$278.29,$365.77,$0.00,$88.30,$0.00,$0.00,$89.73,$512.50,$0.00,$256.25,$405.90,$410.00,$0.00,$80.21,$0.00,$81.59,$0.00
M001145150,SUP,HCPCS C1726,,M001145150  -  CATHETER BLNDIL 14MM 120CM 40MM XXL QD-FOLD SCRCH RST HI,$512.50,$0.00,$512.50,$278.29,$365.77,$0.00,$88.30,$0.00,$0.00,$89.73,$512.50,$0.00,$256.25,$405.90,$410.00,$0.00,$80.21,$0.00,$81.59,$0.00
M001145300,SUP,HCPCS C1753,,M001145300  -  CATHETER BLNDIL 12MM 75CM 60MM XXL QD-FOLD SCRCH RST HI,$512.50,$0.00,$512.50,$278.29,$365.77,$0.00,$88.30,$0.00,$0.00,$89.73,$512.50,$0.00,$256.25,$405.90,$410.00,$0.00,$80.21,$0.00,$81.59,$0.00
M001145320,SUP,HCPCS C1753,,M001145320  -  CATHETER BLNDIL 14MM 75CM 60MM XXL QD-FOLD SCRCH RST HI,$512.50,$0.00,$512.50,$278.29,$365.77,$0.00,$88.30,$0.00,$0.00,$89.73,$512.50,$0.00,$256.25,$405.90,$410.00,$0.00,$80.21,$0.00,$81.59,$0.00
M001145500,SUP,HCPCS C1753,,M001145500  -  CATHETER BLNDIL 16MM 75CM 20MM XXL QD-FOLD SCRCH RST HI,$512.50,$0.00,$512.50,$278.29,$365.77,$0.00,$88.30,$0.00,$0.00,$89.73,$512.50,$0.00,$256.25,$405.90,$410.00,$0.00,$80.21,$0.00,$81.59,$0.00
M001145510,SUP,HCPCS C1753,,M001145510  -  CATHETER BLNDIL 16MM 120CM 20MM XXL SCRCH RST HI STRTH SHFT,$512.50,$0.00,$512.50,$278.29,$365.77,$0.00,$88.30,$0.00,$0.00,$89.73,$512.50,$0.00,$256.25,$405.90,$410.00,$0.00,$80.21,$0.00,$81.59,$0.00
M001145520,SUP,HCPCS C1753,,M001145520  -  CATHETER BLNDIL 16MM 75CM 40MM XXL QD-FOLD SCRCH RST HI,$512.50,$0.00,$512.50,$278.29,$365.77,$0.00,$88.30,$0.00,$0.00,$89.73,$512.50,$0.00,$256.25,$405.90,$410.00,$0.00,$80.21,$0.00,$81.59,$0.00
M001145530,SUP,HCPCS C1726,,M001145530  -  CATHETER BLNDIL 16MM 120CM 40MM XXL SCRCH RST HI STRTH SHFT,$512.50,$0.00,$512.50,$278.29,$365.77,$0.00,$88.30,$0.00,$0.00,$89.73,$512.50,$0.00,$256.25,$405.90,$410.00,$0.00,$80.21,$0.00,$81.59,$0.00
M001145540,SUP,HCPCS C1753,,M001145540  -  CATHETER BLNDIL 16MM 75CM 60MM XXL QD-FOLD SCRCH RST HI,$512.50,$0.00,$512.50,$278.29,$365.77,$0.00,$88.30,$0.00,$0.00,$89.73,$512.50,$0.00,$256.25,$405.90,$410.00,$0.00,$80.21,$0.00,$81.59,$0.00
M001145550,SUP,HCPCS C1753,,M001145550  -  CATHETER BLNDIL 18MM 75CM 20MM XXL QD-FOLD SCRCH RST HI,$512.50,$0.00,$512.50,$278.29,$365.77,$0.00,$88.30,$0.00,$0.00,$89.73,$512.50,$0.00,$256.25,$405.90,$410.00,$0.00,$80.21,$0.00,$81.59,$0.00
M001145560,SUP,HCPCS C1753,,M001145560  -  CATHETER BLNDIL 18MM 120CM 20MM XXL SCRCH RST HI STRTH SHFT,$512.50,$0.00,$512.50,$278.29,$365.77,$0.00,$88.30,$0.00,$0.00,$89.73,$512.50,$0.00,$256.25,$405.90,$410.00,$0.00,$80.21,$0.00,$81.59,$0.00
M001145570,SUP,HCPCS C1753,,M001145570  -  CATHETER BLNDIL 18MM 75CM 40MM XXL QD-FOLD SCRCH RST HI,$512.50,$0.00,$512.50,$278.29,$365.77,$0.00,$88.30,$0.00,$0.00,$89.73,$512.50,$0.00,$256.25,$405.90,$410.00,$0.00,$80.21,$0.00,$81.59,$0.00
M001145580,SUP,HCPCS C1726,,M001145580  -  CATHETER BLNDIL 18MM 120CM 40MM XXL SCRCH RST HI STRTH SHFT,$512.50,$0.00,$512.50,$278.29,$365.77,$0.00,$88.30,$0.00,$0.00,$89.73,$512.50,$0.00,$256.25,$405.90,$410.00,$0.00,$80.21,$0.00,$81.59,$0.00
M001145590,SUP,HCPCS C1753,,M001145590  -  CATHETER BLNDIL 18MM 75CM 60MM XXL QD-FOLD SCRCH RST HI,$512.50,$0.00,$512.50,$278.29,$365.77,$0.00,$88.30,$0.00,$0.00,$89.73,$512.50,$0.00,$256.25,$405.90,$410.00,$0.00,$80.21,$0.00,$81.59,$0.00
M001163980,SUP,HCPCS C1753,,M001163980  -  CATHETER BLNDIL 3MM 120CM 15MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164000,SUP,HCPCS C1753,,M001164000  -  CATHETER BLNDIL 3MM 40CM 20MM U-T D OTW 2 LUM TPR TIP HI-PRS,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164010,SUP,HCPCS C1753,,M001164010  -  CATHETER BLNDIL 3MM 75CM 20MM U-T D OTW 2 LUM TPR TIP HI-PRS,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164020,SUP,HCPCS C1753,,M001164020  -  CATHETER BLNDIL 3MM 120CM 20MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164030,SUP,HCPCS C1753,,M001164030  -  CATHETER BLNDIL 3MM 150CM 20MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164040,SUP,HCPCS C1753,,M001164040  -  CATHETER BLNDIL 3MM 40CM 40MM U-T D OTW 2 LUM TPR TIP HI-PRS,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164050,SUP,HCPCS C1753,,M001164050  -  CATHETER BLNDIL 3MM 75CM 40MM U-T D OTW 2 LUM TPR TIP HI-PRS,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164060,SUP,HCPCS C1753,,M001164060  -  CATHETER BLNDIL 3MM 120CM 40MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164070,SUP,HCPCS C1753,,M001164070  -  CATHETER BLNDIL 3MM 150CM 40MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164080,SUP,HCPCS C1753,,M001164080  -  CATHETER BLNDIL 3MM 40CM 100MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164090,SUP,HCPCS C1753,,M001164090  -  CATHETER BLNDIL 3MM 75CM 100MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164100,SUP,HCPCS C1753,,M001164100  -  CATHETER BLNDIL 3MM 120CM 100MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164110,SUP,HCPCS C1753,,M001164110  -  CATHETER BLNDIL 3MM 150CM 100MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164120,SUP,HCPCS C1753,,M001164120  -  CATHETER BLNDIL 4MM 40CM 15MM U-T D OTW 2 LUM TPR TIP HI-PRS,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164130,SUP,HCPCS C1753,,M001164130  -  CATHETER BLNDIL 4MM 75CM 15MM U-T D OTW 2 LUM TPR TIP HI-PRS,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164140,SUP,HCPCS C1753,,M001164140  -  CATHETER BLNDIL 4MM 120CM 15MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164150,SUP,HCPCS C1753,,M001164150  -  CATHETER BLNDIL 4MM 150CM 15MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164160,SUP,HCPCS C1753,,M001164160  -  CATHETER BLNDIL 4MM 40CM 20MM U-T D OTW 2 LUM TPR TIP HI-PRS,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164170,SUP,HCPCS C1726,,M001164170  -  CATHETER BLNDIL 4MM 75CM 20MM U-T D OTW 2 LUM TPR TIP HI-PRS,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164180,SUP,HCPCS C1726,,M001164180  -  CATHETER BLNDIL 4MM 120CM 20MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164190,SUP,HCPCS C1753,,M001164190  -  CATHETER BLNDIL 4MM 150CM 20MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164200,SUP,HCPCS C1753,,M001164200  -  CATHETER BLNDIL 4MM 75CM 30MM U-T D OTW 2 LUM TPR TIP HI-PRS,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164210,SUP,HCPCS C1753,,M001164210  -  CATHETER BLNDIL 4MM 120CM 30MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164220,SUP,HCPCS C1753,,M001164220  -  CATHETER BLNDIL 4MM 40CM 40MM U-T D OTW 2 LUM TPR TIP HI-PRS,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164230,SUP,HCPCS C1726,,M001164230  -  CATHETER BLNDIL 4MM 75CM 40MM U-T D OTW 2 LUM TPR TIP HI-PRS,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164240,SUP,HCPCS C1726,,M001164240  -  CATHETER BLNDIL 4MM 120CM 40MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164250,SUP,HCPCS C1753,,M001164250  -  CATHETER BLNDIL 4MM 150CM 40MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164280,SUP,HCPCS C1753,,M001164280  -  CATHETER BLNDIL 4MM 40CM 100MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164290,SUP,HCPCS C1726,,M001164290  -  CATHETER BLNDIL 4MM 75CM 100MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164300,SUP,HCPCS C1726,,M001164300  -  CATH BALDILAT 5FR 4MM 120CM 10CM PERI PTA OTW TPR SHFT LP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164310,SUP,HCPCS C1753,,M001164310  -  CATHETER BLNDIL 4MM 150CM 100MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164320,SUP,HCPCS C1753,,M001164320  -  CATHETER BLNDIL 5MM 40CM 15MM U-T D OTW 2 LUM TPR TIP HI-PRS,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164330,SUP,HCPCS C1753,,M001164330  -  CATHETER BLNDIL 5MM 75CM 15MM U-T D OTW 2 LUM TPR TIP HI-PRS,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164340,SUP,HCPCS C1753,,M001164340  -  CATHETER BLNDIL 5MM 120CM 15MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164350,SUP,HCPCS C1753,,M001164350  -  CATHETER BLNDIL 5MM 150CM 15MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164360,SUP,HCPCS C1753,,M001164360  -  CATHETER BLNDIL 5MM 40CM 20MM U-T D OTW 2 LUM TPR TIP HI-PRS,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164370,SUP,HCPCS C1753,,M001164370  -  CATHETER BLNDIL 5MM 75CM 20MM U-T D OTW 2 LUM TPR TIP HI-PRS,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164380,SUP,HCPCS C1753,,M001164380  -  CATHETER BLNDIL 5MM 120CM 50MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164390,SUP,HCPCS C1753,,M001164390  -  CATHETER BLNDIL 5MM 150CM 20MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164400,SUP,HCPCS C1753,,M001164400  -  CATHETER BLNDIL 5MM 75CM 30MM U-T D OTW 2 LUM TPR TIP HI-PRS,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164410,SUP,HCPCS C1753,,M001164410  -  CATHETER BLNDIL 5MM 120CM 30MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164420,SUP,HCPCS C1753,,M001164420  -  CATHETER BLNDIL 5MM 40CM 40MM U-T D OTW 2 LUM TPR TIP HI-PRS,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164430,SUP,HCPCS C1753,,M001164430  -  CATHETER BLNDIL 5MM 75CM 40MM U-T D OTW 2 LUM TPR TIP HI-PRS,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164440,SUP,HCPCS C1753,,M001164440  -  CATHETER BLNDIL 5MM 120CM 40MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164450,SUP,HCPCS C1753,,M001164450  -  CATHETER BLNDIL 5MM 150CM 40MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164480,SUP,HCPCS C1753,,M001164480  -  CATHETER BLNDIL 5MM 40CM 100MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164490,SUP,HCPCS C1726,,M001164490  -  CATHETER BLNDIL 5MM 75CM 100MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164500,SUP,HCPCS C1726,,M001164500  -  CATH BALDILAT 5FR 5MM 120CM 10CM PERI PTA OTW TPR SHFT LP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164510,SUP,HCPCS C1753,,M001164510  -  CATHETER BLNDIL 5MM 150CM 100MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164520,SUP,HCPCS C1753,,M001164520  -  CATHETER BLNDIL 6MM 40CM 15MM U-T D OTW 2 LUM TPR TIP HI-PRS,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164530,SUP,HCPCS C1753,,M001164530  -  CATHETER BLNDIL 6MM 75CM 15MM U-T D OTW 2 LUM TPR TIP HI-PRS,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164540,SUP,HCPCS C1753,,M001164540  -  CATHETER BLNDIL 6MM 120CM 15MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164550,SUP,HCPCS C1753,,M001164550  -  CATHETER BLNDIL 6MM 150CM 15MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164560,SUP,HCPCS C1753,,M001164560  -  CATHETER BLNDIL 6MM 40CM 20MM U-T D OTW 2 LUM TPR TIP HI-PRS,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164570,SUP,HCPCS C1753,,M001164570  -  CATHETER BLNDIL 6MM 75CM 20MM U-T D OTW 2 LUM TPR TIP HI-PRS,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164580,SUP,HCPCS C1753,,M001164580  -  CATHETER BLNDIL 6MM 120CM 20MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164590,SUP,HCPCS C1753,,M001164590  -  CATHETER BLNDIL 6MM 150CM 20MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164600,SUP,HCPCS C1753,,M001164600  -  CATHETER BLNDIL 6MM 75CM 30MM U-T D OTW 2 LUM TPR TIP HI-PRS,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164610,SUP,HCPCS C1753,,M001164610  -  CATHETER BLNDIL 6MM 120CM 30MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164620,SUP,HCPCS C1753,,M001164620  -  CATHETER BLNDIL TPR 6MM 40CM 40MM U-T D OTW NC HDRPH PERI,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164630,SUP,HCPCS C1753,,M001164630  -  CATHETER BLNDIL 6MM 75CM 40MM U-T D OTW 2 LUM TPR TIP HI-PRS,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164640,SUP,HCPCS C1753,,M001164640  -  CATHETER BLNDIL 6MM 120CM 40MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164650,SUP,HCPCS C1753,,M001164650  -  CATHETER BLNDIL 6MM 150CM 40MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164680,SUP,HCPCS C1753,,M001164680  -  CATHETER BLNDIL 6MM 40CM 100MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164690,SUP,HCPCS C1726,,M001164690  -  CATHETER BLNDIL TPR 6MM 75CM 100MM U-T D OTW NC HDRPH PERI,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164700,SUP,HCPCS C1726,,M001164700  -  CATHETER BLNDIL 6MM 120CM 100MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164710,SUP,HCPCS C1753,,M001164710  -  CATHETER BLNDIL 6MM 150CM 100MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164720,SUP,HCPCS C1753,,M001164720  -  CATHETER BLNDIL 7MM 40CM 15MM U-T D OTW 2 LUM TPR TIP HI-PRS,$509.93,$0.00,$509.93,$276.89,$363.93,$0.00,$87.86,$0.00,$0.00,$89.28,$509.93,$0.00,$254.96,$403.86,$407.94,$0.00,$79.80,$0.00,$81.18,$0.00
M001164730,SUP,HCPCS C1753,,M001164730  -  CATHETER BLNDIL 7MM 75CM 15MM U-T D OTW 2 LUM TPR TIP HI-PRS,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164740,SUP,HCPCS C1753,,M001164740  -  CATHETER BLNDIL 7MM 120CM 15MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164750,SUP,HCPCS C1753,,M001164750  -  CATHETER BLNDIL 7MM 150CM 15MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164760,SUP,HCPCS C1753,,M001164760  -  CATHETER BLNDIL 7MM 40CM 20MM U-T D OTW 2 LUM TPR TIP HI-PRS,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164770,SUP,HCPCS C1753,,M001164770  -  CATHETER BLNDIL 7MM 75CM 20MM U-T D OTW 2 LUM TPR TIP HI-PRS,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164780,SUP,HCPCS C1753,,M001164780  -  CATHETER BLNDIL 7MM 120CM 20MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164790,SUP,HCPCS C1753,,M001164790  -  CATHETER BLNDIL 7MM 150CM 20MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164800,SUP,HCPCS C1753,,M001164800  -  CATHETER BLNDIL 7MM 75CM 30MM U-T D OTW 2 LUM TPR TIP HI-PRS,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164810,SUP,HCPCS C1753,,M001164810  -  CATHETER BLNDIL 7MM 120CM 30MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164820,SUP,HCPCS C1753,,M001164820  -  CATHETER BLNDIL TPR 7MM 40CM 40MM U-T D OTW NC HDRPH PERI,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164830,SUP,HCPCS C1753,,M001164830  -  CATHETER BLNDIL 7MM 75CM 40MM U-T D OTW 2 LUM TPR TIP HI-PRS,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164840,SUP,HCPCS C1753,,M001164840  -  CATHETER BLNDIL 7MM 120CM 40MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164850,SUP,HCPCS C1753,,M001164850  -  CATHETER BLNDIL 7MM 150CM 40MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164880,SUP,HCPCS C1753,,M001164880  -  CATHETER BLNDIL 7MM 40CM 100MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164890,SUP,HCPCS C1753,,M001164890  -  CATHETER BLNDIL TPR 7MM 75CM 100MM U-T D OTW NC HDRPH PERI,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164900,SUP,HCPCS C1753,,M001164900  -  CATHETER BLNDIL 7MM 120CM 100MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164910,SUP,HCPCS C1753,,M001164910  -  CATHETER BLNDIL 7MM 150CM 100MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164920,SUP,HCPCS C1753,,M001164920  -  CATHETER BLNDIL 8MM 40CM 15MM U-T D OTW 2 LUM TPR TIP HI-PRS,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164930,SUP,HCPCS C1753,,M001164930  -  CATHETER BLNDIL 8MM 75CM 15MM U-T D OTW 2 LUM TPR TIP HI-PRS,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164940,SUP,HCPCS C1753,,M001164940  -  CATHETER BLNDIL 8MM 120CM 15MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164950,SUP,HCPCS C1753,,M001164950  -  CATHETER BLNDIL 8MM 150CM 15MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164960,SUP,HCPCS C1753,,M001164960  -  CATHETER BLNDIL 8MM 40CM 20MM U-T D OTW 2 LUM TPR TIP HI-PRS,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164970,SUP,HCPCS C1753,,M001164970  -  CATHETER BLNDIL 8MM 75CM 20MM U-T D OTW 2 LUM TPR TIP HI-PRS,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164980,SUP,HCPCS C1753,,M001164980  -  CATHETER BLNDIL 8MM 120CM 20MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001164990,SUP,HCPCS C1753,,M001164990  -  CATHETER BLNDIL 8MM 150CM 20MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001165000,SUP,HCPCS C1753,,M001165000  -  CATHETER BLNDIL 8MM 40CM 30MM U-T D OTW 2 LUM TPR TIP HI-PRS,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001165010,SUP,HCPCS C1726,,M001165010  -  CATHETER BLNDIL 8MM 75CM 30MM U-T D OTW 2 LUM TPR TIP HI-PRS,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001165020,SUP,HCPCS C1753,,M001165020  -  CATHETER BLNDIL 8MM 120CM 30MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001165030,SUP,HCPCS C1753,,M001165030  -  CATHETER BLNDIL 8MM 150CM 30MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001165040,SUP,HCPCS C1753,,M001165040  -  CATHETER BLNDIL TPR 8MM 40CM 40MM U-T D OTW NC HDRPH PERI,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001165050,SUP,HCPCS C1753,,M001165050  -  CATHETER BLNDIL 8MM 75CM 40MM U-T D OTW 2 LUM TPR TIP HI-PRS,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001165060,SUP,HCPCS C1753,,M001165060  -  CATHETER BLNDIL 8MM 120CM 40MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001165070,SUP,HCPCS C1753,,M001165070  -  CATHETER BLNDIL 8MM 150CM 40MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001165080,SUP,HCPCS C1753,,M001165080  -  CATHETER BLNDIL 8MM 40CM 80MM U-T D OTW 2 LUM TPR TIP HI-PRS,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001165090,SUP,HCPCS C1753,,M001165090  -  CATHETER BLNDIL 8MM 75CM 80MM U-T D OTW 2 LUM TPR TIP HI-PRS,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001165100,SUP,HCPCS C1753,,M001165100  -  CATHETER BLNDIL 8MM 120CM 80MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001165110,SUP,HCPCS C1753,,M001165110  -  CATHETER BLNDIL 8MM 150CM 80MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001165120,SUP,HCPCS C1753,,M001165120  -  CATHETER BLNDIL 9MM 40CM 20MM U-T D OTW 2 LUM TPR TIP HI-PRS,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001165130,SUP,HCPCS C1753,,M001165130  -  CATHETER BLNDIL 9MM 75CM 20MM U-T D OTW 2 LUM TPR TIP HI-PRS,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001165140,SUP,HCPCS C1753,,M001165140  -  CATHETER BLNDIL 9MM 120CM 20MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001165150,SUP,HCPCS C1753,,M001165150  -  CATHETER BLNDIL 9MM 150CM 20MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001165160,SUP,HCPCS C1753,,M001165160  -  CATHETER BLNDIL 9MM 40CM 40MM U-T D OTW 2 LUM TPR TIP HI-PRS,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001165170,SUP,HCPCS C1753,,M001165170  -  CATHETER BLNDIL 9MM 75CM 40MM U-T D OTW 2 LUM TPR TIP HI-PRS,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001165180,SUP,HCPCS C1753,,M001165180  -  CATHETER BLNDIL 9MM 120CM 40MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001165190,SUP,HCPCS C1753,,M001165190  -  CATHETER BLNDIL 9MM 150CM 40MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001165200,SUP,HCPCS C1753,,M001165200  -  CATHETER BLNDIL 10MM 40CM 20MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001165210,SUP,HCPCS C1753,,M001165210  -  CATHETER BLNDIL 10MM 75CM 20MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001165220,SUP,HCPCS C1753,,M001165220  -  CATHETER BLNDIL 10MM 120CM 20MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001165230,SUP,HCPCS C1753,,M001165230  -  CATHETER BLNDIL 10MM 150CM 20MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001165240,SUP,HCPCS C1753,,M001165240  -  CATHETER BLNDIL TPR 10MM 40CM 40MM U-T D OTW NC HDRPH PERI,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001165250,SUP,HCPCS C1753,,M001165250  -  CATHETER BLNDIL 10MM 75CM 40MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001165260,SUP,HCPCS C1753,,M001165260  -  CATHETER BLNDIL 10MM 120CM 40MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001165270,SUP,HCPCS C1753,,M001165270  -  CATHETER BLNDIL 10MM 150CM 40MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001165290,SUP,HCPCS C1726,,M001165290  -  CATHETER BLNDIL 12MM 75CM 20MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001165300,SUP,HCPCS C1753,,M001165300  -  CATHETER BLNDIL 12MM 120CM 20MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001165330,SUP,HCPCS C1753,,M001165330  -  CATHETER BLNDIL 12MM 75CM 40MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001165340,SUP,HCPCS C1753,,M001165340  -  CATHETER BLNDIL 12MM 120CM 40MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001165550,SUP,HCPCS C1753,,M001165550  -  CATHETER BLNDIL 4MM 75CM 60MM U-T D OTW 2 LUM TPR TIP HI-PRS,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001165560,SUP,HCPCS C1753,,M001165560  -  CATHETER BLNDIL 4MM 120CM 60MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001165590,SUP,HCPCS C1753,,M001165590  -  CATHETER BLNDIL 5MM 75CM 60MM U-T D OTW 2 LUM TPR TIP HI-PRS,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001165600,SUP,HCPCS C1753,,M001165600  -  CATHETER BLNDIL 5MM 120CM 60MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001165630,SUP,HCPCS C1753,,M001165630  -  CATHETER BLNDIL 6MM 75CM 60MM U-T D OTW 2 LUM TPR TIP HI-PRS,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001165640,SUP,HCPCS C1753,,M001165640  -  CATHETER BLNDIL 6MM 120CM 60MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001165670,SUP,HCPCS C1753,,M001165670  -  CATHETER BLNDIL 7MM 75CM 60MM U-T D OTW 2 LUM TPR TIP HI-PRS,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001165680,SUP,HCPCS C1753,,M001165680  -  CATHETER BLNDIL 7MM 120CM 60MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001169410,SUP,HCPCS C1753,,M001169410  -  CATHETER BLNDIL 3MM 135CM 20MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001169420,SUP,HCPCS C1753,,M001169420  -  CATHETER BLNDIL 3MM 135CM 40MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001169430,SUP,HCPCS C1753,,M001169430  -  CATHETER BLNDIL 3MM 135CM 100MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001169440,SUP,HCPCS C1753,,M001169440  -  CATHETER BLNDIL 4MM 135CM 15MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001169450,SUP,HCPCS C1753,,M001169450  -  CATHETER BLNDIL 4MM 135CM 20MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001169460,SUP,HCPCS C1753,,M001169460  -  CATHETER BLNDIL 4MM 135CM 30MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001169470,SUP,HCPCS C1753,,M001169470  -  CATHETER BLNDIL 4MM 135CM 40MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001169480,SUP,HCPCS C1753,,M001169480  -  CATHETER BLNDIL 4MM 135CM 60MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001169490,SUP,HCPCS C1753,,M001169490  -  CATHETER BLNDIL 4MM 135CM 100MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001169510,SUP,HCPCS C1753,,M001169510  -  CATHETER BLNDIL 5MM 135CM 20MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001169520,SUP,HCPCS C1753,,M001169520  -  CATHETER BLNDIL 5MM 135CM 30MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001169530,SUP,HCPCS C1753,,M001169530  -  CATHETER BLNDIL 5MM 135CM 40MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001169540,SUP,HCPCS C1753,,M001169540  -  CATHETER BLNDIL 5MM 135CM 60MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001169550,SUP,HCPCS C1753,,M001169550  -  CATHETER BLNDIL 5MM 135CM 100MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001169570,SUP,HCPCS C1753,,M001169570  -  CATHETER BLNDIL 6MM 135CM 20MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001169580,SUP,HCPCS C1753,,M001169580  -  CATHETER BLNDIL 6MM 135CM 30MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001169590,SUP,HCPCS C1753,,M001169590  -  CATHETER BLNDIL 6MM 135CM 40MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001169600,SUP,HCPCS C1753,,M001169600  -  CATHETER BLNDIL 6MM 135CM 60MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001169610,SUP,HCPCS C1753,,M001169610  -  CATHETER BLNDIL 6MM 135CM 100MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001169620,SUP,HCPCS C1753,,M001169620  -  CATHETER BLNDIL 7MM 135CM 15MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001169630,SUP,HCPCS C1753,,M001169630  -  CATHETER BLNDIL 7MM 135CM 20MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001169640,SUP,HCPCS C1753,,M001169640  -  CATHETER BLNDIL 7MM 135CM 30MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001169650,SUP,HCPCS C1753,,M001169650  -  CATHETER BLNDIL 7MM 135CM 40MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001169660,SUP,HCPCS C1753,,M001169660  -  CATHETER BLNDIL 7MM 135CM 60MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001169670,SUP,HCPCS C1753,,M001169670  -  CATHETER BLNDIL 7MM 135CM 100MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001169690,SUP,HCPCS C1753,,M001169690  -  CATHETER BLNDIL 8MM 135CM 20MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001169700,SUP,HCPCS C1753,,M001169700  -  CATHETER BLNDIL 8MM 135CM 30MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001169710,SUP,HCPCS C1753,,M001169710  -  CATHETER BLNDIL 8MM 135CM 40MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001169720,SUP,HCPCS C1753,,M001169720  -  CATHETER BLNDIL 8MM 135CM 60MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001169730,SUP,HCPCS C1753,,M001169730  -  CATHETER BLNDIL 8MM 135CM 80MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001169740,SUP,HCPCS C1753,,M001169740  -  CATHETER BLNDIL 9MM 135CM 20MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001169750,SUP,HCPCS C1753,,M001169750  -  CATHETER BLNDIL 9MM 135CM 40MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001169760,SUP,HCPCS C1753,,M001169760  -  CATHETER BLNDIL 10MM 135CM 20MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001169770,SUP,HCPCS C1753,,M001169770  -  CATHETER BLNDIL 10MM 135CM 40MM U-T D OTW 2 LUM TPR TIP,$415.25,$0.00,$415.25,$225.48,$296.36,$0.00,$71.55,$0.00,$0.00,$72.71,$415.25,$0.00,$207.63,$328.88,$332.20,$0.00,$64.99,$0.00,$66.11,$0.00
M001171020,SUP,Custom 27203010,,M001171020  -  CATHETER BALLOON OCCLUSION STANDARD 7FR 110.5MM 65CM 2 LUMEN,$471.45,$0.00,$471.45,$0.00,$336.47,$0.00,$0.00,$0.00,$0.00,$0.00,$471.45,$0.00,$235.73,$373.39,$377.16,$0.00,$0.00,$0.00,$0.00,$0.00
M001171030,SUP,HCPCS C2628,,M001171030  -  CATHETER BALLOON OCCLUSION STANDARD 7FR 110.5MM 100CM 2,$471.45,$0.00,$471.45,$0.00,$336.47,$0.00,$0.00,$0.00,$0.00,$0.00,$471.45,$0.00,$235.73,$373.39,$377.16,$0.00,$0.00,$0.00,$0.00,$0.00
M001171050,SUP,HCPCS C1726,,M001171050  -  CATHETER BALLOON OCCLUSION 14FR 20MM 65CM 2 LUMEN RADIOPQ,$605.65,$0.00,$605.65,$328.87,$432.25,$0.00,$104.35,$0.00,$0.00,$106.04,$605.65,$0.00,$302.83,$479.67,$484.52,$0.00,$94.78,$0.00,$96.42,$0.00
M001171060,SUP,HCPCS C1726,,M001171060  -  CATHETER BALLOON OCCLUSION 14FR 20MM 100CM 2 LUMEN GWIRE,$605.65,$0.00,$605.65,$328.87,$432.25,$0.00,$104.35,$0.00,$0.00,$106.04,$605.65,$0.00,$302.83,$479.67,$484.52,$0.00,$94.78,$0.00,$96.42,$0.00
M001171070,SUP,HCPCS C1726,,M001171070  -  CATHETER BALLOON OCCLUSION 7FR 27MM 65CM 2 LUMEN RADIOPQ,$605.65,$0.00,$605.65,$328.87,$432.25,$0.00,$104.35,$0.00,$0.00,$106.04,$605.65,$0.00,$302.83,$479.67,$484.52,$0.00,$94.78,$0.00,$96.42,$0.00
M001171080,SUP,HCPCS C1726,,M001171080  -  CATH BLNOCC .038IN 7FR 27MM 100CM 2 LUM EQLZR 10ML,$575.93,$0.00,$575.93,$312.73,$411.04,$0.00,$99.23,$0.00,$0.00,$100.84,$575.93,$0.00,$287.96,$456.14,$460.74,$0.00,$90.13,$0.00,$91.69,$0.00
M001171090,SUP,HCPCS C1726,,M001171090  -  CATHETER BALLOON OCCLUSION 7FR 33MM 65CM 2 LUMEN RADIOPQ,$605.65,$0.00,$605.65,$328.87,$432.25,$0.00,$104.35,$0.00,$0.00,$106.04,$605.65,$0.00,$302.83,$479.67,$484.52,$0.00,$94.78,$0.00,$96.42,$0.00
M001171100,SUP,HCPCS C1726,,M001171100  -  CATHETER BALLOON OCCLUSION 16FR 33MM 100CM 2 LUMEN RADIOPQ,$605.65,$0.00,$605.65,$328.87,$432.25,$0.00,$104.35,$0.00,$0.00,$106.04,$605.65,$0.00,$302.83,$479.67,$484.52,$0.00,$94.78,$0.00,$96.42,$0.00
M001171110,SUP,HCPCS C1726,,M001171110  -  CATHETER BALLOON OCCLUSION 7FR 40MM 65CM 2 LUMEN RADIOPQ,$605.65,$0.00,$605.65,$328.87,$432.25,$0.00,$104.35,$0.00,$0.00,$106.04,$605.65,$0.00,$302.83,$479.67,$484.52,$0.00,$94.78,$0.00,$96.42,$0.00
M001171120,SUP,HCPCS C1726,,M001171120  -  CATHETER BALLOON OCCLUSION 7FR 40MM 100CM 2 LUMEN RADIOPQ,$605.65,$0.00,$605.65,$328.87,$432.25,$0.00,$104.35,$0.00,$0.00,$106.04,$605.65,$0.00,$302.83,$479.67,$484.52,$0.00,$94.78,$0.00,$96.42,$0.00
M001173010,SUP,HCPCS C2628,,M001173010  -  CATHETER BALLOON OCCLUSION 6FR 11.5MM 80CM 2 LUMEN RADIOPQ,$471.45,$0.00,$471.45,$0.00,$336.47,$0.00,$0.00,$0.00,$0.00,$0.00,$471.45,$0.00,$235.73,$373.39,$377.16,$0.00,$0.00,$0.00,$0.00,$0.00
M001175000,SUP,Custom 27203010,,M001175000  -  CATHETER BLNOCC .035IN 5FR 8.5MM 65CM EQLZR 2 LUM,$551.13,$0.00,$551.13,$0.00,$393.34,$0.00,$0.00,$0.00,$0.00,$0.00,$551.13,$0.00,$275.56,$436.49,$440.90,$0.00,$0.00,$0.00,$0.00,$0.00
M001181250,SUP,HCPCS C1887,,M001181250  -  MICROCATHETER INFS STRG 3-2.4FR 105CM RNGD STC 18 RADOPQ,"$1,008.00",$0.00,"$1,008.00",$547.34,$719.41,$0.00,$173.67,$0.00,$0.00,$176.49,"$1,008.00",$0.00,$504.00,$798.34,$806.40,$0.00,$157.75,$0.00,$160.47,$0.00
M001181260,SUP,HCPCS C1887,,M001181260  -  MICROCATHETER INFS STRG 3-2.4FR 105CM RNGD STC 18 RADOPQ,"$1,008.00",$0.00,"$1,008.00",$547.34,$719.41,$0.00,$173.67,$0.00,$0.00,$176.49,"$1,008.00",$0.00,$504.00,$798.34,$806.40,$0.00,$157.75,$0.00,$160.47,$0.00
M001181270,SUP,HCPCS C1887,,M001181270  -  MICROCATHETER INFS 90D 3-2.4FR 105CM RNGD STC 18 RADOPQ,"$1,055.25",$0.00,"$1,055.25",$573.00,$753.13,$0.00,$181.81,$0.00,$0.00,$184.77,"$1,055.25",$0.00,$527.63,$835.76,$844.20,$0.00,$165.15,$0.00,$168.00,$0.00
M001181280,SUP,HCPCS C1887,,M001181280  -  MICROCATHETER INFS 90D 3-2.4FR 105CM RNGD STC 18 RADOPQ,"$1,055.25",$0.00,"$1,055.25",$573.00,$753.13,$0.00,$181.81,$0.00,$0.00,$184.77,"$1,055.25",$0.00,$527.63,$835.76,$844.20,$0.00,$165.15,$0.00,$168.00,$0.00
M001181310,SUP,HCPCS C1887,,M001181310  -  MICROCATHETER INFS STRG 3-2.4FR 130CM RNGD STC 18 RADOPQ,"$1,008.00",$0.00,"$1,008.00",$547.34,$719.41,$0.00,$173.67,$0.00,$0.00,$176.49,"$1,008.00",$0.00,$504.00,$798.34,$806.40,$0.00,$157.75,$0.00,$160.47,$0.00
M001181320,SUP,HCPCS C1887,,M001181320  -  MICROCATHETER INFS STRG 3-2.4FR 130CM RNGD STC 18 RADOPQ,"$1,008.00",$0.00,"$1,008.00",$547.34,$719.41,$0.00,$173.67,$0.00,$0.00,$176.49,"$1,008.00",$0.00,$504.00,$798.34,$806.40,$0.00,$157.75,$0.00,$160.47,$0.00
M001181330,SUP,HCPCS C1887,,M001181330  -  MICROCATHETER INFS 90D 3-2.4FR 130CM RNGD STC 18 RADOPQ,"$1,055.25",$0.00,"$1,055.25",$573.00,$753.13,$0.00,$181.81,$0.00,$0.00,$184.77,"$1,055.25",$0.00,$527.63,$835.76,$844.20,$0.00,$165.15,$0.00,$168.00,$0.00
M001181340,SUP,HCPCS C1887,,M001181340  -  MICROCATHETER INFS 90D 3-2.4FR 130CM RNGD STC 18 RADOPQ,"$1,055.25",$0.00,"$1,055.25",$573.00,$753.13,$0.00,$181.81,$0.00,$0.00,$184.77,"$1,055.25",$0.00,$527.63,$835.76,$844.20,$0.00,$165.15,$0.00,$168.00,$0.00
M001181370,SUP,HCPCS C1887,,M001181370  -  MICROCATHETER INFS STRG 3-2.4FR 150CM RNGD STC 18 RADOPQ,"$1,008.00",$0.00,"$1,008.00",$547.34,$719.41,$0.00,$173.67,$0.00,$0.00,$176.49,"$1,008.00",$0.00,$504.00,$798.34,$806.40,$0.00,$157.75,$0.00,$160.47,$0.00
M001181380,SUP,HCPCS C1887,,M001181380  -  MICROCATHETER INFS STRG 3-2.4FR 150CM RNGD STC 18 RADOPQ,"$1,008.00",$0.00,"$1,008.00",$547.34,$719.41,$0.00,$173.67,$0.00,$0.00,$176.49,"$1,008.00",$0.00,$504.00,$798.34,$806.40,$0.00,$157.75,$0.00,$160.47,$0.00
M001181390,SUP,HCPCS C1887,,M001181390  -  MICROCATHETER INFS 90D 3-2.4FR 150CM RNGD STC 18 RADOPQ,"$1,055.25",$0.00,"$1,055.25",$573.00,$753.13,$0.00,$181.81,$0.00,$0.00,$184.77,"$1,055.25",$0.00,$527.63,$835.76,$844.20,$0.00,$165.15,$0.00,$168.00,$0.00
M001181400,SUP,HCPCS C1887,,M001181400  -  MICROCATHETER INFS 90D 3-2.4FR 150CM RNGD STC 18 RADOPQ,"$1,055.25",$0.00,"$1,055.25",$573.00,$753.13,$0.00,$181.81,$0.00,$0.00,$184.77,"$1,055.25",$0.00,$527.63,$835.76,$844.20,$0.00,$165.15,$0.00,$168.00,$0.00
M001182590,SUP,HCPCS C1887,,M001182590  -  MICROCATHETER INFS 3-2.5FR 150CM RNGD RADOPQ BRD DIST TIP,"$1,662.50",$0.00,"$1,662.50",$902.74,"$1,186.53",$0.00,$286.44,$0.00,$0.00,$291.09,"$1,662.50",$0.00,$831.25,"$1,316.70","$1,330.00",$0.00,$260.18,$0.00,$264.67,$0.00
M001182830,SUP,HCPCS C1751,,M001182830  -  CATHETER INFUS MICRO 3-2.8FR .027IN 80CM 20CM KIT RADIOPQ,$899.60,$0.00,$899.60,$488.48,$642.04,$0.00,$155.00,$0.00,$0.00,$157.51,$899.60,$0.00,$449.80,$712.48,$719.68,$0.00,$140.79,$0.00,$143.22,$0.00
M001182840,SUP,HCPCS C1751,,M001182840  -  CATHETER INFUS STR 20.8-30FR .027IN 105CM 10CM RENEGADE,$899.60,$0.00,$899.60,$488.48,$642.04,$0.00,$155.00,$0.00,$0.00,$157.51,$899.60,$0.00,$449.80,$712.48,$719.68,$0.00,$140.79,$0.00,$143.22,$0.00
M001182850,SUP,HCPCS C1751,,M001182850  -  CATHETER INFUS MICRO 3-2.8FR .027IN 105CM 20CM KIT RADIOPQ,$899.60,$0.00,$899.60,$488.48,$642.04,$0.00,$155.00,$0.00,$0.00,$157.51,$899.60,$0.00,$449.80,$712.48,$719.68,$0.00,$140.79,$0.00,$143.22,$0.00
M001182860,SUP,HCPCS C1751,,M001182860  -  CATHETER INFUS MICRO 3-2.8FR .027IN 115CM 10CM KIT RADIOPQ,$899.60,$0.00,$899.60,$488.48,$642.04,$0.00,$155.00,$0.00,$0.00,$157.51,$899.60,$0.00,$449.80,$712.48,$719.68,$0.00,$140.79,$0.00,$143.22,$0.00
M001182870,SUP,HCPCS C1751,,M001182870  -  CATHETER INFUS MICRO 3-2.8FR .027IN 115CM 20CM KIT RADIOPQ,$899.60,$0.00,$899.60,$488.48,$642.04,$0.00,$155.00,$0.00,$0.00,$157.51,$899.60,$0.00,$449.80,$712.48,$719.68,$0.00,$140.79,$0.00,$143.22,$0.00
M001182880,SUP,HCPCS C1751,,M001182880  -  CATHETER INFUS MICRO 3-2.8FR .027IN 135CM 10CM KIT RADIOPQ,$899.60,$0.00,$899.60,$488.48,$642.04,$0.00,$155.00,$0.00,$0.00,$157.51,$899.60,$0.00,$449.80,$712.48,$719.68,$0.00,$140.79,$0.00,$143.22,$0.00
M001182890,SUP,HCPCS C1751,,M001182890  -  CATHETER INFUS MICRO 3-2.8FR .027IN 135CM 20CM KIT RADIOPQ,$899.60,$0.00,$899.60,$488.48,$642.04,$0.00,$155.00,$0.00,$0.00,$157.51,$899.60,$0.00,$449.80,$712.48,$719.68,$0.00,$140.79,$0.00,$143.22,$0.00
M001182900,SUP,HCPCS C1751,,M001182900  -  CATHETER INFUS MICRO 3-2.8FR .027IN 150CM 10CM KIT RADIOPQ,$899.60,$0.00,$899.60,$488.48,$642.04,$0.00,$155.00,$0.00,$0.00,$157.51,$899.60,$0.00,$449.80,$712.48,$719.68,$0.00,$140.79,$0.00,$143.22,$0.00
M001182910,SUP,HCPCS C1751,,M001182910  -  CATHETER INFUS MICRO 3-2.8FR .027IN 150CM 20CM KIT RADIOPQ,$899.60,$0.00,$899.60,$488.48,$642.04,$0.00,$155.00,$0.00,$0.00,$157.51,$899.60,$0.00,$449.80,$712.48,$719.68,$0.00,$140.79,$0.00,$143.22,$0.00
M001182920,SUP,HCPCS C1887,,M001182920  -  CATHETER INFUS 105CM KIT MICROCATHETER RADIOPQ MARKER,"$1,193.53",$0.00,"$1,193.53",$648.08,$851.82,$0.00,$205.64,$0.00,$0.00,$208.98,"$1,193.53",$0.00,$596.76,$945.28,$954.82,$0.00,$186.79,$0.00,$190.01,$0.00
M001182930,SUP,HCPCS C1887,,M001182930  -  CATHETER INFUS 105CM KIT RADIOPQ BRAID HI-FLO RENEGADE MICRO,"$1,193.53",$0.00,"$1,193.53",$648.08,$851.82,$0.00,$205.64,$0.00,$0.00,$208.98,"$1,193.53",$0.00,$596.76,$945.28,$954.82,$0.00,$186.79,$0.00,$190.01,$0.00
M001182940,SUP,HCPCS C1887,,M001182940  -  CATHETER INFUS 115CM KIT RADIOPQ BRAID HI-FLO RENEGADE MICRO,"$1,193.53",$0.00,"$1,193.53",$648.08,$851.82,$0.00,$205.64,$0.00,$0.00,$208.98,"$1,193.53",$0.00,$596.76,$945.28,$954.82,$0.00,$186.79,$0.00,$190.01,$0.00
M001182950,SUP,HCPCS C1887,,M001182950  -  CATHETER INFUS 115CM KIT RADIOPQ BRAID HI-FLO RENEGADE MICRO,"$1,193.53",$0.00,"$1,193.53",$648.08,$851.82,$0.00,$205.64,$0.00,$0.00,$208.98,"$1,193.53",$0.00,$596.76,$945.28,$954.82,$0.00,$186.79,$0.00,$190.01,$0.00
M001182960,SUP,HCPCS C1887,,M001182960  -  CATHETER INFUS 135CM KIT RADIOPQ BRAID HI-FLO RENEGADE MICRO,"$1,193.53",$0.00,"$1,193.53",$648.08,$851.82,$0.00,$205.64,$0.00,$0.00,$208.98,"$1,193.53",$0.00,$596.76,$945.28,$954.82,$0.00,$186.79,$0.00,$190.01,$0.00
M001182970,SUP,HCPCS C1887,,M001182970  -  CATHETER INFUS 135CM KIT RADIOPQ BRAID HI-FLO RENEGADE MICRO,"$1,193.53",$0.00,"$1,193.53",$648.08,$851.82,$0.00,$205.64,$0.00,$0.00,$208.98,"$1,193.53",$0.00,$596.76,$945.28,$954.82,$0.00,$186.79,$0.00,$190.01,$0.00
M001184500,SUP,HCPCS C1887,,M001184500  -  GUIDEWIRE VASCULAR .016IN 105CM 10CM PRELOAD HI-FLO RENEGADE,"$1,540.00",$0.00,"$1,540.00",$836.22,"$1,099.10",$0.00,$265.33,$0.00,$0.00,$269.64,"$1,540.00",$0.00,$770.00,"$1,219.68","$1,232.00",$0.00,$241.01,$0.00,$245.17,$0.00
M001184510,SUP,HCPCS C1887,,M001184510  -  GUIDEWIRE VASCULAR .016IN 105CM 20CM PRELOAD HI-FLO RENEGADE,"$1,540.00",$0.00,"$1,540.00",$836.22,"$1,099.10",$0.00,$265.33,$0.00,$0.00,$269.64,"$1,540.00",$0.00,$770.00,"$1,219.68","$1,232.00",$0.00,$241.01,$0.00,$245.17,$0.00
M001184520,SUP,HCPCS C1887,,M001184520  -  GUIDEWIRE VASCULAR .016IN 115CM 10CM PRELOAD HI-FLO RENEGADE,"$1,540.00",$0.00,"$1,540.00",$836.22,"$1,099.10",$0.00,$265.33,$0.00,$0.00,$269.64,"$1,540.00",$0.00,$770.00,"$1,219.68","$1,232.00",$0.00,$241.01,$0.00,$245.17,$0.00
M001184530,SUP,HCPCS C1887,,M001184530  -  GUIDEWIRE VASCULAR .016IN 115CM 20CM PRELOAD HI-FLO RENEGADE,"$1,540.00",$0.00,"$1,540.00",$836.22,"$1,099.10",$0.00,$265.33,$0.00,$0.00,$269.64,"$1,540.00",$0.00,$770.00,"$1,219.68","$1,232.00",$0.00,$241.01,$0.00,$245.17,$0.00
M001184540,SUP,HCPCS C1887,,M001184540  -  CATHETER GUID 10CM MICRO 2.8-3FR 180CM 135CM KIT STEERABLE,"$1,540.00",$0.00,"$1,540.00",$836.22,"$1,099.10",$0.00,$265.33,$0.00,$0.00,$269.64,"$1,540.00",$0.00,$770.00,"$1,219.68","$1,232.00",$0.00,$241.01,$0.00,$245.17,$0.00
M001184550,SUP,HCPCS C1887,,M001184550  -  MICROCATHETER INFS .016IN 3-2.8FR 180CM RNGD HFL FATHOM,"$1,540.00",$0.00,"$1,540.00",$836.22,"$1,099.10",$0.00,$265.33,$0.00,$0.00,$269.64,"$1,540.00",$0.00,$770.00,"$1,219.68","$1,232.00",$0.00,$241.01,$0.00,$245.17,$0.00
M001184560,SUP,HCPCS C1887,,M001184560  -  MICROCATHETER INFS .016IN 3-2.8FR 180CM RNGD HFL FATHOM,"$1,540.00",$0.00,"$1,540.00",$836.22,"$1,099.10",$0.00,$265.33,$0.00,$0.00,$269.64,"$1,540.00",$0.00,$770.00,"$1,219.68","$1,232.00",$0.00,$241.01,$0.00,$245.17,$0.00
M001184570,SUP,HCPCS C1887,,M001184570  -  MICROCATHETER INFS .016IN 3-2.8FR 180CM RNGD HFL FATHOM,"$1,540.00",$0.00,"$1,540.00",$836.22,"$1,099.10",$0.00,$265.33,$0.00,$0.00,$269.64,"$1,540.00",$0.00,$770.00,"$1,219.68","$1,232.00",$0.00,$241.01,$0.00,$245.17,$0.00
M001196000,SUP,HCPCS C1887,,M001196000  -  CATHETER GD HS CRV 6FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2,$214.50,$0.00,$214.50,$116.47,$153.09,$0.00,$36.96,$0.00,$0.00,$37.56,$214.50,$0.00,$107.25,$169.88,$171.60,$0.00,$33.57,$0.00,$34.15,$0.00
M001196040,SUP,HCPCS C1887,,M001196040  -  CATHETER GD RE S 6FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2,$214.50,$0.00,$214.50,$116.47,$153.09,$0.00,$36.96,$0.00,$0.00,$37.56,$214.50,$0.00,$107.25,$169.88,$171.60,$0.00,$33.57,$0.00,$34.15,$0.00
M001196080,SUP,HCPCS C1887,,M001196080  -  CATHETER GD RE SS CRV 6FR 55CM STRL LF MACH1 LG LUM RADOPQ 2,$214.50,$0.00,$214.50,$116.47,$153.09,$0.00,$36.96,$0.00,$0.00,$37.56,$214.50,$0.00,$107.25,$169.88,$171.60,$0.00,$33.57,$0.00,$34.15,$0.00
M001196120,SUP,HCPCS C1887,,M001196120  -  CATHETER GD RE1 CRV 6FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2,$214.50,$0.00,$214.50,$116.47,$153.09,$0.00,$36.96,$0.00,$0.00,$37.56,$214.50,$0.00,$107.25,$169.88,$171.60,$0.00,$33.57,$0.00,$34.15,$0.00
M001196160,SUP,HCPCS C1887,,M001196160  -  CATHETER GD C1 CRV 6FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2,$214.50,$0.00,$214.50,$116.47,$153.09,$0.00,$36.96,$0.00,$0.00,$37.56,$214.50,$0.00,$107.25,$169.88,$171.60,$0.00,$33.57,$0.00,$34.15,$0.00
M001196200,SUP,HCPCS C1887,,M001196200  -  CATHETER GD C2 CRV 6FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2,$214.50,$0.00,$214.50,$116.47,$153.09,$0.00,$36.96,$0.00,$0.00,$37.56,$214.50,$0.00,$107.25,$169.88,$171.60,$0.00,$33.57,$0.00,$34.15,$0.00
M001196230,SUP,HCPCS C1887,,M001196230  -  CATHETER GD MP CRV 6FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2,$214.50,$0.00,$214.50,$116.47,$153.09,$0.00,$36.96,$0.00,$0.00,$37.56,$214.50,$0.00,$107.25,$169.88,$171.60,$0.00,$33.57,$0.00,$34.15,$0.00
M001196260,SUP,HCPCS C1887,,M001196260  -  CATHETER GD MP CRV 6FR 90CM STRL LF MACH1 LG LUM RADOPQ 2X2,$214.50,$0.00,$214.50,$116.47,$153.09,$0.00,$36.96,$0.00,$0.00,$37.56,$214.50,$0.00,$107.25,$169.88,$171.60,$0.00,$33.57,$0.00,$34.15,$0.00
M001196300,SUP,HCPCS C1887,,M001196300  -  CATHETER GD MP2 CRV 6FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2,$214.50,$0.00,$214.50,$116.47,$153.09,$0.00,$36.96,$0.00,$0.00,$37.56,$214.50,$0.00,$107.25,$169.88,$171.60,$0.00,$33.57,$0.00,$34.15,$0.00
M001196330,SUP,HCPCS C1887,,M001196330  -  CATHETER GD MP2 CRV 6FR 90CM STRL LF MACH1 LG LUM RADOPQ 2X2,$214.50,$0.00,$214.50,$116.47,$153.09,$0.00,$36.96,$0.00,$0.00,$37.56,$214.50,$0.00,$107.25,$169.88,$171.60,$0.00,$33.57,$0.00,$34.15,$0.00
M001196380,SUP,HCPCS C1887,,M001196380  -  CATHETER GD 40D 6FR 90CM STRL LF MACH1 LG LUM RADOPQ 2X2 RND,$214.50,$0.00,$214.50,$116.47,$153.09,$0.00,$36.96,$0.00,$0.00,$37.56,$214.50,$0.00,$107.25,$169.88,$171.60,$0.00,$33.57,$0.00,$34.15,$0.00
M001196450,SUP,HCPCS C1887,,M001196450  -  CATHETER GD ST CRV 6FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2,$214.50,$0.00,$214.50,$116.47,$153.09,$0.00,$36.96,$0.00,$0.00,$37.56,$214.50,$0.00,$107.25,$169.88,$171.60,$0.00,$33.57,$0.00,$34.15,$0.00
M001196480,SUP,HCPCS C1887,,M001196480  -  CATHETER GD ST CRV 6FR 90CM STRL LF MACH1 LG LUM RADOPQ 2X2,$214.50,$0.00,$214.50,$116.47,$153.09,$0.00,$36.96,$0.00,$0.00,$37.56,$214.50,$0.00,$107.25,$169.88,$171.60,$0.00,$33.57,$0.00,$34.15,$0.00
M001196530,SUP,HCPCS C1887,,M001196530  -  CATHETER GD XVR 1 CRV 6FR 55CM STRL LF MACH1 LG LUM RADOPQ 2,$214.50,$0.00,$214.50,$116.47,$153.09,$0.00,$36.96,$0.00,$0.00,$37.56,$214.50,$0.00,$107.25,$169.88,$171.60,$0.00,$33.57,$0.00,$34.15,$0.00
M001196560,SUP,HCPCS C1887,,M001196560  -  CATHETER GD XVR 2 CRV 6FR 55CM STRL LF MACH1 LG LUM RADOPQ 2,$214.50,$0.00,$214.50,$116.47,$153.09,$0.00,$36.96,$0.00,$0.00,$37.56,$214.50,$0.00,$107.25,$169.88,$171.60,$0.00,$33.57,$0.00,$34.15,$0.00
M001196620,SUP,HCPCS C1887,,M001196620  -  CATHETER GD LIMA CRV 6FR 55CM STRL LF MACH1 LG LUM RADOPQ 2,$214.50,$0.00,$214.50,$116.47,$153.09,$0.00,$36.96,$0.00,$0.00,$37.56,$214.50,$0.00,$107.25,$169.88,$171.60,$0.00,$33.57,$0.00,$34.15,$0.00
M001196660,SUP,HCPCS C1887,,M001196660  -  CATHETER GD RDC CRV 6FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2,$214.50,$0.00,$214.50,$116.47,$153.09,$0.00,$36.96,$0.00,$0.00,$37.56,$214.50,$0.00,$107.25,$169.88,$171.60,$0.00,$33.57,$0.00,$34.15,$0.00
M001196700,SUP,HCPCS C1887,,M001196700  -  CATHETER GD BATES 1 CRV 6FR 55CM STRL LF MACH1 LG LUM SH,$214.50,$0.00,$214.50,$116.47,$153.09,$0.00,$36.96,$0.00,$0.00,$37.56,$214.50,$0.00,$107.25,$169.88,$171.60,$0.00,$33.57,$0.00,$34.15,$0.00
M001196800,SUP,HCPCS C1887,,M001196800  -  CATHETER GD BATES 2 CRV 6FR 55CM STRL LF MACH1 LG LUM SH,$214.50,$0.00,$214.50,$116.47,$153.09,$0.00,$36.96,$0.00,$0.00,$37.56,$214.50,$0.00,$107.25,$169.88,$171.60,$0.00,$33.57,$0.00,$34.15,$0.00
M001196960,SUP,HCPCS C1887,,M001196960  -  CATHETER GD RDC1 CRV 6FR 55CM STRL LF MACH1 LG LUM RADOPQ 2,$214.50,$0.00,$214.50,$116.47,$153.09,$0.00,$36.96,$0.00,$0.00,$37.56,$214.50,$0.00,$107.25,$169.88,$171.60,$0.00,$33.57,$0.00,$34.15,$0.00
M001197000,SUP,HCPCS C1887,,M001197000  -  CATHETER GD HS CRV 7FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2,$214.50,$0.00,$214.50,$116.47,$153.09,$0.00,$36.96,$0.00,$0.00,$37.56,$214.50,$0.00,$107.25,$169.88,$171.60,$0.00,$33.57,$0.00,$34.15,$0.00
M001197040,SUP,HCPCS C1887,,M001197040  -  CATHETER GD RE S 7FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2,$214.50,$0.00,$214.50,$116.47,$153.09,$0.00,$36.96,$0.00,$0.00,$37.56,$214.50,$0.00,$107.25,$169.88,$171.60,$0.00,$33.57,$0.00,$34.15,$0.00
M001197080,SUP,HCPCS C1887,,M001197080  -  CATHETER GD RE SS CRV 7FR 55CM STRL LF MACH1 LG LUM RADOPQ 2,$214.50,$0.00,$214.50,$116.47,$153.09,$0.00,$36.96,$0.00,$0.00,$37.56,$214.50,$0.00,$107.25,$169.88,$171.60,$0.00,$33.57,$0.00,$34.15,$0.00
M001197120,SUP,HCPCS C1887,,M001197120  -  CATHETER GD RE L CRV 7FR 55CM STRL LF MACH1 LG LUM RADOPQ 2,$214.50,$0.00,$214.50,$116.47,$153.09,$0.00,$36.96,$0.00,$0.00,$37.56,$214.50,$0.00,$107.25,$169.88,$171.60,$0.00,$33.57,$0.00,$34.15,$0.00
M001197160,SUP,HCPCS C1887,,M001197160  -  CATHETER GD C1 CRV 7FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2,$214.50,$0.00,$214.50,$116.47,$153.09,$0.00,$36.96,$0.00,$0.00,$37.56,$214.50,$0.00,$107.25,$169.88,$171.60,$0.00,$33.57,$0.00,$34.15,$0.00
M001197200,SUP,HCPCS C1887,,M001197200  -  CATHETER GD C2 CRV 7FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2,$214.50,$0.00,$214.50,$116.47,$153.09,$0.00,$36.96,$0.00,$0.00,$37.56,$214.50,$0.00,$107.25,$169.88,$171.60,$0.00,$33.57,$0.00,$34.15,$0.00
M001197230,SUP,HCPCS C1887,,M001197230  -  CATHETER GD MP CRV 7FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2,$214.50,$0.00,$214.50,$116.47,$153.09,$0.00,$36.96,$0.00,$0.00,$37.56,$214.50,$0.00,$107.25,$169.88,$171.60,$0.00,$33.57,$0.00,$34.15,$0.00
M001197260,SUP,HCPCS C1887,,M001197260  -  CATHETER GD MP CRV 7FR 90CM STRL LF MACH1 LG LUM RADOPQ 2X2,$214.50,$0.00,$214.50,$116.47,$153.09,$0.00,$36.96,$0.00,$0.00,$37.56,$214.50,$0.00,$107.25,$169.88,$171.60,$0.00,$33.57,$0.00,$34.15,$0.00
M001197300,SUP,HCPCS C1887,,M001197300  -  CATHETER GD MP2 CRV 7FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2,$214.50,$0.00,$214.50,$116.47,$153.09,$0.00,$36.96,$0.00,$0.00,$37.56,$214.50,$0.00,$107.25,$169.88,$171.60,$0.00,$33.57,$0.00,$34.15,$0.00
M001197330,SUP,HCPCS C1887,,M001197330  -  CATHETER GD MP2 CRV 7FR 90CM STRL LF MACH1 LG LUM RADOPQ 2X2,$214.50,$0.00,$214.50,$116.47,$153.09,$0.00,$36.96,$0.00,$0.00,$37.56,$214.50,$0.00,$107.25,$169.88,$171.60,$0.00,$33.57,$0.00,$34.15,$0.00
M001197380,SUP,HCPCS C1887,,M001197380  -  CATHETER GD 40D 7FR 90CM STRL LF MACH1 LG LUM RADOPQ 2X2 RND,$214.50,$0.00,$214.50,$116.47,$153.09,$0.00,$36.96,$0.00,$0.00,$37.56,$214.50,$0.00,$107.25,$169.88,$171.60,$0.00,$33.57,$0.00,$34.15,$0.00
M001197450,SUP,HCPCS C1887,,M001197450  -  CATHETER GD ST CRV 7FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2,$214.50,$0.00,$214.50,$116.47,$153.09,$0.00,$36.96,$0.00,$0.00,$37.56,$214.50,$0.00,$107.25,$169.88,$171.60,$0.00,$33.57,$0.00,$34.15,$0.00
M001197480,SUP,HCPCS C1887,,M001197480  -  CATHETER GD ST CRV 7FR 90CM STRL LF MACH1 LG LUM RADOPQ 2X2,$214.50,$0.00,$214.50,$116.47,$153.09,$0.00,$36.96,$0.00,$0.00,$37.56,$214.50,$0.00,$107.25,$169.88,$171.60,$0.00,$33.57,$0.00,$34.15,$0.00
M001197530,SUP,HCPCS C1887,,M001197530  -  CATHETER GD XVR 1 CRV 7FR 55CM STRL LF MACH1 LG LUM RADOPQ 2,$214.50,$0.00,$214.50,$116.47,$153.09,$0.00,$36.96,$0.00,$0.00,$37.56,$214.50,$0.00,$107.25,$169.88,$171.60,$0.00,$33.57,$0.00,$34.15,$0.00
M001197560,SUP,HCPCS C1887,,M001197560  -  CATHETER GD XVR 2 CRV 7FR 55CM STRL LF MACH1 LG LUM RADOPQ 2,$214.50,$0.00,$214.50,$116.47,$153.09,$0.00,$36.96,$0.00,$0.00,$37.56,$214.50,$0.00,$107.25,$169.88,$171.60,$0.00,$33.57,$0.00,$34.15,$0.00
M001197620,SUP,HCPCS C1887,,M001197620  -  CATHETER GD LIMA CRV 7FR 55CM STRL LF MACH1 LG LUM RADOPQ 2,$214.50,$0.00,$214.50,$116.47,$153.09,$0.00,$36.96,$0.00,$0.00,$37.56,$214.50,$0.00,$107.25,$169.88,$171.60,$0.00,$33.57,$0.00,$34.15,$0.00
M001197660,SUP,HCPCS C1887,,M001197660  -  CATHETER GD RDC CRV 7FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2,$214.50,$0.00,$214.50,$116.47,$153.09,$0.00,$36.96,$0.00,$0.00,$37.56,$214.50,$0.00,$107.25,$169.88,$171.60,$0.00,$33.57,$0.00,$34.15,$0.00
M001197700,SUP,HCPCS C1887,,M001197700  -  CATHETER GD BATES 1 CRV 7FR 55CM STRL LF MACH1 LG LUM SH,$214.50,$0.00,$214.50,$116.47,$153.09,$0.00,$36.96,$0.00,$0.00,$37.56,$214.50,$0.00,$107.25,$169.88,$171.60,$0.00,$33.57,$0.00,$34.15,$0.00
M001197800,SUP,HCPCS C1887,,M001197800  -  CATHETER GD BATES 2 CRV 7FR 55CM STRL LF MACH1 LG LUM SH,$214.50,$0.00,$214.50,$116.47,$153.09,$0.00,$36.96,$0.00,$0.00,$37.56,$214.50,$0.00,$107.25,$169.88,$171.60,$0.00,$33.57,$0.00,$34.15,$0.00
M001197960,SUP,HCPCS C1887,,M001197960  -  CATHETER GD RDC1 CRV 7FR 55CM STRL LF MACH1 LG LUM RADOPQ 2,$214.50,$0.00,$214.50,$116.47,$153.09,$0.00,$36.96,$0.00,$0.00,$37.56,$214.50,$0.00,$107.25,$169.88,$171.60,$0.00,$33.57,$0.00,$34.15,$0.00
M001198000,SUP,HCPCS C1887,,M001198000  -  CATHETER GD HS CRV 8FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2,$214.50,$0.00,$214.50,$116.47,$153.09,$0.00,$36.96,$0.00,$0.00,$37.56,$214.50,$0.00,$107.25,$169.88,$171.60,$0.00,$33.57,$0.00,$34.15,$0.00
M001198040,SUP,HCPCS C1887,,M001198040  -  CATHETER GD RE S 8FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2,$214.50,$0.00,$214.50,$116.47,$153.09,$0.00,$36.96,$0.00,$0.00,$37.56,$214.50,$0.00,$107.25,$169.88,$171.60,$0.00,$33.57,$0.00,$34.15,$0.00
M001198080,SUP,HCPCS C1887,,M001198080  -  CATHETER GD RE SS CRV 8FR 55CM STRL LF MACH1 LG LUM RADOPQ 2,$214.50,$0.00,$214.50,$116.47,$153.09,$0.00,$36.96,$0.00,$0.00,$37.56,$214.50,$0.00,$107.25,$169.88,$171.60,$0.00,$33.57,$0.00,$34.15,$0.00
M001198120,SUP,HCPCS C1887,,M001198120  -  CATHETER GD RE L CRV 8FR 55CM STRL LF MACH1 LG LUM RADOPQ 2,$214.50,$0.00,$214.50,$116.47,$153.09,$0.00,$36.96,$0.00,$0.00,$37.56,$214.50,$0.00,$107.25,$169.88,$171.60,$0.00,$33.57,$0.00,$34.15,$0.00
M001198160,SUP,HCPCS C1887,,M001198160  -  CATHETER GD C1 CRV 8FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2,$214.50,$0.00,$214.50,$116.47,$153.09,$0.00,$36.96,$0.00,$0.00,$37.56,$214.50,$0.00,$107.25,$169.88,$171.60,$0.00,$33.57,$0.00,$34.15,$0.00
M001198200,SUP,HCPCS C1887,,M001198200  -  CATHETER GD C2 CRV 8FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2,$214.50,$0.00,$214.50,$116.47,$153.09,$0.00,$36.96,$0.00,$0.00,$37.56,$214.50,$0.00,$107.25,$169.88,$171.60,$0.00,$33.57,$0.00,$34.15,$0.00
M001198230,SUP,HCPCS C1887,,M001198230  -  CATHETER GD MP CRV 8FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2,$214.50,$0.00,$214.50,$116.47,$153.09,$0.00,$36.96,$0.00,$0.00,$37.56,$214.50,$0.00,$107.25,$169.88,$171.60,$0.00,$33.57,$0.00,$34.15,$0.00
M001198260,SUP,HCPCS C1887,,M001198260  -  CATHETER GD MP CRV 8FR 90CM STRL LF MACH1 LG LUM RADOPQ 2X2,$214.50,$0.00,$214.50,$116.47,$153.09,$0.00,$36.96,$0.00,$0.00,$37.56,$214.50,$0.00,$107.25,$169.88,$171.60,$0.00,$33.57,$0.00,$34.15,$0.00
M001198300,SUP,HCPCS C1887,,M001198300  -  CATHETER GD MP2 CRV 8FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2,$214.50,$0.00,$214.50,$116.47,$153.09,$0.00,$36.96,$0.00,$0.00,$37.56,$214.50,$0.00,$107.25,$169.88,$171.60,$0.00,$33.57,$0.00,$34.15,$0.00
M001198330,SUP,HCPCS C1887,,M001198330  -  CATHETER GD MP2 CRV 8FR 90CM STRL LF MACH1 LG LUM RADOPQ 2X2,$214.50,$0.00,$214.50,$116.47,$153.09,$0.00,$36.96,$0.00,$0.00,$37.56,$214.50,$0.00,$107.25,$169.88,$171.60,$0.00,$33.57,$0.00,$34.15,$0.00
M001198380,SUP,HCPCS C1887,,M001198380  -  CATHETER GD 40D 8FR 90CM STRL LF MACH1 LG LUM RADOPQ 2X2 RND,$214.50,$0.00,$214.50,$116.47,$153.09,$0.00,$36.96,$0.00,$0.00,$37.56,$214.50,$0.00,$107.25,$169.88,$171.60,$0.00,$33.57,$0.00,$34.15,$0.00
M001198450,SUP,HCPCS C1887,,M001198450  -  CATHETER GD ST CRV 8FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2,$214.50,$0.00,$214.50,$116.47,$153.09,$0.00,$36.96,$0.00,$0.00,$37.56,$214.50,$0.00,$107.25,$169.88,$171.60,$0.00,$33.57,$0.00,$34.15,$0.00
M001198480,SUP,HCPCS C1887,,M001198480  -  CATHETER GD ST CRV 8FR 90CM STRL LF MACH1 LG LUM RADOPQ 2X2,$214.50,$0.00,$214.50,$116.47,$153.09,$0.00,$36.96,$0.00,$0.00,$37.56,$214.50,$0.00,$107.25,$169.88,$171.60,$0.00,$33.57,$0.00,$34.15,$0.00
M001198530,SUP,HCPCS C1887,,M001198530  -  CATHETER GD XVR 1 CRV 8FR 55CM STRL LF MACH1 LG LUM RADOPQ 2,$214.50,$0.00,$214.50,$116.47,$153.09,$0.00,$36.96,$0.00,$0.00,$37.56,$214.50,$0.00,$107.25,$169.88,$171.60,$0.00,$33.57,$0.00,$34.15,$0.00
M001198560,SUP,HCPCS C1887,,M001198560  -  CATHETER GD XVR 2 CRV 8FR 55CM STRL LF MACH1 LG LUM RADOPQ 2,$214.50,$0.00,$214.50,$116.47,$153.09,$0.00,$36.96,$0.00,$0.00,$37.56,$214.50,$0.00,$107.25,$169.88,$171.60,$0.00,$33.57,$0.00,$34.15,$0.00
M001198620,SUP,HCPCS C1887,,M001198620  -  CATHETER GD LIMA CRV 8FR 55CM STRL LF MACH1 LG LUM RADOPQ 2,$214.50,$0.00,$214.50,$116.47,$153.09,$0.00,$36.96,$0.00,$0.00,$37.56,$214.50,$0.00,$107.25,$169.88,$171.60,$0.00,$33.57,$0.00,$34.15,$0.00
M001198660,SUP,HCPCS C1887,,M001198660  -  CATHETER GD RDC CRV 8FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2,$214.50,$0.00,$214.50,$116.47,$153.09,$0.00,$36.96,$0.00,$0.00,$37.56,$214.50,$0.00,$107.25,$169.88,$171.60,$0.00,$33.57,$0.00,$34.15,$0.00
M001198700,SUP,HCPCS C1887,,M001198700  -  CATHETER GD BATES 1 CRV 8FR 55CM STRL LF MACH1 LG LUM SH,$214.50,$0.00,$214.50,$116.47,$153.09,$0.00,$36.96,$0.00,$0.00,$37.56,$214.50,$0.00,$107.25,$169.88,$171.60,$0.00,$33.57,$0.00,$34.15,$0.00
M001198800,SUP,HCPCS C1887,,M001198800  -  CATHETER GD BATES 2 CRV 8FR 55CM STRL LF MACH1 LG LUM SH,$214.50,$0.00,$214.50,$116.47,$153.09,$0.00,$36.96,$0.00,$0.00,$37.56,$214.50,$0.00,$107.25,$169.88,$171.60,$0.00,$33.57,$0.00,$34.15,$0.00
M001198960,SUP,HCPCS C1887,,M001198960  -  CATHETER GD RDC1 CRV 8FR 55CM STRL LF MACH1 LG LUM RADOPQ 2,$214.50,$0.00,$214.50,$116.47,$153.09,$0.00,$36.96,$0.00,$0.00,$37.56,$214.50,$0.00,$107.25,$169.88,$171.60,$0.00,$33.57,$0.00,$34.15,$0.00
M001206130,SUP,HCPCS C1892,,M001206130  -  INTRODUCER SHTH 11FR 30CM BNA PL PLWY COAX LCK TPR PE,$135.00,$0.00,$135.00,$73.31,$96.35,$0.00,$23.26,$0.00,$0.00,$23.64,$135.00,$0.00,$67.50,$106.92,$108.00,$0.00,$21.13,$0.00,$21.49,$0.00
M001207020,SUP,HCPCS C1894,,M001207020  -  INTROD SHTH 6FR 4FR 20CM COAX DILAT JTP HVDTY FLPY XSTIF,$233.13,$0.00,$233.13,$126.59,$166.38,$0.00,$40.17,$0.00,$0.00,$40.82,$233.13,$0.00,$116.56,$184.64,$186.50,$0.00,$36.48,$0.00,$37.11,$0.00
M001207030,SUP,HCPCS C1894,,M001207030  -  SYSTEM INTROD .018IN .038IN FLOPPY STR 6FR 4FR 60CM 145CM 2,$189.38,$0.00,$189.38,$102.83,$135.16,$0.00,$32.63,$0.00,$0.00,$33.16,$189.38,$0.00,$94.69,$149.99,$151.50,$0.00,$29.64,$0.00,$30.15,$0.00
M001207040,SUP,HCPCS C1892,,M001207040  -  SYSTEM INTROD .038IN FLOPPY 6FR 4FR 60CM 20CM DILAT RADIOPQ,$151.88,$0.00,$151.88,$82.47,$108.39,$0.00,$26.17,$0.00,$0.00,$26.59,$151.88,$0.00,$75.94,$120.29,$121.50,$0.00,$23.77,$0.00,$24.18,$0.00
M001207050,SUP,HCPCS C1894,,M001207050  -  SYSTEM INTROD 6FR ACCUSTICK II STERILE DISPOSABLE,$120.00,$0.00,$120.00,$65.16,$85.64,$0.00,$20.68,$0.00,$0.00,$21.01,$120.00,$0.00,$60.00,$95.04,$96.00,$0.00,$18.78,$0.00,$19.10,$0.00
M001207111,SUP,HCPCS C1729,,M001207111  -  INTRODUCER SHEATH .018IN FLOPPY 60CM 6CM RADIOPQ GWIRE,$451.88,$0.00,$451.88,$245.37,$322.50,$0.00,$77.86,$0.00,$0.00,$79.12,$451.88,$0.00,$225.94,$357.89,$361.50,$0.00,$70.72,$0.00,$71.94,$0.00
M001208500,SUP,Custom 27203010,,M001208500  -  SET GSTRM 18GA BVL NDL AFFIXATION DEV BR-MLR TFSTNR SET,$131.25,$0.00,$131.25,$0.00,$93.67,$0.00,$0.00,$0.00,$0.00,$0.00,$131.25,$0.00,$65.63,$103.95,$105.00,$0.00,$0.00,$0.00,$0.00,$0.00
M001221000,SUP,HCPCS C1729,,M001221000  -  CATHETER DRAIN 8FR 30CM LOCK STIFFEN CANNU AMPLATZ ANCHOR,$189.38,$0.00,$189.38,$102.83,$135.16,$0.00,$32.63,$0.00,$0.00,$33.16,$189.38,$0.00,$94.69,$149.99,$151.50,$0.00,$29.64,$0.00,$30.15,$0.00
M001221010,SUP,HCPCS C1729,,M001221010  -  CATHETER DRAIN 10FR 30CM LOCK STIFFEN CANNU AMPLATZ ANCHOR,$189.38,$0.00,$189.38,$102.83,$135.16,$0.00,$32.63,$0.00,$0.00,$33.16,$189.38,$0.00,$94.69,$149.99,$151.50,$0.00,$29.64,$0.00,$30.15,$0.00
M001221020,SUP,HCPCS C2617,,M001221020  -  CATHETER DRAIN 12FR 30CM LOCK STIFFEN CANNU LATEX FREE,$189.38,$0.00,$189.38,$85.22,$135.16,$0.00,$32.63,$0.00,$0.00,$33.16,$189.38,$0.00,$94.69,$149.99,$151.50,$0.00,$29.64,$0.00,$30.15,$0.00
M001221360,SUP,HCPCS C2617,,M001221360  -  STENT URETERAL LARGE REGULAR PROXIMAL PIGTAIL CURVE 2.66MM,$245.63,$0.00,$245.63,$110.53,$175.30,$0.00,$42.32,$0.00,$0.00,$43.01,$245.63,$0.00,$122.81,$194.54,$196.50,$0.00,$38.44,$0.00,$39.10,$0.00
M001221370,SUP,HCPCS C2617,,M001221370  -  STENT URETERAL LARGE REGULAR PROXIMAL PIGTAIL CURVE 2.66MM,$245.63,$0.00,$245.63,$110.53,$175.30,$0.00,$42.32,$0.00,$0.00,$43.01,$245.63,$0.00,$122.81,$194.54,$196.50,$0.00,$38.44,$0.00,$39.10,$0.00
M001221380,SUP,HCPCS C2617,,M001221380  -  STENT NEPHROURETERAL 2.66MM 26CM STIFFENING CANNU INTERNAL,$245.63,$0.00,$245.63,$110.53,$175.30,$0.00,$42.32,$0.00,$0.00,$43.01,$245.63,$0.00,$122.81,$194.54,$196.50,$0.00,$38.44,$0.00,$39.10,$0.00
M001221390,SUP,HCPCS C2617,,M001221390  -  STENT URETERAL LARGE REGULAR PROXIMAL PIGTAIL CURVE 2.66MM,$245.63,$0.00,$245.63,$110.53,$175.30,$0.00,$42.32,$0.00,$0.00,$43.01,$245.63,$0.00,$122.81,$194.54,$196.50,$0.00,$38.44,$0.00,$39.10,$0.00
M001221400,SUP,HCPCS C2617,,M001221400  -  STENT URETERAL LARGE REGULAR PROXIMAL PIGTAIL CURVE 3.33MM,$245.63,$0.00,$245.63,$110.53,$175.30,$0.00,$42.32,$0.00,$0.00,$43.01,$245.63,$0.00,$122.81,$194.54,$196.50,$0.00,$38.44,$0.00,$39.10,$0.00
M001221410,SUP,HCPCS C2617,,M001221410  -  STENT URETERAL LARGE REGULAR PROXIMAL PIGTAIL CURVE 3.33MM,$245.63,$0.00,$245.63,$110.53,$175.30,$0.00,$42.32,$0.00,$0.00,$43.01,$245.63,$0.00,$122.81,$194.54,$196.50,$0.00,$38.44,$0.00,$39.10,$0.00
M001221420,SUP,HCPCS C2617,,M001221420  -  STENT URETERAL LARGE REGULAR PROXIMAL PIGTAIL CURVE 3.33MM,$245.63,$0.00,$245.63,$110.53,$175.30,$0.00,$42.32,$0.00,$0.00,$43.01,$245.63,$0.00,$122.81,$194.54,$196.50,$0.00,$38.44,$0.00,$39.10,$0.00
M001221430,SUP,HCPCS C2617,,M001221430  -  STENT URETERAL LARGE REGULAR PROXIMAL PIGTAIL CURVE 3.33MM,$245.63,$0.00,$245.63,$110.53,$175.30,$0.00,$42.32,$0.00,$0.00,$43.01,$245.63,$0.00,$122.81,$194.54,$196.50,$0.00,$38.44,$0.00,$39.10,$0.00
M001225140,SUP,HCPCS C1729,,M001225140  -  SET NEPHROSTOMY PIGTAIL CURVE 8FR FIRM DUROMETER LOCK VTC,$176.25,$0.00,$176.25,$95.70,$125.79,$0.00,$30.37,$0.00,$0.00,$30.86,$176.25,$0.00,$88.13,$139.59,$141.00,$0.00,$27.58,$0.00,$28.06,$0.00
M001225510,SUP,HCPCS C2617,,M001225510  -  STENT URET .038IN LG REG PGTL CRV 8FR 24CM DRMTR RADOPQ DRN,$313.50,$0.00,$313.50,$141.08,$223.74,$0.00,$54.01,$0.00,$0.00,$54.89,$313.50,$0.00,$156.75,$248.29,$250.80,$0.00,$49.06,$0.00,$49.91,$0.00
M001225520,SUP,HCPCS C1768,,STENT URET 8FR 26CM REG DRMTR LG DRAIN HOLE PROX PGTL LCK,$303.28,$0.00,$303.28,$136.47,$216.45,$0.00,$52.25,$0.00,$0.00,$53.10,$303.28,$0.00,$151.64,$240.20,$242.62,$0.00,$47.46,$0.00,$48.28,$0.00
M001262160,SUP,Custom 27203010,,M001262160  -  NEEDLE ELECTROSURGICAL STANDARD UMBRELLA 5CM 15CM ARRAY TIP,"$5,362.50",$0.00,"$5,362.50",$0.00,"$3,827.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,362.50",$0.00,"$2,681.25","$4,247.10","$4,290.00",$0.00,$0.00,$0.00,$0.00,$0.00
M001271460,SUP,HCPCS C1729,,M001271460  -  CATHETER DRAIN LOOP 8FR 25CM QUICKSTICK FLEXIMA HYDPHI,$170.18,$0.00,$170.18,$92.41,$121.45,$0.00,$29.32,$0.00,$0.00,$29.80,$170.18,$0.00,$85.09,$134.78,$136.14,$0.00,$26.63,$0.00,$27.09,$0.00
M001271470,SUP,HCPCS C1729,,M001271470  -  CATHETER DRAIN LOOP 10FR 25CM QUICKSTICK FLEXIMA HYDPHI,$170.18,$0.00,$170.18,$92.41,$121.45,$0.00,$29.32,$0.00,$0.00,$29.80,$170.18,$0.00,$85.09,$134.78,$136.14,$0.00,$26.63,$0.00,$27.09,$0.00
M001271540,SUP,HCPCS C1729,,M001271540  -  CATHETER DRAIN PIGTAIL CURVE 8FR 35CM FLEXIBLE STIFF CANNU,$190.30,$0.00,$190.30,$103.33,$135.82,$0.00,$32.79,$0.00,$0.00,$33.32,$190.30,$0.00,$95.15,$150.72,$152.24,$0.00,$29.78,$0.00,$30.30,$0.00
M001271550,SUP,HCPCS C1729,,M001271550  -  CATHETER DRAIN 10FR 35CM METAL AND FLEXIBLE STIFFENING CANNU,$190.30,$0.00,$190.30,$103.33,$135.82,$0.00,$32.79,$0.00,$0.00,$33.32,$190.30,$0.00,$95.15,$150.72,$152.24,$0.00,$29.78,$0.00,$30.30,$0.00
M001271560,SUP,HCPCS C1729,,M001271560  -  CATHETER DRAIN PIGTAIL CURVE 8FR 35CM FLEXIBLE STIFF CANNU,$190.30,$0.00,$190.30,$103.33,$135.82,$0.00,$32.79,$0.00,$0.00,$33.32,$190.30,$0.00,$95.15,$150.72,$152.24,$0.00,$29.78,$0.00,$30.30,$0.00
M001271570,SUP,HCPCS C1729,,M001271570  -  CATHETER DRAIN PIGTAIL CURVE 10FR 35CM FLEXIBLE STIFF CANNU,$190.30,$0.00,$190.30,$103.33,$135.82,$0.00,$32.79,$0.00,$0.00,$33.32,$190.30,$0.00,$95.15,$150.72,$152.24,$0.00,$29.78,$0.00,$30.30,$0.00
M001271580,SUP,HCPCS C1729,,M001271580  -  CATHETER DRAIN PIGTAIL CURVE 12FR 35CM FLEXIBLE STIFF CANNU,$190.30,$0.00,$190.30,$103.33,$135.82,$0.00,$32.79,$0.00,$0.00,$33.32,$190.30,$0.00,$95.15,$150.72,$152.24,$0.00,$29.78,$0.00,$30.30,$0.00
M001271590,SUP,HCPCS C1729,,M001271590  -  CATHETER DRAIN PIGTAIL CURVE 14FR 35CM FLEXIBLE STIFF CANNU,$190.30,$0.00,$190.30,$103.33,$135.82,$0.00,$32.79,$0.00,$0.00,$33.32,$190.30,$0.00,$95.15,$150.72,$152.24,$0.00,$29.78,$0.00,$30.30,$0.00
M001271600,SUP,HCPCS C1729,,M001271600  -  CATHETER DRAIN PIGTAIL CURVE 10FR 35CM FLEXIBLE STIFF CANNU,$190.30,$0.00,$190.30,$103.33,$135.82,$0.00,$32.79,$0.00,$0.00,$33.32,$190.30,$0.00,$95.15,$150.72,$152.24,$0.00,$29.78,$0.00,$30.30,$0.00
M001271610,SUP,HCPCS C1729,,M001271610  -  CATHETER DRN PGTL CRV 12FR 35CM FLXB STF CNN LCK DRMTR SFT,$235.25,$0.00,$235.25,$127.74,$167.90,$0.00,$40.53,$0.00,$0.00,$41.19,$235.25,$0.00,$117.63,$186.32,$188.20,$0.00,$36.82,$0.00,$37.45,$0.00
M001271620,SUP,HCPCS C1729,,M001271620  -  CATHETER DRAIN PIGTAIL CURVE 14FR 35CM FLEXIBLE STIFF CANNU,$190.30,$0.00,$190.30,$103.33,$135.82,$0.00,$32.79,$0.00,$0.00,$33.32,$190.30,$0.00,$95.15,$150.72,$152.24,$0.00,$29.78,$0.00,$30.30,$0.00
M001271630,SUP,HCPCS C1729,,M001271630  -  KIT DRAIN 8FR 35CM FIRM DUROMETER LARGE HOLE FLEXIMA,$344.00,$0.00,$344.00,$186.79,$245.51,$0.00,$59.27,$0.00,$0.00,$60.23,$344.00,$0.00,$172.00,$272.45,$275.20,$0.00,$53.84,$0.00,$54.76,$0.00
M001271640,SUP,HCPCS C1729,,M001271640  -  KIT DRAIN 10FR 35CM FIRM DUROMETER LARGE HOLE FLEXIMA,$344.00,$0.00,$344.00,$186.79,$245.51,$0.00,$59.27,$0.00,$0.00,$60.23,$344.00,$0.00,$172.00,$272.45,$275.20,$0.00,$53.84,$0.00,$54.76,$0.00
M001271650,SUP,HCPCS C1729,,M001271650  -  CATHETER DRAIN REGULAR PIGTAIL CURVE 8FR 35CM KIT LOCK,$344.00,$0.00,$344.00,$186.79,$245.51,$0.00,$59.27,$0.00,$0.00,$60.23,$344.00,$0.00,$172.00,$272.45,$275.20,$0.00,$53.84,$0.00,$54.76,$0.00
M001271660,SUP,HCPCS C1729,,M001271660  -  KIT DRAIN REGULAR 10FR 35CM DUROMETER LARGE HOLE FLEXIMA,$344.00,$0.00,$344.00,$186.79,$245.51,$0.00,$59.27,$0.00,$0.00,$60.23,$344.00,$0.00,$172.00,$272.45,$275.20,$0.00,$53.84,$0.00,$54.76,$0.00
M001271770,SUP,HCPCS C1729,,M001271770  -  CATHETER NEPHROSTOMY PIGTAIL CURVE 8FR 25CM LOCK DUROMETER,$190.30,$0.00,$190.30,$103.33,$135.82,$0.00,$32.79,$0.00,$0.00,$33.32,$190.30,$0.00,$95.15,$150.72,$152.24,$0.00,$29.78,$0.00,$30.30,$0.00
M001271780,SUP,HCPCS C1729,,M001271780  -  CATHETER NEPHROSTOMY PIGTAIL CURVE 10FR 25CM LOCK DUROMETER,$190.30,$0.00,$190.30,$103.33,$135.82,$0.00,$32.79,$0.00,$0.00,$33.32,$190.30,$0.00,$95.15,$150.72,$152.24,$0.00,$29.78,$0.00,$30.30,$0.00
M001271790,SUP,HCPCS C1729,,M001271790  -  CATHETER NEPHROSTOMY REGULAR PIGTAIL CURVE 8FR 25CM LOCK,$190.30,$0.00,$190.30,$103.33,$135.82,$0.00,$32.79,$0.00,$0.00,$33.32,$190.30,$0.00,$95.15,$150.72,$152.24,$0.00,$29.78,$0.00,$30.30,$0.00
M001271800,SUP,HCPCS C1729,,M001271800  -  CATHETER NEPHROSTOMY REGULAR PIGTAIL CURVE 10FR 25CM LOCK,$190.30,$0.00,$190.30,$103.33,$135.82,$0.00,$32.79,$0.00,$0.00,$33.32,$190.30,$0.00,$95.15,$150.72,$152.24,$0.00,$29.78,$0.00,$30.30,$0.00
M001271810,SUP,HCPCS C1729,,M001271810  -  CATHETER NEPHROSTOMY PIGTAIL CURVE 12FR 25CM LOCK DUROMETER,$190.30,$0.00,$190.30,$103.33,$135.82,$0.00,$32.79,$0.00,$0.00,$33.32,$190.30,$0.00,$95.15,$150.72,$152.24,$0.00,$29.78,$0.00,$30.30,$0.00
M001271820,SUP,Custom 27203010,,M001271820  -  CATHETER NEPHROSTOMY PIGTAIL CURVE 14FR 25CM LOCK DUROMETER,$190.30,$0.00,$190.30,$0.00,$135.82,$0.00,$0.00,$0.00,$0.00,$0.00,$190.30,$0.00,$95.15,$150.72,$152.24,$0.00,$0.00,$0.00,$0.00,$0.00
M001271830,SUP,HCPCS C1726,,M001271830  -  CATHETER NEPHROSTOMY PIGTAIL CURVE 10FR 25CM LOCK DUROMETER,$190.30,$0.00,$190.30,$103.33,$135.82,$0.00,$32.79,$0.00,$0.00,$33.32,$190.30,$0.00,$95.15,$150.72,$152.24,$0.00,$29.78,$0.00,$30.30,$0.00
M001271840,SUP,HCPCS C1729,,M001271840  -  CATHETER DRAIN 12FR 25CM RADIOPQ SOFT DUROMETER TEMP TIP,$190.30,$0.00,$190.30,$103.33,$135.82,$0.00,$32.79,$0.00,$0.00,$33.32,$190.30,$0.00,$95.15,$150.72,$152.24,$0.00,$29.78,$0.00,$30.30,$0.00
M001271850,SUP,HCPCS C1729,,M001271850  -  CATHETER NPHSTM PGTL CRV 14FR 25CM LCK SFT DRMTR FLXM PU,$190.30,$0.00,$190.30,$103.33,$135.82,$0.00,$32.79,$0.00,$0.00,$33.32,$190.30,$0.00,$95.15,$150.72,$152.24,$0.00,$29.78,$0.00,$30.30,$0.00
M001271860,SUP,Custom 27203010,,M001271860  -  SET NEPHROSTOMY PIGTAIL CURVE 8FR 25CM LOCK REGULAR,$344.00,$0.00,$344.00,$0.00,$245.51,$0.00,$0.00,$0.00,$0.00,$0.00,$344.00,$0.00,$172.00,$272.45,$275.20,$0.00,$0.00,$0.00,$0.00,$0.00
M001271870,SUP,Custom 27203010,,M001271870  -  KIT NEPHROSTOMY PIGTAIL CURVE 10FR 25CM LOCK REGULAR,$344.00,$0.00,$344.00,$0.00,$245.51,$0.00,$0.00,$0.00,$0.00,$0.00,$344.00,$0.00,$172.00,$272.45,$275.20,$0.00,$0.00,$0.00,$0.00,$0.00
M001271880,SUP,Custom 27203010,,M001271880  -  KIT NEPHROSTOMY PIGTAIL CURVE 12FR 25CM LOCK REGULAR,$344.00,$0.00,$344.00,$0.00,$245.51,$0.00,$0.00,$0.00,$0.00,$0.00,$344.00,$0.00,$172.00,$272.45,$275.20,$0.00,$0.00,$0.00,$0.00,$0.00
M001271900,SUP,Custom 27203010,,M001271900  -  KIT NEPHROSTOMY J PIGTAIL CURVE 18FR 21GA 25CM DUROMETER,$344.00,$0.00,$344.00,$0.00,$245.51,$0.00,$0.00,$0.00,$0.00,$0.00,$344.00,$0.00,$172.00,$272.45,$275.20,$0.00,$0.00,$0.00,$0.00,$0.00
M001272600,SUP,HCPCS C1729,,M001272600  -  CATH DRAIN 8FR 35CM LCK PGTL REG DRMTR RADIOPQ BIL PU HYDPHI,$200.63,$0.00,$200.63,$108.94,$143.19,$0.00,$34.57,$0.00,$0.00,$35.13,$200.63,$0.00,$100.31,$158.90,$160.50,$0.00,$31.40,$0.00,$31.94,$0.00
M001272610,SUP,HCPCS C1729,,M001272610  -  CATH DRAIN 10FR 35CM LCK REG DRMTR RADIOPQ BIL PU HYDPHI,$200.63,$0.00,$200.63,$108.94,$143.19,$0.00,$34.57,$0.00,$0.00,$35.13,$200.63,$0.00,$100.31,$158.90,$160.50,$0.00,$31.40,$0.00,$31.94,$0.00
M001272620,SUP,HCPCS C1729,,M001272620  -  CATH DRAIN 12FR 35CM LCK REG DRMTR RADIOPQ BIL PU HYDPHI,$200.63,$0.00,$200.63,$108.94,$143.19,$0.00,$34.57,$0.00,$0.00,$35.13,$200.63,$0.00,$100.31,$158.90,$160.50,$0.00,$31.40,$0.00,$31.94,$0.00
M001272630,SUP,HCPCS C1729,,M001272630  -  CATH DRAIN 14FR 35CM LCK PGTL REG DRMTR RADIOPQ BIL PU FLXM,$200.63,$0.00,$200.63,$108.94,$143.19,$0.00,$34.57,$0.00,$0.00,$35.13,$200.63,$0.00,$100.31,$158.90,$160.50,$0.00,$31.40,$0.00,$31.94,$0.00
M001272640,SUP,HCPCS C1729,,M001272640  -  CATH DRAIN 8FR 35CM LCK FIRM DRMTR RADIOPQ BIL PU HYDPHI,$200.63,$0.00,$200.63,$108.94,$143.19,$0.00,$34.57,$0.00,$0.00,$35.13,$200.63,$0.00,$100.31,$158.90,$160.50,$0.00,$31.40,$0.00,$31.94,$0.00
M001272650,SUP,HCPCS C1729,,M001272650  -  CATH DRAIN 10FR 35CM LCK REG DRMTR RADIOPQ BIL PU HYDPHI,$200.63,$0.00,$200.63,$108.94,$143.19,$0.00,$34.57,$0.00,$0.00,$35.13,$200.63,$0.00,$100.31,$158.90,$160.50,$0.00,$31.40,$0.00,$31.94,$0.00
M001272660,SUP,HCPCS C1729,,M001272660  -  CATH DRAIN 10FR 35CM LCK SFT DRMTR RADIOPQ BIL PU HYDPHI,$200.63,$0.00,$200.63,$108.94,$143.19,$0.00,$34.57,$0.00,$0.00,$35.13,$200.63,$0.00,$100.31,$158.90,$160.50,$0.00,$31.40,$0.00,$31.94,$0.00
M001272670,SUP,HCPCS C1729,,M001272670  -  CATH DRAIN 12FR 35CM LCK SFT DRMTR RADIOPQ BIL PU HYDPHI,$200.63,$0.00,$200.63,$108.94,$143.19,$0.00,$34.57,$0.00,$0.00,$35.13,$200.63,$0.00,$100.31,$158.90,$160.50,$0.00,$31.40,$0.00,$31.94,$0.00
M001273130,SUP,HCPCS C1729,,M001273130  -  CATHETER DRAIN 30CM 2 LUMEN REGULAR DUROMETER VANSONNENBERG,$364.25,$0.00,$364.25,$197.79,$259.97,$0.00,$62.76,$0.00,$0.00,$63.78,$364.25,$0.00,$182.13,$288.49,$291.40,$0.00,$57.01,$0.00,$57.99,$0.00
M001274000,SUP,HCPCS C2617,,M001274000  -  STENT URETERAL LARGE REGULAR PIGTAIL CURVE 2.66MM 20CM,$266.25,$0.00,$266.25,$119.81,$190.02,$0.00,$45.87,$0.00,$0.00,$46.62,$266.25,$0.00,$133.13,$210.87,$213.00,$0.00,$41.67,$0.00,$42.39,$0.00
M001274010,SUP,HCPCS C2617,,M001274010  -  STENT URETERAL LARGE REGULAR PIGTAIL CURVE 2.66MM 22CM,$266.25,$0.00,$266.25,$119.81,$190.02,$0.00,$45.87,$0.00,$0.00,$46.62,$266.25,$0.00,$133.13,$210.87,$213.00,$0.00,$41.67,$0.00,$42.39,$0.00
M001274020,SUP,HCPCS C2617,,M001274020  -  STENT URETERAL LARGE REGULAR PIGTAIL CURVE 2.66MM 24CM,$266.25,$0.00,$266.25,$119.81,$190.02,$0.00,$45.87,$0.00,$0.00,$46.62,$266.25,$0.00,$133.13,$210.87,$213.00,$0.00,$41.67,$0.00,$42.39,$0.00
M001274030,SUP,HCPCS C2617,,M001274030  -  STENT URETERAL LARGE REGULAR PIGTAIL CURVE 2.66MM 26CM,$266.25,$0.00,$266.25,$119.81,$190.02,$0.00,$45.87,$0.00,$0.00,$46.62,$266.25,$0.00,$133.13,$210.87,$213.00,$0.00,$41.67,$0.00,$42.39,$0.00
M001274040,SUP,HCPCS C2617,,M001274040  -  STENT URETERAL LARGE REGULAR PIGTAIL CURVE 2.66MM 28CM,$266.25,$0.00,$266.25,$119.81,$190.02,$0.00,$45.87,$0.00,$0.00,$46.62,$266.25,$0.00,$133.13,$210.87,$213.00,$0.00,$41.67,$0.00,$42.39,$0.00
M001274050,SUP,HCPCS C2617,,M001274050  -  STENT URETERAL LARGE REGULAR PIGTAIL CURVE 3.33MM 20CM,$266.25,$0.00,$266.25,$119.81,$190.02,$0.00,$45.87,$0.00,$0.00,$46.62,$266.25,$0.00,$133.13,$210.87,$213.00,$0.00,$41.67,$0.00,$42.39,$0.00
M001274060,SUP,HCPCS C2617,,M001274060  -  STENT URETERAL LARGE REGULAR PIGTAIL CURVE 3.33MM 22CM,$266.25,$0.00,$266.25,$119.81,$190.02,$0.00,$45.87,$0.00,$0.00,$46.62,$266.25,$0.00,$133.13,$210.87,$213.00,$0.00,$41.67,$0.00,$42.39,$0.00
M001274070,SUP,HCPCS C2617,,M001274070  -  STENT URETERAL LARGE REGULAR PIGTAIL CURVE 3.33MM 24CM,$266.25,$0.00,$266.25,$119.81,$190.02,$0.00,$45.87,$0.00,$0.00,$46.62,$266.25,$0.00,$133.13,$210.87,$213.00,$0.00,$41.67,$0.00,$42.39,$0.00
M001274080,SUP,HCPCS C2617,,M001274080  -  STENT URETERAL LARGE REGULAR PIGTAIL CURVE 3.33MM 26CM,$266.25,$0.00,$266.25,$119.81,$190.02,$0.00,$45.87,$0.00,$0.00,$46.62,$266.25,$0.00,$133.13,$210.87,$213.00,$0.00,$41.67,$0.00,$42.39,$0.00
M001274090,SUP,HCPCS C2617,,M001274090  -  STENT URETERAL LARGE REGULAR PIGTAIL CURVE 3.33MM 28CM,$266.25,$0.00,$266.25,$119.81,$190.02,$0.00,$45.87,$0.00,$0.00,$46.62,$266.25,$0.00,$133.13,$210.87,$213.00,$0.00,$41.67,$0.00,$42.39,$0.00
M001274110,SUP,HCPCS C2617,,M001274110  -  KIT STENT .038IN LARGE REGULAR PIGTAIL CURVE 6FR 22CM DRAIN,$423.75,$0.00,$423.75,$190.69,$302.43,$0.00,$73.01,$0.00,$0.00,$74.20,$423.75,$0.00,$211.88,$335.61,$339.00,$0.00,$66.32,$0.00,$67.46,$0.00
M001274120,SUP,HCPCS C2617,,M001274120  -  KIT STENT .038IN LARGE REGULAR PIGTAIL CURVE 6FR 24CM DRAIN,$423.75,$0.00,$423.75,$190.69,$302.43,$0.00,$73.01,$0.00,$0.00,$74.20,$423.75,$0.00,$211.88,$335.61,$339.00,$0.00,$66.32,$0.00,$67.46,$0.00
M001274130,SUP,HCPCS C2617,,M001274130  -  KIT STENT .038IN LARGE REGULAR PIGTAIL CURVE 6FR 26CM DRAIN,$423.75,$0.00,$423.75,$190.69,$302.43,$0.00,$73.01,$0.00,$0.00,$74.20,$423.75,$0.00,$211.88,$335.61,$339.00,$0.00,$66.32,$0.00,$67.46,$0.00
M001274140,SUP,HCPCS C2617,,M001274140  -  KIT STENT .038IN LARGE REGULAR PIGTAIL CURVE 6FR 28CM DRAIN,$423.75,$0.00,$423.75,$190.69,$302.43,$0.00,$73.01,$0.00,$0.00,$74.20,$423.75,$0.00,$211.88,$335.61,$339.00,$0.00,$66.32,$0.00,$67.46,$0.00
M001274150,SUP,HCPCS C2617,,M001274150  -  KIT STENT .038IN LARGE REGULAR PIGTAIL CURVE 8FR 20CM DRAIN,$423.75,$0.00,$423.75,$190.69,$302.43,$0.00,$73.01,$0.00,$0.00,$74.20,$423.75,$0.00,$211.88,$335.61,$339.00,$0.00,$66.32,$0.00,$67.46,$0.00
M001274160,SUP,HCPCS C2617,,M001274160  -  KIT STENT .038IN LARGE REGULAR PIGTAIL CURVE 8FR 22CM DRAIN,$423.75,$0.00,$423.75,$190.69,$302.43,$0.00,$73.01,$0.00,$0.00,$74.20,$423.75,$0.00,$211.88,$335.61,$339.00,$0.00,$66.32,$0.00,$67.46,$0.00
M001274170,SUP,HCPCS C2617,,M001274170  -  KIT STENT .038IN LARGE REGULAR PIGTAIL CURVE 8FR 24CM DRAIN,$423.75,$0.00,$423.75,$190.69,$302.43,$0.00,$73.01,$0.00,$0.00,$74.20,$423.75,$0.00,$211.88,$335.61,$339.00,$0.00,$66.32,$0.00,$67.46,$0.00
M001274180,SUP,HCPCS C2617,,M001274180  -  KIT STENT .038IN LARGE REGULAR PIGTAIL CURVE 8FR 26CM DRAIN,$423.75,$0.00,$423.75,$190.69,$302.43,$0.00,$73.01,$0.00,$0.00,$74.20,$423.75,$0.00,$211.88,$335.61,$339.00,$0.00,$66.32,$0.00,$67.46,$0.00
M001274190,SUP,HCPCS C2617,,M001274190  -  KIT STENT .038IN LARGE REGULAR PIGTAIL CURVE 8FR 28CM DRAIN,$423.75,$0.00,$423.75,$190.69,$302.43,$0.00,$73.01,$0.00,$0.00,$74.20,$423.75,$0.00,$211.88,$335.61,$339.00,$0.00,$66.32,$0.00,$67.46,$0.00
M001281560,SUP,HCPCS C1729,,M001281560  -  CATHETER DRAIN 8FR 35CM 1 LUMEN REGULAR DUROMETER FLEXIBLE,$197.63,$0.00,$197.63,$107.31,$141.04,$0.00,$34.05,$0.00,$0.00,$34.60,$197.63,$0.00,$98.81,$156.52,$158.10,$0.00,$30.93,$0.00,$31.46,$0.00
M001281570,SUP,HCPCS C1729,,M001281570  -  CATHETER DRAIN 10FR 35CM REGULAR DUROMETER DISSOLVABLE TIP,$197.63,$0.00,$197.63,$107.31,$141.04,$0.00,$34.05,$0.00,$0.00,$34.60,$197.63,$0.00,$98.81,$156.52,$158.10,$0.00,$30.93,$0.00,$31.46,$0.00
M001281580,SUP,HCPCS C1729,,M001281580  -  CATHETER DRAIN REGULAR 12FR 35CM TEMP TIP FLEXIMA HYDPHI,$197.63,$0.00,$197.63,$107.31,$141.04,$0.00,$34.05,$0.00,$0.00,$34.60,$197.63,$0.00,$98.81,$156.52,$158.10,$0.00,$30.93,$0.00,$31.46,$0.00
M001281590,SUP,HCPCS C1729,,M001281590  -  CATHETER DRAIN 14FR 35CM REGULAR DUROMETER DISSOLVABLE TIP,$197.63,$0.00,$197.63,$107.31,$141.04,$0.00,$34.05,$0.00,$0.00,$34.60,$197.63,$0.00,$98.81,$156.52,$158.10,$0.00,$30.93,$0.00,$31.46,$0.00
M001281660,SUP,Custom 27203010,,M001281660  -  KIT NEPHROSTOMY .018IN PIGTAIL CURVE FLOPPY 10FR 21GA 25CM,$364.13,$0.00,$364.13,$0.00,$259.88,$0.00,$0.00,$0.00,$0.00,$0.00,$364.13,$0.00,$182.06,$288.39,$291.30,$0.00,$0.00,$0.00,$0.00,$0.00
M001281790,SUP,HCPCS C1726,,M001281790  -  CATHETER NEPHROSTOMY PIGTAIL CURVE 8FR 25CM LOCK REGULAR,$197.63,$0.00,$197.63,$107.31,$141.04,$0.00,$34.05,$0.00,$0.00,$34.60,$197.63,$0.00,$98.81,$156.52,$158.10,$0.00,$30.93,$0.00,$31.46,$0.00
M001281800,SUP,HCPCS C1729,,M001281800  -  CATHETER NEPHROSTOMY PIGTAIL CURVE 10FR 25CM LOCK SOFT,$197.63,$0.00,$197.63,$107.31,$141.04,$0.00,$34.05,$0.00,$0.00,$34.60,$197.63,$0.00,$98.81,$156.52,$158.10,$0.00,$30.93,$0.00,$31.46,$0.00
M001281810,SUP,Custom 27203010,,M001281810  -  CATHETER NEPHROSTOMY 12FR 25CM REGULAR DUROMETER DRAIN HOLE,$197.63,$0.00,$197.63,$0.00,$141.04,$0.00,$0.00,$0.00,$0.00,$0.00,$197.63,$0.00,$98.81,$156.52,$158.10,$0.00,$0.00,$0.00,$0.00,$0.00
M001281820,SUP,Custom 27203010,,M001281820  -  CATHETER NEPHROSTOMY PIGTAIL CURVE 14FR 25CM LOCK REGULAR,$197.63,$0.00,$197.63,$0.00,$141.04,$0.00,$0.00,$0.00,$0.00,$0.00,$197.63,$0.00,$98.81,$156.52,$158.10,$0.00,$0.00,$0.00,$0.00,$0.00
M001282600,SUP,HCPCS C1729,,M001282600  -  CATH DRAIN 8FR 35CM LCK REG DRMTR TMPTP RADIOPQ BIL PU,$200.63,$0.00,$200.63,$108.94,$143.19,$0.00,$34.57,$0.00,$0.00,$35.13,$200.63,$0.00,$100.31,$158.90,$160.50,$0.00,$31.40,$0.00,$31.94,$0.00
M001282610,SUP,HCPCS C1729,,M001282610  -  CATH DRAIN 10FR 35CM LCK TEMP TIP RADIOPQ BIL PU HYDPHI FLXM,$200.63,$0.00,$200.63,$108.94,$143.19,$0.00,$34.57,$0.00,$0.00,$35.13,$200.63,$0.00,$100.31,$158.90,$160.50,$0.00,$31.40,$0.00,$31.94,$0.00
M001291650,SUP,HCPCS C1729,,M001291650  -  KIT DRAIN 35CM 8FR PU HYDPHI FLXM BIL REG DRMTR STRL DISP,$402.85,$0.00,$402.85,$218.75,$287.51,$0.00,$69.41,$0.00,$0.00,$70.54,$402.85,$0.00,$201.43,$319.06,$322.28,$0.00,$63.05,$0.00,$64.13,$0.00
M0013120021,SUP,Custom 27803010,,M0013120021  -  COIL EMBOLIZATION .018IN HELIX STR 2MM PLATINUM FIBER,$136.50,$0.00,$136.50,$0.00,$97.42,$0.00,$0.00,$0.00,$0.00,$0.00,$136.50,$0.00,$68.25,$108.11,$109.20,$0.00,$0.00,$0.00,$0.00,$0.00
M0013120051,SUP,Custom 27803010,,M0013120051  -  COIL EMBOLIZATION STR 2MM 50MM 5MM 18 COIL PLATINUM FIBER,$136.50,$0.00,$136.50,$0.00,$97.42,$0.00,$0.00,$0.00,$0.00,$0.00,$136.50,$0.00,$68.25,$108.11,$109.20,$0.00,$0.00,$0.00,$0.00,$0.00
M0013120211,SUP,Custom 27803010,,M0013120211  -  COIL EMBOLIZATION 2MM 5MM 10MM 8-18 COIL FIBERED PLATINUM,$198.83,$0.00,$198.83,$0.00,$141.90,$0.00,$0.00,$0.00,$0.00,$0.00,$198.83,$0.00,$99.42,$157.47,$159.06,$0.00,$0.00,$0.00,$0.00,$0.00
M0013120221,SUP,Custom 27803010,,M0013120221  -  COIL EMBOLIZATION .018IN HELIX 4MM 4MM COMPLEX PLATINUM,$994.15,$0.00,$994.15,$0.00,$709.52,$0.00,$0.00,$0.00,$0.00,$0.00,$994.15,$0.00,$497.08,$787.37,$795.32,$0.00,$0.00,$0.00,$0.00,$0.00
M0013120331,SUP,Custom 27803010,,M0013120331  -  COIL EMBOLIZATION .018IN HELIX 6MM 6MM COMPLEX PLATINUM,$198.83,$0.00,$198.83,$0.00,$141.90,$0.00,$0.00,$0.00,$0.00,$0.00,$198.83,$0.00,$99.42,$157.47,$159.06,$0.00,$0.00,$0.00,$0.00,$0.00
M0013120431,SUP,Custom 27803010,,M0013120431  -  COIL EMBOLIZATION .018IN HELIX 4MM 30MM COMPLEX PLATINUM,"$1,025.05",$0.00,"$1,025.05",$0.00,$731.58,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,025.05",$0.00,$512.53,$811.84,$820.04,$0.00,$0.00,$0.00,$0.00,$0.00
M0013120441,SUP,Custom 27803010,,M0013120441  -  COIL EMBOLIZATION .018IN HELIX 7MM 10MM COMPLEX PLATINUM,$205.01,$0.00,$205.01,$0.00,$146.32,$0.00,$0.00,$0.00,$0.00,$0.00,$205.01,$0.00,$102.51,$162.37,$164.01,$0.00,$0.00,$0.00,$0.00,$0.00
M0013120551,SUP,Custom 27803010,,M0013120551  -  COIL EMBOLIZATION .018IN HELICAL 8MM 12MM FIBERED COMPLEX,"$1,025.05",$0.00,"$1,025.05",$0.00,$731.58,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,025.05",$0.00,$512.53,$811.84,$820.04,$0.00,$0.00,$0.00,$0.00,$0.00
M0013120661,SUP,Custom 27803010,,M0013120661  -  COIL EMBOLIZATION .018IN HELICAL COMPLEX 10MM 14MM 60MM,$205.01,$0.00,$205.01,$0.00,$146.32,$0.00,$0.00,$0.00,$0.00,$0.00,$205.01,$0.00,$102.51,$162.37,$164.01,$0.00,$0.00,$0.00,$0.00,$0.00
M0013120771,SUP,Custom 27803010,,M0013120771  -  COIL EMBOLIZATION .018IN HELIX 11MM 17MM COMPLEX PLATINUM,$205.01,$0.00,$205.01,$0.00,$146.32,$0.00,$0.00,$0.00,$0.00,$0.00,$205.01,$0.00,$102.51,$162.37,$164.01,$0.00,$0.00,$0.00,$0.00,$0.00
M001314001,SUP,HCPCS C1725,,M001314001  -  CATHETER ANGIOGRAPHIC MULTPUR SHORT TIP CURVE 5FR 65CM BRAID,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314011,SUP,HCPCS C1725,,M001314011  -  CATHETER ANGIOGRAPHIC MULTPUR SHORT TIP CURVE 5FR 100CM,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314021,SUP,HCPCS C1725,,M001314021  -  CATHETER ANGIOGRAPHIC MULTPUR SHORT TIP CURVE 5FR 65CM BRAID,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314031,SUP,HCPCS C1725,,M001314031  -  CATHETER ANGIOGRAPHIC STR 5FR 100CM BRAID TORQUE SELECTIVE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314041,SUP,HCPCS C1725,,M001314041  -  CATHETER ANGIOGRAPHIC BERN CURVE FLUTE TAPER 5FR 100CM BRAID,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314051,SUP,HCPCS C1725,,M001314051  -  CATHETER ANGIOGRAPHIC BERENSTEIN CURVE 5FR 100CM BRAID,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314061,SUP,HCPCS C1725,,M001314061  -  CATHETER ANGIOGRAPHIC BERENSTEIN CURVE 5FR 100CM BRAID,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314071,SUP,HCPCS C1725,,M001314071  -  CATHETER ANGIOGRAPHIC BERENSTEIN CURVE 5FR 40CM BRAID TORQUE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314081,SUP,HCPCS C1887,,M001314081  -  CATHETER ANGIOGRAPHIC BERENSTEIN CURVE 5FR 40CM BRAID TORQUE,$127.40,$0.00,$127.40,$69.18,$90.93,$0.00,$21.95,$0.00,$0.00,$22.31,$127.40,$0.00,$63.70,$100.90,$101.92,$0.00,$19.94,$0.00,$20.28,$0.00
M001314101,SUP,HCPCS C1725,,M001314101  -  CATHETER ANGIOGRAPHIC BERENSTEIN CURVE 5FR 65CM BRAID TORQUE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314111,SUP,HCPCS C1725,,M001314111  -  CATHETER ANGIOGRAPHIC WEIN CURVE FLUTE TAPER 5FR 100CM BRAID,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314121,SUP,HCPCS C1725,,M001314121  -  CATHETER ANGIOGRAPHIC WEIN CURVE 5FR 100CM BRAID TORQUE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314131,SUP,HCPCS C1725,,M001314131  -  CATHETER ANGIOGRAPHIC HEADHUNTER 1 CURVE 5FR 65CM BRAID,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314141,SUP,HCPCS C1725,,M001314141  -  CATHETER ANGIOGRAPHIC HEADHUNTER 1 CURVE 5FR 100CM BRAID,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314151,SUP,HCPCS C1725,,M001314151  -  CATHETER ANGIO HDHNTR 1 CRV 5FR 100CM IMGR2 BRD TRQ SLCT,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314161,SUP,HCPCS C1725,,M001314161  -  CATHETER ANGIOGRAPHIC HEADHUNTER 3 CURVE 5FR 100CM TAPER TIP,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314171,SUP,HCPCS C1725,,M001314171  -  CATHETER ANGIOGRAPHIC HEADHUNTER 3 CURVE 5FR 100CM BRAID,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314181,SUP,HCPCS C1725,,M001314181  -  CATHETER ANGIOGRAPHIC HEADHUNTER 1 HEADHUNTER CURVE 5FR 100,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314191,SUP,HCPCS C1725,,M001314191  -  CATHETER ANGIOGRAPHIC HEADHUNTER 1 HEADHUNTER CURVE 5FR 100,$30.00,$0.00,$30.00,$16.29,$21.41,$0.00,$5.17,$0.00,$0.00,$5.25,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$4.70,$0.00,$4.78,$0.00
M001314201,SUP,HCPCS C1725,,M001314201  -  CATHETER ANGIOGRAPHIC HEADHUNTER 3 HEADHUNTER CURVE 5FR 100,$30.00,$0.00,$30.00,$16.29,$21.41,$0.00,$5.17,$0.00,$0.00,$5.25,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$4.70,$0.00,$4.78,$0.00
M001314211,SUP,HCPCS C1725,,M001314211  -  CATHETER ANGIOGRAPHIC BENTSON 1 CURVE 5FR 65CM BRAID TORQUE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314221,SUP,HCPCS C1725,,M001314221  -  CATHETER ANGIOGRAPHIC BENTSON 1 CURVE 5FR 100CM BRAID TORQUE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314231,SUP,HCPCS C1725,,M001314231  -  CATHETER ANGIOGRAPHIC BENTSON 1 CURVE 5FR 100CM BRAID TORQUE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314241,SUP,HCPCS C1725,,M001314241  -  CATHETER ANGIOGRAPHIC BENTSON 2 CURVE 5FR 100CM BRAID TORQUE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314251,SUP,HCPCS C1725,,M001314251  -  CATHETER ANGIOGRAPHIC BENTSON 2 CURVE 5FR 100CM BRAID TORQUE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314261,SUP,HCPCS C1725,,M001314261  -  CATHETER ANGIOGRAPHIC BENTSON 3 CURVE 5FR 100CM BRAID TORQUE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314271,SUP,HCPCS C1725,,M001314271  -  CATHETER ANGIOGRAPHIC BENTSON 3 CURVE 5FR 100CM BRAID TORQUE,$30.00,$0.00,$30.00,$16.29,$21.41,$0.00,$5.17,$0.00,$0.00,$5.25,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$4.70,$0.00,$4.78,$0.00
M001314281,SUP,HCPCS C1725,,M001314281  -  CATHETER ANGIOGRAPHIC MANN CURVE 5FR 100CM BRAID TORQUE,$30.00,$0.00,$30.00,$16.29,$21.41,$0.00,$5.17,$0.00,$0.00,$5.25,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$4.70,$0.00,$4.78,$0.00
M001314291,SUP,HCPCS C1725,,M001314291  -  CATHETER ANGIOGRAPHIC MANN CURVE 5FR 100CM BRAID TORQUE,$30.00,$0.00,$30.00,$16.29,$21.41,$0.00,$5.17,$0.00,$0.00,$5.25,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$4.70,$0.00,$4.78,$0.00
M001314301,SUP,HCPCS C1725,,M001314301  -  CATHETER ANGIOGRAPHIC SIMMONS 1 CURVE 5FR 65CM BRAID TORQUE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314311,SUP,HCPCS C1725,,M001314311  -  CATHETER ANGIOGRAPHIC SIMMONS 1 CURVE 5FR 65CM BRAID TORQUE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314321,SUP,HCPCS C1725,,M001314321  -  CATHETER ANGIOGRAPHIC SIMMONS 1 CURVE 5FR 100CM BRAID TORQUE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314331,SUP,HCPCS C1725,,M001314331  -  CATHETER ANGIOGRAPHIC SIMMONS 1 CURVE 5FR 100CM BRAID TORQUE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314341,SUP,HCPCS C1725,,M001314341  -  CATHETER ANGIOGRAPHIC SIMMONS 2 CURVE 5FR 100CM BRAID TORQUE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314351,SUP,HCPCS C1725,,M001314351  -  CATHETER ANGIOGRAPHIC SIMMONS 2 CURVE 5FR 100CM BRAID TORQUE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314361,SUP,HCPCS C1725,,M001314361  -  CATHETER ANGIOGRAPHIC SIMMONS 3 CURVE 5FR 100CM BRAID TORQUE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314371,SUP,HCPCS C1725,,M001314371  -  CATHETER ANGIOGRAPHIC SIMMONS 3 CURVE 5FR 100CM BRAID TORQUE,$30.00,$0.00,$30.00,$16.29,$21.41,$0.00,$5.17,$0.00,$0.00,$5.25,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$4.70,$0.00,$4.78,$0.00
M001314381,SUP,HCPCS C1725,,M001314381  -  CATHETER ANGIOGRAPHIC SIMMONS 4 CURVE 5FR 100CM BRAID TORQUE,$30.00,$0.00,$30.00,$16.29,$21.41,$0.00,$5.17,$0.00,$0.00,$5.25,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$4.70,$0.00,$4.78,$0.00
M001314391,SUP,HCPCS C1725,,M001314391  -  CATHETER ANGIOGRAPHIC NEWTON 1 CURVE 5FR 100CM BRAID TORQUE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314401,SUP,HCPCS C1725,,M001314401  -  CATHETER ANGIOGRAPHIC NEWTON 1 CURVE 5FR 100CM BRAID TORQUE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314411,SUP,HCPCS C1725,,M001314411  -  CATHETER ANGIOGRAPHIC NEWTON 2 CURVE 5FR 100CM BRAID TORQUE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314421,SUP,HCPCS C1725,,M001314421  -  CATHETER ANGIOGRAPHIC NEWTON 2 CURVE 5FR 100CM BRAID TORQUE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314431,SUP,HCPCS C1725,,M001314431  -  CATHETER ANGIOGRAPHIC NEWTON 3 CURVE 5FR 100CM BRAID TORQUE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314441,SUP,HCPCS C1725,,M001314441  -  CATHETER ANGIOGRAPHIC NEWTON 3 CURVE 5FR 100CM TAPER TIP,$30.00,$0.00,$30.00,$16.29,$21.41,$0.00,$5.17,$0.00,$0.00,$5.25,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$4.70,$0.00,$4.78,$0.00
M001314451,SUP,HCPCS C1725,,M001314451  -  CATHETER ANGIOGRAPHIC NEWTON 4 CURVE 5FR 100CM BRAID TORQUE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314461,SUP,HCPCS C1725,,M001314461  -  CATHETER ANGIOGRAPHIC NEWTON 4 CURVE 5FR 100CM TAPER TIP,$30.00,$0.00,$30.00,$16.29,$21.41,$0.00,$5.17,$0.00,$0.00,$5.25,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$4.70,$0.00,$4.78,$0.00
M001314471,SUP,HCPCS C1725,,M001314471  -  CATHETER ANGIOGRAPHIC NEWTON 5 CURVE 5FR 100CM BRAID TORQUE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314481,SUP,HCPCS C1725,,M001314481  -  CATHETER ANGIOGRAPHIC NEWTON 5 CURVE 5FR 100CM BRAID TORQUE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314491,SUP,HCPCS C1725,,M001314491  -  CATHETER ANGIOGRAPHIC CK CURVE 5FR 100CM BRAID TORQUE,$30.00,$0.00,$30.00,$16.29,$21.41,$0.00,$5.17,$0.00,$0.00,$5.25,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$4.70,$0.00,$4.78,$0.00
M001314501,SUP,HCPCS C1725,,M001314501  -  CATHETER ANGIOGRAPHIC MULTPUR GEN CURVE 5FR 100CM BRAID,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314511,SUP,HCPCS C1725,,M001314511  -  CATHETER ANGIOGRAPHIC MULTPUR GEN CURVE 5FR 100CM BRAID,$30.00,$0.00,$30.00,$16.29,$21.41,$0.00,$5.17,$0.00,$0.00,$5.25,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$4.70,$0.00,$4.78,$0.00
M001314521,SUP,HCPCS C1725,,M001314521  -  CATHETER ANGIOGRAPHIC CHUANG B CURVE 5FR 65CM BRAID TORQUE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314531,SUP,HCPCS C1725,,M001314531  -  CATHETER ANGIOGRAPHIC CHUANG B CURVE 5FR 65CM BRAID TORQUE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314541,SUP,HCPCS C1725,,M001314541  -  CATHETER ANGIOGRAPHIC CHUANG C CURVE 5FR 65CM BRAID TORQUE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314551,SUP,HCPCS C1725,,M001314551  -  CATHETER ANGIOGRAPHIC CHUANG C CURVE 5FR 65CM TAPER TIP,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314561,SUP,HCPCS C1725,,M001314561  -  CATHETER ANGIOGRAPHIC CHUANG 2.5 CURVE 5FR 65CM BRAID TORQUE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314571,SUP,HCPCS C1725,,M001314571  -  CATHETER ANGIOGRAPHIC CHUANG 2.5 CURVE 5FR 65CM BRAID TORQUE,$30.00,$0.00,$30.00,$16.29,$21.41,$0.00,$5.17,$0.00,$0.00,$5.25,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$4.70,$0.00,$4.78,$0.00
M001314581,SUP,HCPCS C1725,,M001314581  -  CATHETER ANGIOGRAPHIC CONTRALATERAL 2 CURVE 5FR 65CM BRAID,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314591,SUP,HCPCS C1726,,M001314591  -  CATHETER ANGIOGRAPHIC CONTRALATERAL 2 CURVE 5FR 65CM BRAID,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314601,SUP,HCPCS C1725,,M001314601  -  CATHETER ANGIOGRAPHIC DUCK CURVE 5FR 65CM BRAID TORQUE,$30.00,$0.00,$30.00,$16.29,$21.41,$0.00,$5.17,$0.00,$0.00,$5.25,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$4.70,$0.00,$4.78,$0.00
M001314611,SUP,HCPCS C1725,,M001314611  -  CATHETER ANGIOGRAPHIC DUCK CURVE 5FR 65CM BRAID TORQUE,$30.00,$0.00,$30.00,$16.29,$21.41,$0.00,$5.17,$0.00,$0.00,$5.25,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$4.70,$0.00,$4.78,$0.00
M001314621,SUP,HCPCS C1725,,M001314621  -  CATHETER ANGIOGRAPHIC COBRA 1 CURVE 5FR 65CM BRAID TORQUE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314631,SUP,HCPCS C1725,,M001314631  -  CATHETER ANGIOGRAPHIC COBRA 1 CURVE 5FR 65CM BRAID TORQUE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314641,SUP,HCPCS C1725,,M001314641  -  CATHETER ANGIOGRAPHIC COBRA 1 CURVE 5FR 65CM BRAID TORQUE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314651,SUP,HCPCS C1725,,M001314651  -  CATHETER ANGIOGRAPHIC COBRA 1 CURVE 5FR 65CM BRAID TORQUE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314661,SUP,HCPCS C1725,,M001314661  -  CATHETER ANGIOGRAPHIC COBRA 2 CURVE 5FR 65CM BRAID TORQUE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314671,SUP,HCPCS C1725,,M001314671  -  CATHETER ANGIOGRAPHIC COBRA 2 CURVE 5FR 65CM BRAID TORQUE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314681,SUP,HCPCS C1725,,M001314681  -  CATHETER ANGIOGRAPHIC COBRA 2 CURVE 5FR 65CM BRAID TORQUE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314691,SUP,HCPCS C1725,,M001314691  -  CATHETER ANGIOGRAPHIC COBRA 2 CURVE 5FR 65CM BRAID TORQUE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314701,SUP,HCPCS C1725,,M001314701  -  CATHETER ANGIOGRAPHIC COBRA 3 CURVE 5FR 65CM BRAID TORQUE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314711,SUP,HCPCS C1725,,M001314711  -  CATHETER ANGIOGRAPHIC COBRA 3 CURVE 5FR 65CM BRAID TORQUE,$30.00,$0.00,$30.00,$16.29,$21.41,$0.00,$5.17,$0.00,$0.00,$5.25,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$4.70,$0.00,$4.78,$0.00
M001314721,SUP,HCPCS C1725,,M001314721  -  CATHETER ANGIOGRAPHIC COBRA 3 CURVE 5FR 65CM BRAID TORQUE,$30.00,$0.00,$30.00,$16.29,$21.41,$0.00,$5.17,$0.00,$0.00,$5.25,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$4.70,$0.00,$4.78,$0.00
M001314731,SUP,HCPCS C1725,,M001314731  -  CATHETER ANGIOGRAPHIC COBRA 3 CURVE 5FR 65CM BRAID TORQUE,$30.00,$0.00,$30.00,$16.29,$21.41,$0.00,$5.17,$0.00,$0.00,$5.25,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$4.70,$0.00,$4.78,$0.00
M001314741,SUP,HCPCS C1725,,M001314741  -  CATHETER ANGIOGRAPHIC VAN ANDEL 2 CURVE 5FR 65CM BRAID,$30.00,$0.00,$30.00,$16.29,$21.41,$0.00,$5.17,$0.00,$0.00,$5.25,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$4.70,$0.00,$4.78,$0.00
M001314751,SUP,HCPCS C1725,,M001314751  -  CATHETER ANGIOGRAPHIC TRAIN CURVE 5FR 65CM BRAID TORQUE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314761,SUP,HCPCS C1725,,M001314761  -  CATHETER ANGIOGRAPHIC MIKELSON CURVE 5FR 65CM BRAID TORQUE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314771,SUP,HCPCS C1725,,M001314771  -  CATHETER ANGIOGRAPHIC MIKELSON CURVE 5FR 65CM BRAID TORQUE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314781,SUP,HCPCS C1725,,M001314781  -  CATHETER ANGIOGRAPHIC HK 1 CURVE 5FR 65CM BRAID TORQUE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314791,SUP,HCPCS C1725,,M001314791  -  CATHETER ANGIOGRAPHIC HK 1 CURVE 5FR 65CM BRAID TORQUE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314801,SUP,HCPCS C1725,,M001314801  -  CATHETER ANGIOGRAPHIC SHEPHERD HOOK .8 CURVE 5FR 65CM BRAID,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314811,SUP,HCPCS C1725,,M001314811  -  CATHETER ANGIOGRAPHIC SHEPHERD HOOK .8 CURVE 5FR 65CM BRAID,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314821,SUP,HCPCS C1725,,M001314821  -  CATHETER ANGIOGRAPHIC SHEPHERD HOOK 1 CURVE 5FR 65CM BRAID,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314831,SUP,HCPCS C1725,,M001314831  -  CATHETER ANGIOGRAPHIC SHEPHERD HOOK 1 CURVE 5FR 65CM BRAID,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314841,SUP,HCPCS C1725,,M001314841  -  CATHETER ANGIOGRAPHIC ROSCH 1 CURVE 5FR 65CM BRAID TORQUE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314851,SUP,HCPCS C1725,,M001314851  -  CATHETER ANGIOGRAPHIC ROSCH 1 CURVE 5FR 65CM BRAID TORQUE,$30.00,$0.00,$30.00,$16.29,$21.41,$0.00,$5.17,$0.00,$0.00,$5.25,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$4.70,$0.00,$4.78,$0.00
M001314861,SUP,HCPCS C1725,,M001314861  -  CATHETER ANGIOGRAPHIC ROSCH 2 CURVE 5FR 65CM BRAID TORQUE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314871,SUP,HCPCS C1725,,M001314871  -  CATHETER ANGIOGRAPHIC ROSCH 2 CURVE 5FR 65CM BRAID TORQUE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314881,SUP,HCPCS C1725,,M001314881  -  CATHETER ANGIOGRAPHIC RENAL DOUBLE CURVE 5FR 65CM BRAID,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314891,SUP,HCPCS C1725,,M001314891  -  CATHETER ANGIOGRAPHIC RENAL DOUBLE CURVE 5FR 65CM BRAID,$30.00,$0.00,$30.00,$16.29,$21.41,$0.00,$5.17,$0.00,$0.00,$5.25,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$4.70,$0.00,$4.78,$0.00
M001314901,SUP,HCPCS C1725,,M001314901  -  CATHETER ANGIOGRAPHIC RENAL DOUBLE CURVE 5FR 65CM BRAID,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001314911,SUP,HCPCS C1725,,M001314911  -  CATHETER ANGIOGRAPHIC RENAL DOUBLE CURVE 5FR 65CM BRAID,$30.00,$0.00,$30.00,$16.29,$21.41,$0.00,$5.17,$0.00,$0.00,$5.25,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$4.70,$0.00,$4.78,$0.00
M001315001,SUP,HCPCS C1725,,M001315001  -  CATHETER ANGIOGRAPHIC TENNIS RACQUET CURVE 4FR 65CM BRAID,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001315011,SUP,HCPCS C1725,,M001315011  -  CATHETER ANGIOGRAPHIC .035IN TENNIS RACQUET CURVE 4FR 90CM,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001315021,SUP,HCPCS C1725,,M001315021  -  CATHETER ANGIOGRAPHIC TENNIS RACQUET CURVE 4FR 100CM BRAID,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001315031,SUP,HCPCS C1725,,M001315031  -  CATHETER ANGIOGRAPHIC TENNIS RACQUET CURVE 5FR 65CM BRAID,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001315041,SUP,HCPCS C1725,,M001315041  -  CATHETER ANGIOGRAPHIC TENNIS RACQUET CURVE 5FR 90CM BRAID,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001315051,SUP,HCPCS C1725,,M001315051  -  CATHETER ANGIOGRAPHIC .035IN TENNIS RACQUET CURVE 5FR 100CM,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001315061,SUP,HCPCS C1725,,M001315061  -  CATHETER ANGIOGRAPHIC TENNIS RACQUET CURVE 5FR 65CM BRAID,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001315071,SUP,HCPCS C1725,,M001315071  -  CATHETER ANGIOGRAPHIC .038IN TENNIS RACQUET CURVE 5FR 90CM,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001315081,SUP,HCPCS C1725,,M001315081  -  CATHETER ANGIOGRAPHIC TENNIS RACQUET CURVE 5FR 100CM BRAID,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001315091,SUP,HCPCS C1725,,M001315091  -  CATHETER ANGIOGRAPHIC PIGTAIL CURVE 4FR 65CM BRAID TORQUE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001315101,SUP,HCPCS C1725,,M001315101  -  CATHETER ANGIOGRAPHIC STR FLUSH CURVE 4FR 65CM HIGH FLOW,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001315111,SUP,HCPCS C1725,,M001315111  -  CATHETER ANGIOGRAPHIC .035IN 4FR 90CM PIGTAIL IMAGER II,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001315121,SUP,HCPCS C1725,,M001315121  -  CATHETER ANGIOGRAPHIC STR 4FR 90CM BRAID TORQUE SELECTIVE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001315131,SUP,HCPCS C1726,,M001315131  -  CATHETER ANGIOGRAPHIC PIGTAIL FLUSH CURVE 5FR 65CM HIGH FLOW,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001315141,SUP,HCPCS C1725,,M001315141  -  CATHETER ANGIOGRAPHIC PIGTAIL CURVE 5FR 90CM TAPER TIP FLUTE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001315151,SUP,HCPCS C1725,,M001315151  -  CATHETER ANGIOGRAPHIC PIGTAIL CURVE 5FR 100CM TAPER TIP,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001315161,SUP,HCPCS C1725,,M001315161  -  CATHETER ANGIOGRAPHIC STR FLUSH CURVE 5FR 65CM HIGH FLOW,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001315171,SUP,HCPCS C1725,,M001315171  -  CATHETER ANGIOGRAPHIC STR FLUSH CURVE 5FR 90CM HIGH FLOW,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001315181,SUP,HCPCS C1725,,M001315181  -  CATHETER ANGIOGRAPHIC STR 5FR 100CM BRAID TORQUE SELECTIVE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001315191,SUP,HCPCS C1725,,M001315191  -  CATHETER ANGIOGRAPHIC PIGTAIL CURVE 5FR 65CM BRAID TORQUE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M00131520,SUP,HCPCS C1725,,M00131520  -  CATHETER ANGIOGRAPHIC STR 5FR 65CM BRAID TORQUE SELECTIVE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001315201,SUP,HCPCS C1725,,M001315201  -  CATHETER ANGIOGRAPHIC STR 5FR 65CM BRAID TORQUE SELECTIVE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001315211,SUP,HCPCS C1725,,M001315211  -  CATHETER ANGIOGRAPHIC PIGTAIL CURVE 5FR 90CM BRAID TORQUE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001315221,SUP,HCPCS C1725,,M001315221  -  CATHETER ANGIOGRAPHIC STR 5FR 90CM TAPER TIP FLUTE HUB BRAID,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001315231,SUP,HCPCS C1725,,M001315231  -  CATHETER ANGIOGRAPHIC PIGTAIL CURVE 5FR 100CM BRAID TORQUE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001315241,SUP,HCPCS C1725,,M001315241  -  CATHETER ANGIOGRAPHIC STR 5FR 100CM BRAID TORQUE SELECTIVE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001315251,SUP,HCPCS C1725,,M001315251  -  CATHETER ANGIOGRAPHIC CONTRALATERAL CURVE 4FR 65CM BRAID,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001315261,SUP,HCPCS C1725,,M001315261  -  CATHETER ANGIOGRAPHIC CONTRALATERAL CURVE 4FR 90CM IMAGER II,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001315271,SUP,HCPCS C1725,,M001315271  -  CATHETER ANGIOGRAPHIC CONTRALATERAL CURVE 4FR 100CM BRAID,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001315281,SUP,HCPCS C1726,,M001315281  -  CATHETER ANGIOGRAPHIC CONTRALATERAL CURVE 5FR 65CM BRAID,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001315291,SUP,HCPCS C1725,,M001315291  -  CATHETER ANGIOGRAPHIC CONTRALATERAL CURVE 5FR 90CM BRAID,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001315301,SUP,HCPCS C1725,,M001315301  -  CATHETER ANGIOGRAPHIC CONTRALATERAL CURVE 5FR 100CM BRAID,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001315311,SUP,HCPCS C1725,,M001315311  -  CATHETER ANGIOGRAPHIC CONTRALATERAL CURVE 5FR 65CM TAPER TIP,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001315321,SUP,HCPCS C1725,,M001315321  -  CATHETER ANGIOGRAPHIC CONTRALATERAL CURVE 5FR 90CM BRAID,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001315331,SUP,HCPCS C1725,,M001315331  -  CATHETER ANGIOGRAPHIC CONTRALATERAL CURVE 5FR 100CM BRAID,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001316021,SUP,HCPCS C1725,,M001316021  -  CATHETER ANGIOGRAPHIC MULTPUR SHORT TIP CURVE 4FR 65CM BRAID,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001316031,SUP,HCPCS C1725,,M001316031  -  CATHETER ANGIOGRAPHIC SHORT TIP CURVE 4FR 100CM TAPER TIP,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001316041,SUP,HCPCS C1725,,M001316041  -  CATHETER ANGIOGRAPHIC BARNH CURVE 4FR 100CM BRAID TORQUE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001316061,SUP,HCPCS C1725,,M001316061  -  CATHETER ANGIOGRAPHIC .035IN BERN CURVE 4FR 100CM BRAID,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001316071,SUP,HCPCS C1725,,M001316071  -  CATHETER ANGIOGRAPHIC BERNSTEIN CURVE 4FR 40CM BRAID TORQUE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001316091,SUP,HCPCS C1725,,M001316091  -  CATHETER ANGIOGRAPHIC BERENSTEIN CURVE 4FR 65CM BRAID TORQUE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001316121,SUP,HCPCS C1725,,M001316121  -  CATHETER ANGIOGRAPHIC WEINBERG CEREBRAL CURVE 4FR 100CM,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001316131,SUP,HCPCS C1725,,M001316131  -  CATHETER ANGIOGRAPHIC HEADHUNTER 1 CURVE 4FR 65CM BRAID,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001316151,SUP,HCPCS C1725,,M001316151  -  CATHETER ANGIOGRAPHIC HEADHUNTER 1 CURVE 4FR 100CM BRAID,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001316171,SUP,HCPCS C1725,,M001316171  -  CATHETER ANGIOGRAPHIC HEADHUNTER 3 CURVE 4FR 100CM BRAID,$30.00,$0.00,$30.00,$16.29,$21.41,$0.00,$5.17,$0.00,$0.00,$5.25,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$4.70,$0.00,$4.78,$0.00
M001316191,SUP,HCPCS C1725,,M001316191  -  CATHETER ANGIOGRAPHIC HEADHUNTER 1 HEADHUNTER CURVE 4FR 100,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001316201,SUP,HCPCS C1725,,M001316201  -  CATHETER ANGIOGRAPHIC HEADHUNTER 3 HEADHUNTER CURVE 4FR 100,$30.00,$0.00,$30.00,$16.29,$21.41,$0.00,$5.17,$0.00,$0.00,$5.25,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$4.70,$0.00,$4.78,$0.00
M001316211,SUP,HCPCS C1725,,M001316211  -  CATHETER ANGIOGRAPHIC BENTSON 1 CURVE 4FR 65CM BRAID TORQUE,$30.00,$0.00,$30.00,$16.29,$21.41,$0.00,$5.17,$0.00,$0.00,$5.25,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$4.70,$0.00,$4.78,$0.00
M001316231,SUP,HCPCS C1725,,M001316231  -  CATHETER ANGIOGRAPHIC BENTSON 1 CURVE 4FR 100CM BRAID TORQUE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001316251,SUP,HCPCS C1725,,M001316251  -  CATHETER ANGIOGRAPHIC BENTSON 2 CURVE 4FR 100CM TORQUE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001316271,SUP,HCPCS C1725,,M001316271  -  CATHETER ANGIOGRAPHIC BENTSON 3 CURVE 4FR 100CM BRAID TORQUE,$30.00,$0.00,$30.00,$16.29,$21.41,$0.00,$5.17,$0.00,$0.00,$5.25,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$4.70,$0.00,$4.78,$0.00
M001316291,SUP,HCPCS C1725,,M001316291  -  CATHETER ANGIOGRAPHIC MANI CURVE 4FR 100CM BRAID TORQUE,$30.00,$0.00,$30.00,$16.29,$21.41,$0.00,$5.17,$0.00,$0.00,$5.25,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$4.70,$0.00,$4.78,$0.00
M001316311,SUP,HCPCS C1725,,M001316311  -  CATHETER ANGIOGRAPHIC SIMMONS 1 CURVE 4FR 65CM BRAID TORQUE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001316331,SUP,HCPCS C1725,,M001316331  -  CATHETER ANGIOGRAPHIC SIMMONS 1 CURVE 4FR 100CM BRAID TORQUE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001316351,SUP,HCPCS C1725,,M001316351  -  CATHETER ANGIOGRAPHIC SIMMONS 2 CURVE 4FR 100CM TORQUE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001316371,SUP,HCPCS C1725,,M001316371  -  CATHETER ANGIOGRAPHIC SIM3 CURVE 4FR 100CM BRAID IMAGER II,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001316381,SUP,HCPCS C1725,,M001316381  -  CATHETER ANGIOGRAPHIC SIMMONS 4 CURVE 4FR 100CM BRAID TORQUE,$30.00,$0.00,$30.00,$16.29,$21.41,$0.00,$5.17,$0.00,$0.00,$5.25,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$4.70,$0.00,$4.78,$0.00
M001316401,SUP,HCPCS C1725,,M001316401  -  CATHETER ANGIOGRAPHIC NEWTON 1 CURVE 4FR 100CM TORQUE SELECT,$30.00,$0.00,$30.00,$16.29,$21.41,$0.00,$5.17,$0.00,$0.00,$5.25,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$4.70,$0.00,$4.78,$0.00
M001316421,SUP,HCPCS C1725,,M001316421  -  CATHETER ANGIOGRAPHIC NEWTON 2 CURVE 4FR 100CM BRAID TORQUE,$30.00,$0.00,$30.00,$16.29,$21.41,$0.00,$5.17,$0.00,$0.00,$5.25,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$4.70,$0.00,$4.78,$0.00
M001316441,SUP,HCPCS C1725,,M001316441  -  CATHETER ANGIOGRAPHIC NEWTON 3 CURVE 4FR 100CM BRAID TORQUE,$30.00,$0.00,$30.00,$16.29,$21.41,$0.00,$5.17,$0.00,$0.00,$5.25,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$4.70,$0.00,$4.78,$0.00
M001316461,SUP,HCPCS C1725,,M001316461  -  CATHETER ANGIOGRAPHIC NEWTON 4 CURVE 4FR 100CM BRAID TORQUE,$30.00,$0.00,$30.00,$16.29,$21.41,$0.00,$5.17,$0.00,$0.00,$5.25,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$4.70,$0.00,$4.78,$0.00
M001316481,SUP,HCPCS C1725,,M001316481  -  CATHETER ANGIOGRAPHIC NEWTON 5 CURVE 4FR 100CM BRAID IMAGER,$30.00,$0.00,$30.00,$16.29,$21.41,$0.00,$5.17,$0.00,$0.00,$5.25,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$4.70,$0.00,$4.78,$0.00
M001316491,SUP,HCPCS C1725,,M001316491  -  CATHETER ANGIOGRAPHIC CK CURVE 4FR 100CM BRAID TORQUE,$30.00,$0.00,$30.00,$16.29,$21.41,$0.00,$5.17,$0.00,$0.00,$5.25,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$4.70,$0.00,$4.78,$0.00
M001316511,SUP,HCPCS C1725,,M001316511  -  CATHETER ANGIOGRAPHIC GEN CURVE 4FR 100CM BRAID TORQUE,$30.00,$0.00,$30.00,$16.29,$21.41,$0.00,$5.17,$0.00,$0.00,$5.25,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$4.70,$0.00,$4.78,$0.00
M001316531,SUP,HCPCS C1725,,M001316531  -  CATHETER ANGIOGRAPHIC CHUANG B CURVE 4FR 65CM TORQUE SELECT,$30.00,$0.00,$30.00,$16.29,$21.41,$0.00,$5.17,$0.00,$0.00,$5.25,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$4.70,$0.00,$4.78,$0.00
M001316551,SUP,HCPCS C1725,,M001316551  -  CATHETER ANGIOGRAPHIC CHUANG C CURVE 4FR 65CM BRAID TORQUE,$30.00,$0.00,$30.00,$16.29,$21.41,$0.00,$5.17,$0.00,$0.00,$5.25,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$4.70,$0.00,$4.78,$0.00
M001316571,SUP,HCPCS C1725,,M001316571  -  CATHETER ANGIOGRAPHIC CHUANG 2 CURVE 4FR 65CM BRAID TORQUE,$30.00,$0.00,$30.00,$16.29,$21.41,$0.00,$5.17,$0.00,$0.00,$5.25,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$4.70,$0.00,$4.78,$0.00
M001316581,SUP,HCPCS C1725,,M001316581  -  CATHETER ANGIOGRAPHIC CONTRALATERAL 2 CURVE 4FR 65CM BRAID,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001316611,SUP,HCPCS C1725,,M001316611  -  CATHETER ANGIOGRAPHIC DUCK CURVE 4FR 65CM BRAID TORQUE,$30.00,$0.00,$30.00,$16.29,$21.41,$0.00,$5.17,$0.00,$0.00,$5.25,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$4.70,$0.00,$4.78,$0.00
M001316631,SUP,HCPCS C1725,,M001316631  -  CATHETER ANGIOGRAPHIC COBRA 1 CURVE 4FR 65CM BRAID TORQUE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001316651,SUP,HCPCS C1725,,M001316651  -  CATHETER ANGIOGRAPHIC COBRA 1 CURVE 4FR 65CM BRAID TORQUE,$30.00,$0.00,$30.00,$16.29,$21.41,$0.00,$5.17,$0.00,$0.00,$5.25,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$4.70,$0.00,$4.78,$0.00
M001316671,SUP,HCPCS C1725,,M001316671  -  CATHETER ANGIOGRAPHIC COBRA 2 CURVE 4FR 65CM BRAID TORQUE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001316691,SUP,HCPCS C1725,,M001316691  -  CATHETER ANGIOGRAPHIC COBRA 2 CURVE 4FR 65CM TAPER TIP FLUTE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001316711,SUP,HCPCS C1725,,M001316711  -  CATHETER ANGIOGRAPHIC COBRA 3 CURVE 4FR 65CM BRAID TORQUE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001316731,SUP,HCPCS C1725,,M001316731  -  CATHETER ANGIOGRAPHIC COBRA 3 CURVE 4FR 65CM BRAID TORQUE,$30.00,$0.00,$30.00,$16.29,$21.41,$0.00,$5.17,$0.00,$0.00,$5.25,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$4.70,$0.00,$4.78,$0.00
M001316741,SUP,HCPCS C1725,,M001316741  -  CATHETER ANGIOGRAPHIC VAN CURVE 4FR 65CM BRAID TORQUE,$30.00,$0.00,$30.00,$16.29,$21.41,$0.00,$5.17,$0.00,$0.00,$5.25,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$4.70,$0.00,$4.78,$0.00
M001316751,SUP,HCPCS C1725,,M001316751  -  CATHETER ANGIOGRAPHIC TRAIN CURVE FLUTE TAPER 4FR 65CM BRAID,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001316771,SUP,HCPCS C1725,,M001316771  -  CATHETER ANGIOGRAPHIC MIKELSON CURVE FLUTE TAPER 4FR 65CM,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001316791,SUP,HCPCS C1725,,M001316791  -  CATHETER ANGIOGRAPHIC HK 1 CURVE FLUTE TAPER 4FR 65CM BRAID,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001316811,SUP,HCPCS C1725,,M001316811  -  CATHETER ANGIOGRAPHIC SHK .8 CURVE FLUTE TAPER 4FR 65CM,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001316831,SUP,HCPCS C1725,,M001316831  -  CATHETER ANGIOGRAPHIC SHEPHERD HOOK 1 CURVE 4FR 65CM TAPER,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001316851,SUP,HCPCS C1725,,M001316851  -  CATHETER ANGIOGRAPHIC RIGHT CORON 1 CURVE 4FR 65CM TAPER TIP,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001316871,SUP,HCPCS C1725,,M001316871  -  CATHETER ANGIOGRAPHIC RIGHT CORON SHEPHERDS CROOK 2 CURVE,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001316891,SUP,HCPCS C1725,,M001316891  -  CATHETER ANGIOGRAPHIC RENAL DOUBLE CURVE FLUTE TAPER 4FR 65,$25.48,$0.00,$25.48,$13.84,$18.19,$0.00,$4.39,$0.00,$0.00,$4.46,$25.48,$0.00,$12.74,$20.18,$20.38,$0.00,$3.99,$0.00,$4.06,$0.00
M001316911,SUP,HCPCS C1725,,M001316911  -  CATHETER ANGIOGRAPHIC RENAL DOUBLE CURVE FLUTE TAPER 4FR 65,$30.00,$0.00,$30.00,$16.29,$21.41,$0.00,$5.17,$0.00,$0.00,$5.25,$30.00,$0.00,$15.00,$23.76,$24.00,$0.00,$4.70,$0.00,$4.78,$0.00
M001321751,SUP,HCPCS C1887,,M001321751  -  CATHETER ANGIO .038IN C2 4FR 65CM GLDCATH TIP HDRPH,$139.50,$0.00,$139.50,$75.75,$99.56,$0.00,$24.04,$0.00,$0.00,$24.43,$139.50,$0.00,$69.75,$110.48,$111.60,$0.00,$21.83,$0.00,$22.21,$0.00
M001361480,SUP,HCPCS C1895,,M001361480  -  COIL EMBOLIZATION .018IN STANDARD LENGTH 2D 2MM 4CM,"$1,275.00",$0.00,"$1,275.00",$573.75,$909.97,$0.00,$219.68,$0.00,$0.00,$223.24,"$1,275.00",$0.00,$637.50,"$1,009.80","$1,020.00",$0.00,$199.54,$0.00,$202.98,$0.00
M001361490,SUP,HCPCS C1895,,M001361490  -  COIL EMBOLIZATION .018IN STANDARD LENGTH 2D 2MM 6CM,"$1,275.00",$0.00,"$1,275.00",$573.75,$909.97,$0.00,$219.68,$0.00,$0.00,$223.24,"$1,275.00",$0.00,$637.50,"$1,009.80","$1,020.00",$0.00,$199.54,$0.00,$202.98,$0.00
M001361500,SUP,Custom 27803010,,M001361500  -  COIL EMBOLIZATION 2D HELIX 3MM 6CM 18 COIL OCCLUSION SYSTEM,"$1,022.48",$0.00,"$1,022.48",$0.00,$729.74,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,022.48",$0.00,$511.24,$809.80,$817.98,$0.00,$0.00,$0.00,$0.00,$0.00
M001361510,SUP,Custom 27803010,,M001361510  -  COIL EMBOLIZATION 2D HELIX 3MM 12CM 18 COIL OCCLUSION SYSTEM,"$1,022.48",$0.00,"$1,022.48",$0.00,$729.74,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,022.48",$0.00,$511.24,$809.80,$817.98,$0.00,$0.00,$0.00,$0.00,$0.00
M001361520,SUP,Custom 27803010,,M001361520  -  COIL EMBOLIZATION 2D HELIX 4MM 8CM 18 COIL OCCLUSION SYSTEM,"$1,022.48",$0.00,"$1,022.48",$0.00,$729.74,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,022.48",$0.00,$511.24,$809.80,$817.98,$0.00,$0.00,$0.00,$0.00,$0.00
M001361530,SUP,Custom 27803010,,M001361530  -  COIL EMBOLIZATION 2D HELIX 4MM 15CM 8 COIL OCCLUSION SYSTEM,"$1,022.48",$0.00,"$1,022.48",$0.00,$729.74,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,022.48",$0.00,$511.24,$809.80,$817.98,$0.00,$0.00,$0.00,$0.00,$0.00
M001361540,SUP,Custom 27203010,,M001361540  -  COIL EMBL 8CM 5MM INTLK 2D HLCL FBR OCL DTCH,$942.88,$0.00,$942.88,$0.00,$672.93,$0.00,$0.00,$0.00,$0.00,$0.00,$942.88,$0.00,$471.44,$746.76,$754.30,$0.00,$0.00,$0.00,$0.00,$0.00
M001361550,SUP,Custom 27803010,,M001361550  -  COIL EMBOLIZATION 2D HELIX 5MM 15CM 8 COIL OCCLUSION SYSTEM,"$1,022.48",$0.00,"$1,022.48",$0.00,$729.74,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,022.48",$0.00,$511.24,$809.80,$817.98,$0.00,$0.00,$0.00,$0.00,$0.00
M001361560,SUP,Custom 27803010,,M001361560  -  COIL EMBOLIZATION 2D HELIX 6MM 10CM 18 COIL OCCLUSION SYSTEM,"$1,022.48",$0.00,"$1,022.48",$0.00,$729.74,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,022.48",$0.00,$511.24,$809.80,$817.98,$0.00,$0.00,$0.00,$0.00,$0.00
M001361570,SUP,Custom 27803010,,M001361570  -  COIL EMBOLIZATION 2D HELIX 6MM 20CM 18 COIL OCCLUSION SYSTEM,"$1,022.48",$0.00,"$1,022.48",$0.00,$729.74,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,022.48",$0.00,$511.24,$809.80,$817.98,$0.00,$0.00,$0.00,$0.00,$0.00
M001361580,SUP,Custom 27803010,,M001361580  -  COIL EMBOLIZATION 2D HELIX 8MM 20CM OCCLUSION SYSTEM,"$1,022.48",$0.00,"$1,022.48",$0.00,$729.74,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,022.48",$0.00,$511.24,$809.80,$817.98,$0.00,$0.00,$0.00,$0.00,$0.00
M001361590,SUP,Custom 27803010,,M001361590  -  COIL EMBOLIZATION 2D HELIX 10MM 20CM DETACHABLE OCCLUSION,"$1,022.48",$0.00,"$1,022.48",$0.00,$729.74,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,022.48",$0.00,$511.24,$809.80,$817.98,$0.00,$0.00,$0.00,$0.00,$0.00
M001361600,SUP,Custom 27803010,,M001361600  -  COIL EMBOLIZATION .018IN 2D HELIX BUCK 10MM 30CM OCCLUSION,"$1,022.48",$0.00,"$1,022.48",$0.00,$729.74,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,022.48",$0.00,$511.24,$809.80,$817.98,$0.00,$0.00,$0.00,$0.00,$0.00
M001361610,SUP,Custom 27803010,,M001361610  -  COIL EMBOLIZATION 2D HELIX 12MM 20CM OCCLUSION INTERLOCK,"$1,022.48",$0.00,"$1,022.48",$0.00,$729.74,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,022.48",$0.00,$511.24,$809.80,$817.98,$0.00,$0.00,$0.00,$0.00,$0.00
M001361620,SUP,Custom 27803010,,M001361620  -  COIL EMBOLIZATION .018IN 2D HELIX TAPER 12MM 30CM 18 COIL,"$1,022.48",$0.00,"$1,022.48",$0.00,$729.74,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,022.48",$0.00,$511.24,$809.80,$817.98,$0.00,$0.00,$0.00,$0.00,$0.00
M001361630,SUP,Custom 27803010,,M001361630  -  COIL EMBOLIZATION .018IN 2D HELIX TAPER 14MM 20CM 18 COIL,"$1,022.48",$0.00,"$1,022.48",$0.00,$729.74,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,022.48",$0.00,$511.24,$809.80,$817.98,$0.00,$0.00,$0.00,$0.00,$0.00
M001361640,SUP,Custom 27803010,,M001361640  -  COIL EMBOLIZATION .018IN 2D HELIX 14MM 30CM INTERLOCK IDC,"$1,022.48",$0.00,"$1,022.48",$0.00,$729.74,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,022.48",$0.00,$511.24,$809.80,$817.98,$0.00,$0.00,$0.00,$0.00,$0.00
M001361740,SUP,Custom 27803010,,M001361740  -  COIL EMBOLIZATION DIAMOND 2/3MM 2.3CM 18 COIL RETRACTABLE,"$1,022.48",$0.00,"$1,022.48",$0.00,$729.74,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,022.48",$0.00,$511.24,$809.80,$817.98,$0.00,$0.00,$0.00,$0.00,$0.00
M001361750,SUP,Custom 27803010,,M001361750  -  COIL EMBOLIZATION DIAMOND 2/4MM 4.1CM 18 COIL RETRACTABLE,"$1,022.48",$0.00,"$1,022.48",$0.00,$729.74,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,022.48",$0.00,$511.24,$809.80,$817.98,$0.00,$0.00,$0.00,$0.00,$0.00
M001361760,SUP,Custom 27803010,,M001361760  -  COIL EMBOLIZATION DIAMOND 2/5MM 5.8CM 18 COIL RETRACTABLE,"$1,022.48",$0.00,"$1,022.48",$0.00,$729.74,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,022.48",$0.00,$511.24,$809.80,$817.98,$0.00,$0.00,$0.00,$0.00,$0.00
M001361770,SUP,Custom 27803010,,M001361770  -  COIL EMBOLIZATION DIAMOND 2/6MM 8CM OCCLUSION SYSTEM,"$1,022.48",$0.00,"$1,022.48",$0.00,$729.74,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,022.48",$0.00,$511.24,$809.80,$817.98,$0.00,$0.00,$0.00,$0.00,$0.00
M001361920,SUP,HCPCS C1895,,M001361920  -  COIL EMBOLIZATION 2D LONG LENGTH 10MM 50CM 18 COIL,"$1,275.00",$0.00,"$1,275.00",$573.75,$909.97,$0.00,$219.68,$0.00,$0.00,$223.24,"$1,275.00",$0.00,$637.50,"$1,009.80","$1,020.00",$0.00,$199.54,$0.00,$202.98,$0.00
M001361930,SUP,HCPCS C1895,,M001361930  -  COIL EMBOLIZATION .018IN 2D LONG 14CM 50CM 18 COIL,"$1,275.00",$0.00,"$1,275.00",$573.75,$909.97,$0.00,$219.68,$0.00,$0.00,$223.24,"$1,275.00",$0.00,$637.50,"$1,009.80","$1,020.00",$0.00,$199.54,$0.00,$202.98,$0.00
M001361940,SUP,HCPCS C1895,,M001361940  -  COIL EMBOLIZATION .018IN LONG LENGTH 2D HELIX 18CM 50CM,"$1,275.00",$0.00,"$1,275.00",$573.75,$909.97,$0.00,$219.68,$0.00,$0.00,$223.24,"$1,275.00",$0.00,$637.50,"$1,009.80","$1,020.00",$0.00,$199.54,$0.00,$202.98,$0.00
M001361950,SUP,HCPCS C1895,,M001361950  -  COIL EMBOLIZATION .018IN LONG LENGTH 2D HELIX 20MM 50CM,"$1,275.00",$0.00,"$1,275.00",$573.75,$909.97,$0.00,$219.68,$0.00,$0.00,$223.24,"$1,275.00",$0.00,$637.50,"$1,009.80","$1,020.00",$0.00,$199.54,$0.00,$202.98,$0.00
M001361960,SUP,HCPCS C1895,,M001361960  -  COIL EMBOLIZATION .018IN LONG LENGTH 2D HELIX 20MM 50CM,"$1,275.00",$0.00,"$1,275.00",$573.75,$909.97,$0.00,$219.68,$0.00,$0.00,$223.24,"$1,275.00",$0.00,$637.50,"$1,009.80","$1,020.00",$0.00,$199.54,$0.00,$202.98,$0.00
M001363500,SUP,Custom 27803010,,M001363500  -  COIL EMBOLIZATION .035IN 2D 3MM 4CM OCCLUSION INTERLOCK IDC,"$1,177.13",$0.00,"$1,177.13",$0.00,$840.11,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,177.13",$0.00,$588.56,$932.29,$941.70,$0.00,$0.00,$0.00,$0.00,$0.00
M001363520,SUP,Custom 27803010,,M001363520  -  COIL EMBOLIZATION .035IN 2D HELICAL 4MM 10CM 35 COIL,"$1,177.13",$0.00,"$1,177.13",$0.00,$840.11,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,177.13",$0.00,$588.56,$932.29,$941.70,$0.00,$0.00,$0.00,$0.00,$0.00
M001363530,SUP,Custom 27803010,,M001363530  -  COIL EMBL 20CM 4MM INTLK .035IN,"$1,755.00",$0.00,"$1,755.00",$0.00,"$1,252.54",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,755.00",$0.00,$877.50,"$1,389.96","$1,404.00",$0.00,$0.00,$0.00,$0.00,$0.00
M001363540,SUP,Custom 27803010,,M001363540  -  COIL EMBOLIZATION .035IN 2D 6MM 10CM OCCLUSION DETACHABLE,"$1,177.13",$0.00,"$1,177.13",$0.00,$840.11,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,177.13",$0.00,$588.56,$932.29,$941.70,$0.00,$0.00,$0.00,$0.00,$0.00
M001363550,SUP,Custom 27803010,,M001363550  -  COIL EMBOLIZATION .035IN 2D 6MM 20CM OCCLUSION SYSTEM,"$1,761.40",$0.00,"$1,761.40",$0.00,"$1,257.11",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,761.40",$0.00,$880.70,"$1,395.03","$1,409.12",$0.00,$0.00,$0.00,$0.00,$0.00
M001363560,SUP,Custom 27803010,,M001363560  -  COIL EMBL 40CM 6MM INTLK .035IN,"$2,340.00",$0.00,"$2,340.00",$0.00,"$1,670.06",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,340.00",$0.00,"$1,170.00","$1,853.28","$1,872.00",$0.00,$0.00,$0.00,$0.00,$0.00
M001363570,SUP,HCPCS C1895,,M001363570  -  COIL EMBOLIZATION .018IN 2D HELIX 8MM 10CM OCCLUSION SYSTEM,"$1,177.13",$0.00,"$1,177.13",$529.71,$840.11,$0.00,$202.81,$0.00,$0.00,$206.11,"$1,177.13",$0.00,$588.56,$932.29,$941.70,$0.00,$184.22,$0.00,$187.40,$0.00
M001363580,SUP,Custom 27803010,,M001363580  -  COIL EMBOLIZATION .035IN 2D 8MM 20CM OCCLUSION SYSTEM,"$1,761.40",$0.00,"$1,761.40",$0.00,"$1,257.11",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,761.40",$0.00,$880.70,"$1,395.03","$1,409.12",$0.00,$0.00,$0.00,$0.00,$0.00
M001363590,SUP,Custom 27803010,,M001363590  -  COIL EMBOLIZATION .035IN 2D 8MM 40CM OCCLUSION SYSTEM,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
M001363600,SUP,Custom 27803010,,M001363600  -  COIL EMBOLIZATION .035IN 2D 10MM 20CM OCCLUSION INTERLOCK,"$1,761.40",$0.00,"$1,761.40",$0.00,"$1,257.11",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,761.40",$0.00,$880.70,"$1,395.03","$1,409.12",$0.00,$0.00,$0.00,$0.00,$0.00
M001363610,SUP,Custom 27803010,,M001363610  -  COIL EMBOLIZATION .035IN 2D 10MM 40CM OCCLUSION SYSTEM,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
M001363620,SUP,Custom 27803010,,M001363620  -  COIL EMBOLIZATION .035IN 2D 12MM 20CM OCCLUSION SYSTEM,"$1,761.40",$0.00,"$1,761.40",$0.00,"$1,257.11",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,761.40",$0.00,$880.70,"$1,395.03","$1,409.12",$0.00,$0.00,$0.00,$0.00,$0.00
M001363630,SUP,Custom 27803010,,M001363630  -  COIL EMBOLIZATION .035IN 2D 12MM 40CM FIBER OCCLUSION SYSTEM,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
M001363640,SUP,Custom 27803010,,M001363640  -  COIL EMBOLIZATION .035IN 2D 15MM 20CM OCCLUSION SYSTEM,"$1,761.40",$0.00,"$1,761.40",$0.00,"$1,257.11",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,761.40",$0.00,$880.70,"$1,395.03","$1,409.12",$0.00,$0.00,$0.00,$0.00,$0.00
M001363650,SUP,Custom 27803010,,M001363650  -  COIL EMBOLIZATION .035IN 2D 15MM 40CM OCCLUSION SYSTEM,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
M001363660,SUP,HCPCS C1895,,M001363660  -  COIL EMBOLIZATION .018IN 2D 18MM 20CM OCCLUSION SYSTEM,"$1,761.40",$0.00,"$1,761.40",$792.63,"$1,257.11",$0.00,$303.48,$0.00,$0.00,$308.41,"$1,761.40",$0.00,$880.70,"$1,395.03","$1,409.12",$0.00,$275.66,$0.00,$280.41,$0.00
M001363670,SUP,Custom 27803010,,M001363670  -  COIL EMBOLIZATION .035IN 2D 18MM 40CM OCCLUSION SYSTEM,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
M001363700,SUP,Custom 27803010,,M001363700  -  COIL EMBOLIZATION .035IN CUBE 4MM 6CM OCCLUSION SYSTEM,"$1,177.13",$0.00,"$1,177.13",$0.00,$840.11,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,177.13",$0.00,$588.56,$932.29,$941.70,$0.00,$0.00,$0.00,$0.00,$0.00
M001363710,SUP,Custom 27803010,,M001363710  -  COIL EMBL 17CM 4MM INTLK 360D,"$1,755.00",$0.00,"$1,755.00",$0.00,"$1,252.54",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,755.00",$0.00,$877.50,"$1,389.96","$1,404.00",$0.00,$0.00,$0.00,$0.00,$0.00
M001363720,SUP,Custom 27803010,,M001363720  -  COIL EMBOLIZATION .035IN CUBE 6MM 10CM OCCLUSION SYSTEM,"$1,177.13",$0.00,"$1,177.13",$0.00,$840.11,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,177.13",$0.00,$588.56,$932.29,$941.70,$0.00,$0.00,$0.00,$0.00,$0.00
M001363730,SUP,Custom 27803010,,M001363730  -  COIL EMBOLIZATION .035IN CUBE 6MM 20CM OCCLUSION SYSTEM,"$1,761.40",$0.00,"$1,761.40",$0.00,"$1,257.11",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,761.40",$0.00,$880.70,"$1,395.03","$1,409.12",$0.00,$0.00,$0.00,$0.00,$0.00
M001363760,SUP,Custom 27803010,,M001363760  -  COIL EMBOLIZATION .035IN CUBE 8MM 20CM OCCLUSION SYSTEM,"$1,761.40",$0.00,"$1,761.40",$0.00,"$1,257.11",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,761.40",$0.00,$880.70,"$1,395.03","$1,409.12",$0.00,$0.00,$0.00,$0.00,$0.00
M001363770,SUP,Custom 27803010,,M001363770  -  COIL EMBL 40CM 8MM INTLK 360D,"$2,340.00",$0.00,"$2,340.00",$0.00,"$1,670.06",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,340.00",$0.00,"$1,170.00","$1,853.28","$1,872.00",$0.00,$0.00,$0.00,$0.00,$0.00
M001363790,SUP,Custom 27803010,,M001363790  -  COIL EMBOLIZATION .035IN CUBE 10MM 25CM OCCLUSION SYSTEM,"$1,761.40",$0.00,"$1,761.40",$0.00,"$1,257.11",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,761.40",$0.00,$880.70,"$1,395.03","$1,409.12",$0.00,$0.00,$0.00,$0.00,$0.00
M001363800,SUP,Custom 27803010,,M001363800  -  COIL EMBOLIZATION .035IN CUBE 10MM 40CM OCCLUSION SYSTEM,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
M001363810,SUP,Custom 27803010,,M001363810  -  COIL EMBOLIZATION .035IN CUBE 15MM 25CM OCCLUSION SYSTEM,"$1,761.40",$0.00,"$1,761.40",$0.00,"$1,257.11",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,761.40",$0.00,$880.70,"$1,395.03","$1,409.12",$0.00,$0.00,$0.00,$0.00,$0.00
M001363820,SUP,Custom 27803010,,M001363820  -  COIL EMBOLIZATION .035IN CUBE 15MM 40CM FIBER OCCLUSION,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
M001363830,SUP,Custom 27803010,,M001363830  -  COIL EMBOLIZATION .035IN CUBE 20MM 40CM FIBER OCCLUSION,"$2,250.00",$0.00,"$2,250.00",$0.00,"$1,605.83",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,250.00",$0.00,"$1,125.00","$1,782.00","$1,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
M001363910,SUP,Custom 27803010,,M001363910  -  COIL EMBOLIZATION .035IN DIAMOND 4MM 4.5CM OCCLUSION SYSTEM,"$1,177.13",$0.00,"$1,177.13",$0.00,$840.11,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,177.13",$0.00,$588.56,$932.29,$941.70,$0.00,$0.00,$0.00,$0.00,$0.00
M001363920,SUP,Custom 27803010,,M001363920  -  COIL EMBOLIZATION .035IN DIAMOND 6MM 9CM OCCLUSION INTERLOCK,"$1,177.13",$0.00,"$1,177.13",$0.00,$840.11,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,177.13",$0.00,$588.56,$932.29,$941.70,$0.00,$0.00,$0.00,$0.00,$0.00
M001363930,SUP,Custom 27803010,,M001363930  -  COIL EMBOLIZATION .035IN DIAMOND 8MM 14CM OCCLUSION,"$1,177.13",$0.00,"$1,177.13",$0.00,$840.11,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,177.13",$0.00,$588.56,$932.29,$941.70,$0.00,$0.00,$0.00,$0.00,$0.00
M001363940,SUP,Custom 27803010,,M001363940  -  COIL EMBL 10MM INTLK .035IN,"$1,755.00",$0.00,"$1,755.00",$0.00,"$1,252.54",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,755.00",$0.00,$877.50,"$1,389.96","$1,404.00",$0.00,$0.00,$0.00,$0.00,$0.00
M001363950,SUP,Custom 27803010,,M001363950  -  COIL EMBL 12MM INTLK .035IN,"$1,755.00",$0.00,"$1,755.00",$0.00,"$1,252.54",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,755.00",$0.00,$877.50,"$1,389.96","$1,404.00",$0.00,$0.00,$0.00,$0.00,$0.00
M001391260,SUP,HCPCS C1769,,M001391260  -  GUIDEWIRE VASCULAR STR .014IN 185CM JOURNEY NITINOL HYDPHI,$318.50,$0.00,$318.50,$172.95,$227.31,$0.00,$54.88,$0.00,$0.00,$55.77,$318.50,$0.00,$159.25,$252.25,$254.80,$0.00,$49.85,$0.00,$50.71,$0.00
M001391270,SUP,HCPCS C1769,,M001391270  -  GUIDEWIRE VASCULAR .014IN 185CM 7CM NAVIGATE RADIOPQ ANGLE,$318.50,$0.00,$318.50,$172.95,$227.31,$0.00,$54.88,$0.00,$0.00,$55.77,$318.50,$0.00,$159.25,$252.25,$254.80,$0.00,$49.85,$0.00,$50.71,$0.00
M001391280,SUP,HCPCS C1769,,M001391280  -  GUIDEWIRE VASCULAR .014IN 300CM 2CM FLEXIBLE CONVENTION STR,$318.50,$0.00,$318.50,$172.95,$227.31,$0.00,$54.88,$0.00,$0.00,$55.77,$318.50,$0.00,$159.25,$252.25,$254.80,$0.00,$49.85,$0.00,$50.71,$0.00
M001391290,SUP,HCPCS C1769,,M001391290  -  GUIDEWIRE VASCULAR .014IN 300CM 7CM NAVIGATE RADIOPQ ANGLE,$318.50,$0.00,$318.50,$172.95,$227.31,$0.00,$54.88,$0.00,$0.00,$55.77,$318.50,$0.00,$159.25,$252.25,$254.80,$0.00,$49.85,$0.00,$50.71,$0.00
M0014012160,SUP,Custom 27803010,,M0014012160  -  PUSHER SURG .016FR .018IN 177CM EMBOLIZATION COIL,$419.80,$0.00,$419.80,$0.00,$299.61,$0.00,$0.00,$0.00,$0.00,$0.00,$419.80,$0.00,$209.90,$332.48,$335.84,$0.00,$0.00,$0.00,$0.00,$0.00
M001442001,SUP,Custom 27203010,,M001442001  -  DEVICE FLOW CONTROL 1050 PSI 1 WAY HIGH PRESSURE FLOSWITCH,$11.43,$0.00,$11.43,$0.00,$8.15,$0.00,$0.00,$0.00,$0.00,$0.00,$11.43,$0.00,$5.71,$9.05,$9.14,$0.00,$0.00,$0.00,$0.00,$0.00
M001461541,SUP,HCPCS C1769,,M001461541  -  GUIDEWIRE VASC .035IN 260CM 3CM GLDWR ANG TIP FLXB COR STD,$712.50,$0.00,$712.50,$386.89,$508.51,$0.00,$122.76,$0.00,$0.00,$124.75,$712.50,$0.00,$356.25,$564.30,$570.00,$0.00,$111.51,$0.00,$113.43,$0.00
M001461940,SUP,HCPCS C1769,,M001461940  -  GWIRE VASC .035IN 145CM 9CM INFUS KTZN PERI,$473.28,$0.00,$473.28,$256.99,$337.78,$0.00,$81.54,$0.00,$0.00,$82.87,$473.28,$0.00,$236.64,$374.84,$378.62,$0.00,$74.07,$0.00,$75.35,$0.00
M001461960,SUP,HCPCS C1769,,M001461960  -  GWIRE VASC .035IN 145CM 12CM INFUS KTZN,$473.28,$0.00,$473.28,$256.99,$337.78,$0.00,$81.54,$0.00,$0.00,$82.87,$473.28,$0.00,$236.64,$374.84,$378.62,$0.00,$74.07,$0.00,$75.35,$0.00
M001465001,SUP,HCPCS C1769,,M001465001  -  GUIDEWIRE VASCULAR 6CM J .035IN 145CM 3MM FLEXIBLE TIP,$75.95,$0.00,$75.95,$41.24,$54.21,$0.00,$13.09,$0.00,$0.00,$13.30,$75.95,$0.00,$37.98,$60.15,$60.76,$0.00,$11.89,$0.00,$12.09,$0.00
M001465011,SUP,HCPCS C1769,,M001465011  -  GUIDEWIRE VASCULAR SHORT LARGE J FLAT SPRING COIL .035IN 180,$103.81,$0.00,$103.81,$56.37,$74.09,$0.00,$17.89,$0.00,$0.00,$18.18,$103.81,$0.00,$51.90,$82.22,$83.04,$0.00,$16.25,$0.00,$16.53,$0.00
M001465021,SUP,HCPCS C1769,,M001465021  -  GUIDEWIRE VASCULAR J .035IN 260CM 3MM FLEXIBLE TIP AMPLATZ,$108.46,$0.00,$108.46,$58.89,$77.41,$0.00,$18.69,$0.00,$0.00,$18.99,$108.46,$0.00,$54.23,$85.90,$86.77,$0.00,$16.97,$0.00,$17.27,$0.00
M001465031,SUP,HCPCS C1769,,M001465031  -  GUIDEWIRE VASCULAR J .035IN 145CM 3MM FLEXIBLE TIP AMPLATZ,$75.95,$0.00,$75.95,$41.24,$54.21,$0.00,$13.09,$0.00,$0.00,$13.30,$75.95,$0.00,$37.98,$60.15,$60.76,$0.00,$11.89,$0.00,$12.09,$0.00
M001465041,SUP,HCPCS C1769,,M001465041  -  GUIDEWIRE VASCULAR 6CM LARGE J .035IN 180CM 3MM FLEXIBLE TIP,$103.81,$0.00,$103.81,$56.37,$74.09,$0.00,$17.89,$0.00,$0.00,$18.18,$103.81,$0.00,$51.90,$82.22,$83.04,$0.00,$16.25,$0.00,$16.53,$0.00
M001465091,SUP,HCPCS C1769,,M001465091  -  GUIDEWIRE VASCULAR SHORT STR .035IN 260CM FLEXIBLE TIP,$110.79,$0.00,$110.79,$60.16,$79.07,$0.00,$19.09,$0.00,$0.00,$19.40,$110.79,$0.00,$55.40,$87.75,$88.63,$0.00,$17.34,$0.00,$17.64,$0.00
M001465101,SUP,HCPCS C1769,,M001465101  -  GUIDEWIRE VASCULAR .038IN 260CM 1CM FLEXIBLE TIP AMPLATZ,$110.79,$0.00,$110.79,$60.16,$79.07,$0.00,$19.09,$0.00,$0.00,$19.40,$110.79,$0.00,$55.40,$87.75,$88.63,$0.00,$17.34,$0.00,$17.64,$0.00
M001465171,SUP,HCPCS C1769,,M001465171  -  GUIDEWIRE VASCULAR TAPER .038IN 145CM 6CM STR TIP AMPLATZ,$66.57,$0.00,$66.57,$36.14,$47.51,$0.00,$11.47,$0.00,$0.00,$11.65,$66.57,$0.00,$33.28,$52.72,$53.25,$0.00,$10.42,$0.00,$10.60,$0.00
M001465181,SUP,HCPCS C1769,,M001465181  -  GUIDEWIRE VASCULAR SHORT J .038IN 145CM 4CM FLEXIBLE TIP,$69.58,$0.00,$69.58,$37.78,$49.66,$0.00,$11.99,$0.00,$0.00,$12.18,$69.58,$0.00,$34.79,$55.11,$55.66,$0.00,$10.89,$0.00,$11.08,$0.00
M001465191,SUP,HCPCS C1769,,M001465191  -  GUIDEWIRE VASCULAR STR .038IN 180CM 6CM FLEXIBLE TIP AMPLATZ,$101.48,$0.00,$101.48,$55.10,$72.43,$0.00,$17.48,$0.00,$0.00,$17.77,$101.48,$0.00,$50.74,$80.37,$81.18,$0.00,$15.88,$0.00,$16.16,$0.00
M001465201,SUP,HCPCS C1769,,M001465201  -  GUIDEWIRE VASCULAR STR .038IN 260CM 6CM FLEXIBLE TIP AMPLATZ,$106.14,$0.00,$106.14,$57.63,$75.75,$0.00,$18.29,$0.00,$0.00,$18.58,$106.14,$0.00,$53.07,$84.06,$84.91,$0.00,$16.61,$0.00,$16.90,$0.00
M001465231,SUP,HCPCS C1769,,M001465231  -  GUIDEWIRE VASCULAR STR .035IN 145CM 7CM FLEXIBLE TIP AMPLATZ,$66.15,$0.00,$66.15,$35.92,$47.21,$0.00,$11.40,$0.00,$0.00,$11.58,$66.15,$0.00,$33.08,$52.39,$52.92,$0.00,$10.35,$0.00,$10.53,$0.00
M001465241,SUP,HCPCS C1769,,M001465241  -  GUIDEWIRE VASCULAR STR .035IN 145CM 3.5CM SUPER STIFF SHAFT,$66.15,$0.00,$66.15,$35.92,$47.21,$0.00,$11.40,$0.00,$0.00,$11.58,$66.15,$0.00,$33.08,$52.39,$52.92,$0.00,$10.35,$0.00,$10.53,$0.00
M001465251,SUP,HCPCS C1769,,M001465251  -  GUIDEWIRE VASCULAR TAPER .035IN 180CM 7CM STR TIP AMPLATZ,$101.48,$0.00,$101.48,$55.10,$72.43,$0.00,$17.48,$0.00,$0.00,$17.77,$101.48,$0.00,$50.74,$80.37,$81.18,$0.00,$15.88,$0.00,$16.16,$0.00
M001465261,SUP,HCPCS C1769,,M001465261  -  GUIDEWIRE VASCULAR STR .035IN 260CM 7CM FLEXIBLE TIP AMPLATZ,$106.14,$0.00,$106.14,$57.63,$75.75,$0.00,$18.29,$0.00,$0.00,$18.58,$106.14,$0.00,$53.07,$84.06,$84.91,$0.00,$16.61,$0.00,$16.90,$0.00
M001465501,SUP,Custom 27203010,,M001465501  -  VISE TORQUE ACCEPTS .025-.038 IN GWIRE,$155.95,$0.00,$155.95,$0.00,$111.30,$0.00,$0.00,$0.00,$0.00,$0.00,$155.95,$0.00,$77.98,$123.51,$124.76,$0.00,$0.00,$0.00,$0.00,$0.00
M001465631,SUP,HCPCS C1769,,M001465631  -  GUIDEWIRE VASCULAR .035IN 75CM 7CM DISTAL STR TIP ATRAUMATIC,$66.15,$0.00,$66.15,$35.92,$47.21,$0.00,$11.40,$0.00,$0.00,$11.58,$66.15,$0.00,$33.08,$52.39,$52.92,$0.00,$10.35,$0.00,$10.53,$0.00
M001465641,SUP,HCPCS C1769,,M001465641  -  GUIDEWIRE VASCULAR STR .038IN 75CM 6CM FLOPPY TIP AMPLATZ,$66.15,$0.00,$66.15,$35.92,$47.21,$0.00,$11.40,$0.00,$0.00,$11.58,$66.15,$0.00,$33.08,$52.39,$52.92,$0.00,$10.35,$0.00,$10.53,$0.00
M001465911,SUP,HCPCS C1769,,M001465911  -  GUIDEWIRE VASCULAR SHAPEABLE CURVE .035IN 180CM 5CM STR TIP,$126.58,$0.00,$126.58,$68.73,$90.34,$0.00,$21.81,$0.00,$0.00,$22.16,$126.58,$0.00,$63.29,$100.25,$101.27,$0.00,$19.81,$0.00,$20.15,$0.00
M001465921,SUP,HCPCS C1769,,M001465921  -  GUIDEWIRE VASCULAR SHAPEABLE CURVE .035IN 260CM 5CM STR TIP,$126.58,$0.00,$126.58,$68.73,$90.34,$0.00,$21.81,$0.00,$0.00,$22.16,$126.58,$0.00,$63.29,$100.25,$101.27,$0.00,$19.81,$0.00,$20.15,$0.00
M001466000,SUP,HCPCS C1769,,M001466000  -  GUIDEWIRE VASCULAR LONG .018IN 145CM 10CM RADIOPQ PLATINUM,$194.35,$0.00,$194.35,$105.53,$138.71,$0.00,$33.49,$0.00,$0.00,$34.03,$194.35,$0.00,$97.18,$153.93,$155.48,$0.00,$30.42,$0.00,$30.94,$0.00
M001466010,SUP,HCPCS C1769,,M001466010  -  GUIDEWIRE VASCULAR LONG .018IN 180CM 10CM RADIOPQ PLATINUM,$194.35,$0.00,$194.35,$105.53,$138.71,$0.00,$33.49,$0.00,$0.00,$34.03,$194.35,$0.00,$97.18,$153.93,$155.48,$0.00,$30.42,$0.00,$30.94,$0.00
M001466020,SUP,HCPCS C1769,,M001466020  -  GUIDEWIRE VASCULAR LONG .018IN 260CM 8CM RADIOPQ PLATINUM,$203.35,$0.00,$203.35,$110.42,$145.13,$0.00,$35.04,$0.00,$0.00,$35.60,$203.35,$0.00,$101.68,$161.05,$162.68,$0.00,$31.82,$0.00,$32.37,$0.00
M001466040,SUP,HCPCS C1769,,M001466040  -  GUIDEWIRE VASCULAR SHORT .018IN 180CM 3CM RADIOPQ PLATINUM,$194.35,$0.00,$194.35,$105.53,$138.71,$0.00,$33.49,$0.00,$0.00,$34.03,$194.35,$0.00,$97.18,$153.93,$155.48,$0.00,$30.42,$0.00,$30.94,$0.00
M001466050,SUP,HCPCS C1769,,M001466050  -  GUIDEWIRE VASC .018IN 260CM 3CM PLTN + SHRT TPR TIP RADOPQ,$203.35,$0.00,$203.35,$110.42,$145.13,$0.00,$35.04,$0.00,$0.00,$35.60,$203.35,$0.00,$101.68,$161.05,$162.68,$0.00,$31.82,$0.00,$32.37,$0.00
M001466100,SUP,HCPCS C1769,,M001466100  -  GUIDEWIRE VASCULAR SHORT .025IN 180CM 3CM RADIOPQ PLATINUM,$194.35,$0.00,$194.35,$105.53,$138.71,$0.00,$33.49,$0.00,$0.00,$34.03,$194.35,$0.00,$97.18,$153.93,$155.48,$0.00,$30.42,$0.00,$30.94,$0.00
M001466110,SUP,HCPCS C1769,,M001466110  -  GUIDEWIRE VASCULAR SHORT .025IN 260CM 3CM RADIOPQ PLATINUM,$202.33,$0.00,$202.33,$109.86,$144.40,$0.00,$34.86,$0.00,$0.00,$35.43,$202.33,$0.00,$101.16,$160.25,$161.86,$0.00,$31.66,$0.00,$32.21,$0.00
M001467120,SUP,HCPCS C1769,,M001467120  -  GUIDEWIRE VASCULAR .014IN 300CM 7CM SHORT TAPER STR TIP,$203.35,$0.00,$203.35,$110.42,$145.13,$0.00,$35.04,$0.00,$0.00,$35.60,$203.35,$0.00,$101.68,$161.05,$162.68,$0.00,$31.82,$0.00,$32.37,$0.00
M001467300,SUP,HCPCS C1769,,M001467300  -  GUIDEWIRE VASCULAR STR .018IN 60CM 3CM RADIOPQ PLATINUM PLUS,$203.35,$0.00,$203.35,$110.42,$145.13,$0.00,$35.04,$0.00,$0.00,$35.60,$203.35,$0.00,$101.68,$161.05,$162.68,$0.00,$31.82,$0.00,$32.37,$0.00
M001467310,SUP,HCPCS C1769,,M001467310  -  GUIDEWIRE VASCULAR STR .018IN 180CM 3CM RADIOPQ PLATINUM,$203.35,$0.00,$203.35,$110.42,$145.13,$0.00,$35.04,$0.00,$0.00,$35.60,$203.35,$0.00,$101.68,$161.05,$162.68,$0.00,$31.82,$0.00,$32.37,$0.00
M001467320,SUP,HCPCS C1769,,M001467320  -  GUIDEWIRE VASCULAR STR .018IN 260CM 3CM RADIOPQ PLATINUM,$203.35,$0.00,$203.35,$110.42,$145.13,$0.00,$35.04,$0.00,$0.00,$35.60,$203.35,$0.00,$101.68,$161.05,$162.68,$0.00,$31.82,$0.00,$32.37,$0.00
M001467400,SUP,HCPCS C1769,,M001467400  -  GUIDEWIRE VASCULAR .014IN 180CM 3CM RADIOPQ PLATINUM PLUS,$203.35,$0.00,$203.35,$110.42,$145.13,$0.00,$35.04,$0.00,$0.00,$35.60,$203.35,$0.00,$101.68,$161.05,$162.68,$0.00,$31.82,$0.00,$32.37,$0.00
M001468010,SUP,HCPCS C1769,,M001468010  -  GUIDEWIRE VASCULAR STR .014IN 190CM 2CM STEERABLE TRANSEND,$546.00,$0.00,$546.00,$296.48,$389.68,$0.00,$94.07,$0.00,$0.00,$95.60,$546.00,$0.00,$273.00,$432.43,$436.80,$0.00,$85.45,$0.00,$86.92,$0.00
M001468050,SUP,HCPCS C1769,,M001468050  -  GUIDEWIRE VASC .014IN 182CM 2CM TRNSD EX RADOPQ HDRPH PLTN,"$1,116.25",$0.00,"$1,116.25",$606.12,$796.67,$0.00,$192.32,$0.00,$0.00,$195.45,"$1,116.25",$0.00,$558.13,$884.07,$893.00,$0.00,$174.69,$0.00,$177.71,$0.00
M001468070,SUP,HCPCS C1769,,M001468070  -  GUIDEWIRE VASC .014IN 205CM 2CM TRNSD EX SHP FLPY,"$1,116.25",$0.00,"$1,116.25",$606.12,$796.67,$0.00,$192.32,$0.00,$0.00,$195.45,"$1,116.25",$0.00,$558.13,$884.07,$893.00,$0.00,$174.69,$0.00,$177.71,$0.00
M001468100,SUP,HCPCS C1769,,M001468100  -  GUIDEWIRE VASCULAR STR .014IN 135CM 2CM STEERABLE TRANSEND,$546.00,$0.00,$546.00,$296.48,$389.68,$0.00,$94.07,$0.00,$0.00,$95.60,$546.00,$0.00,$273.00,$432.43,$436.80,$0.00,$85.45,$0.00,$86.92,$0.00
M001468110,SUP,HCPCS C1769,,M001468110  -  GUIDEWIRE VASCULAR STR .014IN 165CM 2CM STEERABLE TRANSEND,$546.00,$0.00,$546.00,$296.48,$389.68,$0.00,$94.07,$0.00,$0.00,$95.60,$546.00,$0.00,$273.00,$432.43,$436.80,$0.00,$85.45,$0.00,$86.92,$0.00
M001468120,SUP,HCPCS C1769,,M001468120  -  GUIDEWIRE VASCULAR STR .018IN 135CM 2CM STEERABLE TRANSEND,$546.00,$0.00,$546.00,$296.48,$389.68,$0.00,$94.07,$0.00,$0.00,$95.60,$546.00,$0.00,$273.00,$432.43,$436.80,$0.00,$85.45,$0.00,$86.92,$0.00
M001468130,SUP,HCPCS C1769,,M001468130  -  GUIDEWIRE VASCULAR STR .018IN 165CM 2CM STEERABLE TRANSEND,$546.00,$0.00,$546.00,$296.48,$389.68,$0.00,$94.07,$0.00,$0.00,$95.60,$546.00,$0.00,$273.00,$432.43,$436.80,$0.00,$85.45,$0.00,$86.92,$0.00
M001468480,SUP,HCPCS C1769,,M001468480  -  GUIDEWIRE VASCULAR STR .018IN 110CM 8CM RADIOPQ V-18,$211.00,$0.00,$211.00,$114.57,$150.59,$0.00,$36.35,$0.00,$0.00,$36.94,$211.00,$0.00,$105.50,$167.11,$168.80,$0.00,$33.02,$0.00,$33.59,$0.00
M001468500,SUP,HCPCS C1769,,M001468500  -  GUIDEWIRE VASCULAR STR .018IN 150CM 8CM RADIOPQ V-18,$178.95,$0.00,$178.95,$97.17,$127.72,$0.00,$30.83,$0.00,$0.00,$31.33,$178.95,$0.00,$89.48,$141.73,$143.16,$0.00,$28.01,$0.00,$28.49,$0.00
M001468520,SUP,HCPCS C1769,,M001468520  -  GUIDEWIRE VASCULAR TAPER .018IN 200CM 8CM RADIOPQ STR TIP,$188.53,$0.00,$188.53,$102.37,$134.55,$0.00,$32.48,$0.00,$0.00,$33.01,$188.53,$0.00,$94.26,$149.32,$150.82,$0.00,$29.50,$0.00,$30.01,$0.00
M001468540,SUP,HCPCS C1769,,M001468540  -  GUIDEWIRE VASCULAR TAPER .018IN 300CM 8CM RADIOPQ STR TIP,$197.25,$0.00,$197.25,$107.11,$140.78,$0.00,$33.99,$0.00,$0.00,$34.54,$197.25,$0.00,$98.63,$156.22,$157.80,$0.00,$30.87,$0.00,$31.40,$0.00
M001468560,SUP,HCPCS C1769,,M001468560  -  GUIDEWIRE VASCULAR STR .018IN 150CM 12CM RADIOPQ V-18,$213.15,$0.00,$213.15,$115.74,$152.13,$0.00,$36.72,$0.00,$0.00,$37.32,$213.15,$0.00,$106.58,$168.81,$170.52,$0.00,$33.36,$0.00,$33.93,$0.00
M001468580,SUP,HCPCS C1769,,M001468580  -  GUIDEWIRE VASCULAR STR .018IN 200CM 12CM RADIOPQ V-18,$213.15,$0.00,$213.15,$115.74,$152.13,$0.00,$36.72,$0.00,$0.00,$37.32,$213.15,$0.00,$106.58,$168.81,$170.52,$0.00,$33.36,$0.00,$33.93,$0.00
M001468600,SUP,HCPCS C1769,,M001468600  -  GUIDEWIRE VASCULAR STR .018IN 300CM 12CM RADIOPQ V-18,$213.15,$0.00,$213.15,$115.74,$152.13,$0.00,$36.72,$0.00,$0.00,$37.32,$213.15,$0.00,$106.58,$168.81,$170.52,$0.00,$33.36,$0.00,$33.93,$0.00
M001491001,SUP,HCPCS C1769,,M001491001  -  GUIDEWIRE VASCULAR STANDARD TAPER .025IN 150CM 3CM FIX CORE,$15.28,$0.00,$15.28,$8.29,$10.90,$0.00,$2.63,$0.00,$0.00,$2.67,$15.28,$0.00,$7.64,$12.10,$12.22,$0.00,$2.39,$0.00,$2.43,$0.00
M001491011,SUP,HCPCS C1769,,M001491011  -  GUIDEWIRE STAR SFC .035 150CM PTFE,$19.50,$0.00,$19.50,$10.59,$13.92,$0.00,$3.36,$0.00,$0.00,$3.41,$19.50,$0.00,$9.75,$15.44,$15.60,$0.00,$3.05,$0.00,$3.10,$0.00
M001491021,SUP,HCPCS C1769,,M001491021  -  GUIDEWIRE VASCULAR STANDARD STR SPRING COIL .038IN 150CM 3CM,$15.28,$0.00,$15.28,$8.29,$10.90,$0.00,$2.63,$0.00,$0.00,$2.67,$15.28,$0.00,$7.64,$12.10,$12.22,$0.00,$2.39,$0.00,$2.43,$0.00
M001491031,SUP,HCPCS C1769,,M001491031  -  GUIDEWIRE VASCULAR STR .035IN 260CM 3CM FIX CORE FLEXIBLE,$34.94,$0.00,$34.94,$18.97,$24.93,$0.00,$6.02,$0.00,$0.00,$6.12,$34.94,$0.00,$17.47,$27.67,$27.95,$0.00,$5.47,$0.00,$5.56,$0.00
M001491451,SUP,HCPCS C1769,,M001491451  -  GUIDEWIRE VASCULAR STR SPRING COIL .035IN 150CM 15CM STARTER,$24.71,$0.00,$24.71,$13.41,$17.63,$0.00,$4.26,$0.00,$0.00,$4.33,$24.71,$0.00,$12.35,$19.57,$19.76,$0.00,$3.87,$0.00,$3.93,$0.00
M001491471,SUP,HCPCS C1769,,M001491471  -  GUIDEWIRE VASCULAR STANDARD TAPER .035IN 180CM 15CM STR TIP,$195.50,$0.00,$195.50,$106.16,$139.53,$0.00,$33.68,$0.00,$0.00,$34.23,$195.50,$0.00,$97.75,$154.84,$156.40,$0.00,$30.60,$0.00,$31.12,$0.00
M001491481,SUP,HCPCS C1769,,M001491481  -  GUIDEWIRE VASCULAR STANDARD TAPER .035IN 260CM 15CM STR TIP,$251.38,$0.00,$251.38,$136.50,$179.41,$0.00,$43.31,$0.00,$0.00,$44.01,$251.38,$0.00,$125.69,$199.09,$201.10,$0.00,$39.34,$0.00,$40.02,$0.00
M001491561,SUP,HCPCS C1769,,M001491561  -  GUIDEWIRE VASCULAR 1.5MM STANDARD ROSEN CURVE TAPER .035IN,$129.88,$0.00,$129.88,$70.52,$92.69,$0.00,$22.38,$0.00,$0.00,$22.74,$129.88,$0.00,$64.94,$102.86,$103.90,$0.00,$20.33,$0.00,$20.68,$0.00
M001491571,SUP,HCPCS C1769,,M001491571  -  GUIDEWIRE VASCULAR 1.5MM STANDARD ROSEN CURVE TAPER .035IN,$208.95,$0.00,$208.95,$113.46,$149.13,$0.00,$36.00,$0.00,$0.00,$36.59,$208.95,$0.00,$104.48,$165.49,$167.16,$0.00,$32.70,$0.00,$33.26,$0.00
M001491601,SUP,HCPCS C1769,,M001491601  -  GUIDEWIRE VASCULAR STANDARD STR .035IN 150CM 3CM FIX CORE,$18.62,$0.00,$18.62,$10.11,$13.29,$0.00,$3.21,$0.00,$0.00,$3.26,$18.62,$0.00,$9.31,$14.75,$14.90,$0.00,$2.91,$0.00,$2.96,$0.00
M001491611,SUP,HCPCS C1769,,M001491611  -  GUIDEWIRE VASCULAR STANDARD STR .035IN 260CM 3CM FIX CORE,$37.24,$0.00,$37.24,$20.22,$26.58,$0.00,$6.42,$0.00,$0.00,$6.52,$37.24,$0.00,$18.62,$29.49,$29.79,$0.00,$5.83,$0.00,$5.93,$0.00
M001491771,SUP,HCPCS C1769,,M001491771  -  GUIDEWIRE VASCULAR BENTSON STANDARD .035IN 180CM 15CM SPRING,$216.00,$0.00,$216.00,$117.29,$154.16,$0.00,$37.22,$0.00,$0.00,$37.82,$216.00,$0.00,$108.00,$171.07,$172.80,$0.00,$33.80,$0.00,$34.39,$0.00
M001491851,SUP,HCPCS C1769,,M001491851  -  GUIDEWIRE VASCULAR J ROSEN CURVE SPRING COIL .035IN 180CM,$180.63,$0.00,$180.63,$98.08,$128.91,$0.00,$31.12,$0.00,$0.00,$31.63,$180.63,$0.00,$90.31,$143.06,$144.50,$0.00,$28.27,$0.00,$28.76,$0.00
M001492031,SUP,HCPCS C1769,,M001492031  -  GWIRE VASC 125CM .025IN STR FIX CORE 3CM TIP 10MM STRT PTFE,$19.50,$0.00,$19.50,$10.59,$13.92,$0.00,$3.36,$0.00,$0.00,$3.41,$19.50,$0.00,$9.75,$15.44,$15.60,$0.00,$3.05,$0.00,$3.10,$0.00
M001492061,SUP,HCPCS C1769,,M001492061  -  GWIRE VASC 150CM .028IN STR FIX CORE 3CM TIP 10MM STRT PTFE,$19.50,$0.00,$19.50,$10.59,$13.92,$0.00,$3.36,$0.00,$0.00,$3.41,$19.50,$0.00,$9.75,$15.44,$15.60,$0.00,$3.05,$0.00,$3.10,$0.00
M001492081,SUP,HCPCS C1769,,M001492081  -  GWIRE VASC 150CM .032IN STR FIX CORE 3CM TIP 10MM STRT PTFE,$28.75,$0.00,$28.75,$15.61,$20.52,$0.00,$4.95,$0.00,$0.00,$5.03,$28.75,$0.00,$14.38,$22.77,$23.00,$0.00,$4.50,$0.00,$4.58,$0.00
M001492111,SUP,HCPCS C1769,,M001492111  -  GWIRE VASC 125CM .035IN STR FIX CORE 3CM TIP 10MM STRT PTFE,$19.50,$0.00,$19.50,$10.59,$13.92,$0.00,$3.36,$0.00,$0.00,$3.41,$19.50,$0.00,$9.75,$15.44,$15.60,$0.00,$3.05,$0.00,$3.10,$0.00
M001492121,SUP,HCPCS C1769,,M001492121  -  GUIDEWIRE VASCULAR STR .035IN 180CM 3CM FIX CORE STARTER,$38.45,$0.00,$38.45,$20.88,$27.44,$0.00,$6.62,$0.00,$0.00,$6.73,$38.45,$0.00,$19.23,$30.45,$30.76,$0.00,$6.02,$0.00,$6.12,$0.00
M001492311,SUP,HCPCS C1769,,M001492311  -  GUIDEWIRE VASCULAR STR .035IN 80CM 3MM FIX CORE STARTER PTFE,$15.28,$0.00,$15.28,$8.29,$10.90,$0.00,$2.63,$0.00,$0.00,$2.67,$15.28,$0.00,$7.64,$12.10,$12.22,$0.00,$2.39,$0.00,$2.43,$0.00
M001492751,SUP,HCPCS C1769,,M001492751  -  GUIDEWIRE VASCULAR .018IN 130CM 3CM SHORT TAPER STR TIP,$196.00,$0.00,$196.00,$106.43,$139.89,$0.00,$33.77,$0.00,$0.00,$34.32,$196.00,$0.00,$98.00,$155.23,$156.80,$0.00,$30.67,$0.00,$31.20,$0.00
M001492761,SUP,HCPCS C1769,,M001492761  -  GUIDEWIRE VASCULAR J SHORT TAPER .018IN 130CM 3CM THRUWAY,$196.00,$0.00,$196.00,$106.43,$139.89,$0.00,$33.77,$0.00,$0.00,$34.32,$196.00,$0.00,$98.00,$155.23,$156.80,$0.00,$30.67,$0.00,$31.20,$0.00
M001492771,SUP,HCPCS C1769,,M001492771  -  GUIDEWIRE VASCULAR STR LONG TAPER .018IN 130CM 3CM SHAPEABLE,$196.00,$0.00,$196.00,$106.43,$139.89,$0.00,$33.77,$0.00,$0.00,$34.32,$196.00,$0.00,$98.00,$155.23,$156.80,$0.00,$30.67,$0.00,$31.20,$0.00
M001492781,SUP,HCPCS C1769,,M001492781  -  GUIDEWIRE VASCULAR J LONG TAPER .018IN 130CM 3CM THRUWAY,$210.10,$0.00,$210.10,$114.08,$149.95,$0.00,$36.20,$0.00,$0.00,$36.79,$210.10,$0.00,$105.05,$166.40,$168.08,$0.00,$32.88,$0.00,$33.45,$0.00
M001492791,SUP,HCPCS C1769,,M001492791  -  GUIDEWIRE VASCULAR STR SHORT TAPER .018IN 190CM 3CM,$196.00,$0.00,$196.00,$106.43,$139.89,$0.00,$33.77,$0.00,$0.00,$34.32,$196.00,$0.00,$98.00,$155.23,$156.80,$0.00,$30.67,$0.00,$31.20,$0.00
M001492801,SUP,HCPCS C1769,,M001492801  -  GUIDEWIRE VASCULAR .018IN 190CM 3CM SHORT TAPER J TIP DISTAL,$196.00,$0.00,$196.00,$106.43,$139.89,$0.00,$33.77,$0.00,$0.00,$34.32,$196.00,$0.00,$98.00,$155.23,$156.80,$0.00,$30.67,$0.00,$31.20,$0.00
M001492811,SUP,HCPCS C1769,,M001492811  -  GUIDEWIRE VASCULAR STR LONG TAPER .018IN 190CM 3CM SHAPEABLE,$196.00,$0.00,$196.00,$106.43,$139.89,$0.00,$33.77,$0.00,$0.00,$34.32,$196.00,$0.00,$98.00,$155.23,$156.80,$0.00,$30.67,$0.00,$31.20,$0.00
M001492821,SUP,HCPCS C1769,,M001492821  -  GUIDEWIRE VASCULAR J LONG TAPER .018IN 190CM 3CM THRUWAY,$196.00,$0.00,$196.00,$106.43,$139.89,$0.00,$33.77,$0.00,$0.00,$34.32,$196.00,$0.00,$98.00,$155.23,$156.80,$0.00,$30.67,$0.00,$31.20,$0.00
M001492831,SUP,HCPCS C1769,,M001492831  -  GUIDEWIRE VASCULAR STR SHORT TAPER .018IN 300CM 3CM,$196.00,$0.00,$196.00,$106.43,$139.89,$0.00,$33.77,$0.00,$0.00,$34.32,$196.00,$0.00,$98.00,$155.23,$156.80,$0.00,$30.67,$0.00,$31.20,$0.00
M001492841,SUP,HCPCS C1769,,M001492841  -  GUIDEWIRE VASCULAR J SHORT TAPER .018IN 300CM 3CM THRUWAY,$196.00,$0.00,$196.00,$106.43,$139.89,$0.00,$33.77,$0.00,$0.00,$34.32,$196.00,$0.00,$98.00,$155.23,$156.80,$0.00,$30.67,$0.00,$31.20,$0.00
M001492851,SUP,HCPCS C1769,,M001492851  -  GUIDEWIRE VASCULAR STR LONG TAPER .018IN 300CM 3CM SHAPEABLE,$196.00,$0.00,$196.00,$106.43,$139.89,$0.00,$33.77,$0.00,$0.00,$34.32,$196.00,$0.00,$98.00,$155.23,$156.80,$0.00,$30.67,$0.00,$31.20,$0.00
M001492861,SUP,HCPCS C1769,,M001492861  -  GUIDEWIRE VASCULAR J LONG TAPER .018IN 300CM 3CM THRUWAY,$196.00,$0.00,$196.00,$106.43,$139.89,$0.00,$33.77,$0.00,$0.00,$34.32,$196.00,$0.00,$98.00,$155.23,$156.80,$0.00,$30.67,$0.00,$31.20,$0.00
M001503000,SUP,HCPCS C1884,,M001503000  -  SYSTEM EMBL PRTC 47MM VC JUG INTROD 12FR TI 38MM GRNFLD,"$2,497.25",$0.00,"$2,497.25","$1,123.76","$1,782.29",$0.00,$430.26,$0.00,$0.00,$437.25,"$2,497.25",$0.00,"$1,248.63","$1,977.82","$1,997.80",$0.00,$390.82,$0.00,$397.56,$0.00
M001503010,SUP,HCPCS C1884,,M001503010  -  SYSTEM EMBL PRTC 47MM VC FEM INTROD 15FR TI 38MM GRNFLD,"$2,497.25",$0.00,"$2,497.25","$1,123.76","$1,782.29",$0.00,$430.26,$0.00,$0.00,$437.25,"$2,497.25",$0.00,"$1,248.63","$1,977.82","$1,997.80",$0.00,$390.82,$0.00,$397.56,$0.00
M001503350,SUP,Custom 27803010,,M001503350  -  DILATOR VASC 12FR INTRO 6-14FR GRNFLD RADOPQ TI VC,$162.50,$0.00,$162.50,$0.00,$115.98,$0.00,$0.00,$0.00,$0.00,$0.00,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$0.00,$0.00,$0.00,$0.00
M001503500,SUP,HCPCS C1884,,M001503500  -  SYSTEM EMBL PRTC 47MM VC NDL SYR ACC INTROD 12FR TI 38MM,$332.50,$0.00,$332.50,$149.63,$237.31,$0.00,$57.29,$0.00,$0.00,$58.22,$332.50,$0.00,$166.25,$263.34,$266.00,$0.00,$52.04,$0.00,$52.93,$0.00
M001504000,SUP,Custom 27803010,,M001504000  -  FILTER VASCULAR .035IN 12FR 46MM 32MM OTW REINFORCE SHEATH,"$2,363.53",$0.00,"$2,363.53",$0.00,"$1,686.85",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,363.53",$0.00,"$1,181.76","$1,871.92","$1,890.82",$0.00,$0.00,$0.00,$0.00,$0.00
M001505010,SUP,Custom 27803010,,M001505010  -  FILTER VASCULAR 12FR OTW CAPSULE GREENFIELD FEMORAL SYSTEM,"$2,363.53",$0.00,"$2,363.53",$0.00,"$1,686.85",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,363.53",$0.00,"$1,181.76","$1,871.92","$1,890.82",$0.00,$0.00,$0.00,$0.00,$0.00
M001509000,SUP,HCPCS C1769,,M001509000  -  GUIDEWIRE VASCULAR STR .016IN 140CM 25CM STEERABLE FATHOM,$744.33,$0.00,$744.33,$404.17,$531.22,$0.00,$128.24,$0.00,$0.00,$130.33,$744.33,$0.00,$372.16,$589.51,$595.46,$0.00,$116.49,$0.00,$118.50,$0.00
M001509010,SUP,HCPCS C1769,,M001509010  -  GUIDEWIRE VASCULAR STR .016IN 140CM 35CM STEERABLE FATHOM,$744.33,$0.00,$744.33,$404.17,$531.22,$0.00,$128.24,$0.00,$0.00,$130.33,$744.33,$0.00,$372.16,$589.51,$595.46,$0.00,$116.49,$0.00,$118.50,$0.00
M001509100,SUP,HCPCS C1769,,M001509100  -  GUIDEWIRE VASCULAR .016IN 180CM 25CM STEERABLE STR TIP,$744.33,$0.00,$744.33,$404.17,$531.22,$0.00,$128.24,$0.00,$0.00,$130.33,$744.33,$0.00,$372.16,$589.51,$595.46,$0.00,$116.49,$0.00,$118.50,$0.00
M001509110,SUP,HCPCS C1769,,M001509110  -  GUIDEWIRE VASCULAR .016IN 180CM 35CM STEERABLE STR TIP,$744.33,$0.00,$744.33,$404.17,$531.22,$0.00,$128.24,$0.00,$0.00,$130.33,$744.33,$0.00,$372.16,$589.51,$595.46,$0.00,$116.49,$0.00,$118.50,$0.00
M0015501010,SUP,HCPCS C1887,,M0015501010  -  CATHETER INFUS .014IN MICRO TAPER 14 FLEX 3-2.8FR .024IN 105,"$1,157.13",$0.00,"$1,157.13",$628.32,$825.84,$0.00,$199.37,$0.00,$0.00,$202.60,"$1,157.13",$0.00,$578.56,$916.45,$925.70,$0.00,$181.09,$0.00,$184.21,$0.00
M0015501030,SUP,HCPCS C1887,,M0015501030  -  CATHETER INFUS .038IN MICRO TAPER-14 FLEX 3-2.8FR .024IN 125,"$1,157.13",$0.00,"$1,157.13",$628.32,$825.84,$0.00,$199.37,$0.00,$0.00,$202.60,"$1,157.13",$0.00,$578.56,$916.45,$925.70,$0.00,$181.09,$0.00,$184.21,$0.00
M0015501040,SUP,HCPCS C1887,,M0015501040  -  CATHETER INFUS .014IN MICRO TAPER-14 FLEX 3-2.8FR .024IN 135,"$1,157.13",$0.00,"$1,157.13",$628.32,$825.84,$0.00,$199.37,$0.00,$0.00,$202.60,"$1,157.13",$0.00,$578.56,$916.45,$925.70,$0.00,$181.09,$0.00,$184.21,$0.00
M0015502030,SUP,HCPCS C1887,,M0015502030  -  CATHETER INFUS .016IN MICRO TAPER 14 FLEX 3-2.8FR .024IN 125,"$1,157.13",$0.00,"$1,157.13",$628.32,$825.84,$0.00,$199.37,$0.00,$0.00,$202.60,"$1,157.13",$0.00,$578.56,$916.45,$925.70,$0.00,$181.09,$0.00,$184.21,$0.00
M0015502040,SUP,HCPCS C1887,,M0015502040  -  CATHETER INFUS .038IN MICRO TAPER 14 FLEX 3-2.8FR .024IN 135,"$1,157.13",$0.00,"$1,157.13",$628.32,$825.84,$0.00,$199.37,$0.00,$0.00,$202.60,"$1,157.13",$0.00,$578.56,$916.45,$925.70,$0.00,$181.09,$0.00,$184.21,$0.00
M001705020,SUP,HCPCS C1874,,M001705020  -  STENT ENDOPRSTH 116CM 10MM 10FR 20MM 90CM COVER COATED,"$3,920.00",$0.00,"$3,920.00","$1,764.00","$2,797.70",$0.00,$675.40,$0.00,$0.00,$686.36,"$3,920.00",$0.00,"$1,960.00","$3,104.64","$3,136.00",$0.00,$613.48,$0.00,$624.06,$0.00
M001705030,SUP,HCPCS C2628,,M001705030  -  STENT ENDOPRSTH 116CM 10MM 10FR 30MM 90CM COVER COATED,"$3,920.00",$0.00,"$3,920.00",$0.00,"$2,797.70",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,920.00",$0.00,"$1,960.00","$3,104.64","$3,136.00",$0.00,$0.00,$0.00,$0.00,$0.00
M001705050,SUP,HCPCS C1874,,M001705050  -  STENT ENDOPRSTH 116CM 10MM 10FR 50MM 90CM COVER COATED,"$3,920.00",$0.00,"$3,920.00","$1,764.00","$2,797.70",$0.00,$675.40,$0.00,$0.00,$686.36,"$3,920.00",$0.00,"$1,960.00","$3,104.64","$3,136.00",$0.00,$613.48,$0.00,$624.06,$0.00
M001705070,SUP,HCPCS C1874,,M001705070  -  STENT ENDOPRSTH 116CM 10MM 10FR 70MM 90CM COVER COATED,"$3,920.00",$0.00,"$3,920.00","$1,764.00","$2,797.70",$0.00,$675.40,$0.00,$0.00,$686.36,"$3,920.00",$0.00,"$1,960.00","$3,104.64","$3,136.00",$0.00,$613.48,$0.00,$624.06,$0.00
M001705230,SUP,HCPCS C2628,,M001705230  -  STENT ENDOPRSTH 116CM 12MM 11FR 30MM 90CM COVER COATED,"$3,920.00",$0.00,"$3,920.00",$0.00,"$2,797.70",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,920.00",$0.00,"$1,960.00","$3,104.64","$3,136.00",$0.00,$0.00,$0.00,$0.00,$0.00
M001705250,SUP,HCPCS C2628,,M001705250  -  STENT ENDOPRSTH 116CM 12MM 11FR 50MM 90CM COVER COATED,"$3,920.00",$0.00,"$3,920.00",$0.00,"$2,797.70",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,920.00",$0.00,"$1,960.00","$3,104.64","$3,136.00",$0.00,$0.00,$0.00,$0.00,$0.00
M001705270,SUP,HCPCS C1874,,M001705270  -  STENT ENDOPRSTH 116CM 12MM 11FR 70MM 90CM COVER COATED,"$3,920.00",$0.00,"$3,920.00","$1,764.00","$2,797.70",$0.00,$675.40,$0.00,$0.00,$686.36,"$3,920.00",$0.00,"$1,960.00","$3,104.64","$3,136.00",$0.00,$613.48,$0.00,$624.06,$0.00
M001705450,SUP,HCPCS C1874,,M001705450  -  STENT ENDOPRSTH 116CM 14MM 12FR 50MM 90CM COVER COATED,"$3,920.00",$0.00,"$3,920.00","$1,764.00","$2,797.70",$0.00,$675.40,$0.00,$0.00,$686.36,"$3,920.00",$0.00,"$1,960.00","$3,104.64","$3,136.00",$0.00,$613.48,$0.00,$624.06,$0.00
M001705470,SUP,HCPCS C1874,,M001705470  -  STENT ENDOPRSTH 116CM 14MM 12FR 70MM 90CM COVER COATED,"$3,920.00",$0.00,"$3,920.00","$1,764.00","$2,797.70",$0.00,$675.40,$0.00,$0.00,$686.36,"$3,920.00",$0.00,"$1,960.00","$3,104.64","$3,136.00",$0.00,$613.48,$0.00,$624.06,$0.00
M001705620,SUP,HCPCS C1874,,M001705620  -  STENT ENDOPRSTH 116CM 6MM 20MM 90CM DELIVERY SYSTEM,"$3,920.00",$0.00,"$3,920.00","$1,764.00","$2,797.70",$0.00,$675.40,$0.00,$0.00,$686.36,"$3,920.00",$0.00,"$1,960.00","$3,104.64","$3,136.00",$0.00,$613.48,$0.00,$624.06,$0.00
M001705630,SUP,HCPCS C1874,,M001705630  -  STENT ENDOPRSTH 116CM 6MM 9FR 30MM 90CM COVER COATED,"$3,920.00",$0.00,"$3,920.00","$1,764.00","$2,797.70",$0.00,$675.40,$0.00,$0.00,$686.36,"$3,920.00",$0.00,"$1,960.00","$3,104.64","$3,136.00",$0.00,$613.48,$0.00,$624.06,$0.00
M001705650,SUP,HCPCS C2617,,M001705650  -  STENT ENDOPRSTH 116CM 6MM 9FR 50MM 90CM COVER COATED,"$3,920.00",$0.00,"$3,920.00","$1,764.00","$2,797.70",$0.00,$675.40,$0.00,$0.00,$686.36,"$3,920.00",$0.00,"$1,960.00","$3,104.64","$3,136.00",$0.00,$613.48,$0.00,$624.06,$0.00
M001705670,SUP,HCPCS C1874,,M001705670  -  STENT ENDOPRSTH 116CM 6MM 9FR 70MM 90CM COVER COATED,"$3,920.00",$0.00,"$3,920.00","$1,764.00","$2,797.70",$0.00,$675.40,$0.00,$0.00,$686.36,"$3,920.00",$0.00,"$1,960.00","$3,104.64","$3,136.00",$0.00,$613.48,$0.00,$624.06,$0.00
M001705720,SUP,HCPCS C1874,,M001705720  -  STENT ENDOPRSTH 116CM 7MM 9FR 20MM 90CM COVER COATED,"$3,920.00",$0.00,"$3,920.00","$1,764.00","$2,797.70",$0.00,$675.40,$0.00,$0.00,$686.36,"$3,920.00",$0.00,"$1,960.00","$3,104.64","$3,136.00",$0.00,$613.48,$0.00,$624.06,$0.00
M001705730,SUP,HCPCS C1874,,M001705730  -  STENT ENDOPRSTH 116CM 7MM 9FR 30MM 90CM COVER COATED,"$3,920.00",$0.00,"$3,920.00","$1,764.00","$2,797.70",$0.00,$675.40,$0.00,$0.00,$686.36,"$3,920.00",$0.00,"$1,960.00","$3,104.64","$3,136.00",$0.00,$613.48,$0.00,$624.06,$0.00
M001705750,SUP,HCPCS C1874,,M001705750  -  STENT ENDOPRSTH 116CM 7MM 9FR 50MM 90CM COVER COATED,"$3,920.00",$0.00,"$3,920.00","$1,764.00","$2,797.70",$0.00,$675.40,$0.00,$0.00,$686.36,"$3,920.00",$0.00,"$1,960.00","$3,104.64","$3,136.00",$0.00,$613.48,$0.00,$624.06,$0.00
M001705770,SUP,HCPCS C1874,,M001705770  -  STENT ENDOPRSTH 116CM 7MM 9FR 90MM 90CM COVER COATED,"$3,920.00",$0.00,"$3,920.00","$1,764.00","$2,797.70",$0.00,$675.40,$0.00,$0.00,$686.36,"$3,920.00",$0.00,"$1,960.00","$3,104.64","$3,136.00",$0.00,$613.48,$0.00,$624.06,$0.00
M001705820,SUP,HCPCS C1874,,M001705820  -  STENT ENDOPRSTH 116CM 8MM 9FR 20MM 90CM COVER COATED,"$3,920.00",$0.00,"$3,920.00","$1,764.00","$2,797.70",$0.00,$675.40,$0.00,$0.00,$686.36,"$3,920.00",$0.00,"$1,960.00","$3,104.64","$3,136.00",$0.00,$613.48,$0.00,$624.06,$0.00
M001705830,SUP,HCPCS C1874,,M001705830  -  STENT ENDOPRSTH 116CM 8MM 9FR 30MM 90CM COVER COATED,"$3,920.00",$0.00,"$3,920.00","$1,764.00","$2,797.70",$0.00,$675.40,$0.00,$0.00,$686.36,"$3,920.00",$0.00,"$1,960.00","$3,104.64","$3,136.00",$0.00,$613.48,$0.00,$624.06,$0.00
M001705850,SUP,HCPCS C1874,,M001705850  -  STENT ENDOPRSTH 116CM 8MM 9FR 50MM 90CM COVER COATED,"$3,920.00",$0.00,"$3,920.00","$1,764.00","$2,797.70",$0.00,$675.40,$0.00,$0.00,$686.36,"$3,920.00",$0.00,"$1,960.00","$3,104.64","$3,136.00",$0.00,$613.48,$0.00,$624.06,$0.00
M001705870,SUP,HCPCS C1874,,M001705870  -  STENT ENDOPRSTH 116CM 8MM 9FR 70MM 90CM COVER COATED,"$3,920.00",$0.00,"$3,920.00","$1,764.00","$2,797.70",$0.00,$675.40,$0.00,$0.00,$686.36,"$3,920.00",$0.00,"$1,960.00","$3,104.64","$3,136.00",$0.00,$613.48,$0.00,$624.06,$0.00
M001705920,SUP,HCPCS C1874,,M001705920  -  STENT ENDOPRSTH 116CM 9MM 10FR 20MM 90CM COVER COATED,"$3,920.00",$0.00,"$3,920.00","$1,764.00","$2,797.70",$0.00,$675.40,$0.00,$0.00,$686.36,"$3,920.00",$0.00,"$1,960.00","$3,104.64","$3,136.00",$0.00,$613.48,$0.00,$624.06,$0.00
M001705930,SUP,HCPCS C1874,,M001705930  -  STENT ENDOPRSTH 116CM 9MM 10FR 30MM 90CM COVER COATED,"$3,920.00",$0.00,"$3,920.00","$1,764.00","$2,797.70",$0.00,$675.40,$0.00,$0.00,$686.36,"$3,920.00",$0.00,"$1,960.00","$3,104.64","$3,136.00",$0.00,$613.48,$0.00,$624.06,$0.00
M001705950,SUP,HCPCS C1874,,M001705950  -  STENT ENDOPRSTH 116CM 9MM 10FR 50MM 90CM COVER COATED,"$3,920.00",$0.00,"$3,920.00","$1,764.00","$2,797.70",$0.00,$675.40,$0.00,$0.00,$686.36,"$3,920.00",$0.00,"$1,960.00","$3,104.64","$3,136.00",$0.00,$613.48,$0.00,$624.06,$0.00
M001705970,SUP,HCPCS C1874,,M001705970  -  STENT ENDOPRSTH 116CM 9MM 10FR 70MM 90CM COVER COATED,"$3,920.00",$0.00,"$3,920.00","$1,764.00","$2,797.70",$0.00,$675.40,$0.00,$0.00,$686.36,"$3,920.00",$0.00,"$1,960.00","$3,104.64","$3,136.00",$0.00,$613.48,$0.00,$624.06,$0.00
M001711000,SUP,HCPCS C1877,,M001711000  -  STENT ENDOPRSTH 100CM 5MM 20MM 75CM DELIVERY SYSTEM FLEXIBLE,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001711010,SUP,HCPCS C1877,,M001711010  -  STENT ENDOPRSTH 5MM 6FR 20MM 135CM FLEXIBLE RECONSTRAINABLE,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001711020,SUP,HCPCS C1877,,M001711020  -  STENT ENDOPRSTH 100CM 5MM 40MM 75CM DELIVERY SYSTEM FLEXIBLE,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001711030,SUP,HCPCS C1877,,M001711030  -  STENT ENDOPRSTH 160CM 5MM 40MM 135CM DELIVERY SYSTEM,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001711040,SUP,HCPCS C1877,,M001711040  -  STENT ENDOPRSTH 100CM 5MM 55MM 75CM DELIVERY SYSTEM FLEXIBLE,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001711050,SUP,HCPCS C1877,,M001711050  -  STENT ENDOPRSTH 160CM 5MM 55MM 135CM DELIVERY SYSTEM,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001711060,SUP,HCPCS C1877,,M001711060  -  STENT ENDOPRSTH 100CM 5MM 80MM 75CM DELIVERY SYSTEM FLEXIBLE,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001711070,SUP,HCPCS C1877,,M001711070  -  STENT ENDOPRSTH 160CM 5MM 80MM 135CM DELIVERY SYSTEM,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001711080,SUP,HCPCS C1877,,M001711080  -  STENT ENDOPRSTH 100CM 6MM 20MM 75CM DELIVERY SYSTEM FLEXIBLE,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001711090,SUP,HCPCS C1877,,M001711090  -  STENT ENDOPRSTH 5MM 6FR 20MM 160CM FLEXIBLE RECONSTRAINABLE,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001711100,SUP,HCPCS C1877,,M001711100  -  STENT ENDOPRSTH 100CM 6MM 45MM 75CM DELIVERY SYSTEM FLEXIBLE,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001711110,SUP,HCPCS C1877,,M001711110  -  STENT ENDOPRSTH 160CM 6MM 45MM 135CM DELIVERY SYSTEM,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001711120,SUP,HCPCS C1877,,M001711120  -  STENT ENDOPRSTH 100CM 6MM 60MM 75CM DELIVERY SYSTEM FLEXIBLE,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001711130,SUP,HCPCS C1877,,M001711130  -  STENT ENDOPRSTH 160CM 6MM 60MM 135CM DELIVERY SYSTEM,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001711140,SUP,HCPCS C1877,,M001711140  -  STENT ENDOPRSTH 100CM 6MM 90MM 75CM DELIVERY SYSTEM FLEXIBLE,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001711150,SUP,HCPCS C1877,,M001711150  -  STENT ENDOPRSTH 160CM 6MM 90MM 135CM DELIVERY SYSTEM,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001711160,SUP,HCPCS C1877,,M001711160  -  STENT ENDOPRSTH 100CM 7MM 20MM 75CM DELIVERY SYSTEM FLEXIBLE,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001711170,SUP,HCPCS C1877,,M001711170  -  STENT ENDOPRSTH 7MM 6FR 20MM 160CM FLEXIBLE RECONSTRAINABLE,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001711180,SUP,HCPCS C1877,,M001711180  -  STENT ENDOPRSTH 100CM 7MM 40MM 75CM DELIVERY SYSTEM FLEXIBLE,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001711190,SUP,HCPCS C1877,,M001711190  -  STENT ENDOPRSTH 160CM 7MM 40MM 135CM DELIVERY SYSTEM,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001711200,SUP,HCPCS C1877,,M001711200  -  STENT ENDOPRSTH STENT 100CM 7MM 6FR 60MM 75CM SYSTEM,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001711210,SUP,HCPCS C1877,,M001711210  -  STENT ENDOPRSTH 160CM 7MM 60MM 135CM DELIVERY SYSTEM,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001711220,SUP,HCPCS C1877,,M001711220  -  STENT ENDOPRSTH 100CM 7MM 90MM 75CM DELIVERY SYSTEM FLEXIBLE,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001711230,SUP,HCPCS C1877,,M001711230  -  STENT ENDOPRSTH 160CM 7MM 90MM 135CM DELIVERY SYSTEM,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001711240,SUP,HCPCS C1877,,M001711240  -  STENT ENDOPRSTH 8MM 6FR 20MM 100CM FLEXIBLE RECONSTRAINABLE,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001711250,SUP,HCPCS C1877,,M001711250  -  STENT ENDOPRSTH 160CM 8MM 20MM 135CM DELIVERY SYSTEM,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001711260,SUP,HCPCS C2617,,M001711260  -  STENT ENDOPRSTH 8MM 6FR 40MM 100CM FLEXIBLE RECONSTRAINABLE,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001711270,SUP,HCPCS C1877,,M001711270  -  STENT TRACHEOBRONCHIAL 8MM 6FR 40MM 135CM ENDOPRSTH UNISTEP,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001711280,SUP,HCPCS C2617,,M001711280  -  STENT ENDOPRSTH 8MM 6FR 60MM 100CM FLEXIBLE RECONSTRAINABLE,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001711290,SUP,HCPCS C2617,,M001711290  -  STENT ENDOPRSTH 160CM 8MM 60MM 135CM DELIVERY SYSTEM,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001711300,SUP,HCPCS C2617,,M001711300  -  STENT ENDOPRSTH 100CM 8MM 80MM 75CM DELIVERY SYSTEM FLEXIBLE,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001711310,SUP,HCPCS C2617,,M001711310  -  STENT ENDOPRSTH 160CM 8MM 80MM 135CM DELIVERY SYSTEM,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001711320,SUP,HCPCS C1877,,M001711320  -  STENT ENDOPRSTH 10MM 6FR 20MM 100CM FLEXIBLE RECONSTRAINABLE,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001711330,SUP,HCPCS C1877,,M001711330  -  STENT ENDOPRSTH 160CM 10MM 20MM 135CM DELIVERY SYSTEM,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001711340,SUP,HCPCS C1877,,M001711340  -  STENT ENDOPRSTH 10MM 7FR 42MM 75CM ENDOPRSTH UNCOVERED,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001711350,SUP,HCPCS C1877,,M001711350  -  STENT ENDOPRSTH 160CM 10MM 42MM 135CM DELIVERY SYSTEM,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001711360,SUP,HCPCS C1877,,M001711360  -  STENT ENDOPRSTH 10MM 68MM 100CM DELIVERY SYSTEM FLEXIBLE,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001711370,SUP,HCPCS C1877,,M001711370  -  STENT ENDOPRSTH 160CM 10MM 68MM 135CM DELIVERY SYSTEM,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001711380,SUP,HCPCS C2617,,M001711380  -  STENT ENDOPRSTH 100CM 10MM 94MM 75CM DELIVERY SYSTEM,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001711390,SUP,HCPCS C1877,,M001711390  -  STENT ENDOPRSTH 160CM 10MM 94MM 135CM DELIVERY SYSTEM,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001712000,SUP,HCPCS C1877,,M001712000  -  STENT ENDOPRSTH 100CM 6MM 24MM 75CM DELIVERY SYSTEM FLEXIBLE,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001712010,SUP,HCPCS C1877,,M001712010  -  STENT ENDOPRSTH 160CM 6MM 24MM 135CM DELIVERY SYSTEM,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001712020,SUP,HCPCS C1877,,M001712020  -  STENT ENDOPRSTH 100CM 6MM 6FR 36MM 75CM SYSTEM NONCOVERED,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001712030,SUP,HCPCS C1877,,M001712030  -  STENT ENDOPRSTH 160CM 6MM 36MM 135CM DELIVERY SYSTEM,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001712040,SUP,HCPCS C1877,,M001712040  -  STENT ENDOPRSTH 100CM 6MM 46MM 75CM DELIVERY SYSTEM FLEXIBLE,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001712050,SUP,HCPCS C1877,,M001712050  -  STENT ENDOPRSTH 160CM 6MM 46MM 135CM DELIVERY SYSTEM,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001712060,SUP,HCPCS C1877,,M001712060  -  STENT ENDOPRSTH 100CM 6MM 59MM 75CM DELIVERY SYSTEM FLEXIBLE,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001712070,SUP,HCPCS C1877,,M001712070  -  STENT ENDOPRSTH 160CM 6MM 59MM 135CM DELIVERY SYSTEM,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001712080,SUP,HCPCS C1877,,M001712080  -  STENT ENDOPRSTH 100CM 7MM 23MM 75CM DELIVERY SYSTEM FLEXIBLE,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001712090,SUP,HCPCS C1877,,M001712090  -  STENT ENDOPRSTH 160CM 7MM 6FR 23MM 135CM SYSTEM NONCOVERED,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001712100,SUP,HCPCS C1877,,M001712100  -  STENT ENDOPRSTH 100CM 7MM 34MM 75CM DELIVERY SYSTEM FLEXIBLE,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001712110,SUP,HCPCS C1877,,M001712110  -  STENT ENDOPRSTH 160CM 7MM 34MM 135CM DELIVERY SYSTEM,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001712120,SUP,HCPCS C1877,,M001712120  -  STENT ENDOPRSTH 100CM 7MM 6FR 55MM 75CM SYSTEM NONCOVERED,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001712130,SUP,HCPCS C1877,,M001712130  -  STENT ENDOPRSTH 160CM 7MM 55MM 135CM DELIVERY SYSTEM,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001712140,SUP,HCPCS C1877,,M001712140  -  STENT ENDOPRSTH 100CM 7MM 67MM 75CM DELIVERY SYSTEM FLEXIBLE,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001712150,SUP,HCPCS C1877,,M001712150  -  STENT ENDOPRSTH 160CM 7MM 67MM 135CM DELIVERY SYSTEM,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001712160,SUP,HCPCS C1877,,M001712160  -  STENT ENDOPRSTH 100CM 8MM 20MM 75CM DELIVERY SYSTEM FLEXIBLE,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001712170,SUP,HCPCS C1877,,M001712170  -  STENT ENDOPRSTH 160CM 8MM 20MM 135CM DELIVERY SYSTEM,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001712180,SUP,HCPCS C1877,,M001712180  -  STENT ENDOPRSTH 100CM 8MM 38MM 75CM DELIVERY SYSTEM FLEXIBLE,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001712190,SUP,HCPCS C1877,,M001712190  -  STENT ENDOPRSTH 160CM 8MM 38MM 135CM DELIVERY SYSTEM,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001712200,SUP,HCPCS C1877,,M001712200  -  STENT ENDOPRSTH 100CM 8MM 47MM 75CM DELIVERY SYSTEM FLEXIBLE,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001712210,SUP,HCPCS C1877,,M001712210  -  STENT ENDOPRSTH 160CM 8MM 47MM 135CM DELIVERY SYSTEM,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001712220,SUP,HCPCS C1877,,M001712220  -  STENT ENDOPRSTH 100CM 8MM 6FR 66MM 75CM SYSTEM NONCOVERED,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001712230,SUP,HCPCS C1877,,M001712230  -  STENT ENDOPRSTH 160CM 8MM 66MM 135CM DELIVERY SYSTEM,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001712240,SUP,HCPCS C1877,,M001712240  -  STENT ENDOPRSTH 100CM 9MM 6FR 18MM 75CM SYSTEM NONCOVERED,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001712250,SUP,HCPCS C1877,,M001712250  -  STENT ENDOPRSTH 160CM 9MM 6FR 18MM 135CM SYSTEM NONCOVERED,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001712260,SUP,HCPCS C1877,,M001712260  -  STENT ENDOPRSTH 100CM 9MM 35MM 75CM DELIVERY SYSTEM FLEXIBLE,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001712270,SUP,HCPCS C1877,,M001712270  -  STENT ENDOPRSTH 9MM 35MM 160CM DELIVERY SYSTEM FLEXIBLE,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001712280,SUP,HCPCS C1877,,M001712280  -  STENT ENDOPRSTH 100CM 9MM 52MM 75CM DELIVERY SYSTEM FLEXIBLE,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001712290,SUP,HCPCS C1877,,M001712290  -  STENT ENDOPRSTH 9MM 52MM 160CM DELIVERY SYSTEM FLEXIBLE,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001712300,SUP,HCPCS C1877,,M001712300  -  STENT ENDOPRSTH 100CM 9MM 61MM 75CM DELIVERY SYSTEM FLEXIBLE,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001712310,SUP,HCPCS C1877,,M001712310  -  STENT ENDOPRSTH 160CM 9MM 61MM 135CM DELIVERY SYSTEM,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001712320,SUP,HCPCS C1877,,M001712320  -  STENT ENDOPRSTH 100CM 10MM 20MM 75CM DELIVERY SYSTEM,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001712330,SUP,HCPCS C1877,,M001712330  -  STENT ENDOPRSTH 160CM 10MM 20MM 135CM DELIVERY SYSTEM,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001712340,SUP,HCPCS C1877,,M001712340  -  STENT ENDOPRSTH 100CM 10MM 39MM 75CM DELIVERY SYSTEM,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001712350,SUP,HCPCS C1877,,M001712350  -  STENT ENDOPRSTH 160CM 10MM 39MM 135CM DELIVERY SYSTEM,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001712360,SUP,HCPCS C2617,,M001712360  -  STENT ENDOPRSTH 10MM 6FR 49MM 75CM UNCOVERED UNISTEP PLUS,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001712370,SUP,HCPCS C1877,,M001712370  -  STENT ENDOPRSTH 160CM 10MM 49MM 135CM DELIVERY SYSTEM,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001712380,SUP,HCPCS C2617,,M001712380  -  STENT ENDOPRSTH 100CM 10MM 69MM 75CM DELIVERY SYSTEM,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001712390,SUP,HCPCS C1877,,M001712390  -  STENT ENDOPRSTH 160CM 10MM 69MM 135CM DELIVERY SYSTEM,"$2,200.00",$0.00,"$2,200.00",$990.00,"$1,570.14",$0.00,$379.05,$0.00,$0.00,$385.20,"$2,200.00",$0.00,"$1,100.00","$1,742.40","$1,760.00",$0.00,$344.30,$0.00,$350.24,$0.00
M001719000,SUP,HCPCS C1876,,M001719000  -  STENT ENDOPRSTH 6MM 22MM CLOSE CELL DESIGN HIGH DELIVERABLE,"$4,500.00",$0.00,"$4,500.00","$2,025.00","$3,211.65",$0.00,$775.33,$0.00,$0.00,$787.91,"$4,500.00",$0.00,"$2,250.00","$3,564.00","$3,600.00",$0.00,$704.25,$0.00,$716.40,$0.00
M001719010,SUP,HCPCS C1876,,M001719010  -  STENT ENDOPRSTH 8MM 21MM CLOSE CELL DESIGN HIGH DELIVERABLE,"$4,500.00",$0.00,"$4,500.00","$2,025.00","$3,211.65",$0.00,$775.33,$0.00,$0.00,$787.91,"$4,500.00",$0.00,"$2,250.00","$3,564.00","$3,600.00",$0.00,$704.25,$0.00,$716.40,$0.00
M001719020,SUP,HCPCS C1876,,M001719020  -  STENT ENDOPRSTH 8MM 29MM CLOSE CELL DESIGN HIGH DELIVERABLE,"$4,500.00",$0.00,"$4,500.00","$2,025.00","$3,211.65",$0.00,$775.33,$0.00,$0.00,$787.91,"$4,500.00",$0.00,"$2,250.00","$3,564.00","$3,600.00",$0.00,$704.25,$0.00,$716.40,$0.00
M001719030,SUP,HCPCS C1876,,M001719030  -  STENT ENDOPRSTH 8MM 22MM CLOSE CELL DESIGN HIGH DELIVERABLE,"$4,500.00",$0.00,"$4,500.00","$2,025.00","$3,211.65",$0.00,$775.33,$0.00,$0.00,$787.91,"$4,500.00",$0.00,"$2,250.00","$3,564.00","$3,600.00",$0.00,$704.25,$0.00,$716.40,$0.00
M001719040,SUP,HCPCS C1876,,M001719040  -  STENT ENDOPRSTH 10MM 24MM CLOSE CELL DESIGN HIGH DELIVERABLE,"$4,500.00",$0.00,"$4,500.00","$2,025.00","$3,211.65",$0.00,$775.33,$0.00,$0.00,$787.91,"$4,500.00",$0.00,"$2,250.00","$3,564.00","$3,600.00",$0.00,$704.25,$0.00,$716.40,$0.00
M001719050,SUP,HCPCS C1876,,M001719050  -  STENT ENDOPRSTH 10MM 31MM CLOSE CELL DESIGN HIGH DELIVERABLE,"$4,500.00",$0.00,"$4,500.00","$2,025.00","$3,211.65",$0.00,$775.33,$0.00,$0.00,$787.91,"$4,500.00",$0.00,"$2,250.00","$3,564.00","$3,600.00",$0.00,$704.25,$0.00,$716.40,$0.00
M001719060,SUP,HCPCS C1876,,M001719060  -  STENT ENDOPRSTH 10MM 37MM CLOSE CELL DESIGN HIGH DELIVERABLE,"$4,500.00",$0.00,"$4,500.00","$2,025.00","$3,211.65",$0.00,$775.33,$0.00,$0.00,$787.91,"$4,500.00",$0.00,"$2,250.00","$3,564.00","$3,600.00",$0.00,$704.25,$0.00,$716.40,$0.00
M0017600121,SUP,HCPCS C1884,,M0017600121  -  PARTICLES EMBOLIZATION 45-150UM 2 VIAL CNTOUR-PVA PVA,$367.01,$0.00,$367.01,$165.16,$261.94,$0.00,$63.23,$0.00,$0.00,$64.26,$367.01,$0.00,$183.51,$290.67,$293.61,$0.00,$57.44,$0.00,$58.43,$0.00
M0017600151,SUP,HCPCS C1884,,M0017600151  -  PARTICLES EMBOLIZATION 45-150UM 5 VIAL CNTOUR PVA,$358.51,$0.00,$358.51,$161.33,$255.87,$0.00,$61.77,$0.00,$0.00,$62.77,$358.51,$0.00,$179.26,$283.94,$286.81,$0.00,$56.11,$0.00,$57.07,$0.00
M0017600221,SUP,HCPCS C1884,,M0017600221  -  PARTICLES EMBOLIZATION 150-250UM 2 VIAL CNTOUR PVA,$367.01,$0.00,$367.01,$165.16,$261.94,$0.00,$63.23,$0.00,$0.00,$64.26,$367.01,$0.00,$183.51,$290.67,$293.61,$0.00,$57.44,$0.00,$58.43,$0.00
M0017600251,SUP,HCPCS C1884,,M0017600251  -  PARTICLES EMBOLIZATION 150-250UM 5 VIAL CNTOUR PVA,$358.51,$0.00,$358.51,$161.33,$255.87,$0.00,$61.77,$0.00,$0.00,$62.77,$358.51,$0.00,$179.26,$283.94,$286.81,$0.00,$56.11,$0.00,$57.07,$0.00
M0017600321,SUP,HCPCS C1884,,M0017600321  -  PARTICLES EMBOLIZATION 250-355UM 2 VIAL CNTOUR PVA,$367.01,$0.00,$367.01,$165.16,$261.94,$0.00,$63.23,$0.00,$0.00,$64.26,$367.01,$0.00,$183.51,$290.67,$293.61,$0.00,$57.44,$0.00,$58.43,$0.00
M0017600351,SUP,HCPCS C1884,,M0017600351  -  PARTICLES EMBOLIZATION 250-355UM 5 VIAL CNTOUR PVA,$358.51,$0.00,$358.51,$161.33,$255.87,$0.00,$61.77,$0.00,$0.00,$62.77,$358.51,$0.00,$179.26,$283.94,$286.81,$0.00,$56.11,$0.00,$57.07,$0.00
M0017600421,SUP,HCPCS C1884,,M0017600421  -  PARTICLES EMBOLIZATION 355-500UM 2 VIAL CNTOUR PVA,$367.01,$0.00,$367.01,$165.16,$261.94,$0.00,$63.23,$0.00,$0.00,$64.26,$367.01,$0.00,$183.51,$290.67,$293.61,$0.00,$57.44,$0.00,$58.43,$0.00
M0017600451,SUP,Custom 27203010,,M0017600451  -  PARTICLES EMBL 355-500UM 5 VL CNTOUR PVA,$348.00,$0.00,$348.00,$0.00,$248.37,$0.00,$0.00,$0.00,$0.00,$0.00,$348.00,$0.00,$174.00,$275.62,$278.40,$0.00,$0.00,$0.00,$0.00,$0.00
M0017600621,SUP,Custom 27203010,,PARTICLES EMBL 500-710UM 2 VL CNTOUR-PVA,$356.25,$0.00,$356.25,$0.00,$254.26,$0.00,$0.00,$0.00,$0.00,$0.00,$356.25,$0.00,$178.13,$282.15,$285.00,$0.00,$0.00,$0.00,$0.00,$0.00
M0017600651,SUP,HCPCS C1884,,M0017600651  -  PARTICLES EMBOLIZATION 500-710UM 5 VIAL CNTOUR PVA,$358.51,$0.00,$358.51,$161.33,$255.87,$0.00,$61.77,$0.00,$0.00,$62.77,$358.51,$0.00,$179.26,$283.94,$286.81,$0.00,$56.11,$0.00,$57.07,$0.00
M0017600821,SUP,Custom 27203010,,PARTICLES EMBL 710-1000UM 2 VL CNTOUR-PVA,$498.75,$0.00,$498.75,$0.00,$355.96,$0.00,$0.00,$0.00,$0.00,$0.00,$498.75,$0.00,$249.38,$395.01,$399.00,$0.00,$0.00,$0.00,$0.00,$0.00
M0017600851,SUP,HCPCS C1884,,M0017600851  -  PARTICLES EMBOLIZATION 710-1000UM 5 VIAL CNTOUR PVA,$358.51,$0.00,$358.51,$161.33,$255.87,$0.00,$61.77,$0.00,$0.00,$62.77,$358.51,$0.00,$179.26,$283.94,$286.81,$0.00,$56.11,$0.00,$57.07,$0.00
M0017601151,SUP,HCPCS C1884,,M0017601151  -  PARTICLES EMBOLIZATION 1000-1180UM 5 VIAL CNTOUR PVA,$358.51,$0.00,$358.51,$161.33,$255.87,$0.00,$61.77,$0.00,$0.00,$62.77,$358.51,$0.00,$179.26,$283.94,$286.81,$0.00,$56.11,$0.00,$57.07,$0.00
M001BATR111000,SUP,HCPCS C1753,,M001BATR111000  -  MODULE CATH POLARCATH PWR SYS PERI CRYOPLASTY,"$1,415.95",$0.00,"$1,415.95",$768.86,"$1,010.56",$0.00,$243.96,$0.00,$0.00,$247.92,"$1,415.95",$0.00,$707.98,"$1,121.43","$1,132.76",$0.00,$221.60,$0.00,$225.42,$0.00
M001NC20000001,SUP,Custom 27203010,,M001NC20000001  -  CARTRIDGE CATH POLARCATH N2O PERI,"$1,354.38",$0.00,"$1,354.38",$0.00,$966.62,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,354.38",$0.00,$677.19,"$1,072.67","$1,083.50",$0.00,$0.00,$0.00,$0.00,$0.00
M001P4100080010,SUP,HCPCS C1753,,M001P4100080010  -  CATHETER BLNDIL 4MM 80CM 100MM POLARCATH PERI ACPT .035IN GW,"$1,982.33",$0.00,"$1,982.33","$1,076.40","$1,414.79",$0.00,$341.54,$0.00,$0.00,$347.09,"$1,982.33",$0.00,$991.16,"$1,570.01","$1,585.86",$0.00,$310.23,$0.00,$315.59,$0.00
M001P4100120010,SUP,HCPCS C1753,,M001P4100120010  -  CATHETER BLNDIL 4MM 120CM 100MM POLARCATH PERI ACPT .035IN,"$1,982.33",$0.00,"$1,982.33","$1,076.40","$1,414.79",$0.00,$341.54,$0.00,$0.00,$347.09,"$1,982.33",$0.00,$991.16,"$1,570.01","$1,585.86",$0.00,$310.23,$0.00,$315.59,$0.00
M001P420080010,SUP,HCPCS C1753,,M001P420080010  -  CATHETER BLNDIL 4MM 80CM 20MM POLARCATH PERI ACPT .035IN GW,"$1,699.13",$0.00,"$1,699.13",$922.62,"$1,212.67",$0.00,$292.75,$0.00,$0.00,$297.50,"$1,699.13",$0.00,$849.56,"$1,345.71","$1,359.30",$0.00,$265.91,$0.00,$270.50,$0.00
M001P420120010,SUP,HCPCS C1753,,M001P420120010  -  CATHETER BLNDIL 4MM 120CM 20MM POLARCATH PERI ACPT .035IN GW,"$1,699.13",$0.00,"$1,699.13",$922.62,"$1,212.67",$0.00,$292.75,$0.00,$0.00,$297.50,"$1,699.13",$0.00,$849.56,"$1,345.71","$1,359.30",$0.00,$265.91,$0.00,$270.50,$0.00
M001P440080010,SUP,HCPCS C1753,,M001P440080010  -  CATHETER BLNDIL 4MM 80CM 40MM POLARCATH PERI ACPT .035IN GW,"$1,699.13",$0.00,"$1,699.13",$922.62,"$1,212.67",$0.00,$292.75,$0.00,$0.00,$297.50,"$1,699.13",$0.00,$849.56,"$1,345.71","$1,359.30",$0.00,$265.91,$0.00,$270.50,$0.00
M001P440120010,SUP,HCPCS C1753,,M001P440120010  -  CATHETER BLNDIL 4MM 120CM 40MM POLARCATH PERI ACPT .035IN GW,"$1,699.13",$0.00,"$1,699.13",$922.62,"$1,212.67",$0.00,$292.75,$0.00,$0.00,$297.50,"$1,699.13",$0.00,$849.56,"$1,345.71","$1,359.30",$0.00,$265.91,$0.00,$270.50,$0.00
M001P460080010,SUP,HCPCS C1753,,M001P460080010  -  CATHETER BLNDIL 4MM 80CM 60MM POLARCATH PERI ACPT .035IN GW,"$1,699.13",$0.00,"$1,699.13",$922.62,"$1,212.67",$0.00,$292.75,$0.00,$0.00,$297.50,"$1,699.13",$0.00,$849.56,"$1,345.71","$1,359.30",$0.00,$265.91,$0.00,$270.50,$0.00
M001P460120010,SUP,HCPCS C1726,,M001P460120010  -  CATHETER BLNDIL 4MM 120CM 60MM POLARCATH RADOPQ PERI ACPT,"$1,699.13",$0.00,"$1,699.13",$922.62,"$1,212.67",$0.00,$292.75,$0.00,$0.00,$297.50,"$1,699.13",$0.00,$849.56,"$1,345.71","$1,359.30",$0.00,$265.91,$0.00,$270.50,$0.00
M001P480080010,SUP,HCPCS C1753,,M001P480080010  -  CATHETER BLNDIL 4MM 80CM 80MM POLARCATH PERI ACPT .035IN GW,"$1,982.33",$0.00,"$1,982.33","$1,076.40","$1,414.79",$0.00,$341.54,$0.00,$0.00,$347.09,"$1,982.33",$0.00,$991.16,"$1,570.01","$1,585.86",$0.00,$310.23,$0.00,$315.59,$0.00
M001P480120010,SUP,HCPCS C1726,,M001P480120010  -  CATHETER BLNDIL 4MM 120CM 80MM POLARCATH PERI ACPT .035IN GW,"$1,982.33",$0.00,"$1,982.33","$1,076.40","$1,414.79",$0.00,$341.54,$0.00,$0.00,$347.09,"$1,982.33",$0.00,$991.16,"$1,570.01","$1,585.86",$0.00,$310.23,$0.00,$315.59,$0.00
M001P5100080010,SUP,HCPCS C1753,,M001P5100080010  -  CATHETER BLNDIL 5MM 80CM 100MM POLARCATH PERI ACPT .035IN GW,"$1,982.33",$0.00,"$1,982.33","$1,076.40","$1,414.79",$0.00,$341.54,$0.00,$0.00,$347.09,"$1,982.33",$0.00,$991.16,"$1,570.01","$1,585.86",$0.00,$310.23,$0.00,$315.59,$0.00
M001P5100120010,SUP,HCPCS C1753,,M001P5100120010  -  CATHETER BLNDIL 5MM 120CM 100MM POLARCATH PERI ACPT .035IN,"$1,982.33",$0.00,"$1,982.33","$1,076.40","$1,414.79",$0.00,$341.54,$0.00,$0.00,$347.09,"$1,982.33",$0.00,$991.16,"$1,570.01","$1,585.86",$0.00,$310.23,$0.00,$315.59,$0.00
M001P5120120010,SUP,HCPCS C1725,,M001P5120120010  -  CATHETER BLNDIL 5MM 120CM 120MM POLARCATH PERI ACPT .035IN,"$2,228.58",$0.00,"$2,228.58","$1,210.12","$1,590.53",$0.00,$383.97,$0.00,$0.00,$390.21,"$2,228.58",$0.00,"$1,114.29","$1,765.04","$1,782.86",$0.00,$348.77,$0.00,$354.79,$0.00
M001P5150120010,SUP,HCPCS C1725,,M001P5150120010  -  CATHETER BLNDIL 5MM 150CM 120MM POLARCATH PERI ACPT .035IN,"$2,487.13",$0.00,"$2,487.13","$1,350.51","$1,775.06",$0.00,$428.52,$0.00,$0.00,$435.48,"$2,487.13",$0.00,"$1,243.56","$1,969.81","$1,989.70",$0.00,$389.24,$0.00,$395.95,$0.00
M001P520080010,SUP,HCPCS C1753,,M001P520080010  -  CATHETER BLNDIL 5MM 80CM 20MM POLARCATH PERI ACPT .035IN GW,"$1,699.13",$0.00,"$1,699.13",$922.62,"$1,212.67",$0.00,$292.75,$0.00,$0.00,$297.50,"$1,699.13",$0.00,$849.56,"$1,345.71","$1,359.30",$0.00,$265.91,$0.00,$270.50,$0.00
M001P520120010,SUP,HCPCS C1753,,M001P520120010  -  CATHETER BLNDIL 5MM 120CM 20MM POLARCATH RADOPQ PERI ACPT,"$1,699.13",$0.00,"$1,699.13",$922.62,"$1,212.67",$0.00,$292.75,$0.00,$0.00,$297.50,"$1,699.13",$0.00,$849.56,"$1,345.71","$1,359.30",$0.00,$265.91,$0.00,$270.50,$0.00
M001P540080010,SUP,HCPCS C1753,,M001P540080010  -  CATHETER BLNDIL 5MM 80CM 40MM POLARCATH PERI ACPT .035IN GW,"$1,699.13",$0.00,"$1,699.13",$922.62,"$1,212.67",$0.00,$292.75,$0.00,$0.00,$297.50,"$1,699.13",$0.00,$849.56,"$1,345.71","$1,359.30",$0.00,$265.91,$0.00,$270.50,$0.00
M001P540120010,SUP,HCPCS C1726,,M001P540120010  -  CATHETER BLNDIL 5MM 120CM 40MM POLARCATH RADOPQ PERI ACPT,"$1,699.13",$0.00,"$1,699.13",$922.62,"$1,212.67",$0.00,$292.75,$0.00,$0.00,$297.50,"$1,699.13",$0.00,$849.56,"$1,345.71","$1,359.30",$0.00,$265.91,$0.00,$270.50,$0.00
M001P560080010,SUP,HCPCS C1753,,M001P560080010  -  CATHETER BLNDIL 5MM 80CM 60MM POLARCATH PERI ACPT .035IN GW,"$1,699.13",$0.00,"$1,699.13",$922.62,"$1,212.67",$0.00,$292.75,$0.00,$0.00,$297.50,"$1,699.13",$0.00,$849.56,"$1,345.71","$1,359.30",$0.00,$265.91,$0.00,$270.50,$0.00
M001P560120010,SUP,HCPCS C1726,,M001P560120010  -  CATHETER BLNDIL 5MM 120CM 60MM POLARCATH RADOPQ PERI ACPT,"$1,699.13",$0.00,"$1,699.13",$922.62,"$1,212.67",$0.00,$292.75,$0.00,$0.00,$297.50,"$1,699.13",$0.00,$849.56,"$1,345.71","$1,359.30",$0.00,$265.91,$0.00,$270.50,$0.00
M001P580080010,SUP,HCPCS C1753,,M001P580080010  -  CATHETER BLNDIL 5MM 80CM 80MM POLARCATH PERI ACPT .035IN GW,"$1,982.33",$0.00,"$1,982.33","$1,076.40","$1,414.79",$0.00,$341.54,$0.00,$0.00,$347.09,"$1,982.33",$0.00,$991.16,"$1,570.01","$1,585.86",$0.00,$310.23,$0.00,$315.59,$0.00
M001P580120010,SUP,HCPCS C1726,,M001P580120010  -  CATHETER BLNDIL 5MM 120CM 80MM POLARCATH RADOPQ PERI ACPT,"$1,982.33",$0.00,"$1,982.33","$1,076.40","$1,414.79",$0.00,$341.54,$0.00,$0.00,$347.09,"$1,982.33",$0.00,$991.16,"$1,570.01","$1,585.86",$0.00,$310.23,$0.00,$315.59,$0.00
M001P6100080010,SUP,HCPCS C1753,,M001P6100080010  -  CATHETER BLNDIL 6MM 80CM 100MM POLARCATH PERI ACPT .035IN GW,"$1,982.33",$0.00,"$1,982.33","$1,076.40","$1,414.79",$0.00,$341.54,$0.00,$0.00,$347.09,"$1,982.33",$0.00,$991.16,"$1,570.01","$1,585.86",$0.00,$310.23,$0.00,$315.59,$0.00
M001P6100120010,SUP,HCPCS C1753,,M001P6100120010  -  CATHETER BLNDIL 6MM 120CM 100MM POLARCATH PERI ACPT .035IN,"$1,982.33",$0.00,"$1,982.33","$1,076.40","$1,414.79",$0.00,$341.54,$0.00,$0.00,$347.09,"$1,982.33",$0.00,$991.16,"$1,570.01","$1,585.86",$0.00,$310.23,$0.00,$315.59,$0.00
M001P6120120010,SUP,HCPCS C1725,,M001P6120120010  -  CATHETER BLNDIL 6MM 120CM 120MM POLARCATH PERI ACPT .035IN,"$2,228.58",$0.00,"$2,228.58","$1,210.12","$1,590.53",$0.00,$383.97,$0.00,$0.00,$390.21,"$2,228.58",$0.00,"$1,114.29","$1,765.04","$1,782.86",$0.00,$348.77,$0.00,$354.79,$0.00
M001P6150120010,SUP,HCPCS C1725,,M001P6150120010  -  CATHETER BLNDIL 6MM 120CM 150MM POLARCATH PERI ACPT .035IN,"$2,487.13",$0.00,"$2,487.13","$1,350.51","$1,775.06",$0.00,$428.52,$0.00,$0.00,$435.48,"$2,487.13",$0.00,"$1,243.56","$1,969.81","$1,989.70",$0.00,$389.24,$0.00,$395.95,$0.00
M001P620080010,SUP,HCPCS C1753,,M001P620080010  -  CATHETER BLNDIL 6MM 80CM 20MM POLARCATH PERI ACPT .035IN GW,"$1,699.13",$0.00,"$1,699.13",$922.62,"$1,212.67",$0.00,$292.75,$0.00,$0.00,$297.50,"$1,699.13",$0.00,$849.56,"$1,345.71","$1,359.30",$0.00,$265.91,$0.00,$270.50,$0.00
M001P620120010,SUP,HCPCS C1753,,M001P620120010  -  CATHETER BLNDIL 6MM 120CM 20MM POLARCATH PERI ACPT .035IN GW,"$1,699.13",$0.00,"$1,699.13",$922.62,"$1,212.67",$0.00,$292.75,$0.00,$0.00,$297.50,"$1,699.13",$0.00,$849.56,"$1,345.71","$1,359.30",$0.00,$265.91,$0.00,$270.50,$0.00
M001P640080010,SUP,HCPCS C1726,,M001P640080010  -  CATHETER BLNDIL 6MM 80CM 40MM POLARCATH PERI ACPT .035IN GW,"$1,699.13",$0.00,"$1,699.13",$922.62,"$1,212.67",$0.00,$292.75,$0.00,$0.00,$297.50,"$1,699.13",$0.00,$849.56,"$1,345.71","$1,359.30",$0.00,$265.91,$0.00,$270.50,$0.00
M001P640120010,SUP,HCPCS C1726,,M001P640120010  -  CATHETER BLNDIL 6MM 120CM 40MM POLARCATH RADOPQ PERI ACPT,"$1,699.13",$0.00,"$1,699.13",$922.62,"$1,212.67",$0.00,$292.75,$0.00,$0.00,$297.50,"$1,699.13",$0.00,$849.56,"$1,345.71","$1,359.30",$0.00,$265.91,$0.00,$270.50,$0.00
M001P660080010,SUP,HCPCS C1753,,M001P660080010  -  CATHETER BLNDIL 6MM 80CM 60MM POLARCATH PERI ACPT .035IN GW,"$1,699.13",$0.00,"$1,699.13",$922.62,"$1,212.67",$0.00,$292.75,$0.00,$0.00,$297.50,"$1,699.13",$0.00,$849.56,"$1,345.71","$1,359.30",$0.00,$265.91,$0.00,$270.50,$0.00
M001P660120010,SUP,HCPCS C1726,,M001P660120010  -  CATHETER BLNDIL 6MM 120CM 60MM POLARCATH RADOPQ PERI ACPT,"$1,699.13",$0.00,"$1,699.13",$922.62,"$1,212.67",$0.00,$292.75,$0.00,$0.00,$297.50,"$1,699.13",$0.00,$849.56,"$1,345.71","$1,359.30",$0.00,$265.91,$0.00,$270.50,$0.00
M001P680080010,SUP,HCPCS C1753,,M001P680080010  -  CATHETER BLNDIL 6MM 80CM 80MM POLARCATH PERI ACPT .035IN GW,"$1,982.33",$0.00,"$1,982.33","$1,076.40","$1,414.79",$0.00,$341.54,$0.00,$0.00,$347.09,"$1,982.33",$0.00,$991.16,"$1,570.01","$1,585.86",$0.00,$310.23,$0.00,$315.59,$0.00
M001P680120010,SUP,HCPCS C1753,,M001P680120010  -  CATHETER BLNDIL 6MM 120CM 80MM POLARCATH RADOPQ PERI ACPT,"$1,982.33",$0.00,"$1,982.33","$1,076.40","$1,414.79",$0.00,$341.54,$0.00,$0.00,$347.09,"$1,982.33",$0.00,$991.16,"$1,570.01","$1,585.86",$0.00,$310.23,$0.00,$315.59,$0.00
M001P720080010,SUP,HCPCS C1753,,M001P720080010  -  CATHETER BLNDIL 7MM 80CM 20MM POLARCATH PERI ACPT .035IN GW,"$1,699.13",$0.00,"$1,699.13",$922.62,"$1,212.67",$0.00,$292.75,$0.00,$0.00,$297.50,"$1,699.13",$0.00,$849.56,"$1,345.71","$1,359.30",$0.00,$265.91,$0.00,$270.50,$0.00
M001P720120010,SUP,HCPCS C1726,,M001P720120010  -  CATHETER BLNDIL 7MM 120CM 20MM POLARCATH RADOPQ PERI ACPT,"$1,699.13",$0.00,"$1,699.13",$922.62,"$1,212.67",$0.00,$292.75,$0.00,$0.00,$297.50,"$1,699.13",$0.00,$849.56,"$1,345.71","$1,359.30",$0.00,$265.91,$0.00,$270.50,$0.00
M001P740080010,SUP,HCPCS C1753,,M001P740080010  -  CATHETER BLNDIL 7MM 80CM 40MM POLARCATH PERI ACPT .035IN GW,"$1,699.13",$0.00,"$1,699.13",$922.62,"$1,212.67",$0.00,$292.75,$0.00,$0.00,$297.50,"$1,699.13",$0.00,$849.56,"$1,345.71","$1,359.30",$0.00,$265.91,$0.00,$270.50,$0.00
M001P740120010,SUP,HCPCS C1726,,M001P740120010  -  CATHETER BLNDIL 7MM 120CM 40MM POLARCATH RADOPQ PERI ACPT,"$1,699.13",$0.00,"$1,699.13",$922.62,"$1,212.67",$0.00,$292.75,$0.00,$0.00,$297.50,"$1,699.13",$0.00,$849.56,"$1,345.71","$1,359.30",$0.00,$265.91,$0.00,$270.50,$0.00
M001P760080010,SUP,HCPCS C2618,,M001P760080010  -  CATHETER BLNDIL 7MM 80CM 60MM POLARCATH PERI ACPT .035IN GW,"$1,699.13",$0.00,"$1,699.13",$0.00,"$1,212.67",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,699.13",$0.00,$849.56,"$1,345.71","$1,359.30",$0.00,$0.00,$0.00,$0.00,$0.00
M001P760120010,SUP,HCPCS C1753,,M001P760120010  -  CATHETER BLNDIL 7MM 120CM 60MM POLARCATH PERI ACPT .035IN GW,"$1,699.13",$0.00,"$1,699.13",$922.62,"$1,212.67",$0.00,$292.75,$0.00,$0.00,$297.50,"$1,699.13",$0.00,$849.56,"$1,345.71","$1,359.30",$0.00,$265.91,$0.00,$270.50,$0.00
M001P780080010,SUP,HCPCS C1753,,M001P780080010  -  CATHETER BLNDIL 7MM 80CM 80MM POLARCATH PERI ACPT .035IN GW,"$1,982.33",$0.00,"$1,982.33","$1,076.40","$1,414.79",$0.00,$341.54,$0.00,$0.00,$347.09,"$1,982.33",$0.00,$991.16,"$1,570.01","$1,585.86",$0.00,$310.23,$0.00,$315.59,$0.00
M001P780120010,SUP,HCPCS C1726,,M001P780120010  -  CATHETER BLNDIL 7MM 120CM 80MM POLARCATH PERI ACPT .035IN GW,"$1,982.33",$0.00,"$1,982.33","$1,076.40","$1,414.79",$0.00,$341.54,$0.00,$0.00,$347.09,"$1,982.33",$0.00,$991.16,"$1,570.01","$1,585.86",$0.00,$310.23,$0.00,$315.59,$0.00
M001P820080010,SUP,HCPCS C1725,,M001P820080010  -  CATHETER BLNDIL 8MM 80CM 20MM POLARCATH PERI ACPT .035IN GW,"$1,699.13",$0.00,"$1,699.13",$922.62,"$1,212.67",$0.00,$292.75,$0.00,$0.00,$297.50,"$1,699.13",$0.00,$849.56,"$1,345.71","$1,359.30",$0.00,$265.91,$0.00,$270.50,$0.00
M001P840080010,SUP,HCPCS C1725,,M001P840080010  -  CATHETER BLNDIL 8MM 80CM 40MM POLARCATH RADOPQ PERI ACPT,"$1,699.13",$0.00,"$1,699.13",$922.62,"$1,212.67",$0.00,$292.75,$0.00,$0.00,$297.50,"$1,699.13",$0.00,$849.56,"$1,345.71","$1,359.30",$0.00,$265.91,$0.00,$270.50,$0.00
M001P840120010,SUP,HCPCS C1726,,M001P840120010  -  CATHETER BLNDIL 8MM 120CM 40MM POLARCATH PERI ACPT .035IN GW,"$1,699.13",$0.00,"$1,699.13",$922.62,"$1,212.67",$0.00,$292.75,$0.00,$0.00,$297.50,"$1,699.13",$0.00,$849.56,"$1,345.71","$1,359.30",$0.00,$265.91,$0.00,$270.50,$0.00
M001PCB50201350,SUP,HCPCS C1726,,M001PCB50201350  -  CATHETER BLNDIL 5MM 135CM 20MM PR CTBLN OTW TPR TIP INFL,"$1,750.00",$0.00,"$1,750.00",$950.25,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
M001PCB5020500,SUP,HCPCS C1753,,M001PCB5020500  -  CATHETER BALDILAT 5MM 50CM 2CM OTW PERIPHERAL CUTTING,"$1,750.00",$0.00,"$1,750.00",$950.25,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
M001PCB5020900,SUP,HCPCS C1726,,M001PCB5020900  -  CATHETER BALDILAT 5MM 90CM 20MM OTW PLAQUE MODIFICATION,"$1,750.00",$0.00,"$1,750.00",$950.25,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
M001PCB60201350,SUP,HCPCS C1726,,M001PCB60201350  -  CATHETER BLNDIL 5MM 135CM 20MM PR CTBLN OTW TPR TIP INFL,"$1,750.00",$0.00,"$1,750.00",$950.25,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
M001PCB6020500,SUP,HCPCS C1753,,M001PCB6020500  -  CATHETER BLNDIL 6MM 50CM 20MM PR CTBLN OTW TPR TIP INFL PORT,"$1,750.00",$0.00,"$1,750.00",$950.25,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
M001PCB6020900,SUP,HCPCS C1726,,M001PCB6020900  -  CATHETER BLNDIL 6MM 90CM 20MM PR CTBLN OTW INFL PORT TPR TIP,"$1,750.00",$0.00,"$1,750.00",$950.25,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
M001PCB70201350,SUP,HCPCS C1753,,M001PCB70201350  -  CATHETER BLNDIL 7MM 135CM 20MM PR CTBLN OTW TPR TIP INFL,"$1,750.00",$0.00,"$1,750.00",$950.25,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
M001PCB7020500,SUP,HCPCS C1753,,M001PCB7020500  -  CATHETER BLNDIL 7MM 50CM 20MM PR CTBLN OTW TPR TIP INFL PORT,"$1,750.00",$0.00,"$1,750.00",$950.25,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
M001PCB7020900,SUP,HCPCS C1753,,M001PCB7020900  -  CATHETER BLNDIL 7MM 90CM 20MM PR CTBLN OTW TPR TIP INFL PORT,"$1,750.00",$0.00,"$1,750.00",$950.25,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
M001PCB80201350,SUP,HCPCS C1753,,M001PCB80201350  -  CATHETER BALDILAT 8MM 135CM 2CM OTW PLAQUE MODIFICATION,"$1,750.00",$0.00,"$1,750.00",$950.25,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
M001PCB8020500,SUP,HCPCS C1753,,M001PCB8020500  -  CATHETER BLNDIL 8MM 50CM 20MM PR CTBLN OTW INFL PORT TPR TIP,"$1,750.00",$0.00,"$1,750.00",$950.25,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
M001PCB8020900,SUP,HCPCS C1753,,M001PCB8020900  -  CATHETER BLNDIL 8MM 90CM 20MM PR CTBLN OTW TPR TIP INFL PORT,"$1,750.00",$0.00,"$1,750.00",$950.25,"$1,248.98",$0.00,$301.52,$0.00,$0.00,$306.41,"$1,750.00",$0.00,$875.00,"$1,386.00","$1,400.00",$0.00,$273.88,$0.00,$278.60,$0.00
M001PCIU400000,SUP,HCPCS C2618,,M001PCIU400000  -  UNIT CATH POLARCATH PERI CRYOPLASTY,"$2,561.00",$0.00,"$2,561.00",$0.00,"$1,827.79",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,561.00",$0.00,"$1,280.50","$2,028.31","$2,048.80",$0.00,$0.00,$0.00,$0.00,$0.00
M001T20100135010,SUP,HCPCS C1725,,M001T20100135010  -  CATHETER BLNDIL 2MM 135CM 100MM POLARCATH PERI ACPT .014IN,"$2,536.38",$0.00,"$2,536.38","$1,377.25","$1,810.21",$0.00,$437.00,$0.00,$0.00,$444.10,"$2,536.38",$0.00,"$1,268.19","$2,008.81","$2,029.10",$0.00,$396.94,$0.00,$403.79,$0.00
M001T20100150010,SUP,HCPCS C1725,,M001T20100150010  -  CATHETER BLNDIL 2MM 150CM 100MM POLARCATH COAX RADOPQ PERI,"$2,536.38",$0.00,"$2,536.38","$1,377.25","$1,810.21",$0.00,$437.00,$0.00,$0.00,$444.10,"$2,536.38",$0.00,"$1,268.19","$2,008.81","$2,029.10",$0.00,$396.94,$0.00,$403.79,$0.00
M001T20120150010,SUP,HCPCS C1725,,M001T20120150010  -  CATHETER BLNDIL 2MM 150CM 120MM POLARCATH PERI ACPT .014IN,"$2,794.95",$0.00,"$2,794.95","$1,517.66","$1,994.76",$0.00,$481.56,$0.00,$0.00,$489.37,"$2,794.95",$0.00,"$1,397.48","$2,213.60","$2,235.96",$0.00,$437.41,$0.00,$444.96,$0.00
M001T20150150010,SUP,HCPCS C1725,,M001T20150150010  -  CATHETER BLNDIL 2MM 150CM 150MM POLARCATH PERI ACPT .014IN,"$3,041.20",$0.00,"$3,041.20","$1,651.37","$2,170.50",$0.00,$523.98,$0.00,$0.00,$532.49,"$3,041.20",$0.00,"$1,520.60","$2,408.63","$2,432.96",$0.00,$475.95,$0.00,$484.16,$0.00
M001T2020135010,SUP,HCPCS C1725,,M001T2020135010  -  CATHETER BLNDIL 2MM 135CM 20MM POLARCATH COAX RADOPQ PERI,"$2,265.50",$0.00,"$2,265.50","$1,230.17","$1,616.89",$0.00,$390.33,$0.00,$0.00,$396.67,"$2,265.50",$0.00,"$1,132.75","$1,794.28","$1,812.40",$0.00,$354.55,$0.00,$360.67,$0.00
M001T2020150010,SUP,HCPCS C1725,,M001T2020150010  -  CATHETER BLNDIL 2MM 150CM 20MM POLARCATH PERI ACPT .014IN GW,"$2,265.50",$0.00,"$2,265.50","$1,230.17","$1,616.89",$0.00,$390.33,$0.00,$0.00,$396.67,"$2,265.50",$0.00,"$1,132.75","$1,794.28","$1,812.40",$0.00,$354.55,$0.00,$360.67,$0.00
M001T2040135010,SUP,HCPCS C1725,,M001T2040135010  -  CATHETER BLNDIL 2MM 135CM 40MM POLARCATH COAX RADOPQ PERI,"$2,265.50",$0.00,"$2,265.50","$1,230.17","$1,616.89",$0.00,$390.33,$0.00,$0.00,$396.67,"$2,265.50",$0.00,"$1,132.75","$1,794.28","$1,812.40",$0.00,$354.55,$0.00,$360.67,$0.00
M001T2040150010,SUP,HCPCS C1725,,M001T2040150010  -  CATHETER BLNDIL 2MM 150CM 40MM POLARCATH PERI ACPT .014IN GW,"$2,265.50",$0.00,"$2,265.50","$1,230.17","$1,616.89",$0.00,$390.33,$0.00,$0.00,$396.67,"$2,265.50",$0.00,"$1,132.75","$1,794.28","$1,812.40",$0.00,$354.55,$0.00,$360.67,$0.00
M001T2060135010,SUP,HCPCS C1725,,M001T2060135010  -  CATHETER BLNDIL 2MM 135CM 60MM POLARCATH PERI ACPT .014IN GW,"$2,265.50",$0.00,"$2,265.50","$1,230.17","$1,616.89",$0.00,$390.33,$0.00,$0.00,$396.67,"$2,265.50",$0.00,"$1,132.75","$1,794.28","$1,812.40",$0.00,$354.55,$0.00,$360.67,$0.00
M001T2060150010,SUP,HCPCS C1725,,M001T2060150010  -  CATHETER BLNDIL 2MM 150CM 60MM POLARCATH PERI ACPT .014IN GW,"$2,265.50",$0.00,"$2,265.50","$1,230.17","$1,616.89",$0.00,$390.33,$0.00,$0.00,$396.67,"$2,265.50",$0.00,"$1,132.75","$1,794.28","$1,812.40",$0.00,$354.55,$0.00,$360.67,$0.00
M001T25100135010,SUP,HCPCS C1725,,M001T25100135010  -  CATHETER BLNDIL 2.5MM 135CM 100MM POLARCATH PERI ACPT .014IN,"$2,536.38",$0.00,"$2,536.38","$1,377.25","$1,810.21",$0.00,$437.00,$0.00,$0.00,$444.10,"$2,536.38",$0.00,"$1,268.19","$2,008.81","$2,029.10",$0.00,$396.94,$0.00,$403.79,$0.00
M001T25100150010,SUP,HCPCS C1725,,M001T25100150010  -  CATHETER BLNDIL 2.5MM 150CM 100MM POLARCATH COAX RADOPQ PERI,"$2,536.38",$0.00,"$2,536.38","$1,377.25","$1,810.21",$0.00,$437.00,$0.00,$0.00,$444.10,"$2,536.38",$0.00,"$1,268.19","$2,008.81","$2,029.10",$0.00,$396.94,$0.00,$403.79,$0.00
M001T25120150010,SUP,HCPCS C1725,,M001T25120150010  -  CATHETER BLNDIL 2.5MM 150CM 120MM POLARCATH PERI ACPT .014IN,"$2,794.95",$0.00,"$2,794.95","$1,517.66","$1,994.76",$0.00,$481.56,$0.00,$0.00,$489.37,"$2,794.95",$0.00,"$1,397.48","$2,213.60","$2,235.96",$0.00,$437.41,$0.00,$444.96,$0.00
M001T25150150010,SUP,HCPCS C1725,,M001T25150150010  -  CATHETER BLNDIL 2.5MM 150CM 150MM POLARCATH PERI ACPT .014IN,"$3,041.20",$0.00,"$3,041.20","$1,651.37","$2,170.50",$0.00,$523.98,$0.00,$0.00,$532.49,"$3,041.20",$0.00,"$1,520.60","$2,408.63","$2,432.96",$0.00,$475.95,$0.00,$484.16,$0.00
M001T2520135010,SUP,HCPCS C1725,,M001T2520135010  -  CATHETER BLNDIL 2.5MM 135CM 20MM POLARCATH PERI ACPT .014IN,"$2,265.50",$0.00,"$2,265.50","$1,230.17","$1,616.89",$0.00,$390.33,$0.00,$0.00,$396.67,"$2,265.50",$0.00,"$1,132.75","$1,794.28","$1,812.40",$0.00,$354.55,$0.00,$360.67,$0.00
M001T2520150010,SUP,HCPCS C1725,,M001T2520150010  -  CATHETER BLNDIL 2.5MM 150CM 20MM POLARCATH PERI ACPT .014IN,"$2,265.50",$0.00,"$2,265.50","$1,230.17","$1,616.89",$0.00,$390.33,$0.00,$0.00,$396.67,"$2,265.50",$0.00,"$1,132.75","$1,794.28","$1,812.40",$0.00,$354.55,$0.00,$360.67,$0.00
M001T2540135010,SUP,HCPCS C1725,,M001T2540135010  -  CATHETER BLNDIL 2.5MM 135CM 40MM POLARCATH PERI ACPT .014IN,"$2,265.50",$0.00,"$2,265.50","$1,230.17","$1,616.89",$0.00,$390.33,$0.00,$0.00,$396.67,"$2,265.50",$0.00,"$1,132.75","$1,794.28","$1,812.40",$0.00,$354.55,$0.00,$360.67,$0.00
M001T2540150010,SUP,HCPCS C1725,,M001T2540150010  -  CATHETER BLNDIL 2.5MM 150CM 40MM POLARCATH PERI ACPT .014IN,"$2,265.50",$0.00,"$2,265.50","$1,230.17","$1,616.89",$0.00,$390.33,$0.00,$0.00,$396.67,"$2,265.50",$0.00,"$1,132.75","$1,794.28","$1,812.40",$0.00,$354.55,$0.00,$360.67,$0.00
M001T2560135010,SUP,HCPCS C1725,,M001T2560135010  -  CATHETER BLNDIL 2.5MM 135CM 60MM POLARCATH RADOPQ PERI ACPT,"$2,265.50",$0.00,"$2,265.50","$1,230.17","$1,616.89",$0.00,$390.33,$0.00,$0.00,$396.67,"$2,265.50",$0.00,"$1,132.75","$1,794.28","$1,812.40",$0.00,$354.55,$0.00,$360.67,$0.00
M001T2560150010,SUP,HCPCS C1725,,M001T2560150010  -  CATHETER BLNDIL 2.5MM 150CM 60MM POLARCATH PERI ACPT .014IN,"$2,265.50",$0.00,"$2,265.50","$1,230.17","$1,616.89",$0.00,$390.33,$0.00,$0.00,$396.67,"$2,265.50",$0.00,"$1,132.75","$1,794.28","$1,812.40",$0.00,$354.55,$0.00,$360.67,$0.00
M001T30100135010,SUP,HCPCS C1725,,M001T30100135010  -  CATHETER BLNDIL 3MM 135CM 100MM POLARCATH PERI ACPT .014IN,"$2,536.38",$0.00,"$2,536.38","$1,377.25","$1,810.21",$0.00,$437.00,$0.00,$0.00,$444.10,"$2,536.38",$0.00,"$1,268.19","$2,008.81","$2,029.10",$0.00,$396.94,$0.00,$403.79,$0.00
M001T30100150010,SUP,HCPCS C1725,,M001T30100150010  -  CATHETER BLNDIL 3MM 150CM 100MM POLARCATH PERI ACPT .014IN,"$2,536.38",$0.00,"$2,536.38","$1,377.25","$1,810.21",$0.00,$437.00,$0.00,$0.00,$444.10,"$2,536.38",$0.00,"$1,268.19","$2,008.81","$2,029.10",$0.00,$396.94,$0.00,$403.79,$0.00
M001T30120150010,SUP,HCPCS C1725,,M001T30120150010  -  CATHETER BLNDIL 3MM 150CM 120MM POLARCATH PERI ACPT .014IN,"$2,794.95",$0.00,"$2,794.95","$1,517.66","$1,994.76",$0.00,$481.56,$0.00,$0.00,$489.37,"$2,794.95",$0.00,"$1,397.48","$2,213.60","$2,235.96",$0.00,$437.41,$0.00,$444.96,$0.00
M001T30150150010,SUP,HCPCS C1725,,M001T30150150010  -  CATHETER BLNDIL 3MM 150CM 150MM POLARCATH PERI ACPT .014IN,"$3,041.20",$0.00,"$3,041.20","$1,651.37","$2,170.50",$0.00,$523.98,$0.00,$0.00,$532.49,"$3,041.20",$0.00,"$1,520.60","$2,408.63","$2,432.96",$0.00,$475.95,$0.00,$484.16,$0.00
M001T3020135010,SUP,HCPCS C1725,,M001T3020135010  -  CATHETER BLNDIL 3MM 135CM 20MM POLARCATH PERI ACPT .014IN GW,"$2,265.50",$0.00,"$2,265.50","$1,230.17","$1,616.89",$0.00,$390.33,$0.00,$0.00,$396.67,"$2,265.50",$0.00,"$1,132.75","$1,794.28","$1,812.40",$0.00,$354.55,$0.00,$360.67,$0.00
M001T3020150010,SUP,HCPCS C1725,,M001T3020150010  -  CATHETER BLNDIL 3MM 150CM 20MM POLARCATH PERI ACPT .014IN GW,"$2,265.50",$0.00,"$2,265.50","$1,230.17","$1,616.89",$0.00,$390.33,$0.00,$0.00,$396.67,"$2,265.50",$0.00,"$1,132.75","$1,794.28","$1,812.40",$0.00,$354.55,$0.00,$360.67,$0.00
M001T3040135010,SUP,HCPCS C1725,,M001T3040135010  -  CATHETER BLNDIL 3MM 135CM 40MM POLARCATH COAX RADOPQ PERI,"$2,265.50",$0.00,"$2,265.50","$1,230.17","$1,616.89",$0.00,$390.33,$0.00,$0.00,$396.67,"$2,265.50",$0.00,"$1,132.75","$1,794.28","$1,812.40",$0.00,$354.55,$0.00,$360.67,$0.00
M001T3040150010,SUP,HCPCS C1725,,M001T3040150010  -  CATHETER BLNDIL 3MM 150CM 40MM POLARCATH PERI ACPT .014IN GW,"$2,265.50",$0.00,"$2,265.50","$1,230.17","$1,616.89",$0.00,$390.33,$0.00,$0.00,$396.67,"$2,265.50",$0.00,"$1,132.75","$1,794.28","$1,812.40",$0.00,$354.55,$0.00,$360.67,$0.00
M001T3060135010,SUP,HCPCS C1725,,M001T3060135010  -  CATHETER BLNDIL 3MM 135CM 60MM POLARCATH COAX RADOPQ MRKNG,"$2,265.50",$0.00,"$2,265.50","$1,230.17","$1,616.89",$0.00,$390.33,$0.00,$0.00,$396.67,"$2,265.50",$0.00,"$1,132.75","$1,794.28","$1,812.40",$0.00,$354.55,$0.00,$360.67,$0.00
M001T3060150010,SUP,HCPCS C1725,,M001T3060150010  -  CATHETER BLNDIL 3MM 150CM 60MM POLARCATH PERI ACPT .014IN GW,"$2,265.50",$0.00,"$2,265.50","$1,230.17","$1,616.89",$0.00,$390.33,$0.00,$0.00,$396.67,"$2,265.50",$0.00,"$1,132.75","$1,794.28","$1,812.40",$0.00,$354.55,$0.00,$360.67,$0.00
M001T35100135010,SUP,HCPCS C1725,,M001T35100135010  -  CATHETER BLNDIL 3.5MM 135CM 100MM POLARCATH PERI ACPT .014IN,"$2,536.38",$0.00,"$2,536.38","$1,377.25","$1,810.21",$0.00,$437.00,$0.00,$0.00,$444.10,"$2,536.38",$0.00,"$1,268.19","$2,008.81","$2,029.10",$0.00,$396.94,$0.00,$403.79,$0.00
M001T35100150010,SUP,HCPCS C1725,,M001T35100150010  -  CATHETER BLNDIL 3.5MM 150CM 100MM POLARCATH PERI ACPT .014IN,"$2,536.38",$0.00,"$2,536.38","$1,377.25","$1,810.21",$0.00,$437.00,$0.00,$0.00,$444.10,"$2,536.38",$0.00,"$1,268.19","$2,008.81","$2,029.10",$0.00,$396.94,$0.00,$403.79,$0.00
M001T35120150010,SUP,HCPCS C1725,,M001T35120150010  -  CATHETER BLNDIL 3.5MM 150CM 120MM POLARCATH PERI ACPT .014IN,"$2,794.95",$0.00,"$2,794.95","$1,517.66","$1,994.76",$0.00,$481.56,$0.00,$0.00,$489.37,"$2,794.95",$0.00,"$1,397.48","$2,213.60","$2,235.96",$0.00,$437.41,$0.00,$444.96,$0.00
M001T35150150010,SUP,HCPCS C1725,,M001T35150150010  -  CATHETER BLNDIL 3.5MM 150CM 150MM POLARCATH PERI ACPT .014IN,"$3,041.20",$0.00,"$3,041.20","$1,651.37","$2,170.50",$0.00,$523.98,$0.00,$0.00,$532.49,"$3,041.20",$0.00,"$1,520.60","$2,408.63","$2,432.96",$0.00,$475.95,$0.00,$484.16,$0.00
M001T3520135010,SUP,HCPCS C1725,,M001T3520135010  -  CATHETER BLNDIL 3.5MM 135CM 20MM POLARCATH COAX RADOPQ PERI,"$2,265.50",$0.00,"$2,265.50","$1,230.17","$1,616.89",$0.00,$390.33,$0.00,$0.00,$396.67,"$2,265.50",$0.00,"$1,132.75","$1,794.28","$1,812.40",$0.00,$354.55,$0.00,$360.67,$0.00
M001T3520150010,SUP,HCPCS C1725,,M001T3520150010  -  CATHETER BLNDIL 3.5MM 150CM 20MM POLARCATH PERI ACPT .014IN,"$2,265.50",$0.00,"$2,265.50","$1,230.17","$1,616.89",$0.00,$390.33,$0.00,$0.00,$396.67,"$2,265.50",$0.00,"$1,132.75","$1,794.28","$1,812.40",$0.00,$354.55,$0.00,$360.67,$0.00
M001T3540135010,SUP,HCPCS C1725,,M001T3540135010  -  CATHETER BLNDIL 3.5MM 135CM 40MM POLARCATH COAX RADOPQ MRKNG,"$2,265.50",$0.00,"$2,265.50","$1,230.17","$1,616.89",$0.00,$390.33,$0.00,$0.00,$396.67,"$2,265.50",$0.00,"$1,132.75","$1,794.28","$1,812.40",$0.00,$354.55,$0.00,$360.67,$0.00
M001T3540150010,SUP,HCPCS C1725,,M001T3540150010  -  CATHETER BLNDIL 3.5MM 150CM 40MM POLARCATH PERI ACPT .014IN,"$2,265.50",$0.00,"$2,265.50","$1,230.17","$1,616.89",$0.00,$390.33,$0.00,$0.00,$396.67,"$2,265.50",$0.00,"$1,132.75","$1,794.28","$1,812.40",$0.00,$354.55,$0.00,$360.67,$0.00
M001T3560135010,SUP,HCPCS C1725,,M001T3560135010  -  CATHETER BLNDIL 3.5MM 135CM 60MM POLARCATH RADOPQ PERI ACPT,"$2,265.50",$0.00,"$2,265.50","$1,230.17","$1,616.89",$0.00,$390.33,$0.00,$0.00,$396.67,"$2,265.50",$0.00,"$1,132.75","$1,794.28","$1,812.40",$0.00,$354.55,$0.00,$360.67,$0.00
M001T3560150010,SUP,HCPCS C1725,,M001T3560150010  -  CATHETER BLNDIL 3.5MM 150CM 60MM POLARCATH PERI ACPT .014IN,"$2,265.50",$0.00,"$2,265.50","$1,230.17","$1,616.89",$0.00,$390.33,$0.00,$0.00,$396.67,"$2,265.50",$0.00,"$1,132.75","$1,794.28","$1,812.40",$0.00,$354.55,$0.00,$360.67,$0.00
M001T40100135010,SUP,HCPCS C1725,,M001T40100135010  -  CATHETER BLNDIL 4MM 135CM 100MM POLARCATH PERI ACPT .014IN,"$2,536.38",$0.00,"$2,536.38","$1,377.25","$1,810.21",$0.00,$437.00,$0.00,$0.00,$444.10,"$2,536.38",$0.00,"$1,268.19","$2,008.81","$2,029.10",$0.00,$396.94,$0.00,$403.79,$0.00
M001T40100150010,SUP,HCPCS C1725,,M001T40100150010  -  CATHETER BLNDIL 4MM 150CM 100MM POLARCATH PERI ACPT .014IN,"$2,536.38",$0.00,"$2,536.38","$1,377.25","$1,810.21",$0.00,$437.00,$0.00,$0.00,$444.10,"$2,536.38",$0.00,"$1,268.19","$2,008.81","$2,029.10",$0.00,$396.94,$0.00,$403.79,$0.00
M001T40120150010,SUP,HCPCS C1725,,M001T40120150010  -  CATHETER BLNDIL 4MM 150CM 120MM POLARCATH PERI ACPT .014IN,"$2,794.95",$0.00,"$2,794.95","$1,517.66","$1,994.76",$0.00,$481.56,$0.00,$0.00,$489.37,"$2,794.95",$0.00,"$1,397.48","$2,213.60","$2,235.96",$0.00,$437.41,$0.00,$444.96,$0.00
M001T40150150010,SUP,HCPCS C1725,,M001T40150150010  -  CATHETER BLNDIL 4MM 150CM 150MM POLARCATH PERI ACPT .014IN,"$3,041.20",$0.00,"$3,041.20","$1,651.37","$2,170.50",$0.00,$523.98,$0.00,$0.00,$532.49,"$3,041.20",$0.00,"$1,520.60","$2,408.63","$2,432.96",$0.00,$475.95,$0.00,$484.16,$0.00
M001T4020135010,SUP,HCPCS C1725,,M001T4020135010  -  CATHETER BLNDIL 5FR 4MM 135CM 20MM POLARCATH SHTH PERI ACPT,"$2,265.50",$0.00,"$2,265.50","$1,230.17","$1,616.89",$0.00,$390.33,$0.00,$0.00,$396.67,"$2,265.50",$0.00,"$1,132.75","$1,794.28","$1,812.40",$0.00,$354.55,$0.00,$360.67,$0.00
M001T4020150010,SUP,HCPCS C1725,,M001T4020150010  -  CATHETER BLNDIL 4MM 150CM 20MM POLARCATH PERI ACPT .014IN GW,"$2,265.50",$0.00,"$2,265.50","$1,230.17","$1,616.89",$0.00,$390.33,$0.00,$0.00,$396.67,"$2,265.50",$0.00,"$1,132.75","$1,794.28","$1,812.40",$0.00,$354.55,$0.00,$360.67,$0.00
M001T4040135010,SUP,HCPCS C1725,,M001T4040135010  -  CATHETER BLNDIL 4MM 135CM 40MM POLARCATH PERI ACPT .014IN GW,"$2,265.50",$0.00,"$2,265.50","$1,230.17","$1,616.89",$0.00,$390.33,$0.00,$0.00,$396.67,"$2,265.50",$0.00,"$1,132.75","$1,794.28","$1,812.40",$0.00,$354.55,$0.00,$360.67,$0.00
M001T4040150010,SUP,HCPCS C1725,,M001T4040150010  -  CATHETER BLNDIL 4MM 150CM 40MM POLARCATH PERI ACPT .014IN GW,"$2,265.50",$0.00,"$2,265.50","$1,230.17","$1,616.89",$0.00,$390.33,$0.00,$0.00,$396.67,"$2,265.50",$0.00,"$1,132.75","$1,794.28","$1,812.40",$0.00,$354.55,$0.00,$360.67,$0.00
M001T4060135010,SUP,HCPCS C1725,,M001T4060135010  -  CATHETER BLNDIL 4MM 135CM 60MM POLARCATH PERI ACPT .014IN GW,"$2,265.50",$0.00,"$2,265.50","$1,230.17","$1,616.89",$0.00,$390.33,$0.00,$0.00,$396.67,"$2,265.50",$0.00,"$1,132.75","$1,794.28","$1,812.40",$0.00,$354.55,$0.00,$360.67,$0.00
M001T4060150010,SUP,HCPCS C1725,,M001T4060150010  -  CATHETER BLNDIL 4MM 150CM 60MM POLARCATH COAX RADOPQ PERI,"$2,265.50",$0.00,"$2,265.50","$1,230.17","$1,616.89",$0.00,$390.33,$0.00,$0.00,$396.67,"$2,265.50",$0.00,"$1,132.75","$1,794.28","$1,812.40",$0.00,$354.55,$0.00,$360.67,$0.00
M001T50100135010,SUP,HCPCS C1725,,M001T50100135010  -  CATHETER BLNDIL 5MM 135CM 100MM POLARCATH COAX RADOPQ PERI,"$2,536.38",$0.00,"$2,536.38","$1,377.25","$1,810.21",$0.00,$437.00,$0.00,$0.00,$444.10,"$2,536.38",$0.00,"$1,268.19","$2,008.81","$2,029.10",$0.00,$396.94,$0.00,$403.79,$0.00
M001T50120135010,SUP,HCPCS C1725,,M001T50120135010  -  CATHETER BLNDIL 5MM 135CM 120MM POLARCATH RADOPQ PERI ACPT,"$2,794.95",$0.00,"$2,794.95","$1,517.66","$1,994.76",$0.00,$481.56,$0.00,$0.00,$489.37,"$2,794.95",$0.00,"$1,397.48","$2,213.60","$2,235.96",$0.00,$437.41,$0.00,$444.96,$0.00
M001T50150135010,SUP,HCPCS C1725,,M001T50150135010  -  CATHETER BLNDIL 5MM 135CM 150MM POLARCATH COAX RADOPQ PERI,"$3,041.20",$0.00,"$3,041.20","$1,651.37","$2,170.50",$0.00,$523.98,$0.00,$0.00,$532.49,"$3,041.20",$0.00,"$1,520.60","$2,408.63","$2,432.96",$0.00,$475.95,$0.00,$484.16,$0.00
M001T5020135010,SUP,HCPCS C1725,,M001T5020135010  -  CATHETER BLNDIL 5MM 135CM 20MM POLARCATH COAX RADOPQ PERI,"$2,265.50",$0.00,"$2,265.50","$1,230.17","$1,616.89",$0.00,$390.33,$0.00,$0.00,$396.67,"$2,265.50",$0.00,"$1,132.75","$1,794.28","$1,812.40",$0.00,$354.55,$0.00,$360.67,$0.00
M001T5040135010,SUP,HCPCS C1725,,M001T5040135010  -  CATHETER BLNDIL 5MM 135CM 40MM POLARCATH COAX RADOPQ PERI,"$2,265.50",$0.00,"$2,265.50","$1,230.17","$1,616.89",$0.00,$390.33,$0.00,$0.00,$396.67,"$2,265.50",$0.00,"$1,132.75","$1,794.28","$1,812.40",$0.00,$354.55,$0.00,$360.67,$0.00
M001T5060135010,SUP,HCPCS C1725,,M001T5060135010  -  CATHETER BLNDIL 5MM 135CM 60MM POLARCATH PERI ACPT .014IN GW,"$2,265.50",$0.00,"$2,265.50","$1,230.17","$1,616.89",$0.00,$390.33,$0.00,$0.00,$396.67,"$2,265.50",$0.00,"$1,132.75","$1,794.28","$1,812.40",$0.00,$354.55,$0.00,$360.67,$0.00
M001T60100135010,SUP,HCPCS C1725,,M001T60100135010  -  CATHETER BLNDIL 6MM 135CM 100MM POLARCATH PERI ACPT .014IN,"$2,536.38",$0.00,"$2,536.38","$1,377.25","$1,810.21",$0.00,$437.00,$0.00,$0.00,$444.10,"$2,536.38",$0.00,"$1,268.19","$2,008.81","$2,029.10",$0.00,$396.94,$0.00,$403.79,$0.00
M001T60120135010,SUP,HCPCS C1725,,M001T60120135010  -  CATHETER BLNDIL 6MM 135CM 120MM POLARCATH PERI ACPT .014IN,"$2,794.95",$0.00,"$2,794.95","$1,517.66","$1,994.76",$0.00,$481.56,$0.00,$0.00,$489.37,"$2,794.95",$0.00,"$1,397.48","$2,213.60","$2,235.96",$0.00,$437.41,$0.00,$444.96,$0.00
M001T60150135010,SUP,HCPCS C1725,,M001T60150135010  -  CATHETER BLNDIL 6MM 135CM 150MM POLARCATH PERI ACPT .014IN,"$3,041.20",$0.00,"$3,041.20","$1,651.37","$2,170.50",$0.00,$523.98,$0.00,$0.00,$532.49,"$3,041.20",$0.00,"$1,520.60","$2,408.63","$2,432.96",$0.00,$475.95,$0.00,$484.16,$0.00
M001T6020135010,SUP,HCPCS C1725,,M001T6020135010  -  CATHETER BLNDIL 6MM 135CM 20MM POLARCATH PERI ACPT .014IN GW,"$2,265.50",$0.00,"$2,265.50","$1,230.17","$1,616.89",$0.00,$390.33,$0.00,$0.00,$396.67,"$2,265.50",$0.00,"$1,132.75","$1,794.28","$1,812.40",$0.00,$354.55,$0.00,$360.67,$0.00
M001T6040135010,SUP,HCPCS C1725,,M001T6040135010  -  CATHETER BLNDIL 6MM 135CM 40MM POLARCATH RADOPQ PERI ACPT,"$2,265.50",$0.00,"$2,265.50","$1,230.17","$1,616.89",$0.00,$390.33,$0.00,$0.00,$396.67,"$2,265.50",$0.00,"$1,132.75","$1,794.28","$1,812.40",$0.00,$354.55,$0.00,$360.67,$0.00
M001T6060135010,SUP,HCPCS C1725,,M001T6060135010  -  CATHETER BLNDIL 6MM 135CM 60MM POLARCATH PERI ACPT .014IN GW,"$2,265.50",$0.00,"$2,265.50","$1,230.17","$1,616.89",$0.00,$390.33,$0.00,$0.00,$396.67,"$2,265.50",$0.00,"$1,132.75","$1,794.28","$1,812.40",$0.00,$354.55,$0.00,$360.67,$0.00
M002002231680,SUP,HCPCS C1768,,M002002231680  -  GRAFT CARDIO 40CM 16X8MM WVN BFUR NONSEALED CLY VRSFT EPTFE,"$1,337.50",$0.00,"$1,337.50",$601.88,$954.57,$0.00,$230.44,$0.00,$0.00,$234.19,"$1,337.50",$0.00,$668.75,"$1,059.30","$1,070.00",$0.00,$209.32,$0.00,$212.93,$0.00
M002020195300,SUP,HCPCS C1768,,M002020195300  -  PATCH CARDIO THK.36MM 3X1IN KNTD ULTHN HMSH FNS,$278.93,$0.00,$278.93,$125.52,$199.07,$0.00,$48.06,$0.00,$0.00,$48.84,$278.93,$0.00,$139.46,$220.91,$223.14,$0.00,$43.65,$0.00,$44.40,$0.00
M00202019530P0,SUP,HCPCS C1768,,M00202019530P0  -  PATCH CV THK.36MM ULTHN TPR 3X1IN HMSH PL FNS KNIT PRETRIM,$310.35,$0.00,$310.35,$139.66,$221.50,$0.00,$53.47,$0.00,$0.00,$54.34,$310.35,$0.00,$155.18,$245.80,$248.28,$0.00,$48.57,$0.00,$49.41,$0.00
M002020851470,SUP,HCPCS C1768,,M002020851470  -  GRAFT CV 2 BRCH THN 14MM 7MM 40CM STRL HMSH G2 VLR MCVL SFT,"$1,834.55",$0.00,"$1,834.55",$825.55,"$1,309.32",$0.00,$316.08,$0.00,$0.00,$321.22,"$1,834.55",$0.00,$917.28,"$1,452.96","$1,467.64",$0.00,$287.11,$0.00,$292.06,$0.00
M002020851680,SUP,HCPCS C1768,,M002020851680  -  GRAFT VASC 2 BRCH 16MM 8MM 40CM STRL HMSH GMCVL 2 VLR CLGN,"$1,834.55",$0.00,"$1,834.55",$825.55,"$1,309.32",$0.00,$316.08,$0.00,$0.00,$321.22,"$1,834.55",$0.00,$917.28,"$1,452.96","$1,467.64",$0.00,$287.11,$0.00,$292.06,$0.00
M002020952080,SUP,HCPCS C1768,,M002020952080  -  GRAFT CV 8MM 60CM STRL HMSH GMCVL 2 VLR STRG TUBE KNIT SFT,"$1,245.73",$0.00,"$1,245.73",$560.58,$889.07,$0.00,$214.63,$0.00,$0.00,$218.12,"$1,245.73",$0.00,$622.86,$986.62,$996.58,$0.00,$194.96,$0.00,$198.32,$0.00
M002020952160,SUP,HCPCS C1768,,M002020952160  -  GRAFT VASC 16MM 30CM STRL HMSH GMCVL PLSTR 2 VLR STRG TUBE,"$1,283.30",$0.00,"$1,283.30",$577.49,$915.89,$0.00,$221.11,$0.00,$0.00,$224.70,"$1,283.30",$0.00,$641.65,"$1,016.37","$1,026.64",$0.00,$200.84,$0.00,$204.30,$0.00
M00202175416P0,SUP,HCPCS C1768,,M00202175416P0  -  GRAFT CARDIO 30CM 16MM 2 VLR WVN STR TUBE HMSH PL PLSTR STRL,"$1,303.78",$0.00,"$1,303.78",$586.70,$930.50,$0.00,$224.63,$0.00,$0.00,$228.28,"$1,303.78",$0.00,$651.89,"$1,032.59","$1,043.02",$0.00,$204.04,$0.00,$207.56,$0.00
M002021754180,SUP,HCPCS C1768,,M002021754180  -  GRAFT VASC 30CM 18MM HMSHLD MCVL WVN STR,"$1,235.50",$0.00,"$1,235.50",$555.98,$881.78,$0.00,$212.87,$0.00,$0.00,$216.33,"$1,235.50",$0.00,$617.75,$978.52,$988.40,$0.00,$193.36,$0.00,$196.69,$0.00
M00202175420P0,SUP,HCPCS C1768,,M00202175420P0  -  GRAFT VASC 30CM 20MM HMSH PL EPTFE 2 VLR WVN STR TUBE SFT,"$1,318.78",$0.00,"$1,318.78",$593.45,$941.21,$0.00,$227.22,$0.00,$0.00,$230.91,"$1,318.78",$0.00,$659.39,"$1,044.47","$1,055.02",$0.00,$206.39,$0.00,$209.95,$0.00
M00202175426P0,SUP,HCPCS C1768,,M00202175426P0  -  GRAFT CARDIO 30CM 36MM 2 VLR SL TXTL STR TUBE WVN HMSH PL,"$1,371.55",$0.00,"$1,371.55",$617.20,$978.88,$0.00,$236.31,$0.00,$0.00,$240.15,"$1,371.55",$0.00,$685.78,"$1,086.27","$1,097.24",$0.00,$214.65,$0.00,$218.35,$0.00
M00202175428P0,SUP,HCPCS C1768,,M00202175428P0  -  GRAFT CV STRG TUBE 28MM 30CM HMSH PL WVN SMTH NDL PSG SUT,"$1,955.63",$0.00,"$1,955.63",$880.03,"$1,395.73",$0.00,$336.94,$0.00,$0.00,$342.41,"$1,955.63",$0.00,$977.81,"$1,548.86","$1,564.50",$0.00,$306.06,$0.00,$311.34,$0.00
M00202175430P0,SUP,HCPCS C1768,,M00202175430P0  -  GRAFT CARDIO 30CM 30MM 2 VLR WVN STR TUBE HMSH PL PLSTR STRL,"$1,371.55",$0.00,"$1,371.55",$617.20,$978.88,$0.00,$236.31,$0.00,$0.00,$240.15,"$1,371.55",$0.00,$685.78,"$1,086.27","$1,097.24",$0.00,$214.65,$0.00,$218.35,$0.00
M00202175434P0,SUP,HCPCS C1768,,M00202175434P0  -  GRAFT VASC 30CM 34MM HMSH PL WVN STR,"$1,371.55",$0.00,"$1,371.55",$617.20,$978.88,$0.00,$236.31,$0.00,$0.00,$240.15,"$1,371.55",$0.00,$685.78,"$1,086.27","$1,097.24",$0.00,$214.65,$0.00,$218.35,$0.00
M002363200201,SUP,HCPCS C1768,,M002363200201  -  GRAFT SIZER 5-24MM,$24.83,$0.00,$24.83,$11.17,$17.72,$0.00,$4.28,$0.00,$0.00,$4.35,$24.83,$0.00,$12.41,$19.67,$19.86,$0.00,$3.89,$0.00,$3.95,$0.00
M002363200211,SUP,HCPCS C1768,,M002363200211  -  TMPLT SZ 24-38MM VASC GFT,$24.83,$0.00,$24.83,$11.17,$17.72,$0.00,$4.28,$0.00,$0.00,$4.35,$24.83,$0.00,$12.41,$19.67,$19.86,$0.00,$3.89,$0.00,$3.95,$0.00
M0031351020,SUP,HCPCS C1757,,M0031351020  -  CATHETER INFS MIC 155CM 15CM FRCKR10,"$2,303.00",$0.00,"$2,303.00",$0.00,"$1,643.65",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,303.00",$0.00,"$1,151.50","$1,823.98","$1,842.40",$0.00,$0.00,$0.00,$0.00,$0.00
M0031441890,SUP,HCPCS C1751,,M0031441890  -  MICROCATHETER CRBRVASC .014-.016IN STRG 2.6-2FR .019IN 150CM,"$2,138.50",$0.00,"$2,138.50","$1,161.21","$1,526.25",$0.00,$368.45,$0.00,$0.00,$374.43,"$2,138.50",$0.00,"$1,069.25","$1,693.69","$1,710.80",$0.00,$334.68,$0.00,$340.45,$0.00
M0031681890,SUP,HCPCS C1751,,M0031681890  -  CATHETER INFS .038IN 2.4-1.7FR .014IN 150CM 6CM EXCLS SL-10,"$2,162.00",$0.00,"$2,162.00","$1,173.97","$1,543.02",$0.00,$372.50,$0.00,$0.00,$378.55,"$2,162.00",$0.00,"$1,081.00","$1,712.30","$1,729.60",$0.00,$338.35,$0.00,$344.19,$0.00
M0031681900,SUP,HCPCS C1751,,M0031681900  -  MICROCATHETER CRBRVASC 45D .014IN PSHP 2.4-1.7FR .0165IN 150,"$2,326.50",$0.00,"$2,326.50","$1,263.29","$1,660.42",$0.00,$400.84,$0.00,$0.00,$407.35,"$2,326.50",$0.00,"$1,163.25","$1,842.59","$1,861.20",$0.00,$364.10,$0.00,$370.38,$0.00
M003182880US0,SUP,HCPCS C1887,,M003182880US0  -  MICROCATHETER INFS 135CM RNGD HFL RADOPQ DIST TIP VORTEC +,"$1,774.25",$0.00,"$1,774.25",$963.42,"$1,266.28",$0.00,$305.69,$0.00,$0.00,$310.66,"$1,774.25",$0.00,$887.13,"$1,405.21","$1,419.40",$0.00,$277.67,$0.00,$282.46,$0.00
M003182900US0,SUP,HCPCS C1751,,M003182900US0  -  CATHETER INFS 150CM 10CM RNGD HF KT MCTH RADOPQ BRAID HDRPH,"$1,774.25",$0.00,"$1,774.25",$963.42,"$1,266.28",$0.00,$305.69,$0.00,$0.00,$310.66,"$1,774.25",$0.00,$887.13,"$1,405.21","$1,419.40",$0.00,$277.67,$0.00,$282.46,$0.00
M0032072209150,SUP,HCPCS C1726,,M0032072209150  -  CATHETER BLNDIL 1.5MM 135CM LF 9MM GTWY OTW 2 LUM HDRPH ACPT,"$2,643.75",$0.00,"$2,643.75","$1,435.56","$1,886.84",$0.00,$455.50,$0.00,$0.00,$462.90,"$2,643.75",$0.00,"$1,321.88","$2,093.85","$2,115.00",$0.00,$413.75,$0.00,$420.89,$0.00
M0032072209200,SUP,HCPCS C1726,,M0032072209200  -  CATHETER BLNDIL 2MM 135CM LF 9MM GTWY OTW 2 LUM HDRPH ACPT,"$2,643.75",$0.00,"$2,643.75","$1,435.56","$1,886.84",$0.00,$455.50,$0.00,$0.00,$462.90,"$2,643.75",$0.00,"$1,321.88","$2,093.85","$2,115.00",$0.00,$413.75,$0.00,$420.89,$0.00
M0032072209250,SUP,HCPCS C1726,,M0032072209250  -  CATHETER BLNDIL 2.5MM 135CM LF 9MM GTWY OTW 2 LUM HDRPH ACPT,"$2,643.75",$0.00,"$2,643.75","$1,435.56","$1,886.84",$0.00,$455.50,$0.00,$0.00,$462.90,"$2,643.75",$0.00,"$1,321.88","$2,093.85","$2,115.00",$0.00,$413.75,$0.00,$420.89,$0.00
M0032072209300,SUP,HCPCS C1726,,M0032072209300  -  CATHETER BLNDIL 3MM 135CM LF 9MM GTWY OTW 2 LUM HDRPH ACPT,"$2,643.75",$0.00,"$2,643.75","$1,435.56","$1,886.84",$0.00,$455.50,$0.00,$0.00,$462.90,"$2,643.75",$0.00,"$1,321.88","$2,093.85","$2,115.00",$0.00,$413.75,$0.00,$420.89,$0.00
M0032072209350,SUP,HCPCS C1726,,M0032072209350  -  CATHETER BLNDIL 3.5MM 135CM LF 9MM GTWY OTW 2 LUM HDRPH ACPT,"$2,643.75",$0.00,"$2,643.75","$1,435.56","$1,886.84",$0.00,$455.50,$0.00,$0.00,$462.90,"$2,643.75",$0.00,"$1,321.88","$2,093.85","$2,115.00",$0.00,$413.75,$0.00,$420.89,$0.00
M0032072215250,SUP,HCPCS C1726,,M0032072215250  -  CATHETER BLNDIL 2.5MM 135CM LF 15MM GTWY OTW 2 LUM HDRPH,"$2,643.75",$0.00,"$2,643.75","$1,435.56","$1,886.84",$0.00,$455.50,$0.00,$0.00,$462.90,"$2,643.75",$0.00,"$1,321.88","$2,093.85","$2,115.00",$0.00,$413.75,$0.00,$420.89,$0.00
M0032072215300,SUP,HCPCS C1726,,M0032072215300  -  CATHETER BLNDIL 3MM 135CM LF 15MM GTWY OTW 2 LUM HDRPH ACPT,"$2,643.75",$0.00,"$2,643.75","$1,435.56","$1,886.84",$0.00,$455.50,$0.00,$0.00,$462.90,"$2,643.75",$0.00,"$1,321.88","$2,093.85","$2,115.00",$0.00,$413.75,$0.00,$420.89,$0.00
M0032072215350,SUP,HCPCS C1726,,M0032072215350  -  CATHETER BLNDIL 3.5MM 135CM LF 15MM GTWY OTW 2 LUM HDRPH,"$2,643.75",$0.00,"$2,643.75","$1,435.56","$1,886.84",$0.00,$455.50,$0.00,$0.00,$462.90,"$2,643.75",$0.00,"$1,321.88","$2,093.85","$2,115.00",$0.00,$413.75,$0.00,$420.89,$0.00
M00326110,SUP,HCPCS C1769,,M00326110  -  GUIDEWIRE VASCULAR .014IN 200CM 35CM SOFT TIP ATRAUMATIC,"$1,386.50",$0.00,"$1,386.50",$752.87,$989.55,$0.00,$238.89,$0.00,$0.00,$242.77,"$1,386.50",$0.00,$693.25,"$1,098.11","$1,109.20",$0.00,$216.99,$0.00,$220.73,$0.00
M00326410,SUP,HCPCS C1769,,M00326410  -  GUIDEWIRE VASC .014IN 200CM 35CM SYNCHRO2 STD ATRM RBN TIP,"$1,316.00",$0.00,"$1,316.00",$714.59,$939.23,$0.00,$226.74,$0.00,$0.00,$230.42,"$1,316.00",$0.00,$658.00,"$1,042.27","$1,052.80",$0.00,$205.95,$0.00,$209.51,$0.00
M00326420,SUP,HCPCS C1769,,M00326420  -  GUIDEWIRE VASCULAR STANDARD .014IN 200CM 35CM PRESHAPED,"$1,386.50",$0.00,"$1,386.50",$752.87,$989.55,$0.00,$238.89,$0.00,$0.00,$242.77,"$1,386.50",$0.00,$693.25,"$1,098.11","$1,109.20",$0.00,$216.99,$0.00,$220.73,$0.00
M00326520,SUP,HCPCS C1769,,M00326520  -  GUIDEWIRE VASC .014IN 300CM 35CM SYNCHRO2 STD ATRM RBN TIP,"$1,715.50",$0.00,"$1,715.50",$931.52,"$1,224.35",$0.00,$295.57,$0.00,$0.00,$300.37,"$1,715.50",$0.00,$857.75,"$1,358.68","$1,372.40",$0.00,$268.48,$0.00,$273.11,$0.00
M003468140,SUP,HCPCS C1769,,M003468140  -  GUIDEWIRE VASC .014IN 300CM STRL LF 2CM TRNSD X SPRT ICE,"$1,351.25",$0.00,"$1,351.25",$733.73,$964.39,$0.00,$232.81,$0.00,$0.00,$236.59,"$1,351.25",$0.00,$675.63,"$1,070.19","$1,081.00",$0.00,$211.47,$0.00,$215.12,$0.00
M0035503010,SUP,HCPCS C1887,,M0035503010  -  CATHETER INFUS .038IN MICRO 3FR .024IN 105CM 12CM KIT GWIRE,"$1,157.13",$0.00,"$1,157.13",$628.32,$825.84,$0.00,$199.37,$0.00,$0.00,$202.60,"$1,157.13",$0.00,$578.56,$916.45,$925.70,$0.00,$181.09,$0.00,$184.21,$0.00
M0035503040,SUP,HCPCS C1887,,M0035503040  -  CATHETER INFUS .018IN MICRO 3-2.8FR .024-.018IN 135CM 12CM,"$1,157.13",$0.00,"$1,157.13",$628.32,$825.84,$0.00,$199.37,$0.00,$0.00,$202.60,"$1,157.13",$0.00,$578.56,$916.45,$925.70,$0.00,$181.09,$0.00,$184.21,$0.00
M003N3EZ25200,SUP,HCPCS C2617,,M003N3EZ25200  -  STENT INTRCRAN 2.5MM 20MM NRFRM EZ 3,"$15,745.00",$0.00,"$15,745.00","$7,085.25","$5,158.80",$0.00,"$2,712.78",$0.00,$0.00,"$2,756.82","$15,745.00",$0.00,"$7,872.50","$12,470.04","$12,596.00",$0.00,"$2,464.09",$0.00,"$2,506.60",$0.00
M003N3EZ30200,SUP,HCPCS C2617,,M003N3EZ30200  -  STENT INTRCRAN 3MM 20MM NRFRM EZ NRFRM3,"$15,745.00",$0.00,"$15,745.00","$7,085.25","$5,158.80",$0.00,"$2,712.78",$0.00,$0.00,"$2,756.82","$15,745.00",$0.00,"$7,872.50","$12,470.04","$12,596.00",$0.00,"$2,464.09",$0.00,"$2,506.60",$0.00
M003N3EZ35200,SUP,HCPCS C2617,,M003N3EZ35200  -  STENT INTRCRAN 3.5MM 20MM NRFRM EZ NRFRM3,"$15,745.00",$0.00,"$15,745.00","$7,085.25","$5,158.80",$0.00,"$2,712.78",$0.00,$0.00,"$2,756.82","$15,745.00",$0.00,"$7,872.50","$12,470.04","$12,596.00",$0.00,"$2,464.09",$0.00,"$2,506.60",$0.00
M003N3EZ40200,SUP,HCPCS C2617,,M003N3EZ40200  -  STENT INTRCRAN 4MM 20MM NRFRM EZ 3,"$15,745.00",$0.00,"$15,745.00","$7,085.25","$5,158.80",$0.00,"$2,712.78",$0.00,$0.00,"$2,756.82","$15,745.00",$0.00,"$7,872.50","$12,470.04","$12,596.00",$0.00,"$2,464.09",$0.00,"$2,506.60",$0.00
M003N3EZ45200,SUP,HCPCS C2617,,M003N3EZ45200  -  STENT INTRCRAN 4.5MM 20MM NRFRM EZ PRELD SLF XPD RADOPQ NTNL,"$15,745.00",$0.00,"$15,745.00","$7,085.25","$5,158.80",$0.00,"$2,712.78",$0.00,$0.00,"$2,756.82","$15,745.00",$0.00,"$7,872.50","$12,470.04","$12,596.00",$0.00,"$2,464.09",$0.00,"$2,506.60",$0.00
M003N3EZ45300,SUP,Custom 27803010,,M003N3EZ45300  -  STENT INTRCRAN 4.5MM 30MM NRFRM EZ PRELD SLF XPD RADOPQ NTNL,"$15,745.00",$0.00,"$15,745.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$15,745.00",$0.00,"$7,872.50","$12,470.04","$12,596.00",$0.00,$0.00,$0.00,$0.00,$0.00
M003SNF3STA0,SUP,Custom 27203010,,M003SNF3STA0  -  STENT INTRCRAN 2FR NRFRM3 STAB CATH,"$2,875.00",$0.00,"$2,875.00",$0.00,"$2,051.89",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,875.00",$0.00,"$1,437.50","$2,277.00","$2,300.00",$0.00,$0.00,$0.00,$0.00,$0.00
M003UZAS30150,SUP,Custom 27803010,,M003UZAS30150  -  STENT 3.0MM 15MM 3.5MM NEUROFORM ATLAS,"$18,125.00",$0.00,"$18,125.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$18,125.00",$0.00,"$9,062.50","$14,355.00","$14,500.00",$0.00,$0.00,$0.00,$0.00,$0.00
M003UZAS30210,SUP,Custom 27803010,,M003UZAS30210  -  STENT 3.0MM 21MM 3.5MM NEUROFORM ATLAS,"$18,125.00",$0.00,"$18,125.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$18,125.00",$0.00,"$9,062.50","$14,355.00","$14,500.00",$0.00,$0.00,$0.00,$0.00,$0.00
M003UZAS30240,SUP,Custom 27803010,,M003UZAS30240  -  STENT 3.0MM 24MM 3.5MM NEUROFORM ATLAS,"$18,125.00",$0.00,"$18,125.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$18,125.00",$0.00,"$9,062.50","$14,355.00","$14,500.00",$0.00,$0.00,$0.00,$0.00,$0.00
M003UZAS40210,SUP,Custom 27803010,,M003UZAS40210  -  STENT 4.0MM 21MM 4.5MM NEUROFORM ATLAS,"$18,125.00",$0.00,"$18,125.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$18,125.00",$0.00,"$9,062.50","$14,355.00","$14,500.00",$0.00,$0.00,$0.00,$0.00,$0.00
M003UZAS40240,SUP,Custom 27803010,,M003UZAS40240  -  STENT 4.0MM 24MM 4.5MM NEUROFORM ATLAS,"$18,125.00",$0.00,"$18,125.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$18,125.00",$0.00,"$9,062.50","$14,355.00","$14,500.00",$0.00,$0.00,$0.00,$0.00,$0.00
M003UZAS45210,SUP,Custom 27803010,,M003UZAS45210  -  STENT 4.5MM 21MM 5.0MM NEUROFORM ATLAS,"$18,125.00",$0.00,"$18,125.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$18,125.00",$0.00,"$9,062.50","$14,355.00","$14,500.00",$0.00,$0.00,$0.00,$0.00,$0.00
M003UZAS45300,SUP,Custom 27803010,,M003UZAS45300  -  STENT 4.5MM 30MM 5.0MM NEUROFORM ATLAS,"$18,125.00",$0.00,"$18,125.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$18,125.00",$0.00,"$9,062.50","$14,355.00","$14,500.00",$0.00,$0.00,$0.00,$0.00,$0.00
M003WS0250090,SUP,HCPCS C2617,,M003WS0250090  -  STENT INTRCRAN 2.5MM 3.5FR 9MM STRL WINGSPAN GTWY SLF XPD,"$15,980.00",$0.00,"$15,980.00","$7,191.00","$5,158.80",$0.00,"$2,753.27",$0.00,$0.00,"$2,797.97","$15,980.00",$0.00,"$7,990.00","$12,656.16","$12,784.00",$0.00,"$2,500.87",$0.00,"$2,544.02",$0.00
M003WS0250150,SUP,HCPCS C2617,,M003WS0250150  -  STENT INTRACRANIAL .014IN 2.5MM 15MM OTW FLEXIBLE TRACKABLE,"$15,980.00",$0.00,"$15,980.00","$7,191.00","$5,158.80",$0.00,"$2,753.27",$0.00,$0.00,"$2,797.97","$15,980.00",$0.00,"$7,990.00","$12,656.16","$12,784.00",$0.00,"$2,500.87",$0.00,"$2,544.02",$0.00
M003WS0300090,SUP,HCPCS C2617,,M003WS0300090  -  STENT INTRCRAN 3MM 3.5FR 9MM STRL WINGSPAN GTWY SLF XPD OTW,"$15,980.00",$0.00,"$15,980.00","$7,191.00","$5,158.80",$0.00,"$2,753.27",$0.00,$0.00,"$2,797.97","$15,980.00",$0.00,"$7,990.00","$12,656.16","$12,784.00",$0.00,"$2,500.87",$0.00,"$2,544.02",$0.00
M003WS0300150,SUP,Custom 27803010,,M003WS0300150  -  STENT INTRCRAN 3MM 3.5FR 15MM STRL WINGSPAN GTWY SLF XPD OTW,"$15,980.00",$0.00,"$15,980.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$15,980.00",$0.00,"$7,990.00","$12,656.16","$12,784.00",$0.00,$0.00,$0.00,$0.00,$0.00
M003WS0350090,SUP,HCPCS C2617,,M003WS0350090  -  STENT INTRCRAN 3.5MM 3.5FR 9MM STRL WINGSPAN GTWY SLF XPD,"$15,980.00",$0.00,"$15,980.00","$7,191.00","$5,158.80",$0.00,"$2,753.27",$0.00,$0.00,"$2,797.97","$15,980.00",$0.00,"$7,990.00","$12,656.16","$12,784.00",$0.00,"$2,500.87",$0.00,"$2,544.02",$0.00
M003WS0350150,SUP,Custom 27803010,,M003WS0350150  -  STENT INTRCRAN 3.5MM 3.5FR 15MM STRL WINGSPAN GTWY SLF XPD,"$15,980.00",$0.00,"$15,980.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$15,980.00",$0.00,"$7,990.00","$12,656.16","$12,784.00",$0.00,$0.00,$0.00,$0.00,$0.00
M003WS0400090,SUP,HCPCS C2617,,M003WS0400090  -  STENT INTRCRAN 4MM 3.5FR 9MM STRL WINGSPAN GTWY SLF XPD OTW,"$15,980.00",$0.00,"$15,980.00","$7,191.00","$5,158.80",$0.00,"$2,753.27",$0.00,$0.00,"$2,797.97","$15,980.00",$0.00,"$7,990.00","$12,656.16","$12,784.00",$0.00,"$2,500.87",$0.00,"$2,544.02",$0.00
M003WS0400150,SUP,Custom 27803010,,M003WS0400150  -  STENT INTRCRAN 4MM 3.5FR 15MM STRL WINGSPAN GTWY SLF XPD OTW,"$15,980.00",$0.00,"$15,980.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$15,980.00",$0.00,"$7,990.00","$12,656.16","$12,784.00",$0.00,$0.00,$0.00,$0.00,$0.00
M00510860,SUP,Custom 27203010,,M00510860  -  BASKET SPEC RTRVL 1.5CM 3.2MM STRL 3CM TRPZD RX LTHTRP DIST,$667.95,$0.00,$710.00,$0.00,$506.73,$0.00,$0.00,$0.00,$0.00,$0.00,$710.00,$0.00,$355.00,$529.02,$568.00,$0.00,$0.00,$0.00,$0.00,$0.00
M00510860,SUP,Custom 27203592,,RX LITHOTRIPTER COMPATABLE BASKET 3,$710.00,$0.00,$710.00,$0.00,$506.73,$0.00,$0.00,$0.00,$0.00,$0.00,$710.00,$0.00,$355.00,$562.32,$568.00,$0.00,$0.00,$0.00,$0.00,$0.00
M00510870,SUP,Custom 27203010,,M00510870  -  BASKET SPEC RTRVL 2MM 3.2MM STRL 4CM TRPZD RX LTHTRP DIST,$667.95,$0.00,$710.00,$0.00,$506.73,$0.00,$0.00,$0.00,$0.00,$0.00,$710.00,$0.00,$355.00,$529.02,$568.00,$0.00,$0.00,$0.00,$0.00,$0.00
M00510870,SUP,Custom 27203593,,RX LITHOTRIPTER COMPATABLE BASKET 4,$710.00,$0.00,$710.00,$0.00,$506.73,$0.00,$0.00,$0.00,$0.00,$0.00,$710.00,$0.00,$355.00,$562.32,$568.00,$0.00,$0.00,$0.00,$0.00,$0.00
M00510880,SUP,Custom 27203010,,M00510880  -  BASKET SPEC RTRVL 2.5CM 3.2MM STRL 5CM TRPZD RX LTHTRP DIST,$667.95,$0.00,$710.00,$0.00,$506.73,$0.00,$0.00,$0.00,$0.00,$0.00,$710.00,$0.00,$355.00,$529.02,$568.00,$0.00,$0.00,$0.00,$0.00,$0.00
M00510880,SUP,Custom 27203594,,RX LITHOTRIPTER COMPATABLE BASKET 5,$710.00,$0.00,$710.00,$0.00,$506.73,$0.00,$0.00,$0.00,$0.00,$0.00,$710.00,$0.00,$355.00,$562.32,$568.00,$0.00,$0.00,$0.00,$0.00,$0.00
M00510890,SUP,Custom 27203010,,M00510890  -  BASKET SPEC RTRVL 3CM 3.2MM STRL 3CM TRPZD RX LTHTRP DIST,$667.95,$0.00,$710.00,$0.00,$506.73,$0.00,$0.00,$0.00,$0.00,$0.00,$710.00,$0.00,$355.00,$529.02,$568.00,$0.00,$0.00,$0.00,$0.00,$0.00
M00510890,SUP,Custom 27203595,,RX LITHOTRIPTER COMPATABLE BASKET 6,$710.00,$0.00,$710.00,$0.00,$506.73,$0.00,$0.00,$0.00,$0.00,$0.00,$710.00,$0.00,$355.00,$562.32,$568.00,$0.00,$0.00,$0.00,$0.00,$0.00
M00513210,SUP,Custom 27203010,,M00513210  -  BASKET SPECIMEN RETRIEVAL 16MM 1MM 120CM AIRWAY ZERO TIP,$626.53,$0.00,$626.53,$0.00,$447.15,$0.00,$0.00,$0.00,$0.00,$0.00,$626.53,$0.00,$313.26,$496.21,$501.22,$0.00,$0.00,$0.00,$0.00,$0.00
M00513740,SUP,HCPCS C1874,,M00513740  -  STENT ESOPHAGEAL 18-23MM 12CM 9CM COVER DISTAL RELEASE NEXT,"$4,142.68",$0.00,"$4,142.68","$1,864.20","$2,956.63",$0.00,$713.76,$0.00,$0.00,$725.35,"$4,142.68",$0.00,"$2,071.34","$3,281.00","$3,314.14",$0.00,$648.33,$0.00,$659.51,$0.00
M00516720,SUP,HCPCS C1874,,M00516720  -  STENT ESOPHAGEAL FLARE LP 18MM 18.5FR 15CM 120CM SELF EXPAND,"$5,973.03",$0.00,"$5,973.03","$2,687.86","$4,262.95",$0.00,"$1,029.12",$0.00,$0.00,"$1,045.83","$5,973.03",$0.00,"$2,986.51","$4,730.64","$4,778.42",$0.00,$934.78,$0.00,$950.91,$0.00
M00516900,SUP,HCPCS C1874,,M00516900  -  STENT ESOPHAGEAL LP 18MM 18.5FR 10CM 7CM PRTL COVER COAXIAL,"$5,912.23",$0.00,"$5,912.23","$2,660.50","$4,219.55",$0.00,"$1,018.65",$0.00,$0.00,"$1,035.18","$5,912.23",$0.00,"$2,956.11","$4,682.49","$4,729.78",$0.00,$925.26,$0.00,$941.23,$0.00
M00516910,SUP,HCPCS C1874,,M00516910  -  STENT ESOPHAGEAL LP 18MM 18.5FR 12CM 9CM PRTL COVER COAXIAL,"$5,912.23",$0.00,"$5,912.23","$2,660.50","$4,219.55",$0.00,"$1,018.65",$0.00,$0.00,"$1,035.18","$5,912.23",$0.00,"$2,956.11","$4,682.49","$4,729.78",$0.00,$925.26,$0.00,$941.23,$0.00
M00516920,SUP,HCPCS C1874,,M00516920  -  STENT ESOPHAGEAL LP 23MM 18MM 153MM 12CM PRTL COVER COAXIAL,"$5,912.23",$0.00,"$5,912.23","$2,660.50","$4,219.55",$0.00,"$1,018.65",$0.00,$0.00,"$1,035.18","$5,912.23",$0.00,"$2,956.11","$4,682.49","$4,729.78",$0.00,$925.26,$0.00,$941.23,$0.00
M00516930,SUP,HCPCS C1874,,M00516930  -  STENT ESOPHAGEAL LP 23MM 18.5MM 10CM 7CM BRAID DELIVERY,"$5,912.23",$0.00,"$5,912.23","$2,660.50","$4,219.55",$0.00,"$1,018.65",$0.00,$0.00,"$1,035.18","$5,912.23",$0.00,"$2,956.11","$4,682.49","$4,729.78",$0.00,$925.26,$0.00,$941.23,$0.00
M00516950,SUP,HCPCS C1874,,M00516950  -  STENT ESOPHAGEAL LP 23MM 18.5FR 15CM 12CM BRAID DELIVERY,"$5,912.23",$0.00,"$5,912.23","$2,660.50","$4,219.55",$0.00,"$1,018.65",$0.00,$0.00,"$1,035.18","$5,912.23",$0.00,"$2,956.11","$4,682.49","$4,729.78",$0.00,$925.26,$0.00,$941.23,$0.00
M00522611,SUP,Custom 27803010,,M00522611  -  CLIP INTERNAL 11MM 235CM 2.8MM SECURE LOCK RADIOPQ USER,$397.13,$0.00,$425.00,$0.00,$303.32,$0.00,$0.00,$0.00,$0.00,$0.00,$425.00,$0.00,$212.50,$314.53,$340.00,$0.00,$0.00,$0.00,$0.00,$0.00
M00522611,SUP,Custom 27203591,,RESOLUTION 235CM,$425.00,$0.00,$425.00,$0.00,$303.32,$0.00,$0.00,$0.00,$0.00,$0.00,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$0.00,$0.00,$0.00,$0.00
M00522612,SUP,Custom 27803010,,M00522612  -  CLIP INTERNAL 11MM OPEN 235CM 2.8MM HEMOSTASIS RESOLUTION,$384.76,$0.00,$384.76,$0.00,$274.60,$0.00,$0.00,$0.00,$0.00,$0.00,$384.76,$0.00,$192.38,$304.73,$307.81,$0.00,$0.00,$0.00,$0.00,$0.00
M00530850,SUP,HCPCS C1769,,M00530850  -  CANNULA ERCP STANDARD 5FR 210CM GWIRE CNTOUR BILIARY STERILE,$114.38,$0.00,$114.38,$62.11,$81.63,$0.00,$19.71,$0.00,$0.00,$20.03,$114.38,$0.00,$57.19,$90.59,$91.50,$0.00,$17.90,$0.00,$18.21,$0.00
M00530860,SUP,HCPCS C1769,,M00530860  -  CANNULA ERCP TAPER 5FR 210CM CNTOUR BILIARY DISPOSABLE,$114.38,$0.00,$114.38,$62.11,$81.63,$0.00,$19.71,$0.00,$0.00,$20.03,$114.38,$0.00,$57.19,$90.59,$91.50,$0.00,$17.90,$0.00,$18.21,$0.00
M00530960,SUP,HCPCS C1769,,M00530960  -  CANNU ERCP .025IN STD TIP GWIRE FLRTP 210CM 5FR BIL STRL,$81.93,$0.00,$81.93,$44.49,$58.47,$0.00,$14.12,$0.00,$0.00,$14.35,$81.93,$0.00,$40.96,$64.89,$65.54,$0.00,$12.82,$0.00,$13.04,$0.00
M00530970,SUP,HCPCS C1769,,M00530970  -  CANNU ERCP .035IN TPR TIP GWIRE FLRTP 210CM 5FR BIL STRL,$81.93,$0.00,$81.93,$44.49,$58.47,$0.00,$14.12,$0.00,$0.00,$14.35,$81.93,$0.00,$40.96,$64.89,$65.54,$0.00,$12.82,$0.00,$13.04,$0.00
M00530980,SUP,HCPCS C1769,,M00530980  -  CANNU ERCP .025IN TPR TIP FLRTP 210CM 5FR BIL STRL DISP,$81.93,$0.00,$81.93,$44.49,$58.47,$0.00,$14.12,$0.00,$0.00,$14.35,$81.93,$0.00,$40.96,$64.89,$65.54,$0.00,$12.82,$0.00,$13.04,$0.00
M00532240,SUP,HCPCS C2617,,M00532240  -  STENT BILIARY 2 PIGTAIL CURVE 10FR 3CM RAPEX TEMPORARY,$135.88,$0.00,$135.88,$61.14,$96.97,$0.00,$23.41,$0.00,$0.00,$23.79,$135.88,$0.00,$67.94,$107.62,$108.70,$0.00,$21.26,$0.00,$21.63,$0.00
M00532260,SUP,HCPCS C2617,,M00532260  -  STENT BILIARY 2 PIGTAIL CURVE 3.3MM 5CM TEMPORARY RAPEX,$135.88,$0.00,$135.88,$61.14,$96.97,$0.00,$23.41,$0.00,$0.00,$23.79,$135.88,$0.00,$67.94,$107.62,$108.70,$0.00,$21.26,$0.00,$21.63,$0.00
M00532270,SUP,HCPCS C2617,,M00532270  -  STENT BILIARY 2 PIGTAIL CURVE 10FR 7CM RAPEX TEMPORARY,$135.88,$0.00,$135.88,$61.14,$96.97,$0.00,$23.41,$0.00,$0.00,$23.79,$135.88,$0.00,$67.94,$107.62,$108.70,$0.00,$21.26,$0.00,$21.63,$0.00
M00533580,SUP,HCPCS C2617,,M00533580  -  STENT BILIARY 10FR 202.5CM DELIVERY SYSTEM RAPEX ADVANIX,$201.45,$0.00,$201.45,$90.65,$143.77,$0.00,$34.71,$0.00,$0.00,$35.27,$201.45,$0.00,$100.73,$159.55,$161.16,$0.00,$31.53,$0.00,$32.07,$0.00
M00534200,SUP,HCPCS C2617,,M00534200  -  STENT BILIARY DUODENAL BEND 7FR 5CM RAPEX PRELOAD DELIVERY,$330.73,$0.00,$330.73,$148.83,$236.04,$0.00,$56.98,$0.00,$0.00,$57.91,$330.73,$0.00,$165.36,$261.94,$264.58,$0.00,$51.76,$0.00,$52.65,$0.00
M00534210,SUP,HCPCS C2617,,M00534210  -  STENT BILIARY DUODENAL BEND 7FR 7CM PRELOAD TEMPORARY RAPEX,$330.73,$0.00,$330.73,$148.83,$236.04,$0.00,$56.98,$0.00,$0.00,$57.91,$330.73,$0.00,$165.36,$261.94,$264.58,$0.00,$51.76,$0.00,$52.65,$0.00
M00534220,SUP,HCPCS C2617,,M00534220  -  STENT BILIARY DUODENAL BEND 7FR 9CM RAPEX PRELOAD ADVANIX,$330.73,$0.00,$330.73,$148.83,$236.04,$0.00,$56.98,$0.00,$0.00,$57.91,$330.73,$0.00,$165.36,$261.94,$264.58,$0.00,$51.76,$0.00,$52.65,$0.00
M00534230,SUP,HCPCS C2617,,M00534230  -  STENT BILIARY DUODENAL BEND 7FR 12CM RAPEX PRELOAD ADVANIX,$330.73,$0.00,$330.73,$148.83,$236.04,$0.00,$56.98,$0.00,$0.00,$57.91,$330.73,$0.00,$165.36,$261.94,$264.58,$0.00,$51.76,$0.00,$52.65,$0.00
M00534260,SUP,HCPCS C2617,,M00534260  -  STENT BILIARY DUODENAL BEND 2.83MM 5CM PRELOAD RAPEX,$330.73,$0.00,$330.73,$148.83,$236.04,$0.00,$56.98,$0.00,$0.00,$57.91,$330.73,$0.00,$165.36,$261.94,$264.58,$0.00,$51.76,$0.00,$52.65,$0.00
M00534270,SUP,HCPCS C2617,,M00534270  -  STENT BILIARY DUODENAL BEND 2.83MM 7CM PRELOAD RAPEX,$330.73,$0.00,$330.73,$148.83,$236.04,$0.00,$56.98,$0.00,$0.00,$57.91,$330.73,$0.00,$165.36,$261.94,$264.58,$0.00,$51.76,$0.00,$52.65,$0.00
M00534320,SUP,HCPCS C2617,,M00534320  -  STENT BILIARY DUODENAL BEND 10FR 5CM PRELOAD RAPEX DELIVERY,$330.73,$0.00,$330.73,$148.83,$236.04,$0.00,$56.98,$0.00,$0.00,$57.91,$330.73,$0.00,$165.36,$261.94,$264.58,$0.00,$51.76,$0.00,$52.65,$0.00
M00534330,SUP,HCPCS C2617,,M00534330  -  STENT BILIARY DUODENAL BEND 10FR 7CM PRELOAD RADIOPQ MARKER,$330.73,$0.00,$330.73,$148.83,$236.04,$0.00,$56.98,$0.00,$0.00,$57.91,$330.73,$0.00,$165.36,$261.94,$264.58,$0.00,$51.76,$0.00,$52.65,$0.00
M00534340,SUP,HCPCS C2617,,M00534340  -  STENT BILIARY DUODENAL BEND 10FR 9CM PRELOAD RADIOPQ MARKER,$330.73,$0.00,$330.73,$148.83,$236.04,$0.00,$56.98,$0.00,$0.00,$57.91,$330.73,$0.00,$165.36,$261.94,$264.58,$0.00,$51.76,$0.00,$52.65,$0.00
M00534350,SUP,HCPCS C2617,,M00534350  -  STENT BILIARY DUODENAL BEND 10FR 12CM PRELOAD TEMPORARY,$330.73,$0.00,$330.73,$148.83,$236.04,$0.00,$56.98,$0.00,$0.00,$57.91,$330.73,$0.00,$165.36,$261.94,$264.58,$0.00,$51.76,$0.00,$52.65,$0.00
M00534360,SUP,HCPCS C1726,,M00534360  -  STENT BILIARY DUODENAL BEND 10FR 15CM PRELOAD TEMPORARY,$330.73,$0.00,$330.73,$179.58,$236.04,$0.00,$56.98,$0.00,$0.00,$57.91,$330.73,$0.00,$165.36,$261.94,$264.58,$0.00,$51.76,$0.00,$52.65,$0.00
M00545170,SUP,HCPCS C1769,,M00545170  -  SPHINCTEROTOME ESCP 4.4FR 20MM STRL 5MM ATME RX CANNULATE,$528.53,$0.00,"$1,110.00",$0.00,$792.21,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,110.00",$0.00,$555.00,$418.60,$888.00,$0.00,$0.00,$0.00,$0.00,$0.00
M00545170,SUP,Custom 27203596,,AUTOTOME RX 44-20MM,"$1,110.00",$0.00,"$1,110.00",$0.00,$792.21,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,110.00",$0.00,$555.00,$879.12,$888.00,$0.00,$0.00,$0.00,$0.00,$0.00
M00545190,SUP,HCPCS C1769,,M00545190  -  SPHINCTEROTOME ESCP 3.9FR 20MM STRL 5MM ATME RX CANNULATE,$528.53,$0.00,"$1,110.00",$0.00,$792.21,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,110.00",$0.00,$555.00,$418.60,$888.00,$0.00,$0.00,$0.00,$0.00,$0.00
M00545190,SUP,Custom 27203597,,AUTOTOME RX 39-20MM,"$1,110.00",$0.00,"$1,110.00",$0.00,$792.21,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,110.00",$0.00,$555.00,$879.12,$888.00,$0.00,$0.00,$0.00,$0.00,$0.00
M00545261,SUP,Custom 27203010,,M00545261  -  SYSTEM CHLGM RX LCK DEV BX CAP DISP OLMPS FUJIFILM G5 SER,$23.06,$0.00,$23.06,$0.00,$16.46,$0.00,$0.00,$0.00,$0.00,$0.00,$23.06,$0.00,$11.53,$18.26,$18.45,$0.00,$0.00,$0.00,$0.00,$0.00
M00545550,SUP,Custom 27803070,,RX STENT / 7 X 5CM,$121.00,$0.00,$121.00,$0.00,$86.36,$0.00,$0.00,$0.00,$0.00,$0.00,$121.00,$0.00,$60.50,$95.83,$96.80,$0.00,$0.00,$0.00,$0.00,$0.00
M00545550,SUP,HCPCS C2617,,M00545550  -  STENT BIL DDNL BND 7FR 5CM RX DLV SYS DISP ACPT .035IN GW,$256.53,$0.00,$203.17,$0.00,$86.36,$0.00,$0.00,$0.00,$0.00,$0.00,$121.00,$0.00,$60.50,$203.17,$96.80,$0.00,$0.00,$0.00,$0.00,$0.00
M00545560,SUP,HCPCS C2617,,M00545560  -  STENT BIL DDNL BND 7FR 7CM RX DLV SYS DISP ACPT .035IN GW,$256.53,$0.00,$256.53,$115.44,$183.08,$0.00,$44.20,$0.00,$0.00,$44.92,$256.53,$0.00,$128.26,$203.17,$205.22,$0.00,$40.15,$0.00,$40.84,$0.00
M00545570,SUP,Custom 27803081,,RX STENT / 7 X 10CM,$121.00,$0.00,$121.00,$0.00,$86.36,$0.00,$0.00,$0.00,$0.00,$0.00,$121.00,$0.00,$60.50,$95.83,$96.80,$0.00,$0.00,$0.00,$0.00,$0.00
M00545570,SUP,HCPCS C2617,,M00545570  -  STENT BIL DDNL BND 7FR 10CM RX DLV SYS DISP ACPT .035IN GW,$256.53,$0.00,$203.17,$0.00,$86.36,$0.00,$0.00,$0.00,$0.00,$0.00,$121.00,$0.00,$60.50,$203.17,$96.80,$0.00,$0.00,$0.00,$0.00,$0.00
M00545580,SUP,Custom 27803072,,RX STENT / 7 X 12CM,$247.50,$0.00,$247.50,$0.00,$176.64,$0.00,$0.00,$0.00,$0.00,$0.00,$247.50,$0.00,$123.75,$196.02,$198.00,$0.00,$0.00,$0.00,$0.00,$0.00
M00545580,SUP,HCPCS C2617,,M00545580  -  STENT BIL DDNL BND 7FR 12CM RX DLV SYS DISP ACPT .035IN GW,$256.53,$0.00,$247.50,$0.00,$176.64,$0.00,$0.00,$0.00,$0.00,$0.00,$247.50,$0.00,$123.75,$203.17,$198.00,$0.00,$0.00,$0.00,$0.00,$0.00
M00545610,SUP,Custom 27803074,,RX STENT / 10 X 7CM,$121.00,$0.00,$121.00,$0.00,$86.36,$0.00,$0.00,$0.00,$0.00,$0.00,$121.00,$0.00,$60.50,$95.83,$96.80,$0.00,$0.00,$0.00,$0.00,$0.00
M00545610,SUP,HCPCS C2617,,M00545610  -  STENT BIL DDNL BND 10FR 7CM RX DLV SYS DISP ACPT .035IN GW,$256.53,$0.00,$203.17,$0.00,$86.36,$0.00,$0.00,$0.00,$0.00,$0.00,$121.00,$0.00,$60.50,$203.17,$96.80,$0.00,$0.00,$0.00,$0.00,$0.00
M00545620,SUP,Custom 27803075,,RX STENT / 10 X 10CM,$121.00,$0.00,$121.00,$0.00,$86.36,$0.00,$0.00,$0.00,$0.00,$0.00,$121.00,$0.00,$60.50,$95.83,$96.80,$0.00,$0.00,$0.00,$0.00,$0.00
M00545620,SUP,HCPCS C2617,,M00545620  -  STENT BIL DDNL BND 10FR 10CM RX DLV SYS DISP ACPT .035IN GW,$256.53,$0.00,$203.17,$0.00,$86.36,$0.00,$0.00,$0.00,$0.00,$0.00,$121.00,$0.00,$60.50,$203.17,$96.80,$0.00,$0.00,$0.00,$0.00,$0.00
M00545630,SUP,Custom 27803076,,RX STENT / 10 X 12CM,$121.00,$0.00,$121.00,$0.00,$86.36,$0.00,$0.00,$0.00,$0.00,$0.00,$121.00,$0.00,$60.50,$95.83,$96.80,$0.00,$0.00,$0.00,$0.00,$0.00
M00545630,SUP,HCPCS C2617,,M00545630  -  STENT BIL DDNL BND 10FR 12CM RX DLV SYS DISP ACPT .035IN GW,$256.53,$0.00,$203.17,$0.00,$86.36,$0.00,$0.00,$0.00,$0.00,$0.00,$121.00,$0.00,$60.50,$203.17,$96.80,$0.00,$0.00,$0.00,$0.00,$0.00
M00545650,SUP,Custom 27803077,,RX STENT / 8.5 X 5CM,$121.00,$0.00,$121.00,$0.00,$86.36,$0.00,$0.00,$0.00,$0.00,$0.00,$121.00,$0.00,$60.50,$95.83,$96.80,$0.00,$0.00,$0.00,$0.00,$0.00
M00545650,SUP,HCPCS C2617,,M00545650  -  STENT BIL DDNL BND 8.5FR 5CM RX DLV SYS DISP ACPT .035IN GW,$256.53,$0.00,$203.17,$0.00,$86.36,$0.00,$0.00,$0.00,$0.00,$0.00,$121.00,$0.00,$60.50,$203.17,$96.80,$0.00,$0.00,$0.00,$0.00,$0.00
M00545660,SUP,Custom 27803078,,RX STENT / 8.5 X 7CM,$121.00,$0.00,$121.00,$0.00,$86.36,$0.00,$0.00,$0.00,$0.00,$0.00,$121.00,$0.00,$60.50,$95.83,$96.80,$0.00,$0.00,$0.00,$0.00,$0.00
M00545660,SUP,HCPCS C2617,,M00545660  -  STENT BIL DDNL BND 8.5FR 7CM RX DLV SYS DISP ACPT .035IN GW,$256.53,$0.00,$203.17,$0.00,$86.36,$0.00,$0.00,$0.00,$0.00,$0.00,$121.00,$0.00,$60.50,$203.17,$96.80,$0.00,$0.00,$0.00,$0.00,$0.00
M00545670,SUP,Custom 27803079,,RX STENT / 8.5 X 10CM,$121.00,$0.00,$121.00,$0.00,$86.36,$0.00,$0.00,$0.00,$0.00,$0.00,$121.00,$0.00,$60.50,$95.83,$96.80,$0.00,$0.00,$0.00,$0.00,$0.00
M00545670,SUP,HCPCS C2617,,M00545670  -  STENT BIL DDNL BND 8.5FR 10CM RX DLV SYS DISP ACPT .035IN GW,$256.53,$0.00,$203.17,$0.00,$86.36,$0.00,$0.00,$0.00,$0.00,$0.00,$121.00,$0.00,$60.50,$203.17,$96.80,$0.00,$0.00,$0.00,$0.00,$0.00
M00545680,SUP,Custom 27803080,,RX STENT / 8.5 X 12CM,$121.00,$0.00,$121.00,$0.00,$86.36,$0.00,$0.00,$0.00,$0.00,$0.00,$121.00,$0.00,$60.50,$95.83,$96.80,$0.00,$0.00,$0.00,$0.00,$0.00
M00545680,SUP,HCPCS C2617,,M00545680  -  STENT BIL DDNL BND 8.5FR 12CM RX DLV SYS DISP ACPT .035IN GW,$256.53,$0.00,$203.17,$0.00,$86.36,$0.00,$0.00,$0.00,$0.00,$0.00,$121.00,$0.00,$60.50,$203.17,$96.80,$0.00,$0.00,$0.00,$0.00,$0.00
M00545700,SUP,HCPCS C2625,,RX STENT / 11.5 X 5,$121.00,$0.00,$121.00,$54.45,$86.36,$0.00,$20.85,$0.00,$0.00,$21.19,$121.00,$0.00,$60.50,$95.83,$96.80,$0.00,$18.94,$0.00,$19.26,$0.00
M00545700,SUP,HCPCS C2617,,M00545700  -  STENT BIL DDNL BND 11.5FR 5CM RX DLV SYS DISP ACPT .035IN GW,$256.53,$0.00,$203.17,$54.45,$86.36,$0.00,$20.85,$0.00,$0.00,$21.19,$121.00,$0.00,$60.50,$203.17,$96.80,$0.00,$18.94,$0.00,$19.26,$0.00
M00545710,SUP,HCPCS C2625,,RX STENT / 11.5 X 7CM,$121.00,$0.00,$121.00,$54.45,$86.36,$0.00,$20.85,$0.00,$0.00,$21.19,$121.00,$0.00,$60.50,$95.83,$96.80,$0.00,$18.94,$0.00,$19.26,$0.00
M00545710,SUP,HCPCS C2617,,M00545710  -  STENT BIL DDNL BND 11.5FR 7CM RX DLV SYS DISP ACPT .035IN GW,$256.53,$0.00,$203.17,$54.45,$86.36,$0.00,$20.85,$0.00,$0.00,$21.19,$121.00,$0.00,$60.50,$203.17,$96.80,$0.00,$18.94,$0.00,$19.26,$0.00
M00545720,SUP,HCPCS C2625,,RX STENT / 11.5 X 10CM,$121.00,$0.00,$121.00,$54.45,$86.36,$0.00,$20.85,$0.00,$0.00,$21.19,$121.00,$0.00,$60.50,$95.83,$96.80,$0.00,$18.94,$0.00,$19.26,$0.00
M00545720,SUP,HCPCS C2617,,M00545720  -  STENT BIL DDNL BND 11.5FR 10CM RX DLV SYS DISP ACPT .035IN,$256.53,$0.00,$203.17,$54.45,$86.36,$0.00,$20.85,$0.00,$0.00,$21.19,$121.00,$0.00,$60.50,$203.17,$96.80,$0.00,$18.94,$0.00,$19.26,$0.00
M00545730,SUP,HCPCS C2625,,RX STENT / 11.5 X 12CM,$121.00,$0.00,$121.00,$54.45,$86.36,$0.00,$20.85,$0.00,$0.00,$21.19,$121.00,$0.00,$60.50,$95.83,$96.80,$0.00,$18.94,$0.00,$19.26,$0.00
M00545730,SUP,HCPCS C2617,,M00545730  -  STENT BIL DDNL BND 11.5FR 12CM RX DLV SYS DISP ACPT .035IN,$256.53,$0.00,$203.17,$54.45,$86.36,$0.00,$20.85,$0.00,$0.00,$21.19,$121.00,$0.00,$60.50,$203.17,$96.80,$0.00,$18.94,$0.00,$19.26,$0.00
M00545740,SUP,HCPCS C2625,,RX STENT / 11.5 X 15CM,$121.00,$0.00,$121.00,$54.45,$86.36,$0.00,$20.85,$0.00,$0.00,$21.19,$121.00,$0.00,$60.50,$95.83,$96.80,$0.00,$18.94,$0.00,$19.26,$0.00
M00545740,SUP,HCPCS C1876,,M00545740  -  STENT BIL DDNL BND 11.5FR 15CM RX DLV SYS DISP ACPT .035IN,$256.53,$0.00,$203.17,$54.45,$86.36,$0.00,$20.85,$0.00,$0.00,$21.19,$121.00,$0.00,$60.50,$203.17,$96.80,$0.00,$18.94,$0.00,$19.26,$0.00
M00545840,SUP,Custom 27203599,,NEEDLEKNIFE RX,$487.50,$0.00,$487.50,$0.00,$347.93,$0.00,$0.00,$0.00,$0.00,$0.00,$487.50,$0.00,$243.75,$386.10,$390.00,$0.00,$0.00,$0.00,$0.00,$0.00
M00545900,SUP,HCPCS C1726,,M00545900  -  CATHETER BLNDIL 12 ATM 4MM 180CM 4CM HRCN RX LOPRFL RADOPQ,$603.05,$0.00,$722.50,$0.00,$515.65,$0.00,$0.00,$0.00,$0.00,$0.00,$722.50,$0.00,$361.25,$477.62,$578.00,$0.00,$0.00,$0.00,$0.00,$0.00
M00545900,SUP,Custom 27203112,,RX DILATATION BLN 4-4/5.8/180,$722.50,$0.00,$722.50,$0.00,$515.65,$0.00,$0.00,$0.00,$0.00,$0.00,$722.50,$0.00,$361.25,$572.22,$578.00,$0.00,$0.00,$0.00,$0.00,$0.00
M00545920,SUP,HCPCS C1726,,M00545920  -  CATHETER BLNDIL 11 ATM 6MM 180CM 4CM HRCN RX LOPRFL RADOPQ,$603.05,$0.00,$722.50,$0.00,$515.65,$0.00,$0.00,$0.00,$0.00,$0.00,$722.50,$0.00,$361.25,$477.62,$578.00,$0.00,$0.00,$0.00,$0.00,$0.00
M00545920,SUP,Custom 27203113,,RX DILATATION BLN 6-4/5.8/180,$722.50,$0.00,$722.50,$0.00,$515.65,$0.00,$0.00,$0.00,$0.00,$0.00,$722.50,$0.00,$361.25,$572.22,$578.00,$0.00,$0.00,$0.00,$0.00,$0.00
M00545960,SUP,HCPCS C1726,,M00545960  -  CATHETER BLNDIL 8 ATM 10MM 180CM 4CM HRCN RX LOPRFL RADOPQ,$603.05,$0.00,$722.50,$0.00,$515.65,$0.00,$0.00,$0.00,$0.00,$0.00,$722.50,$0.00,$361.25,$477.62,$578.00,$0.00,$0.00,$0.00,$0.00,$0.00
M00545960,SUP,Custom 27203115,,RX DILATATION BALLOON 10-5.8/180,$722.50,$0.00,$722.50,$0.00,$515.65,$0.00,$0.00,$0.00,$0.00,$0.00,$722.50,$0.00,$361.25,$572.22,$578.00,$0.00,$0.00,$0.00,$0.00,$0.00
M00546900,SUP,HCPCS C1726,,M00546900  -  CATHETER SPEC RTRVL .035IN 6-7FR 9-12MM 200CM STRL LTX XTRT,$395.06,$0.00,$395.06,$214.52,$281.96,$0.00,$68.07,$0.00,$0.00,$69.17,$395.06,$0.00,$197.53,$312.89,$316.05,$0.00,$61.83,$0.00,$62.89,$0.00
M00546910,SUP,HCPCS C1726,,M00546910  -  CATHETER SPEC RTRVL .035IN 7-6FR 12-15MM 200CM STRL LTX XTRT,$395.06,$0.00,$395.06,$214.52,$281.96,$0.00,$68.07,$0.00,$0.00,$69.17,$395.06,$0.00,$197.53,$312.89,$316.05,$0.00,$61.83,$0.00,$62.89,$0.00
M00546920,SUP,HCPCS C1769,,M00546920  -  CATHETER SPEC RTRVL .035IN 7-6FR 15-18MM 200CM STRL LTX XTRT,$395.06,$0.00,$397.50,$0.00,$283.70,$0.00,$0.00,$0.00,$0.00,$0.00,$397.50,$0.00,$198.75,$312.89,$318.00,$0.00,$0.00,$0.00,$0.00,$0.00
M00546920,SUP,Custom 27203101,,EXTRACTOR RX 15-18MM ABOVE,$397.50,$0.00,$397.50,$0.00,$283.70,$0.00,$0.00,$0.00,$0.00,$0.00,$397.50,$0.00,$198.75,$314.82,$318.00,$0.00,$0.00,$0.00,$0.00,$0.00
M00547000,SUP,Custom 27203010,,M00547000  -  CATHETER BALDILAT 7-6FR 9-12MM 200CM 3 LUMEN SPECIMEN,$366.25,$0.00,$366.25,$0.00,$261.39,$0.00,$0.00,$0.00,$0.00,$0.00,$366.25,$0.00,$183.13,$290.07,$293.00,$0.00,$0.00,$0.00,$0.00,$0.00
M00547010,SUP,Custom 27203010,,M00547010  -  CATHETER BALDILAT 7-6FR 12-15MM 200CM 3 LUMEN SPECIMEN,$366.25,$0.00,$366.25,$0.00,$261.39,$0.00,$0.00,$0.00,$0.00,$0.00,$366.25,$0.00,$183.13,$290.07,$293.00,$0.00,$0.00,$0.00,$0.00,$0.00
M00547020,SUP,Custom 27203010,,M00547020  -  CATHETER BALDILAT 7-6FR 15-18MM 200CM 3 LUMEN SPECIMEN,$366.25,$0.00,$366.25,$0.00,$261.39,$0.00,$0.00,$0.00,$0.00,$0.00,$366.25,$0.00,$183.13,$290.07,$293.00,$0.00,$0.00,$0.00,$0.00,$0.00
M00551591,SUP,HCPCS C1769,,M00551591  -  GWIRE ENDSCP .018IN 450CM EXCH SHP PTHFND BIL STRL DISP,$317.83,$0.00,$317.83,$172.58,$226.84,$0.00,$54.76,$0.00,$0.00,$55.65,$317.83,$0.00,$158.92,$251.72,$254.26,$0.00,$49.74,$0.00,$50.60,$0.00
M00553650,SUP,HCPCS C1874,,M00553650  -  STENT PNCR 15MM 24MM 10MM 146MM 138MM 10.8FR CAUT,"$11,187.50",$0.00,"$11,187.50","$5,034.38","$5,158.80",$0.00,"$1,927.55",$0.00,$0.00,"$1,958.84","$11,187.50",$0.00,"$5,593.75","$8,860.50","$8,950.00",$0.00,"$1,750.84",$0.00,"$1,781.05",$0.00
M00553750,SUP,HCPCS C1874,,M00553750  -  STENT BIL 10MM 10.8FR 146CM 10MM 21MM LUM SDL AXS,"$9,687.50",$0.00,"$9,687.50","$4,359.38","$5,158.80",$0.00,"$1,669.11",$0.00,$0.00,"$1,696.20","$9,687.50",$0.00,"$4,843.75","$7,672.50","$7,750.00",$0.00,"$1,516.09",$0.00,"$1,542.25",$0.00
M00556021,SUP,HCPCS C1769,,M00556021  -  GUIDEWIRE ENDSCP STR .035IN 260CM HIGH PERFORMANCE RAPEX,$428.74,$0.00,$428.74,$232.80,$305.99,$0.00,$73.87,$0.00,$0.00,$75.07,$428.74,$0.00,$214.37,$339.56,$342.99,$0.00,$67.10,$0.00,$68.26,$0.00
M00556041,SUP,HCPCS C1769,,M00556041  -  GUIDEWIRE ENDSCP STR .035IN 450CM HIGH PERFORMANCE RAPEX,$428.74,$0.00,$428.74,$232.80,$305.99,$0.00,$73.87,$0.00,$0.00,$75.07,$428.74,$0.00,$214.37,$339.56,$342.99,$0.00,$67.10,$0.00,$68.26,$0.00
M00556621,SUP,HCPCS C1769,,M00556621  -  GUIDEWIRE ENDSCP STANDARD STR TRIM .038IN 260CM HIGH,$244.64,$0.00,$244.64,$132.84,$174.60,$0.00,$42.15,$0.00,$0.00,$42.83,$244.64,$0.00,$122.32,$193.75,$195.71,$0.00,$38.29,$0.00,$38.95,$0.00
M00558330,SUP,Custom 27203090,,CRE DILATION BALLOON CRE 6-8MM 8CM F/G,$562.50,$0.00,$562.50,$0.00,$401.46,$0.00,$0.00,$0.00,$0.00,$0.00,$562.50,$0.00,$281.25,$445.50,$450.00,$0.00,$0.00,$0.00,$0.00,$0.00
M00558340,SUP,Custom 27203091,,CRE DILATION BALLOON 8-10MM 8CM F/G,$562.50,$0.00,$562.50,$0.00,$401.46,$0.00,$0.00,$0.00,$0.00,$0.00,$562.50,$0.00,$281.25,$445.50,$450.00,$0.00,$0.00,$0.00,$0.00,$0.00
M00558350,SUP,Custom 27203092,,CRE DILATION BALLOON 10-12MM 8CM F/G,$562.50,$0.00,$562.50,$0.00,$401.46,$0.00,$0.00,$0.00,$0.00,$0.00,$562.50,$0.00,$281.25,$445.50,$450.00,$0.00,$0.00,$0.00,$0.00,$0.00
M00558360,SUP,Custom 27203094,,CRE DILATION BALLOON 15-18MM 8CM F/G,$562.50,$0.00,$562.50,$0.00,$401.46,$0.00,$0.00,$0.00,$0.00,$0.00,$562.50,$0.00,$281.25,$445.50,$450.00,$0.00,$0.00,$0.00,$0.00,$0.00
M00558370,SUP,HCPCS C1726,,M00558370  -  CATHETER BALDILAT 6FR 15-18MM 180CM 8CM FIX WIRE HIGH,$468.95,$0.00,$468.95,$254.64,$334.69,$0.00,$80.80,$0.00,$0.00,$82.11,$468.95,$0.00,$234.48,$371.41,$375.16,$0.00,$73.39,$0.00,$74.66,$0.00
M00558380,SUP,HCPCS C1726,,M00558380  -  CATHETER BALDILAT 6FR 18-20MM 180CM 8CM FIX WIRE HIGH,$468.95,$0.00,$562.50,$0.00,$401.46,$0.00,$0.00,$0.00,$0.00,$0.00,$562.50,$0.00,$281.25,$371.41,$450.00,$0.00,$0.00,$0.00,$0.00,$0.00
M00558380,SUP,Custom 27203095,,CRE DILATION BALLOON 18-20MM 8CM F/G,$562.50,$0.00,$562.50,$0.00,$401.46,$0.00,$0.00,$0.00,$0.00,$0.00,$562.50,$0.00,$281.25,$445.50,$450.00,$0.00,$0.00,$0.00,$0.00,$0.00
M00558410,SUP,HCPCS C1726,,M00558410  -  DILATOR ENDSCP 7.5FR 10-12MM 180CM 5.5CM CRE PEBAX ESOPHAGUS,$534.35,$0.00,$534.35,$290.15,$381.37,$0.00,$92.07,$0.00,$0.00,$93.56,$534.35,$0.00,$267.18,$423.21,$427.48,$0.00,$83.63,$0.00,$85.07,$0.00
M00558420,SUP,HCPCS C1726,,M00558420  -  DILATOR ENDSCP 7.5FR 12-15MM 180CM 5.5CM CRE PEBAX ESOPHAGUS,$534.35,$0.00,$534.35,$290.15,$381.37,$0.00,$92.07,$0.00,$0.00,$93.56,$534.35,$0.00,$267.18,$423.21,$427.48,$0.00,$83.63,$0.00,$85.07,$0.00
M00558450,SUP,HCPCS C1769,,M00558450  -  DILATOR ENDSCP 7.5FR 6-8MM 240CM 5.5CM INFLATE CRE PEBAX,$534.35,$0.00,$534.35,$290.15,$381.37,$0.00,$92.07,$0.00,$0.00,$93.56,$534.35,$0.00,$267.18,$423.21,$427.48,$0.00,$83.63,$0.00,$85.07,$0.00
M00558480,SUP,HCPCS C1769,,M00558480  -  DILATOR ENDSCP 7.5FR 12-15MM 240CM 5.5CM INFLATE CRE PEBAX,$534.35,$0.00,$534.35,$290.15,$381.37,$0.00,$92.07,$0.00,$0.00,$93.56,$534.35,$0.00,$267.18,$423.21,$427.48,$0.00,$83.63,$0.00,$85.07,$0.00
M00558500,SUP,HCPCS C1726,,M00558500  -  CATHETER BALDILAT 7.5FR 18-20MM 240CM 5.5CM WIRE GUIDE CRE,$534.35,$0.00,$534.35,$290.15,$381.37,$0.00,$92.07,$0.00,$0.00,$93.56,$534.35,$0.00,$267.18,$423.21,$427.48,$0.00,$83.63,$0.00,$85.07,$0.00
M00558660,SUP,HCPCS C1726,,M00558660  -  DILATOR ESCP 7.5FR 6-8MM 240CM STRL LF 5.5CM CRE INFL BLN,$534.35,$0.00,$534.35,$290.15,$381.37,$0.00,$92.07,$0.00,$0.00,$93.56,$534.35,$0.00,$267.18,$423.21,$427.48,$0.00,$83.63,$0.00,$85.07,$0.00
M00558670,SUP,HCPCS C1726,,M00558670  -  DILATOR ESCP 7.5FR 8-10MM 240CM STRL LF 5.5CM CRE INFL BLN,$534.35,$0.00,$534.35,$290.15,$381.37,$0.00,$92.07,$0.00,$0.00,$93.56,$534.35,$0.00,$267.18,$423.21,$427.48,$0.00,$83.63,$0.00,$85.07,$0.00
M00558680,SUP,HCPCS C1726,,M00558680  -  DILATOR ESCP 7.5FR 10-12MM 240CM STRL LF 5.5CM CRE INFL BLN,$534.35,$0.00,$534.35,$290.15,$381.37,$0.00,$92.07,$0.00,$0.00,$93.56,$534.35,$0.00,$267.18,$423.21,$427.48,$0.00,$83.63,$0.00,$85.07,$0.00
M00558690,SUP,HCPCS C1726,,M00558690  -  DILATOR ESCP 7.5FR 12-13.5-15MM 240CM STRL LF 5.5CM CRE INFL,$534.35,$0.00,$534.35,$290.15,$381.37,$0.00,$92.07,$0.00,$0.00,$93.56,$534.35,$0.00,$267.18,$423.21,$427.48,$0.00,$83.63,$0.00,$85.07,$0.00
M00558700,SUP,HCPCS C1726,,M00558700  -  DILATOR ESCP 7.5FR 15-16.5-18MM 240CM STRL LF 5.5CM CRE INFL,$534.35,$0.00,$534.35,$290.15,$381.37,$0.00,$92.07,$0.00,$0.00,$93.56,$534.35,$0.00,$267.18,$423.21,$427.48,$0.00,$83.63,$0.00,$85.07,$0.00
M00558710,SUP,HCPCS C1726,,M00558710  -  DILATOR ESCP 7.5FR 18-20MM 240CM STRL LF 5.5CM CRE INFL,$534.35,$0.00,$534.35,$290.15,$381.37,$0.00,$92.07,$0.00,$0.00,$93.56,$534.35,$0.00,$267.18,$423.21,$427.48,$0.00,$83.63,$0.00,$85.07,$0.00
M00560071,SUP,HCPCS C1726,,M00560071  -  CATHETER ELHMST 7FR 300CM STRL GLDPRB BP RND DIST TIP FIRM,$307.83,$0.00,$307.83,$167.15,$219.69,$0.00,$53.04,$0.00,$0.00,$53.90,$307.83,$0.00,$153.91,$243.80,$246.26,$0.00,$48.17,$0.00,$49.01,$0.00
M00560150,SUP,Custom 27203010,,M00560150  -  CATHETER ELHMST 7FR 25GA .24MM 210CM INJ GLDPRB BP RND DIST,$531.33,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$420.81,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
M00560150,SUP,Custom 27203118,,INJECTION GOLD PROBE 7FR,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
M00560160,SUP,HCPCS C1726,,M00560160  -  CATHETER ELECTROHEMOSTASIS 10FR 210CM BIPOL STANDARD PLUG,$531.33,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$420.81,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
M00560160,SUP,Custom 27203117,,INJECTION GOLD PROBE 10FR,$750.00,$0.00,$750.00,$0.00,$535.28,$0.00,$0.00,$0.00,$0.00,$0.00,$750.00,$0.00,$375.00,$594.00,$600.00,$0.00,$0.00,$0.00,$0.00,$0.00
M00561831,SUP,Custom 27203010,,M00561831  -  SNARE ENDSCP MINI STANDARD OVAL 2.4MM 195CMX20MM POLYPECTOMY,$47.00,$0.00,$47.00,$0.00,$33.54,$0.00,$0.00,$0.00,$0.00,$0.00,$47.00,$0.00,$23.50,$37.22,$37.60,$0.00,$0.00,$0.00,$0.00,$0.00
M00562321,SUP,Custom 27203010,,M00562321  -  SNARE ESCP MED OVL 2.4MM 240CM 27MM CPTVTR STF DISP PLYP,$34.05,$0.00,$34.05,$0.00,$24.30,$0.00,$0.00,$0.00,$0.00,$0.00,$34.05,$0.00,$17.03,$26.97,$27.24,$0.00,$0.00,$0.00,$0.00,$0.00
M00562391,SUP,Custom 27203010,,M00562391  -  SNARE ENDSCP THIN JUMBO OVAL 2.4MM 240CM 30MM FLEXIBLE WIRE,$34.05,$0.00,$34.05,$0.00,$24.30,$0.00,$0.00,$0.00,$0.00,$0.00,$34.05,$0.00,$17.03,$26.97,$27.24,$0.00,$0.00,$0.00,$0.00,$0.00
M00562401,SUP,Custom 27203010,,M00562401  -  SNARE ENDSCP MEDIUM OVAL 2.4MM 240CM 27MM LOOP FLEXIBLE,$32.92,$0.00,$32.92,$0.00,$23.49,$0.00,$0.00,$0.00,$0.00,$0.00,$32.92,$0.00,$16.46,$26.07,$26.33,$0.00,$0.00,$0.00,$0.00,$0.00
M00562402,SUP,Custom 27203010,,M00562402  -  SNARE ENDSCP STANDARD OVAL 2.4MM 240CMX27MM FLEXIBLE,$21.63,$0.00,$21.63,$0.00,$15.44,$0.00,$0.00,$0.00,$0.00,$0.00,$21.63,$0.00,$10.82,$17.13,$17.31,$0.00,$0.00,$0.00,$0.00,$0.00
M00562671,SUP,Custom 27203010,,M00562671  -  INTRODUCER SHTH 9.5FR HMSTS VLV SDPRT,$45.00,$0.00,$45.00,$0.00,$32.12,$0.00,$0.00,$0.00,$0.00,$0.00,$45.00,$0.00,$22.50,$35.64,$36.00,$0.00,$0.00,$0.00,$0.00,$0.00
M00565020,SUP,HCPCS C1876,,M00565020  -  STENT DUODENAL 22-27MM 10FR 9CM 230CM DELIVERY SYSTEM,"$6,258.18",$0.00,"$6,258.18","$2,816.18","$4,466.46",$0.00,"$1,078.25",$0.00,$0.00,"$1,095.76","$6,258.18",$0.00,"$3,129.09","$4,956.48","$5,006.54",$0.00,$979.40,$0.00,$996.30,$0.00
M00565040,SUP,HCPCS C1874,,M00565040  -  STENT COLONIC 25-30MM 10FR 60CM 230CM DELIVERY SYSTEM,"$6,258.18",$0.00,"$6,258.18","$2,816.18","$4,466.46",$0.00,"$1,078.25",$0.00,$0.00,"$1,095.76","$6,258.18",$0.00,"$3,129.09","$4,956.48","$5,006.54",$0.00,$979.40,$0.00,$996.30,$0.00
M00565050,SUP,HCPCS C1874,,M00565050  -  STENT COLONIC 25-30MM 10FR 90CM 230CM DELIVERY SYSTEM,"$6,258.18",$0.00,"$6,258.18","$2,816.18","$4,466.46",$0.00,"$1,078.25",$0.00,$0.00,"$1,095.76","$6,258.18",$0.00,"$3,129.09","$4,956.48","$5,006.54",$0.00,$979.40,$0.00,$996.30,$0.00
M00565060,SUP,HCPCS C1874,,M00565060  -  STENT COLONIC 25-30MM 10FR 120CM 230CM DELIVERY SYSTEM,"$6,258.18",$0.00,"$6,258.18","$2,816.18","$4,466.46",$0.00,"$1,078.25",$0.00,$0.00,"$1,095.76","$6,258.18",$0.00,"$3,129.09","$4,956.48","$5,006.54",$0.00,$979.40,$0.00,$996.30,$0.00
M00566461,SUP,Custom 27203010,,M00566461  -  KIT PG 20FR 5ML STRL LF EVV PUL METH AMP TROC CNN RND XTRN,$242.87,$0.00,$242.87,$0.00,$173.33,$0.00,$0.00,$0.00,$0.00,$0.00,$242.87,$0.00,$121.43,$192.35,$194.29,$0.00,$0.00,$0.00,$0.00,$0.00
M00566471,SUP,HCPCS C1769,,M00566471  -  KIT PG 11 20FR 22GA 1.5IN STRL LF EVV SFGLD CHLRPRP PUSH,$242.87,$0.00,$242.87,$131.88,$173.33,$0.00,$41.84,$0.00,$0.00,$42.52,$242.87,$0.00,$121.43,$192.35,$194.29,$0.00,$38.01,$0.00,$38.66,$0.00
M00566481,SUP,Custom 27203010,,M00566481  -  KIT PG 24FR 5ML STRL LF EVV PUL METH AMP TROC CNN RND XTRN,$242.86,$0.00,$242.86,$0.00,$173.33,$0.00,$0.00,$0.00,$0.00,$0.00,$242.86,$0.00,$121.43,$192.35,$194.29,$0.00,$0.00,$0.00,$0.00,$0.00
M00566670,SUP,Custom 27203116,,ENCORE 26 SINGLE,$182.50,$0.00,$182.50,$0.00,$130.25,$0.00,$0.00,$0.00,$0.00,$0.00,$182.50,$0.00,$91.25,$144.54,$146.00,$0.00,$0.00,$0.00,$0.00,$0.00
M0056820,SUP,Custom 27203010,,M0056820  -  KIT PG 20FR SIL PUL METH FENST DRP STD CLMP EVV 5ML,$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
M00568201,SUP,Custom 27203010,,M00568201  -  KIT PG 20FR SIL PUL METH FENST DRP STD CLMP EVV 5ML,$202.00,$0.00,$202.00,$0.00,$144.17,$0.00,$0.00,$0.00,$0.00,$0.00,$202.00,$0.00,$101.00,$159.98,$161.60,$0.00,$0.00,$0.00,$0.00,$0.00
M0056824,SUP,Custom 27203010,,KIT PG 24FR PUL METH STD EVV,$137.50,$0.00,$137.50,$0.00,$98.13,$0.00,$0.00,$0.00,$0.00,$0.00,$137.50,$0.00,$68.75,$108.90,$110.00,$0.00,$0.00,$0.00,$0.00,$0.00
M00568241,SUP,Custom 27203010,,M00568241  -  KIT PG 24FR 6824,$202.00,$0.00,$202.00,$0.00,$144.17,$0.00,$0.00,$0.00,$0.00,$0.00,$202.00,$0.00,$101.00,$159.98,$161.60,$0.00,$0.00,$0.00,$0.00,$0.00
M00570360,SUP,HCPCS C1874,,M00570360  -  STENT BIL .035IN 10MM 8.5FR 40MM 194CM WALLFLEX RMLM FLLY,"$6,297.90",$0.00,"$6,297.90","$2,834.06","$4,494.81",$0.00,"$1,085.10",$0.00,$0.00,"$1,102.71","$6,297.90",$0.00,"$3,148.95","$4,987.94","$5,038.32",$0.00,$985.62,$0.00,"$1,002.63",$0.00
M00570370,SUP,HCPCS C1874,,M00570370  -  STENT BIL .035IN 10MM 8.5FR 60MM 194CM WALLFLEX RMLM FLLY,"$6,297.90",$0.00,"$6,297.90","$2,834.06","$4,494.81",$0.00,"$1,085.10",$0.00,$0.00,"$1,102.71","$6,297.90",$0.00,"$3,148.95","$4,987.94","$5,038.32",$0.00,$985.62,$0.00,"$1,002.63",$0.00
M00570380,SUP,HCPCS C1874,,M00570380  -  STENT BIL .035IN 10MM 8.5FR 80MM 194CM WALLFLEX RMLM FLLY,"$6,297.90",$0.00,"$6,297.90","$2,834.06","$4,494.81",$0.00,"$1,085.10",$0.00,$0.00,"$1,102.71","$6,297.90",$0.00,"$3,148.95","$4,987.94","$5,038.32",$0.00,$985.62,$0.00,"$1,002.63",$0.00
M00570520,SUP,HCPCS C1874,,M00570520  -  STENT BILIARY 10MM 8.5FR 40MM RAPEX WALLFLEX PERMALUME,"$6,297.90",$0.00,"$6,297.90","$2,834.06","$4,494.81",$0.00,"$1,085.10",$0.00,$0.00,"$1,102.71","$6,297.90",$0.00,"$3,148.95","$4,987.94","$5,038.32",$0.00,$985.62,$0.00,"$1,002.63",$0.00
M00570530,SUP,HCPCS C1769,,M00570530  -  STENT BILIARY 10MM 8.5FR 60MM RAPEX SELF EXPAND WALLFLEX,"$6,297.90",$0.00,"$6,297.90","$3,419.76","$4,494.81",$0.00,"$1,085.10",$0.00,$0.00,"$1,102.71","$6,297.90",$0.00,"$3,148.95","$4,987.94","$5,038.32",$0.00,$985.62,$0.00,"$1,002.63",$0.00
M00570540,SUP,HCPCS C1874,,M00570540  -  STENT BILIARY 10MM 8.5FR 80MM RAPEX SELF EXPAND WALLFLEX,"$6,297.90",$0.00,"$6,297.90","$2,834.06","$4,494.81",$0.00,"$1,085.10",$0.00,$0.00,"$1,102.71","$6,297.90",$0.00,"$3,148.95","$4,987.94","$5,038.32",$0.00,$985.62,$0.00,"$1,002.63",$0.00
M00570640,SUP,HCPCS C1769,,M00570640  -  STENT BIL 10MM 8FR 60MM 194CM WLSTNT UNCOVER INTGR RTRVL,"$4,215.63",$0.00,"$4,215.63","$2,289.08","$3,008.69",$0.00,$726.33,$0.00,$0.00,$738.12,"$4,215.63",$0.00,"$2,107.81","$3,338.78","$3,372.50",$0.00,$659.75,$0.00,$671.13,$0.00
M00570650,SUP,HCPCS C1769,,M00570650  -  STENT BILIARY 10MM 8FR 80MM RAPEX DELIVERY SYSTEM WALLFLEX,"$4,215.63",$0.00,"$4,215.63","$2,289.08","$3,008.69",$0.00,$726.33,$0.00,$0.00,$738.12,"$4,215.63",$0.00,"$2,107.81","$3,338.78","$3,372.50",$0.00,$659.75,$0.00,$671.13,$0.00
M00570660,SUP,HCPCS C1769,,M00570660  -  STENT BILIARY .035IN 10MM 8.5FR 100MM UNCOVERED RAPEX GWIRE,"$4,215.63",$0.00,"$4,215.63","$2,289.08","$3,008.69",$0.00,$726.33,$0.00,$0.00,$738.12,"$4,215.63",$0.00,"$2,107.81","$3,338.78","$3,372.50",$0.00,$659.75,$0.00,$671.13,$0.00
M00570720,SUP,HCPCS C1874,,M00570720  -  STENT BILIARY .035IN 10MM 8.5FR 40MM 3.2MM RAPEX PARTIALLY,"$6,263.53",$0.00,"$6,263.53","$2,818.59","$4,470.28",$0.00,"$1,079.17",$0.00,$0.00,"$1,096.69","$6,263.53",$0.00,"$3,131.76","$4,960.72","$5,010.82",$0.00,$980.24,$0.00,$997.15,$0.00
M00570730,SUP,HCPCS C1874,,M00570730  -  STENT BIL .035IN 10MM 8.5FR 60MM 3.2MM WALLFLEX FLRSCP MRKR,"$6,263.53",$0.00,"$6,263.53","$2,818.59","$4,470.28",$0.00,"$1,079.17",$0.00,$0.00,"$1,096.69","$6,263.53",$0.00,"$3,131.76","$4,960.72","$5,010.82",$0.00,$980.24,$0.00,$997.15,$0.00
M00573080,SUP,HCPCS C1769,,M00573080  -  SPHINCTEROTOME ENDSCP .035IN 3.9FR 20MM 260CM CHOLANGIOGRAM,$757.08,$0.00,$757.08,$411.09,$540.32,$0.00,$130.44,$0.00,$0.00,$132.56,$757.08,$0.00,$378.54,$599.61,$605.66,$0.00,$118.48,$0.00,$120.53,$0.00
M00582120,SUP,Custom 27203010,,M00582120  -  TUBE GSTRM STD RT ANG 14FR EVV BLN REPL BLSTR,$87.58,$0.00,$87.58,$0.00,$62.51,$0.00,$0.00,$0.00,$0.00,$0.00,$87.58,$0.00,$43.79,$69.36,$70.06,$0.00,$0.00,$0.00,$0.00,$0.00
M00582130,SUP,Custom 27203010,,M00582130  -  TUBE GSTRM STD RT ANG 16FR EVV BLN REPL BLSTR,$87.58,$0.00,$87.58,$0.00,$62.51,$0.00,$0.00,$0.00,$0.00,$0.00,$87.58,$0.00,$43.79,$69.36,$70.06,$0.00,$0.00,$0.00,$0.00,$0.00
M00582160,SUP,Custom 27203010,,M00582160  -  TUBE GSTRM STD RT ANG 24FR EVV BLN REPL BLSTR,$87.58,$0.00,$87.58,$0.00,$62.51,$0.00,$0.00,$0.00,$0.00,$0.00,$87.58,$0.00,$43.79,$69.36,$70.06,$0.00,$0.00,$0.00,$0.00,$0.00
M00583040,SUP,HCPCS C1769,,M00583040  -  SPHINCTEROTOME ENDSCP .035IN 4.4FR 20MM 260CM CANN PRELOAD,"$1,011.08",$0.00,"$1,011.08",$549.01,$721.60,$0.00,$174.20,$0.00,$0.00,$177.03,"$1,011.08",$0.00,$505.54,$800.78,$808.86,$0.00,$158.23,$0.00,$160.96,$0.00
M00583060,SUP,HCPCS C1769,,M00583060  -  SPHINCTEROTOME ENDSCP .035IN 4.4FR 20MM 450CM CANN PRELOAD,"$1,011.08",$0.00,"$1,110.00",$0.00,$792.21,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,110.00",$0.00,$555.00,$800.78,$888.00,$0.00,$0.00,$0.00,$0.00,$0.00
M00583060,SUP,Custom 27203598,,HYDRATOME RX 44-20MM / 450CM,"$1,110.00",$0.00,"$1,110.00",$0.00,$792.21,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,110.00",$0.00,$555.00,$879.12,$888.00,$0.00,$0.00,$0.00,$0.00,$0.00
M00584040,SUP,HCPCS C1769,,M00584040  -  SPHINCTEROTOME ENDSCP .035IN STR 4.4FR 260CM 20MM CANN,"$1,011.08",$0.00,"$1,011.08",$549.01,$721.60,$0.00,$174.20,$0.00,$0.00,$177.03,"$1,011.08",$0.00,$505.54,$800.78,$808.86,$0.00,$158.23,$0.00,$160.96,$0.00
M0061453500,SUP,HCPCS C2617,,M0061453500  -  STENT URETERAL PIGTAIL CURVE LP TAPER 4.8FR 22CM ATTACH,$524.30,$0.00,$524.30,$235.94,$374.19,$0.00,$90.33,$0.00,$0.00,$91.80,$524.30,$0.00,$262.15,$415.25,$419.44,$0.00,$82.05,$0.00,$83.47,$0.00
M0061453510,SUP,HCPCS C2617,,M0061453510  -  STENT URETERAL PIGTAIL CURVE LP TAPER 4.8FR 24CM ATTACH,$524.30,$0.00,$524.30,$235.94,$374.19,$0.00,$90.33,$0.00,$0.00,$91.80,$524.30,$0.00,$262.15,$415.25,$419.44,$0.00,$82.05,$0.00,$83.47,$0.00
M0061453520,SUP,HCPCS C2617,,M0061453520  -  STENT URETERAL PIGTAIL CURVE LP 4.8FR 26CM TAPER TIP BLADDER,$524.30,$0.00,$524.30,$235.94,$374.19,$0.00,$90.33,$0.00,$0.00,$91.80,$524.30,$0.00,$262.15,$415.25,$419.44,$0.00,$82.05,$0.00,$83.47,$0.00
M0061453530,SUP,HCPCS C2617,,M0061453530  -  STENT URETERAL PIGTAIL CURVE LP TAPER 4.8FR 28CM ATTACH,$524.30,$0.00,$524.30,$235.94,$374.19,$0.00,$90.33,$0.00,$0.00,$91.80,$524.30,$0.00,$262.15,$415.25,$419.44,$0.00,$82.05,$0.00,$83.47,$0.00
M0061453610,SUP,HCPCS C2617,,M0061453610  -  STENT URETERAL PIGTAIL CURVE LP TAPER 6FR 24CM ATTACH SUTURE,$524.30,$0.00,$524.30,$235.94,$374.19,$0.00,$90.33,$0.00,$0.00,$91.80,$524.30,$0.00,$262.15,$415.25,$419.44,$0.00,$82.05,$0.00,$83.47,$0.00
M0061752500,SUP,HCPCS C2617,,M0061752500  -  STENT URETERAL TAPER 4.8FR 20CM BLADDER MARK HIGH COIL,$581.43,$0.00,$581.43,$261.64,$414.96,$0.00,$100.18,$0.00,$0.00,$101.80,$581.43,$0.00,$290.71,$460.49,$465.14,$0.00,$90.99,$0.00,$92.56,$0.00
M0061901340,SUP,HCPCS C2617,,M0061901340  -  STENT URET 6FR 28CM W/O GWIRE DUAL DRMTR PLRS HDR+,$356.40,$0.00,$356.40,$160.38,$254.36,$0.00,$61.41,$0.00,$0.00,$62.40,$356.40,$0.00,$178.20,$282.27,$285.12,$0.00,$55.78,$0.00,$56.74,$0.00
M0061901440,SUP,HCPCS C2617,,M0061901440  -  STENT URET 7FR 28CM W/O GWIRE DUAL DRMTR PLRS HDR+,$306.25,$0.00,$306.25,$137.81,$218.57,$0.00,$52.77,$0.00,$0.00,$53.62,$306.25,$0.00,$153.13,$242.55,$245.00,$0.00,$47.93,$0.00,$48.76,$0.00
M0061901520,SUP,HCPCS C2617,,M0061901520  -  STENT URET 8FR 24CM W/O GWIRE PLRS HDR+,$306.25,$0.00,$306.25,$137.81,$218.57,$0.00,$52.77,$0.00,$0.00,$53.62,$306.25,$0.00,$153.13,$242.55,$245.00,$0.00,$47.93,$0.00,$48.76,$0.00
M0061901530,SUP,HCPCS C2617,,M0061901530  -  STENT URET 8FR 26CM W/O GWIRE PLRS HDR+,$356.40,$0.00,$356.40,$160.38,$254.36,$0.00,$61.41,$0.00,$0.00,$62.40,$356.40,$0.00,$178.20,$282.27,$285.12,$0.00,$55.78,$0.00,$56.74,$0.00
M0061901540,SUP,HCPCS C2617,,M0061901540  -  STENT URET 8FR 28CM W/O GWIRE PLRS HDR+,$359.98,$0.00,$359.98,$161.99,$256.91,$0.00,$62.02,$0.00,$0.00,$63.03,$359.98,$0.00,$179.99,$285.10,$287.98,$0.00,$56.34,$0.00,$57.31,$0.00
M0061921300,SUP,HCPCS C2617,,M0061921300  -  STENT URETERAL 2 PIGTAIL CURVE LP TAPER 6FR 2.1FR 20CM 2,$658.50,$0.00,$658.50,$296.33,$469.97,$0.00,$113.46,$0.00,$0.00,$115.30,$658.50,$0.00,$329.25,$521.53,$526.80,$0.00,$103.06,$0.00,$104.83,$0.00
M0061921310,SUP,HCPCS C1768,,M0061921310  -  STENT URETERAL 2 PIGTAIL CURVE LP TAPER 6FR 2.1FR 22CM 2,$658.50,$0.00,$658.50,$296.33,$469.97,$0.00,$113.46,$0.00,$0.00,$115.30,$658.50,$0.00,$329.25,$521.53,$526.80,$0.00,$103.06,$0.00,$104.83,$0.00
M0061921320,SUP,HCPCS C1768,,M0061921320  -  STENT URETERAL 2 PIGTAIL CURVE LP TAPER 6FR 2.1FR 24CM 2,$658.50,$0.00,$658.50,$296.33,$469.97,$0.00,$113.46,$0.00,$0.00,$115.30,$658.50,$0.00,$329.25,$521.53,$526.80,$0.00,$103.06,$0.00,$104.83,$0.00
M0061921330,SUP,HCPCS C1768,,M0061921330  -  STENT URETERAL 2 PIGTAIL CURVE LP TAPER 6FR 2.1FR 26CM 2,$658.50,$0.00,$658.50,$296.33,$469.97,$0.00,$113.46,$0.00,$0.00,$115.30,$658.50,$0.00,$329.25,$521.53,$526.80,$0.00,$103.06,$0.00,$104.83,$0.00
M0061921340,SUP,HCPCS C2617,,M0061921340  -  STENT URETERAL 2 PIGTAIL CURVE LP TAPER 6FR 2.1FR 28CM 2,$658.50,$0.00,$658.50,$296.33,$469.97,$0.00,$113.46,$0.00,$0.00,$115.30,$658.50,$0.00,$329.25,$521.53,$526.80,$0.00,$103.06,$0.00,$104.83,$0.00
M0061921410,SUP,HCPCS C2617,,M0061921410  -  STENT URETERAL 2 PIGTAIL CURVE LP TAPER 7FR 2.1FR 22CM 2,$658.50,$0.00,$658.50,$296.33,$469.97,$0.00,$113.46,$0.00,$0.00,$115.30,$658.50,$0.00,$329.25,$521.53,$526.80,$0.00,$103.06,$0.00,$104.83,$0.00
M0061921420,SUP,HCPCS C2617,,M0061921420  -  STENT URETERAL 2 PIGTAIL CURVE TAPER 7FR 2.1FR 24CM 2,$658.50,$0.00,$658.50,$296.33,$469.97,$0.00,$113.46,$0.00,$0.00,$115.30,$658.50,$0.00,$329.25,$521.53,$526.80,$0.00,$103.06,$0.00,$104.83,$0.00
M0061921430,SUP,HCPCS C2617,,M0061921430  -  STENT URETERAL 2 PIGTAIL CURVE LP TAPER 7FR 2.1FR 26CM 2,$658.50,$0.00,$658.50,$296.33,$469.97,$0.00,$113.46,$0.00,$0.00,$115.30,$658.50,$0.00,$329.25,$521.53,$526.80,$0.00,$103.06,$0.00,$104.83,$0.00
M0061921440,SUP,HCPCS C2617,,M0061921440  -  STENT URETERAL 2 PIGTAIL CURVE LP TAPER 7FR 2.1FR 28CM 2,$658.50,$0.00,$658.50,$296.33,$469.97,$0.00,$113.46,$0.00,$0.00,$115.30,$658.50,$0.00,$329.25,$521.53,$526.80,$0.00,$103.06,$0.00,$104.83,$0.00
M0061921510,SUP,HCPCS C2617,,M0061921510  -  STENT URETERAL 2 PIGTAIL CURVE LP TAPER 8FR 2.1FR 22CM 2,$658.50,$0.00,$658.50,$296.33,$469.97,$0.00,$113.46,$0.00,$0.00,$115.30,$658.50,$0.00,$329.25,$521.53,$526.80,$0.00,$103.06,$0.00,$104.83,$0.00
M0061921520,SUP,HCPCS C2617,,M0061921520  -  STENT URETERAL 2 PIGTAIL CURVE LP TAPER 8FR 2.1FR 24CM 2,$658.50,$0.00,$658.50,$296.33,$469.97,$0.00,$113.46,$0.00,$0.00,$115.30,$658.50,$0.00,$329.25,$521.53,$526.80,$0.00,$103.06,$0.00,$104.83,$0.00
M0061921530,SUP,HCPCS C2617,,M0061921530  -  STENT URETERAL 2 PIGTAIL CURVE TAPER 8FR 2.1FR 26CM 2,$658.50,$0.00,$658.50,$296.33,$469.97,$0.00,$113.46,$0.00,$0.00,$115.30,$658.50,$0.00,$329.25,$521.53,$526.80,$0.00,$103.06,$0.00,$104.83,$0.00
M0062101170,SUP,HCPCS C1726,,M0062101170  -  CATHETER BLNDIL 17CM 30FR 55CM LF 12CM NPHRMX AMPTZ LOPRFL,"$1,077.18",$0.00,"$1,077.18",$584.91,$768.78,$0.00,$185.59,$0.00,$0.00,$188.60,"$1,077.18",$0.00,$538.59,$853.13,$861.74,$0.00,$168.58,$0.00,$171.49,$0.00
M0062251020,SUP,HCPCS C1758,,M0062251020  -  CATHETER BLNDIL 6MM 75CM LF 4CM URMT U QD-FOLD HI-PRS KINK,"$1,131.68",$0.00,"$1,131.68",$614.50,$807.68,$0.00,$194.98,$0.00,$0.00,$198.15,"$1,131.68",$0.00,$565.84,$896.29,$905.34,$0.00,$177.11,$0.00,$180.16,$0.00
M0062251170,SUP,HCPCS C1758,,M0062251170  -  CATHETER BALDILAT SHORT TAPER 5.8FR 18FR 75CM 10CM KINK,"$1,131.68",$0.00,"$1,131.68",$614.50,$807.68,$0.00,$194.98,$0.00,$0.00,$198.15,"$1,131.68",$0.00,$565.84,$896.29,$905.34,$0.00,$177.11,$0.00,$180.16,$0.00
M0062502091,SUP,HCPCS C1894,,M0062502091  -  SHEATH ACCES 2 TAPER 15FR 13FR 36CM KINK RESISTANT RADIOPQ,$94.17,$0.00,$94.17,$51.13,$67.21,$0.00,$16.22,$0.00,$0.00,$16.49,$94.17,$0.00,$47.08,$74.58,$75.33,$0.00,$14.74,$0.00,$14.99,$0.00
M0062601200,SUP,HCPCS C1769,,M0062601200  -  DILATOR SURG 8-10FR 70CM 30CM KINK RESISTANT STYLET SHEATH,$236.20,$0.00,$236.20,$128.26,$168.58,$0.00,$40.70,$0.00,$0.00,$41.36,$236.20,$0.00,$118.10,$187.07,$188.96,$0.00,$36.97,$0.00,$37.60,$0.00
M0062602500,SUP,Custom 27203010,,M0062602500  -  DILATOR SURG SHEATH SET AMPLATZ RENAL STERILE,"$1,131.68",$0.00,"$1,131.68",$0.00,$807.68,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,131.68",$0.00,$565.84,$896.29,$905.34,$0.00,$0.00,$0.00,$0.00,$0.00
M0063201020,SUP,Custom 27203010,,M0063201020  -  BASKET SPEC RTRVL 20MM 7FR 70CM SGR 4WR 0 TIP OVR GW,$528.75,$0.00,$528.75,$0.00,$377.37,$0.00,$0.00,$0.00,$0.00,$0.00,$528.75,$0.00,$264.38,$418.77,$423.00,$0.00,$0.00,$0.00,$0.00,$0.00
M0063201040,SUP,Custom 27203010,,M0063201040  -  BASKET SPEC RTRVL 3FR 16MM 90CM S-D 4WR STON LSR,$649.00,$0.00,$649.00,$0.00,$463.19,$0.00,$0.00,$0.00,$0.00,$0.00,$649.00,$0.00,$324.50,$514.01,$519.20,$0.00,$0.00,$0.00,$0.00,$0.00
M0063301060,SUP,Custom 27203010,,M0063301060  -  BASKET STON RTRVL HLCL 11MM 3FR 120CM STRL GMN 3 PR WRE SCR,$853.95,$0.00,$853.95,$0.00,$609.46,$0.00,$0.00,$0.00,$0.00,$0.00,$853.95,$0.00,$426.98,$676.33,$683.16,$0.00,$0.00,$0.00,$0.00,$0.00
M0063311060,SUP,Custom 27203010,,M0063311060  -  BASKET SPEC RTRVL 120CM 3FR 11MM STON 3WR HLCL 0 TIP PR GMN,$473.00,$0.00,$473.00,$0.00,$337.58,$0.00,$0.00,$0.00,$0.00,$0.00,$473.00,$0.00,$236.50,$374.62,$378.40,$0.00,$0.00,$0.00,$0.00,$0.00
M0063401220,SUP,Custom 27203010,,M0063401220  -  BASKET STON RTRVL HLCL 10MM 1.9FR 120CM STRL BGLY 3WR DISP,$853.95,$0.00,$853.95,$0.00,$609.46,$0.00,$0.00,$0.00,$0.00,$0.00,$853.95,$0.00,$426.98,$676.33,$683.16,$0.00,$0.00,$0.00,$0.00,$0.00
M0063601000,SUP,HCPCS C1726,,M0063601000  -  CATHETER SPEC RTRVL 3FR 120CM 60CM OVL LOOP,$455.50,$0.00,$455.50,$247.34,$325.09,$0.00,$78.48,$0.00,$0.00,$79.75,$455.50,$0.00,$227.75,$360.76,$364.40,$0.00,$71.29,$0.00,$72.52,$0.00
M0063801100,SUP,Custom 27203010,,M0063801100  -  BASKET STON RTRVL 20MM 3FR 120CM STRL LF SGR HEMI PERMAFORM,$853.95,$0.00,$853.95,$0.00,$609.46,$0.00,$0.00,$0.00,$0.00,$0.00,$853.95,$0.00,$426.98,$676.33,$683.16,$0.00,$0.00,$0.00,$0.00,$0.00
M0063901010,SUP,Custom 27203010,,M0063901010  -  BASKET STON RTRVL 12MM 2.4FR 120CM STRL LF 0TP 4WR FLT DIST,$921.93,$0.00,$921.93,$0.00,$657.98,$0.00,$0.00,$0.00,$0.00,$0.00,$921.93,$0.00,$460.96,$730.17,$737.54,$0.00,$0.00,$0.00,$0.00,$0.00
M0063901020,SUP,Custom 27203010,,M0063901020  -  BASKET STON RTRVL 16MM 3FR 90CM STRL LF 0TP 4WR FLT DIST,$921.93,$0.00,$921.93,$0.00,$657.98,$0.00,$0.00,$0.00,$0.00,$0.00,$921.93,$0.00,$460.96,$730.17,$737.54,$0.00,$0.00,$0.00,$0.00,$0.00
M0063901050,SUP,Custom 27203010,,M0063901050  -  BASKET STON RTRVL 12MM 1.9FR 120CM STRL LF 0TP 4WR FLT DIST,$939.48,$0.00,$939.48,$0.00,$670.50,$0.00,$0.00,$0.00,$0.00,$0.00,$939.48,$0.00,$469.74,$744.07,$751.58,$0.00,$0.00,$0.00,$0.00,$0.00
M0063902000,SUP,Custom 27203010,,M0063902000  -  BASKET STON RTRVL 1.9FR 90CM STRL LF ESCAPE SGR STD 4WR NTNL,"$1,158.53",$0.00,"$1,158.53",$0.00,$826.84,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,158.53",$0.00,$579.26,$917.56,$926.82,$0.00,$0.00,$0.00,$0.00,$0.00
M0063902010,SUP,Custom 27203010,,M0063902010  -  BASKET STON RTRVL 1.9FR 120CM STRL LF ESCAPE SGR STD 4WR,"$1,158.53",$0.00,"$1,158.53",$0.00,$826.84,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,158.53",$0.00,$579.26,$917.56,$926.82,$0.00,$0.00,$0.00,$0.00,$0.00
M0063903100,SUP,Custom 27203010,,M0063903100  -  COIL SPECIMEN RETRIEVAL 7MM 3FR 115CM LATEX FREE STONE CONE,"$1,112.15",$0.00,"$1,112.15",$0.00,$793.74,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,112.15",$0.00,$556.08,$880.82,$889.72,$0.00,$0.00,$0.00,$0.00,$0.00
M0063903200,SUP,Custom 27803010,,M0063903200  -  COIL SPECIMEN RETRIEVAL 3FR 10MM 115CM SHEAQTH QUICK RELEASE,"$1,112.15",$0.00,"$1,112.15",$0.00,$793.74,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,112.15",$0.00,$556.08,$880.82,$889.72,$0.00,$0.00,$0.00,$0.00,$0.00
M0064002011,SUP,HCPCS C1758,,M0064002011  -  CATHETER URETERAL 5FR 70CM 1 LUMEN OPEN END INJEC HUB LATEX,$921.45,$0.00,$921.45,$500.35,$657.64,$0.00,$158.76,$0.00,$0.00,$161.34,$921.45,$0.00,$460.73,$729.79,$737.16,$0.00,$144.21,$0.00,$146.69,$0.00
M0064201000,SUP,Custom 27203010,,M0064201000  -  CATH SPBC FDRTP 14FR 15CM KIT BLN PNCT 5ML,$198.00,$0.00,$198.00,$0.00,$141.31,$0.00,$0.00,$0.00,$0.00,$0.00,$198.00,$0.00,$99.00,$156.82,$158.40,$0.00,$0.00,$0.00,$0.00,$0.00
M006580211,SUP,Custom 27203010,,M006580211  -  UNIT ELECTROSURGICAL PROCEDURE SET GENESYS HTA,"$4,209.12",$0.00,"$4,209.12",$0.00,"$3,004.05",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,209.12",$0.00,"$2,104.56","$3,333.62","$3,367.30",$0.00,$0.00,$0.00,$0.00,$0.00
M0066301001,SUP,HCPCS C1769,,M0066301001  -  GWIRE ENDSCP .035IN 150CM STR FLX TP STF SHFT GLDWR HYDPHI 3,$137.89,$0.00,$137.89,$74.87,$98.41,$0.00,$23.76,$0.00,$0.00,$24.14,$137.89,$0.00,$68.95,$109.21,$110.31,$0.00,$21.58,$0.00,$21.95,$0.00
M0066301011,SUP,HCPCS C1769,,M0066301011  -  GUIDEWIRE URO STD .038IN 150CM STRL 3CM GLDWR SFT FLXB STRG,$137.89,$0.00,$137.89,$74.87,$98.41,$0.00,$23.76,$0.00,$0.00,$24.14,$137.89,$0.00,$68.95,$109.21,$110.31,$0.00,$21.58,$0.00,$21.95,$0.00
M0066301101,SUP,HCPCS C1769,,M0066301101  -  GWIRE ENDSCP .035IN 150CM ANG TIP FLX TP STF SHFT GLDWR PU 3,$201.16,$0.00,$201.16,$109.23,$143.57,$0.00,$34.66,$0.00,$0.00,$35.22,$201.16,$0.00,$100.58,$159.32,$160.93,$0.00,$31.48,$0.00,$32.02,$0.00
M0066301121,SUP,HCPCS C1769,,M0066301121  -  GWIRE ENDSCP .038IN 150CM ANG TIP FLX TP STF SHFT GLDWR PU 3,$201.16,$0.00,$201.16,$109.23,$143.57,$0.00,$34.66,$0.00,$0.00,$35.22,$201.16,$0.00,$100.58,$159.32,$160.93,$0.00,$31.48,$0.00,$32.02,$0.00
M0066401041,SUP,HCPCS C1769,,M0066401041  -  GUIDEWIRE URO STRG .035IN 145CM LF 7CM AMP SPST BNTSN FLX TP,$120.44,$0.00,$120.44,$65.40,$85.95,$0.00,$20.75,$0.00,$0.00,$21.09,$120.44,$0.00,$60.22,$95.39,$96.35,$0.00,$18.85,$0.00,$19.17,$0.00
M0066703051,SUP,HCPCS C1769,,M0066703051  -  GUIDEWIRE ENDSCP STR FLOPPY .035IN 150CM 3CM HIGH,$968.75,$0.00,$968.75,$526.03,$691.40,$0.00,$166.91,$0.00,$0.00,$169.62,$968.75,$0.00,$484.38,$767.25,$775.00,$0.00,$151.61,$0.00,$154.23,$0.00
M0066703061,SUP,HCPCS C1769,,M0066703061  -  GUIDEWIRE ENDSCP ANGLE FLOPPY .035IN 150CM 3CM HIGH,$193.75,$0.00,$193.75,$105.21,$138.28,$0.00,$33.38,$0.00,$0.00,$33.92,$193.75,$0.00,$96.88,$153.45,$155.00,$0.00,$30.32,$0.00,$30.85,$0.00
M0066703091,SUP,HCPCS C1769,,M0066703091  -  GUIDEWIRE ENDSCP STR .038IN 150CM 3CM RADIOPQ FLEXIBLE TIP,$193.75,$0.00,$193.75,$105.21,$138.28,$0.00,$33.38,$0.00,$0.00,$33.92,$193.75,$0.00,$96.88,$153.45,$155.00,$0.00,$30.32,$0.00,$30.85,$0.00
M0066703101,SUP,HCPCS C1769,,M0066703101  -  GUIDEWIRE ENDSCP ANGLE .038IN 150CM 3CM 2 FLEXIBLE TIP,$968.75,$0.00,$968.75,$526.03,$691.40,$0.00,$166.91,$0.00,$0.00,$169.62,$968.75,$0.00,$484.38,$767.25,$775.00,$0.00,$151.61,$0.00,$154.23,$0.00
M0067201001,SUP,Custom 27203010,,M0067201001  -  SYSTEM PUMP IRRIGATION 1 HAND ACTION 1 WAY VALVE VACUUM,$212.74,$0.00,$212.74,$0.00,$151.83,$0.00,$0.00,$0.00,$0.00,$0.00,$212.74,$0.00,$106.37,$168.49,$170.19,$0.00,$0.00,$0.00,$0.00,$0.00
M0067301251,SUP,Custom 27203010,,M0067301251  -  EVACUATOR UROLOGY UROVAC BLADDER,$107.98,$0.00,$107.98,$0.00,$77.06,$0.00,$0.00,$0.00,$0.00,$0.00,$107.98,$0.00,$53.99,$85.52,$86.38,$0.00,$0.00,$0.00,$0.00,$0.00
M0068318170,SUP,HCPCS C1781,,M0068318170  -  MESH TRANSVAGINAL UPHOLD CAPIO,"$7,046.25",$0.00,"$7,046.25","$3,170.81","$5,028.91",$0.00,"$1,214.03",$0.00,$0.00,"$1,233.74","$7,046.25",$0.00,"$3,523.13","$5,580.63","$5,637.00",$0.00,"$1,102.74",$0.00,"$1,121.76",$0.00
M0068502110,SUP,HCPCS C1771,,M0068502110  -  SLING TRANSVAGINAL 2.7MM CURVE SYSTEM DELIVERY DEVICE MESH,"$3,940.00",$0.00,"$3,940.00","$1,773.00","$2,811.98",$0.00,$678.84,$0.00,$0.00,$689.86,"$3,940.00",$0.00,"$1,970.00","$3,120.48","$3,152.00",$0.00,$616.61,$0.00,$627.25,$0.00
M0068503000,SUP,HCPCS C1771,,M0068503000  -  SLING PUBOVAGINAL SLING SYSTEM LYNX FMALE SUPRAPUBIC,"$3,753.08",$0.00,"$3,753.08","$1,688.88","$2,678.57",$0.00,$646.64,$0.00,$0.00,$657.13,"$3,753.08",$0.00,"$1,876.54","$2,972.44","$3,002.46",$0.00,$587.36,$0.00,$597.49,$0.00
M0068505000,SUP,HCPCS C1771,,M0068505000  -  SLING PUBOVAGINAL SLING SYSTEM NEEDLE OBTRYX HALO FMALE,"$3,187.50",$0.00,"$3,187.50","$1,434.38","$2,274.92",$0.00,$549.19,$0.00,$0.00,$558.11,"$3,187.50",$0.00,"$1,593.75","$2,524.50","$2,550.00",$0.00,$498.84,$0.00,$507.45,$0.00
M0068505110,SUP,HCPCS C1771,,M0068505110  -  SLING PUBOVAGINAL NEEDLE OBTRYX II HALO MIDURETHRAL,"$3,500.00",$0.00,"$3,500.00","$1,575.00","$2,497.95",$0.00,$603.03,$0.00,$0.00,$612.82,"$3,500.00",$0.00,"$1,750.00","$2,772.00","$2,800.00",$0.00,$547.75,$0.00,$557.20,$0.00
M0613,SUP,Custom 25003010,,ANTIBODY EMA CLONE E29 MS ANHMN .2ML LAB,$569.13,$0.00,$569.13,$0.00,$406.18,$0.00,$0.00,$0.00,$0.00,$0.00,$569.13,$0.00,$284.56,$450.75,$455.30,$0.00,$0.00,$0.00,$0.00,$0.00
M0630,SUP,Custom 25003010,,ANTIBODY CYKRTN CLONE 34BETAE12 MS IGG1 KAPPA MNCLN ANHMN .2,"$1,016.33",$0.00,"$1,016.33",$0.00,$725.35,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,016.33",$0.00,$508.16,$804.93,$813.06,$0.00,$0.00,$0.00,$0.00,$0.00
M0634,SUP,Custom 25003010,,ANTIBODY MLNSM CLONE HMB45 MS ANHMN .2ML LAB,"$1,900.00",$0.00,"$1,900.00",$0.00,"$1,356.03",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,900.00",$0.00,$950.00,"$1,504.80","$1,520.00",$0.00,$0.00,$0.00,$0.00,$0.00
M0701,SUP,Custom 25003010,,ANTIBODY CD45 LCA CLONE 2B11 PD7/26 MS IGG1 KAPPA ANHMN 1ML,$817.85,$0.00,$817.85,$0.00,$583.70,$0.00,$0.00,$0.00,$0.00,$0.00,$817.85,$0.00,$408.93,$647.74,$654.28,$0.00,$0.00,$0.00,$0.00,$0.00
M0725,SUP,Custom 25003010,,ANTIBODY VM CLONE V9 MS ANHMN 1ML LAB,"$1,187.50",$0.00,"$1,187.50",$0.00,$847.52,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,187.50",$0.00,$593.75,$940.50,$950.00,$0.00,$0.00,$0.00,$0.00,$0.00
M0733,SUP,Custom 25003010,,ANTIBODY CD15 CLONE C3D-1 MS IGM KAPPA ANHMN 1ML LAB,$861.60,$0.00,$861.60,$0.00,$614.92,$0.00,$0.00,$0.00,$0.00,$0.00,$861.60,$0.00,$430.80,$682.39,$689.28,$0.00,$0.00,$0.00,$0.00,$0.00
M0750,SUP,Custom 25003010,,ANTIBODY PSA CLONE ER-PR8 MS ANHMN 1ML LAB,$412.50,$0.00,$412.50,$0.00,$294.40,$0.00,$0.00,$0.00,$0.00,$0.00,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$0.00,$0.00,$0.00,$0.00
M0751,SUP,Custom 25003010,,ANTIBODY CD30 CLONE BER H2 MS IGG1 KAPPA ANHMN 1ML LAB,"$1,101.68",$0.00,"$1,101.68",$0.00,$786.27,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,101.68",$0.00,$550.84,$872.53,$881.34,$0.00,$0.00,$0.00,$0.00,$0.00
M0755,SUP,Custom 25003010,,ANTIBODY CD20CY CLONE L26 MS IGG2A KAPPA ANHMN 1ML LAB,"$1,213.70",$0.00,"$1,213.70",$0.00,$866.22,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,213.70",$0.00,$606.85,$961.25,$970.96,$0.00,$0.00,$0.00,$0.00,$0.00
M0776,SUP,Custom 25003010,,ANTIBODY SNPTSN CLONE SY38 MS IGG1 KAPPA ANHMN 1ML LAB,"$1,252.00",$0.00,"$1,252.00",$0.00,$893.55,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,252.00",$0.00,$626.00,$991.58,"$1,001.60",$0.00,$0.00,$0.00,$0.00,$0.00
M0781,SUP,Custom 25003010,,ANTIBODY IGG1 KAPPA DAK-TG6 CLONE MS ANHMN MNCLN CULT SPRNT,$877.60,$0.00,$877.60,$0.00,$626.34,$0.00,$0.00,$0.00,$0.00,$0.00,$877.60,$0.00,$438.80,$695.06,$702.08,$0.00,$0.00,$0.00,$0.00,$0.00
M0823,SUP,Custom 25003010,,ANTIBODY CD31 CLONE JC/70A MS IGG1 .2ML 1ML LAB,"$1,072.33",$0.00,"$1,072.33",$0.00,$765.32,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,072.33",$0.00,$536.16,$849.29,$857.86,$0.00,$0.00,$0.00,$0.00,$0.00
M085401,SUP,Custom 25003010,,ANTIBODY CMV CLONE CCH2 DDG9 MS ANHMN 1ML LAB,"$1,091.25",$0.00,"$1,091.25",$0.00,$778.83,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,091.25",$0.00,$545.63,$864.27,$873.00,$0.00,$0.00,$0.00,$0.00,$0.00
M0873,SUP,Custom 25003010,,ANTIBODY NSE CLONE BBS/NC/6-H14 MS ANHMN .2ML LAB,"$1,556.85",$0.00,"$1,556.85",$0.00,"$1,111.12",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,556.85",$0.00,$778.43,"$1,233.03","$1,245.48",$0.00,$0.00,$0.00,$0.00,$0.00
M1599B,SUP,Custom 27203010,,CABLE NIBP  INTERCONNECT 3.0M,$115.50,$0.00,$115.50,$0.00,$82.43,$0.00,$0.00,$0.00,$0.00,$0.00,$115.50,$0.00,$57.75,$91.48,$92.40,$0.00,$0.00,$0.00,$0.00,$0.00
M1900B,SUP,Custom 27203010,,CABLE OXM 3MR 12TO 9 PIN D-SUB INPT CONNCTR SPO2 ADPR LF,$339.60,$0.00,$339.60,$0.00,$242.37,$0.00,$0.00,$0.00,$0.00,$0.00,$339.60,$0.00,$169.80,$268.96,$271.68,$0.00,$0.00,$0.00,$0.00,$0.00
M3526A,SUP,Custom 27203010,,WIRE 3 LEAD SET SNAP,$340.00,$0.00,$340.00,$0.00,$242.66,$0.00,$0.00,$0.00,$0.00,$0.00,$340.00,$0.00,$170.00,$269.28,$272.00,$0.00,$0.00,$0.00,$0.00,$0.00
M3556,SUP,Custom 25003010,,ANTIBODY CALPONIN CLONE CALP MS IGG1 KAPPA ANHMN 1ML LAB,"$1,900.00",$0.00,"$1,900.00",$0.00,"$1,356.03",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,900.00",$0.00,$950.00,"$1,504.80","$1,520.00",$0.00,$0.00,$0.00,$0.00,$0.00
M3569,SUP,Custom 25003010,,ANTIBODY PR CLONE PGR 636 MS IGG1 KAPPA MNCLN ANHMN .2ML 1ML,"$3,115.03",$0.00,"$3,115.03",$0.00,"$2,223.19",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,115.03",$0.00,"$1,557.51","$2,467.10","$2,492.02",$0.00,$0.00,$0.00,$0.00,$0.00
M3609,SUP,Custom 25003010,,ANTIBODY INHIBIN ALPHA CLONE R1 MS ANHMN 1ML LAB,"$1,193.10",$0.00,"$1,193.10",$0.00,$851.52,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,193.10",$0.00,$596.55,$944.94,$954.48,$0.00,$0.00,$0.00,$0.00,$0.00
M365SC550040,SUP,HCPCS C1787,,M365SC550040  -  KIT STIMULATOR PRECISION SPECTRA SPINE CORD CASE REMOTE CONT,"$2,000.00",$0.00,"$2,000.00",$0.00,"$1,427.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,000.00",$0.00,"$1,000.00","$1,584.00","$1,600.00",$0.00,$0.00,$0.00,$0.00,$0.00
M3717A,SUP,Custom 27203010,,M3717A  -  PAD DFBR HRTSTRT MLFNC XTRN PLUG CONCTR PED LATEX FREE DISP,$60.16,$0.00,$60.16,$0.00,$42.94,$0.00,$0.00,$0.00,$0.00,$0.00,$60.16,$0.00,$30.08,$47.65,$48.13,$0.00,$0.00,$0.00,$0.00,$0.00
M6275033/10.S,SUP,HCPCS A6209,,M6275033/10.S  -  DRSG THK1CM LG 15X10CM NADH CMFT VRSTL PVA VAC WHITEFOAM,$23.48,$0.00,$23.48,$12.75,$16.76,$0.00,$7.03,$0.00,$0.00,$4.11,$23.48,$0.00,$11.74,$18.60,$18.78,$0.00,$3.67,$0.00,$3.74,$0.00
M6275034/10.S,SUP,HCPCS A6209,,M6275034/10.S  -  DRSG THK1CM LG 15X10CM NADH CMFT VRSTL PVA VAC WHITEFOAM,$30.02,$0.00,$30.02,$16.30,$21.42,$0.00,$7.03,$0.00,$0.00,$5.26,$30.02,$0.00,$15.01,$23.78,$24.01,$0.00,$4.70,$0.00,$4.78,$0.00
M6275053/10.S,SUP,HCPCS A6209,,M6275053/10.S  -  DRSG THK3.3CM MED 18X12.5CM NADH CMFT VRSTL PU VAC GFM FOAM,$135.29,$0.00,$135.29,$73.46,$96.55,$0.00,$7.03,$0.00,$0.00,$23.69,$135.29,$0.00,$67.64,$107.15,$108.23,$0.00,$21.17,$0.00,$21.54,$0.00
M6275096/10,SUP,Custom 27203010,,DRESSING THK3.3CM MED 18X12.5CM 2 ADH DRP KT PU VAC GFM SLVR,$148.16,$0.00,$148.16,$0.00,$105.74,$0.00,$0.00,$0.00,$0.00,$0.00,$148.16,$0.00,$74.08,$117.34,$118.52,$0.00,$0.00,$0.00,$0.00,$0.00
M6275096/10.S,SUP,HCPCS A6209,,M6275096/10.S  -  DRSG MED 18X12.5CM OPN PORE HDRPHB NEG PRSS KIT PU VAC GFM,$155.06,$0.00,$155.06,$84.19,$110.66,$0.00,$7.03,$0.00,$0.00,$27.15,$155.06,$0.00,$77.53,$122.81,$124.04,$0.00,$24.27,$0.00,$24.68,$0.00
M6275098/10,SUP,Custom 27203010,,DRESSING THK3.3CM SM VAC GFM SLVR BLK 10X7.5CM M6275098/10,"$1,180.45",$0.00,"$1,180.45",$0.00,$842.49,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,180.45",$0.00,$590.23,$934.92,$944.36,$0.00,$0.00,$0.00,$0.00,$0.00
M6275098/10.S,SUP,HCPCS A6209,,M6275098/10.S  -  DRSG SM 10X7.5CM 1 DRP PAD CONCTR PU VAC GFM SLVR FOAM BLK,$123.77,$0.00,$123.77,$67.20,$88.33,$0.00,$7.03,$0.00,$0.00,$21.67,$123.77,$0.00,$61.88,$98.03,$99.01,$0.00,$19.37,$0.00,$19.70,$0.00
M6275099/10,SUP,Custom 27203010,,DRESSING THK3.3CM LG VAC GFM SLVR BLK 26X15CM M6275099/10,$179.29,$0.00,$179.29,$0.00,$127.96,$0.00,$0.00,$0.00,$0.00,$0.00,$179.29,$0.00,$89.65,$142.00,$143.43,$0.00,$0.00,$0.00,$0.00,$0.00
M6275099/10.S,SUP,HCPCS A6209,,M6275099/10.S  -  DRSG LG 26X15CM 2 DRP SENSATRAC PAD CONCTR PU VAC GFM SLVR,$17.36,$0.00,$17.36,$9.43,$12.39,$0.00,$7.03,$0.00,$0.00,$3.04,$17.36,$0.00,$8.68,$13.75,$13.89,$0.00,$2.72,$0.00,$2.76,$0.00
M653G,SUP,Custom 27203010,,M653G  -  SUTURE SS 5 CCS 18IN MFL NABSB,$39.71,$0.00,$39.71,$0.00,$28.34,$0.00,$0.00,$0.00,$0.00,$0.00,$39.71,$0.00,$19.85,$31.45,$31.77,$0.00,$0.00,$0.00,$0.00,$0.00
M7001,SUP,Custom 27803010,,M7001  -  CATHETER DRN SYS ASPT PLR,$987.50,$0.00,$987.50,$0.00,$704.78,$0.00,$0.00,$0.00,$0.00,$0.00,$987.50,$0.00,$493.75,$782.10,$790.00,$0.00,$0.00,$0.00,$0.00,$0.00
M7019,SUP,Custom 25003010,,ANTIBODY CYKRTN 20 CLONE KS20.8 MS IGG2A KAPPA ANHMN 1ML LAB,"$1,013.43",$0.00,"$1,013.43",$0.00,$723.28,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,013.43",$0.00,$506.71,$802.64,$810.74,$0.00,$0.00,$0.00,$0.00,$0.00
M7047,SUP,Custom 25003010,,ANTIBODY ER CLONE 1D5 MS IGG1 KAPPA MNCLN ANHMN .2ML 1ML LAB,"$2,638.43",$0.00,"$2,638.43",$0.00,"$1,883.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,638.43",$0.00,"$1,319.21","$2,089.64","$2,110.74",$0.00,$0.00,$0.00,$0.00,$0.00
M7165,SUP,Custom 25003010,,ANTIBODY CD34 CLONE QBEND MS IGG1 KAPPA ANHMN 1ML LAB,"$1,173.58",$0.00,"$1,173.58",$0.00,$837.58,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,173.58",$0.00,$586.79,$929.48,$938.86,$0.00,$0.00,$0.00,$0.00,$0.00
M7191,SUP,Custom 25003010,,ANTIBODY PLAP CLONE 8A9 MS ANHMN .2ML LAB,"$1,018.50",$0.00,"$1,018.50",$0.00,$726.90,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,018.50",$0.00,$509.25,$806.65,$814.80,$0.00,$0.00,$0.00,$0.00,$0.00
M7240,SUP,Custom 25003010,,ANTIBODY KI-67 CLONE MIB-1 MS IGG1 KAPPA ANHMN 1ML LAB,"$1,193.03",$0.00,"$1,193.03",$0.00,$851.46,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,193.03",$0.00,$596.51,$944.88,$954.42,$0.00,$0.00,$0.00,$0.00,$0.00
M7630-1A,SUP,Custom 27203010,,MEDIA CYSL 60 LVISC CLR MOUNT,$319.08,$0.00,$319.08,$0.00,$227.72,$0.00,$0.00,$0.00,$0.00,$0.00,$319.08,$0.00,$159.54,$252.71,$255.26,$0.00,$0.00,$0.00,$0.00,$0.00
M8275040/10.S,SUP,Custom 27203010,,DRESSING MED SPIRAL FOAM V.A.C. SIMPLACE,$129.88,$0.00,$129.88,$0.00,$92.69,$0.00,$0.00,$0.00,$0.00,$0.00,$129.88,$0.00,$64.94,$102.86,$103.90,$0.00,$0.00,$0.00,$0.00,$0.00
M8275041/5.S,SUP,HCPCS A6209,,M8275041/5.S  -  KIT DRESSING THK1.75CM MEDIUM 7.5X11.5CM DRAPE PAD CONCTR,$93.58,$0.00,$93.58,$50.81,$66.79,$0.00,$7.03,$0.00,$0.00,$16.39,$93.58,$0.00,$46.79,$74.12,$74.86,$0.00,$14.65,$0.00,$14.90,$0.00
M8275051/10,SUP,HCPCS A6209,,M8275051/10  -  DRSG THK3.3CM SM 10X7.5CM SENSATRAC PAD DRP HDRPHB FLXB OPN,$80.69,$0.00,$80.69,$43.81,$57.59,$0.00,$7.03,$0.00,$0.00,$14.13,$80.69,$0.00,$40.34,$63.91,$64.55,$0.00,$12.63,$0.00,$12.85,$0.00
M8275052/10,SUP,Custom 27203010,,DRESSING THK3.3CM LG 18X12.5CM OPN PORE HDRPHB NEG PRSS KT,$109.07,$0.00,$109.07,$0.00,$77.85,$0.00,$0.00,$0.00,$0.00,$0.00,$109.07,$0.00,$54.54,$86.38,$87.26,$0.00,$0.00,$0.00,$0.00,$0.00
M8275052/10.S,SUP,HCPCS A6209,,M8275052/10.S  -  KIT DRESSING THK3.3CM MEDIUM STANDARD 18X12.5CM 2 ADHESIVE,$99.71,$0.00,$99.71,$54.14,$71.16,$0.00,$7.03,$0.00,$0.00,$17.46,$99.71,$0.00,$49.85,$78.97,$79.76,$0.00,$15.60,$0.00,$15.87,$0.00
M8275053/10,SUP,Custom 27203010,,DRESSING THK3.3CM LG VAC GFM WHT 26X15CM HDRPHB KT PU STRL,$135.28,$0.00,$135.28,$0.00,$96.55,$0.00,$0.00,$0.00,$0.00,$0.00,$135.28,$0.00,$67.64,$107.14,$108.22,$0.00,$0.00,$0.00,$0.00,$0.00
M8275053/10.S,SUP,HCPCS A6209,,M8275053/10.S  -  KIT VAC GFM DRSG SENSATRAC PAD DRP HDRPHB FLXB OPN PORE PU,$122.79,$0.00,$122.79,$66.67,$87.63,$0.00,$7.03,$0.00,$0.00,$21.50,$122.79,$0.00,$61.39,$97.25,$98.23,$0.00,$19.22,$0.00,$19.55,$0.00
M8275057,SUP,Custom 27203010,,CANISTER WND DRAIN PAD TBG CLMP CONNCTR SENSATRAC STRL LF,$48.03,$0.00,$48.03,$0.00,$34.28,$0.00,$0.00,$0.00,$0.00,$0.00,$48.03,$0.00,$24.01,$38.04,$38.42,$0.00,$0.00,$0.00,$0.00,$0.00
M8275057/10.S,SUP,Custom 27203010,,M8275057/10.S  -  PAD WOUND DRAIN TUBE CLMP CONCTR SENSATRAC VAC STERILE,$42.59,$0.00,$42.59,$0.00,$30.39,$0.00,$0.00,$0.00,$0.00,$0.00,$42.59,$0.00,$21.29,$33.73,$34.07,$0.00,$0.00,$0.00,$0.00,$0.00
M8275063/10.S,SUP,Custom 27203010,,M8275063/10.S  -  CANISTER WOUND DRAIN C500ML GEL TUBE CLMP CONCTR CHARCOAL,$82.68,$0.00,$82.68,$0.00,$59.01,$0.00,$0.00,$0.00,$0.00,$0.00,$82.68,$0.00,$41.34,$65.48,$66.14,$0.00,$0.00,$0.00,$0.00,$0.00
M8275065/5,SUP,HCPCS A6209,,M8275065/5  -  DRSG THK1.5CM XL 60X30CM OPN PORE HDRPHB NEG PRSS KIT PU VAC,$253.80,$0.00,$253.80,$137.81,$181.13,$0.00,$7.03,$0.00,$0.00,$44.44,$253.80,$0.00,$126.90,$201.01,$203.04,$0.00,$39.72,$0.00,$40.40,$0.00
M8275080/5,SUP,Custom 27203010,,KCI V.A.C. GRANU FOAM DRESSING ABDOMINAL,$801.14,$0.00,$801.14,$0.00,$571.77,$0.00,$0.00,$0.00,$0.00,$0.00,$801.14,$0.00,$400.57,$634.50,$640.91,$0.00,$0.00,$0.00,$0.00,$0.00
M8275080/5.S,SUP,Custom 27203010,,M8275080/5.S  -  DRSG NADH LYR SENSATRAC PAD TBG PU VAC GFM FOAM ABD,$793.52,$0.00,$793.52,$0.00,$566.33,$0.00,$0.00,$0.00,$0.00,$0.00,$793.52,$0.00,$396.76,$628.47,$634.81,$0.00,$0.00,$0.00,$0.00,$0.00
M8275096/10,SUP,HCPCS A6209,,M8275096/10  -  KIT DRESSING THK3.2CM MEDIUM 18X12.5CM 2 ADHESIVE DRAPE 1,$140.73,$0.00,$140.73,$76.42,$100.44,$0.00,$7.03,$0.00,$0.00,$24.64,$140.73,$0.00,$70.36,$111.46,$112.58,$0.00,$22.02,$0.00,$22.40,$0.00
M8275096/10.S,SUP,HCPCS A6209,,M8275096/10.S  -  DRSG THK3.3CM MED 18X12.5CM SENSATRAC PAD DRP FLXB CNTOUR,$140.73,$0.00,$140.73,$76.42,$100.44,$0.00,$7.03,$0.00,$0.00,$24.64,$140.73,$0.00,$70.36,$111.46,$112.58,$0.00,$22.02,$0.00,$22.40,$0.00
M8275096/5.S,SUP,Custom 27203010,,M8275096/5.S  -  DRSG THK3.3CM MED 18X12.5CM SENSATRAC PAD DRP FLXB CNTOUR,$172.74,$0.00,$172.74,$0.00,$123.28,$0.00,$0.00,$0.00,$0.00,$0.00,$172.74,$0.00,$86.37,$136.81,$138.19,$0.00,$0.00,$0.00,$0.00,$0.00
M8275098/10,SUP,HCPCS A6209,,M8275098/10  -  DRESSING FOAM THK3.3CM SMALL 10X7.5CM SENSATRAC PAD DRAPE,$112.33,$0.00,$112.33,$60.99,$80.17,$0.00,$7.03,$0.00,$0.00,$19.67,$112.33,$0.00,$56.16,$88.97,$89.86,$0.00,$17.58,$0.00,$17.88,$0.00
M8275098/10.S,SUP,HCPCS A6209,,M8275098/10.S  -  DRSG THK3.3CM SM 10X7.5CM SENSATRAC PAD DRP FLXB CNTOUR,$112.33,$0.00,$112.33,$60.99,$80.17,$0.00,$7.03,$0.00,$0.00,$19.67,$112.33,$0.00,$56.16,$88.97,$89.86,$0.00,$17.58,$0.00,$17.88,$0.00
M8275099/10,SUP,HCPCS A6209,,M8275099/10  -  DRESSING FOAM THK3.3CM LARGE 26X15CM ADHESIVE DRAPE,$170.41,$0.00,$170.41,$92.53,$121.62,$0.00,$7.03,$0.00,$0.00,$29.84,$170.41,$0.00,$85.20,$134.96,$136.33,$0.00,$26.67,$0.00,$27.13,$0.00
M8275099/10.S,SUP,HCPCS A6209,,M8275099/10.S  -  DRSG THK3.3CM LG 26X15CM DRP SENSATRAC PAD PU VAC GFM SLVR,$170.41,$0.00,$170.41,$92.53,$121.62,$0.00,$7.03,$0.00,$0.00,$29.84,$170.41,$0.00,$85.20,$134.96,$136.33,$0.00,$26.67,$0.00,$27.13,$0.00
M8275099/5,SUP,Custom 27203010,,DRESSING THK3.3CM LG VAC GFM SLVR BLK 26X15CM M8275099/5,$199.48,$0.00,$199.48,$0.00,$142.37,$0.00,$0.00,$0.00,$0.00,$0.00,$199.48,$0.00,$99.74,$157.99,$159.58,$0.00,$0.00,$0.00,$0.00,$0.00
M8275099/5.S,SUP,Custom 27203010,,M8275099/5.S  -  DRSG THK3.3CM LG 26X15CM DRP SENSATRAC PAD PU VAC GFM SLVR,$206.04,$0.00,$206.04,$0.00,$147.05,$0.00,$0.00,$0.00,$0.00,$0.00,$206.04,$0.00,$103.02,$163.18,$164.83,$0.00,$0.00,$0.00,$0.00,$0.00
M8730,SUP,Custom 27203010,,M8730  -  SUTURE NONABSORBABLE 8-0 BV130-5 18IN 2 ARM MONOFILAMENT,$205.58,$0.00,$205.58,$0.00,$146.72,$0.00,$0.00,$0.00,$0.00,$0.00,$205.58,$0.00,$102.79,$162.82,$164.46,$0.00,$0.00,$0.00,$0.00,$0.00
M8747,SUP,Custom 27203010,,M8747  -  SUTURE PRLN 7-0 BV175-8 24IN MFL DBL ARM BLUE NABSB ETM8747,$137.60,$0.00,$137.60,$0.00,$98.20,$0.00,$0.00,$0.00,$0.00,$0.00,$137.60,$0.00,$68.80,$108.98,$110.08,$0.00,$0.00,$0.00,$0.00,$0.00
M8805,SUP,Custom 27203010,,SUTURE PRLN 6-0 BV-1 24IN MFL DBL ARM BLUE NABSB ET8805H,"$1,166.83",$0.00,"$1,166.83",$0.00,$832.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,166.83",$0.00,$583.41,$924.13,$933.46,$0.00,$0.00,$0.00,$0.00,$0.00
MA30AC,SUP,HCPCS V2632,,MA30AC  -  LENS IOL 5 D +1 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL ACRSF,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA30AC.100,SUP,HCPCS V2632,,MA30AC.100  -  LENS IOL 5 D +10 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA30AC.105,SUP,HCPCS V2632,,MA30AC.105  -  LENS IOL 5 D +10.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA30AC.110,SUP,HCPCS V2632,,MA30AC.110  -  LENS IOL 5 D +11 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA30AC.115,SUP,HCPCS V2632,,MA30AC.115  -  LENS IOL 5 D +11.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA30AC.120,SUP,HCPCS V2632,,MA30AC.120  -  LENS IOL 5 D +12 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA30AC.125,SUP,HCPCS V2632,,MA30AC.125  -  LENS IOL 5 D +12.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA30AC.130,SUP,HCPCS V2632,,MA30AC.130  -  LENS IOL 5 D +13 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA30AC.135,SUP,HCPCS V2632,,MA30AC.135  -  LENS IOL 5 D +13.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA30AC.140,SUP,HCPCS V2632,,MA30AC.140  -  LENS IOL 5 D +14 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA30AC.145,SUP,HCPCS V2632,,MA30AC.145  -  LENS IOL 5 D +14.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA30AC.150,SUP,HCPCS V2632,,MA30AC.150  -  LENS IOL 5 D +15 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA30AC.155,SUP,HCPCS V2632,,MA30AC.155  -  LENS IOL 5 D +15.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA30AC.160,SUP,HCPCS V2632,,MA30AC.160  -  LENS IOL 5 D +16 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA30AC.165,SUP,HCPCS V2632,,MA30AC.165  -  LENS IOL 5 D +16.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA30AC.170,SUP,HCPCS V2632,,MA30AC.170  -  LENS IOL 5 D +17 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA30AC.175,SUP,HCPCS V2632,,MA30AC.175  -  LENS IOL 5 D +17.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA30AC.180,SUP,HCPCS V2632,,MA30AC.180  -  LENS IOL 5 D +18 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA30AC.185,SUP,HCPCS V2632,,MA30AC.185  -  LENS IOL 5 D +18.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA30AC.190,SUP,HCPCS V2632,,MA30AC.190  -  LENS IOL 5 D +19 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA30AC.195,SUP,HCPCS V2632,,MA30AC.195  -  LENS IOL 5 D +19.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA30AC.200,SUP,HCPCS V2632,,MA30AC.200  -  LENS IOL 5 D +20 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA30AC.205,SUP,HCPCS V2632,,MA30AC.205  -  LENS IOL 5 D +20.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA30AC.210,SUP,HCPCS V2632,,MA30AC.210  -  LENS IOL 5 D +21 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA30AC.215,SUP,HCPCS V2632,,MA30AC.215  -  LENS IOL 5 D +21.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA30AC.220,SUP,HCPCS V2632,,MA30AC.220  -  LENS IOL 5 D +22 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA30AC.225,SUP,HCPCS V2632,,MA30AC.225  -  LENS IOL 5 D +22.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA30AC.230,SUP,HCPCS V2632,,MA30AC.230  -  LENS IOL 5 D +23 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA30AC.235,SUP,HCPCS V2632,,MA30AC.235  -  LENS IOL 5 D +23.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA30AC.240,SUP,HCPCS V2632,,MA30AC.240  -  LENS IOL 5 D +24 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA30AC.245,SUP,HCPCS V2632,,MA30AC.245  -  LENS IOL 5 D +24.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA30AC.250,SUP,HCPCS V2632,,MA30AC.250  -  LENS IOL 5 D +25 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA30AC.255,SUP,HCPCS V2632,,MA30AC.255  -  LENS IOL 5 D +25.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA30AC.260,SUP,HCPCS V2632,,MA30AC.260  -  LENS IOL 5 D +26 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA30AC.265,SUP,HCPCS V2632,,MA30AC.265  -  LENS IOL 5 D +26.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA30AC.270,SUP,HCPCS V2632,,MA30AC.270  -  LENS IOL 5 D +27 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA30AC.275,SUP,HCPCS V2632,,MA30AC.275  -  LENS IOL 5 D +27.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA30AC.280,SUP,HCPCS V2632,,MA30AC.280  -  LENS IOL 5 D +28 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA30AC.285,SUP,HCPCS V2632,,MA30AC.285  -  LENS IOL 5 D +28.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA30AC.290,SUP,HCPCS V2632,,MA30AC.290  -  LENS IOL 5 D +29 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA30AC.295,SUP,HCPCS V2632,,MA30AC.295  -  LENS IOL 5 D +29.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA30AC.300,SUP,HCPCS V2632,,MA30AC.300  -  LENS IOL 5 D +30 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA50BM,SUP,HCPCS V2632,,MA50BM  -  LENS IOL 10 D +19.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA50BM.060,SUP,HCPCS V2632,,MA50BM.060  -  LENS IOL 10 D +6 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA50BM.065,SUP,HCPCS V2632,,MA50BM.065  -  LENS IOL 10 D +6.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA50BM.070,SUP,HCPCS V2632,,MA50BM.070  -  LENS IOL 10 D +7 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA50BM.075,SUP,HCPCS V2632,,MA50BM.075  -  LENS IOL 10 D +7.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA50BM.080,SUP,HCPCS V2632,,MA50BM.080  -  LENS IOL 10 D +8 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA50BM.085,SUP,HCPCS V2632,,MA50BM.085  -  LENS IOL 10 D +8.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA50BM.090,SUP,HCPCS V2632,,MA50BM.090  -  LENS IOL 10 D +9 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA50BM.095,SUP,HCPCS V2632,,MA50BM.095  -  LENS IOL 10 D +9.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA50BM.100,SUP,HCPCS V2632,,MA50BM.100  -  LENS IOL 10 D +10 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA50BM.105,SUP,HCPCS V2632,,MA50BM.105  -  LENS IOL 10 D +10.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA50BM.110,SUP,HCPCS V2632,,MA50BM.110  -  LENS IOL 10 D +11 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA50BM.115,SUP,HCPCS V2632,,MA50BM.115  -  LENS IOL 10 D +11.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA50BM.120,SUP,HCPCS V2632,,MA50BM.120  -  LENS IOL 10 D +12 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA50BM.125,SUP,HCPCS V2632,,MA50BM.125  -  LENS IOL 10 D +12.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA50BM.130,SUP,HCPCS V2632,,MA50BM.130  -  LENS IOL 10 D +13 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA50BM.135,SUP,HCPCS V2632,,MA50BM.135  -  LENS IOL 10 D +13.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA50BM.140,SUP,HCPCS V2632,,MA50BM.140  -  LENS IOL 10 D +14 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA50BM.145,SUP,HCPCS V2632,,MA50BM.145  -  LENS IOL 10 D +14.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA50BM.150,SUP,HCPCS V2632,,MA50BM.150  -  LENS IOL 10 D +15 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA50BM.155,SUP,HCPCS V2632,,MA50BM.155  -  LENS IOL 10 D +15.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA50BM.160,SUP,HCPCS V2632,,MA50BM.160  -  LENS IOL 10 D +16 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA50BM.165,SUP,HCPCS V2632,,MA50BM.165  -  LENS IOL 10 D +16.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA50BM.170,SUP,HCPCS V2632,,MA50BM.170  -  LENS IOL 10 D +17 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA50BM.175,SUP,HCPCS V2632,,MA50BM.175  -  LENS IOL 10 D +17.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA50BM.180,SUP,HCPCS V2632,,MA50BM.180  -  LENS IOL 10 D +18 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA50BM.185,SUP,HCPCS V2632,,MA50BM.185  -  LENS IOL 10 D +18.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA50BM.190,SUP,HCPCS V2632,,MA50BM.190  -  LENS IOL 10 D +19 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA50BM.195,SUP,HCPCS V2632,,MA50BM.195  -  LENS IOL 10 D +19.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA50BM.200,SUP,HCPCS V2632,,MA50BM.200  -  LENS IOL 10 D +20 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA50BM.205,SUP,HCPCS V2632,,MA50BM.205  -  LENS IOL 10 D +20.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA50BM.210,SUP,HCPCS V2632,,MA50BM.210  -  LENS IOL 10 D +21 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA50BM.215,SUP,HCPCS V2632,,MA50BM.215  -  LENS IOL 10 D +21.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA50BM.220,SUP,HCPCS V2632,,MA50BM.220  -  LENS IOL 10 D +22 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA50BM.225,SUP,HCPCS V2632,,MA50BM.225  -  LENS IOL 10 D +22.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA50BM.230,SUP,HCPCS V2632,,MA50BM.230  -  LENS IOL 10 D +23 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA50BM.235,SUP,HCPCS V2632,,MA50BM.235  -  LENS IOL 10 D +23.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA50BM.240,SUP,HCPCS V2632,,MA50BM.240  -  LENS IOL 10 D +24 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA50BM.245,SUP,HCPCS V2632,,MA50BM.245  -  LENS IOL 10 D +24.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA50BM.250,SUP,HCPCS V2632,,MA50BM.250  -  LENS IOL 10 D +25 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA50BM.255,SUP,HCPCS V2632,,MA50BM.255  -  LENS IOL 10 D +25.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA50BM.260,SUP,HCPCS V2632,,MA50BM.260  -  LENS IOL 10 D +26 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA50BM.265,SUP,HCPCS V2632,,MA50BM.265  -  LENS IOL 10 D +26.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA50BM.270,SUP,HCPCS V2632,,MA50BM.270  -  LENS IOL 10 D +27 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA50BM.275,SUP,HCPCS V2632,,MA50BM.275  -  LENS IOL 10 D +27.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA50BM.280,SUP,HCPCS V2632,,MA50BM.280  -  LENS IOL 10 D +28 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA50BM.285,SUP,HCPCS V2632,,MA50BM.285  -  LENS IOL 10 D +28.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA50BM.290,SUP,HCPCS V2632,,MA50BM.290  -  LENS IOL 10 D +29 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA50BM.295,SUP,HCPCS V2632,,MA50BM.295  -  LENS IOL 10 D +29.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA50BM.300,SUP,HCPCS V2632,,MA50BM.300  -  LENS IOL 10 D +30 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA60AC.060,SUP,HCPCS V2630,,MA60AC.060  -  LENS IOL 10 D +6 DIOPTER BICNVX 6MM 13MM MULTIPIECE FOLDABLE,$372.50,$0.00,$372.50,$167.63,$265.85,$0.00,$64.18,$0.00,$0.00,$65.22,$372.50,$0.00,$186.25,$295.02,$298.00,$0.00,$58.30,$0.00,$59.30,$0.00
MA60AC.065,SUP,HCPCS V2632,,MA60AC.065  -  LENS IOL +6.5 DIOP 10 D 13MM 6MM PSTCHBR BICNVX MLPC FLD,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA60AC.070,SUP,HCPCS V2632,,MA60AC.070  -  LENS IOL 10 D +7 DIOPTER BICNVX 6MM 13MM MULTIPIECE FOLDABLE,$372.50,$0.00,$372.50,$167.63,$265.85,$0.00,$64.18,$0.00,$0.00,$65.22,$372.50,$0.00,$186.25,$295.02,$298.00,$0.00,$58.30,$0.00,$59.30,$0.00
MA60AC.075,SUP,HCPCS V2632,,MA60AC.075  -  LENS IOL +7.5 DIOP 10 D 13MM 6MM PSTCHBR BICNVX MLPC FLD,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA60AC.080,SUP,HCPCS V2632,,MA60AC.080  -  LENS IOL +8 DIOP 10 D 13MM 6MM PSTCHBR BICNVX MLPC FLD ASYM,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA60AC.085,SUP,HCPCS V2632,,MA60AC.085  -  LENS IOL 10 D +8.5 DIOPTER BICNVX 6MM 13MM MULTIPIECE,$372.50,$0.00,$372.50,$167.63,$265.85,$0.00,$64.18,$0.00,$0.00,$65.22,$372.50,$0.00,$186.25,$295.02,$298.00,$0.00,$58.30,$0.00,$59.30,$0.00
MA60AC.090,SUP,HCPCS V2632,,MA60AC.090  -  LENS IOL 10 D +9 DIOPTER BICNVX 6MM 13MM MULTIPIECE FOLDABLE,$372.50,$0.00,$372.50,$167.63,$265.85,$0.00,$64.18,$0.00,$0.00,$65.22,$372.50,$0.00,$186.25,$295.02,$298.00,$0.00,$58.30,$0.00,$59.30,$0.00
MA60AC.095,SUP,HCPCS V2632,,MA60AC.095  -  LENS IOL 10 D +9.5 DIOPTER BICNVX 6MM 13MM MULTIPIECE,$372.50,$0.00,$372.50,$167.63,$265.85,$0.00,$64.18,$0.00,$0.00,$65.22,$372.50,$0.00,$186.25,$295.02,$298.00,$0.00,$58.30,$0.00,$59.30,$0.00
MA60AC.100,SUP,HCPCS V2632,,MA60AC.100  -  LENS IOL +10 DIOP 13MM 6MM PSTCHBR BICNVX MLPC FLD ASYM,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA60AC.105,SUP,HCPCS V2632,,MA60AC.105  -  LENS IOL +10.5 DIOPTER 10 D BICNVX 6MM 13MM MULTIPIECE,$372.50,$0.00,$372.50,$167.63,$265.85,$0.00,$64.18,$0.00,$0.00,$65.22,$372.50,$0.00,$186.25,$295.02,$298.00,$0.00,$58.30,$0.00,$59.30,$0.00
MA60AC.110,SUP,HCPCS V2632,,MA60AC.110  -  LENS IOL 10 D +11 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM,$372.50,$0.00,$372.50,$167.63,$265.85,$0.00,$64.18,$0.00,$0.00,$65.22,$372.50,$0.00,$186.25,$295.02,$298.00,$0.00,$58.30,$0.00,$59.30,$0.00
MA60AC.115,SUP,HCPCS V2632,,MA60AC.115  -  LENS IOL +11.5 DIOPTER 10 D BICNVX 6MM 13MM MULTIPIECE,$372.50,$0.00,$372.50,$167.63,$265.85,$0.00,$64.18,$0.00,$0.00,$65.22,$372.50,$0.00,$186.25,$295.02,$298.00,$0.00,$58.30,$0.00,$59.30,$0.00
MA60AC.120,SUP,HCPCS V2632,,MA60AC.120  -  LENS IOL +12 DIOP 10 D 13MM 6MM PSTCHBR BICNVX MLPC FLD ASYM,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA60AC.125,SUP,HCPCS V2632,,MA60AC.125  -  LENS IOL +12.5 DIOPTER 10 D BICNVX 6MM 13MM MULTIPIECE,$372.50,$0.00,$372.50,$167.63,$265.85,$0.00,$64.18,$0.00,$0.00,$65.22,$372.50,$0.00,$186.25,$295.02,$298.00,$0.00,$58.30,$0.00,$59.30,$0.00
MA60AC.130,SUP,HCPCS V2632,,MA60AC.130  -  LENS IOL 10 D +13 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM,$372.50,$0.00,$372.50,$167.63,$265.85,$0.00,$64.18,$0.00,$0.00,$65.22,$372.50,$0.00,$186.25,$295.02,$298.00,$0.00,$58.30,$0.00,$59.30,$0.00
MA60AC.135,SUP,HCPCS V2632,,MA60AC.135  -  LENS IOL +13.5 DIOPTER 10 D BICNVX 6MM 13MM MULTIPIECE,$372.50,$0.00,$372.50,$167.63,$265.85,$0.00,$64.18,$0.00,$0.00,$65.22,$372.50,$0.00,$186.25,$295.02,$298.00,$0.00,$58.30,$0.00,$59.30,$0.00
MA60AC.140,SUP,HCPCS V2630,,MA60AC.140  -  LENS IOL 10 D +14 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM,$372.50,$0.00,$372.50,$167.63,$265.85,$0.00,$64.18,$0.00,$0.00,$65.22,$372.50,$0.00,$186.25,$295.02,$298.00,$0.00,$58.30,$0.00,$59.30,$0.00
MA60AC.145,SUP,HCPCS V2632,,MA60AC.145  -  LENS IOL +14.5 DIOPTER 10 D BICNVX 6MM 13MM MULTIPIECE,$372.50,$0.00,$372.50,$167.63,$265.85,$0.00,$64.18,$0.00,$0.00,$65.22,$372.50,$0.00,$186.25,$295.02,$298.00,$0.00,$58.30,$0.00,$59.30,$0.00
MA60AC.150,SUP,HCPCS V2630,,MA60AC.150  -  LENS IOL 10 D +15 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM,$372.50,$0.00,$372.50,$167.63,$265.85,$0.00,$64.18,$0.00,$0.00,$65.22,$372.50,$0.00,$186.25,$295.02,$298.00,$0.00,$58.30,$0.00,$59.30,$0.00
MA60AC.155,SUP,HCPCS V2630,,MA60AC.155  -  LENS IOL +15.5 DIOPTER 10 D BICNVX 6MM 13MM MULTIPIECE,$372.50,$0.00,$372.50,$167.63,$265.85,$0.00,$64.18,$0.00,$0.00,$65.22,$372.50,$0.00,$186.25,$295.02,$298.00,$0.00,$58.30,$0.00,$59.30,$0.00
MA60AC.160,SUP,HCPCS V2632,,MA60AC.160  -  LENS IOL 10 D +16 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM,$372.50,$0.00,$372.50,$167.63,$265.85,$0.00,$64.18,$0.00,$0.00,$65.22,$372.50,$0.00,$186.25,$295.02,$298.00,$0.00,$58.30,$0.00,$59.30,$0.00
MA60AC.165,SUP,HCPCS V2632,,MA60AC.165  -  LENS IOL +16.5 DIOPTER 10 D BICNVX 6MM 13MM MULTIPIECE,$372.50,$0.00,$372.50,$167.63,$265.85,$0.00,$64.18,$0.00,$0.00,$65.22,$372.50,$0.00,$186.25,$295.02,$298.00,$0.00,$58.30,$0.00,$59.30,$0.00
MA60AC.170,SUP,HCPCS V2632,,MA60AC.170  -  LENS IOL 10 D +17 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM,$372.50,$0.00,$372.50,$167.63,$265.85,$0.00,$64.18,$0.00,$0.00,$65.22,$372.50,$0.00,$186.25,$295.02,$298.00,$0.00,$58.30,$0.00,$59.30,$0.00
MA60AC.175,SUP,HCPCS V2632,,MA60AC.175  -  LENS IOL +17.5 DIOPTER 10 D BICNVX 6MM 13MM MULTIPIECE,$372.50,$0.00,$372.50,$167.63,$265.85,$0.00,$64.18,$0.00,$0.00,$65.22,$372.50,$0.00,$186.25,$295.02,$298.00,$0.00,$58.30,$0.00,$59.30,$0.00
MA60AC.180,SUP,HCPCS V2630,,MA60AC.180  -  LENS IOL 10 D +18 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM,$372.50,$0.00,$372.50,$167.63,$265.85,$0.00,$64.18,$0.00,$0.00,$65.22,$372.50,$0.00,$186.25,$295.02,$298.00,$0.00,$58.30,$0.00,$59.30,$0.00
MA60AC.185,SUP,HCPCS V2630,,MA60AC.185  -  LENS IOL +18.5 DIOPTER 10 D BICNVX 6MM 13MM MULTIPIECE,$372.50,$0.00,$372.50,$167.63,$265.85,$0.00,$64.18,$0.00,$0.00,$65.22,$372.50,$0.00,$186.25,$295.02,$298.00,$0.00,$58.30,$0.00,$59.30,$0.00
MA60AC.190,SUP,HCPCS V2630,,MA60AC.190  -  LENS IOL 10 D +19 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM,$372.50,$0.00,$372.50,$167.63,$265.85,$0.00,$64.18,$0.00,$0.00,$65.22,$372.50,$0.00,$186.25,$295.02,$298.00,$0.00,$58.30,$0.00,$59.30,$0.00
MA60AC.195,SUP,HCPCS V2630,,MA60AC.195  -  LENS IOL +19.5 DIOPTER 10 D BICNVX 6MM 13MM MULTIPIECE,$372.50,$0.00,$372.50,$167.63,$265.85,$0.00,$64.18,$0.00,$0.00,$65.22,$372.50,$0.00,$186.25,$295.02,$298.00,$0.00,$58.30,$0.00,$59.30,$0.00
MA60AC.200,SUP,HCPCS V2630,,MA60AC.200  -  LENS IOL 10 D +20 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM,$372.50,$0.00,$372.50,$167.63,$265.85,$0.00,$64.18,$0.00,$0.00,$65.22,$372.50,$0.00,$186.25,$295.02,$298.00,$0.00,$58.30,$0.00,$59.30,$0.00
MA60AC.205,SUP,HCPCS V2630,,MA60AC.205  -  LENS IOL +20.5 DIOPTER 10 D BICNVX 6MM 13MM MULTIPIECE,$372.50,$0.00,$372.50,$167.63,$265.85,$0.00,$64.18,$0.00,$0.00,$65.22,$372.50,$0.00,$186.25,$295.02,$298.00,$0.00,$58.30,$0.00,$59.30,$0.00
MA60AC.210,SUP,HCPCS V2630,,MA60AC.210  -  LENS IOL 10 D +21 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM,$372.50,$0.00,$372.50,$167.63,$265.85,$0.00,$64.18,$0.00,$0.00,$65.22,$372.50,$0.00,$186.25,$295.02,$298.00,$0.00,$58.30,$0.00,$59.30,$0.00
MA60AC.215,SUP,HCPCS V2630,,MA60AC.215  -  LENS IOL +21.5 DIOPTER 10 D BICNVX 6MM 13MM MULTIPIECE,$372.50,$0.00,$372.50,$167.63,$265.85,$0.00,$64.18,$0.00,$0.00,$65.22,$372.50,$0.00,$186.25,$295.02,$298.00,$0.00,$58.30,$0.00,$59.30,$0.00
MA60AC.220,SUP,HCPCS V2630,,MA60AC.220  -  LENS IOL 10 D +22 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM,$372.50,$0.00,$372.50,$167.63,$265.85,$0.00,$64.18,$0.00,$0.00,$65.22,$372.50,$0.00,$186.25,$295.02,$298.00,$0.00,$58.30,$0.00,$59.30,$0.00
MA60AC.225,SUP,HCPCS V2630,,MA60AC.225  -  LENS IOL +22.5 DIOPTER 10 D BICNVX 6MM 13MM MULTIPIECE,$372.50,$0.00,$372.50,$167.63,$265.85,$0.00,$64.18,$0.00,$0.00,$65.22,$372.50,$0.00,$186.25,$295.02,$298.00,$0.00,$58.30,$0.00,$59.30,$0.00
MA60AC.230,SUP,HCPCS V2632,,MA60AC.230  -  LENS IOL 10 D +23 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM,$372.50,$0.00,$372.50,$167.63,$265.85,$0.00,$64.18,$0.00,$0.00,$65.22,$372.50,$0.00,$186.25,$295.02,$298.00,$0.00,$58.30,$0.00,$59.30,$0.00
MA60AC.235,SUP,HCPCS V2632,,MA60AC.235  -  LENS IOL +23.5 DIOPTER 10 D BICNVX 6MM 13MM MULTIPIECE,$372.50,$0.00,$372.50,$167.63,$265.85,$0.00,$64.18,$0.00,$0.00,$65.22,$372.50,$0.00,$186.25,$295.02,$298.00,$0.00,$58.30,$0.00,$59.30,$0.00
MA60AC.240,SUP,HCPCS V2630,,MA60AC.240  -  LENS IOL 10 D +24 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM,$372.50,$0.00,$372.50,$167.63,$265.85,$0.00,$64.18,$0.00,$0.00,$65.22,$372.50,$0.00,$186.25,$295.02,$298.00,$0.00,$58.30,$0.00,$59.30,$0.00
MA60AC.245,SUP,HCPCS V2632,,MA60AC.245  -  LENS IOL 10 D +24.5 DIOPTER BICNVX 6MM 13MM MULTIPIECE,$372.50,$0.00,$372.50,$167.63,$265.85,$0.00,$64.18,$0.00,$0.00,$65.22,$372.50,$0.00,$186.25,$295.02,$298.00,$0.00,$58.30,$0.00,$59.30,$0.00
MA60AC.250,SUP,HCPCS V2632,,MA60AC.250  -  LENS IOL 10 D +25 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM,$372.50,$0.00,$372.50,$167.63,$265.85,$0.00,$64.18,$0.00,$0.00,$65.22,$372.50,$0.00,$186.25,$295.02,$298.00,$0.00,$58.30,$0.00,$59.30,$0.00
MA60AC.255,SUP,HCPCS V2632,,MA60AC.255  -  LENS IOL +25.5 DIOP 10 D 13MM 6MM PSTCHBR BICNVX MLPC FLD,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA60AC.260,SUP,HCPCS V2632,,MA60AC.260  -  LENS IOL +26 DIOP 10 D 13MM 6MM PSTCHBR BICNVX MLPC FLD ASYM,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA60AC.265,SUP,HCPCS V2632,,MA60AC.265  -  LENS IOL 10 D +26.5 DIOPTER BICNVX 6MM 13MM MULTIPIECE,$372.50,$0.00,$372.50,$167.63,$265.85,$0.00,$64.18,$0.00,$0.00,$65.22,$372.50,$0.00,$186.25,$295.02,$298.00,$0.00,$58.30,$0.00,$59.30,$0.00
MA60AC.270,SUP,HCPCS V2632,,MA60AC.270  -  LENS IOL +27 DIOP 10 D 13MM 6MM PSTCHBR BICNVX MLPC FLD ASYM,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA60AC.275,SUP,HCPCS V2632,,MA60AC.275  -  LENS IOL +27.5 DIOPTER 10 D BICNVX 6MM 13MM MULTIPIECE,$372.50,$0.00,$372.50,$167.63,$265.85,$0.00,$64.18,$0.00,$0.00,$65.22,$372.50,$0.00,$186.25,$295.02,$298.00,$0.00,$58.30,$0.00,$59.30,$0.00
MA60AC.280,SUP,HCPCS V2632,,MA60AC.280  -  LENS IOL +28 DIOP 10 D 13MM 6MM PSTCHBR BICNVX MLPC FLD ASYM,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA60AC.285,SUP,HCPCS V2632,,MA60AC.285  -  LENS IOL +28.5 DIOP 10 D 13MM 6MM PSTCHBR BICNVX MLPC FLD,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA60AC.290,SUP,HCPCS V2632,,MA60AC.290  -  LENS IOL 10 D +29 DIOPTER BICNVX 6MM 13MM MULTIPIECE,$372.50,$0.00,$372.50,$167.63,$265.85,$0.00,$64.18,$0.00,$0.00,$65.22,$372.50,$0.00,$186.25,$295.02,$298.00,$0.00,$58.30,$0.00,$59.30,$0.00
MA60AC.295,SUP,HCPCS V2632,,MA60AC.295  -  LENS IOL 10 D +29.5 DIOPTER BICNVX 6MM 13MM MULTIPIECE,$372.50,$0.00,$372.50,$167.63,$265.85,$0.00,$64.18,$0.00,$0.00,$65.22,$372.50,$0.00,$186.25,$295.02,$298.00,$0.00,$58.30,$0.00,$59.30,$0.00
MA60AC.300,SUP,HCPCS V2632,,MA60AC.300  -  LENS IOL 10 D +30 DIOPTER BICNVX 6MM 13MM MULTIPIECE,$372.50,$0.00,$372.50,$167.63,$265.85,$0.00,$64.18,$0.00,$0.00,$65.22,$372.50,$0.00,$186.25,$295.02,$298.00,$0.00,$58.30,$0.00,$59.30,$0.00
MA60MA.000,SUP,HCPCS V2632,,MA60MA.000  -  LENS IOL 5 D +0 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF XPD,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA60MA.010,SUP,HCPCS V2632,,MA60MA.010  -  LENS IOL 5 D +1 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF XPD,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA60MA.030,SUP,HCPCS V2632,,MA60MA.030  -  INTRAOUCLAR LENS MA60MA  3.0D,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA60MAN010,SUP,HCPCS V2632,,MA60MAN010  -  LENS IOL 5 D -1 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF XPD,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA60MAN020,SUP,HCPCS V2632,,MA60MAN020  -  LENS IOL 5 D -2 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF XPD,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA60MAN030,SUP,HCPCS V2632,,MA60MAN030  -  LENS IOL 5 D -3 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF XPD,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA60MAN040,SUP,HCPCS V2632,,MA60MAN040  -  LENS IOL 5 D -4 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF XPD,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MA60MAN050,SUP,HCPCS V2632,,MA60MAN050  -  LENS IOL 5 D -5 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF XPD,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
MAJ-210,SUP,Custom 27203010,,VALVE BIOP BSCP NOMENCLATURE DISP,$166.85,$0.00,$166.85,$0.00,$119.08,$0.00,$0.00,$0.00,$0.00,$0.00,$166.85,$0.00,$83.43,$132.15,$133.48,$0.00,$0.00,$0.00,$0.00,$0.00
MAL-0002,SUP,Custom 27803010,,MAL-0002  -  EXPANDER OPHTHALMIC 7MM SAVES CONSIDERABLE TIME DISPOSABLE,"$1,937.50",$0.00,"$1,937.50",$0.00,"$1,382.79",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,937.50",$0.00,$968.75,"$1,534.50","$1,550.00",$0.00,$0.00,$0.00,$0.00,$0.00
MAP111,SUP,HCPCS C1725,,MAP111  -  VALVE HEMOSTASIS 9FR MAP INSERTION TOOL ACCES-9 METAL,$33.25,$0.00,$33.25,$18.05,$23.73,$0.00,$5.73,$0.00,$0.00,$5.82,$33.25,$0.00,$16.63,$26.33,$26.60,$0.00,$5.20,$0.00,$5.29,$0.00
MAP500,SUP,HCPCS C1769,,MAP500  -  DEVICE TORQUE LATEX FREE PIN VISE SALMON PTFE HYDPHI ACCEPTS,$0.44,$0.00,$0.44,$0.24,$0.32,$0.00,$0.08,$0.00,$0.00,$0.08,$0.44,$0.00,$0.22,$0.35,$0.36,$0.00,$0.07,$0.00,$0.07,$0.00
MAXA,SUP,Custom 27203010,,SENSOR ADLT OXMX OXM ADH STRAP CBL LF DISP 18IN,$34.93,$0.00,$34.93,$0.00,$24.93,$0.00,$0.00,$0.00,$0.00,$0.00,$34.93,$0.00,$17.46,$27.66,$27.94,$0.00,$0.00,$0.00,$0.00,$0.00
MAXIICRTDMMAM,SUP,HCPCS C1882,,MAXIICRTDMMAM  -  MAXIMO II CRT-D ADVANCED SYSTEM,"$60,500.00",$0.00,"$60,500.00","$27,225.00","$5,158.80",$0.00,"$8,138.89",$0.00,$0.00,"$8,138.89","$60,500.00",$0.00,"$30,250.00","$47,916.00","$48,400.00",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
MAXIIDRMMEM,SUP,HCPCS C1882,,MAXIIDRMMEM  -  MAXIMO II DR SYSTEM,"$49,812.50",$0.00,"$49,812.50","$22,415.63","$5,158.80",$0.00,"$8,138.89",$0.00,$0.00,"$8,138.89","$49,812.50",$0.00,"$24,906.25","$39,451.50","$39,850.00",$0.00,"$7,751.33",$0.00,"$7,930.15",$0.00
MAXIIVREMEM,SUP,HCPCS C1882,,MAXIIVREMEM  -  MAXIMO II VR SYSTEM,"$43,750.00",$0.00,"$43,750.00","$19,687.50","$5,158.80",$0.00,"$7,537.91",$0.00,$0.00,"$7,660.28","$43,750.00",$0.00,"$21,875.00","$34,650.00","$35,000.00",$0.00,"$6,846.88",$0.00,"$6,965.00",$0.00
MAX-N,SUP,Custom 27203010,,SENSOR NEO 18IN OXM ADH SPO2,$30.80,$0.00,$30.80,$0.00,$21.98,$0.00,$0.00,$0.00,$0.00,$0.00,$30.80,$0.00,$15.40,$24.39,$24.64,$0.00,$0.00,$0.00,$0.00,$0.00
MAX-P,SUP,Custom 27203010,,SENSOR PED OXMX OXM ADH STRAP CBL LF DISP 18IN,$34.93,$0.00,$34.93,$0.00,$24.93,$0.00,$0.00,$0.00,$0.00,$0.00,$34.93,$0.00,$17.46,$27.66,$27.94,$0.00,$0.00,$0.00,$0.00,$0.00
MAXR,SUP,Custom 27203010,,CABLE SENSOR PULSE OXIMETRY DISPOSABLE ADULT NASAL 18IN  F/O,$30.80,$0.00,$30.80,$0.00,$21.98,$0.00,$0.00,$0.00,$0.00,$0.00,$30.80,$0.00,$15.40,$24.39,$24.64,$0.00,$0.00,$0.00,$0.00,$0.00
MAXX-1915,SUP,HCPCS C1874,,MAXX-1915  -  STENT ESPH 19MM 24FR 150MM 90CM ENDOMAXX OTW FLLY COVERED,"$5,750.00",$0.00,"$5,750.00","$2,587.50","$4,103.78",$0.00,$990.70,$0.00,$0.00,"$1,006.78","$5,750.00",$0.00,"$2,875.00","$4,554.00","$4,600.00",$0.00,$899.88,$0.00,$915.40,$0.00
MAXX-197,SUP,HCPCS C1874,,MAXX-197  -  STENT ESPH 19MM 24MM 70MM ENDOMAXX FLLY COVERED,"$5,750.00",$0.00,"$5,750.00","$2,587.50","$4,103.78",$0.00,$990.70,$0.00,$0.00,"$1,006.78","$5,750.00",$0.00,"$2,875.00","$4,554.00","$4,600.00",$0.00,$899.88,$0.00,$915.40,$0.00
MAXX-2310,SUP,HCPCS C1874,,MAXX-2310  -  STENT ESOPHAGEAL 23MM 24FR 90CM 100CM FULLY COVERED OTW LP,"$5,750.00",$0.00,"$5,750.00","$2,587.50","$4,103.78",$0.00,$990.70,$0.00,$0.00,"$1,006.78","$5,750.00",$0.00,"$2,875.00","$4,554.00","$4,600.00",$0.00,$899.88,$0.00,$915.40,$0.00
MAXX-237,SUP,HCPCS C1874,,MAXX-237  -  STENT ESPH 28MM 23MM 24FR 70MM 90CM ENDOMAXX OTW FLLY CVR,"$5,750.00",$0.00,"$5,750.00","$2,587.50","$4,103.78",$0.00,$990.70,$0.00,$0.00,"$1,006.78","$5,750.00",$0.00,"$2,875.00","$4,554.00","$4,600.00",$0.00,$899.88,$0.00,$915.40,$0.00
MB3555,SUP,HCPCS C1713,,MB3555  -  DISC INTVRTB 15MM 15X5MM STRL MOBI-C FLT SPHRCL PLT MBL INS,"$13,750.00",$0.00,"$13,750.00","$6,187.50","$5,158.80",$0.00,"$2,369.06",$0.00,$0.00,"$2,407.52","$13,750.00",$0.00,"$6,875.00","$10,890.00","$11,000.00",$0.00,"$2,151.88",$0.00,"$2,189.00",$0.00
MB3556,SUP,HCPCS C1713,,MB3556  -  DISC INTVRTB 15MM 15X6MM STRL MOBI-C FLT SPHRCL PLT MBL INS,"$13,750.00",$0.00,"$13,750.00","$6,187.50","$5,158.80",$0.00,"$2,369.06",$0.00,$0.00,"$2,407.52","$13,750.00",$0.00,"$6,875.00","$10,890.00","$11,000.00",$0.00,"$2,151.88",$0.00,"$2,189.00",$0.00
MB3575,SUP,HCPCS C1713,,MB3575  -  DISC INTVRTB 15MM 17X5MM STRL MOBI-C FLT SPHRCL PLT MBL INS,"$11,250.00",$0.00,"$11,250.00","$5,062.50","$5,158.80",$0.00,"$1,938.32",$0.00,$0.00,"$1,969.79","$11,250.00",$0.00,"$5,625.00","$8,910.00","$9,000.00",$0.00,"$1,760.63",$0.00,"$1,791.00",$0.00
MB3595,SUP,HCPCS C1713,,MB3595  -  DISC INTVRTB 15MM 19X5MM STRL MOBI-C FLT SPHRCL PLT MBL INS,"$11,250.00",$0.00,"$11,250.00","$5,062.50","$5,158.80",$0.00,"$1,938.32",$0.00,$0.00,"$1,969.79","$11,250.00",$0.00,"$5,625.00","$8,910.00","$9,000.00",$0.00,"$1,760.63",$0.00,"$1,791.00",$0.00
MB46G,SUP,Custom 27203010,,MB46G  -  SUTURE NONABSORBABLE 5 V-40 30IN 4 STRAND BRAID ETHIBOND,$46.03,$0.00,$46.03,$0.00,$32.85,$0.00,$0.00,$0.00,$0.00,$0.00,$46.03,$0.00,$23.02,$36.46,$36.83,$0.00,$0.00,$0.00,$0.00,$0.00
MC*PE28131YB,SUP,HCPCS C1725,,MC*PE28131YB  -  CATH INTVN .021IN 2.8FR .027IN 130CM MCTH HYDPHI PROGREAT,"$1,350.00",$0.00,"$1,350.00",$705.90,$963.50,$0.00,$232.60,$0.00,$0.00,$236.37,"$1,350.00",$0.00,$675.00,"$1,069.20","$1,080.00",$0.00,$211.28,$0.00,$214.92,$0.00
MC011502,SUP,HCPCS C1751,,MC011502  -  CATHETER TRIPLE LUMEN  SIZE 20,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
MC011503,SUP,HCPCS C1751,,MC011503  -  CATHETER CV 24CM 3 LUM,$287.50,$0.00,$287.50,$129.38,$205.19,$0.00,$49.53,$0.00,$0.00,$50.34,$287.50,$0.00,$143.75,$227.70,$230.00,$0.00,$44.99,$0.00,$45.77,$0.00
MC011505,SUP,HCPCS C1750,,MC011505  -  SET CATH 15.5FR 32CM 3 LUM BSC GW DIL SCPL HMDIAL,$475.00,$0.00,$475.00,$213.75,$339.01,$0.00,$81.84,$0.00,$0.00,$83.17,$475.00,$0.00,$237.50,$376.20,$380.00,$0.00,$74.34,$0.00,$75.62,$0.00
MC061402,SUP,HCPCS C1752,,MC061402  -  SET CATH 14FR 15CM SLX 2 LUM BSC INTRO NDL GW DIL,$212.50,$0.00,$212.50,$0.00,$151.66,$0.00,$0.00,$0.00,$0.00,$0.00,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$0.00,$0.00,$0.00,$0.00
MC061404,SUP,HCPCS C1752,,MC061404  -  SET CATH 14FR 24CM SLX 2 LUM BSC INTRO NDL GW DIL,$212.50,$0.00,$212.50,$0.00,$151.66,$0.00,$0.00,$0.00,$0.00,$0.00,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$0.00,$0.00,$0.00,$0.00
MC061405,SUP,HCPCS C1751,,MC061405  -  SET CATH 14FR 30CM SLX 2 LUM BSC STY INTRO NDL DIL,$475.00,$0.00,$475.00,$213.75,$339.01,$0.00,$81.84,$0.00,$0.00,$83.17,$475.00,$0.00,$237.50,$376.20,$380.00,$0.00,$74.34,$0.00,$75.62,$0.00
MC-125,SUP,Custom 27203010,,FILTER BCTR/VIR DISP,$6.20,$0.00,$6.20,$0.00,$4.42,$0.00,$0.00,$0.00,$0.00,$0.00,$6.20,$0.00,$3.10,$4.91,$4.96,$0.00,$0.00,$0.00,$0.00,$0.00
MC172150SX,SUP,HCPCS C1725,,MC172150SX  -  CATHETER BLNOCC MIC STRG 2.4-1.7FR .017IN 150CM HEADWAY SMTH,"$1,911.55",$0.00,"$1,911.55","$1,037.97","$1,364.27",$0.00,$329.35,$0.00,$0.00,$334.70,"$1,911.55",$0.00,$955.78,"$1,513.95","$1,529.24",$0.00,$299.16,$0.00,$304.32,$0.00
MC40BD.100,SUP,HCPCS V2632,,MC40BD.100  -  LENS IOL 5 D +10 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC40BD.105,SUP,HCPCS V2632,,MC40BD.105  -  LENS IOL 5 D +10.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC40BD.110,SUP,HCPCS V2632,,MC40BD.110  -  LENS IOL 5 D +11 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC40BD.115,SUP,HCPCS V2632,,MC40BD.115  -  LENS IOL 5 D +11.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC40BD.120,SUP,HCPCS V2632,,MC40BD.120  -  LENS IOL 5 D +12 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC40BD.125,SUP,HCPCS V2632,,MC40BD.125  -  LENS IOL 5 D +12.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC40BD.130,SUP,HCPCS V2632,,MC40BD.130  -  LENS IOL 5 D +13 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC40BD.135,SUP,HCPCS V2632,,MC40BD.135  -  LENS IOL 5 D +13.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC40BD.140,SUP,HCPCS V2632,,MC40BD.140  -  LENS IOL 5 D +14 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC40BD.145,SUP,HCPCS V2632,,MC40BD.145  -  LENS IOL 5 D +14.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC40BD.150,SUP,HCPCS V2632,,MC40BD.150  -  LENS IOL 5 D +15 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC40BD.155,SUP,HCPCS V2632,,MC40BD.155  -  LENS IOL 5 D +15.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC40BD.160,SUP,HCPCS V2632,,MC40BD.160  -  LENS IOL 5 D +16 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC40BD.165,SUP,HCPCS V2632,,MC40BD.165  -  LENS IOL 5 D +16.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC40BD.170,SUP,HCPCS V2632,,MC40BD.170  -  LENS IOL 5 D +17 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC40BD.175,SUP,HCPCS V2632,,MC40BD.175  -  LENS IOL 5 D +17.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC40BD.180,SUP,HCPCS V2632,,MC40BD.180  -  LENS IOL 5 D +18 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC40BD.185,SUP,HCPCS V2632,,MC40BD.185  -  LENS IOL 5 D +18.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC40BD.190,SUP,HCPCS V2632,,MC40BD.190  -  LENS IOL 5 D +19 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC40BD.195,SUP,HCPCS V2632,,MC40BD.195  -  LENS IOL 5 D +19.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC40BD.200,SUP,HCPCS V2632,,MC40BD.200  -  LENS IOL 5 D +20 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC40BD.205,SUP,HCPCS V2632,,MC40BD.205  -  LENS IOL 5 D +20.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC40BD.210,SUP,HCPCS V2632,,MC40BD.210  -  LENS IOL 5 D +21 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC40BD.215,SUP,HCPCS V2632,,MC40BD.215  -  LENS IOL 5 D +21.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC40BD.220,SUP,HCPCS V2632,,MC40BD.220  -  LENS IOL 5 D +22 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC40BD.225,SUP,HCPCS V2632,,MC40BD.225  -  LENS IOL 5 D +22.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC40BD.230,SUP,HCPCS V2632,,MC40BD.230  -  LENS IOL 5 D +23 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC40BD.235,SUP,HCPCS V2632,,MC40BD.235  -  LENS IOL 5 D +23.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC40BD.240,SUP,HCPCS V2632,,MC40BD.240  -  LENS IOL 5 D +24 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC40BD.245,SUP,HCPCS V2632,,MC40BD.245  -  LENS IOL 5 D +24.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC40BD.250,SUP,HCPCS V2632,,MC40BD.250  -  LENS IOL 5 D +25 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC40BD.255,SUP,HCPCS V2632,,MC40BD.255  -  LENS IOL 5 D +25.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC40BD.260,SUP,HCPCS V2632,,MC40BD.260  -  LENS IOL 5 D +26 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC40BD.265,SUP,HCPCS V2632,,MC40BD.265  -  LENS IOL 5 D +26.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC40BD.270,SUP,HCPCS V2632,,MC40BD.270  -  LENS IOL 5 D +27 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC40BD.275,SUP,HCPCS V2632,,MC40BD.275  -  LENS IOL 5 D +27.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC40BD.280,SUP,HCPCS V2632,,MC40BD.280  -  LENS IOL 5 D +28 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC40BD.285,SUP,HCPCS V2632,,MC40BD.285  -  LENS IOL 5 D +28.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC40BD.290,SUP,HCPCS V2632,,MC40BD.290  -  LENS IOL 5 D +29 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC40BD.295,SUP,HCPCS V2632,,MC40BD.295  -  LENS IOL 5 D +29.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC40BD.300,SUP,HCPCS V2632,,MC40BD.300  -  LENS IOL 5 D +30 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC50BD,SUP,HCPCS V2632,,MC50BD  -  LENS IOL 5 D +17 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC50BD.100,SUP,HCPCS V2632,,MC50BD.100  -  LENS IOL 5 D +10 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC50BD.110,SUP,HCPCS V2632,,MC50BD.110  -  LENS IOL 5 D +11 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC50BD.120,SUP,HCPCS V2632,,MC50BD.120  -  LENS IOL 5 D +12 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC50BD.130,SUP,HCPCS V2632,,MC50BD.130  -  LENS IOL 5 D +13 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC50BD.140,SUP,HCPCS V2632,,MC50BD.140  -  LENS IOL 5 D +14 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC50BD.150,SUP,HCPCS V2632,,MC50BD.150  -  LENS IOL 5 D +15 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC50BD.160,SUP,HCPCS V2632,,MC50BD.160  -  LENS IOL 5 D +16 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC50BD.170,SUP,HCPCS V2632,,MC50BD.170  -  LENS IOL 5 D +17 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC50BD.180,SUP,HCPCS V2632,,MC50BD.180  -  LENS IOL 5 D +18 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC50BD.190,SUP,HCPCS V2632,,MC50BD.190  -  LENS IOL 5 D +19 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC50BD.200,SUP,HCPCS V2632,,MC50BD.200  -  LENS IOL 5 D +20 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC50BD.210,SUP,HCPCS V2632,,MC50BD.210  -  LENS IOL 5 D +21 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC50BD.220,SUP,HCPCS V2632,,MC50BD.220  -  LENS IOL 5 D +22 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC50BD.230,SUP,HCPCS V2632,,MC50BD.230  -  LENS IOL 5 D +23 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC50BD.240,SUP,HCPCS V2632,,MC50BD.240  -  LENS IOL 5 D +24 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC50BD.250,SUP,HCPCS V2632,,MC50BD.250  -  LENS IOL 5 D +25 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC50BD.260,SUP,HCPCS V2632,,MC50BD.260  -  LENS IOL 5 D +26 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC50BD.270,SUP,HCPCS V2632,,MC50BD.270  -  LENS IOL 5 D +27 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC50BD.280,SUP,HCPCS V2632,,MC50BD.280  -  LENS IOL 5 D +28 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC50BD.285,SUP,HCPCS V2632,,MC50BD.285  -  LENS IOL 5 D +28.5 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC50BD.290,SUP,HCPCS V2632,,MC50BD.290  -  LENS IOL 5 D +29 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC50BD.295,SUP,HCPCS V2632,,MC50BD.295  -  LENS IOL 5 D +29.5 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC60BD,SUP,HCPCS V2632,,MC60BD  -  LENS IOL 5D BCNVX 6MM 13.5MM STRL SLANT 1 PC UV ABS PMMA PC,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC60BD.100,SUP,HCPCS V2632,,MC60BD.100  -  LENS IOL 5 D +10 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC60BD.105,SUP,HCPCS V2632,,MC60BD.105  -  LENS IOL 5 D +10.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC60BD.110,SUP,HCPCS V2632,,MC60BD.110  -  LENS IOL 5 D +11 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC60BD.115,SUP,HCPCS V2632,,MC60BD.115  -  LENS IOL 5 D +11.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC60BD.120,SUP,HCPCS V2632,,MC60BD.120  -  LENS IOL 5 D +12 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC60BD.125,SUP,HCPCS V2632,,MC60BD.125  -  LENS IOL 5 D +12.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC60BD.130,SUP,HCPCS V2632,,MC60BD.130  -  LENS IOL 5 D +13 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC60BD.135,SUP,HCPCS V2632,,MC60BD.135  -  LENS IOL 5 D +13.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC60BD.140,SUP,HCPCS V2632,,MC60BD.140  -  LENS IOL 5 D +14 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC60BD.145,SUP,HCPCS V2632,,MC60BD.145  -  LENS IOL 5 D +14.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC60BD.150,SUP,HCPCS V2632,,MC60BD.150  -  LENS IOL 5 D +15 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC60BD.155,SUP,HCPCS V2632,,MC60BD.155  -  LENS IOL 5 D +15.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC60BD.160,SUP,HCPCS V2632,,MC60BD.160  -  LENS IOL 5 D +16 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC60BD.165,SUP,HCPCS V2632,,MC60BD.165  -  LENS IOL 5 D +16.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC60BD.170,SUP,HCPCS V2632,,MC60BD.170  -  LENS IOL 5 D +17 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC60BD.175,SUP,HCPCS V2632,,MC60BD.175  -  LENS IOL 5 D +17.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC60BD.180,SUP,HCPCS V2632,,MC60BD.180  -  LENS IOL 5 D +18 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC60BD.185,SUP,HCPCS V2632,,MC60BD.185  -  LENS IOL 5 D +18.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC60BD.190,SUP,HCPCS V2632,,MC60BD.190  -  LENS IOL 5 D +19 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC60BD.195,SUP,HCPCS V2632,,MC60BD.195  -  LENS IOL 5 D +19.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC60BD.200,SUP,HCPCS V2632,,MC60BD.200  -  LENS IOL 5 D +20 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC60BD.205,SUP,HCPCS V2632,,MC60BD.205  -  LENS IOL 5 D +20.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC60BD.210,SUP,HCPCS V2632,,MC60BD.210  -  LENS IOL 5 D +21 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC60BD.215,SUP,HCPCS V2632,,MC60BD.215  -  LENS IOL 5 D +21.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC60BD.220,SUP,HCPCS V2632,,MC60BD.220  -  LENS IOL 5 D +22 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC60BD.225,SUP,HCPCS V2632,,MC60BD.225  -  LENS IOL 5 D +22.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC60BD.230,SUP,HCPCS V2632,,MC60BD.230  -  LENS IOL 5 D +23 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC60BD.235,SUP,HCPCS V2632,,MC60BD.235  -  LENS IOL 5 D +23.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC60BD.240,SUP,HCPCS V2632,,MC60BD.240  -  LENS IOL 5 D +24 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC60BD.245,SUP,HCPCS V2632,,MC60BD.245  -  LENS IOL 5 D +24.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC60BD.250,SUP,HCPCS V2632,,MC60BD.250  -  LENS IOL 5 D +25 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC60BD.255,SUP,HCPCS V2632,,MC60BD.255  -  LENS IOL 5 D +25.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC60BD.260,SUP,HCPCS V2632,,MC60BD.260  -  LENS IOL 5 D +26 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC60BD.265,SUP,HCPCS V2632,,MC60BD.265  -  LENS IOL 5 D +26.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC60BD.270,SUP,HCPCS V2632,,MC60BD.270  -  LENS IOL 5 D +27 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC60BD.275,SUP,HCPCS V2632,,MC60BD.275  -  LENS IOL 5 D +27.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC60BD.280,SUP,HCPCS V2632,,MC60BD.280  -  LENS IOL 5 D +28 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC60BD.285,SUP,HCPCS V2632,,MC60BD.285  -  LENS IOL 5 D +28.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC60BD.290,SUP,HCPCS V2632,,MC60BD.290  -  LENS IOL 5 D +29 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC60BD.295,SUP,HCPCS V2632,,MC60BD.295  -  LENS IOL 5 D +29.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MC60BD.300,SUP,HCPCS V2632,,MC60BD.300  -  LENS IOL 5 D +30 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MCEN133,SUP,Custom 27203010,,ELEVATOR SURG 11CM 2MM 2.5MM WORMALD BLNT SCT MLBL FRNTL SIN,"$1,332.50",$0.00,"$1,332.50",$0.00,$951.01,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,332.50",$0.00,$666.25,"$1,055.34","$1,066.00",$0.00,$0.00,$0.00,$0.00,$0.00
MCPE28131YB,SUP,HCPCS C1725,,MCPE28131YB  -  CATHETER INTERVENTIONAL MICRO 2.8FR .027IN 130CM MARKER BAND,"$1,300.00",$0.00,"$1,300.00",$705.90,$927.81,$0.00,$223.98,$0.00,$0.00,$227.62,"$1,300.00",$0.00,$650.00,"$1,029.60","$1,040.00",$0.00,$203.45,$0.00,$206.96,$0.00
MCR-0007,SUP,Custom 27203010,,MCR-0007  -  RETRACTOR SRG STRL MST CPSL RTRCTR,$283.33,$0.00,$283.33,$0.00,$202.21,$0.00,$0.00,$0.00,$0.00,$0.00,$283.33,$0.00,$141.67,$224.40,$226.67,$0.00,$0.00,$0.00,$0.00,$0.00
MCSK3,SUP,Custom 27203010,,HOOK 152MM RTRCT VRT MLBL KNDY,$380.00,$0.00,$380.00,$0.00,$271.21,$0.00,$0.00,$0.00,$0.00,$0.00,$380.00,$0.00,$190.00,$300.96,$304.00,$0.00,$0.00,$0.00,$0.00,$0.00
MCSK5,SUP,Custom 27203010,,TIP SCT MCFR KN 6FR MLBL,$380.00,$0.00,$380.00,$0.00,$271.21,$0.00,$0.00,$0.00,$0.00,$0.00,$380.00,$0.00,$190.00,$300.96,$304.00,$0.00,$0.00,$0.00,$0.00,$0.00
MD800F,SUP,HCPCS C1880,,MD800F  -  FILTER CARDIO MRDN VC FEM DLV KIT,"$4,151.00",$0.00,"$4,151.00","$1,867.95","$2,962.57",$0.00,$715.20,$0.00,$0.00,$726.81,"$4,151.00",$0.00,"$2,075.50","$3,287.59","$3,320.80",$0.00,$649.63,$0.00,$660.84,$0.00
MD800J,SUP,HCPCS C1880,,MD800J  -  FILTER CARDIO MRDN VC JUG DLV KIT,"$4,151.00",$0.00,"$4,151.00","$1,867.95","$2,962.57",$0.00,$715.20,$0.00,$0.00,$726.81,"$4,151.00",$0.00,"$2,075.50","$3,287.59","$3,320.80",$0.00,$649.63,$0.00,$660.84,$0.00
MDRT4101,SUP,HCPCS Q4105,,MDRT4101  -  GRAFT SKIN 10X4IN MESHED DERMAL REGENERATION TEMPLATE BOVINE,"$20,192.00",$0.00,"$20,192.00","$9,086.40","$5,158.80",$0.00,"$3,478.98",$0.00,$0.00,$25.37,"$20,192.00",$0.00,"$10,096.00","$15,992.06","$16,153.60",$0.00,$24.15,$0.00,"$3,214.57",$0.00
MDRT8101,SUP,HCPCS Q4105,,MDRT8101  -  GRAFT SKIN 25X20CM MESH DERMAL REGENERATION TEMPLATE,"$31,974.78",$0.00,"$31,974.78","$14,388.65","$5,158.80",$0.00,"$5,509.09",$0.00,$0.00,$25.37,"$31,974.78",$0.00,"$15,987.39","$25,324.03","$25,579.82",$0.00,$24.15,$0.00,"$5,090.38",$0.00
MH443,SUP,Custom 27011340,,MH443  -  VALVE SCT RED BTN EVIS 140 VID IMG SYS STRL DISP,$183.78,$0.00,$183.78,$0.00,$131.16,$0.00,$0.00,$0.00,$0.00,$0.00,$183.78,$0.00,$91.89,$145.55,$147.02,$0.00,$0.00,$0.00,$0.00,$0.00
MHC1434,SUP,Custom 27203010,,RETAINER TBGRP E 10MR NTR DRSG,$93.33,$0.00,$93.33,$0.00,$66.61,$0.00,$0.00,$0.00,$0.00,$0.00,$93.33,$0.00,$46.66,$73.92,$74.66,$0.00,$0.00,$0.00,$0.00,$0.00
MHC1439,SUP,Custom 27203010,,RETAINER TBGRP G 10MR NTR DRSG STRL,$117.60,$0.00,$117.60,$0.00,$83.93,$0.00,$0.00,$0.00,$0.00,$0.00,$117.60,$0.00,$58.80,$93.14,$94.08,$0.00,$0.00,$0.00,$0.00,$0.00
MIS-7F11,SUP,HCPCS C1894,,MIS-7F11  -  SET INTROD .018IN MICRO STR 7FR 21GA 11CM 2.75IN 1 END GWIRE,$152.50,$0.00,$152.50,$82.81,$108.84,$0.00,$26.27,$0.00,$0.00,$26.70,$152.50,$0.00,$76.25,$120.78,$122.00,$0.00,$23.87,$0.00,$24.28,$0.00
MMSLED-42,SUP,HCPCS C1713,,MMSLED-42  -  WIRE FIX 42MM SLED MEDIAL MALLEOLAR,"$1,887.50",$0.00,"$1,887.50",$849.38,"$1,347.11",$0.00,$325.21,$0.00,$0.00,$330.49,"$1,887.50",$0.00,$943.75,"$1,494.90","$1,510.00",$0.00,$295.39,$0.00,$300.49,$0.00
MMSLEDW,SUP,HCPCS C1713,,MMSLEDW  -  WASHER ORTHOPEDIC SLED MEDIAL MALLEOLAR,$412.50,$0.00,$412.50,$185.63,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
MN60AC.060,SUP,HCPCS V2632,,MN60AC.060  -  LENS IOL 10 D +6 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
MN60AC.065,SUP,HCPCS V2632,,MN60AC.065  -  LENS IOL 10 D +6.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
MN60AC.075,SUP,HCPCS V2632,,MN60AC.075  -  LENS IOL 10 D +7.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
MN60AC.085,SUP,HCPCS V2632,,MN60AC.085  -  LENS IOL 10 D +8.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
MN60AC.095,SUP,HCPCS V2632,,MN60AC.095  -  LENS IOL 10 D +9.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
MN60AC.100,SUP,HCPCS V2632,,MN60AC.100  -  LENS IOL 10 D +10 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
MN60AC.105,SUP,HCPCS V2632,,MN60AC.105  -  LENS IOL 10 D +10.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
MN60AC.110,SUP,HCPCS V2632,,MN60AC.110  -  LENS IOL 10 D +11 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
MN60AC.115,SUP,HCPCS V2632,,MN60AC.115  -  LENS IOL 10 D +11.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
MN60AC.120,SUP,HCPCS V2632,,MN60AC.120  -  LENS IOL 10 D +12 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
MN60AC.125,SUP,HCPCS V2632,,MN60AC.125  -  LENS IOL 10 D +12.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
MN60AC.130,SUP,HCPCS V2632,,MN60AC.130  -  LENS IOL 10 D +13 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
MN60AC.135,SUP,HCPCS V2632,,MN60AC.135  -  LENS IOL 10 D +13.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
MN60AC.140,SUP,HCPCS V2632,,MN60AC.140  -  LENS IOL 10 D +14 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
MN60AC.145,SUP,HCPCS V2632,,MN60AC.145  -  LENS IOL 10 D +14.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
MN60AC.150,SUP,HCPCS V2632,,MN60AC.150  -  LENS IOL 10 D +15 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
MN60AC.155,SUP,HCPCS V2632,,MN60AC.155  -  LENS IOL 10 D +15.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
MN60AC.160,SUP,HCPCS V2632,,MN60AC.160  -  LENS IOL 10 D +16 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
MN60AC.165,SUP,HCPCS V2632,,MN60AC.165  -  LENS IOL 10 D +16.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
MN60AC.170,SUP,HCPCS V2632,,MN60AC.170  -  LENS IOL 10 D +17 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
MN60AC.175,SUP,HCPCS V2632,,MN60AC.175  -  LENS IOL 10 D +17.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
MN60AC.180,SUP,HCPCS V2632,,MN60AC.180  -  LENS IOL 10 D +18 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
MN60AC.185,SUP,HCPCS V2632,,MN60AC.185  -  LENS IOL 10 D +18.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
MN60AC.190,SUP,HCPCS V2632,,MN60AC.190  -  LENS IOL 10 D +19 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
MN60AC.195,SUP,HCPCS V2632,,MN60AC.195  -  LENS IOL 10 D +19.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
MN60AC.200,SUP,HCPCS V2632,,MN60AC.200  -  LENS IOL 10 D +20 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
MN60AC.205,SUP,HCPCS V2632,,MN60AC.205  -  LENS IOL 10 D +20.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
MN60AC.210,SUP,HCPCS V2632,,MN60AC.210  -  LENS IOL 10 D +21 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
MN60AC.215,SUP,HCPCS V2632,,MN60AC.215  -  LENS IOL 10 D +21.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
MN60AC.220,SUP,HCPCS V2632,,MN60AC.220  -  LENS IOL 10 D +22 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
MN60AC.225,SUP,HCPCS V2632,,MN60AC.225  -  LENS IOL 10 D +22.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
MN60AC.230,SUP,HCPCS V2632,,MN60AC.230  -  LENS IOL 10 D +23 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
MN60AC.235,SUP,HCPCS V2632,,MN60AC.235  -  LENS IOL 10 D +23.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
MN60AC.240,SUP,HCPCS V2632,,MN60AC.240  -  LENS IOL 10 D +24 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
MN60AC.245,SUP,HCPCS V2632,,MN60AC.245  -  LENS IOL 10 D +24.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
MN60AC.250,SUP,HCPCS V2632,,MN60AC.250  -  LENS IOL 10 D +25 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
MN60AC.255,SUP,HCPCS V2632,,MN60AC.255  -  LENS IOL 10 D +25.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
MN60AC.260,SUP,HCPCS V2632,,MN60AC.260  -  LENS IOL 10 D +26 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
MN60AC.265,SUP,HCPCS V2632,,MN60AC.265  -  LENS IOL 10 D +26.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
MN60AC.270,SUP,HCPCS V2632,,MN60AC.270  -  LENS IOL 10 D +27 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
MN60AC.275,SUP,HCPCS V2632,,MN60AC.275  -  LENS IOL 10 D +27.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
MN60AC.280,SUP,HCPCS V2632,,MN60AC.280  -  LENS IOL 10 D +28 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
MN60AC.285,SUP,HCPCS V2632,,MN60AC.285  -  LENS IOL 10 D +28.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
MN60AC.290,SUP,HCPCS V2632,,MN60AC.290  -  LENS IOL 10 D +29 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
MN60AC.295,SUP,HCPCS V2632,,MN60AC.295  -  LENS IOL 10 D +29.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
MN60AC.300,SUP,HCPCS V2632,,MN60AC.300  -  LENS IOL 10 D +30 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
MN60MA.000,SUP,HCPCS V2632,,MN60MA.000  -  LENS IOL 5 D +0 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
MN60MA.010,SUP,HCPCS V2632,,MN60MA.010  -  LENS IOL 5 D +1 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
MN60MA.030,SUP,HCPCS V2632,,MN60MA.030  -  LENS IOL 5 D +30 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
MN60MA.040,SUP,HCPCS V2632,,MN60MA.040  -  LENS IOL 5 D +4 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
MN60MA.050,SUP,HCPCS V2632,,MN60MA.050  -  LENS IOL 5 D +5 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
MN60MAN010,SUP,HCPCS V2632,,MN60MAN010  -  LENS IOL 5 D -1 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
MN60MAN020,SUP,HCPCS V2632,,MN60MAN020  -  LENS IOL 5 D -2 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
MN60MAN030,SUP,HCPCS V2632,,MN60MAN030  -  LENS IOL 5 D -3 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
MN60MAN040,SUP,HCPCS V2632,,MN60MAN040  -  LENS IOL 5 D -4 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
MN60MAN050,SUP,HCPCS V2632,,MN60MAN050  -  LENS IOL 5 D -5 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
MPIS-501-NT-SST,SUP,HCPCS C1894,,MPIS-501-NT-SST  -  SET INTROD 40CM 5FR MPNCH .018IN NTNL GWIRE 10CM VLNK STRL,$47.50,$0.00,$47.50,$25.79,$33.90,$0.00,$8.18,$0.00,$0.00,$8.32,$47.50,$0.00,$23.75,$37.62,$38.00,$0.00,$7.43,$0.00,$7.56,$0.00
MPQ-2.5,SUP,HCPCS L8603,,MPQ-2.5  -  AGENT BULKING MACROPLASTIQUE SILICONE ELASTOMER 2.5 ML,"$1,237.50",$0.00,"$1,237.50",$0.00,$883.20,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,237.50",$0.00,$618.75,$980.10,$990.00,$0.00,$0.00,$0.00,$0.00,$0.00
MR17035101,SUP,HCPCS C1751,,MR17035101  -  SET CATHETER 5FR 60CM 1 LUMEN PICC BASIC GWIRE INTROD NEEDLE,$175.00,$0.00,$175.00,$78.75,$124.90,$0.00,$30.15,$0.00,$0.00,$30.64,$175.00,$0.00,$87.50,$138.60,$140.00,$0.00,$27.39,$0.00,$27.86,$0.00
MR17035201,SUP,HCPCS C1751,,MR17035201  -  SET CATHETER 5FR 55CM PICC 2 LUMEN BASIC GWIRE INTROD NEEDLE,$175.00,$0.00,$175.00,$78.75,$124.90,$0.00,$30.15,$0.00,$0.00,$30.64,$175.00,$0.00,$87.50,$138.60,$140.00,$0.00,$27.39,$0.00,$27.86,$0.00
MRCT15004M,SUP,HCPCS C1750,,MRCT15004M  -  5F MINI ATTACHABLE CATHETER,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
MRDP50ASN,SUP,HCPCS C1750,,MRDP50ASN  -  5F MINI ATTACHABLE CATHETER,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
MRDP66AMN,SUP,HCPCS C1788,,MRDP66AMN  -  6.6F DIGNITY PORT,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
MRN-420,SUP,HCPCS L8606,,MRN-420  -  NEEDLE ESCP 3.8FR MACROPLASTIQUE URTH,$75.00,$0.00,$75.00,$0.00,$53.53,$0.00,$0.00,$0.00,$0.00,$0.00,$75.00,$0.00,$37.50,$59.40,$60.00,$0.00,$0.00,$0.00,$0.00,$0.00
MRPP80AFS,SUP,HCPCS C1751,,MRPP80AFS  -  CATHETER CENTRAL VENOUS PRO-FUSE TRINIFLEX OD8 FR ATTACHABLE,$500.00,$0.00,$500.00,$225.00,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
MS DC5020,SUP,Custom 27203010,,MS DC5020  -  BIT DRILL 5IN 2MM QRLSE STRL,$66.30,$0.00,$66.30,$0.00,$47.32,$0.00,$0.00,$0.00,$0.00,$0.00,$66.30,$0.00,$33.15,$52.51,$53.04,$0.00,$0.00,$0.00,$0.00,$0.00
MS03,SUP,Custom 27203010,,MS03  -  STOCKINETTE CAST 25YDX3IN WATER REPELLENT 3M SYNTH,$53.65,$0.00,$42.49,$0.00,$19.52,$0.00,$0.00,$0.00,$0.00,$0.00,$27.36,$0.00,$13.68,$42.49,$21.88,$0.00,$0.00,$0.00,$0.00,$0.00
MS-1106ST,SUP,HCPCS C1769,,MS-1106ST  -  WIRE FIX .045IN KWIRE,$17.50,$0.00,$17.50,$9.50,$12.49,$0.00,$3.02,$0.00,$0.00,$3.06,$17.50,$0.00,$8.75,$13.86,$14.00,$0.00,$2.74,$0.00,$2.79,$0.00
MS-2213,SUP,Custom 27203010,,MS-2213  -  TIP SCRDRVR CRCIFRM,$470.00,$0.00,$470.00,$0.00,$335.44,$0.00,$0.00,$0.00,$0.00,$0.00,$470.00,$0.00,$235.00,$372.24,$376.00,$0.00,$0.00,$0.00,$0.00,$0.00
MSC9023Z,SUP,HCPCS A6196,,MSC9023Z  -  DRESSING GRMCDL 3.125X2.375IN LF ARGLS ANMC FLM TRNS IONIC,$26.69,$0.00,$26.69,$14.49,$19.05,$0.00,$6.91,$0.00,$0.00,$4.67,$26.69,$0.00,$13.35,$21.14,$21.35,$0.00,$4.18,$0.00,$4.25,$0.00
MSC97310,SUP,Custom 27203010,,MSC97310  -  DRESSING FOAM 10X3.5IN GENTLE POSTOPERATIVE STRIP,$58.60,$0.00,$58.60,$0.00,$41.82,$0.00,$0.00,$0.00,$0.00,$0.00,$58.60,$0.00,$29.30,$46.41,$46.88,$0.00,$0.00,$0.00,$0.00,$0.00
MSC9736,SUP,Custom 27203010,,MSC9736  -  DRESSING FOAM 6X3.5IN 7 DAY ADHESIVE ANTIMICROBIAL FLEXIBLE,$63.87,$0.00,$50.59,$0.00,$32.46,$0.00,$0.00,$0.00,$0.00,$0.00,$45.48,$0.00,$22.74,$50.59,$36.38,$0.00,$0.00,$0.00,$0.00,$0.00
MS-CT21,SUP,Custom 27203010,,MS-CT21  -  TAP 2.1MM SURG,$277.50,$0.00,$277.50,$0.00,$198.05,$0.00,$0.00,$0.00,$0.00,$0.00,$277.50,$0.00,$138.75,$219.78,$222.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS-CT27,SUP,Custom 27203010,,MS-CT27  -  TAP 2.7MM SURG,$277.50,$0.00,$277.50,$0.00,$198.05,$0.00,$0.00,$0.00,$0.00,$0.00,$277.50,$0.00,$138.75,$219.78,$222.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS-CTL21,SUP,Custom 27100030,,MS-CTL21  -  TAP 2.7MM LNG BONE TIP SURG ELB ACUMED,$205.00,$0.00,$205.00,$0.00,$146.31,$0.00,$0.00,$0.00,$0.00,$0.00,$205.00,$0.00,$102.50,$162.36,$164.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS-CTL27,SUP,Custom 27100030,,MS-CTL27  -  TAP 2.7MM LNG BONE TIP SURG ELB ACUMED,$277.50,$0.00,$277.50,$0.00,$198.05,$0.00,$0.00,$0.00,$0.00,$0.00,$277.50,$0.00,$138.75,$219.78,$222.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS-D761,SUP,Custom 27203010,,MS-D761  -  BIT DRL 6.1MM,$215.00,$0.00,$215.00,$0.00,$153.45,$0.00,$0.00,$0.00,$0.00,$0.00,$215.00,$0.00,$107.50,$170.28,$172.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS-DC15,SUP,Custom 27203010,,MS-DC15  -  BIT DRL 1.5MM,$147.50,$0.00,$147.50,$0.00,$105.27,$0.00,$0.00,$0.00,$0.00,$0.00,$147.50,$0.00,$73.75,$116.82,$118.00,$0.00,$0.00,$0.00,$0.00,$0.00
MSDC-20,SUP,Custom 27203010,,MSDC-20  -  BIT DRILL 5IN 2MM LNG QRLSE STRL,$135.00,$0.00,$135.00,$0.00,$96.35,$0.00,$0.00,$0.00,$0.00,$0.00,$135.00,$0.00,$67.50,$106.92,$108.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS-DC28,SUP,Custom 27203010,,MS-DC28  -  DRILL SRG 2.8MM 5IN QRLSE,$147.50,$0.00,$147.50,$0.00,$105.27,$0.00,$0.00,$0.00,$0.00,$0.00,$147.50,$0.00,$73.75,$116.82,$118.00,$0.00,$0.00,$0.00,$0.00,$0.00
MSDC-35,SUP,Custom 27203010,,MSDC-35  -  BIT DRILL 5IN 3.5MM ACTRK2 ORTH QRLSE STRL,$135.00,$0.00,$135.00,$0.00,$96.35,$0.00,$0.00,$0.00,$0.00,$0.00,$135.00,$0.00,$67.50,$106.92,$108.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS-DC35,SUP,Custom 27203010,,MS-DC35  -  DRILL SRG 3.5MM 5IN QRLSE,$147.50,$0.00,$147.50,$0.00,$105.27,$0.00,$0.00,$0.00,$0.00,$0.00,$147.50,$0.00,$73.75,$116.82,$118.00,$0.00,$0.00,$0.00,$0.00,$0.00
MSDC-5020,SUP,Custom 27203010,,BIT DRILL 5IN 2MM QRLSE STRL,$135.00,$0.00,$135.00,$0.00,$96.35,$0.00,$0.00,$0.00,$0.00,$0.00,$135.00,$0.00,$67.50,$106.92,$108.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS-DC5020,SUP,Custom 27203010,,MS-DC5020  -  DRILL SRG 2MM 5IN QRLSE,$147.50,$0.00,$147.50,$0.00,$105.27,$0.00,$0.00,$0.00,$0.00,$0.00,$147.50,$0.00,$73.75,$116.82,$118.00,$0.00,$0.00,$0.00,$0.00,$0.00
MSDCL15,SUP,Custom 27203010,,DRILL SURG QRLSE 1.5MM,$95.00,$0.00,$95.00,$0.00,$67.80,$0.00,$0.00,$0.00,$0.00,$0.00,$95.00,$0.00,$47.50,$75.24,$76.00,$0.00,$0.00,$0.00,$0.00,$0.00
MSDCL20,SUP,Custom 27203010,,BIT DRILL 2MM RADL ELB,$80.00,$0.00,$80.00,$0.00,$57.10,$0.00,$0.00,$0.00,$0.00,$0.00,$80.00,$0.00,$40.00,$63.36,$64.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS-DCL28,SUP,Custom 27203010,,MS-DCL28  -  BIT DRILL 2-8MM 2.8MM LNG QRLSE STRL,$147.50,$0.00,$147.50,$0.00,$105.27,$0.00,$0.00,$0.00,$0.00,$0.00,$147.50,$0.00,$73.75,$116.82,$118.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS-DCR20,SUP,Custom 27203010,,MS-DCR20  -  BIT DRILL 5IN 2MM QRLSE STRL,$147.50,$0.00,$147.50,$0.00,$105.27,$0.00,$0.00,$0.00,$0.00,$0.00,$147.50,$0.00,$73.75,$116.82,$118.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS-DCSB32,SUP,Custom 27203010,,MS-DCSB32  -  DRILL SURG SURGIBIT 3.2MM NONSTRL,$147.50,$0.00,$147.50,$0.00,$105.27,$0.00,$0.00,$0.00,$0.00,$0.00,$147.50,$0.00,$73.75,$116.82,$118.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS-DG23,SUP,Custom 27203010,,MS-DG23  -  GUIDE 2MM DRILL DEPTH GA SURG,$842.50,$0.00,$842.50,$0.00,$601.29,$0.00,$0.00,$0.00,$0.00,$0.00,$842.50,$0.00,$421.25,$667.26,$674.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS-DG28,SUP,Custom 27203010,,MS-DG28  -  GUIDE DRILL 2.8MM ASMBLY NONSTRL,$890.00,$0.00,$890.00,$0.00,$635.19,$0.00,$0.00,$0.00,$0.00,$0.00,$890.00,$0.00,$445.00,$704.88,$712.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS-DG40,SUP,Custom 27203010,,MS-DG40  -  GUIDE DRILL 4MM ASMBLY NONSTRL,$925.00,$0.00,$925.00,$0.00,$660.17,$0.00,$0.00,$0.00,$0.00,$0.00,$925.00,$0.00,$462.50,$732.60,$740.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS-DG46,SUP,Custom 27203010,,MS-DG46  -  GUIDE DRILL 4.6MM ASMBLY NONSTRL,"$1,185.00",$0.00,"$1,185.00",$0.00,$845.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,185.00",$0.00,$592.50,$938.52,$948.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS-DS2835,SUP,Custom 27203010,,MS-DS2835  -  SLEEVE DRILL 2.8/3.5MM LAG SCR,$277.50,$0.00,$277.50,$0.00,$198.05,$0.00,$0.00,$0.00,$0.00,$0.00,$277.50,$0.00,$138.75,$219.78,$222.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS-LDC20,SUP,Custom 27203010,,MS-LDC20  -  DRILL SRG LNG 2MM QRLSE,$147.50,$0.00,$147.50,$0.00,$105.27,$0.00,$0.00,$0.00,$0.00,$0.00,$147.50,$0.00,$73.75,$116.82,$118.00,$0.00,$0.00,$0.00,$0.00,$0.00
MSLDC28,SUP,Custom 27203010,,BIT DRILL 2.8MM LNG QC STRL,$135.00,$0.00,$135.00,$0.00,$96.35,$0.00,$0.00,$0.00,$0.00,$0.00,$135.00,$0.00,$67.50,$106.92,$108.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS-LDC28,SUP,Custom 27203010,,MS-LDC28  -  DRILL SRG LNG 2.8MM QRLSE,$147.50,$0.00,$147.50,$0.00,$105.27,$0.00,$0.00,$0.00,$0.00,$0.00,$147.50,$0.00,$73.75,$116.82,$118.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS-LTT27,SUP,Custom 27203010,,MS-LTT27  -  DRILL SRG LNG 2.7MM TPR,$565.00,$0.00,$565.00,$0.00,$403.24,$0.00,$0.00,$0.00,$0.00,$0.00,$565.00,$0.00,$282.50,$447.48,$452.00,$0.00,$0.00,$0.00,$0.00,$0.00
MSLTT35,SUP,HCPCS C1713,,MSLTT35  -  SCREW BONE 3.5MM ORTH TPR,$187.50,$0.00,$187.50,$84.38,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
MS-LTT35,SUP,HCPCS C1713,,MS-LTT35  -  SCREW BONE 2.7MM 35MM LNG CORT LNG TAP QCK CPLR NONSTRL 3.5,$565.00,$0.00,$565.00,$254.25,$403.24,$0.00,$97.35,$0.00,$0.00,$98.93,$565.00,$0.00,$282.50,$447.48,$452.00,$0.00,$88.42,$0.00,$89.95,$0.00
MS-PH28,SUP,Custom 27203010,,MS-PH28  -  BIT DRL 2.8MM,$205.00,$0.00,$205.00,$0.00,$146.31,$0.00,$0.00,$0.00,$0.00,$0.00,$205.00,$0.00,$102.50,$162.36,$164.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS-PH40,SUP,Custom 27203010,,MS-PH40  -  BIT DRL 4MM CANC,$205.00,$0.00,$205.00,$0.00,$146.31,$0.00,$0.00,$0.00,$0.00,$0.00,$205.00,$0.00,$102.50,$162.36,$164.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS-PH46,SUP,Custom 27203010,,MS-PH46  -  DRILL SURG 4.6MM CANC CANC SCR STRL,$205.00,$0.00,$205.00,$0.00,$146.31,$0.00,$0.00,$0.00,$0.00,$0.00,$205.00,$0.00,$102.50,$162.36,$164.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS-PHBCD,SUP,Custom 27203010,,MS-PHBCD  -  BIT DRILL CLRNC,$205.00,$0.00,$205.00,$0.00,$146.31,$0.00,$0.00,$0.00,$0.00,$0.00,$205.00,$0.00,$102.50,$162.36,$164.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS-PIN20,SUP,Custom 27203010,,MS-PIN20  -  PIN FIX 2MM STNM QCK CPLR,$202.50,$0.00,$202.50,$0.00,$144.52,$0.00,$0.00,$0.00,$0.00,$0.00,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$0.00,$0.00,$0.00,$0.00
MS-PIN28,SUP,Custom 27203010,,MS-PIN28  -  PIN DRILL 2.8MM LNG HUM ELB QRLSE DRILL GUIDE CLMP NONSTRL,$202.50,$0.00,$202.50,$0.00,$144.52,$0.00,$0.00,$0.00,$0.00,$0.00,$202.50,$0.00,$101.25,$160.38,$162.00,$0.00,$0.00,$0.00,$0.00,$0.00
MSS4022,SUP,Custom 27203010,,MSS4022  -  DRESSING HYALOMATRIX 5X5CM BILAYER FLXB SEMIPERM,$686.93,$0.00,$686.93,$0.00,$490.26,$0.00,$0.00,$0.00,$0.00,$0.00,$686.93,$0.00,$343.46,$544.05,$549.54,$0.00,$0.00,$0.00,$0.00,$0.00
MS-T35S,SUP,HCPCS C1713,,MS-T35S  -  SCREW BONE 3.5MM SHRT CORT SLFTAP,$330.00,$0.00,$330.00,$148.50,$235.52,$0.00,$56.86,$0.00,$0.00,$57.78,$330.00,$0.00,$165.00,$261.36,$264.00,$0.00,$51.65,$0.00,$52.54,$0.00
MT-1000,SUP,Custom 27203010,,MT-1000  -  MINNIE TIE,"$4,557.50",$0.00,"$4,557.50",$0.00,"$3,252.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,557.50",$0.00,"$2,278.75","$3,609.54","$3,646.00",$0.00,$0.00,$0.00,$0.00,$0.00
MT2000,SUP,Custom 27203010,,LENS IRR MRGN MDGL THRP,$49.95,$0.00,$49.95,$0.00,$35.65,$0.00,$0.00,$0.00,$0.00,$0.00,$49.95,$0.00,$24.98,$39.56,$39.96,$0.00,$0.00,$0.00,$0.00,$0.00
MTA3U0,SUP,HCPCS V2630,,MTA3U0  -  LENS IOL +21 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA3U0.050,SUP,HCPCS V2630,,MTA3U0.050  -  LENS IOL +5 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA3U0.060,SUP,HCPCS V2630,,MTA3U0.060  -  LENS IOL +6 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA3U0.070,SUP,HCPCS V2630,,MTA3U0.070  -  LENS IOL +7 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA3U0.080,SUP,HCPCS V2630,,MTA3U0.080  -  LENS IOL +8 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA3U0.090,SUP,HCPCS V2630,,MTA3U0.090  -  LENS IOL +9 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA3U0.100,SUP,HCPCS V2630,,MTA3U0.100  -  LENS IOL +10 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA3U0.105,SUP,HCPCS V2630,,MTA3U0.105  -  LENS IOL +10.5 DIOP 12.5MM 5.5MM ANTER CHAM 1 PC CNVXPLN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA3U0.110,SUP,HCPCS V2630,,MTA3U0.110  -  LENS IOL +11 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA3U0.115,SUP,HCPCS V2630,,MTA3U0.115  -  LENS IOL +11.5 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA3U0.120,SUP,HCPCS V2630,,MTA3U0.120  -  LENS IOL +12 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA3U0.125,SUP,HCPCS V2630,,MTA3U0.125  -  LENS IOL +12.5 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA3U0.130,SUP,HCPCS V2630,,MTA3U0.130  -  LENS IOL +13 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA3U0.135,SUP,HCPCS V2630,,MTA3U0.135  -  LENS IOL +13.5 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA3U0.145,SUP,HCPCS V2630,,MTA3U0.145  -  LENS IOL +14.5 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA3U0.150,SUP,HCPCS V2630,,MTA3U0.150  -  LENS IOL +15 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA3U0.155,SUP,HCPCS V2630,,MTA3U0.155  -  LENS IOL +15.5 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA3U0.160,SUP,HCPCS V2630,,MTA3U0.160  -  LENS IOL +16 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA3U0.165,SUP,HCPCS V2630,,MTA3U0.165  -  LENS IOL +16.5 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA3U0.170,SUP,HCPCS V2630,,MTA3U0.170  -  LENS IOL +17 DIOP 12.5MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA3U0.180,SUP,HCPCS V2630,,MTA3U0.180  -  LENS IOL +18 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA3U0.185,SUP,HCPCS V2630,,MTA3U0.185  -  LENS IOL +18.5 DIOP 12.5MM 5.5MM ANTER CHAM 1 PC CNVXPLN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA3U0.190,SUP,HCPCS V2632,,MTA3U0.190  -  INTRAOCULAR LENS  MTA3U0   19.0D,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA3U0.200,SUP,HCPCS V2632,,MTA3U0.200  -  INTRAOUCLAR LENS  MTA3U0  20.0D,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA3U0.205,SUP,HCPCS V2630,,MTA3U0.205  -  LENS IOL +20.5 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA3U0.210,SUP,HCPCS V2630,,MTA3U0.210  -  LENS IOL +21 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA3U0.215,SUP,HCPCS V2630,,MTA3U0.215  -  LENS IOL +21.5 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA3U0.220,SUP,HCPCS V2630,,MTA3U0.220  -  LENS IOL +22 DIOP 12.5MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA3U0.230,SUP,HCPCS V2630,,MTA3U0.230  -  LENS IOL +23 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA3U0.235,SUP,HCPCS V2630,,MTA3U0.235  -  LENS IOL +23.5 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA3U0.240,SUP,HCPCS V2630,,MTA3U0.240  -  LENS IOL +24 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA3U0.245,SUP,HCPCS V2630,,MTA3U0.245  -  LENS IOL +24.5 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA3U0.250,SUP,HCPCS V2630,,MTA3U0.250  -  LENS IOL +25 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA3U0.255,SUP,HCPCS V2630,,MTA3U0.255  -  LENS IOL +25.5 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA3U0.260,SUP,HCPCS V2630,,MTA3U0.260  -  LENS IOL +26 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA3U0.265,SUP,HCPCS V2630,,MTA3U0.265  -  LENS IOL +26.5 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA3U0.270,SUP,HCPCS V2630,,MTA3U0.270  -  LENS IOL +27 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA3U0.275,SUP,HCPCS V2630,,MTA3U0.275  -  LENS IOL +27.5 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA3U0.280,SUP,HCPCS V2630,,MTA3U0.280  -  LENS IOL +28 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA3U0.285,SUP,HCPCS V2630,,MTA3U0.285  -  LENS IOL +28.5 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA3U0.290,SUP,HCPCS V2630,,MTA3U0.290  -  LENS IOL +29 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA3U0.295,SUP,HCPCS V2630,,MTA3U0.295  -  LENS IOL +29.5 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA3U0.300,SUP,HCPCS V2630,,MTA3U0.300  -  LENS IOL +30 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA4U0,SUP,HCPCS V2630,,MTA4U0  -  LENS IOL +6.5 DIOP CNVXPLN 5.5MM 13MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA4U0.015,SUP,HCPCS V2630,,MTA4U0.015  -  LENS IOL +15 DIOP 13MM 5.5MM ANTER CHAM CNVXPLN 1 PC PMMA,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA4U0.050,SUP,HCPCS V2630,,MTA4U0.050  -  LENS IOL +5 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA4U0.055,SUP,HCPCS V2630,,MTA4U0.055  -  LENS IOL +5.5 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA4U0.060,SUP,HCPCS V2630,,MTA4U0.060  -  LENS IOL +6 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA4U0.065,SUP,HCPCS V2630,,MTA4U0.065  -  LENS IOL +6.5 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA4U0.070,SUP,HCPCS V2630,,MTA4U0.070  -  LENS IOL +7 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA4U0.075,SUP,HCPCS V2630,,MTA4U0.075  -  LENS IOL +7.5 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA4U0.080,SUP,HCPCS V2630,,MTA4U0.080  -  LENS IOL +8 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA4U0.085,SUP,HCPCS V2630,,MTA4U0.085  -  LENS IOL +8.5 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA4U0.090,SUP,HCPCS V2630,,MTA4U0.090  -  LENS IOL +9 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA4U0.095,SUP,HCPCS V2630,,MTA4U0.095  -  LENS IOL +9.5 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA4U0.100,SUP,HCPCS V2630,,MTA4U0.100  -  LENS IOL +10 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA4U0.105,SUP,HCPCS V2630,,MTA4U0.105  -  LENS IOL +10.5 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA4U0.110,SUP,HCPCS V2630,,MTA4U0.110  -  LENS IOL +11 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA4U0.115,SUP,HCPCS V2630,,MTA4U0.115  -  LENS IOL +11.5 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA4U0.120,SUP,HCPCS V2630,,MTA4U0.120  -  LENS IOL +12 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA4U0.125,SUP,HCPCS V2630,,MTA4U0.125  -  LENS IOL +12.5 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA4U0.130,SUP,HCPCS V2630,,MTA4U0.130  -  LENS IOL +13 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA4U0.135,SUP,HCPCS V2630,,MTA4U0.135  -  LENS IOL +13.5 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA4U0.140,SUP,HCPCS V2630,,MTA4U0.140  -  LENS IOL +14 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA4U0.145,SUP,HCPCS V2630,,MTA4U0.145  -  LENS IOL +14.5 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA4U0.155,SUP,HCPCS V2630,,MTA4U0.155  -  LENS IOL +15.5 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA4U0.160,SUP,HCPCS V2630,,MTA4U0.160  -  LENS IOL +16 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA4U0.165,SUP,HCPCS V2632,,MTA4U0.165  -  INTRAOCULAR LENS  MTA4U0  16.5 D,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA4U0.170,SUP,HCPCS V2632,,MTA4U0.170  -  INTRAOCULAR LENS  MTA4UO  17.0D,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA4U0.175,SUP,HCPCS V2630,,MTA4U0.175  -  LENS IOL +17.5 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA4U0.180,SUP,HCPCS V2630,,MTA4U0.180  -  LENS IOL +18 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA4U0.185,SUP,HCPCS V2630,,MTA4U0.185  -  LENS IOL +18.5 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA4U0.190,SUP,HCPCS V2630,,MTA4U0.190  -  LENS IOL +19 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA4U0.195,SUP,HCPCS V2632,,MTA4U0.195  -  INTRAOCULAR LENS  MTA4U0  19.5D,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA4U0.200,SUP,HCPCS V2630,,MTA4U0.200  -  LENS IOL +20 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA4U0.205,SUP,HCPCS V2632,,MTA4U0.205  -  INTRAOCULAR LENS MTA4U0  20.5D,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA4U0.210,SUP,HCPCS V2630,,MTA4U0.210  -  LENS IOL +21 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA4U0.215,SUP,HCPCS V2630,,MTA4U0.215  -  LENS IOL +21.5 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA4U0.220,SUP,HCPCS V2630,,MTA4U0.220  -  LENS IOL +22.0 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA4U0.225,SUP,HCPCS V2630,,MTA4U0.225  -  LENS IOL +22.5 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA4U0.230,SUP,HCPCS V2630,,MTA4U0.230  -  LENS IOL +23 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA4U0.235,SUP,HCPCS V2630,,MTA4U0.235  -  LENS IOL +23.5 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA4U0.240,SUP,HCPCS V2630,,MTA4U0.240  -  LENS IOL +24 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA4U0.245,SUP,HCPCS V2630,,MTA4U0.245  -  LENS IOL +24.5 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA4U0.250,SUP,HCPCS V2630,,MTA4U0.250  -  LENS IOL +25 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA4U0.255,SUP,HCPCS V2630,,MTA4U0.255  -  LENS IOL +25.5 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA4U0.260,SUP,HCPCS V2630,,MTA4U0.260  -  LENS IOL +26 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA4U0.265,SUP,HCPCS V2630,,MTA4U0.265  -  LENS IOL +26.5 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA4U0.270,SUP,HCPCS V2630,,MTA4U0.270  -  LENS IOL +27 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA4U0.275,SUP,HCPCS V2630,,MTA4U0.275  -  LENS IOL +27.5 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA4U0.280,SUP,HCPCS V2630,,MTA4U0.280  -  LENS IOL +28 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA4U0.285,SUP,HCPCS V2630,,MTA4U0.285  -  LENS IOL +28.5 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA4U0.290,SUP,HCPCS V2630,,MTA4U0.290  -  LENS IOL +29 DIOP 13MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA4U0.300,SUP,HCPCS V2630,,MTA4U0.300  -  LENS IOL +30 DIOP CNVXPLN 5.5MM 13MM CLR STRL KLMN MULTIFLEX,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA5U0,SUP,HCPCS V2630,,MTA5U0  -  LENS IOL +13.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA5U0.050,SUP,HCPCS V2630,,MTA5U0.050  -  LENS IOL +5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA5U0.060,SUP,HCPCS V2630,,MTA5U0.060  -  LENS IOL +6 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA5U0.070,SUP,HCPCS V2630,,MTA5U0.070  -  LENS IOL +7 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA5U0.080,SUP,HCPCS V2630,,MTA5U0.080  -  LENS IOL +8 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA5U0.085,SUP,HCPCS V2630,,MTA5U0.085  -  LENS IOL +8.5 DIOP CNVXPLN 13.5MM 5.5MM ANTER CHAM,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA5U0.095,SUP,HCPCS V2630,,MTA5U0.095  -  LENS IOL +9.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA5U0.100,SUP,HCPCS V2630,,MTA5U0.100  -  LENS IOL +10 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA5U0.105,SUP,HCPCS V2630,,MTA5U0.105  -  LENS IOL +10.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA5U0.115,SUP,HCPCS V2630,,MTA5U0.115  -  LENS IOL +11.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA5U0.125,SUP,HCPCS V2630,,MTA5U0.125  -  LENS IOL +12.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA5U0.135,SUP,HCPCS V2630,,MTA5U0.135  -  LENS IOL +13.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA5U0.140,SUP,HCPCS V2630,,MTA5U0.140  -  LENS IOL +14 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA5U0.145,SUP,HCPCS V2630,,MTA5U0.145  -  LENS IOL +14.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA5U0.150,SUP,HCPCS V2630,,MTA5U0.150  -  LENS IOL +15 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA5U0.155,SUP,HCPCS V2630,,MTA5U0.155  -  LENS IOL +15.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA5U0.160,SUP,HCPCS V2630,,MTA5U0.160  -  LENS IOL +16 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA5U0.165,SUP,HCPCS V2632,,MTA5U0.165  -  LENS IOL +16.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA5U0.170,SUP,HCPCS V2630,,MTA5U0.170  -  LENS IOL +17 DIOP 13.5MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA5U0.175,SUP,HCPCS V2630,,MTA5U0.175  -  LENS IOL +17.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA5U0.180,SUP,HCPCS V2630,,MTA5U0.180  -  LENS IOL +18 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA5U0.185,SUP,HCPCS V2630,,MTA5U0.185  -  LENS IOL +18.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA5U0.190,SUP,HCPCS V2630,,MTA5U0.190  -  LENS IOL +19 DIOP 13.5MM 5.5MM ANTER CHAM 1 PC CNVXPLN PMMA,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA5U0.195,SUP,HCPCS V2630,,MTA5U0.195  -  LENS IOL +19.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA5U0.200,SUP,HCPCS V2630,,MTA5U0.200  -  LENS IOL +20 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA5U0.210,SUP,HCPCS V2630,,MTA5U0.210  -  LENS IOL +21 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA5U0.215,SUP,HCPCS V2630,,MTA5U0.215  -  LENS IOL +21.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA5U0.220,SUP,HCPCS V2630,,MTA5U0.220  -  LENS IOL +22 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA5U0.225,SUP,HCPCS V2630,,MTA5U0.225  -  LENS IOL +22.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA5U0.230,SUP,HCPCS V2630,,MTA5U0.230  -  LENS IOL +23 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA5U0.235,SUP,HCPCS V2630,,MTA5U0.235  -  LENS IOL +23.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA5U0.240,SUP,HCPCS V2630,,MTA5U0.240  -  LENS IOL +24 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA5U0.250,SUP,HCPCS V2630,,MTA5U0.250  -  LENS IOL +25 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA5U0.260,SUP,HCPCS V2630,,MTA5U0.260  -  LENS IOL +26 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA5U0.270,SUP,HCPCS V2630,,MTA5U0.270  -  LENS IOL +27 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA5U0.280,SUP,HCPCS V2630,,MTA5U0.280  -  LENS IOL +28 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA5U0.285,SUP,HCPCS V2630,,MTA5U0.285  -  LENS IOL +28.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA5U0.290,SUP,HCPCS V2630,,MTA5U0.290  -  LENS IOL +29 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA5U0.295,SUP,HCPCS V2630,,MTA5U0.295  -  LENS IOL +29.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTA5U0.300,SUP,HCPCS V2630,,MTA5U0.300  -  LENS IOL +30 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN,$212.50,$0.00,$212.50,$95.63,$151.66,$0.00,$36.61,$0.00,$0.00,$37.21,$212.50,$0.00,$106.25,$168.30,$170.00,$0.00,$33.26,$0.00,$33.83,$0.00
MTLS-30060-TS,SUP,HCPCS C1713,,MTLS-30060-TS  -  SCREW BN 3MM 6MM NS MULTITHREAD LCK TI DRSL SPAN PLT,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
MTLS-30080-TS,SUP,HCPCS C1713,,MTLS-30080-TS  -  SCREW BN 3MM 8MM NS MULTITHREAD LCK TI DRSL SPAN PLT,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
MTLS-30100-TS,SUP,HCPCS C1713,,MTLS-30100-TS  -  SCREW BN 3MM 10MM NS MULTITHREAD LCK TI DRSL SPAN PLT,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
MTLS-30120-TS,SUP,HCPCS C1713,,MTLS-30120-TS  -  SCREW BN 3MM 12MM NS MULTITHREAD LCK TI DRSL SPAN PLT,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
MTLS-30140-TS,SUP,HCPCS C1713,,MTLS-30140-TS  -  SCREW BN 3MM 14MM NS MULTITHREAD LCK TI DRSL SPAN PLT,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
MTLS-30160-TS,SUP,HCPCS C1713,,MTLS-30160-TS  -  SCREW BN 3MM 16MM NS MULTITHREAD LCK TI DRSL SPAN PLT,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
MTLS-30180-TS,SUP,HCPCS C1713,,MTLS-30180-TS  -  SCREW BN 3MM 18MM NS MULTITHREAD LCK TI DRSL SPAN PLT,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
MTNL-30060-TS,SUP,HCPCS C1713,,MTNL-30060-TS  -  SCREW BN 3MM 6MM NS LF CMPR MULTITHREAD TI DRSL SPAN PLT,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
MTNL-30080-TS,SUP,HCPCS C1713,,MTNL-30080-TS  -  SCREW BN 3MM 8MM NS LF CMPR MULTITHREAD TI DRSL SPAN PLT,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
MTNL-30100-TS,SUP,HCPCS C1713,,MTNL-30100-TS  -  SCREW BN 3MM 10MM NS LF CMPR MULTITHREAD TI DRSL SPAN PLT,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
MTNL-30120-TS,SUP,HCPCS C1713,,MTNL-30120-TS  -  SCREW BN 3MM 12MM NS LF CMPR MULTITHREAD TI DRSL SPAN PLT,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
MTNL-30140-TS,SUP,HCPCS C1713,,MTNL-30140-TS  -  SCREW BN 3MM 14MM NS LF CMPR MULTITHREAD TI DRSL SPAN PLT,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
MTNL-30160-TS,SUP,HCPCS C1713,,MTNL-30160-TS  -  SCREW BN 3MM 16MM NS LF CMPR MULTITHREAD TI DRSL SPAN PLT,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
MTNL-30180-TS,SUP,HCPCS C1713,,MTNL-30180-TS  -  SCREW BN 3MM 18MM NS LF CMPR MULTITHREAD TI DRSL SPAN PLT,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
MTP-F010,SUP,Custom 27203010,,MTP-F010  -  REAMER SURG CNCV JNT,"$1,120.00",$0.00,"$1,120.00",$0.00,$799.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,120.00",$0.00,$560.00,$887.04,$896.00,$0.00,$0.00,$0.00,$0.00,$0.00
MTP-F012,SUP,Custom 27203010,,MTP-F012  -  REAMER SURG 12MM CNCV MTP,"$1,120.00",$0.00,"$1,120.00",$0.00,$799.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,120.00",$0.00,$560.00,$887.04,$896.00,$0.00,$0.00,$0.00,$0.00,$0.00
MTP-F014,SUP,Custom 27203010,,MTP-F014  -  REAMER SRG 14MM CNCV,"$1,120.00",$0.00,"$1,120.00",$0.00,$799.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,120.00",$0.00,$560.00,$887.04,$896.00,$0.00,$0.00,$0.00,$0.00,$0.00
MTP-F016,SUP,Custom 27203010,,MTP-F016  -  REAMER SURG 16MM CNCV MTP,"$1,120.00",$0.00,"$1,120.00",$0.00,$799.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,120.00",$0.00,$560.00,$887.04,$896.00,$0.00,$0.00,$0.00,$0.00,$0.00
MTP-F020,SUP,Custom 27203010,,MTP-F020  -  REAMER SRG 20MM CNCV,"$1,120.00",$0.00,"$1,120.00",$0.00,$799.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,120.00",$0.00,$560.00,$887.04,$896.00,$0.00,$0.00,$0.00,$0.00,$0.00
MTP-F024,SUP,Custom 27203010,,MTP-F024  -  REAMER SURG 24MM CNCV MTP,"$1,120.00",$0.00,"$1,120.00",$0.00,$799.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,120.00",$0.00,$560.00,$887.04,$896.00,$0.00,$0.00,$0.00,$0.00,$0.00
MTP-M010,SUP,Custom 27203010,,MTP-M010  -  REAMER SURG 10MM CNVX MTP,"$1,120.00",$0.00,"$1,120.00",$0.00,$799.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,120.00",$0.00,$560.00,$887.04,$896.00,$0.00,$0.00,$0.00,$0.00,$0.00
MTP-M012,SUP,Custom 27203010,,MTP-M012  -  REAMER SURG 12MM CNVX MTP,"$1,120.00",$0.00,"$1,120.00",$0.00,$799.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,120.00",$0.00,$560.00,$887.04,$896.00,$0.00,$0.00,$0.00,$0.00,$0.00
MTP-M014,SUP,Custom 27203010,,MTP-M014  -  REAMER SURG 14MM CNVX MTP,"$1,120.00",$0.00,"$1,120.00",$0.00,$799.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,120.00",$0.00,$560.00,$887.04,$896.00,$0.00,$0.00,$0.00,$0.00,$0.00
MTP-M016,SUP,Custom 27203010,,MTP-M016  -  REAMER SURG 16MM CNVX MTP,"$1,120.00",$0.00,"$1,120.00",$0.00,$799.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,120.00",$0.00,$560.00,$887.04,$896.00,$0.00,$0.00,$0.00,$0.00,$0.00
MTP-M020,SUP,Custom 27203010,,MTP-M020  -  REAMER SURG 20MM CNVX MTP FRFT MIDFT LG,"$1,120.00",$0.00,"$1,120.00",$0.00,$799.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,120.00",$0.00,$560.00,$887.04,$896.00,$0.00,$0.00,$0.00,$0.00,$0.00
MTP-M024,SUP,Custom 27203010,,MTP-M024  -  REAMER SURG 24MM CNVX MTP,"$1,120.00",$0.00,"$1,120.00",$0.00,$799.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,120.00",$0.00,$560.00,$887.04,$896.00,$0.00,$0.00,$0.00,$0.00,$0.00
MWCE-35-5/3-TORNADO,SUP,Custom 27803010,,MWCE-35-5/3-TORNADO  -  COIL EMBOLIZATION TORNADO .035IN PLATINUM 5-3MM,$270.00,$0.00,$270.00,$0.00,$192.70,$0.00,$0.00,$0.00,$0.00,$0.00,$270.00,$0.00,$135.00,$213.84,$216.00,$0.00,$0.00,$0.00,$0.00,$0.00
MWM4051,SUP,HCPCS C9363,,MWM4051  -  DRESSING BIOLOGICAL 5X4IN MESHED ADHERENT BILAYER MATRIX,"$12,534.83",$0.00,"$12,534.83","$5,640.67","$5,158.80",$0.00,"$2,159.69",$0.00,$0.00,"$2,194.75","$12,534.83",$0.00,"$6,267.41","$9,927.59","$10,027.86",$0.00,"$1,961.70",$0.00,"$1,995.54",$0.00
MX0100,SUP,HCPCS C1782,,MX0100  -  TISSUE MORCELLATOR,"$3,567.27",$0.00,"$3,567.27",$0.00,"$2,545.96",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,567.27",$0.00,"$1,783.64","$2,825.28","$2,853.82",$0.00,$0.00,$0.00,$0.00,$0.00
MX563,SUP,Custom 27203010,,MX563  -  SUTURE NONABSORBABLE 2-0 SH 30IN 2 ARM 4 STRAND BRAID,$42.80,$0.00,$42.80,$0.00,$30.54,$0.00,$0.00,$0.00,$0.00,$0.00,$42.80,$0.00,$21.40,$33.90,$34.24,$0.00,$0.00,$0.00,$0.00,$0.00
MX6740,SUP,HCPCS C1760,,MX6740  -  DEVICE CLSR BLK GRN 6-7FR MYNX ACE .035IN VASC LCK SYR,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
MZ30BD,SUP,HCPCS V2632,,MZ30BD  -  LENS IOL 5 D +10 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ30BD.100,SUP,HCPCS V2632,,MZ30BD.100  -  LENS IOL 5 D +10 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ30BD.110,SUP,HCPCS V2632,,MZ30BD.110  -  LENS IOL 5 D +11 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ30BD.120,SUP,HCPCS V2632,,MZ30BD.120  -  LENS IOL 5 D +12 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ30BD.130,SUP,HCPCS V2632,,MZ30BD.130  -  LENS IOL 5 D +13 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ30BD.140,SUP,HCPCS V2632,,MZ30BD.140  -  LENS IOL 5 D +14 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ30BD.150,SUP,HCPCS V2632,,MZ30BD.150  -  LENS IOL 5 D +15 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ30BD.160,SUP,HCPCS V2632,,MZ30BD.160  -  LENS IOL 5 D +16 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ30BD.170,SUP,HCPCS V2632,,MZ30BD.170  -  LENS IOL 5 D +17 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ30BD.180,SUP,HCPCS V2632,,MZ30BD.180  -  LENS IOL 5 D +18 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ30BD.190,SUP,HCPCS V2632,,MZ30BD.190  -  LENS IOL 5 D +19 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ30BD.200,SUP,HCPCS V2632,,MZ30BD.200  -  LENS IOL 5 D +20 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ30BD.210,SUP,HCPCS V2632,,MZ30BD.210  -  LENS IOL 5 D +21 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ30BD.220,SUP,HCPCS V2632,,MZ30BD.220  -  LENS IOL 5 D +22 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ30BD.225,SUP,HCPCS V2632,,MZ30BD.225  -  LENS IOL 5 D +22.5 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ30BD.235,SUP,HCPCS V2632,,MZ30BD.235  -  LENS IOL 5 D +23.5 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ30BD.245,SUP,HCPCS V2632,,MZ30BD.245  -  LENS IOL 5 D +24.5 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ30BD.255,SUP,HCPCS V2632,,MZ30BD.255  -  LENS IOL 5 D +25.5 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ30BD.265,SUP,HCPCS V2632,,MZ30BD.265  -  LENS IOL 5 D +26.5 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ30BD.275,SUP,HCPCS V2632,,MZ30BD.275  -  LENS IOL 5 D +27.5 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ30BD.285,SUP,HCPCS V2632,,MZ30BD.285  -  LENS IOL 5 D +28.5 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ30BD.295,SUP,HCPCS V2632,,MZ30BD.295  -  LENS IOL 5 D +29.5 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ40BD.100,SUP,HCPCS V2632,,MZ40BD.100  -  LENS IOL 5 D +10 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ40BD.105,SUP,HCPCS V2632,,MZ40BD.105  -  LENS IOL 5 D +10.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ40BD.110,SUP,HCPCS V2632,,MZ40BD.110  -  LENS IOL 5 D +11 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ40BD.115,SUP,HCPCS V2632,,MZ40BD.115  -  LENS IOL 5 D +11.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ40BD.120,SUP,HCPCS V2632,,MZ40BD.120  -  LENS IOL 5 D +12 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ40BD.125,SUP,HCPCS V2632,,MZ40BD.125  -  LENS IOL 5 D +12.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ40BD.130,SUP,HCPCS V2632,,MZ40BD.130  -  LENS IOL 5 D +13 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ40BD.135,SUP,HCPCS V2632,,MZ40BD.135  -  LENS IOL 5 D +13.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ40BD.140,SUP,HCPCS V2632,,MZ40BD.140  -  LENS IOL 5 D +14 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ40BD.145,SUP,HCPCS V2632,,MZ40BD.145  -  LENS IOL 5 D +14.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ40BD.150,SUP,HCPCS V2632,,MZ40BD.150  -  LENS IOL 5 D +15 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ40BD.155,SUP,HCPCS V2632,,MZ40BD.155  -  LENS IOL 5 D +15.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ40BD.160,SUP,HCPCS V2632,,MZ40BD.160  -  LENS IOL 5 D +16 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ40BD.165,SUP,HCPCS V2632,,MZ40BD.165  -  LENS IOL 5 D +16.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ40BD.170,SUP,HCPCS V2632,,MZ40BD.170  -  LENS IOL 5 D +17 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ40BD.175,SUP,HCPCS V2632,,MZ40BD.175  -  LENS IOL 5 D +17.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ40BD.180,SUP,HCPCS V2632,,MZ40BD.180  -  LENS IOL 5 D +18 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ40BD.185,SUP,HCPCS V2632,,MZ40BD.185  -  LENS IOL 5 D +18.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ40BD.190,SUP,HCPCS V2632,,MZ40BD.190  -  LENS IOL 5 D +19 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ40BD.195,SUP,HCPCS V2632,,MZ40BD.195  -  LENS IOL 5 D +19.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ40BD.200,SUP,HCPCS V2632,,MZ40BD.200  -  LENS IOL 5 D +20 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ40BD.205,SUP,HCPCS V2632,,MZ40BD.205  -  LENS IOL 5 D +20.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ40BD.210,SUP,HCPCS V2632,,MZ40BD.210  -  LENS IOL 5 D +21 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ40BD.215,SUP,HCPCS V2632,,MZ40BD.215  -  LENS IOL 5 D +21.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ40BD.220,SUP,HCPCS V2632,,MZ40BD.220  -  LENS IOL 5 D +22 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ40BD.225,SUP,HCPCS V2632,,MZ40BD.225  -  LENS IOL 5 D +22.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ40BD.230,SUP,HCPCS V2632,,MZ40BD.230  -  LENS IOL 5 D +23 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ40BD.235,SUP,HCPCS V2632,,MZ40BD.235  -  LENS IOL 5 D +23.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ40BD.240,SUP,HCPCS V2632,,MZ40BD.240  -  LENS IOL 5 D +24 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ40BD.245,SUP,HCPCS V2632,,MZ40BD.245  -  LENS IOL 5 D +24.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ40BD.250,SUP,HCPCS V2632,,MZ40BD.250  -  LENS IOL 5 D +25 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ40BD.255,SUP,HCPCS V2632,,MZ40BD.255  -  LENS IOL 5 D +25.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ40BD.260,SUP,HCPCS V2632,,MZ40BD.260  -  LENS IOL 5 D +26 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ40BD.265,SUP,HCPCS V2632,,MZ40BD.265  -  LENS IOL 5 D +26.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ40BD.270,SUP,HCPCS V2632,,MZ40BD.270  -  LENS IOL 5 D +27 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ40BD.275,SUP,HCPCS V2632,,MZ40BD.275  -  LENS IOL 5 D +27.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ40BD.280,SUP,HCPCS V2632,,MZ40BD.280  -  LENS IOL 5 D +28 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ40BD.285,SUP,HCPCS V2632,,MZ40BD.285  -  LENS IOL 5 D +28.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ40BD.290,SUP,HCPCS V2632,,MZ40BD.290  -  LENS IOL 5 D +29 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ40BD.295,SUP,HCPCS V2632,,MZ40BD.295  -  LENS IOL 5 D +29.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ40BD.300,SUP,HCPCS V2632,,MZ40BD.300  -  LENS IOL 5 D +30 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ60BD,SUP,HCPCS V2632,,MZ60BD  -  LENS IOL 5 D +25.5 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ60BD.040,SUP,HCPCS V2632,,MZ60BD.040  -  LENS IOL 5 D +4 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT 1,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ60BD.050,SUP,HCPCS V2632,,MZ60BD.050  -  LENS IOL 5 D +5 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT 1,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ60BD.060,SUP,HCPCS V2632,,MZ60BD.060  -  LENS IOL 5 D +6 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT 1,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ60BD.070,SUP,HCPCS V2632,,MZ60BD.070  -  LENS IOL 5 D +7 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT 1,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ60BD.080,SUP,HCPCS V2632,,MZ60BD.080  -  LENS IOL 5 D +8 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT 1,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ60BD.090,SUP,HCPCS V2632,,MZ60BD.090  -  LENS IOL 5 D +9 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT 1,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ60BD.100,SUP,HCPCS V2632,,MZ60BD.100  -  LENS IOL 5 D +10 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ60BD.110,SUP,HCPCS V2632,,MZ60BD.110  -  LENS IOL 5 D +11 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ60BD.120,SUP,HCPCS V2632,,MZ60BD.120  -  LENS IOL 5 D +12 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ60BD.130,SUP,HCPCS V2632,,MZ60BD.130  -  LENS IOL 5 D +13 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ60BD.140,SUP,HCPCS V2632,,MZ60BD.140  -  LENS IOL 5 D +14 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ60BD.150,SUP,HCPCS V2632,,MZ60BD.150  -  LENS IOL 5 D +15 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ60BD.160,SUP,HCPCS V2632,,MZ60BD.160  -  LENS IOL 5 D +16 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ60BD.170,SUP,HCPCS V2632,,MZ60BD.170  -  LENS IOL 5 D +17 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ60BD.180,SUP,HCPCS V2632,,MZ60BD.180  -  LENS IOL 5 D +18 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ60BD.190,SUP,HCPCS V2632,,MZ60BD.190  -  LENS IOL 5 D +19 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ60BD.200,SUP,HCPCS V2632,,MZ60BD.200  -  LENS IOL 5 D +20 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ60BD.210,SUP,HCPCS V2632,,MZ60BD.210  -  LENS IOL 5 D +21 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ60BD.220,SUP,HCPCS V2632,,MZ60BD.220  -  LENS IOL 5 D +22 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ60BD.230,SUP,HCPCS V2632,,MZ60BD.230  -  LENS IOL 5 D +23 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ60BD.240,SUP,HCPCS V2632,,MZ60BD.240  -  LENS IOL 5 D +24 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ60BD.245,SUP,HCPCS V2632,,MZ60BD.245  -  LENS IOL 5 D +24.5 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ60BD.250,SUP,HCPCS V2632,,MZ60BD.250  -  LENS IOL 5 D +25 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ60BD.260,SUP,HCPCS V2632,,MZ60BD.260  -  LENS IOL 5 D +26 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ60BD.270,SUP,HCPCS V2632,,MZ60BD.270  -  LENS IOL 5 D +27 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ60BD.280,SUP,HCPCS V2632,,MZ60BD.280  -  LENS IOL 5 D +28 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ60BD.290,SUP,HCPCS V2632,,MZ60BD.290  -  LENS IOL 5 D +29 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ60BD.300,SUP,HCPCS V2632,,MZ60BD.300  -  LENS IOL 5 D +30 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ60BD.320,SUP,HCPCS V2632,,MZ60BD.320  -  LENS IOL 5 D +32 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ60BD.340,SUP,HCPCS V2632,,MZ60BD.340  -  LENS IOL 5 D +34 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ60MD,SUP,HCPCS V2632,,MZ60MD  -  LENS IOL 5 D -1 DIOP MOD C MNSCS 6MM 12.5MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ60MD.000,SUP,HCPCS V2632,,MZ60MD.000  -  LENS IOL 5 D +0 DIOP MOD C MNSCS 6MM 12.5MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ60MD.010,SUP,HCPCS V2632,,MZ60MD.010  -  LENS IOL 5 D +1 DIOP MOD C MNSCS 6MM 12.5MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ60MD.020,SUP,HCPCS V2632,,MZ60MD.020  -  LENS IOL 5 D +2 DIOP MOD C MNSCS 6MM 12.5MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ60MD.030,SUP,HCPCS V2632,,MZ60MD.030  -  LENS IOL 5 D +3 DIOP MOD C MNSCS 6MM 12.5MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ60MDN010,SUP,HCPCS V2632,,MZ60MDN010  -  LENS IOL 5 D -1 DIOP MOD C MNSCS 6MM 12.5MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ60MDN020,SUP,HCPCS V2632,,MZ60MDN020  -  LENS IOL 5 D -2 DIOP MOD C MNSCS 6MM 12.5MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ60MDN030,SUP,HCPCS V2632,,MZ60MDN030  -  LENS IOL 5 D -3 DIOP MOD C MNSCS 6MM 12.5MM CLR STRL SLANT,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ60PDN040,SUP,HCPCS V2632,,MZ60PDN040  -  LENS IOL 5 D -4 DIOP MOD C PLANO CNCV 6MM 12.5MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ60PDN050,SUP,HCPCS V2632,,MZ60PDN050  -  LENS IOL 5 D -5 DIOP MOD C PLANO CNCV 6MM 12.5MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ60PDN060,SUP,HCPCS V2632,,MZ60PDN060  -  LENS IOL 5 D -6 DIOP MOD C PLANO CNCV 6MM 12.5MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ60PDN070,SUP,HCPCS V2632,,MZ60PDN070  -  LENS IOL 5 D -7 DIOP MOD C PLANO CNCV 6MM 12.5MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ60PDN080,SUP,HCPCS V2632,,MZ60PDN080  -  LENS IOL 5 D -8 DIOP MOD C PLANO CNCV 6MM 12.5MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ60PDN090,SUP,HCPCS V2632,,MZ60PDN090  -  LENS IOL 5 D -9 DIOP MOD C PLANO CNCV 6MM 12.5MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
MZ60PDN100,SUP,HCPCS V2632,,MZ60PDN100  -  LENS IOL 5 D -10 DIOP MOD C PLANO CNCV 6MM 12.5MM CLR STRL,$162.50,$0.00,$162.50,$73.13,$115.98,$0.00,$28.00,$0.00,$0.00,$28.45,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$25.43,$0.00,$25.87,$0.00
N103A,SUP,Custom 27203010,,N103A  -  NEEDLE DSCT MIC STRG 3CM LF CO HEAT RST TIP UL SHRP TUNG,$245.00,$0.00,$245.00,$0.00,$174.86,$0.00,$0.00,$0.00,$0.00,$0.00,$245.00,$0.00,$122.50,$194.04,$196.00,$0.00,$0.00,$0.00,$0.00,$0.00
N143001,SUP,HCPCS C1769,,N143001  -  GWIRE VASC 15D .014IN 300CM 5CM INT STY A SHP TIP NTRX NTNL,$281.67,$0.00,$281.67,$152.94,$201.03,$0.00,$48.53,$0.00,$0.00,$49.32,$281.67,$0.00,$140.83,$223.08,$225.33,$0.00,$44.08,$0.00,$44.84,$0.00
N1526,SUP,Custom 25003010,,ANTIBODY DESMIN CLONE D33 MS ANHMN 11ML LAB,"$1,320.00",$0.00,"$1,320.00",$0.00,$942.08,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,320.00",$0.00,$660.00,"$1,045.44","$1,056.00",$0.00,$0.00,$0.00,$0.00,$0.00
N1580,SUP,Custom 25003010,,ANTIBODY CD3 RBT PLYCLN ANHMN 7ML LAB,"$1,320.00",$0.00,"$1,320.00",$0.00,$942.08,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,320.00",$0.00,$660.00,"$1,045.44","$1,056.00",$0.00,$0.00,$0.00,$0.00,$0.00
N181805,SUP,HCPCS C1769,,N181805  -  GWIRE ENDSCP .018IN 180CM HPRFR STF ANG TIP FLXB EXC TRQ,$216.67,$0.00,$216.67,$117.65,$154.64,$0.00,$37.33,$0.00,$0.00,$37.94,$216.67,$0.00,$108.33,$171.60,$173.33,$0.00,$33.91,$0.00,$34.49,$0.00
N2031-3,SUP,Custom 27203010,,HOLDER LOOP BRSS INSL HNDL 8IN,$56.90,$0.00,$56.90,$0.00,$40.61,$0.00,$0.00,$0.00,$0.00,$0.00,$56.90,$0.00,$28.45,$45.06,$45.52,$0.00,$0.00,$0.00,$0.00,$0.00
N7695,SUP,HCPCS A7520,,N7695  -  TUBE ET SYR CK,$11.13,$0.00,$11.13,$0.00,$7.94,$0.00,$0.00,$0.00,$0.00,$0.00,$11.13,$0.00,$5.56,$8.81,$8.90,$0.00,$0.00,$0.00,$0.00,$0.00
N8254,SUP,Custom 27203010,,CANNULA CPAP NEO BN ARWY RDC IRRIT SIL LF DISP 4CM 2.5MM,$28.25,$0.00,$28.25,$0.00,$20.16,$0.00,$0.00,$0.00,$0.00,$0.00,$28.25,$0.00,$14.13,$22.37,$22.60,$0.00,$0.00,$0.00,$0.00,$0.00
N8304,SUP,Custom 27203010,,CANNULA CPAP NEO BN ARWY RDC IRRIT SIL LF DISP 4CM 3MM,$28.25,$0.00,$28.25,$0.00,$20.16,$0.00,$0.00,$0.00,$0.00,$0.00,$28.25,$0.00,$14.13,$22.37,$22.60,$0.00,$0.00,$0.00,$0.00,$0.00
NAV2076,SUP,Custom 27203010,,NAV2076  -  BIT DRL 2.9MM STRL VRTX DISP,"$1,950.00",$0.00,"$1,950.00",$0.00,"$1,391.72",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,950.00",$0.00,$975.00,"$1,544.40","$1,560.00",$0.00,$0.00,$0.00,$0.00,$0.00
NB5STFLP,SUP,Custom 27203010,,NB5STFLP  -  TROCAR LAPSCOP STANDARD LP 5MM FIX SMOOTH ENTRY DIRECTIONAL,$50.75,$0.00,$50.75,$0.00,$36.22,$0.00,$0.00,$0.00,$0.00,$0.00,$50.75,$0.00,$25.38,$40.19,$40.60,$0.00,$0.00,$0.00,$0.00,$0.00
NC9822012,SUP,Custom 27203010,,KIT FTL CELL STN BLOOD BANK 300 TST,$505.00,$0.00,$505.00,$0.00,$360.42,$0.00,$0.00,$0.00,$0.00,$0.00,$505.00,$0.00,$252.50,$399.96,$404.00,$0.00,$0.00,$0.00,$0.00,$0.00
NCSP2009X,SUP,HCPCS C1725,,BALLON SPRINTER NC  RX,$12.50,$0.00,$12.50,$6.79,$8.92,$0.00,$2.15,$0.00,$0.00,$2.19,$12.50,$0.00,$6.25,$9.90,$10.00,$0.00,$1.96,$0.00,$1.99,$0.00
NCSP2012X,SUP,HCPCS C1725,,BALLON SPRINTER NC  RX,$12.50,$0.00,$12.50,$6.79,$8.92,$0.00,$2.15,$0.00,$0.00,$2.19,$12.50,$0.00,$6.25,$9.90,$10.00,$0.00,$1.96,$0.00,$1.99,$0.00
NCSP2015X,SUP,HCPCS C1725,,BALLON SPRINTER NC  RX,$12.50,$0.00,$12.50,$6.79,$8.92,$0.00,$2.15,$0.00,$0.00,$2.19,$12.50,$0.00,$6.25,$9.90,$10.00,$0.00,$1.96,$0.00,$1.99,$0.00
NCSP2021X,SUP,HCPCS C1725,,BALLON SPRINTER NC  RX,$12.50,$0.00,$12.50,$6.79,$8.92,$0.00,$2.15,$0.00,$0.00,$2.19,$12.50,$0.00,$6.25,$9.90,$10.00,$0.00,$1.96,$0.00,$1.99,$0.00
NCSP22506X,SUP,HCPCS C1725,,CATHETER BALDILAT 2.25MM 6MM RAPEX NC NC SPNTR ANGIOPLST,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
NCSP22512X,SUP,HCPCS C1725,,CATHETER BALDILAT 2.25MM 12MM RAPEX NC NC SPNTR ANGIOPLST,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
NCSP22521X,SUP,HCPCS C1725,,CATHETER BALDILAT 2.25MM 21MM RAPEX NC NC SPNTR ANGIOPLST,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
NCSP2506X,SUP,HCPCS C1725,,CATHETER BALDILAT 2.5MM 6MM RAPEX NC NC SPNTR ANGIOPLST,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
NCSP2509X,SUP,HCPCS C1725,,CATHETER BALDILAT 2.5MM 9MM RAPEX NC NC SPNTR ANGIOPLST,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
NCSP2512X,SUP,HCPCS C1725,,CATHETER BALDILAT 2.5MM 12MM RAPEX NC NC SPNTR ANGIOPLST,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
NCSP2515X,SUP,HCPCS C1725,,CATHETER BALDILAT 2.5MM 15MM RAPEX NC NC SPNTR ANGIOPLST,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
NCSP2521X,SUP,HCPCS C1725,,BALLON SPRINTER NC  RX,$12.50,$0.00,$12.50,$6.79,$8.92,$0.00,$2.15,$0.00,$0.00,$2.19,$12.50,$0.00,$6.25,$9.90,$10.00,$0.00,$1.96,$0.00,$1.99,$0.00
NCSP2527X,SUP,HCPCS C1725,,BALLON SPRINTER NC  RX,$12.50,$0.00,$12.50,$6.79,$8.92,$0.00,$2.15,$0.00,$0.00,$2.19,$12.50,$0.00,$6.25,$9.90,$10.00,$0.00,$1.96,$0.00,$1.99,$0.00
NCSP27506X,SUP,HCPCS C1725,,CATHETER BALDILAT 2.7MM 6MM RAPEX NC NC SPNTR ANGIOPLST,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
NCSP27509X,SUP,HCPCS C1725,,CATHETER BALDILAT 2.75MM 9MM RAPEX NC NC SPNTR ANGIOPLST,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
NCSP27512X,SUP,HCPCS C1725,,CATHETER BALDILAT 2.75MM 12MM RAPEX NC NC SPNTR ANGIOPLST,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
NCSP27515X,SUP,HCPCS C1725,,CATHETER BALDILAT 2.75MM 15MM RAPEX NC NC SPNTR ANGIOPLST,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
NCSP27521X,SUP,HCPCS C1725,,CATHETER BALDILAT 2.75MM 21MM RAPEX NC NC SPNTR ANGIOPLST,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
NCSP3006X,SUP,HCPCS C1725,,CATHETER BALDILAT 3MM 6MM RAPEX NC NC SPNTR ANGIOPLST,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
NCSP3009X,SUP,HCPCS C1725,,CATHETER BALDILAT 3MM 9MM RAPEX NC NC SPNTR ANGIOPLST,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
NCSP3012X,SUP,HCPCS C1725,,CATHETER BALDILAT 3MM 12MM RAPEX NC NC SPNTR ANGIOPLST,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
NCSP3015X,SUP,HCPCS C1725,,CATHETER BALDILAT 3MM 15MM RAPEX NC NC SPNTR ANGIOPLST,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
NCSP3021X,SUP,HCPCS C1725,,BALLON SPRINTER NC  RX,$12.50,$0.00,$12.50,$6.79,$8.92,$0.00,$2.15,$0.00,$0.00,$2.19,$12.50,$0.00,$6.25,$9.90,$10.00,$0.00,$1.96,$0.00,$1.99,$0.00
NCSP3027X,SUP,HCPCS C1725,,BALLON SPRINTER NC  RX,$12.50,$0.00,$12.50,$6.79,$8.92,$0.00,$2.15,$0.00,$0.00,$2.19,$12.50,$0.00,$6.25,$9.90,$10.00,$0.00,$1.96,$0.00,$1.99,$0.00
NCSP32506X,SUP,HCPCS C1725,,CATHETER BALDILAT 3.25MM 6MM RAPEX NC NC SPNTR ANGIOPLST,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
NCSP32509X,SUP,HCPCS C1725,,CATHETER BALDILAT 3.25MM 9MM RAPEX NC NC SPNTR ANGIOPLST,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
NCSP32512X,SUP,HCPCS C1725,,CATHETER BALDILAT 3.25MM 12MM RAPEX NC NC SPNTR ANGIOPLST,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
NCSP32515X,SUP,HCPCS C1725,,CATHETER BALDILAT 3.25MM 15MM RAPEX NC NC SPNTR ANGIOPLST,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
NCSP32521X,SUP,HCPCS C1725,,CATHETER BALDILAT 3.25MM 21MM RAPEX NC NC SPNTR ANGIOPLST,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
NCSP3506X,SUP,HCPCS C1725,,CATHETER BALDILAT 3.5MM 6MM RAPEX NC NC SPNTR ANGIOPLST,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
NCSP3509X,SUP,HCPCS C1725,,CATHETER BALDILAT 3.5MM 9MM RAPEX NC NC SPNTR ANGIOPLST,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
NCSP3512X,SUP,HCPCS C1725,,CATHETER BALDILAT 3.5MM 12MM RAPEX NC NC SPNTR ANGIOPLST,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
NCSP3515X,SUP,HCPCS C1725,,CATHETER BALDILAT 3.5MM 15MM RAPEX NC NC SPNTR ANGIOPLST,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
NCSP3521X,SUP,HCPCS C1725,,BALLON SPRINTER NC  RX,$12.50,$0.00,$12.50,$6.79,$8.92,$0.00,$2.15,$0.00,$0.00,$2.19,$12.50,$0.00,$6.25,$9.90,$10.00,$0.00,$1.96,$0.00,$1.99,$0.00
NCSP3527X,SUP,HCPCS C1725,,BALLON SPRINTER NC  RX,$12.50,$0.00,$12.50,$6.79,$8.92,$0.00,$2.15,$0.00,$0.00,$2.19,$12.50,$0.00,$6.25,$9.90,$10.00,$0.00,$1.96,$0.00,$1.99,$0.00
NCSP37506X,SUP,HCPCS C1725,,CATHETER BALDILAT 3.75MM 6MM RAPEX NC NC SPNTR ANGIOPLST,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
NCSP37509X,SUP,HCPCS C1725,,CATHETER BALDILAT 3.75MM 9MM RAPEX NC NC SPNTR ANGIOPLST,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
NCSP37512X,SUP,HCPCS C1725,,CATHETER BALDILAT 3.75MM 12MM RAPEX NC NC SPNTR ANGIOPLST,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
NCSP37515X,SUP,HCPCS C1725,,CATHETER BALDILAT 3.75MM 15MM RAPEX NC NC SPNTR ANGIOPLST,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
NCSP37521X,SUP,HCPCS C1725,,BALLON SPRINTER NC  RX,$12.50,$0.00,$12.50,$6.79,$8.92,$0.00,$2.15,$0.00,$0.00,$2.19,$12.50,$0.00,$6.25,$9.90,$10.00,$0.00,$1.96,$0.00,$1.99,$0.00
NCSP4006X,SUP,HCPCS C1725,,CATHETER BALDILAT 4MM 6MM RAPEX NC NC SPNTR ANGIOPLST,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
NCSP4009X,SUP,HCPCS C1725,,CATHETER BALDILAT 4MM 9MM RAPEX NC NC SPNTR ANGIOPLST,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
NCSP4012X,SUP,HCPCS C1725,,CATHETER BALDILAT 4MM 12MM RAPEX NC NC SPNTR ANGIOPLST,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
NCSP4015X,SUP,HCPCS C1725,,CATHETER BALDILAT 4MM 15MM RAPEX NC NC SPNTR ANGIOPLST,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
NCSP4021X,SUP,HCPCS C1725,,BALLON SPRINTER NC  RX,$12.50,$0.00,$12.50,$6.79,$8.92,$0.00,$2.15,$0.00,$0.00,$2.19,$12.50,$0.00,$6.25,$9.90,$10.00,$0.00,$1.96,$0.00,$1.99,$0.00
NCSP4027X,SUP,HCPCS C1725,,BALLON SPRINTER NC  RX,$12.50,$0.00,$12.50,$6.79,$8.92,$0.00,$2.15,$0.00,$0.00,$2.19,$12.50,$0.00,$6.25,$9.90,$10.00,$0.00,$1.96,$0.00,$1.99,$0.00
NCSP4515X,SUP,HCPCS C1725,,CATHETER BALDILAT 4.5MM 15MM RAPEX NC NC SPNTR ANGIOPLST,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
NCSP4521X,SUP,HCPCS C1725,,BALLON SPRINTER NC  RX,$12.50,$0.00,$12.50,$6.79,$8.92,$0.00,$2.15,$0.00,$0.00,$2.19,$12.50,$0.00,$6.25,$9.90,$10.00,$0.00,$1.96,$0.00,$1.99,$0.00
NCSP5015X,SUP,HCPCS C1725,,CATHETER BALDILAT 5MM 15MM RAPEX NC NC SPNTR ANGIOPLST,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
NL8505061,SUP,Custom 27203010,,NL8505061  -  SHUNT CARDIO 5MM 3.5MM SUNDT CRTD INTNL LOOP CONICAL SPRG,"$1,035.00",$0.00,"$1,035.00",$0.00,$738.68,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,035.00",$0.00,$517.50,$819.72,$828.00,$0.00,$0.00,$0.00,$0.00,$0.00
NL850-5063,SUP,Custom 27803010,,NL850-5063  -  SHUNT CARDIO 10CM 3.5-4MM SUNDT CRTD XTRN NREIN SEG SIL STRL,"$1,120.13",$0.00,"$1,120.13",$0.00,$799.43,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,120.13",$0.00,$560.06,$887.14,$896.10,$0.00,$0.00,$0.00,$0.00,$0.00
NL8505065,SUP,Custom 27803010,,NL8505065  -  SHUNT CARDIO 10CM 3X4MM SUNDT CRTD INTNL LOOP SFT CONICAL,$867.78,$0.00,$867.78,$0.00,$619.33,$0.00,$0.00,$0.00,$0.00,$0.00,$867.78,$0.00,$433.89,$687.28,$694.22,$0.00,$0.00,$0.00,$0.00,$0.00
NL850-5067,SUP,Custom 27803010,,NL850-5067  -  SHUNT CARDIO 10CM 4X5MM SUNDT CRTD INTNL LOOP SFT CONICAL,$867.78,$0.00,$867.78,$0.00,$619.33,$0.00,$0.00,$0.00,$0.00,$0.00,$867.78,$0.00,$433.89,$687.28,$694.22,$0.00,$0.00,$0.00,$0.00,$0.00
NL8505070,SUP,Custom 27803010,,NL8505070  -  SHUNT CARDIO 30CM 4X3MM SUNDT CRTD XTRN LOOP SFT CONICAL,$965.63,$0.00,$965.63,$0.00,$689.17,$0.00,$0.00,$0.00,$0.00,$0.00,$965.63,$0.00,$482.81,$764.78,$772.50,$0.00,$0.00,$0.00,$0.00,$0.00
NL8505071,SUP,Custom 27803010,,NL8505071  -  SHUNT CARDIO 30CM 3X5MM SUNDT CRTD XTRN LOOP SFT CONICAL,$965.63,$0.00,$965.63,$0.00,$689.17,$0.00,$0.00,$0.00,$0.00,$0.00,$965.63,$0.00,$482.81,$764.78,$772.50,$0.00,$0.00,$0.00,$0.00,$0.00
NL850-5072,SUP,Custom 27803010,,NL850-5072  -  SHUNT CARDIO 30CM 5X4MM SUNDT CRTD XTRN LOOP SFT CONICAL,$1.00,$0.00,$1.00,$0.00,$0.71,$0.00,$0.00,$0.00,$0.00,$0.00,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.00,$0.00,$0.00,$0.00
NL850-5076,SUP,Custom 27803010,,NL850-5076  -  SHUNT NS SUNDT CRTD 30CM NREIN XTRN LOOP SIL 4MM 3MM STRL,$1.00,$0.00,$1.00,$0.00,$0.71,$0.00,$0.00,$0.00,$0.00,$0.00,$1.00,$0.00,$0.50,$0.79,$0.80,$0.00,$0.00,$0.00,$0.00,$0.00
NL8505078,SUP,Custom 27803010,,NL8505078  -  SHUNT CARDIO 30CM 4MM 5MM SUNDT CRTD XTRN LOOP NREIN CNTR,"$1,189.65",$0.00,"$1,189.65",$0.00,$849.05,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,189.65",$0.00,$594.83,$942.20,$951.72,$0.00,$0.00,$0.00,$0.00,$0.00
NL865,SUP,Custom 27203010,,NL865  -  BLADE WIRE SAW 12IN ROUND SPIRAL LOOPED END LATEX FREE GIGLI,$121.50,$0.00,$121.50,$0.00,$86.71,$0.00,$0.00,$0.00,$0.00,$0.00,$121.50,$0.00,$60.75,$96.23,$97.20,$0.00,$0.00,$0.00,$0.00,$0.00
NN-8004,SUP,Custom 27011340,,NN-8004  -  HANDPIECE ELECTROSURGICAL 13GA 13CM MYRIAD,"$7,402.50",$0.00,"$7,402.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,402.50",$0.00,"$3,701.25","$5,862.78","$5,922.00",$0.00,$0.00,$0.00,$0.00,$0.00
NN-8011,SUP,HCPCS C1894,,NN-8011  -  SHEATH ENDSCP 13.5MM 50MM GROUNDBREAK ACCES TECHNOLOGY,"$4,975.00",$0.00,"$4,975.00","$2,701.43","$3,550.66",$0.00,$857.17,$0.00,$0.00,$871.08,"$4,975.00",$0.00,"$2,487.50","$3,940.20","$3,980.00",$0.00,$778.59,$0.00,$792.02,$0.00
NN-8012,SUP,HCPCS C1894,,NN-8012  -  SHEATH ENDSCP 13.5MM 60MM GROUNDBREAK ACCES TECHNOLOGY,"$2,487.50",$0.00,"$2,487.50","$1,350.71","$1,775.33",$0.00,$428.58,$0.00,$0.00,$435.54,"$2,487.50",$0.00,"$1,243.75","$1,970.10","$1,990.00",$0.00,$389.29,$0.00,$396.01,$0.00
NN-8013,SUP,HCPCS C1894,,NN-8013  -  SHEATH ENDSCP 13.5MM 75MM GROUNDBREAK ACCES TECHNOLOGY,"$4,975.00",$0.00,"$4,975.00","$2,701.43","$3,550.66",$0.00,$857.17,$0.00,$0.00,$871.08,"$4,975.00",$0.00,"$2,487.50","$3,940.20","$3,980.00",$0.00,$778.59,$0.00,$792.02,$0.00
NN-8016,SUP,Custom 27203010,,NN-8016  -  VALVE MRCLTR .5MM STRL LF NICO MYRIAD INFS MTR LN DISP,$175.00,$0.00,$175.00,$0.00,$124.90,$0.00,$0.00,$0.00,$0.00,$0.00,$175.00,$0.00,$87.50,$138.60,$140.00,$0.00,$0.00,$0.00,$0.00,$0.00
NN-8030,SUP,Custom 27203010,,NN-8030  -  SHEATH ESCP 13.5MM 95MM STRL BRAINPATH ATRM TIP LCK FRST,"$1,243.75",$0.00,"$1,243.75",$0.00,$887.66,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,243.75",$0.00,$621.88,$985.05,$995.00,$0.00,$0.00,$0.00,$0.00,$0.00
NON28226,SUP,HCPCS C1713,,NON28226  -  CAP BOUF REG LG 24IN FLG LF PR MULTIPLY ELC CLSR LTWT LINT,$0.22,$0.00,$0.22,$0.10,$0.16,$0.00,$0.04,$0.00,$0.00,$0.04,$0.22,$0.00,$0.11,$0.17,$0.17,$0.00,$0.03,$0.00,$0.03,$0.00
NON28234P,SUP,HCPCS C1713,,NON28234P  -  CAP BOUF REG LG 24IN LF PR MULTIPLY ELC CLSR LTWT LINT FR PP,$150.88,$0.00,$434.85,$195.68,$310.35,$0.00,$26.00,$0.00,$0.00,$76.14,$434.85,$0.00,$217.43,$119.50,$347.88,$0.00,$23.61,$0.00,$69.23,$0.00
NONB12STF,SUP,Custom 27203010,,NONB12STF  -  TROCAR LAPSCP STD 12MM STRL VPRT+ FX CNN BLDLS INS TIP TISS,$68.08,$0.00,$68.08,$0.00,$48.59,$0.00,$0.00,$0.00,$0.00,$0.00,$68.08,$0.00,$34.04,$53.92,$54.46,$0.00,$0.00,$0.00,$0.00,$0.00
NPAS-100,SUP,HCPCS C1894,,NPAS-100  -  GWIRE VASC .018IN 7FR 22GA 20CM 15CM INTROD NDL NEFF SS PERC,$170.84,$0.00,$170.84,$92.76,$121.92,$0.00,$29.43,$0.00,$0.00,$29.91,$170.84,$0.00,$85.42,$135.31,$136.67,$0.00,$26.74,$0.00,$27.20,$0.00
NR-09903-S,SUP,HCPCS C1894,,INTRODUCER SHTH 9FR 10CM INTGR HMSTS VLV SDPRT TISS DILAT,$75.38,$0.00,$75.38,$40.93,$53.80,$0.00,$12.99,$0.00,$0.00,$13.20,$75.38,$0.00,$37.69,$59.70,$60.30,$0.00,$11.80,$0.00,$12.00,$0.00
NSLX120L,SUP,Custom 27203010,,NSLX120L  -  SEALER BP 13MM 20CM ENSEAL X1 CRV LG JAW,"$2,180.86",$0.00,"$2,180.86",$0.00,"$1,556.48",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,180.86",$0.00,"$1,090.43","$1,727.24","$1,744.69",$0.00,$0.00,$0.00,$0.00,$0.00
NTSE-030115-UDH-MB,SUP,Custom 27203010,,NTSE-030115-UDH-MB  -  XTRT STON 115CM 3FR 1.8CM TPLS MOD BSKT NCRCL NTNL,$458.25,$0.00,$458.25,$0.00,$327.05,$0.00,$0.00,$0.00,$0.00,$0.00,$458.25,$0.00,$229.13,$362.93,$366.60,$0.00,$0.00,$0.00,$0.00,$0.00
N-VVDC-01-ABRM,SUP,Custom 27803010,,N-VVDC-01-ABRM  -  CATHETER XTRN DRN 3MM 33CM EVM VNTRC,$144.00,$0.00,$144.00,$0.00,$102.77,$0.00,$0.00,$0.00,$0.00,$0.00,$144.00,$0.00,$72.00,$114.05,$115.20,$0.00,$0.00,$0.00,$0.00,$0.00
NWL214066H,SUP,HCPCS C1785,,NWL214066H  -  PACEMAKER SENSIA DR CARD SEDR01 NWL214066H,"$8,500.00",$0.00,"$8,500.00","$3,825.00","$5,158.80",$0.00,"$1,464.51",$0.00,$0.00,"$1,488.28","$8,500.00",$0.00,"$4,250.00","$6,732.00","$6,800.00",$0.00,"$1,330.25",$0.00,"$1,353.20",$0.00
OHOOKR-8,SUP,HCPCS C1713,,OHOOKR-8  -  PLATE BN RT OFST OLCRN HK PLT CORT,"$2,212.50",$0.00,"$2,212.50",$995.63,"$1,579.06",$0.00,$381.20,$0.00,$0.00,$387.39,"$2,212.50",$0.00,"$1,106.25","$1,752.30","$1,770.00",$0.00,$346.26,$0.00,$352.23,$0.00
OM-10000,SUP,Custom 27203010,,OM-10000  -  STABILIZER SURGICAL ACROBAT I SUCTION POD MALLEABLE FOOT,"$4,092.50",$0.00,"$4,092.50",$0.00,"$2,920.82",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,092.50",$0.00,"$2,046.25","$3,241.26","$3,274.00",$0.00,$0.00,$0.00,$0.00,$0.00
OMST12BT,SUP,Custom 27203010,,OMST12BT  -  TROCAR LAPSCOP 5-10MM 12MM BLUNT TIP BUILT IN CONVERTER,"$1,089.22",$0.00,"$1,089.22",$0.00,$777.38,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,089.22",$0.00,$544.61,$862.66,$871.38,$0.00,$0.00,$0.00,$0.00,$0.00
OMS-T12BT,SUP,Custom 27203010,,OMS-T12BT  -  TROCAR LAPSCOP 12MM SPCMKR BLNT TIP BLN STRL DISP PRPERITN,$318.05,$0.00,$318.05,$0.00,$226.99,$0.00,$0.00,$0.00,$0.00,$0.00,$318.05,$0.00,$159.03,$251.90,$254.44,$0.00,$0.00,$0.00,$0.00,$0.00
OMST12T,SUP,Custom 27203010,,OMST12T  -  BALLON TIP TROCAR,"$1,645.90",$0.00,"$1,645.90",$0.00,"$1,174.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,645.90",$0.00,$822.95,"$1,303.55","$1,316.72",$0.00,$0.00,$0.00,$0.00,$0.00
ONB12LGF,SUP,Custom 27203010,,ONB12LGF  -  TROCAR LAPSCP LNG 12MM 150MM STRL LF VRSPRT V2 FX CNN BLDLS,$450.75,$0.00,$450.75,$0.00,$321.70,$0.00,$0.00,$0.00,$0.00,$0.00,$450.75,$0.00,$225.38,$356.99,$360.60,$0.00,$0.00,$0.00,$0.00,$0.00
ONXACE-19,SUP,Custom 27803010,,ONXACE-19  -  VALVE AOR 19MM ONX,"$14,875.00",$0.00,"$14,875.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$14,875.00",$0.00,"$7,437.50","$11,781.00","$11,900.00",$0.00,$0.00,$0.00,$0.00,$0.00
ONXACE-21,SUP,Custom 27803010,,ONXACE-21  -  VALVE AOR 21MM ONX,"$14,875.00",$0.00,"$14,875.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$14,875.00",$0.00,"$7,437.50","$11,781.00","$11,900.00",$0.00,$0.00,$0.00,$0.00,$0.00
ONXACE-23,SUP,Custom 27803010,,ONXACE-23  -  VALVE AOR 23MM ONX,"$14,875.00",$0.00,"$14,875.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$14,875.00",$0.00,"$7,437.50","$11,781.00","$11,900.00",$0.00,$0.00,$0.00,$0.00,$0.00
ONXACE-25,SUP,Custom 27803010,,ONXACE-25  -  VALVE AOR 23.4MM 25MM 17.4MM ONX CNFRM-X SW RING PROS,"$14,875.00",$0.00,"$14,875.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$14,875.00",$0.00,"$7,437.50","$11,781.00","$11,900.00",$0.00,$0.00,$0.00,$0.00,$0.00
ONXACE-25/33,SUP,Custom 27803010,,ONXACE-25/33  -  ON-X AORTIC VALVE SIZE 25/33,"$14,875.00",$0.00,"$14,875.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$14,875.00",$0.00,"$7,437.50","$11,781.00","$11,900.00",$0.00,$0.00,$0.00,$0.00,$0.00
ONXACE-27/29,SUP,Custom 27803010,,ONXACE-27/29  -  VALVE AOR 23.4MM 27/29MM 17.4MM ONX CNFRM-X SW RING PROS,"$14,875.00",$0.00,"$14,875.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$14,875.00",$0.00,"$7,437.50","$11,781.00","$11,900.00",$0.00,$0.00,$0.00,$0.00,$0.00
OS-401,SUP,Custom 27804086,,OS-401  -  FILLER BN VOID 4CC,$375.00,$0.00,$375.00,$0.00,$267.64,$0.00,$0.00,$0.00,$0.00,$0.00,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$0.00,$0.00,$0.00,$0.00
OSN-50,SUP,HCPCS C1713,,OSN-50  -  WIRE FX 50MM SLED NTRL OLCRN,"$2,150.00",$0.00,"$2,150.00",$967.50,"$1,534.46",$0.00,$370.43,$0.00,$0.00,$376.45,"$2,150.00",$0.00,"$1,075.00","$1,702.80","$1,720.00",$0.00,$336.48,$0.00,$342.28,$0.00
OSN-70,SUP,HCPCS C1713,,OSN-70  -  WIRE FIX 70MM SLED NEUTRAL OLECRANON,"$2,412.50",$0.00,"$2,412.50","$1,085.63","$1,721.80",$0.00,$415.66,$0.00,$0.00,$422.41,"$2,412.50",$0.00,"$1,206.25","$1,910.70","$1,930.00",$0.00,$377.56,$0.00,$384.07,$0.00
OSW,SUP,HCPCS C1713,,OSW  -  WASHER ORTHOPEDIC LP FIX OLECRANON STERILE,$687.50,$0.00,$687.50,$309.38,$490.67,$0.00,$118.45,$0.00,$0.00,$120.38,$687.50,$0.00,$343.75,$544.50,$550.00,$0.00,$107.59,$0.00,$109.45,$0.00
P100510,SUP,HCPCS C1781,,P100510  -  GRAFT SFT TIS THK1MM 10X5CM STRL PERMACOL PRCN DRML CLGN,$49.00,$0.00,$49.00,$22.05,$34.97,$0.00,$8.44,$0.00,$0.00,$8.58,$49.00,$0.00,$24.50,$38.81,$39.20,$0.00,$7.67,$0.00,$7.80,$0.00
P101010,SUP,HCPCS C9364,,P101010  -  GRAFT SFT TIS THK1MM 10X10CM STRL PERMACOL PRCN DRML CLGN,$49.00,$0.00,$49.00,$0.00,$34.97,$0.00,$0.00,$0.00,$0.00,$0.00,$49.00,$0.00,$24.50,$38.81,$39.20,$0.00,$0.00,$0.00,$0.00,$0.00
P101015,SUP,HCPCS C9364,,P101015  -  GRAFT SFT TIS THK1MM 15X10CM STRL PERMACOL PRCN DRML CLGN,"$7,500.00",$0.00,"$7,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,500.00",$0.00,"$3,750.00","$5,940.00","$6,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
P101828,SUP,HCPCS C9364,,P101828  -  GRAFT SFT TIS THK1MM 28X18CM STRL PERMACOL PRCN DRML CLGN,"$27,720.00",$0.00,"$27,720.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$27,720.00",$0.00,"$13,860.00","$21,954.24","$22,176.00",$0.00,$0.00,$0.00,$0.00,$0.00
P151015,SUP,HCPCS C9364,,P151015  -  GRAFT SFT TIS THK1.5MM 15X10CM STRL PERMACOL PRCN DRML CLGN,$49.00,$0.00,$49.00,$0.00,$34.97,$0.00,$0.00,$0.00,$0.00,$0.00,$49.00,$0.00,$24.50,$38.81,$39.20,$0.00,$0.00,$0.00,$0.00,$0.00
P151020,SUP,HCPCS C9364,,P151020  -  GRAFT SFT TIS THK1.5MM 10X20CM STRL PERMACOL PRCN DRML CLGN,$73.50,$0.00,$73.50,$0.00,$52.46,$0.00,$0.00,$0.00,$0.00,$0.00,$73.50,$0.00,$36.75,$58.21,$58.80,$0.00,$0.00,$0.00,$0.00,$0.00
P151520,SUP,HCPCS C9364,,P151520  -  GRAFT SFT TIS THK1.5MM 20X15CM STRL PERMACOL PRCN DRML CLGN,$49.00,$0.00,$49.00,$0.00,$34.97,$0.00,$0.00,$0.00,$0.00,$0.00,$49.00,$0.00,$24.50,$38.81,$39.20,$0.00,$0.00,$0.00,$0.00,$0.00
P152030,SUP,HCPCS C9364,,P152030  -  GRAFT SFT TIS THK1.5MM 30X20CM STRL PERMACOL PRCN DRML CLGN,$53.90,$0.00,$53.90,$0.00,$38.47,$0.00,$0.00,$0.00,$0.00,$0.00,$53.90,$0.00,$26.95,$42.69,$43.12,$0.00,$0.00,$0.00,$0.00,$0.00
P152040,SUP,HCPCS C9364,,P152040  -  GRAFT SFT TIS THK1.5MM 40X20CM STRL PERMACOL PRCN DRML CLGN,"$43,120.00",$0.00,"$43,120.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$43,120.00",$0.00,"$21,560.00","$34,151.04","$34,496.00",$0.00,$0.00,$0.00,$0.00,$0.00
P224PC8T,SUP,HCPCS C1725,,P224PC8T  -  CATHETER  CENTRAL VENOUS,$124.88,$0.00,$124.88,$67.81,$89.12,$0.00,$21.52,$0.00,$0.00,$21.86,$124.88,$0.00,$62.44,$98.90,$99.90,$0.00,$19.54,$0.00,$19.88,$0.00
P350,SUP,Custom 27203010,,P350  -  PUNCH SURG 3MM SS DRML BIOP RZR SHRP RB HNDL ACPNCH STRL,$7.56,$0.00,$7.56,$0.00,$5.39,$0.00,$0.00,$0.00,$0.00,$0.00,$7.56,$0.00,$3.78,$5.99,$6.04,$0.00,$0.00,$0.00,$0.00,$0.00
P4676-110,SUP,Custom 27203010,,PIPETTE SERO PLST 10ML GRAD PLG MOLD TIP STRL DISP .1ML,$33.00,$0.00,$33.00,$0.00,$23.55,$0.00,$0.00,$0.00,$0.00,$0.00,$33.00,$0.00,$16.50,$26.14,$26.40,$0.00,$0.00,$0.00,$0.00,$0.00
P82012001,SUP,HCPCS C1725,,CATHETER  POLAR DILATOR BALLOON 8X20X120,"$1,500.00",$0.00,"$1,500.00",$814.50,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
PALS-25100-CC,SUP,HCPCS C1713,,PALS-25100-CC  -  SCREW BN 2.5MM 10MM NS GEMINUS PA LCK CNN COCR DIST VOLR RDS,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
PALS-25120-CC,SUP,HCPCS C1713,,PALS-25120-CC  -  SCREW BN 2.5MM 12MM NS GEMINUS PA LCK CNN COCR DIST VOLR RDS,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
PALS-25140-CC,SUP,HCPCS C1713,,PALS-25140-CC  -  SCREW BN 2.5MM 14MM NS GEMINUS PA LCK CNN COCR DIST VOLR RDS,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
PALS-25160-CC,SUP,HCPCS C1713,,PALS-25160-CC  -  SCREW BN 2.5MM 16MM NS GEMINUS PA LCK CNN COCR DIST VOLR RDS,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
PALS-25180-CC,SUP,HCPCS C1713,,PALS-25180-CC  -  SCREW BN 2.5MM 18MM NS GEMINUS PA LCK CNN COCR DIST VOLR RDS,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
PALS-25200-CC,SUP,HCPCS C1713,,PALS-25200-CC  -  SCREW BN 2.5MM 20MM GEMINUS CNN LCK PA COCR DIST VOLR RDS,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
PALS-25220-CC,SUP,HCPCS C1713,,PALS-25220-CC  -  SCREW BN 2.5MM 22MM NS GEMINUS PA LCK CNN COCR DIST VOLR RDS,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
PALS-25240-CC,SUP,HCPCS C1713,,PALS-25240-CC  -  SCREW BN 2.5MM 24MM NS GEMINUS PA LCK CNN COCR DIST VOLR RDS,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
PALS-25260-CC,SUP,HCPCS C1713,,PALS-25260-CC  -  SCREW BN 2.5MM 26MM NS GEMINUS PA LCK CNN COCR DIST VOLR RDS,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
PALS-25280-CC,SUP,HCPCS C1713,,PALS-25280-CC  -  SCREW BN 2.5MM 28MM NS GEMINUS PA LCK CNN COCR DIST VOLR RDS,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
PALS-25300-CC,SUP,HCPCS C1713,,PALS-25300-CC  -  SCREW BN 2.5MM 30MM NS GEMINUS PA LCK CNN COCR DIST VOLR RDS,$350.00,$0.00,$350.00,$157.50,$249.80,$0.00,$60.30,$0.00,$0.00,$61.28,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$54.78,$0.00,$55.72,$0.00
PANL-35080-TS,SUP,HCPCS C1713,,PANL-35080-TS  -  SCREW BN 3.5MM 8MM NLCKG TI CORT,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
PANL-35090-TS,SUP,HCPCS C1713,,PANL-35090-TS  -  SCREW BN 3.5MM 9MM NLCKG TI CORT,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
PANL-35100-TS,SUP,HCPCS C1713,,PANL-35100-TS  -  SCREW BN 3.5MM 10MM BLU NS GEMINUS PA TI CORT VOLR DIST RDS,$247.50,$0.00,$247.50,$111.38,$176.64,$0.00,$42.64,$0.00,$0.00,$43.34,$247.50,$0.00,$123.75,$196.02,$198.00,$0.00,$38.73,$0.00,$39.40,$0.00
PANL-35110-TS,SUP,HCPCS C1713,,PANL-35110-TS  -  SCREW BN 3.5MM 11MM BLU NS GEMINUS PA TI CORT VOLR DIST RDS,$247.50,$0.00,$247.50,$111.38,$176.64,$0.00,$42.64,$0.00,$0.00,$43.34,$247.50,$0.00,$123.75,$196.02,$198.00,$0.00,$38.73,$0.00,$39.40,$0.00
PANL-35120-TS,SUP,HCPCS C1713,,PANL-35120-TS  -  SCREW BN 3.5MM 12MM NS GEMINUS PA NLCKG TI CORT DIST VOLR,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
PANL-35130-TS,SUP,HCPCS C1713,,PANL-35130-TS  -  SCREW BN 3.5MM 13MM NS GEMINUS PA NLCKG TI DIST VOLR RDS,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
PANL-35140-TS,SUP,HCPCS C1713,,PANL-35140-TS  -  SCREW BN 3.5MM 14MM NS GEMINUS PA NLCKG TI DIST VOLR RDS,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
PANL-35150-TS,SUP,HCPCS C1713,,PANL-35150-TS  -  SCREW BN 3.5MM 15MM NS GEMINUS PA NLCKG TI DIST VOLR RDS,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
PANL-35160-TS,SUP,HCPCS C1713,,PANL-35160-TS  -  SCREW BN 3.5MM 16MM NS GEMINUS PA NLCKG TI DIST VOLR RDS,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
PANL-35170-TS,SUP,HCPCS C1713,,PANL-35170-TS  -  SCREW BN 3.5MM 17MM NS GEMINUS PA NLCKG TI DIST VOLR RDS,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
PANL-35180-TS,SUP,HCPCS C1713,,PANL-35180-TS  -  SCREW BN 3.5MM 18MM NS GEMINUS PA NLCKG TI DIST VOLR RDS,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
PAPS1,SUP,Custom 27203010,,PUMP SCT PK,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
PC02520OS,SUP,HCPCS C1781,,PC02520OS  -  MESH SURG PARIETEX 10X8IN VNTRL HERN OPN SKRT RECT PLSTR,"$3,925.00",$0.00,"$3,925.00","$1,766.25","$2,801.27",$0.00,$676.26,$0.00,$0.00,$687.24,"$3,925.00",$0.00,"$1,962.50","$3,108.60","$3,140.00",$0.00,$614.26,$0.00,$624.86,$0.00
PC1016SN,SUP,HCPCS C1768,,PC1016SN  -  PATCH CARDIO 16X10CM APEX PROCESSING SUPPLE PERI-GUARD,"$1,767.10",$0.00,"$1,767.10",$795.19,"$1,261.18",$0.00,$304.46,$0.00,$0.00,$309.40,"$1,767.10",$0.00,$883.55,"$1,399.54","$1,413.68",$0.00,$276.55,$0.00,$281.32,$0.00
PC-1016SN,SUP,HCPCS C1768,,PC-1016SN  -  PATCH CV 16X10CM SP PRGRD APX PRC BVN PRICRD,"$1,767.10",$0.00,"$1,767.10",$795.19,"$1,261.18",$0.00,$304.46,$0.00,$0.00,$309.40,"$1,767.10",$0.00,$883.55,"$1,399.54","$1,413.68",$0.00,$276.55,$0.00,$281.32,$0.00
PC111,SUP,Custom 27803010,,PC111  -  LEGEND FN2-DISS TO M-SCHR(UK),$405.90,$0.00,$405.90,$0.00,$289.69,$0.00,$0.00,$0.00,$0.00,$0.00,$405.90,$0.00,$202.95,$321.47,$324.72,$0.00,$0.00,$0.00,$0.00,$0.00
PCA-15,SUP,HCPCS C1713,,"PCA-15  -  LOCKING PLATE, CURVED A, 15-HOLE","$3,237.50",$0.00,"$3,237.50","$1,456.88","$2,310.60",$0.00,$557.81,$0.00,$0.00,$566.86,"$3,237.50",$0.00,"$1,618.75","$2,564.10","$2,590.00",$0.00,$506.67,$0.00,$515.41,$0.00
PCB10,SUP,HCPCS C1713,,PCB10  -  PLATE BN CRV B NS 10 HL LCK,"$2,587.50",$0.00,"$2,587.50","$1,164.38","$1,846.70",$0.00,$445.81,$0.00,$0.00,$453.05,"$2,587.50",$0.00,"$1,293.75","$2,049.30","$2,070.00",$0.00,$404.94,$0.00,$411.93,$0.00
PCB15,SUP,HCPCS C1713,,PCB15  -  PLATE BN CRV B NS 15 HL LCK,"$3,375.00",$0.00,"$3,375.00","$1,518.75","$2,408.74",$0.00,$581.50,$0.00,$0.00,$590.94,"$3,375.00",$0.00,"$1,687.50","$2,673.00","$2,700.00",$0.00,$528.19,$0.00,$537.30,$0.00
PCDT1,SUP,HCPCS C1781,,PCDT1  -  MESH SRG OVL 13X10IN STRL PRC FLXB TISS SEP LTWT MFL PRLN,"$6,122.25",$0.00,"$6,122.25","$2,755.01","$4,369.45",$0.00,"$1,054.83",$0.00,$0.00,"$1,071.96","$6,122.25",$0.00,"$3,061.13","$4,848.82","$4,897.80",$0.00,$958.13,$0.00,$974.66,$0.00
PCO12,SUP,HCPCS C1781,,PCO12  -  MESH SRG RND 4.8IN PARIETEX COMP 3D WV RND PLSTR VNTRL HRN,"$1,322.03",$0.00,"$1,322.03",$594.91,$943.53,$0.00,$227.78,$0.00,$0.00,$231.48,"$1,322.03",$0.00,$661.01,"$1,047.05","$1,057.62",$0.00,$206.90,$0.00,$210.47,$0.00
PCO12X,SUP,HCPCS C1781,,PCO12X  -  MESH SURG ROUND 12CM 2X4.8IN 2 SIDE OPTIMIZE COMPOSITE LARGE,"$1,207.75",$0.00,"$1,207.75",$543.49,$861.97,$0.00,$208.09,$0.00,$0.00,$211.47,"$1,207.75",$0.00,$603.88,$956.54,$966.20,$0.00,$189.01,$0.00,$192.27,$0.00
PCO1510OS,SUP,HCPCS C1781,,PCO1510OS  -  MESH SRG RECT 6X4IN PARIETEX RSRB COMP PLSTR VNTRL HRN,"$1,704.65",$0.00,"$1,704.65",$767.09,"$1,216.61",$0.00,$293.70,$0.00,$0.00,$298.47,"$1,704.65",$0.00,$852.33,"$1,350.08","$1,363.72",$0.00,$266.78,$0.00,$271.38,$0.00
PCO15X,SUP,HCPCS C1781,,PCO15X  -  MESH SURG ROUND 15CM OPTIMIZE COMPOSITE PROPRIETARY TEXTILE,"$1,580.50",$0.00,"$1,580.50",$711.23,"$1,128.00",$0.00,$272.31,$0.00,$0.00,$276.73,"$1,580.50",$0.00,$790.25,"$1,251.76","$1,264.40",$0.00,$247.35,$0.00,$251.62,$0.00
PCO2015X,SUP,HCPCS C1781,,PCO2015X  -  MESH SURG RECTANGLE OVAL 20X15CM OPTIMIZE COMPOSITE 2 SIDE,"$1,937.43",$0.00,"$1,937.43",$871.84,"$1,382.74",$0.00,$333.81,$0.00,$0.00,$339.23,"$1,937.43",$0.00,$968.71,"$1,534.44","$1,549.94",$0.00,$303.21,$0.00,$308.44,$0.00
PCO20X,SUP,HCPCS C1781,,PCO20X  -  MESH SURG ROUND 20CM 8IN COMPOSITE OPTIMIZE PROPRIETARY,"$3,206.15",$0.00,"$3,206.15","$1,442.77","$2,288.23",$0.00,$552.40,$0.00,$0.00,$561.37,"$3,206.15",$0.00,"$1,603.08","$2,539.27","$2,564.92",$0.00,$501.76,$0.00,$510.42,$0.00
PCO2520OS,SUP,HCPCS C1781,,PCO2520OS  -  MESH SRG RECT RND 10X8IN STRL LF PARIETEX OPN SKRT OPTIMIZE,"$4,387.38",$0.00,"$4,387.38","$1,974.32","$3,131.27",$0.00,$755.92,$0.00,$0.00,$768.19,"$4,387.38",$0.00,"$2,193.69","$3,474.80","$3,509.90",$0.00,$686.62,$0.00,$698.47,$0.00
PCO2520X,SUP,HCPCS C1781,,PCO2520X  -  MESH SURG RECTANGLE OVAL 25X20CM 2 SIDE OPTIMIZE COMPOSITE,"$2,944.65",$0.00,"$2,944.65","$1,325.09","$2,101.60",$0.00,$507.35,$0.00,$0.00,$515.58,"$2,944.65",$0.00,"$1,472.33","$2,332.16","$2,355.72",$0.00,$460.84,$0.00,$468.79,$0.00
PCO3020,SUP,HCPCS C1781,,PCO3020  -  MESH SRG RECT 12X8IN PARIETEX RSRB COMP SKRT RECT PLSTR,"$4,471.20",$0.00,"$4,471.20","$2,012.04","$3,191.10",$0.00,$770.37,$0.00,$0.00,$782.87,"$4,471.20",$0.00,"$2,235.60","$3,541.19","$3,576.96",$0.00,$699.74,$0.00,$711.82,$0.00
PCO3020X,SUP,HCPCS C1781,,PCO3020X  -  MESH SURG RECTANGLE OVAL 30X20CM OPTIMIZE COMPOSITE TEXTILE,"$4,025.80",$0.00,"$4,025.80","$1,811.61","$2,873.21",$0.00,$693.63,$0.00,$0.00,$704.89,"$4,025.80",$0.00,"$2,012.90","$3,188.43","$3,220.64",$0.00,$630.04,$0.00,$640.91,$0.00
PCO3728,SUP,HCPCS C1781,,PCO3728  -  MESH SRG RECT 14.5X11IN LF PARIETEX 3D WV RSRB COMP PLSTR,"$5,309.55",$0.00,"$5,309.55","$2,389.30","$3,789.43",$0.00,$914.81,$0.00,$0.00,$929.66,"$5,309.55",$0.00,"$2,654.78","$4,205.16","$4,247.64",$0.00,$830.94,$0.00,$845.28,$0.00
PCO8OSX,SUP,HCPCS C1781,,PCO8OSX  -  PARIETEX DUAL MESH POLYESTER SKIRTED 8 CM ROUND,"$1,147.35",$0.00,"$1,147.35",$516.31,$818.86,$0.00,$197.68,$0.00,$0.00,$200.89,"$1,147.35",$0.00,$573.68,$908.70,$917.88,$0.00,$179.56,$0.00,$182.66,$0.00
PCO9,SUP,HCPCS C1781,,PCO9  -  MESH SRG RND 3.6IN STRL PARIETEX RND RSRB 3D WV PLSTR VNTRL,$958.53,$0.00,$958.53,$431.34,$684.10,$0.00,$165.15,$0.00,$0.00,$167.83,$958.53,$0.00,$479.26,$759.16,$766.82,$0.00,$150.01,$0.00,$152.60,$0.00
PCO9X,SUP,HCPCS C1781,,PCO9X  -  MESH SURG ROUND 9CM OPTIMIZE COMPOSITE PROPRIETARY TEXTILE,$293.55,$0.00,$293.55,$132.10,$209.51,$0.00,$50.58,$0.00,$0.00,$51.40,$293.55,$0.00,$146.78,$232.49,$234.84,$0.00,$45.94,$0.00,$46.73,$0.00
PCP 050 120 130,SUP,HCPCS C1725,,PCP 050 120 130  -  CATHETER BLNDIL 5MM 130CM 120MM PCFC + OTW LOPRFL COAX,$562.50,$0.00,$562.50,$305.44,$401.46,$0.00,$96.92,$0.00,$0.00,$98.49,$562.50,$0.00,$281.25,$445.50,$450.00,$0.00,$88.03,$0.00,$89.55,$0.00
PD0606,SUP,Custom 27803010,,PD0606  -  PATCH BIOLOGICAL L6 CM X W6 CM W PORCINE DERMIS SOFT TISSUE,"$1,566.00",$0.00,"$1,566.00",$0.00,"$1,117.65",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,566.00",$0.00,$783.00,"$1,240.27","$1,252.80",$0.00,$0.00,$0.00,$0.00,$0.00
PD0808,SUP,Custom 27803010,,PD0808  -  PATCH BIOLOGICAL L8 CM X W8 CM W PORCINE DERMIS SOFT TISSUE,"$2,784.00",$0.00,"$2,784.00",$0.00,"$1,986.94",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,784.00",$0.00,"$1,392.00","$2,204.93","$2,227.20",$0.00,$0.00,$0.00,$0.00,$0.00
PD0822,SUP,Custom 27803010,,PD0822  -  PATCH BIOLOGICAL L22 CM X W8 CM W PORCINE DERMIS SOFT TISSUE,"$7,656.00",$0.00,"$7,656.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,656.00",$0.00,"$3,828.00","$6,063.55","$6,124.80",$0.00,$0.00,$0.00,$0.00,$0.00
PD1010,SUP,Custom 27803010,,PD1010  -  PATCH BIOLOGICAL L10 CM X W10 CM W PORCINE DERMIS SOFT TISSU,"$4,350.00",$0.00,"$4,350.00",$0.00,"$3,104.60",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,350.00",$0.00,"$2,175.00","$3,445.20","$3,480.00",$0.00,$0.00,$0.00,$0.00,$0.00
PD1016,SUP,Custom 27803010,,PD1016  -  PATCH BIOLOGICAL L10 CM X W16 CM W PORCINE DERMIS SOFT TISSU,"$6,960.00",$0.00,"$6,960.00",$0.00,"$4,967.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,960.00",$0.00,"$3,480.00","$5,512.32","$5,568.00",$0.00,$0.00,$0.00,$0.00,$0.00
PD1025,SUP,Custom 27803010,,PD1025  -  PATCH BIOLOGICAL L10 CM X W25 CM W PORCINE DERMIS SOFT TISSU,"$10,875.00",$0.00,"$10,875.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$10,875.00",$0.00,"$5,437.50","$8,613.00","$8,700.00",$0.00,$0.00,$0.00,$0.00,$0.00
PD1620,SUP,Custom 27803010,,PD1620  -  PATCH BIOLOGICAL L16 CM X W20 CM W PORCINE DERMIS SOFT TISSU,"$13,920.00",$0.00,"$13,920.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$13,920.00",$0.00,"$6,960.00","$11,024.64","$11,136.00",$0.00,$0.00,$0.00,$0.00,$0.00
PD2020,SUP,Custom 27803010,,PD2020  -  PATCH BIOLOGICAL L20 CM X W20 CM W PORCINE DERMIS SOFT TISSU,"$17,400.00",$0.00,"$17,400.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$17,400.00",$0.00,"$8,700.00","$13,780.80","$13,920.00",$0.00,$0.00,$0.00,$0.00,$0.00
PD2025,SUP,Custom 27803010,,PD2025  -  PATCH BIOLOGICAL L25 CM X W20 CM W PORCINE DERMIS SOFT TISSU,"$21,750.00",$0.00,"$21,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$21,750.00",$0.00,"$10,875.00","$17,226.00","$17,400.00",$0.00,$0.00,$0.00,$0.00,$0.00
PD2035,SUP,Custom 27803010,,PD2035  -  PATCH BIOLOGICAL L35 CM X W20 CM W PORCINE DERMIS SOFT TISSU,"$30,450.00",$0.00,"$30,450.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$30,450.00",$0.00,"$15,225.00","$24,116.40","$24,360.00",$0.00,$0.00,$0.00,$0.00,$0.00
PD3030,SUP,Custom 27803010,,PD3030  -  PATCH BIOLOGICAL L30 CM X W30 CM W PORCINE DERMIS SOFT TISSU,"$39,150.00",$0.00,"$39,150.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$39,150.00",$0.00,"$19,575.00","$31,006.80","$31,320.00",$0.00,$0.00,$0.00,$0.00,$0.00
PD-31-200,SUP,HCPCS C1713,,PD-31-200  -  CAGE SPNL B STRL DTRAX TI CRV,"$4,375.00",$0.00,"$4,375.00","$1,968.75","$3,122.44",$0.00,$753.79,$0.00,$0.00,$766.03,"$4,375.00",$0.00,"$2,187.50","$3,465.00","$3,500.00",$0.00,$684.69,$0.00,$696.50,$0.00
PD-31-201,SUP,HCPCS C1713,,PD-31-201  -  CAVUX CERVICAL CAGE B 5MM,"$4,375.00",$0.00,"$4,375.00","$1,968.75","$3,122.44",$0.00,$753.79,$0.00,$0.00,$766.03,"$4,375.00",$0.00,"$2,187.50","$3,465.00","$3,500.00",$0.00,$684.69,$0.00,$696.50,$0.00
PD-32-301,SUP,HCPCS C1713,,PD-32-301  -  DTRAX BONE SCREW,"$1,000.00",$0.00,"$1,000.00",$450.00,$713.70,$0.00,$172.30,$0.00,$0.00,$175.09,"$1,000.00",$0.00,$500.00,$792.00,$800.00,$0.00,$156.50,$0.00,$159.20,$0.00
PD3535,SUP,Custom 27803010,,PD3535  -  PATCH BIOLOGICAL L35 CM X W35 CM W PORCINE DERMIS SOFT TISSU,"$52,925.00",$0.00,"$52,925.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$52,925.00",$0.00,"$26,462.50","$41,916.60","$42,340.00",$0.00,$0.00,$0.00,$0.00,$0.00
PDG-AIM-015,SUP,HCPCS C1713,,PDG-AIM-015  -  GUIDE SURG 1.5MM AIMING GEMINUS VOLAR DISTAL RAD,$75.00,$0.00,$75.00,$33.75,$53.53,$0.00,$12.92,$0.00,$0.00,$13.13,$75.00,$0.00,$37.50,$59.40,$60.00,$0.00,$11.74,$0.00,$11.94,$0.00
PF-20,SUP,HCPCS C1729,,PF-20  -  CATHETER DRN 20FR STRL ACT CLRNC TCH PLEURAFLOW CHST TUBE,$968.75,$0.00,$968.75,$526.03,$691.40,$0.00,$166.91,$0.00,$0.00,$169.62,$968.75,$0.00,$484.38,$767.25,$775.00,$0.00,$151.61,$0.00,$154.23,$0.00
PF-24,SUP,HCPCS C1729,,PF-24  -  CATHETER DRN 24FR STRL PLEURAFLOW ACT CLRNC TCH CHST TUBE,$912.50,$0.00,$912.50,$495.49,$651.25,$0.00,$157.22,$0.00,$0.00,$159.77,$912.50,$0.00,$456.25,$722.70,$730.00,$0.00,$142.81,$0.00,$145.27,$0.00
PF-28,SUP,HCPCS C1729,,PF-28  -  CATHETER DRN 28FR STRL ACT CLRNC TCH PLEURAFLOW CHST TUBE,$912.50,$0.00,$912.50,$495.49,$651.25,$0.00,$157.22,$0.00,$0.00,$159.77,$912.50,$0.00,$456.25,$722.70,$730.00,$0.00,$142.81,$0.00,$145.27,$0.00
PF-32,SUP,HCPCS C1729,,PF-32  -  CATHETER DRN 32FR PLEURAFLOW ACT CLRNC TCH,$912.50,$0.00,$912.50,$495.49,$651.25,$0.00,$157.22,$0.00,$0.00,$159.77,$912.50,$0.00,$456.25,$722.70,$730.00,$0.00,$142.81,$0.00,$145.27,$0.00
PFF0025,SUP,HCPCS C1713,,PFF0025  -  SCREW PFF0025 25MM FACET FIXATION ANCHOR,"$5,940.00",$0.00,"$5,940.00","$2,673.00","$4,239.38",$0.00,"$1,023.43",$0.00,$0.00,"$1,040.05","$5,940.00",$0.00,"$2,970.00","$4,704.48","$4,752.00",$0.00,$929.61,$0.00,$945.65,$0.00
PFF0030,SUP,HCPCS C1713,,PFF0030  -  SCREW PFF0030 30MM FACET FIXATION ANCHOR,"$5,940.00",$0.00,"$5,940.00","$2,673.00","$4,239.38",$0.00,"$1,023.43",$0.00,$0.00,"$1,040.05","$5,940.00",$0.00,"$2,970.00","$4,704.48","$4,752.00",$0.00,$929.61,$0.00,$945.65,$0.00
PFF0035,SUP,HCPCS C1713,,PFF0035  -  SCREW PFF0035 35MM FACET FIXATION ANCHOR,"$5,940.00",$0.00,"$5,940.00","$2,673.00","$4,239.38",$0.00,"$1,023.43",$0.00,$0.00,"$1,040.05","$5,940.00",$0.00,"$2,970.00","$4,704.48","$4,752.00",$0.00,$929.61,$0.00,$945.65,$0.00
PFF0040,SUP,HCPCS C1713,,PFF0040  -  SCREW PFF0040 40MM FACET FIXATION ANCHOR,"$5,940.00",$0.00,"$5,940.00","$2,673.00","$4,239.38",$0.00,"$1,023.43",$0.00,$0.00,"$1,040.05","$5,940.00",$0.00,"$2,970.00","$4,704.48","$4,752.00",$0.00,$929.61,$0.00,$945.65,$0.00
PGEN00506,SUP,Custom 27203010,,PGEN00506  -  TIP APPLICATOR 6IN SPRAY EXTENDED ERGONOMIC APPLICATOR,$850.00,$0.00,$850.00,$0.00,$606.65,$0.00,$0.00,$0.00,$0.00,$0.00,$850.00,$0.00,$425.00,$673.20,$680.00,$0.00,$0.00,$0.00,$0.00,$0.00
PGPS002,SUP,Custom 27203010,,PGPS002  -  SEALANT PROGEL PLEURAL AIR LEAK,"$2,075.00",$0.00,"$2,075.00",$0.00,"$1,480.93",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,075.00",$0.00,"$1,037.50","$1,643.40","$1,660.00",$0.00,$0.00,$0.00,$0.00,$0.00
PHSE6,SUP,HCPCS C1781,,PHSE6  -  MESH HERN POLYPRO 4 15/16INX2 5/32INX.5IN NABSB SFT KNTD,"$1,704.02",$0.00,"$1,704.02",$766.81,"$1,216.16",$0.00,$293.59,$0.00,$0.00,$298.36,"$1,704.02",$0.00,$852.01,"$1,349.58","$1,363.22",$0.00,$266.68,$0.00,$271.28,$0.00
PHSM,SUP,HCPCS C1781,,PHSM  -  MESH SURG 3IN 3D MEDIUM 2 15/16IN .75IN 3 15/16INX1.75INX.5,$882.48,$0.00,$882.48,$397.12,$629.83,$0.00,$152.05,$0.00,$0.00,$154.52,$882.48,$0.00,$441.24,$698.92,$705.99,$0.00,$138.11,$0.00,$140.49,$0.00
PHSM6,SUP,HCPCS C1781,,PHSM6  -  MESH HERN POLYPRO 3 15/16INX1.75INX.5IN NABSB SFT KNTD PRLN,"$1,704.02",$0.00,"$1,704.02",$766.81,"$1,216.16",$0.00,$293.59,$0.00,$0.00,$298.36,"$1,704.02",$0.00,$852.01,"$1,349.58","$1,363.22",$0.00,$266.68,$0.00,$271.28,$0.00
PHY1015V,SUP,HCPCS C1781,,PHY1015V  -  MESH SURG 15X10CM FLEXIBLE COMPOSITE TISSUE SEPARATE LP,"$1,856.93",$0.00,"$1,856.93",$835.62,"$1,325.29",$0.00,$319.94,$0.00,$0.00,$325.13,"$1,856.93",$0.00,$928.46,"$1,470.69","$1,485.54",$0.00,$290.61,$0.00,$295.62,$0.00
PHY1520V,SUP,HCPCS C1781,,PHY1520V  -  MESH SURG 20X15CM FLEXIBLE COMPOSITE TISSUE SEPARATE LP OVAL,"$3,372.53",$0.00,"$3,372.53","$1,517.64","$2,406.97",$0.00,$581.07,$0.00,$0.00,$590.50,"$3,372.53",$0.00,"$1,686.26","$2,671.04","$2,698.02",$0.00,$527.80,$0.00,$536.91,$0.00
PHY2025V,SUP,HCPCS C1781,,PHY2025V  -  MESH SURG 25X20CM FLEXIBLE COMPOSITE TISSUE SEPARATE LP,"$5,461.58",$0.00,"$5,461.58","$2,457.71","$3,897.93",$0.00,$941.00,$0.00,$0.00,$956.28,"$5,461.58",$0.00,"$2,730.79","$4,325.57","$4,369.26",$0.00,$854.74,$0.00,$869.48,$0.00
PHY2030R,SUP,HCPCS C1781,,PHY2030R  -  MESH SURG 30X20CM FLEXIBLE COMPOSITE TISSUE SEPARATE,"$5,891.08",$0.00,"$5,891.08","$2,650.98","$4,204.46",$0.00,"$1,015.00",$0.00,$0.00,"$1,031.48","$5,891.08",$0.00,"$2,945.54","$4,665.74","$4,712.86",$0.00,$921.95,$0.00,$937.86,$0.00
PIC-301-IK,SUP,HCPCS C1729,,PIC LINE 3FR,$125.00,$0.00,$125.00,$67.88,$89.21,$0.00,$21.54,$0.00,$0.00,$21.89,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$19.56,$0.00,$19.90,$0.00
PIKA,SUP,Custom 27203010,,PIKA  -  PERCUTANEOUS INSERTION KIT ARTERIAL,$157.63,$0.00,$157.63,$0.00,$112.50,$0.00,$0.00,$0.00,$0.00,$0.00,$157.63,$0.00,$78.81,$124.84,$126.10,$0.00,$0.00,$0.00,$0.00,$0.00
PIKV,SUP,Custom 27203010,,PIKV  -  KIT CATH INS .038IN 18GA 11 SCPL INS NDL SYR GW DIL VN PERC,$159.99,$0.00,$159.99,$0.00,$114.18,$0.00,$0.00,$0.00,$0.00,$0.00,$159.99,$0.00,$79.99,$126.71,$127.99,$0.00,$0.00,$0.00,$0.00,$0.00
PJN1976284,SUP,HCPCS C1898,,PJN1976284  -  LEAD PCMKR 58CM CP NV AV STRD-ELUT SIL BIPOL ACT PJN1976284,"$1,500.00",$0.00,"$1,500.00",$675.00,"$1,070.55",$0.00,$258.44,$0.00,$0.00,$262.64,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$234.75,$0.00,$238.80,$0.00
PK-16,SUP,HCPCS V2790,,PK-16  -  GRAFT SFT TIS THK50-100UM 16MM AMNIOGRAFT PROKERA AMNIO,"$2,237.50",$0.00,"$2,237.50","$1,006.88","$1,596.90",$0.00,$385.51,$0.00,$0.00,$391.77,"$2,237.50",$0.00,"$1,118.75","$1,772.10","$1,790.00",$0.00,$350.17,$0.00,$356.21,$0.00
PL-2080,SUP,HCPCS C1713,,PL-2080  -  SCREW BN CNTRSNK CO CA,$352.50,$0.00,$352.50,$158.63,$251.58,$0.00,$60.73,$0.00,$0.00,$61.72,$352.50,$0.00,$176.25,$279.18,$282.00,$0.00,$55.17,$0.00,$56.12,$0.00
PLA230300,SUP,Custom 27806190,,PLA230300  -  GRAFT EVAS 23MM 19-21MM 3.3CM AORTA,"$7,937.50",$0.00,"$7,937.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,937.50",$0.00,"$3,968.75","$6,286.50","$6,350.00",$0.00,$0.00,$0.00,$0.00,$0.00
PLA320400,SUP,HCPCS C1874,,PLA320400  -  GRAFT EVAS 32MM 27-29MM 4.5CM XCLDR STNT XTD ABRSN RST,"$8,135.00",$0.00,"$8,135.00","$3,660.75","$5,158.80",$0.00,"$1,401.62",$0.00,$0.00,"$1,424.37","$8,135.00",$0.00,"$4,067.50","$6,442.92","$6,508.00",$0.00,"$1,273.13",$0.00,"$1,295.09",$0.00
PL-BG07,SUP,Custom 27203010,,PL-BG07  -  BIT DRILL 7MM BNGFT HRVT,$852.50,$0.00,$852.50,$0.00,$608.43,$0.00,$0.00,$0.00,$0.00,$0.00,$852.50,$0.00,$426.25,$675.18,$682.00,$0.00,$0.00,$0.00,$0.00,$0.00
PL-BSWDL,SUP,HCPCS C1713,,PL-BSWDL  -  PLATE BN NS WDG LT 1ST MTP,"$1,592.50",$0.00,"$1,592.50",$716.63,"$1,136.57",$0.00,$274.38,$0.00,$0.00,$278.83,"$1,592.50",$0.00,$796.25,"$1,261.26","$1,274.00",$0.00,$249.23,$0.00,$253.53,$0.00
PL-BSWDR,SUP,HCPCS C1713,,PL-BSWDR  -  PLATE BN NS WDG TI RT MTRSL OSTM,"$1,592.50",$0.00,"$1,592.50",$716.63,"$1,136.57",$0.00,$274.38,$0.00,$0.00,$278.83,"$1,592.50",$0.00,$796.25,"$1,261.26","$1,274.00",$0.00,$249.23,$0.00,$253.53,$0.00
PLC141400,SUP,HCPCS C1874,,PLC141400  -  GRAFT EVAS 14.5MM 12-13.5MM 14CM GORE XCLDR CNTRLT LG AAA,"$11,557.50",$0.00,"$11,557.50","$5,200.88","$5,158.80",$0.00,"$1,991.30",$0.00,$0.00,"$2,023.63","$11,557.50",$0.00,"$5,778.75","$9,153.54","$9,246.00",$0.00,"$1,808.75",$0.00,"$1,839.95",$0.00
PLC161000,SUP,HCPCS C1876,,PLC161000  -  GRAFT EVAS 16MM 13.5-14.5MM 9.5CM XCLDR STNT ABRSN RST,"$11,275.00",$0.00,"$11,275.00","$5,073.75","$5,158.80",$0.00,"$1,942.63",$0.00,$0.00,"$1,974.16","$11,275.00",$0.00,"$5,637.50","$8,929.80","$9,020.00",$0.00,"$1,764.54",$0.00,"$1,794.98",$0.00
PL-CL6SL,SUP,HCPCS C1713,,PL-CL6SL  -  PLATE SM TI 6 HOLE LCK BONE LEFT CLVCL NONSTRL,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
PL-CL6SR,SUP,HCPCS C1713,,PL-CL6SR  -  PLATE SM 5MM TI 6 HOLE LCK ACUMED BONE RIGHT CLVCL NONSTRL,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
PL-CL8JR,SUP,HCPCS C1713,,PL-CL8JR  -  PLATE TI 8 HOLE J LCK SYS BONE RIGHT CLVCL SHLDR STRL,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
PL-CL8LL,SUP,HCPCS C1713,,PL-CL8LL  -  PLATE LG TI 8 HOLE LCK BONE CLVCL STRL,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
PL-CL8LR,SUP,HCPCS C1713,,PL-CL8LR  -  PLATE LG TI 8 HOLE LCK ACUMED BONE RIGHT CLVCL SHLDR STRL,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
PL-DL26,SUP,HCPCS C1713,,PL-DL26  -  PLATE BN 26MM LT DRSL RADL,"$1,115.00",$0.00,"$1,115.00",$501.75,$795.78,$0.00,$192.11,$0.00,$0.00,$195.23,"$1,115.00",$0.00,$557.50,$883.08,$892.00,$0.00,$174.50,$0.00,$177.51,$0.00
PL-DMTPL,SUP,HCPCS C1713,,PL-DMTPL  -  PLATE TI FSN BONE LEFT DORSAL MTP NONSTRL,"$1,275.00",$0.00,"$1,275.00",$573.75,$909.97,$0.00,$219.68,$0.00,$0.00,$223.24,"$1,275.00",$0.00,$637.50,"$1,009.80","$1,020.00",$0.00,$199.54,$0.00,$202.98,$0.00
PL-DMTPR,SUP,HCPCS C1713,,PL-DMTPR  -  PLATE TI BONE RIGHT DORSAL 1ST MTP NONSTRL,"$1,275.00",$0.00,"$1,275.00",$573.75,$909.97,$0.00,$219.68,$0.00,$0.00,$223.24,"$1,275.00",$0.00,$637.50,"$1,009.80","$1,020.00",$0.00,$199.54,$0.00,$202.98,$0.00
PL-DR26,SUP,HCPCS C1713,,PL-DR26  -  PLATE BN 26MM NS TI RT DIST DRSL RADL,"$1,115.00",$0.00,"$1,115.00",$501.75,$795.78,$0.00,$192.11,$0.00,$0.00,$195.23,"$1,115.00",$0.00,$557.50,$883.08,$892.00,$0.00,$174.50,$0.00,$177.51,$0.00
PL-DR30L,SUP,HCPCS C1713,,PL-DR30L  -  PLATE BN NAR ACLC RDS LT DIST VOLR,"$2,047.50",$0.00,"$2,047.50",$921.38,"$1,461.30",$0.00,$352.77,$0.00,$0.00,$358.50,"$2,047.50",$0.00,"$1,023.75","$1,621.62","$1,638.00",$0.00,$320.43,$0.00,$325.96,$0.00
PL-DR30R,SUP,HCPCS C1713,,PL-DR30R  -  PLATE BN NAR ACLC RDS RT DIST VOLR,"$2,047.50",$0.00,"$2,047.50",$921.38,"$1,461.30",$0.00,$352.77,$0.00,$0.00,$358.50,"$2,047.50",$0.00,"$1,023.75","$1,621.62","$1,638.00",$0.00,$320.43,$0.00,$325.96,$0.00
PL-DR50L,SUP,HCPCS C1713,,PL-DR50L  -  PLATE BN STD ACLC RDS LT DIST VOLR,"$2,047.50",$0.00,"$2,047.50",$921.38,"$1,461.30",$0.00,$352.77,$0.00,$0.00,$358.50,"$2,047.50",$0.00,"$1,023.75","$1,621.62","$1,638.00",$0.00,$320.43,$0.00,$325.96,$0.00
PL-DR50R,SUP,HCPCS C1713,,PL-DR50R  -  PLATE BN STD ACLC RDS RT DIST VOLR,"$2,047.50",$0.00,"$2,047.50",$921.38,"$1,461.30",$0.00,$352.77,$0.00,$0.00,$358.50,"$2,047.50",$0.00,"$1,023.75","$1,621.62","$1,638.00",$0.00,$320.43,$0.00,$325.96,$0.00
PLDR60L,SUP,HCPCS C1713,,PLDR60L  -  PLATE LNG STD BONE LEFT DISTAL RADL,"$1,737.50",$0.00,"$1,737.50",$781.88,"$1,240.05",$0.00,$299.36,$0.00,$0.00,$304.22,"$1,737.50",$0.00,$868.75,"$1,376.10","$1,390.00",$0.00,$271.92,$0.00,$276.61,$0.00
PL-DR60L,SUP,HCPCS C1713,,PL-DR60L  -  PLATE LNG 60MM TI 6 HOLE ACLC BONE LEFT DISTAL VOLR RADL,"$2,047.50",$0.00,"$2,047.50",$921.38,"$1,461.30",$0.00,$352.77,$0.00,$0.00,$358.50,"$2,047.50",$0.00,"$1,023.75","$1,621.62","$1,638.00",$0.00,$320.43,$0.00,$325.96,$0.00
PL-DR60R,SUP,HCPCS C1713,,PL-DR60R  -  PLATE BN LNG ACLC RDS RT DIST VOLR,"$2,047.50",$0.00,"$2,047.50",$921.38,"$1,461.30",$0.00,$352.77,$0.00,$0.00,$358.50,"$2,047.50",$0.00,"$1,023.75","$1,621.62","$1,638.00",$0.00,$320.43,$0.00,$325.96,$0.00
PL-DR65L,SUP,HCPCS C1713,,PL-DR65L  -  PLATE XL ACLC BONE LEFT RADL DISTAL WR HND NONSTRL,"$2,047.50",$0.00,"$2,047.50",$921.38,"$1,461.30",$0.00,$352.77,$0.00,$0.00,$358.50,"$2,047.50",$0.00,"$1,023.75","$1,621.62","$1,638.00",$0.00,$320.43,$0.00,$325.96,$0.00
PL-DR65R,SUP,HCPCS C1713,,PL-DR65R  -  PLATE XLNG TI ACLC BONE RIGHT DISTAL RADL WR HND STRL,"$2,047.50",$0.00,"$2,047.50",$921.38,"$1,461.30",$0.00,$352.77,$0.00,$0.00,$358.50,"$2,047.50",$0.00,"$1,023.75","$1,621.62","$1,638.00",$0.00,$320.43,$0.00,$325.96,$0.00
PL-DR70L,SUP,HCPCS C1713,,PL-DR70L  -  PLATE W ACLC BONE LEFT DISTAL RADL WR HND STRL,"$2,047.50",$0.00,"$2,047.50",$921.38,"$1,461.30",$0.00,$352.77,$0.00,$0.00,$358.50,"$2,047.50",$0.00,"$1,023.75","$1,621.62","$1,638.00",$0.00,$320.43,$0.00,$325.96,$0.00
PL-DR70R,SUP,HCPCS C1713,,PL-DR70R  -  PLATE BN W ACLC RDS RT DIST VOLR,"$2,047.50",$0.00,"$2,047.50",$921.38,"$1,461.30",$0.00,$352.77,$0.00,$0.00,$358.50,"$2,047.50",$0.00,"$1,023.75","$1,621.62","$1,638.00",$0.00,$320.43,$0.00,$325.96,$0.00
PLDS15,SUP,Custom 27203010,,PLDS15  -  STAPLER INTNL ANG RT 15MM STRL LF LDS LNR CUT LKOUT PRELD TI,"$1,015.55",$0.00,"$1,015.55",$0.00,$724.80,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,015.55",$0.00,$507.78,$804.32,$812.44,$0.00,$0.00,$0.00,$0.00,$0.00
PL-ELCLL,SUP,HCPCS C1713,,PL-ELCLL  -  PLATE TI XTD BONE LEFT CORONOID NONSTRL,"$2,252.50",$0.00,"$2,252.50","$1,013.63","$1,607.61",$0.00,$388.09,$0.00,$0.00,$394.39,"$2,252.50",$0.00,"$1,126.25","$1,783.98","$1,802.00",$0.00,$352.52,$0.00,$358.60,$0.00
PL-ELCLR,SUP,HCPCS C1713,,PL-ELCLR  -  PLATE BN NS XTD LCK TI ELB RT CORONOID,"$2,252.50",$0.00,"$2,252.50","$1,013.63","$1,607.61",$0.00,$388.09,$0.00,$0.00,$394.39,"$2,252.50",$0.00,"$1,126.25","$1,783.98","$1,802.00",$0.00,$352.52,$0.00,$358.60,$0.00
PL-ELCOL,SUP,HCPCS C1713,,PL-ELCOL  -  PLATE BN SM NS TI ELB LT CORONOID,"$2,252.50",$0.00,"$2,252.50","$1,013.63","$1,607.61",$0.00,$388.09,$0.00,$0.00,$394.39,"$2,252.50",$0.00,"$1,126.25","$1,783.98","$1,802.00",$0.00,$352.52,$0.00,$358.60,$0.00
PL-ELCOR,SUP,HCPCS C1713,,PL-ELCOR  -  PLATE BN NS TI ELB RT CORONOID,"$2,252.50",$0.00,"$2,252.50","$1,013.63","$1,607.61",$0.00,$388.09,$0.00,$0.00,$394.39,"$2,252.50",$0.00,"$1,126.25","$1,783.98","$1,802.00",$0.00,$352.52,$0.00,$358.60,$0.00
PL-ELLXL,SUP,HCPCS C1713,,PL-ELLXL  -  PLATE XLNG TI BONE L/L EPCND ELB,"$1,847.35",$0.00,"$1,847.35",$831.31,"$1,318.45",$0.00,$318.29,$0.00,$0.00,$323.46,"$1,847.35",$0.00,$923.68,"$1,463.10","$1,477.88",$0.00,$289.11,$0.00,$294.10,$0.00
PL-ELPO,SUP,HCPCS C1713,,PL-ELPO  -  PLATE BN POST ELB,"$2,252.50",$0.00,"$2,252.50","$1,013.63","$1,607.61",$0.00,$388.09,$0.00,$0.00,$394.39,"$2,252.50",$0.00,"$1,126.25","$1,783.98","$1,802.00",$0.00,$352.52,$0.00,$358.60,$0.00
PL-ELRD,SUP,HCPCS C1713,,PL-ELRD  -  PLATE TI 7 HOLE BONE RADL HEAD NONSTRL,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
PL-ELT1027,SUP,Custom 27100030,,PL-ELT1027  -  TAP 2.7MM 2.7MM QRLSE SURG ELB ACUMED 2MM SCR,$565.00,$0.00,$565.00,$0.00,$403.24,$0.00,$0.00,$0.00,$0.00,$0.00,$565.00,$0.00,$282.50,$447.48,$452.00,$0.00,$0.00,$0.00,$0.00,$0.00
PL-ELT1035,SUP,HCPCS C1713,,PL-ELT1035  -  PLATE TI 3.5MM SCR TAP BONE 3.5MM ELB NONSTRL DISP,$565.00,$0.00,$565.00,$254.25,$403.24,$0.00,$97.35,$0.00,$0.00,$98.93,$565.00,$0.00,$282.50,$447.48,$452.00,$0.00,$88.42,$0.00,$89.95,$0.00
PL-FIB11,SUP,HCPCS C1713,,PL-FIB11  -  PLATE TI 11 HOLE BONE LAT MLR FIB NONSTRL,"$1,017.50",$0.00,"$1,017.50",$457.88,$726.19,$0.00,$175.31,$0.00,$0.00,$178.16,"$1,017.50",$0.00,$508.75,$805.86,$814.00,$0.00,$159.24,$0.00,$161.99,$0.00
PL-FIB5,SUP,HCPCS C1713,,PL-FIB5  -  PLATE TI 5 HOLE BONE FIB NONSTRL,"$1,017.50",$0.00,"$1,017.50",$457.88,$726.19,$0.00,$175.31,$0.00,$0.00,$178.16,"$1,017.50",$0.00,$508.75,$805.86,$814.00,$0.00,$159.24,$0.00,$161.99,$0.00
PL-FIB7,SUP,HCPCS C1713,,PL-FIB7  -  PLATE TI 7 HOLE BONE FIB NONSTRL,"$1,017.50",$0.00,"$1,017.50",$457.88,$726.19,$0.00,$175.31,$0.00,$0.00,$178.16,"$1,017.50",$0.00,$508.75,$805.86,$814.00,$0.00,$159.24,$0.00,$161.99,$0.00
PL-FIB9,SUP,HCPCS C1713,,PL-FIB9  -  PLATE TI 9 HOLE BONE LAT MLR FIB NONSTRL,"$1,017.50",$0.00,"$1,017.50",$457.88,$726.19,$0.00,$175.31,$0.00,$0.00,$178.16,"$1,017.50",$0.00,$508.75,$805.86,$814.00,$0.00,$159.24,$0.00,$161.99,$0.00
PL-GLD3,SUP,HCPCS C1713,,PL-GLD3  -  PLATE TI 3 HOLE GLD BONE MLR NONSTRL,"$1,017.50",$0.00,"$1,017.50",$457.88,$726.19,$0.00,$175.31,$0.00,$0.00,$178.16,"$1,017.50",$0.00,$508.75,$805.86,$814.00,$0.00,$159.24,$0.00,$161.99,$0.00
PL-GLD5,SUP,HCPCS C1713,,PL-GLD5  -  PLATE 5 HOLE GLD BONE,"$1,017.50",$0.00,"$1,017.50",$457.88,$726.19,$0.00,$175.31,$0.00,$0.00,$178.16,"$1,017.50",$0.00,$508.75,$805.86,$814.00,$0.00,$159.24,$0.00,$161.99,$0.00
PL-GLD7,SUP,HCPCS C1713,,PL-GLD7  -  PLATE TI 7 HOLE GLD BONE MLR NONSTRL,"$1,017.50",$0.00,"$1,017.50",$457.88,$726.19,$0.00,$175.31,$0.00,$0.00,$178.16,"$1,017.50",$0.00,$508.75,$805.86,$814.00,$0.00,$159.24,$0.00,$161.99,$0.00
PL-LE011,SUP,HCPCS C1713,,PL-LE011  -  PLATE 11 HOLE LCK BONE OLCRN ELB,"$2,125.00",$0.00,"$2,125.00",$956.25,"$1,516.61",$0.00,$366.13,$0.00,$0.00,$372.07,"$2,125.00",$0.00,"$1,062.50","$1,683.00","$1,700.00",$0.00,$332.56,$0.00,$338.30,$0.00
PL-LE013,SUP,HCPCS C1713,,PL-LE013  -  PLATE TI 13 HOLE LCK SYS BONE OLCRN ELB STRL,"$2,062.50",$0.00,"$2,062.50",$928.13,"$1,472.01",$0.00,$355.36,$0.00,$0.00,$361.13,"$2,062.50",$0.00,"$1,031.25","$1,633.50","$1,650.00",$0.00,$322.78,$0.00,$328.35,$0.00
PL-LE09,SUP,HCPCS C1713,,PL-LE09  -  PLATE STD TI 9 HOLE LCK BONE OLCRN NONSTRL,"$2,062.50",$0.00,"$2,062.50",$928.13,"$1,472.01",$0.00,$355.36,$0.00,$0.00,$361.13,"$2,062.50",$0.00,"$1,031.25","$1,633.50","$1,650.00",$0.00,$322.78,$0.00,$328.35,$0.00
PL-LEL10L,SUP,HCPCS C1713,,PL-LEL10L  -  PLATE BN 100MM NS 10 HL LCK TI ELB L/L,"$2,252.50",$0.00,"$2,252.50","$1,013.63","$1,607.61",$0.00,$388.09,$0.00,$0.00,$394.39,"$2,252.50",$0.00,"$1,126.25","$1,783.98","$1,802.00",$0.00,$352.52,$0.00,$358.60,$0.00
PL-LEL10R,SUP,HCPCS C1713,,PL-LEL10R  -  PLATE BN 100MM NS 10 HL LCK TI ELB RL,"$2,252.50",$0.00,"$2,252.50","$1,013.63","$1,607.61",$0.00,$388.09,$0.00,$0.00,$394.39,"$2,252.50",$0.00,"$1,126.25","$1,783.98","$1,802.00",$0.00,$352.52,$0.00,$358.60,$0.00
PL-LEL14,SUP,HCPCS C1713,,PL-LEL14  -  PLATE 14 HOLE SYS BONE RL ELB STRL,"$1,875.00",$0.00,"$1,875.00",$843.75,"$1,338.19",$0.00,$323.05,$0.00,$0.00,$328.30,"$1,875.00",$0.00,$937.50,"$1,485.00","$1,500.00",$0.00,$293.44,$0.00,$298.50,$0.00
PL-LEL14L,SUP,HCPCS C1713,,PL-LEL14L  -  PLATE TI 14 HOLE LCK BONE L/L ELB STRL,"$2,252.50",$0.00,"$2,252.50","$1,013.63","$1,607.61",$0.00,$388.09,$0.00,$0.00,$394.39,"$2,252.50",$0.00,"$1,126.25","$1,783.98","$1,802.00",$0.00,$352.52,$0.00,$358.60,$0.00
PL-LEL14R,SUP,HCPCS C1713,,PL-LEL14R  -  PLATE XLNG TI 14 HOLE BONE RL EPCND NONSTRL,"$2,252.50",$0.00,"$2,252.50","$1,013.63","$1,607.61",$0.00,$388.09,$0.00,$0.00,$394.39,"$2,252.50",$0.00,"$1,126.25","$1,783.98","$1,802.00",$0.00,$352.52,$0.00,$358.60,$0.00
PL-LEL20L,SUP,HCPCS C1713,,PL-LEL20L  -  PLATE TI 20 HOLE LCK BONE L/L EPCND NONSTRL,"$2,252.50",$0.00,"$2,252.50","$1,013.63","$1,607.61",$0.00,$388.09,$0.00,$0.00,$394.39,"$2,252.50",$0.00,"$1,126.25","$1,783.98","$1,802.00",$0.00,$352.52,$0.00,$358.60,$0.00
PL-LEL20R,SUP,HCPCS C1713,,PL-LEL20R  -  PLATE TI 20 HOLE LCK BONE RL ELB NONSTRL,"$2,252.50",$0.00,"$2,252.50","$1,013.63","$1,607.61",$0.00,$388.09,$0.00,$0.00,$394.39,"$2,252.50",$0.00,"$1,126.25","$1,783.98","$1,802.00",$0.00,$352.52,$0.00,$358.60,$0.00
PL-LEL6L,SUP,HCPCS C1713,,PL-LEL6L  -  PLATE TI 6 HOLE LCK BONE L/L ELB NONSTRL,"$2,252.50",$0.00,"$2,252.50","$1,013.63","$1,607.61",$0.00,$388.09,$0.00,$0.00,$394.39,"$2,252.50",$0.00,"$1,126.25","$1,783.98","$1,802.00",$0.00,$352.52,$0.00,$358.60,$0.00
PL-LEL6R,SUP,HCPCS C1713,,PL-LEL6R  -  PLATE TI 6 HOLE LCK BONE RL ELB NONSTRL,"$2,252.50",$0.00,"$2,252.50","$1,013.63","$1,607.61",$0.00,$388.09,$0.00,$0.00,$394.39,"$2,252.50",$0.00,"$1,126.25","$1,783.98","$1,802.00",$0.00,$352.52,$0.00,$358.60,$0.00
PL-LEM12,SUP,HCPCS C1713,,PL-LEM12  -  PLATE TI 12 HOLE LCK ACUMED BONE MDL ELB NONSTRL,"$2,252.50",$0.00,"$2,252.50","$1,013.63","$1,607.61",$0.00,$388.09,$0.00,$0.00,$394.39,"$2,252.50",$0.00,"$1,126.25","$1,783.98","$1,802.00",$0.00,$352.52,$0.00,$358.60,$0.00
PL-LEM16,SUP,HCPCS C1713,,PL-LEM16  -  PLATE BN 16 HL LCK,"$2,252.50",$0.00,"$2,252.50","$1,013.63","$1,607.61",$0.00,$388.09,$0.00,$0.00,$394.39,"$2,252.50",$0.00,"$1,126.25","$1,783.98","$1,802.00",$0.00,$352.52,$0.00,$358.60,$0.00
PL-LEM7,SUP,HCPCS C1713,,PL-LEM7  -  PLATE 84MM TI 7 HOLE LCK ACUMED BONE MDL ELB NONSTRL,"$2,252.50",$0.00,"$2,252.50","$1,013.63","$1,607.61",$0.00,$388.09,$0.00,$0.00,$394.39,"$2,252.50",$0.00,"$1,126.25","$1,783.98","$1,802.00",$0.00,$352.52,$0.00,$358.60,$0.00
PL-LEM8,SUP,HCPCS C1713,,PL-LEM8  -  PLATE 88MM TITANIUIM 8 HOLE LCK BONE MDL ELB NONSTRL,"$2,252.50",$0.00,"$2,252.50","$1,013.63","$1,607.61",$0.00,$388.09,$0.00,$0.00,$394.39,"$2,252.50",$0.00,"$1,126.25","$1,783.98","$1,802.00",$0.00,$352.52,$0.00,$358.60,$0.00
PL-LEM9L,SUP,HCPCS C1713,,PL-LEM9L  -  PLATE LNG TITANIUIM 9 HOLE LCK SYS BONE MDL ELB STRL,"$2,252.50",$0.00,"$2,252.50","$1,013.63","$1,607.61",$0.00,$388.09,$0.00,$0.00,$394.39,"$2,252.50",$0.00,"$1,126.25","$1,783.98","$1,802.00",$0.00,$352.52,$0.00,$358.60,$0.00
PL-LEM9S,SUP,HCPCS C1713,,PL-LEM9S  -  PLATE SHRT TI 9 HOLE LCK BONE MDL ELB STRL,"$2,252.50",$0.00,"$2,252.50","$1,013.63","$1,607.61",$0.00,$388.09,$0.00,$0.00,$394.39,"$2,252.50",$0.00,"$1,126.25","$1,783.98","$1,802.00",$0.00,$352.52,$0.00,$358.60,$0.00
PL-LEO11,SUP,HCPCS C1713,,PL-LEO11  -  PLATE BN NS 11 HL LCK PRECONTOUR TI ELB OLCRN,"$2,252.50",$0.00,"$2,252.50","$1,013.63","$1,607.61",$0.00,$388.09,$0.00,$0.00,$394.39,"$2,252.50",$0.00,"$1,126.25","$1,783.98","$1,802.00",$0.00,$352.52,$0.00,$358.60,$0.00
PL-LEO13,SUP,HCPCS C1713,,PL-LEO13  -  PLATE TI 13 HOLE LCK SYS BONE OLCRN ELB STRL,"$2,252.50",$0.00,"$2,252.50","$1,013.63","$1,607.61",$0.00,$388.09,$0.00,$0.00,$394.39,"$2,252.50",$0.00,"$1,126.25","$1,783.98","$1,802.00",$0.00,$352.52,$0.00,$358.60,$0.00
PL-LEO13E,SUP,HCPCS C1713,,PL-LEO13E  -  PLATE BN 13 HL XTD ELB,"$2,252.50",$0.00,"$2,252.50","$1,013.63","$1,607.61",$0.00,$388.09,$0.00,$0.00,$394.39,"$2,252.50",$0.00,"$1,126.25","$1,783.98","$1,802.00",$0.00,$352.52,$0.00,$358.60,$0.00
PL-LEO17L,SUP,HCPCS C1713,,PL-LEO17L  -  PLATE BN NS 17 HL LCK PRECONTOUR TI ELB LT OLCRN,"$2,562.50",$0.00,"$2,562.50","$1,153.13","$1,828.86",$0.00,$441.51,$0.00,$0.00,$448.67,"$2,562.50",$0.00,"$1,281.25","$2,029.50","$2,050.00",$0.00,$401.03,$0.00,$407.95,$0.00
PL-LEO17R,SUP,HCPCS C1713,,PL-LEO17R  -  PLATE BN NS 17 HL LCK PRECONTOUR TI OLCRN RT,"$2,562.50",$0.00,"$2,562.50","$1,153.13","$1,828.86",$0.00,$441.51,$0.00,$0.00,$448.67,"$2,562.50",$0.00,"$1,281.25","$2,029.50","$2,050.00",$0.00,$401.03,$0.00,$407.95,$0.00
PL-LEO9,SUP,HCPCS C1713,,PL-LEO9  -  PLATE STD TI 9 HOLE LCK BONE OLCRN NONSTRL,"$2,252.50",$0.00,"$2,252.50","$1,013.63","$1,607.61",$0.00,$388.09,$0.00,$0.00,$394.39,"$2,252.50",$0.00,"$1,126.25","$1,783.98","$1,802.00",$0.00,$352.52,$0.00,$358.60,$0.00
PL-LL8LR,SUP,HCPCS C1713,,PL-LL8LR  -  PLATE LNG 8 HOLE BONE RIGHT CLVCL,"$1,862.50",$0.00,"$1,862.50",$838.13,"$1,329.27",$0.00,$320.90,$0.00,$0.00,$326.11,"$1,862.50",$0.00,$931.25,"$1,475.10","$1,490.00",$0.00,$291.48,$0.00,$296.51,$0.00
PL-MCPL,SUP,HCPCS C1713,,PL-MCPL  -  PLATE BN RND NS FSN TI 1ST MCP LT,"$1,017.50",$0.00,"$1,017.50",$457.88,$726.19,$0.00,$175.31,$0.00,$0.00,$178.16,"$1,017.50",$0.00,$508.75,$805.86,$814.00,$0.00,$159.24,$0.00,$161.99,$0.00
PL-MCPR,SUP,HCPCS C1713,,PL-MCPR  -  PLATE TI BONE RIGHT MCP,"$1,017.50",$0.00,"$1,017.50",$457.88,$726.19,$0.00,$175.31,$0.00,$0.00,$178.16,"$1,017.50",$0.00,$508.75,$805.86,$814.00,$0.00,$159.24,$0.00,$161.99,$0.00
PL-MPJL,SUP,HCPCS C1713,,PL-MPJL  -  PLATE BN NS 4 HL FSN TI 1ST MTP LT,"$1,275.00",$0.00,"$1,275.00",$573.75,$909.97,$0.00,$219.68,$0.00,$0.00,$223.24,"$1,275.00",$0.00,$637.50,"$1,009.80","$1,020.00",$0.00,$199.54,$0.00,$202.98,$0.00
PL-MPJR,SUP,HCPCS C1713,,PL-MPJR  -  PLATE SHRT BONE RIGHT MTP,"$1,275.00",$0.00,"$1,275.00",$573.75,$909.97,$0.00,$219.68,$0.00,$0.00,$223.24,"$1,275.00",$0.00,$637.50,"$1,009.80","$1,020.00",$0.00,$199.54,$0.00,$202.98,$0.00
PL-MTPL,SUP,HCPCS C1713,,PL-MTPL  -  PLATE TI FSN BONE LEFT 1ST MTP NONSTRL,"$1,275.00",$0.00,"$1,275.00",$573.75,$909.97,$0.00,$219.68,$0.00,$0.00,$223.24,"$1,275.00",$0.00,$637.50,"$1,009.80","$1,020.00",$0.00,$199.54,$0.00,$202.98,$0.00
PL-MTPLR,SUP,HCPCS C1713,,PL-MTPLR  -  PLATE BN NS 6 HL REV FSN TI 1ST MTP LT,"$1,275.00",$0.00,"$1,275.00",$573.75,$909.97,$0.00,$219.68,$0.00,$0.00,$223.24,"$1,275.00",$0.00,$637.50,"$1,009.80","$1,020.00",$0.00,$199.54,$0.00,$202.98,$0.00
PL-MTPR,SUP,HCPCS C1713,,PL-MTPR  -  PLATE BN NS 4 HL FSN TI 1ST MTP RT,"$1,275.00",$0.00,"$1,275.00",$573.75,$909.97,$0.00,$219.68,$0.00,$0.00,$223.24,"$1,275.00",$0.00,$637.50,"$1,009.80","$1,020.00",$0.00,$199.54,$0.00,$202.98,$0.00
PL-MTPRR,SUP,HCPCS C1713,,PL-MTPRR  -  PLATE TI FSN BONE RIGHT GRT TOE,"$1,275.00",$0.00,"$1,275.00",$573.75,$909.97,$0.00,$219.68,$0.00,$0.00,$223.24,"$1,275.00",$0.00,$637.50,"$1,009.80","$1,020.00",$0.00,$199.54,$0.00,$202.98,$0.00
PLP10342,SUP,HCPCS C1713,,PLP10342  -  PLATE BN 1.3MM NS ANCHORAGE 6 HL LOPRFL PIN FX HL VRSN V1 TI,"$3,675.75",$0.00,"$3,675.75","$1,654.09","$2,623.38",$0.00,$633.31,$0.00,$0.00,$643.59,"$3,675.75",$0.00,"$1,837.88","$2,911.19","$2,940.60",$0.00,$575.25,$0.00,$585.18,$0.00
PLP10462,SUP,HCPCS C1713,,PLP10462  -  PLATE BN LNG 1.3MM NS ANCHORAGE 8 HL LOPRFL PIN FX HL VRSN V,"$3,675.75",$0.00,"$3,675.75","$1,654.09","$2,623.38",$0.00,$633.31,$0.00,$0.00,$643.59,"$3,675.75",$0.00,"$1,837.88","$2,911.19","$2,940.60",$0.00,$575.25,$0.00,$585.18,$0.00
PLP20342,SUP,HCPCS C1713,,PLP20342  -  PLATE BN 0MM STP 1.5MM NS ANCHORAGE LOPRFL PIN FX THRD HL TI,"$3,675.75",$0.00,"$3,675.75","$1,654.09","$2,623.38",$0.00,$633.31,$0.00,$0.00,$643.59,"$3,675.75",$0.00,"$1,837.88","$2,911.19","$2,940.60",$0.00,$575.25,$0.00,$585.18,$0.00
PLP30201,SUP,HCPCS C1713,,PLP30201  -  PLATE BN LG 1.5MM NS ANCHORAGE LOPRFL PIN FX THRD HL TI LT 3,"$3,675.75",$0.00,"$3,675.75","$1,654.09","$2,623.38",$0.00,$633.31,$0.00,$0.00,$643.59,"$3,675.75",$0.00,"$1,837.88","$2,911.19","$2,940.60",$0.00,$575.25,$0.00,$585.18,$0.00
PLP40160,SUP,HCPCS C1713,,PLP40160  -  PLATE BN STRG 16MMX1.5MM NS ANCHORAGE 2 HL LOPRFL UTL SMTR,"$3,061.50",$0.00,"$3,061.50","$1,377.68","$2,184.99",$0.00,$527.48,$0.00,$0.00,$536.04,"$3,061.50",$0.00,"$1,530.75","$2,424.71","$2,449.20",$0.00,$479.12,$0.00,$487.39,$0.00
PLP40220,SUP,HCPCS C1713,,PLP40220  -  PLATE BN STRG 22MMX1.5MM NS ANCHORAGE 3 HL LOPRFL UTL SMTR,"$3,061.50",$0.00,"$3,061.50","$1,377.68","$2,184.99",$0.00,$527.48,$0.00,$0.00,$536.04,"$3,061.50",$0.00,"$1,530.75","$2,424.71","$2,449.20",$0.00,$479.12,$0.00,$487.39,$0.00
PL-PHGL,SUP,HCPCS C1713,,PL-PHGL  -  PLATE LG TI PLRS BONE LEFT PROX HUM NONSTRL,"$3,747.50",$0.00,"$3,747.50","$1,686.38","$2,674.59",$0.00,$645.68,$0.00,$0.00,$656.16,"$3,747.50",$0.00,"$1,873.75","$2,968.02","$2,998.00",$0.00,$586.48,$0.00,$596.60,$0.00
PL-PHGR,SUP,HCPCS C1713,,PL-PHGR  -  PLATE BN LG HUM RT,"$3,747.50",$0.00,"$3,747.50","$1,686.38","$2,674.59",$0.00,$645.68,$0.00,$0.00,$656.16,"$3,747.50",$0.00,"$1,873.75","$2,968.02","$2,998.00",$0.00,$586.48,$0.00,$596.60,$0.00
PL-PHSL,SUP,HCPCS C1713,,PL-PHSL  -  PLATE BN SM HUM LT PROX,"$3,747.50",$0.00,"$3,747.50","$1,686.38","$2,674.59",$0.00,$645.68,$0.00,$0.00,$656.16,"$3,747.50",$0.00,"$1,873.75","$2,968.02","$2,998.00",$0.00,$586.48,$0.00,$596.60,$0.00
PL-PHSR,SUP,HCPCS C1713,,PL-PHSR  -  PLATE SM TI PLRS BONE RIGHT PROX HUM NONSTRL,"$3,747.50",$0.00,"$3,747.50","$1,686.38","$2,674.59",$0.00,$645.68,$0.00,$0.00,$656.16,"$3,747.50",$0.00,"$1,873.75","$2,968.02","$2,998.00",$0.00,$586.48,$0.00,$596.60,$0.00
PL-PHXGL,SUP,HCPCS C1713,,PL-PHXGL  -  PLATE XLNG TI PLRS BONE LEFT PROX HUM NONSTRL,"$3,747.50",$0.00,"$3,747.50","$1,686.38","$2,674.59",$0.00,$645.68,$0.00,$0.00,$656.16,"$3,747.50",$0.00,"$1,873.75","$2,968.02","$2,998.00",$0.00,$586.48,$0.00,$596.60,$0.00
PL-PHXGR,SUP,HCPCS C1713,,PL-PHXGR  -  PLATE XLNG TI PLRS BONE RIGHT PROX HUM,"$3,747.50",$0.00,"$3,747.50","$1,686.38","$2,674.59",$0.00,$645.68,$0.00,$0.00,$656.16,"$3,747.50",$0.00,"$1,873.75","$2,968.02","$2,998.00",$0.00,$586.48,$0.00,$596.60,$0.00
PL-PTACK,SUP,Custom 27803010,,PL-PTACK  -  HOLDER IMPL FRFT MIDFT TEMP FIX TACK PLT,$90.00,$0.00,$90.00,$0.00,$64.23,$0.00,$0.00,$0.00,$0.00,$0.00,$90.00,$0.00,$45.00,$71.28,$72.00,$0.00,$0.00,$0.00,$0.00,$0.00
PL-SA06L,SUP,HCPCS C1713,,PL-SA06L  -  PLATE BN NS 6 HL TI SCAPULAR LT ACROMION,"$3,592.50",$0.00,"$3,592.50","$1,616.63","$2,563.97",$0.00,$618.97,$0.00,$0.00,$629.02,"$3,592.50",$0.00,"$1,796.25","$2,845.26","$2,874.00",$0.00,$562.23,$0.00,$571.93,$0.00
PL-SA06R,SUP,HCPCS C1713,,PL-SA06R  -  PLATE BONE RIGHT ACROMION,"$3,592.50",$0.00,"$3,592.50","$1,616.63","$2,563.97",$0.00,$618.97,$0.00,$0.00,$629.02,"$3,592.50",$0.00,"$1,796.25","$2,845.26","$2,874.00",$0.00,$562.23,$0.00,$571.93,$0.00
PLS-AIM-0910,SUP,Custom 27203010,,"PLS-AIM-0910  -  GUIDE PLS AIMING, .9MM X 10?",$110.00,$0.00,$110.00,$0.00,$78.51,$0.00,$0.00,$0.00,$0.00,$0.00,$110.00,$0.00,$55.00,$87.12,$88.00,$0.00,$0.00,$0.00,$0.00,$0.00
PL-SG04L,SUP,HCPCS C1713,,PL-SG04L  -  PLATE 4 HOLE BONE LEFT GLND SCAPULA STRL,"$2,690.00",$0.00,"$2,690.00","$1,210.50","$1,919.85",$0.00,$463.47,$0.00,$0.00,$471.00,"$2,690.00",$0.00,"$1,345.00","$2,130.48","$2,152.00",$0.00,$420.99,$0.00,$428.25,$0.00
PL-SG04R,SUP,HCPCS C1713,,PL-SG04R  -  PLATE 4 HOLE BONE RIGHT GLND SCAPULA NONSTRL,"$2,690.00",$0.00,"$2,690.00","$1,210.50","$1,919.85",$0.00,$463.47,$0.00,$0.00,$471.00,"$2,690.00",$0.00,"$1,345.00","$2,130.48","$2,152.00",$0.00,$420.99,$0.00,$428.25,$0.00
PLSL3012,SUP,HCPCS C1713,,PLSL3012  -  SCREW BN T8 3MM 12MM BLU NS ANCHORAGE TX HD LCK TI FT/ANKL,$522.60,$0.00,$522.60,$235.17,$372.98,$0.00,$90.04,$0.00,$0.00,$91.50,$522.60,$0.00,$261.30,$413.90,$418.08,$0.00,$81.79,$0.00,$83.20,$0.00
PLSL3016,SUP,HCPCS C1713,,PLSL3016  -  SCREW BN T8 3MM 16MM BLU NS ANCHORAGE TX HD LCK TI FT/ANKL,$522.60,$0.00,$522.60,$235.17,$372.98,$0.00,$90.04,$0.00,$0.00,$91.50,$522.60,$0.00,$261.30,$413.90,$418.08,$0.00,$81.79,$0.00,$83.20,$0.00
PLSL3516,SUP,HCPCS C1713,,PLSL3516  -  SCREW BN T8 3.5MM 16MM YLW NS ANCHORAGE TX HD LCK TI FT/ANKL,$522.60,$0.00,$522.60,$235.17,$372.98,$0.00,$90.04,$0.00,$0.00,$91.50,$522.60,$0.00,$261.30,$413.90,$418.08,$0.00,$81.79,$0.00,$83.20,$0.00
PLSL3518,SUP,HCPCS C1713,,PLSL3518  -  SCREW BN T8 3.5MM 18MM YLW NS ANCHORAGE TX HD LCK TI FT/ANKL,$522.60,$0.00,$522.60,$235.17,$372.98,$0.00,$90.04,$0.00,$0.00,$91.50,$522.60,$0.00,$261.30,$413.90,$418.08,$0.00,$81.79,$0.00,$83.20,$0.00
PLSL3530,SUP,HCPCS C1713,,PLSL3530  -  SCREW BN T8 3.5MM 30MM YLW NS ANCHORAGE TX HD LCK TI FT/ANKL,$522.60,$0.00,$522.60,$235.17,$372.98,$0.00,$90.04,$0.00,$0.00,$91.50,$522.60,$0.00,$261.30,$413.90,$418.08,$0.00,$81.79,$0.00,$83.20,$0.00
PL-SLB10L,SUP,HCPCS C1713,,PL-SLB10L  -  PLATE BN 10 HL LT SCAPULA LAT,"$4,570.00",$0.00,"$4,570.00","$2,056.50","$3,261.61",$0.00,$787.39,$0.00,$0.00,$800.17,"$4,570.00",$0.00,"$2,285.00","$3,619.44","$3,656.00",$0.00,$715.21,$0.00,$727.54,$0.00
PL-SLB10R,SUP,HCPCS C1713,,PL-SLB10R  -  PLATE 10 HOLE BONE SCAPULAR,"$4,570.00",$0.00,"$4,570.00","$2,056.50","$3,261.61",$0.00,$787.39,$0.00,$0.00,$800.17,"$4,570.00",$0.00,"$2,285.00","$3,619.44","$3,656.00",$0.00,$715.21,$0.00,$727.54,$0.00
PL-SMB09L,SUP,HCPCS C1713,,PL-SMB09L  -  PLATE BN 9 HL MED LT SCAPULA,"$4,235.00",$0.00,"$4,235.00","$1,905.75","$3,022.52",$0.00,$729.67,$0.00,$0.00,$741.51,"$4,235.00",$0.00,"$2,117.50","$3,354.12","$3,388.00",$0.00,$662.78,$0.00,$674.21,$0.00
PL-SMB09R,SUP,HCPCS C1713,,PL-SMB09R  -  PLATE 9 HOLE BRDR BONE RIGHT MDL SCAPULA NONSTRL,"$4,235.00",$0.00,"$4,235.00","$1,905.75","$3,022.52",$0.00,$729.67,$0.00,$0.00,$741.51,"$4,235.00",$0.00,"$2,117.50","$3,354.12","$3,388.00",$0.00,$662.78,$0.00,$674.21,$0.00
PL-SMB13L,SUP,HCPCS C1713,,PL-SMB13L  -  PLATE 13 HOLE BRDR BONE LEFT MDL SCAPULA,"$4,570.00",$0.00,"$4,570.00","$2,056.50","$3,261.61",$0.00,$787.39,$0.00,$0.00,$800.17,"$4,570.00",$0.00,"$2,285.00","$3,619.44","$3,656.00",$0.00,$715.21,$0.00,$727.54,$0.00
PL-SMB13R,SUP,HCPCS C1713,,PL-SMB13R  -  PLATE 13 HOLE BRDR LCK BONE RIGHT MDL SCAPULAR NONSTRL,"$4,570.00",$0.00,"$4,570.00","$2,056.50","$3,261.61",$0.00,$787.39,$0.00,$0.00,$800.17,"$4,570.00",$0.00,"$2,285.00","$3,619.44","$3,656.00",$0.00,$715.21,$0.00,$727.54,$0.00
PL-SR27,SUP,Custom 27203010,,PL-SR27  -  REAMER SRG MN FSN PLT SLV WRST,$270.00,$0.00,$270.00,$0.00,$192.70,$0.00,$0.00,$0.00,$0.00,$0.00,$270.00,$0.00,$135.00,$213.84,$216.00,$0.00,$0.00,$0.00,$0.00,$0.00
PL-SR29,SUP,HCPCS C1776,,PL-SR29  -  HEAD RMR MN WRST FSN PLT,$552.50,$0.00,$552.50,$248.63,$394.32,$0.00,$95.19,$0.00,$0.00,$96.74,$552.50,$0.00,$276.25,$437.58,$442.00,$0.00,$86.47,$0.00,$87.96,$0.00
PL-SR30,SUP,Custom 27203010,,PL-SR30  -  REAMER SRG MN ASMB,"$1,690.00",$0.00,"$1,690.00",$0.00,"$1,206.15",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,690.00",$0.00,$845.00,"$1,338.48","$1,352.00",$0.00,$0.00,$0.00,$0.00,$0.00
PL-SR38,SUP,HCPCS C1776,,PL-SR38  -  HEAD RMR NS HBCP SHFT HND WRST,$587.50,$0.00,$587.50,$264.38,$419.30,$0.00,$101.22,$0.00,$0.00,$102.87,$587.50,$0.00,$293.75,$465.30,$470.00,$0.00,$91.94,$0.00,$93.53,$0.00
PL-SR39,SUP,HCPCS C1776,,PL-SR39  -  HEAD RMR HBCP WRST FSN PLT,$630.00,$0.00,$630.00,$283.50,$449.63,$0.00,$108.55,$0.00,$0.00,$110.31,$630.00,$0.00,$315.00,$498.96,$504.00,$0.00,$98.60,$0.00,$100.30,$0.00
PL-SR41,SUP,Custom 27203010,,PL-SR41  -  WRENCH SRG RMR HD HUB CAP,$270.00,$0.00,$270.00,$0.00,$192.70,$0.00,$0.00,$0.00,$0.00,$0.00,$270.00,$0.00,$135.00,$213.84,$216.00,$0.00,$0.00,$0.00,$0.00,$0.00
PLSS3016,SUP,HCPCS C1713,,PLSS3016  -  SCREW BN STD T8 3MM 16MM BLU NS ANCHORAGE TX HD TI FT/ANKL,$358.80,$0.00,$358.80,$161.46,$256.08,$0.00,$61.82,$0.00,$0.00,$62.82,$358.80,$0.00,$179.40,$284.17,$287.04,$0.00,$56.15,$0.00,$57.12,$0.00
PLSS3018,SUP,HCPCS C1713,,PLSS3018  -  SCREW BN STD T8 3MM 18MM BLU NS ANCHORAGE TX HD TI FT/ANKL,$358.80,$0.00,$358.80,$161.46,$256.08,$0.00,$61.82,$0.00,$0.00,$62.82,$358.80,$0.00,$179.40,$284.17,$287.04,$0.00,$56.15,$0.00,$57.12,$0.00
PLSS3020,SUP,HCPCS C1713,,PLSS3020  -  SCREW BN STD T8 3MM 20MM BLU NS ANCHORAGE TX HD TI FT/ANKL,$525.00,$0.00,$525.00,$236.25,$374.69,$0.00,$90.45,$0.00,$0.00,$91.92,$525.00,$0.00,$262.50,$415.80,$420.00,$0.00,$82.16,$0.00,$83.58,$0.00
PLSS3022,SUP,HCPCS C1713,,PLSS3022  -  SCREW BN STD T8 3MM 22MM BLU NS ANCHORAGE TX HD TI FT/ANKL,$358.80,$0.00,$358.80,$161.46,$256.08,$0.00,$61.82,$0.00,$0.00,$62.82,$358.80,$0.00,$179.40,$284.17,$287.04,$0.00,$56.15,$0.00,$57.12,$0.00
PLSS3024,SUP,HCPCS C1713,,PLSS3024  -  SCREW BN STD T8 3MM 24MM BLU NS ANCHORAGE TX HD TI FT/ANKL,$358.80,$0.00,$358.80,$161.46,$256.08,$0.00,$61.82,$0.00,$0.00,$62.82,$358.80,$0.00,$179.40,$284.17,$287.04,$0.00,$56.15,$0.00,$57.12,$0.00
PLSS3026,SUP,HCPCS C1713,,PLSS3026  -  SCREW BN STD T8 3MM 26MM BLU NS ANCHORAGE TX HD TI FT/ANKL,$358.80,$0.00,$358.80,$161.46,$256.08,$0.00,$61.82,$0.00,$0.00,$62.82,$358.80,$0.00,$179.40,$284.17,$287.04,$0.00,$56.15,$0.00,$57.12,$0.00
PLSS3028,SUP,HCPCS C1713,,PLSS3028  -  SCREW BN STD T8 3MM 28MM BLU NS ANCHORAGE TX HD TI FT/ANKL,$358.80,$0.00,$358.80,$161.46,$256.08,$0.00,$61.82,$0.00,$0.00,$62.82,$358.80,$0.00,$179.40,$284.17,$287.04,$0.00,$56.15,$0.00,$57.12,$0.00
PLSS3514,SUP,HCPCS C1713,,PLSS3514  -  SCREW BN STD T8 3.5MM 14MM YLW NS ANCHORAGE TX HD TI FT/ANKL,$358.80,$0.00,$358.80,$161.46,$256.08,$0.00,$61.82,$0.00,$0.00,$62.82,$358.80,$0.00,$179.40,$284.17,$287.04,$0.00,$56.15,$0.00,$57.12,$0.00
PLSS3516,SUP,HCPCS C1713,,PLSS3516  -  SCREW BN STD T8 3.5MM 16MM YLW NS ANCHORAGE TX HD TI FT/ANKL,$358.80,$0.00,$358.80,$161.46,$256.08,$0.00,$61.82,$0.00,$0.00,$62.82,$358.80,$0.00,$179.40,$284.17,$287.04,$0.00,$56.15,$0.00,$57.12,$0.00
PLSS3520,SUP,HCPCS C1713,,PLSS3520  -  SCREW BN STD T8 3.5MM 20MM YLW NS ANCHORAGE TX HD TI FT/ANKL,$358.80,$0.00,$358.80,$161.46,$256.08,$0.00,$61.82,$0.00,$0.00,$62.82,$358.80,$0.00,$179.40,$284.17,$287.04,$0.00,$56.15,$0.00,$57.12,$0.00
PLSS3522,SUP,HCPCS C1713,,PLSS3522  -  SCREW BN STD T8 3.5MM 22MM YLW NS ANCHORAGE TX HD TI FT/ANKL,$358.80,$0.00,$358.80,$161.46,$256.08,$0.00,$61.82,$0.00,$0.00,$62.82,$358.80,$0.00,$179.40,$284.17,$287.04,$0.00,$56.15,$0.00,$57.12,$0.00
PLSS3526,SUP,HCPCS C1713,,PLSS3526  -  SCREW BN STD T8 3.5MM 26MM YLW NS ANCHORAGE TX HD TI FT/ANKL,$358.80,$0.00,$358.80,$161.46,$256.08,$0.00,$61.82,$0.00,$0.00,$62.82,$358.80,$0.00,$179.40,$284.17,$287.04,$0.00,$56.15,$0.00,$57.12,$0.00
PLSS3532,SUP,HCPCS C1713,,PLSS3532  -  SCREW BN STD T8 3.5MM 32MM YLW NS ANCHORAGE TX HD TI FT/ANKL,$358.80,$0.00,$358.80,$161.46,$256.08,$0.00,$61.82,$0.00,$0.00,$62.82,$358.80,$0.00,$179.40,$284.17,$287.04,$0.00,$56.15,$0.00,$57.12,$0.00
PLT-1030,SUP,HCPCS C1713,,PLT-1030  -  PLATE MAXFACL 7X7 HOLE MESH BIODEG 1.5 MM SCR BONE CPS TI,"$2,833.13",$0.00,"$2,833.13","$1,274.91","$2,022.00",$0.00,$488.13,$0.00,$0.00,$496.06,"$2,833.13",$0.00,"$1,416.56","$2,243.84","$2,266.50",$0.00,$443.38,$0.00,$451.03,$0.00
PL-TACK2,SUP,HCPCS C1713,,PL-TACK2  -  PLATE BN 3.75IN TEMP,$90.00,$0.00,$90.00,$40.50,$64.23,$0.00,$15.51,$0.00,$0.00,$15.76,$90.00,$0.00,$45.00,$71.28,$72.00,$0.00,$14.09,$0.00,$14.33,$0.00
PL-TIBAM,SUP,HCPCS C1713,,PL-TIBAM  -  PLATE TI BONE ANT MLR NONSTRL,"$1,017.50",$0.00,"$1,017.50",$457.88,$726.19,$0.00,$175.31,$0.00,$0.00,$178.16,"$1,017.50",$0.00,$508.75,$805.86,$814.00,$0.00,$159.24,$0.00,$161.99,$0.00
PL-TIBMM,SUP,HCPCS C1713,,PL-TIBMM  -  PLATE TI BONE MDL MLR NONSTRL,"$1,017.50",$0.00,"$1,017.50",$457.88,$726.19,$0.00,$175.31,$0.00,$0.00,$178.16,"$1,017.50",$0.00,$508.75,$805.86,$814.00,$0.00,$159.24,$0.00,$161.99,$0.00
PL-TMT14,SUP,HCPCS C1713,,PL-TMT14  -  PLATE TI 4 HOLE CNGR BONE MIDFT NONSTRL,"$1,222.50",$0.00,"$1,222.50",$550.13,$872.50,$0.00,$210.63,$0.00,$0.00,$214.05,"$1,222.50",$0.00,$611.25,$968.22,$978.00,$0.00,$191.32,$0.00,$194.62,$0.00
PL-TMT24,SUP,HCPCS C1713,,PL-TMT24  -  PLATE CNGR BONE MIDFT NONSTRL,"$1,222.50",$0.00,"$1,222.50",$550.13,$872.50,$0.00,$210.63,$0.00,$0.00,$214.05,"$1,222.50",$0.00,$611.25,$968.22,$978.00,$0.00,$191.32,$0.00,$194.62,$0.00
PL-TMT5,SUP,HCPCS C1713,,PL-TMT5  -  PLATE TI 5 HOLE BONE TARSOMETATARSAL NONSTRL,"$1,222.50",$0.00,"$1,222.50",$550.13,$872.50,$0.00,$210.63,$0.00,$0.00,$214.05,"$1,222.50",$0.00,$611.25,$968.22,$978.00,$0.00,$191.32,$0.00,$194.62,$0.00
PL-UL06,SUP,HCPCS C1713,,PL-UL06  -  PLATE BN SHRT STRL 6 HL TI ULNA OSTM,"$1,790.00",$0.00,"$1,790.00",$805.50,"$1,277.52",$0.00,$308.41,$0.00,$0.00,$313.41,"$1,790.00",$0.00,$895.00,"$1,417.68","$1,432.00",$0.00,$280.14,$0.00,$284.97,$0.00
PL-UL06-S,SUP,HCPCS C1713,,PL-UL06-S  -  PLATE TI 6 HOLE SHTNG ACUMED BONE WRST ULN HAND STRL,"$1,790.00",$0.00,"$1,790.00",$805.50,"$1,277.52",$0.00,$308.41,$0.00,$0.00,$313.41,"$1,790.00",$0.00,$895.00,"$1,417.68","$1,432.00",$0.00,$280.14,$0.00,$284.97,$0.00
PL-VO47,SUP,HCPCS C1713,,PL-VO47  -  PLATE 47MM TI BONE VOLR RADL NONSTRL,"$1,020.00",$0.00,"$1,020.00",$459.00,$727.97,$0.00,$175.74,$0.00,$0.00,$178.59,"$1,020.00",$0.00,$510.00,$807.84,$816.00,$0.00,$159.63,$0.00,$162.38,$0.00
PL-VO60,SUP,HCPCS C1713,,PL-VO60  -  PLATE 60MM TI BONE VOLR RADL NONSTRL,"$1,020.00",$0.00,"$1,020.00",$459.00,$727.97,$0.00,$175.74,$0.00,$0.00,$178.59,"$1,020.00",$0.00,$510.00,$807.84,$816.00,$0.00,$159.63,$0.00,$162.38,$0.00
PLVW-14.0-38,SUP,HCPCS C1892,,PLVW-14.0-38  -  SET INTROD 15.5CM 14FR PLWY PERC STRL DISP,$104.40,$0.00,$104.40,$56.69,$74.51,$0.00,$17.99,$0.00,$0.00,$18.28,$104.40,$0.00,$52.20,$82.68,$83.52,$0.00,$16.34,$0.00,$16.62,$0.00
PL-WF33,SUP,HCPCS C1713,,PL-WF33  -  PLATE BN MN NS HBCP 3 CRNR FSN TI WRST,"$2,047.50",$0.00,"$2,047.50",$921.38,"$1,461.30",$0.00,$352.77,$0.00,$0.00,$358.50,"$2,047.50",$0.00,"$1,023.75","$1,621.62","$1,638.00",$0.00,$320.43,$0.00,$325.96,$0.00
PL-WF40,SUP,HCPCS C1713,,PL-WF40  -  PLATE BN NS HBCP TI WRST,"$2,047.50",$0.00,"$2,047.50",$921.38,"$1,461.30",$0.00,$352.77,$0.00,$0.00,$358.50,"$2,047.50",$0.00,"$1,023.75","$1,621.62","$1,638.00",$0.00,$320.43,$0.00,$325.96,$0.00
PL-WF44,SUP,HCPCS C1713,,PL-WF44  -  PLATE MINI TI 4 CRNR FSN HBCP BONE WRST NONSTRL,"$2,047.50",$0.00,"$2,047.50",$921.38,"$1,461.30",$0.00,$352.77,$0.00,$0.00,$358.50,"$2,047.50",$0.00,"$1,023.75","$1,621.62","$1,638.00",$0.00,$320.43,$0.00,$325.96,$0.00
PL-WF50,SUP,HCPCS C1713,,PL-WF50  -  PLATE TI FSN POST HBCP BONE WRST,$82.50,$0.00,$82.50,$37.13,$58.88,$0.00,$14.21,$0.00,$0.00,$14.45,$82.50,$0.00,$41.25,$65.34,$66.00,$0.00,$12.91,$0.00,$13.13,$0.00
PL-WF60,SUP,HCPCS C1713,,PL-WF60  -  PLATE TI SCR HBCP BONE WRST NONSTRL,$237.50,$0.00,$237.50,$106.88,$169.50,$0.00,$40.92,$0.00,$0.00,$41.58,$237.50,$0.00,$118.75,$188.10,$190.00,$0.00,$37.17,$0.00,$37.81,$0.00
PM010-A,SUP,Custom 27200555,,PM010-A  -  KIT DRUG DELIVERY 3.5IN 2.5IN CATHETER ANTIMICROBIAL NEEDLE,$23.00,$0.00,$23.00,$0.00,$16.42,$0.00,$0.00,$0.00,$0.00,$0.00,$23.00,$0.00,$11.50,$18.22,$18.40,$0.00,$0.00,$0.00,$0.00,$0.00
PM020,SUP,Custom 27200555,,PM020  -  SYSTEM DRG DLV ONQ PNBSTR SKR XPD KIT CATH TPL NDL 5IN 6IN,$154.50,$0.00,$154.50,$0.00,$110.27,$0.00,$0.00,$0.00,$0.00,$0.00,$154.50,$0.00,$77.25,$122.36,$123.60,$0.00,$0.00,$0.00,$0.00,$0.00
PM020-A,SUP,Custom 27200555,,PM020-A  -  SYSTEM DRG DLV T 5IN 6IN ONQ PNBSTR SLSKR TPL XPD CATH NDL,$29.50,$0.00,$29.50,$0.00,$21.05,$0.00,$0.00,$0.00,$0.00,$0.00,$29.50,$0.00,$14.75,$23.36,$23.60,$0.00,$0.00,$0.00,$0.00,$0.00
PM040-A,SUP,Custom 27200555,,PM040-A  -  SYSTEM DRG DLV ONQ SLSKR CATH XPD KIT TPL NDL 10IN 8IN,$375.00,$0.00,$375.00,$0.00,$267.64,$0.00,$0.00,$0.00,$0.00,$0.00,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$0.00,$0.00,$0.00,$0.00
PM1110,SUP,HCPCS C1786,,PM1110  -  PACEMAKER CRD THK6MM 52X42MM 9.5ML ACT 1 CHMBR IS-1 CNCT PLS,"$7,425.00",$0.00,"$7,425.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,425.00",$0.00,"$3,712.50","$5,880.60","$5,940.00",$0.00,$0.00,$0.00,$0.00,$0.00
PM1210,SUP,HCPCS C1785,,PM1210  -  PACEMAKER CRD THK6MM 52X52MM 12.8ML ACT 1 CHMBR IS-1 CNCT RF,"$8,775.00",$0.00,"$8,775.00","$3,948.75","$5,158.80",$0.00,"$1,511.89",$0.00,$0.00,"$1,536.43","$8,775.00",$0.00,"$4,387.50","$6,949.80","$7,020.00",$0.00,"$1,373.29",$0.00,"$1,396.98",$0.00
PM2110,SUP,HCPCS C1785,,PM2110  -  PACEMAKER CRD THK6MM 52X46MM 10.5CC ACT 2 CHMBR IS-1 CNCT,"$8,550.00",$0.00,"$8,550.00","$3,847.50","$5,158.80",$0.00,"$1,473.12",$0.00,$0.00,"$1,497.04","$8,550.00",$0.00,"$4,275.00","$6,771.60","$6,840.00",$0.00,"$1,338.08",$0.00,"$1,361.16",$0.00
PM2210,SUP,HCPCS C1785,,PM2210  -  PACEMAKER CARDIAC THK6MM 52X52MM 2 CHAMBER INDUCTIVE,"$10,575.00",$0.00,"$10,575.00","$4,758.75","$5,158.80",$0.00,"$1,822.02",$0.00,$0.00,"$1,851.60","$10,575.00",$0.00,"$5,287.50","$8,375.40","$8,460.00",$0.00,"$1,654.99",$0.00,"$1,683.54",$0.00
PM3210,SUP,HCPCS C2621,,PM3210  -  PACEMAKER CRD THK6MM 58X52MM 13.7ML ANTHEM RF 2 CHMBR IS-1,"$14,750.00",$0.00,"$14,750.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$14,750.00",$0.00,"$7,375.00","$11,682.00","$11,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
PMG-18SP-60-COPE,SUP,HCPCS C1769,,PMG-18SP-60-COPE  -  GWIRE VASC .018IN 60CM 7CM ANG SFT CP MDRL SS STRL DISP,$82.39,$0.00,$82.39,$44.74,$58.80,$0.00,$14.19,$0.00,$0.00,$14.43,$82.39,$0.00,$41.19,$65.25,$65.91,$0.00,$12.89,$0.00,$13.12,$0.00
PMH,SUP,HCPCS C1781,,PMH  -  MESH SURG FLAT 6X6IN KNIT NONABSORBABLE NONREACTIVE PROLENE,$167.34,$0.00,$167.34,$75.30,$119.43,$0.00,$28.83,$0.00,$0.00,$29.30,$167.34,$0.00,$83.67,$132.53,$133.87,$0.00,$26.19,$0.00,$26.64,$0.00
PMII,SUP,HCPCS C1781,,PMII  -  MESH SURG FLAT 6X3IN KNIT NONABSORBABLE NONREACTIVE LATEX,$151.22,$0.00,$151.22,$68.05,$107.93,$0.00,$26.05,$0.00,$0.00,$26.48,$151.22,$0.00,$75.61,$119.77,$120.98,$0.00,$23.67,$0.00,$24.07,$0.00
PML,SUP,HCPCS C1781,,PML  -  MESH SURG FLAT 12X12IN KNIT MONOFILAMENT SOFT PROLENE,$379.86,$0.00,$379.86,$170.93,$271.10,$0.00,$65.45,$0.00,$0.00,$66.51,$379.86,$0.00,$189.93,$300.85,$303.88,$0.00,$59.45,$0.00,$60.47,$0.00
PMXS,SUP,HCPCS C1781,,PMXS  -  MESH SURG FLAT 4X1IN KNIT NONABSORBABLE NONREACTIVE PROLENE,$117.33,$0.00,$117.33,$52.80,$83.74,$0.00,$20.22,$0.00,$0.00,$20.54,$117.33,$0.00,$58.66,$92.93,$93.86,$0.00,$18.36,$0.00,$18.68,$0.00
PN-152836002,SUP,Custom 27203010,,PN-152836002  -  CONCTR EKG ATR VNTRC ASMBLY,$45.05,$0.00,$45.05,$0.00,$32.15,$0.00,$0.00,$0.00,$0.00,$0.00,$45.05,$0.00,$22.53,$35.68,$36.04,$0.00,$0.00,$0.00,$0.00,$0.00
PND6F070956,SUP,HCPCS C1757,,PND6F070956  -  CATHETER DELIVERY SYSTEM STR 6FR .07IN 95CM 6CM LUMEN,"$1,587.50",$0.00,"$1,587.50",$0.00,"$1,133.00",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,587.50",$0.00,$793.75,"$1,257.30","$1,270.00",$0.00,$0.00,$0.00,$0.00,$0.00
PND6F1056,SUP,HCPCS C1757,,PND6F1056  -  CATHETER DELIVERY SYSTEM .035IN .038IN 6FR .053IN 105CM 6CM,"$1,587.50",$0.00,"$1,587.50",$0.00,"$1,133.00",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,587.50",$0.00,$793.75,"$1,257.30","$1,270.00",$0.00,$0.00,$0.00,$0.00,$0.00
PND6F1156,SUP,HCPCS C1757,,PND6F1156  -  CATHETER DELIVERY SYSTEM .035IN .038IN STR 6FR .053IN 115CM,"$1,587.50",$0.00,"$1,587.50",$0.00,"$1,133.00",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,587.50",$0.00,$793.75,"$1,257.30","$1,270.00",$0.00,$0.00,$0.00,$0.00,$0.00
PNG220,SUP,HCPCS C9352,,PNG220  -  GUIDE NERVE 2MM 2CM RESORB BIOCOMPATIBLE SEMIPERMEABLE TUBE,"$3,125.68",$0.00,"$3,125.68",$0.00,"$2,230.79",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,125.68",$0.00,"$1,562.84","$2,475.54","$2,500.54",$0.00,$0.00,$0.00,$0.00,$0.00
PNG230,SUP,HCPCS C9352,,PNG230  -  GUIDE NERVE 2MM 3CM SEMIPERMEABLE NEURAGEN COLLAGEN MATRIX,"$4,202.28",$0.00,"$4,202.28",$0.00,"$2,999.16",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,202.28",$0.00,"$2,101.14","$3,328.21","$3,361.82",$0.00,$0.00,$0.00,$0.00,$0.00
PNG320,SUP,HCPCS C9352,,PNG320  -  GUIDE NERVE 3MM 2CM RESORB BIOCOMPATIBLE SEMIPERMEABLE TUBE,"$3,125.68",$0.00,"$3,125.68",$0.00,"$2,230.79",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,125.68",$0.00,"$1,562.84","$2,475.54","$2,500.54",$0.00,$0.00,$0.00,$0.00,$0.00
PNG-320,SUP,HCPCS C9352,,PNG-320  -  GUIDE NERVE 3MM 2CM RESORB BIOCOMPATIBLE SEMIPERMEABLE TUBE,"$3,125.68",$0.00,"$3,125.68",$0.00,"$2,230.79",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,125.68",$0.00,"$1,562.84","$2,475.54","$2,500.54",$0.00,$0.00,$0.00,$0.00,$0.00
PNG330,SUP,HCPCS C9352,,PNG330  -  GUIDE NERVE 3MM 3CM FLEXIBLE ABSORBABLE TUBE BIOCOMPATIBLE,"$4,202.28",$0.00,"$4,202.28",$0.00,"$2,999.16",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,202.28",$0.00,"$2,101.14","$3,328.21","$3,361.82",$0.00,$0.00,$0.00,$0.00,$0.00
PNG420,SUP,HCPCS C9352,,PNG420  -  GUIDE NERVE 4MM 2CM RESORB BIOCOMPATIBLE SEMIPERMEABLE TUBE,"$3,125.68",$0.00,"$3,125.68",$0.00,"$2,230.79",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,125.68",$0.00,"$1,562.84","$2,475.54","$2,500.54",$0.00,$0.00,$0.00,$0.00,$0.00
PNG430,SUP,HCPCS C9352,,PNG430  -  GUIDE NERVE 4MM 3CM FLEXIBLE ABSORBABLE TUBE BIOCOMPATIBLE,"$4,202.28",$0.00,"$4,202.28",$0.00,"$2,999.16",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,202.28",$0.00,"$2,101.14","$3,328.21","$3,361.82",$0.00,$0.00,$0.00,$0.00,$0.00
PNG520,SUP,HCPCS C9352,,PNG520  -  GUIDE NERVE 5MM 2CM RESORB BIOCOMPATIBLE SEMIPERMEABLE TUBE,"$3,125.68",$0.00,"$3,125.68",$0.00,"$2,230.79",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,125.68",$0.00,"$1,562.84","$2,475.54","$2,500.54",$0.00,$0.00,$0.00,$0.00,$0.00
PNG-520,SUP,HCPCS C9352,,PNG-520  -  GUIDE NERVE 5MM 2CM RESORB BIOCOMPATIBLE SEMIPERMEABLE TUBE,"$3,125.68",$0.00,"$3,125.68",$0.00,"$2,230.79",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,125.68",$0.00,"$1,562.84","$2,475.54","$2,500.54",$0.00,$0.00,$0.00,$0.00,$0.00
PNG530,SUP,HCPCS C9352,,PNG530  -  GUIDE NERVE 5MM 3CM FLEXIBLE ABSORBABLE TUBE NEURAGEN,"$4,202.28",$0.00,"$4,202.28",$0.00,"$2,999.16",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,202.28",$0.00,"$2,101.14","$3,328.21","$3,361.82",$0.00,$0.00,$0.00,$0.00,$0.00
PNG620,SUP,HCPCS C9352,,PNG620  -  GUIDE NERVE 6MM 2CM NEURAGEN PERIPHERAL,"$3,125.68",$0.00,"$3,125.68",$0.00,"$2,230.79",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,125.68",$0.00,"$1,562.84","$2,475.54","$2,500.54",$0.00,$0.00,$0.00,$0.00,$0.00
PNG-620,SUP,HCPCS C9352,,PNG-620  -  GUIDE NERVE 6MM 2CM NEURAGEN PERIPHERAL,"$3,125.68",$0.00,"$3,125.68",$0.00,"$2,230.79",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,125.68",$0.00,"$1,562.84","$2,475.54","$2,500.54",$0.00,$0.00,$0.00,$0.00,$0.00
PNG630,SUP,HCPCS C9352,,PNG630  -  GUIDE NERVE 6MM 3CM FLEXIBLE ABSORBABLE TUBE BIOCOMPATIBLE,"$4,202.28",$0.00,"$4,202.28",$0.00,"$2,999.16",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,202.28",$0.00,"$2,101.14","$3,328.21","$3,361.82",$0.00,$0.00,$0.00,$0.00,$0.00
PNG720,SUP,HCPCS C9352,,PNG720  -  GUIDE NERVE 7MM 2CM RESORB BIOCOMPATIBLE SEMIPERMEABLE TUBE,"$3,125.68",$0.00,"$3,125.68",$0.00,"$2,230.79",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,125.68",$0.00,"$1,562.84","$2,475.54","$2,500.54",$0.00,$0.00,$0.00,$0.00,$0.00
PNG-720,SUP,HCPCS C9352,,PNG-720  -  GUIDE NERVE 7MM 2CM RESORB BIOCOMPATIBLE SEMIPERMEABLE TUBE,"$3,125.68",$0.00,"$3,125.68",$0.00,"$2,230.79",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,125.68",$0.00,"$1,562.84","$2,475.54","$2,500.54",$0.00,$0.00,$0.00,$0.00,$0.00
PNG730,SUP,HCPCS C9352,,PNG730  -  GUIDE NERVE 7MM 3CM EXCELLENT HANDLING SEMIPERMEABLE SIMPLE,"$4,202.28",$0.00,"$4,202.28",$0.00,"$2,999.16",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,202.28",$0.00,"$2,101.14","$3,328.21","$3,361.82",$0.00,$0.00,$0.00,$0.00,$0.00
PNML6F088904M,SUP,HCPCS C1892,,PNML6F088904M  -  SHEATH INTRO LNG MP CRV 6FR 8FR .088IN 90CM 4CM NEURON MXSS,"$1,137.50",$0.00,"$1,137.50",$617.66,$811.83,$0.00,$195.99,$0.00,$0.00,$199.17,"$1,137.50",$0.00,$568.75,$900.90,$910.00,$0.00,$178.02,$0.00,$181.09,$0.00
PNS5F120BER,SUP,HCPCS C1757,,PNS5F120BER  -  CATH THRMB 120CM 5FR .4IN NEURON SLCT .035IN .038IN BER,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
PP17/10,SUP,HCPCS C1894,,DEVICE 17GA 10CM ECHTP COAX THNWL PP INTROD BIOP,$33.88,$0.00,$33.88,$18.39,$24.18,$0.00,$5.84,$0.00,$0.00,$5.93,$33.88,$0.00,$16.94,$26.83,$27.10,$0.00,$5.30,$0.00,$5.39,$0.00
PP1715,SUP,HCPCS C1894,,DEVICE 17GA 15CM ECHTP COAX THNWL PP INTROD BIOP,$40.50,$0.00,$40.50,$21.99,$28.90,$0.00,$6.98,$0.00,$0.00,$7.09,$40.50,$0.00,$20.25,$32.08,$32.40,$0.00,$6.34,$0.00,$6.45,$0.00
PP19/10,SUP,HCPCS C1894,,DEVICE 19GA 10CM ECHTP COAX THNWL PP INTROD BIOP,$33.75,$0.00,$33.75,$18.33,$24.09,$0.00,$5.81,$0.00,$0.00,$5.91,$33.75,$0.00,$16.88,$26.73,$27.00,$0.00,$5.28,$0.00,$5.37,$0.00
PP1915,SUP,HCPCS C1894,,DEVICE 19GA 15CM ECHTP COAX THNWL PP INTROD BIOP,$33.75,$0.00,$33.75,$18.33,$24.09,$0.00,$5.81,$0.00,$0.00,$5.91,$33.75,$0.00,$16.88,$26.73,$27.00,$0.00,$5.28,$0.00,$5.37,$0.00
PP196,SUP,Custom 27203010,,NEEDLE BIOP 19GA 6CM ECHTP COAX THNWL PP INTROD,$37.43,$0.00,$37.43,$0.00,$26.71,$0.00,$0.00,$0.00,$0.00,$0.00,$37.43,$0.00,$18.71,$29.64,$29.94,$0.00,$0.00,$0.00,$0.00,$0.00
PP9031,SUP,Custom 27203010,,PP9031  -  KIT ESCP STRL LF PNPT PAQ DISP,"$1,487.50",$0.00,"$1,487.50",$0.00,"$1,061.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,487.50",$0.00,$743.75,"$1,178.10","$1,190.00",$0.00,$0.00,$0.00,$0.00,$0.00
PRE1001US.S,SUP,HCPCS A6212,,PRE1001US.S  -  UNIT THERAPEUTIC INCISION MANAGEMENT SYSTEM PEEL PLACE KIT,"$1,237.50",$0.00,"$1,237.50",$671.96,$883.20,$0.00,$9.12,$0.00,$0.00,$216.68,"$1,237.50",$0.00,$618.75,$980.10,$990.00,$0.00,$193.67,$0.00,$197.01,$0.00
PRE1101US,SUP,Custom 27011340,,PRE1101US  -  SYSTEM NEG PRSS 13CM PREVENA PEEL AND PLC PTCH,"$1,237.50",$0.00,"$1,237.50",$0.00,$883.20,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,237.50",$0.00,$618.75,$980.10,$990.00,$0.00,$0.00,$0.00,$0.00,$0.00
PRE2001US,SUP,Custom 27203010,,PRE2001US  -  KIT DRESSING 125 THERAPY UNIT CARRYING CASE CANISTER,"$1,487.50",$0.00,"$1,487.50",$0.00,"$1,061.63",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,487.50",$0.00,$743.75,"$1,178.10","$1,190.00",$0.00,$0.00,$0.00,$0.00,$0.00
PRE4001US,SUP,HCPCS C1713,,PRE4001US  -  SYSTEM NEG PRSS -125 MMHG 150ML PREVENA + VIS ADBL ALRM REPL,"$1,625.00",$0.00,"$1,625.00",$731.25,"$1,159.76",$0.00,$279.98,$0.00,$0.00,$284.52,"$1,625.00",$0.00,$812.50,"$1,287.00","$1,300.00",$0.00,$254.31,$0.00,$258.70,$0.00
PROTECTACRTDMMAM,SUP,HCPCS C1721,,PROTECTACRTDMMAM  -  PROTECTA CRT-D ADVANCED SYSTEM,"$60,500.00",$0.00,"$60,500.00","$27,225.00","$5,158.80",$0.00,"$8,138.89",$0.00,$0.00,"$8,138.89","$60,500.00",$0.00,"$30,250.00","$47,916.00","$48,400.00",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
PROTECTADRMMEM,SUP,HCPCS C1721,,PROTECTADRMMEM  -  PROTECTA DR SYSTEM (INCLUDING DF4 HEADER),"$49,812.50",$0.00,"$49,812.50","$22,415.63","$5,158.80",$0.00,"$8,138.89",$0.00,$0.00,"$8,138.89","$49,812.50",$0.00,"$24,906.25","$39,451.50","$39,850.00",$0.00,"$7,751.33",$0.00,"$7,930.15",$0.00
PROTECTAVREMEM,SUP,HCPCS C1721,,PROTECTAVREMEM  -  PROTECTA VR SYSTEM (INCLUDING DF4 HEADER),"$43,750.00",$0.00,"$43,750.00","$19,687.50","$5,158.80",$0.00,"$7,537.91",$0.00,$0.00,"$7,660.28","$43,750.00",$0.00,"$21,875.00","$34,650.00","$35,000.00",$0.00,"$6,846.88",$0.00,"$6,965.00",$0.00
PRT-FSP-DU,SUP,HCPCS C1713,,PRT-FSP-DU  -  PLATE BN PRTN FRAG ULNA DISTAL,"$2,190.00",$0.00,"$2,190.00",$985.50,"$1,563.00",$0.00,$377.33,$0.00,$0.00,$383.45,"$2,190.00",$0.00,"$1,095.00","$1,734.48","$1,752.00",$0.00,$342.74,$0.00,$348.65,$0.00
PRT-FSP-LR,SUP,HCPCS C1713,,PRT-FSP-LR  -  PLATE BN PRTN FRAG ULNA DIST DOUBLE HOCKEY STICK,"$1,970.00",$0.00,"$1,970.00",$886.50,"$1,405.99",$0.00,$339.42,$0.00,$0.00,$344.93,"$1,970.00",$0.00,$985.00,"$1,560.24","$1,576.00",$0.00,$308.31,$0.00,$313.62,$0.00
PRT-FSP-YS,SUP,HCPCS C1713,,PRT-FSP-YS  -  PLATE BN PRTN FRAG ULNA DIST Y,"$1,970.00",$0.00,"$1,970.00",$886.50,"$1,405.99",$0.00,$339.42,$0.00,$0.00,$344.93,"$1,970.00",$0.00,$985.00,"$1,560.24","$1,576.00",$0.00,$308.31,$0.00,$313.62,$0.00
PS11055,SUP,Custom 27803010,,PS11055  -  GRAFT SFT TIS 5X5CM GRFX PRM ALGRF PLCNT MEMBR,"$6,875.00",$0.00,"$6,875.00",$0.00,"$4,906.69",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,875.00",$0.00,"$3,437.50","$5,445.00","$5,500.00",$0.00,$0.00,$0.00,$0.00,$0.00
PS12055,SUP,Custom 27803010,,PS12055  -  GRAFT SFT TIS 5X5CM GRFX COR PLCNT MEMBR ALGRF,"$6,900.00",$0.00,"$6,900.00",$0.00,"$4,924.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,900.00",$0.00,"$3,450.00","$5,464.80","$5,520.00",$0.00,$0.00,$0.00,$0.00,$0.00
PS60005,SUP,Custom 27803010,,PS60005  -  GRAFT SFT TIS 4X2CM STRAVIX ALGRF PLCNT TISS,"$4,512.50",$0.00,"$4,512.50",$0.00,"$3,220.57",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,512.50",$0.00,"$2,256.25","$3,573.90","$3,610.00",$0.00,$0.00,$0.00,$0.00,$0.00
PS60008,SUP,Custom 27803010,,PS60008  -  GRAFT SFT TIS 6X3CM STRAVIX ALGRF PLCNT TISS,"$7,956.25",$0.00,"$7,956.25",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$7,956.25",$0.00,"$3,978.13","$6,301.35","$6,365.00",$0.00,$0.00,$0.00,$0.00,$0.00
PSC026,SUP,HCPCS C1757,,PSC026  -  CATHETER THROMBECTOMY 3.9-2.8FR .026IN 154CM 150CM,"$3,725.00",$0.00,"$3,725.00",$0.00,"$2,658.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,725.00",$0.00,"$1,862.50","$2,950.20","$2,980.00",$0.00,$0.00,$0.00,$0.00,$0.00
PSC041,SUP,HCPCS C1757,,PSC041  -  CATHETER THROMBECTOMY 4.1FR .041IN 141CM REPERFUSION,"$3,725.00",$0.00,"$3,725.00",$0.00,"$2,658.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,725.00",$0.00,"$1,862.50","$2,950.20","$2,980.00",$0.00,$0.00,$0.00,$0.00,$0.00
PSC054,SUP,HCPCS C1757,,PSC054  -  CATHETER THROMBECTOMY 6-5FR .054IN 132CM 136CM REPERFUSION,"$3,725.00",$0.00,"$3,725.00",$0.00,"$2,658.53",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,725.00",$0.00,"$1,862.50","$2,950.20","$2,980.00",$0.00,$0.00,$0.00,$0.00,$0.00
PSD 6002-UN,SUP,Custom 27203010,,PSD 6002-UN  -  STAPLER INTNL 60MM UNV 2 FRNG 1 GEL TUBE STRL LF DISP PRSTRP,$122.92,$0.00,$122.92,$0.00,$87.73,$0.00,$0.00,$0.00,$0.00,$0.00,$122.92,$0.00,$61.46,$97.35,$98.33,$0.00,$0.00,$0.00,$0.00,$0.00
PSD 6006-UV,SUP,Custom 27203010,,PSD 6006-UV  -  STAPLER INTNL STRL LF PRSTRP DR 6 FRNG GEL TUBE LNR VRTS,$67.99,$0.00,$67.99,$0.00,$48.52,$0.00,$0.00,$0.00,$0.00,$0.00,$67.99,$0.00,$33.99,$53.85,$54.39,$0.00,$0.00,$0.00,$0.00,$0.00
PSD 8006-UN,SUP,Custom 27203010,,PSD 8006-UN  -  STAPLER INTNL ENDSCP LNR CTR 6 FRNG PRSTRP DR,$350.00,$0.00,$350.00,$0.00,$249.80,$0.00,$0.00,$0.00,$0.00,$0.00,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$0.00,$0.00,$0.00,$0.00
PSE45A,SUP,Custom 27203010,,PSE45A  -  STAPLER INTERNAL 45MM 340MM LINEAR CUTTER ARTICULATION,"$8,484.68",$0.00,"$8,484.68",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,484.68",$0.00,"$4,242.34","$6,719.87","$6,787.74",$0.00,$0.00,$0.00,$0.00,$0.00
PSEE45A,SUP,Custom 27203010,,PSEE45A  -  STAPLER INTNL STD 340MM 45MM ECHLN FLX PWR + LNR CTR ESCP,"$1,661.12",$0.00,"$1,661.12",$0.00,"$1,185.54",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,661.12",$0.00,$830.56,"$1,315.61","$1,328.89",$0.00,$0.00,$0.00,$0.00,$0.00
PSEE60A,SUP,Custom 27203010,,PSEE60A  -  STAPLER INTERNAL BENT 60MM 440MM RIDGE ASYMMETRICAL LEG LINE,"$3,375.63",$0.00,"$3,375.63",$0.00,"$2,409.18",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,375.63",$0.00,"$1,687.81","$2,673.50","$2,700.50",$0.00,$0.00,$0.00,$0.00,$0.00
PSS-6F-4MT,SUP,HCPCS C1894,,PSS-6F-4MT  -  INTRODUCER SHEATH SHORT 6FR 4CM NO WIRE PRELUDE GREEN,$42.50,$0.00,$42.50,$23.08,$30.33,$0.00,$7.32,$0.00,$0.00,$7.44,$42.50,$0.00,$21.25,$33.66,$34.00,$0.00,$6.65,$0.00,$6.77,$0.00
PSS-7F-4MT,SUP,HCPCS C1894,,PSS-7F-4MT  -  INTRODUCER SHEATH SHORT 7FR 21GA 4CM ORANGE HUB TUBING,$8.50,$0.00,$8.50,$4.62,$6.07,$0.00,$1.46,$0.00,$0.00,$1.49,$8.50,$0.00,$4.25,$6.73,$6.80,$0.00,$1.33,$0.00,$1.35,$0.00
PTA5-35-135-7-14.0,SUP,HCPCS C1725,,PTA5-35-135-7-14.0  -  CATH BALDILAT .035IN 5FR 7MM 135CM 14CM 2 LUM PTA LP GWIRE,$512.50,$0.00,$512.50,$278.29,$365.77,$0.00,$88.30,$0.00,$0.00,$89.73,$512.50,$0.00,$256.25,$405.90,$410.00,$0.00,$80.21,$0.00,$81.59,$0.00
PTB124275,SUP,HCPCS C1874,,PTB124275  -  GORE VIATORR TIPS ENDOPROSTHESIS,"$10,500.00",$0.00,"$10,500.00","$4,725.00","$5,158.80",$0.00,"$1,809.10",$0.00,$0.00,"$1,838.47","$10,500.00",$0.00,"$5,250.00","$8,316.00","$8,400.00",$0.00,"$1,643.25",$0.00,"$1,671.60",$0.00
PTB126275,SUP,HCPCS C1874,,PTB126275  -  GORE VIATORR TIPS ENDOPROSTHESIS,"$10,500.00",$0.00,"$10,500.00","$4,725.00","$5,158.80",$0.00,"$1,809.10",$0.00,$0.00,"$1,838.47","$10,500.00",$0.00,"$5,250.00","$8,316.00","$8,400.00",$0.00,"$1,643.25",$0.00,"$1,671.60",$0.00
PTB128275,SUP,HCPCS C1874,,PTB128275  -  GORE VIATORR TIPS ENDOPROSTHESIS,"$9,750.00",$0.00,"$9,750.00","$4,387.50","$5,158.80",$0.00,"$1,679.88",$0.00,$0.00,"$1,707.15","$9,750.00",$0.00,"$4,875.00","$7,722.00","$7,800.00",$0.00,"$1,525.88",$0.00,"$1,552.20",$0.00
PTB8106275,SUP,HCPCS C1874,,PTB8106275  -  STENT EPRSTH 10MM 6CM STRL 2CM GORE VTR SLF XPD RADOPQ 2 LUM,"$12,360.00",$0.00,"$12,360.00","$5,562.00","$5,158.80",$0.00,"$2,129.57",$0.00,$0.00,"$2,164.14","$12,360.00",$0.00,"$6,180.00","$9,789.12","$9,888.00",$0.00,"$1,934.34",$0.00,"$1,967.71",$0.00
PTB8108275,SUP,HCPCS C1874,,PTB8108275  -  STENT EPRSTH 10MM 8CM STRL 2CM GORE VTR SLF XPD RADOPQ 2 LUM,"$12,360.00",$0.00,"$12,360.00","$5,562.00","$5,158.80",$0.00,"$2,129.57",$0.00,$0.00,"$2,164.14","$12,360.00",$0.00,"$6,180.00","$9,789.12","$9,888.00",$0.00,"$1,934.34",$0.00,"$1,967.71",$0.00
PTH-MP,SUP,Custom 27203010,,MAS PTH TRI-LEVEL CONTROL 6X3ML,$275.00,$0.00,$275.00,$0.00,$196.27,$0.00,$0.00,$0.00,$0.00,$0.00,$275.00,$0.00,$137.50,$217.80,$220.00,$0.00,$0.00,$0.00,$0.00,$0.00
PV014300,SUP,HCPCS C1769,,PV014300  -  JETWIRE JETSTREAM,"$3,125.00",$0.00,"$3,125.00","$1,696.88","$2,230.31",$0.00,$538.42,$0.00,$0.00,$547.16,"$3,125.00",$0.00,"$1,562.50","$2,475.00","$2,500.00",$0.00,$489.06,$0.00,$497.50,$0.00
PV2014L016N,SUP,HCPCS C1751,,PV2014L016N  -  CATHETER ART LN 4FR 16CM PICCO GW NTNL,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
PV2014L022N,SUP,HCPCS C1751,,PV2014L022N  -  CATHETER ART LN 4FR 22CM PICCO GW ADLT FEM ART BRACHIA,$62.50,$0.00,$62.50,$28.13,$44.61,$0.00,$10.77,$0.00,$0.00,$10.94,$62.50,$0.00,$31.25,$49.50,$50.00,$0.00,$9.78,$0.00,$9.95,$0.00
PV2015L20N,SUP,HCPCS C1751,,PV2015L20N  -  CATH ART 5FR .028IN 7.78IN FEM PICCO ADLT STD,"$3,125.00",$0.00,"$3,125.00","$1,406.25","$2,230.31",$0.00,$538.42,$0.00,$0.00,$547.16,"$3,125.00",$0.00,"$1,562.50","$2,475.00","$2,500.00",$0.00,$489.06,$0.00,$497.50,$0.00
PV3116F,SUP,HCPCS C1714,,PV3116F  -  CATHETER ATHRCM JETSTREAM NAVITUS ROT,"$8,500.00",$0.00,"$8,500.00","$4,615.50","$5,158.80",$0.00,"$1,464.51",$0.00,$0.00,"$1,488.28","$8,500.00",$0.00,"$4,250.00","$6,732.00","$6,800.00",$0.00,"$1,330.25",$0.00,"$1,353.20",$0.00
PV3118F,SUP,HCPCS C1714,,PV3118F  -  CATHETER ATHRCM .014IN 7FR 2.4/3.4MM 120CM JETSTREAM NAVITUS,"$8,500.00",$0.00,"$8,500.00","$4,615.50","$5,158.80",$0.00,"$1,464.51",$0.00,$0.00,"$1,488.28","$8,500.00",$0.00,"$4,250.00","$6,732.00","$6,800.00",$0.00,"$1,330.25",$0.00,"$1,353.20",$0.00
PV31300,SUP,HCPCS C1714,,PV31300  -  CATHETER ATHRCM JETSTREAM NAVITUS ROT,"$8,500.00",$0.00,"$8,500.00","$4,615.50","$5,158.80",$0.00,"$1,464.51",$0.00,$0.00,"$1,488.28","$8,500.00",$0.00,"$4,250.00","$6,732.00","$6,800.00",$0.00,"$1,330.25",$0.00,"$1,353.20",$0.00
PV4046,SUP,HCPCS C1751,,PV4046  -  KIT ART LN INJECTATE TEMP SNSR HSNG PICCO,$825.00,$0.00,$825.00,$371.25,$588.80,$0.00,$142.14,$0.00,$0.00,$144.45,$825.00,$0.00,$412.50,$653.40,$660.00,$0.00,$129.11,$0.00,$131.34,$0.00
PV41340,SUP,HCPCS C1714,,PV41340  -  CATHETER ATHRCM .014IN 7FR 2.4/3.4MM 120CM LF JETSTREAM,"$8,500.00",$0.00,"$8,500.00","$4,615.50","$5,158.80",$0.00,"$1,464.51",$0.00,$0.00,"$1,488.28","$8,500.00",$0.00,"$4,250.00","$6,732.00","$6,800.00",$0.00,"$1,330.25",$0.00,"$1,353.20",$0.00
PVE35A,SUP,Custom 27203010,,PVE35A  -  STAPLER INTERNAL 320MM 35MM POWER ADVANCE PLACEMENT TIP,$990.33,$0.00,$990.33,$0.00,$706.79,$0.00,$0.00,$0.00,$0.00,$0.00,$990.33,$0.00,$495.16,$784.34,$792.26,$0.00,$0.00,$0.00,$0.00,$0.00
PVPS,SUP,HCPCS C1781,,PVPS  -  MESH SURG 4.3X4.3CM SELF EXPAND PRTL ABSORBABLE FLEXIBLE,"$1,462.90",$0.00,"$1,462.90",$658.31,"$1,044.07",$0.00,$252.05,$0.00,$0.00,$256.14,"$1,462.90",$0.00,$731.45,"$1,158.62","$1,170.32",$0.00,$228.94,$0.00,$232.89,$0.00
PWL229997H,SUP,HCPCS C1785,,PWL229997H  -  PACEMAKER SENSIA DR CARD SEDR01 PWL229997H,"$22,500.00",$0.00,"$22,500.00","$10,125.00","$5,158.80",$0.00,"$3,876.64",$0.00,$0.00,"$3,939.57","$22,500.00",$0.00,"$11,250.00","$17,820.00","$18,000.00",$0.00,"$3,521.25",$0.00,"$3,582.00",$0.00
PWL242945H,SUP,HCPCS C1785,,PWL242945H  -  PACEMAKER SENSIA 2CH CARD PWL242945H,"$19,655.00",$0.00,"$19,655.00","$8,844.75","$5,158.80",$0.00,"$3,386.46",$0.00,$0.00,"$3,441.43","$19,655.00",$0.00,"$9,827.50","$15,566.76","$15,724.00",$0.00,"$3,076.01",$0.00,"$3,129.08",$0.00
PWL243503H,SUP,HCPCS C1785,,PWL243503H  -  PACEMAKER SENSIA 2CH CARD PWL243503H,"$19,207.50",$0.00,"$19,207.50","$8,643.38","$5,158.80",$0.00,"$3,309.36",$0.00,$0.00,"$3,363.08","$19,207.50",$0.00,"$9,603.75","$15,212.34","$15,366.00",$0.00,"$3,005.97",$0.00,"$3,057.83",$0.00
PWR224751H,SUP,HCPCS C1785,,PWR224751H  -  PACEMAKER SENSIA 2CH CARD PWR224751H,"$18,900.00",$0.00,"$18,900.00","$8,505.00","$5,158.80",$0.00,"$3,256.38",$0.00,$0.00,"$3,309.24","$18,900.00",$0.00,"$9,450.00","$14,968.80","$15,120.00",$0.00,"$2,957.85",$0.00,"$3,008.88",$0.00
PWR230180H,SUP,HCPCS C1785,,PWR230180H  -  PACEMAKER SENSIA DR CARD SEDR01 PWR230180H,"$7,237.50",$0.00,"$7,237.50","$3,256.88","$5,158.80",$0.00,"$1,246.99",$0.00,$0.00,"$1,267.23","$7,237.50",$0.00,"$3,618.75","$5,732.10","$5,790.00",$0.00,"$1,132.67",$0.00,"$1,152.21",$0.00
PXC121000,SUP,Custom 27806189,,PXC121000  -  GRAFT EVAS LOPRFL 12MM 10CM XCLDR STNT XTD DLV SYS SL CUF,"$11,275.00",$0.00,"$11,275.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$11,275.00",$0.00,"$5,637.50","$8,929.80","$9,020.00",$0.00,$0.00,$0.00,$0.00,$0.00
PXSLIM045,SUP,HCPCS C1757,,PXSLIM045  -  CATHETER DELIVERY SYSTEM 45D MICRO 2.95FR .025IN 150CM 2 TIP,"$2,210.00",$0.00,"$2,210.00",$0.00,"$1,577.28",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,210.00",$0.00,"$1,105.00","$1,750.32","$1,768.00",$0.00,$0.00,$0.00,$0.00,$0.00
PXSLIM090,SUP,HCPCS C1757,,PXSLIM090  -  CATHETER DLV SYS 90D 0-.025IN MIC 2.6-2.95FR 150CM PX SLIM 2,"$2,210.00",$0.00,"$2,210.00",$0.00,"$1,577.28",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,210.00",$0.00,"$1,105.00","$1,750.32","$1,768.00",$0.00,$0.00,$0.00,$0.00,$0.00
PXSLIM130,SUP,HCPCS C1757,,PXSLIM130  -  CATHETER DELIVERY SYSTEM 130D 0-.025IN MICRO 2.6-2.95FR 150,"$2,210.00",$0.00,"$2,210.00",$0.00,"$1,577.28",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,210.00",$0.00,"$1,105.00","$1,750.32","$1,768.00",$0.00,$0.00,$0.00,$0.00,$0.00
PXSLIMSTR,SUP,HCPCS C1757,,PXSLIMSTR  -  CATHETER DLV SYS 0-.02IN MIC STRG 2.6-2.95FR .025IN 150CM PX,"$2,210.00",$0.00,"$2,210.00",$0.00,"$1,577.28",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,210.00",$0.00,"$1,105.00","$1,750.32","$1,768.00",$0.00,$0.00,$0.00,$0.00,$0.00
PXX52,SUP,Custom 27203010,,PXX52  -  SUTURE NONABSORBABLE THK1/16IN 2-0 V-5 30IN .25X1/8IN 2 ARM,$198.19,$0.00,$198.19,$0.00,$141.45,$0.00,$0.00,$0.00,$0.00,$0.00,$198.19,$0.00,$99.10,$156.97,$158.55,$0.00,$0.00,$0.00,$0.00,$0.00
PXX77,SUP,Custom 27203010,,PXX77  -  SUTURE NONABSORBABLE THK1/16IN 2-0 V-7 30IN .25X1/8IN 2 ARM,$211.39,$0.00,$211.39,$0.00,$150.87,$0.00,$0.00,$0.00,$0.00,$0.00,$211.39,$0.00,$105.70,$167.42,$169.11,$0.00,$0.00,$0.00,$0.00,$0.00
Q50-65P,SUP,Custom 27204833,,Q50-65P  -  CATHETER OCL 10-50MM 65CM Q50 + BLN STNT GFT DLV FLX TP,"$1,212.50",$0.00,"$1,212.50",$0.00,$865.36,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,212.50",$0.00,$606.25,$960.30,$970.00,$0.00,$0.00,$0.00,$0.00,$0.00
QC-12-30-HELIX,SUP,HCPCS C2628,,QC-12-30-HELIX  -  COIL EMBL .3683MM HLX 12MM .0145IN 30CM AXIUM DTCH PLTN,"$1,802.50",$0.00,"$1,802.50",$0.00,"$1,286.44",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,802.50",$0.00,$901.25,"$1,427.58","$1,442.00",$0.00,$0.00,$0.00,$0.00,$0.00
QC-12-40-3D,SUP,Custom 27803010,,QC-12-40-3D  -  COIL EMBL .3683MM 3D 12MM .0145IN 40CM AXIUM DTCH PLTN,"$2,432.50",$0.00,"$2,432.50",$0.00,"$1,736.08",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,432.50",$0.00,"$1,216.25","$1,926.54","$1,946.00",$0.00,$0.00,$0.00,$0.00,$0.00
QS70406,SUP,Custom 27203010,,QS70406  -  ADHESIVE SKIN DERMA FLEX QS,$40.63,$0.00,$40.63,$0.00,$28.99,$0.00,$0.00,$0.00,$0.00,$0.00,$40.63,$0.00,$20.31,$32.18,$32.50,$0.00,$0.00,$0.00,$0.00,$0.00
QTX321256,SUP,Custom 27203010,,QTX321256  -  ROPE TRC 10FT STRL LF,$195.78,$0.00,$195.78,$0.00,$139.72,$0.00,$0.00,$0.00,$0.00,$0.00,$195.78,$0.00,$97.89,$155.06,$156.62,$0.00,$0.00,$0.00,$0.00,$0.00
R020,SUP,HCPCS C1768,,R020  -  GRAFT SFT TIS CRYOARTERY FEM POPLT ART,"$16,250.00",$0.00,"$16,250.00","$7,312.50","$5,158.80",$0.00,"$2,799.79",$0.00,$0.00,"$2,845.25","$16,250.00",$0.00,"$8,125.00","$12,870.00","$13,000.00",$0.00,"$2,543.13",$0.00,"$2,587.00",$0.00
R0450,SUP,Custom 27203010,,CURETTE 4MM ADSP DRML LOOP TIP SURG SS STRL DISP,$3.75,$0.00,$3.75,$0.00,$2.68,$0.00,$0.00,$0.00,$0.00,$0.00,$3.75,$0.00,$1.88,$2.97,$3.00,$0.00,$0.00,$0.00,$0.00,$0.00
R1212,SUP,Custom 27203010,,DRESSING WOUND PROCELLERA ANTIMICROBIAL 12X12,$900.00,$0.00,$900.00,$0.00,$642.33,$0.00,$0.00,$0.00,$0.00,$0.00,$900.00,$0.00,$450.00,$712.80,$720.00,$0.00,$0.00,$0.00,$0.00,$0.00
R21121,SUP,Custom 27203010,,DISK BTYRT ESTRS M CATRRHL ID,$148.80,$0.00,$148.80,$0.00,$106.20,$0.00,$0.00,$0.00,$0.00,$0.00,$148.80,$0.00,$74.40,$117.85,$119.04,$0.00,$0.00,$0.00,$0.00,$0.00
R30859602,SUP,Custom 27203010,,KIT WLCGN BCTR AG RPD LTX AGGL MCBLTST 30 TST,$59.03,$0.00,$59.03,$0.00,$42.13,$0.00,$0.00,$0.00,$0.00,$0.00,$59.03,$0.00,$29.51,$46.75,$47.22,$0.00,$0.00,$0.00,$0.00,$0.00
R30950801,SUP,Custom 27203010,,REAGENT MCBL STRP GRP C LTX AGGL STREPTEX 50 TST,$4.05,$0.00,$4.05,$0.00,$2.89,$0.00,$0.00,$0.00,$0.00,$0.00,$4.05,$0.00,$2.03,$3.21,$3.24,$0.00,$0.00,$0.00,$0.00,$0.00
R30951001,SUP,Custom 27203010,,REAGENT MCBL XTRT ENZM SPL VL STREPTEX 25 TST,$3.85,$0.00,$3.85,$0.00,$2.75,$0.00,$0.00,$0.00,$0.00,$0.00,$3.85,$0.00,$1.93,$3.05,$3.08,$0.00,$0.00,$0.00,$0.00,$0.00
R30951201,SUP,Custom 27203010,,REAGENT MCBL STRP GRP G LTX AGGL STREPTEX 50 TST,$3.98,$0.00,$3.98,$0.00,$2.84,$0.00,$0.00,$0.00,$0.00,$0.00,$3.98,$0.00,$1.99,$3.15,$3.18,$0.00,$0.00,$0.00,$0.00,$0.00
R314II,SUP,Custom 27203010,,CABLE EKG 3 LEAD SHLD CONNCTR .059IN,$172.08,$0.00,$172.08,$0.00,$122.81,$0.00,$0.00,$0.00,$0.00,$0.00,$172.08,$0.00,$86.04,$136.29,$137.66,$0.00,$0.00,$0.00,$0.00,$0.00
R324II,SUP,Custom 27203010,,CABLE EKG 3 LEAD CONNCTR 3 SHLD .059IN,$186.63,$0.00,$186.63,$0.00,$133.19,$0.00,$0.00,$0.00,$0.00,$0.00,$186.63,$0.00,$93.31,$147.81,$149.30,$0.00,$0.00,$0.00,$0.00,$0.00
R32611,SUP,Custom 27203010,,CABLE  ECG/PATIENT LIFEPACK .059IN 3 LEAD CONFIGURATION 3B C,$164.63,$0.00,$164.63,$0.00,$117.49,$0.00,$0.00,$0.00,$0.00,$0.00,$164.63,$0.00,$82.31,$130.39,$131.70,$0.00,$0.00,$0.00,$0.00,$0.00
R390.003,SUP,Custom 27203010,,R390.003  -  DEVICE EXFIX ROD ATTCH LG EXFIX 4-6 MM SCHNZ SCR NONSTRL,$632.50,$0.00,$632.50,$0.00,$451.42,$0.00,$0.00,$0.00,$0.00,$0.00,$632.50,$0.00,$316.25,$500.94,$506.00,$0.00,$0.00,$0.00,$0.00,$0.00
R390.005,SUP,HCPCS C1713,,CLAMP COMBO MR CONDITIONAL CNTRL EXFIXA LG NSTRL,$0.03,$0.00,$0.03,$0.01,$0.02,$0.00,$0.00,$0.00,$0.00,$0.00,$0.03,$0.00,$0.01,$0.02,$0.02,$0.00,$0.00,$0.00,$0.00,$0.00
R390.008,SUP,HCPCS C1713,,CLAMP OPN ADJ MR CONDITIONAL CNTRL EXFIXA LG NSTRL,$0.03,$0.00,$0.03,$0.01,$0.02,$0.00,$0.00,$0.00,$0.00,$0.00,$0.03,$0.00,$0.01,$0.02,$0.02,$0.00,$0.00,$0.00,$0.00,$0.00
R390.009,SUP,HCPCS C1713,,PIN CLMP ROD 4 PSTN ADJ CNTRL EXFIXA LG NSTRL,$0.03,$0.00,$0.03,$0.01,$0.02,$0.00,$0.00,$0.00,$0.00,$0.00,$0.03,$0.00,$0.01,$0.02,$0.02,$0.00,$0.00,$0.00,$0.00,$0.00
R390.010,SUP,Custom 27203010,,R390.010  -  CLAMP EXFIX LG 6 PSTN PIN NONSTRL,$705.00,$0.00,$705.00,$0.00,$503.16,$0.00,$0.00,$0.00,$0.00,$0.00,$705.00,$0.00,$352.50,$558.36,$564.00,$0.00,$0.00,$0.00,$0.00,$0.00
R390.012,SUP,HCPCS C1713,,PIN 11MM ADJ CNTRL ROD POST OTRGR EXFIXA 30D NSTRL,$0.03,$0.00,$0.03,$0.01,$0.02,$0.00,$0.00,$0.00,$0.00,$0.00,$0.03,$0.00,$0.01,$0.02,$0.02,$0.00,$0.00,$0.00,$0.00,$0.00
R390.051,SUP,Custom 27203010,,R390.051  -  CLAMP EXFIX 4MM DISTAL RADL ADJ NONSTRL,"$1,127.50",$0.00,"$1,127.50",$0.00,$804.70,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,127.50",$0.00,$563.75,$892.98,$902.00,$0.00,$0.00,$0.00,$0.00,$0.00
R394.85,SUP,Custom 27203010,,R394.85  -  ROD EXFIX 300MM 11MM CARFBR SLFDRILL MR CONDITIONAL SET,$355.00,$0.00,$355.00,$0.00,$253.36,$0.00,$0.00,$0.00,$0.00,$0.00,$355.00,$0.00,$177.50,$281.16,$284.00,$0.00,$0.00,$0.00,$0.00,$0.00
R395.786,SUP,Custom 27203010,,R395.786  -  ROD EXFIX 240MM 8MM DISTAL RADL CARFBR NONSTRL,$232.50,$0.00,$232.50,$0.00,$165.94,$0.00,$0.00,$0.00,$0.00,$0.00,$232.50,$0.00,$116.25,$184.14,$186.00,$0.00,$0.00,$0.00,$0.00,$0.00
R6515-01,SUP,Custom 25803010,,R6515-01  -  SOLUTION IRR 2L LTX PHYSIOLYTE PIC 5% MNTL,$30.61,$0.00,$30.61,$0.00,$21.85,$0.00,$0.00,$0.00,$0.00,$0.00,$30.61,$0.00,$15.31,$24.24,$24.49,$0.00,$0.00,$0.00,$0.00,$0.00
RA-04020,SUP,HCPCS C1729,,RA-04020  -  KIT ARTERIAL LINE .018IN 20GA 22GA 1.75IN CATHETER RADIOPQ,$28.80,$0.00,$28.80,$15.64,$20.55,$0.00,$4.96,$0.00,$0.00,$5.04,$28.80,$0.00,$14.40,$22.81,$23.04,$0.00,$4.51,$0.00,$4.58,$0.00
RAN-811-OT,SUP,Custom 27203010,,RAN-811-OT  -  NEEDLE IO 8GA 11CM DLV OPN TIP,$500.00,$0.00,$500.00,$0.00,$356.85,$0.00,$0.00,$0.00,$0.00,$0.00,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$0.00,$0.00,$0.00,$0.00
RBY2C0725,SUP,Custom 27803010,,RBY2C0725  -  COIL EMBL STD .02IN 7MM 25CM PENUMBRA COIL 400 RUBY CMPLX LG,"$2,475.00",$0.00,"$2,475.00",$0.00,"$1,766.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,475.00",$0.00,"$1,237.50","$1,960.20","$1,980.00",$0.00,$0.00,$0.00,$0.00,$0.00
RBY2C0825,SUP,Custom 27803010,,RBY2C0825  -  COIL EMBL STD .02IN 8MM 25CM PENUMBRA COIL 400 RUBY CMPLX LG,"$2,475.00",$0.00,"$2,475.00",$0.00,"$1,766.41",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,475.00",$0.00,"$1,237.50","$1,960.20","$1,980.00",$0.00,$0.00,$0.00,$0.00,$0.00
RBY2C0840,SUP,Custom 27803010,,RBY2C0840  -  COIL EMBL STD .02IN 8MM 40CM PENUMBRA COIL 400 RUBY CMPLX LG,"$3,225.00",$0.00,"$3,225.00",$0.00,"$2,301.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,225.00",$0.00,"$1,612.50","$2,554.20","$2,580.00",$0.00,$0.00,$0.00,$0.00,$0.00
RBYPOD8,SUP,Custom 27803010,,RBYPOD8  -  COIL EMBL 8MM 60CM RUBY POD CMPLX OCCULUSION DEV,"$4,475.00",$0.00,"$4,475.00",$0.00,"$3,193.81",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,475.00",$0.00,"$2,237.50","$3,544.20","$3,580.00",$0.00,$0.00,$0.00,$0.00,$0.00
RBYPODJ60,SUP,Custom 27803010,,RBYPODJ60  -  COIL EMBL J-SFT 60CM STRL LF POD PK,"$3,225.00",$0.00,"$3,225.00",$0.00,"$2,301.68",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,225.00",$0.00,"$1,612.50","$2,554.20","$2,580.00",$0.00,$0.00,$0.00,$0.00,$0.00
RC-15,SUP,HCPCS C1760,,SYSTEM EMBL PRTC VC FLTR 2LVL REM 12FR RCVR CN,"$1,312.50",$0.00,"$1,312.50",$590.63,$936.73,$0.00,$226.14,$0.00,$0.00,$229.81,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$205.41,$0.00,$208.95,$0.00
RC41-12027,SUP,Custom 27203010,,RC41-12027  -  CIRCUIT BRTHG ANES HEAT WIRE 40IN NEO INF,$66.67,$0.00,$66.67,$0.00,$47.58,$0.00,$0.00,$0.00,$0.00,$0.00,$66.67,$0.00,$33.33,$52.80,$53.33,$0.00,$0.00,$0.00,$0.00,$0.00
RCFW-5.0-35,SUP,HCPCS C1894,,RCFW-5.0-35  -  SET INTROD 13CM 5FR CHK-FLO PRFRMR SDARM FIT SIDE CONNECT LN,$47.15,$0.00,$47.15,$25.60,$33.65,$0.00,$8.12,$0.00,$0.00,$8.26,$47.15,$0.00,$23.58,$37.34,$37.72,$0.00,$7.38,$0.00,$7.51,$0.00
RCP3,SUP,HCPCS C1713,,RCP3  -  PLATE BN NS RADL CLMN PIN PLT 3 HL PIN CLMN RADL,"$1,550.00",$0.00,"$1,550.00",$697.50,"$1,106.24",$0.00,$267.06,$0.00,$0.00,$271.39,"$1,550.00",$0.00,$775.00,"$1,227.60","$1,240.00",$0.00,$242.58,$0.00,$246.76,$0.00
RCP5,SUP,HCPCS C1713,,RCP5  -  PLATE BN NS RADL CLMN PIN PLT 5 HL PIN CLMN RADL,"$1,550.00",$0.00,"$1,550.00",$697.50,"$1,106.24",$0.00,$267.06,$0.00,$0.00,$271.39,"$1,550.00",$0.00,$775.00,"$1,227.60","$1,240.00",$0.00,$242.58,$0.00,$246.76,$0.00
RF-310F,SUP,HCPCS C1760,,SYSTEM EMBL PRTC 48CM VC FLTR FEM DLV KT 7FR G2,"$2,750.00",$0.00,"$2,750.00","$1,237.50","$1,962.68",$0.00,$473.81,$0.00,$0.00,$481.50,"$2,750.00",$0.00,"$1,375.00","$2,178.00","$2,200.00",$0.00,$430.38,$0.00,$437.80,$0.00
RFP-400,SUP,Custom 25003010,,SOLUTION DLYST 140 MEQ NA 2 MEQ K 3 MEQ CALCIUM 1 MEQ MG 111,$118.75,$0.00,$118.75,$0.00,$84.75,$0.00,$0.00,$0.00,$0.00,$0.00,$118.75,$0.00,$59.38,$94.05,$95.00,$0.00,$0.00,$0.00,$0.00,$0.00
RFP-401,SUP,Custom 25003010,,SOLUTION DLYST 140 MEQ NA 4 MEQ K 3 MEQ CALCIUM 1 MEQ MG 113,$118.75,$0.00,$118.75,$0.00,$84.75,$0.00,$0.00,$0.00,$0.00,$0.00,$118.75,$0.00,$59.38,$94.05,$95.00,$0.00,$0.00,$0.00,$0.00,$0.00
RG*ES1818SP,SUP,HCPCS C1769,,RG*ES1818SP  -  GUIDEWIRE VASCULAR STR .018IN 180CM 25CM SHAPEABLE SHAFT,$397.50,$0.00,$397.50,$215.84,$283.70,$0.00,$68.49,$0.00,$0.00,$69.60,$397.50,$0.00,$198.75,$314.82,$318.00,$0.00,$62.21,$0.00,$63.28,$0.00
RG*GA1818SP,SUP,HCPCS C1769,,RG*GA1818SP  -  GUIDEWIRE VASCULAR 45D .018IN 180CM 25CM GLIDEWIRE GT HYDPHI,$43.00,$0.00,$43.00,$23.35,$30.69,$0.00,$7.41,$0.00,$0.00,$7.53,$43.00,$0.00,$21.50,$34.06,$34.40,$0.00,$6.73,$0.00,$6.85,$0.00
RH1,SUP,Custom 27203010,,RH1  -  HANDLE INST RUBY DTCH COIL,$595.00,$0.00,$595.00,$0.00,$424.65,$0.00,$0.00,$0.00,$0.00,$0.00,$595.00,$0.00,$297.50,$471.24,$476.00,$0.00,$0.00,$0.00,$0.00,$0.00
RL-3019-S,SUP,HCPCS C1713,,RL-3019-S  -  ROD ORTH 190MM 3MM LEFT RADL WR HND RAD IM IMPL STRL,"$2,690.00",$0.00,"$2,690.00","$1,210.50","$1,919.85",$0.00,$463.47,$0.00,$0.00,$471.00,"$2,690.00",$0.00,"$1,345.00","$2,130.48","$2,152.00",$0.00,$420.99,$0.00,$428.25,$0.00
RL-3021-S,SUP,HCPCS C1713,,RL-3021-S  -  ROD ORTH 210MM 3MM LEFT RADL WR HND RAD IM IMPL STRL,"$2,690.00",$0.00,"$2,690.00","$1,210.50","$1,919.85",$0.00,$463.47,$0.00,$0.00,$471.00,"$2,690.00",$0.00,"$1,345.00","$2,130.48","$2,152.00",$0.00,$420.99,$0.00,$428.25,$0.00
RL-3023-S,SUP,HCPCS C1713,,RL-3023-S  -  ROD ORTH 230MM 3MM LEFT RADL WR HND TI RAD IM IMPL STRL,"$2,690.00",$0.00,"$2,690.00","$1,210.50","$1,919.85",$0.00,$463.47,$0.00,$0.00,$471.00,"$2,690.00",$0.00,"$1,345.00","$2,130.48","$2,152.00",$0.00,$420.99,$0.00,$428.25,$0.00
RL-3619-S,SUP,HCPCS C1713,,RL-3619-S  -  ROD ORTH 190MM 3.6MM LEFT RADL FRARM RAD IM IMPL STRL,"$2,690.00",$0.00,"$2,690.00","$1,210.50","$1,919.85",$0.00,$463.47,$0.00,$0.00,$471.00,"$2,690.00",$0.00,"$1,345.00","$2,130.48","$2,152.00",$0.00,$420.99,$0.00,$428.25,$0.00
RL-3621-S,SUP,HCPCS C1713,,RL-3621-S  -  ROD ORTH 210MM 3.6MM LEFT DISTAL RADL FRARM RAD IM IMPL STRL,"$2,690.00",$0.00,"$2,690.00","$1,210.50","$1,919.85",$0.00,$463.47,$0.00,$0.00,$471.00,"$2,690.00",$0.00,"$1,345.00","$2,130.48","$2,152.00",$0.00,$420.99,$0.00,$428.25,$0.00
RL-3623-S,SUP,HCPCS C1713,,RL-3623-S  -  ROD ORTH 230MM 3.6MM LEFT RADL FRARM RAD IM IMPL STRL,"$2,690.00",$0.00,"$2,690.00","$1,210.50","$1,919.85",$0.00,$463.47,$0.00,$0.00,$471.00,"$2,690.00",$0.00,"$1,345.00","$2,130.48","$2,152.00",$0.00,$420.99,$0.00,$428.25,$0.00
RMT3130,SUP,Custom 27203010,,RMT3130  -  REAMER SURG 3.1MM THDL ROD SYS WR HND 300MM STRL,$497.50,$0.00,$497.50,$0.00,$355.07,$0.00,$0.00,$0.00,$0.00,$0.00,$497.50,$0.00,$248.75,$394.02,$398.00,$0.00,$0.00,$0.00,$0.00,$0.00
RMT-3130,SUP,Custom 27203010,,RMT-3130  -  REAMER SURG 3.1MM THDL ROD SYS WR HND 300MM STRL,$497.50,$0.00,$497.50,$0.00,$355.07,$0.00,$0.00,$0.00,$0.00,$0.00,$497.50,$0.00,$248.75,$394.02,$398.00,$0.00,$0.00,$0.00,$0.00,$0.00
RMT-3137,SUP,Custom 27203010,,RMT-3137  -  REAMER SRG 3.7MM THDL DISP FRARM ROD SYS,$497.50,$0.00,$497.50,$0.00,$355.07,$0.00,$0.00,$0.00,$0.00,$0.00,$497.50,$0.00,$248.75,$394.02,$398.00,$0.00,$0.00,$0.00,$0.00,$0.00
RMT3730,SUP,Custom 27203010,,RMT3730  -  REAMER SURG 3.7MM THDL WR HND DISP,$497.50,$0.00,$497.50,$0.00,$355.07,$0.00,$0.00,$0.00,$0.00,$0.00,$497.50,$0.00,$248.75,$394.02,$398.00,$0.00,$0.00,$0.00,$0.00,$0.00
RMT7340,SUP,Custom 27203010,,RMT7340  -  REAMER SURG 7.3MM THDL 400MM,$497.50,$0.00,$497.50,$0.00,$355.07,$0.00,$0.00,$0.00,$0.00,$0.00,$497.50,$0.00,$248.75,$394.02,$398.00,$0.00,$0.00,$0.00,$0.00,$0.00
RMT8340,SUP,Custom 27203010,,RMT8340  -  REAMER SURG 8.3MM THDL 400MM,$497.50,$0.00,$497.50,$0.00,$355.07,$0.00,$0.00,$0.00,$0.00,$0.00,$497.50,$0.00,$248.75,$394.02,$398.00,$0.00,$0.00,$0.00,$0.00,$0.00
RPC-35-260,SUP,HCPCS C1769,,RPC-35-260  -  GWIRE VASC .035IN 260CM ANG STD TPR STF SHFT EXCH RDRR PC,$81.40,$0.00,$81.40,$44.20,$58.10,$0.00,$14.02,$0.00,$0.00,$14.25,$81.40,$0.00,$40.70,$64.47,$65.12,$0.00,$12.74,$0.00,$12.96,$0.00
RR-3019-S,SUP,HCPCS C1713,,RR-3019-S  -  ROD ORTH 190MM 3MM RIGHT RADL WR HND RAD IM IMPL STRL,"$2,690.00",$0.00,"$2,690.00","$1,210.50","$1,919.85",$0.00,$463.47,$0.00,$0.00,$471.00,"$2,690.00",$0.00,"$1,345.00","$2,130.48","$2,152.00",$0.00,$420.99,$0.00,$428.25,$0.00
RR-3021-S,SUP,HCPCS C1713,,RR-3021-S  -  ROD ORTH 210MM 3MM RIGHT RADL WR HND RAD IM IMPL STRL,"$2,690.00",$0.00,"$2,690.00","$1,210.50","$1,919.85",$0.00,$463.47,$0.00,$0.00,$471.00,"$2,690.00",$0.00,"$1,345.00","$2,130.48","$2,152.00",$0.00,$420.99,$0.00,$428.25,$0.00
RR-3023-S,SUP,HCPCS C1713,,RR-3023-S  -  ROD ORTH 230MM 3MM RIGHT RADL FRARM RAD IM IMPL STRL,"$2,690.00",$0.00,"$2,690.00","$1,210.50","$1,919.85",$0.00,$463.47,$0.00,$0.00,$471.00,"$2,690.00",$0.00,"$1,345.00","$2,130.48","$2,152.00",$0.00,$420.99,$0.00,$428.25,$0.00
RR-3619-S,SUP,HCPCS C1713,,RR-3619-S  -  ROD RADIUS 3.6MM 90MM RIGHT,"$2,690.00",$0.00,"$2,690.00","$1,210.50","$1,919.85",$0.00,$463.47,$0.00,$0.00,$471.00,"$2,690.00",$0.00,"$1,345.00","$2,130.48","$2,152.00",$0.00,$420.99,$0.00,$428.25,$0.00
RR-3621-S,SUP,HCPCS C1713,,RR-3621-S  -  ROD RADIUS 3.6MM 210MM RIGHT,"$2,690.00",$0.00,"$2,690.00","$1,210.50","$1,919.85",$0.00,$463.47,$0.00,$0.00,$471.00,"$2,690.00",$0.00,"$1,345.00","$2,130.48","$2,152.00",$0.00,$420.99,$0.00,$428.25,$0.00
RR-3623-S,SUP,HCPCS C1713,,RR-3623-S  -  ROD ORTH 230MM 3.6MM RIGHT RADL WR HND RAD IM IMPL STRL,"$2,690.00",$0.00,"$2,690.00","$1,210.50","$1,919.85",$0.00,$463.47,$0.00,$0.00,$471.00,"$2,690.00",$0.00,"$1,345.00","$2,130.48","$2,152.00",$0.00,$420.99,$0.00,$428.25,$0.00
RRT08030040L,SUP,HCPCS C1768,,RRT08030040L  -  GRAFT VASCULAR THIN WALL RING STANDARD 8MM 40CM 30CM,"$1,830.00",$0.00,"$1,830.00",$823.50,"$1,306.07",$0.00,$315.30,$0.00,$0.00,$320.42,"$1,830.00",$0.00,$915.00,"$1,449.36","$1,464.00",$0.00,$286.40,$0.00,$291.34,$0.00
RRT08070070L,SUP,HCPCS C1768,,RRT08070070L  -  GRAFT VASCULAR THIN WALL RING 8MM 70CM 70CM GORE-TEX,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
RRT10030030L,SUP,HCPCS C1768,,RRT10030030L  -  GRAFT VASCULAR THIN WALL 10MM 30CM 30CM REMOVABLE RING LINE,"$2,302.50",$0.00,"$2,302.50","$1,036.13","$1,643.29",$0.00,$396.71,$0.00,$0.00,$403.15,"$2,302.50",$0.00,"$1,151.25","$1,823.58","$1,842.00",$0.00,$360.34,$0.00,$366.56,$0.00
RRT10070070L,SUP,HCPCS C1768,,RRT10070070L  -  GRAFT VASCULAR THIN WALL 10MM 70CM 70CM REMOVABLE RING LINE,"$3,002.50",$0.00,"$3,002.50","$1,351.13","$2,142.88",$0.00,$517.32,$0.00,$0.00,$525.71,"$3,002.50",$0.00,"$1,501.25","$2,377.98","$2,402.00",$0.00,$469.89,$0.00,$478.00,$0.00
RS22,SUP,Custom 27203010,,RS22  -  SUTURE NONABSORBABLE 5MM CTX 12IN 2 ARM MERSILENE WHITE,$81.22,$0.00,$81.22,$0.00,$57.97,$0.00,$0.00,$0.00,$0.00,$0.00,$81.22,$0.00,$40.61,$64.33,$64.98,$0.00,$0.00,$0.00,$0.00,$0.00
RS317,SUP,Custom 27203010,,CABLE  ECG/PATIENT 3 LEAD FOR SRS SERIES HP 345P,$93.75,$0.00,$93.75,$0.00,$66.91,$0.00,$0.00,$0.00,$0.00,$0.00,$93.75,$0.00,$46.88,$74.25,$75.00,$0.00,$0.00,$0.00,$0.00,$0.00
RSB501,SUP,HCPCS C1894,,RSB501  -  INTRODUCER SHTH 5FR 6CM 2.5CM PNCL RADOPQ DIL NO MN GW,$46.88,$0.00,$46.88,$25.45,$33.45,$0.00,$8.08,$0.00,$0.00,$8.21,$46.88,$0.00,$23.44,$37.13,$37.50,$0.00,$7.34,$0.00,$7.46,$0.00
RSB502,SUP,HCPCS C1894,,RSB502  -  INTRODUCER SHTH 5FR 10CM 2.5CM PNCL RADOPQ DIL NO MN GW,$53.50,$0.00,$53.50,$29.05,$38.18,$0.00,$9.22,$0.00,$0.00,$9.37,$53.50,$0.00,$26.75,$42.37,$42.80,$0.00,$8.37,$0.00,$8.52,$0.00
RSB503,SUP,HCPCS C1894,,RSB503  -  INTRODUCER SHTH 5FR 25CM 2.5CM PN RO2 DIL RADOPQ KINK RST,$65.00,$0.00,$65.00,$35.30,$46.39,$0.00,$11.20,$0.00,$0.00,$11.38,$65.00,$0.00,$32.50,$51.48,$52.00,$0.00,$10.17,$0.00,$10.35,$0.00
RSB602,SUP,HCPCS C1894,,RSB602  -  INTRODUCER SHTH 6FR 10CM 2.5CM PN RO2 DIL RADOPQ KINK RST,$53.50,$0.00,$53.50,$29.05,$38.18,$0.00,$9.22,$0.00,$0.00,$9.37,$53.50,$0.00,$26.75,$42.37,$42.80,$0.00,$8.37,$0.00,$8.52,$0.00
RSB603,SUP,HCPCS C1894,,RSB603  -  INTRODUCER SHTH 6FR 25CM 2.5CM PN RO2 DIL RADOPQ KINK RST,$65.00,$0.00,$65.00,$35.30,$46.39,$0.00,$11.20,$0.00,$0.00,$11.38,$65.00,$0.00,$32.50,$51.48,$52.00,$0.00,$10.17,$0.00,$10.35,$0.00
RSB702,SUP,HCPCS C1894,,RSB702  -  INTRODUCER SHTH 7FR 2.5CM 10CM DILAT RADIOPQ MRKR,$53.50,$0.00,$53.50,$29.05,$38.18,$0.00,$9.22,$0.00,$0.00,$9.37,$53.50,$0.00,$26.75,$42.37,$42.80,$0.00,$8.37,$0.00,$8.52,$0.00
RSB703,SUP,HCPCS C1894,,RSB703  -  INTRODUCER SHTH 7FR 2.5CM 25CM DILAT RADIOPQ MRKR,$65.00,$0.00,$65.00,$35.30,$46.39,$0.00,$11.20,$0.00,$0.00,$11.38,$65.00,$0.00,$32.50,$51.48,$52.00,$0.00,$10.17,$0.00,$10.35,$0.00
RSB802,SUP,HCPCS C1894,,RSB802  -  INTRODUCER SHTH 8FR 2.5CM 10CM GWIRE DILAT RADIOPQ,$53.50,$0.00,$53.50,$29.05,$38.18,$0.00,$9.22,$0.00,$0.00,$9.37,$53.50,$0.00,$26.75,$42.37,$42.80,$0.00,$8.37,$0.00,$8.52,$0.00
RSB803,SUP,HCPCS C1894,,RSB803  -  INTRODUCER SHTH 8FR 2.5CM 25CM DILAT RADIOPQ MRKR,$65.00,$0.00,$65.00,$35.30,$46.39,$0.00,$11.20,$0.00,$0.00,$11.38,$65.00,$0.00,$32.50,$51.48,$52.00,$0.00,$10.17,$0.00,$10.35,$0.00
RSB902,SUP,HCPCS C1894,,RSB902  -  INTRODUCER SHTH 9FR 10CM 2.5CM PN RO2 DIL RADOPQ KINK RST,$53.50,$0.00,$53.50,$29.05,$38.18,$0.00,$9.22,$0.00,$0.00,$9.37,$53.50,$0.00,$26.75,$42.37,$42.80,$0.00,$8.37,$0.00,$8.52,$0.00
RSB903,SUP,HCPCS C1894,,RSB903  -  INTRODUCER SHTH 9FR 25CM 2.5CM PN RO2 DIL RADOPQ KINK RST,$65.00,$0.00,$65.00,$35.30,$46.39,$0.00,$11.20,$0.00,$0.00,$11.38,$65.00,$0.00,$32.50,$51.48,$52.00,$0.00,$10.17,$0.00,$10.35,$0.00
RSR01,SUP,HCPCS C1887,,RSR01  -  INTROD SHTH 6FR 45CM GUID STR XCUT VLV PN DSTN HYDPHI PTFE,$206.70,$0.00,$206.70,$112.24,$147.52,$0.00,$35.61,$0.00,$0.00,$36.19,$206.70,$0.00,$103.35,$163.71,$165.36,$0.00,$32.35,$0.00,$32.91,$0.00
RSR02,SUP,HCPCS C1887,,RSR02  -  SHEATH GD HS CRV 6FR 45CM 5CM PN DSTN XCUT VLV RADOPQ SS NYL,$205.00,$0.00,$205.00,$111.32,$146.31,$0.00,$35.32,$0.00,$0.00,$35.89,$205.00,$0.00,$102.50,$162.36,$164.00,$0.00,$32.08,$0.00,$32.64,$0.00
RSR14,SUP,HCPCS C1894,,RSR14  -  SHEATH GD LIMA CRV 6FR 45CM 5CM PN DSTN XCUT VLV RADOPQ SS,$205.00,$0.00,$205.00,$111.32,$146.31,$0.00,$35.32,$0.00,$0.00,$35.89,$205.00,$0.00,$102.50,$162.36,$164.00,$0.00,$32.08,$0.00,$32.64,$0.00
RSS001,SUP,HCPCS C1894,,RSS001  -  INTRODUCER SHEATH .035IN 10FR 10CM 2.5CM GWIRE DILAT KINK,$21.88,$0.00,$21.88,$11.88,$15.61,$0.00,$3.77,$0.00,$0.00,$3.83,$21.88,$0.00,$10.94,$17.33,$17.50,$0.00,$3.42,$0.00,$3.48,$0.00
RSS005,SUP,HCPCS C1894,,RSS005  -  INTRODUCER SHEATH 10FR 25CM 2.5CM DILAT KINK RESISTANT,$49.88,$0.00,$49.88,$27.08,$35.60,$0.00,$8.59,$0.00,$0.00,$8.73,$49.88,$0.00,$24.94,$39.50,$39.90,$0.00,$7.81,$0.00,$7.94,$0.00
RSS503,SUP,HCPCS C1894,,RSS503  -  SHEATH INTRO 5FR 10CM 2.5CM PNCL DIL KINK RST PERI ACPT .038,$21.88,$0.00,$21.88,$11.88,$15.61,$0.00,$3.77,$0.00,$0.00,$3.83,$21.88,$0.00,$10.94,$17.33,$17.50,$0.00,$3.42,$0.00,$3.48,$0.00
RSS505,SUP,HCPCS C1894,,RSS505  -  SHEATH INTRO 5FR 25CM 2.5CM PNCL DIL KINK RST SS HDRPH PTFE,$49.88,$0.00,$49.88,$27.08,$35.60,$0.00,$8.59,$0.00,$0.00,$8.73,$49.88,$0.00,$24.94,$39.50,$39.90,$0.00,$7.81,$0.00,$7.94,$0.00
RSS601,SUP,HCPCS C1894,,RSS601  -  INTRODUCER SHEATH .035IN 6FR 10CM 2.5CM MINI GWIRE DILAT,$21.88,$0.00,$21.88,$11.88,$15.61,$0.00,$3.77,$0.00,$0.00,$3.83,$21.88,$0.00,$10.94,$17.33,$17.50,$0.00,$3.42,$0.00,$3.48,$0.00
RSS603,SUP,HCPCS C1894,,RSS603  -  SHEATH INTRO 6FR 10CM 2.5CM PNCL DIL KINK RST PERI ACPT .038,$218.75,$0.00,$218.75,$118.78,$156.12,$0.00,$37.69,$0.00,$0.00,$38.30,$218.75,$0.00,$109.38,$173.25,$175.00,$0.00,$34.23,$0.00,$34.83,$0.00
RSS605,SUP,HCPCS C1894,,RSS605  -  INTRODUCER SHEATH .035IN 6FR 25CM 2.5CM GWIRE DILAT KINK,$49.88,$0.00,$49.88,$27.08,$35.60,$0.00,$8.59,$0.00,$0.00,$8.73,$49.88,$0.00,$24.94,$39.50,$39.90,$0.00,$7.81,$0.00,$7.94,$0.00
RSS606,SUP,HCPCS C1894,,RSS606  -  INTRODUCER SHEATH 6FR 25CM 2.5CM DILAT KINK RESISTANT,$42.88,$0.00,$42.88,$23.28,$30.60,$0.00,$7.39,$0.00,$0.00,$7.51,$42.88,$0.00,$21.44,$33.96,$34.30,$0.00,$6.71,$0.00,$6.83,$0.00
RSS705,SUP,HCPCS C1894,,RSS705  -  SHEATH INTRO 7FR 25CM 2.5CM PNCL DIL KINK RST SS HDRPH PTFE,$498.75,$0.00,$498.75,$270.82,$355.96,$0.00,$85.93,$0.00,$0.00,$87.33,$498.75,$0.00,$249.38,$395.01,$399.00,$0.00,$78.05,$0.00,$79.40,$0.00
RSS706,SUP,HCPCS C1894,,RSS706  -  INTRODUCER SHEATH 7FR 25CM 2.5CM DILAT KINK RESISTANT SMOOTH,$42.88,$0.00,$42.88,$23.28,$30.60,$0.00,$7.39,$0.00,$0.00,$7.51,$42.88,$0.00,$21.44,$33.96,$34.30,$0.00,$6.71,$0.00,$6.83,$0.00
RSS803,SUP,HCPCS C1894,,RSS803  -  INTRODUCER SHEATH .035IN 8FR 10CM 2.5CM DILAT KINK RESISTANT,$21.88,$0.00,$21.88,$11.88,$15.61,$0.00,$3.77,$0.00,$0.00,$3.83,$21.88,$0.00,$10.94,$17.33,$17.50,$0.00,$3.42,$0.00,$3.48,$0.00
RSS805,SUP,HCPCS C1894,,RSS805  -  INTRODUCER SHTH 8FR 25CM 2.5CM PNCL DIL MN GW KINK RST PERI,$49.88,$0.00,$49.88,$27.08,$35.60,$0.00,$8.59,$0.00,$0.00,$8.73,$49.88,$0.00,$24.94,$39.50,$39.90,$0.00,$7.81,$0.00,$7.94,$0.00
RSS903,SUP,HCPCS C1894,,RSS903  -  SHEATH INTROD .038IN 9FR 10CM 2.5CM GWIRE DILAT KINK,$21.88,$0.00,$21.88,$11.88,$15.61,$0.00,$3.77,$0.00,$0.00,$3.83,$21.88,$0.00,$10.94,$17.33,$17.50,$0.00,$3.42,$0.00,$3.48,$0.00
RSZ-3004,SUP,Custom 27203010,,RSZ-3004  -  SIZER IMPL P4.5CM HI PRFL RND 11.1CM 300ML STRL MEMORYGEL,$737.50,$0.00,$737.50,$0.00,$526.35,$0.00,$0.00,$0.00,$0.00,$0.00,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$0.00,$0.00,$0.00,$0.00
RSZ-3504,SUP,Custom 27203010,,RSZ-3504  -  SIZER IMPL P4.8CM HI PRFL RND 11.7CM 350ML STRL MEMORYGEL,$737.50,$0.00,$737.50,$0.00,$526.35,$0.00,$0.00,$0.00,$0.00,$0.00,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$0.00,$0.00,$0.00,$0.00
RSZ-8004,SUP,Custom 27803010,,RSZ-8004  -  SIZER IMPL P6CM HI PRFL RND 15.5CM 800ML STRL MEMORYGEL GEL,"$2,325.00",$0.00,"$2,325.00",$0.00,"$1,659.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,325.00",$0.00,"$1,162.50","$1,841.40","$1,860.00",$0.00,$0.00,$0.00,$0.00,$0.00
RT500-853,SUP,Custom 27203010,,CIRCUIT BRTHG HEAT RESP PORTLESS WYE PRLL WIRE CSTM 5FT ADLT,$31.25,$0.00,$31.25,$0.00,$22.30,$0.00,$0.00,$0.00,$0.00,$0.00,$31.25,$0.00,$15.63,$24.75,$25.00,$0.00,$0.00,$0.00,$0.00,$0.00
RU510418,SUP,HCPCS C1758,,RU510418  -  CATHETER URETHERAL SZ 18,$7.51,$0.00,$7.51,$4.08,$5.36,$0.00,$1.29,$0.00,$0.00,$1.31,$7.51,$0.00,$3.76,$5.95,$6.01,$0.00,$1.18,$0.00,$1.20,$0.00
RU510420,SUP,HCPCS C1729,,RU510420  -  CATHETER ROBINSON URETHERAL SZ 20,$7.81,$0.00,$7.81,$4.24,$5.57,$0.00,$1.35,$0.00,$0.00,$1.37,$7.81,$0.00,$3.90,$6.19,$6.25,$0.00,$1.22,$0.00,$1.24,$0.00
RV80510,SUP,HCPCS C1725,,RV80510  -  CATHETER BLNDIL 5MM 80CM 10CM RIVAL CK 2 LUM TPR TIP LOPRFL,$575.00,$0.00,$575.00,$312.23,$410.38,$0.00,$99.07,$0.00,$0.00,$100.68,$575.00,$0.00,$287.50,$455.40,$460.00,$0.00,$89.99,$0.00,$91.54,$0.00
S0412-00,SUP,Custom 27203010,,KIT FTL MTRN BLOOD HMTLTST 950ML 300 TST,$625.25,$0.00,$625.25,$0.00,$446.24,$0.00,$0.00,$0.00,$0.00,$0.00,$625.25,$0.00,$312.63,$495.20,$500.20,$0.00,$0.00,$0.00,$0.00,$0.00
S-0793-HA42,SUP,Custom 27803010,,S-0793-HA42  -  CUP ACETAB 42MM 22MM CEMENTED ODC ALL POLY HIP,$822.00,$0.00,$822.00,$0.00,$586.66,$0.00,$0.00,$0.00,$0.00,$0.00,$822.00,$0.00,$411.00,$651.02,$657.60,$0.00,$0.00,$0.00,$0.00,$0.00
S-0793-HA46,SUP,Custom 27803010,,S-0793-HA46  -  CUP ACETAB 46MM 22MM CEMENTED ODC ALL POLY HIP,$822.00,$0.00,$822.00,$0.00,$586.66,$0.00,$0.00,$0.00,$0.00,$0.00,$822.00,$0.00,$411.00,$651.02,$657.60,$0.00,$0.00,$0.00,$0.00,$0.00
S-0793-HA50,SUP,Custom 27803010,,S-0793-HA50  -  CUP ACETAB 50MM 22MM CEMENTED ODC ALL POLY HIP,$822.00,$0.00,$822.00,$0.00,$586.66,$0.00,$0.00,$0.00,$0.00,$0.00,$822.00,$0.00,$411.00,$651.02,$657.60,$0.00,$0.00,$0.00,$0.00,$0.00
S-0793-HA54,SUP,Custom 27803010,,S-0793-HA54  -  CUP ACETAB 54MM 22MM CEMENTED ODC ALL POLY HIP,$822.00,$0.00,$822.00,$0.00,$586.66,$0.00,$0.00,$0.00,$0.00,$0.00,$822.00,$0.00,$411.00,$651.02,$657.60,$0.00,$0.00,$0.00,$0.00,$0.00
S-0793-HA58,SUP,Custom 27803010,,S-0793-HA58  -  CUP ACETAB 58MM 22MM CEMENTED ODC ALL POLY HIP,$822.00,$0.00,$822.00,$0.00,$586.66,$0.00,$0.00,$0.00,$0.00,$0.00,$822.00,$0.00,$411.00,$651.02,$657.60,$0.00,$0.00,$0.00,$0.00,$0.00
S0809,SUP,Custom 27203010,,REAGENT AB DILU DAKO 125ML INVIT DX IMMUN,$162.20,$0.00,$162.20,$0.00,$115.76,$0.00,$0.00,$0.00,$0.00,$0.00,$162.20,$0.00,$81.10,$128.46,$129.76,$0.00,$0.00,$0.00,$0.00,$0.00
S100000,SUP,Custom 27203010,,S100000  -  NEEDLE INSFL 14GA 100MM STP TROC BLDLS RADL EXPANDABLE SLV,$40.37,$0.00,$40.37,$0.00,$28.81,$0.00,$0.00,$0.00,$0.00,$0.00,$40.37,$0.00,$20.19,$31.97,$32.30,$0.00,$0.00,$0.00,$0.00,$0.00
S-101,SUP,HCPCS C1763,,S-101  -  GRAFT SFT TIS 3X3IN MEDISKIN PIG DRML CLGN MTRX SHT,$321.00,$0.00,$321.00,$144.45,$229.10,$0.00,$55.31,$0.00,$0.00,$56.20,$321.00,$0.00,$160.50,$254.23,$256.80,$0.00,$50.24,$0.00,$51.10,$0.00
S1020GH,SUP,HCPCS C1884,,S1020GH  -  PARTICLES EMBL 900-1200UM MCSPH 1ML PUR EMBSPH PREFL SYR,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
S-104,SUP,HCPCS C1763,,S-104  -  DRESSING WND .25SQ FT PRCN,$175.78,$0.00,$175.78,$79.10,$125.45,$0.00,$30.29,$0.00,$0.00,$30.78,$175.78,$0.00,$87.89,$139.22,$140.62,$0.00,$27.51,$0.00,$27.98,$0.00
S1-1500U,SUP,Custom 27803010,,S1-1500U  -  STENT LCRML DCT .64MM 40MM STRL MN MNK DIL PLG INSRTR SIL,$145.83,$0.00,$145.83,$0.00,$104.08,$0.00,$0.00,$0.00,$0.00,$0.00,$145.83,$0.00,$72.92,$115.50,$116.67,$0.00,$0.00,$0.00,$0.00,$0.00
S-1399-HH22,SUP,Custom 27803010,,S-1399-HH22  -  HEAD FEM HIP MRS TPR INTLK ION,"$1,147.00",$0.00,"$1,147.00",$0.00,$818.61,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,147.00",$0.00,$573.50,$908.42,$917.60,$0.00,$0.00,$0.00,$0.00,$0.00
S-1399-HH31,SUP,Custom 27803010,,S-1399-HH31  -  HEAD FEM HIP MRS TPR INTLK ION,"$1,147.00",$0.00,"$1,147.00",$0.00,$818.61,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,147.00",$0.00,$573.50,$908.42,$917.60,$0.00,$0.00,$0.00,$0.00,$0.00
S-1399-HH32,SUP,Custom 27803010,,S-1399-HH32  -  HEAD FEM HIP MRS TPR INTLK ION,"$1,147.00",$0.00,"$1,147.00",$0.00,$818.61,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,147.00",$0.00,$573.50,$908.42,$917.60,$0.00,$0.00,$0.00,$0.00,$0.00
S-1399-HH34,SUP,Custom 27803010,,S-1399-HH34  -  HEAD FEM 34MM HIP MRS TPR INTLK,"$1,147.00",$0.00,"$1,147.00",$0.00,$818.61,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,147.00",$0.00,$573.50,$908.42,$917.60,$0.00,$0.00,$0.00,$0.00,$0.00
S-1399-HH62,SUP,Custom 27803010,,S-1399-HH62  -  HEAD FEM 62MM HIP MRS TPR INTLK,"$1,147.00",$0.00,"$1,147.00",$0.00,$818.61,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,147.00",$0.00,$573.50,$908.42,$917.60,$0.00,$0.00,$0.00,$0.00,$0.00
S-1399-HH64,SUP,Custom 27803010,,S-1399-HH64  -  HEAD FEM 64MM HIP MRS TPR INTLK,"$1,147.00",$0.00,"$1,147.00",$0.00,$818.61,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,147.00",$0.00,$573.50,$908.42,$917.60,$0.00,$0.00,$0.00,$0.00,$0.00
S-1399-HH82,SUP,Custom 27803010,,S-1399-HH82  -  HEAD FEM 82MM HIP MRS TPR INTLK,"$1,147.00",$0.00,"$1,147.00",$0.00,$818.61,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,147.00",$0.00,$573.50,$908.42,$917.60,$0.00,$0.00,$0.00,$0.00,$0.00
S-1399-HH83,SUP,Custom 27803010,,S-1399-HH83  -  HEAD FEM 83MM HIP MRS TPR INTLK ION,"$1,147.00",$0.00,"$1,147.00",$0.00,$818.61,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,147.00",$0.00,$573.50,$908.42,$917.60,$0.00,$0.00,$0.00,$0.00,$0.00
S-1399-HH84,SUP,Custom 27803010,,S-1399-HH84  -  HEAD FEM 84MM HIP MRS TPR INTLK,"$1,147.00",$0.00,"$1,147.00",$0.00,$818.61,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,147.00",$0.00,$573.50,$908.42,$917.60,$0.00,$0.00,$0.00,$0.00,$0.00
S-1400-HH22,SUP,Custom 27803010,,S-1400-HH22  -  HEAD FEMORAL +2.5MM C TAPER 22MM LFIT COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
S-1400-HH31,SUP,Custom 27803010,,S-1400-HH31  -  HEAD FEM -2.5MM OFST CTPR 32MM STRL LFIT INTMD NK COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
S-1400-HH32,SUP,Custom 27803010,,S-1400-HH32  -  HEAD FEMORAL +2.5MM 32MM C TAPER NECK PRIM LFIT TRIDENT COCR,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
S-1400-HH34,SUP,Custom 27803010,,S-1400-HH34  -  HEAD FEM +7.5MM OFST CTPR 32MM STRL LFIT INTMD NK COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
S-1400-HH62,SUP,Custom 27803010,,S-1400-HH62  -  HEAD FEMORAL +2.5MM 26MM C TAPER INTERLOK LFIT COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
S-1400-HH64,SUP,Custom 27803010,,S-1400-HH64  -  HEAD FEMORAL +7.5MM 26MM C TAPER INTERLOK LFIT COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
S-1400-HH82,SUP,Custom 27803010,,S-1400-HH82  -  HEAD FEMORAL +2.5MM OFFST C TAPER 28MM LFIT TRIDENT COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
S-1400-HH84,SUP,Custom 27803010,,S-1400-HH84  -  HEAD FEMORAL C TAPER INTERLOCK LFIT COCR HIP,$862.50,$0.00,$862.50,$0.00,$615.57,$0.00,$0.00,$0.00,$0.00,$0.00,$862.50,$0.00,$431.25,$683.10,$690.00,$0.00,$0.00,$0.00,$0.00,$0.00
S-1539-HA46,SUP,Custom 27803010,,S-1539-HA46  -  CUP ACETAB 26MM ODC ALPLY,$822.00,$0.00,$822.00,$0.00,$586.66,$0.00,$0.00,$0.00,$0.00,$0.00,$822.00,$0.00,$411.00,$651.02,$657.60,$0.00,$0.00,$0.00,$0.00,$0.00
S-1539-HA50,SUP,Custom 27803010,,S-1539-HA50  -  CUP ACETAB 50MM 26MM ODC ALL POLY HIP,$822.00,$0.00,$822.00,$0.00,$586.66,$0.00,$0.00,$0.00,$0.00,$0.00,$822.00,$0.00,$411.00,$651.02,$657.60,$0.00,$0.00,$0.00,$0.00,$0.00
S-1539-HA54,SUP,Custom 27803010,,S-1539-HA54  -  CUP ACETAB 54MM 26MM ODC ALL POLY HIP,$822.00,$0.00,$822.00,$0.00,$586.66,$0.00,$0.00,$0.00,$0.00,$0.00,$822.00,$0.00,$411.00,$651.02,$657.60,$0.00,$0.00,$0.00,$0.00,$0.00
S-1539-HA58,SUP,Custom 27803010,,S-1539-HA58  -  CUP ACETAB 58MM 26MM ODC ALL POLY HIP,$822.00,$0.00,$822.00,$0.00,$586.66,$0.00,$0.00,$0.00,$0.00,$0.00,$822.00,$0.00,$411.00,$651.02,$657.60,$0.00,$0.00,$0.00,$0.00,$0.00
S-1645-HF01,SUP,HCPCS C1776,,S-1645-HF01  -  STEM FEM MOD HYDRXAPT 1 HIP,"$5,300.00",$0.00,"$5,300.00","$2,385.00","$3,782.61",$0.00,$913.16,$0.00,$0.00,$927.99,"$5,300.00",$0.00,"$2,650.00","$4,197.60","$4,240.00",$0.00,$829.45,$0.00,$843.76,$0.00
S1699,SUP,Custom 27203010,,REAGENT TRGT RTRVL SOL 500ML CONCEN IMMUN,$773.05,$0.00,$773.05,$0.00,$551.73,$0.00,$0.00,$0.00,$0.00,$0.00,$773.05,$0.00,$386.53,$612.26,$618.44,$0.00,$0.00,$0.00,$0.00,$0.00
S17-45,SUP,Custom 27803010,,S17-45  -  GRAFT ENDOVASCULAR SHEATH ABDOMINAL AORTIC ANEURYSM,"$1,247.50",$0.00,"$1,247.50",$0.00,$890.34,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,247.50",$0.00,$623.75,$988.02,$998.00,$0.00,$0.00,$0.00,$0.00,$0.00
S195,SUP,Custom 27203010,,STAIN GMS 8OZ STK SOL HMTL,$246.25,$0.00,$246.25,$0.00,$175.75,$0.00,$0.00,$0.00,$0.00,$0.00,$246.25,$0.00,$123.13,$195.03,$197.00,$0.00,$0.00,$0.00,$0.00,$0.00
S1967,SUP,Custom 27203010,,REAGENT CLEAN SOL DAB-AWAY 1.25L HMTL,$347.30,$0.00,$347.30,$0.00,$247.87,$0.00,$0.00,$0.00,$0.00,$0.00,$347.30,$0.00,$173.65,$275.06,$277.84,$0.00,$0.00,$0.00,$0.00,$0.00
S20SFRN8,SUP,Custom 27803010,,S20SFRN8  -  CLIP SHRT INTNL UCLP FLXB REG NDL,"$6,210.00",$0.00,"$6,210.00",$0.00,"$4,432.08",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,210.00",$0.00,"$3,105.00","$4,918.32","$4,968.00",$0.00,$0.00,$0.00,$0.00,$0.00
S-2301-2646,SUP,Custom 27803010,,S-2301-2646  -  INSERT ACETAB 46-48MM 26MM 10D KNEE ECNTRC,"$2,299.38",$0.00,"$2,299.38",$0.00,"$1,641.06",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,299.38",$0.00,"$1,149.69","$1,821.11","$1,839.50",$0.00,$0.00,$0.00,$0.00,$0.00
S-2301-2648,SUP,Custom 27803010,,S-2301-2648  -  INSERT ACETAB 48MM 28MM 10D HIP ECNTRC,"$2,125.50",$0.00,"$2,125.50",$0.00,"$1,516.97",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.50",$0.00,"$1,062.75","$1,683.40","$1,700.40",$0.00,$0.00,$0.00,$0.00,$0.00
S-2301-2650,SUP,Custom 27803010,,S-2301-2650  -  INSERT ACETAB 50-52MM 26MM 10D HIP ECNTRC,"$2,299.38",$0.00,"$2,299.38",$0.00,"$1,641.06",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,299.38",$0.00,"$1,149.69","$1,821.11","$1,839.50",$0.00,$0.00,$0.00,$0.00,$0.00
S-2301-2652,SUP,Custom 27803010,,S-2301-2652  -  INSERT ACETAB 52MM 26MM 10D HIP ECNTRC,"$2,299.38",$0.00,"$2,299.38",$0.00,"$1,641.06",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,299.38",$0.00,"$1,149.69","$1,821.11","$1,839.50",$0.00,$0.00,$0.00,$0.00,$0.00
S-2301-2654,SUP,Custom 27803010,,S-2301-2654  -  INSERT ACETAB 54-56MM 26MM 10D HIP ECNTRC,"$2,299.38",$0.00,"$2,299.38",$0.00,"$1,641.06",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,299.38",$0.00,"$1,149.69","$1,821.11","$1,839.50",$0.00,$0.00,$0.00,$0.00,$0.00
S-2301-2656,SUP,Custom 27803010,,S-2301-2656  -  INSERT ACETAB 56MM 26MM 10D HIP ECNTRC,"$2,299.38",$0.00,"$2,299.38",$0.00,"$1,641.06",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,299.38",$0.00,"$1,149.69","$1,821.11","$1,839.50",$0.00,$0.00,$0.00,$0.00,$0.00
S-2301-2658,SUP,Custom 27803010,,S-2301-2658  -  INSERT ACETAB 58-60MM 26MM 10D HIP ECNTRC,"$2,299.38",$0.00,"$2,299.38",$0.00,"$1,641.06",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,299.38",$0.00,"$1,149.69","$1,821.11","$1,839.50",$0.00,$0.00,$0.00,$0.00,$0.00
S-2301-2662,SUP,Custom 27803010,,S-2301-2662  -  INSERT ACETAB 61-72MM 26MM 10D HIP ECNTRC,"$2,299.38",$0.00,"$2,299.38",$0.00,"$1,641.06",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,299.38",$0.00,"$1,149.69","$1,821.11","$1,839.50",$0.00,$0.00,$0.00,$0.00,$0.00
S-2301-2846,SUP,Custom 27803010,,S-2301-2846  -  INSERT ACETAB 46-48MM 28MM 10D ECNTRC,"$2,125.50",$0.00,"$2,125.50",$0.00,"$1,516.97",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.50",$0.00,"$1,062.75","$1,683.40","$1,700.40",$0.00,$0.00,$0.00,$0.00,$0.00
S-2301-2848,SUP,Custom 27803010,,S-2301-2848  -  INSERT ACETAB 48MM 28MM 10D HIP ECNTRC,"$2,125.50",$0.00,"$2,125.50",$0.00,"$1,516.97",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.50",$0.00,"$1,062.75","$1,683.40","$1,700.40",$0.00,$0.00,$0.00,$0.00,$0.00
S-2301-2850,SUP,Custom 27803010,,S-2301-2850  -  INSERT ACETAB 50MM 28MM 10D HIP ECNTRC,"$2,125.50",$0.00,"$2,125.50",$0.00,"$1,516.97",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.50",$0.00,"$1,062.75","$1,683.40","$1,700.40",$0.00,$0.00,$0.00,$0.00,$0.00
S-2301-2852,SUP,Custom 27803010,,S-2301-2852  -  INSERT ACETAB 52MM 28MM 10D HIP ECNTRC,"$2,125.50",$0.00,"$2,125.50",$0.00,"$1,516.97",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.50",$0.00,"$1,062.75","$1,683.40","$1,700.40",$0.00,$0.00,$0.00,$0.00,$0.00
S-2301-2854,SUP,Custom 27803010,,S-2301-2854  -  INSERT ACETAB 54MM 28MM 10D HIP ECNTRC,"$2,125.50",$0.00,"$2,125.50",$0.00,"$1,516.97",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.50",$0.00,"$1,062.75","$1,683.40","$1,700.40",$0.00,$0.00,$0.00,$0.00,$0.00
S-2301-2856,SUP,Custom 27803010,,S-2301-2856  -  INSERT ACETAB 56MM 28MM 10D HIP ECNTRC,"$2,125.50",$0.00,"$2,125.50",$0.00,"$1,516.97",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.50",$0.00,"$1,062.75","$1,683.40","$1,700.40",$0.00,$0.00,$0.00,$0.00,$0.00
S-2301-2858,SUP,Custom 27803010,,S-2301-2858  -  INSERT ACETAB 58-60MM 28MM 10D HIP ECNTRC,"$2,125.50",$0.00,"$2,125.50",$0.00,"$1,516.97",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.50",$0.00,"$1,062.75","$1,683.40","$1,700.40",$0.00,$0.00,$0.00,$0.00,$0.00
S-2301-2862,SUP,Custom 27803010,,S-2301-2862  -  INSERT ACETAB 61-72MM 28MM 10D HIP ECNTRC,"$2,125.50",$0.00,"$2,125.50",$0.00,"$1,516.97",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.50",$0.00,"$1,062.75","$1,683.40","$1,700.40",$0.00,$0.00,$0.00,$0.00,$0.00
S-2301-2866,SUP,Custom 27803010,,S-2301-2866  -  INSERT ACETAB 66-68MM 28MM 10D HIP ECNTRC,"$2,125.50",$0.00,"$2,125.50",$0.00,"$1,516.97",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.50",$0.00,"$1,062.75","$1,683.40","$1,700.40",$0.00,$0.00,$0.00,$0.00,$0.00
S-2301-2870,SUP,Custom 27803010,,S-2301-2870  -  INSERT ACETAB 70-72MM 28MM 10D HIP ECNTRC,"$2,125.50",$0.00,"$2,125.50",$0.00,"$1,516.97",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.50",$0.00,"$1,062.75","$1,683.40","$1,700.40",$0.00,$0.00,$0.00,$0.00,$0.00
S-2301-2874,SUP,Custom 27803010,,S-2301-2874  -  INSERT ACETAB 74MM 28MM 10D HIP ECNTRC,"$2,125.50",$0.00,"$2,125.50",$0.00,"$1,516.97",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.50",$0.00,"$1,062.75","$1,683.40","$1,700.40",$0.00,$0.00,$0.00,$0.00,$0.00
S-2301-3250,SUP,Custom 27803010,,S-2301-3250  -  INSERT ACETAB 50-52MM 32MM 10D HIP ECNTRC,"$2,125.50",$0.00,"$2,125.50",$0.00,"$1,516.97",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.50",$0.00,"$1,062.75","$1,683.40","$1,700.40",$0.00,$0.00,$0.00,$0.00,$0.00
S-2301-3252,SUP,Custom 27803010,,S-2301-3252  -  INSERT ACETAB 52MM 32MM 10D HIP ECNTRC,"$2,125.50",$0.00,"$2,125.50",$0.00,"$1,516.97",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.50",$0.00,"$1,062.75","$1,683.40","$1,700.40",$0.00,$0.00,$0.00,$0.00,$0.00
S-2301-3254,SUP,Custom 27803010,,S-2301-3254  -  INSERT ACETAB 54-56MM 32MM 10D HIP ECNTRC,"$2,125.50",$0.00,"$2,125.50",$0.00,"$1,516.97",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.50",$0.00,"$1,062.75","$1,683.40","$1,700.40",$0.00,$0.00,$0.00,$0.00,$0.00
S-2301-3256,SUP,Custom 27803010,,S-2301-3256  -  INSERT ACETAB 56MM 32MM 10D HIP ECNTRC,"$2,125.50",$0.00,"$2,125.50",$0.00,"$1,516.97",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.50",$0.00,"$1,062.75","$1,683.40","$1,700.40",$0.00,$0.00,$0.00,$0.00,$0.00
S-2301-3258,SUP,Custom 27803010,,S-2301-3258  -  INSERT ACETAB 58-60MM 32MM 10D HIP ECNTRC,"$2,125.50",$0.00,"$2,125.50",$0.00,"$1,516.97",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.50",$0.00,"$1,062.75","$1,683.40","$1,700.40",$0.00,$0.00,$0.00,$0.00,$0.00
S-2301-3262,SUP,Custom 27803010,,S-2301-3262  -  INSERT ACETAB 61-72MM 32MM 10D HIP ECNTRC,"$2,125.50",$0.00,"$2,125.50",$0.00,"$1,516.97",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.50",$0.00,"$1,062.75","$1,683.40","$1,700.40",$0.00,$0.00,$0.00,$0.00,$0.00
S-2301-3266,SUP,Custom 27803010,,S-2301-3266  -  INSERT ACETAB 66-68MM 32MM 10D HIP ECNTRC,"$2,125.50",$0.00,"$2,125.50",$0.00,"$1,516.97",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.50",$0.00,"$1,062.75","$1,683.40","$1,700.40",$0.00,$0.00,$0.00,$0.00,$0.00
S-2301-3270,SUP,Custom 27803010,,S-2301-3270  -  INSERT ACETAB 70-72MM 32MM 10D HIP ECNTRC,"$2,125.50",$0.00,"$2,125.50",$0.00,"$1,516.97",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.50",$0.00,"$1,062.75","$1,683.40","$1,700.40",$0.00,$0.00,$0.00,$0.00,$0.00
S-2301-3274,SUP,Custom 27803010,,S-2301-3274  -  INSERT ACETAB 74MM 32MM 10D HIP ECNTRC,"$2,125.50",$0.00,"$2,125.50",$0.00,"$1,516.97",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.50",$0.00,"$1,062.75","$1,683.40","$1,700.40",$0.00,$0.00,$0.00,$0.00,$0.00
S-2301C-2846,SUP,Custom 27803010,,S-2301C-2846  -  INSERT ACETAB 10D 46MM 28MM ECCENTRIC XFIRE HIP,"$3,105.00",$0.00,"$3,105.00",$0.00,"$2,216.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,105.00",$0.00,"$1,552.50","$2,459.16","$2,484.00",$0.00,$0.00,$0.00,$0.00,$0.00
S-2301C-2848,SUP,Custom 27803010,,S-2301C-2848  -  INSERT ACETAB 10D 48MM 28MM ECCENTRIC XFIRE HIP,"$3,105.00",$0.00,"$3,105.00",$0.00,"$2,216.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,105.00",$0.00,"$1,552.50","$2,459.16","$2,484.00",$0.00,$0.00,$0.00,$0.00,$0.00
S-2301C-2850,SUP,Custom 27803010,,S-2301C-2850  -  INSERT ACETAB 10D 50MM 28MM ECCENTRIC XFIRE HIP,"$3,105.00",$0.00,"$3,105.00",$0.00,"$2,216.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,105.00",$0.00,"$1,552.50","$2,459.16","$2,484.00",$0.00,$0.00,$0.00,$0.00,$0.00
S-2301C-2852,SUP,Custom 27803010,,S-2301C-2852  -  INSERT ACETAB 10D 52MM 28MM ECCENTRIC XFIRE HIP,"$3,105.00",$0.00,"$3,105.00",$0.00,"$2,216.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,105.00",$0.00,"$1,552.50","$2,459.16","$2,484.00",$0.00,$0.00,$0.00,$0.00,$0.00
S-2301C-2854,SUP,Custom 27803010,,S-2301C-2854  -  INSERT ACETAB 10D 54MM 28MM ECCENTRIC XFIRE HIP,"$3,105.00",$0.00,"$3,105.00",$0.00,"$2,216.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,105.00",$0.00,"$1,552.50","$2,459.16","$2,484.00",$0.00,$0.00,$0.00,$0.00,$0.00
S-2301C-2856,SUP,Custom 27803010,,S-2301C-2856  -  INSERT ACETAB 10D 56MM 28MM ECCENTRIC XFIRE HIP,"$3,105.00",$0.00,"$3,105.00",$0.00,"$2,216.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,105.00",$0.00,"$1,552.50","$2,459.16","$2,484.00",$0.00,$0.00,$0.00,$0.00,$0.00
S-2301C-2858,SUP,Custom 27803010,,S-2301C-2858  -  INSERT ACETAB 10D 58-60MM 28MM ECCENTRIC XFIRE HIP,"$3,105.00",$0.00,"$3,105.00",$0.00,"$2,216.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,105.00",$0.00,"$1,552.50","$2,459.16","$2,484.00",$0.00,$0.00,$0.00,$0.00,$0.00
S-2301C-2862,SUP,Custom 27803010,,S-2301C-2862  -  INSERT ACETAB 10D 62MM 28MM ECCENTRIC XFIRE HIP,"$3,105.00",$0.00,"$3,105.00",$0.00,"$2,216.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,105.00",$0.00,"$1,552.50","$2,459.16","$2,484.00",$0.00,$0.00,$0.00,$0.00,$0.00
S-2301C-2866,SUP,Custom 27803010,,S-2301C-2866  -  INSERT ACETAB 10D 66MM 28MM ECCENTRIC XFIRE HIP,"$3,105.00",$0.00,"$3,105.00",$0.00,"$2,216.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,105.00",$0.00,"$1,552.50","$2,459.16","$2,484.00",$0.00,$0.00,$0.00,$0.00,$0.00
S-2301C-2870,SUP,Custom 27803010,,S-2301C-2870  -  INSERT ACETAB 10D 70MM 28MM ECCENTRIC XFIRE HIP,"$3,105.00",$0.00,"$3,105.00",$0.00,"$2,216.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,105.00",$0.00,"$1,552.50","$2,459.16","$2,484.00",$0.00,$0.00,$0.00,$0.00,$0.00
S-2301C-2874,SUP,Custom 27803010,,S-2301C-2874  -  INSERT ACETAB 10D 74MM 28MM ECCENTRIC XFIRE HIP,"$3,105.00",$0.00,"$3,105.00",$0.00,"$2,216.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,105.00",$0.00,"$1,552.50","$2,459.16","$2,484.00",$0.00,$0.00,$0.00,$0.00,$0.00
S-2301C-3250,SUP,Custom 27803010,,S-2301C-3250  -  INSERT ACETAB 10D 50MM 32MM ECCENTRIC XFIRE HIP,"$3,105.00",$0.00,"$3,105.00",$0.00,"$2,216.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,105.00",$0.00,"$1,552.50","$2,459.16","$2,484.00",$0.00,$0.00,$0.00,$0.00,$0.00
S-2301C-3252,SUP,Custom 27803010,,S-2301C-3252  -  INSERT ACETAB 10D 52MM 32MM ECCENTRIC XFIRE HIP,"$3,105.00",$0.00,"$3,105.00",$0.00,"$2,216.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,105.00",$0.00,"$1,552.50","$2,459.16","$2,484.00",$0.00,$0.00,$0.00,$0.00,$0.00
S-2301C-3254,SUP,Custom 27803010,,S-2301C-3254  -  INSERT ACETAB 10D 54MM 32MM ECCENTRIC XFIRE HIP,"$3,105.00",$0.00,"$3,105.00",$0.00,"$2,216.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,105.00",$0.00,"$1,552.50","$2,459.16","$2,484.00",$0.00,$0.00,$0.00,$0.00,$0.00
S-2301C-3256,SUP,Custom 27803010,,S-2301C-3256  -  INSERT ACETAB 10D 56MM 32MM ECCENTRIC XFIRE HIP,"$3,105.00",$0.00,"$3,105.00",$0.00,"$2,216.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,105.00",$0.00,"$1,552.50","$2,459.16","$2,484.00",$0.00,$0.00,$0.00,$0.00,$0.00
S-2301C-3258,SUP,Custom 27803010,,S-2301C-3258  -  INSERT ACETAB 10D 58-60MM 32MM ECCENTRIC XFIRE HIP,"$3,105.00",$0.00,"$3,105.00",$0.00,"$2,216.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,105.00",$0.00,"$1,552.50","$2,459.16","$2,484.00",$0.00,$0.00,$0.00,$0.00,$0.00
S-2301C-3262,SUP,Custom 27803010,,S-2301C-3262  -  INSERT ACETAB 10D 62MM 32MM ECCENTRIC XFIRE HIP,"$3,105.00",$0.00,"$3,105.00",$0.00,"$2,216.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,105.00",$0.00,"$1,552.50","$2,459.16","$2,484.00",$0.00,$0.00,$0.00,$0.00,$0.00
S-2301C-3266,SUP,Custom 27803010,,S-2301C-3266  -  INSERT ACETAB 10D 66MM 32MM ECCENTRIC XFIRE HIP,"$3,105.00",$0.00,"$3,105.00",$0.00,"$2,216.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,105.00",$0.00,"$1,552.50","$2,459.16","$2,484.00",$0.00,$0.00,$0.00,$0.00,$0.00
S-2301C-3270,SUP,Custom 27803010,,S-2301C-3270  -  INSERT ACETAB 10D 70MM 32MM ECCENTRIC XFIRE HIP,"$3,105.00",$0.00,"$3,105.00",$0.00,"$2,216.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,105.00",$0.00,"$1,552.50","$2,459.16","$2,484.00",$0.00,$0.00,$0.00,$0.00,$0.00
S-2301C-3274,SUP,Custom 27803010,,S-2301C-3274  -  INSERT ACETAB 74MM 32MM 10D HIP ECNTRC OMFT,"$3,105.00",$0.00,"$3,105.00",$0.00,"$2,216.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,105.00",$0.00,"$1,552.50","$2,459.16","$2,484.00",$0.00,$0.00,$0.00,$0.00,$0.00
S-2302-2646,SUP,Custom 27803010,,S-2302-2646  -  INSERT ACETAB 46-48MM 26MM 20D HIP ECNTRC,"$2,299.38",$0.00,"$2,299.38",$0.00,"$1,641.06",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,299.38",$0.00,"$1,149.69","$1,821.11","$1,839.50",$0.00,$0.00,$0.00,$0.00,$0.00
S-2302-2648,SUP,Custom 27803010,,S-2302-2648  -  INSERT ACETAB 48MM 26MM 20D HIP ECNTRC,"$2,299.38",$0.00,"$2,299.38",$0.00,"$1,641.06",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,299.38",$0.00,"$1,149.69","$1,821.11","$1,839.50",$0.00,$0.00,$0.00,$0.00,$0.00
S-2302-2650,SUP,Custom 27803010,,S-2302-2650  -  INSERT ACETAB 50-52MM 26MM 20D HIP ECNTRC,"$2,299.38",$0.00,"$2,299.38",$0.00,"$1,641.06",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,299.38",$0.00,"$1,149.69","$1,821.11","$1,839.50",$0.00,$0.00,$0.00,$0.00,$0.00
S-2302-2652,SUP,Custom 27803010,,S-2302-2652  -  INSERT ACETAB 52MM 26MM 20D HIP ECNTRC,"$2,299.38",$0.00,"$2,299.38",$0.00,"$1,641.06",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,299.38",$0.00,"$1,149.69","$1,821.11","$1,839.50",$0.00,$0.00,$0.00,$0.00,$0.00
S-2302-2654,SUP,Custom 27803010,,S-2302-2654  -  INSERT ACETAB 54-56MM 26MM 20D HIP ECNTRC,"$2,299.38",$0.00,"$2,299.38",$0.00,"$1,641.06",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,299.38",$0.00,"$1,149.69","$1,821.11","$1,839.50",$0.00,$0.00,$0.00,$0.00,$0.00
S-2302-2656,SUP,Custom 27803010,,S-2302-2656  -  INSERT ACETAB 56MM 26MM 20D HIP ECNTRC,"$2,299.38",$0.00,"$2,299.38",$0.00,"$1,641.06",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,299.38",$0.00,"$1,149.69","$1,821.11","$1,839.50",$0.00,$0.00,$0.00,$0.00,$0.00
S-2302-2658,SUP,Custom 27803010,,S-2302-2658  -  INSERT ACETAB 58-60MM 26MM 20D HIP ECNTRC,"$2,299.38",$0.00,"$2,299.38",$0.00,"$1,641.06",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,299.38",$0.00,"$1,149.69","$1,821.11","$1,839.50",$0.00,$0.00,$0.00,$0.00,$0.00
S-2302-2662,SUP,Custom 27803010,,S-2302-2662  -  INSERT ACETAB 61-72MM 26MM 20D HIP ECNTRC,"$2,299.38",$0.00,"$2,299.38",$0.00,"$1,641.06",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,299.38",$0.00,"$1,149.69","$1,821.11","$1,839.50",$0.00,$0.00,$0.00,$0.00,$0.00
S-2302-2846,SUP,Custom 27803010,,S-2302-2846  -  INSERT ACETAB 46-48MM 28MM 20D HIP ECNTRC,"$2,125.50",$0.00,"$2,125.50",$0.00,"$1,516.97",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.50",$0.00,"$1,062.75","$1,683.40","$1,700.40",$0.00,$0.00,$0.00,$0.00,$0.00
S-2302-2848,SUP,Custom 27803010,,S-2302-2848  -  INSERT ACETAB 48MM 28MM 20D HIP ECNTRC,"$2,125.50",$0.00,"$2,125.50",$0.00,"$1,516.97",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.50",$0.00,"$1,062.75","$1,683.40","$1,700.40",$0.00,$0.00,$0.00,$0.00,$0.00
S-2302-2850,SUP,Custom 27803010,,S-2302-2850  -  INSERT ACETAB 50-52MM 28MM 20D HIP ECNTRC,"$2,125.50",$0.00,"$2,125.50",$0.00,"$1,516.97",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.50",$0.00,"$1,062.75","$1,683.40","$1,700.40",$0.00,$0.00,$0.00,$0.00,$0.00
S-2302-2852,SUP,Custom 27803010,,S-2302-2852  -  INSERT ACETAB 52MM 28MM 20D HIP ECNTRC,"$2,125.50",$0.00,"$2,125.50",$0.00,"$1,516.97",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.50",$0.00,"$1,062.75","$1,683.40","$1,700.40",$0.00,$0.00,$0.00,$0.00,$0.00
S-2302-2854,SUP,Custom 27803010,,S-2302-2854  -  INSERT ACETAB 54-56MM 28MM 20D HIP ECNTRC,"$2,125.50",$0.00,"$2,125.50",$0.00,"$1,516.97",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.50",$0.00,"$1,062.75","$1,683.40","$1,700.40",$0.00,$0.00,$0.00,$0.00,$0.00
S-2302-2856,SUP,Custom 27803010,,S-2302-2856  -  INSERT ACETAB 56MM 28MM 20D HIP ECNTRC,"$2,125.50",$0.00,"$2,125.50",$0.00,"$1,516.97",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.50",$0.00,"$1,062.75","$1,683.40","$1,700.40",$0.00,$0.00,$0.00,$0.00,$0.00
S-2302-2858,SUP,Custom 27803010,,S-2302-2858  -  INSERT ACETAB 58-60MM 28MM 20D HIP ECNTRC,"$2,125.50",$0.00,"$2,125.50",$0.00,"$1,516.97",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.50",$0.00,"$1,062.75","$1,683.40","$1,700.40",$0.00,$0.00,$0.00,$0.00,$0.00
S-2302-2862,SUP,Custom 27803010,,S-2302-2862  -  INSERT ACETAB 61-72MM 28MM 20D HIP ECNTRC,"$2,125.50",$0.00,"$2,125.50",$0.00,"$1,516.97",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.50",$0.00,"$1,062.75","$1,683.40","$1,700.40",$0.00,$0.00,$0.00,$0.00,$0.00
S-2302-2866,SUP,Custom 27803010,,S-2302-2866  -  INSERT ACETAB 66-68MM 28MM 20D HIP ECNTRC,"$2,125.50",$0.00,"$2,125.50",$0.00,"$1,516.97",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.50",$0.00,"$1,062.75","$1,683.40","$1,700.40",$0.00,$0.00,$0.00,$0.00,$0.00
S-2302-2870,SUP,Custom 27803010,,S-2302-2870  -  INSERT ACETAB 70-72MM 28MM 20D HIP ECNTRC,"$2,125.50",$0.00,"$2,125.50",$0.00,"$1,516.97",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.50",$0.00,"$1,062.75","$1,683.40","$1,700.40",$0.00,$0.00,$0.00,$0.00,$0.00
S-2302-2874,SUP,Custom 27803010,,S-2302-2874  -  INSERT ACETAB 74MM 28MM 20D HIP ECNTRC,"$2,125.50",$0.00,"$2,125.50",$0.00,"$1,516.97",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.50",$0.00,"$1,062.75","$1,683.40","$1,700.40",$0.00,$0.00,$0.00,$0.00,$0.00
S-2302-3250,SUP,Custom 27803010,,S-2302-3250  -  INSERT ACETAB 50-52MM 32MM 20D HIP ECNTRC,"$2,125.50",$0.00,"$2,125.50",$0.00,"$1,516.97",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.50",$0.00,"$1,062.75","$1,683.40","$1,700.40",$0.00,$0.00,$0.00,$0.00,$0.00
S-2302-3252,SUP,Custom 27803010,,S-2302-3252  -  INSERT ACETAB 52MM 32MM 20D HIP ECNTRC,"$2,125.50",$0.00,"$2,125.50",$0.00,"$1,516.97",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.50",$0.00,"$1,062.75","$1,683.40","$1,700.40",$0.00,$0.00,$0.00,$0.00,$0.00
S-2302-3254,SUP,Custom 27803010,,S-2302-3254  -  INSERT ACETAB 54-56MM 32MM 20D HIP ECNTRC,"$2,125.50",$0.00,"$2,125.50",$0.00,"$1,516.97",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.50",$0.00,"$1,062.75","$1,683.40","$1,700.40",$0.00,$0.00,$0.00,$0.00,$0.00
S-2302-3256,SUP,Custom 27803010,,S-2302-3256  -  INSERT ACETAB 56MM 32MM 20D HIP ECNTRC,"$2,125.50",$0.00,"$2,125.50",$0.00,"$1,516.97",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.50",$0.00,"$1,062.75","$1,683.40","$1,700.40",$0.00,$0.00,$0.00,$0.00,$0.00
S-2302-3258,SUP,Custom 27803010,,S-2302-3258  -  INSERT ACETAB 58-60MM 32MM 20D HIP ECNTRC,"$2,125.50",$0.00,"$2,125.50",$0.00,"$1,516.97",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.50",$0.00,"$1,062.75","$1,683.40","$1,700.40",$0.00,$0.00,$0.00,$0.00,$0.00
S-2302-3262,SUP,Custom 27803010,,S-2302-3262  -  INSERT ACETAB 61-72MM 32MM 20D HIP ECNTRC,"$2,125.50",$0.00,"$2,125.50",$0.00,"$1,516.97",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.50",$0.00,"$1,062.75","$1,683.40","$1,700.40",$0.00,$0.00,$0.00,$0.00,$0.00
S-2302-3266,SUP,Custom 27803010,,S-2302-3266  -  INSERT ACETAB 66-68MM 32MM 20D HIP ECNTRC,"$2,125.50",$0.00,"$2,125.50",$0.00,"$1,516.97",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.50",$0.00,"$1,062.75","$1,683.40","$1,700.40",$0.00,$0.00,$0.00,$0.00,$0.00
S-2302-3270,SUP,Custom 27803010,,S-2302-3270  -  INSERT ACETAB 70-72MM 32MM 20D ECNTRC 8MM,"$2,125.50",$0.00,"$2,125.50",$0.00,"$1,516.97",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,125.50",$0.00,"$1,062.75","$1,683.40","$1,700.40",$0.00,$0.00,$0.00,$0.00,$0.00
S-2302-3274,SUP,Custom 27803010,,S-2302-3274  -  INSERT ACETAB 74MM 32MM HIP ECNTRC,"$1,421.88",$0.00,"$1,421.88",$0.00,"$1,014.79",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,421.88",$0.00,$710.94,"$1,126.13","$1,137.50",$0.00,$0.00,$0.00,$0.00,$0.00
S-2302C-2846,SUP,Custom 27803010,,S-2302C-2846  -  INSERT ACETAB 20D 46MM 28MM ECCENTRIC XFIRE HIP,"$3,105.00",$0.00,"$3,105.00",$0.00,"$2,216.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,105.00",$0.00,"$1,552.50","$2,459.16","$2,484.00",$0.00,$0.00,$0.00,$0.00,$0.00
S-2302C-2848,SUP,Custom 27803010,,S-2302C-2848  -  INSERT ACETAB 20D 48MM 28MM ECCENTRIC XFIRE HIP,"$3,105.00",$0.00,"$3,105.00",$0.00,"$2,216.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,105.00",$0.00,"$1,552.50","$2,459.16","$2,484.00",$0.00,$0.00,$0.00,$0.00,$0.00
S-2302C-2850,SUP,Custom 27803010,,S-2302C-2850  -  INSERT ACETAB 20D 50MM 28MM ECCENTRIC XFIRE HIP,"$3,105.00",$0.00,"$3,105.00",$0.00,"$2,216.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,105.00",$0.00,"$1,552.50","$2,459.16","$2,484.00",$0.00,$0.00,$0.00,$0.00,$0.00
S-2302C-2852,SUP,Custom 27803010,,S-2302C-2852  -  INSERT ACETAB 20D 52MM 28MM ECCENTRIC XFIRE HIP,"$3,105.00",$0.00,"$3,105.00",$0.00,"$2,216.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,105.00",$0.00,"$1,552.50","$2,459.16","$2,484.00",$0.00,$0.00,$0.00,$0.00,$0.00
S-2302C-2854,SUP,Custom 27803010,,S-2302C-2854  -  INSERT ACETAB 20D 54MM 28MM ECCENTRIC XFIRE HIP,"$3,105.00",$0.00,"$3,105.00",$0.00,"$2,216.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,105.00",$0.00,"$1,552.50","$2,459.16","$2,484.00",$0.00,$0.00,$0.00,$0.00,$0.00
S-2302C-2856,SUP,Custom 27803010,,S-2302C-2856  -  INSERT ACETAB 20D 56MM 28MM ECCENTRIC XFIRE HIP,"$3,105.00",$0.00,"$3,105.00",$0.00,"$2,216.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,105.00",$0.00,"$1,552.50","$2,459.16","$2,484.00",$0.00,$0.00,$0.00,$0.00,$0.00
S-2302C-2858,SUP,Custom 27803010,,S-2302C-2858  -  INSERT ACETAB 20D 58MM 28MM ECCENTRIC XFIRE HIP,"$3,105.00",$0.00,"$3,105.00",$0.00,"$2,216.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,105.00",$0.00,"$1,552.50","$2,459.16","$2,484.00",$0.00,$0.00,$0.00,$0.00,$0.00
S-2302C-2862,SUP,Custom 27803010,,S-2302C-2862  -  INSERT ACETAB 20D 62MM 28MM ECCENTRIC XFIRE HIP,"$3,105.00",$0.00,"$3,105.00",$0.00,"$2,216.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,105.00",$0.00,"$1,552.50","$2,459.16","$2,484.00",$0.00,$0.00,$0.00,$0.00,$0.00
S-2302C-2866,SUP,Custom 27803010,,S-2302C-2866  -  INSERT ACETAB 20D 66MM 28MM ECCENTRIC XFIRE HIP,"$3,105.00",$0.00,"$3,105.00",$0.00,"$2,216.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,105.00",$0.00,"$1,552.50","$2,459.16","$2,484.00",$0.00,$0.00,$0.00,$0.00,$0.00
S-2302C-2870,SUP,Custom 27803010,,S-2302C-2870  -  INSERT ACETAB 20D 70MM 28MM ECCENTRIC XFIRE HIP,"$3,105.00",$0.00,"$3,105.00",$0.00,"$2,216.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,105.00",$0.00,"$1,552.50","$2,459.16","$2,484.00",$0.00,$0.00,$0.00,$0.00,$0.00
S-2302C-2874,SUP,Custom 27803010,,S-2302C-2874  -  INSERT ACETAB 20D 74MM 28MM ECCENTRIC XFIRE HIP,"$3,105.00",$0.00,"$3,105.00",$0.00,"$2,216.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,105.00",$0.00,"$1,552.50","$2,459.16","$2,484.00",$0.00,$0.00,$0.00,$0.00,$0.00
S-2302C-3250,SUP,Custom 27803010,,S-2302C-3250  -  INSERT ACETAB 20D 50MM 32MM ECCENTRIC XFIRE HIP,"$3,105.00",$0.00,"$3,105.00",$0.00,"$2,216.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,105.00",$0.00,"$1,552.50","$2,459.16","$2,484.00",$0.00,$0.00,$0.00,$0.00,$0.00
S-2302C-3252,SUP,Custom 27803010,,S-2302C-3252  -  INSERT ACETAB 20D 52MM 32MM ECCENTRIC XFIRE HIP,"$3,105.00",$0.00,"$3,105.00",$0.00,"$2,216.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,105.00",$0.00,"$1,552.50","$2,459.16","$2,484.00",$0.00,$0.00,$0.00,$0.00,$0.00
S-2302C-3254,SUP,Custom 27803010,,S-2302C-3254  -  INSERT ACETAB 20D 54MM 32MM ECCENTRIC XFIRE HIP,"$3,105.00",$0.00,"$3,105.00",$0.00,"$2,216.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,105.00",$0.00,"$1,552.50","$2,459.16","$2,484.00",$0.00,$0.00,$0.00,$0.00,$0.00
S-2302C-3256,SUP,Custom 27803010,,S-2302C-3256  -  INSERT ACETAB 20D 56MM 32MM ECCENTRIC XFIRE HIP,"$3,105.00",$0.00,"$3,105.00",$0.00,"$2,216.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,105.00",$0.00,"$1,552.50","$2,459.16","$2,484.00",$0.00,$0.00,$0.00,$0.00,$0.00
S-2302C-3258,SUP,Custom 27803010,,S-2302C-3258  -  INSERT ACETAB 20D 58MM 32MM ECCENTRIC XFIRE HIP,"$3,105.00",$0.00,"$3,105.00",$0.00,"$2,216.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,105.00",$0.00,"$1,552.50","$2,459.16","$2,484.00",$0.00,$0.00,$0.00,$0.00,$0.00
S-2302C-3262,SUP,Custom 27803010,,S-2302C-3262  -  INSERT ACETAB 20D 62MM 32MM ECCENTRIC XFIRE HIP,"$3,105.00",$0.00,"$3,105.00",$0.00,"$2,216.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,105.00",$0.00,"$1,552.50","$2,459.16","$2,484.00",$0.00,$0.00,$0.00,$0.00,$0.00
S-2302C-3266,SUP,Custom 27803010,,S-2302C-3266  -  INSERT ACETAB 20D 66MM 32MM ECCENTRIC XFIRE HIP,"$3,105.00",$0.00,"$3,105.00",$0.00,"$2,216.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,105.00",$0.00,"$1,552.50","$2,459.16","$2,484.00",$0.00,$0.00,$0.00,$0.00,$0.00
S-2302C-3270,SUP,Custom 27803010,,S-2302C-3270  -  INSERT ACETAB 20D 70MM 32MM ECCENTRIC XFIRE HIP,"$3,105.00",$0.00,"$3,105.00",$0.00,"$2,216.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,105.00",$0.00,"$1,552.50","$2,459.16","$2,484.00",$0.00,$0.00,$0.00,$0.00,$0.00
S-2302C-3274,SUP,Custom 27803010,,S-2302C-3274  -  INSERT ACETAB 20D 74MM 32MM ECCENTRIC XFIRE HIP,"$3,105.00",$0.00,"$3,105.00",$0.00,"$2,216.04",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,105.00",$0.00,"$1,552.50","$2,459.16","$2,484.00",$0.00,$0.00,$0.00,$0.00,$0.00
S-2337-HF04,SUP,HCPCS C1776,,S-2337-HF04  -  STEM FEMORAL 4 100MM COLLAR ARC PRESS FIT SECFIT HA TITANIUM,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
S-2337-HF05,SUP,HCPCS C1776,,S-2337-HF05  -  STEM FEMORAL 5 110MM COLLAR ARC PRESS FIT SECFIT HA TITANIUM,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
S-2337-HF06,SUP,HCPCS C1776,,S-2337-HF06  -  STEM FEMORAL 6 COLLARED SECFIT HYDRXAPT HIP,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
S-2337-HF07,SUP,HCPCS C1776,,S-2337-HF07  -  STEM FEMORAL 7 COLLARED SECFIT HYDRXAPT HIP,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
S-2337-HF08,SUP,HCPCS C1776,,S-2337-HF08  -  STEM FEMORAL 8 COLLARED SECFIT HYDRXAPT HIP,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
S-2337-HF09,SUP,HCPCS C1776,,S-2337-HF09  -  STEM FEMORAL COLLARED ARC DEPOSITED SECFIT HYDRXAPT,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
S-2337-HF10,SUP,HCPCS C1776,,S-2337-HF10  -  STEM FEMORAL 10 COLLARED SECFIT HYDRXAPT HIP,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
S-2337-HF11,SUP,HCPCS C1776,,S-2337-HF11  -  STEM FEMORAL 11 COLLARED SECFIT HYDRXAPT HIP,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
S-2337-HF12,SUP,HCPCS C1776,,S-2337-HF12  -  STEM FEMORAL 12 COLLAR ARC DEPOSITED SECFIT HYDRXAPT HIP,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
S-2337-HF13,SUP,HCPCS C1776,,S-2337-HF13  -  STEM FEMORAL 13 COLLARED ARC DEPOSITED SECFIT HYDRXAPT HIP,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
S-2337-HF14,SUP,HCPCS C1776,,S-2337-HF14  -  STEM FEMORAL 14 180MM COLLAR ARC PRESS FIT SECFIT HA,"$5,180.00",$0.00,"$5,180.00","$2,331.00","$3,696.97",$0.00,$892.49,$0.00,$0.00,$906.98,"$5,180.00",$0.00,"$2,590.00","$4,102.56","$4,144.00",$0.00,$810.67,$0.00,$824.66,$0.00
S2368,SUP,Custom 27203010,,REAGENT TRIS EDTA BUFF 500ML PH 9 TRGT RTRVL SOL HISTOLGY,$243.68,$0.00,$243.68,$0.00,$173.91,$0.00,$0.00,$0.00,$0.00,$0.00,$243.68,$0.00,$121.84,$192.99,$194.94,$0.00,$0.00,$0.00,$0.00,$0.00
S2369,SUP,Custom 27203010,,REAGENT TRGT RTRVL SOL CITR 500ML PH 6 CONCEN HISTOLGY,"$1,109.15",$0.00,"$1,109.15",$0.00,$791.60,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,109.15",$0.00,$554.58,$878.45,$887.32,$0.00,$0.00,$0.00,$0.00,$0.00
S-2651-0711,SUP,HCPCS C1776,,S-2651-0711  -  NECK FEMORAL 7 -5MM STR 11MM 155MM REDUCE RSTOR TITANIUM HA,"$11,937.50",$0.00,"$11,937.50","$5,371.88","$5,158.80",$0.00,"$2,056.77",$0.00,$0.00,"$2,090.16","$11,937.50",$0.00,"$5,968.75","$9,454.50","$9,550.00",$0.00,"$1,868.22",$0.00,"$1,900.45",$0.00
S-2651-0713,SUP,HCPCS C1776,,S-2651-0713  -  NECK FEMORAL 7 -5MM STR 13MM 155MM REDUCE RSTOR TITANIUM HA,"$11,937.50",$0.00,"$11,937.50","$5,371.88","$5,158.80",$0.00,"$2,056.77",$0.00,$0.00,"$2,090.16","$11,937.50",$0.00,"$5,968.75","$9,454.50","$9,550.00",$0.00,"$1,868.22",$0.00,"$1,900.45",$0.00
S-2651-0812,SUP,HCPCS C1776,,S-2651-0812  -  NECK FEMORAL 8 -5MM STR 12MM 155MM REDUCE RSTOR TITANIUM HA,"$11,937.50",$0.00,"$11,937.50","$5,371.88","$5,158.80",$0.00,"$2,056.77",$0.00,$0.00,"$2,090.16","$11,937.50",$0.00,"$5,968.75","$9,454.50","$9,550.00",$0.00,"$1,868.22",$0.00,"$1,900.45",$0.00
S-2651-0814,SUP,HCPCS C1776,,S-2651-0814  -  NECK FEMORAL 8 -5MM STR 14MM 155MM REDUCE RSTOR TITANIUM HA,"$11,937.50",$0.00,"$11,937.50","$5,371.88","$5,158.80",$0.00,"$2,056.77",$0.00,$0.00,"$2,090.16","$11,937.50",$0.00,"$5,968.75","$9,454.50","$9,550.00",$0.00,"$1,868.22",$0.00,"$1,900.45",$0.00
S-2651-0913,SUP,HCPCS C1776,,S-2651-0913  -  NECK FEMORAL 9 -5MM STR 13MM 155MM REDUCE RSTOR TITANIUM HA,"$11,937.50",$0.00,"$11,937.50","$5,371.88","$5,158.80",$0.00,"$2,056.77",$0.00,$0.00,"$2,090.16","$11,937.50",$0.00,"$5,968.75","$9,454.50","$9,550.00",$0.00,"$1,868.22",$0.00,"$1,900.45",$0.00
S-2651-0915,SUP,HCPCS C1776,,S-2651-0915  -  STEM FEMORAL 9 -5MM STR 15MM 155MM REDUCE NECK RSTOR HA,"$11,937.50",$0.00,"$11,937.50","$5,371.88","$5,158.80",$0.00,"$2,056.77",$0.00,$0.00,"$2,090.16","$11,937.50",$0.00,"$5,968.75","$9,454.50","$9,550.00",$0.00,"$1,868.22",$0.00,"$1,900.45",$0.00
S-2651-1014,SUP,HCPCS C1776,,S-2651-1014  -  NECK FEMORAL 10 -5MM STR 14MM 155MM REDUCE RSTOR TITANIUM HA,"$11,937.50",$0.00,"$11,937.50","$5,371.88","$5,158.80",$0.00,"$2,056.77",$0.00,$0.00,"$2,090.16","$11,937.50",$0.00,"$5,968.75","$9,454.50","$9,550.00",$0.00,"$1,868.22",$0.00,"$1,900.45",$0.00
S-2651-1016,SUP,HCPCS C1776,,S-2651-1016  -  NECK FEMORAL 10 -5MM STR 16MM 155MM REDUCE RSTOR TITANIUM HA,"$11,937.50",$0.00,"$11,937.50","$5,371.88","$5,158.80",$0.00,"$2,056.77",$0.00,$0.00,"$2,090.16","$11,937.50",$0.00,"$5,968.75","$9,454.50","$9,550.00",$0.00,"$1,868.22",$0.00,"$1,900.45",$0.00
S-2651-1115,SUP,HCPCS C1776,,S-2651-1115  -  NECK FEMORAL 11 -5MM STR 15MM 155MM REDUCE RSTOR TITANIUM HA,"$11,937.50",$0.00,"$11,937.50","$5,371.88","$5,158.80",$0.00,"$2,056.77",$0.00,$0.00,"$2,090.16","$11,937.50",$0.00,"$5,968.75","$9,454.50","$9,550.00",$0.00,"$1,868.22",$0.00,"$1,900.45",$0.00
S-2651-1117,SUP,HCPCS C1776,,S-2651-1117  -  NECK FEMORAL 11 -5MM STR 17MM 155MM REDUCE RSTOR TITANIUM HA,"$11,937.50",$0.00,"$11,937.50","$5,371.88","$5,158.80",$0.00,"$2,056.77",$0.00,$0.00,"$2,090.16","$11,937.50",$0.00,"$5,968.75","$9,454.50","$9,550.00",$0.00,"$1,868.22",$0.00,"$1,900.45",$0.00
S-2651-1216,SUP,HCPCS C1776,,S-2651-1216  -  NECK FEMORAL 12 -5MM STR 16MM 155MM REDUCE RSTOR TITANIUM HA,"$11,937.50",$0.00,"$11,937.50","$5,371.88","$5,158.80",$0.00,"$2,056.77",$0.00,$0.00,"$2,090.16","$11,937.50",$0.00,"$5,968.75","$9,454.50","$9,550.00",$0.00,"$1,868.22",$0.00,"$1,900.45",$0.00
S-2651-1218,SUP,HCPCS C1776,,S-2651-1218  -  NECK FEMORAL 12 -5MM STR 18MM 155MM REDUCE RSTOR TITANIUM HA,"$11,937.50",$0.00,"$11,937.50","$5,371.88","$5,158.80",$0.00,"$2,056.77",$0.00,$0.00,"$2,090.16","$11,937.50",$0.00,"$5,968.75","$9,454.50","$9,550.00",$0.00,"$1,868.22",$0.00,"$1,900.45",$0.00
S-2652-0812,SUP,HCPCS C1776,,S-2652-0812  -  NECK FEMORAL 8 -5MM STR 12MM 205MM REDUCE RSTOR TITANIUM HA,"$12,645.00",$0.00,"$12,645.00","$5,690.25","$5,158.80",$0.00,"$2,178.67",$0.00,$0.00,"$2,214.04","$12,645.00",$0.00,"$6,322.50","$10,014.84","$10,116.00",$0.00,"$1,978.94",$0.00,"$2,013.08",$0.00
S-2652-0814,SUP,HCPCS C1776,,S-2652-0814  -  NECK FEMORAL 8 -5MM STR 14MM 205MM REDUCE RSTOR TITANIUM HA,"$12,645.00",$0.00,"$12,645.00","$5,690.25","$5,158.80",$0.00,"$2,178.67",$0.00,$0.00,"$2,214.04","$12,645.00",$0.00,"$6,322.50","$10,014.84","$10,116.00",$0.00,"$1,978.94",$0.00,"$2,013.08",$0.00
S-2652-0913,SUP,HCPCS C1776,,S-2652-0913  -  NECK FEMORAL 9 -5MM STR 13MM 205MM REDUCE RSTOR TITANIUM HA,"$12,645.00",$0.00,"$12,645.00","$5,690.25","$5,158.80",$0.00,"$2,178.67",$0.00,$0.00,"$2,214.04","$12,645.00",$0.00,"$6,322.50","$10,014.84","$10,116.00",$0.00,"$1,978.94",$0.00,"$2,013.08",$0.00
S-2652-0915,SUP,HCPCS C1776,,S-2652-0915  -  NECK FEMORAL 9 -5MM STR 15MM 205MM REDUCE RSTOR TITANIUM HA,"$12,645.00",$0.00,"$12,645.00","$5,690.25","$5,158.80",$0.00,"$2,178.67",$0.00,$0.00,"$2,214.04","$12,645.00",$0.00,"$6,322.50","$10,014.84","$10,116.00",$0.00,"$1,978.94",$0.00,"$2,013.08",$0.00
S-2652-1014,SUP,HCPCS C1776,,S-2652-1014  -  NECK FEMORAL 10 -5MM STR 14MM 205MM REDUCE RSTOR TITANIUM HA,"$12,645.00",$0.00,"$12,645.00","$5,690.25","$5,158.80",$0.00,"$2,178.67",$0.00,$0.00,"$2,214.04","$12,645.00",$0.00,"$6,322.50","$10,014.84","$10,116.00",$0.00,"$1,978.94",$0.00,"$2,013.08",$0.00
S-2652-1016,SUP,HCPCS C1776,,S-2652-1016  -  NECK FEMORAL 10 -5MM STR 16MM 205MM REDUCE RSTOR TITANIUM HA,"$12,645.00",$0.00,"$12,645.00","$5,690.25","$5,158.80",$0.00,"$2,178.67",$0.00,$0.00,"$2,214.04","$12,645.00",$0.00,"$6,322.50","$10,014.84","$10,116.00",$0.00,"$1,978.94",$0.00,"$2,013.08",$0.00
S-2652-1115,SUP,HCPCS C1776,,S-2652-1115  -  NECK FEMORAL 11 -5MM STR 15MM 205MM REDUCE RSTOR TITANIUM HA,"$12,645.00",$0.00,"$12,645.00","$5,690.25","$5,158.80",$0.00,"$2,178.67",$0.00,$0.00,"$2,214.04","$12,645.00",$0.00,"$6,322.50","$10,014.84","$10,116.00",$0.00,"$1,978.94",$0.00,"$2,013.08",$0.00
S-2652-1117,SUP,HCPCS C1776,,S-2652-1117  -  STEM FEMORAL 11 -5MM STR 17MM 205MM REDUCE NECK RSTOR HA,"$12,645.00",$0.00,"$12,645.00","$5,690.25","$5,158.80",$0.00,"$2,178.67",$0.00,$0.00,"$2,214.04","$12,645.00",$0.00,"$6,322.50","$10,014.84","$10,116.00",$0.00,"$1,978.94",$0.00,"$2,013.08",$0.00
S-2652-1216,SUP,HCPCS C1776,,S-2652-1216  -  NECK FEMORAL 12 -5MM STR 16MM 205MM REDUCE RSTOR TITANIUM HA,"$12,645.00",$0.00,"$12,645.00","$5,690.25","$5,158.80",$0.00,"$2,178.67",$0.00,$0.00,"$2,214.04","$12,645.00",$0.00,"$6,322.50","$10,014.84","$10,116.00",$0.00,"$1,978.94",$0.00,"$2,013.08",$0.00
S-2652-1218,SUP,HCPCS C1776,,S-2652-1218  -  STEM FEMORAL 12 -5MM STR 18MM 205MM REDUCE NECK RSTOR HA,"$12,645.00",$0.00,"$12,645.00","$5,690.25","$5,158.80",$0.00,"$2,178.67",$0.00,$0.00,"$2,214.04","$12,645.00",$0.00,"$6,322.50","$10,014.84","$10,116.00",$0.00,"$1,978.94",$0.00,"$2,013.08",$0.00
S-2652-1317,SUP,HCPCS C1776,,S-2652-1317  -  NECK FEMORAL 17 -5MM STR 13MM 205MM REDUCE RSTOR TITANIUM HA,"$12,645.00",$0.00,"$12,645.00","$5,690.25","$5,158.80",$0.00,"$2,178.67",$0.00,$0.00,"$2,214.04","$12,645.00",$0.00,"$6,322.50","$10,014.84","$10,116.00",$0.00,"$1,978.94",$0.00,"$2,013.08",$0.00
S-2652-1319,SUP,HCPCS C1776,,S-2652-1319  -  NECK FEMORAL 13 -5MM STR 19MM 205MM REDUCE RSTOR TITANIUM HA,"$12,645.00",$0.00,"$12,645.00","$5,690.25","$5,158.80",$0.00,"$2,178.67",$0.00,$0.00,"$2,214.04","$12,645.00",$0.00,"$6,322.50","$10,014.84","$10,116.00",$0.00,"$1,978.94",$0.00,"$2,013.08",$0.00
S-2652-1418,SUP,HCPCS C1776,,S-2652-1418  -  NECK FEMORAL 14 -5MM STR 18MM 205MM REDUCE RSTOR TITANIUM HA,"$12,645.00",$0.00,"$12,645.00","$5,690.25","$5,158.80",$0.00,"$2,178.67",$0.00,$0.00,"$2,214.04","$12,645.00",$0.00,"$6,322.50","$10,014.84","$10,116.00",$0.00,"$1,978.94",$0.00,"$2,013.08",$0.00
S-2652-1420,SUP,HCPCS C1776,,S-2652-1420  -  NECK FEMORAL 14 -5MM STR 20MM 205MM REDUCE RSTOR TITANIUM HA,"$12,645.00",$0.00,"$12,645.00","$5,690.25","$5,158.80",$0.00,"$2,178.67",$0.00,$0.00,"$2,214.04","$12,645.00",$0.00,"$6,322.50","$10,014.84","$10,116.00",$0.00,"$1,978.94",$0.00,"$2,013.08",$0.00
S-2652-1422,SUP,HCPCS C1776,,S-2652-1422  -  NECK FEMORAL 14 -5MM STR 22MM 205MM REDUCE RSTOR TITANIUM HA,"$12,645.00",$0.00,"$12,645.00","$5,690.25","$5,158.80",$0.00,"$2,178.67",$0.00,$0.00,"$2,214.04","$12,645.00",$0.00,"$6,322.50","$10,014.84","$10,116.00",$0.00,"$1,978.94",$0.00,"$2,013.08",$0.00
S-2653-0812-L,SUP,HCPCS C1776,,S-2653-0812-L  -  STEM FEM LEFT HIP 255MM 12-8MM STR DISTAL SLOT RED NECK REV,"$13,222.63",$0.00,"$13,222.63","$5,950.18","$5,158.80",$0.00,"$2,278.19",$0.00,$0.00,"$2,315.18","$13,222.63",$0.00,"$6,611.31","$10,472.32","$10,578.10",$0.00,"$2,069.34",$0.00,"$2,105.04",$0.00
S-2653-0812-R,SUP,HCPCS C1776,,S-2653-0812-R  -  STEM FEM RIGHT HIP 255MM 12-8MM STR DISTAL SLOT RED NECK REV,"$13,222.63",$0.00,"$13,222.63","$5,950.18","$5,158.80",$0.00,"$2,278.19",$0.00,$0.00,"$2,315.18","$13,222.63",$0.00,"$6,611.31","$10,472.32","$10,578.10",$0.00,"$2,069.34",$0.00,"$2,105.04",$0.00
S-2653-0913-L,SUP,HCPCS C1776,,S-2653-0913-L  -  STEM FEM LEFT HIP 255MM 13-9MM STR DISTAL SLOT RED NECK REV,"$13,222.63",$0.00,"$13,222.63","$5,950.18","$5,158.80",$0.00,"$2,278.19",$0.00,$0.00,"$2,315.18","$13,222.63",$0.00,"$6,611.31","$10,472.32","$10,578.10",$0.00,"$2,069.34",$0.00,"$2,105.04",$0.00
S-2653-0913-R,SUP,HCPCS C1776,,S-2653-0913-R  -  STEM FEM RIGHT HIP 255MM 13-9MM STR DISTAL SLOT RED NECK REV,"$13,222.63",$0.00,"$13,222.63","$5,950.18","$5,158.80",$0.00,"$2,278.19",$0.00,$0.00,"$2,315.18","$13,222.63",$0.00,"$6,611.31","$10,472.32","$10,578.10",$0.00,"$2,069.34",$0.00,"$2,105.04",$0.00
S-2653-1014-L,SUP,HCPCS C1776,,S-2653-1014-L  -  STEM FEM LEFT HIP 255MM 14-10MM STR DISTAL SLOT RED NECK REV,"$13,222.63",$0.00,"$13,222.63","$5,950.18","$5,158.80",$0.00,"$2,278.19",$0.00,$0.00,"$2,315.18","$13,222.63",$0.00,"$6,611.31","$10,472.32","$10,578.10",$0.00,"$2,069.34",$0.00,"$2,105.04",$0.00
S-2653-1014-R,SUP,HCPCS C1776,,S-2653-1014-R  -  STEM FEM RIGHT HIP 255MM 14-10MM STR DISTAL SLOT RED NECK,"$13,222.63",$0.00,"$13,222.63","$5,950.18","$5,158.80",$0.00,"$2,278.19",$0.00,$0.00,"$2,315.18","$13,222.63",$0.00,"$6,611.31","$10,472.32","$10,578.10",$0.00,"$2,069.34",$0.00,"$2,105.04",$0.00
S-2653-1115-L,SUP,HCPCS C1776,,S-2653-1115-L  -  STEM FEM LEFT HIP 255MM 15-11MM STR DISTAL SLOT RED NECK REV,"$13,222.63",$0.00,"$13,222.63","$5,950.18","$5,158.80",$0.00,"$2,278.19",$0.00,$0.00,"$2,315.18","$13,222.63",$0.00,"$6,611.31","$10,472.32","$10,578.10",$0.00,"$2,069.34",$0.00,"$2,105.04",$0.00
S-2653-1115-R,SUP,HCPCS C1776,,S-2653-1115-R  -  STEM FEM RIGHT HIP 255MM 15-11MM STR DISTAL SLOT RED NECK,"$13,222.63",$0.00,"$13,222.63","$5,950.18","$5,158.80",$0.00,"$2,278.19",$0.00,$0.00,"$2,315.18","$13,222.63",$0.00,"$6,611.31","$10,472.32","$10,578.10",$0.00,"$2,069.34",$0.00,"$2,105.04",$0.00
S-2653-1216-L,SUP,HCPCS C1776,,S-2653-1216-L  -  STEM FEM LEFT HIP 255MM 16-12MM STR DISTAL SLOT RED NECK REV,"$13,222.63",$0.00,"$13,222.63","$5,950.18","$5,158.80",$0.00,"$2,278.19",$0.00,$0.00,"$2,315.18","$13,222.63",$0.00,"$6,611.31","$10,472.32","$10,578.10",$0.00,"$2,069.34",$0.00,"$2,105.04",$0.00
S-2653-1216-R,SUP,HCPCS C1776,,S-2653-1216-R  -  STEM FEM RIGHT HIP 255MM 16-12MM STR DISTAL SLOT RED NECK,"$13,222.63",$0.00,"$13,222.63","$5,950.18","$5,158.80",$0.00,"$2,278.19",$0.00,$0.00,"$2,315.18","$13,222.63",$0.00,"$6,611.31","$10,472.32","$10,578.10",$0.00,"$2,069.34",$0.00,"$2,105.04",$0.00
S-2653-1317-L,SUP,HCPCS C1776,,S-2653-1317-L  -  STEM FEM LEFT HIP 255MM 17-13MM STR DISTAL SLOT RED NECK REV,"$13,222.63",$0.00,"$13,222.63","$5,950.18","$5,158.80",$0.00,"$2,278.19",$0.00,$0.00,"$2,315.18","$13,222.63",$0.00,"$6,611.31","$10,472.32","$10,578.10",$0.00,"$2,069.34",$0.00,"$2,105.04",$0.00
S-2653-1317-R,SUP,HCPCS C1776,,S-2653-1317-R  -  STEM FEM RIGHT HIP 255MM 17-13MM STR DISTAL SLOT RED NECK,"$13,222.63",$0.00,"$13,222.63","$5,950.18","$5,158.80",$0.00,"$2,278.19",$0.00,$0.00,"$2,315.18","$13,222.63",$0.00,"$6,611.31","$10,472.32","$10,578.10",$0.00,"$2,069.34",$0.00,"$2,105.04",$0.00
S-2653-1418-L,SUP,HCPCS C1776,,S-2653-1418-L  -  STEM FEM LEFT HIP 255MM 18-14MM STR DISTAL SLOT RED NECK REV,"$13,222.63",$0.00,"$13,222.63","$5,950.18","$5,158.80",$0.00,"$2,278.19",$0.00,$0.00,"$2,315.18","$13,222.63",$0.00,"$6,611.31","$10,472.32","$10,578.10",$0.00,"$2,069.34",$0.00,"$2,105.04",$0.00
S-2653-1418-R,SUP,HCPCS C1776,,S-2653-1418-R  -  STEM FEM RIGHT HIP 255MM 18-14MM STR DISTAL SLOT RED NECK,"$13,222.63",$0.00,"$13,222.63","$5,950.18","$5,158.80",$0.00,"$2,278.19",$0.00,$0.00,"$2,315.18","$13,222.63",$0.00,"$6,611.31","$10,472.32","$10,578.10",$0.00,"$2,069.34",$0.00,"$2,105.04",$0.00
S-2722-2210,SUP,Custom 27803010,,S-2722-2210  -  HEAD FEM HIP MRS TPR COCR LFIT,"$1,147.00",$0.00,"$1,147.00",$0.00,$818.61,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,147.00",$0.00,$573.50,$908.42,$917.60,$0.00,$0.00,$0.00,$0.00,$0.00
S2801,SUP,Custom 27203010,,CONTROL PASCAL QUAL STRP HISTOLGY,$302.50,$0.00,$302.50,$0.00,$215.89,$0.00,$0.00,$0.00,$0.00,$0.00,$302.50,$0.00,$151.25,$239.58,$242.00,$0.00,$0.00,$0.00,$0.00,$0.00
S3006,SUP,Custom 27203010,,REAGENT WSH BUFF DUOCISH 1L IMMUN 10X,$192.45,$0.00,$192.45,$0.00,$137.35,$0.00,$0.00,$0.00,$0.00,$0.00,$192.45,$0.00,$96.23,$152.42,$153.96,$0.00,$0.00,$0.00,$0.00,$0.00
S302030-2,SUP,Custom 27203010,,ENZYME LAB PRTNS K PREDIL 110ML,$890.68,$0.00,$890.68,$0.00,$635.67,$0.00,$0.00,$0.00,$0.00,$0.00,$890.68,$0.00,$445.34,$705.42,$712.54,$0.00,$0.00,$0.00,$0.00,$0.00
S3417,SUP,Custom 27203010,,LABEL SLD RL RBN CLEAN PEN KT SEYMOUR,"$1,058.50",$0.00,"$1,058.50",$0.00,$755.45,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,058.50",$0.00,$529.25,$838.33,$846.80,$0.00,$0.00,$0.00,$0.00,$0.00
S3425,SUP,Custom 27203010,,VIAL STN REAGENT,$156.73,$0.00,$156.73,$0.00,$111.85,$0.00,$0.00,$0.00,$0.00,$0.00,$156.73,$0.00,$78.36,$124.13,$125.38,$0.00,$0.00,$0.00,$0.00,$0.00
S420GH,SUP,HCPCS C1884,,S420GH  -  PARTICLES EMBOLIZATION 300-500UM MICROSPHERE .038IN PREFILL,$607.50,$0.00,$607.50,$273.38,$433.57,$0.00,$104.67,$0.00,$0.00,$106.37,$607.50,$0.00,$303.75,$481.14,$486.00,$0.00,$95.07,$0.00,$96.71,$0.00
S-55-150-120-P6,SUP,HCPCS C1876,,S-55-150-120-P6  -  STENT VASCULAR 5.5MM 6FR 150MM 120CM OTW SELF EXPANDABLE,"$2,062.50",$0.00,"$2,062.50",$928.13,"$1,472.01",$0.00,$355.36,$0.00,$0.00,$361.13,"$2,062.50",$0.00,"$1,031.25","$1,633.50","$1,650.00",$0.00,$322.78,$0.00,$328.35,$0.00
S620GH/C,SUP,HCPCS C1884,,S620GH/C  -  PARTICLES EMBL 500-700UM RND 2ML 20ML RD STRL EMBSPH SAL SYR,$515.00,$0.00,$515.00,$231.75,$367.56,$0.00,$88.73,$0.00,$0.00,$90.17,$515.00,$0.00,$257.50,$407.88,$412.00,$0.00,$80.60,$0.00,$81.99,$0.00
S-65-080-120-P6,SUP,HCPCS C1876,,S-65-080-120-P6  -  STENT VASCULAR 6.5MM 6FR 80MM 120CM OTW SELF EXPANDABLE,"$2,062.50",$0.00,"$2,062.50",$928.13,"$1,472.01",$0.00,$355.36,$0.00,$0.00,$361.13,"$2,062.50",$0.00,"$1,031.25","$1,633.50","$1,650.00",$0.00,$322.78,$0.00,$328.35,$0.00
S7150,SUP,Custom 27203010,,REAGENT TSTK XP FRML 3 SET HISTOLGY,$660.00,$0.00,$660.00,$0.00,$471.04,$0.00,$0.00,$0.00,$0.00,$0.00,$660.00,$0.00,$330.00,$522.72,$528.00,$0.00,$0.00,$0.00,$0.00,$0.00
S7439-12,SUP,Custom 27203010,,STAIN CLRFR 2 4GL HPRFR WKG SOL RA HEMATOX CYTO,$58.28,$0.00,$58.28,$0.00,$41.59,$0.00,$0.00,$0.00,$0.00,$0.00,$58.28,$0.00,$29.14,$46.16,$46.62,$0.00,$0.00,$0.00,$0.00,$0.00
S7439-3,SUP,Custom 27203010,,STAIN HMTX 2 4PT HPRFR HISTOLGY,$67.03,$0.00,$67.03,$0.00,$47.84,$0.00,$0.00,$0.00,$0.00,$0.00,$67.03,$0.00,$33.51,$53.09,$53.62,$0.00,$0.00,$0.00,$0.00,$0.00
S7439-33,SUP,Custom 27203010,,STAIN MOD HRS HMTX 1GL HG FR WKG SOL HISTOLGY,$209.35,$0.00,$209.35,$0.00,$149.41,$0.00,$0.00,$0.00,$0.00,$0.00,$209.35,$0.00,$104.68,$165.81,$167.48,$0.00,$0.00,$0.00,$0.00,$0.00
S7439-39,SUP,Custom 27203010,,STAIN MOD PAP OG-6 1GL CYTO,$187.10,$0.00,$187.10,$0.00,$133.53,$0.00,$0.00,$0.00,$0.00,$0.00,$187.10,$0.00,$93.55,$148.18,$149.68,$0.00,$0.00,$0.00,$0.00,$0.00
S7439-4,SUP,Custom 27203010,,STAIN EOSIN Y 4PT HPRFR WKG SOL HISTOLGY,$242.15,$0.00,$242.15,$0.00,$172.82,$0.00,$0.00,$0.00,$0.00,$0.00,$242.15,$0.00,$121.08,$191.78,$193.72,$0.00,$0.00,$0.00,$0.00,$0.00
S7439-7A,SUP,Custom 27203010,,STAIN BLUING SGNTR 1GL WKG SOL REAGENT HMTL,$99.58,$0.00,$99.58,$0.00,$71.07,$0.00,$0.00,$0.00,$0.00,$0.00,$99.58,$0.00,$49.79,$78.87,$79.66,$0.00,$0.00,$0.00,$0.00,$0.00
S820GH,SUP,HCPCS C1884,,S820GH  -  PARTICLES EMBL 700-900UM MCSPH 2ML GRN EMBSPH PREFL SYR,$515.00,$0.00,$515.00,$231.75,$367.56,$0.00,$88.73,$0.00,$0.00,$90.17,$515.00,$0.00,$257.50,$407.88,$412.00,$0.00,$80.60,$0.00,$81.99,$0.00
SA30AT.100,SUP,HCPCS V2632,,SA30AT.100  -  LENS IOL 0 D +10 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
SA30AT.105,SUP,HCPCS V2632,,SA30AT.105  -  LENS IOL 0 D +10.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
SA30AT.110,SUP,HCPCS V2632,,SA30AT.110  -  LENS IOL 0 D +11 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
SA30AT.115,SUP,HCPCS V2632,,SA30AT.115  -  LENS IOL 0 D +11.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
SA30AT.120,SUP,HCPCS V2632,,SA30AT.120  -  LENS IOL 0 D +12 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
SA30AT.125,SUP,HCPCS V2632,,SA30AT.125  -  LENS IOL 0 D +12.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
SA30AT.130,SUP,HCPCS V2632,,SA30AT.130  -  LENS IOL 0 D +13 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
SA30AT.135,SUP,HCPCS V2632,,SA30AT.135  -  LENS IOL 0 D +13.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
SA30AT.140,SUP,HCPCS V2632,,SA30AT.140  -  LENS IOL 0 D +14 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
SA30AT.145,SUP,HCPCS V2632,,SA30AT.145  -  LENS IOL 0 D +14.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
SA30AT.150,SUP,HCPCS V2632,,SA30AT.150  -  LENS IOL 0 D +15 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
SA30AT.155,SUP,HCPCS V2632,,SA30AT.155  -  LENS IOL 0 D +15.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
SA30AT.160,SUP,HCPCS V2632,,SA30AT.160  -  LENS IOL 0 D +16 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
SA30AT.165,SUP,HCPCS V2632,,SA30AT.165  -  LENS IOL 0 D +16.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
SA30AT.170,SUP,HCPCS V2632,,SA30AT.170  -  LENS IOL 0 D +17 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
SA30AT.175,SUP,HCPCS V2632,,SA30AT.175  -  LENS IOL 0 D +17.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
SA30AT.180,SUP,HCPCS V2632,,SA30AT.180  -  LENS IOL 0 D +18 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
SA30AT.185,SUP,HCPCS V2632,,SA30AT.185  -  LENS IOL 0 D +18.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
SA30AT.190,SUP,HCPCS V2632,,SA30AT.190  -  LENS IOL 0 D +19 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
SA30AT.195,SUP,HCPCS V2632,,SA30AT.195  -  LENS IOL 0 D +19.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
SA30AT.200,SUP,HCPCS V2632,,SA30AT.200  -  LENS IOL 0 D +20 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
SA30AT.205,SUP,HCPCS V2632,,SA30AT.205  -  LENS IOL 0 D +20.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
SA30AT.210,SUP,HCPCS V2632,,SA30AT.210  -  LENS IOL 0 D +21 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
SA30AT.215,SUP,HCPCS V2632,,SA30AT.215  -  LENS IOL 0 D +21.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
SA30AT.220,SUP,HCPCS V2632,,SA30AT.220  -  LENS IOL 0 D +22 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
SA30AT.225,SUP,HCPCS V2632,,SA30AT.225  -  LENS IOL 0 D +22.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
SA30AT.230,SUP,HCPCS V2632,,SA30AT.230  -  LENS IOL 0 D +23 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
SA30AT.235,SUP,HCPCS V2632,,SA30AT.235  -  LENS IOL 0 D +23.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
SA30AT.240,SUP,HCPCS V2632,,SA30AT.240  -  LENS IOL 0 D +24 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
SA30AT.245,SUP,HCPCS V2632,,SA30AT.245  -  LENS IOL 0 D +24.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
SA30AT.250,SUP,HCPCS V2632,,SA30AT.250  -  LENS IOL 0 D +25 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
SA30AT.255,SUP,HCPCS V2632,,SA30AT.255  -  LENS IOL 0 D +25.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
SA30AT.260,SUP,HCPCS V2632,,SA30AT.260  -  LENS IOL 0 D +26 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
SA30AT.265,SUP,HCPCS V2632,,SA30AT.265  -  LENS IOL 0 D +26.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
SA30AT.270,SUP,HCPCS V2632,,SA30AT.270  -  LENS IOL 0 D +27 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
SA30AT.275,SUP,HCPCS V2632,,SA30AT.275  -  LENS IOL 0 D +27.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
SA30AT.280,SUP,HCPCS V2632,,SA30AT.280  -  LENS IOL 0 D +28 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
SA30AT.285,SUP,HCPCS V2632,,SA30AT.285  -  LENS IOL 0 D +28.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
SA30AT.290,SUP,HCPCS V2632,,SA30AT.290  -  LENS IOL 0 D +29 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
SA30AT.295,SUP,HCPCS V2632,,SA30AT.295  -  LENS IOL 0 D +29.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
SA30AT.300,SUP,HCPCS V2632,,SA30AT.300  -  LENS IOL 0 D +30 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
SA4644,SUP,Custom 27203010,,BLADDER TOP CCB SA4694,$716.08,$0.00,$716.08,$0.00,$511.06,$0.00,$0.00,$0.00,$0.00,$0.00,$716.08,$0.00,$358.04,$567.14,$572.86,$0.00,$0.00,$0.00,$0.00,$0.00
SA4645,SUP,Custom 27203010,,BLADDER BOTTOM CCB SA4645,$733.23,$0.00,$733.23,$0.00,$523.30,$0.00,$0.00,$0.00,$0.00,$0.00,$733.23,$0.00,$366.61,$580.72,$586.58,$0.00,$0.00,$0.00,$0.00,$0.00
SA4901,SUP,Custom 27203010,,FOAM CCB #SA4901,$171.38,$0.00,$171.38,$0.00,$122.31,$0.00,$0.00,$0.00,$0.00,$0.00,$171.38,$0.00,$85.69,$135.73,$137.10,$0.00,$0.00,$0.00,$0.00,$0.00
SA60AT.290,SUP,HCPCS V2632,,SA60AT.290  -  LENS IOL 0 D +29 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
SA60AT.310,SUP,HCPCS V2632,,SA60AT.310  -  LENS IOL 0 D +31 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF,$335.00,$0.00,$335.00,$150.75,$239.09,$0.00,$57.72,$0.00,$0.00,$58.66,$335.00,$0.00,$167.50,$265.32,$268.00,$0.00,$52.43,$0.00,$53.33,$0.00
SA60AT.350,SUP,HCPCS V2632,,SA60AT.350  -  LENS IOL 0 D +35 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
SA60AT.360,SUP,HCPCS V2632,,SA60AT.360  -  LENS IOL 0 D +36 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
SA60AT.370,SUP,HCPCS V2632,,SA60AT.370  -  LENS IOL 0 D +37 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
SA60AT.380,SUP,HCPCS V2632,,SA60AT.380  -  LENS IOL 0 D +38 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
SA60AT.390,SUP,HCPCS V2632,,SA60AT.390  -  LENS IOL 0 D +39 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
SA60AT.400,SUP,HCPCS V2632,,SA60AT.400  -  LENS IOL 0 D +40 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF,$375.00,$0.00,$375.00,$168.75,$267.64,$0.00,$64.61,$0.00,$0.00,$65.66,$375.00,$0.00,$187.50,$297.00,$300.00,$0.00,$58.69,$0.00,$59.70,$0.00
SA60WF,SUP,HCPCS V2632,,SA60WF  -  LENS IOL 0 D +22.5 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF,$475.00,$0.00,$475.00,$213.75,$339.01,$0.00,$81.84,$0.00,$0.00,$83.17,$475.00,$0.00,$237.50,$376.20,$380.00,$0.00,$74.34,$0.00,$75.62,$0.00
SA60WF.060,SUP,HCPCS V2632,,SA60WF.060  -  LENS IOL 0 D +6 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF,$335.00,$0.00,$335.00,$150.75,$239.09,$0.00,$57.72,$0.00,$0.00,$58.66,$335.00,$0.00,$167.50,$265.32,$268.00,$0.00,$52.43,$0.00,$53.33,$0.00
SA60WF.065,SUP,HCPCS V2632,,SA60WF.065  -  LENS IOL 0 D +6.5 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF,$335.00,$0.00,$335.00,$150.75,$239.09,$0.00,$57.72,$0.00,$0.00,$58.66,$335.00,$0.00,$167.50,$265.32,$268.00,$0.00,$52.43,$0.00,$53.33,$0.00
SA60WF.070,SUP,HCPCS V2632,,SA60WF.070  -  LENS IOL 0 D +7 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF,$335.00,$0.00,$335.00,$150.75,$239.09,$0.00,$57.72,$0.00,$0.00,$58.66,$335.00,$0.00,$167.50,$265.32,$268.00,$0.00,$52.43,$0.00,$53.33,$0.00
SA60WF.075,SUP,HCPCS V2632,,SA60WF.075  -  LENS IOL 0 D +7.5 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF,$335.00,$0.00,$335.00,$150.75,$239.09,$0.00,$57.72,$0.00,$0.00,$58.66,$335.00,$0.00,$167.50,$265.32,$268.00,$0.00,$52.43,$0.00,$53.33,$0.00
SA60WF.080,SUP,HCPCS V2632,,SA60WF.080  -  LENS IOL 0 D +8 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF,$335.00,$0.00,$335.00,$150.75,$239.09,$0.00,$57.72,$0.00,$0.00,$58.66,$335.00,$0.00,$167.50,$265.32,$268.00,$0.00,$52.43,$0.00,$53.33,$0.00
SA60WF.085,SUP,HCPCS V2632,,SA60WF.085  -  LENS IOL 0 D +8.5 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF,$335.00,$0.00,$335.00,$150.75,$239.09,$0.00,$57.72,$0.00,$0.00,$58.66,$335.00,$0.00,$167.50,$265.32,$268.00,$0.00,$52.43,$0.00,$53.33,$0.00
SA60WF.090,SUP,HCPCS V2632,,SA60WF.090  -  LENS IOL 0 D +9 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF,$335.00,$0.00,$335.00,$150.75,$239.09,$0.00,$57.72,$0.00,$0.00,$58.66,$335.00,$0.00,$167.50,$265.32,$268.00,$0.00,$52.43,$0.00,$53.33,$0.00
SA60WF.095,SUP,HCPCS V2632,,SA60WF.095  -  LENS IOL 0 D +9.5 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF,$335.00,$0.00,$335.00,$150.75,$239.09,$0.00,$57.72,$0.00,$0.00,$58.66,$335.00,$0.00,$167.50,$265.32,$268.00,$0.00,$52.43,$0.00,$53.33,$0.00
SA60WF.100,SUP,HCPCS V2632,,SA60WF.100  -  LENS IOL 0 D +10 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF,$335.00,$0.00,$335.00,$150.75,$239.09,$0.00,$57.72,$0.00,$0.00,$58.66,$335.00,$0.00,$167.50,$265.32,$268.00,$0.00,$52.43,$0.00,$53.33,$0.00
SA60WF.105,SUP,HCPCS V2632,,SA60WF.105  -  LENS IOL 0 D +10.5 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF,$335.00,$0.00,$335.00,$150.75,$239.09,$0.00,$57.72,$0.00,$0.00,$58.66,$335.00,$0.00,$167.50,$265.32,$268.00,$0.00,$52.43,$0.00,$53.33,$0.00
SA60WF.110,SUP,HCPCS V2632,,SA60WF.110  -  LENS IOL 0 D +11 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF,$335.00,$0.00,$335.00,$150.75,$239.09,$0.00,$57.72,$0.00,$0.00,$58.66,$335.00,$0.00,$167.50,$265.32,$268.00,$0.00,$52.43,$0.00,$53.33,$0.00
SA60WF.115,SUP,HCPCS V2632,,SA60WF.115  -  LENS IOL 0 D +11.5 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF,$335.00,$0.00,$335.00,$150.75,$239.09,$0.00,$57.72,$0.00,$0.00,$58.66,$335.00,$0.00,$167.50,$265.32,$268.00,$0.00,$52.43,$0.00,$53.33,$0.00
SA60WF.120,SUP,HCPCS V2632,,SA60WF.120  -  LENS IOL 0 D +12 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF,$335.00,$0.00,$335.00,$150.75,$239.09,$0.00,$57.72,$0.00,$0.00,$58.66,$335.00,$0.00,$167.50,$265.32,$268.00,$0.00,$52.43,$0.00,$53.33,$0.00
SA60WF.125,SUP,HCPCS V2632,,SA60WF.125  -  LENS IOL 0 D +12.5 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF,$335.00,$0.00,$335.00,$150.75,$239.09,$0.00,$57.72,$0.00,$0.00,$58.66,$335.00,$0.00,$167.50,$265.32,$268.00,$0.00,$52.43,$0.00,$53.33,$0.00
SA60WF.130,SUP,HCPCS V2632,,SA60WF.130  -  LENS IOL 0 D +13 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF,$335.00,$0.00,$335.00,$150.75,$239.09,$0.00,$57.72,$0.00,$0.00,$58.66,$335.00,$0.00,$167.50,$265.32,$268.00,$0.00,$52.43,$0.00,$53.33,$0.00
SA60WF.135,SUP,HCPCS V2632,,SA60WF.135  -  LENS IOL 0 D +13.5 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF,$335.00,$0.00,$335.00,$150.75,$239.09,$0.00,$57.72,$0.00,$0.00,$58.66,$335.00,$0.00,$167.50,$265.32,$268.00,$0.00,$52.43,$0.00,$53.33,$0.00
SA60WF.140,SUP,HCPCS V2632,,SA60WF.140  -  LENS IOL 0 D +14 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF,$335.00,$0.00,$335.00,$150.75,$239.09,$0.00,$57.72,$0.00,$0.00,$58.66,$335.00,$0.00,$167.50,$265.32,$268.00,$0.00,$52.43,$0.00,$53.33,$0.00
SA60WF.145,SUP,HCPCS V2632,,SA60WF.145  -  LENS IOL 0 D +14.5 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF,$335.00,$0.00,$335.00,$150.75,$239.09,$0.00,$57.72,$0.00,$0.00,$58.66,$335.00,$0.00,$167.50,$265.32,$268.00,$0.00,$52.43,$0.00,$53.33,$0.00
SA60WF.150,SUP,HCPCS V2632,,SA60WF.150  -  LENS IOL 0 D +15 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF,$335.00,$0.00,$335.00,$150.75,$239.09,$0.00,$57.72,$0.00,$0.00,$58.66,$335.00,$0.00,$167.50,$265.32,$268.00,$0.00,$52.43,$0.00,$53.33,$0.00
SA60WF.155,SUP,HCPCS V2632,,SA60WF.155  -  LENS IOL 0 D +15.5 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF,$335.00,$0.00,$335.00,$150.75,$239.09,$0.00,$57.72,$0.00,$0.00,$58.66,$335.00,$0.00,$167.50,$265.32,$268.00,$0.00,$52.43,$0.00,$53.33,$0.00
SA60WF.160,SUP,HCPCS V2632,,SA60WF.160  -  LENS IOL 0 D +16 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF,$335.00,$0.00,$335.00,$150.75,$239.09,$0.00,$57.72,$0.00,$0.00,$58.66,$335.00,$0.00,$167.50,$265.32,$268.00,$0.00,$52.43,$0.00,$53.33,$0.00
SA60WF.165,SUP,HCPCS V2632,,SA60WF.165  -  LENS IOL 0 D +16.5 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF,$335.00,$0.00,$335.00,$150.75,$239.09,$0.00,$57.72,$0.00,$0.00,$58.66,$335.00,$0.00,$167.50,$265.32,$268.00,$0.00,$52.43,$0.00,$53.33,$0.00
SA60WF.170,SUP,HCPCS V2632,,SA60WF.170  -  LENS IOL 0 D +17 DIOP MOD L BCNVX 6MM 13MM CLR STRL LF ACRSF,$335.00,$0.00,$335.00,$150.75,$239.09,$0.00,$57.72,$0.00,$0.00,$58.66,$335.00,$0.00,$167.50,$265.32,$268.00,$0.00,$52.43,$0.00,$53.33,$0.00
SA60WF.175,SUP,HCPCS V2632,,SA60WF.175  -  LENS IOL 0 D +17.5 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF,$335.00,$0.00,$335.00,$150.75,$239.09,$0.00,$57.72,$0.00,$0.00,$58.66,$335.00,$0.00,$167.50,$265.32,$268.00,$0.00,$52.43,$0.00,$53.33,$0.00
SA60WF.180,SUP,HCPCS V2632,,SA60WF.180  -  LENS IOL 0 D +18 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF,$335.00,$0.00,$335.00,$150.75,$239.09,$0.00,$57.72,$0.00,$0.00,$58.66,$335.00,$0.00,$167.50,$265.32,$268.00,$0.00,$52.43,$0.00,$53.33,$0.00
SA60WF.185,SUP,HCPCS V2632,,SA60WF.185  -  LENS IOL 0 D +18.5 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF,$335.00,$0.00,$335.00,$150.75,$239.09,$0.00,$57.72,$0.00,$0.00,$58.66,$335.00,$0.00,$167.50,$265.32,$268.00,$0.00,$52.43,$0.00,$53.33,$0.00
SA60WF.190,SUP,HCPCS V2632,,SA60WF.190  -  LENS IOL 0 D +19 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF,$335.00,$0.00,$335.00,$150.75,$239.09,$0.00,$57.72,$0.00,$0.00,$58.66,$335.00,$0.00,$167.50,$265.32,$268.00,$0.00,$52.43,$0.00,$53.33,$0.00
SA60WF.195,SUP,HCPCS V2632,,SA60WF.195  -  LENS IOL 0 D +19.5 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF,$335.00,$0.00,$335.00,$150.75,$239.09,$0.00,$57.72,$0.00,$0.00,$58.66,$335.00,$0.00,$167.50,$265.32,$268.00,$0.00,$52.43,$0.00,$53.33,$0.00
SA60WF.200,SUP,HCPCS V2632,,SA60WF.200  -  LENS IOL 0 D +20 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM 1,$335.00,$0.00,$335.00,$150.75,$239.09,$0.00,$57.72,$0.00,$0.00,$58.66,$335.00,$0.00,$167.50,$265.32,$268.00,$0.00,$52.43,$0.00,$53.33,$0.00
SA60WF.205,SUP,HCPCS V2632,,SA60WF.205  -  LENS IOL 0 D +20.5 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF,$335.00,$0.00,$335.00,$150.75,$239.09,$0.00,$57.72,$0.00,$0.00,$58.66,$335.00,$0.00,$167.50,$265.32,$268.00,$0.00,$52.43,$0.00,$53.33,$0.00
SA60WF.210,SUP,HCPCS V2632,,SA60WF.210  -  LENS IOL 0 D +21 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF,$335.00,$0.00,$335.00,$150.75,$239.09,$0.00,$57.72,$0.00,$0.00,$58.66,$335.00,$0.00,$167.50,$265.32,$268.00,$0.00,$52.43,$0.00,$53.33,$0.00
SA60WF.215,SUP,HCPCS V2632,,SA60WF.215  -  LENS IOL 0 D +21.5 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM,$335.00,$0.00,$335.00,$150.75,$239.09,$0.00,$57.72,$0.00,$0.00,$58.66,$335.00,$0.00,$167.50,$265.32,$268.00,$0.00,$52.43,$0.00,$53.33,$0.00
SA60WF.220,SUP,HCPCS V2632,,SA60WF.220  -  LENS IOL 0 D +22 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF,$335.00,$0.00,$335.00,$150.75,$239.09,$0.00,$57.72,$0.00,$0.00,$58.66,$335.00,$0.00,$167.50,$265.32,$268.00,$0.00,$52.43,$0.00,$53.33,$0.00
SA60WF.225,SUP,HCPCS V2632,,SA60WF.225  -  LENS IOL 0 D +22.5 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF,$335.00,$0.00,$335.00,$150.75,$239.09,$0.00,$57.72,$0.00,$0.00,$58.66,$335.00,$0.00,$167.50,$265.32,$268.00,$0.00,$52.43,$0.00,$53.33,$0.00
SA60WF.230,SUP,HCPCS V2632,,SA60WF.230  -  LENS IOL 0 D +23 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF,$335.00,$0.00,$335.00,$150.75,$239.09,$0.00,$57.72,$0.00,$0.00,$58.66,$335.00,$0.00,$167.50,$265.32,$268.00,$0.00,$52.43,$0.00,$53.33,$0.00
SA60WF.235,SUP,HCPCS V2632,,SA60WF.235  -  LENS IOL 0 D +23.5 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF,$335.00,$0.00,$335.00,$150.75,$239.09,$0.00,$57.72,$0.00,$0.00,$58.66,$335.00,$0.00,$167.50,$265.32,$268.00,$0.00,$52.43,$0.00,$53.33,$0.00
SA60WF.240,SUP,HCPCS V2632,,SA60WF.240  -  LENS IOL 0 D +24 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF,$335.00,$0.00,$335.00,$150.75,$239.09,$0.00,$57.72,$0.00,$0.00,$58.66,$335.00,$0.00,$167.50,$265.32,$268.00,$0.00,$52.43,$0.00,$53.33,$0.00
SA60WF.245,SUP,HCPCS V2632,,SA60WF.245  -  LENS IOL 0 D +24.5 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF,$335.00,$0.00,$335.00,$150.75,$239.09,$0.00,$57.72,$0.00,$0.00,$58.66,$335.00,$0.00,$167.50,$265.32,$268.00,$0.00,$52.43,$0.00,$53.33,$0.00
SA60WF.250,SUP,HCPCS V2632,,SA60WF.250  -  LENS IOL 0 D +25 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF,$335.00,$0.00,$335.00,$150.75,$239.09,$0.00,$57.72,$0.00,$0.00,$58.66,$335.00,$0.00,$167.50,$265.32,$268.00,$0.00,$52.43,$0.00,$53.33,$0.00
SA60WF.255,SUP,HCPCS V2632,,SA60WF.255  -  LENS IOL 0 D +25.5 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF,$335.00,$0.00,$335.00,$150.75,$239.09,$0.00,$57.72,$0.00,$0.00,$58.66,$335.00,$0.00,$167.50,$265.32,$268.00,$0.00,$52.43,$0.00,$53.33,$0.00
SA60WF.260,SUP,HCPCS V2632,,SA60WF.260  -  LENS IOL 0 D +26 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF,$335.00,$0.00,$335.00,$150.75,$239.09,$0.00,$57.72,$0.00,$0.00,$58.66,$335.00,$0.00,$167.50,$265.32,$268.00,$0.00,$52.43,$0.00,$53.33,$0.00
SA60WF.265,SUP,HCPCS V2632,,SA60WF.265  -  LENS IOL 0 D +26.5 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF,$335.00,$0.00,$335.00,$150.75,$239.09,$0.00,$57.72,$0.00,$0.00,$58.66,$335.00,$0.00,$167.50,$265.32,$268.00,$0.00,$52.43,$0.00,$53.33,$0.00
SA60WF.270,SUP,HCPCS V2632,,SA60WF.270  -  LENS IOL 0 D +27 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF,$335.00,$0.00,$335.00,$150.75,$239.09,$0.00,$57.72,$0.00,$0.00,$58.66,$335.00,$0.00,$167.50,$265.32,$268.00,$0.00,$52.43,$0.00,$53.33,$0.00
SA60WF.275,SUP,HCPCS V2632,,SA60WF.275  -  LENS IOL 0 D +27.5 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF,$335.00,$0.00,$335.00,$150.75,$239.09,$0.00,$57.72,$0.00,$0.00,$58.66,$335.00,$0.00,$167.50,$265.32,$268.00,$0.00,$52.43,$0.00,$53.33,$0.00
SA60WF.280,SUP,HCPCS V2632,,SA60WF.280  -  LENS IOL 0 D +28 DIOP ASYM BCNVX 6MM 13MM ACRSF STABLEFORCE,$335.00,$0.00,$335.00,$150.75,$239.09,$0.00,$57.72,$0.00,$0.00,$58.66,$335.00,$0.00,$167.50,$265.32,$268.00,$0.00,$52.43,$0.00,$53.33,$0.00
SA60WF.285,SUP,HCPCS V2632,,SA60WF.285  -  LENS IOL 0 D +28.5 DIOP BCNVX 118.4 A-CNST 6MM 13MM ACRSF,$335.00,$0.00,$335.00,$150.75,$239.09,$0.00,$57.72,$0.00,$0.00,$58.66,$335.00,$0.00,$167.50,$265.32,$268.00,$0.00,$52.43,$0.00,$53.33,$0.00
SA60WF.290,SUP,HCPCS V2632,,SA60WF.290  -  LENS IOL 0 D +29 DIOP ASYM BCNVX 6MM 13MM ACRSF STABLEFORCE,$335.00,$0.00,$335.00,$150.75,$239.09,$0.00,$57.72,$0.00,$0.00,$58.66,$335.00,$0.00,$167.50,$265.32,$268.00,$0.00,$52.43,$0.00,$53.33,$0.00
SA60WF.295,SUP,HCPCS V2632,,SA60WF.295  -  LENS IOL 0 D +29.5 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF,$335.00,$0.00,$335.00,$150.75,$239.09,$0.00,$57.72,$0.00,$0.00,$58.66,$335.00,$0.00,$167.50,$265.32,$268.00,$0.00,$52.43,$0.00,$53.33,$0.00
SA60WF.300,SUP,HCPCS V2632,,SA60WF.300  -  LENS IOL 0 D +30 DIOP BCNVX 118.4 A-CNST 6MM 13MM ACRSF,$335.00,$0.00,$335.00,$150.75,$239.09,$0.00,$57.72,$0.00,$0.00,$58.66,$335.00,$0.00,$167.50,$265.32,$268.00,$0.00,$52.43,$0.00,$53.33,$0.00
SA8630,SUP,Custom 27203010,,COVER MATTRESS /5J:4K,$919.10,$0.00,$919.10,$0.00,$655.96,$0.00,$0.00,$0.00,$0.00,$0.00,$919.10,$0.00,$459.55,$727.93,$735.28,$0.00,$0.00,$0.00,$0.00,$0.00
SAK 4689,SUP,Custom 27203010,,BLADE MCTM ACED LOW PROFILE,$580.05,$0.00,$580.05,$0.00,$413.98,$0.00,$0.00,$0.00,$0.00,$0.00,$580.05,$0.00,$290.03,$459.40,$464.04,$0.00,$0.00,$0.00,$0.00,$0.00
SAX02D,SUP,HCPCS C1768,,SAX02D  -  GRAFT VASC 90CM 8MM GRTX AXLBFM STRCH REM RING THNWL INTGR,"$6,235.00",$0.00,"$6,235.00","$2,805.75","$4,449.92",$0.00,"$1,074.26",$0.00,$0.00,"$1,091.70","$6,235.00",$0.00,"$3,117.50","$4,938.12","$4,988.00",$0.00,$975.78,$0.00,$992.61,$0.00
SB6AL10,SUP,HCPCS C1887,,CATHETER GUID AL1 CURVE 6FR SHR NX BAL,$112.50,$0.00,$112.50,$61.09,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
SB6AL10SH,SUP,HCPCS C1887,,CATHETER GUID AL1 CURVE 6FR SH SHR NX BAL,$112.50,$0.00,$112.50,$61.09,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
SB6AL20,SUP,HCPCS C1887,,CATHETER GUID AL2 CURVE 6FR SHR NX BAL,$112.50,$0.00,$112.50,$61.09,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
SB6AL20SH,SUP,HCPCS C1887,,CATHETER GUID AL2 CURVE 6FR SH SHR NX BAL,$112.50,$0.00,$112.50,$61.09,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
SB6AL75,SUP,HCPCS C1887,,CATHETER GUID AL7.5 CURVE 6FR 100CM SHR NX BAL,$112.50,$0.00,$112.50,$61.09,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
SB6AR10,SUP,HCPCS C1887,,CATHETER GUID AR1 CURVE 6FR SHR NX BAL,$112.50,$0.00,$112.50,$61.09,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
SB6EBU35,SUP,HCPCS C1887,,CATHETER GUID XB3.5 CURVE 6FR SHR NX BAL,$112.50,$0.00,$112.50,$61.09,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
SB6HS1,SUP,HCPCS C1887,,CATHETER GUID HS1 CURVE 6FR SHR NX BAL,$112.50,$0.00,$112.50,$61.09,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
SB6HS1SH,SUP,HCPCS C1887,,"SA6MP1  -  CATHETER GUIDING SHERPA NX, 6FRX 100CM MP1",$112.50,$0.00,$112.50,$61.09,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
SB6JL35,SUP,HCPCS C1887,,CATHETER GUID JL3.5 CURVE 6FR SHR NX BAL,$112.50,$0.00,$112.50,$61.09,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
SB6JL40,SUP,HCPCS C1887,,CATHETER GUID JL4 CURVE 6FR SHR NX BAL,$112.50,$0.00,$112.50,$61.09,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
SB6JL40SH,SUP,HCPCS C1887,,CATHETER GUID JL4 CURVE 6FR 100CM SH SHR NX BAL,$112.50,$0.00,$112.50,$61.09,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
SB6JR35,SUP,HCPCS C1887,,CATHETER GUID JR3.5 CURVE 6FR SHR NX BAL,$112.50,$0.00,$112.50,$61.09,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
SB6JR40,SUP,HCPCS C1887,,CATHETER GUID JR4 CURVE 6FR SHR NX BAL,$125.00,$0.00,$125.00,$67.88,$89.21,$0.00,$21.54,$0.00,$0.00,$21.89,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$19.56,$0.00,$19.90,$0.00
SB6JR40SH,SUP,HCPCS C1887,,CATHETER GUID JR4 CURVE 6FR SH SHR NX BAL,$112.50,$0.00,$112.50,$61.09,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
SB7AL10,SUP,HCPCS C1887,,CATHETER GUID AL1 CURVE 7FR 100CM SHR NX BAL,$112.50,$0.00,$112.50,$61.09,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
SB7AL20,SUP,HCPCS C1887,,CATHETER GUID AL2 CURVE 7FR 100CM SHR NX BAL,$112.50,$0.00,$112.50,$61.09,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
SB7AL75,SUP,HCPCS C1887,,CATHETER GUID AL.75 CURVE 7FR 100CM SHR NX BAL,$112.50,$0.00,$112.50,$61.09,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
SB7AR10,SUP,HCPCS C1887,,CATHETER GUID AR1 CURVE 7FR 100CM SHR NX BAL,$112.50,$0.00,$112.50,$61.09,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
SB7AR10SH,SUP,HCPCS C1887,,CATHETER GUID AR1 CURVE 7FR 100CM SH SHR NX BAL,$125.00,$0.00,$125.00,$67.88,$89.21,$0.00,$21.54,$0.00,$0.00,$21.89,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$19.56,$0.00,$19.90,$0.00
SB7EBU30,SUP,HCPCS C1887,,CATHETER GUID XB3 CURVE 7FR 100CM SHR NX BAL,$112.50,$0.00,$112.50,$61.09,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
SB7EBU35,SUP,HCPCS C1887,,CATHETER GUID XB3.5 CURVE 7FR 100CM SHR NX BAL,$112.50,$0.00,$112.50,$61.09,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
SB7EBU40,SUP,HCPCS C1887,,CATHETER GUID XB4 CURVE 7FR 100CM SHR NX BAL,$112.50,$0.00,$112.50,$61.09,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
SB7HS1,SUP,HCPCS C1887,,CATHETER GUIDING VISTA BRITE TIP 7FR X .078IN HS,$125.00,$0.00,$125.00,$67.88,$89.21,$0.00,$21.54,$0.00,$0.00,$21.89,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$19.56,$0.00,$19.90,$0.00
SB7HS1SH,SUP,HCPCS C1887,,CATHETER GUID HS1 CURVE 7FR SH SHR NX BAL,$125.00,$0.00,$125.00,$67.88,$89.21,$0.00,$21.54,$0.00,$0.00,$21.89,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$19.56,$0.00,$19.90,$0.00
SB7IMA,SUP,HCPCS C1887,,CATHETER GUID IM CURVE 7FR 100CM SHR NX BAL,$125.00,$0.00,$125.00,$67.88,$89.21,$0.00,$21.54,$0.00,$0.00,$21.89,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$19.56,$0.00,$19.90,$0.00
SB7IMASH,SUP,HCPCS C1887,,CATHETER GUID IM CURVE 7FR 100CM SH SHR NX BAL,$125.00,$0.00,$125.00,$67.88,$89.21,$0.00,$21.54,$0.00,$0.00,$21.89,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$19.56,$0.00,$19.90,$0.00
SB7JL35,SUP,HCPCS C1887,,CATHETER GUID JL3.5 CURVE 7FR 100CM SHR NX BAL,$125.00,$0.00,$125.00,$67.88,$89.21,$0.00,$21.54,$0.00,$0.00,$21.89,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$19.56,$0.00,$19.90,$0.00
SB7JL40,SUP,HCPCS C1887,,CATHETER GUID JL4 CURVE 7FR 100CM SHR NX BAL,$112.50,$0.00,$112.50,$61.09,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
SB7JL40SH,SUP,HCPCS C1887,,CATHETER GUID JL4 CURVE 7FR 100CM SH SHR NX BAL,$112.50,$0.00,$112.50,$61.09,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
SB7JL50,SUP,HCPCS C1887,,CATHETER GUID JL5 CURVE 7FR 100CM SHR NX BAL,$112.50,$0.00,$112.50,$61.09,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
SB7JR35,SUP,HCPCS C1887,,CATHETER GUID JR3.5 CURVE 7FR 100CM SHR NX BAL,$125.00,$0.00,$125.00,$67.88,$89.21,$0.00,$21.54,$0.00,$0.00,$21.89,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$19.56,$0.00,$19.90,$0.00
SB7JR40,SUP,HCPCS C1887,,CATHETER GUID JR4 CURVE 7FR 100CM SHR NX BAL,$112.50,$0.00,$112.50,$61.09,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
SB7JR4SH,SUP,HCPCS C1887,,CATHETER GUIDING VISTA BRITE TIP 7FR X 100CM JR4 SH,$112.50,$0.00,$112.50,$61.09,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
SB7JR50,SUP,HCPCS C1887,,CATHETER GUID JR5 CURVE 7FR 100CM SHR NX BAL,$112.50,$0.00,$112.50,$61.09,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
SB7LCB,SUP,HCPCS C1887,,CATHETER GUID LCB CURVE 7FR 100CM SHR NX BAL,$112.50,$0.00,$112.50,$61.09,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
SB7MP1,SUP,HCPCS C1887,,CATHETER GUID MP1 CURVE 7FR 100CM SHR NX BAL,$112.50,$0.00,$112.50,$61.09,$80.29,$0.00,$19.38,$0.00,$0.00,$19.70,$112.50,$0.00,$56.25,$89.10,$90.00,$0.00,$17.61,$0.00,$17.91,$0.00
SB8AL20,SUP,HCPCS C1887,,CATHETER GUID AL2 CURVE 8FR 100CM CORON SHR NX BAL,$125.00,$0.00,$125.00,$67.88,$89.21,$0.00,$21.54,$0.00,$0.00,$21.89,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$19.56,$0.00,$19.90,$0.00
SB8EBU40,SUP,HCPCS C1887,,CATHETER GUID XB4 CURVE 8FR 100CM CORON SHR NX BAL,$125.00,$0.00,$125.00,$67.88,$89.21,$0.00,$21.54,$0.00,$0.00,$21.89,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$19.56,$0.00,$19.90,$0.00
SBFS045,SUP,Custom 27203010,,SBFS045  -  KIT TRMA FX 1.1MM .045IN SBFS,"$1,015.00",$0.00,"$1,015.00",$0.00,$724.41,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,015.00",$0.00,$507.50,$803.88,$812.00,$0.00,$0.00,$0.00,$0.00,$0.00
SBFS062,SUP,Custom 27203010,,SBFS062  -  KIT IM NL .062IN SLT AWL LK DV BNDRG TL CAP SM BN FX SYS,"$1,015.00",$0.00,"$1,015.00",$0.00,$724.41,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,015.00",$0.00,$507.50,$803.88,$812.00,$0.00,$0.00,$0.00,$0.00,$0.00
SBM-4963,SUP,HCPCS C1765,,"SBM-4963  -  BLANKET SECTION MED (MUST ORDER MIN 4 BX, MED OR SM)",$397.50,$0.00,$397.50,$0.00,$283.70,$0.00,$68.49,$0.00,$0.00,$69.60,$397.50,$0.00,$198.75,$314.82,$318.00,$0.00,$62.21,$0.00,$0.00,$0.00
SBRAR20,SUP,HCPCS C1887,,CATHETER GUIDING VISTA BRITE TIP 7FR X 100CM AR2,$125.00,$0.00,$125.00,$67.88,$89.21,$0.00,$21.54,$0.00,$0.00,$21.89,$125.00,$0.00,$62.50,$99.00,$100.00,$0.00,$19.56,$0.00,$19.90,$0.00
SBT1602D,SUP,HCPCS C1768,,SBT1602D  -  GRAFT VASCULAR STANDARD WALL THIN WALL 2 BRANCH 16MM 8MM 50,"$2,852.50",$0.00,"$2,852.50","$1,283.63","$2,035.83",$0.00,$491.47,$0.00,$0.00,$499.45,"$2,852.50",$0.00,"$1,426.25","$2,259.18","$2,282.00",$0.00,$446.42,$0.00,$454.12,$0.00
SBT1802D,SUP,HCPCS C1768,,SBT1802D  -  GRAFT VASC STD WL THNWL 2 BRCH 18MM 9MM 50CM STRL STRCH GRTX,"$2,852.50",$0.00,"$2,852.50","$1,283.63","$2,035.83",$0.00,$491.47,$0.00,$0.00,$499.45,"$2,852.50",$0.00,"$1,426.25","$2,259.18","$2,282.00",$0.00,$446.42,$0.00,$454.12,$0.00
SBT2002D,SUP,HCPCS C1768,,SBT2002D  -  GRAFT VASCULAR STANDARD WALL THIN WALL 2 BRANCH 20MM 10MM 50,"$2,852.50",$0.00,"$2,852.50","$1,283.63","$2,035.83",$0.00,$491.47,$0.00,$0.00,$499.45,"$2,852.50",$0.00,"$1,426.25","$2,259.18","$2,282.00",$0.00,$446.42,$0.00,$454.12,$0.00
SC-1110-02,SUP,HCPCS L8688,,SC-1110-02  -  NEUROSTIMULATOR IMPLTABLE PRCS PLS GNTR SC-1110,"$36,900.00",$0.00,"$36,900.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$36,900.00",$0.00,"$18,450.00","$29,224.80","$29,520.00",$0.00,$0.00,$0.00,$0.00,$0.00
SC-2218-50,SUP,Custom 27203010,,KIT STM 50CM LINEAR 8 CNTCT LEAD,"$4,780.00",$0.00,"$4,780.00",$0.00,"$3,411.49",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,780.00",$0.00,"$2,390.00","$3,785.76","$3,824.00",$0.00,$0.00,$0.00,$0.00,$0.00
SC-4385-50,SUP,Custom 27203010,,SC-4385-50  -  KIT STM 50CM STY CAP,$412.50,$0.00,$412.50,$0.00,$294.40,$0.00,$0.00,$0.00,$0.00,$0.00,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$0.00,$0.00,$0.00,$0.00
SC-4400,SUP,HCPCS L8688,,SC-4400  -  NEUROSTIMULATOR IMPLTABLE PLS GNTR PLG PORT,$162.50,$0.00,$162.50,$0.00,$115.98,$0.00,$0.00,$0.00,$0.00,$0.00,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$0.00,$0.00,$0.00,$0.00
SC-5500-2,SUP,Custom 27203010,,KIT STM PRCS LINEAR PT PRGMR NEUROMASCULAR,"$2,380.00",$0.00,"$2,380.00",$0.00,"$1,698.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,380.00",$0.00,"$1,190.00","$1,884.96","$1,904.00",$0.00,$0.00,$0.00,$0.00,$0.00
SC-6412,SUP,Custom 27203010,,KIT STM SPNL CORD CHRGR ONLY,"$5,980.00",$0.00,"$5,980.00",$0.00,"$4,267.93",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,980.00",$0.00,"$2,990.00","$4,736.16","$4,784.00",$0.00,$0.00,$0.00,$0.00,$0.00
SCD13,SUP,Custom 27011340,,SCD13  -  DISSECTOR LAPSCOP US HNDPC 13CM SONICISION DISP,"$4,777.50",$0.00,"$4,777.50",$0.00,"$3,409.70",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,777.50",$0.00,"$2,388.75","$3,783.78","$3,822.00",$0.00,$0.00,$0.00,$0.00,$0.00
SCD26,SUP,Custom 27011340,,SCD26  -  DISSECTOR ENDSCP STR JAW HND SWCH CRDLS US 26CM 5,"$4,777.50",$0.00,"$4,777.50",$0.00,"$3,409.70",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,777.50",$0.00,"$2,388.75","$3,783.78","$3,822.00",$0.00,$0.00,$0.00,$0.00,$0.00
SCREWTEST,SUP,HCPCS C1713,,SCREWTEST  -  SCREW SUPPLY TEST NEW ITEM,$50.00,$0.00,$50.00,$22.50,$35.69,$0.00,$8.61,$0.00,$0.00,$8.75,$50.00,$0.00,$25.00,$39.60,$40.00,$0.00,$7.83,$0.00,$7.96,$0.00
SD242.003,SUP,HCPCS C1713,,SD242.003  -  PLATE BN STRG 170MM NS LCP SS WRST 2.4MM SCR,"$7,192.50",$0.00,"$7,192.50","$3,236.63","$5,133.29",$0.00,"$1,239.23",$0.00,$0.00,"$1,259.35","$7,192.50",$0.00,"$3,596.25","$5,696.46","$5,754.00",$0.00,"$1,125.63",$0.00,"$1,145.05",$0.00
SE5423WV,SUP,Custom 27203010,,SE5423WV  -  PACK 23 GA POSTERIOR WIDE-FIELD ELITE,$887.50,$0.00,$887.50,$0.00,$633.41,$0.00,$0.00,$0.00,$0.00,$0.00,$887.50,$0.00,$443.75,$702.90,$710.00,$0.00,$0.00,$0.00,$0.00,$0.00
SE5425WVB,SUP,Custom 27203010,,SE5425WVB  -  PACK VITRTM 25GA STRL LF STELLARIS ELT 2 BLDE CTR W FLD POST,$987.50,$0.00,$987.50,$0.00,$704.78,$0.00,$0.00,$0.00,$0.00,$0.00,$987.50,$0.00,$493.75,$782.10,$790.00,$0.00,$0.00,$0.00,$0.00,$0.00
SE5427MVB,SUP,Custom 27203010,,SE5427MVB  -  PACK 27 GA. BI-BLADE VITREOUS CUTTER POSTERIOR MID-FIELD STE,$987.50,$0.00,$987.50,$0.00,$704.78,$0.00,$0.00,$0.00,$0.00,$0.00,$987.50,$0.00,$493.75,$782.10,$790.00,$0.00,$0.00,$0.00,$0.00,$0.00
SECOC 28/28,SUP,Custom 27803010,,SECOC 28/28  -  OUTER SMALL FRAGMENT CLAMP,$537.50,$0.00,$537.50,$0.00,$383.61,$0.00,$0.00,$0.00,$0.00,$0.00,$537.50,$0.00,$268.75,$425.70,$430.00,$0.00,$0.00,$0.00,$0.00,$0.00
SECURADRMMEM,SUP,HCPCS C1721,,SECURADRMMEM  -  SECURA DR SYSTEM (INCLUDING DF4 HEADER),"$49,812.50",$0.00,"$49,812.50","$22,415.63","$5,158.80",$0.00,"$8,138.89",$0.00,$0.00,"$8,138.89","$49,812.50",$0.00,"$24,906.25","$39,451.50","$39,850.00",$0.00,"$7,751.33",$0.00,"$7,930.15",$0.00
SECURAVREMEM,SUP,HCPCS C1721,,SECURAVREMEM  -  SECURA VR SYSTEM (INCLUDING DF4 HEADER),"$43,750.00",$0.00,"$43,750.00","$19,687.50","$5,158.80",$0.00,"$7,537.91",$0.00,$0.00,"$7,660.28","$43,750.00",$0.00,"$21,875.00","$34,650.00","$35,000.00",$0.00,"$6,846.88",$0.00,"$6,965.00",$0.00
SECX-10-7-30-135,SUP,HCPCS C1876,,SECX-10-7-30-135  -  STENT VASC 30MM 10/7MM 6FR PRTG .014IN 8.5-9.5MM PERI CRTD,"$5,127.50",$0.00,"$5,127.50","$2,307.38","$3,659.50",$0.00,$883.44,$0.00,$0.00,$897.78,"$5,127.50",$0.00,"$2,563.75","$4,060.98","$4,102.00",$0.00,$802.45,$0.00,$816.30,$0.00
SECX-10-7-40-135,SUP,HCPCS C1876,,SECX-10-7-40-135  -  STENT VASC 40MM 10/7MM 6FR PRTG .014IN 8.5-9.5MM PERI CRTD,"$5,127.50",$0.00,"$5,127.50","$2,307.38","$3,659.50",$0.00,$883.44,$0.00,$0.00,$897.78,"$5,127.50",$0.00,"$2,563.75","$4,060.98","$4,102.00",$0.00,$802.45,$0.00,$816.30,$0.00
SECX-8-6-30-135,SUP,HCPCS C1876,,SECX-8-6-30-135  -  STENT VASC 8/6MM 6/8FR 30MM 135CM .014IN RAPEX TPR EXPRT,"$5,127.50",$0.00,"$5,127.50","$2,307.38","$3,659.50",$0.00,$883.44,$0.00,$0.00,$897.78,"$5,127.50",$0.00,"$2,563.75","$4,060.98","$4,102.00",$0.00,$802.45,$0.00,$816.30,$0.00
SECX-8-6-40-135,SUP,HCPCS C1876,,SECX-8-6-40-135  -  STENT VASC 40MM 8/6MM 6FR PRTG .014IN 6.5-7.5MM PERI CRTD,"$5,127.50",$0.00,"$5,127.50","$2,307.38","$3,659.50",$0.00,$883.44,$0.00,$0.00,$897.78,"$5,127.50",$0.00,"$2,563.75","$4,060.98","$4,102.00",$0.00,$802.45,$0.00,$816.30,$0.00
SEDR01,SUP,HCPCS C1786,,SEDR01  -  PACEMAKER CARDIAC 2.8V 1.2AH 7.5MM 47.9X44.7MM IMPLTABLE 2,"$8,500.00",$0.00,"$8,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,500.00",$0.00,"$4,250.00","$6,732.00","$6,800.00",$0.00,$0.00,$0.00,$0.00,$0.00
SEG1411,SUP,HCPCS C1769,,SEG1411  -  GWIRE VASC .014IN 190CM 8CM ANG SEGWAY HYDPHI,$312.50,$0.00,$312.50,$169.69,$223.03,$0.00,$53.84,$0.00,$0.00,$54.72,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$48.91,$0.00,$49.75,$0.00
SEG1412,SUP,HCPCS C1769,,SEG1412  -  STR GUIDEWIRE .014X180 SEGWAY GT,$312.50,$0.00,$312.50,$169.69,$223.03,$0.00,$53.84,$0.00,$0.00,$54.72,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$48.91,$0.00,$49.75,$0.00
SENSH1428W,SUP,HCPCS C1894,,SENSH1428W  -  SHEATH INTROD 28CM GWIRE FLEXIBILITY REINFORCED COIL RADIOPQ,$500.00,$0.00,$500.00,$271.50,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
SENSH1628W,SUP,HCPCS C1894,,SENSH1628W  -  SHEATH INTRO .035IN 16FR 28CM SENTRANT RADOPQ REINF COIL DIL,$500.00,$0.00,$500.00,$271.50,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
SENSH1828W,SUP,HCPCS C1894,,SENSH1828W  -  SHEATH INTRO .035IN 18FR 28CM SENTRANT RADOPQ REINF COIL DIL,$500.00,$0.00,$500.00,$271.50,$356.85,$0.00,$86.15,$0.00,$0.00,$87.55,$500.00,$0.00,$250.00,$396.00,$400.00,$0.00,$78.25,$0.00,$79.60,$0.00
SENSH2028W,SUP,HCPCS C1894,,SENSH2028W  -  SHEATH INTROD 28CM RADIOPQ MARKER BAND REINFORCED COIL DILAT,$625.00,$0.00,$625.00,$339.38,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
SENSH2228W,SUP,HCPCS C1894,,SENSH2228W  -  SHEATH INTRO 22FR 28CM SENTRANT HDRPH AAA,$625.00,$0.00,$625.00,$339.38,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
SENSIADRK2,SUP,HCPCS C2619,,SENSIADRK2  -  SENSIA DR SYSTEM,"$12,500.00",$0.00,"$12,500.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$12,500.00",$0.00,"$6,250.00","$9,900.00","$10,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
SENSIASRK2,SUP,HCPCS C2620,,SENSIASRK2  -  PACEMAKER CARDIAC THK7.5MM 42.9X40.2MM IMPLTABLE 1 CHAMBER,"$6,012.50",$0.00,"$6,012.50",$0.00,"$4,291.12",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,012.50",$0.00,"$3,006.25","$4,761.90","$4,810.00",$0.00,$0.00,$0.00,$0.00,$0.00
SESR01,SUP,HCPCS C1786,,SESR01  -  PACEMAKER CARDIAC 2.8V .97AH 7.5MM 42.9MMX40.2MM 1 CHAMBER,"$5,000.00",$0.00,"$5,000.00",$0.00,"$3,568.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$5,000.00",$0.00,"$2,500.00","$3,960.00","$4,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
SF-2500-6101,SUP,HCPCS C1713,,SF-2500-6101  -  PIN HALF 500MM NONSTRL DISPOSABLE,"$5,250.00",$0.00,"$5,250.00","$2,362.50","$3,746.93",$0.00,$904.55,$0.00,$0.00,$919.23,"$5,250.00",$0.00,"$2,625.00","$4,158.00","$4,200.00",$0.00,$821.63,$0.00,$835.80,$0.00
SFR-4-15,SUP,Custom 27203010,,SFR-4-15  -  DEVICE THROMBECTOMY SOLITARE FR 4X15,"$15,250.00",$0.00,"$15,250.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$15,250.00",$0.00,"$7,625.00","$12,078.00","$12,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
SFR-4-20,SUP,Custom 27203010,,SFR-4-20  -  DEVICE THRMB 31MM 4MM SOLITAIRE FR REVSC,"$15,250.00",$0.00,"$15,250.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$15,250.00",$0.00,"$7,625.00","$12,078.00","$12,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
SFR-6-20,SUP,Custom 27203010,,SFR-6-20  -  DEVICE THRMB 31MM 6MM SOLITAIRE FR REVSC,"$15,250.00",$0.00,"$15,250.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$15,250.00",$0.00,"$7,625.00","$12,078.00","$12,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
SFR-6-30,SUP,Custom 27203010,,SFR-6-30  -  DEVICE THRMB 42MM 6MM SOLITAIRE FR REVSC,"$15,250.00",$0.00,"$15,250.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$15,250.00",$0.00,"$7,625.00","$12,078.00","$12,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
SGL-1,SUP,Custom 27203010,,SGL-1  -  SUTURE CR SURGITIE 0 21IN LGT LOOP DLV SYS ABS,$607.98,$0.00,$607.98,$0.00,$433.91,$0.00,$0.00,$0.00,$0.00,$0.00,$607.98,$0.00,$303.99,$481.52,$486.38,$0.00,$0.00,$0.00,$0.00,$0.00
S-H00703,SUP,HCPCS C1776,,S-H00703  -  STEM FEM HDNK OMFT LNG HIP,"$3,866.00",$0.00,"$3,866.00","$1,739.70","$2,759.16",$0.00,$666.09,$0.00,$0.00,$676.91,"$3,866.00",$0.00,"$1,933.00","$3,061.87","$3,092.80",$0.00,$605.03,$0.00,$615.47,$0.00
SH-0713-S,SUP,HCPCS C1776,,SH-0713-S  -  STEM HUM 130MM 7MM MDLR SHRT SHLDR,"$4,055.00",$0.00,"$4,055.00","$1,824.75","$2,894.05",$0.00,$698.66,$0.00,$0.00,$710.00,"$4,055.00",$0.00,"$2,027.50","$3,211.56","$3,244.00",$0.00,$634.61,$0.00,$645.56,$0.00
SH-0813-S,SUP,HCPCS C1776,,SH-0813-S  -  STEM HUM 130MM 8MM MDLR SHRT SHLDR,"$4,055.00",$0.00,"$4,055.00","$1,824.75","$2,894.05",$0.00,$698.66,$0.00,$0.00,$710.00,"$4,055.00",$0.00,"$2,027.50","$3,211.56","$3,244.00",$0.00,$634.61,$0.00,$645.56,$0.00
SH-0818-S,SUP,HCPCS C1776,,SH-0818-S  -  STEM HUM 180MM 8MM LNG SHLDR,"$4,055.00",$0.00,"$4,055.00","$1,824.75","$2,894.05",$0.00,$698.66,$0.00,$0.00,$710.00,"$4,055.00",$0.00,"$2,027.50","$3,211.56","$3,244.00",$0.00,$634.61,$0.00,$645.56,$0.00
SH-0820,SUP,HCPCS C1776,,SH-0820  -  STEM HUM 200MM 8MM PLRS LNG SHLDR STRL,"$4,987.50",$0.00,"$4,987.50","$2,244.38","$3,559.58",$0.00,$859.32,$0.00,$0.00,$873.27,"$4,987.50",$0.00,"$2,493.75","$3,950.10","$3,990.00",$0.00,$780.54,$0.00,$794.01,$0.00
SH-0820-S,SUP,HCPCS C1776,,SH-0820-S  -  STEM HUM 200MM 8MM PLRS LNG SHLDR STRL,"$4,055.00",$0.00,"$4,055.00","$1,824.75","$2,894.05",$0.00,$698.66,$0.00,$0.00,$710.00,"$4,055.00",$0.00,"$2,027.50","$3,211.56","$3,244.00",$0.00,$634.61,$0.00,$645.56,$0.00
SH-0822-S,SUP,HCPCS C1776,,SH-0822-S  -  STEM HUM 220MM 8MM MDLR LNG SHLDR,"$4,055.00",$0.00,"$4,055.00","$1,824.75","$2,894.05",$0.00,$698.66,$0.00,$0.00,$710.00,"$4,055.00",$0.00,"$2,027.50","$3,211.56","$3,244.00",$0.00,$634.61,$0.00,$645.56,$0.00
SH-0824-S,SUP,HCPCS C1776,,SH-0824-S  -  STEM HUM 240MM 8MM MDLR PLRS LNG SHLDR STRL,"$4,055.00",$0.00,"$4,055.00","$1,824.75","$2,894.05",$0.00,$698.66,$0.00,$0.00,$710.00,"$4,055.00",$0.00,"$2,027.50","$3,211.56","$3,244.00",$0.00,$634.61,$0.00,$645.56,$0.00
SH-0826-S,SUP,HCPCS C1776,,SH-0826-S  -  STEM HUM 8MM 260MM STRL MDLR SHLDR,"$4,055.00",$0.00,"$4,055.00","$1,824.75","$2,894.05",$0.00,$698.66,$0.00,$0.00,$710.00,"$4,055.00",$0.00,"$2,027.50","$3,211.56","$3,244.00",$0.00,$634.61,$0.00,$645.56,$0.00
SH-0828-S,SUP,HCPCS C1776,,SH-0828-S  -  STEM HUM 280MM 8MM MDLR LNG SHLDR,"$4,055.00",$0.00,"$4,055.00","$1,824.75","$2,894.05",$0.00,$698.66,$0.00,$0.00,$710.00,"$4,055.00",$0.00,"$2,027.50","$3,211.56","$3,244.00",$0.00,$634.61,$0.00,$645.56,$0.00
SH-0913-S,SUP,HCPCS C1776,,SH-0913-S  -  STEM HUM 130MM 9MM TI SHLDR,"$4,055.00",$0.00,"$4,055.00","$1,824.75","$2,894.05",$0.00,$698.66,$0.00,$0.00,$710.00,"$4,055.00",$0.00,"$2,027.50","$3,211.56","$3,244.00",$0.00,$634.61,$0.00,$645.56,$0.00
SH-1013-S,SUP,HCPCS C1776,,SH-1013-S  -  STEM HUM 130MM 10MM PLRS TI SHLDR,"$4,055.00",$0.00,"$4,055.00","$1,824.75","$2,894.05",$0.00,$698.66,$0.00,$0.00,$710.00,"$4,055.00",$0.00,"$2,027.50","$3,211.56","$3,244.00",$0.00,$634.61,$0.00,$645.56,$0.00
SH-1018-S,SUP,HCPCS C1776,,SH-1018-S  -  STEM HUM 180MM 10MM MDLR LNG SHLDR,"$4,055.00",$0.00,"$4,055.00","$1,824.75","$2,894.05",$0.00,$698.66,$0.00,$0.00,$710.00,"$4,055.00",$0.00,"$2,027.50","$3,211.56","$3,244.00",$0.00,$634.61,$0.00,$645.56,$0.00
SH-1020-S,SUP,HCPCS C1776,,SH-1020-S  -  STEM HUM 200MM 10MM MDLR LNG SHLDR,"$4,055.00",$0.00,"$4,055.00","$1,824.75","$2,894.05",$0.00,$698.66,$0.00,$0.00,$710.00,"$4,055.00",$0.00,"$2,027.50","$3,211.56","$3,244.00",$0.00,$634.61,$0.00,$645.56,$0.00
SH-1022-S,SUP,HCPCS C1776,,SH-1022-S  -  STEM HUM 220MM 10MM MDLR LNG SHLDR,"$4,055.00",$0.00,"$4,055.00","$1,824.75","$2,894.05",$0.00,$698.66,$0.00,$0.00,$710.00,"$4,055.00",$0.00,"$2,027.50","$3,211.56","$3,244.00",$0.00,$634.61,$0.00,$645.56,$0.00
SH-1024-S,SUP,HCPCS C1776,,SH-1024-S  -  STEM HUM 240MM 10MM MDLR LNG SHLDR,"$4,055.00",$0.00,"$4,055.00","$1,824.75","$2,894.05",$0.00,$698.66,$0.00,$0.00,$710.00,"$4,055.00",$0.00,"$2,027.50","$3,211.56","$3,244.00",$0.00,$634.61,$0.00,$645.56,$0.00
SH-1026-S,SUP,HCPCS C1776,,SH-1026-S  -  STEM HUM 260MM 10MM MDLR SHLDR STRL,"$4,055.00",$0.00,"$4,055.00","$1,824.75","$2,894.05",$0.00,$698.66,$0.00,$0.00,$710.00,"$4,055.00",$0.00,"$2,027.50","$3,211.56","$3,244.00",$0.00,$634.61,$0.00,$645.56,$0.00
SH-1028-S,SUP,HCPCS C1776,,SH-1028-S  -  STEM HUM 280MM 10MM MDLR LNG SHLDR STRL,"$4,055.00",$0.00,"$4,055.00","$1,824.75","$2,894.05",$0.00,$698.66,$0.00,$0.00,$710.00,"$4,055.00",$0.00,"$2,027.50","$3,211.56","$3,244.00",$0.00,$634.61,$0.00,$645.56,$0.00
SH-1213-S,SUP,HCPCS C1776,,SH-1213-S  -  STEM HUM 130MM 12MM MDLR SHRT SHLDR STRL,"$4,055.00",$0.00,"$4,055.00","$1,824.75","$2,894.05",$0.00,$698.66,$0.00,$0.00,$710.00,"$4,055.00",$0.00,"$2,027.50","$3,211.56","$3,244.00",$0.00,$634.61,$0.00,$645.56,$0.00
SH-1313-S,SUP,HCPCS C1776,,SH-1313-S  -  STEM HUM 130MM 13MM MDLR SHRT SHLDR STRL,"$4,055.00",$0.00,"$4,055.00","$1,824.75","$2,894.05",$0.00,$698.66,$0.00,$0.00,$710.00,"$4,055.00",$0.00,"$2,027.50","$3,211.56","$3,244.00",$0.00,$634.61,$0.00,$645.56,$0.00
SH-1340L-S,SUP,HCPCS C1776,,SH-1340L-S  -  HEAD HUM 13MM LEFT SHLDR BODY ASMBLY MDLR PLRS STRL,"$5,910.00",$0.00,"$5,910.00","$2,659.50","$4,217.97",$0.00,"$1,018.26",$0.00,$0.00,"$1,034.79","$5,910.00",$0.00,"$2,955.00","$4,680.72","$4,728.00",$0.00,$924.92,$0.00,$940.87,$0.00
SH-1340R-S,SUP,HCPCS C1776,,SH-1340R-S  -  STEM HUM 13MM ASMBLY TI RIGHT SHLDR,"$5,910.00",$0.00,"$5,910.00","$2,659.50","$4,217.97",$0.00,"$1,018.26",$0.00,$0.00,"$1,034.79","$5,910.00",$0.00,"$2,955.00","$4,680.72","$4,728.00",$0.00,$924.92,$0.00,$940.87,$0.00
SH-1413-S,SUP,HCPCS C1776,,SH-1413-S  -  STEM HUM 130MM 14MM MDLR SHRT SHLDR,"$4,055.00",$0.00,"$4,055.00","$1,824.75","$2,894.05",$0.00,$698.66,$0.00,$0.00,$710.00,"$4,055.00",$0.00,"$2,027.50","$3,211.56","$3,244.00",$0.00,$634.61,$0.00,$645.56,$0.00
SH-1513-S,SUP,HCPCS C1776,,SH-1513-S  -  STEM HUM 130MM 15MM MDLR SHRT SHLDR STRL,"$4,055.00",$0.00,"$4,055.00","$1,824.75","$2,894.05",$0.00,$698.66,$0.00,$0.00,$710.00,"$4,055.00",$0.00,"$2,027.50","$3,211.56","$3,244.00",$0.00,$634.61,$0.00,$645.56,$0.00
SH-1540L-S,SUP,HCPCS C1776,,SH-1540L-S  -  STEM HUM 15MM MDLR BODY ASMBLY LEFT SHLDR STRL,"$5,910.00",$0.00,"$5,910.00","$2,659.50","$4,217.97",$0.00,"$1,018.26",$0.00,$0.00,"$1,034.79","$5,910.00",$0.00,"$2,955.00","$4,680.72","$4,728.00",$0.00,$924.92,$0.00,$940.87,$0.00
SH-1540R-S,SUP,HCPCS C1776,,SH-1540R-S  -  STEM HUM 15MM MDLR BODY ASMBLY RIGHT SHLDR,"$5,910.00",$0.00,"$5,910.00","$2,659.50","$4,217.97",$0.00,"$1,018.26",$0.00,$0.00,"$1,034.79","$5,910.00",$0.00,"$2,955.00","$4,680.72","$4,728.00",$0.00,$924.92,$0.00,$940.87,$0.00
SH-3916-S,SUP,HCPCS C1776,,SH-3916-S  -  HEAD HUM 39MM 16MM SHLDR MDLR PLRS STRL,"$3,462.50",$0.00,"$3,462.50","$1,558.13","$2,471.19",$0.00,$596.57,$0.00,$0.00,$606.26,"$3,462.50",$0.00,"$1,731.25","$2,742.30","$2,770.00",$0.00,$541.88,$0.00,$551.23,$0.00
SH-3920-S,SUP,HCPCS C1776,,SH-3920-S  -  HEAD HUM 39MM 20MM SHLDR MDLR STRL,"$3,462.50",$0.00,"$3,462.50","$1,558.13","$2,471.19",$0.00,$596.57,$0.00,$0.00,$606.26,"$3,462.50",$0.00,"$1,731.25","$2,742.30","$2,770.00",$0.00,$541.88,$0.00,$551.23,$0.00
SH-4317-S,SUP,HCPCS C1776,,SH-4317-S  -  HEAD HUM 43MM 17MM SHLDR TI,"$3,462.50",$0.00,"$3,462.50","$1,558.13","$2,471.19",$0.00,$596.57,$0.00,$0.00,$606.26,"$3,462.50",$0.00,"$1,731.25","$2,742.30","$2,770.00",$0.00,$541.88,$0.00,$551.23,$0.00
SH-4321-S,SUP,HCPCS C1776,,SH-4321-S  -  HEAD HUM 21MM 43MM SHLDR,"$3,462.50",$0.00,"$3,462.50","$1,558.13","$2,471.19",$0.00,$596.57,$0.00,$0.00,$606.26,"$3,462.50",$0.00,"$1,731.25","$2,742.30","$2,770.00",$0.00,$541.88,$0.00,$551.23,$0.00
SH-4718-S,SUP,HCPCS C1776,,SH-4718-S  -  HEAD HUM 47MM 18MM SHLDR PLRS TI,"$3,462.50",$0.00,"$3,462.50","$1,558.13","$2,471.19",$0.00,$596.57,$0.00,$0.00,$606.26,"$3,462.50",$0.00,"$1,731.25","$2,742.30","$2,770.00",$0.00,$541.88,$0.00,$551.23,$0.00
SH-4722-S,SUP,HCPCS C1776,,SH-4722-S  -  HEAD HUM 47MM 22MM STRL MDLR SHLDR,"$3,462.50",$0.00,"$3,462.50","$1,558.13","$2,471.19",$0.00,$596.57,$0.00,$0.00,$606.26,"$3,462.50",$0.00,"$1,731.25","$2,742.30","$2,770.00",$0.00,$541.88,$0.00,$551.23,$0.00
SH-5119-S,SUP,HCPCS C1776,,SH-5119-S  -  HEAD HUM 19MM 51MM SHLDR MDLR STRL,"$3,462.50",$0.00,"$3,462.50","$1,558.13","$2,471.19",$0.00,$596.57,$0.00,$0.00,$606.26,"$3,462.50",$0.00,"$1,731.25","$2,742.30","$2,770.00",$0.00,$541.88,$0.00,$551.23,$0.00
SH-5123-S,SUP,HCPCS C1776,,SH-5123-S  -  HEAD HUM 51MM 23MM SHLDR MDLR PLRS,"$3,462.50",$0.00,"$3,462.50","$1,558.13","$2,471.19",$0.00,$596.57,$0.00,$0.00,$606.26,"$3,462.50",$0.00,"$1,731.25","$2,742.30","$2,770.00",$0.00,$541.88,$0.00,$551.23,$0.00
SH-R1307,SUP,Custom 27203010,,SH-R1307  -  REAMER SURG 13MM 7MM SHLDR,$735.00,$0.00,$735.00,$0.00,$524.57,$0.00,$0.00,$0.00,$0.00,$0.00,$735.00,$0.00,$367.50,$582.12,$588.00,$0.00,$0.00,$0.00,$0.00,$0.00
SH-R1308,SUP,Custom 27203010,,SH-R1308  -  REAMER SURG 13MM 8MM SHLDR,$735.00,$0.00,$735.00,$0.00,$524.57,$0.00,$0.00,$0.00,$0.00,$0.00,$735.00,$0.00,$367.50,$582.12,$588.00,$0.00,$0.00,$0.00,$0.00,$0.00
SH-R1309,SUP,Custom 27203010,,SH-R1309  -  REAMER SURG 13MM 9MM SHLDR,$735.00,$0.00,$735.00,$0.00,$524.57,$0.00,$0.00,$0.00,$0.00,$0.00,$735.00,$0.00,$367.50,$582.12,$588.00,$0.00,$0.00,$0.00,$0.00,$0.00
SH-R1310,SUP,Custom 27203010,,SH-R1310  -  REAMER SURG 13MM 10MM SHLDR,$735.00,$0.00,$735.00,$0.00,$524.57,$0.00,$0.00,$0.00,$0.00,$0.00,$735.00,$0.00,$367.50,$582.12,$588.00,$0.00,$0.00,$0.00,$0.00,$0.00
SH-R1311,SUP,Custom 27203010,,SH-R1311  -  REAMER SURG 13MM 11MM SHLDR,$735.00,$0.00,$735.00,$0.00,$524.57,$0.00,$0.00,$0.00,$0.00,$0.00,$735.00,$0.00,$367.50,$582.12,$588.00,$0.00,$0.00,$0.00,$0.00,$0.00
SH-R1312,SUP,Custom 27203010,,SH-R1312  -  REAMER SURG 13MM 12MM SHLDR,$735.00,$0.00,$735.00,$0.00,$524.57,$0.00,$0.00,$0.00,$0.00,$0.00,$735.00,$0.00,$367.50,$582.12,$588.00,$0.00,$0.00,$0.00,$0.00,$0.00
SH-R1313,SUP,Custom 27203010,,SH-R1313  -  REAMER SURG 13MM 13MM SHLDR,$735.00,$0.00,$735.00,$0.00,$524.57,$0.00,$0.00,$0.00,$0.00,$0.00,$735.00,$0.00,$367.50,$582.12,$588.00,$0.00,$0.00,$0.00,$0.00,$0.00
SH-R1514,SUP,Custom 27203010,,SH-R1514  -  REAMER SURG 15MM 14MM SHLDR,$735.00,$0.00,$735.00,$0.00,$524.57,$0.00,$0.00,$0.00,$0.00,$0.00,$735.00,$0.00,$367.50,$582.12,$588.00,$0.00,$0.00,$0.00,$0.00,$0.00
SH-R1515,SUP,Custom 27203010,,SH-R1515  -  REAMER SURG 15MM 15MM SHLDR,$735.00,$0.00,$735.00,$0.00,$524.57,$0.00,$0.00,$0.00,$0.00,$0.00,$735.00,$0.00,$367.50,$582.12,$588.00,$0.00,$0.00,$0.00,$0.00,$0.00
SH-R1716,SUP,Custom 27203010,,SH-R1716  -  REAMER SURG 17MM 16MM SHLDR,$735.00,$0.00,$735.00,$0.00,$524.57,$0.00,$0.00,$0.00,$0.00,$0.00,$735.00,$0.00,$367.50,$582.12,$588.00,$0.00,$0.00,$0.00,$0.00,$0.00
SH-R1717,SUP,Custom 27203010,,SH-R1717  -  REAMER SURG 17MM 17MM SHLDR,$735.00,$0.00,$735.00,$0.00,$524.57,$0.00,$0.00,$0.00,$0.00,$0.00,$735.00,$0.00,$367.50,$582.12,$588.00,$0.00,$0.00,$0.00,$0.00,$0.00
SIG-3616,SUP,Custom 25003010,,ANTIBODY CA 19-9 PRF MNCLN LAB,"$1,827.50",$0.00,"$1,827.50",$0.00,"$1,304.29",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,827.50",$0.00,$913.75,"$1,447.38","$1,462.00",$0.00,$0.00,$0.00,$0.00,$0.00
SIG45CTAVM,SUP,Custom 27203010,,SIG45CTAVM  -  RELOAD STPLR 2MM 2.5MM 3MM 45MM TN STRL LF EGIA ARTC KNF,"$3,073.20",$0.00,"$3,073.20",$0.00,"$2,193.34",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,073.20",$0.00,"$1,536.60","$2,433.97","$2,458.56",$0.00,$0.00,$0.00,$0.00,$0.00
SILSPT12,SUP,Custom 27203010,,SILSPT12  -  PORT ENDSCP 5MM 12MM FLEXIBLE CANNU OBTURATOR LATEX FREE,"$1,205.31",$0.00,"$1,205.31",$0.00,$860.23,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,205.31",$0.00,$602.66,$954.61,$964.25,$0.00,$0.00,$0.00,$0.00,$0.00
SK-0480-C,SUP,Custom 27203010,,STAIN KT COMBO 480 TST HISTOLGY,$106.25,$0.00,$106.25,$0.00,$75.83,$0.00,$0.00,$0.00,$0.00,$0.00,$106.25,$0.00,$53.13,$84.15,$85.00,$0.00,$0.00,$0.00,$0.00,$0.00
SK200,SUP,Custom 27203010,,SK200  -  KIT VASC 175CM 2MM 2.3-3FR AGN MIC NTNL INTROD TRQ DEV CATH,"$1,400.00",$0.00,"$1,400.00",$0.00,$999.18,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,400.00",$0.00,$700.00,"$1,108.80","$1,120.00",$0.00,$0.00,$0.00,$0.00,$0.00
SK400,SUP,Custom 27203010,,SK400  -  SNARE VASC 175CM 4MM 2.3-3FR AGN MIC NTNL MCTH KIT 150CM,"$1,400.00",$0.00,"$1,400.00",$0.00,$999.18,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,400.00",$0.00,$700.00,"$1,108.80","$1,120.00",$0.00,$0.00,$0.00,$0.00,$0.00
SMC-5060,SUP,Custom 27203010,,SMC-5060  -  SHAFT SM 60MM FXTR BONE,$205.00,$0.00,$205.00,$0.00,$146.31,$0.00,$0.00,$0.00,$0.00,$0.00,$205.00,$0.00,$102.50,$162.36,$164.00,$0.00,$0.00,$0.00,$0.00,$0.00
SMC-5090,SUP,HCPCS C1713,,SMC-5090  -  SCREW BONE 90MM SM SHFT FXTR,$205.00,$0.00,$205.00,$92.25,$146.31,$0.00,$35.32,$0.00,$0.00,$35.89,$205.00,$0.00,$102.50,$162.36,$164.00,$0.00,$32.08,$0.00,$32.64,$0.00
SMT-5060,SUP,Custom 27203010,,SMT-5060  -  ROD EXFIX STABLELOC RADL SS SM BONE FIX SYS STRL,$387.50,$0.00,$387.50,$0.00,$276.56,$0.00,$0.00,$0.00,$0.00,$0.00,$387.50,$0.00,$193.75,$306.90,$310.00,$0.00,$0.00,$0.00,$0.00,$0.00
SMT-5090,SUP,Custom 27203010,,SMT-5090  -  ROD EXFIX 90MM STABLELOC SS SM BONE FIX SYS STRL,$387.50,$0.00,$387.50,$0.00,$276.56,$0.00,$0.00,$0.00,$0.00,$0.00,$387.50,$0.00,$193.75,$306.90,$310.00,$0.00,$0.00,$0.00,$0.00,$0.00
SN 7016X,SUP,Custom 27203010,,SN 7016X  -  DEVICE BIOP 10CM 14GA MNPTY 22MM INSTR AUTO STRL DISP,$85.00,$0.00,$85.00,$0.00,$60.66,$0.00,$0.00,$0.00,$0.00,$0.00,$85.00,$0.00,$42.50,$67.32,$68.00,$0.00,$0.00,$0.00,$0.00,$0.00
SN60AT,SUP,HCPCS V2632,,SN60AT  -  LENS IOL 0D MOD L BCNVX 6MM 13MM STRL ACRSF N STABLEFORCE 1,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
SN60AT.060,SUP,HCPCS V2632,,SN60AT.060  -  LENS IOL 0 D +6 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
SN60AT.070,SUP,HCPCS V2632,,SN60AT.070  -  LENS IOL 0 D +7 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
SN60AT.075,SUP,HCPCS V2632,,SN60AT.075  -  LENS IOL 0 D +7.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
SN60AT.080,SUP,HCPCS V2632,,SN60AT.080  -  LENS IOL 0 D +8 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
SN60AT.085,SUP,HCPCS V2632,,SN60AT.085  -  LENS IOL 0 D +8.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
SN60AT.090,SUP,HCPCS V2632,,SN60AT.090  -  LENS IOL 0 D +9 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
SN60AT.095,SUP,HCPCS V2632,,SN60AT.095  -  LENS IOL 0 D +9.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
SN60AT.100,SUP,HCPCS V2632,,SN60AT.100  -  LENS IOL 0 D +10 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
SN60AT.105,SUP,HCPCS V2632,,SN60AT.105  -  LENS IOL 0 D +10.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
SN60AT.110,SUP,HCPCS V2632,,SN60AT.110  -  LENS IOL 0 D +11 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
SN60AT.115,SUP,HCPCS V2632,,SN60AT.115  -  LENS IOL 0 D +11.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
SN60AT.120,SUP,HCPCS V2632,,SN60AT.120  -  LENS IOL 0 D +12 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
SN60AT.125,SUP,HCPCS V2632,,SN60AT.125  -  LENS IOL 0 D +12.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
SN60AT.130,SUP,HCPCS V2632,,SN60AT.130  -  LENS IOL 0 D +13 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
SN60AT.135,SUP,HCPCS V2632,,SN60AT.135  -  LENS IOL 0 D +13.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
SN60AT.140,SUP,HCPCS V2632,,SN60AT.140  -  LENS IOL 0 D +14 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
SN60AT.145,SUP,HCPCS V2632,,SN60AT.145  -  LENS IOL 0 D +14.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
SN60AT.150,SUP,HCPCS V2632,,SN60AT.150  -  LENS IOL 0 D +15 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
SN60AT.155,SUP,HCPCS V2632,,SN60AT.155  -  LENS IOL 0 D +15.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
SN60AT.160,SUP,HCPCS V2632,,SN60AT.160  -  LENS IOL 0 D +16 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
SN60AT.165,SUP,HCPCS V2632,,SN60AT.165  -  LENS IOL 0 D +16.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
SN60AT.170,SUP,HCPCS V2632,,SN60AT.170  -  LENS IOL 0 D +17 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
SN60AT.175,SUP,HCPCS V2632,,SN60AT.175  -  LENS IOL 0 D +17.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
SN60AT.180,SUP,HCPCS V2632,,SN60AT.180  -  LENS IOL 0 D +18 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
SN60AT.185,SUP,HCPCS V2632,,SN60AT.185  -  LENS IOL 0 D +18.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
SN60AT.190,SUP,HCPCS V2632,,SN60AT.190  -  LENS IOL 0 D +19 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
SN60AT.195,SUP,HCPCS V2632,,SN60AT.195  -  LENS IOL 0 D +19.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
SN60AT.200,SUP,HCPCS V2632,,SN60AT.200  -  LENS IOL 0 D +20 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
SN60AT.205,SUP,HCPCS V2632,,SN60AT.205  -  LENS IOL 0 D +20.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
SN60AT.210,SUP,HCPCS V2632,,SN60AT.210  -  LENS IOL 0 D +21 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
SN60AT.215,SUP,HCPCS V2632,,SN60AT.215  -  LENS IOL 0 D +21.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
SN60AT.220,SUP,HCPCS V2632,,SN60AT.220  -  LENS IOL 0 D +22 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
SN60AT.225,SUP,HCPCS V2632,,SN60AT.225  -  LENS IOL 0 D +22.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
SN60AT.230,SUP,HCPCS V2632,,SN60AT.230  -  LENS IOL 0 D +23 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
SN60AT.235,SUP,HCPCS V2632,,SN60AT.235  -  LENS IOL 0 D +23.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
SN60AT.240,SUP,HCPCS V2632,,SN60AT.240  -  LENS IOL 0 D +24 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
SN60AT.245,SUP,HCPCS V2632,,SN60AT.245  -  LENS IOL 0 D +24.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
SN60AT.250,SUP,HCPCS V2632,,SN60AT.250  -  LENS IOL 0 D +25 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
SN60AT.255,SUP,HCPCS V2632,,SN60AT.255  -  LENS IOL 0 D +25.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
SN60AT.260,SUP,HCPCS V2632,,SN60AT.260  -  LENS IOL 0 D +26 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
SN60AT.265,SUP,HCPCS V2632,,SN60AT.265  -  LENS IOL 0 D +26.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
SN60AT.270,SUP,HCPCS V2632,,SN60AT.270  -  LENS IOL 0 D +27 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
SN60AT.275,SUP,HCPCS V2632,,SN60AT.275  -  LENS IOL 0 D +27.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
SN60AT.280,SUP,HCPCS V2632,,SN60AT.280  -  LENS IOL 0 D +28 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
SN60AT.285,SUP,HCPCS V2632,,SN60AT.285  -  LENS IOL 0 D +28.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
SN60AT.295,SUP,HCPCS V2632,,SN60AT.295  -  LENS IOL 0 D +29.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
SN60AT.300,SUP,HCPCS V2632,,SN60AT.300  -  LENS IOL 0 D +30 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
SN60AT.310,SUP,HCPCS V2632,,SN60AT.310  -  LENS IOL 0 D +31 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
SN60AT.320,SUP,HCPCS V2632,,SN60AT.320  -  LENS IOL 0 D +32 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
SN60AT.330,SUP,HCPCS V2632,,SN60AT.330  -  LENS IOL 0 D +33 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
SN60AT.340,SUP,HCPCS V2632,,SN60AT.340  -  LENS IOL 0 D +34 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
SN60AT.350,SUP,HCPCS V2632,,SN60AT.350  -  LENS IOL 0 D +35 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
SN60AT.360,SUP,HCPCS V2632,,SN60AT.360  -  LENS IOL 0 D +36 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
SN60AT.370,SUP,HCPCS V2632,,SN60AT.370  -  LENS IOL 0 D +37 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
SN60AT.380,SUP,HCPCS V2632,,SN60AT.380  -  LENS IOL 0 D +38 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
SN60AT.390,SUP,HCPCS V2632,,SN60AT.390  -  LENS IOL 0 D +39 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
SN60AT.400,SUP,HCPCS V2632,,SN60AT.400  -  LENS IOL 0 D +40 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N,$472.50,$0.00,$472.50,$212.63,$337.22,$0.00,$81.41,$0.00,$0.00,$82.73,$472.50,$0.00,$236.25,$374.22,$378.00,$0.00,$73.95,$0.00,$75.22,$0.00
SN60WF,SUP,HCPCS V2632,,SN60WF  -  LENS IOL 0D MOD L BCNVX 6MM 13MM STRL ACRSF IQ 1 PC FLD ANT,$475.00,$0.00,$475.00,$213.75,$339.01,$0.00,$81.84,$0.00,$0.00,$83.17,$475.00,$0.00,$237.50,$376.20,$380.00,$0.00,$74.34,$0.00,$75.62,$0.00
SN60WF.065,SUP,HCPCS V2632,,SN60WF.065  -  LENS IOL 0 D +6.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ,$475.00,$0.00,$475.00,$213.75,$339.01,$0.00,$81.84,$0.00,$0.00,$83.17,$475.00,$0.00,$237.50,$376.20,$380.00,$0.00,$74.34,$0.00,$75.62,$0.00
SN60WF.075,SUP,HCPCS V2632,,SN60WF.075  -  LENS IOL 0 D +7.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ,$475.00,$0.00,$475.00,$213.75,$339.01,$0.00,$81.84,$0.00,$0.00,$83.17,$475.00,$0.00,$237.50,$376.20,$380.00,$0.00,$74.34,$0.00,$75.62,$0.00
SN60WF.085,SUP,HCPCS V2632,,SN60WF.085  -  LENS IOL 0 D +8.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ,$475.00,$0.00,$475.00,$213.75,$339.01,$0.00,$81.84,$0.00,$0.00,$83.17,$475.00,$0.00,$237.50,$376.20,$380.00,$0.00,$74.34,$0.00,$75.62,$0.00
SN60WF.090,SUP,HCPCS V2632,,SN60WF.090  -  LENS IOL 0 D +9 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ NTR,$475.00,$0.00,$475.00,$213.75,$339.01,$0.00,$81.84,$0.00,$0.00,$83.17,$475.00,$0.00,$237.50,$376.20,$380.00,$0.00,$74.34,$0.00,$75.62,$0.00
SN60WF.095,SUP,HCPCS V2632,,SN60WF.095  -  LENS IOL 0 D +9.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ,$475.00,$0.00,$475.00,$213.75,$339.01,$0.00,$81.84,$0.00,$0.00,$83.17,$475.00,$0.00,$237.50,$376.20,$380.00,$0.00,$74.34,$0.00,$75.62,$0.00
SN60WF.100,SUP,HCPCS V2632,,SN60WF.100  -  LENS IOL 0 D +10 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ NTR,$475.00,$0.00,$475.00,$213.75,$339.01,$0.00,$81.84,$0.00,$0.00,$83.17,$475.00,$0.00,$237.50,$376.20,$380.00,$0.00,$74.34,$0.00,$75.62,$0.00
SN60WF.105,SUP,HCPCS V2632,,SN60WF.105  -  LENS IOL 0 D +10.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ,$475.00,$0.00,$475.00,$213.75,$339.01,$0.00,$81.84,$0.00,$0.00,$83.17,$475.00,$0.00,$237.50,$376.20,$380.00,$0.00,$74.34,$0.00,$75.62,$0.00
SN60WF.110,SUP,HCPCS V2632,,SN60WF.110  -  LENS IOL 0 D +11 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ NTR,$475.00,$0.00,$475.00,$213.75,$339.01,$0.00,$81.84,$0.00,$0.00,$83.17,$475.00,$0.00,$237.50,$376.20,$380.00,$0.00,$74.34,$0.00,$75.62,$0.00
SN60WF.115,SUP,HCPCS V2632,,SN60WF.115  -  LENS IOL 0 D +11.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ,$475.00,$0.00,$475.00,$213.75,$339.01,$0.00,$81.84,$0.00,$0.00,$83.17,$475.00,$0.00,$237.50,$376.20,$380.00,$0.00,$74.34,$0.00,$75.62,$0.00
SN60WF.120,SUP,HCPCS V2632,,SN60WF.120  -  LENS IOL 0 D +12 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ NTR,$475.00,$0.00,$475.00,$213.75,$339.01,$0.00,$81.84,$0.00,$0.00,$83.17,$475.00,$0.00,$237.50,$376.20,$380.00,$0.00,$74.34,$0.00,$75.62,$0.00
SN60WF.125,SUP,HCPCS V2632,,SN60WF.125  -  LENS IOL 0 D +12.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ,$475.00,$0.00,$475.00,$213.75,$339.01,$0.00,$81.84,$0.00,$0.00,$83.17,$475.00,$0.00,$237.50,$376.20,$380.00,$0.00,$74.34,$0.00,$75.62,$0.00
SN60WF.135,SUP,HCPCS V2632,,SN60WF.135  -  LENS IOL 0 D +13.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ,$475.00,$0.00,$475.00,$213.75,$339.01,$0.00,$81.84,$0.00,$0.00,$83.17,$475.00,$0.00,$237.50,$376.20,$380.00,$0.00,$74.34,$0.00,$75.62,$0.00
SN60WF.145,SUP,HCPCS V2632,,SN60WF.145  -  LENS IOL 0 D +14.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ,$475.00,$0.00,$475.00,$213.75,$339.01,$0.00,$81.84,$0.00,$0.00,$83.17,$475.00,$0.00,$237.50,$376.20,$380.00,$0.00,$74.34,$0.00,$75.62,$0.00
SN60WF.155,SUP,HCPCS V2632,,SN60WF.155  -  LENS IOL 0 D +15.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ,$475.00,$0.00,$475.00,$213.75,$339.01,$0.00,$81.84,$0.00,$0.00,$83.17,$475.00,$0.00,$237.50,$376.20,$380.00,$0.00,$74.34,$0.00,$75.62,$0.00
SN60WF.160,SUP,HCPCS V2632,,SN60WF.160  -  LENS IOL 0 D +16 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ NTR,$475.00,$0.00,$475.00,$213.75,$339.01,$0.00,$81.84,$0.00,$0.00,$83.17,$475.00,$0.00,$237.50,$376.20,$380.00,$0.00,$74.34,$0.00,$75.62,$0.00
SN60WF.165,SUP,HCPCS V2632,,SN60WF.165  -  LENS IOL 0 D +16.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ,$475.00,$0.00,$475.00,$213.75,$339.01,$0.00,$81.84,$0.00,$0.00,$83.17,$475.00,$0.00,$237.50,$376.20,$380.00,$0.00,$74.34,$0.00,$75.62,$0.00
SN60WF.170,SUP,HCPCS V2632,,SN60WF.170  -  LENS IOL 0 D +17 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ NTR,$475.00,$0.00,$475.00,$213.75,$339.01,$0.00,$81.84,$0.00,$0.00,$83.17,$475.00,$0.00,$237.50,$376.20,$380.00,$0.00,$74.34,$0.00,$75.62,$0.00
SN60WF.185,SUP,HCPCS V2632,,SN60WF.185  -  LENS IOL 0 D +18.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ,$475.00,$0.00,$475.00,$213.75,$339.01,$0.00,$81.84,$0.00,$0.00,$83.17,$475.00,$0.00,$237.50,$376.20,$380.00,$0.00,$74.34,$0.00,$75.62,$0.00
SN60WF.215,SUP,HCPCS V2632,,SN60WF.215  -  LENS IOL 0 D +21.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ,$475.00,$0.00,$475.00,$213.75,$339.01,$0.00,$81.84,$0.00,$0.00,$83.17,$475.00,$0.00,$237.50,$376.20,$380.00,$0.00,$74.34,$0.00,$75.62,$0.00
SN60WF.220,SUP,HCPCS V2632,,SN60WF.220  -  LENS IOL 0 D +22 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ NTR,$475.00,$0.00,$475.00,$213.75,$339.01,$0.00,$81.84,$0.00,$0.00,$83.17,$475.00,$0.00,$237.50,$376.20,$380.00,$0.00,$74.34,$0.00,$75.62,$0.00
SN60WF.225,SUP,HCPCS V2632,,SN60WF.225  -  LENS IOL 0 D +22.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ,$475.00,$0.00,$475.00,$213.75,$339.01,$0.00,$81.84,$0.00,$0.00,$83.17,$475.00,$0.00,$237.50,$376.20,$380.00,$0.00,$74.34,$0.00,$75.62,$0.00
SN60WF.230,SUP,HCPCS V2632,,SN60WF.230  -  LENS IOL 0 D +23 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ NTR,$475.00,$0.00,$475.00,$213.75,$339.01,$0.00,$81.84,$0.00,$0.00,$83.17,$475.00,$0.00,$237.50,$376.20,$380.00,$0.00,$74.34,$0.00,$75.62,$0.00
SN60WF.240,SUP,HCPCS V2632,,SN60WF.240  -  LENS IOL 0 D +24 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ NTR,$475.00,$0.00,$475.00,$213.75,$339.01,$0.00,$81.84,$0.00,$0.00,$83.17,$475.00,$0.00,$237.50,$376.20,$380.00,$0.00,$74.34,$0.00,$75.62,$0.00
SN60WF.245,SUP,HCPCS V2632,,SN60WF.245  -  LENS IOL 0 D +24.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ,$475.00,$0.00,$475.00,$213.75,$339.01,$0.00,$81.84,$0.00,$0.00,$83.17,$475.00,$0.00,$237.50,$376.20,$380.00,$0.00,$74.34,$0.00,$75.62,$0.00
SN60WF.250,SUP,HCPCS V2632,,SN60WF.250  -  LENS IOL 0 D +25 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ NTR,$475.00,$0.00,$475.00,$213.75,$339.01,$0.00,$81.84,$0.00,$0.00,$83.17,$475.00,$0.00,$237.50,$376.20,$380.00,$0.00,$74.34,$0.00,$75.62,$0.00
SN60WF.260,SUP,HCPCS V2632,,SN60WF.260  -  LENS IOL 0 D +26 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ NTR,$475.00,$0.00,$475.00,$213.75,$339.01,$0.00,$81.84,$0.00,$0.00,$83.17,$475.00,$0.00,$237.50,$376.20,$380.00,$0.00,$74.34,$0.00,$75.62,$0.00
SN60WF.270,SUP,HCPCS V2632,,SN60WF.270  -  LENS IOL 0 D +27 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ NTR,$475.00,$0.00,$475.00,$213.75,$339.01,$0.00,$81.84,$0.00,$0.00,$83.17,$475.00,$0.00,$237.50,$376.20,$380.00,$0.00,$74.34,$0.00,$75.62,$0.00
SN60WF.275,SUP,HCPCS V2632,,SN60WF.275  -  LENS IOL 0 D +27.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ,$475.00,$0.00,$475.00,$213.75,$339.01,$0.00,$81.84,$0.00,$0.00,$83.17,$475.00,$0.00,$237.50,$376.20,$380.00,$0.00,$74.34,$0.00,$75.62,$0.00
SN60WF.280,SUP,HCPCS V2632,,SN60WF.280  -  LENS IOL 0 D +28 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ NTR,$475.00,$0.00,$475.00,$213.75,$339.01,$0.00,$81.84,$0.00,$0.00,$83.17,$475.00,$0.00,$237.50,$376.20,$380.00,$0.00,$74.34,$0.00,$75.62,$0.00
SN60WF.290,SUP,HCPCS V2632,,SN60WF.290  -  LENS IOL 0 D +29 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ NTR,$475.00,$0.00,$475.00,$213.75,$339.01,$0.00,$81.84,$0.00,$0.00,$83.17,$475.00,$0.00,$237.50,$376.20,$380.00,$0.00,$74.34,$0.00,$75.62,$0.00
SN60WF.295,SUP,HCPCS V2632,,SN60WF.295  -  LENS IOL 0 D +29.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ,$475.00,$0.00,$475.00,$213.75,$339.01,$0.00,$81.84,$0.00,$0.00,$83.17,$475.00,$0.00,$237.50,$376.20,$380.00,$0.00,$74.34,$0.00,$75.62,$0.00
SN60WF.300,SUP,HCPCS V2632,,SN60WF.300  -  LENS IOL 0 D +30 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ NTR,$475.00,$0.00,$475.00,$213.75,$339.01,$0.00,$81.84,$0.00,$0.00,$83.17,$475.00,$0.00,$237.50,$376.20,$380.00,$0.00,$74.34,$0.00,$75.62,$0.00
SN60WS,SUP,HCPCS V2632,,SN60WS  -  LENS IOL 0D BCNVX 6MM 13MM STRL ACRSF IQ NTR STABLEFORCE,"$1,202.50",$0.00,"$1,202.50",$541.13,$858.22,$0.00,$207.18,$0.00,$0.00,$210.55,"$1,202.50",$0.00,$601.25,$952.38,$962.00,$0.00,$188.19,$0.00,$191.44,$0.00
SN60WS.060,SUP,HCPCS V2632,,SN60WS.060  -  LENS IOL 0 D +6 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR,"$1,202.50",$0.00,"$1,202.50",$541.13,$858.22,$0.00,$207.18,$0.00,$0.00,$210.55,"$1,202.50",$0.00,$601.25,$952.38,$962.00,$0.00,$188.19,$0.00,$191.44,$0.00
SN60WS.065,SUP,HCPCS V2632,,SN60WS.065  -  LENS IOL 0 D +6.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR,"$1,202.50",$0.00,"$1,202.50",$541.13,$858.22,$0.00,$207.18,$0.00,$0.00,$210.55,"$1,202.50",$0.00,$601.25,$952.38,$962.00,$0.00,$188.19,$0.00,$191.44,$0.00
SN60WS.070,SUP,HCPCS V2632,,SN60WS.070  -  LENS IOL 0 D +7 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR,"$1,202.50",$0.00,"$1,202.50",$541.13,$858.22,$0.00,$207.18,$0.00,$0.00,$210.55,"$1,202.50",$0.00,$601.25,$952.38,$962.00,$0.00,$188.19,$0.00,$191.44,$0.00
SN60WS.075,SUP,HCPCS V2632,,SN60WS.075  -  LENS IOL 0 D +7.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR,"$1,202.50",$0.00,"$1,202.50",$541.13,$858.22,$0.00,$207.18,$0.00,$0.00,$210.55,"$1,202.50",$0.00,$601.25,$952.38,$962.00,$0.00,$188.19,$0.00,$191.44,$0.00
SN60WS.080,SUP,HCPCS V2632,,SN60WS.080  -  LENS IOL 0 D +8 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR,"$1,202.50",$0.00,"$1,202.50",$541.13,$858.22,$0.00,$207.18,$0.00,$0.00,$210.55,"$1,202.50",$0.00,$601.25,$952.38,$962.00,$0.00,$188.19,$0.00,$191.44,$0.00
SN60WS.085,SUP,HCPCS V2632,,SN60WS.085  -  LENS IOL 0 D +8.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR,"$1,202.50",$0.00,"$1,202.50",$541.13,$858.22,$0.00,$207.18,$0.00,$0.00,$210.55,"$1,202.50",$0.00,$601.25,$952.38,$962.00,$0.00,$188.19,$0.00,$191.44,$0.00
SN60WS.090,SUP,HCPCS V2632,,SN60WS.090  -  LENS IOL 0 D +9 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR,"$1,202.50",$0.00,"$1,202.50",$541.13,$858.22,$0.00,$207.18,$0.00,$0.00,$210.55,"$1,202.50",$0.00,$601.25,$952.38,$962.00,$0.00,$188.19,$0.00,$191.44,$0.00
SN60WS.095,SUP,HCPCS V2632,,SN60WS.095  -  LENS IOL 0 D +9.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR,"$1,202.50",$0.00,"$1,202.50",$541.13,$858.22,$0.00,$207.18,$0.00,$0.00,$210.55,"$1,202.50",$0.00,$601.25,$952.38,$962.00,$0.00,$188.19,$0.00,$191.44,$0.00
SN60WS.100,SUP,HCPCS V2632,,SN60WS.100  -  LENS IOL 0 D +10 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR,"$1,202.50",$0.00,"$1,202.50",$541.13,$858.22,$0.00,$207.18,$0.00,$0.00,$210.55,"$1,202.50",$0.00,$601.25,$952.38,$962.00,$0.00,$188.19,$0.00,$191.44,$0.00
SN60WS.105,SUP,HCPCS V2632,,SN60WS.105  -  LENS IOL 0 D +10.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR,"$1,202.50",$0.00,"$1,202.50",$541.13,$858.22,$0.00,$207.18,$0.00,$0.00,$210.55,"$1,202.50",$0.00,$601.25,$952.38,$962.00,$0.00,$188.19,$0.00,$191.44,$0.00
SN60WS.110,SUP,HCPCS V2632,,SN60WS.110  -  LENS IOL 0 D +11 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR,"$1,202.50",$0.00,"$1,202.50",$541.13,$858.22,$0.00,$207.18,$0.00,$0.00,$210.55,"$1,202.50",$0.00,$601.25,$952.38,$962.00,$0.00,$188.19,$0.00,$191.44,$0.00
SN60WS.115,SUP,HCPCS V2632,,SN60WS.115  -  LENS IOL 0 D +11.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR,"$1,202.50",$0.00,"$1,202.50",$541.13,$858.22,$0.00,$207.18,$0.00,$0.00,$210.55,"$1,202.50",$0.00,$601.25,$952.38,$962.00,$0.00,$188.19,$0.00,$191.44,$0.00
SN60WS.120,SUP,HCPCS V2632,,SN60WS.120  -  LENS IOL 0 D +12 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR,"$1,202.50",$0.00,"$1,202.50",$541.13,$858.22,$0.00,$207.18,$0.00,$0.00,$210.55,"$1,202.50",$0.00,$601.25,$952.38,$962.00,$0.00,$188.19,$0.00,$191.44,$0.00
SN60WS.125,SUP,HCPCS V2632,,SN60WS.125  -  LENS IOL 0 D +12.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR,"$1,202.50",$0.00,"$1,202.50",$541.13,$858.22,$0.00,$207.18,$0.00,$0.00,$210.55,"$1,202.50",$0.00,$601.25,$952.38,$962.00,$0.00,$188.19,$0.00,$191.44,$0.00
SN60WS.130,SUP,HCPCS V2632,,SN60WS.130  -  LENS IOL 0 D +13 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR,"$1,202.50",$0.00,"$1,202.50",$541.13,$858.22,$0.00,$207.18,$0.00,$0.00,$210.55,"$1,202.50",$0.00,$601.25,$952.38,$962.00,$0.00,$188.19,$0.00,$191.44,$0.00
SN60WS.135,SUP,HCPCS V2632,,SN60WS.135  -  LENS IOL 0 D +13.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR,"$1,202.50",$0.00,"$1,202.50",$541.13,$858.22,$0.00,$207.18,$0.00,$0.00,$210.55,"$1,202.50",$0.00,$601.25,$952.38,$962.00,$0.00,$188.19,$0.00,$191.44,$0.00
SN60WS.140,SUP,HCPCS V2632,,SN60WS.140  -  LENS IOL 0 D +14 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR,"$1,202.50",$0.00,"$1,202.50",$541.13,$858.22,$0.00,$207.18,$0.00,$0.00,$210.55,"$1,202.50",$0.00,$601.25,$952.38,$962.00,$0.00,$188.19,$0.00,$191.44,$0.00
SN60WS.145,SUP,HCPCS V2632,,SN60WS.145  -  LENS IOL 0 D +14.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR,"$1,202.50",$0.00,"$1,202.50",$541.13,$858.22,$0.00,$207.18,$0.00,$0.00,$210.55,"$1,202.50",$0.00,$601.25,$952.38,$962.00,$0.00,$188.19,$0.00,$191.44,$0.00
SN60WS.150,SUP,HCPCS V2632,,SN60WS.150  -  LENS IOL 0 D +15 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR,"$1,202.50",$0.00,"$1,202.50",$541.13,$858.22,$0.00,$207.18,$0.00,$0.00,$210.55,"$1,202.50",$0.00,$601.25,$952.38,$962.00,$0.00,$188.19,$0.00,$191.44,$0.00
SN60WS.155,SUP,HCPCS V2632,,SN60WS.155  -  LENS IOL 0 D +15.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR,"$1,202.50",$0.00,"$1,202.50",$541.13,$858.22,$0.00,$207.18,$0.00,$0.00,$210.55,"$1,202.50",$0.00,$601.25,$952.38,$962.00,$0.00,$188.19,$0.00,$191.44,$0.00
SN60WS.160,SUP,HCPCS V2632,,SN60WS.160  -  LENS IOL 0 D +16 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR,"$1,202.50",$0.00,"$1,202.50",$541.13,$858.22,$0.00,$207.18,$0.00,$0.00,$210.55,"$1,202.50",$0.00,$601.25,$952.38,$962.00,$0.00,$188.19,$0.00,$191.44,$0.00
SN60WS.165,SUP,HCPCS V2632,,SN60WS.165  -  LENS IOL 0 D +16.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR,"$1,202.50",$0.00,"$1,202.50",$541.13,$858.22,$0.00,$207.18,$0.00,$0.00,$210.55,"$1,202.50",$0.00,$601.25,$952.38,$962.00,$0.00,$188.19,$0.00,$191.44,$0.00
SN60WS.170,SUP,HCPCS V2632,,SN60WS.170  -  LENS IOL 0 D +17 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR,"$1,202.50",$0.00,"$1,202.50",$541.13,$858.22,$0.00,$207.18,$0.00,$0.00,$210.55,"$1,202.50",$0.00,$601.25,$952.38,$962.00,$0.00,$188.19,$0.00,$191.44,$0.00
SN60WS.175,SUP,HCPCS V2632,,SN60WS.175  -  LENS IOL 0 D +17.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR,"$1,202.50",$0.00,"$1,202.50",$541.13,$858.22,$0.00,$207.18,$0.00,$0.00,$210.55,"$1,202.50",$0.00,$601.25,$952.38,$962.00,$0.00,$188.19,$0.00,$191.44,$0.00
SN60WS.180,SUP,HCPCS V2632,,SN60WS.180  -  LENS IOL 0 D +18 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR,"$1,202.50",$0.00,"$1,202.50",$541.13,$858.22,$0.00,$207.18,$0.00,$0.00,$210.55,"$1,202.50",$0.00,$601.25,$952.38,$962.00,$0.00,$188.19,$0.00,$191.44,$0.00
SN60WS.185,SUP,HCPCS V2632,,SN60WS.185  -  LENS IOL 0 D +18.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR,"$1,202.50",$0.00,"$1,202.50",$541.13,$858.22,$0.00,$207.18,$0.00,$0.00,$210.55,"$1,202.50",$0.00,$601.25,$952.38,$962.00,$0.00,$188.19,$0.00,$191.44,$0.00
SN60WS.190,SUP,HCPCS V2632,,SN60WS.190  -  LENS IOL 0 D +19 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR,"$1,202.50",$0.00,"$1,202.50",$541.13,$858.22,$0.00,$207.18,$0.00,$0.00,$210.55,"$1,202.50",$0.00,$601.25,$952.38,$962.00,$0.00,$188.19,$0.00,$191.44,$0.00
SN60WS.195,SUP,HCPCS V2632,,SN60WS.195  -  LENS IOL 0 D +19.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR,"$1,202.50",$0.00,"$1,202.50",$541.13,$858.22,$0.00,$207.18,$0.00,$0.00,$210.55,"$1,202.50",$0.00,$601.25,$952.38,$962.00,$0.00,$188.19,$0.00,$191.44,$0.00
SN60WS.200,SUP,HCPCS V2632,,SN60WS.200  -  LENS IOL 0 D +20 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR,"$1,202.50",$0.00,"$1,202.50",$541.13,$858.22,$0.00,$207.18,$0.00,$0.00,$210.55,"$1,202.50",$0.00,$601.25,$952.38,$962.00,$0.00,$188.19,$0.00,$191.44,$0.00
SN60WS.205,SUP,HCPCS V2632,,SN60WS.205  -  LENS IOL 0 D +20.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR,"$1,202.50",$0.00,"$1,202.50",$541.13,$858.22,$0.00,$207.18,$0.00,$0.00,$210.55,"$1,202.50",$0.00,$601.25,$952.38,$962.00,$0.00,$188.19,$0.00,$191.44,$0.00
SN60WS.210,SUP,HCPCS V2632,,SN60WS.210  -  LENS IOL 0 D +21 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR,"$1,202.50",$0.00,"$1,202.50",$541.13,$858.22,$0.00,$207.18,$0.00,$0.00,$210.55,"$1,202.50",$0.00,$601.25,$952.38,$962.00,$0.00,$188.19,$0.00,$191.44,$0.00
SN60WS.215,SUP,HCPCS V2632,,SN60WS.215  -  LENS IOL 0 D +21.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR,"$1,202.50",$0.00,"$1,202.50",$541.13,$858.22,$0.00,$207.18,$0.00,$0.00,$210.55,"$1,202.50",$0.00,$601.25,$952.38,$962.00,$0.00,$188.19,$0.00,$191.44,$0.00
SN60WS.220,SUP,HCPCS V2632,,SN60WS.220  -  LENS IOL 0 D +22 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR,"$1,202.50",$0.00,"$1,202.50",$541.13,$858.22,$0.00,$207.18,$0.00,$0.00,$210.55,"$1,202.50",$0.00,$601.25,$952.38,$962.00,$0.00,$188.19,$0.00,$191.44,$0.00
SN60WS.225,SUP,HCPCS V2632,,SN60WS.225  -  LENS IOL 0 D +22.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR,"$1,202.50",$0.00,"$1,202.50",$541.13,$858.22,$0.00,$207.18,$0.00,$0.00,$210.55,"$1,202.50",$0.00,$601.25,$952.38,$962.00,$0.00,$188.19,$0.00,$191.44,$0.00
SN60WS.230,SUP,HCPCS V2632,,SN60WS.230  -  LENS IOL 0 D +23 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR,"$1,202.50",$0.00,"$1,202.50",$541.13,$858.22,$0.00,$207.18,$0.00,$0.00,$210.55,"$1,202.50",$0.00,$601.25,$952.38,$962.00,$0.00,$188.19,$0.00,$191.44,$0.00
SN60WS.235,SUP,HCPCS V2632,,SN60WS.235  -  LENS IOL 0 D +23.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR,"$1,202.50",$0.00,"$1,202.50",$541.13,$858.22,$0.00,$207.18,$0.00,$0.00,$210.55,"$1,202.50",$0.00,$601.25,$952.38,$962.00,$0.00,$188.19,$0.00,$191.44,$0.00
SN60WS.240,SUP,HCPCS V2632,,SN60WS.240  -  LENS IOL 0 D +24 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR,"$1,202.50",$0.00,"$1,202.50",$541.13,$858.22,$0.00,$207.18,$0.00,$0.00,$210.55,"$1,202.50",$0.00,$601.25,$952.38,$962.00,$0.00,$188.19,$0.00,$191.44,$0.00
SN60WS.245,SUP,HCPCS V2632,,SN60WS.245  -  LENS IOL 0 D +24.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR,"$1,202.50",$0.00,"$1,202.50",$541.13,$858.22,$0.00,$207.18,$0.00,$0.00,$210.55,"$1,202.50",$0.00,$601.25,$952.38,$962.00,$0.00,$188.19,$0.00,$191.44,$0.00
SN60WS.250,SUP,HCPCS V2632,,SN60WS.250  -  LENS IOL 0 D +25 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR,"$1,202.50",$0.00,"$1,202.50",$541.13,$858.22,$0.00,$207.18,$0.00,$0.00,$210.55,"$1,202.50",$0.00,$601.25,$952.38,$962.00,$0.00,$188.19,$0.00,$191.44,$0.00
SN60WS.255,SUP,HCPCS V2632,,SN60WS.255  -  LENS IOL 0 D +25.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR,"$1,202.50",$0.00,"$1,202.50",$541.13,$858.22,$0.00,$207.18,$0.00,$0.00,$210.55,"$1,202.50",$0.00,$601.25,$952.38,$962.00,$0.00,$188.19,$0.00,$191.44,$0.00
SN60WS.260,SUP,HCPCS V2632,,SN60WS.260  -  LENS IOL 0 D +26 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR,"$1,202.50",$0.00,"$1,202.50",$541.13,$858.22,$0.00,$207.18,$0.00,$0.00,$210.55,"$1,202.50",$0.00,$601.25,$952.38,$962.00,$0.00,$188.19,$0.00,$191.44,$0.00
SN60WS.265,SUP,HCPCS V2632,,SN60WS.265  -  LENS IOL 0 D +26.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR,"$1,202.50",$0.00,"$1,202.50",$541.13,$858.22,$0.00,$207.18,$0.00,$0.00,$210.55,"$1,202.50",$0.00,$601.25,$952.38,$962.00,$0.00,$188.19,$0.00,$191.44,$0.00
SN60WS.270,SUP,HCPCS V2632,,SN60WS.270  -  LENS IOL 0 D +27 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR,"$1,202.50",$0.00,"$1,202.50",$541.13,$858.22,$0.00,$207.18,$0.00,$0.00,$210.55,"$1,202.50",$0.00,$601.25,$952.38,$962.00,$0.00,$188.19,$0.00,$191.44,$0.00
SN60WS.275,SUP,HCPCS V2632,,SN60WS.275  -  LENS IOL 0 D +27.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR,"$1,202.50",$0.00,"$1,202.50",$541.13,$858.22,$0.00,$207.18,$0.00,$0.00,$210.55,"$1,202.50",$0.00,$601.25,$952.38,$962.00,$0.00,$188.19,$0.00,$191.44,$0.00
SN60WS.280,SUP,HCPCS V2632,,SN60WS.280  -  LENS IOL 0 D +28 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR,"$1,202.50",$0.00,"$1,202.50",$541.13,$858.22,$0.00,$207.18,$0.00,$0.00,$210.55,"$1,202.50",$0.00,$601.25,$952.38,$962.00,$0.00,$188.19,$0.00,$191.44,$0.00
SN60WS.285,SUP,HCPCS V2632,,SN60WS.285  -  LENS IOL 0 D +28.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR,"$1,202.50",$0.00,"$1,202.50",$541.13,$858.22,$0.00,$207.18,$0.00,$0.00,$210.55,"$1,202.50",$0.00,$601.25,$952.38,$962.00,$0.00,$188.19,$0.00,$191.44,$0.00
SN60WS.290,SUP,HCPCS V2632,,SN60WS.290  -  LENS IOL 0 D +29 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR,"$1,202.50",$0.00,"$1,202.50",$541.13,$858.22,$0.00,$207.18,$0.00,$0.00,$210.55,"$1,202.50",$0.00,$601.25,$952.38,$962.00,$0.00,$188.19,$0.00,$191.44,$0.00
SN60WS.295,SUP,HCPCS V2632,,SN60WS.295  -  LENS IOL 0 D +29.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR,"$1,202.50",$0.00,"$1,202.50",$541.13,$858.22,$0.00,$207.18,$0.00,$0.00,$210.55,"$1,202.50",$0.00,$601.25,$952.38,$962.00,$0.00,$188.19,$0.00,$191.44,$0.00
SN60WS.300,SUP,HCPCS V2632,,SN60WS.300  -  LENS IOL 0 D +30 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR,"$1,202.50",$0.00,"$1,202.50",$541.13,$858.22,$0.00,$207.18,$0.00,$0.00,$210.55,"$1,202.50",$0.00,$601.25,$952.38,$962.00,$0.00,$188.19,$0.00,$191.44,$0.00
SN6AT3.150,SUP,HCPCS V2787,,SN6AT3.150  -  DRILL SRG 2.1MM 110MM CNN TI,$995.00,$0.00,$995.00,$0.00,$710.13,$0.00,$0.00,$0.00,$0.00,$0.00,$995.00,$0.00,$497.50,$788.04,$796.00,$0.00,$0.00,$0.00,$0.00,$0.00
SN6AT3.210,SUP,HCPCS V2787,,SN6AT3.210  -  LENS INTRAOCULAR ACRYSOF IQ TORIC STABLEFORCE NATURAL ACRYLI,"$1,237.50",$0.00,"$1,237.50",$0.00,$883.20,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,237.50",$0.00,$618.75,$980.10,$990.00,$0.00,$0.00,$0.00,$0.00,$0.00
SN6AT3.215,SUP,HCPCS V2787,,SN6AT3.215  -  LENS IOL 0 D +21.5 DIOP +1.5 CYL BCNVX 6MM 13MM STRL ACRSF,$995.00,$0.00,$995.00,$0.00,$710.13,$0.00,$0.00,$0.00,$0.00,$0.00,$995.00,$0.00,$497.50,$788.04,$796.00,$0.00,$0.00,$0.00,$0.00,$0.00
SN6AT5.145,SUP,HCPCS V2632,,SN6AT5.145  -  LENS IOL 0 D +14.5 DIOP +3 CYL BCNVX 6MM 13MM STRL ACRSF IQ,"$1,487.50",$0.00,"$1,487.50",$669.38,"$1,061.63",$0.00,$256.29,$0.00,$0.00,$260.45,"$1,487.50",$0.00,$743.75,"$1,178.10","$1,190.00",$0.00,$232.79,$0.00,$236.81,$0.00
SN6AT5.150,SUP,HCPCS V2632,,SN6AT5.150  -  LENS IOL 0 D +15 DIOP +3 CYL BCNVX 6MM 13MM STRL ACRSF IQ,"$1,487.50",$0.00,"$1,487.50",$669.38,"$1,061.63",$0.00,$256.29,$0.00,$0.00,$260.45,"$1,487.50",$0.00,$743.75,"$1,178.10","$1,190.00",$0.00,$232.79,$0.00,$236.81,$0.00
SN6AT5.165,SUP,HCPCS V2787,,SN6AT5.165  -  LENS IOL 0 D +16.5 DIOP +3 CYL BCNVX 6MM 13MM STRL ACRSF IQ,"$1,237.50",$0.00,"$1,237.50",$0.00,$883.20,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,237.50",$0.00,$618.75,$980.10,$990.00,$0.00,$0.00,$0.00,$0.00,$0.00
SN6AT5.185,SUP,HCPCS V2787,,SN6AT5.185  -  LENS IOL 0 D +18.5 DIOP +3 CYL BCNVX 6MM 13MM STRL ACRSF IQ,"$1,237.50",$0.00,"$1,237.50",$0.00,$883.20,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,237.50",$0.00,$618.75,$980.10,$990.00,$0.00,$0.00,$0.00,$0.00,$0.00
SN6AT5.220,SUP,HCPCS V2787,,SN6AT5.220  -  LENS INTRAOCULAR ACRYSOF IQ TORIC STABLEFORCE NATURAL ACRYLI,"$1,237.50",$0.00,"$1,237.50",$0.00,$883.20,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,237.50",$0.00,$618.75,$980.10,$990.00,$0.00,$0.00,$0.00,$0.00,$0.00
SN6AT5.225,SUP,HCPCS V2787,,SN6AT5.225  -  LENS INTRAOCULAR ACRYSOF IQ TORIC STABLEFORCE NATURAL ACRYLI,"$1,237.50",$0.00,"$1,237.50",$0.00,$883.20,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,237.50",$0.00,$618.75,$980.10,$990.00,$0.00,$0.00,$0.00,$0.00,$0.00
SN6AT6.175,SUP,HCPCS V2787,,SN6AT6.175  -  LENS IOL 0 D +17.5 DIOP +3.75 CYL BCNVX 6MM 13MM STRL ACRSF,"$1,237.50",$0.00,"$1,237.50",$0.00,$883.20,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,237.50",$0.00,$618.75,$980.10,$990.00,$0.00,$0.00,$0.00,$0.00,$0.00
SN6AT6.195,SUP,HCPCS V2632,,SN6AT6.195  -  LENS IOL 0 D +19.5 DIOP +3.75 CYL BCNVX 6MM 13MM STRL ACRSF,"$1,237.50",$0.00,"$1,237.50",$556.88,$883.20,$0.00,$213.22,$0.00,$0.00,$216.68,"$1,237.50",$0.00,$618.75,$980.10,$990.00,$0.00,$193.67,$0.00,$197.01,$0.00
SN6AT6.205,SUP,HCPCS V2632,,SN6AT6.205  -  LENS IOL 0 D +20.5 DIOP +3.75 CYL BCNVX 6MM 13MM STRL ACRSF,"$1,237.50",$0.00,"$1,237.50",$556.88,$883.20,$0.00,$213.22,$0.00,$0.00,$216.68,"$1,237.50",$0.00,$618.75,$980.10,$990.00,$0.00,$193.67,$0.00,$197.01,$0.00
SN6AT6.215,SUP,HCPCS V2787,,SN6AT6.215  -  LENS IOL 0 D +21.5 DIOP +3.75 CYL BCNVX 6MM 13MM STRL ACRSF,"$1,237.50",$0.00,"$1,237.50",$0.00,$883.20,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,237.50",$0.00,$618.75,$980.10,$990.00,$0.00,$0.00,$0.00,$0.00,$0.00
SN6AT6.245,SUP,HCPCS V2632,,SN6AT6.245  -  LENS IOL 0 D +24.5 DIOP +3.75 CYL BCNVX 6MM 13MM STRL ACRSF,"$1,237.50",$0.00,"$1,237.50",$556.88,$883.20,$0.00,$213.22,$0.00,$0.00,$216.68,"$1,237.50",$0.00,$618.75,$980.10,$990.00,$0.00,$193.67,$0.00,$197.01,$0.00
SN6AT6.250,SUP,HCPCS V2632,,SN6AT6.250  -  LENS IOL +25 DIOPTER +3.75 CYLINDER 0 D BICNVX 6MM 13MM 1,"$1,237.50",$0.00,"$1,237.50",$556.88,$883.20,$0.00,$213.22,$0.00,$0.00,$216.68,"$1,237.50",$0.00,$618.75,$980.10,$990.00,$0.00,$193.67,$0.00,$197.01,$0.00
SN6AT7.115,SUP,HCPCS V2632,,SN6AT7.115  -  LENS IOL 0 D +11.5 DIOP +4.5 CYL BCNVX 6MM 13MM STRL ACRSF,"$1,237.50",$0.00,"$1,237.50",$556.88,$883.20,$0.00,$213.22,$0.00,$0.00,$216.68,"$1,237.50",$0.00,$618.75,$980.10,$990.00,$0.00,$193.67,$0.00,$197.01,$0.00
SN6AT7.205,SUP,HCPCS V2632,,SN6AT7.205  -  LENS IOL 0 D +20.5 DIOP +4.5 CYL BCNVX 6MM 13MM STRL ACRSF,"$1,237.50",$0.00,"$1,237.50",$556.88,$883.20,$0.00,$213.22,$0.00,$0.00,$216.68,"$1,237.50",$0.00,$618.75,$980.10,$990.00,$0.00,$193.67,$0.00,$197.01,$0.00
SN6AT7U230,SUP,HCPCS V2787,,SN6AT7U230  -  LENS IOL 0 D +23 DIOP +4.5 CYL BCNVX 6MM 13MM STRL ACRSF IQ,"$1,237.50",$0.00,"$1,237.50",$0.00,$883.20,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,237.50",$0.00,$618.75,$980.10,$990.00,$0.00,$0.00,$0.00,$0.00,$0.00
SN6AT8.160,SUP,HCPCS V2787,,SN6AT8.160  -  LENS INTRAOCULAR ACRYSOF IQ TORIC STABLEFORCE NATURAL ACRYLI,"$1,237.50",$0.00,"$1,237.50",$0.00,$883.20,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,237.50",$0.00,$618.75,$980.10,$990.00,$0.00,$0.00,$0.00,$0.00,$0.00
SN6AT8U150,SUP,HCPCS V2787,,SN6AT8U150  -  LENS INTRAOCULAR ACRYSOF IQ TORIC STABLEFORCE ACRYLIC 0 D +1,"$1,237.50",$0.00,"$1,237.50",$0.00,$883.20,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,237.50",$0.00,$618.75,$980.10,$990.00,$0.00,$0.00,$0.00,$0.00,$0.00
SN6AT9.165,SUP,HCPCS V2787,,SN6AT9.165  -  LENS IOL 0 D +16.5 DIOP +6 CYL BICNVX 13MM 6MM,"$1,237.50",$0.00,"$1,237.50",$0.00,$883.20,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,237.50",$0.00,$618.75,$980.10,$990.00,$0.00,$0.00,$0.00,$0.00,$0.00
SN6AT9.170,SUP,HCPCS V2787,,SN6AT9.170  -  LENS IOL 0 D +17 DIOP +6 CYL BCNVX 6MM 13MM STRL ACRSF IQ,"$1,237.50",$0.00,"$1,237.50",$0.00,$883.20,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,237.50",$0.00,$618.75,$980.10,$990.00,$0.00,$0.00,$0.00,$0.00,$0.00
SN6AT9U210,SUP,HCPCS V2632,,SN6AT9U210  -  LENS IOL 0 D +21 DIOP +6 CYL BCNVX 6MM 13MM STRL ACRSF IQ,$995.00,$0.00,$995.00,$447.75,$710.13,$0.00,$171.43,$0.00,$0.00,$174.22,$995.00,$0.00,$497.50,$788.04,$796.00,$0.00,$155.72,$0.00,$158.40,$0.00
SN6CWS,SUP,HCPCS V2632,,SN6CWS  -  LENS IOL 0 D +16 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ,$397.50,$0.00,$397.50,$178.88,$283.70,$0.00,$68.49,$0.00,$0.00,$69.60,$397.50,$0.00,$198.75,$314.82,$318.00,$0.00,$62.21,$0.00,$63.28,$0.00
SN6CWS.060,SUP,HCPCS V2632,,SN6CWS.060  -  LENS IOL 0 D +6 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ,$397.50,$0.00,$397.50,$178.88,$283.70,$0.00,$68.49,$0.00,$0.00,$69.60,$397.50,$0.00,$198.75,$314.82,$318.00,$0.00,$62.21,$0.00,$63.28,$0.00
SN6CWS.065,SUP,HCPCS V2632,,SN6CWS.065  -  LENS IOL 0 D +6.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ,$397.50,$0.00,$397.50,$178.88,$283.70,$0.00,$68.49,$0.00,$0.00,$69.60,$397.50,$0.00,$198.75,$314.82,$318.00,$0.00,$62.21,$0.00,$63.28,$0.00
SN6CWS.070,SUP,HCPCS V2632,,SN6CWS.070  -  LENS IOL 0 D +7 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ,$397.50,$0.00,$397.50,$178.88,$283.70,$0.00,$68.49,$0.00,$0.00,$69.60,$397.50,$0.00,$198.75,$314.82,$318.00,$0.00,$62.21,$0.00,$63.28,$0.00
SN6CWS.075,SUP,HCPCS V2632,,SN6CWS.075  -  LENS IOL 0 D +7.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ,$397.50,$0.00,$397.50,$178.88,$283.70,$0.00,$68.49,$0.00,$0.00,$69.60,$397.50,$0.00,$198.75,$314.82,$318.00,$0.00,$62.21,$0.00,$63.28,$0.00
SN6CWS.080,SUP,HCPCS V2632,,SN6CWS.080  -  LENS IOL 0 D +8 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ,$397.50,$0.00,$397.50,$178.88,$283.70,$0.00,$68.49,$0.00,$0.00,$69.60,$397.50,$0.00,$198.75,$314.82,$318.00,$0.00,$62.21,$0.00,$63.28,$0.00
SN6CWS.085,SUP,HCPCS V2632,,SN6CWS.085  -  LENS IOL 0 D +8.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ,$397.50,$0.00,$397.50,$178.88,$283.70,$0.00,$68.49,$0.00,$0.00,$69.60,$397.50,$0.00,$198.75,$314.82,$318.00,$0.00,$62.21,$0.00,$63.28,$0.00
SN6CWS.090,SUP,HCPCS V2632,,SN6CWS.090  -  LENS IOL 0 D +9 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ,$397.50,$0.00,$397.50,$178.88,$283.70,$0.00,$68.49,$0.00,$0.00,$69.60,$397.50,$0.00,$198.75,$314.82,$318.00,$0.00,$62.21,$0.00,$63.28,$0.00
SN6CWS.095,SUP,HCPCS V2632,,SN6CWS.095  -  LENS IOL 0 D +9.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ,$397.50,$0.00,$397.50,$178.88,$283.70,$0.00,$68.49,$0.00,$0.00,$69.60,$397.50,$0.00,$198.75,$314.82,$318.00,$0.00,$62.21,$0.00,$63.28,$0.00
SN6CWS.100,SUP,HCPCS V2632,,SN6CWS.100  -  LENS IOL 0 D +10 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ,$397.50,$0.00,$397.50,$178.88,$283.70,$0.00,$68.49,$0.00,$0.00,$69.60,$397.50,$0.00,$198.75,$314.82,$318.00,$0.00,$62.21,$0.00,$63.28,$0.00
SN6CWS.105,SUP,HCPCS V2632,,SN6CWS.105  -  LENS IOL 0 D +10.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ,$397.50,$0.00,$397.50,$178.88,$283.70,$0.00,$68.49,$0.00,$0.00,$69.60,$397.50,$0.00,$198.75,$314.82,$318.00,$0.00,$62.21,$0.00,$63.28,$0.00
SN6CWS.110,SUP,HCPCS V2632,,SN6CWS.110  -  LENS IOL 0 D +11 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ,$397.50,$0.00,$397.50,$178.88,$283.70,$0.00,$68.49,$0.00,$0.00,$69.60,$397.50,$0.00,$198.75,$314.82,$318.00,$0.00,$62.21,$0.00,$63.28,$0.00
SN6CWS.115,SUP,HCPCS V2632,,SN6CWS.115  -  LENS IOL 0 D +11.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ,$397.50,$0.00,$397.50,$178.88,$283.70,$0.00,$68.49,$0.00,$0.00,$69.60,$397.50,$0.00,$198.75,$314.82,$318.00,$0.00,$62.21,$0.00,$63.28,$0.00
SN6CWS.120,SUP,HCPCS V2632,,SN6CWS.120  -  LENS IOL 0 D +12 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ,$397.50,$0.00,$397.50,$178.88,$283.70,$0.00,$68.49,$0.00,$0.00,$69.60,$397.50,$0.00,$198.75,$314.82,$318.00,$0.00,$62.21,$0.00,$63.28,$0.00
SN6CWS.125,SUP,HCPCS V2632,,SN6CWS.125  -  LENS IOL 0 D +12.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ,$397.50,$0.00,$397.50,$178.88,$283.70,$0.00,$68.49,$0.00,$0.00,$69.60,$397.50,$0.00,$198.75,$314.82,$318.00,$0.00,$62.21,$0.00,$63.28,$0.00
SN6CWS.130,SUP,HCPCS V2632,,SN6CWS.130  -  LENS IOL 0 D +13 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ,$397.50,$0.00,$397.50,$178.88,$283.70,$0.00,$68.49,$0.00,$0.00,$69.60,$397.50,$0.00,$198.75,$314.82,$318.00,$0.00,$62.21,$0.00,$63.28,$0.00
SN6CWS.135,SUP,HCPCS V2632,,SN6CWS.135  -  LENS IOL 0 D +13.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ,$397.50,$0.00,$397.50,$178.88,$283.70,$0.00,$68.49,$0.00,$0.00,$69.60,$397.50,$0.00,$198.75,$314.82,$318.00,$0.00,$62.21,$0.00,$63.28,$0.00
SN6CWS.140,SUP,HCPCS V2632,,SN6CWS.140  -  LENS IOL 0 D +14 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ,$397.50,$0.00,$397.50,$178.88,$283.70,$0.00,$68.49,$0.00,$0.00,$69.60,$397.50,$0.00,$198.75,$314.82,$318.00,$0.00,$62.21,$0.00,$63.28,$0.00
SN6CWS.145,SUP,HCPCS V2632,,SN6CWS.145  -  LENS IOL 0 D +14.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ,$397.50,$0.00,$397.50,$178.88,$283.70,$0.00,$68.49,$0.00,$0.00,$69.60,$397.50,$0.00,$198.75,$314.82,$318.00,$0.00,$62.21,$0.00,$63.28,$0.00
SN6CWS.150,SUP,HCPCS V2632,,SN6CWS.150  -  LENS IOL 0 D +15 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ,$397.50,$0.00,$397.50,$178.88,$283.70,$0.00,$68.49,$0.00,$0.00,$69.60,$397.50,$0.00,$198.75,$314.82,$318.00,$0.00,$62.21,$0.00,$63.28,$0.00
SN6CWS.155,SUP,HCPCS V2632,,SN6CWS.155  -  LENS IOL 0 D +15.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ,$397.50,$0.00,$397.50,$178.88,$283.70,$0.00,$68.49,$0.00,$0.00,$69.60,$397.50,$0.00,$198.75,$314.82,$318.00,$0.00,$62.21,$0.00,$63.28,$0.00
SN6CWS.160,SUP,HCPCS V2632,,SN6CWS.160  -  LENS IOL 0 D +16 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ,$397.50,$0.00,$397.50,$178.88,$283.70,$0.00,$68.49,$0.00,$0.00,$69.60,$397.50,$0.00,$198.75,$314.82,$318.00,$0.00,$62.21,$0.00,$63.28,$0.00
SN6CWS.165,SUP,HCPCS V2632,,SN6CWS.165  -  LENS IOL 0 D +16.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ,$397.50,$0.00,$397.50,$178.88,$283.70,$0.00,$68.49,$0.00,$0.00,$69.60,$397.50,$0.00,$198.75,$314.82,$318.00,$0.00,$62.21,$0.00,$63.28,$0.00
SN6CWS.170,SUP,HCPCS V2632,,SN6CWS.170  -  LENS IOL 0 D +17 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ,$397.50,$0.00,$397.50,$178.88,$283.70,$0.00,$68.49,$0.00,$0.00,$69.60,$397.50,$0.00,$198.75,$314.82,$318.00,$0.00,$62.21,$0.00,$63.28,$0.00
SN6CWS.175,SUP,HCPCS V2632,,SN6CWS.175  -  LENS IOL 0 D +17.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ,$397.50,$0.00,$397.50,$178.88,$283.70,$0.00,$68.49,$0.00,$0.00,$69.60,$397.50,$0.00,$198.75,$314.82,$318.00,$0.00,$62.21,$0.00,$63.28,$0.00
SN6CWS.180,SUP,HCPCS V2632,,SN6CWS.180  -  LENS IOL 0 D +18 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ,$397.50,$0.00,$397.50,$178.88,$283.70,$0.00,$68.49,$0.00,$0.00,$69.60,$397.50,$0.00,$198.75,$314.82,$318.00,$0.00,$62.21,$0.00,$63.28,$0.00
SN6CWS.185,SUP,HCPCS V2632,,SN6CWS.185  -  LENS IOL 0 D +18.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ,$397.50,$0.00,$397.50,$178.88,$283.70,$0.00,$68.49,$0.00,$0.00,$69.60,$397.50,$0.00,$198.75,$314.82,$318.00,$0.00,$62.21,$0.00,$63.28,$0.00
SN6CWS.190,SUP,HCPCS V2632,,SN6CWS.190  -  LENS IOL 0 D +19 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ,$397.50,$0.00,$397.50,$178.88,$283.70,$0.00,$68.49,$0.00,$0.00,$69.60,$397.50,$0.00,$198.75,$314.82,$318.00,$0.00,$62.21,$0.00,$63.28,$0.00
SN6CWS.195,SUP,HCPCS V2632,,SN6CWS.195  -  LENS IOL 0 D +19.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ,$397.50,$0.00,$397.50,$178.88,$283.70,$0.00,$68.49,$0.00,$0.00,$69.60,$397.50,$0.00,$198.75,$314.82,$318.00,$0.00,$62.21,$0.00,$63.28,$0.00
SN6CWS.200,SUP,HCPCS V2632,,SN6CWS.200  -  LENS IOL 0 D +20 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ,$397.50,$0.00,$397.50,$178.88,$283.70,$0.00,$68.49,$0.00,$0.00,$69.60,$397.50,$0.00,$198.75,$314.82,$318.00,$0.00,$62.21,$0.00,$63.28,$0.00
SN6CWS.205,SUP,HCPCS V2632,,SN6CWS.205  -  LENS IOL 0 D +20.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ,$397.50,$0.00,$397.50,$178.88,$283.70,$0.00,$68.49,$0.00,$0.00,$69.60,$397.50,$0.00,$198.75,$314.82,$318.00,$0.00,$62.21,$0.00,$63.28,$0.00
SN6CWS.210,SUP,HCPCS V2632,,SN6CWS.210  -  LENS IOL 0 D +21 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ,$397.50,$0.00,$397.50,$178.88,$283.70,$0.00,$68.49,$0.00,$0.00,$69.60,$397.50,$0.00,$198.75,$314.82,$318.00,$0.00,$62.21,$0.00,$63.28,$0.00
SN6CWS.215,SUP,HCPCS V2632,,SN6CWS.215  -  LENS IOL 0 D +21.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ,$397.50,$0.00,$397.50,$178.88,$283.70,$0.00,$68.49,$0.00,$0.00,$69.60,$397.50,$0.00,$198.75,$314.82,$318.00,$0.00,$62.21,$0.00,$63.28,$0.00
SN6CWS.220,SUP,HCPCS V2632,,SN6CWS.220  -  LENS IOL 0 D +22 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ,$397.50,$0.00,$397.50,$178.88,$283.70,$0.00,$68.49,$0.00,$0.00,$69.60,$397.50,$0.00,$198.75,$314.82,$318.00,$0.00,$62.21,$0.00,$63.28,$0.00
SN6CWS.225,SUP,HCPCS V2632,,SN6CWS.225  -  LENS IOL 0 D +22.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ,$397.50,$0.00,$397.50,$178.88,$283.70,$0.00,$68.49,$0.00,$0.00,$69.60,$397.50,$0.00,$198.75,$314.82,$318.00,$0.00,$62.21,$0.00,$63.28,$0.00
SN6CWS.230,SUP,HCPCS V2632,,SN6CWS.230  -  LENS IOL 0 D +23 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ,$397.50,$0.00,$397.50,$178.88,$283.70,$0.00,$68.49,$0.00,$0.00,$69.60,$397.50,$0.00,$198.75,$314.82,$318.00,$0.00,$62.21,$0.00,$63.28,$0.00
SN6CWS.235,SUP,HCPCS V2632,,SN6CWS.235  -  LENS IOL 0 D +23.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ,$397.50,$0.00,$397.50,$178.88,$283.70,$0.00,$68.49,$0.00,$0.00,$69.60,$397.50,$0.00,$198.75,$314.82,$318.00,$0.00,$62.21,$0.00,$63.28,$0.00
SN6CWS.240,SUP,HCPCS V2632,,SN6CWS.240  -  LENS IOL 0 D +24 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ,$397.50,$0.00,$397.50,$178.88,$283.70,$0.00,$68.49,$0.00,$0.00,$69.60,$397.50,$0.00,$198.75,$314.82,$318.00,$0.00,$62.21,$0.00,$63.28,$0.00
SN6CWS.245,SUP,HCPCS V2632,,SN6CWS.245  -  LENS IOL 0 D +24.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ,$397.50,$0.00,$397.50,$178.88,$283.70,$0.00,$68.49,$0.00,$0.00,$69.60,$397.50,$0.00,$198.75,$314.82,$318.00,$0.00,$62.21,$0.00,$63.28,$0.00
SN6CWS.250,SUP,HCPCS V2632,,SN6CWS.250  -  LENS IOL 0 D +25 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ,$397.50,$0.00,$397.50,$178.88,$283.70,$0.00,$68.49,$0.00,$0.00,$69.60,$397.50,$0.00,$198.75,$314.82,$318.00,$0.00,$62.21,$0.00,$63.28,$0.00
SN6CWS.255,SUP,HCPCS V2632,,SN6CWS.255  -  LENS IOL 0 D +25.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ,$397.50,$0.00,$397.50,$178.88,$283.70,$0.00,$68.49,$0.00,$0.00,$69.60,$397.50,$0.00,$198.75,$314.82,$318.00,$0.00,$62.21,$0.00,$63.28,$0.00
SN6CWS.260,SUP,HCPCS V2632,,SN6CWS.260  -  LENS IOL 0 D +26 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ,$397.50,$0.00,$397.50,$178.88,$283.70,$0.00,$68.49,$0.00,$0.00,$69.60,$397.50,$0.00,$198.75,$314.82,$318.00,$0.00,$62.21,$0.00,$63.28,$0.00
SN6CWS.265,SUP,HCPCS V2632,,SN6CWS.265  -  LENS IOL 0 D +26.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ,$397.50,$0.00,$397.50,$178.88,$283.70,$0.00,$68.49,$0.00,$0.00,$69.60,$397.50,$0.00,$198.75,$314.82,$318.00,$0.00,$62.21,$0.00,$63.28,$0.00
SN6CWS.270,SUP,HCPCS V2632,,SN6CWS.270  -  LENS IOL 0 D +27 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ,$397.50,$0.00,$397.50,$178.88,$283.70,$0.00,$68.49,$0.00,$0.00,$69.60,$397.50,$0.00,$198.75,$314.82,$318.00,$0.00,$62.21,$0.00,$63.28,$0.00
SN6CWS.275,SUP,HCPCS V2632,,SN6CWS.275  -  LENS IOL 0 D +27.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ,$397.50,$0.00,$397.50,$178.88,$283.70,$0.00,$68.49,$0.00,$0.00,$69.60,$397.50,$0.00,$198.75,$314.82,$318.00,$0.00,$62.21,$0.00,$63.28,$0.00
SN6CWS.280,SUP,HCPCS V2632,,SN6CWS.280  -  LENS IOL 0 D +28 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ,$397.50,$0.00,$397.50,$178.88,$283.70,$0.00,$68.49,$0.00,$0.00,$69.60,$397.50,$0.00,$198.75,$314.82,$318.00,$0.00,$62.21,$0.00,$63.28,$0.00
SN6CWS.295,SUP,HCPCS V2632,,SN6CWS.295  -  LENS IOL 0 D +29.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ,$397.50,$0.00,$397.50,$178.88,$283.70,$0.00,$68.49,$0.00,$0.00,$69.60,$397.50,$0.00,$198.75,$314.82,$318.00,$0.00,$62.21,$0.00,$63.28,$0.00
SN6CWS.300,SUP,HCPCS V2632,,SN6CWS.300  -  LENS IOL 0 D +30 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ,$397.50,$0.00,$397.50,$178.88,$283.70,$0.00,$68.49,$0.00,$0.00,$69.60,$397.50,$0.00,$198.75,$314.82,$318.00,$0.00,$62.21,$0.00,$63.28,$0.00
SOFT33,SUP,Custom 27203010,,SOFT33  -  INSERT CLMP 33MM SOFTJAW SET ATRAUMATIC OCCLUSION HIGH FLOW,$32.50,$0.00,$32.50,$0.00,$23.20,$0.00,$0.00,$0.00,$0.00,$0.00,$32.50,$0.00,$16.25,$25.74,$26.00,$0.00,$0.00,$0.00,$0.00,$0.00
SOFT61,SUP,Custom 27203010,,SOFT61  -  INSERT CLMP 61MM SOFTJAW SET ATRAUMATIC OCCLUSION HIGH FLOW,$37.50,$0.00,$37.50,$0.00,$26.76,$0.00,$0.00,$0.00,$0.00,$0.00,$37.50,$0.00,$18.75,$29.70,$30.00,$0.00,$0.00,$0.00,$0.00,$0.00
SOFT86,SUP,Custom 27203010,,SOFT86  -  INSERT CLMP FGRTY SFJW 86MM ATRM OCL HFLO RBR STRL LATEX,$32.75,$0.00,$32.75,$0.00,$23.37,$0.00,$0.00,$0.00,$0.00,$0.00,$32.75,$0.00,$16.38,$25.94,$26.20,$0.00,$0.00,$0.00,$0.00,$0.00
SP-1863,SUP,HCPCS C1713,,SP-1863  -  COVER BURR HOLE 18.5MM SLOT TEFLON PI,$835.00,$0.00,$835.00,$375.75,$595.94,$0.00,$143.87,$0.00,$0.00,$146.20,$835.00,$0.00,$417.50,$661.32,$668.00,$0.00,$130.68,$0.00,$132.93,$0.00
SP-1864,SUP,HCPCS C1713,,SP-1864  -  PLATE BONE 26MM 2X4 HOLE MATRIX ORAL CRANIOMAXILLOFACIAL,$870.00,$0.00,$870.00,$391.50,$620.92,$0.00,$149.90,$0.00,$0.00,$152.33,$870.00,$0.00,$435.00,$689.04,$696.00,$0.00,$136.16,$0.00,$138.50,$0.00
SP-1865,SUP,HCPCS C1713,,SP-1865  -  MESH CRNL .2MM NS LORENZ TRAUMAONE MDFC ORBT FLR 1.5MM SCR,"$3,670.00",$0.00,"$3,670.00","$1,651.50","$2,619.28",$0.00,$632.32,$0.00,$0.00,$642.59,"$3,670.00",$0.00,"$1,835.00","$2,906.64","$2,936.00",$0.00,$574.36,$0.00,$584.26,$0.00
SP-1889,SUP,Custom 27203010,,SP-1889  -  BLADE SURG 7X2MM REDX,$757.50,$0.00,$757.50,$0.00,$540.63,$0.00,$0.00,$0.00,$0.00,$0.00,$757.50,$0.00,$378.75,$599.94,$606.00,$0.00,$0.00,$0.00,$0.00,$0.00
SP-1942,SUP,HCPCS C1713,,SP-1942  -  PLATE SHUNT MEDIUM 18.5MM SPECIALTY X-DRIVE THINFLAP,$847.50,$0.00,$847.50,$381.38,$604.86,$0.00,$146.02,$0.00,$0.00,$148.39,$847.50,$0.00,$423.75,$671.22,$678.00,$0.00,$132.63,$0.00,$134.92,$0.00
SP-2032,SUP,HCPCS C1713,,SP-2032  -  SCREW BONE 2.5MM 6MM SLFDRILL REDX BLADE BYRD LORENZ,"$1,032.50",$0.00,"$1,032.50",$464.63,$736.90,$0.00,$177.89,$0.00,$0.00,$180.78,"$1,032.50",$0.00,$516.25,$817.74,$826.00,$0.00,$161.59,$0.00,$164.37,$0.00
SP-2256,SUP,HCPCS C1713,,SP-2256  -  PLATE BONE 1MM SPECIALTY TRAUMAONE MANDIB,"$1,847.50",$0.00,"$1,847.50",$831.38,"$1,318.56",$0.00,$318.32,$0.00,$0.00,$323.48,"$1,847.50",$0.00,$923.75,"$1,463.22","$1,478.00",$0.00,$289.13,$0.00,$294.12,$0.00
SP-2258,SUP,Custom 27203010,,SP-2258  -  TAP SURG 2.3MM,"$1,592.50",$0.00,"$1,592.50",$0.00,"$1,136.57",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,592.50",$0.00,$796.25,"$1,261.26","$1,274.00",$0.00,$0.00,$0.00,$0.00,$0.00
SP-2276,SUP,HCPCS C1713,,SP-2276  -  PLATE BONE THK2.6MM SMALL SPECIALTY SYSTEM LORENZ,"$9,147.50",$0.00,"$9,147.50","$4,116.38","$5,158.80",$0.00,"$1,576.07",$0.00,$0.00,"$1,601.65","$9,147.50",$0.00,"$4,573.75","$7,244.82","$7,318.00",$0.00,"$1,431.58",$0.00,"$1,456.28",$0.00
SP-2277,SUP,HCPCS C1713,,SP-2277  -  PLATE BONE THK2.6MM MEDIUM SPECIALTY SYSTEM LORENZ,"$9,945.00",$0.00,"$9,945.00","$4,475.25","$5,158.80",$0.00,"$1,713.47",$0.00,$0.00,"$1,741.29","$9,945.00",$0.00,"$4,972.50","$7,876.44","$7,956.00",$0.00,"$1,556.39",$0.00,"$1,583.24",$0.00
SP-2284,SUP,HCPCS C1713,,SP-2284  -  PLATE BONE 1MM 4 HOLE STR LORENZ TRAUMAONE TITANIUM MANDIB,"$1,582.50",$0.00,"$1,582.50",$712.13,"$1,129.43",$0.00,$272.66,$0.00,$0.00,$277.08,"$1,582.50",$0.00,$791.25,"$1,253.34","$1,266.00",$0.00,$247.66,$0.00,$251.93,$0.00
SP-2292,SUP,HCPCS C1713,,SP-2292  -  PLATE BONE 2MM SPECIALTY TRAUMAONE MANDIB,"$2,492.50",$0.00,"$2,492.50","$1,121.63","$1,778.90",$0.00,$429.45,$0.00,$0.00,$436.42,"$2,492.50",$0.00,"$1,246.25","$1,974.06","$1,994.00",$0.00,$390.08,$0.00,$396.81,$0.00
SP-2371,SUP,HCPCS C1713,,SP-2371  -  PLATE BONE SPECIALTY LORENZ MIDFAC,$910.00,$0.00,$910.00,$409.50,$649.47,$0.00,$156.79,$0.00,$0.00,$159.33,$910.00,$0.00,$455.00,$720.72,$728.00,$0.00,$142.42,$0.00,$144.87,$0.00
SP-2375,SUP,HCPCS C1713,,SP-2375  -  PLATE BONE 1MM LORENZ MANDIB,"$1,677.50",$0.00,"$1,677.50",$754.88,"$1,197.23",$0.00,$289.02,$0.00,$0.00,$293.72,"$1,677.50",$0.00,$838.75,"$1,328.58","$1,342.00",$0.00,$262.53,$0.00,$267.06,$0.00
SP-2376,SUP,HCPCS C1713,,SP-2376  -  PLATE BONE 1MM LORENZ MANDIB,"$1,677.50",$0.00,"$1,677.50",$754.88,"$1,197.23",$0.00,$289.02,$0.00,$0.00,$293.72,"$1,677.50",$0.00,$838.75,"$1,328.58","$1,342.00",$0.00,$262.53,$0.00,$267.06,$0.00
SP-2377,SUP,HCPCS C1713,,SP-2377  -  PLATE BONE 2MM LORENZ TRAUMAONE MIDFAC,"$2,450.00",$0.00,"$2,450.00","$1,102.50","$1,748.57",$0.00,$422.12,$0.00,$0.00,$428.98,"$2,450.00",$0.00,"$1,225.00","$1,940.40","$1,960.00",$0.00,$383.43,$0.00,$390.04,$0.00
SP-2465,SUP,HCPCS C1713,,SP-2465  -  PLATE BONE THK1.6MM LONG Y GRADE II TRAUMAONE LORENZ GOLD,"$2,017.50",$0.00,"$2,017.50",$907.88,"$1,439.89",$0.00,$347.61,$0.00,$0.00,$353.25,"$2,017.50",$0.00,"$1,008.75","$1,597.86","$1,614.00",$0.00,$315.74,$0.00,$321.19,$0.00
SP-2467,SUP,HCPCS C1713,,SP-2467  -  PLATE BONE THK2.6MM SMALL STR ANGLED LORENZ MAGENTA MANDIB,"$4,520.00",$0.00,"$4,520.00","$2,034.00","$3,225.92",$0.00,$778.77,$0.00,$0.00,$791.42,"$4,520.00",$0.00,"$2,260.00","$3,579.84","$3,616.00",$0.00,$707.38,$0.00,$719.58,$0.00
SP-2468,SUP,HCPCS C1713,,SP-2468  -  PLATE BONE THK2.6MM 7 HOLE TRAUMAONE LORENZ MAGENTA MANDIB,"$4,075.00",$0.00,"$4,075.00","$1,833.75","$2,908.33",$0.00,$702.10,$0.00,$0.00,$713.50,"$4,075.00",$0.00,"$2,037.50","$3,227.40","$3,260.00",$0.00,$637.74,$0.00,$648.74,$0.00
SP-2469,SUP,HCPCS C1713,,SP-2469  -  PLATE BONE THK2.6MM 16 HOLE STR TRAUMAONE LORENZ MAGENTA,"$6,870.00",$0.00,"$6,870.00","$3,091.50","$4,903.12",$0.00,"$1,183.67",$0.00,$0.00,"$1,202.88","$6,870.00",$0.00,"$3,435.00","$5,441.04","$5,496.00",$0.00,"$1,075.16",$0.00,"$1,093.70",$0.00
SP-2470,SUP,HCPCS C1713,,SP-2470  -  PLATE BONE THK2.6MM SMALL 7 HOLE CVD LORENZ MAGENTA MANDIB,"$4,075.00",$0.00,"$4,075.00","$1,833.75","$2,908.33",$0.00,$702.10,$0.00,$0.00,$713.50,"$4,075.00",$0.00,"$2,037.50","$3,227.40","$3,260.00",$0.00,$637.74,$0.00,$648.74,$0.00
SP-2472,SUP,HCPCS C1713,,SP-2472  -  PLATE BONE L CRNMXF LEFT 8X10 HOLE XRIGID 1.5/1MM,$737.50,$0.00,$737.50,$331.88,$526.35,$0.00,$127.07,$0.00,$0.00,$129.13,$737.50,$0.00,$368.75,$584.10,$590.00,$0.00,$115.42,$0.00,$117.41,$0.00
SP-2473,SUP,HCPCS C1713,,SP-2473  -  PLATE BN L 8X10 HL XRIGID CRNMXF RT 1.5/1MM SCR,"$1,242.50",$0.00,"$1,242.50",$559.13,$886.77,$0.00,$214.08,$0.00,$0.00,$217.55,"$1,242.50",$0.00,$621.25,$984.06,$994.00,$0.00,$194.45,$0.00,$197.81,$0.00
SP-2526,SUP,HCPCS C1713,,SP-2526  -  PLATE BONE CURVE CRNMXF 5 HOLE 1MM SCR,"$2,892.50",$0.00,"$2,892.50","$1,301.63","$2,064.38",$0.00,$498.36,$0.00,$0.00,$506.45,"$2,892.50",$0.00,"$1,446.25","$2,290.86","$2,314.00",$0.00,$452.68,$0.00,$460.49,$0.00
SP-2566,SUP,HCPCS C1713,,SP-2566  -  PLATE BONE STR 2MM 6 HOLE TRAUMAONE BLUE TITANIUM MANDIB,"$2,290.00",$0.00,"$2,290.00","$1,030.50","$1,634.37",$0.00,$394.56,$0.00,$0.00,$400.96,"$2,290.00",$0.00,"$1,145.00","$1,813.68","$1,832.00",$0.00,$358.39,$0.00,$364.57,$0.00
SP-2575,SUP,HCPCS C1713,,SP-2575  -  PLATE BONE 100D MEDIUM 3X3 HOLE L RIGID TRAUMAONE LORENZ,$877.50,$0.00,$877.50,$394.88,$626.27,$0.00,$151.19,$0.00,$0.00,$153.64,$877.50,$0.00,$438.75,$694.98,$702.00,$0.00,$137.33,$0.00,$139.70,$0.00
SP-2576,SUP,HCPCS C1713,,SP-2576  -  PLATE BONE 100D MEDIUM 3X3 HOLE L RIGID TRAUMAONE LORENZ,$877.50,$0.00,$877.50,$394.88,$626.27,$0.00,$151.19,$0.00,$0.00,$153.64,$877.50,$0.00,$438.75,$694.98,$702.00,$0.00,$137.33,$0.00,$139.70,$0.00
SP-2585,SUP,HCPCS C1713,,SP-2585  -  PLATE .6MM MANDIB 4 HOLE STR 2/2.3MM SCR BONE,"$1,817.50",$0.00,"$1,817.50",$817.88,"$1,297.15",$0.00,$313.15,$0.00,$0.00,$318.23,"$1,817.50",$0.00,$908.75,"$1,439.46","$1,454.00",$0.00,$284.44,$0.00,$289.35,$0.00
SP-2630,SUP,HCPCS C1713,,SP-2630  -  PLATE BONE THK1.6MM STR 2X7 HOLE MATRIX GRADE II TRAUMAONE,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,$0.00,$0.00,$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
SP-2631,SUP,HCPCS C1713,,SP-2631  -  PLATE BONE THK1.6MM 7X2MM CVD MATRIX GOLD MANDIB 2/2.3MM,"$2,625.00",$0.00,"$2,625.00","$1,181.25","$1,873.46",$0.00,$452.27,$0.00,$0.00,$459.62,"$2,625.00",$0.00,"$1,312.50","$2,079.00","$2,100.00",$0.00,$410.81,$0.00,$417.90,$0.00
SP-2665,SUP,HCPCS C1713,,SP-2665  -  PLATE BONE THK1.6MM 7 HOLE 2Y GRADE II TRAUMAONE LORENZ,"$1,515.00",$0.00,"$1,515.00",$681.75,"$1,081.26",$0.00,$261.03,$0.00,$0.00,$265.26,"$1,515.00",$0.00,$757.50,"$1,199.88","$1,212.00",$0.00,$237.10,$0.00,$241.19,$0.00
SP-2703,SUP,HCPCS C1713,,SP-2703  -  PLATE STR 1.6MM 6 HOLE GAP BONE,"$2,450.00",$0.00,"$2,450.00","$1,102.50","$1,748.57",$0.00,$422.12,$0.00,$0.00,$428.98,"$2,450.00",$0.00,"$1,225.00","$1,940.40","$1,960.00",$0.00,$383.43,$0.00,$390.04,$0.00
SP-2834,SUP,HCPCS C1713,,SP-2834  -  SCREW BONE L8 MM OD2.4 MM RIB SELF DRILL LOCK,$625.00,$0.00,$625.00,$281.25,$446.06,$0.00,$107.68,$0.00,$0.00,$109.43,$625.00,$0.00,$312.50,$495.00,$500.00,$0.00,$97.81,$0.00,$99.50,$0.00
SP-2889,SUP,HCPCS C1713,,SP-2889  -  PLATE BN STRG STERNALOCK BLU 24 HL STRNM PRM CLSR SYS,"$3,760.00",$0.00,"$3,760.00","$1,692.00","$2,683.51",$0.00,$647.83,$0.00,$0.00,$658.35,"$3,760.00",$0.00,"$1,880.00","$2,977.92","$3,008.00",$0.00,$588.44,$0.00,$598.59,$0.00
SP-2890,SUP,HCPCS C1713,,SP-2890  -  PLATE BN HEX STERNALOCK BLU 6 HL STRNM PRM CLSR SYS,"$2,210.00",$0.00,"$2,210.00",$994.50,"$1,577.28",$0.00,$380.77,$0.00,$0.00,$386.95,"$2,210.00",$0.00,"$1,105.00","$1,750.32","$1,768.00",$0.00,$345.87,$0.00,$351.83,$0.00
SP-2891,SUP,HCPCS C1713,,SP-2891  -  PLATE BN JL STRG STERNALOCK BLU 8 HL STRNM PRM CLSR SYS,"$1,945.00",$0.00,"$1,945.00",$875.25,"$1,388.15",$0.00,$335.11,$0.00,$0.00,$340.55,"$1,945.00",$0.00,$972.50,"$1,540.44","$1,556.00",$0.00,$304.39,$0.00,$309.64,$0.00
SP-2899,SUP,HCPCS C1713,,SP-2899  -  PLATE BN STRG STERNALOCK BLU 6 HL STRNM PRM CLSR SYS,"$1,962.50",$0.00,"$1,962.50",$883.13,"$1,400.64",$0.00,$338.13,$0.00,$0.00,$343.62,"$1,962.50",$0.00,$981.25,"$1,554.30","$1,570.00",$0.00,$307.13,$0.00,$312.43,$0.00
SP-2913,SUP,HCPCS C1713,,SP-2913  -  PLATE BN 70D L STERNALOCK BLU 8 HL STRNM PRM CLSR SYS,"$1,692.50",$0.00,"$1,692.50",$761.63,"$1,207.94",$0.00,$291.61,$0.00,$0.00,$296.34,"$1,692.50",$0.00,$846.25,"$1,340.46","$1,354.00",$0.00,$264.88,$0.00,$269.45,$0.00
SP-2914,SUP,HCPCS C1713,,SP-2914  -  PLATE BN Y STERNALOCK BLU 12 HL STRNM PRM CLSR SYS,"$3,332.50",$0.00,"$3,332.50","$1,499.63","$2,378.41",$0.00,$574.17,$0.00,$0.00,$583.49,"$3,332.50",$0.00,"$1,666.25","$2,639.34","$2,666.00",$0.00,$521.54,$0.00,$530.53,$0.00
SP-2927,SUP,HCPCS C1713,,SP-2927  -  PLATE BN STRG 1.6MM STERNALOCK BLU 16 HL STRNM PRM CLSR SYS,"$2,870.00",$0.00,"$2,870.00","$1,291.50","$2,048.32",$0.00,$494.49,$0.00,$0.00,$502.51,"$2,870.00",$0.00,"$1,435.00","$2,273.04","$2,296.00",$0.00,$449.16,$0.00,$456.90,$0.00
SP-2984,SUP,HCPCS C1713,,SP-2984  -  PLATE BN 100D X STERNALOCK BLU 8 HL STRNM,"$2,445.00",$0.00,"$2,445.00","$1,100.25","$1,745.00",$0.00,$421.26,$0.00,$0.00,$428.10,"$2,445.00",$0.00,"$1,222.50","$1,936.44","$1,956.00",$0.00,$382.64,$0.00,$389.24,$0.00
SP-2985,SUP,HCPCS C1713,,SP-2985  -  PLATE BN 100D Y STERNALOCK BLU 6 HL STRNM,"$2,445.00",$0.00,"$2,445.00","$1,100.25","$1,745.00",$0.00,$421.26,$0.00,$0.00,$428.10,"$2,445.00",$0.00,"$1,222.50","$1,936.44","$1,956.00",$0.00,$382.64,$0.00,$389.24,$0.00
SP-3001,SUP,HCPCS C1713,,SP-3001  -  PLATE BN 13MM STERNALOCK BLU STRNM JL G,"$2,070.00",$0.00,"$2,070.00",$931.50,"$1,477.36",$0.00,$356.65,$0.00,$0.00,$362.44,"$2,070.00",$0.00,"$1,035.00","$1,639.44","$1,656.00",$0.00,$323.96,$0.00,$329.54,$0.00
SP-3022,SUP,HCPCS C1713,,SP-3022  -  PLATE BN LG .6MM 4 HL CNTR MESH STRNL 1.5MM SCR EZ,"$1,677.50",$0.00,"$1,677.50",$754.88,"$1,197.23",$0.00,$289.02,$0.00,$0.00,$293.72,"$1,677.50",$0.00,$838.75,"$1,328.58","$1,342.00",$0.00,$262.53,$0.00,$267.06,$0.00
SP-3060,SUP,HCPCS C1713,,SP-3060  -  SCREW BN 2MM 9MM OMNIMAX MXLMNDB SD XD,"$2,172.50",$0.00,"$2,172.50",$977.63,"$1,550.51",$0.00,$374.31,$0.00,$0.00,$380.39,"$2,172.50",$0.00,"$1,086.25","$1,720.62","$1,738.00",$0.00,$340.00,$0.00,$345.86,$0.00
SP-3142,SUP,HCPCS C1713,,SP-3142  -  PLATE BN 60D JL STERNALOCK BLU STRNM,"$2,977.50",$0.00,"$2,977.50","$1,339.88","$2,125.04",$0.00,$513.01,$0.00,$0.00,$521.34,"$2,977.50",$0.00,"$1,488.75","$2,358.18","$2,382.00",$0.00,$465.98,$0.00,$474.02,$0.00
SP-3192,SUP,HCPCS C1713,,SP-3192  -  PLATE BN W STERNALOCK BLU 8 HL STRNL,"$3,537.50",$0.00,"$3,537.50","$1,591.88","$2,524.71",$0.00,$609.49,$0.00,$0.00,$619.39,"$3,537.50",$0.00,"$1,768.75","$2,801.70","$2,830.00",$0.00,$553.62,$0.00,$563.17,$0.00
SP-3215,SUP,HCPCS C1713,,SP-3215  -  PLATE BN XW 80MM MESH CRNM CHIARI,"$2,977.50",$0.00,"$2,977.50","$1,339.88","$2,125.04",$0.00,$513.01,$0.00,$0.00,$521.34,"$2,977.50",$0.00,"$1,488.75","$2,358.18","$2,382.00",$0.00,$465.98,$0.00,$474.02,$0.00
SP719521,SUP,Custom 27203010,,REAGENT .8% RBC RSLV 3ML PNL B BLOOD BANK,$391.75,$0.00,$391.75,$0.00,$279.59,$0.00,$0.00,$0.00,$0.00,$0.00,$391.75,$0.00,$195.88,$310.27,$313.40,$0.00,$0.00,$0.00,$0.00,$0.00
SP721380,SUP,Custom 27203010,,REAGENT ANTI-JK LTTL A BCLN 3ML MNCLN RARE GRP BLOOD BANK,$47.50,$0.00,$47.50,$0.00,$33.90,$0.00,$0.00,$0.00,$0.00,$0.00,$47.50,$0.00,$23.75,$37.62,$38.00,$0.00,$0.00,$0.00,$0.00,$0.00
SPD2-US-040-320,SUP,HCPCS C1884,,SPD2-US-040-320  -  SYSTEM EMBL PRTC 320CM .014IN FLTR CPTR WIRE GUID CATH 4MM,"$2,875.00",$0.00,"$2,875.00","$1,293.75","$2,051.89",$0.00,$495.35,$0.00,$0.00,$503.39,"$2,875.00",$0.00,"$1,437.50","$2,277.00","$2,300.00",$0.00,$449.94,$0.00,$457.70,$0.00
SPD2-US-050-320,SUP,HCPCS C1884,,SPD2-US-050-320  -  SYSTEM EMBL PRTC 320CM .014IN FLTR CPTR WIRE GUID CATH 5MM,"$2,875.00",$0.00,"$2,875.00","$1,293.75","$2,051.89",$0.00,$495.35,$0.00,$0.00,$503.39,"$2,875.00",$0.00,"$1,437.50","$2,277.00","$2,300.00",$0.00,$449.94,$0.00,$457.70,$0.00
SPD2-US-060-320,SUP,HCPCS C1773,,SPD2-US-060-320  -  SYSTEM EMBL PRTC 3.2-4.2FR 6MM 320CM 190CM SPIDERFX CPTR WRE,"$3,487.50",$0.00,"$3,487.50","$1,893.71","$2,489.03",$0.00,$600.88,$0.00,$0.00,$610.63,"$3,487.50",$0.00,"$1,743.75","$2,762.10","$2,790.00",$0.00,$545.79,$0.00,$555.21,$0.00
SPH100200-20,SUP,Custom 27803010,,SPH100200-20  -  COIL EMBL 2MM 2.5CM MICRUSPHERE 10 MCIOL SPHRCL LOOP DTCH,"$2,497.15",$0.00,"$2,497.15",$0.00,"$1,782.22",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,497.15",$0.00,"$1,248.58","$1,977.74","$1,997.72",$0.00,$0.00,$0.00,$0.00,$0.00
SPH100250-20,SUP,Custom 27803010,,SPH100250-20  -  COIL EMBL 2.5MM 3.3CM MICRUSPHERE 10 MCIOL SPHRCL LOOP DTCH,"$2,530.45",$0.00,"$2,530.45",$0.00,"$1,805.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,530.45",$0.00,"$1,265.23","$2,004.12","$2,024.36",$0.00,$0.00,$0.00,$0.00,$0.00
SPH100300-20,SUP,Custom 27803010,,SPH100300-20  -  COIL EMBL 3MM 5.4CM MICRUSPHERE 10 MCIOL SPHRCL LOOP DTCH,"$2,530.45",$0.00,"$2,530.45",$0.00,"$1,805.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,530.45",$0.00,"$1,265.23","$2,004.12","$2,024.36",$0.00,$0.00,$0.00,$0.00,$0.00
SPH100350-20,SUP,Custom 27803010,,SPH100350-20  -  COIL EMBL 3.5MM 6.6CM MICRUSPHERE 10 MCIOL SPHRCL LOOP DTCH,"$2,530.45",$0.00,"$2,530.45",$0.00,"$1,805.98",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,530.45",$0.00,"$1,265.23","$2,004.12","$2,024.36",$0.00,$0.00,$0.00,$0.00,$0.00
SPH100500-20,SUP,Custom 27803010,,SPH100500-20  -  COIL EMBL 5MM 9.7CM MICRUSPHERE 10 MCIOL SPHRCL LOOP DTCH,"$2,563.73",$0.00,"$2,563.73",$0.00,"$1,829.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,563.73",$0.00,"$1,281.86","$2,030.47","$2,050.98",$0.00,$0.00,$0.00,$0.00,$0.00
SPH100600-20,SUP,Custom 27803010,,SPH100600-20  -  COIL EMBL 6MM 11.9CM MICRUSPHERE 10 MCIOL SPHRCL LOOP DTCH,"$2,597.03",$0.00,"$2,597.03",$0.00,"$1,853.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,597.03",$0.00,"$1,298.51","$2,056.85","$2,077.62",$0.00,$0.00,$0.00,$0.00,$0.00
SPH100620-20,SUP,Custom 27803010,,SPH100620-20  -  COIL EMBL 6MM 20CM MICRUSPHERE 10 MCIOL SPHRCL LOOP DTCH SFT,"$2,730.20",$0.00,"$2,730.20",$0.00,"$1,948.54",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,730.20",$0.00,"$1,365.10","$2,162.32","$2,184.16",$0.00,$0.00,$0.00,$0.00,$0.00
SPH100700-20,SUP,Custom 27803010,,SPH100700-20  -  COIL EMBL 7MM 13.9CM MICRUSPHERE 10 MCIOL SPHRCL LOOP DTCH,"$2,630.33",$0.00,"$2,630.33",$0.00,"$1,877.26",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,630.33",$0.00,"$1,315.16","$2,083.22","$2,104.26",$0.00,$0.00,$0.00,$0.00,$0.00
SPH100720-20,SUP,Custom 27803010,,SPH100720-20  -  COIL EMBL 7MM 20CM MICRUSPHERE 10 MCIOL SPHRCL LOOP DTCH SFT,"$2,730.20",$0.00,"$2,730.20",$0.00,"$1,948.54",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,730.20",$0.00,"$1,365.10","$2,162.32","$2,184.16",$0.00,$0.00,$0.00,$0.00,$0.00
SPH100800-20,SUP,Custom 27803010,,SPH100800-20  -  COIL EMBL 8MM 16.1CM MICRUSPHERE 10 MCIOL SPHRCL LOOP DTCH,"$2,663.63",$0.00,"$2,663.63",$0.00,"$1,901.03",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,663.63",$0.00,"$1,331.81","$2,109.59","$2,130.90",$0.00,$0.00,$0.00,$0.00,$0.00
SPH100825-20,SUP,Custom 27803010,,SPH100825-20  -  COIL EMBL 8MM 25CM MICRUSPHERE 10 MCIOL SPHRCL LOOP DTCH SFT,"$2,796.80",$0.00,"$2,796.80",$0.00,"$1,996.08",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,796.80",$0.00,"$1,398.40","$2,215.07","$2,237.44",$0.00,$0.00,$0.00,$0.00,$0.00
SPH100900-20,SUP,Custom 27803010,,SPH100900-20  -  COIL EMBL 9MM 18.4CM MICRUSPHERE 10 MCIOL SPHRCL LOOP DTCH,"$2,696.93",$0.00,"$2,696.93",$0.00,"$1,924.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,696.93",$0.00,"$1,348.46","$2,135.97","$2,157.54",$0.00,$0.00,$0.00,$0.00,$0.00
SPH100925-20,SUP,Custom 27803010,,SPH100925-20  -  COIL EMBL 9MM 25CM MICRUSPHERE 10 MCIOL SPHRCL LOOP DTCH SFT,"$2,796.80",$0.00,"$2,796.80",$0.00,"$1,996.08",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,796.80",$0.00,"$1,398.40","$2,215.07","$2,237.44",$0.00,$0.00,$0.00,$0.00,$0.00
SPH101000-20,SUP,Custom 27803010,,SPH101000-20  -  COIL EMBL SPHR 10MM 20.3CM MICRUSPHERE 10 MCIOL SPHRCL LOOP,"$2,730.20",$0.00,"$2,730.20",$0.00,"$1,948.54",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,730.20",$0.00,"$1,365.10","$2,162.32","$2,184.16",$0.00,$0.00,$0.00,$0.00,$0.00
SPH10103020,SUP,Custom 27803010,,SPH10103020  -  COIL EMBL SPHR 10MM 30CM MICRUSPHERE 10 MCIOL SPHRCL LOOP,"$2,830.10",$0.00,"$2,830.10",$0.00,"$2,019.84",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,830.10",$0.00,"$1,415.05","$2,241.44","$2,264.08",$0.00,$0.00,$0.00,$0.00,$0.00
SPH101030-20,SUP,Custom 27803010,,SPH101030-20  -  COIL EMBL 30CM 10MM MICRUSPHERE 10 MCIOL SPHRCL LOOP DTCH,"$2,830.10",$0.00,"$2,830.10",$0.00,"$2,019.84",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,830.10",$0.00,"$1,415.05","$2,241.44","$2,264.08",$0.00,$0.00,$0.00,$0.00,$0.00
SPH181100-20,SUP,Custom 27803010,,SPH181100-20  -  COIL EMBL 11MM 18.9CM MICRUSPHERE 18 MCIOL SPHRCL LOOP DTCH,"$2,725.80",$0.00,"$2,725.80",$0.00,"$1,945.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,725.80",$0.00,"$1,362.90","$2,158.83","$2,180.64",$0.00,$0.00,$0.00,$0.00,$0.00
SPH181200-20,SUP,Custom 27803010,,SPH181200-20  -  COIL EMBL 12MM 20.7CM MICRUSPHERE 18 MCIOL SPHRCL LOOP DTCH,"$2,725.80",$0.00,"$2,725.80",$0.00,"$1,945.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,725.80",$0.00,"$1,362.90","$2,158.83","$2,180.64",$0.00,$0.00,$0.00,$0.00,$0.00
SPH181300-20,SUP,Custom 27803010,,SPH181300-20  -  COIL EMBL 13MM 22.6CM MICRUSPHERE 18 MCIOL SPHRCL LOOP DTCH,"$2,725.80",$0.00,"$2,725.80",$0.00,"$1,945.40",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,725.80",$0.00,"$1,362.90","$2,158.83","$2,180.64",$0.00,$0.00,$0.00,$0.00,$0.00
SPH181400-20,SUP,Custom 27803010,,SPH181400-20  -  COIL EMBL 14MM 24.3CM MICRUSPHERE 18 MCIOL SPHRCL LOOP DTCH,"$2,761.68",$0.00,"$2,761.68",$0.00,"$1,971.01",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,761.68",$0.00,"$1,380.84","$2,187.25","$2,209.34",$0.00,$0.00,$0.00,$0.00,$0.00
SPH181500-20,SUP,Custom 27803010,,SPH181500-20  -  COIL EMBL 15MM 26CM MICRUSPHERE 18 MCIOL SPHRCL LOOP DTCH,"$2,797.53",$0.00,"$2,797.53",$0.00,"$1,996.59",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,797.53",$0.00,"$1,398.76","$2,215.64","$2,238.02",$0.00,$0.00,$0.00,$0.00,$0.00
SPH181600-20,SUP,Custom 27803010,,SPH181600-20  -  COIL EMBL 16MM 27.9CM MICRUSPHERE 18 MCIOL SPHRCL LOOP DTCH,"$2,797.53",$0.00,"$2,797.53",$0.00,"$1,996.59",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,797.53",$0.00,"$1,398.76","$2,215.64","$2,238.02",$0.00,$0.00,$0.00,$0.00,$0.00
SPH181700-20,SUP,Custom 27803010,,SPH181700-20  -  COIL EMBL 17MM 30CM MICRUSPHERE 18 MCIOL SPHRCL LOOP DTCH,"$2,833.40",$0.00,"$2,833.40",$0.00,"$2,022.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,833.40",$0.00,"$1,416.70","$2,244.05","$2,266.72",$0.00,$0.00,$0.00,$0.00,$0.00
SPH181800-20,SUP,Custom 27803010,,SPH181800-20  -  COIL EMBL 18MM 30CM MICRUSPHERE 18 MCIOL SPHRCL LOOP DTCH,"$2,833.40",$0.00,"$2,833.40",$0.00,"$2,022.20",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,833.40",$0.00,"$1,416.70","$2,244.05","$2,266.72",$0.00,$0.00,$0.00,$0.00,$0.00
SPL15006X,SUP,HCPCS C1725,,SPL15006X  -  CATH BALDILAT 1.5MM 6MM RAPEX SMCPNT SPNTR LGND,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
SPL15010X,SUP,HCPCS C1726,,SPL15010X  -  CATHETER BLNDIL 21CM .02IN 1.5MM 142CM LF 10MM SPNTR LGND,$412.50,$0.00,$412.50,$223.99,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
SPL15012X,SUP,HCPCS C1725,,CATHETER BLN 1.5MM 12MM RAPEX LGND SPNTR,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
SPL15015X,SUP,HCPCS C1725,,CATHETER BLN 1.5MM 15MM RAPEX LGND SPNTR,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
SPL15020X,SUP,HCPCS C1725,,CATHETER BLN 1.5MM 20MM RAPEX LGND SPNTR,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
SPL20006X,SUP,HCPCS C1726,,SPL20006X  -  CATHETER BLNDIL 21CM .022IN 2MM 142CM LF 6MM SPNTR LGND,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
SPL20010X,SUP,HCPCS C1726,,SPL20010X  -  CATHETER BLNDIL 21CM .022IN 2MM 142CM LF 10MM SPNTR LGND,$412.50,$0.00,$412.50,$223.99,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
SPL20012X,SUP,HCPCS C1725,,CATHETER BLN 2MM 12MM RAPEX LGND SPNTR,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
SPL20015X,SUP,HCPCS C1725,,CATHETER BLN 2MM 15MM RAPEX LGND SPNTR,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
SPL20020X,SUP,HCPCS C1725,,CATHETER BLN 2MM 20MM RAPEX LGND SPNTR,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
SPL20025X,SUP,HCPCS C1726,,SPL20025X  -  CATHETER BLNDIL 21CM .022IN 2MM 142CM LF 25MM SPNTR LGND,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
SPL20030X,SUP,HCPCS C1726,,SPL20030X  -  CATHETER BLNDIL 21CM .022IN 2MM 142CM LF 30MM SPNTR LGND,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
SPL22506X,SUP,HCPCS C1726,,SPL22506X  -  CATHETER BLNDIL 21CM .022IN 2.25MM 142CM LF 6MM SPNTR LGND,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
SPL22510X,SUP,HCPCS C1726,,SPL22510X  -  CATHETER BLNDIL 21CM .022IN 2.25MM 142CM LF 10MM SPNTR LGND,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
SPL22512X,SUP,HCPCS C1726,,SPL22512X  -  CATHETER BLNDIL 21CM .022IN 2.25MM 142CM LF 12MM SPNTR LGND,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
SPL22515X,SUP,HCPCS C1726,,SPL22515X  -  CATHETER BLNDIL 21CM .022IN 2.25MM 142CM LF 15MM SPNTR LGND,$412.50,$0.00,$412.50,$223.99,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
SPL22520X,SUP,HCPCS C1726,,SPL22520X  -  CATHETER BLNDIL 21CM .022IN 2.25MM 142CM LF 20MM SPNTR LGND,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
SPL22525X,SUP,HCPCS C1726,,SPL22525X  -  CATHETER BLNDIL 21CM .022IN 2.25MM 142CM LF 25MM SPNTR LGND,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
SPL250010X,SUP,HCPCS C1726,,SPL250010X  -  CATHETER BLNDIL 21CM .022IN 2.5MM 142CM LF 10MM SPNTR LGND,$412.50,$0.00,$412.50,$223.99,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
SPL25006X,SUP,HCPCS C1726,,SPL25006X  -  CATHETER BLNDIL 21CM .022IN 2.5MM 142CM LF 6MM SPNTR LGND,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
SPL25012X,SUP,HCPCS C1725,,CATHETER BLN 2.5MM 12MM RAPEX LGND SPNTR,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
SPL25015X,SUP,HCPCS C1725,,CATHETER BLN 2.5MM 15MM RAPEX LGND SPNTR,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
SPL25020X,SUP,HCPCS C1725,,CATHETER BLN 2.5MM 20MM RAPEX LGND SPNTR,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
SPL25025X,SUP,HCPCS C1726,,SPL25025X  -  CATHETER BLNDIL 21CM .022IN 2.5MM 142CM LF 25MM SPNTR LGND,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
SPL25030X,SUP,HCPCS C1726,,SPL25030X  -  CATHETER BLNDIL 21CM .022IN 2.5MM 142CM LF 30MM SPNTR LGND,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
SPL27506X,SUP,HCPCS C1726,,SPL27506X  -  CATHETER BLNDIL 21CM .023IN 2.75MM 142CM LF 6MM SPNTR LGND,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
SPL27512X,SUP,HCPCS C1726,,SPL27512X  -  CATHETER BLNDIL 21CM .023IN 2.75MM 142CM LF 12MM SPNTR LGND,$412.50,$0.00,$412.50,$223.99,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
SPL27515X,SUP,HCPCS C1726,,SPL27515X  -  CATHETER BLNDIL 21CM .023IN 2.75MM 142CM LF 15MM SPNTR LGND,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
SPL27520X,SUP,HCPCS C1726,,SPL27520X  -  CATHETER BLNDIL 21CM .023IN 2.75MM 142CM LF 20MM SPNTR LGND,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
SPL27525X,SUP,HCPCS C1726,,SPL27525X  -  CATHETER BLNDIL 21CM .023IN 2.75MM 142CM LF 25MM SPNTR LGND,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
SPL30006X,SUP,HCPCS C1726,,SPL30006X  -  CATHETER BLNDIL 21CM .023IN 3MM 142CM LF 6MM SPNTR LGND,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
SPL30010X,SUP,HCPCS C1726,,SPL30010X  -  CATHETER BLNDIL 21CM .023IN 3MM 142CM LF 10MM SPNTR LGND,$412.50,$0.00,$412.50,$223.99,$294.40,$0.00,$71.07,$0.00,$0.00,$72.23,$412.50,$0.00,$206.25,$326.70,$330.00,$0.00,$64.56,$0.00,$65.67,$0.00
SPL30012X,SUP,HCPCS C1725,,CATHETER BLN 3MM 12MM RAPEX LGND SPNTR,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
SPL30015X,SUP,HCPCS C1725,,CATHETER BLN 3MM 15MM RAPEX LGND SPNTR,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
SPL30020X,SUP,HCPCS C1725,,CATHETER BLN 3MM 20MM RAPEX LGND SPNTR,$437.50,$0.00,$437.50,$237.56,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
SPL30025X,SUP,HCPCS C1726,,SPL30025X  -  CATHETER BLNDIL 21CM .023IN 3MM 142CM LF 25MM SPNTR LGND,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
SPL30030X,SUP,HCPCS C1726,,SPL30030X  -  CATHETER BLNDIL 21CM .023IN 3MM 142CM LF 30MM SPNTR LGND,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
SPL32512X,SUP,HCPCS C1726,,SPL32512X  -  CATHETER BLNDIL 21CM .023IN 3.25MM 142CM LF 12MM SPNTR LGND,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
SPL32515X,SUP,HCPCS C1725,,BALLON SPRINTER LEGEND  RX,$12.50,$0.00,$12.50,$6.79,$8.92,$0.00,$2.15,$0.00,$0.00,$2.19,$12.50,$0.00,$6.25,$9.90,$10.00,$0.00,$1.96,$0.00,$1.99,$0.00
SPL32520X,SUP,HCPCS C1725,,BALLON SPRINTER LEGEND  RX,$12.50,$0.00,$12.50,$6.79,$8.92,$0.00,$2.15,$0.00,$0.00,$2.19,$12.50,$0.00,$6.25,$9.90,$10.00,$0.00,$1.96,$0.00,$1.99,$0.00
SPL35006X,SUP,HCPCS C1725,,BALLON SPRINTER LEGEND  RX,$12.50,$0.00,$12.50,$6.79,$8.92,$0.00,$2.15,$0.00,$0.00,$2.19,$12.50,$0.00,$6.25,$9.90,$10.00,$0.00,$1.96,$0.00,$1.99,$0.00
SPL35010X,SUP,HCPCS C1725,,BALLON SPRINTER LEGEND  RX,$12.50,$0.00,$12.50,$6.79,$8.92,$0.00,$2.15,$0.00,$0.00,$2.19,$12.50,$0.00,$6.25,$9.90,$10.00,$0.00,$1.96,$0.00,$1.99,$0.00
SPL35012X,SUP,HCPCS C1725,,BALLON SPRINTER LEGEND  RX,$12.50,$0.00,$12.50,$6.79,$8.92,$0.00,$2.15,$0.00,$0.00,$2.19,$12.50,$0.00,$6.25,$9.90,$10.00,$0.00,$1.96,$0.00,$1.99,$0.00
SPL35015X,SUP,HCPCS C1725,,BALLON SPRINTER LEGEND  RX,$12.50,$0.00,$12.50,$6.79,$8.92,$0.00,$2.15,$0.00,$0.00,$2.19,$12.50,$0.00,$6.25,$9.90,$10.00,$0.00,$1.96,$0.00,$1.99,$0.00
SPL35020X,SUP,HCPCS C1725,,BALLON SPRINTER LEGEND  RX,$12.50,$0.00,$12.50,$6.79,$8.92,$0.00,$2.15,$0.00,$0.00,$2.19,$12.50,$0.00,$6.25,$9.90,$10.00,$0.00,$1.96,$0.00,$1.99,$0.00
SPL35025X,SUP,HCPCS C1725,,BALLON SPRINTER LEGEND  RX,$12.50,$0.00,$12.50,$6.79,$8.92,$0.00,$2.15,$0.00,$0.00,$2.19,$12.50,$0.00,$6.25,$9.90,$10.00,$0.00,$1.96,$0.00,$1.99,$0.00
SPL35030X,SUP,HCPCS C1725,,BALLON SPRINTER LEGEND  RX,$12.50,$0.00,$12.50,$6.79,$8.92,$0.00,$2.15,$0.00,$0.00,$2.19,$12.50,$0.00,$6.25,$9.90,$10.00,$0.00,$1.96,$0.00,$1.99,$0.00
SPL37512X,SUP,HCPCS C1725,,BALLON SPRINTER LEGEND  RX,$12.50,$0.00,$12.50,$6.79,$8.92,$0.00,$2.15,$0.00,$0.00,$2.19,$12.50,$0.00,$6.25,$9.90,$10.00,$0.00,$1.96,$0.00,$1.99,$0.00
SPL37515X,SUP,HCPCS C1725,,BALLON SPRINTER LEGEND  RX,$12.50,$0.00,$12.50,$6.79,$8.92,$0.00,$2.15,$0.00,$0.00,$2.19,$12.50,$0.00,$6.25,$9.90,$10.00,$0.00,$1.96,$0.00,$1.99,$0.00
SPL37520X,SUP,HCPCS C1725,,BALLON SPRINTER LEGEND  RX,$12.50,$0.00,$12.50,$6.79,$8.92,$0.00,$2.15,$0.00,$0.00,$2.19,$12.50,$0.00,$6.25,$9.90,$10.00,$0.00,$1.96,$0.00,$1.99,$0.00
SPL40006X,SUP,HCPCS C1725,,BALLON SPRINTER LEGEND  RX,$12.50,$0.00,$12.50,$6.79,$8.92,$0.00,$2.15,$0.00,$0.00,$2.19,$12.50,$0.00,$6.25,$9.90,$10.00,$0.00,$1.96,$0.00,$1.99,$0.00
SPL40010X,SUP,HCPCS C1725,,BALLON SPRINTER LEGEND  RX,$12.50,$0.00,$12.50,$6.79,$8.92,$0.00,$2.15,$0.00,$0.00,$2.19,$12.50,$0.00,$6.25,$9.90,$10.00,$0.00,$1.96,$0.00,$1.99,$0.00
SPL40012X,SUP,HCPCS C1725,,BALLON SPRINTER LEGEND  RX,$12.50,$0.00,$12.50,$6.79,$8.92,$0.00,$2.15,$0.00,$0.00,$2.19,$12.50,$0.00,$6.25,$9.90,$10.00,$0.00,$1.96,$0.00,$1.99,$0.00
SPL40015X,SUP,HCPCS C1725,,BALLON SPRINTER LEGEND  RX,$12.50,$0.00,$12.50,$6.79,$8.92,$0.00,$2.15,$0.00,$0.00,$2.19,$12.50,$0.00,$6.25,$9.90,$10.00,$0.00,$1.96,$0.00,$1.99,$0.00
SPL40020X,SUP,HCPCS C1725,,BALLON SPRINTER LEGEND  RX,$12.50,$0.00,$12.50,$6.79,$8.92,$0.00,$2.15,$0.00,$0.00,$2.19,$12.50,$0.00,$6.25,$9.90,$10.00,$0.00,$1.96,$0.00,$1.99,$0.00
SPL40025X,SUP,HCPCS C1726,,SPL40025X  -  CATHETER BLNDIL 21CM .024IN 4MM 142CM LF 25MM SPNTR LGND,$425.00,$0.00,$425.00,$230.78,$303.32,$0.00,$73.23,$0.00,$0.00,$74.41,$425.00,$0.00,$212.50,$336.60,$340.00,$0.00,$66.51,$0.00,$67.66,$0.00
SPL40030X,SUP,HCPCS C1725,,BALLON SPRINTER LEGEND  RX,$12.50,$0.00,$12.50,$6.79,$8.92,$0.00,$2.15,$0.00,$0.00,$2.19,$12.50,$0.00,$6.25,$9.90,$10.00,$0.00,$1.96,$0.00,$1.99,$0.00
SPLS-20100-TS,SUP,HCPCS C1713,,SPLS-20100-TS  -  PEG FX 2MM 10MM NS GEMINUS SMTH LCK SCR CADDY TI FOSSA RDS,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
SPLS-20120-TS,SUP,HCPCS C1713,,SPLS-20120-TS  -  PEG FX 2MM 12MM NS GEMINUS SMTH LCK SCR CADDY TI FOSSA RDS,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
SPLS-20140-TS,SUP,HCPCS C1713,,SPLS-20140-TS  -  PEG FX 2MM 14MM NS GEMINUS SMTH LCK SCR CADDY TI FOSSA RDS,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
SPLS-20160-TS,SUP,HCPCS C1713,,SPLS-20160-TS  -  PEG FX 2MM 16MM NS GEMINUS SMTH LCK SCR CADDY TI FOSSA RDS,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
SPLS-20170-TS,SUP,HCPCS C1713,,SPLS-20170-TS  -  PEG FX 2MM 17MM NS GEMINUS SMTH LCK SCR CADDY TI FOSSA RDS,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
SPLS-20180-TS,SUP,HCPCS C1713,,SPLS-20180-TS  -  PEG FX 2MM 18MM NS GEMINUS SMTH LCK SCR CADDY TI FOSSA RDS,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
SPLS-20190-TS,SUP,HCPCS C1713,,SPLS-20190-TS  -  PEG FX 2MM 19MM NS GEMINUS SMTH LCK SCR CADDY TI FOSSA RDS,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
SPLS-20200-TS,SUP,HCPCS C1713,,SPLS-20200-TS  -  PEG FX 2MM 20MM NS GEMINUS SMTH LCK SCR CADDY TI FOSSA RDS,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
SPLS-20210-TS,SUP,HCPCS C1713,,SPLS-20210-TS  -  PEG FX 2MM 21MM NS GEMINUS SMTH LCK SCR CADDY TI FOSSA RDS,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
SPLS-20220-TS,SUP,HCPCS C1713,,SPLS-20220-TS  -  PEG FX 2MM 22MM NS GEMINUS SMTH LCK SCR CADDY TI FOSSA RDS,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
SPLS-20230-TS,SUP,HCPCS C1713,,SPLS-20230-TS  -  PEG FX 2MM 23MM NS GEMINUS SMTH LCK SCR CADDY TI FOSSA RDS,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
SPLS-20240-TS,SUP,HCPCS C1713,,SPLS-20240-TS  -  PEG FX 2MM 24MM NS GEMINUS SMTH LCK SCR CADDY TI FOSSA RDS,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
SPLS-20260-TS,SUP,HCPCS C1713,,SPLS-20260-TS  -  PEG FX 2MM 26MM NS GEMINUS SMTH LCK SCR CADDY TI FOSSA RDS,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
SPLS-20280-TS,SUP,HCPCS C1713,,SPLS-20280-TS  -  PEG FX 2MM 28MM NS GEMINUS SMTH LCK SCR CADDY TI FOSSA RDS,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
SPLS-20300-TS,SUP,HCPCS C1713,,SPLS-20300-TS  -  PEG FX 2MM 30MM NS GEMINUS SMTH LCK SCR CADDY TI FOSSA RDS,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
SPLS-20320-TS,SUP,HCPCS C1713,,SPLS-20320-TS  -  PEG FX 2MM 32MM NS GEMINUS SMTH LCK SCR CADDY TI FOSSA RDS,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
SPMTS4014,SUP,Custom 27203010,,REAGENT ANTI-IGG C3D ID MTS GEL CRD 6 TST ANALY,$160.70,$0.00,$160.70,$0.00,$114.69,$0.00,$0.00,$0.00,$0.00,$0.00,$160.70,$0.00,$80.35,$127.27,$128.56,$0.00,$0.00,$0.00,$0.00,$0.00
SPMTS4024,SUP,Custom 27203010,,REAGENT ANTI-IGG ID MTS GEL CRD PLYCLN 6 TST ANALY,$494.85,$0.00,$494.85,$0.00,$353.17,$0.00,$0.00,$0.00,$0.00,$0.00,$494.85,$0.00,$247.43,$391.92,$395.88,$0.00,$0.00,$0.00,$0.00,$0.00
SPS0121K,SUP,HCPCS C1713,,SPS0121K  -  SPACER HUM 99MMX16MM 41MM 7MM INTSPC SM SHLDR PMMA,"$9,975.00",$0.00,"$9,975.00","$4,488.75","$5,158.80",$0.00,"$1,718.64",$0.00,$0.00,"$1,746.54","$9,975.00",$0.00,"$4,987.50","$7,900.20","$7,980.00",$0.00,"$1,561.09",$0.00,"$1,588.02",$0.00
SR-0620-CS,SUP,HCPCS C1876,,SR-0620-CS  -  STENT VASC STRG 6MM 20MM 57CM ENROUTE UBER FLX DLV SYS ANG,"$6,750.00",$0.00,"$6,750.00","$3,037.50","$4,817.48",$0.00,"$1,162.99",$0.00,$0.00,"$1,181.87","$6,750.00",$0.00,"$3,375.00","$5,346.00","$5,400.00",$0.00,"$1,056.38",$0.00,"$1,074.60",$0.00
SR-0630-CS,SUP,HCPCS C1876,,SR-0630-CS  -  STENT VASC 6MM .065IN 30MM 57CM ENROUTE UBER FLX DLV SYS ANG,"$6,750.00",$0.00,"$6,750.00","$3,037.50","$4,817.48",$0.00,"$1,162.99",$0.00,$0.00,"$1,181.87","$6,750.00",$0.00,"$3,375.00","$5,346.00","$5,400.00",$0.00,"$1,056.38",$0.00,"$1,074.60",$0.00
SR-0640-CS,SUP,HCPCS C1876,,SR-0640-CS  -  STENT VASC 6MM 40MM 57CM ENROUTE UBER FLX DLV SYS ANG TIP,"$6,750.00",$0.00,"$6,750.00","$3,037.50","$4,817.48",$0.00,"$1,162.99",$0.00,$0.00,"$1,181.87","$6,750.00",$0.00,"$3,375.00","$5,346.00","$5,400.00",$0.00,"$1,056.38",$0.00,"$1,074.60",$0.00
SR-0730-CS,SUP,HCPCS C1876,,SR-0730-CS  -  STENT VASC 7MM .065IN 30MM 57CM ENROUTE UBER FLX DLV SYS ANG,"$6,750.00",$0.00,"$6,750.00","$3,037.50","$4,817.48",$0.00,"$1,162.99",$0.00,$0.00,"$1,181.87","$6,750.00",$0.00,"$3,375.00","$5,346.00","$5,400.00",$0.00,"$1,056.38",$0.00,"$1,074.60",$0.00
SR-0740-CS,SUP,HCPCS C1876,,SR-0740-CS  -  STENT VASC 7MM .065IN 40MM 57CM ENROUTE UBER FLX DLV SYS ANG,"$6,750.00",$0.00,"$6,750.00","$3,037.50","$4,817.48",$0.00,"$1,162.99",$0.00,$0.00,"$1,181.87","$6,750.00",$0.00,"$3,375.00","$5,346.00","$5,400.00",$0.00,"$1,056.38",$0.00,"$1,074.60",$0.00
SR-0830-CS,SUP,HCPCS C1876,,SR-0830-CS  -  STENT VASC 8MM .065IN 30MM 57CM ENROUTE UBER FLX DLV SYS ANG,"$6,750.00",$0.00,"$6,750.00","$3,037.50","$4,817.48",$0.00,"$1,162.99",$0.00,$0.00,"$1,181.87","$6,750.00",$0.00,"$3,375.00","$5,346.00","$5,400.00",$0.00,"$1,056.38",$0.00,"$1,074.60",$0.00
SR-0840-CS,SUP,HCPCS C1876,,SR-0840-CS  -  STENT VASC 8MM .065IN 40MM 57CM ENROUTE UBER FLX DLV SYS ANG,"$6,750.00",$0.00,"$6,750.00","$3,037.50","$4,817.48",$0.00,"$1,162.99",$0.00,$0.00,"$1,181.87","$6,750.00",$0.00,"$3,375.00","$5,346.00","$5,400.00",$0.00,"$1,056.38",$0.00,"$1,074.60",$0.00
SR-0930-CS,SUP,HCPCS C1876,,SR-0930-CS  -  STENT VASC 9MM 30MM 57CM ENROUTE UBER FLX DLV SYS ANG TIP,"$6,750.00",$0.00,"$6,750.00","$3,037.50","$4,817.48",$0.00,"$1,162.99",$0.00,$0.00,"$1,181.87","$6,750.00",$0.00,"$3,375.00","$5,346.00","$5,400.00",$0.00,"$1,056.38",$0.00,"$1,074.60",$0.00
SR-0940-CS,SUP,HCPCS C1876,,SR-0940-CS  -  STENT VASC 9MM .078IN 40MM 57CM ENROUTE UBER FLX DLV SYS ANG,"$6,750.00",$0.00,"$6,750.00","$3,037.50","$4,817.48",$0.00,"$1,162.99",$0.00,$0.00,"$1,181.87","$6,750.00",$0.00,"$3,375.00","$5,346.00","$5,400.00",$0.00,"$1,056.38",$0.00,"$1,074.60",$0.00
SR-1030-CS,SUP,HCPCS C1876,,SR-1030-CS  -  STENT VASC SHRT STRG 10MM 6FR 30MM 57CM ENROUTE UBER FLX,"$6,750.00",$0.00,"$6,750.00","$3,037.50","$4,817.48",$0.00,"$1,162.99",$0.00,$0.00,"$1,181.87","$6,750.00",$0.00,"$3,375.00","$5,346.00","$5,400.00",$0.00,"$1,056.38",$0.00,"$1,074.60",$0.00
SR-1040-CS,SUP,HCPCS C1876,,SR-1040-CS  -  STENT VASC 10MM .078IN 40MM 57CM ENROUTE UBER FLX DLV SYS,"$6,750.00",$0.00,"$6,750.00","$3,037.50","$4,817.48",$0.00,"$1,162.99",$0.00,$0.00,"$1,181.87","$6,750.00",$0.00,"$3,375.00","$5,346.00","$5,400.00",$0.00,"$1,056.38",$0.00,"$1,074.60",$0.00
SRC140306-20,SUP,Custom 27803010,,SRC140306-20  -  COIL EMBL 3MM 6CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH,"$2,785.85",$0.00,"$2,785.85",$0.00,"$1,988.26",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,785.85",$0.00,"$1,392.93","$2,206.39","$2,228.68",$0.00,$0.00,$0.00,$0.00,$0.00
SRC140406-20,SUP,Custom 27803010,,SRC140406-20  -  COIL EMBL 4MM 6CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH,"$2,785.85",$0.00,"$2,785.85",$0.00,"$1,988.26",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,785.85",$0.00,"$1,392.93","$2,206.39","$2,228.68",$0.00,$0.00,$0.00,$0.00,$0.00
SRC140408-20,SUP,Custom 27803010,,SRC140408-20  -  COIL EMBL 4MM 8CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH,"$2,829.38",$0.00,"$2,829.38",$0.00,"$2,019.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,829.38",$0.00,"$1,414.69","$2,240.87","$2,263.50",$0.00,$0.00,$0.00,$0.00,$0.00
SRC140445-20,SUP,Custom 27803010,,SRC140445-20  -  COIL EMBL 4MM 4.5CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH,"$2,785.85",$0.00,"$2,785.85",$0.00,"$1,988.26",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,785.85",$0.00,"$1,392.93","$2,206.39","$2,228.68",$0.00,$0.00,$0.00,$0.00,$0.00
SRC140507-20,SUP,Custom 27803010,,SRC140507-20  -  COIL EMBL 5MM 7CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH,"$2,829.38",$0.00,"$2,829.38",$0.00,"$2,019.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,829.38",$0.00,"$1,414.69","$2,240.87","$2,263.50",$0.00,$0.00,$0.00,$0.00,$0.00
SRC140512-20,SUP,Custom 27803010,,SRC140512-20  -  COIL EMBL 5MM 12CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH,"$2,829.38",$0.00,"$2,829.38",$0.00,"$2,019.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,829.38",$0.00,"$1,414.69","$2,240.87","$2,263.50",$0.00,$0.00,$0.00,$0.00,$0.00
SRC140609-20,SUP,Custom 27803010,,SRC140609-20  -  COIL EMBL 6MM 9CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH,"$2,829.38",$0.00,"$2,829.38",$0.00,"$2,019.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,829.38",$0.00,"$1,414.69","$2,240.87","$2,263.50",$0.00,$0.00,$0.00,$0.00,$0.00
SRC140615-20,SUP,Custom 27803010,,SRC140615-20  -  COIL EMBL 6MM 15CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH,"$2,872.90",$0.00,"$2,872.90",$0.00,"$2,050.39",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,872.90",$0.00,"$1,436.45","$2,275.34","$2,298.32",$0.00,$0.00,$0.00,$0.00,$0.00
SRC140711-20,SUP,Custom 27803010,,SRC140711-20  -  COIL EMBL 7MM 11CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH,"$2,829.38",$0.00,"$2,829.38",$0.00,"$2,019.32",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,829.38",$0.00,"$1,414.69","$2,240.87","$2,263.50",$0.00,$0.00,$0.00,$0.00,$0.00
SRC140717-20,SUP,Custom 27803010,,SRC140717-20  -  COIL EMBL 7MM 17CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH,"$2,959.95",$0.00,"$2,959.95",$0.00,"$2,112.52",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,959.95",$0.00,"$1,479.98","$2,344.28","$2,367.96",$0.00,$0.00,$0.00,$0.00,$0.00
SRC140812-20,SUP,Custom 27803010,,SRC140812-20  -  COIL EMBL 8MM 12CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH,"$2,872.90",$0.00,"$2,872.90",$0.00,"$2,050.39",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,872.90",$0.00,"$1,436.45","$2,275.34","$2,298.32",$0.00,$0.00,$0.00,$0.00,$0.00
SRC140820-20,SUP,Custom 27803010,,SRC140820-20  -  COIL EMBL 8MM 20CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH,"$3,003.48",$0.00,"$3,003.48",$0.00,"$2,143.58",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,003.48",$0.00,"$1,501.74","$2,378.76","$2,402.78",$0.00,$0.00,$0.00,$0.00,$0.00
SRC140914-20,SUP,Custom 27803010,,SRC140914-20  -  COIL EMBL 9MM 14CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH,"$2,959.95",$0.00,"$2,959.95",$0.00,"$2,112.52",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,959.95",$0.00,"$1,479.98","$2,344.28","$2,367.96",$0.00,$0.00,$0.00,$0.00,$0.00
SRC140922-20,SUP,Custom 27803010,,SRC140922-20  -  COIL EMBL 9MM 22CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH,"$3,003.48",$0.00,"$3,003.48",$0.00,"$2,143.58",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,003.48",$0.00,"$1,501.74","$2,378.76","$2,402.78",$0.00,$0.00,$0.00,$0.00,$0.00
SRC141016-20,SUP,Custom 27803010,,SRC141016-20  -  COIL EMBL 10MM 16CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH,"$2,959.95",$0.00,"$2,959.95",$0.00,"$2,112.52",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,959.95",$0.00,"$1,479.98","$2,344.28","$2,367.96",$0.00,$0.00,$0.00,$0.00,$0.00
SRC141025-20,SUP,Custom 27803010,,SRC141025-20  -  COIL EMBL 10MM 25CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH,"$3,047.03",$0.00,"$3,047.03",$0.00,"$2,174.66",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,047.03",$0.00,"$1,523.51","$2,413.25","$2,437.62",$0.00,$0.00,$0.00,$0.00,$0.00
SRC141118-20,SUP,Custom 27803010,,SRC141118-20  -  COIL EMBL 11MM 18CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH,"$3,003.48",$0.00,"$3,003.48",$0.00,"$2,143.58",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,003.48",$0.00,"$1,501.74","$2,378.76","$2,402.78",$0.00,$0.00,$0.00,$0.00,$0.00
SRC141127-20,SUP,Custom 27803010,,SRC141127-20  -  COIL EMBL 11MM 27CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH,"$3,090.55",$0.00,"$3,090.55",$0.00,"$2,205.73",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,090.55",$0.00,"$1,545.28","$2,447.72","$2,472.44",$0.00,$0.00,$0.00,$0.00,$0.00
SRC141219-20,SUP,Custom 27803010,,SRC141219-20  -  COIL EMBL 12MM 19CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH,"$3,003.48",$0.00,"$3,003.48",$0.00,"$2,143.58",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,003.48",$0.00,"$1,501.74","$2,378.76","$2,402.78",$0.00,$0.00,$0.00,$0.00,$0.00
SRC141230-20,SUP,Custom 27803010,,SRC141230-20  -  COIL EMBL 12MM 30CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH,"$3,134.08",$0.00,"$3,134.08",$0.00,"$2,236.79",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,134.08",$0.00,"$1,567.04","$2,482.19","$2,507.26",$0.00,$0.00,$0.00,$0.00,$0.00
SRE-CV-320S,SUP,Custom 27803010,,SRE-CV-320S  -  EXPANDER TISSUE WALL CHART CURVILINEAR EXTREMITY SOFTSPAN,"$1,825.00",$0.00,"$1,825.00",$0.00,"$1,302.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,825.00",$0.00,$912.50,"$1,445.40","$1,460.00",$0.00,$0.00,$0.00,$0.00,$0.00
SRE-CV-720S,SUP,Custom 27803010,,SRE-CV-720S  -  EXPANDER TISSUE CURVILINEAR 26.2X9CM WALL CHART EXTREMITY,"$1,825.00",$0.00,"$1,825.00",$0.00,"$1,302.50",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,825.00",$0.00,$912.50,"$1,445.40","$1,460.00",$0.00,$0.00,$0.00,$0.00,$0.00
SRS-003-FSP,SUP,HCPCS C1713,,SRS-003-FSP  -  CEMENT BONE NRN SRS FST ST 3ML PTTY STRL,"$2,018.60",$0.00,"$2,018.60",$908.37,"$1,440.67",$0.00,$347.79,$0.00,$0.00,$353.44,"$2,018.60",$0.00,"$1,009.30","$1,598.73","$1,614.88",$0.00,$315.91,$0.00,$321.36,$0.00
SRS-005-FSP,SUP,HCPCS C1713,,SRS-005-FSP  -  CEMENT BONE NRN SRS FST ST 5ML PTTY STRL,"$3,315.05",$0.00,"$3,315.05","$1,491.77","$2,365.95",$0.00,$571.17,$0.00,$0.00,$580.44,"$3,315.05",$0.00,"$1,657.53","$2,625.52","$2,652.04",$0.00,$518.81,$0.00,$527.76,$0.00
SRS-010-FSP,SUP,HCPCS C1713,,SRS-010-FSP  -  CEMENT BONE NRN SRS FST ST 10ML PTTY STRL,"$6,518.20",$0.00,"$6,518.20","$2,933.19","$4,652.04",$0.00,"$1,123.05",$0.00,$0.00,"$1,141.28","$6,518.20",$0.00,"$3,259.10","$5,162.41","$5,214.56",$0.00,"$1,020.10",$0.00,"$1,037.70",$0.00
SRS-015-FSP,SUP,HCPCS C1713,,SRS-015-FSP  -  CEMENT BONE NRN SRS FST ST 15ML PTTY STRL,"$9,567.20",$0.00,"$9,567.20","$4,305.24","$5,158.80",$0.00,"$1,648.38",$0.00,$0.00,"$1,675.14","$9,567.20",$0.00,"$4,783.60","$7,577.22","$7,653.76",$0.00,"$1,497.27",$0.00,"$1,523.10",$0.00
SSSA-EW-09,SUP,Custom 27203010,,SSSA-EW-09  -  ADAPTER INTRO LNG 9FR SFSHTH SL XTD WNG VASC ATN,$110.00,$0.00,$110.00,$0.00,$78.51,$0.00,$0.00,$0.00,$0.00,$0.00,$110.00,$0.00,$55.00,$87.12,$88.00,$0.00,$0.00,$0.00,$0.00,$0.00
ST-030,SUP,Custom 27203010,,BLANKET 30X24IN MED WT PED THRMPLST HPR/HPO H2O CIRC LMNT,$107.00,$0.00,$107.00,$0.00,$76.37,$0.00,$0.00,$0.00,$0.00,$0.00,$107.00,$0.00,$53.50,$84.74,$85.60,$0.00,$0.00,$0.00,$0.00,$0.00
ST09875,SUP,HCPCS C1729,,CATHETER TWIST LOCK CATH-GUARD  CONTAMINATION SHIELD,$38.93,$0.00,$38.93,$21.14,$27.78,$0.00,$6.71,$0.00,$0.00,$6.82,$38.93,$0.00,$19.46,$30.83,$31.14,$0.00,$6.09,$0.00,$6.20,$0.00
ST5678,SUP,HCPCS C1713,,ST5678  -  SET SCREW,$250.00,$0.00,$250.00,$112.50,$178.43,$0.00,$43.07,$0.00,$0.00,$43.77,$250.00,$0.00,$125.00,$198.00,$200.00,$0.00,$39.13,$0.00,$39.80,$0.00
STRAP25,SUP,HCPCS C1781,,STRAP25  -  DEVICE FX 5MM SECURESTRAP 25 ABS STRAP MESH DISP HRN REPR,"$1,527.95",$0.00,"$1,527.95",$687.58,"$1,090.50",$0.00,$263.26,$0.00,$0.00,$267.53,"$1,527.95",$0.00,$763.98,"$1,210.14","$1,222.36",$0.00,$239.12,$0.00,$243.25,$0.00
SU16030,SUP,Custom 27203010,,HOLDER 8IN HGR NDL NAR,$84.63,$0.00,$84.63,$0.00,$60.40,$0.00,$0.00,$0.00,$0.00,$0.00,$84.63,$0.00,$42.31,$67.03,$67.70,$0.00,$0.00,$0.00,$0.00,$0.00
SW46,SUP,Custom 27203010,,SOCK ABS 46X3IN SPC UNV APL,$200.60,$0.00,$200.60,$0.00,$143.17,$0.00,$0.00,$0.00,$0.00,$0.00,$200.60,$0.00,$100.30,$158.88,$160.48,$0.00,$0.00,$0.00,$0.00,$0.00
SXP77,SUP,Custom 27203010,,SXP77  -  SUTURE NONABSORBABLE THK1.5MM 2-0 V-7 30IN 7X3MM 2 ARM BRAID,$200.29,$0.00,$200.29,$0.00,$142.95,$0.00,$0.00,$0.00,$0.00,$0.00,$200.29,$0.00,$100.15,$158.63,$160.23,$0.00,$0.00,$0.00,$0.00,$0.00
SYNCRACRTPMEAM,SUP,HCPCS C2621,,SYNCRACRTPMEAM  -  SYNCRA CRT-P ADVANCED SYSTEM,"$20,587.50",$0.00,"$20,587.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$20,587.50",$0.00,"$10,293.75","$16,305.30","$16,470.00",$0.00,$0.00,$0.00,$0.00,$0.00
T1002,SUP,Custom 27203010,,T1002  -  RETRACTOR SRG 10IN 30MM POST GLND NK TTH SHLDR OSTM,$653.13,$0.00,$653.13,$0.00,$466.14,$0.00,$0.00,$0.00,$0.00,$0.00,$653.13,$0.00,$326.56,$517.28,$522.50,$0.00,$0.00,$0.00,$0.00,$0.00
T12BA20D,SUP,Custom 27203010,,T12BA20D  -  TOOL LGD T12CM 2MM BALL DIAM,$412.25,$0.00,$412.25,$0.00,$294.22,$0.00,$0.00,$0.00,$0.00,$0.00,$412.25,$0.00,$206.13,$326.50,$329.80,$0.00,$0.00,$0.00,$0.00,$0.00
T12BA30D,SUP,Custom 27203010,,T12BA30D  -  TOOL LGD T12CM 3MM BALL DIAM,$412.25,$0.00,$412.25,$0.00,$294.22,$0.00,$0.00,$0.00,$0.00,$0.00,$412.25,$0.00,$206.13,$326.50,$329.80,$0.00,$0.00,$0.00,$0.00,$0.00
T12MH15,SUP,Custom 27203010,,T12MH15  -  TOOL LEGEND 12CM 1.5MM MH,$320.88,$0.00,$320.88,$0.00,$229.01,$0.00,$0.00,$0.00,$0.00,$0.00,$320.88,$0.00,$160.44,$254.14,$256.70,$0.00,$0.00,$0.00,$0.00,$0.00
T12MH20,SUP,Custom 27203010,,T12MH20  -  TOOL LEGEND 12CM 2MM MH,$320.88,$0.00,$320.88,$0.00,$229.01,$0.00,$0.00,$0.00,$0.00,$0.00,$320.88,$0.00,$160.44,$254.14,$256.70,$0.00,$0.00,$0.00,$0.00,$0.00
T12MH20D,SUP,Custom 27203010,,T12MH20D  -  TOOL LEGEND 12CM 2MM DIAM,$348.50,$0.00,$348.50,$0.00,$248.72,$0.00,$0.00,$0.00,$0.00,$0.00,$348.50,$0.00,$174.25,$276.01,$278.80,$0.00,$0.00,$0.00,$0.00,$0.00
T12MH25,SUP,Custom 27203010,,T12MH25  -  TOOL LEGEND 12CM 2.5MM MH,$320.88,$0.00,$320.88,$0.00,$229.01,$0.00,$0.00,$0.00,$0.00,$0.00,$320.88,$0.00,$160.44,$254.14,$256.70,$0.00,$0.00,$0.00,$0.00,$0.00
T12MH25D,SUP,Custom 27203010,,T12MH25D  -  TOOL LEGEND 12CM 2.5MM DIAM,$348.50,$0.00,$348.50,$0.00,$248.72,$0.00,$0.00,$0.00,$0.00,$0.00,$348.50,$0.00,$174.25,$276.01,$278.80,$0.00,$0.00,$0.00,$0.00,$0.00
T12MH30D,SUP,Custom 27203010,,T12MH30D  -  TOOL LEGEND 12CM 3MM DIAM,$348.50,$0.00,$348.50,$0.00,$248.72,$0.00,$0.00,$0.00,$0.00,$0.00,$348.50,$0.00,$174.25,$276.01,$278.80,$0.00,$0.00,$0.00,$0.00,$0.00
T12MH35D,SUP,Custom 27203010,,T12MH35D  -  TOOL LEGEND 12CM 3.5MM DIAM,$348.50,$0.00,$348.50,$0.00,$248.72,$0.00,$0.00,$0.00,$0.00,$0.00,$348.50,$0.00,$174.25,$276.01,$278.80,$0.00,$0.00,$0.00,$0.00,$0.00
T12MH45D,SUP,Custom 27203010,,T12MH45D  -  TOOL LEGEND 12CM 4.5MM DIAM,$348.50,$0.00,$348.50,$0.00,$248.72,$0.00,$0.00,$0.00,$0.00,$0.00,$348.50,$0.00,$174.25,$276.01,$278.80,$0.00,$0.00,$0.00,$0.00,$0.00
T1415A,SUP,Custom 27203010,,T1415A  -  NEEDLE BIOP STANDARD 14GA 15CM COAXIAL HANDLE TEMNO,$162.30,$0.00,$162.30,$0.00,$115.84,$0.00,$0.00,$0.00,$0.00,$0.00,$162.30,$0.00,$81.15,$128.54,$129.84,$0.00,$0.00,$0.00,$0.00,$0.00
T14BA20,SUP,Custom 27203010,,T14BA20  -  TOOL LEGD 14CM TELESC 2MM BALL,$331.50,$0.00,$331.50,$0.00,$236.59,$0.00,$0.00,$0.00,$0.00,$0.00,$331.50,$0.00,$165.75,$262.55,$265.20,$0.00,$0.00,$0.00,$0.00,$0.00
T14BA30,SUP,Custom 27203010,,T14BA30  -  TOOL LEGD 14CM TELESC 3MM BALL,$331.50,$0.00,$331.50,$0.00,$236.59,$0.00,$0.00,$0.00,$0.00,$0.00,$331.50,$0.00,$165.75,$262.55,$265.20,$0.00,$0.00,$0.00,$0.00,$0.00
T14BA40,SUP,Custom 27203010,,T14BA40  -  TOOL LEGEND 14CM TELESC 4MM BALL,$331.50,$0.00,$331.50,$0.00,$236.59,$0.00,$0.00,$0.00,$0.00,$0.00,$331.50,$0.00,$165.75,$262.55,$265.20,$0.00,$0.00,$0.00,$0.00,$0.00
T14MH25,SUP,Custom 27203010,,T14MH25  -  TOOL LEGEND 14CM 2.5MM MH,$357.00,$0.00,$357.00,$0.00,$254.79,$0.00,$0.00,$0.00,$0.00,$0.00,$357.00,$0.00,$178.50,$282.74,$285.60,$0.00,$0.00,$0.00,$0.00,$0.00
T14MH30D,SUP,Custom 27203010,,T14MH30D  -  TOOL LEGEND 14CM 3MM MH DIAM,$391.00,$0.00,$391.00,$0.00,$279.06,$0.00,$0.00,$0.00,$0.00,$0.00,$391.00,$0.00,$195.50,$309.67,$312.80,$0.00,$0.00,$0.00,$0.00,$0.00
T15MH25,SUP,Custom 27203010,,T15MH25  -  TOOL LEGEND 15CM 2.5MM MH,$333.63,$0.00,$333.63,$0.00,$238.11,$0.00,$0.00,$0.00,$0.00,$0.00,$333.63,$0.00,$166.81,$264.23,$266.90,$0.00,$0.00,$0.00,$0.00,$0.00
T15MH30D,SUP,Custom 27203010,,T15MH30D  -  TOOL LEGEND 15CM 3MM DIAM,$367.63,$0.00,$367.63,$0.00,$262.37,$0.00,$0.00,$0.00,$0.00,$0.00,$367.63,$0.00,$183.81,$291.16,$294.10,$0.00,$0.00,$0.00,$0.00,$0.00
T16X12,SUP,HCPCS C1894,,T16X12  -  SHEATH DLV ONQ TNL SYS 12IN 16GA DISP,$175.00,$0.00,$175.00,$95.03,$124.90,$0.00,$30.15,$0.00,$0.00,$30.64,$175.00,$0.00,$87.50,$138.60,$140.00,$0.00,$27.39,$0.00,$27.86,$0.00
T17MH30D,SUP,Custom 27203010,,T17MH30D  -  TOOL LEGEND 17CM 3MM DIAM,$365.50,$0.00,$365.50,$0.00,$260.86,$0.00,$0.00,$0.00,$0.00,$0.00,$365.50,$0.00,$182.75,$289.48,$292.40,$0.00,$0.00,$0.00,$0.00,$0.00
T17X8,SUP,HCPCS C1894,,T17X8  -  TUNNELER SRG 17GA 8IN STRL LF ONQ SHTH DISP,$75.00,$0.00,$75.00,$40.73,$53.53,$0.00,$12.92,$0.00,$0.00,$13.13,$75.00,$0.00,$37.50,$59.40,$60.00,$0.00,$11.74,$0.00,$11.94,$0.00
T18MH25,SUP,Custom 27203010,,T18MH25  -  TOOL MATCH HEAD 2.5 MM 18 CM,$333.63,$0.00,$333.63,$0.00,$238.11,$0.00,$0.00,$0.00,$0.00,$0.00,$333.63,$0.00,$166.81,$264.23,$266.90,$0.00,$0.00,$0.00,$0.00,$0.00
T18MH30D,SUP,Custom 27203010,,T18MH30D  -  TOOL MATCH HEAD 3.0 MM DIAMOND,$367.63,$0.00,$367.63,$0.00,$262.37,$0.00,$0.00,$0.00,$0.00,$0.00,$367.63,$0.00,$183.81,$291.16,$294.10,$0.00,$0.00,$0.00,$0.00,$0.00
T4031,SUP,Custom 27203010,,GRINDER TISS LG 50ML CNTRF TUBE PCTV SLV PEEL PCH STRL DISP,$28.70,$0.00,$28.70,$0.00,$20.48,$0.00,$0.00,$0.00,$0.00,$0.00,$28.70,$0.00,$14.35,$22.73,$22.96,$0.00,$0.00,$0.00,$0.00,$0.00
T43101,SUP,Custom 27804086,,T43101  -  GRAFT BN .5ML GRFTN PTTY JR DBM,$312.50,$0.00,$312.50,$0.00,$223.03,$0.00,$0.00,$0.00,$0.00,$0.00,$312.50,$0.00,$156.25,$247.50,$250.00,$0.00,$0.00,$0.00,$0.00,$0.00
T43102,SUP,Custom 27804086,,T43102  -  GRAFT BONE PUTTY JAR GRAFTON DEMINERALIZED BONE MATRIX 1ML,$350.00,$0.00,$350.00,$0.00,$249.80,$0.00,$0.00,$0.00,$0.00,$0.00,$350.00,$0.00,$175.00,$277.20,$280.00,$0.00,$0.00,$0.00,$0.00,$0.00
T43103,SUP,Custom 27804086,,T43103  -  GRAFT BN 2.5ML GRFTN PTTY JR DBM,"$1,190.00",$0.00,"$1,190.00",$0.00,$849.30,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,190.00",$0.00,$595.00,$942.48,$952.00,$0.00,$0.00,$0.00,$0.00,$0.00
T43105,SUP,Custom 27804086,,T43105  -  GRAFT BONE PUTTY JAR GRAFTON DEMINERALIZED BONE MATRIX 5ML,"$2,162.50",$0.00,"$2,162.50",$0.00,"$1,543.38",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,162.50",$0.00,"$1,081.25","$1,712.70","$1,730.00",$0.00,$0.00,$0.00,$0.00,$0.00
T9MH15,SUP,Custom 27203010,,T9MH15  -  TOOL LEGEND 9CM 1.5MM MH,$318.75,$0.00,$318.75,$0.00,$227.49,$0.00,$0.00,$0.00,$0.00,$0.00,$318.75,$0.00,$159.38,$252.45,$255.00,$0.00,$0.00,$0.00,$0.00,$0.00
T9MH20,SUP,Custom 27203010,,T9MH20  -  TOOL LEGEND 9CM 2MM MH,$318.75,$0.00,$318.75,$0.00,$227.49,$0.00,$0.00,$0.00,$0.00,$0.00,$318.75,$0.00,$159.38,$252.45,$255.00,$0.00,$0.00,$0.00,$0.00,$0.00
T9MH25,SUP,Custom 27203010,,T9MH25  -  TOOL LEGEND 9CM 2.5MM MH,$318.75,$0.00,$318.75,$0.00,$227.49,$0.00,$0.00,$0.00,$0.00,$0.00,$318.75,$0.00,$159.38,$252.45,$255.00,$0.00,$0.00,$0.00,$0.00,$0.00
T9MH25D,SUP,Custom 27203010,,T9MH25D  -  TOOL LEGEND 9CM 2.5MM DIAM,$361.25,$0.00,$361.25,$0.00,$257.82,$0.00,$0.00,$0.00,$0.00,$0.00,$361.25,$0.00,$180.63,$286.11,$289.00,$0.00,$0.00,$0.00,$0.00,$0.00
T9MH30D,SUP,Custom 27203010,,T9MH30D  -  TOOL LEGEND 9CM 3MM MH DIAM,$361.25,$0.00,$361.25,$0.00,$257.82,$0.00,$0.00,$0.00,$0.00,$0.00,$361.25,$0.00,$180.63,$286.11,$289.00,$0.00,$0.00,$0.00,$0.00,$0.00
T9MH35D,SUP,Custom 27203010,,T9MH35D  -  TOOL LEGEND 9CM 3.5MM DIAM,$361.25,$0.00,$361.25,$0.00,$257.82,$0.00,$0.00,$0.00,$0.00,$0.00,$361.25,$0.00,$180.63,$286.11,$289.00,$0.00,$0.00,$0.00,$0.00,$0.00
T9MH45D,SUP,Custom 27203010,,T9MH45D  -  TOOL LEGEND 9CM 4.5MM DIAM,$361.25,$0.00,$361.25,$0.00,$257.82,$0.00,$0.00,$0.00,$0.00,$0.00,$361.25,$0.00,$180.63,$286.11,$289.00,$0.00,$0.00,$0.00,$0.00,$0.00
TA3035L,SUP,Custom 27203010,,TA3035L  -  RELOAD STPLR 30MMX3.5MM BLU STRL LF 1.5MM DST TA 2 ROW LNR,$91.10,$0.00,$91.10,$0.00,$65.02,$0.00,$0.00,$0.00,$0.00,$0.00,$91.10,$0.00,$45.55,$72.15,$72.88,$0.00,$0.00,$0.00,$0.00,$0.00
TA3035S,SUP,Custom 27203010,,TA3035S  -  STAPLER INTERNAL 30MMX3.5MM 1.5MM 2 ROW 2 ACTION HANDLE,$208.00,$0.00,$208.00,$0.00,$148.45,$0.00,$0.00,$0.00,$0.00,$0.00,$208.00,$0.00,$104.00,$164.74,$166.40,$0.00,$0.00,$0.00,$0.00,$0.00
TA3048S,SUP,Custom 27203010,,TA3048S  -  STAPLER INTERNAL 30MMX4.8MM 2MM 2 ROW 2 ACTION HANDLE LINEAR,$216.93,$0.00,$216.93,$0.00,$154.82,$0.00,$0.00,$0.00,$0.00,$0.00,$216.93,$0.00,$108.47,$171.81,$173.54,$0.00,$0.00,$0.00,$0.00,$0.00
TA30V3L,SUP,Custom 27203010,,TA30V3L  -  RELOAD STPLR 30MMX2.5MM WHT STRL LF 1MM DST TA 3 ROW LNR CTR,$102.77,$0.00,$102.77,$0.00,$73.35,$0.00,$0.00,$0.00,$0.00,$0.00,$102.77,$0.00,$51.38,$81.39,$82.22,$0.00,$0.00,$0.00,$0.00,$0.00
TA30V3S,SUP,Custom 27203010,,TA30V3S  -  STAPLER INTERNAL 30MM 3 ROW 2 ACTION HANDLE LINEAR CUTTER,$249.36,$0.00,$249.36,$0.00,$177.97,$0.00,$0.00,$0.00,$0.00,$0.00,$249.36,$0.00,$124.68,$197.49,$199.49,$0.00,$0.00,$0.00,$0.00,$0.00
TA6035L,SUP,Custom 27203010,,TA6035L  -  RELOAD STPLR 60MMX3.5MM BLU STRL LF 1.5MM DST TA 2 ROW LNR,$102.44,$0.00,$102.44,$0.00,$73.11,$0.00,$0.00,$0.00,$0.00,$0.00,$102.44,$0.00,$51.22,$81.13,$81.95,$0.00,$0.00,$0.00,$0.00,$0.00
TA6035S,SUP,Custom 27203010,,TA6035S  -  STAPLER INTERNAL 60X3.5MM STAPLE 2 ACTION HANDLE LINEAR,$215.13,$0.00,$215.13,$0.00,$153.54,$0.00,$0.00,$0.00,$0.00,$0.00,$215.13,$0.00,$107.56,$170.38,$172.10,$0.00,$0.00,$0.00,$0.00,$0.00
TA6048S,SUP,Custom 27203010,,TA6048S  -  STAPLER INTERNAL 60X4.8MM STAPLE 2 ACTION HANDLE LINEAR,$217.44,$0.00,$217.44,$0.00,$155.19,$0.00,$0.00,$0.00,$0.00,$0.00,$217.44,$0.00,$108.72,$172.21,$173.95,$0.00,$0.00,$0.00,$0.00,$0.00
TA9035L,SUP,Custom 27203010,,TA9035L  -  RELOAD STPLR 90MMX3.5MM BLU STRL LF 1.5MM DST TA 2 ROW LNR,$108.15,$0.00,$108.15,$0.00,$77.19,$0.00,$0.00,$0.00,$0.00,$0.00,$108.15,$0.00,$54.07,$85.65,$86.52,$0.00,$0.00,$0.00,$0.00,$0.00
TA9035S,SUP,Custom 27203010,,TA9035S  -  STAPLER INTERNAL 90X3.5MM STAPLE 2 ACTION HANDLE LINEAR,$227.13,$0.00,$227.13,$0.00,$162.10,$0.00,$0.00,$0.00,$0.00,$0.00,$227.13,$0.00,$113.57,$179.89,$181.71,$0.00,$0.00,$0.00,$0.00,$0.00
TA9048L,SUP,Custom 27203010,,TA9048L  -  RELOAD STPLR 90MMX4.8MM GRN STRL LF 2MM DST TA 2 ROW LNR CTR,$109.32,$0.00,$109.32,$0.00,$78.02,$0.00,$0.00,$0.00,$0.00,$0.00,$109.32,$0.00,$54.66,$86.58,$87.45,$0.00,$0.00,$0.00,$0.00,$0.00
TA9048S,SUP,Custom 27203010,,TA9048S  -  STAPLER INTERNAL 90X4.8MM STAPLE 2 ACTION HANDLE LINEAR,$263.98,$0.00,$263.98,$0.00,$188.40,$0.00,$0.00,$0.00,$0.00,$0.00,$263.98,$0.00,$131.99,$209.07,$211.18,$0.00,$0.00,$0.00,$0.00,$0.00
TB-1550K-S,SUP,HCPCS C1713,,TB-1550K-S  -  PIN TNSNBND SYS 50MM ORTH SS STRL,$510.00,$0.00,$510.00,$229.50,$363.99,$0.00,$87.87,$0.00,$0.00,$89.30,$510.00,$0.00,$255.00,$403.92,$408.00,$0.00,$79.82,$0.00,$81.19,$0.00
TB-1570K-S,SUP,HCPCS C1713,,TB-1570K-S  -  PIN TNSNBND KIT 70MM ORTH SS STRL,$510.00,$0.00,$510.00,$229.50,$363.99,$0.00,$87.87,$0.00,$0.00,$89.30,$510.00,$0.00,$255.00,$403.92,$408.00,$0.00,$79.82,$0.00,$81.19,$0.00
TB-1590K-S,SUP,HCPCS C1713,,TB-1590K-S  -  PIN TNSNBND SYS 90MM ORTH SS STRL,$510.00,$0.00,$510.00,$229.50,$363.99,$0.00,$87.87,$0.00,$0.00,$89.30,$510.00,$0.00,$255.00,$403.92,$408.00,$0.00,$79.82,$0.00,$81.19,$0.00
TC003,SUP,HCPCS C1729,,TC003  -  CATH IU THRMCH BLN ABLT EXCESSIVE MENSTRUAL BLD,"$2,472.50",$0.00,"$2,472.50","$1,342.57","$1,764.62",$0.00,$426.00,$0.00,$0.00,$432.91,"$2,472.50",$0.00,"$1,236.25","$1,958.22","$1,978.00",$0.00,$386.95,$0.00,$393.62,$0.00
TC7465,SUP,Custom 27203010,,TRACHEOSTOMY TRAY,$255.98,$0.00,$255.98,$0.00,$182.69,$0.00,$0.00,$0.00,$0.00,$0.00,$255.98,$0.00,$127.99,$202.74,$204.78,$0.00,$0.00,$0.00,$0.00,$0.00
TDF010U,SUP,HCPCS C1721,,TDF010U  -  PARADYM 9550 RF DR,"$38,750.00",$0.00,"$38,750.00","$17,437.50","$5,158.80",$0.00,"$6,676.43",$0.00,$0.00,"$6,784.82","$38,750.00",$0.00,"$19,375.00","$30,690.00","$31,000.00",$0.00,"$6,064.38",$0.00,"$6,169.00",$0.00
TDF011U,SUP,HCPCS C1722,,TDF011U  -  PARADYM 9250 RF VR,"$33,750.00",$0.00,"$33,750.00","$15,187.50","$5,158.80",$0.00,"$5,814.96",$0.00,$0.00,"$5,909.36","$33,750.00",$0.00,"$16,875.00","$26,730.00","$27,000.00",$0.00,"$5,281.88",$0.00,"$5,373.00",$0.00
TDF012U,SUP,HCPCS C1882,,TDF012U  -  PARADYM RF CRT 9750,"$45,500.00",$0.00,"$45,500.00","$20,475.00","$5,158.80",$0.00,"$7,839.42",$0.00,$0.00,"$7,966.69","$45,500.00",$0.00,"$22,750.00","$36,036.00","$36,400.00",$0.00,"$7,120.75",$0.00,"$7,243.60",$0.00
TDF012U SYSTEM,SUP,HCPCS C1882,,TDF012U SYSTEM  -  PARADYM RF CRT 9750 SYSTEM,"$60,500.00",$0.00,"$60,500.00","$27,225.00","$5,158.80",$0.00,"$8,138.89",$0.00,$0.00,"$8,138.89","$60,500.00",$0.00,"$30,250.00","$47,916.00","$48,400.00",$0.00,"$7,751.33",$0.00,"$8,138.89",$0.00
TE-1000,SUP,Custom 27203010,,TE-1000  -  TOOL INSERTION EMBEDDING CURVED PLASTIC HANDLE TITANIUM TIP,$332.50,$0.00,$332.50,$0.00,$237.31,$0.00,$0.00,$0.00,$0.00,$0.00,$332.50,$0.00,$166.25,$263.34,$266.00,$0.00,$0.00,$0.00,$0.00,$0.00
TECR1510,SUP,HCPCS C1781,,TECR1510  -  MESH SRG RECT 6X4IN PARIETEX 2D FLT SHT RGD PLSTR HRN,$179.68,$0.00,$179.68,$80.85,$128.23,$0.00,$30.96,$0.00,$0.00,$31.46,$179.68,$0.00,$89.84,$142.31,$143.74,$0.00,$28.12,$0.00,$28.60,$0.00
TECT1510AL,SUP,HCPCS C1781,,TECT1510AL  -  MESH SRG 6X4IN PARIETEX FLXB ANTM PLSTR LT HRN,$393.10,$0.00,$393.10,$176.90,$280.56,$0.00,$67.73,$0.00,$0.00,$68.83,$393.10,$0.00,$196.55,$311.34,$314.48,$0.00,$61.52,$0.00,$62.58,$0.00
TECT1510AR,SUP,HCPCS C1781,,TECT1510AR  -  MESH SURG PARIETEX 6X4IN RIGHT HERN 3D FLXB LTWT ANTM,$425.13,$0.00,$425.13,$191.31,$303.41,$0.00,$73.25,$0.00,$0.00,$74.44,$425.13,$0.00,$212.56,$336.70,$340.10,$0.00,$66.53,$0.00,$67.68,$0.00
TEM1208GL,SUP,HCPCS C1781,,TEM1208GL  -  MESH SURG 4.7X3IN LEFT FLAP SELF FIXATING ANATOMIC,$739.40,$0.00,$739.40,$332.73,$527.71,$0.00,$127.39,$0.00,$0.00,$129.46,$739.40,$0.00,$369.70,$585.60,$591.52,$0.00,$115.72,$0.00,$117.71,$0.00
TEM1208GR,SUP,HCPCS C1781,,TEM1208GR  -  MESH SURG 4.7X3IN RIGHT FLAP SELF FIXATING ANATOMIC,$739.40,$0.00,$739.40,$332.73,$527.71,$0.00,$127.39,$0.00,$0.00,$129.46,$739.40,$0.00,$369.70,$585.60,$591.52,$0.00,$115.72,$0.00,$117.71,$0.00
TEST,SUP,Custom 27203010,,STENT URETERAL RESONANCE METALLIC 6.0 X 26CM,"$2,425.00",$0.00,"$2,425.00",$0.00,"$1,730.72",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,425.00",$0.00,"$1,212.50","$1,920.60","$1,940.00",$0.00,$0.00,$0.00,$0.00,$0.00
TET1309,SUP,HCPCS C1781,,TET1309  -  MESH SRG RECT 5.2X3.6IN LF PARIETEX 3D HCMB WV KNIT FLT SHT,$275.33,$0.00,$275.33,$123.90,$196.50,$0.00,$47.44,$0.00,$0.00,$48.21,$275.33,$0.00,$137.66,$218.06,$220.26,$0.00,$43.09,$0.00,$43.83,$0.00
TF-19A,SUP,Custom 27803010,,TF-19A  -  VALVE AORTIC 15MM 24MM 19MM TRIFECTA 12MM TISS ANNULUS LTRM,"$15,000.00",$0.00,"$15,000.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$15,000.00",$0.00,"$7,500.00","$11,880.00","$12,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
TF-21A,SUP,Custom 27803010,,TF-21A  -  VALVE AORTIC 16MM 21MM 26MM TRIFECTA 13MM TISS ANNULUS LTRM,"$15,000.00",$0.00,"$15,000.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$15,000.00",$0.00,"$7,500.00","$11,880.00","$12,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
TF-23A,SUP,Custom 27803010,,TF-23A  -  VALVE AOR 13MM 23MM 38IN 17MM TRIFECTA LINX AC BPRTH STNT,"$15,000.00",$0.00,"$15,000.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$15,000.00",$0.00,"$7,500.00","$11,880.00","$12,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
TF-25A,SUP,Custom 27803010,,TF-25A  -  VALVE AORTIC 18MM 25MM 31MM TRIFECTA 14MM TISS ANNULUS LTRM,"$15,000.00",$0.00,"$15,000.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$15,000.00",$0.00,"$7,500.00","$11,880.00","$12,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
TF-27A,SUP,Custom 27803010,,TF-27A  -  VALVE AOR 27MM 27MM 33MM 19MM TRIFECTA LINX FTG RST STNT,"$15,000.00",$0.00,"$15,000.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$15,000.00",$0.00,"$7,500.00","$11,880.00","$12,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
TF-29A,SUP,Custom 27803010,,TF-29A  -  VALVE AORTIC 20MM 29MM 35MM TRIFECTA 16MM TISS ANNULUS LTRM,"$15,000.00",$0.00,"$15,000.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$15,000.00",$0.00,"$7,500.00","$11,880.00","$12,000.00",$0.00,$0.00,$0.00,$0.00,$0.00
TH90G01,SUP,HCPCS C1787,,TH90G01  -  KIT STM NS LF PRX HNDST GU REUSE,"$4,875.00",$0.00,"$4,875.00",$0.00,"$3,479.29",$0.00,$0.00,$0.00,$0.00,$0.00,"$4,875.00",$0.00,"$2,437.50","$3,861.00","$3,900.00",$0.00,$0.00,$0.00,$0.00,$0.00
THD155024/2,SUP,HCPCS C1751,,THD155024/2  -  CATHETER CV STD 14.5FR 19CM HMGLD PRMCTH STAR,$437.50,$0.00,$437.50,$196.88,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
THD155028/3,SUP,HCPCS C1751,,THD155028/3  -  CATHETER CV STD 14.5FR 23CM HMGLD PRMCTH STAR,$437.50,$0.00,$437.50,$196.88,$312.24,$0.00,$75.38,$0.00,$0.00,$76.60,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$68.47,$0.00,$69.65,$0.00
THD155032,SUP,HCPCS C1750,,THD155032  -  SET CATH 32CM 15.5FR TTN HD 2 LUM HMDIAL,$475.00,$0.00,$475.00,$213.75,$339.01,$0.00,$81.84,$0.00,$0.00,$83.17,$475.00,$0.00,$237.50,$376.20,$380.00,$0.00,$74.34,$0.00,$75.62,$0.00
THD155036,SUP,HCPCS C1750,,THD155036  -  SET CATH 90D STRG 15.5FR 36CM TTN HD INTRO NDL GW DIL SCPL,$475.00,$0.00,$475.00,$213.75,$339.01,$0.00,$81.84,$0.00,$0.00,$83.17,$475.00,$0.00,$237.50,$376.20,$380.00,$0.00,$74.34,$0.00,$75.62,$0.00
THD155040,SUP,HCPCS C1750,,THD155040  -  SET CATH 90D STRG 15.5FR 40CM TTN HD INTRO NDL GW DIL SCPL,$475.00,$0.00,$475.00,$213.75,$339.01,$0.00,$81.84,$0.00,$0.00,$83.17,$475.00,$0.00,$237.50,$376.20,$380.00,$0.00,$74.34,$0.00,$75.62,$0.00
THD155055,SUP,HCPCS C1750,,THD155055  -  SET CATH 55CM 15.5FR TTN HD 2 LUM LTRM HMDIAL,$475.00,$0.00,$475.00,$213.75,$339.01,$0.00,$81.84,$0.00,$0.00,$83.17,$475.00,$0.00,$237.50,$376.20,$380.00,$0.00,$74.34,$0.00,$75.62,$0.00
THSF-35-145-AUS,SUP,HCPCS C1769,,THSF-35-145-AUS  -  GWIRE VASC .035IN 145CM 8CM STR FLX TP AMPTZ ULT STF SS PTFE,$59.45,$0.00,$59.45,$32.28,$42.43,$0.00,$10.24,$0.00,$0.00,$10.41,$59.45,$0.00,$29.73,$47.08,$47.56,$0.00,$9.30,$0.00,$9.46,$0.00
TKFV-2,SUP,Custom 27203010,,TKFV-2  -  CLAMP SURG MIC 2 DISP 15GM GRN .2-1MM VN,"$1,787.50",$0.00,"$1,787.50",$0.00,"$1,275.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,787.50",$0.00,$893.75,"$1,415.70","$1,430.00",$0.00,$0.00,$0.00,$0.00,$0.00
TKMV-1,SUP,Custom 27203010,,TKMV-1  -  CLAMP SURG 30GM/SQ MM MEDIUM HEMISPHERE BIOVER POLYCARBONATE,$87.50,$0.00,$87.50,$0.00,$62.45,$0.00,$0.00,$0.00,$0.00,$0.00,$87.50,$0.00,$43.75,$69.30,$70.00,$0.00,$0.00,$0.00,$0.00,$0.00
TKMV-2,SUP,Custom 27203010,,TKMV-2  -  CLAMP SRG 30GM/SQ MM MED HMSPHR BIOVER 2 PLYCRB VN,$162.50,$0.00,$162.50,$0.00,$115.98,$0.00,$0.00,$0.00,$0.00,$0.00,$162.50,$0.00,$81.25,$128.70,$130.00,$0.00,$0.00,$0.00,$0.00,$0.00
TKS100,SUP,Custom 27203010,,TKS100  -  TUBING SCT STRL NEURO,$22.73,$0.00,$23.76,$0.00,$16.96,$0.00,$0.00,$0.00,$0.00,$0.00,$23.76,$0.00,$11.88,$18.00,$19.01,$0.00,$0.00,$0.00,$0.00,$0.00
TN30MCD,SUP,Custom 27203010,,TN30MCD  -  BURR SURG 3MM MATCH FLUTED DIAMOND COARSE TRANSNASAL STERILE,$904.50,$0.00,$904.50,$0.00,$645.54,$0.00,$0.00,$0.00,$0.00,$0.00,$904.50,$0.00,$452.25,$716.36,$723.60,$0.00,$0.00,$0.00,$0.00,$0.00
TN30MFL,SUP,Custom 27203010,,TN30MFL  -  BURR SURG 3MM MATCH FLUTED TRANSNASAL STERILE,$904.50,$0.00,$904.50,$0.00,$645.54,$0.00,$0.00,$0.00,$0.00,$0.00,$904.50,$0.00,$452.25,$716.36,$723.60,$0.00,$0.00,$0.00,$0.00,$0.00
TN7115,SUP,Custom 27203010,,PROCESSOR TISS PREPRC SOL TSTK XP,$147.50,$0.00,$147.50,$0.00,$105.27,$0.00,$0.00,$0.00,$0.00,$0.00,$147.50,$0.00,$73.75,$116.82,$118.00,$0.00,$0.00,$0.00,$0.00,$0.00
TN7120,SUP,Custom 27203010,,FIXATIVE TSTK XP 3.8L MOL HISTOLGY,$111.25,$0.00,$111.25,$0.00,$79.40,$0.00,$0.00,$0.00,$0.00,$0.00,$111.25,$0.00,$55.63,$88.11,$89.00,$0.00,$0.00,$0.00,$0.00,$0.00
TO-FTRT,SUP,Custom 27203010,,TO-FTRT  -  RTRCTR TOBY 2.5MM 4MM SM LG FNL SHOHN TNDN SHTH SURG,$908.38,$0.00,$908.38,$0.00,$648.31,$0.00,$0.00,$0.00,$0.00,$0.00,$908.38,$0.00,$454.19,$719.44,$726.70,$0.00,$0.00,$0.00,$0.00,$0.00
TP-14,SUP,HCPCS C1713,,TP-14  -  PEG FIX 2.5MM 14MM PTHRD,$175.00,$0.00,$175.00,$78.75,$124.90,$0.00,$30.15,$0.00,$0.00,$30.64,$175.00,$0.00,$87.50,$138.60,$140.00,$0.00,$27.39,$0.00,$27.86,$0.00
TP-16,SUP,HCPCS C1713,,TP-16  -  PEG 2.5MM 16MM LNG THRD,$175.00,$0.00,$175.00,$78.75,$124.90,$0.00,$30.15,$0.00,$0.00,$30.64,$175.00,$0.00,$87.50,$138.60,$140.00,$0.00,$27.39,$0.00,$27.86,$0.00
TP20,SUP,HCPCS C1713,,TP20  -  PEG FIXAT 2.5MM 20MM ORTH THRD,$175.00,$0.00,$175.00,$78.75,$124.90,$0.00,$30.15,$0.00,$0.00,$30.64,$175.00,$0.00,$87.50,$138.60,$140.00,$0.00,$27.39,$0.00,$27.86,$0.00
TP341-M01,SUP,Custom 27203010,,TP341-M01  -  2.0-2.5MM BROKEN SCREW HEAD,$562.50,$0.00,$562.50,$0.00,$401.46,$0.00,$0.00,$0.00,$0.00,$0.00,$562.50,$0.00,$281.25,$445.50,$450.00,$0.00,$0.00,$0.00,$0.00,$0.00
TP342-M01,SUP,Custom 27203010,,TP342-M01  -  TIP XTRT 2.5-4 MM BRKN SCR,$562.50,$0.00,$562.50,$0.00,$401.46,$0.00,$0.00,$0.00,$0.00,$0.00,$562.50,$0.00,$281.25,$445.50,$450.00,$0.00,$0.00,$0.00,$0.00,$0.00
TP343-M01,SUP,Custom 27203010,,TP343-M01  -  3.5-5.0MM BROKEN SCREW HEAD,$562.50,$0.00,$562.50,$0.00,$401.46,$0.00,$0.00,$0.00,$0.00,$0.00,$562.50,$0.00,$281.25,$445.50,$450.00,$0.00,$0.00,$0.00,$0.00,$0.00
TP344-M01,SUP,Custom 27203010,,TP344-M01  -  4.5-6.0MM BROKEN SCREW HEAD,$562.50,$0.00,$562.50,$0.00,$401.46,$0.00,$0.00,$0.00,$0.00,$0.00,$562.50,$0.00,$281.25,$445.50,$450.00,$0.00,$0.00,$0.00,$0.00,$0.00
TP345-M01,SUP,Custom 27203010,,TP345-M01  -  5.5-7.0MM BROKEN SCREW HEAD,$562.50,$0.00,$562.50,$0.00,$401.46,$0.00,$0.00,$0.00,$0.00,$0.00,$562.50,$0.00,$281.25,$445.50,$450.00,$0.00,$0.00,$0.00,$0.00,$0.00
TP346-M01,SUP,Custom 27203010,,TP346-M01  -  7.0-8.0MM BROKEN SCREW HEAD,$562.50,$0.00,$562.50,$0.00,$401.46,$0.00,$0.00,$0.00,$0.00,$0.00,$562.50,$0.00,$281.25,$445.50,$450.00,$0.00,$0.00,$0.00,$0.00,$0.00
TP347-M01,SUP,Custom 27203010,,TP347-M01  -  2.0-2.5MM STRIPPED SCREW HEAD,$512.50,$0.00,$512.50,$0.00,$365.77,$0.00,$0.00,$0.00,$0.00,$0.00,$512.50,$0.00,$256.25,$405.90,$410.00,$0.00,$0.00,$0.00,$0.00,$0.00
TP348-M01,SUP,Custom 27203010,,TP348-M01  -  2.5-3.5MM STRIPPED SCREW HEAD,$512.50,$0.00,$512.50,$0.00,$365.77,$0.00,$0.00,$0.00,$0.00,$0.00,$512.50,$0.00,$256.25,$405.90,$410.00,$0.00,$0.00,$0.00,$0.00,$0.00
TP349-M01,SUP,Custom 27203010,,TP349-M01  -  3.5-4.5MM STRIPPED SCREW HEAD,$512.50,$0.00,$512.50,$0.00,$365.77,$0.00,$0.00,$0.00,$0.00,$0.00,$512.50,$0.00,$256.25,$405.90,$410.00,$0.00,$0.00,$0.00,$0.00,$0.00
TP350-M01,SUP,Custom 27203010,,TP350-M01  -  4.5-5.5MM STRIPPED SCREW HEAD,$512.50,$0.00,$512.50,$0.00,$365.77,$0.00,$0.00,$0.00,$0.00,$0.00,$512.50,$0.00,$256.25,$405.90,$410.00,$0.00,$0.00,$0.00,$0.00,$0.00
TP351-M01,SUP,Custom 27203010,,TP351-M01  -  5.0-6.5MM STRIPPED SCREW HEAD,$512.50,$0.00,$512.50,$0.00,$365.77,$0.00,$0.00,$0.00,$0.00,$0.00,$512.50,$0.00,$256.25,$405.90,$410.00,$0.00,$0.00,$0.00,$0.00,$0.00
TP352-M01,SUP,Custom 27203010,,TP352-M01  -  6.0-7.0MM STRIPPED SCREW HEAD,$512.50,$0.00,$512.50,$0.00,$365.77,$0.00,$0.00,$0.00,$0.00,$0.00,$512.50,$0.00,$256.25,$405.90,$410.00,$0.00,$0.00,$0.00,$0.00,$0.00
TPEG-14,SUP,HCPCS C1713,,TPEG-14  -  PEG FIX 14MM THREAD LOCK TORX WRIST VOLAR,$262.50,$0.00,$262.50,$118.13,$187.35,$0.00,$45.23,$0.00,$0.00,$45.96,$262.50,$0.00,$131.25,$207.90,$210.00,$0.00,$41.08,$0.00,$41.79,$0.00
TPEG-16,SUP,HCPCS C1713,,TPEG-16  -  PEG FIX 16MM THREAD LOCK TORX WRIST VOLAR,$262.50,$0.00,$262.50,$118.13,$187.35,$0.00,$45.23,$0.00,$0.00,$45.96,$262.50,$0.00,$131.25,$207.90,$210.00,$0.00,$41.08,$0.00,$41.79,$0.00
TPEG-18,SUP,HCPCS C1713,,TPEG-18  -  PEG FIX 18MM THREAD LOCK TORX WRIST VOLAR,$262.50,$0.00,$262.50,$118.13,$187.35,$0.00,$45.23,$0.00,$0.00,$45.96,$262.50,$0.00,$131.25,$207.90,$210.00,$0.00,$41.08,$0.00,$41.79,$0.00
TPEG-20,SUP,HCPCS C1713,,TPEG-20  -  PEG FIX 20MM THREAD LOCK TORX WRIST VOLAR,$262.50,$0.00,$262.50,$118.13,$187.35,$0.00,$45.23,$0.00,$0.00,$45.96,$262.50,$0.00,$131.25,$207.90,$210.00,$0.00,$41.08,$0.00,$41.79,$0.00
TPEG-22,SUP,HCPCS C1713,,TPEG-22  -  PEG FIX 22MM THREAD LOCK TORX WRIST VOLAR,$262.50,$0.00,$262.50,$118.13,$187.35,$0.00,$45.23,$0.00,$0.00,$45.96,$262.50,$0.00,$131.25,$207.90,$210.00,$0.00,$41.08,$0.00,$41.79,$0.00
TPEG-24,SUP,HCPCS C1713,,TPEG-24  -  PEG FIX 24MM THREAD LOCK TORX WRIST VOLAR,$262.50,$0.00,$262.50,$118.13,$187.35,$0.00,$45.23,$0.00,$0.00,$45.96,$262.50,$0.00,$131.25,$207.90,$210.00,$0.00,$41.08,$0.00,$41.79,$0.00
TPEG-28,SUP,HCPCS C1713,,TPEG-28  -  PEG FIX 28MM THREAD LOCK TORX WRIST VOLAR,$262.50,$0.00,$262.50,$118.13,$187.35,$0.00,$45.23,$0.00,$0.00,$45.96,$262.50,$0.00,$131.25,$207.90,$210.00,$0.00,$41.08,$0.00,$41.79,$0.00
TPLS-23100-TS,SUP,HCPCS C1713,,TPLS-23100-TS  -  PEG FX 2.3MM 10MM NS GEMINUS THRD LCK TI DIST VOLR RDS FOSSA,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
TPLS-23120-TS,SUP,HCPCS C1713,,TPLS-23120-TS  -  PEG FX 2.3MM 12MM NS GEMINUS THRD LCK TI DIST VOLR RDS FOSSA,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
TPLS-23140-TS,SUP,HCPCS C1713,,TPLS-23140-TS  -  PEG FX 2.3MM 14MM NS GEMINUS THRD LCK TI DIST VOLR RDS FOSSA,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
TPLS-23160-TS,SUP,HCPCS C1713,,TPLS-23160-TS  -  PEG FX 2.3MM 16MM NS GEMINUS THRD LCK TI DIST VOLR RDS FOSSA,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
TPLS-23170-TS,SUP,HCPCS C1713,,TPLS-23170-TS  -  PEG FX 2.3MM 17MM NS GEMINUS THRD LCK TI DIST VOLR RDS FOSSA,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
TPLS-23180-TS,SUP,HCPCS C1713,,TPLS-23180-TS  -  PEG FIX 2.3MM 18MM THREADED LOCKING GEMINUS TITANIUM DISTAL,$247.50,$0.00,$247.50,$111.38,$176.64,$0.00,$42.64,$0.00,$0.00,$43.34,$247.50,$0.00,$123.75,$196.02,$198.00,$0.00,$38.73,$0.00,$39.40,$0.00
TPLS-23190-TS,SUP,HCPCS C1713,,TPLS-23190-TS  -  PEG FX 2.3MM 19MM NS THRDLK TI GEMINUS VOLR PLT SYS,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
TPLS-23200-TS,SUP,HCPCS C1713,,TPLS-23200-TS  -  PEG FX 2.3MM 20MM NS GEMINUS THRD LCK TI DIST VOLR RDS FOSSA,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
TPLS-23210-TS,SUP,HCPCS C1713,,TPLS-23210-TS  -  PEG FX 2.3MM 21MM NS GEMINUS THRD LCK TI DIST VOLR RDS FOSSA,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
TPLS-23220-TS,SUP,HCPCS C1713,,TPLS-23220-TS  -  PEG FX 2.3MM 22MM NS GEMINUS THRD LCK TI DIST VOLR RDS FOSSA,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
TPLS-23230-TS,SUP,HCPCS C1713,,TPLS-23230-TS  -  PEG FX 2.3MM 23MM NS GEMINUS THRD LCK TI DIST VOLR RDS FOSSA,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
TPLS-23240-TS,SUP,HCPCS C1713,,TPLS-23240-TS  -  PEG FX 2.3MM 24MM NS GEMINUS THRD LCK TI DIST VOLR RDS FOSSA,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
TPLS-23260-TS,SUP,HCPCS C1713,,TPLS-23260-TS  -  PEG FX 2.3MM 26MM NS GEMINUS THRD LCK TI DIST VOLR RDS FOSSA,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
TPLS-23280-TS,SUP,HCPCS C1713,,TPLS-23280-TS  -  PEG FX 2.3MM 28MM NS GEMINUS THRD LCK TI DIST VOLR RDS FOSSA,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
TPLS-23300-TS,SUP,HCPCS C1713,,TPLS-23300-TS  -  PEG FX 2.3MM 30MM NS GEMINUS THRD LCK TI DIST VOLR RDS FOSSA,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
TPLS-23320-TS,SUP,HCPCS C1713,,TPLS-23320-TS  -  PEG FX 2.3MM 32MM NS GEMINUS THRD LCK TI DIST VOLR RDS FOSSA,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
TPM002U,SUP,HCPCS C1786,,TPM002U  -  REPLY SR,"$6,962.50",$0.00,"$6,962.50",$0.00,"$4,969.14",$0.00,$0.00,$0.00,$0.00,$0.00,"$6,962.50",$0.00,"$3,481.25","$5,514.30","$5,570.00",$0.00,$0.00,$0.00,$0.00,$0.00
TPM002U SYSTEM,SUP,HCPCS C1786,,TPM002U SYSTEM  -  REPLY SR SYSTEM,"$8,205.00",$0.00,"$8,205.00",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$8,205.00",$0.00,"$4,102.50","$6,498.36","$6,564.00",$0.00,$0.00,$0.00,$0.00,$0.00
TPNL-27100-TS,SUP,HCPCS C1713,,TPNL-27100-TS  -  PEG FX 2.7MM 10MM NS GEMINUS THRD NLCKG TI DIST VOLR RDS,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
TPNL-27120-TS,SUP,HCPCS C1713,,TPNL-27120-TS  -  PEG FX 2.7MM 12MM NS GEMINUS THRD NLCKG TI DIST VOLR RDS,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
TPNL-27140-TS,SUP,HCPCS C1713,,TPNL-27140-TS  -  PEG FX 2.7MM 14MM NS GEMINUS THRD NLCKG TI DIST VOLR RDS,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
TPNL-27160-TS,SUP,HCPCS C1713,,TPNL-27160-TS  -  PEG FX 2.7MM 16MM NS GEMINUS THRD NLCKG TI DIST VOLR RDS,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
TPNL-27180-TS,SUP,HCPCS C1713,,TPNL-27180-TS  -  PEG FX 2.7MM 18MM NS GEMINUS THRD NLCKG TI DIST VOLR RDS,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
TPNL-27200-TS,SUP,HCPCS C1713,,TPNL-27200-TS  -  PEG FIX 2.7MM 20MM THREADED NONLOCKING GEMINUS TITANIUM,$247.50,$0.00,$247.50,$111.38,$176.64,$0.00,$42.64,$0.00,$0.00,$43.34,$247.50,$0.00,$123.75,$196.02,$198.00,$0.00,$38.73,$0.00,$39.40,$0.00
TPNL-27220-TS,SUP,HCPCS C1713,,TPNL-27220-TS  -  PEG FIX 2.7MM 22MM THREADED NONLOCKING GEMINUS TITANIUM,$247.50,$0.00,$247.50,$111.38,$176.64,$0.00,$42.64,$0.00,$0.00,$43.34,$247.50,$0.00,$123.75,$196.02,$198.00,$0.00,$38.73,$0.00,$39.40,$0.00
TPNL-27240-TS,SUP,HCPCS C1713,,TPNL-27240-TS  -  PEG FX 2.7MM 24MM NS GEMINUS THRD NLCKG TI DIST VOLR RDS,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
TPNL-27260-TS,SUP,HCPCS C1713,,TPNL-27260-TS  -  PEG FX 2.7MM 26MM NS GEMINUS THRD NLCKG TI DIST VOLR RDS,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
TPNL-27280-TS,SUP,HCPCS C1713,,TPNL-27280-TS  -  PEG FX 2.7MM 28MM NS GEMINUS THRD NLCKG TI DIST VOLR RDS,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
TPNL-27300-TS,SUP,HCPCS C1713,,TPNL-27300-TS  -  PEG FX 2.7MM 30MM NS GEMINUS THRD NLCKG TI DIST VOLR RDS,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
TPNL-27320-TS,SUP,HCPCS C1713,,TPNL-27320-TS  -  PEG FX 2.7MM 32MM NS GEMINUS THRD NLCKG TI DIST VOLR RDS,$217.50,$0.00,$217.50,$97.88,$155.23,$0.00,$37.47,$0.00,$0.00,$38.08,$217.50,$0.00,$108.75,$172.26,$174.00,$0.00,$34.04,$0.00,$34.63,$0.00
TPT1000,SUP,Custom 27203010,,TRAY DRAIN 4.75IN 8FR 15GA PU NDL THOR PARA 1.5IN STRL LTX,$75.25,$0.00,$75.25,$0.00,$53.71,$0.00,$0.00,$0.00,$0.00,$0.00,$75.25,$0.00,$37.63,$59.60,$60.20,$0.00,$0.00,$0.00,$0.00,$0.00
TR-H200L-S,SUP,HCPCS C1776,,TR-H200L-S  -  HEAD RADL 20MM LEFT ELB,"$6,015.00",$0.00,"$6,015.00","$2,706.75","$4,292.91",$0.00,"$1,036.35",$0.00,$0.00,"$1,053.18","$6,015.00",$0.00,"$3,007.50","$4,763.88","$4,812.00",$0.00,$941.35,$0.00,$957.59,$0.00
TR-H200R-S,SUP,HCPCS C1776,,TR-H200R-S  -  HEAD RADL 4D 20MM RT ELB,"$6,015.00",$0.00,"$6,015.00","$2,706.75","$4,292.91",$0.00,"$1,036.35",$0.00,$0.00,"$1,053.18","$6,015.00",$0.00,"$3,007.50","$4,763.88","$4,812.00",$0.00,$941.35,$0.00,$957.59,$0.00
TR-H220L-S,SUP,HCPCS C1776,,TR-H220L-S  -  HEAD RADL ANG 22MM STRL ACUMED ARH ANTM ELB LT,"$6,015.00",$0.00,"$6,015.00","$2,706.75","$4,292.91",$0.00,"$1,036.35",$0.00,$0.00,"$1,053.18","$6,015.00",$0.00,"$3,007.50","$4,763.88","$4,812.00",$0.00,$941.35,$0.00,$957.59,$0.00
TR-H220R-S,SUP,HCPCS C1776,,TR-H220R-S  -  HEAD RADL 22MM RT,"$6,015.00",$0.00,"$6,015.00","$2,706.75","$4,292.91",$0.00,"$1,036.35",$0.00,$0.00,"$1,053.18","$6,015.00",$0.00,"$3,007.50","$4,763.88","$4,812.00",$0.00,$941.35,$0.00,$957.59,$0.00
TR-H240R-S,SUP,HCPCS C1776,,TR-H240R-S  -  HEAD RADL ANG 24MM STRL ACUMED ARH ANTM ELB RT,"$6,015.00",$0.00,"$6,015.00","$2,706.75","$4,292.91",$0.00,"$1,036.35",$0.00,$0.00,"$1,053.18","$6,015.00",$0.00,"$3,007.50","$4,763.88","$4,812.00",$0.00,$941.35,$0.00,$957.59,$0.00
TR-H260L-S,SUP,HCPCS C1776,,TR-H260L-S  -  HEAD RADL ANG 26MM STRL ACUMED ARH ANTM ELB LT,"$6,015.00",$0.00,"$6,015.00","$2,706.75","$4,292.91",$0.00,"$1,036.35",$0.00,$0.00,"$1,053.18","$6,015.00",$0.00,"$3,007.50","$4,763.88","$4,812.00",$0.00,$941.35,$0.00,$957.59,$0.00
TR-H260R-S,SUP,HCPCS C1776,,TR-H260R-S  -  HEAD RADL 26MM 4D RIGHT ANTM STRL,"$6,015.00",$0.00,"$6,015.00","$2,706.75","$4,292.91",$0.00,"$1,036.35",$0.00,$0.00,"$1,053.18","$6,015.00",$0.00,"$3,007.50","$4,763.88","$4,812.00",$0.00,$941.35,$0.00,$957.59,$0.00
TR-H280L-S,SUP,HCPCS C1776,,TR-H280L-S  -  HEAD RADL 28MM ACUMED LEFT ELB TOT STRL,"$6,015.00",$0.00,"$6,015.00","$2,706.75","$4,292.91",$0.00,"$1,036.35",$0.00,$0.00,"$1,053.18","$6,015.00",$0.00,"$3,007.50","$4,763.88","$4,812.00",$0.00,$941.35,$0.00,$957.59,$0.00
TR-H280R-S,SUP,HCPCS C1776,,TR-H280R-S  -  HEAD RADL 28MM STRL RT,"$6,015.00",$0.00,"$6,015.00","$2,706.75","$4,292.91",$0.00,"$1,036.35",$0.00,$0.00,"$1,053.18","$6,015.00",$0.00,"$3,007.50","$4,763.88","$4,812.00",$0.00,$941.35,$0.00,$957.59,$0.00
TR-S0600-S,SUP,HCPCS C1776,,TR-S0600-S  -  STEM RADL 0MM 6MM STRL,"$3,610.00",$0.00,"$3,610.00","$1,624.50","$2,576.46",$0.00,$621.98,$0.00,$0.00,$632.08,"$3,610.00",$0.00,"$1,805.00","$2,859.12","$2,888.00",$0.00,$564.97,$0.00,$574.71,$0.00
TR-S0602-S,SUP,HCPCS C1776,,TR-S0602-S  -  STEM RADL 2MM 6MM STRL,"$3,610.00",$0.00,"$3,610.00","$1,624.50","$2,576.46",$0.00,$621.98,$0.00,$0.00,$632.08,"$3,610.00",$0.00,"$1,805.00","$2,859.12","$2,888.00",$0.00,$564.97,$0.00,$574.71,$0.00
TR-S0604-S,SUP,HCPCS C1776,,TR-S0604-S  -  STEM RADL 4MM 6MM STRL,"$3,610.00",$0.00,"$3,610.00","$1,624.50","$2,576.46",$0.00,$621.98,$0.00,$0.00,$632.08,"$3,610.00",$0.00,"$1,805.00","$2,859.12","$2,888.00",$0.00,$564.97,$0.00,$574.71,$0.00
TR-S0606-S,SUP,Custom 27203010,,TR-S0606-S  -  BNDG NUSTIMWRAP 36X2.5IN CMPR,"$3,610.00",$0.00,"$3,610.00",$0.00,"$2,576.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,610.00",$0.00,"$1,805.00","$2,859.12","$2,888.00",$0.00,$0.00,$0.00,$0.00,$0.00
TR-S0608-S,SUP,HCPCS C1776,,TR-S0608-S  -  STEM RADL 6MM 8MM STRL,"$3,610.00",$0.00,"$3,610.00","$1,624.50","$2,576.46",$0.00,$621.98,$0.00,$0.00,$632.08,"$3,610.00",$0.00,"$1,805.00","$2,859.12","$2,888.00",$0.00,$564.97,$0.00,$574.71,$0.00
TR-S0700-S,SUP,HCPCS C1776,,TR-S0700-S  -  STEM RADL 0MM 7MM ELB,"$3,610.00",$0.00,"$3,610.00","$1,624.50","$2,576.46",$0.00,$621.98,$0.00,$0.00,$632.08,"$3,610.00",$0.00,"$1,805.00","$2,859.12","$2,888.00",$0.00,$564.97,$0.00,$574.71,$0.00
TR-S0702-S,SUP,HCPCS C1776,,TR-S0702-S  -  STEM RADL 2MM 7MM STRL,"$3,610.00",$0.00,"$3,610.00","$1,624.50","$2,576.46",$0.00,$621.98,$0.00,$0.00,$632.08,"$3,610.00",$0.00,"$1,805.00","$2,859.12","$2,888.00",$0.00,$564.97,$0.00,$574.71,$0.00
TR-S0704-S,SUP,HCPCS C1776,,TR-S0704-S  -  STEM RADL 7MM 4MM ELB TOT STRL,"$3,610.00",$0.00,"$3,610.00","$1,624.50","$2,576.46",$0.00,$621.98,$0.00,$0.00,$632.08,"$3,610.00",$0.00,"$1,805.00","$2,859.12","$2,888.00",$0.00,$564.97,$0.00,$574.71,$0.00
TR-S0706-S,SUP,HCPCS C1776,,TR-S0706-S  -  STEM RADL 7MM 6MM,"$3,610.00",$0.00,"$3,610.00","$1,624.50","$2,576.46",$0.00,$621.98,$0.00,$0.00,$632.08,"$3,610.00",$0.00,"$1,805.00","$2,859.12","$2,888.00",$0.00,$564.97,$0.00,$574.71,$0.00
TR-S0708-S,SUP,HCPCS C1776,,TR-S0708-S  -  STEM RADL 8MM 7MM ELB TOT STRL,"$3,610.00",$0.00,"$3,610.00","$1,624.50","$2,576.46",$0.00,$621.98,$0.00,$0.00,$632.08,"$3,610.00",$0.00,"$1,805.00","$2,859.12","$2,888.00",$0.00,$564.97,$0.00,$574.71,$0.00
TR-S0800-S,SUP,HCPCS C1776,,TR-S0800-S  -  STEM RADL 8MM 4MM ELB TI HEAD TOT STRL,"$3,610.00",$0.00,"$3,610.00","$1,624.50","$2,576.46",$0.00,$621.98,$0.00,$0.00,$632.08,"$3,610.00",$0.00,"$1,805.00","$2,859.12","$2,888.00",$0.00,$564.97,$0.00,$574.71,$0.00
TR-S0802-S,SUP,HCPCS C1776,,TR-S0802-S  -  STEM RADL 8MM 2MM ELB HEAD STRL,"$3,610.00",$0.00,"$3,610.00","$1,624.50","$2,576.46",$0.00,$621.98,$0.00,$0.00,$632.08,"$3,610.00",$0.00,"$1,805.00","$2,859.12","$2,888.00",$0.00,$564.97,$0.00,$574.71,$0.00
TR-S0804-S,SUP,HCPCS C1776,,TR-S0804-S  -  STEM RADL 4MM 8MM ELB TI HEAD STRL,"$3,610.00",$0.00,"$3,610.00","$1,624.50","$2,576.46",$0.00,$621.98,$0.00,$0.00,$632.08,"$3,610.00",$0.00,"$1,805.00","$2,859.12","$2,888.00",$0.00,$564.97,$0.00,$574.71,$0.00
TR-S0806-S,SUP,HCPCS C1776,,TR-S0806-S  -  STEM RADL 6MM 8MM HEAD,"$3,610.00",$0.00,"$3,610.00","$1,624.50","$2,576.46",$0.00,$621.98,$0.00,$0.00,$632.08,"$3,610.00",$0.00,"$1,805.00","$2,859.12","$2,888.00",$0.00,$564.97,$0.00,$574.71,$0.00
TR-S0808-S,SUP,HCPCS C1776,,TR-S0808-S  -  STEM RADL 8MM 8MM ELB TOT STRL,"$3,610.00",$0.00,"$3,610.00","$1,624.50","$2,576.46",$0.00,$621.98,$0.00,$0.00,$632.08,"$3,610.00",$0.00,"$1,805.00","$2,859.12","$2,888.00",$0.00,$564.97,$0.00,$574.71,$0.00
TR-S0900-S,SUP,HCPCS C1776,,TR-S0900-S  -  STEM RADL 0MM 9MM STRL,"$3,610.00",$0.00,"$3,610.00","$1,624.50","$2,576.46",$0.00,$621.98,$0.00,$0.00,$632.08,"$3,610.00",$0.00,"$1,805.00","$2,859.12","$2,888.00",$0.00,$564.97,$0.00,$574.71,$0.00
TR-S0902-S,SUP,HCPCS C1776,,TR-S0902-S  -  STEM RADL 9MM 2MM ELB SYS STRL,"$3,610.00",$0.00,"$3,610.00","$1,624.50","$2,576.46",$0.00,$621.98,$0.00,$0.00,$632.08,"$3,610.00",$0.00,"$1,805.00","$2,859.12","$2,888.00",$0.00,$564.97,$0.00,$574.71,$0.00
TR-S0904-S,SUP,HCPCS C1776,,TR-S0904-S  -  STEM RADL 9MM 4MM ELB TOT STRL,"$3,610.00",$0.00,"$3,610.00","$1,624.50","$2,576.46",$0.00,$621.98,$0.00,$0.00,$632.08,"$3,610.00",$0.00,"$1,805.00","$2,859.12","$2,888.00",$0.00,$564.97,$0.00,$574.71,$0.00
TR-S0906-S,SUP,HCPCS C1776,,TR-S0906-S  -  STEM RADL 9MM 6MM TI STRL,"$3,610.00",$0.00,"$3,610.00","$1,624.50","$2,576.46",$0.00,$621.98,$0.00,$0.00,$632.08,"$3,610.00",$0.00,"$1,805.00","$2,859.12","$2,888.00",$0.00,$564.97,$0.00,$574.71,$0.00
TR-S0908-S,SUP,HCPCS C1776,,TR-S0908-S  -  STEM RADL 9MM 8MM ELB STRL,"$3,610.00",$0.00,"$3,610.00","$1,624.50","$2,576.46",$0.00,$621.98,$0.00,$0.00,$632.08,"$3,610.00",$0.00,"$1,805.00","$2,859.12","$2,888.00",$0.00,$564.97,$0.00,$574.71,$0.00
TR-S1000-S,SUP,HCPCS C1776,,TR-S1000-S  -  STEM RADL 0MM 10MM STRL,"$3,610.00",$0.00,"$3,610.00","$1,624.50","$2,576.46",$0.00,$621.98,$0.00,$0.00,$632.08,"$3,610.00",$0.00,"$1,805.00","$2,859.12","$2,888.00",$0.00,$564.97,$0.00,$574.71,$0.00
TR-S1002-S,SUP,HCPCS C1776,,TR-S1002-S  -  STEM RADL 2MM 10MM STRL ELB,"$3,610.00",$0.00,"$3,610.00","$1,624.50","$2,576.46",$0.00,$621.98,$0.00,$0.00,$632.08,"$3,610.00",$0.00,"$1,805.00","$2,859.12","$2,888.00",$0.00,$564.97,$0.00,$574.71,$0.00
TR-S1004-S,SUP,HCPCS C1776,,TR-S1004-S  -  STEM RADL 4MM 10MM STRL,"$3,610.00",$0.00,"$3,610.00","$1,624.50","$2,576.46",$0.00,$621.98,$0.00,$0.00,$632.08,"$3,610.00",$0.00,"$1,805.00","$2,859.12","$2,888.00",$0.00,$564.97,$0.00,$574.71,$0.00
TR-S1006-S,SUP,Custom 27203010,,TR-S1006-S  -  BNDG NUSTIMWRAP 36X6IN CMPR,"$3,610.00",$0.00,"$3,610.00",$0.00,"$2,576.46",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,610.00",$0.00,"$1,805.00","$2,859.12","$2,888.00",$0.00,$0.00,$0.00,$0.00,$0.00
TR-S1008-S,SUP,HCPCS C1776,,TR-S1008-S  -  STEM RADL 10MM 8MM 8MM TR ELB TI STRL,"$3,610.00",$0.00,"$3,610.00","$1,624.50","$2,576.46",$0.00,$621.98,$0.00,$0.00,$632.08,"$3,610.00",$0.00,"$1,805.00","$2,859.12","$2,888.00",$0.00,$564.97,$0.00,$574.71,$0.00
TRX2.3-10,SUP,HCPCS C1713,,TRX2.3-10  -  SCREW BONE 2.3MM 10MM ANKLE CORTICAL,$225.00,$0.00,$225.00,$101.25,$160.58,$0.00,$38.77,$0.00,$0.00,$39.40,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$35.21,$0.00,$35.82,$0.00
TRX2.3-12,SUP,HCPCS C1713,,TRX2.3-12  -  SCREW BONE 2.3MM 12MM ANKLE CORTICAL,$225.00,$0.00,$225.00,$101.25,$160.58,$0.00,$38.77,$0.00,$0.00,$39.40,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$35.21,$0.00,$35.82,$0.00
TRX2.3-14,SUP,HCPCS C1713,,TRX2.3-14  -  SCREW BONE 2.3MM 14MM ANKLE CORTICAL,$225.00,$0.00,$225.00,$101.25,$160.58,$0.00,$38.77,$0.00,$0.00,$39.40,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$35.21,$0.00,$35.82,$0.00
TRX2.3-16,SUP,HCPCS C1713,,TRX2.3-16  -  SCREW BONE 2.3MM 16MM ANKLE CORTICAL,$225.00,$0.00,$225.00,$101.25,$160.58,$0.00,$38.77,$0.00,$0.00,$39.40,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$35.21,$0.00,$35.82,$0.00
TRX2.3-18,SUP,HCPCS C1713,,TRX2.3-18  -  SCREW BONE 2.3MM 18MM ANKLE CORTICAL,$225.00,$0.00,$225.00,$101.25,$160.58,$0.00,$38.77,$0.00,$0.00,$39.40,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$35.21,$0.00,$35.82,$0.00
TRX2.3-20,SUP,HCPCS C1713,,TRX2.3-20  -  SCREW BONE 2.3MM 20MM CORTICAL,$225.00,$0.00,$225.00,$101.25,$160.58,$0.00,$38.77,$0.00,$0.00,$39.40,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$35.21,$0.00,$35.82,$0.00
TRX2.3-22,SUP,HCPCS C1713,,TRX2.3-22  -  SCREW BONE 2.3MM 22MM ANKLE CORTICAL,$225.00,$0.00,$225.00,$101.25,$160.58,$0.00,$38.77,$0.00,$0.00,$39.40,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$35.21,$0.00,$35.82,$0.00
TRX2.3-24,SUP,HCPCS C1713,,TRX2.3-24  -  SCREW BONE 2.3MM 24MM ANKLE CORTICAL,$225.00,$0.00,$225.00,$101.25,$160.58,$0.00,$38.77,$0.00,$0.00,$39.40,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$35.21,$0.00,$35.82,$0.00
TRX2.3-26,SUP,HCPCS C1713,,TRX2.3-26  -  SCREW BONE 2.3MM 26MM ANKLE CORTICAL,$225.00,$0.00,$225.00,$101.25,$160.58,$0.00,$38.77,$0.00,$0.00,$39.40,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$35.21,$0.00,$35.82,$0.00
TRX2.3-28,SUP,HCPCS C1713,,TRX2.3-28  -  SCREW BONE 2.3MM 28MM CORTICAL,$225.00,$0.00,$225.00,$101.25,$160.58,$0.00,$38.77,$0.00,$0.00,$39.40,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$35.21,$0.00,$35.82,$0.00
TRX2.3-30,SUP,HCPCS C1713,,TRX2.3-30  -  SCREW BONE 2.3MM 30MM CORTICAL,$225.00,$0.00,$225.00,$101.25,$160.58,$0.00,$38.77,$0.00,$0.00,$39.40,$225.00,$0.00,$112.50,$178.20,$180.00,$0.00,$35.21,$0.00,$35.82,$0.00
TS101DC,SUP,Custom 27203010,,TS101DC  -  SET TBG DIEGO ELT DECLOG,$117.64,$0.00,$117.64,$0.00,$83.96,$0.00,$0.00,$0.00,$0.00,$0.00,$117.64,$0.00,$58.82,$93.17,$94.11,$0.00,$0.00,$0.00,$0.00,$0.00
TT12,SUP,Custom 27203010,,TT12  -  TUBE LEGEND 12CM T12 TELE STRAIGHT,"$1,486.25",$0.00,"$1,486.25",$0.00,"$1,060.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,486.25",$0.00,$743.13,"$1,177.11","$1,189.00",$0.00,$0.00,$0.00,$0.00,$0.00
TT12A,SUP,Custom 27203010,,TT12A  -  TUBE LEGEND 12CM T12 TELE ANGLED,"$1,486.25",$0.00,"$1,486.25",$0.00,"$1,060.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,486.25",$0.00,$743.13,"$1,177.11","$1,189.00",$0.00,$0.00,$0.00,$0.00,$0.00
TT12C,SUP,Custom 27203010,,TT12C  -  TUBE LEGEND 12CM T12 TELE CURVED,"$1,486.25",$0.00,"$1,486.25",$0.00,"$1,060.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,486.25",$0.00,$743.13,"$1,177.11","$1,189.00",$0.00,$0.00,$0.00,$0.00,$0.00
TT12F,SUP,Custom 27203010,,TT12F  -  TUBE LEGEND 12CM T12 TELE CURVED,"$1,486.25",$0.00,"$1,486.25",$0.00,"$1,060.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,486.25",$0.00,$743.13,"$1,177.11","$1,189.00",$0.00,$0.00,$0.00,$0.00,$0.00
TT14A,SUP,Custom 27203010,,TT14A  -  TUBE LEGEND 14CM T14 TELE ANGLED,"$1,590.80",$0.00,"$1,590.80",$0.00,"$1,135.35",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,590.80",$0.00,$795.40,"$1,259.91","$1,272.64",$0.00,$0.00,$0.00,$0.00,$0.00
TT15,SUP,Custom 27203010,,TT15  -  TUBE LEGEND 15CM T15 TELE STRAIGHT,"$1,521.10",$0.00,"$1,521.10",$0.00,"$1,085.61",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,521.10",$0.00,$760.55,"$1,204.71","$1,216.88",$0.00,$0.00,$0.00,$0.00,$0.00
TT15H,SUP,Custom 27203010,,TT15H  -  TUBE LEGEND 15CM T15 TELE HOODED,"$2,144.30",$0.00,"$2,144.30",$0.00,"$1,530.39",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,144.30",$0.00,"$1,072.15","$1,698.29","$1,715.44",$0.00,$0.00,$0.00,$0.00,$0.00
TT17,SUP,Custom 27203010,,TT17  -  TUBE LEGEND 17CM T17 TELE STRAIGHT,"$1,596.95",$0.00,"$1,596.95",$0.00,"$1,139.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,596.95",$0.00,$798.48,"$1,264.78","$1,277.56",$0.00,$0.00,$0.00,$0.00,$0.00
TT18H,SUP,Custom 27203010,,TT18H  -  TUBE LEGEND 18CM T18 TELE HOODED,"$2,207.85",$0.00,"$2,207.85",$0.00,"$1,575.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,207.85",$0.00,"$1,103.93","$1,748.62","$1,766.28",$0.00,$0.00,$0.00,$0.00,$0.00
TT9,SUP,Custom 27203010,,TT9  -  TUBE LEGEND 9CM T9 TELE STRAIGHT,"$1,250.50",$0.00,"$1,250.50",$0.00,$892.48,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,250.50",$0.00,$625.25,$990.40,"$1,000.40",$0.00,$0.00,$0.00,$0.00,$0.00
TT9C,SUP,Custom 27203010,,TT9C  -  TUBE LEGEND 9CM T9 TELE CURVED,"$1,330.45",$0.00,"$1,330.45",$0.00,$949.54,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,330.45",$0.00,$665.23,"$1,053.72","$1,064.36",$0.00,$0.00,$0.00,$0.00,$0.00
TU1101,SUP,Custom 27203010,,CONTROL MLANLT TMKR LVL 1 ASY 3ML IMMUN,$83.33,$0.00,$83.33,$0.00,$59.47,$0.00,$0.00,$0.00,$0.00,$0.00,$83.33,$0.00,$41.66,$66.00,$66.66,$0.00,$0.00,$0.00,$0.00,$0.00
TU2202,SUP,Custom 27203010,,CONTROL MLANLT TMKR LVL 2 ASY 3ML IMMUN,$83.33,$0.00,$83.33,$0.00,$59.47,$0.00,$0.00,$0.00,$0.00,$0.00,$83.33,$0.00,$41.66,$66.00,$66.66,$0.00,$0.00,$0.00,$0.00,$0.00
TU3303,SUP,Custom 27203010,,CONTROL MLANLT TMKR LVL 3 ASY 3ML IMMUN,$83.33,$0.00,$83.33,$0.00,$59.47,$0.00,$0.00,$0.00,$0.00,$0.00,$83.33,$0.00,$41.66,$66.00,$66.66,$0.00,$0.00,$0.00,$0.00,$0.00
TVI07,SUP,HCPCS C1894,,TVI07  -  TOOL INSERTION 7FR TRANSVALVULAR,$9.00,$0.00,$9.00,$4.89,$6.42,$0.00,$1.55,$0.00,$0.00,$1.58,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$1.41,$0.00,$1.43,$0.00
TVI-07,SUP,HCPCS C1894,,TVI-07  -  TOOL INSERTION 7FR TRANSVALVULAR,$9.00,$0.00,$9.00,$4.89,$6.42,$0.00,$1.55,$0.00,$0.00,$1.58,$9.00,$0.00,$4.50,$7.13,$7.20,$0.00,$1.41,$0.00,$1.43,$0.00
TVTRL,SUP,HCPCS C1771,,TVTRL  -  SLING GYNECOLOGICAL GYNECARE TVT SECUR STRESS URINARY,"$2,262.00",$0.00,"$2,262.00","$1,017.90","$1,614.39",$0.00,$389.73,$0.00,$0.00,$396.06,"$2,262.00",$0.00,"$1,131.00","$1,791.50","$1,809.60",$0.00,$354.00,$0.00,$360.11,$0.00
TW173016,SUP,Custom 27203010,,TW173016  -  ENDO STITCH 10 MM SUTURING DEVICE,$836.10,$0.00,$836.10,$0.00,$596.72,$0.00,$0.00,$0.00,$0.00,$0.00,$836.10,$0.00,$418.05,$662.19,$668.88,$0.00,$0.00,$0.00,$0.00,$0.00
TYPE 14C,SUP,HCPCS L8610,,RING FIXAT 24-28MM MORCHER 11-13MM CPSLR TNSN EXPANDABLE,$447.50,$0.00,$482.85,$201.38,$319.38,$0.00,$482.85,$0.00,$0.00,$78.35,$447.50,$0.00,$223.75,$354.42,$358.00,$0.00,$70.03,$0.00,$71.24,$0.00
U202H,SUP,Custom 27203010,,U202H  -  SUTURE ABSORBABLE 5-0 RB-1 27IN MONOFILAMENT CHROMIC,$299.02,$0.00,$299.02,$0.00,$213.41,$0.00,$0.00,$0.00,$0.00,$0.00,$299.02,$0.00,$149.51,$236.82,$239.22,$0.00,$0.00,$0.00,$0.00,$0.00
U2295-40,SUP,Custom 27203010,,STAIN TCHRM BLUE PRPK 500ML BHOSPHATE BUFF PRSTLGY,$537.15,$0.00,$537.15,$0.00,$383.36,$0.00,$0.00,$0.00,$0.00,$0.00,$537.15,$0.00,$268.58,$425.42,$429.72,$0.00,$0.00,$0.00,$0.00,$0.00
U2295-5,SUP,Custom 27203010,,STAIN TCHRM PRPK WHEATLEY 500ML PRSTLGY,$369.73,$0.00,$369.73,$0.00,$263.87,$0.00,$0.00,$0.00,$0.00,$0.00,$369.73,$0.00,$184.86,$292.83,$295.78,$0.00,$0.00,$0.00,$0.00,$0.00
U2316-2,SUP,Custom 27203010,,SLIDE GSTCLT GCB HMTLTST,$332.45,$0.00,$332.45,$0.00,$237.27,$0.00,$0.00,$0.00,$0.00,$0.00,$332.45,$0.00,$166.23,$263.30,$265.96,$0.00,$0.00,$0.00,$0.00,$0.00
UA1329-S,SUP,Custom 27203010,,UA1329-S  -  GUIDE NEEDLE DUAL READY TO USE INDIVIDUALLY STERILE,$900.00,$0.00,$900.00,$0.00,$642.33,$0.00,$0.00,$0.00,$0.00,$0.00,$900.00,$0.00,$450.00,$712.80,$720.00,$0.00,$0.00,$0.00,$0.00,$0.00
UAB-260,SUP,Custom 27203010,,CONTROL MAS LVL 2 ABN 60ML UA,$56.25,$0.00,$56.25,$0.00,$40.15,$0.00,$0.00,$0.00,$0.00,$0.00,$56.25,$0.00,$28.13,$44.55,$45.00,$0.00,$0.00,$0.00,$0.00,$0.00
UFH-624-R,SUP,HCPCS C2617,,UFH-624-R  -  STENT URET 6FR 24CM W/O GWIRE SET TETH STRAIGHTENER RADIOPQ,$281.25,$0.00,$281.25,$152.72,$200.73,$0.00,$48.46,$0.00,$0.00,$49.24,$281.25,$0.00,$140.63,$222.75,$225.00,$0.00,$44.02,$0.00,$44.78,$0.00
UH1-36-22,SUP,Custom 27803010,,UH1-36-22  -  HEAD BIPOL 36MM 22MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-38-22,SUP,Custom 27803010,,UH1-38-22  -  HEAD BIPOL 38MM 22MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-40-22,SUP,Custom 27803010,,UH1-40-22  -  HEAD BIPOL UNIVERSAL 40MM 22MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-41-22,SUP,Custom 27803010,,UH1-41-22  -  HEAD BIPOL UNIVERSAL 41MM 22MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-41-26,SUP,Custom 27803010,,UH1-41-26  -  HEAD BIPOL UNIVERSAL 41MM 26MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-42-22,SUP,Custom 27803010,,UH1-42-22  -  HEAD BP UNV 42MM 22MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-42-26,SUP,Custom 27803010,,UH1-42-26  -  HEAD BIPOL UNIVERSAL 42MM 26MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-42-28,SUP,Custom 27803010,,UH1-42-28  -  HEAD BIPOL UNIVERSAL 42MM 28MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-43-22,SUP,Custom 27803010,,UH1-43-22  -  HEAD BIPOL UNIVERSAL 43MM 22MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-43-26,SUP,Custom 27803010,,UH1-43-26  -  HEAD BIPOL UNIVERSAL 43MM 26MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-44-22,SUP,Custom 27803010,,UH1-44-22  -  HEAD BIPOL UNIVERSAL 44MM 22MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-44-26,SUP,Custom 27803010,,UH1-44-26  -  HEAD BIPOL UNIVERSAL 44MM 26MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-44-28,SUP,Custom 27803010,,UH1-44-28  -  HEAD BIPOL UNIVERSAL 44MM 28MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-45-22,SUP,Custom 27803010,,UH1-45-22  -  HEAD BIPOL UNIVERSAL 45MM 22MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-45-26,SUP,Custom 27803010,,UH1-45-26  -  HEAD BIPOL UNIVERSAL 45MM 26MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-45-28,SUP,Custom 27803010,,UH1-45-28  -  HEAD BP 45MM 28MM UHR HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-46-22,SUP,Custom 27803010,,UH1-46-22  -  HEAD BIPOL UNIVERSAL 46MM 22MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-46-26,SUP,Custom 27803010,,UH1-46-26  -  HEAD BIPOL UNIVERSAL 46MM 26MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-46-28,SUP,Custom 27803010,,UH1-46-28  -  HEAD BIPOL UNIVERSAL 46MM 28MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-47-22,SUP,Custom 27803010,,UH1-47-22  -  HEAD BIPOL UNIVERSAL 47MM 22MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-47-26,SUP,Custom 27803010,,UH1-47-26  -  HEAD BIPOL UNIVERSAL 47MM 26MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-47-28,SUP,Custom 27803010,,UH1-47-28  -  HEAD BP UNV 47MM 28MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-48-22,SUP,Custom 27803010,,UH1-48-22  -  HEAD BIPOL UNIVERSAL 48MM 22MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-48-26,SUP,Custom 27803010,,UH1-48-26  -  HEAD BIPOL UNIVERSAL 48MM 26MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-48-28,SUP,Custom 27803010,,UH1-48-28  -  HEAD BP 48MM 28MM UHR HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-48-32,SUP,Custom 27803010,,UH1-48-32  -  HEAD BIPOL UNIVERSAL 48MM 32MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-49-22,SUP,Custom 27803010,,UH1-49-22  -  HEAD BIPOL UNIVERSAL 49MM 22MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-49-26,SUP,Custom 27803010,,UH1-49-26  -  HEAD BIPOL UNIVERSAL 49MM 26MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-49-28,SUP,Custom 27803010,,UH1-49-28  -  HEAD BIPOL UNIVERSAL 49MM 28MM UHR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-49-32,SUP,Custom 27803010,,UH1-49-32  -  HEAD BIPOL UNIVERSAL 49MM 32MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-50-22,SUP,Custom 27803010,,UH1-50-22  -  HEAD BIPOL UNIVERSAL 50MM 22MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-50-26,SUP,Custom 27803010,,UH1-50-26  -  HEAD BIPOL UNIVERSAL 50MM 26MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-50-28,SUP,Custom 27803010,,UH1-50-28  -  HEAD BIPOL UNIVERSAL 50MM 28MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-50-32,SUP,Custom 27803010,,UH1-50-32  -  HEAD BIPOL UNIVERSAL 50MM 32MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-51-22,SUP,Custom 27803010,,UH1-51-22  -  HEAD BIPOL UNIVERSAL 51MM 22MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-51-26,SUP,Custom 27803010,,UH1-51-26  -  HEAD BIPOL UNIVERSAL 51MM 26MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-51-28,SUP,Custom 27803010,,UH1-51-28  -  HEAD BIPOL UNIVERSAL 51MM 28MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-51-32,SUP,Custom 27803010,,UH1-51-32  -  HEAD BIPOL UNIVERSAL 51MM 32MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-52-22,SUP,Custom 27803010,,UH1-52-22  -  HEAD BIPOL UNIVERSAL 52MM 22MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-52-26,SUP,Custom 27803010,,UH1-52-26  -  HEAD BIPOL UNIVERSAL 52MM 26MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-52-28,SUP,Custom 27803010,,UH1-52-28  -  HEAD BP 52MM 28MM UHR HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-52-32,SUP,Custom 27803010,,UH1-52-32  -  HEAD BIPOL UNIVERSAL 52MM 32MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-53-22,SUP,Custom 27803010,,UH1-53-22  -  HEAD BIPOL UNIVERSAL 53MM 22MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-53-26,SUP,Custom 27803010,,UH1-53-26  -  HEAD BIPOL UNIVERSAL 53MM 26MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-53-28,SUP,Custom 27803010,,UH1-53-28  -  HEAD BP 53MM 28MM UHR HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-53-32,SUP,Custom 27803010,,UH1-53-32  -  HEAD BIPOL UNIVERSAL 53MM 32MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-54-22,SUP,Custom 27803010,,UH1-54-22  -  HEAD BIPOL UNIVERSAL 54MM 22MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-54-26,SUP,Custom 27803010,,UH1-54-26  -  HEAD BIPOL UNIVERSAL 54MM 26MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-54-28,SUP,Custom 27803010,,UH1-54-28  -  HEAD BIPOL UNIVERSAL 54MM 28MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-54-32,SUP,Custom 27803010,,UH1-54-32  -  HEAD BIPOL UNIVERSAL 54MM 32MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-55-22,SUP,Custom 27803010,,UH1-55-22  -  HEAD BIPOL UNIVERSAL 55MM 22MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-55-26,SUP,Custom 27803010,,UH1-55-26  -  HEAD BIPOL UNIVERSAL 55MM 26MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-55-28,SUP,Custom 27803010,,UH1-55-28  -  HEAD BP 55MM 28MM UHR HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-55-32,SUP,Custom 27803010,,UH1-55-32  -  HEAD BIPOL UNIVERSAL 55MM 32MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-56-22,SUP,Custom 27803010,,UH1-56-22  -  HEAD BIPOL UNIVERSAL 56MM 22MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-56-26,SUP,Custom 27803010,,UH1-56-26  -  HEAD BIPOL UNIVERSAL 56MM 26MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-56-28,SUP,Custom 27803010,,UH1-56-28  -  HEAD BIPOL UNIVERSAL 56MM 28MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-56-32,SUP,Custom 27803010,,UH1-56-32  -  HEAD BIPOL UNIVERSAL 56MM 32MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-58-22,SUP,Custom 27803010,,UH1-58-22  -  HEAD BIPOL UNIVERSAL 58MM 22MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-58-26,SUP,Custom 27803010,,UH1-58-26  -  HEAD BIPOL UNIVERSAL 58MM 26MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-58-28,SUP,Custom 27803010,,UH1-58-28  -  HEAD BIPOL UNIVERSAL 58MM 28MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-58-32,SUP,Custom 27803010,,UH1-58-32  -  HEAD BIPOL UNIVERSAL 58MM 32MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-61-22,SUP,Custom 27803010,,UH1-61-22  -  HEAD BIPOL UNIVERSAL 61MM 22MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-61-26,SUP,Custom 27803010,,UH1-61-26  -  HEAD BIPOL UNIVERSAL 61MM 26MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-61-28,SUP,Custom 27803010,,UH1-61-28  -  HEAD BIPOL UNIVERSAL 61MM 28MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-61-32,SUP,Custom 27803010,,UH1-61-32  -  HEAD BIPOL UNIVERSAL 61MM 32MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-64-26,SUP,Custom 27803010,,UH1-64-26  -  HEAD BIPOL UNIVERSAL 64MM 26MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-64-28,SUP,Custom 27803010,,UH1-64-28  -  HEAD BIPOL UNIVERSAL 64MM 28MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-64-32,SUP,Custom 27803010,,UH1-64-32  -  HEAD BIPOL UNIVERSAL 64MM 32MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-68-26,SUP,Custom 27803010,,UH1-68-26  -  HEAD BIPOL UNIVERSAL 68MM 26MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-68-28,SUP,Custom 27803010,,UH1-68-28  -  HEAD BIPOL UNIVERSAL 68MM 28MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-68-32,SUP,Custom 27803010,,UH1-68-32  -  HEAD BIPOL UNIVERSAL 68MM 32MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-72-26,SUP,Custom 27803010,,UH1-72-26  -  HEAD BIPOL UNIVERSAL 72MM 26MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-72-28,SUP,Custom 27803010,,UH1-72-28  -  HEAD BIPOL UNIVERSAL 72MM 28MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UH1-72-32,SUP,Custom 27803010,,UH1-72-32  -  HEAD BIPOL UNIVERSAL 72MM 32MM UHR COCR UHMWPE HIP,"$1,150.00",$0.00,"$1,150.00",$0.00,$820.76,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,150.00",$0.00,$575.00,$910.80,$920.00,$0.00,$0.00,$0.00,$0.00,$0.00
UL-3021-S,SUP,HCPCS C1713,,UL-3021-S  -  ROD ORTH 210MM 3MM ULN WR HND ULNA IM IMPL STRL,"$2,690.00",$0.00,"$2,690.00","$1,210.50","$1,919.85",$0.00,$463.47,$0.00,$0.00,$471.00,"$2,690.00",$0.00,"$1,345.00","$2,130.48","$2,152.00",$0.00,$420.99,$0.00,$428.25,$0.00
UL-3023-S,SUP,HCPCS C1713,,UL-3023-S  -  ROD ORTH 230MM 3MM ULN ULNA IM IMPL STRL,"$2,690.00",$0.00,"$2,690.00","$1,210.50","$1,919.85",$0.00,$463.47,$0.00,$0.00,$471.00,"$2,690.00",$0.00,"$1,345.00","$2,130.48","$2,152.00",$0.00,$420.99,$0.00,$428.25,$0.00
UL-3025-S,SUP,HCPCS C1713,,UL-3025-S  -  ROD OTHOPEDIC 250MM 3MM ULN WR HND ULNA IM IMPL STRL,"$2,690.00",$0.00,"$2,690.00","$1,210.50","$1,919.85",$0.00,$463.47,$0.00,$0.00,$471.00,"$2,690.00",$0.00,"$1,345.00","$2,130.48","$2,152.00",$0.00,$420.99,$0.00,$428.25,$0.00
UL-3027-S,SUP,HCPCS C1713,,UL-3027-S  -  NAIL 3MM 27CM ULN IM TI NONSTRL,"$2,690.00",$0.00,"$2,690.00","$1,210.50","$1,919.85",$0.00,$463.47,$0.00,$0.00,$471.00,"$2,690.00",$0.00,"$1,345.00","$2,130.48","$2,152.00",$0.00,$420.99,$0.00,$428.25,$0.00
UL-3621-S,SUP,HCPCS C1713,,UL-3621-S  -  NAIL 3.6MM 21CM ULN IM STRL,"$2,690.00",$0.00,"$2,690.00","$1,210.50","$1,919.85",$0.00,$463.47,$0.00,$0.00,$471.00,"$2,690.00",$0.00,"$1,345.00","$2,130.48","$2,152.00",$0.00,$420.99,$0.00,$428.25,$0.00
UL-3623-S,SUP,HCPCS C1713,,UL-3623-S  -  ROD ORTH 230MM ULN ULNA IM IMPL,"$2,690.00",$0.00,"$2,690.00","$1,210.50","$1,919.85",$0.00,$463.47,$0.00,$0.00,$471.00,"$2,690.00",$0.00,"$1,345.00","$2,130.48","$2,152.00",$0.00,$420.99,$0.00,$428.25,$0.00
UL-3625-S,SUP,HCPCS C1713,,UL-3625-S  -  ROD ORTH 250MM 3.6MM ULN WR HND ULNA IM IMPL STRL,"$2,690.00",$0.00,"$2,690.00","$1,210.50","$1,919.85",$0.00,$463.47,$0.00,$0.00,$471.00,"$2,690.00",$0.00,"$1,345.00","$2,130.48","$2,152.00",$0.00,$420.99,$0.00,$428.25,$0.00
UL-3627-S,SUP,HCPCS C1713,,UL-3627-S  -  ROD OTHOPEDIC 270MM 3.6MM ULN WR HND ULNA IM IMPL STRL,"$2,690.00",$0.00,"$2,690.00","$1,210.50","$1,919.85",$0.00,$463.47,$0.00,$0.00,$471.00,"$2,690.00",$0.00,"$1,345.00","$2,130.48","$2,152.00",$0.00,$420.99,$0.00,$428.25,$0.00
ULTRA O-RNG RPL,SUP,Custom 27803010,,ULTRA O-RNG RPL  -  O RING OPTH BLK ULFL REPL SIL,$135.00,$0.00,$135.00,$0.00,$96.35,$0.00,$0.00,$0.00,$0.00,$0.00,$135.00,$0.00,$67.50,$106.92,$108.00,$0.00,$0.00,$0.00,$0.00,$0.00
UM-04018,SUP,Custom 27203010,,UM-04018  -  KIT ARTERIAL LINE 18GA 20GA 16CM 1.5IN INDWELL CATHETER,$131.23,$0.00,$131.23,$0.00,$93.66,$0.00,$0.00,$0.00,$0.00,$0.00,$131.23,$0.00,$65.61,$103.93,$104.98,$0.00,$0.00,$0.00,$0.00,$0.00
UOCP,SUP,HCPCS C1713,,UOCP  -  PLATE BN SHTNG ULNA,"$2,150.00",$0.00,"$2,150.00",$967.50,"$1,534.46",$0.00,$370.43,$0.00,$0.00,$376.45,"$2,150.00",$0.00,"$1,075.00","$1,702.80","$1,720.00",$0.00,$336.48,$0.00,$342.28,$0.00
UPA3030,SUP,HCPCS C1781,,UPA3030  -  MESH SURG ULTRAPRO ADV 30X30CM PRTL ABS LTWT,$619.33,$0.00,$619.33,$278.70,$442.01,$0.00,$106.71,$0.00,$0.00,$108.44,$619.33,$0.00,$309.66,$490.51,$495.46,$0.00,$96.92,$0.00,$98.60,$0.00
UPA31015,SUP,HCPCS C1781,,UPA31015  -  MESH SRG RECT 15X10CM BLU STRP ULTRAPRO ADV PRT ABS LTWT HI,$310.66,$0.00,$310.66,$139.80,$221.72,$0.00,$53.52,$0.00,$0.00,$54.39,$310.66,$0.00,$155.33,$246.04,$248.53,$0.00,$48.62,$0.00,$49.46,$0.00
UPC510,SUP,Custom 27203010,,PACK PRNTR 5 7/8INX8 3/8IN SNY COLOR INK RBN UP-50 UP-50,$2.25,$0.00,$2.25,$0.00,$1.61,$0.00,$0.00,$0.00,$0.00,$0.00,$2.25,$0.00,$1.13,$1.78,$1.80,$0.00,$0.00,$0.00,$0.00,$0.00
UPEG-14,SUP,HCPCS C1713,,UPEG-14  -  PEG FIX 14MM UNTHREADED VOLAR,$262.50,$0.00,$262.50,$118.13,$187.35,$0.00,$45.23,$0.00,$0.00,$45.96,$262.50,$0.00,$131.25,$207.90,$210.00,$0.00,$41.08,$0.00,$41.79,$0.00
UPEG-16,SUP,HCPCS C1713,,UPEG-16  -  PEG FIX 14MM UNTHREADED VOLAR,$262.50,$0.00,$262.50,$118.13,$187.35,$0.00,$45.23,$0.00,$0.00,$45.96,$262.50,$0.00,$131.25,$207.90,$210.00,$0.00,$41.08,$0.00,$41.79,$0.00
UPEG-18,SUP,HCPCS C1713,,UPEG-18  -  PEG FIX 18MM UNTHREADED VOLAR,$262.50,$0.00,$262.50,$118.13,$187.35,$0.00,$45.23,$0.00,$0.00,$45.96,$262.50,$0.00,$131.25,$207.90,$210.00,$0.00,$41.08,$0.00,$41.79,$0.00
UPEG-20,SUP,HCPCS C1713,,UPEG-20  -  SCREW BONE 20MM PEG UNTHREADED TRX,$262.50,$0.00,$262.50,$118.13,$187.35,$0.00,$45.23,$0.00,$0.00,$45.96,$262.50,$0.00,$131.25,$207.90,$210.00,$0.00,$41.08,$0.00,$41.79,$0.00
UPEG-22,SUP,HCPCS C1713,,UPEG-22  -  PEG FIX 22MM UNTHREADED VOLAR,$262.50,$0.00,$262.50,$118.13,$187.35,$0.00,$45.23,$0.00,$0.00,$45.96,$262.50,$0.00,$131.25,$207.90,$210.00,$0.00,$41.08,$0.00,$41.79,$0.00
UPLUG403,SUP,HCPCS C1781,,UPLUG403  -  MESH SURG 14X7CM ONLAY PLUG ULTRAPRO 40MM,$674.33,$0.00,$674.33,$303.45,$481.27,$0.00,$116.18,$0.00,$0.00,$118.07,$674.33,$0.00,$337.16,$534.07,$539.46,$0.00,$105.53,$0.00,$107.35,$0.00
UPLUG553,SUP,HCPCS C1781,,UPLUG553  -  MESH SURG 14X7CM ONLAY PLUG ULTRAPRO 55MM,$674.33,$0.00,$674.33,$303.45,$481.27,$0.00,$116.18,$0.00,$0.00,$118.07,$674.33,$0.00,$337.16,$534.07,$539.46,$0.00,$105.53,$0.00,$107.35,$0.00
USA-FDX,SUP,Custom 27203010,,USA-FDX  -  ASPIRATOR SCT 72IN LF FLD DMD TUBE DISP,"$1,350.00",$0.00,"$1,350.00",$0.00,$963.50,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,350.00",$0.00,$675.00,"$1,069.20","$1,080.00",$0.00,$0.00,$0.00,$0.00,$0.00
V1205,SUP,Custom 27203010,,REAGENT .45% NA CHLOR BTL 1L ANALY,$12.08,$0.00,$12.08,$0.00,$8.62,$0.00,$0.00,$0.00,$0.00,$0.00,$12.08,$0.00,$6.04,$9.57,$9.66,$0.00,$0.00,$0.00,$0.00,$0.00
V402G,SUP,Custom 27203010,,V402G  -  SUTURE ABS 9-0 BV100-3 5IN VIOL VCL MFL COAT,$47.15,$0.00,$47.15,$0.00,$33.65,$0.00,$0.00,$0.00,$0.00,$0.00,$47.15,$0.00,$23.57,$37.34,$37.72,$0.00,$0.00,$0.00,$0.00,$0.00
V4900,SUP,HCPCS C1729,,CATHETER DLYS PRTNL TROCATH ADLT,$125.75,$0.00,$125.75,$68.28,$89.75,$0.00,$21.67,$0.00,$0.00,$22.02,$125.75,$0.00,$62.88,$99.59,$100.60,$0.00,$19.68,$0.00,$20.02,$0.00
V4908(SUB),SUP,Custom 27203010,,V4908(SUB)  -  SET PERITONEAL DIALYSIS,$201.93,$0.00,$201.93,$0.00,$144.11,$0.00,$0.00,$0.00,$0.00,$0.00,$201.93,$0.00,$100.96,$159.93,$161.54,$0.00,$0.00,$0.00,$0.00,$0.00
VAC6000M,SUP,Custom 27203010,,VAC6000M  -  VACUUM EXTRACTION 6MM CUP MUSHROOM TRACTION FORCE INDICATOR,$139.98,$0.00,$139.98,$0.00,$99.91,$0.00,$0.00,$0.00,$0.00,$0.00,$139.98,$0.00,$69.99,$110.86,$111.99,$0.00,$0.00,$0.00,$0.00,$0.00
VAC-6000M,SUP,Custom 27203010,,VAC-6000M  -  VACUUM EXTRACTION 6MM CUP MUSHROOM TRACTION FORCE INDICATOR,$61.48,$0.00,$61.48,$0.00,$43.88,$0.00,$0.00,$0.00,$0.00,$0.00,$61.48,$0.00,$30.74,$48.69,$49.19,$0.00,$0.00,$0.00,$0.00,$0.00
VAMF2626C100TU,SUP,Custom 27803010,,VAMF2626C100TU  -  GRAFT STNT 26MM 100MM VALIANT PROX MAIN SECT FREEFLO CLS WEB,"$42,487.50",$0.00,"$42,487.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$42,487.50",$0.00,"$21,243.75","$33,650.10","$33,990.00",$0.00,$0.00,$0.00,$0.00,$0.00
VAMF2824C150TU,SUP,Custom 27803010,,VAMF2824C150TU  -  GRAFT STNT STRG TPR SINUSOIDAL 25FR 24MM 112MM 100MM VALIANT,"$46,237.50",$0.00,"$46,237.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$46,237.50",$0.00,"$23,118.75","$36,620.10","$36,990.00",$0.00,$0.00,$0.00,$0.00,$0.00
VAMF3026C150TU,SUP,Custom 27803010,,VAMF3026C150TU  -  GRAFT STNT TPR 30MM 26MM 150MM VALIANT CAPTIVIA THRX,"$46,237.50",$0.00,"$46,237.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$46,237.50",$0.00,"$23,118.75","$36,620.10","$36,990.00",$0.00,$0.00,$0.00,$0.00,$0.00
VAMF3228C150TU,SUP,Custom 27803010,,VAMF3228C150TU  -  GRAFT STNT TPR 28MM 150MM VALIANT CAPTIVIA DLV SYS,"$46,237.50",$0.00,"$46,237.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$46,237.50",$0.00,"$23,118.75","$36,620.10","$36,990.00",$0.00,$0.00,$0.00,$0.00,$0.00
VAMF3430C150TU,SUP,Custom 27803010,,VAMF3430C150TU  -  GRAFT STNT TPR 34MM 30MM 150MM VALIANT CAPTIVIA EVAS,"$46,237.50",$0.00,"$46,237.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$46,237.50",$0.00,"$23,118.75","$36,620.10","$36,990.00",$0.00,$0.00,$0.00,$0.00,$0.00
VAMF3434C150TU,SUP,Custom 27803010,,VAMF3434C150TU  -  GRAFT STNT STRG 34MM 150MM VALIANT PROX MAIN SECT CLS WEB,"$46,237.50",$0.00,"$46,237.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$46,237.50",$0.00,"$23,118.75","$36,620.10","$36,990.00",$0.00,$0.00,$0.00,$0.00,$0.00
VAMF3434C200TU,SUP,Custom 27803010,,VAMF3434C200TU  -  GRAFT STNT STRG SINUSOIDAL 34MM 24FR 200MM 212MM VALIANT SYS,"$48,737.50",$0.00,"$48,737.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$48,737.50",$0.00,"$24,368.75","$38,600.10","$38,990.00",$0.00,$0.00,$0.00,$0.00,$0.00
VAMF3632C150TU,SUP,Custom 27803010,,VAMF3632C150TU  -  GRAFT STNT STRG TPR 32MM 36MM 150MM STRL LF VALIANT CAPTIVIA,"$46,237.50",$0.00,"$46,237.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$46,237.50",$0.00,"$23,118.75","$36,620.10","$36,990.00",$0.00,$0.00,$0.00,$0.00,$0.00
VAMF3636C150TU,SUP,Custom 27803010,,VAMF3636C150TU  -  GRAFT STNT SINUSOIDAL STRG 36MM 24FR 167MM 150MM VALIANT,"$46,237.50",$0.00,"$46,237.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$46,237.50",$0.00,"$23,118.75","$36,620.10","$36,990.00",$0.00,$0.00,$0.00,$0.00,$0.00
VAMF3636C200TU,SUP,Custom 27803010,,VAMF3636C200TU  -  GRAFT STNT STRG 36MM 200MM 207MM VALIANT PROX FREEFLO EVAS,"$48,737.50",$0.00,"$48,737.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$48,737.50",$0.00,"$24,368.75","$38,600.10","$38,990.00",$0.00,$0.00,$0.00,$0.00,$0.00
VAMF3838C200TU,SUP,HCPCS C2625,,VAMF3838C200TU  -  GRAFT STNT SINUSOIDAL STRG 38MM 24FR 207MM 200MM VALIANT,"$48,737.50",$0.00,"$48,737.50","$21,931.88","$5,158.80",$0.00,"$8,138.89",$0.00,$0.00,"$8,138.89","$48,737.50",$0.00,"$24,368.75","$38,600.10","$38,990.00",$0.00,"$7,627.42",$0.00,"$7,759.01",$0.00
VAMF4242C150TU,SUP,Custom 27803010,,VAMF4242C150TU  -  GRAFT STNT SINUSOIDAL STRG 42MM 25FR 157MM 150MM VALIANT,"$46,237.50",$0.00,"$46,237.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$46,237.50",$0.00,"$23,118.75","$36,620.10","$36,990.00",$0.00,$0.00,$0.00,$0.00,$0.00
VAMF4242C200TU,SUP,HCPCS C1768,,VAMF4242C200TU  -  GRAFT STNT SINUSOIDAL STRG 42MM 25FR 207MM 200MM VALIANT,"$48,737.50",$0.00,"$48,737.50","$21,931.88","$5,158.80",$0.00,"$8,138.89",$0.00,$0.00,"$8,138.89","$48,737.50",$0.00,"$24,368.75","$38,600.10","$38,990.00",$0.00,"$7,627.42",$0.00,"$7,759.01",$0.00
VBH060502,SUP,HCPCS C1874,,VBH060502  -  STENT ENDOPRSTH 6MM 7FR 5CM 120CM .035IN HEP BIOACTIVE SRFC,"$7,097.50",$0.00,"$7,097.50","$3,193.88","$5,065.49",$0.00,"$1,222.86",$0.00,$0.00,"$1,242.72","$7,097.50",$0.00,"$3,548.75","$5,621.22","$5,678.00",$0.00,"$1,110.76",$0.00,"$1,129.92",$0.00
VBH061002,SUP,HCPCS C1874,,VBH061002  -  STENT ENDOPRSTH 6MM 10CM 120CM .035IN DLV SYS TIP TO HUB DPL,"$8,122.50",$0.00,"$8,122.50","$3,655.13","$5,158.80",$0.00,"$1,399.47",$0.00,$0.00,"$1,422.18","$8,122.50",$0.00,"$4,061.25","$6,433.02","$6,498.00",$0.00,"$1,271.17",$0.00,"$1,293.10",$0.00
VBH080502,SUP,HCPCS C1874,,VBH080502  -  STENT ENDOPRSTH 8MM 5CM 120CM .035IN DLV SYS TIP TO HUB DPL,"$6,737.50",$0.00,"$6,737.50","$3,031.88","$4,808.55",$0.00,"$1,160.84",$0.00,$0.00,"$1,179.68","$6,737.50",$0.00,"$3,368.75","$5,336.10","$5,390.00",$0.00,"$1,054.42",$0.00,"$1,072.61",$0.00
VBH081002,SUP,HCPCS C1874,,VBH081002  -  STENT ENDOPRSTH 8MM 10CM 120CM .035IN DLV SYS TIP TO HUB DPL,"$7,737.50",$0.00,"$7,737.50","$3,481.88","$5,158.80",$0.00,"$1,333.13",$0.00,$0.00,"$1,354.77","$7,737.50",$0.00,"$3,868.75","$6,128.10","$6,190.00",$0.00,"$1,210.92",$0.00,"$1,231.81",$0.00
VBH081502,SUP,HCPCS C1874,,VBH081502  -  STENT ENDOPRSTH 8MM 15CM 120CM .035IN DLV SYS TIP TO HUB DPL,"$8,900.00",$0.00,"$8,900.00","$4,005.00","$5,158.80",$0.00,"$1,533.43",$0.00,$0.00,"$1,558.32","$8,900.00",$0.00,"$4,450.00","$7,048.80","$7,120.00",$0.00,"$1,392.85",$0.00,"$1,416.88",$0.00
VBH090502,SUP,HCPCS C1874,,VBH090502  -  STENT ENDOPRSTH 5CM DELIVERY SYSTEM TIP TO HUB DEPLOYMENT,"$7,487.50",$0.00,"$7,487.50","$3,369.38","$5,158.80",$0.00,"$1,290.06",$0.00,$0.00,"$1,311.00","$7,487.50",$0.00,"$3,743.75","$5,930.10","$5,990.00",$0.00,"$1,171.79",$0.00,"$1,192.01",$0.00
VBH091002,SUP,HCPCS C1874,,VBH091002  -  STENT ENDOPRSTH 10CM DELIVERY SYSTEM TIP TO HUB DEPLOYMENT,"$8,237.50",$0.00,"$8,237.50","$3,706.88","$5,158.80",$0.00,"$1,419.28",$0.00,$0.00,"$1,442.32","$8,237.50",$0.00,"$4,118.75","$6,524.10","$6,590.00",$0.00,"$1,289.17",$0.00,"$1,311.41",$0.00
VBH100502,SUP,HCPCS C1874,,VBH100502  -  STENT EPRSTH 10MM 11FR 5CM 120CM VBHN DLV SYS TIP TO HUB DPL,"$6,737.50",$0.00,"$6,737.50","$3,031.88","$4,808.55",$0.00,"$1,160.84",$0.00,$0.00,"$1,179.68","$6,737.50",$0.00,"$3,368.75","$5,336.10","$5,390.00",$0.00,"$1,054.42",$0.00,"$1,072.61",$0.00
VBH101002,SUP,HCPCS C1874,,VBH101002  -  STENT ENDOPRSTH 10MM 10CM 120CM .035IN DLV SYS TIP TO HUB,"$7,737.50",$0.00,"$7,737.50","$3,481.88","$5,158.80",$0.00,"$1,333.13",$0.00,$0.00,"$1,354.77","$7,737.50",$0.00,"$3,868.75","$6,128.10","$6,190.00",$0.00,"$1,210.92",$0.00,"$1,231.81",$0.00
VBH101002A,SUP,HCPCS C1874,,VBH101002A  -  STENT EPRSTH 10MM 11FR 10CM 120CM VBHN DLV SYS TIP TO HUB,"$9,615.00",$0.00,"$9,615.00","$4,326.75","$5,158.80",$0.00,"$1,656.62",$0.00,$0.00,"$1,683.51","$9,615.00",$0.00,"$4,807.50","$7,615.08","$7,692.00",$0.00,"$1,504.75",$0.00,"$1,530.71",$0.00
VBHR080502A,SUP,HCPCS C1874,,"VBHR080502A  -  VIABAHN ENDOPROSTHESIS , 8X5","$8,765.00",$0.00,"$8,765.00","$3,944.25","$5,158.80",$0.00,"$1,510.17",$0.00,$0.00,"$1,534.68","$8,765.00",$0.00,"$4,382.50","$6,941.88","$7,012.00",$0.00,"$1,371.72",$0.00,"$1,395.39",$0.00
VBJ050502,SUP,HCPCS C1874,,VBJ050502  -  STENT ENDOPRSTH 5CM DELIVERY SYSTEM VIABAHN HEPARIN 120CM 5,"$7,737.50",$0.00,"$7,737.50","$3,481.88","$5,158.80",$0.00,"$1,333.13",$0.00,$0.00,"$1,354.77","$7,737.50",$0.00,"$3,868.75","$6,128.10","$6,190.00",$0.00,"$1,210.92",$0.00,"$1,231.81",$0.00
VBJ051002,SUP,HCPCS C1874,,VBJ051002  -  STENT ENDOPRSTH 10CM DELIVERY SYSTEM VIABAHN HEPARIN 120CM 5,"$8,487.50",$0.00,"$8,487.50","$3,819.38","$5,158.80",$0.00,"$1,462.35",$0.00,$0.00,"$1,486.09","$8,487.50",$0.00,"$4,243.75","$6,722.10","$6,790.00",$0.00,"$1,328.29",$0.00,"$1,351.21",$0.00
VBJ051502,SUP,HCPCS C1874,,VBJ051502  -  STENT ENDOPRSTH 15CM DELIVERY SYSTEM VIABAHN HEPARIN 120CM 5,"$9,737.50",$0.00,"$9,737.50","$4,381.88","$5,158.80",$0.00,"$1,677.72",$0.00,$0.00,"$1,704.96","$9,737.50",$0.00,"$4,868.75","$7,712.10","$7,790.00",$0.00,"$1,523.92",$0.00,"$1,550.21",$0.00
VBJ052502,SUP,HCPCS C1874,,VBJ052502  -  STENT ENDOPRSTH 25CM BIOACTIVE SURFACE CATHETER LOWER,"$15,987.50",$0.00,"$15,987.50","$7,194.38","$5,158.80",$0.00,"$2,754.57",$0.00,$0.00,"$2,799.28","$15,987.50",$0.00,"$7,993.75","$12,662.10","$12,790.00",$0.00,"$2,502.04",$0.00,"$2,545.21",$0.00
VBJ060502,SUP,HCPCS C1874,,VBJ060502  -  STENT ENDOPRSTH 5CM DELIVERY SYSTEM VIABAHN HEPARIN 120CM 6,"$7,737.50",$0.00,"$7,737.50","$3,481.88","$5,158.80",$0.00,"$1,333.13",$0.00,$0.00,"$1,354.77","$7,737.50",$0.00,"$3,868.75","$6,128.10","$6,190.00",$0.00,"$1,210.92",$0.00,"$1,231.81",$0.00
VBJ061002,SUP,HCPCS C1874,,VBJ061002  -  STENT EPRSTH 6MM 6FR 10CM 120CM VBHN DLV SYS HEP SPRFC FEM,"$8,487.50",$0.00,"$8,487.50","$3,819.38","$5,158.80",$0.00,"$1,462.35",$0.00,$0.00,"$1,486.09","$8,487.50",$0.00,"$4,243.75","$6,722.10","$6,790.00",$0.00,"$1,328.29",$0.00,"$1,351.21",$0.00
VBJ061502,SUP,HCPCS C1874,,VBJ061502  -  STENT ENDOPRSTH 15CM DELIVERY SYSTEM VIABAHN HEPARIN 120CM 6,"$9,737.50",$0.00,"$9,737.50","$4,381.88","$5,158.80",$0.00,"$1,677.72",$0.00,$0.00,"$1,704.96","$9,737.50",$0.00,"$4,868.75","$7,712.10","$7,790.00",$0.00,"$1,523.92",$0.00,"$1,550.21",$0.00
VBJ062502,SUP,HCPCS C1874,,VBJ062502  -  STENT ENDOPRSTH 25CM BIOACTIVE SURFACE CATHETER LOWER,"$15,987.50",$0.00,"$15,987.50","$7,194.38","$5,158.80",$0.00,"$2,754.57",$0.00,$0.00,"$2,799.28","$15,987.50",$0.00,"$7,993.75","$12,662.10","$12,790.00",$0.00,"$2,502.04",$0.00,"$2,545.21",$0.00
VBJ070502,SUP,HCPCS C1874,,VBJ070502  -  STENT ENDOPRSTH 5CM DELIVERY SYSTEM VIABAHN HEPARIN 120CM 7,"$7,737.50",$0.00,"$7,737.50","$3,481.88","$5,158.80",$0.00,"$1,333.13",$0.00,$0.00,"$1,354.77","$7,737.50",$0.00,"$3,868.75","$6,128.10","$6,190.00",$0.00,"$1,210.92",$0.00,"$1,231.81",$0.00
VBJ071002,SUP,HCPCS C1874,,VBJ071002  -  STENT ENDOPRSTH 10CM DELIVERY SYSTEM VIABAHN HEPARIN 120CM 7,"$8,487.50",$0.00,"$8,487.50","$3,819.38","$5,158.80",$0.00,"$1,462.35",$0.00,$0.00,"$1,486.09","$8,487.50",$0.00,"$4,243.75","$6,722.10","$6,790.00",$0.00,"$1,328.29",$0.00,"$1,351.21",$0.00
VBJ071502,SUP,HCPCS C1874,,VBJ071502  -  STENT ENDOPRSTH 15CM DELIVERY SYSTEM VIABAHN HEPARIN 120CM 7,"$9,737.50",$0.00,"$9,737.50","$4,381.88","$5,158.80",$0.00,"$1,677.72",$0.00,$0.00,"$1,704.96","$9,737.50",$0.00,"$4,868.75","$7,712.10","$7,790.00",$0.00,"$1,523.92",$0.00,"$1,550.21",$0.00
VBJ072502,SUP,HCPCS C1874,,VBJ072502  -  STENT ENDOPRSTH 25CM BIOACTIVE SURFACE CATHETER DELIVERY,"$15,987.50",$0.00,"$15,987.50","$7,194.38","$5,158.80",$0.00,"$2,754.57",$0.00,$0.00,"$2,799.28","$15,987.50",$0.00,"$7,993.75","$12,662.10","$12,790.00",$0.00,"$2,502.04",$0.00,"$2,545.21",$0.00
VBJ080202,SUP,HCPCS C1874,,VBJ080202  -  STENT ENDOPRSTH 2.5CM DELIVERY SYSTEM VIABAHN HEPARIN 120CM,"$7,355.00",$0.00,"$7,355.00","$3,309.75","$5,158.80",$0.00,"$1,267.23",$0.00,$0.00,"$1,287.80","$7,355.00",$0.00,"$3,677.50","$5,825.16","$5,884.00",$0.00,"$1,151.06",$0.00,"$1,170.92",$0.00
VBJ080502,SUP,HCPCS C1874,,VBJ080502  -  STENT ENDOPRSTH 8MM 7FR 5CM 120CM DELIVERY SYSTEM VIABAHN,"$7,737.50",$0.00,"$7,737.50","$3,481.88","$5,158.80",$0.00,"$1,333.13",$0.00,$0.00,"$1,354.77","$7,737.50",$0.00,"$3,868.75","$6,128.10","$6,190.00",$0.00,"$1,210.92",$0.00,"$1,231.81",$0.00
VBJ081002,SUP,HCPCS C1874,,VBJ081002  -  STENT ENDOPRSTH 8MM 7FR 10CM 120CM DELIVERY SYSTEM VIABAHN,"$8,950.00",$0.00,"$8,950.00","$4,027.50","$5,158.80",$0.00,"$1,542.04",$0.00,$0.00,"$1,567.07","$8,950.00",$0.00,"$4,475.00","$7,088.40","$7,160.00",$0.00,"$1,400.68",$0.00,"$1,424.84",$0.00
VBJ081502,SUP,HCPCS C1874,,VBJ081502  -  STENT ENDOPRSTH 15CM DELIVERY SYSTEM VIABAHN HEPARIN 120CM 8,"$9,660.00",$0.00,"$9,660.00","$4,347.00","$5,158.80",$0.00,"$1,664.37",$0.00,$0.00,"$1,691.39","$9,660.00",$0.00,"$4,830.00","$7,650.72","$7,728.00",$0.00,"$1,511.79",$0.00,"$1,537.87",$0.00
VBJR050502A,SUP,HCPCS C1874,,VBJR050502A  -  STENT EPRSTH 5MM 5CM STRL 120CM VBHN FLXB SLF XPD RADOPQ HEP,"$9,027.50",$0.00,"$9,027.50","$4,062.38","$5,158.80",$0.00,"$1,555.39",$0.00,$0.00,"$1,580.64","$9,027.50",$0.00,"$4,513.75","$7,149.78","$7,222.00",$0.00,"$1,412.80",$0.00,"$1,437.18",$0.00
VBJR051002A,SUP,HCPCS C1874,,VBJR051002A  -  STENT ENDOPRSTH 5MM 10CM 120CM FLEXIBLE SELF EXPAND RADIOPQ,"$9,875.00",$0.00,"$9,875.00","$4,443.75","$5,158.80",$0.00,"$1,701.41",$0.00,$0.00,"$1,729.03","$9,875.00",$0.00,"$4,937.50","$7,821.00","$7,900.00",$0.00,"$1,545.44",$0.00,"$1,572.10",$0.00
VBJR060502A,SUP,HCPCS C1874,,VBJR060502A  -  STENT EPRSTH 6MM 6FR 5CM 120CM VBHN DLV SYS HEP SPRFC FEM,"$9,027.50",$0.00,"$9,027.50","$4,062.38","$5,158.80",$0.00,"$1,555.39",$0.00,$0.00,"$1,580.64","$9,027.50",$0.00,"$4,513.75","$7,149.78","$7,222.00",$0.00,"$1,412.80",$0.00,"$1,437.18",$0.00
VBJR061002A,SUP,HCPCS C1874,,VBJR061002A  -  STENT EPRSTH 6MM 6FR 10CM 120CM VBHN DLV SYS HEP SPRFC,"$9,875.00",$0.00,"$9,875.00","$4,443.75","$5,158.80",$0.00,"$1,701.41",$0.00,$0.00,"$1,729.03","$9,875.00",$0.00,"$4,937.50","$7,821.00","$7,900.00",$0.00,"$1,545.44",$0.00,"$1,572.10",$0.00
VBJR061502A,SUP,HCPCS C1874,,"VBJR061502A  -  VIABAHN ENDOPROSTHESIS, 6MMX 15CM","$11,005.00",$0.00,"$11,005.00","$4,952.25","$5,158.80",$0.00,"$1,896.11",$0.00,$0.00,"$1,926.89","$11,005.00",$0.00,"$5,502.50","$8,715.96","$8,804.00",$0.00,"$1,722.28",$0.00,"$1,752.00",$0.00
VBJR062502A,SUP,HCPCS C1874,,VBJR062502A  -  STENT ENDOPRSTH 6MM 25CM 120CM FLEXIBLE SELF EXPAND RADIOPQ,"$18,087.50",$0.00,"$18,087.50","$8,139.38","$5,158.80",$0.00,"$3,116.39",$0.00,$0.00,"$3,166.98","$18,087.50",$0.00,"$9,043.75","$14,325.30","$14,470.00",$0.00,"$2,830.69",$0.00,"$2,879.53",$0.00
VBJR070202A,SUP,HCPCS C1874,,VBJR070202A  -  STENT EPRSTH 7MM 2.5CM STRL 120CM VBHN FLXB SLF XPD RADOPQ,"$9,027.50",$0.00,"$9,027.50","$4,062.38","$5,158.80",$0.00,"$1,555.39",$0.00,$0.00,"$1,580.64","$9,027.50",$0.00,"$4,513.75","$7,149.78","$7,222.00",$0.00,"$1,412.80",$0.00,"$1,437.18",$0.00
VBJR070502A,SUP,HCPCS C1874,,"VBJR070502A  -  LOW-PROFILE, VIABAHN 7MMX 5CM","$9,027.50",$0.00,"$9,027.50","$4,062.38","$5,158.80",$0.00,"$1,555.39",$0.00,$0.00,"$1,580.64","$9,027.50",$0.00,"$4,513.75","$7,149.78","$7,222.00",$0.00,"$1,412.80",$0.00,"$1,437.18",$0.00
VBJR071002A,SUP,HCPCS C1874,,VBJR071002A  -  STENT ENDOPRSTH SPRFC FEM ART ILIUM 10CM 7MM 7FR,"$9,875.00",$0.00,"$9,875.00","$4,443.75","$5,158.80",$0.00,"$1,701.41",$0.00,$0.00,"$1,729.03","$9,875.00",$0.00,"$4,937.50","$7,821.00","$7,900.00",$0.00,"$1,545.44",$0.00,"$1,572.10",$0.00
VBJR071502A,SUP,HCPCS C1874,,VBJR071502A  -  STENT ENDOPRSTH 7MM 7FR 15CM 120CM DELIVERY SYSTEM VIABAHN,"$11,005.00",$0.00,"$11,005.00","$4,952.25","$5,158.80",$0.00,"$1,896.11",$0.00,$0.00,"$1,926.89","$11,005.00",$0.00,"$5,502.50","$8,715.96","$8,804.00",$0.00,"$1,722.28",$0.00,"$1,752.00",$0.00
VBJR072502A,SUP,HCPCS C1874,,VBJR072502A  -  STENT ENDOPRSTH 7MM 25CM 120CM FLEXIBLE SELF EXPAND RADIOPQ,"$18,087.50",$0.00,"$18,087.50","$8,139.38","$5,158.80",$0.00,"$3,116.39",$0.00,$0.00,"$3,166.98","$18,087.50",$0.00,"$9,043.75","$14,325.30","$14,470.00",$0.00,"$2,830.69",$0.00,"$2,879.53",$0.00
VBJR080502A,SUP,HCPCS C1874,,"VBJR080502A  -  VIABAHN ENDOPROSTHESIS, 8MMX 5CM","$9,027.50",$0.00,"$9,027.50","$4,062.38","$5,158.80",$0.00,"$1,555.39",$0.00,$0.00,"$1,580.64","$9,027.50",$0.00,"$4,513.75","$7,149.78","$7,222.00",$0.00,"$1,412.80",$0.00,"$1,437.18",$0.00
VBP32,SUP,HCPCS C1713,,VBP32  -  PIN FIX 32MM BUTTRESS TITANIUM VOLAR,$937.50,$0.00,$937.50,$421.88,$669.09,$0.00,$161.53,$0.00,$0.00,$164.15,$937.50,$0.00,$468.75,$742.50,$750.00,$0.00,$146.72,$0.00,$149.25,$0.00
VCP740D,SUP,Custom 27203010,,VCP740D  -  SUTURE ABSORBABLE 0 CT-1 18IN CONTROL RELEASE BRAID 8 STRAND,$32.80,$0.00,$32.80,$0.00,$23.41,$0.00,$0.00,$0.00,$0.00,$0.00,$32.80,$0.00,$16.40,$25.98,$26.24,$0.00,$0.00,$0.00,$0.00,$0.00
VE220GS,SUP,HCPCS C1884,,VE220GS  -  PARTICLES EMBL 100-300UM 2ML YLW LC BEAD VL,"$4,237.50",$0.00,"$4,237.50","$1,906.88","$3,024.30",$0.00,$730.10,$0.00,$0.00,$741.95,"$4,237.50",$0.00,"$2,118.75","$3,356.10","$3,390.00",$0.00,$663.17,$0.00,$674.61,$0.00
VE420GS,SUP,HCPCS C1884,,VE420GS  -  PARTICLES EMBL 300-500UM 2ML BLU LC BEAD LBL,"$4,037.50",$0.00,"$4,037.50","$1,816.88","$2,881.56",$0.00,$695.64,$0.00,$0.00,$706.93,"$4,037.50",$0.00,"$2,018.75","$3,197.70","$3,230.00",$0.00,$631.87,$0.00,$642.77,$0.00
VE620GS,SUP,Custom 27203010,,PARTICLES EMBL 500-700UM 2ML LBL LC BEAD RD,"$3,487.50",$0.00,"$3,487.50",$0.00,"$2,489.03",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,487.50",$0.00,"$1,743.75","$2,762.10","$2,790.00",$0.00,$0.00,$0.00,$0.00,$0.00
VEDR01,SUP,HCPCS C1785,,VEDR01  -  PACEMAKER CARDIAC 2.8V 1.3AH 7.5MM 47.9X7.5X44.7MM IMPLTABLE,"$6,125.00",$0.00,"$6,125.00","$2,756.25","$4,371.41",$0.00,"$1,055.31",$0.00,$0.00,"$1,072.44","$6,125.00",$0.00,"$3,062.50","$4,851.00","$4,900.00",$0.00,$958.56,$0.00,$975.10,$0.00
VERSADRK2,SUP,HCPCS C1785,,VERSADRK2  -  PACEMAKER CARDIAC THK7.5MM 47.9X44.7MM IMPLTABLE 2 CHAMBER,"$8,150.00",$0.00,"$8,150.00","$3,667.50","$5,158.80",$0.00,"$1,404.20",$0.00,$0.00,"$1,427.00","$8,150.00",$0.00,"$4,075.00","$6,454.80","$6,520.00",$0.00,"$1,275.48",$0.00,"$1,297.48",$0.00
VG-0108N,SUP,HCPCS C1768,,VG-0108N  -  PATCH CARDIO TAPER 8X.8CM APEX PROCESS VASCU-GUARD BOVINE,$495.10,$0.00,$495.10,$222.80,$353.35,$0.00,$85.30,$0.00,$0.00,$86.69,$495.10,$0.00,$247.55,$392.12,$396.08,$0.00,$77.48,$0.00,$78.82,$0.00
VG-0209N,SUP,HCPCS C1768,,VG-0209N  -  PATCH CARDIO 9X2CM TPR VSGRD BVN PRICRD PERI,$532.50,$0.00,$532.50,$239.63,$380.05,$0.00,$91.75,$0.00,$0.00,$93.24,$532.50,$0.00,$266.25,$421.74,$426.00,$0.00,$83.34,$0.00,$84.77,$0.00
VG1CPAR10P,SUP,HCPCS C1762,,VG1CPAR10P  -  GRAFT BONE 12X14.5X10MM ANTERIOR CERV FUSION PARALLEL SOLID,"$2,995.00",$0.00,"$2,995.00",$0.00,"$2,137.53",$0.00,$516.02,$0.00,$0.00,$0.00,"$2,995.00",$0.00,"$1,497.50","$2,372.04","$2,396.00",$0.00,$468.72,$0.00,$0.00,$0.00
VG1CPAR5P,SUP,HCPCS C1762,,VG1CPAR5P  -  GRAFT BONE VG1 CERV,"$2,995.00",$0.00,"$2,995.00",$0.00,"$2,137.53",$0.00,$516.02,$0.00,$0.00,$0.00,"$2,995.00",$0.00,"$1,497.50","$2,372.04","$2,396.00",$0.00,$468.72,$0.00,$0.00,$0.00
VG1CPAR6P,SUP,HCPCS C1762,,VG1CPAR6P  -  GRAFT BONE 12X14.5X6MM ANTERIOR CERV FUSION PARALLEL SOLID,"$2,995.00",$0.00,"$2,995.00",$0.00,"$2,137.53",$0.00,$516.02,$0.00,$0.00,$0.00,"$2,995.00",$0.00,"$1,497.50","$2,372.04","$2,396.00",$0.00,$468.72,$0.00,$0.00,$0.00
VG1CPAR7P,SUP,HCPCS C1762,,VG1CPAR7P  -  GRAFT BONE 12X14.5X7MM ANTERIOR CERV FUSION PARALLEL SOLID,"$2,995.00",$0.00,"$2,995.00",$0.00,"$2,137.53",$0.00,$516.02,$0.00,$0.00,$0.00,"$2,995.00",$0.00,"$1,497.50","$2,372.04","$2,396.00",$0.00,$468.72,$0.00,$0.00,$0.00
VG1CPAR8P,SUP,HCPCS C1762,,VG1CPAR8P  -  GRAFT BONE 12X14.5X8MM ANTERIOR CERV FUSION PARALLEL,"$2,995.00",$0.00,"$2,995.00",$0.00,"$2,137.53",$0.00,$516.02,$0.00,$0.00,$0.00,"$2,995.00",$0.00,"$1,497.50","$2,372.04","$2,396.00",$0.00,$468.72,$0.00,$0.00,$0.00
VG1CPAR9P,SUP,HCPCS C1762,,VG1CPAR9P  -  GRAFT BONE 12X14.5X9MM ANTERIOR CERV FUSION PARALLEL SOLID,"$2,995.00",$0.00,"$2,995.00",$0.00,"$2,137.53",$0.00,$516.02,$0.00,$0.00,$0.00,"$2,995.00",$0.00,"$1,497.50","$2,372.04","$2,396.00",$0.00,$468.72,$0.00,$0.00,$0.00
VG1C-T46P,SUP,HCPCS C1762,,VG1C-T46P  -  GRAFT BONE 7D 6MM 4MM 1 PIECE LORDOSIS SOLID CENTRL VOID,"$3,327.50",$0.00,"$3,327.50",$0.00,"$2,374.84",$0.00,$573.31,$0.00,$0.00,$0.00,"$3,327.50",$0.00,"$1,663.75","$2,635.38","$2,662.00",$0.00,$520.75,$0.00,$0.00,$0.00
VG1C-T57P,SUP,HCPCS C1762,,VG1C-T57P  -  GRAFT BONE 7D 7MM 5MM 1 PIECE LORDOSIS SOLID CENTRL VOID,"$2,995.00",$0.00,"$2,995.00",$0.00,"$2,137.53",$0.00,$516.02,$0.00,$0.00,$0.00,"$2,995.00",$0.00,"$1,497.50","$2,372.04","$2,396.00",$0.00,$468.72,$0.00,$0.00,$0.00
VG1C-T68P,SUP,HCPCS C1762,,VG1C-T68P  -  GRAFT BONE 7D 12X14.5X8MM 6MM ANTERIOR CERV FUSION PRESERVON,"$3,327.50",$0.00,"$3,327.50",$0.00,"$2,374.84",$0.00,$573.31,$0.00,$0.00,$0.00,"$3,327.50",$0.00,"$1,663.75","$2,635.38","$2,662.00",$0.00,$520.75,$0.00,$0.00,$0.00
VG1C-T79P,SUP,HCPCS C1762,,VG1C-T79P  -  GRAFT BONE 7D 12X14.5X9MM 7MM ANTERIOR CERV FUSION PRESERVON,"$3,247.50",$0.00,"$3,247.50",$0.00,"$2,317.74",$0.00,$559.53,$0.00,$0.00,$0.00,"$3,247.50",$0.00,"$1,623.75","$2,572.02","$2,598.00",$0.00,$508.23,$0.00,$0.00,$0.00
VG1C-T810P,SUP,HCPCS C1762,,VG1C-T810P  -  GRAFT BONE 7D 12X14.5X10MM 8MM ANTERIOR CERV FUSION,"$2,995.00",$0.00,"$2,995.00",$0.00,"$2,137.53",$0.00,$516.02,$0.00,$0.00,$0.00,"$2,995.00",$0.00,"$1,497.50","$2,372.04","$2,396.00",$0.00,$468.72,$0.00,$0.00,$0.00
VG2C-T57P,SUP,Custom 27803010,,VG2C-T57P  -  LIFENET HEALTH 5.75 X 7.22MM CERVICAL LORDOTIC,"$3,247.50",$0.00,"$3,247.50",$0.00,"$2,317.74",$0.00,$0.00,$0.00,$0.00,$0.00,"$3,247.50",$0.00,"$1,623.75","$2,572.02","$2,598.00",$0.00,$0.00,$0.00,$0.00,$0.00
VG501,SUP,Custom 27203010,,"CONTROLLER, V-GRIP DETACHMENT",$437.50,$0.00,$437.50,$0.00,$312.24,$0.00,$0.00,$0.00,$0.00,$0.00,$437.50,$0.00,$218.75,$346.50,$350.00,$0.00,$0.00,$0.00,$0.00,$0.00
VH - 2004,SUP,Custom 27203010,,VH - 2004  -  SYSTEM VSL HRVT SHRT BLNT CONE 30ML VSVW TROC ESCP CNN SL,"$1,312.50",$0.00,"$1,312.50",$0.00,$936.73,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,312.50",$0.00,$656.25,"$1,039.50","$1,050.00",$0.00,$0.00,$0.00,$0.00,$0.00
VKML,SUP,HCPCS C1781,,VKML  -  MESH SURG FLAT 12X12IN KNIT VICRYL POLYGLACTIN 910 WOVEN,"$1,927.71",$0.00,"$1,927.71",$867.47,"$1,375.80",$0.00,$332.13,$0.00,$0.00,$337.53,"$1,927.71",$0.00,$963.85,"$1,526.75","$1,542.16",$0.00,$301.69,$0.00,$306.89,$0.00
VL1060031,SUP,Custom 27203010,,KIT OC VAP GRD PKG,$3.03,$0.00,$3.03,$0.00,$2.16,$0.00,$0.00,$0.00,$0.00,$0.00,$3.03,$0.00,$1.51,$2.40,$2.42,$0.00,$0.00,$0.00,$0.00,$0.00
VLBPL-11-7,SUP,HCPCS C1713,,VLBPL-11-7  -  PLATE BONE 11 HOLE 7 PEG LOCKING VOLAR BEARING PLATE,"$5,187.50",$0.00,"$5,187.50","$2,334.38","$3,702.32",$0.00,$893.78,$0.00,$0.00,$908.29,"$5,187.50",$0.00,"$2,593.75","$4,108.50","$4,150.00",$0.00,$811.84,$0.00,$825.85,$0.00
VLBPL-3-7,SUP,HCPCS C1713,,VLBPL-3-7  -  PLATE BONE 3 HOLE 7 PEG LOCKING VOLAR BEARING PLATE TITANIUM,"$2,700.00",$0.00,"$2,700.00","$1,215.00","$1,926.99",$0.00,$465.20,$0.00,$0.00,$472.75,"$2,700.00",$0.00,"$1,350.00","$2,138.40","$2,160.00",$0.00,$422.55,$0.00,$429.84,$0.00
VLBPL-5-5,SUP,HCPCS C1713,,VLBPL-5-5  -  PLATE BONE 5 HOLE 5 PEG LOCKING VOLAR BEARING PLATE TITANIUM,"$2,962.50",$0.00,"$2,962.50","$1,333.13","$2,114.34",$0.00,$510.42,$0.00,$0.00,$518.71,"$2,962.50",$0.00,"$1,481.25","$2,346.30","$2,370.00",$0.00,$463.63,$0.00,$471.63,$0.00
VLBPL-5-7,SUP,HCPCS C1713,,VLBPL-5-7  -  PLATE BONE 5 HOLE EDGE FREE CNTOUR VOLAR BEARING PLATE LEFT,"$2,962.50",$0.00,"$2,962.50","$1,333.13","$2,114.34",$0.00,$510.42,$0.00,$0.00,$518.71,"$2,962.50",$0.00,"$1,481.25","$2,346.30","$2,370.00",$0.00,$463.63,$0.00,$471.63,$0.00
VLBPL-7-7,SUP,HCPCS C1713,,VLBPL-7-7  -  PLATE BONE 7 HOLE EDGE FREE CNTOUR VOLAR BEARING PLATE LEFT,"$3,237.50",$0.00,"$3,237.50","$1,456.88","$2,310.60",$0.00,$557.81,$0.00,$0.00,$566.86,"$3,237.50",$0.00,"$1,618.75","$2,564.10","$2,590.00",$0.00,$506.67,$0.00,$515.41,$0.00
VLBPL-9-7,SUP,HCPCS C1713,,VLBPL-9-7  -  PLATE BN VOLR BRNG PLT 9 HL 7 PG LCK TI LT WRST,"$4,225.00",$0.00,"$4,225.00","$1,901.25","$3,015.38",$0.00,$727.95,$0.00,$0.00,$739.76,"$4,225.00",$0.00,"$2,112.50","$3,346.20","$3,380.00",$0.00,$661.21,$0.00,$672.62,$0.00
VLBPR-11-7,SUP,HCPCS C1713,,VLBPR-11-7  -  PLATE BONE VOLAR BEARING PLATE TITANIUM RIGHT WRIST 11 HOLE,"$5,187.50",$0.00,"$5,187.50","$2,334.38","$3,702.32",$0.00,$893.78,$0.00,$0.00,$908.29,"$5,187.50",$0.00,"$2,593.75","$4,108.50","$4,150.00",$0.00,$811.84,$0.00,$825.85,$0.00
VLBPR-3-7,SUP,HCPCS C1713,,VLBPR-3-7  -  PLATE BONE 3 HOLE 7 PEG LOCKING VOLAR BEARING PLATE TITANIUM,"$2,700.00",$0.00,"$2,700.00","$1,215.00","$1,926.99",$0.00,$465.20,$0.00,$0.00,$472.75,"$2,700.00",$0.00,"$1,350.00","$2,138.40","$2,160.00",$0.00,$422.55,$0.00,$429.84,$0.00
VLBPR-5-5,SUP,HCPCS C1713,,VLBPR-5-5  -  PLATE TI 5 HOLE 5 PG LCK VOLR BRNG PLT BONE RIGHT,"$2,962.50",$0.00,"$2,962.50","$1,333.13","$2,114.34",$0.00,$510.42,$0.00,$0.00,$518.71,"$2,962.50",$0.00,"$1,481.25","$2,346.30","$2,370.00",$0.00,$463.63,$0.00,$471.63,$0.00
VLBPR-5-7,SUP,HCPCS C1713,,VLBPR-5-7  -  PLATE BONE STANDARD 5 HOLE PEG VOLAR BEARING PLATE RIGHT,"$2,962.50",$0.00,"$2,962.50","$1,333.13","$2,114.34",$0.00,$510.42,$0.00,$0.00,$518.71,"$2,962.50",$0.00,"$1,481.25","$2,346.30","$2,370.00",$0.00,$463.63,$0.00,$471.63,$0.00
VLBPR-7-7,SUP,HCPCS C1713,,VLBPR-7-7  -  PLATE BONE STANDARD 7 HOLE PEG VOLAR BEARING PLATE RIGHT,"$3,237.50",$0.00,"$3,237.50","$1,456.88","$2,310.60",$0.00,$557.81,$0.00,$0.00,$566.86,"$3,237.50",$0.00,"$1,618.75","$2,564.10","$2,590.00",$0.00,$506.67,$0.00,$515.41,$0.00
VLBPR-9-7,SUP,HCPCS C1713,,VLBPR-9-7  -  PLATE BONE 9 HOLE 7 PEG LOCKING VOLAR BEARING PLATE TITANIUM,"$4,225.00",$0.00,"$4,225.00","$1,901.25","$3,015.38",$0.00,$727.95,$0.00,$0.00,$739.76,"$4,225.00",$0.00,"$2,112.50","$3,346.20","$3,380.00",$0.00,$661.21,$0.00,$672.62,$0.00
VLOCL0315,SUP,Custom 27203010,,VLOCL0315  -  DEVICE CLSR 2-0 GS-21 .5 CRC 12IN GRN 37MM V-LOC 180 TPR PNT,$65.75,$0.00,$65.75,$0.00,$46.93,$0.00,$0.00,$0.00,$0.00,$0.00,$65.75,$0.00,$32.88,$52.07,$52.60,$0.00,$0.00,$0.00,$0.00,$0.00
VLOCL0316,SUP,Custom 27203010,,VLOCL0316  -  DEVICE CLOSURE 0 GS-21 .5 CIR 12IN 37MM TAPER POINT,$7.89,$0.00,$7.89,$0.00,$5.63,$0.00,$0.00,$0.00,$0.00,$0.00,$7.89,$0.00,$3.95,$6.25,$6.31,$0.00,$0.00,$0.00,$0.00,$0.00
VLOCL0325,SUP,Custom 27203010,,VLOCL0325  -  DEVICE CLOSURE 2-0 GS-21 .5 CIR 18IN 37MM TAPER POINT,$72.53,$0.00,$72.53,$0.00,$51.76,$0.00,$0.00,$0.00,$0.00,$0.00,$72.53,$0.00,$36.26,$57.44,$58.02,$0.00,$0.00,$0.00,$0.00,$0.00
VLOCL0346,SUP,Custom 27203010,,VLOCL0346  -  DEVICE CLSR 0 GS-21 9IN GRN V-LOC 180 ABS TPR PNT,$910.63,$0.00,$910.63,$0.00,$649.91,$0.00,$0.00,$0.00,$0.00,$0.00,$910.63,$0.00,$455.31,$721.22,$728.50,$0.00,$0.00,$0.00,$0.00,$0.00
VLOCL0604,SUP,Custom 27203010,,VLOCL0604  -  DEVICE CLSR 3-0 V-20 6IN GRN V-LOC 180 SURGALLOY ABS TPR PNT,$62.63,$0.00,$62.63,$0.00,$44.70,$0.00,$0.00,$0.00,$0.00,$0.00,$62.63,$0.00,$31.31,$49.60,$50.10,$0.00,$0.00,$0.00,$0.00,$0.00
VLOCL0614,SUP,Custom 27203010,,VLOCL0614  -  DEVICE CLOSURE 3-0 V-20 .5 CIR 12IN 26MM TAPER POINT,$789.00,$0.00,$789.00,$0.00,$563.11,$0.00,$0.00,$0.00,$0.00,$0.00,$789.00,$0.00,$394.50,$624.89,$631.20,$0.00,$0.00,$0.00,$0.00,$0.00
VLOCL0615,SUP,Custom 27203010,,VLOCL0615  -  DEVICE CLSR 2-0 V-20 12IN GRN V-LOC 180 TPR PNT ABS 2 ANG,$65.75,$0.00,$65.75,$0.00,$46.93,$0.00,$0.00,$0.00,$0.00,$0.00,$65.75,$0.00,$32.88,$52.07,$52.60,$0.00,$0.00,$0.00,$0.00,$0.00
VLOCM0315,SUP,Custom 27203010,,VLOCM0315  -  DEVICE CLOSURE 2-0 GS-21 .5 CIR 12IN 37MM TAPER POINT,$7.89,$0.00,$7.89,$0.00,$5.63,$0.00,$0.00,$0.00,$0.00,$0.00,$7.89,$0.00,$3.95,$6.25,$6.31,$0.00,$0.00,$0.00,$0.00,$0.00
VLOCM0345,SUP,HCPCS C1760,,VLOCM0345  -  WOUND CLOSURE DEVICE ABSORB V LOC 90 2-0 GS-21,$73.68,$0.00,$73.68,$33.15,$52.58,$0.00,$12.69,$0.00,$0.00,$12.90,$73.68,$0.00,$36.84,$58.35,$58.94,$0.00,$11.53,$0.00,$11.73,$0.00
VLOCM0604,SUP,Custom 27203010,,VLOCM0604  -  DEVICE CLSR 3-0 V-20 6IN VIOL V-LOC 90 SURGALLOY ABS TPR PNT,$62.63,$0.00,$62.63,$0.00,$44.70,$0.00,$0.00,$0.00,$0.00,$0.00,$62.63,$0.00,$31.31,$49.60,$50.10,$0.00,$0.00,$0.00,$0.00,$0.00
VLOCM0804,SUP,Custom 27203010,,VLOCM0804  -  DEVICE CLSR 3-0 CV-23 6IN VIOL V-LOC 90 ABS,$753.48,$0.00,$753.48,$0.00,$537.76,$0.00,$0.00,$0.00,$0.00,$0.00,$753.48,$0.00,$376.74,$596.76,$602.78,$0.00,$0.00,$0.00,$0.00,$0.00
VLOCM1904,SUP,Custom 27203010,,VLOCM1904  -  DEVICE CLSR 3-0 CV-23 6IN UD 17MM V-LOC 90 SURGALLOY ABS,$62.63,$0.00,$62.63,$0.00,$44.70,$0.00,$0.00,$0.00,$0.00,$0.00,$62.63,$0.00,$31.31,$49.60,$50.10,$0.00,$0.00,$0.00,$0.00,$0.00
VLOCM1944,SUP,Custom 27203010,,VLOCM1944  -  DEVICE CLSR 3-0 CV-23 .5 CRC 9IN UD 17MM V-LOC 90 SURGALLOY,$62.63,$0.00,$62.63,$0.00,$44.70,$0.00,$0.00,$0.00,$0.00,$0.00,$62.63,$0.00,$31.31,$49.60,$50.10,$0.00,$0.00,$0.00,$0.00,$0.00
VLS03AF,SUP,Custom 27011340,,VLS03AF  -  LINER TRC AIRFLO SHRT HEAD SYNTH,$255.00,$0.00,$255.00,$0.00,$181.99,$0.00,$0.00,$0.00,$0.00,$0.00,$255.00,$0.00,$127.50,$201.96,$204.00,$0.00,$0.00,$0.00,$0.00,$0.00
VLS05AF,SUP,Custom 27011340,,VLS05AF  -  HALTER TRC BREMER AIRFLO TALL CERV LINR LTWT VAC FRM,$255.00,$0.00,$255.00,$0.00,$181.99,$0.00,$0.00,$0.00,$0.00,$0.00,$255.00,$0.00,$127.50,$201.96,$204.00,$0.00,$0.00,$0.00,$0.00,$0.00
VN1004040,SUP,HCPCS C1874,,VN1004040  -  STENT ENDOPRSTH 10MM 4CM 40CM EXPANDABLE PULL LINE SOLID,"$7,695.00",$0.00,"$7,695.00","$3,462.75","$5,158.80",$0.00,"$1,325.81",$0.00,$0.00,"$1,347.33","$7,695.00",$0.00,"$3,847.50","$6,094.44","$6,156.00",$0.00,"$1,204.27",$0.00,"$1,225.04",$0.00
VN1006040,SUP,HCPCS C1874,,VN1006040  -  STENT ENDOPRSTH 10MM 6CM 40CM EXPANDABLE PULL LINE SOLID,"$7,695.00",$0.00,"$7,695.00","$3,462.75","$5,158.80",$0.00,"$1,325.81",$0.00,$0.00,"$1,347.33","$7,695.00",$0.00,"$3,847.50","$6,094.44","$6,156.00",$0.00,"$1,204.27",$0.00,"$1,225.04",$0.00
VN1008040,SUP,HCPCS C1874,,VN1008040  -  STENT ENDOPRSTH 10MM 8CM 40CM EXPANDABLE PULL LINE HOLE,"$7,695.00",$0.00,"$7,695.00","$3,462.75","$5,158.80",$0.00,"$1,325.81",$0.00,$0.00,"$1,347.33","$7,695.00",$0.00,"$3,847.50","$6,094.44","$6,156.00",$0.00,"$1,204.27",$0.00,"$1,225.04",$0.00
VN1010040,SUP,HCPCS C1874,,VN1010040  -  STENT ENDOPRSTH 10MM 10CM 40CM EXPANDABLE PULL LINE HOLE,"$7,695.00",$0.00,"$7,695.00","$3,462.75","$5,158.80",$0.00,"$1,325.81",$0.00,$0.00,"$1,347.33","$7,695.00",$0.00,"$3,847.50","$6,094.44","$6,156.00",$0.00,"$1,204.27",$0.00,"$1,225.04",$0.00
VP40101-070,SUP,Custom 27011340,,VP40101-070  -  IMMOBILIZER ORTH UNV 24IN QCK WRP REINF POST STAY ELC HKLP,$39.70,$0.00,$39.70,$0.00,$28.33,$0.00,$0.00,$0.00,$0.00,$0.00,$39.70,$0.00,$19.85,$31.44,$31.76,$0.00,$0.00,$0.00,$0.00,$0.00
VP-C328,SUP,Custom 25003010,,ANTIBODY CD10 CLONE 56C6 MS IGG1 KAPPA ANHMN 1ML LAB,"$1,512.50",$0.00,"$1,512.50",$0.00,"$1,079.47",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,512.50",$0.00,$756.25,"$1,197.90","$1,210.00",$0.00,$0.00,$0.00,$0.00,$0.00
VPPL-5-7,SUP,HCPCS C1713,,VPPL-5-7  -  PLATE BN NS VOLR FA PLT 5 HL 7 PG WRST LT VOLR,"$1,950.00",$0.00,"$1,950.00",$877.50,"$1,391.72",$0.00,$335.98,$0.00,$0.00,$341.43,"$1,950.00",$0.00,$975.00,"$1,544.40","$1,560.00",$0.00,$305.18,$0.00,$310.44,$0.00
VR702,SUP,Custom 27203010,,VR702  -  REG PRFSN PMP KIT EXTN,"$1,500.00",$0.00,"$1,500.00",$0.00,"$1,070.55",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,500.00",$0.00,$750.00,"$1,188.00","$1,200.00",$0.00,$0.00,$0.00,$0.00,$0.00
VS0602,SUP,Custom 27203010,,"VIVASPIN 6 @ 10,000 MWCO",$877.50,$0.00,$877.50,$0.00,$626.27,$0.00,$0.00,$0.00,$0.00,$0.00,$877.50,$0.00,$438.75,$694.98,$702.00,$0.00,$0.00,$0.00,$0.00,$0.00
VS101000,SUP,Custom 27203010,,VS101000  -  SLEEVE LAPSCOP 12MM 100MM RADIAL EXPAND BLADELESS TROCAR,$113.98,$0.00,$113.98,$0.00,$81.35,$0.00,$0.00,$0.00,$0.00,$0.00,$113.98,$0.00,$56.99,$90.27,$91.19,$0.00,$0.00,$0.00,$0.00,$0.00
VS101005,SUP,Custom 27203010,,VS101005  -  CANNULA ESCP 5MM BLU STRL LF VRSTP BLDLS TROC DIL RADL XPD,$106.55,$0.00,$106.55,$0.00,$76.04,$0.00,$0.00,$0.00,$0.00,$0.00,$106.55,$0.00,$53.28,$84.39,$85.24,$0.00,$0.00,$0.00,$0.00,$0.00
VS150000,SUP,Custom 27203010,,VS150000  -  NEEDLE INSFL LNG 14GA 150MM VRSTP BLDLS TROC EXPANDABLE SLV,$39.95,$0.00,$39.95,$0.00,$28.51,$0.00,$0.00,$0.00,$0.00,$0.00,$39.95,$0.00,$19.98,$31.64,$31.96,$0.00,$0.00,$0.00,$0.00,$0.00
VTP2201,SUP,HCPCS C9356,,VTP2201  -  PROTECTOR TENDON VERAWRAP HYALURONIC ACID ALGINATE 2X2 TENDO,"$4,900.00",$0.00,"$4,900.00","$2,205.00","$3,497.13",$0.00,$844.25,$0.00,$0.00,$857.95,"$4,900.00",$0.00,"$2,450.00","$3,880.80","$3,920.00",$0.00,$766.85,$0.00,$780.08,$0.00
VU-CTE-520,SUP,HCPCS C1789,,VU-CTE-520  -  XPD TISS 520-780ML TXTR CNTER PRFL DERMASPAN P4.5-7CM,"$1,987.50",$0.00,"$1,987.50",$894.38,"$1,418.48",$0.00,$342.44,$0.00,$0.00,$348.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$311.04,$0.00,$316.41,$0.00
VU-CTE-720,SUP,Custom 27803010,,VU-CTE-720  -  EXPANDER TISS P4.7-7.5CM CURVILINEAR 26.2X9CM 720-1080CC,"$1,987.50",$0.00,"$1,987.50",$0.00,"$1,418.48",$0.00,$0.00,$0.00,$0.00,$0.00,"$1,987.50",$0.00,$993.75,"$1,574.10","$1,590.00",$0.00,$0.00,$0.00,$0.00,$0.00
VXH13300,SUP,HCPCS C1874,,VXH13300  -  STENT CORON 3MM 13MM 137CM .014IN RAPEX RPTRL DLV SYS BX VLC,$2.50,$0.00,$2.50,$1.13,$1.78,$0.00,$0.43,$0.00,$0.00,$0.44,$2.50,$0.00,$1.25,$1.98,$2.00,$0.00,$0.39,$0.00,$0.40,$0.00
W0400D,SUP,Custom 27203010,,BRACE WLK S/MED LOW PROFILE ANKL LEG HTOP RCKR SOLE HK/LOP,$163.13,$0.00,$163.13,$0.00,$116.42,$0.00,$0.00,$0.00,$0.00,$0.00,$163.13,$0.00,$81.56,$129.20,$130.50,$0.00,$0.00,$0.00,$0.00,$0.00
W4200,SUP,HCPCS C1760,,W4200  -  CLIP LG INTNL HRZN TI ENDSCP LIGAT STRL DISP LATEX FREE ORNG,$15.59,$0.00,$15.59,$7.02,$11.13,$0.00,$2.69,$0.00,$0.00,$2.73,$15.59,$0.00,$7.80,$12.35,$12.47,$0.00,$2.44,$0.00,$2.48,$0.00
WA22706S,SUP,Custom 27203010,,WA22706S  -  ELECTRODE ELECTROSURGICAL OLYMPUS PLASMA LOOP 30 D MEDIUM DI,"$1,071.85",$0.00,"$1,071.85",$0.00,$764.98,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,071.85",$0.00,$535.92,$848.91,$857.48,$0.00,$0.00,$0.00,$0.00,$0.00
WA22760S,SUP,Custom 27203010,,WA22760S  -  ELECTRODE ELECTROSURGICAL OLYMPUS PLASMA BUTTON MEDIUM DISPO,"$1,120.13",$0.00,"$1,120.13",$0.00,$799.43,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,120.13",$0.00,$560.06,$887.14,$896.10,$0.00,$0.00,$0.00,$0.00,$0.00
WA425600,SUP,Custom 27203010,,KIT IMMUN TST CNTRL CLBRT ELISA VZV IGG 2 96 TST,$779.73,$0.00,$779.73,$0.00,$556.49,$0.00,$0.00,$0.00,$0.00,$0.00,$779.73,$0.00,$389.86,$617.55,$623.78,$0.00,$0.00,$0.00,$0.00,$0.00
WBTN-2750-T,SUP,HCPCS C1713,,WBTN-2750-T  -  WASHER ORTH 5MM 27MM NS GEMINUS TI DIST VOLR RDS FOSSA,$100.00,$0.00,$100.00,$45.00,$71.37,$0.00,$17.23,$0.00,$0.00,$17.51,$100.00,$0.00,$50.00,$79.20,$80.00,$0.00,$15.65,$0.00,$15.92,$0.00
WHV-4,SUP,HCPCS C1713,,WHV-4  -  VOLAR HOOK PLATE,"$1,812.50",$0.00,"$1,812.50",$815.63,"$1,293.58",$0.00,$312.28,$0.00,$0.00,$317.35,"$1,812.50",$0.00,$906.25,"$1,435.50","$1,450.00",$0.00,$283.66,$0.00,$288.55,$0.00
WHV-6,SUP,HCPCS C1713,,WHV-6  -  VOLAR HOOK PLATE,"$2,075.00",$0.00,"$2,075.00",$933.75,"$1,480.93",$0.00,$357.51,$0.00,$0.00,$363.32,"$2,075.00",$0.00,"$1,037.50","$1,643.40","$1,660.00",$0.00,$324.74,$0.00,$330.34,$0.00
WIRE-0.7/080,SUP,HCPCS C1713,,WIRE-0.7/080  -  WIRE FX .7MM 80MM KRSH SS,$50.00,$0.00,$50.00,$22.50,$35.69,$0.00,$8.61,$0.00,$0.00,$8.75,$50.00,$0.00,$25.00,$39.60,$40.00,$0.00,$7.83,$0.00,$7.96,$0.00
WIRE-0.8/120,SUP,HCPCS C1713,,WIRE-0.8/120  -  WIRE FX .8MM 120MM KRSH SS,$50.00,$0.00,$50.00,$22.50,$35.69,$0.00,$8.61,$0.00,$0.00,$8.75,$50.00,$0.00,$25.00,$39.60,$40.00,$0.00,$7.83,$0.00,$7.96,$0.00
WIRE-0.9,SUP,HCPCS C1713,,WIRE-0.9  -  WIRE FIX .9MM KWIRE STAINLESS STEEL,$37.50,$0.00,$37.50,$16.88,$26.76,$0.00,$6.46,$0.00,$0.00,$6.57,$37.50,$0.00,$18.75,$29.70,$30.00,$0.00,$5.87,$0.00,$5.97,$0.00
WIRE-0.9/100,SUP,HCPCS C1713,,WIRE-0.9/100  -  WIRE FX .9MM 100MM NS KRSH,$50.00,$0.00,$50.00,$22.50,$35.69,$0.00,$8.61,$0.00,$0.00,$8.75,$50.00,$0.00,$25.00,$39.60,$40.00,$0.00,$7.83,$0.00,$7.96,$0.00
WIRE-1.1,SUP,HCPCS C1713,,WIRE-1.1  -  WIRE FX 1.1MM NS KRSH,$40.00,$0.00,$40.00,$18.00,$28.55,$0.00,$6.89,$0.00,$0.00,$7.00,$40.00,$0.00,$20.00,$31.68,$32.00,$0.00,$6.26,$0.00,$6.37,$0.00
WIRE-1.6/100,SUP,HCPCS C1713,,WIRE-1.6/100  -  WIRE FX 1.6MM 100MM NS KRSH,$50.00,$0.00,$50.00,$22.50,$35.69,$0.00,$8.61,$0.00,$0.00,$8.75,$50.00,$0.00,$25.00,$39.60,$40.00,$0.00,$7.83,$0.00,$7.96,$0.00
WN-1104ST,SUP,HCPCS C1769,,WN-1104ST  -  GUIDEWIRE ORTH .045IN 4IN SS,$90.00,$0.00,$90.00,$48.87,$64.23,$0.00,$15.51,$0.00,$0.00,$15.76,$90.00,$0.00,$45.00,$71.28,$72.00,$0.00,$14.09,$0.00,$14.33,$0.00
WN-2020,SUP,HCPCS C1769,,WN-2020  -  GWIRE ORTH 20IN 2MM SGL TROCAR TIP,$187.50,$0.00,$187.50,$101.81,$133.82,$0.00,$32.31,$0.00,$0.00,$32.83,$187.50,$0.00,$93.75,$148.50,$150.00,$0.00,$29.34,$0.00,$29.85,$0.00
WN-2020ST,SUP,HCPCS C1769,,WN-2020ST  -  GUIDEWIRE ORTH 2MM 20IN TROC TIP NTNL,$230.00,$0.00,$230.00,$124.89,$164.15,$0.00,$39.63,$0.00,$0.00,$40.27,$230.00,$0.00,$115.00,$182.16,$184.00,$0.00,$36.00,$0.00,$36.62,$0.00
WS0450090,SUP,HCPCS C1876,,WS0450090  -  STENT INTRCRAN 4.5MM 9MM WINGSPAN,"$15,980.00",$0.00,"$15,980.00","$7,191.00","$5,158.80",$0.00,"$2,753.27",$0.00,$0.00,"$2,797.97","$15,980.00",$0.00,"$7,990.00","$12,656.16","$12,784.00",$0.00,"$2,500.87",$0.00,"$2,544.02",$0.00
WS1406ST,SUP,HCPCS C1769,,WS1406ST  -  GUIDEWIRE ORTH 6IN .054IN ACTRK SS 1 TROC TIP,$25.00,$0.00,$25.00,$13.58,$17.84,$0.00,$4.31,$0.00,$0.00,$4.38,$25.00,$0.00,$12.50,$19.80,$20.00,$0.00,$3.91,$0.00,$3.98,$0.00
WS-1504STT,SUP,HCPCS C1769,,WS-1504STT  -  GWIRE ORTH 4IN .054IN SS THRD,$122.50,$0.00,$122.50,$66.52,$87.43,$0.00,$21.11,$0.00,$0.00,$21.45,$122.50,$0.00,$61.25,$97.02,$98.00,$0.00,$19.17,$0.00,$19.50,$0.00
WS1505-DT,SUP,HCPCS C1769,,WS1505-DT  -  WIRE FIX .062IN KWIRE FSN,$17.50,$0.00,$17.50,$9.50,$12.49,$0.00,$3.02,$0.00,$0.00,$3.06,$17.50,$0.00,$8.75,$13.86,$14.00,$0.00,$2.74,$0.00,$2.79,$0.00
WS-1606,SUP,HCPCS C1771,,WS-1606  -  GWIRE ORTH 6IN .062IN SS,$17.50,$0.00,$17.50,$7.88,$12.49,$0.00,$3.02,$0.00,$0.00,$3.06,$17.50,$0.00,$8.75,$13.86,$14.00,$0.00,$2.74,$0.00,$2.79,$0.00
WS2009ST,SUP,HCPCS C1769,,WS2009ST  -  GUIDEWIRE ORTH 9IN 2IN SHLDR ELB SS,$25.00,$0.00,$25.00,$13.58,$17.84,$0.00,$4.31,$0.00,$0.00,$4.38,$25.00,$0.00,$12.50,$19.80,$20.00,$0.00,$3.91,$0.00,$3.98,$0.00
WS-2020,SUP,HCPCS C1769,,WS-2020  -  GWIRE ORTH 20IN .078IN PLRS HUM SHLDR SS,$147.50,$0.00,$147.50,$80.09,$105.27,$0.00,$25.41,$0.00,$0.00,$25.83,$147.50,$0.00,$73.75,$116.82,$118.00,$0.00,$23.08,$0.00,$23.48,$0.00
WS-2409STT,SUP,HCPCS C1769,,WS-2409STT  -  GWIRE ORTH 9IN .094IN 1 TROCAR THRD,$90.00,$0.00,$90.00,$48.87,$64.23,$0.00,$15.51,$0.00,$0.00,$15.76,$90.00,$0.00,$45.00,$71.28,$72.00,$0.00,$14.09,$0.00,$14.33,$0.00
WT-0906STT,SUP,HCPCS C1769,,WT-0906STT  -  GWIRE ORTH 6IN .035IN TI THRD,$90.00,$0.00,$90.00,$48.87,$64.23,$0.00,$15.51,$0.00,$0.00,$15.76,$90.00,$0.00,$45.00,$71.28,$72.00,$0.00,$14.09,$0.00,$14.33,$0.00
WT-1606STT,SUP,HCPCS C1769,,WT-1606STT  -  GWIRE ORTH 5.75IN .062IN ACTRK TI 1 TROCAR TIP THRD,$90.00,$0.00,$90.00,$48.87,$64.23,$0.00,$15.51,$0.00,$0.00,$15.76,$90.00,$0.00,$45.00,$71.28,$72.00,$0.00,$14.09,$0.00,$14.33,$0.00
X0411407,SUP,HCPCS C1713,,X0411407  -  CONNECTOR ROD 10MM CD HORIZON CROSSLINK GDLH LIBERTY SEXTANT,"$4,822.50",$0.00,"$4,822.50","$2,170.13","$3,441.82",$0.00,$830.89,$0.00,$0.00,$844.38,"$4,822.50",$0.00,"$2,411.25","$3,819.42","$3,858.00",$0.00,$754.72,$0.00,$767.74,$0.00
X0590,SUP,Custom 27203010,,BLOTTER EPHRS BIOTN 15ML,$386.53,$0.00,$386.53,$0.00,$275.86,$0.00,$0.00,$0.00,$0.00,$0.00,$386.53,$0.00,$193.26,$306.13,$309.22,$0.00,$0.00,$0.00,$0.00,$0.00
X42200,SUP,HCPCS C1713,,X42200  -  SUB BNGFT 10X2.5CM GRFTN DBM PLIF,"$4,926.25",$0.00,"$4,926.25","$2,216.81","$3,515.86",$0.00,$848.77,$0.00,$0.00,$862.55,"$4,926.25",$0.00,"$2,463.13","$3,901.59","$3,941.00",$0.00,$770.96,$0.00,$784.26,$0.00
X42210,SUP,HCPCS C1713,,X42210  -  SUB BNGFT 5X2.5CM GRFTN DBM PLIF,"$1,701.38",$0.00,"$1,701.38",$765.62,"$1,214.27",$0.00,$293.14,$0.00,$0.00,$297.90,"$1,701.38",$0.00,$850.69,"$1,347.49","$1,361.10",$0.00,$266.27,$0.00,$270.86,$0.00
X44135,SUP,HCPCS C1713,,X44135  -  SUB BNGFT GRFTN LG DFCT DBM OTHBLND JAR 15ML,"$3,432.00",$0.00,"$3,432.00","$1,544.40","$2,449.42",$0.00,$591.32,$0.00,$0.00,$600.92,"$3,432.00",$0.00,"$1,716.00","$2,718.14","$2,745.60",$0.00,$537.11,$0.00,$546.37,$0.00
X44145,SUP,HCPCS C1713,,X44145  -  SUB BNGFT GRFTN SM DFCT DBM OTHBLND JAR 5ML,"$2,340.00",$0.00,"$2,340.00","$1,053.00","$1,670.06",$0.00,$403.17,$0.00,$0.00,$409.72,"$2,340.00",$0.00,"$1,170.00","$1,853.28","$1,872.00",$0.00,$366.21,$0.00,$372.53,$0.00
X523H,SUP,Custom 27203010,,X523H  -  SUTURE NABSB 2-0 SH 36IN GRN EBND 2 ARM BRD,$393.03,$0.00,$393.03,$0.00,$280.51,$0.00,$0.00,$0.00,$0.00,$0.00,$393.03,$0.00,$196.52,$311.28,$314.43,$0.00,$0.00,$0.00,$0.00,$0.00
X559H,SUP,Custom 27203010,,X559H  -  SUTURE NONABSORBABLE 2-0 SH-2 36IN 2 ARM BRAID ETHIBOND,$422.34,$0.00,$422.34,$0.00,$301.43,$0.00,$0.00,$0.00,$0.00,$0.00,$422.34,$0.00,$211.17,$334.49,$337.87,$0.00,$0.00,$0.00,$0.00,$0.00
X833H,SUP,Custom 27203010,,X833H  -  SUTURE NABSB 2-0 SH 30IN GRN EBND BRD,$191.33,$0.00,$191.33,$0.00,$136.55,$0.00,$0.00,$0.00,$0.00,$0.00,$191.33,$0.00,$95.66,$151.53,$153.06,$0.00,$0.00,$0.00,$0.00,$0.00
XA3816KT,SUP,HCPCS C1751,,XA3816KT  -  KIT CATHETER 8.5FR 16CM 3 LUMEN EXPAND CHLORAPREP SAFETY,$825.00,$0.00,$825.00,$371.25,$588.80,$0.00,$142.14,$0.00,$0.00,$144.45,$825.00,$0.00,$412.50,$653.40,$660.00,$0.00,$129.11,$0.00,$131.34,$0.00
XA3820KT,SUP,HCPCS C1751,,XA3820KT  -  CATHETER CV 20CM PEDIASAT 3 LUM OXM CNT SCVO2 MNTR PED,"$1,125.00",$0.00,"$1,125.00",$506.25,$802.91,$0.00,$193.83,$0.00,$0.00,$196.98,"$1,125.00",$0.00,$562.50,$891.00,$900.00,$0.00,$176.06,$0.00,$179.10,$0.00
XBR001002,SUP,HCPCS C1713,,XBR001002  -  WIRE FX OLV 1.2MM 65MM KRSH SMTH TROC TIP,$350.05,$0.00,$350.05,$157.52,$249.83,$0.00,$60.31,$0.00,$0.00,$61.29,$350.05,$0.00,$175.03,$277.24,$280.04,$0.00,$54.78,$0.00,$55.73,$0.00
XC200,SUP,Custom 27803010,,XC200  -  CLIP SUT STRL LF LPR TY VCL 1 PC ABS POLY,$618.06,$0.00,$489.50,$0.00,$251.22,$0.00,$0.00,$0.00,$0.00,$0.00,$352.00,$0.00,$176.00,$489.50,$281.60,$0.00,$0.00,$0.00,$0.00,$0.00
XF0012002,SUP,Custom 27203010,,XF0012002  -  BIT DRL 2MM AO,$490.85,$0.00,$490.85,$0.00,$350.32,$0.00,$0.00,$0.00,$0.00,$0.00,$490.85,$0.00,$245.43,$388.75,$392.68,$0.00,$0.00,$0.00,$0.00,$0.00
XFO082001,SUP,Custom 27203010,,XFO082001  -  BIT DRL 2MM 3MM SCR,$490.85,$0.00,$490.85,$0.00,$350.32,$0.00,$0.00,$0.00,$0.00,$0.00,$490.85,$0.00,$245.43,$388.75,$392.68,$0.00,$0.00,$0.00,$0.00,$0.00
XFO082501,SUP,Custom 27203010,,XFO082501  -  BIT DRL 2.5MM 3.5MM SCR,$490.85,$0.00,$490.85,$0.00,$350.32,$0.00,$0.00,$0.00,$0.00,$0.00,$490.85,$0.00,$245.43,$388.75,$392.68,$0.00,$0.00,$0.00,$0.00,$0.00
XHAT45,SUP,Custom 27203010,,KIT IMMUN TST ELISA ANTI-PF4 45 TST,"$1,181.73",$0.00,"$1,181.73",$0.00,$843.40,$0.00,$0.00,$0.00,$0.00,$0.00,"$1,181.73",$0.00,$590.86,$935.93,$945.38,$0.00,$0.00,$0.00,$0.00,$0.00
XL-105914,SUP,HCPCS C1776,,XL-105914  -  LINER ACETAB 24 36MM HIGH WALL RINGLOC ARCOMXL HIP,"$6,575.00",$0.00,"$6,575.00","$2,958.75","$4,692.58",$0.00,"$1,132.84",$0.00,$0.00,"$1,151.23","$6,575.00",$0.00,"$3,287.50","$5,207.40","$5,260.00",$0.00,"$1,028.99",$0.00,"$1,046.74",$0.00
XM106.0204S,SUP,HCPCS C1763,,XM106.0204S  -  GRAFT SFT TIS 4X2CM XCM BIOLOGIC THK PIG DERM NONCROSS LNK,$485.00,$0.00,$485.00,$218.25,$346.14,$0.00,$83.56,$0.00,$0.00,$84.92,$485.00,$0.00,$242.50,$384.12,$388.00,$0.00,$75.90,$0.00,$77.21,$0.00
XM106.0407S,SUP,HCPCS C1763,,XM106.0407S  -  GRAFT SFT TIS 7X4CM XCM BIOLOGIC THK PIG DERM NONCROSS LNK,"$1,732.50",$0.00,"$1,732.50",$779.63,"$1,236.49",$0.00,$298.50,$0.00,$0.00,$303.35,"$1,732.50",$0.00,$866.25,"$1,372.14","$1,386.00",$0.00,$271.14,$0.00,$275.81,$0.00
XM106.0416S,SUP,HCPCS C1763,,XM106.0416S  -  GRAFT SFT TIS 16X4CM XCM BIOLOGIC THK PIG DERM NONCROSS LNK,"$4,790.00",$0.00,"$4,790.00","$2,155.50","$3,418.62",$0.00,$825.29,$0.00,$0.00,$838.69,"$4,790.00",$0.00,"$2,395.00","$3,793.68","$3,832.00",$0.00,$749.64,$0.00,$762.57,$0.00
XM106.0516S,SUP,HCPCS C1763,,XM106.0516S  -  GRAFT SFT TIS 16X5CM XCM BIOLOGIC THK PIG DERM NONCROSS LNK,"$5,985.00",$0.00,"$5,985.00","$2,693.25","$4,271.49",$0.00,"$1,031.19",$0.00,$0.00,"$1,047.93","$5,985.00",$0.00,"$2,992.50","$4,740.12","$4,788.00",$0.00,$936.65,$0.00,$952.81,$0.00
XM106.0612S,SUP,HCPCS C1763,,XM106.0612S  -  GRAFT SFT TIS 12X6CM XCM BIOLOGIC THK PIG DERM NONCROSS LNK,"$4,455.30",$0.00,"$4,455.30","$2,004.89","$3,179.75",$0.00,$767.63,$0.00,$0.00,$780.09,"$4,455.30",$0.00,"$2,227.65","$3,528.60","$3,564.24",$0.00,$697.25,$0.00,$709.28,$0.00
XM106.0616S,SUP,HCPCS C1763,,XM106.0616S  -  GRAFT SFT TIS 16X6CM XCM BIOLOGIC THK PIG DERM NONCROSS LNK,"$5,939.73",$0.00,"$5,939.73","$2,672.88","$4,239.18",$0.00,"$1,023.38",$0.00,$0.00,"$1,040.00","$5,939.73",$0.00,"$2,969.86","$4,704.27","$4,751.78",$0.00,$929.57,$0.00,$945.60,$0.00
XM106.0620S,SUP,HCPCS C1763,,XM106.0620S  -  GRAFT SFT TIS 20X6CM XCM BIOLOGIC THK PIG DERM NONCROSS LNK,"$8,977.50",$0.00,"$8,977.50","$4,039.88","$5,158.80",$0.00,"$1,546.78",$0.00,$0.00,"$1,571.89","$8,977.50",$0.00,"$4,488.75","$7,110.18","$7,182.00",$0.00,"$1,404.98",$0.00,"$1,429.22",$0.00
XM106.0812S,SUP,HCPCS C1763,,XM106.0812S  -  GRAFT SFT TIS 12X8CM XCM BIOLOGIC THK PIG DERM NONCROSS LNK,"$5,939.73",$0.00,"$5,939.73","$2,672.88","$4,239.18",$0.00,"$1,023.38",$0.00,$0.00,"$1,040.00","$5,939.73",$0.00,"$2,969.86","$4,704.27","$4,751.78",$0.00,$929.57,$0.00,$945.60,$0.00
XM106.0816S,SUP,HCPCS C1763,,XM106.0816S  -  GRAFT SFT TIS 16X8CM XCM BIOLOGIC THK PIG DERM NONCROSS LNK,"$7,920.30",$0.00,"$7,920.30","$3,564.14","$5,158.80",$0.00,"$1,364.63",$0.00,$0.00,"$1,386.78","$7,920.30",$0.00,"$3,960.15","$6,272.88","$6,336.24",$0.00,"$1,239.53",$0.00,"$1,260.91",$0.00
XM106.0820S,SUP,HCPCS C1763,,XM106.0820S  -  GRAFT SFT TIS 20X8CM XCM BIOLOGIC THK PIG DERM NONCROSS LNK,"$9,898.88",$0.00,"$9,898.88","$4,454.49","$5,158.80",$0.00,"$1,705.53",$0.00,$0.00,"$1,733.21","$9,898.88",$0.00,"$4,949.44","$7,839.91","$7,919.10",$0.00,"$1,549.17",$0.00,"$1,575.90",$0.00
XM106.1016S,SUP,HCPCS C1763,,XM106.1016S  -  GRAFT SFT TIS 16X10CM XCM BIOLOGIC THK PIG DERM XCLR MTRX,"$9,898.88",$0.00,"$9,898.88","$4,454.49","$5,158.80",$0.00,"$1,705.53",$0.00,$0.00,"$1,733.21","$9,898.88",$0.00,"$4,949.44","$7,839.91","$7,919.10",$0.00,"$1,549.17",$0.00,"$1,575.90",$0.00
XM106.1020S,SUP,HCPCS C1762,,XM106.1020S  -  DD-XCM BIOLOGIC TISSUE MATRIX 10CM X 20CM/THICK-STERILE,"$12,373.60",$0.00,"$12,373.60",$0.00,"$5,158.80",$0.00,"$2,131.91",$0.00,$0.00,$0.00,"$12,373.60",$0.00,"$6,186.80","$9,799.89","$9,898.88",$0.00,"$1,936.47",$0.00,$0.00,$0.00
XM106.1220S,SUP,HCPCS C1763,,XM106.1220S  -  GRAFT SFT TIS 20X12CM XCM BIOLOGIC THK PIG DERM NONCROSS LNK,"$14,848.33",$0.00,"$14,848.33","$6,681.75","$5,158.80",$0.00,"$2,558.29",$0.00,$0.00,"$2,599.82","$14,848.33",$0.00,"$7,424.16","$11,759.88","$11,878.66",$0.00,"$2,323.76",$0.00,"$2,363.85",$0.00
XM106.1620S,SUP,HCPCS C1762,,XM106.1620S  -  DD-XCM BIOLOGIC TISSUE MATRIX 16CM X 20CM/THICK-STERILE,"$19,795.80",$0.00,"$19,795.80",$0.00,"$5,158.80",$0.00,"$3,410.72",$0.00,$0.00,$0.00,"$19,795.80",$0.00,"$9,897.90","$15,678.27","$15,836.64",$0.00,"$3,098.04",$0.00,$0.00,$0.00
XM106.1625S,SUP,HCPCS C1763,,XM106.1625S  -  GRAFT SFT TIS 25X16CM XCM BIOLOGIC THK PIG DERM HDRT XCLR,"$23,201.73",$0.00,"$23,201.73","$10,440.78","$5,158.80",$0.00,"$3,997.54",$0.00,$0.00,"$4,062.44","$23,201.73",$0.00,"$11,600.86","$18,375.77","$18,561.38",$0.00,"$3,631.07",$0.00,"$3,693.71",$0.00
XM106.2020S,SUP,HCPCS C1763,,XM106.2020S  -  GRAFT SFT TIS 20X20CM XCM BIOLOGIC THK PIG DERM XCLR MTRX,"$24,745.23",$0.00,"$24,745.23","$11,135.35","$5,158.80",$0.00,"$4,263.48",$0.00,$0.00,"$4,332.69","$24,745.23",$0.00,"$12,372.61","$19,598.22","$19,796.18",$0.00,"$3,872.63",$0.00,"$3,939.44",$0.00
XM106.2025S,SUP,HCPCS C1763,,XM106.2025S  -  GRAFT SFT TIS 25X20CM XCM BIOLOGIC THK PIG DERM MTRX STRL,"$30,933.00",$0.00,"$30,933.00","$13,919.85","$5,158.80",$0.00,"$5,329.60",$0.00,$0.00,"$5,416.12","$30,933.00",$0.00,"$15,466.50","$24,498.94","$24,746.40",$0.00,"$4,841.01",$0.00,"$4,924.53",$0.00
XM106.2030S,SUP,HCPCS C1763,,XM106.2030S  -  GRAFT SFT TIS 30X20CM XCM BIOLOGIC THK PIG DERM HDRT XCLR,"$37,116.85",$0.00,"$37,116.85","$16,702.58","$5,158.80",$0.00,"$6,395.05",$0.00,$0.00,"$6,498.86","$37,116.85",$0.00,"$18,558.43","$29,396.55","$29,693.48",$0.00,"$5,808.79",$0.00,"$5,909.00",$0.00
XP-5000,SUP,Custom 27203010,,XP-5000  -  STABILIZER SRG YLW ACRB-I VAC PSTNR,"$2,467.50",$0.00,"$2,467.50",$0.00,"$1,761.05",$0.00,$0.00,$0.00,$0.00,$0.00,"$2,467.50",$0.00,"$1,233.75","$1,954.26","$1,974.00",$0.00,$0.00,$0.00,$0.00,$0.00
XT-7542,SUP,HCPCS C1725,,XT-7542  -  CATHETER BLNDIL .035IN 5FR 4MM 75CM 2CM OPTPLST XT 2 LUM,$497.50,$0.00,$497.50,$270.14,$355.07,$0.00,$85.72,$0.00,$0.00,$87.11,$497.50,$0.00,$248.75,$394.02,$398.00,$0.00,$77.86,$0.00,$79.20,$0.00
Y3462,SUP,Custom 27203010,,MEDIA CULT YST BROTH SENSITITRE,$65.20,$0.00,$65.20,$0.00,$46.53,$0.00,$0.00,$0.00,$0.00,$0.00,$65.20,$0.00,$32.60,$51.64,$52.16,$0.00,$0.00,$0.00,$0.00,$0.00
YO-9,SUP,Custom 27203010,,KIT MYCTST YEASTONE ANIDULAFUNGIN MICAFUNGIN PLT,$791.78,$0.00,$791.78,$0.00,$565.09,$0.00,$0.00,$0.00,$0.00,$0.00,$791.78,$0.00,$395.89,$627.09,$633.42,$0.00,$0.00,$0.00,$0.00,$0.00
Z117H,SUP,Custom 27203010,,Z117H  -  SUTURE ABSORBABLE 6-0 BV-1 30IN 2 ARM MONOFILAMENT PDS II,$39.65,$0.00,$39.65,$0.00,$28.30,$0.00,$0.00,$0.00,$0.00,$0.00,$39.65,$0.00,$19.83,$31.40,$31.72,$0.00,$0.00,$0.00,$0.00,$0.00
Z126H,SUP,Custom 27203010,,Z126H  -  SUTURE ABSORBABLE 5-0 C-1 30IN 2 ARM MONOFILAMENT PDS II,$47.01,$0.00,$47.01,$0.00,$33.55,$0.00,$0.00,$0.00,$0.00,$0.00,$47.01,$0.00,$23.51,$37.23,$37.61,$0.00,$0.00,$0.00,$0.00,$0.00
Z135H,SUP,Custom 27203010,,Z135H  -  SUTURE ABSORBABLE 7-0 BV-1 30IN 2 ARM MONOFILAMENT PDS II,$40.04,$0.00,$40.04,$0.00,$28.58,$0.00,$0.00,$0.00,$0.00,$0.00,$40.04,$0.00,$20.02,$31.71,$32.03,$0.00,$0.00,$0.00,$0.00,$0.00
Z137H,SUP,Custom 27203010,,Z137H  -  SUTURE ABSORBABLE 4-0 V-5 36IN 2 ARM MONOFILAMENT PDS II,$25.17,$0.00,$25.17,$0.00,$17.96,$0.00,$0.00,$0.00,$0.00,$0.00,$25.17,$0.00,$12.58,$19.93,$20.14,$0.00,$0.00,$0.00,$0.00,$0.00
Z60353,SUP,HCPCS L8614,,Z60353  -  IMPLANT COCHLEAR FREEDOM CNTOUR ADVANCE NUCLEUS CI24RE,"$39,847.50",$0.00,"$39,847.50",$0.00,"$5,158.80",$0.00,$0.00,$0.00,$0.00,$0.00,"$39,847.50",$0.00,"$19,923.75","$31,559.22","$31,878.00",$0.00,$0.00,$0.00,$0.00,$0.00
ZBM12060,SUP,HCPCS C2625,,ZBM12060  -  STENT BIL 12MM 6FR 60MM 80CM .035IN SLF XPD DLV SYS LMNX,"$3,883.20",$0.00,"$3,883.20","$1,747.44","$2,771.44",$0.00,$669.06,$0.00,$0.00,$679.92,"$3,883.20",$0.00,"$1,941.60","$3,075.49","$3,106.56",$0.00,$607.72,$0.00,$618.21,$0.00
ZTEG-2P-28-120-PF-US,SUP,HCPCS C1874,,ZTEG-2P-28-120-PF-US  -  GRAFT EVAS 120MM 28MM 22FR ZNTH TX2 THOR AORTIC ANRSM PROX,"$30,235.00",$0.00,"$30,235.00","$13,605.75","$5,158.80",$0.00,"$5,209.34",$0.00,$0.00,"$5,293.91","$30,235.00",$0.00,"$15,117.50","$23,946.12","$24,188.00",$0.00,"$4,731.78",$0.00,"$4,813.41",$0.00